THE BANGLADESH ARSENIC CATASTROPHE:
ONE VIEW FROM OVERSEAS
Richard Wilson
Harvard University wilson5@fas.harvard.edu
Modified October 2006
Written at the Guest Editor’s request for publication in Environmental Science and
Health but rejected for unknown reasons by the main editor
Corrected in September 2007 to account for changes in bangladesh in the intervening 12 months
The 1998 challenge
It is convenient to consider the first (of eight) International Conferences on Arsenic, held jointly by the Dhaka Community Hospital (DCH) and SOES, Jadavpur University, Kolkata, in
February 1998, as a turning point in public attention to the arsenic problem. The 200 participants saw over 100 victims of chronic arsenic poisoning – more than most US dermatologists see in a lifetime. Many of the participants added a strong emotional reaction “we must do something” to their intellectual curiosity.
The following general observations were made in a “Dhaka Declaration” at the end of the conference:
1.) The groundwater of a significantly large area in Bangladesh is contaminated with high concentration of arsenic;
2.) The cause of this arsenic contamination is geological
3.) Supply of arsenic free water is the only solution;
4.) This could also happen in other parts of world ; and
5.) Coordinated and concerted efforts are needed from National and International organizations and individuals to overcome this severe problem.
6.) The arsenic contamination of groundwater in Bangladesh needs to be addressed on an emergency basis;
7.) We shall direct our research for the benefit of all people;
8.) We shall use our knowledge and expertise and unite resources available to us to determine appropriate community based, affordable and sustainable water supply solution;
9.) We shall work in a concerted manner to protect and save people from the arsenic problem, ensure treatment of all patients and identify those at risk;
10.) We agree to share information amongst ourselves, make our findings freely accessible and allow others to use them for the interest of all people
11.) We shall assist in the setting up of organizations/ canters for research, training, storage and dissemination and all over the world.
The meeting from December 13-15th 1968 at DCH discussed several specific ideas although these were not specifically recorded..
(a) It is important to have a national survey of all wells
(b) to encourage “well-switching”; that is to encourage all villagers to switch their use of water from unsafe wells to safe wells without arsenic;

(c) as a "rapid" but (temporary) measure install temporary (household scale) arsenicremoval devices; and
(d) use deep wells (deep enough to penetrate a clay layer) while studying in detail the hydrological effects .
(e) explore a return to surface waters.
These and subsequent meetings emphasized a sense of urgency:
“Act immediately! Remember: a day lost is a few lives lost!” (Dhaka declaration in
2000)
“Less words and more deeds, please!” (Dhaka declaration in 2002)
Yet 8 years later, 30 million Bangladeshis have arsenic laden water.
Attending to the sick (about 60,000 identified at 2007 count) should usually be considered a very high priority in spite of the general rule “an ounce of prevention is worth a pound of cure”. Although a complete cure for arsenic lesions does not seem to be possible, the disease in its early stages (dyspigmentation) may be reversible with supply of good water and a good diet. More important, however, is that dyspigmentation and keratoses need not lead to complete disaster. Walking on a bare foot with keratoses leads to gangrene, and maybe untimely death. Timely treatment, and support for the victim’s family, can avoid these dire consequences. It is hard for an overseas group to attend to this treatment and, to their shame, no government agency seems concerned. It was left to groups such as the Dhaka Community
Hospital to use their limited resources for the purpose.
Lack of funding has often been cited as a reason for delay. The Bangladesh Arsenic
Mitigation Water Supply Project (BAMWSP) was started in late 1998 and funded by the World
Bank to oversee the issues and was planned to run over 4 years. Yet by 2001 BAMWSP had disbursed only US$2 million of the available funds had been disbursed and water-testing and patient identification had been conducted in only 30 out of 463 upazilas. The World Bank had arranged in an unusually short time a loan of about $50 million dollars at low interest rate.
World Bank officials informed me at the time of their expectation that this loan would be spent within two years and more would be forthcoming. My discussions in with the Director General of the Kuwait Fund for Economic and Social Development suggested that a similar loan would be available if the Government of Bangladesh applied for it. IThe author personally carried details to Bangladesh for the DCH meeting in 2000. Funds were available to GoB if they had applied for them. The failure of GoB to even ask the Kuwait Fund directly, even after preliminary overtures had been made, emphasizes the basic problem. Organization at all levels seems to be a major bottleneck. This was well described by a perceptive Harvard undergraduate
(Pripya Patel, born in West Bengal) in her paper "Crisis of (organizational) Capacity" . In late
2001 the Bangladesh electorate brought in a new government. The new government, to their credit, decided that the arsenic problem was an urgent national issue and asked WHO to organize immediately an international conference to discuss the issue and make recommendations for a national policy. Richard Wilson arranged for two important papers to be on his arsenic website
(http://arsenic.ws). Professor Feroze Ahmed's presentation on alternate solutions was there

within a week and one on the geology by Islam and Uddin six months later.
Among the recommendations in the paper on the geology of Bangladesh in 2001 by Islam and Uddin were some similar to those at the DCH meetings but much more cautious:
I -Arsenic safe aquifers must be protected from future contamination at any cost.
II - Research should be undertaken before any decision is taken to withdraw large amount of water from the presently arsenic safe Late Pleistocene-early Holocene aquifer.
III Till definite data are available about the recharge of these aquifers they should not be allowed for exploitation. But the government was painfully slow in turning the conference commendations into policy. Two major GoB committee reports on ground water utilization by
Abdullah et al., and surface water utilization by Faruque et al. were issued in late 2002 but not widely advertised. I only located copies in 2004. Most significant are the recommendations from Abullah et al. Which reiterated the extreme caution of Islam and Uddin:
* In arsenic affected areas, no new tube wells be installed even in the presently arsenic safe aquifer to protect the presently safe water resources.
** Tube wells should be considered as the last option. In case no other alternative water supply options .... in very limited areas deep tube wells may be considered.
Finally, in late 2003, the Government of Bangladesh adopted a national water policy which inter alia , in section 5.2.2 proposed to “give preference to surface water over ground water as source for water supply”. The negative approach inevitably delayed the widespread installation of deep tube wells. Everyone agrees that there are concerns which must be understood. (i) Although arsenic contamination of deep layer is at present much smaller than arsenic contamination of ordinary tubewells at a depth of 40 meters, it is unclear whether it will always remain so. (ii) It has been suggested that a deep well which is not properly grouted can act as a shunt between the contaminated upper aquifer and the deeper aquifer. This could result in irreversible contamination of the lower aquifer as it is being pumped. (iii) Concern about the availability of long term availability of the aquifer also arose from the Dhaka experience, where the groundwater level that was once 11 m in the 1970s went down to 20 m in 1980s and more in 2000. (iv) A Japanese group, the Asia Arsenic Network, installed tube wells in the
Jessore region of Bangladesh and about half have arsenic above the new WHO standard and about 10% above the old one. This suggests that deep tube wells are inappropriate in 15%-25% of the country. Nonetheless most overseas hydrogeologists believe that the deep aquifer will be satisfactory for at least 20 years, (provided that massive use of this aquifer for agriculture is avoided).
After a delay, the Department of Public Health Engineering (DPHE) installed deep tube wells. According to APSU they had produced about 80,000 wells in the country by 2005 providing pure water for 1,500,000 people, in spite of the National Water Policy the Government of Bangladesh, which recommended a focus on surface waters! One must applaud this success and regret that it is only happening slowly. More importantly DPHE have, in 2006, produced an excellent report, (available on the arsenicws website and Bangladesh government website) including maps and a data base. This goes a long way toward addressing concerns of the waverers and deserves wide circulation. In particular their Table 6.1 shows that nearly 100% of

wells meet the 50 µg/m3 standard in some areas. At a meeting at the Royal Geographical
Society in August 2006 Dr Katim Matin Ahmed describing the report, of which he was
Chairman, commented that the Japanese group in (iv) of the preceding paragraph had not dug wells deep enough. This response to a legitimate criticism needs to be widely advertized.
There are some 600-700 NGOs in Bangladesh offering varying levels of health services.
These range in size from BRAC, which employs 25,000 full-time staff and has activities in
50,000 villages, to very small community groups that operate in a single village. NGOs have a comparative advantage in terms of their ability to coordinate water supply interventions with health service interventions, because of the absence of different line ministries vested with different responsibilities, and because of their usually smaller scope of coverage. Most health
NGOs operate community-based services and clinics with limited resources, usually without a medical doctor on staff; however, a few well-equipped and staffed rural hospitals are also run by
NGOs. Professor Quazi Quamruzzaman of DCH, with whom I have worked extensively, repeatedly has emphasized the crucial role of Non Governmental Organizations (NGOs), as did
Islam and Uddin. But the contribution of NGOs has been most disappointing. NGOs have failed as badly or worse than, GoB in communication and they have not, in general, worked well together or with GoB.
The problem is probably the greatest for any surface water use where elimination, or even reduction, of harmful bacteria depends critically on local construction practice and maintenance.
Education of the villager leaders must remain a primary goal for the future. This must include the religious leaders.
At the December 2008 meeting at DCH there was a major discussion on measurement and it was emphasized that it was crucially important. A simple calculation showed that it would take 300 years to measure all wells once if the all the existing laboratory equipment in the country were used. The problem was even worse. An inter-laboratory comparison of laboratory measurements arranged by the International Atomic Energy Agency showed that even some of the best institutions were not measuring properly! Accurate measurement of arsenic in drinking-water at levels relevant to health requires laboratory analysis, using sophisticated and expensive techniques and facilities as well as trained staff not easily available or affordable in many parts of the world. The World Health Organization noted as late as 2006 :
-Analytical quality control and external validation remain problematic.
-Field test kits can detect high levels of arsenic but are typically unreliable at lower concentrations of concern for human health. Reliability of field methods is yet to be fully evaluated.
The problem was clearly one of personnel training. In recent years both situations are

much improved. A more recent inter-laboratory comparison of laboratory instruments shows much greater reliability, and also absolute accuracy in most cases. The “field kits” used to measure arsenic rapidly in the field depend upon the color changes when arsine gas is produced, and the interpretation of these depends critically upon the training of the user and was much in doubt. A digital device, the Arsenator, was developed in Austria which seemed to reduce the subjectivity in observing the color changes, but for reasons unclear it has not achieved acceptance. The field kits were adequate for measurements above 100 ppb but are inaccurate in the region around 30 ppb where they are still needed. Improvements in the field kits, a switch to use of the Hach kit instead of the Merck kit, made by BAMWSP in 2003, and perhaps also a modification in use of the Hach kit suggested by the Columbia University group (allowing ½ hour for the color to develop) has made the problem of less concern, though not completely solved.
Outside consultants repeatedly comment on the importance of easily available testing facilities which are known to be reliable . There has been little progress on the recommendations that there be such facilities in every Upazilla. More troublesome, perhaps, in view of the policy emphasis on surface water, is the almost complete failure of information and testing facilities for faecal coliform bacteria. Even in 2006 neither the problem nor the (partial) solution has been widely discussed or taken up by a government department of weights and measures. But any decision analyst will note that many, if not all, decisions are not based on what is best for the country but on what is best for the decision maker personally.
Once the arsenic level in wells has been measured and the wells painted green or red, it is important to encourage switching to use of the safe wells. Some estimates are that only 30% of villagers have switched wells. While this fraction is not high enough, there are still 20 million villagers who now have pure water instead of the impure water they drank before. In the
Ariahazar upazilla, it has been found that the fraction rose to 60%. I attributed this to the intense village-education programme. Therefore the most important remediation effort that could be immediately undertaken is a massive education programme - particularly among the women in the villages. However instead of touting this success, and drawing the obvious conclusion to build upon it, both the GoB and the NGOs have been remarkably quiet.
Inadequate communication between the major actors, their consultants and their wellwishers overseas, is a major problem which is easy to remedy in principle but in practice may be intractable. A major step was taken on January 7th 1998 when Sara Bennett set up the website
"Arsenic Crisis Information Centre", soon followed by an informal discussion group on the web which is still functioning well (arsenic-crisis@yahoogroups.com). However the site itself has not been updated since 2003. Other websites appeared. My own, the arsenic project website,
(http://arsenic.ws) appeared in summer 1998, others from Columbia University and overseas
NGOs. The Bangladeshi websites have been more static. Although some of these sites are continuously maintained from outside Bangladesh, the use of this method of communication has not been much used inside Bangladesh. Not only are Government of Bangladesh reports not

easily made available, they are sometimes impossible to acquire from outside the country.
Communication does not consist merely in making ideas and data available, in published papers, on the web and in a data repository, someone also has to look at them; to read them; to try to understand them and to act on them. In a major field of science, physics, there exists the
Los Alamos Data Archive where papers are submitted before publication for information and open discussion (incidentally making the peer review process simpler). Yet my attempts to get even western authors to allow their papers to be included on a website before they are published
(even when I possess a copy) have mostly failed. Few persons in Bangladesh have sent me reports for posting or cross referencing - and then often only after a specific request from me.
Mankind often learns more from mistakes than it learns from successes, and although it is hard to admit failures, it is important to do so to help others. This recommendation is probably the least followed. While some western NGOs (particularly Columbia University) have published extensive papers, these are analyses of data and not the data themselves. Analyses inevitably tend to be biased in favor of the authors’ preconceptions whereas data are not.
Moreover, in order to satisfy copyright and other legitimate demands of journal publishers, the papers have an inherent delay and the role or “preprints” used in basic physical sciences has not been common. There was a temporary improvement when the Arsenic Policy Support Group
(APSU) started its website. Reports were dated. Authors were noted.
But this important forward looking project has ended. The APSU website has not been updated even with APSU reports dated before its demise. It seems not yet to have been taken over by another GoB organization.
In January 1998 two other activities were noted which although less important than providing alternate water supplies, have to be worked on simultaneously. Moreover these are activities in which foreign scientists can most easily help and foreign funding agencies are inherently interested because there is world wide applicability. (A) how does arsenic gets into the water supply? so that this might be avoided in the long term. (B) exactly what are the effects of chronic arsenic exposure on people? In the first of these there has been considerable progress. In 1978 two alternate hypotheses were being suggested - the oxidation hypothesis and the reduction hypothesis. In the first of these lowering of the water in the relevant aquifer by continuous pumping was presumed to lay bare iron arsenide, and allow the iron to be oxidized and release the arsenic. A modified proposal was that the lowering was caused by the barrage across the Ganges river (has particular difficulty because the relevant aquifer is fed by rainfall not by the river level. The reduction hypothesis is now considered to be the correct one. As
McArthur states “It becomes increasingly clear that severe arsenic pollution of ground water in most alluvial aquifers worldwide is driven by the microbially-mediated metabolism of organic matter, with FeOOH acting as the source of oxygen: the oxide is reduced during the process and its sorbed arsenic is released to ground water. Despite the widespread acceptance of this mechanism, much about it remains obscure."

Progress in the epidemiological studies about the effects is inherently slow, but nonetheless progress is being made. Prior information suggested that by eating a good diet, with fresh fruit and vegetables, cancer rates can be cut in half, even for lung cancer which is known to be cause by cigarette smoking. Can a good diet help similarly in Bangladesh? It has long been realized that selenium and arsenic are chemical antagonists. Is there a relation between selenium deficiency in the diet and arsenic lesions? Can the incidence of lesions be reduced by doses of selenium? Preliminary studies suggest that eating of betel nuts does exacerbate skin lesions by a factor of two. But use of selenium as an antagonist does not seem to be as important as originally hoped.
Household Arsenic Removal Systems (ARS)
In 1998 household arsenic removal systems were suggested as an urgent temporary measure and some of the problems that have since appeared were foreseen Some systems proved too hard for many villagers to use since they demanded regular cleaning. In the 6th report on such devices in West Bengal, the Jadavapur University group found that 80% of installed systems had been abandoned by 2004 - probably because the iron in the iron-rich waters clogged the system. In 1998 the Government of Bangladesh instituted the Environment
Technology Verification-Arsenic Mitigation (ETV_AM) program to verify the efficacy of
Arsenic Removal Technologies. Under the current GoB regulations, no arsenic removal technology may be deployed in Bangladesh unless it is cleared by the ETV-AM program. In
February 2004 four technologies were approved for "provisional" use and are now being sold. In the unfortunate typical GoB fashion their report was only released two years later in March 2006.
It only became easily available in December 2006 when I was able to place a copy on my website. For some 3 years Dr Hussam of SONO has sent many details of the tests carried out by the Kushtia group, and by others for them. In addition, Dr Sarkar in Bengal Engineering
College, West Bengal, and Dr Sengupta in Lehigh University have published a detailed paper of the results of follow up on over 150 medium sized systems of Dr Sengupta’s design, that seems convincing. It is noteworthy that each of these projects has the backup of a local, dedicated, group which has proved willing and able to learn from mistakes and meet the commitment to users.
These facts may well have influenced the US National Academy of Engineering to award the Grainger prize of $1,000,000 to Dr Abul Hussam and a second prize of $300,000 to Dr
Sengupta. I fully support their choice.
While in 1998 it was thought that the household systems would only be a temporary measure, 80,000 systems had been installed (with overseas NGO funding) it is likely that those with a strong local back up team will retain an important niche in the future especially because of the difficulty of getting an agreed strategy for surface waters.
Surface waters
The failure to develop surface waters in a sanitary manner has been one of the major

failures, and for me a personal disappointment, of the arsenic mitigation efforts. It is important to understand why, and to develop a procedure for the future that avoids the past pitfalls. There was a strong emotional push (of which Professor Dipenkar Chakriborti of West Bengal was, as always, the most eloquent), for returning to surface waters. The country is full of water. Why not learn to use it properly? Alas, that proved a too difficult. Research, and personnel training have so far been inadequate. Instead of an obvious dual (surface and ground waters) approach, there developed an exclusivity that led to intellectual division and delay.
Since the development of the tubewell culture was spurred by problems in sanitation of surface waters it was natural to assume that any return to surface water would be accompanied by an emphasis on sanitation. That did not occur . The government report on surface waters by
Faruque et al. in 2003 barely discussed it. Worse still, it was reasonable to hope that the
International Center for Diarhoehal Disease Research (ICDDR’B) would take a leadership role in ensuring sanitation. They did not . There was no comment on the extensive experience in other tropical countries such as the Blue Nile project or even WHO guidelines for construction of sanitary dugwells. Without a strong guidance from the government some NGOs installed some dugwells without any regard to WHO guidelines for construction, and with no provision for subsequent supervision and maintenance. DCH was better than the others, and wrote reports on the progress of their improved dugwell projects which were promptly posted on the web for all to see. A more complete description is now being published in the formal literature. However, in retrospect, it seems probable that the early measurements, showing no bacteria, were all made directly after the regular cleaning of the wells, whereas bacteria build up weeks and months later.
DCH had recommended cleaning every 3 months. This was also probably inadequate.
Maintenance had been neglected as the bacteria level rose.
DCH, one of the principal workers on surface water, also monitors the health of the people in the areas of concern. The measured levels of bacteria are higher than desirable, but there has been no outbreak of bacteriological disease. Although there is documentation of this, small effects could well have been unobservable. Nonetheless there is an unfortunate defensive posture among those advocating surface waters (such as members of the national policy committee) and even those actively and successfully working under the leadership of DCH.
Chlorination
While coliform (or E coli) are not in themselves dangerous, faecal coliform is widely considered to be an indicator that other dangerous pathogens such as Giardia may be present. .
One WHO guideline was not followed by most surface water users. There was nlittle chlorination of the well water. Yet in at least one jurisdiction there is a memory of the local health inspector providing bleaching powder to villagers. Yet most of the rest of the world have chlorinated since 1842 as detailed in a recent review paper by a water quality expert Professor
Okun. Chakriborti has been recommending chlorination. Nazrul Islam, in a WATSAN 2004 reported that coliform bacteria tended to rise 3 weeks after chlorination. I was given a copy of this report in 2004 and to my shame and eternal regret, I did not read it and lost it until recently.
DCH had recommended cleaning and using lime, every 3 months. It is now clear that every 3 months is not enough in the tropical climate. After high levels of coliform were found in improved dugwells in the Pabna region, DCH began tests of chlorination, using amounts recommended by US EPA, in May 2006. They find that, in that region, chlorination

consistently brings coliform down to reasonable levels but rises precipitously after 20 days, just as Islam had suggested. The suggestion is that chlorination every 2 weeks may well be adequate. This success occurred even during the monsoon period of 2006, when filtering of the water by the soil is less effective. Subsequent measurements during the more serious monsoon flooding of 2007 show that on these occasions, chlorination every week may be necessary.
Fortunately it is cheap and easy. Meera Hira-Smith in West Bengal also finds that chlorination is effective. In parts of Bangladesh where there is insufficient distance from latrines to install a dugwell, and if a deep well is also inappropriate, rainwater collection has been, can be, and probably will be used. But storing rainwater for the 9 months between the monsoon seasons inevitably leads to increases in bacteria count. One does not have to search for sources of bacteria. Some will be there. Fortunately it is simple to chlorinate by adding sodium hypochlorite every one to two weeks into the tank.
Piped water and the long term
Some aspects of a long term future seem clear. The population is dense even in the countryside so that a regional central water supply, centrally purified as appropriate and with simple piping to each village, is likely to be usual in 50 years time. In most of the world surface waters are used for these centrally purified supplies, and it is possible that this will be the case in Bangladesh However, many experts believe that the central supply will come from deep tube wells in most of the country, following the Dhaka pattern, but clearly there will be regional differences. However even those most optimistic about the ability of a deep aquifer to supply drinking water to all the people argue that the use of the deep aquifer for agriculture, for which less bacteriologically pure surface waters may suffice and uses 10 times as much as drinking water, should be discouraged and probably forbidden.
A central village well (in most cases a deep tube well) might supply the whole village in situations where most or all tube wells are polluted by arsenic. These wells could be in a school.
But the fact that most of Bangladesh has electricity leads to another suggestion. The water can be pumped into an overhead tank whence it can be led to water taps throughout the village by simple PVC piping. This has been implemented by Dhaka Community Hospital, using improved dugwells as the source of water, and has proved very successful. In a separate report,
Ahmed has shown that villagers are prepared to pay more for running water than they are for arsenic free water and popularity of this system among the villagers, is evident. The Bangladesh
Water Supply Program Project is organizing and arranging funding for 300 villages over a period of five years. It seems probable that most of these will use deep tube wells as the water source. I note that once clean deep tube well water is pumped to an overhead tank, or carried some distance, bacteria are bound to arise and chlorination must be considered. The overhead tank makes this relatively easy.
In the long term we must be concerned about irrigation water for agriculture. Arsenic pulled out of the ground will be taken up by rice and other foodstuffs. Already there are indications that the uptake by people is equivalent to 3 µg/l in the water. Continued use can only make it worse. In 1998 Alan Smith proposed a simple experiment. Measure urine samples in a polluted village. Replace water for drinking and cooking with bottled arsenic free water for a week and measure again. The final measure will be due to the food, and the difference due to

the water. However this simple direct test has not yet been done.
Conclusion
Few people address treatment for the 60,000 or more presently afflicted. Although there is probably no cure, keeping a patient comfortable and hopefully useful is still important.
Moreover, if a government or an NGO pays attention to the short term task of looking after the sick, there is more confidence in any recommendations for the long term future. DCH and the
UPOSHON foundation spend a lot of effort on the sick. There should be no administrative obstacle extending their noble work.
Everyone is frustrated at the slow pace of provision of pure water in Bangladesh. If provision of pure water were strictly linear it would be hundreds of years before everyone was properly supplied. But the pace seems to be accelerating as infrastructure improves so that there is great hope that this date will be very pessimistic. The concerns about deep tube wells which delayed implementation are being addressed.There is every reason to support DPHE in their work as fast as their manpower can permit.
There has been extensive work on provision of surface waters but only recently has the bacterial content been fully addressed. It seems that chlorination every one to two weeks works for dugwells and may well do so for pond sand filters. Other possibilities to achieve this include avoidance and switching to rainwater during the monsoon when the soil fails to filter. These need to be addressed with urgency. The final arbiter must be the public health: not only by theory but by observation.
In all solutions, involvement of the local community has been beneficial if not absolutely essential. For well switching this is self evident. It is important for deep tube wells. If strong, continual, local support and advice had existed the massive failures of household filters and dug wells might have been eliminated. Empowerment of women may well be an important ingredient in this.
Everyone has recommended enhancing the capability to measure arsenic, other toxic materials and harmful bacteria at the local and regional level. This capability should be reliable, and hopefully inexpensive and therefore accessible to the general population. However the implementation of this recommendation has been poor. Funding might well be provided directly to those NGOs capable of assisting in this.
Last but not least, communication between all the actors, between GoB departments; between GoB and NGOs between in country and out of country experts is still inadequate. This communication is essential to accelerate all the above activities.