Monday, 10 August 2015

Zamfara State, Nigeria

In March 2010, the international humanitarian organization Médecins Sans Frontières (Doctors Without Borders, MSF) discovered an unprecedented epidemic of lead poisoning in a number of remote villages in Zamfara State, Nigeria. Subsequent investigations showed more than 17,000 people were severely poisoned and an estimated 400-500 children died as a result of lead absorption associated with artisanal gold mining/processing in residential compounds.  Several international organizations collaborated with Nigerian health authorities and local civil and traditional governments to provide emergency medical, environmental, technical, and public health response. Remediation activities, conducted in three phases from May 2010 to July 2013, were modeled on Idaho/U.S. Environmental Protection Agency (USEPA) “Superfund” protocols. Post-cleanup activities included extended medical treatment in MSF-run village clinics, monitoring the sustainability of the remediation, and implementation of safer mining practices. 

Remediating the villages presented numerous resource, logistic, cultural, institutional, and technical challenges. The remote area is difficult to access and has little infrastructure. Village life is ruled by overlapping civil, tribal, and Sharia governments, exhibits gender-segregated social structure, suffers numerous endemic diseases with limited healthcare, and a workforce dependent on primitive tools and labor practices. The cleanup evolved from an emergency response initially developed and directed largely by international personnel from TerraGraphics (TG) to a multi-disciplinary program carried out by Nigerian federal, state, and local governments employing village workers. The epidemic has been characterized as unprecedented, and the ensuing cleanup one of the largest and most comprehensive ever undertaken by an African government. 

When villagers first brought children with high fevers and convulsions to makeshift MSF immunization clinics, doctors did not suspect lead poisoning and initially treated for severe malaria and meningitis. When the patients failed to recover, blood samples were sent to a German laboratory that confirmed lead poisoning. In May 2010, the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) dispatched medical and environmental investigators to work with the Zamfara State Ministry of Health (ZMOH) and the Nigerian Federal Ministry of Health (FMOH) to assess the extent of the epidemic. At CDC’s request, TG accompanied the mission to investigate the potential for remediation. The combined team conducted an extensive health and environmental assessment in two villages, Dareta and Yargalma, in Anka and Bukkuyum Local Government Areas (LGAs), respectively, documenting 163 deaths and noting that up to one-third of children under age five in each village had died in the preceding few months. Surveys of six other villages suggested that 250-350 additional children had died of lead poisoning during the height of the epidemic.

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