‘Died from’ or ‘died with’ COVID-19? We need a transparent approach to counting coronavirus deaths

Marc Trabsky, La Trobe University and Courtney Hempton, Deakin University

The COVID-19 death toll is reported every day by state and federal governments. These numbers are often used, alongside case numbers, to assess how public health policies are faring in controlling the pandemic, and to gauge the success of various drugs or interventions.

There’s been confusion, however, over whether reported death statistics reflect those who’ve died from COVID-19, or those who’ve died with the virus. Often it’s hard for medical practitioners to determine which of these categories a death falls into.

But the COVID-19 death toll publicised daily on Australian state and territory government websites and reported to the press does not differentiate between the two. It includes all people who’ve died with SARS-CoV-2 (the virus that causes COVID-19) in their body. It’s unclear if the federal government currently makes this distinction or not.

Lumping these statistics together makes it hard for the public to understand the true impact of the virus. Clarifying what’s being counted as a COVID-19 death is necessary for understanding the impact of the virus, and for informing public health and clinical responses to the pandemic. If we know who is susceptible to dying with COVID-19 because of pre-existing conditions, public health responses could more effectively target and protect potentially vulnerable people and communities.

We are not suggesting this is a reason to downplay the seriousness of the virus, but rather that successful public health engagement requires open communication of death causation data, especially in a pandemic. Therefore, we need a transparent approach to counting and reporting coronavirus deaths in Australia.

Cause of death is not straightforward

Federal Deputy Chief Medical Officer Nick Coatsworth acknowledged that determining cause of death is complex when questioned by reporters on Tuesday, saying:

I remember as a junior doctor trying to do death certificates – it’s not always an easy thing […] I don’t, by any stretch of the imagination, think it’s a reason to underplay the severe impact that COVID has on people who have [pre-existing] conditions.

Indeed, distinguishing between dying with and dying from COVID-19 may require a more complex investigation into the cause of a death, beyond citing a positive SARS-CoV-2 test that was completed prior to the person’s death.

For example, Victoria’s coroner is currently investigating the death of a man in his twenties, who was widely reported as being Australia’s youngest coronavirus death. The coroner is investigating whether his death was primarily caused by SARS-CoV-2, or whether the virus contributed less substantially to his death.

While this death was reported on August 14 in Victoria’s daily death toll, according to The Sydney Morning Herald, as of August 28 it wasn’t counted in the federal COVID-19 death tally. It remains unclear whether the death has been added to the federal count as of today.

Generally when a person dies a medical practitioner is responsible for indicating the cause of death. The doctor will complete a “medical certificate of cause of death”, and inform the Registry of Births, Death and Marriages in their state or territory.

In some circumstances, the cause of a death can also be reported by a coroner, but they typically investigate deaths that are sudden, unnatural, violent or accidental, or which occur during or after medical procedures. The cause of death may be initially unclear at the beginning of a coronial investigation. Sometimes, the determined cause of death may be multiple, while other times it may change when more information is revealed, for example through a post-mortem examination or toxicology tests, or when new information comes to light about how a virus affects the body.

We don’t know the true death rate

The lack of nuance in Australia’s COVID-19 death tally means the true death rate may be unknown, and may be adjusted in the future.

For example, on August 31 Victoria recorded only eight COVID-19 deaths from the previous 24 hours, but also added 33 historical deaths to the toll. According to the state’s Chief Health Officer Brett Sutton, this backlog was due to changes in how aged care providers reported COVID-19 deaths, and differences in reporting methods between the state and federal governments.

On September 4 there were six deaths recorded over the previous 24-hours, but a further 53 historical deaths were added to the daily toll, 50 of which were related to aged care.

There is a lack of transparency about why there is a discrepancy between how Victoria and the Commonwealth count COVID-19 deaths.

A spokesperson for federal Aged Care Minister Richard Colbeck suggested delays in data collection and reporting are the primary reasons for the discrepancies. But there appeared to be confusion in early August in the aged care sector about the necessity of reporting “all COVID-19 related deaths, including those involving other causes or comorbidity factors”, according to a letter written to Victorian aged care providers from the secretary for the Department of Health, Brendan Murphy.

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Read more:
Have there been uncounted coronavirus deaths in Australia? We can’t say for sure, but the latest ABS data holds clues

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Delays may have been caused by aged care providers struggling to verify not only residents who died from COVID-19, but also those suspected to have died with the virus.

The Victorian and Commonwealth governments are reportedly working to reconcile how COVID-19 deaths are counted and reported. But it may be months or years before detailed death data can be analysed.

In the meantime, we need more detail about what’s being reported in the daily COVID-19 death data, and governments should be transparent about what is (and is not) being counted as a COVID-19 death.

Marc Trabsky, Senior Lecturer, La Trobe Law School and Director, Centre for Health, Law and Society, La Trobe University and Courtney Hempton, Associate Research Fellow, Deakin University

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

The big stimulus spending has just begun. Here’s how to get it right, quickly

Shutterstock

Richard Denniss, Crawford School of Public Policy, Australian National University

Responding to COVID-19 required governments to make hard choices with enormous consequences. The biggest were whether to let the disease rip, lock it down, or strike out in search of a middle ground that delivered the best of both worlds.

Different leaders made different decisions and will ultimately be judged by their citizens and historians. But it’s not just in health that COVID-19 requires choices with enormous consequences – it’s also in spending.

Two months ago the government announced a A$17.6 billion coronavirus stimulus package. Remember when that was a lot of money?

Since then it has committed to spend an extra $200 billion.

$200 billion has become base camp

Should we just let the government rip through hundreds of billions more in an attempt to quickly stimulate the economy? Should we put all proposed spending through lengthy cost benefit analyses and parliamentary inquiries?

Or is there some sort of middle path?

In a new paper by The Australia Institute, Design Principles for Fiscal Policy in a Pandemic, Matt Grudnoff, David Richardson and I set out eight criteria on which to judge spending proposals in order to expedite public and parliamentary scrutiny.

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Read more:
It’s just started: we’ll need war bonds, and stimulus on a scale not seen in our lifetimes

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While not all voters will be able to agree on what the most pressing problems are, presumably all voters agree that when it comes to spending vast amounts of public money it is important to have some clear criteria against which voters can subsequently judge the necessarily rapid decisions that are made.

The first two are for stimulus spending to be large in size and speedy in implementation.

The other six use economic theory to help maximise benefit for bucks.

Target households with high marginal propensity to consume

Low income households have a higher “propensity to consume’” than wealthier families who can afford to save some of what they receive. Saved stimulus does nothing to increase demand and employment in the short term.

Direct government spending on goods and services is another way to ensure that money is spent quickly.

Target domestic production

Money spent on imported cars, imported electronics or imported capital equipment will diminish the local benefits of stimulus spending.

Target activities with high employment intensities

Some industries create more direct and indirect jobs per billion dollars of spending than others. Capital intensive mining and construction projects, for example, create far fewer jobs per billion dollars spent than spending on health and community services.

Target those most hurt by the crisis

When considering stimulus spending the government should focus on projects that provide employment opportunities to individuals in industries most affected. Two of these are tourism and hospitality. While such an approach is equitable, it is also efficient as it helps ensure that the skills of the newly-unemployed match those needed by needed by new projects.

Target regions that are most disadvantaged

Building new train lines in NSW might be a good long run investment for the country, but it will do little to create jobs for tourism workers who have lost their jobs in Queensland. Stimulus spending targeted at the regions most effected will be the most likely to socak up unemployment.

Target useful projects that deliver benefits

When considering stimulus spending the government should think about what we want more of after the crisis has ended. An example from an earlier stimulus program is the ocean baths that dot the NSW coastline.

Many were built in order to generate employment during the great depression, yet almost 90 years later we are still enjoying the additional secondary benefits.

Most good projects will meet most of the criteria

While not all good projects will meet all of the criteria spelt out above, most good stimulus projects will meet most of them.

The enormity of the discretionary spending that the Morrison government is about to undertake on our behalf is almost impossible to fathom.

In a normal year the Commonwealth spends $500 billion on all of its services.

In the past two months alone it has committed to spend an additional $200 billion, and it hasn’t even started on the extra spending that will be needed to restore economic health as restrictions unwind.

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Read more:
Look beyond a silver bullet train for stimulus

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The enormity of the spending that will be needed means that, more than ever before, the decisions it makes over the next few months will determine our economic success for decades to come.

For all our sakes it is important it gets these decisions right.

Using principles we have set out for assessing the myriad of potential projects it will consider will give it the best chance to make the biggest difference, and give us some confidence that even though decisions are being made quickly, they are being made well.

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Matt Grudnoff, Senior Economist at The Australia Institute, contributed to this piece.

Richard Denniss, Adjunct Professor, Crawford School of Public Policy, Australian National University

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

Hospital beds and coronavirus test centres are needed fast. Here’s an Australian-designed solution

Deborah Ascher Barnstone, University of Technology Sydney

Two of the most pressing needs worldwide in the coronavirus pandemic are for more hospital beds and testing centres. No country in the world has enough hospital beds or intensive-care unit (ICU) beds for a pandemic. Even the best prepared, like Germany with 33.9 ICU beds per 100,000 citizens, does not have enough.

Most countries have locked down to buy time by flattening the infection curve so fewer patients will present to hospital at once. They hope to use the time to boost hospital capacity.

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Read more:
What steps hospitals can take if coronavirus leads to a shortage of beds

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But the design challenge is significant. We need structures that can be quickly and easily assembled, are inexpensive and meet technical requirements. Architects have always worked on such challenges – the Living Shelter is one recent example.

Here in Australia a consortium is working to develop two designs, one for hospital intensive care units and one for COVID-19 testing centres, that can be used across the country and overseas. By using recycled shipping containers as the core structure, the price of the buildings will be less than a third of the cost of conventional designs.

In both building types, the container doubles as structure and packaging. This means the designs are self-contained and easy to distribute anywhere in the world. All the building parts, technical equipment, cabinets and other fit-out materials pack into the container.

The design of the testing centre is based on a shipping container, which doubles as the packaging for transport.
Author provided

Douglas Abdiel, the director of charitable foundation P&G Purpose, and architect Robert Barnstone are working together on the design and delivery of these hospital units and testing centres.

Barnstone specialises in disaster relief architecture. He has developed designs for emergency housing for the International Red Cross and rapid deployment schools for countries afflicted by disaster. This experience gave Barnstone invaluable insights into the economics and potential construction systems for the hospital units and testing centres.

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Read more:
Coronavirus will devastate Aboriginal communities if we don’t act now

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What are the key requirements?

Any disaster relief architecture must consider several critical design aspects:

• buildings need to be as cheap as possible so limited funds can be stretched to help as many people as possible

• the structure should be lightweight and easy to assemble because professional builders might not be available for construction

• the structure needs to be weatherproof and insulated for variable climates

• medical functions require running water, electricity, air exchange to bring fresh air into the container, and air conditioning to control the temperature inside.

The mechanical services needed in a medical facility are highly specialised and expensive. This makes it particularly challenging to design. Ideally, the structure should be lasting, so money invested in relief efforts is not wasted.

Emergency structures should also be designed for easy packaging and shipping. Standard dimensions of shipping containers, freight costs and delivery logistics must be considered.

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Read more:
Coronavirus an ‘existential threat’ to Africa and her crowded slums

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So how do the two building designs work?

The two proposals for intensive care units and testing facilities use modified shipping containers as the supporting structure. You can see the full designs and specifications here.

The hospital structure is simply a large shed that houses ICU bays. A nurses’ station is located in the centre.

The testing centre is a drive-by place to conduct COVID-19 tests and either process them when a fast test is available or store them for shipping to laboratories.

Used shipping containers are cheap and easy to find. They are made from a steel frame with corrugated steel panelling, which makes them very strong.

Both schemes use prefabricated panels for exterior and interior walls. Window units will be integrated into panels. These come in standard sizes that easily pop into place.

The two design approaches do have differences, however.

The front entry of the rapid deployment hospital annexe.

The hospital uses a full-length 12-metre container. The shipping container acts as the structural and spatial core of the hospital building.

When unpacked, the container sits in the middle of the hospital and supports long-span steel trusses and the roof. It houses office and storage space.

Inside the hospital annexe the container houses the nurses’ annexe and supports the building trusses and roof.

The prefabricated panels form both the outside walls and interior partitions. End walls are made of transparent glass to allow natural light into the interior.

Interior bays for patients are also prefabricated. These line the exterior walls, leaving space for hospital staff to circulate between the ICU bays and central container.

In contrast, the testing centre is a single-unit building made from a half-length six-metre container. A large overhanging canopy covers the roof and front deck to protect against sun and rain.

A water storage tank rests on the roof underneath the canopy. A generator sits on one side. There is a scrub sink and changing area outside, with a curtain that allows for privacy and a bin to dispose of protective equipment.

The exterior of the testing centre has a changing area and sink.

The container doors support storage cabinets for test kits on their inside wall. These doors can swing open so they are flush with the front facade. In this position, the cabinets face the front deck for easy access by nurses and doctors.

The front deck of the testing centre showing storage cabinets.

The interior has ample storage and office furniture.

The testing centre office.

Construction of the prototype test centre was due to begin on April 15. To date, the team has raised A$30,000 to support the effort but needs $20,000 more. At A$3,125 per square metre, compared with about A$10,000 per square metre for usual construction, these solutions are affordable and can be produced and delivered very quickly.

Deborah Ascher Barnstone, Professor, Course Director Undergraduate Studies, School of Architecture, University of Technology Sydney

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

Syria: A Solution Needed

I’m Back: Much Needed Break Over

My massive break is over and I’ll be trying to get back into Blogging and other aspects of life online over the next few weeks. There will be some breaks over the ‘silly season,’ but I’m hoping normal service is being resumed.

Hopefully there will be some improvements along the way as well.

Back from a Break: Much Needed

Well, I’m back from a rather large break which I have to say was much needed. Now that I’m back it is time to probably reflect a little on just what this Blog is about – or rather, where it will be going into the future. This is something I’ll be thinking over a little in coming weeks and I guess what the Blog looks into the future like will be the result of these reflections. So I guess this is really something of a nothing post now that I think about it – except to say that I am back.

 

Plinky Prompt: If You Were President of the U.S., what would be your #1 Priority? Why?

Sabari grasses

If I was president of the United States my number 1 priority would probably be having a serious rethink on both Iraq and Afghanistan. It is not that I think the war on terror should be ended – far from it – just that a review of current
policies is probably needed. There are probably some other ways of doing things that are more helpful, useful and directed towards a determination.

Judges Rule Church in Bekasi, Indonesia Can Worship

Court revokes decree prohibiting Christian activities of HKBP Filadelfia.

JAKARTA, Indonesia, September 15 (CDN) — A court in West Java Province has revoked a local decree that forbade Christian activities of a church in Bekasi and has ordered officials to allow the Christians to establish a place of worship.

After months of conflict and legal battles, the State Administrative Court in Bandung on Sept. 3 revoked the Dec. 31, 2009 decree prohibiting Christian activities of Batak Christian Protestant Filadelfia Church (Huria Kristen Batak Protestant, or HKBP Filadelfia) in Jejalan village, Bekasi. The church had argued that the decree, along with the closure of their worship building on Jan. 12, resulted from pressure by Islamist groups that did not represent the wishes of the area residents.  

The Rev. Palti Panjaitan of HKBP Filadelfia said he was happy that the church at last had found fair authorities who based their decisions on the rule of law, “unlike the regent of Bekasi, who often has been unjust in making a decision by tending to side with a small group of people.”

Since 2008 HKBP Filadelfia has sought permission for a place of worship from Bekasi Regent H. Sa’duddin, who declined to grant it under pressure from a small group of Islamists called the Forum Islamic Ummah Jejalen Raya Bekasi, according to church leaders. The group succeeded in pressuring the Bekasi district to seal the church’s temporary worship place on Jan. 12.

As a result, the church had been holding services on a strip of roadside land in front of the temporary site, using umbrellas to protect them from the intense heat of the sun and from sudden rainstorms.

The judges, identified only as Setiobudi, Irna, and Susilowati, ruled that the regent of Bekasi should issue a permit for the church to establish a place of worship.

“This point is important because if the regent of Bekasi does what the judge said, then we will build our church and no longer serve in the hot sun and the rains that sometimes come unexpectedly,” Pastor Panjaitan said.

He said the church will give notice to the area residents, government officials and security forces to accept the decision of the administrative court.

The regent was given 14 days to appeal, and a member of the church legal team, Parasian Hutasoit, said that the regent has no legal grounds to reject the judges’ decision.

“The decree of the regent of Bekasi is contrary to the constitution of 1945, which is the constitutional foundation of the Republic of Indonesia,” Hutasoit said. “The decree had violated Article 28 of the constitution, which guarantees freedom of religion. Also, it was contrary to Article 29, which guarantees freedom of worship and Law No. 39, 1999, concerning human rights.”

HKBP Filadelfia is now able to worship in the building that was sealed by the regent in January, he said.

Regent Sa’duddin had ruled that the church needed to find a new place to construct its prospective permanent church building because local residents had rejected it – even though the church had secured approval from local residents when it submitted its application for a permit in 2008.

The local government never acted on the application, and Islamist organizations organized protests to pressure government officials to deny approval. The church on March 30 filed suit against Sa’duddin for unilaterally closing their building under construction.

Hutasoit said church leaders would try to approach the regent to discuss the matter further.

“We need not hurry to do that, because all that happens is God’s plan,” he said.

If efforts prove unsuccessful, then the church leaders will proceed to enforce the judges’ ruling through legal means, he said.

Report from Compass Direct News

Motive for Aid Worker Killings in Afghanistan Still Uncertain

Taliban takes responsibility, but medical organization unsure of killers’ identity.

ISTANBUL, August 12 (CDN) — The killing of a team of eye medics, including eight Christian aid workers, in a remote area of Afghanistan last week was likely the work of opportunistic gunmen whose motives are not yet clear, the head of the medical organization said today.

On Friday (Aug. 6), 10 medical workers were found shot dead next to their bullet-ridden Land Rovers. The team of two Afghan helpers and eight Christian foreigners worked for the International Assistance Mission (IAM). They were on their way back to Kabul after having provided medical care to Afghans in one of the country’s remotest areas.

Afghan authorities have not been conclusive about who is responsible for the deaths nor the motivation behind the killings. In initial statements last week the commissioner of Badakhshan, where the killings took place, said it was an act of robbers. In the following days, the Taliban took responsibility for the deaths.

The Associated Press reported that a Taliban spokesman said they had killed them because they were spies and “preaching Christianity.” Another Taliban statement claimed that they were carrying Dari-language Bibles, according to the news agency. Initially the attack was reported as a robbery, which IAM Executive Director Dirk Frans said was not true.

“There are all these conflicting reports, and basically our conclusion is that none of them are true,” Frans told Compass. “This was an opportunistic attack where fighters had been displaced from a neighboring district, and they just happened to know about the team. I think this was an opportunistic chance for them to get some attention.”

A new wave of tribal insurgents seeking territory, mineral wealth and smuggling routes has arisen that, taken together, far outnumber Taliban rebels, according to recent U.S. intelligence reports.

Frans added that he is expecting more clarity as authorities continue their investigations.

He has denied the allegation that the members of their medical team were proselytizing.

“IAM is a Christian organization – we have never hidden this,” Frans told journalists in Kabul on Monday (Aug. 9). “Indeed, we are registered as such with the Afghan government. Our faith motivates and inspires us – but we do not proselytize. We abide by the laws of Afghanistan.”

IAM has been registered as a non-profit Christian organization in Afghanistan since 1966.

Dr. Abdullah Abdullah, a former political candidate, dismissed the Taliban’s claims that team members were proselytizing or spying, according to the BBC.

“These were dedicated people,” Abdullah said according to the BBC report. “Tom Little used to work in Afghanistan with his heart – he dedicated half of his life to service the people of Afghanistan.”

Abdullah had trained as an eye surgeon under Tom Little, 62, an optometrist who led the team that was killed last week. Little and his family had lived in Afghanistan for more than 30 years with IAM providing eye care.

IAM has provided eye care and medical help in Afghanistan since 1966. In the last 44 years, Frans estimates they have provided eye care to more than 5 million Afghans.

Frans said he doesn’t think that Christian aid workers are particularly targeted, since every day there are many Afghan casualties, and the insurgents themselves realize they need the relief efforts.

“We feel that large parts of the population are very much in favor of what we do,” he said. “The people I met were shocked [by the murders]; they knew the members of the eye care team, and they were shocked that selfless individuals who are going out of their way to actually help the Afghan people … they are devastated.”

The team had set up a temporary medical and eye-treatment camp in the area of Nuristan for two and a half weeks, despite heavy rains and flooding affecting the area that borders with Pakistan.

Nuristan communities had invited the IAM medical team. Afghans of the area travelled from the surrounding areas to receive treatment in the pouring rain, said Little’s wife in a CNN interview earlier this week, as she recalled a conversation with her husband days before he was shot.

Little called his wife twice a day and told her that even though it was pouring “sheets of rain,” hundreds of drenched people were gathering from the surrounding areas desperate to get medical treatment.

 

The Long Path Home

The team left Nuristan following a difficult path north into Badakhshan that was considered safer than others for reaching Kabul. Frans said the trek took two days in harsh weather, and the team had to cross a mountain range that was 5,000 meters high.

“South of Nuristan there is a road that leads into the valley where we had been asked to come and treat the eye patients, and a very easy route would have been through the city of Jalalabad and then up north to Parun, where we had planned the eye camp,” Frans told Compass. “However, that area of Nuristan is very unsafe.”

When the team ended their trek and boarded their vehicles, the armed group attacked them and killed all but one Afghan member of the team. Authorities and IAM believe the team members were killed between Aug. 4 and 5. Frans said he last spoke with Little on Aug. 4.

IAM plans eye camps in remote areas every two years due to the difficulty of preparing for the work and putting a team together that is qualified and can endure the harsh travel conditions, he said.

“We have actually lost our capacity to do camps like this in remote areas because we lost two of our veteran people as well as others we were training to take over these kinds of trips,” Frans said.

The team of experts who lost their lives was composed of two Afghan Muslims, Mahram Ali and another identified only as Jawed; British citizen Karen Woo, German Daniela Beyer, and U.S. citizens Little, Cheryl Beckett, Brian Carderelli, Tom Grams, Glenn Lapp and Dan Terry.

“I know that the foreign workers of IAM were all committed Christians, and they felt this was the place where they needed to live out their life in practice by working with and for people who have very little access to anything we would call normal facilities,” said Frans. “The others were motivated by humanitarian motives. All of them in fact were one way or another committed to the Afghan people.”

The two Afghans were buried earlier this week. Little and Terry, who both had lived in the war-torn country for decades, will be buried in Afghanistan.

Despite the brutal murders, Frans said that as long as the Afghans and their government continue to welcome them, IAM will stay.

“We are here for the people, and as long as they want us to be here and the government in power gives us the opportunity to work here, we are their guests and we’ll stay, God willing,” he said.

 

Memorial

On Sunday (Aug. 8), at his home church in Loudonville, New York, Dr. Tom Hale, a medical relief worker himself, praised the courage and sacrifice of the eight Christians who dedicated their lives to helping Afghans.

“Though this loss has been enormous, I want to state my conviction that this loss is not senseless; it is not a waste,” said Hale. “Remember this: those eight martyrs in Afghanistan did not lose their lives, they gave up their lives.”

Days before the team was found dead, Little’s wife wrote about their family’s motivation to stay in Afghanistan through “miserable” times. Libby Little described how in the 1970s during a citizens’ uprising they chose not to take shelter with other foreigners but to remain in their neighborhood.

“As the fighting worsened and streets were abandoned, our neighbors fed us fresh bread and sweet milk,” she wrote. “Some took turns guarding our gate, motioning angry mobs to ‘pass by’ our home. When the fighting ended, they referred to us as ‘the people who stayed.’

“May the fruitful door of opportunity to embrace suffering in service, or at least embrace those who are suffering, remain open for the sake of God’s kingdom,” she concluded.

 

Concern for Afghan Christians

Afghanistan’s population is estimated at 28 million. Among them are very few Christians. Afghan converts are not accepted by the predominantly Muslim society. In recent months experts have expressed concern over political threats against local Christians.

At the end of May, private Afghan TV station Noorin showed images of Afghan Christians being baptized and praying. Within days the subject of Afghans leaving Islam for Christianity became national news and ignited a heated debate in the Parliament and Senate. The government conducted formal investigations into activities of Christian aid agencies. In June IAM successfully passed an inspection by the Afghan Ministry of Economy.

In early June the deputy secretary of the Afghan Parliament, Abdul Sattar Khawasi, called for the execution of converts, according to Agence France-Presse (AFP).

“Those Afghans that appeared on this video film should be executed in public,” he said, according to the AFP. “The house should order the attorney general and the NDS (intelligence agency) to arrest these Afghans and execute them.”

Small protests against Christians ensued in Kabul and other towns, and two foreign aid groups were accused of proselytizing and their activities were suspended, news sources reported.

A source working with the Afghan church who requested anonymity said she was concerned that the murders of IAM workers last week might negatively affect Afghan Christians and Christian aid workers.

“The deaths have the potential to shake the local and foreign Christians and deeply intimidate them even further,” said the source. “Let’s pray that it will be an impact that strengthens the church there but that might take awhile.”

Report from Compass Direct News

Suspected Islamists Shoot Five Christians to Death in Pakistan

Muslim extremist groups had threatened church for two years.

SUKKUR, Pakistan, July 29 (CDN) — A dozen masked men shot five Christians to death as they came out of their church building here on July 15, two months after a banned Islamic extremist group sent church leaders a threatening letter, relatives said.

Pastor Aaron John and church members Rohail Bhatti, Salman John, Abid Gill and Shamin Mall of Full Gospel Church were leaving the church building after meeting to discuss security in light of the threats they had received, said the pastor’s son, Shahid John.

“As we came out of the church, a group of a dozen armed gunmen came and opened fire at us,” said Shahid John, who survived a bullet in his arm. “Fear struck the area. The police arrived 45 minutes after the incident, and we waited for over 45 minutes for the ambulance to arrive.”

Besides Shahid John, five others were wounded in the attack.

In May church leaders received a letter from Islamic extremist group Sip-e-Sahaba (formerly Sipah-e-Sahaba until it was banned) warning the Christians to leave the area, said Kiran Rohail, wife of the slain Rohail Bhatti.

“It said to vacate the land, Christians are not welcomed here, they are polluting our land,” Kiran Rohail said.

The Sip-e-Sahaba and Sunni Tehrik extremist groups are both linked with an area madrassa (Islamic school) whose students had been threatening the church since 2008, Christian sources said.

“In 2008 a group of Muslim students started making threats for the church to vacate the land, as there are only 55 Christian families living in the area,” said the pastor’s widow, Naila John, who also lost her son Salman John in the attack.

The masked gunmen of July 15 had young physiques like those of students, Christian sources said, and their manner of attack indicated they were trained extremists.

The madrassa students that have threatened the church since 2008 belong to the Sunni Tehrik extremist group, the sources said.

Pastor John and Bhatti had reported the threats of the past two years to police, but officers at the local station did not take them seriously, said Naila John.

When they received the threatening letter in May, Pastor John, his son Salman, Bhatti, Gill, Mall and another member of the church, Arif Gill, went to the police station to register a First Information Report (FIR), according to Shahid John.

“Police just took the application but didn’t register the FIR,” he said. “The station house officer just provided two police constables for security.”

On the evening of July 15, the pastor called a meeting to discuss needed security measures, his widow Naila John said. The meeting ended around 7:30 p.m., when they left the building and were sprayed with gunfire.

“No FIR has been registered due to the pressure from the local Islamic groups,” said Kiran Rohail, referring to Sunni Tehrik, Sip-e-Sahaba and the local mosque. “The police came and took our statements, but they didn’t show up again.”

An independent government source confirmed the shooting deaths of the Christians, adding that local Islamist pressure had prevented media from reporting on it.

The church began in 1988, and Pastor John had been leading it since 2001.

Sukkur, in southwest Pakistan’s Sindh Province, has been the site of previous violence against Christians. Last June or July, area Christians said, students from the local madrassa beat Pastor Adnan John of Multan, severely injuring him, after they saw him walking in front of the mosque wearing a cross and holding a Bible. In another instance, the Muslim students prevented Christian students from holding a Christmas program at a park.

In 2006, some 500 Muslims burned down two churches in Sukkur and a convent school on Feb. 19, reportedly over rumors that a Christian threw a copy of the Quran into a trash can. A crowd wielding gasoline bombs torched St. Mary’s Catholic Church and St. Savior’s Church of Pakistan after media and government sources floated the rumor, but local sources said the violence occurred after a Muslim was arrested for burning pages of the Quran and trying to frame his Christian father-in-law, Saleem Gill, with the deed.

After torching the inside of St. Savior’s, the mob turned on Pastor Ilyas Saeed Masih’s home, then went five minutes away to destroy the 120-year-old St. Mary’s edifice.

Report from Compass Direct News