Citation

Goralnick E, Chai PR, Erickson TB. J. Am. Med. Assoc. JAMA 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, American Medical Association)

DOI

10.1001/jama.2022.22661

PMID

36469331

Abstract

Although a focus on trauma response and humanitarian care is essential for the ongoing Russia-Ukraine war, recent posturing by Russian leadership indicates that radiological or nuclear weapons could be used to defend illegally annexed territories in Ukraine. This situation necessitates readiness for nonconventional warfare threats, which include chemical, biological, radiological, nuclear, and explosives (CBRNE) attacks. CBRNE preparedness has been variable among Ukrainian and European Union member states, which may be called on to detect and respond to potential attacks.1,2 Russia or its proxies have used CBRNE weapons in several recent conflicts, and awareness of these risks and mitigation strategies are prudent measures now.3 Based on these historical ingressions, prioritizing education and equipment for health care professionals to recognize and respond to potential CBRNE threats within Ukraine and bordering countries is essential.

Despite regulations against the use of chemical weapons by the Organisation for the Prohibition of Chemical Weapons (OPCW), Russian chemical weapons research has focused on developing highly potent weaponized organophosphates, or nerve agents. The past decade has seen Russia use these agents in assassination attempts of the Skripals and Alexei Navalny through the introduction of nerve agents in food and clothing. These fourth-generation agents (eg, Novichok, a group of nerve agents) are characterized by their lethality, unconventional routes of poisoning, and long-term environmental persistence.3 Russia's connections to Syria also provide insight. The majority of the more than 55 chemical weapon attacks in Syria between 2013 and 2018 involved chlorine gas or the deadly nerve agent sarin in cannisters or combined with bombs dropped from aircraft. Although these events have been attributed to the Syrian government, the close relationship between Syria's Assad regime and Russia suggests that these indiscriminate strategies could be used in the current conflict...

Language: en