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Denial, distress and hope: why we need to talk about nuclear war
  1. John Launer
  1. Associate Editor, Postgraduate Medical Journal, London, UK
  1. Correspondence to Dr John Launer, Associate Editor, Postgraduate Medical Journal, London, UK; johnlauner{at}

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Five years ago, when the world felt a safer place than it does at the moment, I wrote in this column about nuclear war and its prevention.1 I described some of the effects of nuclear weapons and discussed the possibility of a nuclear exchange as a result of a technological error or miscalculation – something that has been narrowly averted several times. I highlighted the work of International Physicians for the Prevention of Nuclear War (IPPNW) in raising awareness of the risks of nuclear war, and its contribution to the ending of the last ‘cold war’ in the 1980s.

My article attracted relatively few readers: around a tenth of the number who sometimes read this column on less distressing topics. I was not very surprised. Nuclear war is almost unbearable to think about so people prefer to avoid the subject. Related to this, most people have been hypnotised for decades by the notion of ‘deterrence,’ and the comforting narrative that ‘mutually assured destruction’ will forever prevent politicians from launching nuclear weapons. A dramatic deterioration in international relations in recent months, with explicit threats by Russia to use such weapons if the west resists its invasion of Ukraine, has now shaken people out of that view.2

I can remember a former time when thinking and talking abut nuclear war was unavoidable. During the ‘Cuba crisis’ of 1962, the United States and the Soviet Union deployed missiles near each other’s borders and came close to firing them. I recall a few tense days when our school teachers discussed whether to let us stay at home with our families. We all survived the crisis, but I have never forgotten the fear we felt. It informed my later involvement with IPPNW and has stayed with me in a subdued form, as with many of my generation.

If we once again have to face the real possibility of nuclear war, and the need to talk about this, how should we do so, and could it lead to hope? In what follows, I take the risk of causing distress (and deterring readers once again) but perhaps that may be necessary so that we can each contribute to working for peace. I am writing as someone with a longstanding and passionate belief in global nuclear disarmament, but readers who feel that maintaining nuclear weapons or further rearmament might be more effective in promoting peace may want to put the opposing case in their responses.

First steps

One of the first things we need to do, I suggest, is acknowledge our own personal fears. Who has not thought recently about what such a war might be like – even if we were previously able to dismiss the idea? Perhaps we should now admit that none of us are alone in having such thoughts. We are all in this frightening situation together. Another challenge is to become more informed about nuclear war would actually be like and to be able to educate others about this, as IPPNW has done over the years. There is no shortage of information about what would happen, from descriptions of the devastation at Hiroshima and Nagasaki, to extensive modelling of the effects of modern nuclear weapons, orders of magnitude more powerful.3

Many people hold on to the fantasy that they would be evaporated immediately in a nuclear fireball. This too is an illusion. Such deaths would happen to comparatively few people who were within a few hundred metres of where a missile fell. Tens of thousands of people further off would die from burns or from injuries as their homes and places of work were destroyed. In the ensuing weeks and months, hundreds of thousands at a greater distance from the blast could die from radiation-induced illnesses as the mushroom cloud dispersed.

Any significant nuclear exchange would probably entail hundreds of bombs landing on urban, military and communication centres on each side of the conflict. The consequences would include the destruction of all fuel and food supplies, medical facilities, financial and government institutions and telecommunications. As a result, most people in the northern hemisphere would die of infection, starvation or exposure. A large scale nuclear war would generate quantities of soot that would reduce global temperatures to that of the last ice age, possibly ending civilisation almost everywhere else in the world. Some remote groups might survive as hunter-gatherers in some places on the globe, but this is uncertain.4

Shared responsibility

Another challenging step psychologically may be to recognise our shared responsibility for the global predicament in which we find ourselves. It is relatively easy at the moment for people in the western world to perceive their own side as good and the other as unreservedly evil. It is equally easy to regard one specific foreign leader as mentally unhinged, while seeing our own rulers as balanced and cautious. However justified these views may be, they ignore the wider context, especially as seen by those outside Europe. If a nuclear war does happen, the short-term survivors in neutral countries elsewhere may not discriminate between the two main nuclear powers that over the years have amassed 13.000 nuclear warheads between them, while knowing that only a few hundred might be enough to bring about a global cataclysm.

How will people view the nations that supported such weapons systems, while knowing they were vulnerable to technical error, run by operatives who might be drunk or drugged, and under the command of one or two men who had a few minutes to make decisions that could annihilate hundreds of millions?5 Will any survivors find it excusable that some of these countries deployed nuclear warheads in submarines, for the purpose of exterminating populations elsewhere after their own naval bases and societies had already been destroyed? Can any of us absolve ourselves of insanity for accepting all of this as normal, and choosing not to think about it or fight to change it?

Global disarmament

Facing these truths might lead one to despair but could also inspire action, as it did previously. The Cuba crisis, fearful as it was, prompted governments and the United Nations (UN) to move forward on a Partial Test Ban Treaty, which came into force the following year. This ended all test detonations of nuclear weapons in the atmosphere or the oceans and brought to an end the deadly effects on human health from radioactive fallout. Progress on global disarmament since then has occurred in fits and starts, generally with the wholehearted support of non-aligned nations, but with a lack of commitment, or with active opposition, from the nuclear powers and their allies.

Last year, however, a significant advance took place: a UN Treaty on the Prohibition of Nuclear Weapons (TPNW) finally came into force. This banned the development, testing, production, and use of all nuclear weapons. The treaty has largely been to the work of ICAN, the International Campaign to Abolish Nuclear Weapons, strongly supported by IPPNW and other peace movements, None of the nuclear powers or members of NATO have signed the treaty so far, but 50 other nations have done so. On 21 June 2022, these signatories are meeting in Vienna to move forward on disarmament and to press other countries to join them. Is it possible that the current terrible conflict in Europe may shock governments and populations into action once again? Beatrice Fihn, executive director of ICAN, certainly hopes it will. She writes:

‘The world is waking up from a 30 year fantasy where the nine nuclear armed states and their allies convinced people that nuclear weapons could exist without ever being used. The past month has made it clear that nuclear weapons do not prevent war, and nuclear war is closer than ever. The only solution is to immediately prioritise nuclear disarmament.’

‘Responsible states and civil society have been hard at work to build this path. The TPNW is the only internationally recognised multilateral disarmament framework that can achieve complete, verifiable and irreversible nuclear disarmament. It is the product of decades of work, collaboration, and centres the voices of those who were impacted by nuclear weapons and those who have pushed for their abolitions across many generations.’6

We should give every possible support to the campaign for disarmament. You can do this directly through ICAN and by supporting IPPNW, or you can join one of its national affiliates. These include Medact in the United Kingdom, Physicians for Social Responsibility in the United States, or one of the other health workers’ organisations around the world who are working for peace.7 Doing so has never been more urgent.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.