International Medical Commission on Bhopal
Encyclopedia
The International Medical Commission Bhopal was established in 1993 to organise medical responses to the 1984 Bhopal disaster
Bhopal disaster
The Bhopal disaster also known as Bhopal Gas Tragedy was a gas leak incident in India, considered one of the world's worst industrial catastrophes. It occurred on the night of December 2–3, 1984 at the Union Carbide India Limited pesticide plant in Bhopal, Madhya Pradesh, India...

 (India).

Background

The immediate scientific and medical response to the 1984 Bhopal disaster
Bhopal disaster
The Bhopal disaster also known as Bhopal Gas Tragedy was a gas leak incident in India, considered one of the world's worst industrial catastrophes. It occurred on the night of December 2–3, 1984 at the Union Carbide India Limited pesticide plant in Bhopal, Madhya Pradesh, India...

 constituted an extraordinary pulling together of hospitals, medical personnel and social services in the area. Coping with a disaster of this scale was unheard of anywhere in the world, and there was widespread admiration for those who responded, often risking their own lives in the process.

However when the long term after effects began to appear, it was obvious that the social and legal climate was inadequate since there was little experience in dealing with a major env. release
Environmental disaster
An environmental disaster is a disaster to the natural environment due to human activity. It should not be confused with the separate concept of a natural disaster.-History:...

. Scientific and medical personnel needed access to accident-related and toxicologic
Toxicology
Toxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...

 information to understand the causes and potential consequences of the disaster. Union Carbide
Union Carbide
Union Carbide Corporation is a wholly owned subsidiary of The Dow Chemical Company. It currently employs more than 2,400 people. Union Carbide primarily produces chemicals and polymers that undergo one or more further conversions by customers before reaching consumers. Some are high-volume...

, the primary repository of this information, faced with lawsuits and the prospect of bankruptcy, closed down its channels of communication. On the other hand, the extreme sensitivities of the local and national government bodies towards all aspects of the disaster, coupled with the lack of expertise and funds, resulted in an inadequate response on India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

’s part to meet the urgent health care and social recovery needs of the community. Whereas local health professionals and the interested scientific community abroad expected a flood of information from a disaster of this magnitude, only a trickle resulted.

These transnational political and legal ramifications threw a veil of secrecy around the disaster and obstructed the discovery of vital medical and toxicologic information. The medical community was often frustrated in its attempts to understand the links between gas exposure and health and devise appropriate treatment strategies. As an example, ignorance about whether the main poison, methyl isocyanate
Methyl isocyanate
Methyl isocyanate is an organic compound with the molecular formula CH3NCO. Synonyms are isocyanatomethane, methyl carbylamine, and MIC. Methyl isocyanate is an intermediate chemical in the production of carbamate pesticides . It has also been used in the production of rubbers and adhesives...

, could decompose to deadly cyanide
Cyanide
A cyanide is a chemical compound that contains the cyano group, -C≡N, which consists of a carbon atom triple-bonded to a nitrogen atom. Cyanides most commonly refer to salts of the anion CN−. Most cyanides are highly toxic....

 gas, led to years of acrimonious debate on the merits of treating the gas victims for cyanide poisoning.

Recognizing the dire need of the gas victims, the Permanent Peoples' Tribunal
Permanent Peoples' Tribunal
The Permanent Peoples' Tribunal is international opinion tribunal that was founded in Bologna June 24, 1979 at the initiative of Senator Lelio Basso. - International opinion tribunal :...

 met in 1992 and recommended that an international medical commission provide an in-depth independent assessment of the situation in Bhopal. The International Medical Commission on Bhopal (IMCB) was thus constituted with 14 professionals from 12 countries who were chosen on the basis of their medical expertise and experience in environmental health
Environmental health
Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health...

, toxicology, neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...

, immunology
Immunology
Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...

, respiratory medicine
Respiratory Medicine
The Respiratory Medicine journal is published by Elsevier Science. Its subjects are internal medicine and practice of medicine.Its ISSN is 0954-6111. Its impact factor in 2004 was 2,086....

 and family medicine
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...

. Drs. Rosalie Bertell and Gianni Tognoni served as the co-chairpersons of the IMCB. At the request of Carbide gas victim organizations, the IMCB conducted a humanitarian visit to India in January 1994 to contribute in any way possible to the relief of the victims and to suggest ways to in which such catastrophic accidents could be prevented in the future or their effects mitigated. During their stay, the IMCB met with government officials, various disaster experts, hospitals, research teams, local private physicians, biochemists, botanists, various survivor groups, environmental activists
Environmentalism
Environmentalism is a broad philosophy, ideology and social movement regarding concerns for environmental conservation and improvement of the health of the environment, particularly as the measure for this health seeks to incorporate the concerns of non-human elements...

 and veterinarian
Veterinarian
A veterinary physician, colloquially called a vet, shortened from veterinarian or veterinary surgeon , is a professional who treats disease, disorder and injury in animals....

s.

Goals

The main goals of the IMCB were:
  1. Betterment of the lives of the victims with rational diagnostic methods and treatment
  2. Clarification of the place and form of international medical assistance and documentation after a catastrophic accident
  3. Recommending legislation to protect humans from military and industrial pollution
  4. Mobilization of international assistance in response to the request of survivors rather than waiting for government invitation.
  5. Provide guidelines for planning health research on the impact of major accidents
  6. Establishment of a precedent for international protection for medical research against interference from vested interest
    Vested interest
    Vested interest is a communication theory that seeks to explain how influences impact behaviors. As defined by William Crano, vested interest refers to the amount that an attitude object is deemed hedonically relevant by the attitude holder...

    s or corporation
    Corporation
    A corporation is created under the laws of a state as a separate legal entity that has privileges and liabilities that are distinct from those of its members. There are many different forms of corporations, most of which are used to conduct business. Early corporations were established by charter...

    s or governments
  7. Legitimization of the voices of survivor organizations and their participation in relevant decisions
  8. Promoting ethical and scientific standards for information collection and communication to victims
  9. Coordination of medical, research, and legal information to assist victims in claims
  10. Alerting the Government of India to the need for full disclosure of potential hazards and environmental impact studies prior to allowing any hazardous industry to set up in India


The commissioners divided their work in various groups:
  • Community & clinical studies: survey of the population followed by clinical testing of selected groups
  • Assessment of availability and quality of medical care, including level of medical resources available.
  • Examination of the adequacy and equity of laws and regulations relating to claims and the distribution of compensation;
  • Evaluation of drug therapy by examination of prescriptions routinely given to survivors;
  • Accident analysis;
  • Review of studies and published literature on the disaster.


The IMCB committed itself to a) provide a full report of its findings and recommendations to the Governments of India and Madhya Pradesh
Madhya Pradesh
Madhya Pradesh , often called the Heart of India, is a state in central India. Its capital is Bhopal and Indore is the largest city....

, victims’ organizations, and all other interested parties; b) stand ready to assist the government of India and medical colleagues to implement the recommendations of the commission; c) enlist the National Advisory Committee to follow up the initiatives of the commission; d) recommend research studies to be undertaken in India on the long-term effects of the gas exposure, and e) assure the wide circulation of its experience and findings in the professional literature.

Findings

Union Carbide

The IMCB publicly condemned Union Carbide and reiterated the company’s full liability not only for responsibility in causing the deadly gas leak, but also for the confounding role of its behaviour with respect to pre-accident preventive and exposure mitigating efforts, and the timely and effective application of the appropriate medical measures at the time of the accident. This included the lack of transparency about the composition of the gases released, resulting in the absence of rational methods of care and planning resulting in loss of sight and in some cases life, and creation of suspicion and conflict among professionals and the population. There was also a lack of emergency preparation which would have made the public and professionals aware of the potential toxins inside the plant and how to respond to an accident.

Indian government

The government of India also was faulted since no clear guidelines were laid down to determine compensation to the victims resulting in undue delays and aggravation of their health status and/or economic survival. The secrecy surrounding the health studies undertaken by the Indian Council of Medical Research
Indian council of medical research
The Indian Council of Medical Research , New Delhi, the apex body in India for the formulation, coordination and promotion of biomedical research, is one of the oldest medical research bodies in the world.-History:...

 (ICMR) may initially have been instituted to protect the litigation process, but in reality made the rational medical treatment and establishment of claims almost impossible. In hindsight, it is clear that the secrecy served no purpose whatsoever and has resulted in non-publication of the information. Moreover, because of the secrecy about the accident itself and the chemicals released, it was difficult for the survivors to document their claims. The Commission also noted an excessive fear among government personnel of bogus claims.

In fulfilling its commitment, results of the community studies conducted by the IMCB have been communicated to the affected population in the form of public meetings, which provided a forum for the victims to ask questions and provide comments. The studies have also been published in various national and international journals so that the scientific community has access to this information.

Recommendations of the IMCB

The IMCB made the following recommendations:

1. Reorganization of the health system to establish a network of community-based primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...

 clinics;
2. The gas-related disease categories need to be broadened to include central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...

 and psychological (PTD) injury;
3. A conference to determine best practice
Best practice
A best practice is a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark...

 rehabilitation medicine, including both Western and Indian expertise, must be undertaken to develop rational treatments and prescription drug
Prescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...

s for survivors.
3. Health data collected by the ICMR should be communicated to the population and submitted for publication in professional journals.
4. Gas victims to have the right of access to their medical records;
5. Victim organizations should be adequately represented in the national and state commissions dealing with the disaster;
6. Criteria for compensation should include medical, economic and social damage to the victims
7. Allocation of resources for economic and social rehabilitation of people and their communities should be made.
8. Thorough examination of the impact of the toxic waste buried on the Union Carbide site and its potential for further damage to public health needs to be researched.

Long-term effects

It is now well known that persistent and chronic gas-related health effects are present in the Bhopal population. However, the full spectrum of effects is yet to be defined, especially in those exposed as children or in utero, and as manifested in survivor reproductive health. There has been a lack of systematic collection of relevant information in these reproductive effects, and also with respect to cancer development or other chronic illnesses as sequelae of the gas exposure.

Recent investigations have shown that local well water has become contaminated by the improper storage of a large amount of hazardous waste in the facility, or on its grounds. This toxic waste is especially hazardous to those still suffering the effects of direct exposure to the gas.

As of 2007, the prospects for learning the sequelae of this disaster do not appear to be bright. What is sorely needed is an independent body to coordinate the health care, research, rehabilitation of gas victims, and care for potential effects in their offspring. Instead of the non-directive symptomatic medical treatment that currently exists, clear guidelines and criteria need to be formulated for specific medical conditions such as damage to broncial tubes, sleep apnea, neuron destruction, etc. . Such an effort could be implemented through India's existing heath care pyramid. Community-level health units should be developed to serve a maximum of 5000 people each. Local hospitals with multiple departments can be used to provide secondary care. A specialized medical center dedicated to treatment and research of the more serious problems arising from the gas leak should be established.

The IMCB believes it is a mistake to simply increase the number of hospital beds in Bhopal. The community has need for more neighborhood clinics, non-drug respiratory therapy, clean air and water, and sheltered workshops, not for more hospital beds.

Need for long-term monitoring

The IMCB has recommended that long-term monitoring of the community for illness and response to treatment be done for several decades. This would include the study of exposed and unexposed areas to observe patterns of illness and death as well as to detect the occurrence of related chronic diseases and the appearance of new diseases. Such an approach needs to be one in which the health professionals involve the community of gas victims as active partners in investigation, provide them with feedback on community health, ensure that their health risks are properly communicated, and thereby enabling an increase in their consciousness, autonomy and self-determination.

Working with other agencies

Recognizing that Bhopal is a tragic model of an industrial epidemic, members of IMCB have expressed willingness to organize international teams when requested, to provide technical assistance and evaluation of other environmental disasters. Rather than the provision of emergency relief functions, for which there are other organizations such as Medecins sans Frontieres and the Red Cross/Red Crescent, the IMCB envisioned three levels:
  1. response to communities who appeal on the basis of chronic disability due to a disaster, after its acute phase is over;
  2. represent victims at the international level, for example, the World Health Agency, to recommend legislative changes required to implement the International Bill of Rights relevant to health and safety, and
  3. working to define the appropriate public health investigations to serve the needs of the injured community rather than use the victim community to merely serve the needs of science.


The International Bill of Rights includes: The Universal Declaration of Human Rights, proclaimed on Dec 10, 1948; The International Covenant on Economic, Social, and Cultural Rights (1976), and the International Covenant on Civil and Political Rights, 1976.

The steps to be taken to achieve the full realization of this right shall include:
- provision for the reduction of infant deaths and for healthy development of the child;
- improvement of all aspects of environmental and industrial hygiene;
- prevention, treatment, and control of epidemic, endemic, occupational and other diseases;
- creation of conditions which would assure to all people medical service and medical attention in the event of sickness,
- assuring the victims a living, work and social environment conducive to healing of its injuries.

To protect these rights, an international body, free of industry and government pressures, and competent to advise on health and safety standards, is required to be able to mediate just and equitable resolution and compensation of damage in the case of unanticipated disasters.

Members of the IMCB

  • Rosalie Bertell
    Rosalie Bertell
    Rosalie Bertell is an American physician and epidemiologist best known for her work in the field of ionizing radiation. A dual citizen of Canada and the United States, she has worked in environmental health since 1970....

     (Canada
    Canada
    Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

    ),
  • Gianni Tognoni (Italy
    Italy
    Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...

    )
  • Thomas Callendar (USA)
  • Jerry Havens (USA)
  • V. Ramana Dhara (USA)
  • Birger Heinzow (Germany
    Germany
    Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

    )
  • Marinus Verweij (Netherlands
    Netherlands
    The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

    )
  • Sushma Acquilla (UK)
  • Paul Cullinan (UK)
  • Wang Zhengang (China
    China
    Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

    )
  • Jerzy Jaskowski (Poland
    Poland
    Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...

    )
  • Leonid Titov (Belarus
    Belarus
    Belarus , officially the Republic of Belarus, is a landlocked country in Eastern Europe, bordered clockwise by Russia to the northeast, Ukraine to the south, Poland to the west, and Lithuania and Latvia to the northwest. Its capital is Minsk; other major cities include Brest, Grodno , Gomel ,...

    )
  • Ingrid Eckerman (Sweden
    Sweden
    Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....

    ),
  • C. Sathyamala (India
    India
    India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

    /UK)

Carbide gas victims’ organizations which worked with IMCB

  • Bhopal Gas Peedit Mahila Stationery Karmachari Sangh
  • Bhopal Gas Peedit Mahila Udyog Sanghatana
  • Bhopal Group for Information & Action
  • Nirashvrit Pension Bhogi Karmachari Sangh
  • Zahreeli Gas Kand Sangharsh Morcha
  • Bhopal Gas Peedith Sangharsh Sahayog Samiti

Further reading

  1. Dhara VR. Findings of the International Medical Commission on Bhopal. The Hindu – Survey of Environment; 2003.
  2. ISSN=1393-8592

Publications of the IMCB & other authors

  1. Eckerman, Ingrid
  2. Eckerman, Ingrid (2004). The Bhopal Saga - Causes and Consequences of the World's Largest Industrial Disaster. India: Universities Press. ISBN 81-7371-515-7.
  3. Eckerman, Ingrid (2006). The Bhopal Disaster 1984 - working conditions and the role of the trade unions. Asian Pacific Newsletter on occupational health and safety 2006;13:48-49.
  4. Eckerman I (2011) Bhopal Gas Catastrophe 1984: Causes and Consequences. In: Nriagu JO (ed.) Encyclopedia of Environmental Health, volume 1, pp. 302–316 Burlington: Elsevier.
  5. Multiple articles in International Perspectives in Public Health; 1996; Vols 11&12. International Institute of Concern for Public Health.
  6. Peer reviewed Bhopal publications on Emory Univ. website.
  7. Dhara V. Ramana. The Bhopal Gas Leak: Lessons from studying the impact of a disaster in a developing nation. Doctoral thesis-Univ. of Massachusetts Lowell. 2000.
  8. Dhara V.R, Gassert TH. The Bhopal Syndrome:persistent questions on toxicity & management. IJOEH 2002;8:380-386
  9. Op-ed in The Hindu on Bhopal disaster & BP oil spill by IMCB members Acquilla, Bertell, Cullinan, Dhara, Heinzow, Tognoni & Verweij, Aug 4, 2010: http://www.thehindu.com/opinion/op-ed/article550062.ece
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