WHO is alarmed by serious reports of the use of highly toxic chemicals in an attack in Khan Shaykhun, southern rural Idleb, Syria. According to Health Cluster partners on the ground treating the patients, at least 70 people have died and hundreds more have been affected. Doctors in Idleb are reporting that dozens of patients suffering from breathing difficulties and suffocation have been admitted to hospitals in the governorate for urgent medical attention, many of them women and children.

"The images and reports coming from Idleb today leave me shocked, saddened and outraged. These types of weapons are banned by international law because they represent an intolerable barbarism," said Dr Peter Salama, Executive Director of the WHO Health Emergencies Programme.

Reports first emerged of the use of chemical weapons agents in Syria in 2012 and have since occurred with disturbing frequency, including repeated allegations of chlorine use in and around Aleppo last year, especially from September to December 2016. This latest reported incident is the most horrific since Ghouta in August 2013.

The capacity of hospitals in the surrounding area is limited, especially as a number of facilities have been damaged as a result of the ongoing conflict. Soon after the reported use of the highly toxic chemical in rural Idleb Tuesday morning, after receiving the first patients, Al Rahma Hospital was rendered temporarily nonfunctional when it was damaged. Ma'ara Hospital, one of the main hospitals in the area, has been out of service since last Sunday due to extensive damage to infrastructure.

Emergency rooms and intensive care units in Idleb are overwhelmed and reporting shortages in medicines required to treat injured patients. Many patients have been referred to hospitals in southern Turkey.

The likelihood of exposure to a chemical attack is amplified by an apparent lack of external injuries reported in cases showing a rapid onset of similar symptoms, including acute respiratory distress as the main cause of death. Some cases appear to show additional signs consistent with exposure to organophosphorus chemicals, a category of chemicals that includes nerve agents.

Medicines – including Atropine, an antidote for some types of chemical exposure, and steroids for symptomatic treatment – were immediately dispatched from WHO’s partner warehouse in Idleb. WHO is shipping additional medicines from Turkey and is ready to provide more life–saving supplies and ambulances as needed. WHO experts in Turkey are communicating with health workers in Idleb to provide around–the–clock guidance on diagnosis and appropriate treatment of patients.