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Saturday, November 2, 2019

Fragile X syndrome

From Wikipedia, the free encyclopedia
 
Fragile X syndrome
Other namesMartin-Bell syndrome,
Escalante syndrome
Fragx-2.jpg
Boy with fragile X syndrome
SpecialtyMedical genetics, pediatrics, psychiatry
SymptomsIntellectual disability, long and narrow face, large ears, flexible fingers, large testicles
ComplicationsAutism features, seizures
Usual onsetNoticeable by age 2
DurationLifelong
CausesGenetic (X-linked dominant)
Diagnostic methodGenetic testing
TreatmentSupportive care, early interventions
Frequency1 in 4,000 (males), 1 in 8,000 (females)

Fragile X syndrome (FXS) is a genetic disorder. Symptoms often include mild to moderate intellectual disability. The average IQ in males is under 55, while about two thirds of females are intellectually disabled. Physical features may include a long and narrow face, large ears, flexible fingers, and large testicles. About a third of those affected have features of autism such as problems with social interactions and delayed speech. Hyperactivity is common and seizures occur in about 10%. Males are usually more affected than females.

Fragile X syndrome is inherited in an X-linked dominant pattern. Women with a premutation have an increased risk of having an affected child. It is typically due to an expansion of the CGG triplet repeat within the Fragile X mental retardation 1 (FMR1) gene on the X chromosome. This results in not enough of the fragile X mental retardation protein (FMRP), which is required for the normal development of connections between neurons. Diagnosis requires genetic testing to determine the number of CGG repeats in the FMR1 gene. Normal is between 5 and 40 repeats, fragile X syndrome occurs with more than 200, and a premutation is said to be present when an intermediate number of repeats occurs. Testing for premutation carriers may allow for genetic counseling.

There is no cure. Early intervention is recommended as it provides the most opportunity for developing a full range of skills. These interventions may include special education, speech therapy, physical therapy, or behavioral therapy. Medications may be used to treat associated seizures, mood problems, aggressive behavior, or ADHD. Fragile X syndrome is estimated to occur in 1.4 in 10,000 males and 0.9 in 10,000 females.

Signs and symptoms

Prominent characteristics of the syndrome include an elongated face, large or protruding ears, and low muscle tone.
 
Most young children do not show any physical signs of FXS. It is not until puberty that physical features of FXS begin to develop. Aside from intellectual disability, prominent characteristics of the syndrome may include an elongated face, large or protruding ears, flat feet, larger testes (macroorchidism), and low muscle tone. Recurrent otitis media (middle ear infection) and sinusitis is common during early childhood. Speech may be cluttered or nervous. Behavioral characteristics may include stereotypic movements (e.g., hand-flapping) and atypical social development, particularly shyness, limited eye contact, memory problems, and difficulty with face encoding. Some individuals with fragile X syndrome also meet the diagnostic criteria for autism

Males with a full mutation display virtually complete penetrance and will therefore almost always display symptoms of FXS, while females with a full mutation generally display a penetrance of about 50% as a result of having a second, normal X chromosome. Females with FXS may have symptoms ranging from mild to severe, although they are generally less affected than males.

Physical phenotype

  • Large, protruding ears (both)
  • Long face (vertical maxillary excess)
  • High-arched palate (related to the above)
  • Hyperextensible finger joints
  • Hyperextensible ('double-jointed') thumbs
  • Flat feet
  • Soft skin
  • Postpubescent macroorchidism (large testicles in men after puberty)
  • Hypotonia (low muscle tone)

Intellectual development

Individuals with FXS may present anywhere on a continuum from learning disabilities in the context of a normal intelligence quotient (IQ) to severe intellectual disability, with an average IQ of 40 in males who have complete silencing of the FMR1 gene. Females, who tend to be less affected, generally have an IQ which is normal or borderline with learning difficulties. The main difficulties in individuals with FXS are with working and short-term memory, executive function, visual memory, visual-spatial relationships, and mathematics, with verbal abilities being relatively spared.

Data on intellectual development in FXS are limited. However, there is some evidence that standardized IQ decreases over time in the majority of cases, apparently as a result of slowed intellectual development. A longitudinal study looking at pairs of siblings where one child was affected and the other was not found that affected children had an intellectual learning rate which was 55% slower than unaffected children.

When both autism and FXS are present, a greater language deficit and lower IQ is observed as compared to children with only FXS.

Autism

Fragile X syndrome co-occurs with autism in many cases and is a suspected genetic cause of the autism in these cases. This finding has resulted in screening for FMR1 mutation to be considered mandatory in children diagnosed with autism. Of those with fragile X syndrome, prevalence of concurrent autism spectrum disorder (ASD) has been estimated to be between 15 and 60%, with the variation due to differences in diagnostic methods and the high frequency of autistic features in individuals with fragile X syndrome not meeting the DSM criteria for an ASD.

Although individuals with FXS have difficulties in forming friendships, those with FXS and ASD characteristically also have difficulties with reciprocal conversation with their peers. Social withdrawal behaviors, including avoidance and indifference, appear to be the best predictors of ASD in FXS, with avoidance appearing to be correlated more with social anxiety while indifference was more strongly correlated to severe ASD. When both autism and FXS are present, a greater language deficit and lower IQ is observed as compared to children with only FXS.

Genetic mouse models of FXS have also been shown to have autistic-like behaviors.

Social interaction

FXS is characterized by social anxiety, including poor eye contact, gaze aversion, prolonged time to commence social interaction, and challenges forming peer relationships. Social anxiety is one of the most common features associated with FXS, with up to 75% of males in one series characterized as having excessive shyness and 50% having panic attacks. Social anxiety in individuals with FXS is related to challenges with face encoding, the ability to recognize a face that one has seen before.

It appears that individuals with FXS are interested in social interaction and display greater empathy than groups with other causes of intellectual disability, but display anxiety and withdrawal when placed in unfamiliar situations with unfamiliar people. This may range from mild social withdrawal, which is predominantly associated with shyness, to severe social withdrawal, which may be associated with co-existing autism spectrum disorder.

Females with FXS frequently display shyness, social anxiety and social avoidance or withdrawal. In addition, premutation in females has been found to be associated with social anxiety. 

Individuals with FXS show decreased activation in the prefrontal regions of the brain.

Mental health

Attention deficit hyperactivity disorder (ADHD) is found in the majority of males with FXS and 30% of females, making it the most common psychiatric diagnosis in those with FXS. Children with fragile X have very short attention spans, are hyperactive, and show hypersensitivity to visual, auditory, tactile, and olfactory stimuli. These children have difficulty in large crowds due to the loud noises and this can lead to tantrums due to hyperarousal. Hyperactivity and disruptive behavior peak in the preschool years and then gradually decline with age, although inattentive symptoms are generally lifelong.

Aside from the characteristic social phobia features, a range of other anxiety symptoms are very commonly associated with FXS, with symptoms typically spanning a number of psychiatric diagnoses but not fulfilling any of the criteria in full. Children with FXS pull away from light touch and can find textures of materials to be irritating. Transitions from one location to another can be difficult for children with FXS. Behavioral therapy can be used to decrease the child's sensitivity in some cases. Behaviors such as hand flapping and biting, as well as aggression, can be an expression of anxiety. 

Perseveration is a common communicative and behavioral characteristic in FXS. Children with FXS may repeat a certain ordinary activity over and over. In speech, the trend is not only in repeating the same phrase but also talking about the same subject continually. Cluttered speech and self-talk are commonly seen. Self-talk includes talking with oneself using different tones and pitches. Although only a minority of FXS cases will meet the criteria for obsessive–compulsive disorder (OCD), a significant majority will have symptoms of obsession. However, as individuals with FXS generally find these behaviors pleasurable, unlike individuals with OCD, they are more frequently referred to as stereotypic behaviors.

Mood symptoms in individuals with FXS rarely meet diagnostic criteria for a major mood disorder as they are typically not of sustained duration. Instead, these are usually transient and related to stressors, and may involve labile (fluctuating) mood, irritability, self-injury and aggression.

Individuals with fragile X-associated tremor/ataxia syndrome (FXTAS) are likely to experience combinations of dementia, mood, and anxiety disorders. Males with the FMR1 premutation and clinical evidence of FXTAS were found to have increased occurrence of somatization, obsessive–compulsive disorder, interpersonal sensitivity, depression, phobic anxiety, and psychoticism.

Vision

Ophthalmologic problems include strabismus. This requires early identification to avoid amblyopia. Surgery or patching are usually necessary to treat strabismus if diagnosed early. Refractive errors in patients with FXS are also common.

Neurology

Individuals with FXS are at a higher risk of developing seizures, with rates between 10% and 40% reported in the literature. In larger study populations the frequency varies between 13% and 18%, consistent with a recent survey of caregivers which found that 14% of males and 6% of females experienced seizures. The seizures tend to be partial, are generally not frequent, and are amenable to treatment with medication.

Individuals who are carriers of premutation alleles are at risk for developing fragile X-associated tremor/ataxia syndrome (FXTAS), a progressive neurodegenerative disease. It is seen in approximately half of male carriers over the age of 70, while penetrance in females is lower. Typically, onset of tremor occurs in the sixth decade of life, with subsequent progression to ataxia (loss of coordination) and gradual cognitive decline.

Working memory

From their 40s onward, males with FXS begin developing progressively more severe problems in performing tasks that require the central executive of working memory. Working memory involves the temporary storage of information 'in mind', while processing the same or other information. Phonological memory (or verbal working memory) deteriorates with age in males, while visual-spatial memory is not found to be directly related to age. Males often experience an impairment in the functioning of the phonological loop. The CGG length is significantly correlated with central executive and the visual–spatial memory. However, in a premutation individual, CGG length is only significantly correlated with the central executive, not with either phonological memory or visual–spatial memory.

Fertility

About 20% of women who are carriers for the fragile X premutation are affected by fragile X-related primary ovarian insufficiency (FXPOI), which is defined as menopause before the age of 40. The number of CGG repeats correlates with penetrance and age of onset. However premature menopause is more common in premutation carriers than in women with the full mutation, and for premutations with more than 100 repeats the risk of FXPOI begins to decrease. Fragile X-associated primary ovarian insufficiency (FXPOI) is one of three Fragile X-associated Disorders (FXD) caused by changes in the FMR1 gene. FXPOI affects female premutation carriers of Fragile X syndrome, which is caused by the FMR1 gene, when their ovaries are not functioning properly. Women with FXPOI may develop menopause-like symptoms but they are not actually menopausal. Women with FXPOI can still get pregnant in some cases because their ovaries occasionally release viable eggs.

FMRP is a chromatin-binding protein that functions in the DNA damage response. FMRP also occupies sites on meiotic chromosomes and regulates the dynamics of the DNA damage response machinery during spermatogenesis.

Causes

Location of FMR1 gene on the X chromosome.
 
Fragile X syndrome is a genetic disorder which occurs as a result of a mutation of the fragile X mental retardation 1 (FMR1) gene on the X chromosome, most commonly an increase in the number of CGG trinucleotide repeats in the 5' untranslated region of FMR1. Mutation at that site is found in 1 out of about every 2000 males and 1 out of about every 259 females. Incidence of the disorder itself is about 1 in every 3600 males and 1 in 4000–6000 females. Although this accounts for over 98% of cases, FXS can also occur as a result of point mutations affecting FMR1.

In unaffected individuals, the FMR1 gene contains 5–44 repeats of the sequence CGG, most commonly 29 or 30 repeats. Between 45-54 repeats is considered a "grey zone", with a premutation allele generally considered to be between 55 and 200 repeats in length. Individuals with fragile X syndrome have a full mutation of the FMR1 allele, with over 200 CGG repeats. In these individuals with a repeat expansion greater than 200, there is methylation of the CGG repeat expansion and FMR1 promoter, leading to the silencing of the FMR1 gene and a lack of its product.

This methylation of FMR1 in chromosome band Xq27.3 is believed to result in constriction of the X chromosome which appears 'fragile' under the microscope at that point, a phenomenon that gave the syndrome its name. One study found that FMR1 silencing is mediated by the FMR1 mRNA. The FMR1 mRNA contains the transcribed CGG-repeat tract as part of the 5' untranslated region, which hybridizes to the complementary CGG-repeat portion of the FMR1 gene to form an RNA·DNA duplex.

A subset of people with intellectual disability and symptoms resembling fragile X syndrome are found to have point mutations in FMR1. This subset lacked the CGG repeat expansion in FMR1 traditionally associated with fragile x syndrome.

Inheritance

Fragile X syndrome has traditionally been considered an X-linked dominant condition with variable expressivity and possibly reduced penetrance. However, due to genetic anticipation and X-inactivation in females, the inheritance of Fragile X syndrome does not follow the usual pattern of X-linked dominant inheritance, and some scholars have suggested discontinuing labeling X-linked disorders as dominant or recessive. Females with full FMR1 mutations may have a milder phenotype than males due to variability in X-inactivation.

Before the FMR1 gene was discovered, analysis of pedigrees showed the presence of male carriers who were asymptomatic, with their grandchildren affected by the condition at a higher rate than their siblings suggesting that genetic anticipation was occurring. This tendency for future generations to be affected at a higher frequency became known as the Sherman paradox after its description in 1985. Due to this, male children often have a greater degree of symptoms than their mothers.

The explanation for this phenomenon is that male carriers pass on their premutation to all of their daughters, with the length of the FMR1 CGG repeat typically not increasing during meiosis, the cell division that is required to produce sperm. Incidentally, males with a full mutation only pass on premutations to their daughters. However, females with a full mutation are able to pass this full mutation on, so theoretically there is a 50% chance that a child will be affected. In addition, the length of the CGG repeat frequently does increase during meiosis in female premutation carriers due to instability and so, depending on the length of their premutation, they may pass on a full mutation to their children who will then be affected. Repeat expansion is considered to be a consequence of strand slippage either during DNA replication or DNA repair synthesis.

Pathophysiology

FMRP is found throughout the body, but in highest concentrations within the brain and testes. It appears to be primarily responsible for selectively binding to around 4% of mRNA in mammalian brains and transporting it out of the cell nucleus and to the synapses of neurons. Most of these mRNA targets have been found to be located in the dendrites of neurons, and brain tissue from humans with FXS and mouse models shows abnormal dendritic spines, which are required to increase contact with other neurons. The subsequent abnormalities in the formation and function of synapses and development of neural circuits result in impaired neuroplasticity, an integral part of memory and learning. Connectome changes have long been suspected to be involved in the sensory pathophysiology and most recently a range of circuit alterations have been shown, involving structurally increased local connectivity and functionally decreased long-range connectivity.

In addition, FMRP has been implicated in several signalling pathways that are being targeted by a number of drugs undergoing clinical trials. The group 1 metabotropic glutamate receptor (mGluR) pathway, which includes mGluR1 and mGluR5, is involved in mGluR-dependent long term depression (LTD) and long term potentiation (LTP), both of which are important mechanisms in learning. The lack of FMRP, which represses mRNA production and thereby protein synthesis, leads to exaggerated LTD. FMRP also appears to affect dopamine pathways in the prefrontal cortex which is believed to result in the attention deficit, hyperactivity and impulse control problems associated with FXS. The downregulation of GABA pathways, which serve an inhibitory function and are involved in learning and memory, may be a factor in the anxiety symptoms which are commonly seen in FXS.

Diagnosis

Cytogenetic analysis for fragile X syndrome was first available in the late 1970s when diagnosis of the syndrome and carrier status could be determined by culturing cells in a folate deficient medium and then assessing for "fragile sites" (discontinuity of staining in the region of the trinucleotide repeat) on the long arm of the X chromosome. This technique proved unreliable, however, as the fragile site was often seen in less than 40% of an individual's cells. This was not as much of a problem in males, but in female carriers, where the fragile site could generally only be seen in 10% of cells, the mutation often could not be visualised. 

Since the 1990s, more sensitive molecular techniques have been used to determine carrier status. The fragile X abnormality is now directly determined by analysis of the number of CGG repeats using polymerase chain reaction (PCR) and methylation status using Southern blot analysis. By determining the number of CGG repeats on the X chromosome, this method allows for more accurate assessment of risk for premutation carriers in terms of their own risk of fragile X associated syndromes, as well as their risk of having affected children. Because this method only tests for expansion of the CGG repeat, individuals with FXS due to missense mutations or deletions involving FMR1 will not be diagnosed using this test and should therefore undergo sequencing of the FMR1 gene if there is clinical suspicion of FXS. 

Prenatal testing with chorionic villus sampling or amniocentesis allows diagnosis of FMR1 mutation while the fetus is in utero and appears to be reliable.

Early diagnosis of fragile X syndrome or carrier status is important for providing early intervention in children or fetuses with the syndrome, and allowing genetic counselling with regards to the potential for a couple's future children to be affected. Most parents notice delays in speech and language skills, difficulties in social and emotional domains as well as sensitivity levels in certain situations with their children.

Management

There is no cure for the underlying defects of FXS. Management of FXS may include speech therapy, behavioral therapy, sensory integration occupational therapy, special education, or individualised educational plans, and, when necessary, treatment of physical abnormalities. Persons with fragile X syndrome in their family histories are advised to seek genetic counseling to assess the likelihood of having children who are affected, and how severe any impairments may be in affected descendants.

Medication

Current trends in treating the disorder include medications for symptom-based treatments that aim to minimize the secondary characteristics associated with the disorder. If an individual is diagnosed with FXS, genetic counseling for testing family members at risk for carrying the full mutation or premutation is a critical first-step. Due to a higher prevalence of FXS in boys, the most commonly used medications are stimulants that target hyperactivity, impulsivity, and attentional problems. For co-morbid disorders with FXS, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are utilized to treat the underlying anxiety, obsessive-compulsive behaviors, and mood disorders. Following antidepressants, antipsychotics such as risperidone and quetiapine are used to treat high rates of self-injurious, aggressive and aberrant behaviors in this population (Bailey Jr et al., 2012). Anticonvulsants are another set of pharmacological treatments used to control seizures as well as mood swings in 13%–18% of individuals suffering from FXS. Drugs targeting the mGluR5 (metabotropic glutamate receptors) that are linked with synaptic plasticity are especially beneficial for targeted symptoms of FXS. Lithium is also currently being used in clinical trials with humans, showing significant improvements in behavioral functioning, adaptive behavior, and verbal memory. Few studies suggested using folic acid, but more researches are needed due to the low quality of that evidence. Alongside pharmacological treatments, environmental influences such as home environment and parental abilities as well as behavioral interventions such as speech therapy, sensory integration, etc. all factor in together to promote adaptive functioning for individuals with FXS. While metformin may reduce body weight in persons with fragile X syndrome, it is uncertain whether it improves neurological or psychiatric symptoms.

Current pharmacological treatment centers on managing problem behaviors and psychiatric symptoms associated with FXS. However, as there has been very little research done in this specific population, the evidence to support the use of these medications in individuals with FXS is poor.

ADHD, which affects the majority of boys and 30% of girls with FXS, is frequently treated using stimulants. However, the use of stimulants in the fragile X population is associated with a greater frequency of adverse events including increased anxiety, irritability and mood lability. Anxiety, as well as mood and obsessive-compulsive symptoms, may be treated using SSRIs, although these can also aggravate hyperactivity and cause disinhibited behavior. Atypical antipsychotics can be used to stabilise mood and control aggression, especially in those with comorbid ASD. However, monitoring is required for metabolic side effects including weight gain and diabetes, as well as movement disorders related to extrapyramidal side effects such as tardive dyskinesia. Individuals with coexisting seizure disorder may require treatment with anticonvulsants.

Prognosis

A 2013 review stated that life expectancy for FXS was 12 years lower than the general population and that the causes of death were similar to those found for the general population.

Research

Fragile X syndrome is the most translated neurodevelopmental disorder under study. The increased understanding of the molecular mechanisms of disease in FXS has led to the development of therapies targeting the affected pathways. Evidence from mouse models shows that mGluR5 antagonists (blockers) can rescue dendritic spine abnormalities and seizures, as well as cognitive and behavioral problems, and may show promise in the treatment of FXS. Two new drugs, AFQ-056 (mavoglurant) and dipraglurant, as well as the repurposed drug fenobam are currently undergoing human trials for the treatment of FXS. There is also early evidence for the efficacy of arbaclofen, a GABAB agonist, in improving social withdrawal in individuals with FXS and ASD.

In addition, there is evidence from mouse models that minocycline, an antibiotic used for the treatment of acne, rescues abnormalities of the dendrites. An open trial in humans has shown promising results, although there is currently no evidence from controlled trials to support its use.

The first complete DNA sequence of the repeat expansion in someone with the full mutation was generated by scientists in 2012 using SMRT sequencing.

History

In 1943, James Purdon Martin and Julia Bell described a pedigree of X-linked mental disability, without considering the macroorchidism (larger testicles). In 1969, Herbert Lubs first sighted an unusual "marker X chromosome" in association with mental disability. In 1970, Frederick Hecht coined the term "fragile site". And, in 1985, Felix F. de la Cruz outlined extensively the physical, psychological, and cytogenic characteristics of those afflicted in addition to prospects for therapy. Continued advocacy later won him an honour through the FRAXA Research Foundation in December 1998.

Neurodevelopmental disorder

From Wikipedia, the free encyclopedia
 
Neurodevelopmental disorder
SpecialtyPsychiatry, neurology

Neurodevelopmental disorders are a group of disorders which affect the development of the nervous system, leading to abnormal brain function which may affect emotion, learning ability, self-control, and memory. The effects of neurodevelopmental disorders tend to last for a person's entire lifetime.

Types

Neurodevelopmental disorders are impairments of the growth and development of the brain and/or central nervous system. A narrower use of the term refers to a disorder of brain function that affects emotion, learning ability, self-control and memory which unfolds as an individual develops and grows. 

The neurodevelopmental disorders currently considered, recognised and/or acknowledged to be as such are:
  1. Intellectual disability (ID) or intellectual and developmental disability (IDD), previously called mental retardation
  2. Specific learning disorders, like Dyslexia or Dyscalculia.
  3. Autism spectrum disorders, such as Asperger's syndrome or Autistic Disorder
  4. Motor disorders including developmental coordination disorder and stereotypic movement disorder
  5. Tic disorders including Tourette's syndrome
  6. Traumatic brain injury (including congenital injuries such as those that cause cerebral palsy)
  7. Communication, speech and language disorders
  8. Genetic disorders, such as fragile-X syndrome, Down syndrome, attention deficit hyperactivity disorder, schizophrenia, schizotypal disorder, hypogonadotropic hypogonadal syndromes
  9. Disorders due to neurotoxicants like fetal alcohol spectrum disorder, Minamata disease caused by mercury, behavioral disorders including conduct disorder etc. caused by other heavy metals, such as lead, chromium, platinum etc., hydrocarbons like dioxin, PBDEs and PCBs, medications and illegal drugs, like cocaine and others.

Presentation

Consequences

The multitude of neurodevelopmental disorders span a wide range of associated symptoms and severity, resulting in different degrees of mental, emotional, physical, and economic consequences for individuals, and in turn families, social groups, and society.

Causes

Development of the nervous system is tightly regulated and timed; it is influenced by both genetic programs and the environment. Any significant deviation from the normal developmental trajectory early in life can result in missing or abnormal neuronal architecture or connectivity. Because of the temporal and spatial complexity of the developmental trajectory, there are many potential causes of neurodevelopmental disorders that may affect different areas of the nervous system at different times and ages. These range from social deprivation, genetic and metabolic diseases, immune disorders, infectious diseases, nutritional factors, physical trauma, and toxic and environmental factors. Some neurodevelopmental disorders, such as autism and other pervasive developmental disorders, are considered multifactorial syndromes which have many causes that converge to a more specific neurodevelopmental manifestation.

Social deprivation

Deprivation from social and emotional care causes severe delays in brain and cognitive development. Studies with children growing up in Romanian orphanages during Nicolae Ceauşescu's regime reveal profound effects of social deprivation and language deprivation on the developing brain. These effects are time dependent. The longer children stayed in negligent institutional care, the greater the consequences. By contrast, adoption at an early age mitigated some of the effects of earlier institutionalization (abnormal psychology).

Genetic disorders

A child with Down syndrome
 
A prominent example of a genetically determined neurodevelopmental disorder is Trisomy 21, also known as Down syndrome. This disorder usually results from an extra chromosome 21, although in uncommon instances it is related to other chromosomal abnormalities such as translocation of the genetic material. It is characterized by short stature, epicanthal (eyelid) folds, abnormal fingerprints, and palm prints, heart defects, poor muscle tone (delay of neurological development) and mental retardation (delay of intellectual development).

Less commonly known genetically determined neurodevelopmental disorders include Fragile X syndrome. Fragile X syndrome was first described in 1943 by J.P. Martin and J. Bell, studying persons with family history of sex-linked "mental defects". Rett syndrome, another X-linked disorder, produces severe functional limitations. Williams syndrome is caused by small deletions of genetic material from chromosome 7. The most common recurrent Copy Number Variannt disorder is 22q11.2 deletion syndrome (formerly DiGeorge or velocardiofacial syndrome), followed by Prader-Willi syndrome and Angelman syndrome.

Immune dysfunction

Immune reactions during pregnancy, both maternal and of the developing child, may produce neurodevelopmental disorders. One typical immune reaction in infants and children is PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection. Another disorder is Sydenham's chorea, which results in more abnormal movements of the body and fewer psychological sequellae. Both are immune reactions against brain tissue that follow infection by Streptococcus bacteria. Susceptibility to these immune diseases may be genetically determined, so sometimes several family members may suffer from one or both of them following an epidemic of Strep infection.

Infectious diseases

Systemic infections can result in neurodevelopmental consequences, when they occur in infancy and childhood of humans, but would not be called a primary neurodevelopmental disorder per se, as for example HIV Infections of the head and brain, like brain abscesses, meningitis or encephalitis have a high risk of causing neurodevelopmental problems and eventually a disorder. For example, measles can progress to subacute sclerosing panencephalitis

A number of infectious diseases can be transmitted congenitally (either before or at birth), and can cause serious neurodevelopmental problems, as for example the viruses HSV, CMV, rubella (congenital rubella syndrome), Zika virus, or bacteria like Treponema pallidum in congenital syphilis, which may progress to neurosyphilis if it remains untreated. Protozoa like Plasmodium or Toxoplasma which can cause congenital toxoplasmosis with multiple cysts in the brain and other organs, leading to a variety of neurological deficits.

Some cases of schizophrenia may be related to congenital infections though the majority are of unknown causes.

Metabolic disorders

Metabolic disorders in either the mother or the child can cause neurodevelopmental disorders. Two examples are diabetes mellitus (a multifactorial disorder) and phenylketonuria (an inborn error of metabolism). Many such inherited diseases may directly affect the child's metabolism and neural development but less commonly they can indirectly affect the child during gestation. (See also teratology).

In a child, type 1 diabetes can produce neurodevelopmental damage by the effects of excess or insufficient glucose. The problems continue and may worsen throughout childhood if the diabetes is not well controlled. Type 2 diabetes may be preceded in its onset by impaired cognitive functioning.

A non-diabetic fetus can also be subjected to glucose effects if its mother has undetected gestational diabetes. Maternal diabetes causes excessive birth size, making it harder for the infant to pass through the birth canal without injury or it can directly produce early neurodevelopmental deficits. Usually the neurodevelopmental symptoms will decrease in later childhood.

Phenylketonuria, also known as PKU, can induce neurodevelopmental problems and children with PKU require a strict diet to prevent mental retardation and other disorders. In the maternal form of PKU, excessive maternal phenylalanine can be absorbed by the fetus even if the fetus has not inherited the disease. This can produce mental retardation and other disorders.

Nutrition

Nutrition disorders and nutritional deficits may cause neurodevelopmental disorders, such as spina bifida, and the rarely occurring anencephaly, both of which are neural tube defects with malformation and dysfunction of the nervous system and its supporting structures, leading to serious physical disability and emotional sequelae. The most common nutritional cause of neural tube defects is folic acid deficiency in the mother, a B vitamin usually found in fruits, vegetables, whole grains, and milk products. (Neural tube defects are also caused by medications and other environmental causes, many of which interfere with folate metabolism, thus they are considered to have multifactorial causes.) Another deficiency, iodine deficiency, produces a spectrum of neurodevelopmental disorders ranging from mild emotional disturbance to severe mental retardation.

Excesses in both maternal and infant diets may cause disorders as well, with foods or food supplements proving toxic in large amounts. For instance in 1973 K.L. Jones and D.W. Smith of the University of Washington Medical School in Seattle found a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in children of alcoholic mothers, now called fetal alcohol syndrome, It has significant symptom overlap with several other entirely unrelated neurodevelopmental disorders. It has been discovered that iron supplementation in baby formula can be linked to lowered I.Q. and other neurodevelopmental delays.

Physical trauma

CT scan showing epidural hematoma, a type of traumatic brain injury (upper left)
 
Brain trauma in the developing human is a common cause (over 400,000 injuries per year in the US alone, without clear information as to how many produce developmental sequellae) of neurodevelopmental syndromes. It may be subdivided into two major categories, congenital injury (including injury resulting from otherwise uncomplicated premature birth) and injury occurring in infancy or childhood. Common causes of congenital injury are asphyxia (obstruction of the trachea), hypoxia (lack of oxygen to the brain) and the mechanical trauma of the birth process itself.

Diagnosis

Neurodevelopmental disorders are diagnosed by evaluating the presence of characteristic symptoms or behaviors in a child, typically after a parent, guardian, teacher, or other responsible adult has raised concerns to a doctor.

Neurodevelopmental disorders may also be confirmed by genetic testing. Traditionally, disease-related genetic and genomic factors are detected by karyotype analysis, which detects clinically significant genetic abnormalities for 5% of children with a diagnosed disorder. As of 2017, chromosomal microarray analysis (CMA) was proposed to replace karyotyping because of its ability to detect smaller chromosome abnormalities and copy-number variants, leading to greater diagnostic yield in about 20% of cases. The American College of Medical Genetics and Genomics and the American Academy of Pediatrics recommend CMA as standard of care in the US.

Bombing of Dresden in World War II

From Wikipedia, the free encyclopedia
 
Bombing of Dresden
Part of strategic bombing during World War II
Bundesarchiv Bild 146-1994-041-07, Dresden, zerstörtes Stadtzentrum.jpg
Dresden after the bombing raid
Date13–15 February 1945
Location
Result
  • Strategic targets destroyed
  • Extensive German casualties
Belligerents
United Kingdom RAF
United States USAAF
Nazi Germany Luftwaffe
Strength
Casualties and losses
7 aircraft 22,700–25,000 deaths

Dresden, 1945, view from the city hall (Rathaus) over the destroyed city
 
The bombing of Dresden was a British/American aerial bombing attack on the city of Dresden, the capital of the German state of Saxony, during World War II in the European Theatre. In four raids between 13 and 15 February 1945, 722 heavy bombers of the British Royal Air Force (RAF) and 527 of the United States Army Air Forces (USAAF) dropped more than 3,900 tons of high-explosive bombs and incendiary devices on the city. The bombing and the resulting firestorm destroyed over 1,600 acres (6.5 km2) of the city centre. An estimated 22,700 to 25,000 people were killed, although larger casualty figures have been claimed. Three more USAAF air raids followed, two occurring on 2 March aimed at the city's railway marshalling yard and one smaller raid on 17 April aimed at industrial areas.

Immediate German propaganda claims following the attacks and post-war discussions on whether the attacks were justified have led to the bombing becoming one of the moral causes célèbres of the war. A 1953 United States Air Force report defended the operation as the justified bombing of a strategic target, which they noted was a major rail transport and communication centre, housing 110 factories and 50,000 workers in support of the German war effort. Several researchers claim not all of the communications infrastructure, such as the bridges, were targeted, nor were the extensive industrial areas outside the city center. Critics of the bombing have claimed that Dresden was a cultural landmark of little or no strategic significance, and that the attacks were indiscriminate area bombing and not proportionate to the military gains. Some in the German far-right refer to the bombing as a mass murder, calling it "Dresden's Holocaust of bombs".

Large variations in the claimed death toll have fuelled the controversy. In March 1945, the German government ordered its press to publish a falsified casualty figure of 200,000 for the Dresden raids, and death toll estimates as high as 500,000 have been given. The city authorities at the time estimated up to 25,000 victims, a figure that subsequent investigations supported, including a 2010 study commissioned by the city council.

Background

Image of Dresden during the 1890s. Landmarks include Dresden Frauenkirche, Augustus Bridge, and the Katholische Hofkirche.
 
A view from the town hall over the Altstadt (old town), 1910
 
Early in 1945, the German offensive known as the Battle of the Bulge had been exhausted, as was the disastrous attack by the Luftwaffe on New Year's Day involving elements of eleven combat wings of the Luftwaffe's day fighter force. The Red Army had launched their Silesian Offensives into pre-war German territory. The German army was retreating on all fronts, but still resisting strongly. On 8 February 1945, the Red Army crossed the Oder River, with positions just 70 km from Berlin. A special British Joint Intelligence Subcommittee report titled German Strategy and Capacity to Resist, prepared for Winston Churchill's eyes only, predicted that Germany might collapse as early as mid-April if the Soviets overran its eastern defences. Alternatively, the report warned that the Germans might hold out until November if they could prevent the Soviets from taking Silesia. Hence, any assistance provided to the Soviets on the Eastern Front could shorten the war.

Plans for a large and intense aerial bombing of Berlin and the other eastern cities had been discussed under the code name Operation Thunderclap in mid-1944, but had been shelved on 16 August. These were now re-examined, and the decision was made to plan a more limited operation.

On 22 January 1945, the RAF director of bomber operations, Air Commodore Sydney Bufton, sent a memorandum to the Deputy Chief of the Air Staff, Air Marshal Sir Norman Bottomley, suggesting that what appeared to be a coordinated air attack by the RAF to aid the current Soviet offensive would have a detrimental effect on German morale. On 25 January, the Joint Intelligence Committee supported the idea, as it tied in with the Ultra-based intelligence that dozens of German divisions deployed in the west were moving to reinforce the Eastern Front, and that interdiction of these troop movements should be a "high priority." Arthur Harris, AOC Bomber Command, nicknamed "Bomber" Harris in the British press, and known as an ardent supporter of area bombing, was asked for his view, and he proposed a simultaneous attack on Chemnitz, Leipzig and Dresden. That evening Churchill asked the Secretary of State for Air, Sir Archibald Sinclair, what plans had been drawn up to carry out these proposals. He passed on the request to Sir Charles Portal, the Chief of the Air Staff, who answered that "We should use available effort in one big attack on Berlin and attacks on Dresden, Leipzig, and Chemnitz, or any other cities where a severe blitz will not only cause confusion in the evacuation from the East, but will also hamper the movement of troops from the West." He mentioned that aircraft diverted to such raids should not be taken away from the current primary tasks of destroying oil production facilities, jet aircraft factories, and submarine yards.

Churchill was not satisfied with this answer and on 26 January pressed Sinclair for a plan of operations: "I asked [last night] whether Berlin, and no doubt other large cities in east Germany, should not now be considered especially attractive targets ... Pray report to me tomorrow what is going to be done".

In response to Churchill's inquiry, Sinclair approached Bottomley, who asked Harris to undertake attacks on Berlin, Dresden, Leipzig, and Chemnitz, as soon as moonlight and weather permitted, "with the particular object of exploiting the confused conditions which are likely to exist in the above mentioned cities during the successful Russian advance". This activity allowed Sinclair to inform Churchill on 27 January of the Air Staff's agreement that, "subject to the overriding claims" on other targets under the Pointblank Directive, strikes against communications in these cities to disrupt civilian evacuation from the east and troop movement from the west would be made.

On 31 January, Bottomley sent a message to Portal saying a heavy attack on Dresden and other cities "will cause great confusion in civilian evacuation from the east and hamper movement of reinforcements from other fronts". British historian Frederick Taylor mentions a further memo sent to the Chiefs of Staff Committee by Sir Douglas Evill on 1 February, in which Evill states interfering with mass civilian movements was a major, even key, factor in the decision to bomb the city centre. Attacks there, where main railway junctions, telephone systems, city administration and utilities were located, would result in "chaos." Ostensibly, Britain had learned this after the Coventry Blitz, when loss of this crucial infrastructure had supposedly longer-lasting effects than attacks on war plants.

During the Yalta Conference on 4 February, the Deputy Chief of the Soviet General Staff, General Aleksei Antonov, raised the issue of hampering the reinforcement of German troops from the western front by paralysing the junctions of Berlin and Leipzig with aerial bombardment. In response, Chief of the British Air Staff Portal, who was in Yalta, asked Bottomley to send him a list of objectives to discuss with the Soviets. Bottomley's list included oil plants, tank and aircraft factories and the cities of Berlin and Dresden. A British interpreter later claimed that Antonov and Joseph Stalin asked for the bombing of Dresden, but there is no mention of these requests in the official record of the conference and the claim was assessed as possible Cold War propaganda.

Military and industrial profile

Front lines in Europe during the Dresden bombings. White areas were held by Germany, pink ones by the Allies, and red denotes recent Allied advances around the periphery of a still largely unoccupied Germany. Grey areas were neutral.
 
Dresden was Germany's seventh-largest city and, according to the RAF at the time, the largest remaining unbombed built-up area. Taylor writes that an official 1942 guide to the city described it as "one of the foremost industrial locations of the Reich" and in 1944 the German Army High Command's Weapons Office listed 127 medium-to-large factories and workshops that were supplying the army with materiel. Nonetheless, according to some historians, the contribution of Dresden to the German war effort may not have been as significant as the planners thought.

The US Air Force Historical Division wrote a report in response to the international concern about the bombing – the report remained classified until December 1978. This said that there were 110 factories and 50,000 workers in the city supporting the German war effort at the time of the raid. According to the report, there were aircraft components factories; a poison gas factory (Chemische Fabrik Goye and Company); an anti-aircraft and field gun factory (Lehman); an optical goods factory (Zeiss Ikon AG); as well as factories producing electrical and X-ray apparatus (Koch & Sterzel [de] AG); gears and differentials (Saxoniswerke); and electric gauges (Gebrüder Bassler). It also said there were barracks, hutted camps, and a munitions storage depot.

The USAF report also states that two of Dresden's traffic routes were of military importance: north-south from Germany to Czechoslovakia, and east-west along the central European uplands. The city was at the junction of the Berlin-Prague-Vienna railway line, as well as the Munich-Breslau, and Hamburg-Leipzig lines. Colonel Harold E. Cook, a US POW held in the Friedrichstadt marshaling yard the night before the attacks, later said that "I saw with my own eyes that Dresden was an armed camp: thousands of German troops, tanks and artillery and miles of freight cars loaded with supplies supporting and transporting German logistics towards the east to meet the Russians".

An RAF memo issued to airmen on the night of the attack indicated that a secondary purpose of the raid was to "show the Russians when they arrive [at Dresden] what [the British] Bomber Command can do." The memo stated:
Dresden, the seventh largest city in Germany and not much smaller than Manchester is also the largest unbombed builtup area the enemy has got. In the midst of winter with refugees pouring westward and troops to be rested, roofs are at a premium, not only to give shelter to workers, refugees, and troops alike, but to house the administrative services displaced from other areas. At one time well known for its china, Dresden has developed into an industrial city of first-class importance ... The intentions of the attack are to hit the enemy where he will feel it most, behind an already partially collapsed front ... and incidentally to show the Russians when they arrive what Bomber Command can do.
In the raid, major industrial areas in the suburbs, which stretched for miles, were not targeted. According to historian Donald Miller, "the economic disruption would have been far greater had Bomber Command targeted the suburban areas where most of Dresden's manufacturing might was concentrated".

The attacks

Night of 13/14 February

Mosquito marker planes dropped the target indicators, which glowed red and green to guide the bombers.
 
The Dresden attack was to have begun with a USAAF Eighth Air Force bombing raid on 13 February 1945. The Eighth Air Force had already bombed the railway yards near the centre of the city twice in daytime raids: once on 7 October 1944 with 70 tons of high-explosive bombs killing more than 400, then again with 133 bombers on 16 January 1945, dropping 279 tons of high-explosives and 41 tons of incendiaries.

On 13 February 1945, bad weather over Europe prevented any USAAF operations, and it was left to RAF Bomber Command to carry out the first raid. It had been decided that the raid would be a double strike, in which a second wave of bombers would attack three hours after the first, just as the rescue teams were trying to put out the fires. Other raids were carried out that night to confuse German air defences. Three hundred and sixty heavy bombers (Lancasters and Halifaxes) bombed a synthetic oil plant in Böhlen, 60 miles (97 km) from Dresden, while de Havilland Mosquito medium bombers attacked Magdeburg, Bonn, Misburg near Hanover and Nuremberg.

When Polish crews of the designated squadrons were preparing for the mission, the terms of the Yalta agreement were made known to them. There was a huge uproar, since the Yalta agreement handed parts of Poland over to the Soviet Union. There was talk of mutiny among the Polish pilots, and their British officers removed their side arms. The Polish Government ordered the pilots to follow their orders and fly their missions over Dresden, which they did.

A Lancaster releases the main part of its load, a 4,000 lb (1,800 kg) HC "cookie" and 108 30 lb (14 kg) "J" incendiaries. (over Duisburg 1944)
 
The first of the British aircraft took off at around 17:20 hours CET for the 700-mile (1,100 km) journey. This was a group of Lancasters from Bomber Command's 83 Squadron, No. 5 Group, acting as the Pathfinders, or flare force, whose job it was to find Dresden and drop magnesium parachute flares, known to the Germans as "Christmas trees", to light up the area for the bombers. The next set of aircraft to leave England were twin-engined Mosquito marker planes, which would identify target areas and drop 1,000-pound target indicators (TIs)" that created a red glow for the bombers to aim at. The attack was to centre on the Ostragehege sports stadium, next to the city's medieval Altstadt (old town), with its congested and highly combustible timbered buildings.

The main bomber force, called Plate Rack, took off shortly after the Pathfinders. This group of 254 Lancasters carried 500 tons of high explosives and 375 tons of incendiaries ("fire bombs"). There were 200,000 incendiaries in all, with the high-explosive bombs ranging in weight from 500 pounds to 4,000 pounds—the so-called two-ton cookies, also known as "blockbusters," because they could destroy an entire large building or street. The high explosives were intended to rupture water mains and blow off roofs, doors, and windows to create an air flow to feed the fires caused by the incendiaries that followed.

The Lancasters crossed into French airspace near the Somme, then into Germany just north of Cologne. At 22:00 hours, the force heading for Böhlen split away from Plate Rack, which turned south east toward the Elbe. By this time, ten of the Lancasters were out of service, leaving 244 to continue to Dresden.

The sirens started sounding in Dresden at 21:51 (CET). Wing Commander Maurice Smith, flying in a Mosquito, gave the order to the Lancasters: "Controller to Plate Rack Force: Come in and bomb glow of red target indicators as planned. Bomb the glow of red TIs as planned." The first bombs were released at 22:13, the last at 22:28, the Lancasters delivering 881.1 tons of bombs, 57% high explosive, 43% incendiaries. The fan-shaped area that was bombed was 1.25 miles (2.01 km) long, and at its extreme about 1.75 miles (2.82 km) wide. The shape and total devastation of the area was created by the bombers of No. 5 Group flying over the head of the fan (Ostragehege stadium) on prearranged compass bearings and releasing their bombs at different prearranged times.

The second attack, three hours later, was by Lancaster aircraft of 1, 3, 6 and 8 Groups, 8 Group being the Pathfinders. By now, the thousands of fires from the burning city could be seen more than 60 miles (97 km) away on the ground, and 500 miles (800 km) away in the air, with smoke rising to 15,000 feet (4,600 m). The Pathfinders therefore decided to expand the target, dropping flares on either side of the firestorm, including the Hauptbahnhof, the main train station, and the Großer Garten, a large park, both of which had escaped damage during the first raid. The German sirens sounded again at 01:05, but as there was practically no electricity, these were small hand-held sirens that were heard within only a block. Between 01:21 and 01:45, 529 Lancasters dropped more than 1,800 tons of bombs.

14–15 February

On the morning of 14 February 431 bombers of the 1st Bombardment Division of the United States VIII Bomber Command were scheduled to bomb Dresden at around midday, and the 3rd Bombardment Division were to follow the 1st and bomb Chemnitz, while the 2nd Bombardment Division would bomb a synthetic oil plant in Magdeburg. The bomber groups would be protected by the 784 North American P-51 Mustangs of VIII Fighter Command, which meant that there would be almost 2,100 aircraft of the United States Eighth Air Force over Saxony during 14 February.

There is some confusion in the primary sources over what was the target in Dresden, whether it was the marshalling yards near the centre or the centre of the built up urban area. The report by the 1st Bombardment Division's commander to his commander states that the targeting sequence was the centre of the built up area in Dresden, if the weather was clear. If clouds obscured Dresden but Chemnitz was clear, Chemnitz was the target. If both were obscured, they would bomb the centre of Dresden using H2X radar. The mix of bombs for the Dresden raid was about 40% incendiaries—much closer to the RAF city-busting mix than that which the USAAF usually used in precision bombardment. Taylor compares this 40% mix with the raid on Berlin on 3 February, where the ratio was 10% incendiaries. This was a common mix when the USAAF anticipated cloudy conditions over the target.

316 B-17 Flying Fortresses bombed Dresden, dropping 771 tons of bombs. The rest misidentified their targets. Sixty bombed Prague, dropping 153 tons of bombs on the Czech city, while others bombed Brux and Pilsen. The 379th bombardment group started to bomb Dresden at 12:17, aiming at marshalling yards in the Friedrichstadt district west of the city centre, as the area was not obscured by smoke and cloud. The 303rd group arrived over Dresden 2 minutes after the 379th found that their view was obscured by clouds, so they bombed Dresden using H2X radar to target this location. The groups that followed the 303rd, (92nd, 306th, 379th, 384th and 457th) also found Dresden obscured by clouds, and they too used H2X to locate the target. H2X aiming caused the groups to bomb with a wide dispersal over the Dresden area. The last group to bomb Dresden was the 306th, and they had finished by 12:30.

Strafing of civilians has become a traditional part of the oral history of the raids, since a March 1945 article in the Nazi-run weekly newspaper Das Reich claimed that this had occurred. Historian Götz Bergander, who was an eyewitness of the raids, found no reports on strafing for 13–15 February, neither by any of the pilots nor by the German military and police. He asserted in Dresden im Luftkrieg (1977) that only a few tales of civilians being strafed were reliable in details, and all were related to the daylight attack on 14 February. He concluded that some memory of eyewitnesses was real, but that it had misinterpreted the firing in a dogfight as being deliberately aimed at people on the ground. In 2000, historian Helmut Schnatz found that there was an explicit order to RAF pilots not to strafe civilians on the way back from Dresden. He also reconstructed timelines with the result that strafing would have been almost impossible, due to lack of time and fuel. Frederick Taylor in Dresden (2004), basing most of his analysis on the work of Bergander and Schnatz, concludes that no strafing took place, although some stray bullets from an aerial dog fight may have hit the ground and been mistaken for strafing by those in the vicinity. The official historical commission collected 103 detailed eyewitness accounts and let the local bomb disposal services search according to their assertions. They found no bullets or fragments that would have been used by planes of the Dresden raids.

On 15 February, the 1st Bombardment Division's primary target—the Böhlen synthetic oil plant near Leipzig—was obscured by cloud, so the Division's groups diverted to their secondary target, Dresden. Dresden was also obscured by clouds, so the groups targeted the city using H2X. The first group to arrive over the target was the 401st, but it missed the city centre and bombed Dresden's southeastern suburbs, with bombs also landing on the nearby towns of Meissen and Pirna. The other groups all bombed Dresden between 12:00 and 12:10. They failed to hit the marshalling yards in the Friedrichstadt district and, as on the previous raid, their ordnance was scattered over a wide area.

German defensive action

Dresden's air defences had been depleted by the need for more weaponry to fight the Red Army, and the city lost its last heavy flak battery in January 1945. By this point in the war, the Luftwaffe was seriously hampered by a shortage of both pilots and aircraft fuel; the German radar system had also been degraded, lowering the warning time to prepare for air attacks. The RAF also had an advantage over the Germans in the field of electronic radar countermeasures.

Of a total of 796 British bombers that participated in the raid, six bombers were lost, three of those hit by bombs dropped by aircraft flying over them. On the following day, a single US bomber was shot down, as the large escort force was able to prevent Luftwaffe day fighters from disrupting the attack.

On the ground

Bodies of civilian casualties
It is not possible to describe! Explosion after explosion. It was beyond belief, worse than the blackest nightmare. So many people were horribly burnt and injured. It became more and more difficult to breathe. It was dark and all of us tried to leave this cellar with inconceivable panic. Dead and dying people were trampled upon, luggage was left or snatched up out of our hands by rescuers. The basket with our twins covered with wet cloths was snatched up out of my mother's hands and we were pushed upstairs by the people behind us. We saw the burning street, the falling ruins and the terrible firestorm. My mother covered us with wet blankets and coats she found in a water tub.
We saw terrible things: cremated adults shrunk to the size of small children, pieces of arms and legs, dead people, whole families burnt to death, burning people ran to and fro, burnt coaches filled with civilian refugees, dead rescuers and soldiers, many were calling and looking for their children and families, and fire everywhere, everywhere fire, and all the time the hot wind of the firestorm threw people back into the burning houses they were trying to escape from.
I cannot forget these terrible details. I can never forget them.
— Lothar Metzger, survivor.
The sirens had started sounding in Dresden at 21:51 (CET). Frederick Taylor writes that the Germans could see that a large enemy bomber formation—or what they called "ein dicker Hund" (lit: a fat dog, a "major thing")—was approaching somewhere in the east. At 21:39, the Reich Air Defence Leadership issued an enemy aircraft warning for Dresden, although, at that point, it was thought Leipzig might be the target. At 21:59, the Local Air Raid Leadership confirmed that the bombers were in the area of Dresden-Pirna. Taylor writes the city was largely undefended; a night fighter force of ten Messerschmitt Bf 110Gs at Klotzsche airfield was scrambled, but it took them half an hour to get into an attack position. At 22:03, the Local Air Raid Leadership issued the first definitive warning: "Warning! Warning! Warning! The lead aircraft of the major enemy bomber forces have changed course and are now approaching the city area".

Over ninety percent of the city centre was destroyed.
To my left I suddenly see a woman. I can see her to this day and shall never forget it. She carries a bundle in her arms. It is a baby. She runs, she falls, and the child flies in an arc into the fire.
Suddenly, I saw people again, right in front of me. They scream and gesticulate with their hands, and then—to my utter horror and amazement—I see how one after the other they simply seem to let themselves drop to the ground. (Today I know that these unfortunate people were the victims of lack of oxygen). They fainted and then burnt to cinders.
Insane fear grips me and from then on I repeat one simple sentence to myself continuously: "I don't want to burn to death". I do not know how many people I fell over. I know only one thing: that I must not burn.
— Margaret Freyer, survivor.
Frauenkirche ruins with a figure of Martin Luther that survived the bombings
 
There were very few public air raid shelters—the largest, underneath the main railway station, was housing 6,000 refugees. As a result, most people took shelter in their cellars, but one of the air raid precautions the city had taken was to remove the thick cellar walls between rows of buildings, and replace them with thin partitions that could be knocked through in an emergency. The idea was that, as one building collapsed or filled with smoke, those using the basement as a shelter could knock the walls down and run into adjoining buildings. With the city on fire everywhere, those fleeing from one burning cellar simply ran into another, with the result that thousands of bodies were found piled up in houses at the end of city blocks.

Body of a woman who died in an air-raid shelter
 
A Dresden police report written shortly after the attacks reported that the old town and the inner eastern suburbs had been engulfed in a single fire that had destroyed almost 12,000 dwellings. The same report said that the raids had destroyed 24 banks, 26 insurance buildings, 31 stores and retail houses, 640 shops, 64 warehouses, 2 market halls, 31 large hotels, 26 public houses, 63 administrative buildings, 3 theatres, 18 cinemas, 11 churches, 6 chapels; 5 other cultural buildings, 19 hospitals including auxiliary, overflow hospitals, and private clinics, 39 schools, 5 consulates, the zoo, the waterworks, the railways, 19 postal facilities, 4 tram facilities, and 19 ships and barges. The Wehrmacht's main command post in the Taschenbergpalais, 19 military hospitals and a number of less significant military facilities were also destroyed. Almost 200 factories were damaged, 136 seriously damaged (including several of the Zeiss Ikon precision optical engineering works), 28 with medium to serious damage, and 35 with light damage.

An RAF assessment showed that 23 percent of the industrial buildings, and 56 percent of the non-industrial buildings, not counting residential buildings, had been seriously damaged. Around 78,000 dwellings had been completely destroyed; 27,700 were uninhabitable, and 64,500 damaged, but readily repairable.

During his post-war interrogation, Albert Speer, Minister of Armaments and War Production for the Third Reich, indicated that Dresden's industrial recovery from the bombings was rapid.

Fatalities

A pile of bodies before cremation
 
According to official German report Tagesbefehl (Order of the Day) no. 47 ("TB47") issued on 22 March the number of dead recovered by that date was 20,204, including 6,865 who were cremated on the Altmarkt square, and they expected that the total number of deaths would be about 25,000. Another report on 3 April put the number of corpses recovered at 22,096. Three municipal and 17 rural cemeteries outside Dresden recorded up to 30 April 1945 a total of at least 21,895 buried bodies of the Dresden raids, including those cremated on the Altmarkt.

Between 100,000 and 200,000 refugees fleeing westwards from advancing Soviet forces were in the city at the time of the bombing. Exact figures are unknown, but reliable estimates were calculated based on train arrivals, foot traffic, and the extent to which emergency accommodation had to be organised. The city authorities did not distinguish between residents and refugees when establishing casualty numbers and "took great pains to count all the dead, identified and unidentified". This was largely achievable because most of the dead succumbed to suffocation; in only four places were recovered remains so badly burned that it proved impossible to ascertain the number of victims. The uncertainty introduced by this is thought to amount to a total of no more than 100. 35,000 people were registered with the authorities as missing after the raids, around 10,000 of whom were later found alive.

A further 1,858 bodies were discovered during the reconstruction of Dresden between the end of the war and 1966. Since 1989, despite extensive excavation for new buildings, no war-related bodies have been found. Seeking to establish a definitive casualty figure, in part to address propagandisation of the bombing by far-right groups, the Dresden city council in 2005 authorized an independent Historian's Commission (Historikerkommission) to conduct a new, thorough investigation, collecting and evaluating available sources. The results were published in 2010 and stated that a minimum of 22,700 and a maximum of 25,000 people were killed.

Wartime political responses

German

Development of a German political response to the raid took several turns. Initially, some of the leadership, especially Robert Ley and Joseph Goebbels, wanted to use it as a pretext for abandonment of the Geneva Conventions on the Western Front. In the end, the only political action the German government took was to exploit it for propaganda purposes. Goebbels is reported to have wept with rage for twenty minutes after he heard the news of the catastrophe, before launching into a bitter attack on Hermann Göring, the commander of the Luftwaffe: "If I had the power I would drag this cowardly good-for-nothing, this Reich marshal, before a court. ... How much guilt does this parasite not bear for all this, which we owe to his indolence and love of his own comforts. ...".

On 16 February, the Propaganda Ministry issued a press release that stated that Dresden had no war industries; it was a city of culture.

On 25 February, a new leaflet with photographs of two burned children was released under the title "Dresden—Massacre of Refugees," stating that 200,000 had died. Since no official estimate had been developed, the numbers were speculative, but newspapers such as the Stockholm Svenska Morgonbladet used phrases such as "privately from Berlin," to explain where they had obtained the figures. Frederick Taylor states that "there is good reason to believe that later in March copies of—or extracts from—[an official police report] were leaked to the neutral press by Goebbels's Propaganda Ministry ... doctored with an extra zero to make [the total dead from the raid] 202,040". On 4 March, Das Reich, a weekly newspaper founded by Goebbels, published a lengthy article emphasizing the suffering and destruction of a cultural icon, without mentioning any damage the attacks had caused to the German war effort.

Taylor writes that this propaganda was effective, as it not only influenced attitudes in neutral countries at the time, but also reached the British House of Commons when Richard Stokes, a Labour Party Member of Parliament (MP), a long term opponent of area-bombing, quoted information from the German Press Agency (controlled by the Propaganda Ministry). It was Stokes' questions in the House of Commons that were in large part responsible for the shift in the UK against this type of raid. Taylor suggests that, although the destruction of Dresden would have affected people's support for the Allies regardless of German propaganda, at least some of the outrage did depend on Goebbels' massaging of the casualty figures.

British

British Prime Minister Winston Churchill was ultimately responsible for the bombing, even though he later tried to distance himself from it.
 
The destruction of the city provoked unease in intellectual circles in Britain. According to Max Hastings, by February 1945, attacks upon German cities had become largely irrelevant to the outcome of the war and the name of Dresden resonated with cultured people all over Europe—"the home of so much charm and beauty, a refuge for Trollope's heroines, a landmark of the Grand Tour." He writes that the bombing was the first time the public in Allied countries seriously questioned the military actions used to defeat the Germans.

The unease was made worse by an Associated Press story that the Allies had resorted to terror bombing. At a press briefing held by the Supreme Headquarters Allied Expeditionary Force two days after the raids, British Air Commodore Colin McKay Grierson told journalists:
First of all they (Dresden and similar towns) are the centres to which evacuees are being moved. They are centres of communications through which traffic is moving across to the Russian Front, and from the Western Front to the East, and they are sufficiently close to the Russian Front for the Russians to continue the successful prosecution of their battle. I think these three reasons probably cover the bombing.
One of the journalists asked whether the principal aim of bombing Dresden would be to cause confusion among the refugees or to blast communications carrying military supplies. Grierson answered that the primary aim was to attack communications to prevent the Germans from moving military supplies, and to stop movement in all directions if possible. He then added in an offhand remark that the raid also helped destroy "what is left of German morale." Howard Cowan, an Associated Press war correspondent, subsequently filed a story saying that the Allies had resorted to terror bombing. There were follow-up newspaper editorials on the issue and a longtime opponent of strategic bombing, Richard Stokes MP, asked questions in the House of Commons on 6 March.
 
Churchill subsequently distanced himself from the bombing. On 28 March, in a memo sent by telegram to General Ismay for the British Chiefs of Staff and the Chief of the Air Staff, he wrote:
It seems to me that the moment has come when the question of bombing of German cities simply for the sake of increasing the terror, though under other pretexts, should be reviewed. Otherwise we shall come into control of an utterly ruined land ... The destruction of Dresden remains a serious query against the conduct of Allied bombing. I am of the opinion that military objectives must henceforward be more strictly studied in our own interests than that of the enemy.
The Foreign Secretary has spoken to me on this subject, and I feel the need for more precise concentration upon military objectives such as oil and communications behind the immediate battle-zone, rather than on mere acts of terror and wanton destruction, however impressive.
Air Chief Marshal Arthur Harris, head of RAF Bomber Command, strongly objected to Churchill's comparison of the raid to an "act of terror," a comment Churchill withdrew in the face of Harris's protest.
 
Having been given a paraphrased version of Churchill's memo by Bottomley, on 29 March, Air Chief Marshal Arthur Harris wrote to the Air Ministry:
I ... assume that the view under consideration is something like this: no doubt in the past we were justified in attacking German cities. But to do so was always repugnant and now that the Germans are beaten anyway we can properly abstain from proceeding with these attacks. This is a doctrine to which I could never subscribe. Attacks on cities like any other act of war are intolerable unless they are strategically justified. But they are strategically justified in so far as they tend to shorten the war and preserve the lives of Allied soldiers. To my mind we have absolutely no right to give them up unless it is certain that they will not have this effect. I do not personally regard the whole of the remaining cities of Germany as worth the bones of one British Grenadier.
The feeling, such as there is, over Dresden, could be easily explained by any psychiatrist. It is connected with German bands and Dresden shepherdesses. Actually Dresden was a mass of munitions works, an intact government centre, and a key transportation point to the East. It is now none of these things.
The phrase "worth the bones of one British grenadier" echoed a famous sentence used by Otto von Bismarck: "The whole of the Balkans is not worth the bones of a single Pomeranian grenadier". Under pressure from the Chiefs of Staff and in response to the views expressed by Portal and Harris among others, Churchill withdrew his memo and issued a new one. This was completed on 1 April 1945:
It seems to me that the moment has come when the question of the so called 'area-bombing' of German cities should be reviewed from the point of view of our own interests. If we come into control of an entirely ruined land, there will be a great shortage of accommodation for ourselves and our allies. ... We must see to it that our attacks do no more harm to ourselves in the long run than they do to the enemy's war effort.

Reconstruction and reconciliation

The Semperoper, the Dresden state opera house, in 2007. It was destroyed during the bombing, and was rebuilt in 1985. It opened exactly 40 years after the bombing on 13 February with the same opera that was last performed before its destruction, Der Freischütz by Carl Maria von Weber.
 
After the war, and again after German reunification, great efforts were made to rebuild some of Dresden's former landmarks, such as the Frauenkirche, the Semperoper (the Saxony state opera house) and the Zwinger Palace (the latter two were rebuilt before reunification). 

In 1956, Dresden entered a twin-town relationship with Coventry. As a centre of military and munitions production, Coventry suffered some of the worst attacks on any British city at the hands of the Luftwaffe during the Coventry Blitzes of 1940 and 1941, which killed over 1,200 civilians and destroyed its cathedral.

The ruins of the Frauenkirche in 1991
 
In 1990, after the fall of the Berlin Wall, a group of prominent Dresdeners formed an international appeal known as the "Call from Dresden" to request help in rebuilding the Lutheran Frauenkirche, the destruction of which had over the years become a symbol of the bombing. The baroque Church of Our Lady (completed in 1743) had initially appeared to survive the raids, but collapsed a few days later, and the ruins were left in place by later Communist governments as an anti-war memorial. 

The reconstructed Frauenkirche is again a part of the baroque skyline of Dresden.
 
A British charity, the Dresden Trust, was formed in 1993 to raise funds in response to the call for help, raising £600,000 from 2,000 people and 100 companies and trusts in Britain. One of the gifts they made to the project was an eight-metre high orb and cross made in London by goldsmiths Gant MacDonald, using medieval nails recovered from the ruins of the roof of Coventry Cathedral, and crafted in part by Alan Smith, the son of a pilot who took part in the raid.

The new Frauenkirche was reconstructed over seven years by architects using 3D computer technology to analyse old photographs and every piece of rubble that had been kept and was formally consecrated on 30 October 2005, in a service attended by some 1,800 guests, including Germany's president, Horst Köhler; previous and current chancellors, Gerhard Schröder and Angela Merkel; and the Duke of Kent.

Post-war debate

Memorial to the victims of the bombing of Dresden
 
The bombing of Dresden remains controversial and is subject to an ongoing debate by historians and scholars regarding the moral and military justifications surrounding the event. British historian Frederick Taylor wrote of the attacks: "The destruction of Dresden has an epically tragic quality to it. It was a wonderfully beautiful city and a symbol of baroque humanism and all that was best in Germany. It also contained all of the worst from Germany during the Nazi period. In that sense it is an absolutely exemplary tragedy for the horrors of 20th century warfare and a symbol of destruction".

Several factors have made the bombing a unique point of contention and debate. First among these are the Nazi government's exaggerated claims immediately afterwards, which drew upon the beauty of the city, its importance as a cultural icon; the deliberate creation of a firestorm; the number of victims; the extent to which it was a necessary military target; and the fact that it was attacked toward the end of the war, raising the question of whether the bombing was needed to hasten the end.

Legal considerations

The Hague Conventions, addressing the codes of wartime conduct on land and at sea, were adopted before the rise of air power. Despite repeated diplomatic attempts to update international humanitarian law to include aerial warfare, it was not updated before the outbreak of World War II. The absence of positive international humanitarian law does not mean that the laws of war did not cover aerial warfare, but there was no general agreement of how to interpret those laws.

Falsification of evidence

The bombing of Dresden has been used by Holocaust deniers and pro-Nazi polemicists—most notably by the British writer David Irving in his book The Destruction of Dresden—in an attempt to establish a moral equivalence between the war crimes committed by the Nazi government and the killing of German civilians by Allied bombing raids. As such, "grossly inflated" casualty figures have been promulgated over the years, many based on a figure of over 200,000 deaths quoted in a forged version of the casualty report, Tagesbefehl No. 47, that originated with Hitler's Reich Minister of Propaganda Joseph Goebbels.

Marshall inquiry

An inquiry conducted at the behest of U.S. Army Chief of Staff, General George C. Marshall, stated the raid was justified by the available intelligence. The inquiry declared the elimination of the German ability to reinforce a counter-attack against Marshal Konev's extended line or, alternatively, to retreat and regroup using Dresden as a base of operations, were important military objectives. As Dresden had been largely untouched during the war due to its location, it was one of the few remaining functional rail and communications centres. A secondary objective was to disrupt the industrial use of Dresden for munitions manufacture, which American intelligence believed was the case. The shock to military planners and to the Allied civilian populations of the German counterattack known as the Battle of the Bulge had ended speculation that the war was almost over, and may have contributed to the decision to continue with the aerial bombardment of German cities.

The inquiry concluded that by the presence of active German military units nearby, and the presence of fighters and anti-aircraft within an effective range, Dresden qualified as "defended". By this stage in the war both the British and the Germans had integrated air defences at the national level. The German national air-defence system could be used to argue—as the tribunal did—that no German city was "undefended". 

Marshall's tribunal declared that no extraordinary decision was made to single out Dresden (e.g. to take advantage of the large number of refugees, or purposely terrorize the German populace). It was argued that the intent of area bombing was to disrupt communications and destroy industrial production. The American inquiry established that the Soviets, pursuant to allied agreements for the United States and the United Kingdom to provide air support for the Soviet offensive toward Berlin, had requested area bombing of Dresden to prevent a counterattack through Dresden, or the use of Dresden as a regrouping point after a strategic retreat.

U.S. Air Force Historical Division report

A U.S. Air Force table showing the tonnage of bombs dropped by the Allies on Germany's seven largest cities during the war
City Population
(1939)
Tonnage
American British Total
Berlin 4,339,000 22,090 45,517 67,607
Hamburg 1,129,000 17,104 22,583 39,687
Munich 841,000 11,471 7,858 19,329
Cologne 772,000 10,211 34,712 44,923
Leipzig 707,000 5,410 6,206 11,616
Essen 667,000 1,518 36,420 37,938
Dresden 642,000 4,441 2,659 7,100
A report by the U.S. Air Force Historical Division (USAFHD) analyzed the circumstances of the raid and concluded that it was militarily necessary and justified, based on the following points:
  1. The raid had legitimate military ends, brought about by exigent military circumstances.
  2. Military units and anti-aircraft defences were sufficiently close that it was not valid to consider the city "undefended."
  3. The raid did not use extraordinary means but was comparable to other raids used against comparable targets.
  4. The raid was carried out through the normal chain of command, pursuant to directives and agreements then in force.
  5. The raid achieved the military objective, without excessive loss of civilian life.
The first point regarding the legitimacy of the raid depends on two claims: first, that the railyards subjected to American precision bombing were an important logistical target, and that the city was also an important industrial centre. Even after the main firebombing, there were two further raids on the Dresden railway yards by the USAAF. The first was on 2 March 1945, by 406 B-17s, which dropped 940 tons of high-explosive bombs and 141 tons of incendiaries. The second was on 17 April, when 580 B-17s dropped 1,554 tons of high-explosive bombs and 165 tons of incendiaries.

As far as Dresden being a militarily significant industrial centre, an official 1942 guide described the German city as "... one of the foremost industrial locations of the Reich," and in 1944, the German Army High Command's Weapons Office listed 127 medium-to-large factories and workshops that supplied materiel to the military. Dresden was the seventh largest German city, and by far the largest un-bombed built-up area left, and thus was contributing to the defence of Germany itself.

According to the USAFHD, there were 110 factories and 50,000 workers supporting the German war effort in Dresden at the time of the raid. These factories manufactured fuses and bombsights (at Zeiss Ikon A.G.), aircraft components, anti-aircraft guns, field guns, and small arms, poison gas, gears and differentials, electrical and X-ray apparatus, electric gauges, gas masks, Junkers aircraft engines, and Messerschmitt fighter cockpit parts.

The second of the five points addresses the prohibition in the Hague Conventions, of "attack or bombardment" of "undefended" towns. The USAFHD report states that Dresden was protected by anti-aircraft defences, antiaircraft guns, and searchlights, under the Combined Dresden (Corps Area IV) and Berlin (Corps Area III) Luftwaffe Administration Commands.

The third and fourth points say that the size of the Dresden raid—in terms of numbers, types of bombs and the means of delivery—were commensurate with the military objective and similar to other Allied bombings. On 23 February 1945, the Allies bombed Pforzheim and caused an estimated 20,000 civilian fatalities; the most devastating raid on any city was on Tokyo on 9–10 March (the Meetinghouse raid) caused over 100,000 civilian casualties. The tonnage and types of bombs listed in the service records of the Dresden raid were comparable to (or less than) throw weights of bombs dropped in other air attacks carried out in 1945. In the case of Dresden, as in many other similar attacks, the hour break in between the RAF raids was a deliberate ploy to attack the fire fighters, medical teams, and military units.

In late July 1943, the city of Hamburg was bombed in Operation Gomorrah by combined RAF and USAAF strategic bomber forces. Four major raids were carried out in the span of 10 days, of which the most notable, on 27–28 July, created a devastating firestorm effect similar to Dresden's, killing at least 45,000 people. Two-thirds of the remaining population reportedly fled the city after the raids.

The fifth point is that the firebombing achieved the intended effect of disabling the industry in Dresden. It was estimated that at least 23% of the city's industrial buildings were destroyed or severely damaged. The damage to other infrastructure and communications was immense, which would have severely limited the potential use of Dresden to stop the Soviet advance. The report concludes with:
The specific forces and means employed in the Dresden bombings were in keeping with the forces and means employed by the Allies in other aerial attacks on comparable targets in Germany. The Dresden bombings achieved the strategic objectives that underlay the attack and were of mutual importance to the Allies and the Russians.

Arguments against justification

The Zwinger Palace in 1900

Military reasons

The journalist Alexander McKee cast doubt on the meaningfulness of the list of targets mentioned in the 1953 USAF report, pointing out that the military barracks listed as a target were a long way out of the city and were not in fact targeted during the raid. The "hutted camps" mentioned in the report as military targets were also not military but were camps for refugees. It is also stated that the important Autobahn bridge to the west of the city was not targeted or attacked, and that no railway stations were on the British target maps, nor any bridges, such as the railway bridge spanning the Elbe River. Commenting on this, McKee says: "The standard whitewash gambit, both British and American, is to mention that Dresden contained targets X, Y and Z, and to let the innocent reader assume that these targets were attacked, whereas in fact the bombing plan totally omitted them and thus, except for one or two mere accidents, they escaped". McKee further asserts "The bomber commanders were not really interested in any purely military or economic targets, which was just as well, for they knew very little about Dresden; the RAF even lacked proper maps of the city. What they were looking for was a big built up area which they could burn, and that Dresden possessed in full measure."

According to the historian Sönke Neitzel, "it is difficult to find any evidence in German documents that the destruction of Dresden had any consequences worth mentioning on the Eastern Front. The industrial plants of Dresden played no significant role in German industry at this stage in the war". Wing Commander H. R. Allen said, "The final phase of Bomber Command's operations was far and away the worst. Traditional British chivalry and the use of minimum force in war was to become a mockery and the outrages perpetrated by the bombers will be remembered a thousand years hence".

A memorial at cemetery Heidefriedhof in Dresden. It reads: "Wieviele starben? Wer kennt die Zahl? An deinen Wunden sieht man die Qual der Namenlosen, die hier verbrannt, im Höllenfeuer aus Menschenhand." ("How many died? Who knows the count? In your wounds one sees the agony of the nameless, who in here were conflagrated, in the hellfire made by hands of man.")
Military facilities in the north
The Albertstadt, in the north of Dresden, had remarkable military facilities that the bombings failed to hit. Today they are officer's schools ("Offiziersschule des Heeres") for the Bundeswehr and its military history museum (from prehistoric to modern times).

As an immoral act, but not a war crime

... ever since the deliberate mass bombing of civilians in the second world war, and as a direct response to it, the international community has outlawed the practice. It first tried to do so in the Fourth Geneva Convention of 1949, but the UK and the US would not agree, since to do so would have been an admission of guilt for their systematic "area bombing" of German and Japanese civilians.
Frederick Taylor told Der Spiegel, "I personally find the attack on Dresden horrific. It was overdone, it was excessive and is to be regretted enormously," but, "A war crime is a very specific thing which international lawyers argue about all the time and I would not be prepared to commit myself nor do I see why I should. I'm a historian." Similarly, British philosopher A. C. Grayling has described British area bombardment as an "immoral act" and "moral crime" because "destroying everything ... contravenes every moral and humanitarian principle debated in connection with the just conduct of war," but, "It is not strictly correct to describe area bombing as a 'war crime'."

As a war crime

Though no one involved in the bombing of Dresden was ever charged with a war crime, some hold the opinion that the bombing was one. 

According to Dr. Gregory Stanton, lawyer and president of Genocide Watch:
... every human being having the capacity for both good and evil. The Nazi Holocaust was among the most evil genocides in history. But the Allies' firebombing of Dresden and nuclear destruction of Hiroshima and Nagasaki were also war crimes – and as Leo Kuper and Eric Markusen have argued, also acts of genocide. We are all capable of evil and must be restrained by law from committing it.
Historian Donald Bloxham states, "The bombing of Dresden on 13–14 February 1945 was a war crime". He further argues there was a strong prima facie case for trying Winston Churchill among others and a theoretical case Churchill could have been found guilty. "This should be a sobering thought. If, however it is also a startling one, this is probably less the result of widespread understanding of the nuance of international law and more because in the popular mind 'war criminal', like 'paedophile' or 'terrorist', has developed into a moral rather than a legal categorisation".

German author Günter Grass is one of several intellectuals and commentators who have also called the bombing a war crime.

Proponents of this position argue that the devastation from firebombing was greater than anything that could be justified by military necessity alone, and this establishes a prima facie case. The Allies were aware of the effects of firebombing, as British cities had been subject to them during the Blitz. Proponents disagree that Dresden had a military garrison and claim that most of the industry was in the outskirts and not in the targeted city centre, and that the cultural significance of the city should have precluded the Allies from bombing it. 

British historian Antony Beevor wrote that Dresden was considered relatively safe, having been spared previous RAF night attacks, and that at the time of the raids there were up to 300,000 refugees in the area seeking sanctuary from the advancing Red Army from the Eastern Front. In Fire Sites, German historian Jörg Friedrich says that the RAF's bombing campaign against German cities in the last months of the war served no military purpose. He claims that Winston Churchill's decision to bomb a shattered Germany between January and May 1945 was a war crime. According to him, 600,000 civilians died during the allied bombing of German cities, including 72,000 children. Some 45,000 people died on one night during the firestorms that engulfed Hamburg in July 1943.

Political response in Germany

Banner expressing support for Arthur Harris and the Allied fight against fascism
 
Far-right politicians in Germany have sparked a great deal of controversy by promoting the term "Bombenholocaust" ("holocaust by bomb") to describe the raids. Der Spiegel writes that, for decades, the Communist government of East Germany promoted the bombing as an example of "Anglo-American terror," and now the same rhetoric is being used by the far right. An example can be found in the extremist nationalist party Nationaldemokratische Partei Deutschlands (NPD). A party's representative, Jürgen Gansel, described the Dresden raids as "mass murder," and "Dresden's holocaust of bombs". This provoked an outrage in the German parliament and triggered responses from the media. Prosecutors said that it was illegal to call the bombing a holocaust. In 2010, several demonstrations by organizations opposing the far-right blocked a demonstration of far-right organizations

Phrases like "Bomber-Harris, do it again!", "Bomber-Harris Superstar – Thanks from the red Antifa", and "Deutsche Täter sind keine Opfer!" ("German perpetrators are no victims!") are popular slogans among the so-called "Anti-Germans"—a small radical left-wing political movement in Germany and Austria. In 1995, the fiftieth anniversary of the bombing, Anti-Germans praised the bombing on the grounds that so many of the city's civilians had supported Nazism. Similar rallies take place every year.

In art and popular culture

Kurt Vonnegut

Kurt Vonnegut's novel Slaughterhouse-Five or The Children's Crusade: A Duty-Dance with Death (1969) used some elements from his experiences as a prisoner of war at Dresden during the bombing. His account relates that over 135,000 were killed during the firebombings. Vonnegut recalled "utter destruction" and "carnage unfathomable." The Germans put him and other POWs to work gathering bodies for mass burial. "But there were too many corpses to bury. So instead the Nazis sent in troops with flamethrowers. All these civilians' remains were burned to ashes".

In the special introduction to the 1976 Franklin Library edition of the novel, he wrote:
The Dresden atrocity, tremendously expensive and meticulously planned, was so meaningless, finally, that only one person on the entire planet got any benefit from it. I am that person. I wrote this book, which earned a lot of money for me and made my reputation, such as it is. One way or another, I got two or three dollars for every person killed. Some business I'm in.
This experience was also used in several of his other books and is included in his posthumously published stories: Armageddon in Retrospect. The firebombing of Dresden was depicted in George Roy Hill's 1972 movie adaptation of Vonnegut's novel

The death toll of 135,000 given by Vonnegut was taken from The Destruction of Dresden, a 1963 book by David Irving. In a 1965 letter to The Guardian, Irving later adjusted his estimates even higher, "almost certainly between 100,000 and 250,000", but all these figures were shortly found to be inflated: Irving finally published a correction in The Times in a 1966 letter to the editor lowering it to 25,000, in line with subsequent scholarship. Despite Irving's eventual much lower numbers, and later accusations of generally poor scholarship, the figure popularized by Vonnegut remains in general circulation. 

Freeman Dyson, a British (and later American) physicist who had worked as a young man with RAF Bomber Command from July 1943 to the end of the war, wrote in later years: "For many years I had intended to write a book on the bombing. Now I do not need to write it, because Vonnegut has written it much better than I could. He was in Dresden at the time and saw what happened. His book is not only good literature. It is also truthful. The only inaccuracy that I found in it is that it does not say that the night attack which produced the holocaust was a British affair. The Americans only came the following day to plow over the rubble. Vonnegut, being American, did not want to write his account in such a way that the whole thing could be blamed on the British. Apart from that, everything he says is true." Dyson later goes on to say: "Since the beginning of the war I had been retreating step by step from one moral position to another, until at the end I had no moral position at all".

Other

  • The German diarist Victor Klemperer includes a first-hand account of the firestorm in his published works.
  • The main action of the novel Closely Observed Trains, by Czech author Bohumil Hrabal, takes place on the night of the first raid.
  • In the 1983 Pink Floyd album The Final Cut, "The Hero's Return", the protagonist lives his years after World War II tormented by "desperate memories", part of him still flying "over Dresden at angels 1–5" (fifteen-thousand feet).
  • In the song "Tailgunner", Iron Maiden starts with "Trace your way back 50 Years / To the glow of Dresden – blood and tears".
  • Jonathan Safran Foer's novel Extremely Loud and Incredibly Close (2005) incorporates the bombings into essential parts of the story.
  • The bombings are a central theme in the 2006 German TV production Dresden by director Roland Suso Richter. Along with the romantic plot between a British bomber pilot and a German nurse, the movie attempts to reconstruct the facts surrounding the Dresden bombings from both the perspective of the RAF pilots and the Germans in Dresden at the time.
  • The bombing is featured in the 1992 Vincent Ward film, Map of the Human Heart, with the hero, Avik, forced to bale out of his bomber and parachute down into the inferno.
  • The devastation of Dresden was recorded in the woodcuts of Wilhelm Rudolph, an artist born in the city who resided there until his death in 1982, and was 55 at the time of the bombing. His studio having burned in the attack with his life's work, Rudolph immediately set out to record the destruction, systematically drawing block after block, often repeatedly to show the progress of clearing or chaos that ensued in the ruins. Although the city had been sealed off by the Wehrmacht to prevent looting, Rudolph was granted a special permit to enter and carry out his work, as he would be during the Russian occupation as well. By the end of 1945 he had completed almost 200 drawings, which he transferred to woodcuts following the war. He organized these as discrete series that he would always show as a whole, from the 52 woodcuts of Aus (Out, or Gone) in 1948, the 35 woodcuts Dresden 1945–After the Catastrophe in 1949, and the 15 woodcuts and 5 lithographs of Dresden 1945 in 1955. Of this work, Rudolph later described himself as gripped by an "obsessive-compulsive state," under the preternatural spell of war, which revealed to him that "the utterly fantastic is the reality. ... Beside that, every human invention remains feeble."

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