An open letter to Prime Minister Atal Behari Vajpayee of India and Prime Minister Nawaz Sharif of Pakistan:

We send this appeal based on long experience in struggling for peace and nuclear sanity in order to sustain life and promote health. A nuclear conflict between India and Pakistan would be an unmitigated catastrophe, not only for the people of India and Pakistan but for all humankind. No society can survive even a modest nuclear attack. No civil defense preparation can mitigate the dreadful consequences. An overwhelmed health care system could not cope with the massive numbers of casualties seeking help. The fatally injured would die in the solitude of their unrelieved agony.

In Hiroshima, a primitive nuclear bomb – less than the magnitude you have recently tested – killed, in a split second, more than 100,000 people and maimed and injured a like number. A majority of the health workers were among the victims and could not respond to the unspeakable suffering. People were incinerated without a trace. Now, 50 years later, survivors are still burdened with enduring nightmares. Noxious radiation effects are continuing to exact a toll in malignant disease.

Nuclear weapons are the deadliest technology science has ever devised and differ from all other military hardware. Given a crisis, there is a compelling incentive for preemption. The fear of losing the nuclear stockpile from a first strike is an incentive to launch on warning or initiate a nuclear attack during the time of intense political confrontation. In fact, the military policy of both superpowers during the cold war was to strike first in a time of crisis. Pakistan and India, sharing a border, have inadequate time for crucial decision making and, with human reaction time being too slow for hair-trigger readiness, these life-and-death judgments will increasingly be relegated to automated computer systems. Ultimately, the bomb takes command of a country’s destiny. These weapons are capable of simultaneously inflicting genocide on the victim and suicide on the attacker. The frequent malfunction of technology is a lesson oft documented.

During the nuclear standoff between the Soviet Union and the United States, both countries had to remove substantial numbers of military personnel assigned to their nuclear forces for reasons of drug abuse, alcoholism, and serious mental and psychological problems.

In fact, nuclear war is an accident waiting to happen. Even if war is prevented, acquiring and maintaining nuclear force-readiness exact enormous economic, psychological and moral costs. The countries of Pakistan and India have demonstrated the power to extend the lives of their people. In both Pakistan and India, citizens no longer need to fear smallpox. Both are eliminating polio as a detractor of enriched lives. You are providing public health benefits unknown to your predecessors. Both India and Pakistan now have the capacity to neutralise all these gains by promoting a public health disaster that would shorten lives and destroy the rich future that is possible. The children yet unborn in these countries and in the rest of the world depend on your proxy vote and awesome power to be used with them in mind. Both nations are in a tight embrace of shared self-interest to see that nuclear weapons are never launched. An immediate powerful trust-building measure would be to pledge no first use of nuclear weapons. You would thereby gain wide support for your well-articulated position that nuclear apartheid can have no sanction.

At the dawn of the atomic age, physicians argued that for a disease without a cure, abolition of nuclear weapons is the only remedy. Now, the essential conclusion is that total elimination of these genocidal weapons is the sole guarantee that they will never us used. Perhaps no obligation to future generations is more compelling than removing the nuclear threat hovering over humankind. Ultimately, it will prove the indispensable prerequisite for a peaceful and just world order in which a higher moral consciousness makes nuclear weapons not only illegitimate but also unthinkable.

Drs Lown and Chazov were recipients of the Nobel Peace Prize in 1985 on behalf of the International Physicians for the Prevention of Nuclear War, which they co-founded.

Journal of the American Medical Association, Editorial August 5, 1998.