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The greatest industrial disaster of India; was it man-made?



Summary of background and causes:

By 1984, only six of the original twelve operators were still working with MIC and the number of supervisory personnel was also cut in half. No maintenance supervisor was placed on the night shift and instrument readings were taken every two hours, rather than the previous and required one-hour readings. Workers made complaints about the cuts through their union but were ignored. One employee was fired after going on a 15-day hunger strike. 70% of the plant's employees were fined before the disaster for refusing to deviate from the proper safety regulations under pressure from management.

In addition, some observers, such as those writing in the Trade Environmental Database (TED) Case Studies as part of the Mandala Project from American University, have pointed to "serious communication problems and management gaps between Union Carbide and its Indian operation", characterised by "the parent companies [sic] hands-off approach to its overseas operation" and "cross-cultural barriers". The personnel management policy led to an exodus of skilled personnel to better and safer jobs.

Equipment and safety regulations:

Union Carbide MIC plant

* It emerged in 1998, during civil action suits in India, that, unlike Union Carbide plants in the US, its Indian subsidiary plants were not prepared for problems. No action plans had been established to cope with incidents of this magnitude. This included not informing local authorities of the quantities or dangers of chemicals used and manufactured at Bhopal.
* The MIC tank alarms had not worked for four years.
* There was only one manual back-up system, compared to a four-stage system used in the US.
* The flare tower and the vent gas scrubber had been out of service for five months before the disaster. The gas scrubber therefore did not treat escaping gases with sodium hydroxide (caustic soda), which might have brought the concentration down to a safe level. Even if the scrubber had been working, according to Weir, investigations in the aftermath of the disaster discovered that the maximum pressure it could handle was only one-quarter of that which was present in the accident. Furthermore, the flare tower itself was improperly designed and could only hold one-quarter of the volume of gas that was leaked in 1984.
* To reduce energy costs, the refrigeration system, designed to inhibit the volatilization of MIC, had been left idle—the MIC was kept at 20 degrees Celsius (room temperature), not the 4.5 degrees advised by the manual, and some of the coolant was being used elsewhere.
* The steam boiler, intended to clean the pipes, was out of action for unknown reasons.
* Slip-blind plates that would have prevented water from pipes being cleaned from leaking into the MIC tanks through faulty valves were not installed. Their installation had been omitted from the cleaning checklist.
* Water sprays designed to "knock down" gas leaks were poorly designed—set to 13 metres and below, they could not spray high enough to reduce the concentration of escaping gas.
* The MIC tank had been malfunctioning for roughly a week. Other tanks had been used for that week, rather than repairing the broken one, which was left to "stew". The build-up in temperature and pressure is believed to have affected the magnitude of the gas release.
* Carbon steel valves were used at the factory, even though they corrode when exposed to acid. On the night of the disaster, a leaking carbon steel valve was found, allowing water to enter the MIC tanks. The pipe was not repaired because it was believed it would take too much time and be too expensive.
* UCC admitted in their own investigation report that most of the safety systems were not functioning on the night of December 3, 1984.
* Themistocles D'Silva asserts in the latest book—The Black Box of Bhopal—that the design of the MIC plant, following government guidelines, was "Indianized" by UCIL engineers to maximize the use of indigenous materials and products. It also dispensed with the use of sophisticated instrumentation as not appropriate for the Indian plant. Because of the unavailability of electronic parts in India, the Indian engineers preferred pneumatic instrumentation. This is supported with original government documents, which are appended. The book also discredits the unproven allegations in the CSIR Report. .....more