Today's date:
Spring 2001

Nuclear Weapons Remain The Greatest Threat

Mary-Wynne Ashford, M.D. (Canada), Abraham Behar, M.D. (France) and Sergei Gratchev, M.D. (Russia) are the co-presidents of International Physicians for the Prevention of Nuclear War. The organization was the Nobel Peace Prize Laureate for 1985.

Moscow - During some of the Cold War's darkest days, two cardiologists, one from the Soviet Union and the other from the United States, dreamed that physicians could be organized into an effective international force to oppose nuclear weapons.
In addition to a shared interest in sudden cardiac death, Bernard Lown of Boston and Evgeni Chazov of Moscow shared a powerful vision of a world liberated from the nuclear threat. They believed that physicians, regardless of political ideology, could be mobilized by their common commitment to protect life and to promote health to see nuclear weapons not as a political/military issue, but as a public health threat unparalleled in human history. And they succeeded beyond all expectations.

Within five years, Lown and Chazov had built International Physicians for the Prevention of Nuclear War (IPPNW), an organization comprising 200,000 doctors and health-care workers in dozens of countries. Their message-built on painstaking research-was one of ''primary prevention'': the health and environmental conse
quences of nuclear war would be so catastrophic that prevention was the only cure.
Tens of millions, perhaps hundreds of millions, would be killed and injured. Massive outbreaks of disease would follow. Food supplies and water would be contaminated and the systems to deliver them destroyed. All essential services, including health services, would be rendered useless. They exposed the hoax of civil defense, and laid bare the folly that large-scale nuclear war was ''survivable'' or ''winnable'' in any meaningful sense. Medical reality, reasoned Lown and Chazov, had to become a part of political reality.

Today, 10 years after the end of the Cold War, a new generation must learn these same lessons. For despite abundant evidence to the contrary, there is a widespread public perception that the threat of nuclear war is a relic of the 20th century. Yet the nuclear powers remain poised and ready, just as they were during the Cold War, to wage nuclear war using war-fighting doctrines that remain fundamentally unchanged.
Moreover, few political leaders are courageous enough to challenge the fundamental, yet deeply flawed, orthodoxy of the nuclear age-that nuclear weapons make us safer and ensure national security when, in fact, they make us all profoundly vulnerable.
Why has reducing the threat of nuclear war slipped so far down the political agenda? Why is the public so blase? India and Pakistan, in a nearly constant state of war for decades, now have nuclear weapons. The Middle East peace process has collapsed and violence is again the order of the day. Israel has nuclear weapons and other states in the region covet them.

The US and Russian arsenals still total more than 30,000 nuclear weapons, with thousands of those on hair-trigger alert, ready to be launched on a moment's notice. Russia, which once maintained a pledge not to be the first to use nuclear weapons, has withdrawn that pledge, even as control over its nuclear arsenal has become a matter of global concern.

The US Senate has rejected the comprehensive test ban treaty and possible US deployment of a national missile defense system threatens to undo decades of efforts to control nuclear weapons.

Despite their promise, enshrined in the Nuclear Non-Proliferation Treaty three decades ago and reiterated just last May, the nuclear weapons states have not, despite some reductions, moved meaningfully toward the elimination of their nuclear arsenals-a promise made in exchange for a commitment from the non-nuclear states not to acquire nuclear arms. So, one may ask, if the nuclear powers are to lead by example, what kind of example are they setting for the rest of the world?
Even if we are lucky, and nuclear weapons are never used in war, by accident, miscalculation or in a terrorist attack on one of the world's cities, the legacy of radioactive and toxic contamination from the testing, production and maintenance of nuclear arsenals over the last half-century presents intractable, costly, long-term problems.

Workers exposed to radiation and chemical hazards as they toiled in nuclear weapons plants, and those living downwind of such sites, continue to pay a high price in death and disease. Some nuclear weapons production sites, such as the Hanford Reservation in Washington state and Chelyabinsk in Russia, still pose potentially catastrophic health and environmental risks.

Cleaning up contaminated soil and water, and quarantining sites that cannot be cleaned will cost untold billions of dollars over hundreds-and perhaps thousands-of years. Holding on to existing nuclear arsenals and the proliferation of new ones only compound these enormous health, safety and environmental problems.

Simply stated, the abolition of nuclear weapons, and redressing the toxic legacy of the nuclear age, are moral, medical and environmental imperatives. The good news is that the opportunity to eliminate nuclear weapons is greater than ever.

Dismissed in past decades, even by arms-control advocates, as utopian and unachievable, abolition is widely supported today, not just by citizens groups, but by world leaders, by national governments and by many who were once ardent practitioners of nuclear statecraft, among them former leaders of the US defense establishment and more than 60 former military commanders from around the world.
The World Court ruled in 1996 that nuclear weapons use, or threatened use, is generally contrary to fundamental principles of international and humanitarian law, and that nuclear weapon states have an obligation to negotiate the elimination of nuclear weapons. The 187 countries that are party to the Nuclear Non-Proliferation Treaty, the US and Russia included, recently af~rmed an obligation to make elimination of nuclear weapons an ''unequivocal undertaking.''

In short, what was once a vision shared by only a few has garnered widespread support. The critical question, of course, is how do we get there from here?
The answer will ultimately be an international agreement-a convention or treaty-that establishes a new norm. IPPNW, with two prominent legal and scientific organizations, has prepared a Model Nuclear Weapons Convention, now under consideration at the United Nations, that provides a vision of what complete nuclear disarmament might look like in concrete detail. Some of the intermediate steps needed to get there are now clear:

1 The US must abandon plans to deploy a national missile defense system. Deployment of such a system would require abrogation of the Anti-Ballistic Missile Treaty and could well spawn a new nuclear arms race. The system is deeply flawed technically and may cost well in excess of $100 billion. The risks of deploying such a system far outweigh the dangers it is supposed to protect against. Indeed, national missile defense has itself become a potential threat to global security.
2 Countries that have not yet done so-the US in particular-must ratify the comprehensive test ban treaty (CTBT) so that it will enter into force. The US Senate's 1999 defeat of the CTBT, an agreement that has been sought for nearly 40 years and is essential to nuclear non-proliferation efforts, was a major step backward. Without US ratification, the CTBT is dead.

3 The US and Russia must take thousands of nuclear weapons off hair-trigger alert. What possible rationale can there be for maintaining a Cold War posture that greatly increases the chances that nuclear weapons will be fired by accident or miscalculation?

4 Both countries must make further deep reductions in their nuclear arsenals on the way to zero. Since a single nuclear warhead is capable of slaughtering a million people, today's nuclear arsenals are excessive by any measure, and even Russia's proposal of 1,500 warheads per side can be seen only as a welcome first step.
John Kenneth Galbraith, the great economist and former advisor to President John F. Kennedy, has called nuclear disarmament the great unfinished business of the 20th century. It is our obligation, as physicians and concerned citizens, to finish the business of nuclear disarmament. The medical reality of nuclear war must inform the political reality of the 21st century. It will be up to an aroused and impassioned citizenry to demand the abolition of nuclear weapons, for unless nuclear weapons are abolished, their use, someday, is a virtual certainty.

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