Deadly silicosis: As model Gujarat sits idle, West Bengal offers comprehensive relief

By Jagdish Patel* 

Deaths resulting from deadly occupational disease silicosis are known to have been first highlighted at the National Human Rights Commission (NHRC) level way back in 2008, when members of the health rights group Jan Swasthya Abhiyan (JSA) from Madhya Pradesh raised the issue at an NHRC review meeting in Delhi. It took almost four years  for NHRC to recognise the deadly nature of the disease and how it was being ignored by state governments.

Tribals from Jhabua and Alirajpur districts of Madhya Pradesh were migrating to Gujarat to work in quartz crushing units in Godhra, where they would get exposed to fine silica dust to contract silicosis and die at an early age. NHRC took it seriously. Another three years later, in 2011 NHRC came up with a report “Recommendations on Preventive, Remedial, Rehabilitative and Compensation Aspects of Silicosis.” This was done in consultation with state governments. NHRC suggested to carry out a survey in different states on the status of silicosis and file report.

In the NHRC report recommended that the cost of treatment the patients should be borne by the employer, and the administration should ensure that. It also recommended that victims may be offered alternative jobs, NGOs should be involved in the monitoring of implementation of the programmes related with rehabilitation of silicosis victims, and counselling should be offered by  state governments.

NHRC presented a special report to Parliament in 2012 in which it noted, "Based on the information gathered, it was a revelation that there are umpteen number of cases in the country, and that, too, of poor Iabourers working in the unorganized sector, who have been worst affected by silicosis. A number of them Iost their Iives following their protracted illness.”

However, the path for having a proper silicosis policy continued to be bumpy policy. While NHRC recommended payment of  Rs 3 lakh compensation to the victims' families in a complaint filed by Juwansing from Madhya Pradesh,  in a complaint filed by a silicosis victim in Rajasthan, it only recommended to pay compensation without naming the amount. 

In 2019 the Rajasthan government came up with a silicosis policy. Under this policy silicosis diagnosis is to be done in each district and those who have been diagnosed are paid a stipulated amount as well as monthly pension. Death compensation was also announced. Later, the Haryana government also declared a silicosis policy.

Acting on a complaint (No 351/6/3/2010), NHRC asked all state governments to come up with a proper rehabilitation policy on the lines of Haryana and Rajasthan for silicosis victims. Ironically, despite calling itself a model state, Gujarat is one state which has not come up with any such policy.  This state of affairs continues despite the fact that the People's Training and Research Centre (PTRC), Vadodara, which had been raising silicosis victims' plight for several decades, has insisted upon the state officials to come up with a viable policy.

In lieu of a policy, all we have is a state government resolution passed in 2015 to pay just Rs 1 lakh to the silicosis victim's family. Initially it was available only to the unorganized sector agate workers of Khambhat, which was later extended to any worker anywhere in Gujarat. The victims who were named in PTRC complaints to NHRC were paid Rs 4 lakh -- on the basis of recommendation by NHRC. 

At present we have two systems in Gujarat: those who apply for the assistance under the state resolution are paid Rs 1 lakh, and those who are named in NHRC complaint are paid the amount as recommended by NHRC (Rs 4 lakh). This is highly discriminatory policy. As per the information given in the official Gujarat government website,  an assistance to 12 beneficiaries was paid in 2019-20, to five others in 2020-21 and another 10 in 2021-22.

Meanwhile, even as Gujarat refuses to act the Health and Family Welfare department, Government of West Bengal, has declared a comprehensive policy for relief, rehabilitation and treatment of silicosis victims on February 25, 2022 is a welcome step by the State government to give justice to the silicosis victims who were not paid an attention so far.
The policy offers Rs 2 lakh to the silicosis victim on diagnosis of the disease and Rs 2 lakh more on the death of the identified silicosis patient. Moreover, it also offers up to Rs 4,000 per month, depending up on the category A, B or C as per the International Labour Organization (ILO) classification to the patient so that one can look after the treatment expenses as well as cover livelihood expenses. Rs 2,000 is offered for performing last rites of the silicosis patients.
After the patient dies family pension of Rs 3,500 will be available to the widow till her life. It also offers Rs 4,000 to Rs 10,000 for the education of the children of the silicosis patients and up to Rs 25,000 for the education and skill development up to two unmarried daughters. It also offers up to Rs 25,000 assistance for marriage of daughter till two daughters.
There is no bar for claiming compensation under  the Employees State Insurance (ESI) Act or the Employees Compensation Act. The good part is, non-worker, if diagnosed with silicosis is also eligible to claim the benefit under this policy.
For diagnosis of silicosis it depends up on X-ray only may be termed as practical but not very progressive. More and more medical professionals depend up on CT scan. Specifically for small opacities, X-ray is not very useful. We do not have any data on Indian condition on proportion of small opacities among newly diagnosed cases of silicosis.
In Indian public health care system availability of good quality of X-ray machines, trained X-ray technicians and radiologist cannot be assured; talking of CT scan would be unachievable goal.
Under the policy, the concerned district magistrate shall constitute a Silicosis Diagnosis Board in each affected district. However, it is not clear who will decide on “affected district” and what will be the criterion to declare a district to be silicosis affected.
Ideally, one known case of silicosis should be sufficient to declare the district to be silicosis affected. The Board will consist of one chest specialist or representative of the Chief Medical Officer of Health (CMOH), one radiologist representative of CMOH, one medical officer of the Directorate of Factories and one concerned joint labour commissioner. Presence of joint commissioner in medical board will complicate matters. In purely medical matters, a non-medico has no role to play.
Similarly, the diagnosis board also does not require occupational health physician or medical graduate with Associate Fellow of Industrial Health (AFIH) or expertise and experience in diagnosis of occupational diseases Or Chest and TB experts.
In India we have not developed B reader expertise for radiologists to read pneumoconiosis X-rays. Nowhere the policy talks of comparing the X-rays with the standard ILO X-ray plates, is again a welcome move. As I have understood these standard X-ray plates are useful for epidemiological studies and not useful for diagnosis of individual patient.

The department has set up a monitoring committee of 6 members for reviewing implementation of the policy. The members are drawn from the Pollution Control Board, Labour Commissioner, Director of Factories and two NGO representatives, apart from the Department of Health and Family Welfare. Now, who 2 NGOs will be is not spoken.
It is the usual experience that the NGOs which are established and operated by a leader of ruling party is given place in such committees but the NGOs working on the subject but critical of the government do not find any place in such committees.
Responsibility of all the functions pertaining to implementation of welfare measures and execution of the policy is assigned to the Labour Department and not the Social Welfare Department. Records will be maintained by the Directorate of Factories.

Preliminary investigation into suspected cases will be done by the Directorate of Factories. They will also develop and impart training course for health workers. Why ministry of health is not assigned this responsibility is a question.
The West Bengal Pollution Control Board will plan programme for control of environmental pollution and not workplace environment. Matter of concern though is, there is no mention of dust levels required to be maintained at workplace to prevent silicosis and monitoring the levels at periodic interval. After Bhopal the ILO helped the State Labour departments set it up.
The State government has created a corpus find of Rs 10 crore for this scheme. This fund will be utilized for workers who are certified having silicosis by the Silicosis Diagnosis Board. Interestingly this find will be used for Construction workers also for whom there is a separate fund available.
The Construction Workers Welfare Board has a scheme to compensate Silicosis patients from that fund. The policy makes it clear that the The Construction Workers Welfare Board do not need to contribute to this Silicosis prevention and control fund but the silicosis affected construction workers shall also avail the benefits provided in this policy. There is no bar on double benefits.
Benefits will be available to any worker working in the factories, establishment, construction site and certified by the Board. It means that the workers may be domicile of W. Bengal or not shall be able to claim the benefits.

 It has come to our notice that workers from Bangladesh illegally migrate to India. Many of them find work in quarries in West Bengal where they get exposed to silica and get silicosis. Once sick, they return to their native where they get diagnosed and later die in penury. Will they be able to claim benefits, I wonder.
The policy provides for conducting preliminary investigation by the Medical Officer of the Directorate of Factories and not any expert from Health department. Workers from manufacturing, construction or service sector may get exposed to silica where Factory Act is not applicable.
Why then the responsibility of investigation should fall on the shoulders of only a Medical Officer of the Directorate of Factories? How many posts of Medical Officers have been sanctioned and how many of them are vacant in the Directorate of Factories? It is a common experience that Directorate of Factories do not have adequate numbers of medical officers appointed.
The policy further provides that the medical officer shall prepare report with recommendations to place before the Diagnosis Board! Why a worker cannot walk oneself to get screened before the Board? It is good to note that the expenditure for investigation etc. shall be taken care of by the Board.
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Director, People’s Training and Research Centre, Vadodara