**5. Case reports: ILVA-Taranto, Melilli-Priolo-Augusta sites, Gela and Milazzo emerging situation, "Terra dei Fuochi" and Seveso**

In order to cope with the huge problem of pollution, experts were mobilized at national and regional levels in the drafting of numerous scientific papers in order to initiate actions to protect health in the areas most affected by the emission of high quantities of contaminants. In many cases, the results of these studies support arguments about correlation between the exposition to pollutants and outbreak of neoplastic diseases; however, for some areas, it has been highlighted that there is a higher incidence in urban areas rather than in sites of national interest, leading to speculation about the etiologic implication of non-industrial contaminants.

At the moment in Italy, the industrial pole of Taranto, Melilli-Priolo-Augusta, Gela e Milazzo sites, and "Terra dei fuochi" and the outcome of the tragedy that occurred in 1976 in Seveso represent the most interesting areas for their extension and extent of involved population. An overview of current developments of studies and the status of remediation undertaken in these areas will be given below.

### **5.1. ILVA-Taranto**

organic carbon was 237.9 µg/m3

432 Current Air Quality Issues

studied hookah bars (4.2 µg/m3

areas will be given below.

).

board usage significantly affects indoor pollutant concentrations.

and industrial air outdoor pollution compared with indoor pollution.

The main areas at high risk of environmental crisis in Italy are described below.

**Milazzo emerging situation, "Terra dei Fuochi" and Seveso**

**5. Case reports: ILVA-Taranto, Melilli-Priolo-Augusta sites, Gela and**

In order to cope with the huge problem of pollution, experts were mobilized at national and regional levels in the drafting of numerous scientific papers in order to initiate actions to protect health in the areas most affected by the emission of high quantities of contaminants. In many cases, the results of these studies support arguments about correlation between the exposition to pollutants and outbreak of neoplastic diseases; however, for some areas, it has been highlighted that there is a higher incidence in urban areas rather than in sites of national interest, leading to speculation about the etiologic implication of non-industrial contaminants. At the moment in Italy, the industrial pole of Taranto, Melilli-Priolo-Augusta, Gela e Milazzo sites, and "Terra dei fuochi" and the outcome of the tragedy that occurred in 1976 in Seveso represent the most interesting areas for their extension and extent of involved population. An overview of current developments of studies and the status of remediation undertaken in these

Dorizas et al. [51] with their study showed that in nine naturally ventilated primary schools of Athens (Greece) during spring, PM concentrations were significantly affected by the ventilation rates and presence of students. Both PM10 and PM2.5 were greater during teaching than the non-teaching hours, and, in many cases, the PM2.5 concentrations exceeded their limit values. For most of the cases, the indoor to outdoor concentrations ratios of PM10 and PM2.5 were much greater than one, indicating that the indoor environment was being mostly affected by indoor sources instead of the outdoor air. Furthermore, it was found that chalk and marker

No similar characteristics were found between indoor pollution and urban and high-risk sites outdoor pollution, because the poor ventilation of houses and buildings in general allows the concentration of chemical and biological pollutants that are not found in similar outdoor concentrations also in severe pollution event. Urban outdoor air pollution refers to the air pollution which the populations are exposed to, living in and around the urban area. Indoor air pollution refers to the pollutants found in indoors. An important difference is in the heavy metals concentration, generally most abundant and with major variability of species in urban

At the moment, in Italy, a reference rule has not been set. For this reason, until today, the main information concerning some guidelines or reference values in indoor air is obtained by the international scientific literature or by the few guidelines issued by other European countries or, for analogy, by other guidelines values regarding outdoor air. However, public health awareness on indoor air quality still lags significantly behind that of outdoor air quality.

, and CO was 32 ppm. Airborne nicotine was present in all

Founded in 1961, ILVA of Taranto is a steel plant at full cycle, where occur all the steps that lead from iron ore to steel [52–54]. The plant, which is partially impounded by order of the judiciary, is the largest steel maker in Europe. The area of Taranto is identified at high risk of environmental crisis because of an extensive industrial area developed close to the urban settlement. Industrial activities are responsible for environmental pollution, mostly due to polycyclic aromatic hydrocarbons (PAHs), heavy metals, organic solvents, polychlorinated biphenyls (PCBs), PM, and dioxin.

Table 1 shows the main pollutants found in soil, ground waters, and sediments of the area of Taranto.


**Table 1.** Main pollutants found in soil, ground waters, and sediments of the area of Taranto

To define the extent of the health risk, rigorous epidemiological studies have been conducted to assess both the short-term effects that occur in acute as a result of rapid changes in the concentrations of pollutants and the long-term effects caused by prolonged exposures and which occur 10–15 years after the start of exposure.

In 2006, the Ministry of Health has funded a project called "SENTIERI" (Studio Epidemiologico Nazionale dei Territori e degli Insediamenti Esposti a Rischio da Inquinamento - National Epidemiologic Study of the Territories and Settlements Exposed to Risk from Pollution) with the purpose to analyse the mortality of populations residing in proximity of a number of industrial agglomerates which by their nature potentially have a high factor of hazardous health and/or environmental contamination such as to be classified as SIN (Sites of National Interest for the Remediation).

The population of Taranto has been the subject of several multi-centre epidemiological studies that have documented the role of air pollution on the increase in short-term and long-term effects [52,53].

Epidemiological analysis of the residents of the city revealed death rates from all causes, for lung, pleura, and bladder cancer and for non-Hodgkin lymphoma. A case-control study on incident cases of these diseases in Taranto suggested a possible link between risks and residence close to the sources of emissions.

A recent study called EpiAir in which subjects were recruited rigorously and it was taken into account the exact georeferencing of areas of residence and employment analysed the spatial variability of air pollutants in Taranto and showed that atmospheric pollution in this city is not distributed homogeneously, but it is mainly widespread in the areas adjacent to industrial pole. In the results of this study have been taken into account the socio-economic status and calculated indices of deprivation; these aspects have a great importance, as many individual habits, such as cigarette smoking, alcohol consumption, physical activity, and obesity, are often associated with social status so that the adjustment made for the socio-economic factor has also adjusted the individual variables not directly measured, providing very reliable data. Moreover, in this study, mortality rate and hospitalization rate were measured to evaluate both long- and short-term effects. Data about mortality are reliable, as 98% of the causes of death were recovered, thanks to the linkage of personal data with the database of the ASL and show an excess of mortality for cancer, cardiovascular, and respiratory diseases. As far as hospital admissions, evaluated from hospital discharge schedule, were concerned, it was difficult to get accurate data because the comparison was made only on the hospital area of Taranto, without taking into account the extra-regional mobility and the secondary diagnosis. Although these are limited, data show an increase of hospitalization for the abovementioned causes. The results of this study have strengthened the argument that there is a correlation between exposure to emissions from the steel plant of Taranto and an increase of cancer and cardiovascular and respiratory diseases [55].

The European Environment Agency, in the list that shows the 622 most polluting industrial plants in Europe, included more than 60 Italian companies; Ilva of Taranto is placed second. As a result, the situation with the city of Taranto and Ilva is currently the subject of discussion and great concern [53,54,56]. To control the situation in the area were enacted several regional laws aiming to carry out the assessment of environmental impact and damage health in order to take targeted action to protect the environment and public health. Moreover, in the Italian Act 6 of February 2014, strategies are defined to make the remediation of contaminated areas from emissions of ILVA.

#### **5.2. Sicily air quality**

In Sicily, four Sites of National Interest have been individuated and the industrial areas of Melili-Priolo-Augusta (Siracusa), Gela (Caltanissetta), and Milazzo (Messina) have been declared by national and regional legislation "areas high risk of environmental crisis." It is likely that the excesses of mortality and morbidity observed in areas of Melili-Priolo-Augusta, Gela, and Milazzo are attributable to occupational exposures and environmental concerns related to the number of plants and the consequent contamination of environmental matrices [57], although the last reports show how these rates do not exhibit a significant increase.

#### *5.2.1. Melilli-Priolo-Augusta sites*

The large industrialized coastal area of eastern Sicily within the territory of the municipalities of Augusta, Priolo Gargallo, and Melilli is defined "petrochemical pole of Siracusa." These territories started to be subject to industrialization in 1948 with the construction of a refinery (the RA.SI.O.M), and in the following years, other industrial facilities were born; currently, the petrochemical pole hosts five refineries of petroleum products, two centrals of ENEL, a gas plant and cogeneration, a factory of magnesite, a cement plant, a purifier of industrial and urban waste and a shipyard.

In these areas, the increase in the number of illness might be linked with PM, which are released into the atmosphere from industrial chimneys and have the ability to convey inside the body, through the lung, every kind of pollutants from the atmosphere. The residents, who have expressed their concerns to environment organizations and public heath institutions, have also noted this potential association.

Official data on emissions point out a long list of definitely carcinogenic and teratogenic chemicals (acrylonitrile, benzene, cadmium, hexavalent chromium, nickel, silicon, vanadium, dioxins, and furans), and many other potential hazards, according to the IARC (Agency International Agency for Research on Cancer).

About PM, the main substances contained in it are represented by heavy metals as shown by the results of a study conducted by the Faculty of Agriculture of the University of Palermo, which used lichen for biomonitoring as their action of bio-accumulators for heavy metals, highlighting a significant presence of these hazardous metals in the environment concerned [57, 58].

These pieces of evidence induced the Ministry of the Environment to recognize the Priolo-Augusta-Melilli site as "an area in environmental crisis for which it has become necessary a legislative and Financial able to address in a timely manner the dramatic emergency." The large amount of epidemiologic studies conducted in these areas highlights the role of atmos‐ pheric pollution in the development of some cancers although recent data published by AIRTUM (Associazione Italiana dei Registri Tumori – Italian Association of cancer registries) [59] show that the higher incidence of cancer in Sicily is found in the city of Catania and in other metropolitan areas, such as Palermo and Messina, as well as in big countries like Acireale and Gravina, leading to hypothesize the role of other risk factors probably linked to road traffic and unhealthy lifestyle, contributing in the outbreak of above mentioned diseases. According to the last published report, the industrial sites are not among the areas with the highest incidence of cancer, as supposed, and surprisingly, the SIN of San Filippo del Mela does not present excess in the incidence of tumors.

#### *5.2.2. Gela and Milazzo emerging situation*

incident cases of these diseases in Taranto suggested a possible link between risks and

A recent study called EpiAir in which subjects were recruited rigorously and it was taken into account the exact georeferencing of areas of residence and employment analysed the spatial variability of air pollutants in Taranto and showed that atmospheric pollution in this city is not distributed homogeneously, but it is mainly widespread in the areas adjacent to industrial pole. In the results of this study have been taken into account the socio-economic status and calculated indices of deprivation; these aspects have a great importance, as many individual habits, such as cigarette smoking, alcohol consumption, physical activity, and obesity, are often associated with social status so that the adjustment made for the socio-economic factor has also adjusted the individual variables not directly measured, providing very reliable data. Moreover, in this study, mortality rate and hospitalization rate were measured to evaluate both long- and short-term effects. Data about mortality are reliable, as 98% of the causes of death were recovered, thanks to the linkage of personal data with the database of the ASL and show an excess of mortality for cancer, cardiovascular, and respiratory diseases. As far as hospital admissions, evaluated from hospital discharge schedule, were concerned, it was difficult to get accurate data because the comparison was made only on the hospital area of Taranto, without taking into account the extra-regional mobility and the secondary diagnosis. Although these are limited, data show an increase of hospitalization for the abovementioned causes. The results of this study have strengthened the argument that there is a correlation between exposure to emissions from the steel plant of Taranto and an increase of cancer and

The European Environment Agency, in the list that shows the 622 most polluting industrial plants in Europe, included more than 60 Italian companies; Ilva of Taranto is placed second. As a result, the situation with the city of Taranto and Ilva is currently the subject of discussion and great concern [53,54,56]. To control the situation in the area were enacted several regional laws aiming to carry out the assessment of environmental impact and damage health in order to take targeted action to protect the environment and public health. Moreover, in the Italian Act 6 of February 2014, strategies are defined to make the remediation of contaminated areas

In Sicily, four Sites of National Interest have been individuated and the industrial areas of Melili-Priolo-Augusta (Siracusa), Gela (Caltanissetta), and Milazzo (Messina) have been declared by national and regional legislation "areas high risk of environmental crisis." It is likely that the excesses of mortality and morbidity observed in areas of Melili-Priolo-Augusta, Gela, and Milazzo are attributable to occupational exposures and environmental concerns related to the number of plants and the consequent contamination of environmental matrices [57], although the last reports show how these rates do not exhibit a significant increase.

The large industrialized coastal area of eastern Sicily within the territory of the municipalities of Augusta, Priolo Gargallo, and Melilli is defined "petrochemical pole of Siracusa." These

residence close to the sources of emissions.

434 Current Air Quality Issues

cardiovascular and respiratory diseases [55].

from emissions of ILVA.

*5.2.1. Melilli-Priolo-Augusta sites*

**5.2. Sicily air quality**

In the area of Gela and the surrounding area rises one of the main industrial centres of the island. The area, declared "area at high risk of environmental crisis," includes the municipalities of Gela, Niscemi, and Butera. Within the bounded area subjected to remediation, there is a large industrial centre, consisting of plants for refining and extraction of crude oil and petrochemical plants. In particular, productions include polyethylene, molten sulphur, sulphuric acid and phosphoric acid, ammonia and fertilizer complexes [57].

The environmental impact of the refinery of Gela comes mainly from emissions into the atmosphere and the consequent presence of pollutants such as SO2, NOX, dust, H2S, and CO. Conveyed emissions are mainly generated in the combustion process and are coming out of the chimneys.

Data provided by ARPA (Regional Agency for Environmental Protection) reveal exceedances in ambient town, some parameters such as benzene, methane, hydrocarbons, and PM10 containing heavy metals such as nickel. A scientific study has shown that the entire area of Gela is heavily influenced by emissions of metals and non-metals from both car traffic or vehicular pollution and industrial pollution. In particular, the study highlights pollution of the particulate present in the aerosol analysing the deposition of the particulates on pine needles. The analysis of pine needles is a fast method for monitoring the pollutants present in the air: the pine needles provide information for the long-term impact of even low levels of pollutants. As for neoplastic diseases, it has not been shown that there is an excess of incidence in this area, although some Sicilian studies highlight an increase of Relative Risk for these diseases compared to other areas of the Region not characterized by the presence of industrial agglomerates. Moreover, in this area, an important role is played by the current wind, responsible for the transport of substances emitted by plants in Gela for long distances, interestingly in particular to Niscemi where contamination of soils by the above mentioned pollutants was found.

The industrial area of Milazzo is characterized by the presence of a large industrial centre, including an oil refinery, a thermoelectric central, a co-generator, a steel mill, a plant for the recovery of lead from spent batteries, and different other smaller factories. In the vicinity of industrial installations, there are several common installations, among which are those belonging to ''area at high risk of crisis environment."

A single study carried out in Milazzo area reveals that children are exposed to elevated concentrations of sulphur dioxide, nitric oxide, and PM2.5. In more weeks, the average concentration evaluated for sulphur dioxide has exceeded 20 µg/m3 , and the PM2.5 average in the study period was about 23 µg/m3 , i.e., twice the WHO air guideline limit. Also, epigenetic markers were associated with air pollutant concentrations – particularly with regard to the nitric oxide pathway [57, 58].

#### **5.3. Terra dei fuochi**

One of the greatest environmental and health criticality that covered Italy in the last two decades is linked to the illegal waste disposal, triggering serious repercussions both in the territories concerned and the health of the residents in these areas and leading the Institutions to take actions that stiffen confidence in themselves and protect the health of the population. Studies carried out in the areas affected by this phenomenon, although not definitive, con‐ firmed an increase in health risks resulting from waste disposal, highlighting in particular an increase in mortality from all causes, the excesses of mortality from specific cancers (liver, lung, stomach, kidney, and bladder) as well as an increase in non-neoplastic diseases of the respi‐ ratory system. The limits of ecological studies mainly reside in the fact that it is not possible to assess the individual characteristics of involved subjects, data on the amount and types of substance emitted are not exact, and therefore, extent of population exposure is not certain and estimates arising from these studies do not provide reliable data on the correlation. Despite the necessity of deepening the studies above, on February 2014, the Italian Parliament approved a law for the protection of these specific areas, which has as main innovations the request for a mapping of polluted areas and crops of these territories, the allocation of funds to carry out a health screening, and the introduction of the crime of burning waste.

This law, if one side has paid attention on the problem, on the other hand has created problems for the application of screening, excellent in itself as a means of prevention, but totally inappropriate to the case in question. It should be noted that on such land occurred the burning of hazardous waste, even radioactive in nature, and that substances emanating from these processes have not been proven to be in correlation with cancers for which screening is scheduled (colorectal, breast, cervix). Moreover, alarmism generated by media has also created skepticism in consumers, even internationally, with a substantial drop in sales of the excellent products from Campania.

However, contrasting the illegality and protecting public health is a duty of the institutions, as well as civic, and to implement the cited actions, the Institutions with the collaboration of experts gathered in the Technical Committee for the Contaminated Territories (CTTC) that provide information on correct methodology to implement the definition of the criteria for the mapping of sites, for the identification of specific diseases to perform a targeted screening, and for implementing the operations of monitoring and remediation.

#### **5.4. Seveso**

The environmental impact of the refinery of Gela comes mainly from emissions into the atmosphere and the consequent presence of pollutants such as SO2, NOX, dust, H2S, and CO. Conveyed emissions are mainly generated in the combustion process and are coming out of

Data provided by ARPA (Regional Agency for Environmental Protection) reveal exceedances in ambient town, some parameters such as benzene, methane, hydrocarbons, and PM10 containing heavy metals such as nickel. A scientific study has shown that the entire area of Gela is heavily influenced by emissions of metals and non-metals from both car traffic or vehicular pollution and industrial pollution. In particular, the study highlights pollution of the particulate present in the aerosol analysing the deposition of the particulates on pine needles. The analysis of pine needles is a fast method for monitoring the pollutants present in the air: the pine needles provide information for the long-term impact of even low levels of pollutants. As for neoplastic diseases, it has not been shown that there is an excess of incidence in this area, although some Sicilian studies highlight an increase of Relative Risk for these diseases compared to other areas of the Region not characterized by the presence of industrial agglomerates. Moreover, in this area, an important role is played by the current wind, responsible for the transport of substances emitted by plants in Gela for long distances, interestingly in particular to Niscemi where contamination of soils by the above mentioned

The industrial area of Milazzo is characterized by the presence of a large industrial centre, including an oil refinery, a thermoelectric central, a co-generator, a steel mill, a plant for the recovery of lead from spent batteries, and different other smaller factories. In the vicinity of industrial installations, there are several common installations, among which are those

A single study carried out in Milazzo area reveals that children are exposed to elevated concentrations of sulphur dioxide, nitric oxide, and PM2.5. In more weeks, the average

markers were associated with air pollutant concentrations – particularly with regard to the

One of the greatest environmental and health criticality that covered Italy in the last two decades is linked to the illegal waste disposal, triggering serious repercussions both in the territories concerned and the health of the residents in these areas and leading the Institutions to take actions that stiffen confidence in themselves and protect the health of the population. Studies carried out in the areas affected by this phenomenon, although not definitive, con‐ firmed an increase in health risks resulting from waste disposal, highlighting in particular an increase in mortality from all causes, the excesses of mortality from specific cancers (liver, lung, stomach, kidney, and bladder) as well as an increase in non-neoplastic diseases of the respi‐ ratory system. The limits of ecological studies mainly reside in the fact that it is not possible to assess the individual characteristics of involved subjects, data on the amount and types of

, and the PM2.5 average in

, i.e., twice the WHO air guideline limit. Also, epigenetic

the chimneys.

436 Current Air Quality Issues

pollutants was found.

belonging to ''area at high risk of crisis environment."

the study period was about 23 µg/m3

nitric oxide pathway [57, 58].

**5.3. Terra dei fuochi**

concentration evaluated for sulphur dioxide has exceeded 20 µg/m3

On July 1976 in Meda (Italy) at the chemical plant ICMESA (Industrie Chimiche Meda Società Azionaria) occurred the Seveso disaster [60]. During the usual production of trichlorophenol, a fungicide, an uncontrolled reaction that sparked the safety valves of the tank reactor took place, releasing the deadly chemical vapour into the atmosphere. About 3000 kg of toxic cloud compound containing dioxin TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) was released into the air. The wind immediately dispersed the toxic cloud eastwards: the dioxin could begin to generate its catastrophic effects, affecting the inhabitants of the area and also making uninha‐ bitable the territory on which it was deposited.

The chemicals released into the air from the ICMESA were carried by the wind and caused the contamination of, mainly, four municipalities: Seveso, Meda, Desio, and Cesano Maderno.

Since no one was at the plant when it happened, the seriousness of the disaster was not immediately observed.

Dioxin has been considered to be the most toxic human-made substance; the Seveso disaster represents the highest known TCDD exposure to residential populations and probably the most studied dioxin contamination incident in history [60, 61].

The most common sign of human health problems was skin disorder. The immediate effects on the population were evident especially from a dermatological point of view: after two days already appeared the first cases of chloracne, a disease that is documented to be associated with dioxin.

In order to estimate health problems of population, a great number of laboratory tests were carried out on blood samples. In 1987, it became possible to measure low levels of dioxin in blood samples. Another important effect of the dioxin exposure concerned reproduction, in particular affecting the sex ratio (a higher proportion of females were born in the first 7 years after the accident). In addition, a large number of pregnancies ended as spontaneous abortions were reported.

The affected places still show signs of contamination. The new EU legislation on industrial equipment of chemical and their coordinated management was started in June of 1982, when the Council of Ministers approved the European Union's Council Directive 82/501/EEC, the Seveso Directive.

A central part of the directive was made by reference to the obligation of transparent public information about industrial accidents, as well as new security measures to be taken in case of an accident [60, 61].

The new concept was approved for industrial workers and the public, the right to know the substance and the form of the problems that could threaten them and the exact operation of the safety procedures.
