CASAL DI PRINCIPE, Italy >> The Italian state arrived in the heartland of the Camorra mafia this month bearing a backhoe. Police officers in polished black boots posed for television cameras as the backhoe clawed into an overgrown field, searching for barrels of toxic waste or some other illegal industrial sarcophagus.

Two jailed mafia informants had identified the field as one of the secret sites where the Camorra had buried toxic waste, near a region north of Naples known as the Triangle of Death because of the emergence of clusters of cancer cases. One environmental group estimates that 10 million tons of toxic garbage has been illegally buried here since the early 1990s, earning billions of dollars for the mafia even as toxins leached into the soil and the water table.

While the dumping has been widely documented, the trash crisis has only worsened, as the parallel problem of the illegal burning of toxic waste has brought the region another nickname, the Land of Fires. With new revelations fueling public outrage, the question is whether the Italian government will confront the Camorra and clean up the mess — and whether the mess can be cleaned up at all.

“The environment here is poisoned,” said Dr. Alfredo Mazza, a cardiologist who documented an alarming rise in local cancer cases in a 2004 study published in the British medical journal The Lancet. “It’s impossible to clean it all up. The area is too vast.”

He added, “We’re living on top of a bomb.”

Garbage is a perennial problem in Italy as landfills run out of space, setting off periodic crises in cities like Rome and Naples. But the land of the Camorra, stretching from the Tyrrhenian Sea to the Apennine foothills, is a particularly vivid tableau of ruined beauty.

Garbage is strewn along highways, tossed beneath overpasses or dumped atop irrigation canals. Rats search for food amid discarded sheets of asbestos, broken computer screens and empty paint cans. Plumes of black smoke often rise, the entrails of trash illegally burned from distant hillsides or abandoned fields.

The landscape is a result of decades of secret dealings between manufacturers in Italy and beyond, who sought to avoid the high costs of legally disposing of hazardous waste, and the Camorra, one of Italy’s three main mafia organizations, which saw the potential to make huge profits by disposing of it illegally.

By burying the waste in its backyard near Naples and the surrounding region of Campania, where the Camorra was born, the mob ensured a measure of protection, and silence. Bosses often exert a powerful influence over the local economy and politicians, especially in small towns like Casal di Principe.

“The mafia has made money on the garbage,” said Ciro Tufano, 44, an accountant who has spent two decades pushing officials to clean up a toxic site near his home. “Politicians must have been aware, but they don’t care. Nobody was tracking this trail of garbage.”

The public has awakened in recent months, though, after a string of disclosures and protests that brought thousands of people onto the streets of Naples in November.

Some revelations came from the declassified 1997 testimony of Carmine Schiavone, a former treasurer for the Casalesi clan, one of the most powerful Camorra factions. Speaking in secret to an investigative parliamentary committee, Schiavone had described nighttime operations in which mobsters wearing police uniforms supervised the burial of toxic garbage from as far away as Germany.

“We are talking about millions of tons,” Schiavone warned in his testimony 17 years ago, portraying an environmental disaster.

Then, the Italian newsmagazine l’Espresso published a cover story titled “Drink Naples and Then Die.” The article detailed a public health survey conducted in 2008 by the U.S. Navy, which has a base in Naples. The Navy study, which had not been publicized in Italy, found serious water contamination. It described “unacceptable risks” in some areas and recommended that all Americans stationed in the region use bottled water for drinking, food preparation and brushing teeth.

Last month, Prime Minister Enrico Letta approved a decree to increase prison sentences for illegally dumping or burning waste. This month, the government announced that a contingent of Italian soldiers would conduct anti-dumping patrols in the region.

“This is a response to an emergency situation,” said Gen. Sergio Costa, commander of the Naples region for Italy’s environmental police. “Politicians now have to respond, because people are now marching on the streets.”

The digging operation with the backhoe this month was supposed to demonstrate the government’s newfound resolve. The location was just outside the usual parameters of the “Triangle of Death” dumping zone, but in a city synonymous with the Casalesi clan. Journalists were invited amid expectations that the backhoe would unearth canisters of hazardous waste. In 2008, a chemical truck had been discovered beneath a field a few miles away.

But what emerged after hours were dirt and skepticism. Officials said later that digging would continue for weeks and that quantities of asbestos and mud tainted by industrial waste had already been recovered. The owner of the land, Stanislao Di Bello, a lawyer who bought the plot in 1990 as an investment, watched the work from behind tinted glasses, unimpressed. He said the authorities had also excavated the land in the early 1990s but found nothing.

“Now, after 16 years, the movie repeats itself,” he said.

The biggest question is whether the buried toxins could cause a public health crisis. More than 500,000 people live in the region, and the Lancet study and other reports have documented cancer rates far above the national average. While no study has sought to prove a direct link, a World Health Organization report conducted with national and local health institutions documented clusters of liver, kidney, pancreatic and other cancers in areas known as dump sites.

In the nearby town of Marigliano, the Rev. Giannino Pasquale has watched cancer spread swiftly among his parishioners. He opened the green ledger that serves as the parish death registry and counted for last year: 27 deaths, 10 from cancer. One of the parish’s most dedicated volunteers died of pancreatic cancer in 2012, three years after his wife had also died of cancer.

“My sense is that there is an agreement between the political parties and the Camorra,” Pasquale said. “Just look around. Tires and asbestos are tossed on the sides of the roads. Why is it not possible to control this area?”

Luigi Sodano, 57, a member of the parish, has lost more than 60 pounds during his battle with pancreatic cancer. His mother has bladder cancer, his nephew has testicular cancer and his nephew’s wife has breast cancer. He is so listless from radiation treatment that he rarely leaves his apartment.

“I’m his angel because I’m always with him,” said his wife, Angela Dioguardi, 53.

Costa, the environmental police commander, said the Camorra had stopped burying waste a few years ago and was now illegally shipping it to Eastern Europe or the Balkans. The acreage where waste is buried is relatively small, he said, but the risks are significantly higher because the dump sites are spread across such a large area.

“It flows all over the place,” he said. “You can be a farmer who is unwittingly irrigating your land with polluted water.”

Local farmers complain that prices are falling because wholesalers are leery of buying their produce. Concerns have also been raised about the region’s famed mozzarella cheese, although Costa said that production was tightly controlled and that no cases of contamination had occurred.

He recalled the early days of the garbage crisis, when he overheard a wiretapped conversation between a Camorra boss and another mobster.

“We’re polluting our own house and our own land,” the mobster said. “What are we going to drink?”

“You idiot,” the boss replied. “We’ll drink mineral water.”