Many of the instruments used every day in NHS surgeries start out from a small town in Pakistan called Sialkot. Almost 25% of instruments, from scalpels to forceps, are made by one of the many small businesses that operate here as part of the medical instrument industry that has been here for decades. Manufacturing these instruments is a multi-stage process, involving skilled workmen working with simple but potentially dangerous equipment. Lack of effective health and safety law in Pakistan means that accidents are common, often leading to severe disability and workers unable to support their families. This is disastrous in a country with high levels of poverty and the medical industry is also failing to provide benefits such as healthcare to its workers.
Many of the stages are also subcontracted to small units of half a dozen workers, often based in poorly lit and badly ventilated single rooms. Workers work twelve hours a day, seven days a week and are paid a few dollars with no job security. Even more alarming is the use of child labour in these units, with some workers as young as seven working with grinders and other machines to make the kind of instruments used throughout the NHS.