The recommendations of ICRP Publication 111 in the light of the ICRP dialogue initiative in Fukushima

1. Background of Publication 111

Publication 111 (ICRP, 2009) provided the first recommendations for dealing with the long-term recovery phase after a nuclear accident. All previous recommendations of the International Commission on Radiological Protection (ICRP) concerning nuclear accidents had been confined to short- and medium-term actions of the emergency phase. The focus of Publication 111 is on the protection of the general population living in long-term contaminated areas after a nuclear accident. As such, there are no recommendations concerning the protection of the so-called ‘responders’ (on-site and off-site), which is the subject of much discussion in Fukushima and certainly deserves to be taken into account in the future by the Commission. It is also important to emphasise that Publication 111 relies mainly on the personal experience of the experts who developed it on the basis of their long engagement with the Belarus population, the Sami reindeer herders in Norway, and Cumbrian sheep farmers in the UK affected by the fallout from Chernobyl.

Publication 111 (ICRP, 2009) was adopted in 2008 and published in 2009, shortly before the Fukushima accident. It was clear that in most countries, including Japan, there was insufficient time to digest this publication before the accident. Publication 111 was translated into Japanese by the Japan Radioisotope Association, and was published about 1 year after the Fukushima accident in 2012. An interesting document prepared by a group of Japanese stakeholders, entitled ‘Introduction to ICRP Publication 111’, was circulated on the web from 2012 (available, in Japanese, at: https://www59.atwiki.jp/birdtaka/pages/23.html), and in 2015, another publication to introduce Publication 111 was prepared by the Japanese ICRP members in cooperation with Japanese experts personally involved in the management of the accident (Niwa et al., 2015).

2. Main Points of Publication 111

Basically, Publication 111 (ICRP, 2009) recognises that living in contaminated areas after a large nuclear accident is a very complex situation affecting all dimensions of life, and all stakeholders of society that cannot be managed solely through radiological protection considerations. This position calls for the modesty of radiological protection professionals, who must admit that protective actions are insufficient on their own to solve all of the problems faced by the affected people.

Regarding the protection of people, Publication 111 (ICRP, 2009) is based on experience which shows that the average level of exposure globally is dependent on the level of contamination, but individual exposures are mainly driven by the behaviour and lifestyles of each affected person. This means that it is not possible to adopt an average approach to manage postaccident situations, and it is necessary to consider the particular circumstances in which the affected communities live, which can differ widely in terms of level of contamination, activities, and lifestyle.

With regard to the basic principles of radiological protection, Publication 111 (ICRP, 2009) refers to those set out in the general recommendations of the Commission. The justification principle states that all decisions concerning radiological protection must do more good than harm. Justification applies to the decision to allow people who wish to live permanently in the contaminated areas to do so. The accident results in a radiological situation in which authorities have to make a decision about where to draw a line between places where people can stay and live if they wish, and places where it is not possible to live because the level of exposure is high and is likely to induce health impacts or it is difficult to maintain the social and economic fabric.This is by far the most difficult decision to be taken after a nuclear accident given the enormous human and material consequences it can potentially cause. In addition, it is also necessary to justify all decisions taken on protective measures to improve the radiological situation, such as decontamination, management of foodstuffs, radiation monitoring, health surveillance, etc. Numerous decisions have to be taken, each of which has advantages and disadvantages (e.g. the impact on decontamination on the environment and the generation of huge quantities of waste that will need to be managed). It can be difficult to balance these advantages and disadvantages, and the process requires experience and wisdom.

The optimisation principle states that the exposure of people should be kept as low as reasonably achievable, given the prevailing circumstances. This principle, which is considered as the cornerstone of the radiological protection system, derives directly from the cautious approach adopted by the Commission since the late 1950s, that regardless of the level of exposure, there is a proportional risk. The optimisation principle should be implemented using a reference level. For the management of the long-term recovery phase after a nuclear accident, Publication 111 (ICRP, 2009) recommends that the reference level should be selected from the lower part of the 1–20 mSv year⁻¹ band, with the long-term objective of keeping residual individual doses caused by the accident around 1 mSv year⁻¹ or lower. Since its publication, this recommendation has been the subject of much debate. This is mainly due to the fact that the Commission has remained deliberately qualitative as regards the fixing of values and their timing, giving only a general framework and leaving the authorities concerned to select the values best suited to the circumstances. As for the value of 1 mSv, it is more a question of equity than of risk. Indeed in the long term, when the situation in the affected territories is considered to be ‘normal’ again from the radiological protection point of view, it would not be fair to apply a different criterion than that used for managing normal situations in areas not affected by the contamination.

The process of selecting the reference value should take into account the prevailing circumstances by weighting the different dimensions that characterise them. Furthermore, as clearly stated in Publication 111 (ICRP, 2009), this process should include all relevant stakeholders. This means that the radiological situation, as well as the economic, social, and psychological situations, must be analysed carefully, particularly characterisation of the contamination, in order to understand where, when, and how people are exposed. This also explains why the Commission does not recommend precise values in advance, but leaves authorities to decide these in consultation with experts and relevant stakeholders. It is important to keep in mind that the reference level has nothing to do with a limit. It is not a regulatory instrument, but a tool to identify which groups of affected people should be prioritised for protection (i.e. the most exposed individuals) and to guide the selection of the protective actions that aim to reduce exposure to a level as low as reasonably achievable.

The experience of Chernobyl in Belarus and Norway has shown that stakeholder engagement is a powerful means of providing affected persons with the necessary knowledge, skills, and ‘know-how’ required to make informed decisions about their own protection (Lochard, 2013). The notions of ‘practical culture of radiological protection' and ‘self-help protection' introduced in Publication 111 (ICRP, 2009) are a direct result of this experience, and the actions undertaken by certain communities in Fukushima over recent years in relation to the ICRP dialogue initiative (e.g. in the village of Suetsugi) confirmed their relevance as well as their operational character. Of course, in order to engage stakeholders, it is essential to set up places for dialogue (termed ‘local forums’ in Publication 111) in order to share information between experts, local authorities and professionals, and citizens. The purpose of dialogue meetings is not only to pass information on to participants, but also to engage in a genuine dialogue on the basis of mutual listening and joint analysis to assess the situation and possible actions, and to prepare decisions.

It is the responsibility of the authorities to implement an inclusive monitoring system and a health surveillance programme in the affected areas. From this perspective, the role of the authorities is to establish the conditions and implement the means to facilitate engagement of the affected population in the rehabilitation process. Particularly important is the setting of an inclusive exposure monitoring system and a health surveillance programme in the affected areas. Measurement of individual exposure is key for effective implementation of the optimisation principle by the authorities, and also to allow individuals to make informed decisions about their protection. The importance of individual monitoring was underlined by the participants many times at the ICRP dialogue meetings. Medical surveillance is certainly one of the aspects not yet fully mastered in postaccident management. Despite the experience from Chernobyl, many questions remain about the role and ways to organise this surveillance. This point should be developed further based on the Fukushima experience.

3. How Publication 111 was Received

The Commission's objective with Publication 111 (ICRP, 2009) was not to add an a new technical document to the long list of reports already in existence concerning the implementation of protective actions, but to draw the lessons from Chernobyl’s experience in particular regarding the population’s involvement in the recovery process. As mentioned earlier, there were some criticisms about Publication 111, particularly concerning the virtual absence of dose criteria to manage the situation, and the lack of detailed information on the practical implementation of the optimisation process. These criticisms emerged soon after Publication 111 was published, and were obviously reiterated at the time of the Fukushima accident. There were also misunderstandings about the objectives of the long-term recovery phase, which may reflect difficulties for experts unfamiliar with a postaccident situation to grasp the complexity of the human dimension at stake. In terms of radiological protection, the objective was clearly to reduce exposure to a level as low as reasonably achievable through the implementation of appropriate protective measures. However, experience from Chernobyl showed that this objective only made sense if it is at the service of rehabilitating the living conditions of the affected people. The reduction of exposure is not an end in itself, it is only a means. What ultimately matters is the wellbeing and dignity of people. Achievement of this objective is a complex process that mobilises resources and presupposes particular conditions that depend largely on the circumstances. The Commission did not intend to make recommendations on this approach, and Publication 111 merely acknowledged the problem and indicated a general term for the route to be pursued in general terms.

That said, the confrontation of Publication 111 (ICRP, 2009) with the situation in Fukushima was instructive. Despite criticisms, it is undeniable that Publication 111 has served as a landmark for many experts and non-experts, and has gained some support. This was achieved gradually as stakeholders took measure of the difficulties and challenges posed by the accident situation. It is also noteworthy that, for many people affected directly by the accident, Publication 111 provided real support, as evidenced by the following personal message received in Spring 2012:

After the nuclear accident, raging voices over Fukushima left behind those of us who live in Fukushima. Everybody wanted to have his say, disregarding what we think and feel. I could not accept that. I even felt angry. The reason why I started Ethos in Fukushima comes from the conviction that it is we who should narrate our life. In the midst of the turmoil, Publication 111 was the only support for our mind (Ryoko Ando – Ethos in Fukushima).

This message was, of course, important for all those who had contributed to Publication 111 (ICRP, 2009), because Ando confirmed that it was difficult to understand the spirit of this publication if one had not experienced living in a contaminated area among the affected people, and that in spite of all the criticisms, ICRP had fulfilled their work properly.

4. Contribution of The Icrp Dialogue Initiative

The ICRP dialogue initiative confirmed what had been identified after Chernobyl, namely the very strong concen about health, particularly that of children; loss of control over everyday life; apprehension about the future; disintegration of family life, and of the social and economic fabric; and the threat to the autonomy and dignity of affected people. However, through their testimonies and reflections, the ICRP dialogue participants shed light on the complexity of the situation. Together they told a story, and gave rise to the emergence of a narrative on this complexity. Although the experience from Chernobyl allowed the identification of key issues characterising the postaccident situation, the ICRP dialogue initiative has clarified what is at stake in terms of human, social, and economic dimensions.

As stated previously, Publication 111 (ICRP, 2009) purposely adopted a minimalist approach to the use of dose criteria. Thus, no dose value is proposed for allowing people to stay permanently in contaminated areas, because it is considered that the value to be adopted will differ for each accident based on the characteristics of its consequences. Similarly, only a range of values is recommended to select the reference level, with the qualitative indication that it should be in the lower part of the 1–20 mSv year⁻¹ band (i.e. ≤10 mSv year⁻¹). This also depends on the prevailing circumstances. The only recommended value is the long-term objective to keep residual individual doses caused by the accident around 1 mSv year⁻¹ or lower.

On the issue of dose criteria, it is interesting to note that participants in the ICRP dialogue meetings occasionally mentioned the existence of dose criteria, particularly the reference level, but never discussed their rationale. Discussion at the ICRP dialogue meetings confirmed that people affected by the contamination were primarily motivated by what they can do to improve their situation from the radiological point of view. When they have acquired the practical radiological protection culture, they are able to make their own decisions according to the radiological situation and to act according to their desires (what is called self-help protection). Dose criteria are for them only benchmarks to guide their actions. In turn, the ICRP dialogue participants discussed and analysed the impact of dose criteria on daily life, and particularly the fact that they may be a blocking factor for action and a source of division between people, with negative consequences for communities (Ando, 2016).

The ICRP dialogue initiative highlighted the need to implement as soon as possible in the emergency phase a radiation monitoring system to characterise the radiological situation. This is obviously important to guide the action of the public authorities, but even more for the affected people themselves. However, access to information on ambient dose rates and contamination of food products is not sufficient for individuals to make decisions about their behaviours and activities in order to control their exposures. On the contrary, experience has shown that this information tends to paralyse individuals' actions. Only access to external and internal individual exposures allows people to link the radiological situation that characterises their familiar environment and their lifestyle. In this perspective, the distribution in some affected communities of the Fukushima Prefecture of high-performance personal dosimeters has proved to be a powerful way to help people regain control of the situation and thus confidence. It is obviously the responsibility of the public authorities to rapidly set up in the affected territories a system of individual monitoring of radiological exposures so that everyone can understand not only the level of her/his exposure, but also of the reasons that lead to it. The importance of a rapid characterisation of the radiological situation adapted both to the needs of the public authorities and affected people is certainly one of the key lessons of the ICRP dialogue initiative.

The latter also confirmed the importance of establishing meeting places at local community level between the experts and affected people in order to develop a practical radiological protection culture and favour self-help protection. For the experts, these places are the means, through listening to the affected people, to understand their concerns, their questions, and their expectations. For the affected people, it is not only a matter of receiving general information about the situation of their community, but of understanding how they personally are exposed, and what the issues are for them and the community. This exchange process is what the Commission calls ‘co-expertise’. On the one hand, the experts bring their knowledge on radiation, and on the other hand, the affected people bring their knowledge on their behaviour and local living conditions. Experience has shown that it is only by crossing these two knowledge fields that it is possible to develop a practical radiological culture, which in turn favours self-help protection. The Commission has sometimes been criticised for promoting self-help protection, with the accusation that this is transferring the burden of protection to the affected persons, and is faciltating the disengagement of public authorities. However, the Commissison would argue that self-help protection does not mean a transfer of responsibility from authorities and experts to affected persons, but empowers the latter so that they regain autonomy for decision making and thus their dignity.

In Publication 111 (ICRP, 2009), the role of the authorities and affected people is described as complementary: on the one hand, authorities have the responsibility to put in place the conditions and means for effective and fair management of the radiological situation, and on the other hand, affected people can implement self-help protective measures individually if they have the means, and if they wish, to do so. It is also the responsibility of the authorities to ensure that self-help protection can develop. There is a division between what must be done collectively and what can be done individually to ensure the best possible protection. The ICRP dialogue initiative revealed the importance of the specific characteristics of the affected communities in terms of the rehabilitation of living conditions. The same level of contamination can have different consequences depending on economic and social specificities, but also on the traditions, culture, and history of each community. This aspect calls for further reflection on the articulation of action at local, regional, and national levels in order to identify what types of governance mechanisms would be most suitable to consider this diversity.

Among the many contributions of the ICRP dialogue initiative, it is worth mentioning the protection of children. This is a major concern for many parents in Fukushima, especially mothers, as it has been and remains in the territories affected by the accident in Chernobyl. It is no coincidence that this was the subject of two dialogue meetings: the first in November 2012, dealing with the education of children and young people; and the second in August 2014, devoted to all issues related to raising children. The experience of Fukushima and Chernobyl shows that the practical modalities of this protection depend not only on circumstances but also on mentalities, and cover a wide spectrum of actions. Beyond differences, what is common is the desire not to keep children, and particularly teenagers, away from problems concerning life in a contaminated territory. At the final ICRP dialogue meeting, several adolescents testified about their activities, and made it clear that they intended to be involved in the future in the rehabilitation of living conditions in the Prefecture. This raises the question of the role of parents and educators in the dissemination and transmission of a practical radiological culture among young people, which goes well beyond the acquisition of scientific bases about radiation at school.

The ICRP dialogue initiative also found that family members were often divided regarding how to deal with the protection of children, particularly young children, and the question of whether or not to develop specific advice for them was debated. On this point, the Commission merely emphasises the fact that children deserve special attention, and relies on common sense regarding the most appropriate measures to ensure their protection. This was implicit in Publication 111 (ICRP, 2009). The ICRP dialogue initiative clearly highlighted that, in Fukushima, overprotection of children from the potential effects of contamination, particularly by restricting their outdoor activities, has led to indirect effects that can be very detrimental to their health, their social life, and their psychomotor development. What is the right balance? It is a complex issue that appeals to many ethical values and remains largely open. The ICRP dialogue meetings provided valuable insight into all the issues facing children and adolescents living in a contaminated territory. It was also stressed that, despite appearances, children are often stronger than adults believe, and it is important to provide a forum for children to speak as they have a lot of interesting things to say about the situation. These considerations, which are completely absent from Publication 111, will undoubtedly be included in the future recommendations of the Commission.

5. Conclusions

The ICRP dialogue initiative confirmed that radiological protection following a nuclear accident must focus on the rehabilitation of living conditions; in other words, restoration of the dignity and wellbeing of people. The ICRP dialogue meetings did not raise new issues concerning the protection of people living in long-term contaminated areas, calling for a significant change to the principles, criteria, and advice of Publication 111 (ICRP, 2009). However, the ICRP dialogue initiative brought several important clarifications and complements concerning the human and organisational dimensions of the rehabilitation process, and the challenge is now to incorporate these elements into the updated version of Publication 111 that is currently in development. These clarifications represent a unique and invaluable contribution of the ICRP dialogue participants to the management of future postaccident situations.