Radiological Protection of People and the Environment in the Event of a Large Nuclear Accident

Draft document: Radiological Protection of People and the Environment in the Event of a Large Nuclear Accident
Submitted by ACRO, ACRO, France (
Commenting on behalf of the organisation

A nuclear accident cannot be reduced to a radiation protection problem as it has inevitably social, environmental and economic consequences. The daily life of people can be deeply affected. Thus, the ICRP has drafted a new publication on large accidents that takes into account various aspects of the response considering all impacts. ACRO welcomes this initiative but regrets that the draft submitted to public consultation has severe shortcomings.

Reference levels

The main problem is that reference levels are not protective enough. First of all, ICRP considers that “there is reliable scientific evidence that whole-body exposures on the order of ≥100 mSv can increase the probability of cancer occurring in an exposed population. Below 100 mSv, the evidence is less clear. The Commission prudently assumes, for purposes of radiological protection, that even small doses might result in a slight increase in risk” (22). Such statement does not take into account all the results of the scientific literature. As a matter of facts, this draft report reproduces the levels of the ICRP publication 103, which are the same as in ICRP publication 60 which dates back to 1990. These levels are mainly based on the follow-up of the Hiroshima and Nagasaki hibakushas (TD86). There are many other studies in radiobiology and in epidemiology that strongly suggest the existence of stochastic effects below 100 mSv and that the linear and non-threshold relationship is based on facts and not only "on a precautionary basis for the management of radiation protection." See for example Refs. [LD].

ACRO urges ICRP to reduce the reference levels and limits it recommends.

After a nuclear disaster, ICRP recommends: “For protection of responders after the urgent emergency response, the reference level should not exceed 20 mSv per year. For people living in long-term contaminated areas following the emergency response, the reference level should be selected within or below the Commission’s recommended band of 1–20 mSv for existing exposure situations, taking into account the actual distribution of doses in the population and the tolerability of risk for the long-lasting existing exposure situations, and there is generally no need for the reference level to exceed 10 mSv per year. The objective of optimisation of protection is a progressive reduction in exposure to levels on the order of 1 mSv per year” (j).

As this statement is hardly understandable, ICRP adds: “The Commission considers that annual exposures of the order of 10 mSv during the first years of the recovery process, added to exposure received during the emergency response, could lead to total exposures greater than 100 mSv in a relatively short period of time for some affected people. Therefore, it is not recommended to select reference levels beyond 10 mSv per year when it is estimated that such exposures could continue for several years, which may be the case once the recovery phase starts. In addition, experience from Chernobyl and Fukushima has shown that for exposure levels of the order of 10 mSv per year, it is difficult – given the multiple societal, economic, and environmental negative consequences associated with the long-lasting presence of contamination, and the numerous restrictions imposed on everyday life by the protective actions – to maintain sustainable and decent living, working, and production conditions in affected areas” (80).

The introduction of a new reference level at 10 mSv/y is welcome since Japan, for example, sticks to 20 mSv/y more than 8 years on in Fukushima. The progressive reduction in exposure to levels on the order of 1 mSv/y or below is not protective enough without a time frame. In contrast, U.S. guidelines require relocation when people may be exposed to 20 mSv or more of radiation in the first year and 5 mSv or below from the second year. The long-term objectives are to keep doses at or below 50 mSv in 50 years. The relocation protective action guide addresses post-plume external exposure to deposited radioactive materials and inhalation of re-suspended radioactive materials that were initially deposited on the ground or other surfaces [USEPA1992, FEMA2013].

ACRO urges ICRP to introduce other reference levels accompanied by specific time frame for the cumulated doses over the years as in the USA.

It is worth reminding that the population may have already been exposed to doses up to 100 mSv during the emergency phase.

Regarding the emergency phase, the ICRP states: “For the optimisation of protective actions during the emergency response, the Commission recommends that the reference level for restricting exposures of the affected population and the emergency responders should generally not exceed 100 mSv. This may be applied for a short period, and should not generally exceed 1 year” (77). But it later explains that “an emergency exposure situation may be of very short duration (hours or days), or it may continue for an extended period of time (weeks, months, or years)” (85). An emergency that requires urgent actions cannot last months or even years! This is not consistent with ICRP’s reference level for emergency should not exceed one year. If the emergency lasts longer, there is no reference level anymore.

Moreover, as explained by ICRP, “for emergency response decisions, in the event of a nuclear accident, especially in the early phase, the need to act quickly is not conducive to stakeholder involvement” (51). Thus, extending emergency beyond reasonable periods of time will hinder stakeholder involvement.

In the case of the accident at the Fukushima dai-ichi nuclear power plant (NPP), the ICRP recalls that “on 22 April 2011, the area outside the 20-km zone for which it was estimated that the projected dose within 1 year of the accident could reach 20 mSv was designated as the ‘deliberate evacuation area’. The national government issued an order that relocation of people from the deliberate evacuation area should be implemented in approximately 1 month. The criterion for relocation was selected by the government with consideration of the 20–100-mSv per year band of reference levels for emergency exposure situations recommended by ICRP” (B7). An evacuation order released 42 days after the emergency declaration with more than a month to comply is NOT an emergency evacuation! Japanese authorities betrayed their citizen by referring to the emergency exposure situation.

As a conclusion, the emergency phase should be as short as possible otherwise authorities will refer to highest reference values and exclude stakeholder involvement. Note that on a purely physical point of view, short-lived radioelements generally dominate the external exposure for a month and then longer-lived nuclei such as radioactive caesium dominate. There is no need to extend the emergency phase to long duration.

ACRO urges ICRP to reduce the emergency phase to the shortest possible period of time that should not exceed a month.

Protection of children and pregnant women

ICRP “recommends paying particular attention to children and pregnant women, for whom radiological risks may be greater than for other groups of individuals. Strategic social and economic activities should also be the subject of specific protection provisions in implementation of the optimisation process.” (65) As a matter of facts, foetus and young children are more sensitive to radiations than adults but most of dose limits and reference levels were derived for adults. ICRP’s recommendations to enforce a better protection are very deceiving. They include:

- “thyroid dose monitoring in the early phase [that] is important for children and pregnant women.” (102)

- “administration of stable iodine during the early phase [that] is particularly important for pregnant women and children.” (130)

- “control of the radiological quality of milk, which is an important part of the diet of children in most countries, [that] is particularly important during the early phase of an accident because it is a potential source of thyroid exposure from radioactive iodine.” (134)

- “A subcategory of health monitoring [that] is the follow-up of potentially sensitive subgroups (e.g. children, pregnant women);” (198)

ACRO urges ICRP to introduce more protective limits and reference levels for pregnant women, infants and children.

Evacuation and protection of populations

Surprisingly, the executive summary of the draft report does not mention displaced people and their protection. Later, in the main text ICRP claims that “worldwide experience after nuclear and non-nuclear accidents shows that nations and individuals are not willing to readily abandon affected areas” (57), which is not correct. In Fukushima, only 23% of the people who were forced to evacuate have returned after the evacuation orders were lifted. In addition, many families evacuated on their own, without any support.

Moreover, ICRP only considers “temporally relocation”. In both Chernobyl and Fukushima cases, there are still vast zones where nobody is allowed to come back and many families are permanently relocated. Why are they ignored by the ICRP?

ICRP might consider that once they left the contaminated areas, they are not concerned by radiation protection anymore and they do not deserve to be considered. But they escaped radiation exposure!

Relocated people and returnees should benefit from the same consideration in the publication. Relocated people are suffering from financial difficulty, discrimination and marginalisation (bullying in case of children). Many feel guilty to have abandoned their hometown, those who remained and those who returned. They need special protection and consideration.

ICRP’s draft only considers populations living in contaminated territories who did not evacuate or who returned. Note also that many returnees do not live in their home but have been relocated in a new dwelling in their hometown. In some towns and villages, they have to live in a completely new district.

ICRP notes that “temporary relocation is, however, associated with psychological effects. Several studies carried out after the Fukushima accident showed significant increases in the incidence of depression and post-traumatic stress disorder among relocated residents of Fukushima Prefecture” (136). But living in contaminated territories is also associated with psychological effects and stress that is never mentioned. Field work conducted in Japan indicates that this trauma is real [Shinrai2019 and references therein]. The insistence on the “psychological effects of relocation” hides the trauma of those who stayed, or returned, and feel “trapped” in this unchosen situation.

The only suggested solution is the dissemination of radiological culture to learn how to live in contaminated territories with an optimised radiation exposure to help people to address their daily life concerns. However, ICRP never considers that this could be a too heavy burden for many and that most families would like to offer another future to their children, free from a burden of constant checking and assessment of every move of their daily lives.

ICRP mentions only once that “individuals have a basic right to decide whether or not to return. All decisions about whether to remain in or leave an affected area should be respected and supported by the authorities, and strategies should be developed for resettlement of those who either do not want or are not permitted to move back to their homes” (158). This is not enough and should be more substantiated by practical advices to the authorities.

ACRO urges ICRP to seriously consider displaced populations and refer to the Guiding Principles on Internal Displacement of the United Nations’ Economic and Social Council [UNESC1998]. Recalling that “displacement nearly always generates conditions of severe hardship and suffering for the affected populations”, these Guiding Principles on Internal Displacement provide them guaranties. In particular, “competent authorities have the primary duty and responsibility to establish conditions, as well as provide the means, which allow internally displaced persons to return voluntarily, in safety and with dignity, to their homes or places of habitual residence, or to resettle voluntarily in another part of the country. Such authorities shall endeavour to facilitate the reintegration of returned or resettled internally displaced persons.” They add that “internally displaced persons have the right to be protected against forcible return to or resettlement in any place where their life, safety, liberty and/or health would be at risk” and that “special efforts should be made to ensure the full participation of internally displaced persons in the planning and management of their return or resettlement and reintegration”.

Vulnerable people are particularly at risk in case of a severe nuclear accident. ICRP acknowledges that “during the months following the Fukushima nuclear accident, a general increase in mortality was observed (excluding deaths due to the earthquake and tsunami), especially among elderly people. This increase cannot be attributed to the direct health effects of radiation, although it is a direct consequence of the accident” (40). Also, “the unplanned evacuation of elderly or medically-supervised people from nursing homes may have caused more harm than good for these people” (54). Thus, “evacuation can be inappropriate for certain populations, such as patients in hospitals and nursing homes, as well as elderly people, if it is not well planned” (124).

ACRO agrees with ICRP on this point, but considers that extended sheltering of vulnerable people in exposed areas should be well prepared. Staff should agree to take care of patients in spite of the radiological situation.

Confidence and stakeholder’s involvement

In its draft report, ICRP frequently explains that a nuclear accident generates “complexity” or “complex situations” without explaining what does such expressions mean. See e.g. § (15). Without nuclear accident, life and society are already complex. But individuals and groups have built up mechanisms to face such complexity based on trust. A nuclear accident challenges this confidence and affected population are lost in front an unprecedented situation. Thus, the main challenge for authorities is to deliver trustworthy information.

ICRP mentions once “a collapse of trust in experts and authorities” (29) and suggests that “protective actions should contribute to regaining the confidence of all people in relation to the affected area” (66). But confidence should be kept rather than restored!

The selected protective actions should be explained and justified to the affected populations. Then, regular reassessment is necessary knowing the large uncertainties underlying the early decision process. Thus, the step-by-step process shown in Fig. 2.2 should be extended to include explanation and re-evaluation. Furthermore, stakeholder involvement should be specifically mentioned here.

ICRP explains that “the optimisation process must recognise that there are inevitable conflicting interests, and seek to reconcile the differences and needs of various groups. For example, producers of goods, services, and food will wish to continue production, but their ability to do so is affected by the willingness of consumers to receive and purchase these items” (66). In its publication on Ethical Foundations of Radiological Protection, ICRP ignored these conflicting interests and ACRO considered in its comments that it was a major shortcoming. Thus, ACRO is satisfied to see that they are acknowledged here. However, the response is disappointing: “protective actions should contribute to regaining the confidence of all people in relation to the affected area” (66). That’s all!

When ICRP recommends that “any decision altering a radiation exposure situation should do more good than harm” (48) does it consider individuals, groups, the nation? Responders will be exposed to save others. ICRP further writes: “Responsibility for judging justification usually falls on the authorities to ensure an overall benefit, in the broadest sense, to society, and thus not necessarily to each individual” (50). This position is in conflict with the right to health of the Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family”.

Anand Grover, Special Rapporteur to UN Human Rights Council, noted in his report on Fukushima: “ICRP recommendations are based on the principles of optimisation and justification, according to which all actions of the Government should be based on maximizing good over harm. Such a risk-benefit analysis is not in consonance with the right to health framework, as it gives precedence to collective interests over individual rights. Under the right to health, the right of every individual has to be protected. Moreover, such decisions, which have a long-term impact on the physical and mental health of people, should be taken with their active, direct and effective participation” [HRC2013].

ACRO urges ICRP to seriously address the conflicts of interest inherent to its radiation protection principles with a sincere involvement of stakeholder.

On the long term, ICRP promotes co-expertise process and stakeholder involvement. ACRO also supports such an approach. However, “ICRP dialogues” in Fukushima promoted in the draft report are not an example to follow as they were limited to people agreeing with ICRP’s point of view and only implemented in very few selected towns. Opponents were not allowed to attend the meetings. Such meetings can only generate frustrations to the people who are excluded or feel excluded. Dialogues should be open to all component of the affected populations.

At public meetings, participants are confronted with authorities and their experts to deal with complex issues. People are therefore not in a position to make their views considered, unless they are assisted by experts they have chosen themselves. After a severe nuclear accident, people are even more vulnerable and cannot stand up to the authorities. Participants should also be able to forge their own point of view without authorities before engaging dialogue with authorities. Moreover, the co-expertise process presented in the draft report is only for a minority of the population that is ready to fight for recovery and rehabilitation of the contaminated zone. It completely ignores populations who would prefer other solutions such as relocation. They would also need a co-expertise process!

Finally, regarding the characterisation of the radiological situation, ICRP writes: “Experience shows that the pluralism of organisations involved in implementation of the radiation monitoring system (authorities, expert bodies, local and national laboratories, non-governmental organisations, private institutes, universities, local stakeholders, nuclear operators, etc.) is an important factor in favour of confidence in the measurements among the affected population” (161). ACRO fully agrees with this, but accumulating data is not enough and citizen monitoring should be supported financially. Data should be easily accessible to anybody and independent analysis should be supported. Trends and modelling are also important for a decision process.

ACRO urges ICRP to reconsider its recommendation on the co-expertise process and stakeholder involvement.

Protection of the responders

Regarding the emergency responders, ICRP writes: “When an occupationally exposed worker is involved as a responder, the exposure received during the response should be accounted for and recorded separately from exposures received during planned exposure situations, and not taken into account for compliance with occupational dose limits” (120). This recommendation is not acceptable.

Exposure doses have the same impact, whether taken in an emergency situation or during planned interventions, and they are cumulative. In Fukushima, many workers are residing in contaminated areas where they continue to be exposed. These additional doses are not taken into account.

ACRO urges ICRP to reconsider its position: recording of doses received by responders must take into account all exposure situations, to ensure compliance with a dose-life limit value that should not exceed 500 mSv. French regulations set a life-dose limit of 1000 mSv for responders in a radiological emergency situation. ACRO considers that this latter limit is too high and that, in addition, it should include all doses received in any exposure situation.


A severe nuclear accident induces irreversible damages but cannot be ruled out. ICRP should recommend that upmost efforts are done by nuclear operators to avoid accidents and that independent nuclear safety authorities enforce the highest standard. If such standards cannot be fulfilled, the nuclear plant should be phased out.


[FEMA2013] Federal Emergency Management Agency, Program Manual - Radiological Emergency Preparedness, June 2013

[HRC2013] Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, Mission to Japan (15 - 26 November 2012), 2 May 2013 (A/HRC/23/41/Add.3)

[LD] Some scientific publications related to the stochastic impact of low doses of radiation:

  • Zhou H. et al. Radiation risk to low fluences of α particles may be greater than we thought. Proc. Natl. Acad. Sci. USA (2001) 98(25): 14410–14415
  • Rothkamm K. et al. Evidence for a lack of DNA double-strand break repair in human cells exposed to very low X-ray doses. Proc. Natl. Acad. Sci. USA (2003) 100(9): 5057–5062
  • Mancuso M. et al. Oncogenic bystander radiation effects in Patched heterozygous mouse cerebellum. Proc. Natl. Acad. Sci. USA (2008) 105(34): 12445–12450
  • Löbrich M. et al. In vivo formation and repair of DNA double-strand breaks after computed tomography examinations. Proc. Natl. Acad. Sci. USA (2005) 102(25): 8984–8989
  • Beels L. et al. Dose-length product of scanners correlates with DNA damage in patients undergoing contrast CT. Eur. J. of Radiol. (2012) 81: 1495–1499
  • Brenner DJ. Et al. Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know. Proc. Natl. Acad. Sci. USA (2003) 100(24): 13761–137662
  • Watanabe T. et al. Hiroshima survivors exposed to very low doses of A-bomb primary radiation showed a high risk for cancers. Environ. Health Prev. Med. (2008) 13(5): 264-70
  • Ozaka K. et al. Studies of the Mortality of Atomic Bomb Survivors, Report 14, 1950–2003: An Overview of Cancer and Noncancer Diseases. Rad. Res. (2012) 177: 229-243
  • Pearce M.S. et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet (2012) 380(9840):499-505.
  • Mathews J.D. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. (2013) 346:f2360
  • Bollaerts K. et al. Childhood leukaemia near nuclear sites in Belgium, 2002–2008. Eur. J. Cancer Prev. (2018) 27(2): 184-191
  • Hsieh WH. et al. 30 years follow-up and increased risks of breast cancer and leukaemia after long-term low-dose-rate radiation exposure. Br. J. Cancer (2017) 117(12): 1883-1887
  • Spycher B.D. et al. Background Ionizing Radiation and the Risk of Childhood Cancer: A Census-Based Nationwide Cohort Study. Environ. Health Perpect. (2015) 123(6): 622-628
  • Kendall G.M. et al. A record-based case–control study of natural background radiation and the incidence of childhood leukaemia and other cancers in Great Britain during 1980–2006. Leukemia (2013) 27(1):3-9.
  • Richardson DB. et al. Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS). BMJ (2015) 351: h5359.
  • Little MP. et al. Leukaemia and myeloid malignancy among people exposed to low doses (<100 mSv) of ionising radiation during childhood: a pooled analysis of nine historical cohort studies. Lancet Haematol. (2018) 5(8): 346-e358.
  • NCRP Commentary No. 27: Implications of recent epidemiologic studies for the linear-nonthreshold model and radiation protection. NCRP 2018.

[SHINRAI2019] Christine Fassert and Reiko Hasegawa, Shinrai research Project: The 3/11 accident and its social consequences – Case studies from Fukushima prefecture, Rapport IRSN/2019/00178

[UNESC1998] United Nations, Economic and Social Council, Commission on Human Rights 1998, Guiding Principles on Internal Displacement, E/CN.4/1998/53/Add.2, 11th February 1998

[USEPA1992] United States Environmental Protection Agency, Office of Radiation Programs, Manual of Protective Action Guides and Protective Actions for Nuclear Incidents, Revised 1991, second printing, May 1992. EPA-400-R-92-001.