In his book “The Wars of the Jews,” historian Flavius Josephus describes how even before the outbreak of the Great Revolt in the first century, the Passover holiday in the Temple ended in disaster. Due to the fact that a Roman soldier provoked the Jewish pilgrims to Jerusalem, young men started to throw stones at the Roman regiment. The Roman soldiers broke into the Temple and caused panic.
The crowd tried to flee: “There was great confusion at the exits from the Temple Mount, where the masses of those fleeing were pushed, and about 10,000 people were trampled by the feet of their brethren, or suffocated and died. That is how this holiday turned into a time of mourning for the entire nation, and in every home there was wailing and sighing,” Josephus wrote.
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Even before the coronavirus pandemic, mass gatherings were considered events that could trigger numerous health-related dangers: from the transmission of contagious diseases to environmental threats such as extreme weather conditions, and also disasters such as fires, the collapse of buildings or terror attacks.
According to current research, stampeding is the second biggest cause of death at mass events (after death as a result of heat conditions).
To this day, religious events are considered the largest mass gatherings in the world, with the most prominent being the hajj (the Muslim pilgrimage to Mecca), and the Kumbh Mela Hindu festival in India.
Scientific interest in stampedes has increased in recent years, one reason being the disaster at the 2010 Love Parade in Duisburg, Germany, in which 21 people were killed; and the 2015 hajj, in which over 2,000 people were killed and which is considered the most lethal stampede in recorded history.
Although over 10,000 people died in 350 stampede incidents throughout the world between 1980 and 2012, scientific knowledge about the precise causes of the events is still limited.
One example of those limitations is the hajj tragedy in Saudi Arabia, a country famous for the tools it uses to control the movement of the crowd during the pilgrimage – including the construction of a special bridge to prevent bottlenecks – after a previous accident that occurred there in 2006.
Meta-analysis of the scientific literature dealing with stampedes, which was published in the peer-reviewed medical periodical Prehospital and Disaster Medicine in 2017, identified 64 scientific articles dealing with such disasters. According to the study, the definition of stampeding itself is not uniform in the various scientific articles.
The researchers wrote that old studies tended to describe such disasters as resulting from irrational behavior in the crowd – either after panic arose for some specific reason, or when too many people tried to reach a certain spot simultaneously.
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Some of the articles even described the crowd’s “bestial” behavior.
However, modern research has found that this understanding of the crowd’s irrational behavior is erroneous, and that failures in planning and management of the events are the main reason for stampeding accidents.
Studies based on interviews with disaster victims have even demonstrated that at key moments, “the crowd would cooperate and behave rationally,” the researchers stated.
As expected, overcrowding plays a central role in the unfolding of disasters. But modern research highlights that the main risk is not the overall number of participants at a given event, but localized crowding at key points – and it also depends on the nature of the event and the participants.
According to research, the pattern that repeats itself in stampedes is that when the overcrowding increases, the free-flowing movement of the crowd stops and a wave pattern is created in which the crowd stops and continues to move, stops and continues to move.
“This pattern can cause the crowd’s loss of control of the movement, and individuals within it are randomly pushed aside,” write the researchers. “When one of them loses his balance and trips, or is thrown down, people around them start to fall due to the sudden imbalance in the forces.”
The researchers also describe how, in this situation, people in the crowd begin to step on one another in order not to fall. If the event doesn’t end quickly, those who are at the bottom of the mass of bodies are likely to die from what is called traumatic asphyxia – strong pressure on the chest that prevents the regular flow of blood and oxygen to the brain.
A smaller percentage of the victims die from internal injuries caused by being trampled. Aside from that, those injured in a stampede are likely to suffer from head injuries, chest bleeding, fractures and serious muscle injuries that are likely in turn to destroy the kidneys. Survivors of such accidents, the researchers note, are also at greater risk of suffering from a variety of emotional disturbances, from anxiety and depression, to the outbreak of phobias and PTSD.
Although scientific knowledge is incapable of fully explaining why stampede events take place, on a practical level there are long-term action plans as to how to prepare for and manage mass gatherings, according to Dr. Bruria Adini of Tel Aviv University, who specializes in the preparation and response of health-care systems to mass-casualty events and disasters.
“Preparing for a mass-casualty event takes years. There are theories that have been constructed both in Israel and worldwide,” says Adini, who served in the Israel Defense Forces’ Medical Corps and was in charge of preparing the hospitals for emergency events. “It’s a language that’s shared by all the first responders, including the police, firefighters and Magen David Adom emergency services, hospitals, local governments, and so on,” she says.
Mass gatherings, Adini explains, can be divided into two types: those that take place unexpectedly; and those that are known in advance.
The challenge in the unexpected events is to adapt the principles of managing mass events to the situation that has developed. And in fact, according to the 2018 meta-analysis, stampede events at unplanned mass gatherings were 40 times as deadly as events that were included in studies and took place at planned events.
The Lag Ba’omer celebration at Mount Meron, Adini stresses, was not an unexpected event. “There’s a procedure that every organization is familiar with. The procedure also includes the preliminary organization and its drill, as well as coordination and communication among the various forces, and the issue of oversight and control: who’s in charge of the entire event; who commands each of the organizations in terms of professional conduct; and the control and sharing of information. All these elements, especially regarding Mount Meron and Lag Ba’omer, already exist and have been drilled for many years,” she says.
One of the factors affecting the scope of the disaster is the time it takes for the rescue services to reach the victims.
“The belated evacuation of the Love Parade area, six minutes after the crowd surge began, is considered one of the reasons for the outcome – 21 dead,” write the researchers in the meta-analysis of the 2010 disaster in Germany.
In the case of Mount Meron, Adini says she “assumes there was a bottleneck that led to this disaster. If it was hard to reach the victims due to the overcrowding, then it’s also hard for the rescue services to arrive, in spite of their close proximity, to rescue the victims and transfer them to places for treatment.”
What caused the bottleneck exactly? That’s something an inquiry will have to determine. “In most cases at mass gatherings that are known in advance, the problem is that someone in the chain of command and control, and coordination among the forces, operated incorrectly. The procedure is constructed for the reality. It really does take into account the physical conditions and the capabilities of the rescue services,” Adini says.
“There were many rescue services there. There were hundreds of ambulances, thousands of policemen, etc. All the elements were present,” the researcher adds. “We have to wait for an investigation, of course. We’re in the midst of the process and I really don’t presume to know what happened,” she says. “However, I don’t think we’ll reach the conclusion that it’s something we couldn’t have thought of beforehand, or that it’s something that’s really unusual and not relevant to advance planning.
“It’s very painful to say that – certainly at this time when we’re still experiencing pain and regret in regard to the terrible disaster, and there are families still searching for their loved ones,” Adini responds when asked if she believes the accident could have been prevented. “Unlike natural disasters, which we cannot prevent and whose consequences we can only try to mitigate, we’re supposed to prevent such events as at Mount Meron from taking place.”