Israel keeps its promise of a 'Holocaust' in Gaza

'Barbarous' siege

The Gaza Strip, with a population of some 1.5 million, has been placed under a total siege by the Israeli army since June 2007, shortly after Hamas took control over the strip from Fatah. Later that year, in September, the Israeli government declared Gaza a "hostile entity" and stepped up its military attacks. In January 2008, Israel decided to further reduce the amount of fuel, electricity, food and water supplies into Gaza, justifying the collective punishment as a 'response' to the Palestinian resistance firing home-made shells at the nearby Israeli town of Sderot (see this report about the humanitarian implications of the siege).

The decision by the Israeli government to reduce electricity supplies to the Gaza Strip came after the Israeli Supreme Court rejected a petition against the plan filed by ten Palestinian and Israeli human rights groups. The human rights groups said the measures "violate international laws" as they deliberately cause harm to the civilians and deprive them from the basic energy they need to run vital services. The cut of diesel supplies had already contributed to 20% electricity deficit in Gaza, with power outages of over eight hours a day and directly affecting hospitals, medical centres, water pumps, public transportation and other vital services.

On February 17th, the ambulance service in Gaza announced a complete halt of work due to what the Health Ministry described as "severe shortage of fuel." Many patients have also been denied necessary medical treatment outside due to the siege, in what some described as "a matter of revenge". According to Palestinian medical sources, well over a hundred Palestinian patients, including many children, have so far died because of the siege [ 1 2 3 ].

As Gazans scrambled for supplies, Palestinian resistance fighters blew open the Israeli-built steel walls that make the borders between the Gaza Strip and Egypt on January 23rd. Hundreds of thousands of Palestinians poured into Egypt's Sinai peninsula, breathing a collective sigh of relief following a half-year of total closure of all Gaza border crossings. However, the Egyptian border guards soon started sealing off the iron border again. The Rafah crossing, south of Gaza, is the sole outlet to the outside world for Gaza's 1.5 million residents since June last year.

On February 20th, several European Union lawmakers urged Israel to refrain from inflicting "collective punishment" on the Palestinian residents in the Gaza Strip. In a press conference titled "Coming back from Gaza and Sderot", with the participation of members from different political groups of the European Parliament who took part to the fact-finding mission to Israel and Palestine between 2 and 7 February, 2008, Jill Evans MEP (Green) affirmed that "the situation in Palestine is reaching breaking point. The siege is an inhuman and illegal collective punishment of the people in Gaza and is causing huge suffering. It has to be stopped. There has to be international action to lift the siege, end the occupation and resume peace negotiations."

Concluding a visit to Palestine and Israel, the United Nations' Undersecretary General for humanitarian affairs John Holmes made similar remarks and called for reopening the borders of the Gaza Strip in order to relief the suffering of the residents.

Earlier that year, a report authored by the UN Special Rapporteur John Dugard concluded that "Palestinian terrorism" is the "inevitable consequence" of Israeli occupation. While "Palestinian terrorist acts are deplorable," it added, "they must be understood as being a painful but inevitable consequence of colonialism, apartheid or occupation."

On February 26th, just before the escalation started, the report was briefly flagged up by Associated Press. Israel was quick to reject the 'claims' as "inflammatory" and the report has since been ignored by the Western corporate media in a continuation of their biased reporting on the Israeli aggression against Palestinians (see this MediaLens alert).

'Holocaust' in Gaza

On February 29th, the Israeli deputy Defense Minister provoked outrage after threatening Palestinians with a "holocaust". Matan Vilnai told the Israeli army radio that "the more [rocket] fire intensifies and the rockets reach a longer range, they [the Palestinians] will bring upon themselves a bigger holocaust because we will use all our might to defend ourselves." The same twisted logic is used by the far-right and Holocaust deniers to blame Jewish people for the Nazi Holocaust.

However, preparations for a large-scale invasion of the Gaza Strip seem to have been under way long before that provocative comment. The Israeli government had reportedly already approved a military plan, similar to the US invasion of Iraq in 2003. According to the Jewish Press website, Israeli sources said that a plan, drafted by the Israeli military's general staff, had been endorsed by the Israeli defense minister Ehud Barak.

On February 7th, during a visit to an Israeli military base in the south of Israel, Barak said the Israeli army will "intensify its military operations" in the Gaza Strip, allegedly to stop Palestinian home-made Qassam rockets that continue to be launched from Gaza at Israeli targets. He added that Israel will eventually "put an end" to the attacks by continuing its military operation and imposing punishments and fortifying the nearby Israeli communities surrounding the Gaza Strip. On February 10th, the Defense Minister confirmed that his army will carry out more strikes on Gaza.

Meanwhile, another Israeli minister called for the "total annihilation" of some Gaza neighbourhoods. Me'air Shetrit called for responding to what he termed "sabotaging operations" by "totally annihilating some Gaza neighbourhoods" so that "the residents of the Gaza Strip will understand how serious the Israeli threats are." Other Israeli politicians have made similar comments.

On February 11th, Barak stated that he had ordered the Israeli army to start preparing for the wide-scale offensive in Gaza. He told the Knesset's Foreign Affairs and Security Committee that his troops are "attacking the Palestinian coastal region day and night, with a high chance for those attacks to expand." On February 17th, he again vowed to strike back heavily against Palestinians, particularly the ruling Hamas in Gaza, as home-made shells continue to hit Israeli areas adjacent to Gaza. At the same time, Israeli prime minister Ehud Olmert, while giving a speech at a conference of Jewish agencies leaders, granted the Israeli army the "upper hand" in deciding how to strike what he called "perpetrators of terror", first and foremost those who belong to Hamas.

Since coming to power after the 2006 democratic elections, the Islamist group has repeatedly proposed a long-term truce with Israel. Israel, however, has repeatedly shunned such offers, branding Hamas a "terrorist group". In June 2007, Israel imposed a total siege on Gaza after Hamas took over the coastal territory, amidst a power struggle with Fatah, president Mahmud Abbas's party, which has been committed to 'peace negotiations' with Israel (see this interesting Vanity Fair article).

Last year, after killing more than 300 Palestinians in the Gaza Strip in air strikes and ground offensives, Israel still failed to stop the home-made shells fired by Palestinian fighters into adjacent Israeli towns.

'Full-scale war'

Since the siege started in June 2007, Israeli air strikes and ground incursions, allegedly targeting Palestinian militants, have become an almost daily occurrence, often killing civilians and destroying residential buildings.

For example, on February 7th, Palestinian medical sources reported that six Palestinians, including one teacher, were killed and several residents were injured in three separate Israeli air strikes that were supposed to target groups of Palestinian militants in different areas in the Gaza Strip. On February 15th, eight Palestinians, mainly members of one family, were killed and nearly eighty others injured when the Israeli air force fired missiles at the house of one of the leaders of the Islamic Jihad in Al-Boreij refugee camp in central Gaza. (Many more incidents can be found on the IMEMC, PNN and IE websites.)

On February 14th, an undercover Israeli force attacked several Palestinian homes in the eastern side of Rafah, southern Gaza, and rounded up 30 men, aged between 15 and 50, and took them to a nearby military base at the Rafah-Israel border. The area located near the Gaza International Airport has suffered frequent Israeli attacks since the beginning of the Palestinian Intifada (uprising) in September 2000.

On Wednesday, 27 February, 2008, the Israeli army stepped up its air strikes and ground 'incursions' in what many observers described as a "full-scale, one-sided war". According to the Israeli Information Center for Human Rights in the Occupied Territories (B’Tselem), 106 Palestinians were killed in the Gaza Strip between February 27th and March 3rd, and at least 54 of them, including 25 children, did not take part in any fighting. Al-Mezan Center For Human Rights put the number at 107, including 55 civilians, of whom 27 were children and 6 women. The Israeli Chief of Staff had claimed that 90 percent of those killed were "armed".

On Wednesday evening, an Israeli strike on the northern part of Gaza killed three Palestinian children, bringing the death toll within 24 hours to 12. Palestinian medical sources confirmed that the three children's bodies reached hospital dismembered, while at least 17 others were wounded, including 6 children. By Friday, the Israeli government announced that its army has completed preparations for a wide-scale offensive against Gaza (more).

Around 1am on Saturday, at least 30 tanks and bulldozers, supported by a battalion of infantry troops attacked the Jabalyia refugee camp in the northern part of the Gaza Strip. Palestinian medical sources reported that at least 26 Palestinians killed and 62 injured, bringing the death toll since Wednesday to 56. Eyewitnesses said Israeli troops and tanks invaded Jabalyia and opened fire at resident homes, while Israeli helicopters were firing missiles at civilians homes and cars (more).

Even civilian facilities, such as medical centres, were not spared. On February 28th, for example, an Israeli air strike aimed at the Ministry of the Interior building in Gaza also destroyed the nearby Palestinian Medical Relief Society (PMRS) head office. PMRS is one of the largest non-governmental health service providers in Palestine, reaching 1.4 million Palestinians in over 490 cities, towns and villages. The attack also hit a nearby residential building, killing a five-month-old baby. The The disability rehabilitation sector in Palestine, part of the Network of the Non-governmental Organizations, also reported that the Israeli army had targeted several facilities that deal with rehabilitation and killed Hammad Mirshid, 47, who suffered a hearing impairment. The army also broke into a rehabilitation facility, causing a lot of damage, and used it as a military post.

By now, the war in Gaza had attracted the international community and media's attention. The Palestinian Ministry of Health announced that some hospitals in Gaza could no longer provide medical care because they have no electricity or medical supplies. Medical crews reported that they came under fire as they tried to evacuate the injured from Jabalyia refugee camp. The Al-Jazeera Arabic correspondent in the Gaza Strip, Hiba Abu Shamalih, also reported that she came under fire along with her camera crew as they were covering the events in Gaza. The Palestinian President Mahmoud Abbas said on Saturday that the ongoing Israeli attacks on Gaza were "more than a holocaust."

Meanwhile, the Israeli army announced that Palestinian militants killed two Israeli soldiers and destroyed a military vehicle on Saturday. Palestinian resistance groups also fired 13 home-made shells at nearby Israeli areas, injuring three civilians in the southern Israeli town of Sderot that borders the Gaza Strip. The Al-Qassam brigades, the armed wing of the Hamas movement, said that 8 of its fighters were killed on Saturday during armed clashes with the Israeli army. The Al-Quds brigades of the Islamic Jihad also said that three of their fighters were killed in clashes on that same day.

'Not over'

Israeli forces pulled out on Sunday-Monday overnight after five days of bloodshed. But Israeli Prime Minister Ehud Olmert warned that the withdrawal of troops from Gaza does not mean Israel's military operation there is over, adding that "what happened in recent days was not a one-off event."

Indeed, just after the Israeli army announced ending its offensive in the Gaza Strip, Palestinian medical sources reported that 8 Palestinians, said to be Hamas fighters, were killed by Israeli shells on different parts of Gaza on Monday dawn (more).

Later on, a senior Israeli official, quoted by Reuters, said Israel had called a "two-day interval" while US Secretary of State Condoleezza Rice visits Jerusalem and the West Bank on Tuesday and Wednesday, which is meant to move Israeli-Palestinian peace negotiations forward. Rice, however, has already told reporters in Egypt that Hamas is "trying to destroy the peace talks." Hamas's spokesperson, Sami Abu Zuhri, said Rice's statement was part of her intention to "give the green light" to the ongoing war on the Hamas movement and the Palestinian resistance. Palestinian president Mahmud Abbas had formally suspended contacts with Israel in protest at its attacks on Gaza.

Protests and solidarity

Since the start of the siege in June 2007, there have been many mass protests inside Palestine and Gaza itself. A massive demonstration was held at the Erez Checkpoint in Beit Hanoun, north Gaza, on January 26th, where people assembled on both sides of the fence to protest against the siege and the humanitarian crisis in Gaza. On February 11th, flower farmers in the city of Beit Lahiya, north Gaza, decided to destroy about 500,000 square meters of flower plants in protest at their inability to export their produce due to ongoing Israeli blockade on Gaza. On February 14th, a large number of Gaza vehicles stopped engines for half an hour in protest at the continued Israel cut of fuel supplies to the region. On February 25th, thousands of women, children and men formed a human chain around the Gaza Strip in protest at the Israeli siege (more). Peaceful demonstrations also took place in Bethlehem, Nazareth and other places in Palestine and Israel.

Many defiant actions by Israeli activists have also been reported. For example, a convoy of food supplies, provided by a group of Israeli peace activists, entered Gaza on February 19th through the Israeli-controlled commercial crossing of Sufa in southern Gaza.

More recently, the entirety of the West Bank was on strike on Sunday, February 2nd, in solidarity with the mourners and lost souls of the Gaza Strip. The streets of Jenin and Nablus were filled with protesters, while in Ramallah Hamas and Fateh called a joint demonstration. Kids were seen at the Wall in Ramallah throwing stones, and the same happened in Bethlehem at Rachel's Tomb. The air was said to have been full of acrid smoke as children set tires on fire and dumped out garbage cans and set them ablaze (report).

Palestinian protests were often violently attacked by Israeli forces. Seven Palestinian teenagers were injured on February 2nd when Israeli troops attacked a demonstration organised by the villagers of Bil'in, a village near Ramallah known internationally for its non-violent protests (more). On the same day, one Palestinian boy was killed and at least 45 were injured when the Israeli army attacked protests standing in Hebron, south West Bank, in solidarity with the people of Gaza. On February 3rd, Israeli forces imposed a curfew on a western Jenin village, which saw a non-violent demonstration against the Israeli aggression in Gaza. A Palestinian teenager was killed and several others injured on the same day when Israeli army troops attacked a protest organised by school students in the village of Al-Mazra'a Al-Sarqiya, near Ramallah.

Since the start of the siege, there have also been numerous solidarity demonstrations and actions throughout the world. To list only a few of those reported on Indymedia sites worldwide, the past few months have seen protests in Israel, Portland, Washington DC, St. Petersburg (FL), Seattle, Berkeley, Dublin [2], The Hague, Berlin, London [2 3 4 5] , Manchester, Sheffield [2], Wales and elsewhere.

Called by the Popular Committee Against the Siege (PCAS), February 23rd saw a global day of action against the Israeli blockade on Gaza. Mass demonstrations and protests took place in around 30 countries across Europe, Asia, Africa and the two Americas. In many cities, lights also went off for half an hour in solidarity with the people of Gaza (see also the End Gaza Siege website). As the chairman of the Gaza Committee Jamal al-Khudari put it: "The demonstrations we saw on TV screens in many countries indicate a genuine support for the Palestinian people."

Afghan mothers give children opium

Afghanistan is the world’s leading producer of opium. Villagers in remote areas of Badakhshan Province, north-eastern Afghanistan, have been using opium as a substitute for medicine for years. They are oblivious to the harm it can do to their health.

There is no official data about the number of drug addicts in Badakhshan. However, the United Nations Office for Drugs and Crimes (UNODC) says one million people are addicted to drugs there, 45,000 of whom are women.

This video short shows a women’s opium smoking session in the village of Jukhan, tucked away in mountainous Badakhshan. While efforts are being made to rehabilitate drug addicts in the village, Bibi Mulla, her relatives and friends smoke opium at home and give it to their children up to three times a day.

Obama, Clinton battle for LGBT vote

Hillary Clinton holds conference calls to reporters on LGBT papers in Ohio and Texas where Barack Obama bought ads as the race enters its critical days.

Even as Sen. Barack Obama's campaign finalized an ad buy for four full-page ads in local gay weeklies in Ohio and Texas, Sen. Hillary Clinton was conducting a conference call on LGBT issues and answering the questions of local reporters from the Dallas Voice, Outlook Weekly and Gay People's Chronicle. Altogether, Clinton has done interviews with six LGBT outlets, including The Advocate, Logo and The Washington Blade.

Obama has given one interview to an LGBT news outlet, in October to The Advocate. On Thursday, he published an open letter to the LGBT community on the blog Bilerico Project, the second such post he has made to that site.

Obama makes gay ad buys in Ohio, Texas

Full-page ads are set for Friday in four queer papers as the campaign lavishes some of its cash advantages on LGBTs in the days before critical March 4 primaries.

The Obama campaign is lavishing some of its cash advantage on the LGBT community with targeted ad buys in Ohio and Texas leading up to the critical March 4 primaries in both states (Rhode Island and Vermont also vote that day).

According to Eric Stern, a member of the Obama LGBT steering committee, the campaign has just completed an ad buy with queer newspapers in the four largest LGBT markets of those two states -- Columbus, Cleveland, Dallas and Houston.

Full-page ads will appear starting Friday in Outlook Weekly of Columbus, the Gay People's Chronicle of Cleveland, the Dallas Voice and OutSmart, which is based in Houston. Buying a full-page, four-color ad that appears one time typically costs anywhere between $1,000 and $2,000 in weekly publications. In the Gay People's Chronicle, for instance, the ad cost about $850, according to the paper's advertising manager; the same ad went for about $1,500 in the Dallas Voice.

Stern called the coordinated buy "the icing on the cake" in terms of the Obama camp's outreach to the gay community in Ohio and Texas.

"It's a direct appeal to LGBT voters asking for their support," he said, adding that the ad includes information about how people can get involved with the campaign.

The Obama campaign has actively been trying to cut into the long-standing ties between gay men and lesbians and Hillary Clinton. Stern paraphrased the message of the ad as a "call for the country to come together and unify around creating national progress toward equality for LGBT Americans."

(Kerry Eleveld, The Advocate)

Gay Travels in the Muslim World

Michael T Luongo

Homosexuality doesn't officially exist in Muslim countries. These stories beg to differ

Like many Westerners, my knowledge of the Muslim world is limited. My only direct experience is of visiting Dubai, where homosexuality is illegal and homophobia is rife. I can't say it's a place I'd revisit in a hurry. Like everyone else, I've the heard the horror stories emanating from Iran and Saudi Arabia. So I must confess that my first thought when faced with a book called Gay Travels in the Muslim World was "Why?". Why travel to places where attitudes towards homosexuality are still stuck in the dark ages? Why pay your pink pounds into enconomies where gay rights aren't recognised? Why risk discrimination and worse in countries where gay men and women are locked up, publicly hanged or flogged to death? Why not go somewhere else instead?

The reailty, of course, is that what we commonly refer to as "the Muslim world" isn't monolithic. As this collection of true-life stories shows, there are many ways to be a Muslim. Editor Michael T Luongo was prompted to put this book together after calling for submissions for an earlier book, Between the Palms, and being surprised at the number of stories involving gay men's travels in the Middle East and experiences with Muslim men who had migrated to other countries. So there's the story of a nice Jewish boy who settles down in Mauritania, West Africa, and enjoys sex with local men, none of whom identifies as gay. There's the man in Bangladesh who takes a tour of the local cruising spots and discovers a world of prostitution and rooms rented for less than a dollar an hour. There's the editor himself in Afghanistan, where he's surprised to learn that, even under the Taliban, gay wedding ceremonies were taking place in Kandahar. And there's the gay soldier's tour of duty in Iraq, and touching encounter with a man he calls "The Gay Iraqi".

Luongo would probably take issue with the idea of a "gay Iraqi". In his introduction, he stresses that "a tremendous difference exists between how homosexuality is expressed in the Western world and the Islamic world... To simplify a very complex issue, in Europe and America and places under Western influence, homosexual desire and acts become the very definition of a person, they create an identity that separates him or her from the rest of society.

In much of the Islamic world, homosexual desire and acts are simply one aspect among others, something people do but not something that defines a person above all other traits". I must say I'm not entirely convinced by this argument. People who identify as gay are not necessarily guilty of separating themselves from the rest of society, any more than people who are Muslim are automatically guilty of separating themselves from those who are not. Many gay people are happily integrated with their heterosexual friends and family, just as many Muslims are integrated with the wider communities in which they live. And in cities like London at least, there are men and women who are both Muslim and openly gay.

Among the most cheering sights at Gay Pride recently were the gay Muslims with a banner proclaiming "Allah Doesn't Make Mistakes". On the other hand, there are large numbers of people in Europe and America who regularly have homosexual sex but do not identify as gay, either because they're genuinely bisexual or, more often, because they're riddled with guilt and have internalised homophobia. The refusal of a gay identity isn't an expression of free choice but a symptom of oppression. I dare say a similar thing occurs in countries more repressive than ours, where Pride marches are outlawed and homosexuality is so taboo that its very existence is denied. It was only a few months ago that Iran's President Mahmoud Ahmadinejad declared to the audience at a university in New York: "In Iran we don't have homosexuals like you do in your country." And maybe they don't. Maybe they have homosexuals who are far too terrified of ever coming out the American way, and who choose to see themselves as "men who have sex with men" because, quite frankly, it's their only chance of survival.

But survive they do, and their tales make illuminating reading. This book hasn't prompted me to change my holiday plans, but it has made me think seriously about what it means to be gay and Muslim. And that, surely, is a step in the right direction.

Pentagon Charges Sept. 11 Suspects

The Pentagon has charged six detainees at Guantanamo Bay with murder and war crimes in connection with the Sept. 11 terror attacks, and officials said Monday the United States will seek the death penalty.

Brig. Gen. Thomas W. Hartmann said the charges lay out a long-term sophisticated plan by the al-Qaida terrorist network to attack the United States of America. The attack over six years ago killed nearly 3,000 people.

Hartmann, the legal adviser to the U.S. military tribunal system, said the six include Khalid Sheik Mohammed, the suspected mastermind of the attacks, in which hijacked planes were flown into buildings in New York and Washington. Another hijacked plane crashed in the fields of western Pennsylvania.

The military will recommend that the six men be tried together before a military tribunal. But the cases may be clouded because of recent revelations that Mohammmed was subject to a harsh interrogation technique known as waterboarding -- which critics call torture.

Asked what impact that will have on the case, Hartmann said it will be up to the military judge to determine what evidence is allowed.

Prosecutors have been working for years to assemble the case against suspects in the attacks that prompted the Bush administration to launch its global war on terror.

The other five men being charged are: Mohammed al-Qahtani, the man officials have labeled the 20th hijacker; Ramzi Binalshibh, said to have been the main intermediary between the hijackers and leaders of Al Qaeda; Ali Abd al-Aziz Ali, known as Ammar al-Baluchi, a nephew of Khalid Sheikh Mohammed, who has been identified as Mohammed's lieutenant for the 2001 operation; al-Baluchi's assistant, Mustafa Ahmad al-Hawsawi; and Waleed bin Attash, a detainee known as Khallad, who investigators say selected and trained some of the hijackers.

How does it feel to die?

Anna Gosline is a science writer in Vancouver, Canada

IS IT distressing to experience consciousness slipping away or something people can accept with equanimity? Are there any surprises in store as our existence draws to a close? These are questions that have plagued philosophers and scientists for centuries, and chances are you've pondered them too occasionally.

None of us can know the answers for sure until our own time comes, but the few individuals who have their brush with death interrupted by a last-minute reprieve can offer some intriguing insights. Advances in medical science, too, have led to a better understanding of what goes on as the body gives up the ghost.

Death comes in many guises, but one way or another it is usually a lack of oxygen to the brain that delivers the coup de grâce. Whether as a result of a heart attack, drowning or suffocation, for example, people ultimately die because their neurons are deprived of oxygen, leading to cessation of electrical activity in the brain - the modern definition of biological death.

If the flow of freshly oxygenated blood to the brain is stopped, through whatever mechanism, people tend to have about 10 seconds before losing consciousness. They may take many more minutes to die, though, with the exact mode of death affecting the subtleties of the final experience. If you can take the grisly details, read on for a brief guide to the many and varied ways death can suddenly strike.

Drowning

The "surface struggle" for breath

Death by drowning has a certain dark romance to it: countless literary heroines have met their end slipping beneath the waves with billowy layers of petticoats floating around their heads. In reality, suffocating to death in water is neither pretty nor painless, though it can be surprisingly swift.

Just how fast people drown depends on several factors, including swimming ability and water temperature. In the UK, where the water is generally cold, 55 per cent of open-water drownings occur within 3 metres of safety. Two-thirds of victims are good swimmers, suggesting that people can get into difficulties within seconds, says Mike Tipton, a physiologist and expert in marine survival at the University of Portsmouth in the UK.

Typically, when a victim realises that they cannot keep their head above water they tend to panic, leading to the classic "surface struggle". They gasp for air at the surface and hold their breath as they bob beneath, says Tipton. Struggling to breathe, they can't call for help. Their bodies are upright, arms weakly grasping, as if trying to climb a non-existent ladder from the sea. Studies with New York lifeguards in the 1950s and 1960s found that this stage lasts just 20 to 60 seconds.

When victims eventually submerge, they hold their breath for as long as possible, typically 30 to 90 seconds. After that, they inhale some water, splutter, cough and inhale more. Water in the lungs blocks gas exchange in delicate tissues, while inhaling water also triggers the airway to seal shut - a reflex called a laryngospasm. "There is a feeling of tearing and a burning sensation in the chest as water goes down into the airway. Then that sort of slips into a feeling of calmness and tranquility," says Tipton, describing reports from survivors.

That calmness represents the beginnings of the loss of consciousness from oxygen deprivation, which eventually results in the heart stopping and brain death.

Heart attack

One of the most common forms of exit

The "Hollywood Heart Attack", featuring sudden pain, desperate chest-clutching and immediate collapse, certainly happens in a few cases. But a typical "myocardial infarction", as medical-speak has it, is a lot less dramatic and comes on slowly, beginning with mild discomfort.

The most common symptom is, of course, chest pain: a tightness, pressure or squeezing, often described as an "elephant on my chest", which may be lasting or come and go. This is the heart muscle struggling and dying from oxygen deprivation. Pain can radiate to the jaw, throat, back, belly and arms. Other signs and symptoms include shortness of breath, nausea and cold sweats.

Most victims delay before seeking assistance, waiting an average of 2 to 6 hours. Women are the worst, probably because they are more likely to experience less well-known symptoms, such as breathlessness, back or jaw pain, or nausea, says JoAnn Manson, an epidemiologist at Harvard Medical School. Survivors say they just didn't want to make a fuss; that it felt more like indigestion, tiredness or muscle cramps than a heart attack. Then again, some victims are just in denial.

Delay costs lives. Most people who die from heart attacks do so before reaching hospital. The actual cause of death is often heart arrhythmia - disruption of the normal heart rhythm, in other words.

Even small heart attacks can play havoc with the electrical impulses that control heart muscle contraction, effectively stopping it. In about 10 seconds the person loses consciousness, and minutes later they are dead.

Patients who make it to hospital quickly fare much better; in the UK and US more than 85 per cent of heart attack patients admitted to hospital survive to 30 days. Hospitals can deploy defibrillators to shock the heart back into rhythm, and clot-busting drugs and artery-clearing surgery.

Bleeding to death

Several stages of haemorrhagic shock

The speed of exsanguination, as bleeding to death is known, depends on the source of the bleed, says John Kortbeek at the University of Calgary in Alberta, Canada, and chair of Advanced Trauma Life Support for the American College of Surgeons. People can bleed to death in seconds if the aorta, the major blood vessel leading from the heart, is completely severed, for example, after a severe fall or car accident.

Death could creep up much more slowly if a smaller vein or artery is nicked - even taking hours. Such victims would experience several stages of haemorrhagic shock. The average adult has 5 litres of blood. Losses of around 750 millilitres generally cause few symptoms. Anyone losing 1.5 litres - either through an external wound or internal bleeding - feels weak, thirsty and anxious, and would be breathing fast. By 2 litres, people experience dizziness, confusion and then eventual unconsciousness.

"Survivors of haemorrhagic shock describe many different experiences, ranging from fear to relative calm," Kortbeek says. "In large part this would depend on what and how extensive the associated injuries were. A single penetrating wound to the femoral artery in the leg might be less painful than multiple fractures sustained in a motor vehicle crash."

Fire

It's usually the toxic gases that prove lethal

Long the fate of witches and heretics, burning to death is torture. Hot smoke and flames singe eyebrows and hair and burn the throat and airways, making it hard to breathe. Burns inflict immediate and intense pain through stimulation of the nociceptors - the pain nerves in the skin. To make matters worse, burns also trigger a rapid inflammatory response, which boosts sensitivity to pain in the injured tissues and surrounding areas.

As burn intensities progress, some feeling is lost but not much, says David Herndon, a burns-care specialist at University of Texas Medical Branch in Galveston. "Third-degree burns do not hurt as much as second-degree wounds, as superficial nerves are destroyed. But the difference is semantic; large burns are horrifically painful in any instance."

Some victims of severe burns report not feeling their injuries while they are still in danger or intent on saving others. Once the adrenalin and shock wear off, however, the pain quickly sets in. Pain management remains one of the most challenging medical problems in the care of burns victims.

Most people who die in fires do not in fact die from burns. The most common cause of death is inhaling toxic gases - carbon monoxide, carbon dioxide and even hydrogen cyanide - together with the suffocating lack of oxygen. One study of fire deaths in Norway from 1996 found that almost 75 per cent of the 286 people autopsied had died from carbon monoxide poisoning.

Depending on the size of the fire and how close you are to it, concentrations of carbon monoxide could start to cause headache and drowsiness in minutes, eventually leading to unconsciousness. According to the US National Fire Protection Association, 40 per cent of the victims of fatal home fires are knocked out by fumes before they can even wake up.

Decapitation

Nearly instantaneous

Beheading, if somewhat gruesome, can be one of the quickest and least painful ways to die - so long as the executioner is skilled, his blade sharp, and the condemned sits still.

The height of decapitation technology is, of course, the guillotine. Officially adopted by the French government in 1792, it was seen as more humane than other methods of execution. When the guillotine was first used in public, onlookers were reportedly aghast at the speed of death.

Quick it may be, but consciousness is nevertheless believed to continue after the spinal chord is severed. A study in rats in 1991 found that it takes 2.7 seconds for the brain to consume the oxygen from the blood in the head; the equivalent figure for humans has been calculated at 7 seconds. Some macabre historical reports from post-revolutionary France cited movements of the eyes and mouth for 15 to 30 seconds after the blade struck, although these may have been post-mortem twitches and reflexes.

If you end up losing your head, but aren't lucky enough to fall under the guillotine, or even a very sharp, well-wielded blade, the time of conscious awareness of pain may be much longer. It took the axeman three attempts to sever the head of Mary Queen of Scots in 1587. He had to finish the job with a knife.

Decades earlier in 1541, Margaret Pole, the Countess of Salisbury, was executed at the Tower of London. She was dragged to the block, but refused to lay her head down. The inexperienced axe man made a gash in her shoulder rather than her neck. According to some reports, she leapt from the block and was chased by the executioner, who struck 11 times before she died.

Electrocution

The heart and the brain are most vulnerable

In accidental electrocutions, usually involving low, household current, the most common cause of death is arrhythmia, stopping the heart dead. Unconsciousness ensues after the standard 10 seconds, says Richard Trohman, a cardiologist at Rush University in Chicago. One study of electrocution deaths in Montreal, Canada found that 92 per cent had probably died from arrhythmia.

Higher currents can produce nearly immediate unconsciousness. The electric chair was designed to produce instant loss of consciousness and painless death - a step up from traditional hangings - by conducting the current through the brain and the heart.

Whether it achieves this end is debatable. Studies on dogs in 1950 found that electrodes had to be placed on either side of the head to ensure sufficient current passed through the brain to knock the creature out. There have been many botched executions - those that required several jolts to kill, or where flames leapt from the prisoner's head, in one case due to a damp synthetic sponge being attached to the electrodes on the prisoner's head, which was such a poor conductor it was heated up by the current and caught fire.

An analysis in 2005 of post-mortem remains from 43 prisoners sentenced to death by electrocution found the most common visible injuries to be head and leg burns where the electrodes were attached. The study's senior author, William Hamilton, a medical examiner in Florida, concluded that these burns occurred post-mortem and that death was indeed instantaneous.

However, John Wikswo, a biophysicist at Vanderbilt University in Nashville, Tennessee, maintains that the thick, insulating bones of the skull would prevent sufficient current from reaching the brain, and prisoners could instead be dying from heating of the brain, or perhaps from suffocation due to paralysis of the breathing muscles - either way, an unpleasant way to go.

Fall from a height

If possible aim to land feet first

A high fall is certainly among the speediest ways to die: terminal velocity (no pun intended) is about 200 kilometres per hour, achieved from a height of about 145 metres or more. A study of deadly falls in Hamburg, Germany, found that 75 per cent of victims died in the first few seconds or minutes after landing.

The exact cause of death varies, depending on the landing surface and the person's posture. People are especially unlikely to arrive at the hospital alive if they land on their head - more common for shorter (under 10 metres) and higher (over 25 metres) falls. A 1981 analysis of 100 suicidal jumps from the Golden Gate Bridge in San Francisco - height: 75 metres, velocity on impact with the water: 120 kilometres per hour - found numerous causes of instantaneous death including massive lung bruising, collapsed lungs, exploded hearts or damage to major blood vessels and lungs through broken ribs.

Survivors of great falls often report the sensation of time slowing down. The natural reaction is to struggle to maintain a feet-first landing, resulting in fractures to the leg bones, lower spinal column and life-threatening broken pelvises. The impact travelling up through the body can also burst the aorta and heart chambers. Yet this is probably still the safest way to land, despite the force being concentrated in a small area: the feet and legs form a "crumple zone" which provides some protection to the major internal organs.

Some experienced climbers or skydivers who have survived a fall report feeling focused, alert and driven to ensure they landed in the best way possible: relaxed, legs bent and, where possible, ready to roll. Certainly every little helps, but the top tip for fallers must be to aim for a soft landing. A paper from 1942 reports a woman falling 28 metres from her apartment building into freshly tilled soil. She walked away with just a fractured rib and broken wrist.

Hanging

Speed of death depends on the hangman's skill

Suicides and old-fashioned "short drop" executions cause death by strangulation; the rope puts pressure on the windpipe and the arteries to the brain. This can cause unconsciousness in 10 seconds, but it takes longer if the noose is incorrectly sited. Witnesses of public hangings often reported victims "dancing" in pain at the end of the rope, struggling violently as they asphyxiated. Death only ensues after many minutes, as shown by the numerous people being resuscitated after being cut down - even after 15 minutes.

When public executions were outlawed in Britain in 1868, hangmen looked for a less performance-oriented approach. They eventually adopted the "long-drop" method, using a lengthier rope so the victim reached a speed that broke their necks. It had to be tailored to the victim's weight, however, as too great a force could rip the head clean off, a professionally embarrassing outcome for the hangman.

Despite the public boasting of several prominent executioners in late 19th-century Britain, a 1992 analysis of the remains of 34 prisoners found that in only about half of cases was the cause of death wholly or partly due to spinal trauma. Just one-fifth showed the classic "hangman's fracture" between the second and third cervical vertebrae. The others died in part from asphyxiation.

Michael Spence, an anthropologist at the University of Western Ontario in London, Canada, has found similar results in US victims. He concluded, however, that even if asphyxiation played a role, the trauma of the drop would have rapidly rendered all of them unconscious. "What the hangmen were looking for was quick cessation of activity," he says. "And they knew enough about their craft to ensure that happened. The thing they feared most was decapitation."

Lethal injection

US-government approved, but is it really painless?

Lethal injection was designed in Oklahoma in 1977 as a humane alternative to the electric chair. The state medical examiner and chair of anaesthesiology settled on a series of three drug injections. First comes the anaesthetic thiopental to speed away any feelings of pain, followed by a paralytic agent called pancuronium to stop breathing. Finally potassium chloride is injected, which stops the heart almost instantly.

Each drug is supposed to be administered in a lethal dose, a redundancy to ensure speedy and humane death. However, eyewitnesses have reported inmates convulsing, heaving and attempting to sit up during the procedure, suggesting the cocktail is not always completely effective.

The reason, say Leonidas Koniaris at the University of Miami Miller School of Medicine, is insufficient thiopental. He and his colleagues analysed 41 executions by lethal injection in North Carolina and California, and compared anaesthetic doses to known effects in animal models, such as pigs. As the same dose of thiopental is used regardless of body weight, the anaesthesia produced in some heavier inmates might be inadequate, they concluded.

"I think that awareness is a real possibility in a large fraction of executions," says Koniaris. That awareness might include feelings of suffocation from paralysed lungs and the searing, burning pain of a potassium chloride injection. The effect of the paralytic, however, might mean that witnesses never see any outward signs of pain.

The Supreme Court is now going to review whether this mode of execution is legal.

Explosive decompression

It takes your breath away

Death due to exposure to vacuum is a staple of science fiction plots, whether the unfortunate gets thrown from an airlock or ruptures their spacesuit.

In real life there has been just one fatal space depressurisation accident. This occurred on the Russian Soyuz-11 mission in 1971, when a seal leaked upon re-entry into the Earth's atmosphere; upon landing all three flight crew were found dead from asphyxiation.

Most of our knowledge of depressurisation comes from animal experiments and the experiences of pilots in accidents at very high altitudes. When the external air pressure suddenly drops, the air in the lungs expands, tearing the fragile gas exchange tissues. This is especially damaging if the victim neglects to exhale prior to decompression or tries to hold their breath. Oxygen begins to escape from the blood and lungs.

Experiments on dogs in the 1950s showed that 30 to 40 seconds after the pressure drops, their bodies began to swell as the water in tissues vaporised, though the tight seal of their skin prevented them from "bursting". The heart rate rises initially, then plummets. Bubbles of water vapour form in the blood and travel through the circulatory system, obstructing blood flow. After about a minute, blood effectively stops circulating.

Human survivors of rapid decompression accidents include pilots whose planes lost pressure, or in one case a NASA technician who accidentally depressurised his flight suit inside a vacuum chamber. They often report an initial pain, like being hit in the chest, and may remember feeling air escape from their lungs and the inability to inhale. Time to the loss of consciousness was generally less than 15 seconds.

One mid-1960s experiment by the US Army Aeromedical Research Laboratory in New Mexico found that a chimpanzee had a period of useful consciousness of just 11 seconds before lack of oxygen caused them to pass out.

Surprisingly, in view of these apparently traumatic effects, animals that have been repressurised within 90 seconds have generally survived with no lasting damage.

Death - Delve deeper into the riddle of human mortality in the special report.

Weblinks

• Centers for Disease Control and Prevention Drowning Fact Sheet
• http://www.cdc.gov/ncipc/factsheets/drown.htm

HIV rates rise in gay New Yorkers under 30

HIV infection rates among New York City gay men under 30 years of age rose during the last six years, health authorities reported.

The majority of the new cases occurred among gay African-Americans and Latinos. Among gay men under 20 years of age, more than 90 percent of those diagnosed with HIV belonged to one of those two ethnic groups, the report read.

According to a study by the city Department of Health and Mental Hygiene, new diagnoses of HIV among gays in New York City increased by 33 percent during the last six years, from 374 in 2001 to 499 in 2006.

Gays between 13 and 19 years of age registered a high increase in HIV infection rates -- from 41 new cases six years ago to 87 in 2006.

Every borough in the city except Staten Island witnessed an increase in infection rates.

The Department of Health report did not offer possible explanations as to why rates of infection have risen among gay men under 30, and adolescents between 13 and 19 in particular.

Dr. Donna Futterman, director of the youth AIDS program at Children's Hospital of Montefiore, said teenagers in minority groups may feel more pressure to hide their sexual orientation.

"The pressure to hide their identity puts them in riskier situations than if they could openly date and express their wishes and expectations," Futterman said.

Health Commissioner Thomas Frieden urged young people to reduce their number of sexual partners, and use condoms more consistently.

Frieden pointed out that the current generation of young people is growing up without having seen friends die of AIDS, which could be giving them the false impression "that HIV is not such a terrible disease."

MAURITANIA: UN refugee agency calls for funds to get Mauritanian refugees home

An 18-year-old Senegalese government-issued refugee card. Cards like these were issued to Mauritanians expelled from their homes in 1989

The UN refugee agency is asking donors for US$7 million to help tens of thousands of Mauritanians return home nearly 20 years after ethnic fighting forced them to leave.

Forced from their homes and livelihoods in 1989 the refugees – living in Senegal and Mali – have long insisted that their return be supervised and backed by the UN refugee agency (UNHCR). In June the Mauritanian government formally requested UNHCR assistance with the repatriation.

“We call on the international community to help Mauritania turn this painful page in our history,” Moustapha Toure, spokesperson for the Mauritanian refugees, told IRIN.

Some 25,000 Mauritanians are expected to set off from Senegal and Mali next month in UNHCR-operated boats and trucks, with the refugee agency providing food and protection along the way as well as assistance to local communities.

Part of the funds – about $1.7 million – is earmarked for protection and monitoring of refugees’ legal rights. “The authorities will provide returnees with the necessary documentation to ensure their access to civil rights, land and property in a dignified manner,” UNHCR says in its appeal.

After years of refugees’ apprehension about their status upon returning home, the newly elected Mauritanian government in July formally invited them, saying they could return safely and with dignity.

Of some 60,000 people who originally fled Mauritania, about 30,000 remain in northern Senegal and some 6,000 in Mali.

An initial survey conducted by UNHCR and Senegalese officials in July and August found that some 24,000 refugees in Senegal expressed a wish to return home. A few hundred refugees living in Mali are also expected to return.

UNHCR says given “the limited absorption capacity of return areas”, it expects to assist 7,000 people to return by the end of this year and the rest in 2008.

Helping local communities

Part of the funds will be used to build up health and education facilities as well as boost agricultural capacity in communities where refugees will return, UNHCR says.

“It is assumed that returning refugees have maintained regular contact with their relatives in Mauritania, which will improve reintegration prospects in their communities of origin,” UNHCR says in the appeal document. “However, as communities in Mauritania are already facing a shortage of resources, returnee families, consisting often of up to nine members each, will put an important strain on already scarce food and water sources.”

The appeal covers the construction of 35 wells and the building or rehabilitation of 20 health centres and 20 classrooms. In addition, it calls for agricultural tools and seeds for returnees as well as host communities.

Refugees will receive two months food rations from UNHCR and three months basic food rations from the World Food Programme to further mitigate the strain on local communities.

UNHCR says it is negotiating a tripartite agreement with the Senegalese and Mauritanian governments, intended to provide a legal framework covering property rights and legal documentation for refugees. The agreement is expected to be finalised before repatriation begins in October, the agency says.

Truth and reconciliation

While refugees have welcomed the assistance of their government and UNHCR, many are calling for a truth and reconciliation commission to discuss the events of 1989 once repatriation is completed, refugee spokesperson Toure told IRIN.

Mauritanian President Mohamed Ould Cheikh Abdallahi said in a speech in June: “I am urging all Mauritanians to get mobilised in order to welcome, as warmly and in as brotherly a manner as possible, our fellow countrymen and women in solidarity.”

“Our president has recognised the state’s responsibility to restoring our human rights,” Toure said. “We hope the international community will fully support that initiative so we can put ourselves firmly on the path of national reconciliation.”

Some 60,000 black Mauritanians were expelled from their country to neighbouring Senegal and Mali in 1989 when a border dispute erupted into ethnic violence. Thousands of Mauritanians living in Senegal at the time were also forced out.

“Tactical Momentum” in Iraq and Our New Sunni “Friends”

In an August 25 article in the New York Times (”Hear a General, Hug a Sheik: Congress Does the Iraq Circuit,” by Sheryl Gay Stolberg and Damien Cave) we learn that the encouraging, but misleading, phrase “Tactical Momentum” is apparently being used by General David Petraeus in his briefings of the many Congressmen making the pilgrimage to Iraq of late. This phrase, or something similar, is likely to feature prominently in Gen. Petraeus’ report this month on the situation in Iraq.

That choice of words suggests that a process is underway inside Iraq of expanding and sustainable stability, which would have to involve the resolution of the deep ethno-sectarian rifts that have been tearing that already battered country apart. Gen. Petraeus and others speaking out in support of the current surge also commonly assert or imply strongly that the gains made in recent months in predominantly Sunni Arab areas of Iraq are the direct result of the surge. This simply is not the case.

By far, the gains made in mainly Sunni Arab portions of Iraq, especially al-Anbar province, are the result of rising anger among many Sunni Arabs over the abuses associated with al-Qaeda in Iraq cadres in their midst — resentment that has been building since 2004. This has very little to do with the current surge. Indeed, only around 5,000 additional US troops of almost 30,000 sent to Iraq since the beginning of the surge have gone to al-Anbar because the focus of the surge was the Baghdad area.

Furthermore, this alliance of convenience between US forces and Sunni Arab tribal notables and insurgents is bitterly opposed by the Shi’a-dominated Maliki government and its supporters because there is no desire on their part to have armed Sunni Arabs assemble more freely, acquire still more arms one way or another without US interference, or join local Iraqi security forces in large numbers. In effect, what has been going on is the formation, with US acquiescence, of Sunni Arab militias. Yet, by encouraging and exploiting this phenomenon, American troops, alongside such forces, have dealt severe blows to al-Qaeda in Iraq — perhaps the most encouraging successes in Iraq since 2003.

Nonetheless, those now helping us in al-Anbar and other largely Sunni Arab strongholds remain deeply opposed to the American occupation and fiercely oppose the Shi’a and Kurdish dominated government in Baghdad. This is why one senior American commander working with these elements reportedly has instructed his men not to trust our new best friends. If and when al-Qaeda in Iraq has been crushed, these same Sunni Arabs might well turn once again against the next two parties on their hit list. As a result, we would want to make sure that when that time arrives, we get out of their way as expeditiously as possible. This is almost certainly why General Odierno mentioned recently the possibility of pulling out of some areas in al-Anbar once they are “stabilized” (i.e. made free of al-Qaeda in Iraq).

There should be little reason to fear that once these Sunni Arab elements have defeated al-Qaeda in Iraq that, in the absence of US forces, these elements would invite the terrorists back in. Having betrayed such fanatical jihadists and fought against them alongside US forces, allowing them to return would carry the very real risk of bloody retribution.

Meanwhile, the profound political problems plaguing Iraq, which the surge was supposed to resolve by creating the necessary “space” or security environment, continue unabated. In fact, they appear to be worsening, in part because of the military cooperation between US forces and Sunni Arabs. Additionally, the Iraqi government remains dysfunctional. It is not only unable to pass the benchmarks so earnestly desired by Washington but, in fact, seems unwilling to do so because the idea of providing Sunni Arabs with a greater share of the political and financial pie (so Sunni Arabs will more readily buy in to the political process) is something anathema to many Shi’a and Kurds.

Unfortunately, many political figures across the political spectrum back here in the US don’t understand what is happening in Iraq. Supporters of the Bush Administration believe recent successes relating to Iraq’s Sunni Arabs are the result of the surge and that Iraq can be progressively stabilized by a continued US presence. Many of those on the other side of the political spectrum believe there has not been much success and to the extent there is, any progress would support the Administration’s case for remaining in Iraq.

Neither view holds water. The success in Sunni areas is real, but Iraq’s lethal ethno-sectarian fault-lines remain and opposition to occupation among our new Sunni Arab allies has not waned. The latter almost certainly will demand that we withdraw from their areas of Iraq once we finish helping them destroy the terrorists in their midst.

Consequently, lest we risk renewed resistance in predominantly Sunni Arab areas of the country farther down the road, the US should do just that. This would allow us to pull out of the previously most dangerous portions of Iraq in a more orderly and peaceful fashion. To avoid getting caught in the middle between Sunni and Shi’a, Washington should not wait too long before ordering a withdrawal from the rest of the country too.

Wayne White

Child marriage a neglected problem

Two years ago, in the western Malian village of Korera-Kore, a 13-year-old girl was forced into marriage during her school summer holiday. She died after complications during sex on her wedding night.

This young Malian, whose case was documented by a local organisation called the Coordination of Women’s Associations and Non-governmental organisations (CAFO), is one of more than 60 million women globally who were married or in union before the age of 18, according to estimates by the UN Children’s Fund (UNICEF).

Campaigners say forced early marriage, or child marriage, is a problem that has been largely untouched by the international community. In Mali it is considered by the research organisation Population Council as “one of the most severe crises of child marriage in the world today”; the few workers in this field say progress is too slow.

“There hasn’t been a really concerted effort to address the issue [at the international level],” said Naana Otoo-Oyortey, a founding member of the Forum on Marriage and the Rights of Women and Girls, a network of mostly UK-based organisations who campaign against early marriage and violence against women. “It’s been a neglected issue.”

Otoo-Oyortey said unlike female genital mutilation/cutting, which is prohibited in many international conventions, child marriage receives little visibility and little funding from donors for programmes to reduce the practice, despite its link to increased rates of maternal mortality, fistula and HIV/AIDS.

Legal framework In Mali, a girl is legally allowed to wed at the age of 15 with the consent of her parents. In some cases, girls younger than 15 can wed with the authorisation of a judge. A government bill that would, among other things, raise the legal age of marriage to 18 has been on the books for five years, but has yet to be passed. “Now, it’s a question of political will,” said Bakary Traoré, technical adviser on children at the Malian Ministry for the Promotion of Women, Children and Family. According to Founé Samaké, lawyer and member of the Clinique juridique des femmes maliennes, a legal aid clinic, Malian law punishes the abduction of women for forced marriage by one to five years in prison. When the abducted girl is less than 15 years old, the sentence is up to 10 years of forced labour and, at the discretion of the judge, an injunction banning the convicted person from specified places for up to 20 years. But enforcing the law is an “arduous task”, Samaké said, because family members are often accomplices in the forced marriage.

Slow decline

In Mali, according to the latest statistics from the 2001 Demographic and Health Survey, 65 percent of women aged 20-24 were married by the age of 18, one of the highest rates in the world. Nationwide, 25 percent of girls were married by the age of 15, and one in 10 married girls aged 15-19 gave birth before age 15.

While this marks a decrease since 1987, when 79 percent of Malian women married as children, advocates say the numbers are not dropping fast enough, largely because not enough people are working on the subject.

“The global trend has been a slow decline,” said Nassra Abass, a consultant in UNICEF’s child protection section in New York. “[But] there’s definitely a lot more that we can do.”

She said UNICEF’s focus has been on reducing female genital cutting (FGC), a movement that has “momentum”, unlike child marriage, honour killings and other traditional practices considered harmful by the UN.

“There have not been very many resources or much time invested in early marriage. There aren’t many programmes running. That’s why the decline is slow,” Abass told IRIN.

Dangers

The mild decline in early marriage in Mali has been attributed to the few education and awareness raising programmes that do exist.

In the western Malian region of Kayes, where 83 percent of girls are married by the age of 18, particular effort has been paid to informing people of the risks of early marriage.

According to the UN Population Fund (UNFPA), girls aged 15-19 are twice as likely to die during pregnancy or childbirth as women aged 20-24. Among girls aged 10-14, the risk is five times greater. Early onset of sexual activity has also been linked to increased risk of HIV/AIDS because child brides are less likely to be educated and more likely to have unprotected sex with older men who have had more sexual partners.

New research by CAFO of Nioro du Sahel, one of Kayes’s largest cities, showed that in Kayes, between 2005 and May 2007, at least 10 girls - many not yet teenagers - lost their lives because of complications after their wedding nights, sometimes due to haemorrhaging after forced intercourse.

Education

As a result, in July, CAFO joined with UNICEF, the government department responsible for the promotion of women, and the union of independent radio and TV stations, to organise the first public awareness campaign in the region of Kayes. It included a three-day workshop with religious and community leaders, informing them of the dangers of early marriage and helping them produce messages against early marriage to be broadcast in the local media. A similar workshop took place in the eastern region of Gao in June.

“We were ignorant. We married girls at 9, 10, 11 or 12 years old. Now, we’ve seen the reality. We will no longer practice this,” Diawara Mamadou, head of the town of Gogui and one of 12 community representatives present at the workshop, told IRIN.

For the last two years, UNICEF has also been working with communities in three regions of Mali - Segou, Mopti and Kayes - to inform residents of the risks, help them abandon the practice, and set up committees that will intervene in cases of early marriage. UNICEF in Mali has set up an internal working group to better coordinate work on early marriage, and hopes to extend these programmes nation-wide.

“[In Mali], we are the only ones interested in this problem,” said Fabienne Dubey, assistant programme officer for education at UNICEF-Mali. “I don’t know of other organisations working on this. It is still very rudimentary.”

Photo: IRIN

Women do a lot of cooking, cleaning and manual work in Mali. Education is poor

UNFPA runs educational programmes focusing on reproductive health that include, but do not specifically target, early marriage. Starting in 2008, UNFPA will make early marriage more of a priority, according to reproductive health programme officer Mariam Cissoko.

What works

“The most important thing that a national government should do is ensure enforcement of its own laws,” said Kathy Selvaggio, senior policy advocate at the Washington, DC-based International Center for Research on Women, an organisation lobbying the US government to spend more of its aid money fighting early marriage.

She said legal enforcement must be combined with programmes that provide alternatives to early marriage by increasing the levels of education and economic opportunities of girls.

“Where you have successes in combating child marriage, [as in India and Ethiopia], they’ve been these comprehensive approaches,” Selvaggio told IRIN.

The Malian government does consider child marriage a form of violence against women, and “there is a whole policy to fight against violence done to women,” according to Kanté Dandara Touré, national director for the promotion of women at the Ministry for the Promotion of Women, Children and Family.

She said the national committee for the fight against detrimental practices does include early marriage in its sensitisation work, using media, community leaders and theatre, but no government programme targets early marriage exclusively.

...It's a question of priorities, and right now female genital cutting is at the top...

“It’s a question of priorities,” and right now “female genital cutting is at the top,” Touré said, noting that more than 90 percent of Malian women are circumcised.

Priorities

Making early marriage a political priority is a necessary first step for change, according to maternal mortality research by Professor Jeremy Shiffman, of the Maxwell School of Citizenship and Public Affairs of Syracuse University.

“In Honduras, safe motherhood became one of the country’s foremost health priorities, and between 1990 and 1997, the country experienced a 40 percent decline in its maternal mortality ratio, one of the most significant reductions in such a short time span ever documented in the developing world,” he wrote in a May 2007 article in the American Journal of Public Health.

He found that nine factors shaped the degree to which maternal mortality reduction emerged on the national policy agenda, including efforts by international agencies to establish a global norm concerning its unacceptability; financial and technical resources from international donors; the degree to which national advocates coalesced as a political force; the generation of national attention for the cause; and the existence of competing health causes.