In Syrian Hospital, No More Antidote For Chemical Victims

Syria Deeply talked Dr. Abdel Hay Tennari, who treated at least 22 critical victims from the April 4 toxic gas attack in Khan Sheikhoun.

Treating one of the victims of the April 4 attack
Treating one of the victims of the April 4 attack
Alexandra Bradford

After a suspected chemical attack earlier this week in the southeastern Syrian province of Idlib that killed dozens of civilians, Dr. Abdel Hay Tennari, an internal medicine specialist doing his residency on respiratory diseases at a field hospital supported by the Syrian-American Medical Society in Idlib, rushed to treat victims arriving at the Sarmin Field Hospital.

Speaking to Syria Deeply by phone, he said that the 22 critical patients he had treated so far all exhibited signs of exposure to a nerve agent. Their symptoms — foaming at the mouth and fluid filling the lungs, which can lead to suffocation — were consistent with the effects of Sarin gas. At least 74 people died in the alleged chemical attack, according to a document detailing the victims' names that was released by the Idlib Health Directorate. World leaders accused Syrian president Bashar al-Assad's government of carrying out the attack. However, Damascus issued a statement categorically denying that it used any form of poisonous gas in Khan Sheikhoun.

SYRIA DEEPLY: What did your patients tell you about the incident?

DR. ABDEL HAY TENNARI: They told me that there was an attack from an airplane and they saw a rocket that was released from the airplane. Soon after, they started having problems breathing and they felt weakness in their bodies. So many people died from the attack in Khan Sheikhoun and many who arrived at hospitals were already dead.

We received 22 patients where I practice at Sarmin Field Hospital, and many of these people arrived with severe injuries. We know that other hospitals closer to the attack have received many more patients, many of them children and elderly people. Many parents have been separated from their children following the attack and families are looking for their children everywhere. They are going from hospital to hospital trying to find their children. I saw one baby: He was so tiny, and he was alone. We have no idea who his parents are and because he is so small we can't ask him.

There are hundreds of victims, and so far we can confirm that 65 people have died. The more critical patients that I have treated are those who had inhaled high amounts of the toxin.

Assad's government has denied that their military used chemical weapons in Khan Sheikhoun. Do you believe this to be true?

Patients have said that the attack came from a regime airplane; the regime also used chemical agents before when they attacked Eastern Ghouta near Damascus four years ago. Also, 36 hours before the chemical attack, the regime launched three airstrikes on Marrat al-Numan Hospital, completely destroying the hospital. Marrat al-Numan is a large central hospital which is 25 km from the site of the attack. This hospital would have been used to treat and save a large number of the patients. We believe that the regime has purposely attacked this hospital to cause maximum casualties. They have done this before by attacking other hospitals in Idlib and throughout Syria.

Were you able to tell what type of toxin your patients inhaled?

The chemical agent is Sarin. We feel that the regime used Sarin because of two main things. First, the symptoms exhibited by the patients are consistent with the use of Sarin. This includes: shortness of breath, huge amount of excessive secretion from the mouth and lungs with induced dyspnea, and constricted pupils. Hundreds of people from the same attack have displayed these same symptoms.

There are rumors that are being widely spread through social media channels.

Second, the patients I have treated have recovered after being given Pralidoxime, which is an antidote to Sarin. Those who were given the Sarin antidote became stable in about an hour. The fact that patients responded so quickly to the antidote makes us believe that the regime used the chemical agent Sarin.

There have been rumors circulating that families are being told that a person who otherwise appears to have died from the effects of the chemical could be revived within 48 hours. Do you have a response to this?

There are rumors that are being widely spread through social media channels like WhatsApp, Telegram messenger and Facebook that, during the attack on Ghouta four years ago, some victims came back to life. My guess is that those victims were not seen by doctors or checked with the correct machine to see if there was cardiac activity prior to being confirmed dead. But this is a rumor. A patient who is dead, or a severe patient who has not received treatment will not survive. But people hear rumors and they rush to believe it.

Is Pralidoxime being used to treat all patients exposed to the chemical agent?

Unfortunately, there's a shortage of the antidote, so only the most severe patients received it. We have now referred the difficult cases to Turkey, because they have the antidote there. But even this is risky because it takes two or three hours to get to Turkey and many patients will lose their lives on the way.

As a doctor, I am afraid because now we don't have the antidote anymore. If the regime uses Sarin again, we won't be able to treat and save people.

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Ecological Angst In India, A Mining Dumpsite As Neighbor

Local villagers in western India have been forced to live with a mining waste site on the edge of town. What happens when you wake up one day and the giant mound of industrial waste has imploded?

The mining dumpsite is situated just outside of the Badi village in the coastal state of Gujarat

Sukanya Shantha

BADI — Last week, when the men and women from the Bharwad community in this small village in western India stepped out for their daily work to herd livestock, they were greeted with a strange sight.

The 20-meter-high small hill that had formed at the open-cast mining dumpsite had suddenly sunk. Unsure of the reason behind the sudden caving-in, they immediately informed other villagers. In no time, word had traveled far, even drawing the attention of environment specialists and activists from outside town.

This mining dumpsite situated less than 500 meters outside of the Badi village in the coastal state of Gujarat has been a matter of serious concern ever since the Gujarat Power Corporation Limited began lignite mining work here in early 2017. The power plant is run by the Power Gujarat State Electricity Corporation Limited, which was previously known as the Bhavnagar Energy Company Ltd.

Vasudev Gohil, a 43-year-old resident of Badi village says that though the dumping site is technically situated outside the village, locals must pass the area on a daily basis.

"We are constantly on tenterhooks and looking for danger signs," he says. Indeed, their state of alert is how the sudden change in the shape of the dumpsite was noticed in the first place.

Can you trust environmental officials?

For someone visiting the place for the first time, the changes may not stand out. "But we have lived all our lives here, we know every little detail of this village. And when a 150-meter-long stretch cave-in by over 25-30 feet, the change can't be overlooked," Gohil adds.

This is not the first time that the dumpsite has worried local residents. Last November, a large part of the flattened part of the dumpsite had developed deep cracks and several flat areas had suddenly got elevated. While the officials had attributed this significant elevation to the high pressure of water in the upper strata of soil in the region, environment experts had pointed to seismic activities. The change is evident even today, nearly a year since it happened.

It could have sunk because of the rain.

After the recent incident, when the villagers raised an alarm and sent a written complaint to the regional Gujarat Pollution Control Board, an official visit to the site was arranged, along with the district administration and the mining department.

The regional pollution board officer Bhavnagar, A.G. Oza, insists the changes "aren't worrisome" and attributes it to the weather.

"The area received heavy rain this time. It is possible that the soil could have sunk in because of the rain," he tells The Wire. The Board, he says, along with the mining department, is now trying to assess if the caving-in had any impact on the ground surface.

"We visited the site as soon as a complaint was made. Samples have already been sent to the laboratory and we will have a clear idea only once the reports are made available," Oza adds.

Women from the Surkha village have to travel several kilometers to find potable water

Sukanya Shantha/The Wire

A questionable claim

That the dumpsite had sunk in was noticeable for at least three days between October 1 and 3, but Rohit Prajapati of an environmental watchdog group Paryavaran Suraksha Samiti, noted that it was not the first time.

"This is the third time in four years that something so strange is happening. It is a disaster in the making and the authorities ought to examine the root cause of the problem," Prajapati says, adding that the department has repeatedly failed to properly address the issue.

He also contests the GPCB's claim that excess rain could lead to something so drastic. "Then why was similar impact not seen on other dumping sites in the region? One cannot arrive at conclusions for geological changes without a deeper study of them," he says. "It can have deadly implications."

Living in pollution

The villagers have also accused the GPCB of overlooking their complaint of water pollution which has rendered a large part of the land, most importantly, the gauchar or grazing land, useless.

"In the absence of a wall or a barrier, the pollutant has freely mixed with the water bodies here and has slowly started polluting both our soil and water," complains 23- year-old Nikul Kantharia.

He says ever since the mining project took off in the region, he, like most other villagers has been forced to take his livestock farther away to graze. "Nothing grows on the grazing land anymore and the grass closer to the dumpsite makes our cattle ill," Kantharia claims.

The mining work should have been stopped long ago

Prajapati and Bharat Jambucha, a well-known environmental activist and proponent of organic farming from the region, both point to blatant violations of environmental laws in the execution of mining work, with at least 12 violations cited by local officials. "But nothing happened after that. Mining work has continued without any hassles," Jambucha says. Among some glaring violations include the absence of a boundary wall around the dumping site and proper disposal of mining effluents.

The mining work has also continued without a most basic requirement – effluent treatment plant and sewage treatment plant at the mining site, Prajapati points out. "The mining work should have been stopped long ago. And the company should have been levied a heavy fine. But no such thing happened," he adds.

In some villages, the groundwater level has depleted over the past few years and villagers attribute it to the mining project. Women from Surkha village travel several kilometers outside for potable water. "This is new. Until five years ago, we had some water in the village and did not have to lug water every day," says Shilaben Kantharia.

The mine has affected the landscape around the villages

Sukanya Shantha/The Wire

Resisting lignite mining

The lignite mining project has a long history of resistance. Agricultural land, along with grazing land were acquired from the cluster of 12 adjoining villages in the coastal Ghogha taluka between 1994 and 1997. The locals estimate that villagers here lost anything between 40-100% of their land to the project. "We were paid a standard Rs 40,000 per bigha," Narendra, a local photographer, says.

The money, Narendra says, felt decent in 1994 but for those who had been dependent on this land, the years to come proved very challenging. "Several villagers have now taken a small patch of land in the neighboring villages on lease and are cultivating cotton and groundnut there," Narendra says.

They were dependent on others' land for work.

Bharat Jambucha says things get further complicated for the communities which were historically landless. "Most families belonging to the Dalit or other marginalized populations in the region never owned any land. They were dependent on others' land for work. Once villagers lost their land to the project, the landless were pushed out of the village," he adds. His organization, Prakrutik Kheti Juth, has been at the forefront, fighting for the rights of the villages affected in the lignite mining project.

In 2017, when the mining project finally took off, villagers from across 12 villages protested. The demonstration was disrupted after police used force and beat many protesters. More than 350 of them were booked for rioting.

The villagers, however, did not give up. Protests and hunger strikes have continued from time to time. A few villagers even sent a letter to the President of India threatening that they would commit suicide if the government did not return their land.

"We let them have our land for over 20 years," says Gohil.

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