In 1994, a pneumonic plague epidemic broke out in India. It was particularly widespread in Surat, Gujarat, where it resulted in 52 deaths and in a large internal migration of about a quarter of the city's 1.5 million, who fled fearing quarantine ^[1]

A combination of heavy monsoon rain and clogged sewers led to massive flooding which resulted in unhygienic conditions and a number of uncleared animal carcasses. It is believed that this situation precipitated the epidemic.^[2] There was widespread fear that the flood of refugees might spread the epidemic to other parts of India and the world, but that scenario was averted, probably as a result of effective public health response mounted by the Indian health authorities.^[3]

Much like the Black Death that spread through medieval Europe, some questions still remain unanswered about the 1994 epidemic in Surat.^[4]

Initial questions about whether it was an epidemic of plague arose because the Indian health authorities were unable to culture Yersinia pestis, but this could have been due to lack of sophisticated laboratory equipment.^[4] Yet, there are several lines of evidence strongly suggesting that it was a plague epidemic: blood tests for Yersinia were positive, a number of individuals showed antibodies against Yersinia and the clinical symptoms displayed by the affected were all consistent with the disease being plague.^[5]

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