Personal views: Don't drink the water . . .
Authors: Andrew S Furber
Journal: BMJ (2003)

It was about 4 am when the phone rang. I answered it with the usual worries about why someone should be calling me at this time. To my relief it was not a relative informing me of a family illness, but a friend letting me know of a possible threat to my own health. “We've been told that the hospital has been admitting lots of people with vomiting and the rumour is that terrorists have put arsenic in the water supply.”


It was raining outside so I put a bucket out to collect some of the run off from the roof, and went back to bed. 


Our response to terrorism is inconsistent



I was nonchalant not because I mistrusted the story—although I did have doubts about its credibility—but because of the effect of living in Kathmandu under the daily threat of terrorist activity. The Maoist Insurgency in Nepal had started in the mid-1990s and had gradually grown in intensity and extent. A deliberate release into a major water supply would have been a change in tactic and would have shown a higher level of sophistication than previously, but it would not have been beyond the realms of possibility.

A phone call at a similar hour about a month earlier had informed me of the massacre of most of the Nepali royal family. Days of uncertainty and rumour followed, fuelled by an attempted cover up by official news sources. No one quite believed the initial government explanation that most of the king's immediate family had been killed in a freak accident. Public pressure led to an official inquiry that implicated the crown prince, but left many questions unanswered. Conspiracy theories remain rife.

It was not surprising then that people were suspicious of government assurances that the capital's water supply had not been contaminated. Our landlord, who lived in the top storey of our flat, assured us that we would have enough water from his ground well to survive for months. However, I suspected that he was exaggerating, especially when his relatives started turning up with large buckets.

By the evening of the same day I had been reassured that the threat was not credible. It turned out that only a few patients had turned up at hospital with vomiting, and this was probably related to a common food source. A colleague who tests ground water in Bangladesh for arsenic (where chronic exposure is a real threat to health) found no evidence of contamination in samples from Kathmandu. I doubted that the Maoist terrorists could obtain sufficient arsenic to overcome the considerable dilutional effect of the large reservoir. It was also hard to see how they could have dumped this quantity of material in the reservoir without the guards being alerted (and I knew the site was guarded).

The particulate matter in the rain water that ran off the roof clogged up my water filter, but otherwise this scare caused no damage. The Maoists continued planting small bombs in the city and rumours circulated about what else the terrorists were capable of doing.

I am now back in the United Kingdom and training in public health. My involvement in health protection work means that I may be getting another phone call about a deliberate release of a biological, chemical, or radiological substance into the water supply. Should I be unlucky enough to receive such a phone call, going back to bed will not be an option this time.

I am under no illusion that I would be anything other than a small cog in a big machine. Other agencies (the water company and the police to name the two most important) will rightly take a lead in the early stages.

Public health involvement is likely to be to protect the public from the health consequences of the harmful agent or, perhaps more likely, the effects of an interrupted water supply.

Communication with the public will be key. Water is so essential to life that panic can quickly ensue if its supply is suddenly withdrawn. The water companies have contingency plans in place to cover most eventualities and the police have considerable experience from the terrorist threat from the IRA. I am reasonably assured that any new terrorist activity will be well handled.

What I am less sure of is that we are doing the right thing in response to terrorism globally. Many developing nations, like Nepal, live under constant threat of terrorist activity. Often such activity is born from grinding poverty. Mostly it is directed at national governments but occasionally it spills out and affects the international community.

Our response to terrorism is inconsistent. When it affects us no expense is spared. When it affects others in distant countries we are sometimes less quick to respond. Relatively little (compared with the costs of war) is invested in dealing with the root causes of discontent such as poverty, disease, and political disaffection.

If we do experience a terrorist threat to our water supply, remember that we are well positioned to deal with it. Remember also that most developing nations will lack this capacity.