The Indian city of Bhopal experienced one of the world's worst industrial disasters in 1984. 31 years later, it remains one of the most toxic residential areas in the world.

Nina Joshi Ramsey by Ash Photography & Design

Nina Joshi Ramsey by Ash Photography & Design

In the immediate aftermath of the poisonous gas leak there was a high fatality count. Among survivors, large numbers experience the effects in their everyday life, both physically and mentally.

A 2015 review found enduring physical symptoms and also mental health needs that included post-disaster anxiety-depression, post-traumatic stress disorder (PTSD) and adjustment disorders. This is a blemish to a fast-advancing superpower nation competing with others as well as its own past.

At 12.05am on 3rd December, 1984, a gas tank exploded at a pesticide plant owned by Union Carbide India Limited. It leaked 40 tonnes of methyl isocyanate (MIC) on the 700,000 residents of Bhopal. MIC is a highly reactive gas with disastrous effects. Figures vary, but at least 2,000 people died during the night. Up to 5,000 within 72 hours and 15,000 in the weeks that followed. Up to 200,000 are said to have been directly affected.

MIC attacks the eyes and lungs. It also gets into the blood stream and affects all other organs. Victims drowned in their own body fluids. High proportions of pregnant women suffered spontaneous abortions.

The physical symptoms of survivors included eye and lung problems as well as gastrointestinal and genealogical issues. Many of these were investigated after the disaster without full resolution.

Within a fortnight of the disaster, the Indian Council of Medical Research (ICMR) identified psychological issues. Acute needs included addressing 'states of confusion, reactive psychoses, anxiety-depression and grief'. Long-term needs were divided into four categories: survivors reacting to acute and chronic disabilities; unaffected exposed populations facing future uncertainties; psychological effects of broken families, and rehabilitation effects.

A scarcity of mental health professionals in the state of Madhya Pradesh meant it took another eight weeks before help arrived. A psychiatrist, clinical psychologist and social worker visited ten general medical clinics to interview affected populations. Assessments and some systematic studies were carried out, with symptoms compared against control populations living far from the gas-exposed area.

Senior psychiatrists prepared vignettes to sensitise medical professionals to psychological complaints because, unfortunately, many considered such symptoms to be imagined or related to claims for compensation. Experts were temporarily brought into the area for studies and training. Whilst an improvement in capabilities was noted, there was no systematic provision of services. An ICMR study that observed a strong initial relationship between brain damage and gas-affected children was stopped part-way, and soon after all ICMR activities ceased.

Despite the absence of systematic scientific research, anecdotal evidence has been de-prioritised. Yet wives lamented the turn of personality in their husbands, with complaints of uncharacteristic violence, irritability and alcoholism. 

Women suffered gynealogical problems, which meant the inability to find marriage matches for many. Breakdown of social structures, employment, loss of family members, and coping with gas-related illness and grief led to further mental trauma.

A mantra emerged that those who perished were the lucky ones and survivors were left asking for death from God. Whilst government agencies didn't seem to recognise gas-related mental health needs, survivors considered even a compassionate ear therapeutic.

R. S Murthy, a mental health professional, has been active in studies and reviews from the early days of the Bhopal disaster. He concluded in early 2015 that training and practices within communities may serve the mental health needs of affected populations better than clinical settings that have yet to have significant effect.

Disasters inevitably cause fatalities and trauma, and recovery from each will have differing and nuanced resources. However, disaster recovery cannot automatically happen. It has to be a goal. Someone has to plan and be accountable for the population's needs. The home of that responsibility remains a key question.

Nina Joshi Ramsey has written a novel based on the Bhopal disaster, Lifewalla. It is available now in paperback, priced £9.99, with 100 per cent of proceeds going to Bhopal charities. For more information www.lifewalla.org.