HAWSH AL-RAFQA, Lebanon: Just 10 days after Ali Turki Kayal’s father died of leukemia in 2016, his 18-year-old son Hussein was diagnosed with the disease. Hussein died of complications related to his treatment last month.
He was 21 years old.
“My son was in the 10th grade when he got it,” Kayal recalls. “He was a great student, but he stopped studying when it happened. He told me, ‘Dad, I’m only going to live a few years and then I’ll die like the rest of them, why should I bother continuing my studies?’”
A few doors down from Kayal’s house, his uncle Ali Mohammad Kayal lies half-conscious on a living-room mattress, an IV in his arm.
He has cancer of the liver and pancreas, and has just returned from treatment in Beirut, 70 kilometers away from his home in Hawsh al-Rafqa. Dark rings circle his eyes. His silver hair runs thin.
“It’s the Litani,” the 55-year-old says through labored breaths, blaming the nearby river for his cancer.
“In Hawsh al-Rafqa, we’re not living anymore.”
The small western Baalbeck town’s main road crosses over a bridge, a brief walk from Ali Mohammad Kayal’s house. Underneath, the Litani River flows a lifeless gray, between piles of garbage that line its shallow banks.
It divides the town in half, emitting a putrid odor of raw sewage.
“We used to drink from the river and bathe in it. In summer, especially on Sundays, you would see hundreds of children, naked, playing in the river,” the town’s Mayor Adel Yazbeck told The Daily Star from a small bookshop he owns near the town center. “I spent many summers reading my book by the river, fishing in the river. It was a river of life, glory and well-being that transformed into a river of death.”
The mayor’s own son died in 2014, after fighting cancer for four years. “He had lung cancer, from the smell of the Litani River,” Yazbeck claims. “My cousin, who lived right next to the river like us, died a month before my son, with the same sickness.”
The mayor, a retired schoolteacher, rattled off the names of a dozen other people in the town of about 6,000 who have succumbed to the disease. “We’ve had more than 50 cancer deaths in the past eight years, two new cases in the past month alone, and the reason is the Litani,” he said.
For decades, Lebanon’s longest river has been polluted by industry, raw sewage and bad farming practices. The fetid water seeps into the ground, contaminating drinking-water wells, and is widely used for irrigation in Lebanon’s agriculture sector. Successive governments have failed to clean up the Litani, even with tens of millions of dollars in loans from the international community.
The new Parliament, elected in May, has worked to prioritize the issue, supporting a crackdown on the factories that pollute the river.
Last month, lawmakers also endorsed the acquisition of loans from the Islamic Development Bank for a project to route sewage out of the river to a treatment plant.
The plan seeks to create a 20-kilometer sewage network linking up the towns of western Baalbeck, from Shmustar, upstream of Hawsh al-Rafqa, down to a treatment plant planned for Tamnin al-Tahta, south of the town. But the project, managed by the Council for Development and Reconstruction, is expected to take at least two years. Locals say they can’t handle the wait.
They made national news last month when they staged a protest against the high cancer rates, calling for quick action by the government.
This prompted an op-ed by Philippe Lazzarini, Lebanon’s U.N. resident coordinator and humanitarian coordinator, titled, “We can still save the Litani River.”
The piece opened with a quote from one of the protest chants: “I don’t want the cancer to kill me.”
Yazbeck, the mayor, spoke of a recent meeting with Baalbeck MP Jamil al-Sayyed in which the lawmaker agreed to try to find a temporary solution. It was ultimately decided that the town’s portion of the larger sewage network would be constructed ahead of the rest of the network’s completion. This plan would divert the entire segment of the Litani in Hawsh al-Rafqa through the sewer to prevent the waters from seeping into the ground, reducing the odor they emit.
But Charbel Abo Abs, the CDR engineer in charge of the project, told The Daily Star that it was unlikely such a plan would go forward, and that Hawsh al-Rafqa would have to wait until 2021 for a river clean of “98 percent” of its sewage, when the CDR’s project is fully completed.
An engineer with Green Line General Trading and Contracting, a Kuwaiti company contracted by the CDR to build the network, agreed, telling The Daily Star the company could not implement such a project without a drastic change in plans.
“By the time the state does something, those who died will have come back again,” Ali Turki Kayal said. He said locals are now considering taking it upon themselves to raise money from each house in the town to fund their own project to deal with the river.
In addition to pollution from the Litani, some residents believe the high cancer rates are being caused by radioactive material allegedly dumped on the nearby Mount Sannine during the Civil War.
Hasan Abdullah, a doctor and one of the founders of the nearby Riyak Hospital, said the theory had some credence. Cancers associated with radioactivity, including leukemia and thyroid cancer, are highly prevalent in the town.
He said that cancers in the digestive system, associated with water pollution, are also rapidly increasing.
His hospital has meanwhile found groundwater nitrate levels exceeding the normal rate by 40 percent. While there have been no studies definitely linking cancer to the Litani, studies have associated high nitrate levels with an increased risk of cancer.
Clear statistics on cancer rates are hard to come by for the area surrounding Hawsh al-Rafqa, but caretaker Health Minister Ghassan Hasbani told The Daily Star that cancer rates across Lebanon increased by 5.6 percent between 2005 and 2016.
Abdullah said Riyak Hospital registered a cancer rate 6 percentage points higher than the world average among its patients. “This year more than last year, and last year more than the year before that.”
Adding to the problem, Abdullah said the sorry state of the country’s finances and general “chaos” in the government had led to a reduction in the amount of days the hospital can afford offering cancer treatment, down to just one or two days per week, depending on the treatment.
Hasbani previously denied that anyone has died as a result of the state’s failure to secure funding for cancer drugs.
But a local medical source told The Daily Star that the state’s shortcomings in the health sector, including a recent monthslong failure to secure funding for drugs for those with cancer and chronic illnesses, affecting 25,000 patients, had “lowered the life expectancy of those with cancer.”
The source spoke on condition of anonymity for fear of publicly contradicting Hasbani’s statement.
During its last legislative session, Parliament approved funding for the drugs.
In addition to negligence in terms of legislation, MP Sayyed told The Daily Star the state has also failed to assess the cause of high cancer rates in the area, including the possibility of Sannine harboring radioactive waste. Sayyed said hospitals could also ironically be to blame for high cancer rates in Hawsh al-Rafqa because they dispose of medical waste, including radioactive waste, into the river.
Hasbani, however, said that medical waste from all hospitals is picked up and treated by Arc en Ciel, an NGO, and that the ministry has never heard any complaint of hospitals dumping radioactive waste.
Rather, he said the dumping of industrial waste and sewage is the “biggest national problem that is causing all of these issues,” and did not deny that sewage from hospitals also finds its way into rivers.
Back in Hawsh al-Rafqa, the mayor said the situation has gotten so bad that people are refusing to go to the hospital for fear they will be diagnosed with cancer.
“We can’t carry this burden anymore, but we also can’t run away. Nobody has a cent to leave this place and rent a house somewhere else. It’s a catastrophe. All we can do is wait.
“The other day, my wife had a stomach ache,” he said. “She told me, ‘Hajj, could I have that disease?’ I told her to stop being delusional. But people are scared, my friend.
“Our lives are gripped by the specter of cancer.”