Wednesday, 25 September 2019

Human Rights Watch reports on lead poisoning at Kabwe, Zambia.

Lead, zinc, and vanadium mining in the city of Kabwe (formerly Broken Hill) in Central Province, Zambia, began under the Rhodesian Broken Hill Development Company in 1904, when the area was under British Rule, with concerns about the toxicity of the industry first being raised in 1916. The mines were acquired by the South African mining company Anglo American, who continued to run the industry through independence in 1964, until the industry was nationalised in 1970. Mining at Kabwe was controlled by the state-run Zambia Consolidated Copper Mines Limited until 1994, when the mines were deemed to be unprofitable and were closed down. Zambia Consolidated Copper Mines Limited was subsequently privatised, with the government-owned Zambia Consolidated Copper Mines Investment Holdings taking over liability for environmental issues at sites it owned, and its assets (including the right to carry out further mining) being sold off. 

Decades of lead mining have taken a severe toll on the environment at Kabwe, with soil in the area contaminated with lead, wind blown dust with a high level of lead affecting much of the city, and high levels of lead found in crops and livestock grown in the area, surface waters and shallow wells, as well as in the blood of many people living in the city.

In a report published on 23 August 2019 the international organisation Human Rights Watch lays out the problems faced by the local community in Kabwe due to the presence of lead pollution from the former mines, as well as the failures of previous remediation measures to address this problem, and make proposals as to what steps can be taken to alleviate the ongoing problem of lead pollution in Kabwe.

Lead is a heavy metal that is highly toxic to humans when ingested or inhaled. The WorldHealth Organization maintains that there is no known safe level of lead exposure. Elevated lead levels damage the brain, kidneys, liver, stomach, nerves, and blood cells, which may result in anaemia,  IQ deficits, reduced attention span, reading and learning disabilities, behavioural problems, hearing loss, impaired growth and visual and motor functioning, anaemia, high blood pressure, coma, convulsions, or death. Lead poisoning can often go undetected, as it may not manifest in obvious symptoms. 

Children are especially at risk because they are more likely to ingest lead dust when playing in the soil, their brains and bodies are still developing, and they absorb four to five times as much lead as adults. The consequences for children who are exposed to high levels of lead and are not treated include reading and learning barriers or disabilities; behavioural problems; impaired growth; anaemia; brain, liver, kidney, nerve, and stomach damage; coma and convulsions; and death. After prolonged exposure, the effects are irreversible. Lead also increases the risk of miscarriage and can be transmitted through both the placenta and breastmilk.

In the early 1970s an outbreak of children suffering from convulsions and comas in the Kasanda suburb of Kabwe was found to have been caused by lead poisoning, the children were given chelation therapy (a chemical process in which a synthetic solution, ethylenediaminetetraacetic acid, which binds to the metals and then can be excreted, is injected into the bloodstream to remove heavy metals and/or minerals from the body), despite which four of them died.

This prompted a study by AJL Clark of the University of London, which found high lead levels in the soil, air, and vegetation in Kasanda, Chowa, and Makululu, and elevated blood lead levels in infants, children, and new mothers. Clark tested over 600 children in Chowa, Kasanda, and Makululu and 125 newborn infants and their mothers in Kasanda, and found a direct correlation between high blood lead levels in newborns and their mothers. Lead levels in soil were found to be as high as 9400 parts per million, compared to the 400 parts per million considered to be a maximum safe level for soil in areas where children play by the US Environmental Protection Agency.

In the 1990s Zambia Consolidated Copper Mines carried out a series of studies into both soil lead concentrations and lead levels in blood, finding high concentrations of lead in both soil and blood samples. This was followed by a program which administered chelation therapy, provided clean topsoil to households in Chowa to cover the contaminated soil, and gave families tips for reducing lead exposure in the home. A subsequent environmental assessment carried out on behalf of the World Bank found that this program was 'fraught with problems', 'inadequate for the need', and 'the absolute minimum that could be considered adequate', noting that the clean topsoil had already begun to erode in some areas, re-exposing the lead-contaminated soil.

Between 2003 and 2011 the World Bank-funded Copperbelt Environment Project undertook a number of steps to address the lead pollution in Kabwe, though this too was hampered by the lack of a comprehensive remediation program, and therefore achieved only limited results. The project cleaned the Kabwe Canal to reduce the risk of lead recontamination through seasonal flooding, removed mine waste material from some residential areas, and removed topsoil and planted grass and trees in the yards of 3100 households. It also planted grass at schools, including those closest to the mine plant area and others in Kasanda, Makandanyama, Mutwe Wansofu, Makululu, and Luangwa, and built new water infrastructure and subsidised water rates to make it less difficult for residents to maintain the new vegetation.

The project also supported an Integrated Case Management program, which conducted blood lead testing of about 5000 children below age 7 at local health centres and provided treatment (nutritional supplements - including milk, soya, and blood tonic - or chelation therapy) to about 2800 of the children tested. After the project ended Zambia Consolidated Copper Mines Investment Holdings continued to administer blood tests to children under seven until 2016, when the test kits ran out, though by this time there was no chelation therapy available for children with high levels of lead in their blood, and cleanup efforts to reduce the environmental threat had also stopped, and with it any hope of reducing children's ongoing exposure to lead.

In May-June 2012, researchers at the University of Zambia, Hokkaido University, and the Zambian Ministry of Health conducted blood lead testing of 246 children under age 7 at health centres in Chowa, Kasanda and Makukulu and found 'alarming' levels of lead in the children's blood. All of the children were found to have  unsafe levels of lead in their blood, with eight children found to have lead at levels at which about half of children would be expected to die or have seizures or comas.

In 2016 the Japan International Cooperation Agency launched five-year research project intended to identify the environmental, health, and socioeconomic effects of lead in Kabwe, as well as possible remediation strategies, which aims to blood lead testing of select children and adults in Kabwe, aiming to test four family members each from 25 households in each of Kabwe’s 40 census areas, and will oversee the blood lead testing that occurs under the government’s new World-Bank funded project.

In the same year the Zambian Government and World Bank launched the Zambia Mining and Environmental Remediation and Improvement Project, which aims to address environmental health risks in highly polluted areas in Kabwe and Copperbelt Province, though as yet this project has taken no action.

In June and November 2018, Human Rights Watch visited five townships in Kabwe where children have been found to have elevated blood lead levels; Chowa, Makululu, Waya, Railway, and Katondo. They interviewed parents and guardians of children with elevated lead levels to find out what kind of cleanup, testing, and treatment efforts the government had carried out in the years after 2011. They also interviewed local education officials, school headteachers, teachers, and students to learn about the extent of government efforts to examine contamination in schools and to ensure quality, inclusive education for children with disabilities, as well as small-scale miners at the site of the former Kabwe mine about the hazards of their work, the precautions they take to reduce lead exposure, and their reasons for seeking a livelihood there. Finally, they asked community members, including children, what they would like the government to do to address the lead contamination, especially in light of the current World Bank-funded government project.

Three girls play the game isolo on the ground in the lead-affected township of Waya in Kabwe. Soil is the main source of lead exposure in Kabwe. Zama Neff/Human Rights Watch.

Human Rights Watch found that the remediation model of grass planting at homes and schools proved unsustainable when the project ended, and dust from unpaved roads remained an environmental hazard, and that government’s efforts to reduce lead exposure since 2011 largely consisted of sharing dust reduction tips that community members struggled to carry out. Government testing and treatment efforts were limited and inconsistent in the years since 2011. Government-run health facilities in Kabwe had no chelation medicine or lead test kits in stock, and there was no health database set up to track cases of lead-related hospitalisation or death. Inclusive education is a country-wide challenge in Zambia, and in Kabwe, the disability screening process does not even investigate lead-related causes. Finally, large waste piles at the site of the old mine and ongoing small-scale mining both continue to pose health risks.

The interviews found that many children had been tested and found to have high blood lead levels, but that treatments such as chelation therapy were not available, so that most were simply offered nutritional supplements, and returned to the areas where they were being exposed to lead. Many such children were suffering from long term health conditions, as well as facing problems at school relating  to poor memory and short attention spans, both symptoms of lead poisoning.

The most recent program of soil analysis in the area was carried out in 2014 by 2014 the international nongovernmental organisation Pure Earth, and found dangerously high levels of lead in the soil of Kasanda, Chowa, Makululu, and Mutwe Wansofu townships. Other townships where children have shown high blood lead levels, such as Waya, Katondo, and Railway were not included, due to the limited scope of the study.

The townships of Chowa, Kasanda, Makandanyama, and Makululu are home to 76 000 people, including 39 000 children, 13 000 of them under the age of five. It is estimated that 95% of the children in these townships have elevated lead levels in their blood, with 50% being at a level that should be considered for chelation therapy. Human Rights Watch found 60 children in these townships that had been diagnosed with elevated blood lead levels since 2011, with most being offered only nutrition supplements as a treatment, and showing ongoing symptoms consistent with lead poisoning.

Rather than adopt a comprehensive remediation program, the government’s measures so far have relied on grass planting at homes and schools, some topsoil replacement, and community education on dust reduction. The government’s focus on grass-planting as a remediation measure proved to be unsustainable. The government has also failed to address other sources of lead contamination, including road dust. As a result, tens of thousands of families are still exposed to lead on a daily basis.

Residents continue to be exposed to high levels of lead in Kabwe, revealing the inadequacies of past remediation efforts. Lead can be found in the soil in people’s yards in the areas around the former Kabwe mine, as well as dust outside and within homes. Given the extent of contamination, all residents of Kabwe’s affected townships are at risk of ingesting or breathing in lead dust. Resident who grow crops in contaminated soil or cook outdoors face additional risks.

During the dry season from roughly May to October, lead dust represents a particularly significant hazard for those who ingest or inhale it When Human Rights Watch visited affected townships in Kabwe, dust was ubiquitous. In one family’s backyard, a rooster shook its wings and became enveloped in a cloud of dust. Dust stuck to children’s hands, faces, and clothes as they played outside on the ground. Passing cars and trucks left a thick haze in their wake.

Although dust is a hazard in all of Kabwe’s contaminated townships, the threat is particularly acute in the informal settlements of Makululu and Waya, where housing is much more exposed to the outdoors than in the formal settlements of Chowa and Kasanda. As a result, children in these neighbourhoods are likely to encounter more dust in their homes.

Clothes hang to dry near a residence in the lead-affected township of Makululu in Kabwe. Zama Neff/Human Rights Watch.

Since 2011 Zambia Consolidated Copper Mines Investment Holdings staff have continued to conduct home visits intended to share tips with parents and guardians for reducing lead exposure. But the suggested measures, such as watering grass and washing floors and hands regularly, only provide limited protection against lead.

In addition, families have struggled to implement these recommendations. Many of the families who spoke to Human Rights Watch said they could not afford the water necessary to maintain grass or clean their homes regularly, making re-exposure to contaminated soil and dust inevitable.

Lead contamination in Kabwe therefore has a disproportionate impact on the poor for at least three reasons: undernourishment increases the amount of lead the body absorbs, lead dust is a particular hazard in informal settlements, and the water required to maintain grass and reduce dust is expensive.

19 community members whom Human Rights Watch interviewed identified the lack of affordable water as an impediment to reducing lead exposure. These community members identified water access as a challenge regardless of whether they relied on running water, communal taps, or well water. A man who had three grandchildren with elevated lead levels observed that people needed water to keep grass alive and said, 'Right now the cost of water is higher than electricity…. It’s horrible. Charges are too high.' Other parents and grandparents echoed these concerns. A grandmother said she had been told to sprinkle water when sweeping, but it was hard to do. When she used more water, the bill would rise steeply.

Other models for home remediation do not depend on water and are therefore more likely to last in Kabwe. A pilot project by Pure Earth and Environment Africa in Chowa combined environmental assessment, yard remediation, house cleaning, community education, and drainage improvements. The yard remediation and house cleaning were voluntary programs, involving the covering of the yard with a barrier cloth and clean soil and then the cleaning of the home with a specialised vacuum. Meanwhile, in Zamfara State, Nigeria, remediation efforts that addressed lead contamination from mining activity focused on removing lead-contaminated soil from residential areas altogether and replacing it with clean soil.

Kabwe’s contaminated townships include public and private schools, play areas, health centres, parks, soccer fields, markets, and places of worship. Past government efforts to clean up public spaces focused on rehabilitating areas where children spend the most time, namely schools and play parks. Neither effort proved successful, however. The project planted grass at schools but did not take any sustainable measures to contain the contamination. The project created new, lead-free play parks for children, but nine out of eleven were vandalised.

From 2015-2016, Samuel Mutiti, a geologist at Georgia College took soil samples at eight Kabwe schools. The only school for which data is currently public is David Ramushu Combined School in Kasanda, where Mutiti found the school grounds to be so contaminated that he and subsequently began a crowd-funded project that organised independent remediation efforts. Part of his remediation plans involved grass planting, but he told Human Rights Watch that the cost of water would not be an issue because the school had its own borehole, and he would help them design an irrigation system to utilise it.

Human Rights Watch spoke with headteachers at four other schools in or near the contaminated areas. None of them knew whether their schools were contaminated. They expressed concern about the hazards of lead and said they would appreciate information on soil levels so that they could ensure a safe learning environment for their students.

Playing in Kabwe comes with risks. Children cannot be sure of avoiding lead exposure in their own yards, streets, or schools. Given the extent of contamination in the townships around the old mine site, children in those areas lack safe spaces to play. Small children have increased hand-to-mouth activity, which makes them particularly vulnerable to ingesting lead soil or dust when they play outside.

Children play in a backyard in the lead-affected township of Chowa in Kabwe. Juliane Kippenberg/Human Rights Watch.

Unregulated access to the former mine site further endangers children. Intrigued by the massive pile of mine waste, children play there and have done so for decades. In 2002, a government-commissioned environmental assessment noted that two boys had drowned in the past year after going to play in one of the mine pits filled with water. At the time, Zambia Consolidated Copper Mines had built a wire fence around the pit, but people had stolen it.

Nearly two decades later, children continue to play on the site. Human Rights Watch spoke to a group of 13 elementary school students, of whom three said they played at the Black Mountain tailings dump. One boy said he slid down the mountain, acknowledging that it was fun but also dangerous. In another Human Rights Watch meeting with eleven older children, seven said they had played at the Black Mountain when they were younger.

Soil sampling was carried out at Chowa Health Centre in 2017. The health centre, which included a new maternity wing that housed pregnant and breastfeeding mothers, had soil lead concentrations that far exceeded safe levels. There is no other public data on soil lead concentrations at health centres, but Kasanda Clinic and Mine Hospital are both located within townships found to have extremely high soil lead levels as recently as 2014.

In 2017, an environmental health expert conducted soil sampling at Chowa Health Centre, pictured here, which revealed soil lead concentrations that far exceeded safe levels, ranging from 1,241 ppm to 13,843 ppm, well above the international standard of 400 ppm. Zama Neff/Human Rights Watch.

Environmental remediation experts have long identified road dust as a significant contamination risk in Kabwe’s affected townships. As early as 1996, a study emphasised the value of reducing road dust to reduce lead exposure pathways. More recently, a 2015 study of children’s blood lead levels, co-authored by a representative of the national More recently, a 2015 study of children’s blood lead levels, co-authored by a representative of the national Ministry of Health, observed that road dust on unpaved roads heightened contamination pathways in Makululu township., observed that road dust on unpaved roads heightened contamination pathways in Makululu township.Despite this the government has failed to address the issue of road dust on a large scale, although a road near a private nursery and primary school very close to the old mine site, was paved to reduce the dust from passing vehicles. The government’s Road Development Agency has had plans to pave roads in Chowa and Makululu since 2013, but the project has stalled for lack of funds. Unpaved roads in Kabwe’s contaminated townships can be found throughout the residential areas. So long as roads remain unpaved, road dust risks undermining any new remediation efforts.

Despite international guidance that children with elevated blood lead levels should receive monitoring and repeat testing, and despite the widespread lead contamination found throughout Kabwe, lead testing itself has not been consistently available. Several thousand children under 7 were tested from 2011-2016. Children were tested either at local health centres or at the  Zambia Consolidated Copper Mines Investment Holdings laboratory adjacent to Mine Hospital. They came from the townships surrounding the former Kabwe mine, including Chowa, Kasanda, Makululu, Makandanyama, Mutwe Wansofu, Waya, Katondo, and Railway. All of these townships were found to include at least some children with elevated blood lead levels.  Under the program, parents and guardians were not told their child’s precise blood lead level, only a class from 1 to 5. They were told orally and were not given anything in writing further explaining the lead level.

Despite the widespread need for testing and treatment, Zambia Consolidated Copper Mines Investment Holdings ran out of test kits in 2016. As a result, most children born after 2016 were never tested for lead. Given that the government’s testing and treatment programs from 2007-2016 only targeted children below the age of 7, many adults, including pregnant women and breastfeeding mothers, never had access to free, government-funded testing. Human Rights Watch could not find any steps being taken to prevent mother-to-child transmission of lead during pregnancy or breastfeeding. If no solid efforts were in fact underway, it would be of particular concern given that a government-commissioned study found that 48% of women of childbearing age had high blood lead levels, and that the practise of geophagia (soil ingestion) among pregnant women is common.

Most of the children with lead exposure whose parents or guardians Human Rights Watch interviewed have not had access to proper treatment, due to a lack of chelation medicine and limited stocks of nutritional supplements, such as milk, soya, and blood tonic. Even when treatment has been provided, treatment efforts have been fraught with problems. Without ongoing cleanup, no treatment program can effectively reduce lead poisoning because patients will be immediately re-exposed.

The testing and treatment program no longer included chelation medicine after 2011. Human Rights Watch could not find a single individual who received chelation through a government program after 2011. According to Ministry of Health officials and hospital staff, chelation medicine is not currently available at either of Kabwe’s two public hospitals.

Since 2011 children under 7 who were found to have elevated lead levels were given either milk and soya or a vitamin syrup called Vard’s Blood Tonic, or a combination of both. Vard’s is a vitamin syrup containing Iron, Vitamin C, and B-Complex, intended to counteract anaemia, which can be both a cause and effect of increased lead absorption. After the initial provision, distribution of nutritional supplements was erratic or eventually ended. Parents or guardians for more than 40 children told Human Rights Watch that their children initially received milk, soya, and/or blood tonic in response to elevated blood lead levels. Some families reported being given nutritional supplements when they were first tested that were discontinued without being told why. Zambia Consolidated Copper Mines Investment Holdings advised parents to buy milk and soya themselves, but some parents and guardians told Human Rights Watch they could not afford to buy these items regularly or at all.

Although there are limited records of children’s hospitalisation and death from lead poisoning in the early 1970s, there are no recent records. Zambia’s Health Management Information System, a national health database, does not track such cases, and local health authorities have not set up any parallel system to collect and analyse data on lead poisoning. Human Rights Watch interviewed one mother whose son had extremely elevated lead levels at age 4 and died four years later, but there was no way to determine whether lead exposure played any role in his death.

In December 2016, the Zambian government launched a five-year World Bank-funded project, the Zambia Mining and Environmental Remediation and Improvement Project. Human Rights Watch is concerned, however, that the project will not address the full scope of lead poisoning and contamination. Over two years after its launch, the project remains in the planning stages, in part a result of bureaucratic delays relating to secondment (the temporary reassignment of officials to new, project-related positions) and project restructuring. Officials in the Ministry of Mines and Minerals Development attributed the delays to several factors, including bureaucracy within both the Zambian government and the World Bank and the rules of public procurement.

In response to the delays, the World Bank rated overall implementation progress 'Moderately Unsatisfactory' in its June 2019 Implementation Status & Results Report. The delays, compounded by what some community members described as the government’s poor information sharing and community engagement, have caused frustration and distrust among residents. Zambian government officials and World Bank representatives told Human Rights Watch that the government intended to commence the remediation and health components of the project before the end of 2019.

In July 2018, the Kabwe Municipal Council issued a request for bids for the engineering design for the remediation program, suggesting that it would focus on households in Chowa and Kasanda as well as other 'contaminated hotspots with lead-bearing material'. The Council’s stated objective was to decrease soil lead levels in areas where surface soil lead concentrations were 'routinely greater than 2,000 mg/kg'. At time of writing, the company that will design the remediation program had not yet been appointed.

The remediation program is also intended to improve the drainage and flow of the Kabwe Canal, which was used to discharge mine waste when the mine was still operational. The canal annually becomes clogged with weeds and debris and then floods during the rainy season, The program also includes plans to upgrade the Kabwe solid waste dump site so it can serve as a repository for contaminated material from residential areas. Given the failure of previous projects to reduce soil lead levels in Kabwe’s affected townships, the new project should adopt a more effective remediation approach. The new remediation design should be both comprehensive and sustainable enough to ensure a lasting solution.

The former mine canal, pictured here, which discharged mine waste when the mine was still operational, annually becomes clogged with weeds and debris. It then floods during the rainy season, contaminating adjacent neighborhoods with lead. Juliane Kippenberg/Human Rights Watch.

The Zambia Mining and Environmental Remediation and Improvement Project also includes plans for testing and treating at least 10,000 children, pregnant women, mothers, and other individuals, which will be overseen by the District Medical Officer in Kabwe. Children are meant to receive treatment in the form of chelation therapy or nutritional supplements, depending on their blood lead levels. As an improvement on the last project, children with blood lead levels of 45 ug/dL will be eligible for chelation therapy. Under the last project, only children with blood lead levels of 65 ug/dL and above received chelation. Without coordinated efforts to remediate, however, chelation will not be effective, a fact the World Bank notes in its Project Appraisal Document.

Human Rights Watch was unable to ascertain the specific plans under the new project for the treatment of adults, including pregnant or breastfeeding women or other women of childbearing age. Breastmilk alternatives (i.e., infant formula) would be advisable for women with elevated blood lead levels, so long as the government ensures that breastmilk alternatives are targeted and do not disturb general community norms around breastfeeding. Infants born to women with elevated blood lead levels may also require specialised care.

At time of writing, the testing and treatment regimen had not begun, and the Zambian government was still in the process of procuring chelation medicine through the United Nations Children’s Fund. Officials from the Ministry of Mines and Minerals Development stated that the treatment campaign would commence with the first delivery of drugs in September 2019. Human Rights Watch was unable to confirm that the government will ensure that chelation is preceded by remediation in the case of each child treated, given the delays in both components of the project.

The right to the highest attainable standard of health is guaranteed by international treaties to which Zambia is a party, including the International Covenant on Economic Social and Cultural Rights, the Convention on the Rights of the Child, and the African Charter on Human and Peoples’ Rights. The Committee on Economic, Social and Cultural Rights, the treaty body which interprets state obligations under the International Covenant on Economic Social and Cultural Rights and monitors state compliance with its provisions, has held that social determinants of health are crucial to the full realisation of the right to health, including 'healthy occupational and environmental conditions, and access to health-related information and education'. According to the Committee on Economic, Social and Cultural Rights, a state party cannot, under any circumstances, justify its noncompliance with core obligations, which are non-derogable. The core obligations defined by the committee include providing essential drugs. Chelation medicine, included on both the World Health Organisation Model List of Essential Medicines and the World Health Organisation Model List of Essential Medicines for Children, should be seen as one such essential drug. The government should include it on its own list of essential medicines and take immediate steps to ensure its availability.

The 2012 Persons with Disabilities Act of Zambia requires the government to ensure that persons with disabilities receive inclusive education, reasonable accommodation, 'the support required, within the general education system, to facilitate their effective education,' and 'effective individualised support measures … in environments that maximise academic and social development, consistent with the goal of full inclusion.' Reasonable accommodations can include allowing a student more time, reducing levels of background noise, or employing a qualified learning support assistant for one or more students. This applies to all children with disabilities—whether or not they are proven to be connected to lead.

Lead poisoning can impair cognitive development, resulting in problems with concentration, memory, and learning. Parents, grandparents, teachers, and education officials told Human Rights Watch that children in Kabwe struggled with these very problems. Both an official at the Ministry of General Education and members of an education-focused NGO in the capital told Human Rights Watch that the national government is currently doing little to improve education for children with disabilities or learning barriers. Despite the prevalence of increased lead levels in Kabwe, education authorities said they were not routinely testing children with concentration and memory issues for lead levels. They assumed that lead exposure had caused learning barriers and disabilities but could not recall any cases in which they had requested lead tests.

Some headteachers and teachers described their efforts to support children experiencing learning barriers. One headteacher said that his school sought to assist students experiencing learning barriers through additional support within the classroom and outside, individual attention, and involvement of parents. However, he also acknowledged that tuition was required for extra lessons. Human Rights Watch spoke to the parents and guardians of a number of children who had been tested and found to have elevated lead levels and who faced challenges in school because of poor memory, inability to focus, or slower pace when learning. Some said that their children did not receive accommodations in school to address these problems.

The Convention on the Rights of Persons with Disabilities, to which Zambia is party, calls inclusive education 'a fundamental human right of all learners'. An inclusive education system should focus on 'the full and effective participation, accessibility, attendance and achievement of all students' in the ordinary school system. The education system should provide a personalised educational response and 'flexible curricula, teaching and learning methods, which requires support and reasonable accommodation so that learners are able to fulfil their potential'. Accommodations for pupils experiencing learning barriers or learning disabilities may include changing the location of a class, providing different forms of communication and learning materials in alternative/accessible formats, or providing students with a note taker. Provision of non-material accommodations, such as allowing a student more time, reducing levels of background noise, sensitivity to sensory overload, alternative evaluation methods or replacing an element of curriculum by an alternative element, should also be considered. Support can also consist of a qualified learning support assistant, either shared or on a one-to-one basis, depending on the requirements of the student.

The Convention on the Rights of the Child guarantees 'the right of the child to engage in play and recreational activities appropriate to the age of the child'. The Committee on the Rights of the Child has stated that children have a spontaneous urge to play and participate in recreational activities and will seek out opportunities to do so in the most unfavourable environments. However, certain conditions need to be assured, in accordance with children’s evolving capacities, if they are to realise their rights to the optimum extent. One of these conditions, the Committee has found, is 'An environment sufficiently free from waste, pollution, traffic and other physical hazards to allow them to circulate freely and safely within their local neighbourhood'.

Twenty-five years after the closure of the Kabwe mine, its waste dumps remain in place. No meaningful work has been undertaken to remove the source of the contamination. Lead dust from the uncovered waste dumps continues to blow over to nearby residential areas and threaten community health. The government has not conducted a remediation or reclamation (land restoration) program and has recently issued several licenses for small-scale mining. Small-scale mining at the former mine site produces risks to residents’ health by creating another pathway for exposure to lead dust. The government has also granted a large-scale mining license for much of the former mine area to a company that plans to recover lead, zinc, and vanadium from the waste. Waste processing, if not carefully managed, carries the risk of creating further problems for human health and the environment by generating additional dust and polluting the water.

The former mine area contains over three million tons of tailings (waste from the mining process), about 2.5 million tons of slag (waste from the smelter), and other waste. The most visible waste dump is a large, dark pile of slag, locally known as the .Black Mountain' because of its dark colour. While the lead content in different kinds of waste varies, every kind of lead waste poses risks to human health and the environment.

After the 1994 closure of the mine, Zambia Consolidated Copper Mines issued a Kabwe Mine Site Rehabilitation and Decommissioning Plan in 1995 to address its environmental legacy. Over the next two years, Zambia Consolidated Copper Mines began to cover the tailings dumps (mine waste) with coarse, granular slag to reduce windblown lead dust. However, a World Bank-funded environmental assessment found in 2002 that those measures were 'incomplete because of financial constraints'. The government’s strategy document for remediation does not include an assessment of remediation or reclamation options for the defunct Kabwe mine, such as capping (sealing) or removing the mine’s waste piles, both practises employed elsewhere to remediate contaminated sites, for example in the United States, Canada, and Ghana.

Since its closure in 1994, small-scale mining has become the main activity at the former Kabwe mine. Artisanal and small scale mining, that is, mining with little or no machinery, has been taking place in the absence of one central mining company. Small-scale mining for lead poses severe health risks and affects children in Kabwe twofold. First, children risk getting exposed to particularly high levels of lead when adult family members work at the mine and return home with lead on their body, clothes, tools, or shoes. Second, older children themselves work at the mine. Small-scale mining is an important economic sector in Zambia and many other countries across the globe, but small-scale mining for lead is rare. While the government has issued some licenses for mining, there are also unlicensed, illegal mining operations.

View of a former mine pit, now flooded, at the old mine site in Kabwe. In the foreground is an area where small-scale miners still work today. Diane McCarthy/Human Rights Watch

When Human Rights Watch visited the mine area, adult men, adult women, and a few older boys were working at several spots, including the 'Black Mountain' and another area they called the 'Savage Mountain.' They dug up the soil and rocks, placed them in bags, and carried them to collection places or buyers. Some would wash the rocks to sift out certain minerals. Miners said they were mining for zinc and lead, as well as rock material called dolomite and the lead ore galena, and explained that other tasks including crushing rocks and selling the mined material to buyers. Most adults working at the mine were aware that lead is dangerous and tried to take steps to protect themselves, their children, and other relatives, such as washing and changing cloths before returning home. In their current form, these safety measures are unlikely to eliminate the risks to miners or their children. The miners are still exposed to lead dust while they work, and the lack of proper washing facilities near the mine site means they will not be able to remove all lead dust from their bodies, hair, clothes, shoes, and other items, such as bags.

Some adult miners started working at the mine when they were under the age of 18 and still in school. After school hours, they worked at the mine to pay school fees. Human Rights Watch interviews confirmed that adult and child small-scale miners in Kabwe work in hazardous conditions. Although the Kabwe Municipal Council staff have gone to the mine site to teach the miners about safety, most miners are working without adequate precautions to protect themselves or their families from lead exposure. It is therefore a positive sign that the Zambian government has expressed an interest in ending unlicensed small-scale mining at the old mine site and that its latest World Bank-funded project includes plans to develop alternative income-generating activities for community members.

The Worst Forms of Child Labour Convention prohibits the worst forms of child labour, including 'work which, by its nature or the circumstances in which it is carried out, is likely to harm the health, safety or morals of children' (also known as hazardous work). As a state party to the Worst Forms of Child Labour Convention, Zambia is obligated to take immediate and effective steps to ascertain what forms and conditions of child labour violate the convention and then prohibit and eliminate them. The Convention obliges member states to take immediate action to prevent children from engaging in the worst forms of child labour; and to provide direct assistance for the removal of children engaged in the worst forms of child labour.

Zambia is also a party to the Minimum Age Convention, which sets the basic minimum age for employment at 15, and states that children ages 13 to 15 may participate only in light work that is not likely to be harmful to their health or development or hinder their education. The Minimum Age Convention also prohibits children under 18 from engaging in hazardous work.

A sign at the old mine site is intended to deter residents of Kabwe from entering, but many come here anyway for small-scale mining. Juliane Kippenberg/Human Rights Watch.

If mining is to continue, however, the government should ensure that operations are licensed, regularly monitored, and only conducted in accordance with mining regulations and law. According to national law, small-scale mining licenses can only be granted when a project brief or environmental impact assessment has been approved by the Zambia Environmental Management Agency.

In 2012, the government issued a large-scale mining license covering over seven square kilometres to a British company called Berkeley Mineral Resources. With the license, the company acquired the Kabwe tailings stockpiles as well as all other mined resources or unmined resources at the former mine, meaning they gained access both to waste produced during previous mining and to raw materials that had not yet been mined. At the same time, Zambia Consolidated Copper Mines Investment Holdings retained historical liabilities, shielding Berkeley Mineral Resources from legal liability for existing environmental damage. In addition, Berkeley Mineral Resources' subsidiary Enviro Processing Limited obtained a small-scale mining license in 2011. The government has opened the door for further mining and mineral waste processing, but it has not addressed the legacy of contamination.

Enviro Processing Limited submitted an environmental impact statement to the Zambia Environmental Management Agency. The company has stated that it was planning to clean up the former Kabwe mine by removing lead and zinc from the tailings through chemical processing/ Waste processing carries the risk of creating further problems for human health and the environment by generating additional dust and polluting the water.

Human Rights Watch interviewed two independent experts on mine tailings for an assessment of Enviro Processing Limited’s environmental impact statement: Ann Maest, a geochemist and Chief Scientist with E-Tech International, a non-profit that provides environmental technical support to communities on potential environmental impacts of large development projects, and Stuart Levit is a land reclamation specialist working with the US based Center for Science in Public Participation.  Both experts concluded that EPL’s proposal failed to demonstrate how any harmful impacts of the proposed reprocessing activities would be prevented or mitigated. In particular, they concluded that the environmental impact assessment lacked vital information and baseline data on the composition of the tailings, the existing water and air quality, and other factors, resulting in an inconclusive and poor assessment of environmental and health risks.

In 2018, Jubilee Metals Group, a South African company, entered into a joint venture with Berkeley Mineral Resources. As designated sole operator of the project, Jubilee Metals reviewed and changed Berkeley Mineral Resources’s plans by, among other things, opting to separate the zinc and lead recovery processes and proposing a method to recover the highly valuable metal vanadium as well. In March 2019, Jubilee Metals announced that it had bought a refinery right next to the former Kabwe mine for zinc processing, and that it anticipated producing metal within one year. Human Rights Watch spoke with Berkeley Mineral Resources and Jubilee Metals and wrote both companies, requesting further information on how they planned to address the environmental and health risks of these operations. Berkeley Mineral Resources responded by referring Human Rights Watch to Jubilee. Jubilee did not respond. Representatives of the Zambia Environmental Management Agency told Human Rights Watch they had recently met with Jubilee Metals to discuss its proposed Kabwe project and instructed Jubilee to submit a new environmental impact assessment before commencing operations.

Governments have a duty to protect human rights in the context of business activity, through effective regulation. The United Nations Guiding Principles on Business and Human Rights, which the UN Human Rights Council endorsed in 2011, state that this 'requires taking appropriate steps to prevent, investigate and redress such abuse through effective policies, legislation, regulations and adjudication'. Governments also have a duty to effectively enforce that legal and regulatory framework once it is in place, to prevent abuse and ensure accountability and redress for abuses that do occur. Governments should also continually assess whether existing rules, and the enforcement of those rules, are actually adequate to the task of ensuring respect for human rights, and improve upon them if they are not..

While governments have the primary responsibility to respect, protect, and fulfil human rights under international law, private entities, including businesses, also have internationally recognised responsibilities regarding human rights, including workers’ rights and children’s rights. The UN Guiding Principles on Business and Human Rights are widely accepted as a legitimate articulation of businesses’ human rights responsibilities. They specify that businesses should exercise human rights due diligence to identify human rights risks associated with their operations, take effective steps to prevent or mitigate those risks, and ensure that the victims of any abuses have access to remedies.

The Convention on the Rights of the Child has maintained that 'duties and responsibilities to respect the rights of children extend in practise beyond the State and … apply to private actors and business enterprises,' and that 'all businesses must meet their responsibilities regarding children’s rights and States must ensure they do so.' The committee has also noted that 'voluntary actions of corporate responsibility by business enterprises, such as social investments, advocacy and public policy engagement, voluntary codes of conduct, philanthropy, and other collective actions, can advance children’s rights,' but that these actions 'are not a substitute for State action and regulation of businesses … or for businesses to comply with their responsibilities to respect children’s rights.' Furthermore, the Convention on the Rights of the Child has stated, 'if children are identified as victims of environmental pollution, immediate steps should be taken by all relevant parties to prevent further damage to the health and development of children and repair any damage done'.

For these reasons Human Rights Watch makes the following recommendations:

That the Government of Zambia  should acknowledge full responsibility for remedying the ongoing harms caused by the now-defunct Kabwe mine, and develop a program for sustainable, comprehensive lead remediation, testing, and treatment in Kabwe, which should establish a fund to support ongoing nutrition and health care needs for long-term lead-affected residents of Kabwe.

That the Zambian Ministry of Mines and Mineral Development conduct a thorough environmental assessment of current lead levels in Kabwe soil, dust, air, crops, and water, as well as other possible exposure pathways, to identify priority areas for remediation under the current World Bank-funded project, and publish this data, and ensure that the remediation of contaminated hotspots under the current World Bank-funded project and any other efforts are both comprehensive and sustainable.

The ministry should also ensure that small-scale mining activities at and around the former Kabwe mine are closely monitored and that laws and regulations on mining and the environment are enforced, inform miners about precautions they should take to protect themselves and their families from lead, and develop alternative economic opportunities for artisanal and small-scale miners.

Furthermore it should work with the Ministry of Labour and Social Security to assist children to transition out of small-scale mining operations in Kabwe and into schools and vocational training. Ensure that there is ongoing monitoring of child labour in small scale mines.

The ministry should also develop and implement a comprehensive and sustainable solution for the remediation and reclamation of the former Kabwe mine, such as the capping or removal of waste piles, and publish all environmental liability agreements developed at the time of mine privatisation.

Human Rights Watch also recommends that Kabwe District Council should publish existing data on lead levels in soil, air, and elsewhere in the environment in Kabwe, work with the Ministry of Mines and Minerals Development to ensure that the remediation of contaminated hotspots under the current World Bank-funded project and any other efforts are comprehensive and sustainable, and ensure regular, broad, and meaningful public consultation and participation in the development, implementation, and monitoring of remediation efforts. Include dedicated measures that facilitate the participation of groups that may face specific impacts or that are marginalised, such as women, youth, children, the elderly, and people with disabilities.

A small-scale miner working at the waste dump in Kabwe known as Black Mountain shows a piece of rock. Juliane Kippenberg/Human Rights Watch.

Human Rights Watch recommends that the Kabwe District Health Office ensure that all children and adults in Kabwe are given access to free testing and, as appropriate, free treatment for lead poisoning., and undertake regular monitoring of blood lead levels, iron deficiency, neurodevelopment, nutrition, and other relevant indicators. Ensure that all treatment, especially chelation therapy, coincides with remediation; without remediation, patients will be re-exposed to lead when they return home. The District Health Office should also provide support for women with elevated blood lead levels during pregnancy and after delivery, including breastmilk alternatives (i.e., infant formula) for women with elevated blood lead levels, ensure that breastmilk alternatives are targeted and do not disturb general community norms around breastfeeding, provide specialised care for infants born to women with elevated blood lead levels, and Train more community health workers.

The Zambian Ministry of Health should ensure health workers at all levels of the public health system are trained on lead poisoning detection and prevention, testing, post-test counselling, treatment, and patient confidentiality, track lead poisoning in the national Health Management Information System or develop a separate database for Kabwe to track cases of lead poisoning, including lead-related hospitalisation and mortality, and update the Zambia Essential Medicine List to include chelation medicine.

The Zambia Environmental Management Agency should conduct an environmental impact assessment of small-scale mining on the site of the defunct Kabwe mine, and ensure that small-scale mining only takes place if it complies with all laws and regulations that protect human health and the
environment, and also conduct a new environmental impact assessment of plans by Jubilee Metals Group to recover lead, zinc, and vanadium from tailings and slag in Kabwe, and ensure that any future business undertakings, including re-mining, respect human rights and neither contribute to further lead contamination nor undermine efforts at remediation.

The Ministry of General Education and Kabwe District Education Board should ensure inclusive education and reasonable accommodations for children with disabilities and learning barriers, integrate environmental education on lead into the school curriculum in Kabwe, and ensure teachers receive additional training to understand how lead can affect learning, instruct the District Assessment Centre to request lead tests for children with disabilities, ensure schools have sufficient numbers of adequately trained teachers to provide learning support while addressing large class-room sizes.

The World Bank should promote regular community engagement and information-sharing under the Zambia Mining and Environmental Remediation and Improvement Project and encourage the Zambian government to ensure that key goals for testing, treatment, and remediation are met under the project in a timely manner.

Furthermore Human Rights Watch recommends that donor countries and UN agencies support the efforts of the Government of Zambia and civil society actors to address lead poisoning in Kabwe and that UN special procedures bodies and treaty bodies monitor the impact of lead in Kabwe on children’s rights, the right to health, the right to a healthy environment, and the right to a quality, inclusive education, monitor the progress of health and remediation efforts in Kabwe, and monitor the Zambian government’s implementation of its international obligations in relation to lead contamination and children’s rights, such as the Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights. Urge the government to ensure that it complies with these obligations.

Finally Human Rights Watch recommends that the African Commission on Human and People's Rights address the impact of lead contamination on children’s rights in Kabwe in future research undertakings, missions, or statements on Zambia.

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