COPENHAGEN - "Clouds of dust were falling on us at every blow of the truncheon, but at that time we knew nothing about asbestos," recalled Jesús Ropero Calcerrada, a 73-year-old man who was tasked with scraping asbestos from railway carriages during his working life in Beasáin, in the Basque country in Spain. He and others were not offered any protection from the asbestos they were removing, according to the workers' committee.

Workers like Jesús, interviewed by Grupo Merca2, represent the most well-known group of victims of exposure to asbestos — older working men. Around 35 years ago, he and others removed the deadly mineral from wagons, armed with a truncheon and a crowbar. A year ago, he was diagnosed with mesothelioma and has to live connected up to an oxygen cylinder and receive morphine for pain.

"I have a wife, look how beautiful she is, and seven grandchildren for whom I'll put up with whatever I can. At least I hope that they get something with the compensation," he said a few weeks ago, referring to an attempt to get a settlement with his former employer.

Jesús Ropero Calcerrada died on 5 November 2022, a fortnight after he was interviewed for this investigation.

That bleak picture, of working men, drawn from heavy industries such as construction, the railways and the shipyards, is starting to change. A growing number of women have also been exposed to asbestos without knowing, and form an increasing percentage of the grim statistics.

Helen Bone, a 40-year-old former nurse in Middlesbrough, England, is one of them. Last year she was diagnosed with the aggressive cancer, mesothelioma — tumours forming in the protective tissues that surround organs including the lungs, stomach and pelvis. The cancer is overwhelmingly linked to exposure to asbestos. Bone was exposed to asbestos in both the education and healthcare sectors, as a pupil, patient and nurse — but has never directly worked with the substance.

"I was guilty of the thinking, that this was an old man's disease. But the more you go onto the support groups, the more you notice how many women have it now," she tells EUobserver.

Helen Bone's case is not an isolated example. Many women like her have spent years working or studying in contaminated buildings — or even visiting them as members of the public. The presence of damaged asbestos in buildings — including shops, hospitals, schools and public buildings — is upending the traditional picture of asbestos victims.

Not just old men

Where once working men in heavy industry were diagnosed with cancers related to a more direct exposure to asbestos, now women in professions such as teaching, nursing and other occupations are being diagnosed, as well as young people. From a widely-held perception that asbestos poses a direct occupational risk in a handful of industries, revised global figures now suggest that a once direct risk has become a diffuse risk to almost all of us.

The World Health Organization's (WHO) homepage refers to a global toll of asbestos deaths in 2004 of 107,000. Since then, new estimates of the global death rate from leading scientists have revised figures sharply upwards, suggesting that just under one quarter of a million people die from asbestos related disease each year.

Mesothelioma, a type of cancer which develops in the lining that protects the surface of some of the body's organs, including the stomach, chest and pelvis, almost always linked to asbestos exposure. Other estimates for related cancers are reached by multiplying mesothelioma cases by a specific factor. In 2012 a group of scientists suggested this factor should be increased to 6.1 for exposure to one form of asbestos, chrysotile, in the paper, Estimating the asbestos-related lung cancer burden from mesothelioma mortality.

This was followed by more research by other scientists, including the 2018 study, Global Asbestos Disaster, co-authored by Dr Jukka Takala, a former president of the International Commission on Occupational Health and a leading expert on asbestos and health.

"Nearly all international experts now agree on the annual number of deaths of asbestos globally to be around 250.000," Takala tells EUobserver.

The International Labour Organisation (ILO), together with the World Health Organisation (WHO), in their first report on the Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), published last year, come up with a slightly lower figure of 209,841 deaths linked to occupational exposure to asbestos — which is still far higher than previous estimates.

A more alarming analysis, from the Institute of Health Metrics and Evaluation (IHME), at the University of Washington School of Medicine, suggests that as many as 90,730 deaths in the EU and the United Kingdom in 2019 (the latest year for which data is available) were linked to occupational asbestos. The global occupational rate of death for asbestos in this analysis was 239,333.

No longer 'occupational'

These revised figures mean that the death rate from exposure to asbestos may be around twice as high as previous data had suggested — and in some countries three times as high or even more.

Using the IHME database and extrapolating estimated death rate for each country, this suggests a figure of more than 18,000 deaths for the UK, whilst official figures suggest instead an occupational death rate of around 5,000. In Denmark, health experts estimate around 400 deaths a year are linked to asbestos; the dataset suggests a figure of over 1,300.

On top of that, according to IHME, there has been an alarming growth in deaths from mesothelioma in Sweden, one of the first countries to ban asbestos, where all forms were banned in 1982. Takala tells EUobserver he thinks the new wave of deaths is due to the asbestos still present in buildings and continuously released to the surroundings. through various work processes, such as demolition and renovations.

He adds that he expects to see a new wave of deaths in other countries where asbestos was banned later than in Sweden.

Banned — but still widely present

Asbestos was banned throughout the EU in 2005 and earlier in a number of European countries, such as Poland in 1997, and the UK in 1999. News about bans is tracked on the website of the International Ban Asbestos Secretariat, which is working towards a global embargo of the use of the mineral and to mitigate the damage it causes.

However, it is still present in buildings all over Europe. In homes and buildings open to the public, including hospitals, schools, museums and shops, asbestos lurks in hidden places, behind ceiling and floor tiles and mixed into cement, roofing felt and textured wall coverings as well as being readily visible on roofs, gutters and soffits as well as used to insulate boilers and pipes.

This cross-border collaboration, carried out across nine European countries, looked at the state of play across Europe regarding nation state and EU strategies on asbestos; where the deadly substance is found, how it is being dealt with and the health impacts of living with the presence of asbestos. The investigation has revealed a patchy reaction to the presence of asbestos in Europe, with different countries and federal authorities pursuing widely-different policies, ranging from removal in Poland, to a so-called "management in situ" strategy in the UK.

In Europe, only the Flanders region of Belgium and Poland have developed strategies to remove asbestos from buildings. In 2017 the Dutch government proposed a ban on asbestos roofs by 2024, but its upper house, the Senate, rejected the proposal. Poland is the only EU member state with a national action plan to eradicate asbestos by 2032.

In Spain, a recent law obliges local governments to do a census of asbestos in buildings by April 2023. But the law is not entirely clear on whether private buildings should be included or not. Trade data indicate that Spain has imported more than 2.6 million tonnes of asbestos throughout the 20th century. But data is lacking on where asbestos is across Spain.

In Italy, estimates by the health ministry's prevention directorate indicates it will take between 60 and 100 years to complete reclamation. Ezio Bonnano, president of the National Asbestos Observatory, believes 350,000 students in 2400 schools are exposed to asbestos. "We can say there are still no less than 40 million tonnes of asbestos in Italy," he says. The estimate of schools containing asbestos has not shifted between 2012-2022 as new buildings with asbestos keep being discovered. The risk is therefore not declining.

In Croatia, according to estimates from non-governmental organisations, citizens have themselves removed around 40,000 asbestos roofs and facades, with some 50,000 private homes still requiring renovation. There is no data of asbestos in public buildings. Neighbouring Slovenia has no data on tonnage or where asbestos is to be found.

In the UK, an all-party parliamentary select committee recommended a 40 year timetable to remove asbestos in buildings and to create a register of asbestos, but the government has as yet refused to implement it.

No clear knowledge across Europe of scale of problem

In Flanders, figures suggest some 2.3m tonnes asbestos in public and private buildings, as well as in utilities. Starting in November 2022, private buildings for sale built before 2001 must have an asbestos certificate, issued by certified experts, which must demonstrate that any asbestos in the building is safe. By 2032 this will be compulsory for all house owners.

In the Netherlands there is no central registration of asbestos in buildings. Administrators have been encouraged to make an inventory of asbestos in schools and hospitals. An asbestos survey is compulsory prior to demolition or removal of asbestos in buildings erected before 1994, if there is any suspicion of asbestos being present. In October 2018, the lower house, the House of Representatives, adopted a motion to make a national overview of the total number of square metres of roofs to be renovated and to specify this per municipality. In August 2022 there were still 80m m2 of asbestos roofs in the Netherlands.

In Poland an official database estimates that there are about 14.5m tonnes of asbestos in the country. Whilst its national asbestos removal plan has been praised, it is not actually legally-binding on local regions, which are tasked to do the job. In 2010 the programme was amended, which meant that even some heavily-damaged roofs would not be designated as being in need of "urgent removal".

In Denmark, between 30 and 40 percent of roofs on private houses and other buildings, such as agricultural sheds, are believed to contain asbestos material. But these numbers are based on the house owners' technical reports, not evaluated by experts or sampled for health reasons. There is no overall estimate of the total amount of asbestos.

In the UK, around six million tonnes of asbestos are believed to be contained in 210,000–400,000 buildings. 90 percent of publicly-owned hospitals and 81 percent of all schools contain asbestos, Freedom Of Information requests made to the authorities by this investigation have shown but there is no national register of where asbestos is to be found which is accessible to the public.

Following the Russian invasion of Ukraine, the energy crisis has refocused attention on energy saving measures, such as better insulation. However, this may mean that asbestos hidden within buildings may be removed during retrofit, which carries risks for the general public and the workers tasked with the work as fibres become airborne.

Workers put at risk

The Recovery and Resilience Facility, a major plank of an EU programme called NextGenerationEU came into force in 2021 and aims to help the EU "achieve its target of climate neutrality by 2050", making grants and loans available to member countries worth nearly €724bn, with 37 percent of the funding being targeted at investment in green transition. Funding is available for renovation — but if it is carried out without clear action on worker protection whilst asbestos is removed, it could cause even more exposure to the deadly fibres.

"There's an urgent risk that workers will be paying the price for energy saving. There are 35 million buildings — buildings that will be renovated or demolished by workers in the context of the Renovation Wave and the European Green Deal. We cannot turn our backs on them," says Tom Deleu, general secretary of the European Federation of Building and Woodworkers, representing plumbers, wood workers, electricians and others in the construction and retrofit sectors. Many of those buildings, built before the ban on asbestos, will contain asbestos.

Asbestos has since long been acknowledged as the biggest occupational killer worldwide and the major occupational cause of cancer.

The new ILO/WHO health statistics now emphasise the risks of this deadly mineral even more. They add weight to demands to change the existing occupational exposure levels (OEL) — the level of asbestos fibres in the air that can be tolerated for workers from a health perspective. Additionally, these exposure levels are only for occupational health. There are no European-wide limits or thresholds for indoor or outdoor exposure for the general public — despite the fact that asbestos related cancers can be triggered from inhaling fibres.

The upcoming renovation wave puts focus not only on exposure levels and the lack of reliable data across most EU countries about where asbestos is found, but also on the training and certification of workers who may come into contact with it during renovation.

In addition, there has until recently been little attention focussed on what happens to asbestos once it is removed from buildings. European countries have taken very different approaches to both registering where asbestos is taken to and revealing that data. In the UK the Environment Agency has provided data to this investigation for landfills where asbestos may be taken; in Poland, a picture of both illegal and legal removal is taking shape; in Flanders it is sent to approved landfills but there is some illegal dumping as well.

Some hope is emerging as two plants that claim to vitrify asbestos, rendering it safe to be recycled, have been built in France and the UK. Scaling these plants up to meet the demand as potentially hundreds of tonnes of asbestos need to be safely dealt with will prove a challenge, however.

The European Parliament has considered evidence on death rates, the lack of knowledge across Europe on asbestos in situ, unregistered landfill and ambitious plans for renovation, and together with trade unions and health experts, is calling for concerted new action.

The parliament has pushed for an ambitious new strategy — acknowledged by the EU Commission, which put forward more modest proposals in September. The lack of agreement by nation states and the EU means that pace, costs and strategy remain thorny issues.

In the meantime, it is ordinary people paying the price for political inaction.

Helen Bone had to take medical retirement from the nursing profession. "If I hadn't been diagnosed, we would be a working family, paying our taxes. I loved my job; I'm going to miss it so much". That picture is repeated in thousands of working families across Europe, as family members cope with the diagnosis of an incurable — and avoidable — cancer.