Goiania Radiation Incident: When Greed and Ignorance Combine to Lead to Tragedy
What can lead to large-scale radiation contamination of the area? It seems that the answer to this question is quite simple and, if we are talking about the peaceful use of the atom, it lies in the area of the activities of the nuclear industry and energy - nuclear power plants, uranium enrichment plants, radioactive waste storage facilities, etc. At least, accidents at these facilities often become the cause of environmental pollution with all the attendant consequences.
However, an incident that occurred in the Brazilian city of Goiania in 1987 clearly shows that to create a local mini-Chernobyl with human casualties and dozens of victims, neither a nuclear reactor nor any leak from a hazardous materials storage base is required. It is enough to have two not very educated, but very eager for free scrap metal people and one medical device.
prehistory
In order to get at least a general idea of why such an incident was possible at all, one needs to pay attention to the local specifics of the region - a lot will immediately become clear. The fact is that Goiânia, although a large city with a population (at that time) of more than a million people, was highly differentiated in terms of living standards. Relatively rich areas in it were combined with almost slums, the residents of which were mostly below the poverty line.
Many of them did not even have a basic level of literacy, that is, they simply could not read or write. Accordingly, they could not have any basic knowledge of what radiation is and how it harms the body - and they probably mistook the familiar "radiation" sign in the form of three diverging rays for some kind of fan icon. Therefore, it is not surprising that this tragedy occurred in exactly this area.
It is worth adding that the population of poor areas was generally inclined to religiosity and mysticism. At first glance, this has nothing to do with the tragedy, but in many ways this circumstance contributed to the spread of radioactive contamination. However, more on that later, and now let's move on to what started it all.
Surely many people, even those not particularly versed in medical topics, know about radiotherapy of oncological diseases. Its main goal is to locally stop the division of cancer cells (and kill existing ones) by destroying their DNA with radiation. One of the methods of such treatment is remote irradiation of the tumor with an external source of ionizing radiation, which is some radioactive isotope.
This method of cancer radiotherapy was used by a private medical institution, the Goiani Institute of Radiotherapy (GIRT), which had been operating in Goiania since the 1970s. To carry out this type of activity, the institute had at its disposal two specialized installations, officially registered with regulatory authorities: one with a source based on cobalt-60, and the second on cesium-137, which caused the Goiani local Chernobyl.
Radiotherapy unit
This radiotherapy unit was manufactured in Italy by Barazzetti & Company in the 1950s and sold to GIR by Generey SpA. It is a vertical stand on which is mounted an irradiation head consisting of a radiation shield and an exit window at the bottom through which ionizing radiation affects the human body.
The capsule with the radioactive substance is placed on the source wheel, made of lead and stainless steel, forming a mechanism with a rotating shutter. To release the radiation to the outside, the shutter is rotated by an electric motor in order to align the capsule with the radiation equipment - the beam exit hole. Between the rotating shutter and the electric motor drive is a cylindrical protective plug. These elements are collectively called a rotating assembly.
Inside the capsule is 137 grams of cesium-93 salt (the capsule was produced in the 70s in the USA), similar in appearance to rice grains. Its activity was at a level of approximately 50 TBq - 50 trillion disintegrations per second, and the dose rate at a distance of a meter was 4.56 gray per hour. To understand how "evil" the contents of the capsule are in terms of radioactivity: a dose of 6-8 gray can already become lethal.
Rotating assembly of radiotherapy unit
And this radioactive "good" suddenly became completely ownerless, since at the end of 1985 GIR was forced to suspend its activities. This did not happen because of bankruptcy - the institute was simply asked to leave the premises through the court (the initiator was a religious organization - the owner of the land). At the same time, during the move, a property dispute arose, as a result of which GIR was able to take only the cobalt installation for radiotherapy.
The cesium capsule remained in place practically unguarded - the room where it was kept, according to the IAEA report, was regularly frequented by vagrants and other marginal individuals. So cesium contamination of the area, if they tried to open the capsule, was only a matter of time.
What 93 grams of cesium-137 did
On September 13, 1987, two unemployed and freeloading friends, Roberto Dos Santos Alves and Wagner Mota Pereira, decided to make some money from the scrap metal left in the empty premises of the clinic. Having broken in, they found the ill-fated radiotherapy unit. They were especially taken with the shiny (stainless steel body) rotating assembly, which the looters separated from the radiation head using tools they had brought with them, and took away in a wheelbarrow to Alves' house.
It is noteworthy that, although the rotating assembly with the source was not completely disassembled, both friends managed to receive a decent dose of radiation - for three days both suffered from vomiting, and Pereira developed severe dizziness, diarrhea, and a severely swollen arm (the initial stage of a radiation burn). On September 15, he even went to the hospital, but the doctors there attributed all the symptoms to an allergy and advised him to simply lie down at home and not to exert himself physically.
The building of the clinic from which the radioactive element was stolen
On September 18, Alves, apparently suffering less from radiation sickness than his comrade, decided to see what they had stolen. Having placed the assembly under a mango tree in his yard, he tried to pull out the rotating wheel of the radioactive source shutter. In the end, he succeeded, after which Alves pierced the exit window of the capsule with a screwdriver, from which cesium-137 poured out.
How much cesium-137 spilled out is anyone's guess, but it later turned out that almost the entire yard and even Alves' house were contaminated with radioactive dust. In addition, the wind and rain also did their job - they carried the cesium far beyond the boundaries of the home. But that's not the worst of it, since Alves, not finding anything useful in the find, handed it over to a local scrap metal dealer, Devar Ferreira.
And that's where it all began. Walking through his garage at night, where he kept scrap metal, Ferreira noticed that the contents of the rotating assembly (the capsules in it) were glowing bluish. Thinking that the cesium-137 grains were precious stones or even a magical substance, he brought them home and for several days distributed them to relatives, friends and acquaintances, some of whom (hello to the lack of knowledge and belief in magic) even rubbed their skin with the glowing powder like carnival makeup.
The distribution of cesium-137 among people
On September 22, Ferreira decided that the rotating assembly would be a good idea to sell, as it contained a fair amount of lead. To get it out, he called in two young workers who began to open it up. Then, on September 25, Ferreira sold the lead and the rest of the source assembly to another buyer of scrap metal and other recyclable materials for recycling.
By September 28, signs of radiation sickness (vomiting, diarrhea, burns, etc.) began to appear in one way or another in a large number of people - all those who had come into contact with the cesium salt. Maria, Ferreira's wife, also feeling unwell, was the first to guess that the mass illness of relatives and friends was connected with those very glowing grains. Taking a travel bag, she and her husband's worker went to the warehouse of the recyclables buyer to whom Ferreira had recently sold the emitter.
Having put the fragments of the rotating assembly in a bag, Maria and her assistant took a bus to the local health department. Entering the office of one of the doctors, she put the bag on his desk with the words: "This is killing my family." After a short hesitation, the doctor (who received a dose of 1,3 Gy while the bag was standing nearby) decided not to tempt fate and took the bag into the yard, placing it on a chair near the outer wall of the building.
Having urgently sent Maria and her assistant (while he was dragging the bag, he managed to receive almost half of the lethal dose of radiation - about 3 Gy and a severe burn on his shoulder) to the Health Center, he contacted the Toxicology Information Center and reported that they had possibly brought him some remnants of X-ray equipment.
At the same time, a doctor from the hospital for tropical diseases, where other people with radiation burns from the ill-fated cesium-137 were being treated (they were sent there because they were thought to have some kind of malaria or something similar), contacted the toxicology center and said that the skin lesions did not at all resemble an infection, but were very much like the effects of radiation.
Here we must give credit to the professionalism of the doctors. Realizing that it smelled like a large-scale catastrophe, they invited a medical physicist to measure the radiation background from the bag Maria had brought. During the first measurement, the specialist's radiometer simply went off the scale even before approaching the bag, which was taken for a malfunction. The second device showed the same results, and then the scale of what had happened began to become clear.
As a result of background measurements at scrap metal dealers' warehouses and their homes, as well as interviews with witnesses, it became clear that this matter would not end so easily.
Determining the scale
A number of dosimetric measurements of houses where the victims lived, as well as public places (streets, etc.) showed that the main contamination with cesium-137 salt, although local and covering an area of about one square kilometer, but the radioactive dust is spread over several blocks. Accordingly, it was logical to assume that there are many dozens of people with internal irradiation and external contamination.
Pollution zones of the area
On September 29, the Brazilian government urgently mobilized all special services: police, firefighters, and doctors. To prevent further spread of radioactive pollutants, the authorities ordered security forces to cordon off the entire suspected "dirty" area, prohibiting entry without a special pass.
To ensure dosimetric control, a sort of transit point was set up at the local Olympic stadium, where citizens from the affected area were carefully examined by dosimetrists to detect internal and external radiation from cesium. As panic grew, people flocked to the stadium to get tested, even without any reason. A total of 112 people were tested.
Dosimetric control at the Olympic stadium
Despite the fact that hundreds and even thousands of dosimetric measurements were taken in the houses and streets of the "dirty" area, it was impossible to get a general picture without dosimetry from the air. For this, a helicopter equipped with a gamma spectrometer based on a sodium iodide crystal was used.
Flying at an altitude of about 40 meters above the ground, the helicopter conducted research on 67 square kilometers of terrain. The flyby generally yielded the same results - nothing significant was found except for one "spot". Later, a car was used with a sensor from the helicopter installed on it, additionally reinforced with a spectrometer on a smaller crystal and Geiger-Muller counters. Like the helicopter, the car made measurements in real time, but from the ground, driving around the area.
A vehicle with installed dosimetric equipment
Injured
Of the total number of people examined by dosimetrists, 249 people were found to have been exposed to internal or external radioactive contamination. Of this number, 129 people were exposed to both internal (ingress of cesium into the body) and external contamination. Of these, 49 people were hospitalized - 22 victims required intensive care.
There were ten particularly severe patients. Of these, four died:
The wife of the buyer Ferreira, Maria. During all the time of "playing" with the magic grains of cesium-137, she received a dose of 5,7 gray. She showed signs of illness even before she decided to take the capsule with cesium to the health department - even her mother came to look after her, having also received a considerable dose. But the mother survived, but Maria died on October 23, 1987, at the age of 38.
Ferreira's brother's daughter was a six-year-old girl. Her father gave her some cesium-137 grains as a toy, saying, look how beautifully they glow. As a result, after playing with them (the grains easily crumbled into dust), the girl took a sandwich with unwashed hands and ate it, swallowing quite a bit of radioactive material along the way. She received a dose of 6 gray. She died on October 23, 1987.
Two young men, workers at Ferreira's warehouse, dismantling a rotating assembly to remove the lead casing. They received doses of 4,5 to 5,3 gray. One was 22 years old, the other 18 years old - they died one after the other. The first on October 27, 1987, the second on October 28.
What is remarkable is that both the two looters who stole the radiotherapy unit and Ferreira, who distributed cesium-137 to his family and friends, survived. Although they received fairly high doses of radiation, which certainly affected their health.
As for the treatment of the victims, their very presence in medical institutions required special protective measures. The fact is that the level of internal contamination was so high that even the patients' sweat was especially dangerous. An even greater danger was posed by excrement, through which cesium was actually removed from the body. Flushing this waste down the toilet was strictly prohibited, since there was a risk of radiation contamination of wastewater and then rivers.
Instead of the usual sanitary ware, latrines for patients were equipped with special containers. The 350 kg of feces and 3 cubic meters of urine that had accumulated had to be decontaminated by filtration and the use of quicklime and cement. Contact with patients and their excreta, medical workers received a dose of about 5 mSv (500 mR) over several months.
To speed up the removal of cesium-137 from the body, Brazilian doctors used Prussian blue in huge doses - from 1 to 10 grams per day. Based on the fact that with such quantities of the drug there was a risk of side effects, the condition of patients was monitored around the clock by a special medical team. In general, Prussian blue showed good results, but it took years to completely remove cesium-137 from the human body.
Deactivation
Hundreds of people took part in the decontamination activities. During the work, 85 heavily contaminated residential buildings were discovered, of which 41 buildings were subject to evacuation. To determine the radiation background, specialists selected the "cleanest" point outside the building, but with the condition that the distance to it was small enough to stick a radiometer through the window. Then all the things inside the building were checked. Furniture, household items, etc. contaminated with cesium were taken out and sent for burial.
Demolition of Alvarez's home after he uncovered a rotating assembly in his yard
"Clean" items were wrapped in polymer film to prevent radioactive dust from getting on them. Then the room was cleaned with a specialized vacuum cleaner, all surfaces were washed, paint was stripped from the walls and floors, and ceramic tiles, if any, were washed with a mixture of Prussian blue and acid. The outside of the roofs of the houses were washed with a special compound (in some places it was necessary to completely re-roof them), and their surfaces were "vacuumed" from the inside.
More than ten buildings, including houses, could not be washed. As a result, they were demolished. At the same time, the place where the building had previously been was either concreted or covered with clean soil. Also, spots of radiation contamination were found in the areas around houses, on sidewalks, in bars, shops and on the walls of houses at a great distance from the epicentre of the tragedy. Everything that could be "washed" was washed, soil from the yards was cut off and taken to the burial ground. Also, about 50 contaminated cars were found that required decontamination.
The liquidators also had to work with the local vegetation: branches with leaves that had already accumulated cesium were cut off from trees and bushes. The fruits of all agricultural plants in the contaminated area were removed so that cesium would not enter the bodies of people and animals along with them.
Loading soil contaminated with cesium-137 into barrels
A remote location 20 kilometers from Goiânia was chosen to store the radioactive waste generated during the decontamination of the area and the treatment of people. The waste was classified as non-radioactive, low-level, and medium-level. Non-radioactive and low-level waste was loaded into metal barrels with a capacity of 40, 100, and 200 liters, as well as metal boxes with a capacity of up to 5 tons.
Much of this waste class consisted of bales of paper taken from the warehouse of a scrap dealer to whom Ferreira had sold the remains of a rotating assembly of a radiotherapy machine. These were placed in shipping containers for temporary storage and subsequent processing. The intermediate-level waste, which posed the greatest danger, was placed in 200-liter drums, which were then installed in protective “cups” made of reinforced concrete with a wall thickness of 200 mm.
Temporary storage facility for radioactive waste
The transportation of waste with a total volume of about 3500 cubic meters to a temporary storage site took place from October 25 to December 19 and required 275 full loads of trucks. However, the entire range of activities related to the liquidation of the consequences, including the organization of a permanent underground waste storage site, as well as radiation monitoring and treatment (health monitoring) of the victims, dragged on for years.
Conclusions
In fact, what happened in Goiânia was the largest radiation incident in Brazil — even the IAEA assigned it a hazard level 5 as an accident with wide-ranging consequences. To put it into perspective, the Kyshtym accident, when a large release of radioactive waste occurred at the Mayak plant in the USSR, contaminating vast territories, was assigned a level 6.
Only in Goiânia, it was not the nuclear power plants or nuclear fuel factories that were guilty, but simple uneducated lovers of freebies. It is worth adding that no one received real prison terms - not even those two unlucky looters who decided to profit from the abandoned buildings of the GIR. Although the Institute of Radiology itself did pay a fine, but a relatively small one.
In general, it remains to add that it is clearly not worth taking apart something whose contents you are not sure of. And this applies not only to radiotherapy installations - even old wrist and wall clocks, compasses and various measuring devices can be dangerous, since in the past, radium-based luminescent mass was actively used to paint the hands and scales of devices (so that they glowed at night), which crumbles over the years and turns into deadly radioactive dust.
Source of information and images:
"The Goiania Radiation Accident" (Russian version). International Atomic Energy Agency, Vienna. 1989.
Information