Indonesian National Seminar - Asbestos: Poison Scattered in the Disaster Nation
Welcoming delegates to a national asbestos seminar held in Jakarta on May 9, 2019, Darisman representing the Indonesian Ban Asbestos Network (INA-BAN) said: Asbestos is a danger and the danger is not a myth. According to the latest available data, more than 222,000 people die every year from asbestos-related diseases. In his speech at the National Seminar Asbestos: Poison Scattered in the Disaster Nation, a seminar commemorating International Occupational Health and Safety Day 2019 and organized jointly by INA-BAN and the International Labour Organization (ILO), Jakarta, Darisman warned that if Indonesia did not emulate the actions of countries which had prohibited asbestos and continued using asbestos, then the number of victims would keep increasing.
Asbestos in Indonesia
In Indonesia, the use of asbestos remains legal and 90% of asbestos consumed is used for roofing. The people at risk, Darisman said, were workers, members of the public and people in disaster areas including humanitarian workers who were at extreme risk of deadly exposures.
Indonesia does not have an asbestos mine, Darisman pointed out to participants; all the asbestos used in the country is imported from other countries. Indonesia processes asbestos fiber in factories and 90% is used to make roofing materials such as tiles and sheeting. Darisman affirmed that there would be no problem should the import of asbestos be stopped as nowadays there were many sustainable and environmentally friendly materials which could be used in place of asbestos products. In Vietnam, the transition to a safer, asbestos-free technology had already begun and factories which formerly used used asbestos are now using cellulose.
M. Darisman (standing) delivered his speech at the opening of the National Seminar Asbestos: Poison Scattered in the Disaster Nation. Photo courtesy of INA-BAN.
Darisman explained that the motivation for INA-BANs campaign to ban asbestos was the human tragedy caused by asbestos exposures and stated that there were many victims:
Up until now only one or two patients have been diagnosed, because the medical costs to achieve this are so high and we have limited funds. We have recently facilitated check-ups for 20 people and more than half of them were found to have been affected by asbestos.
Although it should be the governments role to provide medical check-ups and care for the injured, he said, we need to accumulate the data to show them that this is a real problem.
The next speaker was Dr. Francisco Santos OConnor, an occupational health and safety specialist working for the International Labor Organization (ILO) office in Bangkok who made his presentation via skype. Dr. OConnor talked about the impact of asbestos exposures on working people. The number of annual global deaths due to occupational diseases was very high: 2.8 million people died from occupational toxic exposures. There were so many types of unsafe workplaces, so much avoidable ill health and so many premature deaths, he said.
Furthermore, he added, according to the ILO half of all occupationally cancers were caused by exposure to asbestos; the most common asbestos-related diseases contracted by workers were mesothelioma, the signature and fatal cancer associated with asbestos exposure, and lung cancer. The asbestos epidemic in Europe was the reason that European countries had decided to ban asbestos.
There is a long latency period from the time someone is exposed to asbestos and the time they get ill. Even if the use of asbestos is stopped in Indonesia, people will still get lung cancer and mesothelioma for decades to come. In addition, the presence of asbestos-containing products already within the countrys infrastructure will impose a heavy cost for safe removal and disposal.
Dr. OConnor said that the most effective way to prevent asbestos-related deaths was to stop using asbestos; this policy had been endorsed by the ILO which was encouraging the Government to adopt national asbestos prohibitions to protect workers from occupational exposures. The United Nations, which is committed to protecting workers rights and reducing deaths from dangerous materials, also believed that asbestos use should be banned. Concluding his remarks, the speaker reiterated that banning asbestos would indeed protect workers and the public and would not adversely affect the national economy.
Research of Asbestos-Related Diseases in Indonesia
Data from the research referenced by Occupational Specialist Dr. Anna Suraya showed that in 2017 there were 2.78 million work-related deaths from diseases and accidents around the world of which: 29% (~835,000) were caused by cancer and 60% (~1,670,000) occurred in Asian countries. Research recently published by Professor Jukka Takala estimated that deaths from lung cancer accounted for 54-75% of annual occupational disease mortality and that exposures to asbestos were responsible for the majority of these deaths as well as other cancer deaths including mesothelioma and cancer of the lung, larynx and ovary.
Asbestos-related disease is not a myth; the BPJS (Social Insurance Administration Organization) said that 27% of occupational disease claims in 2018 were for asbestos-related diseases. Dr. Suraya said: in 2016 we found the first asbestos case at PT Trigraha and directly reported it. In 2017 we also reported some cases, so the existence of these cases is not a myth anymore.
In fact, the use of asbestos began in Indonesia in 1950 when it was first imported. In 1981, asbestos disease was listed on the occupational disease register with other diseases such as pneumoconiosis, lung cancer and mesothelioma. According to Ministry of Manpower Regulation (Number 1/1981) there has been an obligation to report listed asbestos diseases as occupational diseases for nearly forty years.
Presidential Regulation number 7 (2019) further strengthened the acknowledgment of the role of asbestos in the causation of occupational disease. Until 2016, no case of asbestos-related disease had been reported formally in Indonesia, but, in 2018, cases of asbestos-related disease accounted for 26% of the compensation from occupational disease in Indonesia.
Dr. Anna Suraya (standing) presented her research on asbestos-related diseases in Indonesia. Photo courtesy of INA-BAN.
Even though, internationally there were many studies about the effects of asbestos, there have been no studies published about asbestos-related disease in Indonesia. Nowadays, researchers in Persahabatan National Hospital are working on case control research about asbestos-related lung cancer in Indonesia. The cohort is made up of patients with lung cancer proven by checking histology and controls who do not have lung cancer as proven by CT scans. Out of 674 prospective subjects, samples have already been collected from 500 of whom 185 have already been paired with controls.
Preliminary results from pioneering research by Dr. Anna Suraya and her team revealed that asbestos-exposed workers have twice the risk of contracting lung cancer as non-exposed workers. Dr. Suraya told the seminar:
People working in the asbestos industry, in whatever job, have three times the chance of contracting lung cancer as other workers Data remains lacking about other asbestos-related diseases such as mesothelioma, asbestosis and other disorders.
Based on these findings, Dr. Suraya and her team called for a reappraisal of Indonesias asbestos policy and the implementation of measures to protect workers and members of the public from the asbestos hazard. She also recommended other academics undertake research into other asbestos-related diseases in order to be establish the consequences of asbestos use in Indonesia. Concluding her remarks, Dr. Suraya pointed out that in Indonesia, lung cancer is a major killer; in Persahabatan National Hospital, there are more than 1,000 lung cancer patients currently being treated. Widespread ill health in the country presents an obstacle to identifying victims of asbestos-related lung cancer. It is not enough to ask a lung cancer patient if he did or did not smoke; occupational histories with detailed information about all past employment, working conditions and exposures to toxic materials like asbestos are vital.
Ministry of Social Affairs: the Danger of Asbestos in High-Risk Disaster Areas
The next speaker was Mrs Idha Kurniasih, from the Ministry of Social Affairs (Kemensos). In her presentation entitled: Asbestos Handling in Emergencies, she told the meeting that the Ministry had provided leadership in the drive to address asbestos problems with a particular focus on the construction industry. She said:
We made raising asbestos awareness a priority action in the context of disaster management especially in Lombok and Sunda Strait where many people were still using asbestos.
Based on the experience in Lombok, the speaker identified major issues relating to asbestos in post-disaster situations:
Mrs. Kurniasih told the meeting that the Ministry had a coordinated asbestos strategy which addressed key issues at local and national levels. Amongst at-risk communities, work had been done to raise awareness of the asbestos hazard, advocate the use of safer alternative products and provide lab testing to identify hazardous material. At the national level, safety guidance information for aid workers and volunteers had been produced; technical assistance and mentoring had been provided; collaborative projects with the Ministry of Health Affairs and the World Health Organization (WHO) to lobby the government for improved management of asbestos were proceeding.
To improve safety in disaster-prone areas, the Ministry of Social Affairs had encouraged actions by municipal and state officials to adopt decrees about asbestos usage; in the longer-term, these measures should be endorsed by the Ministry. Concluding her presentation, the speaker reconfirmed the Ministrys commitment to addressing the asbestos hazard to protect public health and to progress work in disaster-prone areas as a matter of priority.
From the left, Idha Kurniasih (Ministry of Social Affairs), Dave Hodgkin (International Red Cross), Medi Herlianto (BNPB), Sawung (Walhi-Eknas), Firman Budiawan (INA-BAN). Photo courtesy of INA-BAN.
International Post Disaster Specialist: the Danger of Asbestos in High-Risk Disaster Areas
The next speaker was Dave Hodgkin, an International Post Disaster Shelter specialist, with over 20 years experience in post disaster shelter and housing recovery. He was currently engaged by the International Federation of the Red Cross as part of their global mandate to ensure the coordination of shelter assistance in all natural disasters worldwide. In the current context, Mr. Hodgkin had been engaged to support the Ministry of Social Affairs in their role as the lead agency for the coordination of non-government shelter assistance in the ongoing Palu, Lombok and Sunda Straight disaster responses. The speaker mentioned that he had been fortunate to enjoy a long relationship with Indonesia, having assisted in the coordination support teams of all major responses in Indonesia since 1999.
Mr. Hodgkin noted that he first became concerned about the issue of asbestos in Indonesia during the 2004 tsunami Aceh response, when a number of NGOs had unwittingly proposed crushing contaminated rubble to use as road base and landfill, while yet other agencies had unknowingly commenced shelter projects including materials containing asbestos. This concern continued in ensuing responses, notably after the Yogyakarta 2006 earthquake, 2009 West Java and West Sumatera earthquakes and the 2010 Nias Island tsunami and earthquake response. Lombok however was the first time that he had seen such large quantities of asbestos in the rubble, with over 20% of roofs in North Lombok made with asbestos cement, much of it now being salvaged and reused or crushed, pulverised and spread out in mass programs to speed up reconstruction.
To justify his high level of concern, Mr. Hodgkin started by sharing his experience as a builder in Canberra where the infamous Mr Fluffy asbestos insulation scandal had cost the state hundreds of millions of dollars in clean-up fees. The cost to remove this asbestos was so high, that knowing little about it the speaker had decided in 1992 to train as an asbestos removalist. Going through the training and licensing process, he quickly became aware of the high risk and gave up on doing asbestos removal work and has never since questioned the cost!
These concerns led the speaker to advise the Ministry of Social Affairs and IFRC to bring on board specialist asbestos experts to work with WHO, ILO and appropriate line ministries and agencies to develop and provide clear advice on:
In response to the above advice IFRC had hired a trained industrial hygienist to provide initial advice and was now looking to bring in a specialist asbestos epidemiologist. The IFRC Shelter Coordination Support team were committed to continuing to support the Ministry of Social Affairs and other relevant line agencies and ministries to reduce asbestos risk in disasters in Indonesia.
Mr. Hodgkin congratulated INA-BAN on behalf of the IFRC for this important initiative that aligned with the IFRCs own guidelines on the dangers of asbestos in disasters and congratulated both the Ministry of Social Affairs and the National Disaster Management Agency, along with ILO and WHO, for their ongoing concern and support on this important issue.
BNPB (National Agency for Disaster Countermeasure): Asbestos, the Risk of Additional Disaster, Needs Standard Operational Procedure (SOP)
Medi Herlianto from the National Disaster Management Agency (BNPB) reminded delegates that Indonesia is located at the meeting point of the Pacific, Eurasian and Indian-Australian tectonic plates and is home to 127+ active volcanoes. More than a decade since the 2004 tsunami, disaster trends have increased in frequency and intensity and the severity of the challenges we faced had grown with the discovery of a new fault line. In 2010, 81 fault lines had been identified; by 2016, this number had increased to 295, making Indonesia one of the most disaster-prone countries in the world.
The speaker told delegates: Last year, Indonesia experienced 2,372 disasters and more than 3.5 million people were affected and displaced. Natural disasters also caused the collapse of buildings and most of the locations of these disasters were in places which had a very high use of asbestos roofs. Asbestos-containing material has been incorporated into many Indonesian houses with particularly high usage reported on the islands of Sumatra and Java and in the Southeast part of Nusa Tenggara Province. According to Mr. Herlianto: if asbestos is not carefully handled, it can prove dangerous and operational procedures must be put in place to protect people There must be a strategic policy (in place).
Unfortunately, temporary shelters (huntara) were still being built, the speaker said, using roofs made of asbestos. In addition, all the waste and debris in disaster areas contained asbestos, which the BNPB is obliged to clean up. Agreeing with INA-BAN, Mr. Herlianto said that asbestos was a potential killer and pledged that BNPB and its partners would undertake massive and sustainable actions related to asbestos, conduct asbestos awareness outreach work with the Regional Government and the public and build a strategic asbestos policy in collaboration with stakeholders in high-risk communities, especially in light of the increased hazard posed by asbestos in the aftermath of a disaster. In addition, he said, the adoption of legislation banning asbestos imports was vital.
Another valuable contribution to the meeting came from Saung, representing the Indonesian Forum for the Environment (Walhi), who said that Walhi had rejected all use of asbestos which was a known carcinogen and a serious threat to human health. Asbestos-containing products could be easily broken during a disaster and toxic fibers liberated, the speaker pointed out. The post-disaster use of asbestos products should be banned and factories currently using asbestos should make the transition to safer and greener technologies.
Participants at the National Seminar Asbestos: Poison Scattered in the Disaster Nation. Photo courtesy of INA-BAN.
May 20, 2019