By: Dr Amaal Khalid Chauhan.
Picture a moulder outside Lahore kneading wet clay well before dawn, a toddler sleeping on a mat nearby while he works the bricks to be baked beside him. When the season is over, he’ll have had shaped tens of thousands of those bricks, developed the lung condition most kiln workers here do, and still have money owed to his boss; money that, on paper, Pakistani law has forbidden anyone from holding over him since 1992. That’s close enough to the median outcome for an industry Pakistan both needs, and largely ignores in policy planning and implementation.
The scale alone should concern health planners: Pakistan has more than 20,000 brick kilns and more than 4.5 million brick-kiln workers, concentrated in Punjab and Sindh where over half of the country’s bonded labourers are believed to work in brick kilns. Across South Asia, satellite researchers at the University of Nottingham have mapped more than 55,000 kilns in a “Brick Belt” spanning Pakistan, India, Bangladesh and Nepal, while a regional ILO survey found close to 70 percent of the region’s five million-plus kiln workers were in bonded or forced labour, with roughly one in five underage.
The reason for those numbers is a cash-advance system known as “peshgi”. Owners give workers a loan at the beginning of a season, for a wedding, a funeral, an illness, and that loan immediately binds the worker to the kiln for that season, tracked in an informal ledger that the worker typically has no control of. Similarly, piece-rate wages are set low enough and deductions made are opaque enough that the balance rarely reaches zero, the debt passed down to the next generation as families essentially live at the kiln with no means to escape.
The same dependence extends to something as basic as water: workers in nearly nine in ten kilns surveyed in Punjab relied upon untreated, polluted and contaminated ground water for consumption while three-quarters of toilet facilities were deprived of any water supply.
Contracts between owners and workers, if they exist, tend to be oral, despite written documentation being a legal obligation since 2016. This was due to a statute that also deemed that the peshgi advance be capped at Rs 50,000. Four years later, in 2020, a Lahore High Court bench found, that neither law was meaningfully enforced and ordered every brick-kiln to be registered within the next 6 months. 6 year later, this has yet to come to pass.
Certain critics of the 2016 statute argued that by overseeing cash-advance instead of banning it, the state might legitimise the very system that creates bondage rather than abolishing it, thereby placing an exception inside what was meant to be a cure. The debt, meanwhile, continues to reproduce itself.
When the monsoon season comes, production stops for weeks, and workers borrow again to eat, so when the kiln reopens, they’re already in arrears. A March 2026 Guardian investigation documented the edge of that desperation, as brokers target debt-trapped kiln workers for illegal kidney sales. A pattern the Sustainable Development Policy Institute’s field interviews had already recorded in 2009, parents selling a child’s kidney to clear kiln debts.
The resulting clinical picture is not surprising considering the exposure to dust and smoke. A 2024 systematic review of more than a hundred kiln-pollution studies found workers consistently showing worse lung function, higher rates of respiratory symptoms and more musculoskeletal complaints than unexposed comparison groups. A study in Kasur of 60 workers found pollutant levels in excess of WHO and national guideline values and roughly four in five with abnormal lung function.
Heat risk data is more sparse for Pakistan, but neighbouring kilns using similar piece-rate systems yield informative insights. A Chennai-area study found 94 percent of summer workers noting excessive sweating (which can lead to electrolyte disturbances), 86 percent reporting tiredness and dizziness, and 67 percent reporting headaches, with occupational heat exposure during the hot season near the limit of human tolerance. An eastern India study using WBGT heat stress measure, found losses of roughly 4 to 7 percent in productivity per degree Celsius rise in heat, with female workers suffering more than male workers; the researchers associated that with measurable cardiovascular strain. In West Bengal, workers are paid by the furan (per thousand bricks carried), which creates a perverse incentive to not slow down despite rising temperatures until output drops off significantly once temperatures pass roughly 35°C.
Injury trends are consistent: a Pakistani social assessment found moulders suffering substantial back, leg, and joint pain as a direct consequence of working posture and repetitive lifting. And when workers do get sick or injured, services are unavailable – kilns are in rural or peri-urban areas, and research by the ILO has documented this mismatch between available health services and the needs of this workforce. The SDPI recorded this same dependence on private doctors in 2009, seven years before the oversight law even existed, and the ILO identified it again roughly eight years later. Ironically, many kilns are not even properly registered as workplaces in the first place, which means protections written for “employers” and “factories” often never formally attach to them at all.
This cycle spares neither children nor women: since output dictates debt repayment, whole families work the kiln, and as mentioned previously, regional estimates suggest close to one in five South Asian kiln workers is under 18 (despite the ban on under-14s). Pakistan’s Human Rights Commission has documented unusually high child mortality at kiln sites, and roughly one in twenty nearby families reporting a child who lost their eyesight. Women perform the same physical labour while bearing the responsibility of childcare, and multiple assessments document harassment and gender-based violence with no confidential channels to report either.
Recently, in May 2026, Punjab’s Labour department held a multi-stakeholder consultation in Lahore on a proposed Minimum Wages Framework for brick-kiln workers, based on a 2025 wage notification advanced by the Bonded Labour Liberation Front and its general secretary Syeda Ghulam Fatima, who told the session that effective enforcement of minimum wage law is both a legal and moral obligation. This comes weeks after kiln workers themselves held an eight-hour sit-in at the Lahore Press Club demanding minimum-wage enforcement, bonded labour abolition, social-security and old-age-benefit registration, and an end to child labour.
An effective list, and an effective public-health intervention. A worker whose pay is documented and whose debts are audited can turn down a dangerous shift without putting his family’s food at risk; a household with a functioning complaints mechanism can pull a sick child off the kiln floor rather than send him back to work to keep pace with the ledger. However, success this time, unlike before, should be measured in inspections and registered kilns, not another empty promise. For the kiln worker, the law meant to protect them has been on the books for years. But until Pakistan measures enforcement rather than legislation, that law remains on paper, – and out of their reach.
The right outcome measure for this workforce isn’t disease prevalence, but whether a family can get sick, get treatment, and not lose a child’s well-being or a worker’s livelihood in the process. Until Pakistan’s health and labour inspection systems start to ask that question jointly, the kiln worker’s cough will continue to be diagnosed, and continue to go untreated, and for the same reason every time: they cannot afford to stop. [ENDS]
Note: Author is the young medical graduate passionate about tackling social reasons for health inequalities and can be reached at amaal.chauhan1@gmail.com
