11 January 1993
on the health effects of the Chernobyl
nuclear accident and the need for stronger
(Rapporteur: Mrs RAGNARSDOTTIR,
Iceland, Independence Party)
The state of health of children and adults in the areas of Russia, Belarus and Ukraine contaminated by Chernobyl radiation is of very great concern. Essential action to monitor medium-term health effects - including psycho-sociological effects - has been determined within the frame of the Council of Europe's Partial Agreement on Co-operation for the Prevention of, Protection against and Organisation of Relief in Major Natural and Technological Disasters. Co-ordinated with the Commission of the European Communities and the Radiation Unit of the European Centre for Environment and Health of the World Health Organisation (WHO), the SIEAD epidemiological monitoring and advisory programme seeks to establish a computerised network in eight hospitals across the contaminated area (including one in north-east Turkey) with a telecommunication link by a satellite of the European Space Agency. The Assembly wants governments to support and accelerate this programme, not only for the practicalities and substance of the programme itself but as an expression of European sympathy and concern for the predicament of the affected population.
I. Draft recommendation
1. The state of health today and in the coming years of children and adults in the areas of Russia, Belarus and Ukraine contaminated by Chernobyl radiation is of very great concern.
2. In 1990, when a request came from the Government of the USSR to assess the environmental and health situation and to evaluate measures already taken to protect the population, the international community responded swiftly.
3. The International Chernobyl Project, co-ordinated by the International Atomic Energy Agency (IAEA), was part of this response.
4. The Assembly salutes the project as an invaluable contribution to the management of a disastrous situation. In regard to criticism made of the project report (May 1991), the Assembly considers that the scientific and technological community must feel free to publish their findings and interpretations of data in the form which seems to them most responsible and appropriate. It is the responsibility of media professionals - and, indeed, of parliamentarians - to convey the right messages to the general public, and to sustain the quality of the debate.
5. Essential complementary action to monitor medium-term health effects - including psycho-sociological effects - has been determined within the frame of the Council of Europe's Partial Agreement on Co-operation for the Prevention of, Protection against and Organisation of Relief in Major Natural and Technological Disasters. Co-ordinated with the Commission of the European Communities and the Radiation Unit of the European Centre for Environment and Health of the World Health Organisation (WHO), the SIEAD epidemiological monitoring and advisory programme seeks to establish a computerised network in eight hospitals across the contaminated area (including one in north-east Turkey) with a telecommunication link by a satellite of the European Space Agency.
6. The Assembly considers that this action is fully in line with Recommendation 1153 (1991) on concerted European policies for health, to which the Committee of Ministers has responded positively.
7. The Assembly accordingly recommends that the Committee of Ministers:
i. invite governments to support and accelerate the SIEAD programme, not only for the practicalities and substance of the programme itself but as an expression of European sympathy and concern for the predicament of the affected population;
ii. instruct its Steering Committee for Health to report on implementation of this programme and initiate action on the basis of its findings in regard to nuclear safety, in the context of its co-operation with the World Health Organisation and with reference to the findings and conclusions of the International Chernobyl Project.II. Explanatory memorandum
by Mrs RAGNARSDOTTIR
1. On 26 April 1986 one of the four units of the Chernobyl nuclear power plant went out of control. Vast quantities of radioactive materials were released. Within days, l00 000 people were evacuated from a 3O km radius "prohibited" zone. In the following months 600 000 emergency workers1 spent varying amounts of time in this zone and at the reactor itself to restore control.
2. 825 000 people continued to live in areas known to be contaminated2. This was a cause of great stress and anxiety. The authorities came under corresponding pressure to evacuate and re-locate this population.
3. Radiation occurs naturally in the environment, in addition to what is caused artificially by civil and military operations. There are internationally agreed standards of measurement and established thresholds for evaluating and defining the levels of risk to health from exposures to radiation and its absorption3.
4. Authorities of the ex-USSR had taken part in the establishment of these standards and definitions through their membership of the IAEA (International Atomic Energy Agency). The standards are based on recommendations of the ICRP (International Commission for Radiological Protection). But people in the affected areas (and beyond) had no more confidence in the authorities. Official statements on levels of contamination and risks to health were no longer believed4.
5. Policies for evacuation and re-location of entire communities (not to mention policies for restoring control and managing the risks to health of the emergency workers) required to be based on credible measurements of radioactivity in the environment and on rational evaluation of risks to health. The government of the ex-USSR had to seek international assistance5. An appeal was accordingly made to the international community.
6. In 1990, in response to this appeal, the International Chernobyl Project was launched. It was carried out by 200 scientists and medical experts from 25 countries. Though misleadingly referred to as an IAEA report, it was merely co-ordinated and managed by the IAEA. The United Nations World Health Organisation (WHO), Food and Agricultural Organisation (FAO), International Labour Office (ILO), World Meteorological Organisation (WMO) and Scientific Committee on Effects of Atomic Radiation (UNSCEAR), together with the Commission of the European Communities, also took part. The Director of the Radiation Effects Research Foundation in Hiroshima was Chairman of the project's International Advisory Committee.
7. In Vienna 21-24 May 1991 the project's findings were examined by 400 scientists at an international conference.
8. Criticism has been directed to the report of the project published in May 1991 (see motion for a recommendation in Document 6505). The Social, Health and Family Affairs Committee has considered this criticism at an open hearing held in Strasbourg on 3 February 1992 with representatives of the International Atomic Energy Agency, of the Council of Europe's SIEAD project and of the Republics of Belarus and Ukraine. On the Rapporteur's proposal, at its meeting 22-24 June 1992 in Biasca, the committee agreed to salute the report as an invaluable contribution to the management of a disastrous situation, while noting that information on certain aspects of the disaster was as yet far from complete. In any event, vigorous debate within the medical and scientific community is to be welcomed - as is also vigorous public debate on the policy issues involved.
9. The project was specifically directed to the position of the 825 000 people outside the "prohibited" zone but living in contaminated areas. Those evacuated from the "prohibited" zone and almost all emergency workers were further afield.
10. According to the project report no currently observable health disorders were directly attributable to radiation. This affirmation was based on carefully collected data and complex statistical considerations. In the state of today's techniques and knowledge, the effects of radiation may only be detectable after a number of years6, and the rate of increase in the incidence of cancer in the area concerned had been rising for a decade.
11. This affirmation did not mean that Chernobyl radiation has not already had effects which will give rise over time to serious disorders in significant numbers of the population. It means that members of the population afflicted in the coming years with (for example) cancer will only know the relative probability of Chernobyl being the cause. The existence of more or less intense concentrations of particular forms of radioactivity in particular localities with correspondingly shorter or longer term effects on health is not (within the scope of present knowledge) inconsistent with this general affirmation. Accordingly, more intensive monitoring in particular localities for shorter term effects on health - such as, for example, thyroid - is essential.
12. Our committee takes the view that the scientific and technological community must be able to publish their findings and interpretations of data in the form which seems to them most responsible and appropriate. It is the responsibility of media professionals -and, indeed, of parliamentarians - to convey the right messages to the general public.
13. The state of health today and in the coming years of children and adults in the areas of Russia, Belarus and Ukraine contaminated by Chernobyl radiation is of very great concern. The International Chernobyl Project has made an invaluable contribution to rational management of the post-disaster situation as well as to setting the health and environmental issues in perspective. Follow-up action to the project now needs to be ensured in the form of extensive and systematic monitoring of the health of individuals and provision for remedial treatment at the earliest opportunity in the event of such treatment being required. This will also help to alleviate anxiety - subject, of course, to full and proper identification of all affected individuals, including those who by now have long moved to other areas.
14. A programme for follow-up action has been defined within the framework of the Council of Europe's Partial Agreement on Co-operation for Prevention of, Protection against and Organisation of Relief in Major Natural and Technological Disasters7. Co-ordinated with the Commission of the European Community and the Radiation Unit of the WHO European Centre for Environment and Health, the SIEAD programme (système d'information epidémiologique et d'aide à la décision medicale) involves the setting-up of a computerized network in eight hospitals across the contaminated area and a telecommunication link through a satellite of the European Space Agency. The pilot phase should be started this autumn with delivery of the equipment and commencement of staff training - subject to the necessary decisions being taken at ministerial level. The committee particularly welcomes the attention being paid to the psycho-sociological aspects of the disaster in the frame of this programme.
15. Attached in annex to this memorandum are the statements made at the committee's open hearing of 3 February 1992 by the representatives of the International Atomic Energy Agency and the Council of Europe's SIEAD programme, together with the preamble to the report on implementation of the pilot phase of this programme (20 August 1992), the statement made by the Rapporteur to the hearing of the Committee on Science and Technology on nuclear power plants in central and eastern Europe (Budapest, 1 July 1992), and the motion to which our committee is responding.
MOTION FOR A RECOMMENDATION ON THE CHILDREN OF CHERNOBYL
Statement made at the open hearing of 3 February 1992
Mr Morris Rosen
Vice-Chairman, International Advisory Committee
The International Chernobyl Project
Director for Nuclear Security
International Atomic Energy Agency (IAEA Vienna)
I am sincerely pleased that your committee has given me the opportunity this afternoon to discuss with you the results of the International Chernobyl Project, an independent and scientifically authoritative study completed last year. The study was co-ordinated by the International Atomic Energy Agency and examined not only the health impact, but also the extent of the environmental contamination and the protective measures undertaken by the Soviet Government.
I wish to begin by emphasising that although the project's major conclusion concerning the absence at this time of direct health effects in the population studied is consistent with assessments being carried out by the United Nations Scientific Committee on the Effects of Atomic Radiation and has not been refuted by any credible studies to date, the accident at Chernobyl had a societal impact unparalleled in industrial history. The early consequences resulted in the evacuation of more than 100 000 people and involved hundreds of thousands of rescue workers. Vast populations in Belarus, the Ukraine, and the Russian Federation continue to live with stress and anxiety due to the lingering uncertainty about the future.
The International Chernobyl Project launched in 1990 was an important step in assisting the affected populations through scientifically authoritative information. Additional initiatives are under way to deal with the consequences of the accident. The United Nations General Assembly Resolution 45/190 of 21 December 1990 urged co-ordination and co-operation with planned efforts of the United Nations System and appealed:
"... to all states members of the international community, intergovernmental and non-governmental organisations, the business community, scientific bodies and individuals to continue to provide all appropriate support and assistance to the areas most affected by the accident ...".
The United Nations Secretary General appointed the Director General of the United Nations Office in Vienna to co-ordinate assistance within the United Nations system. Additionally, the World Health Organisation has plans for a long term international programme for the study of medical aspects of the Chernobyl accident and for the establishment of a WHO international centre to study radiation medical problems. International collaboration in the growing number of humanitarian and scientific efforts will be an essential ingredient in fully alleviating the large societal consequences of the Chernobyl accident.
The debate over the radiation effects on health and the environment from the Chernobyl accident will persist for many more years. However, undoubtedly it will not be enlightened by impassioned references to the recent study co-ordinated by the International Atomic Energy Agency as incomplete, misleading and flawed.
The study had the active participation of seven international bodies which included the World Health Organisation, the United Nations Scientific Committee on the Effects of Atomic Radiation, and the Food and Agricultural Organisation of the United Nations. It was carried out by a team of some 200 experts associated with research institutes, universities and other organisations in twenty-five countries. There were twenty-eight physicians in what was the largest multinational interdisciplinary venture ever undertaken in the field of radiation protection.
An independent international advisory committee composed of leading radiation and medical specialists was headed by Dr Isuzo Shigematsu, Director of the Radiation Effects Research Foundation in Hiroshima. Dr Shigematsu's research establishment has, since 1950, monitored and analysed the health situation of atomic bomb survivors in Japan.
The advisory committee was solely responsible for the conduct of the investigation as well as for the conclusions contained in their final document. Two of its nineteen members were the Vice-Presidents of the Academies of Science of the Ukraine and of Belarus, while others were specialists in medicine, radiopathology, radioepidemiology, nutrition and radiation protection. The results of the International Chernobyl Project were candidly presented to a peer audience at a week long conference in Vienna during May of this year, attended by over 300 international experts.
The assessment was purposely directed to persons who have been residing in settlements in the contaminated areas since the time of the accident. This was the population which was uncertain about the real health and environmental situation. They had a pressing need to be factually informed. They were being continuously subjected to scientific and media reports of serious health disorders attributed to radiation effects. They were being told that food and water were not safe to drink due to contamination with radioactive materials. There was a necessity for scientific facts, but more so for a humanitarian response to the needs of the people and the authorities in the affected areas.
The radiological health effects to the more that 100 000 people evacuated from the prohibited zone around the Chernobyl site and the emergency personnel who were brought into the region temporarily for recovery work is of genuine concern and certainly of scientific interest. However, these individuals are no longer exposed to radiation from the Chernobyl environment. Any health-related consequences from their previous exposures were not of primary interest to the Chernobyl Project, as this knowledge would not materially contribute to resolving the immediate and urgent concern which had to do with the safety of continued habitation of the existing population in the contaminated areas.
The World Health Organisation is embarking on a long term study of the evacuees and emergency personnel which will include extensive medical surveillance. Doubtless, there may have been individuals with significant radiation exposure, some of whom may indeed in the future suffer from radiation induced illnesses. Nonetheless, it is likely, based on the International Chernobyl Project experience, that much of what is now being described and referred to as facts may not be verified through well conducted medical and scientific studies.
Although understanding difficult for many to accept, the International Advisory Committee of the Chernobyl Project found that although there were significant non-radiation-related health disorders and considerable psychological consequences in the populations examined and studied, no health disorders could be attributed directly to radiation. Currently, 10% to 15% of the adults have significant general medical problems which are likely related to dietary or other environmental factors.
The extensive medical data examined did not indicate a substantial increase in the incidence of leukaemia or cancer or hereditary effects. The data did reveal that cancer incidence had been rising for the last decade. The increase started before the Chernobyl accident occurred and has continued at the same rate since the accident. The data did not show a marked increase in childhood leukaemia or thyroid tumours since the accident.
Many of the clinical investigations in the USSR were done poorly, producing confusing or contradictory results. The few adequately performed Soviet studies are consistent with the Chernobyl Project findings and have not substantiated any of the reported health effects alleged to be due to radiation.
Nevertheless owing to limitations in the investigative and statistical methods, the possibility of some slight increase in the incidence of cancers cannot be altogether excluded. Nor can the development of an increased number of cancer cases, after a longer latent period, be excluded. Cancer however is a very common disease, with upwards of 20% of death attributable to it. Unless the number of radiation induced cancers is large it may be difficult to be certain that the cancers are actually attributable to radiation. It is only well organised statistical studies which may in the long term be able to establish such a relationship.
The project's major conclusion concerning the absence at this time of direct health effects in the population studied agreed with those reached by experts from the World Health Organisation who visited the affected areas in 1989, and is consistent with assessments being carried out by the United Nations Scientific Committee on the Effects of Atomic Radiation. There are no credible studies to date which have come to any other conclusion.
The International Chernobyl Project constitutes an important body of information which is available for examination in a 700-page technical report and is summarised in an overview document directed to the less scientific audience. These documents would be useful reading to those who continue to question the project's results.
Specific comments on motion
I wish before concluding to add additional comments in response to several points contained in the Parliamentary Assembly motion before you.
Point 1 contains the following statement:
"..., the process of evacuation officially continues, with 70 000 being evacuated in 1990 and 140 000 to be evacuated in the near future;".
My comments to this point make reference to the General Conclusions for Protective Measures of the International Chernobyl Project which speaks to the need for relocation:
"The protective measures taken or planned for the longer term, albeit well intentioned, generally exceed what would have been strictly necessary from a radiological protection viewpoint. The relocation and foodstuff restrictions should have been less extensive. These measures are not justified on radiological protection grounds; however, any relaxation of the current policy would almost certainly be counterproductive in view of the present high levels of stress and anxiety amongst inhabitants of the contaminated areas of concern and people's present expectations. It is recognised, however, that there are many social and political factors to be taken into consideration, and the final decision must rest with the responsible authorities. At any rate, no modification introduced should lead to more restrictive criteria."
Point 2 in the Parliamentary Assembly motion contains the following statement:
"(the IAEA report), which states there is no evidence of an increase in oncological illnesses or birth defects ... is suspect because it excludes individuals who were resident within a 30 km radius of Chernobyl, because it ignores the 600 000 emergency workers ... and ... because an increased incidence of cancer would not be measurable until 1996."
I have already remarked that the radiological health effects to the more than 100 000 people evacuated and the emergency personnel is of genuine concern and of scientific interest. The World Health Organisation has plans for a multi-million dollar long term study of these populations which will include extensive medical surveillance. As I have also already said, doubtless, there may have been individuals with significant radiation exposure, some of whom may indeed in the future suffer from radiation induced illnesses. Nonetheless, it is likely, based on the International Chernobyl Project experience, that much of what is now being described as factual health effects may not be verified through well conducted medical and scientific studies. Although numbers are not available, some of the evacuees and emergency personnel are currently residing in areas investigated in the International Chernobyl Project and they were included in the studies.
As to the reference in point 2 of the motion that increased cancer incidence would not be measurable until 1996, I would note that birth defects from radiation received by the foetus, and some thyroid cancers as well as leukaemia are radiation health effects which are observable in the shorter term. The International Chernobyl Project reported in its detailed conclusion under the heading Current health effects attributed to radiation that,
"Reported adverse health effects attributed to radiation have not been substantiated either by those local studies which were adequately performed of by the studies under the project."
and under the heading Potential delayed health effects that,
"Available data reviewed do not provide an adequate basis for determining whether there has been an increase in leukaemia or thyroid cancers as a consequence of the accident ... On the basis of the doses estimated by the project and currently accepted radiation risk estimates, future increase over the natural incidence of all cancers or hereditary effects would be difficult to discern, even with large and well designed long term epidemiological studies."
Finally I will turn to point 3 in the Parliamentary Assembly motion which contains the following statement:
"Noting that those worst affected by the accident are the children of the Ukraine and, especially, Belarus, where 20% of the land is still contaminated;".
My comments here make reference to the detailed conclusions for health impact of the International Chernobyl Project which reported under the heading General health that,
"The children who were examined were found to be generally healthy ..."
and under the heading Thyroid gland disorders that,
"No abnormalities in either thyroid stimulating hormone (TSH) or free thyroid hormone (T4) were found in children examined. No statistically significant difference was found between surveyed contaminated and surveyed control settlements for any age group. Mean thyroid sizes and the size distributions were the same for populations of surveyed contaminated and surveyed control settlements. Thyroid nodules were extremely rare in children; they occurred in up to 15% of adults in both surveyed contaminated and surveyed control settlements. Project results are similar to those reported for populations in other countries."
and finally under the heading Hematology that,
"Some young children with low haemoglobin levels and low red cell counts were identified. However, there were no statistically significant differences between values for any age group of the population in surveyed contaminated and surveyed control settlements ... Immune systems ... do not appear to have been significantly affected by the accident."
Finally in closing may I note that there have also been studies conducted in Cuba and Israel of children who were reported to be resident within the 30 km radius of Chernobyl and also in Pripyat, the town adjacent to the Chernobyl plant site. Although no detailed documentation has been made available to allow an evaluation of the scientific validity of the investigations, the results have revealed no clinical or laboratory pathologies which could be directly related to the radiological consequences of the accident. There are current proposals for additional studies to examine the problem of thyroid cancers by independent experts under the auspices of WHO and the CEC, Brussels.
MOTION FOR A RECOMMENDATION ON THE CHILDREN OF CHERNOBYL
Statement made at the open hearing of 3 February 1992
Professor Hubert Planel
Faculty of Medicine, Toulouse
Co-ordinator of the Council of Europe's programme
for epidemiological information systems and aid to
medical decision (SIEAD - APO - Chernobyl)
As we know, in the immediate aftermath of the Chernobyl disaster, numerous measures were taken:
- to treat people exposed to heavy doses of radiation;
- to prevent thyroid afflictions, particularly among children;
- to protect the population from the effects of radioactive fallout, involving the evacuation of more than 100 000 people.
In addition, as radioactive fallout had affected vast areas of Ukraine, Belarus and the Russian Federation, dosimetric studies were rapidly carried out with a view to assessing the potential risks and carrying out or continuing evacuations.
An enormous amount of work was subsequently done by the Soviet authorities and a number of national or international bodies such as the SCPRI (France), the World Health Organisation (WHO) and the Vienna-based International Atomic Energy Agency (IAEA). The dosimetric studies carried out at the time on the soil, in the air and on foodstuffs were vitally important, as it was possible to assess the impact of the Chernobyl disaster on the basis of the results and, in particular, to estimate the risks of cancer among adults and children.
It soon became clear that with the exception of areas in the immediate vicinity of the explosion, received or future doses were low, and certainly below initial estimates. A substantial proportion of annual doses were shown to be close to natural irradiation levels, that is 2,5 mSv or 250 mrem. Some doses were higher but not above 0,05 Sv or 5 rem, that is, the annual limit for persons exposed over many years to ionising radiation in their work.
What conclusions should be drawn from these data? Do they suggest, as stated in the international assessment committee report drawn up by members of the WHO and IAEA, that the disorders observed to date do not result from irradiation in contaminated areas but from psychological illnesses caused by evacuation?
Should we also conclude that in view of the very low doses involved, there will be no significant increase in the number of cancer cases? Has the work carried out by doctors and experts now come to an end, or will it soon do so?
I do not believe this to be the case and I think there are a number of grounds for adopting a positive, and I would say more prudent attitude:
1. First and foremost, radiological and radiobiological reasons:
Fallout of radionuclides varied considerably from one region to another. The aforementioned report acknowledges that its calculations do not take account of hot spots, where radioactivity levels were far higher. I believe that this point needs to be re-examined.
Together with Caesium 137, Iodine 131 formed the main component of the radioactive fallout. We know that iodine has a great affinity for the thyroid gland, especially in children. Indeed, doses to the thyroid gland were sometimes very high, reaching or even exceeding four Grays among children. The WHO has acknowledged this danger. Moreover, it appears to be confirmed by the results of a survey recently conveyed to a meeting of specialists at the Neuherberg radiology centre in Germany. Cases of thyroid cancer recorded in children in Minsk apparently increased from two in 1984 to more than fifty in 1991.
Assuming that these facts are correct - and there is no reason to doubt them - could it be argued that this increase in the number of cases of thyroid cancer is due solely to malnutrition or psychological illnesses?
Apart from Caesium 137 and Iodine 131, it was possible to isolate other radionuclides in the fallout, such as Plutonium, Pu 239, as emphasised by BELYAYEV and BOROVOY8. Its presence also gives rise to serious concern.
In this connection, we note that a radionuclide's efficiency depends on several different factors: its life, or more accurately its period, that of plutonium being 244 centuries; its life (or, more accurately, half-life) in the human body, that of plutonium being greater than 100 years.
Other relevant factors include the absorption channel, in this case the respiratory tract, the type of radiation and also the granulometry, or size of the radioactive particles. In the case of Chernobyl, a substantial proportion of the fallout consisted of minute particles of a few thousandths of a millimetre in diameter. The plutonium contained in these particles must have lodged in the mucous membrane of the bronchi. Alpha emitters, that is, of radiation approximately twenty times more efficient than X-rays or cobalt 60 gamma rays, these particles are capable of delivering high localised doses, which are obviously far higher than overall dosimetric levels. Will they cause an increase in cases of lung cancer? This is a risk which we cannot afford to ignore.
2. Medical and psychosocial reasons:
Chernobyl is the most serious non-military accident involving nuclear energy to date. Whereas at Hiroshima and Nagasaki irradiation was essentially acute, in the Chernobyl case acute irradiation only affected a relatively small section of the population, but very large numbers of people were exposed to radiation and continue to be so. In radiological terms, therefore, Chernobyl is very different from the military explosions at Hiroshima and Nagasaki.
The size of the area affected by radioactive fallout explains why this disaster aroused such widespread public concern, not only in Ukraine, Belarus and the Russian Federation but also in several Western European countries. It should not be forgotten that, to take Caesium 137 alone, 42% of fallout occurred in the three Soviet republics, 21% outside Europe and 37% within Europe itself.
To a large extent these fears were compounded by the controversies which raged at the time over the area covered by radioactive clouds, what were acceptable levels of exposure and the appropriate response. These fears remain. Should we not try to remove, or at least assuage them, especially since they have arisen in countries which are heavily committed to nuclear energy?
Can these fears, and the protests to which they could give rise, be dealt with simply by producing dosimetric data, irrespective of the accuracy of the methods used? We do not believe so. On the contrary, in our opinion the only way to assuage public concern is to monitor the populations of contaminated areas and to carry out thorough epidemiological surveys.
Admittedly this is an enormous task and there are many difficulties involved.
Clearly, the size of the contaminated areas and the limited probability of detecting pathological consequences on the basis of received doses may represent major obstacles. But it is worth noting that this probability increases when statistics cover large populations. In other words, if exposure to radiation of 100 rem results in 125 additional fatal cancers in a population of 10 000, the same number of cancers will be observed in a population of one million exposed to radiation of only one rem. In other words, the size of the population which needs to be monitored does not represent an insurmountable obstacle:
- another difficulty, which may prove critical, is linked to the fact that the studies which the Council of Europe is considering will be carried out several years after the disaster. This is a valid point, but it is worth remembering that cancers, and in particular solid tumours, appear fifteen to thirty years after irradiation. In the cases of Hiroshima and Nagasaki, chromosome aberrations in the blood cells of survivors or disorders in their descendants were detected up to thirty or forty years later;
- other difficulties arise from the general state of health care in the former USSR and, in particular, the fact that it is impossible to collect and transmit data from epidemiological surveys in satisfactory fashion.
These are serious obstacles, and indeed they explain why the Council of Europe is carrying out this work. It was on the basis of these considerations that the former Soviet Union asked the Council of Europe for assistance.
The former USSR, which had already become a member of the Open Partial Agreement on the prevention of, protection against, and organisation of relief in major natural and technological disasters, invoked this agreement when it applied to the Council of Europe for assistance in following up Chernobyl on 21 July 1990. More specifically, it needed help in setting up a computer network and supplies of telecommunications equipment. The Council of Europe could not ignore this request, especially since, over and above the technical assistance referred to above, it represented an opportunity to carry out humanitarian work.
European and Soviet experts met on a number of occasions in various countries and drew up a specific aid programme entitled SIEAD-APO (System of Epidemiological Information and Assistance in Medical Decision-making).
As its title suggests, this is a two-part programme:
- the first part centres on epidemiological aspects, and consists in defining on a joint basis a survey programme based on specific protocols and using information technology;
- moreover, by providing a computer network and equipment, and by training - and I emphasise this point - the staff who will be required to use this technology, the Council of Europe's programme should help to improve the standard of health care in the three republics. Obviously, the resources used for the epidemiological surveys will also be made available to doctors for use in their everyday work. Accordingly, the second part of the programme consists of assistance in medical decision-making.
I would like to conclude by emphasising that the programme submitted by the Council of Europe has attempted to avoid two pitfalls:
1. The members of the committees involved in this programme did not wish to deal solely with the Moscow authorities as was invariably the procedure in the past, or in this particular case with Obninsk, a town in the vicinity of Moscow where a radiology centre is located which is heavily involved in monitoring the impact of Chernobyl. Accordingly, the Council of Europe did not draw up a programme which could be implemented outwards from the centre. This is the method proposed by other organisations but it obviously goes against the grain of current political developments in the former Soviet Union.
In contrast, the SIEAD/CHERNOBYL programme is targeted directly on the three republics of Ukraine, Belarus and Russia. The programme should be carried out from the bottom up, ie from provincial hospitals or clinics to the capitals of these countries.
For practical purposes and reasons of prudence, it has been decided that the Council of Europe programme will start with a pilot phase lasting two and a half years. During this period software packages will be developed and training carried out. Once the hardware has been supplied a start can be made with epidemiological surveys and medical assistance but on a limited basis. They will be restricted to six regions, two for each republic, and will only concern children and teenagers in these areas. Examinations of thyroid glands and haematological examinations will be carried out. However, work effected during the pilot phase may be of interest to the population at large and thereby assist medical decision-making. This will depend mainly on our (ex-)Soviet colleagues.
A more general, ambitious final phase may be implemented in the light of the results obtained at the end of the pilot phase.
2. Duplication between the SIEAD programme and programmes carried out by other organisations, in particular the WHO, was another potential pitfall. It is worth noting that in fact the WHO has been kept informed of developments in the Council's programme and has been invited to a number of meetings, in particular a meeting held on 18 and 19 December 1991 at the International Agency for Research on Cancer (IARC) in Lyons. It had already been decided to set up an epidemiological sub-group linked to the Medical Committee of the SIAED Programme at the Strasbourg meeting of 8, 9 and 10 October 1991.
This group would be entrusted with carrying out a feasibility study in the six regions during the pilot phase.
The European Communities will also take part in this programme, particularly in the dosimetric field, and will provide financial backing.
IN CONCLUSION, the Council of Europe has drawn up a programme for defining and supplying an epidemiological information system which also assists medical decision-making. All preparatory studies have been completed and the pilot phase can begin without further delay.
Statement by the Rapporteur to the hearing
of the Committee on Science and Technology
on nuclear power plants in central and eastern Europe
(Budapest, 1 July 1992)
1. The Committee on Social, Health and Family Affairs is currently working in response to a motion on the children of Chernobyl. Among issues discussed are measures taken towards epidemiological research, medical treatment and the financial scope. Although the motion is primarily focused on children, the committee takes into account the status of the whole population which may be affected by the accident occurring in April 1986.
2. On 3 February this year the committee held a hearing on the subject where Dr Morris Rosen from the International Atomic Energy Agency (IAEA) explained the report on the International Chernobyl Project managed by the IAEA and carried out by 200 scientists and medical experts from 25 countries. A statement was also given by Professor Hubert Planel, the co-ordinator of the Council of Europe's programme for epidemiological information systems and aid to medical decision.
3. At a meeting in Biasca, Switzerland last week, my preliminary draft report and recommendation were discussed.
4. The Chernobyl Project report affirmed that no currently observable health disorders were directly attributable to radiation. However, since the report was published, there have been indications of abnormal increase in the incidence of thyroid cancer in certain areas, especially in Minsk, where five to six cases are found per month out of a population of two million children under the age of fifteen.
5. Our committee is also concerned about psychological effects on the population in the contaminated areas, and it questions whether this aspect is properly managed. Conveying right messages to the general public - which the committee considers to be the task of media professionals and, indeed, of parliamentarians - should be a priority.
6. The committee appreciates the invaluable contribution of the IAEA to the rational management of the post-disaster situation. But in the light of subsequent information, it is of the utmost importance that the action taken in epidemiological research and monitoring is well co-ordinated and prepared.
7. Indications of scientific work on previous nuclear disasters in the former Soviet Union give rise to the question whether this work has been of practical use for the Chernobyl Project. The committee acknowledges that there may be incentives on the part of government authorities and individual operators to cover up difficulties and even disasters.
8. The committee therefore considers that action should be taken:
- to ensure that psychological aspects are taken into account through better information;
- to examine the potential "post-Chernobyl" danger compared with previous disasters;
- to co-ordinate epidemiological research and monitoring cost-effectively;
- to co-ordinate funding of follow-up action to the International Chernobyl Project;
- to re-examine standards of measurement of contamination to ensure they are set low enough.
9. The committee is also considering the following recommendations:
- remedial action should be properly planned;
- there should be an increased co-operation from countries not currently participating;
- with more and more nations applying for membership of the Council of Europe, it should be ensured that they commit themselves in advance to co-operate in this area.
Reporting committee: Social, Health and Family Affairs Committee.
Budgetary implications for the Assembly: None.
Reference to committee: Doc. 6505 and Reference No. 1753 of 25 November 1991.
Draft recommendation: adopted by the committee on 16 December 1992 by 15 votes to 0 with 1 abstention.
Members of the committee: MM. Pini (Chairman), Mrs Håvik, Mr Rathbone (Vice-Chairmen), Mrs Albrink, MM. Banks, Beix, Benvenuti, Bloetzer, Bowden (Alternate: Mr Cox), Curto, Danev, Diaz de Mera, Ferris, Mrs Fleetwood, MM. Foschi, Gouteyron, Gusenbauer, Mrs Haarstad, Mrs Halonen, MM. Hörcsik, Jurgens, Karakaş, Koehl, Liapis, Liberatori, Libicki, Marques, Menzel, Meyer zu Bentrup, Ottenbourgh, Miss Özver, MM. Palacios, Pécriaux, Pottakis, Psaila Savona, Mrs Ragnarsdottir, MM. Regenwetter, Reimann, Schwimmer, Mrs Soutendijk-van Appeldoorn, MM. Ternak, Wielowieyski, N ... (Alternate: Mr Fiala).
N.B. The names of the members present at the meeting are in italics.
Secretaries to the committee: Mr Hartland and Ms Meunier .
1 1 1. While the number of evacuees seems to be around 100 000, it is not clear how many emergency workers were involved. While some reports refer to the number indicated, that is 600 000, many experts believe that the actual number of occupationally exposed people in the emergency actions was much lower.
2 2 2. 825 000 is the official number for people living in areas with "contamination" larger than 5 Ci/km삲.
3 3 3. These standards and thresholds clearly need to be the subject of review - if necessary (following the Chernobyl experience) at more frequent intervals than is at present the case.
4 4 4. Apparently, this is still the case.
5 1 1. The World Health Organisation (WHO) sent a team of experts in June 1989, as did the League of Red Cross and Red Crescent Societies in early 1990. The WHO concluded among other things that "scientists who are not well versed in radiation effects have attributed various biological and health effects to radiation exposure. These changes cannot be attributed to radiation exposure, especially when the normal incidence is unknown, and are much more likely to be due to psychological factors and stress. Attributing these effects to radiation not only increases the psychological pressure in the population and provokes additional stress-related health problems, it also undermines confidence in the competence of the radiation specialists". The League of Red Cross and Red Crescent Societies made similar observations. (Source: communication from the IAEA, 6 July 1992.)
6 1 1. Medical science is addressing as a matter of urgency the problem of detecting its effects at an earlier interval.
7 2 2. Participating governments: Belgium, France, Greece, Italy, Luxembourg, Malta, Portugal, San Marino, Spain, Turkey, and also of Russia, Belarus, Ukraine, Israel, Monaco and Algeria. Observers attend from Austria, Switzerland and Germany.
8 1 1. Proceedings of the international conference on nuclear accidents and the future of energy, Paris 15, 16 and 17 April 1991, Ed. Soc. Fr. En. Nuc.