A review of current assistance programs for victims of nuclear weapons highlights that no single best practice exists and that much more work needs to be done to extend the benefits of these programs to all who have suffered.
Current assistance programs for victims of nuclear weapons use and testing have provided compensation or other benefits to individuals in about a dozen countries around the world.
Article 6 of the 2017 Treaty on the Prohibition of Nuclear Weapons (TPNW) requires states parties to provide assistance - “including medical care, rehabilitation and psychological support as well as…social and economic inclusion” - to individuals affected by the use or testing of nuclear weapons. All states parties with the ability to help are required to do so, not only those states where victims of nuclear use and testing live.
This review points to the following policy questions for when states parties to the TPNW or others design future victim assistance. It highlights that no single best practice exists and that much more work needs to be done to extend the benefits of these programs to all who have suffered.
1. Who does the program intend to assist and how does it determine eligibility?
While some programs only provide assistance in response to a radiation-linked illness, others support all habitants of an affected area or all nuclear test veterans.
For programs predicated on an illness, there have been two general approaches for determining eligibility. One approach uses geographic and time-bound criteria to presume impact and eligibility. This approach is easier to understand and administer, but draws hard categorical boundaries.
The second approach measures exposure and the likelihood that exposure caused illness by examining demographic and behavioral factors. While this approach appears more equitable in theory, it raises serious challenges in practice. Further, the threshold for eligibility within the formula may be more of a political calculation than a scientific one.
While the enabling statute of France’s program includes a presumption of causation, it also states that radiation exposure must cause more than a “negligible risk.” As a result, the French administering agency initially used a more technical approach to establish risk that resulted in claim approval rates of less than 10%, leading to widespread frustration. In 2017, the program was amended to remove the “negligible risk” language and, while questions still remain about program application, initial data show that claim acceptance rates rose above 50% in 2018.
2. Is the assistance monetary compensation or programmatic (e.g. health care) assistance? Is it one-time or ongoing?
Some programs have provided one-time financial compensation (United States, France, Canada, Fiji, Isle of Man, India), some provide ongoing financial compensation (China), some provide other ongoing benefits (Japan for decades, Australia only belatedly), and some provide a combination of financial and non-financial compensation (Russia, Kazakhstan, Marshall Islands).
Long-term assistance programs may better meet victims’ ongoing needs, but also require more robust program structure or bureaucracy.
The TPNW calls for assistance that establishes or reestablishes social and economic inclusion of the impacted communities. Provision of health care or pension payments are positive contributions, but a more comprehensive assessment of individual and community needs may be necessary to meet this standard moving forward.
3. Does the assistance account for changing costs over time (e.g. inflation)?
For programs with one-time benefit awards, it is important to consider how costs may change over time. Under the U.S. program, the award amounts have remained the same over a 30-year period; general inflation has cut the value of these awards essentially in half.
4. Does the assistance account for multi-generational harm?
As first-generation victims from World War II and the subsequent era of nuclear testing age and pass away, the focus for victim assistance may shift to second- and third-generation victims. There is growing concern that the harm caused by radiation exposure gets passed down to future generations.
Kazakhstan provides healthcare for children born in affected areas, but no other programs recognize and compensate for the harm caused directly on second-generation survivors. Some existing programs provide benefits to family members in the case of death of the primary victim.
5. Are the benefits of the assistance distributed without discrimination across all affected populations?
Countries often started with benefits to veterans and then expanded to civilians, although some like China only provide veteran assistance.
Most often, tests were conducted in close proximity to already marginalized groups, including colonized or Indigenous populations and some groups have received more assistance than others. Under the French program, for example, only one Algerian has received compensation over the last decade.
6. Does the assistance come with an explicit apology or assumption of moral responsibility by the providing entity?
Only the United States has issued an apology, and only to its own citizens in 1990 legislation. To citizens of the Marshall Islands, the U.S. stated it had a responsibility for the nuclear tests but it did not apologize.
The United Kingdom refuses to recognize any health impacts from nuclear tests or provide any compensation. France recently recognized the involuntary contributions of French Polynesia to its nuclear program, but has not apologized for any of its tests. Other countries have provided payment to veterans without accepting legal or moral responsibility.
While the TPNW does not legally require an apology (in part because it requires non-responsible states to provide assistance when possible), it is important to many victims and communities.
In summary, these questions raise important policy issues to be discussed and highlight shortcomings in existing programs. Looking ahead, the rights-based approach established in the TPNW should guide future victim assistance efforts, even for states not party to the treaty. It is important to also pay attention to the TPNW language that calls for age- and gender-sensitive assistance, given the evidence that shows women and girls are more affected by fallout. Policymakers must consider the questions raised above with input and participation from the directly affected communities themselves.