A government-appointed committee that investigated the stampede at a temple in Goa on May 3 has concluded that the tragedy was “entirely preventable” and stemmed from “a combination of poor planning, lack of enforcement, ignored directives, and inadequate infrastructure”.
Six people were killed and at least 100 were injured in the attended by thousands of devotees at Lairai Devi temple in North Goa’s Shirgao village in the early hours of May 3. The Jatra, held in honour of Goddess Lairai Devi, is attended by thousands of special devotees, called ‘Dhonds’, who come from across Goa and neighbouring states.
The committee report flagged institutional and procedural shortcomings by the organisers (the management committee of the Shree Lairai Saunsthan), the district administration, police and the local body (village panchayat). The “absence of basic crowd control infrastructure, disregard for specific administrative instructions and failure to utilise modern surveillance tools” contributed to a critical breakdown in safety, the report said.
It said the stampede was “not an inevitable act of fate” beyond human control, but a “preventable tragedy resulting from systemic oversights and fractured accountability”. The committee found that the stampede was precipitated by a “confluence of preventable lapses and oversights among key stakeholders”.
“The immediate trigger was overcrowding on the sloped pathway between Tali (the holy pond) and Homkhand (fire pit), compounded by the sudden surge and forward movement of a group of Dhonds, disregarding the protocol, which caused the fall of a person and a subsequent domino effect,” the report said.
“However, this critical incident was precipitated by a chain of arising from inadequate crowd risk assessment, absence of unidirectional circulation planning, non-implementation of safety directives, ambiguity in sectoral responsibilities, failure to utilise surveillance tools, unregulated roadside vending and the lack of pre-emptive crowd behaviour management,” it said.
The report said the crowd was permitted to enter the sloped pathway from Tali in groups, “which were subsequently channelled into a two-by-two queue formation after the end of the sloped gradient leading towards Homkhand. This arrangement resulted in a build-up of people on the sloped section, causing overcrowding in that area. The overcrowding, coupled with attempts by some groups of Dhonds to push forward through the crowd and their unruly behaviour, caused instability among devotees walking along the slope”.
As a consequence, a person fell face-first on the sloped section, triggering a chain reaction in which several people behind and around her lost their balance and fell over one another. “Owing to the downward slope, limited visibility and the push of the crowd and unruly behaviour, the people approaching from behind were unaware of the fall and continued moving forward, leading to the stampede,” the report said.
The stampede “could likely have been averted with proper planning, risk assessment, and the implementation of effective crowd management strategies”, it said.
Releasing the report in a press conference on Tuesday, Goa Chief Minister said the tragic incident was an “eye opener”.
“The fact-finding committee has pointed out shortcomings by several stakeholders — the temple committee, the district administration, district police, village panchayat and crowd behaviour, and it is everyone’s collective responsibility. The police have filed a case against unknown people and that inquiry will continue. The government will take action based on the recommendations (of the committee) in the next few days,” he said.
Sawant said that to avoid such incidents in future, crowd management plans will be outlined in advance, in accordance with norms of the disaster management authority, for all religious festivals.
A statement from the office of the Chief Minister said show-cause notices have been issued to eight officers in connection with the inquiry. Notices were issued to former district magistrate, North Goa district; former SP, North Goa; former deputy collector and SDM, Bicholim; former DSP, Bicholim; former mamlatdar, Bicholim; former police inspector, Bicholim police station; former inspector, Mopa police station; and panchayat secretary, Shirgao.
