Bhopal: an industrially induced epidemic
- new medical report

To coincide with the twelfth anniversary of the Bhopal leak of deadly methyl isocyanate from the Union Carbide pesticide plant in December 1984, the International Medical Commission on Bhopal (IMCB) is releasing its final evaluation of the survivors.

The IMCB consisted of a team of 13 medical specialists who examined survivors in 1994 and have held detailed discussions with the authorities in Bhopal. In damning new studies(1), the IMCB has concluded that:

• medical care lacks continuity and specificity and survivors' medical conditions often go unrecognised, untreated or mistreated;
• health care and treatment which is appropriate for chronic illness is urgently needed;
• neglect of those in utero, now aged under 18, or born to gas affected survivors, is appalling: they are neither registered nor compensated for their suffering and disabilities.

Medical care
In addition to the widely recognised damage that methyl isocyanate caused to lungs and eyes, the IMCB has identified likely neurotoxi-cological damage, and evident post traumatic stress syndrome. As many as 50,000 survivors may be still suffering from partial or total disability and medical care oriented towards managing chronic pain and disability could assist survivors in maximising their remaining health.
    The IMCB believes that the Government of India needs be more proactive and could adopt Bhopal as a priority for its policy of community based health services. The government should support the monitoring of reproductive effects, cancers and other adverse outcomes.
Current medical care and treatment of Bhopal survivors generally reflects symptomatic treatment of acute illness. Some commonly prescribed drugs, such as corticoster-oids, with significant potential toxicity, have little or no demonstrated benefit. The IMCB found no apparent difference in the treatment of symptoms for persons with Carbide gas exposure, relative to that given to non-gas exposed people with the same symptoms, indicating that no therapies have been specifically recognised by the medical community for this new syndrome or injury.
    Dr. Rosalie Bertell, co-ordinator of the IMCB said that members were shocked to find "irrational, unnecessary and costly drugs being used in Bhopal on survivors of this unique industrially induced epidemic. These gas victims should have been monitored for the best available and most effective therapies. This is unacceptable medical practice and leads to further exploitation of the gas victims." The greatest need of survivors is for chronic care and economic assistance. The plight of children and young adults is especially urgent. The IMCB strongly urges the government to register, compensate and monitor survivors who were in utero, or under the age of 18 at the time of the disaster, and of the children of the survivors. Many survivors now pay large portions of their income on doctors and medicines.

Social and economic conditions
Survivors of the gas disaster have experienced severe social and economic disruption. They have lost family members and providers and in many cases lost their jobs and ability to work, have had to move to poorer living quarters, and to deal with delays and unfairness in the legal system. Survivors have not received adequate compensation.
    The IMCB also hopes that the Government of India will take seriously the recommendations of the London Session of the Permanent Peoples' Tribunal (hosted by the Pesticides Trust [now PAN UK]) which developed the Charter on Industrial Hazards and Human Rights(2).

Union Carbide shrugs off blame
While the Government of India agreed an out-of court settlement with Union Carbide on behalf of the victims, the company has not fairly met its responsibilities for the Bhopal disaster. For example, the company failed to provide toxicological information on methyl isocyanate to officials and emergency workers, and has failed to respond to repeated summons to appear before the Magistrate Court of Bhopal to answer charges of culpable homicide.
    In a decision that has brought protests from survivors and support groups, the Indian Supreme Court recently reduced the criminal charges against senior officials of the company to a charge of death by negligence, with a maximum sentence of two years. The consequences of this decision are compounded by a general directive of the Supreme Court in early 1996 (in Common Cause vs. Union of India) that cases be dropped where the commencement of the trial is delayed by at least two years and the maximum punishment is three years(3).

Conclusion
Although the medical community in Bhopal met the immediate needs following the disaster, the chronic medical, economic and social needs of survivors have not been adequately addressed. The IMCB urges the Government of India to establish an 'Indian Medical Commission-Bhopal' to oversee ongoing needs and care of the survivors, and to recommend appropriate interventions on behalf of the survivors and their children. (BD)

1. Bertell, R, G. Tognoni, IMCB: A model for the future, National Medical Journal of India (NMJ), 9:86-91, 1996; Cullinan, P., S.D. Acquilla, V.R. Dhara, Long term morbidity in survivors of the 1984 Bhopal Gas leak, NMJ, 9:5-10, 1996; Perspectives in Public Health, International Institute of Cencern for Public Health, Toronto, Canada, Vols 11-12, 1996.
2. Charter on Industrial Hazards and Human Rights, The Other Media, Delhi, India, and the Pesticides Trust [now PAN UK], London, 1996.
3. Editorial comment, India Today, 15 October 1996.

The thirteen commissioners on the IMCB were led by Dr. Rosalie Bertell, Epidemiologist, President, International Institute of Concern for Public Health, Canada.

[This article first appeared in Pesticides News No. 34, December 1996, page16]