Introduction

There seems to be two certainties in the Alexander Litvinenko case. The first is that he died from polonium-210 (210Po) poisoning . The second is that 210Po as a poison is almost 100% certain to kill anyone if ingested .

Alexander Litvinenko died on 23 November 2006, 22 days after first checking into the Bartnet General Hospital in north London . Alexander may have claimed that he was poisoned but he died not knowing what the poison was, a recurring theme of uncertainty and opaqueness consistent with a clandestine, radiological incident of suspected espionage.

On November 3rd, 2006 Litvinenko was admitted to the Bartnet General Hospital in north London with symptoms of vomiting, diarrhea, fatigue and abdominal pain which was evidence of Acute Radiation Syndrome in the prodromal phase . His condition deteriorated and he was transferred to the University College Hospital in central London on November 17th, alert but weak. Litvinenko would start experience hair loss and bleeding in the coming days. At the time he claimed in media interviews that he had been poisoned. Litvinenko showed all the symptoms of acute radiation syndrome, but no radiation had been detected at this point. According to Geoil Bellingan, the clinical director of the department of critical care at UCH, “The Geiger counter readings were negative”. 210Po is not detectable when digested in the human body which gives rise to suspicions of Cold War era espionage rather than terrorism .

Litvinenko became progressively worse and on November 22, was incubated and placed on mechanical ventilation. His vital organs failed one after the other, and in the end his immune system collapsed as his white blood cell count plummeted to virtually nil .

Britain’s Atomic Weapons Establishment confirmed 210Po was the radionuclide emitting alpha particles into his organs on November 23, but the news could not reach the hospital before Litvinenko could find out what killed him .

International Espionage

Using common profiling techniques, the following analysis provides additional information about the radiological event, its implications for public health and security, and the long term political and social consequences in the aftermath.

Adversary Target

Alexander Litvinenko is a former officer of the Soviet era KGB and a former Russian Federal Security Service agent (FSB). During the late 1990’s Litvinenko worked for the FBS organized crime unit assigned to combat corruption during the Russia’s transition to a free market economy. It is in this post that Litvinenko became aware of what is described as officials “lining their own pockets” and “settle accounts with undesirable persons.” Litvinenko became a fierce critic of Putin who he singled out in a bizarre press conference and personal accusations of being a pedophile that caused a media frenzy in . Litvinenko accused Putin publically of orchestrating the 1999 series of apartment bombings which Putin blamed on Chechen separatists, and had used to justify an invasion of Chechnya in that same year. Suspiciously a new Russian law authorizing the elimination of individuals outside of Russia, who the Kremlin accuses of terrorism or extremism, was passed close to the 2006 Litvinenko incident . These events all fueled Litvinenko worries and suspicious that his life may be in danger.

Target Location

Litvinenko is lured to the Millennium Hotel by Ex-FSB agent Kovtun, Andrei Lugovoi and potentially a third suspect Sokolenko who met with Litvinenko at the London hotel bar. The meeting was supposedly a business meeting and the perpetrators used social engineering techniques to fool Litvinenko into believing that the meeting was a legitimate. However, as Litvinenko explained to police during their investigation, he felt suspicious of the three men during the meeting. Allegedly the tea they offered was already on the table and he drank after they had already had their tea. The target location is important because it was in central London, one the worlds most visited cities and a hub for European and international business travelers. The suspects knew that they would need to travel internationally with the radioactive substance, and that it must not be detectable by ordinary means. Hence the choice to use 210Po which was hard to detect if at all since the alpha particles emitted only traveled less than 2cm.

Mode of Operation

The police report suspects that a poison must to have been administered in a cup of tea at the bar of the Millennium Hotel .  Litvinenko likely received an amount that would have fit on the head of a pin with room to spare, estimated to be in excess of 1 GigaBecquerels. Becquerel is the measure of alpha particle radiation per second and equal to 1 billion alpha particles emitted per second from the dose he estimated to have ingested . It is believed by investigators that the 210Po was dissolved in a tasteless liquid solution and slipped into his tea before or during his meeting with the Russian businessmen. While not toxic unless ingested, the 210Po would become highly toxic once it lined Litvinenko’s gastrointestinal tract, seep into his bloodstream and spread throughout his body, first targeting rapidly dividing cells like hair, skin, stomach, and bone marrow .

It would take only a few days to incapacitate Litvinenko, and as it would later be revealed, the medial staff could not detect or identify the source of radiation, even though the symptoms of radiation poisoning would be obvious.

Object in Crime

Nuclear physicists call polonium “the Terminator” because it is the final element created in the process known as slow neutron capture . However, it seems completely appropriate description for an advanced, sophisticated and certain killer poison when ingested. Polonium occurs naturally in the Earth’s crust as a by-product of the decay of uranium-238, and accounts for 1 percent of the total annual dose of background radiation. It is created by bombarding bismuth-209 with neutrons inside a nuclear reactor and is hard to find in high concentrations. Only about 100 grams are produced every year and of that most of it is produced in Russia for the purposes of static cleaning and industrial supplies . 210Po has a half-life of 138 days which means that half of the agent will decay in four and a half months . The properties of the radioactive agent expose some parts of the adversaries’ motives and intentions. They must have planned the event well in advance and rigorously. This also leads one to believe that the adversaries must have had access to classified and highly technical information if they were to survive the event themselves.

The choice of poising was no accident. Alpha, unlike Gamma and Beta particles are not able to pass through a sheet of paper and can therefore easily be transported with minimal (relative to situation) risk to the adversary if contained appropriately. However, when even a tiny quantity is ingested or inhaled, it has immediate and devastating biological consequences.

Timing

Litvinenko became ill on November 1, 2006 and went to the hospital with gastro intestinal symptoms on 3rd of November date.  The poisoning very likely occurred on November 1 or shortly before since Polonium poising shows symptoms consistent with those of Litvinenko. He could have been poisoned on 1 November 2006, where he accepted an offer to meet Lugovoi and Kovtun, former Russian agent turned businessman, at the Millennium Hotel bar.

The suspects perpetrators would have ample time to dispose of the agents in the hotel room bathroom, where evidence of the substance was found. They must have known that the tea cups would be washed by the dishwashers at the hotel several times before anyone would discover the alpha particle radiation, and therefore the trail and timeframe of the event could not be proven concretely. This lack of concrete evidence would later create a tuff between Russian Authorities who would not extradite their citizens because evidence was not sufficient, and British Authorities who claimed that it was sufficient for the suspects to stand trial.

Motive

According to Alexei Kondaurov, a former KGB general who is now a parliamentarian critical of Putin’s government “You only need exotic ways of killing people when you don’t want the truth to be revealed” . Attempting to hide or obscure the truth behind a crime or act of terrorism is surefire modus operandi in cases of sophisticated, organized or politically motivated criminal acts including espionage. It is for this reason that the investigation suggests foul play by powerful actors tied to the event by means of association and support.

No arrests have been made for the murder of Litvinenko, and therefore there has been no trial. The information known about the motive is limited to what was released by the authorities in the UK.  There are many theories about the assassination of Litvinenko. It is possible that the motive of the to set an example, punishment for a ‘traitor’ – Alexander fled from court prosecution in Russia and received political asylum in the United Kingdom, he had become a fierce critic of the Kremlin. Also interesting is that it emerged later that former Russian spy Alexander was allegedly being paid by a British secret service MI6, adding to the spy drama.

The amount of 210Po used to poison Litvinenko was so great that he had no hope of survival. According to James Geary and Victor Akunov in the article the “First Assassination of the 21st Century”, Litvinenko would become the first known person to have died of 210Po exposure, and the first to be murdered with it . The obscure choice of poison and arcane nature of the incident is a chilling reminder of Cold War era espionage. The intent to intimidate an extremely select number of individuals that are not part of the general public or even ordinary officials, seems undeniable, targeted, and even personal. If the purpose of the assassination was to send a warning to other dissidents as Litvinenko suggested in previous attacks on Putin’s controversial laws, the assassins chose their weapon wisely. 210Po creates all the terror of a nuclear strike without the risk of massive fatalities .

Comparative historical examples

There have been several similar incidents of radiation poisoning in the past. One specific noteworthy incident is that of late president of the Palestinian Authority, Yasser Arafat.  Arafat died in November 2004 a month after a sudden onset of symptoms including severe nausea, vomiting, diarrhea and abdominal pain, followed by multiple organ failure and death. In 2011 traces of 210Po was found on his clothes and after his body was exhumed in 2012, abnormal levels of 210Po was found in his remains and tomb. However, the absence of myelosuppression and hair loss compared to Litvinenko’s symptoms, could be explained by differences in the time delivery-scheme of intake. The Bayesian statistical analysis moderately supported the suspicion that Arafat was intentionally poisoned by 210Po .

In 1957 Nikolai Khokhlov a former agent turned Russian critic took part in an anti-Soviet conference in Frankfurt, Germany. Shortly after sipping coffee that was given to him, he felt ill losing clumps of hair and strange legions on his face. Doctors at an American military hospital eventually identified radioactive thallium and managed to save his life . Radioactive thallium was initially suspected to be the radioactive agent used to poison Litvinenko.

Since the fall of the Berlin wall, many revelations were made about the use of the secret services agents in the German Democratic Republic, Bulgaria and Russia about deliberate radiation of prisoners in jail cells, cars that attempted to hide passengers needing to cross the borders to the West, and attacks on individuals suspecting of trading secrets with the West. Several people allegedly lost their lives by means of radiation poisoning in the 1970’s to 1990’s .

Analysis of steps taken by law enforcement

From November 23, when the agent was identified as 210Po. the British Health Protection Agency monitored 40 sites where at least 20 sites had significant levels of 210Po contamination. The HPA tested urine samples of about 700 people of which the highest dose assessed was about 100 mSv .

Britain officially requested the extradition of Russian businessman Andrei Lugovoi on May 22nd 2007 who had at least a dozen meetings with Litvinenko in London the prior year. This was however declined by the Russian government citing a text in Russian law that prevents Russia from extraditing its citizens to foreign countries .

According to the article Polonium Papers that appeared in the Nation on June 18th, 2007 neither Russia nor Britain was forthcoming with information. Russia’s Prosecutor General Yury Chaika claimed that Britain had not provided evidence of the case against Lugovoi nor has it seen a medical report on the cause of Litvinenko’s’ death. Therefore, no case was filed against Lugovoi in Russia. Meanwhile in Britain, the coroner’s report was not released and there is therefore no official report on Litvinenko’s cause of death and therefore nobody was indicted .

Shortcomings, errors and correct judgement in the Alexander Litvinenko Case

Even though doctors immediately identified the symptoms as that of radiation positioning, it was not possible to identify 210Po as the radioactive substance. This was partly due to no former 210Po incident ever being recorded and because the alpha particle emission range was a very small area, less than 2cm .

Police were concerned that the public may have been exposed and healthcare workers may have been on contact with Litvinenko’s body fluids which would have been highly radioactive at the time. The immediate response was to identify contamination locations, communicating technical and medical information to governments and the public. Scenarios of

It took the investigators some time to complete the investigation and there was a 3 months’ period of time where no information was provided.

Public health perceptions and consequences

According to two studies from the literature review, it appeared that the public were well informed by the Health Protection Agency and that there was a satisfactory level of trust in the information that was disseminated. It was found in a survey that at least 11.7% of the sample perceived some risks to their personal health, while 71% of the sample knew that there is no risk to their personal health unless they were at least in one of the contaminated areas and more specifically has come in contact with the contaminant directly .

Perceptions of risk can lead to anxiety and behavioral changes in the general public. It is therefore important to understand how the public perceives a hazard so that appropriate medical, social, and economic effects are taken into account . In the case of the Litvinenko incident, the media and public generally perceived the adversarial motive to be politically motivated, an act of espionage, or a crime . During the investigation that ensued, several locations were shut down, hotel room doors removed and disposed of as radioactive waste, and some rooms in London hotels are still out of service.  Litvinenko’s home and office were contaminated, as were airplane seats, taxis and even parts of a soccer stadium . Despite radiation consistently rated as one of the most feared environmental hazards, it is surprising that rates of perceived risk were not higher, even when there was no risk of contamination. According to Paddy Regan, a lecturer in nuclear physics at the University of Surrey outside London “Polonium is useless as a weapon of mass destruction”. If it had been poured into London’s water supply instead of Litvinenko’s tea, it would have dispersed so quickly that no one would have received a dangerous dose .

Generally, when the perception is that a radiological incident was the result of terrorism, the publics anxiety and concern about personal health could be expected to increase . The media and health authorities in the UK effectively staved the public’s perceptions of risk to personal health by confirming that the incident seemed to have been targeted only to Litvinenko. There seems to be a perception that if the adversaries were terrorists, then the public health risk must be greater than when the adversaries’ goals were espionage because there is an association with the possibility of future incidents . This is particularly true for London residents that experienced the London Underground train station bombings only 17 months prior on July 7th, 2005.

In the end, one man’s murder became a glimpse into the new world of highly technical, sophisticated assassinations where hit men have access to terrible weapons .

Recommendations for mitigation

Public perceptions about radiological, and other incidents, are likely to change quickly and without warning as new information becomes available or when the media reports related stories. This change in circumstances must be considered carefully and plans must be prepared in advance of any incident. Ongoing consultation with stakeholders, in particular those on the receiving end of this information, should help to prevent and correct any similar problems in the event of a future incident .

“Once gamma was eliminated,” Beilingan from the UCH says, “we were looking at all toxic agents. But the list of possible agents was very, very long” . Litvinenko’s case is unique in that 210Po was never before used in a poisoning and it is therefore not surprising that the doctors could not immediately identify it. However, it does raise the questions of how prepared any medical team in any hospital would be if another incident occurs? From the lessons it became clear that if the Geiger counters failed to pick up any telltale gamma radiation, which is the easiest kind to detect, additional tools or equipment were limited to detect internal radiation poisoning, and the quantities that were ingested by Litvinenko. The initial hypothesis was radioactive thallium was used in the poisoning, but after this was ruled out, Beilingan’s team were baffled . It finally took a urine sample from Britain’s’ Atomic Weapons Establishment (AWE) to detect the alpha particle radiation of the decaying 210Po. 201Po can only be detected by urine tests and the conventional radiation testing at hospitals will test for easily detectable gamma rays, which in the Litvinenko case would have not been effective .

Because of the circumstances surrounding Litvinenko’s poisoning in a London hotel, one of the worlds most visited cities, an integrated response was necessary. The confirmation of toxic levels of 210Po in the patient led to the establishment of an integrated multi-agency public health emergency response, including implementation of national government emergency preparedness plans .

An analysis of the United States CDC responses to the incident following Litvinenko’s death “Death by Polonium-210: lessons learned from the murder of former Soviet spy Alexander Litvinenko” by Robin B. McFee and Jerrold B. Leikin, found that healthcare and first responder’s lack of experience in radiation incidents, significantly threaten mitigation efforts in the United States. There is valid concern that medical responses to radiation incidents, whether the result of radiological warfare, acts of terrorism, political assassinations, occupational or industrial accidents, or even medically irradiated patient are one of the least taught among all disciplines within medical education . Of all weapons of mass destruction, radiation is the least known by any profession that may be involved in mitigation, prevention, triage, law enforcement or any other related activity. There was also a finding that international cooperation and was needed. There was a major follow up of visitors from 52 different countries to London including citizens of the United States .

Recommendations were that education about global threats and radiation-related events, such as the Litvinenko, Arafat and other cases can alert authorities, first responders and medical staff to potential threats as well as raise awareness of the unique circumstances of radiation incidents. First responders ought to know the symptoms and be able to identify radiological events, control a public panic that may ensure, and protect themselves from the known threats. Finally, it was found that the psychological effects on the general public may very well be one of the main concerns because perceptions of radiological events are heavily influences by the motive and modus operandi. Therefore, risk communication strategies must be tailored appropriately to the context of the event.

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