‘Worst-case scenario’: Middle East nuclear concerns haunt top health officials

World Health Organization officials are preparing for a nuclear catastrophe if the U.S.-Israel war with Iran escalates further.

U.N. staff are monitoring the fallout of U.S-Israeli attacks on Iran’s atomic sites and remain “vigilant” for any type of nuclear threat, Hanan Balkhy, WHO regional director for the eastern Mediterranean, told POLITICO.

“The worst-case scenario is a nuclear incident, and that’s something that worries us the most,” Balkhy said. “As much as we prepare, there’s nothing that can prevent the harm that will come … the region’s way — and globally if this eventually happens — and the consequences are going to last for decades.”

Staff are prepared for a nuclear incident in its “broader sense,” including an attack on a nuclear facility or the use of a weapon, Balkhy said. “We are thinking about it, and we’re just really hoping that it does not happen.”

U.S. President Donald Trump has vowed to “eliminate the imminent nuclear threat posed by the Iranian regime,” though he has provided no evidence that Tehran was developing a nuclear weapon.

Last June, the U.S. in coordination with Israel targeted nuclear infrastructure throughout Iran. The Atomic Energy Organization of Iran confirmed that attacks took place at its Fordow, Isfahan and Natanz sites. The U.S. and Israel have continued to target nuclear sites since they launched their new offensive on Feb. 28.

U.S. President Donald Trump is seen during the his departure the White House en route Hebron, Kentucky on March 11, 2026, in Washington DC. | Celal Gunes/Anadolu via Getty Images

Israel and the United Arab Emirates also have nuclear facilities within range of Iran’s missiles, though there are no reports of these being targeted. Israel is itself widely believed to have a significant arsenal of nuclear weapons.

To date there have been no reported signs of radioactive contamination anywhere in the region. But if a nuclear incident did expose people to dangerous levels of radiation, it would risk causing significant immediate trauma to their lungs and skin, and heighten the danger of developing cancer and mental health problems, Balkhy explained.

The 1986 nuclear accident at the Soviet nuclear plant in Chernobyl, Ukraine officially caused around 30 deaths in the first few months, and later contributed to a surge in thyroid cancers, numbering in the thousands, and to high anxiety among the local population over the following decades.

“I think those who read the history of previous incidents, whether intentional or accidental, are very aware of what we’re talking about,” Balkhy said. An estimated 110,000 to 210,000 people died from the U.S. nuclear attacks on the Japanese cities of Hiroshima and Nagasaki in 1945.

As the war continues, some senior figures have begun to speculate on the use of nuclear warheads. David Sacks, Trump’s AI adviser, said he worried about “Israel escalating the war by contemplating using a nuclear weapon.” Trump rubbished the suggestion, telling reporters: “Israel wouldn’t do that.”

The WHO is refreshing its staff on how to respond in the event of a nuclear incident, including providing advice to officials on the public health risks and what measures people should take to protect themselves. 

Smoke rises after airstrikes in Tehran, Iran on March 13, 2026. | Fatemeh Bahrami/Anadolu via Getty Images

Balkhy also warned there could be significant health impacts, such as respiratory illness, from the attacks on Iranian oil facilities earlier this month that have covered Tehran in smoke.

Attacks on health systems

Meanwhile, the WHO has continued to decry attacks on health infrastructure in the region.

The WHO has so far recorded 46 attacks on health workers in Iran and Lebanon, with 38 killed, since the war began on Feb. 28. Israel killed 14 health workers in Lebanon in two strikes on March 13, including an attack on the Bourj Qalaouiyeh primary health care center in the south of the country.

In a follow-up statement to POLITICO, Balkhy called the attacks “tragic and unacceptable,” adding that health workers must be protected under international law “at all times.” Health workers and United Nations officials have previously accused Israel of systematically destroying Gaza’s health system.

Israel has denied that charge, typically stating the attacks are justified on military grounds or, such as in the case of a deadly double-tap strike on Nasser Hospital last year, a “tragic mishap.” By mid-2025, 94 percent of Gaza’s hospitals had been damaged or destroyed, according to the WHO.

Kuwait reported on March 17 that two paramedics were injured when shrapnel from an Iranian attack fell on a medical center.

A view of tents as Lebanese families who were forced to leave their homes due to Israeli attacks, took shelter in a school building in the Dahieh district of the capital Beirut, Lebanon, on March 15, 2026. | Houssam Shbaro/Anadolu via Getty Images

Health ministries in Iran and Lebanon reported 1,444 and 886 civilian deaths, respectively, as of March 17. Lebanon says 107 children have died from the latest bombardment.

The United Nations estimates that between 600,000 and 1 million Iranian households have been temporarily displaced, while there are 946,000 self-registered displaced individuals in Lebanon, according to figures provided to POLITICO by the WHO.

The Israeli Ministry of Health does not include casualties in its daily updates on the war. As of March 8, the government said 13 people had been killed.

The fragile health system in Lebanon, which was already under severe pressure before the latest attacks from Israel, is struggling to deal with the large numbers of displaced.

“You’re talking about access to good food, clean water, the disruption of medical care provision, whether it’s childhood immunizations, whether it’s access to their medications, the dialysis patients, the cancer patients, it will have a huge toll on the people of Lebanon,” Balkhy said.

An ambulance belonging to the Islamic Health Organisation seen outside Jabal Amel Hospital after an Israeli airstrike in Tyre, Lebanon on March 17, 2026. | Sally Hayden/SOPA Images/LightRocket via Getty Images

The conflict is also exacerbating a Palestinian health crisis, with heavy restrictions on the amount of aid entering Gaza, Balkhy said. The WHO has reported critical shortages of medicines and medical supplies in Gaza, despite Israel saying there is enough aid entering the territory to meet humanitarian needs.

The Palestinian Ministry of Health, meanwhile, says there are zero stocks of 46 percent of essential medicines.

The scale of destruction in Gaza was so overwhelming, Balkhy said, that it would take “billions of dollars” and “decades to re-establish a dignified environment for these people to live in.”