Though the Syrian government has denied responsibility for the attack, witnesses tell Reuters that they saw a Syrian army jet drop three conventional bombs on the town Tuesday morning, along with one that left a cloud of white smoke.
Civil defense worker Khaled al-Nasr described the scene to Reuters: “We saw everyone was on the ground. People were squirming. Some had foam coming out of their mouths. We started picking people up.” Nasr says that shortly after arriving on the scene, he felt a burning sensation in his eyes but kept working until he was unable to continue. “I couldn’t breathe,” he said.
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Chemical attacks are horrifying and experts say they’re often deadly—especially for children. “It’s the most obscene way to die that I’ve ever seen, and that’s coming from someone who has seen a great deal of deaths,” says Annie Sparrow, M.D., a critical-care pediatrician at The Mount Sinai Hospital. A person’s reaction to a chemical attack depends on what chemical it is, she explains, but sarin is a nerve agent that paralyzes a person’s muscles. “You can’t breathe, so you suffocate to death,” she says. Sarin is not only inhaled, it’s absorbed into a person’s clothes and skin: “It’s a disaster,” she says.
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Symptoms of a sarin attack often include loss of voluntary muscle control, an inability to breathe, drooling or foaming at the mouth, nausea, and vomiting, and “pinpointing” of the pupils, says John Gilbert, a senior science fellow with the Center for Arms Control and Nonproliferation. “Several Khan Sheikhun victims also exhibited what can be described as ‘claw hands,’ where a victim’s hands contract in a claw-like posture, often with the hand bent forward at the wrist,” he says.
Sarin is liquid at a moderate temperature and pressure but vaporizes very quickly (in seconds to minutes) once it’s exposed to air, Gilbert says. Once it’s released, sarin dissipates quickly but is heavier than air, which means, “It would stay close to the ground or even descend into low places such as basements or bomb shelters,” Gilbert says. If sarin is released, people who die often have no external injuries such as shrapnel wounds or burns. “There may also be dead birds or animals near the site of a sarin release and those animals would also not show external wounds,” he says.
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It’s possible to reduce “cross contamination” (i.e. sarin impacting medical aid workers or others trying to help a victim), by spraying victims with a fire hose or using special decontaminated solutions, Gilbert says. A victim’s clothes are also often removed and thrown away to try to limit exposure.
If someone survives a sarin attack, they can be delirious, have schizophrenia-like symptoms, vomiting, and seizures, Sparrow says, adding, “it takes a long time to wear off.” Some people may even be paralyzed forever. “If you survive it, it’s not like you’re going to survive it intact,” she says.
Some reports say chlorine may have been used in the Syrian attacks as well, which Sparrow says turns into hydrochloric acid and “dissolves” a person’s lungs when it’s breathed in. “Lungs start filling with blood and fluid,” she says. “More people can survive a chlorine attack, but if you do survive, you can be left with long-term health complications.”
There is a sarin gas antidote—atropine–which Sparrow calls a “great drug,” but it has to be administered to a person quickly. “No one teaches you how to deal with this stuff in med school, and you don’t always know what [chemical] you’re facing,” she says. “It’s so difficult.”