No time to waste: What Japan and the world needs to learn from Chernobyl

Alexey V. Nesterenko, Vassily B. Nesterenko & Alexey V. Yablokov.
New York Academy of Sciences. Volume 1181. 2009. Pages vii–xvi, 1–327, E1–E39
Excerpt from final chapter, the summary of the authors’ meta-analysis of studies of the Chernobyl disaster. The book is out of print and the New York Academy of Sciences has stated it has no plan to reprint it. They allow free access to it if you register a free membership. Thus I hope no one objects to my republishing this excerpt here. 
15. Consequences of the Chernobyl Catastrophe for Public Health and the Environment 23 Years Later

The explosion of the fourth block of the Chernobyl nuclear power plant in Ukraine on April, 26, 1986 was the worst technogenic accident in history. The information presented in the first 14 parts of this volume was abstracted from the several thousand cited scientific papers and other materials. What follows here is a summary of the main results of this meta-analysis of the consequences of the Chernobyl catastrophe.
The principal methodological approach of this meta-review is to reveal the consequences of Chernobyl by comparing differences among populations, including territories or subgroups that had and have different levels of contamination but are comparable to one another in ethnic, biologic, social, and economic characteristics. This approach is clearly more valid than trying to find “statistically significant” correlations between population doses that are impossible to quantify after the fact and health outcomes that are defined precisely by morbidity and mortality data.

15.1. The Global Scale of the Catastrophe

1. As a result of the catastrophe, 40% of Europe was contaminated with dangerous radioactivity. Asia and North America were also exposed to significant amounts of radioactive fallout. Contaminated countries include Austria, Finland, Sweden, Norway, Switzerland, Romania, Great Britain, Germany, Italy, France, Greece, Iceland, and Slovenia, as well as wide territories in Asia, including Turkey, Georgia, Armenia, The Emirates, China, and northern Africa. Nearly 400 million people lived in areas with radioactivity at a level exceeding 4 kBq/m2 (≥0.1 Ci/km2) during the period from April to July 1986.

2. Belarus was especially heavily contaminated. Twenty-three years after the catastrophe nearly 5 million people, including some 1 million children, live in vast areas of Belarus, Ukraine, and European Russia where dangerous levels of radioactive contamination persist (see Chapter 1).

3. The claim by the International Atomic Energy Agency (IAEA), the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), and several other groups that the Chernobyl radioactive fallout adds “only” 2% to the natural radioactive background ignores several facts:
  • ·         First, many territories continue to have dangerously high levels of radiation.
  • ·         Second, high levels of radiation were spread far and wide in the first weeks after the catastrophe.
  • ·         Third, there will be decades of chronic, low-level contamination after the catastrophe (Fig. 15.1).
  • ·         Fourth, every increase in nuclear radiation has an effect on both somatic and reproductive cells of all living things.
  • ·         Figure 15.1. Total additional radioactivity (in petabequerels) in the global environment after the Chernobyl catastrophe: (1) Am-241, (2) Pu (239 + 240), (3) Pu-241, (4) Sr-90, (5) Cs-137, (6) I-131 (Mulev, 2008).

4. There is no scientific justification for the fact that specialists from IAEA and the World Health Organization (WHO) (Chernobyl Forum, 2005) completely neglected to cite the extensive data on the negative consequences of radioactive contamination in areas other than Belarus, Ukraine, and European Russia, where about 57% of the Chernobyl radionuclides were deposited.

15.2. Obstacles to Analysis of the Chernobyl Consequences

1. Among the reasons complicating a full-scale estimation of the impact of the Chernobyl catastrophe on health are the following:

  • Official secrecy and unrectifiable falsification of Soviet Union medical statistics for the first 3.5 years after the catastrophe.
  • Lack of detailed and clearly reliable medical statistics in Ukraine, Belarus, and Russia.
  • Difficulties in estimating true individual radioactive doses in view of: (a) reconstruction of doses in the first days, weeks, and months after the catastrophe; (b) uncertainty as to the influence of individual “hot particles”; (c) problems accounting for uneven and spotty contamination; and (d) inability to determine the influence of each of many radionuclides, singly and in combination.
  • Inadequacy of modern knowledge as to: (a) the specific effect of each of the many radionuclides; (b) synergy of interactions of radionuclides among themselves and with other environmental factors; (c) population and individual variations in radiosensitivity; (d) impact of ultralow doses and dose rates; and (e) impact of internally absorbed radiation on various organs and biological systems.

2. The demand by IAEA and WHO experts to require “significant correlation” between the imprecisely calculated levels of individual radiation (and thus groups of individuals) and precisely diagnosed illnesses as the only iron clad proof to associate illness with Chernobyl radiation is not, in our view, scientifically valid.

3. We believe it is scientifically incorrect to reject data generated by many thousands of scientists, doctors, and other experts who directly observed the suffering of millions affected by radioactive fallout in Belarus, Ukraine, and Russia as “mismatching scientific protocols.” It is scientifically valid to find ways to abstract the valuable information from these data.

4. The objective information concerning the impact of the Chernobyl catastrophe on health can be obtained in several ways:

  • ·         Compare morbidity and mortality of territories having identical physiographic, social, and economic backgrounds and that differ only in the levels and spectra of radioactive contamination to which they have been and are being exposed.
  • ·         Compare the health of the same group of individuals during specific periods after the catastrophe.
  • ·         Compare the health of the same individual in regard to disorders linked to radiation that are not a function of age or sex (e.g., stable chromosomal aberrations).
  • ·         Compare the health of individuals living in contaminated territories by measuring the level of incorporated Cs-137, Sr-90, Pu, and Am. This method is especially effective for evaluating children who were born after the catastrophe.
  • ·         Correlate pathological changes in particular organs by measuring their levels of incorporated radionuclides.

The objective documentation of the catastrophe's consequences requires the analysis of the health status of about 800,000 liquidators, hundreds of thousands of evacuees, and those who voluntary left the contaminated territories of Belarus, Ukraine, and Russia (and their children), who are now living outside of these territories, even in other countries.

5. It is necessary to determine territories in Asia (including Trans-Caucasus, Iran, China, Turkey, Emirates), northern Africa, and North America that were exposed to the Chernobyl fallout from April to July 1986 and to analyze detailed medical statistics for these and surrounding territories.

15.3. Health Consequences of Chernobyl

1. A significant increase in general morbidity is apparent in all the territories contaminated by Chernobyl that have been studied.
2. Among specific health disorders associated with Chernobyl radiation there are increased morbidity and prevalence of the following groups of diseases:

  • ·         Circulatory system (owing primarily to radioactive destruction of the endothelium, the internal lining of the blood vessels).
  • ·         Endocrine system (especially nonmalignant thyroid pathology).
  • ·         Immune system (“Chernobyl AIDS,” increased incidence and seriousness of all illnesses).
  • ·         Respiratory system.
  • ·         Urogenital tract and reproductive disorders.
  • ·         Musculoskeletal system (including pathologic changes in the structure and composition of bones: osteopenia and osteoporosis).
  • ·         Central nervous system (changes in frontal, temporal, and occipitoparietal lobes of the brain, leading to diminished intelligence and behaviorial and mental disorders).
  • ·         Eyes (cataracts, vitreous destruction, refraction anomalies, and conjunctive disorders).
  • ·         Digestive tract.
  • ·         Congenital malformations and anomalies (including previously rare multiple defects of limbs and head).
  • ·         Thyroid cancer (All forecasts concerning this cancer have been erroneous; Chernobyl-related thyroid cancers have rapid onset and aggressive development, striking both children and adults. After surgery the person becomes dependent on replacement hormone medication for life.)
  • ·         Leukemia (blood cancers) not only in children and liquidators, but in the general adult population of contaminated territories.
  • ·         Other malignant neoplasms.

3. Other health consequences of the catastrophe:

  • ·         Changes in the body's biological balance, leading to increased numbers of serious illnesses owing to intestinal toxicoses, bacterial infections, and sepsis.
  • ·         Intensified infectious and parasitic diseases (e.g., viral hepatitis and respiratory viruses).
  • ·         Increased incidence of health disorders in children born to radiated parents (both to liquidators and to individuals who left the contaminated territories), especially those radiated in utero. These disorders, involving practically all the body's organs and systems, also include genetic changes.
  • ·         Catastrophic state of health of liquidators (especially liquidators who worked in 1986–1987).
  • ·         Premature aging in both adults and children.
  • ·         Increased incidence of multiple somatic and genetic mutations.

4. Chronic diseases associated with radioactive contamination are pervasive in liquidators and in the population living in contaminated territories. Among these individuals polymorbidity is common; that is, people are often afflicted by multiple illnesses at the same time.

5. Chernobyl has “enriched” world medicine with such terms, as “cancer rejuvenescence,” as well as three new syndromes:

  • ·         “Vegetovascular dystonia”—dysfunctional regulation of the nervous system involving cardiovascular and other organs (also called autonomic nervous system dysfunction), with clinical signs that present against a background of stress.
  • ·         “Incorporated long-life radionuclides”—functional and structural disorders of the cardiovascular, nervous, endocrine, reproductive, and other systems owing to absorbed radionuclides.
  • ·         “Acute inhalation lesions of the upper respiratory tract”—a combination of a rhinitis, throat tickling, dry cough, difficulty breathing, and shortness of breath owing to the effect of inhaled radionuclides, including “hot particles.”

6. Several new syndromes, reflecting increased incidence of some illnesses, appeared after Chernobyl. Among them:

  • ·         “Chronic fatigue syndrome”—excessive and unrelieved fatigue, fatigue without obvious cause, periodic depression, memory loss, diffuse muscular and joint pains, chills and fever, frequent mood changes, cervical lymph node sensitivity, weight loss; it is also often associated with immune system dysfunction and CNS disorders.
  • ·         “Lingering radiating illness syndrome”—a combination of excessive fatigue, dizziness, trembling, and back pain.
  • ·         “Early aging syndrome”—a divergence between physical and chronological age with illnesses characteristic of the elderly occurring at an early age.

7. Specific Chernobyl syndromes such as “radiation in utero,” “Chernobyl AIDS,” “Chernobyl heart,” “Chernobyl limbs,” and others await more detailed definitive medical descriptions.

8. The full picture of deteriorating health in the contaminated territories is still far from complete, despite a large quantity of data. Medical, biological, and radiological research must expand and be supported to provide the full picture of Chernobyl's consequences. Instead this research has been cut back in Russia, Ukraine, and Belarus.

9. Deterioration of public health (especially of children) in the Chernobyl-contaminated territories 23 years after the catastrophe is not due to psychological stress or radiophobia, or from resettlement, but is mostly and primarily due to Chernobyl irradiation. Superimposed upon the first powerful shock in 1986 is continuing chronic low-dose and low-dose-rate radionuclide exposure.

10. Psychological factors (“radiation phobia”) simply cannot be the defining reason because morbidity continued to increase for some years after the catastrophe, whereas radiation concerns have decreased. And what is the level of radiation phobia among voles, swallows, frogs, and pine trees, which demonstrate similar health disorders, including increased mutation rates? There is no question but that social and economic factors are dire for those sick from radiation. Sickness, deformed and impaired children, death of family and friends, loss of home and treasured possessions, loss of work, and dislocation are serious financial and mental stresses.

15.4. Total Number of Victims

1. Early official forecasts by IAEA and WHO predicted few additional cases of cancer. In 2005, the Chernobyl Forum declared that the total death toll from the catastrophe would be about 9,000 and the number of sick about 200,000. These numbers cannot distinguish radiation-related deaths and illnesses from the natural mortality and morbidity of a huge population base.
2. Soon after the catastrophe average life expectancy noticeably decreased and morbidity and mortality increased in infants and the elderly in the Soviet Union.
3. Detailed statistical comparisons of heavily contaminated territories with less contaminated ones showed an increase in the mortality rate in contaminated European Russia and Ukraine of up to 3.75% and 4.0%, respectively, in the first 15 to 17 years after the catastrophe.
4. According to evaluations based on detailed analyses of official demographic statistics in the contaminated territories of Belarus, Ukraine, and European Russia, the additional Chernobyl death toll for the first 15 years after the catastrophe amounted to nearly 237,000 people. It is safe to assume that the total Chernobyl death toll for the period from 1987 to 2004 has reached nearly 417,000 in other parts of Europe, Asia, and Africa, and nearly 170,000 in North America, accounting for nearly 824,000 deaths worldwide.
5. The numbers of Chernobyl victims will continue to increase for several generations.

15.5. Chernobyl Releases and Environmental Consequences

1. Displacement of the long half-life Chernobyl radionuclides by water, winds, and migrating animals causes (and will continue to cause) secondary radioactive contamination hundreds and thousands of kilometers away from the Ukrainian Chernobyl Nuclear Power Station.
2. All the initial forecasts of rapid clearance or decay of the Chernobyl radionuclides from ecosystems were wrong: it is taking much longer than predicted because they recirculate. The overall state of the contamination in water, air, and soil appears to fluctuate greatly and the dynamics of Sr-90, Cs-137, Pu, and Am contamination still present surprises.
3. As a result of the accumulation of Cs-137, Sr-90, Pu, and Am in the root soil layer, radionuclides have continued to build in plants over recent years. Moving with water to the above-ground parts of plants, the radionuclides (which earlier had disappeared from the surface) concentrate in the edible components, resulting in increased levels of internal irradiation and dose rate in people, despite decreasing total amounts of radionuclides from natural disintegration over time.
4. As a result of radionuclide bioaccumulation, the amount in plants, mushrooms, and animals can increase 1,000-fold as compared with concentrations in soil and water. The factors of accumulation and transition vary considerably by season even for the same species, making it difficult to discern dangerous levels of radionuclides in plants and animals that appear to be safe to eat. Only direct monitoring can determine actual levels.
5. In 1986 the levels of irradiation in plants and animals in Western Europe, North America, the Arctic, and eastern Asia were sometimes hundreds and even thousands of times above acceptable norms. The initial pulse of high-level irradiation followed by exposure to chronic low-level radionuclides has resulted in morphological, physiological, and genetic disorders in all the living organisms in contaminated areas that have been studied—plants, mammals, birds, amphibians, fish, invertebrates, bacteria, and viruses.
6. Twenty years after the catastrophe all game animals in contaminated areas of Belarus, Ukraine, and European Russia have high levels of the Chernobyl radionuclides. It is still possible to find elk, boar, and roe deer that are dangerously contaminated in Austria, Sweden, Finland, Germany, Switzerland, Norway, and several other countries.
7. All affected populations of plants and animals that have been the subjects of detailed studies exhibit a wide range of morphological deformities that were rare or unheard of prior to the catastrophe.
8. Stability of individual development (determined by level of fluctuating symmetry—a specific method for detecting the level of individual developmental instability) is lower in all the plants, fishes, amphibians, birds, and mammals that were studied in the contaminated territories.
9. The number of the genetically anomalous and underdeveloped pollen grains and spores in the Chernobyl radioactively contaminated soils indicates geobotanical disturbance.
10. All of the plants, animals, and microorganisms that were studied in the Chernobyl contaminated territories have significantly higher levels of mutations than those in less contaminated areas. The chronic low-dose exposure in Chernobyl territories results in a transgenerational accumulation of genomic instability, manifested in cellular and systemic effects. The mutation rates in some organisms increased during the last decades, despite a decrease in the local level of radioactive contamination.
11. Wildlife in the heavily contaminated Chernobyl zone sometimes appears to flourish, but the appearance is deceptive. According to morphogenetic, cytogenetic, and immunological tests, all of the populations of plants, fishes, amphibians, and mammals that were studied there are in poor condition. This zone is analogous to a “black hole”—some species may only persist there via immigration from uncontaminated areas. The Chernobyl zone is the microevolutionary “boiler,” where gene pools of living creatures are actively transforming, with unpredictable consequences.
12. What happened to voles and frogs in the Chernobyl zone shows what can happen to humans in coming generations: increasing mutation rates, increasing morbidity and mortality, reduced life expectancy, decreased intensity of reproduction, and changes in male/female sex ratios.
13. For better understanding of the processes of transformation of the wildlife in the Chernobyl-contaminated areas, radiobiological and other scientific studies should not be stopped, as has happened everywhere in Belarus, Ukraine, and Russia, but must be extended and intensified to understand and help to mitigate expected and unexpected consequences.

15.6. Social and Environmental Efforts to Minimize the Consequences of the Catastrophe

1. For hundreds of thousands of individuals (first of all, in Belarus, but also in vast territories of Ukraine, Russia, and in some areas of other countries) the additional Chernobyl irradiation still exceeds the considered “safe” level of 1 mSv/year.
2. Currently for people living in the contaminated regions of Belarus, Ukraine, and Russia, 90% of their irradiation dose is due to consumption of contaminated local food, so measures must be made available to rid their bodies of incorporated radionuclides (see Chapter IV.12–14).
3. Multiple measures have been undertaken to produce clean food and to rehabilitate the people of Belarus, Ukraine, and European Russia. These include application of additional amounts of select fertilizers, special programs to reduce levels of radionuclides in farm products and meat, organizing radionuclide-free food for schools and kindergartens, and special programs to rehabilitate children by periodically relocating them to uncontaminated places. Unfortunately these measures are not sufficient for those who depend upon food from their individual gardens, or local forests, and waters.
4. It is vitally necessary to develop measures to decrease the accumulation of Cs-137 in the bodies of inhabitants of the contaminated areas. These levels, which are based upon available data concerning the effect of incorporated radionuclides on health, are 30 to 50 Bq/kg for children and 70 to 75 Bq/kg for adults. In some Belarus villages in 2006 some children had levels up to 2,500 Bq/kg!
5. The experience of BELRAD Institute in Belarus has shown that active decorporation measures should be introduced when Cs-137 levels become higher than 25 to 28 Bq/kg. This corresponds to 0.1 mSv/year, the same level that according to UNSCEAR a person inevitably receives from external irradiation living in the contaminated territories.
6. Owing to individual and family food consumption and variable local availability of food, permanent radiation monitoring of local food products is needed along with measurement of individual radionuclide levels, especially in children. There must be general toughening of allowable local food radionuclide levels.
7. In order to decrease irradiation to a considered safe level (1 mSv/year) for those in contaminated areas of Belarus, Ukraine, and Russia it is good practice to:

  • ·         Apply mineral fertilizers not less than three times a year on all agricultural lands, including gardens, pastures, and hayfields.
  • ·         Add K and soluble lignin to forest ecosystems within a radius up to 10 km from settlements for effective reduction of Cs-137 in mushrooms, nuts, and berries, which are important local foods.
  • ·         Provide regular individual intake of natural pectin enterosorbents (derived from apples, currants, etc.) for 1 month at least four times a year and include juices with pectin daily for children in kindergartens and schools to promote excretion of radionuclides.
  • ·         Undertake preventive measures for milk, meat, fish, vegetables, and other local food products to reduce radionuclide levels.
  • ·         Use enterosorbents (ferrocyanides, etc.) when fattening meat animals.

8. To decrease the levels of illness and promote rehabilitation it is a good practice in the contaminated areas to provide:

  • ·         Annual individual determination of actual levels of incorporated radionuclides using a whole-body radiation counter (for children, this must be done quarterly).
  • ·         Reconstruction of all individual external irradiation levels from the initial period after the catastrophe using EPR-dosimetry and measurement of chromosomal aberrations, etc. This should include all victims, including those who left contaminated areas—liquidators, evacuees, and voluntary migrants and their children.
  • ·         Obligatory genetic consultations in the contaminated territories (and voluntary for all citizens of childbearing age) for the risks of severe congenital malformations in offspring. Using the characteristics and spectra of mutations in the blood or bone marrow of future parents, it is possible to define the risk of giving birth to a child with severe genetic malformations and thus avoid family tragedies.
  • ·         Prenatal diagnosis of severe congenital malformations and support for programs for medical abortions for families living in the contaminated territories of Belarus, Ukraine, and Russia.
  • ·         Regular oncological screening and preventive and anticipatory medical practices for the population of the contaminated territories.

9. The Chernobyl catastrophe clearly shows that it is impossible to provide protection from the radioactive fallout using only national resources. In the first 20 years the direct economic damage to Belarus, Ukraine, and Russia has exceeded 500 billion dollars. To mitigate some of the consequences, Belarus spends about 20% of its national annual budget, Ukraine up to 6%, and Russia up to 1%. Extensive international help will be needed to protect children for at least the next 25 to 30 years, especially those in Belarus because radionuclides remain in the root layers of the soil.

10. Failure to provide stable iodine in April 1986 for those in the contaminated territories led to substantial increases in the number of victims. Thyroid disease is one of the first consequences when a nuclear power plant fails, so a dependable system is needed to get this simple chemical to all of those in the path of nuclear fallout. It is clear that every country with nuclear power plants must help all countries stockpile potassium iodine in the event of another nuclear plant catastrophe.

11. The tragedy of Chernobyl shows that societies everywhere (and especially in Japan, France, India, China, the United States, and Germany) must consider the importance of independent radiation monitoring of both food and individual irradiation levels with the aim of ameliorating the danger and preventing additional harm.

12. Monitoring of incorporated radionuclides, especially in children, is necessary around every nuclear power plant. This monitoring must be independent of the nuclear industry and the data results must be made available to the public.

15.7. Organizations Associated with the Nuclear Industry Protect the Industry First—Not the Public

1. An important lesson from the Chernobyl experience is that experts and organizations tied to the nuclear industry have dismissed and ignored the consequences of the catastrophe.
2. Within only 8 or 9 years after the catastrophe a universal increase in cataracts was admitted by medical officials. The same occurred with thyroid cancer, leukemia, and organic central nervous system disorders. Foot-dragging in recognizing obvious problems and the resultant delays in preventing exposure and mitigating the effects lies at the door of nuclear power advocates more interested in preserving the status quo than in helping millions of innocent people who are suffering through no fault of their own. It need to change official agreement between WHO and IAEA (WHO, 1959) providing hiding from public of any information which can be unwanted of nuclear industry.

15.8. It Is Impossible to Forget Chernobyl

1. The growing data about of the negative consequences of the Chernobyl catastrophe for public health and nature does not bode well for optimism. Without special large-scale national and international programs, morbidity and mortality in the contaminated territories will increase. Morally it is inexplicable that the experts associated with the nuclear industry claim: “It is time to forget Chernobyl.”
2. Sound and effective international and national policy for mitigation and minimization of Chernobyl's consequences must be based on the principle: “It is necessary to learn and minimize the consequences of this terrible catastrophe.”

15.9. Conclusion

U.S. President John F. Kennedy speaking about the necessity to stop atmospheric nuclear tests said in June 1963:
“… The number of children and grandchildren with cancer in their bones, with leukemia in their blood, or with poison in their lungs might seem statistically small to some, in comparison with natural health hazards, but this is not a natural health hazard—and it is not a statistical issue. The loss of even one human life or the malformation of even one baby—who may be born long after we are gone—should be of concern to us all. Our children and grandchildren are not merely statistics toward which we can be indifferent.”
The Chernobyl catastrophe demonstrates that the nuclear industry's willingness to risk the health of humanity and our environment with nuclear power plants will result, not only theoretically, but practically, in the same level of hazard as nuclear weapons.

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