The coroner’s words at the conclusion of Wassam al Jundi’s inquest were matter of fact.

“Diagnosis of severe silicosis lung disease. Awaiting lung transplant. Admitted on Friday 17 May 2024 for potential lung transplant to Harefield Hospital. Had deteriorated since last review with pulmonary hypertension. Bedside echo showed severe pulmonary hypertension with pericardial effusion and left ventricular compromise. Not suitable for transplant as too unwell. Deteriorated and died in hospital on 22 May 2024.”

Wassam had been exposed to silica. The dust is a potent killer, causing the lung-petrifying disease silicosis and cancers, lung, renal and autoimmune diseases. Any work in quarries, ceramics, construction or brick making comes with a potentially fatal exposure risk.

But engineered stone is different, and Wassam worked with engineered stone. The artificial stone product produces a dust that is much finer, remaining suspended in the air for months rather than minutes (Hazards 165). It can penetrate deeper into the lungs, destroying the air sacs, causing the development of silicosis faster and killing workers from the progressive disease much younger.

Marek Marzec (above), a father of three originally from Poland, but living in London, had been employed since 2012 by several engineered stone firms in north London and Hertfordshire. Like Wassam, he was told he is no longer well enough for a lung transplant. It was his only hope to extend his life.

The 48-year-old was diagnosed with silicosis in April 2024. Since then, his condition has deteriorated rapidly, and he has been told by doctors he has only weeks to live.

Speaking from his hospital bed at London’s Whittington Hospital, Marek said: “I arrived in the UK hoping to build a better life and wanting to make sure that my young daughters were financially secure. Instead, because of the work I did cutting quartz worktops, I have been left unable to breathe and in terrible pain.”

‘At risk of death’

Both Marek and Wassam worked with engineered stone, an artificial product made from silica blended with resins and other additives. Its main use is as an alternative to granite and marble in kitchen countertops.

Wassam started work in the industry aged 20 in May 2016. He was diagnosed with silicosis just five years later. By May 2024 he was dead at just 28 years of age.

Lydia Brown, the West London senior coroner who is overseeing Wassam’s inquest, is concerned work with artificial stone comes with “a risk of death”. In the 25 October 2024 Prevention of Future Deaths report based on her investigation into Wassam’s death, she notes: “The last two decades have seen a rapid growth in the use of artificial stone and this death demonstrates the emergence of a severe progressive form of silicosis.

“Many of the companies specialising in the finishing process of working with this product have a small number of employees and there appears to be an absence of safe working conditions, with no adequate water suppression systems for the dust created, inadequate respiratory personal protective equipment and absent or inadequate ventilatory systems.

“This is therefore continuing to put the workforce at risk of death due to untreatable lung compromise.”

DEATH WISH A 25 October 2024 coronial Prevention of Future Deaths report after the death from silicosis of artificial stone worker Wassam al Jundi aged 28 is demanding the Health and Safety Executive (HSE) explain by 23 December 2024 “action to be taken or proposed to be taken, setting out the timetable for action. Otherwise you must explain why no action is proposed.”

Both Wassam and Marek were patients of Dr Jo Feary, a lung disease specialist at London’s Royal Brompton Hospital. Since mid-2023, when she was referred her first case, she’s seen 16 relatively young men with silicosis caused by engineered stone exposure.

Other countries have seen thousands of cases. Britain has identified just a handful. But engineered stone is a large and growing nationwide industry in the UK (Hazards 165). It is home to Europe’s largest manufacturer. The problem is certainly out there. It will just take a greater effort to find it.

Hidden victims

In 2015 Australia had just one confirmed case of silicosis related to engineered stone. This prompted investigations by workplace safety regulators, and the identification of a further 5,000 workers diagnosed with the condition.

In the US, it took a 2019 review of hospital silicosis discharge records to identify the country’s first case linked to engineered stone. By September 2024, there were 178 confirmed cases of silicosis in California alone related to engineered stone, according to an October 2024 UCLA Center for Occupational and Environmental Health report, with at least 13 deaths and 19 lung transplants.

STONE DEAD Hospital lung disease consultant Jo Feary is treating dying engineered stone workers. Like some of HSE’s own experts, she believes the UK silica dust exposure standard isn’t sufficiently protective and a ban on engineered stone can be justified.

But Britain and HSE lack this intelligence.

Responding to questions from Hazards after the regulator was instructed in the Prevention of Future Deaths report to explain what it was doing to address the problem, an HSE spokesperson said it “is engaging with occupational lung disease clinicians to build their understanding of how these cases are diagnosed, which will help to inform future interventions in this area.”

Britain’s entire intelligence on engineered stone-related silicosis so far comes from Dr Feary’s London cluster. Writing with colleagues in the journal Thorax about the initial eight cases of artificial stone silicosis reported in the UK, with an average age of 34, she said current UK guidance fails by design.

The August 2024 paper notes this guidance recommends monitoring workers in the industry after 15 years, but that is very likely to miss cases and fails to account for intensity, not just length, of exposure. “The cases we present illustrate the failure of the employer to take responsibility for exposure control in their workplaces,” the paper notes. “National guidelines are urgently needed, as well as work to enumerate the at-risk population and identify cases early.”

It is a problem senior coroner Lydia Brown says was illustrated in the case of Wassam al Jundi, dead at 28. “Any current surveillance health and safety monitoring is unlikely to achieve a satisfactory outcome as the onset of untreatable disease predates the 15 year surveillance programmes. In this case exposure appears to have commenced in May 2016 and he was diagnosed with silicosis in 2021, a mere five years after his initial exposure.”

HUMAN COST Personal injury lawyer Ewan Tant says his clients working with engineered stone are facing “appalling” conditions. Among several of Dr Feary’s patients he is representing is Marek Marzek, a father of young daughters who is receiving end of life care.

Dr Christopher Barber, of Sheffield Teaching Hospitals, in a Thorax editorial linked to Dr Feary’s paper, noted: “Considering the availability of [artificial stone] kitchen worktops, the arrival of [artificial stone] silicosis in the UK is one which has been feared by clinicians for some time.”

UK doctors may be missing cases, he noted, as they struggle to differentiate the signs and symptoms from sarcoidosis, a condition he says is unrelated to silica inhalation, but which has similar clinical features. 

“Greater awareness of [artificial stone] silicosis is also required among a wider range of healthcare professionals due to the increased risk of mycobacterial, renal, and autoimmune connective [tissue] disease,” he added.

Poor standards

“Evidence from photographs and an in-life statement suggest Wassam was working in completely unsafe conditions to avoid dust exposure,” senior coroner Lydia Brown noted. Her Prevention of Future Deaths report, sent to HSE and two government departments and requiring a response by 23 December 2024, stated they have the “power” to address the problem.

It is power HSE has declined to exercise. For over a decade HSE has refused consistently to introduce tighter controls on workplace silica exposures (Hazards 161) and insists there should not be a ban on engineered stone. It means UK employers work to an HSE exposure limit that is far from safe.

However, Australia and the US enforce a silica exposure standard set at half the UK limit of 0.1 mg/m³ of respirable crystalline silica and six times more protective for silicosis. HSE accepts the 0.1mg/m³ exposure standard also comes with a 40 per cent higher risk of lung cancer (Hazards 148).

Amid mounting international concerns, the UK is belatedly reviewing the UK limit.
Dr Feary and colleagues in a separate August 2024 Thorax study have reviewed the evidence already. They examined for the first time all the available evidence published up to the end of February 2023 to establish the silica cumulative risk and identify the exposure level at which that risk would be reduced.

They concluded “research supports the reduction of permissible exposure limits from 0.1 mg/m³ to 0.05 mg/m³” over an 8-hour working shift – the limits already in place in the US and Australia. 

In Australia, a 2022 Curtin University study supported by the national union federation ACTU estimated the shift from a 0.1mg/m³ to a 0.05mg/m³ exposure standard will save thousands of lives in the country each year, and possibly 80,000 plus lives over a working lifetime (Hazards 161).

The move to a tighter standard is supported by UK unions. TUC head of safety Shelly Asquith said “the current exposure limit for silica is far too high. Research shows that if the workplace exposure limit was halved it could prevent hundreds of deaths in the decades ahead. 

“The Health and Safety Executive should take urgent action to reduce the limit, and they should review the evidence presented by doctors calling for a ban.

“We also need tougher enforcement, with more resources for the Health and Safety Executive, as we know there are rogue companies who play fast and loose with the safety of the people they employ.”

Engineering a ban

In 2023, Australia announced a ban on engineered stone products following a well-organised campaign spearheaded by the national union federation ACTU. The ban took effect on 1 July 2024.

Some major users, like the homewares giant IKEA, dropped engineered stone use in Australia ahead of the ban. “Engineered stone benchtops form just part of the IKEA range and many alternative materials are available,” IKEA Australia said.

In the absence of a similar lead from HSE, the Swedish retail giant still carries engineered stone in its UK stores.

Despite the unique risks associated with engineered stone, HSE continues to treat it like other sources of silica exposure and refuses to consider a ban.

An HSE spokesperson told Hazards: “Great Britain has a robust and well-established regulatory framework in place to protect workers from the health risks associated with exposure to hazardous substances. We continue to work with industry to raise awareness of managing the risks of exposure to respirable crystalline silica.

“As part of this engagement, we are consulting with industry on best practice guidelines and we met with manufacturers of stone, on Monday 7 October 2024, to discuss practical solutions to tackle this shared issue. We will also hold further workshops with other stakeholders in the supply chain, with the aim of securing coordinated and collaborative impact on the causes of unsafe levels of worker exposure.”

The guidelines-only line has been welcomed by the UK’s engineered stone industry.  

DON’T DO IT  The Worktop Fabricators Federation (WFF) is working closely with the Health and Safety Executive (HSE) to stop the UK following Australia’s lead and banning engineered stone. 

“There is no appetite in Westminster for Australian-style product-bans,” said Worktop Fabricators Federation (WFF) general secretary Chris Pateman. “If the Australian industry had been subject to the kind of regulatory environment we enjoy in the UK, the ban would probably never have come about in the first place.”

A WFF statement “that gives the facts” on engineered stone risks, states: “We can’t stop the operation of a free market.”

Asking “who is to blame?” for the industry’s silicosis problem, it blames its customers.

“At bottom, it’s customers who want the beauty of a stone worktop but don’t want to pay the price premium associated with proper factory management, controls, health and supplier audits and expensive cutting, polishing and grinding machinery and the associated water and dust-handling infrastructure.”

Westminster’s decision not to ban was based entirely on advice from HSE. A 10 Downing Street spokesperson told the i digital newspaper in August 2024: “It remains the case that the Health and Safety Executive has apprised the government that it is not currently considering restricting its use, and that there are already regulations in place that require employers to put in place proper control measures to protect the health of workers when using it.”

Dr Feary – the consultant whose patients are dying of engineered stone-induced silicosis – does not share HSE’s confidence in these control measures and has suggested the UK government might be better advised to follow Australia’s lead.

“The [artificial stone] market is dominated by small companies in which regulation has been shown to be challenging to implement. Furthermore, at least some worktop manufacturers may fail to provide adequate technical information relating to potential risks,” Dr Feary and her co-authors state in their Thorax paper. 

“The introduction of a legal requirement to report cases of [artificial stone] silicosis, implementation of health and safety regulation with a focus on small companies, and a UK ban on artificial stone (as introduced in Australia in 2024) must be considered.”

Even HSE’s own expert advisers don’t agree with HSE’s advice. An August 2024 editorial in the journal Occupational and Environmental Medicine, whose three authors include John Cherrie and Martie van Tongeren – both members of HSE’s eight-strong Workplace Health Expert Committee (WHEC) – advises the UK to follow Australia’s lead and ban engineered stone.

They say they “disagree” with the approach preferred by HSE and the industry “because of the nature of the hazard presented by these materials and the difficulty in ensuring all employers and workers understand the risks and abide by the necessary control measures. 

“Furthermore, according to the hierarchy of control, elimination and/or substitution with less hazardous materials is most effective when reducing risks. Early evidence from Australia suggests that the ban has already resulted in innovations by the sector to develop new products with no or very low silica content.”

HSE is out of touch on silica. But it is not out of pocket. A one-day ‘Controlling exposures to respirable crystalline silica’ training course advertised by HSE for 11 March 2025 costs £560 a head.

Both the UK industry and HSE have lessons to learn – and they may be costly.
In August 2024, a Los Angeles County jury handed down a $52.4 million (approx £40m) verdict against three artificial stone countertop manufacturers sued by an artificial stone fabrication worker dying from silicosis.

Gustavo Reyes Gonzalez, 34, sued 34 manufacturers. Twenty-nine settled with Reyes, and two were granted summary judgment. The other three cases went to trial.
Among the companies sued was Caesarstone, which lists 138 suppliers in the UK (Hazards 165).

The same month Chicago worktop manufacturer Florenza Marble & Granite was fined $1m by US safety regulator OSHA for the silica exposures that left a father and son both requiring lung transplants as a result of their work with engineered and natural stone products.

We are talking big numbers at risk. An estimated 600,000 workers in the UK are still routinely exposed to the lung-wrecking dust. Extrapolating from European estimates in a July 2019 paper by Professor John Cherrie, a member of HSE’s Workplace Health Expert Committee, you reach a figure of over 150,000 UK workers who could be exposed above the current limit with a near 1-in-3 risk of life-sapping silicosis (Hazards 148).

And the deadlier nature of the ultrafine silica dust in the engineered stone industry could mean many are at a much higher risk than in traditional stone work.

Dust to dust

It is this human cost that is hardest to bear.

Marek’s solicitor, Leigh Day partner Ewan Tant, said: “This is a tragic case, with my client now on end-of-life care as a result of working with engineered stone, in what he alleges were appalling conditions, totally unfit for purpose. No-one should end up facing the bleakest of outcomes simply as a result of going to work.

WASTED LIFE  “I cannot tell you how angry I am that I was allowed to work in these conditions and that my life has been cut short simply for doing my job,” says dying engineered stone worker Marek Marzek.

“We are deeply concerned that, unless something is done to address the dangers of working with engineered stone without proper protection, we may be looking at more cases with similarly appalling – and potentially fatal – outcomes in the near future.”

The lawyer is now representing several workers whose health has been devastated by exposure to engineered stone, including the family of Wassam al Jundi.

Marek knows he too will soon leave his young family behind. “I cannot tell you how angry I am that I was allowed to work in these conditions and that my life has been cut short simply for doing my job,” he said from his hospital bed.

“I am not the only person whose life has been put at risk by this lethal dust. It is time for urgent action to stop these dangerous working conditions I had to face before other stone workers contract this terrible disease and die.”

Selected references

• Feary J, Devaraj A, Burton M, and others. Artificial stone silicosis: a UK case series. Thorax 2024;79:979-981.
• Barber C. Artificial stone silicosis arrives in the UK: a tragic case of history repeating. Thorax 2024;79:895-896.
• Howlett P, Gan J, Lesosky M, and others. Relationship between cumulative silica exposure and silicosis: a systematic review and dose-response meta-analysis. Thorax 2024;79:934-942.
• Kromhout H, van Tongeren M, Cherrie JW. Should engineered stone products be banned? Occupational and Environmental Medicine 2024;81:329-330.
• Improving Silicosis Outcomes in the UK, All Party Parliamentary Group for Respiratory Health, January 2023.
  Silicosis in stone fabrication workers. Morbidity and Mortality Weekly Report (MMWR), 27 September 2019 / 68(38);813–818.
• Fazio JC, Gandhi SA, Flattery J, and others. Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California. JAMA Intern Med. 2023;183(9):991–998. doi:10.1001/jamainternmed.2023.3295. Published online July 24, 2023.
• Hua JT, Rose CS, Redlich CA. Engineered Stone–Associated Silicosis—A Lethal Variant of an Ancient Disease. JAMA Intern Med. Published online July 24, 2023. doi:10.1001/jamainternmed.2023.3260.

How does silica dust hurt you?

Workplace silica exposure can cause potentially fatal cancers and lung and kidney diseases, and may lead to arthritis and other chronic health problems. In general, the more you are exposed, the greater the risk.

Silicosis  A progressive disease in which accumulation of respirable crystalline silica particles causes an inflammatory reaction in the lung, leading to lung damage and scarring and, in some cases, progresses to complications resulting in disability and death. Silicosis is a UK government-recognised prescribed industrial disease. Silicosis can be complicated by bacterial infections including pulmonary tuberculosis (silicotuberculosis).

Lung and other cancers  HSE accepts silica exposure is responsible for several hundred lung cancer deaths in the UK each year. It estimates males exposed to silica at the UK standard of 0.1 mg/m³ have a lifetime risk of lung cancer, Britain’s biggest cancer killer, almost 40 per cent higher than for all males. Silica-related lung cancer is a UK government-recognised prescribed industrial disease. The International Agency for Research on Cancer (IARC)  notes: “Crystalline silica in the form of quartz or cristobalite dust is carcinogenic to humans (Group 1).” In the US, the safety regulator OSHA acknowledges the lung cancer association and says there is more limited evidence of associations with laryngeal, stomach and oesophageal cancers.

Other respiratory diseases  HSE and other regulatory agencies including OSHA accept silica exposure can cause chronic obstructive pulmonary disease (COPD) and impaired lung function, with affected workers frequently diagnosed with work-related emphysema or chronic bronchitis.

Renal and autoimmune diseases  HSE publications acknowledge the link between kidney disease and silica exposure. According to the US regulator OSHA: “There is also suggestive evidence that silica can increase the risk of rheumatoid arthritis and other autoimmune diseases. In fact, an autoimmune mechanism has been postulated for some silica-associated renal disease.” It adds: “OSHA preliminarily concludes that there is substantial evidence that silica exposure increases the risks of renal and autoimmune disease.” Renal disease caused by silica exposures can be deadly. Studies have linked silica exposure at work to sarcoidosis and scleroderma.

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LAST GASP

Wassam is dead at 28. Marek, confined to a hospital bed, knows he is destined to follow soon. A coroner has demanded that the Health and Safety Executive (HSE) responds to a silica crisis killing UK workers faster and younger. Hazards editor Rory O’Neill questions when HSE will act to end the silica dust exposures that are turning lungs to stone.

SILICA ACTION!

Don’t swallow HSE’s dust line. Send an e-postcard to HSE demanding it introduce a more protective UK silica exposure limit no higher than 0.05mg/m³ and with a phased move to 0.025mg/m³