Advances and challenges in the struggle for comprehensive care for exposed communities
By Milushka Rojas Mezarino | Coordinator of the Red Uniendo Manos Peru
*This article is an abridged version, the original version published in Spanish can be found on the Red Uniendo Manos Peru’s blog
Peru is characterized as a country that is purely mining, extractivist, or dependent on large investment in the mining and hydrocarbons sector. Even though this characterization may be relevant when looking at the reports of the main economic activities that contribute to the national GDP, the impacts of these economic activities should call the attention of authorities and citizens due to the alarming rates of risk to environmental and human health that it presents in the country.
In 2020, the Ministry of Health (MINSA) reported that the risk of exposure to contamination by heavy metals and other toxic chemical substances affects more than 10 million people, 31.15% of people nationwide. In addition, it indicated that in regions where these activities are carried out, it can also be observed that exposure to heavy metals is accompanied by exposure to arsenic (a metalloid that is harmful to health) and crude oil.
In the Ombudsman Report “In defense of people exposed to heavy metals, metalloids and other chemical substances: The impacts of environmental contamination (2021)” it is noted that there are regions with more than 50% of the population exposed (Lambayeque, Ucayali, Cusco, Moquegua, Madre de Dios, Callao, Amazonas, Puno, Pasco). Of these groups, the most vulnerable are children under 5 years of age, older adults and pregnant women. As of July 2021, mining environmental liabilities reached 7,668, and hydrocarbon environmental liabilities reached 3,231.
Although the National Policy for Comprehensive Care of Exposed Persons has existed since March 2018 the complaint from the Ombudsman’s Office in 2021 is noteworthy: “although 83% of the public health agencies across the country have reported having identified risk factors for exposure to heavy metals, metalloids and chemical substances, only 5 have a plan”. 83% of such agencies in 20 regions did not have an approved Comprehensive Action Plan.
“although 83% of the public health agencies across the country have reported having identified risk factors for exposure to heavy metals, metalloids and chemical substances, only 5 have a plan”.
These and other conditions related to environmental and human health continue to motivate not only protests, but also the articulation of the affected civil society. In 2017, leaders of communities affected by metal contamination agreed to form a platform or space for struggle from which to advocate for their cases. The limitations detected in the exchange of experiences at the local and regional levels pointed out the lack of specific national policies that give priority to the problem and propose to address it in an articulated and contextualized manner. The allocation of sectoral responsibilities, and of regional and local governments was ambiguous.
Due to the clamor of advocacy from civil society, in July 2020, the Temporary Multisectoral Commission for the Comprehensive and Integrated Approach in favor of the Population Exposed to Heavy Metals was created. Said commission had the mandate to prepare a technical report that contains the proposal of the Special Multisectoral Plan for comprehensive intervention in favor of the population exposed to heavy metals, including prevention, remediation, mitigation and control strategies for exposure to heavy metals; as well as monitor, supervise and evaluate its implementation.
In May 2021, Law No. 31189 was approved to strengthen prevention, mitigation and health care affected by contamination with heavy metals and other chemical substances. Said law mandates a) the Cabinet of Ministers and Ministry of Health to define the actors and intersectoral and intergovernmental mechanisms for the incorporation of prevention, mitigation and health care affected by contamination with heavy metals and other chemical substances in plans and programs; b) declare the priority of health care for people affected by contamination with heavy metals and other chemical substances to be of national interest; and c) commission the preparation of its regulations within 90 days after its promulgation.
In July 2021, one year after the installation of the Temporary Multisectoral Commission, the “Special Multisectoral Plan for Comprehensive Intervention to favor the population exposed to heavy metals, metalloids and other toxic chemical substances” (PEM) was issued and approved by the President of the Republic.
The PEM defined specific tasks organized into 3 strategic axes:
1) Environmental quality management to improve people’s health,
2) Comprehensive health and sanitation management, and
3) Institutionality, including the creation of a commission to monitor its implementation.
Thus, objectives and activities were established for an articulated action of the Executive sectors of government, indicating what tasks they should fulfill within a period of 5 years. In addition, a Commission to monitor the plan was created.
The first axis of the Plan mandates sectors and levels of government to:
1) Identify the areas affected by contamination and prioritize their risk, and
2) Reduce the risk and implement remediation actions.
In other words, prepare a national diagnosis of the contaminated areas and technically present the qualification of their risk levels. At the same time, it would generate mechanisms to control the sources of contamination, make use of new technologies or innovations to improve environmental monitoring and implement remediation actions in the affected areas. These activities must consider the participation of civil society at all stages.
The second axis, mainly mandates the health, agriculture, production, and housing sectors of government to:
1) Identify the exposed and affected population for their care;
2) Carry out sanitary surveillance (epidemiological and nutritional) and food safety;
3) Expand and improve sanitation in prioritized areas (safe and potable water, wastewater and waste treatment); and
4) Strengthen capacities and competencies of water service providers.
In other words, it would identify sources of exposure, exposed population, potentially exposed. It would also carry out periodic health and epidemiological analysis at the regional level in relation to exposure or affectation by metals, metalloids and other toxic chemical substances. Lastly it would update normative documents and strengthen capacities of goverment and civil society based on these mandates.
The third axis mandates the government and civil society to:
1) Articulate efforts to improve policies, technical regulatory instruments and public programs for the implementation of the PEM;
2) Develop evaluation, follow-up, and communication mechanisms; and
3) Manage intersectoral financing mechanisms, budgetary programs concerning care, prevention, and comprehensive mitigation of contamination from heavy metals, metalloids, and other toxic chemical substances.
That is, the diagnosis of the regulatory situation for the comprehensive attention to the problem, the preparation of an immediate response protocol to environmental and health emergencies, the preparation of reports on compliance with the PEM, the strengthening of assistance and social protection programs, a diagnosis of financing instruments and sources, financing proposals and public or private investment projects.
A few days after commemorating another year of World Environment Day, we can see that the aforementioned regulatory advances are almost null. The recent change of officials and authorities (due to the change of government in December 2022) that were informed or trained by the Health and Environment sectors to implement the PEM in 2022, have led to a undoing of trust generated in previous years. In reaction to the acts of state violence in relation to the protests that began in December of 2022, until mid-May 2023, the dialogue between the National Platform (civil society) and the State (the Permanent Commission) was paralyzed.
Taking it up again requires integrating the historical reasons of those affected to the projection of sustainable development and the exploitation of resources. It is not a question of continuing to raise the discourse of the “manger dog” from the Executive or Legislative, but of understanding and integrating into the dialogue environmental sustainability, the empathy of the authorities and of the regions that do not bear environmental liabilities and threats to human health. The indicated tools guide the way, but reaching them has not been easy. The central State and its levels of government must prioritize articulation, manage existing resources and increase their competence to comply with the PEM.
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