Introduction by Croakey: More than 130 health journals published a joint editorial recently calling for governments to support the re-establishment of a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war.
The authors warned that a worldwide nuclear arms race is underway: “Nine states jeopardise all humanity and the biosphere by claiming an exclusive right to wield the most destructive and inhumane weapons ever created,” they wrote.
“The world desperately needs the leaders of these states to freeze their arsenals, end the modernisation and development of new, more dangerous nuclear weapons, and ensure that new technology such as artificial intelligence can never trigger the launch of nuclear weapons.”
With the World Health Assembly underway until 27 May, it is timely to hear from one of the editorial’s co-authors, Dr Tilman Ruff AO, about the significance of a related resolution proposing a renewed WHO program of work on nuclear weapons and health.
Tilman Ruff writes:
While the news from this year’s World Health Assembly (WHA) is dominated by the landmark Pandemic Agreement, another matter of potentially even greater consequence will be discussed at the Assembly – the effects of nuclear war on public health.
Through dedicated and skilful diplomacy, sponsored by currently 16 states led by Pacific Island states Marshall Islands, Samoa and Vanuatu, the effects of nuclear weapons and war on public health are again on the WHA agenda. A resolution proposing a renewed WHO program of work on nuclear weapons and health is up for debate and decision late this week or early next.
As Nobel laureate Professor Peter Doherty wrote to me recently: “I don’t see a pandemic finishing us off, and climate change itself would (to quote Keating) ‘do us slowly’. The one sure path to extinction is nuclear war.”
The WHO Constitution requires WHO “to act as the directing and coordinating authority on international health work”. It is a striking and anomalous omission the WHO has not for over three decades addressed the health dimensions of the most acute existential threat to humankind and the Earth systems on which we depend.
This is particularly the case as the danger of nuclear war has never been more urgent, reflected in the Doomsday Clock this year being set at 89 seconds to midnight, further forward than it has ever been since its founding in 1947.
New more dangerous nuclear weapons and threats to use them have proliferated, disarmament is going backwards and treaties constraining nuclear weapons have been abrogated.
Nuclear-armed Russia and Israel are involved in active wars, and just last week India and Pakistan were embroiled in escalating tit-for-tat cross-border attacks, including on military facilities away from their border, during which the body in Pakistan which controls that nation’s nuclear arsenal was activated.
Some history
The World Health Organization (WHO) is the only United Nations (UN) specialised agency to be so inclusively and accountably governed.
Its highest decision-making body is the World Health Assembly, meeting in May each year in Geneva, which until the US completes its planned withdrawal under the Trump regime, includes senior representatives from the ministries of health of 194 nations, one more than the formal membership of the UN of 193.
In 1981, as the Cold War was reaching its icy depths, the WHA adopted Resolution WHA 34.38, on “The role of physicians and other health workers in the preservation and promotion of peace as the most significant factor for the attainment of health for all”.
It requested the WHO Director-General to study how WHO could contribute to preventing nuclear war, disarmament and peace, and to establish a broad and “authoritative international committee of scientists and experts to comprehensively report on the threat of thermonuclear war and its potentially baneful consequences for the life and health of peoples of the world”.
The committee’s landmark 1984 report Effects of nuclear war on health and health services concluded that: “It is obvious that no health service in any area of the world would be capable of dealing adequately with the hundreds of thousands of people seriously injured by blast, heat or radiation from even a single 1-megaton bomb.”
The 1983 WHA endorsed the committee’s conclusion “that it is impossible to prepare health services to deal in any systematic way with a catastrophe resulting from nuclear warfare, and that nuclear weapons constitute the greatest immediate threat to the health and welfare of [hu]mankind.”
A second edition of this report, with new data on radiation effects, firestorms and nuclear winter and famine, was issued in 1987. It concluded: “After a major nuclear war famine and diseases would be widespread and social, communication and economic systems around the world would be disrupted”.
It reiterated that “It is obvious that the health services in the world could not alleviate the situation in any significant way. Therefore the only approach to the treatment of health effects of nuclear warfare is primary prevention, that is, the prevention of nuclear war.”
These reports were important in authoritatively documenting the direct and indirect, short and longer term health and environmental consequences of plausible scenarios of nuclear war.
They made a vital contribution to educating the world’s health community, public and decision-makers about the catastrophic consequences of any use of nuclear weapons, the impossibility of any effective medical response, and the imperative for primary prevention of nuclear war. They provided an important stimulus to progress in nuclear disarmament and the end of the Cold War.
After the second report, the WHA asked the Director-General to continue collaborative work on nuclear weapons and health and to report periodically to the Assembly on relevant developments.
In 1993, the WHA responded to an initiative of International Physicians for the Prevention of Nuclear War (IPPNW) and requested an Advisory Opinion from the International Court of Justice, the world’s highest legal authority, on the question: In view of the health and environmental effects, would the use of nuclear weapons by a state in war or other armed conflict be a breach of its obligations under international law including under the WHO Constitution?
While the Court in the end judged that technically it could not give the advice requested by WHO, it did deliver its Advisory Opinion in 1996 on a broader question posed by the UN General Assembly (UNGA) in 1994 which subsumed the WHO request: Is the threat or use of nuclear weapons permitted in any circumstances under international law?
The WHO request laid the foundation for the broader UN request, and the Court relied on evidence from WHO on the health and environmental effects of nuclear weapons.
The Court’s landmark 1996 Advisory Opinion found: “…that the threat or use of nuclear weapons would generally be contrary to the rules of international law applicable in armed conflict, and in particular the principles and rules of humanitarian law” and a unanimous ruling by the judges that for all states: “There exists an obligation to pursue in good faith and bring to a conclusion negotiations leading to nuclear disarmament in all its aspects under strict and effective international control.”
Since then, WHO has neglected this issue, and in 2020 its mandate on nuclear weapons and health was retired as part of internal house-keeping. WHO’s previous reports are now between 30 and 40 years old and badly need updating.
Global action
In a parallel initiative led by Ireland and New Zealand, in late 2024, the UNGA voted overwhelmingly to establish a 21-member independent scientific panel to undertake a new UN comprehensive study on the effects of nuclear war, with its final report due in 2027.
Noting that “removing the threat of a nuclear war is the most acute and urgent task of the present day”, the panel has been tasked with examining the physical effects and societal consequences of a nuclear war on a local, regional and planetary scale. It will examine the climatic, environmental and radiological effects of nuclear war, and their impact on public health, global socioeconomic systems, agriculture and ecosystems.
The resolution, supported by 144 states including Australia, calls upon UN agencies, including WHO, to support the panel’s work, including by “contributing expertise, commissioned studies, data and papers”. All UN Member States are encouraged to provide relevant information, scientific data and analyses; facilitate and host panel meetings, including regional meetings; and make budgetary or in-kind contributions.
Such a broad authoritative international assessment of the most acute existential threat to humankind and planetary health is also long overdue. The last such report dates from 1989 (chaired by Australian Prof Henry Nix). It is shameful that France, UK and Russia opposed this resolution.
Every government should support the current WHA resolution to re-establish a WHO mandate on nuclear weapons and health. Regrettably, nation state politics is at play in the WHA as elsewhere, and after WHO Executive Board discussion, eight informal consultation meetings, many scores of bilateral meetings and numerous revisions, Pakistan, Russia and UK have reserved their position on the current resolution, and North Korea has opposed it.
The four-year program of work planned by WHO to deliver on a new mandate will both input into the UN study, and be wider in addressing the harms of nuclear weapons development, production, testing and disposal.
With WHO’s current budget crisis, it will be important for states to not only support a new mandate, but step up to ensure WHO has the modest resources needed to implement it.
A rare joint editorial in over 130 health journals strongly supports the call for all governments to contribute substantively to both WHO’s work and the new UN study on nuclear war.
Current evidence is the crucial base for good policy and action. Prevention is always the best cure. In regard to nuclear war, it is the only option, and time is not on our side to end nuclear weapons before they end us.
• Dr Tilman Ruff AO is a board member and past co-president of International Physicians for the Prevention of Nuclear War, International Councillor for the Medical Association for Prevention of War, founding chair of the International Campaign to Abolish Nuclear Weapons, and Hon Principal Fellow in the School of Population and Global Health, University of Melbourne.
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