Syria Chemical Weapons Report Due For Release

Doctors' Plea For Syria Medical Aid

Updated: 7:15am UK, Monday 16 September 2013

British doctors have written an open letter in the Lancet medical journal calling for attacks on hospitals and medics to halt in Syria. This is the letter in full:

The conflict in Syria has led to what is arguably one of the world's worst humanitarian crises since the end of the Cold War.

An estimated 100 000 people have been killed, most of them civilians, and many more have been wounded, tortured, or abused.

Millions have been driven from their homes, families have been divided, and entire communities torn apart; we must not let considerations of military intervention destroy our ability to focus on getting them help.

As doctors and medical professionals from around the world, the scale of this emergency leaves us horrified.

We are appalled by the lack of access to health care for affected civilians, and by the deliberate targeting of medical facilities and personnel.

It is our professional, ethical, and moral duty to provide treatment and care to anyone in need.

When we cannot do so personally, we are obliged to speak out in support of those risking their lives to provide life-saving assistance.

Systematic assaults on medical professionals, facilities, and patients are breaking Syria's health-care system and making it nearly impossible for civilians to receive essential medical services.

According to WHO, 37% of Syrian hospitals have been destroyed and a further 20% severely damaged.

Makeshift clinics have become fully fledged trauma centres struggling to cope with the injured and sick.

According to the Violations Documentation Centre, an estimated 469 health workers are currently imprisoned, and about 15 000 doctors have been forced to flee abroad according to the Council on Foreign Relations.

Of the 5,000 physicians in Aleppo before the conflict started, only 36 remain.

The targeted attacks on medical facilities and personnel are deliberate and systematic, not an inevitable nor acceptable consequence of armed conflict.

Such attacks are an unconscionable betrayal of the principle of medical neutrality.

The number of people requiring medical assistance is increasing exponentially, as a direct result of conflict and indirectly because of the deterioration of a once-sophisticated public health system and the lack of adequate curative and preventive care.

Horrific injuries are going untended; women are giving birth with no medical assistance; men, women, and children are undergoing life-saving surgery without anaesthetic; and victims of sexual violence have nowhere to turn to.

The Syrian population is vulnerable to outbreaks of hepatitis, typhoid, cholera, and dysentery.

The lack of medical pharmaceuticals has already exacerbated an outbreak of cutaneous leishmaniasis, a severe infectious skin disease that can cause serious disability, there has been an alarming increase in cases of acute diarrhoea, and in June aid agencies reported a measles epidemic sweeping through districts of northern Syria.

In some areas, children born since the conflict started have had no vaccinations, meaning that conditions for an epidemic, which have no respect for national borders, are ripe.

With the Syrian health system at breaking point, patients battling chronic illnesses including cancer, diabetes, hypertension and heart disease, and requiring long-term medical assistance have nowhere to turn for essential medical care.

The majority of medical assistance is being delivered by Syrian medical personnel but they are struggling in the face of massive need and dangerous conditions.

Governmental restrictions, coupled with inflexibility and bureaucracy in the international aid system, is making things worse.

As a result, large parts of Syria are completely cut off from any form of medical assistance.

Medical professionals are required to treat anyone in need to the best of their ability. Any wounded or sick person must be allowed access to medical treatment.

As doctors and health professionals we urgently demand that medical colleagues in Syria be allowed and supported to treat patients, save lives, and alleviate suffering without the fear of attacks or reprisals.

To alleviate the effect on civilians of this conflict and of the deliberate attacks on the health-care system, and to support our medical colleagues, we call on the Syrian Government and all armed parties to refrain from attacking hospitals, ambulances, medical facilities and supplies, health professionals and patients; allow access to treatment for any patient; and hold perpetrators of such violations accountable according to internationally recognised legal standards.

We call on all armed parties to respect the proper functions of medical professionals and medical neutrality by allowing medical professionals to treat anyone in need of medical care and not interfering with the proper operation of health-care facilities.

Governments that support parties to this civil war should demand that all armed actors immediately halt attacks on medical personnel, facilities, patients, and medical supplies and allow medical supplies and care to reach Syrians, whether crossing front lines or across Syria's borders.

We call on the UN and international donors to increase support to Syrian medical networks, in both government and opposition areas, where, since the beginning of the conflict, health professionals have been risking their lives to provide essential services in an extremely hostile environment.

We declare that we have no conflicts of interest.

14.59 | 0 komentar | Read More

Costa Concordia Salvage Operation Under Way

By Tom Kington, in Giglio

Salvage officials have begun the mammoth task of righting the crippled Costa Concordia as jacks hoist it off rocks near the Tuscany coast.

The daring operation was delayed by about three hours due to bad weather, and began at 9am local time (8am).

"All checks have been carried out and the operation has begun," said Fabrizio Curcio, the deputy Civil Protection chief.

The rescue effort, which is expected to last about 12 hours, will see the giant ship gradually rotated and rolled upright.

Five hundred engineers and divers are working on the salvage

The officials have warned the stranded vessel will bend and suffer enormous internal damage during the €600m (£503m) operation, known as "parbuckling".

But they are confident the ship's hull will remain intact as 56 massive chains tighten around it, avoiding the nightmare scenario of the 114,000-ton vessel shattering and spilling its contents into the waters around the Italian island of Giglio.

Sergio Girotto, project manager for Micoperi - the Italian firm that has teamed up with US company Titan to raise the Concordia - said: "The ship will probably bend during the operation and metal inside will buckle."

"We have 12,000 tons of pressure to use, which would lift two Eiffel Towers, but I hope we will only need five or six thousand."

The cruise liner capsized in shallow water 20 months ago after smashing into rock, causing the deaths of 32 passengers.

Two bodies are still missing, and officials hope they will now be found.

Much will depend on how firmly the ship is wedged onto two pinnacles of underwater granite where it came to rest on the night of January 13, 2012, prompting the evacuation of 4,200 passengers and crew.

Experts have said there is little danger of pollution

The two outcrops, which are embedded six metres into the hull of the ship, are the great unknown at the heart of the operation, which will see the ship hoisted by jacks on to a bed of 1,000 cement bags and six underwater platforms bigger than a football pitch.

Franco Gabrielli, who has supervised the Italian government's role in the operation, told reporters ahead of the salvage attempt that the operation had a 100% chance of success.

The ship is due to be hauled 65 degrees back to upright position.

Within the first hour or two, the ship should be wrenched free from the two granite outcrops it is impaled on, said Franco Porcellacchia, an engineer working on the salvage for ship owner Costa Cruises.

Four to five hours will then be needed to pull the ship upwards before gravity takes over, and its final descent into an upright position, also taking four to five hours, is controlled by adjusting the buoyancy of the massive metal tanks attached to its sides.

A 12-man team will control the pulleys and tanks from a barge close to the wreck.

How the ship will look if it is successfully righted

Marine biologist Giandomenico Ardizzone, who has been monitoring the sea bed for the ship's operator Costa Crociere, said he had dived under the vessel on Saturday to fix cameras on the points where the rocks plunge into the hull.

"We have been told to get ready for loud noises during the lifting," said Mr Ardizzone.

He added that 29,000 tons of water will pour out of the ship as it is pulled upright, an even greater amount, 43,000 tons, will enter the ship.

"That means less of the ship will be visible out of the water after the parbuckling," he said.

What does come out will be polluted water that has swilled inside the ship for months in a mix of residual fuels, heavy metals and rotten food, including more than three tons of melon, 500 litres of olive oil, 14,000 packets of cigarettes, 18,000 bottles of wine, eight tons of beef and over 11 tons of fish.

Mr Ardizzone said the quantities of heavy metals and fuels were too small to create concern for the surrounding protected marine park, a view shared by Maria Sargentini, the head of a public commission set up to monitor the operation.

:: Live Coverage on Sky News

14.59 | 0 komentar | Read More

School Uniform Costs 'Must Be Cut' - Minister

Schools are being urged to avoid branded uniforms to cut costs for cash-strapped parents.

Schools minister David Laws said the cost of clothing was often "unnecessarily high" at a time when family budgets were being squeezed.

An Office of Fair Trading investigation last year suggested that three quarters of schools placed restrictions on where uniforms could be bought.

That typically added £5 to the price tag for each item, leaving parents an estimated £52m a year worse off.

Speaking at the Liberal Democrat conference in Glasgow, Mr Laws announced new guidance for schools.

Exclusive single supplier contracts should not be used, unless regular tendering processes are run to ensure firms provide value for money.

They should also not enter into 'cashback' agreements with shops.

Compulsory items of uniform should be available relatively cheaply, and branding should be kept "to a minimum", under the guidelines.

Schools are urged to avoid changing specifications frequently.

Mr Laws said: "Costs at the start of a school term can quickly add up, particularly for families with several school age children.

"School uniforms can be an important sign of identity and pride, but at a time when many family budgets are squeezed parents should not be forced to spend more than they need to.

"We will send a strong signal to schools that it is vital to secure value for money for parents before changing or introducing new school uniforms.

"Parents need to be able to shop around to find the best deal.

"I want to see fewer schools using single suppliers and branded items, which keep costs unnecessarily high."

14.59 | 0 komentar | Read More

Peru Drugs: Melissa Reid 'To Plead Guilty'

Why Peru Became The Cocaine Hotspot

Updated: 2:26am UK, Sunday 15 September 2013

By Pete Norman, Sky News Online

Peru has overtaken Colombia as the world's leading cocaine producer, according to experts.

Home to the ancient Inca civilisation, Peru is rugged, remote and the ultimate source of the mighty Amazon river.

It is also home to a long-running guerrilla campaign by the leftist Shining Path group.

While urban and coastal inhabitants have benefited greatly from market-focused economic development since the early 1980s, when military rule ended, the rural poor have gained little.

Its hilly, isolated and fertile regions are home to the guerrillas, who rely on cocaine production, hostage-taking and corruption for funds.

According to the CIA, Peru was the world's largest coca leaf producer until 1996, when neighbouring Colombia took the lead.

It says that in 2009 Peru had 100,000 acres under coca leaf production compared to Colombia's 286,000 acres - with the potential to produce 225 metric tons of pure cocaine.

US-supported efforts to reduce or eradicate coca leaf in Colombia have now tipped the scales of production towards Peru.

Aerial spraying of herbicide in Colombia has affected coca crops covering 250,000 acres while manual eradication has been done on another 150,000 acres.

The UN has said Colombia reduced its area under coca cultivation by 25% in 2012 - the biggest annual reduction since the international body began monitoring it in 2001.

Around 30 Britons are now in Peruvian prisons on drug-related convictions, according to the Foreign and Commonwealth Office.

The UN Office of Drugs and Crime is expected to release its official 2012 Peru coca crop estimate in September.

Its World Drug Report 2011 said that although the area under coca leaf production was around 75% of the 1990 area, the current yield might be up to a third greater.

While Colombia still supplies virtually all of North America's cocaine, the CIA said much of the drug exported from Peru through land, air and sea routes is destined for Europe and other markets.

North America and Europe cocaine consumption has stabilised in recent years while growth has increased in Oceania and Asia Pacific regions.

It said: "Finished cocaine is shipped out from Pacific ports to the international drug market, (while) increasing amounts of base and finished cocaine, however, are being moved to Brazil, Chile, Argentina, and Bolivia for … trans-shipment to Europe and Africa."

Smaller quantities are carried through air routes by so-called drug mules, while larger loads travel by sea to west Africa prior to distribution throughout Europe.

14.59 | 0 komentar | Read More

89% Of Nurses Say A&E Patients Put In Danger

Nine out of 10 nurses working in acute and emergency care believe current pressure on A&E services is putting patients in danger, a nursing union has warned.

The Royal College of Nursing (RCN) said a survey of its members found that 89% of nursing staff thought the people they were meant to be caring for were being put at risk.

Some 85% said patient safety was being compromised by the strain on departments, while one in five said this was the case on every shift.

The poll of 416 RCN members found 89% said they had experienced increased pressure in their A&E department in the last six months.

A lack of beds and staff were both key reasons for department strain

More than three quarters cited increased attendance at A&E as the reason for increased pressure, while 74% blamed inappropriate attendance at A&E where patients could have been treated elsewhere.

The survey also found 57% cited a lack of beds for patients coming into A&E, while 54% said there were too few health care staff on duty to cope with demand.

Dr Peter Carter, chief executive and general secretary of the RCN, said: "Our member survey demonstrates the same picture that NHS Confederation leaders are painting - that emergency services and the staff working within them are under increasing pressure which is putting patient safety at risk.

"Staff enter the health profession to save and improve lives through first class care.

"However they simply cannot deliver this if there are too few staff to properly treat and monitor the increasing numbers of patients, not enough beds to put them in and no clear signposting to community care that could prevent attendance at A&E."

The survey was conducted in July.

A Department of Health spokeswoman said: "We know A&E departments are under pressure. There are over one million more people visiting A&E compared to three years ago.

"However we know, on the whole the NHS is performing well, latest weekly figures show 96% of patients were seen in under four hours and there are more clinical staff, including 4,300 more doctors since 2010.

"We have given A&E departments an additional £500m to make sure the best care is available for every patient this winter and the next and have set aside an additional £3.8bn to help join up health and care services."

14.59 | 0 komentar | Read More

Sky Poll: Drunk A&E Patients Should Be Charged

By Thomas Moore, Health Correspondent

Patients who visit A&E while drunk or under the influence of recreational drugs should pay for the treatment they receive, according to the large majority of people questioned for a Sky News poll.

More than seven in 10 of those questioned said anyone needing emergency medical care because they were intoxicated should be charged for using NHS services.

Experts say at least seven million people a year attend A&E while drunk, placing an enormous strain on health service resources.

Sky News is broadcasting from inside the Queen's Medical Centre, Nottingham

The poll commissioned for State of Emergency, Sky News' weekend of live coverage from Nottingham's Queen's Medical Centre, shows that two in three people believe A&E services are in crisis and patients are being put at risk.

The Sky News poll of 1,106 people carried out by Survation also shows that eight out of 10 believe the Government must take immediate action to avoid major issues in A&E.

And more than six in 10 blame government cuts for any staff shortages and poor levels of care.

However, three-quarters of those questioned agreed that doctors and nurses were trying their best, but were being worked too hard.

To address the A&E care crisis, almost two-thirds of those asked thought consultants should be forced to work weekends and nights, with four in 10 saying senior doctors who refuse should receive less pay.

More than nine out of 10 opposed the provision of breast enlargements and tattoo removals on the NHS.

Nearly two-thirds also believed NHS managers were paid too much.

:: A&E Live Updates: Sky News On Emergency Ward

The think tank 2020health estimates that on an average weekday up to three out of every 10 patients attending A&E are there because of alcohol, and at the weekend that goes up to seven in 10.

Chief executive Julia Manning said: "We should be sending a really strong message that this is a misuse of A&E. A&E is there for people who've had road trauma accidents (and) major health incidents.

"It's not there for people who have just been mucking around and drinking too much. So we need to think of a way of creating a disincentive for people to get drunk and go to A&E, and we think one of the ways is that people should be invoiced for that use of A&E."

Health Secretary Jeremy Hunt told Sky News that while he understood the public desire for the move, it would be a difficult measure to introduce.

"I understand why people would want that, but I think in practice it's very, very difficult to differentiate between the people who have a health problem because of a direct decision they've taken themselves, and people who are unlucky.

"I think it's also one of the fundamental things that we all love about the NHS - that in an emergency you can turn up at a hospital and get treated.

"I think the day we started differentiating and saying we're only going to treat some people, and other people are going to have to pay, I think would be a step in the wrong direction."

On Saturday, Mr Hunt warned that it would be "very, very tough" for the NHS to avoid a repeat of last winter's A&E care crisis.

In an exclusive interview with Sky News, the Health Secretary admitted to being "concerned" about the high demand for emergency care and the pressure staff are under.

Health Secretary Jeremy Hunt has warned of a repeat winter A&E crisis

In the first three months of this year 94 out of 148 hospital trusts failed to meet the target for treating 95% of patients within four hours of them arriving at A&E.

Although the pressure eased over the summer, waiting times have begun to climb once more. Some hospitals are already breaching the target, even before winter pressures kick in.

The Government has given the NHS an extra £500m to pay for short term measures over the next two years to help ease the pressure.

That could include employing more locum consultants in A&E departments and setting up GP surgeries inside hospitals.

"A lot of things are happening to give support to the front line," said Mr Hunt.

"But that's not to say we are not worried about it, because it is going to be very tough, and we understand that."

The national director for acute episodes of care for NHS England, Professor Keith Willett, told Sky News that demand for emergency care is likely to rise once again this winter.

He will shortly unveil plans to divert more A&E patients towards the care of GPs, paramedics and chemists.

But in the short term patients will have to accept they have to wait for care.

"Safety is the priority," he said.

"We will do everything we can to maximise the way patients receive their care as quickly and optimally as possible.

"But it is a pressured system and we have to work within the envelope we have and the skills and staff we have."

:: As part of the poll 1,106 adults were surveyed on September 2-3 by Survation on behalf of Sky News.

14.59 | 0 komentar | Read More

Millions 'Should Not Be In A&E' - Exclusive

By Thomas Moore, Health Correspondent

Up to 6.5 million patients every year should avoid going to A&E and be treated by GPs, paramedics and even chemists instead, the doctor leading the review of NHS emergency services claims today.

Around one third of all people who visit A&E each year could be diverted away from hospital under plans to be unveiled shortly by NHS chiefs.

In an exclusive interview with Sky News, the doctor in charge of re-shaping emergency services in England said family doctors, ambulance staff and pharmacists could treat them instead to relieve the pressure on A&E.

Indicating for the first time how he hopes to radically reform A&E, Professor Keith Willett, the national director for Acute Episodes of Care, said: "We know that 15% to 30% of people who turn up to be treated at A&E could have been treated in general practice.

"They did not know that because the system did not obviously make itself available to them."

He said patients with routine medical problems are going to A&E because they cannot get a quick enough appointment with their GP. Others are frustrated by out-of-hours services.

Prof Willett says a long-term solution is needed

"We can look at the way primary care is available to people," he said.

"By changing the way we deliver services we can start to address the demand. We can do the same thing in terms of the ambulance services and how much, how many patients they treat, at the scene, rather than transfer and that's about them having the right information.

"We would look to the public to understand the issues and when the situation does get difficult, to take the advice that I've suggested about phoning first, to get the right advice, to go to the right place, to think of using your general practitioner or indeed your pharmacist, (who) give a lot of advice for minor ailments."

Professor Willett and the medical director for NHS England, Professor Sir Bruce Keogh, will publish their plan for reforming emergency services later this autumn. It is expected to be implemented two years from now.

The plan will acknowledge that demand for care will continue to rise with an ageing population. But it will set out a series of measures for reducing pressure on A&E departments.

They are expected to include:

:: A&E units will have to ensure a consultant is available seven days a week

:: Other senior doctors, such as elderly care specialists, will be expected to help assess and treat patients arriving at A&E

:: Paramedics will treat more patients at home or by the roadside so they don't need hospital care

:: Patients will be encouraged to 'ring first', using the NHS111 helpline to be directed towards appropriate care.

Health Secretary Jeremy Hunt wants GPs to be more proactive

Health Secretary Jeremy Hunt has also said GPs must take on a bigger role. Next week he will call on GPs to do more to prevent patients with chronic conditions, such as diabetes, from suffering emergency complications.

In an interview for State Of Emergency, Sky News' 24 hours of live coverage from Nottingham's Queen Medical Centre which begins today at 5pm, Mr Hunt said: "The role of GPs in caring for older people needs to be proactive - checking up on people, finding out how they are, heading off problems before they happen - rather than reactive.

"GPs are busy, so to make that happen we have to find ways of getting more capacity in the system and that is a big challenge.

"But we have to address that. In the end, if the NHS is to be sustainable, it has to be about prevention as much as cure."

But GPs say they are already doing what they can.

Professor Mike Pringle, president of the Royal College of General Practitioners, said: "They are overwhelmed by the workload they are expected to deliver.

"We have got to start to build general practice, not blame it, not victimise it.

"We have to invest in it if we are going to solve these problems. And I am sure the Secretary of State recognises that."

England's A&E departments were under severe pressure last winter.

Waiting times reached their worst in nine years between January and March 2013, with more than 300,000 patients waiting more than four hours for treatment.

The Government has given the NHS an extra £500m over two years to find short-term solutions to the likely rise in demand for emergency care in the winter months.

Hospitals could bring GPs into A&E departments to see patients with more minor problems and more locum A&E doctors are likely to be employed to fill vacancies.

Only half the training posts for emergency medicine have been filled in the last two years, and more than a third of hospital trusts have vacancies for A&E consultants.

Professor Willett said a long-term solution is required.

"We do have to address the emergency medicine workforce," he said.

"But that will not produce new consultants for several years. So we have to manage the situation and take away from emergency medicine teams those patients who could be managed by other parts of the system.

"Defaulting to seeing an emergency medicine consultant is not necessary for many of those patients and it is frustrating to wait."

15.00 | 0 komentar | Read More