Buying a packet of cigarettes in Belgium these days can be a harrowing experience.

European cartons already carry large health warnings, such as “Smoking Kills” and “Smoking When Pregnant Harms Your Baby,” often framed in black and occupying up to half the surface of the pack. But since May, smokers in this rain-swept country of 10 million people have also been confronted with graphic pictorial warnings on their cigarette packs.

The pictures are not for the faint-hearted. One shows a man with a swollen-red tumour protruding from his neck. “Smoking can lead to a slow and painful death,” reads the advice underneath.

Another shows a smoker in a prison cell clutching bars made of cigarettes. The moral of the story? “Smoking is addictive. Don’t start.”

Other pictures the Belgian government plans to rotate over the next three years show toothless gums, blackened lungs and open heart surgery.

So far, Belgium is the only European country to force manufacturers to splash gory pictures across cigarette packets. But Britain, Latvia, Portugal and Romania intend to follow Brussels’ example in future, according to the European Commission.

Speaking at the launch of a photo exhibition showing how other countries are using cigarette cartons to get their anti-smoking message across, EU Health Commissioner Markos Kyprianou said: “Pictorial warnings are a cost effective public health measure, which not only serve as a prominent source of health information, but are also likely to reduce tobacco use in the population.”

Evidence from countries which have introduced photo warnings appears to suggest Mr Kyprianou, who used to get through a packet of smokes a day, is right.

In Canada, which became the first country to slap graphic pictures on cartons in 2001, almost a third of ex-smokers admitted the images had encouraged them to quit. And seven out of 10 adults said the warnings were an effective way of informing them about the dire health effects of smoking.

In his speech, Mr Kyprianou congratulated Belgium on becoming the first EU country to introduce pictorial warnings on cigarette packs. But not everyone shares the Cypriot’s enthusiasm.

“It’s unfair on smokers,” says Frank Schulte, a Flemish cameraman who says the pictures will have no influence on his smoking habit. “There are a lot of car accidents but if you go to buy a new car do they paste pictures of the victims on the windscreen of the vehicle? I watched my father die of lung cancer as a result of smoking and that was cruel enough. But that didn’t make me stop smoking.”

Heavily taxed by governments, barred from smoking in offices, bars, restaurants and other public spaces and now forced to carry around anti-smoking billboards, these are not happy days for European smokers.

“There is a general trend to take away the rights of smokers, who still make up one in four of the population in Europe,” says Catherine Armstrong, Press Officer for British American Tobacco, makers of the Lucky Strike and Kent brands and the world’s second largest cigarette manufacturer. “Smokers are increasingly finding themselves marginalized.”

European smokers are used to being stung by the inland revenue - a packet of cigarettes in Britain is almost twice as expensive as the United States, although most European countries are cheaper than the UK – but they are not used to facing restrictions on lighting up outside the confines of their own homes.

Ireland, a country famed for its nicotine-stained pubs, was the first EU state to ban smoking in enclosed public spaces in 2004. Since then, almost a dozen European countries have followed suit – to varying degrees.

Scotland outlawed smoking in workplaces and enclosed public spaces, such as bars and restaurants, in March and the rest of the United Kingdom followed in July. Italy, Malta and Sweden only allow smoking in sealed-off, ventilated areas. And France, where film directors still consider smoking sexy and café debates are fuelled by nicotine and coffee, introduced similar measures on February 1 – although bars and restaurants have until the end of the year to fall into line.

Other countries that have banned smoking in all public spaces except bars and restaurants include Cyprus, Estonia, Finland, the Netherlands, Slovenia, Spain and – as of January 1, Belgium.

In January, the European Commission unveiled a discussion paper entitled “Towards a Europe free from tobacco smoke,” which made no attempt to hide its support for an EU-wide bar on smoking in public. “I’d like to see a comprehensive, complete ban adopted everywhere in Europe,” said Mr. Kyprianou at the launch of the report.

The measures are certainly backed by the European public, in particular in countries where smoking bans have been introduced. Over 80% of Europeans are in favor of outlawing smoking in indoor public spaces such as offices, shops and airports. However, this figure drops to 75% for restaurants and 61% for bars and pubs, according to a poll sponsored by the European Commission, the EU’s powerful executive body.

“It should be left to the owners of restaurants, bars and nightclubs to decide what their smoking policies should be,” says Greg Prager, Director of External Affairs for Phillip Morris International, the world’s biggest tobacco company and the makers of the Marlboro brand.

Some cigarette makers, such as British American Tobacco, may dispute the effects of tobacco on non-smokers – “clinical studies have not shown a massive increase in risk,” says Ms. Armstrong – but the EU Commission is in no doubt about the hazards of second-hand smoke. According to studies quoted in its policy paper, almost 80,000 adults die each year in the EU as a result of passive smoking – at a massive cost to the European taxpayer.

The 27-member Commission, which drafts all European Union laws, is also convinced that smoking bans work. It quotes studies showing an 8% drop in tobacco sales in Italy and a 14% fall in Norway following recent public smoking blocks in the two countries. In Ireland, 80% of ex-smokers said the new law had encouraged them to kick the habit.

Europe’s tough stance against smoking stands in stark contrast to the United States, where there are few federal laws against smoking in public spaces and health warnings on cigarette packs are miniscule.

“I am amazed that American authorities have not seen the potential of health warnings that are being used all over the world,” says Garfield Mahood, Executive Director of the Non-Smokers’ Rights Association and the designer of the Canadian system. Noting that both American and Canadian Camel cigarettes are made on the same production line in North Carolina – with the former displaying virtually invisible warnings and the latter strong and stark advice about the dangers of smoking, Mahood says: “My question is: don’t U.S. kids deserve as much protection as Thai or Canadian kids?”