Nowhere to Go, Say Gazans in South under Israeli Bombardment

Palestinians inspect the damage in the rubble of a building destroyed during Israeli bombardment in Rafah, on the southern Gaza Strip, on December 2, 2023, amid continuing battles between Israel and the militant group Hamas. (AFP)
Palestinians inspect the damage in the rubble of a building destroyed during Israeli bombardment in Rafah, on the southern Gaza Strip, on December 2, 2023, amid continuing battles between Israel and the militant group Hamas. (AFP)
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Nowhere to Go, Say Gazans in South under Israeli Bombardment

Palestinians inspect the damage in the rubble of a building destroyed during Israeli bombardment in Rafah, on the southern Gaza Strip, on December 2, 2023, amid continuing battles between Israel and the militant group Hamas. (AFP)
Palestinians inspect the damage in the rubble of a building destroyed during Israeli bombardment in Rafah, on the southern Gaza Strip, on December 2, 2023, amid continuing battles between Israel and the militant group Hamas. (AFP)

Under aerial bombardment from Israel, people sheltering in the south of the Gaza Strip after fleeing their homes earlier in the war said on Saturday they had nowhere safe to go now.

The city of Khan Younis is the focus of Israeli air strikes and artillery fire after fighting resumed on Friday following the collapse of a week-long truce. Its population has swelled in recent weeks as several hundred thousand people from the northern Gaza Strip have fled south.

Some are camping in tents, others in schools. Some are sleeping in stairwells or outside the few hospitals operating in the city. A World Health Organization official said on Friday that one of the hospitals was "like a horror movie" as hundreds of wounded children and adults waited for treatment.

Abu Wael Nasrallah, 80, scoffed at the Israeli army's latest order to move further south to Rafah, bordering Egypt. Children were injured in Israeli strikes in the town on Friday.

The message was delivered via leaflets dropped from the sky over several districts in Khan Younis.

"This is nonsense," Nasrallah told Reuters. He had heeded Israeli evacuation orders and moved from the northern Gaza Strip earlier in the war that broke out on Oct. 7 when Hamas militants crossed into Israel and killed 1,200 people, mostly civilians.

Some 193 Palestinians had been killed since the truce expired, the Gaza health ministry said on Saturday, adding to the death toll of more than 15,000 Gazans announced by Palestinian health authorities.

Israel says it is making efforts to prevent civilian casualties as the fighting moves south. Addressing reporters in Tel Aviv on Saturday, a senior adviser to Israeli Prime Minister Benjamin Netanyahu said humanitarian groups were informed of what he described the "safer areas".

"We've not asked the whole population of the south to relocate, we've not even asked the whole population of Khan Younis to relocate. But those neighborhoods, those specific areas where we know there is going to be heavy combat, we've asked people there to relocate," Mark Regev said.

'Night of horror'

Nasrallah said he and his family would stay put because they had already lost everything.

"There is nothing left to fear. Our homes are gone, our property is gone, our money is gone, our sons have been killed, some are handicapped. What is left to cry for?"

A mother of four, who gave her name as Samira, said she had fled south from Gaza City with her children after Israel began bombing there last month. They now shelter with friends in a home west of Khan Younis.

She said Friday night had been one of the most terrifying since she arrived: "A night of horror."

She and other residents said they feared the intensity of the bombing in Khan Younis and the nearby city of Deir al-Balah meant Israel's ground invasion of the south was imminent.

Another man, who gave his name as Yamen, said he and his wife and six children had fled the north weeks ago and were sleeping in a school.

"Where to after Deir al Abalah, after Khan Younis?" he said. "I don't know where to take my family."

The UN estimates that up to 1.8 million people in the Gaza Strip - or nearly 80% of the population - have been forced to flee during Israel's devastating bombing campaign.

Israel has sworn to annihilate Gaza-based Hamas in response to the Oct. 7 attack.



New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
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New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)

Scientists studying the new mpox strain that has spread out of Democratic Republic of Congo say the virus is changing faster than expected, and often in areas where experts lack the funding and equipment to properly track it.

That means there are numerous unknowns about the virus itself, its severity and how it is transmitting, complicating the response, half a dozen scientists in Africa, Europe and the United States told Reuters.

Mpox, formerly known as monkeypox, has been a public health problem in parts of Africa since 1970, but received little global attention until it surged internationally in 2022, prompting the World Health Organization to declare a global health emergency. That declaration ended 10 months later.

A new strain of the virus, known as clade Ib, has the world's attention again after the WHO declared a new health emergency.

The strain is a mutated version of clade I, a form of mpox spread by contact with infected animals that has been endemic in Congo for decades. Mpox typically causes flu-like symptoms and pus-filled lesions and can kill.

Congo has had more than 18,000 suspected clade I and clade Ib mpox cases and 615 deaths this year, according to the WHO. There have also been 222 confirmed clade Ib cases in four African countries in the last month, plus a case each in Sweden and Thailand in people with a travel history in Africa.

"I worry that in Africa, we are working blindly," said Dr. Dimie Ogoina, an infectious diseases expert at Niger Delta University Hospital in Nigeria who chairs the WHO's mpox emergency committee. He first raised the alarm about potential sexual transmission of mpox in 2017, now an accepted route of spread for the virus.

"We don’t understand our outbreak very well, and if we don't understand our outbreak very well, we will have difficulty addressing the problem in terms of transmission dynamics, the severity of the disease, risk factors of the disease," Ogoina said. "And I worry about the fact that the virus seems to be mutating and producing new strains."

He said it took clade IIb in Nigeria five years or more to evolve enough for sustained spread among humans, sparking the 2022 global outbreak. Clade Ib has done the same thing in less than a year.

MUTATING 'MORE RAPIDLY'

Mpox is an orthopoxvirus, from the family that causes smallpox. Population-wide protection from a global smallpox vaccine campaign 50 years ago has waned, as the vaccinating stopped when the disease was eradicated.

Genetic sequencing of clade Ib infections, which the WHO estimates emerged mid-September 2023, show they carry a mutation known as APOBEC3, a signature of adaptation in humans.

The virus that causes mpox has typically been fairly stable and slow to mutate, but APOBEC-driven mutations can accelerate viral evolution, said Dr. Miguel Paredes, who is studying the evolution of mpox and other viruses at Fred Hutchison Cancer Center in Seattle.

"All the human-to-human cases of mpox have this APOBEC signature of mutations, which means that it's mutating a little bit more rapidly than we would expect," he said.

Paredes and other scientists said a response was complicated by several mpox outbreaks happening at once.

In the past, mpox was predominantly acquired through human contact with infected animals. That is still driving a rise in Congo in clade I cases – also known as clade Ia - likely due in part to deforestation and increased consumption of bushmeat, scientists said.

The mutated versions, clade Ib and IIb, can now essentially be considered a sexually transmitted disease, said Dr. Salim Abdool Karim, a South African epidemiologist and chair of the Africa CDC’s mpox advisory committee. Most of the mutated clade Ib cases are among adults, driven at first by an epidemic among female sex workers in South Kivu, Congo.

The virus also can spread through close contact with an infected person, which is likely how clusters of children have been infected with clade Ib, particularly in Burundi and in eastern Congo’s displacement camps, where crowded living conditions may be contributing.

Children, pregnant women and people with weakened immune systems or other illnesses may be at greater risk of serious mpox disease and death, say the WHO and mpox scientists.

Clade I has typically caused more severe disease, with fatality rates of 4%-11%, compared to around 1% for clade II. Ogoina said data from Congo suggests few have died of the new Ib version, but he feared some data is being mixed up.

More research is urgently needed, but three teams tracking mpox outbreaks in Africa say they cannot even access chemicals needed for diagnostic tests. Clade Ib can also be missed by some diagnostic tests.

Planning a response, including vaccination strategies, without this is difficult, the scientists said.

Karim said around half of cases in eastern Congo, where Ib is particularly prevalent, are only being diagnosed by doctors, with no laboratory confirmation.

Getting samples to labs is difficult because the healthcare system is already under pressure, he said. And around 750,000 people have been displaced amid fighting between the M23 rebel group and the government.

Many African laboratories cannot get the supplies they need, said Dr. Emmanuel Nakoune, an mpox expert at the Institut Pasteur in Bangui, Central African Republic, which also has clade Ia cases.

"This is not a luxury," he said, but necessary to track deadly outbreaks.