Over 40 people, including children, killed in Sudan hospital attack, says WHO chief
Saturday's attack on the Al Mujlad Hospital took place in West Kordofan, near the front line between the Sudanese army and the paramilitary Rapid Support Forces.
WHO Director General Tedros Adhanom Ghebreyesus called for attacks on health infrastructure to stop, without saying who was responsible.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Reuters
3 hours ago
- Reuters
Elevance Health loses bid to challenge US Medicare star ratings
CHICAGO, Aug 19 (Reuters) - A federal judge in Texas on Tuesday rejected Elevance Health's (ELV.N), opens new tab challenge of the U.S. government's calculation for the health insurer's star ratings for some of its government-backed Medicare plans after the company said improper rounding cost it at least $375 million. U.S. District Judge Mark Pittman in Fort Worth, Texas, sided with the U.S. Department of Health and Human Services after the company sued to fight the star rating assigned to one of its contracts, arguing the agency's calculations for the ratings were flawed. Pittman said Elevance had not pointed out any major problems with the calculations and that the process is too complicated for the court to evaluate it beyond that. Elevance, the parent of companies including Anthem Blue Cross and Blue Shield and Carelon, provides Medicare Advantage plans in the U.S. The plans are funded by the Medicare health insurance program for seniors and some disabled people, but administered by private insurers. The U.S. Centers for Medicare & Medicaid Services, which is part of HHS, issues star ratings for the plans, from one to five stars, to help beneficiaries choose among them. Plans with higher star ratings receive higher payments from the government if they keep costs below certain targets. Those bonus payments can be worth hundreds of millions or billions of dollars. Elevance had said the agency's calculations for 2025 caused at least one of its contracts to just miss being rated at the next higher tier, likely costing the company at least $375 million in bonus and other payments. A spokesperson for Elevance did not immediately respond to a request for comment. Neither did representatives for HHS. Elevance filed its lawsuit in October, after one of its contracts received a score of 3.749565 and was assigned 3.5 stars. The company said CMS had not followed its own regulations when it rounded down, and the contract should have been rounded up to 4 stars. HHS countered that its scoring process was sound, arguing that if the court allowed Elevance's challenge to move forward, it would be opening the door to yearly challenges from insurers whose contracts just missed the cutoff for higher tiers. The company was one of several health insurers to sue after CMS released the 2025 star ratings. Last month, another Texas federal judge tossed a lawsuit brought by Humana that challenged the reduction in the health insurer's star ratings after finding that Humana had failed to exhaust all of its out-of-court options to challenge the ratings.
The Guardian
4 hours ago
- The Guardian
The silent epidemic: the pros and cons of screening for prostate cancer
'You will feel a little pressure.' My doctor had instructed me to lower my boxers, bend forward and place my elbows on the table. As with most men over 50, it was time for my annual digital rectal exam, or DRE: those riveting moments when the doctor takes a 'look' at the prostate gland, which is just below the bladder and in front of the rectum. Its position makes the examination difficult. The physician inserts a well-lubricated finger into the patient's rectum to feel for abnormalities such as lumps, nodules or areas of hardness. As uncomfortable as the procedure can be, in my experience, it rarely lasts for more than 10 seconds. As always, she said everything looked fine. In my rush to pull my boxers up and change the subject, I didn't bother to ask any more questions. At the time, I was clueless that as men age, the prostate becomes increasingly susceptible to cancer. In the rare event the disease tops the news cycle, it's because of high-profile diagnoses, such as for former US president Joe Biden in May, Nelson Mandela, Robert De Niro and the Chicago Cubs hall of famer Ryne Sandberg, who died in late July. Even so, important details of the illness often go unreported. I – like many others – typically dismissed the topic with a yawn, being of the uninformed but persistent impression that it's 'the best cancer to have'. All I knew was that prostate cancer tends to move slowly and can be successfully treated when detected early. Now I am a prostate cancer survivor, whose prostatectomy in 2020 almost came too late. I didn't know that in the US, prostate cancer is the second leading cause of cancer death in men. One in eight will be diagnosed with it. One in 44 will die from it. Being uninformed about those details and testing options could have killed me. 'Prostate cancer has been called the Silent Epidemic,' said Dr Samuel L Washington, a urologic surgeon who specializes in oncology at the University of California in San Francisco. Even with an active lifestyle, healthy nutritional regimen and digital screenings, cancer can sneak in undetected. 'Many men with prostate cancer won't experience any outward signs or symptoms until the disease is advanced, which is why testing is so critical,' said Dr Clifford Gluck, a urologist and Founder of Dr Gluck's Wellness Center in Massachusetts. 'If not caught early, it can break free of the prostate and run unchecked through the body, with a particular penchant for bone.' Once prostate cancer has spread to other parts of the body, the five-year relative survival rate is only 37%. 'In 2023, only about 38% of men between 50 and 64 were screened for the disease,' said Washington. 'Sadly, a lack of screening remains one of many factors leading to increased rates of men presenting with more advanced disease over the last decade. The more advanced the cancer, the harder it is to treat.' Before my 62nd year, I routinely postponed my annual physical, assuming I was bulletproof. I was athletic and ate a plant-based diet. My life was free of processed foods, recreational drugs, tobacco, asbestos and weapons-grade plutonium. I experienced no symptoms indicative of prostate cancer, such as erectile dysfunction or urinary issues that reportedly led to the former president's diagnosis. Then, after a couple of cross-country moves with my family, I no longer had a primary physician. Dismissing my claims of invincibility, my wife handed me a list of internists. I booked a physical, and my new doctor ordered my first-ever PSA (prostate-specific antigen) test. PSA is a protein produced by the prostate. Normal and cancerous prostate cells produce it, but cancerous ones tend to produce more. That said, an elevated PSA level is not always indicative of cancer. Generally, a normal, or non-elevated score for men over 60 is under four; for men under 59, under two-and-a-half; and for younger men, under one. But 'PSA levels differ for each person,' said Dr Ash Tewari, professor and chairperson of the department of urology at the Icahn School of Medicine at Mount Sinai. 'While scores below four are preferred, it is most important to understand whether a PSA level is changing from year to year.' Variables such as family history, overall health, nutrition and race can have an effect. 'At the very least, I urge patients to have the conversation with their doctor,' he said. Mine was a harrowing 17. My doctor called, speaking with a breathless urgency that made me feel I might not live to the end of the conversation. 'It's almost certain,' he said, 'that you have prostate cancer.' The PSA test is a common, though imperfect, screening test for prostate cancer recommended by many urologists and primary care physicians for men starting at age 50. It is also one of the only ways to catch prostate cancer early. I asked my two previous primary care physicians why they had never ordered one, and they argued that the test sets off too many false alarms and causes undue stress; elevated PSA levels can be symptomatic of issues other than cancer, such as an infection. Also, I had never asked for one. (They must have confused my BA in English with a medical degree.) After hearing I had been diagnosed with prostate cancer, one conceded: 'In hindsight, a PSA test would have been a good idea.' Their reluctance is not unusual. Many doctors in the US shy away from prescribing the test because of the uncertainty of what an elevated score means, how patients react to that uncertainty and risks associated with subsequent exploratory procedures like biopsies. A PSA test can correctly indicate that prostate cancer is present, as it did for me. But it can also result in a false positive, suggesting cancer is present when it isn't (6 to 7% per screening round); a false negative, or not picking up that cancer is present (according to the UK's National Institute for Health and Care Excellence, 15% of people with a normal PSA test result may have prostate cancer); or catch slow-growing cancers that might never have caused issues. The latter is called overdiagnosis, and treatment can expose 'a person unnecessarily to potential complications', according to the National Cancer Institute: these include urine leakage, increased urination, loose stools or rectal bleeding, and loss of erections or decreased erections. Current estimates suggest that 20%–40% of screen-detected prostate cancers may never have caused harm, with risk varying by age, PSA levels, and Gleason Score. 'There are risks to the test,' said Dr Nancy L Keating, MD, MPH, professor of healthcare policy & medicine at Harvard Medical School. The PSA test has a C rating from the US Preventive Services Task Force (USPSTF). For context, an A rating means the USPSTF strongly recommends the test. A C means doctors may offer it, 'but that patients should make an individual decision about screening after discussing potential benefits and harms with their doctor', said Keating. Sign up to Well Actually Practical advice, expert insights and answers to your questions about how to live a good life after newsletter promotion 'There appears to be a modest benefit to screening for some men,' said Keating. 'But most prostate cancers are not likely to be deadly, and many men will experience the harms of screening, such as anxiety and unnecessary biopsies, and treatments like radiation or removal of the prostate that can lead to incontinence and erectile dysfunction, without experiencing benefits,' said Keating, who thinks it is important for patients to understand the test's limitations. In one 2024 study that followed more than 400,000 men aged 50-69, one invitation to do a PSA test produced a small mortality benefit. 'The small reduction in prostate cancer deaths by using the test to screen healthy men does not outweigh the potential harms,' Professor Richard Martin, lead author of the study and cancer research scientist at the University of Bristol in the UK, said at the time. 'This results in some men going on to have invasive treatment that they don't need, many years earlier than without screening, and the test is also failing to spot some cancers that do need to be treated.' Regret following a prostate biopsy isn't rare – even when no cancer is found. A 2024 multicenter cohort study reported that about 5% of men regretted undergoing the procedure, often due to pain, bleeding, or unexpected psychological distress. In qualitative studies, men who believed they had been overdiagnosed and unnecessarily treated reported lasting regret, uncertainty, and emotional distress – even years after treatment. Men more susceptible to prostate cancer, and therefore more likely to benefit from a PSA test, include African American men, men with a family history of prostate cancer, and those with genetic mutations such as BRCA1 or BRCA2, according to the American Cancer Society. Gluck noted that the PSA test has a low USPSTF grade 'primarily due to concerns about side-effects from surgery or radiation treatments'. But advances in technology, treatment and surgical techniques – such as high-intensity focused ultrasound (HIFU), a non-invasive treatment that uses targeted sound waves to destroy prostate cancer while preserving urinary and sexual function – make screening a 'far more favorable proposition' now, he said. My PSA score definitely spiked my anxiety, despite knowing I might only have an infection. The only way to determine what it meant was an MRI and a prostate biopsy. I dreaded the biopsy, which was to a digital exam what a root canal is to flossing. My urologist explained that there were some risks, such as infection and false negatives, but for me, confirming whether I had cancer far outweighed them. Nothing about these processes counted as pleasant. For the MRI, I was ensconced in the machine for about 40 minutes. A week after that, the doctor inserted an ultrasonic probe into my rectum to guide him as he extracted 12 small samples of my prostate. The biopsy redefined my concept of vulnerability, but although it seemed like hours, it took less than 20 minutes – and anticipating the pain was worse than the actual pain. After a few days of mild tenderness, I was back to normal. For all of the worry and discomfort, if the biopsy revealed no trace of cancer, I would have uncorked the champagne. Unfortunately, my results showed a high Gleason score – which measures how different cancer cells look under a microscope compared with normal cells – consistent with aggressive prostate cancer. But I was relieved to hear that the disease hadn't spread beyond the prostate membrane. Had I waited another two or three months, according to my post-operation pathology report, it probably would have. Six weeks after the biopsy, I underwent a radical robotic nerve-sparing prostatectomy, a roughly five-hour operation to remove the prostate using minimally invasive tools. Finding data on success rates was frustrating given the myriad factors that can affect the outcome, which include Gleason scores, age, health, obesity, comorbidities and whether or not the cancer has metastasized beyond the prostate. I banked on my fitness and the skill of my surgeon as deciding factors to undergo the operation. My greatest fears were long-term incontinence or erectile dysfunction, but I was fortunate not to suffer either. As lucky as I was, earlier testing and detection would have afforded me more treatment options. 'The benefits of early detection can't be overstated, which is why I advise men between 50 and 70 years of age to have a PSA discussion annually,' said Tewari. 'PSA screening combined with imaging is an important approach to effectively screen for prostate cancer.' It took moving across the country, my wife's diligence and a doctor who routinely prescribed PSA tests for my cancer to be diagnosed. It was a complicated road, and experts' divergence on the effectiveness of screening show just how difficult it can be for a layperson to make these kinds of medical decisions. It's not ideal to rely on a testing option that at best results in an estimated 10 out of 1,000 people avoiding death from prostate cancer, with treatment options that can result in incontinence and sexual dysfunction. But taking the test when I did had a dramatic impact. It saved my life. At the very least, I wish I'd had an earlier opportunity for a detailed discussion with my doctor. Given what I know now, I would have preferred screening and early detection, because for me, there is no such thing as the best type of cancer. Ed Manning is a 67-year-old technology executive, jazz pianist and freelance writer who is writing a memoir about surviving prostate cancer
Telegraph
7 hours ago
- Telegraph
Cholera epidemic sweeps Sudan killing 40 in just a week
Sudan is battling its worst cholera outbreak in years as hundreds of thousands of people fleeing violence crowd into unsanitary displacement camps. The outbreak, which is centred on Darfur in western Sudan, began last year but is now spreading at an unprecedented rate, said Adam Rojal, spokesperson of the General Coordination of Darfur Displaced People and Refugees organisation. Doctors Without Borders (MSF) said its teams in Darfur had resorted to treating people on the floors of its medical centres and had seen over 2,300 cholera patients in the last week alone. At least 40 people died, it added. Water shortages across Darfur have made it impossible to follow essential hygiene measures, such as washing dishes and food, said MSF. Most of the cases have been reported in Tawila, north Darfur, where hundreds of thousands of people are living in cramped displacement camps with little access to sanitation or clean water. In Tawila, people have to make do with an average of three litres of water a day for all their drinking, cooking and hygiene – less than half the emergency minimum of 7.5 litres recommended by the World Health Organisation (WHO), MSF said. Najla Adam Ahmed, a displaced person who is currently living in the Daba Nair camp in Tawila, told The Telegraph that people often have no choice but to drink from contaminated water sources. 'The water supply is very limited in some places and non-existent in others…with so many people, there is bound to be dirt everywhere,' she said. Sylvain Penicaud, an MSF project coordinator in Tawila, said: 'Just two weeks ago, a body was found in a well inside one of the camps. It was removed, but within two days, people were forced to drink from that same water again' Hawa Muhammad Mousa, 60, caught cholera and suffered diarrhoea, vomiting and a fever for six days. He said he feared he would die when he 'lost consciousness from the severity of the pain,' before he received treatment at a local health centre. 'The conditions are critical and very difficult,' said Mr Mousa, adding that the camp he's living in in Tawila has no toilets or sewage system. Cholera is caused by ingesting food or water contaminated by the bacterium Vibrio cholerae, which infects the intestines and makes them produce large quantities of fluid, leading to severe diarrhoea and vomiting. Death can come rapidly without treatment but it can be treated by replacing lost fluids and electrolytes with a mixture of sugars and salts dissolved in water, or intravenous fluids. There is also an effective vaccine. Photographs shared with The Telegraph from a camp in Jebel Marra, about 18 miles southwest of Tawila, show multiple cholera patients per bed, with others sprawled on metal benches. Sudan's civil war has been raging since April 2023, when violence erupted between Sudanese army chief General Abdel Farrah al-Burhan and his former deputy Mohamed Hamdan, the warlord better known as Hemedti, who leads the Rapid Support Forces (RSF) paramilitary group. In addition to the four million people who have now fled Sudan, a record 11.6 million people have been displaced within the country, about half of whom are in the Darfur region. The recent surge in cholera cases in Darfur has been driven by a fresh wave of internal displacement that came after the RSF launched a major attack on the Zamzam displacement camp, where famine was officially declared a year ago, and laid siege to the nearby city of El Fasher. Earlier this month Unicef estimated that the fighting in North Darfur had put over 640,000 children under the age of five at risk of hunger, violence and disease. More than 380,000 people who fled the violence have arrived in Tawila in recent months, straining already stretched healthcare in the camps there to breaking point. Sultanah Ismail Habib, 25, said she fled Zamzam camp 'at night in complete secrecy' with her five children when she heard 'the sound of intense gunfire in all directions'. She said she witnessed at least 20 people being killed by the RSF and many more dying of hunger and thirst on the 46-mile trek to Tawila. 'It was very difficult, and I had no means of transportation,' she told The Telegraph. Adam Omar Hussein Abdullah, 38, said he couldn't sleep for three days after the RSF attacked and only reached Tawila with 'great effort and humiliation'. RSF fighters beat him and stole all his belongings on the journey. 'I've lost everything in this war,' he said. Haja Youssef Saeed, 35, was trapped in El Fasher for six months before the 'abundance of disease and famine' pushed her to travel to Tawila with her children by donkey and on foot. Ms Saeed said she saw many people dying from starvation in El Fasher, which is the Sudanese Army's last stronghold in the region, adding that people had resorted to eating animal feed to stay alive. 'We wash it with water and eat it when we feel hungry,' she said. 'There is no such thing as feeling full in El Fasher.' The situation is not much better in Tawila, and she said she and her three children hadn't eaten since she arrived in the town three days earlier. In Tawila, heavy rains are deepening the crisis by destroying what little sewage infrastructure there is, leading to further contamination of the water supply. Tuna Turkmen, MSF's head of mission in Sudan, said the situation was 'beyond urgent,' with cases now 'spreading well beyond displacement camps' and across Darfur and the rest of the country. Sudan has reported nearly 100,000 suspected cases of cholera and more than 2,400 deaths since the outbreak was first declared more than a year ago. Experts have warned that the epidemic has already spread into neighbouring countries. In bordering Chad, 16 deaths and 288 cases were reported in the second week of August and South Sudan is also grappling with the 'worst and longest' cholera outbreak in its history. Mr Turkman called on the Ministry of Health, Unicef and the WHO to launch an emergency international response 'at a pace that matches the urgency this catastrophic situation requires.' 'Every day of delays costs lives…Survivors of war must not be left to die from a preventable disease,' he said.
