Evidence, Commentary, and Judgment

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3.2.3 Nuclear War and the Provision of Health Services

In assessing the overall effects of nuclear war the Tribunal sought to identify more clearly the scale of physical and psychological damage to civilian populations and the ability of health services to provide for victims.

The first witness to appear in this category was Dr. Dawson, Under Secretary of the British Medical Association . He presented the Tribunal with copies of the report by the BMA's Board of Science and Education on the medical effects of nuclear war as his prime proof of evidence10. This report reviewed all the major studies of nuclear attacks on the UK and examined mortality rates and medical response. The BMA report establishes that in the UK there are approximately 160,000 acute beds available within the National Health Service (NHS) in peace-time. After a nuclear attack the majority of these would have been destroyed. Many victims would suffer from serious second and third degree burn injuries, orthopaedic, abdominal, spinal and thoracic injury from blast effects, as well as from the effects of high levels of radioactivity and infection. The report points out that substantial numbers of victims of nuclear attack even if they survive the first few days would require major surgery for blast trauma plus plasma and blood transfusions for burn and radiation injury. The majority of victims requiring such treatment (likely to be many millions) are certain to die. The report concludes (p124):

"The explosion of a single nuclear bomb of the size used at Hiroshima over a major city in the UK is likely to produce so many cases of trauma and burns requiring hospital treatment that the remaining medical services in the UK would be completely overwhelmed. An attack with, for example, 200 megatons represents an explosive power some 15,000 times greater than the Hiroshima bomb or the equivalent of forty (40) times all the conventional explosive used in the whole of the Second World War.

The NHS could not deal with the casualties that might be expected following the detonation of a single one megaton weapon over the UK. It follows that multiple nuclear explosions over several, possibly many, cities would force a breakdown in medical services across the country as a whole.

There is no possibility of increasing the production of certain drugs in a short period of tension before a war, and if it is wished to have large quantities of blood products available for transfusion purposes or the bulk of the present generation of medical practitioners in the country trained for certain eventualities, then all of these things would have to be done now and the country must exist on a more or less permanent emergency footing."

Dr. Dawson indicated that the BMA had taken the view in its study that the calculations performed by independent scientists on the effects of attacks on the UK were more realistic than those of the British Home Office. The members of the Tribunal note that regardless of who is right or wrong on this issue, the essential conclusions of the BMA report remain indisputable.

Additional evidence on the effects of nuclear war on the medical services was provided by Dr. Haines of the Department of Community Medicine at the Middlesex Hospital, London.

A third witness in this section, Dr Thompson, provided the Tribunal with useful information on the possible psychological reactions to nuclear disasters. Such evidence is based on observed reactions to past natural disasters and extrapolation to a post-nuclear society is difficult. Under examination Dr. Thompson expressed the view that approximately one half of the survivors of an attack would probably suffer from a 'disaster syndrome' in which people would feel 'dazed, stunned, bewildered, and apathetic and behave mechanically'. He estimated that a further 25% would be capable of reacting usefully but would suffer from a role conflict, i.e. family versus duty. The remaining 25% would be incapable of reacting. The Tribunal accepted that severe psychological disturbance was likely to be a major indirect effect of the use of nuclear weapons which would pose a serious threat to the continuing existence of initial survivors even at 'limited' scales of attack. The lack of a normal outside world would be a critical factor in amplifying the psychological effects.

The attention of the Tribunal was also drawn to a recent report by the International Committee of Experts in Medical Sciences and Public Health to the World Health Organization11. The report concludes that:

"The immediate and the delayed loss of human and animal life would be enormous, and the effect on the fabric of civilization would be either to impede its recovery or make recovery impossible. The plight of survivors would be physically and psychologically appalling. The partial or complete disruption of the health services would deprive survivors of effective help. The committee is convinced that there is a sound professional basis for its conclusions that nuclear weapons constitute the greatest immediate threat to the health and welfare of mankind."

The members of the Tribunal believe this conclusion has significant legal implications.


10 The Medical Effects of Nuclear War. Report of the British Medical Association's Board of Science and Education, John Wiley, Chichester, 1983.

11 Effects of Nuclear War on Health and Health Services, Report of the International Committee of Experts in Medical Sciences and Public Health to Implement Resolution WHA34.38, World Health Organization, Geneva 1984.

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