THE SILICOSIS STRUGGLE MARCHES ON

               
                For more than seven years now, a resolute struggle has been going on in Delhi led by People’s Rights and Social Research (PRASAR) against silicosis, an incurable occupational disease. In a scenario where national and international health investment is dictated by what diseases the international donors are willing to put their money in, the struggle has succeeded in bringing to the fore a serious health concern which has so far been neglected. It has highlighted the crucial issues of labour standards, occupational safety and human rights in the mining and quarrying industry. It is has also managed to engage various arms of the State - from various ministries to the National Human Rights Commission and the Supreme Court - to recognise and deal with the issue. More important perhaps, it has been successful in exposing the policies of the State and politics of its inaction. It has succeeded in establishing that the onus of the diagnosis, treatment and rehabilitation of victims lies on the State and the companies. This article continues the saga of this struggle earlier reported in Revolutionary Democracy Volume XII, No. 1, April 2006.

                Tucked away in a dusty corner of the country’s capital, beyond all the pomp and splendour of the city, Lal Kuan is home to several hundreds of people whose lives are ridden by disease and despair. Lal Kuan had been at the centre of mining and quarrying activity since independence. It was one of the four places in the Capital famous for the production and supply of stone chips used for the infrastructure development of Delhi. Today it is the home of former mine workers and stone crushers ailing from silicosis. At least 3,000 villagers have died in the last 13 years from silicosis, tuberculosis and other respiratory ailments in the area. It is also home to a resolute struggle for the recognition of one of the oldest occupational diseases-silicosis, for exposing the politics behind the neglect and for affixing the responsibility of the Government and companies in dealing with it.
                Once, about 300 stone crushers operated in the area employing about 4000 migrant manual labourers. When the crushers were started the required manual labour was not available in the area. Initially some manual labour was brought from the rural areas of Rajasthan, Uttar Pradesh, Bihar and Madhya Pradesh. Soon after as the word spread about the employment opportunities more and more labour started coming on its own. Most of the labourers belonged to the Scheduled castes, Scheduled tribes or other backward classes and did not have either much education or vocational skills. They worked as casual labourers in crushers and quarry and uncertainty of work and low wages meant that they were often not in a position to pay for the basic facilities such as housing, drinking water, electricity and education for their children.
                However, all the crushing and mining operations came to a halt in 1992 when the Supreme Court, in response to the Public Interest Legislation filed by lawyer Mr. M.C. Mehta, ordered the closure of all mechanical stone crushers established/operating in the Delhi area and quarry workers and miners be shifted to Pali in Haryana. While this judgement contributed to reducing pollution levels in Delhi and enabled the building contractors to buy the land in cheaper prices, its ambiguous position on the issue of occupational health hazards rendered the lives of the poor workers, most of whom were either left jobless or forced to shift to other places were mining continued, more vulnerable.
                As early as 1988, a study done by AIIMS doctors had revealed that at least 6 persons were suffering in Lal Kuan from Silicosis. But the no steps were taken, not even an enquiry was conducted, in this regard.
                The misery in Lal Kuan came to light after an inquiry by PRASAR in 2001 revealed that several persons from the village who were involved in mining, quarrying and crushing activities had died prematurely and that there was no accountability of any sort on the part of the government or the employing agency. PRASAR’s journey began in 1999 when a few young activists visited Lal Kuan to work in the field of education amongst the people staying there. They found that people died because of tuberculosis very often in the area. An obvious question came to their mind, why are people dying of TB and so often? Why was there an unprecedented occurrence of death and ill health among the residents of the area? They started inquiring into the root cause of the fatal problem. What they found out was astounding. Those who had died earlier due to tuberculosis were all working in stone crushing units near Lal Kuan. 
                In 2001, PRASAR conducted a study and surveyed 146 people and it was found that at least 83 persons were suffering from silicosis and other respiratory diseases like TB and silico-tuberculosis. Their interactions with 55 people who had lost their family members also revealed that the deceased also suffered from symptoms that indicated that they too had succumbed to silicosis.
                Despite a halt in mining and stone crushing operations, the silicosis victims in Lal Kuan area continued to be neglected and wrongly diagnosed. Many silicosis victims died due to improper treatment and unavailability of medicines. Most of the patients suffering from respiratory problems are prescribed medicines for tuberculosis by the  government dispensary. According to S.A. Azad of PRASAR, ‘If patients do not improve after three to four courses of tuberculosis medicines, it meant that the affliction was something else. Silicosis is common in Lal Kaun, but no one acknowledged this as it would imply compensation.’
                Silicosis, one of the oldest occupational diseases, is an incurable lung disease caused by the inhalation of dust containing free crystalline silica. Silica is the second most common mineral in the earth’s crust and is a major component of sand, rock, and mineral ores. Overexposure to dust that contains microscopic particles of crystalline silica can cause scar tissue to form in the lungs, which reduces the lungs’ ability to extract oxygen from the air we breathe. It is a disabling, irreversible and sometimes fatal lung disease. It progresses even when exposure stops. In addition to silicosis, inhalation of crystalline silica particles has been associated with other diseases, such as bronchitis and tuberculosis. 
                Lakhs of workers in India, the majority of who are in the unorganised sector, encounter high-risk silica exposures. Some examples of the industries and activities that pose the greatest potential risk for worker exposure include: construction, stone cutting, glass manufacturing, mining, agriculture, shipbuilding, ceramics, clay, and pottery, railroad, the manufacturing of soaps and detergents etc. 
                Though there is no cure for the disease, it is 100 per cent preventable if employers, workers, and health professionals work together to reduce exposure. The process of the control of silicosis consists of dust control measures and medical measures. The preventive measures that the employers may adopt include the application of appropriate technology, which will avoid the formation of silica containing dust, or use of other engineering methods, which will control the dust. Silicosis can also be contained by compliance with prescribed exposure limits and technical standards. Also of importance is the medical surveillance of worker’s health to detect early development of silicosis. The use of personal protective equipment is another manner of protection though of a temporary nature.
                However, the fact remains that despite the seriousness of the disease, the Government has failed to give any attention to it. No studies have been undertaken yet to assess the prevalence of silicosis in the country. There is a complete lack of awareness of the disease among the workers who are never warned of the effects of working in the quarries, mines, etc which would affect them by silicosis. The lack of awareness about the disease is also glaring among the doctors and health authorities. In Lal Kuan for instance for several years silicosis victims continued to be improperly diagnosed and prescribed medicines for tuberculosis and other respiratory problems. This when coupled with the neglect and casual attitude of the health authorities spells death for the workers.
                The mining or quarrying activities are undertaken under leases, which are of the duration of 3-4 years and hence the primary employers often choose to save themselves the financial burden of installing any mechanism or machinery for the safety of the workers by recruiting labour through contractors. In almost all cases, employers under-report the number of employees so as to escape any sort of liability under labour laws. Employed through a chain of contractors and sub-contractors, most of the workers are unaware even of who their real employer, let alone their rights. This chain of inaction and neglect is completed by the total lack of monitoring or inspection of working conditions or equipment by the Labour and Health departments.
                Through a complaint in 2003 and rigorous campaigning, PRASAR successfully engaged the National Human Rights Commission in favour of setting up a national task force on silicosis besides deliberating on issues whether existing laws are adequate enough to address the issue of silicosis or a separate legislation to be framed to deal with the issue and to make recommendations on the issue to the Central/ State Government as the case may be. The NHRC had also directed that a copy of the complaint be sent to the Union Health Minister, Labour Minster, Labour Commissioner, Delhi government and the Director, Pollution Control Department etc. These agencies were asked to look into the allegations contained and to submit their comment and an action taken report within four weeks of receipt of the NHRC letter. None of the departments mentioned above have responded yet. In March 2007 the Commission noted that though government policies and provisions were in place concerning silicosis, there is a need to work on the seriousness of these. It also noted that the real problem arises in the unorganised sector where even minimum basic precautions are not taken. The Commission directed that States identified with high number of cases of silicosis be monitored - to identify and map pockets with incidence of silicosis. It also directed States issue notices under Section 85 of the Factories Act so that enterprises employing less than 10 labourers also come under the purview of the Act.
                After 7 years of struggle, a major break-through came in October 24, 2005 when the Chief Minister of Delhi, Ms. Sheila Dixit convened a meeting in Delhi Secretariat to discuss the prevalence of silicosis in the Lal Kuan area. The meeting was attended by the Health Minister of the Government of Delhi, Food Minister, Principal Secretary (Health and Family Welfare), Secretary cum Director Social Welfare, Divisional Commissioner and Director Health Services (DHS). Mr. Satish Sinha of Toxics Link and Mr. Azad of PRASAR along with some people of Lal Kuan were also present in the meeting. After talking to all the concerned persons and the victims, the Chief Minister has agreed to the following long-term demands of the people of the area:

*      A multi purpose community centre for the treatment of occupational diseases to be set up at Tejpur near Lal Kuan and a mobile medical van with one doctor, one attendant and one nurse will visit the area four days a week for the treatment of silicosis and other occupational diseases and will distribute free medicines; 
*      A team constituted to immediately conduct the survey of the affected persons in Lal Kuan area and submit their report for further actions to be taken;
*      The Social Welfare Department and Divisional Commissioner’s office have been asked to coordinate a joint intervention for physical survey of the affected people and bring them into the Antyodaya scheme which will include granting of pensions for the silicosis victims;
*      The Social Welfare Department and the Health Department will also assist the affected people to improve their skills for alternative livelihood opportunities for the people of Lal Kuan.

                It was decided in the meeting that PRASAR would facilitate the implementation of these developmental activities in the area.
                Following this, the Delhi Government has set up a dedicated hospital for occupational diseases in Tejpur near Lal Kuan. A health survey has also been conducted in Lal Kuan by a team constituted by the Government through the Centre for Occupational and Environmental Health, Maulana Azad Medical College, Delhi. The Team confirmed that 44 out of the 111 persons investigated suffered from silicosis or silico-tuberculosis. Another 33 persons were found to suffer from tuberculosis. The majority of those who were investigated had a history of working in stone crushers. The Government has also agreed to explore the feasibility of compensation to silicosis victims under the Workmen’s Compensation Act or other Act/Rules and has directed individual workers suffering from silicosis to file claims for compensation before the Labour Commissioner.
                PRASAR has also been able to intensify its struggle for the silicosis victims and the other affected communities of the mining industries by filing a PIL in the Supreme Court of India. On 27 March, 2006 the Supreme Court issued an order to the Ministry of Labour, Health, and Company and Law and State governments for formulation of a Central Committee to formulate guidelines for the prevention of dust exposure in stone quarries and crushers all over the country.
                Though the Central Government has not filed its response in the Supreme Court, the Ministry of Labour along with the NHRC through the Director General, Factory Advice Service and Labour Institutes, Mumbai (DGFASLI) have initiated a national programme to ascertain the extent of the problem of silicosis in Indian industries, and to scientifically assess its prevalence in the country, the existing control and preventive mechanism etc. A national workshop to develop strategies in this regard was called in early December 2007 in Mumbai.
                Despite all these overtures, considering that the silicosis high-risk industries are largely in the unorganised sector, it remains to be seen how serious the Government is about ensuring that employers adhere to strict guidelines regarding engineering methods for dust control and how compensation will reach the workers, currently employed or retired.
                As struggles around the issue of silicosis continue and remain to be waged in several parts of the country, there are several lessons that the success and strategies of this ongoing struggle in Lal Kuan hold for them.
                Firstly, the struggle has worked not only towards awareness and diagnosis of the deadly occupational disease silicosis among workers. But more important perhaps, it has exposed the policies of the State and the politics of its inaction. It has succeeded in establishing that the onus of diagnosis, treatment and rehabilitation of victims lies on the State and the companies. It is also unique in the way it has managed to engage various arms of the State - from various ministries to the NHRC and the Supreme Court- to recognise and deal with the issue.
                Secondly, the Lal Kuan struggle has highlighted the crucial issues of labour standards, occupational safety and human rights in the mining and quarrying industry. Mining and quarrying in India are not new sectors of economic activity though they have attained a larger share, particularly since India became a part of the ‘open market’ and ‘liberalisation’ regime under GATT and later WTO in the last decade of the  20th Century. A lot of questions have been rightly raised time and again on the issue of impact on natural resources and environment and compliance with environmental laws. However, one fall-out of mining still remains inadequately discussed and addressed - that of occupational conditions and labour standards.
                The massive investments that the sector has seen in the past few years have not been reflected at all in the way the activity itself is done. There have been very few technological innovations. Most of the labour in the sector belongs to the unorganised sector and continues to be employed on a contract basis without any security of tenure or any other labour rights. From accidents to owning up the occupation diseases related to the mining, the sector has shown utter disrespect to human life and dignity. Tuberculosis to silicosis and varied forms of cancer, the mining sector’s contribution to the labour force has been thankless to say the least. On the one hand the mining companies escape unhurt from ownership of occupational accidents and diseases, while on the other even the state disowns such victims and takes the side of the ‘investors’. 
                Thirdly, the Lal Kuan struggle has also exposed the politics of health investment in the country. In a scenario where international charity donors are happy to invest quoting ‘malnutrition, poor living conditions’ etc. and where HIV, AIDS and other such diseases are considered gold mines, it is of little wonder that the State or the companies (whose CSR runs many hospitals and health projects of even NGOs), choose to completely neglect research on diseases like silicosis. Diseases which are complex because they not only involve issues of labour standards, occupational hazards and hence taking the influential mining lobby head-on, but also because they largely affect people who cannot afford to pay for the treatment they need.

S.A. Azad, PRASAR. Email: prasar21@gmail.com
Update Collective No. 2, 2007.