Arriving on January 19, 2013 in Chongqing on a cold and foggy afternoon, I knew that this trip to China would be different from my previous trips. However, little did I know that on this trip I would be witnessing history in the making. Our destination was Zhong County, deep inside the Chongqing municipality on the banks of the picturesque and mighty Yangzi River, where the headquarters of the “Self Help Group” led by Xiaoying, a survivor of the November 1993 Zhili Fire, was located. This fire was one of the worst Industrial fires to strike China, engulfing a toy factory in Shenzhen, killing more than eighty-eight young workers, mostly women, and injuring hundreds more, including Xiaoying,Footnote ¹ who was only sixteen at that time. They were making toys for the famous Italian brand “Chicco.” I have been lucky to know Xiaoying personally for more than a decade. She provides support to the victims of occupational accidents and diseases in China; she helps enable the transition from helpless victims to powerful agents of change, inspiring the victims not only in China, but also all over Asia.

“I was pulled out of a mass of bodies, my coworkers. I was presumed dead but somehow miraculously survived. With more than 70 percent of my body having serious burns, it took many years and a number of reconstructive surgeries to somehow get me on my feet.” These words Xiaoying spoke during one of the radio interviews she gave in November 2012 when I accompanied her to the United States where she received the American Public Health Association's (APHA) award for her outstanding contribution toward occupational safety and health. Xiaoying is one of the millions of migrant workers in China who had paid an extremely high price for the “China Miracle.” China has always amazed me with its pace of change. I had visited Zhong Country nearly four years earlier, and already I could see a lot of changes: many new buildings, a brand new highway connecting to Chongqing, and a wide range of new and modern hotels. It made me think that no country in the history of industrialization has grown at this unprecedented rate. China has also displaced Japan and become the second largest economy in the world. However, the gloss of economic growth does not reflect the heavy price China pays in terms of damage to its fragile environment and also to the health of its workers. I meet workers who have lost their limbs or been poisoned due to hazardous chemicals at the workplaces.

In the meantime, we arrived at Xiaoying's office, and she explained the preparations for the twentieth anniversary. “We are going to meet some of my ex-coworkers. We will also visit a family that lost three young girls in the fire,” Xiaoying announced to us. I understood this was the first reunion of this kind. “I am excited to meet them; we have not met for such a long time. It was difficult to find them,” said Xiaoying.

Twenty years is surely a long time, especially when you were bonded by and separated after a life-changing event. I was curious to understand how those women had been dealing with their lives. It was important to me as I had just returned from Dhaka, after meeting the survivors of the Tazreen Fire, which killed about 114 people—predominantly young women—in circumstances very similar to the Zhili Fire. I wanted to understand what was in store for Bangladesh as we were about to enter what felt like our own time machine. We traveled from Zong County into the deep villages over the hills to meet the family of two brothers who lost three daughters. All three cousins were buried side by side in their field. “Our girls were the best in the village,” said their father. “They didn't need to die so young. We never recovered from the shock and trauma.”

We heard the stories of the girls over the elaborate lunch that was prepared for us. Chinese New Year was approaching, and I could feel the festive atmosphere. I could see many young people, and I was told they come home for the festival. “This is the only time our village is full of life; otherwise young people have to go to work in cities, and we are alone sometimes with their children,” a mother of the girls remarked during the lunch. We also understood that the girls were recruited directly from the villages.

“The agents [of factories] would come to villages so that they could get the best girls,” commented Xiaoying. I felt I was witnessing the largest migration in the history of humanity. The scale is unprecedented, with the number of migrants from rural areas to the manufacturing sites in cities estimated to be anywhere between 200 and 250 million (230 million according to the All-China Federation of Trade Unions), about two-thirds the population of the United States. The Chinese “miracle” has been built on the fragile shoulders of these migrants who continue to toil endlessly in sweatshops in China for an average of ten to twelve hours a day to make “cheap” and “affordable” products ranging from low-tech toys to hi-tech computers and iPhones.

After thanking our hosts for their kind hospitality, we left the village with lots of good wishes and a big pumpkin as a return gift. Xiaoying managed to organize a meeting with four other former co-workers, who she had not met since the tragic fire. They all met at a local clothing shop, where one of the women was working. It was an emotional reunion. Almost all of them had moved ahead in their lives. Some worked in a noodle shop, and some had their own businesses, but all of them remembered Zhili starkly. Tears on their cheeks revealed that twenty years had not dampened their emotions. In the evening we sat together for dinner and talked about that “fateful day” and the working conditions in the factory at that time.

“Nobody talked about fire safety in those days. Finishing orders in time was the highest priority. The doors and windows remained locked. It was a routine. Fire exits remained blocked, and there were no fire drills ever conducted,” Ms. Chen, one of the survivors, remembered during the dinner. Coming back from Dhaka, “locked doors” and “bolted windows” reverberated in my head, as it seemed Dhaka was a repetition of Zhili. Over the years, every major fire in Asia draws an infamous comparison to the Triangle Shirtwaist Factory Fire of New York in 1911 that also featured locked doors and bolted windows. Providing safe exits is the very foundation of workplace health and safety, precautions that were denied to these women twenty years ago.

The discussion moved to how things have changed in recent times. “Such fires cannot take place presently in China,” remarked Xiaoying. “A lot has changed since Zhili. There have been adequate fire safety measures. Our sacrifice paved the way for better working conditions for future generations,” she added.

I told them about the Tazreen fire and how the women there faced similar conditions as they. They were amazed that such conditions still existed elsewhere or “anywhere.” Xiaoying expressed desire to meet the victims and encourage them to empower themselves and not to lose hope. I was hoping women in Bangladesh would also see the transformation of the Chinese victims into empowered women advocating for change. We made plans to bring them together.

The next day we visited Xiaoying's office, where she and her organization provide direct support to victims of occupational accidents and diseases. Occupational disease is the much bigger problem in present day China, impacting millions, which, Xiaoying says, is even acknowledged by the Chinese government. Health Minister Chen Zhou made an unprecedented statement in 2010,Footnote ² claiming, “Some 200 million Chinese workers serving more than 30 sectors have been exposed to various health hazards in the workplace on the mainland.” The Chinese government also updates the figures on occupational diseases annually, though most of the activists, including Xiaoying, believe that the actual numbers are much higher, as the majority of workers with occupational diseases remain undiagnosed. The report also includes more than 700,000 accumulated cases of occupational diseases since 1949, a majority of them occupational lung diseases (pneumoconiosis). Xiaoying also agrees that the burden of occupational lung diseases in China is huge. She has been working with the silicosis (lung disease due to inhalation of silica dust) victims who were exposed while making tatami mats, which are used as flooring material in Japan.

“Diagnosis was a major issue in the early years, and many of the silicosis cases were wrongly diagnosed as tuberculosis,” explained Xiaoying. “Although the diagnosis has improved, the compensation for victims is still an uphill struggle.” The difficulties of getting compensation for occupational illnesses associated with silicosis was evident four years ago in the unprecedented “Open Chest” case widely reported in the media, which really shook the authorities. It involved migrant worker Zhang Haichao, who worked in the Zhendong Abrasion Proof Material Company in Henan Province, China. During the course of his work he was exposed to silica dust and acquired silicosis. His disease was diagnosed by hospitals in Zhengzhou (capital of Henan) and also in Beijing. However, the official occupational disease hospital repeatedly refused to certify him as suffering from silicosis, and instead he was officially diagnosed to be suffering from tuberculosis. Frustrated with the official diagnosis (or lack of it), as it would not entitle him for official compensation, in May 2009 he persuaded a doctor to carry out a live lung biopsy to confirm his silicosis. This extreme procedure is not required for a disease that can be confirmed by a simple x-ray. Zhang's extreme step was widely publicized and resulted in proper diagnosis and compensation of 615,000 RMB from his employer. Xiaoying also listed other key problems workers face in claiming compensation. Many employers, in order to save money, either do not buy insurance or fail to buy the proper insurance for their workers. In cases of sickness or injury, workers find it impossible to get compensation. One of the requirements for diagnosis is to have an employment history, and most often employers refuse to cooperate in providing these documents, as they feel it might bring a bad name to the company involved. This complicates the diagnosis procedure for the victims. The monopoly of diagnoses also poses problems. Migrant workers are routinely made to run from one clinic to other as “official” clinics in their hometowns do not recognize their diagnosis.

As I reflect on this trip to China, I feel that in the past decade there have been a lot of changes in China and that the growth of grassroots victims groups has been one of the most important steps in bringing about realistic and sustainable reform. I have also witnessed definite changes in state responses to worker safety and health, although this change of heart did not occur overnight. If the developments are observed closely, for the past decade the change or improvement has been in response to the growing victims' movement in China, which at times has been the most radical form of the labor movement inside China. Ironically, the impetus at the macrolevel has been predominantly in the area of fostering technical collaboration with the Chinese state agencies and the official trade union—the All-China Federation of Trade Unions (ACFTU). Both the US government and European Union have injected millions of dollars into the Chinese economy to help improve its safety, and grassroots health groups receive almost no mention at macrolevel policy briefings; neither are they consulted or involved in these “technical” discussions. The OSH problem in China is not merely a technical issue, as it is sometimes portrayed, which can be solved by technical collaboration. The critical question remains: How can workers and victims be involved in the process of decision making to foster grassroots democracy in a country where most of the decisions are taken centrally? The empowerment of these grassroots groups is crucial in envisaging future change. We strongly believe that reform in China has come from within and will continue to come from within, so we need to play a moderating role in strengthening these organizations to enable them to fight for themselves.

Xiaoying was badly injured in the Zhili fire with most of her body burned, and no one thought she would recover. She received sympathetic support from everyone, but that did not change things. Xiaoying decided to stand firm and take a lead in organizing the victims. She personifies the determination of victims to fight for worker health and safety from within. There are millions more itching to lead the change. How long can they be ignored?