In September 1994 an outbreak diagnosed as pneumonic plague struck Surat, then among India's dirtiest and fastest-growing industrial cities, built on textiles, diamonds and migrant labour. Dozens died, several hundred thousand residents fled, and India briefly faced international travel and trade restrictions. From 1995 the municipal commissioner S. R. Rao restructured the Surat Municipal Corporation: the city was split into six zones whose officers held commissioner-level powers, senior staff were required to spend hours each day in the field and in slums, open drains were covered, pay-and-use toilets built and door-to-door waste collection enforced with penalties. Within two years Surat was being ranked among the cleanest cities in India.
Surat became the standard Indian demonstration that urban sanitation is a problem of municipal administration and accountability rather than of money alone, and it is routinely cited as the ancestor of later sanitation ranking regimes such as Swachh Survekshan. The epidemic also forced drainage, flooding and epidemic risk onto the agenda of India's industrial boomtowns.
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