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Four Medical and Environmental Cases
for Eradicating Nuclear Weapons
INTERNATIONAL PHYSICIANS FOR THE PREVENTION OF NUCLEAR WAR
Zero is the only option
Credits and Acknowledgements
The publication of this briefing paper was made possible thanks to a gen-
erous financial contribution from IPPNW’s Swedish affiliate, Svenska
Läkare mot Kärnvapen (SLMK).
This paper was written and edited by John Loretz, Program Director of
International Physicians for the Prevention of Nuclear War. It draws
extensively from the work of climate scientists at Rutgers University and
the University of Colorado at Boulder, including Alan Robock, O. B.
Toon, Michael Mills, and their colleagues, who have been documenting
the climate effects of regional nuclear war since 2007. An archive of sci-
entific articles and supporting materials is available at
http://climate.envsci.rutgers.edu/nuclear. Recent studies published by
physician experts on the medical consequences of nuclear war, includ-
ing Lachlan Forrow, Ira Helfand, and Victor W. Sidel, were also primary
sources for this paper, and are cited in the notes. Aki Morizono designed
and produced the paper. IPPNW is solely responsible for the policy con-
clusions expressed in this paper and for any errors that may have been
introduced in the editing process.
INTERNATIONAL PHYSICIANS FOR THE PREVENTION OF NUCLEAR WAR
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ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
1
“Nuclear weapons are unique in their
destructive power, in the unspeakable human suffering
they cause, in the impossibility of controlling their effects in space and
time, in the risks of escalation and in the threat they pose to the environ-
ment, to future generations, indeed, to the survival of humanity....
“Preventing the use of nuclear weapons means preventing their prolifera-
tion and combating the transfer of materials and technology needed to
produce them.
It requires the fulfillment of
existing obligations to pursue negoti-
ations to prohibit and completely
eliminate such weapons.”
—Statement of International Committee of the Red Cross (ICRC)
to the 2009 UNGA First Committee, 9 October 2009
2
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
he goal of a nuclear-weapons-free
world, embedded in Article VI of the
Non-Proliferation Treaty, has been
embraced by a large majority of UN
member states; by prominent diplomats,
policy experts, and military leaders
worldwide; and by overwhelming majori-
ties of citizens in all countries where the
question has been asked in public opin-
ion surveys. UN Secretary-General Ban
Ki-Moon and his predecessor, Kofi
Annan, have both said that ridding the
world of nuclear weapons is one of the
most urgent priorities of the international
community.
1
US President Barack
Obama committed himself to working for
“the peace and security of a world with-
out nuclear weapons” in Prague on April
5, 2009.
The importance—in fact the necessity—
of getting to zero has been explained by
senior ministers, diplomats, and retired
military leaders in several countries,
including the US.
2
Their views echo the
conclusions of international physicians,
lawyers, scientists, and civil society
organizations, who have been pressing
the case for nuclear abolition almost
since the beginning of the nuclear age,
and certainly since the entry into force of
the Non-Proliferation Treaty some 40
years ago.
The priority and urgency of nuclear disar-
mament have also been articulated by
high-level international bodies convened
for the purpose of assessing the nuclear
threat and for recommending solutions.
Among these have been the Canberra
Commission on the Elimination of
Nuclear Weapons (1995); the Inter-
national Court of Justice (1996); the
Weapons of Mass Destruction (Blix)
Commission (2006); and the International
Commission on Nuclear Non-
Proliferation and Disarmament (2009).
The latter issued its final report in
December 2009, the first paragraph of
which should be committed to memory
by anyone concerned with the survival of
humankind:
“Nuclear weapons are the most inhu-
mane weapons ever conceived, inher-
ently indiscriminate in those they kill and
maim, and with an impact deadly for
decades. Their use by anyone at any
time, whether by accident, miscalculation
or design, would be catastrophic. They
are the only weapons ever invented that
“There is no doubt that, if the
peoples of the world were more
fully aware of the inherent dan-
ger of nuclear weapons and the
consequences of their use, they
would reject them, and not per-
mit their continued possession
or acquisition on their behalf by
their governments, even for an
alleged need for self-defence.”
—Canberra Commission
“So long as any state has nuclear
weapons, others will want them.
So long as any such weapons
remain, there is a risk that they
will one day be used, by design
or accident. And any such use
would be catastrophic.”
—Weapons of Mass Destruction Commission
Secretary-General Ban Ki-moon. "The United Nations and security in a nuclear-weapon-free world." Address to the East-West Institute. New York. October 24, 2008.
Secretary-General Kofi Annan. Lecture. Princeton University. November 28, 2006.
George P. Shultz, William J. Perry, Henry A. Kissinger, Sam Nunn. A world free of nuclear weapons. Wall Street Journal. January 4, 2007; Douglas Hurd, Malcolm Rifkind,
David Owen, George Robertson. Start worrying and learn to ditch the bomb: It won't be easy, but a world free of nuclear weapons is possible. The Times of London. June 30,
2008; Helmut Schmidt, Richard von Weizsäcker, Egon Bahr, Hans-Dietrich Genscher. Toward a nuclear-free world: a German view. The New York Times. January 9, 2009;
Aleksander Kwasniewski, Tadeusz Mazowiecki, Lech Walesa. The unthinkable becomes thinkable: Towards the elimination of nuclear weapons. Gazeta Wyborcza. April 3,
2009. Odvar Nordli, Gro Harlem Brundtland, Kåre Willoch, Kjell Magne Bondevik, Thorvald Stoltenberg. A Nuclear Weapons-Free World. Aftenposten. June 4, 2009; Alain
Juppé, Bernard Norlain, Alain Richard, Michel Rocard. Pour un désarmement nucléaire mondial, seule réponse a la prolifération anarchique. Le Monde. October 15, 2009.
Introduction
1
2
Introduction
T
3
have the capacity to wholly destroy life
on this planet, and the arsenals we now
possess – combining their blast, radia-
tion and potential ‘nuclear winter’ effects
– are able to do so many times over.
Climate change may be the global policy
issue that has captured most attention in
the last decade, but the problem of
nuclear weapons is at least its equal in
terms of gravity – and much more imme-
diate in its potential impact.”
3
Despite this upsurge in global support for
a world without nuclear weapons, the
road toward zero remains obstructed
and the pace at which the nuclear-
weapon states and the policy elites seem
content to move is unacceptably slow.
Behind the encouraging rhetoric about a
nuclear-weapons-free world we see only
modest, incremental proposals that will
likely postpone the negotiation of a com-
prehensive nuclear disarmament agree-
ment—a Nuclear Weapons Conven-
tion—for another two or three decades or
more. Even President Obama has said
that a nuclear-weapons-free world may
not be achieved in his lifetime.
To put it plainly, the world does not have
the luxury of time when it comes to elim-
inating the dangers posed by nuclear
weapons. Every day that they remain in
fallible human hands is a day in which
we might experience a humanitarian and
environmental catastrophe. Every day in
which that catastrophe is averted must
be counted as borrowed time.
International Physicians for the Preven-
tion of Nuclear War has produced this
briefing paper summarizing current med-
ical and scientific knowledge about
nuclear war and its consequences in the
belief that a thorough and unvarnished
understanding of the destructive power
of nuclear weapons will compel decision
makers to fulfill the promise of Article VI
of the NPT and to eliminate the
prospects of nuclear famine, nuclear
winter, and nuclear mass murder without
further delay.
“[T]he adoption each year by
the General Assembly, by a
large majority, of resolutions
recalling the content of resolu-
tion 1653 (XVI), and requesting
the member States to conclude
a convention prohibiting the use
of nuclear weapons in any cir-
cumstance, reveals the desire
of a very large section of the
international community to take,
by a specific and express prohi-
bition of the use of nuclear
weapons, a significant step for-
ward along the road to complete
nuclear disarmament.”
—International Court of Justice, 1996
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
International Commission on Nuclear Non-proliferation and Disarmament. Eliminating nuclear threats: A practical agenda for global policymakers. Canberra/Tokyo. 2009.
3
ONLINE:BLOG
Learn more about the medical and environmental
consequences of nuclear war and contribute to the
discussion at nuclear-zero.org.
4
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
limate scientists who worked with
the late Carl Sagan in the 1980s to
document the threat of nuclear winter
have produced disturbing new research
about the climate effects of low-yield,
regional nuclear war.
4
Using South Asia as an example,
5
these
experts have found that even a limited
regional nuclear war on the order of 100
Hiroshima-sized nuclear weapons would
result in tens of millions of immediate
deaths and unprecedented global cli-
mate disruption. Smoke from urban
firestorms caused by multiple nuclear
explosions would rise into the upper tro-
posphere and, due to atmospheric heat-
ing, would subsequently be boosted
deep into the stratosphere.
The resulting soot cloud would block
7–10% of warming sunlight from reach-
ing the Earth’s surface, leading to signif-
icant cooling and reductions in precipita-
tion lasting for more than a decade.
Within 10 days following the explosions,
there would be a drop in average surface
temperature of 1.25° C. Over the follow-
ing year, a 10% decline in average glob-
al rainfall and a large reduction in the
Asian summer monsoon would have a
significant impact on agricultural produc-
tion. These effects would persist over
many years. The growing season would
be shortened by 10 to 20 days in many of
the most important grain producing
areas in the world, which might com-
pletely eliminate crops that had insuffi-
cient time to reach maturity.
There are currently more than one billion
people in the world who are chronically
malnourished. Several hundred million
more live in countries that depend on
imported grain. Even a modest, sudden
decline in agricultural production could
trigger significant increases in the prices
for basic foods, as well as hoarding on a
global scale, making food inaccessible to
poor people in much of the world. While
it is not possible to estimate the precise
extent of the global famine that would fol-
low a regional nuclear war, it seems rea-
sonable to anticipate a total global death
toll in the range of one billion from star-
vation alone. Famine on this scale would
also lead to major epidemics of infec-
tious diseases, and would create
immense potential for mass population
movement, civil conflict, and war.
These findings have significant implica-
tions for nuclear weapons policy. They
are powerful evidence in the case
against the proliferation of nuclear
weapons and against the modernization
Tens of millions die
immediately in regional
nuclear war with 100
Hiroshima-size weapons
Smoke and soot injected
into upper atmosphere
spreads globally,
blocks sunlight
Sudden global cooling
shortens growing
season, disrupts
agriculture worldwide
Ecological damage
persists for several years
Infectious disease epi-
demics and environmental
conflict follow
One billion nuclear famine
deaths possible
Nuclear Famine: How a Regional Nuclear War
Will Cause Global Mass Starvation
KEY POINTS
Alan Robock, et.al. Climatic consequences of regional nuclear conflicts, Atmospheric Chemistry and Physics Discussion 2006;6:11817-11843.
A conflict of this magnitude would not necessarily involve the extremely large nuclear arsenals of the US and Russia. It could arise between emerging nuclear powers such
as India and Pakistan, or it could result from escalation in the Middle East. Even the remaining US tactical nuclear weapons based in Europe would be sufficient to cause
the devastation described here. The question is often raised about the likelihood of a nuclear war between India and Pakistan. While this scenario is presented primarily
as an example of the global destruction of which these relatively small arsenals are capable, Indian leaders, including General Deepak Kapoor and Defence Minister A. K.
Antony, have recently warned that the possibility of limited nuclear war in a region marked by territorial disputes, ethnic and religious tensions, and socio-economic dispar-
ities is a reality. “Limited war under nuclear overhang possible” General Deepak Kapoor. Defence Forum Of India. November 24, 2009.]
4
5
CASE STUDY #1
C
of arsenals in the existing nuclear
weapon states. Even more important,
they argue for a fundamental reassess-
ment of the role of nuclear weapons in
the world. If even a relatively small
nuclear war, by Cold War standards—
within the capacity of eight nuclear-
armed states—could trigger a global ca-
tastrophe, the only viable response is the
complete abolition of nuclear weapons.
Two other issues need to be considered
as well. First, there is a very high likeli-
hood that famine on this scale would
lead to major epidemics of infectious dis-
eases. Previous famines have been
accompanied by major outbreaks of
plague, typhus, malaria, dysentery, and
cholera. Despite the advances in med-
ical technology of the last half century, a
global famine on the anticipated scale
would provide the ideal breeding ground
for epidemics involving any or all of these
illness, especially in the vast megacities
of the developing world.
Famine on this scale would also provoke
war and civil conflict, including food riots.
Competition for limited food resources
might well exacerbate ethnic and region-
al animosities. Armed conflict among
nations would escalate as states
dependent on imports adopted whatever
means were at their disposal to maintain
access to food supplies.
"The first nuclear war so
shocked the world that in spite of
the massive buildup of these
weapons since then, they have
never been used again. But the
only way to eliminate the possi-
bility of climatic catastrophe is to
eliminate the weapons."
— Alan Robock, O. B. Toon.
Local nuclear war; global suffering.
Scientific American. January 2010.
5
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
AUSTRALIA
CANADA
CENTRAL EUROPE
CHINA
INDIA
RUSSIA/UKRAINE
SOUTH AFRICA
USA
10-30
10-20
10-20
10-20
10
10-30
10
20-30
REGION
GROWING
DAYS
LOST
STAPLE CROPS AFFECTED
WHEAT
MAIZE RICE
The debris injected into the atmos-
phere from 100 15-Kt explosions
and resulting fires would produce an
average surface cooling of -1.25ºC
that would last for several years. In
addition, there would be major
declines in precipitation – up to 40%
– in many of the world’s most impor-
tant grain growing regions. The end
result is significant curtailment of the
growing seasons for the world’s
most essential grain crops.
GROWING SEASON LENGTH
WHEAT: 110-130 growing days
RICE: ~120 days
MAIZE:126-200 days
FIG. 1 IMPACT ON GLOBAL AGRICULTURE OF REGIONAL NUCLEAR WAR (100 15-KT EXPLOSIONS)
The Tambora volcano erup-
tion in 1815 — the largest in
recorded history — caused a
year-long global cooling of
about 0.4ºC-0.7ºC and a dra-
matic shortening of the growing
season around the world. Four
major frosts during the summer
of 1816 caused extensive dam-
age to crops, particularly to
maize, much of which was
destroyed. Famine in densely
populated countries was the
inevitable result. Climate dis-
ruption from a regional nuclear
war would be far more severe
and would last up to ten times
as long.
CLIMATE DISRUPTION
LEADS TO FAMINE
UN PHOTO: JOHN ISAAC
6
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
nuclear war using only a small frac-
tion of current global arsenals
would quickly cause prolonged and cata-
strophic stratospheric ozone depletion.
The impact on human and animal health
and on fundamental ecosystems would
be disastrous.
Scientists have known for more than two
decades that a global nuclear war—an
event that came perilously close during
the Cold War between the US and the
former Soviet Union, and which cannot
be ruled out as long as those massive
arsenals exist—would severely damage
the Earth’s protective ozone layer.
Studies in the 1980s by the US National
Research Council and others showed
that solar heating of the smoke produced
by massive fires would displace and
destroy significant amounts of stratos-
pheric ozone.
6
Early in 2008, physicists and atmospher-
ic scientists from the University of
Colorado, UCLA, and the National
Center for Atmospheric Research pub-
lished important new findings that a
regional nuclear war involving 100
Hiroshima-sized bombs would result in
severe losses in stratospheric ozone.
7
The scientists concluded that a regional
nuclear conflict between India and
Pakistan in which each used 50
Hiroshima-sized weapons (~15 kt) would
produce an estimated 6.6 teragrams (Tg)
of black carbon. In addition to the global
surface cooling described above, large
losses in stratospheric ozone would per-
sist for years. The global mean ozone
column would be depleted by as much
as 25% for five years after the nuclear
exchange. At mid-latitudes (25-45%) and
at northern high latitudes (50-70%),
ozone depletion would be even more
severe and would last just as long.
Substantial increases in ultraviolet radia-
tion would have serious consequences
for human health. Those consequences,
as we know from earlier studies of
stratospheric ozone loss—the “ozone
hole” that prompted the Montreal
Protocol and the phasing out of ozone-
depleting chlorofluorocarbons (CFCs)—
Soot from burning cities
displaces and destroys
stratospheric ozone
Average global ozone
depletion up to 25%
for five years after
nuclear exchange
25-45% depletion
at mid-latitudes;
50-70% at northern
high latitudes
Substantial increases
in ultraviolet radiation
Increased rates of skin
cancer, eye damage,
destruction of aquatic
ecosystems
Effects persist for years
KEY POINTS
A Nuclear Ozone Hole: The Global Cancer
Burden of a Regional Nuclear War
Fred Solomon and Robert Q. Marston (ed.). The Medical Implications of Nuclear War. Institute of Medicine, National Academies Press. Washington, DC. 1986; S. L.
Stephens, J. W. Birks. Bioscience 35, 557 (1985); R.C. Malone, L.H. Auer, G.A. Glatzmaier, M.C. Wood, O.B. Toon, J. Geophys. Res. Atm. 91, 1039 (1986); C.Y.J. Kao,
G.A. Glatzmaier, R.C. Malone, R.P. Turco, J. Geophys. Res.-Atm. 95, 22495 (1990).
Michael J. Mills, Owen B. Toon, Richard P. Turco, Douglas E. Kinnison, Rolando R. Garcia. Massive global ozone loss predicted following regional nuclear conflict.
Proceedings of the National Academy of Sciences. 105, 5307–5312. April 8, 2008.
6
7
A
CASE STUDY #2
include steep increases in skin cancer,
crop damage, and destruction of marine
phytoplankton.
A 1-Tg infusion of soot would also dan-
gerously deplete stratospheric ozone,
although the effects would be smaller
and shorter-lived than in the 5-Tg case.
The study concluded that global mean
ozone column losses would peak at 8%
and that the perturbation would last up to
four years. One of the most surprising
findings is that the magnitude and dura-
tion of the predicted ozone reductions
from the regional nuclear war considered
by the scientists are greater than those
calculated in the 1980s for global ther-
monuclear war with yields a thousand
times greater.
7
“Increased UV radiation is large-
ly detrimental, damaging terres-
trial and oceanic plants and pro-
ducing skin cancer, ocular dam-
age, and other health effects in
humans and animals.
Conclusive evidence shows that
increased UV-B radiation dam-
ages aquatic ecosystems,
including amphibians, shrimp,
fish, and phytoplankton.”
— Michael J. Mills, Owen B. Toon, et al
7
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
LESS OZONE, MORE ILLNESS
Carbon injected into the atmos-
phere from a regional nuclear
war using 100 Hiroshima-sized
weapons would reduce protec-
tive ozone by as much as 40%
in mid latitudes, contributing to
steep increases in skin and eye
diseases, immune system dam-
age, genetic damage, and harm
to marine and other plant life.
FIG. 2 BIOLOGICAL CONSEQUENCES OF OZONE DEPLETION AT 45°N
Source: The Environmental Consequences of Nuclear War Volume II, Harwell and Hutchinson, 1985
OZONE DECREASE (%)
40102030
DAMAGE INCREASE (%)
PLANT DAMAGE
UVB INCREASE
DNA DAMAGE
100
150
50
200
ore than 20 years ago, climate sci-
entists led by the renowned Carl
Sagan coined the term “nuclear winter”
to describe the global ecological destruc-
tion that would result from a massive
nuclear exchange between the US and
the former Soviet Union. Applying cli-
mate model simulations available to
them at the time, the scientists conclud-
ed that smoke and dust produced by a
catastrophic nuclear war would cause
rapid drops in temperature and precipita-
tion, block sunlight, and threaten agricul-
ture worldwide for at least a year.
Using modern climate models that have
been developed to study global warming,
some of these same scientists and their
colleagues have recently returned to the
question of nuclear winter and have
reexamined the climate consequences
of a range of nuclear wars. These new
studies have reconfirmed that a nuclear
war involving the large arsenals of the
US and Russia would result in a nuclear
winter even more long lasting than previ-
ously thought.
8
The scientists looked at the effects over
a 10-year period of two different scenar-
ios that are possible today—a nuclear
war injecting 150 teragrams [Tg] of
smoke into the upper troposphere over a
one-week period, and one producing 50
Tg of smoke. One important difference
between now and 20 years ago, which
they looked at closely, has been the
growth of cities and, consequently, larger
smoke emissions from the same targets.
They calculated that roughly 150 Tg of
smoke would be emitted by the use of
the entire current global nuclear arsenal
with a yield of 5,000 megatons.
9
If one-
third of the current arsenal were used, 50
Tg of smoke would be emitted.
In the 150 Tg scenario, black carbon par-
ticles spread quickly across the upper
stratosphere and produce “a long-lasting
climate forcing” that would last for more
than a decade and affect both the
Northern and Southern hemispheres.
Among the effects would be a 45% glob-
al average reduction in precipitation and
a global average surface cooling of -7°C
to -8°C, which would persist for years.
By comparison, the scientists remind
us, “the global average cooling at the
depth of the last ice age 18,000 years
ago was about 5°C,” which would be “a
climate change unprecedented in speed
and amplitude in the history of the
human race.” At the extremes, people in
Nuclear Winter: The Earth’s Life-Sustaining
Ecosystems Remain at Risk
Catastrophic war
with current arsenal
devastates global climate
45% global average
reduction in precipitation
in worst case
Global average surface
cooling of -7°C to -8°C,
more extreme than last
ice age
-20°C in North America;
-30°C in Eurasia
Food production stops;
most people on Earth
die within one year
Even a portion of existing
arsenal causes severe
and unprecedented
climate disruption
KEY POINTS
8
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
A. Robock, L. Oman, G. L. Stenchikov. Nuclear winter revisited with a modern climate model and current nuclear arsenals: Still catastrophic consequences. Journal Of
Geophysical Research 2008;112 [www.pnas.org/content/105/14/5307].
The US and Russia possess about 95% of these weapons, a proportion that has remained virtually unchanged since the Cold War.
8
9
M
CASE STUDY #3
North America and Eurasia would expe-
rience cooling of more than -20°C and
-30°C respectively.
The reductions in temperature and pre-
cipitation in the 50 Tg scenario were
about half those for 150 Tg, over the
same timescale. While not cold enough
to be classified as “nuclear winter,”
according to the scientists, such climate
forcing would still be “severe and
unprecedented.”
Perhaps the most extreme and lethal
impact would be the collapse of agricul-
ture. The earlier nuclear winter studies
concluded that food production would
cease entirely around the world for at
least a year, leading to death by starva-
tion for most of the human population.
The results of the new studies paint an
even grimmer picture: “this period of no
food production needs to be extended by
many years, making the impacts of
nuclear winter even worse than previ-
ously thought.”
“The effects of the smoke cloud
on surface temperature are
extremely large....A global aver-
age surface cooling of -7°C to -
8°C persists for years, and after
a decade the cooling is still -4°C.
Considering that the global aver-
age cooling at the depth of the
last ice age 18,000 years ago
was about -5°C, this would be a
climate change unprecedented
in speed and amplitude in the
history of the human race.”
—Alan Robock, Luke Oman, George L.
Stenchikov. Nuclear winter revisited. 2008
8
9
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
Source: Alan Robock, L. Oman, and G. L. Stenchikov (2007)
8
NUCLEAR WINTER: THE SKEPTICS WERE WRONG
ritics of the early scientific evidence for nuclear
winter pointed to limitations in computer technolo-
gy and climate models available in the 1980s to support
their claim that the environmental consequences of a
massive nuclear war would be less catastrophic than
Carl Sagan and his colleagues were telling the public
and policy makers. The nuclear winter findings have
now been verified, with the help of state-of-the-art
atmospheric general circulation models (GCMs) devel-
oped to study global warming.
“It turns out that not only do we still get a nuclear winter
using the previous baseline case, but that the climate
response is much longer than that of earlier results, and
current nuclear arsenals can still produce a nuclear win-
ter,” according to the authors of a 2007 paper in the
Journal of Geophysical Research.
C
Example of a three dimensional climate
model from the Office of Oceanic and
Atmospheric Research.
hysicians first confronted the medical
consequences of the use of nuclear
weapons on August 6, 1945, when surviv-
ing medical personnel struggled to care
for the massive casualties in the after-
math of the Hiroshima nuclear explosion:
In a city of two hundred and forty five
thousand, nearly a hundred thousand
people had been killed or doomed at one
blow; a hundred thousand more were
hurt. The people ... wept and cried, for
Dr. Sasaki to hear, “Sensei! Doctor!”....
Bewildered by the numbers, staggered
by so much raw flesh, Dr. Sasaki lost all
sense of profession and stopped working
as a skillful surgeon and a sympathetic
man; he became an automaton,
mechanically wiping, daubing, winding,
wiping, daubing, winding.
11
Many of Dr. Sasaki’s patients who sur-
vived the injuries caused by heat, fire, and
blast soon developed the devastating fea-
tures of acute radiation sickness: severe
gastrointestinal problems, uncontrolled
bleeding, hair loss, and extreme suscepti-
bility to infection. With the city’s medical
facilities almost entirely destroyed, effec-
tive care was virtually impossible.
The 12.5-kiloton bomb detonated in the
air over Hiroshima created ground tem-
peratures that reached about 7,000
degrees Celsius. Of the 76,000 buildings
The blast, heat,
and radiation from
a single nuclear weapon
can kill hundreds of
thousands of people,
placing nuclear weapons
in a class of their own
as weapons of mass
destruction.
A large-scale nuclear
war would destroy the
economic, communica-
tions, and transportation
infrastructures on which
the entire population
depends for survival.
Casualties among
physicians and health
workers, combined
with the destruction
of hospital and clinics,
would make caring for
survivors extremely diffi-
cult or even impossible.
Even if they are not
exploded, nuclear
weapons present hazards
at every step in their pro-
duction, testing, storage,
and transportation.
KEY POINTS
Casualties of Nuclear War: Why Prevention
is Still the Only Cure
10
10
10
11
in the city, 92% were destroyed or dam-
aged. There were more than 100,000
deaths and about 75,000 injuries among
a population of about 250,000. Of the
298 physicians in the city, 270 were dead
or injured and 1,564 of 1,780 nurses died
or were injured.
The 21-kiloton bomb detonated in the air
over Nagasaki three days later leveled
6.7 million square meters (2.6 square
miles). There were 75,000 immediate
deaths and 75,000 injuries, with similar
destruction of medical facilities and per-
sonnel and similar health consequences
for the population of the city.
In the decades following the atomic
bombings of Hiroshima and Nagasaki,
the medical effects of nuclear weapons
have been documented in painstaking
detail and published in medical and sci-
entific journals, books, and monographs
(see "Medical Consequences of Nuclear
War," facing page).
Excerpted and adapted from L. Forrow, V. W. Sidel, J. E. Slutzman. Medicine and nuclear war: preventing proliferation and achieving abolition. IPPNW monograph. 2007.
John Hersey. Hiroshima. New York: Vintage Books. 1989 (reprinted edition).
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
P
FAR RIGHT: UN PHOTO MILTON GRANT
CASE STUDY #4
11
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
• A significant number of people would be deaf-
ened due to ruptured eardrums.
• Many people would be blinded. The initial flash
of light at the start of a detonation bleaches reti-
nal pigments causing flash blindness for up to 40
minutes. Viewing the fireball can cause more per-
manent damage, including retinal burns and
scars in the visual field.
• Radiation exposure would result from the initial
radiation flux of neutrons and gamma rays and
from the fallout of the radioisotopes produced by
the detonation. Radiation poses a particular
problem for rescuers attempting to
assess the severity of injuries since
there is no way, especially in the initial
period, to know whether a person has
received a moderate exposure and
might survive with adequate care or
has received a large exposure
and will die regardless of what
treatment is offered.
• The combinations of
the diverse injuries
(burns, crush injuries,
ruptured organs,
fractures, exten-
sive blood loss,
and radiation
exposure) would
multiply the likeli-
hood that injuries
would be fatal.
MEDICAL CONSEQUENCES OF NUCLEAR WAR
The physical effects of nuclear weapons include a heat (thermal) wave, a blast wave, an electromag-
netic pulse, the release of ionizing radiation, and the production of isotopes, many of them radioac-
tive. Specifically, the effects of a 10-20-kiloton nuclear weapon include:
• At the center of the blast (ground zero) the over-
pressures are greater than 20 pounds per square
inch (psi), sufficient to destroy all but the skele-
tons of reinforced concrete structures.
• At approximately 0.6 mile (1.0 km) from the cen-
ter of the blast, the overpressures are about 10
psi, sufficient to destroy all wood and brick-built
structures.
• The blast not only destroys buildings but turns
bricks, lumber, furniture, cars, and people into
missiles. Overpressures on the order of 0.5 to 2
psi, which would prevail within 1.3–2.2 km of the
hypocenter of a 1-kiloton blast, will turn a window
into a thousand particles of glass traveling in
excess of 100 miles per hour.
• The winds rushing out from the center of the
blast cause air to rush back in fanning the fires
produced by the thermal radiation and the initial
blast damage creating a firestorm.
• In a densely populated area, injuries include
tens of thousands of burns, with many of them
third degree. These occur on top of thousands of
crush injuries due to collapsed buildings. Hospital
beds, trained personnel, and medical supplies in
the immediate area are unavailable.
• Many victims would suffer from ruptured organs
(particularly lungs), penetrating trauma (due to
the objects that were turned into missiles), frac-
tured skulls, and compound fractures from peo-
ple having been turned into missiles until they
struck any hard object.
UN PHOTO: YOSUKE YAMAHATA
12
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
As global arsenals have changed in size
and composition following the Cold War
and in the early years of a new century,
scientific and medical studies have kept
pace. A 2002 study published in the
British Medical Journal estimated the
casualties from a 12.5- kiloton nuclear
explosion at ground level near the port
area of New York City. The model pro-
jected 262,000 people would be killed,
including 52,000 immediately and the
remainder succumbing to radiation sick-
ness. Caring for survivors would also be
difficult, if not impossible, with the loss of
1,000 hospital beds in the blast and
another 8,700 in areas of high radiation
exposure.
12
A related study published in 2002
showed that if only 300 of the weapons in
FATALITIES
Estimated fatalities due to
immediate radiation, blast,
and fire damage from an
attack using 50 nuclear
weapons with 15-kt yield
on various countries.
Source: O.B. Toon, A. Robock, et al. Consequences of Regional-Scale Nuclear Conflicts. Science March, 2, 2007.
FATALITIES
18,000,000
ARGENTINA
BRAZIL
EGYPT
FRANCE
IRAN
ISRAEL
16,000,000
14,000,000
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
0
JAPAN
PAKISTAN
RUSSIA
UK
USA
COUNTRIES
FIG. 3 PREDICTED FATALITIES
12
I. Helfand, L. Forrow, J. Tiwari. Nuclear terrorism. BMJ, 2002;324(7333):356–9.
CHINA
INDIA
13
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
I. Helfand, L. Forrow, M. McCally, RK. Musil. Projected US Casualties and Destruction of US Medical Services From Attacks by Russian Nuclear Forces. Medicine & Global
Survival, 2002;7:68-76.
National Cancer Institute. Calculation of the estimated lifetime risk of radiation related thyroid cancer in the United States from the Nevada Test Site fallout. 1997.
International Physicians for the Prevention of Nuclear War. Radioactive heaven and earth: the health and environmental effects of nuclear weapons testing in, on, and
above the earth. New York:Apex Press. 1991.
A. Makhijani, H. Hu, K. Yih, editors. Nuclear wastelands: a global guide to nuclear weapons production and its health and environmental effects. Cambridge, Mass: MIT
Press. 1995.
J. L. Lyon, S. C. Alder, M. B. Stone, A. Scholl, J. C. Reading, R. Holubkov, et al. Thyroid disease associated with exposure to the Nevada nuclear weapons test site radi-
ation: a reevaluation based on corrected dosimetry and examination data. Epidemiology, 2006;17(6):604–14. The Gray (Gy) is the SI unit of absorbed radiation dose. It is
equal to one Joule per kilogram of target mass. For x- and g -rays, one Gy equals one Sievert (Sv).
E. Ostroumova, B. Gagniere, D. Laurier, N. Gudkova, L. Krestinina, P. Verger, et al. Risk analysis of leukaemia incidence among people living along the Techa River: a
nested case control study. J Radiol Prot, 2006;26(1):17–32.
14
15
16
17
18
the Russian arsenal attacked targets in
American cities, 90 million people would
die in the first half hour. A comparable US
attack on Russia would produce similar
devastation. Furthermore, these attacks
would destroy the entire economic, com-
munications, and transportation infra-
structure on which the rest of the popula-
tion depends for survival. In the ensuing
months the vast majority of people who
survived the initial attacks in both coun-
tries would die of disease, exposure, and
starvation.
13
Such force levels are less
than one third of the nuclear weapons
each country will retain after the current
round of START negotiations.
Nuclear weapons present hazards in vir-
tually all areas of their life cycle.
Production and testing have their own
impacts. The US National Cancer
Institute estimated that the release of
iodine-131 in fallout from US nuclear test
explosions was by itself responsible for
49,000 excess cases of thyroid cancer
among American citizens.
14
A 1991 IPPNW study estimated that the
strontium-90, cesium-137, carbon-14,
and plutonium-239 released worldwide
in all nuclear test explosions would be
responsible for 430,000 cancer deaths
by the year 2000.
15
Moreover, there are
additional widespread health and envi-
ronmental effects of nuclear weapons
production as the result of massive con-
tamination of land by radioactive materi-
als and toxic chemicals.
16
Epidemiological studies in the last
decade have indicated serious health
effects on individuals exposed as a result
of nuclear weapons testing and manu-
facture. A reevaluation of the relationship
between Nevada Test Site fallout and
thyroid disease showed a greater than
previously thought excess risk for thy-
roiditis at a rate of 4.9 per Gy of expo-
sure.
17
In addition, mortality and morbid-
ity of United Kingdom and New Zealand
military personnel involved in nuclear
tests in the 1950s and 1960s was found
to be worse than those who were not
involved. Radioactive material releases
from the Mayak nuclear weapons facility
in Russia contaminated the region sur-
rounding the Techa River and led to an
additional risk of leukemias (excluding
chronic lymphoid) of 4.6 times the back-
ground risk per Gy of exposure.
18
“Today, the world has a third and
possibly final opportunity to end
the threat of nuclear weapons
definitively, before nuclear
explosions again devastate
cities, nations, or even the plan-
et. The only real way this can be
achieved is through a universal,
verifiable, and enforceable treaty
banning nuclear weapons from
our world – a Nuclear Weapons
Convention.”
— Lachlan Forrow, Victor Sidel, and Jonathan
Slutzman. Medicine and Nuclear War.
IPPNW. 2007.
13
or more than 45 years, physicians
have documented and described the
horrifying medical and humanitarian con-
sequences of nuclear weapons explo-
sions. We have informed political and
military leaders that doctors, hospitals,
and other medical infrastructure would
be so completely overwhelmed in the
event of a nuclear war that we would be
unable to respond in any meaningful way
to relieve the suffering of survivors or to
restore health to a devastated world. We
have warned that the unique nature of
nuclear weapons — their unprecedented
destructive power and the radiation they
release, causing cancers, birth
defects, and genetic disor-
ders across generations
— removes any moral justification for
their use as weapons of war and requires
their abolition.
The findings described in this briefing
paper have significant implications for
nuclear weapons policy. They are power-
ful evidence in the case against the pro-
liferation of nuclear weapons and against
the modernization of arsenals in the
existing nuclear weapon states. Even
more important, they argue for a funda-
mental reassessment of the role of
nuclear weapons in the world. If even a
relatively small nuclear war, by Cold War
standards, could trigger a global catas-
trophe, the only viable response is the
complete abolition of nuclear weapons.
14
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
Conclusion
F
15
“The [World Medical Association]
considers that it has a duty to work for
the elimination of nuclear weapons.
Therefore the WMA:
* condemns the development, testing, production, stockpiling, transfer,
deployment, threat and use of nuclear weapons;
* requests all governments to refrain from the development, testing, pro-
duction, stockpiling, transfer, deployment, threat and use of nuclear
weapons and to work in good faith towards the elimination of nuclear
weapons; and
* requests all National Medical Associations to join the WMA in supporting
this Declaration and to urge their respective governments to work towards
the elimination of nuclear weapons.
—The World Medical Assembly, Seoul, Korea, October 2008
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
16
ZERO IS THE ONLY OPTION: Four Medical and Environmental Cases for Eradicating Nuclear Weapons
“The existence of thousands of
nuclear weapons is the most dan-
gerous legacy of the Cold War....I
state clearly and with conviction
America's commitment to seek the
peace and security of a world with-
out nuclear weapons.”
—President Barack Obama, April 5, 2009
International Physicians
for the Prevention of Nuclear War
(IPPNW) is a federation of national medical
organizations in 62 countries, representing
doctors, medical students, other health workers,
and concerned citizens who share the common
goal of creating a more peaceful and secure world
freed from the threat of nuclear annihilation.
The International Campaign to Abolish Nuclear
Weapons(ICAN) is a global grassroots movement for
disarmament through a legally binding, verifiable and
timebound Nuclear Weapons Convention.
More than 200 organizations in 60 countries are part of the
campaign, and thousands of individuals have signed our
petition for a nuclear-weapon-free world. We provide a
voice to the overwhelming majority of people glob-
ally who support abolition.
Zero is the Only Option:
Four Medical and Environmental Cases
for Eradicating Nuclear Weapons
INTERNATIONAL PHYSICIANS FOR THE PREVENTION OF NUCLEAR WAR
IPPNW.ORG NUCLEAR-ZERO.ORG
CASE STUDY #1
Nuclear Famine: How a Regional
Nuclear War Will Cause Global
Mass Starvation
CASE STUDY #2
A Nuclear Ozone Hole: The Global
Cancer Burden of a Regional
Nuclear War
CASE STUDY #4
The Casualties of Nuclear War:
Why Prevention is Still
the Only Cure
CASE STUDY #3
Nuclear Winter: The Earth’s
Life-Sustaining Ecosystems
Remain at Risk
UN PHOTO: ARPAN MUNIER
UN PHOTO: MILTON GRANT
