On Aug.. 26, 1994, the plague struck Surat, a city in the state of Gujarat in western India, and Government officials declared an international public health emergency. The plague in Surat was mostly pneumonic, though the bubonic form was found in three villages in Maharashtra preceding the pneumonic outbreak in Surat.

Because of rumors that Surat would be quarantined and when that action was delayed one-fourth of Surat residents (400,000 to 600,000 people) fled the city within four days of announcement of the epidemic. By Oct. 18, 1994, a total of 52 plague related deaths were reported and total suspected cases numbered approximately 1000 .