JC_ChirgwinJuan Carlos Chirgwin is a family doctor working at CLSC Park Extension health facility in Montreal, Canada


Now that “Canada is back” and “sunny ways” are on the horizon, as Prime Minister Trudeau has said, we in the medical community should also look to the light. True, we made progressive strides in the last half century, producing today’s medical body, which is more ethnically and gender diverse. Medicine has opened up new fields and models of thinking, notably in global health and social determinants of health. Physicians have been spokespersons for worthy causes for decades, but is our medical community paying sufficient attention to the nuclear risk?

An article by Dr. Helfand and Dr. Sidel, “Docs and Nukes—Still a Live Issue” appeared in the NEJM last October. It is a call to doctors worldwide to become aware of the nuclear threat and to join an international campaign to eliminate nuclear weapons. If you have heard enough about global warming, you are probably not aware of its equally evil twin, nuclear war. This threat pushed doctors in the US, the Soviet Union, Western Europe and Canada to form International Physicians for the Prevention of Nuclear War (IPPNW), winner of the 1985 Nobel Peace Prize. Many countries formed affiliates of IPPNW, and Canada has Physicians for Global Survival.

That was during the Cold War, but you would be mistaken if you thought the nuclear threat ended with the fall of the Berlin Wall in 1990. Although the absolute number of nuclear warheads dropped from over 60 thousand to current estimates of 15 thousand, these are true weapons of mass destruction. Their blast and thermal effects kill millions of victims at a time, while the still horrific death toll of Hiroshima and Nagasaki was in the thousands given that those bombs were weaker fission weapons. Modern fusion nuclear weapons are more devastating and are aimed at cities. They reach their targets within 30 minutes and 2000 such warheads remain on high alert, meaning that government leaders would only have 15 minutes to decide whether to fire their nuclear arsenal in what would become a global suicide with hardly any life form spared destruction. Dr. Helfand has described in numerous international forums how even a limited nuclear weapon exchange between India and Pakistan could cause a 1.25 degree Celsius drop in global temperatures, crop failures, famine and a mass exodus of survivors fleeing starvation.

What can we do? As doctors we could begin recognizing and acknowledging the danger, as has been done by the American Medical Association and the World Medical Association. Would our Canadian Medical Association agree with their conclusions? How about our Royal College of Physicians and Surgeons of Canada or our College of Family Physicians of Canada? We would be stating the obvious: there is no possible medical response in a nuclear weapon attack on any city in the world. Most hospitals would be destroyed along with their physicians and teams. Smaller hospitals spared from the firestorms would need access to a blood supply in quantities we cannot maintain even today in non-war conditions. There are not enough burn units in North America to care for survivors of nuclear strikes. Working with irradiated patients who were improperly decontaminated would render any field hospital impossible to manage, while first responders could not drive through the rubble of downed skyscrapers. This is the ultimate public health threat, in which we doctors are rendered utterly useless.

But despair not. The International Campaign to Abolish Nuclear Weapons needs our involvement in highlighting the medical consequences of nuclear war. Why now? After all, it is 2016! What better time than now.