Belarus is a small country of some 10 million people situated on the western most edge of the former Soviet Union. This strategic position, on this east-west divide, makes this country no newcomer to the experience of invasion; the second world war decimated the population and devastated its towns and villages. But the latest invasion, by the cloud of radioactive fallout from the stricken nuclear reactor at Chernobyl, on 26 April 1986, has proved to be an invasion like no other before it.

The accident happened at I a.m.on a Saturday morning of a holiday weekend which was to prove to be warm, bright and sunny. An ideal time for children to play out of doors, to visit the dacha and get the garden prepared for the coming season, to attend the upcoming May Day parades, in short to throw off the long winter and enjoy the spring. The silent march of the radioactive cloud across the northern parts of Ukraine and the southern parts of Belarus left no trace detectable to human senses, no discoloration or visible sediment on the ground, no odour: nothing to see, smell, hear or taste. Yet there is a legacy from this invasion, and we are seeing it now, and we will continue to do so for the next half century.

About half the population of Belarus lives in the countryside, many others have dachas and most have relatives living outside the main towns and cities. They are therefore very closely dependent upon their environment, on the earth to grow things and feed themselves and their animals, on the rivers and lakes for fish and water, and on the forest for its fruits of berries and mushrooms.

In the Gomel region, closest to Chernobyl, contamination was very heavy from long-lived isotopes,primarily Cesium 137, leading initially to dose rates greater than those internationally agreed as limits to protect radiation workers. Like anywhere on this planet, Belarus experiences some level of natural background radiation. It leads to doses of about I to 2 mGy/year. Initially, doses in some parts Gomel region would have exceeded more than 100 times this and some areas are too contaminated to live in even now. Indeed, some 15 percent of the population of Gomel region has migrated, especially the young and qualified who can find work elsewhere.

For a community dependent on food produced locally between 80 and 90 percent of the dose to those living in a contaminated area comes from radioactivity in the food, especially milk. Milk is important mainly because so much is consumed each day, especially by children. Considerable dose reduction can therefore be achieved by importing food from "clean'" areas.This is being done with considerable success in the most heavily contaminated areas of Gomel and Mogilev regions such that now doses are the equivalent to a doubling or trebling of natural background radiation levels. Such increases could be incurred from natural radiation by simply moving to live in other parts of Europe. The health impact of this exposure is not a cause for concern but the psychological impact of feeling that the environment is "poisoned", of feeling that the produce from the garden or farm is tainted, is a cause for concern. Prolonged stress of this kind leads to illness and a considerable reduction in wellbeing.

There are economic considerations as well. Clean food is all very well if you can afford it. The economic transition in the former Soviet Union has increased prices of many things, including many foodstuffs, close to those of western Europe but salaries have not risen proportionately and so home produced food increasingly means the difference between eating and being hungry. On my last visit to Minsk many people were to be seen returning to the city on Sunday evening with buckets full of mushrooms and sacks of potatoes. This situation, together with the migration which has destroyed the "social fabric" of whole areas, is the psycho-social legacy of the accident; it should not be underestimated and its impact on public health is far from trivial.

On this visit I travelled down to the south-western part of the country in the Brest region to two districts, Stollin and Luninetz. Here the towns and villages are dotted around gently rolling fields and forests, criss-crossed by rivers. There are almost as many horse and carts as there are cars and most people draw their water from wells. I was reminded, by the painted wood houses, the fenced gardens and the wide village streets, of the film of Dr Zivago. According to my colleagues in Minsk, it was 1988 before the full extent of contamination here, some 240 km from Chernobyl, was realised in Belarus.

What had drawn my attention to this area though was the increased levels of childhood thyroid cancer reported here. This condition was first observed in Gomel region where the incidence rate increased dramatically in 1991. In 1994 the rate was nearly 500 times the rate observed before the accident (which had been comparable with rates observed in other parts of Europe).

Childhood thyroid cancer is a rare disease, and fortunately, with appropriate treatment, can be cured. Appropriate treatment is however expensive and requires specialist techniques many of which were not available in Belarus in 1991. On my first visit to Minsk in 1992 with two endocrinologist colleagues, Professor Pinchera from Pisa Italy and Professor Williams from Cambridge, England, to investigate the claims being made of an increase, we were amazed that in a single day, in a single hospital, we could see eleven children recovering from recent operations for thyroid cancer.

Even a major city hospital elsewhere in Europe or the USA would be surprised to see more than one or two cases in any year. To date in Belarus there have been more than 400 cases since the accident, all treated in Minsk by the same medical team led by Professor E.P. Demidchik. In public health terms such numbers are not dramatic, but these are young lives having to undertake a major surgery, sometimes, several, at a time when they should be gaining an education and enjoying childhood. Those whose thyroid is completely removed are destined to remain for the rest of their lives on a drug to replace the thyroid function. Given these considerations this is not such a small consequence of the accident.

The situation has been exacerbated by a reluctance of scientists in the west to recognise the connection between this increase and Chernobyl. This has resulted in a delay in bringing resources to Belarus to deal with the problem and undoubtedly treatment has not, in the past, been as good as it might have been because of this. If comprehensive treatment is not applied early on complications can follow, some of which may be fatal.

The cause seems to be almost certainly the radioactive isotopes of iodine which become concentrated in the thyroid glands and deliver large doses, especially in children. Milk may have been especially important as a route of exposure because it concentrates iodine very rapidly after deposition on grass. The isotopes of iodine decay quickly but within three months of the accident doses of up to several Gy to the thyroid, about 1000 times that due to natural radiation in a year, were received in parts of the Gomel, Brest and Minsk regions.

The situation in Belarus is further complicated by a lack of stable iodine in the soil and thus in diet. The result of this is goitre or enlarged thyroid. Currently, about 40 percent of the population of Belarus have these symptoms, which could be easily be mitigated by supplementation of the diet with iodine in salt. This would be true anywhere in the world and iodine deficiency is not uncommon, even in Europe today. But it is especially important in Belarus since an iodine deficient thyroid will more quickly develop a cancer if radiation has caused the initial change necessary for the cancer to form. Given that cancers will continue to develop over the next half century in those who were children at the time of the accident it is important to assess the degree of deficiency and ensure that it is corrected with iodized salt.

This is just one of the many practical activities being developed by the WHO under the International Thyroid Project (ITP) which is a part of the global International Programme on the Health Effects of the Chernobyl Accident (IPHECA) initiated by the World Health Assembly in 1992. (see following article). The ITP aims to equip Belarus with the necessary tools to deal with the public health consequences of the increased thyroid disease, to improve the diagnosis of the cases so that treatment can start as early as possible so as to have the best chance of success and the least disruption to these young lives, to improve the treatment available and to mitigate the expression of the disease in future years.

There is much humanitarian aid presently being provided to Belarus by a multitude of charities. Many offer holidays for children in Italy, the UK, Germany, etc. and some are longer term schemes that bring children to Israel, for example, for up to two years. Such schemes are very valuable and undoubtedly benefit the children who are able to participate. The principle benefit is, however, to remove the children, for a short time, from a disadvantaged environment. The sad facts are that the damage to the thyroid, if it has been done, is there and cannot be reversed, and in southern Belarus alone there are estimated to be at least 1 million children, adolescents and young adults at such elevated risk of thyroid cancer. It is therefore also necessary to improve the health care available to them in Belarus. This requires a degree of coordination between charitable organisations which is at present not evident.

Given the seriousness of the situation one might think Belarus is a depressing place. Far from it, and those who have visited there will know this very well. It is a young vital country where especially the children have great talent and a tremendous zest for life. An enduring memory of mine is a troop of young Belarussians, aged between nine and eleven years, dancing traditional folk dances in their red and white national dress. They surely deserve our help, in a difficult time, to overcome the blight that man's ingenuity and chance have together inflicted upon their young lives.

Source: DHA News: September-October 1995, p.9-11