What is autoinflammatory disease, the rare immune condition with waves of fever?

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John Silke, Walter and Eliza Hall Institute and Najoua Lalaoui, Walter and Eliza Hall Institute

Just over 20 years ago, people from three generations of an American family were referred to the National Institutes of Health (NIH) in Washington DC with an unknown disease.

They were ten to 82 years old and had symptoms including monthly episodes of unexplained high fevers (up to 41℃), lasting two to seven days.

They also had painful swollen lymph nodes, enlarged spleens and livers, abdominal pain, mouth ulcers, joint pain, and a patchwork of other symptoms.

The symptoms, which they’d had since shortly after birth, seemed like an inflammatory reaction. However, doctors could not trace the episodes to an infection.

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Explainer: what is inflammation and how does it cause disease?

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We now know these symptoms are typical of autoinflammatory diseases – rare conditions with seemingly unprovoked episodes of fever and inflammation.

Because the inflammatory episodes occur regularly, the diseases are also known as “periodic fever syndromes”. In addition to being painful and debilitating, some of the conditions can damage vital organs, such as the heart and lungs.

What causes autoinflammatory disease?

Autoinflammatory diseases are caused by abnormal activation of the innate immune system, the body’s first-line defence against invading pathogens.

The innate immune system is a hard-wired response that can quickly mobilise to fight foreign invaders. Among its many roles is the release of cytokines.

These are immune messengers critical for alerting and recruiting other cells to the fight, increasing blood circulation and inducing fever. More about cytokines later.

However, in autoinflammatory diseases, invading microbes don’t cause the fever and inflammation. Instead, genetic changes (mutations) lead to the innate immune system being activated for what appears to be no reason, causing uncontrolled inflammation.

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Explainer: what is the immune system?

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Autoinflammatory diseases typically begin in childhood, often from birth, and are lifelong conditions. The genetic mutations can be passed from parents to their children, leading to multiple cases of disease in an extended family.

Autoinflammatory diseases are different from autoimmune diseases, such as multiple sclerosis, which are caused by defects in the adaptive immune system, a different arm of the immune response.

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Read more:
Explainer: what are autoimmune diseases?

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There are a number of different autoinflammatory diseases, often caused by different genetic mutations.

How do we treat autoinflammatory disease?

Autoinflammatory diseases cannot be cured, and treatment is usually to relieve symptoms during an attack. Patients are often treated with high doses of corticosteroids, a broad-brush approach to suppress the immune system.

Autoinflammatory diseases are also quite rare, which in the past has made it difficult to develop specific treatments.

Because autoinflammatory diseases are typically associated with excess production of cytokines, they are sometimes treated with so-called biologics – antibodies that mop up these excess cytokines.

These are usually antibodies to the cytokines tumour necrosis factor (TNF) or interleukin-1.

However biologics are expensive, and can have significant side-effects.

Without knowing the cause of an inflammatory disease, treatment is a trial and error process; a drug that works for one person may not work for another.

Antibodies against the molecule TNF (above) can be used to treat excess inflammation.
from www.shutterstock.com/StudioMolekuul

Can genetic testing help?

The discovery of mutations in genes causing autoinflammatory diseases has led to the development of genetic tests to help diagnosis.

However, some people with autoinflammatory disease do not have a change in one of the known disease-causing genes.

So our researchers have established the Australian Autoinflammatory Disease Registry to help identify other genetic causes of autoinflammatory diseases.

How we found out about the underlying mechanism

While the NIH researchers were looking for a cause of the American family’s disease, another strand of the story was playing out in Australia.

We were looking at the role of the master cytokine TNF, which controls many aspects of the body’s inflammatory response, and its partner RIPK1.

Usually, the body has many checks and balances to ensure these molecules are tightly controlled.

But we worked with the US scientists who found a critical mutation in the gene coding for RIPK1. We found this mutation, leading to changes in just one amino acid, was enough to supercharge its partner TNF into an elite killer.

This is what triggered the uncontrolled inflammation behind the American family’s disease.

Our team named this condition CRIA syndrome (cleavage-resistant RIPK1-induced autoinflammatory syndrome).

So what does this mean?

Understanding the molecular mechanism by which CRIA syndrome causes inflammation gives us an opportunity to get to the root of the problem, and to offer an alternative to existing treatments.

For this American family, treatment with an agent that inhibits the faulty RIPK1 might be a tailored option.

Lastly, the discovery of CRIA syndrome now confirms RIPK1 can play an important role in regulating inflammation in humans. So it may also play a role in far more common human illnesses, such as colitis (inflammation of the colon), rheumatoid arthritis and the skin condition psoriasis.

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John Silke, Leader, Infection, Inflammation and Immunity theme, Walter and Eliza Hall Institute and Najoua Lalaoui, Postdoctoral research fellow, Inflammation Division, Walter and Eliza Hall Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What are hives, the common skin condition that gives you itchy, red bumps?

The itchiness of hives or urticaria can severely affect people’s quality of life, particularly if symptoms last or antihistamines don’t work.
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Rodney Sinclair, University of Melbourne

Have you ever wondered who buys those huge boxes of antihistamines prominently displayed all year round in your local pharmacy? If antihistamines were just used for hay fever, you’d think sales would be good in spring, but pretty mediocre for the rest of the year.

Many of the antihistamines sold in Australia are actually for hives, or what doctors call urticaria. Hives produces multiple red, raised bumps (or wheals) that are incredibly itchy. Hives occurs all year round.

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Read more:
Common skin rashes and what to do about them

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The condition is really common, with a Korean study showing around 22% of people can expect to have it at some time in their life.

Some people also get angioedema, where small blood vessels leak fluid into the tissues, causing spectacular swelling. If the swelling affects your throat and airways you can suffocate.

Fortunately, for the vast majority of people, hives comes and goes in a couple of weeks. While you can feel pretty miserable when you have it, antihistamines work well to control the rash and itch. Suffocation is exceptionally rare.

When hives won’t go away

If you are unlucky enough to still have hives after six weeks, it’s likely to persist six months, six years or even 26 years later.

This is what dermatologists call chronic urticaria, which affects about 1% of the population (around 250,000 Australians). The itch, sleep disturbance, swelling and rash associated with it severely impair people’s quality of life. Of all skin diseases, chronic urticaria seems to worsen your mood and disrupt day-to-day living the most.

One antihistamine tablet is usually enough to control hay fever. But people with chronic urticaria may need two, three or sometimes four tablets a day to control their itch. Even that may not be enough to stop the wheals.

What causes hives?

So what causes hives? If your hives go away within six weeks, you probably had them because of a delayed reaction to a viral infection. Sometimes this acute condition is caused by an allergic reaction to a medication; an antibiotic allergy is a common cause. Occasionally a food allergy causes hives.

What about chronic urticaria, when hives last more than six weeks? Doctors don’t know the exact cause. While patients often suspect a food allergy, doctors rarely find a food trigger.

We don’t know exactly what causes hives, seen here as raised, red bumps or wheals.
from www.shutterstock.com

But we know autoimmunity is involved, when the body’s immune system targets itself.

Most patients with chronic urticaria have antibodies against their own immune system. In particular, these antibodies target molecules critical to a normal allergic response (immunoglobulin E, or IgE, and its receptor).

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Read more:
Explainer: what are autoimmune diseases?

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When antihistamines don’t work

If antihistamines don’t help, there are other options.

Medications that specifically target IgE and get to the root cause of urticaria autoimmunity are now available, provided you meet all the special criteria. Only dermatologists are allowed to prescribe this medicine on the PBS.

To date, omalizumab has been the most effective treatment for chronic urticaria patients who don’t respond to antihistamines. It’s given as an injection under the skin every four weeks. Unfortunately symptoms in fewer than 50% of patients are completely controlled.

A new drug ligelizumab, which is still in clinical trials, is showing promise, according to international research we were involved with published recently in the New England Journal of Medicine. However, this experimental drug, which also targets IgE autoimmunity, is only available in Australia as part of a clinical trial.

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Read more:
Randomised control trials: what makes them the gold standard in medical research?

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Rodney Sinclair, Professor of Dermatology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Depression Could Be More a Physical Than Mental Condition, Say Scientists

Iran: Persecution News Update

The link below is to an article reporting on the condition of an American pastor jailed in Iran.

For more visit:
http://christiannews.net/2013/08/15/american-pastor-imprisoned-in-iran-suffering-with-increasing-pain-from-internal-injuries/

Two Christians Slain in Attack Outside Church in Pakistan

Muslim youths kill two, wound two others after dispute over teasing of Christian women.

KARACHI, Pakistan, March 22 (CDN) — Two Christians were gunned down and two others are in a serious condition with bullet wounds after Muslim youths attacked them outside a church building in Hyderabad last night, witnesses said.

Residents of Hurr Camp, a colony of working-class Christians in Hyderabad in Sindh Province, were reportedly celebrating the 30th anniversary of their Salvation Army church when a group of Muslim youths gathered outside the building and started playing music loudly on their cell phones. They also started teasing Christian women as they arrived for the celebration, according to reports.

Christians Younis Masih, 47, Siddique Masih, 45, Jameel Masih, 22, and a 20-year-old identified as Waseem came out of the church building to stop the Muslim youths from teasing the Christian women, telling them to respect the sanctity of the church. A verbal clash ensued, after which the Muslim youths left, only to return with handguns.

Witnesses told Compass by phone that the Muslim youths opened fire on the Christians, killing Younis Masih and Jameel Masih instantly, and seriously injuring Siddique Masih and Waseem. The injured men have been transferred to a hospital in Karachi, the provincial capital of Sindh.

Younis Masih is survived by his wife and four children, while Jameel Masih was married only a month ago, and his sudden death has put his family into a state of shock.

“My son had gone to the church to attend the anniversary celebrations from our family…a few hours later we were told about his death,” a wailing Surraya Bibi told Compass by telephone from Hyderabad. “I got him married only a month ago. The cold-blooded murderers have destroyed my family, but our most immediate concern is Jameel’s wife, who has gone completely silent since the news was broken to her.”

She said the local police’s indifference towards the brutal incident had exacerbated the Christians’ sorrow.

“The police were acting as if it was not a big deal,” she said. “They did not register a case until late at night, when all of us blocked the main Hyderabad Expressway along with the two dead bodies for some hours.”

Jameel Masih’s paternal uncle, Anwar Masih, told Compass that police were biased against the Christians, as “none of the accused has been arrested so far, and they are roaming the area without any fear.”

He said police had taken into custody some teenagers who had no involvement in the killings.

“This has been done just to show their senior officials that they are not sitting idle,” he said.

Anwar Masih said the families had little hope for justice, because “if we have to dishonor the dead bodies by placing them on the roads to get a case registered, what should we hope for when the investigations begin?”

He said that during their protest, some leaders of the Muttahida Qaumi Movement, a regional political party known for its secular but often violent ideology, arrived and suggested the Christians retaliate against the Muslims.

“We told them that as Christians we are not going to take the law into our hands,” Anwar Masih said.

He said that Jameel Masih’s father, Sardar Masih, and the other Christians would visit the Baldia Colony police station Wednesday morning (March 23) to see whether there has been any progress in the investigation.

“Please pray for us,” he said.

Compass made efforts to contact Hyderabad District Police Officer Munir Ahmed Sheikh to ask about progress in the case and whether any of the named suspects have been arrested by police, but the calls were unanswered.

The killing of the two Christians comes a week after another Christian, sentenced to life imprisonment on false blasphemy charges, died in Karachi Central Prison. The family of Qamar David claims he was murdered on March 15, while conflicting reports from the jail suggest that he died of heart failure.

If David died from torture, yesterday’s killings bring the number of Christians murdered in March alone to four, the most prominent among them being Federal Minister for Minority Affairs Shahbaz Bhatti, who was assassinated in Islamabad on March 2 for opposing the country’s controversial blasphemy laws.

Report from Compass Direct News
http://www.compassdirect.org

Christian Woman Freed from Muslim Kidnappers in Pakistan

Captors tried to force mother of seven to convert to Islam.

LAHORE, Pakistan, March 11 (CDN) — A Christian mother of seven here who last August was kidnapped, raped, sold into marriage and threatened with death if she did not convert to Islam was freed this week.

After she refused to convert and accept the marriage, human traffickers had threatened to kill Shaheen Bibi, 40, and throw her body into the Sindh River if her father, Manna Masih, did not pay a ransom of 100,000 rupees (US$1,170) by Saturday (March 5), the released woman told Compass.   

Drugged into unconsciousness, Shaheen Bibi said that when she awoke in Sadiqabad, her captors told her she had been sold and given in marriage.

“I asked them who they were,” she said. “They said that they were Muslims, to which I told them that I was a married Christian woman with seven children, so it was impossible for me to marry someone, especially a Muslim.”

Giving her a prayer rug (musalla), her captors – Ahmed Baksh, Muhammad Amin and Jaam Ijaz – tried to force her to convert to Islam and told her to recite a Muslim prayer, she said.

“I took the musalla but prayed to Jesus Christ for help,” she said. “They realized that I should be returned to my family.”

A member of St. Joseph Catholic Church in Lahore, Shaheen Bibi said she was kidnapped in August 2010 after she met a woman named Parveen on a bus on her way to work. She said Parveen learned where she worked and later showed up there in a car with two men identified as Muhammad Zulfiqar and Shah. They offered her a job at double her salary and took her to nearby Thokar Niaz Baig.

There she was given tea with some drug in it, and she began to fall unconscious as the two men raped her, she said. Shaheen Bibi was unconscious when they put her in a vehicle, and they gave her sedation injections whenever she regained her senses, she said.

When she awoke in Sadiqabad, Baksh, Amin and Ijaz informed her that she had been sold into marriage with Baksh. They showed her legal documents in which she was given a Muslim name, Sughran Bibi daughter of Siddiq Ali. After Baksh had twice raped her, she said, his mother interjected that she was a “persistent Christian” and that therefore he should stay away from her.

Shaheen Bibi, separated from an abusive husband who had left her for another woman, said that after Baksh’s mother intervened, her captors stopped hurting her but kept her in chains.

 

Release

Her father, Masih, asked police to take action, but they did nothing as her captors had taken her to a remote area between the cities of Rahim Yar Khan and Sadiqabad, considered a “no-go” area ruled by dangerous criminals.

Masih then sought legal assistance from the Community Development Initiative (CDI), a human rights affiliate of the European Center for Law & Justice. With the kidnappers giving Saturday (March 5) as a deadline for payment of the ransom, CDI attorneys brought the issue to the notice of high police officials in Lahore and on March 4 obtained urgent legal orders from Model Town Superintendent of Police Haidar Ashraf to recover Shaheen, according to a CDI source.

The order ultimately went to Assistant Sub-Inspector (ASI) Asghar Jutt of the Nashtar police station. Police accompanied by a CDI field officer raided the home of a contact person for the captors in Lahore, Naheed Bibi, the CDI source said, and officers arrested her in Awami Colony, Lahore.

With Naheed Bibi along, CDI Field Officer Haroon Tazeem and Masih accompanied five policemen, including ASI Jutt, on March 5 to Khan Baila, near Rahim Yar Khan – a journey of 370 miles, arriving that evening. Area police were not willing to cooperate and accompany them, telling them that Khan Baila was a “no-go area” they did not enter even during daytime, much less at night.

Jutt told area police that he had orders from high officials to recover Shaheen Bib, and that he and Tazeem would lead the raid, the CDI source said. With Nashtar police also daring them to help, five local policemen decided to go with them for the operation, he said.

At midnight on Sunday (March 6), after some encounters and raids in a jungle area where houses are miles apart, the rescue team managed to get hold of Shaheen Bibi, the CDI source said. The captors handed over Shaheen Bibi on the condition that they would not be the targets of further legal action, the CDI source said.

Sensing that their foray into the danger zone had gone on long enough, Tazeem and Jutt decided to leave but told them that those who had sold Shaheen Bib in Lahore would be brought to justice.

Fatigued and fragile when she arrived in Lahore on Monday (March 7), Shaheen Bibi told CDN through her attorneys that she would pursue legal action against those who sold her fraudulently into slavery and humiliation.

She said that she had been chained to a tree outside a house, where she prayed continually that God would help her out of the seemingly impossible situation. After the kidnappers gave her father the March 5 deadline last week, Shaheen Bibi said, at one point she lifted her eyes in prayer, saw a cross in the sky and was comforted that God’s mighty hand would release her even though her father had no money to pay ransom.

On four previous occasions, she said, her captors had decided to kill her and had changed their mind.

Shaheen Bibi said there were about 10 other women in captivity with her, some whose hands or legs were broken because they had refused to be forcibly given in marriage. Among the women was one from Bangladesh who had abandoned hope of ever returning home as she had reached her 60s in captivity.

Masih told CDN that he had prayed that God would send help, as he had no money to pay the ransom. The day before the deadline for paying the ransom, he said, he had 100 rupees (less than US$2) in his pocket.

Report from Compass Direct News

Lao Officials to Expel More Christian Families from Village

Katin chief says previously expelled Christians will be shot if they return.

DUBLIN, November 9 (CDN) — Officials in Katin village, southern Laos have ordered six more Christian families to renounce their faith or face expulsion in early January, advocacy group Human Rights Watch for Lao Religious Freedom (HRWLRF) reported today (Nov. 9).

The Katin chief and the village religious affairs officer, along with local security forces, recently approached the six families with the threat after having expelled 11 Christian families, totaling 48 people, at gunpoint last January. The six families now under threat had become Christians since the January expulsion.

The eviction last January followed months of threats and harassment, including the confiscation of livestock and other property, the detention of 80 men, women and children in a school compound and the death by asphyxiation of a Christian villager. (See http://www.compassdirect.org, “Lao officials Force Christians from Worship at Gunpoint,” Feb. 8.)

Immediately after the expulsion, two more families in Katin village became Christians despite the obvious risk to their personal safety, according to HRWLRF. The village chief allowed them to remain in Katin but warned all villagers that their own homes would be “torn down” if they made contact with the expelled Christians.

In the following months, the expelled villagers suffered from a lack of adequate shelter, food and water, leading to eye and skin infections, diarrhea, dehydration and even the death of one villager. Katin authorities also denied Christian children access to the village school. (See http://www.compassdirect.org, “Christians Expelled from Village Suffer Critical Illnesses,” May 14.)

District officials in early May gave the Christians permission to return to Katin and take rice from their family barns to prevent starvation, said another source on condition of anonymity. Some families then tried to cultivate their rice fields to avoid losing them completely, but the work was extremely difficult as authorities had confiscated their buffaloes, essential to agriculture in Laos.

 

Threat to Shoot

In July, officials from the Saravan provincial headquarters and the Ta-oyl district religious affairs office met with the evicted families in their shelters at the edge of the jungle and encouraged them to return to Katin, HRWLRF said.

The Christians agreed to return under five conditions: that authorities designate a Christian “zone” within Katin to avoid conflict with non-believers; that all forms of persecution end; that their children return to school; that Christians must be granted the right of burial in the village cemetery; and that the village award compensation for six homes destroyed in the January eviction.

When higher-level officials approached Katin leaders with these terms, village officials and local residents rejected them, insisting that they would only allow the Christians to return if they gave up their faith. The higher officials invoked Decree 92, a law guaranteeing the rights of religious minorities, but village heads said they would shoot every Christian who returned to Katin.

Shortly after this discussion took place, a further four families in Katin became Christians, according to HRWLRF.

A communist country, Laos is 1.5 percent Christian and 67 percent Buddhist, with the remainder unspecified. Article 6 and Article 30 of the Lao Constitution guarantee the right of Christians and other religious minorities to practice the religion of their choice without discrimination or penalty.

Report from Compass Direct News

Pakistani Muslims Beat Elderly Christian Couple Unconscious

80-year-old’s bones broken after he refused prostitute that four men offered.

SARGODHA, Pakistan, October 21 (CDN) — An 80-year-old Christian in southern Punjab Province said Muslims beat him and his 75-year-old wife, breaking his arms and legs and her skull, because he refused a prostitute they had offered him.

From his hospital bed in Vehari, Emmanuel Masih told Compass by telephone that two powerful Muslim land owners in the area, brothers Muhammad Malik Jutt and Muhammad Khaliq Jutt, accompanied by two other unidentified men, brought a prostitute to his house on Oct. 8. Targeting him as a Christian on the premise that he would not have the social status to fight back legally, the men ordered him to have sex with the woman at his residence in village 489-EB, he said.

“I turned down the order of the Muslim land owners, which provoked the ire of those four Muslim men,” Masih said in a frail voice. District Headquarters Hospital (DHQ) Vehari officials confirmed that he suffered broken hip, arm and leg bones in the subsequent attack.

His wife, Inayatan Bibi, said she was cleaning the courtyard of her home when she heard the four furious men brutally striking Masih in her house.

“I tried to intervene to stop them and pleaded for mercy, and they also thrashed me with clubs and small pieces of iron rods,” she said by telephone.

The couple was initially rushed to Tehsil Headquarters Hospital Burewala in critical condition, but doctors there turned them away at the behest of the Jutt brothers, according to the couple’s attorney, Rani Berkat. Burewala hospital officials confirmed the denial of medical care.

Taken to the hospital in Vehari, Inayatan Bibi was treated for a fractured skull. The beatings had left both her and her husband unconscious.

Berkat said the Muslim assailants initially intimidated Fateh Shah police into refraining from filing charges against them. After intervention by Berkat and Albert Patras, director of human rights group Social Environment Protection, police reluctantly registered a case against the Jutt brothers and two unidentified accomplices for attempted murder and “assisting to devise a crime.” The First Information Report (FIR) number is 281/10.

Station House Officer Mirza Muhammad Jamil of the Fateh Shah police station declined to speak with Compass about the case. Berkat said Jamil told her that the suspects would be apprehended and that justice would be served.

Berkat added, however, that police appeared to be taking little action on the case, and that therefore she had filed an application in the Vehari District and Sessions Court for a judge to direct Fateh Shah police to add charges of ransacking to the FIR.

Doctors at DHQ Vehari said the couple’s lives were no longer in danger, but that they would be kept under observation.

Report from Compass Direct News

Church under Attack in Indonesia Agrees to Change Venue

Congregation accepts offer under condition that government build them permanent building.

JAKARTA, Indonesia, September 29 (CDN) — A West Java church has agreed to move temporarily to a government-selected site following Islamist harassment that included a Sept. 12 attack on two of its leaders.

The Batak Christian Protestant Church (Huria Kristen Batak Protestan, or HKBP) in Ciketing village, Bekasi, decided in a congregational meeting on Sunday (Sept. 26) to accept a government offer to move worship services to the former Organization and Political Party (OPP) building on the condition that local officials will keep a promise to build a new house of worship for them within two years in the Mustika Sari district.

The Rev. Luspida Simanjuntak, who received hospital treatment after she was struck with a wooden plank by suspected Islamic extremists in the Sept. 12 attack, said that the church was ready to stop struggling.

“We are tired of being intimidated and terrorized,” Pastor Simanjuntak said. “We will be able to worship quietly and peacefully.”

Church lawyer Saor Siagian said that the church had accepted the temporary move with the understanding that the Bekasi municipal government must fulfill its pledge. The government will build a new church building to replace the structure the church is leaving on a 2,500-square meter lot belonging to PT Timah, the Government Tin Mining Co. in the Mustika Sari area of Bekasi. The lot is zoned for general and social facilities.

The government had suggested two alternative locations: the PT Timah lot and a 1,900-square meter parcel in the Strada Housing area. The congregation and leaders of HKBP Ciketing chose the PT Timah property.

The first HKBP Ciketing worship service in the former OPP Building took place without incident on Sunday, with the Bekasi government providing buses to transport the congregation to the new site. Pastor Simanjuntak said the congregation is thankful for the new temporary site, but it does not accommodate the entire congregation. The 10-meter by 14-meter building accommodates 250 people, but normally 300 attend services, and some had to stand outside, she said.

Dozens of police guarded the location.

Zaki Oetomo, a Bekasi city official, told Compass that the building could be used rent-free for two years, with an extension possible if the church desired. The government has offered to provide the buses to transport the congregation to and from the site every week.

 

20-Year Wait

The Ciketing church originally met in the Pondok Timur Indah housing development with 10 families in 1990, and therefore has generally been called the HKBP Pondok Timur Indah.

“By 1995 it had grown to 30 families,” Manorangi Siahaan, a church member, told Compass.

In those days the worship services were held in different members’ homes. Manorangi acknowledged that the house church worship did spark some small protests.

Between 1990 and 2010, the church leaders requested building permits three separate times, in 1995, 2000 and 2010. Not once did the local government respond, church leaders said.  

By 2005 the congregation had grown to 150, and church leaders bought a 2,170-square meter lot in Ciketing village, near Bekasi City, to construct a church building. They built a semi-permanent structure, which was later torn down because they lacked a building permit under pressure from an Islamic group claiming to speak for the local citizens. As a result, the congregation went back to worshipping in homes on a rotating basis.

In 2007 the congregation had grown to 300 people. They bought a house in Pondok Timur Indah, in the Mustika Jaya area of Bekasi City, to use for worship. The Bekasi government sealed the house on March 1 under pressure from Islamic groups. On July 2, the government sealed the house a second time because the congregation was continuing to worship there. Then on July 11, the church was forced to move their worship service to a vacant property in Ciketing, which had been readied for a church building. This site was about 3 kilometers from their property in Pondok Timur Indah.

Protests by Islamic groups mounted each Sunday at the Ciketing site, culminating in the attack on Pastor Simanjuntak and elder Hasian Sihombing, who was stabbed in the stomach and heart.

Report from Compass Direct News

Indonesian Church Leaders Wounded in Attack

Elder remains in critical condition after being stabbed in heart, stomach.

JAKARTA, Indonesia, September 15 (CDN) — An elder of a West Java church that Muslim groups attacked last month remains in critical condition after a motorcyclist stabbed him in the heart and stomach on his way to a service on Sunday (Sept. 12), according to Theophilus Bela, president of the Jakarta Christian Communication Forum.

Hasian Sihombing of Batak Christian Protestant Church (Huria Kristen Batak Protestan, or HKBP) sustained a wound to his heart of three centimeters. Also injured in the attack was the Rev. Luspida Simanjuntak, struck with a wooden block on her back, head and face by another motorcyclist when she tried to help Sihombing.

Simanjuntak, who suffered dizziness after the attack, was still weak and receiving hospital treatment along with Sihombing at Mitra Keluarga Hospital Bekasi Timur, Bela stated in an e-mail advisory today.

A member of the HKBP congregation, Ratna Gurning, told Compass that she was with Sihombing as he and other church members walked to the service in the Ciketing area of Bekasi, where the church has been meeting in an open field after officials in June sealed a house they had used for worship in the Pondok Timur housing complex in Jejalen Jaya sub-district, Bekasi.

“About 500 meters from church, they saw some [16] motorcyclists on eight motorcycles were following them,” Gurning said. “Suddenly, our church elder, Hasian, was stabbed in his stomach.”

Sihombing was bleeding profusely, Gurning said, and Pastor Simanjuntak came to help him.

“Rev. Luspida was beaten from behind with a wooden beam, which struck her head, face, and back,” Gurning said.

Gurning said that Pastor Simanjuntak recognized the assailants as having “come to a religious service of HKBP’s community” to protest.  

On Aug. 8 at least 300 members of the Islamic People’s Forum and the Islamic Defenders Front broke through a police barricade and ordered 20 members of the HKBP church meeting in Ciketing to leave, according to Bela. When the church members refused, the protestors assaulted the group with sticks, stones or their bare hands. Some required hospital treatment.

The previous Sunday, Aug. 1, around 300 Muslim protestors and 300 police officers surrounded members of the HKBP as they worshiped in the open field, and one protestor hit Pastor Simanjuntak on the cheek.

The 1,500-strong congregation has been waiting for local officials to respond to a building permit application filed in 2006. When Muslim neighbors in December 2009 objected to the meetings in a housing complex on the grounds that the church had no permit, officials banned church members from meeting there.

With its building permit application delayed, the church ignored the ban, leading officials to seal the building on June 20. Bekasi Mayor Mochtar Mohammad on July 9 reportedly said he would allow the congregation to meet in public areas or at the city hall, and Pastor Simanjuntak moved worship to the proposed building site. Her church has now filed a case against the Bekasi administration.

Member of Parliament Sukur Nababan told Compass that police must apprehend the assailants in Sunday’s attack quickly. He refuted a comment by Jakarta and Bekasi police officials who said that the incident was not religiously motivated.

“This is not purely criminal,” Nababan said. “This incident was premeditated. Freedom of religious is the responsibility of the government.”

Nababan called on the Bekasi officials to grant a permit to the church for its Christian activities in accordance with the constitutional rights of all Indonesians.

The coordinator of HKBP church’s legal team, Saor Siagian, agreed that the police leaders’ views that the attack was not religiously motivated were erroneous.

“The stabbing of Hasian was not purely a criminal act,” Siagian told Compass. “This incident was pre-planned, and it was terrorism against religious rights.”  

On the day of the attack, President Susilo Bambang Yudhoyono reportedly asked Djoko Suyanto, minister of political, legal and security affairs, to work with the head of Indonesian Police Jendral Bambang Hendarso Danuri to arrest the assailants.

The chairman of the Communion of Churches in Indonesia, the Rev. Andreas Yewangoe, asked police to thoroughly investigate, stop allowing violence and guarantee security for the congregation.

“We also ask all Christians to remain steadfast in the face of this calamity and not be provoked,” he said.

A demonstration in front of National Police Headquarters in Jakarta is scheduled for Thursday (Sept. 16) at 2:30 p.m. to urge police to seriously investigate the attack.

Report from Compass Direct News