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January 20th, 2009 - Doctors Struggle to Treat Burns Consistent with White Phosphorus

News article from the Guardian

News article from the Times

Summary of White Phosphorus Weapons in Gaza

Gaza Doctors Struggle to Treat Deadly Burns Consistent with White Phosphorus

Dozens dying after Israeli attacks from injuries ‘unlike any seen before’ that medics say should not be fatal


By Rory McCarthy

The Guardian

January 20, 2009


Doctors in Gaza described today how they had struggled to treat dozens of patients with terrible and unusually deadly burns consistent with white phosphorus weapons, during Israel's three-week war in Gaza.


Nafiz Abu Shabaan, head of the burns unit at Shifa hospital and the most senior burns surgeon in Gaza, said 60 to 70 patients had died in his unit during the war from severe burns that were unlike any injury he had previously seen.


Patients with only relatively small burn injuries, which ought to be survivable, were dying unexpectedly.


His account, along with evidence from survivors, corroborates mounting evidence from groups such as Human Rights Watch and Amnesty International that the Israeli military fired phosphorus shells into populated areas of Gaza in direct violation of international humanitarian law. Amnesty said it believes Israel is guilty of a war crime.


White phosphorus is allowed to be used as a smokescreen on the battlefield in certain situations, but its use in civilian areas is prohibited under United Nations conventions.


The Israeli military has at times denied using white phosphorus, and at other times has said only that it uses weapons "in compliance with international law".


Yesterday the military said it would launch an internal investigation. Israel's Ma'ariv newspaper reported yesterday that the Israeli military had now admitted using phosphorus munitions, but only in open areas.


Abu Shabaan, who was trained in Egypt, Britain and the United States and has been head of the Shifa burns unit for 15 years, said he and his staff had been stunned by the "unusual wounds" they found.


"It starts with small patches and in hours it becomes wide and deep and in some cases it reaches the point where even the general condition of the patient deteriorates rapidly and unexpectedly," he said.


Doctors had noticed a "very bad odour from the wound," he said. In many cases patients also suffered unexpected and severe toxicity, and had to be rushed into intensive care. In one case, a consultant anaesthetist suffered minor burns on his chest after burning material sprayed from within a patient's wounds during an ­operation.


Small burns were causing death. "A patient with 15% burns should not die, but we are seeing cases with 15% burns where they are dying," Abu Shabaan said. He believed, based on what he had read and what foreign doctors helping at the hospital had told him, that the wounds were consistent with phosphorus.


He described one patient, a three-year-old girl, who was sent for a scan because of a head wound: "After about two hours she came back, we opened the wound, and smoke came out from the wound," he said. Surgeons used forceps to pull out a substance from the wound that was "like dense cotton and it started to burn," he said. "The piece continued to burn until it disappeared." The child, who was from Atatra, in Beit Lahiya, in northern Gaza, died.


In the Shifa burns unit yesterday, Sabbah Abu Halima described how her house, also in Atatra, had been hit early in the war by several shells which killed her husband, Sa'ad Allah, and four of their children: Abdul Rahim, 14, Zayid, 10, Hamza, eight, and Shahed, who was 15 months old. She herself suffered severe burns to her right arm, abdomen, left leg and her feet, burns which doctors said appeared to be consistent with white phosphorus.


There were 16 members of the family in the house when an Israeli shell landed outside, close to a bedroom. Sa'ad Allah gathered his four children around him and they ran to another part of the house. A second shell then hit their living room, killing Sa'ad Allah and the three boys immediately. Another shell then landed, knocking Sabbah to the ground. "I fell on the ground and there was a fire. The room was full of smoke and it smelt very bad. Three times I heard my daughter say 'Mama, mama, mama', but I couldn't see her," she said. The infant daughter, Shahed, collapsed and died.


Sabbah's own clothes were burning and she rolled on the floor trying to put out the fire before she was pulled out of the house and rushed to hospital by her relatives. Her wounds were smoking for several hours.


Two others from the family were killed as they tried to retrieve the bodies. Their corpses, along with the body of Shahed, were recovered on 8 January by medics from the Red Cross and the Palestinian Red Crescent. The decomposing bodies of Sa'ad Allah and his three sons were only found a week later.


The Israeli strike on the warehouses in the main UN compound in Gaza City last Thursday was also believed to be the result of three white phosphorus shells. Small pieces of burning material were seen at the site hours after the blast. Yesterday the remains of hundreds of tonnes of food and aid in the warehouses were still smouldering. The jagged remains of 155mm artillery shell lay outside.


Doctors at the Shifa are now keeping two tissue biopsies from each patient. "We are asking for international organisations to send experts to investigate and test to know the type of weapons that have been used, and to tell us how to deal with this type of injury," Abu Shabaan said. "I have been here since 1985 working in the burns unit and head of department for 15 years and I have never seen something like this."

What is white phosphorus?


White phosphorus weapons are 155mm artillery shells containing 116 white phosphorus wedges. When the shell explodes it spreads the wedges over several hundred square metres. They ignite on contact with the air and burn at more than 800C. When they touch human skin they burn to the bone, causing terrible injuries and forcing doctors to excise large areas of flesh to prevent the burn spreading.


Using white phosphorous is not illegal. It can be used as an incendiary weapon, to set fire to military targets, to mark military targets, or to spread smoke. However, its use is strictly limited under UN conventions and international humanitarian law.


Fundamental rules stipulate civilians must be protected, and that attacks must not cause "disproportionate" damage to civilians and civilian objects. Particular care must be taken when using white phosphorus weapons and they cannot be used as an incendiary weapon against a military target that is not clearly separated from civilian areas.


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Blind and burnt: Mahmoud, 14, young victim of banned white phosphorus shelling


By Sheera Frenkel

The Times

January 20, 2009


Israel's three-week offensive in the Gaza Strip may be over but Mahmoud Mattar, 14, will not be able to sense the quiet that has descended on his home town of Jabalya.


Blinded in both eyes, with third-degree burns over much of his torso, Mahmoud lies unconscious in the Sheikh Zayid Hospital on the outskirts of Cairo. He has said little since January 6, when an Israeli attack on his village in northern Gaza left him nearly dead on the street outside his mosque. Doctors say that he will never see again - and that the burns on his body were caused by white phosphorus, a controversial incendiary weapon that Israel originally denied using.


“He was walking to the mosque when the attack started,” his uncle, Nahad Mattar, said. “Two of his friends who were walking with him were killed instantly. Their bodies are in pieces. He was hit by something and his body began to burn.


“There were bits of blood and skin all over him. We couldn't tell what was his and what was other people.”


Witnesses in Jabalya describe the signs of white phosphorus shelling - thick white smoke, a strong smell and fires that burn until covered with sand - and say that dozens more experienced burns in the same attack.


Israel, which originally denied the use of white phosphorus in Gaza when questioned by The Times two weeks ago, has since said that all weapons used in Gaza were “within the scope of international law”. Most Nato countries, including Britain and the US, use white phosphorus to create smokescreens. Its use as a weapon of war in civilian areas is banned under the Geneva Convention of 1980.


The Times has uncovered dozens of incidents in which doctors say that civilians have been wounded by white phosphorus, which burns at extremely high temperatures until its oxygen is cut off. Last week UN officials in Gaza were certain that their compound had been hit by white phosphorus shells.


Yesterday Amnesty International said its team had found proof that Israeli forces were using white phosphorus in densely-populated residential areas in Gaza City and in the north. “We saw streets and alleyways littered with evidence, including still burning wedges and the remnants of the shells and canisters fired by the Israeli army,” said Christopher Cobb-Smith, a weapons expert touring Gaza as part of Amnesty's fact-finding team.


Medical experts in Gaza said that they were collecting tissue samples from burns victims to test for white phosphorus, but were unsure when they could be sent to the laboratories. Doctors in Egypt have barred journalists from hospitals where hundreds of wounded Palestinians have been taken. They would not comment publicly on the wounds, but in private said that they had “no doubt” they were treating chemical phosphorus burns.


Allison El Soukary, a British nurse who lives in Cairo and worked in an Essex burns unit for several years, said: “The shapes of the burns, small circular splotches that go deep into the skin - those are where the chemical hit and burnt through.” Doctors are unsure how long it will take for Mahmoud to recover. His breathing is ragged and unsteady and he does not understand where he is or why he is in pain. On the day he was wounded his father and brother took him to Gaza City's Shifa Hospital. They said the prayer for the dead and were sure he was going to die. When they got to the hospital there were no beds, so they laid him on the ground with all the others.


Because of the extent of his injuries, Mahmoud received special clearance to travel to Egypt for treatment. But the convoy of 14 ambulances that attempted to make their way to the border came under fire and were forced to turn back. Two days later they were able to cross through the Rafah border crossing with Egypt.


In the Sheikh Zayid Hospital there are 29 patients who were pulled from the fighting in Gaza. At least five have burns consistent with phosphorus, say experts. Muhammad Hassanat, 26, and his neighbour Tamer Omar Ellouhe, 18, both lost their legs when a volley of artillery fire hit their Gaza City suburb of Zeitoun - the same area where dozens of members of the Samouni family were buried alive in an Israeli strike. The survivors were forced to wait several days for ambulances to get through the fighting. Yesterday Samouni family corpses were still being pulled from the rubble.


Mahmoud Hassanat, Muhammad's brother, now sits in the polished marble hospital cafeteria, dividing his worry between family members still in Gaza and the patients upstairs.


“I had left him for dead,” he said. “I went to cemetery to prepare a burial plot and our father had gone home to tell our mother that her son was killed. Our mother went running down the street and discovered that he was still breathing a little. Doctors also thought he would die, but he is alive.”


Without his legs and with a broken arm, jaw, and ribs, Muhammad will no longer be able to support his wife and four children in his old job as an electrician. “We were attacked by an army. But we are not an army, we have no way to defend ourselves,” said his brother. “We will go back to our home. We are not political but we will go on with Hamas. This is how it is.”


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