Nuclear war between Israel and Iran: lethality beyond the pale - PubMed

80~~/100~~

Verdict High Trust Credible: peer-reviewed scenario-modelling study. The bibliographic details and the method and results summary check...

✓ 15 checks out ✕ 1 disputed ? 6 unverified

☰ Full analysis The complete summary ⌄

The content is a PubMed record for Dallas CE, Bell WC, Stewart DJ, Caruso A and Burkle FM Jr, 'Nuclear war between Israel and Iran: lethality beyond the pale', Conflict and Health 2013;7(1):10, doi:10.1186/1752-1505-7-10, PMID 23663406, PMCID PMC3671126, published 10 May 2013. The publisher (BioMed Central/Springer), PubMed, the Harvard DASH repository, the University of Georgia OpenScholar record and Johns Hopkins Pure all confirm the record. Their abstracts match the abstract here word for word, including the modelling tools (ArcGIS 9.3, the Defense Nuclear Agency WE program, DTRA HPAC V404SP4, the Brode thermal model as modified by Binninger, and LandScan 2007) and the 3 Israeli and 18 Iranian cities modelled. The 'Similar articles' and 'Cited by' entries I checked are real, including a 2026 EXCLI Journal review (PMID 42459933, dated 25 June 2026), which is genuine and not a fabrication. The main factual weakness is the Background claim that 'Iran has enriched enough nuclear material to build them [nuclear weapons]'. Arms Control Association analyses of the IAEA's May 2013 report put Iran's 20% enriched stockpile at 182 kg, below the roughly 240–250 kg needed for one weapon even after further enrichment. The claim is therefore disputed for 2013. By 2025 Iran's 60% stockpile was enough for several weapons if enriched further, so the premise matters more now than when it was published. The projected deaths and injuries are model results that depend on assumed weapon yields; they cannot be confirmed or refuted as facts. The tone leans towards advocacy: the title phrase 'beyond the pale' and conclusions such as 'utterly unacceptable outcomes' reflect the authors' openly stated public-health position. These limits are reflected in the score.

What checked out (15)

The article exists: Dallas CE et al., 'Nuclear war between Israel and Iran: lethality beyond the pale', Conflict and Health 2013;7(1):10; doi:10.1186/1752-1505-7-10; PMID 23663406; PMCID PMC3671126; published 10 May 2013 (PubMed; BioMed Central).
Authors are Cham E Dallas, William C Bell, David J Stewart, Antonio Caruso and Frederick M Burkle Jr; the lead author's affiliation is the Institute for Disaster Management, University of Georgia (PubMed; Harvard DASH; Johns Hopkins Pure).
Methods: ArcGIS 9.3, the Defense Nuclear Agency WE program for blast and prompt radiation, DTRA HPAC V404SP4 for fallout, the Brode thermal model as modified by Binninger, and the ORNL LandScan 2007 population dataset (wording matches the abstracts on PubMed, Springer, Harvard DASH and UGA OpenScholar).
Results: casualties were estimated for three Israeli and eighteen Iranian cities (PubMed; Springer; UGA OpenScholar).
Israel was simulated with 15 kt weapons (e.g. two 15 kt detonations on Tel Aviv; single detonations on Haifa and Beer-Sheva), and Iranian cities with 50–500 kt weapons (Springer full text; ResearchGate PDF; figure captions on the publisher site).
Figure captions for Iranian cities (Hamandan [sic], Rasht, Reza Iyeh, Kerman, Qazvin, Yazd, Zahedan, etc.) match the publisher's own HTML.
Israel has an official policy of nuclear ambiguity, neither confirming nor denying that it has nuclear weapons, while being widely judged to possess them (UK House of Commons Library briefing CBP-9075, citing SIPRI). This supports the 'widely accepted, while not openly declared' part of the Background.
Similar article: Bell WC, Dallas CE, 'Vulnerability of populations and the urban health care systems to nuclear weapon attack – examples from four American cities', Int J Health Geogr 2007;6:5 (BMC).
Similar article: Dallas CE, Burkle FM Jr, 'Nuclear war in the Middle East: where is the voice of medicine and public health', Prehosp Disaster Med 2011;26(5):383-5; PMID 22509536 (PubMed; Cambridge Core).
Similar article: Abrams HL, 'Medical resources after nuclear war. Availability v need', JAMA 1984 (JAMA Network; Semantic Scholar).
Cited by: Ben Saad H et al., 'Radiation emergency preparedness in the middle east…', EXCLI J 2026 Jun 25;25:938-953; PMID 42459933; PMCID PMC13369915. This is a real 2026 publication that cites the 2013 paper, though its reference list garbles the authors as 'Cham LB, Kim BC' (PubMed; PMC; EXCLI).
Cited by: Veenema TG, Burkle FM Jr, Dallas CE, Confl Health 2019;13:9 (BMC; Johns Hopkins Pure).
Cited by: Ratnayake R et al., 'Conflict and Health: seven years of advancing science in humanitarian crises', Confl Health 2014;8:7 (Springer; PMC).
Cited by: Desai SP et al., 'Human Consequences of Multiple Nuclear Detonations in New Delhi (India)', IJERPH 2021;18(4):1740; PMID 33670135 (PubMed; PMC; MDPI).
Cited by: Dallas CE et al., 'Readiness for Radiological and Nuclear Events among Emergency Medical Personnel', Front Public Health 2017;5:202 (Frontiers).

✕ Disputed claims 1 claim ⌄

DISPUTED (not marked False): the Background statement that 'Iran has enriched enough nuclear material to build them'. When published in May 2013, Arms Control Association analyses of the IAEA's May 2013 report (dated 22 May 2013) said Iran's 20% enriched stockpile (182 kg) was below the roughly 240–250 kg needed for one weapon even after further enrichment. The August 2013 analysis (dated 28 August 2013) gave 185.8 kg. Iran had not enriched to weapons grade. The statement is imprecise at best unless read as latent capacity after further enrichment. By 2025 the premise had become closer to accurate in that sense: the IAEA estimated Iran's 60% stockpile was enough for several weapons if enriched further (CBS/AP, May 2025; Bulletin of the Atomic Scientists, July 2025). It is not marked False because 'enough to build' is ambiguous and could mean enough feedstock for further enrichment.

? Unverified claims 6 claims ⌄

The specific projected figures for deaths, injuries, burns and radiation cases in each city are model outputs. They can be traced back to the paper (e.g. Mother Jones reported the paper's estimate of about 5.6 million deaths and 1.6 million injuries in Tehran), but cannot be checked against real events. They count as accurately reported model results, not verified facts.
The claim that nuclear technology spreading in the Middle East 'greatly increases the likelihood' of nuclear war is a strategic judgement that cannot be tested empirically.
The predicted long-term mental-health effects, collapse of law and order, and disruption to the economy and education are qualitative forecasts, not measured outcomes.
The claim that clinicians would have 'little to no familiarity' with treating radiation victims is plausible and consistent with the authors' later readiness research (Dallas et al. 2017), but I did not confirm it with Israel- or Iran-specific data.
Reference list entries 3–5 (Cordesman/CSIS 2007; CIA Factbook 2009; Dolan, DNA EM-1 1972) were not opened. Only 5 references are shown in this extract, while the full paper has more.
The PMIDs for Bell & Dallas 2007 (17328796), Abrams 1984 (6737669), Ratnayake 2014 (24843382), Veenema 2019 (30962816) and Dallas 2017 (28868272) were not checked one by one on PubMed, although the articles themselves were confirmed.

⌕ Sources & how we checked Search journal, source grades, confidence ⌄

Confidence

Medium-High (about 80%) — Confidence is high for the bibliographic details, the abstract wording, the methods and the citation network, all confirmed by several independent primary sources (publisher, PubMed, two institutional repositories). It is lower for the substance because the core outputs are hypothetical casualty projections that cannot be checked as facts. The full text could not be read in detail, a few PMIDs were checked only indirectly, and the enrichment premise is ambiguous: disputed for 2013, more nearly true by 2025. The score of 80 balances strong provenance and transparent methods against the dated or contested premise, the assumptions built into the scenarios, and some advocacy-tinged language.

Search journal

Nuclear war between Israel and Iran: lethality beyond the pale Dallas Conflict and Health 2013

Dallas Bell Stewart Burkle Israel Iran nuclear war casualties Conflict and Health

Dallas Conflict and Health 2013 7:10 PMID nuclear war Israel Iran PubMed

"three Israeli and eighteen Iranian cities" nuclear casualties

Dallas 2013 Israel Iran nuclear HPAC LandScan 2007 ArcGIS 9.3 casualties Tehran 15 Kt Tel Aviv

Iran 2013 IAEA enriched uranium 20% stockpile enough for bomb

Iran enriched uranium enough for nuclear weapons IAEA 60% stockpile

Iran 60% enriched uranium IAEA report 2025 enough for weapons if further enriched

https://www.cbsnews.com/news/iran-has-amassed-even-more-near-weapons-grade-uranium-un-watchdog-says/

Israel nuclear weapons undeclared SIPRI estimate

Radiation emergency preparedness in the middle east EXCLI Journal Ben Saad

Ben Saad 2026 EXCLI radiation emergency Middle East Dallas 2013 lethality beyond the pale

Vulnerability of populations and the urban health care systems to nuclear weapon attack four American cities Bell Dallas 2007

https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-6-5

Nuclear war in the Middle East: where is the voice of medicine and public health Dallas Burkle 2011

Medical resources after nuclear war availability v need Abrams JAMA 1984

https://jamanetwork.com/journals/jama/article-abstract/393774

The nursing profession critical component nuclear global health workforce Veenema Burkle Dallas 2019

https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-019-0197-x

Human Consequences of Multiple Nuclear Detonations in New Delhi triage Desai Bell Dallas 2021

Readiness for Radiological and Nuclear Events among Emergency Medical Personnel Dallas 2017 Frontiers

https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2017.00202/full

Conflict and Health: seven years of advancing science in humanitarian crises Ratnayake 2014

Article metrics

Emotion 14% · Reading grade 10.2 · 1858 words

≡ The article we checked Full text as retrieved ⌄

## Nuclear war between Israel and Iran: lethality beyond the pale

Cham E Dallas et al. Confl Health.2013.

## Abstract

**Background:** The proliferation of nuclear technology in the politically volatile Middle East greatly increases the likelihood of a catastrophic nuclear war. It is widely accepted, while not openly declared, that Israel has nuclear weapons, and that Iran has enriched enough nuclear material to build them. The medical consequences of a nuclear exchange between Iran and Israel in the near future are envisioned, with a focus on the distribution of casualties in urban environments.

**Methods:** Model estimates of nuclear war casualties employed ESRI's ArcGIS 9.3, blast and prompt radiation were calculated using the Defense Nuclear Agency's WE program, and fallout radiation was calculated using the Defense Threat Reduction Agency's (DTRA's) Hazard Prediction and Assessment Capability (HPAC) V404SP4, as well as custom GIS and database software applications. Further development for thermal burn casualties was based on Brode, as modified by Binninger, to calculate thermal fluence. ESRI ArcGISTM programs were used to calculate affected populations from the Oak Ridge National Laboratory's LandScanTM 2007 Global Population Dataset for areas affected by thermal, blast and radiation data.

**Results:** Trauma, thermal burn, and radiation casualties were thus estimated on a geographic basis for three Israeli and eighteen Iranian cities. Nuclear weapon detonations in the densely populated cities of Iran and Israel will result in an unprecedented millions of numbers of dead, with millions of injured suffering without adequate medical care, a broad base of lingering mental health issues, a devastating loss of municipal infrastructure, long-term disruption of economic, educational, and other essential social activity, and a breakdown in law and order.

**Conclusions:** This will cause a very limited medical response initially for survivors in Iran and Israel. Strategic use of surviving medical response and collaboration with international relief could be expedited by the predicted casualty distributions and locations. The consequences for health management of thermal burn and radiation patients is the worst, as burn patients require enormous resources to treat, and there will be little to no familiarity with the treatment of radiation victims. Any rational analysis of a nuclear war between Iran and Israel reveals the utterly unacceptable outcomes for either nation.

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## Figures

[](

**Figure 1**
Sensitivity of Fire Radii to different Values of Model Variables.

[](

**Figure 2**
**Iran – Map of all modeled detonations.** Showing the radiation exposure plumes from all of the nuclear detonations nationwide for this scenario.

[](

**Figure 3**
**Single 250 KT nuclear weapon detonation casualties for Arak, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 4**
**Single 500 KT nuclear weapon detonation casualties for Ardabil, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is relatively lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 5**
**Single 250 KT nuclear weapon detonation casualties for Hamandan, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 6**
**Single 500 KT nuclear weapon detonation casualties for Rasht, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 7**
**Single 500 KT nuclear weapon detonation casualties for Reza Iyeh, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 8**
**Single 500 KT nuclear weapon detonation casualties for Kerman, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 9**
**Single 100 KT nuclear weapon detonation casualties for Qazvin, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 10**
**Single 250 KT nuclear weapon detonation casualties for Yazd, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 11**
**Single 500 Kt nuclear weapon detonation casualties for Zahedan, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 12**
**Multiple detonation casualties for one 50 Kt, one 100 Kt, one 250 Kt, one 500 Kt nuclear weapon, Karaj, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 13**
**Multiple detonation casualties for three 100 Kt nuclear weapons for Bandar Abbas, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 14**
**Multiple detonation casualties for two 500 Kt nuclear weapons for Esfahan, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 15**
**Multiple detonation casualties for three 500 Kt nuclear weapons for Mashad, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 16**
**Multiple detonation casualties for two 500 Kt nuclear weapons for Shiraz, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 17**
**Multiple detonation casualties for two 500 Kt nuclear weapons for Tabriz, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 18**
**Multiple detonation casualties for one 250 Kt and one 500 Kt nuclear weapon for Ahvaz, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 19**
**Multiple detonation casualties for three 250 Kt nuclear weapons Kermanshah, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 20**
**Multiple detonation casualties for five 100 Kt nuclear weapons for Tehran, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 21**
**Multiple detonation casualties for five 250 Kt nuclear weapons for Tehran, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 22**
**Multiple detonation casualties for five 500 Kt nuclear weapon for Tehran, Iran.** Rings display trauma causalities for 8.1 and 3.0 psi, and 2nd degree burns. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 23**
**Israel – Map of all modeled detonations.** Showing the radiation exposure plumes from all of the nuclear detonations nationwide for this scenario.

[](

**Figure 24**
**Single 15 Kt nuclear weapon detonation casualties for Beer-Sheva, Israel.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 25**
**Single 15 Kt nuclear weapon detonation casualties for Haifa, Israel.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

[](

**Figure 26**
**Multiple detonation casualties for two 15 Kt nuclear weapons for Tel Aviv, Israel.** Rings display trauma causalities for 8.1 and 3.0 psi, 2nd degree burns, and the outer ring is lower trauma casualties for 0.6 psi. Radiation exposures are delineated by color in the dispersion plume.

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## References

1.       1.    Dallas CE, Bell WC. Prediction Modeling to Determine the Adequacy of Medical Response to Urban Nuclear Attack. Disaster Med Public Health Prep. 2007;1(2):80–89. doi: 10.1097/DMP.0b013e318159a9e3. - [DOI]( - [PubMed](

2.       1.    Bell WC, Dallas CE. Vulnerability of populations and the urban health care systems to nuclear weapon attack – examples from four American cities. Int J Health Geographics. 2007;6(5):1–33. [ [ "External link:  - [PMC]( - [PubMed](

3.       1.    Cordesman AH. Iran, Israel and Nuclear War. Washington, D.C: Center for Strategic and International Studies (CSIS); 2007. [ [ "External link:

4.       1.    CIA Factbook. Washington D.C; 2009. [ [ "External link:

5.       1.    Dolan P. Capabilities of Nuclear Weapons, Defense Nuclear Agency Effects Manual Number 1 (EM-1) Washington, D.C: Defense Nuclear Agency; 1972.

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