Dozens of people waiting for aid among 94 killed in Gaza, authorities say
Dozens of people were killed in air strikes that pounded the Strip on Wednesday night and Thursday morning, including 15 people killed in strikes that hit tents in the sprawling Muwasi zone, where many displaced Palestinians are sheltering.
A separate strike on a school in Gaza City sheltering displaced people also killed 15.
Palestinians carry boxes containing food and humanitarian aid packages delivered by the Gaza Humanitarian Foundation (Abdel Kareem Hana/AP)
Gaza's Health Ministry said the number of Palestinians killed in Gaza has passed 57,000, including 223 missing people who have been declared dead, since the war began on October 7 2023.
The ministry does not differentiate between civilians and combatants in its death count but says that more than half of the dead are women and children.
The deaths come as Israel and Hamas inch closer to a possible ceasefire that would end the 21-month war.
US President Donald Trump said on Tuesday that Israel had agreed on terms for a 60-day ceasefire in Gaza and urged Hamas to accept the deal before conditions worsen.
But Hamas's response, which emphasised its demand that the war end, raised questions about whether the latest offer could materialise into an actual pause in fighting.
Smoke from an Israeli bombardment billows over the Gaza Strip (Ariel Schalit/AP)
The Israeli military blames Hamas for the civilian casualties because it operates from populated areas. The military said it targeted Hamas militants and rocket launchers in northern Gaza that launched rockets towards Israel on Wednesday.
The war began when Hamas-led militants attacked southern Israel, killing 1,200 people and taking roughly 250 hostages.
The war has left the coastal Palestinian territory in ruins, with much of the urban landscape flattened in the fighting.
More than 90% of Gaza's 2.3 million population has been displaced, often multiple times. And the war has sparked a humanitarian crisis in Gaza, leaving hundreds of thousands of people hungry.
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South Wales Argus
43 minutes ago
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UN reports 613 killings near aid distribution points and convoys in Gaza
Spokeswoman Ravina Shamdasani said the rights office was not able to attribute responsibility for the killings. But she said 'it is clear that the Israeli military has shelled and shot at Palestinians trying to reach the distribution points' operated by the Gaza Humanitarian Foundation (GHF). She said it was not immediately clear how many of those killings had taken place at GHF sites, and how many occurred near convoys. Speaking to reporters at a regular briefing, Ms Shamdasani said the figures covered the period from May 27 to June 27, and 'there have been further incidents' since then. She said she was basing the information on an internal situation report at the office of the UN High Commissioner for Human Rights. Ms Shamdasani said the figures, compiled through its standard vetting processes, were not likely to tell a complete picture, and 'we will perhaps never be able to grasp the full scale of what's happening here because of the lack of access' for UN teams to the areas. In a message to The Associated Press, Ms Shamdasani said that of the total deaths, 509 killings were 'GHF-related' meaning at or near its distribution sites. 'Information keeps coming in,' she added. 'This is ongoing and it is unacceptable.' The GHF has denied any serious injuries or deaths on its sites and says shootings outside their immediate vicinity are under the purview of Israel's military. More deaths reported near aid distribution sites occurred overnight on Friday, according to officials in Nasser Hospital in Khan Younis. At least three Palestinians were killed near aid sites in Rafah, which is close to two operated by GHF. Another 17 were killed waiting for trucks to pass by in eastern Khan Younis in the Tahliya area. Meanwhile, 15 Palestinians were killed in Israeli air strikes, including eight women and one child, the hospital said. The strikes hit the Muwasi area, where many displaced Palestinians are sheltering in tents. An Israeli army tank advances in the Gaza Strip (Leo Correa/AP) Israel's military said it was looking into Friday's reported strikes. The military, whose forces are deployed on the roads leading to the aid distribution sites, has previously said it fires warning shots to control crowds or at Palestinians who approach its troops. Also on Friday, Israel's military said a soldier was killed in combat in the north of Gaza and it was investigating. Over 860 Israeli soldiers have been killed since the war began, including more than 400 during the fighting in Gaza. The recent killings took place as efforts to halt the 21-month war appeared to be moving forward. Hamas said on Friday that it was holding discussions with leaders of other Palestinian factions to discuss a ceasefire proposal presented to it by Egyptian and Qatari mediators. Hamas will give its final response to mediators after the discussions have concluded, the statement said. The Health Ministry in Gaza said the number of Palestinians killed in the territory has passed 57,000. The war began when Hamas-led militants attacked southern Israel, killing 1,200 people and taking about 250 hostages.
Telegraph
an hour ago
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Why Normal Pressure Hydrocephalus (NPH) like Billy Joel's is so hard to diagnose
The gradual onset of impaired mobility and cognitive decline in later life is almost invariably inauspicious – indicative of some progressive neurological disorder for which regrettably there is not much that can be done. There are however a few (very important) exceptions highlighted recently by the news that American singer/songwriter Billy 'Uptown Girl' Joel is currently receiving treatment for the obscurely named condition Normal Pressure Hydrocephalus (NPH). This is a disorder of the Cerebrospinal fluid (CSF) secreted in generous quantities from the two cavernous ventricles within the brain from where it circulates over its surface and down the spinal column before being reabsorbed. Its diverse functions include, variously, nourishing the tissues with which it is in contact, keeping the brain buoyant within the bony skull, and acting as a 'shock absorber' protecting it from traumatic injuries to the head. The precise mechanism of NPH is not known, but it is probably due to partial obstruction of the flow of the fluid around the brain so it accumulates within the ventricles, causing them to enlarge, thus compromising the function of the neuronal circuits in close proximity. Hence the impaired mobility – an abnormal shuffling gait as if the feet are 'glued to the ground' – and the cognitive impairments characteristic of mild dementia: forgetfulness, poor concentration, changes in personality and behaviour and so on. Logically then a surgical procedure that drains the excess fluid from the ventricles should, by allowing those adversely affected neuronal circuits to recover, result in a marked improvement. As indeed it may. But that of course presupposes making the diagnosis in the first place, which is problematic on several counts. NPH is frequently overlooked The gradual insidious onset may too readily be misattributed to the normal process of ageing where some degree of impaired mobility and cognitive decline is unexceptional. Then by the time the symptoms are severe enough to warrant medical attention, there is a high probability they may be due to some progressive neurological disorder (such as Alzheimer's) so other possible explanations are not pursued. And while one might expect an MRI scan would show the ventricles to be enlarged, the findings can be ambiguous, especially in the early stages, and require further confirmatory specialist tests. The upshot being that NPH as a remediable cause of cognitive decline is almost certainly commoner than might be supposed and frequently overlooked. This is well illustrated by the cautionary experience of a reader who was advised his mother's deteriorating mental state was due to a series of 'mini strokes' and it would be best to place her in a nursing home and 'get on with the rest of my life'. This he was most reluctant to do. Soon after she fell and broke her arm, requiring a further stay in hospital 'where the doctors all tried to reconcile me to coming to terms with my mother's worsening dementia'. Instead he sought a second opinion privately from a neurologist who picked up on the two important clues that her mental decline had coincided with her gait becoming unsteady (hence the broken arm) and also urinary incontinence (a further 'late' symptom of NPH) – attributed by her GP to cystitis, but which had not responded to treatment with antibiotics. Further investigations confirmed she did indeed have NPH. Following the procedure to drain the excess fluid from those expanded ventricles she has made 'virtually a complete recovery'.
The Guardian
2 hours ago
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Trump's Medicaid cuts are coming for rural Americans: ‘It's going to have to hit them first'
When Hurricane Helene drowned western North Carolina in muck and floodwater last year, it caught folks off-guard. Now, local leaders in places like Asheville expect the Republican-led reconciliation bill – called the 'big, beautiful bill' by Donald Trump – to bear down on rural America. And they wonder whether people are missing the warning signs. 'It's going to have to hit them first,' said Laurie Stradley, CEO of Impact Health in Asheville, a Medicaid-funded non-profit providing social services to some people still digging out from the flood. Medicaid is the single largest health insurance program in the US. The public program covers 71 million low-income, disabled and elderly US residents. It pays for half of all US births and the care of six in 10 nursing home residents. When Trump's sprawling tax-and-spending bill passed on Thursday, it heralded more than $1tn in federal cuts to Medicaid, which experts worry will push Republican-led states to abandon parts of the program and leave people without access to timely healthcare. 'This is an extraordinarily regressive bill,' said Joan Akler, executive director and co-founder of Georgetown University's Center for Children and Families. 'This is the largest rollback of healthcare coverage that we've ever seen and all in service of an agenda to drive tax cuts that will disproportionately benefit wealthy people and corporations.' Medicaid 'expansion' is a key provision of Obamacare, formally called the Affordable Care Act of 2010. The expansion provides largely no-cost health insurance to people earning up to 138% of the federal poverty level, or $36,777 for a family of three. Although Obamacare has been the law for more than a decade, Medicaid expansion proved politically divisive in Republican states, and many only recently decided to accept enormous federal subsidies to cover their residents. The Medicaid cuts in the bill could have particularly acute consequences in North Carolina, a politically competitive state, where experts said the bill could trigger a 'kill switch' to end Medicaid expansion. 'If the state spends any state dollars to implement the expansion population or expansion coverage, it triggers an automatic ending to Medicaid expansion,' said Kody Kinsley, North Carolina's former secretary of health and an architect of the state's Medicaid expansion. North Carolina is set to lose $32bn in federal funding in the next decade, according to an analysis by the office of the Republican senator Thom Tillis, who represents the state. He's one of just three Senate Republicans who voted against the bill on Tuesday. North Carolina's expansion only went into effect in December 2023, and in less than 19 months it enrolled more than 650,000 people – all of whom will lose coverage if the program ends. Those North Carolinians are only some of the 17 million people expected to lose health insurance by 2034 across the country, according to estimates from the non-partisan Congressional Budget Office. Nearly 12 million people will lose insurance because of attacks on Medicaid. 'Ultimately, Medicaid being cut is going to kill people,' said Molly Zenkler, a nurse at Mission hospital in Asheville. 'I deal with people getting their feet literally amputated because they don't have access to diabetic care. This is just going to get increasingly worse.' The reconciliation bill cuts state funding through a number of provisions. On healthcare specifically, the bill attacks complex financial maneuvers states use to draw down federal funds. It also requires states to spend enormous sums – perhaps tens of millions of dollars per state – implementing work requirements, effectively adding layers of expensive red tape. Congressional Republicans in favor of the bill argue it targets 'waste, fraud and abuse'. However, it is already well-known that most Medicaid beneficiaries who can work do, and that Medicaid is one of the most cost-efficient health programs in the US, according to the American Hospital Association. North Carolina is one of a dozen conservative states that wrote a 'trigger' law into Medicaid expansion. Not all function like North Carolina's – the laws are, in the words of an expert with Georgetown University's McCourt School of Public Policy, a 'lesson in federalism' – but they nevertheless underscore the difficult choices state legislators will face because of congressional Republicans' cuts. One such program that could be on the chopping block is a pilot with Impact Health, which uses Medicaid expansion funds for social needs that affect health – an effort to reduce long-term costs. Stradley gave the example of a Medicaid-covered child with severe asthma who hit the local emergency room three times a week for breathing treatments. Impact's program used Medicaid funds to replace moldy rugs with laminate flooring in the child's home, and to buy a vacuum with a Hepa filter. The cost to Impact Health was about $5,000, 'but now this child is going to the emergency room a couple times a year instead of a couple times a month. And so, every month we're saving about $4,500.' The program's knock-on effects boost the local economy: the work to replace the rug was done by a local carpenter, and the child's mother isn't calling out from work, increasing her job stability. 'One of the ways that we talk about this program is that it's a hand up rather than a handout,' she said. 'Almost half of the folks that are recipients in our program are children … Then you look at the adults. Most of them are working multiple jobs, and those jobs don't come with benefits, because they're working two or three part-time jobs in order to make ends meet.' The enormity of Medicaid means large cuts to the program imperil not only patients, but the institutions that serve them – especially rural hospitals and clinics hanging on 'by a thread', according to Kinsley. One of US residents' few rights to healthcare is in emergency departments, where hospitals are required to stabilize patients regardless of ability to pay. That makes emergency departments the go-to source for healthcare for the uninsured. An analysis released by the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill earlier this year showed that 338 rural hospitals around the country were at risk of imminent closure with the cuts to Medicaid contained in the bill. Rural states such as Kentucky are expected to be disproportionately hard-hit as well. Thirty-five of the rural hospitals at risk of closure – about 10% – are in Kentucky, even though Kentucky's 4.5 million residents comprise about 1.3% of the US's population. About a third of Kentucky residents are on Medicaid, according to figures from Kentucky's cabinet for health and family services. The program benefits about 478,900 adults. The situation is similarly dire in Arizona, another battleground state, which also has a trigger law on the books. Although the reconciliation bill may not 'trigger' a rollback of Medicaid expansion, it does undermine a key financing mechanism for the state's program called a 'provider tax'. 'We estimate Arizona's healthcare system would lose over $6bn over the next seven years,' said Holly Ward, a spokesperson for the Arizona Hospital and Healthcare Association, in a statement. 'In other words, more than 55% of Arizona hospitals would be operating in the red,' she said. 'Hospitals will be, at best, forced to restrict services such as obstetrics, behavioral healthcare and other complex services, and at worst, will close their doors altogether.' Another issue is the potential for Republicans' cuts to drive up the cost of healthcare for Americans who are privately insured, including through employers. As hospitals fight to survive, they will try to extract as much money as possible from other sources of funding – namely, commercial insurance. In addition, rural healthcare providers worry the water will be muddied by the sheer complexity of US healthcare. Private companies have a hand in managing – and therefore branding – state Medicaid programs. 'A lot of our rural voters may not even realize that what they have is Medicaid, because there are so many names for it,' said Stradley. However, the precarious situation is already worrying people whose lives have been stabilized because of Medicaid. Amanda Moynihan is a single mother of three children – ages nine, 12 and 16 – living in Kuna, Idaho. Medicaid expansion has helped her become a 'functioning human in society', she said. Routine medical care for herself and her children, along with other assistance programs, has meant the difference between grinding poverty and a shot at the middle class. Idaho, one of the most politically conservative states in the union, expanded Medicaid in 2018 with an overwhelming ballot-referendum vote of 61-39. Even if Idaho's 'trigger law' does not go into effect, the state could face similar fiscal challenges to Arizona. 'Back two years ago, before I started school, I was just in fight-or-flight, just trying to pay the bills there. I didn't ever see a future of what I could do. And then I just started with one class,' she said. Moynihan has completed an associate degree in psychology and is starting the social work bachelor's degree program at Boise State University in the fall. For now, she's working part time with the Idaho Commission for the Blind and Visually Impaired and planning to pick up work at a gas station because it has a college scholarship benefit. But without stability to pursue higher education, her future 'would be making the minimum wage, which is about $15 an hour, barely paying rent in a low-income household'.
