Bio Weapons Full Text2
Bio Weapons Full Text2
Bio Weapons Full Text2
WEAPONS
Submitted by the Executive Editor with the comments of 46 reviewers taken into
account
EXECUTIVE SUMMARY
The development, production and use of biological and chemical weapons are
prohibited by international treaties to which most states of the world have subscribed:
the 1925 Geneva Protocol, 1 the 1972 Biological and Toxin Weapons Convention, 2 and
the 1993 Chemical Weapons Convention. 3 Not all states have joined, however, and
valid concerns remain that some states may yet resort to the weapons. Moreover,
non-state entities may try to gain access to the weapons for purposes of terrorism.
biological weapons, has been rare. Even so, the magnitude of possible impacts on
civilian populations of their use or threatened use obliges governments both to seek
prevention and to prepare response plans. Such response plans can and should be
example from the increasing availability of robust and relatively simple means for
rapid and specific laboratory diagnosis via DNA-based and other molecular methods.
disease.
1
Protocol for the Prohibition of the Use in War of Asphyxiating, Poisonous or other Gases, and of
Bacteriological Methods of Warfare.
2
Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological
(Biological) and Toxin Weapons and on Their Destruction.
3
Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical
Weapons and on their Destruction.
ii
The extent to which specialist personnel, equipment and medical stockpiles
may be needed for protective preparation is a matter for national judgement in the
The two Conventions include provision for assistance in the event of attack or
threat of attack. The Organisation for the Prohibition of Chemical Weapons (OPCW),
which is the international authority for the 1993 Convention, is putting practical
arrangements into place for such assistance in regard to chemical weapons. As yet,
there is no similar organization for biological weapons, but the WHO, among other
Each of these matters is discussed in detail in the main body of the present
consistent or integral with existing plans that address outbreaks of disease, natural
iii
member states for developing or strengthening preparedness and response activities
management programmes.
chemical agents may demand more resources than are available. International
assistance could become essential. Channels for such international assistance are
to all countries which are Member States of specialized organizations such as OPCW
(e.g. in cases of use or threat of use of chemical weapons, and for preparedness
planning), and to States Parties to the1972 Biological and Toxin Weapons Convention
iv
(6) With the entry into force of the 1972 and 1993 Conventions and their
continuing progress towards universality, there have been great strides towards
“outlawing the development and use in all circumstances of chemical and biological
agents as weapons of war”, as called for in the 1970 edition of the present report.
However, as the world moves deeper into the new age of biotechnology, WHO
Member States are reminded that every major new technology of the past has come to
be exploited, intensively, not only for peaceful purposes, but also for hostile ones. All
states are therefore encouraged to implement the two Conventions fully and
principles that underlie the Conventions; and to support measures that would build
(7) The statement by the World Health Assembly in May 1967 that
“scientific achievements, and particularly in the field of biology and medicine - the
most humane science – should be used only for mankind’s benefit, but never to do it
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CONTENTS
2.1 CONTEXT
2.2 CHANGING TECHNOLOGY
2.3 NEW SCIENCE
2.4 A PRELIMINARY THREAT ASSESSMENT
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4.2.3 Introduce risk reduction strategies
Box: A six-step process for communicating with the public
4.2.4 Quantify the residual risk
4.2.5 Monitor the risk management programme
4.3 RESPONSE
4.3.1 Response before any overt release
4.3.2 Distinguishing features of biological and chemical incidents
Table 4.1: Differentiation of biological and chemical attack
4.3.3 Response to biological incidents
4.3.4 Response to chemical incidents
APPENDIX 4.1 THE SARIN INCIDENTS IN JAPAN
APPENDIX 4.2 PROBLEMS RELATED TO PROTECTION
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LIST OF CONTRIBUTORS
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CHAPTER 1: INTRODUCTION
Thirty years have passed since the World Health Organization published its
1970 report Health Aspects of Chemical and Biological Weapons (1.01). During that
time there have been significant changes. On the negative side there has been the
large-scale use of both mustard gas and nerve gas in the Iran/Iraq war; the use of these
agents by the Iraqi government against its own citizens, most conspicuously at
Halabja in March 1988; 4 and the use of sarin on two occasions (in 1994 and 1995) by
the Aum Shinrikyo religious cult in public places in Japan, including the Tokyo
subway (the cult also made preparations, fortunately ineffective, to use biological
weapons). On the positive side, the Biological and Toxin Weapons Convention and
the Chemical Weapons Convention came into force in 1975 and 1997 respectively,
and the Organisation for the Prohibition of Chemical Weapons (OPCW) has started its
Russia and the United States, and monitoring the world’s chemical industry to prevent
future misuse. These and other developments, both technical and political, over that
period led to a need for a review. This Second Edition is the result.
The technical situation has been one of further development along already
identified lines rather than totally new concepts. The most important agents of
biological and chemical warfare probably still include ones listed in the 1970 edition.
There have been rumours of nerve gases of still greater power than VX or VR, but the
main important development in chemical weapons has been the ‘binary munition’,
4
Statement by the UN Secretary-General to the 3 rd Meeting of the General Assembly of 12 October
1998 (document A/C.1/53/PV.3), 3-5.
1
which carries out the final stage of synthesis of the agent from precursors in the bomb,
shell or warhead immediately before or during delivery to the target. As for biological
The accessibility of biological agents on a militarily significant scale has been much
with the problem of biological and chemical weapons. Following the public
weapons, which, as in the 1925 Geneva Protocol prohibiting their use, had previously
resultant Biological and Toxin Weapons Convention (hereinafter ‘BWC’) was opened
for signature in 1972 and entered into force three years later. Concerns about the
1990s about bioweapons programmes in the former Soviet Union and in Iraq, led the
states parties to establish an ad hoc group mandated to negotiate a protocol that would
2
The Geneva disarmament conference intensified its efforts on the problem of
chemical weapons in the 1980s and submitted the completed draft of a chemical
The CWC was opened for signature in 1993 and entered into force four years later.
states has clearly changed since the First Edition of this report. It now resides mainly
in regions of the world where certain states still hold back from joining the two
Conventions. Also, the risk that non-state entities might resort to the weapons remains
1969 to co-operate with a group of consultant experts that was then being established
to prepare a report for the UN on biological and chemical weapons and the effects of
their possible use. The UN report was duly completed and released in July 1969
(1.02). It drew from a submission by the WHO that had been prepared by a group of
3
two non-governmental organizations engaged in study of the subject, namely
Pugwash5 and the Stockholm International Peace Research Institute (SIPRI). 6 Shortly
General to continue the work (1.05). The result, which expanded the original
submission to the UN, became the First Edition of the present report.
Over the years since then, WHO has taken steps to keep itself informed of
relevant developments. At the Fortieth World Health Assembly, in 1987, the subject
of chemical warfare was raised and referred to the Executive Board, which, at its
Effects on Health of Chemical Weapons that had drawn from a study updating parts of
the 1970 report (1.06). WHO funds were thereafter provided for a Working Group
availability of such information. The meeting took place at WHO Headquarters on 7-9
Regarding biological weapons and the need to be able to respond under Article
2(d) of the WHO Constitution to emergencies that they might cause, contacts were
developed towards the end of 1990 between the Federal Department of Foreign
Affairs of Switzerland and the WHO. There was concern then about unpreparedness
to respond to the consequences of any attack there might be with weapons of mass
5
The Pugwash Conferences on Science and World Affairs is an international organization of scientists,
to which the Nobel Peace Prize was awarded in 1995, whose activities have included close attention to
matters of biological and chemical warfare since the 1950s (1.03).
6
SIPRI, funded by the Swedish Parliament, was then working, in consultation with Pugwash, on its six-
volume study of the historical, technical, military, legal and political aspects of biological and chemical
warfare armament and disarmament (1.04).
4
Kuwait. This led to a collaboration between the WHO and the Swiss Disaster Relief
Unit, from which resulted Task Force Scorpio, an equipped and trained team of
specialists that could have been dispatched by ambulance jet at short notice to an
afflicted area (1.08). Since that time there has been attention to possible associations
projected BWC protocol. More generally, as the public has become more conscious
as an act of war or of terrorism, WHO has become concerned about the information
efforts in the biological/chemical field, including the provision of financial support for
In May 2001, the Fifty-Fourth World Health Assembly requested the Director-
Second Edition of the report is in line with the request of the World Health Assembly.
Moreover, in view of the need for WHO to provide a complete scientific assessment
on which to base technically sound advice for preparedness and response, both
biological and chemical agents are covered as in the First Edition, in order to provide
technical and policy level. It was addressed to public health and medical authorities
5
as well as to those concerned with emergency reactions to suspected or actual use of
the weapons. The present Second Edition is directed at much the same readership:
government policy makers; public health authorities, health practitioners and related
their specialist advisors. Not all of the First Edition has been subsumed within the
The Second Edition, like the First, presents an analysis of the health aspects of
define implications for WHO and its Member States. The assessment concentrates on
civilian aspects. Little attention is paid to the purely military aspects, some of which
were taken up in the First Edition. It remains the case that the great majority of
Member States have experienced neither biological nor chemical warfare. For them,
unless this historical record becomes violently disrupted, the present report may seem
to have little relevance, especially when set against the emergence of new diseases,
such as HIV/AIDS and Ebola, and the re-emergence of diseases previously considered
under control in much of the world, such as tuberculosis and malaria. The relevance
of the report lies, rather, in the context of risks that, historically, have been low but
precautionary planning.
The report also considers the 1972 BWC and the 1993 CWC, to which nearly
three quarters of WHO Member States are party. 7 These two treaties and their
7
The status of individual WHO Member States under the 1925 Geneva Protocol, the 1972 Biological
Weapons Convention and the 1993 Chemical Weapons Convention is set out in Annex INSERT.
6
national implementing legislation constitute a form of protection against the weapons,
and also a route to international assistance in the event that the weapons are
nevertheless used.
In the present report, biological weapons are ones whose intended target
toxic substances that they themselves generate. Such toxins can sometimes be isolated
and used as weapons. Since they would then be working, not through infectivity, but
through toxicity, they would fall within the definition given below of a chemical
weapon, even though there would still be grounds for regarding them as biological
weapons. The BWC covers toxins, by which it means toxins produced by any living
The present report does the same, while recognising that toxins also fall within the
CWC.
Chemical weapons are weapons that work principally through toxicity, which
though their chemicals may also have toxic effects. Only if those toxic effects are the
main ones sought from the weapon is it regarded as a chemical weapon. Some toxic
7
chemicals, such as phosgene, hydrogen cyanide and tear gas, may be used for civil or
peaceful purposes as well as for hostile purposes. In the latter case they, too, are
chemical weapons.
1.4 STRUCTURE
The main body of the report is in five chapters. These are supported by a set
Chapters 2 and 3 describe how biological and chemical agents may menace
public health. They proceed from the historical to the present day, from the general to
the particular. Their purpose is to identify what is essential to any planning to avert or
deliberately.
the steps that Member States may take to prepare themselves for the possibility of
The intention here is to provide, not the detailed guidance of an operational manual,
detailed information.
Chapter 5 considers the part that law, both national and international, can play
assistance.
8
Supplements may be issued in due course, for two main purposes. One would
be to extend the range of topics addressed in this report, for example on health aspects
plants rather than against people. The other purpose would be to update the
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CHAPTER 2: ASSESSING THE THREAT TO PUBLIC HEALTH
Public health faces many challenges, and there is now concern that, among
released has not been given sufficient attention. Biological warfare, in particular, is
For public health authorities, the matter is one of relative priority. Where should such
deliberate releases be ranked -- high or low -- among the many contingencies for
which medical preparedness is needed? The present chapter addresses this question by
2.1 CONTEXT
Poisons and pathogenic micro-organisms are among the natural health hazards
with which human beings are obliged to co-exist. Difficult to perceive and therefore
to avoid, they present a threat that is insidious as well as damaging or deadly. The
species has survived by adaptation. In part this has been physiological, as in the
development of the immune system far back in vertebrate evolution. In part the
adaptation has been social, as in the development of individual and public health
The codes of professional behaviour adopted by the military that forbid the use
of poison and therefore also disease may be regarded as a part of that same social
adaptation. Reaching back to the Manu Laws of India through, for example, the
Saracen code of warfare drawn from the Koran, the Lieber Code of 1863 in America
6
and the 1925 Geneva Protocol (2.01), this taboo seems so widespread, ancient and
Chapter 5, which details how the multilateral treaties of 1972 and 1993 on the total
prohibition of biological and chemical weapons have extended that law. Promoting
the new law-making was a widespread sense that powerful new weapons were on the
verge of proliferating and diffusing within a global security system otherwise poorly
almost from its inception, differentiated conventional weapons from weapons of mass
destruction. It had defined the latter in terms of their operating principles8 but the
concern was with their consequences: their potential for bringing devastation, death
and disease to human societies on a scale incompatible with survival. New weapons-
technology might, in other words, be generating threats to the species that called for
In unique summit session in January 1992, the Security Council determined that the
peace and security". Moreover, the 15 member states of the Council also committed
themselves "to working to prevent the spread of technology related to the research for
or production of such weapons and to take appropriate action to that end" (2.04).
8
In September 1947, weapons of mass destruction were defined in a Security Council document as
"atomic explosive weapons, radioactive material weapons, lethal chemical and biological weapons, and
any weapons developed in the future which have characteristics comparable in destructive effect to
those of the atomic bomb or other weapons mentioned above" (2.03). It was this wording, proposed by
the United States, that the UN subsequently used to differentiate the two broad categories of weapon in
order to guide its work on the "system for the regulation of armaments" required under Article 26 of the
UN Charter.
7
Public health infrastructure throughout most of the world is stretched to its
limits coping with natural health hazards. In 1998, a quarter of the world’s 53.9
million deaths were due to infectious disease, and in the developing countries
infectious disease caused one in two deaths (2.05). More than 2 billion people are
seriously ill from disease at any given moment, so it is estimated (2.06). Against such
a background, the additional menace to public health of disease set loose in a country
such a nature as to be beyond the capability of the healthcare system to cope. For
of threat can therefore be envisaged that ranges between those two extremes: relative
insignificance at one end, mass destruction of life or mass casualties at the other.
situated will be determined by the characteristics of the threat and by the vulnerability
of the threatened, vulnerability reflecting such factors as health status and public-
release of infective agents that cause contagious disease, such as smallpox, for which
Proven resort to biological or chemical weapons by military forces has been rare in
recorded history. Unproven instances have been more common, which could be taken
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as testimony either to the problem of proof, or to the obscurity of such unverified
poison gas or germ warfare lends itself to calumny and disinformation. In unrecorded
and the deliberate pollution of, for example, otherwise protected water supplies is an
expedient to which retreating forces must often have become attracted in the field.
Only in recent times, however, have the weapons moved from the insignificant
towards the mass-destruction end of the spectrum. Technological change has brought
this about.
The event that most clearly marked the emergence of this form of warfare
from its pre-history took place near Ypres in Belgium on 22 April 1915, eight months
into what was becoming the First World War. Alone among the belligerents, Germany
possessed large industrial capacity for the liquefaction of chlorine gas, and, as the war
progressed, it turned to this comparative advantage as a possible way out both of the
trench-warfare that was immobilizing its armies in the field and of the shortage of
explosives brought about by enemy naval blockade. These military necessities were
accorded precedence, in keeping with the (since disavowed) German legal doctrine of
Kriegsraison, over the ancient prohibition of poison warfare that had been reaffirmed
at The Hague less than a decade previously. Starting on the late afternoon of that day,
180 tonnes of liquid chlorine contained in 5,730 pressure cylinders were released into
the breeze that would carry the resultant cloud of asphyxiating vapour towards enemy
lines. The available records are sparse, but some say that as many as 15,000 French,
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Algerian and Canadian soldiers fell casualty to this onslaught, a third of them dead.
The actual numbers may have been different, but, whatever they were, here was the
The weapon worked by polluting the air that its targeted population was
obliged to breathe, so protection, in the form of air filters, was not impossible to
arrange. The first filters worked by chemical reaction with the poison gas. They were
more than large enough to consume the reactant held in the filter. Improved filters
were then introduced that worked by physical adsorption of the pollutant, as in the
masks", that today remain the principal and most dependable countermeasure against
vapour or aerosol threat. By 1917, the growing efficacy of gas masks had stimulated
resort to chemicals that could attack on or through the skin. The paramount example
was an oily liquid known as "mustard gas". The skin is harder to protect effectively
than the lungs if those protected are to remain mobile and active. But effective skin
attack commonly requires much more agent than does inhalation attack, meaning that
the weapons are effective over a substantially smaller area. Mustard gas used in hot
weather is an exception to this general rule, as even its vapour attacks the skin. This
is one of several reasons why this particular chemical agent remains so menacing
even nowadays.
Another way forward for the weaponeers was to use special agent-
dissemination methods capable of surprising target populations before they could don
10
masks. Such a result could be achieved with crash airborne concentrations of agent
with the imperceptible airborne casualty-producing dosages that could, with the right
weapons at least against military forces. Comparable protection of larger and less
disciplined civilian populations would be much harder, but not necessarily impossible,
to achieve. The countermeasures include medical ones, in the forms of therapy and,
that can be worn for many hours and automatic agent-detection equipment able to
give early warning of the need to mask or to enter air-conditioned protective shelter
Latterly, new instruments of international law have taken their place in this array,
economic or technological base is not capable of supporting all that is needed. That is
why, when chemical warfare has recurred since the first world war, it has invariably
taken place within the less industrialized regions of the world. Regions afflicted
China (1937-42), Viet Nam (1961-75), Yemen (1963-67) and Iran/Iraq (1980-88) [to
insert reference]. In other conflicts, notably the second world war, the widespread
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chemical weapons as compared with weapons whose effects are more difficult to
warfare.
Vulnerabilities are not absent from even the best equipped protective arrays.
The struggle for supremacy between offence and defence which characterized the
development of chemical warfare during the first world war continued after it. The
search for novel agents was one of the forms taken by that competition. It included
searches for agents capable of inducing new types of physiological effect from which
for example, which promised to reduce the political costs of resort to armed force, or
all, there was the search for agents of increased potency that would enable weapon
delivery systems to be used more economically and more efficiently. Toxic chemicals
whose effective doses were measurable in tens of milligrams per person, as was the
case with phosgene and hydrogen cyanide, came to be supplanted in the 1940s and
fewer munitions would be needed for the attack of a given target, thereby conferring
logistical benefit. The most prominent of these nerve gases and other chemical-
warfare agents of our time are identified in Chapter 3 and described in Annex 3.
Beyond the nerve gases on that scale of increasing toxicity lie certain toxins,
such as those described in Annex 2, and beyond them, down in the nanogram and
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smaller effective-dose range, are pathogenic bacteria and viruses. As understanding of
the microbiology and airborne spread of infectious disease accelerated during the
1920s and 1930s, so too did the idea of weaponizing microbial pathogens as a more
powerful form of poison gas. By the time of the second world war, biological
weapons, exploiting the same delivery technology and the same understanding of
cloud physics, meteorology and airborne dispersion. Before the end of that war, the
grounds in, at least, Europe and North America. There were reports, too, of field
or glanders had been exploited by saboteurs during the first world war in covert
attracted attention. This in turn gave rise to investigation of other possible ways of
disease that would then spread of its own accord to parts of the target population not
initially exposed to biological agent was one such concept. Because of uncertainties
associated with the epidemic spread of disease, such a concept could not be
accommodated at all readily within military doctrine except in the context of certain
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types of strategic or clandestine operation. So in their selection of biological agents to
During the first half of the cold-war years, arsenals of biological weapons
exploiting some of these, and other, concepts were accumulated, alongside nerve gas
and other chemical weapons, on both sides of the superpower confrontation. After
1970, biological armament appears to have continued only on one side. The principal
biological agents known with reasonable certainty to have been weaponized during
that time are identified in Chapter 3 and described in Annex 1. The biological
weapons ranged from clandestine devices for special forces up to designs for large
guided missiles or heavy bomber aircraft armed with munitions capable of generating
for far-distant rear targets, or of non-contagious disease for closer targets. Here were
biological weapons that could in principle greatly exceed the mass-casualty effects of
1964-68, of aerial weapons each capable of laying down a cross-wind line source of
thus appeared that people living within areas on the order of thousands of square
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chemical weapons, defence science advisers were at that time anticipating a new
generation that could attack targets up to the order of 100,000 square kilometres in
area (2.07).
chemical or biological agents also brought new categories of target into consideration,
such as foodcrops and livestock. At the time of the second world war, chemicals had
been discovered that were as toxic to plant-life as the new nerve gases were to people.
used as weapons in several conflict-areas of southeast Asia and Africa during the
period 1950-75, sometimes targetted against foodcrops and sometimes against the
forest vegetation that could furnish concealment. Certain plant and animal pathogens
were also weaponized. Indeed, some of the first wide-area biological and toxin
antipersonnel weapons were based on agent delivery systems originally conceived for
anti-agriculture purposes.
biological agents are indirect, the present report does not address either them or their
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2.3 NEW SCIENCE
inherent factors such as the competition between the weapon and the protection
doctrine. More profoundly, technological change has also been driven by advance of
the basic sciences within which the technology is rooted. A current concern is that
new understanding in the life sciences is accumulating so rapidly that major change in
happening even now. Exacerbating this concern are certain non-military technologies
that are emerging from new science and diffusing around the world, for some of these,
notably biotechnology, are potentially dual use, having application also in biological
of all the activities concerned with human health and nutrition, yet in principle it also
offers means of producing novel and perhaps more efficacious biological agents and
programmed way the genetic properties of living organisms could allow the insertion
of new heritable properties into micro-organisms that make them more resistant to the
detect by routine assays. In so doing the chances are high that some other valued
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Still other aggressive possibilities may lie beyond these manipulations.
specific genes.
Given the range and variety of pathogens already present in nature, the
obvious. Nor is it the case that the new biotechnologies necessarily favour the
offence over the defence. Vulnerability to biological agents exists chiefly because of
present inability to detect their presence in time for prompt masking or sheltering.
Rapid detection methods based on modern molecular techniques are now being
brought into service, although the extent to which they have the necessary sensitivity
and ability to report in a timely manner with exclusion of false positives is not clear.
requirement, even when PCR or other amplifying technologies are used. Other new
biotechnologies are transforming the development of vaccines, while others still are
thought to promise nonspecific alternatives to vaccines. Yet there can be little doubt
that the spread of advanced biotechnology and the new accessibility of information
about it offer new tools to any country or ill-minded group intending to develop a
biological weapon. (2.09, 2.10, 2.11, 2.12, 2.13, 2.14, 2.15, 2.16)
the outset of this chapter, the far mass-destruction end may perhaps have been
17
approached by some of the bacterial or viral aerosol weapons of the cold war. That
there should be uncertainty about this lies chiefly in the demonstrable existence of
the spectrum: the greater and more assured the mass-destructive power sought for the
weapon, the greater the practical difficulties of achieving it. There are, in short,
intended target. Toxic or infective materials can be spread through drinking water or
expected to remain localized unless the contaminated items were themselves widely
spread or unless any biological agent that had been used succeeded in initiating
contagious disease. Otherwise, large-scale effects are available if the materials can be
dispersed in the form either of vapour or of an aerosol cloud of liquid droplets or solid
particles that can then be inhaled. This mode of attack is subject to much uncertainty.
The movement of the vapourized or aerosolized agent towards and across its target
would be by atmospheric transport, which would move the agent both laterally and
Annex INSERT, the rate of this dispersion will vary greatly depending on the
stability of the atmosphere at the time; and the direction of travel will depend on local
vapour released inside enclosed spaces rather than in the open, the situation would of
course be different. Beyond that there is the fact that some agent materials may be
unstable in the atmosphere and decay over time following their dissemination in
airborne form, which process may itself also stress the agent to the point of substantial
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degradation or complete inactivation. In addition, for the agent to be retained after
inhalation and to exert its intended pathological effects, further technical requirements
must be satisfied. In the case of particulate material, for example, larger particles may
not be able to penetrate far enough into the respiratory tract, while smaller ones may
not be retained there. The optimal size range is, moreover, a narrow one, and the
production and maintenance of the optimal size distribution within an aerosol cloud is
condensation that will be taking place as the cloud travels. These considerations
These technical factors operate to render such large-scale forms of attack more
reaching the target population for a period of time sufficient to cause the desired
the atmosphere could result either in the agent becoming diluted to harmlessness or in
the cloud missing the target due to some veering of the wind. Such attacks are bound,
Nor do these delivery considerations represent the only or even the most
demanding technical problems. In the case of biological agents, there are, for
example, the difficulties of selecting the appropriate strain in the first place and then
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of maintaining its virulence throughout culturing, harvesting, processing, storing,
weapons may be low, if it nonetheless happened with, improbably, all the many
imponderables and uncertainties favouring the attacker, then the consequences of the
event could be great. So, in considering strategies for national preparedness against
weighed against the possibility of public health hazards of higher probability but
also be prudent not to overestimate them (2.17). Given the emotive force of even an
governments at least to consider how to address such dangers, should they occur, as
an integral part of the national response to other challenges to public health and
wellbeing.
Technical factors are not the only consideration. Throughout much of the
provisions of national and international law, will act to amplify the practical problems
20
of acquiring and gaining advantage from the weapons. These constraints will impede
access to the requisite materials. They will also obstruct those less tangible forms of
or even from academics, whose corporate image, reputation or trading status would
stand to suffer once their involvement became apparent. Further, there would be
suggests that the number of competent groups or states intending actually to use such
Even so, due preparation for such an eventuality, with a response strategy and
plan held at the ready, may be judged necessary. Whether in relation to natural
formulated a general response strategy and plan, which they will maintain in the light
with chemical or biological attacks will overlap with those dealing with natural or
this chapter, it is clear that there can be no simple answer. Where, for a country’s
21
resort to biological or chemical weapons may lie at any given moment, and hence the
magnitude of the threat inherent in that balance, will surely depend primarily on
authorities will need to make their own assessments. The fact that there is
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CHAPTER 3: BIOLOGICAL AND CHEMICAL AGENTS
considered. It is not possible to prepare specifically for all possible biological and
preparedness to counter biological and chemical threats, then targeting of its preparation
and training on a limited but well chosen group of agents will provide the necessary
understanding for a capability that will be adequate for a far wider range of possibilities.
gained that are valid for virtually any agent. In addition to being impractical from a
preparedness perspective, long and exhaustive lists of agents also produce a misleading
presentation of the extent of possible threats. The present chapter sets out an approach to
weapons, from which conclusions are drawn to complete the threat assessment initiated
in Chapter 2.
Biological and chemical weapons have been described as the “poor man’s atom
bomb”, but this conveys a misleading impression of their ease of production and their
utility. It is not enough that biological and chemical agents be highly infective or highly
resist degradation during handling and storage, and during the energy-transfer processes
that will, in most scenarios, be involved in disseminating it against its target. In use, the
15
agent must be spread in such a way that the necessary infective or effective dosage is
delivered to the target population. The agent must be relatively easy to produce from
produced, it must be weaponized and, depending on the concept of deployment and use,
stored without undue risk to its possessor. The effectiveness with which the weapon is
deployed will depend on the extent to which this has been addressed and practised.
Technology and concepts for use continue to develop. For example, many biological and
chemical agents were selected in the past for a retaliatory capability, which consequently
required a long storage life. However, different approaches, such as the binary concept,
mean that this is no longer necessarily the case for chemical agents. Precursors can be
mixed to generate actual agent either just prior to or during weapon launch, though
stability of precursors might then become a factor affecting choice. For biological
agents, concepts of use other than retaliation could act to reduce the requisite storage
period.
investigated for their potential utility as weapons, few have been judged as satisfactory
candidates, and even fewer have found their way into weapons and actually been used.
The selection principles in these past programmes have been driven primarily by
considerations relating to their planned military use. It is not necessary to explore such
military considerations here in order to arrive at guidance on the agents that should, or
need not, be at the centre of preparedness concern today. Guidance can instead be drawn
from activities associated with the international biological and chemical treaties and
from the historical record of biological and chemical armament and use, which
necessarily reflect the same selection principles. A progressively sharper focus on agents
16
of concern can be gained, first, from the treaty definitions of biological and chemical
weapons; then from the lists of agents that have been negotiated to facilitate treaty
which agents have been weaponized or stockpiled in recent times; and finally from the
The intergovernmental negotiations that culminated in the BWC and then the
CWC commenced while the first edition of the present study was being prepared. In
1969, in order to set the scope of its study, WHO relied in the first edition on the
concepts of toxicity and infectivity to distinguish chemical and biological weapons from
employed for their toxic effects on man, animals and plants”, and biological-warfare
agents as ones “that depend for their effects on multiplication within the target organism,
and that are intended for use in war to cause disease or death in man, animals or plants”.
technical approach, for they were aiming to control technologies that were often dual-use
in character, in other words applicable both to warfare and to peaceful purposes. For
example, the negotiators would not be able to prohibit production of the principal killer
gas of the first world war, phosgene, without at the same time denying feedstock to
manufacturers of certain plastics and of other worthwhile commodities. Nor would they
threatening vaccine production. There were many such examples. So the negotiators
took the general purpose for which a biological or a chemical agent was intended as the
criterion of whether activities involving that agent should or should not be subject to
17
prohibition or control under their treaties. Such a general purpose criterion is to be found
in those parts of both the Biological and the Chemical Weapons Convention where the
scope of the treaty is stated. Thus, the prohibitions set out in the two treaties extend to all
biological agents and toxins, and to essentially all chemicals, unless they are intended for
peaceful purposes, and unless their types and quantities are consistent with such
purposes. In addition, the CWC uses the concept of toxicity, applying its general purpose
criterion to “toxic chemicals” and “their precursors”, defining both of these categories of
chemical in broad terms. In contrast, the BWC does not seek to define the biological
agents and toxins of its scope. The actual language used in the two Conventions to define
the weapons to which they apply is set out in the adjacent boxed text [NOTE: The text
particular agents have had to be drawn up so as to focus the efforts of the implementers.
The Chemical Weapons Convention includes three such negotiated lists (“schedules”) in
which selected toxic chemicals and precursors are “identified for the application of
verification measures”. These schedules are set out in the treaty’s Annex on Chemicals.
They list 29 specific chemicals and 14 families of chemicals. Some of the families are
very large indeed, running into many millions of specific chemicals, most of which have,
however, never actually been made or characterized. For example, the dialkyl
it seems that only 118 have actually been synthesized (3.01), and even the family of
alkyl alkylphosphonofluoridates with which Schedule 1 opens, which is the sarin family
of nerve gases, theoretically contains 3,652 members. Large though these numbers are,
18
the CWC makes it clear that its schedules are not meant as a definitive listing of all
chemicals that constitute “risks to the object and purpose of this Convention”. The
schedules simply exemplify chemicals covered by its general purpose criterion. The
Biological Weapons Convention, which is a much shorter and simpler legal instrument,
contains no analogous schedules, but such lists have been developed for inclusion in the
BWC Protocol now under negotiation, 9 again to exemplify, not to define, the scope of
the general purpose criterion. Several authorities, including defence agencies, have
compiled such lists of potential biowarfare and bioterrorism agents in recent years.
Some are identified in Table 3.1, from which it may be seen just how much variation
9
Ad Hoc Group of the States Parties to the Convention on the Prohibition of the Development, Production
and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction, document
BWC/Ad Hoc Group/56 (parts 1 and 2) dated 18 May 2001.
19
Table 3.1 Biological agents variously cited as possible weapons for use against
human beings
20
Hantaan/Korean haem. fever, X X X
etc, A98.5
Sin Nombre, J12.8 X
Crimean-Congo X X X X
haemorrhagic fever, A98.0
Rift Valley fever, A92.4 X X X X
Ebola fever, A98.3 X X X
Marburg, A98.4 X X X
Lymphocytic X
choriomeningitis, A87.2
Junin, A96.0 (Argentinian X X X
haem.fever)
Machupo, A96.1 (Bolivian X X X
haem.fever)
Lassa fever, A96.2 X X X
Tick-borne X X X X X
encephalitis/Russian spring-
summer encephalitis, A84.0/
A84
Dengue, A90/91 X X X X
Yellow fever, A95 X X X X X
Omsk haemorrhagic fever, X
A98.1
Japanese encephalitis, A83.0 X X
Western equine X X X
encephalomyelitis, A83.1
Eastern equine X X X X X
encephalomyelitis, A83.2
Chikungunya, A92.0 X X X X
O’nyong-nyong, A92.1 X
Venezuelan equine X X X X X X
encephalomyelitis, A92.2
Variola major, B03 X X X X X X
(smallpox)
Monkey pox, B04 X X
White pox (a variant of X
variola virus)
Influenza, J10,11 X X X
PROTOZOA
21
Toxoplasma gondii, B58 X
(toxoplasmosis)
Schistosoma species, B65 X
(bilharziasis)
Notes
• Diseases are identified by the numeric code assigned by the WHO International
Classification of Diseases, 10th edition.
• UN (1969): United Nations, Chemical and bacteriological (biological) weapons and
the effects of their possible use: Report of the Secretary-General, New York, 1969.
• WHO (1970): World Health Organization, Health aspects of chemical and biological
weapons: Report of a WHO Group of Consultants, Geneva, 1970.
• BWC CBM-F (1992): UN Office of Disarmament Affairs, compilation of
declarations of information by BWC states parties in accordance with the extended
confidence-building measures agreed at the Third Review Conference, DDA/4-
92/BW3 plus Add.1, Add.2 and Add.3: data from Section 2, Past offensive biological
R&D programmes, of the Form F as filed by Canada, France, Russia, the UK and the
USA.
• Australia Group (1992): Australia Group document AG/Dec92/BW/Chair/30 dated
June 1992.
• NATO (1996): NATO Handbook on the Medical Aspects of NBC Defensive
Operations, AMedP-6(B), Part II - Biological.
• APHA (2000): J Chin (editor), Control of Communicable Diseases Manual, 17th
edition, Washington, DC: American Public Health Association, 2000.
• BWC draft Protocol (2001): Ad Hoc Group of the States Parties to the Convention
on the Prohibition of the Development, Production and Stockpiling of
Bacteriological (Biological) and Toxin Weapons and On Their Destruction,
document BWC/AD HOC GROUP/56-2, at pp 465-66, which is in Annex A of the
Chairman’s Composite Text for the BWC Protocol.
22
3.1.2 Guidance from the historical record
Toxic and infective agents that have in the past been available to the forces of
states in weaponized forms are identified in official state papers now open to the scrutiny
of historians. This historical record is not complete, because not all past possessor states
have yet opened relevant papers, and of those that have the papers rarely extend into the
present two or three decades (the declarations received by UNSCOM are an exception in
that they include reference to weaponization during the period 1987-91). An extensive
listing of the antipersonnel agents can be compiled nevertheless. The listing set out in
Table 3.2 covers the period since January 1946 and is drawn from an archive of collected
state papers, works of historical scholarship and other documentation at the University of
having otherwise entered the process of weaponization. For convenience, Table 3.2
groups the agents into categories that are explained and used later in this report.
For some of the toxic chemicals in Table 3.2, an indication of relative importance
the different agents that have been declared to the OPCW as part of the obligatory
declarations required from states parties to the Chemical Weapons Convention. These
Table 3.3 shows that an aggregate total of 69,863 tonnes of chemicals have been
declared as chemical weapons to the OPCW by its member states. Of that total 5,422
tonnes had been verified as destroyed by 31 December 2000. The table also indicates the
breakdown of quantities declared. These declared stockpiles fall under the monitoring
10
The archive is the Sussex Harvard Information Bank, which is maintained at SPRU, University of
23
provisions of the Chemical Weapons Convention, and are thus under international
control.
Turning, finally, to the historical record of actual use of toxic and infective
agents for hostile purposes, it must be observed that the information available may be
less complete even than that on weaponization or stockpiling, not least because of the
role of these agents in clandestine warfare, on which official records are often sparse.
Moreover, there are instances of chemical and biological weapons being reported as
having been used when in fact they were not used, the reports originating in
misperception or other error, or in intention to deceive. Table 3.4 summarises the record
of antipersonnel use, drawn from the same archive as used for Table 3.2. Its entries are
restricted to those instances since 1919 in which the fact of use can be regarded as
indisputable, and in which the toxic or infective agents employed have been sufficiently
identified. The use of anti-plant or anti-animal agents is not included. Table 3.4
includes in its last two entries the use of toxic or infective antipersonnel agents by non-
state groups, including episodes regarded as act of terrorism, on which the historical
record is even sparser than that for the possessor state programmes.
Taken together, Tables 3.2, 3.3 and 3.4 suggest that the number of agents actually
weaponized or used is considerably smaller than the number of agents selected for
description in the literature on biological and chemical warfare. Nevertheless, for the
representative group of agents that is to guide the present report it seems necessary to
add only three further agents: Variola major, which is smallpox virus;
Sussex, UK, by the Harvard Sussex Program on CBW Armament and Arms Limitation (see
www.sussex.ac.uk/spru/hsp).
24
industry in tens of kilotons per year; and the chemical psychotomimetic agent lysergide,
also known as LSD. Annexes 1, 2 and 3 present further particulars of the representative
group of agents.
25
Table 3.2 Toxic and infective anti-personnel agents stockpiled or otherwise weaponized
for state forces since 1946 according to official documents of possessor states
Blood gases:
hydrogen cyanide
Nerve gases:
ethyl NN-dimethylphosphoramidocyanidate (tabun, or GA)
O-isopropyl methylphosphonofluoridate (sarin, or GB)
O-1,2,2-trimethylpropyl methylphosphonofluoridate (soman, or GD)
O-cyclohexyl methylphosphonofluoridate (cyclosarin, or GF)
O-ethyl S-2-diisopropylaminoethyl methylphosphonothiolate (VX)
O-ethyl S-2-dimethylaminoethyl methylphosphonothiolate (medemo)
O-isobutyl S-2-diethylaminoethyl methylphosphonothiolate (VR)
Further toxins
Ricin
Saxitoxin
Clostridium botulinum toxin
Staphylococcal enterotoxin
Aflatoxin
26
Viruses
Venezuelan Equine Encephalitis virus
27
Table 3.3 Aggregate quantities of chemical agents declared to the OPCW by its
member states, as of 31 December 2000
11
Based on figures from the OPCW annual report for 2000 (3.02), rounded to the nearest tonne.
12
Chemical weapons on the basis of Schedule 1 chemicals and their parts and components. See Table 3.2 for
their chemical identities.
13
Including mustard gas in oil product.
14
A reaction product containing about 60% mustard gas and 40% Agent T
15
Methylphosphonyl difluoride (binary nerve-gas component)
16
72% isopropyl alcohol, 28% isopropylamine (binary nerve-gas component)
17
Ethyl 2-diisopropylaminoethyl methylphosphonite (binary nerve gas component).
18
Chemical weapons on the basis of all other chemicals and their parts and components. Category 3 chemical
weapons comprise unfilled munitions and devices, and equipment specifically designed for use directly in
connection with employment of chemical weapons
28
Table 3.4 Some verified instances of hostile use of anti-personnel toxic and infective
agents since 1919
29
3.2 DISSEMINATION OF BIOLOGICAL AND CHEMICAL AGENTS
For any release of a chemical or biological agent, the nature and degree of hazard
will depend on a multitude of factors, including, among other things, the agent and the
amount, the method by which the agent is disseminated, factors that influence its
toxicity, infectivity or virulence both during and after its release, its movement and
dilution in the atmosphere, and the state of protection and susceptibility of those
exposed. Two general types of hazard are usually distinguished -- inhalation hazard and
biological and chemical agents that may create an inhalation or contact hazard to
that might cause decomposition or inactivation of chemicals or toxins or, for infective
agents, properties that might cause loss of viability or more subtle changes that primarily
spray that evaporates to form a vapour while still airborne; or as a spill or spray
deposited on surfaces that subsequently evaporates to form a vapour. For some agents,
30
membranes, especially those of the conjunctivae. For chemical agents able to act
agents deposited directly on people or on surfaces likely to come into contact with
effective only for heat-resistant and non-combustible agents, which may evaporate
For infective agents, the principal hazard to people would be from inhalation.
For many infective agents, the hazard is greatest if the agent reaches the target
population in the form of particles within a narrow size range -- small enough to
penetrate to the alveoli in the depths of the lungs but not so small that most of the
particles fail to be deposited and instead are simply exhaled. In terms of diameter, the
corresponding size range is approximately 0.6 to 5 µm. Contact with an infective agent
and its entry into the body via a wound or via mucous membranes may also present a
hazard, although generally much less than that from inhalation. Infective agents may be
Particles in the respirable size range and smaller have such low gravitational
settling velocities that the movement in the atmosphere of a cloud of such particles is
like that of a vapour cloud. A particulate cloud of this type is known as an aerosol,
denoting a colloidal suspension of matter in air. For both vapour and aerosol, the rate of
31
deposition depends not on gravity but rather on chemical and physical forces that might
bind the molecules or particles to specific surfaces with which they come into contact,
thereby removing them from the cloud. Although wind and other mechanical
small and even that would be bound to soil or other particles of diameter too large to be
atmosphere cause it to spread both horizontally and vertically (up to the top of the
atmospheric mixing layer, if such a layer is present) at a rate that depends strongly on the
degree of atmospheric turbulence, resulting in lower dosages with larger down-wind and
cross-wind distances from the source. Nevertheless, if the atmosphere is relatively stable
and depending on the nature and amount of the agent, dosages may reach hazardous
Most biological and chemical agents affect the lungs in some way, even if the
respiratory system is not the primary target organ. The body is most vulnerable to this
route of exposure because of the large surface area and gas-exchanging function of the
organism, may instead carry it to the lymph system where it may proliferate and cause
32
systemic infection. Usually, the onset of symptoms after a respiratory exposure to
chemical agents is much earlier than after skin exposure or ingestion. With some
biological agents, in contrast, most notably Bacillus anthracis, cutaneous infection may
the vapour in air but also the period of time over which exposure occurs. For this
time, commonly known as the “Haber product” (W, or Ct-product, with units such as
mg.min.m-3). With some agents, notably hydrogen cyanide, the formula becomes more
complicated for low concentrations or long exposure times, as it needs correction for
factors such as the rate of detoxification in the body. With other agents, such as the
nerve gases, this dose-rate dependence is less marked. Corrections will also be needed
for variation in volume of air being breathed in a given time, partial excretion and
incomplete absorption. The eventual effective dose in the body is thus dependent on a
variety of internal and external factors. Some are characteristic of the agent, while
others depend on the exposed individual and her or his level of activity. Vapours can
only be absorbed by the lungs as long as the individual remains in the toxic atmosphere,
so, as soon as respiratory protection means are used or the individual is removed from
the contaminated atmosphere, breathing of clean air will flush the respiratory system and
Unlike vapours, aerosol particles of a certain size are accumulated over time in
the respiratory system. While particles between 5 and 10µm are largely retained in the
nose and throat (and may subsequently be swallowed, adding an ingestion component to
33
the exposure), particles smaller than 0.6µm in diameter will not deposit in the respiratory
system and will simply be exhaled. Volatile chemical agents, however, if inspired in the
form of fine particles (< 0.6 µm) may then evaporate due to the higher temperature in the
lungs, so adding to the vapour load in the lungs. Particles in the range 1 - 5µm will be
deposited in the lungs. The action of aerosolised agents in the lungs will therefore
continue even after removal of the individual from the contaminated air or the
downwind, the integrated dosage it presents at ground level will be diminished by the
deposition.
While many modern chemical agents are designed to penetrate the skin, few
biological agents will do so. The presence of injuries, sores or skin rashes might change
this significantly and allow even biological agents to enter the body by this route. As a
general rule, the thinner, more vascular, and moister the skin, the more prone it is to
penetration. High relative humidity promotes skin penetration. Liquid spills and
aerosols cause a hazard for skin penetration that can be several orders of magnitude
higher than from vapours. Spills will occur mainly around the point of delivery. In case
of makeshift devices, a larger fraction of agent will be in the spills and a smaller part will
usually be aerosolised. Aerosol particles, in contrast to the much larger particles that
will occur in a spray or dust, do not tend to settle on surfaces and might just pass without
any harm to the skin (exceptions are hairy areas where aerosol particles might be
34
trapped). The onset of symptoms after skin exposure to chemical or biological agents is
usually delayed compared with respiratory or ingestive exposure. The eyes are
particularly sensitive to chemical agents and may develop symptoms of exposure very
fast and at relatively low concentrations. Biological pathogens may survive much longer
on mucous membranes than on the skin, due to the increased moisture that is present.
Biological and chemical agents can enter the digestive system in contaminated
the nose/throat and upper airways. Of all exposure routes this is the easiest to control,
provided that the contaminated sources are known (or at least suspected). Simple
hygienic measures and control of the supplies of food and drinking water can reduce the
onset of symptoms (compared with respiratory exposure) and the increased prevalence
of systemic rather than localised effects might appear as a disease or general malaise
Since the particle size is not important after deposition on surfaces, even non-
respirable aerosols can contaminate food supplies or drinking water over long distances.
35
The chief characteristic of biological agents is their ability to multiply in a host
over time. Their aggressive potential is rooted in this characteristic. The disease they
may cause results from a multi-factorial interaction between the biological agent, the
host (including the latter’s genetic constitution, nutritional status and the immunological
status of its population) and the environment (e.g. sanitation, temperature, water quality,
Biological agents are commonly classified according to their taxonomy, the most
salient taxa being fungi, bacteria and viruses. Such classification is important to medical
treatment. Biological agents can also be characterised by their intrinsic features, notably
and stability19 , all of which influence their potential for use as weapons.
The infectivity of an agent reflects its capability to enter, survive and multiply in
a host, and may be expressed as the proportion of persons exposed to a given dose who
become infected.
can be quantified as the ratio of the number of clinical cases over the number of infected
hosts. Different strains of the same micro-organism may cause disease of different
severity, e.g. infection due to Brucella melitensis is usually more severe than infection
19
The definition of these terms given below in general follows J M Last, A Dictionary of Epidemiology,
fourth edition, Oxford University Press, 2001.
36
Lethality reflects the ability of an agent to cause death in an infected population.
The case-fatality rate -- i.e. the proportion of clinically recognised cases of a specified
disease who die as a result of that illness within a specified time (e.g. during outbreaks of
measured by the ratio of the number of clinical cases over the number of exposed
persons.
agent and the first appearance of the signs and symptoms of disease associated with the
infection. This is affected by many variables such as the initial dose, virulence, route of
For those infections that are contagious, a measure of their contagiousness is the
number of secondary cases following exposure to a primary case in relation to the total
involved may be direct or indirect. The transmission may, for example, result from
through inanimate material that has become contaminated with the agent, such as soil,
blood, bedding, clothes, surgical instruments, water, food or milk. There may also be
transmission can occur via biting insects, arthropods, or other invertebrate hosts. The
37
distinction between types of transmission is important when methods for controlling
contagion are being selected. Thus, direct transmission can be interrupted by appropriate
handling of infected persons, while indirect transmission requires other approaches, such
of the agent to survive the influence of environmental factors such as air pollution,
of different ways, depending on the type of characteristic that is of primary concern. This
can lead to potentially confusing differences in the way that chemical agents are grouped
are described below in order to introduce and explain frequently used terminology.
people for as long as they remain exposed. They are acutely aware of discomfort caused
by the agent, and usually remain capable of removing themselves from exposure to it
unless they are otherwise constrained. Usually they will recover fully in a short time
after exposure ends, with no medical treatment required. An incapacitating agent also
disables, but people exposed may not be aware of their predicament, as with certain
psychotropic agents, or may be rendered unable to function or move away from the
38
exposed environment. The effect may be prolonged, but recovery may be possible
without specialised medical aid. A lethal agent causes the death of those exposed.
This is not a particularly precise way of classifying agents, as their effects will
depend on dose received and on the health and other factors determining the
susceptibility to adverse affects on the individuals exposed. Tear gas (such as CS or CN),
usually a harassing agent, could be lethal if a person were exposed to a large quantity in
a small closed space. On the other hand, nerve agents, usually lethal, might only
incapacitate if the target were exposed only to a low concentration for a short time.
Protective measures may be aimed at reducing the level of the effect if total protection is
not possible. For example, the use of pre-treatment and antidotes in a nerve gas victim is
unlikely to provide a complete “cure”, but it may well reduce what would have been a
Another form of classification is according to route of entry of the agent into the
body (see section 3.3 above). Respiratory agents are inhaled and either cause damage
to the lungs, or are absorbed there and cause systemic effects. Cutaneous agents are
absorbed through the skin, causing damage to the skin (e.g. mustard) or gaining access to
the body to cause systemic effects (e.g. nerve agents), or both. According to its physical
remain in the area where they are applied for long periods (sometimes up to a few
weeks). They are generally low-volatility substances that contaminate surfaces and have
a primary hazard potential of contact with the skin. A secondary danger is inhalation of
39
vapours that may be released. Persistent agents may consequently be used for creating
obstacles, for contaminating strategic places or equipment, for area denial, or, lastly, for
causing casualties. Protective footwear and/or dermal protective clothing will often be
required in contaminated areas, usually together with respiratory protection. Mustard and
VX are persistent agents. Non-persistent agents do not stay long in the area of
application. Being volatile substances, they evaporate or disperse rapidly, and may
after the area has cleared. Surfaces are generally not contaminated, and the primary
danger is from inhalation, and secondarily from skin exposure. Respirators will be the
concentrations are below skin toxicity levels. Hydrogen cyanide and phosgene are
Finally, chemical agents are often grouped according to effect on the body, the
classes being differentiated according to, for example, the primary organ system that is
affected by exposure. Typical classes are: nerve agents or “gases” (e.g. sarin, VX, VR);
vesicants or skin-blistering agents (e.g. mustard gas, lewisite); lung gases, asphyxiants
or choking agents (e.g. chlorine, phosgene); blood gases or systemic agents (e.g.
hydrogen cyanide); sensory irritants (e.g. CN, CS, CR); and psychotropic agents (e.g.
BZ).
WEAPONS
40
The most prominent immediate consequence of incidents involving biological or
chemical weapons is their ability to cause mass casualties. It is this characteristic that
directs most preparedness strategies. The potential for overwhelming medical resources
and infrastructure is magnified by the fact that the psychological reaction of a civilian
population to biological or chemical attack is likely to be far more severe than that
support strategies combined with risk communication are an integral addition to the
response services that are needed to manage the many exposed and non-exposed
casualties that may present at medical facilities. A graphic and instructive illustration of
the nature of short-term consequences of urban attack with chemical agents is provided
by study of the 1994-95 terrorist attacks in Japan in which the nerve gas sarin was used.
Details of the short-term injuries that are caused by the various biological and
including delayed, prolonged and environmentally mediated health effects felt far
beyond the time and circumstances of employment of the weapons, have generally
received less attention in the literature than the more obvious short term consequences
discussed above.
Some biological and chemical agents have the potential for causing physical or
mental illnesses that either remain evident or only become evident months or years after
the weapons have been used. Such effects have long been recognised, and have indeed
41
been the subject of specific scientific monographs (3.03, 3.04). They may extend the
potential for harm of biological or chemical weapons beyond their immediate target area
in time as well as space. Users may seek to exploit this characteristic of the weapons for
offensive purposes, but for many agents too little is known about long-term effects for
Such uncertainty also affects the planning of medical countermeasures, and not
much more can be done than to outline the various possibilities needing further study.
Unanticipated long-term effects of agents may later prove more harmful than the
presence of certain chemicals in the environment, may not be helpful guides to the
effects of those same agents under the quite different conditions of deliberate release, in
which generally greater quantities may be involved. Useful pointers to what the
are hazardous for humans, and the methods of treatment and the likely long-term effects
chemical agents may be defined: chronic illness; delayed effects; new infectious diseases
The potential for chronic illness after exposure to some toxic chemicals is well
exposure was reported after the First World War (3.05). Such experience is also
42
recorded in reports describing the current status of Iranian casualties from Iraqi mustard
gas during the Gulf War of the 1980s (3.06, 3.07). Follow-up of Iranian victims has
revealed debilitating long term disease of the lungs (chronic bronchitis, bronchiectasis,
mustard gas keratitis with blindness), and skin (dry and itchy skin, with multiple
hypertrophy to atrophy). Deaths from pulmonary complications are still occuring at the
time of writing, approximately twelve years after all exposure had ended. 20 Details of
Biological agents, too, may cause long lasting illness, including some of the agents of
particular concern. Brucella melitensis infections, which are typically more severe than
brucellosis due to B suis or B abortus, especially affect bones, joints and heart
(endocarditis). Relapses, fatigue, weight loss, general malaise and depression are
may last for many months. The viral encephalitides may have permanent effects on the
disregarded. Concerning carcinogenesis, both viral and chemical agents have been
not at present known. Only limited information is available on the ability of certain
20
K Keshavarz (Chief Physician Baghiyat’ollah Hospital, Teheran), personal communication.
43
many alkylating agents have been found to be carcinogenic. Some compounds of
military interest, such as mustard gas, are alkylating agents. While the evidence
(3.08). As to teratogenesis, certain chemicals and infective agents can cause severe
damage to the developing human foetus. Thalidomide and the rubella virus are
particularly well known examples. It is not known whether any of the specific chemical
or biological agents addressed here would have teratogenic effects at the doses likely to
incident of release. Regarding mutagenesis, insufficient attention has been given to the
possibility that known chemical and biological agents might cause detrimental
alterations in the human genome. Several chemicals are reported to induce such changes
If biological agents are used to cause diseases that are not endemic in the country
attacked, this may result in the disease becoming endemic, either in human populations,
or in suitable vectors such as arthropods and in other non-human hosts, such as rodents,
degradation, and can persist, particularly in soil, for long periods and, by infecting and
44
Finally, there is the possibility of effects mediated by ecological change. New
foci of disease might become established as a result of ecological changes, caused by use
of biological agents infective for man and animals, or as a result of the use of anti-plant
agents. These could exert profoundly adverse long-term effects on human health via
reductions in the quality and quantity of the food supply derived from plants or animals.
The broad conclusion to be drawn from the foregoing analysis is that there are
enormous difficulties associated with assessing the long-term health effects of exposure
to chemical and biological agents. Confounding variables often affect the results of
(which by nature are often non-specific) from background occurrence of the same
symptoms due to a wide spectrum of other causes. Conflicting data and inconclusive
Vietnam, where the chemical was extensively disseminated in the 1970s during the
Vietnam War (3.09). Investigations have paid special attention to the Orange-production
at elevated levels in sampled blood lipid and body fat, and highly toxic to specific test
animals. In a more recent example, and with even less scientific evidence available
amongst the many factors that have been put forward as potential causes of the so-called
Gulf War syndrome. In both cases, a wide range of long-term symptoms and adverse
45
health effects (including carcinogenesis, teratogenesis, mutagenesis, and a plethora of
non-specific somatic and psychological symptoms) have been claimed to have been
caused by exposure to chemical agents, amongst other possible causes (3.10). Despite
intensive investigation, definitive explanations have not yet been found in either case.
Distinct from their ability to cause physical injury and illness, biological or
chemical agents are amenable to the waging of psychological warfare because of the
horror and dread that they can inspire. Even if the agents are not actually used, the fear
of them can cause disruption, even panic. Exacerbation of such effects can be expected
from the exaggerated accounts of biological and chemical weapons that are often to be
found in political circles and in the news media. Also, people may be more able to
understand and comprehend the wounding effects of conventional weapons than those of
toxic or infective materials. These matters are taken up in more detail in Annex CHECK
The emergence and spread of long-range ballistic missile delivery systems has
increased the sense of vulnerability to biological or chemical attack that can prevail in
cities, where the population may seem largely unprotectable, and this in turn has
increased the psychological warfare potential. This was demonstrated in Tehran during
the ‘war of the cities’ in the final stage of the Gulf War of the 1980s when the prospect –
extent that the actuality of high-explosive warheads had not. There was further
demonstration during the Kuwait War of 1990-91, with fears that Scud missiles launched
against cities of Israel might be armed with chemical warheads. In addition to military
and civil defence personnel, much of the civilian population was issued with anti-
46
chemical protective equipment and trained in procedures for chemical defence.
proven otherwise, despite the fact that no chemical warheads were actually launched by
Iraq.
This chapter has introduced the wide variety of toxic and infective agents that
could be used for hostile purposes. It has proposed that a considered and realistic
approach to evaluating the threat identifies a relatively small group of agents that should
form the focus of protective preparation. Preparedness can thereby be built against
Of the various methods available for release of biological and chemical agents,
the major risk emanates from their dissemination as aerosols or, in the case of some
chemicals, as vapour. Against these hazards, the primary requirements are for
respiratory protective equipment and for means of predicting the potential spread of the
airborne agent so that preventive and protective measures can be implemented in areas
Skin exposure hazards primarily result from chemical agents and will mostly
occur in the immediate vicinity of a release. Here the mainstay of protection will be
protective clothing. Skin protection may be required to protect against both direct liquid
exposure, and potential skin damage from high vapour concentrations. If a vapour hazard
is involved, respiratory protection using adsorptive carbon filters will also be required.
47
By understanding the general properties and potential consequences of the use of
preparedness programme should not only make provision for the immediate casualty-
producing potential of such agents, but also for the long-term consequences that could
48
TEXT FOR THE BOX IN SECTION 3.1.1:
(a) Toxic chemicals and their precursors, except where intended for purposes not
prohibited under this Convention, as long as the types and quantities are consistent with
such purposes;
(b) Munitions and devices, specifically designed to cause death or other harm through
the toxic properties of those toxic chemicals specified in subparagraph (a), which would
be released as a result of the employment of such munitions and devices;
(c) Any equipment specifically designed for use directly in connection with
the employment of munitions and devices specified in subparagraph (b).
Any chemical which through its chemical action on life processes can cause
death, temporary incapacitation or permanent harm to humans or animals.
This includes all such chemicals, regardless of their origin or of their
method of production, and regardless of whether they are produced in
facilities, in munitions or elsewhere.
[…]
49
(a) Industrial, agricultural, research, medical, pharmaceutical or other
peaceful purposes;
(c) Military purposes not connected with the use of chemical weapons and
not dependent on the use of the toxic properties of chemicals as a method of
warfare;
50
CHAPTER 4: PUBLIC HEALTH READINESS FOR BIOLOGICAL OR
CHEMICAL INCIDENTS
civilian populations is largely a local responsibility in many parts of the world. Local
authorities have the greatest opportunity to impact positively on events, and will
generally be held accountable should the incident be mishandled. While national and
local officials to have response systems and plans in place before an incident actually
occurs.
This chapter provides a framework that local and national authorities could
chemical agents may have been released deliberately. It is not intended to provide an
didactic training text. The goal is rather to demonstrate that the standard principles of
other hazards, and that these principles can be used to identify areas needing
considered as an outline of the issues that will need to be addressed. Further resources
attacks are concerned, states party to the CWC, who have thereby become members
of the OPCW, have access to international aid for their preparedness activities.
Assistance in assessing needs, and specific training, can be accessed by contact with
Secretariat. As to biological attacks, Article VII of the BWC makes some provision
37
for assistance in the event of a state party becoming exposed to danger as a result of
violation of the Convention. For further information on this and other sources of
Readiness needs also to extend to situations in which a threat has been made
that biological or chemical agents are to be released. While such a threat may be a
hoax, the authorities concerned need to be able to allay public fears and concerns as
well as to initiate appropriate action to locate and neutralize any suspect device.
to be discussed in this chapter and the preparedness of military forces to protect their
while it may be possible for some countries adequately to warn, encapsulate and
who make up combat forces in an active theatre of war, the protection of a civilian
may be positive danger in holding out a prospect of adequate civil protection that is
The first responders to an attack with a toxic substance with prompt effects are
likely to be police, fire departments and emergency medical personnel on or near the
infective agent, or with a toxic agent having only delayed effects, are more likely to
38
be regular healthcare providers, including nurses, physicians and hospital emergency
personnel and biological weapons on public health infrastructure, they both can result
response would be required with the primary focus on contamination control and early
medical treatment. Emergency personnel would have to locate and identify the
contaminated area immediately (the “hot zone”) and may have to act within minutes if
lives are to be saved. On the other hand, a covert release of a biological agent would
be more likely to become evident over a longer period of time -- days or even weeks.
the disease might appear in different parts of the country (or world), and the full
picture might only become evident after combining information, medical reports, and
surveillance data from multiple areas. Biological agents that are transmissible from
disease.
for biological and chemical incidents. However it must be noted that, in the early
phases of an incident, it may not be clear whether the causative agent is biological or
39
chemical, or possibly even mixed. As a result, first responders may find themselves
needing to manage both types of incident before the relevant specialists for biological
adopt an approach that is consistent with the principles of management of any other
type of public health emergency. While attacks with biological and chemical agents
would have some distinct features, they do not necessarily require the formation of
completely new and independent response resources. A well designed public health
and emergency response system can provide a significant capacity for responding to a
limited biological or chemical attack and can form the basis for developing measures
designed specifically to mitigate the effects. A chemical agent attack would share
preparedness for such an incident. A biological agent attack would generally have the
health programmes must be involved in the response, which will have more to do with
the mobilization of infection control strategies (as for any outbreak of disease).
Establishing routine sensitive and near real time disease surveillance systems
will serve a dual purpose in natural and deliberate outbreaks. It is important to have
such systems in place well in advance of an attack, so that the background disease
40
of its possible contribution during deliberately caused outbreaks. A national centre
may detect a national outbreak not noticed in any one regional locality. It can also
mechanisms for routine exchange of information between the public health and
other health events by the media and interest-groups, notably the Program for
has established epidemic intelligence capabilities and actively collects, verifies and
partners and member states weekly, and once officially notified they are made public
electronically through the World Wide Web and in printed form through the Weekly
chemical incident.
41
Identification of the presence of a covert release may be a particularly difficult
frequency, nature, and location of emergency calls) are a valuable emergency service
or chemical agents.
onto dedicated specialized response units is that the relative infrequency of call-out
chemical unit throughout a region could never match the 24-hour availability and
specialists (e.g. sampling and analysis for definitive identification of agent involved).
This suggests that a readiness and response strategy should be directed at enabling the
local public health, emergency response and other authorities (fire brigade, ambulance
services, police force, and civil defence) to respond to and manage the incident scene
in its early phases, with specialized functions being added later by a dedicated mobile
biological and chemical response unit. The exception might be the pre-positioning of
special response units for highly visible events (e.g. the Olympic Games) that might
42
This approach indicates that planning of a response system should address the
personnel who will perform the primary response, and the specialists who will
supplement the primary response with specialised functions. A third group that needs
complete unless attention has been given to distribution of the knowledge that the
what they should do after an attack. A final area of consideration is the medical
treatment centres (usually hospitals) that will receive potentially large numbers of
casualties (both exposed victims and those who think they may have been exposed).
should address two distinct areas. In this chapter, these will be referred to as
preparedness (what needs to be addressed well before an incident takes place), and
process, and to identify the areas that require attention in a logical manner. This can
43
• Monitor the risk-management programme, and repeat the process as
required.
These steps can be used to identify areas of activity during both the pre-attack
“preparedness” phase, and the post warning or attack “response” phase. While
which is usually found in risk management guides (as well as some hazard-specific
technical considerations), the principles of applying these steps remain the same.
4.2 PREPAREDNESS
This step, and the hazard evaluation step that follows, is commonly referred to
with particular inputs from the country's law enforcement, intelligence, and
biological or chemical weapons against the population, the agents that could be used,
and the circumstances under which the weapons might be used. This is an exercise
that is broad in its scope, and requires active liaison between law enforcement,
security and health agencies (typically centralized state institutions) with local
44
automatically improve a population’s ability to manage biological incidents.
occurring and its consequences must be evaluated. Justified and well motivated
decisions on resource allocation can only be made after these steps are complete.
The level of risk that exists is also a function of the potential vulnerability of
system that may be exposed to biological or chemical hazards, and will determine the
current ability to respond to and manage the emergency (4.02). This further requires a
incidents. When identified needs are measured against currently available resources,
analysis of defence against biological and chemical weapons is most likely to need
45
The details of risk reduction within a specific incident after it has occurred
will be discussed in the response sections below. This section refers to risk reduction
is avoidance of the hazard altogether. In the current context, this would mean pre-
vigilance and response system needs in order to serve as a deterrent, and the
potentially negative results that demonstration of concern about the threat could
terrorism could have the opposite effect to that which is desired. Some biological
hoaxes have been inspired by media or government statements about the threat of bio-
terrorism.
intelligence about terrorist groups and their activities. As the agents may be
46
manufacture need not be large or particularly distinctive (from a viewpoint external to
little help. Intelligence regarding terrorism relies heavily on human sources. The
development and production programmes and facilities have been large-scale and of
protracted duration, terrorist activities could be much less conspicuous and therefore
biological or chemical weapons a crime, and that empowers law enforcers to act
against suspected protagonists before an actual event occurs. Details of how this is
addressed in the CWC and BWC, and the implementation thereof, can be found in
Chapter 5.
information that could aid proliferation. This could range from “cookbook” type
applied to dual-use technology and equipment. The international norm which has
been established by the majority of the world’s nations by their acceptance of the
principles of the BWC and the CWC is a strong force to confront, and could be a
47
4.2.3.2 Preparation of an ability to respond
hazardous materials protocols, public health plans, and the current training of police,
or chemical agents.
Most civilian healthcare providers have little experience with illnesses caused
by biological and chemical weapons. They may therefore have little expectation that a
patient's symptoms may be due to such weapons, especially in the early phases of an
recognition and initial management of both biological and chemical casualties, and
information when suspicion of an unusual incident arises. Education and training must
clinical presentation, diagnosis, prophylaxis and therapy for the most important
planning and drills must prepare physicians and staff for mass-casualty patient
48
such education and training is expensive and may be manpower intensive, yet may be
the most cost-effective aspect of medical preparation for biological terrorism. Such
training will also be the cornerstone of an approach to prevent anxiety and fear in
methods. Secondary to the need for diagnosis for medical treatment purposes, forensic
analysis will be required from samples obtained from a delivery system or the
identification of biological agents more quickly, and even at the attack site. Such state
Failure adequately to prepare the healthcare system and its providers for
biological attack could result not only in late detection of an outbreak, but could also
Should the local healthcare facilities and personnel be perceived as inadequate for
managing the outbreak and the clinical cases, the population, including potentially
infectious patients, may travel long distances to seek treatment, promoting spread of
the outbreak.
49
Where particular utility for equipment, antidotes, antibiotics or vaccines has
been identified, pre-attack stockpiling and planning for distribution systems to make
them available to the exposed population would be necessary. The financial cost of
such stockpiles, depending upon the items chosen and the quantities stockpiled, could
biological or chemical weapons could only be justified in extremely unusual and very
specific threat situations. In high risk situations, the supply to each person or family of
with antidotes for self-injection) or antibiotics can be considered. The cost and
logistical burden of this type of preparation may be prohibitive, however, and it may
not be feasible for poor countries or countries with large numbers of people needing
protection. In such cases, and dependent on the agent involved, selective protective
measures may still be considered for high risk groups (e.g. prophylactic antibiotics for
synonymous with an ability to respond, or that the community without all the latest
generally a more important part of preparation for chemical attack than it is for
biological attack. The use of biological and chemical protective equipment requires
introduction of such equipment can hamper the ability to respond, and can in fact be
50
dangerous. Some of the problems associated with the use of protective equipment are
occurs if it is to have any chance of success. The adjacent CHECK box shows how a
should know how they will be expected to act in the event of an attack, well before
any threat materialises. The communication plan may include radio and television
non-emotive language. Clear instructions should be provided on how the alarm would
communication packages are available (e.g., 4.03, 4.04). A well constructed media
plan is essential, both as part of the pre-incident education process, and to avoid
provocative.
4.2.4 Quantify the residual risk, and make a risk acceptance decision
Once the risk reduction measures discussed above have been put into place, it
is necessary to reassess the residual risk, and make a decision on whether preventive
51
and preparedness measures have been effective, and are adequate. The level of
residual risk that can be accepted will depend on the circumstances of the region
involved. One country may need to address a significant risk of terrorist use of
different part of the world, the assessed low risk of biological or chemical incidents
will not support major resource expenditure, and acceptance of a reduced ability to
respond may be justified. Such decisions are clearly extremely difficult, and will be
52
A Six Step Process for Communicating with the Public a
Identify information
• Who. ..is affected, the message source, etc?
• What. ..is the message, the problem, the solution, etc?
• When. ..did it happen, should it happen, should there be action?
• Where. ..what place is affected, where should people go, etc?
• Why. ..is it important that the message be followed?
Prepare messages • How ...to respond, to deal with the situation, etc?
Select communication
mechanisms • News releases
• Public service announcements
• Talk shows, including call-in programmes
• Advertisements. flyers, circulars
• Local community personnel
Send message • Emergency management committee members,
service clubs, voluntary organizations, and police
• Simulation exercises
• Monitoring media messages before and during emergencies
• Surveys
• Questionnaires
• Formal reviews after emergencies
53
a
Adapted from Community Emergency Preparedness, WHO, Geneva, 1999
4.2.5 Monitor the risk management programme, and repeat the process as
required
ensure that adopted strategies are proving to be adequate. This implies continuous
attention to the threat analysis process, and constant evaluation of the ability to
wherever they may occur, should provide real information to guide the ability of the
be incorporated into future planning. Since the publication of the first edition of this
report, the first recorded incident of terrorist attack on civilians using chemical
illustrations and lessons regarding the nature of and response to civilian attacks with
chemicals can be learned. For example, the observation that the majority of patients
arrived at hospitals on their own initiative, and using their own transport, has
important implications for the distribution of triage and decontamination abilities. The
movement of mobile units to the incident scene implies that their services will not be
available for those who take themselves to hospital. Further discussion of this incident
sickened 751 people in a small town in Oregon, USA, by using cultures of Salmonella
54
enterica Typhimurium bacteria to contaminate the salad-bars of ten restaurants over a
The main point to be extracted from this discussion is that the logic and
on the same principles that should be applied when preparing for any disaster or
emergency. Those interested in obtaining more details of the process are referred to a
4.3 RESPONSE
received, there are a number of activities that can and should be carried out before the
release. The sequence in which these activities are performed will depend on the
activities within the community – such as the response to a fire or the discovery of a
experts who should have trained to work together to analyse such information by
55
group of analysts and experts to evaluate threat or suspected incident information
warning and the analysis warrants such action, it may be appropriate to initiate a
search for those responsible for the warning or for witnesses who may have seen
them.
approaches 21 .
character (or even a mix). This will allow the appropriate specialists to become
involved in management of the incident. It will also allow the choice of protective
21
An internationally marketed system for containment, neutralisation, and decontamination of
chemical and/or biological devices has been developed by the Canadian based company Irvin
Aerospace – see <www.irvin.co.uk/products/blast.htm>.
56
equipment appropriate for that hazard. For example, an oro-nasal mask may
guide, chemical attacks are more likely to produce simultaneous and similar
symptoms in a relatively restricted area near the release point, and relatively soon
after release. Biological attacks are more likely to present with the appearance of ill
individuals at medical centres and/or doctors over a longer period of time, and far
with delayed effects may be much more difficult to differentiate from infectious
disease. While there are no definitive and invariable distinguishing features, the
indicators set out in Table 4.1 below may help to differentiate biological and chemical
attacks.
57
Table 4.1 Differentiation of biological and chemical attack
Unexplained odour.
58
4.3.3 Response to biological incidents
complex task, which will require co-operation between civil defence, emergency
response, law enforcement, public health and medical personnel. The normally
ordering and prioritizing an approach is needed. The requisite response activities, and
following table:
59
strategies. the affected population that conveys information
and instructions as needed
Quantify the residual risk, and Decide whether local and national resources are
make a risk acceptance decision. adequate, and whether international resources
should be accessed.
The specific actions identified in the table are expanded in the paragraphs below.
Since responses to natural and to intentionally caused outbreaks will follow similar
other publications for more details on public health response to epidemic emergencies
(e.g., 4.10). The intention is to indicate activities that response planners need to
address. Sources of more detailed information on these tasks are given in Annex Z
INSERT.
60
requires a prior realisation that a release has actually occurred, or the suspicion that an
outbreak has been intentionally caused. Many factors will influence the decision to
initiate such response and particularly on whether the release was overt or covert. A
covert release, just as any other outbreak of disease, will only be detected when cases
environmental data, may indicate that the outbreak could be the result of a deliberate
outbreaks as a tool to warn that an unusual outbreak may be underway has been
discussed in section 4.1 above. A threatened or overt release will generate response
requirements more akin to the early stages of a chemical release, described below.
While determination that it has indeed happened will most likely come from signs and
symptoms in people and animals, it may also require sampling and detection of
medical measures. Because some of these agents may cause an infection that is
be at all easy. The development of sensitive, timely biological agent detectors for a
61
broad array of potential threat agents will require significant advances in technology
in order to make them widely accessible and may not be available for some time. The
problem is particularly acute in regard to those highly infective agents that can create
The extent to which laboratory support will be able to aid initial diagnosis and
network of diagnostic laboratories. The nature of the biological sample required, and
specific laboratory techniques required for agent identification, will vary according to
the organism and its properties may allow tracing to a source laboratory. This is a
highly specialised activity. It is distinct from the basic diagnostic procedures needed
incubation periods of the biological agents. One proven method to improve the
experts who have trained together and are able to evaluate the situation quickly and
efficiently by telephone conference or computer link at very short notice (see also
section 4.3.1 above). The committee should include a biologist and a physician who
possibly the military, a forensic psychologist, a representative from the public health
62
community and on-scene authorities. A group such as this, armed with all information
available at the time, could make the best decision possible regarding the way ahead.
may help predict the spread of the aerosol particles. The first steps will, however,
have been to gather information on wind direction and speed and on possible sources.
With an ongoing outbreak, a retrospective analysis may indicate that cases originate
from specific areas, and may be a valuable indicator of an upwind site of original
release. 22
significant problem after biological attack. Respirable particles will either be carried
by the wind or lifted into the atmosphere and diluted following release. Larger
particles will mostly fall to the ground, and be inactivated by the elements. Continued
therefore of less concern following biological attack than it is for chemical attack.
22
Investigators of the accidental release of anthrax spores in 1979 from the Soviet military biological
facility in Sverdlosk were able to use aerosol spread analysis to show a striking occurrence of cases of
pulmonary anthrax in persons who were located within specific isopleths originating from the point of
suspected release (4.11, 4.12).
63
4.3.3.4 Risk communication and information distribution
Due to the potential for widespread fear and panic following a biological
incident, clear and accurate communication of the risks to the public is paramount. It
must be made known that medical evaluation and treatment is available, and how to
access it. If there are preventive measures that could be implemented to minimize the
chance of exposure and infection, these must be clearly and rapidly communicated.
If the incident involves a specific release point with a potential airborne agent,
might possibly provide some protection for nearby populations from a biological
agent cloud. An improvised sealed area could be provided by moving into a single
room, and sealing openings with adhesive tape. Wet towels or clothing can be pressed
have shown that improvised shelter within buildings may only be beneficial initially,
and that the total dosage of the substance indoors could eventually approach or even
equal the dose receivable outdoors. People should therefore leave the shelter as soon
as the cloud has passed, which will, however, not be easy to determine without agent
occurs. Reference sources for further information can be found in Annex Z CHECK.
available (or indeed, appropriate) for the local population. If respiratory protection
64
were considered appropriate, oronasal particulate or smog masks, or even improvised
healthcare workers could lead to the perception amongst the population that health
centres and hospitals themselves constitute a high-risk source of infection. This could
discourage potentially infected persons from seeking treatment from the local
healthcare providers, and lead them to travel to other healthcare facilities, thereby
increasing the risk of secondary transmission in the event that the infection is
contagious.
During the spread of a biological aerosol, the primary route of exposure would
be via the airways and respiratory tract. Respiratory protection would then be the
adequate for biological agents (in contrast to the activated-charcoal or similar filters
that would be needed for filtration of air contaminated with chemical vapour).
Most of the agents of special concern do not cause contagious disease, but
some do, in which case, once infections are established in the population, spread of
aerosol droplets, contact of infected body fluids with mucous membranes or broken
skin, and even ingestion could all be involved in secondary spread of the agent.
should always be applied. The standard principles of barrier nursing and infection
65
control will be the main elements for protection for responders. Details are readily
likely to be useful for the management of any secondary spread there might be of the
infection than for the primary manifestations of the attack. In some cases, pre-attack
infection control measures could have a crucial impact on limiting secondary spread,
for example washing hands after contact, avoiding direct contact with secretions from
infected individuals, keeping exposed persons away from public places, or isolating
should be told what signs and symptoms to watch out for and who to call or where to
go if they are manifest. Too little specificity in such public advice may result in local
aggravate the situation by facilitating the spread of infection and the rise of secondary
66
outbreaks. Movement of patients should be restricted to that which is required to
as the viral haemorrhagic fevers (such as Ebola or Marburg), plague and smallpox.
considering the sheer number of cases there might be. Provision may be made to care
for patients at sites other than healthcare centres, such as gymnasia, sports arenas or at
home.
ones, since biological agents are non-volatile, difficult to re-aerosolize and leave little
residue on skin or surfaces. Many pathogens deposited on surfaces would rapidly die,
though some may resist for longer (4.15). However it would be prudent to be prepared
may be extremely difficult or impossible. The contaminated zone may not be defined
until the outbreak has been characterized. At or near the release point of a biological
agent, where large particles may have deposited, area decontamination (or whole
have a concentration of 0.05% (i.e. 1 g/litre = 1000 ppm) of available chlorine, with a
stronger solution of 0.5% (i.e. 10 g/litre = 10,000 ppm) available chlorine used in
67
situations such as suspected Lassa and Ebola virus outbreaks. The use of 0.5%
blood and body fluids; and that of 0.05% available chlorine solution for disinfecting
gloved or bare hands and skin, floors, clothing, equipment and bedding (4.16). Most
experts now agree that water, or soap and water might be adequate, and probably
safer, for removal of most biological agents from human skin. Buildings can be
vapour produced from the heating of paraformaldehyde. Because of the lack of other
building clean after an agent release. Additional to the standard principles of barrier
nursing referred to above for highly transmissible agents, disposal of waste materials,
considered (4.17).
area may need to be considered via establishment of a sanitary cordon. This will
involve the co-ordinated efforts of several public service groups to inform the people
affected, control water and food supplies, regulate the movement of people in and out
(4.18), currently under revision. The IHR provide an essential global regulatory
68
framework to prevent the international spread of diseases through permanent
4.3.3.7 Triage
large numbers of people seeking care. The development of scientifically sound case
definition(s) suitable under local circumstances and the definition of the population at
risk of becoming ill are very important for triage (the initial reception, assessment,
and prioritisation of casualties). Such information can generally be gathered from the
time, place and person description of the outbreak or in some circumstances from
more specific survey. Fear and panic can be expected from genuinely symptomatic
patients, concerned public, and from involved healthcare providers. Any healthcare
facility will need plans in place to deal with overwhelming numbers of people seeking
care or advice simultaneously, and to ensure that resources are utilised for those who
are most likely to benefit. Psychological support, and active treatment of anxiety will
biological agents may be warranted. This treatment would depend upon availability
and effectiveness against the agent involved, for example immunization would be an
69
important element of control for a smallpox or plague outbreak. This might include all
those who enter hospitals where patients are housed and treated.
Because several weeks are required for immunity to develop after vaccination,
distribution must be activated. In essence the choice is either to take the drug to the
potentially exposed person or to have the person come to the drug. The latter option
generally requires fewer personnel. It will be necessary to have stocks greater than
needed for those exposed, because it may be difficult to distinguish between those
who have actually been exposed and those who simply believe themselves to have
been exposed. Cases may be much greater in number than the total number of hospital
countries. An early decision to enlist the assistance of international aid (on which see
Chapter 6) may save many lives. The WHO is able to offer public health assistance to
70
Due to the delay of onset of symptoms, the movement of exposed individuals
having been used it is possible that outbreaks will be widely distributed. Efficient and
co-ordinated collection of national data will be necessary to track the outbreak, and to
mobilise resources to areas most in need. Again, good public health and near to real-
The sequelae of a biological attack could manifest for many years after the
incident. Careful case identification, record keeping, and monitored follow up will be
required both from the practical viewpoint of comprehensive medical care, and
because of the need to study such incidents and improve preventative and response
large number of different groups. Effective co-ordination and training of such multi-
necessary authority over the various parties involved in the response. This
requirement may be in conflict with other considerations – for example, the law
enforcement officers who usually take overall responsibility for the response action in
criminal incidents may not have the necessary background and expertise to deal with
71
biological or chemical incidents. The solution will be to ensure a high-level,
and specialist advisors who ensure that the specific features of the incident are given
appropriate consideration.
applying, once again, the systematic steps of risk management as has just been done
Protect responders.
Control contamination:
• Establish “hot-zone” scene control to
limit contamination spread.
• Conduct immediate operational
decontamination on-site, and
decontamination of all persons leaving
the “hot-zone”.
72
Conduct casualty triage.
Quantify the residual risk, and Decide whether local and national resources are
make a risk acceptance decision. adequate, and whether international resources
should be accessed.
Monitor the risk management Continuously monitor the residual hazard level on
programme, and repeat the process the site, and adjust response activities as needed.
as required.
Implement follow up activities (e.g. of long term
injuries and rehabilitation).
As in the section on response to biological attack, the actions identified by the risk
nature of chemical hazard being confronted, if any. It commences with the reasoned
and logical application of observation skills, including the analysis of all available
the substance itself (if it is an overt release), and the signs and symptoms of persons
exposed. It is instructive to note that, after the terrorist chemical attacks in Japan, the
first indication that nerve gas had been released was the recognition of characteristic
activities for some time before analytical results confirmed the nature of the chemical
73
Detection strategies may include the use of a variety of devices that can
provide an initial indication of the agent involved. This is needed to guide initial
linked to warning or alert mechanisms which will be used to activate response (by
primary responders, specialist responders, and the population). Decisions are needed
on the basic philosophy of response activation. The approach of treating all suspicious
scenarios (as exemplified by the Israeli approach to Scud missiles during the Kuwait
war). Lower risk scenarios may be more efficiently addressed with an approach
calling for further response only if positive chemical detection results are obtained.
the forensic investigation with rescue and medical operations. Response personnel
must operate without disturbing the integrity of the crime scene, while forensic
responders must be careful to maintain chain of custody procedures with clothes and
personal effects that may be removed as part of the decontamination process. This
74
Under the provisions of the Chemical Weapons Convention, member states of
management requirements.
assessment is the prediction of spread of the agent cloud. This is the basic first step
time. These can then be used to decide where effects will be greatest, and to direct the
75
Where high-risk areas have been identified during the preparedness phase, it is
possible to utilise computerised models that take the specific local topography and
regarding numbers of casualties that may result as the could spreads, and deployment
If there is suspicion that the hazard may spread to affect the downwind
population (as predicted in the hazard evaluation step above), a warning and public
response system will need to be activated. This may include evacuation instructions,
the hazard area is not expected to spread, a large scale incident is likely to generate
widespread fear and public reaction. Rapid distribution of accurate and helpful
population to stay indoors, and to close all windows and doors. A sealed area might
be improvised (as described in 4.3.3.4 regarding shelter from biological agents – and
IPE, ranging from simple aprons and half-mask respiratory protection, to fully
76
encapsulating self contained impermeable ensembles. The range that is stockpiled,
and the choice for individual incidents, is absolutely dependent on the risk assessment
and the nature of chemicals involved. In areas where the threat is significant, it may
large protected areas with filtered air supplies where people can shelter without the
need for individual protective equipment. The outstanding example of this approach
can be found in Switzerland, where threat assessments during the Cold War era led to
the need for contamination control. Important elements of contamination control are:
procedures; and
• on-site decontamination procedures, ensuring that all persons or items leaving the
dirty areas are cleaned and monitored before passing on to the clean environment.
response to mass casualty incidents is such that many patients are likely to arrive at
medical centres via transport routes other than emergency services, bypassing on-site
77
decontamination facilities. It is important that the triage ability of casualty reception
There are many models for the layout of contamination control centres, and
4.3.4.6 Triage
procedures that have been adapted for contamination control purposes. Conventional
Due to the rapidity of onset of effects with some chemical agents, responders to a
As with any mass casualty situation, it will be necessary to ensure that potentially
limited resources are expended for the benefit of those who are most likely to benefit
from them. This can lead to difficult triage decisions, requiring the attention of the
most experienced clinical personnel available. Depending on the casualty load, it may
to handle the sudden influx. It must be expected that many more individuals will seek
treatment than are actually exposed. Psychological support teams should be available
hospital beds.
78
Medical care includes prophylaxis (pre-exposure treatment measures for high-
risk personnel to prevent or minimise the effects of exposure), diagnosis, and actual
treatment.
There are not many examples of true prophylaxis, but there are certain
situation, or emergency responders who must function within a high risk area known
exposure to chemical warfare agents. These could range from established techniques
the substance is known, specific treatment protocols may be required for on-site
treatment of the medium and long term effects of exposure. As for all response
79
4.3.4.8 Definitive decontamination
Once the immediate manifestations of the incident have been managed, a final
decontamination of the site will be required. This is a specialised activity, and will in
political response. As for many other aspects of chemical incident response, member
assistance measures. Due to the transient nature of some chemicals and their effects,
contaminated area, the risk it poses to response activities, and to determine when the
area can be re-opened to the public without further risk. Monitoring must continue
until the “all clear” is sounded, which can only occur after definitive decontamination
and certification of removal of all residual hazard. This will be a function for
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4.3.4.11 Follow up.
the acute effects of exposure, it must also be recognised that some chemical agents
have long-term effects that could manifest over a period of many years (see section
3.6.2). Well- organised and well-administered follow-up programmes are required, not
only for the benefit of the patients, but also for the advancement of medical
involve the usual primary responders (ambulance teams, fire fighters, police, etc),
specialist responders (such as military chemical defence units) and the public. Overall
site command needs to be allocated to an authority that will be able to exert the
control required for limitation of the hazard, and to achieve the required co-ordination
81
APPENDIX 4.1: THE SARIN INCIDENTS IN JAPAN
sarin nerve-gas against commuters on the Tokyo subway system. The highly
publicised attack killed twelve people and caused over 5000 to seek care. If it were
not for the prompt and massive emergency response effort launched by the Japanese
authorities, and some fortunate mistakes by the terrorist group, the incident could
have been much more devastating. Whilst this was the most publicised incident, it
was not the first incidence of nerve-gas attack in Japan. In June 1994, seven people
were killed and over 300 injured in an attack by the same group on a residential
lessons learned from these incidents. It draws heavily on a number of excellent and
interested reader is referred to these source texts for more details (4.1.1 – 4.1.6).
Background
The Aum Shinrikyo sect was the brainchild of Chizuo Matsumoto, whose
small publishing house and yoga school, which gradually developed into a cult. He
expansion, increasingly bizarre teachings and rituals for devotees, and ultimately
subversion with the aim of achieving supremacy for his followers in Japan. The group
82
attracted a surprisingly large international membership numbering in the tens of
armament programmes, which were highly ambitious in their scope. Plans included
Aum Shinrikyo’s chemical weapons abilities made world-wide news after the
Tokyo subway attack in 1995, but the quest for a biological weapons capability
actually predated the chemical programme. Despite intensive expenditure and effort
to acquire the means to develop and disseminate biological agents, actual distribution
attempts (of botulinum toxin in April 1990, and anthrax in 1993) failed, fortunately
The cult had more success with its chemical programme, which was launched
experimenting with VX, tabun, soman, mustard, hydrogen cyanide and phosgene, the
final focus and main effort was on the nerve-gas sarin. A plan was developed for the
During 1994, Aum Shinrikyo was involved in a legal process concerning the
legality of a land purchase. A gas attack on the overnight premises of three involved
judges was planned for 27 June of that year, apparently to pre-empt an unfavourable
fan and drip system, venting sarin vapour from the window of a disguised delivery
83
truck. After a twenty minute release period, the gas spread over an elliptical area
measuring about 800 by 570 meters (with most effects occurring within a smaller area
of 400 by 300 meters). While the judges survived, 7 unfortunate residents died as a
result of the attack, with 54 other hospital admissions, and 253 persons seeking care at
doctors could rely only on what they observed to guide treatment – clinical
report revealed that the cause of the poisoning had been the chemical warfare agent
in a water specimen taken from a pond in the affected area. No evidence found at that
Aum Shinrikyo’s activities regarding chemical weapons. Ironically, they had been
no provisions of national legislation at the time had been transgressed. The pretext for
a raid on the suspected development facility was provided when evidence linked an
informed Asahara of the imminent raid (for which chemical defence training of police
officers was being conducted). In an apparent attempt to dissuade police from making
the raid, an attack on the Tokyo subway system was hastily planned. On the morning
of 20 March 1995, five two-man teams carried out the attack. Each team consisted of
one getaway driver and one subway rider. Four subway riders carried two double
layered plastic bags and one rider carried three, each bag containing about half a litre
84
of sarin. The sarin was only about 30% pure, due to its hasty production for the
specific attack. Five subway lines converging on the station of Kasumigaseki had
been selected (where many Japanese government buildings and the Tokyo
Metropolitan Police Department are located). At around 0800 hrs, during peak
commuting time, the five assailants placed their sarin-filled bags on the train floor,
pierced them with sharpened umbrella tips, 23 and disembarked from the trains several
The first emergency call was received by the Tokyo fire department at 0809
hrs, and before long, emergency public-health authorities were inundated with calls
for aid from multiple subway stations, where affected passengers were disembarking
and seeking medical help. 131 ambulances and 1,364 Emergency Medical
medical and fire department authorities. More than 4,000 people found their own way
to hospitals and doctors using taxis, private cars, or on foot. The lack of emergency
exposure of medical staff (135 ambulance staff, and 110 staff in the main receiving
Having initially been misinformed that a gas explosion had caused burns and
23
Of the eleven bags, only eight were actually ruptured – three were subsequently recovered intact. It is
estimated that around 4.5 kilograms of sarin were released.
85
Annex 3). An official announcement by the police that sarin had been identified came
to the hospitals via television news, about 3 hours after the release.
Overall, 12 heavily exposed commuters died, and around 980 were mildly to
moderately affected (with about 500 requiring hospital admission). More than 5000
Observations
There is much that can be learned via analysis of these attacks, on both a
general (international threat oriented), and specific (immediate effect and response)
Magnitude of the event. While the human consequences of the event should
not be diminished, they should also not be exaggerated. The frequently encountered
casualty toll of “over 5000” must be seen in its true perspective. The attack was
serious – 12 people died, 54 were severely injured, and around 980 were mildly to
moderately affected. The majority of the 5000 seeking help were (understandably)
worried that they might have been exposed, many with psychogenic symptoms. This
dissemination via the media to reassure and inform a concerned public. It also
medical resources are reserved for those that really have been exposed. Before being
presented as evidence of the utility of toxic chemicals for terrorism, the casualty
figure of 12 dead should be compared to the death tolls of recent terrorist attacks
86
and Dar es Salaam (257), the federal building in Oklahama City, USA (168), and the
frightening new era in terrorist methodology, a sober assessment of the actual results
shows otherwise. It is true that this was one of the most highly publicised terrorist
attacks in history. The result for Aum Shinrikyo, however, can hardly be judged as
raid on cult premises, and on a broader level incitement of social upheaval. In fact the
raid was delayed only for 48 hours, the Japanese government remained firmly in
power, and most of the cult’s senior members are now imprisoned.
ample budgetary, equipment and expertise resources, and years in which to develop
their weapons programmes, Aum Shinrikyo failed to use biological agents effectively,
and achieved relatively limited success with their chemical programme. Aspirant
terrorists may well find these results a deterrent, not an encouragement to seek
compelling evidence of the cult’s growing chemical activities, initiated well before
the Tokyo subway attack, no Japanese laws prohibited these activities at the time, and
pre-emptive actions could not be launched. Since entry into force of the Chemical
87
Weapons Convention in 1997, all member states (including Japan) have been able to
undertaking any activities that are prohibited to the state party itself. 24 With such
weapons aspirations is enabled. Likewise, the entry into force of the BWC in 1975
has obliged all its states parties (including Japan) to take the measures necessary for
implementation
and Tokyo incidents, medical staff had to rely on clinical observation to guide their
nature of the event. The follow-up forensic and legal process was considerably aided
new biomedical testing methods, scientists in the Netherlands were later able to
retrieve sarin from the stored blood samples of 10 out of 11 victims from the Tokyo
incident, and 2 out of 7 samples from the Matsumoto incident – unequivocal evidence
24
See, further, Appendix 2 to Chapter 5, pp INSERT
88
Importance of decontamination abilities and protection. About 10% of
responding ambulance staff reported symptoms of exposure, as did 110 staff at the
major receiving hospital (although these symptoms were generally mild in nature).
This was due to the lack of decontamination abilities on site, and the lack of
protective equipment for initial responders and hospital staff. Before jumping to the
conclusion that high level protection is always required, it should be considered that
10% mildly affected also means that 90% were not affected at all. A reasonable
helpers due to the ergonomic problems of wearing protective clothing (see Appendix
4.2 below). Rapidly deployable decontamination abilities are required on site (to
facilities. Regarding the latter requirement, it is important to note that the majority of
people seeking medical help arrived on their own volition, and using their own
transport. This would effectively negate much of the utility of on-site decontamination
systems, even had they been available, as they would usually be used for victims
channels available to emergency response personnel were not able to cope with the
which hospitals could receive patients). As a result, a number of patients did not
89
benefit from interventions such as airway support, intubation, or intravenous therapy
responders is crucial to their own safety, and to their ability to provide appropriate
local authority with the ability to communicate with and co-ordinate the activities of
Complicated formalities and high level approval channels prevented the rapid
mobilisation of the full abilities of specialist chemical defence abilities within the
Japanese military.
majority of the Tokyo hospital staff, as for medical personnel in most parts of the
world, were not trained in the principles of chemical casualty care, and had no
ability that can be reserved for military specialists, as it is the local hospitals that will
receive the immediate casualty load. Dissemination of such knowledge and training
into the standard medical curricula, and down to first responder and local hospital
Conclusion
publicised mass casualty situation. In scale, however, it did not approach the human
90
and environmental toll that has resulted from a number of recent terrorist attacks
using conventional explosives. Despite many difficulties, emergency units and local
hospitals were able to achieve a remarkably rapid response, without which the
casualty figures may have been considerably higher. While analysis of the event
reveals a number of important lessons for authorities to consider when preparing for
such incidents, it also reveals many of the technical difficulties and limitations of
91
APPENDIX 4.2: PROBLEMS RELATED TO PROTECTION
The focus of the threat posed by the biological and chemical weapons of possessor
states (though not necessarily by those of such non-state groups as may possess them)
has shifted since the 1980’s from the cooler climates of Europe to less temperate
regions of Asia and Africa. Experience and training in these regions has led
temperate environments can impose significant functional burdens on those using it.
to be struck between the degree of protection commensurate with the potential hazard
and the resultant compromise of the functions to be carried out whilst wearing such
requirements for civil incident response teams and those for military personnel, who
environment.
response teams or military forces, is familiarity through repeated training using the
equipment. If extended operations using protection are required, the following factors
92
insulation is increased, evaporation of sweat from body surfaces is reduced, and
the body consequently loses a significant proportion of its natural ability to lose
clothing is being worn, that fatal heat stroke can be reached in less than one
associated with wearing a respirator is the effort required to breathe against the
resistance of the filter canister. This can severely limit the work rate possible,
communicate with colleagues, the general discomfort from the often bulky
stress), and perception of the reduced ability to function and perform tasks
may result.
93
simple tasks. Thick rubber gloves create problems with any task requiring fine
the masks may be incompatible with optical equipment, and medical personnel
gas attack actually materialises. Pyridostigmine can, however, have side effects
of its own, such as diarrhoea, intestinal cramps and visual problems. The most
medication usually present is atropine, being the basic antidote required after
poisoning, it can have significant side effects such as increased heart rate, heart-
rhythm disturbances, dry mouth and decreased sweating (causing more severe
they are likely to need shorter deployment periods, and are more able to provide
personnel with rest periods outside of the contaminated area without losing efficiency.
94
An important element of preparedness for any authority facing a biological
and chemical threat is the logistics associated with the issuing of protective equipment
to the necessary personnel. Some equipment, once removed from sealed packaging or
unsuitable for reuse. If large numbers of personnel require protective equipment, this
Conclusion
equipment for extended periods could become manifest in a military situation even
without actual use of biological or chemical weapons. They could become evident in
defending party, and could even be the objective towards which the threat was
introduced by the aggressor. However, a state that elects not to introduce biological
and chemical defensive and protective abilities could be vulnerable to the full mass
note that no major use of biological or chemical weapons has yet been initiated
against forces that are well equipped and trained for conditions of biological or
chemical warfare.
balancing these issues and producing a strategy which is justified by and relevant to
the potential threat. Over-reaction to a threat could be the very effect sought by a
95
biological or chemical aggressor.
96
CHAPTER 5: LEGAL CONTEXT
National and international law were identified in Chapter 2 as a key part of the
agents, and to help mitigate the consequences should such release nevertheless
happen. The present chapter describes the pertinent features of that law. At the
international level, the most important legal instruments are the BWC and the CWC.
Both provide for international co-operation in order to prevent the use of chemical
and biological weapons, and for assistance and co-operation in cases where breaches
of these treaties are suspected, especially in cases when use of such weapons has
occurred. The chapter opens with an account of the Geneva Protocol of 1925, which
for several decades was the principal international treaty in the field. The two
Conventions are then described in turn, with information in each case about the
international obligations they establish and about the national measures required to
At least since the early 1600s, international law has condemned what would
been reported since antiquity. Subsequent development of that law (5.01) could be
seen in the Brussels Declaration of 1874, which outlawed, inter alia, the use of poison
or poisoned weapons. It could be seen again at the Hague Peace Conference of 1899,
70
gases”. Further, the 1899 Conference adopted a convention that enunciated in treaty
form the Brussels prohibition of use of poison or poisoned weapons in land warfare, a
condemnation that was carried forward into 1907 Hague Convention IV concerning
the laws and customs of war on land. Then, following the extensive use of chemical
weapons such as chlorine and mustard gas during the First World War I, the
these weapons so as to prevent their future use. This led member states of the League
of Nations to sign the Protocol for the Prohibition of the Use in War of Asphyxiating,
1925, during the Conference for the Supervision of the International Trade in Arms
and Ammunition and in Implements of War. This treaty, which is usually referred to
as the Geneva Protocol of 1925, entered into force on 8 February 1928. France is its
depositary. By the beginning of 2001, it had 132 states parties, including the five
permanent members of the United Nations Security Council but not including 59
other gases and of all analogous liquids, materials or devices” and also “extends this
prohibition to the use of bacteriological methods of warfare”. The prohibitions set out
in the Protocol are now considered to have entered customary international law and
are therefore binding even upon states that are not parties to it. However, the Geneva
Protocol prohibits only the use of the weapons, not their possession. Moreover, since
many states parties at the time reserved a right to use the weapons in retaliation
against an attack with such weapons, the treaty was in effect a no-first-use agreement.
25
See Annex INSERT
71
There were also states parties that reserved a right to use the weapons against states
disarmament conference began in the late 1960s, at the time when the first edition of
the present report was being prepared, there was much debate on whether a
sought or, initially, a prohibition only of biological weapons. The United States, at
that time not yet party to the Geneva Protocol, declared its unilateral renunciation of
biological and toxin weapons during 1969-1970. This encouraged the international
on their Destruction. Opened for signature on 10 April 1972 and entering into force
on 26 March 1975, the BWC had 143 states parties as of June 2001, including the five
permanent members of the United Nations Security Council but not including 48
CHECK AGAIN LATER of the WHO member states. 26 The United Kingdom, the
USA and the Russian Federation are the depositaries of the treaty.
weapons embodied in the Geneva Protocol. In Article I it identifies items that each
26
See Annex INSERT
72
otherwise acquire or retain”. As has already been noted (in Chapter 3), the items are
instead defined as: “(1) Microbial or other biological agents, or toxins whatever their
origin or method of production, of types and in quantities that have no justification for
of delivery designed to use such agents or toxins for hostile purposes or in armed
general purpose. Such an approach was adopted so as not to obstruct the many
and toxins, while at the same time enabling the Convention to cover any as-yet-
unknown products of biotechnology and of new science that might find use as
weapons. The treaty does not define either the “biological agents” or the “toxins” to
which it refers, but it is clear from the proceedings both of its negotiation and of its
subsequent review conferences that these terms are not restricted to human pathogens
but extend to other animal and plant pathogens, and that, in addition, the toxins are
not limited to microbial products but extend to all toxic substances produced by living
Another important obligation is set forth in Article II, which requires states
later than nine months after the entry into force of the Convention for the state party
concerned. The BWC also requires states parties to facilitate the exchange of
equipment, material and scientific and technological information for the use for
73
keeping in mind that the treaty prohibits the transfer of agents, toxins, weapons,
(Article III).
The operation of the BWC has been reviewed at intervals of five or six years. States
parties reaffirmed during their review conferences that the Convention was
1946]”, and in the first year thereafter five states parties affirmed that they had had
such programmes, disclosing particulars. The five states were Canada, France, Russia,
the United Kingdom and the United States. The periods of activity declared for the
offensive programmes all terminated prior to entry of the BWC into force except for
the declaration by the Russian Federation, which specified “1946 to March 1992" as
measures from a scientific and technical standpoint. The VEREX Report was
74
submitted for the consideration of the States Parties”. The Ad Hoc Group is expected
The BWC stipulates that each state party is obliged to take any necessary
measures to implement the provisions of the Convention within its territory or any
territory under its control anywhere (Article IV). Besides the basic obligations
mentioned above, there are other areas where national measures are necessary if there
implement the obligation under Article III not to transfer to anyone agents, toxins or
measures for promoting technical co-operation in the field of biological activities has
Among their national measures under Article IV, some states parties have
enacted implementing legislation. For example, the United Kingdom introduced the
Biological Weapons Act in 1974, Australia the Crimes (Biological Weapons) Act in
1976, New Zealand the New Zealand Nuclear Free Zone, Disarmament, and Arms
Control Act in 1987, and the United States the Biological Weapons Anti-Terrorism
Act in 1989, while already in 1972, long before the BWC had entered into force for it,
building data-exchanges that BWC states parties have agreed during review
75
conferences, and the declarations made in accordance with it constitute the only
readily available synoptic reference on the topic. Adopted by the Third Review
Conference in 1991, it asks states parties for annual returns of information about
prohibited under BWC Article I, exports of pathogenic microbial agents and toxins,
and imports of the same. Between 1992 and 1997, 46 (one third) of the states parties
at least one of the three areas, and 26 declaring that they had enacted legal measures
in all three areas. Examples of the legislative measures are given at the end of this
The CWC was negotiated over a period of more than two decades. It was a
period during which related agreements were also concluded, notably the restrictions
on warfare conducted with chemicals toxic to plant-life set out in the 1977
Modification Techniques, and the reaffirmation of the Geneva Protocol by the 149
Stockpiling and Use of Chemical Weapons and on Their Destruction (5.02) was
opened for signature on 13 January 1993, entered into force on 29 April 1997 and, as
of June 2001, had 143 states parties, 27 including the five permanent members of the
UN Security Council but not including 52 CHECK AGAIN LATER of the WHO
27
This means that 143 states had deposited their instruments either of ratification of the CWC or of
accession to it. An additional 31 states had signed the treaty, but not yet ratified their signature.
76
member states. 28 The CWC creates an elaborated regime to ensure compliance. It
retention, transfer and use of chemical weapons. It also forbids states parties to assist,
BWC, the CWC uses a general purpose criterion to define its scope, 29 so that states
parties have the right to conduct activities involving toxic chemicals for purposes not
prohibited under the CWC. Similarly, the provisions of the CWC must also be
The CWC stipulates that the states parties must totally destroy their existing
stockpiles of chemical weapons and the related production facilities that are located
on their territory or under its jurisdiction or control within ten or, under certain
conditions, fifteen years after the CWC’s entry into force. This destruction process
must be completed in such a way as to ensure the safety of the population and the
compliance. This relies on several types of verification technique and method that
28
See Annex INSERT
29
The language that the CWC uses to specify the weapons that it covers is quoted, and discussed
further in Chapter 3.
77
allow for protection of national security interests. This verification machinery, which
investigate allegations of violation of the treaty, is run by the OPCW. The main
in accordance with the Convention that are independently conducted by the OPCW
operation. (5.03)
While less than forty percent of the states parties are directly affected by the
routine verification regime, all states parties participate in the security benefits
conferred by the Convention. Accordingly, arrangements are in place for the delivery
to OPCW member states of assistance against use and threat of use of chemical
agreed upon between the OPCW and the UN and will be extended to other
which the Technical Secretariat of the OPCW has considerable expertise (5.04).
legislation. Under Article VII, paragraph 4, states parties are required to establish a
National Authority. The twin pillars of the Convention's verification regime are thus
(1) the OPCW Technical Secretariat (through which compliance is verified) and (2)
compliance with those obligations not overseen by the Secretariat). The National
78
Authority is intrinsic to the success of the verification regime. As the national focal
point for liaison with the OPCW and other states parties, the national collection point
are key to the effectiveness of the Convention itself. To meet its basic obligations as a
state party, the state must be in a position to carry out the following eight fundamental
functions, all of which involve its National Authority to a greater or lesser extent: (a)
submit all the required declarations; (b) communicate with the OPCW; (c) co-operate
with other states parties; (d) facilitate OPCW inspections; (e) respond to OPCW
requests for assistance; (f) protect the confidentiality of classified information; (g)
monitor and enforce national compliance; and (h) co-operate in the field of chemical
activities for purposes not prohibited under the Convention, including the
equipment for the production, processing or use of chemicals for purposes not
the information needed for an accurate national declaration, and for export/import
controls. The requirements are described further in Appendix 5.2. Experience in the
79
obligations; the regime for scheduled chemicals (regulation of Schedule 1
Four years after entry into force of the CWC, 38 percent of states parties have
met their obligation to inform the OPCW of the legislative and administrative
measures taken to implement the Convention. At its fifth session (May 2000) the
Conference of the States Parties encouraged states parties that are in a position to do
so to offer assistance other states parties in their efforts to fulfil their obligations under
5.4 CONCLUSION
release nevertheless occur, the legal regime just described stands alongside the
chemical agents to such a degree that this complementarity needs to be built upon.
Clearly prevention and protection can be no substitute for one another. They can
instead be mutually reinforcing. The conclusion has to be, then, that an emphasis on
the one should not become a detraction from the other, for a danger is bound to exist
that confidence in protective preparation may diminish the value seen in preventive
80
preparation. Full and complete implementation of the 1972 and 1993 Conventions is
81
APPENDIX 5.1: BWC IMPLEMENTING LEGISLATION
New Zealand: New Zealand Nuclear Free Zone, Disarmament and Arms Control Act
1987
82
“Prohibition of biological weapons - No person shall manufacture, station,
acquire or possess, or have control over any biological weapons in the New
any organization to do so, shall be fined under this title or imprisoned for life
States.
“(b) DEFINITION. - For purposes of this section, the term “for use as a
83
Brazil: Law no. 9.112 (1995) (unofficial translation)
Article II. The goods mentioned in Art. 1 will be recorded in Lists of Sensitive
Goods periodically brought up-to-date and published in the Diario Oficial [...]
Article III. According to the regulation established and published in the Diario
Oficial, previous formal authorization from the competent federal organs will
ii. services directly linked with goods contained in the List of Sensitive
Goods...
Article VI. The export of sensitive goods and directly linked services in
violation of the provisions of this Law and its regulating norms will subject the
i. admonition
iv. suspension of the right to export for a period of six month to five years;
84
Article VII. The natural persons that, directly or indirectly, by act or omission,
Australia: The Quarantine Act (1908) and Regulations, the Biological Control Act
(1984) and Regulations, and the Therapeutic Goods Act (1989) and Regulations.
The Quarantine Act 1908 and Regulations require prior permission before a
and toxins, may only be imported into Australia if approval has been given by
nature of the organisms and the risks involved. High risk organisms such as
stringent high security conditions. Very few imports are approved and
“This Act [...] provides powers additional to those of the Quarantine Act in
order to regulate the release of biological agents for the control of pests,
85
Therapeutic Goods Act (1989) and Regulations
The Act covers the import and export of therapeutic goods and would include
use.
86
APPENDIX 5.2: CWC IMPLEMENTING LEGISLATION
legislation must be in place prohibiting actions which would contravene a state party’s
obligations under Article I. Any natural and legal person on the territory of a state
party shall be prohibited under penal law, for instance, to develop, produce or
otherwise acquire chemical weapons, to transfer such weapons to anyone, to use them
well as administrative sanctions. For consistency with the Convention, the national
Convention. The Convention requires states parties to extend the application of these
nationality. Furthermore, states parties shall assist each other and co-operate to
obligations would add significantly to the object and purpose of the Convention to
are the most basic violations of the very purpose of the Convention, penalties should
states parties includes the penalty of life imprisonment for the most serious violations.
States may find it complex to comply with their obligation under Article VII,
paragraph 2, to respond to requests from other states parties for co-operation and legal
assistance. The modalities of such co-operation and legal assistance could range from:
(1) extradition; (2) mutual legal assistance in penal matters; (3) transfer of prisoners;
87
(4) seizure and forfeiture of illicit proceeds of crime; (5) recognition of foreign penal
international co-operation and legal assistance in criminal matters: the modalities and
need to check whether their municipal law and their various treaties concerning
different forms of mutual legal assistance concluded with other states will allow for
co-operation in this regard. If a state party seeks mutual legal assistance and meets
chemicals
States parties shall by law require public and private entities or persons to
specified in the Convention when threshold limits are exceeded. On the basis of this
information states parties are able to meet their obligation under the Convention to
submit a full and accurate declarations to the OPCW on national activities related to
overview of activities regulated by the CWC and ensure complete declarations some
From entry into force of the Convention, states parties were required to notify
88
another state party and were prohibited from transferring Schedule 1 chemicals to or
from states not party. From 29 April 2000, the transfer of Schedule 2 chemicals to
states not party to the Convention was also prohibited. Appropriate measures of states
parties shall also ensure that Schedule 3 chemicals transferred to states not party to the
Convention shall only be used for purposes not prohibited. Each state party’s National
Authority has to negotiate and conclude facility agreements with the OPCW
Technical Secretariat in certain declared facilities. In order to fulfil those tasks, the
National Authority has to identify sites, both public and private, that have to be
declared and which have to provide data for inclusion in the state's initial and annual
overview of the national activities which might be relevant for the Convention.
Among the initiatives that have been advanced to ease the problem, the
Caribbean States developed a pesticide regulation model act in which the provisions
required to implement the CWC are incorporated. The result, a draft Pesticides and
Toxic Chemicals Control Act and Regulations has a fourfold value: (i) it allows the
parliaments concerned to consider the regulations for pesticides and toxic chemicals
in one single step; (ii) ratification of and accession to the CWC will be facilitated; (iii)
a single interministerial agency in each country will be responsible for pesticides and
toxic chemicals and serve as the National Authority under the Convention (iv) the
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CHAPTER 6:INTERNATIONAL SOURCES OF ASSISTANCE
categorised as:
(c) medical and other assistance in order to handle potentially massive damage
The principal organisation for political support is the United Nations . In the
case of chemical attack the Organisation for the Prohibition of Chemical Weapons
(OPCW) would also be important for its members. If in the future an organisation is
established under the Biological Weapons Convention, this too would play a role in
provided by OPCW (see section 6.4 below). The Biological Weapons Convention
also requires its States Parties to come to each others assistance in certain
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General assistance of a medical nature could be provided in either case by the
the United Nations (FAO) and the Office International des Epizooties (OIE) could
be asked to provide assistance where an attack was focused on plant (FAO) or animal
(FAO and/or OIE), rather than human targets. Where local resources are insufficient
to cope with humanitarian aspects of the situation it could be appropriate to call on the
non-governmental organizations.
may be appropriate to turn to the armed forces for help, including those of other
armed forces have supported relief effort on an invitational basis under the United
Nations umbrella.
The use or threat of use of chemical or biological weapons by one state against
another would clearly constitute a threat to international peace and security and,
accordingly fall within the responsibility of the UN Security Council, to which the
facts should be promptly reported. Both the BWC and the CWC make provision for
the involvement of the Security Council when there are allegations of use of these
weapons and arrangements are in place for investigation of the facts (see below).
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6.1.1 Investigation of alleged use
November 1988 mandated the Secretary General to investigate “reports that may be
brought to his attention by any Member State concerning the possible use of chemical
and bacteriological (biological) or toxin weapons […] in order to ascertain the facts of
the matter…”. Under the terms of the resolution the Secretary General has
experts, appointed pursuant to the resolution, has provided in its report A/44/561,
dated 4 October 1989, guidance as to how such investigations might be carried out.
The above procedure retains its relevance for investigations of alleged use of
biological weapons. The Chemical Weapons Convention (CWC), which entered into
force on 29 April 1997, obliges OPCW (see below) to investigate alleged use of
party to the CWC, the OPCW is obliged to cooperate with the Secretary General in
accordance with Article II.2(c) of the Relationship Agreement between the UN and
1981-82: Asia. Investigations took place long after the alleged attacks, on-site
83
1984-88: Iran. Investigations took place within days of the alleged attacks, on-
site visits were made and samples-taken; Iraq was identified as the
1987-88: Iraq. Chemical injuries among Iraqi soldiers were verified by the
1992: Mozambique . Investigations were made more than a month after the
timely on-site visit did not reveal any proof of use of chemical
weapons. (6.12)
1993: Iraq. Investigation of alleged internal use of chemical weapons did not
In the period reported, the Secretary General was not asked to conduct any
consultation concerning an alleged use carried out under the BWC, see below.)
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From the UN experience it is clear that it is essential for the request to be
made to the Secretary General immediately after the incident has taken place to
population, humanitarian assistance could be sought from the United Nations. The
resolution A/RES/46/182 of 14 April 1992 to serve as the central focal point and
coordinating official for UN emergency relief operations. That person is also the
Under Secretary General for Humanitarian Affairs and supported by the UN Office
responsible for mobilising and coordinating international disaster response and can be
85
• serve as the central coordinating entity with governments, intergovernmental
• In addition, OCHA has a Military and Civil Defence Unit (MCDU), which is
the focal point in the UN humanitarian system for the mobilization and
to humanitarian emergencies.
In addition, OCHA is the focal point in the UN system for the mobilization
and co-ordination of military and civil defence assets whenever utilised in response to
humanitarian emergencies.
office in Geneva, or through the United Nations Resident Coordinator in the affected
country.
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6.2 ORGANISATION FOR THE PROHIBITION OF CHEMICAL
WEAPONS
State Party has the right to request and, subject to the procedures set forth in
paragraphs 9,10 and 11, to receive assistance and protection against the use or threat
investigation and submit a first report within 72 hours to the Executive Council. If
required, the time for the investigation can be extended repeatedly by additional 72-
hour periods. A new report has to be submitted after each such period. The Executive
the States Parties to the CWC in May 1997 the Organisation established a voluntary
fund for action under Article X and invited states parties to inform the Technical
Secretariat of the assistance they may elect to provide in accordance with Article X,
paragraph 7. To 31 December 2000, the voluntary fund has received around Euros
600,000 in contributions and approximately 40 states parties have made more or less
30
This provision does not specify the source of the attack, which could be another state or a non-state
actor such as a terrorist group.
87
specific offers of assistance-in-kind, ranging from protective equipment to putting
The assistance pledged to be delivered through the OPCW, upon request, can
protective equipment, especially for use by civilians. The delivery of such equipment
to a requesting state party will, at best, take several days, possibly more than a week,
after which the state party will have to distribute the equipment within the country.
facilitate the conduct of such training, a series of courses has been arranged for chief
purpose is that such chief instructors should be able to train local instructors, who, in
turn, can train the exposed population in the appropriate use of personal protective
equipment.
Technical Secretariat of the OPCW, in cooperation with various member states. These
include, for example, courses for medical personnel, training in the use of analytical
88
Information about such courses, and how to apply to attend them, is available
Offers from member states of assistance teams that could be made available to
assist in the case of need include, inter alia, medical teams, detection teams,
decontamination teams, and teams for providing the necessary infrastructure support
for assistance operations. Some air transport capacity has also been offered; however,
it is expected that the costs for transporting the teams might to a certain extent have to
establish and maintain a data bank for the use of any requesting state party, containing
weapons as well as such other information that may be provided by states parties.
This data bank has been established. It is indexed by a database, using the CDS-ISIS
the data bank have to be addressed directly to the OPCW Technical Secretariat, but it
expert advice on how a state party can improve its protective capacity against
chemical weapons. This provision affords a low-key opportunity to ask for assistance
without having to accuse any state of using chemical weapons. In order to implement
this provision, a protection network has been established. The network currently
89
coming from some 20 member states. A state party can request help from the
protection network without any costs: the salaries will be paid by the member states
putting the experts at the disposal of the OPCW, and the travel costs will be covered
by the OPCW.
Within the framework of Article X, paragraph 5, the Secretariat can also upon
(1) Any State Party to this convention which finds that any other State Party
Convention may lodge a complaint with the Security Council of the United
Nations. Such a complaint should include all possible evidence confirming its
out any investigation which the Security Council may initiate, in accordance
with the provisions of the Charter of the United Nations, on the basis of the
complaint received by the Council. The Security Council shall inform the
In regard to the provision of assistance, this is also provided for under Article
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Each State Party to this Convention undertakes to provide or support
assistance, in accordance with the United Nations Charter, to any Party to the
Convention which so requests, if the Security Council decides that such Party has
that could establish implementing procedures for them through a protocol to the
Convention is currently proceeding within an ad hoc group of states parties (see 5.2.1
above).
The States Parties to this Convention undertake to consult one another and to
cooperate in solving any problems which may arise in relation to the objective of, or
in the applications of the provisions of, the Convention. Consultation and cooperation
procedures within the framework of the United Nations and in accordance with its
Charter.
At their second review conference, in 1986, the states parties set up a procedure
and thus improve implementation of this article. A meeting of this type was
convened in 1997 to resolve a dispute in which Cuba had alleged that the United
insects.
91
6.4 WORLD HEALTH ORGANIZATION
WHO is a specialized agency of the United Nations with 191 Member States. Its
Secretariat includes a headquarters in Geneva, six regional offices and 141 country
offices. According to its Constitution, the functions of the Organization shall be, inter
alia:
of cases and deaths from a variety of diseases. In view of its mandate outlined above,
United Nations to cooperate with the United Nations Group of Consultant Experts on
this subject. 31
31
See section 1.2 above.
92
A number of WHO programmes provide technical assistance on various
relevant aspects of public health, for example: preparedness and response to complex
chemical safety; food safety; and mental health. These programmes rely heavily on
diseases within the scope of WHO’s surveillance and response programme have been
electronic forms, an updated listing of these documents being accessible through the
World Wide Web. WHO is responsible for the administration of the International
competent) within which national and global surveillance and response networks can
during the last 30 years of the 20th century, a revised version of the IHR is under
preparation.
93
The International Programme on Chemical Safety (IPCS), a joint venture of
WHO, the International Labour Organization (ILO) and the United Nations
management of chemicals and the protection of human health and the environment,
produces guidelines and training material relevant in the preparedness for and
countries, allows rapid access to toxicological, analytical and clinical expertise. Such
NATIONS
FAO is an autonomous agency of the United Nations system with 175 member
requires, inter alia, that the FAO shall furnish such technical assistance as
concerned, such missions as may be needed to assist them to fulfil the obligations
94
With regard to biological and chemical weapons, FAO has not been formally
involved in the control of these weapons. FAO is, however, prepared to play an active
part within its broad mandate in providing technical and humanitarian assistance. In
recent years FAO has contributed significantly in emergency relief and rehabilitation
when droughts and floods, earthquakes and hurricanes, locust swarms and livestock
plagues, war and civil strife, and natural and man-made disasters have caused
The OIE) (the World Organization for Animal Health) is composed of the
official veterinary services of 157 countries. Its three main goals, established since its
beginning in 1924, are: to inform governments of the occurrence and course of animal
co-ordination of research on, and control of, important animal diseases; and to work
Although the OIE has no programmes or activities with the specific objective
about the occurrence, prevention and control of animal diseases, including zoonoses,
is relevant to this objective. Senior animal health officials from all countries convene
95
The OIE has established an information system to collect and disseminate
information on outbreaks of animal diseases that are the most serious from animal and
an internationally agreed classification of the disease: i.e. List A and List B diseases. 32
The OIE has an emergency fund which is available for sending missions to
abstract of the previous year’s epidemiological and disease control situation, and the
International Animal Health Code are available on the World Wide Web.
participation at the community level. They provide analysis and expertise, serve as
early warning mechanisms and help monitor and implement international agreements.
32
List A Diseases are transmissible diseases which have the potential for very serious and rapid spread,
irrespective of national borders, which are of serious socio-economic or public health consequence and
which are of major importance in the international trade of animals and animal products. List B
Diseases are transmissible diseases which are considered to be of socio-economic and/or public health
importance within countries and which are significant in the international trade of animals and animal
96
Some are organised around specific issues, such as human rights, the environment or
consequences caused by CBW differs depending on their goals, their venue and their
mandate.
very likely that, in addition to the local administrations, NGOs would be actively
OCHA Geneva
UN Office for the Coordination of Humanitarian Affairs
United Nations
Palais des Nations
CH-1211 Geneva 10
Switzerland
Telephone: ++41-22 917-1234
Facsimile: ++41-22 917-0023
E-mail: ochagva@un.org
[Outside official working hours, the Duty Officer of the OCHA office in Geneva can
be reached at any time through the emergency telephone number ++41-22 917-2010]
products.
97
World Health Organization
Avenue Appia 20
CH-1211 Geneva 27, Switzerland
Telephone: ++41-22 791 21 11
Facsimile: ++41-22 791 3111
Internet: http://www.who.int
98
LITERATURE CITATIONS
Note that these citations have yet to be brought into the format and degree of detail
expected by WHO
1.01 Health aspects of chemical and biological weapons: report of a WHO group
1.02 Chemical and bacteriological (biological) weapons and the effects of their
1969.
1.03 De Cerreño ALC and Keynan A, eds. Scientific cooperation, state conflict: the
and biological warfare. Vols. 1–6. Stockholm, Almqvist & Wicksell, 1971–
75.
1987.
Organization, 1989.
1.08 Steffen R et al. Preparation for emergency relief after biological warfare.
92
2.01 Marin MA. The evolution and present status of the Laws of War. Academie de
2.06 Moodie M, Taylor WJ, Jr. Contagion and conflict: health as a global security
2000:3.
2.07 North Atlantic Treaty Organization, Standing Group, von Kármán Committee.
93
2.09 Dubuis B. Recombinant DNA and biological warfare. Eidgenössische
2.10 United Kingdom of Great Britain and Northern Ireland. New scientific and
biology. In: Drell SD, Sofaer AD, Wilson GD, eds. The new terror: facing the
Press, 1999:39–75.
2.15 Kadlec RP, Zelicoff AP. Implications of the biotechnology revolution for
warfare: modern offense and defense. Boulder and London, Lynne Rienner,
2000:11–26.
2.16 Block SM. The growing threat of biological weapons. American Scientist,
2.17 Measures for controlling the threat from biological weapons. The Royal
94
3.01 Kireev AF, et al. Identification of alkylphosphonic acid derivatives by IR and
3.05 Papirmeister B et al. Medical defence against mustard gas: toxic mechanisms
and pharmacological implications. Boca Raton, Ann Arbor, MA, CRC Press,
1991:26.
3.06 Emad A, Rezaian GR. The diversity of the effects of sulfur mustard gas
3.07 Emad A, Rezaian GR. Immunogobulins and cellular constituents of the BAL
fluid of patients with sulfur mustard gas induced pulmonary fibrosis. Chest,
1999, 115:1346–1351.
95
3.08 Pechura M, Rall DP, eds. Veterans at risk: the health effects of mustard gas
3.09 Veterans and agent orange: health effects of herbicides used in Vietnam,
3.10 Fulco CE, Liverman CT, Sox HC, eds. Gulf war and health: Vol I. Depleted
4.01 Grein TW et al. Rumors of disease in the global village: outbreak verification.
4.02 Natural disasters: protecting the public’s health. Scientific publication no 575.
4.03 Norlander L et al., eds. A FOA briefing book on biological weapons. Umeå,
Establishment, 1992.
4.06 Carus WS. The Rajneeshees (1984). In: Tucker JB, ed. Toxic terror: assessing
terrorist use of chemical and biological weapons. Cambridge, MA, MIT Press,
2000:115–137.
96
4.07 Community emergency preparedness: a manual for managers and policy-
4.08 Sidell FR, Patrick WC, Dashiell TR. Jane’s Chem-Bio Handbook. Janes
4.09 APIC Bioterrorism Task Force, Centers for Disease Control Hospital
at www.cdc.gov/ncidod/hip/Bio/13apr99APIC-CDCBioterrorism.PDF and at
http://www.apic.org/educ/readinow.html. [check]
4.11 Meselson M, et al. The Sverdlovsk anthrax outbreak of 1979. Science, 1994,
266:1210–08.
4.13 Garner JS. Guidelines for isolation precautions in hospitals. Hospital Infection
4.14 Infection control for viral haemorrhagic fevers in the African health care
setting. Centers for Disease Control and Prevention, Atlanta, GA, and Geneva,
Springer-Verlag, 1984.
97
4.16 Guidelines for the collection of clinical specimens during field investigation of
Assembly in 1973 and the Thirty-fourth World Health Assembly in 1981 (3rd
annotated ed.). Geneva, World Health Organization, 1969. Full text also
4.19 [An Iranian publication on the Janbasan foundation patient follow-up and
4.20 [Another Iranian publication on the Janbasan foundation patient follow-up and
4.1.1 Smithson AE. Rethinking the Lessons of Tokyo. In: Smithson AE, Levy LA,
eds. Ataxia: the chemical and biological terrorism threat and the US response.
Washington, DC, The Henry L. Stimson Center, 2000:71–111 (Report No. 35).
4.1.2 Tu AT. Overview of Sarin terrorist attacks in Japan. In: Natural and selected
4.1.3 Okumura T et al. Tokyo subway Sarin attack: disaster management. Part 1:
617.
98
4.1.4 Okumura T et al. Tokyo subway Sarin attack: disaster management. Part 2:
4.1.5 Okumura T et al. Tokyo subway Sarin attack: disaster management. Part 3:
5:625–628.
4.1.6 Kulling P. The terrorist attack with Sarin in Tokyo. Socialstyrelsen report .
4.1.7 Seto Y et al. Toxicological analysis of victims' blood and crime scene evidence
samples in the Sarin gas attack caused by the Aum Shinrikyo cult. In: Natural
4.1.8 Polhuijs M, Langenberg JP, Benschop HP. New method for retrospective
5.01 Roberts R, Guelff R. Documents on the Laws of War (3rd ed.). Oxford, Oxford
99
accordance with Depositary Notification C.N.246.1994.TREATIES-5 issued
on 31 August 1994 and the change made under Article XV (new paragraph
March 2000. [Place of publication and publisher.] The text of the Convention
convention, The Hague, London and Boston, Kluwer Law International, 1999.
session, OPCW document C-V/DG.11 dated 12 May 2000. [place and year of
5.06 Checklist for the legislator and model national implementing legislation and
Weapons: the legal texts. The Hague, TMC Asser Press, 1999:310–315.
fifth session, OPCW document C-V/DEC.20, 19 May 2000. [place and year of
100
5.2.1 Cooperation and legal assistance for the effective implementation of
proceedings in preparation.
23 May 2000.
6.03 UN Security Council document S/17127, 24 April 1985, plus Add.1, 30 April
1985.
6.04 UN Security Council document S/17911, 12 March 1986, plus Add.1 and
6.06 UN Security Council document S/19823, 25 April 1988, plus Add.1, 10 May
6.07 UN Security Council document S/20060, 20 July 1988, plus Add.1, 2 August
1988.
101
6.08 UN Security Council document S/20063, 25 July 1988, plus Add.1, 2 August
1988.
6.10 McCormack TLH. International law and the use of chemical weapons in the
102