Categoria: guerra

ENGLISH

December 3, 2023

https://www.bmj.com/content/383/bmj.p2681/rapid-responses

Dear  Editor, 

you aptly illustrated that UN bodies asked for full stop of the military operations on Gaza, appealed to the ICC, in view of a carnage of women and children (70% of the 15.000 plus victims) as never before in the century and targeting of health infrastructures and personnel. 

After a pause, this is just starting again.

Calls to protect health personnel by medical professionals, were not echoed by the Israeli Medical Association, national medical associations, and the World Medical Association; they remained silent, regardless of clear targeting of health services. They ignored the sacrifice in lives (plus 160 victims) of medical teams and expressed no solidarity and support for their abnegation in the dire situation. 

The ethical dilemmas of Gaza professionals lacking means for proper anesthesia, pain relief and for reducing post trauma infections, should interrogate medical professionals and be ground for requesting protection and accounting. Hundreds more children’s and adult’s lives were lost in hospitals, adding to those killed by the weapons. 

It was not proven that Al Shifa was the location of central command of Hamas, and anyhow how this implies attacks on all (29/35) health facilities in the North of Gaza? 

Since October 8, all were strangled by cutting water, electricity, fuel, food and all medical supplies, menaced if did not close, then directly hit and personnel arrested or displaced forcibly out of the facility. 

Summarizing major events: October  17 Alhi hospital courtyard bombed; Turkish friendship cancer, Eyes, Wada, Pediatric Nasser and Rantissi hospitals hit and forced to close, the last with forcible displacement of the personnel and families, while not transportable babies were left unattended; Awda hospital and the Aqsa hospital repeatedly damaged by hits, whit many victims; Indonesia hospital and Shifa -both hit many times destroying whole sections, killing attending nurses and others. Essential machinery, surgical theaters, oxygen generator, solar panels, and ICUs directly hit; personnel kept captive while bodies of the dead accumulated in their premises, when hospital had become shelter for thousands of displaced people. 

Regardless of abnegation of personnel, no fully functional medical facilities and maternities remain in the North of Gaza. 52 out of 75 primary care clinics and adult not communicable disease and dialysis services forced to close. The medical and science faculties in Gaza were destroyed.  More than 100 UNWRA personnel was killed. More than 50 ambulances taken off use.

Worse, this is not totally new or unexpected: since 2014 IDF attacked hospitals and education structures, impairing survival and future for all. During the 17 years siege of Gaza, health services were constantly impaired through denial of instruments and supplies, restricting permits for training and of access for foreign professionals, as documented by UN, major NGOs (1). Since 2021 this ban was the tightest, and the economic crisis due to the blockade induced decrease in the number of university medicine and science students.

The temporary ceasefire showed the immense devastation also of hospitals, made more sad because attacks on hospital was recommended also by 100 Israeli doctors (2) in contravention with any international law and ethics.

Should not all professionals and their associations, finally chorally ask a full unconditional and long lasting ceasefire, condemn the destruction of health structure which multiplies deaths, recognize the abnegation of the Gaza colleagues, appreciate that a war crime has been committed and lament also the forced dispersal of accumulated work, experience and labor invested in the Gaza’s health system which can hardly be reconstructed in short time? should they not uphold the inalienable human right of care for the people of Gaza? should they not help by standing strongly to go beyond temporary charity and advocate for stable resolutions?

Paola Manduca, Geneticist, 

retired Associate Professor University of Genoa, Italy

paolamanduca@gmail.com

ITALIANO

Caro editore,

hai giustamente illustrato che gli organismi delle Nazioni Unite hanno chiesto la cessazione totale delle operazioni militari su Gaza, hanno fatto appello alla Corte penale internazionale, in vista di una carneficina di donne e bambini (il 70% delle oltre 15.000 vittime) come mai prima nel secolo e che ha preso di mira la salute infrastrutture e personale.

Dopo una pausa, tutto questo ricomincia.

Le richieste di protezione del personale sanitario da parte dei professionisti medici non hanno trovato eco nell’Associazione medica israeliana, nelle associazioni mediche nazionali e nella World Medical Association; sono rimasti in silenzio, nonostante la chiara presa di mira dei servizi sanitari. Hanno ignorato il sacrificio di vite umane (più di 160 vittime) delle équipe mediche e non hanno espresso solidarietà né sostegno per la loro abnegazione in una situazione disastrosa.

I dilemmi etici dei professionisti di Gaza, privi di mezzi per un’anestesia adeguata, per alleviare il dolore e per ridurre le infezioni post trauma, dovrebbero interrogare i professionisti medici e costituire la base per richiedere protezione e rendicontazione. Altre centinaia di bambini e adulti hanno perso la vita negli ospedali, aggiungendosi a quelli uccisi dalle armi.

Non è stato dimostrato che Al Shifa fosse la sede del comando centrale di Hamas, e comunque come ciò implica attacchi a tutte le (29/35) strutture sanitarie nel nord di Gaza?

Dall’8 ottobre, tutti sono stati strangolati tagliando acqua, elettricità, carburante, cibo e tutte le forniture mediche, minacciati se non venivano chiusi, poi colpiti direttamente e il personale arrestato o sfollato con la forza fuori dalla struttura.

Riassumendo i principali eventi: 17 ottobre bombardato il cortile dell’ospedale Alhi; Amici turchi per cancro, gli ospedali Eyes, Wada, Pediatric Nasser e Rantissi colpiti e costretti a chiudere, l’ultimo con sfollamento forzato del personale e delle famiglie, mentre i bambini non trasportabili sono stati lasciati incustoditi; l’ospedale di Awda e l’ospedale di Aqsa ripetutamente danneggiati dai colpi, con numerose vittime; L’ospedale indonesiano e quello di Shifa hanno entrambi colpito più volte distruggendo intere sezioni, uccidendo infermieri e altre persone. Colpiti direttamente macchinari essenziali, sale operatorie, generatori di ossigeno, pannelli solari e unità di terapia intensiva; il personale veniva tenuto prigioniero mentre i corpi dei morti si accumulavano nei loro locali, quando l’ospedale era diventato rifugio per migliaia di sfollati.

Nonostante l’abnegazione del personale, nel nord di Gaza non rimangono strutture mediche e maternità pienamente funzionanti. 52 su 75 ambulatori di assistenza primaria e servizi di dialisi e malattie non trasmissibili per adulti sono costretti a chiudere. Le facoltà di medicina e di scienze a Gaza sono state distrutte. Più di 100 membri del personale dell’UNWRA furono uccisi. Sono state dismesse più di 50 ambulanze.

Quel che è peggio, non è una cosa del tutto nuova o inaspettata: dal 2014 l’IDF ha attaccato ospedali e strutture educative, compromettendo la sopravvivenza e il futuro di tutti. Durante i 17 anni di assedio di Gaza, i servizi sanitari sono stati costantemente compromessi attraverso la negazione di strumenti e forniture, la limitazione dei permessi di formazione e di accesso per i professionisti stranieri, come documentato dalle Nazioni Unite e dalle principali ONG (1). Dal 2021 questo divieto è stato il più severo e la crisi economica dovuta al blocco ha provocato una diminuzione del numero degli studenti universitari di medicina e scienze.

Il cessate il fuoco temporaneo ha mostrato l’immensa devastazione anche degli ospedali, resa ancora più triste perché gli attacchi agli ospedali sono stati raccomandati anche da 100 medici israeliani (2) in violazione di qualsiasi diritto ed etica internazionale.

Non dovrebbero tutti i professionisti e le loro associazioni chiedere finalmente in coro un cessate il fuoco totale, incondizionato e duraturo, condannare la distruzione delle strutture sanitarie che moltiplica le morti, riconoscere l’abnegazione dei colleghi di Gaza, apprezzare che è stato commesso un crimine di guerra e lamentare anche la forzata dispersione del lavoro accumulato, dell’esperienza e della manodopera investita nel sistema sanitario di Gaza che difficilmente può essere ricostruito in breve tempo? non dovrebbero forse sostenere il diritto umano inalienabile alla cura del popolo di Gaza? non dovrebbero forse aiutarli impegnandosi con forza ad andare oltre la carità temporanea e a sostenere risoluzioni stabili?

Paola Manduca, Geneticist, 

retired Associate Professor University of Genoa, Italy

paolamanduca@gmail.com

References

1-  https://www.icrc.org/en/document/gaza-protecting-healthcare-conflict

-https://casebook.icrc.org/case-study/israelpalestine-operation-protective-edge-gaza-13-june-26-august-2014 

– https://www.ohchr.org/en/hr-bodies/hrc/co-i-gaza-conflict/report-co-i-gaza

2- https://www.aa.com.tr/en/middle-east/israeli-doctors-group-calls-for-bombing-al-shifa-hospital-in-gaza/3044872

– https://www.commondreams.org/news/gaza-doctors-letter

Marwa and Hameed have only one child who is still alive. In 2012, a little girl died in Marwa’s life – with a deformed head, without a brain. In 2013, Leyla was born, but she died half an hour after birth – without kidneys, with deformed arms. The neighbours, Nadia and Mohammad, had three children, but all three died shortly after birth. The fourth child was born in 2011, dead and deformed. We are in Fallujah, an old city with 300,000 inhabitants. Fallujah – the Mother of Mosques – was the base of the Iraqi resistance, and was slaughtered by the US Army in 2004. Twice, in April and in November, everything alive in Fallujah was the target of killers on rooftops and in cockpits. Two years later, more and more mothers in the city started to have abortions, and more and more children were born deformed. Just like in Basra in the South: the bombing of Basra began in the Gulf War in 1990 and continued for twenty years. In 1995, more abortions and malformations was observed. In 2013, the number tripled. As in Nangarhar, the province that took the most bombs during America’s revenge war against Afghanistan after the 11 September attack. In 2005, I (HH) was invited by colleagues at the provincial hospital in Jalalabad to study birth defects they had never seen before.

Is there a pattern here? Let’s look at Gaza: In Christmas 2008, Gaza was bombed day and night for three weeks. Local wars are opportune laboratories for testing “improved weapons”, and two months earlier Israel had received batches of new American high explosives. In the tissue samples from the wounds of the survivors of the Christmas War, our research team found aluminium, copper, mercury, barium, vanadium, nickel, manganese and cadmium – all metals in higher concentrations than in uninjured control subjects. In 2011, we analyzed hair samples from newborns with birth defects at Shifa hospital. The concentration of mercury and selenium was significantly higher in the deformed babies than in healthy controls. In hair samples from pregnant Gazan mothers after the 2014 war, we observed the same pattern. From 2006 to 2017, the frequency of congenital structural malformations has increased from 1.1 to 1.9% and preterm births from 1.1 to 7.9%. About 40% of these children will die during the first month of life. But it’s worse: Malformations of the heart are not included – add two percent. Diseases and system errors making their clinical debut later in life such as cancer, immune defects and behavioral disorders are not included – add at least five percent.

Epigenetics and metals

Our body is in constant change. From the time I attach myself to the wall of the warm womb until I die, I form new cells and discharge cells that are damaged or expired. New cells are created on the basis of the gene recipes stored in the previous generation. This is the river of life. It can be damaged in two ways. Either genetically – by messing with the recipe, the DNA molecule in the cell nucleus. Or epigenetically – by messing up the expression, transmission and understanding of the recipes, of the gene signals. Because cells are talking to each other, and they use estrogen channels for communication, both in girls and boys. A number of metals can interfere with the recipient cells’ estrogen receptors, thus creating incorrect signals into the cell nucleus. These false messengers – “metal estrogens” – do not work along a simple dose-response line, the more-brandy-the-more-drunk. Minimal quantities are enough to confuse the signaling system and thereby cell division, and the effects of the heavy metal cocktail are totally unpredictable. In the first weeks of life in the mother’s womb, while we are just a cluster of a few hundred stem cells, while the organs – and especially the nervous tissue – are in the making, a single reading error may trigger disaster.

Let’s trace the path to these metals: Thermobaric projectiles are used against apartment buildings and shelters/tunnels. Thermo(heat)-bar(pressure) explosives work by spreading a cloud of highly explosive gases which are then ignited in an ultra-fast explosion. No conventional explosive weapon creates equivalent heat and pressure. The latest generation thermobaric projectile uses aluminum dust as explosive gas. Microparticles of aluminum – 5 hundredths of a millimeter in size – with a coating of heavy metal are ignited and spread over the impact field. Colleague Ghassan Abusitta at Shifa hospital reported three weeks ago more and more burn patients, then the thermobaric weapon are in use.

The explosive dust spreads everywhere. The pulverization of buildings spreads the metals to the entire population. Mum breathes, drinks and eats – and is slowly poisoned. The metals pass from the mother’s blood, across the placental barrier and into the fetus’s blood, where they also cross the blood-brain barrier. Mother dilutes her own toxic reserves while poisoning her young. All the metals we found in the tissue samples in Gaza have documented epigenetic effects. If this is not chemical warfare, the authors of this chronicle have misunderstood the term.

The hardest thing to think about

Cells talk to each other, but they have memory as well: Nano-doses of heavy metals leave epigenetic traces in the fetal germ cells. These traces lie dormant, are activated during adolescence, and can then be passed on to grandchildren’s children.

What kind of future are we looking into?

Hans Husum is a surgeon with a doctorate in war surgery.

Paola Manduca is professor of genetics at the University of Genoa.

“Klassekampen”, December 1, 2023