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The Medical Implications of Nuclear War, Institute of Medicine. ~ 1986 by the National Academy of Sciences. National Academy Press, Washington, D.C. Food and Nutrition in the Aftermath of Nuclear War ALEXANDER LEAF, M.D. Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts Hunger and starvation would plague the survivors of a nuclear war. Millions of people would starve to death in the first few years following an all-out nuclear war. This statement has a high probability of being accurate as indicated by the following considerations: 1. World food reserves, as measured by total cereal stores at any given time, are frighteningly small should production fail. They have amounted in recent years to about 2 months' supply of cereals at present consumption rates. ~ In the United States food stores would feed the population for about a year.2 Portions of the stores, however, would be destroyed by blast or fire or would be contaminated by radioactivity.3 4 Crops in the field would be damaged to an unpredictable extent.4 5 2. More important, the means to transport the food from sites of harvest or storage to the consumers would no longer exist. Transportation centers would be prime targets of an aggressor intent on destroying the industrial competence of an opponent to sustain a war. Roads, bridges, and rail and port facilities would be likely targets. Foods that appear in our markets are not grown locally. In Massachusetts, for example, more than three- quarters of the food arrives from out of state by truck or rail, and supplies on hand would last for only a few days. In a nuclear attack most of these supplies in urban areas would be destroyed. In the United States and other developed countries, food no longer is carried by farmers to nearby markets. The northeastern United States is particularly vulnerable to a breakdown in transportation of foods since 284

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FOOD AND NUTRITION IN THE AFTERMATH OF NUCLEI We 285 some 80 percent of its food is imported, but other sections of the country would fare only little better. Eighty-five percent of U.S. corn is grown in 11 Midwestern states. One-sixth of the wheat is grown in Kansas alone, and most of the rest is grown from Texas north to Minnesota, North Dakota, and Montana, with some being grown in Michigan, the Pacific Northwest, and New York State, but only a negligible amount is grown in the Northeast. Two-thirds of the soybeans are grown in the Great Lakes States and the Corn Belt. Rice is grown mainly in Arkansas, Louisiana, Texas, Mississippi, and California. Fruit and vegetable production is nearly as regionally concentrated.2 With key railway links and highways de- stroyed and gasoline and diesel fuels unavailable, whatever crops survived could not be moved to places where they would be needed. 3. Food is supplied today in the United States and developed countries by a complex network of enterprises that involves not only farming, animal husbandry, and fishing but also farm machinery, pesticides, fertilizers, petroleum products, and commercial seeds. This network utilizes sophis- ticated techniques and technology to handle the food that is produced. These include grain elevators, slaughterhouses, cold-storage plants, flour mills, canning factories, and other packaging plants. It also includes the transportation, the storage, and the marketing and distribution of foods through both wholesale and retail outlets. A breakdown in this vast agri- business would be an inevitable consequence of a nuclear war. Without the means to harvest, process, and distribute those crops that survived, there would be much spoilage. 4. So much of the social and economic structure of society as we know it would be destroyed that relationships that we take for granted would disappear. Money would have little or no value. Food and other necessities would be obtained, when available, by barter. More likely, as people became desperate with hunger, survival instincts would take over, and armed individuals or marauding bands would raid and pilfer whatever supplies and stores still existed. Those fortunate individuals who had stores would hoard their resources and soon become the victims of the crazed behavior of starving and desperate survivors who would ransack ware- houses and attack individual homes. Law enforcement would not exist, and many would be killed in the fighting between those trying forcefully to obtain possession of food stores and those trying to protect their own homes, families, and food supplies. 5. The early death of millions of humans and animals following a major nuclear war would not sufficiently compensate for the reduced available food supplies. Stocks of fuels, fertilizers, agricultural chemicals, and seed would soon be exhausted. Not only functioning tractors but also beasts of burden would be in short supply, and food production would become

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286 HEALTH CONSEQUENCES OF NUCLEAR WAR very labor intensive a throwback to the primitive farming methods of the Middle Ages or earlier. The resistance of insects to radiation and the lack of pesticides would further reduce the yield of crops. Fields downwind from targeted sites are likely to be made unusable by radioactive fallout for weeks to years. 6. A reduction in average temperature by even 1C at the Earth's surface because of the absorption of solar energy by soot and dust in the atmosphere would shorten the growing season in northern latitudes and markedly reduce or prevent maturation and ripening of grains that are the staple of human diets. But the debates that have been heard are not of whether a "nuclear winter" would occur but how many tens of degrees the tem- perature would be reduced and for how long. During most of the growing season, a sharp decline in temperature for only a few days may be sufficient to destroy crops. The lack of rain that has been predicted after a nuclear war would contribute to crop failures. Since most of the wheat and coarse grains are grown in the temperate regions of the Northern Hemisphere, which would be the zones most affected by a "nuclear winter," it is evident that a nuclear war, especially during the spring or summer, would have a devastating effect on crop production and food supplies for at least that year. The United States and Canada are literally the breadbasket for the world; total cereal production in North America in 1982 was 387 million metric tons, of which 123 million metric tons or nearly one-third was exported. 7. After the atmospheric soot and dust finally clear, the destruction of the stratospheric ozone would allow an increase in hard ultraviolet-B (UV- B) rays to reach the Earth's surface. In addition to the direct harmful effects to the skin and eyes of humans and animals, these hard ultraviolet rays would be damaging to plant life and would interfere with agricultural production. If the oxides of nitrogen increase in the troposphere, there may occur an actual increase of ozone at the lower levels of the atmos- phere.6 Ozone is directly toxic to plants. 8. There would likely be a deterioration of the quality of the soil following a nuclear war. The death of plant and forest coverage because of fire, radiation, the lack of fertilizers, and the probable primitive slash- and-burn agricultural practices of survivors would leave the soil vulnerable to erosion by wind and rain. Desertification and coarse grasses and shrubs would render agriculture and animal husbandry less productive. 9. Water supplies may be seriously reduced after a nuclear war. Dams and large irrigation projects may well be targets, especially in a counter- value attack. Reduced rainfall, which is predicted in some models of the climatic effects of a nuclear war, would interfere with agricultural pro

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FOOD AND NUTRITION IN THE AFTERMATH OF NUCLEAR WAR 287 ductivity. If freezing temperatures actually were to occur during the warm season, surface waters would be frozen and unavailable. Radioactive fall- out would contaminate reservoirs and surface waters with long-lived ra- dioactive isotopes, primarily strontium-90, which has a half-life of 28 years, and cesium-137, which has a half-life of 33 years. These elements in the groundwater would soon be taken up by plants and would enter the food chain. Eventually they would become concentrated in humans; the strontium would accumulate in bones and the cesium in cytoplasm, where they would contribute to the long-term burden of radioactivity in survivors. 10. Not only would food be scarce but it would likely be unsanitary as well. The destruction of sanitation, refrigeration, and food-processing methods, especially in the remaining urban areas or population centers, would result in the contamination of food by bacteria, particularly by enteric pathogens. Spoiled meat, carrion of domestic animals and even of human corpses, are likely to be eaten by starving persons, as has happened in major famines in the past.2 Pathogens to which civilized man has lost resistance would be acquired from foods and water contaminated by ex- creta and flies, other insects, and rodents, which would likely proliferate in the aftermath of nuclear war. 11. But the hunger and starvation would not be limited to the combatant countries alone, or even to just the Northern Hemisphere. It would truly be a global occurrence. Even without the spread of the possible climatic effects of a "nuclear winter" to the Southern Hemisphere, millions would die of starvation in noncombatant countries. Today a large portion of food exports goes to parts of the world where, even with the grain imports shown in Table 1, millions of people suffer from undernutrition and hun- ger 2,3,7 The number of undernourished persons in developing countries is stag- gering, approaching one-quarter of all mankind.2 On the basis of 1980 data, the World Bank estimated that some 800 million persons in devel- oping countries from 61 to 71 percent of their population have defi- cient diets.7 The U.N. Food and Agriculture Organization, using slightly more stringent criteria, estimate that some 16 to 23 percent of the global population, or 436 million persons, have food intake levels that permit little more than survival (1.2 times the basal metabolic rate, a level of caloric intake below which survival is not possible and which is incom- patible with productive work).8 9 In addition, the World Health Organi- zation identifies at least 450 million children that suffer from varying degrees of protein malnutrition.~ A large number of these persons are dependent on the food supply and price structure made possible by the

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288 HEALTH CONSEQUENCES OF NUCLEAR WAR TABLE 1 Total Cereal Exports and Importsa Total Cereals ( x 106 metric tons) Exported/ Percent of Imported Produced Production Country Exports United Statesb95 333 29 Canada28 54 52 European Economic Community18 133 14 Argentina18 34 53 Australia11 14 79 Total170 568 30 Imports Africa24 74 32 South America11 80 14 Asia (except People's Republic of China)64 363 18 Europe31 271 11 Total130 788 16 United States2 333 0 USSR33 173 19 aCereals comprise wheat, coarse grains, and rice. bThe United States, with 5 percent of the world's population, grows 20 percent of the world's cereals and imports only 0.7 percent of the world's total cereal imports. SOURCE: U.N. Food and Agnculture Organization (1985).i food exports of North America, so a disruption of these supplies would have grave consequences for most of the populations of developing coun- tries.2 In the past decade an increasing interdependence of countries on their food supplies has occurred.~-~3 In 1982, as shown in Table 1, the major grain-exporting countries, the United States, Canada, the European Eco- nomic Community, and Australia, exported 170 million metric tons of cereals.) The developing countries were the major recipients of these exports. Africa imported 24 million metric tons of cereals in 1982, which is equal to one-third of its own total grain production for that year. In South America cereal imports equaled 11 percent of total cereal produc- tion, and in Asia, excluding the People's Republic of China, this figure equaled 18 percent of total cereal production. By 1990 the situation in the countries with a food production deficit will worsen and the food shortages will increase, despite their efforts to increase production and contain populations.9 ~4 Of this deficit, 40 percent will occur in Asia, 25

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FOOD AND NUTRITION IN THE HEATH OF NUCLEI WE 289 percent in North Africa and the Middle East, 22 percent in Sub-Sahara Africa, and 12 percent in Latin America.~4 In conclusion, it is evident from the considerations listed above that hunger and starvation would decimate the survivors of a major nuclear war. Millions of deaths would result not only among survivors in com- batant countries but throughout the world. The developing countries, in fact, would possibly be the main victims of this famine, as their populations may not be reduced as immediately as would those in the combatant countries. Starvation would be essentially global a consequence of nu- clear war that would not have been predictable from a simple extrapolation from the experiences in Hiroshima and Nagasaki. NOTES FUN. Food and Agriculture Organization. 1985. Food outlook No. 6, 1985. Rome: Food and Agriculture Organization. 2Scrimshaw, N. 1984. Food, nutrition, and nuclear war. N. Engl. J. Med. 311:272-276. 3Hjort, H. W. 1982. The impact on global food supplies. Ambio 11:153-157. 4Bensen, D. W. et al., eds. 1971. Proceedings of a Symposium. Survival of food crops and livestock in the event of nuclear war. Conf-700929. Springfield, Va.: National Technical Information Service. 5Bondietti, E. A. 1982. Effect on agriculture. Ambio 11:138-142. 6Crutzen, P. J., and J. W. Birks. 1982. The atmosphere after a nuclear war: Twilight at noon. Ambio 11:114-125. 7Reutlinger, S., and H. Alderman. 1980. Prevalence of calorie deficiency diets in de- veloping countries. World Bank Staff Working Paper No. 374. Washington, D.C: World Bank. World Health Organization Food and Nutrition. 1975. Energy and protein requirements; recommendations by a joint FAD/WHO informal gathering of experts. Vol. 1(2):11-19. 9U.N. Food and Agriculture Organization. 1981. Agriculture toward 2000. Rome: Food and Agriculture Organization. iInfant and young child nutrition. 1983. Report by the Director General to the World Health Assembly, March 15, 1983. Document WHA 36/1983/7. iiInternational Food Policy Research Institute. 1977. Recent and prospective develop- ments in food consumption: Some policy issues. IFPRI Research Report No. 2, Revised Edition. Washington, D.C.: International Food Policy Research Institute. Gosling, T. 1980. Developed-country agricultural policies and developing-country sup- plies: The case of wheat. International Food Policy Research Institute, Research Report No. 17. Washington, D.C.: International Food Policy Research Institute. i3U.S. Department of Agriculture. 1970. World demand prospects for wheat in 1980 (With emphasis on trade by less developed countries). Foreign Agricultural Economic Report No. 62, U. S. Department of Agriculture, U. S. Economic Research Service. Wash- ington, D.C.: U.S. Government Printing Office. International Food Policy Research Institute. 1977. Food needs of developing countries: Projections of production and consumption to 1990. Research Report No. 3. Washington, D.C.: International Food Policy Research Institute.