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."

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

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

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Conn. Shooter Adam Lanza: 'Obviously Not Well'

Adam Lanza of Newtown, Connecticut was a child of the suburbs and a child of divorce who at age 20 still lived with his mother.

This morning he appears to have started his day by shooting his mother Nancy in the face, and then drove her car to nearby Sandy Hook Elementary School, armed with two handguns and a semi-automatic rifle.

There, before turning his gun on himself, he shot and killed 20 children, who President Obama later described as "beautiful little kids" between five and 10 years of age. Six adults were also killed at the school. Nancy Lanza was found dead in her home.

A relative told ABC News that Adam was "obviously not well."

Family friends in Newtown also described the young man as troubled and described Nancy as rigid. "[Adam] was not connected with the other kids," said Barbara Frey, who also said he was "a little bit different ... Kind of repressed."

State and federal authorities believe his mother may have once worked at the elementary school where Adam went on his deadly rampage, although she was not a teacher, according to relatives, perhaps a volunteer.

Nancy and her husband Peter, Adam's father, divorced in 2009. When they first filed for divorce in 2008, a judge ordered that they participate in a "parenting education program."

Peter Lanza, who drove to northern New Jersey to talk to police and the FBI, is a vice president at GE Capital and had been a partner at global accounting giant Ernst & Young.

Adam's older brother Ryan Lanza, 24, has worked at Ernst & Young for four years, apparently following in his father's footsteps and carving out a solid niche in the tax practice. He too was interviewed by the FBI. Neither he nor his father is under any suspicion.

"[Ryan] is a tax guy and he is clean as a whistle," a source familiar with his work said.

Police had initially identified Ryan as the killer. Ryan sent out a series of Facebook posts saying it wasn't him and that he was at work all day. Video records as well as card swipes at Ernst & Young verified his statement that he had been at the office.

Two federal sources told ABC News that identification belonging to Ryan Lanza was found at the scene of the mass shooting. They say that identification may have led to the confusion by authorities during the first hours after the shooting. Neither Adam nor Ryan has any known criminal history.

A Sig Sauer handgun and a Glock handgun were used in the slaying and .223 shell casings – a round used in a semi-automatic military-style rifle -- were also found at the scene. Nancy Lanza had numerous weapons registered to her, including a Glock and a Sig Sauer. She also owned a Bushmaster rifle -- a semi-automatic carbine chambered for a .223 caliber round. However, federal authorities cannot confirm that the handguns or the rifle were the weapons recovered at the school.

Numerous relatives of the Lanzas in New Jersey, Connecticut, Massachusetts, as well as multiple friends, are being interviewed by the FBI in an effort to put together a better picture of the gunman and any explanation for today's tragedy.

"I think the most important thing to point out with this kind of individual is that he did not snap this morning and decide to act out violently," said former FBI profiler Mary Ellen O'Toole. "These acts involve planning and thoughtfulness and strategizing in order to put the plan together so what may appear to be snap behavior is not that at all."

With reporting by Pierre Thomas, Jim Avila, Santina Leuci, Aaron Katersky, Matthew Mosk, Jason Ryan and Jay Shaylor

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NATO says Syrian Scuds hit "near" Turkey

BEIRUT (Reuters) - NATO accused Syrian President Bashar al-Assad's forces of firing Scud missiles that landed near to the Turkish border, in explaining why it was sending anti-missile batteries and troops to the bloc's frontier.

The Syrian government, which finds itself under attack from rebels in the capital Damascus and by a diplomatic alliance of Arab and Western powers, denies firing such long-range, Soviet-built rockets and had no immediate comment on the latest charge.

Admiral James Stavridis, the American who is NATO's military commander, wrote in a blog on Friday: "Over the past few days, a handful of Scud missiles were launched inside Syria, directed by the regime against opposition targets. Several landed fairly close to the Turkish border, which is very worrisome."

It was not clear how close they came. NATO member Turkey, once friendly toward Assad but now among the main allies of the rebels, has complained of occasional bullets and artillery fire, some of which has been fatal, for many months. It sought the installation of missile defenses on its border some weeks ago.

"Syria is clearly a chaotic and dangerous situation; but we have an absolute obligation to defend the borders of the alliance from any threat emanating from that troubled state," Stavridis wrote.

Batteries of U.S.-made Patriot missiles, designed to shoot down the likes of the Scuds popularly associated with Iraq's wars under Saddam Hussein in the 1990s, are about to be deployed by the U.S., German and Dutch armies, each of which is sending up to 400 troops to operate and protect the rocket systems.

The Syrian government has accused Western powers of backing what it portrays as a Sunni Islamist "terrorist" attack on it and says Washington and Europe have publicly voiced concerns of late that Assad's forces might resort to chemical weapons solely as a pretext for preparing a possible military intervention.

In contrast to NATO's air campaign in support of Libya's successful revolt last year against Muammar Gaddafi, Western powers have fought shy of intervention in Syria. They have cited the greater size and ethnic and religious complexity of a major Arab state at the heart of the Middle East - but have also lacked U.N. approval due to Russia's support for Assad.

Moscow reacted angrily on Friday to the way U.S. officials seized on comments by a top Kremlin envoy for the Middle East as evidence that Russia was giving up on Assad. Comments by Mikhail Bogdanov on Thursday in which he conceded Assad might be ousted did not reflect a change in policy, the Foreign Ministry said.

Assad's diplomatic isolation remains acute, however, as Arab and Western powers this week recognized a new, united coalition of opposition groups as Syria's legitimate leadership. Large parts of the country are no longer under the government's control and fighting has been raging around Damascus itself.

European Union leaders who met in Brussels on Friday said all options were on the table to support the Syrian opposition, raising the possibility that non-lethal military equipment or even arms could eventually be supplied.

In their strongest statement of support for the Syrian opposition since the uprising began 20 months ago, EU leaders instructed their foreign ministers to assess all possibilities to increase the pressure on Assad.

With rebels edging into the capital, a senior NATO official said that Assad is likely to fall and the Western military alliance should make plans to protect against the threat of his chemical arsenal falling into the wrong hands.

HUNGER SPREADS

Desperation for food is growing in parts of Syria and residents of the northern city of Aleppo say fist fights and dashes across the civil war front lines have become part of the daily struggle to secure a loaf of bread.

"I went out yesterday and could not get any bread. If only the problem was just lack of food - there is also a huge shortage of fuel, which the bakeries need to run," said Ahmed, a resident of the battle-scarred Salaheddine district.

He said people get into fist fights over flour and rebels regularly have to break up fights by firing into the air.

The World Food Programme (WFP) says as many as a million people may go hungry this winter, as worsening security conditions make it harder to reach conflict zones.

Forty thousand people have now been killed in the most enduring and destructive of the Arab revolts. The government severely limits press and humanitarian access to the country.

U.N. humanitarian chief Valerie Amos said on Friday the United Nations is committed to maintaining aid operations in Syria.

"NOTHING OFF THE TABLE"

At the EU summit, Britain's David Cameron pushed for an early review of the arms embargo against Syria to possibly open the way to supply equipment to rebels in the coming months. Germany and others were more reluctant and blocked any quick move. But there was widespread agreement that whatever action can be taken under current legislation should be pursued, and the arms embargo would still be reviewed at a later stage.

"I want a very clear message to go to President Assad that nothing is off the table," Cameron told reporters at the end of a two-day summit. "I want us to work with the opposition ... so that we can see the speediest possible transition in Syria.

"There is no single simple answer, but inaction and indifference are not options."

Among factors holding Western powers back from arming the rebels is the presence in their ranks of anti-Western Islamist radicals. Following a U.S. decision this week to blacklist one such group, Jabhat al-Nusra, a "terrorist" group, thousands of Syrians demonstrated on Friday against ostracizing the movement.

The latest, weekly Friday protests in rebel-held areas were held under the slogan: "The only terrorism in Syria is Assad's".

Inspired by Arab uprisings across the region, Syrian protesters were met with gunfire by Assad's security forces in March 2011. Armed revolt overtook the movement, which has become increasingly sectarian - waged by majority Sunni Muslims against forces loyal to Assad, who is from the minority Alawite sect, an offshoot of the Shi'ite Islam practiced in Assad's ally Iran.

A video posted on the Internet showed dozens of Sunni rebels dressed in camouflage gear congratulating and kissing each other outside a burning Shi'ite shrine.

A fighter holding a rifle said the group was destroying the "dens of the Shi'ites". Reuters could not independently verify the video, which was posted on YouTube on Wednesday and purports to be filmed in the northern town of Jisr al-Shughur.

(Writing by Oliver Holmes and Alastair Macdonald; Editing by Michael Roddy)

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Hundreds hold vigil after US school massacre

NEWTOWN, Connecticut: Hundreds of people attended a mass Friday night at a church in Newtown, Connecticut, paying tribute to the victims of the elementary school massacre that left at least 27 dead.

The church was so packed that dozens of people crowded outside the St. Rose of Lima Catholic church -- just a mile from the Sandy Hook elementary school where the tragedy took place.

"This is a kind of community, when things like that happen, they really pull together," Monsignor Robert Weiss said as he closed the special service he convened after hearing news of the slaughter.

"As so many people don't have extended family, friends become very important. And you see evidence of that tonight," he added.

As Weiss spoke, many outside the church stood in silence, still in shock over the attack by the heavily armed young gunman who killed 26 people, including 20 small children, before dying.

Some lit candles and others joined hands in a large circle and sang Christmas songs.

David Connors, father of triplets, all of whom were at the school during the shooting, brought his children to the Mass.

"It's hard. I've never imagined a thing like that could happen here," he told AFP, though he said the children, two boys and a girl, were doing well.

When the gunshots began, they "heard noises. But they were in a separate part of the building" and were evacuated to a fire station near the school, he explained.

For Ray Horvath, a retiree who volunteers at the Connecticut Department of Education in Newtown, the mass was comforting, even though he is not religious.

"It's nice to see the concern of all these people," he said, fighting tears.

"I wish I was a person of faith because it would sustain me, but I don't have it."

- AFP/lp

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HC allows auction of 25 quarries in Punjab

CHANDIGARH: Around four months after banning all mining activities, the Punjab and Haryana high court on Friday allowed auction of 25 quarries in various districts of Punjab.

While permitting the state to initiate the process of auctioning the mining quarries under a close and strict monitoring mechanism, the court of Justice Rajive Bhalla observed that the system of issuing manual slips for lifting minerals from the quarries was being misused.

The court also issued directions to instal weighing machines at the quarries to keep a tab on each vehicle's weight to prevent contractors from extracting material in addition to the prescribed limit by over-digging and thereby harming the ecology.

In August this year, the HC had imposed complete and immediate ban on mining in the state without environmental clearance in operational quarries of up to five hectares in the state.

The court also directed that environment impact assessment committee would grant permission in each case so that there was no ecological degradation. The HC has also told the trial courts to avoid releasing vehicles and equipment used for illegal mining.

The division bench also made it clear that the HC's endeavour was only to ensure the undertaking of mining after obtaining requisite permission and following the rules, which was not being done.

Justice Bhalla was miffed over the recent statements made by the state governments that rates of building material have reached all time high because of stay on mining by the Punjab and Haryana high court.

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Study: People worldwide living longer, but sicker

LONDON (AP) — Nearly everywhere around the world, people are living longer and fewer children are dying. But increasingly, people are grappling with the diseases and disabilities of modern life, according to the most expansive global look so far at life expectancy and the biggest health threats.

The last comprehensive study was in 1990 and the top health problem then was the death of children under 5 — more than 10 million each year. Since then, campaigns to vaccinate kids against diseases like polio and measles have reduced the number of children dying to about 7 million.

Malnutrition was once the main health threat for children. Now, everywhere except Africa, they are much more likely to overeat than to starve.

With more children surviving, chronic illnesses and disabilities that strike later in life are taking a bigger toll, the research said. High blood pressure has become the leading health risk worldwide, followed by smoking and alcohol.

"The biggest contributor to the global health burden isn't premature (deaths), but chronic diseases, injuries, mental health conditions and all the bone and joint diseases," said one of the study leaders, Christopher Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.

In developed countries, such conditions now account for more than half of the health problems, fueled by an aging population. While life expectancy is climbing nearly everywhere, so too are the number of years people will live with things like vision or hearing loss and mental health issues like depression.

The research appears in seven papers published online Thursday by the journal Lancet. More than 480 researchers in 50 countries gathered data up to 2010 from surveys, censuses and past studies. They used statistical modeling to fill in the gaps for countries with little information. The series was mainly paid for by the Bill & Melinda Gates Foundation.

As in 1990, Japan topped the life expectancy list in 2010, with 79 for men and 86 for women. In the U.S. that year, life expectancy for men was 76 and for women, 81.

The research found wide variations in what's killing people around the world. Some of the most striking findings highlighted by the researchers: — Homicide is the No. 3 killer of men in Latin America; it ranks 20th worldwide. In the U.S., it is the 21st cause of death in men, and in Western Europe, 57th.

— While suicide ranks globally as the 21st leading killer, it is as high as the ninth top cause of death in women across Asia's "suicide belt," from India to China. Suicide ranks 14th in North America and 15th in Western Europe.

— In people aged 15-49, diabetes is a bigger killer in Africa than in Western Europe (8.8 deaths versus 1 death per 100,000).

— Central and Southeast Asia have the highest rates of fatal stroke in young adults at about 15 cases per 100,000 deaths. In North America, the rate is about 3 per 100,000.

Globally, heart disease and stroke remain the top killers. Reflecting an older population, lung cancer moved to the 5th cause of death globally, while other cancers including those of the liver, stomach and colon are also in the top 20. AIDS jumped from the 35th cause of death in 1990 to the sixth leading cause two decades later.

While chronic diseases are killing more people nearly everywhere, the overall trend is the opposite in Africa, where illnesses like AIDS, malaria and tuberculosis are still major threats. And experts warn again shifting too much of the focus away from those ailments.

"It's the nature of infectious disease epidemics that if you turn away from them, they will crop right back up," said Jennifer Cohn, a medical coordinator at Doctors Without Borders.

Still, she acknowledged the need to address the surge of other health problems across Africa. Cohn said the agency was considering ways to treat things like heart disease and diabetes. "The way we treat HIV could be a good model for chronic care," she said.

Others said more concrete information is needed before making any big changes to public health policies.

"We have to take this data with some grains of salt," said Sandy Cairncross, an epidemiologist at the London School of Hygiene and Tropical Medicine.

He said the information in some of the Lancet research was too thin and didn't fully consider all the relevant health risk factors.

"We're getting a better picture, but it's still incomplete," he said.

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Online:

www.lancet.com

http://healthmetricsandevaluation.org

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Health-Exchange Deadline Looms

All of the Affordable Care Act, also known as "Obamacare," doesn't go into effect until 2014, but states are required to set up their own health care exchanges or leave it to the federal government to step in by next year. The deadline for the governors' decisions is Friday.

The health insurance exchanges are one of the key stipulations of the new health care law. They will offer consumers an Internet-based marketplace for purchasing private health insurance plans.

But the president's signature health care plan has become so fraught with politics that whether governors agreed to set up the exchanges has fallen mostly along party lines.

Such partisanship is largely symbolic because if a state opts not to set up the exchange, the Department of Health and Human Services will do it for them as part of the federal program. That would not likely be well-received by Republican governors, either, but the law forces each state's chief executive to make a decision one way or the other.

Here's what it looks like in all 50 states and the District of Columbia:

20 states that have opted out -- N.J., S.C., La., Wis., Ohio, Maine, Ala., Alaska, Ariz., Ga., Pa., Kan., Neb., N.H., N.D., Okla., S.D., Tenn., Texas and Wyo.

Charles Dharapak/AP Photo

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Several Republican governors have said they will not set up the exchanges, including Chris Christie (N.J.), Nikki Haley (S.C.), Bobby Jindal (La.), Scott Walker (Wis.), John Kasich (Ohio), Paul LePage (Maine), Robert Bentley (Ala.), Sean Parnell (Ark.), Jan Brewer (Ariz.), Nathan Deal (Ga.), Tom Corbett (Pa.), Sam Brownback (Kan.), Dave Heineman (Neb.), John Lynch (N.H.), Jack Dalrymple (N.D.), Mary Fallin (Okla.), Dennis Daugaard (S.D.), Bill Haslam (Tenn.), Rick Perry (Texas), and Matt Mead (Wyo.).

3 States Out, but a Little More Complicated -- Mont., Ind. and Mo.

The Montana outgoing and incoming governors are both Democrats, but the Republican state legislature rejected the Democratic state auditor's request to start setting up a state exchange. So a federal exchange will be set up in Montana as well.

The Indiana outgoing and incoming governors are both Republicans and outgoing Gov. Mitch Daniels deferred the decision to governor-elect and U.S. Rep. Mike Pence, who said his preference is not to set up a state health care exchange, paving the way for the feds to come in too.

In Missouri, Gov. Jay Nixon is a Democrat, but Prop E passed on Nov. 6, which barred his administration from creating a state-based exchange without a public vote or the approval of the state legislature. After the election, he sent a letter to the Department of Health and Human Services saying he would be unable to set up a state-based exchange, meaning the federal government would have to set up its own.

1 State Waiting for the White House -- Utah

Utah already has a state exchange set up, a Web-based tool where small-business employees can shop and compare health insurance with contributions from their employee. In a letter Republican Gov. Gary Herbert sent to the White House Tuesday, he asked for its exchange, called Avenue H, to be approved as a state-based exchange under the Affordable Care Act as long as state officials can open it to individuals and larger businesses.

Norm Thurston, the state's health reform implementation coordinator, says authorities there "haven't received an official response" from the White House, but "we anticipate getting one soon."

There are some sticking points that don't comply with the exchanges envisioned by the Affordable Care Act and Utah would like to keep it that way.

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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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China shares up over 3% on data, policy hopes

SHANGHAI: Chinese shares were up more than three per cent in afternoon trade on Friday on fresh signs of an economic recovery and hopes new policies will emerge from a key government meeting, dealers said.

The benchmark Shanghai Composite Index jumped 3.02 per cent, or 62.24 points, to 2,123.72.

British banking giant HSBC said on Friday its preliminary purchasing managers' index (PMI) hit a 14-month high of 50.9 in December, compared with a final reading of 50.5 for November.

"The PMI data confirmed that the domestic economy has turned for the better. The index was also pushed up by expectations for policies from the economic work conference," Zheshang Securities analyst Zhang Yanbing told AFP.

China is expected to hold its annual economic work conference over the weekend to lay out policies for next year, state media reported.

- AFP/xq

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SC issues notice to Centre on petition seeking justice for Kargil war hero Captain Saurav Kalia

NEW DELHI: The Supreme Court has issued notice to the Centre on a petition seeking direction to Union of India to move International Court of Justice against Pakistan for mutilation of Captain Saurav Kalia's body during Kargil war by Pakistani soldiers.

When petitioner NK Kalia, father of the dead soldier, said India should have moved ICJ on its own, SC said the door is still open for Union Government to do so even after 13 years of the incident.

SC said it wants to find out during the hearing whethet it would be constitutionally correct to direct Union of India to move the ICJ.

When NK Kalia alleged that he had fought alone for 13 years to protect not only his son's honour but the dignity of Indian soldiers as a whole, the court said it shared the petitioner's anguish much more that what is stated in the petition.

Capt Kalia was leading a patrol party when he was captured by Pakistani soldiers. He was tortured before being killed. His mutilated body was later haded over to Indian Army.

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