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Article 2 of the Convention. List of occupational diseases for which compensation is payable. Extension of the scope of the list of occupational diseases and poisonings which qualify for compensation. The Committee notes the information provided by the Government in reply to its previous comments concerning the updating of the list of occupational diseases and the extension of its scope to cover all possible pathological factors arising from lead or mercury poisoning and anthrax infection, including in any atypical or new forms, as prescribed by Article 2 of the Convention. The Government indicates in particular that the revision of the list of schedules of occupational diseases for which compensation is payable in Tunisia takes place every three years, the last one having been in 2017 (Order of the Minister of Social Affairs and the Minister of Health of 29 March 2018 concerning schedules of occupational diseases). The Committee notes the Government’s indication that this revision covered 20 schedules and resulted in the creation of a new schedule relating to strong inorganic acid mists containing sulphuric acid. However, the Committee observes that the list of occupational diseases still enumerates restrictively the pathological factors from lead or mercury poisoning and anthrax infection covered by the occupational disease compensation scheme, even though the Government indicates that no cases of occupational pathology due to anthrax infection have been reported since the setting up of the occupational disease compensation scheme. The Committee also notes the Government’s statement that the review of the compensation system for eligible pathologies forms part of the overall reform of the Tunisian occupational safety and health system which is under way. The Committee once again requests the Government to extend the scope of the list of occupational diseases to cover all possible pathological factors arising from lead or mercury poisoning and anthrax infection, including in any atypical or new forms, as prescribed by the Convention, and expresses the firm hope that the reform under way will result in the adoption of substantive measures.
Application of the Convention in practice . (i) Recognition for compensation purposes of occupational diseases which are not on the list. With regard to its request to facilitate ways to recognize occupational diseases which are not on the list, the Committee notes the Government’s indication that occupational diseases not recognized by the National Health Insurance Fund (CNAM) which do not appear in the schedules of occupational diseases are considered to be diseases of an occupational nature, with doctors obliged to report them stating the nature of the toxic agent to whose action the disease is attributed and the occupation of the patient, so that the authorities can take them into account the next time the list of occupational diseases is revised. The Committee requests the Government to indicate whether workers who have contracted an occupational disease not recognized by the CNAM but whose occupational nature has been established by a doctor, and also, where applicable, their dependants, are entitled to compensation on the same terms as other victims of occupational diseases recognized by the CNAM. If not, the Committee requests the Government to provide statistical information on the number of workers poisoned by substances on the list appended to the Convention who have contracted occupational diseases not on the list but who have not been entitled to compensation.
(ii) Establishment of a procedure for the recognition of occupational diseases for compensation purposes. With regard to the establishment of a procedure for the recognition of occupational diseases, as the Committee had suggested to the Government as an alternative to expanding the list of occupational diseases, the Committee notes the Government’s indication that a proposal to this end will be discussed at the Ministry of Social Affairs with the social partners in the very near future. The Committee welcomes this information and hopes that the social dialogue process announced by the Government will result in better protection of victims in cases of occupational disease. In this regard, the Committee invites the Government to establish a procedure for the recognition of occupational diseases which are not on the CNAM list, in order to ensure that the victims of these diseases receive compensation, and requests the Government to provide information on any measures taken or contemplated in this respect.
While noting this information, the Committee recalls that it has been advised that, on the basis of the recommendations of the Standards Review Mechanism Tripartite Working Group (SRM Tripartite Working Group), the Governing Body decided that the member States for which Convention No.18 is in force should be encouraged to ratify the Employment Injury Benefits Convention, 1964 [Schedule I amended in 1980] (No. 121), which is more recent, or the Social Security (Minimum Standards) Convention, 1952 (No. 102), accepting the obligations of its Part VI (GB.328/LILS/2/1). Part VI of Convention No. 102 and Convention No. 121 reflect the modern approach with respect to employment injury benefit. The Committee therefore encourages the Government to follow up the decision adopted by the Governing Body at its 328th Session (October-November 2016) approving the recommendations of the SRM Tripartite Working Group and to consider ratifying Convention No. 121 or Convention No. 102 (Part VI), as these represent the most up-to-date instruments in this subject area.

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Article 2 of the Convention. List of occupational diseases. In its previous comments, the Committee observed that the schedule of occupational diseases established under Act No. 94-28 of 21 February 1994, as revised in 1999, 2003 and 2007, contains a restrictive list of the pathological factors associated with toxic substances such as lead and mercury, whereas the Convention is intentionally drafted in general terms so as to cover all possible pathological factors due to poisoning by the said substances, including any that might be atypical or new. The Committee requested the Government to send a copy of the newly revised list of occupational diseases together with information regarding the procedure for recognizing the occupational origin of a disease that is not included in the schedule of occupational diseases.
The Committee notes that, in its last report, the Government states that, despite prior indications that the newly revised list of occupational diseases should have been published in 2011, the process of revising the said list is still not completed. It also notes the Government’s indication that, in accordance with sections 3(3) and 87 of Act No. 94-28 of 1994, all occupational diseases are covered by the legislation concerning occupational accidents and diseases and medical doctors are obliged to report cases of any kind of occupational diseases, not only the ones on the list. However, as the Government indicates, the recognition of occupational diseases, which are not on the list, by the National Health Insurance Fund (CNAM) is impossible. The Government states that workers, who are affected by such diseases, therefore have to enforce their rights to employment injury benefits through the judicial process. The Committee requests the Government to provide statistical information on the number of workers poisoned by the substances listed in the Schedule to the Convention, who contracted occupational diseases not mentioned in the list, and who successfully filed a lawsuit to enforce their rights to employment injury benefits. Furthermore, the Committee requests the Government to indicate the reasons, for which the adoption of the new list of occupational diseases has been hampered during the past five years and indicate whether a new timeframe has been established with a view to its adoption. Should the list be amended, the Committee requests the Government to enlarge its scope to cover all possible pathological factors connected with lead or mercury poisoning and anthrax infection, including in any forms that might be atypical or new. Alternatively, the Committee encourages the Government to facilitate the ways of recognition of occupational diseases, which are not on the list, including by establishing a procedure of recognition of such diseases by the CNAM.
Recommendations of the Standards Review Mechanism. The Committee notes that, according to the recommendations made by the Tripartite Working Group of the Standards Review Mechanism, as approved by the ILO Governing Body, member States which have ratified the Convention are encouraged to ratify the Employment Injury Benefits Convention, 1964 [Schedule I amended in 1980] (No. 121), and/or the Social Security (Minimum Standards) Convention, 1952 (No. 102), and accept the obligations in its Part VI, as the most up-to-date instruments in this subject area (GB.328/LILS/2/1). The Committee reminds the Government of the possibility of availing itself of ILO technical assistance in this respect.

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In its previous comments, the Committee had observed that the schedule of occupational diseases established under Act No. 94-28 of 21 February 1994 contains a restrictive list of the pathological factors associated with toxic substances such as lead and mercury, whereas the Convention is intentionally couched in very general terms so as to cover all possible pathological factors, including any that might be atypical or new. In its report for 2011, the Government indicates that, in order to offset the limitative nature of the list and to incorporate all atypical and new pathological factors associated with the agents designated in the tables of occupational diseases, section 3 of the aforementioned Act provides for a periodic review of the tables at least once every three years. In practice, the list has been revised on three occasions since 1995 – in 1999, 2003 and 2007 – and a new decree was scheduled for adoption in 2011. The revisions take into account the latest scientific advances and the cases of newly recognized occupational diseases. The Committee takes note of this information and requests the Government to send a copy of the 2011 revised List of Occupational Diseases together with information regarding the procedure for recognizing the occupational origin of a disease that is not included in the schedule of occupational diseases, including details on how the burden of proof is regulated.

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The Committee notes the schedule of occupational diseases established by the Order of 10 January 1995 and communicated by the Government in its last report. In this respect, the Committee notes that the various pathological symptoms which appear in the column of the abovementioned schedule entitled “Description of disease” seem, as opposed to the schedule currently in effect, to be of a restrictive nature. The schedule of occupational diseases previously in effect established an indicative list, in so far as it included, at the end of each of the lists of diseases caused by different pathological factors, all the morbid symptoms that may be linked to contact with the substance in question. The Committee recalls that the Convention does not contain a restrictive list of symptoms likely to be caused by the different retained substances, but one that it is, on the contrary, drawn up in very general terms. In this way, the Convention covers all possible pathological symptoms, including those which are atypical or new and which may appear following poisoning or the action of the retained substances. The Committee therefore invites the Government to provide detailed information on this matter in its next report.

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The Committee notes the information provided by the Government in its report to the effect that Act No. 94-28 of 21 February 1994 has established a new compensation scheme for employment accidents and occupational diseases, the management of which is entrusted to the National Social Security Fund. The Committee notes that, under the terms of section 3 of the above Act, the schedule of diseases presumed to be occupational in their origin, as well as the main types of work liable to cause them, shall be established by joint order of the Ministers of Public Health and Social Affairs, and that the schedule also determines the period within which workers remain entitled to compensation for occupational disease contracted when they are no longer exposed to the causes of the disease. In this respect, noting the order of 10 January 1995 establishing the schedule of occupational diseases, under the terms of section 3 of the above Act, the Committee notes that the schedules of occupational diseases will be published in a special edition. Considering that these schedules have not been provided, it requests the Government to communicate a copy of the special edition mentioned above.

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