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More than two months after a toxic gas leak from sewage left 11 dead in Jiaspora district of Ludhiana on April 30, the judicial investigation conducted into the incident remained inconclusive, and no one was held responsible for the tragedy, while stating that it may have led to collaborative factors” to the tragedy and that “there is no reliable evidence to determine” whether the tragedy was caused by choked sewage lines or a sudden industrial discharge.
While the Judicial Investigation Report was submitted by Sub-Division Judge (SDM, West) Harjinder Singh to Deputy Commissioner Ludhiana Surabhi Malik last week on June 29, two more investigations into the incident – one ordered by the National Green Court (NGT) and the other being conducted by Ludhiana Police Special Investigation Team (SIT) – Still underway. Here is a summary of what has happened so far in three investigations:
The judicial investigation is inconclusive, a 223-page report finding no one directly responsible for the tragedy
The 223-page report (copy with The Indian Express) provided by SDM says that reports and observations submitted by several stakeholders and agencies such as Municipal Corporation, Punjab Pollution Control Board (PPCB), Council of Scientific and Industrial Research (CSIR), have been The Central Pollution Control Board (CPCB) analyzed the investigation and confirmed that the spread of toxic hydrogen sulfide (H2S) was the cause of death. However, the report is still inconclusive about the cause of such a high concentration of hydrogen sulfide gas in wastewater and who is responsible for it.
Sh Sheelendra Pratap Singh of Indian Institute of Toxicology Research, Lucknow, gave his observation that H2S is a naturally occurring gas in sewers but such high amount of concentration is not usually heard of and could be due to anaerobic digestion of sewage waste along with high amount of acid/metal. Dr. Lakshmi, an epidemiologist from PGIMER Chandigarh, has pointed out that no such report of H2S death in open space has been reported anywhere in the world,” says an excerpt.
“PPCB reported that industries within 500 meters of the site were inspected and it was found that out of a total of 113 industries examined, 17 were polluting water. Of the 17, four were at the end of the accident, 3 were consumers of acids and 13 were found Upstream, 11 of them were acid consuming,” adds the report.
Citing a report from Dr. Anjan Rai, Director of the CSIR, he says: “Evidence from the medical examiner and his initial forensic assessment suggests that hydrogen sulfide is the main causative agent but we cannot rule out carbon monoxide as a second causative agent.”
“PPCB stated in its final report that possible causes of H2S buildup were clogged air vents, clogged drains, poorly designed sewers, blockages/stagnation, slow velocities of sludge/sludge formation, etc.,” the report says.
The Powers report, in its final analysis of several submissions from stakeholders and institutions, says: “The drawn deductions/scientific interpretations offered by different agencies are limited by the scale and scope of samples collected by different agencies at different locations at different times that day… It cannot be recreated.” The exact ambient conditions in the sewers were not tested on the day of the tragedy today…but that does not mean that deductions cannot be drawn on the basis of existing reports.”
Some of the observations mentioned in the report are: “There were no sewage blockages reported by the residents and no blockages were clearly observed. There were no ventilation holes in the manholes. The buildings were very crowded and cross ventilation was minimal. In the apartment building of Arte’s clinic, there was a dry drain hole which was probably the most likely source of vomit sewage gases into the house. There was heavy rain the day before. Hydrogen sulfide gas poisoning has been proven by medical evidence, forensic evidence, and gas detectors. There was a dead cat on the ground floor but a dog survived in the same building upstairs. This adds to the theory of formation of a lethal gas blanket with the highest concentration at ground level since hydrogen sulfide is usually much denser and heavier than air.”
The report concluded that no one could be held directly responsible for the tragedy and that it was an “accumulation” of “cooperative factors” that may have led to the buildup of hydrogen sulfide gas that day, the report says: “Obviously different stakeholders have different interpretations of the implications.” on the same facts. It would be appropriate to draw some conclusions on this aspect as to what cannot be ruled out, rather than using conjectures to reach indisputable conclusions.”
“The result is that—first, there was an anomaly in the equilibrium conditions of the sewers on the day of the accident. There is no reliable evidence to determine whether this was due to structural discrepancies of the sewer lines at those locations or due to sudden abnormal industrial discharge. It is understood that all interactions The aforementioned chemistry is plausible, even at the same time with the right ambient conditions.Determining which of these effects would have dominated at that point will be largely speculative and probable in nature, the report says.
“It is evident from the facts provided by several agencies that a particular stretch of sewer was behaving quite abnormally compared to its upstream and downstream points… This report posits that there appeared to be an accumulation of provocative conditions over time and a sudden stimulating event that could have triggered to this tragedy… Factors that have accumulated over time may include intermittent industrial unloading, meat residue discharge, inadequate aeration and sludge formation… However, acknowledging the collaborative factors that could have led to this incident is relevant from Where to strengthen preparedness for the future… Hence our findings focus on suggestive steps based on lessons learned from this disaster,” the report concludes, adding that these observations have also been brought to the attention of the NGT Committee.
Truth NGT
The National Green Court (NGT) in its order of May 2 has set up an eight-member fact-finding committee chaired by PPCB Chairman Adarsh Pal Vig. The committee has been ordered to submit its report by June 30, but the investigation is still ongoing. The case is now up for hearing on July 13.
Speaking to The Indian Express, Vij said the committee will consider inputs, observations and sub-reports from all stakeholders including the judicial investigation before submitting the final report. “We may submit an interim report or request an extension of the deadline,” he said. The committee has held three meetings so far and visited the venue.
SIT the police
A Special Investigation Team (SIT) of Ludhiana Police headed by SP (Investigation) Harmeet Singh Hundal is also conducting a separate investigation and the report has yet to be submitted to the Commissioner of Police.
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