In light of Israel's ongoing concern with Iran's nuclear program and its potential threat, questions arise about whether the country is prepared for the consequences of a nuclear attack on its territory. Are there enough shelters? Is there sufficient awareness among civilians? Do hospitals have proper protocols and equipment, and are there adequate medications to save those exposed to radiation?
To answer these questions, we spoke with Arik Avni, head of the radiation department at Pluri, a biomedical engineering company specializing in cellular therapy, about the damage that could occur following a nuclear bomb detonation, healthcare system functioning, and the types of medications that should be stockpiled in advance to treat victims.
"First, it's important to know that the number of casualties and extent of damage from a nuclear bomb depend on the type and size of the bomb. In the case of a 'regular' atomic bomb, there would be several impact zones. Within 1-2 kilometers (0.6-1.2 miles) from the center of impact, there would be almost complete destruction and high mortality within minutes after the explosion itself. In the second zone, 2-10 kilometers (1.2-6.2 miles), there would be exposure to ionizing radiation, causing severe injuries and burns. Some of these victims will die quickly unless they receive prompt and effective treatment," Avni said.
"In the more distant zone, ranging from 10-50 kilometers (6.2-31 miles) and sometimes even further, the main problem is radioactive contamination – fallout – that moves with the wind. In this range, people may be exposed to radiation for extended periods and develop Acute Radiation Syndrome (ARS)," he added.
What are the main damages caused by this syndrome?
"First, exposure particularly affects bone marrow, the digestive system, and the nervous system. It also causes traumatic burns, blast injuries, and secondary infections. This is the initial impact during the months following the explosion itself. However, chronic diseases such as cancer develop in the body over time."
"Beyond the direct impact on people exposed to radiation in this area, one of the effects of this reality is the collapse of the healthcare system, as it will need to handle mass casualties," Avni emphasized. "The number of victims would be truly enormous. This involves the need to isolate victims, test and identify radiation levels in each victim, and conduct mass evacuations, which will burden not only the healthcare system that will need to use alternative facilities but also other state systems that will need to find housing for evacuees, food, clothing, and other support activities. The mental health system will also experience an unprecedented emergency reality due to the extensive psychological effects that will affect many people."
The massive scale of expected damages requires comprehensive advance preparation by all authorities, Avni said. "It's very important to train all medical teams to deal with radiation injuries. Many victims will seek treatment, and if the teams are not experienced, the condition of many victims could deteriorate rapidly. Additionally, teams and all security forces in the field need to have personal protective equipment that allows them to be in the contaminated area without being harmed. Obviously, large shelters and emergency plans need to be prepared – including a rapid and efficient mass evacuation plan.
"During the response to victims, it's important to have life-saving medications in storage and equipment for monitoring radiation and decontaminating the bodies of victims and caregivers. Additionally, there are more advanced treatments including infusions, antibiotics, immune support, and treatment for ARS symptoms."
Why is radioactive radiation so dangerous?
"Radioactive radiation damages any tissue it passes through, and high exposure can have immediate and long-term effects. When the body is exposed to high levels of radiation, it damages cellular structures such as blood cells in the bone marrow – hematopoietic stem cells – which are particularly sensitive to radiation because they multiply at high frequency. Radiation affects cell division processes, leading to severe damage to several critical systems simultaneously. Bone marrow, where blood cells are formed, is one of the areas most vulnerable to radiation.
"Radioactive radiation acts on cells with high energy, strong enough to break bonds in DNA molecules within cells. The damage to DNA in bone marrow cells causes severe impairment of cell regeneration ability and even cell death."
What medications should the state maintain to better assist victims?
"First, the state needs to maintain a significant emergency supply of fluid treatments. It also needs to maintain broad-spectrum antibiotics, electrolytes, and blood and platelet transfusions. There are also medical treatments for acute radiation syndrome that have already been approved worldwide. These are medications that accelerate the production of white blood cells in bone marrow. However, it should be noted that this treatment is limited to producing white blood cells and does not provide a comprehensive solution that can address all damages to the hematopoietic system.
"There are additional advanced treatments that can help. Our company produces a drug called PLX-R18, a cellular therapy based on placental cells that assists in bone marrow regeneration and improves the production of white blood cells, red blood cells, and platelets."
According to Avni, tests have shown that this type of treatment greatly improves the victim's chances of survival and is "suitable for a scenario of mass casualties with thousands of victims, where treatment is delayed due to the inability to reach all victims immediately."
