HOW PHYSICIANS INFLUENCED DUTCH NUCLEAR WEAPON POLICIES: A CIVIL SOCIETY CASE-STUDY Текст научной статьи по специальности «Социальная и экономическая география»

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How physicians influenced Dutch nuclear weapon policies: A civil society case-study

P. Buijs

Chair IPPNW Netherlands, Independent researcher, Handweg 23, 1185TS Amstelveen, Netherlands

For citation: Buijs P. How physicians influenced Dutch nuclear weapon policies: A civil society case study. Vestnik of Saint Petersburg University. International Relations, 2021, vol. 14, issue 4, pp. 475-502. https://doi.org/10.21638/spbu06.2021.407

This case study describes activities from the Dutch Association for Medical Polemology (IP-PNW-affiliate NVMP-Physicians for Peace) from 1969 onwards, focused primarily on recent strategies, employed by civil society, to influence Dutch policies regarding the urgency of abolishing nuclear weapons due to their unacceptable medical and humanitarian consequences. By itself and together with other civil society organisations, NVMP promoted an active Dutch nuclear disarmament policy, specifically regarding the Non-Proliferation Treaty with its Arti-cle-VI Global Zero-obligations, and the United Nations' Treaty on the Prohibition of Nuclear Weapons (TPNW). Several achievements of the NVMP are highlighted, from the Medical Appeal (2015) to the 50th anniversary Congress (Hague Peace Palace, November 26, 2019) and its aftermath. After presenting his major findings and conclusions, the author shares some experience-based, policy-oriented recommendations about the specific physicians' position and their medical-humanitarian message, followed by suggestions on strategies for reaching out to politicians, decision-makers, and statesmen that can help IPPNW affiliates elsewhere, and other civil society organizations, who are promoting a nuclear weapon-free world. Finally, the author petitions to repeat successful early 1980s Russian-American IPPNW initiatives, which were directly aimed at their political leaders. The article concludes with the presentation of one initiative. .

Keywords: nuclear weapons, nuclear disarmament, Non-Proliferation Treaty, Netherlands, Russia.

50 years NVMP-Physicians for peace/IPPNW-Netherlands Introduction: NVMP and Hippocrates' oath...

"Weapons of mass destruction are still the greatest long-term existential threat to the world" [1].

"Ending the NW-threat is an urgent health and humanitarian imperative!" [2]

Despite severe NATO-pressure [3], The Netherlands joined the UN-nuclear ban-negotiations (TPNW, 2017) as the only NATO-member, while later in 2017 a new centre-right government stated to "actively pursue a nuclear weapon-free world" [4, p. 47], never

© St. Petersburg State University, 2021

formulated before. What this has to do with ".. .grassroots pressure on its Parliament" [5], in particular by physicians, will be explained in this article. Its goal: describing activities of the NVMP-Physicians for Peace/IPPNW-Netherlands1 [1] from 1969 on — focused on recent years — to stimulate policies, directed at a NW-free world, based on arguments originating from Hippocrates' oath. The NVMP translated that universal foundation for medical ethics and practice, especially the Do-not-harm-principle, into: "It is our preventive medical duty to warn for unspeakable medical-humanitarian harm, nuclear weapons can cause. 'Prevention is better than cure' doesn't apply here: cure will be impossible, leaving only one option: prevention, ban & abolish NWs!". But first briefly the international background.

International framework: 75 years nuclear weapons

"A nuclear war cannot be won and must never be

fought" [6]

In 1945, Japan witnessed the agonizing effects of the most devastating weapons of mass destruction ever invented: atom bombs. On July, 16 1945 in the New Mexico desert, the top-secret US-Manhattan Project resulted in the first nuclear test ever. Three weeks later, an Uranium-bomb (Little Boy, 15 kiloton TNT) wiped out Hiroshima, while on August 9, 1945 a plutonium-bomb (Fat Man, 25 kiloton TNT) destroyed Nagasaki. The medical-humanitarian consequences were appalling, and substantial aid was impossible: most medical professionals were killed and infrastructure completely ruined [7]. End 1945, 210.000 civilians had died, directly by the blast and heat, or later by radiation — mostly women, children and elderly. Many more people were wounded, some still being treated. Since then, the world tries to get rid of these horrendous weapons. The first UN-resolution ever (1946) was about total abolition, unanimously supported, also by the USA and USSR. But the Cold War caused a very expensive arms race, up to about 70.000 nuclear warheads [8], bringing the world several times at the brink of annihilation, e. g., during the Cuba Crisis (1962): 'We lucked out!' US-Defence Secretary McNamara admitted [9]. This brought diplomacy back, leading to several USA-USSR arms-control treaties and the multilateral Non-Proliferation Treaty (1970), with three pillars: non-proliferation; nuclear arms race cessation and NWs-reduction, finally to zero (Article VI); peaceful nuclear energy use. Almost all countries ratified, including the P5 (Permanent UN-Security Council-members USA, USSR, UK, France, China), then the only NW-states. However, the nuclear arsenals kept on growing, also by newcomers: India, Pakistan, Israel, North-Korea. Begin 1980's, the two superpowers wanted to deploy hundreds destabilising middle- and short-range nuclear missiles in Europe: US-Pershing/Tomahawks and Soviet SS-20's. This caused worldwide mass protest, with success, also thanks to Reagan and Gorbachev, preferring negotiations above confrontations, confirming afterwards, IPPNW's medical arguments gave them a final push [10]. Both agreed on the INF-Treaty, keeping Europe sub-strategic weapon-free, and reducing their arsenals from 70.000 to about 13.000 — proving massive reduction is feasible. However, Global Zero-negotiations are absent for decades. Conversely, a new nuclear arms race has started, giving the US

1 NVMP: Dutch Association for Medical Polemology, affiliate of the International Physicians for Prevention of Nuclear War IPPNW (1980, Nobel Peace Prize 1985), called 'NVMP' in this article.

Nuclear Posture Review (18-2-2018) and President Putin's answer, March 1, 2018 [11]. All NW-States are modernising their arsenals, at enormous costs [12], while the Trumpadministration even considered to resume nuclear testing (forbidden by the CTB-Treaty), skipping important NW-treaties like INF, JCPOA, Open Skies and almost New Start, despite Putin's repeated offer for unconditional five-years-extension. Nowadays, nine states possess about 14.000 nuclear warheads — 93 % Russian/American — up to 1000 times stronger than those of Japan [13]. About 1900 are ready for launch-within-minutes, while decision times are shortened by new technologies like Artificial Intelligence and hypersonic missiles, much faster than current ones. These developments, combined with risks of terrorist- and cyber-attacks, and of dual-tipped missiles, causing uncertainty about nuclear/non-nuclear load, make experts assess the current situation much more hazardous than during the Cold War. The Atomic Scientists keep their Doomsday Clock in its most dangerous position ever: 100 seconds for midnight.

The Netherlands, a NATO-founder (1949), has little to say about her nuclear tasks, from 1959 on: information remained top-secret and only US-Presidents decide when, where and how many nuclear bombs must be dropped by Dutch pilots [14]. Probably not much has changed, although after 1989, only one of the seven original Dutch nuclear tasks remained: Volkel airbase hosts circa 20 US-nuclear B12 free-fall-bombs — a public secret, — making our country an obvious target. Civil society protest caused already several parliamentary resolutions, rejecting these bombs, but governments overruled them,

arguing nuclear sharing is a NATO-obligation. However, in fact it is a bilateral Dutch-

American agreement, and states like Spain, Iceland, Denmark, Norway, Lithuania and even France remained full NATO-members, despite their independent nuclear policies [15]. So, mankind has invented a 'defence mechanism' that any moment can lead to its total annihilation, intended or, more likely, unintended, by technical or human failure2. According to experts, the question is not "if" but "when" this Doomsday Machine [16] will start. So, what can be done, especially by countries like The Netherlands, its civil society or specific professions like physicians?

NVMP-Physicians for Peace: 50 years of activities

In 1969, Dutch physicians wanting to prevent health harm by war, founded the NVMP, continuing a rich tradition [17]. Many activities were developed, declining after the Cold War, and revitalizing after 2013. Describing all this would widely exceed the article's limits, so we focus on recent years, when a new international anti-NWs-movement arose. In the seventies and eighties, many physicians joined the NVMP, because of worldwide protests against new US and Soviet-midrange missiles, involving e. g., 1.000.000 demonstrators in New York and 550.000 in The Hague: still records in both countries. NVMP published a page-size advertisement about nuclear war-consequences. So, NWs became NVMP's key-issue, joining IPPNW (1980), co-organizing its third World Congress (Amsterdam, 1983), receiving a remarkable message: "Nuclear war cannot be won and must never be fought! No task has greater significance for us and the entire world than to work for success of the Geneva-negotiations to reverse the growth in nuclear arsenals and move toward genuine

2 E. g. early 2021, while a tele-working US-Strategic Command nuclear deterrence manager left his computer, his son posted a cryptic tweet, being a nuclear launch code: ;l;;gmlxzssaw. (www.bbc.com/news/ technology-56578544).

peace. <...> They deserve full support of all, who seek progress toward peace, like your organization". Was signed: Ronald Reagan. Because of IPPNW's Nobel peace prize (1985), NVMP reached 2500 members — and IPPNW 135.000 in 41 countries [18]. After 1989, however, many thought NWs disappeared. Like IPPNW-affiliates elsewhere, NVMP lost many members, despite raising issues like nuclear energy and the Balkan-, Afghanistan-and Iraqi-wars. However, the World Court Project and Abolition 2000 showed, NWs were still important, confirmed by the Hague International Court of Justice lawsuit [19] (1996), concluding 'NW-threat or -use would generally be contrary to the rules of international law applicable in armed conflicts, in particular <...> humanitarian law' — a legal milestone.

After 2000, 'The 21st Century Hague-Agenda for Peace & Justice' became an official UN-document with fifty action points. NVMP was actively involved in IPPNW-campaigns on landmines, cluster ammunition, depleted uranium, small arms, Peace & Global Health Education and Medical Peace work, also becoming the Dutch Mayors-for-Peace-secretariat.

President Obama's 'NW-abolition speech' (Prague, 2009) gave new hope for Global Zero. However, Republican senators only wanted to ratify the New START-Treaty, concluded with Russian President Medvedev, if Obama agreed to modernize the US-nuclear arsenal, for one trillion dollars/30 years. So, nuclear disarmament slowly halted.

IPPNW, ICAN and the Ban Treaty

Looking for new nuclear disarmament impulses, South-East-Asian and Australian IPPNW-members3 developed ideas about forbidding NWs (2007), like earlier biological and chemical weapons. So, they initiated ICAN: International Campaign to Abolish Nuclear Weapons, introducing the ICRC-inspired Human Impact of NW's (HINW-)Approach, linked to hibakusha-experiences (Hiroshima & Nagasaki survivors). With Beatrice Fihn, a Swedish lawyer, appointed as director, ICAN started organizing bottom-up civil society actions, culminating in activists-weekends, followed by official State Actors-conferences. Norway premiered (Oslo, March 2013), Mexico followed (Nayarit, January 2014), while Austria organized an impressive decisive one (Vienna, December 2014): again, an activists-weekend, followed by a prestigious official two-day HINW-Conference in the majestic Hofburg, with 158 participating countries, including NW-States (USA, UK, France, China) and also The Netherlands, as well as civil society. Austria's FA-Minister Sebastian Kurz — later Prime Minister — opened, followed by Pope Frances' Nuntius, ICRC-President Peter Maurer and Hiroshima-survivor Setsuko Thurlow. After two intense days, Minister Kurz, summarizing the conference results, presented the Vienna Pledge: developing a ban treaty to fill the legal gap for NW-prohibition and -elimination [20].

Within six months 127 countries supported this Pledge, so UN-procedures started for a ban treaty, first by an Open Ending Working Group (OEWG, Geneva, 2016), then by official UN-negotiations (New York, 2017), fiercely opposed by NATO-allies [3], except one: The Netherlands joined the negotiations. On July 7, 2017, 122 countries agreed about the text. Meanwhile, 83 countries signed, and on 24-10-2020, the 50th UN-member ratified the Treaty: Honduras. So, 90 days later the TPNW entered-into-force, making NWs illegal, according to international law. This IPPNW-initiated bottom-up development, in-

3 Especially Ron McCoy (Malaysia), Sue Wareham/Tilman Ruff (Australia).

cluding 607 Civil Society groups in 106 countries, organized by ICAN, created new momentum in the stagnating nuclear disarmament process, leading to new energy, initiatives and activists, especially youngsters.

NVMP's revival: Medical Appeal resonates in parliament and abroad

"Nuclear weapons are a health issue" [2]

These developments inspired the NVMP, attending HINW-conferences and the 20th IPPNW-World Congress (Astana, 2014), hearing many convincing old and new arguments for a NW-free world. End 2014, the NVMP-board developed a strategy to help getting nuclear disarmament back on the Dutch political & public agenda. First step: building a solid base within health care, from where to reach out to other relevant actors. So, the NVMP-chair wrote a Medical Appeal, Old and new NW-dangers, stating: "The medical, humanitarian and infrastructural consequences are so disastrous that we will not be able to offer any substantial medical help. <...> Meanwhile research shows that even a small nuclear conflict will cause 'nuclear famine', potentially causing up to two billion deaths because of massive crop failures. Moreover, near accidents by technical failure or human error have already brought us several times near the nuclear abyss. <... So>, don't let these weapons of mass destruction ever be used, on purpose or by accident. Elimination is the ultimate prevention, and a NW-ban would be a big step forward" [21]. In no-time, 100 leading Dutch healthcare executives, clinicians and scientists eagerly signed this appeal [21], though healthcare-CEOs seldom speak out in political matters, because of impartiality towards their patients.

On UN-International Day for Total NW-Elimination, September 26, 2015, NVMP organized a manifestation Nuclear Weapons, who cares? in the Amsterdam debate centre De Balie — physicians earning two CME-points. Covered by local media, experts presented the horrific short, medium and long-term medical effects of a small nuclear explosion above Rotterdam, commented by Dutch Red Cross, PAX, medical students and young doctors. Then, the Medical Appeal, already published in the main Dutch medical journal, was presented to the chairs of the Royal Dutch Medical Association and Mayors for Peace, representing two target groups: health professionals and general public.

Regarding the third group, politicians, the NVMP joined the Red Cross/PAX-campaign Civil Society Initiative against NWs, successfully collecting 45,000 signatures, needed to enforce a parliamentary debate about banning NWs. Shortly before, April 19, 2016, a NVMP-delegation rendered, covered by radio, the Medical Appeal to the Parliamentary FA-Commission, received above expectation, also by the rightwing VVD from Prime-minister Rutte. It was even used to argue the main resolution, asking FA-Minister Koenders (Social-democrats/PvdA) for "effective measures leading to a NW-free world, including ban negotiations". PvdA-spokesman Servaes said in parliament: "Last week the NVMP rendered us a Medical Appeal, asking to promote ban negotiations, taking steps to realize it!" [22] Koenders reacted positive on behalf of the VVD-PvdA-coalition 'Rutte-II'. Three other resolutions were adopted too, opposing NW-modernisation and demanding NW-withdrawal from Dutch and European soil4.

4 Of course, Red Cross and Pax also contribute to this success.

After presenting this Appeal at an international IPPNW-Medact conference (London, November 2015), Fiona Godlee, conference chair and editor-in-chief of the renowned BMJ (British Medical Journal) invited the NVMP-chair for an article about the Appeal. Published February 19, 2016 [23], it ended: "We hope to inspire medical communities elsewhere to come into action too by using this or adapted wording', what indeed happened5. Recommended by the FA-ministry, he also presented the Appeal at the UN-OEWG (Geneva, May 2016), that prepared official Ban-negotiations, with The Netherlands, other NATO-members and civil society participating.

Given these positive (inter)national developments, the NVMP organised a second Balie-Meeting, 'Is the nuclear deadlock over?', October 1, 2016, to support the four parliamentary nuclear disarmament-resolutions, inviting old and new allies: Mayors-for-Peace, Red Cross, PAX, but also IALANA6, the President-Director of Dutch Railways — one of our largest companies (20,000 employees) and the first 'big employer' openly advocating a NW-free world — and religious and humanistic organisations. Initially, both were reluctant: the early 80's anti-NW-movement had caused deep divisions among their members, because some found 'the left' dominated the protests. NVMP's non-party-political, medical-humanitarian arguments proved helpful: 'No matter if you are right- or left-wing: NWs don't discriminate, they will eliminate us all!' So, after three decades-of-silence, protestant and humanistic representatives again publicly rejected NWs7. Experts told why the global situation was even more dangerous than before 1989, like IPPNW-co-president Ira Helfand, explaining nuclear famine/winter [24] and stating, The Netherlands could make a difference in reaching a NW-free world. Afterwards, NVMP presented the Balie-meet-ing results to the FA-Ministry, where civil servants invited Helfand and me for extensive discussions.

Civil Society Coalition for a NW-free world

All Balie-speakers emphasised: "NWs are unacceptable!" So how to unite them/their organizations? NVMP drafted an Oped, urging FA-minister Koenders to indeed support the Ban negotiations, asking the Balie-speakers to co-sign, including the last line: 'We will critically follow the government's actions and develop social pressure if needed'. They did, so NVMP invited them to discuss how to organize that pressure. All appeared, December 15, 2016, deciding to form an ad-hoc Civil Society Coalition for a NW-free world, called Balieberaad (Balie-Council). NVMP offered to organize regular meetings. The Council wrote another Open Letter to praise minister Koenders, joining the Ban negotiations, highlighting HINW-arguments and the Dutch bridge-building role "between NW-states and others". The Red Cross proposed "Dialogue, negotiations, binding agreements and humanitarian values", replacing the outdated Mutual-Assured-Destruction(MAD)-con-cept [25]. The Letter was published on Parliamentary Election Day, March 15, 2017. Social-Democrats, minister Koenders' party, lost heavily, while 'centre-right' got the majority. So, influencing negotiations about a new government became extra important for civil society. The Balieberaad, meeting monthly, proposed each organisation to first approach political parties separately, urging them to intensify Rutte-II's NW-course, especially re-

5 IPPNW-affiliates in Australia/Belgium/Germany/Italy/Norway/UK.

6 Phon vd Biesen, vice-chair International Association of Lawyers against Nuclear Arms.

7 Karin vd Broeke/Christa Compas.

garding Ban negotiations. The NVMP also urged for maximum international diplomatic and public pressure to force NW-States to finally fulfil their Article VI NPT-disarmament obligations, completely within NATO-regulations8.

To increase pressure — also because dangerous US-North-Korea power play proved nuclear war was possible [26] — the Balieberaad conceived a Civil Society Appeal, urging reinforcement of the previous constructive NW-policy, supporting a Ban Treaty, consistent with NPT-Article VI. Twenty well-known Dutch (wo)men enthusiastically signed, including the main FA-expert Ko Colijn, Nobel Prize winner Physics Ben Feringa, celebrated conductor Jaap van Zweden, religious leaders and prominent physicians. The main quality newspaper NRC published it, June 8, 2017, titled '2000 NWs on red alert: "ACT NOW!", adding: "Despite NATO's disapproval The Netherlands negotiate about a NW-Ban". The new government must increase the pressure, according to Peter Buijs, Ko Colijn, Ben Feringa c. s. This Appeal was also well received by Parliament, July 6, 2017: the main parties were present again, as did the media.

One day later in New York, 122 UN-members concluded a final TPNW-text. The Netherlands voted against, conform criteria giving earlier9, promising to continue pursuing a NW-free world by building bridges between TPNW-proponents and -opponents. The delegation was praised for its constructive collaboration10. Nevertheless, Dutch civil society was disappointed. Any moment a more right-wing government could replace 'Rutte-II', even more dominated by 'his' winning VVD. So, NVMP initiated another Balieberaad-manifestation, September 25, 2017, to further increase civil society pressure, in The Hague, our political capital, using the NRC-title: '2000 NWs on red alert: ACT!'

For the first time Marjolijn van Deelen, head of MoFA's Non-proliferation & Disarmament Unit, spoke, reviewing Dutch NW-policy, underlining why an active civil society is important and explaining, why the TPNW wasn't signed. However, as civil servant, she couldn't answer IALANA-lawyer Phon vd Biesen, arguing why TPNW enforces instead of undermines the NPT — NATO's narrative. Also, Bishop Gerard de Korte, Roman-Catholic NW-spokesman, premiered, especially important regarding the Christian-Democratic Party (CDA), key-player in negotiations for a new government. He plead a NW-free world, wishing the new government to join.

'Rutte-III' actively pursues a NW-free world

Unexpected, the Bishop was heard: the right-wing VVD and CDA formed a coalition with two much smaller, more centre-left parties: Democrats'66 and Christian-Union (CU). This 'Rutte-III-Government', more right-wing than its precursor, stated in its Coalition Agreement: 'Within the framework of alliance obligations, this government actively pursues a NW-free world' — result of civil society pressure by NVMP a. o., D66- and CU-MPs explained11. Both were pro-TPNW, but VVD and CDA remained fiercely opposed, like the new FA-Minister, also VVD-member.

8 The Netherlands succeeded in getting mentioned Article VI-obligations and 'NATO pursuing a NW-free world' in the Warsaw NATO-2016-Summit communiqué, (MoFA-letter to Parliament, October 27, 2016).

9 Efficacy, verifiability, broad support, including from NW-states, balanced with other relevant treaties, compatible with NATO-membership (MoFA-letter to NVMP, February 16, 2018).

10 E. g., Austrian negotiator Thomas Hajnoczi, XXIth IPPNW World Congress, York, August 2017.

11 MPs Sjoerdsma (D66) & Voordewind (CU) informed the author.

This confronted the Balieberaad with a dilemma: using its limited time and energy to get the TPNW signed, with almost no chance of success, or focussing on the government's active pursuing a NW-free world, which would enable direct contact and discussion with coalition-politicians, also about TPNW. Balieberaad-partners chose the last option, arguing: If this government seriously pursues a NW-free world, but refuses to sign the TPNW, the only alternative is 'revitalising' NPT Article VI: complete, verifiable nuclear disarmament (Global Zero) as result obligation, applying to all NW-States (ICJ, 1996) [19]. Inspired by the Nobel Peace Prize-2017 for ICAN's TPNW-endeavours, the Balieberaad approved a NVMP-proposal for a 'three-step-strategy 2018':

1. Another Civil Society Appeal to stimulate the government's 'active pursuit', to play an initiating, bridge building international disarmament role, especially regarding NPT-Art. VI.

2. Offering the four coalition-MPs expert assistance in translating the 'active pursuit' into (inter)national political practice.

3. Another 'Hague-manifestation' to increase political pressure.

2018: NVMP and Parliament

The NVMP started 2018 with its first New Year-letter to the Foreign-Minister, wishing him success in actively pursuing a NW-free world, mentioning 85 % of the Dutch population rejects NWs [27]. So, not-signing the TPNW implicated at least activating NPT-Arti-cle VI. "Seldom a small country gets such an opportunity on the world stage to help saving our planet from an extremely dangerous Cold War heritage, we cannot shift to our (grand) children". The VVD-minister answered surprisingly extensive, congratulating NVMP with bringing the NW-issue back on the agenda, explaining many MoFA-policy aspects, confirming the strong Dutch international position to play a practical, innovative role at implementing Article VI, wishing to keep contact with civil society partners like NVMP12. Internationally, 2018 started ominously: the Doomsday Clock was put forward at two minutes before midnight — only comparable with the Cold War-year 1953 — followed by alarming new US and Russian NW-plans [11], lowering the atomic threshold and starting a new NW-race.

The NVMP incorporated these developments in a draft-Appeal, asking the government to urgently act to help reversing this dangerous trend by demanding the NW-States to fulfil their Article VI-obligations. "What a present to humanity it would be if 'fifty-years-NPT' could be celebrated with starting meaningful negotiations for a NW-free world. And which government could better initiate this than ours, given its Coalition Agreement!' After Balieberaad-partners commented, the Appeal was signed by 111 influential civil society representatives from medical, scientific, religious, civil service, legal, media and artistic background — well received again by Parliament, September 25, 2018, and even translated into a resolution. Earlier 2018, contacts with MPs had already contributed to a resolution mentioning the positive Dutch role during the TPNW-negotiations, asking a clear strategy regarding the 'active pursuit of nuclear disarmament'" [28]. Minister Blok (FA) answered extensively, partly with usual statements like 'NATO is a nuclear alliance as long as there are NWs', but also with 'Nuclear disarmament is a Dutch priority. The government committed itself clearly and repeatedly to <.. .> Global Zero, in conformation

12 MoFA-Director Security Policies Hester Somsen on behalf of FA-minister Blok, February 16, 2018.

with Article VI NPT-obligations. <.> The only way to exclude NW-use is their complete elimination.' Active NGO's support '.the government in pursuing actively Global Zero'. International tensions make '.the Dutch pioneer role even more important, as initiator and bridge builder, keeping Global Zero in sight.' concluding: 'Making the NPT Review 2020 a success is our top-priority!' [29]. Remarkable lines, echoing previous NVMP-views.

Coalition-MP's also welcomed off-the-record brainstorm sessions with Balieberaad-experts to prepare parliamentary debates with the FA-Minister. This facilitated also bilateral contacts, sometimes very confidential. And finally, a new Balieberaad-manifestation, 'Dutch contribution to a NW-free world', was helpful, again on UN-Day of Total NW-ab-olition, September 26, 2018. Experts outlined the increasingly dangerous global situation, aggravated by the INF-in-jeopardy. Church leaders, Mayors, NVMP and others urged the government to intensify pursuing a NW-free world. Political parties from right to left were invited, illustrating our non-party-political, medical-humanitarian approach — lessons learned from the early 80's. All accepted, including VVD and CDA, just like most political youth-organizations — important, giving a NW-knowledge lack among youngsters. All efforts resulted November 20, 2018 in a parliamentary majority resolution, composed of key lines from the Balieberaad-Appeal, urging the government to initiate international dialogue with the NW-States about comprehensive, verifiable abolition, according to Article VI NPT [30]. Congratulating MPs called this result exceptional for an extra-parliamentary pressure group, given the complex issue. Another resolution, about the TPNW, got a remarkable MoFA-answer: there are no legal obstacles for signing, only political [31].

Earlier, the main FA-Advisory Board AIV (chair: former NATO-SG De Hoop Scheffer) unexpectedly invited us13 to give our view on advising the government about NWs14. So on May 30, 2018, we presented scientific evidence from The Lancet, BMJ, JAMA and other medical top-journals about the unacceptable medical-humanitarian consequences of NW-use. Summarising: the incredible heat destroys everything, including (medical) infrastructure, reducing humans to shadows, leaving the survivors with severe burns, blindness from retinal burns and disabling scars. A gigantic blast causes direct death, multiple fractures, deafness from burst ear drums, ruptured organs and internal hemor-rhaging. Radiation, unique for NWs, causes acute deadly sickness (nausea, dehydration) and middle & long-term diseases like leukaemia, thyroid cancer, solid tumours, genetic and congenital damage. The only possible NVMP-conclusion: "urgently abolish NWs! Our government pursues that, so we expect your AIV-Commission to advise how!"

2019: AlV-advice and the government's reaction

NVMP's medical-humanitarian message and the INF-in-peril caused considerable delay in what was expected to be a straightforward, NW-friendly AIV-advice15. The final version16 was quite ambiguous: supporting credible nuclear deterrence and continuing the F-16/F35A nuclear task, but also great concern about a new nuclear arms race, disruptive

13 MoFA had signalled AIV.

14 Pugwash, Red Cross and PAX were invited too.

15 Several sources mentioned, the advice was revised twice, because AIV-board members found a. o. NVMP-arguments insufficiently incorporated.

16 AIV-Advies, January 31, 2019, https://www.adviesraadinternationalevraagstukken.nl/documenten/ publicaties/2019/01/29/kernwapens-in-een-nieuwe-geopolitieke-werkelijkheid

new technologies, proliferation and important NW-treaties lost. Key lines: "Any nuclear detonation must be prevented, because of the unacceptable humanitarian consequences!" and ".the main challenge is to strictly abide by the NPT, including fulfilling the obligation for the NW-States under Article VI to negotiate about verifiable total nuclear disarmament" (p. 11). Urgent Advice: 'initiate negotiations within NATO, UN and directly with Russia, even to discuss a total sub-strategic NW-removal from Europe.' Remarkable lines, echoing NVMP's medical-humanitarian message.

Shortly afterwards the NVMP-chair met Jaap de Hoop Scheffer, complimented him with his advice to urgently take initiatives, but also emphasized a crucial contradiction: "You advocate 'Never use NWs', but also credible nuclear deterrence, making adversaries believe we really will use NWs!" His reaction: "An irresolvable paradox!". My answer: "We must resolve it, before it is too late!" This paradox fully returned in the governments answer [32], starting powerful: "The only way NW-use can be completely ruled out is by eliminating them completely — one of the Dutch objectives for a NW-free world <... to be reached by .> article VI NPT under strict, effective international control. The Netherlands has urged NATO to explicitly commit itself to this important article" [14]. "The lack of progress on nuclear disarmament <...> has rightly caused growing frustration among governments, civil society and general public. The government shares this frustration" — not mentioning this also caused the TPNW-movement. Nevertheless, the government's reaction reflects civil society's wish, articulated by the NVMP/Balieberaad: "The Netherlands therefore focus on making concrete and valuable contributions to the disarmament process by acting as driving force and bridge builder, seeking the right position and partners to exert maximum influence, <.> to pragmatically identify opportunities, form coalitions and maintain pressure on all fronts, to take steps to achieve global zero"17.

Negotiations with Russia to remove sub-strategic NWs

"The government endorses also the importance of dialogue with Russia in the social, political and military domains <...> to prevent misconceptions, miscommunication and escalation, and identify and shape opportunities for effective and mutual arms control." Then, surprisingly: "The government's aim is still that the Netherlands would no longer need to fulfil a nuclear task when the F-16 is eventually replaced by the F-35 <... and .> will work with its allies <. > to identify possible ways of achieving the withdrawal of all Russian and American sub-strategic NWs throughout Europe (from the Atlantic to the Urals)". Disarmament steps ".must be complete, mutual, verifiable and irreversible". "Success may seem remote, making an attempt all the more urgent. A logical time <...> would be when NWs in Europe are due for modernisation"18. This quite differs from earlier standpoints: simply replacing free-fall B62 bombs by modernized, manoeuvrable B62-12 ones. Again, echoing civil society demands?

Before debating this with two ministers (FA & Defence), Parliament organized a Round table with civil society, June 26, 2019, another example of 'bottom-up' influence on Dutch NW-policy. Initially, only Red Cross and NVMP were invited to present Position Papers, later also Pugwash, PAX, the Council of Churches and some experts.

17 See: https://www.tweedekamer.nl/kamerstukken/brieven_regering/detail?id=2019Z08205&did=20 19D16635

18 Ibid.

NVMP's Position Paper

After paraphrasing J. F. Kennedy — "We must eliminate NWs, before they eliminate us!" — NVMP repeated the many pro's and some con's of the AIV-advice and the government's response, mentioned above. Another pro: both fully recognize the dangers of new technological developments (AI, digital undermining/cyber, 'killer robots', hypersonic missiles), drastically shortening decision time in case of uncertainty (e. g., about 'yes/no' nuclear-tipped or retaliation), risking even to completely lose human control. Unlike AIV and the government however, NVMP found this another powerful argument to conclude, like in 1992 retiring general Butler, chief-commander of the US-nuclear arsenal: "Nuclear weapons are too dangerous: we must abolish them a.s.a.p.!" — applauded by many topmilitary in East & West.

AIV nor the government mentioned another major NVMP/IPPNW-argument, also providing common ground to NW- and non-NW-States: 'A limited regional nuclear conflict will inevitably cause Nuclear Famine by massive amounts of soot in the atmosphere, leading to less sunlight, lower temperatures, huge crop failures, famine with up to two billion people dying, and massive refugee streams. Gorbachev and Reagan considered this scientific evidence, provided by IPPNW, the final push to start negotiations, with considerable success (INF-Treaty, NW-decrease from 70.000->15.000). Their successors should finish that job, NVMP stated. "So, The Netherlands can translate its 'active pursuit' in helping developing maximum global pressure on the NW-States to finally fulfil their NPT-Art. VI obligations. <.> Our country is well equipped: good diplomatic reputation, participating in many relevant networks — also with NW-States — regarding verification, transparency, fissile material, CTBT, risk management/prevention of accidents, with goodwill among TPNW-supporting countries, because we joined the 2017-UN-negotiations"19.

Finally, the NVMP urged the government to join the AIV's sense of urgency, especially regarding the existential paradox: 'never again NW-detonations' versus 'credible nuclear deterrence, advising: start a.s.a.p. NATO-discussions about replacing the 20th-century MAD-concept, risking billions of lives, by a 21st century NW-free security concept. Meanwhile, like physicians in emergency situations: urge life saving stabilizing measures to reduce the immediate danger — de-alerting, de-targeting and No-first-Use, like China, India and earlier the Soviet Union — in order to reach Global Zero relatively safely. All this apparently was food for thought: parliament postponed the debates.

Building good relations with MoFA

By rendering NVMP's Medical Appeal to Marjolijn van Deelen, MoFA-Disarmament Unit's head, and later 2016 Balie-meeting results, with a one-hour-talk afterwards, good relations with the FA-Ministry started. It promoted that NVMP could present its ideas at the OEWG (2016), AIV (2018) and NPT PrepCon (New York, 2019), while NVMP invited MoFA at the 2017-Balieberaadmanifestation. Mutual trust grew, especially since the goal, "pursuing a NW-free world", collided by Rutte-III's Coalition Agreement. Helpful were the New Year Wishes to the FA-Minister, giving his extensive response in 2018. So NVMP repeated that in 2019, presenting itself to the new minister, Stef Blok, as an ally of the

19 See: https://www.nvmp.org/wp-content/uploads/2021/10/NVMP-Position-Paper-2-7-2019.pdf

Governments 'active pursuit': "Mankind faces a fundamental choice: Do we accept NWs? Then the question is not 'if' but 'when' complete disaster will happen. Or, how difficult it may be, we must abolish NWs. We physicians are proud that our government chose the last option. <.> We want to contribute by celebrating our 50th anniversary, end 2019, in the Peace Palace, together with other NW-free world-advocates like UN-under-SG Izumi Nakamitsu and Hiroshima-survivor Setsuko Thurlow. So <. > we would appreciate to discuss a possible MoFA-commitment".

Soon, Marjolijn van Deelen invited NVMP, including advisor Jan Hoekema, ex-MP, Mayor and MoFA-civil servant on NWs. NVMP explained: "Becoming 50, you don't want to get presents, but to give presents, like the Peace Palace as platform to advocate a NW-free world, to support Minister Blok's top priority — a successful RevCon — and to ask speakers suggestions for an active Dutch role, proposing a classic medical framework:

^Diagnosis: The unacceptable medical-humanitarian NW-impact;

^Prognosis: How serious is the current situation and the need to act?

*Therapy: What must be done, especially by The Netherlands?

After a panel to promote dialogue and suggestions for Dutch RevCon-contributions, a Peace Palace Appeal would conclude the event".

The FA-ministry agreed, offered financial support and helped inviting Nakamitsu and minister Blok. Regular meetings followed, a. o. about other speakers. NVMP's wish to invite Beatrice Fihn (ICAN) was respected, despite MoFA's TPNW-declining. NVMP agreed with MoFA's wish, Eirini Lemos (NATO), reasoning NATO also pursues a NW-free world. Respecting each other also meant focussing on the NPT, without 'banning' the TPNW.

NVMP's 50th anniversary 'Urgent appeal for a NW-free world:

connecting medical-humanitarian and political perspectives'

'Advocacy and research by the health community have already provided huge momentum and robust evidence to inform and change nuclear policies' [2]

So, on November 26, 2019, the highlight of '50-years-NVMP' started in the Hague Peace Palace. Despite scepticism among some NVMP- and Balieberaad-members, FA-minister Blok echoed surprisingly much of their views. Quoting Gorbachev about "... the ongoing risk NWs pose to the world" he reproached US and Russia of practising the opposite of nuclear disarmament. Picturing geopolitics shifting from searching shared interests, cooperation and dialogue towards zero-sum thinking, rivalry and conflict, he continued: In 1950 already there were NWs, 1000 times more powerful than the bomb on Hiroshima. <.> Enough to destroy the world many times over. "He called NPT-confer-ences..." crucial to exert pressure on NW-states and <.> for lobbying for new initiatives, to move towards a NW-free world. I believe the Netherlands is well positioned to do this. <...> We must demand that the NW-states take action to implement NPT Article VI!". "The Netherlands is dedicated to achieve a NW-free world in a safe, secure and stable way. <...> Therefore, we want to play a leading role on disarmament by forging partnerships and focusing on international cooperation", e. g. regarding fissile material, verification, restraint in nuclear doctrines, and transparency to build confidence, facilitating disar-

mament steps. Supporting the UN-SG disarmament agenda, he called the NPT the only credible instrument and unsurprisingly the TPNW "effective nor enforceable". Urgently asking for ".new, innovative solutions", he concluded, quoting Gorbachev again: "All nations should declare: NWs must be destroyed, to save ourselves and our planet!"'20 My introduction already mentioned: "Anytime NWs can be launched, causing unspeakable medical-humanitarian and environmental harm on an unimaginable scale, without hope for help. Therefore we, physicians, raise our voice, to signal this intolerable risk and urgently call for action, helping with the Diagnosis and Prognosis. However, for the Therapy we need others: politicians, experts, diplomats, moral leaders, according to today's subtitle Connecting medical-humanitarian and political perspectives". "We physicians may need some idealism, but certainly realism. The world is facing an existential choice, although too many people are unaware: either we accept NWs — then, the question is not if, but when they will be used, with apocalyptic consequences — or, how difficult that may be, we must destroy these weapons before they destroy us. And we are lucky we still can, given how often the world was already on the brink of nuclear annihilation". Despite many positive MFA-developments, some tough issues remain, like: 'NATO stays a nuclear alliance as long as NWs exist'. How to escape this vicious circle? Or: 'This government remains committed to both nuclear disarmament and credible nuclear deterrence: how to overcome this paradox?', ending: "May all contributions today favor progress in a very complex matter, showing realistic perspectives on the ultimate goal: a NW-free world!"

Many urgent appeals

Many 'anniversary-presents' followed: wise words from very committed expertspeakers, confirming many NVMP-viewpoints [33]. To enable reviewing and evaluating achievements of 50-years-NVMP, the main Conference statements are summarized here.

UN-under-SG and High Representative of Disarmament Izumi Nakamitsu thanked the NVMP/ Dr. Peter Buijs for tireless efforts over five decades pursuing a NW-free world, emphasizing that such dedication and expertise are needed now more than ever. She suggested for the upcoming NPT-RevCon and beyond:

— leadership, especially by the NW-States, reaffirming their NPT-commitment for a NW-free world;

— rebuilding cooperation and transparency to create trust;

— re-establishing dialogue and negotiations in good faith, recognizing the importance of multilateral solutions, in closer cooperation with (non-)traditional stakeholders;

— a new vision to address NW-dangers, including new technologies; charting a course to NW-elimination, strictly adhering to verifiability, irreversibility, transparency, accountability, compliance and enforcement;

— taking security concerns serious; strengthening civilian protection;

— interlocutors to engage with current divisions, forging consensus.

20 For all quotes during this meeting (29 November 2019), see: https://www.nvmp.org/wp-content/ uploads/2020/01/EINDRAPPORT261119.pdf

She ended: "In particular, I very much welcome Dutch leadership and willingness to support creative ways to advance discussions on a new disarmament vision, <.> looking forward working with you as bureau-member in 2020, to achieve this outcome". Tone set!

Diagnosis

The diagnosis-part about the intolerable medical-humanitarian NW-impact started with Setsuko Thurlow, telling about her apocalyptic experiences as 13-year-old Hiroshima survivor: "There were no doctors, no nurses: they were killed too. Thousands of people were dying, begging for water. Not a drop was given. People were carrying their eyeballs in their hands, their stomachs were burst open, intestines stretching out. It was hell on earth".

IPPNW-co-president Ira Helfand put this horror into broader perspective: even a limited nuclear war, e. g., India versus Pakistan, will affect us all: 100 Hiroshima-sized bombs on major cities would kill 20 million people within a week by fires, explosions and immediate radiation. Global temperatures will decrease 1.3 degrees, cutting food production, causing up to two billion starvations [34]. Next, Helfand described effects of one 20 megaton NW-explosion on Amsterdam. Within a split second a 20 million degrees Celsius fireball reaches out for three kilometres around, vaporizing all people, trees, buildings, even the upper earth layer. Six kilometres around, winds 1000 kilometres/hour destroy every construction. Nine kilometres around, the heat melts automobiles, and 25 kilometres around, everything flammable burns. Thousands of fires merge into a giant 800 degrees Celsius firestorm 50 kilometres across, consuming all oxygen, killing everybody — in Amsterdam over two million people. "Daily we live with this danger, deliberate or by accident. At least six times since 1979 either Moscow or Washington prepared to launch NWs, believing they were already attacked."

Miguel Jorge, World Medical Association-president, representing 10 million physicians, confirmed by video that every physician must request governments to refrain from developing, testing, production, stockpiling, deployment, transfer, threat and use of NWs and to work in good faith towards their elimination.

Prognosis

"Prognosis is grim!" said Tom Countryman, former US-undersecretary-of-state for Arms Control & International Security, mentioning potential nuclear flashpoints (N-Korea, India-Pakistan, Baltics), delusive concepts of limited/contained/winnable nuclear wars, the permanent risk of false alarms and technological developments. "I am not a physician, but I think <...> we must do more to raise public consciousness, to make the patient aware of the true prognosis!". "If great powers will not lead, others must", meaning The Netherlands. "Activism of doctors focused on health and survival of the human species <...> inspires us to teach individuals, motivate society and move governments to a more peaceful path!"

'NWs are a global disease!' retired Russian Ambassador Sergei Batsanov stated, having negotiated several disarmament agreements since 1976. He described destabilization risks of new technologies, eliminating decision time for launching in uncertain situations, especially when enormous data amounts are outsourced to Artificial Intelligence: "Really

frightening!" He also warned for the lack of bi- and multilateral dialogue & cooperation, concluding: "It's time to act!", advising a multi-component therapy: dialogue about combining modest steps and more radical visions. "So, my prognosis is cautiously optimistic: the human race always found new ways of addressing what seemed to be insurmountable problems."

Therapy

After video-messages from ICRC — absent because of its yearly Landmine Conference — and Pope Francis ("NW-use is immoral!"), the therapy-part followed. "I couldn't agree more!", former Irish President and UN-High Commissioner Human Rights Mary Robinson, chair of The Elders21 said about the Urgent Appeal-title, before presenting the Elders '4-D's-program':

— Doctrine: No-First-Use-declarations by every NW-state;

— De-alerting most US/Russian NWs;

— Diminish the operationally deployed global NW-stockpiles; extend New START;

— Decrease the current 14,000 NWs to 2000, with both superpowers max 500 each.

"The Dutch Coalition Agreement about 'actively pursuing a NW-free world' is a welcome, laudable antidote to the bellicose posturing of some leading powers.", she continued, concluding: "Ireland introduced the Irish Resolutions at the UN in 1958, eventually leading to the NPT <...> I encourage your Government to show leadership on this vital issue, hopefully as influential as Ireland!" Dutch NW-expert Sico van der Meer (Clingen-dael) translated a typical medical skill into global policy: emergency measures preventing the patient's immediate death, enabling fundamental therapy: NW-abolition. He named four categories:

1. Declaration policies: no-first-use-declarations or the Gorbachev/Reagan-quote: 'Nuclear war can never be won and should never be fought'. "Any NW-state leader can do this, preferably all together".

2. Communication & cooperation': information sharing, transparency, joined warning centres & training, lessons learned from incidents/accidents, ensuring safe communication lines, especially during crisis.

3. Operational measures: extending launch decision time by de-alerting and de-targeting, e. g., from towns to oceans.

4. Limiting NW-roles, -types and -numbers in doctrines and postures. Dismantle short/intermediate-range nuclear missiles, tactical and low yield NWs.

Finally, he addressed the NW-States — "It's about shared benefits and security for all." — and The Netherlands: "Smaller countries could promote political willingness in NW-States. In doctors language: injecting good ideas into policy debates!"

Eirini Lemos, deputy-head of NATO's nuclear disarmament-unit was ".very pleased to be invited by doctors for this diagnostic event." Quoting SG Stoltenberg: "NATO's goal is a NW-free world, and the NPT the only way to achieve this", she stated, that despite unpromising political and security environments, we must pursue general disarmament by a

21 See: https://theelders.org/who-we-are

two-pillar-approach: deterrence and step-by-step disarmament (the 'unsolvable paradox' discussed earlier, PB). She praised initiatives like the:

— Non-Proliferation & Disarmament Initiative NPDI, spearheaded by the Netherlands, promoting greater transparency in how NW-States fulfil their disarmament obligations;

— Swedish Stepping Stones-Approach, bringing together states with different perspectives to reduce nuclear risk and improve transparency;

— US-CEND initiative: Creating-an-Environment-for-Nuclear-Disarmament.

"States seek NWs, because they think it is in their security interests. So, we can only reach a NW-free world through painstaking work of resolving underlying political tensions and conflicts", she continued, not mentioning NPT-Article VI-obligations22.

After raising the key challenge — "... managing our conflicts by non-nuclear means" — she concluded: "Advancing nuclear disarmament demands political will from all parties and a mechanism to turn that will into meaningful disarmament progress. NPT provides the mechanism, NATO-allies will contribute the political will." Words to remember!

ICAN-director Beatrice Fihn explained, how TPNW supports and complements the NPT to reach its ultimate goal: a NW-free world. But honest discussions about NPT's successes and shortcomings are needed: successes like non-proliferation during the Cold War, disarming post-Soviet NW-states, strong taboo against NW-spread, showing diplomacy works, even in times of great tension. "NPT's continued success is vital to maintain global security". So, its shortcomings must be solved, like no effective NW-taboo as such, while the NPT-drafters included a separate, complementary Treaty in Article VI: "... pursue negotiations in good faith <...> on a Treaty on general, complete disarmament." Also, nuclear abolition is not rooted in humanitarian law. The TPNW fills both gaps, Fihn said, also eliminating the underlying issues blocking action on other shortcomings, like NW-states failing to implement specific actions from the 2010-NPT Action Plan: CTBT-ratification, negotiating a Fissile Material Cut-off Treaty, further US-Russian reductions, reducing the NW-role in military doctrines. "TPNW brings humanitarian framing, legal grounding and moral clarity to the promise of NW-elimination." she concluded, inviting all states to join the TPNW, consistent with their Article VI-obligations. "This is a precarious moment for the NPT and indeed the world. We can only salvage both with a renewed commitment to ending NWs before they end us".

Final words came from the young generation. Dutch medical student Britt Vegting: "We face two existential threats: climate change, happening slowly and could be halted, and NWs, which damage will be immediate and irreversible and should be prevented <...> From health perspective the current situation is unacceptable. This should be top priority in health policy everywhere. Young people must play a critical role in raising awareness and developing new strategies. So, let my generation be part of the highly important abolition-negotiations. We did not cause the current harmful situation but must live with the disastrous consequences!"

22 Her remarks raised more questions: "NPT's central bargain was successful". Really? Non-proliferation: yes; fulfilling Article VI: no. "Russia and China continue expanding their nuclear arsenals." USA not (NPR 2018)? "India, Pakistan and N-Korea have still not signed the NPT." Did Israel?

Panel discussion: What can we do?

"Several times we became within minutes of nuclear war, when deterrence failed. Many nuclear policy-architects admit: 'Only unbelievable luck saved us!' We must find other, 21-century defence mechanisms." (Panellist Ira Helfand, November 26, 2019)

Kazakhstan's Ambassador Magzhan Ilyassov started in medical style: his country represents a heavily sick patient, that eventually managed to heal himself. After 1989, Kazakhstan was the world's fourth largest nuclear power: 1100 warheads and the largest nuclear test site: 500 tests in 50 years, heavily polluting an area, half The Netherlands. The government decided to dismantle its NWs, supported by Russian and American partners. In 2009 Central-Asia was declared NW-free and in 2019 Kazakhstan ratified the TPNW. Then, panel leader Jan Hoekema asked two questions:

1."What must urgently be done in 2020, directed at a NW-free world?"

Mary Robinson: extending New START; a successful NPT-RevCon; more NW-States supporting No-First-Use; more youngsters like Britt to reach people-under-fifty. Ira Hel-fand advocated an urgent policy shift, promoted by the global peace movement, like from 'We can win nuclear wars!' to 'Nuclear war can never be won and should never be fought!' (Reagan, 1981, resp.1983). "Political decisions to eliminate NWs can be taken quick!"

Britt Vegting urged for raising awareness, using the medical perspective. Eirini Le-mos plead dialogue, especially with youngsters, about ideas, challenges and realistic steps towards a NW-free world: "Issues, high on NATO's agenda, also after 2020!" Beatrice Fihn: "TPNW's entry-into-force and the 75th 'Hiroshima & Nagasaki-anniversaries' provide huge global educational moments, with hibakusha's still alive to listen to." She hopes, progressive NATO-states could take steps to engage by attending TPNW-state parties meetings.

2. "What can The Netherlands contribute?"

Mary Robinson: The Netherlands is well positioned to lead developing ideas to protect Europe against the 'post-INF-dangers', together with other NATO- and also non-NATO-countries (Sweden/Finland/Ireland). Ira Helfand advised: Sign the TPNW! Most Dutch want it. And tell the USA: "Nuclear deterrence is unacceptable!"

Britt Vegting: "Working on how my generation can act, by connecting climate change and NWs." Eirini Lemos found the Dutch leading role within NATO really important: pragmatic, spearheading at verification and risk-reduction, bringing the debate forward. The same applied to the Dutch RevCon-co-presidency, she said, bringing everybody together for dialogue, with the NPT as cornerstone to reach a NW-free world. Beatrice Fihn plead channelling public opinion into actual political pressure, via parliamentarians, city councils, banks and pension funds, divesting from NW-industry. Quoting Desmond Tutu's 'I'm prisoner of hope', Mary Robinson concluded: spread energy and inspiration to make a difference. 'Like your appeal says: Let's wake up!'

Dutch Government's reaction: urgency point taken!

"What I really took from the discussions was the sense of urgency! <...> Your message is a big support. It will keep us motivated, especially because of the youth voices.", Marjolijn van Deelen (MoFA, RevCon-vice-chair) concluded. "I like ambassador Batsa-nov's metaphor: when a patient is very sick you use multiple therapies. This direction we have taken nationally, we look at all avenues that could realistically reach results <...>, in which we try to make concrete steps". "Regarding the NPT RevCon, we will have to find common ground, what will not be easy. <.> That's why we keep calling for creative ideas, especially focused on the NW-States, who have particularly responsibilities. But non-NW-States can do much too!", mentioning Regional Conferences, The Netherlands organized as PrepCom-2017-chair, enabling more dialogue. Ambassador Adam Bugajski (Poland, RevCon-vice-chair too) added: "I was intrigued by the medical dimension <.> Applying this to the NPT-process, the PrepComs play the diagnosis-role, the prognosis would be the RevCon and the RevCon-decisions implement the therapy."

Reviewing the discussions, NVMP-chair's tentative conclusion was: the title 'Urgent appeal' and subtitle about 'Connecting' apparently had worked, especially hearing Mar-jolijn van Deelen about urgency and supportive for the government — important NVMP-conference aims, next to empowering The Netherlands, like many speakers did: 'Play a leading role during the RevCon-proces, especially urging the NW-States to act according to NPT-article VI!'

But civil society must act too, Peter Buijs added, like ".physicians, using their medical-humanitarian arguments and impartial position of trust, like IPPNW-doctors did the early 80s by convincing Reagan and Gorbachev to start negotiations. That heritage is under great pressure, so we must find new ways to convince the current leaders, by mobilizing civil society/public opinion and connecting with experts, moral leaders, diplomats and politicians, building global pressure on the NW-States! Therefore, we prepared a Peace Palace Wake-up Appeal! Chazia Mourali, a famous Dutch performer, will present it"23.

Afterwards, Dutch Parliament received the speakers to discuss with MPs from right to left 'What can be done, especially by the Netherlands, to reach a NW-free world?' The same happened before the event at the Ministry with the MoFA-staff. Speakers highly appreciated this: Ira Helfand, who attended hundreds NW-related events, told the IPPNW-Executive Committee, this was one of the best he ever joined.

Aftermath: civil society actions in COVID-times

Inspired by "26/11", the NVMP started 2020 again with New Year wishes to FA-minister Blok, reflecting on the joint 'Peace Palace-Event, the FA-ministry's conclusions about urgency, and the speakers' support for a Dutch leading role during the NPT-RevCon-process, especially regarding Article VI-obligations. So, we suggested to initiate a broad Coalition for a NW-free world to increase political, diplomatic, moral and civil society pressure on the NW-States, "For all humanity!", Blok's closing words at '26-11'.

On March 10, 2020, a NVMP-delegation, including student Britt Vegting, evaluated this joint-venture with MoFA-Director Security Policies, Hester Somsen. "A well-balanced

23 See: https://www.nvmp.org/wp-content/uploads/2019/12/NVMP_PeaceAppealA5.pdf

conference with excellent speakers, like Britt!", she concluded, proposing to continue collaboration. NVMP of course agreed, proposing to focus on synergy between civil society and MoFA's NW-policies.

Afterwards, a NVMP-board delegation met with two medical students and a young doctor. Enthusiastic having attended '26/11', they wanted to join the NVMP-Board — gladly accepted, having missed this student-link for years! Finally, on March 10, 2020 NVMP had convened the Balieberaad for a NW-free world, including two newcomers: the Council of Churches and Pugwash. In 2019 this civil society coalition had only met two times, mainly discussing (inter)national political developments and preparing meetings with Parliament, but without specific actions, because initiator/organizer NVMP was too occupied with its 50th anniversary. So, the NVMP owed its allies new initiatives, proposing:

1. A new Civil Society Appeal, regarding the RevCon.

2. An autumn-manifestation.

3. NW-related recommendations for the election.

PAX added action proposals for 6 & 9 August, 75 years after the US-atom bombs on Japan, and for September 26, 2020, UN-day for Total NW-Abolition, at Volkel, 'our' US-NW Airbase. The churches proposed to question 'nuclear deterrence'. All agreed, tasks were allocated, deadlines defined. However..

Six urgent election recommendations

.Two days later, COVID changed everything, including lockdowns and postponement of the NPT-RevCon, our main action target. However, continuing by phone, email, apps, Zoom etc. and after intensive draft-exchanges, Balieberaad-partners agreed six urgent political recommendations. The Netherlands:

1. Intensifies its active pursuing a NW-free world.

2. Intensifies its initiating, bridge-building role, emphasizing the NW-states' obligations regarding NPT-Article VI.

3. Skips its last nuclear task.

4. Starts NATO-debate about alternatives for nuclear deterrence.

5. Signs & ratifies the TPNW.

6. Shifts weapon expenditures to diplomacy and war causes (poverty, hunger etc).

Summer 2020, all political parties received them, nine incorporating several points into their election-programs, especially 3 and 524. After lockdown, NVMP-members participated in several Balieberaad-memorial activities about 'Hiroshima & Nagasaki': before the Amsterdam Stock Market a huge ICBM-silo was projected, and several Opeds were published, also from our young board members. One month later, many Balieberaad-partners spoke at a 'social-distancing' manifestation at Volkel-airbase, finish of a two-days bike tour Dusseldorf-Volkel, organized by Dutch and German medical students. A première: Greenpeace was represented too, established after anti-US-nuclear testing actions (1971). Typical Dutch: the airbase offered coffee.

24 See: https://www.nvmp.org/kieskompas-kernwapens/

Next, the Balieberaad-partners invited Greenpeace to join, connecting NWs to the other existential global challenge: climate change, especially appealing to youngsters. So, on October 22, 2020, seven civil society partners met online, discussing further activities, like specific actions towards political parties to boost our election recommendations; a new Civil Society Appeal; contacting other 'NW-hosting states' (Germany, Belgium, Italy) to coordinate actions to get rid of these 'US-presents' and preparing for the 50th TPNW-ratification. That happened two days later, despite desperate US-resistance [35]. Ninety days later, the Balieberaad celebrated online the Entry-Into-Force, like many likeminded organisations worldwide.

Other '26/11 follow-ups'

With speaker Miguel Jorge, World Medical Association-chair, NVMP explored the feasibility of a Global Medical Community Appeal to the NW-States leaders, explaining that the COVID-19-pandemic will be peanuts, compared with a nuclear detonation — inevitable, unless we act. Jorge reacted positively but preferred to wait until COVID-19 is more-or-less under control. Meanwhile, IPPNW translated this idea into a webinar, January 21, 2021, celebrating the TPNW Entry-into-force, together with WMA, ICRC and other International Health organisations, with a strong common statement [36].

Another speaker, Sergey Batsanov, promoted the 'Peace-Palace-Dialogue-Model' — his words — in Geneva, at the ICRC, and first in St-Petersburg, at the Forum of knowledge, organized by the State University and Presidential Library. They invited the NVMP-chair at day-3 — "Threat of nuclear war and NPT-future.", September 24, 2020 — for a keynote: "How Dutch physicians influenced NW-policies" — base for this article and reason to ask his friend, Petersburg-citizen Valery Gergiev, for a welcome word, which he did: "Nuclear weapons are dangerous! We all have responsibility in front of our children and future generations. We have to do our best to help peace and understanding between nations, between countries and, most difficult, between politicians" [37]. Very welcome words from Russian civil society.

(Inter)nationalpolitical developments...

Meanwhile, the Dutch political discussion continued. On January 29, 2020, Parliament finally debated MoFA's 'April 18, 2019-letter', including position papers from NVMP a. o. MPs discussed many hours about negotiations with Russia, more transparency about the US-NWs at Volkel and other NW-issues, without making much progress. So, a follow up-debate was held at July 2, 2020, leading to only one adopted resolution, asking the government to use the B12-modernisation for a strategic Russia-USA-NATO-dialogue about mutual, verifiable, irreversible medium-range NW-withdrawal from Europe. In between, 12-2-2020, the left-wing opposition parties invited NVMP a. o. to discuss a remarkable resolution, for the first time supporting bi-lateral instead of unilateral nuclear disarmament: a gesture to the coalition-parties.

During the Commission on Disarmament, February 24, 2020, FA-minister Blok sharply confronted the NW-states with their Article VI NPT-obligations: "Take action!" He also warned that if New Start got lost, ".we are in a reckless street race without brakes!"

Strong words for a 'gentleman-minister'! Peace Palace-echo's? Because of 50-years-NPT, March 10, 2020, the P5 reaffirmed their ".commitment to the NPT in all aspects <...> We support the ultimate goal of a world without NWs with undiminished security for all." Do words matter?

Summer 2020, Marjolijn van Deelen left MoFA, introducing two successors25, with whom NVMP continued fruitful discussions and initiatives about further Dutch contributions to a NW-free world, including a more constructive 'TPNW-treatment'.

COVID-year 2020 ended with two positive international developments:

— Biden's election as US-president, given his hopeful campaign promises about New Start, JCPOA and even No-first-use-initiatives. Just in time in office, he called President Putin to confirm the unconditional New Start-extension, meant to address more 21st century security challenges, including all NWs [38]. Putin already suggested (February 11, 2021) to "discuss other steps aiming to curb the arms race and to facilitate overall arms control."

— TPNW's 50th ratification, evoking positive wording by NATO-members like Canada and Germany26, while the new Belgian Coalition Agreement wants to explore "... how TPNW can stimulate multilateral nuclear disarmament"27.

Here we re-enter the international NW-arena, this article's starting point. Time to summarize results, conclusions and recommendations.

Main findings/results

"Advocacy and research by the health community have already provided huge momentum and robust evidence to inform and change nuclear policies" [2]

This case study shows several NW-related NVMP(-initiated)-activities from 2015 on, with plausible effects on Dutch politics, like:

1. The unique paragraph in the 2017 Coalition Agreement of the centre-right Rutte-III-government: 'Within the framework of alliance obligations, this government actively pursues a NW-free world.' MPs from two governmental parties explained, actions from NVMP a. o. enabled this.

2. Despite severe NATO-opposition, The Netherlands joined the UN-nuclear ban-negotiations (TPNW, 2017) as the only NATO-member, following a resolution, argued by MP Servaes: "Last week the NVMP rendered us a Medical Appeal, asking to promote ban negotiations, taking steps to realise it!"

3. Several other parliamentary adopted resolutions, especially from November 20, 2018, composed of key lines from a NVMP-initiated Appeal, subscribed by 111 well known Dutch (wo)men, urging the government to start an international dialogue with the NW-States, aiming at comprehensive, verifiable NW-abolition, according to NPT-Art. VI. FA-minister Blok made already a start (CD, February 26, 2020).

25 Ingeborg Delissen and Ana de Velde Harsenhorst.

26 See: https://www.bundestag.de/resource/blob/814856/28b27e2d04faabd4a4bc0bfd0579658c/WD-2-111-20-pdf-data.pdf

27 See: https://www.belgium.be/sites/default/files/Regeerakkoord_2020.pdf

4. The final NW-advice (February 1, 2019) from the Dutch Foreign Policy Advisory Board AIV (chair: former NATO-SG De Hoop Scheffer), reflecting several points, presented by NVMP, like: 'Any future nuclear detonation must be prevented because of the unacceptable humanitarian consequences!','. .fulfilling the Article VI NPT obligation for the NW-States to negotiate verifiable total nuclear disarmament.' and a sense of urgency, NVMP's top-priority.

5. 'Urgency!' was also the FA-Ministry's main takeaway from '26-11-2019', while minister Blok's speech reflected many other important NVMP-messages (grim NW-diagnosis and prognosis; the only fundamental therapy: abolishing all NWs — mentioned also in MoFA-letters to parliament from 2018 on, including an active Dutch diplomatic role, applauded by most speakers.

Other relevant findings/results:

1. Fruitful relations with the Parliamentary FA-Committee, always eager to accept NVMP-(initiated-)Appeals — taken seriously, giving follow-up invitations for Position Papers, (bi-lateral) consultations and a Parliamentary Round Table, while NVMP organized off-the-record brainstorm sessions with civil society-experts, joined by governmental MPs to prepare parliamentary NW-debates with the FA-Minister.

2. Fruitful relations with the FA-ministry, resulting in presenting the NVMP-Medi-cal Appeal to the OEWG (UN, May 2016), being heard by the AIV, co-organizing NVMP's 50th anniversary-Congress 'Urgent appeal for a NW-free world', with FA-Minister Blok, UN-under-SG Nakamitsu and many other speakers (Peace Palace, November 26, 2019) — very positive assessed, followed by structural NVMP-FA-ministry collaboration, leading to several new (inter)national initiatives.

3. Organising dialogue, aiming at synergy between all kind of proponents for a NW-free world, from Beatrice Fihn (ICAN) via Ira Helfand (IPPNW), Mary Robinson (The Elders), medical student Britt Vegting (NVMP) to Eirini Lemos (NATO) — another NVMP-goal of '26-11-2021'.

4. Other '26-11-2019-effects', like NVMP-chair's contribution to the St-Petersburg University Forum of Knowledge, November 26, 2020, leading to this article, and a very recent Russian-American Appeal (see last page).

5. The Dutch Civil Society Coalition for a NW-free world Balieberaad (Balie-Coun-cil), initiated and organized by NVMP, bringing together the Council of Churches, Red Cross, Humanistic Association, Mayors for Peace, Greenpeace, PAX, Pug-wash and IALANA-lawyers. It pressured Parliament and Government by Opeds, Appeals, Manifestations, urgent recommendations for the 2021-election programs — used by many political parties — and for a new Coalition Agreement.

Conclusions

1. The NVMP, alone and together with other civil society organisations, influenced several times Dutch policies to urgently and actively pursue a NW-free world, with assignable effects/results.

2. Progress regarding TPNW-support succeeded mainly during 'Rutte-II' (20132017); Rutte-III stayed fiercely opposed.

3. Helpful were NVMP's

— independent, impartial position of trust;

— science-based medical-humanitarian arguments;

— initiative for a broad civil society coalition-for-a-NW-free-world, Balieberaad;

— good connections with Parliament, FA-ministry and (inter)national NW-ex-perts.

4. Getting media-attention remained difficult, after initial successes.

NVMP's 50th anniversary-congress ' Urgent appeal for a NW-free world; connecting medical-humanitarian and political perspectives' (Peace Palace, November 26, 2021) can be considered as an extra international reality-check on NVMP's NW-view & strategies: nuclear disarmament-proponents, from ICAN to NATO, including Dutch FA-minister Blok, confirmed in general NVMP's grim NW-diagnosis and prognosis, the urgent 'first-aid-need' to eliminate acute dangers, and the only fundamental therapy: total NW-elimination. Speakers appreciated the medical framework (Diagnosis/Prognosis/Therapy) and dialogue, looking for commonly shared perspectives, with a full-fledged TPNW-role, while strongly welcoming active Dutch diplomacy.

Overall conclusion: it makes sense for civil society to raise its voice and act, even at the huge, complex NW-issue. NVMP demonstrated, physicians can play a specific stimulating, convincing, initiating, uniting role.

Limitations, lessons learned, recommendations

Because of his Forum-of-Knowledge keynote, this Journal invited the NVMP-chair to write an extended version about NVMP-activities 1969-2019, an offer, he couldn't refuse. Advantages: descriptions from inside, giving more insight than an outsider could in why & how the NVMP operates. Main risk: to be too subjective/biased. Solutions: referring to as many verifiable quotes/sources as possible and asking experts to read drafts critically. Also difficult for the author to assess is if and how his personal features may have influenced the NVMP-successes.

And of course, one doesn't have to be a physician to succeed, like e. g. ICAN demonstrated. Initiated by IPPNW-physicians though, this bottom-up campaign made it to a UN-NW-ban Treaty, despite fierce NW-states-resistance, thanks to many enthusiastic, mostly young, non-medical campaigners, next to pioneering countries like Austria, Norway and Mexico. Nevertheless, TPNW-pioneer-diplomat Alexander Kmentt, considers medical arguments key for TPNW's success [39]. So, what are physician's advantages? Here some lessons-learned, followed by recommendations, health professionals and civil society elsewhere may use to influence policymakers regarding a NW-free world.

Lessons-learned

1. Physicians have strong, science-based health messages, like:

— NW-use will have catastrophic medical-humanitarian consequences on an unimaginable scale, possibly ending civilisation: the nuclear winter;

— also a limited, regional nuclear war will have disastrous planetary health effects by nuclear famine, causing up to two billion extra deaths;

— any substantial medical help will be impossible;

— experts assess the nuclear risk the highest ever [40], urging to act now, because any moment nuclear-tipped missiles can be launched (un)intended.

2. Physicians have a position of trust towards politicians, experts, media and the public, because their impartiality, not suspected offake news, without personal (financial) interest, only Hippocrates' Oath, obliging them to warn for health risks.

3. The medical-humanitarian message applies to all political positions: "Left or right, NWs don't discriminate: we all will die!"

Recommendations/takeaways

1. A Medical Appeal, signed by prominent professionals, can help convincing policy-makers and uniting other civil society-groups for a NW-free world, like the Dutch Balieberaad, each group adding its own anti-NWs-arguments to the medical ones: religious, humanistic, environmental, legal etc., all fitting under the 'humanitarian umbrella'.

2. Medical metaphors can be helpful towards politicians, media and public, like:

— the medical framework 'Diagnosis/Prognosis/short-and long-term Therapy;

— regarding imminent great health risks, physicians must take first-aid measures to prevent death-at-the-spot, before starting fundamental therapies. So, nuclear powers must urgently take measures like no-first use, de-alerting & de-targeting;

— referring to COVID: "Mankind experiences huge disruptive Corona-pandemic-consequences: millions of victims, crippled economies, huge unemployment, poverty, inequity. However, nuclear war will dwarf this. Fortunately, we know exactly the prevention: ban & abolish NWs!"

3. All this also provides a strong base for bold international initiatives, like IPPNW-founders took in the 80's, convincing Gorbachev and Reagan about nuclear disarmament (see below), and IPPNW-physicians in 2007, initiating what became ICAN/TPNW. Both initiatives rewarded the Nobel Peace Prize.

Inspiration from a common past

IPPNW paid ".considerable service to mankind by spreading authoritative information and creating awareness of the catastrophic atomic warfare consequences <...> contributing to increasing pressure of public opposition to proliferation of NWs." (Nobel-Peace-Prize-committee, October 11, 1985)28

This article will hopefully inform, but also inspire health professionals and other civil society-organisations elsewhere to act/intensify acting, especially in Russia and the USA, the nuclear super-powers. In 1980, US-PSR (Physicians for Social Responsibility) published a one-page advertising, "DANGER: NUCLEAR WAR", directed at Carter and Brezhnev, signed by physicians, scientists and concerned citizens. Brezhnev answered per-

28 See: https://www.nobelprize.org/prizes/peace/1985/ceremony-speech/ 498 Вестник СПбГУ. Международные отношения. 2021. Т. 14. Вып. 4

sonally that the USSR had long been committed to banning these and all other weapons of mass destruction. Directly after, PSR founded IPPNW, together with Russian colleagues. Recently, it started a broad civil society-movement, Back-from-the-brink, supported by churches, city councils, Mayors for Peace a. o., demanding:

— No-First-Use-declarations;

— ending sole, unchecked US-President's authority for NW-launch;

— ending Hair-Trigger Alert;

— don't replace US-nuclear arsenal with enhanced weapons;

— pursue verifiable agreements among NW-States for NW-elimination.

Early 2021, the famous NEJM published US-IPPNW-co-founder Bernard Lown's plea29, urging the medical community to support this campaign [41]. The Russian IPP-NW-affiliate has a rich history too. On 10-12-1985, its chair, IPPNW-co-founder Eugene Chazov, and Lown accepted the Nobel Peace Prize. Chazov: "Peoples are heedful of physicians, warning them of the danger and recommend the means of prevention. From the first days of our movement we suggested a prescription for survival which envisaged a NW-test ban, freeze, reduction and eventually elimination of NWs, No-First-Use, ending the arms race on Earth and preventing it in outer space, creating an atmosphere of trust between peoples and countries, and promoting close international cooperation". Still very up to date.

IPPNW-Russia also organized many activities, especially in the nineties, till recent meetings with deputy-FA-minister Ryabkov and an IPPNW/Pugwash-initiative about President Putin's proposals regarding New Start and post-INF stability [42]. In 2017, the affiliate welcomed an IPPNW-delegation, including this author, at the Science Academy in Moscow, with among the speakers the Duma FA-Committee-chair, and PM Medve-dev asking to draft a nuclear disarmament declaration. The affiliate's greatest achievement however may be Chazov, arranging a meeting, where the IPPNW-leadership convinced Michael Gorbachev to end the nuclear arms race and start disarming [43]. Gorbachev later about IPPNW: "What they are doing commands great respect. For what they say and do is prompted by accurate knowledge and a passionate desire to warn humanity about the danger looming over it. In the light of their arguments and the strictly scientific data which they possess, there seems no room left for politicking. And no serious politician has the right to disregard their conclusions" [10, p. 154].

Giving the dangerous current NW-situation, Chazov's and Lown's IPPNW-endeav-our deserves repetition, e. g., by a new, urgent Appeal from 'physicians, scientists and concerned citizens' from both countries to their leaders to finish the job, their predecessors successfully started, and finally end the permanent existential threat, posed to all of us by their nuclear arsenals. The 10th NPT-Review Conference provides an excellent opportunity for their leadership in fulfilling their Article 6 NPT-obligations. Like in the early eighties, that also requires global civil society pressure, with a new tool: the TPNW. NVMP/ IPPNW, Balieberaad and many other civil society organisations will definitely help increasing political, diplomatic, scientific, medical and moral pressure on the NW-States. To conclude, a fresh foretaste.

29 February 16, 2021, Lown died, 99 years old.

IPPNW/Pugwash Appeal to Presidents Putin & Biden

"A nuclear war cannot be won and must never be fought!" [6]

Half May 2021, the NVMP-chair saw opportunities for a Russian-American Civil Society Appeal: the Putin-Biden-summit. He wrote a first draft, directed straight to both presidents, and contacted Russian and American Peace-Palace-speakers. Together they conceived a final IPPNW/Pugwash Appeal, referring to courageous cooperation between the leaders of two great nations30 ".To put an end to the greatest risk facing humanity: a nuclear apocalypse, intended or unintended". Two urgent demands were formulated:

1. Reaffirm the Gorbachev/Reagan-statement 'A nuclear war cannot be won and must never be fought!' — which the Trump-administration repeatedly refused to embrace.

2. Commit to a bilateral, result-oriented strategic dialogue — absent for years — leading to further reduction of nuclear risks and re-discovering the road to a NW-free world.

In no-time, 25 High-level Russians and Americans signed, like Igor Ivanov, former Russian FA-Minister; William Perry, former US-Defence Secretary; General Vyacheslav Trubnikov, former head of Russian Foreign Intelligence Service, Edmund Brown Jr., former California's Governor, General Victor Esin, former Head of chief Staff, Russian Strategic Missile Forces, headed, according to the ACA-press release [44] by 'Peter Buijs, M. D., chair IPPNW Netherlands, who initiated the Appeal'. Just before being published in both countries, it was handed over to high-level interagency-teams in Washington and Moscow, preparing the Summit — apparently not in vain [45]. Directly after their talks, June 16, 2021, both presidents released a Joint Statement, saying: ".even in periods of tension, we are able to make progress on our shared goals of <.> reducing the risk of armed conflicts and the threat of nuclear war." "Today, we reaffirm the principle that a nuclear war cannot be won and must never be fought. Consistent with these goals, the United States and Russia will embark on an integrated bilateral Strategic Stability Dialogue in the near future." Already in July, a ministerial follow up took place and continued in September. Diplomatic sources indicated that the IPPNW/Pugwash-Appeal was quite helpful. Hopefully, this IPPNW-inspired Russian-American civil society initiative has helped to make the world a bit safer.

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Received: September 5, 2021 Accepted: October 5, 2021

Author's information:

Peter Buijs — MD, PhD, Chair IPPNW Netherlands, Independent researcher; buijspc@gmail.com