STATEMENT FROM THE COLLEGIUM RAMAZZINI TO THE COURT IN PAKISTAN
Chief Justice Gulzar Ahmad
Supreme Court of Pakistan
Constitution Avenue, G-5/2
Islamabad 44000
PAKISTAN
e-mail: mail@supremecourt.gov.pk
The Collegium Ramazzini is an international scientific society that examines
critical issues in occupational and environmental medicine with a view
towards action to prevent disease and promote health. The Collegium derives
its name from Bernardino Ramazzini, the father of occupational medicine, aprofessor of medicine of the Universities of Modena and Padua in the late
1600s and the early 1700s. The Collegium is comprised of 180 physicians andscientists from 35 countries, each of whom is elected to membership. The
Collegium is independent of commercial interests.
Introduction
The world is at a late stage in the process of ending the tragedy of asbestos use.
Over 60 countries all over the world have banned new uses of all forms of asbestos,consistent with the recommendations of the World Health Organization and theInternational Labor Organization calling for global bans since 2006. But asbestos
use still remains at one third of its all-time high, at about 1.2 million m.t./year. Mostof this (85%) is used in Asian countries, where the impossibility of protecting
construction workers and citizens from the deadly dust is overwhelminglyapparent. The most recent estimate of the death toll from asbestos worldwide is
255,000 annually.

The last of the global asbestos corporations got out of the business in 1999, leaving
the industry to national and a few regional companies. The worldwide industry
coordinates its messaging with propaganda largely directed by the asbestos mining
companies serving the world market from Russia and Kazakhstan. The Russian
government strongly supports the asbestos trade, even using trade pressures overrice from Thailand and tea from Sri Lanka to discourage these countries frombanning asbestos. In Vietnam, Russian and Kazakh asbestos interests have boughtroofing plants and organized a trade association to oppose government efforts toban asbestos in fiber-cement roofing. Asbestos mining interests also hired a spy toconduct surveillance of public health workers who were trying to ban asbestos andobtain compensation for asbestos victims in Asian countries.
The Problem
At least 90 percent of all asbestos used worldwide is in construction materials,asbestos-cement sheet (including corrugated roofing and flat sheets), pipe, andwater storage tanks. In moving to ban asbestos, Thai authorities have found that
non-asbestos roof tiles cost only 10 percent more than asbestos and increase thecost of building a town house by only US$65, less than one percent of the total
construction cost. The volume of scrap asbestos building waste from demolishedstructures in Japan will exceed 1 million tons/year for the first quarter of thiscentury. Brazilian economists calculate that the initial price advantage of asbestos
construction materials is more than offset by the added cost of hazardous waste
disposal at the end of the product life cycle, under regulations now in effect in Brazil.
This information on the technical and economic basis for banning asbestos was
published by the World Health Organization (1).
Construction materials are of particular concern, because of the large number ofworkers in the construction trades, the difficulty of instituting control measures,and the continuing threat posed by in-place materials that eventually require
alterations, repair, and disposal. Very high levels of airborne asbestos have beenrecorded where power tools were used to cut asbestos-cement (A-C) products.
Renovations and repairs in buildings containing A-C materials can also endanger
building occupants. In many countries today, these materials are removed only at
great cost by specially trained and certified workers wearing full enclosure
protective clothing “space suits”; the careful disposal of the asbestos waste material
creates another enormous problem, as buildings age and have to be demolished.
The airborne concentrations of asbestos that construction workers experience,using power tools to cut A-C pipe and sheet, can be extremely high, over 250
fibres/cc. This contrasts with daily average occupational exposure limits of 0.1 f/cc
in many countries and a short-term peak exposure limit in the US of 1.0 f/cc. The
demolition of A-C wall panels and other structural elements can cause very highexposures for workers and building occupants, while causing long-term
contamination in buildings and surrounding areas. Maintenance work on A-C pipes

entails danger for utility workers throughout the service life of the pipes. The use ofhigh-speed disc cutters created exposures averaging 92 f/cc for workers repairingunderground A-C pipes. The World Trade Organization, in supporting the right ofFrance to ban asbestos, rejected the claim that “controlled use” of asbestoscontaining construction materials is realistic (2).
There are dangers throughout the life cycle of asbestos used in construction
materials. The World Bank has described this, in urging the use of safer building
materials (3):“From the industrial hygiene viewpoint, asbestos creates a chain of exposure
from the time it is mined until it returns to the earth at the landfill or an
unauthorized disposal site. At each link in the chain, occupational andcommunity exposures co-exist. Workers in the mines are exposed to the fibres
while extracting the ore; their families breathe fibres bought home on theirwork clothes. Workers in the mills and factories process the fibre andmanufacture products with it; their families are also secondarily exposed.
Communities around the mines, mills and factories are contaminated with theirwastes; children play on tailings piles and in contaminated schoolyards;transportation of fibre and products contaminates roads and right-of-ways.
Tradesmen who install, repair and remove asbestos-containing materials are
exposed in the course of their work, as are bystanders in the absence of proper
controls. Disposal of asbestos wastes from any step in this sequence not only
exposes the workers handling the wastes but also local residents when fibres
become airborne due to insufficient covering and erosion control. Finally, thecycle is often repeated when discarded material is scavenged and re-used in theabsence of measures to remove asbestos-containing materials from the waste
stream and dispose of them properly.”
Chrysotile asbestos accounts for over 95 percent of all the asbestos ever used, and itis the only type in international trade for the past 20 years. International
authorities have concluded that chrysotile asbestos causes cancer and that no levelof exposure can be considered free from cancer risk (4-6).
Criminality of Asbestos Use
The most prominent criminal prosecution of asbestos industry owner-executives
has been in Italy. The defendants were owner-executives from Switzerland andBelgium who ran Eternit asbestos mines and A-C sheet and pipe factories in Italyand many other countries. One of the defendants died before the trial court issued
its verdict.
Evidence showed that Swiss asbestos billionaire Stephan Schmidheiny was wellaware of asbestos dangers from the time he took over as chief executive of theEternit enterprise in 1976. He held training sessions that year to prepare hismanagers on the issue of asbestos health hazards, so they could intimidate anddeceive unionists and mislead concerned journalists and factory neighbors. He thensold or closed most of Eternit’s worldwide asbestos businesses, putting the funds
into a Swiss corporation, Anova. He hired a public relations firm to arrange theItalian bankruptcy in 1986 and to assure that all responsibility for harm in Italy
would be confined to the Italian Eternit executives, and all liability would be limited
to the old Swiss Eternit Group, which had little value and was essentially an empty
shell .
Trial and appeal courts found Schmidheiny guilty of creating an environmental
disaster and sentenced him to 18 years in jail. The case was thrown out on a legal
technicality in its final appeal in 2014, on grounds that the statute of limitations
barred prosecution for that offense more than 10 years after the Italian businessclosed in 1986 (7).
A manslaughter trial then proceeded against Schmidheiny in Turin resulting inconviction in May of 2019. Three more manslaughter and murder trials areproceeding against Schmidheiny in other regions of Italy, where thousands of deaths
have occurred among Eternit workers and their family members and people withenvironmental exposure near the closed manufacturing plants.
Extensive corporate documents disclosed in legal discovery show that since the1930s and 1940s, major firms in many industries (oil, chemical, shipbuilding,automotive, rubber, etc.), in addition to the big asbestos companies, were wellaware of the deadliness of asbestos. But the workers were not warned or protected,and very few were compensated for disability and death. A “conspiracy of silence”
enabled the use of asbestos to rise for decades during which workers had no idea ofthe delayed lethal danger of breathing the dust in the air at levels they often couldn’t
even see. The record of patently criminal corporate behavior was business-asusual. Juries in US and Australian and Brazilian civil courts have assessed punitive
damages against a number of corporations.
Asbestos and the Dadex Case in Pakistan
In January 2013, the Pakistan National Assembly’s Standing Committee on Human
Resource Development recommended that Pakistan ban the import and use ofchrysotile asbestos. When the Chairman of the International Chrysotile Association
expressed the opposition to that recommendation to Dr. Mahmood A. Khwaja(Senior Adviser, Chemicals and Sustainable Industrial Development, Sustainable
Development Policy Institute of Pakistan), this brought a response from 143 publichealth scientists and organizations from thirty countries (8).
“The signers of the Statement:

* Condemn the dangerous misinformation that the International Chrysotile
Association (a lobby group for the global asbestos industry) is disseminating inPakistan, because this misinformation will cause unnecessary disease and death.
* Condemn the International Chrysotile Association for trying to undermine a publichealth initiative in Pakistan to protect the people of Pakistan from asbestos-relateddiseases and death.
* Emphasize that the scientific consensus is clear that all asbestos causes harm tohealth and that the use of any form of asbestos should be globally banned.
* Urge the Government of Pakistan to protect the health of its citizens by banning
the import and use of asbestos, as the Pakistan National Assembly’s Standing
Committee on Human Resource Development has recommended.”
In considering the Dadex case now before the Pakistan Supreme Court for further
review based on the independent expert report submitted to the honorable Court,
the Court has learned of the positions of leading authoritative internationalorganizations, including WHO, ILO, and other United Nations bodies. Dadex, likeasbestos-cement manufacturing plants all over Asia including Pakistan, hasexperienced occupational disease including cancer among the workers and asbestos
pollution in the plant and at an external asbestos waste dumping site. Large waste
dumps consisting of fine chrysotile asbestos fibers and small pieces of asbestoscement are produced as a design feature of this industry, because breakage occurs
in manufacturing, and the pieces of broken asbestos-cement sheets and pipes can’tbe recycled or sold.
Governments everywhere have been unable to properly protect manufacturing
plant workers and construction workers using the products; similarly,
governmental environmental authorities everywhere have proved inadequate tocontrol pollution around asbestos factories and waste dump sites. This has been thecase all over the world, and this is why it makes sense to ban asbestos and switch tosafer alternative materials. Asbestos is a silent killer, a fine dust with no warning
properties that causes cancer years after exposure occurs.
Conclusion
Public awareness that even environmental exposure causes mesothelioma has led
the leading industrial countries and many others to ban asbestos. The asbestos
industry is making its last stand in Asia, as long as governments will tolerate its
business model and allow the needless, widespread construction of people’s living
and working environment with a deadly mineral.
In Brazil, the courts shut down the asbestos industry in 2017. The Supreme Court ofBrazil decided that since asbestos use could not be controlled and the lethality of allforms of asbestos was firmly established, its use would have to be stopped – and it
was. The Supreme Court in Pakistan is now well placed to take similar action toclose down this criminal industry in Pakistan.

References
1. Review of substitutes for asbestos construction products by a WHO
temporary advisor. Annex 4 in National Programmes for Elimination ofAsbestos-Related Diseases: Review and Assessment 07-08 June 2011, Bonn
Copenhagen: World Health Organization Regional Office for Europe, 2012,
Annex 4, pp. 22-29.
http://www.euro.who.int/__data/assets/pdf_file/0005/176261/NationalProgrammes-For-Elimination-Of-Asbestos-related-Diseases-Review-AndAssessment.pdf
2. European Communities – Measures Affecting Asbestos and Asbestos-Containing
Products. AB-2000-11 Report of the Appellate Body, WT/DS135/AB/R
World Trade Organization, Geneva, (March 12, 2001).
https://www.wto.org/english/tratop_e/dispu_e/135abr_e.pdf
3. Good Practice Note: Asbestos: Occupational and Community Health Issues (17pp). World Bank Group, Washington DC (May 2009).
https://siteresources.worldbank.org/EXTPOPS/Resources/AsbestosGuidanc
eNoteFinal.pdf
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Appeal by Epidemiologists to Ban Asbestos Worldwide and End Related
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(2010) https://monographs.iarc.fr/wpcontent/uploads/2018/06/mono100C-11.pdf
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7. Castleman B. Criminality and Asbestos in Industry. New Solutions 26(4):557-580 (2016). The case was: Tribunale di Torino - Prima Sezione Penale,
Processo n. 5119/09 against De Cartier, Jean-Louis and Schmidheiny,Stephan.
8. International Statement condemns asbestos industry interference to preventa proposed ban on asbestos in Pakistan (Feb. 22, 2013).
http://central.bcwebinc.com/~rightcan/?p=1883