There are probably more than 11 million nationwide. Initially the tubewell revolution was held responsible for ridding the country of the terrible cholera and typhoid epidemics of the 1940s and 1950s. Yet these diseases still occur extensively and it seems that it is the improved knowledge about their treatment that has significantly decreased the death rate, not a cleaner water supply. UNICEF has acknowledged that the widespread use of tubewell drinking water has had almost no detectable impact on the rates of diarrhoea] disease and parasite infection.

But this pales into relative insignificance alongside the monumental tragedy with which they are now associated - millions of people in Bangladesh are being slowly poisoned by arsenic which has contaminated the water drawn from the tubewells. It is not fully understood why arsenic which occurs naturally, is increasingly being released into groundwater. But studies indicate 1 in 10 people who regularly drink arsenic-contaminated water may ultimately die from cancers, including those of the lung, bladder and skin.

Fatima assists in the outpatients department of a Dhaka hospital. She is welcoming and helpful to patients. After the department closes, she sits quietly embroidering. She came to the hospital for treatment when her skin became blemished. The dark, blotchy patches were diagnosed as symptoms of arsenic poisoning. Her family no longer wanted her at home and saw little chance of getting her married, so she stayed on at the hospital.

By contrast, in another village the local community has helped Ali to continue supporting his ailing family. He was a labourer until pain from the black warty nodules on his palms and soles made it impossible. He now sells betel nuts and runs a small stall bought with a donation from his village.

In the hospital ward above Fatima, Josma lies recovering from a leg amputation after her nodules changed to cancerous gangrene. She is just 10 years old. Recently discharged from hospital is Abu, who was treated for bladder cancer. Rekha died from lung cancer. Many more internal cancers go undiagnosed.

In 1996 doctors from Dhaka Community Hospital working at a mobile health clinic noticed that a large number of patients had skin conditions that could indicate chronic arsenicosis. Then they encountered a man who had been told by doctors in India that he definitely had arsenicosis and that it came from Bangladeshi tubewells.

With great difficulty the following history of silence was unearthed. The Bangladeshi government had been told about the possibility of pollution in 1984, had tested a few tubewells and found at least one with arsenic. It kept quiet. Tubewells continued to be installed. In 1993 the Government and the World Health Organisation were officially told. They kept quiet. In 1995 a delegation of Government and UN agencies went to an international conference on arsenic poisoning in Calcutta but on their return they continued sinking tubewells and remaining silent.

When the Dhaka Community Hospital discovered what was happening, they went to the agencies involved to expose the problem. They were accused of being scaremongers trying to create panic. The hospital went to the press but official attempts to suppress the news continued.

Finally in January 1997, survey results from 14 of Bangladesh�s 64 districts were published showing high arsenic toxicity levels in tubewell water. It was another three months before the problem was acknowledged in a WHO statement saying that arsenic in drinking water was a �Major Public Health Issue� which should be dealt with on an �Emergency Basis�. It was a further two years before UNICEF admitted publicly on US television that they had been �a part of the problem.� Under pressure from the Government, funded by the UN Development Programme, did its own survey in 1998 and confirmed the extent of the problem So years of possible remedial action were wasted. Tubewells need retesting at least every three months - yet no retesting policy has been formulated, and field-testing kits are neither publicly available nor cheap.

This is the story of the largest poisoning of a population in history, with millions at risk. Yet aid agencies and the Government have taken years to admit their mistake.

This shocking story by Asa Zama has been taken from the March 2001 issue of New International. It is particularly disturbing because in many of these agencies completely well-intentioned people were responsible for the lethal silence. As our readers will grasp, the moral of the tale extends far beyond Health Care and Bangladesh.

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In the WSJ (22/3) we read under the bylines of Peter Waldman and John Fialka:

�The Environmental Protection Agency�s decision Tuesday to rescind the Clinton administration�s tighter standard for arsenic in drinking water was welcomed by communities and industries facing high costs for cleanup.