Tag Archives: ‘bomb’

Sask. woman who got stomach removed to thwart cancer describes life with ‘ticking time bomb’

For years, Summer Heide didn’t eat spicy food because the slightest indigestion would trigger fears that she had stomach cancer.

She would lay awake at night, terrified that she would die and leave her children without a mother.

Heide, a 32-year old farmer from southeastern Saskatchewan, isn’t a hypochondriac. A rare and deadly stomach cancer runs in her family and, since learning she inherited a gene mutation that could cause cancer, she’s been forced to make agonizing decisions and take drastic steps to save her own life.

“It was just too much fear over the unknown,” Heide said. “There was always the little bit of ‘When is the ticking time bomb going to go off? When might I get the cancer?'”

DNA discovery

Heide was only a toddler when her aunt, RoseMarie Lawrence, passed away from stomach cancer in 1991. She was just 29 years old.

That kind of stomach cancer, known as diffuse gastric cancer, is particularly sneaky. Cancer cells grow in loose clusters — not a tumour — that can easily move and multiply in the stomach lining. Initial symptoms, such as heartburn, seem innocuous. By the time the cancer is detected, it’s usually too late.

Heide’s uncle Luke Lawrence, RoseMarie’s husband, remembers asking the doctor whether their two children were at risk of getting the cancer.

“I was very concerned for my children because I knew nothing about cancer,” he said. “[The doctor] says ‘Cancer is not contagious.’ At that time, they didn’t know anything about hereditary forms of cancer.”


Luke Lawrence lost his wife and daughter to an aggressive stomach cancer that the family eventually learned was hereditary. (Trent Peppler/CBC)

Sixteen years later his daughter Erin, Heide’s cousin, was diagnosed with the same cancer that had killed her mother.

She was 20 years old and passed away within seven months.

Before she passed away, doctors suggested Erin get genetic testing. She took a blood test, one that didn’t exist before her mother died, and discovered she had a rare mutation in the CDH1 gene that causes Hereditary Diffuse Gastric Cancer Syndrome. It’s a disorder that can pass down through families and puts people at a high risk for developing stomach cancer at a young age.

A child has a 50 per cent chance of inheriting the gene mutation from a parent who is a carrier.

“We didn’t know none of this until it was far too late because Erin had already been diagnosed with Stage 4 of this form of cancer,” said Luke Lawrence, “So [the testing] was to create an awareness for the family, more so than what we could do for Erin. That’s why we did it.”

The family calls it “Erin’s Gift.”

In 2007, Heide and seven other family members went for predictive genetic testing to see if they also carried the gene mutation. Five tested positive, including her grandmother, her father, and herself. 


Summer Heide (second from right) tested positive for the gene mutation that causes Hereditary Diffuse Gastric Cancer (HDGC). So did her sister, Ali Kowaluk (left) and her father, Clint Birkenshaw (second from left). Her brother, Caleb Birkenshaw (right), tested negative. (Submitted by Summer Heide)

Heide was 19 when she got the results.

“It was devastating, obviously, but I think I was so young and naive that I didn’t actually think about what that meant,” Heide said.

What it meant was Heide’s chances of developing the deadly stomach cancer by age 80 were as high as 83 per cent. Women who have the mutation also have an estimated 60 per cent risk of developing lobular breast cancer in their lifetime.

Genetic testing revealed that Summer Heide has a gene mutation that increases her chances of developing a deadly stomach cancer. That discovery has forced Heide to make agonizing decisions that affect her life and the lives of her children. 5:21

Demand for genetic testing increases

Demand for cancer-related genetic testing has increased exponentially over the past two decades, according to the Canadian Association of Genetic Counsellors. Referrals to some genetic testing clinics in the country have doubled or even tripled in recent years.

“Patients are more aware of it, physicians are more aware of it, and the testing has become better. The technology has improved,” said Ingrid Ambus, a genetic counsellor at North York General Hospital in Toronto, adding that testing can now diagnose hereditary cancer syndromes beyond the more common ovarian and breast cancers.

Less than 10 per cent of cancers have hereditary causes, but researchers have identified more than 80 genes in which mutations can be passed down through families and potentially cause cancer.

Ambus said patients often find it “empowering” to know that a cancer runs in their family so they can seek counselling, screen for the cancer, make lifestyle changes or have preventative surgery.


Summer Heide was 19 years when she learned she had inherited a gene mutation that put her at high risk of developing developing a deadly stomach cancer at a young age. (Submitted by Summer Heide)

A genetic counsellor advised Heide that the only way for her to prevent aggressive gastric cancer would be to remove her entire stomach, a procedure called a prophylactic total gastrectomy.

She met with a surgeon in 2007, but was told there wasn’t enough clinical information available at that time to guarantee that she could have children after a total gastrectomy.

She decided to wait.

Soon, she would have to make another difficult choice.

Passing on the gene

When Heide and her husband were ready to have children, they had the option to do in-vitro fertilization (IVF) with pre-implantation genetic diagnosis on her embryos. That would have allowed them to only implant embryos that didn’t have the mutation.

“I didn’t want to do that,” said Heide. “I do feel like some feel like it’s a little bit selfish, because I could spare my kids from having the gene. But I wouldn’t get the kids that I have if I were to choose that, and I would never choose anybody different.”


Summer and Nick Heide welcomed their first child, Mikka, into the world on May 8, 2009. (Submitted by Summer Heide)

After Heide and her husband had their first two children, Mikka and Harlow, her anxiety began to grow. She was tortured by the fact that her cousin Erin had passed away just seven months after diagnosis. Heide wondered whether cancer was already forming inside her.

“No one would love [my daughters] like me. So every, like, Christmas or birthday, or any type of holiday, I would always go above — take lots of pictures, make it perfect — in case it was their last one with me,” she said.

Heide still resisted the idea of getting an invasive surgery to remove her stomach. She was worried about long-lasting side affects, including diarrhea, vomiting and fatigue.

She’d also had one of her veins cut during a routine endoscopy — a diagnostic test to look for cancer — and began to vomit blood and lose consciousness.

“I was mentally making peace with myself and God that maybe my time had come. That shakes a person deeply,” she said.

From that point on, she had a deep fear of medical procedures. She would schedule a gastrectomy, then cancel.

Game changer

Then, in 2014, her younger sister, Ali Kowaluk, decided to get genetic testing.

Kowaluk admits she had procrastinated. Then she got married and began to contemplate having children. She knew it was time to visit a genetic counsellor at the Royal University Hospital in Saskatoon.

She tested positive for the gene mutation and knew immediately that she would have the surgery.


Ali Kowaluk poses pregnant in 2019. Five years earlier, she started contemplated having children and decided she needed to know for her future children’s sake whether she carried that gene mutation that could lead to cancer. (Debra Mavin Photography)

Kowaluk had her entire stomach removed at the age of 23. Afterward, the surgeon told her that tests on tissues removed from her revealed Stage 1 cancer.

“So that was hard to hear, still hard to talk about. I don’t talk about that part very much,” Kowaluk said, choking up.

Undetected, the aggressive cancer would have certainly gone on to kill her. The surgery saved her life.

“I could not be here today,” Kowaluk said.

Now a mother of one-year-old Winston, Kowaluk is shaken by how close she came to passing away like her cousin Erin.

Kowaluk’s near-death experience was a wake-up call for big sister, Heide.

One night, after both of her daughters fell asleep during their bedtime story, one curled up under each arm, she lay there praying to God and silently sobbing. The next morning, she woke up with mental clarity. It was time to have the surgery.

“Knowing you carry a gene with such devastating potential is a heavy weight to carry. It was heavier than I could mentally handle any longer,” she said. 


Summer Heide’s daughter, Mikka, coaxes her mother into taking a walk inside a Calgary hospital a few days after she had surgery to remove her stomach. (Submitted by Summer Heide)

Heide got her stomach removed at Calgary Foothills Hospital in 2015.

The recovery took nearly a year and was excruciating, she said. She could barely get off the couch some days.

Two years after the surgery, despite not knowing if it was possible, she got pregnant and had a third child, a boy named Huxley. It seemed to reset her body, she said.

The next generation

Today, Heide stands in her kitchen, sunshine pouring through the window, snacking on tiny bites of chicken and cottage cheese.

The 5-foot-5, 105-pound woman eats every couple hours and only small amounts, because she doesn’t have a stomach to digest and store food. She has to chew everything until it’s mush, and eating and drinking fluid at the same time pushes food into her small intestine too quickly and makes her sick.

She has reached a level of peace and confidence with her health that she hasn’t had in years.

“Of course, I wish we didn’t have this gene, but it’s also a gift that we know about it, because I might not be sitting here today if I didn’t know about it,” she said.


Sisters Ali Kowaluk (left) and Summer Heide (right) pose with their sons at Heide’s home near Rocanville, Sask.. The two women have had their entire stomachs surgically removed. (Trent Peppler/CBC)

Unfortunately, her worries aren’t over.

“The worry about myself has now been put onto my kids, because I just worry and hope that none of them have the gene,” Heide said,

Each of her three children, and Kowaluk’s son, has a 50 per cent chance of inheriting the gene mutation. They can get tested when they’re 18.

The two women hope that, by then, medical advancements will provide better options for testing, treating and preventing the disease.

“I have high hopes for him,” Kowaluk said of her son Winston.

Heide shares the same optimism.

“It’s hard, but it is what it is. We’re lucky that we get a chance at life.”

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Truck bomb in Somalia’s capital kills at least 79 people

A truck bomb exploded at a busy security checkpoint in Somalia’s capital on Saturday morning, killing at least 79 people, including many students, authorities said.

It was the worst attack in Mogadishu in more than two years, and witnesses said the force of the blast reminded them of the city’s devastating 2017 bombing that killed hundreds.

The blast occurred during rush hour as Somalia returned to work after its weekend. At least 125 people were wounded, Aamin Ambulance service director Abdiqadir Abdulrahman said, and hundreds of Mogadishu residents donated blood in response to desperate appeals.

President Mohamed Abdullahi Mohamed condemned the attack as a “heinous act of terror” and blamed the al-Shabaab extremist group, which is linked to al-Qaeda and whose reach has extended to deadly attacks on luxury malls and schools in neighbouring Kenya. 

Bodies lay on the ground amid the blackened skeletons of vehicles. At a hospital, families and friends picked through dozens of the dead, gingerly lifting sheets to peer at faces.


A woman reacts as her injured child is assisted at the Madina Hospital following the explosion in Mogadishu. (Feisal Omar/Reuters)

Most of those killed were university and other students returning to class and police officers, said Somalia’s police chief Gen. Abdi Hassan Hijar. He said the vehicle detonated after police at the checkpoint blocked it from proceeding into the city.

Somalis mourned the deaths of so many young people in a country trying to rebuild itself after decades of conflict. Two Turkish brothers were among the dead, Somalia’s foreign minister said. Turkish President Recep Tayyip Erdogan condemned the attack.

Links to al-Shabaab

While there was no immediate claim of responsibility, al-Shabaab often carries out such attacks. The extremist group was pushed out of Mogadishu several years ago but continues to target high-profile areas, such as checkpoints and hotels in the seaside city.

Al-Shabaab is now able to make its own explosives, its “weapon of choice,” United Nations experts monitoring sanctions on Somalia said earlier this year. The group had previously relied on military-grade explosives captured during assaults on an African Union peacekeeping force.

Despite that advance in bomb-making, one security expert said the unlikely choice of target Saturday — a checkpoint at the western entrance to the capital — reflected al-Shabaab’s weakening capability to plan and execute attacks at will. Mogadishu recently introduced tougher security measures that Somali officials said make it more difficult to smuggle in explosives.

“It feels like they literally knew that their [car bomb] may not proceed through the checkpoint into the city undetected, considering the additional obstacles ahead, so bombing the busy checkpoint in a show of strength appeared to be an ideal decision,” the Mogadishu-based Ahmed Barre told The Associated Press.

Al-Shabaab was blamed for the truck bombing in Mogadishu in October 2017 that killed more than 500 people. The group never claimed responsibility for the blast that led to widespread public outrage.

Some analysts said al-Shabaab didn’t dare claim credit as its strategy of trying to sway public opinion by exposing government weakness had badly backfired.


No one immediately claimed responsibility for the blast. Al Qaeda-linked Islamist group al-Shabaab regularly carries out such attacks in an attempt to undermine the government. (Abdirazak Hussein Farah/AFP via Getty Images)

“This explosion is similar like the one … in 2017. This one occurred just a few steps away from where I am and it knocked me on the ground from its force. I have never seen such a explosion in my entire life,” witness Abdurrahman Yusuf said.

The attack again raises concern about the readiness of Somali forces to take over responsibility for the Horn of Africa country’s security in the coming months from the AU force.

Al-Shabaab, the target of a growing number of U.S. airstrikes since President Donald Trump took office, controls parts of Somalia’s southern and central regions. It funds itself with a “taxation” system that experts describe as extortion of businesses and travellers that brings in millions of dollars a year.


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Malta businessman charged in journalist’s car bomb killing

One of Malta’s wealthiest men, Yorgen Fenech, was charged in a Valletta court on Saturday with complicity to murder in the car bomb killing of anti-corruption journalist Daphne Caruana Galizia in 2017.

The levelling of official charges against Fenech marked a milestone in the investigation into the murder of Caruana Galizia, a campaigning journalist who investigated and exposed corruption. Fenech’s alleged ties to ministers and senior officials has also spawned a political crisis for the government of Prime Minister Joseph Muscat, who appeared close to resigning on Saturday.

Fenech pleaded not guilty to the charge of complicity to murder and to other charges related to the case, which include membership of a criminal gang, and conspiracy to cause an explosion.

In a statement, Muscat told Reuters he would speak about his future after the hearing. Official sources said he was expected to announce his resignation later in the evening or on Sunday.

No official statement has been issued.

Asked about this before Fenech was charged, a spokesperson for the prime minister said that Muscat “has pledged various times he wants to see this case through. He will make announcements in due course.”

Alleged mastermind

Fenech, 38, was taken to court under a heavy armed police escort almost two years to the day since three men were charged with having set off the bomb that killed the journalist on Oct. 16, 2017.

The three have pleaded not guilty and are still awaiting trial.

Dressed in a charcoal suit and dark glasses, shaven-headed Fenech stood up to hear the charges in a hushed courtroom less than a metre away from the three sons of Caruana Galizia, who were also joined in the courtroom by her husband Peter, her parents, Michael and Rose Vella, and her sisters.


People hold pictures of slain journalist Daphne Caruana Galizia as they participate in a demonstration to demand justice over her murder outside the office of the prime minister at Auberge de Castille in Valletta on Friday. (Yara Nardi/Reuters)

With music from a nearby bar drifting into the courtroom, the businessman made no application for bail.

Fenech said when he spoke to journalists on Friday that the “truth will come out” and, in court filings, he has made clear he intends to implicate other key members of Muscat’s government, in both the murder plot and other corruption.

Sources briefed on the murder investigation told Reuters that police regard Fenech as the mastermind of the journalist’s killing. But, in court filings, Fenech has tried to implicate Muscat’s former chief of staff Keith Schembri, who was arrested on Tuesday in connection with the murder but released without charge two days later.

Immediately after the hearing, the family of Caruana Galizia urged authorities to continue to probe into who else was involved in the murder.

The family said: “We now expect the Prime Minister to leave office, and parliament, with immediate effect to allow a free and full investigation into his and Keith Schembri’s role in Daphne’s assassination.”

Alleged middleman trades information for pardon

Fenech was arrested on Nov. 20 on his luxury yacht as he allegedly attempted to leave the island, days after another man, Melvin Theuma, was arrested in a money-laundering case and immediately told police he had been the middleman in the murder plot and offered information in return for a pardon.

The Maltese government accepted Theuma’s pardon request but later turned down another request for a pardon by Fenech.

Muscat has been in power since 2013, having won two general elections in a row, the last in 2017. His Labour Party is expected to hold a leadership election in January.


Maltese Prime Minister Joseph Muscat addresses a news conference in Valletta on Friday. (Yara Nardi/Reuters)

Schembri, a close friend and right-hand-man of Muscat, and former Tourism Minister Konrad Mizzi both resigned on Tuesday.

Neither Schembri or his lawyers have commented since his resignation or arrest. He previously denied any wrongdoing. Mizzi on Tuesday denied any business links with Fenech and any wrongdoing.

Caruana Galizia had reported that Schembri and Mizzi owned secret companies in Panama. Leaked emails indicated those same companies intended to earn money from an offshore company called 17 Black. Last November, an investigation by Reuters and the Times of Malta showed that 17 Black was owned by Fenech.

There is no evidence that funds were ever transferred to Mizzi and Schembri, and Mizzi has denied any connection with 17 Black or the murder.

Caruana Galizia, 53, was killed by a car bomb as she drove out of her home in Bidnija, 11 kilometres from Valletta, just half an hour after writing a blog describing Schembri as “a crook.”

Investigators subsequently told a court that the bomb was set off from a yacht off Valletta harbour.

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Car bomb in Syrian town along border with Turkey kills 13

A car bomb exploded in a northern Syrian town along the border with Turkey on Saturday killing 13 people, Turkey’s Defence Ministry said.

The ministry said about 20 others were wounded when the bomb exploded in central Tal Abyad, which was captured last month by Turkey-backed opposition gunmen from Kurdish-led fighters.

The ministry blamed Syrian Kurdish fighters for the attack, saying it harshly condemns it and called on the international community to take a stance against this “cruel terror organization.” There was no immediate claim of responsibility.

Last month, Turkey invaded northeastern Syria to push out Syrian Kurdish fighters, who it considers terrorists for their links to a Kurdish insurgency inside Turkey.

Earlier on Saturday, the Kurdish-led Syrian Democratic Forces (SDF) said Christian fighters will now oversee security in a northern Syrian region that has witnessed fighting between Turkey-backed troops and Kurdish-led militia.

The SDF said the deployment will take place in villages close to the town of Tal Tamr in the Khabur river region. That area is home to Syria’s dwindling Christian Syriac and Assyrian communities.


Turkey’s Defence Ministry said about 20 others were wounded when the bomb exploded in central Tal Abyad. (The Associated Press)

Turkish-backed fighters have been advancing in northern Syria since last month, leading to the displacement of about 200,000 people. There have been concerns in Christian villages about possible atrocities by Turkey-backed fighters, which include former jihadists.

The SDF said it’s deploying the Syriac Military Council and Assyrian fighters in the Khabur river region. Both groups are part of the SDF.

The announcement came a day after Turkey and Russia launched joint patrols in northeastern Syria, under a deal that halted a Turkish offensive against Syrian Kurdish fighters who were forced to withdraw from the border area following Ankara’s incursion.

Though the truce has mostly held, it has been marred by accusations of violations from both sides and occasional clashes. Turkish President Recep Tayyip Erdogan has threatened to resume the offensive if deemed necessary.


People check the destruction after a car bomb exploded in Tal Abyad. (The Associated Press)

But the United States had partnered with the Syrian Kurdish fighters, their top allies in the war against the ISIS group. The relationship has strained ties between Washington and Ankara who are NATO allies.

After an abrupt and widely criticized decision by U.S. President Donald Trump to withdraw American troops from this part of Syria, the Kurdish forces approached the Syrian government and Russia for protection. Syrian government troops and Russian military police subsequently moved into areas along the border.

Christians made up about 10 per cent of Syria’s pre-war population of 23 million, who co-existed with the Muslim majority and enjoyed freedom of worship under President Bashar al-Assad’s government. Most have left for Europe over the past 20 years, with their flight significantly gathering speed since the start of the current conflict.

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‘A ticking time bomb’: Brittany Crew breaks Canadian shotput record (again) for silver medal

LIMA, Peru — Canadian shotput star Brittany Crew said ahead of competition at the Pan American Games that she felt a bump in distance coming, calling it “a ticking time bomb.” That blast finally went off on Friday, as she registered a new Canadian record of 19.07 metres and earned a silver medal in the process.

“This is the bomb,” she says.

Heading into her sixth and final throw, the Canadian sat in third place with a mark of 18.47, but she made her last attempt count.

“I’m over the moon,” she says. “I knew I had it in me today but I had to dig deep on the last throw and I think that’s one of the clutch things I can do. I’m going to give my coach a heart attack one day.”

It was the third time she broke the national record this season, and has also been putting up big results on the Diamond League circuit this year, all despite losing months to a serious foot injury she suffered around this time last year.

That’s actually why this is Crew’s first Pan Am Games — the Toronto native missed her last two chances to compete in front of a home crowd because of injuries.


“Better late than never,” she says. “I actually sprained my ankle before the 2015 Pan Am Games in Toronto so I missed the opportunity to compete at home there, and then I ended up breaking my foot right before [North American, Central American and Caribbean Championships], which was another opportunity to compete at home.

“I guess I’m just not meant to compete at home, which is funny.”

Long road to recovery

Crew’s coach, Richard Parkinson, has been working with her for the past six years. He says the broken foot was a big blow, but Crew handled things like a true professional and is all-systems go heading into a crucial year.

“It was tough [but] she handled it extremely well, she listened to doctors, listened to physio…She’s a professional now [and] she had to look after it. It healed very well, she didn’t want to get sidelined

“This year is very important. Pan Ams and worlds lead into the Olympic Games, so she knew she needed to look after business, to rehab and give it time.”


Brittany gets a flag from her coach Richard Parkinson after securing the silver medal. (Carlos Osorio for CBC Sports)

Crew says the break wasn’t all bad — she was allowed to start to miss her sport after what felt like non-stop competition and training.

“I’ve been kind of go-go-go and it was a blessing in disguise because I got a few months that I was forced to take off of training,” she says. “So I was allowed to actually miss the sport and actually focus on my studies and I graduated this year.

“I got to focus on other things and actually miss the sport, so I think it was a blessing in disguise.”

Parkinson says Crew managed to turn the negative of her injury into a positive by focusing on aspects of her training she could still work on.

“Mentally it was tough for her, while other people were doing things, she couldn’t. She’s worked hard doing other things she could do,” he says. “Her upper body strength, those numbers are way up over last year. She’s very disciplined and did a great job coming back.”

Getting it all off her chest

Crew knows a thing or two about how to channel pain into positives. One thing track and field fans might not know about her is that Crew is a budding songwriter.

Her grandfather bought her a guitar when she was about 12, and taught her a few chords before Crew started teaching herself.

Crafting songs was just another way Crew was able to get a weight off her chest, as it were.


Canada’s Brittany Crew secures the silver medal in the women’s shotput during the Pan Am Games in Lima, Peru on Friday. (Carlos Osorio for CBC Sports)

“I started to kind of vent. I didn’t have a horrible childhood, but I didn’t have it easy,” she says. “My dad has an addiction to prescription medication, so he’s been struggling with that for awhile now, so that’s where it came from, just writing songs to get my feelings out for that.

“Just kind of used it as music therapy…if I was feeling anything, I could just put it out in a song, and that makes you feel a little bit better. It’s out there, in the open, on a piece of paper, and you’re not keeping it inside.”

Eyes on the Olympic prize

While putting pen to paper may be part of a future career, her current goals are clear.

“My ultimate goal would be to get an Olympic medal,” she says. “I’ve already been to the Olympics once, and I got the experience that time but the next step would be to leave with a medal.


Canada’s Brittany Crew unloads her final throw at the Pan Am Games on Friday. (Carlos Osorio for CBC Sports)

“When I was at Rio, I was just happy to be there. I wasn’t expected to make the team and then you see everyone getting medals and you’re like ‘man, I want one of those.'”

Now that she’s broken the Canadian record three times and eclipsed the 19-metre mark, she believes she’s on the right path.

“This is what I need to throw, this is on track for a medal in Tokyo,” she says. “Maybe there’s more in the tank this year.”

 

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At least 25 dead as Russian jets bomb northwestern Syria, rescuers say

Aerial strikes on Monday killed at least 25 people, mostly civilians, in northwestern Syria in the sixth week of a Russian-led military offensive that has so far killed hundreds of civilians, according to residents and civil rescuers.

They said war planes flying at high altitude, which monitors said were Russian Sukhoi jets, dropped bombs on the village of Jabala in southern Idlib province, with rescuer teams so far pulling out 13 bodies, including women and children.

Russian jets were also behind several raids that hit the towns of Khan Sheikhoun, Kafr Battikh and several other villages that left at least another 12 civilians dead, according to another local rescuer.

Rescuers say the major aerial campaign that Moscow has thrown its weight behind since it was launched in earnest at the end of April has killed over 1,500 people, with more than half of the death toll being civilians.

Residents and local and international aid agencies that support the rebel-held areas say the sustained campaign that has bombed schools and knocked down medical centres was meant to smash the spirit of civilians in opposition areas.

More than 300,000 people have fled the front lines to the safety of areas near the border with Turkey, UN and aid agencies say.


Syrians fill containers with water in a camp for internally displaced people near Kah, in northern Idlib province near the border with Turkey, on June 3. Thousands of people have fled to border areas for safety. (Aaref Watad/AFP/Getty Images)

The Russian-backed offensive has so far failed to make major inroads into rebel territory in northern Hama and southern Idlib provinces, where mainstream rebels backed by Turkey alongside jihadist fighters are putting up fierce resistance in their last remaining bastion in Syria.

Russia and the Syrian army deny allegations of indiscriminate bombing of civilian areas or a campaign to paralyze everyday life in opposition-held areas and say they are fighting al-Qaeda-inspired Islamist militants.

Moscow blames the rebels for breaking a truce by hitting government-held areas and says Turkey has failed to live up to its obligations under a deal brokered last year that created a buffer zone in the area that obliges it to push out militants.

Civilians in rebel-held areas, where many oppose returning to Syrian President Bashar al-Assad’s one-party rule, look to Turkey which has steadily built up a military presence in the area as a protector against the Russian-led strikes.

Northwest Syria — including Idlib province and parts of neighbouring provinces — has an estimated three million inhabitants, about half of whom had already fled fighting elsewhere, according to the United Nations.

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Bomb attacks at church kill many in southern Philippines

Twin bombings during a church service in the southern Philippines killed at least 21 people and wounded 71, security officials said, days after a referendum on autonomy for the mainly Muslim region returned an overwhelming "yes" vote.

The first explosion went off inside the cathedral in Jolo, on the island province of Sulu, and was followed by a second blast in the car park outside, killing military and civilians, officials said.

There was no immediate claim of responsibility.

It followed Friday's announcement that the region, a mainly Muslim part of the predominantly Catholic Philippines, had approved a plan to govern itself by 2022, boosting hopes for peace in one of Asia's poorest and most conflict-torn regions.

Monday's referendum saw 85 per cent of voters back the creation of an autonomous area called Bangsamoro. Although Sulu was among only a few areas that rejected autonomy, it will still be part of the new entity.

'Deny terrorism any victory'

Defence Secretary Delfin Lorenzana called the attack a "dastardly act" and urged the local population to be vigilant and work with the authorities to "deny terrorism any victory."

"We will use the full force of the law to bring to justice the perpetrators behind this incident," he said in a statement.

Civilians bore the brunt of the attack, which also killed at least seven soldiers.

Colonel Gerry Besana, spokesman of the military's Western Mindanao Command, said an examination of the bomb materials should reveal who was behind it.

National police chief Oscar Albayalde said it was possible the militant Abu Sayyaf group could be involved.

"They want to disturb the peace and order, they want to show force and sow chaos," Albayalde said on radio.

Jolo is a stronghold of the Abu Sayyaf, which has a reputation for bombings and brutality, and for having pledged allegiance to Islamic State. The militant group is also heavily involved in piracy and kidnapping.

Last week's referendum came at a critical time for the Philippines, which hopes to end decades of separatist conflict in Mindanao that experts say has given rise to extremism.

That has stoked fears that foreign radicals will gravitate to Mindanao to capitalize on porous borders, jungles and mountains, and an abundance of arms.

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At least 20 killed in suicide bomb attack in Somalia's capital

Islamic extremists detonated four bombs outside a hotel in the capital of Mogadishu on Friday afternoon, killing at least 20 people and injuring 17, said police.

After the three explosions in front of the hotel, a fourth blast hit as medics attempted to rescue the injured.

The suicide bombs detonated near the perimeter wall of the Sahafi Hotel, which is across the street from the Somali Police Force's Criminal Investigations Department, said Capt. Mohamed Hussein.

Some of the victims were burned beyond recognition when one car bomb exploded next to a minibus, he said.

Somali security forces shot dead four gunmen who tried to storm through a hole blown into the hotel's wall, but did not succeed in entering, he said.

"Although they failed to access the hotel, the blasts outside the hotel killed many people," said Hussein.

"The street was crowded with people and cars, bodies were everywhere," said Hussein Nur, a shopkeeper who suffered light shrapnel injuries on his right hand. "Gunfire killed several people, too."

Somalia's Islamic extremist rebels, al-Shabaab, claimed responsibility for the bombs, according to the group's Adalus radio station.

Among the dead was the manager of the Sahafi Hotel, whose father was its owner before he was killed in an al-Shabaab attack in 2015, said Hussein.

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U.S. mail bomb suspect ordered held without bail

The man accused of mailing 14 pipe bombs to prominent critics of U.S. President Donald Trump was ordered held without bail as the FBI confirmed a package similar to the ones discovered last week had been intercepted Monday. It was addressed to CNN in Atlanta.

​Cesar Sayoc, 56, his salt-and-pepper hair pulled back into a ponytail, remained largely silent in a Florida courtroom, only acknowledging Judge Edwin Torres's reading of the charges against him.

Shackled and wearing a beige jumpsuit, Sayoc began to tear up, and the three attorneys with him stood shoulder to shoulder to obscure reporters and photographers from seeing him.

Sayoc was scheduled to appear in court in Miami again on Friday morning.

Just hours before his appearance, bomb squads were called to a post office in Atlanta about a suspicious parcel.

The FBI did not identify to whom the most recent package was addressed, but CNN President Jeff Zucker announced that a suspicious package addressed to the cable television network was intercepted Monday at an Atlanta post office.

Zucker said there was no imminent danger to the CNN Center. Another package was delivered to the cable network's New York offices last week, causing an evacuation.

Sayoc is accused of sending bubble-wrapped manila envelopes to Democrats including Barack Obama, Hillary Clinton and Joe Biden, as well as George Soros, the philanthropist of a number of leftish causes who figures in several conspiracy theories propagated by hard right web sites. 

The packages were intercepted from Delaware to California. At least some listed a return address of U.S. Debbie Wasserman Schultz, former chair of the Democratic National Committee.

She represents the Florida district where the former male stripper, pizza driver and strip club DJ lived in an older van covered with bumper stickers praising Trump, disparaging Democrats and CNN and showing rifle crosshairs over liberals like Clinton and filmmaker Michael Moore.

Authorities did not immediately say who might be responsible for sending the most recent package to CNN, but law enforcement officials have said they believe the packages were staggered and more could be discovered.

A bomb squad arrives with other authorities at a mail facility in Atlanta after reports that a suspicious package was found on Monday. (John Spink/Atlanta Journal-Constitution via AP)

Sayoc was arrested Friday outside a South Florida auto parts store after investigators said they identified him through fingerprint and DNA evidence. Sayoc's case is expected to be moved to New York, where he will be prosecuted by the U.S. Attorney's Office, officials said.

Authorities say Sayoc faces more than 50 years in prison if convicted on all charges. None of the bombs exploded, and no one was injured.

The very first thing that the president did was condemn the attacks both in Pittsburgh and in the pipe bombs. The very first thing the media did was blame the president. – Sarah Sanders, White House spokesperson 

Trump tweets

The mass mailings have heightened political tensions ahead of midterm elections on Nov. 6 that will determine the composition of Congress as well as state houses.

Trump, in a series of tweets on Monday morning, continued to focus his attention on media coverage.

"The Fake News is doing everything in their power to blame Republicans, Conservatives and me for the division and hatred that has been going on for so long in our country," he said.

Instead, Trump said, it is the "inaccurate, and even fraudulent, reporting of the news" that is driving much of the heated rhetoric in the country.

White House spokesperson Sarah Sanders defended the president's comments during a briefing today, saying, "The very first thing that the president did was condemn the attacks both in Pittsburgh and in the pipe bombs. The very first thing the media did was blame the president and make him responsible for these ridiculous acts." 

She added, "The only person responsible for carrying it out, either of these heinous acts, were the individuals that carried them out." 

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U.S. authorities arrested mail bomb suspect after he DJ'd at a Florida nightclub

In the hours before his arrest, as federal authorities zeroed in and secretly accumulated evidence, Cesar Sayoc was in his element: spinning classic and Top 40 hits in a nightclub where he'd found work as a DJ.

As he entertained patrons from a dimly lit booth overlooking a stage at the Ultra Gentlemen's Club, where Halloween decorations hung in anticipation of a costume party, he could not have known that U.S. investigators that very evening were capitalizing on his own mistakes to build a case against him.

He almost certainly had no idea that lab technicians had linked DNA on two pipe bomb packages he was accused of sending to prominent Democrats to a sample previously collected by Florida state authorities. Or that a fingerprint match had turned up on a separate mailing that authorities say he sent.

And he was probably unaware that investigators scouring his social media accounts had found the same spelling mistakes on his online posts — "Hilary" Clinton, Debbie Wasserman "Shultz" — as on the mailings he'd soon be charged with sending.

'Criminals make mistakes'

In the end, prosecutors who charged Sayoc with five federal crimes Friday say the fervent supporter of U.S. President Donald Trump unwittingly left behind a wealth of clues, affording them a critical break in a coast-to-coast investigation into pipe bomb mailings that spread fear of election-season violence. The bubble-wrapped manila envelopes, addressed to Democrats such as Barack Obama and Hillary Clinton and intercepted from Delaware to California, held vital forensic evidence that investigators say they leveraged to arrest Sayoc four days after the investigation started.

"Criminals make mistakes, so the more opportunities that law enforcement has to detect them, the greater chance they're going to be able to act on that, and that appears to be what happened here," said former U.S. Justice Department prosecutor Aloke Chakravarty, who prosecuted the Boston Marathon bombing case.

In this undated photo released by the Broward County Sheriff's office, Cesar Sayoc is seen in a booking photo, in Miami. Federal authorities took Sayoc, 56, of Aventura, Fla., into custody Friday in Florida in connection with the mail-bomb scare that earlier widened to 12 suspicious packages. (Broward County Sheriff's Office/via Associated Press)

But It wasn't always clear that such a break would come, at least not on Monday when the first package arrived: a pipe bomb delivered via mail to an estate in Bedford, New York, belonging to billionaire liberal activist George Soros. That same day, Sayoc, still under the radar of law enforcement, retweeted a post saying, "The world is waking up to the horrors of George Soros."

Additional packages followed, delivered the next day for Clinton and Obama and after that to the cable network CNN, former Attorney General Eric Holder, former Vice-President Joe Biden and other Democratic targets of conservative ire.

Social media conspiracy theories

Each additional delivery created more unease. But together they also provided more leads for the FBI, which mined each pipe bomb for clues at a laboratory in Quantico, Virginia.

As the packages rolled in, technicians hit a breakthrough: a fingerprint and DNA left on a package sent to Rep. Maxine Waters, a California Democrat and one of the intended pipe bomb recipients, and DNA on a piece of pipe bomb intended for Obama. The FBI said it had identified no other possible matches on the evidence it had examined.

Besides that, the FBI said, his social media posts that traffic in online conspiracy theories, parody accounts and name-calling include some of the same misspellings as were noticed on the 13 packages he was charged with sending.

The clues, authorities say, led them to a 56-year-old man with a long criminal history who'd previously filed for bankruptcy and appeared to be living in his van, showering on the beach or at a local fitness centre.

As the FBI worked around the clock, and as Americans were busy debating the hard-edged political climate and whether Trump had fanned the flames with his rhetoric, it was business as usual for Sayoc as he took to Twitter to denigrate targets like Soros. That was not uncommon for the amateur body builder and former stripper whose social media accounts are peppered with memes supporting Trump and posts vilifying Democrats.

'I didn't know this guy was mad crazy'

On Thursday from noon to 9 p.m. as law enforcement grew ever closer, descending on a postal sorting facility in Opa-locka, Florida, Sayoc was working as a disc jockey at a West Palm Beach nightclub where he'd found work in the last two months. There, he spun his music from inside a small dimly lit booth overlooking a stage with performers dancing below. Autographed photos of scantily clad and nude adult entertainers were plastered across the walls like wallpaper.

"I didn't know this guy was mad crazy like this," said Stacy Saccal, the club's manager. "Never once did he speak politics. This is a bar. We don't talk politics or religion in a bar, you know?"

Disc jockey Scott Meigs poses for a photograph at Ulta Gentleman's Club, Friday, Oct. 26, in West Palm Beach, Fla. Meigs said he has known mail bombing suspect Cesar Sayoc for 20 years. (Ellis Rua/Associated Press)

But Scott Meigs, another DJ at the club, had a different experience.

He said Sayoc had been talking about politics to everybody at the club for the last two weeks, preaching the need to elect Republicans during the November elections. "I just figured he was passionate about the upcoming elections."

The next morning, he was taken into custody near an auto parts store in Plantation, Florida, north of Miami. Across the street, Thomas Fiori, a former federal law enforcement officer, said he saw about 50 armed officers swarm a man standing outside a white van with windows plastered with stickers supporting Trump and criticizing media outlets including CNN.

They ordered him to the ground, Fiori said, and he did not resist.

"He had that look of, 'I'm done, I surrender,"' Fiori said.

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