We aimed for a quantitative evaluation that justifies guidelines for evacuation which take into consideration both the human and economic costs. To the best of our knowledge, such an evaluation has not been performed yet. The present guidelines published by the International Atomic Energy Agency (IAEA) are probably based on averting radiation risk only; IAEA did not cite any quantitative estimation of the human cost of evacuation.
Quantitative estimation of the human and monetary costs of evacuation and, alternatively, the human and monetary costs of radiation exposure (non-evacuation). Associating human life with monetary value is psychologically difficult and somewhat challenging ethically; however, there is no escape from such an association (cost-effectiveness analysis) when making decisions regarding public health and safety, since extraneous public expenditures lead to a statistical life shortening. Estimating worst-case health consequences of irradiation, we used the conservative linear no-threshold (LNT) model because this model is widely used in spite of its controversy. In our estimation of the human cost of evacuation, we considered three factors: (a) direct loss of life (after Fukushima, 1% of the evacuees died within 2 years due to causes directly related to their evacuation), (b) loss of quality of life, and (c) loss of wealth leading to loss of life. The connection of economic loss with loss of life was performed according to the median cost-effectiveness threshold of 50-100 thousand USD per quality-adjusted life year.
Even according to mortality calculations based on LNT, the overall loss of life due to evacuation is higher than the loss of life due to irradiation if the population-averaged first-year radiation dose is 500 mSv or less.
Based on the performed analysis, we suggest avoiding evacuation if the projected first-year dose is below 500 mSv. This suggested action level is about five-fold higher than the action level presently recommended by the IAEA (100 mSv per year).

The management of mass fatalities following disasters is a complex process which requires the involvement of multiple stakeholders and resources. A garbage dump at Meethotamulla in Sri Lanka suddenly collapsed, resulting in the death of 32 individuals. Efforts to implement best practice guidelines in Disaster Victim Identification (DVI) during this disaster revealed several important aspects that need to be considered by the forensic community. Delays in initiating the legal processes to investigate and manage the incident resulted in public dissatisfaction towards the post-disaster management process. Body recovery by Police and military personnel without the involvement of medical teams had numerous shortcomings including the lack of proper tagging and photography, commingling of body parts, and non-preservation of personal items. Public expectation and demand for early release of the bodies conflicted with the necessity to undergo a stringent DVI process according to best practice guidelines. Many adaptations and alternate strategies were necessary to ensure that DVI could be done scientifically. The use of primary identification markers including odontology and DNA had many limitations including non-availability of antemortem data, resource availability and cost. Identification was established using a combination of secondary identification markers including clothing, jewelry, scars, tattoos, morphological descriptions and circumstantial evidence. In two cases, odontological features further supported positive identification. Samples for DNA were obtained and preserved but were not utilized in establishing the identities. This paper highlights the need for better public awareness and multidisciplinary commitment in managing mass fatalities and also reflects on the challenges of implementing best practice DVI guidelines in low-resource settings with different legal and socio-cultural expectations.