Zamfara State, Nigeria

INTRODUCTION
In March 2010, the international humanitarian organization Médecins Sans Frontières (Doctors Without Borders, MSF) discovered an outbreak of lead poisoning in remote villages in Zamfara State, Nigeria. More than 17,000 people were severely poisoned and 400-500 children died as a result of soil lead contamination associated with artisanal gold mining/processing in residential compounds. 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 “Superfund” protocols. Post-cleanup activities included medical treatment in MSF-run clinics, monitoring the sustainability of the remediation, and implementation of safer mining practices. The epidemic has been characterized as unprecedented, and the ensuing cleanup one of the largest and most comprehensive ever undertaken by an African government.

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 SOURCE OF LEAD POISONING

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 homes to utilize the women’s labor. During the rapid increase in mining activities, a dangerous gold ore exceeding 10% lead was introduced. 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 outside the villages. However, extremely hazardous waste and contaminated soils remained in the residences and communal areas.

MSF/TG focused on emergency medical treatment and environmental response. MSF, ZMOH, and FMOH developed village ch-elation therapy clinics. All entities agreed that children could not live in contaminated homes as it would compromise the treatment. Coupled with local resistance to relocation, this required the villages to be re-mediated prior to commencing chelation.

REMEDIATION ACTIVITIES
Remediation continued over three and one-half years in three phases, encompassing 8 villages and 17,000 residents

Phase I Remediation was an emergency response in two villages (Dareta and Yargalma). While MSF and ZMOH established village clinics and implemented treatment protocols, TG and ZMOE developed emergency remediation protocols appropriate to local resources. The work was conducted by ZMOE with TG providing technical guidance. By September 2010, remediation and relocation of mining activities had reduced the average blood lead level of children entering treatment from 173 µg/dL to 86 µg/dL.

    June 2010-July 2011

    Funding: Zamfara State, TG, Blacksmith Institute (BI), and MSF

    148 Homes remediated

    Exposures reduced for >2,100 residents

    Allowed MSF to treat >100 children

Phase II Remediation addressed five villages (Abare, Duza, Sunke, Tungar Daji, and Tungar Guru) resident to 6,385 people. During Phase II, further investigation by the CDC and Nigerian authorities suggested that artisanal gold mining was occurring in other areas and significant lead contamination was confirmed in more than 30 villages. Another study revealed water quality problems related to the mining activities.

Additional surveys conducted by TG and ZMOE found extensive contamination in Bagega Village, where 1,500 children under age five were at severe risk for lead poisoning. An adjacent abandoned processing site (Industrial Area) had more than 8,700 cubic meters of high concentration lead waste extending into the main water reservoir serving the region. 

    October 2011 - March 2011

    Funding: United Nations (UN) Central Emergency Response Fund (CERF), United Nations Children’s Fund (UNICEF), Zamfara State, TG, and BI

    Exposures reduced for >6300 people

    Allowed MSF to treat >1,200 children

Phase III commenced following 18 months of advocacy encouraging the Nigerian federal government to complete the remediation in Bagega. TerraGraphics International Foundation (TIFO), the non-profit humanitarian successor to TG, was retained to provide remediation oversight when funding was released in February 2013. Efforts are ongoing by the Nigerian governments and the affected communities to sustain the remedy and adopt safer mining techniques.

    February - July 2013
    Funding: Nigerian Federal Government

    352 homes, 54 public areas, the Industrial Area, the contaminated reservoir remediated

    Exposures reduced for >7,000 residents

    Allowed MSF to treat >650 children

SUMMARY
    >27,000 cubic meters of contaminated soils and mining waste removed

    820 residential compounds and ore processing areas in 8 villages remediated

    Soil lead exposures decreased 97%

    2349 children to received chelation treatment

    Mean pre-treatment blood lead levels for children <five years of age declined from 173 µg/dL to <20 µg/dL over the four year remedial program


    > 2,300 children < 5 years of age received chelation therapy

The unprecedented outbreak and subsequent response demonstrate that, given sufficient political will and modest investment, the world’s most challenging environmental health crises can be addressed and resolved within the capabilities of host countries.