World Bank loan raises concerns around chronic kidney disease in Nicaragua’s sugarcane industry

26 September 2013

Fairfood is concerned that the recent 15 million dollar World Bank loan to expand the Montelimar sugar plantation in Nicaragua will intensify the already existing Chronic Kidney Disease of unknown etiology (CKDu) epidemic in the region. This disease has already killed +thousands of sugarcane workers in Nicaragua and neighbouring countries. Of course, Fairfood and other workers’ rights advocates want the Central American sugarcane industry to grow and prosper, but only in a manner that gives back to the people employed by that industry and that allows for the region’s long term development. We had hoped that the World Bank and International Finance Cooperation (IFC) shared this goal.

According to the Pan American Health Organization, the annual death toll from CKD has more than doubled between 2000 and 2010.  From 2009 to 2011 there were nine times as many deaths from CKD in the sugar growing regions of Nicaragua, as there were deaths from the same cause throughout the rest of the country. Report from the First International Research Workshop on MeN

The World Bank approved the most recent loan just weeks after Central America’s health ministries adopted a declaration stating that CKDu is a top public health priority.

“This disease fundamentally affects socially vulnerable groups of agricultural communities along the Pacific Coast of Central America, predominates among young men, and has been associated with conditions including toxic environmental and occupational risk factors, dehydration, and habits that are damaging to renal health,” reads the declaration.

Back in 2006 the IFC, the World Bank’s private lending arm, gave a loan of 25 million dollars to a leading Nicaraguan sugarcane plantation to improve productivity and maximize its capacity. In 2008 former workers from this plantation suffering from CKDu filed a complaint with the IFC’s Compliance Advisor Ombudsman making the case that the increased sugarcane cultivation had magnified and worsened the impact of the disease in the community. As part of the dispute settlement Boston University carried out different studies to look into the epidemic’s causes. In August 2012 Boston University concluded that there was still not enough evidence to say that working conditions at the sugar plantation caused CKDu (Boston University Report). There is, however, scientific consensus that the strongest causal hypothesis for the CKDu epidemic is repeated episodes of heat stress and dehydration during heavy work in hot climates.

According to the World Bank the new 15 million dollar loan to Montelimar mill in Nicaragua will be used to acquire more land to increase planted area and to invest in water irrigation and other infrastructures. The Environmental and Social Impact Assessment process states that there is no definitive scientific answer to the cause of CKDu and all possible connections remain open to future research.

Chronic Kidney Disease can be caused by a number of factors and related to a number of different possible underlying health factors, like diabetes. However, the victims of CKD in Central America are relatively young and otherwise healthy. Victims of this disease  in the region have a few other characteristics in common as well: many of them are sugarcane workers performing intensive manual labour from sunrise to sunset. They have little formal education and in most cases lack access to medical care. There is also limited access to clean and safe drinking water, causing many to drink local groundwater in areas of heavy pesticide use.

While Fairfood agrees that additional research is needed to find the etiology of the disease, we also acknowledge that it is the consensus of scientists that heat stress and other “occupational exposures are most likely to be playing a role” in the epidemic.

In this regard, it is good to see that Montelimar is acknowledging the link between dehydration and CKDu and their responsibility to address this potential harm by providing water and hydration solutions to workers. However, at Fairfood we think that this is not enough and we would also like the World Bank and IFC to demand provisions addressing the numerous additional occupational risk factors contributing to the disease. This would ensure that the expansion of sugarcane plantations and production at Montelimar will be beneficial for all stakeholders, including local workers.

Image: Lon & Queates CC license