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Image: IAEA symbol to warn about radiation dangers. Source: IAEA - Photo: 2024

Is the IAEA Securing Medical Radioactive Sources in Conflict Areas?

By Tariq Rauf*

VIENNA | 11 July 2024 (IDN) — On Friday, 12th July 2024, the 35-member Board of Governors of the International Atomic Energy Agency (IAEA) will meet in emergency session to discuss the bombing of a children’s hospital in Kyiv and the safety and security of medical radioactive sources in use in the medical facility. This emergency session has been called by Ukraine.

Surprisingly none of the IAEA Member States neighbouring Gaza have yet requested an emergency session of the IAEA Board of Governors concerning the safety and security of medical radioactive sources in hospitals destroyed by bombing in Gaza over the past nine months.

While the Agency rightly has been outspoken, including at the Security Council, in warning against the risks of releases of radioactive materials as a result of military attacks on nuclear power reactors in Ukraine; in contrast the Agency seems to have been strangely silent on the risks of bombing hospitals where high-potency radioactive sources are in medical uses—such as in Gaza and now in Ukraine.

In addition to the destruction by bombing of a children’s hospital in Kyiv, according to satellite images analyzed by Al Jazeera’s Sanad verification agency, 24 hospitals have been damaged or destroyed in the Gaza Strip: 6 hospitals in northern Gaza, 10 hospitals in Gaza City, 1 hospital in Deir el-Balah, and 7 hospitals in Khan Younis. At the time of this writing, the number and type of medical radioactive sources at the Kyiv children’s hospital is not publicly announced; according to one estimate at least 27 radioactive sources were in use in the destroyed or damaged hospitals in Gaza.

Why has the Agency, or the State of Palestine, Israel, Egypt, Lebanon, Syria, Jordan, Turkey and other IAEA Member States not raised the alarm about the safety and security of medical radioactive sources in Gaza? It has fallen to Ukraine to bring the matter of the safety and security of medical radioactive sources to the attention of the Agency and its Board of Governors. Except for Ukraine, the other 177 IAEA Member States have been derelict in this matter.

“Shaping the Future”

The recently concluded 2024 International Conference on Nuclear Security (2024ICONS) on the theme of “Shaping the Future” apparently failed to address “the present” on safety and security of medical radioactive sources, despite claiming to “Raise awareness of a wide range of nuclear security topics to maintain and further strengthen national nuclear security regimes for nuclear and other radioactive materials and associated facilities used for peaceful purposes, as well as international cooperation in strengthening nuclear security globally”.

Radioactive sources in medical and other uses can pose a serious radiological hazard. Rescue and medical workers, civilians and military personnel all are vulnerable to the radiation risks from damaged or broken medical radioactive sources at bombed hospitals.

In 1987, the Goiânia incident in Brazil was the world’s worst incident involving a radioactive source. Cesium chloride (cesium-137 teletherapy unit) from a dumped source ended up in a scrap yard undetected for over two weeks. More than 112,000 persons were monitored, some 250 people were found to be contaminated from handling the radioactive source and four died in the first month.

According to the IAEA, Goiânia’s legacy of a handful of Cs-137 in addition to the human casualties is 3,000 cubic metres of contaminated waste, buried in a near surface repository on the outskirts of the city, where it must be isolated for the next 300 years. Subsequently, the IAEA working with Member States established a “Cradle to Grave” approach for countries to take responsibility to keep radioactive material safe and secure. Over the years the Agency has helped States to secure hundreds of radioactive sources, but a gap has appeared now with such sources in bombed medical facilities.

IAEA Nuclear Safety and Nuclear Security Guidance

The IAEA is the competent international authority to regulate the safety and security of nuclear and other radioactive materials, including radioactive sources in medical uses. IAEA Member States have established that both nuclear safety and nuclear security are the responsibility of the State and to adopt the IAEA’s safety and security fundamentals and standards for use in their national regulations.

The Agency administers an international regime of legally binding and non-legally binding instruments to ensure the safety and security of nuclear and other radioactive materials.

In this regard, legally non-binding instruments include the Code of Conduct on the Safety and Security of Radioactive Sources and its Supplementary Guidance on the Import and Export of Radioactive Sources and Guidance on the Management of Disused Radioactive Sources.

The IAEA Basic Safety Guide RS-G-1.9 establishes the categorization of radioactive sources which is used in the IAEA Code of Conduct on the Safety and Security of Radioactive Sources. The Agency has devised a risk-based ranking of radioactive sources and practices in five categories:

  1. Extremely dangerous to the person: This source, if not safely managed or securely protected, would be likely to cause permanent injury to a person who handled it or who was otherwise in contact with it for more than a few minutes. It would probably be fatal to be close to this amount of unshielded radioactive material for a period in the range of a few minutes to an hour.
  2. Very dangerous to the person: This source, if not safely managed or securely protected, could cause permanent injury to a person who handled it or who was otherwise in contact with it for a short time (minutes to hours). It could possibly be fatal to be close to this amount of unshielded radioactive material for a period of hours to days.
  3. Dangerous to the person: This source, if not safely managed or securely protected, could cause permanent injury to a person who handled it or who was otherwise in contact with it for some hours. It could possibly — although it would be unlikely — be fatal to be close to this amount of unshielded radioactive material for a period of days to weeks.
  4. Unlikely to be dangerous to the person: It is very unlikely that anyone would be permanently injured by this source. However, this amount of unshielded radioactive material, if not safely managed or securely protected, could possibly — although it would be unlikely — temporarily injure someone who handled it or who was otherwise in contact with it for many hours.
  5. Most unlikely to be dangerous to the person: No one could be permanently injured by this source. This amount of radioactive material, if dispersed, could not permanently injure persons. This amount of radioactive material, if dispersed, could not permanently injure anyone.

Medical Radioactive Sources and Uses

Radioactive isotopes are widely used in hospitals and medical centres for diagnostic and therapeutic applications. The range of radioisotopes in medical uses include: Technetium-99m (Tc-99m), Cesium-137 (Cs-137), Iodine-131(I-131), Iodine-125 (I-125), Iodine-123(I-123), Flourine-18(F-18), Tritium (H-3), Cobalt-60 (Co) and Carbon-14(C-14), among others.

High intensity sealed radioactive sources are used in hospitals for a number of applications, including brachytherapy, teletherapy, blood irradiation, calibration etc. Most of these sources are relatively small with radioactivity ranging from a few up to a few hundred MBq (megabecquerel), except the teletherapy and blood irradiation source, which may have high intensity. Once the source becomes weak for further applications it is removed and replaced, and the depleted source sent for disposition.

Hospitals and nuclear medicine centres generate radioactive waste in both solid and liquid forms, as well as gases. The radioactive solid waste constitutes syringes, needles, cotton swabs, vials, contaminated gloves, absorbent materials, clothing and utensils of patients administered high doses of radioisotopes such as Iodine-131.

Xenon-133, Carbon-14, Hydrogen-3, Nitrogen-13, Technetium-99m aerosols, Iodine-131 and Iodine-125 are volatile radioactive sources that release radioactive vapours, generating airborne radioactive waste.

Furthermore, patients who are administered high therapeutic doses of radioisotopes (such as, Iodine-131 for treating thyroid cancer) discharge solid and liquid bodily waste containing Iodine-131 that can emit radioactivity for up to two months. Continuing this macabre discussion, cadavers of deceased patients administered high dosages of radioisotopes (such as Iodine-131) also pose a radiation hazard for a certain period of time.

Medical uses of radioisotopes include: Fluoroscopy: dynamic (real time) imaging; focused X-ray beams; Brachytherapy using Cesium 137 (low dose rate brachytherapy) or Iridium 192 (high dose rate brachytherapy); Linear accelerator using microwave technology (similar to that used for radar to accelerate electrons to collide with a heavy metal target to produce high-energy x-rays); Positron emission tomography (PET, positron emitters like carbon-11 and fluorine-18) to diagnose lung, colorectal, head and neck, and esophageal cancers.

According to one source, radioisotopes in medical uses include: Carbon-11 and Flourine-19 (brain scan to trace glucose); Chromium-51 (diagnose albinism, image the spleen and gastrointestinal track); Gallium-67 (whole-body scan for tumors); Selenium-75 (pancreas scan); Krypton-81m and Xenon-133 (lung ventilation scan); Strontium-81 (scan for bone cancer and bone diseases); Mercury-197 (kidney scan); Iron-59 (bone marrow function and anemias); Iodine-131 and Iodine-123 (diagnosis of thyroid malfunction); Technetium-99m (brain, liver, kidney, bone scans, and diagnosis of the damaged heart muscle); Phosphorous-32 (detect eye tumors); and Thallium-201 (heart scan and exercise stress test).

Is the IAEA Up to the Challenge?

While the IAEA single handedly has surpassed its Member States in establishing “seven indispensable pillars for ensuring nuclear safety and security during an armed conflict”, and “five concrete principles essential for averting ‘a catastrophic incident’ at the Zaporizhzhya nuclear power plant”; the Agency still has to elaborate equivalent principles for the safety and security of medical radioactive sources in bombed hospitals and nuclear medicine centres.

The Statement on 20 May by the IAEA at the opening of the 2024 International Conference on Nuclear Security 2024, inter alia noted that “Radioactive sources are extensively used in many domains, including medicine, industry, agriculture and research. An incident in one State can have far-reaching consequences for others, so security for one is security for all”.

But it seems that this was an empty statement as no mention was made regarding the safety and security of radioactive sources in the bombed hospitals in Gaza. It is not evident that the IAEA even has a list of the types and numbers of such sources at hospitals in Gaza. The silence on this matter by the States neighbouring Gaza, as well as by those States that champion nuclear safety and nuclear security, also is inexplicable (to be polite about this failure).

Clearly the IAEA is failing on the job of drawing attention to the dangers and risks of radioactive sources in medical uses in bombed hospitals in Gaza and now in Ukraine.

The emergency session of the IAEA Board of Governors this Friday, 12 July 2024, must address the matter of the dangers and risks of radioactive sources in medical uses in bombed hospitals not only in Ukraine but also in Gaza.

The Agency must formulate guidance and standards on this matter, insist on sending assessment and recovery teams to bombed hospitals to recover and secure radioactive sources. The IAEA Board of Governors, for a change, must adopt a non-political technical Resolution inter alia calling for an end to bombing of hospitals, establishing a regime to assure immunity of hospitals utilizing nuclear medicine, and providing assistance to bombed nuclear medical facilities. Not doing so would be height of irresponsibility!

*Tariq Rauf is former Head of Verification and Security Policy at the IAEA. Personal views are expressed here. [IDN-InDepthNews]

Image: IAEA symbol to warn about radiation dangers. Source: IAEA

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