title: Public health aspects of the world's largest mass gathering: The 2013 Kumbh Mela in Allahabad, India.
abstract: India's Kumbh Mela remains the world's largest and longest mass gathering. The 2013 event, where participants undertook a ritual bath, hosted over 70 million Hindu pilgrims during 55 days on a 1936 hectare flood plain at the confluence of the Yamuna and Ganga Rivers. On the holiest bathing days, the population surged. Unlike other religious, cultural, and sports mass gatherings, the Kumbh Mela's administration cannot estimate or limit the participant number. The event created serious and uncommon public health challenges: initiating crowd safety measures where population density and mobility directly contact flowing bodies of water; providing water, sanitation, and hygiene to a population that frequently defecates in the open; and establishing disease surveillance and resource use measures within a temporary health delivery system. We review the world's largest gathering by observing first-hand the public health challenges, plus the preparations for and responses to them. We recommend ways to improve preparedness.
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Satchit
authors.initials: S
authors.lastname: Balsari
authors.affiliation: Harvard TH Chan School of Public Health, 75 Francis Street, Boston, MA, 02115, USA. ggreenou@hsph.harvard.edu.
authors.forename: P Gregg
authors.initials: PG
authors.lastname: Greenough
authors.affiliation: Department of Medicine (Cardiology) and Epidemiology & Biostatistics, University of California San Francisco, La Jolla, CA, USA.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Kazi
authors.affiliation: University of California, San Diego, La Jolla, CA, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Heerboth
authors.affiliation: Department of Community Medicine, Motilal Nehru Medical College, George Town, Allahabad, Uttar Pradesh, 211001, India.
authors.forename: Shraddha
authors.initials: S
authors.lastname: Dwivedi
authors.affiliation: FXB Center for Health and Human Rights, 651 Huntington Avenue, Boston, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Leaning
mesh_terms: D003441:Crowding; D018596:Hinduism; D006801:Humans; D007194:India; D011159:Population Surveillance; D015980:Public Health Practice; D012449:Safety; D012499:Sanitation
keywords: crowd control; epidemic surveillance; hygiene; mass gathering; sanitation; water supply