For all the years that the world has focused on the confrontation between Western nations and Iran, oceans of ink have been spilled over many aspects of its nuclear program — the quantity and quality of its enriched uranium, various UN Security Council resolutions, the number of Iranian centrifuges, IAEA safeguards, compliance with the Non-Proliferation Treaty, diplomatic negotiations, red lines, U.S. and Israeli attack scenarios, possible Iranian responses, the impact of a nuclear Iran, and so on.

Yet, almost nothing has been written about one critical factor: the impact on Iranian civilians, if the U.S. and/​or the Israelis were to attack Iran’s nuclear facilities.

That vacuum has now been filled, thanks to a recent lengthy report — The Ayatollah’s Nuclear Gamble: The Human Cost of Military Strikes Against Iran’s Nuclear Facilities. It was authored by Khosrow Semnani, an Iranian-American industrialist and philanthropist with extensive experience in the industrial management of nuclear waste and chemicals.

The University of Utah’s Hinckley Institute of Politics and Omid for Iran, a nonprofit organization based in Salt Lake City, Utah, published the assessment. Author Semnani has provided support for conferences and educational initiatives in the United States.

The report examined various military options against different sites but regardless – perhaps it shouldn’t come as a surprise — the news was horrifyingly bad for Iraqi civilians. Iran insists its nuclear-development efforts are for peaceful purposes, and that it has no desire to build atomic weapons.

According to the report:

It is highly likely that the casualty rate at the physical sites will be close to 100 percent. Assuming an average two-shift operation, between 3,500 and 5,500 people would be present at the time of the strikes, most of whom would be killed or injured as a result of the physical and thermal impact of the blasts. If one were to include casualties at other targets, one could extrapolate to other facilities, in which case the total number of people killed and injured could exceed 10,000.

The report analyzed the impact of pre-emptive conventional strikes on four key nuclear sites: Isfahan’s uranium conversion facility, which contains an estimated 371 metric tons of uranium hexafluoride; Natanz’s fuel-enrichment plant; Arak’s heavy-water plant; and Bushehr’s nuclear power plant.

The report did not include the deeply-buried Fordow site near Qom in its analysis, but it is almost certain that Fordow would be targeted with powerful bunker busters.

To the extent that war planners would consider “collateral damage,” the euphemism for civilian casualties as a factor the news is grim. “There is no viable military option for dealing with Iran’s nuclear challenge,” the report concludes. “Iran has built its nuclear facilities in major urban centers making it impossible to carry out surgical strikes without killing large number of civilians.”

The eventual toll, however, could well be more than 10,000 dead. For example, attacks at Isfahan and Natanz would release existing stocks of fluorine and fluorine compounds which would turn into hydrofluoric acid — a highly-reactive agent that, when inhaled, would make people “drown in their lungs.” Fluorine gases are more corrosive and toxic than the chlorine gas used in World War I. Once airborne, at lethal concentrations, these toxic plumes could kill virtually all life forms in their path.

Aside from the fluorine, the uranium hexafluoride itself also poses dire consequences. The report estimates that if only 5% of 371 metric tons of uranium hexafluoride produced at the Isfahan facility becomes airborne during or after an attack, the toxic plumes could travel five miles with the Immediately Dangerous to Life or Health (IDLH) level of 25 milligrams per cubic liter spreading over 13 square miles:

With prevailing wind directions and speeds at 9.4 miles/​hour moving towards the city, in about one hour, this plume could expose some of the 240,000 residents in Isfahan municipality’s eastern districts, particularly districts 4 and 6. At a 20% release, the IDLH plume will travel 9 miles covering 41 square miles and could expose some of the 352,000 residents, mainly in districts 13, 4, and 6, as well as residents in the region north of district 4. If we assume a conservative casualty rate of 5 to 20% among these populations, we can expect casualties in the range of 12,000–70,000 people. [emphasis in original]

Such scenarios are even worse than catastrophes like the 1984 gas leak in Bhopal, India, or the 1986 nuclear meltdown at Chernobyl, Ukraine. And, like Chernobyl, the effects could be long-lasting. The environmental degradation due to the spread of airborne uranium compounds, and their entry into water, soil and the food chain, would likely introduce long-term, chronic health risks, including spikes in cancer rates and birth defects.

Not only that: an attack on Iran’s nuclear sites could prove contagious. “An attack on the Bushehr nuclear power plant would pose a grave environmental and economic threat to civilians in Kuwait, the United Arab Emirates, Iraq and Saudi Arabia,” the report said. “It would not only devastate the important business centers and fishing communities of the Persian Gulf, but also contaminate desalination plants, port facilities and oil fields.”

Some thoughts worth pondering, next time you hear the words “Iran,” “nuclear,” and “surgical strikes” traveling in close formation.