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In bones, neural communications, fertilisation and more Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link The importance of calcium in life Last updated: 12/03/25, 16:45 Published: 10/04/25, 07:00 In bones, neural communications, fertilisation and more Did you know that the same mineral that gives your bones strength also helps to maintain your heartbeat and even plays a role in the very start of life? Calcium, the most abundant mineral in the human body, is primarily found in bones and teeth as calcium phosphate (Ca₃(PO₄)₂). But beyond its structural role, calcium ions are essential for nearly every biological function, from muscle contractions to nerve signalling. What makes calcium so versatile, while other minerals like iron, have far more limited roles? To truly understand its significance, we must explore its underlying chemical properties. Calcium and bones The calcium ion carries a 2+ charge allowing it to form stronger ionic bonds and interact strongly with negatively charged molecules like nucleotides and ATP. This makes it essential for energy transfer in cells. In comparison to monovalent ions like Na+ and K+, calcium, therefore, has a more significant charge density, increasing affinity for anions. However, the ion also has more shells than beryllium and magnesium in the same group (Group 2), contributing to reduced charge density. These properties are very crucial in determining the strength of Calcium compounds, as a high charge density may result in problems with toxicity and difficulty in the breakdown of the product. Calcium phosphate exists as hydroxyapatite in bones and teeth, giving them hardness and rigidity. Hydroxyapatite forms hexagonal crystals that are tightly packed, contributing to the dense, durable structure of bones. These crystals are organised into a matrix along collagen fibres, creating a composite material that combines rigidity (from hydroxyapatite) and flexibility (from collagen). The properties of hydroxyapatite make it uniquely suited for its roles in the body. Its hardness provides bones with the ability to resist deformation and compression, while its porous structure allows space for blood vessels, bone marrow, and the exchange of nutrients and waste. Osteoclasts break down the bone releasing calcium and phosphate ions while osteoblasts can reabsorb this calcium to reform bones in another area of the body, maintaining skeletal health and strength. Neural communication Imagine a relay race where one runner must pass the baton to the next for the race to continue. In a similar way, calcium ions act as messengers in the nervous system, triggering the release of neurotransmitters which allow nerve cells to communicate with each other. Upon experiencing a stimulus, sodium ions begin to enter neurones through voltage-gated sodium channels, causing depolarisation, which sends an electrical signal throughout the neurone that results in the opening of other sodium channels, carrying the electrical signal throughout the neurone until the signal reaches the axon terminal. When the action potential reaches the axon terminal, it triggers the opening of voltage-gated calcium channels in the membrane of the presynaptic neurone. Calcium ions from the extracellular fluid flow into the neurone due to the concentration gradient. This influx of calcium ions is a critical step in neural communication, as it directly facilitates the release of neurotransmitters stored in synaptic vesicles. This action helps to coordinate the strength and the timing of each heartbeat. Calcium ions bind to proteins on the surface of these vesicles, which enables the vesicles to fuse with the presynaptic membrane. This fusion releases neurotransmitters, such as acetylcholine, into the synaptic cleft—a tiny gap between the presynaptic and postsynaptic neurones. These neurotransmitters then bind to specific receptors on the postsynaptic neurone, leading to either an excitatory or inhibitory response. For example, acetylcholine often causes an excitatory response, such as muscle contraction or memory formation. Fertilisation Calcium ions are crucial for fertilisation, facilitating key events from sperm-egg interaction to the activation of embryonic development. When a sperm binds to the egg’s outer layer, calcium ions trigger the release of enzymes from the sperm, enabling it to penetrate the egg. Following the sperm-egg fusion, calcium ions are released within the egg, creating a wave-like signal. The rise in intracellular calcium levels in the egg has several critical effects triggers the cortical reaction, in which cortical granules – small vesicles located beneath the egg’s plasma membrane- release their contents into the space between the plasma membrane and the zona pellucida. The enzymes released during this reaction modify the zona pellucida, making it impermeable to other sperm. This process prevents polyspermy, ensuring that only one sperm fertilises the egg. This precise calcium signalling achieves successful fertilisation and the initiation of new life. Role of calcium in other organisms Calcium is a vital element essential for initiating and sustaining human life, but its importance extends far beyond the human body. Its role is not confined to animals as calcium is equally critical in the physiology of plants and fungi, where it contributes to a wide range of biological processes. In plants, calcium ions are used to form calcium pectate, a chemical used to strengthen the cell walls of the cell and make plant cells stick together. Additionally, calcium is vital for root development and nutrient uptake. It helps in the formation of root nodules in legumes, where nitrogen-fixing bacteria establish symbiotic relationships, and it influences the movement of ions across cell membranes to regulate nutrient transport. Furthermore, calcium oscillations play a crucial role in regulating the polarised growth of fungal hyphae, which are essential for environmental exploration and host infection. Hyphal growth is characterised by a highly localised expansion at the tip, requiring cytoplasmic movement and continuous synthesis of the cell wall. Calcium ions are central to these processes, functioning as dynamic signalling molecules. Calcium concentration is highest at the growing hyphal tip, forming a steep gradient essential for maintaining growth direction. This gradient is not static but oscillatory, with periodic fluctuations in cytosolic calcium levels. These oscillations arise from the interplay of calcium influx through plasma membrane channels like voltage-gated channels. These are critical for coordinating key processes at the hyphal tip. Calcium regulates vesicle trafficking by triggering the fusion of vesicles carrying enzymes with the plasma membrane. Additionally, calcium modulates the actin cytoskeleton, which provides tracks for vesicle transport and maintains the structural polarity of the hypha. Periodic calcium signals promote the dynamic assembly and disassembly of actin filaments, ensuring flexibility and responsiveness to physical barriers to mobility during growth. Through its oscillatory signalling, calcium enables the precise regulation required for hyphal growth and network formation. Conclusion In conclusion, calcium is a remarkably versatile element, playing vital roles across a diverse range of organisms. In humans and animals, it not only provides structural integrity through bones and teeth but also regulates critical physiological processes such as nerve signalling. Beyond animal systems, calcium is also essential in plants, where it strengthens cell walls and improves structure. In fungi, calcium oscillations are fundamental to hyphal growth, coordinating vesicle trafficking. From building bones to driving vital biological processes, calcium is a silent powerhouse in life. Its influence stretches across humans, plants, and even fungi. Its role is truly indispensable. Written by Barayturk Aydin Related articles: Bone cancer / Tooth decay REFERENCES Haider, A. et al. (2017) Recent advances in the synthesis, functionalization and biomedical applications of Hydroxyapatite: A Review, RSC Advances. Available at: https://pubs.rsc.org/en/content/articlehtml/2017/ra/c6ra26124h (Accessed: 24 November 2024). Splettstoesser, T. (2024) Action potentials and synapses, Queensland Brain Institute - University of Queensland. Available at: https://qbi.uq.edu.au/brain-basics/brain/brain-physiology/action-potentials-and-synapses (Accessed: 01 December 2024). Abbott, A., L. (2001) ‘Calcium and the control of mammalian cortical granule exocytosis’, Frontiers in Bioscience, 6(1), p. d792. doi:10.2741/abbott. Vaz Martins, T. and Livina, V.N. (2019) What drives symbiotic calcium signalling in legumes? insights and challenges of imaging, International journal of molecular sciences. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6539980/#:~:text=Currently%2C%20two%20different%20calcium%20signals,formation%20of%20the%20root%20nodule%2C (Accessed: 01 December 2024). Lew, R.R. (2011) ‘How does a hypha grow? the biophysics of pressurized growth in fungi’, Nature Reviews Microbiology, 9(7), pp. 509–518. doi:10.1038/nrmicro2591. Project Gallery

Impact of war and geopolitics on health in Palestine Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Life under occupation: the health and well-being of Palestinians Last updated: 08/01/26, 18:56 Published: 13/03/25, 08:00 Impact of war and geopolitics on health in Palestine This is article no. 1 in a series about global health injustices. Next article: Civil war in Sudan . Introduction Welcome to the Global Health Injustices Series, which will focus on critically examining the health inequalities and inequities faced by vulnerable populations within different countries and regions worldwide and even put forward actionable steps to improve their health and wellbeing. This series will begin with Palestine, as it has been an enduring crisis that should be addressed to include long-lasting benefits and outcomes for the Palestinians. Palestine: from a rich history to current occupation Palestine is a country in the Middle East (West Asia) mainly bordered by Israel. Palestine is unique in its various cultures and knowledge, moulded by multifaceted events and geopolitical shifts over centuries. The multidimensional cultural landscape of Palestine illustrates the impact of civilisations, such as the Romans, Byzantines, and Ottomans, who each had their religions, languages, and cultures, which still exist in various forms today. The resilience of the Palestinians is evident through their distinct traditions, art, food and environment, which are essential to their identity. With these testaments in mind, Palestinians are facing consistent strife because they are under constant occupation, blockade and cutting off of needed supplies carried out by Israel, as noted by several humanitarian and human rights non-governmental organisations (NGOs) like Amnesty International and Save the Children. These actions are facilitated by nations, notably the United States and the United Kingdom, through arms and weapons trade. Hence, the struggle for the Palestinians to have autonomy and freedom, among other human rights within their own homeland, is a consistent fight that requires ongoing international cooperation and solidarity. Geopolitics: its detrimental impacts on the Palestinians Given the currently divisive geopolitical landscape, it is essential to bring attention to the health outcomes of the Palestinian population, especially since at least half of them are children. A report from the Global Nutrition Cluster called “Nutrition Vulnerability and Situation Analysis / Gaza” had several key findings and tables (see Tables 1 and 2 ). Firstly, more than 90% of children less than a year old, along with pregnant and breastfeeding women, encounter high under-nutrition due to poverty. Another finding was that approximately 90% of children under five are impacted by at least one infectious disease, and 81% of households in Gaza lack clean and safe water. However, the authors noted limitations in their analysis, such as limited data sources because collecting it is difficult within the context of Gaza, and this was true for screening. Another report from the organisation Medical Aid For Palestinians (MAP), titled “Health Under Occupation” from 2017, discussed healthcare access and outcomes more broadly. For example, they noted that in 2016, up to one-third of patients’ permits to exit Gaza for healthcare access were either denied or delayed. Moreover, they stated that 40% of people in Gaza live below the poverty line. Given the recent geopolitical shifts in power, these findings from both reports will likely be higher now. This brings forthcoming uncertainty about whether the health outcomes of Palestinians will improve. In a recent qualitative study involving the views of Palestinian physicians in the West Bank, they shared their experiences of violence, threats of violence, issues with healthcare access for themselves and patients, financial difficulties to support their families, struggle to help their patients and limited access to education due to harsher life under occupation. Thinking more largely about emergency care in Palestine, one scoping review reported the depletion of healthcare resources such as medical equipment and medications. The authors even related how human rights violations and the destruction of the Palestinian healthcare system, including emergencies, have exacerbated outcomes; the most notable were stroke, myocardial infarction and traumatic injury, among other non-infectious diseases. Although the authors included this information from a human rights standpoint, they called for additional interventions and research to fill in and learn gaps within emergency care to enhance health outcomes for Palestinians. This review was published in 2022, and again, many geopolitical shifts in power have taken place within a few years. Therefore, it can be deduced that emergency care is drastically needed for the Palestinians; this is primarily compelled by the blockade in Gaza and occupation in the West Bank. Focusing on the mental health outcomes among Palestinians, they have become worse. In another scoping review, researchers focused on trauma among young Palestinian people in Gaza; the authors noted that events, such as exposure to devastation and violence, as well as the death or loss of friends and family, have contributed to mental health outcomes ranging from post-traumatic stress disorder (PTSD) to depression. Nevertheless, the authors stated that further qualitative research is vital to addressing gaps in knowledge and enhancing mental health outcomes among the Palestinian youth and the wider population. Connecting back to how the modern geopolitical landscape is very dynamic, the poorer mental health outcomes among Palestinians have conceivably increased. Urgent calls to action: recommendations from NGOs to upholding human rights Given all of these detrimental impacts on the health and wellbeing of Palestinians, there are recommendations from organisations, notably the United Nations (UN), for ways forward towards upholding the human rights of Palestinians: Immediately end all practices of collective punishment, including lifting its blockade and closures – and the “complete siege”- of Gaza, and urgently ensure immediate access to humanitarian and commercial goods throughout Gaza, commensurate with the immense humanitarian needs. Ensure that all Palestinians forcibly displaced from Gaza are allowed to return to their homes creating safe conditions and fulfil its responsibilities as an occupying Power in this regard. End the 56-year occupation of the Occupied Palestinian Territory, including East Jerusalem as part of a broader process towards achieving equality, justice, democracy, non-discrimination, and the fulfilment of all human rights for all Palestinians. These recommendations, among others mentioned in the report from the United Nations (UN) High Commissioner for Human Rights, were divulged in 2024; the year had been a challenging time, particularly in Gaza, due to the complete blockade of food, water and essentials like medical supplies; in addition to this, many explosives were dropped on Gaza, killing thousands of men, women and children. Finally, buildings, such as hospitals and homes, were destroyed. Conclusion: moving forward towards a equitable and equal future for Palestinians Reflecting on everything discussed in this article, the numerous injustices happening to Palestinians must not go on; they have been suppressed for nearly 75 years by governments and the mainstream media before receiving closer attention, examination and debate within Western society recently. Therefore, we need to take actionable steps by initiating more open discussions of justice and advocacy involving the voices of Palestinians, such as myself and others. Furthermore, it is crucial always to nudge those in positions of power worldwide to fulfil their responsibilities as civil servants and defend human rights for everyone. Both of these actions uphold the health and wellbeing of Palestinians living in Gaza and the West Bank, especially as enabling the recommendations from the UN and other NGOs. As for the wider international community, we must continue upholding human rights to maintain our health and wellbeing. In my next article, I will discuss Sudan because this population has also encountered many injustices, primarily the civil war that has been occurring since 2023. This has impacted the health and wellbeing of the Sudanese population, which requires thorough attention and discussion. Written by Sam Jarada Related articles: Gentrification and well-being / Health Inequalities / Impacts of global warming on NTDs / Global health injustices- Bangladesh , Sri Lankan Tamils REFERENCES Human rights in Israel and the Occupied Palestinian Territory. Amnesty International. 2022. Available from: https://www.amnesty.org/en/location/middle-east-and-north-africa/middle-east/israel-and-the-occupied-palestinian-territory/report-israel-and-the-occupied-palestinian-territory/ Occupied Palestinian Territory. Save the Children International. 2024. Available from: https://www.savethechildren.net/occupied-palestinian-territory Nutrition Vulnerability and Situation Analysis / Gaza. 2024. Available from: https://www.nutritioncluster.net/sites/nutritioncluster.com/files/2024-02/GAZA-Nutrition-vulnerability-and-SitAn-v7.pdf HEALTH UNDER OCCUPATION. Medical Aid For Palestinians. 2017. Available from: https://www.map.org.uk/downloads/health-under-occupation---map-report-2017.pdf Husam Dweik, Hadwan AA, Beesan Maraqa, Taher A, Zink T. Perspectives of Palestinian physicians on the impact of the Gaza War in the West Bank. SSM - Qualitative Research in Health. 2024 Nov 14;6:100504–4. Available from: https://www.sciencedirect.com/science/article/pii/S2667321524001136 Rosenbloom R, Leff R. Emergency Care in the Occupied Palestinian Territory: A Scoping Review. Health and Human Rights. 2022 Dec;24(2):255. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9790939/ Abdallah Abudayya, Fugleberg T, Nyhus HB, Radwan Aburukba, Tofthagen R. Consequences of war-related traumatic stress among Palestinian young people in the Gaza Strip: A scoping review. Mental Health & Prevention. 2023 Nov 25;32:200305–5. Available from: https://www.sciencedirect.com/science/article/pii/S2212657023000478 M.I. Human rights situation in the Occupied Palestinian Territory, including East Jerusalem, and the obligation to ensure accountability and justice - Report of the United Nations High Commissioner for Human Rights - Advance unedited version (A/HRC/55/28) - Question of Palestine. United Nations. Available from: https://www.un.org/unispal/document/human-rights-situation-in-opt-unohchr-23feb-2024/ Project Gallery

'Manis pentadactyla' is the dominant pangolin species in China Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Pangolins: from poached to protected Last updated: 27/03/25, 11:15 Published: 27/02/25, 08:00 'Manis pentadactyla' is the dominant pangolin species in China This is article no. 4 in a series on animal conservation. Next article: How Gorongosa National Park went from conflict to community . Previous article: Beavers are back in Britain Pangolins are a group of eight scaled mammal species from Asia and Africa. They are being poached mainly for their scales and meat, driving them to dangerously low numbers. Although commercial trade is banned for all species, pangolins are the most illegally trafficked animals in the world. One pangolin species has a fascinating story because of its appeal to traditional medicine and demand in a populated country. That species is the Chinese pangolin Manis pentadactyla , and this article will describe its threats and conservation efforts. About pangolins in China Manis pentadactyla is the dominant pangolin species in China, living south of the Yangtze River ( Figure 1 ). The Sunda pangolin Manis javanica has a tiny habitat in southwest China ( Figure 1 ). Pangolins prefer natural forests, with an ambient temperature of 18-27°C and plenty of termites and ants to eat. Both Chinese species were classified as critically endangered in 2014, though accurately estimating pangolins' distribution and population size is complex. This is because they are nocturnal, solitary, and live underground. Pangolins also make no obvious sounds, or leave no apparent traces, for scientists to detect their presence. Despite these challenges, Chinese scientists are learning more about pangolin habitat to improve conservation strategies. Threats facing Chinese pangolins Chinese pangolins are critically endangered for various human-caused reasons ( Figure 2 ). The biggest reason is poaching because pangolin meat is a local delicacy, and its scales, bones, and blood are used in traditional Chinese medicine. Pangolin scales have recently been removed from the official list of ingredients for Chinese medicine, but that has not stopped hospitals from selling them. In a recent study, only a third of Chinese hospitals selling roasted pangolin scales had the required permit. Permits are also needed to sell or manufacture patented medicines containing pangolin scales, considered the gold standard for treating many conditions. Because these medicines and pangolin meat are so revered, one hunted pangolin sells for up to 90,000 yuan (≈£9800). This has incentivised the hunting and illegal trafficking of non-native pangolin species into China - where they could outcompete, or spread diseases to native species. Thus, illicit trade for traditional medicine threatens Chinese pangolins. Habitat destruction has made Chinese pangolins more vulnerable to poaching. Natural forests are being destroyed to grow crops, grow economic trees like rubber, or build human infrastructure. Farms or rubber plantations have fewer ants and termites than natural forests, so pangolins cannot survive there. As a result, in some parts of China, the pangolin geographical range halved in 30 years. With acres of this unsuitable habitat separating fragments of forest, pangolins may struggle to find mates, and inbreeding could be an issue. Thus, habitat loss is contributing to the decline of the Chinese pangolin. Conservation Conservation measures were taken in the last few decades in response to the pangolin population decline. In China, hunting pangolins was first restricted in 1987, and they were given legal protection in 1989. The Chinese government tightened this protection in 2020 after suggestions that pangolins were an intermediate species for SARS-CoV-2 to transmit from bats to humans. In addition to national restrictions, international authorities restricted pangolin trade, and the Chinese government ran public awareness campaigns about their endangered status ( Figure 3 ). Pangolins also have 100,000 squared kilometres of protected habitat in China, though this is only 9% of what models predict as a suitable pangolin habitat. Habitat protection and trade restrictions are essential to protect pangolins because captive breeding has either failed or acted as a front for illegal trafficking. Although Chinese pangolin conservation has come far in the last 40 years, more can be done. Conclusion Humans have driven Chinese pangolins to near extinction, mainly by hunting for traditional medicine ingredients and destroying native habitats. Conservation efforts have primarily involved legal and habitat protection, but pangolins are challenging to monitor and impossible to breed in captivity. Hopefully, public awareness and a clampdown on illegal trafficking will help to save this unique mammal species. Written by Simran Patel Related articles: Conservation of marine iguanas / Galapagos tortoises REFERENCES Challender, D. et al. (2013) IUCN Red List of Threatened Species: Manis pentadactyla . IUCN Red List of Threatened Species . Available from: https://www.iucnredlist.org/en (Accessed 23rd October 2024). Convention On International Trade In Endangered Species Of Wild Fauna And Flora (2017) Appendices I, II and III valid from 4 October 2017 . Available from: https://cites.org/sites/default/files/eng/app/2017/E-Appendices-2017-10-04.pdf . Mammoser, G. (20th February 2017) Chinese Police Go After ‘Pangolin Princess’ Who Proudly Eats Endangered Species. VICE . Available from: https://www.vice.com/en/article/chinese-police-go-after-pangolin-princess-who-proudly-eats-endangered-species/ (Accessed 23rd October 2024). Wang, Y., Turvey, S.T. & Leader-Williams, N. (2023) The scale of the problem: understanding the demand for medicinal pangolin products in China. Nature Conservation . 52: 47–61. Available from: https://doi.org/10.3897/natureconservation.52.95916 (Accessed 23rd October 2024). Xinhua News Agency (2015) Opinions of the Central Committee of the Communist Party of China and the State Council on Accelerating the Construction of Ecological Civilization . Beijing: The Central Government of the People’s Republic of China. Available from: https://www.gov.cn/xinwen/2015-05/05/content_2857363.htm (Accessed 23rd October 2024). Zhang, F., Chen, Y., Tang, X., Xi, F., Cen, P., Pan, Z., Ye, W. & Wu, S. (2024) Predicting the distribution and characteristics of Chinese pangolin habitat in China: Implications for conservation. Global Ecology and Conservation . 51: e02907. Available from: https://www.sciencedirect.com/science/article/pii/S2351989424001112 (Accessed 23rd October 2024). Zhang, F., Wang, W., Mahmood, A., Wu, S., Li, J. & Xu, N. (2021) Observations of Chinese pangolins ( Manis pentadactyla ) in mainland China. Global Ecology and Conservation . 26: e01460. Available from: https://www.sciencedirect.com/science/article/pii/S235198942100010X (Accessed 23rd October 2024). Zhang, F., Wu, S. & Cen, P. (2022) The past, present and future of the pangolin in Mainland China. Global Ecology and Conservation . 33: e01995. Available from: https://www.sciencedirect.com/science/article/pii/S235198942100545X (Accessed 19th October 2024). Project Gallery

Looking at silicon dioxide Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link The effects of nanoparticles on health Last updated: 17/07/25, 10:50 Published: 01/05/25, 07:00 Looking at silicon dioxide There are around 100 trillion harmless and beneficial microbes in the gut, representing as many as 5,000 different species! They are called the gut microbiota and are essential for regulating brain function through the microbiota-gut-brain axis, controlling intestinal inflammation and more. Nanoparticles may alter the gut microbiota, posing a risk to health and well-being. Read on to find out more about how. What are nanoparticles? Nanoparticles are small particles that are usually less than 100 nm in diameter. One example of a common nanoparticle is silicon dioxide, which can be found as the food additive E551. Silicon dioxide nanoparticles (SiO2NPs) are commonly used as anti-caking agents in free-flowing powdery food products, such as spices and coffee. These nanoparticles can be toxic, damaging cells, tissues, and organs including the liver, kidneys, and lungs. The damage is primarily due to the way SiO2NPs react in the body as a result of their size: even though SiO2NPs are bigger than 100 nm in the form of E551, when the SiO2NPs are in the gastrointestinal tract, they can clump together and degrade into a smaller size of 10-50 nm. The experiment Researchers completed several experiments to examine the effects of exposure to SiO2NPs on health. This article will specifically talk about one experiment where they looked at the impacts of SiO2NPs on the gut microbiota. For this experiment, the researchers hypothesised that oral exposure to SiO2NPs will cause changes in the gut microbiota, affecting diversity and function in mice. 20 healthy male 4-week-old mice were used, weighing 8 to 12 grams. Researchers administered either SiO2NPs solution or vehicle solution for 28 days. The vehicle solution can be considered the control and was created out of a sterile saline solution. All bacteria contain the 16S rRNA gene which is highly conserved, meaning that the sequence remains mostly unchanged across different species. After 28 days, the researchers took faecal samples from the mice and conducted 16S rRNA gene sequencing of the bacterial DNA in the faeces to analyse the gut microbiota. Figure 1 shows the process of 16S rRNA gene sequencing, a method used to identify and compare bacterial diversity without needing to grow bacterial cultures. Because it is culture-free, 16S sequencing can survey complex microbiomes or difficult environments to study. This technique is commonly used to identify bacteria down to the genus or species level, depending on the needs of the experiments. Researchers looked at the alpha diversity of the gut microbiota, with Sob, Ace, Chao, Simpson, and Shannon indices being used. Sob, Ace and Chao give information about the number of species, while Simpson and Shannon give information about the community diversity, including the species evenness. The results The results of this experiment, as seen in Figure 2 , show that there was a significant increase in Sob, Ace, and Chao indices, but there was no substantial change in Simpson or Shannon indices. This suggests that SiO2NPs can change the diversity of gut microbiota, which could impact their biological functions. For example, if there are changes to the gut microbiota, it could result in increased inflammation in the intestine. This could potentially lead to the immune system’s defences in the gut being weaker, allowing harmful pathogens to pass through the epithelial barrier more easily. Conclusion One of the main weaknesses of this experiment is that it was conducted on mice. Because of this, the study's findings cannot be directly translated to humans. In addition, the study was conducted over only 28 days, meaning we don’t know the long-term effects and consequences of the impacts of SiO2NPs on the gut microbiota. Nevertheless, this is still a critical study as it shows that SiO2NPs do impact the gut microbiota. It also shows that maintaining healthy gut microbiota is important. This can be done by being mindful of what we eat. So next time, instead of having instant noodles full of additives, think about making a home-made soup with your favourite vegetables! Eating unprocessed whole foods is not just good for us, but also for our gut microbiota! Written by Naoshin Haque Related articles: Nanomedicine / Nanoparticles as diabetes treatment / Nanogels / Nanocarriers / Silicon hydrogel lenses / Microbiota Project Gallery

Delving into the 'Nudge' effect by Thaler and Sunstein Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Libertarian Paternalism and the ‘Nudge’ Approach Last updated: 05/11/25, 20:21 Published: 06/11/25, 08:00 Delving into the 'Nudge' effect by Thaler and Sunstein This is article no. 4 in a series on behavioural economics. Next article: Effect of time (coming soon). Previous article- Loss aversion . So far in our series of behavioural economics, we have discussed why and how people may make less favourable decisions than traditional economics assumes. We have spoken about how people can still be honest even when they are faced with a decision where they can be materially better off; and when someone loses their wallet, they feel more distaste than finding some money on the street; and how an endowment adds a bizarre sense of additional worth, that would cause you to think twice about trading it for something equally valuable. In today’s article, we are going to address why this is important to policy makers, and subsequently you and I, by exploring how governments and institutions can influence our decisions in ways that may seem paternalistic yet still respect individual freedom. This idea lies at the heart of libertarian paternalism . The idea behind the “Nudge” Nudge is a book written by Nobel Prize–winning economist Richard Thaler and legal scholar Cass Sunstein. Building on their 2003 paper, the book develops the idea that people’s choices can be shaped not only by the options available, but also by the context in which those options are presented — even by factors that seem trivial or irrelevant. This is where the concept of a “nudge” comes in: small design changes that steer people toward better decisions without restricting their freedom to choose. A simple change: the pension example A classic example comes from workplace pensions. Before 2008, when someone joined a new company, they were asked whether they wanted to join the company pension scheme. Most people didn’t — they took their full pay instead and failed to save for retirement. This created a growing problem for the government: an ageing population without enough savings to maintain a comfortable lifestyle. The solution was remarkably simple. Instead of asking employees to opt in to a pension, companies began enrolling them automatically, giving them the option to opt out instead. The choice remained exactly the same, pension or no pension, but the framing made all the difference. Opting out felt like losing something, and because people are naturally loss-averse, far fewer did so. In 2012, just under 50% of employees in the private sector had a pension. By 2018, after the introduction of auto-enrolment, that number had risen to around 80%. All from a change in default wording on a form. Libertarian Paternalism – a justification Paternalism is generally considered the situation where the government interferes in our choices, for better or for worse, much like a parent telling their children what they can and cannot do. In many cases, society accepts paternalism as necessary: we ban harmful drugs, make theft illegal, and impose safety regulations. But should governments really be meddling with our personal financial decisions? Should they be influencing our choices about pensions, spending, or saving? Whether they should or shouldn’t is ultimately a political question, not an economic one. However, what we can do is consider Richard Thaler and Cass Sunstein’s explanation of why policies such as pension defaults represent something fundamentally different. When the government restricts drugs or criminalises theft, it removes our freedom to choose — these are examples of hard paternalism, enforced by law. But with pensions, the government doesn’t force participation. The choice remains entirely yours: you can stay enrolled or opt out. This preservation of choice embodies the libertarian element — the freedom to decide for oneself. At the same time, by changing how the choice is presented, such as making enrolment the default option, policymakers can dramatically alter behaviour in a direction they consider beneficial. That is where the paternalistic element comes in. According to Thaler and Sunstein, this combination of freedom and gentle guidance is what defines libertarian paternalism . In Thaler and Sunstein’s eyes, nudging individuals towards better decisions through the use of policy is better and less controversial than implementing outright bans and mandates. It respects our autonomy while encouraging outcomes that they believe will improve collective welfare. If the government genuinely believes certain decisions are in the public’s best interest, then libertarian paternalism provides a way to influence behaviour without infringing on people’s right to choose. A question of freedom I do, however, pose some questions to you. If the government can influence your decision making through manipulating people’s psychology, can it truly be called libertarian ? And more fundamentally - does the government really know best? In recent years, the 'Nudge' approach has faced criticism, particularly regarding the assumptions it makes about what constitutes a “better” decision and who gets to define it. Despite this, the research continues to shape public policy across the world — from pensions and health to energy use and education. What’s crucial is that we remain aware of the ways our choices can be influenced. Recognising these nudges allows us to make decisions that best reflect our own values, circumstances, and goals. And on a deeper level, if every choice we make can be subtly shaped by those in power, how do we ensure that nudges serve the public interest — and not the interest of those who nudge? Written by George Chant Project Gallery

Using toxins for pain management Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Anthrax Toxin Last updated: 18/09/25, 08:45 Published: 03/04/25, 07:00 Using toxins for pain management Introduction Pain is a response and signal to organisms that there is damage to the body. This could be due to an infection, tissue damage or organ damage. Different types of pain medication have been manufactured in the last decade. This includes the artificial manufacture of opioids, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, using pathogens like bacteria and other substances. Bacteria have been investigated for managing and treating pain, with varying levels of effectiveness. Research by Yang et al. (2021) has shown that bacteria can interact with organisms and communicate with the nervous system, leading to analgesia (pain relief). Bacteria can also activate nociceptors, receptors that respond to pain, to alert the organism of damage. These nociceptors can also detect bacterial processes that release pain-producing toxins. Yang et al.’s research specifically looked at the bacterial toxin Bacillus anthracis ( Figure 1 ). It is a significant factor in the spread of anthrax, an infectious disease, and their experiments showed that it can lead to analgesia, as Bacillus anthracis and nociceptors can work together to suppress pain. The experiment The experiment by Yang et al. looked at different methods to target and suppress specific nociceptive neurons to decrease pain in mammals using bacteria. The study focused on the interactions between nociceptors and Bacillus anthracis . The researchers found that Bacillus anthracis toxin was made up of three substances: protective antigen (PA), lethal factor (LF), and edema factor (EF), as shown in Figure 2 . They created edema toxin (ET) using PA and EF, and administered the ET to mice via the intrathecal route (through the spinal canal, also shown in Figure 2 ). The scientists used different doses of PA, LF and EF. The intrathecal route was used to limit the diffusion of ET to the spinal cord and sensory neurons, preventing ET from moving into other organs. The researchers then analysed the mouse neurons to compare the sequences before and after the experiments and determine the effectiveness of the treatments. The results indicated high levels of ANTXR2 receptors (high-affinity receptors for anthrax toxins), meaning the response to pain was faster. The results The researchers examined the mechanical sensitivity and thermal latency. Mechanical sensitivity is the ability to differentiate between and respond to mechanical stimuli, and thermal latency is the ability to differentiate between and respond to heat stimuli. In mammals, signs of pain can be quantified using these indicators. The higher the threshold, the lower the pain. The threshold levels of these factors were compared up to 24 hours after the injections of the PA, PA + LF and PA + EF, as shown in Figure 3. Figure 3 : Line graphs showing the results of the intrathecal injections. (A) Line graph of mechanical sensitivity thresholds after intrathecal administration. (B) Line graph of thermal sensitivity thresholds after intrathecal administration. (C) Line graph of mechanical sensitivity thresholds on the day and 24 hours after the second injection. After administration of the injections via the intrathecal route, thresholds of mechanical sensitivity, Figure 3A , were increased significantly for several hours. The injection of PA + EF resulted in the highest threshold, remaining at 1.0 g 6 hours post-injection, compared to the injections of PA and PA + LF, which both had a threshold of below 0.5 g 6 hours post-injection. The thresholds of thermal latency, shown in Figure 3B , also increased significantly for several hours. Again, the injection of PA + EF resulted in the highest latency, remaining for more than 20 seconds 6 hours post-injection, compared to the injections of PA and PA + LF, which both had a latency of below 20 seconds 6 hours post-injection. The results from Figures 3A and 3B suggest that the injections of PA + EF were the most effective in increasing the thresholds of both mechanical sensitivity and thermal latency. A second injection of ET was administered, and thresholds of mechanical sensitivity were again elevated, as shown in Figure 3C . After the second injection, the effects of pain relief were more potent. In the graph, at D2, the threshold of mechanical sensitivity 6 hours after the second injection was above 1.5 g for mice given ET, compared to below 1.0 g 6 hours after the first injection for mice given ET. This could be due to the upregulation of the ANTXR2 receptors induced by ET. Upregulation is when hormone secretion is suppressed, and the number of receptors (in this case, ANTXR2) increases, causing a faster response to the stimulus (in this case, pain). This suggests that ET can result in pain receptors being affected, leading to a faster analgesic response. The researchers concluded that this experiment did result in analgesia in mice as ET targeted specific nociceptors. The results from this experiment are significant because they indicate that pain behaviour can be blocked by intrathecal administration of a harmful bacterial toxin such as Bacillus anthracis . Conclusion Yang et al. (2021) found that the injection of the ET via the intrathecal route results in blocked pain behaviour in mice. The experiment is significant as it has shown that a harmful toxin can have positive effects. However, it is difficult to know if the effects will be replicated in humans as human trials have not yet been carried out. In addition, the sample size was very small, with a maximum of eight mice observed after each injection. This could result in high variability (the data points would be more spread out from the mean and, therefore, less consistent) and inconclusive results. Nevertheless, with further study, experimentation, and refinement of the ET via the intrathecal method, new therapies for people with pain, especially chronic pain, could be created in the future. Different dosages of the ET could be experimented upon to see whether a higher dosage has better results, with a bigger sample size, and human trials. The results from Yang et al. (2021) showed that intrathecal ET injections are promising, and if successful in humans, this method would ease the burden on healthcare systems worldwide. Written by Naoshin Haque Related articles: Ibuprofen / The Pain Gate Theory Project Gallery

Health in Syria and Lebanon are hindered by inequities and inequalities stemming primarily from warfare Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Syria and Lebanon’s diverging yet connected struggles Last updated: 05/03/26, 14:55 Published: 19/06/25, 07:00 Health in Syria and Lebanon are hindered by inequities and inequalities stemming primarily from warfare This is article no. 4 in a series about global health injustices. Previous article: Yemen- a neglected humanitarian crisis . Next article: Injustices in conflicted Kashmir . Introduction Welcome to the fourth article of the Global Health Injustices Series. The previous article discussed Yemen, specifically how the health and well-being of the population are affected by the intricate geopolitics at play. In this article, I collaborated with Jana Antar , to discuss Syria and Lebanon. Although these countries border one another, they encounter distinct challenges. Similar to previous articles, the health and wellbeing of the Syrian and Lebanese people are hindered by the inequities and inequalities stemming primarily from warfare. Impact of war on healthcare: Syria's deliberate destruction Since the onset of the Syrian conflict in 2011, the country’s healthcare system has been systematically dismantled. Beyond the direct casualties of war, the destruction of hospitals, clinics, and medical supply chains has led to a secondary crisis, one where preventable deaths become inevitable. Between 2011 and 2020, Physicians for Human Rights documented nearly 600 attacks on healthcare facilities. The deliberate targeting of hospitals and medical personnel has rendered healthcare not just a casualty of war, but a weapon of war itself ( Figure 1 ). This destruction has had catastrophic consequences. Maternal and infant mortality rates have soared, vaccination coverage has plummeted, and chronic disease management has become nearly impossible. In the northwest of Syria, where displaced populations reside in makeshift camps, infectious diseases such as cholera and tuberculosis continue to spread due to poor sanitation and lack of medical oversight. The COVID-19 pandemic only exacerbated these challenges, whereby 46% of reported cases in Northwest Syria resulted in death due to the collapse of medical infrastructure. As of early 2025, only 57% of hospitals and 37% of primary healthcare centres in Syria remain fully functional. The remaining facilities operate under severe constraints due to damage from attacks and resource shortages. In 2024 alone, there were 77 attacks on healthcare facilities, further disrupting access to trauma care, maternal health, and treatment for chronic illnesses. Overcrowding in displacement camps and poor sanitation have also heightened the risk of outbreaks such as tuberculosis, making urgent intervention critical ( Figure 2 ). Impact of war on healthcare: Lebanon's fragile healthcare system Lebanon, a country once regarded as a regional medical hub, has borne the brunt of Syria’s refugee crisis. With an estimated 1.5 million Syrian refugees seeking shelter within its borders, the country has faced a 50% surge in demand for healthcare services. The healthcare system, already strained before the crisis, has since crumbled under the weight of economic collapse, political instability, and donor fatigue. The Lebanese economic crisis, which began in 2019, had devastating effects on healthcare delivery. The Lebanese pound has lost over 90% of its value, placing essential medical supplies out of reach for hospitals and individuals. Pharmacies frequently run out of life-saving medications, power outages disrupt critical care units, and the departure of healthcare professionals has left hospitals understaffed. The situation has worsened due to escalating hostilities, starting from the south of Lebanon and later expanding, displacing over 112,000 people as of February 2025. The violence has led to the closure of 130 primary health centres and seven hospitals, with 15 out of 153 hospitals either non-functional or operating at reduced capacity. In Nabatieh Governorate alone, 40% of hospital bed capacity has been lost. Attacks on health workers and facilities continued to mount between January and November 2024, when 137 attacks were reported, nearly half of which resulted in fatalities. These disruptions create a ripple effect, limiting immediate medical care and undermining public health initiatives such as vaccination programs and maternal health services. NGOs: the last line of defence In the face of government inaction, non-governmental organisations (NGOs) have become the backbone of healthcare provision in Syria and Lebanon. International and local NGOs have mobilised to provide vaccination campaigns, mental health support, and medical supplies to those in need. For example, WHO and UNICEF have facilitated vaccination drives, reaching 250,000 children under five years old, 30% of whom were displaced Syrians. However, while NGOs have played a crucial role in mitigating healthcare crises, their efforts remain primarily reactive rather than systemic and preventative, addressing immediate needs without long-term sustainability, and not adequately focusing on precautionary measures to avoid these undesirable situations. In fact, NGOs face mounting challenges. The overwhelming demand for services, lack of sustainable funding, and security threats have made it increasingly difficult for organisations to operate. Moreover, while NGOs are stretched in their deliverables, the humanitarian workers encounter frequent targeting, making their mission even more perilous. Conclusion: the role of the international community The crises in Syria and Lebanon are not isolated events; they are a reflection of global health injustices that demand international attention and intervention. Providing short-term aid is no longer enough, so long-term solutions must be prioritised to rebuild these destroyed healthcare systems. Moreover, de-escalating both crises would improve health outcomes for the vulnerable communities in Syria and Lebanon. The next article will focus on the population in conflicted Kashmir; addressing their injustices is crucial because of the profound impact and lack of coverage in mainstream discussions. Written by Jana Antar and Sam Jarada Related articles: Understanding health through different stances / Ethnic , and Socioeconomic health equalities REFERENCES A Decade of Destruction: Attacks on health care in Syria. The IRC. 2025. Available from: https://www.rescue.org/report/decade-destruction-attacks-health-care-syria-0 The Syrian Conflict: Eight Years of Devastation and Destruction of the Health System - PHR. PHR. 202. Available from: https://phr.org/our-work/resources/the-syrian-conflict-eight-years-of-devastation-and-destruction-of-the-health-system/ Ammar W, Kdouh O, Hammoud R, Hamadeh R, Harb H, Ammar Z, et al. Health system resilience: Lebanon and the Syrian refugee crisis. Journal of Global Health. 2016 Dec;6(2). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5234495/ Lebanon 2025 Indicators and Targets Lebanon Multi-year Strategy 2023 -2025. Available from: https://reporting.unhcr.org/sites/default/files/2025-01/Lebanon%20-%20Strategy%202023%20%E2%80%93%202025_0.pdf Lebanon | Humanitarian Action. Humanitarianaction.info . 2024. Available from: https://humanitarianaction.info/document/global-humanitarian-overview-2025/article/lebanon-1 WHO. WHO’s Health Emergency Appeal 2025 [Internet]. 2025. Available from: https://cdn.who.int/media/docs/default-source/documents/emergencies/2025-appeals/2025-hea-lebanon.pdf?sfvrsn=45f2a018_5&download=true Lebanon’s Pharmaceutical Sector: Challenges, Opportunities, and Strategic Solutions. LCPS. 2025. Available from: https://www.lcps lebanon.org/en/articles/details/4903/lebanon%E2%80%99s-pharmaceutical-sector-challenges-opportunities-and-strategic-solutions Sousa C, Akesson B, Badawi D. “Most importantly, I hope God keeps illness away from us”: The context and challenges surrounding access to health care for Syrian refugees in Lebanon. Global Public Health. 2020 Jun 12;1–10. Syrian refugee access to healthcare in Lebanon - Lebanon. ReliefWeb. 2020. Available from: https://reliefweb.int/report/lebanon/syrian-refugee-access-healthcare-lebanon World. Lebanon: a conflict particularly destructive to health care [Internet]. Who.int . World Health Organization: WHO; 2024. Available from: https://www.who.int/news/item/22-11-2024-lebanon--a-conflict-particularly-destructive-to-health-care Project Gallery

The intersection of physics and religion: the redshift and expanding galaxies Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Creatio ex Nihilo: a Christian creation doctrine including physics Last updated: 09/11/25, 20:52 Published: 20/11/25, 08:00 The intersection of physics and religion: the redshift and expanding galaxies At first glance, physics seems like a fairly straightforward field. Maths is the language that explains how everything in the universe behaves in a particular way. But the more you delve into the field, the more you realise that it actually intersects with all other fields - biology, neuroscience, philosophy, religion, etc. The example covered in this article is the creation of the universe. One of the subfields of physics is cosmology - the study of the universe, or cosmos, including its origin, development and fate. The most famous piece of modern work to come out of this field is the Big Bang theory. This is the suggestion that 13.8 billion years ago, the universe started out as a very hot, very dense point smaller than the size of an atom before it suddenly and rapidly expanded - bang! Out of this came everything. Every atom for all known and unknown things in the universe, all of the laws of time and space, literally everything came into existence in a big explosion of energy. How do we know this? Well, there is evidence of the Big Bang theory all over the universe, as far as physicists can tell. Particles flying about the universe can provide information about where they came from. For example, if we study the light from other galaxies we can see that the light is ‘red-shifted’ - meaning that as the galaxies move away from us, it shows up differently on the light spectrum then it would if it was very close. Think of it like when you drop a stone in the middle of a pond. The ripples start out very close together, but as they move away from the center they stretch out. Light does the same thing and physicists can use this to determine how celestial objects are moving, which is how we know the universe continues to expand. Such evidence not only tells us a lot about the universe as it is now, but it also allows us to theorise about the universe’s beginning. Unfortunately, this then begs the question…what caused the Big Bang? Better yet, what was there before the Big Bang? Nothing? Perhaps, but then how did everything in the universe come into being from nothing? It is questions like these that create an opportunity for other fields to join the conversation. One suggested answer to this particular question comes from the long-held Christian doctrine ‘creatio ex nihilo’, which is Latin for creation from, or out of, nothing. This concept is found in Genesis 1:1, ‘In the beginning God created the heavens and the earth.’ The suggestion is that first, there was nothing (which physics cannot prove or disprove). Then, God the Creator began the act of creation, which physics describes as the Big Bang. Physics cannot prove or disprove God as Creator either. Therefore, the argument is that the creatio ex nihilo doctrine is technically a valid possibility. Regardless of whether these theories are true or not, the topic of creation is an example of how physics works with other fields like religion or philosophy. Physics cannot necessarily answer all of the big questions, but it can certainly help provide information about the universe we live in. Written by Amber Elinsky Related article: The Anthropic Principle- Science or God? Project Gallery

Not getting enough sleep can increase the risk of developing Alzheimer’s Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Sleep less…remember less: the hidden link between sleep and memory loss Last updated: 10/07/25, 18:27 Published: 17/04/25, 07:00 Not getting enough sleep can increase the risk of developing Alzheimer’s People often don’t get enough sleep for a variety of reasons, ranging from intentional choices like work or study demands (because who needs sleep when you’ve got deadlines, right?), to the growing concern with screen time (a.k.a. the “I’ll just watch one more episode” syndrome), and of course, procrastination (where your brain convinces you that 3 a.m. is a great time to suddenly get productive). But it’s not all fun and games—serious issues like insomnia, sleep apnoea, family responsibilities, or even shift work can also interfere with rest. Sleep disorders are increasingly common, with around one in three people in the UK affected, and they’re particularly prevalent among the elderly. However, not getting enough sleep can increase the risk of developing Alzheimer’s disease (AD). How do sleep disorders impact Alzheimer’s disease? Insomnia is characterised by difficulty falling asleep or staying asleep, which can lead to prolonged fatigue and memory issues. As shown in Figure 1 , people with insomnia tend to have some similarity in markers as those with Alzheimer’s disease, such as an increased level of Aβ and tau proteins in the brain. This is primarily because a lack of sleep prevents the effective removal of harmful products from the brain – this accumulation increases a person’s risk of AD. A plethora of experimental studies on humans and animals have shown that lack of sleep can lead to increased circulating levels of TNF-α and the gene resulting in more TNF-α secretion. This pro-inflammatory cytokine exacerbates AD pathology because neuroinflammation can lead to dysfunction and cell death, which are key markers of AD. Other pro-inflammatory cytokines, like IL-1, have been found to be relevant in the link between sleep deprivation and AD. Overexpression of IL-1 in the brain leads to abnormal changes in nerve cell structures especially relating to Aβ plaques. This highlights IL-1’s key role in plaque evolution and the synthesis of Amyloid Precursor Protein, which promotes amyloid production that eventually results in AD pathology. What type of sleep can impact one’s risk of Alzheimer’s disease? Studies using more objective measures, like actigraphy (which tracks sleep-wake activity), found that sleep quality (sleep efficiency) is more important than total sleep time. For example, women with less than 70% sleep efficiency were more likely to experience cognitive impairment. Increased wakefulness during the night also moderated the relationship between amyloid deposition (a hallmark of AD) and memory decline. Uncertainties… However, it remains unclear whether poor sleep directly causes AD or if the disease itself leads to sleep disturbances. Some studies suggest a bidirectional relationship. Aging itself leads to poorer sleep quality, including reduced sleep efficiency, less slow-wave sleep (SWS), and more frequent awakenings. Sleep disorders like obstructive sleep apnoea, insomnia, and restless legs syndrome also become more common with age. What are the next steps? The good news is that many sleep disorders, including insomnia, are manageable, and improving sleep quality could be a simple yet powerful way to reduce Alzheimer’s risk. Additionally, early diagnosis and treatment of conditions like sleep apnoea and insomnia may help slow or even prevent neurodegenerative changes. s researchers continue to explore the intricate relationship between sleep and Alzheimer’s, one thing is clear: getting a good night’s sleep isn’t just about feeling refreshed. It is a crucial investment in long-term brain health. Written by Blessing Amo-Konadu Related articles: Overview of Alzheimer's / Hallmarks of Alzheimer's / CRISPR-Cas9 in AD treatment / Memory erasure / Does insomnia run in families? REFERENCES Lucey, B. (2020). It’s complicated: The relationship between sleep and Alzheimer’s disease in humans. Neurobiology of Disease , [online] 144, p.105031. doi: https://doi.org/10.1016/j.nbd.2020.105031 . NHS (2023). Insomnia . [online] www.nhsinform.scot . Available at: https://www.nhsinform.scot/illnesses-and-conditions/mental-health/insomnia/ . Pelc, C. (2023). Not getting enough deep sleep may increase the risk of developing dementia . [online] Medicalnewstoday.com . Available at: https://www.medicalnewstoday.com/articles/not-getting-enough-deep-sleep-may-increase-dementia-risk#Clarifying-the-link-between-sleep-aging-and-dementia-risk [Accessed 22 Dec. 2024]. Sadeghmousavi, S., Eskian, M., Rahmani, F. and Rezaei, N. (2020). The effect of insomnia on development of Alzheimer’s disease. Journal of Neuroinflammation , 17(1). doi: https://doi.org/10.1186/s12974-020-01960-9 . Project Gallery

A scientific reflection on the humanitarian, physical, and psychological cost of war Facebook X (Twitter) WhatsApp LinkedIn Pinterest Copy link Maveerar Naal: health, trauma, and resilience amid decades of war Last updated: 05/03/26, 14:49 Published: 27/11/25, 08:00 A scientific reflection on the humanitarian, physical, and psychological cost of war Every year on the 27th of November — and throughout the month of remembrance — Eelam Tamils worldwide observe Maveerar Naal, honouring those who lost their lives during Sri Lanka’s war (1983–2009). While traditionally centred on fallen fighters, this period also serves as a vital opportunity to reflect on the epidemiology of trauma, the collapse of public health systems, and the long-term physical and psychological consequences carried by Eelam Tamil communities after more than two decades of conflict. This article reframes Maveerar Naal not only as a commemoration, but also as a scientific reflection on the humanitarian, physical, and psychological cost of war — and the resilience of those who survived it. A health system under siege From the mid-1980s onward, northern and eastern Sri Lanka experienced a chronic, escalating humanitarian emergency. Repeated mass displacement, food scarcity, blocked medical supply routes, and intermittent bombardment steadily eroded the region’s healthcare infrastructure. Clinics became inaccessible due to shelling or military restrictions, and maternal and child health services deteriorated sharply. Early epidemiological observations from the 1990s documented widespread anxiety, depression, and trauma symptoms among civilians, demonstrating that mental-health consequences were emerging long before the war’s final years. By the late 2000s, the public health crisis intensified dramatically. As the conflict entered its final phase — from late 2008 to May 2009 — more than 2.5 million people were trapped in active conflict zones, while approximately 800,000 civilians were internally displaced. Entire districts lost functional hospitals; others were forced to convert schools, churches, and tarpaulin shelters into emergency medical centres. Human resource shortages reflected the near-total systemic collapse: in some northern districts, only 34 of 108 midwife posts and 6 of 27 doctor posts remained filled. Pregnant women delivered in makeshift bunkers, neonatal mortality spiked, and infectious diseases spread rapidly through overcrowded displacement camps. For many, survival came at the cost of long-term disability, untreated injuries, and profound psychological trauma. Physical health consequences across populations The physical scars of the war persist across generations. Civilians experienced blast injuries, shrapnel wounds, burns, and amputations, often without access to timely surgical care. Emergency operations were performed in unsterile environments; in some cases, anaesthesia was unavailable, forcing staff to improvise with inadequate substitutes. Conditions in displacement camps — overcrowding, poor sanitation, contaminated water — led to outbreaks of diarrhoea, hepatitis A and E, and vector-borne diseases. For combatants, chronic health burdens are well-documented. Peer-reviewed studies, including research published in journals such as the International Journal of Social Psychiatry and the Journal of Rehabilitation Medicine , report the following long-term conditions among injured veterans: Back pain: 69.4% Knee osteoarthritis: 18.8% Hypertension: 22.4% Diabetes: 34.2% Phantom-limb pain among amputees: over 77% PTSD among amputees: ~41.7% These outcomes reflect years of untreated injuries, limited rehabilitation access, chronic stress, and long-term nutritional deficiencies. Psychological trauma and intergenerational consequences The psychological impact of the war has been profound. Medical workers described witnessing mass casualties with inadequate supplies — a situation that produced significant moral injury, compassion fatigue, and long-lasting mental-health consequences. Among severely injured fighters, mental-health assessments published in trauma and rehabilitation journals report: PTSD: 41.7% Adjustment disorder: 16.4% Depressive disorder: 15.6% Somatoform/dissociative disorders: significant prevalence Civilians exposed to high-intensity conflict show similarly alarming patterns. Studies from humanitarian organisations and academic institutions report that approximately: 64% of civilians exhibited long-term trauma-related effects 27% experienced PTSD 26% had anxiety disorders 25% had depression 18% experienced functional disability due to psychological distress Notably, emerging research has identified intergenerational transmission of trauma, with children of survivors — even those born after 2009 — displaying elevated rates of anxiety, behavioural challenges, and trauma-related symptoms. This represents a critical area for continued scientific study and intervention. Health workers on the frontline: the hidden scientific story The war’s final months produced some of the most extreme medical working conditions documented in modern conflict settings. For ethical, political, and safety reasons, this article does not name frontline medical staff; however, their experiences are well-recorded in reports by Physicians for Human Rights (PHR), Human Rights Watch (HRW), and eyewitness testimonies. One regional physician coordinated makeshift hospitals inside schools and religious buildings. With no supplies, he sterilised instruments over open flames, used sarongs as dressings, and suspended IV fluids from tree branches. He performed dozens of emergency surgeries daily, sometimes operating while artillery fire struck nearby. A field-hospital superintendent described conducting amputations without anaesthesia, supported only by volunteer nurses. When their facility was shelled — an incident documented by multiple international observers — dozens died instantly. Survivors were treated in trenches illuminated by mobile phone torches. Another medical coordinator reported overseeing triage for thousands of displaced civilians, many severely dehydrated or malnourished. He described having to prioritise patients based solely on survivability, an ethically devastating but necessary decision in conditions of extreme scarcity. PHR and HRW documented at least 30 direct attacks on hospitals between December 2008 and May 2009. These incidents — some among the most thoroughly investigated attacks on medical facilities globally — illustrate the catastrophic collapse of health infrastructure and the extraordinary resilience of those who continued to provide care. Reflection, healing, and the path ahead Maveerar Naal is, at its core, a day of remembrance. Yet for many Eelam Tamils, it is also a day of scientific reflection — a moment to acknowledge the measurable, long-term consequences of conflict on physical health, mental well-being, and community resilience. Healing requires investment in: Long-term mental-health services rooted in trauma-informed care Rehabilitation programmes for amputees and individuals with chronic injuries Public health research into intergenerational trauma Accessible healthcare for survivors living in diaspora communities Preservation of evidence and health data for historical and scientific record By understanding the epidemiology of suffering, communities can better design strategies for recovery. By recognising the extraordinary resilience of civilians, fighters, and health workers, they honour all forms of courage. And by grounding remembrance in scientific truth, Maveerar Naal becomes not only a memorial, but a commitment to protecting health, dignity, and humanity for future generations. In remembering the past, we build the foundation for a more compassionate, prepared, and resilient future. Written by Jeevana Thavarajah Related articles: Impact of war on health (series) / South Asian Mental Health / Ethnic Health Inequalities REFERENCES Amnesty International (2009) Sri Lanka: Twenty Years of Make-Believe. Available at: https://www.amnesty.org/en/documents/asa37/005/2009/en/ BBC News (2009) Sri Lanka shells no-fire zone. Available at: http://news.bbc.co.uk/2/hi/south_asia/8046136.stm Catani, C. et al. (2008) ‘War trauma, child abuse and PTSD in Sri Lankan children’, Journal of Child Psychology and Psychiatry . Available at: https://pubmed.ncbi.nlm.nih.gov/18673497/ Channel 4 News (2011) Sri Lanka’s Killing Fields. Available at: https://www.channel4.com/news/sri-lankas-killing-fields Fernando, G. and Ferrari, M. (2013) ‘Short- and long-term psychological effects of war in Sri Lankan populations’, Asian Journal of Psychiatry . Available at: https://pubmed.ncbi.nlm.nih.gov/23885541/ Human Rights Watch (2009) Sri Lanka: Repeated Shelling of Hospitals. Available at: https://www.hrw.org/news/2009/05/08/sri-lanka-repeated-shelling-hospitals International Committee of the Red Cross (ICRC) (2014) War injury rehabilitation and prosthetics – Sri Lanka. Available at: https://www.icrc.org/en/document/sri-lanka-prosthetics-rehabilitation International Crisis Group (2010) War Crimes in Sri Lanka. Available at: https://www.crisisgroup.org/asia/south-asia/sri-lanka/war-crimes-sri-lanka Office of the High Commissioner for Human Rights (OHCHR) (2015) OISL Report: Sri Lanka. Available at: https://www.ohchr.org/en/hr-bodies/hrc/oisl-sri-lanka Physicians for Human Rights (PHR) (2009) PHR calls for inquiry into detention of doctors and war crimes in Sri Lanka. Available at: https://phr.org/news/phr-calls-for-inquiry-into-detention-of-doctors-and-war-crimes-in-sri-lanka/ Project Gallery