The Bhopal Legacy

An interview with Dr. Rosalie Bertell

Dr. Rosalie Bertell is president of the Toronto-based International Institute of Concern for Public Health. She has a doctorate in biometry, and has researched cancer and birth defects, with specific emphasis on environmental causes, since 1966. Dr. Bertell is a 1986 winner of the Right Livelihood Award, the alternative Nobel Prize, and a 1993 UN Environmental Program Global 500 laureate. She recently chaired the International Medical Commission Chernobyl, and directed the International Medical Commission Bhopal.

Multinational Monitor: What is the International Medical Commission Bhopal?

Rosalie Bertell: When the Permanent People's Tribunal was held in Bhopal in October 1993, it recommended bringing in a team of physicians to investigate the problems that the survivors of Bhopal were reporting, especially things like their medical care, the treatment they were getting, the fairness of compensation.

With the assistance of activist groups in Bhopal, London and New York, I organized the Commission. I sent out about 60 invitations to universities and research establishments, primarily to physicians who had shown interest in environmental health. More than 30 said they would be willing to go. We chose 13 physicians from 11 different countries and with different expertise. Each one served without pay, other than travel costs and expenses. We went to Bhopal in January 1994.

MM: What did you conclude about the lingering health effects of the Union Carbide gas leak?

Bertell: We did an epidemiological survey to find out what illnesses the people had 10 years after the disaster, that were likely to be connected to the disaster. We looked for illnesses where there is a gradation of effect, so that the effect is higher as you get closer to the factory.

We found that the respiratory illness was still showing a graded effect. There was neurotoxicological damage, not previously reported, that was also showing a trend with distance. The people were still suffering from post-traumatic stress syndrome. The government has never connected post-traumatic stress syndrome to the disaster, but it is obvious; people were still having nightmares and breaking out in sweats and were really traumatized even 10 years after the disaster. The other thing that was related to distance was damage to cornea of the eye. There were other secondary effects, but those were the most prominent ones.

MM: What does that mix of problems mean for people's day-to-day lives?

Bertell: It means permanent disability.

Often the injured person was the person who was earning money for a family, and they can't earn money like they did before. They might be blind, or they might be suffering from intermittent blindness.

Some of the victims' medical costs are taken care of by the government. But the delivery system is so poor that if people are really sick, they go to private physicians, whom they have to pay. Out of the little money they have, they are overpaying for medical care, they are paying for medicines because they can't always get them for free -- the lines are too long at the hospital, or the supply runs out.

The people are still going to hospital emergency rooms with their illnesses, and doctors are seeing as many as 1,500 patients a day, which is ridiculous. The doctors don't have continuity of medical records, they don't have a record of which medicines the victims have taken and which ones are effective and which ones are not effective.

So the whole situation is still disastrous. The needs of the people have not been met.

MM: How many people are suffering from the range of problems you described?

Bertell: The death count is probably a little over 10,000 now. The number that were exposed originally was probably 500,000.

We looked at adults, between age 18 and 60, and estimated that there are about 50,000 who are permanently damaged. What was startling was that the younger adults, those between 18 and 35, showed more damage than those over 35. That means two things: one, you better take a good luck at the children, because they could be still worse; and second, this problem is going to last for a long time, because as those young adults get older, the damage will cause more chronic illness.

MM: What has been Union Carbide's contribution to medical care for the victims in Bhopal?

Bertell: I would say next to nothing. They settled out of court for $470 million, the amount covered by their insurance plus the interest it accrued while they were disputing the compensation figure. So that didn't really cost them anything. Beyond that, they basically did nothing.

Because it was an out-of-court settlement, we cannot now reopen the decision given the evidence of damage now available, evidence which was not known at the time of settlement.

They did sell their plant in Bhopal. The Supreme Court of India seized the money from the plant sale, to try to get Union Carbide officials to come back and go through a trial.

[Former Union Carbide chief executive officer] Warren Anderson, for example, has been indicted. When he arrived in India [the day after the gas leak], he was arrested and then released on bond. He left the country when he was still bonded, and he has been declared an absconder from justice.

Union Carbide has been working behind the scenes to get that money used for something they can brag about. They have been trying to get the money used for a hospital, the one that Union Carbide says they have built in Bhopal. The construction on the hospital is finished, but it is not yet opened. We actually opposed it.

MM: Why did you oppose construction of a hospital?

Bertell: Bhopal now has more per capita hospital beds than is recommended by the World Health Organization, and they have more hospitals being built besides the Union Carbide one. Also, the victims are chronically ill; they don't need acute care in a hospital.

We strongly opposed it, and Union Carbide did reduce the number of hospital beds from 600 to 250, and they agreed to put 20 primary health care centers out into the community, where they are really needed.

We would like to complete this pyramid of health care by setting up community health centers that feed into the primary centers that then feed into the hospital. This would move the health care system into the communities where the people live. For example, they could have classes on breathing exercises and environmental awareness of things they could do to reduce the stress on their bodies. What is needed is the possibility of really direct help and record keeping, not another aloof hospital.

MM: The Commission says it "publicly and clearly condemns Union Carbide and reiterates its full liability ... for the responsibility for the deadly gas leak." To what extent should the company be judged responsible for the leak itself?

Bertell: In the first place, they should submit to the court. That is something that a court should determine -- the responsibility and the blame for a disaster like that. Union Carbide went to court in the States to say that the Indian courts were capable and should handle the litigation, but then refused to cooperate with them. I think they can be faulted at that level.

The plant was producing a pesticide. Normally Union Carbide does not allow MIC, methyl isocyanate, a pesticide component, to be stored. They produce MIC and then produce the pesticide in one step, whereas they were storing it in Bhopal. It was stored improperly, not refrigerated. There is an emergency release for the gas that was not working. There were several problems in the plant. They had not been keeping it up. They also had accidents prior to this and recommendations had been made as to what should be done in the plant, but they had not been implemented.

MM: The Commission's findings condemn Union Carbide's "confounding role ... with respect to the timely and effective application of appropriate medical measures." How has Carbide confounded medical treatment for the victims?

Bertell: Methyl isocyanate breaks down into cyanide poisoning in the body. They had in the hospital the antidote for cyanide. However, it was 3 days before anyone got the information on the fact that they could use the antidote. They could have prevented some of the permanent tissue damage had they used it.

The normal procedure when you move an industry like that into an area, especially a residential area, is that you file with the government emergency personnel (like the hospitals, the police, the fire department) the materials you are working with, what could happen in an accident, what the antidote is. That is normal emergency procedure. That should have all been done when they opened the plant, not three days after a major disaster.

MM: You also criticized the evacuation plans, or lack thereof.

Bertell: There had been no plans or exercises for evacuation.

I think what the people did is what everybody would be inclined to do in such a case. When they woke up in the middle of the night and their eyes were smarting and they were having trouble breathing, they thought right away of the factory, It is the dominant structure in the area, and they had had accidents there before. So the people tried to run away from the factory. In so doing, many of them actually ran in the toxic clouds and made their exposures much greater, both because they were running with the cloud and because they increased their breathing while running. They would have been better staying where they were, but this was never explained to them.

Also, the gas was very heavy, and people on the second floor managed to live when people on the first floor died. A simple thing like going up stairs would have helped, but nobody knew this until the whole thing was over.

The level of information that people had was significant to whether or not they survived.

MM: Do you have other recommendations for appropriate medical care for the victims, in addition to the call for a pyramid health care scheme emphasizing community health centers?

Bertell: The essence of this is that it is an industrially induced epidemic. The people who are the most knowledgeable about what it did to the human body are the victims. Whatever medical system is set up, it has to have participation by the people who actually experienced the gas. They have to have a say in how medical facilities -- especially the community-level medical centers -- are run and what kinds of things they do. It is the people who know which kinds of therapies are helping and which ones aren't. People are quite clear on it, and they need to be respected as part of the decision making in this whole process.

MM: What would you like to see Union Carbide do at this point in time?

Bertell: The people are still asking for them to apologize. They have never apologized. They never said they were sorry. I know that has legal implications, but I think it is a bankrupt society in which people can't say they are sorry when they do something like that.

I think the Union Carbide officials should come back and face the court and stop spreading their rumors that some disgruntled employee created the disaster. If they have information on such an employee, they have never submitted it to the court. That is the place where those kinds of things should be determined.

MM: The Bhopal disaster is obviously a watershed case. How has it changed the way multinationals operate abroad?

Bertell: I don't think it has, and that is scary. I think that most of them think that Union Carbide got away with it, and maybe they could get away with it. I think the effect has been minimal.

MM: What kind of changes in corporate or government policies would you like to prevent future Bhopals?

Bertell: In the first place, I don't think we need to handle this kind of toxic material. The pesticide was created to kill a jungle in Vietnam for the Vietnam war. The use of pesticides has proven to be damaging to human health and plants and animals. It is a megadeath invention, so we can't expect it to be harmless. I think we need to rethink what we make, and realize you can't put all your efforts into producing death and think it is going to be compatible with life.

I think the locating of factories in highly congested residential areas is unacceptable.

The not filing of data on toxics and potential hazards with local officials and emergency personnel is unethical and outrageous behavior. The right to know supersedes industrial companies' interest in secrecy for patents and copyrights. That secrecy is unacceptable when you threaten the life and health of workers and the general public.

Finally, there has to be clarification and codification of the human right to life and health, because it is being threatened in very gross and widespread ways by industrial, technological and military activities.