JOHN YANG: Tonight on PBS News Weekend, death and destruction in the Middle East, as Hamas launches a surprise assault on Israel drawing swift retaliation and why medication to treat alcoholism has been underutilized for years.

Then a look inside the aftermath of a chemical disaster in North Carolina and how the government decides to which chemicals to regulate.

WOMAN: I could smell the smoke is that closer and when I had to do to gas when I saw it was to do the fertilizer cleaner.

You can see the blaze.

(BREAK) JOHN YANG: Good evening, I'm John Yang.

Tonight months of escalating tensions between Israelis and Palestinians have erupted into a firestorm.

In an unprecedented surprise attack, the militant Hamas rulers of Gaza sent dozens of fighters into Israel by land, sea and air.

Gun battles raged for hours and communities across southern Israel and officials on both sides say Israeli soldiers and civilians are now captives in Gaza.

Israel responded with airstrikes on Gaza cities, flattening Hamas offices and residential buildings.

At this hour at least 200 Israelis are reported dead and 1,100 wounded.

Palestinian officials say at least 198 Palestinians are dead and 1,600 wounded most from fighting in Israel.

Tonight special correspondent and Nurit Ben is in Tel Aviv.

And we should warn you that some of the images in her report are disturbing.

NURIT BEN: Terror and carnage on Israel streets as rockets from Hamas filled.

GOLAN, Resident of Ashkelon (through translator): At around six in the morning a rocket fell here near the house.

Everything got burnt.

The house was destroyed.

We live in a reality that's not real.

NURIT BEN: Israeli sheltered in place as dozens of Hamas gunmen and Israeli border towns.

Civilians are sharing videos on social media of unprecedented scenes, heavily armed militants going house to house firing machine guns under the cover of heavy rocket fire.

These videos have been reported in Israeli media but are unconfirmed by PBS.

This video from Hamas shows how militant paragliders were also able to circumvent Israel's heavily fortified border.

Gazans also broke through the border fence separating the narrow strip from Israel.

The Israel Defense Forces said Hamas had kidnapped Israeli soldiers and civilians.

Hamas said it was holding scores of hostages in Gaza.

There were also unverified videos of Gazans purportedly stomping on an Israeli soldiers body and Hamas militants capturing women and children.

Israel responded with airstrikes on Gaza.

BENJAMIN NETANYAHU, Prime Minister, Israel (through translator): Since this morning, the State of Israel has been at war.

Our first objective is to clear out enemy forces.

The second objective is to exact an immense price from the enemy.

NURIT BEN: Prime Minister Benjamin Netanyahu spoke with President Joe Biden Saturday.

JOE BIDEN, U.S. President: The world's seen appalling images, thousands of rockets in a space of hours, raining down on his holy cities.

When I spoke with Prime Minister Netanyahu this morning, I told him the United States stands with the people of Israel in the face of these terrorist assaults.

Israel has the right to defend itself and his people full stop.

NURIT BEN: As Israel declared war, Palestinian civilians sought shelter.

AMAL ABU DAKA, Resident of Gaza (through translator): Of course, we are in fear.

They're afraid of what they'll do, they might wipe us off the face of the earth.

NURIT BEN: The attacks came one day after the 50th anniversary of what Israel calls the Yom Kippur War.

In 1973, Syrian and Egyptian forces launched a surprise attack on Israel.

Tonight, many Israelis are likening the intelligence to that war.

Today, Hamas supporters celebrated the attacks, as Commander Muhammad Deif urged Palestinians everywhere to fight.

MUHAMMAD DEIF, Hamas Military Commander (through translator): This day is the great revolution day to put an end to the last occupation and last apartheid regime in the world.

NURIT BEN: All of this is happening I mean deep division inside Israel with 10 months of mass protests against this government's judicial reforms.

But in a statement this evening, opposition leader Yair Lapid announced an offer to form an emergency unity government with Benjamin Netanyahu.

Lapid saying that the Prime Minister knows that with the current extreme and dysfunctional government, he says he cannot manage a war.

Now Netanyahu is indicated he is open to an emergency unity government but not without those far right ministers.

And that is likely a no go.

John.

JOHN YANG: Nurit, I know you told us that you're still hearing sirens, you're still hearing explosions.

You're in Tel Aviv.

Just tell us, what is it like in Israel right now, tonight NURTI BEN: Really is hard to overstate the shock and terror, quite frankly, that this coordinated surprise attack has caused the shaping up to be clearly the worst ever terror attack on Israeli civilians, and also the biggest intelligence failure since the Yom Kippur War half a century ago.

As you also mentioned, the rocket fire we've been hearing that recently, late into this evening, rockets actually landing in four different locations in central Israel, including in Tel Aviv with some injuries reported.

So you know, John, one of the surreal parts of this day has been listening to Israeli television and radio news throughout the day.

And I think that's a sort of good barometer of how Israeli citizens have been feeling.

It's sort of turned into a helpline with really desperate people calling in sharing their stories and asking for information about their loved ones about people that they could not track down.

And really even now, some 18 hours after Hamas launched those attacks, there is an incredibly thick fog of war.

And maybe the only thing is that we are far away from the end of this war.

JOHN YANG: Narit Ben in Tel Aviv on a day to remember in in Israel.

Nurit, thank you very much and please stay safe.

Elsewhere to 6.3 magnitude earthquake shook western Afghanistan today, killing more than 300 people and injuring scores of others of 5.5 magnitude aftershock followed.

People fled crumbling buildings and took refuge in the streets.

Last year, a massive earthquake killed more than 1,000 people in the eastern part of that quake prone country.

And Senate Majority Leader Chuck Schumer and a bipartisan delegation of five other senators were in Shanghai today the first step and a trip that will also take them to South Korea and Japan.

They're the first American lawmakers to visit China in four years.

They met with Chinese Communist Party officials and discussed how to stop the flow of fentanyl into Mexico and how American businesses could better compete in China.

Still to come on PBS News Weekend, treating alcoholism with medication and what happens to a community in the aftermath of a chemical disaster.

(BREAK) JOHN YANG: If you have diabetes or depression medication might be part of your treatment.

But for people suffering from alcohol abuse disorder, medication is rarely prescribed.

Ali Rogin reports on the potential that medication holds for treating this disease and why it's underused.

ALI ROGIN: Nearly 30 million Americans struggle with alcohol addiction and the problem has steadily gotten worse, accelerating since the pandemic began.

Yet less than 5 percent of people reported getting treatment of any.

But drugs used to treat alcohol use disorder have been on the market for decades and more are currently being studied.

Dr. Sarah Wakeman runs the Substance Use Disorder Initiative at Massachusetts General Hospital Brigham.

Thank you so much, Dr. Wakeman for joining us.

First of all, let's talk about how the medical community defines alcohol use disorder.

And also what if the trend line has been has the problem gotten more prevalent since the pandemic began?

DR. SARAH WAKEMAN, Mass General Brigham: The definition of alcohol use disorders compulsively using alcohol despite problems.

And so those can be problems in your life, like in your relationships, or your ability to work or carry out your functions, or in your house.

So continuing to use alcohol despite known health, either mental or physical health problems that are exacerbated by use.

So like many health conditions, and many areas of substance use disorder, we've seen worsening trends and fawns have of the pandemic.

And this is true both for heavy drinking and also alcohol use disorder and health conditions related to alcohol use.

One of the most scary trends we've seen, actually, soon after the pandemic hit, we saw an increase in alcohol related mortality, which is largely driven by liver disease or liver failure from heavy alcohol use.

ALI ROGIN: And people might not be so aware that medication is available to address alcohol use disorder, how has medication been used historically in the United States?

SARAH WAKEMAN: It's vastly underutilized.

So you talked about your opening, we have millions of people who meet criteria for alcohol use disorder.

Fewer than 8 percent really access treatment in a given year.

And of those less than 2 percent of people access treatment with medications.

And there's lots of reasons for that.

But it is one area of medicine that really doesn't make its way to people who need it most.

ALI ROGIN: Can you tell us about the drugs that are already available to treat alcohol use disorder?

And why aren't they prescribed more readily here.

SARAH WAKEMAN: So there are three FDA approved medications available in the U.S. for treatment of alcohol use disorder.

There's also other medications that are off label are not officially approved for that indication, but are very effective.

And these medicines, for the most part, work by reducing the urge to want to drink and the pleasurable feedback that you get from drinking.

And so they can be really powerful.

And it's been shown to help reduce heavy drinking days, and also to improve the likelihood that someone can achieve abstinence meaning not drinking at all.

I think many people aren't even aware that there are medications they could ask their doctor for, or that could be a part of their treatment.

And we have to remember, as a society, for more than 100 years, we've really carved addiction out as something separate from the rest of our healthcare system are somehow different than the rest of medical care or medical conditions that we treat.

And so there's been this idea that addiction, although we sometimes say it's an illness, many of our policies and our clinical procedures really approach it like it's an issue of morality or willpower.

And so really undoing that ideology.

Those general stigmatizing notions is really important to bring addiction back into the medical system back into medical training, so that doctors and nurses and other health care professionals feel comfortable addressing this and offer medication treatment just like they would for depression, or diabetes or heart disease.

ALI ROGIN: What about elsewhere in the developed world, how is medication used in other parts of the world?

SARAH WAKEMAN: Medications used much more commonly, for example, in Europe, where there's even a method of using medication as needed to reduce heavy drinking.

So if you know that when you go to a cocktail party or around holidays, or during times of stress, you're more likely to drink heavily or at a level above what you want to be drinking for your health or life goals.

You can actually take a medicine before that, and it's been shown to help reduce heavy drinking.

ALI ROGIN: There's been increased attention on diabetes drugs like Ozempic, that they have been shown to reduce symptoms of alcohol use disorder.

What is the potential there and also what are some concerns around the use of these drugs for that purpose?

SARAH WAKEMAN: And it's really exciting.

We obviously need to utilize medications, we have an existence, but we always need more innovation and better medication and more options for patients.

The early studies both serve anecdotes about people who've taken these medications and found that they're craving or urge to want to drink have diminished are really promising.

There's also some animal studies in mice showing reduction in alcohol use and alcohol seeking behaviors.

Obviously, there needs to be clinical trials that show that this is effective, and that it gets to the right clinical endpoints.

And that would require funding and research.

And so usually that takes on the order of years for those kinds of approvals to happen.

I think that can sound like a long time.

But in the meantime, we have effective medications that exist, that are easy to prescribe that any doctor can prescribe.

And so really encouraging people who are listening, if you're struggling, if a family member is struggling, you could talk to your doctor, this could be one component of lots of different types of treatments that are available for alcohol use disorder.

ALI ROGIN: And lastly, let's talk about when should someone reach out for help seeking treatment or otherwise addressing an alcohol use disorder.

SARAH WAKEMAN: Think of you're worried about your alcohol use if someone in your life is worried about it.

Those are probably the two best predictors.

If you're having health related consequences from alcohol use, like liver problems, even feeling hungover having any times like a blackout.

You don't remember what happened.

Those are all really worrisome symptoms and alcohol was playing a role in your life that could begin causing problems.

I think many people don't know about the lower level drinking limits that we think of when we talk about lower risk drinking.

It's really no more than seven drinks a week for a woman or anyone over 65.

And no more than 14 drinks a week for a man who's under 65.

I think if you try to make changes to your alcohol use to get it to a healthier level and you find it's hard to cut back or hard to make changes, that sometimes can be an indication that things may have gotten out of your control.

And it's never a wrong thing to talk to someone or ask for help because the earlier we can provide support, the earlier we can intervene, the better someone will do.

ALI ROGIN: Dr. Sarah Wakeman with Massachusetts General Hospital Brigham, thank you so much for talking about this important issue.

SARAH WAKEMAN: Thanks for having me.

JOHN YANG: Earlier this year a train derailment in East Palestine Ohio spilled toxic chemicals on the ground and into the air.

Eight months later people -- there people there are still waiting for answers about the long term health and environmental consequences.

What happened in Ohio isn't uncommon.

On average, there's a chemical incident in this country every two days.

We went to North Carolina for a look at how one city is trying to move forward after a chemical disaster.

So the plan was literally just across the way here.

SABRINA WEBSTER, Winston-Salem Resident: Yes.

JOHN YANG: Sabrina Webster was born and raised in this Winston Salem neighborhood.

SABRINA WEBSTER: Growing up in Pinegrow.

You had your grandparents, your aunties, your cousins, your family and friends.

JOHN YANG: A tight knit community where she felt safe and secure.

But that all changed one night in early 2022.

What was that night like?

What do you remember?

SABRINA WEBSTER: I got a call from my daughter.

And she said Mom, you're going to have to take a detour, she said, is a fire on Indiana Avenue.

I could smell the smoke as I got closer.

And when I had to take a detour, that's when I saw it was the weaver fertilizer plant.

You can see the blaze, and you can see the fireman up on a high ladder.

Just spraying water down.

JOHN YANG: The fire at the Winston Weaver fertilizer plant was fueled by what was stored inside 600 tons of ammonium nitrate, a chemical commonly used in fertilizer that can accelerate fires and even explode at high temperatures.

SABRINA WEBSTER: I'll stop my policeman.

And he told me I couldn't go no further.

And I don't miss it.

Well, I need to come home and check on my daughter and check on my pet.

He radio ahead and I could hear his sergeant telling him tell her to get her items and move out.

Leave as soon as possible.

JOHN YANG: At home, Webster grab what she could, close family portraits per dog GB and fled.

SABRINA WEBSTER: It couldn't even come through there.

JOHN YANG: Webster then called her cousin Vanda Thomas who lives nearby.

VANDA THOMAS, Winston-Salem Resident: I grabbed my pocket book.

My child, my fiancee, and we get in the car without pajamas on.

And we left.

JOHN YANG: No one died in Winston-Salem that night, but other communities haven't been so lucky.

In 2013, a fertilizer plant explosion level the farming community of western North Central Texas.

MAN: At first, we just saw a little bit of smoke.

Next thing I know shrapnel was falling down everywhere burning all of us and we just got out and ran.

JOHN YANG: The blast left 15 people dead, 12 of them first responders and as many as 200 others injured.

Since 2021, there have been 614 accidents in the United States involving chemicals.

And between 2016 and 2020, 133 chemical accidents required more than 64,000 people to be evacuated from their homes and at least 85,000 to shelter in place.

MAYA NYE, Federal Policy Director, Coming Clean: Chemical disasters occur about once every other day in the United States.

And so this is this is a massive problem.

JOHN YANG: Maya Nye is the federal policy director at Coming Clean, a nonprofit group that advocates for greater safety in the chemical industry.

She says the Environmental Protection Agency's risk management program regulates facilities that use these dangerous chemicals.

MAYA NYE: It's really intended to prevent chemical disasters.

And it also requires the facilities develop plans for how they're going to respond to an emergency when a disaster occurs.

And to look at what is you know, what is the worst possible case scenario that can happen should, you know, all of the chemicals at our plant and At least at one time there was a huge explosion.

JOHN YANG: Last year the EPA proposed changes to the program which covers about 12,000 U.S. locations.

While the chemical industry largely supports the current EPA risk management program, they worry that some of the proposed changes go too far.

Kimberly Wise White as head of Regulatory Affairs at the American Chemistry Council.

KIMBERLY WISE WHITE, American Chemistry Council: So they need to be very targeted on where there are accidents where those accidents are driving risks, and identifying those areas and really focusing enhancements in the RNP program in that area.

JOHN YANG: But nice as the revisions don't go far enough.

WOMAN: They have around 140 chemicals that are on this list that they implemented back in the 90s.

And it hasn't really been updated since.

JOHN YANG: Currently, the program covers more than 250 substances that the EPA says pose a significant hazard.

Not on the list, the ammonium nitrate that was stored at the Winston Weaver plant.

The same substance used in the 1995 Oklahoma City federal building bombing the deadliest homegrown terror attack in U.S. history.

According to a North Carolina regulators report, the ammonium nitrate at the weaver plant was improperly stored.

Water was allowed to seep into the wooden bins holding the chemical which could trigger an explosion.

The report also revealed the leaky roof might have contributed to an electrical short and potential fire.

In a statement to PBS News Weekend, the EPA said preventing chemical releases is a shared responsibility and the prime responsibility is on the owners and operators handling chemicals.

The Winston Weaver Company didn't respond to a request for comment.

Five lawsuits have been filed against Winston Weaver alleging negligence, saying they failed to follow industry safety protocols.

But Nye says any regulatory gaps are putting communities in danger, especially populations that are already vulnerable.

MAYA NYE: Communities around chemical facilities are predominantly black, Latino, and low income communities.

And oftentimes these communities have the least resources to respond to, and to be able to recover from disasters after they happen.

JOHN YANG: This vacant lot is all that's left of the Winston Weaver fertilizer plant, at least all that's visible.

Residents of this neighborhood worry what hazardous chemicals may have been left behind in the soil and in the water.

DR. CALLIE BROWN, Wake Forest University School of Medicine: So that's going to tell us about the sedimentation in the water -- JOHN YANG: Dr. Kelly Brown is an Assistant Professor of Pediatrics at Wake Forest University School of Medicine.

CALLIE BROWN: And the immediate aftermath of the fire there were community meetings that were held in that neighborhood.

They wanted this to be studied and I didn't want to be forgotten.

JOHN YANG: She's leading a five-year study looking at the long term health effects from the Weaver plant fire.

What sorts of medical events would you expect to see, after an incident like this?

CALLIE BROWN: In the first year, we're going to be looking at things like emergency department visits hospitalizations, and there we do think maybe respiratory illnesses.

In the longer term we don't really have any hypotheses for what we're going to find.

So we're looking at lots of different types of diagnoses, things like diabetes, high blood pressure, cancer, dementia, it's a wide variety of things that that could be associated with living in this neighborhood around the plant.

JOHN YANG: Brown's team will look for lingering contamination in soil, water and air samples in a two mile radius of the plant site.

It sounds like part of the goal of this is to empower people in the community.

CALLIE BROWN: Absolutely.

They had very clear questions and things that they wanted us to look at their good questions and important questions.

And so we're able to use the data and the resources that we have to get that data back to the community.

SABRINA WEBSTER: It was an explosion.

I wouldn't be sitting here with you today.

A whole lot of families in this neighborhood generations would have been wiped off the face of this earth.

JOHN YANG: For Sabrina Webster and Vanda Thomas, the chemical fire could have gotten much worse.

But it's hard for them not to worry about what's in the air they breathe in in the soil in which they once grew vegetables.

VANDA THOMAS: They'll peppers, our grow onions, just right here in this little patch.

JOHN YANG: And she hopes her community will be one of the last to live in fear of the next disaster.

Online right now how Oklahoma farmers in school districts are working together to bring down the cost of school lunches, part of a program sponsored by the U.S. agriculture department.

All that and more is on our website pbs.org/newshour.

And that is PBS News Weekend for this very busy Saturday.

On Sunday, the role of racism has played in keeping some Americans from learning how to swim, putting them at risk of drowning.

I'm John Yang.

For all of my colleagues, thanks for joining us.

See you tomorrow.