Kamran Abbasi1, Parveen Ali2, Virginia Barbour3, Kirsten Bibbins-Domingo4, Marcel GM Olde Rikkert5, Peng Gong6, Andy Haines7, Ira Helfand8, Richard Horton9, Robert Mash10, Arun Mitra8, Carlos Monteiro11, Elena N. Naumova12, Eric J. Rubin13, Tilman Ruff8, Peush Sahni14, James Tumwine15, Paul Yonga16, Chris Zielinski17
doi: http://dx.doi.org/10.5195/ijms.2023.2179
Volume 11, Number 3: 171-173
Keywords: Nuclear war; Risk; War; Global issues; Global health; Healthcare professional; Conflict; Nuclear bomb; Advocacy; World issues; Planetary health (Source: MeSH-NLM).
In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 seconds before midnight, reflecting the growing risk of nuclear war.1 In August, 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War.2 The danger has been underlined by growing tensions between many nuclear armed states.1,3 As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet—and urge action to prevent it.
Current nuclear arms control and non-proliferation efforts are inadequate to protect the world's population against the threat of nuclear war by design, error, or miscalculation. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) commits each of the 190 participating nations ”to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control”.4 Progress has been disappointingly slow and the most recent NPT review conference in 2022 ended without an agreed statement.5 There are many examples of near disasters that have exposed the risks of depending on nuclear deterrence for the indefinite future.6 Modernization of nuclear arsenals could increase risks: for example, hypersonic missiles decrease the time available to distinguish between an attack and a false alarm, increasing the likelihood of rapid escalation.
Any use of nuclear weapons would be catastrophic for humanity. Even a “limited” nuclear war involving only 250 of the 13 000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk.7,8 A large-scale nuclear war between the USA and Russia could kill 200 million people or more in the near term, and potentially cause a global “nuclear winter” that could kill 5–6 billion people, threatening the survival of humanity.7,8 Once a nuclear weapon is detonated, escalation to all-out nuclear war could occur rapidly. The prevention of any use of nuclear weapons is therefore an urgent public health priority and fundamental steps must also be taken to address the root cause of the problem—by abolishing nuclear weapons.
The health community has had a crucial role in efforts to reduce the risk of nuclear war and must continue to do so in the future.9 In the 1980s the efforts of health professionals, led by the International Physicians for the Prevention of Nuclear War (IPPNW), helped to end the Cold War arms race by educating policy makers and the public on both sides of the Iron Curtain about the medical consequences of nuclear war. This was recognised when the 1985 Nobel Peace Prize was awarded to the IPPNW. (http://www.ippnw.org).10
In 2007, the IPPNW launched the International Campaign to Abolish Nuclear Weapons, which grew into a global civil society campaign with hundreds of partner organizations. A pathway to nuclear abolition was created with the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017, for which the International Campaign to Abolish Nuclear Weapons was awarded the 2017 Nobel Peace Prize. International medical organizations, including the International Committee of the Red Cross, the IPPNW, the World Medical Association, the World Federation of Public Health Associations, and the International Council of Nurses, had key roles in the process leading up to the negotiations, and in the negotiations themselves, presenting the scientific evidence about the catastrophic health and environmental consequences of nuclear weapons and nuclear war. They continued this important collaboration during the First Meeting of the States Parties to the Treaty on the Prohibition of Nuclear Weapons, which currently has 92 signatories, including 68 member states.11
We now call on health professional associations to inform their members worldwide about the threat to human survival and to join with the IPPNW to support efforts to reduce the near-term risks of nuclear war, including 3 immediate steps on the part of nuclear-armed states and their allies: first, adopt a no first use policy;12 second, take their nuclear weapons off hair-trigger alert; and, third, urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts. We further ask them to work for a definitive end to the nuclear threat by supporting the urgent commencement of negotiations among the nuclear-armed states for a verifiable, timebound agreement to eliminate their nuclear weapons in accordance with commitments in the NPT, opening the way for all nations to join the Treaty on the Prohibition of Nuclear Weapons.
The danger is great and growing. The nuclear armed states must eliminate their nuclear arsenals before they eliminate us. The health community played a decisive part during the Cold War and more recently in the development of the Treaty on the Prohibition of Nuclear Weapons. We must take up this challenge again as an urgent priority, working with renewed energy to reduce the risks of nuclear war and to eliminate nuclear weapons.
None.
Dr Olde Rikkert reported receiving research grants from the Dutch Research Council and Netherlands Organisation for Health Research. Dr Haines reported grants from the Wellcome Trust and additional funding from the Oak Foundation; royalties from Cambridge University Press for a book on planetary health; consulting fees paid to his institution for serving as a senior advisor on climate change from Wellcome Trust; serving on steering committees or advisory groups for global health for African research organizations (without compensation); and cochairing working groups on climate change (without compensation). Dr Helfand reported receiving honoraria for speaking engagements (all donated to Back from the Brink, IPPNW, or Physicians for Social Responsibility); support for travel and lodging for Nobel Peace Laureates summit, World Federation of Public Health Associations World Congress, and UN Human Rights Commission Youth Summit; and serving on the boards for IPPNW and International Campaign to Abolish Nuclear Weapons (without compensation). Dr Ruff reported receiving consulting fees from the Institute for Energy and Environmental Research for related work; honoraria from the Choisun Ilbo media group and from Hyogo Medical Practitioners Association and Peace Boat for presentations on nuclear weapons; payment for serving as expert witness on radiation and health for Environmental Justice Australia; serving on a rotavirus vaccine development scientific advisory board for Murdoch Children's Research Institute; serving on several committees related to nuclear weapons and prevention of nuclear war; and serving as copresident of IPPNW. Dr Yonga reported serving as a principal investigator for a COVID-19 antiviral for Atea Pharmaceuticals; receiving honoraria for lectures, presentations, and educational events from bioMerieux and Pfizer; serving on an advisory board for Pfizer; and serving on committees or panels for the European Society of Clinical Microbiology and Infectious Diseases. Mr Zielinski reported receiving payment as senior advisor on the IPPNW journals project. No other disclosures were reported.
This Editorial is being published simultaneously in multiple journals. For the full list of journals see https://www.bmj.com/content/full-list-authors-and-signatories-nuclear-risk-editorial-august-2023.
1. Science and Security Board, Bulletin of the Atomic Scientists. A time of unprecedented danger: it is 90 seconds to midnight. 2023 Doomsday Clock Statement. Jan 24, 2023. Accessed June 1, 2023. https://thebulletin.org/doomsday-clock/current-time/
2. 2022. Future Generations Counting on Our Commitment to Step Back from Abyss, Lift Cloud of Nuclear Annihilation for Good, Secretary-General Tells Review Conference, Press Release SG/SM/21394. Aug 1, 2022, Accessed July 10, 2023 https://press.un.org/en/2022/sgsm21394.doc.htm
3. Tollefson J. Is nuclear war more likely after Russia's suspension of the New START treaty? Nature 2023; 615:
4. 2005 Review Conference of the Parties to the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). May 2–27, 2005. Accessed June 2, 2023. https://www.un.org/en/conf/npt/2005/npttreaty.html
5. Mukhatzhanova 10th NPT Review Conference: why it was doomed and how it almost succeeded. Arms Control Association. October 2022. Accessed June 2, 2023 https://www.armscontrol.org/act/2022-10/features/10th-npt-review-conference-why-doomed-almost-succeeded
6. Lewis P, Williams H, Pelopidas, Aghlani S. Too close for comfort, cases of near nuclear use and options for policy. Chatham House Report. April, 2014. Accessed June 1, 2023.
7. https://www.chathamhouse.org/2014/04/too-close-comfort-cases-near-nuclear-use-and-options-policy
8. Bivens M. Nuclear famine. IPPNW. August, 2022. Accessed June 1, 2023. https://www.ippnw.org/wp-content/uploads/2022/09/ENGLISH-Nuclear-Famine-Report-Final-bleed-marks.pdf
9. Xia L, Robock A, Scherrer K, et al. Global food insecurity and famine from reduced crop, marine fishery and livestock production due to climate disruption from nuclear war soot injection. Nat Food 2022; 3: 586–96.
10. Helfand I, Lewis P, Haines A. Reducing the risks of nuclear war to humanity. Lancet 2022; 399: 1097–98.
11. Nobel Prize Outreach AB. International Physicians for the Prevention of Nuclear War—facts. 1985. Accessed June 1, 2023. https://www.nobelprize.org/prizes/peace/1985/physicians/facts/
12. UN Office for Disarmament Affairs. Treaties Database. Treaty on the Prohibition of Nuclear Weapons, status of the Treaty. January 2021. Accessed June 1, 2023. https://treaties.unoda.org/t/tpnw
13. Center for Arms Control and Non-Proliferation. No first use: frequently asked questions. Accessed June 2, 2023. https://armscontrolcenter.org/issues/no-first-use/no-first-use-frequently-asked-questions/
Kamran Abbasi, 1 Editor-in-Chief, British Medical Journal.
Parveen Ali, 2 Editor-in-Chief, International Nursing Review.
Virginia Barbour, 3 Editor-in-Chief, Medical Journal of Australia.
Kirsten Bibbins-Domingo, 4 Editor-in-Chief, JAMA
Marcel GM Olde Rikkert, 5 Editor-in-Chief, Dutch Journal of Medicine.
Peng Gong, 6 Editor-in-Chief, Chinese Science Bulletin.
Andy Haines, 7 London School of Hygiene and Tropical Medicine.
Ira Helfand, 8 Past President, International Physicians for the Prevention of Nuclear War.
Richard Horton, 9 Editor-in-Chief, The Lancet.
Robert Mash, 10 Editor-in-Chief, African Journal of Primary Health Care & Family Medicine.
Arun Mitra, 8 Past President, International Physicians for the Prevention of Nuclear War.
Carlos Monteiro, 11 Editor-in-Chief, Revista de Saúde Pública.
Elena N. Naumova, 12 Editor-in-Chief, Journal of Public Health Policy.
Eric J. Rubin, 13 Editor-in-Chief, New England Journal of Medicine.
Tilman Ruff, 8 Past President, International Physicians for the Prevention of Nuclear War.
Peush Sahni, 14 Editor-in-Chief, National Medical Journal of India.
James Tumwine, 15 Editor-in-Chief, African Health Sciences.
Paul Yonga, 16 Editor-in-Chief, East African Medical Journal.
Chris Zielinski, 17 University of Winchester, Vice-President, World Association of Medical Editors (WAME).
Correspondence: Chris Zielinski. Address: Sparkford Rd, Winchester SO22 4NR, United Kingdom. Email: czielinski@ippnw.org
Cite as Abbasi K, Ali P, Barbour V, Bibbins-Domingo K, Olde Rikkert MGM, Gong P, et al. Reducing the Risks of Nuclear War—the Role of Health Professionals. Int J Med Stud. 2023 Jul-Sep;11(3):171-3.
Copyright © 2023 Kamran Abbasi, Parveen Ali, Virginia Barbour, Kirsten Bibbins-Domingo, Marcel GM Olde Rikkert, Peng Gong, Andy Haines, Ira Helfand, Richard Horton, Robert Mash, Arun Mitra, Carlos Monteiro, Elena N. Naumova, Eric J. Rubin, Tilman Ruff, Peush Sahni, James Tumwine, Paul Yonga, Chris Zielinski
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 11, NUMBER 3, September 2023