Mass faintings afflict the women who sew our clothes

  • Young women are fainting in large numbers at garment factories that manufacture clothes for world-famous brands like Puma, Asics, Nike, Bestseller and VF, which owns Vans and North Face.
  • In 2016, the Cambodian authorities reported that 1160 garment workers had fainted in 18 factories. In the last six months alone, 500 garment workers fainted and were hospitalized.
  • Danwatch and The Guardian interviewed fourteen garment workers at five factories in Cambodia who have fainted or have witnessed mass faintings.
  • Experts in work environment and nutrition call conditions “analogous to slavery”, and say that the international brands are in conflict with established guidelines as well as their own policies for occupational health and safety.
  • According to experts in corporate social responsibility, Puma, Asics, VF, Nike and Bestseller have responsibility with respect to wages, contracts, and working conditions – including food and drink, breaks, and temperatures – at the factories.
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Mass faintings afflict the women who sew our clothes

Clothing and shoes from brands like Bestseller, Nike, Puma, Asics, Vans and North Face are manufactured at textile factories in Cambodia, where garment workers faint by the hundreds every year. Doctors, experts and the women themselves blame exhaustion, malnutrition, overheating and panic.

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Louise Voller
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Nikolaj Houmann Mortensen
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Jarl Kaldan
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Louise Voller
Journalist
Nikolaj Houmann Mortensen
Journalist
Jarl Kaldan
Photographer
Clothing and shoes from brands like Bestseller, Nike, Puma, Asics, Vans and North Face are manufactured at textile factories in Cambodia, where garment workers faint by the hundreds every year. Doctors, experts and the women themselves blame exhaustion, malnutrition, overheating and panic.

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Our investigation:

Along with The Guardian, we interviewed 14 seamstresses working in Cambodian factories where mass faintings occurred in 2016-2017. We asked about working conditions, transport, food, housing, and how the women experience their working conditions. The garment workers’ names have been changed, and the factories’ names have been replaced by the brands they are associated with to protect the workers.

One by one, they slump over their sewing machines or onto the ground outside the factory.  Their bodies go limp, their legs give way, and their lifeless arms cannot break their fall as they hit the factory’s concrete floor.

Hundreds of seamstresses lose consciousness more or less simultaneously.  In the last six months alone, more than 600 garment workers at five factories have been treated at hospitals following mass faintings.  Some collapsed but remained conscious.  Others were unconscious for up to an hour.

One of the largest incidents occurred in November 2016 at a factory making running shoes for Asics, where 140 garment workers fainted and were sent to the hospital for treatment.  The next day, 70 workers fainted, and 150 more the day after that, forcing the factory to shut down temporarily.

In February of this year, 28 garment workers fainted at a Nike factory, and shortly thereafter, 36 were hospitalized after fainting or collapsing at a Bestseller factory.  Most recently, in March, approximately 40 workers fainted at a Puma factory. These numbers have been confirmed by Cambodia’s National Social Security Fund, the nationwide health insurance scheme.

Mass faintings

According to the Cambodian Ministry of Labour, there were 1160 reported incidents of workers fainting at 18 different factories in 2016 alone.  

In 2015, 1806 incidents were reported at 32 factories.

Source: National Social Security Fund, Cambodia

There are nearly as many explanations for the mass-fainting phenomenon as there are people making a living in Cambodia’s most important industry.  Textiles are this small developing country’s largest export, and in less than 20 years, the industry has made it possible for 700,000 women to enter the workforce and become economically independent of their husbands.  Nearly all garment workers in Cambodia are women.

Danish fashion brands such as Bestseller and PWT Group, like their international counterparts Puma, Nike, Gap and H&M, have moved to Cambodia, which offers quick and cheap manufacturing. But do these low prices come at great cost?

Interviews with garment workers, labour unions, NGOs and trade associations offer an inside look at Cambodia’s closely-guarded textile factories and paint a picture in sharp contrast to the sustainability strategies and ethical guidelines touted by these international brands.

In these factories, where hunger and exhaustion are a constant, one isolated incident can unleash a communal feeling of anxiety and resignation that causes bodies to fall limply to the factory floor.

Danish brands in Cambodia

Bestseller and PWT Group do not publish their lists of suppliers, but confirm to Danwatch that they manufacture clothing in Cambodia. Bestseller produces clothes at just under 40 factories. PWT has approximately 25% of its production in the country. They would not identify the factories they use.

A fire

It is still early in the morning of February 24, 2017, at the factory that manufactures clothes for Bestseller in Takeo Province, but the women have already been sewing for two hours.  The silent smoke that billows through the factory is the first sign that a fire has broken out in the factory.

Panic spreads among the terrified women, who run back and forth between each other looking for a way out of the factory and away from the spreading fire.  But the doors are locked.  They find a way out into the courtyard, but the Chinese line supervisor sends them back in again.  The fire is not dangerous, he says; it’s nearly extinguished.  But flames and smoke continue to curl through the long hall with its hundreds of abandoned sewing machines and brightly coloured fabrics.  The seamstresses run out of the factory three times, and are ordered back in each time.

Bestseller factory

One worker mentions the logo VILA, manufactured by the Bestseller corporation, and shipping documents confirm that Bestseller did produce clothes at the factory in July 2016.  Bestseller estimates that it has 50-60 suppliers in Cambodia, but declined to name them.

They are paralysed with fear, according to 28-year-old Thida, who was at work at the Bestseller factory the day the fire broke out.

“I felt like I couldn’t move at all.  When I heard the alarm again, we ran out of the building for the third time, and then the workers began to faint one after another, at their machines and outside.  My legs were shaking, I couldn’t move my feet.”

Tomiko, aged 18, has not been working at the factory very long.  She is performing quality control at her station when she hears the alarm.  She begins to run.

“The last thing I remember is running for the exit.  I was certain I would die in the fire.  Then I collapsed,” says Tomiko.

Tomiko and the approximately 40 other garment workers who faint wake up either shortly afterwards or at the hospital.  A third woman who was at the factory that day, 32-year-old Sohtia, wakes up at the clinic with an IV drip in her arm.  No one asks how she is, and no one tells her what has happened or what kind of treatment she has received.

“I was so scared when I woke up that I had trouble breathing.  Even though I was receiving treatment, I kept thinking about what had happened, and my heart was filled with fear. I had no energy, I couldn’t move my arms or legs.  I was completely exhausted,” says Sohtia.

Bestseller: We saw the faintings

Bestseller tells Danwatch that they happened to be at the factory for an unannounced visit the same day that the fire and mass faintings took place.

“The fire broke out at 9:45 a.m., and all the workers in the entire factory were evacuated to an assembly point in front of the factory, as they had practiced during fire drills.  At 10:15 a.m., the fire was extinguished,” wrote Bestseller in a statement to Danwatch.

According to the brand’s communications director, Jesper Stubkier, workers told Bestseller during a follow-up visit several weeks later that approximately 40 had fainted and 12 were taken to the hospital.

“We have been working with this Chinese supplier for more than ten years, and have been in dialogue with them about the incident in Cambodia,” he said.

Bestseller has been manufacturing clothing there since 2015, and at the brand’s first visit to the factory, it noted “conditions that would have to be remedied before a partnership could begin.”

These included an inadequate number of fire extinguishers, no standpipes, improperly labelled emergency exits, and deficient electrical systems.  In addition, there was only one nurse on the premises, whereas Cambodian law requires a doctor and two nurses on site at a factory that has as many workers as this factory.

Bestseller did not note the issues that the workers have mentioned; heat, lack of or turned off cooling systems, lack of water, food or breaks for employees, or the short-term contracts that are renewed beyond two years.

Terrified garment workers are treated in the hospital after faintings at a Bestseller factory in February 2017.

Day two: more faintings

That day, everyone got a half-day off from work, but the next morning, when the women punch in at the factory again, more workers begin to faint.

“I felt dizzy and my head hurt, and then I became afraid and felt very weak, so I got a half hour to recover before I went back to work,” says Sohtia.

She has fainted before.  A few years ago, at another factory, an unpleasant smoke filled the factory, and she didn’t know if it was toxic or not.  The same fear, the one that paralysed her arms and legs, is also the last thing she remembers before fainting on that occasion.

The seamstresses believe that they collapsed because of smoke inhalation and panic during the mass fainting at the Bestseller factory in February. At other factories, it might be a light bulb that explodes and sets off an alarm, or a sewing machine that gives a woman an electric shock that sends her to the floor – partly from the shock, and partly from fright.

The brain short-circuits, causing the women’s bodies to become immobilised when their lives are in danger.

But if it is panic that causes the women to faint, why are mass-faintings not documented in other parts of Cambodian society?  Could it be the conditions inside the factories that cause the women to faint all at once?

Fast Fashion

The fashion industry is extremely competitive, which means that clothing companies are constantly increasing the number of collections they offer in order to tempt consumers to buy more goods. On average, the number of collections offered by clothing companies increased from two to between four and five in the years 2000-2011.

H&M now launches between 12-16 collections per year, and Zara tops 24, according to a 2016 report by McKinsey.  Both brands manufacture in Cambodia, but were not a part of this investigation.

Sophea Norea had management measure the temperature at an Asics factory, where she works. It was 37 degrees, which is dangerous to the health, experts say.

Behind the factory walls

Production targets used to be lower: eight pieces per hour.  But in the last two months alone, they have risen so high that Sophia Norn and the other seamstresses at the Asics factory must produce 24 items per hour.  That makes 240 items per day, which is hard, she says. 

An item can be a pocket, a hemmed sleeve, or a zipper.  The seamstresses do their best to avoid tricky stitching tasks, since the production targets do not always reflect an item’s degree of difficulty.  For this reason, these tasks are favourites of the line supervisors: assigned as punishment when they believe the women are not working fast enough, or when they complain about working conditions.

Because of the ever-increasing number of collections offered by brands, the factories are extremely busy from April to September, when garment workers are expected to work overtime.

The sun is searing in May.  The temperature outside can easily reach 37ºC, with humidity at 80-90%.  In the village where Sophia Norn lives, the neighbours sleep in hammocks among the stilts that elevate their wooden houses; the air is still, and only the flies swirl about.

She appears to be unaffected by the heat as she welcomes us in jeans, a short-sleeved pink blouse, and perfect makeup.  Like most of the garment workers, she is used to wearing several layers of clothing and long pants, even when working inside factories without air conditioning or even ordinary fans – either because they don’t work, or because they are only turned on when visitors are present, the women report.

The clothing protects their arms and legs against contact with chemicals and fibres in the items they produce.

“Temperatures inside the factories are quite high,” says Norn.  Last year, as the union representative at the Asics factory, the 28-year-old asked the management to measure the temperatures at the factory.

That was after watching 139 of her colleagues fainted on the job.

At 11:30 a.m., the temperature was between 32 and 34ºC at the factory; a few hours later, it had risen to 35-36ºC, and in one building it was 37ºC.

“Certain departments have small fans to cool the area, but in others, the fans are only designed to remove dust from the factory.  So it gets very hot,” she says.

At another factory, which manufactures clothing for Puma, union leader Kim So Thet of CCAWDU measured the temperature at 35ºC using an app on her telephone.

Leakena, aged 22, works at a third factory, which manufactures for the Vans label.  She requests paracetamol a few times a week to treat her headache and dizziness, but also because she believes the pills can lower her body temperature.  But in February, after 20 women fainted at the Vans factory, something happened.

“Recently, two workers fainted again, one in the morning, one at 4:00 p.m., and then 10 to 20 more, I heard.  They got three days off to rest.  After that, I noticed that the cooling system was cleaned, and now it works a bit better,” says Leakena.

Garment workers get off work. They work 8-12 hours a day, Monday to Friday. In high season, they work Sundays as well.

How much are you allowed to work in Cambodia?

The legal workday is 8 hours, plus 2 hours voluntary overtime, 6 days per week.  Sunday is usually a day off.

In reality, however, the many changing fashion collections have increased pressure on manufacturing so much that seamstresses often work 10-12 hour days, 6 days a week.

When the workday is done, they stand crammed along with their colleagues in the back of a truck for the 1-2 hour ride home, where they get little sleep before the workday begins again.

Source: CENTRAL, Solidarity Center

Dangerous temperatures

When the temperature tops 35ºC, demanding physical labour puts a strain on the body, says Jane Frølund Thomsen, Senior Hospital Physician in the Department of Occupational and Environmental Medicine at Bispebjerg Hospital, in response to the seamstresses’ reports.

She explains that when we sweat, the perspiration must evaporate for the skin to cool off.  This requires energy.  But if the humidity rises above 60%, our bodies are unable to cool off because our sweat cannot evaporate.

“Yes, we have access to drinking water, but there isn’t enough.  We are allowed to bring our own drinking water, but not energy drinks,” says Samnang, a 28-year-old employee at a Puma factory.

It is critically important to have access to lots of water, but that is not all, says Dr Thomsen.

Health insurance for the people

In 2016, Cambodia’s workers received health insurance, called the National Social Security Fund, which pays for treatment at clinics for injuries and illnesses, whether they were contracted on the job or not. Treatment of certain serious illnesses is not covered, however. The insurance is funded with equal contributions from workers and employers representing 1.3% of salary.

A study by Better Factories Cambodia and the ILO, in which 3302 workers were interviewed by staff from Angkor Research, showed that nearly half of all workers – 46.5% – had recently felt dizzy, lightheaded, tired, or had cold hands or feet, all of which could be signs of anaemia, low blood sugar, poor circulation, or reactions to chemical cleaning agents. The ILO study concluded that if the symptoms are not treated, they can lead to fainting.

Garment Workers’ Health and Nutrition Status, and Food Provision in Factories.

“When you sweat profusely, you lose not only fluids but also salts, which are not present in drinking water.  So if you don’t replace the lost fluids with juice, milk or something else containing salt, you thin the blood.  This creates an imbalance that can affect the brain. Blood pressure falls because the body is trying to give off heat, and symptoms like headache and dizziness set in.  If you continue to work at high temperatures and humidity, your core body temperature rises. This can lead to circulatory collapse, or what is known as heat stroke,” she says.

Several of the seamstresses say that there is not enough drinking water at the factory, or that they make do without water because there is not enough time to get it.  And then there is the hunger.  All the garment workers Danwatch spoke with say that they are hungry at work.  Outside of the lunch hour from 11:00-12:00, they may not eat on the job, because they risk damaging the clothing. 

“I don’t eat between noon and 8:00 p.m.,” says Sohtia from the Bestseller factory. “I’m hungry most of the day, so sometimes I hide a snack in my clothes, but it’s not allowed to have snacks inside.  If they catch you, you can be fired.”

By 4:00 p.m., her stomach is screaming, says Leakena. “I tell myself to forget it, but on the way home I am completely exhausted, and my body hurts.”

Dr Thomsen characterises the seamstresses’ descriptions of their working conditions as “analogous to slavery”.

“The combination of physically demanding work, high temperatures, and humidity, along with lack of access to food, water or rest, would never be accepted in a Danish context.  These are slavery-like conditions, if they are not allowed access to food, drink or rest,” she says.

"We are of course aware of the fact that there is room for improvement. That is why we work every day to improve the workers environment through dialogue, follow up, training and audits in the factories".
Jesper-1
Jesper Stubkier
Head of Communication, Bestseller.
Many garment workers come from rural areas and live in dorms next to the factories. They often only see their children and parents 3-4 times a year.

Erik Jørs, a senior researcher in occupational and environmental medicine at the University of Southern Denmark, agrees.

Heat, lack of water, inadequate food, and exhaustion can lead to faintings, even mass faintings, he says.

“It is well known that illness is contagious.  We frequently see epidemics among employees at the same workplace with the same symptoms because a rumour of cancer or mould allergy spreads after just one person is diagnosed.  This could be the case with the faintings as well: you’re exhausted, you see your neighbour pass out, and suddenly you’re on your way down, too.”

These “slavery-like conditions” would not be acceptable in neighbouring Vietnam, which experiences similar temperatures and humidity, but has rather different occupational safety regulations.

This is according to Garrett Brown, an expert in work environment with the California branch of the Occupational Safety and Health Administration, who has inspected garment factories in Asia.

At factories in Vietnam, the indoor temperature may not exceed 32ºC.  If it does, the factory must install mechanisms to regulate ventilation and temperature, according to guidelines from Better Work Vietnam, a subsidiary of the International Labour Organisation (ILO).

Brown agrees with Dr Thomsen.  “If the body continues to lose fluids, there is a likelihood of serious symptoms of heat stroke: general discomfort, lack of coordination, muscle pain and cramps, fatigue, blurred vision, headache, dizziness and fainting,” he says.

“So if these illnesses, which begin at one level and have a step-by-step progression based on workers’ exposure and activity level, the result can be life-threatening heat stroke.”

The garment workers drive to and from work in trucks, where they stand closely together, 50-70 workers at a time. Every week there are accidents involving trucks and wounded garment workers.

These are slavery-like conditions, if they are not allowed access to food, drink or rest.
Jane Frølund Thomsen
Expert in work environment, Department of Public Health, Copenhagen University

Not a living wage

She gets up at 4:30 a.m., when darkness still hangs over the rice paddies and the neighbouring houses a little farther off.  She fills the rice cooker with rice and water, and reheats leftovers from last night’s dinner over the fire in the little kitchen beside the house.  Children and adults sleep in the same room on the upper floor, at the top of a steep ladder. All is still quiet.

The kitchen is a wooden shed with a corrugated metal roof.  It has neither walls nor floor, just the clay earth below and flowered saris that sway gently in the breeze.  It is already hot.  Nineteen-year-old Ary helps her mother feed the chickens before eating a little breakfast and walking to the truck that will drive her to work at 5 a.m.

“I have to be at the factory at 7 a.m., and if I have time, I eat before I start work.”

Ary jumps up onto the flatbed of the truck that carries the garment workers along the country road to the factory.  There are neither seats nor roof on the truck bed, so the women must stand for the entire trip, some for up to 2 hours.  When the truck is full, 50-60 women stand on the flat bed, holding onto a railing above their heads as the truck rocks back and forth through Phnom Penh’s chaotic traffic.

24-year old Putrea works in a Puma factory. She has a 4-year old son, whom she only sees 3-4 times a year. This is where she lives.
"Cambodia’s occupational safety laws say little with respect to heat in the workplace. There is one law, Prakas 147, which says that if employees’ health or work is affected by elevated temperatures, the employer must ensure that the workplace is cooled with fans or air conditioning. The law does not specify limits for temperature or humidity".
Heng Bon
Attorney, Solidarity Center Cambodia

The trucks are extremely dangerous, and in 2015, almost 700 were involved in traffic accidents – almost two per day.  The women are well aware of the danger, but there are no other choices.

The alternative is to leave their children and move into a room near the factory in Phnom Penh or in the huge industrial parks in other provinces.  Putrea, who works at the Puma factory, chose to do this.  The 24-year-old seamstress has a four-year-old son who lives in her hometown of Siem Reap.  She seems him about four times a year.

Putrea earns $210-220 per month, of which she sends $100 home to her parents.  It is quite normal for women to support their families in this way, whether they live at home or not.

Ary still lives at home, and she gives almost her entire wage to her mother.

“Every month when I get paid, I keep about $10-20, and give the rest to my mother.  When we built this house, I took out a loan that I am repaying now.  I have no other income,” says Ary.

The paradox is clear.  The garment industry has gotten the women into the work force, offering them an income that ought to make them financially independent.  But in reality, they are now even more trapped, since their husbands do not make as much money driving a tuk-tuk or working in construction.  This means the women have to cover expenses for the entire family, including their parents. 

It is out of the question for them to give up their jobs.  Most of them exhaust their salaries before the month is up, and only those who grow their own rice and vegetables can be sure that their families will have enough to eat.  If a parent becomes ill and must go to the hospital, the family’s fragile financial situation is thrown into chaos.

Thida would rather not work at a factory.  Her husband drives a tuk-tuk in Phnom Penh, where he sleeps in his vehicle at night and only comes home once in a fortnight.  And when he comes, he does not always bring money with him.

“I would rather have my own business.  I wish I could make more money selling vegetables or meat – then I would have time to take care of my children. But my income must sustain my family. We have debts to pay, so I have no other choice.”

Fainting is commonplace

In an April, 2017 study, 10,000 female textile workers report that the most common health problems they encounter are colds, fever, flu, headache, dizziness, fatigue, and fainting.

Health Needs, Health Seeking Pathways, and Drivers of Health Seeking Behaviors of Female Garment Factory Workers in Cambodia

What does it cost to live in Cambodia?

A living wage is a salary that can provide decent living conditions for a worker and his/her dependents within normal working hours (not including overtime) from one source of income, including a modest savings.

Basic necessities include food, clothing, housing, personal and medical items, utilities, education, transport, communication, and anything else that is needed to meet a basic standard of living.

Source: Living Wage Survey for Cambodia's Garment Industry (2009)
Increased wages – and expenses

A 2013 study from the Worker Rights Consortium showed that garment workers in 15 countries, including Cambodia, had less purchasing power in 2011 than in 2001 because of increases in the prices of food, housing and other basic necessities.

“You can be excused from overtime”

The seamstresses work Monday to Friday from 7:40 a.m. to 6:00 p.m., and on Saturdays they often work until 4:00 p.m.  There is a one-hour break from 11:00 to 12:00, when the women eat lunch.  The two hours from 4:00 to 6:00 p.m. are overtime.  Overtime is not compulsory; “you can be excused,” as several of the seamstresses put it.

But it is rare that they do.

“On payday, most of my salary disappears,” says Sohtia quietly.  Even though her poverty is obvious, it is still shameful to say it aloud.

Sohtia earns a base salary of $175 per month, and earns extra for the 10 hours of overtime each week.

“My husband doesn’t earn as much, so most of our expenses are my responsibility.  That’s why I can’t save any money at all.  I give $40 to a relative to take care of my child, and spend $2.50-5.00 on food for myself, my husband and my son per day,” she says.

“I still don’t have enough money at the end of the month.  So I borrow from my co-workers to buy food.  And even though the food I can afford doesn’t taste good, or doesn’t have proper ingredients in it, we eat it in order to fill our stomachs.”

The organisation Asia Floor Wage has calculated that in order to meet the most basic living expenses in Cambodia, a person must earn $430 per month.  The seamstresses we spoke with earn approximately $190-210 per month if they work 12 hours of overtime per week.

In other words, they make less than half of what it costs to live in Cambodia.

This is confirmed by Bent Gehrt, Field Director for Southeast Asia at the Worker Rights Consortium, who has been monitoring textile factories in Asia for more than thirteen years.

Thinner in the garment industry

Nearly a third, or 31%, of the garment workers in Krawinkel’s study were malnourished, which is double the rate of the rest of the population, in which only 14% are underweight.

Source: Nutritional and Micronutrient Status of Female Workers in a Garment Factory in Cambodia.
If the heat becomes too strong, there will be a lack of oxygen, and the workers will not get enough oxygen in their blood. That can contribute to the faintings
Doctor Sao Chanta
Sao Chanta
Doctor, Bati District Referral Health Care

“The workers earn far from enough to nourish themselves and their families,” he says.

“We once investigated the typical midday meal for a garment worker here in Cambodia.  They buy a soup made from old vegetables that are sold cheaply.  We measured its calorie content, and it’s not nearly enough.  If you assume that a person needs 2200 calories per day, then there should be 700 calories in each meal – but there are only 400 calories in that sort of meal,” says Gehrt.

The workers’ salaries are the fundamental reason for many of the problems, says Erik Jørs.

“They must work many hours in order to earn enough, but they still can’t afford to feed themselves adequately.  This causes health problems that can result in exhaustion and malnourishment.”

The low pay causes another problem, too. Overtime – which the seamstresses themselves say that they want to do, and in principle do voluntarily.

“They can’t just say no to overtime because they have short-term contracts, typically lasting three months.  So simply the threat of losing their job means that no one can turn it down, even if they’re tired,” says Gehrt.

The Diagnosis

Heat.  Overtime.  Hunger, thirst and plain exhaustion. And suddenly, panic.

Perhaps the mass faintings are not so difficult to understand.  A phenomenon that seems most of all to be a healthy reaction to an unhealthy environment calls for a medical opinion.

At Cambodia’s National Social Security Fund (NSSF), which pays for the workers’ treatment at hospitals, we hear yet another assessment of why the mass faintings take place. 

Director Cheav Bunrith says, “In the first place, we have the workers’ health.  They don’t know how to eat in an appropriately nutritious way.”

“Some factories do not have sufficient oxygen levels, because there are too many machines and workers in the same room, so the workers do not get enough oxygen.  This can be compounded by chemicals that are sprayed on the clothes or used to repel insects,” says Bunrith, noting that the Ministry of Labour advises factories in how to make improvements.

There is some indication that the cause of the faintings can be found in the minimal food the women eat in the course of the day.

"We found a relatively large number of women with anaemia, which can also be a predisposing factor in fainting. When you suffer from anaemia, you have a reduced oxygen supply to the brain. And if you work, this can easily lead to fainting or collapse. Anaemia can be caused by malnutrition, especially iron or certain vitamin deficiencies".
Michael Krawinkel
Michael Krawinkel
Professor and author of 'Nutritional and Micronutrient Status of Female Workers in a Garment Factory in Cambodia'.
"Panic over a sudden danger, like a fire or electric shock, is the trigger. Most importantly, if you are already weak and don’t eat much, and your heart is not strong enough, then you are likely to be the first to faint".
Rah Sokheng
Doctor, Sokha Bati Clinic
Hospital Director, Dr Sao Chanta at Bati District Referral Health Care treated the fainted garment workers from the Bestseller factory. They were dehydrated and exhausted, he says.

Doctors: Malnutrition, oxygen deprivation and anaemia

At Sokha Bati Clinic, it was Dr Rah Sokheng who received approximately half of the 40 workers that either felt poorly or had fainted after the fire broke out in February at the Bestseller factory.

The treatment was the same.  If a seamstress was unconscious, she would receive first aid and be examined for elevated blood pressure.  All received an IV-drip with glucose.

“And then there are those who are faking because they want a half-day off.  It’s maybe 10 out of 100, but honestly, the vast majority of them are exhausted and malnourished,” says Dr Sokheng, confirming Gehrt’s description of the poor quality of the women’s lunches.

“They buy food from the carts outside the factories, so they live off cheap food without protein, and because they earn so little money, they try to limit what they spend on food, which is why they get so little nourishment.”

A lack of food and oxygen combined with exhaustion might explain one or two faintings.  But can it explain nearly 40 or even 100 like it happened at the Puma factory at the same time?

“Panic over a sudden danger, like a fire or electric shock, is the trigger. Most importantly, if you are already weak and don’t eat much, and your heart is not strong enough, then you are likely to be the first to faint,” says Dr Sokheng.

A little while later, we drive to another hospital in the area that received seamstresses from the same factory in February.

Hospital director Dr Sao Chanta at Bati District Referral Health Care receives us warmly.  He is proud of his hospital, a part of the national health insurance programme that began last year to treat workers for free – and to send the bill to the factories via the government.

“As I see it, it is most important that the ventilation at the factories be improved to ensure sufficient air supply.  It is especially important to install fans, preferably air conditioning.  If the heat becomes too strong, there will be a lack of oxygen, and the workers will not get enough oxygen in their blood. That can contribute to the faintings,” says Dr Chanta.

“Finally, the workers must eat and drink enough, with clean drinking water.  If these things are implemented, the mass faintings will be radically reduced.”

What is Better Factories Cambodia?

Better Factories Cambodia was founded in 2001 as a collaboration between the US government, which offered a favourable trade deal with Cambodia regarding textiles – the US-Cambodia Bilateral Textile Trade Agreement – in exchange for upholding ILO conventions on workers’ rights in the country.  The BFC monitors garment factories in Cambodia and offers guidance to businesses, but does not have legal authority.

Sky-high food prices

The pay for Cambodian garment workers has in fact risen quite a bit recently, from $50 in 2007 to $153 in 2017. At the same time, however, the price of food has risen more than 84%, according to calculations Danwatch made based on figures from the Cambodian Ministry of Agriculture. According to Asia Floor Wage, $153 is still far below the “living wage” in Cambodia of $430.

Additional food leads to clear improvements

Among those paying attention to the garment workers’ nutrition is Professor Michael Krawinkel, who does research into malnutrition at the University of Giessen’s Institute of Nutritional Sciences in Germany.  He recently issued a report on malnutrition among Cambodian garment workers.

“I was most surprised by the high incidence of malnutrition and anaemia among the workers, as well as by the amount of money they spend on food.  Even by Cambodian standards, it is a surprisingly small amount of money to spend on food purchases.  The women try to spend as little as possible on their own lives in Phnom Penh,” says Professor Krawinkel.

“The low calorie intake could easily be a contributing factor to fainting, and therefore offers of food and drink could certainly help prevent the faintings.  But of course that costs money, and so the brands that manufacture here would have to accept the additional cost.”

According to the seamstresses interviewed by Danwatch and The Guardian, only the factory that manufactures clothes for Nike offers its workers a free meal.

The organisation Better Factories Cambodia (BFC) was founded as a collaboration between the USA and Cambodia, in which the USA offered favourable trade agreements to Cambodia’s garment industry if the country promised to uphold the ILO’s core conventions on workers’ rights.  BFC’s job, therefore, is to visit factories and attempt to correct problems like the mass faintings.

Arianna Rossi of Better Factories Cambodia says that the organisation experimented several years ago with free lunches at selected factories. 

The report concluded that the workers who received snacks or meals showed “significant improvements” and achieved markedly better food security.

ILO: Key principles on working-time arrangements
  • Need for daily, weekly and perhaps annual limits on working hours
  • Importance of keeping overtime exceptional, limiting the number of additional hours and providing adequate compensation
  • Right to regular and uninterrupted weekly rest
  • Right to paid annual leave
  • Need to keep night-time work exceptional and warranting special protection
  • Importance of enterprises’ needs in respect of flexible working-time arrangements
  • Right to collective bargaining and the full and genuine consultation of employers’ and workers’ representatives on working-time regulation
  • Need for an effective labour inspection system or other enforcement measures to prevent and punish abusive practices
Source: ILO
Some of these cases are mass-acting. If they see an official, they faint.
loo
Ken Loo
Generalsekretær for Cambodjas tekstilindustris brancheforening, Garment Manufacturers Association Cambodia

Cambodian trade association: “It’s an act”

The Cambodian garment industry consists of just over 800 factories, worth in excess of $5 billion.  Nevertheless, it is vulnerable to a phenomenon like mass faintings.

Every day that a factory must shut its doors, its owner loses $100,000 on average, according to Ken Loo, general secretary of the national garment industry’s trade association, Garment Manufacturers Association Cambodia.

He also doesn’t quite believe in the mass faintings.

“To begin with, the term ‘mass-faintings’ is imprecise.  It’s not 100 people fainting at once.  You have perhaps 100-150 people who become nauseated or feel unwell, and they are all sent to the hospital for treatment.  Then the reports say 150 faintings.”

Loo believes the faintings have only one thing in common.  “Low blood sugar,” he says.

“Of course there are cases where there has been inadequate ventilation or overheating, but these are the exception, not the rule. By and large the main cause has been poor health and low blood sugar.”

Don’t you have any responsibility as an industry?

“Of course it’s the employer’s responsibility to ensure decent working conditions, or at least make sure that they don’t cause the workers to faint.  So a decent temperature level and proper ventilation.  But if the workers don’t eat breakfast, and for one reason or another faint at 10:00 a.m., that’s not the employer’s fault.”

A fair amount of research suggests that they are in poorer health and have lower BMI than other Cambodians. What do you say to that?

“I don’t know anything about that.”

What about anaemia?

“Well, anaemia, I don’t know if it’s high compared to the rest of the population, but if you say you’ve seen research…”

I’m just wondering if there’s a connection here.

“Well, obviously there’s a connection, they’re skipping meals!”

The workers say they are not allowed to eat snacks during the day, because it can damage the fabrics…

“Not alone damage the fabrics, they’re supposed to be working!”

Yes, but if the reason they’re fainting is low blood sugar, perhaps an idea would be to allow them snacks and water?

“A number of these are cases of mass-acting.  If they see a government official, they faint.  But as soon as the official isn’t looking at them any more, they’re talking on their mobile phones again, full of energy.  It’s just an excuse for a day off for them.”

Loo continues, unprompted.

“Perhaps you would like us to comment on the unions’ accusations that workers are not paid enough to eat properly or to live in proper houses, but this is total nonsense.  They all have smartphones.  If I choose to use public transport or walk to work and live in a big house, I can’t claim that I don’t earn enough to own a BMW.  It is a life choice, and it’s the same for the workers.  They can’t say they don’t earn enough when they all have a smartphone.  You say that communication is a necessity? Fine. But you don’t need a smartphone.  And some of them take out loans to buy motorcycles.  If the banks give them a loan, then their household income must be at a certain level.  If you don’t eat properly, I’m sure you can get a loan from a micro financing institution.  So I won’t accept that assertion. It’s nonsense and stupid,” he says.

“We take faintings seriously”

Bestseller, Puma, Nike, VF and Asics confirm that the mass-faintings happened, and all brands have conducted an inquiry either right after the faintings or in relation to interview requests from the Guardian and Danwatch.

We have asked for specific interviews, but unfortunately this has not been possible according to the brands. Instead, they have answered our questions in writing.

All brands claim to be in compliance with ILO regulations, and that the worker environment at their factories is in compliance with their own policies on occupational health and safety.

At Asics, whose factory experienced 290 workers faint in November 2016, they state:

“Overall, fainting is a complex situation in Cambodia with multiple factors to consider. ASICS takes all cases involving its supplier base very seriously, as compliance with international safety and ethical working standards is of utmost importance to us”.

At Puma, whose supplier factory experienced 150 workers faint in March this year. Head of Communication Kerstin Neuber writes:

“We recognise that Cambodia presents unique challenges from a compliance perspective; we have never been confronted with this type of issue in the other countries, in which we source”.

At Nike, whose supplier factory experienced 28 workers faint in February this year, Communications Director Alex Smiddy, writes:

“We take the issue of fainting seriously, as it can be both a social response and an indication of issues. Therefore, we’ve continued to review the incident from February 2017 to more deeply understand the factory’s adherence to the Nike Code of Conduct and Code Leadership Standards”.

At VF, whose supplier factory experienced 20 workers faint in December this year and 21 workers faint in September 2016, Director for Public Relations, Vanessa McCutchen, writes:

“It is of absolute importance to VF that all workers in our supplier factories are operating in safe, healthy environments where human rights are respected. Our teams work hard to make certain that working conditions in our contract supplier factories, including temperature or working breaks, are followed per local laws and regulations”.

At Bestseller, whose supplier factory experienced 40 workers faint in February, Head of Communication, Jesper Stubkier writes:

“It is of course regrettable, and as described, we have addressed this specific incident. We are currently looking into how we can further address some of the issues, which are causing mass-faintings”.  

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