DAMASCUS, SYRIA: At least 70 people have been killed in a suspected chemical attack on the rebel-held town of Khan Sheikhoun in north-western Syria.
And more than hundreds suffered symptoms reliable with reaction to a nerve agent after what the opposition and Western powers said was a Syrian government air strike on the area.
The Syrian military denied using any chemical agents, while its ally Russia said an air strike hit a rebel depot full of chemical munitions.
What happened?
Activists and witnesses said warplanes attacked Khan Sheikhoun when many people were asleep.
Mariam Abu Khalil, a 14-year-old resident who was awake, told the New York Times that she had seen an aircraft drop a bomb on a one-storey building. The explosion sent a yellow mushroom cloud into the air that stung her eyes. "It was like a winter fog," she said. She sheltered in her home, but recalled that when people started arriving to help the wounded, "they inhaled the gas and died".
Victims experienced symptoms including redness of the eyes, foaming from the mouth, constricted pupils, blue facial skin and lips, severe shortness of breath and asphyxiation, it added.
A Medecins Sans Frontieres (MSF) medical team supporting the Bab al-Hawa hospital, near the Turkish border, confirmed similar symptoms in eight patients brought there from Khan Sheikhoun.
What were they exposed to?
The World Health Organisation (WHO) said that the likelihood of a chemical being responsible was "amplified by an apparent lack of external injuries reported in cases showing a rapid onset of similar symptoms, including acute respiratory distress as the main cause of death".
"Some cases appear to show additional signs consistent with exposure to organophosphorus chemicals, a category of chemicals that includes nerve agents."
The Organisation for the Prohibition of Chemical Weapons (OPCW) expressed serious concern about the reports and said a fact-finding mission was "in the process of gathering and analysing information from all available sources".
The OPCW will not be able to confirm anything until samples are tested at an accredited laboratory, but a doctor at a hospital in the town of Sarmin ( a town in Syria) who treated some of the casualties believes it was the nerve agent Sarin.
"All the patients had the same symptoms - difficulty in breathing, weakness," Dr Abdulhai Tennari told the BBC. "They had huge secretions in their respiratory tracts, which induced suffocation."
He noted that when the most serious cases were given an antidote for Sarin poisoning, atropine, their conditions became stable and they survived.
MSF said the patients' symptoms were "consistent with exposure to a neurotoxic agent such as Sarin". Its medical teams also reported that victims smelled of bleach, suggesting they had been exposed to chlorine as well.
What is Sarin?
Sarin is highly toxic and considered 20 times as deadly as cyanide.
As with all nerve agents, Sarin inhibits the action of the acetylcholinesterase enzyme, which deactivates signals that cause human nerve cells to fire. This blockage pushes nerves into a continual "on" state. The heart and other muscles - including those involved in breathing - spasm. Sufficient exposure can lead to death via asphyxiation within minutes.
Sarin is almost impossible to detect because it is a clear, colourless and tasteless liquid that has no odour in its purest form. It can also evaporate and spread through the air.
Has Sarin been used in Syria before?
The Syrian government was accused by Western powers of firing rockets filled with Sarin at several rebel-held suburbs of the capital Damascus in August 2013, killing hundreds of people.
President Bashar al-Assad denied the charge, blaming rebel fighters, but he did subsequently agree to destroy Syria's declared chemical arsenal.
Despite that, the OPCW and UN have continued to document the use of chemicals in attacks.
A joint investigation that concluded in October 2016 said that government forces had used chlorine as a weapon at least three times between 2014 and 2015. It also found Islamic State militants had used the blister agent sulphur mustard.
© BBC News
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