Six die in methanol poisonings in Laos, victims of a ‘forgotten crisis’

Victorian 19-year-olds Holly Bowles and Bianca Jones were on a backpacking trip through South East Asia when they checked in to Nana’s Backpacker Hostel in the popular tourist destination of Vang Vieng. At this stage, an officer at Vang Vieng’s Tourism Police office has told the Associated Press that a “number of people” have been detained, no charges have been laid. The owner of the Nana Backpacker Hostel has also been detained by Laos police for questioning.

The Laos government issued a statement, saying “The Government of the Lao PDR is profoundly saddened over the loss of lives of foreign tourists in Vang Vieng District, Vientiane Province and expresses its sincere sympathy and deepest condolences to the families of the deceased.

“The government has been conducting investigations to find causes of the incident and to bring the perpetrators to justice in accordance with the law.

“The government reaffirms that it always attaches the importance and pays attention to the safety of both domestic and foreign tourists.”

On 26 November, Laos police announced they have detained eight employees of Nana’s Backpacker Hostel, while DFAT revealed it is supporting another Australian who is in hospital with possible methanol poisoning. The bodies of Bianca Jones and Holly Bowles have been returned to Australia.

These six deaths have garnered international attention, but methanol poisonings as the result of contaminated alcohol are a “forgotten crisis” according to experts. Ethanol makes drinks more alcoholic, but methanol is a cheaper chemical compound that is sometimes used as an alternative in production. In the process of human bodies attempting to break down methanol, it creates toxic, damaging chemicals: formaldehyde and formic acid. It can take approximately 10 to 12 hours for symptoms to show, which may include vomiting, seizures, dizziness, and blindness or vision changes. Without timely medical intervention, or in some cases even with it, methanol poisoning can lead to blindness, organ failure, coma, and death.

Médecins Sans Frontières (MSF) has monitored both suspected and confirmed methanol poisoning worldwide. In the last 12 months, there have been 58 suspected methanol poisoning incidents, which affected 1,200 people and 406 deaths.

Indonesia, a popular tourist destination and therefore the most likely place for foreign victims to have their cases reported to authorities and by media, had 24 methanol poisoning incidents in the last 12 months. India had nine, Bangladesh and Pakistan had four each, and Iran had three. In March 2023, more than 1,000 Iranians fell ill, and more than 300 of them died after they consumed methanol in the expectation that it would protect them from a new coronavirus.

Until this event in Laos, it had recorded no previous incidents in the past 12 months. However, in April 2023, a presentation at the Asia-Pacific CRVS Research Forum in Bangkok revealed the extensive lack of efficiency and accuracy of recording and reporting the number of deaths, causes and factors involved. There was very little integration between administrative, medical, and other sectors leading to fragmentation that hampered an accurate, national documentation of deaths.

MSF started tracking suspected methanol poisonings in 2019. Since their research began, they have documented 943 incidents leading to nearly 13,000 deaths. These numbers are a vast underrepresentation of the actual incidents, injuries and deaths resulting from methanol poisoning. Local cases are largely unreported in global media and may not be reported to authorities.

The Department of Foreign Affairs and Trade updated its travel advice for Laos, warning travellers to “be alert to the potential risks, particularly with spirit-based drinks, including cocktails” in the country.

As medical experts have told media, the symptoms of methanol poisoning can present as food poisoning in the early stages or appear to witnesses as the victim being intoxicated. This delays medical intervention, diagnosis and treatment. As an MSF expert in methanol poisonings told media,

“Even for the health professionals, there’s lack of awareness on how to treat, how to diagnose, how to manage.”

Most emergency rooms do not immediately conduct tests for blood methanol levels, requiring clinicians to make judgments based on physical examination, patient’s history, and laboratory tests.

What is methanol?

In 1923, methanol was a dependable staple of industry that has only gained popularity since. It is used in the production of model cars, aviation fuel, fragrances, dry gas or gas line antifreeze, copy machine fluid, and other products.

According to researchers, around 10mL of methanol is the lowest quantity that can be fatal to an adult, although there have been cases when people have consumed more than 400 mL without experiencing any adverse effects. The minimal quantity that can cause death in untreated patients is around 80g, and intake of half of this amount can be predicted to cause visual abnormalities.

The Methanol Institute, which represents the global methanol industry, released a press statement from its Singapore office on November 22, which stated: “The Methanol Institute (MI) is concerned and saddened to learn of what appears to be a bootleg alcohol poisoning incident in Laos, which as of now has tragically cost the lives of 6 people who are believed to have died due to consuming alcohol illegally tainted with methanol…

MI, the trade association for the global methanol industry, continues to work hard to combat methanol poisoning through the dissemination of poisoning prevention and first aid information across the globe in a variety of languages.”

It added “while even small amounts of methanol in spirits is potentially fatal, successful treatment of methanol poisoning is possible if it can be diagnosed within 10-30 hours of ingestion.”

In April 2023, 28-year-old Sydney man Charlie Bradley, died on route to hospital in Canggu, Bali. Hours earlier, he’d been caught on CCTV staggering, having seizures, and collapsing after drinking in a nearby beach club. In media reports, Bali police claimed they did not have figures on drink poisoning incidents, and that there was no evidence to confirm drink poisoning had occurred. The Centre for Indonesian Policy Studies had evidence indicating that 487 people died in Indonesia from illegal alcohol poisoning from 2013 to 2016, the result of high tariffs and heavy taxes on alcohol leading to counterfeit alcohol and substituting methanol for ethanol.

Navigating the Laos legal system

According to the Foreign Law Guide for Laos (or the Lao People’s Democratic Republic), the civil law-based legal system was largely a colonialist inheritance resulting from the French colonial administrators, combined with Lao customary law. The Constitution of Lao PDR was adopted in 1991 and amended in 2003.

Under the Constitution of the Lao PDR 2015 (Constitution), the State consists of the National Assembly, President, Government, Local People’s Assembly, Local Administration, People’s Court and the Office of the Public Prosecutor.

The Global Organized Crime Index (GOCI) reports human and drug trafficking are significant in Laos as a result of endemic poverty, poor law enforcement, and rampant corruption within government agencies. The country is also a destination for smuggling and transit, owing to its borders with Thailand and Myanmar – though enforcement has increased in the past six years, GOCI reports that law enforcement’s capacity is weak – especially in comparison to China and Thailand’s enforcement capacity.

Illegal firearms, tobacco and counterfeit goods are also a major source of illegal trade in Laos, along with the import of fake medicine into Laos.

Laos has established five different court levels, but according to GOCI, “due process is often denied in practice. The courts are heavily influenced by corruption and subject to the ruling party’s influence, with key decisions often made secretly. Defendants are often presumed guilty, and the judicial system is plagued by long procedural delays.”

There is virtually no appeals processes, and although law in Laos prohibits it, arbitrary arrests and searches without warrants are frequent. Detainees are subject to lengthy pre-trial detention periods, and there have been reports of torture. Laos prisons are overcrowded, with poor sanitation and inadequate medical care.

GOCI further reports there is a lack of capacity and training in criminal investigations, and that in criminal cases, it is not uncommon for prosecutors to have a limited understanding of how to prosecute particular offences.

Around 20 per cent of the Laos population live below the poverty line. The Laotian Times reports that many parts of the region are without infrastructure, dependent on agriculture, and many communities lack basic electricity and transportation. Laos is classified as one of 45 Least Developed Countries (LDCs) by the United Nations as of December 2023.

While justice may or may not be achieved, or perceived to be achieved, through prosecution of perpetrators of methanol poisoning in Laos, the onus is also on governments – not least Australian – to educate and warn travellers of the risk of bootleg alcohol, and the first aid measures to take if ingestion is suspected.