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Community elder Grace Redsky from Shoal Lake 40 First Nation performs a water-healing ceremony at a man-made channel created 100 years ago during construction of the Winnipeg aqueduct. Cut off from the mainland, the community has been under a boil-water advisory since an outbreak of cryptosporidiosis nearly two decades ago.JOHN WOODS/The Canadian Press

This story is part of Headwaters, a series on the future of our most critical resource

Gloria Atlookan's three children have never known what it's like to drink a glass of water straight from their taps at home.

They are becoming teenagers, a time when grooming is important. But Ms. Atlookan will not allow them to bathe more than once every two or three days.

She's seen what washing the skin has done to other children living at the Neskantaga First Nation, an Ontario fly-in community nearly 500 kilometres north of Thunder Bay. Sores and rashes spread across their arms, legs, bellies and faces.

"As a mother, I get really scared sometimes," Ms. Atlookan said. "As long as I can remember, we've been under a boil-water advisory."

In point of fact, it's been two decades. That's when Neskantaga's water-treatment plant, which was then just a couple years old, broke down, never to run again. Which means the water could be contaminated with any number of bugs that pose threats to human health.

But not washing also has its risks. In overcrowded houses on reserves in remote Northwestern Ontario where clean running water is not available, a deadly type of bacteria called MRSA is proliferating. MRSA is a staph infection that causes sores and boils on the skin, and can penetrate the body to infect internal organs. It is resistant to commonly used antibiotics.

"I believe these things constitute a significant public health emergency," said Mike Kirlew, a doctor who treats people living on the isolated reserves and who has conducted a study of the diseases he has seen proliferate when the water is not clean. "People are paying with their lives."

Neskantaga is an extreme example of a nationwide problem. At any one time, about one in six of Canada's more than 600 First Nations is under a boil-water advisory, some of which have been in effect for years. There are also parts of reserves where there is no running water at all – where the toilet on cold winter nights is a slop pail in a closet.

Many First Nations, like Neskantaga, are located on bodies of water that served aboriginal populations for thousands of years before filtration was even a possibility.

But stationary communities create water problems that did not affect the nomadic ancestors of today's indigenous people. Even remote parts of Canada are more polluted today than they were centuries ago. And water has always had the capacity to carry pathogens that can make people sick – the problem was just not dealt with then in the way it's expected today.

The federal government promised in 1977 to provide indigenous communities with water and sanitation similar to that which exists elsewhere in Canada. But efforts to meet that pledge have often been met with failure. Poor construction of pipes and filtration systems, a lack of training for those who are left to run the plants, and a tangled web of jurisdictional issues create a quagmire of issues that prevent the clean water from flowing.

Prime Minister Justin Trudeau said during the recent election campaign that, if elected, he would end the need for boil-water advisories on First Nations within five years. "It's not right in a country like Canada," he told a town hall. "This has gone on for far too long."

Mr. Trudeau then turned the job of fixing the problem over to Carolyn Bennett, the Indigenous and Northern Affairs Minister who is also a medical doctor and who, as a former critic in the same portfolio, has seen the effects of the problem first-hand on many occasions.

Ms. Bennett recalls visiting reserves in the Island Lake region of northern Manitoba during the H1N1 influenza pandemic of 2009. "You have 14 people living in one house and you are handing them a bar of soap and telling them to wash their hands, but there is no running water," she said. "This is an even bigger problem than just boiling the water. It is about how we sit down with the First Nations leadership and chiefs and council and develop a plan in a Kelowna-like process."

Kelowna refers to the $5-billion deal signed with First Nations in 2005 by former Liberal prime minister Paul Martin that aimed to address a wide range of issues affecting Canada's indigenous peoples, but was scrapped when the Conservatives came to power. It included a promise of $400-million to bring clean water to remote indigenous communities.

But some people say the water problems faced by the First Nations are almost too big, too broad in scope, to be solved by cash alone.

Lalita Bharadwaj, a toxicology expert at the University of Saskatchewan in Saskatoon, has been studying the issue for years and says governments make the mistake of trying to apply blanket solutions to diverse situations. The truth, said Bharadwaj, is that there are as many different water issues as there are First Nations communities in Canada.

In a place like Neskantaga, it's a filtration plant that was not built properly. In another, it is a communal well that is being polluted by agricultural run-off or an upstream mining operation. In some communities, there is a filtration plant but no pipes. In others, no one has the proper training and certification to deal with breakdowns.

"I do believe that the government needs to invest some time and go to each individual First Nation and find out what are the issues around the drinking water supply," said Dr. Bharadwaj – a daunting task given the number of communities.

In addition, said Dr. Bharadwaj, there are jurisdictional issues that have hamstrung the process of water delivery.

At the federal level, Health Canada is responsible for monitoring the water quality on aboriginal lands, Indigenous Affairs provides money for building the facilities, and Environment Canada sets the standards for waste water. Meanwhile, the indigenous leadership in each community is responsible for maintaining and monitoring the water systems on a daily basis. And water resources, in general, fall within the purview of the provinces.

The communication between the various agencies is ineffective, said Dr. Bharadwaj, which complicates an already complex situation – and leaves vulnerable people at risk.

One of the biggest threats now facing First Nations in Northwestern Ontario is MRSA, the bacteria that causes boils and abscesses and can then invade the body to infect the bloodstream and the kidneys.

Dr. Kirlew said the number of cases of MRSA he's seen on First Nations has "skyrocketed" since he moved to Sioux Lookout, Ont., a decade ago. In a 2012-13 study, he found the rate of MRSA infection on First Nations in Northwestern Ontario was 20 times the rate found in a previous study done in Calgary between 2000 and 2006. Between 2001 and 2008 in the mostly indigenous communities of Northern Saskatchewan, meanwhile, the annual rate of infection rose to 142.6 per 10,000 from 8.2 per 10,000; in one place the rate was as high as 482.

"This bug has been associated with socio-economic conditions like lack of access to water, overcrowding, lack of access to proper housing," said Dr. Kirlew. "It can cause overwhelming sepsis in some cases. And we have had people who have passed away, either because of the infection itself or because of complications from the infection."

Alvin Fiddler, the Grand Chief of the Nishnawbe Aski Nation that represents 49 First Nations in Northwestern Ontario including Neskantaga, said on any given day, nearly half of those communities will be under some type of water advisory – from the basic "boil water" to the more serious "do not consume" and the most forceful "do not use."

During the recent federal election campaign, Mr. Fiddler met with Mr. Trudeau and pointed out that many of the communities within the Nishnawbe Aski Nation are being pressured by industry and government to allow resource development in their regions.

"My point was, how can these communities be expected to meaningfully engage in these processes, trying to engage with multi-billion-dollar companies or governments, when they are worried about whether their children will be able to access clean water," he said. "They need to take care of these things first, before they can be expected to come to these tables and have negotiations with government and companies. We need to have that happen."

Ms. Bennett said she is committed to finding a solution, even if the issues are complex and difficult.

"It means that you sit down and set some targets and then work together on the plan and the budget that would be required to achieve that plan. So I think that is doable," she said. "I think Canadians see it as a human right, almost, that people should be able to expect to turn on the tap and drink a glass of water. It's a health imperative, but it's also symbolic of the conditions in which certain First Nations still have to live."

Gloria Atlookan just wants her wait for clean water to end. Her children are always amazed, she said, when they visit Thunder Bay and are permitted to drink right out of the tap, but clean water is something they should be able to take for granted when they are at home.

"Sometimes I get frustrated," she said. "And sometimes I wonder how long do we have to live like this."

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