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Iran continues to play a cat and mouse game with the U.N.’s International Atomic Energy Agency (IAEA) and with the United States. Early in October, when another secret site for enriching uranium was discovered, Tehran “magnanimously” agreed to certain future international inspections. To be sure, the actual promise of any such inspections, which was quickly and naively praised by both IAEA head Dr. Mohamed El-Baradei and U.S. President Barack Obama, will be effectively meaningless.

Back in July, U.S. Vice-President Joe Biden had courageously asserted that Israel, “as a sovereign nation,” has the right to protect itself against a nuclearizing Iran. In law, as my regular readers in The Jewish Press will quickly recognize, the precise protective action that Mr. Biden had in mind is called “anticipatory self-defense.” Subsequently, however, official Washington offered Jerusalem much less audacious advice than considering a permissible preemption. In essence, the current and still plainly futile message from this country remains tougher sanctions.

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On several occasions, of course, the so-called “international community” has already imposed “serious” sanctions against Iran. Nonetheless, uranium enrichment has only accelerated in that country. At no time, in fact, has Tehran shown even the slightest inclination to value a promised proper place in the world community more highly than getting “the bomb.”

In Israel, Prime Minister Netanyahu understands that his country can rely upon its anti-missile system for only a very limited measure of active defense. Israel’s ballistic missile defense (BMD) network, including even the Arrow, can never provide the Jewish State with adequate security from a nuclear attack on its civilian populations.

No country can be expected to cooperate in its own annihilation. Leaving Iran to the manifestly unpersuasive sanctions of the United States, and/or of the United Nations, could bring Israel to the outer limits of survival. If U.S. President Obama already understands this, and if he also genuinely cares about Israel’s survival, he would not now still be demanding that Mr. Netanyahu hew obsequiously to a discredited and banal policy of contradictory Iran options.

What does Israel really have to fear in a nuclear Iran? There are tangible and terrifying answers. Twenty-nine years ago, I published the first of nine books that contained informed descriptions of physical and medical consequences of nuclear war. These generic descriptions were drawn largely from a major 1975 report by the National Academy of Sciences, and included the following still valid expectations: large temperature changes; contamination of food and water; disease epidemics in crops, domesticated animals, and humans due to ionizing radiation; shortening of growing seasons; irreversible injuries to aquatic species; widespread and long-term cancers due to inhalation of plutonium particles; radiation-induced abnormalities in persons in utero at the time of detonations; a vast growth in the number of skin cancers and an increasing number of genetic disease.

Overwhelming health problems would afflict the survivors of any Iranian nuclear attack upon Israel. These problems would extend beyond prompt burn injuries. Retinal burns would occur in the eyes of persons far from the explosions. Many Israelis would be crushed by collapsing buildings and torn to shreds by flying glass. Others would fall victim to raging firestorms. Fallout injuries would include whole-body radiation injury, produced by penetrating, hard gamma radiations; superficial radiation burns produced by soft radiations; and injuries produced by deposits of radioactive substances within the body.

After an Iranian nuclear attack, even a “small” one, those few medical facilities that might still exist in Israel would be taxed far beyond capacity. Water supplies would become altogether unusable. Housing and shelter could be unavailable for hundreds of thousands, perhaps even millions, of survivors. Transportation would break down to rudimentary levels. Food shortages would be critical and long-term.

Israel’s complex network of exchange systems would be shattered. Virtually everyone would be deprived of the most basic means of livelihood. Emergency police and fire services would be decimated. All systems dependent upon electrical power could stop functioning. Severe trauma would occasion widespread disorientation and psychiatric disorders for which there would be limited therapeutic services.

Normal human society would cease. The pestilence of unrestrained murder and banditry would augment plague and epidemics. Many of the survivors would expect an increase in serious degenerative diseases. They would also expect premature death, impaired vision, and sterility. An increased incidence of leukemia and cancers of the lung, stomach, breast, ovary and uterine cervix would be unavoidable.

Extensive fallout would upset many delicately balanced relationships in nature. Israelis who survive the nuclear attack would still have to deal with enlarged insect populations. Like the locusts of biblical times, mushrooming insect hordes would spread from the radiation-damaged areas in which they arose.

Insects are generally more resistant to radiation than humans. This fact, coupled with the prevalence of unburied corpses, uncontrolled waste and untreated sewage, would generate tens of trillions of flies and mosquitoes. Breeding in the dead bodies, these insects would make it impossible to control typhus, malaria, dengue fever and encephalitis.

Throughout Israel, tens or even hundreds of thousands of rotting human corpses would pose the largest health threat. The survivors would envy the dead.

Interactions between individual effects of nuclear weapons would make matters far worse.Although any Israeli preemption effort would now encounter enormously serious operational difficulties, the Jewish State can never rely upon American or international guarantees, or even upon its own system of ballistic missile defense. In the best of all possible worlds, perhaps, Israel could comfortably renounce the current right to individual self-defense, and depend instead upon meaningful promises of collective security. But, surely, we do not yet live in such a world of reason and goodness.

So, what’s the bottom line? For now, Israel’s best hope would seem to lie in some prospect of internal Iranian reform, and Jerusalem should therefore do whatever it can to help along any such transformation. At the same time, it is entirely possible that the Islamic Republic of Iran will remain unchanged with respect to its basic critical stance on Israel, and that suitably enhanced forms of essential military preparedness will still have to be implemented in Israel.

As long as Israel can reasonably assume that any expected Iranian leadership will remain rational, Prime Minister Netanyahu could correctly focus on “living with a nuclear Iran.” Such a “coexistence” policy would represent a regrettable but largely unavoidable position, one that would need to be backed up with a selectively partial end to Israel’s “nuclear ambiguity” (the so-called “bomb in the basement”), and with genuinely credible threats of Israeli nuclear reprisals for nuclear aggressions. More precisely, these deterrent threats would have to include aptly explicit references to Israel’s nuclear targeting doctrine (“counter-city” or “counter-value,” never “counter force”), as well as compelling evidence of both the survivability and penetration-capability of Israel’s nuclear deterrent forces.

If, however, Israel cannot reasonably assume that all still-plausible Iranian leaderships will remain rational, Mr. Netanyahu would need to make highly informed judgments concerning the expected probability of Iranian leadership irrationality. Where such an expectation would be “low,” Israel could continue to rely in part upon the enhanced nuclear deterrence measures just discussed. There would also have to be a complementary and partial reliance upon Ballistic Missile Defense (BMD). But where such an expected probability would be deemed “high,” Israel could have absolutely no rational alternative to some form of preemption against pertinent Iranian nuclear assets or infrastructures.

For Israel, with regard to Iran, there are no easy choices and no good choices. Like it or not, therefore, in fulfilling his sacred and codified obligation to protect the Jewish State, Prime Minister Netanyahu will have to choose the least unattractive option.

LOUIS RENÉ BERES was educated at Princeton (Ph.D., 1971) and is Professor of International Law at Purdue. Born in Zurich, Switzerland on August 31, 1945, he is author of several of the earliest major books on nuclear strategy and nuclear war, including APOCALYPSE: NUCLEAR CATASTROPHE IN WORLD POLITICS (The University of Chicago Press, 1980), and SECURITY OR ARMAGEDDON: ISRAEL’S NUCLEAR STRATEGY (D.C. Heath, Lexington Books, 1986). Dr. Beres was also Chair of Project Daniel, a small private group that delivered its own special report on ISRAEL’S STRATEGIC FUTURE to former Prime Minister Ariel Sharon in January 2003. He is Strategic and Military Affairs columnist for The Jewish Press.

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Louis René Beres (Ph.D., Princeton, 1971) is Emeritus Professor of International Law at Purdue and the author of twelve books and several hundred articles on nuclear strategy and nuclear war. He was Chair of Project Daniel, which submitted its special report on Israel’s Strategic Future to former Israeli Prime Minister Ariel Sharon, on January 16, 2003.