A tense autumn to come in the Middle East

The international community must do everything possible to prevent further escalation across the region.

Across the Middle East, the Arab Uprisings of the last two years have given way to an atmosphere of continuous uncertainty and growing tension, in some areas marked by incidents of violence, sometimes prolonged, sometimes sporadic. The outlook in the months ahead is dark.

Darkest of all is the prolonged conflict in Syria. There are real fears that the intensifying battles there may spill over into other countries in the region. Turkey watches, deeply concerned. Together with Jordan, it is struggling with a huge influx of refugees from Syria. Protracted violence in Syria can only destabilise the region further and, the longer the factions war in Syria, the less likely it is that a single, unified and strong Government will succeed the morally bankrupt Assad regime.

Lakhdar Brahimi has impressed in his first days as UN envoy. But, as Kofi Annan discovered, the task in formulating a coherent international response to a growing crisis is immense. This is especially true within the UN Security Council. But we cannot allow the present position to continue: if we do so, the situation will worsen, not stay the same.

The particular danger is that conflict will spread beyond Syria's borders. Increased activity by Iran in emphasising its support for Assad has added to tension and violent incidents, such as that which happened in Turkey earlier this week, act as dangerous individual sparks in a flammable environment.

In Egypt, a similar, tense atmosphere prevails. President Morsi's dismissal  of individual members of the military establishment form part of a longer stand off between emerging democratic forces and a residually strong, but perhaps weakening, Army. The tide of Egyptian affairs appears to moving towards more openness but broad suspicion remains about the new Government's views on women's rights in the context of a new constitution. Concerns have been intensified by the recent violence in Sinai between the Egyptian forces and extremist elements, events which precipitated Morsi's personnel changes.

Israel had expressed concerns previously about extremist elements in Sinai, warning of increased instability there. It has added to Israel's increased anxiety at developments following the Arab Uprisings. Far from making Israel more amenable to dealing with Arab regimes with a more democratic mandate, events have caused Israel to be more concerned at trends in the region posing increased threats to its security. The perception is not helped by contacts between Hamas and the new Egyptian Government and also by intemperate language about Israel which, if stability is to prevail, must be recognised and accepted as a permanent, legitimate state in the region.

The next months, in the lead up to the US Presidential Election, are crucial. There has been strong concern expressed by Israel over many months over the lack of progress in securing Iran's compliance with its non-proliferation obligations. Rhetoric is intensifying once more and speculation of a pre-emptive military strike against Iran is increasing, not diminishing. It is a time for rational assessments and cool analysis. The impact of an attack at the heart of this, most sensitive and unpredictable of regions, is impossible to predict. The international community must take all steps it can to ensure that it does not take place.

Ian Lucas is the Labour MP for Wrexham

Protestors in Yemen in 2011. Photograph: Getty Images

Ian Lucas is the Labour MP for Wrexham.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear