Nuclear emergencies, such as those which occurred in Chernobyl and Fukushima, have resulted in large numbers of persons being exposed to ionising radiation. In addition, they have caused major and continuing upheavals in the lives of populations affected by fallout, both directly (emergency and accident recovery workers, evacuees, persons living in areas where dose reduction measures were taken) and indirectly (persons living in less contaminated regions).

Some populations have undeniably sustained health impacts from the radiological consequences of accidents, in particular early emergency workers in Chernobyl who suffered acute radiation syndrome and young people who developed thyroid cancer as a result of fallout from that accident. Many others, however, have suffered serious consequences that were not directly related to the biological effects of radiation, but rather induced by the event itself, the presence of radioactive contamination and consequent emergency and remediation measures taken, and/or uncertainties about radiation levels and health effects. These include intensive care unit patients and institutionalised elderly persons evacuated after the accident at Fukushima; clean-up workers who developed anxiety, depression, post-traumatic stress disorders and suicide ideation; and evacuees and residents of contaminated areas whose lives were affected by emergency and/or remediation actions taken, and who continue to experience social and economic disturbances resulting from raised levels of radioactivity in the environment.

Strategies for preparedness and surveillance should aim to meet society's needs for accurate information on doses and health effects and provide a system of follow-up that allows affected population both to feel, and to be, well-monitored for radiation and its possible effects. Surveillance programmes raise ethical issues and challenges that need to be addressed, however: though affected populations may consider them beneficial in terms of health monitoring and care, the surveillance can create undue anxiety in populations; conversely, persons whose dose levels do not warrant particular medical surveillance may suffer psychological consequences if not included in the surveillance programme. At present, there are no well-established, comprehensive strategies for preparedness and health surveillance relating to radiation accidents. This highlights the clear need to learn from past experiences and plan measures that engage affected populations in their follow-up, enabling them to better manage their situation.

It is upon this background that we submit this proposal, with the overarching objective of building upon lessons learned from experience with populations affected by Chernobyl, Fukushima and other nuclear emergencies to develop recommendations for medical and health surveillance of populations affected by previous and future radiation accidents.

Recommendations will be made focusing on the following three complementary aspects:

1. Dose assessment supporting emergency response, clinical decision-making in the aftermath of a nuclear emergency and long-term follow-up of exposed populations;
2. Improvement of living conditions of affected populations, responding to their needs and engaging them in surveillance programmes while avoiding generation of unnecessary anxiety; and
3. Improvement of population estimates of radiation-induced risk both for radiation protection and for communication with affected populations, if and where feasible.

Financial Support

Funding for the SHAMISEN is provided by the EURATOM Programme of the European Commission in the framework of the OPERRA (Open Project for the European Radiation Research Area) project, FP7 grant agreement no: 604984.