In a dingy room of a small house lies an ailing man on a squeaky bed. He has little energy to move or reach out for a glass of water lying at an arm’s length. He stops after every few steps to regain his breath. Recurring fever, cough, chest pain, breathing difficulty, appetite loss and rapid weight loss are some of the symptoms he is living with.

Hailing from Nutt Kallar Village, in Kamoke tehsil of Gujranwala district, 30 something years old, Muhammad Ilyas is a victim of the life-threatening and incurable disease called silicosis.

Silicosis has already claimed nine lives in his village, and nine more in his neighbouring villages, over the past few years. When these people died, the real cause of their death was unknown. They were diagnosed for tuberculosis and treated for the same by local doctors, paramedics and hakeems.

Coincidently, all of them, including Ilyas, worked at the stone crushing factories in Gujranwala district, where they inhaled hazardous silica dust on a daily basis.

Incapacitated by this lethal disease, Ilyas is hoping for a miracle to happen, and is expecting compensation and financial support from the state.

His hopes though are not unfounded, as "there are efforts being made at different levels," says Usama Khawar Ghumman, 23, a law graduate from Lahore University of Management Sciences (LUMS). Currently doing summer internship at the Supreme Court of Pakistan (SCP), he belongs to the village where most of these deaths occurred.

Everytime Ghumman went home for holidays from LUMS, he heard of more deaths. His father is a farmer and has a dera, where villagers gather and interact with each other. "The most prominent among those who assembled used to be two brothers -- Tahir and Qaisar -- who were both over six feet tall, broad-shouldered and well-built. Known to the locals as Giant Brothers, they were believed to be invincible. Both lost their lives in a span of a few months. They also worked at a stone crushing plant," he says.

Their deaths shook Ghumman. He set his mind on investigating the cause of these deaths. He struggled to collect evidence so that he could take a legal recourse. He discussed the issue with his teachers at the university and took the campus-based Public Lawyers Front (PLF) on board. With their support, he ultimately succeeded in filing a writ petition with the Lahore High Court (LHC) and an application for suo moto action with the Supreme Court of Pakistan (SCP), authored with the support of advocate Yahya Farid Khawaja.

In a rather unprecedented move, the SCP has sought reports from different respondents, including the labour and environment departments.

Arshad Mahmood, Deputy Director, Occupational Safety & Health (OSH) at Punjab Labour Department says they have carried several trainings for workers and owners on silicosis. But, "the problem is that both employers and workers take it easy and leave things as they are".

Silica dust particles under five microns in size are not filtered during inhalation and they ultimately settle on lungs. Once the deposition starts, lungs get affected and start absorbing and retaining water and may develop cancer after some time.

One wonders if stone crushing is a common occupation - in fields such as mining, blasting, drilling and marble grinding -- then why the instances of death are so high in Gujranwala? Because, "There is a ready demand for powdered quartz stone mixed with boric powder in the city’s huge ceramics industry. This end product gives glaze to ceramics, sanitary ware and tiles and is also used for lining furnaces from inside," says Mahmood.

Activity at a typical stone crushing unit involves manual breaking of stones into smaller pieces by hammers, grinding of these pieces through a mechanical process, mixing of this powder with boric with shovels and hands and finally packing of the end products in bags with bare hands. Silica dust hangs in the air like a suspended cloud, under which men toil.

The Punjab environment department distances itself from silicosis-related deaths, on the pretext that it has no legal sanction to enter factories. The department can take action over hazardous emissions or effluents flowing out of factories whereas the labour department must check all the violations inside the units, says Naseem-ur-Rehman, spokesman, Punjab Environment Protection Department (EPD).

However, Rehman says, they have issued notices to several factories emitting silica dust, in quantities above acceptable standards, and forwarded their cases to the environment tribunal. "The punitive action has to be taken by the tribunal as EPD cannot interfere," he adds.

No doubt that media has highlighted the prevalence of silicosis among workers but the recent suo moto action by the SCP has brought it into the limelight with a renewed vigour. "It was difficult to build a case in the absence of evidence," says Ghumman, who tried to get two silicosis patients -- Ilyas and Abdullah -- tested for silicosis at Divisional Headquarter (DHQ) Hospital Gujranwala. The attending doctors refused to carry out chest CT scan of the patients because they were convinced they were suffering from tuberculosis (TB).

Unnerved by this show of apathy, he took the patients to Lahore and got them tested for silicosis at a private clinic. The CT scans cost him Rs7,000 each but the results confirmed they were suffering from the disease.

There is a strong likelihood that deaths in Gujranwala’s Nutt Kallar village occurred due to silicosis for the symptoms were same.

People’s Rights and Social Research Centre (PRASAR) of India, which has shared research, manuals and handbooks on silicosis with them, is also supporting the petitioners.

Dr Khawar Abbas Chaudhry, the pulmonologist who diagnosed Ilyas and Abdullah with silicosis, believes silicosis and TB show overlapping symptoms. "It is unfortunate that most consultants reach conclusions in less than five minutes. Diagnosis of silicosis involves a detailed interview of the patient, a look at his lifestyle, occupation and environment he works in," he says.

Dr Chaudhary says in Pakistan there is not a single law on silicosis whereas in India there are 15 laws on this disease alone. The risks can be reduced by providing protective gear including N-95 helmets to workers and installing dust settlers, scrubbers, mechanisation, wetting methods and controlled environment in this industry, he adds.

So, if if solutions are simple and clear, then what stops the labour departments from taking corrective steps?

Syed Hasnat Javed, Director Labour Welfare, Punjab says his department carries out regularly surveys in the province. In the recent past, he says, "the department spotted 10 to 12 stone crushing units in Gujranwala, 5 in Sheihkupura and one in Lahore. Ashraf Stone and Lining Industry, owned by Ashraf Ansari, where most deaths have reportedly occurred, has shifted to Sialkot whereas the one in Lahore has been shut down.

He says earlier the factories could not be registered under the Factories Act 1934. But now the limit of employees has been reduced to 5 from 50, for a factory to be covered by this act. The department has issued notices to stone crushing factories but it does not have the powers to shut them down. "We requested them to stop employing people till proper measures were taken but they did not comply. So, the government is planning to invoke local government act under which DCOs can take action against activities liable to cause harm to public," he sa

The labour department has also introduced a toll free helpline 0800 33888 where complaints again violations at stone crushing units can be registered.

Ashraf Ansari says that he had only three employees so his factory could not be registered under labour laws. He refutes charges that people had died working at his factory. He says there are hundreds of stone crushing factories in the country and these contractual workers move from one to the other all the time. "You don’t know where they contract the disease," he adds.

Ansari has shifted his factory to Sialkot but at the moment it has been sealed on grounds that he has not obtained a No Objection Certifcate (NOC) from the concerned department. A meeting, he says, has been called by the labour department and environmental department officials after Eid where things will be sorted out.

Ansari says he provides masks to his workers but if the government thinks it is not enough he is ready to upgrade his machinery and take more protective steps.

While all eyes are fixed on the SCP and the action it takes, Khalid Hanjra, brother of the "Giant Brothers" is worried about the future of his extended family. "The disease has wiped out one generation of my family. We have lost everything," he regrets.