The people's Republic of Bangladesh occupies a territory in the north-eastern part of the Indian subcontinent above the Bay of Bengal between 20⁰.34'- 26⁰.38' N latitude and 88⁰.01'-92⁰.41' E longitude. It has a territory of 147,570 sq. km and a population of 130 million. Population growth rate is 2.1 annum. Density of population 800 per sq.km; sex ratio: 106 male to 100 female. Literacy rate was 32.4% in 1991 but now it is about 47%. There are 88.3% Muslims, 10.5% Hindus, 0.6% Buddhists and 0.3% Christians and  others 0.1% . The urban population constitutes 20.1% and rural population 79.9%. The state language is Bengali, but English is widely used and understood.
 

Bangladesh has a parliamentary form of government with the prime Minister as the chief executive. The country is divided into 6 administrative divisions. Each division is subdivided into Zilas, which in their turn consists of thanas. Thanas are then divided into unions consisting of several Mouzas (revenue villages). At present there are 64 districts and 496 thanas. There are 19.4 million households distributed over 59.990 Mouzas.
 

Climate

Bangladesh enjoys sub-tropical climate with the average temperature ranging in summer between 21-34 degrees C and in winter between 11-29degrees Average rainfall: 1194- 3454 mm: highest humidity in July – 99% and lowest in December 31%.
 

Bangladesh has emerged as an independent state after a 9-month long bloody liberation war in 1971. Before that time it was a province of Pakistan and was called East Pakistan. Going further back this land was a part of the provinces of Bengal and Assam of the British colony of India. As a result of the anti-colonial struggle of the people of India the British had to quit India in 1947 and while doing so they divided the subcontinent into two separate states, namely India and Pakistan on religious ground.
 

Brief geological outline

Bangladesh occupies the major portion of the Bengal basin. Nearly 85% of the recent sediments of Bangladesh have been deposited by alluvial and deltaic processes of the mighty rivers like the Ganges, the Brahmaputra, the Meghna and the Teesta. Many other smaller rivers also have their contributions, but to a lesser extent. There are about 230 rivers with a total length of about 24, 140 km. The active delta occupies the area south of the Ganges river and mostly west of the Meghna estuary. Most of the delta is less than 15 m above the sea level and the tidal zone is generally 3 m above that level. There are some hilly regions in the north-east and the south-east and some high lands in the north and north-western part of the country.

Composition of sediments depends on the rocks of their origin. Those associated with the river Ganges tend to be rich in clay and often contain silts, rather than clay.

Total forest area covers about 14% of the land area.

Mineral resources include natural gas, coal, limestone, hard rock, lignite, silica sand, which clay etc. Radioactive sand deposits have been found along the beaches.
 

Health status

According to 1995 statistic, crude birth rate is 27, crude death rate 8.6, infant mortality rate 78 and life expectancy at birth 58. Predominant diseases/symptoms are acid secretion, heartburn, dyspepsia, gastritis, peptic ulcer (10. 16%), diarrhoea (10.84%), cold (6.7%) fever (11.55%), scabies, abscess (3.63%), rheumatism (3.28%), malaria (3.28%), asthma (2.54%), influenza (3.07%), blood pressure (1.67%) typhoid (1.56%), measles (0.96), tuberculosis (0.53%), and others.
 

Water habit

97% of the population of Bangladesh use tube-well water for drinking and cooking purposes. The rural people use pond, lake and river water for washing, bathing and other domestic purposes. The urban people use deep tube-well water for the same. For irrigation river and deep tube-well waters are used.

According to DPHE source, in 1993-94 there were 855, 996 hand/shallow tube-wells in rural areas and the number of deep tube-wells in 8 former coastal of Chittagong, Noakhali, Sylhet, Khulna, Barishal, Faridpur, Patuakhali and Jessore was 51,819.
 

Genesis of the arsenic problem

Until recently the arsenic problem was almost unknown in Bangladesh, although in neighboring West Bengal it became evident in the mid-eighties. Arsenic specialists in Calcutta however, predicted that as the younger deltaic deposition stretched from West Bengal into Bangladesh, the latter might also have arsenic contamination of ground water. The prediction held true as they found patients from the bordering districts of Bangladesh with arsenical skin lesion going to Calcutta for treatment. They warned the government of Bangladesh and the WHO about the presence of arsenicosis patients in Bangladesh in the early nineties and accordingly Bangladesh government began some investigations in this direction, however it was kept more or less unpronounced and neither the physician community, nor the public knew anything about it until 1996 when Dhaka Community Hospital came into the scene.

In June 1996, Dhaka Community Hospital held a health camp at Pakshi in the western part of the country in which several skin patients were suspected of having arsenical skin lesions. Tube-well from that area was tested and was found to have high content of arsenic. DCH informed the local officials and made newspaper reports. Following this news on arsenic began flowing from other districts, There were rumor and tales, however nobody seemed to be knowing how real the arsenic threat was. DCH felt the need to respond to the interest of the public health and send a fact finding team consisting of 8 members including 3 skin specialists and 3 other senior doctors to that area. They collected water samples from 41 tube-wells and biological samples (nail, hair, skin and urine) form 95 patients. Water samples were tested at the BCSIR Laboratories, Dhaka, while biological samples were tested at the School of Environmental Studies, Jadavpur University, Calcutta 66% of the water samples and more than 90% of the biological samples water found to have higher than normal concentration of arsenic. DCH made the results public in a national seminar held with the participation of Dr. Dipankar Chakraborty of the SOES, Jadavpur University, Calcutta in January 1997 and urged the government and other concerned organizations to take immediate steps to face the problem.
 

Extent of the problem

At present several departments of the government with assistance from international donor agencies, some NGOs, university departments and private organizations are working on the arsenic problem and although there is lack of standardization in their work (for example, some are using laboratory methods, others are using kits for testing water) and exchange of information among themselves, an overall gloomy picture has emerged. Judging from the scattered reports publish to the press from time to time many organizations have found unacceptable level of arsenic in ground water form a vast majority of the districts of the country and a large number of patients suffering and dying from arsenicosis and its complications. To present a systematic view and statistically sound conception of the extent of the arsenic problem in Bangladesh, we below use data collected by Dhaka Community Hospital in collaboration with School of Environmental studies, Jadavpur University, Calcutta.
 

To date 30,000 tube-wells from 64 districts have been tested for the presence of arsenic in underground water by the above-mentioned organizations. In 47 districts water samples were found to have arsenic above 0.05mg/1, the maximum permissible limit, recommended by WHO and in 54 districts the arsenic concentration was more than 0.01 mg/1, the WHO recommended value for safe water. In those 47 districts where arsenic concentration crossed 0.05 mg/1 limit, 54.64% of the samples were found to have crossed that border. Area of these 47 districts is 47,732, sq. km with a population of 76.9 million. At the present state of knowledge it can be safely concluded that although not all tube-wells are contaminated, there are thousands of pockets of contaminated underground water in at least two thirds of the districts of Bangladesh and the people living there are at real risk of developing arsenic toxicosis.
 

In terms of patients

DCH and SOES conducted surveys for arsenicosis patients in 64 districts and found patients with arsenical skin lesions in 32 of them. They examined 24664 people in the affected villages and 33.6% of them were diagnosed as patients with arsenical akin manifestations. A Total of 2167 hair samples, 2165 nail samples, 220 skin samples and 830 urine samples were analyzed and an average of 94% of them were found to have arsenic concentration above the normal limit. A report form the National Institute of Preventive and Social Medicine stated that they had more than 800 arsenicosis patients in their list. At the skin department of IPGM & R 250 patients with arsenical skin lesions have been investigated and treated. It is obvious that if systematic surveys are conducted in all the districts where there is high level of arsenic in underground water, more patients will be found. So at this moment it can be safely concluded that there are thousands of arsenicosis patients in Bangladesh.
 

Causes of arsenic contamination

Earlier several hypotheses were put forward including one that the arsenic compound treated rural electrification poles were the source of arsenic contamination of underground water and the other that insecticides and fertilizers were the culprit, but these did not found to hold water. Now it has been more or less generally agreed upon that the source of arsenic contamination is geological with mobilization of arsenic due some Geochemical processes.
 

Efforts in mitigation of arsenic disaster

Since 1996 different organizations including the government, NGOs and private organizations have come forward to study different aspects of the arsenic problem and find out ways of combating against it, however these are still in very initial stage. The government has formed a National Steering Committee with the minister of health and family planning as its chairman. Other government bodies involved in the arsenic work are: Ministry of Local Government, Rural Development and Co-operatives (MoLGRDC), Ministry of Health and Family Welfare (MoH&FP), Economic Relations Division of the Ministry of Finance, Planning Commission, Environmental and Geographic Information System for water Resources Planning (EGIS), National Institute of Preventive, Social and Occupational Medicine, Department of Public Health Engineering (DPHE), Institute of Postgraduate Medicine and Research (IPGM&R).

International donor agencies have shown their interest in the arsenic problem. At least 3 arsenic teams of the World Bank have visited Bangladesh by December 1997. The UNDP has funded a Rapid Action Program (RAP) which is currently being implemented jointly by the Ministry of Health and Family Welfare and Dhaka Community Hospital in 200 villages of the arsenic affected districts. In 3 months time the program is to assess the gravity of the situation if the villages, seek community based solutions to the problem and put forward recommendations for further programs to be drawn. The UNICEF has provided field test kits to DPHE and other organizations and is considering elaborate programs. WHO invited arsenic experts to this country and held a meeting in New Delhi on the arsenic problem in Bangladesh. Foreign missions like the British High Commission/DFID, the Embassies of Japan/JICA, Denmark/DANIDA, Canada/CIDA and the Netherlands have shown their willingness to take part in the fight against arsenic. Asia Arsenic Network is actually running a project in Samta, a remote village in the western part of the country.

Some NGOs are actively involved in efforts to solve the arsenic problem. The Disaster Forum, an association of NGO’s working in disaster management was once very active in organizing arsenic activities, but now it seems to have lost its tempo. Perhaps without the initial support of the Disaster Forum, the arsenic situation would not have taken the shape it has today. Some other NGO’s deserve mentioning like ADAB, NGO Forum, BRAC, Grameen Bank etc.

As a private organization Dhaka Community Hospital has been involved in the alleviation of the arsenic problem form the very beginning. It has conducted extensive surveys, sampling, supportive treatment of patients, training programs for doctors and other health and community workers and awareness program. When at the beginning it was being said that the arsenic problem was not that serious and being exaggerated, DCH held a national seminar in January 1996 and proved that it was a real threat to our public health. Currently DCH is engaged in implementing the Rapid Action program in collaboration with the Ministry of Health and Family Welfare. It has organized the International seminar in collaboration with SOES.

School of Environmental Studies, Jadavpur University, Calcutta, West Bengal, India (SOES) has been the pioneer organization in ringing alarms for arsenic calamity in Bangladesh. Actually it is in the laboratory of this school that most of the water samples and almost all the biological samples from Bangladesh have been tested for arsenic. Its director Dr. Dipankar Chakraborty has extensively traveled over vast region of the country over and over again meeting with peoples in their doorstep, collecting samples and supporting and soothing patients and relatives. He has direct consultative links with almost all the organizations in this country who are working on arsenic. His role in raising the arsenic awareness in this country is enormous.

Other organizations that deserve to be mentioned include Atomic Energy Commission and BCSIR Laboratories who have some facilities for water testing, although very costly for the common people; ICDDR,B which is experimenting with removal of arsenic from contaminated water; geological departments of Rajshahi and Dhaka Universities, chemistry department of Jahangirnagar University and BUET who are doing some work in their respective fields.
 

Conclusion

There is no doubt that the arsenic situation in Bangladesh is very grave to say the least. Patients are suffering, relatives are desperate and physicians are at a loss. Still we are optimistic that with joint efforts of the government, national organizations, international agencies and scientific community some solution will be reached that will bring smile to faces of the distressed. To mobilize and organize efforts of the international community toward that goal is the prime target of this seminar.