In the early hours of August 21, a series of alleged chemical attacks struck various suburbs of Damascus, the bulk of them in neighborhoods that together make up an area east of the city center known as Eastern Ghouta. Among the neighborhoods targeted just after 2 AM were Jobar (the site of a previous chemical disbursal), Zermalka, Ayn Tarma, Douma, Arbeen, Saqba and Harasta. Yet another hit, this one in the southwestern district of Moadamiya, which is close to the elite Fourth Division's airbase in Mezze, was also reported.
The death toll varies from the high hundreds to over 1,500. But the scores of videos of civilian and rebel victims uploaded to the Internet give a gruesome indicator that the carnage may only increase as more and more sufferers languish without adequate medical care. Some of these videos show young children in a state of total shock, responding listlessly to treatment or marveling at the fact that they are still alive. Others videos show adults foaming at the mouth and convulsing, or corpses lying in neat rows on the ground, wrapped in shrouds.
By early Wednesday evening, a senior Obama administration official told the Wall Street Journal that Washington has "strong indications" that the Assad regime was behind these latest atrocities. Israeli Defense Minister Moshe Ya'alon was the first U.S. ally to state unequivocally that Damascus was indeed the culprit. (Israel's intelligence on Syria is considered the best in the world.)
I spoke with two doctors from Douma yesterday. The first, Dr. Majed Abu Ali, the communications manager of Douma city medical office, which is part of the medical office of Eastern Ghouta, said that in his district alone, about 630 cases of exposed patients had been observed with symptoms including respiratory failure, muscle spasms, confused mental states, and pinpoint pupils. "Thirty-six of these cases needed ventilation and intubation, and 16 also had to be sent to the ICU."
Because of how ill-equipped his team was for handling so large a casualty figure all at once, Dr. Abu Ali said that his own personnel did not take the necessary precautions before treating those possibly exposed to a deadly agent. For instance, they failed to remove the tainted clothing of patients and some of the medical staff became exposed secondarily and required their own treatment regimens as a result.
The Douma medical office fielded patients from around eight separate attacks. According to Dr. Abu Ali, the attacks were against rebel-held positions in Eastern Ghouta while the last two struck "civilian neighborhoods." The latter attacks "were ten times more severe in terms of casualties than the previous ones. Injuries from [the rebel-held areas] numbered around 63. From the civilian areas, around 600," Dr. Abu Ali reported.
More than 50 percent of those affected were women and children. Not all patients responded to atropine, a drug commonly administered to counteract nerve agent exposure, evidently due to the intense concentration of whatever was used. Thousands of atropine injections were given, and supplies of the medicine were running low.
I also spoke with Dr. Khaled Ad'doumi, director of Douma city medical office, and asked if his staff were able to determine the exact substance used. "We already know from [a] medical study we conducted that the symptoms of exposure to organophosphate compounds are similar to the ones we observed yesterday." These compounds, alleged to have been used in prior chemical attacks in Syria, including the one in Khan al-Assal which the UN is meant to investigate, are the basis for many industrial pesticides. They are also used to make sarin and VX gas. Dr. Ad'doumi believes adamantly that sarin was used by no one other than the regime.
Gwyn Winfield, the editor of CRBNe, a journal which monitors unconventional weaponry, told Foreign Policy "No doubt it's a chemical release of some variety -- and a military release of some variety." He thinks, though, that whatever substance was deployed was not in a purified form. In a subsequent appearance on CNN, Winfield said: "It may well be that this was some kind of an Assad homebrew where he has managed to get elements of an organophosphate, mix it with other chemicals, and then delivered it onto these people." Winfield also noted that the perpetrator can only have come from the military. "This isn't a small rogue element; this isn't a small group. This is a concentrated, well-organized attack by a significant player."
A chemical "cocktail" of varying agents might account for the reported contradictions in symptoms exhibited all over Damascus yesterday.
Dr. Ad'doumi said that most fatalities his office saw were caused by suffocation. "We had to make choices of who is going to die and who will survive because of the shortage of medical supplies and medical personnel." At the time I spoke to him -- around 3 PM EST -- he estimated the death toll at 1,600 in Eastern Ghouta alone. (These figures cannot be independently verified.) And exact casualties, he said, could not yet be determined. But of the total number of Syrians affected by the attacks, he claimed that his facility only treated about a quarter.
A major factor Dr. Ad'doumi attributed to the high patient rate is that many Syrians in Damascus kept their windows open all night and were exposed while they slept. My colleague James Miller, who has analyzed much of the evidence emerging from these attacks, told me that a source of his in Damascus believes that so many children were affected because Eastern Ghouta is routinely shelled. He said, "a lot of the kids go to basements when the explosions happen, often to sleep. But the gas was heavy, and stayed low to the ground, traveling right into the basements and trapping them there."
According to Human Rights Watch (HRW), which reviewed satellite imagery of Eastern Ghouta, "the affected neighborhoods are predominantly residential with some warehouses, markets, and assorted commercial facilities on the periphery, adjacent to the main highways."