13 Feb 96 Special Federal Program to Render Medical and Social Assistance to the Population and Normalize the Sanitary and Hygienic State of Population Centers of the Republic of Altay Exposed to Radiation as a Result of Nuclear Testing at the Semipalatinsk Range, for 1996-1997 and for the Period to the Year 2000 1. State of the Problem The Special Federal Program to Render Medical and Social Assistance to the Population and Normalize the Sanitary and Hygienic State of Population Centers of the Republic of Altay Exposed to Radiation as a Result of Nuclear Testing at the Semipalatinsk Range, for 1996-1997 and for the Period to the Year 2000 (henceforth the Program), was developed in accordance with Edict No 309, 2 March 1993 of the President of the Russian Federation "On Measures of State Support to the Socioeconomic Development of the Republic of Gornyy Altay" with regard for provisions of the Federal Law "On Social Protection of Citizens Exposed to Radiation as a Result of Nuclear Testing at the Semipalatinsk Range." Scientific research established the fact of exposure of the environment and population of a number of rayons of the Republic of Altay to radiation from 22 nuclear bursts. The health of inhabitants of these rayons is characterized by a high incidence of malignant tumors, an elevated infant mortality, and a decrease in life span (compared to average indicators for Russia). Around 50 locations where an elevated radiation background was recorded and over 70 local centers of contamination by the radioactive products of nuclear bursts were revealed in the Republic of Altay. According to preliminary estimates the average exposure doses in certain rayons may have exceeded 5 cSv, and may have been responsible for remote unfavorable consequences to the health of people living in these territories. Research associated with evaluating and forecasting the medical and demographic situation and the population's health showed that under the standard territorial classification, the Republic of Altay falls in group 1--the most unfavorable. Of interest is the high perinatal mortality, which is 20-35 percent higher than in regions with similar landscape and geography; high levels of infant mortality and congenital abnormalities (developmental defects) are noted. Indicators of oncological morbidity exceed the averages for the Russian Federation. The sanitary and hygienic state of population centers exposed to radiation is alarming. Problems concerned with supplying the population with drinking water meeting the established quality standards have not been solved, and only 30 percent of the population of the Republic of Altay gets its water from a water pipeline network. Rural population centers lack municipal sewage systems. The incidence of acute intestinal infections, viral hepatitis and helminthiasis in the population exceeds average indicators for the Russian Federation by three to four times, which is a consequence of an unsatisfactory sanitary and hygienic situation in population centers, in food industry, public food service and trading enterprises, and in children's preschool and primary school institutions. The level of development of sanitary supervision in the Republic of Altay falls significantly short of modern requirements. One of the reasons for such a situation is the weak material and equipment base of public health institutions and the sanitary and epidemiological service, and their shortage of qualified specialists. 2. The Program's Goal The goal of this Program is to solve problems associated with mitigating the negative medical, social and psychological consequences of the effects of radiation from nuclear testing at the Semipalatinsk range on the health of the population of the Republic of Altay, with rendering highly qualified medical assistance to it, and with improving living conditions (Attachment No 1).1 These goals are achieved by creating conditions permitting systematic observation of the health of exposed individuals, revealing among them persons with a higher risk and the sick, treating them and improving their health, helping people exposed to radiation to surmount psychological stress, normalize the sanitary and hygienic situation in the population centers of rayons exposed to radiation, conducting radiation monitoring in the Republic of Altay, reducing the level and doses of further exposure to other radiation sources (medical and radon), and shaping a healthy way of life. Scientific research having the purpose of identifying population centers subjected to significant radiation effects (over 5 cSv) and estimating the population's exposure doses will be continued. Measures of social protection of victims (payment of benefits and compensation) will be determined after the doses received by the population are determined retrospectively, and after the list of population centers exposed to radiation is updated and confirmed. The Program is to be carried out in 1996-2000 in two phases: the first phase--1996-1997; the second phase--1998-2000. 3. Safeguarding the Health of People Exposed to Radiation The Program foresees the following measures: forming an effective system at the republican and rayon levels for improving the health of citizens exposed to radiation; creating a three-tiered system of early diagnosis of disease, medical assistance, and rehabilitation of victims (central rayon hospital--interrayon specialized department- -republican diagnostic center); carrying out detailed clinical and epidemiological research within the population; improving the medical personnel training and advanced training system; establishing a medical dosimetric register providing an effective system by which to monitor and maintain records on the health of citizens exposed to radiation and their progeny, and providing assistance to republican public health agencies in implementing the necessary measures of medical rehabilitation; raising the effectiveness of preventive medicine, revealing disease early and treating it, and making specialized health care accessible to citizens in relation to the most widespread forms of disease. In order that these measures could be implemented, the Program includes plans for establishing new medical institutions, expanding and rebuilding ones currently in operation, increasing the capacities of local sanatorium and health resort bases, providing therapeutic and diagnostic apparatus and pharmaceuticals to rayon and city hospitals and specialized institutions at the republican level, and erecting housing for medical workers. 4. Normalization of the Sanitary and Hygienic State of Population Centers Exposed to Radiation The radiation situation in the Republic of Altay is not currently detrimental to the life of the population and to its economic activity therein. At the same time the sanitary and hygienic state of population centers exposed to radiation, the material and equipment base of sanitary and epidemiological institutions, and the number of specialists working in them are at a low level. The Program calls for planning and erecting centers for sanitary and epidemiological supervision in seven rayons exposed to the effects of nuclear testing, a block of radiological laboratories at the Republican Center for Sanitary and Epidemiological Supervision in the city of Gorno-Altaysk, and housing for specialists of the sanitary and epidemiological supervision service. There are plans for building and developing water supply systems providing the population with drinking water meeting existing quality standards and public utility systems in stricken rayons, and erecting shops processing agricultural raw materials and herbs to be used in producing pharmaceuticals, baby food and dietetic foods out of local ecologically clean raw materials. 5. Scientific Support to the Program, and Further Development of Research on the Effect of Nuclear Testing on the Population of Altay The Program foresees scientific research in the following basic directions: retrospective assessment of the radiation situation in the Republic of Altay in the period of nuclear testing at the Semipalatinsk range and of the exposure doses of the population, on the basis of an approved procedure accounting for the peculiarities of the local mountainous topography; retrospective determination of exposure doses during the period of nuclear testing, and study of the correlation between the morbidity of the population of the Republic of Altay and radiation exposure during the period of nuclear testing; study of the ecological, radiation, sanitary, and hygienic situations in rayons subjected to the effects of nuclear testing; continuation of research on radiational, hygienic, toxicological, sanitary, biomedical, and psychophysiological factors with the purpose of evaluating their joint effects on the population of radioactively contaminated territories; study and prediction of the medical and demographic situation and the health of people exposed to radiation, and their progeny, and evaluation of the effectiveness of implementing the Program in these directions; development and substantiation of the methods of rehabilitating persons exposed to radiation and their progeny; scientific support to maintenance of the republic's medical and dosimetric register of persons exposed to radiation; preparation of proposals on producing pharmaceuticals out of local natural resources that would raise the resistance of persons exposed to radiation and of their progeny; development of procedures for obtaining therapeutic, preventive, and dietetic foodstuffs out of local resources. The Program foresees information and analytical support to scientific research at the federal and international levels, organization and conduct of scientific conferences and seminars, publication of collections of scientific works and monographs, and international cooperation in studying the effects of nuclear testing on people and in developing measures to rehabilitate victims. 6. The Program's Funding Appropriations funding the Program total 534,710 million rubles, including R512,354 million from the federal budget and R22,356 million from the budget of the Republic of Altay and extrabudgetary sources. In addition foreign exchange appropriations amounting to US$17.2 million are foreseen for acquisition of imported equipment and instruments. Appropriations for 1996 will be R85,274 million, including R70,118 million from the federal budget. The volume of funding of the Program's measures is broken down in Attachment No 2.1 7. Mechanism of the Program's Implementation, and Organization of Its Management and Supervision of Its Implementation The Program is to be implemented in accordance with a procedure approved by Decree No 594, 26 July 1995 of the Government of the Russian Federation "On Implementing the Federal Law 'On Deliveries of Products for Federal State Needs'." The Russian Federation Ministry for Civil Defense, Emergencies and Natural Disasters, and the Government of the Republic of Altay are to be the clients of the Program for the state. The forms and methods of organizing management of the Program's implementation are to be determined by the clients of the state. Each year the Government of the Republic of Altay is to draw up measures by which to reach the Program's targets. These measures are to be coordinated with the Russian Federation Ministry for Civil Defense, Emergencies and Natural Disasters and with the appropriate ministries and departments of the Russian Federation. Scientific support to the Program is to be supervised by a regional scientific council contained within the Scientific and Technical Council of the Russian Federation Ministry for Civil Defense, Emergencies and Natural Disasters (with the rights of a section). The plan of scientific research subjects is to be approved by the Russian Federation Ministry for Civil Defense, Emergencies and Natural Disasters and the Government of the Republic of Altay according to the established procedure. Scientific work is to be financed on the basis of an agreement between the Russian Federation for Civil Defense, Emergencies and Natural Disasters and the Government of the Republic of Altay. Reports on scientific research conducted in the basic directions are to be submitted in phases to the Russian Federation for Civil Defense, Emergencies and Natural Disasters, together with proposals for introducing their results. The procedure for funding the Program and accounting for its expenses, and the procedure for reporting on use of resources allocated for its implementation are to be determined by normative documents of the Russian Federation Ministry of Economics, the Russian Federation Ministry of Finance, the Central Bank of the Russian Federation, the Russian Federation Ministry for Civil Defense, Emergencies and Natural Disasters and the Russian Federation State Committee for Statistics. The procedure and mechanism for managing the Program's implementation may be updated on the basis of joint decisions of the Russian Federation Ministry for Civil Defense, Emergencies and Natural Disasters and the Government of the Republic of Altay. The clients of the state are to maintain supervision over the Program's fulfillment. Each year prior to 1 February the clients of the state are to submit reports on progress under the Program and on the effectiveness with which budget and other resources are used to the Russian Federation Ministry of Economics and the Russian Federation Ministry of Finance. 8. Evaluation of the Anticipated Effectiveness and Socioeconomic Consequences of the Program's Implementation Improvement of the health of people living in rayons exposed to radiation as a result of nuclear testing, a decrease in possible negative consequences of radiation exposure to the health of citizens, enhancement of the quality of health care to the population, and improvement of the living conditions of the citizens of stricken territories are anticipated to be the results of the Program's implementation.
FOOTNOTE 1. Not published.