SEKOTONG, IndonesiaIpan is 16 months old and suffering his third seizure of the morning. His head is too large for his body, and his legs are as thin as sticks. He arches his back, and his limbs stiffen. He cries out in pain.
His mother, Fatimah, tries to comfort Ipan, but there’s not much she can do. A dukun, or shaman, says his soul was invaded by the spirits of the monkey, bat, and octopus. On his advice, Fatimah and her husband, Nursah, changed the boy's name from Iqbal to Ipan and fed him tiny rice balls mixed with octopus.
“The dukun says this is why Ipan’s legs look like a monkey’s legs,” Nursah says. “Actually, I don’t believe that, but I will try anything.”
Doctors say the real culprit is more down-to-earth: mercury poisoning. His parents are small-scale miners who used the heavy metal to process gold for years before Ipan was born, including while Fatimah was pregnant.
Millions of people in 70 countries across Asia, Africa, and South America have been exposed to high levels of mercury as small-scale mining has proliferated over the past decade. The United Nations Environment Programme estimates that at least 10 million miners, including at least four million women and children, are working in small “artisanal” gold mines, which produce as much as 15 percent of the world’s gold.
More than a million miners scratch out an illegal living digging for gold in at least 850 hot spots, says Yuyun Ismawati, a 2009 winner of the Goldman Environmental Prize who has conducted extensive research on small-scale mining. Many of them fall prey to corrupt authorities who take a share of the gold rather than enforcing a law that bans mercury use.
Indonesia, an archipelago of 17,500 islands with the world’s fourth largest population, has one of the worst mercury problems, according to Stephan Bose-O'Reilly, a children’s health expert who volunteers at the Indonesian environmental group BaliFokus Foundation.
"Indonesia is a real global hot spot," Bose-O’Reilly said during a recent trip to Indonesia examine miners in the gold fields. “I haven’t seen anything worse than here."
Ipan is one of at least 46 suspected victims of mercury poisoning identified by doctors in impoverished southwestern Lombok, a tourist island next to Bali. Another 131 people with mercury poisoning have been found on the islands of Java, Lombok, and Sulawesi, according to Ismawati.
Many more victims likely remain undiscovered in remote villages across Indonesia. Nationwide, Ismawati estimates that 100,000 to 200,000 people are suffering from mercury poisoning and another 10,000 to 20,000 children have birth defects from exposure in the womb.
Some of the miners heat mercury in their kitchens, where the vapors can reach concentrations that are quadruple the amounts considered safe under World Health Organization standards.
High doses of mercury, which is a neurological poison, are a well-documented cause of birth defects, including crippling deformities and nervous system disorders. The most notorious episode of mercury poisoning occurred in Japan in the 1950s when a factory dumped the heavy metal into Minamata Bay. More than 2,000 people were poisoned by the bay’s seafood, killing some, and dozens of children suffered severe birth defects.
In Indonesia, child labor is common in the gold fields, with boys as young as eight digging the ore and as young as 12 burning the mercury-gold amalgam.
Mujiburrahman, 14, who lives in the West Lombok village of Luang Baluk, says he began torching mercury two years ago. “I burn the amalgam two or three times a week,” he says. “I never wear protective clothing.” The smoke, he says, simply “disappears.”
Doctors have identified 24 children in mining villages in the Sekotong district in southwestern West Lombok with birth defects or ailments caused by mercury.
Among them is Lailatul Azwa, who was born in September without a left hand. Like Ipan, she suffers frequent seizures.
Six-year-old Aida was born with deformed fingers on both hands.
Nyimas, who suffered from an enlarged skull and other serious deformities, died earlier this year at the age of eight. She was in a near-vegetative state all her life.
“Mercury vapor is very toxic to the brain, especially during development, and exposures may therefore be detrimental to pregnant women and small children,” says Harvard environmental health professor Philippe Grandjean, one of the world’s leading experts on the effects of mercury exposure.
Indonesia’s Gold Rush
Small-scale gold mining began to take hold in Indonesia after the 1998 fall of Suharto, its longtime military ruler, and has flourished in an ensuing era of lax governance. Nearly all artisanal miners use mercury to extract gold, even though the practice has been banned by the government since 2014.
Indonesia’s small-scale miners produce five billion dollars in gold a year, according to Atmadji Sumarkidjo, special assistant to Luhut Pandjaitan, coordinating minister for security and political affairs. That’s about 7 percent of the country's total gold production. Indonesia's gross domestic product was about $873 billion in 2015.
Miners have released hundreds of tons of mercury into the water, soil, and air, often in poor, remote areas, contaminating food and wildlife. In some villages, families use mercury-laced mine waste as the foundation for their homes or to surface their yards and walkways.
In the central Java regency of Wonogiri, where small-scale gold miners have operated for more than 15 years, residents were alarmed two years ago when the local environmental agency tested guavas, cassavas, papayas, and bananas grown in the area and found them to be highly contaminated with mercury.
“Children in the mining areas have been exposed to mercury since they were in the womb, and some are born with deformities,” Ismawati says. “When they grow up, they inhale contaminated air, drink contaminated water, and eat contaminated rice.”
Miners flock to newly discovered gold fields in Indonesia, often in national parks or on other public land, where they operate without required permits. They dig deep mine shafts, dredge rivers, destroy forests, and poison the environment.
Noisy tumblers known as ball mills operate almost continually in mining communities, often next to homes, grinding the ore along with mercury and water to extract the gold. As the tumblers rattle and spin, the rock breaks down and flecks of gold bind to the mercury. Afterwards, the miners drain off the liquid and recover some excess mercury, but much of it becomes vapor and pollutes the air or flows onto the ground and into waterways.
In the final stage of extracting the gold, the miners typically heat their mercury and gold with a blowtorch, sending poisonous mercury vapors into the air. Inhaling the vapors produced by burning the amalgam is the most dangerous form of exposure, doctors say.
Karto Paimin, 67, lives with his family in the placid hills of Wonogiri in a wooden, Javanese-style house with a high peaked roof and a large living area. The family has tunneled about 50 feet into the hillside below the house to find ore, which they process with mercury in their ball mill in the garden.
After many hours of labor, Paimin has produced a small lump of mercury and gold, which he takes to the kitchen at the far end of the house. The room has a dirt floor, woven bamboo walls and a rudimentary woodstove with no chimney. Two large pots of soup simmer on the fire at midafternoon.
Paimin brings out a piece of pipe, which is about 18 inches long and closed at one end. He slips the mercury-gold amalgam into the sealed end of the pipe and places it in the fire. He rests the other end of the pipe in a small dish of water on the floor. His daughter, Yuni, 33, and grandson, Galang, 9, squat nearby to watch.
As the pipe heats up, the mercury melts and most of it flows into the dish. But some evaporates, and the fumes escape into the room.
Krishna Zaki, of the group BaliFokus, has lugged a portable vapor analyzer into the kitchen and tests the air. He detects about 4,000 nanograms of mercury per cubic meter, four times the World Health Organization’s safety threshold of 1,000.
Ismawati immediately tells the family members that the air in the kitchen is unsafe, so they should all go outside. But none of them—including the child—heed her advice.
When the process is complete, Paimin retrieves a hot two-gram pellet of gold, which he can sell for the equivalent of about $75.
Outside, Paimin’s wife, Dinah, 55, has been complaining of headaches and difficulty breathing. Ismawati gives her simple coordination tests, including touching her nose with her finger and moving her wrists simultaneously. She does poorly, and Ismawati recommends she get tested for mercury exposure. Dinah is shocked. She and her husband had no idea mercury was harmful.
“Now I know,” Paimin laments. “But before today I didn’t know, and I cooked the mercury in the kitchen.”
Since Roman times, when slaves worked the cinnabar mines, mercury has been known to cause a wide range of symptoms, including headaches, tremors, drooling, difficulty walking, and eventually, death. But mercury poisoning can be difficult to diagnose because it has many symptoms in common with other ailments.
The extent of mercury-related health problems in Indonesia is only now emerging as BaliFokus, volunteer doctors, and a few government officials search out victims and test for mercury in the air, food, homes, and water.
Erick Gunawan, a public health service doctor in Sekotong on Lombok island, has held two screenings in mining communities with BaliFokus’s help and found dozens of potential mercury victims. He believes there are many more who have been poisoned and hopes to hold more screenings.
“It’s like an iceberg,” he says. “You only see what’s on top but you can’t see what’s below.”
Claims of Extortion
The slow-growing environmental disaster has begun to attract attention from top officials in the administration of President Joko Widodo.
Coordinating minister Pandjaitan cited illegal mining last year as one of the security challenges facing the country. Sumarkidjo, his aide, says the minister was referring in part to the illegal miners who destroy the environment and spread mercury in their communities.
He says the minister was particularly concerned by the rapid destruction and widespread use of mercury by miners on remote Buru Island, the site of a former prison in the Moluccas Islands where a gold rush has drawn many thousands of miners since 2012.
“It’s not small-scale when you look at Buru Island,” he says. “It will take years to clean up the mercury.”
Gatot Sugiharto, founder of the Indonesian People’s Mining Association, says miners are forced to give as much as half their earnings to corrupt police and soldiers who control access to mining areas and demand payment. He alleges that billions of dollars go into the pockets of officials who should be enforcing the law against using mercury.
“The miners lose about 50 percent of their product to pay the extortion,” he says. “Sometimes police take it all.”
Sumarkidjo agrees that the miners’ illegal status makes them vulnerable to extortion and acknowledged that the police and military take a significant share.
“Our office does not have proof of how much they take,” the minister’s aide says. “But you can’t do these illegal things without the understanding of the authorities— the police and the local military. Everyone takes the opportunity to take something.”
Sugiharto, a former miner himself, advocates legalizing the small-scale miners because it is the only way to end mercury use. Operating outside the law means the miners pay no taxes, depriving the government of much-needed revenue. If they were legal, he says, the government could teach them methods that do not use mercury, regulate their activities, and collect taxes to pay for health care, mercury cleanup, and land rehabilitation.
“Being illegal, all activity is uncontrolled,” he says. “They use mercury inside their houses, hiding from the public or from the officers. It’s very, very dangerous because sometimes they burn the mercury in the kitchen or in their rooms.”
The extent of mercury contamination around the globe has prompted international action. In 2013, 128 nations signed the Minamata Convention on Mercury, which aims to limit the trade and use of mercury worldwide.
The UN agreement doesn't ban mercury in small-scale gold mining but requires signatories to take steps to reduce its use and eliminate it "where feasible." Countries are required to draft detailed action plans for eliminating amalgam burning and educating the public on mercury's dangers, among other steps.
Indonesia signed the pact but is not among the 25 countries, such as the United States, that have ratified it so far. It will take effect once 50 nations ratify it.
Tuti Hendrawati Mintarsih, director general of hazardous waste in Indonesia’s Ministry of Environment and Forestry, says her agency is developing the country's action plan. But in tackling the mercury problem, she says the government is hampered by overlapping jurisdictions and a lack of funds to locate victims, provide care, and clean up contamination.
In the meantime, mining continues uninterrupted.
Resti Fauzia, age two, has never spoken a word. She stopped walking at 18 months, says her mother, Ocih. She can’t grasp objects or stand without help. When she sleeps, she has seizures.
Her family lives in the village of Pangkal Jaya, near Pongkor Mountain, about 60 miles southwest of Jakarta. Illegal miners have been digging for gold there since at least 2000. More than 10,000 miners work there today.
For 15 years, Resti's family has operated a ball mill just outside the kitchen door. Volunteer doctors working with BaliFokus examined the girl and concluded she was suffering from mercury poisoning.
On the day the medical team examined her, mercury levels outside the kitchen measured 20 times higher than the WHO safety threshold.
“No one ever told us that mercury is dangerous,” Ocih says.
This story was produced in collaboration with the Pulitzer Center on Crisis Reporting.