In a soft, faltering voice, her large brown eyes staring absently ahead, Winfrida Besa repeats “A-B-C-D” over and over as she tries to sing the ABCs. With her thin, hollow face and slight frame, 7-year-old Winfrida looks much younger than she really is.

“Winfrida doesn’t go to school. She would just leave the classroom and wander off, and we worry she would get lost,” sighs her grandfather, Bobby Besa, 60. The little girl was born “normal,” he says, but soon she was exhibiting a constellation of disturbing symptoms that are familiar to residents of Kabwe, Zambia. The diagnosis came after blood testing at the local clinic: Lead poisoning.

Winfrida Besa, 7 (center), with her 5-year-old cousin Mable, in their home in the lead-contaminated neighborhood of Magandanyama in Kabwe, Zambia. Winfrida has suffered from extreme lead poisoning that has left her severely stunted and with cognitive impairments that prevent her from understanding simple instructions. She is unable to attend school. Her cousin Mable has also tested positive for lead poisoning and is now on medication. Studies have found that the overwhelming majority of children living near the former Broken Hill lead and zinc mine have elevated levels of lead, and roughly half have levels that require urgent medical attentiton. Lead is a powerful neurotoxin that can cause a wide array of health problems including include memory loss, behavioral issues, learning disabilities, cardiovascular problems and kidney damage. In some cases lead poisoning can even be fatal.

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This city of almost 300,000 people, 80 miles north of Zambia’s capital of Lusaka, was identified by a 2022 U.N. report as a “sacrifice zone” — one of the most polluted places on the planet. Between 1906 and 1994, Kabwe was home to Broken Hill, one of the world’s largest lead and zinc mines. For decades, highly toxic lead particles were blown across town, carried by the wind and the waterways, contaminating the soil in courtyards, playgrounds and on dirt roads where speeding trucks raise plumes of dust.

Who is to blame? That’s the subject of a class action lawsuit filed in 2020 on behalf of 100,000 Kabwe residents against a subsidiary of the mining company Anglo American, seeking compensation for lead poisoning.

In response to questions from NPR, Anglo American pointed to a statement that said its subsidiary, Anglo American South Africa, was only indirectly involved in the mine between 1925 and 1974 to provide “technical services,” and never “owned or operated it.” The mine was nationalized in 1971 and operated under a Zambian state-owned company, ZCCM, until its closure in 1994.

Anglo American said while it had “sympathy” for the residents of Kabwe and “contamination was not acceptable anywhere,” it wasn’t “responsible for the current situation.”

A South African court threw out the lawsuit in December 2023, saying it would set a “grave precedent” that “a business could be held liable half a century after its activities have ceased, to generations not yet born, as a result of being tested against future knowledge and standards unknown at the time.”

But the claimants’ lawyers, who won permission to appeal nearly a year ago, argue that the dangers have been apparent for a very long time. As yet there is no date set for the appeal.

Andrew Siyanga, 77, a former worker at the Broken Hill lead and zinc mine, photographed in his home in the heavily contaminated neighbourhood of Chowa in Kabwe, Zambia. Siyanga remembers regular testing of employee lead levels and recalls how workers at the mine were routinely “leaded out” — transferred to safer areas — when their lead levels passed a certain threshold.

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Sitting in his garden in Chowa township, one of the most polluted areas in Kabwe, former miner Andrew Siyanga, 77, remembers his colleagues being “leaded out” as early as 1969, when he joined Broken Hill as a young workshop employee. He says the long-time owner of the mine — Zambia Broken Hill Development Company Limited used that phrase when transferring employees to safer areas, outside of Kabwe, if their levels of lead were deemed too high in weekly testing. Some were only “leaded out” for a few days, but others required months to return, or never came back. (The owner became ZCCM after nationalization.)

Dr. Ian Lawrence, who was employed as a doctor at the mine in 1969 and 1970, says he became alarmed at the high death rates among young children in the residential township where mine employees lived, according to a 2020 affidavit filed in connection with the class action lawsuit. He took blood samples from about 500 children under the age of 5 and found that nearly all exceeded safe blood lead levels. In the affidavit, Dr. Lawrence stated that he believed dust from the mine was poisoning the children,

Despite these red flags, production continued at the mine until its closure in 1994. Even now, 30 years later, the former grounds of the Broken Hill mine swarm with independent miners digging in the toxic slag left behind in search of zinc, lead, and stones they sell back to mining companies.

“We are scared of lead, but we don’t have any other way to put food on the table,” one miner explains. “We get sick,” says another, as he sifts black soil to separate out the heavier lead slag. “Short memory,” adds a third, darkly joking about a symptom of chronic lead poisoning, before jumping into the artificial lake to rinse himself off.

This continued activity at the mine, by constantly disturbing the toxic dust, compounds the problems that have plagued the surrounding community for more than a century.

A dusty street scene in Kabwe, Zambia. The town’s dust is still heavily contaminated with lead after nearly 100 years of lead mining and smelting that eventually ceased in 1994. Lead poisoning continues to affect thousands in the town.

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“Kabwe is the most contaminated site that I know of on the planet,” says Jack Caravanos, clinical professor of environmental public health sciences at NYU’s School of Global Public Health.

He was part of an international team of scientists behind a 2018 report published in the journal Environmental Research, which analyzed the health impact of lead exposure on children in Kabwe. Data showed that more than 95% of children in the most affected townships had elevated blood lead levels, and half had levels requiring medical intervention. In another large-scale study by Japanese and Zambian researchers, published in the journal Nature in 2020, nearly 75% of residents tested across the entire Kabwe district had elevated blood lead levels.

Artisanal miners Mike Kunda (left) and Jacob Phiri work on the site of the former Broken Hill lead and zinc mine, in Kabwe, Zambia. Thirty years after the mine’s closure, the earth remains heavily contaminated, with lead levels in the soil up to 100 times higher than the safe limit. Yet faced with a shortage of jobs, many in the town feel they have little choice but to try to make a living searching for minerals here. Using little more than their bare hands and some basic tools, they expose themselves to dangerously high levels of lead.

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“You are living with the thought that anytime, this might kill you,” says Mable Besa, Winfrida’s grandmother. In the township of Makandanyama, near the old mining grounds, she explains, it is impossible to escape the pollution. That 2018 report noted that soil samples taken from near her home were “highly contaminated with the metal.” She worries about that every time she wipes dust off her couch.

Winfrida’s exposure may have started in utero: Her late father, who died in a car accident, scavenged on the site of the former mine. Her mother died a few years ago from an unknown sickness — the symptoms of which, including weakness and abdominal pain, are consistent with lead poisoning. Lead in a mother can affect a developing fetus, and studies suggest that paternal lead exposure can lead to low birth weight or prematurity.

Testing has revealed that Winfrida’s 5-year-old cousin also has high blood lead levels, so both girls are on what’s known as chelation therapy: introducing elements into the body that bind with the lead to facilitate its excretion from the body.

But there are limits to how helpful that can be. Caravanos asks, “What’s the point of giving people a pill, if they’re going to be exposed the next day?” In this environment, limiting daily exposure is almost impossible. Young children are particularly at risk, as they tend to play in the dirt and frequently put their hands in their mouths.

Winfrida and her cousin have dusty hands and faces, having just come in from the courtyard where a crowd of children is watching a traditional dancer perform, his feet kicking up clouds of ochre dust as he jumps to the rhythm of drums. “Every child that is born needs to step on the ground, but the soil is contaminated,” laments Mable Besa. “It’s not manageable to just stop the children from playing outside. If you wash their clothes, they gather dust when you hang them up. Even inside the house, if you leave food in the pots, you will find dust there,” she says.

Mable Besa, 49, hangs up laundry on her washing line in the lead-contaminated neighborhood of Magandanyama in Kabwe, Zambia. Nearly a century of lead mining and smelting in the town has left Magandanyama’s dust with extreme levels of lead. Beta lives with two of her grandchildren, both of whom suffer from lead poisoning. “It’s not manageable to just stop the children from playing outside,” she says. “If you wash their clothes, they gather dust when you hang them up. Even inside the house, if you leave food in the pots, you will find dust there.” Beta lives with two of her grandchildren, both of whom suffer from lead poisoning.

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A few houses away, Rose Asabi, 58, digs through boxes to find the scattered pages on which she has listed the names of all 515 neighborhood children affected by lead poisoning. She has worked as a community health mobilizer since 2006, informing families about the risks, recording lead poisoning cases and referring them to the local clinic.

Community health mobilizer Rose Asabi, 58, scans through a list containing the details of the 515 children from her immediate area who are suffering from lead poisoning. Asabi lives in Magandanyama, one of the neighborhoods worst affected by lead contamination caused by decades of mining and smelting in the town. Asabi’s own grandchildren all have blood lead levels of between 45 and 89 micrograms per deciliter, a level that requires urgent medical treatment — the safe limit is considered to be no more than 5. “We’re scared,” she says. “The soil is contaminated. The environment is a threat to the people living in it.”

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A few houses away, Rose Asabi, 58, digs through boxes to find the scattered pages on which she has listed the names of all 515 neighborhood children affected by lead poisoning. She has worked as a community health mobilizer since 2006, informing families about the risks, recording lead poisoning cases and referring them to the local clinic.

“The majority of children in this community have blood lead levels above 45 [micrograms per deciliter of blood], and in some cases, it even goes up to 110,” she explains. According to the World Health Organization (WHO), there is no known safe level of lead in blood — although the safety threshold is generally set a 5 micrograms per deciliter (about half a cup of blood) and urgent medical treatment is required starting at 45 micrograms.

“Many have memory loss, stunted growth … they get involved in fights or they don’t grasp the concepts they are taught at school,” Asabi says. “Sometimes, a child will wake up in pain all over their body, or become weak in the joints.” These are all known signs of lead poisoning, which attacks the central nervous system and most organs including the heart, kidney and liver, causing irreversible damage, according to WHO.

Ethan Kaunda, 4, looks out of the doorway of his home in the lead-contaminated neighborhood of Magandanyama in Kabwe, Zambia. Ethan suffers from lead poisoning that has left him with cognitive impairment and other health problems.

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Children play in Magandanyama, a neighborhood in Kabwe, Zambia, where a century of lead mining and smelting has made the town’s dust toxic. Children are worst affected by lead poisoning, partly because their brains are still developing, and partly because they tend to ingest far more dust than adults.

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Sitting on the ground in the yard, her four grandchildren play with spinning tops made out of bottle caps. Their blood lead levels range between 45 and 89 micrograms per deciliter, she says. After testing finally became available to adults last year, Asabi’s blood tests also came back positive for high blood lead levels. She is currently on chelation medication, which only became widely available in Kabwe in recent years, after decades of pressure from civil society organizations, including Human Rights Watch.

In 2016, Zambia received a $65.6 million World Bank loan to support cleanup efforts. The vision is to end contamination from the mine site, bury lead-contaminated surfaces with pavement or cement, and roll out testing and treatment at a much larger scale, particularly for children. A January 2024 World Bank status report rated the project outcomes as “moderately satisfactory,” but according to a report by Human Rights Watch published two months later, little had been achieved apart from cleaning up “a small number of homes” and a highly polluted canal. With the country currently in the grip of a devastating drought, even basic remediation measures such as planting grass in the courtyards, which was encouraged by authorities in order to reduce the spreading of toxic dust, are no longer possible.

Even further, another investigation released by Human Rights Watch on March 5 accuses the Zambian government of worsening pollution in Kabwe by issuing licenses for mining and toxic waste processing.

Cleanup efforts have not dealt with the “source of contamination”: the waste at the former mine, the report states. Instead, it details, “mining, removal, and transport of the waste has generated more lead dust and spread it to other parts of Kabwe, resulting in huge additional health risks for people who have already been exposed to toxic lead for decades.”

An inter-ministerial committee to address the contamination, announced in April 2024 by the President Hakainde Hichilema, has not yet been officially established, according to Human Rights Watch.

A young independent miner displays pieces of lead mined from the site of a former industrial lead mine in the town of Kabwe, Zambia. Lead levels in the blood of children surveyed in the area averaged nearly ten times higher than the CDC’s benchmark for what constitutes abnormal levels.

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Zambia’s Minister of Mines and Minerals Development, Paul Kabuswe, told NPR the government was “determined to deal with the issues of lead pollution in Kabwe.”

“At some point, Kabwe was described as the most polluted town in the world – it’s going to take time to remediate a town like that,” he said. “The problem is big and deep, and requires a lot of time and resources to deal with.”

If new mining licenses were issued, he said, it was because the area “still has other minerals apart from the lead” – but the government would act “decisively” if anyone was found to have “exacerbated the issue of pollution”.

“Everyone who was part of the pollution in Kabwe must take responsibility,” he said, calling on nongovernmental groups to hold to account the “foreign companies” that were involved in the former lead mine.

Kabwe’s mayor Patrick Chishala praises the progress but readily admits that more should be done. He believes the city should be treated “as a special case” by the government. A former high school teacher, Chishala personally witnessed the effects of lead pollution on his young students.

“We have declared war between the people of Kabwe and the lead,” he says. In addition to testing and treatment, community mobilizers like Asabi have been charged with raising awareness in affected communities. “The most important thing that we have done is to inform the people,” Chishala says. Now the key issue, he says, is to ensure that every lead surface is finally covered. “We want to see one day a city free from lead,” he adds.

A waste heap known as Black Mountain stands at the site of the former Broken Hill lead and zinc mine, in the town of Kabwe, Zambia, one of the most contaminated sites on earth. Thirty years after the closure of the mine, Black Mountain continues to further contaminate the town with toxic dust whenever the wind blows.

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Some experts, including Caravanos, fear that might be impossible – and that the only real solution is to move people away. The former mine “may forever remain a contaminated site,” he says.

But for Mable Besa, who has raised her children and grandchildren in her house in Makandanyama township, moving isn’t a viable option, mainly for financial reasons. One of her sons still scavenges at the mining dump, for lack of better employment opportunities. “There is nowhere to go,” she sighs.

Julie Bourdin is a freelance journalist based in South Africa. She covers human rights and climate-related stories across Africa and Europe. She’s trudged through abandoned mines, dived in Cape Town’s icy waters and flown over Lesotho’s mountain Kingdom.

Tommy Trenchard is an independent photojournalist based in Cape Town, South Africa. He has previously contributed photos and stories to NPR on the Mozambique cyclone of 2019, Indonesian death rituals and illegal miners in abandoned South African diamond mines and won a World Press Photo prize for an image in his story for NPR on clashes between elephants and people in Zambia.