"The images and reports coming from Idleb today leave me shocked, saddened and outraged. These types of weapons are banned by international law because they represent an intolerable barbarism," said Dr Peter Salama, Executive Director of the WHO Health Emergencies Programme.
Reports first emerged of the use of chemical weapons agents in Syria in 2012 and have since occurred with disturbing frequency, including repeated allegations of chlorine use in and around Aleppo last year, especially from September to December 2016. This latest reported incident is the most horrific since Ghouta in August 2013.
The capacity of hospitals in the surrounding area is limited, especially as a number of facilities have been damaged as a result of the ongoing conflict. Soon after the reported use of the highly toxic chemical in rural Idleb Tuesday morning, after receiving the first patients, Al Rahma Hospital was rendered temporarily nonfunctional when it was damaged. Ma'ara Hospital, one of the main hospitals in the area, has been out of service since last Sunday due to extensive damage to infrastructure.
Emergency rooms and intensive care units in Idleb are overwhelmed and reporting shortages in medicines required to treat injured patients. Many patients have been referred to hospitals in southern Turkey.
The likelihood of exposure to a chemical attack is amplified by an apparent lack of external injuries reported in cases showing a rapid onset of similar symptoms, including acute respiratory distress as the main cause of death. Some cases appear to show additional signs consistent with exposure to organophosphorus chemicals, a category of chemicals that includes nerve agents.
Medicines -- including Atropine, an antidote for some types of chemical exposure, and steroids for symptomatic treatment -- were immediately dispatched from WHO’s partner warehouse in Idleb. WHO is shipping additional medicines from Turkey and is ready to provide more life-saving supplies and ambulances as needed. WHO experts in Turkey are communicating with health workers in Idleb to provide around-the-clock guidance on diagnosis and appropriate treatment of patients.
Since 2012, when the first reports emerged of the use of chemicals as weapons in Syria, WHO has been engaged in public health preparedness for the management of patients exposed to chemical or toxic gas. These actions have included issuing new clinical management protocols, preparing hospitals to receive and treat patients, distributing protective equipment to hospitals, and raising awareness amongst Syrians on how they can protect themselves against exposure and when to seek treatment. In 2016, WHO trained 200 clinicians on the initial management of chemical weapons cases including pre-hospital decontamination, referral, triage and treatment. An additional 65 doctors in northern Syrian were trained by WHO’s field office in Gaziantep, southern Turkey. The majority of doctors trained were from Idleb, the governorate where today’s attack took place. However, given the numbers of patients requiring treatment, available trained staff is insufficient.
WHO is in continuous contact with health partners in Idleb to monitor health impact and needs, and is working with cross-border partners to reduce morbidity and save lives.
The use of chemical weapons is a war crime and is prohibited in a series of international treaties. These include the Hague Declaration concerning Asphyxiating Gases, the 1925 Geneva Protocol, the Chemical Weapons Convention (CWC) and the Statute of the International Criminal Court (ICC).