Afroze measures her life in dialysis sessions. At 42, she spends two days every week attached to a machine at the Bhopal Memorial Hospital and Research Centre (BMHRC), set up to provide free specialised care to survivors of the 1984 gas leak and their children. After each session, she says, her body becomes so weak she can barely stand. Her vision is fading, and even drinking water can trigger breathlessness as fluid builds up in her lungs. Last year, she slipped into a coma and spent six days on a ventilator. But the disease is only part of her burden.
“The doctors had practically given up,” she says. “My parents and siblings somehow saved me. But we are struggling in every possible way.” Her father, a retired municipal watchman and gas survivor, lives on a modest pension while coping with diabetes and spinal problems. Her mother’s lungs, damaged over decades, now require constant oxygen support. The family rents a cylinder for Rs 5,000 a month.
Afroze now needs a kidney transplant. A private hospital estimated the cost at Rs 6 lakh. Her family first applied for financial support from the Gas Relief Department last November. The application was flagged for incomplete paperwork. They resubmitted in February. The approval came after more than two months, following repeated interventions by activists—and even then, only Rs 4 lakh was sanctioned. More than six months after the initial application, they are still waiting for the remaining Rs 2 lakh. “No one explained why,” Afroze says. “How are we supposed to arrange the rest of the money?”
Forty-one years after the world’s worst industrial disaster killed thousands overnight, survivors say they are fighting another battle—against failing health-care systems, bureaucratic indifference and delayed treatment.
On the night of December 2-3, 1984, toxic methyl isocyanate gas leaked from the Union Carbide plant in Bhopal, killing as many as 10,000 people within three days of the leak while exposing hundreds of thousands more. Over the decades, respiratory illnesses, cancers, neurological disorders, kidney diseases and reproductive health problems have persisted across generations. The disaster is often remembered as a moment frozen in 1984. But for the survivors, it continues through dialysis machines, oxygen cylinders, cancer wards and files that move slowly between government offices while diseases advance inside their bodies.
Afroze’s struggle is not an isolated tragedy. It reflects the condition of a health-care system responsible for nearly 4.3 lakh registered gas victims and their children. Hospital admission data for January 2026 shows that out of a total of 827 admissions, 565 were Bhopal gas victims and another 50 were dependents of gas victims, together accounting for nearly three-fourths of all admissions.
Among departments, ophthalmology reported the highest number of admissions at 202, of which 145 were gas victims. Urology recorded 100 admissions, including 64 gas victims and 14 dependents of survivors, while cardiology saw 82 admissions, with 62 gas victims. Gastro surgery admitted 76 patients and pulmonary medicine admitted 72, again with gas victims forming the majority in both departments. Nephrology recorded 51 admissions, neuro-medicine 34, neurosurgery 38, and surgical oncology 35. ICU admissions stood at eight, all of them gas victims, while the critical care unit recorded 53 admissions, including 47 gas victims. Yet survivors and activists say the infrastructure meant to care for them remains deeply understaffed, fragmented and overwhelmed.
“For the past 22 years, the committee has been receiving many complaints from gas victims,” says Poornendu Shukla, a member of the Supreme Court (SC) Monitoring Committee overseeing medical rehabilitation for gas victims, whose latest report came out in September, 2025. One of the most serious gaps, he says, is the shortage of specialists. Facilities for treating gas-related illnesses exist on paper, but critical posts remain vacant. Even the Pulmonary Medicine Centre in Jahangirabad, specifically set up for respiratory diseases caused by gas exposure, does not have a pulmonary specialist. “What does rising patient load mean if there is no neurologist in the neurology department?” Shukla says. “If there is no nephrologist despite dialysis machines being available, treatment quality will obviously suffer.”
The result is predictable. Patients are forced to turn to private hospitals for procedures that government facilities cannot provide—as in Afroze’s case—or wait until their conditions worsen.
Shukla argues that the problem is structural. Government salaries, he says, are too low to attract and retain specialists who can earn far more in private practice. Without reforms and incentives, the gap is unlikely to close.
The Shortcomings of Ayushman Bharat
For Sami, the system failed his mother long before she died. His mother, Rizwana Begum, was 13 at the time of the gas leak. In April 2025, she was diagnosed with stage-four kidney cancer.
“She was healthy. Then suddenly we found out it had already spread,” says Sami. Doctors believed the illness may have been linked to gas exposure. Treatment required immunotherapy injections costing nearly Rs 2 lakh each, to be administered every 15 days. The family, which runs a small cloth shop, borrowed money for the first injection. What followed was months of delay. The case moved between hospitals and the gas relief department for approvals. “They delayed things so much, often in the name of the Ayushman Bharat scheme, that by then my mother’s condition had deteriorated completely,” Sami says.
Between April 2024 and February 2026, gas relief hospitals referred over 2,146 patients elsewhere for treatment.
Although gas victims are entitled to benefits under the scheme, its package-based system does not align well with chronic and complex conditions such as advanced cancers or long-term kidney diseases.
Monitoring committee reports have also pointed out that several diagnostic procedures and outpatient treatments are not covered. Some medicines once provided free are no longer included, forcing patients to pay out of pocket. Hospitals repeatedly push patients to seek treatment through the Ayushman Bharat scheme, a process families say often lead to further delays in critical care.
“The injections that were supposed to be given every 15 days were arriving after one and a half months,” Sami says. Rizwana received only a few doses before she died in February this year. “Our slippers wore out from all the trips,” Sami says. “We would go there and they would simply say, ‘It hasn’t come yet’. Meanwhile, my mother was suffering terribly.” He still believes his mother may have survived had treatment come on time.
For Nahid, this bureaucratic delay means pleading for stoma bags that allow her to perform most basic bodily functions with dignity. She was one-week-old when the gas leaked. Today, she is 42 and battling rectal cancer.
After surgery, she depends on stoma bags attached to her abdomen. She needs at least one every two days. But approvals for these are often delayed. At times, she is forced to use the same bag for two or three days. “It causes bleeding and severe rashes,” she says. Each bag costs around Rs 300, while her husband earns roughly just Rs 400 a day, working as a labourer. “If one bag costs Rs 300, how are we supposed to eat and raise children and survive?” she asks.
The biggest barrier, she says, is bureaucracy within the gas relief department itself. Officials demand repeated documentation, including her “red list”, which hospitals are often reluctant to provide. The “red list” is a document containing details of all the treatment she has received so far. “The people at Jawahar Hospital do not give it easily. The officials say they will only approve my medical instruments if I bring that list. Otherwise, they will not process anything,” she says. Her mother, also a survivor, is now in intensive care battling blood cancer after years of illness.
A Broken Referral System
When facilities and specialists are unavailable, the BMHRC refers the patients to other hospitals—Hamidia, AIIMS Bhopal, Jawaharlal Nehru Cancer Hospital and others.
Between April 2024 and February 2026, gas relief hospitals referred over 2,146 patients elsewhere for treatment. The Jawaharlal Nehru Gas Rahat Hospital alone accounted for 553 referrals, while the Indira Gandhi Gas Rahat Hospital referred 488 patients and Kamla Nehru Hospital 469.
In 2025 alone, 676 patients were referred from the BMHRC due to lack of beds or facilities.
But there is little clarity as to what happens after referral.
Data on surgeries, transplants or treatment outcomes is not consistently maintained. Patients are often sent from one hospital to another without proper coordination.
To address this, the state government constituted a referral coordination team in April 2024. It was meant to ensure that patients were sent only to appropriate facilities, maintain records and monitor outcomes.
On the ground, however, even the coordination mechanism shows gaps. When Outlook contacted members listed in the April affidavit, gaps emerged within the coordination mechanism itself. Ayra Singh, the network engineer tasked with coordinating all work, said she had not worked with the BMHRC for the past two years. Akshat Malviya, assigned to handle Hamidia Hospital-related work, said he had stopped dealing with gas relief patients nearly a year ago after being given other duties. Sunil, a staff member at the BMHRC handling referrals, says his role was limited to coordinating bed availability and that he did not maintain patient data. Meanwhile, Santosh Singh and Vishal, who handled AIIMS-related referrals, did not respond to repeated calls.
Activists say this leads to patients effectively disappearing within the system. “Patients are referred without checking whether beds are available or whether that hospital even has the required facility,” says Rachana Dhingra of the Bhopal Group for Information and Action. Her constant interventions have helped many survivors get timely treatments.
The SC committee has recommended a digital tracking system to monitor referrals, complaints and patient movement in real-time. For now, such systems remain incomplete. “The core recommendation from the beginning has always been patient-centric treatment and a patient-centric system,” he adds.
For Afroze, the failures of the system are deeply personal. She once dreamed of opening her own school. She worked with children through NGOs and taught at a school before kidney failure changed the course of her life. “My whole life collapsed.” she says.
“Just because treatment is free does not mean it has to be undignified,” says Dhingra. “This is not charity. This is their right.”
Mrinalini Dhyani is a senior correspondent at Outlook. She covers governance, health, gender and conflict, with a strong emphasis on lived realities behind policy debates
