The true toll of the water crisis in First Nations communities across Canada can’t be known because the government has failed to track and study water-related illnesses.
That stands in the way of tackling the problem, experts told the Institute for Investigative Journalism as part of “Clean Water, Broken Promises,” a year-long investigation conducted in collaboration with universities across the country and a consortium of media outlets including The Tyee.
Some critics charge the “black hole” of information is intentional because it allows authorities to duck responsibility.
A disproportionate number of illnesses which occur as a result of contaminated drinking water are in First Nations communities with substandard water systems, but the data needed to map the reality are missing.
Even the First Nations Health Authority in British Columbia, the first provincewide health authority to serve First Nations in Canada, revealed that it does not track data on water-related illnesses or deaths in First Nations in the province.
“There's an obligation of the Crown to be aware of it, and do something about it,” said Aimée Craft, an Anishinaabe-Métis associate professor in the faculty of common law at the University of Ottawa. She said a failure to track this information prevents the development of policies needed to address this issue.
Missing, too, is the robust level of published expert research that might be expected for so serious and complex a health issue in Canada (see sidebar).
First Nations have suspected that cancer, stomach infections, bacterial contamination, skin conditions, birth defects and even deaths can be attributed to their water. While water can impact health in a variety of complex ways, experts say there is no excuse to not be tracking certain basic ailments.
“There are direct consequences of challenges in water quality,” said Dr. Alan Katz, director of the Manitoba Centre for Health Policy. “This is not something that we should see as being difficult to describe or challenging,” he said in an interview. “It's historically the birth of public health.”
But critics say government’s failure to collect such data may be on purpose.
“There’s nothing. It’s a black hole. I always tell people, it’s a deliberate black hole,” said Charlie Angus, NDP MP for Timmins-James Bay, Ont. “This is all about protecting the government from liability. If they don't track it, there's no evidence.”
The federal government is facing multiple lawsuits in relation to water access and quality on First Nations including two high-profile class actions brought by members of Tataskweyak Cree Nation and Curve Lake and Neskantaga First Nations that allege Canada is negligent “in creating and failing to remedy conditions of inadequate access to potable water.”
In a January interview with the minister of Indigenous services, Marc Miller agreed there was a need for more information on the impact of bad water, saying “certainly, we need better water data.” However, he denied claims the lack of it benefited the government. “There's no incentive in hiding information. There's no incentive in not collecting information.”
When water can’t be trusted
Arlene Nakogee lives in Kashechewan in northern Ontario. Her three-year-old daughter has suffered from a painful skin condition since she was three months old. She said the toddler is covered in sores and is often itchy and in pain but says there is little she can do for her.
Nakogee believes the problems have been caused by the water in her home, but she said, “I have no choice but to use the tap water.”
She suspects chlorination is playing a role in her daughter’s skin problems. “You could smell the bleach whenever you run the water here,” said Nakogee.
Chlorinating drinking water is a standard method of removing bacteria. Indigenous Services Canada calls it “one of the most important public health achievements of the 20th century.” Yet, the heavy use of chlorine is said to cause skin problems.
Chief Emily Whetung of Curve Lake First Nation in Ontario said, like Nakogee, she doesn’t trust the water in her community. Several years ago she said she and her family contracted what she believes was E. coli poisoning after consuming water from her family’s well. “We were all violently ill for a couple of days,” said Whetung.
Following the illness, they got their well tested. She said the health officials who tested the water were terrified about the E. coli levels.
She said after decades of water issues in the community, whenever people feel unwell, they have the same questions: “Is it just me, is it the water? And did I come in contact with something, is it the water?”
Chief Whetung says people who reside in First Nations live with an underlying understanding “that you’re not starting from a point of clean water.”
But she counts herself lucky. “Both of my parents were teachers, so we had no issue buying bottled water for my entire life.”
She is a lawyer who worked in Peterborough and is often questioned about why she does not just move to a city. “When you choose to leave the reserve there’s social consequences, there’s cultural consequences, there’s absolutely language and knowledge consequences that are far more significant than someone who decides that living outside of a city is better for them.”
Curve Lake First Nation had a boil water advisory in parts of the community from July 2016 to June 2018. When she was elected as Chief, water was one of her priorities.
She said though her community has qualified for funding to design a water treatment plant, a fix is still at least several years away.
While Canadians may have become accustomed to hearing about drinking water advisories, each one represents a community of people who need to drink, cook, bathe and clean using that water. When a boil water advisory is in place, residents are required to bring water to a rolling boil for at least one minute before using it for drinking, cooking, brushing teeth, washing produce and even bathing infants and toddlers.
In 2016, researchers from the University of Saskatchewan did a review of peer-reviewed research published between 2000 and 2015 on water and health in Indigenous communities in Canada. They found that problems like skin issues and gastrointestinal illnesses, like those experienced by Nakogee’s daughter and Chief Whetung, were two of the most commonly reported in relation to water.
They also found reports of birth defects, obesity, anxiety and depression, heart diseases, liver diseases, kidney problems, neurological problems, immunopathology, cancers, thyroid conditions and infant mortality in connection to low-quality water.
‘No national surveillance system’ for outbreaks
The Institute for Investigative Journalism contacted 59 organizations that keep health data across the country, including provincial and territorial ministries of health, ministries of Indigenous affairs, and coroners’ offices to try to find statistics that show how often people living on reserves are sick or even die as a result of their water.
Among the 28 across the country that replied, responses were similar. “Data about waterborne illnesses on First Nations communities fall under the jurisdiction of the First Nations and Inuit Health Branch at Health Canada,” wrote the media relations team at Public Health Ontario.
However, a request to the federal government through Health Canada revealed that neither Health Canada, Statistics Canada, nor Indigenous Services Canada keeps data on deaths and illnesses resulting from contaminated water in Indigenous communities.
“There is no national surveillance system specifically for waterborne disease outbreaks,” said spokesperson for Indigenous Services Canada Leslie Michelson. “When epidemiological evidence indicates that drinking water is, or may be, responsible for a disease outbreak, a DWA is issued.”
She said tracking of waterborne illness is done locally but “can be under-reported as they are difficult to identify, and the collection of information can be incomplete or not widely published/distributed.”
She added that since the First Nations and Inuit Health Branch was created in 2003, there has not been a confirmed waterborne disease outbreak identified in a First Nation.
At the time of his response, David Wolkowski was a spokesperson for Health Canada. He told the IIJ by email that “the ongoing monitoring of waterborne illnesses does occur and is well understood at the local and provincial/territorial public health level.” He suggested contacting provincial and territorial ministries of health for a better picture.
The IIJ contacted 13 different health agencies and ministries at the provincial level. They said they did not track water-related illnesses or deaths on First Nations, though seven said they did track this information for the off-reserve population. Most said this was the jurisdiction of the federal government; others referred the IIJ to individual First Nations or simply said they did not have the information.
B.C.’s First Nations Health Authority, the first provincewide health authority to serve First Nations in Canada, reported that it wasn’t tracking water-related illnesses or deaths in First Nations.
“Our only involvement with FN water systems is from an environmental health standpoint. I would refer you to Indigenous Services Canada which is responsible for on-reserve water systems,” said communications officer John Moody.
Coroner offices in Alberta, Quebec and the Yukon reported no deaths related to drinking water since the year 2000, nor did the Saskatchewan Coroners Service since the beginning of their electronic records in 2015.
“I think there’s a major data gap here,” said Jeff Reading, a health sciences professor at Simon Fraser University who said the government has a responsibility to know the health impact of years of living with deficient water systems.
In 2018, reporting by the auditor general found policy-makers needed more data about indicators such as education, income and health to close socio-economic gaps between First Nations people living on reserves and other Canadians.
The report revealed Indigenous Services Canada has collected and has access to a significant amount of data that could “help effect real change and improve lives,” but that it failed to use this data to assess if well-being was improving in First Nations communities. That failure could lead to a misallocation of funding and areas requiring attention could be missed, the auditors said.
By not measuring the progress of its programs, the government is leaving policy-makers and First Nations in the dark about what’s effective. “First Nation leadership, they are very interested in knowing how these programs are working or not working to help them better gauge success,” said Joe Martire, one of the principal auditors on the file.
Water-related deaths, of children and infants, have been suspected in places like Lytton First Nation and Gull Bay.
In 1999, Darlene King lost her baby son Owen John in Gull Bay First Nation. He died of bacterial meningitis when he was seven months old. “I was just so filled with grief, my whole world had come crashing down,” said King.
Over 20 years later, she still doesn’t know if the water in the community played a role, “I've been wondering all these years,” said King. At the time of her son’s death, dangerous levels of E. coli were reported in the community’s water.
“Back then, you just drank whatever water was available,” said King.
She said more should be done to get to the bottom of how living with bad water is affecting the health of people living in Gull Bay and First Nations across the country. “A lot of people die without even finding out the causes. Like people back home will have cancer for years, or people complaining about something wrong with them. Like knowing that something's wrong with them already, and saying it's probably, you know, could be the water.”
In Canada, deaths are classified by the World Health Organization system, which selects for a single immediate cause of death. Health professionals can list an underlying cause, although it is not required. Experts say this system makes it hard for researchers or the government to understand what role water may have played in a death.
“Most of these deaths would be deemed natural — people may not link the origin of the infection to the drinking water source — and thus, we would be unaware of the scope of this issue,” said Stephanie Rea of the Ontario Office of the Chief Coroner, in an email. If the death were assumed to be natural, the coroner’s office wouldn’t be called to investigate, she wrote.
In 2019, researchers from the Manitoba Centre for Health Policy Leona Star and Alan Katz reviewed data on First Nations deaths and concluded that the international coding system for deaths does not “adequately describe First Nations experiences.” They found deaths are often grouped as from "external causes," which can include injuries, poisonings and also potentially water-related issues.
“We were stuck with large categories that we just couldn't make sense of, in terms of the real reason that people had died,” said Katz. He said the categorization of deaths doesn't take into account the issues around racism and colonization at the root of many deaths.
In part, he said this is because of the lack of data. “To describe racism, you need to actually have some data to support that. And we have traditionally not collected that within the health-care system,” said Katz.
He said that as a result, solutions are stunted. “Unless you actually have some statistics to point out why it's an issue, it's very often difficult to get people to respond to a problem,” said Katz.
Data obtained by the IIJ from Statistics Canada shows the infant mortality rate on-reserve is near to double the off-reserve rate. In the developing world, poor sanitation due to a lack of safe water is the cause for one in five infant deaths according to WaterAid, an international charity that works around water and sanitation issues. In Canada, less is known about how water impacts the infant mortality rate, though some suspect a connection.
“Water is so essential to life, right? And our ability to nourish our bodies and create strong, healthy children,” said Amber Skye, a researcher at McMaster University and a resident of Six Nations of the Grand River in Ontario. “We see higher rates of pretty much everything in First Nations women's health in terms of diabetes, gestational diabetes and preterm births, overweight births.”
Water is not only crucial to the physical well-being of mothers and children, said Skye, but also for mental and spiritual health. “Birth is a ceremony for our people, and that connection with our birth and the water is very strong.”
Skye’s mother Dawn Martin-Hill, an associate professor of Indigenous studies and anthropology at McMaster University, is leading a large-scale study looking at issues with water on Six Nations. She said she was shocked to find that even the community’s birth centre struggles with water. “They were in crisis several times because they had multiple births happening and they ran out of water,” said Martin-Hill.
Midwives from the community estimate near to half of mothers returning home with new babies don’t have access to clean water. The midwives are currently doing research to find exact numbers.
Bad water’s ripple effect
Sol Mamakwa is an NDP MPP in the riding of Kiiwetinoong, Ont. He lived without running water in Kingfisher Lake First Nation until he was 23. “It was hard. But it was just the way things were,” said Mamakwa.
He now represents 31 First Nations, including Neskantaga First Nation, which has faced the longest-running boil water advisory in Canadian history. He said water issues weigh on residents of First Nations.
Last year, a young woman took her own life in Neskantaga. “This girl never grew up opening the tap,” said Mamakwa, “and that certainly has an impact on mental health and wellness.”
“Water is one of those fundamental building blocks of all life. So, if it’s missing, then it is obviously a big problem for maintaining good health,” says SFU’s Reading.
Lack of access to water can harm health in ways not immediately obvious. For example, prevalence rates of diabetes are three to five times higher in First Nations, Métis and Inuit populations. Some like Lalita Bharadwaj, professor at the University of Saskatchewan’s School of Public Health, have questioned whether reliance on carbonated or sugary drinks may play a role. In places where individuals have to buy bottled water, need to boil their water or do not like the taste of their water, purchasing these types of drinks may be easier or cheaper than drinking water she said, noting more research on the connection is required.
Communities with inadequate water often also have inadequate housing. The two issues can combine to create dangerous conditions.
Danika Littlechild is an assistant professor at Carleton University and a member of Neyaskweyahk, Ermineskin Cree Nation located in Maskwacis, southeast of Edmonton. She said in her community because people do not have adequate sanitation in their homes, there is a high demand for wound care.
“What we see a lot of, actually, is a significant number of amputations. And it sounds extreme to say that, but the fact is that there’s so much diabetes. So, say, a diabetic gets cut on their foot, and they have no adequate sanitation in their home, they can’t wash it properly,” said Littlechild.
Melanie O’Gorman, an associate professor in the department of economics at University of Winnipeg, has looked at health outcomes in communities that rely on cisterns for water, large storage tanks that are filled by trucks.
The federal government says about one in seven homes in First Nations communities across the country depend on this system. Research has shown that these containers are prone to contamination.
Kylie Meguinis is a resident of Tsuut’ina Nation near Calgary who lives with 11 others and relies on trucked water. "I don’t trust my own cistern because it hasn’t gotten cleaned in years,” she said.
The pandemic makes this even more dangerous. “An additional bacterial infection may compromise immune systems and add additional risk for COVID-19 or other types of infection,” said Bhardwaj.
Homes like Meguinis’s, which can sometimes house up to 15 people, have cisterns which hold between 1,000 to 7,000 litres. They are generally filled up once or twice a week and as a result many families have to ration water.
Being at home more often during the pandemic put even more demand on water for Meguinis’s family. “We’re all at home. We’re consuming water. We’re needing to do this, we’re needing to do that, and I have to wash clothes, and wash dishes, to cook, to keep the house clean. And it was such a frustrating situation,” she said.
Needing to restrict water use comes with risks, according to O’Gorman. “People, when they ration their water, this means that they may be unable to clean their houses sufficiently, so that mold and respiratory issues may result.”
‘I’ve just never seen the due diligence’
Critics allege the reason more is not known about the toll of the water crisis is intentional. “The government works on the principle that if they don’t have the data, it’s very difficult to come up with a solution, which means they don’t have to spend money,” said NDP MP Angus.
“I've just never seen the due diligence that's required from a department who oversees the health and safety of so many thousands of people,” said Angus.
"Colonial systems are kind of sometimes willfully blind in their colonial structures to issues, and that’s why there’s very little data," said Dr. Kirlew.
But the federal government is obligated to collect information so key to First Nations’ well-being, believes Reading. “Those were things that were agreed upon in exchange for land, and there is a legal basis for the fiduciary obligations of the Crown towards Indigenous people, and that’s basic Indigenous relations.”
Craft said a failure to know the extent of the water crisis is not an excuse for inaction. “If some Canadians are not able to access their basic human rights, there's an obligation in the Crown to be aware of it, and do something about it.”
This summer, Chief Whetung became a plaintiff in a class-action lawsuit that seeks $1 billion in damages for a breach of the charter rights, $1 billion for negligence, breach of fiduciary duty and nuisance and $100 million in punitive damages from the government for its failures to provide safe drinking water.
Whetung said she hopes the suit will speed up the federal government’s response to the water crisis. “We’re hoping to see a commitment to the infrastructure that’s needed for every First Nation to have clean drinking water for every member of their community.”
Tomorrow: Lead has been identified in the water in many First Nations schools in B.C.
With files from Michael Wrobel.
Institute for Investigative Journalism reporting fellowships: Jaida Beaudin-Herney (First Nations University of Canada), Emma Wilkie (University of King’s College), Karina Zapata (Mount Royal University).
See the full list of “Broken Promises” series credits and more information about the consortium on the Clean Water, Broken Promises website.
Produced by the Institute for Investigative Journalism, Concordia University.
For tips on this story, please contact the reporters at: iij.tips(at)protonmail.com
Read more: Indigenous, Health
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