Mehmet Savasir was 24 when he learned he was dying. His treatment for what a local doctor had assumed was tuberculosis wasn't working. The pain in his lungs was getting worse, he found breathing increasingly difficult, and he had lost 20 kilograms in two months.
Then, after a tomographic scan, a specialist asked him if he had ever worked in a factory where jeans were sand-blasted. Surprised, he admitted that he had. "He told me that I had silicosis," Savasir remembers, sitting in the two-room flat that he rents with his wife and three children in a poor district of the southeastern Turkish city of Diyarbakir. "I was relieved. I asked what the cure was. When he said there wasn't one, I collapsed."
Given free treatment by the staff of Diyarbakir's Dicle Hospital, Savasir has recovered some of his strength today, but anything more strenuous than a slow walk remains out of the question. "I can't even cut wood," he says. "I just sit and watch my wife do it." In the meantime, friends he once shared a work place with have begun to die.
The medical profession has known about silicosis for well over a century. But it usually manifests itself among miners and road-builders, and only after at least a decade of work. Since 2005, Turkish doctors have slowly become aware of a more acute version of the disease, affecting workers employed to give denim the worn look that has become fashionable over the past decade.
"As little as two months of work can be enough to trigger the disease," says Tekin Yildiz, the chest expert at Dicle Hospital who diagnosed Savasir when he came down from his village of Kocakoy, north of Diyarbakir in April 2008.
Like other young men in a region where land, divided up among children, was increasingly scarce, Savasir had been traveling to the West of Turkey for years. He had collected scrap metal and worked on building sites. But the 2001 banking crisis left the construction sector in tatters. That was when relatives from his village mentioned the factory in the western Istanbul suburb of Yeni Bosna.
"They said the pay was good, and it was," remembers Savasir, who says he got nearly twice the Turkish minimum salary of 620 TL for 72 hour weeks. "We worked in pairs in rooms about four meters square pumping sand under high pressure onto the fabric. The only ventilation was a small fan. They gave us medical masks to cover our mouths with."
It is a primitive technique that caused an outbreak of deaths in Eastern Europe in the 1960s. Since then, sand-blasters in the textile and construction sectors in the West have been obliged to work with body-suits filled with air pumped in from outside. More often, the job is done by unmanned machines.
"We knew it was dirty work," says Orhan Tektas, adding that factory foremen used to warn any worker who visited the doctor not to mention what they did. "When we woke up in the morning, in a dormitory next to the workshop, we had to rub the sand out of our eyes. We got out as soon as the economy improved."
For many, it was too late. Following his first meeting with Mehmet Savasir, Tekin Yildiz traveled to Kocakoy to see if anybody else had the condition. Seventy-five village men told him they had done the same job. Thoracic tomography showed 70 percent of them had varying degrees of silicosis. Yildiz says 13 of them are now very sick. Five have already died.
In two villages near Karliova, two hundred miles north of Diyarbakir, locals say up to 300 men are affected by silicosis.
"If I said that there was one patient per household, I'd be lying," says Aydin Bartu, 27, sitting in his house in Toplular, newly rebuilt with money he and his brother earned as sand-blasters in Istanbul. "In some families two or three people are dying of this."
Up the road in Taslicay, villagers buried the latest victim, aged 28, in mid-November. "It is like some awful plague," says Bartu, who tests found had not contracted silicosis.
While deaths from silicosis in Turkey as a whole has now risen above 45, estimates of how many people have the disease vary. Tekin Yildiz calls 1,000 "a conservative estimate." An Istanbul-based association set up to fight for the rights of former sand-blasters says up to 50 percent of an estimated 10,000 people who worked in the sector are at risk.
Former sand-blasters in both Karliova and Diyarbakir say they worked with jeans stamped with some of the world's most famous brand names, and the association has held a series of demonstrations in front of shops belonging to Turkey's most famous jeans brand, Mavi. Mavi and other companies deny any malpractice.
Nedim Ozbek, the president of the association of jean manufacturers, a sector he says employs 300,000 in Turkey, contends the sweat-shop-style factories that most silicosis sufferers say they worked in all but disappeared from Turkey years ago. Even so, health inspectors in Istanbul have closed down more than 20 such facilities since the Ministry of Health outlawed sand-blasting workshops this April.
The owners of some of these unsafe factories have escaped justice in part because their former employees are as short of money as they are of time. Under Turkish law, victims should be entitled to both sick pay and compensation. Like well over half the estimated 3 million people working in Turkey's textile sector, however, many silicosis victims were uninsured employees of unregistered companies. "At the very least I would like to know that my children are being looked after when I am gone," says Savasir. "But I barely have enough money to feed them now, let alone go to Istanbul to fight my case in court."
Nicolas Birch specializes in Turkey, Iran and the Middle East.