Over the last years, an abundance pesticides and uncontrolled use, with exposure and adverse health effects on human health and environment, have become a serious issue to be concerned, especially when the number of intentional and unintentional poisonings have been increased in the Low- and Middle-income countries (LMIC). In addition to serious environmental impacts such as undermining the biodiversity, destroy the beneficial insects and natural enemies in the ecosystems. The highly hazardous pesticides (HHPs) increased risks to people through indirect or direct contact during life cycle of pesticide, including production, handling, use, and even the obsolete products. It also causes adverse effects on food security from the contaminated vegetables and fruits. It is one of the major sources of water and soil pollution. Their continues use will adversely affects the sustainable agriculture scheme in LMICs. However, HHPs are limited in numbers but it causes most of the high poisonings and adverse effects on human health and the environment, particularly in low and middle-income countries. ”. In 2015, the fourth session of the International Conference of Chemicals Management (ICCM4) of SAICM, adopted a resolution that recognized HHPs as an “issue of concern” and called for concerted action to address HHPs ( https://www.who.int/ipcs/features/hazardous_pesticides.pdf?ua=1). That global issue has been addressed by FAO, WHO and UNEP as well as those of many other public and private stakeholders active in the topic. Therefore, actions are needed on these HHPs, which is now widely known and there is no justification for waiting any longer before acting appropriately to ban them or restrict their use.
1.1. Acute poisoning of HHPs globally and in NENA region
At global level, pesticides are used in agriculture, horticulture, public health protection, and domestically, in addition to be used in general commerce and in therapeutic medicine. Agricultural pesticide poisoning is one of the major underlying public health problems, and it is one of the most common self-injury images in the global southern hemisphere (Ballantyne and Salem, 2006). However, Boedeker et al. (2020) reported that unintentional acute pesticide poisoning cases exceeds 350 million every year, especially in farming communities in low and middle-income countries LMIC, which means about 44% of worldwide farming population of approximately 860 million are poisoned by pesticides every year. Self-poisoning with pesticides represents 14–20% of global suicides and is particularly common in low-income and middle-income countries, where there are easy access to highly hazardous pesticides by farmers of small-scale farming, (WHO, 2020).
Mew et al. (2017), estimated the total suicides and calculated the portion due to pesticide poisoning, for seven WHO regional and income strata, the data were collected from 108 countries. The estimation indicated that there are approximately 110,000 pesticide self-poisoning deaths each year from 2010 to 2014, which is equivalent to 13.7% of the global suicides. The weighted estimates of the percentage of pesticide suicide and the annual cases in high-income countries is 1.7%, and 3,300 case respectively; many countries (44%) reported no pesticide suicides. In Eastern Mediterranean regions, an estimates of 7.1% and 2100 suicide are due to pesticide poisoning reported annually. While in African region, the portion is 3.5% and 2100 cases respectively. The data of high-quality method suicide was unavailable for several countries in Eastern Mediterranean and African regions. Therefore, the incidences are underestimated in these regions.
The percentage of the poisoning due to pesticide varies considerably between middle-income countries in regions. Where, the lowest rate of poisoning at 0.9% was in the middle-income countries in the European region and the highest rate of 48.3% was in LMIC in the Western Pacific region (WHO, 2008; 2015; Mew E.J. et al. 2017). Moreover, in the Qassim Region of Saudi Arabia from 1999 to 2003. The number of chemical poisoning cases increased from 66 to 114, the average age of patients was 17.7 years, and over 39% were children aged ≤ 5 years. Most cases were due to pesticide poisoning, nine deaths were recorded, of which four were by pesticide poisoning (Moazzam et al. 2009). While, in Jordan the number of fatal pesticide poisoning cases has increased over a 20-year period from 23.5 to 35 cases per year, while in other study organophosphorus (OP) was responsible for 308 deaths over 13 years (Abu Al-Ragheb, et al. 1989; Abdullat, et al. 2006). Furthermore, WHO Class I OP pesticides can cause severe poisoning, but the exposure doses are usually smaller than that with intentional poisoning (WHO, 2008; 2015). The registration process of pesticides supposed to be restricted only to those pesticides that are used for intended function, and such use does not promote adverse side effects either on human health or on the environment. Many cases of pesticide poisoning, appear to be as result of careless acts. That occur because of lack of knowledge of the toxicity of the pesticide, lack of awareness, lack of preventive measures, and not use of protective equipment during spraying and handling pesticides, as well as easy access to extremely or highly toxic pesticides, in addition to that some of HHPs are readily available and insufficiently regulated (WHO, 2004; Maroni et al. 2006; Atreya, 2008; Martínez-Valenzuela et al. 2009). The ready availability of highly hazardous pesticides is a problem because they are so lethal, and the easy accessibility of HHPs, can make the difference between survival and death.
In this context, HHPs are responsible for severe cases of poisoning. Suicides due to pesticide poisoning are a very significant problem in many stressed, rural agricultural communities in LMICs. A review of global pesticide suicides estimated that there were 160,000 every year with HHPs, (Mew et al 2016, Karunarathne et al, 2020). However, Dylan Weir (2021) from center for pesticide suicide prevention (CPSP) reported that, “Introduction of (HHPs) into poor rural communities in the 1950s and 60s without the resources to support their safe use resulted in a rapid increase in number of accidental, occupational and suicidal poisoning deaths". More than 14 million people have die from pesticide suicide in these communities, in addition to hundreds of thousands likely death from occupational and accidental poisoning. Most of these incidents occur in developing counties, notably Africa, Asia, and Central and South America, where highly hazardous pesticides (HHPs) are readily available and insufficiently regulated. There is strong evidence that a high proportion of such death can be averted completely by making HHPs less accessible (Eddleston, Lancet 2020). The relatively simple and immediately achievable approach that could drastically reduce deaths caused by pesticides worldwide are: ban on highly hazardous pesticides. Implementation of the international recommendations to phase out highly hazardous pesticides by the 2006 FAO Council could significantly reduce the burden of unintentional acute pesticide poisoning. The banning of HHPs as mitigation measure succeeded in Sri Lanka to reduce the rate of suicide dramatically by more than 70% over 20 years (Gunnell et al. 2007).
1.2. Chronic health effect of HHPs
The intensive use of pesticides including those are classified as Highly Hazardous pesticides HHPs in agricultural which ultimately polluting the food. For example, in 1994, the cost of chemical pesticides in Jordan Valley farms reached about 24% of operating costs. The haphazard use of such chemicals causes major damage to air quality, soil, crops, and groundwater, consequently affecting human health on the long-run (Hajjar, 2012).
The pesticide residues have been found in blood plasma of labors in agricultural farms. Direct or unintentional exposure to pesticides causes neuromuscular disorders and stimulation of drug and steroid metabolism (Subramaniam and Solomon, 2006). In Eastern Mediterranean, The population in the Region are often exposed to pesticide residues, which may be illegal (prohibited or internationally restricted) or obsolete pesticides, as well as legally permitted pesticides. Intensive exposure to certain types of pesticides may lead to harmful and serious human health effects, such as increased risk rate of cancer, reproductive disorders, disruption of the immune system, neuro-behavioral impairment, disruption in endocrine system, Genotoxicity and an increase in birth defects (Philippe and Yousfi, 2020).
HHPs are endanger people's health in multiple ways, that due to increases the accidental and intentional poisonings and food contamination cases. Whereas in the most recent review by Philippe, et al (2021) from relevant scientific publications were available for 10 of the 22 countries in the Eastern Mediterranean Region, namely Egypt, Iran, Jordan, Kuwait, Lebanon, Morocco, Pakistan, Qatar, Saudi Arabia and Tunisia. The data were collected from more than 6,000 samples of fruits and vegetables were analyzed in the region from 2005 to 2019. They reported that fourteen pesticides were identified, which were reported in at least two countries in the region and at least two times in in considered commodity not authorized to be used on it or at a concentration above the international Maximum residue levels (MRLs). These 14 compounds are all insecticides belonging to the following chemical classes: 5 organo-phosphates (OP) (chlorpyrifos, diazinon, dimethoate, malathion and profenofos), 3 pyrethroid (cypermethrin, deltamethrin and fenpropathrin), 3 neonicotenoid (imidacloprid, thiacloprid and acetamiprid), 1 carbamate (carbofuran), and 1 sulfonate (propargite). In addition, 7 organochlorine (OC) pesticides (namely DDT, aldrin, dieldrin, chlordane, endrin and Heptachlor, and endosulfan). However, in the earlier study, Philippe, et al (2020) Concluded that in Eastern Mediterranean Region, The exceedance in values set by FAO and WHO of pesticide residues found in fruits and vegetables is likely to lead to consumer health problems. Moreover, the residues of several organic chlorinated pesticides, taht are listed in the Stockholm Convention has been repeatedly reported in fruits and vegetables. Unintentional exposure in general to public are occurred by eating contaminated food or drinking pesticide-contaminated water, also to whom live near field where pesticides usually used, (Jaga & Dharmani, 2003). Moreover, in Jordan, Abdullat et al., (2015) reported that as results of use of OP insecticides, the cholinesterase levels among workers living in agricultural communities with intensive agricultural activity showed 52% inhibition in plasma and 41.1% in erythrocyte as compared to the normal levels observed in urban areas. Non-occupational exposure originating from pesticide residues in food, air and drinking water generally involves low doses and is chronic cause of health problems including the incidences of cancer, neurological illnesses such as Parkinson’s disease and reproductive, endocrine disruption, and developmental disorders (Ntzani et al., 2013). However, in Eastern Mediterranean Region, Philippe and Al-Yousf (2020) identified a clear relationship between occupational exposure to pesticides and a number of non-communicable diseases (NCDs). For examples, respiratory symptoms were reported in 65.9% of farmers exposed to pesticides in Pakistan (Khoso, et al 2019); lymphoproliferative disorders reported with farmers following exposure to pesticides (Salem, et al 2014); while, in Yemen hepatocellular carcinoma reported with 73.7% of farmers having a history of contact with chemical insecticides (Salem et al. 2012). In some cases, spills of chemicals, leakages, or faulty spraying equipment led to a great risk from accidental exposure to pesticides. The exposure of workers increases specially if workers not paying attention to the safety instruction on how to handle and use of pesticides. In addition, the retail workers at pesticide stores are at risk of exposure to pesticides that available in stores, especially if they deal with various pesticide products including the HHPs. The presence of such hazardous chemicals in the working environment without taking precaution measures will constitutes potential occupational exposure. Evidently, workers who deal directly with pesticides such as those who mix, handle, transport and apply pesticides will be exposed to high doses of pesticide directly or indirectly because of the nature of their work and are therefore at higher risk of potential acute intoxications (Fenske, et al 2005; Reeves & Schafer 2003; Calvert, et al. 2008).
1.3. POPs insecticides in NENA region:
The Organochlorine (OC) pesticides were the most widely used insecticides such as DDT, hexachloro cyclohexane (HCH), aldrin and dieldrin in the period of 1945–1980, in developing countries of Africa and Asia (FAO, 2005). OC pesticides are considered as HHPs because it act as endocrine disrupting chemicals (EDCs) (Sohail et al., 2004). In addition, most of OC are carcinogens and neurotoxic, (Kaiser, 2000), they are considered as persistent organic pollutants (POPs) and can persist in the environment for decades such as DDT, which pose a global threat to the entire ecological system. The intensive use of OC insecticides in controlling horticulture insects, mosquito species and other public health insects, resulted in global contamination of the organochlorine insecticides in the soil and water all over the world (Jayraj et al. 2016). The data about the level of organochlorine contamination in soil and water in Middle Eastern region are very rare, with few investigations were conducted. The presence of OC insecticides were detected in soil of Damascus countryside and in soil and water sample from costal area of Syria (Hajjar, 2001; 2012), as well as found in the soil, ground water and Nile river water of Kafer El-Zayat- Egypt (Doghem et al1996), the DDTs were the main compounds were detected in most of the samples. Although, none of the chlorinated hydrocarbon pesticides is presently recommended, or registered for the use in agriculture. Nevertheless, many incidents of food contamination with POPs insecticides are still being reported that, due to their persistence in soils (Philippe, et al. 2021). Pesticide residues of POPs in soils can contaminate food even more than 30 years after their last application (Yadav et al 2015).
Organochlorines cause chronic health problem to human because, it acts as endocrine disrupting chemicals (EDCs) by interfering with molecular circuitry and function of the endocrine system (Sohail et al., 2004), in addition, many OC are carcinogens and neurotoxic, reproductive toxicant and cause disproportion of thyroid hormones, that can lead to a variety of disorders (Jayraj et al. 2016). Moreover, women of reproductive age, especially during pregnancy, are much more vulnerable to toxic compounds such as POP pesticides that can be passed through the placenta and breast milk to their infants (Hajjar & Maky 2016; Costa Souza et al 2020). Whereas Torres-Sánchez et al. (2009) found that, prenatal exposure to p,p’-DDE and its presence in cord serum lead to disappearance of neuronal development after 12 months of infant age. However, these persisted organic compounds are still exist and detectable in many different types of environmental samples (e.g., soil, water, fish, sediment, vegetables, fruits, milk, foodstuffs), also potentially cause human's chronic health problem. These compounds have Potential for long-range environmental transport and its residues detected distant from the treated area (Srivastava 2018; Fitzgerald &. Wikoff 2014; Hajjar 2012; Yadav et al 2015).
1.4. Effect on environment and biodiversity:
Pesticides including HHPs are a threat to the environment because they undermine biodiversity, wild birds are an essential part of biodiversity and of great importance to the ecosystem. Decline in the bird community is an important indicator of environmental pollution. The continuous use of HHPs is one of the main causes of bird death and reduction. Whereas, the impact in many cases, was not due to direct exposure, but results from indirect exposure, for example, the frequent use of pesticides in the soil transmitted to earthworms which are ingested by birds, (Pereira et al. 2009: Mitra et al., 2011). Insecticides and acaricides are usually used to control insect and mite populations in agricultural production systems. However, most of insecticides are not specific in their effete, as it does not only kill the target pest but also indirectly harmful to natural enemy, causing destruction and rapid decline in beneficial insect populations (Cloyd R.A. 2012; Abbar et al. 2010; 2012). Continuing reliance on pesticides may eventually lead to several potential ecological problems including resistance, secondary pest outbreaks, and/or target pest resurgence. Pesticides enter the environment can kill, inhibit or alter the functions of non-target organisms, whereas, many of these non-target organisms are beneficial. According to global monitoring data of 452 invertebrate species, there has been a 45% decline of invertebrate populations over the past 40 years (Dirzo, et al. 2014). Agricultural practices and pollution are the key factors that threaten up to one million species with extinction, where, many incidental toxicity of farm and wild animals, were reported, (Mansour, 2004; Ibitayo, 2006; Jayraj, et al. 2016).
Most insecticides are highly toxic to honeybees, unlike most fungicides and herbicides, systemic insecticides are considered highly toxic to honeybees, also destroy pollinators, so their toxicity is not limited to the adults of bee workers directly, but also will be transferred to the pollen in treated plants and the contaminated pollen collected by bees in the treated fields is stored in the hive and remains toxic for an extended period, this will negatively affect hives, causing a high death rate in bees (Kumar, et al. 2020). Exposure of pollinators to pesticides can be decreased by reducing the use of pesticides, by implementation of IPM as alternative forms of pest management in addition to ban or restriction on the use of HHPs (IPBES 2016). However, herbicides contribute to reduced plant diversity and reduce or alter pollinators’ food and nesting resources (IPBES 2016). In near east region, many experiments were conducted and prove the harmful toxicity of conventional pesticides including the Organophosphate, Pyrethroid and Carbamate on the local natural enemies, for example, Trichogramma cacoeciae, Aphelinus mali HALD and Ascogaster quadridentata Wesmael (Hajjar & Al-Masoud, 2018; Abbar et al. 2010; 2012 a, b). However, to minimize the adverse effects of pesticides on natural enemies, there is an urgent need to assess and measure the risks of pesticides against natural enemies and identify the harmful insecticides. Pesticides may lethal to non-targeted organisms in addition to sub-lethal effects on behavioral and development of the beneficial insects, such as changes in rates of efficiency, longevity, sex ratio, and adult emergence (Cloyd R. A, 2012; Firake et al., 2012; Blibech et al., 2015).
1.5. Recommended mitigation:
Apparently, ban or restriction of HHPs is the direct and prompt scheme that could save hundreds of thousands of lives a year. Therefore, it should be common practice in LMIC, those countries should be assisted to build capacity and create an integrated system for the management, registration and monitoring of pesticides and establishing a pesticide database. Newly developed pesticides are generally safer than the older pesticides wich still used widely in LMIC countries. While the major multinational pesticide industry are keen to sell the newer pesticides, which are most likely to be more effective on the intentional pest and less toxic to unintentional species. But it's unlikely that the generic and black-market industry in low- and middle-income countries would change their sales as they keep producing the conventional highly toxic pesticides. One obstacle in ban or highly restrict the HHPs in NENA is probably a common belief by local farmers that pesticide use, and even HHP use, is essential for agriculture. This problem can be mitigated by awareness scheme. Guidance to the alternative practices and products to control pests in fields. The lack or absence of data on the problem of HHPs in many LMIC are due to underreporting of poisoning and suicides cases. This misrepresents the scale of the problem and can affect the governmental decision to deprioritize pesticide bans. Although, most of HHPs are banned or severely restricted by developed countries. Nevertheless, they are still widely used in LMIC. Even if their numbers are limited, they are known to be one of the main causes of most health and environmental problems, including poisoning, suicide, and chronic diseases such as cancers, in addition to severe pollution of water and soil as well as food. Their continued use therefore affects sustainable agriculture, food safety and public health