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Traumatized by war, hundreds of Lebanon’s children struggle with wounds both physical and emotional

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BEIRUT (AP) — Curled up in his father ’s lap, clinging to his chest, Hussein Mikdad cried his heart out. The 4-year-old kicked his doctor with his intact foot and pushed him away with the arm that was not in a cast. “My Dad! My Dad!” Hussein said. “Make him leave me alone!” With eyes tearing up in relief and pain, the father reassured his son and pulled him closer.

Hussein and his father, Hassan, are the only survivors of their family after an Israeli airstrike last month on their Beirut neighborhood. The strike killed 18 people, including his mother, three siblings and six relatives.

“Can he now shower?” the father asked the doctor.

Ten days after surgery, doctors examining Hussein’s wounds said the boy is healing properly. He has rods in his fractured right thigh and stitches that assembled his torn tendons back in place on the right arm. The pain has subsided, and Hussein should be able to walk again in two months — albeit with a lingering limp.

A prognosis for Hussein’s invisible wounds is much harder to give. He is back in diapers and has begun wetting his bed. He hardly speaks and has not said a word about his mother, two sisters and brother.

“The trauma is not just on the muscular skeletal aspect. But he is also mentally hurt,” Imad Nahle, one of Hussein’s orthopedic surgeons, said.

Israel said, without elaborating, that the strike on the Mikdad neighborhood struck a Hezbollah target. In the war that has escalated since September, Israeli airstrikes have increasingly hit residential areas around Lebanon. Israel accuses the Lebanese militant group of hiding its capabilities and fighters among civilians. It vows to cripple Hezbollah, which began firing into northern Israel after Hamas’ Oct. 7 attack triggered the war in Gaza.

But children have been caught in the midst.

With more strikes on homes and in residential areas, doctors are seeing more children affected by the violence. More than 100 children have been killed in Lebanon in the past six weeks and hundreds injured. And of the 14,000 wounded since last year, around 10% are children. Many have been left with severed limbs, burned bodies, and broken families — scars that could last for a lifetime.

Ghassan Abu Sittah, a renowned British-Palestinian surgeon who is also treating Hussein, sees that long road ahead. This is his worry: “It leaves us with a generation of physically wounded children, children who are psychologically and emotionally wounded.”

‘What do they want from us?’

At the American University of Beirut Medical Center, which is receiving limited cases of war casualties, Nahle said he operated on five children in the past five weeks — up from no cases before. Most were referred from south and eastern Lebanon.

A few miles away, at the Lebanese Hospital Geitaoui, one of the country’s largest burns centers increased its capacity by nearly 180% since September so it could accommodate more war wounded, its medical director Naji Abirached said. About a fifth of the newly admitted patients are children.

In one of the burn center’s ICU units lies Ivana Skakye. She turned 2 in the hospital ward last week. Ivana has been healing from burns she sustained following an Israeli airstrike outside their home in southern Lebanon on Sept. 23. Israel launched hundreds of airstrikes that day in different parts of Lebanon, making it the deadliest day of the war so far. More than 500 people were killed.

Six weeks later, the tiny Ivana remains wrapped in white gauze from head to toe except her torso. She sustained third-degree burns over 40 percent of her body. Her hair and head, her left side all the way to her legs, both her arms and her chest were burned. Her family home was damaged, its ceiling set afire. The family’s valuables, packed in their car as they prepared to leave, were also torched. Ivana’s older sister, Rahaf, 7, has recovered faster from burns to her face and hands.

Fatima Zayoun, their mother, was in the kitchen when the explosion hit. Zayoun jumped up to grab the girls, who were playing on the terrace.

It was, Zayoun said, “as if something lifted me up so that I can grab my kids. I have no idea how I managed to pull them in and throw them out of the window. She spoke from the ICU burns unit. “They were not on fire, but they were burned. Black ash covered them. … (Ivana) was without any hair. I told myself, `That is not her.’”

Now, Ivana’s wound dressings are changed every two days. Her doctor, Ziad Sleiman, said she could be discharged in a few days. She’s back again to saying “Mama” and “Bye — shorthand for wanting to go out.

Like Hussein, though, Ivana has no home to return to. Her parents fear collective shelters could cause an infection to return.

After seeing her kids “sizzling on the floor,” Zayoun, 35, said that even if their home is repaired, she wouldn’t want to return. “I saw death with my own eyes,” she said.

Zayoun was 17 last time Israel and Hezbollah were at war, in 2006. Displaced with her family then, she said she almost enjoyed the experience, riding out of their village in a truck full of their belongings, mixing with new people, learning new things. They returned home when the war was over.

“But this war is hard. They are hitting everywhere,” she said. “What do they want from us? Do they want to hurt our children? We are not what they are looking for.”

Attacks at home can be hard for kids to deal with

Abu Sittah, the reconstructive surgeon, said most of the children’s injuries are from blasts or collapsing rubble. That attack on a space they expect to be inviolable can have lingering effects.

“Children feel safe at home,” he said. “The injury makes them for the first time lose that sense of security — that their parents are keeping them safe, that their homes are invincible, and suddenly their homes become not so.”

One recent morning, children were playing in the courtyard of a vocational school-turned-shelter in Dekwaneh, north of Beirut, where nearly 3,000 people displaced from the south are now living. The parents were busy with an overflowing bathroom that serves one floor in a building that houses nearly 700 people.

Only playtime brings the children, from different villages in the south, together. They were divided in two teams, ages ranging between 6 and 12, competing to get the handkerchief first. A tiny girl hugged and held hands with strangers visiting the shelter. “I am from Lebanon. Don’t tell anyone,” she whispered in their ears.

The game turned rowdy when two girls in their early teens got into a fist fight. Pushing and shoving began. Tears and tantrums followed. The tiny girl walked away in a daze.

Maria Elizabeth Haddad, manager of the psychosocial support programs in Beirut and neighboring areas for the U.S.-based International Medical Corps, said parents in shelters reported signs of increased anxiety, hostility and aggression among kids. They talk back to parents and ignore rules. Some have developed speech impediments and clinginess. One is showing early signs of psychosis.

“There are going to be residual symptoms when they grow up, especially related to attachment ties, to feeling of security,” Haddad said. “It is a generational trauma. We have experienced it before with our parents. … They don’t have stability or search for (extra) stability. This is not going to be easy to overcome.”

New phases of life begin

Children represent more than a third of over 1 million people displaced by the war in Lebanon and following Israeli evacuation notices, according to U.N. and government estimates (more than 60,000 people have been displaced from northern Israel). That leaves hundreds of thousands in Lebanon without schooling, either because their schools were inaccessible or have been turned into shelters.

Hussein’s father says he and his son must start together from scratch. With help from relatives, the two have found a temporary shelter in a home — and, for the father, a brief sense of relief. “I thank God he is not asking for or about his mother and his siblings,” said Hassan Mikdad, the 40-year-old father.

He has no explanation for his son, who watched their family die in their home. His two sisters — Celine, 10, and Cila, 14 — were pulled out of the rubble the following day. His mother, Mona, was pulled out three days later. She was locked in an embrace with her 6-year-old son, Ali.

The strike on Oct. 21 also caused damage across the street, to one of Beirut’s main public hospitals, breaking solar panels and windows in the pharmacy and the dialysis unit. The father survived because he had stepped out for coffee. He watched his building crumble in the late-night airstrike. He also lost his shop, his motorcycles and car — all the evidence of his 16 years of family life.

His friend, Hussein Hammoudeh, arrived on the scene to help sift through rubble. Hammoudeh spotted young Hussein Mikdad’s fingers in the darkness in an alley behind their home. At first he thought they were severed limbs — until he heard the boy’s screams. He dug out Hussein with glass lodged in his leg and a metal bar in his shoulder. Hammoudeh said he didn’t recognize the boy. He held the child’s almost-severed wrist in place.

In the hospital now, Hussein Mikdad sipped a juice as he listened to his father and his friend. His father turned to him, asking if he wanted a Spider-Man toy — an effort to forestall a new outburst of tears. He said he buys Hussein a toy each day.

“What I am living through seems like a big lie. …The mind can’t comprehend,” he said. “I thank God for the blessing that is Hussein.”



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From transmission to symptoms, what to know about avian flu after B.C. case

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A B.C. teen has a suspected case of H5N1 avian flu — the first known human to acquire the virusin Canada.

The provincial government said on the weekend that B.C.’s chief veterinarian and public health teamsare still investigating the source of exposure, but that it’s “very likely” an animal or bird.

Human-to-human transmission is very rare, but as cases among animals rise, many experts are worried the virus could develop that ability.

The teen was being treated at BC Children’s Hospital on Saturday. The provincial health officer said there were no updates on the patient Monday.

“I’m very concerned, obviously, for the young person who was infected,” said Dr. Matthew Miller, director of the Michael G. DeGroote Institute for Infectious Disease Research at McMaster University in Hamilton, Ont.

Miller, who is also the co-director of the Canadian Pandemic Preparedness Hub, said there have been several people infected with H5N1 in the U.S.,and almost all were livestock workers.

In an email to The Canadian Press on Monday afternoon, the Public Health Agency of Canada said “based on current evidence in Canada, the risk to the general public remains low at this time.”

WHAT IS H5N1?

H5N1 is a subtype of influenza A virus that has mainly affected birds, so it’s also called “bird flu” or “avian flu.” The H5N1 flu that has been circulating widely among birds and cattle this year is one of the avian flu strains known as Highly Pathogenic Avian Influenza (HPAI) because it causes severe illness in birds, including poultry.

According to the World Health Organization, H5N1 has been circulating widely among wild birds and poultry for more than two decades. The WHO became increasingly concerned and called for more disease surveillance in Feb. 2023 after worldwide reports of the virus spilling over into mammals.

HOW COMMON IS INFECTION IN HUMANS?

H5N1 infections in humans are rare and “primarily acquired through direct contact with infected poultry or contaminated environments,” the WHO’s website says.

Prior to the teen in B.C., Canada had one human case of H5N1 in 2014 and it was “travel-related,” according to the Public Health Agency of Canada.

As of Nov. 8, there have been 46 confirmed human cases of H5N1 in the U.S. this year, the Centers for Disease Control and Prevention says. There is an ongoing outbreak among dairy cattle, “sporadic” outbreaks in poultry farms and “widespread” cases in wild birds, the CDC website says.

There has been no sign of human-to-human transmission in any of the U.S. cases.

But infectious disease and public health experts are worried that the more H5N1 spreads between different types of animals, the bigger the chance it can mutateand spread more easily between humans.

WHAT ARE THE SYMPTOMS OF H5N1?

Although H5N1 causes symptoms similar to seasonal flu, such as cough, fever, shortness of breath, headache, muscle pain, sore throat, runny nose and fatigue, the strain also has key features that can cause other symptoms.

Unlike seasonal flu, most of the people infected in the U.S. have had conjunctivitis, or “pink-eye,” said Miller.

One reason for that is likely that many have been dairy cattle workers.

“At these milking operations, it’s easy to get contamination on your hands and rub your eyes. We touch our face like all the time without even knowing it,” he said.

“Also, those operations can produce droplets or aerosols, both during milking and during cleaning that can get into the eye relatively easily.”

But the other reason for the conjunctivitis seen in H5N1 cases is that the strain binds to receptors in the eye, Miller said.

While seasonal flu binds to receptors in the upper respiratory tract, H5N1 also binds to receptors in the lower respiratory tract, he said.

“That’s a concern … because if the virus makes its way down there, those lower respiratory infections tend to be a lot more severe. They tend to lead to more severe outcomes, like pneumonias for example, that can cause respiratory distress,” Miller said.

WILL THE FLU VACCINE PROTECT AGAINST H5N1?

We don’t know “with any degree of certainty,” whether the seasonal flu vaccine could help prevent infection with H5N1, said Miller.

Although there’s no data yet, it’s quite possible that it could help prevent more severe disease once a person is infected, he said.

That’s because the seasonal flu vaccine contains a component of H1N1 virus, which “is relatively closely related to H5N1.”

“So the immunity that might help protect people against H5N1 is almost certainly conferred by either prior infection with or prior vaccination against H1N1 viruses that circulate in people,” Miller said.

HOW ELSE CAN I PROTECT MYSELF?

The Public Health Agency of Canada said as a general precaution, people shouldn’t handle live or dead wild birds or other wild animals, and keep pets away from sick or dead animals.

Those who work with animals or in animal-contaminated places should take personal protective measures, the agency said.

This report by The Canadian Press was first published Nov. 11, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.



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Wisconsin Supreme Court grapples with whether state’s 175-year-old abortion ban is valid

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MADISON, Wis. (AP) — A conservative prosecutor’s attorney struggled Monday to persuade the Wisconsin Supreme Court to reactivate the state’s 175-year-old abortion ban, drawing a tongue-lashing from two of the court’s liberal justices during oral arguments.

Sheboygan County’s Republican district attorney, Joel Urmanski, has asked the high court to overturn a Dane County judge’s ruling last year that invalidated the ban. A ruling isn’t expected for weeks but abortion advocates almost certainly will win the case given that liberal justices control the court. One of them, Janet Protasiewicz, remarked on the campaign trail that she supports abortion rights.

Monday’s two-hour session amounted to little more than political theater. Liberal Justice Rebecca Dallet told Urmanski’s attorney, Matthew Thome, that the ban was passed in 1849 by white men who held all the power and that he was ignoring everything that has happened since. Jill Karofsky, another liberal justice, pointed out that the ban provides no exceptions for rape or incest and that reactivation could result in doctors withholding medical care. She told Thome that he was essentially asking the court to sign a “death warrant” for women and children in Wisconsin.

“This is the world gone mad,” Karofsky said.

The ban stood until 1973, when the U.S. Supreme Court’s landmark Roe v. Wade decision legalizing abortion nationwide nullified it. Legislators never repealed the ban, however, and conservatives have argued the Supreme Court’s decision to overturn Roe two years ago reactivated it.

Democratic Attorney General Josh Kaul filed a lawsuit challenging the law in 2022. He argued that a 1985 Wisconsin law that prohibits abortion after a fetus reaches the point where it can survive outside the womb supersedes the ban. Some babies can survive with medical help after 21 weeks of gestation.

Urmanski contends that the ban was never repealed and that it can co-exist with the 1985 law because that law didn’t legalize abortion at any point. Other modern-day abortion restrictions also don’t legalize the practice, he argues.

Dane County Circuit Judge Diane Schlipper ruled last year that the ban outlaws feticide — which she defined as the killing of a fetus without the mother’s consent — but not consensual abortions. The ruling emboldened Planned Parenthood to resume offering abortions in Wisconsin after halting procedures after Roe was overturned.

Urmanski asked the state Supreme Court in February to overturn Schlipper’s ruling without waiting for a lower appellate decision.

Thome told the justices on Monday that he wasn’t arguing about the implications of reactivating the ban. He maintained that the legal theory that new laws implicitly repeal old ones is shaky. He also contended that the ban and the newer abortion restrictions can overlap just like laws establishing different penalties for the same crime. A ruling that the 1985 law effectively repealed the ban would be “anti-democratic,” Thome added.

“It’s a statute this Legislature has not repealed and you’re saying, no, you actually repealed it,” he said.

Dallet shot back that disregarding laws passed over the last 40 years to go back to 1849 would be undemocratic.

Planned Parenthood of Wisconsin filed a separate lawsuit in February asking the state Supreme Court to rule directly on whether a constitutional right to abortion exists in the state. The justices have agreed to take the case but haven’t scheduled oral arguments yet.

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This story has been updated to correct the Sheboygan County district attorney’s first name to Joel.

The Canadian Press. All rights reserved.



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When to catch the last supermoon of the year

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CAPE CANAVERAL, Fla. (AP) — Better catch this week’s supermoon. It will be a while until the next one.

This will be the year’s fourth and final supermoon, looking bigger and brighter than usual as it comes within about 225,000 miles (361,867 kilometers) of Earth on Thursday. It won’t reach its full lunar phase until Friday.

The supermoon rises after the peak of the Taurid meteor shower and before the Leonids are most active.

Last month’s supermoon was 2,800 miles (4,500 kilometers) closer, making it the year’s closest. The series started in August.

In 2025, expect three supermoons beginning in October.

What makes a moon so super?

More a popular term than a scientific one, a supermoon occurs when a full lunar phase syncs up with an especially close swing around Earth. This usually happens only three or four times a year and consecutively, given the moon’s constantly shifting, oval-shaped orbit.

A supermoon obviously isn’t bigger, but it can appear that way, although scientists say the difference can be barely perceptible.

How do supermoons compare?

This year features a quartet of supermoons.

The one in August was 224,917 miles (361,970 kilometers) away. September’s was 222,131 miles (357,486 kilometers) away. A partial lunar eclipse also unfolded that night, visible in much of the Americas, Africa and Europe as Earth’s shadow fell on the moon, resembling a small bite.

October’s supermoon was the year’s closest at 222,055 miles (357,364 kilometers) from Earth. This month’s supermoon will make its closest approach on Thursday with the full lunar phase the next day.

What’s in it for me?

Scientists point out that only the keenest observers can discern the subtle differences. It’s easier to detect the change in brightness — a supermoon can be 30% brighter than average.

With the U.S. and other countries ramping up lunar exploration with landers and eventually astronauts, the moon beckons brighter than ever.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.



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