Tag Archives: Death

Living like ghosts in the ruins of Syria’s besieged Aleppo

still taken from video on social media showing aleppo's emptiness

By John Davison and Suleiman Al-Khalidi

BEIRUT/AMMAN (Reuters) – Even if it were somehow possible to escape eastern Aleppo, Abdullah Shiyani, a 10-year-old boy who dreams of being a doctor, says he wouldn’t leave. It would mean leaving behind too many people who need help.

“We have a lot of injured people here,” he told Reuters over the Internet. “Maybe we can help them.”

His father was a fighter, killed on the frontline. So he lives with his five siblings in a neighborhood that is almost an empty ghost town. They survive off money from a charity, buying potatoes, parsley and onions when they can. Three weeks ago they even had some meat.

Three of his friends were killed in a rocket attack a few months ago. With school long-since closed, he and his other friends spend their days racing through the empty streets, kicking a ball or playing a game called “guns and knives”.

They duck into buildings when the planes fly overhead, he says, because “we know about the machine guns firing from the planes”.

Aleppo, Syria’s biggest city before civil war uprooted half of the country’s population and killed hundreds of thousands of people, is now the conflict’s biggest prize. Opposition-held areas are now under total siege and heavy bombardment as President Bashar al-Assad’s government attempts to deal a death blow to a five year rebellion.

The city has been divided into rebel and government-held zones for years. But recent months have seen government troops, backed by Russian air strikes and Shi’ite fighters from Lebanon, Iran, Iraq and Afghanistan, close in on the rebel zone, where a quarter of a million people remain trapped.

Civilians reached by Reuters over the Internet and telephone tell of a bleak existence amid the ruins — of shortages of food, water and electricity, and incessant fear for their own lives and their loved ones.

“Every day there are about three to four (air) raids close to our house,” said 33-year-old mother-of-one Um Fahd, whose husband, brother and father have all been killed. “Our neighbor’s house was shelled and destroyed. A lot of people have died but we’re still here, thank God.”

She and her son survive on an allowance of $50 a month from a charity, barely enough for food.

“It’s not enough, but we’re grateful for whatever we get,” she said.

In the home she shares with her son, her sister and her sister’s three children, the entire family crams into the sturdiest room in the house whenever they hear warplanes, in the hope it will shield them from bombing.

“When the kids hear the sound of plane, they immediately know that they should go to that room,” she said.

Another woman, Um Ahmed, described how she and her husband careered through gunfire and shelling to flee during a brief window when the siege was broken. When it was reimposed, her two sons and their families remained trapped inside. Her voice trembled as she described her own escape under gunfire.

“I hesitated about leaving. I didn’t want to leave them behind. I haven’t been able to sleep at night, I’m so scared for them, because of the bombardments,” she said.

BROKEN FAMILIES

Aleppo has been one of the Middle East’s great cities for centuries. Its picturesque old center of covered spice markets has long since been reduced to rubble by street fighting. The crisis dramatically intensified earlier this year, when the government side captured territory north of the city, severing a vital supply route to Turkey.

A complete blockade of the rebel-held eastern sector was imposed in July, when pro-government forces severed the last road in. A rebel counter attack, heavily supported by Sunni Muslim jihadist groups, broke the siege in August, but government forces reimposed it in the last few days.

The government-held west of Aleppo holds more people and has also faced increasingly heavy insurgent shelling. But the destruction in the rebel-held east, targeted in daily air strikes, has been far more extensive.

The west came close to being encircled itself during fighting last month as rebels severed the only road in. The advancing government forces secured that route on Friday.

The devastation, death and displacement have left some neighborhoods of the besieged east sparsely populated, residents said. There is little work and no school. Most people spend their days trying to secure enough food to survive, and taking cover when the bombs fall. The children grow up fast.

The director of the al-Quds hospital in eastern Aleppo, Dr Hamza al-Khatib, said that during a recent suspected chlorine gas attack, children young enough to remember little other than war appeared to know instinctively how to react.

“I was shocked how five- or six-year-old children were holding oxygen masks alone, without help – like they were grown men who understood that this was the way to relieve their suffering,” he said.

Rescue workers accused the government of carrying out the Sept. 6 chlorine attack. Damascus denied involvement, saying “terror groups” were behind such attacks. The United Nations has blamed the government for previous attacks using chlorine gas.

When people die, relatives take the kids.

“My wife is looking after the five children my son left behind, and I’m helping her,” said 65-year-old Eid al-Ibrahim, whose eldest son was killed in an air strike.

People sometimes have to fight for their food.

“In our neighborhood they sell bags of five bread loaves … organized by the neighborhood council,” Ibrahim said, describing “a lot of crowding and fighting.”

Brita Hagi Hassan, president of the city council for opposition-held Aleppo, said prices had gone up by 10 times due to shortages induced by the siege. He said around 15 to 20 percent of eastern Aleppo’s residents left during the time the siege was lifted.

Many now eat little but lentils and cracked wheat. Electricity from motor generators is available only for three to six hours a day and damage to power facilities has long left eastern Aleppo with no running water.

Opposition-held neighborhoods have long suffered air strikes and attacks with barrel bombs — drums packed with explosives and shrapnel dropped from the air — from the government side.

The United Nations’ Commission of Inquiry on Syria has condemned the bombing of medical facilities in rebel-held districts, which it said were “explicitly targeted for destruction or assassination” of staff.

Damascus denies targeting civilians. A Syrian military source said the aim is to stop rebel shelling of western Aleppo and to encircle the militants in the east.

(Reporting by John Davison and Suleiman al-Khalidi; additional reporting by Tom Perry; editing by Tom Perry and Peter Graff)

Curbs on excessive force proposed for Cleveland police

Police officer at Republican convention

By Kim Palmer

CLEVELAND (Reuters) – Cleveland police would face new limits on the use of force under proposals issued on Thursday by a group charged with monitoring the city’s police department, after a U.S. Justice Department report highlighted abuses by some of its officers.

The report came just weeks after Tamir Rice, aged 12, was shot and killed by a rookie Cleveland police officer in November 2014, triggering national outrage over another case involving a young African-American who died at the hands of police.

Rice was shot after a 911 caller reported someone waving a gun outside a city recreation center. Investigators later determined he had been in possession of a replica-type gun that shot pellets, not bullets.

Changes proposed by the Cleveland Police Monitoring Team – a group of 17 national experts and community activists – include a requirement that officers use de-escalation tactics before resorting to force, such as creating distance from the threat involved.

Officers would also be required to provide medical aid, rather than just request aid, for anyone injured after the use of force. Cleveland officers were roundly criticized for waiting eight minutes before providing first aid to the wounded Rice, who died a day after he was shot.

Cleveland police did not carry first-aid kits at the time of Rice’s death, a policy that has changed since then.

Officers would also be barred from using chokeholds or force against suspects already handcuffed under the monitoring team’s proposals, and prohibited from putting themselves in harm’s way in a manner that might then require the use of deadly force.

A Cleveland police officer who was in the path of an oncoming vehicle, after a high-speed car chase in 2013, shot the first in a barrage of 137 rounds fired by 13 officers that killed the man and woman in the car.

The proposals from the Cleveland Police Monitoring Team are still subject to public comment this month. If approved by a judge and federal officials, they would take effect sometime early next year, according to Matthew Barge, the oversight consent decree monitor.

(Reporting by Kim Palmer; Editing by Ben Klayman and Tom Brown)

Sorrow, selfies compete at New York’s 9/11 memorial 15 years on

9/11 Memorial

By Gina Cherelus

NEW YORK (Reuters) – The memorial in New York City at the site where the Twin Towers fell in the Sept. 11 attacks 15 years ago straddles two worlds: one of the living and one of the dead.

A marker for where more than 2,600 people were killed, it attracts tourists from around the world. Some are drawn there to pause and reflect, others to satisfy a morbid fascination with the site of the worst attack on U.S. soil since Pearl Harbor was bombed in 1941.

Clutching cell phones, cameras and selfie sticks, visitors generally take their time around the National September ll Memorial Museum. They are expected to turn out in droves on Sunday for the 9/11 anniversary.

More than 23 million people have seen the memorial and 4 million have been to the museum since they were opened five years ago, leaving some local people thinking the significance of the site as a place for mourning is fading.

Rosanne Hughes’ husband died on Sept. 11, 2001, while he was on a work visit at the Windows on the World restaurant high in the World Trade Center’s North Tower.

Now a board member of the New Jersey 9/11 Memorial Foundation, she said it was hard for victims’ relatives to sometimes see insensitive or even rude behavior at the plaza in Lower Manhattan.

“It’s very disrespectful for people to go there and take selfies and smile for the cameras and in the background is where the towers collapsed,” Hughes said.

“I saw people with their kids running around, you know laughing, having fun. I guess people just don’t understand that it’s just not that type of museum.”

Early on that bright Tuesday morning in 2001, two hijacked planes were slammed into the North and South towers of the World Trade Center. A third plane was flown into the Pentagon near Washington, D.C., and a fourth crashed in a Pennsylvania field.

MELANCHOLIC MUSEUM

The memorial and museum, which cost more than $700 million to build, feature twin pools with waterfalls, each covering nearly an acre. The pools stand in the footprints of the towers.

Flanking the pools are platforms dotted with Swamp white oak trees and ivy beds. The names of every person who died in the 9/11 attacks are inscribed on bronze panels that rim the pools.

Coins glistened from the inner ledges of the pools, sharing space with paper napkins, bottle caps and even a plastic coffee cup one recent Sunday.

A security guard, who declined to give his name, said that during patrols he had to ask children to not sit on the names of the dead and stopped adults from stubbing out cigarettes on them.

The mood inside the museum, beneath “Ground Zero,” is more solemn, its 110,000 square feet bearing witness to the attacks. People’s identification cards, blood-stained shoes, photographs of fathers, wives, brothers and co-workers, intimate stories of loss and recovery tell the story.

Outside once again, Hughes said it was upsetting to see hotdog vendors and souvenir stands near the memorial.

“We still have anger over what happened too, and we’ve moved forward from that. But this is something that just doesn’t go away,” she said.

“It may be a photo-op for them but for us it is still very painful to watch.”

Kenneth T. Jackson, a New York City historian and professor at Columbia University, said the attacks made the World Trade Center the most famous place in the world, and he believes visitors instantly realize its significance.

“It now joins the long list of New York City tourist attractions and, for better or worse, it is one,” he said. “Even if there was no memorial, even if they left some broken stuff there, people would visit.”

(Reporting by Gina Cherelus; Editing by Daniel Wallis and Toni Reinhold)

‘Superbug’ infection related deaths are going uncounted

Kelly and Ryan Breaux sit holding a portrait of their deceased daughter Emma Breaux in their home in Breaux Bridge, Louisiana, on June 16, 2016. The husband and wife lost twins, Emma and Talon, to different superbugs that they contracted while in the neonatal unit at Lafayette General Hospital.

By Ryan McNeill, Deborah J. Nelson and Yasmeen Abutaleb

RICHMOND, Va. (Reuters) – Josiah Cooper-Pope, born 15 weeks premature, did fine in the neonatal intensive care unit for the first 10 days of his life.

Then, suddenly, his tiny body started to swell. Overnight, he grew so distended that his skin split.

His mother, Shala Bowser, said nurses at Chippenham Hospital in Richmond, Virginia, told her that Josiah had an infection and that she should prepare for the worst. On Sept. 2, 2010, she was allowed to hold him for the first and last time as he took his final breath. He was 17 days old.

What no one at the hospital told Bowser was that her newborn was the fourth baby in the neonatal unit to catch the same infection, methicillin-resistant Staphylococcus aureus, better-known as MRSA. It would sicken eight more, records show – nearly every baby in the unit – before the outbreak had run its course.

The shock of her son’s death came back to her when, after being contacted by Reuters earlier this year about the outbreak, Bowser went to Virginia’s Division of Vital Records to get a copy of Josiah’s death certificate. The cause of death: “Sepsis due to (or as a consequence of): Prematurity.” Sepsis is a complication of infection, but there was no mention of MRSA.

“My heart hurts,” Bowser said, sobbing. “I saw what this did to him. And then they just threw a bunch of words on the death certificate.”

According to their death certificates, Emma Grace Breaux died at age 3 from complications of the flu; Joshua Nahum died at age 27 from complications related to a skydiving accident; and Dan Greulich succumbed to cardiac arrhythmia at age 64 after a combined kidney and liver transplant.

In each case – and in others Reuters found – death resulted from a drug-resistant bacterial infection contracted while the patients were receiving hospital care, medical records show. Their death certificates omit any mention of the infections.

Fifteen years after the U.S. government declared antibiotic-resistant infections to be a grave threat to public health, a Reuters investigation has found that infection-related deaths are going uncounted, hindering the nation’s ability to fight a scourge that exacts a significant human and financial toll.

“YOU NEED TO KNOW”

Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them. The Centers for Disease Control and Prevention (CDC), the go-to national public health monitor, and state health departments lack the political, legal and financial wherewithal to impose rigorous surveillance.

As a result, they miss people like Natalie Silva of El Paso, Texas, who contracted a MRSA (pronounced MER-suh) infection after giving birth. She died from infection-related complications nearly a year later, at age 23.

Silva’s sisters fought a successful battle to get the hospital to cite MRSA on her death certificate. Still, her death went uncounted: The Texas health department doesn’t track deaths like hers from antibiotic-resistant infections, and neither does the CDC.

As America learned in the battle against HIV/AIDS, beating back a dangerous infectious disease requires an accurate count that shows where and when infections and deaths are occurring and who is most at risk. Doing so allows public health agencies to quickly allocate money and manpower where they are needed. But the United States hasn’t taken the basic steps needed to track drug-resistant infections.

“You need to know how many people are dying of a disease,” said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics Policy, a Washington-based health policy research organization. “For better or worse, that’s an indicator of how serious it is.”

Drug-resistant infections are left off death certificates for several reasons. Doctors and other clinicians get little training in how to fill out the forms. Some don’t want to wait the several days it can take for laboratory confirmation of an infection. And an infection’s role in a patient’s death may be obscured by other serious medical conditions.

There’s also a powerful incentive not to mention a hospital-acquired infection: Counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage.

Doctors and other clinicians also may simply not understand the importance of recording the infections. Sandy Tarant, the doctor who signed Josiah Cooper-Pope’s death certificate, told Reuters that he thought “it didn’t matter” whether he cited a MRSA infection.

Legally, he’s right. Most states don’t require doctors to specify whether MRSA was a factor in a death. Washington and Illinois are exceptions.

State laws govern how death certificates are filled out. Most use a model law that mandates financial penalties for anyone who deliberately makes a false statement on the document, said Patricia Potrzebowski, director of the National Association for Public Health Statistics and Information Systems. The penalties are often small and rarely enforced, she said.

“AN IMPRESSIONIST PAINTING”

Not even the CDC has a good handle on the extent of the problem. The agency estimates that about 23,000 people die each year from 17 types of antibiotic-resistant infections and that an additional 15,000 die from Clostridium difficile, a pathogen linked to long-term antibiotic use.

The numbers are regularly cited in news reports and scholarly papers, but they are mostly guesswork. Reuters analyzed the agency’s math and found that the estimates are based on few actual reported deaths from a drug-resistant infection.

The agency leaned heavily on small samplings of infections and deaths collected from no more than 10 states in a single year, 2011. Most didn’t include populous areas such as Florida, Texas, New York City and Southern California.

From those small samples, the CDC then extrapolated most of its national estimates, introducing so much statistical uncertainty into the numbers as to render them useless for the purposes of fighting a persistent public health crisis.

Describing the estimates to Reuters, even CDC officials used words like “jerry-rig,” “ballpark figure” and “a searchlight in the dark attempt.”

Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, said the agency, pressured by Congress and the media to produce “the big number,” settled on “an impressionist painting rather than something that is much more technical.”

In a statement emailed to Reuters, CDC officials said they released the 2013 estimates report “despite its limitations because of our profound concern about the seriousness of the threat.” The agency said it is working on improving its estimates.

The numbers of uncounted deaths from drug-resistant infections “speak to what can happen when we don’t allocate the necessary resources to bolster … our public health safety network,” said Senator Sherrod Brown. “When we see discrepancies in reporting, are unable to finance a workforce to monitor infections, and can’t even soundly estimate the number of Americans that die from [antibiotic-resistant infections] each year, we know we have a problem.”

The Ohio Democrat recently introduced a bill that would require the CDC to collect more and better data on superbug infections and death rates.

In the absence of a unified national surveillance system, the onus of monitoring drug-resistant infections and related deaths falls on the states. A Reuters survey of the health departments of all 50 states and the District of Columbia found wide variations in how they track seven leading “superbug” infections – if they do so at all.

Only 17 states require notification of C. difficile infections, for example, while just 26 states and Washington, D.C., do the same for MRSA. Fewer than half require notification of infections by carbapenem-resistant Enterobacteriaceae (CRE), a family of pathogens that the CDC has deemed an “urgent threat.” CRE gained notoriety when more than 200 people were sickened through contaminated medical scopes in hospitals from 2012 to 2015.

Twenty-four states and the District of Columbia – an area comprising 3 of every 5 Americans – said they do not regularly track deaths due to antibiotic-resistant infections. In contrast, all 50 states require reporting of deaths from AIDS. Deaths from hepatitis C and tuberculosis are also closely tracked.

“GROSSLY UNDER-REPORTED”

States that said they do track deaths generally do so for only a few types of drug-resistant infections and not consistently. In the survey, they reported a combined total of about 3,300 deaths from 2003 to 2014.

That’s a tiny fraction of the actual toll: A Reuters analysis of death certificates found that nationwide, drug-resistant infections were mentioned as contributing to or causing the deaths of more than 180,000 people during the same period. To conduct the analysis, Reuters worked with the CDC’s National Center for Health Statistics’ Division of Vital Statistics to search text descriptions on death certificates to identify relevant deaths.

Among the states that don’t require reporting of superbug deaths is California, the nation’s most populous state. The Reuters analysis identified more than 20,000 deaths linked to drug-resistant infections during the 12-year period, the most of any state. A health department spokeswoman said the state legislature authorized the department to be notified of infections, but not deaths.

Tennessee doesn’t require notification of deaths, either. The Reuters analysis found more than 5,500 deaths linked to superbugs there, more than half of them MRSA-related.

“We know we have a problem with MRSA in Tennessee,” said Marion Kainer, the state’s director of antimicrobial resistance programs. Requiring hospitals to report deaths is more than the department can take on right now, she said. “We have a significant problem getting clinicians to report just the disease,” she said. “It’s grossly under-reported.”

The totals from the Reuters analysis also indicate that the problem is getting worse nationwide, as the number of deaths from drug-resistant infections more than doubled from 8,600 in 2003 to about 16,700 in 2014. (Some of that increase could be the result of clinicians’ increased awareness of the infections.)

Death certificates aren’t a perfect measure. They can be wrong: Cause of death often is a judgment call by clinicians, who may blame a drug-resistant infection in error. More likely, they undercount drug-resistant deaths, as cases like that of Josiah Cooper-Pope show. Just how far under is impossible to know.

But there are clues: Connecticut, with a grant from the CDC, is the only state that closely monitors MRSA deaths. It logged 2,084 deaths from drug-resistant infections from 2003 to 2014, all but 10 from MRSA. That’s nearly twice the number of deaths from MRSA in the state that Reuters found in its death certificate analysis.

One reason for the disparity is that the state’s count includes anyone who died with MRSA, even if it wasn’t the cause of death, said Dr Matthew L. Cartter, Connecticut’s epidemiologist. He also said death certificates may undercount MRSA deaths because the physician may cite a general infection-related condition – death due to sepsis, for example – without mentioning the actual bacteria involved, or merely describe the mechanics of death, such as organ failure or cardiac arrest.

For many victims’ relatives interviewed by Reuters, the death certificate held special significance. They had watched an infection squeeze the life out of a loved one, often over several months and in gruesome ways. To find no official record of that on the death certificate came as a shock. It was as if the killer got away.

MISLEADING DEATH CERTIFICATES

Dan Greulich’s medical records show that, after his transplant operation, he spent five months battling drug-resistant infections that left him so debilitated he asked to be taken off of life support. He died in June 2012. By the time of his death – due to “cardiac arrhythmia,” according to the death certificate – the cost of his care at UCLA Medical Center amounted to more than $5 million.

“When the doctor wouldn’t count him as one of the people who die from hospital-acquired infections, I was outraged,” said Rae Greulich, his widow. She considered suing the hospital but never did.

UCLA Medical Center declined to comment.

Joshua Nahum’s recovery from a skydiving accident on Sept. 2, 2006, was going so well at Longmont United Hospital in Colorado that he was transferred to Northern Colorado Rehabilitation Hospital a month later in preparation for going home.

Within days, his temperature spiked, his condition deteriorated, and he was transferred back to Longmont. There, he was diagnosed with meningitis from Enterobacter aerogenes, a virulent drug-resistant pathogen spread almost exclusively in healthcare settings.

By the time he died on Oct. 22, the swelling in his brain had made him a quadriplegic, said his father, Armando Nahum. The infection was “the most immediate cause of his death,” his neurosurgeon, Dr E. Lee Nelson, told Reuters.

His death certificate said he died of “Delayed Complications of Craniocerebral Injuries” from the accident. “I remember being dumbfounded. ‘Are you serious?’” Nahum said. “All I asked was that they write the truth – that Josh died of an infection.”

Hospital records obtained by the family show he also contracted meningitis from a methicillin-resistant Staphylococcus epidermidis infection while at Longmont. Similar to MRSA, it is a potentially lethal drug-resistant bug.

In an email statement, Nancy Driscoll, chief nursing officer at Longmont United, said an independent review concluded that Nahum’s care “was appropriate.” She did not respond to questions about how he contracted the infections. Northern Colorado Chief Executive Officer Beth Bullard declined to discuss the case.

Because Nahum died nearly two months after the accident, the cause of death was certified by the Boulder County coroner’s office. Dr John E. Meyer, deputy coroner at the time, signed the death certificate. He told Reuters that he did not recall the case but would not have thought to specify that the complication was an infection.

“There’s certainly no rule that I know of,” he said.

Patient safety groups petitioned the CDC in 2011 to add a question about hospital-acquired infections to its standard death certificate, which is used by many states.

CDC Director Dr Thomas Frieden wrote that he would consider including patient advocates in discussions the next time the agency revises its death certificate, but there were no plans to make any changes “in the near future.”

In a statement emailed to Reuters, Frieden said: “While death certificates provide helpful information, the unfortunate reality is that they don’t provide in-depth clinical information.”

PROTECTIVE SECRECY

Antibiotic-resistant bacteria have been around nearly as long as antibiotics. Alexander Fleming discovered penicillin, the first modern antibiotic, in 1928, saving millions of lives from infections that just a few years earlier would have been fatal. By 1940, researchers were reporting that bacteria had already developed resistance to the drug.

Modern science became locked in a war of one-upmanship with the microbial world. Researchers would develop a class of drugs to replace those that were becoming ineffective, and soon enough, bacteria would begin showing resistance to the new drugs – a problem worsened by widespread overprescription of antibiotics and their overuse in farm animals.

By the 1990s, drug-resistant infections had reached crisis proportions. Advances in medicine have been, paradoxically, a big reason for the worsening epidemic.

More people than ever are living with weak immunity: premature infants, the elderly, and people with cancer, HIV and other illnesses that were once fatal but are now often chronic conditions. That’s also why superbugs most often occur in hospitals, nursing homes and other healthcare facilities – places where susceptible populations are concentrated.

In 2001, a task force led by the CDC, the Food and Drug Administration and the National Institutes of Health declared antibiotic-resistant infections to be a grave public health threat and issued an action plan to tame the problem. The group’s recommendations included creating a national surveillance plan and speeding development of new antibiotics.

Yet not a single new class of antibiotics has been approved for medical use since 1987. Despite years of efforts to educate healthcare workers about infection control, multiple studies show that many still routinely flout even basic preventive measures, like hand-washing.

While the types of bacteria showing drug resistance have multiplied, the federal government requires hospitals to report infections for only two of them, MRSA bacteremia, or blood infection, and C. difficile. It requires limited reports on the others and relies on the states to fill in the gaps.

In 2014, the administration of President Barack Obama issued a new national action plan to combat antibiotic-resistant bacteria. Congress followed last year with a $160 million increase in the CDC’s budget to bolster research, drug development and surveillance of superbugs by the states.

But as Reuters found, surveillance carried out by the states can come up against strong institutional resistance and laws that shield the healthcare industry.

Under Virginia law, Chippenham Hospital should have reported its 2010 MRSA outbreak to the state Department of Health when the third baby in the neonatal intensive care unit tested positive for the bug, health department officials said. That was four days before newborn Josiah Cooper-Pope fell ill.

Instead, according to Virginia Health Department records and interviews with department officials, the hospital didn’t notify public health officials until nearly every baby in the unit had been infected – and then only by mail.

By that time, Josiah had been dead two weeks and another baby was in critical condition with a MRSA infection.

After persuading the hospital to temporarily close the unit and bringing the outbreak under control, Health Department investigators found that Chippenham hadn’t taken basic steps to prevent MRSA’s spread, such as training staff, scrubbing furniture and computers, and testing all infants in the nursery when the infection first surfaced.

Jennifer Stanley, a spokesperson for Hospital Corp of America, which owns Chippenham, said that since the outbreak, the hospital has put in place “aggressive infection prevention measures” and “intensive education and training.”

Virginia took no action against the hospital for the lethal outbreak.

“HOW THE SAUSAGE IS MADE”

The state can fine hospitals for violating regulations, but “this is not the approach [the Department of Health] typically follows,” said Maribeth Brewster, department spokesperson. Officials prefer “working closely” with hospitals to correct patient safety problems, she said, and a follow-up inspection at Chippenham Hospital found no regulatory violations, so no action was warranted.

In response to a Reuters public records request on the outbreak, the Health Department sent a copy of its investigation report in which the name and address of the hospital were blacked out.

The same was true for 22 more superbug outbreaks in Virginia healthcare facilities since 2007 that involved more than 130 patients, including 15 who died. State law prohibits the agency from identifying the location of outbreaks. At least 27 other states have similar laws or policies in place.

Disclosing the names of healthcare providers “would serve as a significant disincentive to the timely reporting of disease outbreaks,” said Brewster, the Virginia Health Department spokesperson.

Tarant, the doctor who signed Josiah’s death certificate, put it this way: “Things like this, if dealt with appropriately, are best if kept internally. I don’t think people want to see how the sausage is made.”

At a conference last year, hospital infection-control specialists told CDC officials that medical staff and internal review boards sometimes blocked them from reporting infections as required by state law or by the Centers for Medicare & Medicaid Services (CMS), which reduces payments to hospitals for preventable infections and high infection rates.

The specialists said medical staff sometimes were discouraged from testing patients with clear signs of infection – one of several tactics they said staff used to get around reporting rules.

Those complaints were detailed in a notice the CDC and CMS sent late last year to hospitals nationwide, warning them that offenders could be fined and cut off from federal funds for covering up infections they are legally required to disclose.

Officials said that due to database limitations, they did not know whether any facilities had been cited for underreporting infections since the notice was issued.

Acknowledging any infection caught in a hospital or other healthcare setting carries another risk: The paper trail can support a subsequent lawsuit.

Emma Grace Breaux and her twin brother, Talon, fell ill from infections shortly after they were born 12 weeks premature at Lafayette General Medical Center in Lafayette, Louisiana, in 2005. Talon died at 15 days old after becoming infected by a virulent strain of Pseudomonas aeruginosa, a ubiquitous bacteria that easily contaminates hospital equipment.

“The day we buried him, we found out about Emma’s infection,” said Kelly Breaux, their mother.

Emma had a MRSA infection. She survived, but with permanent damage to her heart, lungs and one leg.

Three and a half years later, Emma was in Florida to have her leg repaired when she came down with swine flu. It was too much for her heart and lungs. After a six-week battle, she died at Miami Children’s Hospital just shy of her fourth birthday. Her death certificate blamed flu-related pneumonia. Including MRSA as a cause of death “was not considered,” said Dr Sharon Skaletzky, who was at Miami Children’s at the time and signed the death certificate.

Talon’s case was clear-cut; his death certificate cited septic shock due to his hospital-acquired Pseudomonas infection as the cause of death.

Emma’s was more complicated. Her medical expenses alone eventually exceeded $4 million for repeated hospitalizations due to complications from her MRSA infection. The family sold their home, truck and other possessions to stay afloat while she underwent multiple operations.

A Louisiana appeals court ultimately ruled that MRSA was responsible for her death and in 2013 upheld a jury award of more than $6 million in damages and medical expenses for the twins.

Lafayette General Medical Center spokesperson Daryl Cetnar said no one with knowledge of the case was available.

NATIONAL PRIORITIES

Lack of a unified national surveillance system makes it next to impossible to count the number of drug-resistant infections, fatal or otherwise. Theoretically, deaths could be counted through the nation’s vital statistics.

Those numbers, compiled by the National Center for Health Statistics (NCHS), include births, marriages, divorces and, using data culled from death certificates, information on what is killing whom. The numbers are critical in determining how money is distributed for research and public health campaigns.

As examples in this article show, superbug infections are often omitted from death certificates. But even when they are recorded, NCHS can’t feed that information into vital statistics: The World Health Organization (WHO) classification system the agency uses lacks mortality codes for most drug-resistant infections, though it has codes for more than 8,000 other possible causes of death.

The CDC added codes for use in the United States for terrorism-related deaths a year after the Sept. 11, 2001, attacks. It could do the same for deaths from drug-resistant infections. Officials told Reuters the CDC is instead working to incorporate the codes into the WHO’s next revision of the international classification system. The revised system is expected to be completed in 2018 but not fully in use until the 2020s.

There are other ways to count deaths, such as searching the text of death certificates as Reuters did in its analysis with help from the NCHS. CDC officials told Reuters they now are exploring “how we might be able use literal text capture to get additional information on resistant infection deaths which could be useful for annual tracking.”

As it stands, the CDC has the National Healthcare Safety Network. Under this surveillance program, about 5,000 hospitals and in-patient rehabilitation facilities file quarterly reports on several types of healthcare-related infections as a condition of receiving Medicare and Medicaid payments.

But only two superbug infections are on the reportable list, MRSA bacteremia and C. difficile. The others are reported under only limited circumstances, such as when related to a hysterectomy or a catheter-associated urinary tract infection.

The reports are typically five to seven months old by the time they are logged, and thus aren’t useful for real-time surveillance. And the CDC doesn’t require facilities to report deaths. Determining cause of death is difficult and would entail extra training for hospital staff who fill out the forms and oversight, which the agency can’t afford, according to Dr Daniel Pollock, surveillance branch chief for the CDC’s Division of Healthcare Quality Promotion.

CDC Director Frieden, noting that there is “no simple way to code for drug-resistant infections” on death certificates, said the CDC “is supporting states’ efforts to respond to antibiotic resistance and help protect Americans from this threat.”

Just 16 state health departments told Reuters that they tally deaths from reportable antibiotic-resistant infections. Eight others track deaths only when they are part of an outbreak. (Pennsylvania and Georgia declined to answer the survey questions.)

Among states that don’t track deaths is Texas, where Natalie Silva contracted MRSA in November 2012 at Hospital Corp of America’s Del Sol Medical Center in El Paso. Two days after giving birth to a healthy boy by cesarean section, her incision began gushing blood, said her sister, Crystal Silva. Back at the hospital, Natalie Silva tested positive for MRSA.

Hospital staff assured Silva it was safe to continue holding and breastfeeding her week-old son, according to Crystal Silva and her other sister, Stephanie Hall. One month later, her son was in the neonatal intensive care unit battling his own MRSA infection, they said.

He survived. For Silva, the next few months brought a cascade of medical complications, records show. Multiple infections led to multiple surgeries that left her paralyzed. Hall recalled spending a Friday night in September 2013 at her sister’s bedside, painting Silva’s fingernails metallic blue and her toenails metallic purple, optimistic that her sister would return home.

Three days later, Silva died.

Silva’s doctors wanted to blame cardiac arrest on the death certificate, Silva’s sisters said.

Del Sol Medical Center declined to comment.

Silva’s family paid $3,000 for an autopsy that confirmed that the MRSA infection contributed to her death. Her death certificate lists cardiopulmonary arrest as the immediate cause of death, due to complications from a MRSA infection.

“She was 23 years old and healthy. We knew that MRSA played a huge role,” said Crystal Silva. “We had to fight for them to include it.”

In September last year, Hall filed a medical malpractice and wrongful death lawsuit against Del Sol in El Paso County District Court, alleging that the hospital was responsible for Silva’s MRSA infection and the fatal complications that followed. The lawsuit is seeking payment to Silva’s two children for the loss of their mother, loss of her wages while she was sick, medical costs and funeral expenses.

Christine Mann, spokeswoman for the Texas health department, said counting superbug deaths would require a formal statute or rule change in the state. “We prioritize our resources and attention toward taking public health action where it is most needed,” she said.

Natalie Silva’s was among about 10,000 deaths linked to antibiotic-resistant infections in Texas from 2003 to 2014, according to the Reuters analysis. Though her sisters succeeded in getting an honest reckoning on Silva’s death certificate, her death by superbug was never counted.

(Edited by John Blanton)

Key IS leader killed in air strike in Syria

An Islamic State flag is seen in this picture illustration

By Angus McDowall  and Phil Stewart

BEIRUT/WASHINGTON (Reuters) – Islamic State said on Tuesday one of its most prominent and longest-serving leaders was killed in what appeared to be an American air strike in Syria, depriving the militant group of the man in charge of directing attacks overseas.

A U.S. defense official told Reuters the United States targeted Abu Muhammad al-Adnani in a Tuesday strike on a vehicle  traveling in the Syrian town of al-Bab. The official stopped short of confirming Adnani’s death, however.

Such U.S. assessments often take days and often lag behind official announcements by militant groups.

Adnani was one of the last living senior members, along with self-appointed caliph Abu Bakr al-Baghdadi, who founded the group and stunned the Middle East by seizing huge tracts of Iraq and Syria in 2014.

As Islamic State’s spokesman, Adnani was its most visible member. As head of external operations, he was in charge of attacks overseas, including Europe, that have become an increasingly important tactic for the group as its core Iraqi and Syrian territory has been eroded by military losses.

The group reacted by saying his death would not harm it, and his killers would face “torment”, a statement in the group’s al-Naba newspaper said, according to the Site Intelligence monitoring group.

“Today, they rejoice for the killing … and then they will cry much when Allah will overpower them, with His permission, with affliction of the worst torment by the soldiers of Abu Muhammad and his brothers,” the statement said.

Advances by Iraq’s army and allied militia toward Islamic State’s most important possession of Mosul have put the group under new pressure at a moment when a U.S.-backed coalition has cut its Syrian holdings off from the Turkish border.

Those military setbacks have been accompanied by air strikes that have killed several of the group’s leaders, undermining its organizational ability and dampening its morale.

A U.S. counter-terrorism official who monitors Islamic State said Adnani’s death would hurt the militants “in the area that increasingly concerns us as the group loses more and more of its caliphate and its financial base … and turns to mounting and inspiring more attacks in Europe, Southeast Asia and elsewhere”.

Under Adnani’s auspices, Islamic State launched large-scale attacks, bombings and shootings on civilians in countries outside its core area, including France, Belgium and Turkey.

The official said Adnani’s roles as propaganda chief and director of external operations had become “indistinguishable” because the group uses its online messages to recruit fighters and provide instruction and inspiration for attacks.

Islamic State’s Amaq News Agency reported that Adnani was killed “while surveying the operations to repel the military campaigns against Aleppo.” Islamic State holds territory in the province of Aleppo, but not in the city where rebels are fighting Syrian government forces.

Amaq did not say how Adnani, born Taha Subhi Falaha in Syria’s Idlib Province in 1977, was killed. Islamic State published a eulogy dated Aug. 29 but gave no further details.

INROADS INTO ISLAMIC STATE

Adnani was a Syrian from Binish in Idlib, southwest of Aleppo, who pledged allegiance to Islamic State’s predecessor, al Qaeda, more than a decade ago and was once imprisoned by U.S. forces in Iraq, according to the Brookings Institution.

He was from a well-to-do background but left Syria to travel to Iraq to fight U.S. forces there after its 2003 invasion, and only returned to his homeland after the start of its own civil war in 2011, a person who knew his family said.

He once taught theology and law in jihadi training camps, according to Brookings. A biography posted on militant websites says he grew up with a “love of mosques” and was a prolific reader.

He had been the chief propagandist for the ultra-hardline jihadist group since he declared in a June 2014 statement that it was establishing a modern-day caliphate spanning swaths of territory it had seized in Iraq and neighboring Syria.

Adnani had often been the face of the Sunni militant group, such as when he issued a message in May urging attacks on the United States and Europe during the holy month of Ramadan, and as in Sept. 2014 when he called on supporters to kill Westerners throughout the world.

Recent advances by the U.S.-backed Syrian Democratic Forces, an alliance of Kurdish and Arab militias, and by Syrian rebels backed by Turkey, have made inroads into Islamic State holdings in Aleppo province, cutting them off from the Turkish border and supply lines along it.

Iraqi army advances against the jihadist group meant Baghdad was on track to retake Mosul by the end of this year, the head of the U.S. military’s Central Command General Joseph Votel said on Tuesday.

AIR STRIKE

Among senior Islamic State officials killed in air strikes this year are Abu Ali al-Anbari, Baghdadi’s formal deputy, and the group’s “minister of war”, Abu Omar al-Shishani. Adnani had joined the group under its founder Abu Musab al-Zarqawi.

There were conflicting reports earlier on Tuesday as to where and how Adnani died.

A senior Syrian rebel official said Adnani was most probably killed in the Islamic State-held city of al-Bab in an air strike. Citing unconfirmed reports, he said Adnani was in the Aleppo region to raise morale in the face of mounting pressure.

Islamic State’s territory around Aleppo is of particular significance to the group because it is also the location of Dabiq, where an Islamic prophecy holds the last battle between Muslims and infidels will rage, heralding the end of time.

Iraq said in January that Adnani had been wounded in an air strike in the western province of Anbar and then moved to the northern city of Mosul, Islamic State’s capital in Iraq.

The United States designated him a “global terrorist” this year and said he was one of the first foreign fighters to oppose U.S.-led coalition forces in Iraq since 2003 before becoming spokesman of the militant group.

There was a $5 million reward on his head under the U.S. “Rewards for Justice” program.

(Reporting by Angus McDowall in Beirut, Stephen Kalin in Erbil, Iraq, Maher Chmaytelli in Baghdad, Suleiman al-Khalidi in Amman and Idrees Ali, Yara Bayoumy, Warren Strobel, Phil Stewart and John Walcott in Washington; Editing by Alistair Bell, James Dalgleish, William Maclean and Nick Macfie)

More than 300 million at risk of diseases from dirty water

A boy searches for coins thrown by devotees as religious offerings in a polluted water channel near a temple in Kolkata

By Magdalena Mis

LONDON (Thomson Reuters Foundation) – More than 300 million people in Asia, Africa and Latin America are at risk of life-threatening diseases like cholera and typhoid due to the increasing pollution of water in rivers and lakes, the United Nations Environment Programme (UNEP) said.

Between 1990 and 2010, pollution caused by viruses, bacteria and other micro-organisms, and long-lasting toxic pollutants like fertilizer or petrol, increased in more than half of rivers across the three continents, while salinity levels rose in nearly a third, UNEP said in a report on Tuesday.

Population growth, expansion of agriculture and an increased amount of raw sewage released into rivers and lakes were among the main reasons behind the increase of surface water pollution, putting some 323 million people at risk of infection, UNEP said.

“The water quality problem at a global scale and the number of people affected by bad water quality are much more severe than we expected,” Dietrich Borchardt, lead author of the report, told the Thomson Reuters Foundation.

However, a significant number of rivers remain in good condition and need to be protected, he said by phone from Germany.

About a quarter of rivers in Latin America, 10 percent to 25 percent in Africa and up to 50 percent in Asia were affected by severe pathogen pollution, largely caused by discharging untreated wastewater into rivers and lakes, the report said.

Some 3.4 million people die each year from diseases such as cholera, typhoid, polio or diarrhea, which are associated with pathogens in water, UNEP said.

It estimated that up to 164 million people in Africa, 134 million in Asia and 25 million in Latin America were at risk of infection from the diseases.

It said building more sewers was not enough to prevent infections and deaths, adding that the solution was to treat wastewater.

Organic pollution, which can cause water to be completely starved of oxygen, affects one kilometer (0.6 mile) out of seven kilometers (4.4 miles) of rivers in Latin America, Africa and Asia, threatening freshwater fisheries, UNEP said.

Severe and moderate salinity levels, caused by the disposal of salty water from mines, irrigation systems and homes, affect one in 10 rivers on the three continents, making it harder for poor farmers to irrigate their crops, it said.

The trend of worsening water pollution was “critical”, Borchardt said.

“It is much more expensive to clean up surface water from severe pollution than to implement proper management which includes prevention of pollution,” he said. “Tools are available but the challenge is to implement them.”

(Reporting by Magdalena Mis; Editing by Katie Nguyen.; Please credit Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s rights, corruption and climate change. Visit news.trust.org)

Islamic State Car bomb kills 10 in Somalia

A Somali policeman looks at the wreckage of a vehicle destroyed by a car bomb at the Banadir beach restaurant at Lido beach in Somalia's capital Mogadishu,

MOGADISHU (Reuters) – The death toll from an attack late on Thursday by Islamic militants on a seaside restaurant in the Somali capital Mogadishu has risen to 10, police said.

The attackers set off a car bomb at the Banadir restaurant at the city’s Lido beach before engaging security forces in a fight for several hours.

The casualties comprised six civilians, two members of the security forces and two of the attackers, Ali Abdullahi, a police officer, said on Friday.

Al Qaeda-linked al Shabaab claimed the attack, which ended at around 3:00 a.m. local time, police said.

The group has carried out a series of deadly attacks in Somalia to try to topple the Western-backed government.

In a separate incident in southern Somalia, a roadside bomb planted by al Shabaab militants injured 10 people, police said on Friday, raising the number of wounded from three initially.

One of those wounded in the explosion in Baardhere town in Gedo region was the local district commissioner, police said.

(Reporting by Feisal Omar and Abdi Sheikh; Writing by Duncan Miriri)

Gun, bomb attack on American University in Kabul kills 12

tudents walk toward a police vehicle after they were rescued from the site of an attack at the American University of Afghanistan in

By Mirwais Harooni and Hamid Shalizi

KABUL (Reuters) – Twelve people, including seven students, were killed in an attack on the American University in Kabul that sent hundreds of students fleeing in panic, police said on Thursday, before the assault ended when two gunmen were shot dead.

The attack began at around 6:30 p.m. (1400 GMT) on Wednesday with a large explosion that officials said was a car bomb followed by gunfire, as suspected militants battled into the complex where foreign staff and pupils were working.

Elite Afghan forces surrounded the walled compound and eventually worked their way inside, according to a senior interior ministry official.

Sporadic gunfire could be heard through the night and, before dawn, police said the operation had concluded after they killed at least two attackers.

There was no claim of responsibility for an attack in which Kabul police chief Abdul Rahman Rahimi said seven students, three policemen and two security guards were killed, the second incident involving the university this month.

President Ashraf Ghani called the assault “a cowardly attempt to hinder progress and development in Afghanistan”.

“Attacking educational institutions and public places and targeting civilians will not only fail to shake our determination, but will further strengthen it to fight and eradicate terror,” he said in a statement.

Islamist militant groups, mainly the Afghan Taliban and a local offshoot of Islamic State, have claimed a string of recent bomb attacks aimed at destabilizing Afghanistan and toppling the Western-backed government of Ghani.

One Ugandan man – a faculty member – was among the wounded, according to a list at the Kabul emergency hospital.

In a statement, the university said it was working with authorities to make sure everyone was accounted for.

“My number one priority at this point is the safety and security of all faculty staff, and students,” said Mark A. English, the university president.

Fraidoon Obaidi, chief of the Kabul police Criminal Investigation Department, told Reuters that police had evacuated between 700 and 750 students from the university, which is popular with the children of Afghanistan’s elite.

DESPERATE ESCAPES

Terrified students recounted barricading themselves in classrooms or jumping from windows to escape.

“Many students jumped from the second floor, some broke their legs and some hurt their head trying to escape,” Abdullah Fahimi, a student who escaped, told Reuters. He injured his ankle making the leap.

“We were in the class when we heard a loud explosion followed by gunfire. It was very close. Some students were crying, others were screaming,” he said.

Others said they scrambled toward an emergency exit, scaled walls and jumped to safety.

The university buildings are protected by armed guards and watchtowers but the gunmen still got in.

Edrees Nawabi, another student at the university, said he had long been concerned about campus security.

“We were scared but also we wanted to be educated,” he said.

It was the second time this month that the university or its staff had been targeted.

Two teachers, an American and an Australian, were abducted at gunpoint from a road near the university on Aug. 7. They are missing.

The American University of Afghanistan has about 1,700 students and advertises itself as the country’s only not-for-profit, “non-partisan”, co-educational university. It opened in 2006 and caters to full-time and part-time students.

Taliban insurgents control large swaths of Afghanistan, and the security forces are struggling to contain them, especially in the provinces of Helmand to the south and Kunduz to the north.

NATO ended its combat mission in December 2014 but thousands of foreign troops remain to train and assist Afghan forces, while several thousand other U.S. soldiers are engaged in a separate mission focusing on al Qaeda and Islamic State.

The United States said it was closely monitoring the situation in Kabul following the university attack and that forces from the U.S.-led coalition were involved in the response in an advise-and-assist role.

State Department spokeswoman Elizabeth Trudeau said the U.S. Embassy was working to account for all of its personnel and to locate and assist any U.S. citizens affected.

(Additional reporting by Ayesha Rascoe, Susan Heavey and Arshad Mohammed in WASHINGTON; Writing by Mike Collett-White and Lincoln Feast; Editing by Jonathan Oatis and Paul Tait)

At least 120 killed as quake flattens towns in central Italy

rescuers helping those in Italian quake

By Steve Scherer

ACCUMOLI, Italy (Reuters) – An earthquake flattened towns in central Italy in the early hours of Wednesday, killing at least 120 people and burying some alive in their sleep, with volunteers and firefighters racing to free those trapped under mounds of rubble as darkness fell.

The quake razed mountain homes and buckled roads in a cluster of communities some 140 km (85 miles) east of Rome. It was powerful enough to be felt in Bologna to the north and Naples to the south, each more than 220 km from the epicenter.

“I was blown away by what I saw. We haven’t stopped digging all day,” said Marcello di Marco, 34, a farmer who traveled from the town of Narni some 100 km away to help with emergency services’ rescue efforts in the hamlet of Pescara del Tronto.

In the nearby village of Accumoli, a family of four, including two boys aged 8 months and 9 years, were buried when their house imploded.

As rescue workers carried away the body of the infant, carefully covered by a small blanket, the children’s grandmother blamed God: “He took them all at once,” she wailed.

The army was mobilized to help with special heavy equipment and the Treasury released 235 million euros ($265 million) of emergency funds. At the Vatican, Pope Francis dispatched part of the Holy See’s tiny firefighting force to help in the rescue.

Rescue workers used helicopters to pluck survivors to safety in more isolated villages cut off by landslides and rubble.

Aerial photographs showed whole areas of Amatrice, last year voted one of Italy’s most beautiful historic towns, flattened by the 6.2 magnitude quake. Many of those killed or missing were visitors.

“It’s all young people here, it’s holiday season, the town festival was to have been held the day after tomorrow so lots of people came for that,” said Amatrice resident Giancarlo, sitting in the road wearing just his underwear.

“It’s terrible, I’m 65 years old and I have never experienced anything like this, small tremors, yes, but nothing this big. This is a catastrophe,” he said.

Scores of people are believed unaccounted for, with the presence of the holidaymakers making it difficult to tally.

Prime Minister Matteo Renzi, who gave the latest toll figure after visiting the area, called for national unity.

“We Italians are very good at arguing and being polemical but now let’s stand in solidarity and pride alongside those who are rescuing others,” he said. “Today is a day for tears. Tomorrow we can talk of reconstruction.”

VOICES UNDER THE RUBBLE

Patients at the badly damaged hospital in Amatrice were moved into the streets and a field hospital was set up.

“Three quarters of the town is not there anymore,” Amatrice mayor Sergio Pirozzi told state broadcaster RAI. “The aim now is to save as many lives as possible. There are voices under the rubble, we have to save the people there.”

Accumoli’s mayor, Stefano Petrucci, said some 2,500 people were left homeless in the local community of 17 hamlets.

Residents responding to wails muffled by tonnes of bricks and mortar sifted through with their bare hands before emergency services arrived with earth-moving equipment and sniffer dogs. Wide cracks had appeared like open wounds on the buildings that were still standing.

The national Civil Protection Department said some survivors would be put up elsewhere in central Italy, while others would be housed in tents that were being dispatched to the area.

Most of the damage was in the Lazio and Marche regions, with Lazio taking the brunt of the damage and the biggest toll. Neighboring Umbria was also affected. All three regions are dotted with centuries-old buildings susceptible to earthquakes.

The U.S. Geological Survey said the quake struck near the Umbrian city of Norcia. Italy’s earthquake institute INGV registered it at 6.0 and put the epicenter further south, closer to Accumoli and Amatrice.

It was relatively shallow at 4 km below the earth’s surface.

INGV reported 150 aftershocks in the 12 hours following the initial quake, the strongest measuring 5.5.

Residents of Rome were woken by the tremors, which rattled furniture, swayed lights and set off car alarms in most of central Italy.

“It was so strong. It seemed the bed was walking across the room by itself with us on it,” Lina Mercantini of Ceselli, Umbria, about 75 km away from the hardest hit area, told Reuters.

Italy sits on two fault lines, making it one of the most seismically active countries in Europe.

The last major earthquake to hit the country struck the central city of L’Aquila in 2009, killing more than 300 people.

The most deadly since the start of the 20th century came in 1908, when an earthquake followed by a tsunami killed an estimated 80,000 people in the southern regions of Reggio Calabria and Sicily.

(Additional reporting by Philip Pullella, Gavin Jones, Stephen Jewkes, Eleanor Biles and Giulia Segreti; Writing by Crispian Balmer and Philip Pullella; Editing by Louise Ireland)

Powerful earthquake in Italy overnight, killing at least 73, thousands homeless

A man is carried away after having been rescued alive from the ruins following an earthquake in Amatrice

By Steve Scherer

ACCUMOLI, Italy (Reuters) – A powerful earthquake devastated a string of mountainous towns in central Italy on Wednesday, trapping residents under piles of rubble, killing at least 73 people and leaving thousands homeless.

The quake struck in the early hours of the morning when most residents were asleep, razing homes and buckling roads in a cluster of communities some 140 km (85 miles) east of Rome.

A family of four, including two boys aged 8 months and 9 years, were buried when their house in Accumoli imploded.

As rescue workers carried away the body of the infant, carefully covered by a small blanket, the children’s grandmother blamed God: “He took them all at once,” she wailed.

The army was mobilized to help with special heavy equipment and the treasury released 235 million euros ($265 million) of emergency funds. At the Vatican, Pope Francis canceled part of his general audience to pray for the victims.

Aerial photographs showed whole areas of Amatrice, voted last year as one of Italy’s most beautiful historic towns, flattened by the 6.2 magnitude quake.

“It’s all young people here, it’s holiday season, the town festival was to have been held the day after tomorrow so lots of people came for that,” said Amatrice resident Giancarlo, sitting in the road wearing just his underwear.

“It’s terrible, I’m 65-years-old and I have never experienced anything like this, small tremors, yes, but nothing this big. This is a catastrophe,” he said.

Accumoli mayor Stefano Petrucci said some 2,500 were left homeless in the local community, which is made up of 17 hamlets.

Residents responding to wails muffled by tonnes of bricks and mortar sifted through the rubble with their bare hands before emergency services arrived with earth-moving equipment and sniffer dogs. Wide cracks had appeared like open wounds on the buildings that were still standing.

The national Civil Protection Department said some survivors would be put up elsewhere in central Italy, while others would be housed in tents that were being dispatched to the area.

Italian Prime Minister Matteo Renzi said he would visit the disaster area later in the day: “No one will be left alone, no family, no community, no neighborhood. We must get down to work .. to restore hope to this area which has been so badly hit,” he said in a brief televised address.

The quake hit during the summer when the area, usually sparsely populated, hosts large numbers of holidaymakers.

A spokeswoman for the civil protection department, Immacolata Postiglione, said the dead were in Amatrice, Accumoli and other villages including Pescara del Tronto and Arquata del Tronto. She put the initial death toll at 73, but said rescue teams had only just reached some stricken areas.

The earthquake caused damage in three regions — Umbria, Lazio and Marche — and was felt as far away as the southern Italian port city of Naples.

DISAPPEARING IN DUST

The hospital in Amatrice was among the buildings that were badly damaged, and patients were moved into the streets.

“Three quarters of the town is not there anymore,” Amatrice mayor Sergio Pirozzi told state broadcaster RAI. “The aim now is to save as many lives as possible. There are voices under the rubble, we have to save the people there.”

RAI reported that two Afghan girls, believed to be asylum-seekers, were also missing in the town.

The U.S. Geological Survey, which measured the quake at 6.2 magnitude, said it struck near the Umbrian city of Norcia, while Italy’s earthquake institute INGV registered it at 6.0 and put the epicenter further south, closer to Accumoli and Amatrice.

The damage was made more severe because the epicenter was at a relatively shallow 4 km below the surface of the earth. Residents of Rome were woken by the tremors, which rattled furniture, swayed lights and set off car alarms in most of central Italy.

“It was so strong. It seemed the bed was walking across the room by itself with us on it,” Lina Mercantini of Ceselli, Umbria, about 75 km away from the hardest hit area, told Reuters. Olga Urbani, in the nearby town of Scheggino, said: “Dear God it was awful. The walls creaked and all the books fell off the shelves.”

INGV reported 60 aftershocks in the four hours following the initial quake, the strongest measuring 5.5.

Italy sits on two fault lines, making it one of the most seismically active countries in Europe.

The last major earthquake to hit the country struck the central city of L’Aquila in 2009, killing more than 300 people.

The most deadly since the start of the 20th century came in 1908, when an earthquake followed by a tsunami killed an estimated 80,000 people in the southern regions of Reggio Calabria and Sicily.

($1 = 0.8868 euros)

(Writing by Crispian Balmer and Philip Pullella, reporting by Steve Scherer, Philip Pullella, Stephen Jewkes, Eleanor Biles and Giulia Segreti.; Editing by Nick Macfie, Robert Birsel and Peter Graff)