Millions of Surgical Instruments Used in the NHS Daily Are Made in Pakistani Sweat Shops Where Child Labour Is Used; as the Fair Trade Campaign Is Helping to Improve Working Conditions and Practices across the Global Food and Textile Industry, Attention Is Now Being Turned to the Way Surgical Instruments Are Produced, as Health Editor Madeleine Brindley Reports

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Byline: Madeleine Brindley

THE image of a tray of sterile and gleaming surgical instruments laid out neatly on a green sheet beside the operating table is a million miles away from the often hazardous conditions in which they are produced.

Rather then being the product of an equally sterile factory manned by hi-tech robots and machinery, millions of the instruments used every day in the NHS are produced in sweat shop conditions in Pakistan.

Children as young as seven are working long hours alongside adults in often squalid conditions with little or no protection against harmful chemicals and dangerous machinery for a pittance.

It is unclear what proportion of surgical instruments used daily in the NHS in Wales are produced in such conditions, but campaigners believe that instruments manufactured in these condition in the back-street factories of the Pakistani city of Sialkot find their way into Welsh hospitals, health centres and clinics.

It is estimated that two thirds of the world's basic surgical instruments are manufactured in Sialkot.

These are, in turn, supplied to companies in Europe and the US, which often simply check and repackage them before they are supplied to various national health systems, with a corresponding increase in price.

A paper by surgeon and fair medical trade expert Dr Mahmood Bhutta, published in the British Medical Journal in 2006, said a pair of high-quality Iris scissors has a selling price of just $2 from the Pakistani manufacturer but retails to the end-user, which includes the NHS, for approximately $60.

The British Medical Association (BMA) is now campaigning for fair and ethical trade in surgical instruments and working to raise awareness among doctors about the use of child labour and dangerous working conditions in Sialkot.

Dr Bhutta, the BMA's adviser on the Medical Fair and Ethical Trade group, said: "It's basically sweat shop labour.

"Those people who are making these instruments are working terribly long hours - they are working 12 hours a day, seven days a week and they get paid very poorly.

"They are exposed to terrible health and safety hazards with all sorts of machinery and chemicals without really adequate protection.

"In the surgical instruments industry there are several thousand children working to make products, including for the NHS. Some of them are as young as seven."

A briefing paper prepared for BMA members states that around 9% of the 100 million surgical instruments manufactured in Sialkot every year are exported to the UK.

"The majority of production is still manual," the paper states. "Manual production requires close attention to detail and necessitates a skilled workforce in order to ensure that the products are manufactured to a high standard.

"However, many manufacturers do not have the capacity to market products direct to international buyers, such as the NHS, meaning manufacturers are unable to access higher end prices.

"Furthermore, the industry is very competitive, which creates downward pressure on wages.

"Employment conditions in manufacturing industries in general in Pakistan are poor with unsafe and unhealthy working conditions and inadequate remuneration presenting particular cause for concern."

Among the key issues surrounding the manufacture of surgical instruments in Sialkot is the ongoing use of child labour.

Figures from the International Programme on Elimination of Child Labour suggest that 3.3 million children between five and 14 are working in various industries in Pakistan, from domestic labour to quarrying. Between 2,000 and 5,000 children are thought to be employed in the surgical instrument industry.

Dr Bhutta said there was "significant" use of child labour that is not reported.

The BMA said: "Large factories have a total ban on child labour but children can be found working in the smaller, local sub-contracted manufacturing units where young boys are employed as apprentices, working alongside adult workers. …