A nurse organizes blood samples at the Tengani health centre in the Nsanje district of Southern Malawi in November 2014. Riders for Health’s biker Mathias Semba will collect the samples to be delivered over 100 kilometres away in Thiolo before being tested at a viral load lab.
Marco Longari / AFP
Generated with artificial intelligence.
AI can support healthcare workers where access to health remains limited. But bots are not a magic wand.
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The World Health Organization (WHO) estimates that there will be a shortage of 11 million healthcare workers worldwide by 2030. The gap is bound to worsen a situation in which, according to the WHO, 4.5 billion people will not have access to basic medical care in 2021.
“We have to realise that there are people in the world who will never see a doctor their entire life. We are in fact talking about millions of individuals,” says Annie Hartley, a physician and professor at the Swiss Federal Institute of Technology Lausanne (EPFL) and Harvard in the US.
Artificial intelligence and bots could represent a paradigm shift in healthcare, — particularly in countries with limited medical infrastructure. These tools can support healthcare workers by offering diagnostic guidance and treatment recommendations.
Hartley developed an AI tool called Meditron, which is now involved in a collaboration with the Swiss Tropical and Public Health Institute (Swiss TPH) and D-tree, a US based NGO with a strong presence in Geneva, focused on improving healthcare access across Africa.
The initiative, known as MAM*AI, aims to roll out Meditron to healthcare workers on the island of Zanzibar, Tanzania. Tailored specifically for maternal healthcare, the tool supports midwives and health professionals in caring for pregnant women. Meditron is currently available as an invite-only app on a testing platform and belongs to the same family as chatbots such as ChatGPT, Gemini, or Claude, though it is focused exclusively on medical use.
“Large language models are extraordinary because they have the potential to bridge a huge information gap with simple conversation. This technology is massively scalable and has very concrete potential. It’‘s a very exciting time,” Hartley says.
Originally launched by EPFL in 2023, Meditron is built to be adaptable to various regional and clinical contexts, whether in Africa, North America, or Europe.
“Right now, we’re working to understand how a midwife responds to a clinical problem. In other words, to grasp the actual local dynamics so we can provide useful data to those programming Meditron,” explains Riccardo Lampariello, CEO of D-tree.
“Once development is complete, we hope every midwife in Zanzibar will be able to use this tool in their daily work. After that, the goal is to consolidate what we’ve learnt and scale to other countries adapting it,” he says.
The platform has not yet launched in Zanzibar, as D-tree continues discussions with local health authorities to assess needs and ensure readiness. The next steps will include platform promotion and staff training.
One of the main hurdles for healthcare access in Sub-Saharan regions such as Zanzibar is the lack of qualified health workers.
Frank Pancha Chisel walks in 2014 to the Mikolongwe health centre, three hours from his village, to get a month’s worth of ARV therapy for himself and the other five members of his group of patients.
Afp Photo / Marco Longari
Lack of training
Medical knowledge and first aid are often entrusted to community health workers, generally volunteers who, after a few months’‘ basic training, act as a medical reference in the community to which they belong.
“You can have all the resources in the world – the most expensive drugs or the most advanced MRI [a medical imaging technique] – but if you don’t know how, when or why to use them, they are useless,” Hartley says. “Information is the most valuable resource. And what is a doctor if not a source of information?”
This is where a tool such as Meditron can help, by interpreting a symptom, clarifying a doubt about which medicine to prescribe or offering guidance on how to carry out an emergency procedure. Meditron for instance can guide the health worker to ask the right questions to understand whether to refer the person to hospital or recommend certain treatments.
If a pregnant woman shows up with a headache, the system might instruct the health worker to ask if she recently measured her blood pressure to check if she is not suffering from preeclampsia, a disease that is easily treatable but if not identified becomes fatal for both mother and child.
“The data show that these systems increase the ability to make correct diagnoses,” says Lampariello.
Reliable information
With so many chatbots available, building a trustworthy and specialised medical platform poses two main challenges.
The first one is to provide information that is reliable, as opposed to common chatbots such as ChatGPT that give no guarantee of what is provided.
The ChatGPT website, for example, reports that “ChatGPT is designed to provide useful answers based on patterns learned during training. However, like all language models, it can generate incorrect or misleading content”.
“In developing countries, people who rely on health apps for consumers often have no alternative. In settings where human and financial resources are limited, the impact of new technologies on health becomes even more significant, and their margin of error must be minimised as much as possible,” says Agata Ferretti, a bioethicist and former researcher at the Swiss federal technology institute ETH Zurich.
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That’s why Meditron must meet the same standards of accuracy as a licensed physician – especially since most users lack the means to independently verify its advice.
The second challenge, which goes hand in hand with the first, is what AI experts call “governance”, or the possibility of controlling the language model by adjusting its parameters or training it on specific data. “It’ is crucial that these tools are developed and tested in close collaboration with local communities, within their specific context,.”, Ferretti says.
“The software cannot be a copy-paste from one country to the next. Clinical protocols vary, as do the roles and skills of healthcare personnel, the incidence of diseases, and sometimes even the medications and their dosages. It’s therefore essential that the solution takes these differences into account,”, Lampariello explains.
For example, a child presenting with a high fever must be evaluated differently depending on local malaria rates.
Linguistic and cultural nuances
“In Africa, I had a patient who claimed to have a ‘pregnant knee’. I knew she meant a swollen knee, but what would a language model understand?” asks Hartley.
To ensure the app is as reliable as possible, Meditron has been integrated in Moove, which stands for Massive Open Online Validation and Evaluation. It’s a health-related artificial intelligence platform operated by Hartley’s laboratory in Lausanne and also used in Rwanda, Kenya, Nigeria and Ethiopia.
Trials aimed mainly at testing the system’‘s medical knowledge base, are also being carried out in Switzerland, with contributions from the university hospitals of Lausanne, Geneva and Bern for the medical side and the Artificial Intelligence Centre of the EPFL for IT support.
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“The information has to be evaluated by specialists, because it is important to check its accuracy first. There are safe ways to introduce these tools, and we don’‘t want to give them to untrained people too early,” says Hartley.
Researchers are conducting extensive clinical trials, challenging Meditron with real-world medical questions posed by doctors from around the world. Responses are evaluated based on multiple criteria, including safety, accuracy, and bias.
“The question is ‘how to test properly the quality and reliability of these technologies?’ Several factors need to be considered, such as bias, for examples on gender, data protection and privacy, and clinical validity” asks Ferretti.
Talks with Zanzibar’s health authorities are nearly complete. The project team is now seeking further funding from EPFL’s Tech4Dev initiative, which supports tech development in low-income settings. If approved, the team hopes to begin rollout in the coming months.
““We are absolutely determined to put this into practice and measure its impact. I am confident that once made available, these tools will become an essential part of routine care,” Hartley says.
Edited by Virginie Mangin/ts
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How can we ensure safe and fair AI in healthcare?
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Artificial intelligence is massively impacting how healthcare is delivered and we all have a role to play in making sure it’s done in a safe and bias-free way, argue researchers at the forefront of AI and medicine.
Read more: How can we ensure safe and fair AI in healthcare?
Today will be one of the shortest days of the year, all because Earth’s spin is inexplicably speeding up.
While the hours of daylight certainly last longer in the summer, the full day of 9 July 2025 will be 1.3 milliseconds shorter than average.
It takes our planet 24 hours, or 86,400 seconds, to make one full rotation around its axis, though this rate does fluctuate by a tiny amount. To track these changes, the International Earth Rotation and Reference Systems Service (IERS) continuously measures the length of the day to a high level of accuracy.
In 2020, the IERS noticed our planet was speeding up, and has been getting steadily faster ever since.
Their data predicts this year’s shortest days are set to fall on 9 July, 22 July and 5 August, when the Moon is furthest from the equator.
The Moon has always subtly affected our planet’s spin through tidal braking, where the Moon’s gravitational pull causes our planet to bulge.
As well as creating the tides, this deformation slowly leaches away momentum from Earth’s rotation, causing our planet to slow down by around 2 milliseconds per century.
This means that for the dinosaurs of the Triassic Era 200 million years ago, a day was just under 23 hours long. Meanwhile, in another 200 million years, the day will have extended to 25 hours long.
The days were short for a Brachiosaurus
The IERS will occasionally add a leap second to the year to make sure high-precision clocks run on time. The most recent leap second was added on December 31, 2016.
When the Moon is further from the equator, the breaking effect isn’t as strong and so these days are a tiny bit longer. However, the times being seen in recent years are a full half millisecond shorter than those seen prior to 2020.
While some events have been known to change Earth’s rotation – the 9.0 Japan earthquake in 2011 shortened the day by 1.8 microseconds – no one knows what’s causing the current trend.
The slowing won’t have any catastrophic effect on our planet – it’s far too short for anyone to notice – it did result in the IERS choosing to skip a leap second in 2025, and may have to take one back in 2029.
Whatever the cause, this is unlikely to be an ongoing effect, and our planet will eventually return to its long-term pattern of winding down.
Islamabad, Pakistan – Seven decades ago, one of South Asia’s greatest fiction writers, Saadat Hasan Manto, published a short story set in a village in Pakistan’s Punjab province. The plot revolved around rumours of an Indian plan to “shut down” water to Pakistan by closing off rivers that irrigated the province’s crops.
A character in the 1951 story titled Yazid responds to that chatter by saying, “…who can close a river; it’s a river, not a drain.”
That theory is now on test, 74 years later — with implications for two of the world’s most populous nations that are also nuclear-armed neighbours.
In April 2025, after gunmen killed 26 civilians, almost all tourists, in an attack in Indian-administered Kashmir, New Delhi blamed armed groups that it said were backed by Pakistan for the violence.
India announced it was walking out of the Indus Waters Treaty (IWT), a six-decade-old transboundary water agreement that governs the division of water from the Indus Basin’s six rivers. The treaty is a lifeline for more than 270 million people, most of whom live in Pakistan.
A day after India’s announcement, Pakistan’s National Security Committee (NSC), the country’s top security body, rejected the “unilateral” move, warning that “any diversion of Pakistan’s water is to be treated as an act of war”.
In the weeks that followed, India and Pakistan engaged in an intense four-day conflict in May, during which both countries exchanged missile and drone strikes, before US President Donald Trump announced a ceasefire between them.
But though the guns have fallen silent, for now, the neighbours have both launched diplomatic campaigns aimed at convincing the world about their narratives.
And India has refused to reconsider its decision to set aside the IWT. On June 21, Amit Shah, India’s home minister and the man widely considered as the second-in-command to Prime Minister Narendra Modi, declared the treaty would remain suspended permanently.
“It will never be restored. International treaties cannot be annulled unilaterally, but we had the right to put it in abeyance, which we have done,” Shah told The Times of India, the country’s leading newspaper, in an interview.
“The treaty preamble mentions that it was for peace and progress of the two countries, but once that has been violated, there is nothing left to protect,” he said.
For Pakistan, a lower riparian country, even the possibility of water disruption is an existential threat.
Blocking river flows threatens agriculture, food security, and the livelihoods of millions. It could also, warn experts, set the stage for a full-fledged war between India and Pakistan.
So can India really stop Pakistan’s water? And can Pakistan do anything to mitigate that risk?
The short answer: India cannot completely stop the flow of rivers into Pakistan, given the current infrastructure that it has. But experts caution that even a small diversion or blockage could hurt Pakistan, particularly during the winter season. And at the moment, Pakistan does not have the reservoirs it needs to store enough water to deal with the crisis it would face if India were to manage to stop the flow of the Indus Basin rivers.
A river that defines the region
The mighty Indus River, the 12th longest in the world, originates from Mount Kailash in Tibet at an elevation of 5,490 metres (18,000 feet).
It flows northwest, cutting through the scenic yet disputed Kashmir region, before entering Pakistan and travelling some 3,000 kilometres (1,864 miles) south to the Arabian Sea.
In Pakistan’s Khyber Pakhtunkhwa province, the Indus is joined by its western tributaries – the Swat and Kabul Rivers – as it carves through mountainous terrain.
Entering the fertile plains of Punjab, the river’s five eastern tributaries — the Jhelum, Chenab, Ravi, Beas and Sutlej — meet the Indus.
These rivers flow through Indian-administered Kashmir and other Indian states before entering Pakistan.
This geographic dynamic, with India as the upper riparian state and Pakistan the lower state, has fed into long-standing distrust between the neighbours.
To be clear, transboundary water conflicts are not exclusive to Pakistan and India, and historians have recorded wars over water since ancient times.
In the last half a century alone, Turkiye, Syria and Iraq have had disputes over water sharing due to the construction of dams on the Tigris and Euphrates Rivers.
More recently, there is an ongoing water conflict between Egypt and Sudan against Ethiopia, an upper riparian state constructing a dam on the Nile, causing insecurity among the two lower riparian nations.
In South Asia itself, Bangladesh, India and Nepal have water-sharing disputes over the Ganges-Brahmaputra-Meghna rivers system.
Partition’s lingering legacy
As with most India-Pakistan disputes, the two countries’ tensions over water are rooted in the partition of the subcontinent in August 1947, when both nations gained independence from British colonial rule.
The region of Jammu and Kashmir, where the Jhelum originates and the Chenab flows, became a central point of conflict.
But another critical issue was the division of Punjab’s irrigation system, which had operated as a unified network under British rule. Canals, rivers and headworks were all intertwined, complicating water sharing.
A short-lived agreement held until March 1948, when India suspended water flow through two canals into Pakistan. The stoppage left nearly eight percent of cultivable land in Pakistani Punjab without water for five weeks.
That early crisis inspired Manto’s Yazid and served as the catalyst for the Indus Waters Treaty.
With World Bank mediation and financial support, the treaty [PDF] was signed in September 1960, after nine years of negotiations between India and Pakistan.
According to Majed Akhter, senior lecturer in geography at King’s College London, the treaty was a “hydraulic partition” that followed political partition. “It was needed to resolve issues of the operation of an integrated irrigation system in Punjab, a province which the British invested heavily in and that was partitioned in 1947,” he told Al Jazeera.
But Akhter pointed out that water sharing between the neighbours is also linked to their dispute over Kashmir. Both India and Pakistan control parts of the region, with China also administering two slices of Kashmir. India, however, claims all of Kashmir, and Pakistan claims all of the region other than the parts controlled by China, its ally.
“Territorial control of Kashmir means control of the waters of the Indus, which is the main source of water for the heavily agrarian economies” of Pakistan and India, Akhter said.
India and Pakistan have fought three of their four wars over Kashmir, before the latest conflict in May.
A view of Baglihar Dam, also known as Baglihar Hydroelectric Power Project, on the Chenab river which flows from Indian-administered Kashmir into Pakistan, at Chanderkote in Jammu region May 6, 2025 [Stringer/ Reuters]
Treaty that divided the rivers
The 85-page treaty is unusually structured. Unlike most global water treaties that share water according to their total volume of flows, the IWT divides the rivers.
The three eastern rivers – Ravi, Sutlej, and Beas – were allocated entirely to India, while the three western rivers – Indus, Jhelum, and Chenab – were reserved for Pakistan’s exclusive use.
India, however, was permitted to build “run-of-the-river” hydroelectric projects on the western rivers, provided they adhered to design limitations meant to ensure uninterrupted water flow to Pakistan.
The treaty also has a three-tiered dispute resolution mechanism.
Any technical questions are brought before the Permanent Indus Commission, a standing bilateral body composed of one commissioner from each country, which is set up under the IWT clauses.
If the commission can’t resolve any differences, the matter is then referred to a neutral expert under the supervision of the World Bank. If the dispute still remains unresolved, it can then be taken to the Permanent Court of Arbitration (PCA). The Hague-based PCA is not a United Nations agency but an intergovernmental organisation to which countries go to “facilitate arbitration and other forms of dispute resolution between states”.
Though the treaty has been in place for over six decades, this formal dispute resolution path has only been invoked in three cases, all involving Indian hydroelectric power projects on western rivers: Baglihar, Kishenganga and Ratle.
India was able to win its case regarding Baglihar, a dam built on the Chenab, before a neutral expert in 2007, following which the project started operating a year later.
The Kishenganga project, built on the Jhelum, again faced resistance from Pakistan, which claimed the construction would impact water flow into Pakistan-administered Kashmir.
The matter was taken to the PCA, where a 2013 decision allowed India to divert water for power generation purposes, while ensuring that water flow towards Pakistan continued. The project was inaugurated in 2018 by Indian PM Modi.
The Ratle hydroelectric plant, also being constructed on the Chenab, is the latest flashpoint between the two neighbours.
Pakistan has sought the PCA’s involvement over the dispute, but India has argued that under the IWT, the countries need to first go before a neutral expert. However, with India now no longer adhering to the water-sharing treaty, a cloud hovers over the arbitration process, while construction on the project continues.
‘Blood and water’
Over its 65-year history, the IWT has withstood major pressures: Wars, a secessionist movement in Indian-administered Kashmir, recurring military skirmishes, deadly attacks in India that New Delhi has blamed on Pakistan-backed armed groups, and even nuclear tests by India and Pakistan.
The April 2025 Pahalgam attack marked a breaking point. But signs of the treaty’s fragility had emerged long before that.
In September 2016, following an attack on an Indian Army base in Uri, a town in Indian-administered Kashmir, that killed at least 18 Indian soldiers, India accused the Jaish-e-Muhammad, a Pakistan-based armed group that has carried out multiple attacks on Indian soil, of being behind the Uri strike.
Pakistan swiftly denied any involvement of its government, but India’s then-Home Minister Rajnath Singh branded Pakistan a “terrorist state” that supported “terrorists and terrorism groups”.
Prime Minister Narendra Modi, then in his first term leading the Hindu majoritarian Bharatiya Janata Party, declared, “Blood and water cannot flow at the same time”, amid growing calls within India to stop the flow of water in Pakistan.
Nine years later, after India actually walked out of the treaty, former Pakistani Foreign Minister Bilawal Bhutto Zardari issued a warning even more chilling than Modi’s original comment.
“The Indus is ours and will remain ours, either our water will flow through it, or their blood,” he thundered at an April rally in Sindh, a province named after the Indus River (Sindhu in Sanskrit).
Tarbela Dam is Pakistan’s largest dam, which was completed in 1976 on the Indus River and has a storage capacity of 11.6 million acre-feet [File Photo: Anjum Naveed/AP Photo]
Symbolism or substance?
Several water experts argue that India’s suspension of the IWT is more symbolic than immediately harmful to Pakistan.
Naseer Memon, an Islamabad-based environmental and water expert, called it a “political gimmick” designed to generate anxiety in Pakistan rather than alter water flows.
First, there’s international law, which Pakistan believes is on its side. “Modi is trying to portray that he would stop Pakistan’s water immediately. But legally, he cannot decide anything about the IWT unilaterally,” Memon told Al Jazeera.
Three weeks after India’s suspension of the treaty, Ajay Banga, the Indian-American president of the World Bank, also said that there is no provision in the IWT that allows a party to unilaterally suspend the treaty.
“There is no provision in the treaty to allow to be suspended. The way it was drawn up, it either needs to be gone or it needs to be replaced by another one. That requires the two countries to want to agree,” he said during a visit to New Delhi in May.
Geography and infrastructure also limit what India can do. Daanish Mustafa, professor of critical geography at King’s College London, argued that these factors protect Pakistan more than its policymakers on either side acknowledge. “The fanatic attachment to hydro-control in India and hydro-vulnerability in Pakistan is almost comical,” he told Al Jazeera.
Of the six rivers in the Indus Basin, the waters of three — the Sutlej, Beas and Ravi — are in any case only for India’s use, under the IWT.
Of the three rivers whose waters belong to Pakistan, the Indus passes briefly through Indian-administered Kashmir and Ladakh. But Memon, the Islamabad-based expert, said that topography in the region means that the river passes through areas that are snowy, with little space for any canal diversion or agricultural projects. “Plus, there is not enough quantum of water in the Indus in that area which would make it feasible for India to build any project,” he said.
Indian hydroelectric projects on the remaining two rivers — the Kishenganga dam on the Jhelum, and Baglihar dam and the under-construction Ratle dam on the Chenab — have sparked concerns in Pakistan, which has protested against them under the IWT.
Islamabad alleges that the projects could allow India to lower water levels into Pakistan, and that the Kishenganga dam could also change the course of the Jhelum. New Delhi rejects these allegations.
In reality, experts say that as with the Indus, India lacks the ability to divert water from the Jhelum, too. The river passes through populated areas of Indian-administered Kashmir such as Baramulla and Jammu, Memon said. Any plans to construct a dam there could put the population at risk of inundation.
The case of the Chenab is different. Its waters “could be disturbed” by India, Memon said, though not in all seasons.
The expert says that the river has several potential sites where dams could be built. But even if India built a dam, Memon said, it would not be able to store much water during the summer season, when the flow of water is at its peak, as that could risk flooding India’s own population living near the project. To avoid that, India would need to allow water to flow downstream — into Pakistan.
Anuttama Banerji, a New Delhi-based political analyst and water specialist, agreed that India cannot “stop” the river flow, only regulate its release.
“The flow of the Chenab River can be regulated through dams and storage facilities, but India would need serious capital investment [for that]”, she said. “The threat won’t materialise for Pakistan in the immediate term.”
Still, warn many experts, just because India cannot at the moment stop water flow into Pakistan does not reduce either the value of the IWT as a weapon for New Delhi, or Islamabad’s vulnerability in the future.
‘Real pressure point’
Dan Haines, environmental historian at University College London and author of the book Rivers Divided: Indus Basin Waters in the Making of India and Pakistan, warned that even symbolic disruptions of water flows by India could undermine Pakistan’s agriculture.
Agriculture accounts for almost 25 percent of Pakistan’s gross domestic product (GDP) and employs more than 40 percent of the workforce.
“The Indian government announced the abeyance very quickly after the Pahalgam terrorist attack because it knows that water is a real pressure point for Pakistan. Water is very politically sensitive,” Haines said.
In many ways, the recent fracture over river-sharing is precisely what the IWT had tried to insulate India-Pakistan relations from, say analysts.
“What India is attempting to do is to drag the issue of water squarely back into the domain of politics, which the treaty explicitly sought to separate,” Erum Sattar, lecturer in sustainable water management at Tufts University, told Al Jazeera.
“Given Pakistan’s reliance on the waters of the Indus, it is absolutely the case that having the treaty hold in its present form is critical and vital to Pakistan.”
And Pakistan needs to prepare for a future where India might have the ability to hurt it more than it currently can, using water, said Ahmed Irfan Aslam, a lawyer by practice, and a former federal minister who oversaw portfolios including law, justice, water, climate change, and investment. Aslam has also represented Pakistan in international water arbitration cases, including under the IWT.
“India does not have the capacity to stop rivers from flowing today. But that does not mean that they cannot acquire or develop that strategy over time,” he said.
Memon, too, agreed that while India can’t block the Chenab’s flow into Pakistan in the summer, the dynamic changes when the weather does.
“The real concern, however, arises during winter when water flow reduces. And in case India builds storage or diversion projects, they could cause harm to Pakistan’s winter crops, such as wheat,” he said. “Additionally, if there is a lean water flow in the summer season, the dams can also store water during that time as well, which could hurt Pakistan’s agriculture.”
Shiraz Memon (no relation to Naseer), a former Pakistani representative on the Permanent Indus Commission for Pakistan, also said that he feared that future Indian projects on the Chenab could eventually hurt Pakistan.
These projects — including the Ratle dam — “could hold water between 50 to 60 days during winter, which could be very damaging to Pakistan’s Punjab, which is entirely reliant on the Chenab River for its agricultural needs,” he told Al Jazeera.
How prepared is Pakistan for an India block on water flows?
At the moment, Pakistan has limited water storage capabilities. The country has three major multipurpose reservoirs – Mangla, Tarbela, and Chashma – as well as 19 barrages and 12 inter-river link canals.
Together, these allow for the storage of just under 15 million acre-feet (MAF) of water, enough for approximately four weeks. International standards recommend storage equivalent to at least 120 days.
To address the shortfall, Pakistan is building two major dams on the Indus River – Mohmand and Diamer-Bhasha – which are expected to increase capacity by another nine MAF upon their completion in 2028 and 2029, respectively.
Pakistan Prime Minister Shehbaz Sharif recently acknowledged the need for expanded storage and pledged to act. “The enemy has certain evil designs against Pakistan and wants to take steps against the water treaty. For that, the government has decided that we will build our water storage,” Sharif said on July 1.
In effect, that sets up a race between India potentially developing the capability to actually block the flow of water into Pakistan if it wants to, and Pakistan building storage facilities big enough to reduce the risk of a forced water shortage.
Still, no matter how much storage capacity Pakistan builds, it won’t be enough to survive more than short-term disruptions to water flow, if India were to try to block rivers from entering into its neighbour’s territory.
Khurram Dastgir Khan, a former federal minister for foreign affairs and defence in Pakistan, said that India acquiring the capability to divert or store water in the medium to long term could push the region into war.
“India’s threat is a genuine, existential concern,” Khan, a senior leader of the ruling Pakistan Muslim League-Nawaz, told Al Jazeera. “The Indus Basin is a civilisation. Flow of these waters has braced our environment and sustained development of Pakistan’s culture, arts, agriculture, and industry. But PM Modi and his ministers have threatened repeatedly to stop every drop of water flowing into Pakistan.”
What makes that threat particularly worrying for Pakistan, said Aslam, the other former minister, is the breakdown in any trust between the neighbours.
“What you have right now is a situation in which we as Pakistanis feel that good faith is no longer there on the other side of the border,” Aslam told Al Jazeera during an interview at his residence in Islamabad.
But Aslam acknowledged that the sentiment might be shared across the border. “Indians may have a similar view on this about Pakistan,” he conceded.
People take photographs on the dry Chenab River after the flow of water was halted from a dam, at Akhnoor, on the outskirts of Jammu in India in May 2025 [Channi Anan/AP Photo]
A new Indus Waters Treaty?
For now, both sides have adopted hard-line positions. New Delhi has rejected any reversal of the IWT suspension, while Pakistani officials have termed it an “act of war” and accused India of weaponising water.
But analysts — and some Pakistani politicians — still hold out hope for diplomacy, or international legal intervention.
“India, we hope, and we expect, will act like a responsible state,” said Aslam. “And eventually, whatever issues there are, two neighbours will have to sit down to talk to each other and resolve.”
Al Jazeera reached out to several Pakistani government officials – including the ministers for defence, information, and water – but received no responses about the government’s plan of action for a scenario when India actually is able to — and does — block the flow of water.
However, a senior military official, speaking on condition of anonymity, pointed out that Pakistan was already invoking international legal channels to make its case.
Since 2016, Pakistan has been protesting India’s hydroelectric projects on the Jhelum and Chenab at the Permanent Court of Arbitration (PCA) in The Hague. Last week, the PCA ruled that India’s decision to hold the IWT in abeyance did not impact its authority to adjudicate the case.
However, India has consistently refused to recognise the PCA’s authority in the case, so it is unclear whether New Delhi will accept any verdict that emerges from that court.
That effectively leaves Pakistan with two options: a military response, or a diplomatic solution.
The senior military official said that for Pakistan, the Indus waters were a “lifeline for the 250 million people of the country”.
“We see this as an act of war, and if there is any action taken by the Indians which we deem harmful to our interest, we will respond,” the official told Al Jazeera. “Any act of war authorises us to deliver an appropriate, legitimate and befitting response at a time and place of our choosing.”
Banerji, also a former fellow at the Washington-based Stimson Center, said any military response would be unwise given that the recent conflict has already reduced space for dialogue.
“I believe Pakistan should also reassess the treaty and see where it can derive benefits from a modified treaty, as that can enable the treaty to acquire a new form that is mutually beneficial to both sides,” she said.
Mustafa, the King’s College London geography professor, said Pakistan could use India’s decision to walk away from the IWT to also seek a renegotiated agreement — including by staking a claim to some of the water from the eastern rivers that New Delhi currently controls fully.
Aslam said that although direct negotiations between India and Pakistan remain the most effective way forward, the current climate makes dialogue unlikely.
“As a measure of last resort, I think the [Pakistan] government has made its position very clear on this,” he said.
“If Pakistan is deprived of water, all options are there on the table, including the consideration to use military solutions.”
Winner here 12 months ago, currently sitting pretty at the top of the World Triathlon Championship Series rankings, Australia’s Matt Hauser goes into Saturday’s WTCS Hamburg as the man to beat.
The home of triathlon in Germany, the city-centre course gears up for another top-tier showdown that will bring 2025 to the halfway point in the chase for the world titles. A sprint-distance challenge, it packs in a 750m Binnenalster Lake swim (complete with infamous tunnel segment just as the exit approaches), a tight and technical 20km bike and then 5km all-in run to the finish.
For nearly a quarter of a century, Hamburg has been welcoming the best in the world, and the 24th edition promises to be one for the ages. Watch the action unfold on TriathlonLive.tv from 16:35 local time on Saturday.
Hauser wears the trousers
First onto the pontoon will be Matt Hauser. With a win and two silvers from his three outings to date this year, his form and consistency has been impressive. First or second out of the water at each, aggressive on the bike and still able to produce the goods on the run, Hauser continues to look every bit the champion-in-waiting at his home Grand Final come October.
Before any thoughts of that, though, there is still plenty of racing to come. The last WTCS round in Alghero saw Miguel Hidalgo blunt Hauser’s typically fast finish by building an unassailable lead straight out of T2. Round one in Abu Dhabi saw Hayden Wilde out sprint his Aussie rival. In between, in Yokohama, Hauser clocked the fastest 10km of the day. Last year he bossed Hamburg, gold coming after the fastest 5km of the day: 13m40s.
Hidalgo up for more fireworks
Brazil’s Hidalgo sits almost 400 points away from the top spot in second, but the confidence will be flowing from his, and his country’s, first ever Series win in Alghero at the end of May. It was a huge month for the 25-year-old, piecing together the race he always knew he had in him, the gold following bronze in Yokohama. Now, he will want to be in the mix once again off the bike and push on to top his previous best 7th place here after a chastening debut over the T100 distance in Vancouver.
The current Lusophone men’s triathlon takeover continues with Portugal’s Vasco Vilaça and Ricardo Batista separated by 105 points and a major French absentee from the action this weekend, Leo Bergere. It was back in 2020 that Vilaça cemented his growing reputation here with silver in the standalone World Championships, following that with two more seconds in 2023 and 2024. How he would savour a first time on the top step on Saturday.
Paquet a threat if packs come together
Canadian pair Charles Paquet and Tyler Mislawchuk have never fully clicked with the course here, both scoring just one top 10 here to date, but both safe in the knowledge they have a podium-capacity kick to call upon. Spain’s Roberto Sanchez has looked close to his sharpest so far in 2025 and could well run into medal contention, as could his U23 world champion teammate David Cantero, the fastest man over the 5km at Abu Dhabi’s season opener.
Britain’s Ben Dijkstra has finally landed on the Series scene in 2025 with two top tens so far, and the 2023 World Champion Dorian Coninx continues to build back to his best despite illness forcing him out of Alghero. Henry Graf also missed out there after falling ill ahead of Yokohama, his 4th place in Abu Dhabi heralding the arrival of another promising young talent through the German triathlon pipeline.
Csongor Lehmann (HUN) will hope to build on his Tiszaujvaros World Cup win last weekend, while Brazil’s Manoel Messias starts on the blue carpet for the first time since Abu Dhabi, having run the fastest recorded Ironman Marathon of all time in Brazil last month.
The start could be crucial, though, with the likes of Mark Devay (HUN), Max Stapley (GBR), Tayler Reid (NZL) and Alessio Crociani (ITA) likely to dart the swim along with no.1 Hauser. A small unit out front would need serious bike firepower to stay away like they did in Alghero, though. Without Bergere around to help drive it, this could quickly become a big-pack day for the men just as we saw last year, and that would mean a 5km shoot-out to savour.
FULL WTCS HAMBURG START LIST TRIATHLONLIVE.TV 12 JULY 2025 16:35 CEST
NOTE FOR EDITORS: The 2025 World Triathlon Championship Series comprises SEVEN RACES plus the Championship Finals. A Series win is worth 1,000 POINTS. The winner of the Championship Finals receives 1,250 POINTS. Continental Championship winners receive 400 points. The number of points reduces by 7.5% with each position thereafter. (WTCS Abu Dhabi was worth 750 points as per the 2024 rules) The top THREE points scores from the season PLUS those earned in the Finals will be combined to determine the 2025 WORLD CHAMPION.
Fawad Chaudhry approaches CJP Yahya over delay in case hearing
The chief justice says Registrar’s Office would inform them about scheduling of case in due course
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ISLAMABAD (Dunya News) – Former federal minister Fawad Chaudhry appeared before Chief Justice of Pakistan (CJP) Justice Yahya Afridi on Tuesday, expressing concern over the delay in the hearing of his case despite court orders.
Accompanied by his lawyer, Advocate Faisal Chaudhry, the former minister told court that his case had not been scheduled for hearing, despite prior directives. Advocate Faisal argued that a larger bench was available, so the case should have been fixed accordingly.
Fawad Chaudhry also pointed out that since the Supreme Court’s instructions, the May 9-related cases were being heard on a daily basis, yet his case remained pending.
In response, CJP Yahya Afridi remarked that there must be no injustice while implementing the directive to conclude the cases within four months.
He emphasized that a single case should be heard in one anti-terrorism court (atc) on a given day, rather than having different aspects of the same case heard in separate courts simultaneously.
The chief justice assured that the Registrar’s Office would inform them about the scheduling of their case in due course.
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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
WPP, the London-based advertising agency searching for a new chief executive, has slashed its forecast for revenues and profits this year, blaming a “challenging economic backdrop”.
The group said on Wednesday that like-for-like revenue in 2025 when removing pass-through costs — the fees paid to external suppliers — would decline by 3-5 per cent after poor trading in the first half of the year.
This marks a sharp downgrade from its previous expectations of flat to down 2 per cent for the year. That estimate was based partly on an assumption that new business would pick up through the year, which WPP said has failed to materialise.
WPP said that macro economic conditions had weighed heavily on client spending and that there had been less new business than expected. That would lead to a decline in headline operating profit margin of 50 to 175 basis points for the full year, it added.
Like-for-like revenue would decline by 4.2 per cent to 4.5 per cent in the second half, following a fall of up to 6 per cent in the second quarter, it said.
Mark Read, the chief executive who announced his departure in June after a 30-year career with the agency, said: “Since the start of the year, we have faced a challenging trading environment with macro pressures intensifying and lower net new business.”
Tilta has released three new camera cages, each available in two configurations to suit different needs. The latest models include a vintage-style cage for the FUJIFILM GFX100RF (Travel or Light Kit), a similar retro-inspired design for the Leica Q3 (Travel or Base), and a full cage for the Canon R50 V (also available in a pared-down Base version). Let’s take a closer look.
Tilta is known for their camera support gear for both photography and cinematography. Back in May, they introduced a cage for the Panasonic LUMIX S1RII, S1II, and S1IIE, which we covered in our podcast that month. At NAB this year, Tilta was also named co-winner of the CineD Best-of-Show Award in the Camera Support category for the Nucleus-M II, a redesigned wireless lens control system with a new FIZ unit offering four channels of control plus several other notable new features. Now, Tilta has added three new camera cages to their expanding lineup.
Vintage Camera Cage Travel Kit for the FUJIFILM GFX100RF. Image credit: Tilta
Vintage Camera Cage for FUJIFILM GFX100RF – Lightweight and Travel Kits
Tilta has released a Vintage Camera Cage designed specifically for the FUJIFILM GFX100RF, available in two versions: the Lightweight Kit and the more fully featured Travel Kit. Both share the same L-bracket foundation, machined from aluminum and paired with a wood-textured handgrip. A slim top plate offers protection while maintaining access to controls, and the cage avoids overbuilding, keeping the camera’s medium-format form factor relatively intact.
Vintage camera cage for FUJIFILM GFX100RF. Image credit: Tilta
The Travel Kit includes a few additions for practical use on the move, like strap connection points, a baseplate compatible with ARCA-Swiss mounts, and a battery door flap for bottom access without removing the cage. The Lightweight Kit is more minimal and skips those extras while maintaining the same structural frame. Visually, both Kits have a retro aesthetic with a warm-toned walnut grip, slim top plate, and a premium leather half-case that gives the setup a classic look without interfering with the GFX100RF’s handling or ergonomics.
Leica Q3 Vintage Camera Cage Travel Kit. Image credit: Tilta
Vintage Camera Cage for Leica Q3 – Base and Travel Kits
Tilta’s Vintage Camera Cage for the Leica Q3 offers lightweight support without altering the camera’s shape. Made from aluminum and wood, it adds grip and mounting points while keeping the footprint compact.
Vintage Camera Cage Travel Kit for the Leica Q3. Image credit: Tilta
The Base Kit includes a low-profile L-bracket that attaches via the hot shoe. It maintains access to the battery and features a tilting screen, along with a thumb grip, lens cap, and two leather strap buckles for a shoulder strap. The detachable hot shoe cover can hold a flash or a small accessory, and while there are no built-in tripod threads, the base works with ARCA-Swiss plates. The Travel Kit adds a leather-textured top plate with thumb support, a rotating ARCA quick-release base with ¼”-20 threads, and a strap for cross-body or shoulder carry. Both versions keep the Q3’s clean design while offering just enough added function in a minimal frame.
Camera Cage for Canon R50 V Base Kit. Image credit: Tilta
Full Cage and Base Kit for the Canon R50 V
Tilta’s cage for the Canon R50 V is designed with compact video rigs in mind and comes in two versions: a Full Cage and a minimal Base Kit. Both share the same aluminum bottom plate, silicone-lined grip, and side-mounted accessories. The Base Kit offers a pared-down setup without top coverage, suited for lighter builds that still benefit from some added structure. The Full Cage has a top plate that wraps around the camera for added protection and includes extra mounting points, which could be useful for rigging accessories like a monitor or microphone.
Full Camera Cage for Canon R50 V. Image credit: Tilta
Both versions feature a modular system that includes an ARCA-Swiss compatible bottom plate, NATO rail, cold shoe receiver, and ¼”-20 threads with locating points. A built-in, multifunctional, magnetic screwdriver is included, and all ports and the battery remain accessible. Of the three Tilta cages released, this one is the most fully equipped for video setups while still staying light and compact.
Price and availability
All three Tilta camera cages are now available for purchase on the Tilta website at a 10% discount until July 11th. Pricing depends on the camera model and kit configuration. The Leica Q3 Base Kit is priced at $89, while the Travel Kit is $159, which includes additional accessories. The FUJIFILM GFX100RF Lightweight Kit is currently priced at $44, and the Travel Kit at $107. The Canon R50 V Full Cage is priced at $69, while the more minimal Base Kit is available for $80.
Also of interest are Tilta’s current Summer Flash and Amazon deals – worth checking out if you’re looking for some new gear!
Do you prefer a minimalist cage with just the essentials or a full wraparound rig with all the mounting options? What kind of camera cage are you currently using, if any? Let us know in the comments.
A boy cools himself off in a fountain in front of The Bolshoi Theatre in Moscow, Russia, on July 8, 2025. — AFP
PARIS: Recent European heatwaves were made up to 4°C hotter in several cities due to human-driven climate change, scientists reported on Wednesday, thrusting temperatures into ranges hazardous to thousands of vulnerable individuals.
A rapid assessment conducted by over a dozen scientists from five European research institutes concluded that global warming significantly increased the risk of heat-related fatalities during the episode.
Between late June and early July, temperatures surged past 40°C across much of Europe, breaking records and prompting widespread health alerts as the season’s first major heatwave gripped the continent.
The EU’s climate monitor Copernicus on Wednesday said it was the hottest June on record in western Europe, where some schools and tourist sites were shuttered as the mercury soared.
To assess what role climate change played, scientists compared how intense a heatwave would have been in a world that had not warmed due to burning masses of fossil fuels.
Using historical weather data, they concluded the heatwave “would have been 2-4°C cooler” without human-induced climate change in all but one of the 12 cities studied.
The added degrees greatly elevated the risk in these cities, which have a combined population of more than 30 million and include major capitals Paris, London and Madrid.
“What that does is it brings certain groups of people into more dangerous territory,” said researcher Ben Clarke from Imperial College London, which co-led the study with the London School of Hygiene and Tropical Medicine.
“For some people it’s still warm, fine weather. But for now a huge sector of the population, it’s more dangerous,” he told reporters.
Life and death
The study, for the first time, also sought to estimate the death toll from the heatwave in the 12 cities studied, and how many could be attributed to climate change.
Tourists hold umbrellas as they walk in front of the closed Acropolis Hill in Athens, Greece, during a heatwave on July 8, 2025. — AFP
Based on peer-reviewed scientific methods and established research on heat and mortality, the study concluded the heatwave likely caused about 2,300 deaths between June 23 and July 2 across the 12 cities studied.
But about 1,500, or roughly two thirds, of all these deaths would not have occurred had climate change not pushed temperatures to such dangerous highs, researchers said.
The authors — from research institutions in the UK, Netherlands, Denmark and Switzerland — stressed this estimate was just a snapshot of the wider heatwave, as no official count was yet available.
Heatwaves are particularly dangerous for the elderly, the sick, young children, outdoor workers, and anyone exposed to high temperatures for prolonged periods without relief.
The effect on health is compounded in cities, where heat is absorbed by paved surfaces and buildings, making urban areas much hotter than their surroundings.
Copernicus said large parts of southern Europe experienced so-called “tropical nights” during the heatwave, when overnight temperatures don’t fall low enough to let the body recover.
“An increase in heatwave temperature of just two or four degrees can mean the difference between life and death for thousands of people,” said Garyfallos Konstantinoudis, a lecturer at Imperial College London.
“This is why heatwaves are known as silent killers. Most heat-related deaths occur in homes and hospitals out of public view and are rarely reported,” he told reporters.
Authorities say it could take weeks to tally a more definitive death toll from the recent heatwave, but similar episodes have claimed tens of thousands of lives in Europe during previous summers.
Children can benefit from a variety of dermatologic laser procedures, from hair removal to treatment of scars and vascular anomalies. However, the data on the safety and effectiveness of lasers for treating skin conditions in pediatric patients is lacking, as are clinical guidelines.
Lasers have been widely used in pediatric dermatology, with the earliest reports of laser treatment of port-wine stains going back 30 years or more. The steady evolution of devices has improved clinical results, but the use of lasers in children for dermatologic conditions carries unique challenges, pediatric dermatologists who specialize in laser treatments have reported.
A multitude of indications for ablative fractional lasers (AFL) for pediatric patients exist. However, “performing laser surgery on kids tends to be a very different experience than working with adult patients,” Andrew C. Krakowski, MD, network chair of Dermatology at St. Luke’s University Health Network in Easton, Pennsylvania, told Medscape Medical News. “First off, adult patients want to be there, usually to have something being made to look better. Kids, on the other hand, want to be anywhere other than the doctor’s office.”
Kristen M. Kelly, MD
Lasers can be useful for patients of all ages, “from newborns to people over 100 years old, depending on what you’re trying to treat,” Kristen M. Kelly, MD, professor and chair of Dermatology at the UCI Irvine School of Medicine, Irvine, California, told Medscape Medical News. “Just like any therapeutic modality, you want to make sure that you know how to use it, that you’re using it for the correct indications, you’re using it in the correct way for that particular indication.”
Indications for Lasers in Pediatric Dermatology
Pediatric patients can undergo laser procedures for many of the same indications as adults, including hair removal. Anna Yasmine Kirkorian, MD, chief of Dermatology at Children’s National Hospital, Washington, DC, and colleagues reviewed the ethical and clinical considerations of lasers and other hair removal modalities in pediatric patients in a 2024 review. “All methods of hair removal appear to be safe and generally well tolerated in children, and there are no age restrictions to any modality,” Kirkorian and her coauthors wrote. Regarding lasers specifically, they added, “in the pediatric population, lasers have the most extensive data supporting their use for hair removal, and their safety profile in treating other dermatologic conditions adds to the existing body of evidence.”
AFL can be used for a host of scarring indications in pediatric patients, including hypertrophic scarring, keloid scarring, acne scarring, and surgical scarring. At the Society for Pediatric Dermatology annual meeting held the day before the American Academy of Dermatology meeting in March, Krakowski said the treatment of self-cutting scars is another indication.
Andrew C. Krakowski, MD
“A big focus of mine is treating kids’ scars; not just the appearance of scars but, perhaps even more importantly, any deficit in function the scar may be causing,” Krakowski told Medscape Medical News.
Other pediatric indications Krakowski enumerated include collagen nodules and contracture, repigmentation of pulse dye laser hypopigmentation, porokeratotic eccrine ostial and dermal duct nevus, Dowling-Degos disease, angiofibromas in tuberous sclerosis, recessive dystrophic epidermolysis bullosa, Goltz syndrome, and infantile hemangiomas and birthmarks.
Psychosocial Issues in Children
“Scars can also be associated with posttraumatic stress disorder and depression,” Krakowski said. Burn scars are a typical example of the latter. And disfiguring scars can also be associated with increased anxiety and feelings of social isolation in adolescents and teenagers.
“These scar-related comorbidities are often under-investigated and underreported, so you really have to make the deliberate point to ask your patients and then be prepared to address what they share,” he said.
Children with chronic skin conditions deal with a host of psychosocial issues, such as bullying and stigmatization, different from those that adults deal with, a multisite cross-sectional study of 1671 children published last year in JAMA Dermatology reported.
The study concluded that this is an area that requires further study and one that dermatologists need to take more seriously. While skin disorders “are often regarded as less serious” than other groups of diseases, “a child or adolescent with a chronic skin disorder risks becoming the target for bullying, alienation, and feelings of reduced self-worth, leading to stigma,” the authors wrote.
“There are both physical and emotional scars,” Kelly said. “Sometimes, that’s something that people need an opportunity to be able to deal with.” In some cases, other resources, such as counseling or group therapy, may be in order, she said.
Informed Consent for Pediatric Patients
Obtaining informed consent for a dermatologic laser procedure for a child is far different from the process for adults, Kirkorian told Medscape Medical News. “Children cannot consent to procedures, but as often as is possible, they should be able to assent,” she said. The dermatologist must be able to explain the procedure to the child in an age-appropriate manner.
Anna Yasmine Kirkorian, MD
“For procedures, such as laser hair removal, which are elective and not medically necessary, the child should both want to participate in the procedure and be able to comply with safety requirements,” such as having the ability to wear eye protection and stay still during the procedure, she said.
Parents play an integral role in the informed consent process because they are the ones ultimately giving the informed consent for their child, Kirkorian said. But the child must also cooperate. “It’s important that we do not force children to undergo procedures that are not medically necessary or the only option if they are unwilling participants,” she said.
Two examples Kirkorian offered where the child’s cooperation is vital are cryotherapy for the treatment of verruca or intralesional steroid injections for the treatment of alopecia areata. She only performs these procedures on children if they “are willing and able to participate because these procedures can be painful and do not lead to resolution of the condition in all cases,” she said. “If a child cannot or will not participate with such procedures, then alternative medical treatments would be indicated.”
Medically necessary procedures, such as biopsy of a changing nevus, require a different approach, she said. “If a child cannot comply, then we consider a sedated procedure as an alternative,” Kirkorian said.
Informing parents and children of procedures requires different approaches for each, Kelly said. “Obviously, the language you might use for the parents and the children could be somewhat different, because, certainly, you want everyone to understand.”
In addition, “you want to work with the parents to find the best way to approach the information with the child,” she added. “You want them to be informed. You also don’t want to create unnecessary fear, and so you need to find the right approach to let them know what will be happening but not scare them.”
Pain Management in Children
Children also have different pain management needs. “Obviously, it’s not a totally painless procedure,” Lisa Arkin, MD, director of Pediatric Dermatology and co-director of the Birthmarks and Vascular Anomalies Program at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin, said of laser ablation. “Most kids of an appropriately selected age and maturity can tolerate these procedures in the office.”
Here, the dermatologist may need to take a nuanced approach based on the type of injury or condition being treated, she said. “There’s always sort of a select patient population, particularly the kids who’ve had extensive burns, where there’s just too much trauma, and you just need to leverage general anesthesia to keep them comfortable.”
In children, the same principles apply as in adults: mitigating anxiety, pain, and fear, Arkin said. Techniques include topical anesthetic cream, cooling of the epidermis, and use of the Buzzy handheld device that combines a reusable ice pack and vibration near the treatment area.
Lisa Arkin, MD
“Control is a big thing for kids,” Arkin said. “They want to know how much it’s going to hurt and how many pulses it will take so that they can mentally wrap their head around expectations.”
Another strategy in small children that Kirkorian has found useful is having the parent hold the child during the laser treatment. “There are many positions or embraces that can be taught, especially by collaborating with child-life teams,” she said. “The parent’s job is to provide comfort, not to ‘hold the child down.’”
Besides topical anesthetics, vibratory devices, and cold sprays, other approaches include distraction with videos, music, or virtual reality, Kirkorian said.
“Lastly, dermatologists who perform procedures on children should feel very comfortable doing so and be able to perform the procedures quickly and effectively on a moving patient,” she added. Otherwise, the child should be referred to a board-certified pediatric dermatologist.
Managing Expectations
Preparing parents and children for the eventual outcome also requires some skill and nuance. “Dermatologists should explain the procedure plan in detail with parents in advance of the procedure while being mindful that this discussion might be best performed without the child present in case it will increase the child’s anxiety if it is a small child,” Kirkorian said.
“For older children or adolescents, it’s important to include them in the discussion because they cannot be ‘held down’ or restrained safely, so they need to be able to understand and assent,” she added.
Kelly gave an example of how that conversation can go with a child. “If I’m treating a scar — and I would say the same thing to adults — I never promise that I’m going to completely remove the scar,” she said. “I’m not going to be able to make it go away like it had never happened, but we can dramatically improve it.”
A Word About Teenagers
In Krakowski’s experience, “teenagers are awesome” and have often been the most motivated of patients “because they want nothing more than to fit in with their peers,” whereas adults “tend to want to stand out from the people around them.”
However, teenagers can also present unique challenges compared with younger children, he said.
“The trouble with teenagers, though, is that they are old enough and strong enough to be able to get off the exam table and walk out of the procedure room,” Krakowski said. “You can be halfway through a procedure, and if they decide they are finished, there is not much you can do about it.”
His advice: Plan ahead so that the treatment can be completed. For example, to treat atrophic scars from chronically inflamed acne, which is the most common condition he treats with lasers in teenagers, he’s switched from AFL to a fractional nonablative device because patients tolerate it better. Referring to AFL, he said, “I know this device hurts and is associated with significant downtime.”
With the nonablative device, “I can finish the treatments, and I know the patients will notice some significant improvement by the end of our third or fourth treatment session,” Krakowski said.
That, he said, improves the chances that these potentially difficult pediatric patients will complete their treatment.
Krakowski and Kirkorian reported having no relevant financial relationships. Arkin reported having financial relationships with Amgen, Eli Lilly and Company, Merck, and Sanofi/Regeneron. Kelly reported having financial relationships with Solta Medical, Candela, Michelson Diagnostics, Sciton, Inc., Lutronic, Cutera, Primus Pharmaceuticals, and Shanghai Fudan-Zhangjiang BioPharmaceutical.
Richard Mark Kirkner is a medical journalist based in Philadelphia.
