The paper provides comparative analysis of health effects after radioactive contamination of the Techa River and the 1957 radiation accident at the Mayak Production Association (Mayak PA) in terms of efficiency of performed protective measures. Both radiation accidents took place in the Urals Region, Russia, within a short period of time due to poor-quality of storage technology of liquid radioactive waste. Despite different pathways of radioactive contamination of the environment (air or water), similar long-term combined (external γ- and internal) exposure of the population took place. Countermeasures after the 1957 radiation accident included not only scheduled but also emergency evacuation of people. Scheduled activities on the Techa River were delayed and insufficient and resulted in exposure of local residents at doses greatly exceeding permissible levels. It also led to development of both early deterministic effects and increase in leukemia and solid cancer incidence, and mortality in the long-term period.