After 200 Days of War, Where Have the Gaza Ceasefire Negotiations Reached?

Relatives of Israeli prisoners demonstrate in Tel Aviv to demand that the government reach an agreement to release the detainees held by Hamas. (AFP)
Relatives of Israeli prisoners demonstrate in Tel Aviv to demand that the government reach an agreement to release the detainees held by Hamas. (AFP)
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After 200 Days of War, Where Have the Gaza Ceasefire Negotiations Reached?

Relatives of Israeli prisoners demonstrate in Tel Aviv to demand that the government reach an agreement to release the detainees held by Hamas. (AFP)
Relatives of Israeli prisoners demonstrate in Tel Aviv to demand that the government reach an agreement to release the detainees held by Hamas. (AFP)

Two hundred days since the eruption of war in the Gaza Strip, ceasefire efforts are still ongoing even though it remains to be seen whether mediators in Egypt, Qatar, and the United States will be able to resolve the crisis.

Since its start on Oct. 7, the war has only stopped for one week, following an Egyptian Qatari-mediated agreement in November during which Hamas released more than 100 of its hostages and Israel freed about three times this number of Palestinian prisoners.

Since that “lone truce,” the mediators have been pushing for another “broader and more comprehensive” agreement, but their efforts have not borne fruit so far. Expert in Israeli affairs at Al-Ahram Center for Political and Strategic Studies Dr. Saeed Okasha attributed this failure to “miscalculations on the part of both sides of the conflict.”

“Tel Aviv accepted the first truce, believing that it would help in relieving pressure, and then quickly decide the battle in its favor. For its part, Hamas hoped it would be able to build an international drive to end the war, believing that Israeli Prime Minister Benjamin Netanyahu’s accepting of the deal would weaken his position and damage his image before the international community because he views the movement as terrorist,” Okasha told Asharq Al-Awsat.

During the past months, the hope of achieving a “truce” rose at times and faded at others, as the mediators’ efforts stumbled at continued “Israeli intransigence” and “conditions” that Hamas was not willing to abandon.

At the end of January, hope was pinned on the “framework of a three-stage truce agreement, each lasting 40 days.” The framework was agreed upon at a meeting in Paris that was attended by the intelligence chiefs of Egypt, the United States, and Israel, in addition to the Qatari prime minister. They expected that the proposal would ultimately lead to talks over ending the war completely.

But this framework, which was described as "constructive" by officials in Israel and the US, did not translate into reality after six rounds of indirect negotiations, which moved from Paris to Cairo to Doha and then back to Paris.

Towards the end of the month of Ramadan, Cairo hosted a new round of negotiations during which the Director of the CIA, William Burns, presented to Hamas a proposal to restore calm. It called for a six-week truce during which Hamas would release 40 Israeli hostages in exchange for the release of 800 to 900 Palestinians arrested by Israel, the entry of 400 to 500 trucks of food aid daily, and the return of the displaced from northern Gaza to their homes.

However, the mediators were unable to convince both parties to accept the deal, so the negotiations reached a “dead end.” Here, Okasha said: “Neither party wants to make concessions, because that means losing the battle.”

He noted that Tel Aviv is seeking to achieve a military victory by invading the city of Rafah, while Hamas is heading toward “political suicide.”

Egyptian Foreign Minister Sameh Shoukry confirmed in an interview with CNN last week that the talks “were continuing and have never been interrupted” even though “an agreement has not been reached yet.”



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.