Government orders review of approval system for health products in response to supplement-related illnesses.
Health officials in Japan have raided a factory belonging to Kobayashi Pharmaceutical after the drugmaker reported a fifth death possibly linked to its dietary supplements advertised as helping to lower cholesterol.
On Saturday, officials from the ministries of health, labour and welfare as well as local authorities inspected the facility in the city of Osaka that had made the supplements containing an ingredient called red yeast rice, or “beni koji”.
Kobayashi said on Friday that five people had died and 114 people were being treated in hospitals after taking the products. Japan’s Ministry of Health says the supplements are responsible for the deaths and illnesses, and warned that the number of those affected could increase.
The company has said that little is known about the exact cause of the illnesses, which include kidney failure. An investigation into the products is under way in cooperation with government health authorities.
A Japanese pharma company has recalled health supplements containing an ingredient called red yeast rice after deaths and hospitalisations [Reuters]
Reports of health problems surfaced in 2023, although “beni koji” has been used in various products for years.
“Beni koji” contains Monascus purpureus, a red mould that is also used as a red colouring in some foods.
The products were recalled on March 22, two months after the company received official medical reports about the problem. The company’s president, Akihiro Kobayashi, has apologised for not acting sooner.
The supplements could be bought at pharmacies without a prescription. Kobayashi said about a million packages were sold over the past three fiscal years. It also sold “beni koji” to other manufacturers, and some products were exported to countries like China and Taiwan.
The government has ordered a review of the approval system for health products in response to the supplement-related illnesses. A report is due in May.
A Chinese consumers association on Friday urged consumers to stop usage, saying it was concerned about the risk of Kobayashi products, state media reported.
Kobayashi Pharma has recalled cholesterol-lowering supplements with red yeast rice over possible link to kidney disease.
A Japanese drugmaker whose dietary supplements are at the centre of a growing health scare has reported two more deaths potentially linked to a pill that lowers cholesterol.
Thursday’s announcement by Kobayashi Pharmaceuticals brings the total number of deaths under investigation by the company and health ministry to four, with more than 100 people hospitalised.
Japan’s Prime Minister Fumio Kishida told parliament on Thursday that “we need to make clear the cause [of the illnesses] and consider various responses if necessary”.
He was responding to an opposition politician who urged him to revise safety frameworks that were relaxed under former Prime Minister Shinzo Abe.
Last week, Kobayashi recalled three of its supplements, including Beni Koji Choleste Help, after about 106 customers were hospitalised because of kidney problems.
The over-the-counter products contain an ingredient called red yeast rice, or “beni koji”, which is supposed to help lower bad cholesterol.
The company said on Thursday that it was in the “process of confirming the facts and causal relationships” in the two additional fatalities and “decided to make this report public from the viewpoint of prompt disclosure”.
“Beni koji” contains Monascus purpureus, a red mould that is also used as food colouring.
Public concern
Government spokesman Yoshimasa Hayashi said at a media conference that the government has urged the pharma company to take “swift and serious action toward determining the cause” and disclose relevant information as “concern among the public is spreading”, Japan’s Kyodo news agency reported.
The Osaka-based drugmaker has yet to pinpoint a specific cause but said there was a possibility that the products contained “ingredients we had not intended to include”.
The fermentation process can produce a toxin called citrinin which can damage the kidneys, however, the company said its analysis did not detect any citrinin.
Medical studies describe red yeast rice as an alternative to statins for lowering high cholesterol, but also warn of a risk of organ damage depending on its chemical makeup.
In addition to the supplements, more than 40 products from other companies containing “beni koji”, including miso paste, crackers and a vinegar dressing, have been recalled, the health ministry said.
Hayashi said Japan was sharing information with the World Health Organization and relevant countries after online sales of products subject to the drugmaker’s voluntary recalls were suspended in China, while products have also been removed from circulation in Taiwan.
The company supplies red yeast rice to some 50 firms in Japan and two in Taiwan.
A Kobayashi executive said last week that the company first received complaints about kidney problems in January.
Kate Middleton, the Princess of Wales, has disclosed that she has cancer and is undergoing chemotherapy.
Here is what is known so far:
What did Kate say?
On Friday afternoon, Kate released a video update regarding her health. The message, recorded on Wednesday, was broadcast two days later.
It came after weeks of speculation about her whereabouts and health since she was hospitalised in January.
“In January, I underwent major abdominal surgery in London and at the time, it was thought that my condition was non-cancerous,” Kate said.
“The surgery was successful. However, tests after the operation found cancer had been present. My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment.”
She explained her diagnosis was a “huge shock”.
“As you can imagine, this has taken time. It has taken me time to recover from major surgery in order to start my treatment. But, most importantly, it has taken us time to explain everything to George, Charlotte and Louis in a way that is appropriate for them, and to reassure them that I am going to be OK,” Kate added, referring to her three children with Prince William, the eldest son of King Charles and heir to the British throne.
Prince George is 10 years old; Princess Charlotte, 8; and Prince Louis, 5.
Kate didn’t reveal what type of cancer she had been diagnosed with, while she also asked for space and privacy.
“We hope that you will understand that, as a family, we now need some time, space and privacy while I complete my treatment,” she explained.
“My work has always brought me a deep sense of joy and I look forward to being back when I am able, but for now I must focus on making a full recovery.”
From left: Prince George, Prince Louis and Princess Charlotte leave Buckingham Palace [File: Alastair Grant/AP]
The cancer diagnosis is the latest in a series of health challenges that the royal family has had to battle.
King Charles was diagnosed with cancer in February, less than 18 months after succeeding his mother Queen Elizabeth following her death in September 2022. He has since stepped back from public engagements. Buckingham Palace has not said at what stage his cancer was found.
On January 21, Prince Andrew’s ex-wife, Sarah, Duchess of York, said she had malignant melanoma, a form of skin cancer.
What kind of surgery did Kate have on January 16?
Kate, 42, had what was described as abdominal surgery on January 16. The news wasn’t announced until the next day when Kensington Palace revealed that the princess was recovering from a planned operation.
At the time, officials said her condition wasn’t cancerous but did not specify what kind of surgery she had, saying only that it was successful. They also explained she was unlikely to return to public duties until after Easter, which falls this year on March 31.
Kate was released from the London Clinic, a private hospital located near Regent’s Park in the heart of the UK capital, on January 29. Following her discharge, she went back to Windsor, which is situated to the west of London, to further her recuperation.
Charles was discharged from the same hospital on the same day as Kate.
What happened next after leaving the hospital on January 29?
Despite the palace explaining the timeline of the princess’s recovery, Kate’s health and location triggered huge speculation. Kate made her first public appearance on March 4 when she was spotted in Windsor. She was seated in the front passenger seat of a car driven by her mother, Carole Middleton.
What about the Mother’s Day picture on March 10?
The speculation continued to grow and amid a social media frenzy, Kate and William published an official photograph of her and her three children on Mother’s Day – celebrated on March 10 in the UK.
But instead of ending the speculation, it fuelled it further, after news agencies retracted it because it appeared to have been manipulated. A day later Kate admitted that she had edited the photograph, and apologised.
Like many amateur photographers, I do occasionally experiment with editing. I wanted to express my apologies for any confusion the family photograph we shared yesterday caused. I hope everyone celebrating had a very happy Mother’s Day. C
— The Prince and Princess of Wales (@KensingtonRoyal) March 11, 2024
She was later photographed alongside her husband in a car departing Windsor Castle.
“First of all, why in this current climate do you think you can release a manipulated image and get away with it,” Afua Hagan, journalist and royal commentator, told Al Jazeera.
“But what really baffles me is Kate didn’t do this alone. She has a team around her,” Hagan said.
“There is also an issue with the public relations and communications team, which has badly let you down. Your team has thrown you under the bus, Princess of Wales, and you are taking the blame,” she added.
Is it unusual to find cancer after surgery?
While it’s rare to find cancer after surgery for a noncancerous problem, it does happen in about 4 percent of such surgeries, said Yuman Fong, a surgeon at the City of Hope cancer centre in Southern California.
“That 4 percent figure represents someone who’s going to the operating room for what is thought to be benign disease such as a procedure to remove the gallbladder or ovarian cysts,” Fong said.
What kind of treatment is Kate having?
The palace statement said no details would be provided about her cancer or her treatment, other than that she started it in late February.
After successful surgery, chemotherapy is often used to help kill any stray cancer cells and to prevent the cancer from coming back. Treatments have evolved, and when chemotherapy is used now, it’s sometimes for shorter periods or lower doses than it once was.
“Fatigue, nausea, tingling in the hands and feet, and sometimes hair loss are side effects of chemotherapy,” said Monica Avila, a doctor at Moffitt Cancer Center in Tampa, Florida. “But there are medications for improving these side effects. And cold caps that cool the scalp can prevent hair loss,” Avila said.
“A patient can take anywhere from a few weeks to a month or two to recover from those effects,” Avila added. Numbness and tingling can take longer to disappear, she added.
Is it unusual to find cancer in someone young?
Cancer is rare in young adults. But in developed countries, rates of some cancers are rising among younger adults. Kate is 42.
“We hate it when young people get cancer, but at the same time, they are the ones that recover best,” Fong said.
According to Macmillan Cancer Support, “about 393,000 people in the UK are given the news that they have cancer” every year. According to the centre, in the UK on average someone is diagnosed with cancer at least every 90 seconds.
And about 167,000 people die from cancer every year in the UK, an average of “460 people every day”.
What have been the reactions after Kate’s announcement?
Prince Harry and his wife Meghan, who have been estranged from William and Kate since their move to California in 2020, wished the princess well.
“We wish health and healing for Kate and the family, and hope they are able to do so privately and in peace,” they said in a statement.
Kate’s brother James Middleton also offered his support, with a photo of the two of them when they were children.
“Over the years, we have climbed many mountains together. As a family, we will climb this one with you too ⛰️❤️”
King Charles said he was very proud of Kate for speaking about the cancer.
Charles is “so proud of Catherine for her courage in speaking as she did” and has “remained in the closest contact with his beloved daughter-in-law throughout the past weeks,” after they spent time in hospital together, a Buckingham Palace spokesperson said.
Charles and his wife Camilla “will continue to offer their love and support to the whole family through this difficult time,” the spokesperson added.
Prime Minister Rishi Sunak said Kate “has the love and support of the whole country”.
In a post on X, US President Joe Biden said he and First Lady Jill Biden “join millions around the world in praying for your full recovery, Princess Kate”.
Jill and I join millions around the world in praying for your full recovery, Princess Kate. https://t.co/jtLp8Uo23d
US research agency finds no ‘biological abnormalities’ in US officials reporting incidents, but says symptoms are real.
The National Institutes of Health (NIH) in the United States has found no evidence that government employees reporting symptoms of the “Havana Syndrome” suffer from “biological abnormalities”, including brain injury.
In a statement announcing its study on Monday, the US medical research agency stressed that, despite its findings, the unexplained ailments “are very real”.
First reported in the Cuban capital Havana in 2016, the syndrome results in vertigo, headaches, cognitive dysfunction and ear-ringing. Since then, US foreign service and intelligence personnel have reported enduring such symptoms across the world.
“Using advanced imaging techniques and in-depth clinical assessments, a research team at the National Institutes of Health found no significant evidence of MRI-detectable brain injury, nor differences in most clinical measures compared to controls, among a group of federal employees who experienced anomalous health incidents (AHIs),” the NIH said in a statement on Monday.
The study compared test results and MRI imaging between healthy volunteers and more than 80 US government employees and their relatives who are experiencing “anomalous health incidents”.
“The researchers were unable to identify a consistent set of imaging abnormalities that might differentiate participants with AHIs from controls,” the NIH said.
The administration of US President Joe Biden had vowed to work “tirelessly” to tackle Havana Syndrome.
In November 2021, Secretary of State Antony Blinken appointed two officials to lead the government’s response to the issue, calling it an “urgent priority” for Washington.
Earlier that year, possible “Havana Syndrome” cases at the US embassy in Hanoi led to Vice President Kamala Harris delaying a visit to Vietnam by three hours.
There had been early speculations that the symptoms may be caused by microwaves deliberately targeting US officials abroad.
But several US intelligence agencies concluded last year that it was “very unlikely” that a foreign adversary was responsible for Havana Syndrome. Their findings were released in a report by the National Intelligence Council.
Still, US officials have sought to acknowledge that those reporting symptoms are indeed suffering from ailments.
Carlo Pierpaoli, a lead author on the NIH study, said lack of evidence of difference in neurological imaging between healthy individuals and those experiencing AHIs “does not exclude that an adverse event impacting the brain occurred” in people with Havana Syndrome symptoms.
“It is possible that individuals with an AHI may be experiencing the results of an event that led to their symptoms, but the injury did not produce the long-term neuroimaging changes that are typically observed after severe trauma or stroke,” Pierpaoli said in a statement.
“We hope these results will alleviate concerns about AHI being associated with severe neurodegenerative changes in the brain.”
Rafah, Gaza – The loss of nine-year-old Yazan, or Yazouna as his mother called him, hangs like a dark cloud over the el-Kafarna family’s tiny living space.
They huddle together in a shelter that Sharif el-Kafarna rigged up out of bits of wood, cardboard and sheeting in front of the third-floor door to the elevator in an UNRWA school in Rafah.
It is tidy inside and a string of Ramadan bunting hangs on one wall, but nothing can hide the fact that the family of five sleeps, prays, eats and spends all day in a space about eight metres square (80 feet square).
Breaking down, his mother wept: “This is our first Ramadan without Yazan, God has ordained this for us and we cannot complain, we can only praise him and have faith.”
Yazan died on March 4 at the Abu Youssef al-Najjar Hospital in Rafah, hooked up to breathing machines and IV drips, his body having wasted away to nothing during five months of relentless war during which his family ran from one supposed “safe place” to another, terrified, destitute and hungry.
He would have turned 10 on June 4.
Yazan’s family spend all their time in the cramped shelter his father was able to build in front of an elevator door on a school landing [Screengrab/Sanad/Al Jazeera]
A protected childhood
Yazan was diagnosed with cerebral palsy as a month-old infant, amid an earlier Israeli assault on the Gaza Strip in 2014.
His parents took great pains to structure his life in Beit Hanoon where they lived before the war so he had the food, supplements and healthcare he needed.
“Yazan needed special vitamin mixes for his mental acuity and these injections to keep his body strong, as well as physiotherapy which he needed regularly.”
“He needed healthy food as well, eggs, vegetables, fruits, dairy. He would also eat baby cereal and we would puree foods for him so he could eat,” his father, Sharif said.
He also received physiotherapy at home by therapists from various associations who would visit the family home regularly. There were also therapists who worked with him to provide psychological support and some basic learning.
“He enjoyed his sessions, you could see it in his eyes. He would smile, sometimes he’d clap, too, and his eyes would follow what was happening, like the trainers talking to him or shows on a screen that we’d show him,” his father said.
The little boy was thriving, and his parents celebrated him as much as they protected him.
Yazan’s mother broke down as she spoke to Al Jazeera about the loss of Yazan [Screengrab/Sanad/Al Jazeera]
“We’d have birthday parties for Yazan. He would smile, he would clap when he heard music, he was moving well, thank God.
“We’d do the whole thing, with a birthday cake and party food, just like we did for the other kids,” his mother said.
Understanding and love
The couple has three surviving children, eight-year-old Mouin, four-year-old Wael and four-month-old Mohamed, who was born weeks after Israel began its assault on Gaza on October 7.
Mouin was the closest of the brothers to Yazan, his mother told Al Jazeera.
“He would sit with him and watch him for me when I had to be in another room. He didn’t change his diapers or anything like that, but he would spend hours with him just watching something or chattering,” she said.
Because Yazan could not speak, he made different sounds depending on what he needed, his father said.
“I couldn’t understand what he wanted to, well, his mum was the one who knew what he wanted based on the sound he was making,” he said.
Yazan’s mother smiled fondly at the memory of her relationship with her eldest.
“He was closer to me … such a good kid, our relationship was great and I always understood him. He’d make a particular noise when he was hungry, another one if he was startled.
Yazan’s father, Sharif, is still devastated at what happened to Yazan [Screengrab/Sanad/Al Jazeera]
“I took him with me everywhere, to market, to my family’s places, he just came along. We went to the beach, too, but I didn’t put him in the sea because I always worried he’d get too cold, I’d just bathe him in the tub.”
Memories of that past life bring fleeting smiles to her face as she describes their two-bedroom home with its big living room and kitchen where the children had space to play – now they huddle with their parents in a tiny space all day.
“Fridays we’d have a big family meal, then take our afternoon siestas and go out to visit our families, either we’d go to my family or to my in-laws’,” she said.
Sharif used to work as a driver, earning enough money to provide everything the family needed, especially Yazan.
“I tried to do the same here,” he said. “We’re from Beit Hanoon, we were displaced to Jabalia, then Nuseirat, then Deir el-Balah, and when we got here, I made sure we had our own space, so Yazan would be as comfortable as I could manage for my son,” Sharif continued.
War brings the beginning of the end
“I was so happy when I was watching my son growing day by day when he had the food and medicines he needed. But then when the war started, he couldn’t get the treatment or the right food any more,” Sharif said.
Yazan was alert and thriving before the war, thanks to his family’s efforts to take care of him [Courtesy of the el-Kafarna family]
They tried, he continued, as hard they could to secure what Yazan needed to survive – soft, nutritious food that could be eaten by the little boy – but first, the supplies dwindled, then the black market prices rose alarmingly, then finally, there was no more of the food to be found.
Yazan’s health began to deteriorate in front of his parents’ horrified eyes as they carried him in their arms from one supposed “safe” place of displacement to another.
No amount of softened bread scraps they gathered for him could help keep him alert and strong, and his already thin frame began to waste away.
“He started to deteriorate day after day. We didn’t have enough medicine so I’d try to skip days to make what we had stretch further,” his father said sadly.
“We took him to the hospital and he lived his last days on life support at Abu Youssef al-Najjar Hospital. By then he was no longer able to respond to anything, not even his mother.”
Yazan spent 11 days in the hospital before he died on March 4.
“I can never forget Yazan,” his mother said, in tears.
“He’s in my heart and mind every minute of every day. Look at what’s happening to our children!”
People and Power travels to Zambia to investigate one of the world’s worst ‘sacrifice zones’.
Around the world, tens of millions of people live in so-called “sacrifice zones”, areas which have become permanently impaired by environmental degradation, mostly due to pollution from heavy industry. One of the worst such sacrifice zones is in Kabwe, Zambia.
Here, 220,000 residents live close to an old lead and zinc mine which operated for almost a century. Although the mine closed in 1994, many residents say their children are now suffering from the effects of lead poisoning, and are seeking compensation.
Some 9,000 doctors walked off the job two weeks ago over government plans to increase medical school admissions.
South Korea has said it will suspend the licences of trainee doctors who have ignored an ultimatum to end a strike over government plans to increase medical school admissions.
About 9,000 junior doctors walked out on February 20, leading to the cancellation of some operations and treatments as well as hampering the operation of hospitals’ emergency units.
On Monday, Health Minister Cho Kyoo-hong said the authorities would visit hospitals to find out whether the doctors had returned to work and “take action according to the law and principle without exception”.
Speaking in a televised briefing, he said those who had not returned “may experience serious problems in their personal career path”.
The doctors taking strike action are a fraction of South Korea’s 140,000 doctors. But they account for as many as 40 percent of the total doctors at some major hospitals.
Thousands took to the streets of Seoul on Sunday at a mass rally organised by the Korean Medical Association (KMA), which represents private practitioners, defying a February 29 government deadline for them to return to work or face legal action, including possible arrest.
The doctors say the government should first address pay and working conditions before trying to increase the number of physicians.
“The government is pushing the reforms unilaterally and that, the doctors cannot accept under any circumstances”, Kim Taek-woo of the Korea Medical Association told the crowd of protesters, who wore black masks.
Under South Korean law, doctors are restricted from taking strike action.
“The government is very aware of the reasons why all doctors are opposing the increase in the medical school admissions but are exploiting policies to turn doctors into slaves forever.”
Thousads of doctors have joined the strike against a government plan to make more places available at medical schools [Jung Yeon-je/AFP]
The government says the move to increase the number of students admitted to medical schools by 2,000 from the 2025 academic year is necessary because of the rapidly ageing population and the country’s low number of doctors to patients. At 2.6 doctors per 1,000 people, South Korea’s rate is one of the lowest in the developed world.
The plan to boost medical school admissions is popular with the public, with about 76 percent of respondents in favour, regardless of political affiliation, according to a recent Gallup Korea poll.
President Yoon Suk-yeol has taken a hard line on the strike and has seen his approval ratings climb as the standoff drags on.
With legislative elections in April and Yoon’s party looking to win back a parliamentary majority, the government is unlikely to compromise quickly, analysts said.
But doctors have also pledged not to back down, saying the government’s plan did not address the sector’s real problems.
“We have nowhere to retreat any more. We will not just sit idly by the government acting undemocratic,” Lee Jeong-geun, the interim head of the KMA, said at Sunday’s protest.
In 1950, Roald Dahl wrote a short story titled Poison. The tale, set in colonial India and often found in deckle-edged children’s anthologies, tells a riveting story about racism.
In the story, a striped snake called a common krait slithers on the stomach of one of the main characters. The journey to save the character from the krait’s bite brings the plot to a panicky crescendo, to reveal that the poison was racism all along.
The krait possibly worked as an excellent metaphor because the fear of poisonous snakes is very real and pervasive in India, among other South Asian countries including Pakistan, Nepal and Sri Lanka.
Hence, snakes have slithered their way into folklore, pop culture and media, but incidents of venomous bites may also be rising.
The World Health Organization estimates that 5.4 million people worldwide are bitten by snakes each year – half of those by venomous snakes, causing 100,000 deaths.
Snakebites in South Asia contribute to almost 70 percent of these deaths. Research from India alone indicates that 58,000 deaths result from about one million cases of snakebite envenoming there each year, the WHO said. Worryingly, this is likely to rise. A 2018 study from the University of Kelaniya in Sri Lanka also concluded that climate change is likely to increase the number of snakebites.
The WHO announced last year that it is stepping up its work to prevent snakebites in South Asia, which it describes as a “biodiversity hotspot for venomous snakes, and is also home to some of the world’s most densely packed agrarian communities”.
Where do snakebites occur most frequently in South Asia?
Data about snakebites in South Asia is patchy, a fact which prompted the WHO to add snakebite poisoning to its list of neglected tropical diseases in June 2017.
No official data has been available from Pakistan since 2007, when 40,000 snakebites occurred, killing 8,200 people, according to the WHO.
Nepal’s official Ministry of Health and Population does not have official data for snakebite deaths, either. However, a study carried out by doctors in Nepal showed that 40,000 people are bitten by snakes every year there, too, of whom about 3,000 die.
The WHO estimated that 33,000 snakebites in Sri Lanka between 2012 and 2013 had resulted in 400 deaths.
It is thought that these numbers are severely underreported, however, due to the lack of research into snakebites in South Asia. “Because they’re underreported, it’s thought to be maybe not as large of an issue,” said Rmaah Memon, a resident physician at Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women’s Hospital.
Furthermore, as the study from the University of Kelaniya suggests, snakebites in Sri Lanka may already be increasing. That study carried out climate change projections and estimated that the annual snakebite burden could increase by 31.3 percent over the next 25 to 50 years.
The common krait, one of the ‘big four’ snakes in India [Shutterstock]
Which snakes are the most common?
Common species of snakes found in Pakistan and India include the big four: the common krait, Russell’s viper, saw-scaled viper and the Indian viper (naja naja).
Other species include the king cobra, which averages 3-3.6 metres in length but can grow as large as 5.4 metres. It is found in northern India and also in Nepal alongside the banded and common kraits, green pit vipers, checkered keelbacks and the Nepal kukri snake.
In Sri Lanka, species of Russell’s viper and the common krait are found, as well as the Indian python.
The king cobra can be found in northern India and Nepal [Shutterstock]
How dangerous are snakebites?
Of the 5.4 million snakebites which occur each year, 1.8 to 2.7 million result in “envenoming”. Envenoming is when the poison from a snakebite results in a possibly life-threatening disease.
“Snake venom can kill the victim from a few minutes up to two to three hours if not treated in time,” said Sadanand Raut, a doctor who, along with his wife Pallavi Raut, has made it his mission to prevent snakebite deaths entirely in the Narayangaon region of India’s Maharashtra state. Raut is also a member of the WHO roster of experts for snakebite envenoming.
Raut explained that the type of snake venom depends on the species of snake. He said that Indian cobras have very quick-acting neurotoxic venom, which means it has a paralysing effect that can cause symptoms minutes after the bite.
While krait bites inject the same type of venom, it may take longer – four to six hours after the bite – for symptoms to show. Krait bites might not hurt initially, but cause issues such as an inability to open the eyes, difficulty in breathing and cardiac problems when left untreated, Raut added.
Other snakes such as Russell’s vipers and saw-scaled vipers release vasculotoxic venom. These snakebites are very painful and result in necrosis, which means death of the body tissue. Raut explained that vasculotoxic venom can result in the thinning of the blood and can even lead to kidney failure. The symptoms can begin to show within minutes of the bite.
The Russell’s viper releases a vasculotoxic venom which can result in necrosis – the death of body tissue [Shutterstock]
What happens when a snake bites you?
The effects of a poisonous snakebite can be terrifying, according to those who have survived.
Kabiraj Kharel was about 18 years old when a krait bit his right hand. Kharel, now 50, whose family are farmers, had been removing ears from a batch of corn at his home in Sagarnath, Nepal, close to the Indian border, when he noticed the bite.
Kharel recalled feeling terrified. “I thought I was going to die,” he told Al Jazeera. He rushed to get medical help.
The nearest hospital was 25km (15.5 miles) from his house. Kharel said that he was aware of his surroundings for the first 20km, then his eyes and tongue began to tingle and go numb. After that, he lost consciousness.
Venomous snakebites can cause difficulty in breathing, an inability to open the eyes and cardiac problems. Symptoms can be felt quicker with some types of snakes – for example, Indian cobras – than others such as kraits.
If a venomous snakebite is left untreated or is treated too late, it can result in paralysis, breathing difficulties, bleeding disorders and kidney failure. Sometimes, the tissue damage can be bad enough to merit the amputation of a limb, resulting in permanent disability. Snakebites that are left untreated or are treated too late can prove fatal as well.
Kharel regained consciousness after being given doses of antivenom at the hospital. He woke up disoriented. “I thought to myself, ‘Where am I?’”
Jignasu Dolia, a wildlife biologist and conservationist in northern India’s Uttarakhand area, who carries out conservation-based research on king cobras, explained that not all snakebites result in envenoming, in fact about half of king cobra bites are “dry bites”, which means the snake does not inject any venom or may only inject small, non-lethal quantities.
However, all snakebites should be considered venomous until proven otherwise and victims should be taken immediately to a hospital emergency room.
A snake is ‘milked’ for its venom [Shutterstock]
How does antivenom work?
Dolia explained that antivenom is produced by “milking” venom out of snakes, injecting a small amount into an animal, usually horses, and harvesting the antibodies produced to refine them into the antidote.
Pakistan has, in the past imported antivenom from India, said Memon.
Memon said that the antivenom does not work as well on snakebites in Pakistan, even for the same species of snake, due to slight variations in geography and diet.
Can people easily access antivenom?
Awareness is a serious issue. Memon cited a 2000 study which showed that 44.5 percent of people interviewed in rural Sindh were unaware that antivenom even existed.
In rural Pakistan and India, in particular, there is often a significant time delay between snakebites and treatment for victims.
Memon added that people in rural Pakistan and India sometimes delay going to hospital because they prefer to visit local natural healers instead. While natural healers are important figures in local communities, they do not have access to the necessary antivenom.
This also results in the underreporting of snakebite cases. “Because they’re underreported, it’s thought to be maybe not as large of an issue,” said Memon.
She added that antivenom production across South Asia needs to be improved. In Pakistan, only one authorised site of antivenom production exists – Islamabad’s National Institutes of Health (NIH).
Antivenom is very expensive, so making it more affordable would also be a step in the right direction, she said. Most antivenom also needs to be refrigerated, which can be a problem in Pakistan where there are electricity outages, especially during the monsoon season. “Creating a kind of composition of antivenom that does not need refrigeration would be ideal.”
How is climate change affecting snakebites?
Climate change is another major issue. Research by Emory University, published in July 2023, showed a considerable increase in the likelihood of being bitten by a snake for every degree Celsius that daily temperatures increase.
There are many different species of snake and optimal living conditions vary for each, which is why it is hard to predict or even generalise about the effect of global warming on snakes generally.
Rising temperatures, however, are known to make habitats for some species of snake unsuitable for them. Conditions can become too dry for snakes to thrive, explained Michael Starkey, conservation biologist and founder of Save the Snakes, a California-based organisation dedicated to conserving snakes and mitigating human-snake conflict.
This can cause snakes to move to areas where conditions are better – often areas where humans are living, thus increasing the likelihood of humans and snakes interacting.
Human encroachment into the natural habitat of snakes has caused a rising incidence of snakebites [Shutterstock]
Some snakes may adapt to changing weather conditions while others may run out of suitable habitats altogether, eventually going extinct.
A rise in temperature is not the only climate change effect that could be causing an increase in human-snake interactions, resulting in more snakebites.
Following record-breaking rain in Pakistan in 2022, for example, Save the Children released a report stating that 54 percent of flood-affected families in Pakistan were sleeping outside in tents or makeshift shelters.
The report added that children sleeping without adequate shelter faced an increased risk of dangerous snakebites since stagnant water attracts venomous snakes.
Since climate-induced habitat loss is causing snakes to migrate, “believe it or not, they’re stressed out”, said Starkey. This may possibly explain more erratic behaviour that would lead to a higher number of venomous snakebites.
Starkey added that snakes are also losing their habitats to the construction of urban infrastructure which encroaches on their territory.
All of these things are a threat to snakes’ existence.
Why do we need snakes?
Experts say that it is essential for humans to learn to coexist with wildlife better, including with snakes, for their own benefit.
Snakes can actually be very helpful to humans. They typically eat rats and rodents and also serve as prey for hawks, owls and larger snakes. If snakes die out, the food chain and ecosystem will fall out of balance.
“They’re a pest control service and help with our ecosystems,” explained Starkey.
Globally, rodents destroy 20 to 30 percent of crops each year, according to the International Rice Research Institute, which says it is dedicated to abolishing poverty and hunger among people and populations that depend on rice-based agrifood systems.
A viper common in South Asia eats a white rat [Shutterstock]
Rodents also carry ticks that carry bacteria which causes Lyme disease. The ticks infect people by biting them, causing symptoms such as a fever, rash, joint pains and headaches. Researchers at the University of Maryland in the United States in 2013 found a link between the decline of rattlesnakes and a rise in Lyme disease.
Furthermore, killing snakes puts people at higher risk of being bitten. This is because the closer humans are to snakes, the more likely snakes are to act in defence and bite.
Dolia explained that king cobra bites are rare, at least in India. The few deaths that have been recorded due to envenoming by this snake have “usually occurred as a result of rescuers mishandling the snake”.
Dolia added that king cobras, which are endangered, usually eat other snakes, including venomous ones such as other types of cobra, which are known to cause many human fatalities.
So, how do we prevent snakebites and protect snakes?
Awareness of simple measures that will prevent snakes from entering homes or getting into crops will help, said Starkey. These include keeping grains in airtight containers so they do not attract rodents which in turn, attract snakes. General pest control around properties may also help.
There needs to be more awareness about what treatment to seek, said Memon, whose own grandfather died from a snakebite near the family home in Tharparkar in the southern Sindh province.
Instead of visiting doctors, people in South Asia rush to natural healers to treat snakebites. This leads them to miss the “golden window of time” to treat the bites quickly, explained Raut, adding that awareness should be spread in schools, rural centres, tribal institutes and medical institutions.
Memon said that the production of antivenom needs to be ramped up throughout South Asia, adding that making it more affordable would be a step in the right direction.
Most antivenom also needs to be refrigerated, which can be a problem in Pakistan where there are electricity outages, especially during monsoon season. “Creating a kind of composition of antivenom that does not need refrigeration would be ideal.”
This week, more than 40 organisations working on health justice around the globe put out an urgent call to the global health and human rights community. In an open letter, we issued a call to global health bodies, health institutions, professional associations and the World Medical Association (WMA) to take immediate action on the Israeli government’s continuing onslaught on Gaza – because the war on Palestine is an issue of health justice, too.
Israel’s onslaught – which the International Court of Justice (ICJ) has ruled “plausibly” meets the conditions of genocide – has claimed the lives of more than 30,000 Palestinians in less than five months. This means that since October 7, the Israeli military has killed 250 Palestinians on average per day – a higher death rate than any other 21st-century conflict. Additionally, more than 70,000 Palestinians have been wounded and over a million have been displaced.
Israel’s deliberate targeting of hospitals across Gaza – considered a war crime under international law – undoubtedly contributed to this staggering death toll. At the time of writing, only 11 out of Gaza’s 35 hospitals are partially functional.
Israel has destroyed much more than Gaza’s hospitals. The targeting of laboratories, other health facilities, ambulances, doctors, nurses and patients, coupled with the blockade on lifesaving medical supplies, has put a wrecking ball through Gaza’s entire health system and left 2.2 million people with little access to healthcare at a time they are facing near constant, indiscriminate bombardment and the threat of famine. Since the beginning of the war, at least 337 health workers have been killed, including two of only four pathologists in Gaza.
People suffering from chronic illnesses are unable to access vital medicines, and disease is spreading at an unprecedented rate amid a sanitation crisis caused by a severe lack of access to clean water. The World Health Organization (WHO) has described the state of healthcare in Gaza as being “beyond words”.
Research published by the Johns Hopkins Bloomberg School of Public Health in the United States and the London School of Hygiene & Tropical Medicine in the United Kingdom suggests an escalation of the conflict could lead to nearly 86,000 excess deaths over the next six months once the effects of war-induced disease, epidemics and malnutrition are accounted for. The report estimates that even if there is no escalation, and conditions remain as they are today, there will still be 66,720 excess deaths in Gaza over the next six months.
This is why, as activists, health workers and organisations working in the health sector for justice, equity, anti-racism and decolonisation, we are using our voices to speak up and urge as well as compel our colleagues and others, especially global health bodies and associations, to take action. As Israel uses healthcare, food and water as weapons of war, we know all too well – as organisations that have worked on issues of health justice and access to medicines for millions of people around the world – that it is imperative that we speak up and demand an end to impunity, and real action and consequences.
So why target our call to the global health community? We feel that there has been a widespread lack of regard by many in this community for the unfolding health crisis in Gaza. As we also noted in the open letter we published this week, hardly any discussion on the current state of health services in Gaza has graced the pages of the 17 global health journals that currently fill the public space. Our research shows that a PubMed search on journal articles containing the words “Global Health”, “Gaza” and “health” published since October 2023 retrieved only two, published by The Lancet and the British Medical Journal, that featured any discussion about the ethical, human rights and professional challenges that arose from the current conflict.
So we ask: why have our universities, medical schools, professional associations and academic bodies remained silent? Save for a few, isolated public statements, the response from those who we expect to maintain the highest medical and scientific professional and ethical standards around the world has been a deafening silence.
While the American Medical Association (AMA) rightfully issued, in 2022, a very strong condemnation of Russia’s invasion of Ukraine, an effort by some members to do the same for Israel’s war on Gaza in 2023 was shut down. And at this stage of the genocide, any continued silence will be judged as complicity.
This demonstrates blatant double standards that can only be explained by racist dehumanisation of the Palestinian people.
A climate of virulent censorship, especially in the Global North, has also led to open victimisation of health workers and academics who dare to speak out in their personal capacity in defence of the rights of Palestinians and against racism. But we refuse to be silenced, and we call on the global health community at large to stand firm in the face of this intimidation.
We must call out Israel’s war crimes and unequivocally condemn the genocide that is under way in Gaza – and Israel’s long-standing medical apartheid in the occupied Palestinian territories – and support colleagues who are being targeted for speaking out about anti-Palestinian racism.
We must also pressure all governments to immediately resume and increase funding for the critical work of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and other agencies helping Palestinians in Gaza and elsewhere in occupied territory. We should refuse to collaborate with Israeli health institutions, universities, research councils, pharmaceutical companies and any organisations affiliated with the military in any form.
As health professionals and activists, we are obliged to speak out, both morally and professionally. We are also obliged to take whatever steps in our power to halt and prevent this genocide. To do anything less would be a complete dereliction of our duty to support and uphold the right – of everyone – to health.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.
Six children have died from dehydration and malnutrition at hospitals in northern Gaza, the Health Ministry in the besieged Palestinian territory has said, as the catastrophic humanitarian situation in the besieged enclave worsens.
Two children died at al-Shifa Hospital in Gaza City, the ministry said on Wednesday. Earlier it reported that four children died at the Kamal Adwan Hospital in northern Gaza, while seven others remained in critical condition.
“We ask international agencies to intervene immediately to avert a humanitarian catastrophe in northern Gaza,” Health Ministry spokesperson Ashraf al-Qudra said in a statement, as Israel’s attacks on Gaza continue.
“The international community is facing a moral and humanitarian test to stop the genocide in Gaza.”
Kamal Adwan Hospital’s Director Ahmed al-Kahlout said that the hospital had gone out of service due to a lack of fuel to run its generators. On Tuesday, Al-Awda Hospital in Jabalia also went out of service for the same reason.
In a video posted on Instagram and verified by Al Jazeera’s Sanad verification unit, journalist Ebrahem Musalam shows an infant on a bed inside the pediatric department at Kamal Adwan Hospital, as power comes in and out.
Musalam said the children in the department are suffering from malnutrition and a lack of infant formula, and that necessary devices have stopped working due to the constant power outages as a result of fuel shortages.
Palestinian group Hamas on Wednesday said that the closure of Kamal Adwan Hospital would exacerbate the health and humanitarian crisis in Northern Gaza, which is already teetering on the brink of famine as Israel continues to block or disrupt aid missions there.
‘Killing and starvation’
On Wednesday, Israel said a convoy of 31 trucks carrying food had entered northern Gaza. The Israeli military office that oversees Palestinian civilian affairs, the Coordination of Government Activity in the Territories (COGAT), also said nearly 20 other trucks entered the north on Monday and Tuesday.
These were the first major aid deliveries in a month to the devastated, isolated area, where the United Nations has warned of worsening starvation.
Israel has held up the entry of aid into Gaza for weeks, with Israeli protesters taking part in demonstrations calling for no aid to be allowed into the territory, even as hunger and disease spread.
UN officials say Israel’s months-long war, which has killed nearly 30,000 people in Gaza, has also pushed a quarter of the population of 2.3 million to the brink of famine.
Project Hope, a humanitarian group operating a clinic in Deir el-Balah in central Gaza, has said that 21 percent of the pregnant women and 11 percent of the children under the age of five it has treated in the last three weeks are suffering from malnutrition.
“People have reported eating nothing but white bread as fruit, vegetables, and other nutrient-dense foods are nearly impossible to find or too expensive,” Project Hope said.
Qatar, France Reaffirm in Joint Communique Depth, Breadth of Their Strategic Partnership
— Ministry of Foreign Affairs – Qatar (@MofaQatar_EN) February 28, 2024
In a joint communique on Wednesday, Qatar and France stressed their opposition to an Israeli military offensive on Rafah in southern Gaza and underlined their “rejection of the killing and starvation suffered by the Palestinian people in the Gaza Strip”.
They called for the opening of all crossings into Gaza, including in the north, “to allow for humanitarian actors to resume their activities and notably the delivery of food supply and pledged jointly $200m effort in support of the Palestinian population”.
Jan Egeland, secretary-general of the Norwegian Refugee Council, also said Israel must allow aid trucks into Gaza in order to address the dire humanitarian crisis.
“Hundreds of aid trucks wait in line to cross into Gaza at the Rafah and Kerem Shalom [Karem Abu Salem] crossings to a starving civilian population,” Egeland said in a social media post, with a video showing scores of aid trucks lined up.
“There has not been a single day we have gotten the needed 500 trucks across. The system is broken and Israel could fix it for the sake of the innocent.”
Hundreds of aid trucks wait in line to cross into Gaza at the Rafah and Kerem Shalom crossings to a starving civilian population. There has not been a single day we have gotten the needed 500 trucks across. The system is broken and Israel could fix it for the sake of the innocent pic.twitter.com/dMb9gTbchJ
Medical aid group Doctors Without Borders, also known as Medecins Sans Frontieres (MSF), has meanwhile said that medical workers are struggling to serve hundreds of thousands of displaced people in Gaza who are living in dire conditions with nowhere to go.
“Healthcare has been attacked, it’s collapsing. The whole system is collapsing. We are working from tents trying to do what we can. We treat the wounded. With the displacements, people’s wounds have been infected. And I’m not even talking about the mental wounds. People are desperate. They don’t know anymore what to do,” MSF’s Meinie Nicolai said.
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