Annals qf the MBC - vol. 5 - n' 3 -
September 1992
MAKING THE
MEDITERRANEAN SAFER
Saliba L.J.
WHO Project, Athens, Greece
SUMMARY. Although not directly
concerned with bums and fire disasters, this article highlights problems of the
Mediterranean that are of great interest to the MBC. The presence of petrochemical and
other fire hazard industries brings the environmental problem even closer to the concerns
of our organization, reasons for which we are pleased to reproduce parts of this report of
an important project of the World Health Organization.
Reproduced by courtesy of WHO: World Health Forum, vol.
11, 1990.
The 18 countries bordering the Mediterranean Sea have a population of around 350 million
people, of whom 135 million live in the coastal zone; in addition, approximately 100
million tourists visit the Mediterranean region annually. Tourism normally peaks between
May and September and is concentrated in the coastal areas. During this period, bathing
beaches are heavily overcrowded and there is a high consumption of fish and other seafood
by both local people and tourists. There is also a high incidence of gastrointestinal and
other diseases.
The sea is one of the main socioeconomic resources of the Mediterranean region. About 20
years ago, bathing in the Mediterranean began to be associated with various diseases and
disorders affecting not only the gastrointestinal tract (such as cholera, typhoid and
enteroviral diseases) but also the skin, eyes, ears and upper respiratory tract.
Furthermore, the former types of disease became linked with the consumption of raw
seafood, especially where epidemics occurred.
This situation, together with the reduction of fish populations, and the disruption of
marine ecosystems, became a matter of concern throughout the region, and there was fear
that a major oil spill might occur at sea. During the period 1971-75 there were many calls
for concerted action to improve matters, which led to an expansion of research on marine
pollution in several Mediterranean countries, a collaborative attempt to control pollution
at the municipal level, and the conclusion of bilateral and multilateral aggreements on
the protection of the marine environment. An increased interest in the Mediterranean area
was taken by several United Nations agencies, the Commission of the European Communities,
the Council of Europe, and other bodies. Finally, the Mediterranean Action Plan, a
multi-agency enterprise coordinated by the United Nations Environment Programme (UNEP),
was adopted by practically all Mediterranean states in 1975.
Where pollution comes from
Other than floating garbage that litters much of the coast, perhaps the most visible form
of pollution in the Mediterranean is oil. Slicks of small to medium size are frequently
left by oil tankers. However, 80-85% of the total amount of pollutants entering the
Mediterranean comes from land-based sources. Municipal wastes from coastal population
centres, including tourist complexes, are discharged directly into the sea, very largely
without having been treated. Industrial wastes may be discharged in a similar manner or
may reach the sea from inland locations through rivers, canals, and the atmosphere. The
intensification and mechanization of agriculture have led to the increased use of
pesticides and fertilizers, a certain proportion of which reaches the sea indirectly
through rivers and the atmosphere.
A survey conducted in 1976 and 1977 indicated that the annual pollution load entering the
sea directly from the coastal zone or in rivers included 320,000 tons of phosphorus,
800,000 tons of nitrogen, 60,000 tons of detergents, 12,000 tons of phenols, 100 tons of
mercury, 3900 tons of lead, 2400 tons of chromium, 21,000 tons of zinc, 90 tons of
organochlorine pesticides and 120,000 tons of mineral oils. In addition, thousands of tons
of chemicals, mainly pesticides, reach the sea via the atmosphere. The location of the
major industrial areas along the Mediterranean coastline is shown in the figure.
Health effects
Humans are exposed to marine pollutants mainly through the consumption - of fish and other
seafood, the ingestion of sea water while swimming or bathing, and direct contact with
sand or sea water. Exposure to bacterial or viral pollution produces relatively short-term
effects in both local people and tourists, the latter being generally the more susceptible
group. Exposure to chemical pollutants has relatively long-term effects, except where
gross contamination occurs, local people being affected more than tourists.
The main health hazard arising from the industrial pollution of sea water is associated
with the consumption of seafood. The toxicity of individual chemical pollutants is
reasonably well known, but there is much less information on their interaction with each
other and between them and naturally occurring substances. Seafood is not generally
analysed for chemical pollutants; however, routine monitoring of certain substances is
conducted. One of these is mercury, for which some countries have established maximum
acceptable concentrations in various fish and shellfish. Relatively high levels of
chemical pollutants in seafood may have no noticeable effct on its smell or taste, and the
earliest symptoms of accumulation in the human body are not, as a rule, specific for
chemical poisoning. The presence of such pollutants can only be determined through
relatively sophisticated clinical and biochemical tests.
Prevention and control
The mobile character of the sea makes marine pollution a matter of international concern.
The earliest approach to joint regional action was organized at the first session of the
United Nations Intergovernmental Working Group on Marine Pollution, when representatives
of Mediterranean states recommended that the specific conditions of the area demanded a
strategy separate from the overall global one then under discussion. In 1975 a
comprehensive action plan was prepared jointly by various United Nations agencies and
submitted to the coastal states. The Mediterranean Action Plan has been operational since
that time.
The Mediterranean Action Plan
The Convention for the Protection of the Mediterranean Sea against Pollution is supported
by protocols covering the dumping of wastes at sea, cooperation in pollution emergencies,
pollution from land-based sources, and specially-protected areas; other protocols are
being prepared. The protocol covering land-based pollution is regarded by the countries
concerned as one of the most important components of the Plan.
The Long-term Programme of Pollution Monitoring and Research in the Mediterranean Sea has
been operational since 1982. It provides information needed for the development and
implementation of preventive and control measures. The scientific work is done by
laboratories in the Mediterranean countries. At the end of 1987 nearly 100 institutions
were performing regular monitoring for the programme, and 125 research projects were in
progress.
Complementary to this programme are subregional projects in water resource management,
aquaculture, renewable energy, human settlements, tourism, and soil protection, where the
state of existing knowledge is sufficient to justify concrete practical action.
Since 1979 the Plan has been financed mainly by the governments of the region and by the
EEC, which contribute to a special fund. Furthermore, contributions in cash, services and
kind are provided by various United Nations specialized agencies and there is support from
the countries hosting the coordinating unit and the regional centres. WHO implements the
health-related aspects of the programme.
Coastal water quality control
The most frequently used recreational beaches are located in or near densely populated
areas, and consequently the majority of them are directly affected by municipal sewage. In
some areas, recreational beaches have been under regular sanitary surveillance for several
years, normally within the framework of public health programmes. The enforcement of
standards is variable, but compliance is gradually improving and the monitoring of the
quality of coastal water is becoming better organized. In countries where standards for
the microbiological quality of bathing waters were not previously enforced, monitoring
programmes are now in various stages of operational development.
The question arises as to whether there is a real prospect of success in the attempt to
get 18 diverse countries to agree to common standards for microbiological parameters, when
even the methodologies utilized differ within the region. A better approach might be to
develop common guidelines and to encourage each country to work out the details according
to its particular situation.
For the last five epidemiological studies years, microbiological and have been performed
in various areas to try and correlate water quality with health effects. Current water
quality standards are based on concentrations of bacteria indicative of pollution with
sewage. There is strong epidemiological evidence linking concentrations of bacteria
derived from sewage with the main gastrointestinal diseases. The evidence of correlation
with diseases and disorders of other parts of the body, particularly the eyes, ears, nose,
skin and upper respiratory tract, is more controversial. Most studies have included the
analysis of a wider range of bacteria in sea water than is usual in routine monitoring, or
defined in standards. Consequently, if correlations are established, further studies would
be needed to reduce routine monitoring to pratical proportions. Ultimately, of course,
bathing beaches can only be made safe if sources of pollution are removed through adequate
treatment and disposal methods.
Mercury
In 1987, emission standards were adopted for mercury discharges into the Mediterranean.
However, a considerable amount of the mercury in the sea originates from natural sources.
A protocol for the conduct of clinical studies on people with high mercury levels in their
hair has been devised by WHO, and national institutions are expected to begin putting it
to use shortly.
The health hazard presented by mercury is being tackled through the control of discharges
and the laying down of maximum acceptable cor)centrations in fish and shellfish. Perhaps
limits should also be placed on mercury levels in produce intended for conversion into
fish-meal. Such measures, however, do not protect consumers of large amounts of fish.
These people have to be properly identified and the extent of their exposure assessed so
that practical action, particularly in the form of dietary advice, can be taken.
Other pollutants
Several other chemicals being discharged into the Mediterranean also accumulate in
seafood. However, seafood is not the only vehicle by which chemicals are taken in by man,
and even moderate amounts of chemicals, if ingested in addition to those in other foods,
could lead to Safety limits being exceeded. Control over the amounts reaching the sea
would clearly be beneficial. Other sources would have to be controlled in different ways.
In 1985 the Mediterranean states issued a declaration specifying targets to be achieved
during the second decade of the Action Plan. They include: the establishment of sewage
treatment plants in all cities round the Mediterranean with more than 100,000 inhabitants,
and of appropriate outfalls and/or treatment plants for all towns with more than 10,000
inhabitants; the assessment of the environmental impact of proposed developments, with a
view to ensuring their suitability; measures for reducing industrial pollution and for the
disposal of solid waste; and the reduction of air pollution, which may give rise to acid
rain and thus menace coastal areas and the marine environment.
RESUME. Cet article, bien qu'il ne traite
pas des brfilures et des catastrophes Xincendie, met au premier plan des problemes de la
Mediterranee qui interessent beaucoup notre MBC. La pr6ence Xindustries p6trochimiques et
autres qui representent un risque Xincendie rapproche les prob16mes de 1'environnement des
preoccupations de notre organisation. Pour cette raison nous sommes tr6 contents de
reproduire certaines parties de ce rapport sur un important projet de I'Organisation
Mondiale de la Sanite.
BIBLIOGRAPHY
- UNE/ECE/UNIDO/FAO/UNESCO/WHO/IAEA: Pollutants from
land-based sources in the Mediterranean. Geneva, United Nations Environment Programme
(UNEP Regional Seas Reports and Studies, No. 32), 1984.
- Microbial pollution of Mediterranean coastal areas and
associated health effects: report on a joint WHO/UNEP meeting, Athens, 1987. Copenhagen,
WHO Regional Office for Europe, 1988 (unpublished document EUR/1CP/CEH 052).
- Shuval, H.I.: Thalassogenic infections- health effecis
associated with microbial contamination of marine bathing waters and shellfish -growing
areas. Copenhagen, WHO Regional Office for Europe, 1985 (unpublished
document EUR/1CP/CEH 001 m06/6).
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