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

  1. 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.
  2. 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).
  3. 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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