Editor’s Note: Ira Helfand, M.D., is a past president of International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985. Barry Levy, M.D., M.P.H., is an adjunct professor of public health at Tufts University School of Medicine and author of the new book “From Horror to Hope” about the health impacts of war. He is a past president of the American Public Health Association. Matt Bivens, M.D., is an instructor in medicine at Harvard Medical School and former chair of Greater Boston Physicians for Social Responsibility. The views expressed in this commentary are their own. Read more opinion articles on CNN.
The world is shocked by the violence in Ukrainian cities besieged by Russian forces, as they suffer under indiscriminate mortar, bomb and missile attacks. But these horrors could lead to something far worse – escalation to nuclear war. If we are going to avoid this ultimate catastrophe, we need to work urgently for the elimination of all nuclear weapons.
Since the end of the Cold War more than 30 years ago, most people have paid little mind to the continued existence of nuclear weapons. But there are still more than 13,000 nuclear warheads in world arsenals, 90% of them held by either the United States or Russia, according to the Arms Control Association. Experts were decrying these thousands of nuclear weapons as an ongoing existential threat to humanity even before Russian President Vladimir’s Putin’s recent warnings that he may use Russia’s nuclear weapons.
Russian military doctrine, like US military doctrine, allows for the first use of a nuclear weapon to gain battlefield advantage or stave off major military defeat.
If the Kremlin feels itself losing a conventional war, will it resort to the nuclear option as Putin has explicitly threatened? Tactical or “battlefield,” nuclear weapons are far smaller than the enormous warheads intended to destroy cities – but the smallest of them still has the force of up to 300 tons or 0.3 kilotons of TNT.
Such a bomb creates a fireball 300 feet across. The flames and explosion could destroy residential buildings and cause life-threatening burns to anyone within about 1,000 feet and deliver a lethal dose of radiation to anyone within about 2,000 feet.
Yet as bad as that sounds, in some ways, the worst thing about such a small bomb is its very smallness. It provides a terrible temptation to a military under pressure to go nuclear “just a little.”
We cannot be certain what would happen next if Putin decided to take this smaller nuclear option. But war games in which a tactical nuclear weapon is used have usually progressed to full-scale nuclear war. Once that threshold is crossed, neither side tends to know how to stop.
A nuclear war between Russia and NATO allies would be an unimaginable tragedy. A single 100-kiloton (100,000-ton) bomb detonated over Washington, for example, would likely kill 170,000 people and injure hundreds of thousands. A similar bomb detonated over Moscow would likely kill 250,000 and injure more than a million. In both cities, the medical care system would be destroyed outright and what few emergency medical resources remained would be totally overwhelmed.
But in a large-scale war, it would not be a single bomb over a single city. Rather it would be many bombs over many cities. A 2003 report showed that if just 300 of the roughly 1,500 weapons deployed in the Russian strategic arsenal exploded over US cities, 75 to 100 million people would die in the first day.
But they might be the lucky ones: The vast majority of those who survived the initial attack would also die over the coming months from radiation sickness, infectious diseases, famine and exposure.
In the wake of such a massive nuclear attack, the entire economic infrastructure would be destroyed: the electric grid, the Internet, food and water supply systems, the health care system – it would all be gone.
Temperatures would be terribly cold, as a large-scale nuclear war would have also put 150 million tons of soot into the upper atmosphere, triggering a “nuclear winter,” global famine and likely the end of civilization as we understand it.
It is overwhelming to consider a disaster of this magnitude, but we must. If we are lucky enough to survive this dangerous moment, we must ensure that we never find ourselves in such peril again.
Get our free weekly newsletter
The only way to guarantee that nuclear weapons are never used is to eliminate all of them. Americans must negotiate now with all other nuclear-armed countries for a verifiable agreement to dismantle them – as President Joe Biden himself forcefully asserted in 2017. “If we want a world without nuclear weapons, the United States must take the initiative to lead us there,” then-Vice President Biden stated, adding, “As the only nation to have used nuclear weapons, we bear a great moral responsibility to lead the charge.”
Perhaps the current moment – a planet-wide near-death experience – will finally motivate us to rise to that challenge.