by Ghamdan al-Daqaimi
Sana’a, Yemen , March 2015 –
(Al-Arabi al-Jadid) -Samar Ali fears the death of her three-year-old child, Ayham, once every month when he suffers from diarrhea and refuses to take oral rehydration solutions.
“He gets diarrhea almost every month, lasting two to four days at a time. The doctor says that it is mainly caused by drinking water,” adds Ali, 31, who lives in Sana’a.
Water scarcity is not the only problem for the residents of the Yemeni capital. Hundreds of thousands of people, particularly children under the age of 5, drink contaminated water which private establishments produce and sell as “treated and potable,” thanks to poor government supervision and inspection.
This reporter collected and tested samples from 10 different water bottling establishments in Sana’a, where a total of 180 plants serve hundreds of thousands among Sana’a’s 3 million population. The results of the tests, conducted at the National Center of Public Health Laboratories, showed bacterial contamination in 80% of the samples. The analysis also found human fecal bacteria in 60% of the samples which doctors described as the most serious type of contamination.
Drinking water producers exploit the Environmental Health Department’s poor supervision, the lacking role of the Water Resources Authority, and lenient penalties in the provisions of the Food Control and Regulation Law 38 of 1992, its amendments in Law 13 of 2002, and Ministerial Resolution 24 of 1994.
In addition to violating health requirements stipulated in the law, the original water source is also contaminated. There are more than 15,000 unsupervised random wells in the capital’s basin that constitute the primary water source for the bottling plants.
| The Food Control and Regulation Law stipulates “penalizing anyone selling food containing any form of toxic or harmful substance; food that is fully or partially made with damaged or alien substance making it unfit for human consumption; or adulterated food … with maximum prison of two months or minimum fine of 10,000 Yemeni riyals ($46.51 )…”
Such contamination is deemed the major cause of intestinal diseases, mainly diarrhea, according to specialized doctors and academics.
Concerned government agencies, which place diarrhea as the second most fatal illness among children under the age of 5, lack accurate statistics on the mortality and morbidity rate of diarrhea-related illnesses in this category. Children under 5 constitute 4 million of Yemen’s total population of 24 million. The United Nations Children’s Fund (UNICEF) said on its website in mid-2013 that nearly 70,000 Yemeni children under the age of 5 die every year from diarrhea, pneumonia, and malaria.
Hundreds of thousands of Sana’a residents turn to bottled water distributors to escape the contamination and rust of the public water supply network, which covers only 40-45 percent of the needs of the capital’s population. In addition, the network does not operate regularly, according to engineer Saleh Abdul Wadood, technical director of the Sanaa Municipality’s Water and Sanitation Institute.
Dr. Majed Al-Juneid, undersecretary of primary care at the Yemeni Health and Population Ministry, says that the water Yemenis drink “outside Sanaa” is more contaminated than the capital’s treated water. Replying to this reporter’s questions, Al-Juneid says: “You analyzed samples in the capital that we consider much better than the contaminated and untreated water most Yemenis drink in the rural areas and other cities.”
But Al-Juneid denies the Health Ministry’s responsibility, saying: “The ministry is not responsible for providing drinking water or controlling contamination.” He called for “concerted efforts of the different government agencies through raising awareness to obtain clean drinking water.” He says that the Health Ministry “is playing a major role in treating the problem of diarrhea cases, mainly introducing the Rotavirus vaccine, which is necessary even without contaminated drinking water.”
This reporter visited 10 establishments, each for three separate times and monitored the operation of unsupervised tankers transporting water from the wells to bottling plants, which partially treat the water and sell it in unclean and in repeatedly used bottles. This is not to mention the workers’ obvious lack of personal hygiene.
The workers (which include children) do not wear protective clothing, such as caps, masks, or sterilized gloves, in violation of Ministerial Resolution 111 of 2001 on health requirements for establishments producing and selling food products, as well as government regulations.
This violation was observed in all 10 establishments, which were too small without divisions between the production stages (except in one plant). The risk of contamination increases with workers sleeping on the job.
Only two bottling plants had glass façades, while the doors and structures in the rest do not block out harmful insects and environmental pollution, such as car exhaust fumes, smoke, and dirt. This also violates health requirements issued by the Environmental Health Department at the Public Works Office, in addition to the specifications set by the Yemen Standardization, Metrology and Quality Control Commission.
Yemeni Consumer Protection Society president Fadel Muqbil says that “more than 80 percent of these establishments produce water unfit for human consumption as they contain all types of harmful bacteria because treatment is limited only to filtering residue without killing the microbes and bacteria.”
Mohammad Mansour, a former worker in one bottling plant, says that “hygiene was not a priority” where he worked for nearly a year and half. He adds that “only water is used to wash the returned bottles without any form of sterilization” of white plastic containers for 4, 5, and 10 liters with a label sticker of the company’s name. The bottles are transported in uncovered trucks to the grocery stores to sell to consumers.
Among other offences that this reporter observed were toilets directly open to the space used for the production and sale of water without any form of insulation. If there were sinks, they lacked hot water, soap, and hand dryers. Workers using toilets return directly to work in the water bottling production lines after merely rinsing their hands.
In one establishment, a tube used fill the bottles was laying on the floor less than 150 centimeters from a toilet without a door. There are no sanitary fittings, as stipulated in the 2001 law, in this establishment, which also lacks general hygiene as dirt clearly covers the tiled floors and walls.
Dr. Sanad Abdo Mohammad, director of Al-Razi Medical Center in the Saawan neighborhood in eastern Sana’a, says that the center “received 617 people, including children, in the first quarter of 2014 with diarrhea, typhoid, and digestive and urinary diseases.” He adds: “Between 45 and 50 percent of the patients caught them from drinking contaminated water, mainly Kawthar,” the common term for bottled water.
The sample test results are catastrophic with record-breaking contamination found in this water. One tested water sample found 130 fecal bacteria cells per millimeter, while Yemeni specifications require bacteria-free bottled water.
Dr. Yahya Rajaa, professor of community medicine at Sana’a University, describes the results as “painful and interesting,” noting that the analysis “discovered that 80 percent of the 10 samples are contaminated — 60 percent with fecal coliform bacteria and 80 percent general coliform.” The tests proved that “only 20 percent of the samples are drinkable.”
Rajaa explains: “Coliform bacteria measures fecal contamination in water. It could be contaminated with other types of harmful and contagious bacteria, such as salmonella causing typhoid and shigella bacteria, which trigger severe diarrhea and digestive disorders.”
He continues to say that water may also carry “viral contamination, such as Hepatitis A and E and rotavirus, causing severe diarrhea, or primary parasites like amoeba and giardia, which are common diseases in Yemen.” He adds that drinking water is the major cause of these diseases in the country.
Dr. Khaled Al-Muayyad, associate professor of microbiology and immunity at Sana’a University Medical School, says that the bacterial results found in the lab tests “indicate there are other harmful types in this water, directly putting human beings at risk.” He notes “the emergence of these indicators in other similar stations (bottling plants) means it poses a direct risk on public health.”
Academics and doctors who saw the 10 lab results say that consumers drinking this water would immediately suffer diarrhea caused by viruses, bacteria, or parasites.
Al-Mu’ayyad argues that the tested water “is neither potable nor fit for human consumption and directly affects the elderly with low immunity because it gives them constant diarrhea.” He indicates that the risk of severe diarrhea could cause the death of children under the age of 5. “This reflects the grave damage posed on the segment of low immunity consumers.”
The Health and Population Ministry says in its annual disease report that 28,271 diarrhea cases were recorded in 2013, including 12,663 children under 5, in addition to 6,104 monitored by the epidemic surveillance program.
According to the same report, which compiled statistics from several government hospitals and community health centers in the capital, 23,958 suffered the following diseases: typhoid, paratyphoid, dysentery, amoebic dysentery, digestive disorders, parasites, and bacterial food poisoning.
Dr. Ali Jahaf, director of family health at the Health Ministry, says that water contamination and poor sanitation and general and personal hygiene are the main reasons for the outbreak of diarrhea.
UNICEF warned last March against what it called the “hovering threat of outbreaks of cholera and other water borne diseases in Yemen.”
Dozens of parents interviewed in Sana’a agreed that diarrhea was the most common disease among their children during the past two months.
In western Sana’a’s Hael Street, Taha Hussein Al-Ridi, a 32-year-old carpenter, says that his son, 18 months, and 3-year-old daughter “have repeatedly suffered diarrhea since their birth. It is mostly severe diarrhea that begins with a high fever and it worries me.”
Dr. Wassim Al-Zanem, pediatrician and internist at the World Islamic Relief Commission’s medical center in Al-Sanina neighborhood in western Sana’a, says that the center received 3,000 children in the first half of 2014. He indicates that 30 to 50 percent were less than 5 years old, suffering diarrhea and other intestinal illnesses (food poisoning, stomach and intestinal infections, dysentery, and typhoid). He adds that “uncontrolled contaminated drinking water is the main reason for the outbreak of these diseases.”
Nabila Al-Hakimi, a laboratory specialist in the same center, says that 161 children tested from August 1 to August 19, 2014 “showed that 70 had shigella bacteria and 91 had common parasites and worms, such as amoeba and giardia.”
Internist Dr. Saeed Numan says that “this water is a significant and major cause of these diseases, but children are the most vulnerable to diarrhea because some mothers use it to make their infants’ formula.”
Stunted growth and cancer
Repeated severe diarrhea during childhood is also largely responsible for the general short stature (dwarfism) of the Yemenis, according to Sami Saeed, head of UNICEF’s water and environmental sanitation. “If we want to improve the Yemenis’ height, we must reduce diarrhea,” he says.
UNICEF indicates that “among Yemen’s 4.5 million children under the age of 5, more than two of five children suffer stunted growth and dwarfism, leading to serious effects on their physical and mental growth; nearly 13 percent suffer severe malnutrition.”
Like thousands of consumers who believe danger dwells in the water’s atoms, Mohammad Al-Jadri says: “Sometimes we notice an increase in chlorine in the water because we can taste it.” This confirms that unqualified staff operates these establishments, in which 70 percent of bottling plants in Sanaa treat water with ultraviolet rays and 30 percent treat it by adding chlorine or other sterilizing solutions, according to the Environmental Health Department, the regulating authority.
Dr. Abdul Jalil Darham, chemistry and food analysis professor at Sana’a University Agriculture School, says that high chlorine ratios in water beyond the safe range (0.5 percent part per million at least 30 minutes after contact) affects the liver on the long term. Other medical sources say too much chlorine in water could cause cancer of the liver, bladder, and kidney.
Attention to vaccines, ignoring primary reason
The Health and Population Ministry spent millions of dollars annually since 2012 to provide the anti-diarrhea Rotavirus vaccination, which does not have guaranteed results, according to an employee at the ministry. Health officials say that the contaminated water problem, which is the primary cause of diarrhea, is the responsibility of other government departments.
But the Health Ministry acknowledges that diarrhea caused by the rotavirus was responsible for the death of 5,000 children under the age of 5 — before the vaccine — and the reason for 43 percent of all other diarrhea cases, according to epidemic surveillance data sponsored by the World Health Organization (Al-Sab’een Hospital in Sanaa and Swedish Hospital in Taiz).
Some 1,855,500 doses of this vaccine were imported in 2014 to inoculate more than 850,000 Yemeni children under the age of 12 months as part of the routine immunization program.
Dr. Jahaf (family health director) says that the government contributed $615,737 in 2014 of the actual cost of the vaccination. The Global Alliance for Vaccines and Immunizations contributed $4,155,500 under an agreement between the two sides.
Asked about giving attention to the vaccine and ignoring the main reason — or contaminated drinking water — Jahaf says: “Because it is the product of human experience through thousands of years, which cites that prevention is better than cure. It is the golden rule averting communities and individuals from costs and the tragedy of disease and treatment.”
He adds: “Improvement of water, sanitation, and public and personal hygiene will undoubtedly ease the diarrhea problem, but will not completely eradicate it, which prompted advanced countries to vaccinate their children as protection against diarrhea.”
On the same issue, Saeed from UNICEF says: “Rotavirus is one of the important vaccinations recommended by WHO … There is definitely a need to highlight the importance of obtaining safe water, keeping it clean, and raising awareness across society.”
A Health Ministry employee, who spoke on condition of anonymity, says that the ministry’s failure (before introducing this type of vaccine) to adopt a comprehensive scientific study identifying the most prevalent genotypes of the virus — as well as the different immunological and physical factors of Yemeni children — does not eventually lead to best practice.
Even worse, the same source says, there is no supervision or assessment of the results of the vaccination and its effect on reducing disease and death of children in Yemen, although world standards require these measures.
He confirms that the Health Ministry, WHO, and UNICEF directly or indirectly contribute in maintaining diarrhea diseases by showing no interest in finding a solution to the main cause represented in contaminated drinking water.
Health Ministry, WHO, and UNICEF officials deny this accusation.
Dr. Sanad Mohammad says that it is more important to “provide the 70 government medical centers in the capital with the required facilities, equipment, and solutions they currently lack, making the task of saving and detecting many diseases difficult.”
Accusations, violations, non-deterrent rulings
Most water bottling plant owners show understanding of the lab test results and complain about the negative behavior of some inspection employees.
One such owner, who spoke on condition of anonymity, says: “Business has declined since 2011, preventing me for doing the necessary maintenance in my establishment.”
Another owner says that upon taking three of his workers for medical tests for health insurance, a government inspector “tried to convince me to ignore the issue in return for a bribe, but I went ahead with the official procedure.”
According to Environmental Health Department statistics in Sana’a, violations were issued against 64 water treatment establishments from January to July 2014 for partially treating drinking water; 35 were referred to the prosecution for violations that included water contamination.
The violations cited lack of health insurance for workers, failure to conduct regular lab tests on produced water, failure to change the filters on required time, using containers with green algae inside, and using dark pipes instead of transparent ones to fill the containers from a treated water tank.
The Food Control and Regulation Law 38 of 1992 and its amendments penalize offenders to a maximum prison term of two months or a minimum fine of YER 10,000 ($46. 51). According to Ministerial Resolution 24 of 1994, under which most violations are issued, the fine is set at YER 100 – 3,000 ($0.46 – $13.95).
Water Law 33 of 2002 and its amendments set the minimum penalty of one month prison or a maximum fine of YER 300,000 ($1,395.34), but it has yet to be enforced.
Dr. Mohammad Al-Asbahi, director of the Environmental Health Department (municipality), says: “Our role focuses on control, inspection, issuing violation notices, and referring offenders to the prosecution for the judiciary to handle the issue, which usually entails non-deterrent fines.”
He adds that “judicial procedures are different in the districts and depend on the judge’s discretion. We do not interfere in the court procedures and some become annoyed if we ask about the measures taken.”
Government regulatory parties blame lack of capabilities for the ongoing deterioration.
Mohammad Ali Abdo Mohammad, health inspector at the Environmental Health Department, says: “We have many difficulties, mainly lack of technical and financial capabilities, in addition to the necessary and sufficient field equipment and inadequate laws.”
Mohammad adds that inspection operations have recently become more difficult with the general power cuts, saying that they “prevent inspection of sterilization units during official hours when there is no electricity to operate the equipment.”
Al-Asbahi cites the following reasons disrupting efforts to secure water that is fit for human consumption: Shortage of qualified personnel, security problems facing his employees and curbing them from taking measures against the offenders, negligence of the plant owners, other regulatory agencies do not control the wells, and other reasons.
Al-Asbahi says that his department has four water specialists for 180 plants in the capital, adding that “one employee passes by one establishment once every two to four weeks.”
On accusations of corruption among employees, the director of the Environmental Health Department says: “All regulatory agencies are accused of corruption, especially municipal employees. People even look at the penalty fines as robbery and blackmail. We suffer from the consumers’ lack of trust and cooperation with us to arrive at better control.”
Al-Asbahi adds: “We established a hotline for consumer complaints on all types of commodities, including bottled water. Water establishment owners can call 012777038. We attentively receive complaints around the clock and we can go personally to the specified locations to take the necessary measures. But unfortunately, no one is interested in making complaints.”
He continues to say: “The reusable containers in these establishments are in bad condition due to their unhealthy misuse and inability to clean them properly. This is the biggest problem we face at the municipality.”
Abdo Mohammad agrees, saying: “We hope for a binding decision banning the sale of these containers and obliging the owners to abide by the ban. Different sized disposable and inexpensive containers have been introduced in an attempt to overcome the trend of reusable containers.”
The Water Resources Authority in Sana’a, which is authorized by law to ensure that the water sold meets Yemen’s specification standards, earlier this year launched an ambitious program to organize the participation of the private sector, which is supplied with city drinking water (wells, technical and bottling establishments, and tankers).
Despite the authority’s repeated advertisements since January about issuing licenses to practice, none of the water producers bothered to license their establishments. Meanwhile, specialists at the Water Authority and Environmental Health Department accuse each other for not signing last March’s agreement specifying each side’s functions and authorities.
| There are 180 private establishments in the Yemeni capital, Sana’a. Most lack minimum hygiene requirements, producing contaminated drinking water that threatens public health and affects hundreds of thousands of residents, especially children under the age of 5. The Environmental Health Department at the Sana’a Municipality filed violations against 64 establishments in the first seven months of 2014; 35 were referred to the prosecution for violations including contaminated water, failure to wear protective and appropriate clothing during work, and failure to change filters on required time. The courts mostly rule with non-deterrent fines.
* This investigation was conducted with support from Arab Reporters for Investigative Journalism, ARIJ — www.arij.net – and coached by Hisham Abdullah.