Water Pollution Silent Killer in North Afghan District

In June 2011, Najibullah, a farmer from the village of Larghan, a collection of mud-walled compounds on the edge of the city of Aybak, brought his uncle and five cousins to the Samangan provincial hospital in northern Afghanistan.

All of them had been violently sick after drinking from the river that provides the village’s only source of potable water, Najibullah told an IWPR reporter at the hospital.

Illness caused by contaminated drinking water was not uncommon, the farmer said, and the problem was worsening year by year. Since 2001, increasing numbers of villagers had been struck down after drinking from the local water source, despite an influx in development aid that he and other villagers said hardly addressed the need for clean drinking water.

At the hospital, an aging facility with few beds, Dr Ahmad Shah Samie, who treated the men, confirmed that the water source was the cause of this most recent outbreak of illness.

“They were all suffering from dehydration after getting sick from drinking dirty water,” he said. “In this instance, all six were treated and survived,” he added.

Many others have not been so lucky.

Walking through the cemeteries of the villages around Aybak, a city of 170,000 not far from the border with Uzbekistan, one can see hundreds of graves of men, women and children who died prematurely. They are not victims of war. If local medical personnel and family members are to be believed, drinking water is the hidden killer, causing hundreds of deaths from dehydration, diarrhoea, typhus fever and kidney disease.

The issue came to light most recently when Dr Yusef Faez, then head of the Samangan provincial hospital, told the local Ariana TV station that only two per cent of Aybak’s residents had access to clean drinking water – a claim that is disputed by other provincial officials – and questioned why provincial officials were not addressing the problem.

The day after the interview aired, Faiez was fired from his post by Samangan governor Khairullah Anush, who was, according to officials from his office, incensed at the doctor’s temerity.

Faez’s abrupt dismissal is symptomatic of broader attitudes of official indifference toward Aybak’s water crisis, according to villagers and some officials interviewed by the IWPR reporter.

In an investigation conducted over several months, the reporter discovered that the number of deaths caused by contaminated water in villages around Aybak appears to be vastly under-reported by provincial health officials.

A handful of senior health officials admit that the issue of water-related deaths has been downplayed, saying that to reveal the true scope of the problem would expose them to severe criticism from central government.

Others, however, dismissed the claim outright, with one saying the deaths were “not the media’s business”, and another – a senior health official – refusing to allow his subordinates to talk to IWPR.

The reporter spent June and July documenting 744 deaths – 219 men, 225 women, 300 children – that occurred between 2009 and 2010 in the villages of Hasan Khil, Quch Nehal-e Bala, Quch Nehal-e Payin, Dalkhahi and Larghan. He created a basic questionnaire which he used in interviews with heads of households in the five villages, asking whether deaths had occurred in the family, what caused them, whether officials had been notified, and whether the death was linked to drinking water.

The reporter then surveyed the village cemeteries, looking for new grave sites.

Interviews conducted with village representatives confirmed that a large number of deaths had been caused by contaminated water.

Aybak, located on the banks of the river Khulm, is well-known for the melons grown in the area. Villages located some distance from the river receive irrigation water every 20 days or so. Some of this water runs into underground cisterns and the rest is stored in open-air reservoirs.

A visit to one such reservoir about seven kilometres from Aybak found about 25 women and children by the water, along with four donkeys which had walked down a series of steps cut into the earthen walls and were standing in the muddy pool at the bottom of the catchment area.

The women and children were gathering water in plastic gallon jugs. One woman filled a bowl and gave it to a donkey to drink. When the donkey finished, the woman poured the rest of the water into her plastic jug. Asked why she did this, she replied, “The water is clean, because donkeys just suck up the water like sheep. If it was a dog, it would make the water dirty, because they drink differently from donkeys.”

Nearby, a donkey urinated along the edge of the reservoir, and this ran down into the water. Half the surface of the water was choked by plants and grasses. Stirring the plants with a stick turned the water a muddy black.

After the jugs were filled, the villagers loaded them on the donkeys to take back to their homes. In front of one house belonging to a man called Shir Ali in Hasan Khil village, several one-gallon jugs sat in the open under the hot sun. One had no lid, and the water was hot to the touch.

Shir Ali, a 50-year-old who has lived in the village his entire life, described how he gets drinking water for his family. He walked over to a group of clay pots and lifting the plastic sheet covering them. The water was grey and worms could be seen in it. Ali described pouring the water through a piece of cloth to filter out the worms, saying that this prevented his family from becoming sick.

He acknowledged that these primitive measures were not enough to keep everyone healthy, and that those who did fall ill frequently had little recourse other than to wait for their sickness to end and hope they survived.

“We are poor and don’t have good water sources or [medical] facilities. When we get sick we just wait to see if we die,” he said.

While regional health officials were generally unwilling to release certificates giving cause of death, the IWPR reporter was able to review hundreds of the documents that sick villagers have to fill out before they are admitted to hospital. Village administrators have to collect these documents, which include symptoms suffered by the sick, before the patient is registered at the government hospital in Aybak, a 70-year-old facility with 30 beds and approximately 25 doctors.

The documentation revealed a haphazard registration process that frequently failed to record patients’ symptoms accurately and led to excessively broad diagnoses and vague causes of death.

Hospital administrators say they see 250 to 300 patients a month who are ill because of poor drinking water.

Dr Shafiullah, head of the provincial epidemic diseases department, acknowledged that in the past five years, dehydration, diarrhoea and typhoid fever – all caused by dirty water – topped the list of illnesses, including those with fatal outcomes.

Other hospital officials, however, estimated the number of drinking water-related deaths in 2009-10 at only around 300. Most refused to comment when shown the list of 744 deaths compiled by IWPR after a month spent interviewing family members and neighbours in villages and photographing grave markers.

Dr Abdul Hamid, director of health services for Samangan province, disputed both the number of patients and the causes of death claimed by those hospital staff who spoke to the reporter.

While visiting the Samangan hospital, IWPR’s reporter witnessed Dr Abdul Hamid accusing Dr Shafiullah of revealing “our secret information” on the number of water-related deaths.

Dr Abdul Hamid later asked the reporter not to publish the findings of the investigation, saying that to do so would lay the provincial health administration open to criticism.

“There have been too many cases involving deaths during that period… if this list of deaths is published, the Ministry of Health will order an investigation into the [provincial] health department about this,” he said.

In Kabul, a spokesman for the health ministry dismissed claims that a large number of deaths can be attributed to poor quality drinking water.

“In Afghanistan, 27 per cent of people do not have access to clean drinking water, but this is not the cause of any of the deaths that you mention,” said the spokesman, Ghulam Sakhi.

In Aybak, the official response to difficult questions about water quality and the link to rising numbers of deaths has been to refer the matter further up the administrative ladder.

“If people want to have clean water, they should put pressure on the governor, the mayor and other representatives,” Ahmad Ali Tamsake, a member of Samangan’s provincial council, said. “If they don’t, this [officials] unresponsiveness will not stop.”

Governor Anush refused IWPR’s repeated requests for an interview, directing him instead to his spokesman, Sediq Azizi.

“These people are not neglected. Every year we present our problems to the ministries in Kabul, but they have not taken any action yet,” Azizi said. “But basically, these deaths are the will of Allah. They are not the media’s business at all…. It isn’t the governor’s fault that wells cannot be dug in Aybak.”

Other officials in the provincial government – the mayor if Aybak, the head of reconstruction programmes in Aybak, Mohammad Aman Amin, and water department head Mohammad Rasul, claimed to know nothing about deaths from contaminated water.

None would comment on the situation, though Mohammad Aman Amin claimed the government had spent four million US dollars in the past four years on improving drinking water across the province. He said dozens of 300-cubic-metre covered reservoirs had been built in and around Aybak.

Villagers say the illnesses continue, and that the reservoirs are uncovered and the water unfiltered.

In Kabul, health ministry spokesman Sakhi said his ministry was not responsible for providing clean drinking water. “Distribution is not our responsibility. We only provide medical services,” he said.

Villagers in Hasan Khil say they expect one or two relatives to die every summer, the period when good-quality drinking water is least available. But they say they have recently carried so many family members to their graves that they do not cry any more.

Shir Ali told the reporter that two years ago, his 12 year-old daughter fell ill after drinking water.

“Moment by moment her condition worsened and she was in great pain,” he said. “The following morning, I took her to a doctor who told me, ‘Your daughter has cholera and she’ll probably die in one or two days.’ She actually died five hours after arriving home later that day.”

Najibullah Danish is an IWPR-trained reporter in Afghanistan.

This report was produced in November 2011 as part of the Afghan Investigative Journalism Fund project, and originally published on the Afghan Centre for Investigative Journalism website which IWPR has set up locally.