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The Bhopal aftermath –
generations of women affected

On the night of 2-3 December 1984 about 40 tonnes of methyl isocyanate leaked from a pesticide factory owned by the US company Union Carbide, in Bhopal, India, exposing over half a million people to a highly toxic cloud. Satinath Sarangi reports on the health studies continuing in the aftermath of the disaster. He calls for better treatment and care for women who have suffered reproductive ill-health.

Survivors organisations are still fighting for justice and hold an annual protest on the anniversary. Photo: Steve J Benbow

Background to the disaster
Late on Sunday evening, 2 December 1984, during routine maintenance of the methyl isocyanate (MIC) tanks, a large quantity of water entered one of the 60 tonne storage tanks. None of the safety systems was operating, and this triggered off a runaway reaction resulting in a tremendous increase of temperature and pressure. Just before midnight, a deadly cocktail of MIC, hydrogen cyanide, mono methyl amine and other chemicals was carried by a northerly wind to the neighbouring communities. Over the next couple of hours close to 40 tonnes of the chemicals spread over the city of about one million people.
   
People woke up surrounded by a poison cloud so dense and searing that they could hardly see. As they gasped for breath, the effects of the gas grew even more suffocating.
The Indian Council of Medical Research (ICMR) had exclusive responsibility for conducting research on the immediate, short and long term health effects of exposure to the gas. Some of the early effects noted included respiratory physiology and anatomy, gastric hyperacidity, chronic ophthalmic inflammation, anxiety and gene abnormalities. The research has now been halted, but no well-conducted cohort or case-control study was carried out although a cohort for following selected symptom prevalence in the affected population was assembled.

Assessment of reproductive effects
As part of its decade-long epidemiological study, the ICMR identified elevated menstrual irregularities and excessive bleeding among gas exposed residents. However, none among the 24 research projects carried out by the ICMR in Bhopal was directed towards identifying, assessing or treating reproductive health consequences of the disaster. In the context of official neglect, non-government agencies have generated critical, albeit sporadic, information on short and long term reproductive consequences of the disaster.
   
In March 1985 Dr Rani Bang and Dr Mira Sadgopal examined 224 women from severely and mildly affected communities. Their report ‘An epidemic of gynaecological diseases’ based on a study of 218 women from severely and mildly affected communities, indicated high rates of leucorrhoea, pelvic inflammatory disease, cervical erosion and excessive menstrual bleeding.
   
In March 1985, 104-109 days after exposure, a study was initiated by the Citizen’s Committee for Relief and Rehabilitation, Bhopal. This cross-sectional community based study with random sampling of both seriously exposed and mildly exposed populations showed that out of 198 women clinically examined, 100 (50.5%) had persistent reproductive system symptoms.
   
In the same month, a survey carried out by another non-government organisation, Medico Friend Circle (MFC) showed that among women in the age group of 15–45 years there was a significant alteration in the menstrual cycle in the severely exposed as compared to the less exposed. Differences included shortening of the cycle length, excessive bleeding during menstruation, change in the colour of blood, dysmenorrhoea and leucorrhoea.
   
Another MFC study on pregnancy outcome and menstrual health was carried out retrospectively on a random sample of 1632 households (population 8165). 14% of women in this study reported shortening of cycle length by five days or more, 11.5% women reported disruption of the regularity of cycle. Significantly higher numbers reported episodes of missed and delayed periods.
   
A study carried out five years after the gas leak on 136 women from the seriously affected area and 139 from mildly affected area (age 20–44 years) who had borne at least one child in the previous five years, showed that the rate of spontaneous abortion in pregnancies exposed in-utero was 26.7% in the seriously exposed group compared to 10% in the mildly affected population. In the subsequent period, rates of spontaneous abortion were 26.3% and 7.8% respectively in the two populations.
   
In January 1994, Dr Ingrid Eckerman the Swedish member of the International Medical Commission on Bhopal, an independent group of 15 medical specialists from 11 countries, reported menstrual disturbances and excessive vaginal secretion (as well as respiratory, neurological and other symptoms) among the majority of the gas affected women she interviewed

New research needed
While damages caused to the respiratory, ocular, gastro-intestinal, neurological and musculo-skeletal systems have been documented in limited studies by the government agency the Indian Council of Medical Research (ICMR), reproductive health consequences of the disaster have been paid no official attention at all.
   
Generations of women were affected by the gas. Among women who were pregnant at the time of the disaster, 43% aborted. In the years that followed, the spontaneous abortion rate remained four to ten times worse than the national Indian average. Only 50% of pre-pubescent girls who were exposed to the gas had normal menstrual cycles. It is now coming to light that even girls who were exposed in infancy and in their mother’s wombs are experiencing ‘menstrual chaos’.
   
Today, fifteen years after the disaster and in spite of persistent demands of women survivor organizations, reproductive health of gas-exposed women continues to be a neglected area in terms of official surveillance, research and therapeutic intervention.
   
In 1996, the Bhopal Medical Appeal (a project supported by the Pesticides Trust [now PAN UK]) raised funds for the Sambhavna Clinic which dispenses free health care to gas-affected people in Bhopal, and which pays special attention to women’s health.

A call for funds
The recent qualitative survey on adverse menstrual symptoms among teenage women with a history of gas exposure, convinced the Sambhavna Trust of an acute need to establish a project that monitors the problem, and for evolving safe, simple, effective and inexpensive therapeutic intervention. For the success of this project active participation of the survivors is essential. Workers at the Sambhavna Clinc believe it is possible to inspire, train and equip young women survivors in the community to monitor menstrual disorders. The specific aims of this project are:

  • To record a six month menstrual history among women aged 13-25 in neighbourhoods exposed and unexposed to Union Carbide’s gases.

  • To determine whether prevalence of reproductive system symptoms is increased among gas exposed women.

  • To determine whether the menstrual cycle length and duration of menses is different among exposed and unexposed women.

  • To determine whether fertility is reduced among exposed women.

To date over 3,200 people from the UK have given generously to the Bhopal Medical Appeal. Further donations can be sent to PAN UK Bhopal Account. Development House, 56-64 Leonard Street, London EC2A 4JX, UK. 

Satinath Sarangi is the Managing Trustee of the Sambhavna Trust, 44 Sant Kanwar Ram Nagar, Berasia Road, Bhopal 462001, India, sathyu@bhavna.unv.ernet.in


In remembrance – A ‘Day of No Pesticide Use’

The Pesticides Action Network (PAN), an international coalition of like-minded public interest groups, marks the anniversary of the Bhopal disaster, 3 December, as a Day of No Pesticides Use.
   
PAN aims to have this day recognised by governments and UN agencies throughout the world to draw attention to public opposition to pesticides through a range of actions. PAN encourages individuals, industry, researchers and governments to learn lessons from incidents like the Bhopal accident, and encourage the use of alternatives to hazardous chemicals.


Women's problems
After the incident, no one under 18 years old was registered as a victim. Yet, at least 200,000 children are estimated to have been exposed to the gas, half of them girls. As they approach the age when they should start menstruating, some girls find that they are experiencing three or four cycles a month, others have only one period in three months. Many experience pain which more than one have strikingly described as ‘writhing like a fish out of water’. It is hard for young girls to talk about such things and their mothers do not know what to do. We are looking for ways to treat this without hormonal drugs.

A sample of testimonies taken by the Sambhavna Clinic during one day in June 1999

Teenager one
Age 19 years; age at exposure 4 years
Menarche at 15 years
For the first five to six months my periods were irregular and without much discomfort. Then I stared getting terrible abdominal cramps. I get nauseous, giddy and my head aches. I take allopathic medicines to get relief from pain. My cycles are irregular and there is a delay of 5-7 days. There have been times when I did not get my periods for two months. Also there is excessive bleeding, in the form of clots. During my periods I cannot do any work.

Teenager two
Age 17 years; age at exposure 2 years
Menarche at 12 years
When I started menstruating it was quite bearable but I have been having terrible problems for the last three years. I get periods once in four months. I get irritable, have abdominal pain and I cannot concentrate on anything. There is pain all over my body. For days before my periods I writhe in agony like a fish out of water. My eyes are weak. I am sad most of the time. I do not know how but I feel that my health problems are my fault and I have to bear them. I do not know how long. I am told not to mention my problems to anybody but it is the truth. I used to feel I would rather die than have a life like this. At last I know I can do something about it.

Teenager three
Age 17 years; age at exposure 2 years
Menarche at 12 years
When I started my periods, they were regular for three to four months but then they stopped for four months. So I took some pills and got my periods. For the last one year my problems with irregular cycle are getting worse. I had my periods once in five months. For the last seven months I have not had my periods at all. I have been taking medicines but there is no improvement. I hope you can help me.

Teenager four
Age 21 years; age at exposure 6 years
Menarche at 15 years
At first my periods seemed okay but after 4 months there was excessive bleeding. My periods are very irregular and I have severe pain before I get them. The pain lasts for two to three days. I get fever and severe headache. I cannot do work or sleep. I cannot eat and just take tea or milk. When I have excessive bleeding there are clots. Currently I am taking treatment at the Sambhavna Clinc and I have got much relief from pain. I have seven sisters and all of them have similar menstrual problems. Several of my friends at school have problems too.

[This article first appeared in Pesticides News No. 46, December 1999, pages 4-5]


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