Cytotoxicity of water supply in a Palestinian refugee camp and a Syrian informal tented settlement in Lebanon

Deficient water, sanitation, and hygiene (WASH) significantly account for a high burden of disease across the globe. Lebanon, an Eastern Mediterranean lower-middle-income country with a polluted environment, a fragmented healthcare system, and an ongoing severe economic crisis, faces serious challenges in sustaining safe water supplies, especially in vulnerable communities, while also hosting the world highest refugee population per capita. This study aimed to examine the mutagenicity, and the estrogenic and androgenic activities of water supplies, across both a Palestinian refugee camp and a Syrian informal settlement. Water samples were collected from two targeted camps in Dbayeh and Choueifat, North and South of the Capital City Beirut, respectively, between the months of September and October 2022. Microbial and physicochemical properties of samples were determined, including fecal contamination, total dissolved solids, and various minerals and salts. Organic pollutants were extracted using pre-packed solid phase extraction (SPE) columns, and then mutagenicity of extracts was examined using the Ames test in two Salmonella typhi bacterial strains. The estrogenic and androgenic activities of extracts were assessed using the yeast estrogen and androgen screen tests assays (YES/YAS). Results show excessive levels of total coliforms and total dissolved solids (TDS) in samples from both sites. In addition, the water supply from the Dbayeh Palestinian refugee camp is mutagenic, while the water supply from the Choueifat Syrian informal settlement shows anti-androgen activity. Our findings provide valuable WASH baseline data in two major vulnerable communities in Lebanon, and highlight the importance of a water toxicity testing approach concomitant with a water safety plan, based on a holistic strategy that covers all stages of the water supply chain.

Feature selection approaches for predictive modelling of cadmium sources and pollution levels in water springs

The World Health Organization lists cadmium (Cd) as one of the top ten chemicals of public health concern. Cd is toxic at relatively low exposure levels and has acute and chronic effects on both health and the environment. In this study, we investigate a suite of data-driven methods that could assist decision-makers in estimating Cd levels in water springs, and in identifying polluting sources. Machine learning (ML) regression models were used to identify sources of contamination and predict Cd levels based on support vector machines and a variety of tree-based models, including Random Forests, M5Tree, CatBoost, and gradient boosting. Feature selection analysis revealed that heavy traffic and distance to a major power plant in the sampled area play a leading role in springs Cd contamination, together with precipitation levels and average of slopes of the closest waste dumps upstream to sampled springs. Our best performing ML model was the Adaboost regression tree using all the features (RMSE = 19.36, R^2 = 0.64). Our findings highlight the effectiveness of predictive data-driven modeling in addressing environmental challenges, particularly in high-risk areas with low resources.

Towards a renewed public health regulatory and surveillance role in water, sanitation and hygiene (Editorial)

Evidence from the burden of disease studies indicates that improving water, sanitation and hygiene (WSH) is a primary disease prevention measure. It prevents 57% of diarrheal deaths, contributes to prevention and management of neglected tropical diseases, and is the first line of defense against Cholera. Moreover, water and sanitation (W&S) services and hygiene contribute to programme initiatives including new-born, child and maternal health; infection prevention and control; universal health care; antimicrobial resistance; and health emergencies. Access to W&S services is recognized by the United Nations as a human right.

Assessment of toxic metals and phthalates in children's toys and clays

Toxic metals and phthalates are introduced in the manufacturing of plastic toys and modeling clays. In Lebanon, inexpensive plastic toys and modeling clays (sold in dollar stores) are affordable and popular, and there is no legislation to monitor or regulate such toys. This study aimed to assess the quality of inexpensive plastic toys and modeling clays imported in Lebanon. Metal concentrations in toys, namely, zinc [not detectable (ND) to 3,708 μg/g], copper (ND to 140), chromium (ND to 75 μg/g), tin (ND to 39 μg/g), and cadmium (Cd) (ND to 20 μg/g), were lower than the European Union (EU) Directive limits, whereas lead (ND to 258 μg/g) in 10% of samples and antimony (Sb) (ND to 195 μg/g) in 5% of samples were greater than the EU limits. In modeling clays, most of the metals were lower than the EU Directive limits except for Cd and arsenic (As). Cd was detected in 83% of samples, with a mean level of 9.1 μg/g, which is far greater than the EU Directive limit (1.9 μg/g). The As mean level of 4.5 μg/g was greater than the EU limit (4.0 μg/g) and was detected in 9% of samples. Phthalic acid esters (PAEs) were found in 60% of children's toys and 77% of modeling clays. Phthalic acid butyl ester had the highest-level PAE encountered and was ≤59.1 % in one type of clay. However, among children's toys, di(4-octyl) ester terephthalic acid was the highest encountered phthalate at a concentration of 25.7%. The community survey indicated that 82% of households purchase their toys from inexpensive shops and that only 17% of parents were aware of the health hazard of such toys. Consequently, an intervention plan was proposed for the provision of safe toys to children.

Management of microbial food safety in Arab countries

Microbial food safety remains a major economic and public health concern in Arab countries. Over the past several years, many of these countries have attempted to revise and upgrade food quality control and surveillance programs; however, these systems vary in scope and effectiveness. This review addresses the major reported foodborne outbreaks and multidrug resistance of pathogenic microorganisms isolated from food products. Major foodborne pathogens of concern included Brucella spp., Clostridium botulinum, fecal coliforms, Escherichia coli O157:H7, Listeria monocytogenes, Salmonella, and Staphylococcus aureus. Measures for managing microbial food hazards based on a comprehensive risk analysis also are proposed.

The challenges of sustainable access to safe drinking water in rural areas of developing countries: case of Zawtar El-Charkieh, Southern Lebanon

Adequate and safe water is important for human health and well-being, economic production, and sustainable development. Failure to ensure the safety of drinking water may expose the community to the risk of outbreaks of waterborne and infectious diseases. Although drinking water is a basic human right, many people do not have access to safe and adequate drinking water or proper sanitation facilities. The authors conducted a study to assess the quantity, cost, continuity, coverage, and quality of drinking water in the village of Zawtar El-Charkieh, Lebanon. Their aim was to identify the challenges of sustainable access to safe drinking water in order to determine the short-term management actions and long-term strategies to improve water quality. Results revealed that contamination of the source, absence of any disinfection method or insufficient dose, poor maintenance operations, and aging of the networks are significant factors contributing to water contamination during the storage and distribution process. Establishing a comprehensive drinking water system that integrates water supply, quality, and management as well as associated educational programs in order to ensure the safety and sustainability of drinking water supplies is essential.

Effectiveness of wastewater management in rural areas of developing countries: a case of Al-Chouf Caza in Lebanon

Alike many developing countries, Lebanon lacks a national wastewater management strategy that can effectively protect public health and environmental quality. This has led the local communities and municipalities to plan and implement their own arrangements for wastewater treatment systems. However, most municipalities still lack the human and financial resources, management capabilities, and environmental awareness necessary to implement wastewater management in an environmentally sound manner. As such, the effectiveness of these systems, particularly with regard to the quality of the treated effluent, warrants evaluation. Accordingly, a performance evaluation of the treatment/disposal systems, taking three villages in Al-Chouf Caza in Lebanon as a case study, was carried out. The conducted field work, visual assessment, and laboratory analyses of effluent discharges revealed that the existing systems for wastewater treatment in the three villages are either not properly functioning or operational but ineffective and, consequently, hardly achieve any treatment higher than primary. Although developing countries are being encouraged to implement wastewater treatment systems with the promise of financial aid from developed nations, it is important that local conditions are considered carefully to make full use of any aid. It is very crucial to take into account the economic status of the community and the municipality in question. There is no point in adopting the most advanced technology for wastewater treatment if there is no mechanism to ensure maximum efficiency.

Effect of women's perceptions and household practices on children's waterborne illness in a low income community

An ecosystem approach to human health was adopted in a community-based study carried out in Bebnine, an underserved town in Lebanon. The objective of the study is to examine the association between women's household practices and diarrhea among children in a setting where contaminated drinking water and intestinal diseases are common. A total of 280 women were randomly selected and interviewed using a structured questionnaire. Data were collected on 712 children between the ages of 6 and 14. The study instrument included determinants of diarrhea such as sociodemographic characteristics, water, sanitation, hygiene practices, gender variables, and behavioral risk factors. Multivariate regression analysis was employed to examine the association between water handling practices and diarrhea. The prevalence of diarrhea is 5%. Female children are more likely to suffer from diarrhea than male children (OR = 2.58; 95% CI: 1.19-5.62). Treatment of drinking water at the household level and the use of drinking water for cooking and the preparation of hot beverages are protective against diarrhea (OR = 0.15; 95% CI: 0.03-0.65). Female caretakers' behaviors such as daily bathing and seeking medical care at times of illness are protective against diarrhea in children. The findings suggest that diarrhea is a gendered health problem. Female children, who are generally more involved in household activities than male children, are at higher risk of suffering from diarrhea. Female caretakers' personal hygiene, household practices, and perceptions of diarrhea are additional risk factors. Intervention activities would be more effective if based on a better understanding of gender roles and household power relations.

Provision of safe domestic water for the promotion and protection of public health: a case study of the city of Beirut, Lebanon

Securing adequate safe drinking water and proper sanitation is a major challenge facing the developing world. The "Water for Life Decade" emphasizes the importance of upgrading national water quality and sanitation services. This study assessed the domestic water profile in the city of Beirut. Samples were collected from three types of household water sources (municipality, private wells, and vended water bottles) and assessed for their physiochemical and microbiological profile. At the same time, a cross-sectional survey assessing water consumption patterns and the prevalence of water-borne diseases was conducted. The results showed a deficient water quality profile in all three water sources. The measured physiochemical and bacteriological parameters reflected the high frequency of water-borne diseases. Action to secure a safe domestic water supply is essential. The plan should guarantee the protection of water sources, ensure sufficient treatment of domestic water and upgrade the national program for potable water quality control. Periodic quality monitoring and legislating the chaotic water-vending sector are indispensable. Additionally, the deterioration of private well sources by sea and wastewater infiltration necessitates the enforcement of legislation associated with the use and management of private wells. Consumer awareness and active contributions to promote and protect public health are important.

Assessment of domestic water quality: case study, Beirut, Lebanon

In urban cities, the environmental services are the responsibility of the public sector, where piped water supply is the norm for urban household. Likewise, in Beirut City (capital of Lebanon) official water authorities are the main supplier of domestic water through a network of piping system that leaks in many areas. Beirut City and its suburbs are overpopulated since it is the residence of 1/3 of the Lebanese citizens. Thus, Beirut suffers deficiency in meeting its water demand. Water rationing, as a remedial action, is firmly established since four decades by the Lebanese Water Authorities. Consumers resorted then to private wells to supplement their domestic water needs. Consequently, household water quality is influenced by external factors relating to well water characteristics and internal factors depending on the types of the pipes of the distribution network and cross connections to sewer pipes. These factors could result in chemical and microbial contamination of drinking water. The objective of this study is to investigate domestic water quality variation in Beirut City emerging form the aforementioned factors. The presented work encircles a typical case study of Beirut City (Ras Beirut). Results showed deterioration pattern in domestic water quality. The predicted metal species and scales within the water pipes of distribution network depended on water pH, hardness, sulfate, chloride, and iron. The corrosion of iron pipes mainly depended on Mg hardness.

Variation of metals in bed sediments of Qaraaoun Reservoir, Lebanon

The Qaraaoun Reservoir (impoundment of the River Litani) is the only artificial surface water body in the country, Lebanon. Earlier study on the water quality of the Qaraaoun Reservoir identified three water quality zoning with a central distinct zone suitable for multipurpose water usage. The objective of this study was to extend the earlier work by considering the total metal content of reservoir bed sediments and hence to evaluate factors that control metal deposition or capture. Water samples were collected from 15 sampling sites and sediment samples were simultaneously collected from 9 sites. Water parameters analyzed were pH, Eh, DO and temperature. Sediment samples were dried and sieved and sediment < 75 microm was retained for analysis. Sediments were subjected to a stepwise heating process with aqua regia to extract the metals, and their content in sediments determined by ICP-MS. The sediment data revealed higher metal contents where the river entered the reservoir which matched higher concentrations of water parameters at the influx site. Regression analysis of total metals in sediments with distance from the river Litani influx point to the dam revealed a log trend for Fe, Cr and Ni, whereas, the concentrations of Cu, Zn, Cd, Pb were better described by a polynomial regression. Three sediment zones were identified: entrance, oxidation (central) and reducing (near dam) zones. Sediment contents of Zn, Cu and Pb correlated with organic content, whereas sediment Cr and Ni were associated with iron. It was concluded that sediments act as a sink for metals and the deposition of metals is primarily related to sediment organic content and the level of dissolved oxygen in water.

Evaluation of water quality of the Qaraaoun Reservoir, Lebanon: suitability for multipurpose usage

The increased demand on water resources in Lebanon as a result of: progressive urbanization, socio-economic growth, agricultural activities and development of industries is, according to the national authorities, a major critical factor by the year 2010. Political difficulties in earlier years imply a dearth of pertinent data. The objective of this study was to evaluate water quality of the Qaraaoun Reservoir of the Litani River and assess its feasibility for multi-purpose usage as one of the solutions to the aggravated water problems in Lebanon. Samples were collected from 18 sampling sites at several dates during the dry season. Parameters analysed were, pH, electrical conductivity, TDS, turbidity, alkalinity, Ca, Mg, TH, Cl-, SO4(2-), NH3, NO3(-), PO4(3-), Fe, Al, Na, Zn, Cr, Cu and As. The reported data were in compliance with WHO guidelines, USEPA regulation and EEC directives. Statistical analysis of the data defined three distinct environmental zones and water quality in the central, main zone satisfied most criteria. It is concluded that the reservoir water is fit for multipurpose uses, namely, drinking, domestic, recreational activities, irrigation, fisheries, livestock and industrial, and should be properly managed accordingly.

Transboundary movement of hazardous wastes into Lebanon: Part 1. The silent trade

This paper discusses the transboundary movement of hazardous wastes into developing countries, frequently referred to as the "silent trade," and the new efforts by the Basel Convention to control the international movement of hazardous wastes. The importation of hazardous wastes into Lebanon is examined in terms of waste trade activities (e.g., types, quantities, and management responses) as of 1987. The focus is on the national response, the roles played by different parties (e.g., politicians, expert groups, nongovernmental organizations, international organizations, and mass media) and their impact on the current status of events. Key challenges facing developing countries in managing silent-trade activity are identified in terms of environmental health and safety implications.

Transboundary movement of hazardous wastes into Lebanon: Part 2. Environmental impacts and the need for remedial actions

This paper discusses the transboundary movement of hazardous wastes (the "silent trade") into Lebanon in terms of environmental impacts and remedial actions. It highlights the projected impacts on potable-water quality, the exposure of the groundwater aquifer, and the status of quality control programs. The public responses to these problems are presented and characterized in terms of mistrust and rejection. The constraints developing countries face in handling environmental impacts and undertaking remedial actions are emphasized. The vision derived from the decade covered (1990-2000) emphasizes the need for international collaboration, through Basel Convention efforts, to control the transboundary movement of hazardous wastes and the disposal of such wastes. The need for "global harmonization" should be given serious consideration.

Decision to Fluoridate. 2. Intake of Fluoride from Nonmilk Fluids by Children under two Years of Age in Lebanon

This study investigated fluoride intake from fluids consumed by children 0 to 2 years of age residing in urban and rural areas in Lebanon. An area sample of 150 families with children was selected from Beirut and three villages in the Shouf Area in Mount Lebanon (70 and 80 families, respectively). Food diaries for two weekdays and one weekend day were obtained for children aged 0 to 2 years in urban and rural areas (76 and 85 children, respectively), and their fluoride intake from fluids was assessed. Children were given tea, anise, mint, and mixed herbal teas for various reasons, such as their medicinal, warming, and calming effects. They were also given orange flower water, orange juice, and rice water. In urban areas, the fluoride intakes from fluids, expressed as percentages of the estimated safe and adequate (ESA) intake of fluoride, were 48.5% among children 0 to 6 months old, 110.5% among those 7 to 12 months old, 21.9% among those 13 to 18 months old, and 43.5% among those 19 to 24 months old. In rural areas, the ESA fluoride intake from teas was 180.9%, 115.9%, 102.0%, and 71.5% for children aged 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months, respectively. In view of the substantial level of intake of fluoride from nonmilk fluids among children in this study, decisions regarding water fluoridation in Lebanon should consider these results.

Decision to Fluoridate. 1. Fluoride Levels in Herbal Teas Used in Lebanese Communities

This study assessed fluoride levels in herbal teas available in the Lebanese market, taking into consideration methods of preparation and time. The fluoride contents of two-minute decoctions prepared from 25 different brands of herbal teas were measured. Only tea and maté were prepared as infusions, and decoctions were prepared from tea, anise, mint, and mixed herbs (0.5, 1, 2, 3, 4, 5, and 10 minutes). For two-minute decoctions, fluoride concentrations ranged from 0.620 to 1.680 mg/L for tea (mean, 0.955 mg/L), 0.056 to 0.060 mg/L for anise (mean, 0.058), 0.030 to 0.037 mg/L for mint (mean, 0.033), 0.010 to 0.068 mg/L for mixed herbs (mean, 0.039), and 0.143 to 0.185 mg/L for maté (mean, 0.160). More fluoride was leached in tea decoctions than in infusions with the same preparation time. Leaching of fluoride reached a maximum after boiling for 10 minutes for tea, mint, and mixed herbs; boiling for 3 minutes for anise; and five runs for maté. Fluoride levels were highest in tea decoctions, followed by mixed herbs, anise, and mint. These findings point to the importance of considering fluoride levels from herbal teas in the overall determination of fluoride intake. In addition, such studies enrich databases required when considering fluoridation as a policy issue.