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Doc. 7680
7 October 1996
REPORT1 on
the health effects of the Chernobyl nuclear accident
(Rapporteur: Mr JACQUAT, France, Liberal, Democratic and Reformers' Group)
Summary
In Belarus, Russia and Ukraine, the growth in the incidence of thyroid cancers principally in children, is now a proven fact. Local treatment resources are blatantly inadequate. The international community has to display solidarity, to increase technical assistance and financial aid and to draw lessons from Chernobyl for the protection of public health.
I. Draft resolution
1. The Assembly recalls its Resolution 1087 (1996) adopted on the 10th anniversary of the Chernobyl accident and dealing with its effects.
2. It notes that in Belarus, Russia and Ukraine the growth in the incidence of thyroid cancers, principally in children, is now a proven fact; this phenomenon, which appeared as from 1990, is more or less pronounced depending on the region and will persist for several years; the average frequency of this cancer is ten times greater in children.
3. This effect of the Chernobyl accident was foreseeable owing to the absence or very marked inadequacy of administration of stable iodine to the populations, furthermore suffering from chronic iodine deficiency, in the contaminated regions.
4. The Assembly observes that despite large-scale international aid, local treatment resources are blatantly inadequate having regard to the number of persons irradiated. The hospitals cannot carry out isotope treatment because of inadequate supplies of iodine 131 and almost total absence of isolation wards. The deteriorating economic situation in Belarus, Russia and Ukraine means that these states are dependent on donations from abroad.
5. In the current state of knowledge, it is difficult to assess accurately the other possible health effects of the Chernobyl accident.
6. The Assembly invites the international community to display solidarity with Belarus, Russia and Ukraine and to draw lessons from Chernobyl for the protection of public health.
7. It invites the member states and the various international organisations, particularly the European Union:
i. to maintain or increase their financial aid and technical assistance to Belarus, Russia and Ukraine, giving priority to local treatment of patients and ensuring health checks on the evacuated populations, especially children having lived or still living in the contaminated regions;
ii. to see that aid is allocated equally to the three countries according to their needs;
iii. for the moment, to admit to their hospitals more sick children requiring urgent treatment not available in Belarus, Russia and Ukraine;
iv. to support the action of the various non-governmental organisations involved;
v. to develop a policy on public information and prevention of nuclear health risks;
vi. to train doctors and improve their knowledge in this field.
II. Explanatory memorandum
by Mr JACQUAT
1. Following the Chernobyl accident, the Parliamentary Assembly of the Council of Europe entrusted Ms Ragnarsdóttir with the task of drawing up a report on the health effects of the Chernobyl nuclear accident.2
This report, published on 11 January 1993, found that the state of health of children and adults in the areas of Belarus, Russia and Ukraine contaminated by Chernobyl radiation was of very great concern. Consequently, Ms Ragnarsdóttir recommended that the Council of Europe should lend its support to any measures taken to deal with the health effects of the Chernobyl accident. These findings contradicted those of Mr Morris Rosen of the International Atomic Energy Agency (IAEA — Vienna), also Vice-Chairman of the International Advisory Committee of the International Chernobyl Project. According to Mr Rosen, no data at the time pointed to a significant increase in cancer in general, including cancer of the thyroid, because "no abnormalities in either thyroid stimulating hormone (TSH) or free thyroid hormone (T4) were found in children examined". The report went on to insist on the difficulty in establishing a direct relation between pathological manifestations and radiation among inhabitants of the contaminated areas.
This opinion, based on observations made from 1986-91 can no longer be accepted. Indeed, although many points remain a mystery, and in spite of a necessarily cautious attitude, the mission3 and the resulting report demonstrate that the radiological effects of the Chernobyl accident are indisputable.
2. All the specialists whom we met, doctors or parliamentarians dealing with the effects of the Chernobyl accident, confirmed an increase in the incidence of thyroid cancer in children, a phenomenon already mentioned repeatedly in the national and international press. Unusually, this phenomenon appeared early, that is as of 1990.
3. The number of thyroid cancer cases affecting children in Belarus increased from two in 1986, to seven in 1988, 27 in 1990 and 90 in 1994. According to Ms Bogdanova, 47 cases were diagnosed in Ukraine in 1995. This phenomenon varies from region to region: on average, the cancer rate in children has increased ten-fold. The radioactive origin is indisputable since it is in the regions most contaminated by Iodine 131 that the number of thyroid cancers is highest. This effect of the Chernobyl accident was foreseeable as the result of the lack or extreme inadequacy of the administration of stable iodine in the contaminated regions: this fault was recognised repeatedly in the talks we had. Furthermore, contamination took place in populations already suffering from a chronic state of iodine insufficiency.
This increase in thyroid tumours was also brought about by the delay in taking radio-protective measures in respect of food. Indeed, it is indisputable that most of the irradiation was internal, of digestive origin.
Local medical care is notoriously inadequate, despite major international aid contributed by the European Union, various European states, WHO, the United States and Japan.
4. This aid has taken the form of supplying echography apparatus to hospitals, enabling close surveillance of the contaminated populations. The Kyiv Endocrinology Centre has a gamma camera (not yet in operation), equipment for thyroid biopsies and a cryostat and freezer supplied by the European Union.
A Minsk hospital treating children suffering from thyroid cancer has been supplied with a gamma camera by the EDF and two scanners by Philips.
5. Whereas diagnosis techniques and surgical care are satisfactory, Belarus and Ukraine hospitals cannot, on the contrary, provide the isotope treatment which the young patients need, especially as these tumours develop rapidly and are often accompanied by gland and lung metastases. This absence of isotopic treatment arises not only because it is impossible to supply sufficient quantities of Iodine 131 but also because of the almost total lack of isolation wards (only one at the Kyiv Radiology Centre — whilst three are being built in Kyiv — and none at all in Belarus).
6. This explains why western countries have offered to transfer young patients to their hospitals. Fourteen children have been treated in France (La Pitié-Salpêtrière hospital) and 100 at Essen hospital (Germany). Although these transfers pose many problems, budgetary as well as psychological, the medical care currently available in Belarus and Ukraine is such that we can only recommend continuation of this humanitarian aid.
7. The increase in the cases of thyroid cancers in children will continue for many years because the number of children exposed to heavy doses of radiation is high. It is believed that, in the contaminated regions, 16 000 children received a dose in the thyroid varying from 2 to 10 Grays. 1 600 children received a dose higher than 10 Grays. The authorities of both republics are aware of this problem and have taken important surveillance measures.
8. A higher number of thyroid cancers has also been observed among adults since the Chernobyl accident. In Belarus 202 cases were reported in 1988 and 512 in 1993. Although the Iodine 131 contamination is probable, in some cases the increase may be the result of improved detection techniques.
9. Apart from thyroid cancer — in particular thyroid cancer among children — it is still difficult to assess exactly the health effects of the Chernobyl accident. Indeed, the information which we have received has frequently been contradictory.
For example, according to Mr Ponomarenko, Ukraine's Deputy Minister of Health, the health effects of the Chernobyl accident are far worse than commonly reported:
—th e frequency of leukaemia has doubled,—
—th e number of malignant tumours in adults has increased six-fold.An
An increase in cases of cataract and of male sexual impotence has also been observed. Among emergency workers, 800 deaths in 1993 are thought to have been directly linked to their participation in work carried out on the Chernobyl site.
This information must be treated with caution, in particular concerning the rate of leukaemia.
10. Knowing the leukaemogenic effects observed after exposure to atomic radiation, in particular among the survivors of Hiroshima and Nagasaki, we have sought to gather data on this matter systematically. According to our sources of information, no change in the incidence of leukaemia has been observed, including among emergency workers. According to other sources, in particular Mr Kholosha, Minister in charge of Chernobyl-related matters, a very slight increase has been observed among emergency workers, although no statistical evidence has been produced. Doctors working at the Kyiv Endocrinology Centre confirm that no epidemiological study has been carried out on this subject. According to the head of the maternity and children's hospital in Kyiv, all health data of monitored children, living or having lived in the contaminated regions, is due for publication at the end of April. It would obviously be of great interest for the Council of Europe's parliamentary committee to have access to this document.
11. The media have also exaggerated the effects of the Chernobyl accident. For example, at the Minsk Congress in March 1996, Mr Crick of the IAEA referred to a British television programme according to which major defects were detected in a million children born after the accident. This could not possibly be true since, although the head of the Kyiv maternity hospital did refer to a slight increase in deformed foetuses, he was unable to offer any precise data on the subject. According to the same source sterility had been discovered in 30% of girls and 40% of boys who have lived in contaminated areas. This phenomenon, which would obviously be of considerable importance both medically and socially, seems disputable since none of the other people we questioned mentioned it.
12. The Chernobyl accident was followed by various pathological effects. Not directly linked to radioactivity, they are the consequence of the psychological trauma caused by the accident itself, by inaccurate and even incoherent information, and by often over-hasty evacuations. It should be remembered that the entire population of Pripyat (40 000) were forced to abandon their homes within a few hours on 27 April 1986. Furthermore, it was not until May 1991, that is after the publication of dosimetric studies carried out by the International Atomic Energy Agency, that the Soviet Government passed a law to protect citizens harmed by the Chernobyl disaster. In other words, whereas 125 000 people had already been evacuated in the spring and summer of 1986, many others did not discover until 1991 that they had been living in highly contaminated areas.
All of these facts explain a major increase in pathologies in Belarus and Ukraine, reported in the course of our talks: neuro-psychological disorders (the most common), digestive illnesses, cardiovascular disorders, chronic bronchitis, etc.
The "Chernobyl syndrome" probably also led to an increase in the number of suicides.
These various pathologies are observed among children as well as adults. According to information gathered at the maternity and children's hospital, Kyiv, the number of patients was particularly high among children living within a 30 km radius of Chernobyl.
13. The Belarus and Ukrainian authorities have set up machinery to monitor the evacuated populations. A cancer register has been set up. Staff working in the power-station are now housed in Slavutich, a new town with 30 000 inhabitants, 50 km from Chernobyl. We visited this town, built with the aid of various republics of the former Soviet Union to replace Pripyat where residual radioactivity amounts to 45 µSv/hour (a figure obtained during our visit to the power station).
14. Health monitoring and epidemiological surveys, due in response to the Chernobyl disaster, pose serious problems, however, not only because of the very high number of irradiated persons (3 160 000 including 700 000 emergency workers — the figure given to us) but also the economic situation of Belarus and Ukraine. For example, on 5 March 1996, patients had to be evacuated temporarily from Kyiv's radiological medicine centre, a modern hospital specially built after the 1986 disaster, because the hospital had been unable to pay its electricity bills.
15. The lack of resources was a subject repeatedly raised by everyone we talked to. It also emerged from our visits that international aid has led to rivalry — some hospitals have complained that equipment donated as part of international aid has been shared out unfairly. Furthermore, Belarus officials repeatedly bemoaned the fact that they had not been granted more assistance although the radioactive fall-out was greater in their country.
Conclusions
16. Our visits and interviews with doctors and parliamentarians confirmed the existence of the radiological effects of the Chernobyl accident.
The increase in the number of thyroid cancers among children is considerable. There is undoubtedly a correlation between this phenomenon and irradiation by iodine 131. Increases in other disorders are regularly reported but fluctuate from one information source to another.
While government authorities have done much to deal with the effects of the Chernobyl accident, health care equipment and facilities are still woefully inadequate.
Given all of these considerations, it seems to us highly desirable that aid supplied by western nations and international organisations (such as the European Union's current and future programme, outlined at the recent Minsk Congress) should be pursued and even stepped up.
APPENDIX
Mission programme
Kyiv and Minsk, 14 to 20 March 1996
a. Kyiv (Republic of Ukraine)
14 March 1996
Meetings with:
Mr Victor Ponomarenko Deputy-Minister of Public Health
Mr Volodymyr Kholocha Minister for Problems related to the Protection of Populations in the wake of the Chernobyl accident
Mr Vladislav Torbis Head of Department
Mr Vladimir Yatsenko Member of the Ukrainian Parliament, Chairman of the Chernobyl Committee
The French Ambassador
15 March 1996
Meeting with members of the Chernobyl Parliamentary Committee, in the presence of Mr Yatsenko
Visit to the Endocrinological Clinic. Meetings with:
Mr Mykola Tronko Member of the Academy, Director of the Clinic
Mr Ovsei Epstein Head of the Functional Diagnosis Service
Ms Tatiana Bogdanova Head of the Pathological Anatomy Laboratory
Mr Valery Platonovich Deputy Director, in charge of Chernobyl problems
Visit to the maternity and children's hospital
Meeting with the Director, Mr Anatoliy Matiyko
Visit to the Franco-Ukrainian Centre "Chernobyl Children"
Meeting with Ms Olga Vassilenko
16 March 1996
Visit to the Chernobyl nuclear power station
Meeting with the Deputy Director of the power station and the Director of International Relations
b. Minsk (Republic of Belarus)
18 March 1996
Participation in the First Conference of the European Commission of Belarus, the Federation of Russia and Ukraine, on the radiological consequences of the Chernobyl accident
19 March 1996
Visits to Aksakkovchina Hospital (attached to the Medical Radiology Institute of Minsk)
Meeting with Mr Sergei Korytko, Director
Discussion at a medical staff meeting, attended by a representative of the Association of Parents of Child Victims of Chernobyl
Meeting with the President of the Supreme Assembly of Deputies of Belarus, with Mr Victor Khomich, member of the Belarus Parliament, Chairman of the Chernobyl Committee (with the participation of a representative of the Health Ministry)
20 March 1996
Meeting with the French Ambassador
Reporting committee: Social, Health and Family Affairs Committee.
Budgetary implications for the Assembly: none.
Reference to committee: Doc. 7344 and Reference No. 2018 of 25 September 1995.
Draft resolution unanimously adopted by the committee on 23 September 1996.
Members of the committee: Mr Gusenbauer (Chairman), Mr Rathbone (Vice-Chairman) (Alternate: Lord Dundee), Mr About, Mrs Albrink, Mrs Andnor, Mr Arnau, Mrs Aytaman, Mr Banks, Mrs Belohorská, Sir Andrew Bowden, MM. Bugli, Buzatu, Carvalho Martins, Christodoulides, Chyzh (Alternate: Stepanov), Dees, Deguara (Alternate: Farrugia), Dinçer, Dionisi, Djerov, Mrs Fleetwood, Mrs Gatterer, Mr Geoffroy, Mrs Golemi, MM. Gross, Haack, Hegyi, Mrs Høegh, MM. Horn, Jacquat, Jonsson, Keller, Kollwelter, Kotlar, Koucký, Mrs Kušnere, Mr Leitner, Mrs Luhtanen, MM. Maginas, Małachowski, Marmazov, Mrs Maximus, MM. Mazzone, Melnikov, Mozetič, Nestor, Mrs Van Nieuwenhoven, MM. Niza, Pattison, Paunescu, Mrs Poptodorova, Mrs Pulgar, MM. Raška, Raškinis, Scaglioso, Sharapov, Valkeniers (Alternate: Weyts) (Vice-Chairman), Mrs Vermot-Mangold, Mr Volodin (Alternate: Mrs Oleinik), MM. Vrettos, Wielowieyski.
N.B. The names of those members present at the meeting are printed in italics.
Secretaries to the committee : Ms Coin et Ms Meunier.
1 1By the Social, Health and Family Affairs Committee.
2 1 See Recommendation 1208 (1993) and Doc. 6731 on the health effects of the Chernobyl nuclear accident and the need for stronger international action: text adopted by the Assembly on 5 February 1993 (29th Sitting).
3 2 The rapporteur was accompanied by an expert, Dr Hubert Planel, Professor at the Toulouse Faculty of Medicine. The mission programme is appended.