Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

Read More..

School Shooting: Officials Seek Details on Gunman

The FBI is in at least three states interviewing relatives and friends of the elementary school gunman who killed 20 children, seven adults and himself, trying to put together a better picture of the shooter and uncover any possible explanation for the massacre, ABC News has learned.

The authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview relatives of Adam Lanza, 20, and his mother, who was one of Lanza's shooting victims.

The victims died Friday when Lanza invaded Sandy Hook Elementary School in Newtown, Conn., and sprayed staff and students with bullets, officials said. Lanza also was found dead in the school.

Lt. Paul Vance said 18 children died in the school and two more died later in a hospital.

Six adults also were slain, bringing the total to 26. Among them was the school's principal, Dawn Hochsprung, multiple sources told ABC News. Another adult victim was teacher Vicki Soto, her cousin confirmed.

In addition to the casualties at the school, Lanza's mother, Nancy Lanza, was killed in her home, federal and state sources told ABC News.

According to sources, Lanza shot his mother in the face, then left his house armed with at least two semi-automatic handguns, a Glock and a Sig Sauer, and a semi-automatic rifle. He was also wearing a bulletproof vest.

READ: Connecticut Shooter Adam Lanza: 'Obviously Not Well'

Lanza then drove to the elementary school and continued his rampage, authorities said.

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It appeared that Lanza died from what was believed to be a self-inflicted gunshot wound. The rifle was found in his car.

"Evil visited this community today," Gov. Dan Malloy said at a news conference Friday evening.

CLICK HERE for more photos from the scene.

In the early confusion surrounding the investigation, federal sources initially identified the suspect as Adam's older brother Ryan Lanza, 24. Identification belonging to Ryan Lanza was found at the shooting scene, federal sources told ABC News.

Ryan Lanza soon took to Facebook to say he was alive and not responsible for the shooting. He later was questioned by police.

During the rampage, first-grade teacher Kaitlin Roig, 29, locked her 14 students in a class bathroom and listened to "tons of shooting" until police came to help.

"It was horrific," Roig said. "I thought we were going to die."

She said that the terrified kids were saying, "I just want Christmas. ... I don't want to die. I just want to have Christmas."

A tearful President Obama said Friday that there was "not a parent in America who doesn't feel the overwhelming grief that I do."

The president had to pause to compose himself after saying these were "beautiful little kids between the ages of 5 and 10."

As he continued with his statement, Obama wiped away tears from each eye. He has ordered flags flown as half staff.

It is the second worst mass shooting in U.S. history, exceeded only by the Virginia Tech shooting in 2007 when 32 were killed before the shooter turned the gun on himself. The carnage in Connecticut exceeded the 1999 Columbine High School shooting in which 13 died and 24 were injured.

Friday's shooting came three days after masked gunman Jacob Roberts opened fire in a busy Oregon mall, killing two before turning the gun on himself.

The Connecticut shooting occurred at the Sandy Hook Elementary School, which includes 450 students in grades K-4. The town is located about 12 miles east of Danbury, Conn.

The massacre prompted the town of Newtown to lock down all its schools and draw SWAT teams to the school, authorities said.

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U.S., rebels urge gloomy Moscow to help oust Assad

BEIRUT (Reuters) - Syria's rebel leadership and the United States seized on Russian pessimism over President Bashar al-Assad's future to urge Moscow to help push its ally into ceding power and end the battles closing in around his capital.

"We want to commend the Russian government for finally waking up to the reality and acknowledging that the regime's days are numbered," the U.S. State Department spokeswoman said after a senior Kremlin envoy conceded publicly on Thursday that Assad's opponents could win the 20-month-old civil war.

"The question now is, will the Russian government join those of us in the international community who are working with the opposition to try to have a smooth democratic transition?" U.S. spokeswoman Victoria Nuland added in Washington.

In Marrakech, where his new coalition won recognition from other international powers as the legitimate leadership of Syria, rebel political leader Mouaz al-Khatib said he believed Russia, ally and arms supplier to the Assad dynasty since Soviet times, was looking for ways out of its support for a lost cause.

"I believe that the Russians have woken up and are sensing that they have implicated themselves with this regime, but they don't know how to get out," al-Khatib told Reuters. He held them "particularly responsible" for helping Assad with arms but said Moscow need not "lose everything" in Syria if it changed tack.

Under President Vladimir Putin, wary since last year's Libyan war of what Russia sees as a Western drive to use the United Nations to overthrow national leaders it dislikes, Russia has blocked U.N. efforts to squeeze Assad, who has also had strong support from his long-time sponsor Iran.

But Mikhail Bogdanov, a deputy foreign minister and the Kremlin's special envoy for Middle East affairs, was quoted as saying in Moscow: "One must look the facts in the face."

"Unfortunately, the victory of the Syrian opposition cannot be ruled out." The Syrian government, he said, was "losing control of more and more territory" and Moscow was preparing to evacuate Russian citizens if necessary.

Nuland said Bogdanov's comments demonstrated that Moscow now "sees the writing on the wall" on Syria and said Russia should now rally behind U.N. efforts to prevent a wider bloodbath.

"They can withdraw any residual support for the Assad regime, whether it is material support (or) financial support," she said. "They can also help us to identify people who might be willing, inside of Syria, to work on a transitional structure."

DIPLOMACY

International envoy Lakhdar Brahimi, who has met Russian and U.S. officials twice in the past week, is seeking a solution based on an agreement reached in Geneva in June that called for the creation of a transitional government in Syria.

But Russia has repeated warnings that recognition of al-Khatib's coalition, notably by the United States, is undermining diplomacy, and rejected U.S. contentions that the Geneva agreement sent a clear message that Assad should step down.

Nuland said the Brahimi meetings could lay the framework for a political structure to follow Assad:

"We've said all along to the Russians that we are concerned that the longer that this goes on, and the longer it takes us to get to an alternative political path for Syria, the only path is going to be the military one and that is just going to bring more violence.

"We all ought to be working together."

Bogdanov, whose government has suggested that Assad himself should be allowed to see through a transition he has promised, suggested the rebels and their allies were set on a military solution and he gave little hint of detente with Washington.

"The fighting will become even more intense and (Syria) will lose tens of thousands and, perhaps, hundreds of thousands of civilians," Bogdanov was quoted as saying. "If such a price for the removal of the president seems acceptable to you, what can we do? We, of course, consider it absolutely unacceptable."

The head of NATO, Anders Fogh Rasmussen, said elsewhere: "I think the regime in Damascus is approaching collapse."

A U.S. official said: "Assad probably still believes that Syria is his and illusions can die hard. But Assad and those closest to him have got to be feeling the psychological strain of fighting a long war that is not going their way."

DAMASCUS BATTLES

But Al-Khatib, who played down Western concerns of sectarian Sunni Islamists in rebel ranks, warned that the fighting was far from over, even as it has begun to rattle the heart of Assad's power in Damascus. On Wednesday, a car bomb killed at least 16 people in a nearby town which is home to many military families.

"The noose is tightening around the regime," al-Khatib said.

"(But) the regime still has power. People think that the regime is finished, but it still has power left, but it is demoralized and however long it lasted its end is clear."

Day and night, Damascenes can hear the thunderous sound of bombardment aimed at rebel-held and contested neighborhoods.

The city's streets have now turned into a labyrinth of checkpoints and road blocks, with several major roads permanently closed off to traffic by concrete barriers.

"We escape from one place and trouble follows," said one grandmother, Um Hassan, as she described to Reuters her family's flight from one neighborhood to another as fighting seeps into the capital. "I don't know where we can keep running to."

Nonetheless, al-Khatib played down demands for their allies to provide heavier weaponry - a request long resisted by governments wary of anti-aircraft missiles and other hardware reaching Islamist rebels who might turn them against the West.

"The Syrian people ... no longer need international forces to protect them," he said, not specifying whether he meant a no-fly zone, arms supplies or other military support.

The opposition chief said he was willing to listen to proposals for Assad to escape with his life - "The best thing is that he steps down and stops drinking the blood of the Syrian people" - and outlined three scenarios for a change of power:

Al-Khatib ruled out the Russian proposal suggesting Assad hand over power to a transitional government while remaining president, saying it was "disgraceful for a slaughtered nation to accept to have a killer and criminal at its head".

The British-based Syrian Observatory said war planes bombed rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

Syria has relied on war planes and helicopters to bombard rebel districts but Damascus denied accusations by U.S. and NATO officials that it had fired Scud missiles in recent days. The foreign ministry said the long-range missiles were not used against "terrorist groups," a term it uses for the rebels.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

(Additional reporting by Steve Gutterman in Moscow and Andrew Quinn in Washington; Writing by Alastair Macdonald; Editing by Michael Roddy) For an interactive look at the uprising in Syria, please click on http://link.reuters.com/rut37s

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Bell tolls for Beijing's Drum Tower homes

BEIJING - China's capital is to destroy swathes of ancient courtyard homes surrounding a 13th-century landmark in what is being called an effort to preserve Beijing's historical legacy, residents said Friday.

Large numbers of hutong homes, some of them dating back to the Qing dynasty, will be demolished around the Drum and Bell Towers -- a tourist hotspot in Beijing's historic centre -- to make way for a large plaza, they said.

Notices for the "destroy and evict" project are plastered throughout the quarter, dated Wednesday and saying the work was due to be completed by February 24.

Besides protecting the historic legacy of the capital, the project is also aimed at restoring and repairing old and dilapidated buildings, the notices said.

Forced evictions are a major source of unrest in China. Ordinary citizens routinely accuse local officials and developers of cashing in on a property boom by clearing away longstanding residents to pave the way for new projects.

Destroying old homes in central Beijing has particular sensitivity. Critics say new development projects rob the capital of its cultural legacy.

"We have been hearing this was going to happen for years, but now that the notices are up there is not much you can do but leave," said souvenir shop seller Ma Yong.

"When I first saw the notices I felt nothing but despair."

Besides having her rented shop torn down, Ma's small home nearby, where she lives with her retired husband, will also be flattened.

Residents must negotiate compensation with the newly set up "destroy and evict" office near the Bell Tower, with compensation beginning at around 40,000 yuan (US$5,800) per square metre.

Between 130 and 500 homes are to be destroyed, state press reports said.

Officials refused to answer questions when approached by AFP.

"A lot of people are opposed to the campaign, 40,000 yuan per square metre is too cheap, especially with the price of housing in Beijing sky-rocketing," said the manager of a coffee shop near the Drum Tower, who gave her surname only as Wang.

"People are already asking for 150,000 yuan per square metre," she said.

Others said they were happy with the compensation.

"We took the money," said Zhou Li, 51, who was to move out to the suburbs with his elderly parents this weekend after living most of his life near the Bell Tower.

- AFP/ir

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Vaishnodevi gets seasons's first snowfall

JAMMU: Trikuta hills housing the cave shrine of Mata Vaishnodevi today received the season's first snowfall even as pilgrims continued their journey to pay obeisance.

Trikuta hills and nearby areas received 4 inches of season's first snow, shrine board officials said.

Despite the snowfall, over 15,000 pilgrims are on their way to the cave shrine to pay their obeisance, they said.

Braving the chill, pilgrims were seen shouting hymns and moving towards the Bhawan from Katra, the base camp of the shrine, they said.

Read More..

Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

Read More..

Critics Faulted Rice's Work on Benghazi, Africa

United Nations Ambassador Susan Rice removed herself from possible consideration as secretary of state after becoming yet another player in the divide between the left and right.

Rice, who withdrew her name Thursday, has faced months of criticism over how she characterized the Sept. 11 attack on a U.S. consulate in Benghazi, Libya. She also has come under fire for her approach to dealing with African strongmen.

Rice became a target for conservatives when she went on Sunday morning current affairs shows such as ABC News' "This Week" following the Benghazi attack and failed to characterize it as a pre-meditated act of terror. Instead, she said it was a spontaneous response to an anti-Islam film produced in the United States and cited in the region as an example of anti-Islamicism in the West.

After it became clear that Rice's assertions were untrue and elements of the Obama administration may have known that to be the case, Republican Sens. Lindsey Graham, John McCain and Kelly Ayotte said they would do whatever they could to block Rice's possible nomination to replace Hillary Clinton as secretary of state.

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"This is about the role she played around four dead Americans when it seems to be that the story coming out of the administration -- and she's the point person -- is so disconnected to reality, I don't trust her," Graham said. "And the reason I don't trust her is because I think she knew better. And if she didn't know better, she shouldn't be the voice of America."

Members of the administration defended Rice. At his testimony before Congress, Gen. David Petraeus, the former CIA director, said Rice was speaking from unclassified talking points given to her by the CIA.

Senate Intelligence Committee Chairwoman Dianne Feinstein, D-Calif., reiterated what Petraeus said outside his closed-door hearing before the Senate.

"The key is that they were unclassified talking points at a very early stage. And I don't think she should be pilloried for this. She did what I would have done or anyone else would have done that was going on a weekend show," Feinstein said. "To say that she is unqualified to be secretary of state, I think, is a mistake. And the way it keeps going, it's almost as if the intent is to assassinate her character."

Minutes after she announced her withdrawal from the process, Graham tweeted, "I respect Ambassador Rice's decision."

McCain's office released a paper statement saying, "Senator McCain thanks Ambassador Rice for her service to the country and wishes her well. He will continue to seek all the facts surrounding the attack on our consulate in Benghazi that killed four brave Americans."

Over the last few weeks, criticism of Rice had grown beyond her response to Benghazi to include a closer scrutiny of her work in Africa, where she had influence over U.S. policy during the Clinton administration.

Critics of her Africa dealings were not partisan -- but included human rights workers, journalists and some Africans themselves.

Among the most serious critiques was the accusation that she actively protected Rwandan President Paul Kagame and senior members of his government from being sanctioned for funding and supporting the rebels that caused Eastern Congo's recent violence.

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Russia says Syrian rebels might win; car bomb kills 16

BEIRUT (Reuters) - Syrian rebels are gaining ground and might win, Russia's deputy foreign minister said on Thursday, in the starkest such admission from a major ally of President Bashar al-Assad.

"One must look the facts in the face," Russia's state-run RIA quoted Mikhail Bogdanov as saying. "Unfortunately, the victory of the Syrian opposition cannot be ruled out."

Bogdanov, who is Kremlin's special envoy for Middle East affairs, said the Syrian government was "losing control of more and more territory" and that Moscow was preparing plans to evacuate Russian citizens if necessary.

Advancing rebels now hold an almost continuous arc of territory from the east to the southeast of Damascus, despite fierce army bombardments designed to drive them back.

A car bomb killed at least 16 men, women and children in Qatana, a town about 25 km (15 miles) southwest of Damascus where many soldiers live, activists and state media said.

The explosion occurred in a residential area for soldiers in Qatana, which is near several army bases, said Rami Abdelrahman, head of the pro-opposition Syrian Observatory for Human Rights.

He put the death toll as 17, including seven children and two women. State news agency SANA said 16 people had died.

State television blamed the blast on "terrorists" - its term for rebels - and showed footage of soldiers walking by a partly collapsed building, with rubble and twisted metal on the road.

The attack follows three bombs at the Interior Ministry on Wednesday evening, in which state news agency SANA said five people were killed, including Abdullah Kayrouz, a member of parliament from the Syrian Social Nationalist Party.

Apart from gaining territory in the outskirts of Damascus in recent weeks, rebels have also made hit-and-run attacks or set off bombs within the capital, often targeting state security buildings or areas seen as loyal to Assad, such as Jaramana, where twin bombs killed 34 people in November.

BACK TO THE WALL

Insurgents launched an offensive on Damascus after a July 18 bombing that killed four of Assad's closest aides, including his feared brother-in-law Assef Shawkat, but were later pushed back.

With his back to the wall, Assad is reported to be turning ever deadlier weapons on his adversaries.

U.S. NATO officials said on Wednesday that the Syrian military had fired Scud-style ballistic missiles, which are powerful but not very accurate, against rebels in recent days.

Human Rights Watch said some populated areas had been hit by incendiary bombs, containing flammable materials such as napalm, thermite or white phosphorous, which can set fire to buildings or cause severe burns and respiratory damage.

The British-based Syrian Observatory said war planes were bombing rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

The United States, European powers and Arab states bestowed their official blessing on Syria's newly-formed opposition coalition on Wednesday, despite increasing signs of Western unease at the rise of militant Islamists in the rebel ranks.

Western nations at "Friends of Syria" talks in Marrakech, Morocco rallied around a new opposition National Coalition formed last month under moderate Islamist cleric Mouaz Alkhatib.

Russia, which along with China has blocked any U.N. Security Council measures against Assad, criticized Washington's decision to grant the coalition formal recognition, saying it appeared to have abandoned any effort to reach a political solution.

Bogdanov's remarks were the clearest sign yet that Russia is preparing for the possible defeat of Assad's government.

"We are dealing with issues of preparations for an evacuation. We have mobilization plans and are clarifying where our citizens are located," Bogdanov said.

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Cricket: Clarke vows no complacency against Sri Lanka

HOBART, Australia: Skipper Michael Clarke has vowed there will be no complacency in the Test series with Sri Lanka, insisting Australia will improve on their recent performances against South Africa.

The Australians had the better of the opening two Tests against the world number one Proteas only to be crushed by 309 runs in the series decider in Perth last week.

Sri Lanka are ranked sixth in the world, have not won in 10 Tests in Australia over 25 years and are rated outsiders to upset Clarke's team in the three-Test series, beginning in Hobart on Friday.

Former Australian quick Rodney Hogg has rubbished the Sri Lankan attack as the "worst ever" to come to Australia, with Nuwan Kulasekara, Shaminda Eranga and Chanaka Welegedara only having 38 Tests and 99 wickets between them.

Clarke said the third-ranked Australia were focused only on beating Sri Lanka in the first Test since 168-Test great Ricky Ponting's retirement.

"The opposition is irrelevant to how you judge yourself as players," he said.

"Our goal is not to come out and play the same way against Sri Lanka as we did against South Africa.

"We have to learn from that series, take the positives - and I thought there were a lot of positives - and the areas where we need to get better, we need to make sure we do that.

"I'm sure that if we improve on the series against South Africa, we'll continue to have success."

Mitchell Johnson has been left out for the Hobart Test with Australia opting for the pace attack of Ben Hilfenhaus, Peter Siddle and left-armer Mitchell Starc, supplemented by swing bowler Shane Watson and spinner Nathan Lyon.

Recalled Phil Hughes will bat at number three with Watson at four while Clarke and veteran Mike Hussey stay at five and six in the Australian line-up now missing Ponting.

"The strength and advantage we now have in our top four is that all four have opened the batting for Australia," Clarke said.

"So against the new ball they will be very well suited and if we lose early wickets we're still very capable against the new ball which is a real positive."

Clarke also defended the daredevil batting style of opener David Warner, whose second innings dismissal for 29 against South Africa in Perth triggered criticism.

"The one thing we have to understand about Davey, is that the same ball that got him out in Perth, we were all applauding in Adelaide when it went over slips for four. That's the way he plays," he said.

"The only thing I continue to say to Davey is to make sure his intent is there. When the intent is there, his defence is better, his shot selection is better.

"Sometimes it's not going to look great when he gets out, but on the other hand he has the X-factor. He takes the game away from the opposition in the first session of a Test match ... there's not many players in the world that have that talent."

Clarke rated Warner's unbeaten 123 in last year's Hobart Test against New Zealand as among the dashing left-hander's finest.

"I think one of Davey's greatest innings was the hundred he scored here against New Zealand in really tough batting conditions. He still had that intent, even though the wicket was doing a lot. His shot selection was perfect. "In a perfect world, you'd love to bottle that, but you have to have a bit of give and take with Davey."

- AFP/de

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5-year-old girl dies after consuming expired noodles

SRINAGAR: A five-year-old girl died while other family members were taken seriously ill after they consumed a packet of expired noodles in south Kashmir's Kulgam district, police said.

Abroo, daughter of Nisar Ahmad Chak of Manzgam village, along with her parents and three siblings, fell unconscious after consuming the noodles, which had expired in the year 2007, on Tuesday evening, superintendent of police, Kulgam, Muhammad Shafi Mir told PTI.

The pack of noodles had been brought from the family's own shop owned by Chak and his brother Gulzar Ahmad Chak, Shafi said.

The entire family was immediately rushed to a hospital in Kulgam where they were given a 'gastric lavage' (stomach wash), afterwards which they were referred to Srinagar for further treatment, he said.

Abroo died on the way to Srinagar, he said, adding that the other members of the family are being treated in two different hospitals of Srinagar.

The parents are under treatment at SMHS hospital, while the children were admitted to G B Pant hospital here.

The SP said the noodle wrapper and other samples have been taken by the police for evidence and a detailed report is awaited.

Police has registered a case under section 174 of CRPC and investigations are on, Shafi said.

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