It has been 20 years since the world's most infamous nuclear test site was shuttered, but fallout from the Soviet Union's nuclear program is evident today.From 1949 to 1989, residents of the former Soviet oblast of Semipalatinsk lived under the shadow of a mushroom cloud. Over that time, at least 456 nuclear devices -- both atmospheric and underground -- were detonated at the 18,000-square-kilometer site known as Semipalatinsk-21.What began as the crown jewel in the Soviet nuclear program proved to be synonymous with tragedy.The human suffering that took place at the site was well-documented, even before testing ended in 1989 and the site officially closed on August 29, 1991. Some 200,000 villagers essentially became human guinea pigs, as scientists explored the potential and dangers of nuclear weapons. Residents were reportedly ordered to step outside their homes during test blasts so that they could later be examined as part of studies on the effects of radiation. Some locals can describe -- from first-hand experience -- what a mushroom cloud looks like.And they are paying a horrendous price.Soil, water, and air remain highly irradiated in the fallout area, where according to scientists the level of radiation is 10 times higher than normal.One in every 20 children in the area is born with serious deformities. Many struggle with different types of cancer and more than half of the local population has died before reaching the age of 60."Almost all my classmates and friends have died," says 50-year-old farmer Aiken Akimbekov, a native of the village of Sarzhal, located near the so-called "atomic lake" formed by a powerful nuclear explosion in the mid-'60s."That lake is void of any living creature. Fish can't live there," Akimbekov says. "When the wind blows from that direction, it makes people feel sick. It causes high blood pressure in some, and it also brings a very strange smell."Akimbekov belongs to the generation of local inhabitants who grew up witnessing mushroom clouds appearing on the skyline every now and then. People would also hear explosions and feel frequent tremors.The villagers in the middle of the remote steppe had no idea that deadly weapons were being tested around them or the devastating impact these tests would have on the health and lives of generations to come.The Soviet government kept the tests secret and any questions about local inhabitants’ ill health or the high rates of birth defects were muted with explanations of bad genes or poor sanitation.It wasn't until the mid-1980s that Kazakh activists began to ask questions about the true nature of the tests and launched a campaign to close down the site.Their wish was eventually granted. The last nuclear experiment was carried out in 1989 and the site officially closed two years later. But the suffering of the residents didn't end with the closure of Semipalatinsk-21.Dr. Toleukhan Nurmukhamedov says he has witnessed women delivering babies with horrific birth defects in the maternity wards in Semey, a city recently renamed from its Soviet-era name of Semipalatinsk, which lies about 160 kilometers to the east of the test site.One baby was born with no arms, while another was born with a deformed face and misshapen head too large for his body, says Nurmukhamedov, who is in charge of the regional family planning center.Most of these newborns are abandoned and left for the underfunded local orphanage to raise.Nurmukhamedov has called on the authorities to introduce so-called compulsory genetic passports to prevent people whose genes were damaged by exposure to radiation from having children. He suggests all women and men should undergo medical tests to determine the risks.The controversial idea has prompted criticism by many locals, who accuse the doctor of violating people's right to have children.Nurmukhamedov, however, insists he is not playing god. The doctor says he doesn't see any sense in bringing into the world severely malformed babies and abandoning them to die in orphanages.Nurmukhamedov also calls on Russia to acknowledge its responsibility for the inhumane experiments carried out on the population and to pay for medical treatment."Germany has apologized for the deeds of the Nazis. Why shouldn't Russia do the same for the devastating tests carried out on Kazakh soil?" the doctor asks.An apology isn't going to make the problem disappear, however. As environmental activist Margulan Hamiyev says, "The radiation will not go away. It is deep in the water and soil. It's in the air."Hamiyev says steps should be taken to ensure that land used for nuclear tests is not used for farming or opened for settlement. But according to local parliamentarian Nurtai Sabilyanov, the authorities are, in fact, currently considering the possibility of using land on the former test site for agriculture.In the village of Sarzhal, Akimbekov says villagers were told by officials the land around the village is safe to graze livestock on and to grow wheat."The radiation experts visited here," Akimbekov says. "They made a conclusion that there is no danger of radiation and that it is possible to use this land for pasture."We're just ordinary people. If officials tell us this place is safe, we believe it is safe."Akimbekov says he has heard about the hazards of radiation but doesn't see any options. Like most locals, he, too, makes ends meet by farming."If people were given homes and land somewhere safe, no one would stay here," the farmer says.