This teaching case describes the fatal stampede in Allahabad, India during the 2013 Kumbh Mela festival, and the lessons it offers for thinking about global health risks and responses to unintentional accidents and injuries related to mass gatherings. The case is part of a teaching pack, “Accidents & Injuries: Lessons from a Stampede,” which also includes a companion instructor’s guide, discussion guide, role-play exercise, annotated bibliography, and glossary of terms. The case is suitable for undergraduate and graduate classes in the study of religion, humanitarian aid, public health, and emergency medicine with a focus on disaster management.

This case describes efforts to balance public health concerns with religious and cultural practices of religion pilgrims in India. The Kumbh Mela festival, the largest mass gathering in the world, takes place every 12 years in Allahabad, India. Pilgrims at the 2013 festival followed toilet and water sanitation practices common in South Asia, practicing defecation in both designated areas (contained squat toilets and private “flag” areas for open defecation) as well as public defecation in the sand or by the riverbanks. The construction of the site - and organization of the facilities to support it - follow a detailed system that has developed over decades of close collaborations with national, state, and regional governments and religious leaders, and includes the provision of clean drinking water and public toilets. This case describes efforts by government officials during the 2013 festival to ensure and maintain adequate and appropriate sanitation facilities (toilets and the use of safe drinking water) and the long-term impact of the observed practices on the physical environment. The case introduces students to the conditions and challenges of water and sanitation as it relates to cultural issues (social determinants of health) in global communities with limited resource for optimal health governance.