The Hidden Toll of Occupational Health Hazards: A Qualitative Study of Workers from Small-Scale Illegal Miners in Ghana

Abstract

Background: Small-scale illegal gold mining, or “Galamsey”, is an important livelihood in Ghana but exposes workers to serious occupational health risks. This study aimed to explore the lived experiences, perceptions of health hazards, and coping strategies of workers from illegal small-scale gold mines in the Atwima Mponua District to inform context-specific interventions and policies. Methods: This qualitative study employed a phenomenological design to explore the occupational health experiences of workers from illegal small-scale gold mines in the Atwima Mponua District. A total of 16 purposively selected workers, ten men and six women, aged 27 to 44 years, with mining experience ranging from 3 to 12 years, working across roles including excavators, washers/panners, chemical processors, ore grinders, and support workers, were interviewed in depth, using a semi-structured interview guide. Thematic analysis was used to analyse the data according to Braun and Clarke’s model. Findings: There were four dominant themes: (1) normalization of risk and fatalistic attitudes about mining risks; (2) Respiratory Manifestations and Dust-Related Ailments; (3) chemical exposures and dermatological conditions; and (4) traumatic injuries from pit collapses, mining equipment accidents, and heavy physical labour. Participants demonstrated low levels of knowledge about long-term health outcomes and reported substantial obstacles to accessing healthcare, including fear of legal action, financial constraints, and geographic isolation. Conclusions: Workers from illegal small-scale gold mines in the Atwima Mponua District bear a serious, hidden occupational health burden normalized by poverty and criminalization. Urgent, comprehensive interventions are needed that address legal protection, economic alternatives, accessible healthcare, and harm reduction.

1. Background

Artisanal and small-scale mining (ASM) is an important economic sector in sub-Saharan Africa, supporting millions of individuals at the same time as posing significant Occupational Health issues [1,2]. A recent scoping review states that although mining represents only 1% of the total workforce, it accounts for 8% of fatal injuries worldwide [2]. The legal and illegal small-scale gold mining in Ghana directly employs an estimated 1 million people and indirectly around 4.5 million dependents [3]. The illegal segment of this industry, locally referred to as “Galamsey” (meaning “harvest them and sell”), is frequently characterized by limited regulatory oversight and variable adherence to occupational health and safety standards, which may increase workers’ exposure to occupational hazards [4,5].

Ghana’s Small-Scale Gold Mining Law (PNDC Law 218) provides a formal licensing pathway for artisanal operators, but the process is complex, costly, and requires land documentation that most informal workers cannot obtain. Political, economic, and bureaucratic barriers have historically impeded formalization [5]. National estimates from the Ghana Minerals Commission indicate that illegal galamsey operations engage between 500,000 and 1 million workers nationally, with a substantial proportion located in the Ashanti Region, though precise district-level figures are unavailable due to the clandestine nature of these operations.

The occupational health literature on formal mining operations is extensive, documenting well-established risks, including pneumoconiosis, silicosis, noise-induced hearing loss, and traumatic injuries [6]. However, the informal and illegal nature of galamsey operations means that workers in this sector remain largely invisible to health surveillance systems, labour protections, and epidemiological research [7]. This invisibility is compounded by the criminalization of illegal mining activities, which creates barriers to healthcare access and official documentation of mining-related health conditions [3,8].

The Atwima Mponua District in the Ashanti Region of Ghana has witnessed significant illegal mining activities over the past two decades, driven by high unemployment, rural poverty, and the presence of both alluvial and hard-rock (eluvial/residual) gold deposits [9]. Galamsey operations differ greatly from industrial mining. They rely on rudimentary tools and unshored pit excavations [5]. Workers handle toxic substances directly, including mercury for gold amalgamation and cyanide for leaching ore tailings [4]. Unlike formal mines, these operations lack engineering controls and personal protective equipment. Both mercury and cyanide are used within the district, though not always at the same workstation [10]. Workers often labour in poorly ventilated underground shafts without respiratory protection, safety equipment, or emergency medical provisions [11].

Previous quantitative studies have documented high prevalence rates of respiratory symptoms, dermatological conditions, and musculoskeletal disorders among ASM workers [3,12]. However, these studies have predominantly focused on measurable health outcomes rather than exploring how miners themselves perceive, experience, and respond to occupational hazards [12,13]. This gap is significant: without understanding the subjective experience of risk, the social and economic forces that shape risk-taking behaviour, and the structural barriers that prevent workers from seeking care, effective occupational health interventions cannot be designed or implemented.

Miners’ perceptions of occupational health hazards are also of particular importance in illegal mining, where formal occupational health interventions are difficult to implement owing to the secrecy of operations [10]. The provision of health education, policy-based interventions, and harm-reduction interventions should be grounded in an understanding of how miners perceive risk, how they decide on safety behaviours, and how they act in the complex intersection of economic need and health vulnerability [9,10]. This paper used a qualitative phenomenological research methodology to explore the occupational health experiences of workers from illegal small-scale gold mines in the Atwima Mponua District.

2. Methods and Materials

2.1. Study Design

This study employed a qualitative exploratory design grounded in phenomenology. An interpretive phenomenological analysis (IPA) approach was used to explore and interpret the lived occupational health experiences of workers from illegal small-scale gold mines [14]. IPA is particularly suited to research questions that seek to understand how individuals make sense of their personal and social world, and how they experience phenomena in the context of specific social and environmental circumstances [14]. The approach is well established in occupational health research. Qualitative exploratory designs are appropriate when limited evidence exists on a phenomenon and when the aim is to gain an in-depth understanding from participants’ perspectives [15]. The research sought to understand the essence of occupational health experiences from the miners’ own perspectives, recognising that their perceptions are shaped by cultural, economic, and social contexts.

2.2. Study Setting

The study was conducted in the Atwima Mponua District, located in the Ashanti Region of Ghana, approximately 40 km from Kumasi, the regional capital. The district has a population of approximately 135,000 and an economy based primarily on agriculture and small-scale mining [16]. Illegal mining activities are concentrated in several communities, including Pakyi No. 2, Toase, and Keniago, where alluvial surface deposits and hard-rock underground gold workings attract both local and migrant workers.

Healthcare infrastructure in the district consists of one district hospital, three health centres, and several Community-based Health Planning and Services (CHPS) compounds. However, geographical barriers, inadequate staffing, and limited diagnostic capabilities constrain access to occupational health services, particularly for illegal miners who may fear legal consequences of disclosure [17].

2.3. Study Population

The study population comprised adult individuals (18 years and above) who were actively engaged in illegal small-scale gold mining activities within the Atwima Mponua District, located in the Ashanti Region of Ghana.

2.4. Inclusion Criteria

Individuals who were 18 years of age or older, who had been engaged in illegal small-scale gold mining activities for at least six months, and who were willing to provide informed consent.

2.5. Exclusion Criteria

Individuals employed in formal, licensed mining operations were excluded from the study. Individuals who were critically ill or unstable at the time of data collection were also excluded, as were individuals who were not present during the period of data collection.

2.6. Participant Selection and Recruitment

Purposive sampling was employed to recruit participants who could provide rich, experiential accounts of occupational health experiences in illegal small-scale gold mining [18]. Initial contact with potential participants was facilitated through community gatekeepers, including traditional leaders, opinion leaders, and mining gang leaders who vouched for the research team’s confidentiality commitments. Snowball sampling techniques were subsequently employed, with participants referring other miners who met the inclusion criteria [19]. Maximum variation sampling ensured diversity in participants’ mining roles (excavators, washers, chemical processors, transport workers), duration of mining experience, and demographic characteristics. A total of 16 participants were recruited between March and August 2025. Sample size was determined by saturation, the point at which no new information emerged from additional interviews [20]. This sample size falls within the range typically recommended for qualitative thematic analysis studies (12–25 participants), where analytical depth is prioritised over statistical breadth [20]. The purposive inclusion of participants across five distinct occupational roles, both sexes, a wide age range (27–44 years), varying migration backgrounds (local and migrant), and mining tenures spanning 3 to 12 years ensured maximum variation and strengthened the representativeness of the sample within the illegal mining population of the study district. Participants, ten men and six women, ranged in age from 27 to 44 years, with mining experience spanning 3 to 12 years.

2.7. Data Collection

An in-depth interview guide was used as the primary method of data collection. This guide was developed based on a literature review, consultation with occupational health experts, and pilot interviews with three miners. The instrument was not a pre-existing validated scale but was constructed de novo from the literature, consistent with standard phenomenological practice. The domains and key questions were drawn from established occupational health research frameworks. The guide addressed four broad domains: (1) descriptions of daily mining activities and work environment; (2) perceptions of occupational health risks; (3) personal experiences of work-related symptoms and ailments; and (4) health-seeking behaviours and barriers to care.

Health symptoms were elicited exclusively through open-ended, narrative prompts such as “Can you describe any health problems you have experienced since working here?” and “Have you noticed any changes in your body since starting this work?” The interview guide did not employ a symptom checklist, and research assistants were explicitly trained not to suggest, name, or imply any specific diagnoses. Follow-up probes were used only to encourage elaboration of symptoms the participant had already spontaneously described. This approach minimized the risk of interviewer suggestion while enabling rich, unprompted symptom narratives.

Interviews were conducted in participants’ preferred language (Twi, Fante, or English) by bilingual research assistants trained in qualitative interviewing techniques. To build trust and ensure participant comfort, interviews were conducted in private, neutral locations selected by participants, including community centres, participants’ homes, or quiet outdoor spaces away from mining sites. Each interview lasted 45 to 90 min (mean duration: 63 min). All interviews were audio-recorded with participant consent and supplemented with field notes documenting non-verbal communication, contextual observations, and the interviewer’s reflections. Interviews conducted in Twi or Fante were transcribed in the original language and subsequently translated into English by certified translators.

2.8. Interview Guide Development and Piloting

The interview guide was developed based on a comprehensive review of literature on the occupational health hazards, working conditions, and coping strategies of workers from illegal small-scale gold mines. The guide was designed to elicit rich, personal narratives consistent with the study’s phenomenological approach. To ensure clarity, relevance, and cultural appropriateness, the guide was piloted with three eligible participants who met the inclusion criteria but were not part of the final sample. Minor revisions were made in response to feedback, improving the clarity, flow, and sensitivity of the questions.

2.9. Data Analysis

Data were analysed using thematic analysis following the six-phase framework proposed by Braun and Clarke [21]: (1) familiarisation with data through repeated reading of transcripts; (2) generating initial codes systematically across the dataset; (3) searching for themes by collating codes into potential themes; (4) reviewing themes against coded extracts and the entire dataset; (5) defining and naming themes; and (6) producing the final report with vivid examples. Both inductive and deductive approaches were employed. Inductive coding allowed themes to emerge organically from participants’ accounts without imposing predetermined categories. Deductive elements, informed by existing occupational health frameworks, were applied when interpreting the themes in relation to the wider literature. The four themes are presented in Section 3 in the order of their prominence and theoretical significance as determined during analysis. This ordering reflects their relative centrality to the data and to the study’s research aim [22]. NVivo 14 software was used to facilitate data management, coding, and theme development. Coding was performed independently by two researchers to enhance credibility. Discrepancies were resolved through discussion and consensus. An audit trail documented analytical decisions, and a reflexive journal captured researchers’ assumptions and potential biases that might influence interpretation [23]. Member checking, a trustworthiness strategy in qualitative research whereby preliminary findings are returned to participants for verification and correction, was conducted with eight participants who reviewed findings and confirmed the accuracy of interpretations.

2.10. Rigor and Trustworthiness

Trustworthiness was established through multiple strategies aligned with Lincoln and Guba’s criteria [24]. Credibility was enhanced through prolonged engagement in the field (six months), triangulation of data sources (interviews, field notes, and observational data), peer debriefing sessions, and member checking. Transferability was addressed through a thick description of the research context, participants, and findings, enabling readers to assess its applicability to other settings. The structural and socio-economic conditions documented in this study—including the absence of occupational health and safety regulation, use of rudimentary equipment, direct handling of mercury and cyanide, economic marginalisation, and barriers to healthcare access—are widely reported in illegal small-scale mining settings across Ghana and sub-Saharan Africa, which supports the plausibility of transferring findings to comparable contexts [9,12]. Dependability was strengthened through detailed documentation of research decisions and an external audit by an independent qualitative researcher. Confirmability was ensured through reflexive practice and maintenance of an audit trail linking raw data to interpretations.

2.11. Ethical Considerations

This study received ethical clearance from the KAAF University Ethics Committee, under approval number IRB-KU/HSS/25/02/12-01. Before enrolment, all participants were fully informed about the objectives, procedures, potential risks, and benefits of the study. Written informed consent was obtained from each participant before data collection commenced. The research was conducted in strict adherence to the principles outlined in the Declaration of Helsinki and followed established ethical guidelines for conducting research involving vulnerable populations. Measures were taken to ensure confidentiality, voluntary participation, and the right to withdraw at any stage without penalty.

3. Results

3.1. Participant Characteristics

Sixteen workers from illegal small-scale gold mining operations participated in this study. Ten were men, and six were women. Participants ranged in age from 27 to 44 years, with a mean age of 35 years. Mining experience ranged from 3 to 12 years, with a mean of 6.75 years. Educational attainment was generally low: five participants had no formal education, seven had completed primary school, and four had attained Junior High School level. The majority (nine of sixteen) were migrants, primarily from northern Ghanaian regions (Northern, Upper East, and Upper West regions), reflecting the economic push factors that drive labour migration to mining areas. Seven participants were non-migrants from within the district. Occupational roles represented included excavators (five participants), washer/panners (four), chemical processors (four), one ore grinder, and two support workers. None of the participants held health insurance or had a formal employment contract, and all reported working between six and seven days per week (

Table 1. Sociodemographic and Occupational Characteristics of Participants.

Worker ID	Age	Gender	Education	Migrant Status	Mining Role	Experience
Worker 1	29	Male	No formal education	Yes	Excavator	5 years
Worker 2	34	Male	Primary	Yes	Excavator	8 years
Worker 3	36	Male	Primary	No	Excavator	9 years
Worker 4	41	Male	No formal education	Yes	Chemical processor	7 years
Worker 5	33	Male	Primary	No	Ore grinder	12 years
Worker 6	38	Male	Junior High	Yes	Excavator	6 years
Worker 7	31	Male	Primary	Yes	Support worker	4 years
Worker 8	27	Female	No formal education	No	Chemical processor	3 years
Worker 9	39	Male	Junior High	Yes	Excavator	11 years
Worker 10	44	Female	Primary	No	Washer/panner	6 years
Worker 11	28	Male	No formal education	Yes	Chemical processor	5 years
Worker 12	38	Female	Primary	No	Washer/panner	7 years
Worker 13	30	Female	Junior High	Yes	Washer/panner	4 years
Worker 14	42	Female	No formal education	No	Washer/panner	9 years
Worker 15	35	Male	Primary	Yes	Chemical processor	7 years
Worker 16	32	Female	Junior High	No	Support worker	5 years

).

The following thematic findings are presented in the order of their prominence and theoretical centrality as determined during analysis. In keeping with the phenomenological and qualitative nature of this study, evidence is presented through verbatim participant excerpts. These excerpts are the primary analytical evidence in IPA research, enabling readers to evaluate interpretive claims directly [14].

3.2. Thematic Findings

Thematic analysis of the interview data revealed four major themes and several sub-themes, as follows: (1) normalization of risk and fatalistic beliefs; (2) respiratory manifestations and dust-related ailments; (3) chemical exposures and dermatological conditions; (4) traumatic injuries and musculoskeletal disorders. Each theme is presented below with its associated sub-themes and illustrative participant quotations, identified by worker codes.

3.2.1. Theme 1: Normalization of Risk and Fatalistic Beliefs

Participants normalized occupational risks, viewing health hazards as an unavoidable part of mining. Economic survival outweighed health concerns, outcomes were often attributed to divine will, and safety measures were seen as impractical or largely absent.

Sub-Theme 1.1: Economic Survival as Primary Driver

Participants prioritized earning a living over protecting their health, seeing risky mining work as their only option to support themselves and their families. In this regard, a 36-year-old excavator with 9 years of work experience had this to say:

“The work is dangerous, of which we are all aware. Whenever I enter the pit early in the mornings, I do not know whether I will emerge alive. But what can I do? I am supposed to feed children and pay school fees. My family is hurt if I do not work. That is, I have to take the risk day in and day out. This is the only survival tactic we have”

(Worker 3, male, 36 years old)

The gendered element was emphasized by a 44-year-old woman who works as a washer:

“I had three children as a result of being left out by my husband. Not a single one of them will hire a woman with no education. Working in the mines is the only job that I can make a decent income to support my kids and keep them enrolled in school. The chemicals are burning my skin; my chest is aching, but I cannot stop. Where will I get money? I am aware that one day this work will kill me, yet the time is not yet, so I will have to survive”

(Worker 10, female, 44 years old)

Another male participant aged 29 years added:

“In my North village, there is nothing to do. Drought causes nothing to be produced in the farms. I came here five years ago. The labour at the mines is quite difficult and hazardous, but at least I will be able to send money back home to my family. In the absence of this work, we would starve. Then, I do not refuse the dangers, as I do not have another choice.”

(Worker 1, male, 29 years old)

Sub-Theme 1.2: Fatalistic Attribution to Divine Will

Most participants perceived occupational hazards through a religious lens, believing that God ultimately determines whether a person lives or dies. This fatalistic orientation enabled them to continue working despite the risks, providing psychological comfort in the absence of material safety measures.

A male participant aged 41 years explained:

“We are only safeguarded by God in this work. You will die whether you are mindful or not if He wants you to die. When He desires you to live, it is even though the pit falls, you will be alive. Then we trust in God and get down to business. It is in the hand of his own and not ours what will happen”

(Worker 4, male, 41 years old)

A survivor of the pit collapse said:

“The earth buried me last year, and I ought to have been killed, but God spared me, since it was not my time. I continue working in the pits because I believe that God will guide me as long as He knows that it is my time. No one can dictate when they are going to die; it is only God who knows”

(Worker 6, male, 38 years old)

Another female participant stated:

“We pray every day before going to work. We pray God to guard us against accidents and send us home safe. That is all we can do. The rest is in God’s hands. There are those miners who die and those who survive. Nobody is lucky or safe because it is fate and not safety equipment that decides who lives and who dies”

(Worker 14, female, 42 years old)

Sub-Theme 1.3: Perceived Inaccessibility of Protective Measures

Participants knew about protective equipment but viewed it as too expensive, impractical for their work, or unavailable due to the illegal nature of mining.

A 31-year-old male support worker explained the economic barriers:

“Those safety things, such as nose masks, gloves, boots, and helmets, are very expensive. One good respirator costs more than what I earn in two weeks. How can I buy it? And even if I save money to buy one, where will I find it? The shops in town do not sell professional safety equipment. They are for large-scale mining companies, not for us”

(Worker 7, male, 31 years old)

A 28-year-old male chemical processor noted the barrier created by the illegal status of their work:

“Because we are illegal workers, we cannot go to government offices or mining companies to ask for safety training or equipment. They would arrest us instead of helping us. So, we use what we have, our bare hands, our strength, and our experience. We learn about safety from each other, not from any official training”

(Worker 11, male, 28 years old)

3.2.2. Theme 2: Respiratory Manifestations and Dust-Related Ailments

Respiratory symptoms were the most common and severe health issue reported. Participants described ongoing breathing problems from dust, worsening lung health over time, and limited knowledge of specific respiratory diseases.

Sub-Theme 2.1: Pervasive Dust Exposure and Acute Symptoms

Participants reported intense dust exposure during mining, particularly underground and during crushing activities. Ore crushing was performed primarily using ball mills (stamp mills), which generate fine, highly respirable silica-containing particles in the most hazardous size fraction. Exposure caused coughing, nasal congestion, eye irritation, and breathing difficulty that began within minutes of starting work.

A 29-year-old male excavator described his experience of prolonged dust exposure underground:

“Inside the hole, or pit, the dust is like fog and so thick that you cannot see even your own hands sometimes. When you breathe, the dust enters your nose, mouth, and chest. Within minutes of starting work, you begin coughing. Your eyes burn, and water, and your nose becomes completely blocked. After work, when I cough, the sputum is black like coal. Sometimes there is blood in it as well”

(Worker 1, male, 29 years old)

A 33-year-old male ore grinder explained the particularly severe exposure associated with crushing activities:

“The crushing work produces the worst dust. When the machine is running, the whole area becomes white with dust. You cannot avoid breathing it; it is everywhere. Your clothes become white, your skin becomes white, and your eyes are red and painful. You are coughing continuously while working. Even using a cloth over my nose and mouth does not help much because the dust is so fine that it goes through everything.”

(Worker 5, male, 33 years old)

A 32-year-old female support worker described the persistent nature of dust-related symptoms:

“The dust stays in your body even after you finish work. At night, hours after I have stopped working, I am still coughing up dust. It takes days for the black colour in my sputum to clear, and by then, I am back in the pit, breathing more dust. So, it is continuous; the dust never really leaves your lungs.”

(Worker 16, female, 32 years old)

Sub-Theme 2.2: Progressive Respiratory Deterioration

Several participants with particularly lengthy mining tenures described a gradual deterioration in respiratory function over the course of their working lives, characterising worsening symptom frequency, reduced exercise capacity, and persistent dyspnoea at rest.

A 30-year-old female washer/panner, who had four years of mining experience, narrated the deterioration of her physical ability:

“Four years ago, when I entered this trade, I was in very good health. I was able to travel long distances, carry heavy loads, and work without a break. At present, I am unable to walk rapidly and carry heavy items without feeling out of breath. I can even, when I am at rest, feel that I am labouring, a poor supply of air into my thoracic cavity. The coughing episode is chronic, whether I am at work or sleeping. My lungs seem to be weakened, but I do not see another way than to continue to struggle”.

(Worker 13, female, 30 years old)

It is noted that the respiratory symptoms reported by washer/panners, such as Worker 13, were attributable to their proximity to crushing and excavation operations and to time spent underground, rather than to the panning process itself, which is a wet activity generating minimal airborne dust.

A 36-year-old male excavator who had nine years of experience recounted the course of symptoms:

“The dust made me cough when I first came into the mine, but I felt relieved after taking a few hours off. Nine years later, now I cough all the time, in the morning, the afternoon, at night. There is a constant constriction of my thoracic compartment, as though it were pressed. I wake up at night because of poor ventilation. Climbing the stairs causes dyspnoea. Every year is a decline, but the enslavement of work continues”.

(Worker 3, male, 36 years old)

A 34-year-old male excavator who had eight years of experience assessed himself against new workers:

“I feel that there is a slight difference between younger workers who are new to the mining industry. They submit to a high working rate, they tend to have slow fatigue, and they rarely cough. On the other hand, we long-term tenure sufferers find it difficult, as we do not have previous work intensity. Our physiologies fall into a poor state. A number of my colleagues who joined work at the same time as I had to quit due to a serious thoracic condition. One of them died last year, supposedly of pulmonary pathology”.

(Worker 2, male, 34 years old)

Sub-Theme 2.3: Limited Disease Awareness and Self-Diagnosis

Participants lacked awareness of specific respiratory diseases such as silicosis, pneumoconiosis, or chronic obstructive pulmonary disease. Instead, they used descriptive, experiential terms to characterize their conditions and often attributed symptoms to multiple possible causes beyond dust exposure.

A 39-year-old male excavator with eleven years of mining experience used folk terminology to describe his condition:

“What we have, we call it ‘miner’s cough’ or ‘dust sickness.’ I don’t know the medical name for it. All miners get it eventually. It is just part of the work. The dust makes your chest sick. Some people say it can lead to tuberculosis, but I don’t know if that is true or just rumours.”

(Worker 9, male, 39 years old)

A 38-year-old female washer/panner with seven years of experience attributed her symptoms to multiple possible causes:

“My chest problems come from many things, the dust, yes, but also the chemicals, the damp conditions underground, the heat, maybe infections too. I don’t know exactly what is wrong with my lungs. When I cough up blood, I worry it might be TB, but I haven’t been tested because I fear going to the hospital. So, I just manage with herbs and tablets from the chemical shop.”

(Worker 12, female, 38 years old)

A 35-year-old male chemical processor with seven years of experience expressed misconceptions regarding causation:

“Some people say the chest problems are from breathing dust, others say it is a curse or spiritual attack. I think it is both the physical dust that damages the lungs, but also there are spiritual forces that make some people sicker than others. That is why some miners who work in the same conditions stay healthy while others get very sick.”

(Worker 15, male, 35 years old)

3.2.3. Theme 3: Chemical Exposures and Dermatological Conditions

Dermatological manifestations and systemic symptoms related to mercury and cyanide exposure constituted a prominent theme. Three sub-themes emerged: direct dermatological effects of chemical contact, systemic and neurological symptoms from chronic exposure, and unsafe chemical handling practices stemming from inadequate knowledge and resources.

Sub-Theme 3.1: Dermatological Manifestations from Chemical Contact

Participants who handled mercury and cyanide described serious and long-lasting skin problems. These included burns, peeling skin, wounds, scars, and infections after direct contact with chemicals.

A 27-year-old female chemical processor with three years of experience described serious skin damage:

“The mercury burns my skin badly. The skin on my hands peels off often. I tried using gloves, but they are costly and tear easily, so I usually work with my bare hands. The burns turn into sores and take a long time to heal. Sometimes they get infected and smell. My hands are now rough and full of scars. I know the chemical is harming me, but this is how we get the gold.”

(Worker 8, female, 27 years old)

A 41-year-old male chemical processor with seven years of experience reported severe burns from cyanide:

“Cyanide is very dangerous. If it touches your skin, it burns immediately. I have many burn marks on my arms and hands. Some burns took months to heal. One time, cyanide was poured on my leg, and I could not walk home by myself. The pain was too much. But we do not have proper containers or protective clothing, so these accidents happen often.”

(Worker 4, male, 41 years old)

A 31-year-old male support worker with four years of experience described ongoing skin problems:

“My skin has changed because of the chemicals. Some parts are darker, and some are lighter. The skin on my hands cracks and bleeds, especially in the dry season. I get itchy rashes often. Medicine from the chemical shop helps for a short time, but the problem comes back because I keep working with the chemicals every day.”

(Worker 7, male, 31 years old)

Sub-Theme 3.2: Systemic and Neurological Effects

Beyond skin problems, participants reported other health effects they believed were caused by chemical exposure. These included shaking hands, memory problems, mood changes, headaches, dizziness, and nausea.

A 35-year-old male chemical processor with seven years of experience described changes in his body and behaviour:

“After working with these chemicals for many years, my body has changed. My hands shake, and I cannot hold things steady. I forget things easily. Sometimes I feel confused. My wife says I get angry quickly, and I am not patient anymore. I cannot concentrate well.

I think the chemicals have affected my brain, but I do not know what to do about it.”

(Worker 15, male, 35 years old)

A 30-year-old female washer with four years of experience reported memory and sensory problems:

“Since I started working with chemicals, I have headaches almost every day. They are worse after using mercury or cyanide. My fingers and toes feel numb and tingle often. I forget important things easily. Sometimes I feel dizzy and sick to my stomach. These problems are getting worse.”

(Worker 13, female, 30 years old)

A 28-year-old male chemical processor with five years of experience described the effects of chemical fumes:

“The fumes from cyanide are very harmful. When we mix or heat it, the smoke makes your eyes water and your throat burn. Your head starts to ache quickly. Some workers have fainted from the fumes. After breathing it, I feel weak and sick for hours. My chest feels tight, and I lose my appetite. The fumes affect the whole body.”

(Worker 11, male, 28 years old)

Sub-Theme 3.3: Inadequate Chemical Safety Knowledge and Practices

Participants showed limited knowledge about safe handling, storage, and disposal of chemicals. Chemicals were often kept in unsafe containers, used without protection, and thrown away improperly.

A 33-year-old male ore grinder with twelve years of experience described unsafe storage:

“We keep mercury and cyanide in any container we find, like old water bottles or cooking oil bottles. They are not labelled, so someone can mistake them for water. We keep them near where we sleep and eat because we have nowhere else to store them. I know this is not safe, but we have no better option.”

(Worker 5, male, 33 years old)

A 44-year-old female washer with six years of experience explained the lack of proper training:

“No one taught us how to use these chemicals safely. We learned by watching others. We do not know the right amount to use or how to protect ourselves well. Sometimes we mix different chemicals because we think it will work better, but we do not know if it is dangerous. We are just trying to get more gold.”

(Worker 10, female, 44 years old)

A 29-year-old male excavator with five years of experience described disposal practices:

“After using the chemicals, we pour the waste into nearby streams or bury it in the ground. Sometimes we burn mercury, and the smoke spreads into the air. We know this is harmful, but we have no proper way to dispose of it. There is no support for us, so we manage the best we can.”

(Worker 1, male, 29 years old)

3.2.4. Theme 4: Traumatic Injuries and Musculoskeletal Disorders

Acute traumatic injuries and chronic musculoskeletal disorders represented immediate and ongoing physical consequences of mining work. Three sub-themes emerged: pit collapse injuries and fatalities, equipment-related traumatic injuries, and chronic musculoskeletal pain, disability, and the economic consequences of disabling injuries.

Sub-Theme 4.1: Pit Collapses and Burial Injuries

Pit collapses emerged as the most feared hazard, resulting in fatalities, severe crush injuries, and long-term disabilities. The absence of structural engineering, proper shoring, or safety inspections created a constant risk of catastrophic collapse.

A 38-year-old male excavator with six years of experience shared his experience:

“Last year in April, the pit collapsed on me and two other workers. We were working about 15 m underground when the walls gave way. I was completely buried; I could not move, could not breathe, could only wait and pray. My colleagues dug frantically to reach us. I was buried for more than three hours before they pulled me out. My right leg was crushed, broken in three places. The bone was sticking out through the skin. One of the other workers died; they could not reach him in time. Even now, one year later, I have been in pain every day. I cannot walk properly anymore. My leg is crooked and weak. But I must still work because I have no other income. Every time I go down into a pit now, I remember that day and fear it will happen again.”

(Worker 6, male, 38 years old)

A 39-year-old male excavator with eleven years of experience explained why pits collapse:

“The pits collapse because we don’t have proper engineering. We just dig down as far as we can, following the gold deposits. We don’t use timber supports or concrete like the big mining companies. The walls are just bare earth and rock. During the rainy season, water seeps in and weakens the walls. Eventually, they give way. We know this is dangerous, but we don’t have the knowledge, materials, or money to make the pits safer. So, we just hope and pray that the walls will hold.”

(Worker 9, male, 39 years old)

A 36-year-old male excavator with nine years of experience described how common it is:

“Collapses happen often… maybe two or three times a year here. Some people survive; some do not. Many injuries, many deaths. Nobody records it.”

(Worker 3, male, 36 years old)

Sub-Theme 4.2: Equipment-Related Traumatic Injuries

Injuries from improvised mining equipment, tools, and machinery were commonly reported. The absence of safety guards, emergency stops, or proper maintenance resulted in amputations, lacerations, and crush injuries.

A 28-year-old male chemical processor with five years of experience said,

“Our machines have no guards. They are old and rough. I saw a man lose his arm in the crusher. Just like that. No compensation. When you are injured, you are on your own.”

(Worker 11, male, 28 years old)

A 34-year-old male excavator with eight years of experience explained:

“Hammers slip. Rocks fall. Pickaxes hit people. I have many scars. Three of my toes broke once. We only go to the hospital if it is very serious.”

(Worker 2, male, 34 years old)

A 32-year-old female support worker with five years of experience added:

“Our equipment breaks down often because it is old and poorly maintained. When pumps fail, the pits flood, and people can drown. When winches break, people fall from heights. When generators malfunction, they can electrocute workers or cause fires. All these accidents could be prevented with proper equipment and maintenance, but we cannot afford good equipment, and we lack the technical knowledge for proper maintenance. So, we make do with what we have and hope nothing goes wrong.”

(Worker 16, female, 32 years old)

Sub-Theme 4.3: Chronic Musculoskeletal Disorders, Disability, and Economic Consequences

Chronic musculoskeletal problems from prolonged heavy labour, repetitive movements, and awkward working postures were nearly universal among participants. These conditions caused persistent pain, reduced functional capacity, and progressive disability, but were rarely treated due to healthcare access barriers. Beyond the physical suffering, disabling injuries carried severe economic consequences, as injured workers had no access to compensation, social protection, or alternative income sources, forcing many to return to dangerous work despite their conditions.

A 38-year-old male excavator with six years of experience said:

“When my leg broke, I stayed home for eight months. No income. We used all our savings for hospital bills. Now I still work with pain because I have debts to pay.”

(Worker 6, male, 38 years old)

A 42-year-old female washer with nine years of experience described her husband’s situation:

“My husband lost his hand in the mine. After that, no work, no money. I had to start mining myself. Our children stopped school because we could not pay fees.”

(Worker 14, female, 42 years old)

4. Discussion

This qualitative study provides rich insights into the occupational health experiences of small-scale illegal miners in the Atwima Mponua District of Ghana. The findings reveal a complex intersection of economic vulnerability, environmental hazards, legal marginalization, and inadequate health infrastructure that creates conditions for substantial but largely invisible occupational morbidity and mortality. The four major themes, normalization of risk, respiratory manifestations, chemical exposures, and traumatic injuries, collectively illustrate how structural factors shape individual health outcomes in this vulnerable population.

The normalization of occupational hazards observed in this study reflects broader patterns documented among workers in precarious and informal employment globally [25,26]. Miners’ fatalistic attitudes toward health risks serve as psychological coping mechanisms that enable them to continue dangerous work in the absence of viable economic alternatives [27]. This finding resonates with Bourdieu’s concept of habitus, where individuals’ perceptions and behaviours are shaped by their structural positions and constrained choices [28].

However, it would be reductive to interpret miners’ risk acceptance merely as individual choice or cultural fatalism. Rather, it must be understood within the context of structural violence—the systematic ways in which social structures harm or disadvantage individuals [10]. In rural Ghana, where unemployment rates are high and agricultural livelihoods are increasingly precarious due to climate change and land degradation [29], illegal mining represents one of the few available income-generating activities. The criminalization of galamsey without the provision of economic alternatives effectively forces individuals to choose between legal compliance and family subsistence.

Participants’ references to divine protection and fatalistic acceptance align with findings from other studies of dangerous occupations in low-resource settings [30]. These belief systems may provide psychological comfort and community solidarity while simultaneously inhibiting collective action for improved working conditions or safety measures. Public health interventions must therefore address both the material conditions that necessitate dangerous work and the ideological frameworks that normalize occupational suffering.

The respiratory symptoms described by participants, chronic cough, dyspnoea, chest pain, and haemoptysis, are consistent with established patterns of mining-related respiratory disease [31]. While participants lacked formal diagnoses, their symptoms suggest possible silicosis, chronic obstructive pulmonary disease (COPD), pneumoconiosis, or tuberculosis, all documented among artisanal miners in sub-Saharan Africa [32]. The high silica content of gold ore and the absence of dust suppression measures in illegal mining operations create conditions for intense respirable crystalline silica exposure [33]. Previous studies have documented silica concentrations in artisanal mining environments exceeding occupational exposure limits by orders of magnitude [34,35,36]. The progressive nature of respiratory symptoms reported by participants, with worsening over years of mining work, aligns with the dose-response relationship between cumulative silica exposure and pneumoconiosis development [37].

Particularly concerning is the potential overlap between pneumoconiosis and tuberculosis (TB). Silica exposure increases TB risk through impairment of macrophage function and disruption of normal lung architecture [38]. Ghana has a TB prevalence of approximately 148 per 100,000 population [39,40], and miners constitute a high-risk group often excluded from TB screening programs due to their legal status. The haemoptysis reported by some participants could indicate active TB, but fear of legal consequences prevents them from seeking diagnosis and treatment, potentially contributing to ongoing community transmission.

The inadequacy of makeshift respiratory protection (cloth face coverings) underscores the need for interventions that are both effective and accessible to illegal miners. Standard occupational health recommendations for respirators may be impractical given the cost, availability, and training requirements. Harm reduction approaches that acknowledge the reality of continued illegal mining while providing accessible protective equipment and health education may be more appropriate than prohibitionist policies that drive mining further underground [41].

The dermatological and neurological symptoms attributed to mercury and cyanide exposure represent another dimension of occupational health consequences in illegal mining. Elemental mercury used in gold amalgamation is readily absorbed through the skin and lungs, causing both local dermatological effects and systemic toxicity affecting the central nervous system, kidneys, and cardiovascular system [42,43].

The neurological symptoms described by participants, tremor, cognitive impairment, mood changes, and behavioural alterations, are characteristic of chronic mercury intoxication. These symptoms often develop insidiously and may be dismissed or attributed to other causes. A study of artisanal gold miners in Zimbabwe found that 32% had elevated blood mercury levels, with neurological symptoms correlating with duration of mercury exposure [44]. Given the similar exposure patterns in our study setting, substantial mercury toxicity among illegal miners in Atwima Mponua is highly probable but undocumented due to lack of biomonitoring and health surveillance.

Cyanide, while acutely toxic, is rapidly metabolized and typically causes acute rather than chronic poisoning [45]. The chemical burns and respiratory irritation described by participants likely result from direct contact with sodium or potassium cyanide solutions and inhalation of hydrogen cyanide vapors during gold leaching processes. Chronic low-level cyanide exposure can cause thyroid dysfunction and neurological effects [46], though these were not specifically mentioned by participants, possibly due to lack of awareness or attribution.

Environmental contamination from mercury and cyanide use extends beyond occupational exposures to affect broader communities through water and soil pollution [47]. This creates additional public health concerns, as families living near mining sites may experience secondary exposures through contaminated water sources and agricultural products [48]. Comprehensive interventions must, therefore, address both direct occupational exposures and environmental health dimensions.

The frequency and severity of traumatic injuries described by participants reflect the inherently dangerous nature of small-scale mining operations conducted without engineering controls, safety equipment, or emergency response capacity. Pit collapses, equipment injuries, and falling rock hazards are well-documented in the mining safety literature [49,50], but the absence of regulatory oversight, mine planning, or structural engineering in illegal operations magnifies these risks substantially.

The economic consequences of occupational injuries are particularly devastating for illegal miners who lack workers’ compensation, disability insurance, or alternative income sources. A disabling injury effectively eliminates both the injured worker’s earning capacity and any prospects for recovery, given the absence of social safety nets. This creates a cycle where injured miners must continue working despite disabilities, further compromising their health and safety [51]. The musculoskeletal disorders resulting from prolonged heavy labour, awkward postures, and repetitive movements represent chronic occupational health consequences that receive less attention than acute injuries but contribute substantially to disability and reduced quality of life [52]. These conditions are likely exacerbated by poor nutrition, inadequate rest, and the inability to access physiotherapy or pain management services. The findings of this study, whilst derived from a single district in Ghana, are contextually grounded in conditions that are widely documented across illegal and artisanal small-scale gold mining operations throughout Ghana and sub-Saharan Africa. The regulatory vacuum, reliance on unshored pit excavations, direct handling of mercury and cyanide without protective equipment, economic marginalisation, and barriers to healthcare access described by participants mirror those reported in comparable communities in the Western, Eastern, and Ashanti Regions of Ghana, as well as in artisanal mining settings in Tanzania, Zimbabwe, Senegal, and the Democratic Republic of Congo [6,33,36,44]. These structural homologies suggest that the thematic framework and experiential accounts generated by this study offer substantial public health value beyond the Atwima Mponua District. Policymakers, public health practitioners, and researchers operating in analogous illegal mining contexts may draw on these findings to inform occupational health interventions, advocacy strategies, and future research agendas. In particular, the themes of risk normalisation, chemical exposure, respiratory deterioration, and injury-driven economic catastrophe are likely to resonate across the sub-Saharan African region, where illegal small-scale mining continues to expand.

5. Strengths and Limitations

This study used qualitative methods to explore the lived experiences of a hard-to-reach population. Trust was built through prolonged field engagement, diverse participants were included, and rigorous analysis strengthened credibility. However, several limitations should be acknowledged; First, the study used a qualitative design, so findings reflect depth of understanding rather than statistical generalisability. Second, no comparison group from licensed mining was included, which limits conclusions specific to illegal status. Third, health conditions were self-reported without clinical confirmation. Fourth, photographic documentation was not possible due to the illegal nature of operations. Fifth, participants may have withheld sensitive information out of fear of legal consequences. Finally, findings are drawn from a single district and may not generalise broadly, though the detailed descriptions provided support transferability assessment. With respect to sample size, 16 participants is consistent with published norms for qualitative phenomenological and thematic analysis research, wherein analytical saturation rather than numerical adequacy determines sufficiency [20]. Saturation was confirmed during data collection, and the purposive inclusion of participants across diverse occupational roles, genders, migration statuses, educational backgrounds, and mining tenures of varying duration enhances the representativeness of the findings within the illegal small-scale mining population. Notwithstanding its single-site design, this study’s findings are likely transferable to comparable illegal small-scale mining communities in Ghana and the broader sub-Saharan African region, given the well-documented structural similarities in regulatory absence, chemical use, worker demographics, and occupational health burden across these settings [9,12,49].

6. Conclusions

This study reveals the serious but often overlooked health risks faced by workers from illegal small-scale gold mines in Atwima Mponua District. Workers experience respiratory problems, chemical exposures, traumatic injuries, and chronic pain, all of which are normalised as the unavoidable cost of economic survival. Criminalization, poverty, and limited healthcare access delay treatment and worsen preventable conditions. Addressing these challenges requires tackling poverty and unemployment, improving access to healthcare regardless of legal status, and adopting practical harm-reduction strategies to protect miners’ health.