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Arsenic Crisis Today -
Strategy For Tomorrow

Dr. Zafar Adeel
Academic Programme Officer
Environment and Sustainable Development, UNU



Awareness about the pollution of drinking water with arsenic and the significance of the crisis rose significantly within the international community during the 1990's. In the developing world, the presence of arsenic in groundwater extracted from the alluvial aquifer underlying West Bengal and Bangladesh has highlighted the significance of this problem. In fact, the estimated number of affected people in this region alone is of astonishing proportions. Naturally-occurring and human-induced arsenic pollution in drinking water has since been discovered in many parts of the world. It is now recognized as a problem of truly global dimensions. It also means that our earnest attention and the collaborative efforts of researchers, practitioners and officials are required to combat this crisis.

This document presents ideas and concepts for ways to cope with the arsenic crisis. The focus is on Bangladesh, but the findings may be applied to any other part of the world. The information in this document is targeted to the general public, policy makers and practitioners in the field. The problems are indeed very complex and span a number of sectors and stakeholders; a simplified approach for describing these issues is taken here.

It is my hope that by working together with international agencies, bilateral donors and national governments, we can identify approaches best suited to deal with this complex problem. The people affected by this crisis need our urgent attention. Our collective efforts must be based on clear thinking and built around practical steps that can lead us to concrete solutions for the future.

Prof. Hans van Ginkel
Rector, UNU
UN Under Secretary General

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A Message from the Speaker, Bangladesh Parliament

I am happy to learn that the United Nations University and NGO Earth Identity Project are going to hold a roundtable discussion on one of the more serious health hazards of today - arsenic contamination. I am distressed to hear that possibly 20-30 million people in Bangladesh are affected by arsenic contamination, and that out of 64 districts, people of 59 districts are affected by arsenic. It is also horrifying to contemplate that another 80 million people are under threat of dying from arsenicosis within the next few years. To avoid such a catastrophe, immediate measures to combat the disease should be taken nationally and internationally.

Although some steps have been taken to mitigate the crisis facing our country today, I believe more effective and speedy measures should be undertaken before the disease takes more valuable lives. It is encouraging that Earth Identity Project and the United Nations University have come forward with numerous ideas to overcome this horrifying problem today. I hope that they succeed in their efforts and wish them all the best.

Mr. Humayun Rashid Chaudhury, MP
Speaker of the Bangladesh Parliament

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A Summary of Policy Alternatives

The arsenic pollution crisis in Bangladesh is a disaster of unprecedented proportions. The number of people potentially impacted by this problem (some 28-35 million) is more than that for any of the individual crises facing the humanity today. By the virtue of its sheer size, it is pushing the limits of our knowledge and the capacity to respond to it. It is a complex problem that is multi-faceted and multi-sectoral. In turn, it requires clear thinking and a comprehensive strategic response. This strategy should be cohesive and cover all aspects of the problem. The actions under such a strategy should be clearly divided into emergency measures that into effect right away and long-term tasks that work gradually over the next few years.

Emergency Measures

  • Raising public awareness should be the starting point for any approach to deal with the arsenic problem
  • Groundwater treatment technologies that are cheap, efficient and easy to use should be applied at a large scale as an interim or mid-term solution
  • Immediate measures must be taken to protect the health of those living in areas with arsenic-contaminated water
  • Improving nutrition and fighting undernourishment has to be a central element of the fight against the arsenic crisis
  • Participation of the civil society has to be a key element of designing, planning and implementing remediation strategies
  • Intra-governmental coordination is a must for effective implementation
  • Information dissemination and transparency play a key role in effectiveness of remedial strategies while building the confidence of stakeholders, particularly general public

Long-Term Policy Alternatives

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The Arsenic Crisis - A Disaster of Unprecedented Proportions

The pollution of groundwater by arsenic in West Bengal, India and Bangladesh has led to a human disaster of unprecedented proportions. Some recent estimates show that more than 35 million people are potentially at risk from drinking arsenic-contaminated water (Smith et al., 2000). This indeed brings the problem to a catastrophic scale in a limited region never before experienced. In comparison, the current estimate of people possibly infected by the HIV virus all over the world is around 34 million (UN AIDS, 2001). The sheer magnitude of this disaster means that we are faced with new challenges and tasks that have likely been never undertaken before. It also provides an opportunity for various actors to join hands and improve the situation for those affected by this problem.

The crisis has its roots in another worthy effort to fight water-borne diseases that had impacted this tropical region for a long time. Acute health problems, such as gastrointestinal diseases and infant mortality, were attributed to drinking bacteria-contaminated surface water. It was therefore believed that using groundwater would easily circumvent the problem because groundwater at certain depths is not exposed to bacterial contamination. Presence of arsenic in groundwater was not considered a concern during the 1970's when a campaign of switching to groundwater as a source of drinking water was undertaken. Over a period of about 20-25 years since then about four million wells have been installed to utilize the groundwater from shallow aquifer layers, typically less than 200m deep (UNICEF, 1999).

The alluvial aquifer that underlies the Ganges-Brahamputra river basin contains arsenic in mineral form. Exploitation of groundwater from these wells for drinking water and irrigation purposes has resulted in mobilizing the arsenic (Rahman et al., 2001). Presence of arsenic from natural and anthropogenic sources in the groundwater is not unusual and has been documented in other parts of the world, including Brazil, Thailand, Taiwan, and Vietnam.

Areas Affected by Arsenic Pollution

The British Geological Survey (BGS), in cooperation with the Department of Public Health Engineering (DPHE) of the Government of Bangladesh (GoB), has conducted the most systematic nation-wide survey of the water quality in wells (GoB, 2000). The aim of that study was to establish the extent of arsenic contamination and to understand the basic hydrochemistry. The final data set for that study comprised samples from 3534 tube wells from 61 of the 64 districts and 433 of the 496 thanas in Bangladesh. Although almost all the pertinent areas of potential arsenic contamination were sampled, the sample size is approximately 0.1% of the total number of wells in Bangladesh. As a result of this survey, the spatial extent of the arsenic pollution is well-defined in general, although much greater localized information is still needed.

The DPHE/BGS survey has also helped estimate the population exposed to drinking water in which arsenic exceeds the Bangladesh drinking water standard of 50 parts per billion (or microgram per liter). These estimates range between 28 and 35 million, and are also significantly higher than those provided earlier (e.g., an estimate of 20 million provided by WHO). Even more importantly, size of the problem is also related to how the "arsenic-clean" water is defined. If, for example, the WHO guideline for arsenic in drinking water is used the number of people affected jumps to the 46-57 million range - an increase of more than 60%!

These numbers clearly indicate that the magnitude of the problem is immense. Consequently, the response to the problem has to be accordingly scaled-up. It also means that the response has to be undertaken at a much faster pace than has been the case. This, undoubtedly, would require concerted and cohesive action by various players active in this field.

A Public Health Catastrophe

It is important to appreciate the suffering of the large population impacted by arsenic poisoning through drinking contaminated water. A large number of patients with visible or measurable health impacts are anticipated - although such precise estimates for Bangladesh have not even been developed as yet. In neighboring West Bengal, about 200,000 patient are estimated by WHO for an exposed population of about 1.5 million. The exposed population in Bangladesh is at least 20 times that in West Bengal!

An additional complicating factor in underestimating the impact of arsenic exposure exists. It takes several years of drinking arsenic-contaminated water to develop visible symptoms - although they may appear earlier in some patients. This hints towards a "surprise factor" where a much larger than anticipated number of people may be impacted.

Societal Problems and Lack of Knowledge

Several studies on the arsenic crisis indicate the lack of knowledge about the arsenicosis, its causes and possible remedies. This is particularly true because the vast majority of the population lives in rural areas and is not well-educated. Pre-existing notions and superstitions about the diseases triggered by arsenic exposure further worsen the situation. This is despite the concerted efforts made by many players to educate the general public and raise the level of awareness. Given the magnitude of the problem and the level of education amongst the villagers, this is a particularly challenging undertaking.

Additionally, the arsenic contamination problem has triggered a number of social and societal problems that could not have been foreseen and are still not fully recognized or understood. Recent studies confirm that worst arsenic problems are encountered by the poorest fraction of the society (WHO, 2000) - particularly those who are already undernourished. Significant gains can be made in educating the people about improving the level of nutrition in their diet and supporting them in the endeavor, as and when necessary. By adopting a policy of improved nutrition the vulnerability of the exposed population to health effects can be minimized.

There is also a certain social stigma associated with people affected by arsenicosis, with the disease wrongly attributed to sins in the current or past lifetimes. Clearly, this indicates that ignorance about causes and remedies for the arsenic-related problems. Yet another societal impact is that on livelihoods of families that lose head of the household or "bread-earners" to the disease. There is a need for serious consideration of alternative livelihoods for people who may be affected by arsenicosis as well as for the orphans and widows of those who pass away.

It needs to be re-emphasized the raising public awareness on the arsenic pollution and related health problems is largely a societal problem. One has to overcome the obstacles mentioned earlier to make a public awareness campaign successful. Therefore, it is critical to fully engage the civil society in developing and implementing such campaigns. Numerous NGOs active in this area could be an invaluable asset in this respect.

The Need for Urgent Measures

It is obvious that the scale of the problem has caught everyone by surprise. Historically, disasters of much lesser magnitude (such as major floods, earthquakes or even the AIDS epidemic) have required a response on "emergency" footings. In this case, the additional incentive is that significant time has been spent in fully understanding the magnitude of the problem. This increases the level of urgency in developing and implementing a comprehensive response.

The Bangladesh government, with support from international agencies and local and international NGO groups, have initiated a number of programmes to determine the extent of the problem. It is also undertaking a complete evaluation of arsenic levels in all the wells in Bangladesh; please see the graphic below outlining the well screening process being coordinated by BAMWSP. Considering the unprecedented scale of this disaster, it has been a major challenge to come up with a cohesive strategy to tackle the problem. This is particularly difficult because the problem is multi-dimensional and involves a number of sectors. Another confounding factor is the scientific uncertainty in a number of aspects, including the exact mechanism of arsenic mobilization, exact delineation of arsenic contamination (with concentration levels and estimated water volume) and effective medical remedies for arsenicosis.

A number of measures are proposed in this document that draw upon previous experiences in disaster management but are specific to the problem. Such measures would include extensive awareness raising programmes, public health protection initiatives, measures to improve the level of nutrition in villages, and providing means to treat water at either household or community level. Successful implementation of these activities requires close cooperation and joint implementation with civil society actors. Involvement of NGOs in design and implementation of activities is critical.

The most important element in these emergency responses is the role of the Government of Bangladesh. It has to provide guidance and leadership in the emergency initiative while also serving as a coordinator and facilitator between various agencies. Obviously, this is no easy task! In other emergency situations, intervention at the highest level of government is often required to elicit an appropriate response. A similar approach in Bangladesh should be encouraged.

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Emergency Measures Needed

The unprecedented scale of the arsenic crisis means that much rapid action is necessary to minimize its impact. The population that has been impacted can be offered improved access to improved nutrition, facilities for getting hygienically-clean water, and educating the affected population about nature of the problem and how to cope with it. Natural disasters - which typically occur at a much smaller scale - require action on emergency footings to minimize adverse effects. Well-established codes of conduct - such as those developed by the International Red Cross - should provide overall guidelines for the humanitarian relieg efforts. The arsenic crisis also demands setting up of similar emergency management institutions and involvement of the GoB and other stakeholders at the highest level.

Raising Everyone's Awareness

It is of utmost importance to make the general public, practitioners and policymakers aware of the full range of issues relevant to the arsenic crisis. The most essential element of this activity has to be informing people that consuming water containing arsenic has serious health consequences. Obviously, this approach can only work if alternative sources of drinking water are also available simultaneously. These can include methodologies for treatment of contaminated water at household and community level, rainwater harvesting, utilization of groundwater from deeper aquifers and bottled water supply. In response to the urgent need for awareness raising, GoB and UNICEF launched in December 1999 a Nationwide Communication Strategy for Arsenic. This strategy has been implemented fairly successfully and its impacts should be fully evaluated.

The existing strategy must be further strengthened through involvement of various international agencies and civil society actors. This strategy constitutes an integral part of the arsenic mitigation activities, and will seek to raise of public awareness to change water use patterns. The materials designed for this programme will promote changes in lifestyle behavior - particularly water usage - in communities impacted by arsenic contamination. Those efforts will be reinforced by messages disseminated through mass media.

Any awareness-raising campaign has to involve various members of the civil society, including health workers, doctors, engineers, technicians, agricultural extension workers, imams, students, and NGO groups. Such a campaign must comprise the following elements:

Public Health Protection

The impacts of arsenic pollution on human health - keratosis, melanosis and others - are typically gradual. Some researchers have divided them into four categories or levels ranging from mild to severe (Oshikawa et al., 2001). The transition from one level to another occurs due to continued long-term exposure to arsenic contaminated water. Some of the research work done by Oshikawa et al. (2001) in Thailand clearly indicates either improvement in health or halting further worsening when use of contaminated water is discontinued in the early stages of the disease. This has important implications for formulating health protection alternatives. It goes without saying that provision of clean and affordable supply of freshwater is absolutely essential to halting the further impacts of the problem.

Developing and implementing a health policy for arsenicosis patients poses several challenges for government agencies, civil society groups and international organizations. Firstly, convincing the general public that the simple step of using clean freshwater will help with the emerging epidemic is a difficult task. This difficulty has to be viewed in the context of similar publicity campaigns carried out in the 1970's and 1980's to promote that groundwater is the safest source of water. The credibility barrier so-created can be overcome through involvement of local communities in the development of health protection programmes. Secondly, providing clean freshwater at low cost or free of charge would require considerable investment in developing, managing and operating a reliable water supply system. Interim measures such as supplying bottled water may not be sustainable in the long-term. Needless to say, international funding agencies as well as bilateral donors can and have stepped in to assist in the process.

Another important public health issue is setting the standard for what is "clean" water. Currently, Bangladesh employs a drinking water standard of 50 parts per billion (or micrograms per liter) which is based on some earlier guidelines established by the World Health Organization (WHO, 1993). Many countries including Bangladesh have either kept this as the national standard or as an interim target, with the realization that significant impacts may also exist at lower concentrations in the 10-50 part per billion range. Existing scientific evidence should be weighed carefully and the drinking water standard for arsenic should be reviewed for Bangladesh's own conditions. Obviously, this will have significant impacts in identifying and delineating the regions impacted by the arsenic groundwater pollution.

In order to undertake an emergency-based response to protect the public health, a number of steps must be taken on immediate basis. These should include the following,

Safe Water Options

The most important emergency measure needed is to prevent further exposure by providing them with arsenic-free safe drinking water. People in Bangladesh, particularly in the rural areas, are accustomed to using groundwater from hand-operated tubewells. In principle, it was considered safe from bacteriological pollution, unlike surface water. In view of the overwhelming dependence of the population on groundwater, point-of-use treatment of arsenic-contaminated groundwater appears to a promising option for providing safe water to the rural population. Socio-economic conditions of Bangladesh demand a low cost for setting up and operation, particularly when dealing with treatment units that would operate at the household level.

A number of promising commercial and non-commercial technologies are available that suit Bangladesh's local conditions, particularly in the rural settings. Another option is to treat the surface water, in which the contamination is mostly biological in nature. Yet another option is to capture rainwater and utilize it for drinking purposes. Rainwater harvesting can potentially suffer from biological contamination and may require some form of treatment to ensure its safety.

Various technologies have been used successfully for removing arsenic from groundwater. The most commonly used technologies include co-precipitation with alum or iron; adsorptive filtration (e.g., using activated alumina); ion exchange; and membrane processes such as reverse osmosis. A number of comparative evaluation programmes provide the necessary information about the effectiveness and efficiency of these treatment processes, the environmental technology verification-arsenic mitigation (ETV-AM) studies being undertaken by Ontario Centre for Environmental Technology Advancement (OCETA), with the support of the Canadian International Development Agency (CIDA).

Nutrition Improvement

There is a strong relationship between the nutrition levels of people in an area the extent of health problems observed. As an example, some of the work done through the Asia Arsenic Network in the Jessore District of Bangladesh in 1998 shows a strong negative relationship between household income data and prevalence of arsenicosis. More importantly, the study showed that there were no arsenicosis patients in any of the income classes above the income range of 140,000-150,000 Taka per year. The underlying fact is that the poorest sector of the society also suffers from poor access to adequate food and nutrition, and is also prone to poor hygienic conditions in the household. Other evidence from Taiwan and Thailand also suggests that some nutritional factors may modify cancer risks associated with arsenic.

Coordination of Efforts

In many countries, political involvement at the highest level is required to marshal an effective and timely governmental response to environmental disaster. At the same time, various government ministries need to be involved in the emergency response, in part because no individual ministry is capable of coping with the wide range of issues related to the arsenic crisis. Different ministries and international agencies have different experience and expertise that would likely be required at various times throughout the emergency response. One agency should be responsible for coordination of the overall implementation, so that lines of authority and responsibility are clearly identified. There must also be an effort to directly engage the civil society.

Integrated response is a must for the emergency measures to be successful. Policymakers must realize that dealing with the arsenic crisis on the short term as well as long-term strategy will have other effects on the country. These may include economic impacts - whether positive or negative, direct or indirect - on a number of sectors including agriculture and related industry, water management, public health and the overall national economy. The urgency for designing an emergency management paradigm is, therefore, at the highest level.

This emergency management paradigm should also deal with a number of indirect issues. There should be transparency in those agencies dealing with those impacts. Transparency means that there should be openness and honesty in information about the arsenic crisis and its potential impacts. At-risk regions, populations and sectors should be identified and notified in a timely manner.

Emergency measures need to be backed by adequate expertise and funding. National expertise should be maintained and strengthened over time so that government agencies can fall back to it for long-term implementation. Funding from donor agencies can be used to help to build national expertise. This would show commitment of donors and enhance the prospects for long-term planning instead of fostering a reliance on ad hoc responses.

A Partnership with the Civil Society

The affected communities and the stakeholders all have to work together towards the success of the emergency measures. This partnership has to be developed and cultured at the earliest stages of the short-term responses. It should extend to involvement of the stakeholders in design and implementation of various measures. This is particularly necessary when existing social practices and customs are counter to the desired response - such as changing the habit of drinking untreated well water to the one that requires extra effort to treat the water. As an example, it is difficult to convince people that they can store water safely and use it for drinking purposes. For success of this partnership, several of the existing NGO's must be fully engaged in various activities.

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Long-Term Policy Options

A long-term strategy is essential and central to the success of any measures against the arsenic crisis. Such a long-term strategy or policy should adequately identify the scope of the problem, the range of solutions available and the resources necessary for its implementation. To mobilize the necessary resources, the government agencies have to work closely with international agencies and bilateral donor agencies. It is also important to realize that implementing the long-term policy will not only help in the fight against arsenic crisis but can also reap benefits for the sustainable development of the country.

There are five sectors that will be directly impacted in the long-term and must, therefore, be addressed in the policy. These sectors include public health care, food supply, water resources, scientific research and information management.

Health Policy for Arsenic Patients

The existing estimates of people affected by drinking arsenic-contaminated groundwater range from 28 to 57 million. It is not unreasonable to argue that significant fraction of these people will likely develop symptoms of arsenicosis; a similar trend is observed in the neighboring West Bengal. It is also clear that these symptoms manifest themselves after a prolonged exposure of several years to arsenic contamination. A long-term health policy must take into account this pattern of delayed appearance of patients. This means that there is some time available to fully build the capacity of existing health care services to cope with an increased flow of arsenic patients.

There are no known cures for arsenicosis at the moment, the best treatment is to drink arsenic-free water. Some researchers claim that increased levels of vitamin A, vitamin C, vitamin E and proteins assist the body in fighting arsenicosis symptoms. Similarly, increased level of other micro-nutrients is essential. Some symptoms of arsenicosis, such as skin lesions can be relieved temporarily; for example treatment with medicated lotions that soften the skin.

A long-term health policy should include the following basic elements:

Food Security

Bangladesh currently faces a food security challenge. A recent report on State of the Environment in Asia and the Pacific (UN, 2000) projects approximately 37 million people will still be undernourished in the year 2010. The impacts of the arsenic pollution on this worsening food security have not been considered explicitly. It is also not clear whether arsenic in irrigation water is taken up by the plants or if a fraction of such uptake ends up in food. These issues of food security, both science- and policy-oriented, have to be considered in developing the overall long-term policy to fight the arsenic crisis.

Water Resource Management

Bangladesh has abundant water resources - both in terms of surface water and groundwater, as shown in Table 1. An estimate of the exact volume of groundwater contaminated with arsenic above WHO guidelines is not readily available. The figure below shows the sectoral distribution of freshwater and groundwater, respectively. It is obvious that a vast majority of groundwater is utilized by the agricultural sector.

The abundance of available surface water, if managed appropriately, would obviate the need for utilization of groundwater in the first place. However, installing an infrastructure on a nation-wide basis for treatment and delivery of freshwater is a major undertaking. The overall approaches for remediating arsenic contamination problem, however, cannot be successful if they do not account for water availability as a broader resource management issue. In this respect, rainwater harvesting can be an important resource for drinking water - successful implementation has been undertaken in Bangladesh and Thailand (UNICEF, 2000; Oshikawa, 2001).

Table 1. Water resources in Bangladesh (Source: WRI, 2000)

  Average annual internal renewable water resources
Annual withdrawals
Average annual groundwater recharge
Annual groundwater withdrawals
Total km3 105.0 14.6 21.0 10.7
Per capita (m3) 813 134 163 19.6

It is also important utilize groundwater as a freshwater resource. It is possible that a number of "safe" non-domestic uses of arsenic-contaminated water may be found. More significantly, the potential for treating the groundwater for domestic purposes is quite large. By treating the groundwater for arsenic contamination, it attains hygienically superior quality than readily-available surface water. A number of technologies are available for removing arsenic from groundwater to below the drinking water standards; these have been described in some detail in other publications (e.g., WHO, 2000 and BUET-UNU, 2001). To be fully applicable, these technologies must be acceptable for users, easy to operate, efficient under local climate conditions and cheap. Nevertheless, scaling up the implementation of these technologies at national or district level is a daunting task, both from technical and financial points of view. It can only be implemented if the international agencies, NGO groups and relevant government institutions join their resources.

A major factor that will govern the range of alternatives for long-term water resource management is availability of human and financial resources. This has to include capital investment in infrastructure as well as cost of maintenance. In order to make this possible, a broad cooperation between various stakeholders is necessary. Most importantly, the government has to initiate a dialogue with international agencies and bilateral donor agencies for its implementation.

Scientific Research on Key Issues

A number of gaps in the scientific knowledge exist at the moment. These must be tackled keeping in mind the particular conditions prevailing in Bangladesh. Information from scientific research should be directly fed into the policy development process, as some of the research findings may have far-reaching consequences. Some of the more critical research needs are discussed in this section.

Information Management and Dissemination

One major aspect of strategies to tackle the arsenic pollution problem is management and dissemination of information to various stakeholders, including researchers, policymakers, politicians, international donor agencies and the general public. The information can come in various forms including, but not limited to, the following:

A comprehensive information management approach must be adopted to centralize and organize the vast volumes of information being generated currently as well as those to be generated in the near future. The information management paradigm should include the following:

Transparency in information management is also critical for fully understanding the problems and for developing a cohesive strategy. Openness and transparency can increase trust among government agencies, scientists and the public. At a minimum, it can create awareness as well as educate, alert, and prepare people about the risks they may face. Transparency between the government agencies and donors is also necessary, so that the needs and expectations of both are well understood.

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This document was developed with cooperation and suggestions from several individuals, organizations and government agencies. In particular, the support from a number of parliamentarians was invaluable in development of this document. These include H.E. Mr. Humayun Rashid Chaudhury, Speaker Bangladesh Parliament, Hon'ble State Minister for Planning, Dr. Muhiuddin Khan Alamgir, Hon'ble State Minister for Health & Family Planning, Dr. M. Amanullah and Deputy Minister for LGRD, Mr. Saber Hossain Chowdhury. The production of this document was made possible by the contributions of Ms. Nasrine Karim and Ms. Kawahara of the Earth Identity Project. The tireless efforts put in by Ms. Kiyomi Yamada and Mr. Hiromi (Mohd. Humayun) Inayoshi of EIP deserve special recognition.

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All the statements provided in the document are those of the author. The views expressed in this document do not constitute endorsement of technologies or commercial products by UNU or EIP.

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