CAO Cases

Arne Hoel, The World Bank

Latin America & the Caribbean

Nicaragua / Nicaragua Sugar Estates Limited-01/León and Chinandega

Center for International Environmental Law (CIEL) on behalf of local residents
Date Filed
March 01, 2008
Case Status
Open - Ombudsman



Nicaragua Sugar Estates Limited (NSEL) is the owner of an agro-energy complex located northwest of Managua, in the department of Chinandega. This IFC-financed project seeks to expand NSEL’s production and processing of sugarcane. In March 2008, the Center for International Environmental Law lodged a complaint with the CAO on behalf of 673 residents of communities in the departments of León and Chinandega and former NSEL employees. The complaint raised the following concerns:


1. Health impacts on local communities including Chronic Kidney Disease (CKD) & respiratory problems as a result of sugarcane burning;

2. Labor and working conditions such as rights of association and restrictions to forming a union;

3. Inappropriate land acquisition in relation to indigenous communities;

4. Offsite environmental impacts including water contamination, air pollution and pesticide effluence;

5. IFC compliance with performance standards, policies and procedures.


CAO Action

ASOCHIVIDA and NSEL signed a framework agreement in November 2008 where they agreed to engage in a dialogue process convened by the CAO focused on three areas: an independent study to investigate the cause of CKD, improvements to care for those suffering from CKD in Chichigalpa, and ways to provide alternate means of livelihood for those affected by the disease. Efforts in these three areas are ongoing, and since February 2009 parties have met regularly to discuss actions and progress. 


Independent Study to investigate the cause of CKD

A critical concern for the parties was to understand the cause of CKD through a credible and independent investigation. In a competitive process facilitated by the CAO, the dialogue participants together chose Boston University from a pool of nine highly qualified institutions to conduct an independent epidemiological scoping study. The Boston University team first conducted a Scoping Study in 2009 to summarize the available information on CKD in the region, identify data gaps, and recommend research activities to address those gaps. As follow up to the scoping study, the following six research activities have been completed: 


· An Industrial Hygiene/Occupational Health Assessment (August 2010), which evaluated the potential hazards associated with chemicals and work practices at ISA;

· An Investigation of Water Quality (August 2010), which included the analysis of a large number of contaminants in water samples collected from locations selected by ASOCHIVIDA;

· A Qualitative Analysis of Interviews with Physicians and Pharmacists (September 2011), which summarized data from semi-structured interviews with health professionals in Nicaragua to assess their perceptions regarding renal disease in the region;

· A Pilot Cohort Study (February 2012), which assessed the feasibility of conducting a complete retrospective cohort study to evaluate the relationship between work practices at ISA and CKD;

· An Investigation of Biomarkers in Workers (April 2012), which evaluated biological markers of kidney injury and CKD in ISA workers, miners, construction workers, and port workers;

· An Investigation of Urinary Biomarkers in Adolescents (June 2012), which evaluated evidence of subclinical kidney damage among adolescents in different areas of Nicaragua.


BU’s findings to date, along with studies from other researchers, indicate that there is an epidemic of CKD in Nicaragua. The cause of epidemic is still unknown but is likely to result from a combination of multiple factors. Results suggest that one or more of these risk factors are occupational but more research is needed to identify them specifically. Heat stress related to strenuous work in conditions of high temperature is one such factor that is likely (though not yet proven) to play a role in the excess of CKD. Though on its own it is an unlikely explanation for the epidemic, heat stress may magnify the effect of low-level exposures to nephrotoxic agents that alone would not result in CKD. Such low-level exposures might occur at work but could also be due to non-occupational factors that are ubiquitous in a region and cause repeated subclinical acute kidney injury, as the evidence from the adolescents biological testing suggests. 


It appears that the CKD epidemic is neither limited to the sugar industry nor to Nicaragua. CKD has been found in workers of other industries such as mining, fishing, construction and ports. It has been documented as prevalent along the west coast of Central America and in other countries of other regions of the world, such as Sri Lanka, India or Egypt. 


Moving forward, BU plans to actively continue to investigate both occupational and non-occupational factors with a broader geographic scope. Their upcoming research includes investigations of:


- kidney injury and CKD development in workers from multiple industries (including sugarcane) and different countries of Central America (including Nicaragua);

- early kidney injury in adolescents and children;

- genetic susceptibility as a potential contributor to the excess of CKD.


As part of its continued efforts, BU has formed a new collaboration with subject matter experts at the US Centers for Disease Control and Prevention for the purpose of conducting the new occupational and non-occupational studies.


In the meantime, and based on a series of recommendations from BU, NSEL has launched a program aimed at reducing the risk of heat stress among workers.  They have updated protocols for hydration, shade, and rest; doubled the size of the health and safety staff active in the field to enforce these policies; introduced an acclimatization period at the beginning of the zafra; improved oversight of contractors; and put into operation a mobile clinic (with two more to be introduced next year). 


Click on “View documents” below to read BU’s reports describing the methods, results, and conclusions for each of the studies conducted, and all other documentation related to the dialogue table. 

Improvements in care for those suffering from CKD

Medical needs are profound, particularly in light of the lack of options for medication, dialysis and transplant. At the dialogue table, ASOCHIVIDA and NSEL agreed to search for opportunities to improve the quality of local health care services, as the need to do so was identified in the Needs Assessment Report commissioned by the CAO and finalized in May 2011. As a first step, ultrasound equipment and the services of a radiologist were provided by NSEL. Later, NSEL and the German Investment Corporation (DEG) offered to donate US$ 320,000 to MINSA to improve facilities and services at the local Health Center in Chichigalpa. MINSA originally accepted the offer but the project was soon modified to build and equip a new renal clinic alongside a new general hospital to be constructed in Chichigalpa. While MINSA has completed the new hospital it has not yet approved the construction of the renal health clinic. 


Alternate means of livelihood and other donations for those affected by CKD

ASOCHIVIDA and NSEL have agreed to address the urgent need to support community members who are sick and unable to work or are survivors of workers who have passed away. Community support includes food aid, development of a microcredit program, improvement to housing and alternative income generation approaches for ASOCHIVIDA members.


Since June 2009, NSEL has committed to provide up to 2,000 members of ASOCHIVIDA with basic food provision, as well as yearly educational packages for over 1,545 children. In addition, a business development expert has been providing support to the parties since January 2010 to help identify income-generating activities, with program implementation beginning later in 2010.


ASOCHIVIDA and NSEL have continued to meet regularly with the assistance of CAO, and progress toward mutual goals is ongoing.  Since the start, the dialogue process has made much progress toward improving conditions for ASOCHIVIDA members, as evidenced by NSEL’s support of numerous community development programs. Starting in 2009, NSEL, through direct investment or by leveraging aid though associated organizations, has spent over US$ 6.2 million on community aid and investment in research, with another US$ 2.6 million committed through 2014. The breakdown of expended or committed funds for the period 2009 through 2014 follows:


• Food supply: US$ 3,590,000


• Health care and improvements at the Chichigalpa clinic: US$ 1,570,850


• Financial contributions to the CKD research effort: US$ 2,500,000


• Improvements to housing: US$ 485,000


• Income generation projects: US$ 598,000


• Other donations and support: US$ 135,000

Prior to CAO involvement, NSEL also provided US$ 2 million as humanitarian aid to former workers affected with CKD.  A detailed breakdown of aid provided by NSEL through the CAO process is available at the documents link below.


In addition to facilitating the dialogue table between ASOCHIVIDA and NSEL, the CAO has assisted community members from Goyena and Abangasca in addressing concerns with NSEL operations. The CAO intervention helped NSEL improve and publicize the company grievance mechanism, an important step in facilitating resolution of community concerns. This part of the complaint is now closed.


Boston University have released a report that summarizes research activities conducted for the dialogue table and presents suggestions for future research. Click on “View documents” below to read that summary, as well as other reports describing the methods, results, and conclusions for each of the studies conducted by Boston University, and all other documentation related to the dialogue table.



On June 28, 2012 a settlement agreement was reached between ASOCHIVIDA and NSEL. The agreement includes provisions relating to improvements in direct medical care and medical facilities for sufferers of CKD; the development of income-generating projects for households impacted by the disease; and continued support for independent research into the cause of the disease and its link to the sugarcane industry carried out by Boston University, whose team of experts was jointly chosen by the parties as part of the dispute resolution process. While CAO prepares to conclude its monitoring role, efforts to improve access and quality of healthcare at the local level for those suffering from CKD and to expand the scientific study on the causality of the disease into a regional initiative are ongoing.  Under a new institutional framework, BU has formed a collaboration with the US Centers for Disease Control and Prevention for the purpose of conducting new occupational and non-occupational studies with a broader geographic scope.


The full Agreement in Spanish and English is available below.


Status as of September 24, 2014

Project information

Project Name & Number
Nicaragua Sugar Estates Limited S.A. 25331
Nicaragua Sugar Estates Limited
Agriculture and Forestry
Latin America & the Caribbean
Environmental Category
$25 million (A Loan) & $30 million (B Loan)

Case Tracker


  • Eligible: Completed
  • Assessment Period: Completed
  • Facilitating Settlement: Completed
  • Monitoring/Close-out: In Process