John Launer: Nuclear war—it’s time to face up to the risks
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1540 (Published 12 July 2023) Cite this as: BMJ 2023;382:p1540
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Dear Editor
Dr Launer has righlty mentioned about the devastating effects of nuclear weapons, and highlighted the moral responsibilities of medical professionals to prioritize the elimination of nulcear weapons as an urgent medical, humanitarian and public health imperative. We as a doctor have profound understanding of both the immediate and the long term consequences of war.
Recently, I was one of the 15th biketour participants from nine different countries who pedalled from Nairobi to Mombasa (320 miles) in five days from 20th April 2023, rallying young doctors and medical students to raise awareness and promote advocacy on disarmament, climate justice and health.
Following biketour, International Physicians for the Prevention of Nuclear War (IPPNW) 23rd World congress culiminated in the 'Mombasa declaration' and 'an appeal for peace and prevention of Nuclear war'. The first congress in the African continent brought the links between the health consequences of the climate crisis and Nuclear weapons - especially as they relate to Africa, and within the context of other world events. Nuclear famine, Military CO2 emissisons, nuclear brinkmanship during war, climate and conflict, Nuclear power - energy choices, and Treaty for the Prohibition of Nuclear weapons (TPNW) were discussed.
After the manmade disaster of Kakhova Dam in Ukraine last month, many believe that the Zaporizhzhia nuclear power plant is next and is a 'dirty bomb' waiting to happen. Similarly, planned B 61-12 atom bombs deployment in RAF Lakenheath, Suffolk, and around NATO military bases in Europe, Russian deployment of nuclear weapons in Belarus further raises alarm and brings Doomsday clock to 90 seconds to midnight.
The very First Meeting of State Parties of the Nuclear Ban Treaty from 21 – 23 June 2023, where members state parties convened by the Under Secretary General and High Representative for Nuclear Disarmament Affairs in Vienna laid a blueprint for future congregations and action on nuclear disarmament featuring universalisation, helping people and places harmed by nuclear weapons, the inclusion of civil society and particularly affected communities, a progressive approach to gender and disarmament, working with scientists and other UN treaties. It was a generational event, and I hope the first of many productive meetings of state parties to the treaty where nuclear weapon states including the UK will participate.
With the upcoming movie of Christopher Nolan's biopic about Robert J Oppenheimer named 'Oppenheimer' - leader of Manhattan project, first atom bomb explosion, Trinity test in New Mexico - should help to remind us of how badly the development of modern weapons has played out for individuals and for all of humanity and the 6th August - 78th commemoration of Hiroshima day, atomic detonation in WWII by the USA - should galvanise the mass population about the horrors of weapons of mass destruction. We should come together and share the common goal of creating a more peaceful and secure world freedom from the threats of nuclear annihilation and armed violence.
Reference:
Biketour
https://www.medact.org/2023/blogs/2023-ippnw-bike-tour/
MOMBASA Declaration
https://peaceandhealthblog.com/2023/05/05/the-world-urgently-needs-to-ch...
An appeal for peace and prevention of nuclear war
https://peaceandhealthblog.com/2023/05/05/mombasa-appeal-for-peace-and-p...
Member state Parties TPNW
https://www.medact.org/2022/blogs/blueprint-for-nuclear-disarmament/
Competing interests: No competing interests
Dear Editor,
John Launer makes a very powerful and lucid case for the extreme risk to humanity currently posed by nuclear weapons. But I'm torn between congratulating the BMJ on publishing such a timely and vital opinion piece, and castigating them for having devoted so little space over the years to the threat of nuclear war, in comparison with their frequent, excellent coverage of the other existential threat to humanity, the climate emergency.
I'd like to make a couple of points that Launer didn't have space to address; CND calculates the cost of replacing the current Trident system to be at least £205 billion, yes, billion. And that's not including the government's plan to increase the number of warheads by 40%, in breach of international commitments under the Non-proliferation Treaty. That would pay for doctors' and nurses' pay demands, make a huge contribution to social care funding, and leave plenty over to set the country seriously on course for net zero by 2030. What a frightening and terrible waste of money.
In the meantime, almost half the member states of the UN have now signed the UN's 2017 Treaty for the Prohibition of Nuclear Weapons, but not the UK or the other nuclear 'powers'. I believe this should be a major issue at the next general election, preventing nuclear war being the strongest of all preventive medicine interventions.
Competing interests: No competing interests
Dear Editor
Dr Launer is quite right to point out the danger and consequent catastrophe of even a limited nuclear exchange between Russia and the West, and the role doctors around the world have in campaigning for nuclear de-escalation and peace.
Sending weapons such as depleted uranium and cluster bombs to Ukraine will not ensure Russia’s defeat but at best render the areas under occupation uninhabitable and at worst push us further down the path towards nuclear war; a path from which there is no return.
The war in Ukraine is the most devastating conflict in Europe since World War II. A year into the conflict and amidst the dreadful loss of life on all sides, it looks like war between Russia and Ukraine is really a conflict between Nato and Russia, in which the former seeks to challenge the emergence of a new Eurasian-centric capitalist bloc.
It is clear too that (most of) the nations comprising the EU and Nato are willing to pull out all stops to defeat or greatly weaken Russia, regardless of the human costs to Ukraine, and have already handed over billions of dollars in military aid alongside vast quantities of weapons from their own arsenals. Britain provided £2.3 billion in military aid to Ukraine in 2022 whilst the US has given at least $46.6bn in military aid since the war began.
For the US, at least, this is a perfect war in which it can fight a key geopolitical opponent without getting its hands dirty and having to explain an influx of body bags to the US public like in Iraq and Afghanistan. Additionally, 2024 is an election year and a greater number of US politicians are becoming uneasy at Biden’s blank cheque to Ukraine. And frankly sending billions to fund a war abroad rather than investing the money at home is not exactly a vote winner. Next year it would be tempting for the US to say “mission accomplished” and make the war in Ukraine Europe’s problem, leaving the EU to sort out the mess and come to a disadvantageous settlement with Russia.
As doctors we have a role to work with peace movements within Ukraine, Russia and beyond to call for a swift and just settlement to the war. Concurrently we must condemn rhetoric or action by any world leader that seeks to prolong the war in Ukraine whilst the people of Russia, Ukraine and Europe bear the human and economic cost of the conflict. We need to be wary too, of forces both within Nato and beyond that are seeking to prolong the conflict in Ukraine for ideological reasons, due to the lucrative nature of war (not least for the arms industry), or for personal ambition.
Competing interests: No competing interests
Dear Editor
John Launer’s article and Hannah Walker’s generally supportive response are much to be commended – they both point out the dangers and futility of nuclear war and Dr Walker is correct about the mindset of the Russian leadership as ‘simply … another type of armament to be used in gaining an objective’. I am sure that Dr Walker is aware that the 1985 Nobel Laureate “International Physicians for the Prevention of Nuclear War” (IPPNW) was founded in 1980, and the predecessor of its UK affiliate (now known as ‘Medact’ www.medact.org ) was founded in the 1950s; so a coalition – including Russians – of doctors against nuclear weapons has existed for decades. IPPNW also founded the International Campaign Against Nuclear Weapons (ICAN) which was awarded the Nobel Peace Prize in 2017 for its contribution to the ‘Treaty for the Prohibition of Nuclear Weapons’ (TPNW) which came into force in 2021. The TPNW represents the most realistic option for global nuclear disarmament through the Nuclear Non-Proliferation Treaty of 1970 (‘NPT’), as it offers a route for all the States which possess nuclear weapons to honour the obligation signed by China, France, Russia, the US and the UK to disarm ‘in good faith’ (according to the NPT’s article VI).
Dr Walker is only too correct in criticising the implication that a limited nuclear exchange (battlefield use) could contain an outbreak of full-scale nuclear war, and in her statement that the UK Government has no plan for its citizens in the event of nuclear war. Depressingly, the outlook for a peaceful resolution of the Ukraine tragedy looks no nearer in spite of an apparent weakening of President Putin’s leadership over the Russian peoples whose general attitudes in the face of military failures appears to be one of passive resignation in line with a long history of tolerance of sufferings on scales we find unimaginable. Nevertheless, there are voices in Russia which question the need for their government’s nuclear postures; and these voices could be better heard. Russian scientists within Russia and in the diaspora are fully aware of the other global existential threat – climate change – and given a chance, and so long as much of the world is making tangible advances in reducing the dominance of fossil fuels as a source of energy and development, may yet change the course of history.
The other climatic factor, to which John Launer refers very briefly, is the onset of a ‘nuclear winter’ which would follow a significant exchange of nuclear weapons targetting cities, ports and military installations. Updated modelling by climate scientists show that even a ‘limited war’ with an exchange of 5% of the current world arsenal of nuclear weapons would cause a decade of severe famines affecting many inhabitants of non-combatting nations (Xia et al 2022).
There is every reason for health professionals and indeed all global citizens to actively oppose not just the actual proliferation of nuclear weapons but to promote a world free of nuclear weapons. This is undoubtedly a big ask and fraught with dangers, not least while transiting to such a state; but while such weapons exist, and while nuclear power plants offer strong temptations to desperate leaders of nuclear-weapons-possessing states (such as the Russians facing a failure of their forces in Ukraine) the longer such a conflict persists, the greater the risk of a nuclear Armageddon. Acting together in a well-informed way offers us the best hope of survival.
Reference
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 3, 586–596 (2022). https://doi.org/10.1038/s43016-022-00573-0
No Competing Interests
Competing interests: No competing interests
Dear Editor
John Launer is quite correct in his analysis, but his solution is not necessarily the answer.
The use of “tactical” or battlefield nuclear weapons has been an integral part of Russia’s battle plans since the late 1970s, when the Soviet Union and Warsaw Pact countries faced NATO in Europe. There is no moral or cultural taboo to prevent their use - as there is in other countries - within the Russian mindset. Nuclear weapons are simply seen as another type of armament to be used in gaining an objective.
I recently watched the 1984 film “Threads” for the second time. It depicts in graphic detail the effects of a massive nuclear exchange. When the film was released, I was serving in Germany. After watching it, I couldn’t sleep for weeks; and I was, at the time, very well trained in NBC warfare and survival.
It is much too late to begin building a coalition of doctors against nuclear weapons with the hope of influencing Mr Putin. If - and it is a big if - the war in Ukraine ends in a way which satisfies the Ukrainian people and permits Putin to extract his forces without losing face within Russia, then that is the time to regroup and press for disarmament. That is, however, an unrealistic expectation.
Equally unrealistic is the notion that there is any such thing as a limited nuclear exchange (battlefield use), with the implication that such an event could be contained. It can’t. The Russian establishment is already floating the concept of a “necessary” nuclear escalation amongst its citizens - through articles from philosophers to commentators on state media.
The UK Government has no plan for its citizens in the event of nuclear war; or if it has, it hasn’t told said citizens. Millions will die, and medical facilities will be overwhelmed within 24 hours. The country will collapse within days.
Perhaps the most effective strategy would be for doctors (and nurses, and all public servants, and the public) to press the Government very vocally to release its Civil Defence Plans. I doubt there are any, but doing so would expose the lack.
Competing interests: No competing interests
Re: John Launer: Nuclear war—it’s time to face up to the risks
Dear Editor
I would like to add another educational role that physicians can perform to reduce the risk of nuclear war. Physicians can teach politicians how to conduct peaceful negotiations between governments with nuclear weapons. Physicians know how to conduct effective medical interviews with difficult patients, such as resistant patients. When approaching a resistant patient, it is important to employ strategies that can help build rapport and foster open communication.
Following are some tips on how to approach a resistant patient (1):
• Stay composed and show empathy towards the patient's emotions and concerns. This can help create a safe and non-judgmental environment.
• Give the patient your full attention and actively listen to their concerns. Reflect back on what they say to demonstrate that you understand and validate their feelings.
• Take the time to address any concerns or misconceptions the patient may have. Provide clear explanations and evidence-based information to help alleviate their resistance.
• Work with the patient to set realistic and achievable goals. Breaking down larger goals into smaller steps can make them more manageable and increase the patient's motivation.
Politicians need education for conducting peaceful negotiations to eliminate possible nuclear risk. This education can be effectively done by physicians who are highly competent in approaching resistant patients.
Competing interests: No competing interests
17 July 2023
Yasuharu Tokuda, MD MPH
Consultant Generalist Physician
Okinawa, Japan
References
1: Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes.
Arch Intern Med. 1999;159:1069-1075.
Competing interests: No competing interests