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Ronneby became the world’s worst known case of PFAS contamination. The polarization in society was enormous. On one side was the municipality responsible, making excuses. On the other side were concerned poisoned citizens who took the municipality to court. How did this happen and what are the lessons we can learn from the environmental disaster that affected several generations of Swedes?
PFAS in municipal water
On December 16, 2013, residents of the municipality of Ronneby heard on the news that their tap water had been switched to another source. The water supply, which had won awards for being one of the cleanest in Sweden, had been found to contain high levels of PFAS. These synthetic chemicals, widely used in industrial processes and manufacturing, are often referred to as ‘persistent chemicals’ because they do not break down easily and can remain in the environment for hundreds of years, or even longer.
For many in Ronneby, including municipal employees, chemicals were forever still largely a mystery. “In December 2013, PFAS was completely unknown to us,” said Roger Fredriksson, who was mayor at the time. News reports said the chemicals had seeped into the municipal water system from the firefighting foam used at the air base. It had been going on for years, even decades, but no one had previously thought to check the water for PFAS, which has neither taste nor smell. Yet the municipality’s message to residents was reassuring: the old water supply had now been turned off and switched to a clean source.
The next day, December 17, the Swedish Food Agency made an announcement that sounded reassuring to many: the chemicals “did not pose an acute health risk”. While drinking a glass of Ronneby’s tap water wouldn’t make you acutely ill, the problem was the long-term consequences. Over the past 12 years, much more research has been done on the links between PFAS and diseases such as cancer and diabetes, but by 2013 there was already a reasonable amount of knowledge about the health risks of these chemicals. The production and use of PFAS had been restricted in the EU since 2009 (although firefighting foams were exempt from this restriction).
A few days after the first discovery, Ronneby’s management contacted researchers at nearby Lund University. They knew that the drinking water had been heavily contaminated with PFAS; the question was to what extent this showed up in the blood of local people. As children are particularly vulnerable to chemical contamination, they would start by testing 11-year-olds from Ronneby schools. In February 2014, the blood samples arrived at the laboratory of Christian Lindh, a university researcher. When Lindh did his tests, he found that the results were so impossibly high that he had to do them again to ‘double-check’. Children from affected areas had more than 37 times as much PFAS in their blood as children outside the contaminated zone.
Where did the PFAS contamination come from?
It was found that the source and origin of the environmental pollution came mainly from the airfield. Water-based film-forming foam is extremely effective in firefighting: it can extinguish flammable liquid fires, such as those caused by jet fuel spills. Chemicals in the foam create a stable blanket over liquid fuel, trapping the flammable vapors and extinguishing the fire. Afterwards, the foam sinks into the sandy soil and disappears.
Once again, the municipality tried to alleviate the concerns of local residents, quoting a doctor from Lund who said there was no reason to expect “that the children will develop any diseases in the future caused by PFAS”. Because the news of the children’s study was couched in such reassuring terms, Ronneby resident Afzelius, like many others in Ronneby, did not really start to worry until he received a letter asking him to take a blood sample. The letter, emblazoned with logos from Ronneby municipality, the Skåne region and Lund University, urged all local residents to get tested for PFAS. “It was actually the first time I reacted. I thought: ‘Why do they want to test my blood?”, said Afzelius.
In the spring of 2014, people in Ronneby queued to have their blood tested for PFAS. The lines were long and the atmosphere was tense. People felt “a mixture of anxiety, confusion and growing distrust”, Afzelius recalled.
The results arrived by post a few months later. Afzelius was shocked by what he read. To help recipients interpret the numbers, the letter included comparative results. Afzelius’ PFAS levels were at least nine times higher than those of people outside the contaminated area. “I immediately thought, okay, damn, this is really, really high,” he said. His case was far from the worst. Some people in Ronneby found themselves staring at numbers more than 1 000 times higher than the level now considered safe.
Ronneby became the world’s worst known case of PFAS contamination
It was now official: Ronneby was the world’s worst known case of PFAS contamination. But at the time, few outsiders noticed. The media didn’t offer much coverage – that would come later – and residents had to find out for themselves what all this meant for them. The problem was that no one seemed to know. Everyone had to do what they could, both to manage the situation, and to prevent further damage.
After discovering that he had high levels of PFAS in his blood, Afzelius tried to remove chemicals from everyday life. It was almost impossible. He got rid of outerwear that had been treated with PFAS to make them waterproof, and he threw away his microwave-safe popcorn and baking paper. But the list of PFAS sources was so long that it was hard to keep up. These chemicals are found in pots and pans and sunscreen, dental floss and carpet fibers, pizza boxes and walking boots. They have been found in meat, fish and eggs. We don’t just ingest them, we absorb them through our skin. After Afzelius renovated his kitchen, he learned that PFAS were present in the wallpaper.
What are PFAS?
The first PFASs were developed in the 1930s by German scientists and used to insulate electrical wires. Many more types of PFAS followed. Today, there may be more than 14,500 permanent chemicals, with new ones constantly being added to the list. PFAS do not degrade at high temperatures or when exposed to aggressive chemicals, making them useful in manufacturing. To make PFAS, scientists replace hydrogen atoms bonded to carbon with fluorine, which creates such a strong bond that the molecule does not interact with other substances, such as water or frying oil. Its strength means that almost nothing can break it down, either in the body or in the environment.
One thing Afzelius couldn’t part with was his Teflon pan: it was simply too comfortable. Teflon, which is a brand name for a chemical substance polytetrafluoroethylene (Ptfe), was one of the earliest forms of PFAS developed in the 1960s. A whitish powder discovered by chance by scientists at the US chemical company DuPont, it proved remarkably useful in a variety of household products. As well as Teflon pans, it helps light bulbs cope with extreme heat and allows the hot plates of straighteners to glide over hair. Like Teflon, the firefighting foam that leaked into Ronneby’s water system was developed in the 1960s. By the 2010s, after years of research, scientists had begun to identify links between some cancers and PFAS in firefighting foam and in the protective equipment worn by firefighters. There are, of course, other risk factors for firefighters, including vapors inhaled from fires, which complicate the research. What we do know, said Jeff Burgess, a toxicologist at the University of Arizona, is that exposure to certain chemicals is associated with increased cancer risk – such as PFOA, a type of PFAS, and testicular cancer.
As scientists gathered more evidence of the harmful health effects of PFAS, the list of sites where groundwater or soil had been contaminated by Afff foam continued to grow: Korsør in Denmark; El Paso County in the United States; Saint-Louis in France. In the UK, several military sites are now under investigation after PFAS from firefighting foam leaked into drinking water sources. Yet none of these sites are even close to Ronneby in terms of contamination levels. The PFAS levels found in Ronneby’s water were not just ‘high’ – they were the highest ever detected in municipal drinking water: 2 450 times above the safety threshold to be introduced in 2023. “The population was extremely exposed, even compared to other highly exposed population groups,” said Annelise Blomberg, an epidemiologist at Lund University.
In June 2014, Afzelius started a Facebook group, which quickly gained hundreds of members. People shared test results and posted links to studies. They managed to set up a meeting with city officials, representatives of the Swedish Armed Forces and researchers from Lund University. It was held at a school in Kallinge. So many people showed up that the crowd spilled out of the low brick building. “The crowd was like looking at pictures from the 18th century – people standing with flaming torches and pitchforks,” recalled one participant.
“will PFAS make us sick?”
At the meeting, the audience kept asking themselves: will PFAS make us sick? Can we get rid of it from our blood? Some people started shouting – a very unusual behavior in Sweden. Representatives from the municipality, who were on stage, asked people to “stay calm”, but without much effect. Afzelius thought some of the experts were patronizing. He remembered one of them saying: ‘I’m a chemist. Are you?” He had the feeling that the officials just wanted to move on. Afzelius and a number of other locals then decided to take matters into their own hands. The first meeting of what became the PFAS Association took place around Afzelius’ kitchen table. The six people gathered became the board. They wrote their ideas on Post-it notes and stuck them all over Afzelius’ kitchen cabinets. By the end of the meeting, after three or four hours, they had decided to take their case to court.
It was a big gamble. In West Virginia and Ohio, the affected residents who filed a class action lawsuit against DuPont secured a $670 million settlement. Nothing similar was possible in Ronneby. “Many countries, including Sweden, don’t have legislation equipped for this kind of lawsuit,” says Markus Segerström, a lawyer who represented dozens of people from Ronneby against the municipal water supplier. Instead, each person had to sue on their own, risking their own money. And they couldn’t sue for damages just because their water had contained chemicals forever. “Under current Swedish law, you usually need a diagnosed illness – which most people with elevated PFAS levels in their blood don’t have,” said Segerström. “Part of our argument is that the courts, through case law, should expand the scope of compensation to include PFAS exposure even without a formal diagnosis. Historically, compensation in Sweden has been limited to concrete damage or clearly documented financial losses – such as a doctor’s visit or a prescription. You have to prove specific costs.”
Sweden has a system where if you lose, you have to pay all your lawyers’ fees and those of your opponent. “It’s scary,” said Afzelius. “Here all the financial risk has been on us.” Because Ronneby is home to many low-income families, even the initial court fee, SEK 2 800 per person, was too much for some. In addition, many in Ronneby either worked for the armed forces or the municipality, or were subcontractors to one of them, so they were “afraid to speak out, for fear of losing their jobs or facing backlash,” Afzelius said.
Residents sue the municipality
The case started in July 2016 with 165 plaintiffs. The media, which had initially followed the municipality’s line on the relatively low risk to residents, now published articles on PFAS “poisoning”. “The case dragged on for months, and then years; it was a new area of law and a lot of evidence had to be gathered,” said Johan Öberg, the plaintiffs’ lawyer. As the years passed, the legal costs increased. In 2021, a family of four could find that their costs amounted to 240,000 SEK, which would only be recovered if they won. Several people abandoned legal action because they ran out of money. The stress was enormous. Afzelius felt personally responsible for the fate of his friends and neighbors. “I started this,” he said. “What would happen if we lost? We would still be poisoned for the rest of our lives, and then pay for it.”
To make matters worse, this was not a simple case of heroes versus villains: the people of Ronneby were effectively suing their own municipality, as the water company is wholly owned by Ronneby municipality. “It’s really, really emotionally difficult to fight against the people who are supposed to protect you,” said Afzelius.
On April 13, 2021, Afzelius and the remaining board members of the association gathered. When the result finally came from the district court at 14:00, they erupted with joy. The water company was found liable for causing injuries to the residents whose drinking water had been contaminated. “It was a moment of pure, shared victory,” said Afzelius. But their happiness was short-lived. The water company appealed, and on December 20, 2022, the ruling was overturned. The court said the plaintiffs had failed to show they had suffered direct harm due to PFAS. Anyone who fell ill would have to prove it was directly caused by PFAS – which, despite the studies that have shown links between PFAS and diseases including cancer, remains an impossible feat. “That’s what we struggle with as epidemiologists. It’s very difficult to prove causality,” said Christel Nielsen, an environmental health researcher at Lund University.
After the appeal, the plaintiffs had to pay the water company’s legal bills in addition to their own. “We lost our breath. We felt completely abandoned,” said Afzelius. Ten of the plaintiffs chose not to proceed – they couldn’t take the financial risk of continuing the lawsuit. Others were simply exhausted by the whole process: the waiting, the emotional uncertainty. The remaining plaintiffs decided to take the matter to the Supreme Court. They had to act quickly: they had only three weeks to prepare their case. At that point, the Swedish media gave the case a lot of attention, and people all over the world watched the story unfold. One of them was Robert Bilott, the lawyer, portrayed by Mark Ruffalo in Dark Waters, who had led the legal battle against DuPont in West Virginia and Ohio. “I’ve been closely following developments in the PFAS litigation in Sweden,” Bilott said, noting that he was particularly interested in seeing whether the Swedish court would recognize PFAS blood contamination as a compensable injury.
PFAS and diseases
The questions raised by the Ronneby case were not only legal, but also scientific. Nielsen became a researcher at Lund University in 2016, after the Ronneby scandal broke, and started working on the case immediately. She compares her research on the effects of PFASs to building a puzzle out of many scattered pieces and trying to figure out the big picture.
She and her research team face constant staff and funding shortages. Despite this, she and her team have managed to struggle enough to publish just over a dozen studies. They found that women in Ronneby whose water was contaminated had an increased risk of polycystic ovary syndrome – a chronic, incurable condition that can reduce fertility. They found an 18% increased risk of type 2 diabetes, 19% higher susceptibility to COVID-19 and higher risk of osteoporosis. As for cancer rates, the research needs to be updated. A 2022 study conducted on data up to 2016 showed “no overall excess risk” in the contaminated area for all types of cancer, but “modestly increased risk of kidney cancer”. Nielsen believes the results may differ now. “We know that the latency period for cancer is often more than 10, 15 years,” she said.
In the fall of 2021, Afzelius noticed a lump in his right arm. It was firm, about the size of half an egg. At first, he didn’t make much of it – he thought it was just a result of pushing himself too hard at the gym. But when the lump continued to grow, Afzelius went to see a doctor. After several biopsies, the lump turned out to be an inflammatory leiomyosarcoma, an extremely rare cancer – so rare that only a couple dozen cases have been reported in medical literature. That means the numbers are too small to reach statistical significance. Yet Afzelius is not the only person in town to have suffered from leiomyosarcoma. Royne Robertsson, who worked at the air base in the early 2000s cleaning firefighting equipment, underwent major surgery on her left leg in 2012 to treat a variant of the same rare cancer. Robertsson often thinks about the firefighting foam that clung to his leg as he cleaned. “Nobody said it was dangerous,” he said.
Among the original six board members of the PFAS Association, four have developed cancer since 2018, three of them under the age of 50: Afzelius, Karlsson and Tilholm. One, Thomas Lähdet, died of cancer in 2018. “Most of them got sick after 2013,” said Afzelius. “We are not even part of their statistics.”
Funding problems make it difficult for Nielsen and her colleagues to answer all the questions that Ronneby residents may have about their health. For now, she is focusing on one issue she finds particularly important, and which also worries Afzelius and Wikström: how PFASs are passed on from generation to generation, and what that legacy means for the future well-being of their children. At Lund University, there is a room lined with refrigerators full of plastic bags containing rigid, reddish disks. These are samples of placentas collected from women who gave birth in Ronneby between 2015 and 2020, over a study of how PFASs are passed from one generation to the next, and what effects these permanent chemicals can have on children. It’s not just placentas: the fridges also contain samples of umbilical cord blood and breast milk.
Many mothers in Ronneby shudder to think that they could pass PFAS to their children. “I think it’s a terrible burden to put on parents,” said Nielsen. For some, however, the latest findings have brought relief. Some mothers who felt guilty about bottle-feeding their babies and dissolving the formula in what turned out to be contaminated water could feel relieved by the new research findings. One study found that the breast milk of Ronneby mothers also contained PFAS. Whether the mothers had chosen to breastfeed or bottle-feed, the damage would have happened anyway.
Cancer, infertility, childhood developmental disorders, liver diseases, immune system disorders.
Studies by Nielsen and her colleagues show that children in Ronneby with high exposure to PFAS are at higher risk of developmental language disorders, “which is a useful indicator of other neurodevelopmental outcomes,” Nielsen said. Other research points to a higher risk of congenital malformations, liver disease and cancer. There also appear to be problems with children’s immune systems. Nielsen’s latest study also suggests that these children are more likely to suffer from certain types of infections, such as ear infections.
On December 5, 2023, the final judgment was delivered. The court ruled that simply having PFAS in the bloodstream constituted personal injury, regardless of whether you were ill or not. It was a precedent. “The Supreme Court had to create new case law,” said Segerström.
The world was watching. In the US, Harry Deitzler, a West Virginia attorney who worked with Bilott, was “thrilled” to hear that the association had won the case. In Italy, Laura Facciolo of Mamme No PFAS, a group of parents fighting chemical pollution in the Veneto region, was encouraged by the ruling. “I really hope that Italian judges will be inspired by this,” she said.
Yet the story was far from over for those in Ronneby. Shortly after the Supreme Court’s announcement, Afzelius met with his lawyers. “They said to me: Okay, now it starts,” he recalled. In Segerström’s office, the phones were ringing off the hook: people wanted to file new lawsuits against the municipal water company, this time hoping it would lead to something more concrete: a payout, a health care program. One hundred and fifty decided to sue. “It could take years before they get a solution,” said Segerström.
“There is no testing before chemicals are put on the market. We are basically chasing these new substances years after they have been put on the market to understand what health effects they have already had”
Legislation on PFAS is also tightening. In the EU, PFAS and PFOA have been banned in everyday products since 2020, while the US banned PFOA in household products in 2014. PFAS-based Afff firefighting foams were banned in 2019. But this does not mean that there are no longer any PFAS in firefighting foams, or that consumer products are now safe. Scientists warn that older forms of permanent chemicals are simply being replaced by other compounds that may be equally toxic but are currently less well understood. For Nielsen, it feels like trying to slow down a runaway train. Studying the effects of pollutants is a race against the clock. “There is no testing before chemicals are put on the market. We’re basically chasing these new substances years after they’ve been put on the market to understand what health effects they’ve already had,” she said. Jana Weiss, an environmental chemist at Stockholm University adds: “To further complicate matters, we are still discovering new PFAS in human blood that science did not even know existed. Given the huge number of PFAS put on the market, we can assume that we are only catching a fraction of what is actually there.”
“And no one took responsibility,” said Afzelius, shaking his head. “No one.”
Some people in Ronneby are exhausted of hearing about PFAS and just want it all to be over. “It’s like if we don’t talk about it, it doesn’t exist,” said Afzelius. He’s tired, but he’s determined to keep going. He wants the world to know about the dangers of PFAS, so that another Ronneby case does not happen again. Above all, however, he is fighting for the children, he says. With the doses of PFAS the children have received through the municipal water, they will be middle-aged before their PFAS levels drop to those of an average Swede. “And no one took responsibility,” Afzelius said, shaking his head. “No one.”
By Anna Böhlmark
TIP: It cannot be excluded that other municipalities’ drinking water does not contain PFAS or traces of PFAS. Avoid ingesting PFAS or pharmaceutical residues that may be present in municipal drinking water by using a water filter on your tap. The Aronia store Instapure filter is effective on PFAS. You can find it here.
