CRITICAL ANALYSIS OF BHOPAL

GAS TRAGEDY CASE

INTRODUCTION
The Bhopal gas tragedy was an industrial accident. It happened at a Union Carbide Pesticide
plant in the city of Bhopal, India. On 3 December 1984, the plant released 42 tons of toxic
methyl isocyanate (MIC) gas, exposing more than 500,000 people to toxic gases. The Bhopal
disaster is frequently cited as the world's worst industrial disaster.
A mixture of poisonous gases flooded the city, causing great panic as people woke up with a
burning sensation in their lungs. Thousands died immediately from the effects of the gas. The
first official immediate death toll was 2,259. Another estimate is that 8,000 died within two
weeks of incidence.
On December 3, 1984,highly toxic methyl isocyanides (MIC), which had been manufactured
and stored in Union Carbide’s chemical plant in Bhopal, escaped into the atmosphere and
killed over 3,500 people and seriously injured about 2 lakh people.
The Bhopal gas leak disaster (Processing of Claims) Act, 1985 was passed by parliament to
ensure that the claims arising out of the Bhopal disaster were dealt with speedily, effectively,
equitably and to the best advantage of the claimants.

FACTS OF THE CASE

It is basically the critical analysis on how it happened
o Bhopal is the capital of a state, Madhya Pradesh, which is essentially underdeveloped.
This state provided a number of incentives to start industries, such as backward area
investment allowance. Union Carbide India Ltd set up a unit at Bhopal to formulate a
range of pesticides and herbicides derived from a carbonyl base.

o The plant was located adjacent to residential areas and was only 3 kilometers from the
Bhopal Railway station and bus stand.

o When UCIL applied for a license to manufacture MIC, the Administrator of the city
suggested that the unit should be shifted outside the city, but this was not accepted by the
Government and UCIL was given license to manufacture MIC in the existing premises.

o The new manufacturing facility was sanctioned in 1979, and UCIL was licensed to
produce 5000 tons of carbaryl based pesticides. The demand for the pesticide was
reducing because of the import of new products like synthetic pyrethroids. The sales of
MIC based pesticides were only 1500 tons in 1983 compared to 2211 tons in 1982.
o MIC is stored in three underground tanks made of stainless steel, tank 610, tank 611 and
tank 619. The tanks have to be kept refrigerated so that the temperature of storage is kept
close to 0°C and not above 15°C as given by the safety manual of Union Carbide
Corporation (UCC), but not followed.

o After the tank there is a vent gas scrubber to neutralize the MIC in case of release, by
spraying alkali. Then there is a flare tower to burn the remaining gases going from the
vent gas scrubber, which was also not working.

o As per the safety manual the scrubber should be kept in active mode, which means that
the pump has to spray alkali as long as the plant is operating, but in October 1984 a
decision was taken to keep it in passive mode. Similarly it was decided to shut down the
refrigeration plant, to cut the cost of manufacturing.

o There are two process venting lines RVVH (relief valve and vent header) and PVH
(process vent header). As per the process chart given by Union Carbide Corporation,
RVVH and PVH are not interconnected, but a major decision was taken to carry out a
major plant modification connecting RVVH and PVH sometime in May 1984 before the
accident.

o Around 26 November 1984, the operator tried to pressurize MIC tank 610 to transfer MIC
to the processing unit, as it contained about 42 tons of MIC. Though nitrogen was sent in,
the tank failed to get pressurized. This itself was an indication that there is a leak
somewhere. Instead of attending to the leak, the management decided to pressurize tank
611 containing about 40 tons of MIC.

o On December 3, the MIC plant supervisor ordered washing of MIC lines assuming that
there was a blockage in the line. At about 9.30 pm on 3 December 1984, the operator
began washing out four lines in the MIC storage area, and all these were connected to the
RVVH. The operation started pumping water under high pressure into the four lines, but
he found that some lines were clogged (blocked).

o Workers stopped washing and reported the problem to the supervisor. The supervisor,
who was transferred from a completely different plant to this unit only two weeks before
the event, gave further instructions for rewashing after 20 minutes.

o The operator need to insert a slip blind (spectacle blind is a safety device used to isolate a
section of line or piece of equipment when the line or equipment needs to be inspected or
removed from service) so that water would not go into the MIC tanbefore washing but the
absence of using a slip blind while washing the lines was the triggering event.
3rd December 1984, day of accident:
o Washing of relief valve lines started without isolation.

o Operator notices the lines are blocked but MIC Plant supervisor orders washing to
continue.

o Pressure in the tank 610 was 2 Psi (Pounds per square inch).

o Water entry started from RVVH to PVH.

o The tank Operator logs pressure in tank 610 as 10 Psi.

o First leak of MIC detected.

o Plant supervisor notified about the high pressure and MIC leak.

o Supervisor ordered stopping of washing operations.

o Tea break for operator.

o Attempt to start the vent gas scrubber.

o Pump Plant superintendent, on being informed about the leak, arrives at the spot and saw
pressure gauge reading over range.

o Concrete tanks get very hot.

o MIC operator reports escape of MIC through the vent line at 33 meters high.

o Toxic Gas Alarm was alerted, but switched off.

o Police official on patrol reports to police control room that something had gone wrong at
UCIL.

o Police control room informs the city police chief.

o UCIL staff when telephoned report that everything is normal.

o Additional District Magistrate informs the Works Manager of UCIL at his residence
about the leak to the safety valve, but 40 to 45 Tons of MIC already escaped before that.

o Public siren was restarted but the blast already took place.
Water entered the MIC tank along with iron from the iron pipes, though as per the safety
manual only stainless steel can be used. Ferric ions act as catalyst for polymerization of MIC.
Water reacts with MIC violently. The polymerization generated heat and the pressure rose
sharply and blast took place.
MIC vapors started affecting people in the vicinity, and a large number of people started
running out of the houses. On the morning of 3 December, Hamidia hospital had about 12000
persons. Again on the night of 3/4 December, MIC from the atmosphere re-condensed and
more people were affected. On the 4 December 1984 Hamidia Hospital had to handle about
55000 people, whereas the hospital had capacity for only 750 people.
Even after three days, the air in the vicinity of the plant had fairly high levels of cyanide
concentration.
With no doubt, it was a result of poor hazard management, poor safety management practice,
poor use of early warning system, poor perception of the risk involved and so on.

SECTIONS OF FACTORIES ACT WHICH WERE NOT FOLLOWED

PROPERLY
Factories Act 1948, Section 40: Safety of building and machinery.
If it appears to the Inspector that any building or part of a building or any part of the ways,
machinery or plant in a factory is in such a condition that it is dangerous to human life or
safety, he may serve on [the occupier or manager or both] of the factory an order in writing
specifying the measures which in his opinion should be adopted, and requiring them to be
carried out before a specified date.

Factories Act 1948, Section 36: Precautions against dangerous fumes, gases,
etc.
No person shall be required or allowed to enter any chamber, tank, vat, pit, pipe, flue or other
confined space in any factory in which any gas, fume, vapor or dust is likely to be present to
such an extent as to involve risk to persons being overcome thereby, unless it is provided
with a manhole of adequate size or other effective means of egress

Factories Act 1948, Section 37: Explosive or inflammable dust, gas.

Factories Act 1948, Section 40A: Maintenance of buildings
Etc.
ANALYSIS OF FAILURE
o Poor perception of risk involved.
o Failure to perceive the gravity of the situation after the trigger event.
o Poor safety specification.
o Poor training and use of inexperienced operators.
o Poor emergency procedures and standards.
o Poor maintenance of machines and faulty alarm system.
o No limits for the exposure of chemical and toxic substances was present.
HIGH COURT JUDGEMENT
Justice Seth used English Rules of procedure to create an entitlement to interim compensation
(i.e. it is permissible for courts to grant relief of interim payment under the substantive law of
torts). Under the English rules, interim relief granted in personal injury cases if a prima facie
case is made out. He said that “more than prima facie case have been made out” against the
Carbide.
He observed that the principle of absolute liability without exceptions laid down in M.C.
Mehta case applied more vigorously to the Bhopal suit. He holds that Carbide is financially a
viable corporation with $ 6.5 billion unencumbered asset and $200millions encumbered
assets plus an insurance which could cover up to $250millions worth of damages. Given
carbide’s resources, it is eminently just that it meet a part of its liability by interim
compensation (Rs.250cr.)
In Union Carbide Corporation v Union of India (AIR 1990 SC 273), the Supreme Court
secured a compromise between the UCC and Government of India. Under the settlement,
UCC agreed to pay US $470 million in full and final settlement of all past, present and future
claims arising from the Bhopal disaster. In addition to facilitate the settlement, the Supreme
Court exercised its extraordinary jurisdiction and terminated all the civil, criminal and
contempt of court proceedings that had arisen out of the Bhopal disaster. It was declared by
the court that if the settlement fund is exhausted, the Union of India should make good the
deficiency.
Review petition under Art.137 and writ petitions under Art.32 of the Constitution of India
were filed questioning the constitutional and under the Bhopal Act (providing for the
registration and processing of claims) and the resultant categorization of the victims was also
upheld. It was laid down that there is no need to tie down the tortfeasor to future liability
[UCC v UOI AIR 1992 SC 248].
CONCLUSION
The tragedy of Bhopal continues to be a warning sign at once ignored and heeded. Bhopal
and its aftermath were a warning that the path to industrialization, for developing countries in
general and India in particular. If the Provisions Relating to Hazardous Processes would be
present at the time of accident and other safety, health and welfare provisions would be
followed, we would never had to face such Industrial disaster. Some moves by the Indian
government, including the formation of the Ministry of Environment and Forests (MoEF),
have served to offer some protection of the public's health from the harmful practices of local
and multinational heavy industry and grassroots organizations that have also played a part in
opposing rampant development.