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The Growing Threat ofNuclear War and the Role ofthe Health Community

The Growing Risk of Crimea, the European Leadership Net­ In this setting prominent leaders on both of Nuclear War work (ELN) documented a large irlcrcase sides have expressed alatm about rhe grow­ in inciderlts involving close c rlcounters ing danger of nudeat w~\r. After the end of the Cold W:.r the in­ between nuclear capable NATO :.nd Rus­ tense military rivalry between the Soviet sian military forces. A report issued by the Speaking in January, when the Bulletin of Uniofl and rhe United Stares/NATO was ELN concluded, .. ~n,ese events add up to the Atomic Scientisrs annouoced thar irs replaced by a much more cooperative re­ a highly d istutbiog picn1re of violations Doomsday C lock would temain at three hltionship, and fears of war between the of national airspace, emergency scrambles, minutes to midnight, former US Secre ~ nuclear superpowers faded. As recently narrowly avoided mid-air collisions, close tary of Defence William Perry stated, "'The as the 2014 US Quadrennial Defence encounters at sea, simulated attack runs danger of a nuclc::ar catastrophe toda)~ in Review, c01lAicr between rhe two fom1e r and orher dangerous actiOJlS happe11ing 011 my judgmenr is greater that it was duriog adversaries was not considered a realistic a regular basis over a very wide geographi­ the Cold War ... and yet O\lr policies sim· possibility [1]. cal area" [3]. Further, both sides ha~•e con­ ply do not reflect those dangers" [6]. His ducted large scale military exercises in Eu­ assessment was echoed two months later Unfortmlately, relations between Rus­ rope, leading rhe ELN toconclude, .. Russia by Igor l vanov, Russia1l Foreign Mi1\ist"er sia :md the US/NATO have deteriorated is preparing for a conAict with NATO, ~md !Tom 1998 to 2004. Speaking in Brussels dramatically since then. In the Syrian and NATO is preparing for a possible con­ on ~1arch 18, Ivanov warned that, "'The risk Ukrainian wars, the two have supported op­ frontation with Russia" [4]. 1he danger of confrontation with the use of nuclear posi11g sides, nlising the possibility of ope11 inhetent in this situation is magrlified by weapons in Europe is higher than in the military conflict and fears that S\lCh conflict the <.:\IJTCnt R\JSSian military d JJUH.: ly as nuclear weapon :md fissi le materi ~tl stock· not to come against R\ISSia as rcg:.•rds a and ret\lrn to the status quq mile" (5). US/ piles, :md undertaken extensive develop· possible armed conflict ... I want to re­ NATO military planning has always envi­ ment and testing ofa dh·crse array ofballis­ mind you that Russia is o r1e of rhe mosr sioned possible first use oflll tdear weapons ric and ctuise missiles (with ranges from 60 powerful nuclear nations,. (2). ]n the in the face of a Soviet/R\ISSian convention­ to 5000 km) to :.cquire the :.bility to deploy months following the R\ISSian annexation al :lttack in Europe. and launch nuclear \VCapons from the air,

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from land, and from st.•bm:1rines at se-a.1l1ey In April 2016, at the conclosion of the No· and again in 1980 compt•te r errors in the ha\'C put in place command and control sys· clear Securiry Summit, the VVhite House US caused American radar systems to dis· rcms and doccrines that i1WOJ\'e, in the case Press secretary expressed concem abour, play, i r~ correct l y, incoming Soviet missiles of Pakistan, first t.•se of nt.•clear weapons in "the risk that a conventional conflict be· on their monitors. Tn September 1983, a conAict and, in the case of 1ndi:1, massive tween India and Pakist'Jn <.:oold escalate to Soviet military r:tdar incorrectly reported retaliatory strikes against population centres include the usc of nuclear weapons"' [18]. a NATO attack in progress. In November [8-10] . Should Pakistan use nudeat weapons of rhar year the Soviet leadership incor· agtlinst Indian conventional forces in such reedy concluded that a NATO mili"-ttY In May-July l999,the two countries fought a sit\Jation, l ndi:m nltclear doctrine calls for exercise was the cover for an :u.:tl• ~ll attack a war which apparently included mobiliza· massh·e retaliation directed at Pakistani cit· that was about to be launched. On Janu· tiOJ'l of nuclear weapons by Pakistan, mak­ ies and Pakistan has rhreate11ed ro respond ary 25, 1995, a full 5 years after the end ing it the most significant miliraty conAicr in kjnd. of the Cold War, Russia11 milirary radar benvecn two m~<.:lear :1rmed states [11). incorrectly identified a Norwegian Black They also went through a major military With Pakistan building ever closer mili· Brant XII rocket launched to study the crisis (December 2001 to June 2002) rrig­ mry and eCOilOmic ries ro Chi11a, a11d India aurora boreaJis as a Trident missile aimed gcred by an arrack 011 l11dia's parlia•nCilf by becoming a strategic parmet of the U11ired at Moscow. lslamist militants believed in lndi:1 to be States, s~•ch a fi.•ture Sollth As i ~m conAict backed by Pakistan, which included the two may quickly take on a global dimension In each of these situations preparations for countries movi11g a combined roral of over given the increasingly tense 11arure of the a countctsrrike were initiated a11d nuclcat half a million troops to their border [12]. g.-eat powet tivalry betwee11 Chi11a and the war was avened by minutes. The slow pace of 1ndi:m deployment and us [20]. inconclusive outcome of the stand· oA:.lcd The danger of this kind of mistake oc· India's army to begirl plarlning and train­ North Korea has a track record of repeatedly curring again is amplified by currerlt de· ing for a 1nore decisive and rapid con\'en­ threare11ing the use of nuclear weapo!lSi for fic iencies in Russia11 radar warning sys· tional Mrnck on Pakis"''" [13]. Pakisrnn e.xample, in l\1arch 2()16 it warned it wollld terns. Russia h:ts no sp:tce· b:tsed satellite began testing a short- range truck-mounted make a .. pre~emptive and ofiCnsh·e nuclear early warning systems to alert them to the mobile missile to deliver low-yield nuclear strike" in response to joint US-South Ko­ launch of nuclear-armed ballistic missiles weapons on the battlefield [14]. 1bis latter rean milir:tty exercises [2l}. l t is capable of from rhe ocean, so their waming time development has increased long-standing enriching uranillm ~nd prodt•dng weapons· could be as short ~s 10 to 15 minotes. The international concerns about the security grade plutonium and has deployed short­ only way for Russia to guarantee the abil· of nuclear weapons and fissile materials in and mcdium·range ballistic missiles as wcU ity to launch its forces before they arc de· Pakismn give1\ the latge-scale and frequent as resting long-range missiles [22]. srroyed by a pre-emptive atmck would be lslamist militant attacks on milit:ary targets to prc·dele!r-tte laonch ~uthori ty to field in the country and the ideological polariza­ commanders. Under these conditions, the tjon within the armed forces and broader Unintended Use of time pressure to make a launch decision society associated with the rise of hard-line N uclear Weapons could greatly increase the cha11ce ofan ac· lslamist political gro\lps over the past three cidenta l launch, especially if a computer decades [15]. While these growing tensions amongst nu­ error caused a false warning of attack dur­ clear armed states could lead to the deliber­ ing a crisis [24]. Recently, military lead· Potential triggers for anncd conflic-t be­ ate use of 1luclear weapons, there is also the ets have begun to warn of a rlew threat tween Pakist:tn and l ndia inclltde another <.:ontinlling danger th:tt they cot•ld trigger that might cause the onintended la\mc.:h major attack on India by Tsl:unist miJitant the lmintended or accidental liSe of these of nuc.:le~r weapons: cyberterrorism. In a groups like the one in ~1umbai ln Novem· weapons. June 2015 speech, retired Marine Gen. bet 2008 thar was linked to intellige•lce James Cartwright, former head of the agencies in Pakis"'" (16]. A second possible There h:tve been at least fi ve

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wider n~aclear conflict. 1l1is danger is in· 8000 tcnsificd by the continued US and Rus­ 7300 7000 sia!\ policy of maintaining their mis...~:;iles on h:1ir trigger alert, f\ally prepared for use 6000 Retired and simply awaiting an order to hnmch • [25]. There is also extensive evidence that 5000 Stockpiled individuals with resp.'tcnsivc plans ofall njnc nuck-ar armed nuclear weapons, the nuclcar·armcd stares and Russia that poses a global threat. A se­ states to enhance their nuclear arsenals. arc reaffirming the importance of nuclear ries of sn1dies have shown that locaHzcd, we-aporls- and are carryir1g our extensive and regiorlal nudear war will als-o have cam­ Although the world's inventory of m•clear costly modernizations: of their nuelt:.tr :use­ strophic effects worldwide. weapons has declined significantly over the nals [28]. (sec table) past two~and-a-half decades, from around We undertook a literature search using 58,300 warheads in 1991, there remai1\ 1he scope of these modemizarion plans- has the Web of Scierlce database Topic Seatch roughly 15,375 warheads today of which led observers to characterize them :ls the fi.mction, on 14 March 2016, CO\'Cring doc­ 4,200 arc deployed with operational forces. beginning of a new :trms race and a new uments ln English published from 2005 to Nearly 1,800 warheads arc on alert and Cold War [29). 2016, using the search strategy: (("'Nuclear ready for usc on short notice (27). (Figure) \.Yeapon•" OR .. nuclear war•" O R .. aromic we:.tpon•" OR "atomic war•,. OR "ntlcle:tr ~'hilc Russia, the US, and Britain con· The Health Consequences conflict~) and (Climate OR ·c~matc tinuc to reduce their inventories, the pace of Nuclear War Change" OR environment• OR .. Ozone of reduction ha.~:; slowed compared with the Depletion" OR ozone OR Starvation OR past two decades. Tn fi1ct, fo\•r of the world's Given the growing d:wgcr of nuclear war, it fumine OR Agriculture' O R crop' OR nudear· armed st~nes (China, Palcist:1n, ln· is important to consider the he:.tlth conse­ Food)). dia and North Korea) arc inrrtasing their quences ofsuch a conflict. 1\udcat atse1tals. The scenario that has beer\ stttdied mos-r fre­ The acute effects of nuclear weapons are quently is a l_imited nt1elear w:.tr between ln­ There arc currently no negotiations between well described in pre\'·ioos m:~or reports by di:l :.tnd Pakistan involving 100 Hiroshima nuclear-armed states about reducing war· WHO and the US Institute of Medicine sized warheads, small by modern standards, head inventories or curraHirlg opel".uions [30,31]. While there have been important targeted 0 11 utbarl cemers. (11\is is a delib­ and modernizations. lnstead, there are signs developments regarding ionising radi:ttion erate tmderestimate of the ftlll potenti:ll of that the deepening crises in Europe and the he:.tlth effects in recent decades, it is in rel:t· war in Sot1th Asi:t: the combined :.usenals

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Table. Modernization Activities of the Nine N\•clear· armed S~ttes

Russia France o replacing all 5ovietoera 55- 18, 55°19 and 55°25 intcrcon· o modernizing its 5SBN Beet with the new M51 5LBM that tinenr.•l ballistic missiles (ICBMs) by the early· 2020s with will soon receive a new warhe~1d. difiCrcnt versions of the SS-27 and a new .. hc.-avy~ silo-based • anning its bomber force with ALCMs. ICBM. • replacing Mirage 2000N aircraft with the Rafale which will • building eight new baUistic missile submarines (SSBNs) be armed with a new ALCI\1. with the new 55-N-32 (B,davn) missile to replace eight opo United Kingdom crational Soviet-era Delta-class SSBNs and their missiles. • dcvdoping a r\cw SSBN class m replace rhe curte11r Van­ o upgmding its old Tuol60 (Bklckj:.ck) and T uo95MS (Bear) guard-class S5BNs which will carry the life oextended Trio bombers so they can continue to operate until a new bomber dc1n II 05 with a new guidance system. c;an repl:tce them sometime in the 2020s. • eqtaipping ct.•rrent SLB1'vls with enhanced warheads. o graduaUy replacing the old A5· 15 air-launched cruise mis· sile (ALCM) with a new ALCM known as the Kh-102. (>akis-tan • modernizing some of its non-strategic nuclear forces, re­ o deploying new and longer-range 5hahecn· III ballistic miso placing the old 55·21 short-range ballistic missile (SRBM) siles, Ra'ad ALCI\1s, Babur grom\d-launched cruise mis­ \\;th the 55o26 (lskander), replacing the old 55-No21 siles, and de\rcloping a nuclear SLCM. se:.ol:nmched land· :.tt<•ck cruise missile (SLCM) with the • dcployi11g a tactical nuclear weapor), the 60-kilomcter 55oN•30A (Kalibr), and replacing the old 5u-24 (Fencer) NASR missile. fighter-bomber with the 5u· 34 (Fullback). • increasing production of fissile matetial for additional war­ heads. U1t ited States o building a new Aeet of 12 5SBNs to replace the current 14 India SSBNs. The new submarines will catty an impro\'ed vetsiOI\ • deploying and developing longer- range ballistic missiles of the Trident II 05 sea· l:mnched ballistic missile (SLBM) that ta1\ mrgec all of Pakisra11 and China, including several with 11ew guidance system and enhar)ced warheads. new versions of the Agni missile family. modemi~

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ofl ndi:t and Pakistan actuaUy contain more <.-onsttmption, and would not begin tO offset in South Asi:t, the glob:tl cl.imate effects than 220 nuclear warheads.) The direct ef­ the shortfall over a full decade [38). Fur­ would be far worse. A war involving only fects in South Asia are cara.srmphic. Some thermore, there are curret\tly 795 millior\ the strategic weapotlS that will still be de­ 20 million people would die in the first people who are alre:.tdy ttndernourishcd at ployed when New START is 1\•Uy imple­ week from the direct effects of the explo ~ b:tseline [39). There are also some 300 mil­ mented would pot some 150 million tons sions, fire and local radiation [32]. lion people who enjoy adequate nutrition of soot in the upper atmosphere, and drop today, bur live in countries highly depen· temperatures around the world by ~C . lt\ The global consequences-global climate dent on food imports which would probably the interior regions of North America and disnaption and rest.Jitant fit m in e ~would be not be :tv:tihtble :ts grain exporting CO\Intries Ettrasia, temper:ttt.tres \VO\.IId faJI by 25 to far more devastating. The fires caused by suspended exports to feed their own people. 30"C. These conditions would persist for these nuclear weapoos would loft 6.5 mil­ In addiriot\, there are 11early a billion people more than a decade. Ternpetaturcs Or\ Earth liOI'l tons ofsoor into the upper atmosphere. in China with incom~s of S5 a day or less ha\'e nor beetl rhar cold since the last ice The impact of this SOOt has been e.xamined who are adequately fed today, but who h:lVe age. ln the temper:.1te regions of the North· by three teams of cHmatc scientists using shared little in China's growing prosperity ern Hemisphere, the temperature would faH three differe1U climate 1nodels a1\d mak­ over the last several decades. All of these below freezing for some portion of every ing the conservative assumptiorl rhar only people, arourld rwo bi lliotl, would be ar risk day for at least rwo years [43]. Under rhcsc 5 million tons of soot :uc injected into the tmder the potential f:.tm ine conditions that conditions food prodoction would stop and atmosphere [33-35). Each model shows would result from this limited, regional nu­ the vast majority of the human race would signific:uu dtops in average surf."tce temper­ clear war [ 40]. Large scale war betweer\ the starve. ature a11d average prec.ipirarion across the US ar\d Russia would be fat worse. lr1 early globe with the effects lasting fo r more th:tn 2016, Rttssia and the US were estimated to a decade. The most sophisticated and recent possess 7300 and 6970 nuclear warheads rc­ Efforts to Eliminate tnodel shows the most pei"Sistem declines it\ specth·ely, 93% of the global roral of 15,375. Nuclear Weapons remperantre at\d precipiration, which have Under rhe provisioi\S of the New START not yet returned to baseline after 26 years, treaty, each of these cotmtries will retain Understanding of the unprecedented ex· as long as the model was run. \,Yhile the some 1550 strategic (long range) nuclear istential threat posed by nuclear weapons fuel density of modern cities varies, there warheads when the Treaty is fuHy imple­ was widely recognized in the very first is nothir\g specific to lndiaff'akisrarl about merued in 2018. Most of these weapons resolution of the U1\ited Natiot\S General such a sccmtrio. Nude:.tr we:.tpons :are ex· are 10 to 50 times more powerf'-1 1 than the Assembly in January 1946, calling for the tremcly efficient at igniting. over large areas, bombs which destroyed Hiroshima [41). A elimination of atomic weapons [44]. The simultaneous fires which rapidly coalesce 2002 study showed that if just 300 of the preamble of the 1970 nuclear Non-Prolif­ and inject large volumes ofsoot and smoke weapons in the Russian atserul hit utbar\ eration T rcary (N PT) oper1s: "'Coosider· into the stratosphere. targets in the US, 75 to 100 miUion people ing the devastation that wottld be visited would die in the first half hour from the upon all mankind by a nuclear war and the This climate disruption would in turn have firestorms and explosjons [42). This attack consequent need to make every effort to profout\dly negative impact Orl food pro· would also destroy m.ost of the infra.'it:ruc· avert the danger ofsuch a war .. ."[45]. Yet duction. The maize crop in the US, the tt.•rc - the electric ga-id, internet, b:tnking for most of the P'.tst 71 years, the sh:tred world's largest producer, would decline and public health systems, food distribution interests of humanity, based on the real an average of 12% over a full decade [36). network - needed to suppon the rest of the consequences of any usc of nuclear weap­ In China, the world's largest producer of populatiOt\, most of whom would succurnb Orls, have beerl sidelined by the perceived grain, middle season rice wOttld dedine to exposure, starvation and epidemic disease interests of the 9 governments that pos· by I 7% over a full decade, maize by 16%, in the months followlng. A US counterat· sess and threaten ttse of nttcle:.tr weapons, and winter wheat, by a truly catastrophic tack would be expected to cause the same which have dictated the pace and extent 31% (37] . level ofdestruction in Russia, and if NATO of t\uclear anns conttol and disarmamem. were involved in the conflict, Ctmada and However, the obligation tO pttrstte effective Under <.1.1rrent conditions, adequ:tte human mttch of Ettrope would face similar des true· measures towards nttclear disarmament is nutrition cannot be sustained in the face of tion. a shared responsibility of all 190 NPT sig­ declines of food productiOt\ of this rnagni· t\atoty stares, at\d the lruernational Court tl.1 de. Tot:tl world gnin reserves in Ja_n~t ary These direct effects arc only part of the ofjustice in its 1996 Advisory Opinion on 2016 amounted to only 84 days of global story, however. As is true for a limited war nttclear weapons ttnanimotasly roled that

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there e.xists an obligation not only to ptar· governmental meetings dedicated to the a treaty. 1his recommendation was taken sue in good faith, but to bring to a conclu· humanitarian impacts of nuclear weapons. forward in a resolution co-sponsored by 57 sion, negoriario1\S leading 10 flucleat disar­ 1here was no significa11t disagreemem at srares [58) and adopted by the UNGA FiNt on:unent [46]. these conferences regarding the cxten· Committee on 27 October 2016, with 123 sive expert evidence presented, leading to S"-ltCS voting yes, 38 (predominantly nucle­ The contemporary 'Humanitarian In.itiath·c' the conclusions 1) that any usc of nuclear ar-armed and nuclear-allied) voting no, and on nuclear weapons bega1l with Jntcma­ weapat there is a legal gap sight. 1his is increasingly seen by a subsran· tember 1945 -a renewed priority [47]. A for nuclear weapons, in that the most de· tial majority ofstates as the most promising few week.< later, the five yearly 2010 NPT srn.active and indiscriminate of all weapons and realistic srep which can now be raken ro Review ConfetCilCC outcome doetuncnr are the only weapon of mass desrructiOI\ progress rhe eradicati011 of nuclear we:apo11s, referred for the first time to "deep concern not yet explicitly prohibited tmder interna· and the conclusion of S\ICh a treaty would about the catastrophic consequences of any tiona! Jaw [54]. At the end of the Vienna constitute the most significant de,·clopmcnt use of nuclear weapons" (48). In 201 1, the confete1\CC1 rhe Austrian govemrne11t is· in nuclear disatmament since rhe end of the Council of Oelegares, the highest govern­ sued a pledge "'ro cooperate with aH relevnnt Cold \'Vat. Treaties unequivocaHy prohibit· ing body of the Red Cross/Red Crescent stakeholders ... to stigm:tri.ze, prohibit and ing tmacceptable weapons :md providing for Movement, called on all states "to ensure eliminate nuclear weapons in light of their their subsequent elimination has been the rhat nuclear' weapo11s ate never again used'", unacceprable humanjratiatl COI\sequences approach successfully used in telari011 to cv· and "'ro pursue i1\ good faith and C011clude and associated risks"; to "fill the legal gap cry other kind of i1\disc:riminare, inhumane with urgency and determin:.1tion negotia· for the prohibition and elimination of n\t· weapon - biologi<-.1, toxin (59) and chemi­ tions to prohibit the usc of and completely clear weapons" [55]. As of 20 March 2016, cal weapons [60], followed by antipersonnel eliminate nuclear weapons through a legally 127 states have endorsed this I-lumanitadan landmincs [61] and cluster munitions [62]. bindi1tg international agreemenr, based on Pledge, wirh a11 additiOJlal 22 states voring existing commitments and international in fa\'Our ofa resolution bringing the Pledge obligations" [ 49]. A special issue of the to the UNGA [56]. The Role of the Health Movement's flagship journal, the lntema· Community tiona/ Rt"Virw oflht R~d Cron) '11te hluna11 1he 2015 General Assembly also vored costs of nucle:1r we:1pons", was rec.:ently pub· ovenvhelmingly to es~:ablish :an Open End· Involvement of the medical commtlnity in lished. ed Working Group (OEWG) to address these efforts to eliminate nuclear weapons this legal gap, which though open to all Aows from a long history of medica] and Beginni11g in 2012, at e,·ery 1 JYf 1neet· states, was opposed and boycotted by all rhe scie1Uific concem about 11uclear weap<)I\S. ing and UN General Assembly (UNGA), a nuclear· armed states. The \~Vo rking Group After the hydrogen bomb code n:omed growing number of states, from 16 in 2012 was charged with reporting back to the Castle Bravo was detonated at Bikini Atoll to 144 in 2015, ha,'e supported resolutions 2016 UNGA on effective legal measures with a yield of around 15 megatons (mil­ affirming rhe ct1Utaliry of humanital'i:tll required ro attain a1"1d maintain a \ ...'Orld lions of tOllS of TNT equivalent), double considerations in advancing nuclear dis· free of nuclear weapons. 1t "'recommended that predicted, there was widespread pro· armament, and the need to prevent use of with widespread Stlpport for the General test from m:my world leaders together nuclear weapons under any circumstances Assembly to convene a conference in 2017, with Albert Einstein and the Federation [SO]. In 2013 and 2014 three successive operl to all Srares, wirh rhe parricipatiOI\ of American Scientists (63]. In 1957, as fuct· based international conferences on the and contribution of civil society, to negoti· atmospheric testing of nt.1clear we:.•1>

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ing a test b:tn was signed by 9000 scientists the detonation ofa single meg:1ton weapon In 2007, IPPNW foRonald Reagan and In Moscow in October 2015, the World Cfti\CCI'S, and made other estimates of the Mikhail Gorbachev had profound eAecr, Medical AssociatiOI\ Ce1\CraJ Assembly likely health consequcJtces of atmospheric bri1\gi1\g them to declare ir'l 1985 that "A Ull31\imously updated irs Statcmeru Ol\ nuclear testing (64). n\acle:tr war cannot be won :md must never Nnuclear arms race; amended in 2008, requesting all National A series of four [65-68) influential anicles agree on the elimination of iruermediate Medical Associations ro educate their pub­ appeared in rhe Nl"W England Journal of range 1\uclear missile-si and come close to lics a1'1d govemrncrlts about the heahh im­ Medirine in 1962 describing the medical an agreement to eliminate their n\1clear pacts of nuclear war and '"to join the WMA eA:Ccts of a thermonuclear attack on Mas· arsenals entirely. Corbachev wrote that in supporting this Declaration and to urge sachusens, rhe (limil'ed) role of the medical without rhe effOrts of IPPNVV- awarded their respective go\·emmems to work to ba1\ professio1\ in dealiog with rhe coosequences, the Nobel Peace Prize in 1985- these dis­ and climi1131e nudeat weaporls"[74]. and the psychiatric and social aspects ofciv · armament initiatives ~wou l d probably have il defence. The authors, who were members been impossible" [72]. Given the potential In April 2016, the WMA joined with of a new organization Physidans for Sqdal for nuclear war to occur as a result of er­ IPPJ\l\IV, the World Federation of Public Rupomibility, concluded thar as 1\0 effective ror ar'ld the lack ofevidence that a planned Health Associarior\S :11\d the I1UCI'I\atio1\al clinical response was possible, doctors "must medical response can have :my perceptible Co\mcil of Nurses. in submitting to the begin to explore a new area of preventive impact on the outcome, it has been sug­ UN Working Group the first such united medicine, the pre\'ention of thermonuclear, gested that ..support for deterrence with statement detailing the health and humani­ chemical and biological warfare"'. these weapons as a policy for national or tarian imperative ro ban and elimi1\ate nu­ global secur·ity appears to be incompatible clc:~r weapons (75]. All other gl ob:~! health Negotiations on a ban on nuclear t<:sting with basic principles of medical ethics and progress and efforts could come to nought continued inconclusi\•cly unti11963 because international law. The primary medical re· if we do not succeed in eradicating nuclear of concen\s about the potential to COI\ceal spo1uibility under such circ-umstances is to weapons before rhey are again used i11 war. clandestine tests. \!Vith evidcnte of wide· participate in attempts to prevent n\1clear There has ne\'er been a better opportunity spread radioacti\'e faUout and accumulation war" [73]. New evidence about the per­ nor greater need for united and effective of strontium· 90 in the deciduous teeth of vasive threats to health of the detonation ht-alth professional engagement to remove children around the world, public opini01\ of e\'en a small perce1\t'age of the world's the most acute existential threat ro global swung strongly in fiwou r of banning atmo· macle:tr :1rsenals, together with the faih1re he:.llth and survivaL spheric nuclear testing :md the Limited Test of the Non· Proliferation Treaty to prevent Ban treaty was agreed in 1963, but progress the retention and modernization of nu· towards a comprehe11sh·e treaty proved clear weaporls has give1'1 impetus to a new References fmstratingly slow. global movement to ban nuclear weapons. 1. http:l/:ar-chive.deftn.sc.g

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'\<." '( CO), L '-.j'S 93 Nuclear War World Medical t1 Journal WN\A

\VMking towards the d imin:nion of nuckar re:.chingcritic:.lwill.c>rg/ imagc:s/documents./ wma.ncrlen/30public:.ttonsl10policies/n7/ (ac· wC<~pons. Ccnev.~: ICRC. 2011. http://www. Disoumament-fora/1com/ 1com16/rcsolutions/ ces.scd May9.2016). icrc.orglcnglrcsourcc!lldocumenu/rcsolution/ !At.pdf(•=ssed Ocmbc• 30, 201(>). 75. UN General Assembly. The health and humani· coun<:il-del~tt$-tUOl uti<:>n- 1 -20l 1 .htm (.-c­ 59.Conventipic 3/fo reign --a ff1.1 i 1'$/lu.J­ htt)'J$://www.OJ>C\\',Org/ch emical ·w·e:.~pons·con · lm Hdfoml, MD manitarian·c:ffortslhumimpact_20131id7086031 \pc Tntegr:Ation and foreign Affairs Fed­ s.. ,.,. N Eng!) MCoc.. (•7. Lciderman PI I, Mendelson Jl l. Some psychiar· for the PrN.N.wtion ofNudtar J#lr, Ul'll0OOS :and medicine; some ethical dilemmas. O

94 ISSN zz;6-o;8o or f) WM.A

Official Journal ofThe World Medical Association, Inc. Nr. 3, October zor6 vol. 62

Contents

Currently the Earth is a Planet ofPiastics ...... 81

Interview with Sir Michael Marmot, President of the World Medical Association ...... 82

Migration ofDoctors and WorkingT ime Arrangements from an International Perspective ...... 83

Women in Migration: Beyond Statistics ...... 84

The Growing Threat ofNuclear War and the Role ofthe Health Community ...... 86

WMA Calls on Governments to Ban and Eliminate Nuclear Weapons ...... 95

The Value of Resiliency Training in Postgraduate Medical Education ...... 95

The Role ofPhysicians Fighting Children Trafficking and Illegal Adoptions: the Use of Genetic Identification ...... 96

Why Should the World Medical Association not Change its Policy towards Euth.anasia.? ...... 99

Voluntary Euthanasia and Physician-assisted Suicide: Should the WMA Drop its . . } 0 pposttion...... 103

One Health and Antimicrobial Resistance ...... 108

Global Development ofMedical Science and Publication Opportunities and Challenges ...... 112

Southeast European Medical Forum ...... 114

Paul Cibrie: Defending the Medical Profession in the Age ofInternationalization ...... 117

Introduction to work at COP22 ...... 119