Former workers allege that dozens have died after years of inhaling silica dust at the Ogijo plant, with many treated for tuberculosis. They say families received little or no compensation. In this investigation, Hammad Abdulrasheed exposed how workers of African Refractory and Allied Products Limited (ARAP) are dying and contracting silicosis, the lung disease caused by inhaling silica-containing boric acid. The investigation also exposed that the families of the dead workers are not being compensated after their untimely deaths.

By Hammad Abdulrasheed

Simon Oguche was 29 when he died in July 2023. For a year and six months, he worked as a mechanical engineer at African Refractory and Allied Products Limited (ARAP) in Ogijo, Ogun State, earning about ₦2,500 ($1.88) a day. Early in 2023 a cough set in and refused to clear. Fever, fatigue, chest tightness and shortness of breath followed, and by the end he could not breathe without oxygen.

The company kept calling him to repair its machines while he was ill. His mother, Roseline Oguche, 58, recalled that he sometimes left his hospital bed to attend to the factory’s equipment and then returned for treatment. “When he had closed from work, they still called him to repair what had spoiled because he was good at engineering,” she said. “Sometimes, I accompanied him at midnight when they called him, because I was worried about his safety.”

When his condition worsened, Simon spent about a month on oxygen at Dansochris Hospital in Ogijo. The company representatives who had called him so often stopped coming once he could no longer breathe unaided, his family said. According to Roseline, ARAP gave no financial or other support during his illness or after his death, even though it had named him its best worker and rewarded him with a cooler.

The family was already in mourning. Simon’s elder sister had died in hospital a week before him, and his father, a police officer, was killed in an armed robbery in Festac, Alakija, in 2008. Roseline said Simon was first treated for tuberculosis (TB). When he did not improve, she decided to take him to Kogi State for further treatment. After her daughter died, she took Simon’s medical documents, bills and receipts to ARAP to ask for help with his treatment and transport. “The supervisor told me he had nothing and there was nothing he could do,” she recounted. She raised the money herself to take her daughter’s body and Simon to Kogi, and estimated that the family spent more than ₦1 million on treatment in Ogijo and over ₦400,000 on treatment and transport in Kogi.

Simon was too weak to walk. His younger sister, Dorris, rode one motorcycle with their belongings while Simon was carried on another. He died about a week after his sister. “They used my pikin until he died,” Roseline said. “The dust covered him as if he had been put inside yam flour. The nose mask he wore could not protect him. There was no support for his treatment, burial or compensation.”

She had warned Simon about the dust, she added, but he assured her that the company had designed its system so the dust would rise and not affect workers. Residents had complained about the pollution for years, she said, and a neighbour had developed a similar illness.

‘It was as if they were treating a different illness’

Dorris Oguche said her brother worked in the ramming mass section for the whole year and six months. Their mother repeatedly urged him to stay home and get checked when the company called him back, but he kept responding to requests for repairs. Dorris believes the dust and chemicals damaged his lungs until he needed oxygen. When he first fell ill, he went to the company clinic, TopMed Hospital, but his condition kept worsening until the family moved him to Dansochris.

“He was sick for almost two months. His condition was serious, and he was admitted to the clinic and given drugs. But the drugs did not help. It was as if they were treating a different illness at the company clinic. They do not even check whether their staff are sick,” she said angrily. “The work he did last before the illness became worse, we were not sure if they paid him. Had there been money, we were supposed to sue them in court.”

She described how the cough dragged on for about a month before Simon was admitted to Dansochris, put on oxygen and given a course of antibiotics. When he still did not improve, the family took him to Otukpo General Hospital, which referred them to Iga in Ankpa, where TB is treated. “We did not know it was silicosis,” she said. “We arrived on Saturday, and he died around 6 a.m. on Sunday. Simon died in our hands. I even donated blood. After I donated blood, he died that Sunday morning. He was named the best staff member, but none of the company’s foreign owners or supervisors came to our house.”

Dorris said she worked in ARAP’s block-making section and refused a transfer to ramming mass because she feared the exposure. In her view, the ramming mass workers needed regular medical tests, and the material they handled was not ordinary stone. “What they did was wrong. It was not a goat that died. Some workers have stopped working, while others have never recovered,” she said.

The company and the disease

ARAP is a Nigerian manufacturer of refractory materials used in high-temperature industrial processes, particularly steel production. Its products include silica ramming mass, high-alumina bricks, tundish boards, castables and nozzle-filling compounds, and it says the ramming mass is supplied to induction furnaces and steel plants in Nigeria. The factory sits at KM 45, Ikorodu-Shagamu Road, Ogijo. The directors listed on the Corporate Affairs Commission include Indian nationals Sharma Ravi Kant, Alok Gupta and Gupta Raj; South African national Terblanche Daniel Hendrik; and Nigerian national Onwuka Emeka.

Making ramming mass means crushing quartz stone into fine powder, and that releases respirable crystalline silica dust. Inhaled over time, the dust causes inflammation and permanent scarring of the lungs, a disease called silicosis. It brings a persistent cough, shortness of breath, fatigue and chest pain, and it has no cure. It can keep progressing after exposure stops and, in severe cases, end in respiratory failure and early death. Long exposure also raises the risk of lung cancer and chronic obstructive pulmonary disease. Reported safety concerns at the plant include inadequate protective equipment, poor ventilation and insufficient training.

Silicosis is easily confused with TB. Both cause cough, breathlessness, fatigue and similar chest X-ray findings, and silica exposure raises the risk of TB, so a patient can have both. Diagnosis depends on a worker’s exposure history and lung imaging, which is why a wrong label can go unchallenged for months.

A supervisor who saw it coming

Jane Okafor, 42, was a teacher before the cost of rent pushed her from Bariga, Lagos, to Ogijo, where factory work was the only job on offer. She joined ARAP in 2022 and worked until 5 January 2026, supervising at least 17 casual workers in the ramming mass department. Her first symptom was heavy weight loss, which she blamed on stress. A fever and a persistent cough followed, and three hospital visits over four months did not clear it. Her worry deepened when Super Ola, a fellow supervisor fell ill with the same symptoms of consistent coughing and died in December 2025. 

“If I had known the dust I inhaled over four years could cause this disease, I would have left as soon as I noticed the first signs,” Okafor reflected. “I believe early treatment could have helped. The disease does not show clear signs at first, and people may not realise how ill they are until their condition becomes critical. By then, the drugs may no longer work.”

In December 2025, TopMed Hospital placed her on a six-month TB course. After three months with no change, she returned to the doctor and was told to continue. She finished in June, still coughing, and then saw a pulmonologist at a general hospital, who asked about her earlier diagnosis and reviewed her tests and scans before prescribing new ones. She said a test result once showed suspected silicosis, but workers were usually treated for TB because the right diagnostic equipment was not available. She still has chest pain, especially in cold weather.

“Sometimes, if I don’t have money to buy the drugs, I wait until I get money,” she told this reporter. “There was a time they said they had called a specialist at TopMed, but I didn’t go, because the only thing they do is prescribe drugs and we are the ones buying them. I don’t really have the strength. We are dealing with fatigue in this condition. Getting out of the house is always an issue for me. I cannot trek for three minutes without panting heavily.”

The illness has cost her more than ₦200,000 in medication, and she sometimes goes without drugs when she cannot afford them. As a supervisor, she took home less than ₦100,000 a month even with overtime. She no longer works, and even short walks are difficult. “It is painful to know you can work and are not lazy, but your body will not let you,” she said. “I have children to feed, and even buying food and medication is a struggle. Sometimes I depend on my family, but there is only so much anyone can do.”

She supervised the processing of quartz, a white stone, into silica ramming mass, and she described a plant where the dust was never fully controlled. Workers wore double masks, yet dust still reached their noses. She wrote repeatedly to management and the safety administrator asking for better protective equipment, and management sometimes promised action but did not always follow through. Respirators arrived after her repeated requests, shortly before she left, but workers complained that they were hot and hard to breathe through, so some took them off. She warned casual workers who handled dusty materials to be careful and sometimes advised them to leave the area until the dust settled. She believes the factory could have been designed to control dust better, with systems that capture it before it escapes. Fine quartz particles can pass through pipes or block them when the pipes are not maintained, she explained, and regular maintenance would cut the amount released. Workers who spend long shifts there, from 7 a.m. to 6 p.m., face prolonged exposure, and symptoms may not appear early.

“Some people think they are careful and are not inhaling the dust,” she said. “If God helps me recover, I want to share my experience so others can learn from it. The best thing is to avoid prolonged exposure. People may already be affected without knowing it, because our bodies are different. Residents have protested about pollution before, and the Ogun State Environmental Protection Agency came to the area before Bartholomew died. This is not a new problem. It has affected many people living nearby.”

Okafor knew four colleagues who died: Super Ola, in December 2025; Bartholomew Aniemeka, in March 2026; Samson, a maintenance worker; and Ademola Fasanya both in May. She named two others who are battling similar illnesses, including Idowu and Gideon known as Odogwu. Aniemeka was a supervisor until he fell ill in mid-2025 and was replaced.

Ade’s death hit her hardest. She was already at home, too sick to work, when the news reached her. “I was shocked,” she said. “He was also a supervisor and my former colleague. There was never a day we didn’t see each other. If I didn’t see him, he would come to me. If I didn’t see him, I would go to him. Of all people, I was very surprised. His death took everyone by surprise because it happened suddenly.” Ade’s brother, Imoleayo, declined to comment despite all efforts by this reporter to speak with him about Fasanya’s death. He also worked for the company but was sacked.

Okafor said the company’s foreign owners rarely visited the factory and relied on supervisors and managers to report on operations, and that managers were changed every six months to a year, which she believed limited their exposure to the dusty areas. She urged the Ogun State Government to create other jobs, because most residents depend on factory work and keep returning to it despite the dangers. “You cannot expect a Nigerian to open this kind of factory abroad without it being shut down,” she said.

Okafor regarded Aniemeka as a brother because they shared a tribe and a language. His last message to her was a “good morning” that she did not answer. When she later asked how he was, his sister, Cynthia, told her he had died. She is still too pained to reread their old messages.

‘Forty-eight’ deaths

Bartholomew Aniemeka worked at ARAP from 2016 to June 2025, about nine years as a supervisor in the mechanical department of the ramming mass section. He earned between ₦700 and ₦1,000 a day until fatigue made it impossible to continue, and another worker took his place. In a video that went viral on 6 March 2026, he described how the production process filled the air with dust that workers breathed for years. His illness was first misdiagnosed as TB, he said, which delayed proper treatment. He alleged that 48 of his former colleagues had died of similar symptoms and said he had compiled their names and dates of death. He also alleged that workers were told to stop production and hide whenever government officials came to inspect.

Aniemeka died in March 2026. His sister and caregiver, Cynthia Divine, confirmed the death to this reporter on 22 March, which brought the number he reported to 49. She described his final weeks as severe, with weight loss, shortness of breath and episodes of suffocation. At the time of the first interview, she said, ARAP had not compensated any family of the dead workers. When this reporter contacted her again in August, she first declined to talk. After further questions, she said the company had visited Aniemeka’s mother, but she did not disclose the amount of compensation paid to Aniemeka’s mother. Two other workers, Super Ade and Samson known as Baba Calabar, died in May, according to people interviewed for this report. Super Ola had died in December 2025.

Rejoice Mary, Aniemeka’s fiancée and the mother of his son, now lives with her parents. His family gave her ₦100,000 and pays ₦10,000 each month for the child, she disclosed, an amount she called too small to meet his needs.

Shut, then reopened without official statement 

The video prompted a federal response. The Federal Ministry of Labour and Employment ordered ARAP closed after an inspection by its Occupational Safety and Health Department found significant risks to workers, including exposure to silica dust. TheCable reported on 19 March that Minister of State for Labour and Employment, Nkeiruka Onyejeocha, gave the order during an inspection that also sealed two other Ogijo factories, African Non-Ferrous Industries Limited and Metalworld Recycling Limited. The minister said the ministry had given the factories written notice on 9 December 2025 over violations of safety standards, mandatory hazard training and protective equipment, and that none complied. “People are dying on a daily basis, and the numbers are increasingly unaccounted for,” she was quoted as saying.

Dr Onyejeocha said preliminary findings showed regulatory breaches, including lapses in licence renewal and discrepancies between ARAP’s stated operations and its actual production. These fall under Section 30 of the Factories Act, which governs the protection of workers from harmful substances. She directed that a Prohibition Notice be issued pending a comprehensive investigation, and said workers would be protected under labour laws while it went on. A few weeks later, ARAP reopened. No official statement permitted it to resume or said whether it had met the safety standards, and the other two factories reopened as well.

‘There are holes in my two lungs’

When this reporter met Idowu Shola, 35, on 29 August 2026, his first question was how the reporter had recognised him so easily. The answer was his cough. In weeks of interviews with current and former ARAP workers, this reporter had heard the same persistent cough repeatedly, the symptom they all tied to silica exposure. Shola worked at ARAP for 16 years, from 2009 to 2025, and was one of the company’s early employees.

Minutes before the interview, a company manager walked past and Shola went over to complain about TopMed Hospital. He had pressed the company for a medical form that would allow him to be treated, he explained. The clinic gave him an injection on two visits but asked for the form again before a third, and he left in frustration. “It looks insulting to me for declining to give me a third injection because the company has not submitted my medication form for the bill,” he complained. “That is why I don’t like going to the hospital. It’s them that are supposed to fix a date with us to come at a particular time for a check-up, but the medication is not like that, because you have to complain until they do something. People are looking as if I am okay, but I am not, because I know what I am battling with. If they continue like this, we can slowly lose our lives.”

Shola was a supervisor in the mechanical department of the ramming mass section and second in command to Aniemeka. His job put him directly in the dust, and he wore two face masks. His cough began in early 2025. When medication failed, a chest X-ray led to a TB diagnosis. In August 2026 he was still coughing and vomiting, and battling fatigue, weakness and diarrhoea. Food sometimes goes down the wrong way and sets off a fit of coughing that leaves him spent, and walking fast can make him vomit, forcing him to stop and recover. A doctor told him he would no longer have the energy for strenuous work. If he survives, he might manage a lighter job, such as gatekeeping or running a small business, but he cannot afford to start one while paying for medication and supporting his family.

“My lung that is not damaged may help the other lung,” he said. “When I did the X-ray, the result showed there were holes in my left lung. The right lung also has holes with dust, but the dust and holes are much smaller than in the left. These holes cannot just cover like that. I would not have energy again. The cough, if it comes sometimes, will hold me down. I will drop everything to cough it out, and I wouldn’t be able to do anything afterward because I would be so tired.”

Shola found Aniemeka’s claim of more than 40 deaths believable because Aniemeka had been compiling names while he was sick. According to Shola, Aniemeka’s illness first began about three years earlier. He recovered, went back to ARAP because he knew no other work, and continued for another year and a half before his condition worsened and he died in March 2026. Shola himself knew at least 20 former ARAP workers who had died, and named four friends who died in 2024: Sodiq, Lekan, AB and Friday. He alleged that their families received no compensation. There is no official record, he believed, because a sick worker stops coming to the factory and later dies at home.

“If you are sick and don’t come to the company again, no one will send for you,” he said. “I used to complain and beg people for money. Once the salary came in, I would pay the people I owed, buy drugs and take care of myself and my family. My wife just got pregnant. There are more than 100 people currently working there. People are there to survive. That is their daily bread. Companies should understand the danger they are putting people through. They don’t see it as important. I started with ₦850 a day and we were paid weekly. We put stone inside the machine. There are two departments, and the tundish department has fewer hazards.”

He added that dust exposure can leave lasting damage even after a worker quits. He called for regular medical examinations and for workers to be rotated out of dusty areas to limit prolonged exposure, and warned that symptoms may not show for years. “According to what the doctor told me, I would not have energy to work again,” he said. “But as a man, we need to survive. The only work we know is ARAP. I cannot calculate the amount I have spent. I told the company to give us medication assistance.”

Shola said ARAP is not the only source of pollution in Ogijo. He named African Non-Ferrous Industries Limited (Anfil), which he linked to lead dust and heavy-metal contamination of the air, soil and water, and Metalworld Recycling Limited, which processes hazardous industrial scrap, notably used lead-acid batteries, into lead, aluminium and zinc ingots for export. According to him, the factories share the same premises, and chemical smells drift across the community. Asked why people stay, he said many have no choice: some have built homes they cannot afford to leave, and jobs are scarce.

Workers who left

Elijah Awosika, 26, worked at ARAP for six years, starting in 2019 while still in secondary school because of family difficulties. He was a loader, packing ground stone and chemicals into cement bags. Nose masks were available, but wearing them all shift was hard because sweat soaked them, and the work forced loaders to keep moving quickly. Shifts ran from 7 a.m. to 6 p.m., with night work at times, and he said workers sometimes ended up sleeping in the dust. His daily pay rose from ₦1,400 to ₦2,100 by the time he left. He said workers were only told to wear nose masks and never informed about the possible health effects of boric acid in the materials.

When Simon Oguche, Baba Ijebu, Lekan and other workers died, Awosika grew afraid. He had earlier been advised to drink hot water for chest tightness, and the deaths made him suspect his symptoms were tied to the factory’s dust. In 2024 he told his contractor he was unwell and needed a medical check-up, but the contractor warned that the cost of the test would be deducted from his wages. He could not afford that, so he asked a colleague to help him pretend to faint so that he would be rushed to hospital. The plan worked, and a test showed early infection in his left lung. He left ARAP as soon as he was discharged and treated himself for four months.

“I still feel slight pain in my lungs, especially when the weather is cold, when there is a strong breeze or when I drink something cold,” he said. “I plan to have another X-ray. When the doctor said I was getting better, I decided to leave because I did not want more dust to affect me. Even after leaving, I continued to experience symptoms and treated myself for four months. I am still receiving treatment.”

He recalled how Super Ola, a close supervisor, fell ill and died in December 2025. Ola’s first symptoms appeared in October and resembled a fever, and at the end-of-year inter-factory football competition he complained of typhoid and could not finish the match. After his death, former workers opened a WhatsApp group and shared videos on social media to draw attention to what was happening. Some of Ola’s relatives objected, Awosika said, because they did not know what had passed between him and the company, and they threatened to report the group to the police unless the videos came down. Awosika closed the group and deleted the videos. His experience at the factory taught him that workers who develop a fever often treat it themselves and keep working, believing it is an ordinary illness, until they become too weak to continue. A cough can then last for months, and among the workers he knew, he said, no one who reached that stage had survived.

Onome David, 23, lived in Ogijo for six years and worked at ARAP for three before leaving in 2023. He quit after a friend and colleague, Emeka Ifeanyi, fell ill. Ifeanyi could not defecate for a week, and tests showed his left kidney had been affected. He had worked at the company for two years. David said ARAP, which processes stone for silica ramming mass, and True Metals Nigeria Limited, which recycles lead-acid batteries, operate inside the same compound, and he had worked for both. He noticed an unusual sweet taste in his mouth and throat and left factory work in December 2023, fearing kidney trouble like his friend’s. Residents, he added, regularly complained about pollution.

Compensation

Philip Dominic, 35, a former ARAP worker, is the brother of Samson Ndifereke, known as Baba Calabar, who died in May 2026 at 41. Samson worked three years in the mechanical department of the ramming mass section, where he was regularly exposed to dust, and Dominic had worked in the same department before leaving. Samson’s illness began with a cough. The family first took him to TopMed Hospital for tests and treatment and paid for his medication, and as he grew worse he was moved to Olabisi Onabanjo University Teaching Hospital in Sagamu, where he died after about three months of illness.

“When they realised he was getting worse, they transferred him to the general hospital,” Dominic recounted. “He died there, and the company called to tell us our brother had died. The hospital asked us to come and see him before he was taken to the mortuary. They had been giving him paracetamol, and when his condition worsened, they moved him from one hospital to another.” Samson tried every remedy he heard of, including drinking heated oil on the advice of others, and fatigue eventually left him unable to do ordinary tasks. The family learnt only after his death that he had an eight-year-old child in the village.

ARAP later gave the family ₦300,000 for burial expenses, Dominic disclosed. “I found out on the day of the burial that they had paid ₦300,000,” he said. “If I had been there, I would not have accepted that ridiculous amount. Is that money? It is better to close the company. I cannot count the lives lost, and people are still going there to work because they do not know what is happening.” He called on the government to create better job opportunities so that people are not forced into dangerous work.

Inside the factory today

On 28 August 2026, this reporter met two current ARAP workers, Uztaz and Bello Issa, who live near ARAP and the battery-recycling company. Uztaz, a supervisor who has worked at the company for just over a year, coughed repeatedly as he spoke. He understands the dangers of working in a dust-filled environment, he conceded, but has little choice because he needs to earn a living and feed his family.

Both men described limited access to medical check-ups and inadequate safety equipment. Workers are supposed to undergo examinations every two weeks, they said, but these were not happening, and the company had stopped giving workers the milk they used to receive to blunt the effects of the dust. One of them said work clothes tear within a week or two, forcing workers to turn up in their own clothes, shoes and slippers, and that safety boots and other items are not replaced regularly. “You can get boots this year and still be using the same pair the following year,” he said. He alleged that the company supplies complete protective equipment only when government officials are expected, and that workers without it are told to hide in a corner. “Once the government leaves, they collect it back,” he said.

Medical care is harder still for contract workers, he explained. A worker who falls ill reports to his contractor, who has limited power to arrange treatment. Contractors sometimes take about two workers to hospital each week and pay the bills themselves. Some sick workers travel to their villages for care, and others return to work after recovering even if the underlying cause has not been addressed. He pointed to Mr Ola, who fell ill, recovered, went back to work and later died, and argued that the outcome could have been different if the company had responded when symptoms first appeared. “If the company had taken action when it started, it would not have become like this,” he said. Nearly all the workers are employed through contractors, he added, which leaves them with little influence over their conditions. He named TopMedics as the hospital the contractors use.

Amaechi Sunday, 36, looked emaciated when this reporter met him. He quit ARAP on 22 August 2026 after more than four years, and was promoted to replace Super Ola, who died in December 2025. He worked from 7 a.m. to 6 p.m. in heavy dust and had not developed a persistent cough, although he coughed during a phone call with this reporter in October and attributed it to something being fried beside him. He quit because the stress was too much and his pay could not feed him properly. “I stopped working there on 22 August 2026 because I could no longer cope with what I was going through,” he said. “As a supervisor, the work was too stressful. I controlled workers, and I had been assistant to Super Ola before he died and I replaced him. The dust is too much. They also delay our pay. Instead of paying us every two weeks, they add another seven days. I calculated everything and decided to leave.”

Residents react

Ogijo is home to several factories, including ARAP, True Metals Nigeria Limited, African Non-Ferrous Industries Limited and Metalworld Recycling Limited. Residents live, work, attend school and buy food close to these sites, and they say emissions have blackened and damaged the roofs of their houses. Exposure to industrial pollutants carries serious health risks, though the effects depend on the substances involved and the level and duration of exposure.

Residents who have lived in the community for eight years said factory operations are affecting their breathing, and that the problem used to be worse at night. They did not know the health implications when they built their houses, they said, and some water tanks have been contaminated with chemicals. They want the government to remove the factories. “It is affecting us. Sometimes we cannot breathe properly because the fumes choke us. When the chemicals are released, our eyes hurt. The government should help remove the factories. Look at how damaged our roofs are. Some people’s water tanks and taps have also been affected,” one resident said.

Joe Segun, another resident, said the factories processing metals, batteries and stone have affected the community. Some workers have developed kidney problems and others struggle to breathe, he said, and the noise is especially loud at night, which this reporter also experienced while staying at a hotel nearby. A third resident, who said the companies arrived after the community was established, blamed the fumes and gases for breathing problems and urged the government to shut the factories.

What experts say

Christopher Muyiwa Opeyemi, a Fellow of the West African College of Physicians, honorary consultant pulmonologist at the University of Ilorin Teaching Hospital and senior lecturer in the Department of Medicine at the University of Ilorin, noted that the International Labour Organization has confirmed that inhaling silica dust at work harms the lungs. Workers who breathe it repeatedly develop progressive scarring, he explained. Immune cells in the lungs called alveolar macrophages take up the silica but cannot break it down, which sets off persistent inflammation and fibrous nodules in the tissue. The disease takes four forms: acute, which can appear within weeks or years of exposure; accelerated, within five to 10 years; chronic, which typically appears decades after first exposure; and progressive massive fibrosis, in which chronic silicosis fills the lungs with extensive scarring. The usual pattern is that a worker is exposed repeatedly over several years, and how fast the disease progresses depends on the total duration of exposure and its intensity, meaning the dose of dust inhaled.

Early warning signs are unexplained breathlessness with unexplained weakness or weight loss, and a persistent cough that gradually worsens in a worker with a history of exposure, he said. He named three tests as the most important for diagnosing and monitoring silicosis: chest X-ray, chest CT and spirometry, which measures lung function. Diagnosis rests on combining a patient’s occupational history with chest X-ray or CT images. People about to start jobs where they could be exposed to silica should have a chest X-ray before they begin, he said, and exposed workers should repeat it regularly to catch the disease before symptoms appear. A normal X-ray before the job, followed by a clinical diagnosis of silicosis after documented work in a silica-dust industry, may qualify a worker to file for compensation under International Labour Organization rules.

Opeyemi warned that doctors without specialist training in lung disease often mistake silicosis for tuberculosis (TB). The two diseases cause similar symptoms and similar patterns of lung damage on a chest X-ray, TB is much more common in Nigeria, and a doctor who does not probe a patient’s complaints and occupational history may assume TB. The two can also occur together, because silicosis makes a person more likely to develop active TB. The cost of the mistake is high, he said: TB drugs will not work on silicosis, and the lungs keep deteriorating while the right diagnosis is missed.

Established chronic silicosis generally cannot be cured because it is progressive, and removing a worker from exposure may not reverse damage already done, he said. Acute silicosis responds better to treatment when it is caught early and exposure stops. Most patients with symptomatic chronic silicosis die of worsening respiratory failure or cor pulmonale, in which lung disease strains the right side of the heart. The emphasis, he said, should be on early detection and, above all, on preventing exposure by enforcing workplace dust regulations.

On the ARAP deaths, Opeyemi said proven, documented exposure to silica dust at the factory, proven non-use of respiratory protection or poor working conditions, and health histories showing no other likely harmful exposure, together with compatible chest X-ray findings, would be enough to establish that exposure at ARAP contributed to the deaths. Documented evidence that more than two ARAP workers died with similar complaints, he added, is itself highly suggestive.

He recommended that ARAP screen all prospective employees with a chest X-ray and spirometry before hiring, so that each worker’s baseline health is on record, and repeat both tests every year. Workers with occupational silica exposure should have a chest X-ray or spirometry every six to 12 months, he said. He also called for more and better respirators and enforced use by all staff, particulate monitors at strategic points around the factory to measure dust during working hours, better engineering dust controls, strict compliance with the government’s permissible exposure limit for workplace dust, and referral of any employee with unexplained breathlessness, cough or weight loss to a pulmonologist.

After watching Aniemeka’s video, Opeyemi found his account consistent with silicosis symptoms. He then reviewed Okafor’s chest CT images and said they showed fibrosis in the upper and lower lungs, with signs that the lungs are shrinking. In his judgment, she battles with silicosis and not the TB she was treated for over six months at TopMed Hospital without improvement. Shola’s CT image, he said, showed fibrosis in the right lung, and he added that specialists examine the images themselves rather than relying only on radiologists’ reports. All the workers at the plant are at high risk if exposure continues, he warned. “It is majorly diagnosed clinically and by chest CT images,” he said. “Most non-respiratory doctors will miss the diagnosis.”

He added:  “The solution for people with silicosis is Palliative management only. There is nothing like a cure except by lung transplant. Especially when most of the lung has been affected.”

Musa Wasagu, a pulmonologist at Usmanu Danfodiyo University Teaching Hospital in Sokoto, compared the damage to a skin wound that heals by forming a scar, with continued exposure making it worse. Acute silicosis can appear within months to a year, he said, while chronic silicosis, the most common form, may take 10 to 30 years. Persistent dry cough, difficulty breathing and tiredness are its main symptoms, and the disease can be fatal. He advised affected workers to see a pulmonologist and keep up regular follow-ups, and recommended chest X-rays, CT scans and spirometry to assess lung health. Employers should provide suitable masks and use dust-control methods such as wet drilling, he said, though a mask protects only if it is the right type and is worn properly. Leaving a job where silica is present does not necessarily stop the disease once it has started, but ending exposure can slow it. He called on companies to comply with workplace safety standards and urged regulators to build effective monitoring systems and impose serious consequences on employers who fail to protect workers.

As silicosis advances, the lungs stiffen and transfer less oxygen into the blood, and areas of scarring can merge and destroy healthy tissue, a condition called progressive massive fibrosis. A study of 1,487 silicosis patients published in Respiratory Medicine, “Predictors of mortality in silicosis”, found that 74 per cent of recorded deaths were from respiratory conditions linked directly or indirectly to the disease. Another study, in Occupational and Environmental Medicine, found that the risk of death from silicosis rises with cumulative silica exposure.

The World Health Organisation (WHO) identifies silica exposure and silicosis as important risk factors for TB. Its evidence review reports a relative risk of death of 3.0 for TB patients who also have silicosis, compared with TB patients who do not. Silica damages the lungs’ natural defences, making TB infection easier and potentially worsening its course, and WHO guidance supports early TB detection among silica-exposed workers, who may also have other undiagnosed lung diseases. A systematic review in BMC Public Health found a strong link between silicosis and TB and noted that the confusion between them can delay TB treatment, potentially contributing to deaths. Some workers have silicosis alone, while others have both diseases.