An ICIJ Investigation Island of the Widows

Mysterious kidney disease now 'top priority' in Central America

Thousands of men working in Central American sugarcane fields are dying of chronic kidney disease, yet governments and the sugar industry have done little in response

In this investigation

Island of the Widows
Key Findings

Key findings

  • A wave of chronic kidney disease is devastating communities along the Pacific coast of Central America. Each year from 2005 to 2009, kidney failure has killed more than 2,800 men in that region, according to an analysis of global health data.
  • Victims are mostly men who conduct manual labor — mostly harvesting sugarcane. In El Salvador and Nicaragua over the last two decades, the number of men dying from kidney disease has risen fivefold.
  • The disease’s cause remains a mystery. A key contributing factor and potential culprit: dehydration and heat stress from strenuous labor. Researchers also suspect that exposure to an unknown toxin may trigger onset of the disease.
  • The World Bank issued more than $100 million in loans to Nicaragua’s sugar industry during the height of the epidemic without formal consideration of the kidney disease among its workers.
  • Central America accounts for one-fourth of the US's raw sugar imports. Those with the resources to solve the mystery — the U.S. and other wealthy nations and international development agencies — largely have resisted pleas to investigate.

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Deadly disease is devastating communities in Central America, where it has decimated the ranks of sugarcane workers.

This map of Central America shows the number of kidney disease deaths in 2009, as well as the increase in mortality rates…

Our analysis of the toll from chronic kidney disease (CKD) in Central America is based on mortality data from the World Health Organization. Our goal was to obtain to a conservative estimate of the epidemic’s impact in the region, despite the lack of formal recognition or classification for the new strain of the disease.

Why does it strike mostly men who mostly work in sugarcane fields? What triggers it? Why are so many people dying? What have wealthier nations and NGOs done to help?

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