An unusual phenomenon is taking root across Sri Lanka’s agricultural and fishing communities. A growing number of predominantly 20-30 year-old men are finding themselves afflicted with chronic kidney disease. This disease progresses slowly. Oftentimes, by the time most of these men seek treatment, their kidneys have usually reached a stage of irreversible damage.
Medically known as Chronic Kidney Disease of Unknown Etiology (CKDU), the direct cause of this debilitating condition affecting young men in agricultural and fishing communities across Sri Lanka (as well as parts of the Balkans, Nicaragua, Mexico, Egypt, and East Africa) remains a mystery.
Evidence suggests the illness may also be emerging in other regions, leaving the medical community perplexed. A 2016 mission report by the World Health Organization explains that “[…]exposure to a combination of factors that are toxic to the Kidneys seems to be the cause of this disease, toxic factors identified up to now include arsenic, cadmium, and nephrotoxic agrochemicals.”
But this explanation only provides an ambiguous origin of the disease. By exclusively blaming pesticides as the source of the CKDU epidemic, government agencies fail to understand the true context of the issue. After all, the use of agrochemicals has been commonplace across Sri Lankan farms since the 1970s after the Sri Lankan government began offering farmers a fertilizer subsidy in 1962.
Cases of CKDU have only become prevalent in the nation since the 1990s so, some extraneous factor is likely at play. In truth, there is no singular cause for CKDU.
The International Water Management Institute estimates that Chronic Kidney Disease affects 10 percent of the world population – in Sri Lanka alone, 150,000 are infected. Yet, the trend is clear – the regions in which CKDU has taken the largest hold are in Sri Lanka’s dry agricultural regions. In the nation’s bread basket, Sri Lanka’s North Central Province (NCP), particularly in the Anuradhapura and Vavuniya districts, roughly 18 percent of the general population is afflicted with CKDU.
In areas where CKDU is common, farmers primarily obtain their drinking water from irrigation canals and shallow aquifers that are recharged by canal seepage. Runoff from neighboring fields often leeches into town wells, contaminating drinking water with pesticides from which families draw their supply.
Previously NCP residents acquired their well water with buckets, but have now switched to pump systems, according to hydrologist Tissa Illangasekare of the Colorado School of Mines.
Though these pumps have made obtaining water much more convenient for families, they further exacerbate the negative health effects of the water as pumps are placed at the bottoms of wells. So,when water levels are low, toxic chemicals may concentrate in the remaining shallow water and then into the pumps.
Water contamination isn’t limited to pesticide use. In Puttalam, a major fishing town situated on the brackish Puttalam Lagoon, the water is “hard” – containing up to 366 milligrams of magnesium per liter, almost 40 times more than what is considered the healthy limit..
Without an attested method of water purification, already-impoverished families must choose either to spend the extra money to purchase filtered water or continue to drink the polluted water regardless of its long term health detriments.
The recent spike in CKDU cases is not just a result of localized factors, but is rather being increasingly shaped by broader environmental changes – specifically, climate change. As global temperatures increase, so does the intensity and frequency of extreme heat events..
These environmental changes have placed an even greater strain on Sri Lankan farmers, who in response have been forced to increase their pesticide usage, contributing to greater contamination in the water table. Alongside increased pesticide usage, prolonged heat exposure caused by climate change has been proven to exacerbate the harmful effects of exposure to toxic agrochemicals.
The Sri Lankan government has been undergoing an economic meltdown since 2019. Loan deals and corruption at the hands of the ruling Rajapaksa political family, who have dominated Sri Lankan politics since the end of the Sri Lankan civil war in 2009, has resulted in a weak economy..
The International Monetary Fund estimates that the Sri Lankan government has amassed a total of $63.9 billion in external debt, as of 2023. Public frustration over economic mismanagement and worsening living conditions reached a tipping point in the 2022 Aragalaya, a mass protest movement that saw thousands of Sri Lankans take to the streets – bringing about the resignation of then-president Gotabaya Rajapaksa.
Struggling to manage foreign loans, Sri Lanka’s government-run hospitals have been left understaffed and incapacitated. With rural dialysis units across the country unable to effectively treat those in greatest need, farmers who cannot afford private hospital treatment are often left severely under treated for CKDU.
At its core, the CKDU epidemic is a combination of a multitude of seemingly unrelated challenges plaguing the island nation at once. The recent upheaval of a decades worth of economic downturn, exorbitant pesticide use in rural communities and the tainting of agricultural water tables as well as the intensification of climate change and increasing global temperatures have caused and exacerbated the country’s many issues over the past few years. All of these factors have become the perfect storm, fueling the rise of CKDUand leaving countless communities reeling in its wake.
