Chernobyl Liquidators' Health
as a Psycho-Social Trauma

6. Conclusions

       The aim of this work has been to elicit the picture of the health state of the liquidators — the people who worked in the Chernobyl zone in 1986—1990, mitigating the consequences of the explosion at the Chernobyl NPP, and whose total estimated number is 0.6—0.9 million — and analyse its possible causes.
       For this purpose, first the radiation and non-radiation circumstances of work and stay in the Chernobyl zone were analysed in detail, and it was concluded that the majority of the liquidators have received irradiation doses (not exceeding several dozens Roentgens, in terms of the exposure dose), which are considered to be insufficient to reach the threshold of clear signs of radiation injury. On the contrary, a set of the non-radiation harmful factors affecting the liquidators' bodies and psyches in the zone made their in-zone experiences quite hard, and rather similar to those of combatants.
       Then, after the discussion of the criteria for the selection of literature in such a controversial field as the Chernobyl impact on the human health, the present health state of the liquidators has been assessed based on the literature data. First, it has been shown that those of the consequences, which in the mass consciousness and perception are most frequently associated with Chernobyl (cancer, negative impact upon the reproductive function, supposedly deadly effect of inhaling Pu-containing “hot particles”), according to the results of examinations, surveys, calculations and modelling, presented in literature, had been proved to actually have NO significant effect (e.g., expected radiation-induced increase of the onco-mortality (as compared to the expected spontaneous one) for the liquidators of 1986 is estimated as 12%, of 1987 — as 4%.). Literature data on the physical health of the liquidators have not shown significant deviations from the corresponding data for either the nuclear professionals, irradiated within the same range of doses, or the intact populations. Thus, no influence of the radiation factor has been manifested. However, significant differences were discovered in the psychic health of the liquidators as compared to the two groups mentioned. This difference was shown to be due to the considerable influence of the factors of psychological and social-economic nature, especially of “post-zone”, present period of the liquidators' life.
       This has led to the necessity, first, to study the frameworks which could explain the effects of different harmful factors and circumstances of stay and work in the Chernobyl zone, namely, those of stress, distress and general adaptation syndrome (according to Selye); of occupational stress; of the impact of extreme/unusual environments; and of post-traumatic stress disorder (PTSD). The PTSD (or, in a broader terminology, traumatic stress) concept, which embraces an essential share of the consequences in psychological and social sphere, predicted by the two preceding models, and generalises the data for many various individually- and mass-traumatic events, has proved to be especially relevant for the Chernobyl liquidators' case. The concepts have helped to locate different traumatic features of the Chernobyl zone, which have not received adequate attention yet. The health outcomes, predicted by these models, are in a qualitatively good correspondence with those actually observed.
       Essential (and, most likely, dominating) influence of the “post-zone”, present-day factors upon the liquidators' health was derived from both the reported data on the liquidators' health, and the frameworks of Chernobyl impact upon the liquidators. The analysis of the data about economic and psychological state of the modern societies of the countries “in transition” (Ukraine and Russia) has shown that, as members of these societies, the liquidators are experiencing distress, caused by a complex of economic, political, social and psychological circumstances. Moreover, they are additionally affected by a series of negative factors, specific for this group, and caused in particular by the lack of adequate information and misinformation about Chernobyl and its radiation and medical consequences, by the deficiencies of the medical treatment of the Chernobyl-affected, and by the current Chernobyl welfare system.
       The medical mistakes — both intentional and not intentional, the latter connected with inadequate perception of the diseases of the Chernobyl-affected by the medical doctors, and the medication bias in the treatment — constitute a substantial hazard for the liquidators in their post-zone life. The welfare system, which is partly (as far as the higher compensations are concerned) based on the principle “compensation upon disease”, does not seem to be effective with regard to its task but, vice versa, stimulate diseases and poor social adaptation of the liquidators.
       Further, the comparison of the data on the Chernobyl liquidators with those for other groups of the affected by the traumatic events of different nature (wars, nuclear tests, Chernobyl-caused contamination) has shown that the conclusions obtained in this study fit into the general rule. It is possible to state that the regularity of ecological (and, most likely, social as well) catastrophes (Mirnyi 1999a, 1999b), consisting in “a shift of the main harmful factor/factors (1) with the distance from the epicentre and (2) with time after the triggering event — from primary (direct) to secondary (more and more indirect) factors”, was confirmed in this study.
       The present health of the Chernobyl liquidators is explained rather by the complex of the Chernobyl-evoked psychological, social, economic and political harmful factors both of the Chernobyl zone and (especially) of post-zone period of their lives — than by the fact of their irradiation in the zone and its biological consequences.
       This conclusion should form the basis for the measures to decrease the risk for the liquidators' health and for the elaboration of an adequate and complex system of rehabilitation of the Chernobyl liquidators, which should incorporate vast international experience of treatment of survivors.

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Design by: M.Opalev
Studio ARWIS  Kharkov, 2001