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Monday, February 20, 2017

Does Chlorine Make You Pass Out?

Syria Chlorine Allegations:
Does Chlorine Make You Pass Out?
Seems Everyone Says it Does, in Syria Anyway
Adam Larson, aka Caustic Logic
February 21-23, 2017
important additions, March 16
edits March 23, 30

Does chlorine gas cause a victim to lose consciousness, or pass out, often on first contact? Syrian opposition activists, Human Rights Watch, several powerful governments, and many others seem to feel this is standard, or at least a very common effect. For a recent example, on February 9, one rebel died in Irbeen, Damascus suburbs, in a supposed chlorine attack by Syrian government forces that also sickened many. An opposition source said "four victims were transported to Arbeen Hospital with symptoms consistent with chlorine gas exposure including; difficulty breathing, loss of consciousness and foaming at the mouth." (Press Release)

The main relevance of this supposed symptom is how it cause so many chlorine attack fatalities to, as I recently panned it, "just sit there and die." I decided to put my foot down on this subject while reviewing a Human Rights Watch report, detailing 9 to 16 fatalities from eight attacks in rebel-held eastern Aleppo in late 2016. In perhaps every case where the chlorine bomb fell into or near someone's home, everyone inside apparently passed out or got paralyzed, and inhaled a fatal amount before anyone could come rescue them. Some might have been alive still, but they'd be well doomed by then and die eventually, no matter how good the medicine.

(note: "foaming at the mouth" is also overrated: strained, rapid breathing, with mucous involved, can cause bubbles, which can form a foam. It's not really a chlorine indicator.) 

This instant blacking-out is also reported in earlier attacks, back into 2015 and 2014, and has been the norm - individuals and whole families just sit there and die every chance they get. (some review at the end). That's obviously not because they're so dull, but because they passed out, or become paralyzed, early in the process and couldn't do anything after that. 

However, the people telling and selling this story seem to be some combination of liars and idiots. Chlorine does not make the victim just black out.

Maybe the core research was done by some Islamist watching the cartoon show Futurama. In this scene, a chlorine gas cloud is produced after "Nibbler" drinks an entire swimming pool and then burps. The non-robots cough a bit, and then tip over unconscious and lay there. The immune robot  laughs, then rusts and tips over.

That seems like a good fit with the cases reported out of Syria. It starts out right, but quickly goes wrong, from a scientific standpoint.  (An accurate response wouldn't be funny at all, like this sort-of is) Let's take a moment to consider this as if it matters.

The basics: chlorine turns to hydrochloric and other acids on contact with water. So moist tissues like eyes, airways, or sweaty skin will be damaged by droplets of highly corrosive acid. That's how it kills germs in water, and how it would kill a human or animal. The effect is mechanical, and the injuries are incurred during exposure, however intense and however long that is.

The patient remains conscious, but starts coughing, eventually with blood coming up (they would want it to, to make room for air). Death only come later, as chronic low blood-oxygen, damage to the lungs, and the body's often fatal response play out (a secretion of protective mucous often comes far too late to help, and contributes to suffocation). There's little that can be done medically to reverse the damage. Medics can suction the lungs and provide respiratory support to keep the patient breathing until, hopefully, they pull through and heal. But other times, even that's not enough and the patient dies after a long struggle.

The Literature Says:
A seminal source on chlorine's effects was compiled after the first World War, when it was widely used as a chemical weapon (to mixed effect, I might add). Medical Diseases of the War" by Arthur Hurst, M.A., MD (Oxon), FRCP. - excerpt:
The first effect of inhalation of chlorine is a burning pain in the throat and eyes, accompanied by a sensation of suffocation; pain, which may be severe, is felt in the chest, especially behind the sternum. Respiration becomes painful, rapid, and difficult ; coughing occurs, and the irritation of the eyes results in profuse lachrymation. Retching is common and may be followed by vomiting, which gives temporary relief...
... When a man lives long enough to be admitted into a clearing station, he is conscious, but restless; his face is violet red, and his ears and finger nails blue ; his expression strained and anxious as he gasps for breath...
The closest we get to the cartoon version - 
Severe headache rapidly follows with a feeling of great weakness in the legs; if the patient gives way to this and lies down, he is likely to inhale still more chlorine, as the heavy gas is most concentrated near the ground. In severe poisoning unconsciousness follows; nothing more is known about the cases which prove fatal on the field within the first few hours of the "gassing," except that the face assumes a pale greenish yellow colour.
The chlorine-colored face is something other sources don't mention, but the kinds of clouds made in World War 1 have rarely been seen since. And our central question, it's unclear how closely or uniformly black-out  "follows" in severe cases. It's generally not mentioned at all on lists of symptoms: Wikipedia: consciousness not mentioned - Medline: consciousness not mentioned - US Centers for Disease Control (CDC): consciousness not mentioned.  (see also an earlier list at ACLOS, where it also never comes up)

Another, more detailed CDC page acknowledges passing out is sometimes associated with chlorine poisoning, but puts in context:
"Not all of the signs and symptoms exhibited by subjects exposed to moderate to high concentrations of chlorine gas are caused directly by chlorine.  In general, it is believed that effects such as nausea and vomiting are reflex in origin..." (you cough so hard you throw up) "...and headache and loss of consciousness are probably due to the hypoxia caused by pulmonary edema."
That is, fluid-filled lungs keep oxygen from getting into the blood (hypoxia), and hence to the brain, leading to an oxygen-starved brain (cerebral hypoxia). This causes headache - a very common symptom - and to unconsciousness - seemingly less common. That situation will require some minutes at least to develop, and longer yet to get that bad.
However common, headache and passing out aren't really primary signs - they're common to many different poisons, and other more obvious and specific signs should appear well before these. Other sources I've read suggest people usually don't lose consciousness at all - they remain aware and responsive until the moment they die. When they do lose consciousness, most commonly, it's a short final stage before they finally die. That is, it's more of a last thing than a first thing.

For anyone who does finally black out, they should usually get out the door at least (in the Syrian home scenario), though if the damage is severe enough, they may not get much farther before they're breathing so bad they finally collapse. But the first minutes should always be a time consciousness and free will. Wracked with pain, panic, and harsh coughing, still, they'll try to get away to fresher air, and most should succeed.

So I stand by this rule of thumb: If someone seems to just sit there and die from a chlorine attack, something unusual is probably at work.

That can have various innocent causes in fluke cases, but if the pattern is too prevalent, or other counter clues exist (both apply across the record in Syria), it's probable that the chlorine-bomb story just isn't true. Much evidence and logic, in many cases analyzed over years, suggests that anyway. In fact, it often seems the victims might have been hostages of the opposition/Islamist forces, intentionally gassed to death as propaganda devices, with the intent to get their enemies in more trouble and encourage foreign intervention. But whatever the explanation, the one offered is inadequate, and that suggests some kind of cover-up.

Add 3-16: One important aspect I overlooked at first. See below: When People Stop Walking. If you want to try and debunk me here, this is probably the avenue to explore, the best reason people might just lay there and die. But as I explain, I don't think it's adequate either. 

Recent Cases in the United States
WWI deaths happened because of trenches and enemy fire, and massive clouds made on purpose, using winds deliberately to kill - not common anymore, but industrial accidents can cause them. There are probably many examples all over the world, but three from here in the US come up prominently. None of these mentions unconsciousness, nor specifies that everyone stayed awake. But the third case at least offers some useful insights.

Festus, Missouri, 2002
First, a case with no deaths and little detail on symptoms, just for the visuals and an idea of how it spreads On August 14, 2002, tons of chlorine was released at DPC Enterprises in Festus, Missouri. An incorrect hose type corroded from the gas, and the safety shut-off failed. The resulting deep cloud, 48,000 pounds spilled, was captured on video, pinned between the plant and the raised railroad tracks. 

In a CNN Video from later, the cloud looks more yellow than it does here, and is being shut off finally and dissipates. This explains there was almost no wind, so the gas just sat there and didn't spread much, even into the nearby trailer park, which was evacuated anyway. 66 sought medical care, but apparently no one died. (CSB.gov, source for video still, which seems color-saturated by the way, but this is an exceptionally thick cloud, and would display the color well)

Spokane, Washington, 2015
This is where I live, and this was local news. At Pacific Steel (basically a scrap metal recycling plant). On Wednesday, August 12, 2015, a pressurized one-ton container for chlorine, that was supposed to be empty, wound up leaking. They don't know where it came from, or why it was not empty. Apparently, it was being put on the conveyor by a crane, but was accidentally punctured, and a cloud of gas described as yellow streamed out "in a rapid fashion, making a huge cloud," Assistant Fire Chief Brian Schaeffer said. (CNN) There was enough of it people down the street saw it pouring out of the plant “Everybody saw the yellow puff,” one witness said. “The puff of whatever didn’t look good.” (Spokesman-Review)

CNN's report sounds almost like those from Syria at the same time, but truer: "Those in the area said the gas smelled strongly of cleaning products. Many nearby began experiencing breathing trouble and tightness in the throat. ... Effects of the chemical ranged from minor respiratory issues to severe respiratory issues," with no mention of losing consciousness. 

Fire officials first thought announced it was Arsenic Trichloride, but soon decided it was chlorine. (KHQ) Several plant workers were seriously exposed, with 13 admitted to hospitals, and four put in intensive care. Three of these recovered within a day or so, but one worker, named Edward Dumaw, died after more than three days in intensive care. "A family friend said doctors were unable to repair Dumaw's lungs and that his heart was failing.  Dumaw died Saturday evening." (KHQ)

One report noted "Pacific Steel could not say if Dumaw was operating a crane or on the ground at the time the chlorine gas was released into the air." (Green Bay Press Gazette) If he was the crane operator, he might puncture the tank while it was close to the cab, but wherever, he was probably closest to it, and got the most concentrated blast, maybe right in the face. This would causing massive damage in a matter of seconds. It's probably amazing he managed to live three days.

Did he lose consciousness, or walk out alert but in crisis? That's the question, but the answer still isn't clear. I was thinking of calling to ask around ... but I don't think that's necessary. Nothing so far suggests he or anyone should have passed out, and there's no mention of it. The next case may settle it.

Graniteville, North Carolina, 2015
Around 3 am on January 6, 2005, an accident led one train to crash into another that was parked, near the Avondale Mills plant. The moving train (wrongly routed by negligent track settings) was carrying several cars worth of chlorine products, which largely wound up spilled. At right is a view from the morning after, following the worst of it (cropped from the photo used at Wikipedia - note the very pale color here - this is fairly well dispersed).

A US Department of Transportation report explained:
About  5,400  residents  were  evacuated.  The  chlorine  gas  had already affected many people: 554 were treated at hospitals, 75 were admitted,  and  nine  would  eventually  die  from  its  poison  (2): 
Nine deaths gives us some depth where less-common symptoms might appear. Some cases sound like people might have passed out where they were and/or slept through their death. But let's consider it in some detail. The report gives these nine as:
...the train’s engineer (who had survived the crash), three workers in the mill, a truck driver sleeping in his cab, a man in a shack one block from the wreckage, two workers who had evacuated the mill on foot into the woods, and one other person (7).
The cited sources are gone, but Wikipedia's article suffices, saying about the same, along with names we don't need to include here, and some details that may help. The other person is a 4th plant employee. A victim #10 is added here, a driver who passed through the plume (it filled his car and he kept breathing it?). Later he had a slow deterioration, and finally died, over three months later (let's not count this one, but note he kept on driving, instead of passing out and crashing)

The dead victims are mostly employees of Avondale Mills, working at the plant at the juncture where the crash happened. Anyone who died at their work station is a candidate for instant loss of consciousness. But we don't know their stations or often just where they died. But in many cases we can see they died some distance away.

Considerations: early morning attack, it's dark, and not as many people are around. A badly gassed person could get inside, find a phone in an empty office, call 9-11, cough blood and gasp into the reciever, lay there dying, and be found dead, or found alive, but then die in the hospital. They might go what they think is upwind, and it might be, but if they breathed too much and upwind is into the woods, they'd die choking alone in the woods, and be found in the morning.

Also note: rescuers were told to hold back, not having the right protective gear. The plume drifted many miles, for days, but it was dispersed and no deaths were reported out here, just immediate acute inhalations, and the stray victim #10.

And here's a lesser known point of some interest: a piece at chemicalspill.org explains how "some trying to flee had difficulty starting their cars and trucks as the chlorine worked with the humidity in the air on ignitions. Cell phones also did not always work for the same reason." 

Chlorine Levels: "EPA set up a chlorine monitor at the crash site that maxed out at 1.5 ppm. Although the incident response lasted for several days, a better monitor that would show actual levels of chlorine in the ambient air was not used." This sounds grossly inadequate. The fatal level must have been reached, and the IDHL rating (immediate danger to health and life) for chlorine is 10ppm. Since nine died, it must have gone several times over what the meter would show. In fact, from what I've read around (see a case below with readings over 300ppm after a smaller incident), I would guess readings at the site right after would be in excess of 500ppm, and I wouldn't be surprised if it was even twice that high.)

With those points in mind, here's where and how the nine fatalities died:
1) engineer, found at site, died at hospital  - vague location, "survived the crash," but perhaps injured badly besides gassed (unable to walk, perhaps)
2, 4) plant employees, found in wooded area, dead - may have tried getting away, but slowly choked to death from the damage in the woods
3) plant employee, 25 feet inside the entrance of mill HQ, ground floor, alive but later died at the hospital - probably not at station, but didn't get far before he fell - may have been going for a phone
5) plant employee found on the loading dock - the same one he worked at? This could be a swift pass-out, or like the others but he just didn't get far
6) plant employee - found in a break area, dead
7) plant employee - found in an office, dead - (both likely going for cleaner air, and for the phone, but only after breathing way too much)
8) truck driver, found in his truck cab, dead - maybe he slept through the first part of breathing it, woke up in crisis but spent too long trying to drive away, couldn't start the engine (noted problem), could have stepped out in the cloud and tried to walk away, but likely died in the driver's seat, maybe after realizing he was doomed and giving up.
9) found in his home, dead - Maybe prior medical problems, woke up at the crash noise, fell back asleep with a vengeance (took a pill? might need them, living so close to the tracks), breathed a weaker concentration for a while as he slept, and woke up too late. I bet he was out of bed, maybe had the phone in hand and even called 9-11, but he didn't make it to the door. Likely 20 others had a similar story but fared better and lived, most of them easily.

This last might apply to the November 20 incident and other night-time attacks in Syria, where people were caught sleeping. Except it's harder to sleep through chlorine released from a barrel bomb that fell through your roof. You'd wake up right away, and sleep through none of the damage. So, no, this doesn't help in the Syrian home scenario.

When People Stop Walking
(added 3-16)
I can be faulted here for overlooking one seemingly minor effect that could actually explain the Syria anomalies. As mentioned above but not explore, this was noted in World War I. Hurst:
Severe headache rapidly follows with a feeling of great weakness in the legs; if the patient gives way to this and lies down, he is likely to inhale still more chlorine, as the heavy gas is most concentrated near the ground.
We've already established that headache, besides unconsciousness, is caused by low blood oxygen. It won't be instant. The weak legs will be fatigue, strong there as one runs to escape the cloud. This is likely the same: not enough oxygen for the muscles to work easily. This mobility problem could cause a victim to lay down, if not fully until death, at least until they got a fatal dose.

But these were WWI exposures, to fit soldiers, but ones with mammoth plumes sent over them, and nothing but fields and trenches around. There was no up, usually, and if there was enemy gunmen had it covered. The nearest edge of the cloud might be a kilometers away and hard to know which direction. Having no escape might have amplified the variable effect of the legs - and maybe the whole person - just giving up, and even seeking a denser cloud to get this affair over with. In other circumstances, it might be less of an issue.

Tulare, California, June, 2010
But a similar inability to walk, as well as a sort of paralysis and falling down feature rather heavily in this semi-recent accident story where chlorine sounds almost paralytic. This was in Tulare, California, in June, 2010 (not one I noticed in my first search). Like in Spokane, this happened at a recycling plant where a non-emptied tank with chlorine was ruptured. Scientific American would report on it 16 months later, with employee Beverly Martinez giving the most details. Not a floor worker but someone with an office, she was there when the gas hit.
A couple dozen people – workers and customers – dropped to the ground, gasping for air. Martinez fell, too.
Almost instantly, it sounds like, she was sort-of-paralyzed. "I couldn't get up. I felt like I was being strangled. I thought, 'I'm going to die. I'll never see my granddaughter grow up." But then she did get up, and started moving towards the building across the street. Then she ran into co-worker Ricky Mejia laying on the ground, calling for help. He was an inspector, and may have gotten a bad dose when he went to inspect the accident.
"Ricky couldn't breathe, he couldn't walk. I'm stocky, and I told him to grab my side. Myrna Navarro was already hanging on my shoulder. She was praying enough for everyone. In my head, I was getting to the Firestone tire warehouse across the street. It seemed like an eternity,” she said.

“Then, I couldn't do it anymore. I said to Ricky, 'Your wife is pregnant. You've got a baby coming. Get up!' " They finally made it to the warehouse, where Mejia collapsed.
When she put the options as walk or die, they all resumed on their own to safety. No one was really paralyzed,  no one blacked out, and no one died. 23 people were taken to hospitals, and 6 were admitted. Two suffered severe exposure and had to be put on life support. One was Ricky who thought he couldn't walk at first. He was kept for 11 days before he was fully recovered.  Ongoing problems 16 months later: lung problems, stress disorders, stomach problems (probably from the stress).

This apparently was a large cloud that took a lot of walking to fully escape, but I suspect it was not terribly dense, or someone would have died. The article says concentrations were measure at "328 parts per million near the tank" afterwards, which is very high and easily fatal (33x the IDHL rating). It would be even higher at the beginning. But it must have been far weaker in the swathe Beverly dragged half the crew through, because none of them died.

By this unusual account, the anomalous response so common in Syria almost makes sense. But in fact, this story sounds odd, and may not be the exact truth (possibly embellished, or just not remembered right because of the trauma). 

But let's just take the story; maybe there's sometimes a sudden fall when the bad air first hits you, like the wind being knocked out of you - you might drop down into the cloud, kneeling or laying. Then maybe there's a period of paralysis, and/or a perceived inability to walk that makes people just lay on the ground. But if so, we also see it tends to be optional - everyone in this story got over it, got moving again, and lived to tell their own story. In "Free Syria," that seems not to happen. No one gets out, or helps anyone else get out. They all die, and someone else tells the story for these peculiar victims. 

In fact, I can see some pro-rebel think tanker in the UK, with no science background and used to thinking of the Syrian people as passive props... he's drafting the list of symptoms to claim, fake, or cause in order to convince outsiders of chlorine use (drafted as "watch for these signs of Assad crime and report it swiftly"). He's eating cheese crackers from a box set sideways. He scans this very story while pondering the low-fatality problem (Of course, a few folks will have to die in order to spur intervention). Bingo! He decides paralysis and laying there is a feature to watch out for, what the Brits consider a valid sign ... and that will explain why x number wind up dying, tragically, on rebel videos. Wouldn't that be (darkly) funny? Because something similar was in Scientific American ... besides on that Futurama episode.

Recent Case With Rabbits, Regarding Syria
Consider also, how two exposed rabbits die, which should be quite similar ... as shown in Monitor analysis here, and in more detail at ACLOS, in the infamous Tekkim chemical test video, a thin, pale vapor of chlorine is produced in the flask by pouring hydrochloric acid on powdered potassium permanganate, and rolls across the floor of a small plexiglass cage, lidded over. It has no room to disperse, and will yield quicker death than usual. Also a rabbit's faster metabolism likely means it'll happen several times faster. (maybe not, or partly, whatever...)

The rabbits don't like breathing it, and blink their eyes as if irritated. The white rabbit doesn't just blink but squeezes its eyes shut most of the time, and also seems to sort of sneeze or cough a few times, and might be bleeding from the nose. One tries to get higher or escape early on, and the other only after a period of (denial?). Eventually one panics, and they both start trying, with increasing urgency, until - about two minutes in - they slip and trip over each other on the plexiglass, then struggle for several moments on the floor, but cannot get back up. They stop trying and lay there, but likely remain conscious. It seems they simply gave up at that point, and it's hard to say how quickly they black out or die after that. They remain kicking and wiggling a bit for many seconds, and then camera goes back to the narrator, who starts talking about the humans he hates, and hopes to gas this same way.

Add 3-16: This is another case for the victim just laying there file, alongside many fatalist WWI soldiers. As in those cases, though, we have to ask what friggin' option did they have? I don't think this is passing out, but tiredness plays into it. I think it's a conscious choice to give up and wait for the blackness.

This shouldn't apply to any but the most severely depressed citizens who are free to move, and just a few steps from the exit of their own house. In fact we could say if people really do just sit there and dire from chlorine, as alleged, they're more likely to be in a situation akin to a rabbit cage, than to being at liberty in their own homes.

We see no indications that people normally just sit there and die. In massive incidents, a few fluke cases might. But what they're reporting in Syria makes little scientific sense, and it might be a complete lie, of the kind they've been caught telling before. Here, I'll try and review all related cases, with some notes on just how they sat there and died. 

all fatal alleged chlorine incidents blamed on Syrian or Russian forces (there are some blamed on rebels as well):

4 fatal incidents in 2014
...all with the relevant details unclear. But most affected displaced families (IDPs), which is its own issue, suggesting possible captivity - if so, they also will have just sat there and died, from whatever, likely in some gas chamber.
April 11 - IDPs, 2 immediate deaths, from head wounds - a delayed death in Turkey, from the gas - not a good example.
April 18 - IDPs, woman, husband, son, IDP from Khan Sheikhoun + another, details unclear
April 21 - 3 dead, boy died same day, girl and mother 4 days later in Turkey - details unclear
May 22 = IDPs OPCW: "a mother aged 30 years, her sister aged 16 years, and two children (a five-year-old girl and a four-year-old boy) belonging to the same family" - details unclear.

Two non-deadly incidents later in 2014: "The injured showed all the signs of chemical exposure — red eyes, fluids leaking from their noses, red lips. Some were choking. The worst affected had fallen unconscious." (The Times)

4 in 2015
1) March 16, Sarmin, Idlib:
“There was a very strong chlorine smell there,” Muhammad Yazan, a local activist, told Human Rights Watch. Yazan went to the impact site in Sarmin, as well as to another village that was attacked in Idlib province. “One of our team members passed out due to the smell. ..." (PBS)
"(the victims) had gone down to the basement to seek shelter from the impact of the explosion, as they usually did, which led to their immediate suffocation as the gas, being heavier than air, slipped down to their shelter."
"immediate suffocation" here doesn't mean death, apparently, just immobilization. After some time...
"... The whole family was moved to the field hospital while still alive, but  they were so severely affected that the medical staff failed to save their lives. Due to their exposure to high levels of the toxic gas and the fall of the barrel directly on their house, they died one by one."
By the video evidence, medical negligence clearly played a role in their deaths, and chlorine clearly did not. (see here)
"Laith Fares,  activist,  civil defense worker and reporter for the civil defense teams told the VDC that a large number of civil defense workers had suffered from exposure to gas  due to lack of masks. They showed symptoms including respiratory irritation, burning in the throat, redness in the eyes and severe cough." (VDC report)
He doesn't mention paralysis or unconsciousness as anything they experienced. But it seems the victims did:
“We were told that a family lives in the basement. Three of us went down the stairs. I took one breath and (blah blah)  I saw a woman on the stairs. She was blue and was not breathing...."
This the grandmother in the family. She stopped moving, passed out, fell asleep, before she got up the stairs. I know the site, there are many stairs, so it's hard to say how far she allegedly got out of the small apartment, which I doubt they really lived at (the children shown on video clearly were not exposed to any serious amount of chlorine).
"...We evacuated her and a minute later the next team went in and evacuated the other family. They were wearing masks - that is why they were able to go all the way down. They evacuated the father, mother and three babies. They all died.” (Amnesty International)
And none of them could move until then, not even to get out and onto the stairs - they just sat there and died. Five people. Only the oldest one tried to leave everyone behind and half-succeeded. Does this make any sense?

Add 3-16: The OPCW were told a different story: the parents and the boy, Mohammed, managed to get out of the house ... while grandma and the girls didn't. That's perhaps half-plausible. (UN report, page 84) In another version, they say the same but goof up ages, claiming the parents and the oldest (male) child escaped (OPCW). But Mohammed was the youngest. And everyone else, talking straight to the public, is clear that he and both parents just laid there inside with the girls, until some White Helmets types showed up to save them.

Add 3-16: And I forgot this part: After a trip to the hospital, the victims' stripped and washed bodies
continued to emit such strong fumes, Dr. Tennari claimed, that his eyes burned and he felt vaguely sick. This is a patently nonsensical claim, and furthermore, the video record proves Dr. Tennari wasn't actually there. No wonder his "memories" make no sense. (see here) He also said, (as the New York Times heard) a nurse “fainted from the chlorine fumes off the injured.”

2) March 31: little info - one man died in Idlib city, in chlorine bombing just after liberation - vacuum missiles and more were said to kill far more, and Islamist victory massacres of soldiers, minorities, or anyone apparently didn't happen at all (by reports, anyway).

3) May 2, Neirab Idlib:
A rescuer told HRW:
"I saw a small child wrapped in blankets but I couldn’t reach him. The third time, fluid started streaming from my eyes, my nose, and my mouth. I felt like I was going to pass out. I started running and I lost consciousness. I didn’t wake up until other civil defense workers washed me with water."
That's just not correct, if this is chlorine. He claims he couldn't even outrun the swift unconsciousness caused by... as we've learned, sometimes, from pulmonary edema triggering cerebral hypoxia, after a prolonged struggle with badly damaged lungs.  He doesn't even mention his lungs or coughing. It sounds more like sarin, maybe. But he wasn't alone: the older man and his infant son never moved from where they were inside, as if chlorine freezes you in place, like sleeping beauty, until a shining White Helmet can defeat the chlorine dragon, break into the castle, and kiss you.
"Two of those exposed during the May 2 Neirab attack later died: the young boy Kayali saw, who died within hours of exposure reportedly from suffocation, and his father, in his 60s, who died at a hospital in Turkey a few days after the attack." (Human Rights Watch)
4) May 15: little info, a woman dies in Idlib province, Mishmishan

7 fatal incidents in 2016
... all in besieged eastern Aleppo in the run-up to re-conquest/liberation

1) Aug. 10 - a woman and her three children killed ... "One doctor described the deaths of two children and their mother from the August 10 attack: “At first, two children and their mother arrived to the hospital. The children were unconscious and unresponsive. Their mother was shivering, coughing, and wheezing. She barely could breathe and was drooling heavily from her mouth. Their clothes were covered in a wet substance with a sharp smell, like chlorine. The two kids went into cardiac arrest after around fifteen minutes. We tried to resuscitate them to no avail. Five minutes later, the mother also died.”" (HRW)

2) Sept. 6 - "Some fainted and vomited, one doctor said." (HRW) one teenage girl and a younger man both reported dead from the chlorine - both are likely seen in different videos, and neither looks like a chlorine victim. No known details on how they were supposedly exposed.

3) Nov. 20 - a family of 6 all died in their home, unidentified by almost everyone
"Abu Mohammed, an employee at the Ikhlas Medical Center, told Human Rights Watch that at least two munitions fellin al-Sakhour shortly after midnight on November 20. One fell 75 meters from his house, he said, and another about 200-300 meters away. He put a wet cloth over his mouth and went out to check the neighborhood. In one house, he saw five dead civilians, a mother, father and three children. Their faces were blue." (HRW)

They were all in the house. Maybe one child made it out the door, or was somewhere else? All are seen in full street clothes, after this midnight attack, but with no shoes. Did they sleep in their clothes, or manage to get dressed after waking up? Because the did not get out to safety, before they tipped over and became passive props in the story, waiting for rescue.

Research suggests they were held hostage, tied up, perhaps upside-down, and gassed with something extreme, likely including smoke. That may sound far-fetched, but they look very strange, with hair sticking up, and this would explain why they just sat there and died.Further, the dark rings around their eyes suggest each family member was hit hard in the back of the head, cracking their skulls, about 2-3 days prior to their killings. Yeah... not god. That might be why they sat there and got tied up, but thy shouldv'e been awake again for whatever was done to them in the end. (see here)

CNN, referring to the same family:
"We were sleeping when a barrel bomb fell near our home," a man explains on the video. "We went down and discovered it was chlorine gas. The victims weren't activists or anything ... but they were suffocating so much, they turned blue. It was a man, four kids, and his wife. The oldest boy was 10 years old. Why did this happen? May God curse you, Bashar (al-Assad)."

In fact, research suggests they might have been a Christian family of the kind that not only doesn't support the Sunni extremist rebellion, they sometimes get kidnapped by it. "Two medics said the al-Baytounji family had suffocated to death because the barrel bomb, which fell in the Sakhour district at about midnight, had been laced with chlorine gas." (Reuters) The name seems connected to Aleppo's Christian community. (same "see here" above)

4) 11-23 - a woman died, inside her home, age 55 but unidentified by everyone

5) 11-28 - "Firas Badawi, a photographer with the Aleppo Media Center ... saw a helicopter ...the munition had hit a playground ...  "We rescued 11 or 12 people who had sought shelter in surrounding buildings, fearing an explosive barrel attack. Most had lost consciousness and there was foam coming from their mouths. We thought they had died. Others couldn’t breathe and were screaming from pain in the chest, coughing and burning in the eyes." (HRW) - 2 reported dead, no details at all.

6) 12-8 - 2 reported dead, some confusion - "Al-Khattat said that the attack killed two people: Ammar Shohaiber, around 40, and Mohammad Abrach, around 50: "Ammar’s house was very close to the impact site and it was full of chlorine gas. We gave him first aid and he seemed to get better, but at night his conditions worsened."  They don't say if he was found inside or outside his house. Mr. Abrach (listed by the VDC as an un identified woman) is even more vague - did he have his own house, or were they in the same place? (HRW)

7) 12-9 - 5 reported dead, no details at all.

2 in 2017 (so far) -
1) Feb. 9, Irbeen: one rebel died, no one else apparently just sat there and died, but some people did pass out. As noted at the top of the article, activists reported "symptoms consistent with chlorine gas exposure including; difficulty breathing, loss of consciousness and foaming at the mouth."

2) March 25, Latamna, Hama: A surgeon, the patient he was working on, someone else reported killed in chlorine attack on an underground hospital. "“most of the injured suffered from fainting, red eyes and shortness of breath”, the Hama Civil Defense reported." (Syria Direct) (And see Monitor analysis of the attack here)

= 17 fatal incidents total (dozens and dozens of non-fatal attacks reported). The number of fatal attacks isn't necessarily that high considering, and the numbers of dead aren't really suspect. It's these incorrect little details like  instant black-out, and other signs of cover-up, that makes these claims so dubious.

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