About the Author(s)

Abbasi Kamran
British Medical Journal, London, United Kingdom

Parveen Ali symbol
Health Sciences School, University of Sheffield, Sheffield, United Kingdom

Doncaster and Bassetlaw Teaching Hospitals, Lead, United Kingdom

Sheffield University Interpersonal Violence Research Group, Sheffield, United Kingdom

Virginia Barbour symbol
Medical Journal of Australia, Brisbane, Australia

Kirsten Bibbins-Domingo symbol
University of California, San Francisco, United States of America

Marcel G.M. Olde Rikkert symbol
Dutch Journal of Medicine, Nijmegen, The Netherlands

Radboud University Medical Center, Nijmegen, The Netherlands

Richard Horton symbol
The Lancet, London, United Kingdom

Robert Mash symbol
Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa

African Journal of Primary Health Care and Family Medicine, Stellenbosch, South Africa

Carlos Monteiro symbol
Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paolo, Brazil

Elena N. Naumova symbol
Tufts University, Boston, United States of America

Eric J. Rubin symbol
New England Journal of Medicine, Cambridge, United States of America

Peush Sahni symbol
All India Institute of Medical Sciences, New Delhi, India

James Tumwine symbol
School of Medicine, Kabale University, Kampala, Uganda

Paul Yonga symbol
CA Medlynks Medical Centre and Laboratory, Nairobi, Kenya

East African Medical Journal, Nirobi, Kenya

Chris Zielinski Email symbol
University of Winchester, Winchester, United Kingdom

World Association of Medical Editors, Winchester, United Kingdom

Arun Mitra
Indian Doctors for Peace and Development, Ludhiana, India

Tilman Ruff symbol
International Physicians for the Prevention of Nuclear War, University of Melbourne, Melbourne, Australia

Andy Haines symbol
London School of Hygiene and Tropical Medicine, London, United Kingdom

Ira Helfand
International Physicians for the Prevention of Nuclear War, Springfield, United States of America


Kamran A, Ali P, Barbour V, et al. Reducing the risks of nuclear war – The role of health professionals. Afr J Prm Health Care Fam Med. 2023;15(1), a4249. https://doi.org/10.4102/phcfm.v15i1.4249


Reducing the risks of nuclear war – The role of health professionals

Abbasi Kamran, Parveen Ali, Virginia Barbour, Kirsten Bibbins-Domingo, Marcel G.M. Olde Rikkert, Richard Horton, Robert Mash, Carlos Monteiro, Elena N. Naumova, Eric J. Rubin, Peush Sahni, James Tumwine, Paul Yonga, Chris Zielinski, Arun Mitra, Tilman Ruff, Andy Haines, Ira Helfand

Received: 25 July 2023; Accepted: 07 Aug. 2023; Published: 27 Sept. 2023

Copyright: © 2023. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

In January 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 s before midnight, reflecting the growing risk of nuclear war.1 In August 2022, the UN Secretary-General António Guterres warned that the world is now in ‘a time of nuclear danger not seen since the height of the Cold War’.2 The danger has been underlined by growing tensions between many nuclear-armed states.1,3 As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet – and urge action to prevent it.

Current nuclear arms control and non-proliferation efforts are inadequate to protect the world’s population against the threat of nuclear war by design, error or miscalculation. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) commits each of the 190 participating nations ‘to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control’.4 Progress has been disappointingly slow and the most recent NPT review conference in 2022 ended without an agreed statement.5 There are many examples of near disasters that have exposed the risks of depending on nuclear deterrence for the indefinite future.6 Modernisation of nuclear arsenals could increase risks; for example, hypersonic missiles decrease the time available to distinguish between an attack and a false alarm, increasing the likelihood of rapid escalation.

Any use of nuclear weapons would be catastrophic for humanity. Even a ‘limited’ nuclear war involving only 250 of the 13 000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk.7,8 A large-scale nuclear war between the USA and Russia could kill 200 million people or more in the near term and potentially cause a global ‘nuclear winter’ that could kill 5–6 billion people, threatening the survival of humanity.7,8 Once a nuclear weapon is detonated, escalation to all-out nuclear war could occur rapidly. The prevention of any use of nuclear weapons is therefore an urgent public health priority and fundamental steps must also be taken to address the root cause of the problem – by abolishing nuclear weapons.

The health community has had a crucial role in efforts to reduce the risk of nuclear war and must continue to do so in the future.9 In the 1980s, the efforts of health professionals, led by the International Physicians for the Prevention of Nuclear War (IPPNW), helped to end the Cold War arms race by educating policymakers and the public on both sides of the Iron Curtain about the medical consequences of nuclear war. This was recognised when the 1985 Nobel Peace Prize was awarded to the IPPNW (http://www.ippnw.org).10

In 2007, the IPPNW launched the International Campaign to Abolish Nuclear Weapons, which grew into a global civil society campaign with hundreds of partner organisations. A pathway to nuclear abolition was created with the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017, for which the International Campaign to Abolish Nuclear Weapons was awarded the 2017 Nobel Peace Prize. International medical organisations, including the International Committee of the Red Cross, the IPPNW, the World Medical Association, the World Federation of Public Health Associations, and the International Council of Nurses, had key roles in the process leading up to the negotiations, and in the negotiations themselves, presenting the scientific evidence about the catastrophic health and environmental consequences of nuclear weapons and nuclear war. They continued this important collaboration during the first Meeting of the States Parties to the Treaty on the Prohibition of Nuclear Weapons, which currently has 92 signatories, including 68 member states.11

We now call on health professional associations to inform their members worldwide about the threat to human survival and to join with the IPPNW to support efforts to reduce the near-term risks of nuclear war, including three immediate steps on the part of nuclear-armed states and their allies: firstly, adopt a no first use policy12; secondly, take their nuclear weapons off hair-trigger alert; and, thirdly, urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts. We further ask them to work for a definitive end to the nuclear threat by supporting the urgent commencement of negotiations among the nuclear-armed states for a verifiable, timebound agreement to eliminate their nuclear weapons in accordance with commitments in the NPT, opening the way for all nations to join the Treaty on the Prohibition of Nuclear Weapons.

The danger is great and growing. The nuclear-armed states must eliminate their nuclear arsenals before they eliminate us. The health community played a decisive part during the Cold War and more recently in the development of the Treaty on the Prohibition of Nuclear Weapons. We must take up this challenge again as an urgent priority, working with renewed energy to reduce the risks of nuclear war and to eliminate nuclear weapons.


  1. Science and Security Board, Bulletin of the atomic scientists. A time of unprecedented danger: It is 90 seconds to midnight. 2023 Doomsday Clock Statement [homepage on the Internet]. 2023 [cited 2023 June 1]. Available from: https://thebulletin.org/doomsday-clock/current-time/
  2. UN. Future generations counting on our commitment to step back from Abyss, lift cloud of nuclear annihilation for good, secretary-general tells review conference [homepage on the Internet]. Press Release 01 August 2022 [cited 2023 July 10]. SG/SM/21394. Available from: https://press.un.org/en/2022/sgsm21394.doc.htm
  3. Tollefson J. Is nuclear war more likely after Russia’s suspension of the New START treaty? Nature. 2023;615:386. https://doi.org/10.1038/d41586-023-00679-w
  4. UN. Review conference of the parties to the treaty on the non-proliferation of nuclear weapons (NPT) May 2–27, 2005 [homepage on the Internet]. 2005 [cited 2023 June 2]. Available from: https://www.un.org/en/conf/npt/2005/npttreaty.html
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  6. Lewis P, Williams H, Pelopidas, Aghlani S. Too close for comfort, cases of near nuclear use and options for policy [homepage on the Internet]. Chatham House Report. 2014 [cited 2023 June 1]. Available from: https://www.chathamhouse.org/2014/04/too-close-comfort-cases-near-nuclear-use-and-options-policy
  7. Bivens M. Nuclear famine [homepage on the Internet]. IPPNW. 2022 [cited 2023 June 1]. Available from: https://www.ippnw.org/wp-content/uploads/2022/09/ENGLISH-Nuclear-Famine-Report-Final-bleed-marks.pdf
  8. Xia L, Robock A, Scherrer K, et al. Global food insecurity and famine from reduced crop, marine fishery and livestock production due to climate disruption from nuclear war soot injection. Nat Food. 2022;3:586–596. https://doi.org/10.1038/s43016-022-00573-0
  9. Helfand I, Lewis P, Haines A. Reducing the risks of nuclear war to humanity. Lancet. 2022;399(10330):1097–1098. https://doi.org/10.1016/S0140-6736(22)00422-6
  10. Nobel Prize Outreach AB. International physicians for the prevention of nuclear war – Facts [homepage on the Internet]. 1985 [cited 2023 June 1]. Available from: https://www.nobelprize.org/prizes/peace/1985/physicians/facts/
  11. UN Office for Disarmament Affairs. Treaties database. Treaty on the prohibition of nuclear weapons, status of the treaty [homepage on the Internet]. 2023 [cited 2023 June 1]. Available from: https://treaties.unoda.org/t/tpnw
  12. Center for Arms Control and Non-Proliferation. No first use: Frequently asked questions [homepage on the Internet]. 2023 [cited 2023 June 2]. Available from: https://armscontrolcenter.org/issues/no-first-use/no-first-use-frequently-asked-questions/

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