The ongoing asbestos trade & hidden disease in India

India is now the biggest asbestos market in the world, but government and industry are failing to acknowledge the risks to workers and their families with asbestos-related diseases.

Since 2000, dozens of countries have banned the use of white asbestos, or chrysotile. This diminished the size of the asbestos industry, so it identified new markets for its product to survive — primarily in Asia. None have been as significant as India, whose imports of white asbestos have grown from 99,000 tonnes in 2000 to 485,182 tonnes in 2023.

Banned

The World Health Organisation, International Labour Organization, scientific bodies in over 65 countries which have banned it, and numerous non-industry-funded scientific studies have all confirmed that white asbestos is potentially lethal. While scientists agree that brown and blue asbestos (which are no longer mined) is more toxic, all forms of asbestos, including white asbestos, have been shown to cause asbestosis (scarring of the lungs from asbestos fibres), lung cancer, and mesothelioma. Worldwide, estimates are that over 100,000 people died from asbestos exposure in 2023.

White asbestos is not in the United Nations treaty governing the international list of hazardous chemicals. This is voted on by member states. India, and a handful of other countries still mining or importing white asbestos, including Russia and Kazakhstan, have continually voted against ratifying that it is harmful.

The argument from industry defenders is that the risk from asbestos comes only from other asbestos fibres. White asbestos, they say, is safe. They suggest claims to the contrary are grounded in conspiracy.

“There is an underhanded ploy to mask the truth about Chrysotile roofing sheets, spread a baseless fear and try to distance the product from the society,” wrote the Indian Fibre Cement Products Manufacturers Association (FCPMA) in 2019. In India, asbestos is mainly used in cement products like roofing, which are bought by lower-income people due to its low price and durability. The FCPMA acknowledges that other asbestos is harmful but says, “Serpentine chrysotile does not cause any health hazards.”

The FCPMA also added “Workers in the Chrysotile Fibre Cement product industry in India have not had any adverse health effects in spite of decades of service, there being no risk of exposure to Fibre Cement dust because of pollution control measures installed in the factories.”

Mareena Hawkes of Coimbatore in southern India has seen first-hand the dangers of white asbestos. There remains a lack of awareness in India that white asbestos can cause asbestosis, lung cancer, or mesothelioma. When people do fall ill, it can be challenging to receive an accurate diagnosis.

Her husband, Christopher Hawkes, worked from 1998 until 2010 for Everest in Coimbatore, one of over 100 asbestos cement factories in India. The family lived in the company’s housing quarters, close to the factory. In 2004, Hawkes and her three-year-old daughter, Cynara, had lung issues and felt breathless. A doctor advised them to move home and away from the factory, but nearly 20 years later, both are still struggling with breathlessness. “We can’t walk properly – we walk a hundred feet, and we get heavy breathing.” In 2023, Christopher was also sent to the doctor for lung issues.

The asbestos dust was a constant issue for Hawkes’ family when she lived in the company’s quarters. “Every day, morning and evening, we have to sweep because you’ll get the white patches [of asbestos dust] all over the floor of the house.” Hawkes added that Everest did not tell her husband the health-risks of white asbestos.

Hawkes’ father-in-law, L.G. Hawkes, also worked in the factory. Hawkes said he was never told that white asbestos could be dangerous. He died from lung cancer aged 72 in 2010.

“Doctors and medical specialists have very low to non-existent knowledge of asbestos and the effects it has on people exposed to it.”

Asbestos-related diseases can be difficult to diagnose. “Countries that still import raw chrysotile asbestos and manufacture products do not have the knowledge, expertise, and resources to diagnose asbestos-related diseases successfully,” said Shane McArdle, who works at the Asbestos and Dust Diseases Research Institute (ADDRI) and runs training programs in countries still using asbestos.

“Doctors and medical specialists have very low to non-existent knowledge of asbestos and the effects it has on people exposed to it,” McArdle said. The ADDRI finds that even if doctors do know about asbestos diseases, if they don’t have the equipment and resources, they’ll still struggle to properly diagnose asbestos diseases.

This figure, however, struggles to account for countries like India, whose government have no official figures on asbestos diseases, alongside poor surveillance of asbestos illnesses and inadequate healthcare training.

The risk is not just to factory workers. Those who work extensively with the materials, such as construction workers, are most at risk. While asbestos-cement roofing is safe when undamaged, Hawkes says it’s not widely known that if you cut or damage the sheeting, you can release toxic asbestos fibres. Hawkes gives talks to raise awareness, but she spoke of receiving threats from workers connected to the factories and having to take precautions to stay safe.

Hawkes is now chair of the All India Asbestos Workers and Family Welfare Association. In this role, she also helps those who have lost family members to asbestos diseases, such as Sherine Edmonds.

Lung cancer

Edmonds grew up in Everest’s living quarters. Her father, Rodney Leslie Stephen, worked as a fitter in the factory from 1960 until 1997. It wasn’t until he was dying from lung cancer that Stephen came to learn about the dangers of asbestos. He died aged 87, the same year as his diagnosis, after struggling with his health for over 20 years.

Her father’s gradual decline began while he was in his 60s. He struggled with breathlessness, he lost weight, and his hands became numb – all symptoms of asbestosis.

As Edmonds has had severe health issues unconnected with asbestos for most of her life, Stephen’s declining health took a backseat. As a child, she had kidney failure and kidney operations, and a litany of health issues continue to plague her to this day. So, Stephen’s focus was on helping and caring for his daughter.

Eventually, they had to go to the hospital. “Slowly, slowly, everything was shutting down,” she said. “I think then he could not breathe. He was very bad.”

The doctors explained to Edmonds the severity of the situation: it was stage four lung cancer. Worried the diagnosis would overwhelm and further harm his health, she didn’t tell her father immediately. When she did, he was initially convinced he would have more time.

“He just looked and he said, ‘It’s nothing. I won’t die. I am born to live for many more years.’ He was very worried about me.” she said. “I had to remove my gallbladder also at the time. So he didn’t want to worry us because my mom also passed away, so we don’t have anyone here.”

Edmonds saw her father, whom she describes as a resilient man always looking out for his family, become totally dependent now on her and her husband. Ultimately, the doctors said it was futile to continue bringing him to the hospital and adding to their significant debt, so they looked after him at home.

“If you have a lot of money, you can do so many things, but poor people just have to say yes and keep quiet.”

“I think about 10 or 15 days [before he died],” she said, “we had to put the Pampers (on) him. Then he knew the seriousness of it, and we couldn’t leave him after that. We were in his room throughout. I used to sleep downstairs with him. … My husband used to give him a bath, and I used to take him to the toilet. When he saw the Pampers, he knew that it was gone. He started crying.”

The doctor also asked Edmonds if she wanted to have her lungs checked for potential asbestos diseases. She declined, saying she couldn’t handle any more bad news.

Despite working in the factory for decades, Stephen was never told white asbestos could be dangerous, nor was he given protective equipment, Edmonds says. Asbestos has been known to cause asbestosis since the 1920s, and the industry knew of the link to lung cancer since the 1940s.

Edmonds and her husband had to sell their wedding rings to pay for the funeral costs. The family have been cast into significant debt and is barely surviving now. “Financially, we are lost. We really lost because we had to spend a lot on his treatment,” she said. “We have gone through so much. My hopes are just buried.”

Stephen was never officially diagnosed with asbestosis, and neither the government nor Everest has paid compensation to her family. Edmonds feels her lack of resources makes it more complicated to appeal.

“We just left it. … But we cried a lot,” she said. “If you have a lot of money, you can do so many things, but poor people just have to say yes and keep quiet.”

Compensation and justice

British lawyer Krishnendu Mukherjee has seen the challenges his clients have faced trying to receive compensation for asbestos-related diseases in India. Mukherjee has helped over 4,000 people in India obtain compensation for acquiring an asbestos-related disease. The vast majority of these cases were for asbestosis, which is potentially fatal.

The compensation for these claims is drawn from a fund from a former major British company, Turner & Newell, from when they were active in India until 1995. However, those exposed by other means, or via Indian-based companies have a more challenging route to obtain any measure of justice.

“Unfortunately, the Indian legal system isn’t fit for purpose, for these types of claims at least,” Mukherjee said. “So compensation claims take years in India, and the competent levels of compensation are very low in India.” Mukherjee gives an example of a group of workers filing a case against an Indian company in 2005, but the litigation is still ongoing with no end in sight.

Meanwhile, the danger of people developing asbestos-related diseases will persist for many decades. “There can be no eliminating asbestos-related diseases without eliminating the sources of exposure which causes the disease: chrysotile asbestos,” said ADDRI’s McArdle.

Even if a total ban on asbestos were implemented today, the amount of asbestos-containing materials in the environment and the latency period from exposure for asbestos diseases means there will be sickness and death in India for many decades to come.

Hawkes also wants to see the Indian government take decisive action by banning asbestos. She has also called on them to provide free treatment to those affected by asbestos diseases. “Ensuring access to necessary medical care is our primary and only expectation,” and in the interim, for the asbestos industry to adhere to strict precautions to protect workers and the public. “Until a ban is implemented, we expect precautions such as the mandatory use of masks, proper protective equipment, and stringent safety protocols to minimize exposure and health risks.”

“Every day, people come to us seeking assistance for themselves and their families, sharing their suffering and hardships. Tragically, many have already passed away without receiving the support they needed.”