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Final Report

Chemical, Biological, Radiological, and Nuclear

Threats

September 2017

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FINAL REPORT

2017

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1 _________________________________________________________________________________ Atlantic Treaty Association

Atlantic Treaty Association

Who We Are

Founded in 1954, the Atlantic Treaty Association (ATA) is an organization of policy-makers designed to produce top-notch knowledge on strategic themes while conducting research, analyses, training, education, and information activities tailored to the promotion of transatlantic values and enhanced non-military cooperation between civil society and institutions.

For over 60 years ATA has fostered the development of transatlantic security policy alongside diplomats, military, industry, academia and journalists in order to strengthen the bond between influential stakeholders within the Alliance.

National Associations

ATA Headquarters is based in Brussels and coordinates an extended and highly qualified network of 37 national Atlantic Councils and their respective youth divisions to facilitate policy development in key areas of security and defense.

Youth Atlantic Treaty Association (YATA)

Special relevance is attributed to the Youth Atlantic Treaty Association (YATA), our young professional contingent, designed to prepare the next generation of Atlanticist leaders to face the challenges and threats of the present and future security scenarios.

ATA Council Meeting 2015

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Concept Note Objective

In recent years, the threat of chemical, biological, radiological, and nuclear (CBRN) attacks have increased. In particular, the danger of CBRN warfare waged by organised crime or terrorist cells presents itself as a possibility. The European response remains slow, especially in connection to medical capacity should an attack take place. It is essential to analyze these shortcomings and make way for new policies and approaches in the event the CBRN risk becomes a reality. The purpose of this Report is to provide a viable assessment of the CBRN threat and operational capability within Europe to address it.

Goals

a) To bring together experts and policy makers to analyze how to better prepare

for the CBRN risk with a focus on prevention and medical capacity; b) To examine the current CBRN threat as well as future threats; c) Provide policy recommendations to NATO and the EU

Authors

- Col. Vratislav Osvald-Director of the Joint CBRN Defence Centre of

Excellence (JCBRN Def COE)

- Malcolm Sperrin-Lt Col RAMC and Professor of Radiology at Reading University. IAEA Inspector and a Specialist Advisor on behalf on Interpol

- Alessandro Boncio-European Expert Network on Terrorism Issues (EENeT) of the Advanced Institute of Technique Studies from the Arma dei Carabinieri

Language

English

Documents

ATA Webpage - Final Report

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Report Executive Summary This report analyzes the current vulnerabilities in Europe related to the risk of an accident or an attack involving CBRN materials, pointing out EU current capacities and provides policy recommendations to heighten capabilities, knowledge and preparedness. A special emphasis will be dedicated to the radiological and nuclear (RN) threats due to radioelements depletion resulting in lasting effects of contaminated areas as this is an area currently lacking specific policies or capability requirements for mitigating life-threatening injuries. Background As of today, we are facing evolving threats from both, state and non-state actors, causing complex challenges, including hybrid warfare, terrorism, organised crime, cyber-attacks and a wide range of events involving weapons of mass destruction (WMD) and chemical, biological, radiological, and nuclear (CBRN) threats.

The full extent of the potential CBRN threats cannot be predicted because they can evolve in non-linear ways and can be affected by a number of outside factors, including economy, flow of goods and people, meteorological conditions, etc. Such uncertainty can make it difficult to determine the nature or origin of such a threat, and complicate response efforts when detailed information is not yet available. However, there are indications that terrorists intend to acquire CBRN substances for malicious purposes. In addition, there are evidences that even some sovereign states attempt to acquire nuclear weapons and the means of delivery, which could pose a significant threat to the international community in the near future.

Effective responses to CBRN events often require their initiation before the origin or full extent of the event is understood. This requires familiarity with various aspects of diverse scenarios that can only be achieved through advanced consideration. Advanced planning together with the access to timely, accurate and relevant information is a critical component of any CBRN response, heavily supported by the diverse, multipurpose capabilities necessary to provide the operational flexibility for a wide range of future CBRN response efforts.

Status in the European Union The European Union and the Euro-Atlantic community in general are currently facing two main security threats related to terrorism, represented by foreign terrorist fighters trained in Syria and able to execute complex attacks (so called “returnees issue”), and the risk represented by the influence and jihadization capability of ISIS and other salafi-jihadist groups which can result in a potential escalation of attacks all over Europe.

Despite recent and continuous loss of territories and assets by ISIS and the current “underground” rebranding and adaptation of likeminded terrorist organizations such as al-Qa’ida or al-Nusra, there is a coherent jihadist strategy aiming at shifting the West’s focus from the Middle East to Western countries; contemporary jihadist propaganda asks sympathizers not to travel to jihadi battlefields, but to carry out attacks in their own countries.

Airmen inspect simulated M-9 paper during their chemical, biological,

radiological and nuclear training (U.S. Air Force photo by Airman 1st Class Kelsey Waters,

2013).

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In this context, the possibility that a jihadist group might launch a terrorist attack using CBRN (chemical, biological, radiological or nuclear) agents remains one of the gravest threats to homeland security in the world; it is definitely not a new phenomenon, as terrorist organizations in the past have tried to purchase CBRN materials to exploit the mass casualties and the psychological and sociological effects linked to such a tragic hypothesis.

Interpol takes note of the risk of groups like ISIS accessing CBRN weapons in their latest European Union Terrorism Situation and Trend Report.

The phenomenon of individuals travelling for terrorist purposes to conflict zones increases the risk that expertise in the use of chemical weapons can be transferred to the European Union by returning foreign terrorist fighters. Both Syria and Iraq have had chemical weapon programmes in the past, as well as production facilities and stockpiles which may not have been completely destroyed, despite international community and OPCW efforts.”1

According to this report, CBRN materials remain highly attractive to terrorists and several incidents in 2015 involved actual or attempted malevolent use of CBRN materials with criminal or unknown intentions. Incidents involving attempted sale of radioactive materials by organized crime groups occurred in Moldova, Ukraine, Turkey, and Poland.2

Interpol also highlights that Jihadist terrorists and their sympathizers regularly express threats involving CBRN materials in their propaganda.

Mr. Wolfgang Rudischhauser, Director of the WMD Non-proliferation Section at NATO, expresses similar concerns in an article from late last year.

We might thus soon enter a stage of CBRN terrorism, never before imaginable. Worrying reports confirm that ISIL has gained (at least temporarily) access to former chemical weapons storage sites in Iraq. They might soon do so in Libya. They allegedly used toxic chemicals in the fighting around Kobane. Even more worrying, there are press reports about nuclear material from Iraqi scientific institutes having been seized by ISIL. This demonstrates that while no full-scale plots have been unveiled so far, our governments need to be on alert. Generating improved military and civil prevention and response capabilities should be a high priority and should not fall victim to limited budgets in times of economic crisis.3

He also warns about the damage that could have been caused if for example the recent Charlie Hebdo’ attacks had been targeted against a metro station using explosive devices containing radioactive sources or chemical material instead of using Kalashnikovs.

Consequentially linked to the above-mentioned issue is the necessary know-how to assemble a device to weaponize such agents; chemicals products could be simply mixed to obtain lethal agents, but storage and effective dispersal systems are more difficult to achieve as the 1995 sarin attack in Tokyo confirmed4. On the other hand, biological weapons are even harder to isolate and use for a terrorist attack. Even though bacteria and pathogens can be obtained, their handling is very risky and can result in spreading diseases in terrorist camps and population5.

1 Europol, “European Union Terrorism Situation and Trend Report 2016,” European Police Office, 2016. 2 Ibid. 3Wolfgang Rudischhauser, “Could ISIL Go Nuclear?” NATO Review, May 26, 2015. 4 The sarin was contained (in its liquid form) in plastic bags perforated with umbrella tips into subway train coaches. Leaking out and

evaporating, the gas affected passengers and rescuers, but due to its dilution, its lethality was lowered. 5 A. Amiga & R. Schuster, “EU report: ISIS could commit chemical or biological attack in the West,” Haaretz, December 13, 2015.

French Police responding to attack on AirProducts, which

intended to blow up gas tanks (The Washington Post, 2015).

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Therefore, the biggest danger in terms of a more likely scenario involving CBRN agents is related to radiological IEDs or ‘dirty bombs’. This is especially the case for the so-called “orphan sources”6, which are usually found, stolen or mishandled by several people, or willingly dismissed as ordinary waste by nonchalant companies, resulting in possible terrorist acquisition. More than 150 cases of trafficking of radioactive materials are reported annually to the International Atomic Energy Agency (IAEA)7. In this context, Interpol STONE project was launched in 2016 to counter RN smuggling and identify individuals involved in RN materials trafficking8.

Jihadist networks usually have three possible channels to purchase CBRN substances. The first supplying channel is represented by former proliferation programs which are now disbanded; chemicals, radiological, biological and nuclear material originating, for instance, from former Soviet programs are rumored to be in the hands of organized crime groups9. The same reasoning applies to the former Libyan chemical storage sites raided by various extremist factions after overthrowing the Qaddafi regime10.

Another supplying system that bypasses the difficulties of smuggling CBRN substances into a country is diverting them from peaceful civilian activities. Examples of recent (failed) attacks in Europe are the plans to strike a nuclear power plant developed by the Brussels cell responsible for the March 2016 terrorist attacks11 or the June 2015 ISIS-inspired attempt by a French individual who rammed his vehicle into a gas factory trying to explode gas tanks12.

Finally, the digital age communication facilitated the development of black markets with encrypted transactions and virtual payments; the use of the dark web to purchase CBRN substances is in fact steadily increasing due to the virtual non-traceability of communications and the secure procedure of payment without a material exchange of money.13 In 2014, Kuntal Patel bought a deadly toxin (Abrin) through a US Dark web site for a bitcoin exchange value of £95014; in April 2016, speaking to a group of heads of state and foreign ministers, US President Obama described how a terrorist group had bought radioactive isotopes through brokers on the Dark Web15.

6 An orphan source is a self-contained radioactive source that is no longer under proper regulatory control due to abandonment, loss,

misplacement or theft. 7 B. Immenkamp, “ISIL/Da'esh and non-conventional weapons of terror,” European Parliamentary Research Service, December 2015, p.4. 8 Interpol, “Radiological and Nuclear Terrorism: Project Stone,” Interpol, 2017. 9 P.J. Smith, “The terrorism ahead: confronting transnational violence in the Twenty-first Century,” Routledge, p. 104, 2015. 10 A. S. Hatita, “Libya militias capture chemical weapons: army official,” Asharq al-Awsat, February 21, 2015. 11 K. Vick, “ISIS attackers may have targeted nuclear power station,” Time.com, March 25, 2016. 12 A. Faiola & V. Demoustier, “Explosion hit French factory; terrorism probe opened,” The Washington Post, June 26, 2015. 13 Press release, “A primer on DarkNet marketplaces,” Federal Bureau of Investigation, November 1, 2016. 14 “Breaking bad inspired murder plot by daughter,” BBC News, September 22, 2014. 15 G. Weimann, “Terrorist migration to the Dark Web,” Perspective on Terrorism, Vol. 10 No. 3 (2016).

IAEA packages and transports radioactive material using a secure process to prevent incidents, including trafficking (IAEA Imagebank, 2011)

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What jihadist networks still lacks is the operational know-how to assemble a CBRN explosive device; this can easily become another vulnerability in the future for Western countries, as various suspected terrorists have already tried to infiltrate chemical, biological, and nuclear laboratories to acquire methodological, technological and instrumental knowledge to handle weapons of mass destruction.

Taking into account the feasibility of these disastrous events, it is sufficient to consider the numerous targets can be potentially attacked by a terrorist cell exploiting CBRN materials. Nuclear power plant sabotage, Vehicle-Borne

Improvised Explosive Devise (VBIED) attacks against chemical plants or tankers, theft from research laboratories and the subsequent use of spores, bacteria and viruses in enclosed environments are just a few of the scenarios analyzed by CBRN defense experts.

Impact of an RN Attack Radioactive material can either be dispersed in the environment (Radiological Dispersal Device – dirty bomb) or directly irradiate people (Radiation Emission Device) resulting in individuals being exposed to alpha, beta or gamma rays. Polonium poisoning has been already employed in different occasions; orphan sources could easily be attached to explosive devices to spread ionizing radiations that can be inhaled, ingested or leading to people’s skin or clothes being exposed). Of course, the most dangerous incidents should be theorized against nuclear power plants, with the risk of leaks or (worse) explosions resulting in a wider contaminated area with longer lasting effects not only on people, but also on the environment.

Although the exact impact from a RN attack is hard to estimate, there are some simulations made on the damage that a detonation containing radioactive materials would cause to a city.

• As part of the US Department of Homeland Security’s Improvised Nuclear Device (IND) preparedness program Mr. Brooke Buddemeier from the Lawrence Livermore National Laboratory have calculated that a 10KT ground explosion within 1.6 miles of the U.S Capitol would lead to 1 million people exposed to 1Gy or more in the first 4 days. His simulation suggests that such a scenario would lead to more than 50,000 deaths due to blast, burn or radiation.

• Another simulation made by Dr. Cham Dallas from the Institute of Disaster Management and presented to the US Senate Homeland Security Committee concludes that 180,000 people would be injured and in need of treatment (10KT detonation).

US Navy team uses a VBIED for training purposes in Arizona (U.S. Air Force photo/Staff Sgt. Joshua Strang, 2013).

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The second sector of concern is psychological; after a terrorist incident, terror is instilled in the population, especially if the attack is against a soft target. Way afterward, statements of CBRN use for the attack will heighten this fear, leading to psychosis and possible alienation of suspected ill/contaminated victims. Such substances are usually not perceptible by human senses, thus creating a fear determined by the absence of recognizable threats.

The third affected area is sociological and will directly influence our collective behavior; in the wake of terrorist attacks against music venues, stadiums or restaurants, many people will decide to avoid such places. Long term effects however, can lead to behavior and routine changes, adapting one’s lifestyle to new threats and fears (in the 50’s, for instance, individuals bought private shelters fearing an imminent nuclear holocaust).

There are also logistic and operational problems to consider; CBRN substances released in an urban area will lead to prolonged emergency situations in time and space; metropolitan areas contaminated with biological, chemical or radiological agents will be forbidden for long periods, complicating the victim’s rescue operations and influencing institutional, economic and normal activities resumption.

Lawrence Livermore National Laboratory demonstrates nuclear explosive impact on Washington, D.C. based Buddemeier’s analysis (Lawrence Livermore National Laboratory, 2009).

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Government Approach Since the WTC and the successive wave of anthrax and ricin attacks in 2001, both the United States and the European Union espoused and strengthened strategies to increase their preparedness and capabilities related to CBRN terrorist attacks.

EU Response

In 2009, the EU released the CBRN Action Plan as part of this strategy addressing 124 actions (related to specific sectors – chemical, biological, nuclear and radiological – as well as horizontal actions) to be implemented by Member States16. The plan’s three main strands are the prevention, detection and preparedness/response to CBRN incidents.

As seen, a crucial role is played by the immediate medical response to such incidents in order to mitigate the effects of CBRN agents released during a terrorist attack; the EU Action Plan identified some actions directed at determining

medical countermeasures and vulnerabilities among MS, as well as providing an exchange of best practices in the field of CBRN medical responses17. In 2010, the EU also established the CBRN Centres of Excellence initiative, seeking to improve capacities of countries to mitigate CBRN risks.

In 2014, the EU adopted a Communication on a new approach to the detection and mitigation of CBRN-E18 risks and the 2016 CBRN Action Plan’s Second Progress Report reviewed the implementations made, including the opening of the EU Nuclear Security Training Facility, the development of a database of the CBRN-E glossary and the

organization of numerous training courses and exercises19.

However, the nature of these actions relies more on risk assessment and strategic response than on operational measures to increase CBRN medical capacities. An EU Council report of February 2017 highlighted gaps in the European Emergency Response Capacity, especially in the field of CBRN search and rescue operations in contaminated environment and decontamination of patients exposed to CBRN agents20. The majority of CBRN-CoE projects also rely on training, e-learning, raising awareness and best practices sharing in order to reach a standardized level of preparedness; what should be increased is the operational medical capacity in terms of field equipment and specific medicines to be employed.

16 “Council conclusions on strengthening chemical, biological, radiological and nuclear (CBRN) security in the European Union - an EU

CBRN Action Plan – Adoption,” Council of the European Union, November 12, 2009. 17 S. Jackson, “European Union CBRN medical countermeasure preparedness,” cbrnportal.com, May 26, 2014. 18 The acronym is related to Explosive devices to blow and release CBRN agents in the environment 19 “Annual Progress Report on the implementation of the European Union strategy against the proliferation of Weapons of Mass

Destruction (2016)”, Council of the European Union - European External Action Service (EEAS), January 17, 2017, p.12. 20 “Report from the Commission to the European Parliament and the Council on progress made and gaps remaining in the European

Emergency Response Capacity,” Council of the European Union, February 17, 2017.

CBRN Action Plan

Prevention Detection Preparedness/Response

CBRN Centres of Excellence

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RN Medical Capacity Universal Capacity

The medical countermeasures often on offer include the issuing of potassium iodide but this only relates to the mitigation of effects arising from the release of radioactive iodine. This has arisen as a result of the most likely

mechanism for exposure to radioactive isotopes being the release from the nuclear power industry where iodine is present in the fissile material. For exposures derived from the release of isotopes such as Co, Tc etc., KI presents no benefit and in fact the toxic side effects may be detrimental especially where a population considers that the small amount of KI in table salt presents the equivalent appropriate opportunity of desired effect.

The population at risk, is likely to be affected in a much broader range of ways than either trauma or radioactive contamination. Many of the radiotoxic effects will mimic stress reactions and hence there is a very high likelihood of the worried-well being the dominant call on health provision. This is likely to present a very significant challenge to medical capacity especially where there is some element of social unrest. In addition, specific medication is needed for a successful treatment of Acute Radiation Syndrome (ARS), which would be critical to protect responders and the general population against the immediate and potentially deadly acute consequences of RN accidents, which also need to be stockpiled in addition to KI.

The preparedness therefore extends well beyond that normally expected of conventional societal challenges and care must be given to ensure that such factors are addressed very early since some level of infrastructure and education are necessary beyond that which could be instigated at the early stages of a real event.

European Capacity

Protection measures and crisis response plans against RN incidents are prepared for nuclear power plants and nuclear industry. Potassium Iodide (KI) is widely distributed among local populations and some stock is available in army stores and specialised hospitals. Limited amounts are also available for first responders; however, in case of a radiological or nuclear incident, KI pills can only help to remove radioactive iodine and thus reduce the future odds of thyroid cancer. Additionally, KI cannot treat near-term (acute) radiation-induced injury or mortality.

While KI and other decorporating agents are available there are no stockpiled medical countermeasures for the treatment of ARS, which would be critical to protect responders and general population against the acute and potentially deadly consequences of RN incidents.

In general, hospitals are not well prepared for any kind of CBRN incident, and in case of a RN incident, the situation is even worse. Only a few specialised facilities and military hospitals are trained and equipped to cope with irradiated or contaminated casualties in case of a nuclear war. Beyond these mentioned facilities, crisis response plans for RN incidents are not sufficiently prepared. In addition, specific medication is needed for a specific, successful treatment of ARS and decorporation of radiative isotopes which both need to be additionally stockpiled.

Thus, a wider range of medical radiation countermeasures are needed. In the past, several countries have researched radioprotectives that can protect against a wider spectrum of radiation exposure; those programmes are more or less frozen, though.

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Research and Development Europe also has serious gaps when it comes to supporting research and development of CBRN medical countermeasures. In the U.S, the Biomedical Advanced Research and Development Authority (BARDA) was established to be responsible for procurement and development of countermeasures against chemical, biological nuclear and radiological (CBRN) threats. In 2016 BARDA’s budget was $522M. In addition, the agency also manages Project BioShield ($646M in FY2016), which includes the procurement and advanced development of medical countermeasures for CBRN agents, as well as the advanced development and procurement of medical countermeasures for pandemic influenza and other emerging infectious diseases.

BARDA was created by US Congress with the mission to fund and thus bridge development of CBRN countermeasures via the "valley of death" (e.g. the late stages of product development). BARDA's support ensures continuity of funding for medical countermeasures developed by industry or emerging from the basic research and preclinical development activities sponsored by the National Institutes of Health (NIH).

One specific example of a medical radiation countermeasure that US (NIH, BARDA and DOD) has supported with funding is Entolimod. Entolimod is capable of reducing the odds of ARS-related mortality 2-3-fold even after the doses of radiation that are lethal to 70% of exposed victims. This year, the European Medicines Agency (EMA) has started

looking in to Entolimod and has approved the drugs pediatric investigation plan (PIP), which is an important step in paving the way for receiving a Marketing Authorization Application (MAA) in Europe and hence would make the drug available in all European countries.

In Europe, few funding opportunities for research and development of medical countermeasures are available and to this date and there is no coordinating mechanism on an EU level addressing the capacity gaps in medicine. The European Parliament has addressed the issue in the Resolution Strengthening chemical, biological, radiological and nuclear (CBRN) security in the European Union21 where they stress that the necessary

research and development funding should be provided in the CBRN field and calls on the Commission to propose a strategy for developing the biodefense industry in Europe.

Governments across Europe should encourage the continuous innovation in this field and support efforts to make sure effective medical radiation countermeasures are both developed and made available.

Conclusion Although initial radiological and nuclear crisis response plans exist in all EU countries, a long-term crisis management (CM) is mostly missing (cf. Fukushima Daiichi disaster). In a medium or large-scale incident, a stricken country might not have the power to cope with the situation due to several reasons:

• Lack of decontamination capabilities and capacities,

• Limited stock of decontamination solutions,

21“Resolution Strengthening chemical, biological, radiological and nuclear (CBRN) security in the European Union,” European Parliament, December 14, 2010.

BARDA’s Centers for Innovation in Advanced

Development and Manufacturing works to enhance public health

emergency preparedness (BARDA,

2017).

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• Limited specialised medical capabilities and capacities,

• Lack of waste management capabilities and capacities (including disposal of contaminated water),

• Limited Crisis Response (CR) and counter measure capabilities and capacities.

National capacities might fully exhaust the inventory in as few as two to three days; external reinforcement is, therefore, a critical aspect of any radiological or nuclear CR and CM operation. Only a few nations have introduced military capabilities to decontaminate wounded personnel. This raises the requirement for a minimum level of interoperability amongst units and synchronized E&T plans within the EU territory and beyond. Some cross boundary bilateral or multilateral radiological and nuclear exercises are already in place; however, in most cases, these are related to nuclear power plant incidents and focusing on CR only. Larger exercises that include more EU countries (not only neighbours) and CM are vital to ensure that a stricken country can be reinforced by other nations and capabilities and capacities can be shared.

As a result, this could lead to a situation that Nations do not have to build up individual robust capabilities and capacities, but rather develop advanced deployable technologies, which better reflect operational needs. A great example of multilateral cooperation could be the establishment of the “EAPC Inventory of National CBR(N) Consequence Management” as an initial step towards a future CBR(N) CM stockpile. Prevention and Protection against and Recovery from a CBR(N) incident are complex in nature and expensive issues. Efforts should focus on prevention measures; however, should these fail, an international system ready to cope with CBR(N) incidents must be established to mitigate large scale effects.

The following areas are to be considered:

Cooperation

Regular, coordinated communication with relevant partners, entities and IO is essential during all CBRN response phases. This communication is aided by personal relationships that forge common understanding and mutual trust. These relationships can be achieved through regular joint exercises and training opportunities. An integrated joint task force-like structure with clearly defined roles for each participant could aid in synchronising response operations. It would be most effective to leverage existing EU Nations’ assets that are already prepared to respond to a rapidly emerging CBRN crisis. With respect to radiological and nuclear defence, EU Member States and NATO Allies22 could consider the following activities for increased practical cooperation:

Exercising

Continually exercising these capabilities, particularly among different entities that could be called upon to lead or contribute to a response, will foster important relationships and save time if a real crisis emerges.

Preventive Measures

The primary effort should be focused on preventive measures. Highly populated areas should be equipped with sensitive detectors for monitoring. In order to monitor cargo, movement toll stations, highway frames and ports of disembarkation (sea, air, road and rail terminals) should be equipped with systems to continuously monitor cargo content. If prevention fails, land- and air-based γ-spectrometry should be fielded to effectively search for illicit trafficking of radionuclides.

22 To support nations in a case of a radiological incident NATO is able and capable to provide military capabilities, such as the Combined Joint CBRN Defence Task Force (CJ-CBRND-TF) and Medical Radiological Incident Investigation Teams (MRIIT) as well as civilian capabilities like the Euro-Atlantic Disaster Response Coordination Centre (EADRCC), Advisory Support Teams (AST) and Rapid Reaction Teams (RRT). In a supporting role, the Joint CBRN Defence Centre of Excellence is able to provide Modelling & Simulation in order to predict hazard areas as well as its Reachback capabilities.

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CBR(N) Warning Systems and Knowledge Management

Standardized CBR(N) Warning Systems should be developed in order to ensure early warning and minimum casualties and to enable international response to CBRN incidents. In addition, effective CBR(N) Knowledge management and information sharing is an essential pre-requisite for effective prevention, early protection and recovery from CBR(N) incidents.

Stockpiled CBR(N) Medical Countermeasures

A clear guidance on distribution and availability of medical countermeasures (including KI and other decorporation agents and drugs to treat ARS) as well as stockpiling under EAPC supervision should be considered in order to ensure timely availability in sufficient amounts whenever and anywhere needed.

While KI and other decorporation agents are currently available there are no EU-approved radioprotectors for the treatment of ARS, which would be critical to protect responders and the general population against the acute and potentially deadly consequences of RN accidents.

Medical treatment of radiologically contaminated or irradiated casualties is a critical part of all CR measures. Hence, appropriate capabilities should be available at the regional and state level for small and medium scale incidents, while large scale incidents should be dealt with internationally to effectively utilize capacity available among Nations.

Policy Recommendations 1. Confirm the information gathering networks function properly and that the risks arising from events outside of

the EU are considered and mitigated against.

2. Create a EU wide register of key RN advisors including on-call responsibilities.

3. Develop a technical guide for the management of RN events to include key spelling or key terms, immediate actions etc. This should be independent of communication networks.

4. Identify vulnerabilities in the medical pre-planning post RN event. This should include international opportunities and the use of military assets as well as NGO capacity.

5. Instigate a system for challenging the state and EU level CBRN Centres of Excellence. Create a master programme aimed at high-risk forensics skills.

6. Identify factors relevant to the identification and control of the worried-well patients.

7. Support and fund RN product development in EU.

8. Support EU-based manufacturing of medical radiation countermeasures to establish a standby capacity.

9. Introduce EU based stockpiling of radiation countermeasures to effectively increase medical capacity across the member states.

10. Widen radiation protection from only KI to additional medical countermeasures that would save many lives and protect responders and the general population against the acute and potentially deadly consequences of radiological or nuclear accidents.