As we’ve seen recently, President Trump seems quite comfortable responding to world problems with military force. So far this has not involved using nuclear weapons. But President Trump has a history with these weapons. A few weeks before his inauguration, he called for a renewed arms race, tweeting that the United States should “greatly strengthen and expand its nuclear capability.” He told one journalist that he would welcome an arms race, and has said that he wants to be “unpredictable” with these weapons. These statements come after more than three decades of bipartisan efforts to decrease the threat from nuclear weapons.
Not surprisingly, a week into the new administration, the Bulletin of Atomic Scientists moved its Doomsday Clock half a minute closer toward catastrophe – the closest the clock has been to “midnight” since 1953. And of course, at the moment, our country is engaged in a risky game of brinksmanship with North Korea.
Before the U.S. begins expanding its nuclear arsenal, setting off an arms race and heightening tensions with other nuclear-capable countries, we should be very clear about the medical consequences of nuclear war. It’s been more than two decades since the end of the Cold War, and many people may not know what such a conflagration would look like. As a physician and a scientist who grew up during that era, I remember.
Let’s start with the weapons. The power of nuclear warheads is measured in kilotons; each kiloton is equal to the explosive power of 1,000 tons of TNT. The 12.5 kiloton bomb that exploded over Hiroshima killed approximately 100,000 people, and completely destroyed the city. The U.S. has 450 Minuteman land-based intercontinental ballistic missiles (ICBMs); each one carries either a 300 or 335-kiloton nuclear warhead, more than 25 times more powerful than the Hiroshima bomb. The Russians have at least 300 ICBMs, which can carry 1,040 nuclear warheads ranging from 100 to 800 kilotons apiece. In addition, the U.S. and Russia each have well over a thousand additional nuclear warheads that can be delivered by submarines and long range bombers. Many other countries have nuclear weapons, including France, Great Britain, China, Pakistan, India, Israel, and the especially dangerous North Korea.
When a nuclear bomb explodes, it unleashes a cascade of five massively destructive effects: an initial blast wave, an electromagnetic pulse, a thermal wave, a radiation burst, and radioactive fallout. The blast wave creates an enormous wind that travels at supersonic speeds outward in all directions from ground zero, destroying all people, animals and buildings for miles. Those who aren’t killed by the initial blast will be in mortal danger from flying debris. The electromagnetic pulse can damage electronic devices over an enormous area, possibly hundreds of miles; this may disrupt all electrical power and all forms of modern communication. The explosion also causes a thermal wave that has a temperature of 10 million degrees Centigrade or higher; this completely incinerates anything close to ground zero, causes severe burns to anyone within several miles, and has the potential to trigger enormous fires. The intense light from this thermal blast causes retinal burns in anyone looking directly at it, even those who are miles away.
Finally, fallout, radioactive dust and particles from the explosion, floats downwind of ground zero; wherever the wind takes the fallout, people suffer damaged immune systems and an increased cancer risk. If there are multiple bombs, with multiple fallouts, the food supply around the world could be contaminated. In areas further from the blast, contamination of the water supply and disruption of sanitation systems would raise the risk of infectious disease outbreaks.
What could the health care system do after a nuclear explosion? Very little. In the immediate area, hospitals would be destroyed, and doctors and other health care workers would be dead. There would be little or no remaining equipment, supplies, or medicine, even morphine for the victims suffering unspeakable pain. Movement of casualties would be extremely difficult.
There is an even darker scenario, one that makes questions about medical care superfluous. If as few as 100 bombs were to explode over densely-populated cities, soot from the resulting fires would enter the upper atmosphere and lead to global cooling for a decade or more—resulting in a nuclear winter. If the United States and Russia use their several thousand weapons, the planet will cool dramatically, likely leading to a mass extinction and the end of civilization and life as we know it.
All of this information is well-known and scientifically validated. It is not controversial. The severity of effects differs depending on the particular scenario, but the undeniable fact is that nuclear war poses a grave and present danger to our planet.
In the United States, the president has sole authority to order a nuclear strike. Within a few minutes of that order, missiles could be launched. This policy must be changed. Sen. Edward Markey of Massachusetts and Rep. Ted Lieu of California have introduced a bill that would prohibit the president from launching a first strike without a prior declaration of war by Congress. The Constitution gives Congress alone the power to declare war; a nuclear first strike is undoubtedly an act of war. This change in our nuclear policy is long overdue, and makes sense no matter who is in the White House. It is especially urgent now, though, given the current president’s apparent attitude toward the issue. This change would represent a small but crucial first step toward the ultimate elimination of these weapons from the world.
So, before the U.S. begins ramping up its nuclear arsenal, or threatens to use these weapons preemptively, thus encouraging other countries to do the same, we need to think very carefully, lest we find ourselves plunging over a nuclear cliff. The future of our country and our planet hangs in the balance.
Peter Gorman, MD MS is an associate professor of neurology at the University of Maryland School of Medicine.