The calls for extradition of Warren Anderson, former head of Union
Carbide Corporation, to India for trial reached a new pitch, with
Greenpeace announcing on Aug 29 that it has located Anderson in the USA.
Anderson was the chief executive officer of Union Carbide in December,
1984, when an explosion at the company's pesticide plant in Bhopal,
India, caused the world's worst industrial disaster.

Although a Bhopal court ordered Anderson's extradition almost a decade
ago, the Indian and US governments have not enforced the demand. "Now
that Anderson's address is known, India must immediately and formally
push for his arrest and extradition on charges of culpable homicide",
said Ganesh Nochur, campaigns director of Greenpeace India.
Anderson's extradition to face charges of culpable homicide is just one
thread in the complex web of the aftermath of Bhopal. The toxic effects
of methyl isocyanate (MIC) that leaked from the pesticide plant continue
to unfold among those people directly affected as well as subsequent
generations, according to campaigners.

The MIC gas leak killed 8000 people within days and injured half a
million. Since then, thousands more have died. An estimated 150 000
people directly affected by the gas leak now live with chronic illnesses
such as fibrosis, bronchial asthma, chronic obstructive airways disease,
emphysema, and recurrent chest infections. Pulmonary tuberculosis among
the exposed population is notably higher than India's national average.
In the absence of any official long-term medical surveillance and
mortality studies, unpublished data and anecdotal evidence are all that
is available. These data point to a silent medical disaster in Bhopal.
Studies have indicated a high prevalence of congenital diseases among
children born several years after the disaster, ailments such as
premature menopause among women, secondary infertility, cancers in women
and children, and retarded growth in adolescents.

All official research on the immediate and long-term effects of MIC were
terminated in 1994. Nevertheless, the Indian Council of Medical Research
(ICMR)--the government agency funding these studies--has yet to publish
its final report on the effects of this disaster. "Most of the findings
have been published in research journals. We could not publish the
final, consolidated report since many of the project directors have
either retired or died", an ICMR spokesperson said.

The Bhopal Memorial Hospital and Research Centre (BMHRC), set up with
money from the seizure of Union Carbide shares to treat gas victims and
undertake long-term surveillance, has yet to begin any research.
Although BMHRC became functional in July, 2000, it was formally
inaugurated by India's President Abdul Kalam only last week.

"There has been a setback in research", agrees Indraneel Mittra,
director general, BMHRC. "We will soon start the research wing and also
set up a department of public health and epidemiology to gather data. We
will take over from where the ICMR had left." But crucial follow-up may
have been lost between 1994 and now. "We wanted to follow-up children
born soon after the disaster, through infancy and as they grew--to
monitor their growth and development till they attained puberty. But
ICMR terminated the studies midway, though the project advisory
committee had recommended that children exposed to MIC in womb should be
followed up till the age of 15", notes Prashant Pathak, a former
assistant research officer in an ICMR project.

"Children are being born with deformities like cleft palate, three eyes,
all fingers joined, one extra finger, one testicle, different skull
shapes, and Down's syndrome", says N Ganesh, a researcher at the
Jawaharlal Nehru Cancer Hospital and Research Centre (JNCHRC). Ganesh
drew his sample from gas- hit areas designated as "grade A" for the
severity of MIC exposure. "My study is only indicative of the situation
in Bhopal", he says. "We need to do long-term genetic studies, because
some of the abnormalities may be due to consanguineous marriages
prevalent among the local Muslim community."

Data for 300 MIC-exposed cancer patients from JNCHRC show that cancers
of breast, lung, bone, and stomach are high among the MIC-exposed
population, whereas cancers of the buccal mucosa and cervix are high in
the unaffected population. Genetic studies of MIC-affected cancer
patients have shown abnormalities "which in turn may be leading to
cancers. We are continuing our studies to establish direct or indirect
evidence of carcinogenecity of MIC in affected populations", says
Ganesh.

Another recent study on growth patterns of adolescents born before and
after the gas tragedy indicates growth retardation among youngsters
exposed to MIC and children conceived to exposed parents. The sample
size was 140 children. "MIC-exposed children and those born to exposed
parents have lower weight, height, sitting height, mid-arm circumference
than normal children", reports Nishant Ranjan, researcher at the
Sambhavana Trust, which runs a free clinic for the victims.

The lack of long-term medical research is a key unresolved issue, says
Satinath Sarangi (Bhopal Group for Information and Action). "The BMHRC
clinics do not even have treatment protocols for specific gas-related
illnesses. They have no gynaecological wing although a large number of
women have problems like menstrual irregularities and excessive vaginal
secretions", he notes. BMHRC says it is committed to provide free
medical treatment to gas victims only for 8 years. But experts feel that
those affected by the gas leak need to be followed up for their
lifetime. "Long-term monitoring has to be done for at least the next 50
years. Formal studies in ocular, respiratory, reproductive, immunologic,
genetic and psychological health must be continued to elucidate the
extent and severity of long-term effects", says R Srinivasa Murthy
(National Institute of Mental Health and Neurosciences, Bangalore).

Dinesh C Sharma

The Lancet