Text by Marilyn Smith / Photos by Nigel Dickinson
Any discussion about the links between the accident at the Chernobyl nuclear power plant and human health is guaranteed to create controversy. Just days before the 20th anniversary of the accident, Greenpeace issued a report claiming that 100 000 fatal cancer cases would arise from the accident. With this figure, Greenpeace lobbed heavy criticism at The Chernobyl Forum figures, which estimate a total 4000 deaths. In turn, IAEA experts argue that far too many reports, including the Greenpeace study, try to achieve the impossible – i.e., obtain accurate results from unsound science. For some scientists, the disparity is, at least in part, a function of when, where and under which regime the disaster occurred.
|Dr. Mikhail Balanov was a leading nuclear scientist in the former Soviet Union at the time of the accident, and was directly involved in efforts to decontaminate individuals and the plant site itself.|
“When Chernobyl exploded, there were a few radiation experts in the area,” says Mikhail Balonov, a retired TC Technical Officer and a Soviet Union nuclear expert. “We were mostly concentrated at the major research centres in Moscow, Saint Petersburg and Chelyabinsk.”
Mr. Balonov paints a bleak picture of the days immediately following the disaster. He personally stripped clothing and shaved the head of severely contaminated individuals – who had to travel almost a thousand km to Moscow or Saint Petersburg before receiving appropriate attention. This was an era in which ‘liquidators’ (individuals who cleaned up after the disaster) did not wear dosimeter devices to measure radiation exposure. In addition, the former Soviet Union was notorious for shoddy record keeping and for concealing the magnitude of the accident for far too long.
|Director Eleonora Kapitonova oversees the challenge of ensuring that research, diagnostics and treatment are fully integrated at the Republican Research Centre for Radiation Medicine and Human Ecology in Gomel, Belarus.|
Such factors create a dual challenge for the Republican Research Centre for Radiation Medicine and Human Ecology in Gomel, Belarus. The Centre provides diagnostic services and treatment for the populations from Belarus who have been affected by the Chernobyl accident. At times the Centre also provides these services for populations from Ukraine and the Russian Federation. The ultimate aim of the Centre is to improve the future outlook for individuals who have been exposed to radiation and to increase scientific knowledge of diseases associated with radiation exposure. Yet it is true that in addressing current health impacts, the Centre’s health professionals must also take into account past shortcomings.
The reference to ‘human ecology’ in the Centre’s name reflects a growing awareness that in order to provide effective treatment for diseases resulting from radiation exposure, it is vitally important to better understand how humans interact with nature and their environment. The TC programme is planning to help the Centre acquire the equipment and expertise necessary to build capacity in its research, diagnostic and clinical treatment departments – and to link them together.
|Regular monitoring of individual radiation levels is an important aspect of health care in the affected regions.|
On the hospital side of the Centre, most of the patients are so-called “liquidators”, or inhabitants from the territories that were affected by the Chernobyl accident, who have multiple conditions ranging from cancer, cataracts and cardiac problems to lung disease and malfunction of the haematosis (blood production) system. Children and adolescents in the wards generally come for treatment of thyroid cancer or immune disorders such as leukaemia and alopecia (a condition in which the immune system attacks hair follicles, resulting in hair loss all over the body).
The increased incidence in thyroid cancer, particularly amongst children, is directly linked to the Chernobyl accident and, more specifically, to the early release of radioactive iodine and subsequent consumption of contaminated milk. The thyroid gland requires iodine to produce hormones that regulate various bodily functions. However, it is incapable of distinguishing between the natural, stable element and the radioactive version: it will simply absorb what is available. At the time of the accident, iodine deficiency was widespread in the affected areas (it is still a significant problem). Had Chernobyl occurred in the western world, where something as simple as adding iodine to salt had already significantly reduced deficiencies, the impact might have much more moderate.
|Young children and adolescents are particularly susceptible to thyroid cancer and leukaemia.|
Dr. Svetlana Matzkevich, Head of the Centre’s Division of the State Dosimetry Register, deals with the health consequences of the Chernobyl accident on a daily basis. One of the biggest challenges, she says, is lack of information about exposure doses – particularly when one considers the quality of medical treatment that was available in the Soviet Union at the time.
“It must be recognized that when Chernobyl occurred, exposure control was very poor and exposure records were practically non-existent,” says Dr. Matzkevich. “We treat all patients as though their conditions resulted from the disaster. But in some cases, individuals who underwent X rays or radiotherapy around the same time may have acquired greater doses of radiation from those ‘controlled’ events than from the accident itself.”
|Dr. Svetlana Matzkevich and TC Programme Management Officer Andrei Chupov work closely to identify needs at the Centre and develop plans through which Agency TC can contribute to new equipment, training or expertise.|
|State-of-the-art radiotherapy equipment and new digital technologies are vital to providing effective treatment to individuals with Chernobyl-related conditions. The TC programme helped provide training for staff to ensure optimal use of these tools.|
In addition, armed with better means to acquire data, Dr. Matzkevich is taking on the issue of record maintenance by overseeing the creation of a state registry for people who have been exposed to radiation. In line with the IAEA’s Thematic Safety Areas for radiation protection, the registry will track doses for three categories of individuals: 1) professionals, covering approximately 10 000 individuals who work in more than 700 Belarusian enterprises that have radiation sources; 2) medical patients who undergo radiation-based diagnosis or treatment protocols; and 3) public exposure that results from accidents or emergencies.
The main goal of the registry is to identify critical groups within the population and, thereby, to determine when it is necessary to take action to reduce radiation exposure in a particular demographic group or to develop more effective treatment plans. The registry will also be used by government officials to calculate appropriate settlements and compensation packages.
Dr. Matzkevich is also working with other scientists at the Centre to test and validate a new technique, known as ‘dose reconstruction’, which might help to create a more realistic image of the events which took place in 1986. It has been demonstrated that by sophisticated analyses of some solid materials (e.g., bricks or ceramic tiles) from contaminated sites, it is possible to calculate the radiation dose received at the time of the disaster.
|Using hard materials (e.g. ceramic or brick) from evacuated areas, scientists can measure current radioactivity levels to calculate contamination at the time of the accident. This process is known as ‘radiation reconstruction’ and may have application in human health.|
“We believe we can do the same with enamel,” says Dr. Matzkevich. “We can take a reading from someone’s teeth and determine whether they were contaminated by the Chernobyl accident or by an excessive dose of radiotherapy two years after this event.”
The technique is not yet 100% accurate, but shows strong potential. Dr. Matzkevich expects to complete the necessary research in two to three years. But she also admits that developing the capacity to pinpoint the time and source of an individual’s exposure has political implications. “What is to be done for someone who has been compensated under the ‘victims of Chernobyl’ plan for 20 years but is, in actual fact, a victim of a poorly regulated medical facility?”
Today, it is widely recognized that high level radiation exposure causes general weakening of the immune system, which may be linked to many other diseases. In addition to those mentioned above, Chernobyl is often regarded as the source of increased incidence in diseases of endocrine systems, diabetes, and conditions related to the airway and gastrointestinal tract. Although it is now recognized that low-dose radiation may cause genetic mutation, there is little consensus on the impact in this area of the accident at Chernobyl.
|Many of the Centre’s adult patients have multiple conditions arising from radiation exposure, which require holistic care.|
In contrast, there is almost universal agreement about psychological trauma that may be connected to the disaster itself or to chronic stress, depression or anxiety related to current personal health problems and ongoing radiation risks. Even after 20 years, many people view themselves as ‘victims’ of Chernobyl and have developed a ‘dependency’ mentality. Many health experts emphasize the need to encourage people to recognize that they are ‘survivors’ and that they can exercise greater control over their own health and over their futures.
Maxim Orel exemplifies the attitude that health providers believe can make a difference. Along with his family, Maxim was evacuated from a village near Chernobyl at the age of seven, and subsequently grew up near Moscow – beyond the heavy cloud of health anxiety that hangs over the heads of nearby residents. When he first applied for his current position as interpretive guide inside the exclusion zone, friends warned him about the health risks associated with working “on site”. Maxim opted to do his own research by talking to people who have worked at the plant for the past 20 years.
“I think the real danger is becoming “radio-phobic”. If I worry about my health constantly, it creates too much stress in my body. Maybe I will give myself a heart attack,” says Maxim. “The key is to be optimistic, to exercise, to eat well and to live as normal a life as possible.”
The Chernobyl Forum, published in 2005, was sponsored by the IAEA, WHO, UNDP, FAO, UNEP, UNOCHA, UNSCEAR and the World Bank Group, along with the governments of Belarus, the Russian Federation and Ukraine. A summary of the report is available on-line at: www.iaea.org/Publications/Booklets/Chernobyl/chernobyl.pdf