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HOME > J Prev Med Public Health > Volume 58(2); 2025 > Article
Perspective
 Almost 80 Years After Hiroshima and Nagasaki: Are World Governments and Healthcare Systems Ready for a Nuclear War?
Céleo Ramírez1orcid, Reyna M. Durón2corresp_iconorcid
Journal of Preventive Medicine and Public Health 2025;58(2):227-229.
DOI: https://doi.org/10.3961/jpmph.24.577
Published online: March 31, 2025
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1Hospital del Valle, San Pedro Sula, Honduras

2Instituto de Investigaciones One Health, Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras

Corresponding author: Reyna M. Durón, Instituto de Investigaciones One Health, Universidad Tecnológica Centroamericana, Boulevard Kennedy, V-782, Tegucigalpa 11101, Honduras, E-mail: reyna.duron@unitec.edu.hn
• Received: October 4, 2024   • Revised: November 22, 2024   • Accepted: November 29, 2024

Copyright © 2025 The Korean Society for Preventive Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Since the detonation of the first atomic bomb during World War II, geopolitical issues and armed conflicts have reminded us of the threat posed by nuclear weapons in the short, medium, and long term. The potential consequences include millions of deaths and severe injuries from blast, heat, and acute ionizing radiation. Whatever the country, in the post-acute stage of a nuclear attack, the first challenge for health and rescue personnel will be gaining access to affected populations amidst destroyed infrastructure, hazardous radioactivity, and limited health facilities and medical supplies. Subsequently, the focus will shift to providing timely and appropriate treatment for survivors, addressing environmental damage, and combating malnutrition. Beyond the immediate human toll, the destruction of city infrastructure and the loss of centuries of cultural heritage are also at stake. Governments and health systems must prepare for these scenarios, although any medical or mitigation response may prove inadequate to halt the devastating impact of a failed disarmament or nuclear non-proliferation treaty. Scientists should raise awareness about the dire consequences of nuclear warfare and the realities of a post-nuclear era.
  • Keywords: Atomic warfare, Cancer, Disasters, Emergency prepardness, Radioactivity
In this post-coronavirus disease 2019 era, the World Health Organization is urging nations to prepare for future pandemics [1]. However, the potential use of biological, chemical, and particularly nuclear weapons in upcoming conflicts presents new challenges. Many governments and healthcare systems around the world may lack adequate response plans for the ensuing catastrophes [2]. Currently, medical education is refocusing on the health determinants of acute and chronic diseases. However, this scope needs to be expanded, as there are already reported gaps in medical preparedness for nuclear emergencies [3].
Currently, it is estimated that there are 13 000 nuclear weapons worldwide, with approximately 90% of these owned by Russia and the United States. The remaining 10% are held by China, France, the United Kingdom, Pakistan, India, North Korea, and Israel [4].
Nearly 80 years ago, the world witnessed the devastating effects of atomic bombs when Hiroshima and Nagasaki were struck, resulting in 140 000 (40% of its total population) and 73 000 (27% of its total population) deaths, respectively. Hiroshima was hit by a 15-kiloton bomb, while Nagasaki faced a 21-kiloton explosion. Remarkably, these bombs were 3000 times less powerful than the Tsar Bomba, a Russian thermonuclear bomb [5,6]. Thousands of survivors in those cities died outdoors hours later from burns, multiple traumas, and a lack of timely medical attention, while many others succumbed days or weeks later due to complications from radiation-induced bone marrow failure, which led to uncontrollable hemorrhages and infections. In the following years, there was an increased incidence of various types of cancer (primarily leukemia), teratogenic effects, posttraumatic stress disorder, and other diseases [5].
Approximately 90% of the medical and paramedical personnel in Hiroshima and 43% in Nagasaki were killed instantly. This disparity may be attributed to the fact that Nagasaki Medical College Hospital, located only 600 meters from the blast site, was the strongest concrete building in the city [5]. This underscores the importance of investing in a substantial number of anti-nuclear shelters as a primary measure for every country to protect its citizens from nuclear attacks. However, implementing this effectively would pose significant budgetary and logistical challenges for many countries worldwide. Nonetheless, developing inclusion or exclusion criteria for the use of nuclear shelters and communicating these criteria clearly and transparently to the public would raise several ethical concerns.
After a nuclear attack, with the subsequent loss of telecommunications and many land communication routes, available rescue and health personnel would face significant challenges in reaching the affected areas. They would risk their lives amid destroyed infrastructure, dangerous radioactivity, and limited healthcare facilities and supplies. Triage would become a critical task, requiring decisions on how to deliver curative or palliative interventions to optimize efforts and medical supplies.
Governments must also prepare to address the food insecurity and subsequent malnutrition among adults and children that could arise in the short term from a collapse of global food supply chains. Both regional and global economies would likely face crises as well. Additionally, radioactive contamination of fertile lands and freshwater sources, along with the potential for a nuclear winter, could severely impact crop production, exacerbating global food shortages for an indefinite period [7].
Another potential scenario during a nuclear or non-nuclear conflict could involve a deliberate attack on any of the world’s existing nuclear power plants. The environmental and public health damage following the Chernobyl nuclear accident rendered the city permanently uninhabitable, with both local and remote contamination continuing for decades. Although the effects on public health and the environment were less severe following the Fukushima nuclear plant disaster after the 2011 tsunami, the repercussions of both nuclear accidents are still evident today [8].
An unprecedented global migration crisis would occur, compounded by widespread malnutrition and poor sanitation, creating an ideal environment for the outbreak of epidemics and even new pandemics [9]. Governments worldwide should establish designated zones within their territories for refuge, healthcare, and other basic needs. The availability of medications for managing major chronic diseases such as heart disease, cancer, and diabetes mellitus, as well as access to treatment for the millions of nuclear attack survivors, would be severely compromised by a global shortage of medicines [10]. Amidst this catastrophe, there is also the risk of descending into anarchy.
If all efforts to prevent nuclear war fail, nations that did not participate or were not directly affected must collaborate to devise common strategies for addressing the environmental, economic, social, and public health consequences of a new nuclear age. Effective governance is crucial in developing emergency plans; therefore, all countries will need to establish new agreements for the common good and to prevent future nuclear attacks.
Sanitary systems must be effective on a global scale, as a nuclear disaster does not respect geographical boundaries, and mitigating its impact will require costly transnational strategies. Poverty and social inequality, already severe in many low-income countries, render these regions particularly susceptible to diseases linked to nuclear radiation. Challenges will include severe skin diseases caused by ultraviolet exposure due to significant damage to the ozone layer, and outbreaks of infectious diseases driven by poor hygiene and a lack of medications. Additionally, shifts in the prevalence of communicable and non-communicable diseases will necessitate updates in health personnel training and therapeutic guidelines to address new epidemiological scenarios.
A nuclear disaster would usher in a new social order, compelling leaders and humanity at large to choose between further destruction and recovery. It is likely that some regions will become sparsely populated due to the immediate impact of a nuclear attack. Conversely, extensive areas may become uninhabitable due to radioactive contamination and the widespread destruction of infrastructure, including urban, economic, and telecommunications systems. In a post-nuclear world, natural resources would be far scarcer than those available to the first human settlements, from which major empires and powers emerged—empires that ultimately chose to activate nuclear power and irrevocably alter the course of history.
Any estimate of the effects of a large-scale nuclear war may be imprecise, and it appears that any medical or mitigation response would be insufficient. However, governments around the world must prepare in all possible areas to counteract the impending trail of death that would follow humanity’s failure to prevent a nuclear escalation through diplomatic efforts.
A total nuclear disarmament at the global level currently seems utopian. However, as members of the scientific community, we must promote awareness in both political and civil discourse about the potential consequences of a nuclear conflict, whose impact extends beyond a mere health crisis.

Ethics Statement

This paper is a perspective, so it did not need ethical approval.

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

This study was supported by the Universidad Tecnológica Centroamericana.

Acknowledgements

None.

Author Contributions

Both authors contributed equally to conceiving the study, analyzing the data, and writing this paper.

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      Almost 80 Years After Hiroshima and Nagasaki: Are World Governments and Healthcare Systems Ready for a Nuclear War?
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