SHAMISEN Project Research Articles

An ethical dimension to accident management and health surveillance

Many radiation protection actions carry a multitude of direct and indirect consequences that can impact on the welfare of affected populations. Health surveillance raises ethical challenges linked to privacy and data protection, as well as questions about the net benefit of screening. The SHAMISEN project recognized these issues and developed specific recommendations to highlight ethical challenges. Following a brief overview of ethical issues related to accident management, this paper presents the SHAMISEN recommendations: R1 The fundamental ethical principle of doing more good than harm should be central to accident management; and R4 Ensure that health surveillance respects the autonomy and dignity of affected populations, and is sensitive to any inequity in the distribution of risks and impacts. While a holistic approach to accident management means that decisions will be complicated by different values, perceptions and uncertainties about outcomes, addressing ethical issues could help ensure that the assumptions and potential conflicts behind eventual decisions are as transparent as possible.

Living conditions and health status of populations living in territories impacted by nuclear accidents – Some lessons for developing health surveillance programme

This paper explores how health concerns of populations living in contaminated areas following radiological accidents can be considered in developing health surveillance. The research was performed in the framework of the SHAMISEN project, and aimed at identifying the impacts on, and challenges associated with, living and social conditions of affected populations. These objectives were achieved through the analysis of specific Case Studies in different situations observed after the Chernobyl accident (Belarus and Norway) and the activities carried out after the Fukushima accident. It incorporates an analysis of testimonies of medical experts and local stakeholders from contaminated territories in Japan within two Case Studies as well as through a dedicated workshop jointly organised with Fukushima Medical University in Japan in March 2016. The analysis addresses the following topics:•Expectations and worries of the people regarding their health and welfare;•Role of the different stakeholders (health professionals, radiological protection professionals, local population, authorities, etc.) in improving living and social conditions in contaminated areas;•Contribution of the implemented protective actions to well-being and their direct benefits for populations;•Sustainability and continuity of the projects/actions;•Ethical considerations;•Stakeholder participation, dialogue, information and communication issues;•Education and training provision and need.Thus, this paper outlines key lessons learned from each of these topics, by providing tangibles examples from the analysis of the various Case Studies.

The SHAMISEN Recommendations on preparedness and health surveillance of populations affected by a radiation accident

This paper, the last in the Special Issue (SI) on the SHAMISEN project, presents an overview of the SHAMISEN Recommendations for Preparedness and Health Surveillance of Populations Affected by a Radiation Accident. The recommendations are based on the lessons learnt from previous nuclear accidents, and the engagement activities with different stakeholder groups, described in the other papers of this SI. The SHAMISEN project developed a total of 28 recommendations. They include general recommendations, applicable across all phases of an accident, and specific recommendations for each of the three main phases: preparedness, early and intermediate, and long-term recovery. The recommendations are subdivided by topic: health surveillance, epidemiological studies, dose reconstruction, evacuation, and training of and communication with health personnel and other actors involved in liaising with affected populations. Each recommendation is divided into 3 sections - why, how and who - thus providing background and concrete advice as to how each SHAMISEN recommendation should be implemented and by whom. It is notable that many recommendations are also applicable to other disaster types, including the current SARS-CoV-2 pandemic.

The SHAMISEN Project: Challenging historical recommendations for preparedness, response and surveillance of health and well-being in case of nuclear accidents: Lessons learnt from Chernobyl and Fukushima

Experience suggests that current nuclear accident response planning in European countries mostly has a technical focus, with less attention paid to social, psychological and ethical issues. Information provided tends to be directed towards decisions made by experts, rather than for the support of affected populations. The SHAMISEN (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) consortium, composed of close to 50 experts from 10 countries, performed a critical review of current recommendations and experiences regarding dose assessment and reconstruction, evacuation decisions, long-term health surveillance programmes and epidemiological studies. The review included case studies and lessons drawn from the living conditions and health status of populations affected by the Chernobyl and Fukushima accidents, taking an integrative approach to health and well-being. Based on this work, SHAMISEN developed a series of comprehensive recommendations aimed at improving the preparedness, response, long-term surveillance and living conditions of populations affected by past or future radiation accidents, in a manner responding to their needs, while minimising unnecessary anxiety.