Far From Violence, Gaza Wounded Find Care at Cairo Hospital

A Palestinian boy receives medical care at Nasser Institute hospital in Cairo, on December 3, 2023, after he was evacuated to Egypt following his injuries sustained amid fighting between Israel and Hamas in the Gaza Strip. (Photo by Khaled DESOUKI / AFP)
A Palestinian boy receives medical care at Nasser Institute hospital in Cairo, on December 3, 2023, after he was evacuated to Egypt following his injuries sustained amid fighting between Israel and Hamas in the Gaza Strip. (Photo by Khaled DESOUKI / AFP)
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Far From Violence, Gaza Wounded Find Care at Cairo Hospital

A Palestinian boy receives medical care at Nasser Institute hospital in Cairo, on December 3, 2023, after he was evacuated to Egypt following his injuries sustained amid fighting between Israel and Hamas in the Gaza Strip. (Photo by Khaled DESOUKI / AFP)
A Palestinian boy receives medical care at Nasser Institute hospital in Cairo, on December 3, 2023, after he was evacuated to Egypt following his injuries sustained amid fighting between Israel and Hamas in the Gaza Strip. (Photo by Khaled DESOUKI / AFP)

Ilham Majid was praying when bombs fell on her Gaza house, and her husband only found her hours later under the rubble, alive but seriously wounded.

She was one of the luckier ones -- 17 other family members, including two of her children, were killed in that fateful October 31 raid in the Jabalia refugee camp of northern Gaza, where Israel has been fighting Hamas militants following deadly attacks earlier that month.

Now, like several other Palestinians from the Gaza Strip, Majid is receiving medical treatment in Egypt.

"All of a sudden I felt the house crumbling. Three stories collapsed on top of me," the 42-year-old recalled from her hospital bed at Cairo's Nasser Hospital.

"I got shrapnel all over my body. My liver was hit, my leg, ribs and my jaw are all broken. I cannot walk."

Majid said her husband found her trapped under the rubble of the house by chance four-and-a-half hours later, thanks to one of her fingers that was sticking out.

"I almost could not breathe -- almost dead," she said, AFP reported.

Her 15-year-old daughter was killed in the bombardment, and 10 days later the body of her 17-year-old son was pulled from under the debris. It was already rotting.

Ever since the tragedy that ripped apart her family -- 50 relatives were staying at the house when it was hit -- Majid has been looking at pictures of her son on her cell phone.

Since early October, several Palestinians wounded in Israel's bombardment of the Gaza Strip, and some suffering various illnesses, have been authorized to leave the besieged territory and travel to Egypt for medical care.

More than 15,500 people, mostly civilians, have been killed in Gaza since fighting began on October 7, according to Gaza health ministry.

Israel unleashed an air and ground campaign against the densely-populated territory with the aim of destroying Hamas, after the militants broke through Gaza's militarized border into Israel.

The war on Gaza has devastated swathes of the coastal territory, levelled entire neighbourhoods and destroyed much of the infrastructure, including hospitals.

Even before fighting resumed on Friday after a week-long pause during which Hamas released hostages in exchange for prisoners held by Israel, Gaza's health system was on its knees with hospitals resembling a "horror movie", according to the World Health Organization (WHO).

Now it is "catastrophic", the UN agency has said.

Currently, only 18 of Gaza's 36 hospitals are even minimally to partially functional, with the three main hospitals in the north barely operative, Richard Peeperkorn, WHO's representative in the Palestinian territories, told reporters in Geneva via video-link from Gaza on Friday.

The United Nations says not a single hospital in northern Gaza can carry out surgeries after several were attacked by Israel, while those in the south are overwhelmed by the number of casualties they receive daily.

At Cairo's Nasser Hospital, patients such as Majid are trying to slowly regain their strength far away from the violence and chaos consuming Gaza.

Yussef, 13, lay in a bed staring into the distance, his face puffy.

Dried blood stained his right leg which was held together with metal rods.

"He was in a complete state of shock when I found him," said his older brother, under the rubble of their four-storey home in the Shati refugee camp.

In another hospital room further down the corridor, Lubna al-Shafei, 36, said she was being treated for a "neck wound".

"On October 23, our house in the centre of Gaza City was destroyed. My son was killed and my husband was wounded," she said.

Last week the Egyptian health ministry announced the launch of an initiative aimed at providing medical care for 1,000 children wounded in Gaza.

Already 28 premature babies who were trapped at Al-Shifa Hospital, Gaza's largest which was besieged and ultimately raided by Israeli forces, have been taken to Egypt.

The United Arab Emirates and Tunisia have also taken in Palestinians wounded in Gaza, namely children in need of medical care.

France and Italy have sent ships to Egypt to serve as hospitals for wounded civilians from Gaza.



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.