Dime &

White phosphorus

Done by:Mohammed A Qazzaz

On December 27, 2008, Israel launched “Operation Cast Lead” – a 22-day military

campaign with the stated aim of suppressing rocket fire from Gaza into Israel. Human

Rights Watch documented serious violations of the laws of war by Israel, Hamas and

other Palestinian armed groups, some of which amounted to war crimes. In Gaza,

more than 700 civilians died in the fighting; in Israel, 3 civilians lost their lives.

Laws-of-war violations by Israeli forces included drone-launched missile attacks that

killed 29 civilians, the killing of 11 civilians holding white flags, and the use of white

phosphorus munitions in densely populated areas. Hamas and other Palestinian armed

groups violated the laws of war by firing hundreds of rockets deliberately or

indiscriminately into civilian areas in Israel.

DIMEDense Inert Metal

Explosive

A DIME weapon is a bomb or missile that detonates with powerful and lethal explosive power confined to a small area.

USA : - create it. - firstly uses it. - passed it to Israel .

Dime Bomb is a mixture of:

-Carbon fibers -An explosive material (such as HMX

or RDX) -Small particles of a chemically inert

material such as tungsten.

Dime Bomb

DIME is LCD (”low collateral damage”)

- DIME bombs produce a superheated “micro-shrapnel” of powdered Heavy Metal Tungsten Alloy (HMTA) .

- (HMTA) composed of tungsten and other metals such as cobalt and nickel or iron .

-Those shrapnel enter the body , which is very lethal at close range

)4 meters or 13 feet.(  

-Survivors close to the lethal zone may have their limbs amputated ,(as the micro shrapnel can slice through soft tissue and bone).

Effects of Dime *DIME wounds are:

-Considered to be untreatable.

-The metal is delivered in the form of a fine powder which is can’t be removed by surgery, and can’t be detected by X-ray.

-When the shrapnel hits the body, it causes very strong burns that destroy the tissues around the bones… it burns and destroys internal organs, like the liver, kidneys, and the spleen.

Effects of Dime

Scientific studies have found that HMTA is :

- Chemically toxic. - Damages the immune system, rapidly causes cancer, and attacks DNA (genotoxic).

- Rapidly induces??!!: rhabdomyosarcoma cancers.

- In the summer of 2006 , Israel had been using a new weapon

in the Gaza Strip, similar to DIME .

• Diagnosis :• Unusual injury (complete amputation,

low hemorrhage& severe heat at the point of amputation but no metal shrapnel).

• Tissue damage.

DIME

Management

Patient come to the hospital with shock , so he is supplied with :- Blood, fluids, plasma and antibiotics ( for aerobic &anaerobic).

Surgery

Washing wounds with normal saline. Removal of necrotic tissues . Leave the stump open and put abdominal swaps into it for dressing . After 5 days , reopen the wound in OR under GA.

Cont… Suture the wounds and skin graft if needed.

Remove sutures after 2 weeks.

Physiotherapy & rehabilitation.

Artificial limbs.

White Phosphorus

White Phosphorus (WP)

-Known as Willy Pete. -WP is a colorless to yellow translucent

wax-like substance with a pungent, garlic-like smell.

-The form used by the military is highly energetic (active) and ignites once it is exposed to oxygen (spontaneously

flammable).

Production Of WP

Never found free in nature. Phosphate rock, an impure tri-calcium

phosphate, (important source) .

Tri-calcium phosphate, the essential ingredient of phosphate rock, is heated in the presence of carbon and silica in an electric furnace or fuel fired furnace.

Cont…

Elementary phosphorus is liberated as vapor and may be collected under phosphoric acid.

Uses of WP • Military :ammunition, and to produce

smoke for concealing troop movements and identifying targets.

• Industry :{fertilizers ,special glasses , food additives, and cleaning compounds}.

• Small amounts of WP were used in the past in pesticides and fireworks.

Incendiary

• P4 + 5 O2 → 2 P2O5• P2O5 + 3 H2O → 2 H3PO4

• Highly flammable Produce heat with yellow flame and dense white smoke .

• Continue to burn unless deprived of atmospheric oxygen.

ROUTES OF EXPOSURE: White phosphorus can be

absorbed into the body by:– Ingestion– Skin contact– Eye contact– Inhalation

Burn By WPWP is Highly lipophilic.The resultant burn is deep and

painful (second and third degree ). Rapid dermal penetration. Necrotic area with a yellowish color Burns on the skin are deep and

painful; produce a firm scar surrounded by vesiculation.

Cont…

• Absorption of phosphorus into the body through the burned area, resulting in liver, heart and kidney damage, and in some cases multiple organ failure.

Skin Burn

Oral ingestion • The accepted lethal dose when white

phosphorus is ingested orally is 1 mg per kg of body weight,

• The ingestion of 15 mg may be lethal .• Vomiting, stomach cramps, drowsiness • Phosphorus-laden stool ("smoking stool

syndrome"). • It may also cause liver, heart or kidney

damage.

• Israel used White Phosphorus against targets in Gaza in January 2009.

WP in Gaza

• The initial cases are not discovered. • Second or third grade burn.• Ordinary burn management.• Admission to burn unit. • But….

During debridement, Extensive necrotic tissue Burn had extended into the

underlying tissue (2⁰ 3⁰)Burn had reignited.

Some cases died.

• How had medical stuff diagnosed? Corporation with foreign medical

stuff. Media attention.

WP management• Circulated to medics :

– Secure the scene because live munitions may be in the area.

– Perform ABCs of resuscitation.– Terminate further oxidation of

phosphorus by irrigation or placement of saline-soaked and/or water-soaked pads on areas of exposure.

• Remove affected clothing and rinse affected skin areas with cold sodium bicarbonate solution or cold water.

• Remove visible phosphorus with squared object (knife-back etc.), but it is painful.

Surgery department

During OR:• Removal WP particles and

surrounding necrotic tissues.• If WP particles are small, wood lamb

(ultraviolet light) is used that results in the fluorescing of the white phosphorus and may facilitate its removal.

Cont…

• Some cases had admitted to ICU due to: – Septicemia – Electrolytes imbalance

• Some cases died.

Cont…

• Fluid replacement.• Monitoring of electrolytes and

ECG.• Medication (Silver sulfadiazine,

Neomycin).• Skin graft.

Follow up

• 10 cases only are now recorded as white phosphorus burn in Shifa Medical Center.

• Periodic testing for:– blood phosphorus concentration.– Liver function test.– Kidney function test.

Cont…

No obvious complications were found except high blood phosphorus concentration after 2 years .

(mg/dL)p

Living (Years)Age

5.15

Tel-al-Hawa 5 A.E.R.

4.95

Tel-al-Hawa 7 L.E.R.

4.95

Tel-al-Hawa 5 K.E.R.

3.33

Tel-al-Hawa 32 A.E.R.

4.15

Tel-al-Hawa 25 H.E.R.

_ Aamer project 52 A.K.

_ Beit Lahia 40 S.A.H.

_ Beit Lahia 3 F.A.H.

_ Tel-al-Hawa 25 M.E.J.

4 Tel-al-Hawa 25 M.E.H.

• A presence, higher than the expected average quantity, of the following metals:

• Al, Ti, Cu, Sr, Ba, Co, Mo, W, U, Cr, Li, B, Mn, Rb, As, Cs, Hg, Zn, Ni, Sn, Pb, V, Cd, Ga, Be, Pt, Tl, Mg, Na, K, Ca, and Sb.

Metals detected by ICP/MS in bioptic

samples from Gaza victims

• The presence of toxic and carcinogenic metals in wound tissue is indicative of the presence in weapon inducing the injury.

• Metal contamination of wounds carries unknown long term risks for survivors, and can imply effects on populations from environmental contamination.

 

Cont…

Environmental quality authority

National studies on soil, water and plants were not made because: Coordination debility. Financing deficiency. Equipments deficiency. No complaints.

Prevention!! • Escape as you can.• Cover visible phosphorus

particles in area with sand, blanket or wet pads.

• Cover burned skin with wet pads as possible.