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    Nigeria: Prevention is key to stop children from dying of lead poisoning

    A worker shows the mercury-gold amalgam at the Bagega gold processing site

    A worker shows the mercury-gold amalgam at the Bagega gold processing site. Nigeria, 2012. © Olga Victorie/MSF

    In March 2010, Doctors Without Borders received an alert about a high number of child fatalities in Nigeria’s Zamfara state, where more than 400 children died within just six months in several villages. “When Doctors Without Borders arrived, we were suffering a lot,” remembers Alhaji Muhammadu Bello, head of Dareta village. “In my village, 120 children died. Six or seven were dying every day.”

    Laboratory tests later confirmed high levels of lead in the blood of survivors. The root cause of the poisoning was environmental contamination through unsafe, artisanal mining activities in the area, where gold deposits contain an unusually high concentration of lead. Lead can cause severe brain damage and death in children.

    Artisanal mining had been going on for a decade in this area. People transformed the villages into processing sites and contaminated the environment for many years. Children were exposed to contaminated dust and soil in the villages.
    Benjamim Mwangombe, Project Coordinator

    Before Doctors Without Borders could start treating patients, the contaminated areas needed to be remediated so that children would not be continually re-exposed to toxins. Between June 2010 and August 2013, TerraGraphics International Foundation, an environmental engineering organization, provided environmental management training to Zamfara state’s Environmental Sanitation Agency (ZESA).

    In partnership with the community, eight villages in Anka and Bukkuyum local government areas were remediated, by removing contaminated soils and mineral processing waste from residential areas, wells and ponds.  

    Between May 2010 and December 2021, Doctors Without Borders screened 8,480 children under five for lead poisoning. More than 80 per cent of them were enrolled in a medical lead program, including 3,549 children who received lengthy chelation therapy to remove lead from their blood.

    Five years after the outbreak in Zamfara, another lead poisoning outbreak was discovered in two villages in Nigeria’s Niger state in April 2015. It was also caused by artisanal gold mining and resulted in the death of at least 30 children. Doctors Without Borders provided chelation treatment to 139 children shortly after remediation and handed over the project to Niger state authorities and traditional leaders in October 2018.

    Remediation and chelation therapy are not only very expensive, but also insufficient to eliminate the lead poisoning hazard in the communities. Due to the rampant poverty and lack of other employment opportunities in the area, small-scale mining remains the only option for many people.  Many were unaware of the health hazards caused by their mining practices. Some previously remediated areas were re-contaminated.

    A gold mining site on the road between Bagega and Anka

    A gold mining site on the road between Bagega and Anka. The rocks will be taken to gold processing sites. The mining sites are very dangerous, there are steep holes in the ground and they are not supported. Recently one of the tunnels caved in, leaving a few of the miners buried. Nigeria, 2012. © Olga Victorie/MSF

    A patient check-up as part of her visit to MSF's "Mango Clinic."

    A patient check-up as part of her visit to Doctors Without Borders' "Mango Clinic." The clinic is just outside Abare, one of seven villages in Zamfara State where Doctors Without Borders runs outreach clinics treating children affected by lead poisoning. Nigeria, 2012. © Olga Victorie/MSF

    Succimer (the medicine used for chelation therapy) at MSF's "Mango Clinic."

    Succimer (the medicine used for chelation therapy) at Doctors Without Borders' "Mango Clinic". Nigeria, 2012. © Olga Victorie/MSF

    Community members participate in a training on safer mining practices.

    Community members participate in a training on safer mining practices. Nigeria, 2022. © Olga Victorie/MSF

    “We had children who were re-exposed more than three times. Even if their compound is clean, maybe they play on their uncle’s compound where the soil is contaminated,” says Mwangombe.

    The only sustainable long-term solution is the prevention of lead poisoning. Doctors Without Borders engaged  OK International, an external partner specialized in occupational and industrial health, to develop and implement safer mining pilot projects in Niger and Zamfara states, in partnership with Nigeria’s Federal Ministry of Mines and Steel Development and the responsible state agencies.

    Miners were provided with information and tools to reduce exposure during mining and processing activities, and to minimize off-site contamination. The results of the pilot projects have been encouraging, and the state governments say they are committed to scaling up safer mining practices in Zamfara and Niger states. “We will continue to ensure that the environment remains clean, so that children will not get poisoned again,” says Alhaji Shehu Anka, general director of ZESA.

    Almost 12 years after Doctors Without Borders first started intervening in the area, no more children are dying of lead poisoning in Zamfara. As a result, Doctors Without Borders handed over the program to key ministries of the Zamfara state government, the Anka Emirate Council and the local community at the beginning of February 2022.

    Meeting with community leaders and the Emir of Anka to mark the handover of MSF’s lead poisoning project.

    Meeting with community leaders and the Emir of Anka to mark the handover of Doctors Without Borders' lead poisoning project. Nigeria, 2021. © MSF

    Mwangombe says the significant decrease in the under-fives mortality and morbidity related to lead toxicity is not the only success. “Another big achievement was that our intervention was community-based. The community has been involved throughout so that they could take ownership. We also improved local capacity. In the future, if there is another outbreak, there will be capacity to respond.”

    One of the key factors for the successful reduction of exposure to lead poisoning was the involvement of international organizations with expertise in environmental health, safer mining and occupational health that complemented Doctors Without Borders' medical response.

    However, challenges remain. Artisanal mining is a poverty-driven activity that will persist as long as gold mining is profitable. Recently, another area with a high level of lead contamination was discovered in Abare village in Zamfara. At the end of January 2022, the Zamfara state government approved the financing of the environmental remediation of the contaminated area.

    For the long-term sustainability of remedies, and to prevent children from dying from lead poisoning again, all partners need to remain committed to promoting and maintaining safe mining practices.

    “Prevention requires involvement from everyone – from village chiefs and traditional leaders to state authorities and legislators, so that everyone’s efforts will help maintain the remedy that we have handed over and prevent any future outbreak of lead poisoning in Zamfara state”, says Mwangombe.