Gaza’s health system close to collapse as electricity crisis threatens total blackout

World Health Organization warns hospitals could be plunged into darkness by end of February without fresh funding to keep emergency generators running

Hospitals in Gaza will face an almost total power blackout by the end of February unless funding is secured to keep emergency generators running, the World Health Organization has warned.

An ongoing electricity crisis in Gaza has left hospitals reliant on emergency generators for up to 20 hours a day, while medical staff have been forced to cut back on basic services such as equipment sterilisation and diagnostics. About 500,000 litres of fuel are required each month to sustain critical care in Gaza, but funding will only cover hospitals needs until the end of February.

Dr Mahmoud Daher, head of the WHOs Gaza sub-office, said the health system is on the edge of collapse. Without urgent fundraising, hospitals will face a disastrous situation, he said. There are at least 200 babies and people in intensive care units. It would be a really fatal situation for them. There are dozens of people who are going to surgical operations that would be affected.

Fears over the humanitarian situation intensified following a series of tweets by Donald Trump on Tuesday, in which he threatened to cut funding for the Palestinian Authority unless it recommences peace talks. The US ambassador to the UN, Nikki Haley, earlier said the US would cut funds to UNRWA, the UNs agency for Palestinian refugees, unless the authority went back to the negotiating table.

Dr Andy Ferguson, director of programmes for Medical Aid for Palestinians (Map), an organisation that works with hospitals and other healthcare providers across Gaza and the West Bank, said electricity outages in Gaza, combined with medical shortages and severe restrictions on freedom of movement, were creating a medical emergency.

Difficulties with sterilising equipment have caused a rise in hospital infections, he added, while power fluctuations have damaged sensitive medical equipment.

Worsening maternal malnutrition and increasing rates of premature and low-birthweight babies have led to instances of dangerous overcrowding in the neonatal intensive care unit in al-Shifa hosptial, said Ferguson.

Palestinian children do their homework by candlelight during a power cut in Gaza City. Photograph: Mahmud Hams/AFP/Getty Images

As a result, explained Ferguson, incubators designed to accommodate one baby were often occupied by several. Medical staff are having to look after as many as seven critically ill babies each at a time, compared to the UK standard of 1:1 or 1:2 care. Overcrowding of this type makes adequate monitoring and infection control impossible.

Generators are also in need maintenance, the WHO warned, but hospitals are unable to carry out repairs due to restrictions on moving goods into Gaza.

We have been told by doctors in a neonatal unit that there were periods when staff in the units were forced to make manual ventilation to patients in intensive care because the generators didnt function, said Daher. Its a matter of seconds sometimes.

The WHOs latest figures show hospitals are experiencing severe shortages of drugs and medical disposables. Of 516 medications on the essential drug list, 223 (43%) were at zero stock levels in November, which means central supplies will be totally depleted in less than a month. At the end of November, drugs used in the emergency departments and intensive care units were at 48% zero stock, while power shortages have made it harder for hospitals to collect and store large quantities of blood.

There are also dramatic decreases in the proportion of people securing permits to access healthcare outside Gaza, said Daher. In October, 45% of patients who applied to the Israeli authorities for such treatment were unsuccessful. Figures are expected to show that there were fewer exit permits granted in 2017 than in any year since the WHO began monitoring applications.

Map knows of at least 30 patients who died in 2017 after being either prevented from exiting by Israel or unable to secure financial coverage for their referral from the Palestine Authority, said Ferguson.

The Israeli government has yet to respond to a request for comment.

The UN will launch its humanitarian response plan for the occupied Palestinian territory later this month, and is expected to call for $374m (275m) to meet humanitarian needs in the Gaza Strip.

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Bangladeshi girl could be first female with tree man syndrome

10-year-old Sahana Khatun is in Dhaka for treatment of rare condition at hospital where young man suffering from disease received groundbreaking surgery

A young Bangladeshi girl with bark-like growths on her face could be the first female afflicted by tree man syndrome, doctors studying the rare genetic condition said on Tuesday. Sahana Khatun, 10, has growths on her chin, ear and nose, but doctors at Dhakas Medical College hospital are still conducting tests to establish if she has the unusual skin disorder.

Fewer than half a dozen people worldwide have epidermodysplasia verruciformis but none so far have been women, said Samanta Lal Sen, the head of the hospitals burn and plastic surgery unit. We believe she is the first woman, Sen said.

Her father, a poor labourer from Bangladeshs rural north, said he didnt worry too much when the first warts appeared on his daughters face about four months ago. But as the growths spread rapidly, he grew concerned and brought Khatun from their village to the capital for treatment.

We are very poor. My daughter lost her mother when she was only six. I really hope that the doctors will remove the barks from my beautiful daughters face, her father, Mohammad Shahjahan, said.

Another of Khatuns doctors said the young patient was displaying a milder form of the disease, and it was hoped she would make a quicker recovery than those in the more advanced stages. The hospital has been treating one man with a serious case of the disease for the better part of a year, conducting 16 surgical procedures to remove giant warts from his hands and legs.

Huge growths weighing 5kg each had consumed the hands of 27-year-old Abul Bajandar, the first recorded Bangladeshi to be suffering from the disease. His plight has captured national attention and the interest of Prime Minister Sheikh Hasina, who promised the patient would receive treatment free of charge.

Doctors said in January that for the first time in a decade, Bajandar had been able to touch his wife and daughter, and was almost ready to leave the ward.

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Women bear the brunt as finances and families are undone by India’s cash crisis

Bank accounts are rare among Indian women, leaving them unable to deposit savings that many have preferred to keep secret from their spouses

By midday, Soni Mishra* has taken off her dupatta (scarf), wiped the makeup off her sweaty face, and phoned her husband twice to make sure he can collect their son from school. Mishra, along with at least a dozen other women, has been queuing for two hours in baking heat at a Dena Bank branch in Mumbai, hoping to deposit a bundle of cash she has brought with her.

For the past 15 years, Mishra, a housewife, has been saving for a rainy day. Every month, my husband gives me some money for the household expenses. I spend most of it, but I save a few rupees in case of an emergency. I save for my sons education, for his future. My husband also saves, of course, but I save so I have my own money in case theres a problem in my life.

Mishra wants to deposit her 500 and 1,000 rupee (11.91) notes at the bank, before 30 December. In an effort to crack down on corruption, tax evasion and black markets, the prime minister, Narendra Modi, announced last month that the high-value banknotes, which account for roughly 80% of the total cash in circulation in India, were to be withdrawn. However, the notes can be banked before the year-end deadline.

In India, millions of women like Mishra keep bundles of cash stashed away in hidden biscuit tins or tupperware, under sinks, or at the back of wardrobes. Some collect tens of thousands of rupees over the years, hoping to pitch in for their childrens weddings or education, or save for old age.

Every woman saves, Mishra says. You never know what problems youre going to have, and we all keep money in the house, in a safe or in a box hidden somewhere. Its a security for a woman. Because of this announcement, I now feel very insecure.

Though they have large amounts of money, women are kept out of the banking system. Roughly 80% of Indian women dont have a bank account. Culturally, managing the household income is seen as a male preserve, so accounts tend to be in the mans name and the vast majority of women arent involved in making big financial decisions.

With the cash crackdown, womens savings are at risk. Many will have to hand their money to their husbands to deposit in a bank. If their savings exceed 2.5 lakh rupees (2,950), they will have to pay a 45% tax, and a penalty of up to 200% if the bank finds an income mismatch. With little access to reliable information, and little experience of the banking system, women nationwide have been thrown into panic by Modis announcement.

The Gauravi womens crisis centre in Bhopal, a city in central India, received more than 200 requests for help in five days from women with currency problems. Unfortunately, a lot of the women who come here dont have bank accounts, and many of them dont have information about what to do now, says Shivani Saini, coordinator at the centre.

Many of them are not allowed to watch TV, so they dont know what Modi has said. Many think they can only deposit their cash at the banks near their childhood homes they dont know that you can go to any bank and deposit cash. Now, their husbands are scaring them, saying, Why did you hide so much money from me? The police are going to come and catch you.

At least two women who came to the crisis centre had been beaten and thrown out of their homes for hiding money from their husbands. The moment they reveal to their husbands that they have cash saved up, the husbands start pressuring them to hand it over. One woman came here with six children at 6am. She had been kicked out for lying to her husband and she had nowhere else to go. In desperation, women are selling their 1,000 and 500 rupee notes cheap, accepting 800 rupees or 300 rupees in exchange.

Id say 100% of women in this area save cash, and especially migrant women, who have come to this region after being married off. They cant even go back to their parents house if theres some difficulty, Saini says. Women cant join six-hour queues. Nobody else is going to cook food on their behalf. This is a very disheartening decision for women.

Priyanka Bhatia, founder of Women on Wealth, which helps women manage their finances and start businesses, says women are bearing the brunt of the demonetisation announcement. People are taking advantage of women because they know they have no choice but to buy food for their house or books for their kids. Nobodys giving change for a 500 or 1,000 rupee note.

We usually advise women to save, so they can use that capital to start a business or achieve personal goals, but now they feel their savings are worthless.

*Name changed to protect identity

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Air pollution more deadly in Africa than malnutrition or dirty water, study warns

Annual human and economic cost of tainted air runs to 712,000 lost lives and 364bn, finds Organisation for Economic Co-operation and Development

Africas air pollution is causing more premature deaths than unsafe water or childhood malnutrition, and could develop into a health and climate crisis reminiscent of those seen in China and India, a study by a global policy forum has found.

The first major attempt to calculate both the human and financial cost of the continents pollution suggests dirty air could be killing 712,000 people a year prematurely, compared with approximately 542,000 from unsafe water, 275,000 from malnutrition and 391,000 from unsafe sanitation.

While most major environmental hazards have been improving with development gains and industrialisation, outdoor (or ambient particulate) air pollution from traffic, power generation and industries is increasing rapidly, especially in fast-developing countries such as Egypt, South Africa, Ethiopia and Nigeria.

Annual deaths from ambient [outdoor] particulate matter pollution across the African continent increased by 36% from 1990 to 2013. Over the same period, deaths from household air pollution also continued to increase, but only by 18%, said a researcher at the Paris-based Organisation for Economic Co-operation and Development development centre. The OECD is funded by the worlds richest 35 countries.

For Africa as a whole, the estimated economic cost of premature air pollution deaths in 2013 was roughly $215bn (175bn) a year for outdoor air pollution, and $232bn for household, or indoor, air pollution.

The studys author, Rana Roy, is concerned by the pace at which outdoor air pollution is growing in Africa, bucking the downward trend in most countries. Used cars and trucks imported from rich countries are adding to urban pollution caused by household cooking on open fires.

This mega-trend is set to continue to unfold throughout this century. It suggests that current means of transportation and energy generation in African cities are not sustainable, said Roy. Alternative models to those imported from industrialised economies, such as dependence on the individual automobile, are necessary.

It is striking that air pollution costs in Africa are rising in spite of slow industrialisation, and even de-industrialisation in many countries. Should this latter trend successfully be reversed, the air pollution challenge would worsen faster, unless radically new approaches and technologies were put to use.

The new problem of outdoor air pollution is too large to be ignored or deferred to tomorrows agenda. At the same time, Africa cannot afford to ignore the old problem of household pollution or to consider it largely solved: it is only a few high-income countries Algeria, Egypt, Libya, Mauritius, Morocco, Seychelles and Tunisia that can afford to view the problem of air pollution as being a problem of outdoor particulate pollution alone.

The study stresses that there is not nearly enough knowledge of the sources of air pollution and its impact in much of Africa. It quotes UK scientist Mathew Evans, professor of atmospheric chemistry at York University, who is leading a large-scale investigation of air pollution in west Africa.

London and Lagos have entirely different air quality problems. In cities such as London, its mainly due to the burning of hydrocarbons for transport. African pollution isnt like that. There is the burning of rubbish, cooking indoors with inefficient fuel stoves, millions of steel diesel electricity generators, cars which have had the catalytic converters removed and petrochemical plants, all pushing pollutants into the air over the cities. Compounds such as sulphur dioxide, benzene and carbon monoxide, that havent been issues in western cities for decades, may be a significant problem in African cities. We simply dont know.

Whereas China has reached a level of development that has allowed it to concentrate on solving air pollution, most African countries must grapple with several major environmental burdens at the same time, said the report.

[They] are not in the position of a China, which can today focus on air pollution undistracted by problems such as unsafe water or unsafe sanitation or childhood underweight, said Roy.

Henri-Bernard Solignac-Lecomte, head of the Europe, Middle east and Africa unit at the OECD development centre, said the paper made a double case for action. Air pollution in Africa increasingly hurts people and hinders economic development. Reducing it requires urgent action by governments to change the unsustainable course of urbanisation. Indeed, Africa urbanises at a very fast pace: todays 472 million urban dwellers will be around a billion in 2050. Todays investment choices will have decade-long impacts on urban infrastructure and the quality of life of urbanites.

Bold action to improve access to electricity, using clean technologies such as solar power, can contribute to reducing the exposure of the poorer families to indoor smog from coal or dung-fired cooking stoves.

As for outdoor pollution, African economies would be well advised to learn from the experience of industrialised countries, for example by developing mass public transportation systems like Rabat or Addis-Ababa are doing with their tramways.

Roy warned that the human and economic costs of air pollution might explode without bold policy changes in Africas urbanisation policies.

He concluded with a call for urgent international action: If Africas local air pollution is contributing to climate change today, at a time when its population stands at 1.2 billion, or 16% of the worlds population, it is safe to suppose that it is likely to contribute considerably more when its population increases to around 2.5 billion, or 25% of the worlds population in 2050, and thence to around 4.4 billion, or 40% of the worlds population in 2100.

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Argentina: hundreds of thousands of women set to protest against violence

Organizers urge women to stop work and other activities for an hour in Wednesday womens strike following rape and torture of a 16-year-old girl

Hundreds of thousands of women in Argentina are expected to join a national protest over violence against women on Wednesday, after a horrifying attack in which a 16-year-old girl was raped and tortured.

We are saying enough! We wont go back to being submissive and we wont tolerate any more of the misogyny or violence that all us women have to deal with, says Sabrina Cartabia, one of the organizers of the march.

The protest marked with the Twitter hashtag #MircolesNegro, or Black Wednesday was prompted by the abduction of Luca Prez, a schoolgirl who was drugged, raped and tortured earlier this month in the coastal city of Mar del Plata.

NiUnaMenos (@NiUnaMenos_)

Este mircoles #VivasNosQueremos #NiUnaMenos #ParoDeMujeres

October 17, 2016

The cruelty of her attack was such that Prez suffered a cardiac arrest, according to prosecutor Mara Isabel Snchez, who described it as an act of inhuman sexual aggression.

Following their assault, the assailants washed the 16-year-old in an attempt to erase forensic evidence and took her to a nearby hospital, where she died shortly after arrival from internal injuries sustained during her rape.

I know its not very professional to say this, but Im a mother and a woman, and though Ive seen thousands of cases in my career, Ive never seen anything like this, prosecutor Snchez told local media.

But Prezs murder is just the latest in a harrowing sequence of femicides, crimes usually committed by husbands, boyfriends, family members or acquaintances of the victim. In more than one case, the woman has been set on fire by her partner.

This violence is trying to teach us a lesson, it wants to put us back in a traditional role into which we dont fit any more, says Cantabria. Its not a specific blow by a specific man against one woman in particular, its a message to all women to return to our stereotypical roles.

Cartabia is a member of the collective Ni Una Menos (Not One Less meaning not one more woman lost to male violence), which organized Argentinas first march against gender-related crimes in June last year.

That protest and a second one in June drew hundreds of thousands of
women to the street in a growing movement to fight male violence against women.

In 2012, Argentina passed legislation against femicide, a legal term encompassing domestic violence, honor killings and other categories of hate crimes against women.

But campaigners warn that machista attitudes have been slow to change: in the last 18 days alone, 19 women have been killed in Argentina.

In an open letter earlier this week, Prezs brother, Matas Prez, said that police initially refused to let him see his sisters body because of the horrific nature of the violence she was subjected to.

I refused to leave until I could see her; she was on a stretcher, her eyes half-closed, like she always slept, he said.
Prezs mother, Mara Montero, called on women to join the protest so that no more families are destroyed like ours.

Organizers of Wednesdays womens strike called for every woman in the country to stop work, study and other activities for an hour at 1pm.

In your office, school, hospital, law court, newsroom, shop, factory, or wherever you are working, stop for an hour to demand no more machista violence, wrote the march organizers.

Government statistics show that crimes against women have risen 78% since 2008 in Argentina, a rise that may be partly attributable to growing awareness of the phenomenon, but has prompted a national debate over sexist attitudes.

People take part in an earlier protest against femicides in Buenos Aires in June. Photograph: Eitan Abramovich/AFP/Getty Images

Every 30 hours a woman is killed in such crimes, according to statistics kept by La Casa del Encuentro, an NGO that helps female victims of violence.

The murder of Luca Prez came only a few days after a march by tens of thousands of women protesting about crimes against women in the central city of Rosario ended in violence when police fired rubber bullets and teargas into the crowd gathered outside the citys cathedral.

The strike starts at 1pm, with the ceasing of all work and private activities, followed by a march congregating on the main Plaza de Mayo square in Buenos Aires.

Three suspects have been arrested in the Prez case, but her family has since reported receiving death threats.

We have to gather strength and take to the streets, wrote Matas Prez in his open letter. We all have to shout together, more than ever: Not one less.

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Revealed: how raid by Kenyan police drove street children to their deaths

Activists fear routine violence against homeless youths in Eldoret is turning into deliberate policy of killing them

It was a Sunday, so there was little to do but mark time and sniff glue. The shops were shut, the market half empty. With few people out and about, begging was unlikely to be a profitable enterprise.

Instead, many of Eldorets street children had retreated to its central rubbish dump. Foetid and pestilential, this wasteland has long been a haven for the waifs of Kenyas fifth city, the countrys highland capital and long-distance running heartland.

California Barracks, as it is known to the 700 homeless children and young adults who sleep there, usually provides something to eat: unwanted food dumped by local hotels or overripe fruit discarded by traders from the nearby market. It also offers a refuge, from society and from Eldorets police, who can rarely stomach the stench.

But not on that day, the penultimate Sunday of May. It was getting on for 4pm, the shadows lengthening on a chilly afternoon. Some of the children were asleep. Others sought solace in the cheap, hunger-suppressing fix of solvent abuse: boys inhaled glue from plastic containers clutched to their nostrils, girls in their early teens shared theirs with infants strapped to their backs.

In the warren of alleys above, the police advanced silently from three directions. Municipal officers, known as county askaris, carried cudgels and led the way; men from the Administrative Police, a feared state paramilitary unit, followed with rifles and teargas.

The inhabitants of California Barracks have grown accustomed to police brutality. Many there that Sunday had experienced it, like Samuel Asacha. A decade ago, when he was 15, he had one of his eyes gouged out by a particularly notorious officer. Or Shereen, then 10, and Shelagh, 14, both badly disfigured in 2014 when the same man, they say, threw acid in their face.

But the raid on California Barracks seemed different. This was not casual, workaday bullying but a carefully planned operation, systematic, meticulous and one which city authorities have until now largely managed to cover up.

They gave no warning, said Eric Omondi, who at 20 is, like Samuel, one of the older members or prefects of California Barracks. It was an ambush. Suddenly there were kids screaming, teargas being fired and officers shooting into the air.

Advancing in a line, beating as they went, the police forced their victims towards the Sosiani river, which hugs the southern perimeter of the dump. Babies, girls, boys, disabled and able alike, were trampled down in merciless fashion.

None caught were spared, not even a 17-year-old called Mary, whom Omondi saw being beaten with such force that her baby fell headfirst from her arms onto the stony ground.

In a wheelchair after being run over by a county bulldozer clearing homeless shelters last year, Ronny, 16, had no chance of escape.

As blows rained down on his head and shoulders, he begged his tormenters to stop: I told them If you dont stop, you are going to kill me. They replied: We dont care if we kill you. If killing you is what will scare others away, we will do it.

By now some had managed to slip through the police lines, but others had been pushed to the riverbank. To escape the blows, they had no choice but to plunge into the Sosiani, then in full spate after heavy rains.

The Sosiani river. Six children drowned after police forced them into the river and fired teargas. Photograph: Adrian Blomfield

Although many did not know how to swim, prefects such as Omondi managed to help the stronger scramble for the far bank. But then the police fired teargas into the water. For the weaker, it was too much; they began to drown.

Omondi found the first body, belonging to his friend Francis Azmam a boy of 13 known as Sudi, or lucky caught in the roots of a tree overhanging the river. He had multiple injuries on his head, chest and ribs, on his stomach and back, he said.

Six children died in total and over the next two days the corpses of five more children would wash up downstream. The oldest, identified by social workers as Zakayo, was 16. The youngest, known as Ndogo or Little, was nine.

Eldoret, Kenya

It was a horrific day for the street communities of Eldoret, but not the only one this year in which children have been killed.

Activists are convinced that the county government has embarked on a policy of trying to rid Eldoret of its street children population by killing them, or killing enough of them to force the others to flee.

The administration of Jackson Mandago, the county governor, denies that claim, presenting all police actions against street communities as a measured response to counter petty crime, blamed by some in the city on street children.

But activists point to a steadily escalating campaign that began in February 2015, when some 30 street children were bitten when police set dogs on them, according to the Ex-Street Children Community Organisation, a group of activists. The following October, the county authorities forcibly rounded up more than 100 street children, forced them into a lorry and dumped them 80 miles away in Malaba, a town on the Ugandan border. Most walked back to Eldoret.

The killings began after that, activists say. Ex-Street has documented the deaths of 14 minors so far this year, including three boys shot dead as they ran from police and three more whose bodies were found days after they had been arrested. At least five more are missing after being taken into custody and another two 9-year-old Kevin Simuyu and David Kamau, eight, have not been seen since they were shot and wounded by police a fortnight after the raid on California Barracks.

Some believe that the attacks on street children are ethnically motivated. Most are not members of the countys dominant Kalenjin community, the ethnic group of Kenyas powerful deputy president, William Ruto.

The region around Eldoret has witnessed some of Kenyas worst ethnic violence, often because of politically-manipulated tensions over land ownership. In 1991, Kalenjin warriors impaled foetuses ripped from dying Kikuyu women on spears which were then placed on the side of the road leading into Eldoret, as anger over Kikuyu encroachment into the ancestral lands exploded.

The violence reached a peak after a controversial election in 2007 saw Mwai Kibaki, a Kikuyu, re-elected president. At least 1,200 people were killed in the ensuing violence across Kenya, but the clashes were at their deadliest in and around Eldoret, where scores of Kikuyu women and children sheltering in a church were burned to death by Kalenjin fighters.

A street in Eldoret, Kenya. Photograph: Graeme Robertson for the Guardian

Although the Kalenjin and Kikuyu are now reconciled and share power (President Uhuru Kenyatta is a Kikuyu), some local politicians and clergymen say the attacks on street children appear to be part of a campaign of intimidation designed to force non-Kalenjins to leave Eldoret.

If we dont stop the killing of street families, this will escalate, said Peter Chomba, a ruling party county legislator, who is Kikuyu. If you look at what is happening, it is a pre-planned campaign. They profile professions drawn from certain communities and then attack them. What is happening is an attempt to claim this place for one community.

Whatever the motive, few Kenyans would be particularly shocked to hear that the police were killing minors in Eldoret. Human rights groups have raised repeated concerns that extrajudicial killings have become part of police culture in Kenya. Reports of the execution of suspected Islamists, petty criminals and even human rights activists are becoming increasingly common.

Last week Kenyas Daily Nation newspaper published a database documenting 122 police killings in the country so far this year. The database showed only two police killings in Eldoret this year and activists and some politicians say there has been a concerted effort to suppress the killings of street children in the city.

County legislators said that witnesses who had filmed the police operation at California Barracks from nearby buildings had been arrested and their mobile phones confiscated.

Benson Juma, one of directors of Ex-Street, was attacked by unidentified men who attempted to force him into a car days after leading more than a dozen witnesses to the killing of street children to the Guardian. He escaped, twice, thanks to the intervention of passersby. Juma has now fled Eldoret and is in hiding.

With Kenya set to go to the polls next year, he predicts the attacks on street children will only worsen. It is turning into Brazil, he said. It is too much to bury and bury and bury our colleagues. It is too much we may be forced to do something else to show the government that we are tired and fed up, to show them that we feel the pain.

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US covering up opposition breaches of Syria ceasefire, Russia claims

Three-day old deal under strain amid diplomatic tensions and frustrations about UN aid convoys being unable to reach besieged civilians

Russia accused the US of covering up opposition violations in Syria on Thursday as the three-day old ceasefire came under increasing strain.

The Russian defence ministry said that Syrian regime forces had pulled back from the Castello road, a key access route into Aleppo, but that opposition groups had not withdrawn.

The Russian foreign ministry also complained of opposition shelling. Only the Syrian army has been observing the ceasefire regime, while the US-led moderate opposition has been increasing the number of shellings of residential quarters, the ministry statement said. Moreover, it appears that the verbal curtain of Washington is aimed at hiding the non-fulfilment of the US obligations.

The strained rhetoric came as the first UN aid convoy bound for besieged eastern Aleppo remained stuck in the absence of permits from Damascus.

The UN special envoy, Staffan de Mistura, said the Syrian government had not provided facilitation letters that had been agreed as part of the ceasefire deal, meaning that 40 trucks full of humanitarian supplies were halted at the Turkish border.

De Mistura, who said the hold-up was a clear breach of the ceasefire agreement, said the intended delivery of aid into eastern Aleppo, subject to a different permission regime, was also being blocked by hurdles put in place by the Syrian government and opposition fighters.

The delivery of aid is a precondition of the survival of a cessation of hostilities that came into effect on Monday and is designed to lead to unprecedented joint Russian-American action against terror groups inside Syria.

De Mistura insisted the Russians were as disappointed as the UN at the deeply regrettable refusal of the Syrian government to grant letters of permission in line with the agreement. He said he had been given fresh assurances by the Russians at a meeting on Thursday morning that the absence of the permission letters was a very severe disappointment, but he did not specify what pressure the Russians were placing on the Syrians to abide by the agreement.

Hundreds of trucks were ready to be loaded, he said, and an opportunity to deliver aid and help solidify the ceasefire was being wasted. The UN has said it cannot cross front lines or checkpoints without Syrian permission.

The separate blockage over eastern Aleppo has left 20 UN trucks that travelled from Turkey into a buffer zone waiting for the past 48 hours for UN agreement that it is safe to travel along the Castello Road, the main supply route into the divided city, where 250,000 people are desperate for food and fuel.

Jan Egeland, head of the United Nations humanitarian taskforce for Syria, said the trucks were still in the buffer zone and could go on a minutes notice. De Mistura said the aid could not move into Syrias second city before the Castello Road route had been fully secured.

Syrians unload boxes after a 48-truck aid convoy entered the rebel-held town of Talbiseh, a besieged area in northern rural Homs, in July. Photograph: Mahmoud Taha/AFP

The Russian-American agreement states trucks should be allowed to travel into eastern Aleppo without the need for written permission from the Syrian government. The Syrian government involvement is limited to being informed of the details of the aid being delivered, and details of what had been delivered.

In addition, as part of the agreement, regime checkpoints on the Castello Road should be withdrawn, and opposition forces inside the citys east should not seek to block the delivery. The trucks are ready and sealed, and the agreement is that once they move they will not be harassed and they will not be investigated and they will be moving along that road, De Mistura said.

There have been reports that some opposition fighters are rejecting the delivery of the aid on the basis that it rejects the terms of the broader Russian-American agreement, including the plan to target fighters from the former al-Nusra front. The US says al-Nusra is linked to al-Qaida and is a legitimate target alongside Islamic State. But other groups in eastern Aleppo are reluctant to abandon al-Nusra.

Under the ceasefire plan the Russian and Americans are supposed to create a joint centre to agree legitimate targets to attack by air. The Syrian air force would then in effect be grounded in those specified areas.

Despite the problems, De Mistura insisted the Russian-American agreement is and remains a potential game-changer. He said it was too much to describe it as a cessation of hostilities, saying instead it had produced a reduction of violence, adding that by and large it is holding and is, in fact, substantial.

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