School playgrounds across Syria are being transformed into vegetable gardens where children whose diets have been devastated by six years of war can learn to grow — and then eat — aubergines, lettuces, peppers, cabbages and cucumbers.

Traditional Syrian cuisine is typical of the region, and rich in vegetables. Its mainstays include hummus, minced lamb cooked with pine nuts and spices, varied salads, stews made with green beans, okra or courgettes and tomatoes, stuffed cabbage leaves and artichoke hearts.

But the six-year war has changed that for much of the population, and many now live mainly on bread or food aid.

According to U.N. figures, unemployment now stands at more than 50 percent, and nearly 70 percent of the population is living in extreme poverty, in what was once a relatively wealthy country.

“The ongoing crisis in Syria is having a devastating effect on the health and nutrition of an entire generation of children,” Adam Yao, the U.N. Food and Agriculture Organization’s (FAO) acting representative in Syria, said on Tuesday, ahead of the start of the school year.

FAO is helping some 17 primary schools in both government and opposition-controlled areas to plant up to 500 meter-square fruit and vegetable plots in war-torn areas including Aleppo, Hama, Homs, Idlib and the outskirts of Damascus.

Young children are often the most vulnerable to malnutrition in a crisis, which can have serious and long-lasting effects on their growth and future development.

“Good nutrition is a child’s first defense against common diseases and important for children to be able to lead an active and healthy life,” Yao added.

The primary schools, which began planting in May, have produced 12 tons of fruit and vegetables. Another 35 schools are expected to start transforming their playgrounds soon in Aleppo and in rural areas around Damascus.

Rising prices, falling production

The price of food has risen since the start of the war — agriculture production has plummeted, and the country now relies on food imports to make up the shortfall. Transporting food around the country has also become difficult and costly.

About 13.5 million people in Syria are in need of humanitarian assistance. Of those, 7 million are unable to meet their basic food needs.

Some 5 million people receive international food aid, but not everyone in need can be reached, and the World Food Program says it has had to cut the amount of calories in its family food baskets because of funding shortages.

“The donors are generous, but we don’t know how long they can continue to be generous and rely on taxpayers’ money,” the FAO’s Yao told Reuters.

Vulnerable families are receiving help from FAO to grow food at home, so they can become less reliant on food aid.

“Food aid is very important, but … we should combine both, in a way that people grow their own food and move away from food aid gradually,” he said.

In a country where more than half the population has been forced to flee their homes, many moving several times, investing in agriculture helps people to stay put for as long as it is safe, Yao added.

“Agriculture has become a hope for [many] because they can grow their own food and survive — even in the besieged areas.”
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By the time the rain stops, Harvey will have dumped about 1 million gallons of water for every man, woman and child in southeastern Texas — a soggy, record-breaking glimpse of the wet and wild future that global warming could bring, scientists say.

While scientists are quick to say that climate change didn’t cause Harvey and that they haven’t determined yet whether the storm was made worse by global warming, they do note that warmer air and water mean wetter and possibly more intense hurricanes in the future.

“This is the kind of thing we are going to get more of,” said Princeton University climate scientist Michael Oppenheimer. “This storm should serve as warning.”

There’s a scientifically accepted method for determining if some wild weather event has the fingerprints of man-made climate change, and it involves intricate calculations. Those could take weeks or months to complete, and then even longer to pass peer review.

Storms to produce more rain

In general, though, climate scientists agree that future storms will dump much more rain than the same size storms did in the past.

That’s because warmer air holds more water. With every degree Fahrenheit, the atmosphere can hold and then dump an additional 4 percent of water (7 percent for every degree Celsius), several scientists say.

Global warming also means warmer seas, and warm water is what fuels hurricanes.

When Harvey moved toward Texas, water in the Gulf of Mexico was nearly 2 degrees (1 degree Celsius) warmer than normal, said Weather Underground meteorology director Jeff Masters. Hurricanes need at least 79 degrees F (26 C) as fuel, and water at least that warm ran more than 300 feet (100 meters) deep in the Gulf, according to University of Miami hurricane researcher Brian McNoldy.

Downpours on the rise

Several studies show that the top 1 percent of the strongest downpours are already happening much more frequently. Also, calculations done Monday by MIT meteorology professor Kerry Emanuel show that the drenching received by Rockport, Texas, used to be maybe a once-in-1,800-years event for that city, but with warmer air holding more water and changes in storm steering currents since 2010, it is now a once-every-300-years event.

There’s a lot of debate among climate scientists over what role, if any, global warming may have played in causing Harvey to stall over Texas, which was a huge factor in the catastrophic flooding. If the hurricane had moved on like a normal storm, it wouldn’t have dumped as much rain in any one spot.

Harvey stalled because it is sandwiched between two high-pressure fronts that push it in opposite directions, and those fronts are stuck.

Oppenheimer and some others theorize that there’s a connection between melting sea ice in the Arctic and changes in the jet stream and the weather patterns that make these “blocking fronts” more common. Others, like Masters, contend it’s too early to say.

An off-the-chart-event

University of Washington atmospheric scientist Cliff Mass said that climate change is simply not powerful enough to create off-the-chart events like Harvey’s rainfall.

“You really can’t pin global warming on something this extreme. It has to be natural variability,” Mass said. “It may juice it up slightly but not create this phenomenal anomaly.”

“We’re breaking one record after another with this thing,” Mass said.

Closing in on rainfall record

Sometime Tuesday or early Wednesday, parts of the Houston region will have broken the nearly 40-year-old U.S. record for the heaviest rainfall from a tropical system — 48 inches, set by Tropical Storm Amelia in 1978 in Texas, several meteorologists say.

Already 15 trillion gallons of rain have fallen on a large area, and an additional 5 trillion or 6 trillion gallons are forecast by the end of Wednesday, meteorologist Ryan Maue of WeatherBell Analytics calculates. That’s enough water to fill all the NFL and Division 1 college football stadiums more than 100 times over.

 
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The muddy floodwaters now soaking through dry wall, carpeting, mattresses and furniture in Houston will pose a massive cleanup challenge with potential public health consequences.

It’s not known yet what kinds or how much sewage, chemicals and waterborne germs are mixed in the water. For now, health officials are more concerned about drownings, carbon monoxide poisoning from generators and hygiene at shelters. In the months and years to come, their worries will turn to the effects of trauma from Hurricane Harvey on mental health.

At a shelter set up inside Houston’s George R. Brown Convention Center, Dr. David Persse is building a clinic of doctors and nurses and trying to prevent the spread of viruses or having to send people to hospitals already stretched thin.

“This is rapidly evolving,” said Persse, Houston Director of Emergency Medical Services. “I always worry in these large congregations of people about viral outbreaks that cause nausea, vomiting and diarrhea. And we are just getting started.”

Medics have been at the convention center since it started taking in evacuees, along with police and other first responders. Over the last 24 hours, doctors and nurses arrived at the convention center to volunteer.

Fewer than 20 people have been hospitalized so far from the convention center.

“One of our goals is to appropriately treat people here with minor things so we don’t send everybody off to the hospital,” Persse.

Many of the around 3,000 people who fled from Harvey’s flooding waited hours in water mixed with sewage, oil and gasoline. Some weren’t able to grab their medications or medical devices. Police officers on Monday afternoon were looking for more wheelchairs.

Donors have brought diapers, baby formula and other basic necessities to the convention center. Officials are working with local pharmacies to replace lost medicines and dialysis clinics to serve patients in need of treatment. The Red Cross is arranging to bring in portable showers. A shipment of 50 wheelchairs was on the way Monday afternoon.

The U.S. Environmental Protection Agency will begin sampling the floodwaters as soon as possible, said EPA spokeswoman Liz Bowman in an email Monday. EPA teams will also be visiting water and sewage plants to offer help, she said.

EPA helped secure Superfund pollution cleanup sites last week ahead of the storm and is continuing to check with site operators.

Floodwater can be dangerous for people with open wounds, particularly if they have other health conditions. After Hurricane Katrina, five people with infected wounds died and health officials believe that exposure to brackish floodwater contributed to the deaths.

Katrina taught other lessons.

“In Katrina, a lot of people were concerned about illnesses from contact with the floodwater, but more infectious disease was associated with poor hygiene in overcrowded shelter facilities,” said Karen Levy, associate professor of environmental health at Emory University in Atlanta.

At Houston-area shelters, access to clean water or hand sanitizer and proper disposal of human waste should be stressed, she said.

Any health problems will be more dangerous for the most vulnerable — people with immune disorders, the elderly and the poor, Levy said.

Katrina left a wake of post-traumatic stress disorder and depression, said Dr. Pierre Buekens, dean of Tulane University’s School of Public Health and Tropical Medicine.  He said their surveys showed roughly 10 percent had PTSD, but also that people were resilient.

“I’m sure this will happen in Houston,” he said.

The most common flood-related deaths occur when people try to drive through flooded areas, according to the Centers for Disease Control and Prevention.  Carbon monoxide may kill more as people return to homes without electricity and hook up generators, said the CDC’s Renee Funk.

“Any sort of roof over a generator is actually a problem,” Funk said. “When people go in and out to refill the generator they can be overcome. If a structure is attached to the house, the house can fill with fumes.”

Best advice: Use a battery-operated carbon monoxide detector in the house if you’re using a generator for power, she said.

Mold is also a health hazard. The CDC recommends removing and disposing of drywall and insulation that was tainted by floodwater or sewage. Mattresses, pillows, carpeting — even stuffed toys — should be tossed out. Hard surfaces can be disinfected with a solution of one cup of bleach to five gallons of water.

“That little spot of mold can grow in the home especially in the heat of the South,” said Dr. Parham Jaberi of the Louisiana Department of Health.

 If mold covers more than 100 square feet, a trained mold remover is recommended, he said.

 
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More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients apparently went unreported to police, says a government audit that faults Medicare for failing to enforce a federal law requiring immediate notification.

The Health and Human Services inspector general’s office was issuing an “early alert” Monday on its findings from a large sampling of cases in 33 states. Investigators say Medicare needs to take corrective action right away.

“We hope that we can stop this from happening to anybody else,” said Curtis Roy, an audit manager with the inspector general’s office, which investigates fraud, waste and abuse in the health care system. The audit is part of a larger ongoing probe, and additional findings are expected, he said.

With some 1.4 million people living in U.S. nursing homes, quality is an ongoing concern. Despite greater awareness, egregious incidents still occur.

Using investigative data analysis techniques, auditors from the inspector general’s office identified 134 cases in which hospital emergency room records indicated possible sexual or physical abuse, or neglect, of nursing home residents. The incidents spanned a two-year period from 2015-2016.

Illinois had the largest number of incidents overall, with 17. It was followed by Michigan (13), Texas (9), and California (8).

In 38 of the total cases (28 percent), investigators could find no evidence in hospital records that the incident had been reported to local law enforcement, despite a federal law requiring prompt reporting by nursing homes, as well as similar state and local requirements.

“Based on the records we had available to us, we could not determine that they had been reported to law enforcement,” said Roy.

The federal statute has been on the books more than five years, but investigators found that Medicare has not enforced its requirement to report incidents to police and other agencies, or risk fines of up to $300,000.

Nursing home personnel must immediately report incidents that involve a suspected crime, within a two-hour window if there’s serious bodily injury. Otherwise, authorities must be notified within 24 hours.

Medicare “has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in (nursing homes) are identified and reported,” the inspector general’s report said.

In a statement, the Centers for Medicare and Medicaid Services said “nursing home resident safety is our priority and primary focus,” and it is committed “to ensure these vulnerable people are properly cared for, and that all viable or alleged instances involving abuse or neglect are fully investigated and resolved.”

The agency said it has long required nursing homes to immediately report abuse and neglect to state officials, and it will have a formal response to the inspector general’s findings once the audit is complete.

The inspector general is urging Medicare to start systematically scouring computerized billing records for tell-tale signs of possible abuse of nursing home residents. Investigators used that approach to find the cases, matching emergency room and nursing home records.

Of the 38 unreported cases, 31 involved alleged or suspected rape or sexual abuse, about 4 out of 5.

But even among the 96 cases that were ultimately reported to police, investigators were unable to tell if the federal requirement for “immediate” notification was followed.

In one case classified as “reported to law enforcement,” an elderly woman with verbal and mobility limitations was taken to the emergency room after she was allegedly sexually assaulted by a male resident of the same nursing home. The report said two silver-dollar-sized bruises were noted on her right breast.

Nursing home staff had helped the woman bathe and change clothes after the incident. “These actions could have destroyed any evidence that may have been detected using the rape kit,” said the report.

Nursing home employees did not immediately report the incident to police, although the federal reporting requirement was in effect. The nursing home “should have reported the incident to law enforcement within two hours of witnessing the incident,” the report said.

Instead, the following day the nursing home contacted the woman’s family, who called the police, triggering an investigation.

Citing a separate probe by state officials, the inspector general’s report said the nursing home “contacted local law enforcement in an attempt to keep law enforcement from investigating the incident.”

The state’s own report found that the nursing home told police “we were required to report it but that we were doing our own internal investigation and did not need (police) to make a site visit…no one was interested in pressing charges.” The police continued their investigation.

The state later cited the nursing home for failing to immediately notify the patient’s doctor and family, as well as other violations of federal regulations. But state officials classified the incident as resulting in “minimum harm or potential for actual harm.”

No other details were provided in the federal report. The inspector general’s office reported all 134 cases to local police.

The number of nursing home residents is expected to grow in coming years as more people live into their 80s and 90s. Medicaid is the main payer for long-term care, while Medicare covers doctors’ services and hospital care for elderly people and the disabled.
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