When Ali Ali Abdullah Saleh learned that journalists had arrived in his small village of Al-Maqwal, located southeast of Sana’a, he ran out to receive them.

Although conservative traditions and tribal norms characterize the village residents, he asked female reporters to visit his home and talk with his wife and daughters. “I want you to interview them and see how much we are suffering due to this problem,” he insisted.

Saleh’s six daughters are suffering dental fluorosis, which is characterized by discolored, blackened, mottled or chalky-white teeth and a clear indication of overexposure to fluoride.

“Our father told us that sulfur in our drinking water caused this damage to our teeth,” said the oldest daughter, 16-year-old Ghadah. Like other girls in the village, Ghadah didn’t complete her education at primary school, so she had no opportunity to discover that what she thought was sulfur actually is fluoride.

Fluoride naturally exists in water and is derived from fluorine, the 13th most common element in the Earth’s crust. It’s well known that fluoride helps prevent and even reverse the early stages of tooth decay.

However, constant intake of excessive fluoride can lead to dental fluorosis, as well as severe and permanent bone and joint deformations of skeletal fluorosis. Early symptoms include sporadic pain and stiffness of joints. Headache, stomachache and muscle weakness also can be warning signs. The next stage is osteosclerosis (hardening and calcifying of the bones), and finally, damage to the spine, major joints, muscles and nervous system.

Whether dental or skeletal, fluorosis is irreversible and no treatment exists. The only remedy is prevention by keeping fluoride intake within safe limits. The World Health Organization estimate of a permissible upper limit for fluoride in drinking water was set at 1.5 milligrams per liter.

“Death from poison is better than dying of thirst”

According to the latest information, fluorosis is endemic in at least 25 countries worldwide, including Yemen. However, the situation in Yemen is worse and more serious because the nation suffers severe water shortage, which leads most of its population to depend on underground water.

“We don’t have any other choice. Our only water source is the wells. Now, they’ve told us not to drink from the wells, so the only options we have is to drink from the two surface water wells or buy water, which costs a lot,” Saleh said, also mentioning armed conflicts that have occurred between locals due to lack of water.

“Many people drink from the well, knowing that the water has a high fluoride rate, but they keep saying that ‘Death from poison [fluoride] is better than dying of thirst,’” says Ali Mohammed Taher, engineer at the Public Authority for Rural Water Resources, warning about citizens’ random digging for drinking water. He said some dig to 1,000 meters in mountainous areas where water contains high fluoride.

Studies conducted by the same rural water authority discovered that residents of Sana’a, Ibb, Taiz, Dhale’ and Dhamar drink water with high percentages of fluoride.

UNICEF involvement

A field visit by rural water authority specialists to Al-Khaw’h village in Sanhan district southeast of Sana’a revealed that of 149 children in the village, 47 have advanced stages of rickets, including 32 males and 15 females. All of those affected are under age 10.

Field tests show that the level of fluoride in the region’s drinking water varies between 3 and 6.5 milligrams per liter from one village to another.

Testing also found that children and the elderly suffer dangerous bone problems. The team warned that children are more prone to osteomalacia and rickets, while the bones of the elderly experience corrosion and osteoporosis, which may develop into skeletal fluorosis.

High fluoride concentrations in water also lead to bad material effects, eroding plumbing components such as the pump and pipes, particularly when in the presence of high concentrations of some other elements.

Such warnings have led Yemeni authorities to request UNICEF’s help and support to fight excessive fluoride levels in water to save people, especially children.

“The government isn’t yet fully aware of the fluoride problem or convinced of its adverse impact upon the population. For example, some have suggested establishing defluoridation stations in these regions, but I believe such a solution isn’t practical, particularly because these regions lack electricity to run such stations,” says UNICEF engineer Sami Abu Bakr Sa’eed, general director of the Water and Environment Unit.

He calls for further efforts to support more research on the subject and promote systematic policy responses by governments. He added that UNICEF will consider other countries’ experiences in this field, such as India, which uses water filter technology.

Abu Bakr’s statements came following a meeting last Thursday that brought together leaders of Sanhan district’s local council and officials from the Rural Water Project.

UNICEF and local authorities reviewed the results of the field studies regarding the negative impact of fluoride on area inhabitants. They stressed the important role that the local council must play in order to increase public awareness regarding random digging of wells, coupled with monitoring the digging process and preventing people from drinking water from wells containing fluoride.

“We recently asked residents to use such water for washing or cooking, but not for drinking. We also advise those who’ve already been infected to take care of their nutritional status and eat large quantities of food containing calcium and phosphorous,” Taher noted.

However, such advice doesn’t supplant the urgent need for sources of clean drinking water. “Digging new wells, establishing a water station, distributing water filters or whatever the solution is, we need it now urgently – both for our sake and our children’s health,” Saleh concluded.