Bhopal gas tragedy


On 3rd December 1984 a serious gas leakage was happened in Bhopal, India. A poisonous gas contains methyl isocyanate (MIC) was accidentally spread out into night air from the Union Carbide India Limited (UCIL) plant. Originally, the leak was caused by a large volume of water entering one of the MIC storage tanks around 9.30 pm the day before. The pressure and temperature in tank rose continuously and then the storage tank burst around 12.30 am due to the chemical reaction between MIC and water. However, UCC claimed that the MIC unit storage tank was deliberately destroyed by a disgruntled worker. (Sumohon Matilal & Heather Hopfl, 2009, p.959)

The sudden stun of poisonous gases caused the two local hospitals, the Hamidia and Javaprakas became overwhelming. The doctors could not provide the immediate treatment to the victims because UCIL provided little emergency information regarded the compound of the poisonous gas leakage. (Frank P. Lees, 1996, A5.7)

There were 800,000 residents in Bhopal at that time, approximately 2,000 people died immediately, 300,000 people were injured, and about thousand animals were killed. Five year later, a series of studies have showed that, many of the survivors now live with ailments such as partial or complete blindness, gastrointestinal disorders, impaired immune system, post traumatic stress disorders, and menstrual problem in women. (Dale Sullivan, 1998)

Basically, this pesticide plant was owned by Union Carbide Corporation (UCC), but it was operated by UCIL. Initially, the primary objective of UCIL plant was to manufacture pesticides for use in agricultural purpose and provide sufficient pesticides to India market. (Jackson B. Browing) The UCC began losing money in sales and this resulted in reduction cost of maintenance and safety and health of the plant. Low standard of safety and poor maintenances were the main contributing factor to the gas tragedy. Eventually, the report of Jackson B. Browing, a retired vice president, health safety, and environmental program of UCC (1993, p.12) stated that $470 million dollars was paid to India government and the victims of the tragedy in February 1989 as the final settlement for the litigation of this accident.

Management and Operation

The Management and its Structure

The UCC plant, Bhopal started operation in 1969. 50.9 % share of UCIL plant was owned by UCC and 40.1% by the Indian Investors. (Ingrid Eckerman, 2005, pp.24) Since UCC was the majority shareholder, the marketing, operation, and management of the UCIL plant were dictated by UCC. (Loong Wong, 2005) Because of the disaster, the management structure of UCIL plant was changed and put under the direction of Union Carbide battery division. (Frank P. Lees, 1996,)

In the early stage, the plant was only allowed to formulate carbamate pesticides from concentrates imported from the United Stated. The company was fully granted to manufacture their own carbarly by the India government with a trade name Sevin in 1975. The manufacturing process of Sevin was exactly same as the process which is adopted at UCC plant, W.Virginia. Initially, UCIL did not produce MIC and it was imported from USA. (Frank P. Lees, A5.2). However, in 1980 UCIL began manufacture its own MIC based on the technology that supplied by the American parent company. (Ingrid Eckerman, 2005, pp. 24)

The Objective of the Management

The demand of the pesticides was extremely high in between 1956 and 1970 in India because of the Green Revolution which is a scheme used by India government to increase productivity of the crops by using high modern input such as high yielding seed, machinery, fertilizers, and pesticides. UCC decided to invest in chemical industry to produce pesticides in India because the company considered that it was a profitable business. (Sumohon Matilal & Heather Hopfl, 2009, p.959)

Union Carbide built up pesticide plant in Bhopal, India because of its central location. Additionally, the railway station and the Upper Lake of Bhopal was close to the plant, which provided adequate water source to plant and the railway system was readily spanned over the major city of India like Bombay and Calcutta. (Sumohon Matilal & Heather Hopfl, 2009, pp. 957)

Industrial Processes

The essential material to manufacture Sevin was MIC. Initially, methyl carbamoyl chloride (MCC) and hydrogen were formed by reacting monomethylamine (MMA) with excessive vapor phosgene and then the reaction product transferred to chloroform for quenching process. Quench liquid was used to separate the unreacted phosgene and send back to reaction system for recycling purpose.

Afterward, the liquid from the still fed into the pyrolysis section and then the stream from the pyrolyser condenser was processed in MIC refining system to obtain MIC. Finally, MIC was formed and then run to the storage tanks. Basically, the MIC storage system consisted of three storage tanks, two for normal use and one for emergency use.

Causes of Accident

Human Factors

The UCC cut cost by reducing the permanent work forces from 859 to 642. The MIC plant operators were reduced from eleven to five per shift and the maintenance staff was also cut from four to two per shift. (Sumohon Matilal & Heather Hopfl, 2009) Basically, the plant operators must at least a degree holder and passed with a six month training program that provided by UCIL but the hired operators were only have high school qualification.( Roli Varma & Daya R. Varma, 2005)

Besides that, the wrong procedures in pipe washing were used, causing runaway reaction. Additionally, the maintenance staff did not notice that the contaminant had already entered into the MIC storage tank for 6 weeks because of the shoddy maintenance in MIC storage tanks. Thus precondition of accident was formed. (Paul Shrivastava, 1994)

In addition, Ingrid Eckerman (2001) pointed out that major hazards was found in the MIC units and the safety audits from the American parent company also had highlighted that the workers performance and safety standard in Bhopal plant were below the American standards in 1982. However, the UCIL was ready to take action on it, but UCC never sent professional to follow up this.

Design and Process Factors

The UCIL plant design especially the safety systems was not constructed according to the West Virginia plant, US. However, the workers in Bhopal plant were told the other way round. (T.R.Chouhan, 2005).

Back integration which is a hazardous process of the raw materials and intermediate products for formulation of the final product within one facility was implemented for economics reason. (Edward Broughton, 2005)

Root Causes

The location of UCIL plant was too close to the heavily populated area. Basically, this settlement was illegal but the India government gave squatter right to the company in 1984. (Frank P. Lees, 1996) Besides that, the management decisions causing the flare tower system in need of repair was neglected and the scrubber system was in stand-by mode to save the operating cost. In addition, the coolant was removed from the refrigeration system that used to cool the MIC storage tanks. (Ronald J. Willey, Dennis C. Hendershot & Scott Berger, 2006)


According to T.R. Chouhan, ex-MIC plant operator, Bhopal (2005), the vent gas scrubber was designed to neutralize the toxic gases that come from the MIC plant. Unfortunately, it was not capable in handling the runaway reaction.

On the other hand, suppose the flare tower was capable in burning out all of the excessive carbon monoxide and MIC vapors at the manageable level but it was not at the time of the incident.

Furthermore, MIC storage 30 tons refrigeration system had been shut down for a couple of time to save electricity. This system was actually used to maintain the temperature of MIC below 5C to prevent runaway reaction.

In addition, the warning alarm which is designed for the community supposed to sound for long but it was not. Only the side alarm had activated and caused the residents in Bhopal could not escape as soon as possible. Lastly, there was no evacuation plan for the community of Bhopal and the community was not told about the gas leakage after the accident.

Consequences of the Effects of the Accident


Many of the survivors were still suffering from chronic illnesses such as fibrosis, bronchial asthma, and recurrent chest infection. Besides that, many children were born after the disaster with deformities such as cleft palate, three eyes, all finger joined, one extra finger, and different skull shapes. (Dinesh C Sharma, 2002) Not only this, the women' reproductive health was also affected. The stillbirth rate increase dramatically and the spontaneous abortion rate was increase three to four time and still keeping on raising for several years. (Ingrid Eckerman, 2001)

Environment and Ecology

Water pollution was found. The underground water in Bhopal was polluted by the abandoned chemicals in the factory after the disaster and it was not safe for drinking. (Clouds of Injustice, 2004)Large amount of cattle in the affected area were killed. The plant life was severely damaged and widespread defoliation of tree was also occurred. (TED Case Studies)

Damage Costs

The $28 million UCIL plant was completely closed in India and caused the 650 workers lost their jobs. The UCC research and development center also was closed three month later. All local business and state government offices were closed for three weeks. This resulted in losing business and tax. (Paul Shrivastava, n.d) Another great loss was Union Carbide had to pay $470 million to the damage caused in this accident. (Dale Sullivan, 1998)

Improvements and Preventions

Design and Process

The plant location should move far away from the city area. The good emergency plan should be designed to the neighbor community. Unproven manufacturing processes should not be used. Besides that, a modification is required in piping system shown in Figure 6.1 to avoid the water near to the MIC storage tanks.

Human Resource

The responsible for the plant between UCC and Indian investors should be stated clear to avoid the shrug off responsibility after the accident. A quality training program should be provided to enhance the worker skill in handling the hazardous MIC substances before going into operation.

Safety and Health

India government should strengthen the safety regulations for all the multi-national companies who would like to invest in their country. However, increasing the safety standard is more preferable rather than decreasing it. Although, the cost in upgrading the safety systems is very expensive but by doing this, the company would have minor cost incurred in medical claims, environmental clean-up and safety/ health litigation. Additionally, a safe working environment will make the worker will be more willingly work for the company.

Besides that, all the safety equipments should be working at the time. The MIC storage should be checked regularly to make sure all the equipments in production are working properly and thus the precondition of disaster will be reduce significantly.

In addition, the company should provide sufficient public information regarding the hazardous MIC to the community around the plant area through the local media such as radio, and newspapers so that the community will able to take appropriate action for self rescue in case the accident happens.


The lesson of Bhopal disaster was a wake-up call to raise the safety awareness

List of References
  • Dale Sullivan. (1998) Bhopal Gas Tragedy. Available at: (Accessed on 14 November 2009)
  • Sumohon Matilal and Heather Hopfl. (2009) 'Accounting for the Bhopal Disaster: footnotes and photographs', Accounting, Auditing & Accountsability Journal Vol.22 No.6, pp. 953-972
  • Frank P. Lees. (1996).Loss of Prevention, Volume 3,2nd edn, Butterworth Heinemann.
  • Ingrid Eckerman. (2005).The Bhopal Saga. Causes and Consequences of the World's Largest Industrial Disaster. University Press (India) Private Limited
  • Jackson B. Browing (1993) Disaster at Bhopal. Available at: (Accessed on 15 Nov 2009)
  • Paul Shrivastava. (1994) 'Analysis Democratic Control of Technological risk in Developing Countries', Ecological Economics 14, pp. 195-208
  • Ingrid Eckerman, Chemical Industry and Public Heatlh. Available at: (Accessed on 14 November)
  • T.R. Chouhan. (2005) 'The Unfolding of Bhopal Disaster', Journal of Loss Prevention in the Process Industries 18, pp. 205-208
  • Roli Varma & Daya R. Varma (2005). The Bhopal Disaster of 1984 Available at: (Accessed on 14 November 2009)
  • Edward Broughton (2005). The Bhopal Disaster and its Aftermath. Available at: (Accessed on 16 November 2009)
  • Dinesh C Sharma. (2002) 'Bhopal Health Disaster Continues to Unfold', The Lancet, Vol 360, Issue 9339, pp. 859
  • Paul Shrivastava. (n.d), 5 Long-term Recovery from Bhopal Crisis. Available at: of the victims and their community. (Accessed on 17 November 2009)

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