Region

BEIRUT — One hundred and twenty Palestinian children in Yarmouk were Sunday allowed out of the besieged refugee camp in southern Damascus to sit public exams, the UN agency for Palestinian refugees said.

“UNRWA arranged for the [120] students temporarily to leave Yarmouk to enable them to participate in nationwide state exams for ninth graders,” said the agency’s spokesman Chris Gunness.

Once home to 150,000 Palestinians as well as Syrian residents, embattled Yarmouk has been under total army siege for the past year.

The camp is the scene of frequent violence despite a truce and its estimated 18,000 remaining residents also face dire food and medical shortages.

The students who temporarily left Yarmouk are being hosted at two government and UN-run facilities, and they have been provided with hygiene kits and a stipend, said Gunness.

“However, the situation the students left remains dire. There have been no UNRWA distribution of food parcels to civilians in Yarmouk since 13 May,” he added.

In a Tweet, Gunness said: “Imagine being a 9th grader in Syria! Where must you think your future lies?”

According to the Syrian Observatory for Human Rights, food and medical shortages have killed more than 100 people in the camp.

RAFAH, Palestinian Territories — Aid convoys from Algeria and Jordan crossed Sunday from Egypt into Israeli-blockaded Gaza with $2.5 million (1.8 million euros) worth of supplies, the Palestinian territory’s Hamas government said.

Alaa Al Batta, a government official, told a news conference at the Rafah border crossing that a 14-member Algerian delegation brought medicines and medical equipment worth $2 million for the opening of an Algerian-sponsored hospital in the southern Gaza town of Khan Younis.

“We brought 253 kinds of medicine and 144 medical devices,” said Sheikh Yahya Sarri, leader of the Algerian team.

Kifah Al Amaryah, heading a Jordanian “Miles of Smiles” convoy, said his 20-strong team, delivering aid worth $0.5, would follow up on more than 100 aid projects and launch a new vocational training scheme, also in Khan Younis.

The Rafah crossing, Gaza’s only border not controlled by Israel, has been mainly closed by Egyptian authorities since July, when Hamas’ ally, president Mohamed Morsi of the Muslim Brotherhood, was toppled in Cairo.

Egypt only opens the crossing for humanitarian and other special cases.

Israel strictly controls movement of goods and individuals across its land border with Gaza and maintains a tight air and maritime blockade of the coastal strip.

TRIPOLI — Heavily armed gunmen stormed Libya’s parliament with anti-aircraft weapons on Sunday in an assault claimed by forces loyal to a renegade ex-general who has vowed to purge the country of Islamist militants.

In a confusing, chaotic attack, heavy smoke rose from the parliament building in Tripoli as gunmen clashed with guards. A Reuters reporter said the attackers raided and left, and other unknown gunmen later closed off nearby streets.

Another witness said attackers had kidnapped two people and heavy gunfire could be heard across other parts of Tripoli, where rival brigades of former rebels have often clashed since ending their 2011 war against Muammar Qadhafi.

Details of who carried out the parliament attack were unclear, but a spokesman for retired Libyan Gen. Khalifa Haftar said his forces had carried out the assault as part of his campaign to rid Libya of Islamist militants.

“These are members of the Libyan National Army,” Mohamed Al Hejazi, spokesman for the group said, using the name of the irregular forces loyal to Haftar.

Haftar, a former rebel in the war against Qadhafi, had already sent his fighters into Benghazi on Friday against Islamist militants based there, claiming Libya’s government had failed to halt violence in the eastern city.

At least 40 people were killed in those clashes, which involved some air force helicopters.

On Saturday, Parliamentary Speaker and Military Commander-in-Chief Nuri Abu Sahmain accused Haftar of trying to stage a coup. Several reports said Sahmain had been kidnapped after Sunday’s attack, but he denied that.

Armed brigades

After the 2011 NATO-backed war, Libya’s weak government and nascent army struggled to impose any authority over heavily armed brigades and militias who once fought Qadhafi and have become powerbrokers often challenging the state.

Libya’s parliament has been paralysed by divisions between Islamist parties and more nationalist rivals, leaving many Libyans frustrated at the lack of progress towards democratic transition since the fall of Qadhafi.

Militia brigades in armoured trucks mounted with anti-aircraft canons have often stormed parliament, occupied ministries and even kidnapped the prime minister last year in a show of military muscle to make political demands.

But Sunday’s attack on parliament was the most serious violence in the capital for months, and appeared to expand Haftar’s campaign against hardline Islamists, who emerged as a force in North Africa since the Arab Spring revolts of 2011.

Lawmaker Omar Bushah told Reuters that gunmen had stormed into the General National Congress building, raiding lawmakers’ offices and set the building on fire.

There were no immediate reports of any casualties from hospital officials.

Coup rumours

Haftar stirred rumours of a coup in February by appearing in a Libyan military uniform to call for a presidential committee to be formed to govern until new elections as a way to end the country’s political impasse.

It was unclear how much support Haftar has in the regular armed forces or among the network of competing militias who have carved out fiefdoms in parts of the country.

But in Benghazi, the cradle of the uprising against Qadhafi, authorities have struggled to curb violence and stem attacks blamed on Ansar Al Sharia, an Islamist group that Washington labels as a terrorist organisation.

Since the end of Qadhafi’s one-man rule, Libya’s fragile democracy has hobbled from crisis to crisis with the country on its third prime minister since March, its new constitution unwritten and parliament deadlocked by infighting.

Just hours before the attack, new Prime Minister Ahmed Maiteeq announced he had formed a government pending parliamentary approval this week, after the country went nearly two months without a functioning government.

Complicating Libya’s transition, the most powerful brigades of former rebels — such as the Zintans, the Misratans and the Operations Room of Libya’s Revolutionaries — have loosely allied themselves competing political factions.

Former rebel commanders and protesters have also taken over key oil ports and pipelines, cutting Libya’s oil output to 200,000 barrels per day from 1.4 million bpd to demand more autonomy and a greater share of oil wealth.

DUBAI — Iran appeared to take a harder line in its nuclear dispute with world powers on Sunday by dismissing as “ridiculous” one idea that could allay Western concerns about a planned atomic research reactor.

The fate of the heavy-water reactor at Arak, which has not yet been completed, is one of several thorny issues in talks between Iran and six powers aimed at reaching a long-term deal on Tehran’s nuclear programme by an agreed July 20 deadline.

“It is ridiculous that the power of the [Arak] reactor would be cut from 40 megawatts to 10 megawatts,” nuclear negotiator Abbas Araghchi said, the official IRNA news agency reported.

Western powers fear the Arak plant — 250km southwest of Tehran — could provide a supply of plutonium — one of two materials, along with highly enriched uranium, that can trigger a nuclear explosion — once operational.

Iran says it would produce isotopes for medical treatments, and denies any of its nuclear work is aimed at making a bomb.

If operating optimally, Arak could produce about nine kilogrammes of plutonium annually, enough for about two atom bombs, the US Institute for Science and International Security says.

Araghchi made no other reference to the idea in the remarks carried by IRNA, and it was not clear whether such a reduction in electrical power at the planned facility had been formally proposed at the latest round of talks last week.

But possible options that could allow Iran to keep the reactor at Arak while satisfying the West that it would not be used for military purposes include reducing its megawatt capacity and altering the way it will be fuelled, experts say.

Iran’s atomic energy organisation chief said in February Tehran was prepared to modify Arak, while insisting that Western concerns over Arak were a ploy to apply pressure on Tehran.

The fate of Arak was a big hurdle in talks last year that led to a landmark agreement to curb sensitive aspects of Iran’s nuclear programme in exchange for some easing of sanctions.

Araghchi said Iran’s negotiating team would do its utmost to get an accord by July 20 based on the country’s “red lines”, but it would not be a “tragedy” if no deal was reached by then.

Iran’s red lines include preserving the Arak reactor and maintaining the enrichment capabilities.

He said the talks would resume in Vienna on June 16-20.

Iranian Foreign Minister Mohammad Javad Zarif said on his Twitter account that a deal was “possible”.

“Back from Vienna after tough discussions. Agreement is possible. But illusions need to go. Opportunity shouldn’t be missed again like in 2005,” Zarif tweeted.

Zarif was referring to a 2005 proposal for Iran to convert all of its enriched uranium to fuel rods, making it impossible to use it for nuclear weapons. The proposal was rejected as the United States was not prepared to accept any level of Iranian nuclear enrichment.

Today, Western diplomats privately acknowledge that forcing Iran to halt all uranium enrichment, as stipulated in UN Security Council resolutions, is unrealistic given the scale of the work and resistance from Tehran.

In a related development, the International Atomic Energy Agency said a team from the UN nuclear watchdog would hold one-day talks with officials in Tehran on Tuesday.

The IAEA-Iran talks are separate from those between Tehran and six world powers — the United States, France, Germany, Britain, China and Russia — but are complementary, as both focus on fears that Iran may covertly be seeking weapons capability.

The six powers want Iran to scale back uranium enrichment and other sensitive nuclear activity and accept more rigorous UN inspections to deny it any capability of quickly producing atomic bombs, in exchange for an end to sanctions.

NEW YORK — The biggest risk that Middle East Respiratory Syndrome (MERS) will become a global epidemic, ironically, may lie with globe-trotting healthcare workers.

From Houston to Manila, doctors and nurses are recruited for lucrative postings in Saudi Arabia, where MERS was first identified in 2012. Because the kingdom has stepped up hiring of foreign healthcare professionals in the last few years, disease experts said, there is a good chance the MERS virus will hitch a ride on workers as they return home.

“This is how MERS might spread around the world,” said infectious disease expert Dr Amesh Adalja of the University of Pittsburgh Medical Centre.

It can take five to 14 days for someone infected with MERS to show symptoms, more than enough time for a contagious person to fly to the other side of the world without being detectable.

Healthcare workers “are at extremely high risk of contracting MERS compared to the general public”, Adalja said.

The threat has attracted new attention with the confirmation of the first two MERS cases in the United States. Both are healthcare workers who fell ill shortly after leaving their work in Saudi hospitals and boarding planes bound west.

About one-third of the MERS cases treated in hospitals in the Saudi Red Sea city of Jeddah were healthcare workers, according to the World Health Organization.

Despite the risk, few of the healthcare workers now in, or planning to go to, Saudi Arabia are having second thoughts about working there, according to nurses, doctors and recruiters interviewed by Reuters.

Michelle Tatro, 28, leaves next week for the kingdom, where she will work as an open-heart-surgery nurse. Tatro, who typically does 13-week stints at hospitals around the United States, said her family had sent her articles about MERS, but she wasn’t worried.

“I was so glad to get this job,” she told Reuters. “Travel is my number one passion.”

So far, international health authorities have not publicly expressed concern about the flow of expatriate medical workers to and from Saudi Arabia.

“There is not much public health authorities or border agents can do,” said infectious disease expert Dr Michael Osterholm of the University of Minnesota. “Sure, they can ask people, ‘did you work in a healthcare facility in Saudi Arabia,’ but if the answer is yes, then what?”

Healthcare workers are best placed to understand the MERS risk, Osterholm said, and “there should be a heightened awareness among them of possible MERS symptoms”.

Neither the Centres for Disease Control and Prevention nor the Department of Homeland Security responded to questions about whether they were considering monitoring healthcare workers returning to the United States.

Soaring demand

In the last few years, the number of expatriates working in Saudi Arabia has soared, said Suleiman Arabie, managing director of Houston, Texas-based recruiting firm SA International, with thousands now working in the kingdom.

About 15 per cent of physicians working in the kingdom are American or European, and some 40 per cent of nurses are Filipino or Malaysian, according to estimates by recruiters and people who have worked in hospitals there.

The majority of US-trained medical staff are on one- or two-year contracts, which results in significant churn as workers rotate in and out of Saudi medical facilities.

The Saudi government is building hundreds of hospitals and offering private companies interest-free loans to help build new facilities. Its healthcare spending jumped to $27 billion last year from $8 billion in 2008. Building the hospitals is one challenge, staffing them with qualified personnel is another.

Arabie’s firm is trying to fill positions at two dozen medical facilities in Saudi Arabia for pulmonologists, a director of nursing, a chief of physiotherapy and scores more.

Doctors in lucrative, in-demand specialties such as cardiology and oncology can make $1 million for a two-year contract, recruiters said.

Nurses’ pay depends on their home country, with those from the United States and Canada earning around $60,000 a year while those from the Philippines get about $12,000, recruiters said. That typically comes with free transportation home, housing, and 10 weeks of paid vacation each year. For Americans, any income under about $100,000 earned abroad is tax-free, adding to the appeal of a Saudi posting.

One Filipina nurse, who spoke anonymously so as not to hurt her job prospects, told Reuters that she was “willing to go to Saudi Arabia because I don’t get enough pay here”. In a private hospital in Manila, she made 800 pesos (about $18) a day.

“I know the risks abroad but I’d rather take it than stay here,” she said. “I am not worried about MERS virus. I know how to take care of myself and I have the proper training.”

None of Arabie’s potential candidates “have expressed any concern” about MERS. Only one of the hundreds of professionals placed by Toronto-based medical staffing firm Helen Ziegler & Associates Inc. decided to return to the United States because of MERS, it said, and one decided not to accept a job in Jeddah she had been hired for.

Recruitment agencies in Manila have also continued to send nurses to the kingdom since the MERS outbreak, said Hans Leo Cacdac, the head of the Philippine Overseas Employment Administration. The government advises that returning workers be screened for MERS, Labour and Employment Secretary Rosalinda Baldoz said this week.

Expat healthcare workers now working in Saudi Arabia feel confident local authorities are taking the necessary steps to combat the spread of MERS in hospitals.

“Just today they came and put up giant posters in our hospital on MERS,” said Dr Taher Kagalwala, a paediatrician originally from Mumbai who works at Al Moweh General Hospital in a town about 120 miles from Tai’f city in western Saudi Arabia

“I have not heard of or seen any healthcare workers looking to leave their jobs or return to their countries because of the MERS panic. If it was happening, there would have been gossip very soon.”

RIYADH/WASHINGTON  — Saudi Arabia has reported five new deaths from the Middle East Respiratory Syndrome (MERS) respiratory virus, bringing the death toll in the world’s worst-hit country to 168.

In its latest tally, issued on Saturday, the health ministry said the total number of infections in the kingdom from the coronavirus since it first appeared in 2012 now stood at 529 people.

Among the latest fatalities were two men aged 67 and 55 and an 80-year-old woman in Jeddah, the port city where a spate of cases among staff at King Fahd Hospital last month led to the dismissal of its director and the health minister.

In addition, a 71-year-old man and another aged 77 died in Riyadh and Medina respectively, the ministry website reported.

Other nations including Egypt, Jordan, Lebanon, the Netherlands, the United Arab Emirates and the United States have also recorded cases, mostly in people who had been to the kingdom.

The World Health Organisation carried out a five-day inspection visit to Saudi Arabia this month and pinpointed breaches in its recommended infection prevention measures as being partly responsible for the spike in hospital infections.

MERS, or Middle East Respiratory Syndrome, is considered a deadlier but less transmissible cousin of the SARS virus that appeared in Asia in 2003 and infected 8,273 people, 9 per cent of whom died.

Like SARS, it appears to cause a lung infection, with patients suffering coughing, breathing difficulties and a temperature. But MERS differs in that it also causes rapid kidney failure.

Meanwhile, an Illinois man has contracted the MERS respiratory virus after coming into contact with the first case of the mysterious Middle East pathogen in the United States, become the third infected person.

It was during an ongoing investigation on the first case of MERS coronavirus in the United States that officials identified the new case, the Centres for Disease Control and Prevention said Saturday.

“CDC officials explained that these laboratory test results are preliminary and suggest that the Illinois resident probably got the virus from the Indiana patient and the person’s body developed anti-bodies to fight the virus,” the agency said in a statement.

It said the Illinois resident, who has not recently travelled outside the United States, met twice with the Indiana patient before he was identified as the first known case of MERS in the United States.

As part of the investigation, health officials have tested people who came into contact with the Indiana resident.

The identities of the MERS patients have not been released.

The Illinois resident was first tested for MERS on May 5, and those test results were negative. But a blood sample tested positive on Friday, showing he has anti-bodies to MERS.

“This latest development does not change CDC’s current recommendations to prevent the spread of MERS-CoV,” said David Swerdlow, who is leading the agency’s MERS response.

“It’s possible that as the investigation continues, others may also test positive for MERS-CoV infection but not get sick.”

The United States has previously announced two confirmed cases of MERS, which originated in Saudi Arabia and has since spread to more than a dozen countries.

The first patient, who fell ill in April, has been discharged from a hospital in Indiana.

OCCUPIED JERUSALEM — The number of Jewish settlers in the Israeli-occupied West Bank could grow by as much as 50 per cent by 2019, Israel’s ultra-nationalist construction minister said on Friday.

Palestinians want the West Bank as part of their future state, and blamed settlement expansions for the breakdown last month of US-mediated peace talks with Israel — a position supported in part by Washington, but rejected by the Israelis.

Construction and Housing Minister Uri Ariel, a member of the hardline Jewish Home Party in Israeli Prime Minister Benjamin Netanyahu’s conservative coalition government, said the negotiations on Palestinian statehood were in their “dying throes” and predicted the settler population would spiral.

“I think that in five years there will be 550,000 or 600,000 Jews in Judea and Samaria, rather than 400,000 [now],” he told Tel Aviv radio station 102 FM, using a biblical term for the West Bank, which many Israelis see as a religious birthright and security bulwark.

Most world powers deem the Israeli settlements illegal.

Ariel put the number of Israelis in East Jerusalem at between 300,000 and 350,000. Some 2.5 million Palestinians live in the West Bank and East Jerusalem, areas which, along with the Gaza Strip, Israel occupied in a 1967 war.

During the nine months of failed peacemaking, Ariel published tenders for settlement construction which were cited by the United States as having contributed to the impasse by convincing Palestinian President Mahmoud Abbas that Netanyahu was not serious about reaching an accord.

US officials have also faulted Abbas for unilaterally signing 15 conventions meant to advance Palestinian independence and for entering a unity pact with Islamist Hamas rivals who control Gaza and spurn coexistence with Israel.

Netanyahu has said he would be willing to make way for a future Palestine in the West Bank, though Israel wants to annex swathes of settlements and keep East Jerusalem.

The Jewish Home opposes Palestinian statehood altogether, raising speculation in Israel that Netanyahu, in the unlikely event of a diplomatic breakthrough, would eject the party from his coalition.

Hosting US Defence Secretary Chuck Hagel in Jerusalem on Friday, Netanyahu put the onus for the deadlock on Abbas.

“One of the things we have found, unfortunately, is that our Palestinian neighbours are moving ahead in a pact with Hamas. The United States has designated Hamas rightly as a terrorist organisation,” he said.

“I think the Palestinians have to make a simple choice — a pact with Hamas, or peace with Israel. But they cannot have both.”

RIYADH — Health authorities in Saudi Arabia have reported three more fatalities from the MERS respiratory virus, taking the death toll in the world’s worst-hit country to 163.

The health ministry website also revealed on Saturday that 520 cases have been recorded in the country since Middle East Respiratory Syndrome first appeared in Saudi Arabia in 2012.

It said three women died on Friday, including one in Riyadh, 48, and a 67-year-old in the western city of Taif.

A third woman died in Jeddah, the port city where a spate of cases among staff at King Fahd Hospital last month sparked public panic and the dismissal of its director and the health minister.

Other nations including Egypt, Jordan, Lebanon, the Netherlands, the United Arab Emirates and the United States have also recorded cases, mostly in people who had been to the desert kingdom.

On Wednesday, the World Health Organisation said its emergency committee, which includes global medical and policy experts, had flagged mounting concerns about the potentially fatal virus.

The WHO called on countries to improve infection prevention and control, collect more data on MERS and to be vigilant in preventing it from spreading to vulnerable countries, notably in Africa.

But it has so far stopped short of declaring an international health emergency, which would have far-reaching implications such as travel and trade restrictions on affected countries.

A WHO team carried out a five-day inspection visit to Saudi Arabia earlier this month and pinpointed breaches in its recommended infection prevention measures as being partly responsible for the spike in hospital infections.

MERS is considered a deadlier but less transmissible cousin of the SARS virus that appeared in Asia in 2003 and infected 8,273 people, 9 per cent of whom died.

Like SARS, it appears to cause a lung infection, with patients suffering coughing, breathing difficulties and a temperature. But MERS differs in that it also causes rapid kidney failure.

CHICAGO — Scientists leading the fight against Middle East Respiratory Syndrome (MERS) say the next critical front will be understanding how the virus behaves in people with milder infections, who may be spreading the illness without being aware they have it.

Establishing that may be critical to stopping the spread of MERS, which emerged in the Middle East in 2012 and has so far infected more than 500 patients in Saudi Arabia alone. It kills about 30 per cent of those who are infected.

It is becoming increasingly clear that people can be infected with MERS without developing severe respiratory disease, said Dr David Swerdlow, who heads the MERS response team at the US Centres for Disease Control and Prevention.

“You don’t have to be in the intensive care unit with pneumonia to have a case of MERS,” Swerdlow told Reuters. “We assume they are less infectious [to others], but we don’t know.”

The CDC has a team in Saudi Arabia studying whether such mild cases are still capable of spreading the virus. Swerdlow is overseeing their work from Atlanta.

They plan to test the family members of people with mild MERS, even if these relatives don’t have any symptoms, to help determine whether the virus can spread within a household.

Cases of the disease, which causes coughing, fever and sometimes fatal pneumonia, have nearly tripled in the past month and a half, and the virus is moving out of the Arabian Peninsula as infected individuals travel from the region.

Since late April, the first two cases of MERS have been reported on US soil. Dutch officials reported their first two cases this week. Infections have also turned up in Britain, Greece, France, Italy, Malaysia and elsewhere.

Since MERS is an entirely new virus, there are no drugs to treat it and no vaccines capable of preventing its spread. It is a close cousin of the virus that caused Severe Acute Respiratory Syndrome or SARS, which killed around 800 people worldwide after it first appeared in China in 2002.

Because MERS patients can have “mild and unusual symptoms”, the World Health Organisation advises healthcare workers to apply standard infection control precautions for all patients, regardless of their diagnosis, at all times.

“Asymptomatic carriers of diseases can represent a major route for a pathogen to spread,” said Dr Amesh Adalja of the University of Pittsburgh Medical Centre.

“Just think of Typhoid Mary,” he said, referring to the asymptomatic cook who spread typhoid fever to dozens of people in the early 20th century.

Not even a cough

Milder symptoms played a role in the second US case of MERS, a man who started having body aches on a journey from Jeddah on Saudi Arabia’s Red Sea coast to the United States.

It took the patient more than a week before he sought help in an emergency department in Orlando, Florida. Once he arrived, he waited nearly 12 hours in the ER before staff recognised a MERS link and placed him in an isolation room. The patient did not have signs of a respiratory infection, not even a cough.

Dr Kevin Sherin, director of the Florida Department of Health for Orange County, believes that made it less likely that he could spread the infection. Hospital workers have tested negative, but the health department and the CDC are still checking on hundreds of people who might have been in contact with the patient.

A CDC study published earlier this week looked at some of the first cases of MERS that occurred in Jordan in 2012.

Initially, only two people in that outbreak were thought to have MERS. When CDC disease detectives used more sensitive tests that looked for MERS antibodies among hospital workers, they found another seven people had contracted MERS and survived it.

That suggests there may be people with mild cases “that can serve as a way for the virus to spread to other individuals, which makes it a lot harder to control,” Adalja said.

Scientists are especially concerned because a lot of recent cases of MERS are among people who did not have contact with animals such as camels or bats that are believed to be reservoirs for the virus.

“If they don’t have animal contact, where do they pick it up? Potentially, asymptomatic cases,” said Dr Michael Osterholm, an infectious disease expert from the University of Minnesota.

BAGHDAD — Iraq’s election commission said Saturday the results from last month’s general election would finally be released within days as nationwide attacks pushed this year’s death toll to more than 3,500.

The Independent High Electoral Commission said delays in the count after the April 30 vote were because of a litany of complaints, and said provisional results — which are subject to further challenge — would be published on either Sunday or Monday.

Although results have not been released, political parties have nevertheless sought to build alliances in a bid to get a head-start on government formation, with incumbent Prime Minister Nouri Maliki seeking a third term.

Maliki’s critics accuse him of consolidating power and blame him for a marked deterioration in security in recent months.

Nevertheless, Maliki’s political party is still expected to win the most seats in parliament, despite probably falling short of a majority on his own.

Attacks in and around Baghdad and north Iraq killed seven people on Saturday, pushing the 2014 death toll to more than 3,500, according to an AFP tally.

Four people died in a roadside bombing in a market area of the predominantly Sunni Arab town of Tarmiyah, north of Baghdad, officials said.

Separate bombings in Latifiyah south of the capital, and in Salaheddin province in the north, killed two soldiers, and a civil servant was shot dead in Baghdad itself.

On Friday, shelling killed four people in the militant-held city of Fallujah a short drive west of Baghdad, where troops have gone on the offensive without making much apparent headway.