to down load this presentation from this link https://mohmmed-ink.blogspot.com/2020/12/dime-white-phosphorus.html Dime and white phosphorus

1. Done by:
Mohammed A Qazzaz

2. 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.

3. 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.

4. DIME
Dense 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 .

5. Dime Bombis 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

6. 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 .

7. - 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).

10. 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.

11. 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.

13. - In the summer of 2006 , Israel
had been using a new weapon
in the Gaza Strip, similar to
DIME .

14. • Diagnosis :
• Unusual injury (complete amputation,
low hemorrhage& severe heat at the
point of amputation but no metal
shrapnel).
• Tissue damage.
DIME

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

17. 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.

18.  Suture the wounds and skin graft if
needed.
 Remove sutures after 2 weeks.
 Physiotherapy & rehabilitation.
 Artificial limbs.

20. White Phosphorus

21. 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).

22. 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.

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

24. 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.

25. 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.

26. ROUTES OF EXPOSURE:
White phosphorus can be
absorbed into the body by:
– Ingestion
– Skin contact
– Eye contact
– Inhalation

27. Burn By WP
WP 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.

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

29. Skin Burn

32. 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.

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

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

35. 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.

36. 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.

37. • 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.

38. 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.

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

40. • Fluid replacement.
• Monitoring of electrolytes and
ECG.
• Medication (Silver sulfadiazine,
Neomycin).
• Skin graft.

41. 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.

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

43. (mg/dL)
p
LivingYearsAge
5.1
5
Tel-al-Hawa5A.E.R.
4.9
5
Tel-al-Hawa7L.E.R.
4.9
5
Tel-al-Hawa5K.E.R.
3.3
3
Tel-al-Hawa32A.E.R.
4.1
5
Tel-al-Hawa25H.E.R.
_Aamer project52A.K.
_Beit Lahia40S.A.H.
_Beit Lahia3F.A.H.
_Tel-al-Hawa25M.E.J.
4Tel-al-Hawa25M.E.H.

44. • 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

45. • 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.

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

47. 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.