Following alarming child mortality reports from Zamfara State (Northwest Nigeria) in June 2010, Médecins Sans Frontières / Doctors Without Borders along with the Nigerian government, the United States Centres for Disease Control, United Nations agencies, and other groups responded to what is now considered the largest environmental lead poisoning crisis in history. At the outset, over 400 children died and thousands more were discovered to have excessive and unprecedented levels of lead in their blood as a result of artisanal mining activities. Through the last 2.5 years, MSF has successfully treated over 2000 children. A necessary precondition for treatment has been environmental remediation which consists of removing lead from the home environment. Since chelation therapy, the main component of treatment for lead poisoning, is ineffective if children continue to be exposed, it is the initial remediation of seven of the eight most contaminated villages identified in the last two years that paved the way for MSF to provide medical treatment to lead poisoned children.
As a result, hundreds of lives have been saved and mortality rates among children under-5 have fallen drastically in remediated areas (prior to MSF's intervention, some villages suffered over 40 per cent of their children perish from the poisoning, while the cumulative mortality since has been less than three per cent). Nearly one thousand children have since been discharged, many with an excellent chance of leading normal lives despite the astonishing levels of toxicity they have suffered.
However, one highly contaminated village has yet to be remediated. To this day, hundreds of children in Bagega continue to suffer the devastating symptoms and life-threatening risk associated with lead poisoning. The remediation efforts that had been previously so successful in seven other villages of Zamfara State foundered in Bagega due to lack of funds, despite ongoing promises of assistance from Nigerian authorities for the affected population.
MSF is standing by, ready to begin treatment in Bagega as soon as remediation is completed. Until that happens, the children of Bagega continue to be at high risk of death and the debilitating effects of lead toxicity including brain damage. An internationally recognised expert in environmental remediation, Terra Graphics International Foundation, which played a key part in the remediation of the first seven villages, is also standing by ready to assist and ensure that remediation is done effectively and thoroughly. What remains is for the funds, earmarked by the Federal Government at the Abuja International Lead Poisoning Conference of May 2012, to be released and the clean up to begin.
Indeed, time has run out. The situation in Bagega has reached a crisis point. After a delay of more than two years, remediation was scheduled to start in October 2012. At this moment, it is unclear where the funds are, and no action has occurred. If remediation is not started within a few weeks, it will not be finished before the beginning of the next rainy season, and until remediation is complete MSF will not be able to begin treatment for the children of Bagega. In the meantime, more children are born into a toxic environment, more lives are lost, and the effects become increasingly irreversible.
As a medical doctor, I know that young children living in Bagega village are at risk of seizures, organ failure and death due to lead exposure. When parents from Bagega bring their severely ill children to us for treatment of lead poisoning, we experience first-hand the anguish they feel living in a community that puts the lives of their children at risk. Without remediation our hands are tied. With every delay, more children will die and a generation is at risk of long-term brain damage from lead poisoning.
That remediation has not yet started in Bagega is both inexplicable and unacceptable. The funds have long since been promised and all parties are apparently prepared and committed to the clean up. What then prevents this activity from happening?
Of course, remediation alone is not enough. MSF looks forward to working with the Ministry of Health to continue to treat the victims of lead poisoning, and I urge the Ministry of Mines and Steel Development in Nigeria to support a safer mining programme to mitigate the danger of more contamination. Only through a three-pillar approach, with medicine, remediation, and safer mining practices will the crisis in Zamfara be truly resolved.
On my recent visit to Nigeria, I conveyed these concerns to the Inter-ministerial Committee on Lead Poisoning, and to the Ministers of Health and Mines and Steel Development. I am grateful that the Nigerian government is taking this issue so seriously, and I would like to thank the ministers, their employees, and the Committee for their warm reception and taking the time to discuss this issue. I was encouraged to hear of the renewed commitment by the ministers and Committee to address the contamination in Bagega, and look forward to seeing the work begin very soon.
•Dr. Karunakara is the International President of Médecins Sans Frontières / Doctors Without Borders (MSF), a medical humanitarian organisation that has been providing medical services throughout Nigeria since 1971
