Ihor Kuzin, Deputy Minister of Health, Chief State Sanitary Doctor

Since March 2022, one of the largest nuclear power plants in Ukraine and Europe has been seized by Russian troops. Back then, it came as a shock to many when cameras located at ZNPP broadcast live the shelling of the plant by Russian shells. More than a year later, Ukrainians have already realized that there are no limits for the Russian military and political leadership in matters of moral and ethical character or global security. The Ukrainian government, represented by the President of Ukraine, the Ministry of Foreign Affairs, and experts, has repeatedly emphasized to the world that the issue of the ZNPP cannot be a matter of war between Russia and Ukraine alone, but concerns the entire world. Recently, Ukrainian intelligence has stated that the risks of a terrorist attack by Russia on the ZNPP have decreased, but have not completely disappeared. However, our experience shows that there is no point in relying on someone's "good will." The state is preparing for emergencies and their consequences, including in the medical field.

Ukrinform talked to Deputy Minister of Health, Chief State Sanitary Doctor of Ukraine Ihor Kuzin about the readiness of medical institutions for a possible terrorist attack at the Zaporizhzhia NPP.

AT LEAST 190 HOSPITALS IN UKRAINE ARE READY TO RECEIVE PATIENTS IN CASE OF EMERGENCY

- Recently, there have been many recommendations on how to act in the event of a Russian terrorist attack on the ZNPP. At the same time, the information field has already voiced the thesis that the risks of a terrorist attack have somewhat decreased. And yet, in the event of an emergency, how ready is the medical sector to respond to the consequences of a terrorist attack and radiation threats?

- As long as the occupants are on the territory of ZNPP, the risks of a terrorist attack will remain. The plant must be controlled by the Ukrainian authorities to have access to all the necessary information. Therefore, the risks remain, and they must be taken into account when planning all our activities.

Regarding preparedness. We have at least 190 hospitals that are contracted under the National Health Service of Ukraine (NHSU) Emergency Preparedness Package ["Readiness of a healthcare facility to provide medical care in emergency situations"] These hospitals have been contracted for the second year, previously it was a COVID-19 package, now it is an emergency preparedness package. It stipulates that a medical facility is ready to respond to chemical, biological, radiation, and nuclear risks. It sets out a minimum list of medicines to provide medical care to patients who are admitted or may be admitted to such a facility. The selection of these medical facilities, their contracting and operation are tied to the respective territory to be able to hospitalize those patients who may appear there in the event of either the use of weapons of mass destruction or an accident.

That is why the Ministry of Health and local health departments are now focusing on working out all the mechanisms at the level of each region, on strengthening these institutions at the regional level. In particular, these hospitals are involved in relevant exercises on a regular basis to find out how well certain mechanisms are worked out.

These include training for medical staff and command and staff exercises, where we practice interaction with other institutions and organizations.

The second area of strengthening these medical institutions is to provide them with appropriate medical devices and personal protective equipment. Most often, we use the humanitarian aid that comes to the country for this purpose. The third block is to train medical workers in the specifics of providing medical care in the event of radiation, nuclear, chemical or biological threats. International partners and the WHO are working on this. Also, at the level of each region, there are approved patient routes that patients are sent to in case of certain threats, if it is a biological, radiation or nuclear threat.

- For what reasons can patients be hospitalized in such hospitals? Depending on what may happen at ZNPP, what are the reasons for hospitalization?

- Medical institutions that are specifically contracted under the emergency response package will accept those patients who need emergency medical care during the evacuation or if they come with any urgent conditions. This means that in the event of a hypothetical accident, if an emergency occurs, a decision may be made to evacuate the population of a certain part of the territory. The decision to evacuate is made by local authorities depending on the forecast of a particular emergency. The nearest healthcare facility contracted under the disaster preparedness package will receive all patients seeking emergency medical care - heart attacks, strokes, or any injuries that occurred during evacuation activities. This assistance will be provided in full. In the event of a chemical threat, all patients who need emergency medical care will be hospitalized in such a medical facility.

Regarding radiation threats. Of course, we do not expect a significant influx of patients to these hospitals. Because any degree of radiation sickness does not develop within one or two days, but at least within two weeks. Depending on what type, nature of the accident, we will understand which hospitals we will need to include to provide medical care for patients with radiation sickness. And there are several options here. For a mild, moderate degree, medical institutions that are contracted under the emergency preparedness package will be involved. For extremely severe or severe degrees, the Center for Radiation Medicine, a medical institution of the National Academy of Medical Sciences, which is specialized in radiation threats and risks, will be used.

WE CONSIDER ALL POSSIBLE SCENARIOS WHEN TALKING ABOUT A TERRORIST ATTACK AT ZNPP

- Many experts, including scientists and nuclear power experts, have already spoken out about the threats and risks of a terrorist attack at ZNPP. In particular, there was a thesis that there should be no consequences like those after the Chornobyl accident, that the risks of radioactive iodine emissions are low, and that the territories could be contaminated, in particular, with radioactive isotopes of cesium and strontium. In this regard, what do citizens need to know?

The worst-case scenario is that a power unit is brought online and then a terrorist attack is committed on an already operating reactor

- It is difficult to make definite predictions here. Currently, a certain number of power units are suspended and not in operation. Indeed, when a nuclear power plant is not in operation, there is no radioactive iodine that can be released during a potential accident. But we need to consider all possible emergency scenarios, since we are talking about terrorism. The worst-case scenario is that a power unit is brought online and then a terrorist attack is carried out on an already operating reactor. Then a release of radioactive iodine may indeed occur.

Regardless of the specific isotopes within the possible release, they will lead to essentially total exposure of a certain number of people in the affected area. And the average affected area varies from 30 to 50 km around nuclear power plants. This distance depends on the capacity of nuclear power plants. In the case of ZNPP, we are talking about a 50-kilometer zone, since it is one of the most powerful nuclear power plants. Therefore, we expect that the level of contamination in this area may be such that evacuation is likely to be necessary if the release and accident are of the highest possible level. But I want to emphasize that more detailed forecasts can be provided when we have detailed information about the actual emergency that has already occurred.

- What will this mean for citizens?

- The basic first action that should be universal for everyone is that people should understand that in the event of an accident, they should go indoors, close windows and doors, take off dirty clothes, take a shower, stay indoors, and wait for information from official sources.

Why this is important: When a potentially dangerous situation or accident occurs, modeling is carried out, additional research of environmental factors is conducted, the scale of the accident is determined, and safe evacuation routes are formed. Only then can the authorities provide official information on the safety of evacuation routes. What to do to protect yourself from potentially high radiation doses. First of all, do not panic, do not try to evacuate from a certain territory on your own, because there is a risk of going in the direction of the highest contamination, not the lowest, to a dirty zone, not a clean one. And there are many other risks.

It should be understood that any radiation accident will always lead to radiation contamination of the area. And everything will depend on the isotopic composition that will be released. Further actions will depend on when and how much will be released, provoked by a terrorist attack. If the levels are high, special measures will be taken to clean up the soil. This can be either adding an additional layer of soil or, conversely, digging it up and removing it to make the area habitable. And many other activities that will take place after the emergency itself.

EVEN IN CASE OF A LOCALIZED RADIATION ACCIDENT, AN EXTENDED LIST OF STUDIES WILL BE CONDUCTED

- If such an accident occurs, what happens to the water supply? Are there any risks of radioactive contamination of water?

In the recommendations, we advise to have at least a week's supply of water in a sealed package

- The first thing people need to listen to is the advice to stockpile water, food, clean clothes, especially if they live in the area of a potential accident. We are talking about areas close to the ZNPP. In such recommendations, we advise you to have at least a week's supply of water, which should be in a sealed package. This can be either ordinary water from the water supply network or filtered water, any water that will last at least a week. Depending on the type of water intake, where the radioactive cloud is moving, a decision is made on whether surface water can be used for water intake. Additionally, drinking water will be tested for radioactivity, the presence of background, which may or may not exceed the norm. Everything will depend on the extent to which surface water intakes will be contaminated. After such studies are done, a final decision will be made on the possibility or impossibility of using drinking water from the water supply network. If the use of the water supply network is banned, local authorities will provide drinking water, for example, as was the case in Kherson region. If the decision is made that the water is suitable for consumption, then an official notification will allow its use. I would like to note that even in the case of radioactive contamination of surface water bodies, radioactive dust will still settle in the form of silt over time, and after some time the water will be suitable for consumption. But some time needs to pass. And after any radiation accident, even a local one limited to a hundred-meter zone, there will still be an expanded list of studies and controls to find out all possible risk factors of internal exposure to humans.

- Who will carry out such control of the water supply network?

- The main area of responsibility lies with utility companies, water utilities that provide centralized water supply. They are responsible for compliance with all safety and quality indicators. If they do not have or do not have such capacities, they conclude contracts with other laboratories that do. In accordance with the requirements of state sanitary rules and regulations, they take water samples at least once every two weeks and send them to laboratories that have such equipment. The Centers for Disease Control and Prevention of the Ministry of Health have the appropriate equipment to test both food and drinking water. And we, for our part, will also provide additional control and, if necessary, inform and help water utilities.

Natalia Molchanova

Photo courtesy of the Ministry of Health, Yevhen Kotenko