(Corrects third paragraph to read "thousands affected", not
* Nerve gases designed to kill many people very swiftly
* Antidotes like atropine effective if given immediately
* Nerve damage means survivors likely to suffer disabilities
By Kate Kelland, Health and Science Correspondent
LONDON, Aug 23 Even those who survived the
suspected chemical weapons attack in Damascus - and many
hundreds didn't - may have life-long disabilities and health
problems for which there are few effective treatments.
The death toll from the incident, the latest grisly episode
in Syria's two-and-a-half-year civil war, could well rise in
coming days as doctors and other health workers who suffered
secondary exposure via the direct victims start to succumb to
the agent's poison.
Antidotes and emergency treatments do exist for patients
suffering the immediate effects of poisoning by a nerve agent -
something many experts fear happened to the thousands affected
in rebel-held areas of the Syrian capital on Wednesday.
But if no help comes within the first hour or so, the
chances become slim that an antidote drug like atropine or
oxime, or the sedative diazepam, will do much good.
"(Treatment) needs to be immediate. The damage is done very
quickly," said Ray Zilinskas, a chemical and biological weapons
expert at the Monterey Institute of International Studies in the
"Longer term, the major risk is the result of significant
restricted breathing," which could also lead to brain damage,
said Alastair Hay, a professor of environmental toxicology and
chemical weapons expert at Britain's Leeds University.
ONE BREATH COULD BE DEADLY
Nerve gases are the most potent and deadly of the known
chemical agents. "They are rapidly lethal and are hazardous by
any route of exposure," says Sharon Ruetter of the U.S. Army
Edgewood Chemical Biological Center in Maryland.
In a review of chemical weapons hazards in the Environmental
Health Perspectives journal, Ruetter said it was theoretically
possible to release nerve gases in high enough concentrations
that "one breath would be incapacitating or deadly".
Nerve gases include tabun, soman and sarin - the agent
experts think is most likely to have been used in Syria.
They interfere with transmissions between nerves, or between
nerves and muscle cells, causing muscle weakness or paralysis,
including paralysis of the diaphragm and heart. They also cause
seizures, loss of body control, restricted breathing, sweating,
profuse nasal and lung secretions and constricted pupils.
"With the number of casualties we've seen - the figures I'm
seeing at the moment are up to 2,000 dead - and the sorts of
symptoms, the rapidity of death ... the only plausible
explanation is a chemical weapon," said Hamish de
Bretton-Gordon, the former commander of the chemical, biological
and nuclear counter-terrorism unit at Britain's defence
"If it is a chemical weapon, it's most likely to be a nerve
agent - and we know that sarin has been used in the past in
Syria. We know that Assad has very large stockpiles of sarin,
and a delivery of sarin would create these kinds of casualties."
Hay said that from pictures and videos he'd seen, nasal and
lung secretions - signs consistent with nerve gas poisoning -
were "very evident in many of the victims".
Then there's the question of whether the antidote is
available - and if so, in what quantities.
If the victims - whose writhing bodies and agonised faces
shocked the world when Syrian activists published pictures and
videos - did suffer a nerve agent attack, then atropine would be
the treatment of choice.
A generic medicine, it is used in anaesthesia as a
premedication, in emergency situations or during surgery to make
the heart beat faster, and to reverse the effects of poisons
that make people hyper-salivate, or foam at the mouth.
Troops at risk of chemical weapons attacks often carry
atropine auto-injectors to administer into thigh muscles.
Since it is a core medicine on the World Health
Organization's "Essential Drugs List" - a list of minimum
medical needs for any basic healthcare system - hospitals in
Syria should have it, but may not have enough to treat a large
number of people quickly.
"We have emergency (atropine) stockpiles here in the United
States that could be accessed in a short time - and most
industrialised countries would be the same," said Zilinskas.
In Syria, while most hospitals should have small amounts
when they are functioning properly, the fear now is that
supplies will be severely limited, and that any stockpiles are
most likely to be held by the military.
"The question is how quickly would the military share? How
quickly would they get it to victims?" said Zilinskas. "It
doesn't do much good if it arrives two or three hours later."
(Reporting by Kate Kelland; Editing by Will Waterman)