“Many villagers used to come with me for dialysis,” 62-year-old Bose recalled on his way back home after his dialysis treatment at a private hospital in Tamil Nadu’s Madurai, which is 40 kilometres from his village. “But, not many of them are alive,” he said. Bose, who had been undergoing dialysis since 2016, had been one of the many dialysis patients from A Mukkulam and surrounding villages in the Virudhunagar district of Tamil Nadu. “I used to be healthy and was into farming. But with the dialysis, it consumes most of my time,” Bose had told this reporter in late August 2021. A month later, Bose, too, passed away.
Residents of more than 20 villages in the area, including Mukkulam, have been witnessing an unusual number of renal failures, respiratory issues, and other complications. According to the residents of these villages, until 10 years ago, they did not face such health issues. They attribute their health problems to the pollution caused by a biomedical waste disposal unit in the locality.
Ramky Energy and Environment Limited, a Common Biomedical and Waste Treatment Facility (CBMWTF), was established near Mukkulam in 2006. It is one of the 10 facilities operating in Tamil Nadu. Biomedical waste from 1,633 medical facilities in Madurai, Theni, Virudhunagar, Ramanathapuram, Dindugal districts are collected and disposed of in this facility.
“Initially, we thought it was a pharmaceutical company. It was only from 2010 that we started seeing the impact of this company on our health,’ said Thangapandian, the village president of A Mukkulam. “There was an abnormal rise in the number of kidney-related problems and cancer patients in the vicinity. In Thottiankulam village, within a one-month period in 2013, there were four to five deaths of people who were not more than 30 years old,” said Thangapandian, whose brother also died of kidney failure a few years ago.
Common Biomedical and Waste Treatment Facilities are classified as ‘Red Category Industries,’ per the Central Pollution Control Board (CPCB), as they cause high levels of pollution. According to the revised CPCB guidelines of 2016, a CBMWTF shall preferably be set up in a notified industrial area or should have a buffer zone of 500 metres from residential areas to minimise its impact on the local population. However, even villages outside this buffer zone have been directly affected by the pollution, said the residents.
62-year-old Bose travelled 40 km to Madurai City for dialysis treatment eight times a month for more than five years
“The company is 500 meters away from my house. But stay at my house for a night and you will understand the strength of the odour when they burn waste,” Indra, a resident of Nedunkulam village, told this reporter. Indra explained black spots on the surface of her water tank, car, utensils, and clothes, allegedly caused by the smoke.
The smoke is produced by incineration of biomedical waste, which includes human and animal tissues, body parts, organs, expired or discarded medicines, cotton swabs, masks and gloves, among others.
Sakthivel, a resident of Thottiankulam, said his village was the first to be affected by the pollution due to the proximity and direction of the wind. “In 2013-2014, we used to wonder why our livestock is fleeing and later noticed the black smoke billowing towards our village. When there is no wind, the smoke settles to the ground. The goats never ate the grasses that the smoke touched. Those that did, died,” he said.
A lot of villagers have abandoned rising livestock due to frequent deaths
Vadivel, Indra’s husband, suffers from knee pain and was warned by his doctor that he will lose his kidneys if he doesn’t take proper precautions. Prasanna Kumar, Vadivel’s doctor, who runs an Ayurveda health centre in Madurai, said that he has been seeing a lot of kidney patients from the region who were not able to find the cause of the ailment.
Dr Sampath Kumar, Head of Nephrology Department, Madurai Meenakshi Mission Hospital, who has researched on the high number of kidney failure patients in the region, said, “We collected data from more than 250 people and did extensive testing of the kidney function, and found that more than 50% to 60% of them had significant kidney disease.”
He mentioned that there are multiple factors at play when it comes to renal failure. “One of these factors is environmental change. There is not only an increase in the temperature due to global warming but also smoke particles that are circulating because of air pollution. That has a say in the kidney function,” he said. “Once these particles go into the lungs, it produces inflammation, which is not confined to lungs. It slowly spreads to other organs too.”
In the absence of a Chronic Kidney Disease (CKD) registry in India and the lack of regular health check-ups of the population at large, there is no recent data on the number of kidney failure patients in Tamil Nadu. A population-based study published in 2006 estimates the prevalence of end-stage kidney disease at around 151 to 232 per million population in India.
Due to the lack of extensive health survey, the villagers themselves collected data from A Mukkulam and surrounding villages, and found that more than 90 people have died due to kidney failure between 2012 and 2016.
“It’s an extraordinary situation. If it is not caused by this unit, then it is something else. The state government has a responsibility to find the cause of the ailments,” said Nityanand Jayaraman, an environmental activist based in Chennai, who was approached by the village residents a few years ago to discuss the issue.
Murugan, a 33-year-old from Mudukankulam village, is an engineering graduate who practices farming now. He and his relatives cultivate a variety of crops, especially groundnuts, on 20 acres of land, which is just a kilometre away from the Ramky facility.
“Since we are dependent on rains and the company is on higher grounds, even a small spell of rain will make the polluted water from the factory roll down to our fields,” he said. “We feel that the land has hardened because of the polluted water. After using this water for cultivation, our yield has reduced from 35 sacks in one acre of land four years ago to 18 sacks now,” he added.
Fugitive emissions, that is, leakage from pipes and valves of the incinerator
Sakthivel from Thottiankulam village alleged that the agricultural lands near the unit are shrinking in number. “No one can go there for farming. We used to cultivate groundnut, pulses, cotton, maize, but now we can’t. If we go near the unit, we feel suffocated by the pollution,” he said.
Murugan availed a solar-powered borewell from the Tamil Nadu government but he doesn’t use it now to irrigate his fields. Groundnut shrubs sparsely grew in the field where he used the borewell water compared to other rainfed fields. He fears that with a rainfall deficit over the last few years and unusable borewells, he and other farmers are feeling let down by the state government.
After continuous petitions by the public, the Virudhunagar District Collector sent officials to inspect Ramky’s facility on June 26, 2013. According to the order copy signed by the Mukkulam Panchayat President, the officials found the unit had not acquired the requisite permissions from the Panchayat office, Fire Department, Joint Secretary of Health and Public Services, Police Department, and Labour Department.
The order copy also mentions that the officials investigated the area and found that the smoke emitting from the unit was causing many ailments among villagers and the death of livestock within a 1.5 km radius of the unit.
The Collector, using his emergency powers prescribed under the Tamil Nadu Panchayat Act 1994, ordered the closure of the unit. The village panchayat president then sealed the unit on July 4, 2013. The company immediately went to the Madurai Bench of the Madras High Court to challenge the seal order, arguing they were not served the proper notice. The court ruled in the company’s favour and instructed the Panchayat leader to remove the lock and seal of the unit.
The unit continues to function to date.
In April 2015, The Hindu reported about a health camp conducted in Mukkulam village by Meenakshi Mission Hospital, a private hospital based in Madurai. According to the report, of the 159 persons screened, 72 had kidney-related problems, 42 had symptoms of asthma and others had developed allergies.
“Apart from diabetes patients, almost everyone above 40 years here takes medicines for lungs and kidney-related issues,” said 27-year-old Arun Kumar from Mukkulam village, who works as a medical representative in Tirunelveli district.
Dr Saravanan, a cancer specialist who runs a multi-speciality hospital in Madurai that sees a lot of dialysis patients from Mukkulam and surrounding villages, said, “I think the villagers have been exposed to factory smoke for months and years. Many come from that region come with asthma. Apart from lung disorders, we are seeing a lot of kidney failures, too.”
In 2017, hearing a writ petition filed for the permanent closure of Ramky Energy and Environment Limited, the Madras High Court ordered a medical camp to be conducted to ease public fear and shed light on the issue.
Ramky biomedical waste treatment facility
However, when the medical camp was organised in September 2017 in Mukkulam, the villagers refused to co-operate, because the medical team hadn’t brought the equipment to properly conduct the camp, and no effort was taken to arrange transportation for affected people from nearby villages, said Vanjinathan, a High Court advocate who took up the case when the villagers approached him in 2011. “People are ready to participate if the officials come with proper equipment to diagnose kidney failures, respiratory illnesses, and take blood tests. But till today, the medical camp has not been conducted,” he added.
When repeated petitions to various officials bore no fruit, 12 village panchayats in the surrounding area passed a resolution on October 2, 2015, demanding the closure of Ramky Energy and Environment Limited. They also hoisted black flags in front of their homes.
After hearing people’s complaints, a month later, the District Environmental Engineer (DEE) sent a report to the Tamil Nadu Pollution Control Board (TNPCB), stating that the factory violated the consent conditions (to get a no-objection certificate for operation), that it failed to provide continuous online monitoring system (to monitor whether emissions are within permissible levels) and connect with CARE AIR (Centre for Accessing Real-Time Air (Quality) Information Report) of the TNPCB. In another report to TNPCB a month later, the DEE also pointed out that the unit did not renew its authorisation to handle the biomedical waste.
“The DEE recommended that the unit stop its operation and have the medical waste rerouted to their Salem unit. But no action was taken,” Vanjinathan said.
When this reporter reached out to Ramky Energy and Environment Limited with questions, they offered no answers.
Even as the villagers were protesting and demanding closure of the existing biomedical waste disposal unit, a subsidiary company of Ramky, called Tamil Nadu Waste Management Limited, got consent to operate in 2016. The Hazardous Waste Treatment Storage and Disposal Facility (TSDF) in Undurumikidakulam, which has a capacity of 240,000 tonnes per annum (TPA), is the only facility in Tamil Nadu that exists side by side with a CBMWT unit.
It is a facility that doubles as a landfill to dispose of hazardous waste from factories. It is also one of the two facilities of the same company that handles hazardous waste from factories in Tamil Nadu. A bigger facility with an incinerator is set up in Sipcot Industrial Complex in Gummidipoondi, near Chennai.
According to Nityanand, there is apparently no assurance that there won’t be any leaks of leachate water from the landfill into groundwater, even if it is done in a scientific manner. “Manufacturers of landfill liners used to secure such landfills with a 20-year guarantee that there won’t be any leaks. But if there is a leak, the manufacturers won’t take responsibility,” he alleged. He also cast apprehensions about how the landfill methods are followed in reality. “If there is any change in the design, the liner won’t last even for 20 years. The manufacturers would have safeguarded their businesses, but what is the safeguard for the villagers?’ he asked.
While the Undurumikidakulam facility is currently a landfill, the proposal to set up an integrated facility (Integrated Common Hazardous Waste Treatment Storage, Disposal, and Recycling Facility) has received consent from the Tamil Nadu government in 2020.
The Integrated facility, which is expected to receive 175,000 TPA of hazardous waste, will have an incinerator for factory waste, e-waste recycling, and waste to energy conversion.
According to Prabhakaran, an Environmental Engineer at Poovulagin Nanbargal, a Chennai-based environmental advocacy group, a centralised system of having one Common Biomedical Waste Disposal and Treatment facility for five to six districts could also cause pollution and impact people.
“The government should undertake a scientific study about how these CBMWTF’s incinerators and hazardous waste landfills have affected the local population to date,” he said. He also pointed out that there is no proper monitoring mechanism in place, to understand how much hospital waste are generated and how much of it is properly disposed of. The Biomedical Rules 2016 encourage states to follow a barcode method, which will help track and monitor biomedical waste from hospitals to CBWTFs. This process was to make the system more transparent. However, Tamil Nadu hasn’t implemented it yet.
According to Shanmugam, Virudhunagar District Environmental Engineer, Tamil Nadu Pollution Control Board, “This waste cannot be disposed of anywhere. So allocating a location for such incinerators is difficult. Disposal of waste brings down the economic and commercial value of that area, too. So It becomes a socio-economic issue for the public.” He also alleged that when such health issues arise in the same locality, the public tends to point fingers at these facilities.
“Engineers don’t have solutions, they just have answers to questions,” said Nityanand. “They have three ideas to manage hazardous waste: either dig and bury them, or burn them, or release them into water bodies. Here, the solution is dirtying and polluting Mukkulam.”
In 2017, the villagers organised an all-party meeting calling for the closure of the unit in Kariapatti, a nearby town where around 2,500 people participated. Various leaders from across party lines participated and extended their support to the people’s agitation. “The DMK government has given a promise that they will shut down the unit in their manifesto. So people are waiting for that,’ said advocate Vanjinathan.
“Organising the protests was a costly affair to the villagers. Since most of them are daily wage labourers, it was difficult for them to skip work continuously and attend these protests,” said Thangapandian, Mukkulam village president. “Not long after that, we had COVID-19 disrupting our daily lives and then the state elections in 2021. So, we are not actively protesting as of now,’ he said.
“In Nedunkulam, there are two people in a very bad shape due to kidney failures. They may die today or tomorrow,” said Sakthivel from Thottiankulam. “After hearing our complaint an RO plant was installed here in our village. But that hasn’t stopped many more health issues from cropping up,” he alleged.
The villagers want the government to conduct a medical camp by an independent team of doctors, preferably from Chennai, with proper equipment and notification to all the affected villages in order to understand how many people are affected by various illnesses.
Until then, many residents will continue with their routine dialysis treatment, hoping at least the next generation will be able to live in the village without the dread of contracting life-threatening diseases.
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Nantha Kishore is a freelance video journalist based in Tamil Nadu. He has worked with leading publications like Ozy, Mongabay, The Caravan Magazine, The Diplomat, Stories Asia, Asiaville News and others. He has also produced short documentaries and worked on current affairs stories in the region.
This story was reported under the National Foundation for India (NFI) Fellowship for independent journalists.