Working with Communities
to Improve Environmental Health
Batken Province, Kyrgyz Republic
Background
Batken Province, Kyrgyzstan includes part of the agriculturally rich Ferghana Valley and beautiful mountain ranges. It is home to just over half a million people.
This area was heavily exploited by the Soviet Union (USSR) for strategic minerals, including gold, mercury, antimony, and uranium. Since the breakup of the USSR, the mineral economy in Batken has largely collapsed. Severe legacy environmental contamination remains, posing risk for increased environmental-related disease within communities. The region is also one of the most seismically active in the world, creating the potential for transboundary pollution issues.
Médecins Sans Frontières (MSF) has worked in Kyrgyzstan since 2006. In 2016, MSF began consulting with the Krygyz Republic Ministry of Health (MOH) to develop a project in Batken. They requested assistance from TIFO to assess potential heavy metal risks in the region. In 2018, MOH, TIFO, and MSF officially began an environmental health project, with the goal of assessing mining contamination and developing an intervention strategy to reduce non-communicable diseases in the area. The Soviet-era mining/smelting towns of Aidarken, Chauvay, and Kadamjay City in Kadamjay Rayon were of particular concern. Aidarken is among the world’s largest mercury operations, Chauvay is the site of an abandoned mercury mine and smelter, and Kadamjay City has an antimony mine and smelting operations.
The project is lead by federal and district Ministry of Health representatives
The handheld x-ray fluorescent spectrometer (XRF) gives real-time soil heavy metal concentrations.
The team from the first site visit in 2016 at the beginning of the project
The head of the MOH lab giving a tour of his facility in 2017.
Decades of mercury mining and smelting wastes sit adjacent to Aidarken town.
Water samples were collected from mining areas by TIFO in 2018 in partnership with the Kyrgyz government.
Activities
This project works with local leaders to reduce exposure to individuals living in contaminated communities. MSF developed programming with MOH related to non-communicable diseases and maternal health. Simultaneously, TIFO collaborated with all partners to perform:
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Staff Health and Safety assessment and mitigation program (2016-2022)
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Assessed potential exposure risks to MSF staff living in the region.
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Developed exposure reduction recommendations, and routine environmental and biological monitoring programs for staff.
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Seismic risk assessment (2018)
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Estimated the potential loss of human life due to earthquake damage to buildings and mining wastes.
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Predicted potential impacts to mine waste in the event of landslides, rock falls, lake outbursts, and mudflows during earthquakes or intense weather events.
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Environmental sampling (2019)
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Targeted public and residential areas in Aidarken, the villages surrounding Aidarken, and Chauvai.
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Supported Kadamjay Rayon Sanitary Hygienic Laboratory’s (SHL) capacity to assess sites for contamination that exceed health-risk criteria at low cost.
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The support of the community, Kombinot, local governments, and the stakeholder committee was key to the successful implementation of one of the largest environmental sampling efforts ever undertaken in the region.
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Active mining operations were excluded from the assessment.
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Human Health Risk Assessment (HHRA, 2019-2021)
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Quantified risk to people exposed to known hazards, such as contaminants in soil, water, air, and food.
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Three major contaminants in the communities were identified: arsenic, antimony, and mercury. The first two are byproducts of mercury extraction.
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Assessment key findings:
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Contaminated vegetables are a concern, especially for young children and pregnant women.
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Contaminated soil is a significant risk for children.
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Transport of highly contaminated material from industrial areas into the community increases the risk.
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The use of mine water for irrigation poses a significant risk.
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Biological monitoring (2021)
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Focused on children and women of child-bearing age living in high-risk areas as identified in the HHRA.
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Results showed elevated blood levels of antimony and arsenic.
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Intervention Programs
TIFO is working with partners to develop health intervention programs and advocacy for national strategies to address environmental health issues. The HRRA and biomonitoring results were shared with stakeholder groups, along with a list of recommended interventions to reduce exposures. Immediate interventions include:
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Consistent, thorough washing and peeling of fruits and vegetables.
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Consistent dust abatement measures indoors (frequent cleaning).
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Designating “safe” outdoor play areas with barriers from contaminated soils.
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Discouraging/preventing children from visiting industrial sites.
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To the extent possible, avoid growing crops in soil with high heavy metal concentrations.
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Fencing off contaminated areas.
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Train local doctors and nurses on environmental health intervention priorities, with a focus on exposure reduction.
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Develop environmental awareness messages for reducing the exposure of heavy metals to the general population, especially children.
Long-term intervention recommendations include:
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Spot remediation to provide safe play areas.
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Developing a program where residents can have produce tested for metals by Kadamjai Rayon Sanitary Hygienic Laboratory (SHL).
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Re-routing and/or treating mind and Kombinot water to prevent residential and agricultural use.
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Remediation of Aidarken sludge ponds, Chauvai kombinot area, and Eshme field with tailings.
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Remediation of residential, public, and agricultural areas with high contamination.
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Continue to assess and analyze medical, environmental, and public health system needs.
In 2024, TIFO and the Massachusetts College of Pharmacy and Health Sciences (MCHPS) were awarded a grant for the development of an Environmental Health Education Program (EHEP) in the Kadamjai District, of Batken. (Read press release here.) The grant was awarded by the Public Diplomacy Department of the Embassy of the United States in Bishkek, Kyrgyz Republic.
With this grant funding MOH, the International Higher School of Medicine (IHSM), and the State Sanitary and Epidemiological Surveillance (SES), with support from TIFO and MCPHS, are developing an educational program for healthcare providers and environmental professionals. This program will provide an environmental health education framework that meets MOH requirements and is informed by United States guidance and practice standards.
EHEP Outcomes:
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Help healthcare providers increase their knowledge of exposure-reducing interventions and identify new opportunities to integrate these interventions into patient offerings and case management.
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Establish new partnerships between U.S. and Kyrgyz agencies, educational providers, fellowship programs, and clinical continuing education providers.
Partners
Past and ongoing activities are led by Kyrgyz partner with support from MSF and TIFO.
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Kyrgyz Ministry of Health (MOH)
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Kadamjai Rayon Sanitary Hygienic Laboratory (SHL)
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Aidarken Hospital and surrounding clinics (under MOH)
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Kadamjay Hospital
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A local stakeholder committee with representatives from local MOH, the Kombinot, local government, schools, women’s groups, and others.
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International Centre of Earth Simulation (ICES)
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Kyrgyz Ministry of Emergency (MOE)
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International Higher School of Medicine (IHSM)
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State Sanitary and Epidemiological Surveillance (SES)
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Médecins Sans Frontières (MSF)
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TerraGraphics International Foundation (TIFO)
TIFO Publications
Spearman S, Bartrem C, Sharshenova A, Salymbekova K, Isirailov M, Gaynazarov S, Gilmanov R, von Lindern I, von Braun M, Moller G (2022). Comparison of X-ray Fluorescence (XRF) and Atomic Absorption Spectrometry (AAS) Results for an Environmental Assessment at a Mercury Site in Kyrgyzstan.
This work is supported by a grant from the United States Department of State [grant number SKG10023GR0109].