Dear Attorney General,

President of the Council of Ministers:

Earth Watch Corps wants to establish a dialogue with you in order to address the health crisis due to toxic metals and substances in the province of Espinar, Cusco. For this reason, we share with you the findings and recommendations of our most recent report on the subject, entitled Failed State of Health: Health Emergency in Indigenous Peoples of Espinar, Peru, and urge you to guarantee the implementation of an Emergency Public and Environmental Health Strategy to address it.

Between 2018 and 2020, Earth Watch Corps conducted desk and field research in 11 Indigenous communities in the province of Espinar, Cusco. The organization found levels of toxic metals and substances in people who volunteered for the study that demonstrate the health risk to which Indigenous communities in Espinar are exposed.

Together with experts from contracted laboratories, the research team took blood and urine samples from 150 volunteers from the communities. Of 150 people tested, 78% (117 people) of them had high levels of lead, arsenic, cadmium, mercury and/or manganese.

• More than 58% (88 people) had high levels of arsenic, which can lead to nausea and vomiting, decreased number of red and white blood cells, and abnormal heart rhythm.
• More than 29% (44 people) had high levels of manganese, which can be toxic and accumulate in the brain, bones, liver, kidneys and pancreas.
• More than 12% (19 people) had high levels of cadmium, which can lead to kidney disease, lung damage and bone fragility.
• More than 4% (7 people) had high levels of lead, which can affect almost all organs and systems in the body. The effects of lead include anemia and high blood pressure, kidney damage, weakness in the fingers, wrists or ankles, and severe brain damage at high levels.
• More than 3% (5 people) had high levels of mercury, which can be toxic to the nervous system, immune system, digestive system, skin, lungs, kidneys and eyes.

The lack of monitoring of victims' health and the identification and treatment of long-term health risks has denied the population a significant and vital aspect of their right to health. The population of Espinar has the right to know whether exposure to toxic metals and substances could cause long-term health problems and, if so, what they are and how they can be treated.

In this regard, Earth Watch Corps urges you to implement the following recommendations:

1. Design and implement, with full participation and in consultation with the 11 Indigenous communities of Espinar and its representative organizations, an Emergency Public and Environmental Health Strategy for Espinar. The Strategy should have a differentiated approach to Indigenous and gender identity and allocate the appropriate human, physical and financial resources for its implementation.
2. Ensure the availability of accessible, affordable and quality health services to address any specific health problems faced by people exposed to toxic metals and substances.
3. To complete and publicly present the results of the causality study of the presence of toxic metals and substances found in the water of Espinar, commissioned to the Peruvian Institute of Nuclear Energy. These results should be socialized with the Indigenous communities of Espinar in an accessible format.
4. Ensure that any action implemented under the Public and Environmental Health Strategy complies with the State's obligations in accordance with international human rights standards.
5. Conduct a comprehensive and participatory damage assessment, identifying those responsible for damages and, where appropriate, design a reparations plan in accordance with international human rights standards.

Sincerely,