The April 30 1998 issue of The New England Journal of Medicine – carries an article by members of International Physicians for Prevention of Nuclear War (IPPNW). It describes what would happen in medical terms if a single Russian submarine were to launch its missiles. They estimate nearly 7 million immediate deaths when 48 warheads land on targets in and near 8 cities. Injuries not immediately fatal would be vastly more than the medical facilities of all North America could deal with. Hundreds of thousands of people with severe burns would need care in specialized burn units, but there are just 1708 burn beds in the whole of U.S.A. and perhaps one or two hundred in Canada. Millions later would suffer radiation sickness, which is virtually untreatable.

The title of the article is "Accidental Nuclear War: A Post-Cold War Assessment." It shows that a realistic assessment by governments is very much needed, followed urgently by action to reduce the risk. IPPNW is the organization that was awarded the 1985 Nobel Peace Prize for drawing the attention of the world to the fact that its entire medical resources would be powerless to respond to the disaster of a major nuclear war. Now they are drawing attention to the fact that these dreadful weapons, though only half as many, are still ready to be launched in minutes and an all-out nuclear war could result from an unauthorized launch or a false alarm.

The risks we survived in the Cold War of 1947 to 1987 were worse than we realized at the time. Living through those years, being taught to hide under school desks with brown paper bags for protection, or reading unbelievable government pamphlets on evacuation of cities and survival after nuclear war, we gradually became used to living under the threat of instant disaster. Looking back, it is obvious there would have been many errors in any system as big as the U.S. apparatus for nuclear retaliation.

During the Cold War those in charge, ultimately the U.S. president and the General Secretary of the Communist Party in Russia, had a frighteningly short time to make the decision that could end civilization. With the Cold War over for 10 years, the response to a warning has not altered – nuclear retaliation is still only minutes away. For example, on 9 November 1979: a practice tape was accidentally played on the computer, which was at that moment the operational one at NORAD headquarters. It showed the picture of a massive missile attack coming from U.S.S.R. towards the United States. U.S. missiles would have been launched in 15 minutes so as to get away before the Soviet missiles exploded, but fortunately the mistake was discovered in six minutes.

The most recent incident to become public knowledge was on 25 January 1995. A rocket carrying scientific apparatus was launched from Norway, to make measurements in the upper atmosphere. Thirty-five countries including Russia had been warned a week in advance, but the message had not reached the Russian Defense Ministry. When the rocket was detected by Russian radar it had only five minutes' flight time to Moscow, and was first thought to be heading that way. President Yeltsin was informed and his nuclear emergency suitcase was activated ready to launch a counterattack before it landed. Fortunately the actual flight path, not landing on Russian territory, was correctly determined in that short time. But suppose the rocket steering had malfunctioned and headed in the direction of Moscow. Would the world have been condemned to destruction by nuclear war, started by a malfunctioning rocket, which did not have a warhead of any kind?

Suppose a single Russian missile did destroy an American city. What would be the American response? Putting aside the very questionable morality of destroying half a million innocent Russians to avenge half a million innocent Americans, would it not be better for both sides to have an enforced delay of at least 24 hours before any missile could be launched? That would make an unauthorized launch much less likely; and if it did happen, would we not prefer the leaders on both sides to have time for thought before they could take the next steps? The authors of the New England Journal paper advocate a treaty under which all warheads are removed from their missiles and held in guarded storage. Verification of compliance could be achieved by the inspections already permitted under the START I treaty for nuclear arms reduction. There is no effective medical response to a nuclear war. To take the missiles off alert is a matter of preventive medicine.