The Effects of Nuclear Weapons

Medical Implications of Nuclear War

H. Jack Geiger, M.D., 1984

H. Jack Geiger, M.D. is Arthur C. Logan Professor of Community Medicine and director of the Program in Health, Medicine, and Society of the City College of New York. Most of Dr. Geiger's professional career has been focused on problems of health and poverty. He was a founding member of Physicians for Social Responsibility. In 1982, the Public Health Association of New York gave him its Award of Merit in Global Public Health for tireless efforts toward the prevention of nuclear war.

Whiteley: What are the medical effects of nuclear weapons?

Geiger: Well everybody thinks first, when they think of nuclear weapons, of radiation. But radiation is only one of the major effects. The two others, the ones of most concern to people anywhere near where a nuclear weapon explodes are blast and heat. We usually describe them {nuclear weapons} in terms of one-megaton, simply because that's the standard unit of currency. What is the effect of a one-megaton weapon. These days weapons are getting smaller, a third of a megaton, a fifth of a megaton, half-a-megaton, and so on. But there are getting to be many more of them, and one of the great difficulties is that you get about a three-to-one advantage when you go to multiple smaller warheads. In other words, you can explode a one-megaton weapon and get a certain amount of damage. If you explode three warheads the total only has to be about a third as big to do the same amount of damage. In other words, I can do one megaton's worth of damage with just 300 kilotons (a third of a megaton) in three separate bombs.

Whiteley: Why is that?

Geiger: The reason is that larger weapons are so wasteful - if that's the word for it - so wasteful of energy. Down near ground zero, where they are just making the rubble bounce, you spread it out and put those circles of destruction next to each other, you get much more death and destruction per megaton, and that's the way, of course, all the weaponry is going. So there's a false reassurance that people are often given that things must be getting better because the megatonnage is going down in our arsenal and everybody else's arsenal, and narrowly, technically that's true, but the destructive power is not going down. And the capacity to kill and injure and destroy the environment is not going down. If anything it's going up, and it's easier to deliver because the warheads are smaller, we now have multiple warheads on a single missile.

It's hard to describe how powerful the forces are that we are talking about. The blast is like a gigantic crushing force. The figures tend not to mean much to anybody but physicists: 5 lbs. per square inch, 10 lbs. per square inch of pressure. They are pressures sufficient, for example near ground, within two or three miles of ground zero in a one-megaton weapon to take a skyscraper and pancake all the floors down, one on top of the other, blow all the floors out sideways, leave nothing but the steel skeleton standing intact, if that, and pick up people of course, and blow them with enormous velocities substantial distances. Or pick up pieces of concrete, steel, debris, objects the size of a locomotive, and hurl them at people. So a nuclear bomb, first of all, does the same things to human beings that conventional weapons do. It crushes them, it fractures their skulls, it breaks their bones, it hurls missiles and pieces of steel and concrete into their chests and into their abdomens, it crushes their organs, it causes profound hemorrhage and shock - all of the things that ordinary weapons do. Except that it does those things over a much bigger area to a much greater number of people. And its effect on the environment is so great, this ability to take the strongest concrete reinforced steel skyscraper and crush it, thereby killing all of the people inside. Or collapsing the building onto people who are outside, that the effect of blast alone is much greater than with conventional weapons.

The second thing that a nuclear weapon does is to destroy people and the environment with heat. Perhaps the single most destructive effect of a nuclear weapon is what is called, in an airburst at any rate, the thermal pulse. When you explode a nuclear weapon you have created a small sun on the surface of the earth, rather than as far away as the sun is. You have temperatures at Hiroshima (and that was a tiny weapon, a firecracker) starting out at ground zero at 3000 degrees centigrade. This is a wave of heat that will set the environment and everything in it spontaneously on fire on a clear day, as far away as six miles from ground zero. Closer in than that, people simply burn, their clothing catches fire. Further out than that, trees, the grass outside will burn.

If there were drapes here and we were four or five miles from a nuclear explosion, the drapes would burn, this wooden wall would catch fire, the carpeting would burn inside and outside. So that one of the consequences of any nuclear explosion over a city is that you will have hundreds of thousands of people with second and third degree burns over thirty percent of their body surface or more. And then thousands, or tens of thousands, more burns from people trapped in the wreckage from all of the buildings and environments that are on fire. We need to remember that in all of the United States there are perhaps 2000 hospital beds specially equipped for treating burn patients, and in one medium-sized city we would have 30 or 40 thousand people with those kinds of burns. So trauma from blasts, and burns, all of that before we even begin to talk about radiation. What radiation does, and it's unique to nuclear weapons as compared to other weapons, is first of all travels long distances, so that people in very huge areas downwind from a nuclear explosion, or from multiple nuclear explosions of the kind that will be directed at missile fields, air bases, military installations, power plants, nuclear power plants, defense industries and the like - people in huge areas downwind from them will be affected - will be endangered at least by radioactive fallout. Various kinds of radiation carried in the dust particles that are thrown up, particularly by a ground burst in a nuclear explosion, drifting or blown downwind, fanning out in really very unpredictable ways depending on which way the wind is blowing and how strong, and a whole variety of other local conditions. And that radiation, some of it in the form of what we think of as x-rays, others as fast neutrons, others in other forms, is profoundly damaging to all biological organisms.

Whiteley: What is it about the radiation that's blown on the wind that's so damaging to people?

Geiger: Any kind of radiation is damaging. Let me hasten to add that nobody should be afraid of having a chest x-ray or getting needed medical diagnostic or therapeutic radiation because of this. That has a purpose and it's controlled and it's focused, and it's contained and so on. But radiation is like a set of invisible bullets fired into the insides of ourselves; any form of radiation, particularly the gamma rays and the neutrons that will be in this fallout. And they destroy selectively the fastest growing tissues in the body, so that radiation goes after the bone marrow, where all our blood cells are being made. It goes after the lining of the digestive tract which has cells that turn over very rapidly, and what's of concern to people is that at not very enormous doses in terms of what would be produced by a major nuclear exchange, people will start to die. First of acute radiation illness, bleeding from everywhere because the blood clotting mechanisms are destroyed, having bloody vomiting and bloody diarrhea, becoming totally vulnerable to infection. Many people will die of secondary infection because all of their white cells and other defenses are gone. And this is in garden variety radiation sickness rather than very acute and overwhelming forms that destroy the central nervous system in higher doses and can cause death very rapidly.

This will occur over very wide areas, and that's why one hears talk about the need for sheltering against radiation, and why there was talk in the 1960s of everybody having a little fallout shelter in their frontyard or their backyard. Why you can still walk around public buildings and see a faded sign that says "fallout shelter." And people were given the illusion that those mechanisms would protect them in the event of a nuclear war.

Whiteley: And your understanding is that the simple power of those weapons is such that anywhere near an area where one is used, those shelters are simply inadequate.

Geiger: Well, what you have to do is recall the late 50s and early 60s for the first stage of all of this. That was a time when President Eisenhower, for a while, until he learned better, Commissioner Lilienthal of the Atomic Energy Commission and a variety of others were saying if we all just bought a little fallout shelter and put it in our frontyard or our backyard, we wouldn't have to worry about nuclear weapons. Nelson Rockefeller, then the governor of New York, spent a whole afternoon in a mock fallout shelter in the window of Macy's to show people how much fun it would be to be in a fallout shelter. Edward Teller said a little radiation was probably good for you - it stirred up the genes - biological nonsense of that period. And thousands of people, in fact, ran out and at considerable expense bought these things. One of them who bought one or built one was Commissioner Lilienthal of the Atomic Energy Commission. The first thing that happened, there was a small brush fire nearby and his fallout shelter burned down, which is what would have happened to tens of thousands of them as a consequence of the fires that would have been set by any real nuclear explosions.

The things that were wrong with this fallout shelter idea, particularly for urban areas, is it didn't have anything to do with blast or heat. Yes, it is possible to shield against fallout. It is not possible to protect against overwhelming pressures of the kind that will crush a skyscraper, or overwhelming heat of the kind that will melt steel and concrete, vaporize glass, unless one has very expensive, very complicated facilities far underground with all kinds of special steel supporting and frameworks, and all kinds of thermal insulation, and an independent oxygen supply, and a way of ventilating waste gasses in the atmosphere, and the ability to stay down there for 30 or 60 days.

Now there are some of these kinds of shelters inside of mountains, near Washington, for the President and selected high other officials of our government, and I presume other governments have done the same thing. And the National Air Defense Center under the mountain in Wyoming or Colorado is built something like that, but there is no way to do that for 230 million of us - all of the rest of us - and fallout shelters are simply no use if you are anywhere near a target, because you'll be killed by blast and heat.

Whiteley: You've divided the civil preparedness planning into four phases in your analysis. What is the evacuation phase intended to do, and what are the problems with it?

Geiger: Well, first it might make things clearer to explain what this so-called "Crisis Relocation Plan" is. Once it became apparent in part because of the work of a group of young physicians in the early 1960s to make clear to the public what the effects of blast and heat and radioactive fallout were: What a real thermonuclear attack on the United States, or any other contemporary nation, would be; how much death and destruction and devastation there would be; the fact (among other things) that most of the physicians and other health workers would be killed, and most of the hospitals would be destroyed. And among all of the millions of wounded there would be no effective way to give care. After our relative effectiveness in that, and in demonstrating that the above-ground testing that was going on out in Nevada was in fact depositing iodine, radioactive iodine and radioactive strontium in the bodies of infants in children in St. Louis and other parts downwind, we got the Partial Test Ban Treaty accomplished - this is 1963 - and the group of young physicians was an organization called Physicians for Social Responsibility (PSR), and we thought we had really done something; in a way I think we had. And we all got into other kinds of efforts and ventures, and PSR didn't do very much for the next 15 years or so.

Unfortunately nobody stopped building missiles, and nobody stopped building bombs, and nobody stopped improving the ways to deliver their varieties or their effectiveness. And by the late 1970s we realized once again, suddenly, that we had an overwhelming problem; we, Physicians for Social Responsibility started again. One of the things that we are focused on is the new fake game of survivability of nuclear war. The false promise that one can survive in any sense of that word that has meaning. And what the government has been saying for some years now is 'okay, we concede that fallout shelters alone aren't good enough, and if you're in the cities blast and heat will get you, and if you're in target areas, blast and heat will get you.' But we have another plan. Let's assume, they say, a big attack on the United States about 6000 megatons, 450 targets, all of the major missile fields, air bases, SAC bomber bases, and other pertinent military installations, plus most of the defense industry. That turns out to be all of the major population centers in the United States, to be every city in the United States over 50,000 people, and probably to be every community in the United States of more than 25,000 people.

We hear a lot about gaps, parenthetically. The only real gap that I'm sure of is that there's a terrible shortage of targets in relation to the number of nuclear weapons that the major powers have. It's hard to find - there are so many now - it's hard to find anything useful to aim them at, the redundancy is so great. So we're all the way down to places of 25,000. Let's assume this kind of attack. The government likes to say that's only 3% of the land area of the United States, but if you push them they admit well, yes that's true; it's about 160 or 170 million people that live in that 3%. Okay, they say. What we're going to do is we're going to move in the event of a nuclear crisis, if it looks likes it's going to be a nuclear war, we will move 145 million people from those target areas, a mean distance of 150 or 200 miles by car, bus, boat, plane, motorcycle, bicycle, any way you can think of. We'll move 145 million people, 150 or 200 miles each to so-called 'safe' rural areas. There they will be away from blast and heat because there are no weapons (they think) aimed at those areas. And everybody will go into fallout shelters because there is danger of fallout no matter where you are. And they will stay there protected from fallout and away from blast and heat until after the war is over. And that way, the government furthermore promises, or seems to promise, up to 80% of the American population can survive even a major war of this kind.

Whiteley: What are the major problems in your analysis of the evacuation phase of this plan?

Geiger: First of all, this assumes that there will be a minimum of three to five days of warning, that somehow the President or somebody in the government will know (in the middle of a crisis) that things are really getting so bad that people ought to be moved, and that knowledge will come to him or her at least 72 hours, maybe five days before the war actually begins. That's a whole uncertain assumption at best. How will anybody know? How will there be three to five days? Well, the government says, if they start to evacuate, we'll start to evacuate, and each side can see the other by satellite. Of course, if one side starts to evacuate in the middle of the crisis it's a little unlikely that the other side will call up and say hey, we just saw you doing that. What are you doing that for? Are you planning to bomb us tonight? Maybe we better bomb you this afternoon. In short, the protective measure becomes the trigger for just what you're trying to avoid. That's the first assumption of 72 to 96 hours or more of warning time.

The second assumption of course is that you're guessing right about what the target areas and what the safe areas are going to be. The third assumption is that it will be physically and logistically possible to move this number of people in that time. It's a journey of 15 billion person miles in three days. There has never been anything like it in the recorded history of the human species. I know what the plan was for New York, and the absurd assumptions on which it was based. New York City, for example, the plan was that people would be moved out by plane, because the government was going to commandeer every 747 in the United States and half of the DC10s and the other wide body planes, and they were all somehow going to fly in and out of Kennedy and LaGuardia and Newark airports repeatedly over three days. People would go up the Hudson River on freighters which were assumed to be filling the New York City docks empty. Busses were going to carry people. The way they were going to handle the traffic jam, and I'll come to the cars in a second, is that every road out of New York City would be made one-way. The difficulty is they had the busses scheduled for three round-trips each, and they never quite figured out if all the roads were one-way, how the busses were going to come back, let alone would anybody agree to drive them back. And then two million automobiles, all of which were assumed to be in perfect repair, not going to break down, and with full tanks of gas at the start of the crisis. Well, anybody that's tried to get in or out of any major city in a rush hour on an ordinary day, when there is no nuclear war threatened, will begin to understand how absurd all of this is.

The biggest absurdity is a different one. This assumes, this plan, an orderly and compliant population, and no panic. People with even numbered license plates will leave today; those with odd numbered plates will calmly wait until tomorrow. And if you question the government about this they say, well, people behave well during disasters; our experience with hurricanes and chemical tank fires and so on is that people behave very well, and cooperatively. As if nuclear war were like any disaster in previous human experience, and as if people would behave the same way. Those are just some of the problems. Then, of course, there are the problems when people get to the so-called 'host' area, the so-called 'safe' rural area to join the 50 million people who are already there. First, it is assumed the 50 million people will be happy to see them come. Secondly, it is assumed somehow that where there had been 50 million people there will now be food, water, housing and other minimal supplies enough for 145 million or 150 million more. I haven't said a word about the enormous problem of medical care during the migration, as well as when everybody gets to these remote areas - most of them are without hospitals, without doctors, without any social network or social system. What do you do when the person in the car with you has a heart attack? Who do you call, how do you get help in this packed highway? No real plans for that.

Whiteley: Your point is that just statistically, that large a number of people is going to generate an enormous number of routine emergencies.

Geiger: If you take the ordinary rate in the United States among healthy people of life-threatening emergencies, heart attacks, gastrointestinal bleedings, strokes, convulsions, and so on, one can calculate very simply that in three days, among 145 million people while this migration is going on, there will be about 80,000 life-threatening emergencies, just to start with. That's assuming that people aren't running around shooting each other over gasoline in their panic, that there are no traffic accidents on these highways, or any other unusual events.

Whiteley: What about just the number of births in that period of time?

Geiger: There will be a very difficult problem for the planners for women in the late stages of pregnancy. Do you put them on the highway in the middle of this crowd to go to this rural area where there are no facilities? (We'll come in a minute to what their experience will really be), or do you leave them behind with the other people who are too ill to be moved - all in one big hospital, one hopes has turned into a gigantic intensive care unit to have their babies, there at target zero for the bomb. What kind of a choice is that? It's a choice the government doesn't talk about. Now we've got all of these 195 million people: 145 million for the cities, and 50 million from the host areas themselves out in these rural areas. And they've got three days to get ready for the war and the fallout. And what they are suppose to do is find shelter with friends and relatives. Well, most of them don't have friends and relatives, and what shelter means is unclear. Secondly, they're to go to congregate shelters. That turns out to be jargon for movie theaters, high schools, gymnasiums, any other kinds of public buildings. And they are suppose to take dirt and pile it up along the walls of that building and on the roof to shield against radiation.

Or for most of them, since the space isn't nearly big enough, they're suppose to dig what's called an expedient shelter: a hole in the ground that has to be at least three feet deep and three feet wide per person, and be shored up and have some kind of a lumber roof over it and have dirt piled on top of that. The least known figure in the United States, I think, is how much one cubic yard of dirt weighs. It weighs 2,700 pounds. The average person would have to move somewhere between five and eight tons of dirt to build his or her part of such a shelter. We're talking about people without tools, without equipment, without back-hoes. We're not allowing for the fact that it might be winter and the ground might be frozen. It's 2,700 pounds per cubic yard of dirt when it's not frozen, when it's not muddy, when it's not wet, and so on. They are suppose to dig the shelter, and then they are suppose to go down into this shelter and they have to stay there for a minimum of 14 days, and much more likely 30 days. And in many parts of the country where fallout will be intense, people who stay alive free of radiation sickness would have to be in those shelters for 60 days - two months or more.

Nobody has really addressed the questions of how they're going to eat, or how they're going to get water, or what they're going to do about sanitation, or what they're going to do about medical care - all of those strokes and heart attacks and GI bleeds and births and complicated deliveries, and people running out of medications for their diabetes or their heart disease, or their thyroid disease, that's all going to be going on underground. Furthermore, if I wanted, as a physician, to sit down and write the worst possible scenario that I could for the outbreak of epidemic disease, I would take 145 million people and crowd them together in holes in the ground without water, without sanitation, without adequate ventilation; many of them walking in with bronchitis, other ordinary infections, some of them with tuberculosis and so on, and I would write that scenario for the outbreak of epidemic disease.

Whiteley: Dr. Geiger, thank you for sharing with us today your insights into the medical effects of nuclear war.