https://arab.news/mj7ca
RIYADH: Saudi medical authorities announced on Wednesday that a complicated surgical procedure to separate conjoined twins will be performed on Thursday, the Saudi Press agency reported.
The operation, which follows the implementation of directives from King Salman and Crown Prince Mohammed bin Salman, will be carried out under the supervision of Adviser at the Royal Court and General Supervisor of KSrelief Dr. Abdullah Al-Rabeeah.
A medical and surgical team is set to separate the Syrian conjoined twin brothers — Bassam and Ihsan — at King Abdullah Specialist Children’s Hospital in the King Abdulaziz Medical City at the Ministry of National Guard in Riyadh.
Al-Rabeeah, who is also head of the medical and surgical team, said in a press statement that the operation was expected to take 9.5 hours and would be conducted in five stages, with the participation of 26 consultants, specialists, technical, nursing and support staff.
He said that the Syrian twins, who arrived from Turkiye on May 22, are 32 months old and weigh 19 kg together. The medical team has conducted examinations showing that the twins are conjoined in the lower chest, abdomen, liver and intestines, he said.
The examinations showed that Ihsan was considered the more dominant twin due to the absence of the urinary and reproductive systems (kidneys, ureters, bladder and male reproductive organs) in Bassam.
Ihsan also suffers from major congenital heart defects that reduce his life expectancy, along with atrophy in his neurological development, which makes his chances of survival very slim.
Al-Rabeeah said that to save Bassam’s life, the medical team decided to perform the operation to separate the twins.
He said that the operation is the 58th within the Saudi program for conjoined twins, which has supervised 130 cases from 23 countries since 1990.
Al-Rabeeah thanked King Salman and Crown Prince Mohammed bin Salman for the support the conjoined twins separation program receives.
JEDDAH: For more than 30 years, the skilled work of surgeons at Saudi Arabia’s Conjoined Twins Program has allowed children to enjoy healthy, normal and independent lives, making the Kingdom a world leader in one of the most complex surgical procedures in modern medicine.
Among them is pediatric surgeon Dr. Abdullah Al-Rabeeah, who has variously served as the Kingdom’s health minister, as an adviser to the Royal Court, and as supervisor-general of the King Salman Humanitarian Aid and Relief Center, KSrelief.
On Thursday, Al-Rabeeah successfully separated Syrian twins Bassam and Ihsan in a surgery that lasted seven and a half hours and took place over five phases with the participation of 26 specialized Saudi doctors, according to SPA.
Over the course of his career as a surgeon, Al-Rabeeah has conducted 58 operations on conjoined twins born to poor families from 23 countries. Overall, the program has supervised some 130 cases, clocking up hundreds of operating hours.
Bassam and Ihsan, who were flown in from Turkiye in May, are just shy of their third birthday. Joined at the lower chest, abdomen, liver and intestines, they together weighed 19kg. Although Bassam’s condition is stable, Ihsan is sadly not expected to live longer than a few days.
“(Ihsan is) considered an intruder on his brother Bassam because there is no urinary and reproductive system at the kidneys, ureters, bladder and male genitals,” Al-Rabeeah said following the surgery, according to SPA.
“(He) also suffers from significant birth defects in the heart that impede his life with atrophy in neurological development, and he has deficiencies and congenital defects in the intestine.”
To save Bassam’s life, the medical team decided to go ahead with the highly complex operation to separate the twins. “This operation is a rescue operation for Bassam, who is in fair and stable health condition,” the medical team told SPA.
Surgeries carried out by the Conjoined Twins Program are fully sponsored by the Saudi government. They offer children a chance to enjoy a long and healthy life, free of round-the-clock care, and relieved of the mental and physical strain of their condition.
Conjoined twins, often referred to as Siamese twins, are a rare reproductive phenomenon, occurring only once in every 50,000 to 60,000 births. Other estimates suggest that they occur just once in every 200,000 live births.
130 Cases supervised by medical staff.
58 Separation surgeries carried out.
28 Countries from where patients have traveled.
According to medical studies, about 60 percent of conjoined twins are stillborn, while some 40 percent of those who survive birth then die within a few days. About 70 percent of conjoined twins are females.
The frequency of cases tends to vary depending on various factors such as geographical location — with a somewhat higher incidence in Southwest Asia and Africa — genetic predisposition and environmental influences.
In May last year, doctors performed a complicated 15-hour surgery on twin Yemeni boys, Yousef and Yassin. Underlining the difficulties involved, one of the twins also died on the second day of the surgery as a result of heart failure.
The surviving twin pulled through and remains in a stable condition under observation at the King Abdullah Specialized Children’s Hospital in King Abdulaziz Medical City in Riyadh, according to the Saudi Press Agency.
The hospital plays a crucial role in the Kingdom’s Conjoined Twins Program. Equipped with state-of-the-art medical facilities and advanced technology, the hospital is staffed by a highly skilled medical team specializing in complex pediatric care.
“With the grace of Allah, then the presence of a specialized team and a specialized center, the Kingdom, under the leadership of the Custodian of the Two Holy Mosques and his trustworthy crown prince, have invested in two things — in infrastructure (and), what’s more important than that, is investing in people,” Al-Rabeeah told Arab News on Thursday.
“My colleagues have the experience and ability. Therefore, the presence of experience and infrastructure contribute to building the success of these operations.”
Given the risks involved, doctors are not always convinced separation is the best course. From 1990-2011, 34 of the 64 cases that were presented to the Saudi team were deemed inoperable due to life-threatening deformities in the infants.
Conjoined twins are in different classifications depending on the extent and location of their physical connection.
The condition arises from a rare event during early embryonic development when a single fertilized egg fails to separate completely into two individuals. As a result, the twins may share certain organs, limbs or other body structures.
Due to the complexity of conjoined twin pregnancies and the potential health challenges they pose, medical professionals often closely monitor such pregnancies and may recommend specialized prenatal care and planning for delivery.
The ultimate decision on whether to attempt separation surgery depends on several factors, including the twins’ overall health, the feasibility of separation and the potential risks involved.
“The existence of conjoined organs that are important and sensitive makes a twin separation operation difficult, as well as the existence of congenital defects in some organs, such as the heart, urinary system, or the reproductive system and, at times, in the brain, makes the operation complex,” Al-Rabeeah told Arab News.
“Therefore, the difficulty lies in how the twins are conjoined, and to what degree exactly, and congenital defect generally makes the operation complex, performed in specific medical centers in the world.”
The most common type of conjoined twins, thoracopagus, account for about 40 percent of cases, whereby twins are joined at the chest or upper abdomen, and in some cases may share a heart, liver, or other thoracic organs.
BIO
Abdullah Al-Rabeeah, MD, FRCSC
Dr. Al-Rabeeah is head of the surgical and multidisciplinary team for the Saudi conjoined twins program.
Education
1979: Bachelor’s degrees in medicine and surgery from King Saud University, Riyadh
1986: General surgery fellowship at the University of Alberta Hospital Edmonton, Canada
1987: Pediatric surgery fellowship at the IWK Hospital for Children, Dalhousie University, Halifax, Nova Scotia, Canada
Employment
2015-present: Supervisor general of aid agency KSrelief
2009-14: Minister of Health
2009-16: Member of the board of trustees of King Abdullah University of Science and Technology
2010-14: Chairman of the board of King Faisal Specialist Hospital and Research Center
2005-09: Founder and president of the King Saud bin Abdulaziz University for Health Sciences at King Abdulaziz Medical City
2003-09: CEO of National Guard Health Affairs at King Abdulaziz Medical City
Omphalopagus twins, meanwhile, are connected at the lower abdomen and may share parts of the gastrointestinal tract, liver, or other abdominal organs.
The rarest type of conjoined twin, craniopagus parasiticus, is when one twin is not fully formed and is dependent on the other for survival. The underdeveloped twin may be attached to the head or body of the more fully formed sibling.
The specific challenges associated with each type of conjoined twin can vary widely. The feasibility of separation surgery and the potential health risks depend on the extent of the connection and the vital organs involved.
Each case requires individualized medical evaluation and decision-making by a multidisciplinary team of experts. Highly detailed surgical planning is required for a conjoined twin separation surgery to go ahead.
“For me, every twin matters,” Al-Rabeeah told Arab News in an interview in March this year. “And I can tell you myself, and all of my colleagues, the team, they believe that those children are part of their family.”
RIYADH: Saudi Arabia and Kuwait have asserted exclusive ownership of the Al-Durra gas field in the maritime “Divided Area” after tensions with Iran rose once again in the long-running dispute over the lucrative site.
The Saudi minister of foreign affairs reaffirmed the joint ownership, calling on Iran to engage in negotiations to demarcate the eastern border of the area.
The Kuwaiti oil minister also rejected Iran’s claims over the field and urged Tehran to initiate discussions about the area.
In a statement released by the Saudi Press Agency on Tuesday, a Foreign Ministry source emphasized the natural resources in the “Divided Area” are solely owned by Saudi Arabia and Kuwait.
“We renew our previous calls for Iran to start negotiations to demarcate the eastern border of the submerged divided area between the Kingdom and Kuwait, as one negotiating party opposite the Iranian side,” the ministry stated.
Following Saudi Arabia’s declaration, Kuwait also asserted its exclusive rights over the Al-Durra gas field. According to state news agency KUNA, Kuwaiti Oil Minister Saad Al-Barrak expressed strong opposition to Iran’s planned activities in the area.
“We categorically and totally reject Iran’s planned activities around the premises of the Al-Durra offshore gas field,” Al-Barrak said,
In an interview with Asharq during the 8th Organization of the Petroleum Exporting Countries’s International Seminar, he added: “Iran must first enter into the demarcation of international borders, and after that, whoever has a right will get it according to the rules of international law.”
A source close to Kuwait’s Foreign Ministry revealed to KUNA that the “maritime area where Al-Durra offshore field lies is part of the State of Kuwait’s sea territories, and the natural resources therein are shared between Kuwait and Saudi Arabia,” dismissing any claims by Iran.
The source added: “Only the state of Kuwait and Saudi Arabia have exclusive rights to the natural resources of the Al-Durra field.”
This assertion solidifies Kuwait’s position and underscores the shared ownership between the two neighboring countries.
The dispute over the Al-Durra gas field has been ongoing for many years. In March, Kuwait and Iran held joint negotiations in Tehran, emphasizing the need to resolve the matter in accordance with international laws.
Iran’s persistence in pursuing activities in the area however adds to the complexity of the dispute and poses challenges to achieving a resolution.
The Al-Durra gas field is a common submerged area between Saudi Arabia and Kuwait located in the Arabian Gulf. It is situated within the Al-Hasa Governorate, which is a part of the Eastern Province of Saudi Arabia.
The discovery of this oil field dates back to the 1960s, which coincided with the commencement of the demarcation process for the maritime borders between Saudi Arabia and Kuwait.
The ownership of the field was evenly divided between the two countries, becoming effective in 1970.
The gas field is one of the largest in the world with abundant natural gas reserves.
It is expected to produce 1 billion cubic feet of gas daily and 84,000 barrels per day of condensate, and plays a significant role in Saudi Arabia and Kuwait’s gas production.
The Al-Durra oil field’s strategic importance and the potential wealth it holds have attracted the attention of neighboring countries, particularly Iran.
The dispute over its ownership and exploitation rights arises from differing interpretations of maritime boundaries and conflicting claims by Tehran.
In 2001, Iran began granting contracts for its exploration, which prompted Saudi Arabia and Kuwait to finalize the demarcation of their maritime borders, which included the Al-Durra oil field.
Despite objections from Iran, Saudi Arabia and Kuwait signed an agreement in 2022 to jointly develop and explore the field.
IN NUMBERS
• 1 billion cubic feet estimated daily gas production.
• 84,000 barrels estimated daily production of liquefied natural gas.
The controversies surrounding the operations escalated following Iran’s announcement in June that it was prepared to commence drilling in the Al-Durra gas field.
Mohsen Khojsteh Mehr, the managing director of the National Iranian Oil Co., indicated that Iran is allocating sizeable resources for exploring the site.
“Considerable resources have been allocated to the board of directors of the National Iranian Oil Co. for the implementation of the development plan for this field,” said Mehr, according to Iranian state media.
Despite attempts at negotiations and agreements between Kuwait, Saudi Arabia, and Iran, a definitive resolution to the dispute has remained elusive, leading to ongoing tensions and disagreements in the region.
The competing claims and Iran’s readiness to begin drilling in the Al-Durra field further exacerbate the tensions in the region.
As the situation unfolds, it remains to be seen whether diplomatic negotiations or other means will be employed to reach a mutually agreeable resolution between the concerned parties.
LONDON: It takes courage and vision to make contemporary additions to precious heritage buildings in a bid to grant them a new lease of life, but the results are almost always successful and dramatic.
London, for example, has the Great Court of the British Museum, the striking turn-of-the-millennium transformation of the 19th-century building by renowned architect Sir Norman Foster, which when completed in 1999 created a breathtaking enclosed space uniting the two wings of the building under a gigantic roof of glass and steel.
In Paris, architect Ieoh Ming Pei’s imposing glass pyramid in the main courtyard of the Louvre was described as “sacrilegious” when the design, sheltering a vast new underground entrance lobby, was proposed in 1984 as a solution to the museum’s inability to handle the ever-increasing number of visitors drawn to the city’s number-one attraction.
Initially, as The New York Times reported in 1985, the design was described variously as “an architectural joke,” “an eyesore,” “an anachronistic intrusion of Egyptian death symbolism in the middle of Paris” and “a megalomaniacal folly.”
Today, however, the Louvre would not be the Louvre without its pyramid, and its attendant three smaller siblings, beloved of Parisians and photographed by tourists almost as much as the museum’s star attraction, Leonardo da Vinci’s Mona Lisa.
Less well known globally, but equally striking, is the ancient-and-modern blend that is Moritzburg Castle in Halle, near Leipzig, Germany. In 2008 the crumbling remnants of the 15th-century building, in neglected near-ruin for centuries, were not restored, but recruited as component parts of the thoroughly contemporary modern art museum that appeared to grow up organically out of the remains.
“By this means,” as the Kulturstiftung Sachsen-Anhalt cultural foundation said, “the palace and its colorful history have successfully been artistically brought into the present . . . Moritzburg Castle’s present architectural appearance thus also stands for the museum’s new beginnings at the start of the 21st century.”
Now the same might be said of a bold new plan to build a luxury boutique hotel within the precincts of the Saudi UNESCO World Heritage site of Hegra at AlUla.
The Chedi Hegra, due to open by the end of this year, is being constructed not as a standalone addition to one of the most dramatic landscapes Saudi Arabia has to offer, but by making imaginative use of a number of old buildings, including two outstanding pieces of architecture steeped in history — the Madaen Saleh railway station, a stop on the historic Hejaz railway that ran from Damascus to Madinah, and the adjacent Ottoman fort, one of a series built in the 18th century to protect pilgrims traveling to Makkah.
The history of this region is as rich as it is long. The Hegra archaeological area, which in 2008 became the first property in Saudi Arabia to be inscribed on UNESCO’s World Heritage List, is the largest conserved site of the Nabataean civilization south of Petra in Jordan.
At its heart is a stunning necropolis of 111 monumental tombs, most with decorated facades, carved out of the surrounding sandstone rocks between the 1st century BCE and the 1st century AD.
Earlier civilizations left their mark here too. Located in a valley settled from remote antiquity thanks to the presence of ample subterranean water, in this location before the rise of the Nabataeans ruled the sheikdom of Dadan, and then the Kingdom of Lihyan, both of which left traces of their passing in the rocks and the sand.
Ancient Hegra, as the UNESCO nomination document attests, was “at the crossroad of international trade and of different cultures and civilizations, and played a key role in the exchange of goods and cultural traditions between Arabia and the Mediterranean world, becoming a wealthy and important halt for the caravans crossing the Arabian Peninsula carrying incense and spices from Yemen and India.”
And more recent history, no less fascinating, can be found within the UNESCO site, including the path of one of the three great Hajj pilgrimage routes, all of which are on Saudi Arabia’s UNESCO Tentative List as potential future World Heritage Sites.
Alongside the Darb Zubaydah, which linked the Iraqi city of Kufa to Makkah, and the Egyptian Hajj road, from Haqel on the Gulf of Aqaba, runs the Syrian Hajj road from Damascus, which passed through AlUla on its way south to Makkah.
In addition to its Islamic heritage, this is a road that was traveled for centuries by traders and Bedouin, many of whom left their marks in ancient rock carvings along the route.
The square, thick-walled Hegra fortress, which dates from 1744 to 1757 and has an ancient well in its courtyard, was one of the many forts built to protect the pilgrims’ routes to Makkah.
It was partially renovated in 1985, and not for the first time — it is thought that it was previously restored in the late Ottoman period, probably when the railway station was built, in about 1906.
The historic Hejaz railway, which ran 1,300 km from Damascus to Madinah, was built by the Ottoman Empire before World War I and followed the course of the old Syrian pilgrimage caravan route.
The 700 km section of the railway that ran through what is now Saudi Arabia is also on UNESCO’s Tentative List as a potential World Heritage site of universal importance.
One of the great engineering achievements of its day — and all the more significant historically because its construction was funded by donations from Islamic communities around the world — the railway reduced the journey time for pilgrims to Makkah from about six weeks to just a few days.
The railway was also used to carry Ottoman forces south to maintain Turkish control over the Hejaz, but after being repeatedly attacked and disabled during World War I by T.E. Lawrence (“of Arabia”) and the forces of the Arab Revolt, it fell into disuse, never to be restored.
Today, traces of the railway can still be seen all along its route — tracks, half-buried in sand, toppled engines lying where they fell after being blown up by mines more than a century ago, and more than 2,000 bridges and other structures along its total length.
Now, both the railway station and the Ottoman fort are to find a new lease of life as component parts of the new hotel, as part of the broader determination in a Saudi Arabia focused on diversifying away from dependence on fossil fuels to attract visitors by making the most of its many heritage assets.
This is, of course, not the first time that ancient and modern have been brought together as Saudi Arabia pursues its ambitious plans to develop the country’s potential as a hub for cultural tourism.
Until now, perhaps the most striking example of this determination not to treat heritage assets as museum pieces, frozen in time, but to breathe new life into them as key attractions is the preservation of Diriyah, birthplace of the Kingdom, as the jewel at the heart of the architecturally sympatico Diriyah Gate development just west of Riyadh.
But the plan for Hegra, executed audaciously and confidently within the bounds of a World Heritage site, sets a new standard for bold reimagination of heritage assets.
And this is about far more than merely the creation of yet another luxury hotel. The Chedi Hegra, the first hotel planned for the World Heritage site, is part of the wider mission of the Royal Commission for AlUla, working with local and international experts in archaeology, heritage conservation and preservation, architecture and master planning “to deliver an environmentally and historically sensitive transformation of AlUla.”
RCU is building the hotel directly into several existing structures, including the railway station and Hegra Fort, with existing structural and exterior walls, some of which are of historic mud-brick construction, being preserved and integrated with the modern architecture.
The vast majority of the UNESCO World Heritage site, says RCU, “will remain untouched by construction and carefully preserved by RCU to maintain the integrity of Hegra’s incredible human and natural heritage.”
The Chedi Hegra, says John Northen, the RCU’s vice president of hotels and resorts, “embodies the fulfilment of our Journey Through Time master plan, with its deep respect for heritage, sustainable design features, and an authentic luxury experience that celebrates what makes AlUla a special destination for travelers seeking both comfort and adventure.”
Equally important, with the relatively modest but pioneering Chedi Hegra — the construction of which will use local materials, businesses and labor, and when up and running is expected to create at least 120 jobs — the RCU is demonstrating its determination to work hand in hand with the local community and to “invest in education and learning for AlUla’s next generation and create training and employment opportunities for its people.”
In AlUla, thanks to a bold and imaginative blending of the old and the new, Saudi Arabia is demonstrating how its past can play an increasingly important role in its future.
RIYADH: A team of Saudi surgeons on Thursday separated Syrian conjoined twins during a seven-hour operation carried out at the King Abdullah Specialist Children’s Hospital in Riyadh.
Bassam and Ihsan, who are 32 months old and weigh around 19 kilograms, were said to be in a stable condition following the complicated surgical procedure.
The twins shared lower chest, abdomen, liver, and intestines, with Ihsan being the more dominant and Bassam missing urinary and reproductive systems including kidney, ureter, bladder, and male reproductive organs.
Separation surgery took place in five stages and involved a 26-member medical team comprised of consultant, specialists, technical, nursing, and support staff.
Dr. Abdullah Al-Rabeeah, adviser at the Royal Court and general supervisor of the Saudi aid agency KSrelief, led the operation undertaken on the directives of King Salman and Crown Prince Mohammed bin Salman.
The surgery was made all the more complex due to Ihsan having major congenital heart defects and cerebral development atrophy, reducing his chances of survival. Al-Rabeeah pointed out that to save Bassam’s life, the medical team decided to perform the operation to separate the twins.
He said: “The existence of conjoined organs that are important and sensitive makes a twin separation operation difficult, as well as the existence of congenital defects in some organs, such as the heart, urinary system, or the reproductive system and, at times, in the brain, makes the operation complex.
“Therefore, the difficulty lies in how the twins are conjoined, and to what degree exactly, and congenital defect generally makes the operation complex, performed in specific medical centers in the world.”
After the procedure, the twins were transferred to a children’s intensive care unit where they will remain under supervision.
The children’s parents thanked the king, crown prince, and medical team for their support.
Mahmud Salih, their father, said: “We communicated with the Saudi aid agency, and they got back to us, all thanks to them. All procedures were done in the best possible way, from the start until we arrived here.
“It was a critical case, and the separation operation was required. All praise to Allah. The benefactors connected with us, and we were eased by King Abdullah hospital, Dr. Abdullah Al-Rabeeah, and the excellent medical staff.”
The surgery was the 58th operation to separate conjoined twins conducted under a Saudi program which has supervised 130 cases from 23 countries since 1990.
Majd Nafea, a nurse and member of the 26-strong multidisciplinary team, started working on the specialist operations in 2019.
She said: “The first operation I worked in was generally difficult for me, as I had never witnessed a twin separation operation. But after that, and with each operation, it has become a bit easier.”
Al-Rabeeah said: “The Kingdom of Saudi Arabia has invested in its cadres, its citizens, and everyone has obtained a distinguished education in the most prestigious universities in the world.
“Now they are returning to prove that Saudi cadres are representative of the Kingdom, and one such example is the Saudi program for the separation of conjoined twins.”
The twins and their parents were flown from the Turkish capital Ankara to Saudi Arabia on May 22.
“It has been a month since we arrived, and there’s no better welcome than the one we received. May Allah reward them 1,000 times, and bless them,” Salih added.
RIYADH: A Saudi delegation is taking part in the fourth G20 Space Economy Leaders Meeting, which began on Thursday in Bengaluru, India.
Mohammed Al-Tamimi, CEO of the Saudi Space Agency, is leading the Kingdom’s team at the two-day gathering, during which participants will discuss ways to enhance the role of the space economy and its tangible contributions to efforts to address global challenges and achieve the UN’s Sustainable Development Goals, the Saudi Press Agency reported.
The delegates include representatives of space agencies and related organizations from G20 member states, along with invited guests from other countries and the heads of international and regional organizations.
Speaking during the meeting, Al-Tamimi said the spirit of cooperation and optimism that is entrenched in the annual gathering has become the shared trait of global space activities and endeavors. It is a trait that will continue to shape humanity’s long-term future in terms of how it makes use of the space sector and its applications, he added.
He also extended thanks to authorities in India and officials from the Indian Space Research Organization for hosting the important meeting.
The Kingdom is working to promote the cooperative goals of the meeting, in line with its commitments as a signatory to the Artemis Accords, which serve as a guide for sustainable civil space exploration, and its contributions to efforts to implement the practical aspects of the 1967 Outer Space Treaty, Al-Tamimi said.
The annual meeting is one of the results of the Kingdom’s presidency of the G20 in 2020, during which it was placed on the group’s agenda for the first time in an effort to enhance space-related cooperation between countries to maximize the benefits of the space economy and the utilization of associated data to support sustainable development, food security and global health.