Nuclear War World Medical f) Journal WN\A 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<x:trine of 1980"s" (7].1he increased tensions between could escalate to nuclear war. "nuclear de-escalation". Rather than seeing the US and Russia have been matched by a llUI.:h.:al WC;f.J1VIl:> JJUH.: ly as <l tlt:lCilClll lO ~i111ila1 c;.:,:\.-.tlativu in lhc Uangc.a vf uudc.u Over rhe past two years, both sides have 11uclear arrack, this doctrine embraces "the wal' i11 Sourh Asia. engage<l in n\lcl<:~tr sabre rattling tlmt is idea that, if Russia were faced with al:trge ~ reminiscent of the worst periods of the scale convention:tl :ttmck th:tt exceeded its Since the nucl<:::.lr we:.•pon tests of May 1998 Cold War. Speaking about the conflict in capacity for defence. it might respond with by India and then Pakistan, the two states Uktairle in August 2014, Russian Presi­ a limited nuclear strike" i11 order to fotcc ha\'e ex-panded marly-fold their tespecr-ivc dent Vladimir Putin warned "it is better the other side tO quickJy end the conflict 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, 86 Nuclear War World Medical Journal WN\A 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 <x:casions US Strategic Comm:tnd, warned that it trigger is the recurring artillery exchanges since 1979 when e ither \ +Vas hington or might be possible fo r terrorists to hack along the line of control in Kashmir, and oc· Moscow prepared to launch nuclear weap­ into Russian or American command and casionally the intetnational bo!'det berwee11 ons in the mistake11 belief rhar rhe orhet conrrol systems and laUJlch one or mote Palcist:.tn and 1ndia, which often claim sig· side had already htt•n<:hed a n~•clear attack n\•clear missiles, a launch which would nificant military and civilian cas~l tllties (17).