It is the number one work-related disease in China, with an estimated more than one million cases. It is contracted by inhaling mineral dust, most common among coal miners and those who work on building sites, sand-blasting, welding and gem and jade processing. It has no cure and in nearly all cases, is fatal. Among the victims are 180 migrant workers from Leiyang city, Hunan province, who worked for several years in underground blasting and drilling in Shenzhen, laying the foundations for the skyscrapers and subway lines that impress millions of visitors each year. 'We are now suffering in differing degrees from occupational pneumoconiosis,' they wrote in a letter to the Shenzhen city government in June last year. 'It has already caused the death of 15 of us and 10 more are no longer able to work in any capacity. We suffer constant pain and have fallen increasingly into debt. In all this time, neither our employers nor any public authority has provided us with any medical or work-related illness compensation.' This is an excerpt from a report published yesterday by China Labour Bulletin (CLB) entitled 'The Hard Road: seeking justice for the victims of pneumoconiosis in China'. The CLB is a Hong Kong-based NGO that campaigns for the rights of workers in China. According to official figures, there are about 600,000 cases of pneumoconiosis on the mainland. But reports in the Legal Daily on March 3 indicate that there are about 900,000; other studies suggest the real figure is higher still. It takes an average of 17 years from the first exposure to the appearance of the disease; among those exposed to highly concentrated levels of silica dust, the time can be one to three years. There is no cure; doctors can only slow growth of the disease. Such treatments are expensive and beyond the reach of the migrant workers who form the vast majority of the victims. The report presents a picture of a Kafkaesque trap in which employees in industries with a large emission of dust work for years without knowing of the disease that may take their life. They cannot claim compensation from companies because they lack a written contract, the firm has moved or changed its name, and legal and municipal authorities make little effort to assist them. The Leiyang workers are a typical example. They spent long hours in dangerous and poorly ventilated construction sites in Shenzhen with little or no protection from clouds of rock dust. The pay was good but nobody told them of the terrible long-term effects of inhaling the dust. By 1999, several were complaining of exhaustion and repeated influenza. As their strength declined, many returned home. The first died in 2002. 'Over 40 from our village came to be drillers and 10 have already died,' Xu Zhihui , one of them, told CLB. 'There are eight with the disease in stage three, like me, and four or five with stage two; only a few have not got sick. As a result, most of our fields are fallow and some children cannot go to school.' Their attempts to obtain compensation from their employers, first directly and then through the legal system, were hampered by the fact that the disease appeared after they had finished working in Shenzhen and they did not have written proof of employment. The courts would not accept evidence of the disease alone. In May last year, after 15 of them had died, the rest returned to Shenzhen to demand compensation. Without corroboration from their employers, a city hospital refused to confirm their illnesses were work-related. They protested outside the city government offices on June 15. On July 29, the government offered 30,000 yuan (HK$34,100) in compensation to the 150 whose employment relationships could not be confirmed. On August 5, on the advice of the CLB, they filed an administrative lawsuit against the city's health bureau, saying it had failed in its legal duty to enforce laws and regulations to protect their health. To avoid getting sued, the city paid a total of 14 million yuan, with sums to individuals ranging from 70,000 yuan to 290,000 yuan. This collective action, with help from an outside institution - the CLB - was a rare success for workers with pneumoconiosis. The majority only discover the disease years after they left their employment and are unable to obtain any compensation. Firms in the jewellery industry used regular medical exams to discover workers in the early stage of the disease and find ways to fire them. Some firms collude with or pay off officials and medical practitioners responsible for disease diagnosis and assessment. Firms change the company name, location or legal representative to avoid compensation. One example is the Lucky Jewellery Factory, set up by Lucky Gems & Jewellery Factory of Hong Kong, in Longgang district in Shenzhen in 1984. In June 1997, it moved 50 kilometres to Huicheng district in Huizhou and changed its name to Huizhou Huicheng Lucky Jewellery Factory. In early 2005, it moved the short distance to Haifeng in the port city of Shanwei , where it became Guangdong Lucky Jewellery Arts & Gifts. In 2002, 40 employees diagnosed with silicosis sought compensation from the firm. A labour arbitration committee in Huicheng ruled against them on the grounds that there was 'no relationship between Huizhou Huicheng Lucky Jewellery Factory and the Lucky Jewellery Factory of Shenzhen'. Such transfers have the additional benefit of moving from one jurisdiction to another; officials and courts may refuse to act against a firm in another jurisdiction. Workers have sued the firm for compensation for silicosis, with little success. One, Ran Qimei, from a town in Jiangxi , worked as a stone cutter from February 1990 until 2002. In 2006, she was diagnosed with stage two silicosis. She applied for one million yuan in compensation to a district arbitration committee in Huicheng; it rejected the application. She filed a lawsuit with a district court, which ruled that the company should pay 20,000 yuan. Both sides rejected the ruling and have appealed to a higher court. The most spectacular case was that of Zhang Haichao , a 29-year-old villager from Henan , who contracted pneumoconiosis from working at an abrasive materials factory in Xinmi , Henan. In 2008, several hospitals confirmed the disease but he was told he needed a formal diagnosis from a hospital in Xinmi. It initially refused to examine him because the factory did not provide proof of employment. When it did, the hospital diagnosed him with tuberculosis and not pneumoconiosis - an apparent case of the company paying the hospital. In June last year, he was operated on; doctors found no TB but his lungs were clogged with dust. The media furore created by the case led to Zhang being awarded 615,000 yuan by his former employer. He has about six years left to live and spends his time helping other migrant workers. To address the problem, the CLB report recommends setting up workers' health and safety committees in high-dust industries, and allowing NGOs and other social groups to monitor occupational diseases and help victims. It said local governments needed to be more active in enforcing occupational health and safety laws, with a strict employment registration system for workers at risk from exposure to high levels of dust. The government should initiate a public education campaign to ensure workers are fully aware of the risks of their jobs and their rights to redress should they be injured or fall ill at work. The government should impose a levy on firms in high-dust industries and use the revenue to set up a fund to treat and support victims of pneumoconiosis. Courts and government bodies should be more flexible in taking such cases; courts should accept them on the basis that the plaintiff is suffering from the disease alone. The CLB said Beijing did recognise that occupational diseases, especially pneumoconiosis, were a serious problem and were amending the laws in a bid to alleviate them. 'We argue that amending the law is only the beginning of the process,' it said. 'Laws have to be enforced judiciously and fairly, employers must be made to honour their legal obligations and officials in charge of disease diagnosis, assessment and compensation must adopt a more humane approach to the thousands of pneumoconiosis victims who come before them each year.'