Bhopal: the lingering tragedyBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7479.1410 (Published 09 December 2004) Cite this as: BMJ 2004;329:1410
It was a bolt from the blue. In the early hours of the morning of 3 December 1984 toxic methyl isocyanate gas leaked out of the storage tanks of Union Carbide's plant in Bhopal, Madhya Pradesh, India. Residents awoke to clouds of suffocating gas and began a desperate flight through the dark streets. No warning alarm was given, and no evacuation plan had been prepared. It was an industrial disaster without parallel in history. Victims arrived at hospitals blind and with breathing problems. Doctors did their best to manage them, but it was an exercise in futility. The causative agent had not been identified, and so treatment was empirical. Only the next morning was the magnitude of the devastation seen. Dead bodies of humans and animals blocked the streets. Leaves had turned black, and an acrid smell lingered in the air. The sheer enormity of loss was heartbreaking. Destruction, under the guise of development, had smoked life out of the town.
Twenty years down the line the nightmare continues. A 40 year old woman breathes with difficulty in her one room home. Her husband works at a construction site. He is breathless even at rest. Prospective employers hesitate to take him on, because they view him as a liability. Both of them have interstitial lung disease resulting from exposure to methyl isocyanate gas. Treatment is free, but the prognosis is poor. With no steady source of income the couple's future looks bleak.
The Union Carbide plant had been a symbol of development in the town. It offered employment to many people, directly and indirectly. It was seen by the local population as a landmark to be proud of, and their hopes and aspirations were inextricably tied to it. It offered attractive salaries and was seen by many as a means to escape an impoverished existence. In hindsight, however, there were only questionable benefits and unquestionably cruel costs.
Another tragic case: nearly two decades after he was exposed to the gas an expert in forensic medicine is admitted to a coronary care unit with severe cor pulmonale secondary to interstitial lung disease. With a courage born of firm conviction he had stayed in town right through the disaster and during its aftermath. His skills were needed in identifying bodies and understanding the organ pathologies caused by the toxic gas. His carefully documented autopsy findings formed the basis of our understanding of the gas's toxic effects. Extensive lung damage resulting from inhalation of the deadly vapours were the wages of his diligence. An unsung hero, he finally succumbed to the after effects of inhalation of the gas.
A nurse in an intensive care unit suddenly stops giving cardiopulmonary resuscitation to a patient, as she is mildly breathless and unable to go on. When questioned, she says that she has interstitial lung disease resulting from exposure to gas during the disaster. She is worried that she herself might need cardiopulmonary resuscitation soon. During the disaster she could not flee the town because she was on duty. Victims were crowding into her hospital. The result was that she became a victim herself. Consequent lung damage was the outcome of her dedication. Fiercely courageous, she starts the resuscitation again.
In the aftermath of the tragedy the victims were compensated for their losses. More financial compensation is in the offing. Free treatment and counselling for illnesses related and unrelated to exposure to the gas have been (and continue to be) provided. Dependants of victims have been (and still are) given free medical care. Technically, the law has been followed. However, what goes unseen is the fact that the victims live with the frustration of being chronically ill, anxiety about an inadequate income, and fear of becoming unwanted inconveniences in society. There is sense of a community brimming over with disappointments, frustrations, and aggravations. How long will it simmer before things come to a boil?
In the wake of such a disaster most settlements are made through courts of law. Usually financial compensation, free health care, and rehabilitation in terms of a job and a place to stay are offered. Long term social problems—probably as painful as the initial trauma—are often overlooked. Over time they fester and create myriad predicaments of their own. Frustrations and inadequacies begin to permeate every aspect of the survivors' lives. The consequences then have an effect on the community as a whole.
Perhaps it is time to review the entire procedure of settlements, compensation, and rehabilitation after any disaster—industrial or otherwise. Legal and financial issues are certainly important, but it is myopic to stop at just these. The long term psychosocial fallout of large scale disasters needs to be dealt with, in addition to the overt medical problems. Many of these needs may be unforeseen. The capacity to deal with these tribulations is an indicator of the resilience and health of a community; it is also an indicator of good governance. With a little insight it should be possible to incorporate sensitivity, perceptiveness, and flexibility into rehabilitation programmes. It would make victims' lives easier and the world a better place for them to adapt to. Would that be asking for too much?