The sequence of garment factory fires and building collapses provoked widespread calls domestically and internationally to improve workplace health and safety conditions in Bangladesh which is a key destination country among the Low and Middle Income Countries (LMIC) in the world where Western companies outsourced garments production to profit from its abundant and cheap labour and scarcely enforced environmental and occupational health and safety standards. These incidents also dragged global attention to the very low wages, benefits and conveniences at many of these factories. These heartbreaking man-made disasters emphasised needs and rights of factory workers that remained ignored and unmet for too long.
With the difficulty to keep pace with a flourishing, largely manual labour-intensive sector, arose a need to fill these low-skilled positions. This immense need for labour-force was mostly filled by women from lower socio-economic background with no or minimal educational attainment and zero skill-sets with essentially no alternate income-earning opportunities in the country. The factory owners in Bangladesh were not simply prepared to arrange and provide this working population with the very basic safety provisions. Some owners were overwhelmed with this suddenly-arrived business opportunity whereas some were simply not sincere in putting together the means and resources.
Consequentially, work-related injuries became highly prevalent in these factory-settings. The burden of these injuries are usually more drastic and severe in a LMIC like Bangladesh where social safety and supportive system is almost non-existent and the injured or disabled workers become either penniless or remain to be completely dependent on their family members, relatives and well-wishers for their survival since wage from their work is the only means of livelihood for most of these factory workers.
Almost all the recent health and safety initiatives many of which undertaken and funded by the European and North American retailers and buyers focus on primary prevention of these work-related injuries by targeting to improve building, fire and electrical safety; however, the needs and applications of tertiary (downstream or after the fact) interventions to bring already injured workers back to labour force has not been on the radar. Earlier measures after a work-place disaster often help make the rehabilitation process of the injured workers faster and sustainable. Primary prevention measures -- physical changes, safety training and regulations -- for these incidents are most important, but once a workplace disaster does strike, it is imperative to document and understand all consequences to identify the need, plan and deliver rehabilitation and recovery measures for the maimed workers. After a factory catastrophe befalls, primary provisions of acute medical care are critical; nevertheless, rehabilitation measures provided by professionals like physical and occupational therapists need to be planned as well for saving the workers from becoming permanently or partially disabled from their injuries by helping in social and economic re-integration of the survivors.
With this context, learning from Centre for the Rehabilitation of the Paralysed (CRP) will be useful to share as this organisation played a vital role for the workers during and after the Rana Plaza disaster. Their experience will be helpful for national and international stakeholders to identify gaps in planning service delivery provisions after such man-made disasters occur. CRP is located not that far from Rana Plaza and it started numerous initiatives from the very beginning for the surviving victims and provided them with immediate support including medical care, nursing care, ambulances, blood supply, dried foods etc. Later, a consortium was formed by CRP, Centre for Disability in Development, Handicap International, International Committee of the Red Cross and BRAC for coordinating total casualty management and identification of cases that needed long term rehabilitation. CRP also worked with Bangladesh Garment Manufacturers & Exporters Association (BGMEA) and International Labour Organisation (ILO) for identification and transfer of the survivors from different hospitals to specialised hospitals for proper care and medical management. CRP provided services to about 509 survivors on immediate medical management to long-term community reintegration. It has provided rehabilitation and reintegration care with a holistic approach-- immediate medical management, therapeutic care (to regain functional activities), rehabilitation planning, vocational training, supplying wheeled mobility aids, supporting in job placement, educating family members, and following them up in the community.
In an evaluation study to assess the effectiveness of CRP-provided services, data were gathered 2 years after the incident on the survivors' level of engagement in income generating activities, self-reported status on their quality of life, participation level in community activities. The study also looked into their change in income and occupations after sustaining the injuries. It was a very difficult population to study as they all suffered from multiple injuries and these injuries varied widely by nature, severity and body parts affected. The findings should educate the government, healthcare providers, factory owners, Western companies and buyers, and public health and policy advocates nationally and internationally on what worked and what did not.
About the general health of the Rana Plaza survivors, majority were found to have become independent in walking in terms of mobility status and only 8.3 per cent reported to have any remaining difficulty. It suggests that survivors have somewhat recovered from their major ailments and should be prepared to engage in economic and community activities. CRP appears to have succeeded in the medical and rehabilitation management of many of these survivors and most of them were in good enough health conditions. However, at the point of conducting this study, 55 survivors were found to be either jobless or reported to have become housewives (16 per cent). There can be various reasons behind this - one being the support they receive from family members and the other being how desperate their economic need was.
In terms of their new occupations, shop management, animal husbandry, and sewing ranked high. These suggest that CRP or other similar rehabilitation service and vocational training providers may focus on developing and providing with more training on how to operate a small retail shop, how to raise animals, or initiating sewing as a business. These livelihood options are quite prevalent in rural Bangladesh and capital requirement is quite low to start these. Previous garment work experience probably helped some of them get back to sewing business. All survivors were garment factory workers before the disaster but given the need of physical fitness and stamina to continue working there, it was nearly impossible for them to return to their previous jobs. Even if survivors gained full physical fitness to return to garment jobs, some may be hesitant to go back after sustaining a major traumatic experience. They were more willing to accept any other jobs with much lower pay.
The income level was found to be still quite low among the survivors. This loss of income and change in occupations show clearly the economic loss for these workers who lost regular full-time jobs in the factory setting. In terms of reintegration back into the community, female survivors faced greater difficulty than males.
As the Western countries and companies outsource more businesses in LMICs, major disasters like Rana Plaza may become an unfortunate reality in the coming years as many of these countries are not well-prepared on recovery and rehabilitation measures for their injured workers. In Bangladesh, people with disability face insensitivity and marginalisation in the society. The country needs to continue creating more economic and social opportunities for these vulnerable population groups and develop and expand functional social safety nets. Creation of modified jobs and making other workplace accommodations in mainstream industries are of fundamental importance for people who recover from injuries and who have disabilities. Development and expansion of rehabilitation services capacity and initiating more disability assistance programmes are badly needed in Bangladesh.
Documenting and describing the health and functional status and following up on the economic consequences such as change in income and occupation after a disaster is vital as it highlights the post-event suffering and impact. A factory disaster results in short-term and long-term disability among the survivors. A comprehensive rehabilitation process or approach that targets both the physical and mental losses as well as looks into missed labour force participation opportunity is needed for a meaningful and sustainable recovery.
Hasnat M Alamgir is Professor, Department of Pharmacy, East West University, Dhaka.