Samiran Nundy

Corruption: medicine’s dirty open secret

Doctors must fight back against kickbacks

Nuclear terrorismCommentary: The myth of nuclear deterrence in south AsiaCommentary: The psychology of terrorists

# Nuclear terrorism {#article-title-2} Three members of International Physicians for the Prevention of Nuclear War and Physicians for Social Responsibility discuss the threat of nuclear terrorism and conclude that the only effective way to tackle it is to abolish nuclear weapons The attack on the World Trade Center in New York clearly showed that there are terrorists who are willing to inflict civilian casualties on the scale that would be expected with the use of a weapon of mass destruction. In this article we consider the form that nuclear terrorism could take and estimate the casualties that would occur if a nuclear bomb the size of that dropped on Hiroshima was detonated in a large urban area. The enormous casualties to be expected from such an attack argue strongly for a strategy of primary prevention. #### Summary points In the aftermath of 11 September 2001 nuclear terrorism has emerged as a real threat Nuclear terrorism could take several forms, from an attack on nuclear power plants and reactors to the detonation of a nuclear bomb in an urban area The international community urgently needs to expand its efforts to secure existing stockpiles of nuclear weapons and materials, particularly in Russia, Pakistan, and India The elimination of nuclear weapons should be high on the global public health agenda Nuclear terrorism might take several forms. An attack on a nuclear power plant or other nuclear installation could result in a massive release of radioactive material. Despite initial statements by the US Nuclear Regulatory Commission that commercial power plants could withstand an aircraft crashing into them, it seems likely these plants are highly vulnerable. As early as 1982 a study by the Argonne National Laboratory of the US Department of Energy found that, if a jet aircraft crashed into a nuclear reactor and only 1% of its fuel ignited after … Correspondence to: Z A Bhutta

Is there hope for South Asia

Yes, if we can replicate the models of Kerala and Sri Lanka Two years turned the Indian subcontinent into South Asia. Between 14 August 1947 and 4 February 1948, India, Pakistan (its eastern part would later become Bangladesh), and Sri Lanka all gained independence from the British Empire. Amid the optimism of independence, the new states were comparable in population health and development indicators. Their progress since has been different. This issue of the BMJ maps out the extent of the regions myriad difficulties. Non-communicable and communicable diseases ravage South Asia (see pp 781, 794, 807, 811). Tobacco and pharmaceutical industries are exploiting weak legislation to nurture new markets (pp 778, 780, 801). There is little pride in the progress of surgery (p 782), health research (p 826), or postgraduate education (p 779). Yet one challenge dwarfs all these: the desperate state of maternal and child health. Several articles reinforce the message that the scale of morbidity and mortality caused by neglect of mothers and children …

Thinking the unthinkable

Preparing for Armageddon in South Asia News p 1412 The unthinkable has actually happened. Over a span of barely four years, the subcontinent and its military and political leadership seem to have moved seamlessly from an obtuse nuclear capability and a doctrine of nuclear deterrence to the present state of nuclear weaponisation.1 As a million soldiers face each other across the volatile line of control and the border between India and Pakistan, the arguments have shifted from no use of nuclear weapons to their potential use in the event of conventional war, to the current state of actual deployment. To a large extent the numerical superiority of the Indian army and air force translates into a no win situation for Pakistan in the event of a conventional conflict. Faced with the potential of humiliation and dismemberment in such a scenario, a nuclear first strike becomes a frighteningly real possibility.2 The debate and outcry on this reckless brinkmanship in South Asia has remained confined to the peace groups, and the vernacular press has largely been jingoistic and indifferent to the disastrous consequences of nuclear war. While …

Surgery in South Asia

A private complication of a public problem It is difficult to write about surgery in South Asia with any sense of pride. In most of the region health care, and especially surgical care, is concentrated in major hospitals in big cities. In villages and small towns the health infrastructure exists on paper, but even minor procedures are not carried out because equipment does not work, and surgeons are reluctant to undertake operations for which they are not well trained. In a community survey of surgical emergencies in the northern areas of Pakistan, the incidences of acute abdominal, trauma, and obstetric emergencies therefore far exceeded the rates of acute surgical intervention.1 In rural areas of Pakistan the overall rate of surgery was 124/100 000 patients per year compared with 8253/100 000 in the United States. Death rates were correspondingly high. Even in city hospitals the situation is not much different. …

A radical prescription for the Medical Council of India

Hope for a cure

Unmet need for surgery in South Asia

Despite increased specialisation and technology, surgical care in the world’s most populous region is inequitable and remains inaccessible to most people, say Sanjay Nagral and colleagues

On the brink of conflict: the people of South Asia deserve better

Countries must work together for enduring peace and wellbeing in the region

Twelve years on: a call for papers for another special collection of articles on South Asia

The BMJ will revisit its ground breaking South Asia theme issue of 2004

World Medical Association’s tainted president, Ketan Desai

New appointment raises questions from India’s medical profession