Sharafat Azad

Sharafat Azad is addressing the gaping hole in occupational health hazard prevention, treatment and rehabilitation in India. With the majority of India’s work force in the informal sector, most laborers work in dangerous health conditions for little pay and without access to insurance or treatment for their occupation-related diseases. Focusing first on dust-induced silicosis, Sharafat is setting up clinics for suffering laborers, institutionalizing training for doctors to recognize and treat the occupational disease, and lobbying the government for recognition and care for silicosis sufferers. Driven to his work by the suffering he saw first in the stone-crushing units of Lal Quan in Delhi, Azad has since dedicated himself to organizing the prevention and treatment of occupation-related diseases in India.

Azad is developing a system of support and care for occupation-related diseases across India. Beginning with dust induced silicosis, Azad has designed a pilot model of treatment and rehabilitation that he plans to adapt to other occupational diseases. From getting silicosis recognized by the government as an occupational health hazard (one of only twenty-nine diseases so far to be so recognized as such), to helping health care institutions diagnose and treat the disease, Azad is ensuring that all of the existing machinery works effectively to resolve the burgeoning crisis of occupational health in the growing industrial labor market of India. Through his extensive research and application of existing data, Azad is helping the government, business and civil society to recognize the scale and implications of silicosis-related diseases in the mining and road-building industries. From his initial work with victims of silicosis in the Lal Quan stone crushing units of Delhi, Azad has created a model to help address the work-related hazards attached to this occupation across the country. He has founded a clinic for occupational disease in Lal Quan, and a training center for occupational health in Delhi that trains doctors to diagnose and treat silicosis patients. Azad is currently working with three state governments to help replicate his Lal Quan rehabilitation model. Combining efforts to inform and pressure the government with an effort targeted at doctors, workers, and employers, Azad is opening a whole new space in India for the field of informal worker protection and care.

A startling 92 percent of India’s workforce of 457 million works is in the unorganised (or informal) sector and contributes 60 percent of the country’s gross domestic product. The last survey by the National Sample Survey Organization and the National Commission on Enterprises in the Unorganized Sector estimates that 98.5 percent of workers in the unorganized sector do not have any social security coverage. A large proportion of current health problems in India are occupational in origin, yet receive low priority since their victims are not recognized as employed persons by the formal system.

Silicosis is a widespread illness. About three million mineworkers and seven million construction industry workers are exposed annually to different kinds of dust, one of which is free silica, a highly dangerous carcinogen. Thousands of Indian quarry workers die a slow death from silicosis without any compensation from their employers, as they are unable to prove the link between their illnesses and the conditions of their work. Most of them had never ever heard of silicosis, yet every third person among them is diagnosed with tuberculosis, and the average life span for these workers is forty years.

Many of the symptoms of silicosis are similar to those of tuberculosis (TB). In fact, TB is often a direct result of silicosis; however, silicosis is often misdiagnosed as simply TB, which carries no compensatory liability. Some state governments have passed legislation to tackle silicosis as an occupational disease; but while such laws may be applicable to workers in the organized sector, compensation for informal workers is exceptionally rare. As a result, the vast majority of workers and their families receive no support for work-related illnesses. Additionally, in stark contrast to the Employee State Insurance Scheme where the formal workers’ medical expenses are subsidized by both the employer and the government, the informal worker goes unattended.

The cost of death, injuries and disease at work in India can be conservatively estimated at more than US$12 billion annually (the most recent and available government figures date back to 1990). The lack of recognition and understanding of occupational diseases is a key element of the deficiency of support infrastructure and expertise needed to deal with issues of occupational disease.

Azad’s vision is to create a uniform relief and rehabilitation framework across the country with specific relief measures tailored to suit specific diseases. Through multiple interventions for relief, rehabilitation and prevention of silicosis, Azad is laying the foundations for the field of occupational health prevention and care. His first step was to work at the community level to create the local solutions for victims of occupational disease.

Azad began to work with the Centre for Environmental and Occupational Health and medical professionals to establish the link between stone crushing and silicosis, and address the chronic misdiagnoses that were denying people their rights to compensation for work-related injuries. Azad then filed a Public Interest Litigation at the Delhi High Court seeking to issue legal guidelines for the prevention and treatment of silicosis and other incidental diseases, and for the rehabilitation, compensation, and alternative employment of victims and their families. Azad won the case, a landmark victory, which resulted in silicosis being recognized as an occupational disease by Employment State Insurance hospitals.

The win in the Delhi High Court encouraged Azad to petition the Supreme Court for a national level policy change across the country’s stone-crushing and quarry units to implement health and safety standards. The apex court has directed all twenty-nine Indian states to furnish relevant data on incidences of occupational diseases and workplace compensatory and safety norms. Moreover, Azad intends to capitalize on the new global economic scenario to build up a market for good behavior and best practices and introduce international standards and norms.

To carry forward this work Azad has mobilized other groups such as Toxics Link led by Ashoka Fellow Ravi Agarwal, the Delhi Forum, the Center for Education and Communication, and the Human Rights Law Network, spearheaded by Ashoka Fellow Colin Gonsalves, to form the Khaan Mazdoor Adhikar Manch (Informal Labor Rights Platform). One of the group’s first actions was to petition the National Human Rights Commission and demand compensation from the labor ministry for those affected by silicosis. Good media exposure resulted in a high-level meeting convened by the Chief Minister of Delhi, attended by the Health Minister, Food Minister, Principal Secretary (Health and Family Welfare), Director Social Welfare, and Director Health Services along with members of PRASAR and the media.

The Lal Quan model thus came into being with the government deciding, per Azad’s recommendations, to build a multipurpose hospital for the treatment of occupational diseases in the area. In addition, the state agreed to form a medical team of occupational health experts to conduct a clinical survey of the community, while the Social Welfare Department coordinates a physical survey of the affected people and the Social Welfare Department and the Health Department assist in creating alternative livelihood opportunities for citizens of Lal Quan. Such commitments represent a major step for India’s government that Azad looks to replicate across India.

The court’s stance has also ensured that the various government agencies comply with may of Azad’s recommended strategies. Mobile medical vans now visit the area four days a week, distributing free medicines for silicosis and other respiratory and occupational diseases. The hospital with the X-ray facility needed for the detection of silicosis is nearly complete, as is the medical survey to be submitted to the Delhi government. The Social Welfare Department is also providing subsidized food and pensions to the victims in the area.

Azad has organized volunteers to take on the responsibility to monitor the implementation of these government programs to make sure that all legislation and advocacy results in significant, measurable results for the people suffering from silicosis. This success has helped all of the various actors in the process learn and develop new ways to go about dealing with occupational hazards.

Azad believes there are six community-oriented components to this kind of abatement work, regardless of the nature of the specific disease: Community Organization, Social Welfare, Health, Basic Amenities, Education and Livelihood. He is now taking this six-part model to the states of Jharkhand and Karnataka, again focusing initially on silicosis-related diseases. He uses existing government data and research to create tools that help identify the link between exposure to silica dust and various diseases. For example, in Rajasthan, he highlights high levels of early age widowhood and tuberculosis in mining communities to draw attention to the problem.

At each stage in the process, Azad is careful to place his silicosis-related work in the larger framework of society’s need to respond effectively and fairly to all issues of occupational health and safety. He has lobbied the government to begin working with employers to design compensation packages and is framing the next twenty-nine recognized occupational health risks as part of the government mandate to protect workers.

Born into a farming family in the Muzaffarnagar district of the north Indian state of Uttar Pradesh, Azad did not enter formal schooling until he was ten. According to him, his real learning started when he came to Delhi to do his undergraduate and post-graduate studies at the well-known Jamia Milia University, where the difference between the haves and the have-nots became very clear to him. Around the same time, his growing belief that education was the only way out of poverty led him to start a school in his village for which he trained some village youth as teachers. Poverty forced him to quit his doctoral research midway and join a local factory as a finance assistant. He quickly rose to the post of factory manager.

Azad left the factory to work at a bank, and it was there that he obtained seed funding to found a school in the Lal Kuan area, which inhabited by a large population of poor migrant laborers. He went far beyond the scope of his original work, establishing ten Balwadis (child-care centers) and then ten bridge schools for dropouts. He trained twenty local teachers for his education program. While investigating reasons for low and sporadic attendance in the schools, he discovered that over the past thirteen years more than 3,000 people had died of silicosis, TB and other breathing ailments and more than 70,000 others were at risk for the same.

In 2001 Azad started investigating the causes of the disease and discovered that the percentage of persons above fifty-five years of age in Lal Quan was strikingly low and that chronic disease and death in families were pauperizing entire communities, leaving children orphaned or forcing them to enter the informal market as child laborers. He also found that poverty and illiteracy combined with employer and government apathy were the main causes of denial of workplace-related illness compensation. That was when he started his campaign PRASAR to change people’s attitudes toward workplace diseases. The acronym translates into Hindi as ‘Broadcast.’