Voices From Pakistan

The child worker: Shakeel Ahmed, 13

Ahmed began working in a surgical instrument workshop at eight years old. "I do not like this work, in fact I want to go to school but my father says that I should work," he says. Shakeel's three uncles and elder brother all work in the industry. He does all kinds of work including polishing and grinding.

He and the other workers are paid on a piece rate for the instruments they make. If Shakeel works all day, he can earn about 170 rupees (£1.42). The work can be dangerous because the workshop does not provide protective equipment or clothing. "If anything breaks up, it can hit me, I need to work carefully otherwise it is very dangerous."

Minor injuries in the workshop are common and Shakeel saw a major accident last year. "[A worker] was operating a polisher, the stone blade broke suddenly and it hit his head and it started to bleed, other workers caught him and carried him to hospital," he recalls.

The adult worker: Nasir Bhatti, 49

Bhatti has been working in the industry since he was nine years old. He says it is common for workers to get into debt with their employers, for example if they have a large expenditure or if the workshop does not have many orders.

"Poor workers get into debt when they have some problem and they pay it back or it is deducted from their wages," he says. This can place workers in hoc to their employer and make it difficult for them to demand better conditions. He is paid a piece rate per item he makes and earns 250 to 300 rupees (£2.15 to £2.60) a day.

Bhatti is sanguine about the risks of working in the workshop. "Every work is dangerous," he says. "We are used to it and we work very carefully." He has been injured "many times" but never seriously. "I have seen countless workers' injuries, this is part of our work," he says.

This information about Shakeel Ahmed and Nasir Bhatti was provided by Liaquat Javed, of BRIC Pakistan (Backwards Rehabilitation and Improvement Commission), an NGO set up in 1997 that works to improve the conditions of workers in Pakistan.

The NGO: Liaquat Javed, head of BRIC Pakistan

Javed says conditions in the handful of large surgical instrument factories are generally good, but much of the work is done by workers in small workshops with two to 20 workers.

"The working conditions at home-based units are extremely bad and poor," he says. "There are no health and safety measures and no training. The wages are nominal ... the situation is very bad but workers have no option. If they will not work how will they earn a daily living?"

These conditions are common in the industry. "If you walk the streets you will find countless workshops where you will see a horrible situation - child laborers, workers' faces full with metal dust and noise. The children operate polishers, grinders and at many units I saw the children working with chemicals without any gloves or masks.

"Workers are not aware of their rights. They are illiterate, they have no unions and they are not allowed to make unions. Workers are deprived of education, health and justice."

He believes that buyers such as the NHS have the most power to make changes by forcing their suppliers to take action. "In this horrible situation, buyers can play best role if they put demands to the suppliers. So the NHS can play very positive role," he says.

The factory boss: Sheraz Safdir, chair of the Surgical Instruments Manufacturers Association

Safdir admits that working conditions in the industry could be improved, but says child labour has been almost eliminated. "No more children are coming into this field," he says. "You can hardly find any children in the industry. The big companies don't have any children."

The International labor Organization's estimate of 5,800 child laborers working in surgical instrument manufacture is out of date, says Safdir, adding that the industry is working to improve conditions for the workers. "We are regularly monitoring those workshops. We are also investing a lot of money in them for the betterment of their employees and for better working conditions."

He accuses NGOs such as the ILO of talking up the child labor problem to obtain more charitable donations from abroad. "The trouble with these people is that if there is no child labor in the surgical industry, how are they going to get their funds from abroad? What are these NGOs going to work on? They are not giving the true picture to the world. They have their own interests."

According to Safdir, there is currently a shortage of skilled laborers so some workers are demanding a golden handshake of £1,000 just to begin work at a factory. He says that for conditions to improve buyers such as the NHS will have to pay more for the products, but this extra money should be monitored to make sure that it benefits workers.