‘Hell Falling’: Fear and Grief in Rafah After Deadly Israeli Raid 

A child looks on as Palestinians inspect a destroyed area following an Israeli airstrike on the Rafah refugee camp, southern Gaza Strip, 12 February 2024. (EPA)
A child looks on as Palestinians inspect a destroyed area following an Israeli airstrike on the Rafah refugee camp, southern Gaza Strip, 12 February 2024. (EPA)
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‘Hell Falling’: Fear and Grief in Rafah After Deadly Israeli Raid 

A child looks on as Palestinians inspect a destroyed area following an Israeli airstrike on the Rafah refugee camp, southern Gaza Strip, 12 February 2024. (EPA)
A child looks on as Palestinians inspect a destroyed area following an Israeli airstrike on the Rafah refugee camp, southern Gaza Strip, 12 February 2024. (EPA)

Majed al-Afifi was just 40 days old when he was killed, his uncle told AFP in Rafah where Israeli forces bombed multiple homes while rescuing two Gaza hostages.

"We heard the bombing without warning," said Said al-Hams, 26, in Rafah refugee camp.

His nephew, a twin, "was born exactly 40 days ago and was killed", while their mother was wounded.

The newborn is among around 100 people killed by Israeli forces overnight in Rafah, according to the health ministry in Gaza.

Dozens of Israeli strikes pounded Rafah, where some 1.4 million people have sought refuge during four months of war between Israel and Hamas militants.

While there was jubilation in Israel over the liberation of the two hostages, in Rafah people recounted a fearful night.

"The situation was hell," said Abu Suhaib, who was sleeping dozens of meters from where Israeli forces struck.

"We heard the sound of explosions, like hell falling down on civilians," he told AFP.

The 28-year-old said he heard warplanes firing, shooting and a helicopter landing.

A massive pile of rubble stands where multiple buildings were flattened by Israeli strikes, beside the remains of a four-storey house.

Witnesses said the residents of the house fled two months ago, after the Israeli military warned them it would be bombed.

The aerial bombardment also left five vast craters, at least 10 meters wide and five metres deep, an AFP journalist said.

"I can't tell you how we survived the night," said Abu Abdullah al-Qadi, who was woken by the sound of shooting.

"They killed my cousin, they killed a lot of people with strikes," he told AFP, as dozens gathered by the destroyed buildings.

"They stormed this building and it appears that they freed prisoners -- and then they bombed it," said Qadi.

"They bombed all the houses next to it," he added.

'A terrifying night'

The refugee camp sits in the heart of Rafah, where vast crowds have gathered after following Israeli orders to flee other parts of Gaza.

Despite mounting international alarm at a possible ground invasion of the city, Israeli Prime Minister Benjamin Netanyahu vowed Monday that "continued military pressure" is the only way to free all hostages.

Palestinian militants seized about 250 hostages during their October 7 attack on southern Israel, according to an AFP tally based on official Israeli figures. Israel says around 130 are still in Gaza, though 29 are thought to be dead.

The Hamas attack resulted in the deaths of about 1,160 people, mostly civilians, according to an AFP tally based on official figures.

The relentless offensive by Israel has killed at least 28,340 people in Gaza, mostly women and children, according to the latest health ministry toll.

Fearing an onslaught by ground forces, dozens of families already displaced by the war started packing up their scant belongings on Monday.

"It was a terrifying night," said Alaa Mohammed, from northern Gaza, dismantling a tent in western Rafah.

"What happened at night foreshadows something big happening in Rafah. It seems that the Israeli army will enter Rafah as they announced," said the 42-year-old.

The family is planning on travelling to the Deir al-Balah area of central Gaza, an earlier focus for Israeli troops after they destroyed swathes of the north.

Mohammed started gathering their blankets and mattresses, after a sleepless night, while relatives went in search of transport.

"A lot of families around me undid their tents like us," he said.

"I hope we can find a car or a truck. We called more than one driver we know, but all of them are busy."



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.