The SHAMISEN Recommendations on preparedness and health surveillance of populations affected by a radiation accident

•The 28 SHAMISEN Recommendations are based on lessons from past accidents.•They cover all phases of an accident and multiple relevant fields of expertise.•The motivation, strategy and responsibility for implementation is described.•The approach was holistic covering doses, health, socio-economic & ethical issues.•Many recommendations are applicable to other disaster types (e.g. COVID19). This paper, the last in the Special Issue (SI) on the SHAMISEN project, presents an overview of the SHAMISEN Recommendations for Preparedness and Health Surveillance of Populations Affected by a Radiation Accident. The recommendations are based on the lessons learnt from previous nuclear accidents, and the engagement activities with different stakeholder groups, described in the other papers of this SI. The SHAMISEN project developed a total of 28 recommendations. They include general recommendations, applicable across all phases of an accident, and specific recommendations for each of the three main phases: preparedness, early and intermediate, and long-term recovery. The recommendations are subdivided by topic: health surveillance, epidemiological studies, dose reconstruction, evacuation, and training of and communication with health personnel and other actors involved in liaising with affected populations. Each recommendation is divided into 3 sections - why, how and who - thus providing background and concrete advice as to how each SHAMISEN recommendation should be implemented and by whom. It is notable that many recommendations are also applicable to other disaster types, including the current SARS-CoV-2 pandemic.