MRSA superbug

Gaza bombardment worsens superbug outbreaks

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Original article by Misbah Khan republished from TBIJ under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Israeli blockades and bombings have left doctors without basic medicines to treat infections

Content warning: This story contains graphic images and descriptions of injuries

There is a growing and dire public health crisis taking place in Gaza. Israeli blockades and hospital bombings are fuelling a superbug emergency, with civilians who survive starvation and injury later facing untreatable, life-threatening infections.

Doctors on the ground told the Bureau of Investigative Journalism (TBIJ) they were treating wounds infested with maggots and using vinegar to fight infections.

“Wounds are left open much longer [and the] injured are delayed in receiving proper care or not able to get care at all, which increases the risk of infections and emergence of antimicrobial resistance [AMR],” says Krystel Moussally, an epidemiologist monitoring the situation for Doctors without Borders (MSF).

The infections are so severe that they don’t respond to many of the antibiotics that are designed to treat them. Badly infected wounds can lead to limb amputations and, in some cases, death.

Vinegar is being used to disinfect and treat wounds because other medicines are unavailable. Dr Khaled al Shawwa

Medical organisations, including MSF and Medical Aid Palestine, say that targeted bombings of hospitals and humanitarian aid blockades are restricting access to healthcare in Gaza, exacerbating infections that don’t respond to essential medicines.

In some cases, doctors have run tests to discover that infections can be fought with certain antibiotics – but have not been able to get their hands on the life-saving drugs.

‘I’ve never seen these types of cases before’

As explosions sound in the background, Dr Alaa Alshurafa tries to relay her day-to-day experience treating superbug infections in Gaza city. Over a WhatsApp call that keeps cutting out, she conveys the damage these drug-resistant infections are inflicting in the war zone.

Dr Alaa, 30, was forced to flee her home in northern Gaza with her family after the war began. Despite this, she is serving as a doctor at one of the medical points set up by The International Federation of Red Cross and Red Crescent Societies (IFRC) in Gaza city.

Every morning, before she leaves for work, she checks that no one on her route has reported a warning from the Israeli Defense Force of a potential airstrike. The clinic is a 15-minute walk from where she lives. She has to do the journey on foot, leaving her exposed to a potential attack by drone, air or sniper.

Dr Alaa al Shurafr’s walk to her clinic takes her past rubble. Dr Alaa al Shurafr

Once she does arrive at the clinic, the medical point is flooded with more than a hundred patients a day.

When she spoke to TBIJ, she was facing an outbreak of impetigo, a highly contagious bacterial skin infection most common in children. It causes blisters and itchy sores and is usually treated with an antibiotic cream.

“I’ve never seen these types of cases before,” Dr Alaa said. “It’s a very severe form of impetigo, an extensive form which includes faces and the whole body. We don’t have sufficient antibiotics.”

What little medicine is available is extremely expensive and while it does work sometimes, it is not always effective. “I’ve seen many cases that come again and again because of failure of treatment,” she said. “The rate of reinfection [could be] because of overcrowding and maybe misuse of antibiotics or nonadherence to the antibiotic regime plays a role.”

The most common type of bacteria that leads to impetigo is Staphylococcus aureus. A drug-resistant variant of this bacteria is behind the MRSA superbug.

70% of Staphylococcus aureus infections in wounded patients in Gaza are the MRSA superbug strain

MRSA infections are resistant to many common antibiotics, making them severe and even potentially fatal.

Moussally, the MSF epidemiologist, said: “It might be that this type of infection is difficult to treat not only because of [lack of] access to oral antibiotics, but more so because of a high resistance of the Staphylococcus bacteria causing it.”

Without adequate laboratory testing it is hard to say if the bacteria has developed stronger resistance.

Moussally’s work tracking drug-resistant bacteria in Gaza dates back to before 7 October and the start of the war. Then, MSF could monitor infections through labs at Nasser and Al-Awda Hospitals in Gaza. But over the course of the war, both hospitals have been besieged and attacked, making lab tests extremely challenging.

However, data collected by MSF at the hospitals from 2019 to 2023 showed that more than 70% of Staphylococcus aureus in wounded patients was the MRSA superbug strain.

Even before the war, superbugs were already a problem in Gaza; TBIJ reported on the issue as far back as 2018.

Open wounds left to fester

Content warning: graphic imagery below

In Gaza’s remaining hospitals, surgeons are overwhelmed by critical cases. Patients with open, but not initially deadly, wounds that need reconstructive surgery are lower priority, and often forced to wait or seek help at Red Cross and Red Crescent medical points.

Any length of time a person spends with their flesh or, in many cases, bone exposed raises the risk of superbugs and – as multiple doctors report – maggots.

“It is not uncommon to see explosive injury patients with limb injuries and open fractures to develop infections either from the wound itself or from… operations,” says Dr Abdulwhhab Abu Alamrain, who currently works in the orthopaedic department of a government hospital.

A leg injury, which developed a drug-resistant infection, sustained by a 35-year-old man in an explosion in September

Pseudomonas aeruginosa is another highly drug-resistant bacteria. It can infect wound dressings, causing bandages to turn green and smell like mown grass. Doctors in Dr Abdulwhhab’s orthopaedic department have seen cases; tests, available at a few private labs still operating in Gaza and seen by TBIJ, show some Pseudomonas infections don’t respond to any antibiotics at all.

Dr Abdulwhhab said: “This results in two options, either amputation or refusal [of an amputation] and face death. Unfortunately, we have seen many cases that have died either because of refusal or because they accept [the amputation] at the last moment [and die] waiting for surgery or on the operation table.”

Lessons from history

This is not the first time war has worsened a superbug crisis. During the war in Iraq, a lethal strain of the drug-resistant bacteria Acinetobacter baumannii infected American soldiers. Media at the time called it ‘Iraqibacter’.

The superbug infections weren’t confined to the borders of Iraq. Injured soldiers lost limbs, suffered sepsis, and some died back home in US hospitals after their wounds became infected with the bacteria.

The emergence of this strain of Acinetobacter baumannii was detected after its spread in the US hospitals. But due to the lack of testing capacity in Iraq, the extent to which it affected Iraqi civilians at the time is unknown.

“Iraq is a lesson about what war has done and why we have an ongoing crisis of AMR in a place like Iraq. We need to learn these lessons,” said Dr Omar Dewachi, an Iraqi medical anthropologist who narrates the touring exhibit The Pathogen of War.

Acinetobacter baumannii infections have also been reported in Gaza.

Using vinegar as medicine

With so many patients and so few drugs, some doctors report resorting to using vinegar to disinfect and treat wounds.

Moussally said: “Partially functioning hospitals are overcrowded with a huge caseload of injuries, lack of basic supplies needed to treat infections and do proper wound care management and are functioning with sub-standard infection prevention and control measures being the best they can do under the conditions they face. All of this drives AMR.”

Dr Khaled al Shawwa came home to Gaza city from Jerusalem to visit his family for the weekend on 5 October 2023 – two days before the Hamas attacks. He has been in Gaza ever since. He was previously a GP and had just completed his surgical qualification in Jerusalem.

He now works in the outpatient department at a clinic set up by MSF. There he deals with 80-130 patients a day. He told TBIJ: “We see Pseudomonas very frequently and sometimes we use vinegar, we apply it on the wounds. Nurses have a bottle of vinegar on the wound-dressing shelf.”

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The World Health Organization has repeatedly raised concerns about drug-resistant strains of Pseudomonas.

The best practice to prevent bacteria gaining resistance to even more antibiotics is to treat infections carefully with specific drugs, preferably after lab testing to make sure the medicine will work. In Gaza, however, doctors have to work with what they have.

“Drugs are not always available. We are guided by the availability of the drugs and availability of the tests. Where I work, the drugs come in shipments and donations. In some shipments you have one or two types of antibiotics. You don’t have many options … It’s not your decision,” Dr Khaled said.

Despite the limited resources, he and his colleagues at the local pharmacies have concocted a mixture of available antibiotics and steroids to try to treat difficult infections. “You have to do anything. You can’t just leave the patients alone.”

Israel Defense Forces did not respond to TBIJ’s request for comment.

Header image: The wreckage of an ambulance at the Kamal Adwan Hospital in northern Gaza. Credit: AFP via Getty Images.

Reporter: Misbah Khan
Video editor: Katia Pirnak
Global Health editor: Fiona Walker
Deputy editors: Chrissie Giles and Katie Mark
Editor: Franz Wild
Production editor: Frankie Goodway
Fact checker: Somesh Jha
Additional contributor: Hitham Toman

TBIJ has a number of funders, a full list of which can be found here. None of our funders have any influence over editorial decisions or output.

Original article by Misbah Khan republished from TBIJ under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Genocide denier and Current UK Prime Minister Keir Starmer is quoted that he supports Zionism without qualification. He also confirms that his active support and that of UK's air force has been essential in Israel's mass-murdering genocide. Includes URLs https://www.declassifieduk.org/keir-starmers-100-spy-flights-over-gaza-in-support-of-israel/ and https://youtu.be/O74hZCKKdpA
Genocide denier and Current UK Prime Minister Keir Starmer is quoted that he supports Zionism without qualification. He also confirms that UK air force support has been essential in Israel’s mass-murdering genocide. Includes URLs https://www.declassifieduk.org/keir-starmers-100-spy-flights-over-gaza-in-support-of-israel/ and https://youtu.be/O74hZCKKdpA
Genocide denying UK Foreign Secretary David Lammy says that UK is suspending 30 of 350 arms licences to Israel. He also confirms the UK government's support for Israel's Gaza genocide and the UK government and military's active participation in genocide.
Genocide denying UK Foreign Secretary David Lammy says that UK is suspending 30 of 350 arms licences to Israel. He also confirms the UK government’s support for Israel’s Gaza genocide and the UK government and military’s active participation in genocide.
Continue ReadingGaza bombardment worsens superbug outbreaks

Revealed: Conservatives took more than £800,000 from private health firms

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Original article republished from Open Democracy

Private health tycoons have wined and dined senior ministers while cashing in on NHS contracts

Martin Williams

12 January 2023, 11.02pm

Private health firms have donated more than £800,000 to the Conservative Party over the past ten years, openDemocracy can reveal.

This includes companies run by wealthy tycoons who have wined and dined former prime ministers Boris Johnson and Theresa May and other senior ministers.

NHS sign
Rishi Sunak’s party has accepted huge donations from private health firms.

The finding comes as the government hands out more NHS contracts to the private sector in a bid to tackle the backlog in the health service.

The British Medical Association has warned that relying on the private sector threatens the “sustainability of the NHS”, which has suffered from “a decade of underinvestment”.

Now, an investigation by openDemocracy reveals how Rishi Sunak’s party has received at least £800,000 from more than 35 private health and social care businesses. The true figure could be even higher because donors do not have to declare their field of work, meaning some may have flown under the radar.

And this is on top of huge personal donations from some of the business moguls behind these private healthcare companies.

Health profits

The Conservative Friends of the NHS is a group of Tory-voting doctors and health professionals who claim to support the NHS. The group’s president is health minister Maria Caufield and it has hosted stalls at the Conservative Party’s annual conference.

But the organisation’s chairman and founder, Dr Ashraf Chohan, has not worked for the NHS for 23 years, according to his LinkedIn profile, and himself has a private GP and private health insurance.

Chohan is a private health tycoon who set up a portfolio of medical and nursing businesses in London. One of his firms, West End Medical Practice Limited, has donated more than £198,000 to the Tories since 2019 – making it one of the sector’s biggest political donors.

As chair of the Conservative Friends of the NHS, Chohan has met with senior politicians, including Boris Johnson, Liz Truss and Nadhim Zahawi. Before Christmas, in the midst of the ongoing NHS crisis, he also attended a “meaningful” meeting at Number 10.

Despite the group’s claim to support the NHS, it has repeatedly championed a two-tier health system on Twitter, saying the private sector “should be applauded for reducing demand for the NHS”. In other tweets it has advocated health insurance and argued that “all high taxpayers must have [private health] insurance by 2025”.

Experts say reliance on private health firms is creating a system in which poorer people who cannot afford to go private are “left to put up or shut up”.

NHS outsourcing to the private sector has also been linked to higher mortality rates. And hospitals that use private cleaning companies have been linked with higher rates of the MRSA superbug.

Image reads Accident & Emergency, A & E
NHS outsourcing to the private sector has been linked to higher mortality rates.

During the pandemic, Chohan – who previously donated to Labour before switching – came under scrutiny over two private firms he ran with his son that sold Covid tests. Reports said customers were charged between £80-£200 for the PCR tests, but many complained about lost samples and refused refunds.

Another Conservative Party donor is Genix Healthcare Ltd, which is part of a group of private dental clinics that makes the “majority” of its £6.6m income from NHS contracts.

The company was set up in response to the “severe shortage of NHS dentists” and says it aims to become the “dental corporate of choice for the NHS”.

Genix Healthcare has bankrolled the Tories with donations worth more than £158,000 since 2015, including cash and sponsorships.

Its owner, Mustafa Mohammed, who has posed for photos with Johnson and May and boasted about owning a Rolls-Royce and a Mercedes S-Class, has also given almost £225,000 of his own money to the party.

This includes a £20,000 donation to Jeremy Hunt in 2019, the year after he resigned as health secretary.

As one of the party’s top donors, Mohammed has been part of an elite Tory dining club called the Leader’s Group, which enjoys regular access to the prime minister and senior government figures.

Care homes and GPs

The majority of Tory donations from the private health sector have come since the pandemic began in 2020.

One such donor, Doctor Care Anywhere Group PLC, has given the party more than £37,000 in the past two years – and reportedly spent £1,000 on a ticket for government minister Paul Scully to watch a cricket match at Lord’s.

The company, which charges up to £60 for a single telephone call with a GP, raked in £25m revenue in the 2021 financial year.

Yet its records from last year say that a “severe shortage of GPs in the UK” has meant the firm’s “clinician capacity is currently insufficient to meet patient demand”. Bosses said they would not try to incentivise staff with additional pay rises because this would impact on Doctor Care Anywhere’s “cash generation”.

The Conservatives also accepted £28,000 worth of donations from Advinia Health Care Limited, which operates a network of 36 care homes across the UK.

The company has earned huge amounts of public money and boasted almost £96m in turnover in its latest financial accounts. From this, Advinia took more than £1.8m of pre-tax profits.

“Approximately 80% of group revenues came from state-funded Local Authorities and CCGs [clinical commissioning groups],” the company’s 2021 report says, adding that the taxpayer money “provide[s] the group steady, secure and timely cash inflows”.

But despite its healthy finances, Advinia’s founder and chairman, Dr Sanjeev Kanoria, recently called on Sunak to increase the government’s financial support to private care homes.

The Tories continued to accept donations from Advinia Health Care even after questions were raised about its finances. In 2019, the Guardian reported that the company had been placed under investigation by regulators over concerns about its cash flow and financial management. It was also claimed that bosses had refused to agree to an independent audit of its finances.

The true owners of Advinia Health Care remain unknown, thanks to the company’s financial structure. Records say the ultimate controlling party is the ‘Paraman Trust Settlement’, but there is no explanation of what this is, where it is located, or who is behind it. There is no trace of the Paraman Trust Settlement on the UK’s official company registry and little mention of it anywhere online.

Money donated by companies like Advinia Health Care comes on top extra cash that has been personally given by wealthy business tycoons in the health sector.

They include Dolar Popat, who has donated more than £188,000 in the past decade. Popat used to run a care home business and was appointed to the House of Lords in 2010.

John Nash is another former private healthcare tycoon who has donated to the Conservatives and been made a peer. Nash is the former chairman of Care UK, which operates 150 residential homes for elderly people.

Another firm, Babylon Healthcare, which provides GP consultations over the phone, also came under the spotlight recently amid reports that shareholders had donated to the former health secretary, Matt Hancock.

Original article republished from Open Democracy

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Continue ReadingRevealed: Conservatives took more than £800,000 from private health firms