Doctors in China have described the chaos unfolding within hospitals as COVID-19 infections sweep the country.
Three health care professionals spoke anonymously to Sky News, painting a picture of emergency departments “packed” with patients, “ventilators and oxygen machines everywhere” and “not enough IV beds”.
But assessing the scale of the impact is difficult because accurate case and death numbers are not being released and speaking out comes with huge risk.
Despite this, some doctors have spoken exclusively to Sky News and described just how much pressure the system is under.
One doctor in the northern city of Shenyang explained how “our emergency room (ER) is packed with patients, dozens of times busier than usual”.
“It is not easy for the elderly to get admitted” they said.
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“There aren’t enough ambulances. Ventilators and oxygen machines are everywhere in the ER.
“There are not enough IV beds. Before we had a doctor-patient ratio of 1:4 or 1:5, now it’s more like 1:10.”
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They also described the high mortality rate being seen, contrary to the official numbers which state that just a tiny handful of people have died from the virus in the last few months.
A death from COVID in China is so narrowly defined that on a typical day the authorities will announce just one, two, three or even no deaths.
This is despite the fact an estimated 250 million people (18% of the population) have been infected with COVID in December alone, according to information leaked by sources close to the government.
What the doctor describes clearly disputes the official figures.
“This wave of COVID is lethal for the elderly, especially with underlying diseases and dysfunctions such as high blood pressure, diabetes and heart conditions,” the doctor said.
“For every 10 elderly patients with severe conditions admitted to the ER, around 50% die.”
Image: Doctors told Sky News there have not been enough ambulances or hospital beds available
‘One person must stay on duty for days’
Another doctor in Beijing spoke about the huge pressures on hospital staff with so many patients arriving and many doctors and nurses also falling sick.
“There are not enough staff in the department as all the nurses have tested positive for COVID-19. Now one person must stay on duty for several days,” the doctor said.
“The majority, if not all, patients for follow-up visits and consultations either have COVID or have recovered from COVID.”
But it has left the 1.4 billion population exposed as there is limited herd immunity and large proportions of the elderly who are not fully vaccinated.
In addition, the healthcare system is under-resourced with not enough intensive care beds.
While the spread in Beijing is predicted to have peaked, it is expected that the countrywide peak will not come for another month or so and there are concerns about how smaller regional towns will cope.
America appears to have hit the three key locations in Iran’s nuclear programme.
They include Isfahan, the location of a significant research base, as well as uranium enrichment facilities at Natanz and Fordow.
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Natanz was believed to have been previously damaged in Israeli strikes after bombs disrupted power to the centrifuge hall, possibly destroying the machines indirectly.
However the facility at Fordow, which is buried around 80 metres below a mountain, had previously escaped major damage.
Details about the damage in the US strikes is not yet known, although Mr Trump said the three sites had been “obliterated”.
The US has carried out a “very successful attack” on three nuclear sites on Iran, President Donald Trump has said.
The strikes, which the US leader announced on social media, reportedly include a hit on the heavily-protected Fordow enrichment plant which is buried deep under a mountain.
The other sites hit were at Natanz and Isfahan. It brings the US into direct involvement in the war between Israel and Iran.
Israeli Prime Minister Benjamin Netanyahu hailed the “bold decision” by Mr Trump, saying it would “change history”.
Iran has repeatedly denied that it is seeking a nuclear weapon and the head of the UN’s nuclear watchdog said in June that it has no proof of a “systematic effort to move into a nuclear weapon”.
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3:34
Trump: Iran strikes ‘spectacular success’
Addressing the nation in the hours after the strikes, Mr Trump said that Iran must now make peace or “we will go after” other targets in Iran.
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Commenting on the operation, he said that the three Iranian sites had been “obliterated”.
“There will be either peace or there will be tragedy for Iran far greater than we have witnessed over the last eight days,” he said.
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1:20
Benjamin Netanyahu said Donald Trump and the US have acted with strength following strikes on Iran’s nuclear facilities.
In a posting on Truth Social earlier, Mr Trump said, “All planes are safely on their way home” and he congratulated “our great American Warriors”. He added: “Fordow is gone.”
He also threatened further strikes on Iran unless it doesn’t “stop immediately”, adding: “Now is the time for peace.”
It is not yet clear if the UK was directly involved in the attack.
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Among the sites hit was Fordow, a secretive nuclear facility buried around 80 metres below a mountain and one of two key uranium enrichment plants in Iran.
“A full payload of BOMBS was dropped on the primary site, Fordow,” Mr Trump said. “Fordow is gone.”
There had been a lot of discussion in recent days about possible American involvement in the Iran-Israel conflict, and much centred around the US possibly being best placed to destroy Fordow.
Meanwhile, Natanz and Isfahan were the other two sites hit in the US attack.
Natanz is the other major uranium enrichment plant in Iran and was believed to have possibly already suffered extensive damage in Israel’s strikes earlier this week.
Isfahan features a large nuclear technology centre and enriched uranium is also stored there, diplomats say.
Israelis are good at tactics, poor at strategic vision, it has been observed.
Their campaign against Iran may be a case in point.
Short termism is understandable in a region that is so unpredictable. Why make elaborate plans if they are generally undone by unexpected events? It is a mindset that is familiar to anyone who has lived or worked there.
And it informs policy-making. The Israeli offensive in Gaza is no exception. The Israeli government has never been clear how it will end or what happens the day after that in what remains of the coastal strip. Pressed privately, even senior advisers will admit they simply do not know.
It may seem unfair to call a military operation against Iran that literally took decades of planning short-termist or purely tactical. There was clearly a strategy of astonishing sophistication behind a devastating campaign that has dismantled so much of the enemy’s capability.
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3:49
How close is Iran to producing a nuclear weapon?
But is there a strategic vision beyond that? That is what worries Israel’s allies.
It’s not as if we’ve not been here before, time and time again. From Libya to Afghanistan and all points in between we have seen the chaos and carnage that follows governments being changed.
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Hundreds of thousands have died. Vast swathes of territory remain mired in turmoil or instability.
Which is where a famous warning sign to American shoppers in the 80s and 90s comes in.
Ahead of the disastrous invasion that would tear Iraq apart, America’s defence secretary, Colin Powell, is said to have warned US president George W Bush of the “Pottery Barn rule”.
The Pottery Barn was an American furnishings store. Signs among its wares told clumsy customers: “You break it, you own it.”
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Iran and Israel exchange attacks
Bush did not listen to Powell hard enough. His administration would end up breaking Iraq and owning the aftermath in a bloody debacle lasting years.
Israel is not invading Iran, but it is bombing it back to the 80s, or even the 70s, because it is calling for the fall of the government that came to power at the end of that decade.
Iran’s leadership is proving resilient so far but we are just a week in. It is a country of 90 million, already riven with social and political discontent. Its system of government is based on factional competition, in which paranoia, suspicion and intense rivalries are the order of the day.
After half a century of authoritarian theocratic rule there are no opposition groups ready to replace the ayatollahs. There may be a powerful sense of social cohesion and a patriotic resentment of outside interference, for plenty of good historic reasons.
But if that is not enough to keep the country together then chaos could ensue. One of the biggest and most consequential nations in the region could descend into violent instability.
That will have been on Israel’s watch. If it breaks Iran it will own it even more than America owned the disaster in Iraq.
Iran and Israel are, after all, in the same neighbourhood.
Has Israel thought through the consequences? What is the strategic vision beyond victory?
And if America joins in, as Donald Trump is threatening, is it prepared to share that legacy?
At the very least, is his administration asking its allies whether they have a plan for what could come next?