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The extent of the damage
The leak killed over 8,000 people in its immediate aftermath and caused multi-systemic injuries to over 500,000 people. Breathlessness; loss of appetite; pain; menstrual irregularities; recurrent fever; persistent cough; neurological disorders; fatigue; weakness; anxiety and depression are among the most common symptoms. Research findings on chromosomal aberrations suggest that the future generations of the survivors will possibly carry the leftovers of the industrial toxins.

Available information
Most of the information on the medical consequences of the Union Carbide disaster in Bhopal has been generated by the Indian Council of Medical Research (ICMR). Thirty-six municipal wards of the city of Bhopal were identified by the state government as affected by Union Carbide's gases. They were categorized by the ICMR as either severely, moderately or mildly affected areas. Unfortunately most of the ICMR studies were prematurely terminated and all of them were wound up in December 1994.

The principal findings of the ICMR:

(1)The toxins from Union Carbide's factory have crossed into the blood stream of those exposed and have caused damage to the lungs, brain, kidneys, muscles as well as gastro-intestinal, reproductive and immune systems. The toxins have also crossed the placental barrier leading to fetal poisoning.

(2)Of the patients treated at the Hamidia hospital immediately after the disaster, 98.9% suffered from breathlessness, 85.8% had eye problems, 91% had gastro-intestinal problems and, in varying degrees, there were at least 16 other complications. More than ten of these symptoms persisted among the survivors till as late as 1992 (when the last ICMR report was published) with the addition of menstrual irregularities, spontaneous abortions and neurological and mental health problems.

(3)Six monthly morbidity surveys from 1987 to 1991 show that the number of people with exposure-related symptoms is actually increasing. According to one study there were three times more people with respiratory symptoms in 1991 as compared to 1987.

The termination of research
The official agency for recording disaster related mortality was wound up in December 1992. Over 120,000 men, women and children continue to suffer from a host of exposure-related illnesses and associated complications. With the premature termination of research and monitoring there is almost no current data on the prevalence of tuberculosis, cancers and infertility among the exposed population, all of which are reported to be on the rise by doctors involved in treatment of the survivors.

Epidemiology
An epidemiological survey coupled with clinical investigation carried out by the International Medical Commission on Bhopal, composed of 14 medical specialists from 11 different countries in January 1994 has reported significant multi-organ symptoms persistent among the exposed population. Clinical examination has shown significant lung impairment, marked reduction in control over limb movement and reduced memory function caused by exposure. Their findings include evidence of neuro-toxic injuries in the exposed population including neurological vestibular dysfunction, central neurological and neurological peripheral toxic effects.

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