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MedSin 6.30pm Monday 9 November 2009 Plymouth

Environmental and historical contexts are vital in describing and understanding disease in a population. The environment of Gaza and the predicament of its people are unique. To know of it and to feel it in your bones will help you to a deeper understanding of euphemism - 'ethnic cleansing', isolation, stigmatization and, with this latter word on my tongue, crucifixion.

In transporting you again over those 3,100 sea miles to Gaza, you will consider what are the essentials of human existence on this beautiful planet. Good water and food for the body. The love of family. Security within a society. Nourishment for the soul.

I will stick to my text and a few pictures so that I can end inside 50 minutes to allow plenty of time for questions.
Gaza - an ancient oasis on the 'via maris'. Sweet water. WW2 - 66,000 in Gaza. Eyad Serraj, psychiatrist, native of Gaza, recalls running through woods, birds in the boughs, down to the sparkling sea with the glint of plentiful fish. The population of Palestine then was 1.85 million, one third being Jews - almost all of whom were recent immigres from Europe, and two thirds Palestinian Arabs. Now there are 11 million people living in Palestine, 6 million being in that part which is named Israel. So the population has grown sixfold in sixty years.

Back to '47/'48.
Palestinian And Jewish Land 1946
Palestinian And Jewish Land 1946
UN Partition Plan 1947
UN Partition Plan 1947
The first – Mandate Palestine - Balfour declaration of 1917 which, in 126 words gave away the native peoples land to another group who had no title over the mass of it. So called Arab-Israeli war and el nakba - catastrophe of April/May 1948. 80% of the Palestinian Arab population - 800,000, driven by terror and by force of arms from their homes, their living and their land. A largely pastoral population in a land which was, WAS, 'the land of milk and honey'. Many fled to Gaza on foot, and others escaped in vehicles or by boat.
They lived in tents for several years.
They were given materials to make concrete blocks and simple houses. About 50% of the population of Gaza are refugees. The UNWRA -UN Works and Relief Agency - set up by one of the first UN resolutions dealt with all Palestinian refugees – Lebanon, Syria, Jordan, 'West Bank', Gaza (which took the majority), Egypt, Iraq. It helps to sustain the misery to this day and not to solve it. Others to a wider diaspora, including Chile and about 40 countries in all. UN Geneneral Assembly resolution 194 was passed in November 1948 and required, patronisingly, that Palestinians who wished to live in peace with their Jewish neighbours should be allowed to return by the newly declared state of Israel. Statehood for 'Israel' was dependent on its observation of UNGA 194 but no 'return' has ever taken place. The population of Gaza has since swelled to 1.5 million from about a quarter of a million in '48 and this is squeezed into 365 square kilometres. That is 4000 persons per square km. On average, there are six children per family. Attitudes to contraception mirror those of Catholics here a few decades ago. It is only acceptable to most if the mother's health might be affected by another child. Strict sexual mores mean that chlamydia is uncommon and thus tubal scarring with consequent infertility. 45% of the population are 15 or under! Literacy is said to be 93% and the proof that education is cherished.

Agriculture. A sandy but productive land – citrus fruits grow well and with excellent flavour. Strawberries, vegetables and salad crops, tomatoes, date palms in the south. Largely dependent on irrigation. Flowers, such as carnations, were exported in large quantity before 2000. So little land, the majority do not till it. The staple foods are imported, with UNWRA having been responsible since 1948 for the feeding and education of those 50% who are refugees.

Communications. There was some freedom of movement in earlier decades so people could travel to East Jerusalem across Israel to worship at Al Aqsa mosque and to the 'West Bank'. Over 100,000 men would cross into Israel to work; their wages were vital to Gaza and to their families. Oppressive restrictions came with the second intifada (shaking loose) in 2000. A siege was laid in March 2006 when Hamas won a majority of seats in the legislature in scrupulous elections. That siege became draconian in June 2007 when Hamas pre-empted a coup by Fatah controlled security forces. About 100 lorries a day bring food and goods into Gaza each day, whereas there used to be 1000. The only port is a harbour for fishing boats. Without a port these people cannot trade and breathe. The French were building a modern port in 2000, with Saudi money, when the Israelis bombed it. Handfuls of Palestinians move in and out across the Israeli border in the north and the Egyptian border in the south, the latter being controlled by Israel. I will speak of the sick and these borders later.

Economy. The unemployment rate (I think males only) is about 50%. 80% of the population is below that poverty line of about a dollar a day. One wage earner, and a low wage at that, might be supporting an extended family of several dozen. The people are industrious and ingenious but commerce is throttled by the blockade – the medieval siege as I have called it. In the recent promised 'greater shoah'/holocaust, almost every one of the remaining 250 factories were destroyed. There was a thriving clothes manufacturing and tailoring business for export. This employed thousands until 2000.

Services. The water is polluted and scarce. I will talk of it later. The sewage system is becoming more inadequate because of population pressure, lack of spare parts (blockaded) and of investment, attacks by the Israeli military and interruptions to the power supply. Large volumes of untreated or partly treated sewage have to flow into the Mediterranean. At present the power is on for about 12 hours a day. That means hospitals rely on generators a lot and they therefore break down with long use. Petrol and diesel supplies are restricted by Israel. Our charity representative relies on fuel from the tunnels for his car.

Military action. Although it was agreed that the fishermen could go out 20 miles they cannot sail more than a few miles from the shore at most. They are frequently harassed and shot at by gun boats which can go at 45 knots and which have a variety of sophisticated weapons. Many have been injured and several killed. One such boat rammed our vessel in the dark, in a stiff sea, 53 miles off Haifa, with the clear intention of sinking the vessel and drowning the 16 of us on 30 December last. We were intent on joining our sisters and brothers in solidarity and to help as best we could.

Farmers are shot at from the borders.

Quote from PMG 7 November

Israeli attack – injuries: Gaza – evening, Israeli tanks shelled the Ash Shuja’iya district during an incursion that included armoured vehicles escorted by reconnaissance aircraft. Two Palestinian Resistance fighters were wounded by intensive Israeli fire during the invasion.

Israeli attack – agricultural sabotage: Central Gaza – morning, firing indiscriminately, Israeli armoured vehicles and bulldozers, escorted by reconnaissance aircraft, raided Palestinian territory to the east of the Al Bureij refugee camp. At the same time, an enemy tank shelled houses while the bulldozers went to work destroying crops.

Israeli attack: Central Gaza – evening, Israeli armoured vehicles, covered by reconnaissance aircraft, shot their way indiscriminately into Palestinian territory east of Deir al Balah and took two people prisoner.

Israeli attack – agricultural sabotage: Khan Yunis – morning, the Israeli Army opened fire from the Green Line on Palestinian farmers at work on land to the east of the town of Al Qarara.

NB – the many attacks in the 'West Bank' and Jerusalem are excluded.

7 children have been killed in the fields since the ceasefire of 18 January. UAVs – drones, patrol the skies night and day. Some are armed with thermobaric missiles. They are surrounded by the fourth largest armed force in the world - on the seas, on land and in the air. The fear does not show in most and the people go on with their grossly restricted lives with remarkable stoicism. Resilience is their badge.

Water All the water, 120 million cubic metres of it, comes from the one coastal aquifer aside from 5% from Israel. It is being abstracted at twice the rate of its replenishment. That replenishment comes mostly from the east where calcium oolite rocks yield calcium chloride, and from the west where there is some salt water ingress. The water is therefore salty. The aquifer is also fed by rainfall, agricultural irrigation and by sewage - about 20% of the total, sinking through the pervious soils to the shallow aquifer. The water is grossly polluted –

a. with viruses, bacteria and protozoa

b. with some of the 400 tons of pesticides which have been used in horticulture and with teratogenic substances like lindane in the list

c. nitrates from fertilizers in horticulture and from the sewage contamination

d. heavy metals

e. probably with dioxins - rubbish is often incinerated.

The majority of people drink bottled water or water from bowsers which has been treated by reverse osmosis. I suspect that the poorest people rely on the chlorinated water that comes out of the tap.

What diseases occur because of these pollutants?

a. The water being chlorinated, I imagine there is little transmission of hepatitis etc. The giardia I got in Gaza probably came from salads.

b. The Hamas government are regulating the use of pesticides I believe but the residues of insecticides, fungicides and herbicides will probably take a long time to decay. I stress that reverse osmosis deals with them. I have heard it claimed that the miscarriage rate has risen and that might reflect increased foetal malformation. Young wives are presenting with primary ovarian failure; this is thought to be due to an environmental influence. There is a much increased risk of hypospadias - the urethra exits below the penis. There are degrees of severity. A feminising pollutant in the mother is the likely cause. A paediatric urological surgeon, Jihad AbuDaia deals with these many cases very expertly at the European Hospital.

c. Nitrates cause methaemoglonaemia – the blue baby syndrome. The haemoglobin cannot pick up oxygen. That is seen in Gaza. An association between nitroso compounds and large bowel cancer is claimed.

d. Heavy metals contaminate some of the 'pesticides' for instance. I do not know if disease is being caused by them. There is a long list.

e. When I led a group of doctors to Gaza in 2006, I insisted that we met the men in charge of the sewage system and those who ran the water system. We saw the beaten up sewage lagoons. I asked about possible dioxin contamination of the aquifer; they were uncertain. We do not speak much of these potent chemicals in the UK. They are teratogenic, oncogenic and mutagenic. They do not degrade in the environment. When ingested they are taken up in fat. The most grotesque poisoning with these agents occurred with Agent Orange in Vietman. This defoliant, which was sprayed from aircraft to lay bare the forest, contained large amounts of dioxin. Foetal deformities were very frequent, among other evil affects – lymphomas etc. This graph of rising dioxin concentration in Esthwaite Water, Cumbria is food for thought.
Concentration profile of PCDD in a dated sediment core from Esthwaite Water, Cumbria. The sources are unknown.

f. lastly but most importantly there is the influence of the scarcity of water on the urinary system. I have no figures but infection and stone are common in Gaza. High summer temperatures and humidity increase the need for volume. The short urethra in the female increases the risk of ascending infection with motile bacteria and this is countered by drinking plenty. I imagine that pyelo-nephritis is common in young girls and this probably contributes to a higher incidence of chronic pyelonephritis, chronic renal failure and the need for dialysis.

I am not being personal – but how many of you had a bath or shower this morning? Hands up. How many of you were instead sharing a cold tap with several other families in a biting north-east wind? When I am washing our vegetables under the tap, having already cleaned off the soil by our water butt, I think of women in Gaza. Their greens are often grown with the help of human sewage – night soil. How thoroughly can they be cleaned of giardia etc to be safely eaten raw. Fuel is precious. Some of you saw the child cooking flat bread with cardboard for a fire. Diarrhoeal disease is common, worms are common.

Iron deficiency anaemia. This is common in Gaza. About a third of the children under 5 and a third of women have an iron deficiency anaemia defined as being a haemoglobin of less than 11 grams per 100ml. The published figures vary of course, given the environment in which these studies are carried out.

The causes –
a. a poor diet, the staples being flour and lentils and little animal protein

b. intestinal worms – ascaris lumbricoides the most common – does not cause bleeding like the vile hookworm but I imagine it competes for nutrients in the lumen whilst it produces millions of eggs. Eggs picked up in soil and water.

c. inadequate cooking – I have referred to the fuel poverty, as with our old people in our rich country. When in Gaza in May last year I was told that a bottle of gas which cost 3 shekels in Egypt (about half a dollar) was selling for 50 shekels in Gaza having been brought through the tunnels at Rafah.

The effects -

a. Retardation of cerebral development in the young child. I think this is likely to be due to the deficiency of iron as a co-enzyme in cerebral cellular growth. There are thousands of references on this retardation. Think of it – not reaching your potential for lack of iron.

b. Child bearing – fatigue, less able to withstand bleeding, greater post partum bleeding – and in the baby – pre-term delivery more common, lower birth weight, poor iron stores and poor cognitive performance.

Malnutrition Definitions vary. Two simple signs in the elderly in Britain, and very familiar to me in my specialties, are lack of orbital fat indicating negative carbohydrate balance and masseter wasting showing negative protein balance. The child of Gaza, and those many other poor children in our world, is stunted for lack of food of sufficient quantity and quality. Roughly two-thirds of the population - 50 percent of whom are under 18 - is deemed food insecure, according to FAO. Whilst the UK population throws away a third of its food.
UNICEF 2000 Low weight at birth, insufficient feeding, inadequate care and nutrient depletions caused by repeated bouts of illness culminate over time in a child whose height is less than that of other children of the same age. Such stunting is a standard marker of a failure in early growth. Deprivations in feeding and care that impair growth in the critical first years may also reduce a child’s cognitive development and learning ability, often leading to poor school performance and dropping out. Some 39% of children under five in the developing world are stunted – around 209 million children. Stunting rates are highest in Asia and sub-Saharan Africa. Stunting also occurs when babies are born underweight because the mother was poorly nourished or because she was herself stunted. Once established, stunting and its effects typically become permanent. Stunted children may never regain the height lost and most will never gain the corresponding weight. And when the window of early childhood is closed, the associated cognitive damage is often irreversible.

The central causes are firstly mass unemployment – the remaining 250 factories were raized in the recent holocaust of Gaza adding to this, and secondly the draconian siege. The latter restricts choice and quantity of food. The ban on cement and steel rods means little building work.

Inherited disorders and consanguinity. 28% of marriages are between first cousins. I can discuss this freely in Gaza because the prophet Mohammed gave the sound advice to go out of one's country to marry ie join a wider gene pool. I have seen congenital deafness in a family affecting 3 out of 7 children, blindness and a vicious neural condition called familial spastic paraplegia affecting 3 out of 7 children. Ironically, potential couples are screened in Gaza for thalassaemia.

Psychological illness. It is terrible to report that PTSD occurs in over 90% children according to my friend, the psychiatrist Dr Eyad Serraj. Silence, nightmares, and learning going backwards. Bed wetting up to teenage years is common in both genders. These sequelae of grotesque inhumanity are compensated in part by strong family and community bonds plus an avidity for learning. One cause is the production of sonic booms by F16 bombers flying at roof top over Gaza. In November 2006 that happened night after night.

Weapons. I wish to include injuries caused by weapons as disease, epidemic disease. The world's population has been subjected to scaremongering over swine 'flu but they are not told about the numbers being killed or injured by small arms fire – and the rest.

Bullets, cannon, shells - 'Stand at Rafah with one's back to the wall of steel piles and view the Warsaw of 1943. The facades of those few buildings which remain standing are pock marked by thousands upon thousands of bullets and cannon shells, hatred in every one. The mound over there! My friend, a lecturer in English at the Islamic University of Gaza was given thirty minutes to leave in April 2004 with his wife and six children before it was shelled in the dead of night.' (part of a letter by me to the Morning Star)

Flechette weapons – small darts, discs etc which are flung widely at high velocity. Flechettes

Thermobaric or 'fuel/air' weapons – as bombs or as rockets, from planes, unmanned aerial vehicles (drones) or fired from the surface as our troops are doing in Afghanistan. There is an intitial detonation and then a secondary detonation of a powder such as aluminium. This produces a marked pressure wave and then a negative pressure as the oxygen is consumed. It can 'kill round corners'. There may be little external evidence of injury in a person who dies of visceral tearing etc.

DIME – Dense Inert Metal Explosive. Shearing amputations – sometimes across the lower trunk.

White phosphorus – P15. As you know it ignites on exposure to air. Incendiary weapons were proscribed in war by the Hague Convention of 1907. All weapons are terrible in their potential but this is one of the worst. But I will show you worse. The chemical can burn down to the bone and the pain is extreme, as you would imagine. It is also very toxic and people died in Gaza after they suddenly collapsed. 

Uranium weapons. It is believed that these were used in Gaza in the recent holocaust.

Medical care: interrogation. There is little tertiary care in Gaza and for a raft of reasons. Patients with cancers and severe medical conditions are referred to Egypt, Jordan and Israel. Entry to Israel requires interrogation at Erez by Shin Bet, the internal security force. If the patient does not agree to collaborate in some way, they are sent home to perish. This is documented in detail by the Physicians for Human Rights – Israel (Ran Yarom).

I have turned up the high power lens to describe these man made diseases in Gaza as best I can. But it is no good knowing what the cholera vibrio looks like if we do not follow Dr John Snow's path and consider the genesis of these diseases.

Here it is, and some of you might recoil.

Image This is a photo of a satisfied looking Hitler beside Il Duce. Hitler invaded Poland on a pretext. 36 million people died in WW2, 27 million being Russian. On usual ratios we can assume 100 million were maimed in some way. There were several holocausts, including those of Hiroshima and Nagasaki.

Image This is President Lyndon Johnson. The Vietnam war was started on the pretext that the US fleet was attacked in the Gulf of Tonkin – August 1964. Up to 4 million Vietnamese were killed and 60,000 US servicemen.

Image This photo is of Anthony Charles Lynton Blair. He agreed to bring hell to earth in Iraq at a barbecue in Crawford in April 2002. He used several pretexts to dupe those who wanted to be duped. He helped kill over 1 million of a population of 25 million and caused 4 million to flee their homes – equivalent in the UK to 12 million refugees. He and his allies used uranium weapons, as the allies had done previously in 'Desert Storm', so that in Fallujah there is a very high rate of foetal deformity and a still birth rate of over 20%. The imams are advising the wives not to have babies.

Image This is a photo of PM Ehud Olmert who used Qassam rockets as a pretext to bring hell to earth in Gaza between 27 December 2008 and 18 January 2009 and which was promised as a 'greater shoah' by Matan Vilnai, deputy defence minister in February 2008.

What separates Hitler's war from the samples that follow? The Nuremberg Principles and trials of 1946 and the Charter of the United Nations. Nuremberg speaks of aggressive war being the supreme war crime – from which all other crimes flow – refugees, theft of natural resources, starvation, rape, destruction of cultures, of a people's memory etc

The wars I cite above are all supreme war crimes, as was the recent shoah. It is as if there never were any Nuremberg Principles.

This photo is of Ali Abbas, aged 9 from Zawaniyah near Baghdad, and 10 days after Blair and Bush's 'Shock and Awe' started.
Just as his arms were incinerated, so too were his mum and dad, and 10 other relatives. I am certain that only a nuclear weapon could have produced such a sun burst of thermal energy. Ali symbolises the depth of evil being done by psychopaths, Blair being prime amongst them.
The vortex of evil sucks forever louder. All that I have described is wilful – intended - planned.

The political class have nothing to offer but yet more pain and loss. Corporate action from the medical profession is absent. Doctors mostly are silent or they march in step. But you young people, and Medsin, give me realistic hope.

Doctors are close to suffering. They should never tolerate man made disease, injury and killing unless it be the last resort.

My motto for these last 8 years since I have stood with the Palestinian people, and with the others targeted by the war on Islam, is adapted from a surgical maxim of mine. It is 'do your best to heal and not to harm'.

It all comes down to this.
This photo of a boy comes from the web site of Haim Bresheeth. The words are mine.
Thank you

"It's right that we explain there is a chain of terror that links Pakistan and the Afghanistan-Pakistan border to the streets of our cities in Britain." Mr Brown PhD (History) said this at the Cenotaph 7 November 2009

''There is an axis of evil with Tel Aviv at one pole and Washington at the other. In the centre is London where barbarity and treachery is clothed in plummy speech and fine spectacle. Power shuttles backwards and forwards along this axis as busily as the jets carrying the psychopaths to these command centres which bring hell to earth.'' Mr Halpin MB BS FRCS said this on Dartmoor 8 November 2009

America The Betrayed Walt Whitman: "Poet of the People" By Richard C Cook

URL of this article: Global Research, November 6, 2009

'It is time for each and every individual who values his or her own life along with the creative potential of the human spirit to begin to work with others to create a new nation and world. The government isn't going to do it for us. Please believe me. This is not a system that can be reformed. It is a system that must be replaced. And it must be replaced by the ordinary working men and women who have been crushed, used, and abused during the past ugly half-century.'

My biggest mistake was to grow up and to grow into middle age believing our government was essentially benign. Should that be part of the messsage? Examine things for yourselves, do not trust governments - they have too much to gain from your acquiescence! Dr Chris Burns-Cox FRCP 7 November 2009

ONE Worsening malnutrition for Gaza children
World Health Organization reported that more than 10% of children in Israeli-besieged Gaza 'chronically malnourished'. Saturday, 25 April 2009 09:39

Rising poverty, unemployment and food insecurity in Gaza, compounded by the recent 23-day Israeli offensive, have increased the threat of child malnutrition, say UN agencies, health ministry officials and healthcare NGOs in Gaza.

UN World Health Organization (WHO) officials are concerned by the warning signs, including rising malnutrition indicators - like increased cases of stunting, wasting and underweight children - and continuing high rates of anaemia among children and pregnant women.

A Food and Agriculture Organization (FAO)/World Food Programme (WFP) qualitative food security assessment for Gaza in 2008 and early 2009 points to increasing food insecurity compared to 2007, said FAO food security adviser Erminio Saco based in Jerusalem; and according to the Palestinian Central Bureau of Statistics (PCBS) food acquisition and energy consumption in Gaza declined by 10 percent between 2005 and 2007.

Over the past 18 months the agricultural sector has been struggling to cope with an Israeli blockade on imports and exports, causing lower productivity and reducing access to affordable fresh food, according to FAO.


The UN Children’s Fund (UNICEF) said in January that 10.3 percent of children under five are stunted (low height for age), a steadily increasing trend over recent years.

Stunting is usually attributed to a chronic lack of protein and micronutrients, including iron and essential vitamins, according to WHO. “More than 10 percent of children in Gaza are chronically malnourished,” said WHO officer Mahmoud Daher in Gaza, reporting a slight increase over 2008.

Children’s hygiene has also declined due to the lack of a consistent electricity supply since the blockade was instituted. Clothes washing and bathing has been limited, especially during the conflict, according to residents.

In April 2008 UNICEF estimated there were about 255,000 under-five children in Gaza, with about 26,265 at risk of malnutrition, and 657 most likely to be severely wasted.

Roughly two-thirds of the population - 50 percent of whom are under 18 - is deemed food insecure, according to FAO.

Wasting and underweight

The number of under-five children suffering from acute malnutrition - wasting (low weight for height) - in Gaza almost doubled between 2006 and 2008 from 1.4 to 2.4 percent, according to UNICEF. Wasting is considered a public health problem if the affected population exceeds 5 percent, but WHO is concerned by the significant increase.

In 2008, 2.5 percent of under fives were underweight (weight for age), according to WHO in Gaza.


"Anaemia among children and pregnant women is high in Gaza and there are fluctuations in the rates according to availability of food and the political and economic situation in the area,” said Daher.

WHO believes iron and vitamin A deficiencies have increased during and since the conflict. The results of WHO’s current anaemia assessment in Gaza are due in May, but according to Daher, 65 percent of children aged 9-12 months, and 35 percent of pregnant women are anaemic.

The UN agency for Palestinian refugees (UNRWA) has an assessment due in July, but is also concerned about the increase in anaemia cases, according to UNRWA health officer Mohammed Maqadma.

There is a positive correlation between malnutrition and low meat (animal proteins) intake, low consumption of fruit, family size and income, according to UNICEF.

The amount of affordable fresh fruit and protein on the Gaza market has been significantly reduced due to the closures, according to OCHA. “The last shipment of livestock entered Gaza on 31 October 2008, and since the Hamas takeover in June 2007 livestock imports have been severely restricted,” said OCHA field officer Hamada al-Bayari in Gaza.

The director of all 56 primary healthcare centres run by the health ministry in Gaza, Fouad Issawi, said cases of stunting and anaemia increased in 2008 and 2009. Since 2007 the amount of anti-anaemia drugs - like ferrous carbonate (with vitamin C) and folic acid - required by primary health clinics had increased dramatically, he said.

“There was a rise in anaemia amongst children in our centres in 2008 and [this is] continuing,” said Adnan al-Wahaidi, director of Ard al-Insan Benevolent Association in Gaza, the main healthcare NGO supporting an estimated 16,000 undernourished children.

“Women with children who are underweight or wasting have been coming to the centres in greater numbers over the last few months; many of their husbands died during the recent conflict or are unemployed.”

TWO Disease when it comes

SIEGE – 360 died

The number of Palestinians who have died as a result of the Israeli siege on Gaza has passed 360, a statement released by the health ministry of the deposed Palestinian government in Gaza has said. The statement followed the death of a Palestinian man on Tuesday, who was denied approval to leave the Strip to receive medical treatment abroad. Asaad Ibrahim Mohammad Asfour, 51, who had lung cancer and cancer of the bronchial tubes, is the latest victim of Israel's

THREE Effect of iron-deficiency anemia on cognitive skills and neuromaturation in infancy and childhood. Walter T.

Institute of Nutrition and Food Technology, University of Chile, Santiago. This email address is being protected from spambots. You need JavaScript enabled to view it.
Iron-deficiency anemia in infancy has been consistently shown to negatively influence performance in tests of psychomotor development. In most studies of short-term follow-up, lower scores did not improve with iron therapy, despite complete hematologic replenishment. The negative impact on psychomotor development of iron-deficiency anemia (IDA) in infancy has been well documented in more than a dozen studies during the last two decades. Two studies will be presented here to further support this assertion. Additionally, we will present some data referring to longer follow-up at 5 and 10 years as well as data concerning recent descriptions of the neurologic derangements that may underlie these behavioral effects. To evaluate whether these deficits may revert after long-term observation, a cohort of infants was re-evaluated at 5 and 10 years of age. Two studies have examined children aged 5 years who had anemia as infants using comparable tools of cognitive development showing persisting and consistent important disadvantages in those who were formerly anemic. These tests were better predictors of future achievement than psychomotor scores. These children were again examined at 10 years and showed lower school achievement and poorer fine-hand movements. Studies of neurologic maturation in a new cohort of infants aged 6 months included auditory brain stem responses and naptime 18-lead sleep studies. The central conduction time of the auditory brain stem responses was slower at 6, 12, and 18 months and at 4 years, despite iron therapy beginning at 6 months. During the sleep-wakefulness cycle, heart-rate variability--a developmental expression of the autonomic nervous system--was less mature in anemic infants. The proposed mechanisms are altered auditory-nerve and vagal-nerve myelination, respectively, as iron is required for normal myelin synthesis.
PMID: 17016952 [PubMed - indexed for MEDLINE]

AND Food Nutr Bull. 2003 Dec;24(4 Suppl):S104-10.

FOUR Ankylostoma doudenale Hookworms File Format: PDF/Adobe Acrobat - Quick View Islamic University of Gaza 2009-2008. A practical guide to Diagnostic Medical ... identification of hookworms in stool specimens, primarily from the -

FIVE Troubled Water – Palestinians Denied Fair Access to Water

SIX Uninsured families in US – higher death rate in the children John Hopkins

17,000 children died in 37 states over 2 decades. Risk of death increased by 60% if family uninsured.