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Tuesday, August 20, 2019

4-21-2014 CW Incident: Victim Questions

August 20, 2019

I've gathered some general information and analysis on this subject, first at ACLOS long ago, then recently in more detail here, including strange symptoms and chemical findings, and unusually sharp forensic questions. But that post is already sprawling, and these further victim details deserve their own post with room to breathe. Here I mainly draw on details from this 2016 report of the Syrian-American Medical Society (SAMS):

A New Normal: Ongoing Chemical Weapons Attacks in Syria, February, 2016
https://www.sams-usa.net/wp-content/uploads/2016/09/A-New-Normal_Ongoing-Chemical-Weapons-Attacks-in-Syria.compressed.pdf


On the cover - bottom: Binnish, Idlib, March 23, 2015. That's not chlorine, as reported: it's too light, too green = prob. special effects colored smoke. Good start...

The top image is described "Bab Al Hawa Hospital, Idlib, April 21, 2014."

I was slow to connect that image (or a similar one shown below) to the alleged chlorine attack in Talmenes, Idlib, on that day, but finally did some time ago. (Such mainstream news photos were rare, not something I watched for - most visual clues come from "activist" videos and photos) As it was reported at the time:

"A Reuters photograph of another young boy who had been transferred to a hospital closer to the Turkish border showed him lying dead on a stretcher with blood around his mouth. Medics said he had been exposed to chlorine gas at Telminnes." (via Business Insider).

Well, it doesn't look like his eyes were exposed much, if at all. But his airways, apparently so. It's never good when one and not the other is affected. It's not normal, requires an explanation. (or so I think - a non-expert. If one squeezes their eyes shut on first sting, redness could be kept minimal. It's debatable if this is too minimal)


This was perhaps the best-illustrated and most widely-accepted of four deadly attacks in the Hama-Idlib border area during April-May 2014 (small tolls adding up to about 10 killed in total). It's the only one of the four where the fatalities were not listed as "displaced" from other towns. In three of four cases they were reported as strangers. At right is the map of where people from wound up dying in these shady chlorine events. It always seemed possible that "displaced" was a sort of code for captives kidnapped - as some 80 Alawi civilians were in February, from nearby Ma'an (besides from other places and times). The people taken from Ma'an (white circle at right) were mostly women and children. The IDPs listed as killed were almost entirely women and children too, a pattern that does carry over here in Talmenes. But it seems less suspicious in having hometown victims and no red arrows pointing to it. Odd that it was also the one with Reuters photo, and the best general reception, despite half its barrel bomb impacts being ruled fake by the OPCW's own experts.

But the SAMS report adds details that raise serious questions.

Background, from SAMS report
Of some 350 affected people, the report explains, 19 cases required "more advanced medical care, which they received at Medical Facility A" (one of two unnamed facilities "at the Syrian-Turkish border" that handled patients for this incident). Prior to this, many or all came to Alsiddiq field hospital, one of whose medics described the following symptoms:

* irritation
* seizure (one case)
* vomiting,
* bluish skin,
* redness of the skin with itching,
* redness of the eyes,
* hyper secretion of saliva,
* dyspnea / difficulty breathing
* pupil contraction 
* epiphora [watering eyes],
* cough,
* abdominal pain,
* loss of consciousness

Others mentioned in case details include:
* tachycardia [over-fast heartbeat]
* sweating
* dilated pupils [contraction noted in general - a contradiction?]
* crackles in both lungs areas [meaning damage evident in x-rays?]
* pink foamy secretions

These signs/symptoms are a strange mix of consistent with chlorine, inconsistent, and debatable. "Constricted" pupils were common in this attack, That's mentioned as a sign for sarin, but the only mention on an individual level is for the Al-Hashash boy, with dilated pupils - which is rightly connected to BZ or Agent 15 (see page 32). Chlorine causes neither, just irritation of the whole eye surface. This and loss of consciousness in particular suggest something other chlorine is (allegedly) at work. BZ-Agent 15 is also uniquely suggested by irritation, abdominal pain, but contra-indicated by sweating and salivation. If any one class of chemicals can explain all this, it doesn't seem SAMS has a category for it. They have four categories:
* sarin/nerve agent
* chlorine/choking agent
* mustard gas/blister agent
* BZ or Agent 15/psychotomimetic agent

The 21 April attack reportedly killed people of two families at two nearby locations - not one family as I had first read it. OPCW Fact-Finding Mission report S/1230/2014 (Dec. 18 2014 - PDF link) relates the narrative of two devices dropped by helicopter in quick succession at around 10:30 to 10:45 am. The released chlorine gas reportedly affected 350 people, and caused fatalities in two homes in Talmines about 100 meters apart. The associated names are redacted and never given, but the FFM agrees with all other sources that three died - a young boy and teenage girl in one home, an older woman in the other.

Five specific, detailed cases
The SAMS report describes five serious cases, 3 of them fatal, one unclear. Below I'll consider these in the order given, each with summarized report details, then other sources and notes.

First Case: Mohammad Abdul-Razzak Alhashash, age 6. "He was getting prepared to go to school when he was exposed to a yellow toxic gas. He was unable to breathe and lost consciousness." He arrived at the hospital at 1:30 pm, about three hours after the reported attack, already "intubated under mechanical ventilation," but he died anyway at 2:00 pm. As the one boy aged 6/7 to die, this is clearly the one in photographs. It's not clear if he was also transferred "closer to the Turkish border" (as mentioned above) in that short time, or after death, or at all. Clinical signs: "redness in the face, pink foamy secretions, pupil dilation, diffused crackles in both lungs areas." No mention of oxygen levels, as there is with the others.

VDC lists Mahmoud Abdul Razaq Hashash "Nawas" child-male, age 7, died 4-21 "Martyred due to exposure to Chlorine gas which was contained in a barrel bomb shelled on his house, delivered by the government helicopter" Mohammad vs. Mahmoud could just be a typo - very similar. Either could be accurate, but more likely Mohammad.

FFM heard about and saw medical records for "a seven-year-old boy, who died within a few hours of exposure." He was only "some 15 m from the point of impact of the barrel bomb" yet "there were no signs of physical trauma on his body" - important to prove it was the chemical part, not the dropped bomb blowing up that killed him. From suffocation, the boy "developed cyanosis and, as explained by interviewees, “turned blue in colour”." A bit in the lips, but otherwise, not really. I'd say he displays about normal lividity, suggesting his suffocation was not that prolonged. In fact, it seems very doubtful he struggled with death anywhere near as long as the claimed 3 hours before arriving at the clinic. All that blood means serious internal damage, which is more likely to cause a swift death.

On the cover, an extra-wide view shows a blue catheter tube attached to his groin with lots of tape. I don't think that's normal. A contact with more medical insights had a few guesses what this tube could be. None were related to chlorine response, all tending to respond to existing medical conditions and to happen in a hospital, not at home, likely not even at any facility in Talmines. This is a serious clue of something wrong with the lodged story.

Second Case: Khadejah Barakat, 65-year-old female, was at home when the bomb landed and "yellow gas started to spread and she experienced difficulty breathing and asphyxia." She arrived to the hospital at 2:30 pm (about 4 hours after the reported attack), awake and alert but "with symptoms of dyspnea, tachycardia, sweating, irritation, extensive cough, crackles in both lungs areas." She was immediately put on a ventilator, by a more specific "2:40" pm. A starting O2 saturation of 70% dropped to 60% before 7:00 the next morning (April 22) when she was "transferred to Turkey for advanced medical care."

The entry in the SAMS report ends there, but she's one of two delayed deaths in Turkey, both listed by the VDC on April 25: Khadiga Mohammad Barkat, A-F, Telmenes, died in Turkey, on (or was listed on) April 25, "Martyred with due to exposure to Chlorine gas which was contained in a barrel bomb delivered by the government helicopter on a house on 21-04-2014." OPCW FFM clarifies it's not just listing: "In the second house ... the matriarch of this family died as a result of this exposure on 25 April 2014, in a hospital outside the Syrian Arab Republic."

Third case: Marwa Hashash, 15-year-old girl, was at home (same one her brother was at, presumably, prior to 1:30 pm) but not preparing for school. She was, after all, a girl in "liberated" Syria. "The toxic material container hit" at the same time it did for Mohammad/Mahmoud, but it was some 5-6 hours before she "arrived to the hospital at 7:00 pm." After all that time, she was "awake and oriented" with the usual listed symptoms up to crackles, "and O2 saturation of 60%." That's bad, where Khadija got before transfer and death. But Marwa would be much younger and more resilient. Along with Mrs. Barakat and others, "she was transferred to Turkey for advanced medical care at 7:00 am on April 22, 2014."

As with Mrs. Barakat, the story ends there, but the VDC doesn't list anyone of this name as dying. The OPCW report just lists three fatalities, with the girl presumably being her sister of similar name and similar-contested-age (?) listed under "fifth case." So implicitly, this one survived despite the ominous story given.

Fourth case: Ahmad Barakat, 64-year-old male, was at home (pres. with Khadija, but not explained) "when the toxic material container hit." He arrived to the hospital at the same rounded-off 2:30 pm, with the same status: "awake and oriented" with the same symptoms but for "O2 saturation of 80% on room air," reaching "90% with the oxygen mask," even upon arrival. This increased to 95% before he was released after 48 hours on April 23. His chest x-ray shown, barring a mix-up - it's dated 4-23 in writing, image stamped 4-24, the day after his discharge.

"The patient reported his testimony about the attack and his injury, and it matched all the other testimonies previously mentioned." This might be one of those "miracle survivors" and storytellers who clarifies regime blame, and who may not be who he claims to be. Unlike some, he has a medical case, allegedly ... but it's not much of one. A serious faker might easily volunteer for mild exposure as evidenced here.

Fifth case: Marioumeh Alhashash, 19-year-old woman, at home, with her brother Mohammad, other sister. arrived to the hospital at 2:30 pm, an hour later, but 4.5 hours earlier than sister Marwa - "She was at home" when the "yellow gas started to spread, and she experienced difficulty breathing and asphyxia. Upon arrival, the patient was unconscious" (again unusually), with the usual list of symptoms, and "O2 saturation of 45%." That's worse than Marwa had, and makes unconsciousness more plausible.

It sounds like she wasn't transferred to Turkey like her sister and Mrs. Barakat, whose stories end there with no further details. Marioumeh apparently stayed closer to the people reporting details. "After observation on mechanical ventilation for 72 hours, O2 saturation did not surpass 92%. The patient was transferred to ICU and died on April 25, 2014 of respiratory deterioration and noncardiac lung edema." The report explains how images below show "the patient’s situation and CXR 24 hours after the attack," noting "The first name on the X-Ray is inaccurate by mistake." Also, it's not shown - there's a readout of vital signs, then a view of another machine displaying some other readings. the only x-ray shown is for Mr, Barakat.

But Maryomeh Abdul Razak al-Hashash "Nawas", is listed by the VDC as girl, age 14 (not adult age 19), from Telmenes, "Martyred with her brother due to exposure to Chlorine gas ..." and as dying on April 25 in Turkey, not the local ICU. By that, she strangely died after the same 4 day wait as Mrs. Barakat. FFM report nearly agrees: "The family living in the first house lost a seven-year-old boy, who died within a few hours of exposure, and a teenage girl, who died on the third day after exposure," which should be the 24th. "Teenage" is more consistent with 14 than 19, but both do contain "teen." The other girl in the SAMS report, Marwa, was a very similar age of 15. Considering the vagueness with Mohamed's age of 6 or 7, 14 or 15 sounds kind of like one person's age, not two.

arrival timeline:
(of course the universally rounded-off times are noteworthy in their vagueness)
* attack at 10:30 to 10:45 am
* 1:30 pm, Mohammad arrives, about 3 hours after
* 2:00 Mohammad dies (only death of the day)
* 2:30 Marioumeh and both Barakats arrive
* 2:40 Khadeeja Barakat put on ventilation
* 7:00 Marwa arrives, at least 8 hours after the alleged attack.

It's not clear how this adds up, and that's the problem.

A female patient, not clear who, from the report:

Another, heavier and older female patient. Possibly Mrs. Barakat? Odd yellow-brown discoloration on her cheek but not forehead, faintly on upper arm and hand, not on the very pale underside. She does look bad off, somehow...


Locations
The FFM report gives the coordinates provided with videos of the alleged attack sites.

Courtyard (staged) "impact" loc. 1 in the northeast of town (unverified), Barakat home - N36.7426167° E35.6408333° - on Wikimapia

The crater caused when the barrel bomb landed - even the FFM couldn't buy that.


Kitchen "impact" loc. 2 just SW of that ("verified"), al-Hashash home - N35.6405500° E36.7418833° - on Wikimapia

Barakat details
Barakat is a very common name, probably too common to reveal telling patterns in a VDC search. But note the SAMS report describes a man and a woman of this name and same basic age (64 and 65) as patients who both arrived at 2:30. Logically, they're from the same home and related. To be cohabiting at that age, Ahmad and Khadeeja should be a married couple. But to have the same last name suggests it was a non-Muslim marriage; they would most likely be Christians, or perhaps Druze, Atheist, or just less-observant Muslims. That doesn't prove anything, but it's noteworthy.

Someone labeled on Wikimapia (in Arabic) a library owned or founded by Fateh Barakat Abu Abdo ( فاتح بركات ابو عبدو ) from Beirut, and/or Mohamed Barakat Ascot ( محمد بركات اسكوت ), here in the northeast of town, just 80-90 m west of the staged location # 1. That might well be related. I wasn't able to quickly dig up any further information about this person.


Al-Hashash - Al-Nawas details
Al-Hasash - (ar: الحشاش ) - VDC has only 63 fatalities named Hashash, with no obvious and relevant patterns. A man and boy of the name, from Aleppo's Fardous district, died the day before the Talmenes attack. That's statistically unusual, but not clearly related to suggest family targeting.
Wikimpaia gives for a spot in the south of town (Google translated): "peace upon you Geologist Riad Hashash, Telmens southern neighborhood, is currently resident in Saudi Arabia and work in the Center for soil testing."

The VDC gives both Hashash children the added "Nawas" (or Al-Nawas - Arabic: النعواص ). I'm not sure how that connects - another name they might go by, mother's name, something. It's not a common name - VDC has it only on these two fatalities. And Wikimapia lists it only once, in their same town: a home of Mustafa Al-Nawas also in the south of Talemenes - in fact just a bit south of the Hawash label. "Mustafa al-Nawas' sons work in grain trading And some of them in education" So per these labels anyway, the names Hashash and Nawas belong here, just like Barakat. As yet I'm not sure the names really go with the victims, or give any clue as to why they would be singled-out to die (that victims are picked at random from a helicopter is not a fact but a point of faith, and it's one I don't accept.).

So at the first house, a boy and two older sisters are reported (barring a mix-up), with other family possible but not mentioned.

Add 8-22: Or other family members are generally not mentioned. Just a week after the attack, a claim I haven't seen repeated or clarified: April 29, 2014, Ruth Sherlock, the Telegraph: "... in the village of Talmenes, another attack saw hundreds wounded and a family destroyed as two of the children died and the pregnant mother was taken into intensive care." No one else mentions that or explains what happened with her, or anything about a father or other relatives. Except ...

Syrian Government account - an unreported victim
But the OPCW's FFM heard another story - they had a protecting father who was killed. FFM report s-2016-738, Annex IV, Point # 20 explains how the Syrian government "provided the name of the owner of the house that had been targeted" and it was accurate: "The name corresponds to the name of the owner of the house at location #2. The Government had stated that this person had died in the attack" The name given isn't shared, but is said to match (whose?) records. If it's Al-Hashash, or perhaps Nawas, that supports the other reports. If the name doesn't match...

Elsewhere the report says this man "and his child" were killed, for a total of two fatalities. The singular form could refer to the boy or the girl, depending on their sources. They might not deny but just didn't hear about a sibling or the Barakat woman dying as well.

But the FFM was determined not to believe that story; "however, this person was interviewed by the FFM several months after the attack" or, as point 51 clarifies "a witness interviewed by the FFM later identified himself as this person (i.e., the owner of the house and father of the child that died in the attack)." It's possible he wasn't really that man. But they ignore that possibility, and wind up with reason to reject the government's story. But we can't ignore it, and are left with the possibility of another and un-reported death.

I have to re-visit the previous day's al-Hashash deaths, seeming to be a man and his child. The 4-20 deaths clicked out from this list and re-loaded with /ar turned to /en give:
Mohammad Hashash, adult-male, age 37
Sohaib Hashash child-male, age 6

Logically the latter is the son of the former, but it's not specified or certain. Both from Ferdaws, Aleppo (seeming to refer to a district in the middle of the city). Presumably they died there, and not in a home he also owned in Talmenes? They died on April 20 from "Warplane shelling" - a rather ambiguous category, especially given the notes: "Several people martyred in a massacre due to the regime air forces' shelling with explosive barrels, Documented through the forensic office"

For what it's worth, a man named Mohamed is unlikely to have a son name Mohamed, as the 6/7-year-old boy who died in Talmenes was. His middle name was given as Abdulrazaq, and should be shared by both sisters, reflecting their father's name. But it seems plausible that, if other details lined up, a 6-year-old Sohaib Mohammed Hashash was could be re-branded in this way, as his father was not, and his sister(s) were added in the same way.

For good measure, the basic story this was part of, from the same FFM report, Annex IV, point 11: "[the Syrian government's story was that] an armed opposition group fired a projectile from Ma’ar Shamarin (south of Talmenes) that fell in the centre of the village, close to a residential house which is one of the residential properties mentioned in paragraph 10 above. The impact caused substantial damage and two people died."

The only mention of a chemical aspect was this: "One witness said to have heard the explosion and smelled an odour like “rotten eggs”, but did not see any injured people." That's definitely not the smell of chlorine, and not likely to be confused with it.

With the basic locations set, videos for geolocation and damage assessment, it's possible to check the trajectory of any projectile. From the south supports the government story. From any other direction but straight down (as from a helicopter) would support no one's story. This goes on my to-do list.

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