A Twenty-Year Review of Medical Findings in a Marshallese Population Accidentally Exposed to Radioactive Fallout

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BROOK HAVEN NATIONAL LABORATORY ASSOCIATED UNIVERSITIES, INC. UNITED-STATES ENERGY RESEARCH AND DEVELOPMENT ADMINISTRATION

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l%is report was prepared as an account of work sponsored by the United States Government. Neither the United States nor the United States EnergyResearchand any legal liability or raponsibilky forthe accuracy,completenessor usdidness of any information,apparatus, product or processdisclosed, or represents that its use would Printed in the United States of America Nauonal Technical [tiot-mation Semite U.S. Department of Commerce 5285 Port Royal Road Price: Printed Copy, Domestic $6.25;

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The medical examinations of the Marshall Islanders accidentally exposed to radioactive fallout in 1954 have now covered a span of 20 veam. A 5-year period has elapsed since findinp have been presented in full, and this report includes details of this period as well as a summaty of the data for the entire 20 yearn Some background i&ormation is presented tit. The Marshall Islands were chosen aa an atomic bomb proving ground at the time of Operation Crossroads at Bikini in 1946 and were subsequently used for numerous tests at both Bikini and Eniwetok until the moratorium was declared in 1958. These islands were chosen because of their isolated location in the vast, nearly empty ocean area of ?vlicronesia j ust north of the equator, east of the Caroline Mantis, and northwest of the Gilbert Islands, about halfway between the Hawaiian Islands and Australia. The Marshall Islands comprise 34 islands and atolls spread over some 180,000 square miles of ocean. Each atoll consists of a lowIying chain of sandy, palm covered islands connected by a reef surrounding and protecting a central blue-green lagoon. Habitable land area is surprisingly small - only about 70 square miles in the entire Marshall Islands. The climate is tropical, and the trade winds blow much of the year. The atolls involved in the 1954 accident are located in the about 100 nautical miles east of Bikini, Rongerik about 135 miles east of Bikini, and Utirik 275 miles east of Bikini. During the past century the Marshallese people have been governed by four countries. Germany purchased the Marshall Islands from Spain in 1886 and governed them until 1917, when Japan took over under a League of Nations mandate; Japan declared ownership in “1933 when she ‘broke horn the League of Nations. The United States liberated the Marshalls in 1944, during World War II, and was given authority under a United Nations man&tc to adminimer the scattered islands of Micronesia as the Trust Territory of the Pacific Islands; this was done first by the U.S. Navy and later by the Department of the Interior. The early explorers and traders found the islands inhabited by friendly, gentle, primitive people, living in thatched huts, fishing from outrigger canoet, and subsisting entirely from the nment. The increasing encroachment of civilizau via traders, missionaries, and governing authorities has changed their way of iife. The missionaries brought religion, clothing, and changed customs. A dollar economy baaed on copra production and employment by local governments has tended ~adually to supplant the enSanitary conditions and health care in the Marshalls had been primitive, with treatment of the sick ollen involving a large element of superstition and magic, and apparently did not improve under Japanese rule. During World War II the Marshallese were forced to live on low calorie die~ with inadequate medical care. When the U.S. was made trustee in 1947, the .Navy, under the auspices of its Bureau of Medicine and Surge~, undertook a comprehensive medical survey of island populations in the Trust Territory including the Marshall Islands, using one of its vessels, the USS Whiibqy.~ The sutvey showed that unsanitary conditions with regard to flies, garbage disposal, arid excretory habiu made for mukipie intestinal parasitic infestations and diseases. A high percentage of the people had positive Kahn tests, associated with yaws, and widespread treatment with penicillin proved extremely effective. Diseases of the eyes and skin, acute and chronic respiratory diseases, and vitamin deficiencies were especially common. No malari~ filariasis, yellow fever, or cholera was seen. Subsequent health care in the Trust Territory was hampered by lack of trained medical personnel and poor transportation to the outer islands. This was the status when our special medical examinations began. Some of the events over the years in the Marshall Islands that are relevant to the medical surveys are liited in Appendix 1. The first examinations in 1954 tier the fallout were conducted by an emergency medical team, requested by the Atomic Energy Commission, directed by Dr. E.P. Cronkite and composed largely of Navy medical personnel whose service experience proved extremely helpful for this fieldtype operation. Resurveys were conducted at 6 months under Dr. V.P. Bond and at 12 months under Dr. Cronkite. In 1956 the survqm were placed under the direction of the author at Brookhaven National Laboratory. Since then the surveys have been conducted in conjunction with the Department of Health SeMces of the Trust Territory and with the participation of medical specialists horn the Armed Forces and t%om medical centers

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!3qxued Mamhailac at Kwajaiein immediately afler evacuation, March 1954. Part of decontamination procedures at Kwajalein, March 1954. Initial medical examinations at Kwajalcin, March 1954. Ejet Wlage, where Rongclap pcopie lived for 3 years. Typical Rongelap house, 1954.

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in the United States, including endocrinologists, cardiologists, hematologists, internists, surgeons, dix 2). The varietv of specialists indicates the diversity of the examinations conducted over the years. The BNL group has been fortunate in maintaining a clcae liaison with the Atomic Bomb Casualty Commission in Japan, and several physicians formerly associated with it have participated in our surveys We have also had a close relationship with the people studying the Japanese fishermen exposed to the Bravo fallout; in 1964 exchange visits were arranged for Dr. Kumatori and the author to attend surveys both of these fishermen and of the Marshallese. In May 1954, upon completion of the initial examinations (conducted at Kwajalein), the 82 Rongelap people, because of the contamination of their home isiands, were moved to lMajuro Atoll, and they were examined there in September 1954 and in March 1955, 1956, and 1957. They returned to Rongelap, to live in a newly built village, in July 1957, after radiological surveys had shown the island to be safe for habitation. The 157 Utirik people were taken home after the initial examinations, since their island was only slightly contaminated and was considered safe for habitation. The 28 military personnel exposed on Rongerik Atoll were taken to Tripler Army Hospital for Following the initial acute effects of radiation on the Rongelap people, the examinations over the next 9 years revealed few significant findings. An increase in miscarriages and stillbirths among the exposed women during the lirst 5 years was thought to be related to radiation exposure, but general health and d~casc incidence in the exposed people were about the same as in the unexposed Rongelap people who had returned from other islands and served as a comparison population. During thi3 uneventfid period, suggestions were made for reducing the scope or frequency of the surveys, but these were never seriously considered since it was realiacd that little is known about the late cffmts of radiation on humans and effects might still appear. In 1963 the unexpected apearance of growth retardation in some children and of thyroid abnortnalhia fully justified this reasoning. In 1972 a case of fatal acute myelogenous leukemia developed in a 19-year-old exposed Rongelap boy, indicating the need for additional sutweillance. The surveys therefore were expanded to include a hematological check in the exposed Rongelap people every 6 months. At that time also difficulties were encountered in maintaining a strict thyroid treatment program in the exposed Rongelap people, with potential serious results, particularly in the people who had had thyroid surgery. The decision was therefore made to place a resident physician in the Marshall Islands to keep check on the treatment program and assist the Trust Territoty in general health care of the Rongelap and Utirik people. The medical findings on the Marshallese have ‘been published in numerous BNL reports and Some problems have been encountered in carrying out the medical surveys in the islands. Carefid planning is required for all necessary equipment and supplies to be on hand at the remote location, and procedures must be adapted to field conditions with proper electronic support. Some technical procedures such as staining of blood smears and cell cultures present problems under tropical, humid conditions. Providing adequate transpot-t& tion has been a major difficulty. While the lNaw linmiahed LST’s and amphibious planes, problems were minimal, but for most of the surveys we have had to rely on cargo ships chartered by the Trust Territory, and these have sometimes proved unreliable in meeting schedules or hazardous because of faulty life-saving devices and inadequate navigational equipment. Once the survey team was lost at sea for more than a day trying to find an island, and twice ships ran aground on reefk. Sxrtailboat travel in rough waters was hazardous; the trip fmm ship to shore was sometimes in outrigger canoes and might result in wet passengers and baggage. To overcome these problems, an LC U was recently acquired for carrying out the .\ECsponaored radiological and medical surveys in the Other problems included the following: The language barrier hampered communication with . the people, even though a limited number of reable. The lack of adequate vital statistics resulted in uncertainty in the exact age of many of the people; and medical records were poorly kept, particularly in the outer islands (e.g., the health aide would ofien give the cause of death as “too old”). It was difficult to obtain consent for an autopsy, even at district medical centers, because of tiilinq against mutilation of the body afier death. Some of the subjects thought that drawing blood made them feel weak; and some questioned the

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Pcople returning to Rongclap ( 1957) after 3 years at Majuro. Trust Territory cargo v-l carxying personnel and supplies for medical suxweys, 1966. Rebuilt village on Rongelap to whti people returned in 1957. Tnsst Tcmitory cargo vesselon mcfaftrr dcpartum kom Rongclap Suppo m Navy amphibious planes during the early annual “nations facilitated visits to the outer islands. Moving equipment ashore. In recent years this task has been facilitated by the acquisition of a jeep and a tractor.

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need for continued examinations when no significant findings were reported. In spite of such prob- [ems, the people have alwavs been friendly, and, except on one occasion (a case of political interference, described below), have generally cooperated in the examinations. Psychological reaction to the fallout has been reflected at various times in fears regarding fertility, a beiief that &h poisoning was due to radioacuvity rather than to the poisonous nature of the fish, feelings of weakness attributed to radiation, and fear of thyroid cancer and leukemia (following the death of the Rongelap boy). A major concern for the past 5 years has been local political interference and questions concerningthe medical examinations. The Trust Territory now has a Congress of Micronesia (not connected with the U.S. administration), which has appointed a Special Committee to investigate the heaith status of the Rongelap and Utirik people. Utiounded accusations were made by certain local politicians that the United States deliberately exposed the people to fallout so that they could be used as “guinea pigs” to study the eff~ and that the medical team was concealing deaths from radiation and was not reporting all of its findings. In March 1972 the sunwy was interrupted by the politicians and had to be aborted at Rongdap. Aiienvards the Congress of Micronesia appointed medical obsenmrs to accompany the team on a survey in September 1972. Two prominent physicians panied the team and participated in the examinations. Their report to the Congress of Micronesia was most favorable and has done much to quiet the political accusations. The Special Committee on Rongelap and Utirik published a lengthy repro+ of its investigations, including the report of the obsemem, and this also has helped bring about a more Two major bills have been initiated by the Congress of Micronesia. One concerns payment of travel and living expenses for any patient from Rongelap and Utirik on our examination list who needs hospitalization. This bill has been approved by U.S. authorities and is being implemented. The other concerns compensation for the Rongelap people for ill effects of fallout exposure and provides also for a payment to the Utirik people and for special compensation to the parents of the boy who died of leukemia. (See Appendix 1.) We believe that the Rongeiap people are entitled to further compensation for injuries received, although, on the basis of the effects of their previous compensation in 1965, the ultimate benefits are doubtful, and another payment might push them fwther toward the state of welfare and perpetuai dole. Dr. WNiam Peck, the former Director of Health Services in the Trust Territory, has put this situation nicely: “To withhold further funds and thus deepen the grievance, or increase the compensation and thereby the dolor of dependence - either course of action seems only to compound their original injury, and our dilemma!” Further problems in the iMarshall Islands are associated with the return of the former residents to live on Bikini and Eniwetok, which were contaminated during the testing program. Numerous rdologicai surveys have indicated that with certain restrictions these atolls can be habitable again. Since a number of concrete homes have been completed on Bikini, about 40 people have returned, but they must be subsidized because i~ will be several years before the coconut arid other mea bear hit. A number of people are expected to return to Eniwetok to live in the near future. The medical team as well as other radiological safety personnel at BNL have been assigned the teqxmsibility of personnel and environmental monitoring to assure the radiological safety of the returning people. Pemonnel monitoring and environmental surveys at Bikini were instituted a few years ago, and only very low levels of internally absorbed radionuclides have been noted. ERDA is sponsoring continuing surveys of these atolls, being done by several institutions. The medical surveys have been a rewarding experience for all the personnel who have participated. We have been fortunate in obtaining the semices of talented specialists and technicians and in having the continued staunch support and assistance of many people at Brookhaven National Laboratory, ERDA, and the Trust Territory, and the authorities at Kwajalein, without which the succcu of the surveys would not have been possible. The medical team has developed a deep friendship for the Marshallese over the years. In spite of the injuries and hardships resulting from the 1954 accident, they have cooperated with us even through the period of political disturbances. With the improved political climate and attitude toward the examination we look forward to continuing these important and challenging missions and to offering specialized health care to these Mamhall Islanders in future yearn. R/i. Conard, iM.D.

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Chronological Listing of Events in the Mamhall Islands ............................. A Summary of the Findings Over the 20 …