Mental And Physiological Health Effects

By: Professor Natividad Carpintero-Santamaría

General Secretary of the Instituto de Fusión Nuclear “Guillermo Velarde” ETSII – UPM Department of Energy Engineering - ETSII - UPM Madrid (Spain)


Radiological terrorism is a challenge that transcends national borders and one of the most disruptive asymmetric threats to security in the 21st century.  One of the most important concerns relies on the potential use by a terrorist group, either acting independently or acting as part of a bigger organization that could detonate a Radiological Dispersion Device (RDD) or dirty bomb. The main purpose of a dirty bomb is to cause social chaos as well as panic and traumatic and post-traumatic psychological-psychogenic effects in the population. The physiological and psychological damage caused by the explosion of an RDD would most likely be greater than the effects produced by the radioactive contamination.

Radiological dispersion devices (RDDs) or dirty bombs

Dirty bombs are easily made, with a combination of chemical explosives (such as gunpowder, dynamite, semtex, or C-4) and the kind of radioactive material (ampoule, vial or depot) that is commonly found in hospitals, industries, food sterilization facilities or biochemical research centers. Both the efficiency of the dirty bomb and its radioactive contamination level depend on the chemical explosive used and the radiological toxicity of the material. The greater the amount of chemical explosives, the more effective the scattering of the radioactive material will be.

Although no attacks with radioactive agents have occurred, the relative accessibility of some of these materials presents a continuing threat of radioactive terrorism and governments must develop strategic programs to detect and prevent it, and ultimately, to respond effectively. 

Health effects produced by the explosion of an RDD

The health effects of an RDD explosion may vary significantly according to particle energy, and whether alpha, beta and gamma particles are inhaled, ingested or skin-absorbed. The activity of the radioactive source is another variable as well as the orography, building blocks, population density, wind conditions, etc.

The explosion of an RDD could contaminate the water supply, food and other consumer articles. During the expansion of the radioactive cloud produced in the explosion of a dirty bomb, the radionuclides can be inhaled, ingested, deposited on the skin or by puncture or injury of people found in the cloud expansion area. When inhaling, alpha emitters go to the lungs; beta emitters can be absorbed either by the lungs and the bones; beta emitter of I-131 is absorbed by the thyroid gland; gamma emitters are absorbed preferably by the lungs. In contact with the skin, alpha emitters produce negligible effects; beta emitters can produce grave burns; and gamma emitters deeply penetrate into the body following a rectilinear path that fades exponentially with the penetrated distance in the body.

The physiological and psychological damage caused by the explosion would most likely be greater than the effects produced by the radioactive contamination. Since radioactivity is inaudible, tasteless, intangible and odorless, an overestimation of the radiation exposure can lead to severe psychological pathologies such as 1) Psychosomatic symptoms: physical symptoms originated from mental emotional causes. 2) Post-traumatic stress disorder (PTSD): mental health condition triggered by a terror event, either experiencing it or witnessing it. 3)  Mass psychogenic illness: real symptoms causing harmful effects. They can be triggered by misunderstood or false information. 4) The worried well: individuals that go to the doctor with emotional problems. Some may have been exposed to the attack but not physically affected. Others may have heard about the attack and are concerned about their welfare.

With respect to radioactivity, because of disinformation or, more important, because of the manipulated information of some sensationalist mass media, people generally have a deep fear. To increase panic and chaos, the terrorists’ first action would be to contact mass media, radio and TV channels to inform them that a “nuclear device” would have exploded and radioactive contamination would be spreading throughout the city and affecting most of its population. An adequate manipulation of the situation by terrorists would create broad terror, chaos and panic among the people. The residents’ panic, overreaction and level of anxiety would be the same regardless of the amount or type of radioactive material dispersed. Although RDD radiological impact is local or regional, in terms of social shock it would immediately take a transnational dimension.

Evidence on the psychological impact of a terrorist attack involving intangible nature agents occurred in Tokyo (Japan) in 1995 during the sarin gas attack perpetrated on the subway system by the group Aum Shinrikyo. A great deal of the approximately 5,500 persons that went to 280 medical facilities in Tokyo were people that, either did not suffer gas exposure harm or were not genuinely affected, but were afraid to become ill. “In all, 1,046 patients were admitted to 98 hospitals. […] Of the more than 5,000 patients whose hospital visits were directly related to the attack, less than 20 patients were admitted and treated in intensive care units.”

Another incident that illustrates social alarm happened in London when ex-agent Alexander V. Litvinenko reportedly died from radioactive Polonium-210 poisoning in the intensive care unit of the University College Hospital in London on November 23, 2006.  By November 26, 2006 “hundreds of people contacted the NHS [National Health Service] direct hotline to seek advice about potential radiation poisoning. […] By December 4, more than 3,000 persons had phoned the British Health Protection Agency.” Studies carried out to analyse the scope of the London Po-210 incident point out, “More than 700 UK residents were tested for possible contamination with polonium-210 […] Overall 139 individuals (prevalence 0.19 (95% CI O.13 to 0.27)) showed evidence of internal contamination with (210)Po, although none with intakes likely to cause adverse health effects.”

In the case of the explosion of a dirty bomb the number of casualties, both those physiologically and psychologically injured, would create an arduous task for hospital logistics. The prevention of contamination of hospital personnel and facilities becomes a priority. Treatment of radiological victims requires isolation and is varied and complex. They have to be cared for daily under multidisciplinary and different hematological, surgical, radiotherapeutic or chemotherapeutic treatment of patients at risk from immunosuppression, cancer or blood dyscrasias.  Among other critical measures, all the people in the contaminated zone should be submitted to medical monitoring controls to assess the received radioactive dose in order to allow physicians to predict the effects that finally may occur.

The work of first emergency responders in CBRN incidents is a strenuous task. (Photo of the author)


The probability that a terrorist group could produce a dirty bomb is high, but the lethality could be reduced with an adequate emergency response. The explosion of a dirty bomb would cause social, psychogenic and psychological effects that would hinder overcoming the difficulties and circumstances caused by its potential explosion. “[Director-general of the International Atomic Energy Agency (IAEA)] Mr Amano said the fact that there has never been a major terrorist attack involving nuclear or other radioactive material “should not blind us to the severity of the threat."

Natividad Carpintero-Santamaría is Full Professor at the Polytechnic University of Madrid, General Secretary of the Institute of Nuclear Fusion and Member of the Presidium of the European Academy of Sciences. She holds a Diploma in High Studies of Defence and a Diploma as University Expert in Transnational Organized Crime and Security. She is a collaborator in CBRN threats research at the Spanish Centre for National Defence Studies and other institutions. She has been member of the Consulting Board of the International Working Group of the G8 Global Partnership. She has published several papers on asymmetric threats, WMD terrorism, illicit trafficking of radioactive materials and energy security. She authored the book “The Atom Bomb: The Human Factor during Second World War” (Díaz de Santos, 2007) and co-edited the book Inertial Confinement Nuclear Fusion: A Historical Approach by Its Pioneers (Foxwell and Davies, 2007) considered as recommended reading by the EUROfusion Corsortium of the European Commission. She has been granted the Cross of Aeronautical Merit (white distinctive) and the Cross of Military Merit (white distinctive).