The source of the epidemic was artisanal gold mining that became prolific in 2009-10. For several months, ore processing was conducted at numerous sites within the villages. Because local religious and cultural practices include the sequestration of married women, ore crushing, washing, and gold recovery were undertaken within the residential compounds to utilize the women’s labor. At some point during the rapid increase in mining activities, a dangerous ore exceeding 10% lead was introduced, severely exposing young children, pregnant women, and nursing mothers. By April 2010, with death and illness prevalent, the local Emirates ordered a temporary suspension of artisanal ore processing and later required that all operations be moved approximately one-half kilometer from the villages involved in mining. However, extremely hazardous exposures associated with residual waste and contaminated soils remained in the residential compounds and exterior processing areas.
Due to the continuing mortality, MSF/TG focused on emergency medical treatment and environmental response. MSF, ZMOH, and FMOH developed village chelation therapy clinics. However, all entities agreed that returning treated children to contaminated homes would compromise the treatment. Coupled with local resistance to relocation, this required the villages to be remediated prior to commencing chelation. Remediation continued over three and one-half years in three phases, encompassing 8 villages and 17,000 residents. More than 2,300 children under five years of age received chelation therapy.