During the Cold War, the United States and the former Soviet Union amassed nuclear weapon stockpiles with a collective destructive power hundreds of thousands of times that of the two bombs that obliterated the Japanese cities of Hiroshima and Nagasaki in August 1945. After peaking at more than 70,000 in 1986, the absolute number of weapons gradually declined from the implementation of various arms control treaties to 12,331 today. However, as stated plainly in a recent editorial published in more than 120 medical journals worldwide, “This does not mean humanity is any safer.” The authors urged readers to make the elimination of nuclear weapons an urgent public health priority, reiterating a 2023 editorial on similar themes:
Any use of nuclear weapons would be catastrophic for humanity. Even a “limited” nuclear war involving only 250 of the 13,000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk. A large-scale nuclear war between the US and Russia could kill 200 million people or more in the near term, and potentially cause a global “nuclear winter” that could kill 5 to 6 billion people, threatening the survival of humanity.
The last of the nuclear arms accords, the New START treaty between the United States and the Russian Federation, is set to expire in 2026. Both countries are spending enormous amounts to modernize their existing arsenals. A 2024 editorial in Science, noting rising tensions between the United States and Russia, China, and North Korea, observed that “the risk of nuclear war has not been so high since the Cuban Missile Crisis.” The historical events depicted in the Academy Award–winning film Oppenheimer are no longer just history; at New Mexico’s Los Alamos National Laboratory, for the first time in decades, the United States has resumed building plutonium cores. Despite safety precautions, factory workers and bystanders will be at high risk of radiation exposure and subsequent cancer, lung, and kidney problems.
The world is woefully unprepared for the health consequences of the use of a single nuclear device, much less a nuclear war. In 2024, the New York City Department of Health held a series of workshops on hospital emergency responses to an improvised nuclear detonation by a nonstate terrorist actor. Health professionals who survive a nuclear explosion (90% of those in Hiroshima were killed instantly) would likely face a catastrophic loss of communications, impassable transportation routes, and “risk their lives amid destroyed infrastructure, dangerous radioactivity, and limited healthcare facilities and supplies.”
At last month’s World Health Assembly, the World Health Organization (WHO) overwhelmingly passed a resolution to update Cold War era reports on the health and environmental effects of nuclear weapons and war by 2029. (The United States was absent, having withdrawn from the WHO in January.) Doctors have been at the forefront of campaigns against nuclear weapons since 1961, when Physicians for Social Responsibility was founded. The organization, which later expanded its list of “gravest threats to health and survival” to include excessive military spending, fossil fuels, and climate change, provides education on the health effects of nuclear testing and reality checks on government messages (eg, duck and cover) that suggest that nuclear war could be survivable. A current exhibit at Harvard University’s Countway Library highlights the social activism of former medical school and public health faculty.
