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Cholera

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Cholera v Praze

Cholera v Praze , ' (Cholera in Prague) ' is a 1914 Austro-Hungarian comedy film directed by Alois Jalovec .

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Cholera

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Vibrio

V. adaptatus V. aerogenes V. aestivus V. aestuarianus V. agarivorans V. albensis V. alfacsensis V. alginolyticus V. anguillarum V. areninigrae V. artabrorum V. atlanticus V. atypicus V. azureus V. brasiliensis V. bubulus V. calviensis V. campbellii V. casei V. chagasii V. cholerae V. cincinnatiensis V. coralliilyticus V. crassostreae V. cyclitrophicus V. diabolicus V. diazotrophicus V. ezurae V. fluvialis V. fortis V. furnissii V. gallicus V. gazogenes V. gigantis V. halioticoli V. harveyi V. hepatarius V. hippocampi V. hispanicus V. ichthyoenteri V. indicus V. kanaloae V. lentus V. litoralis V. logei V. mediterranei V. metschnikovii V. mimicus V. mytili V. natriegens V. navarrensis V. neonatus V. neptunius V. nereis V. nigripulchritudo V. ordalii V. orientalis V. pacinii V. parahaemolyticus V. pectenicida V. pelagius V. penaeicida V. pomeroyi V. ponticus V. proteolyticus V. rotiferianus V. ruber V. rumoiensis V. salmonicida V. scophthalmi V. splendidus V. superstes V. tapetis V. tasmaniensis V. tubiashii V. vulnificus V. wodanis V. xuii Allomonas Kalina et al. 1984 Beneckea Campbell 1957 (Approved Lists 1980) Lucibacterium Hendrie et al. 1970 (Approved Lists 1980) Vibrio is a genus of Gram-negative bacteria , possessing a curved-rod (comma) shape, several species of which can cause foodborne infection , usually associated with eating undercooked seafood. Being highly salt tolerant and unable to survive in fresh water, Vibrio spp. are commonly found in various salt water environments. Vibrio spp. are facultative anaerobes that test positive for oxidase and do not form spores . All members of the genus are motile . They are able to have polar or lateral flagellum with or without sheaths. Vibrio species typically possess two chromosomes , which is unusual for bacteria. Each chromosome has a distinct and independent origin of replication , and are conserved together over time in the genus. Recent phylogenies have been constructed based on a suite of genes (multilocus sequence analysis ). O. F. Müller (1773, 1786) described eight species of the genus Vibrio (included in Infusoria ), three of which were spirilliforms. Some of the other species are today assigned to eukaryote taxa, e.g., to the euglenoid Peranema or to the diatom Bacillaria . However, Vibrio Müller, 1773 became regarded as the name of a zoological genus, and the name of the bacterial genus became Vibrio Pacini, 1854. Filippo Pacini isolated micro-organisms he called " vibrions " from cholera patients in 1854, because of their motility. In Latin "vibrio" means "to quiver". The genus Vibrio contains a large number of species, and these vary somewhat in their biochemical characteristics. Colony, morphological, physiological, and biochemical characteristics of the genus Vibrio are shown in the Table below. Note: Group-1: Vibrio alginolyticus ; Group-2: Vibrio natriegens, Vibrio pelagius, Vibrio azureus ; + = Positive; – =Negative; V =Variable (+/–)Several species of Vibrio are pathogens . Most disease-causing strains are associated with gastroenteritis , but can also infect open wounds and cause sepsis . They can be carried by numerous marine animals, such as crabs or prawns, and have been known to cause fatal infections in humans after exposure. Risk of clinical disease and death increases with certain factors, such as uncontrolled diabetes, elevated iron levels (cirrhosis, sickle cell disease , hemochromatosis ), and cancer or other immunocompromised states. Pathogenic Vibrio species include V. cholerae (the causative agent of cholera ), V. parahaemolyticus , and V. vulnificus . V. cholerae is generally transmitted by contaminated water . Pathogenic Vibrio species can cause foodborne illness (infection), usually associated with eating undercooked seafood. When ingested Vibrio bacteria can primarily result in watery diarrhea along with other secondary symptoms. The pathogenic features can be linked to quorum sensing , where bacteria are able to express their virulence factor via their signaling molecules. V. vulnificus outbreaks commonly occur in warm climates and small, generally lethal, outbreaks occur regularly. An outbreak occurred in New Orleans after Hurricane Katrina , and several lethal cases occur most years in Florida. As of 2013 in the United States, Vibrio infections as a whole were up 43% when compared with the rates observed in 2006–2008. V. vulnificus , the most severe strain, has not increased. Foodborne Vibrio infections are most often associated with eating raw shellfish . V. parahaemolyticus is also associated with the Kanagawa phenomenon, in which strains isolated from human hosts (clinical isolates) are hemolytic on blood agar plates , while those isolated from nonhuman sources are not hemolytic. Many Vibrio species are also zoonotic . They cause disease in fish and shellfish, and are common causes of mortality among domestic marine life.A common sign of Vibrio infection is cholera . Cholera primarily presents with rapid water loss by watery diarrhea. Other symptoms include vomiting and muscle cramps. Water loss can lead to dehydration which can be mild to moderate to severe. Moderate to severe dehydration requires immediate treatment. V. cholerae is the most common pathogen that causes cholera. The gold standard for detecting cholera is through cultures of stool samples or rectal swabs. Identification is then done through microscopy or by agglutination of antibodies. Cultures are done in thiosulfate citrate bile-salts sucrose agar. V cholerae will form yellow colonies. Vibriosis is a sign of a more severe Vibrio infection. Common causes of vibriosis include consumption of raw or undercooked seafood, primarily oysters, or wound exposure to sea water. The majority of V. parahemolyticus infections can be self-limiting and symptoms include diarrhea, nausea, headaches, fever and chills. V. vulnificus can lead to a more serious disease, particularly in wound infection which can turn into necrotizing fasciitis . V. parahaemolyticu s is the most common pathogen in vibriosis, however V. vulnificus is more common in people who have certain risk factors like older age, liver disease or diabetes mellitus. Like all vibrio diagnosis, vibriosis can also be determined in stool cultures. V. parahemolyticus and V. vulnificus will form green colonies. A common sign of Vibrio infection is cholera . Cholera primarily presents with rapid water loss by watery diarrhea. Other symptoms include vomiting and muscle cramps. Water loss can lead to dehydration which can be mild to moderate to severe. Moderate to severe dehydration requires immediate treatment. V. cholerae is the most common pathogen that causes cholera. The gold standard for detecting cholera is through cultures of stool samples or rectal swabs. Identification is then done through microscopy or by agglutination of antibodies. Cultures are done in thiosulfate citrate bile-salts sucrose agar. V cholerae will form yellow colonies. Vibriosis is a sign of a more severe Vibrio infection. Common causes of vibriosis include consumption of raw or undercooked seafood, primarily oysters, or wound exposure to sea water. The majority of V. parahemolyticus infections can be self-limiting and symptoms include diarrhea, nausea, headaches, fever and chills. V. vulnificus can lead to a more serious disease, particularly in wound infection which can turn into necrotizing fasciitis . V. parahaemolyticu s is the most common pathogen in vibriosis, however V. vulnificus is more common in people who have certain risk factors like older age, liver disease or diabetes mellitus. Like all vibrio diagnosis, vibriosis can also be determined in stool cultures. V. parahemolyticus and V. vulnificus will form green colonies. Medical care depends on the clinical presentation and the presence of underlying medical conditions. Because Vibrio gastroenteritis is self-limited in most patients, no specific medical therapy is required. Patients who cannot tolerate oral fluid replacement may require intravenous fluid therapy. Although most Vibrio species are sensitive to antibiotics such as doxycycline or ciprofloxacin , antibiotic therapy does not shorten the course of the illness or the duration of pathogen excretion. However, if the patient is ill and has a high fever or an underlying medical condition, oral antibiotic therapy with doxycycline or ciprofloxacin can be initiated. Patients with noncholera Vibrio wound infection or sepsis are much more ill and frequently have other medical conditions. Medical therapy consists of:Because Vibrio gastroenteritis is self-limited in most patients, no specific medical therapy is required. Patients who cannot tolerate oral fluid replacement may require intravenous fluid therapy. Although most Vibrio species are sensitive to antibiotics such as doxycycline or ciprofloxacin , antibiotic therapy does not shorten the course of the illness or the duration of pathogen excretion. However, if the patient is ill and has a high fever or an underlying medical condition, oral antibiotic therapy with doxycycline or ciprofloxacin can be initiated. Patients with noncholera Vibrio wound infection or sepsis are much more ill and frequently have other medical conditions. Medical therapy consists of:The most effective method to prevent cholera is the improvement of water and food safety. This includes the sanitation of water, proper preparation of food and community awareness of outbreaks. Prevention has been most effective in countries where cholera is endemic. Another method is cholera vaccines . Examples of cholera vaccines include Dukoral and Vaxchora. Prevention of vibriosis is mostly effected in food processing. Food items, mostly seafood, that commonly contain vibrio organisms are regularly controlled. The water that seafood is fished or farmed from is analyzed to determine microorganism content. Food processing methods like pasteurization and high pressure are used to eliminate microorganisms and pathogens. The most effective method to prevent cholera is the improvement of water and food safety. This includes the sanitation of water, proper preparation of food and community awareness of outbreaks. Prevention has been most effective in countries where cholera is endemic. Another method is cholera vaccines . Examples of cholera vaccines include Dukoral and Vaxchora. Prevention of vibriosis is mostly effected in food processing. Food items, mostly seafood, that commonly contain vibrio organisms are regularly controlled. The water that seafood is fished or farmed from is analyzed to determine microorganism content. Food processing methods like pasteurization and high pressure are used to eliminate microorganisms and pathogens. V. harveyi is a pathogen of several aquatic animals, and is notable as a cause of luminous vibriosis in shrimp (prawns). Aliivibrio fischeri (or V. fischeri ) is known for its mutualistic symbiosis with the Hawaiian bobtail squid , which is dependent on microbial luminescence. The "typical", early-discovered Vibrio species, such as V. cholerae , have a single polar flagellum (monotrichous) with sheath. Some species, such as V. parahaemolyticus and V. alginolyticus , have both a single polar flagellum with sheath and thin flagella projecting in all directions (peritrichous), and the other species, such as V. fischeri , have tufts of polar flagella with sheath (lophotrichous). Typical bacterial flagellum structure contains three components: the basal body, the hook and the filament. Like typical bacteria, Vibrio spp, have these three components, but with increased complexity in the basal body. In addition, Vibrio spp. use five or six distinct flagellum subunits to construct the flagellar filament, rather than the single flagellin found in many other bacteria. In Vibrio spp, most have a single flagellum located on one pole of the bacterium, although some species have additional flagella in peritrichous or lophotrichous arrangements. Another difference is that the gradient used to power the flagellar motor is sodium driven rather than proton driven; this creates greater torque, and Vibrio flagella have been shown to rotate over five times faster than the H+-driven flagella of E. coli . The flagellum is also surrounded by a sheath extending from the membrane. The purpose of this sheath has yet to be determined. Motility is very important for Vibrio spp for infection. Research has shown that a variety of Vibrios mutants that are defective in flagella synthesis or non-motile are defective in infection. Loss of motility in Vibrio has shown impaired colonization and adherence to host's intestines. Typical bacterial flagellum structure contains three components: the basal body, the hook and the filament. Like typical bacteria, Vibrio spp, have these three components, but with increased complexity in the basal body. In addition, Vibrio spp. use five or six distinct flagellum subunits to construct the flagellar filament, rather than the single flagellin found in many other bacteria. In Vibrio spp, most have a single flagellum located on one pole of the bacterium, although some species have additional flagella in peritrichous or lophotrichous arrangements. Another difference is that the gradient used to power the flagellar motor is sodium driven rather than proton driven; this creates greater torque, and Vibrio flagella have been shown to rotate over five times faster than the H+-driven flagella of E. coli . The flagellum is also surrounded by a sheath extending from the membrane. The purpose of this sheath has yet to be determined. Motility is very important for Vibrio spp for infection. Research has shown that a variety of Vibrios mutants that are defective in flagella synthesis or non-motile are defective in infection. Loss of motility in Vibrio has shown impaired colonization and adherence to host's intestines. Natural transformation is a common bacterial adaptation for DNA transfer that employs numerous bacterial gene products. For a recipient bacterium to bind, take up, and recombine exogenous DNA into its chromosome, it must become competent , that is, enter a special physiologic state. The DNA-uptake process of naturally competent V. cholerae involves an extended competence-induced pilus and a DNA-binding protein that acts as a ratchet and reels DNA into the periplasm. Natural transformation has also been described for V. fisheri , V. vulnificus and V. parahaemolyticus . V. cholerae has been used in discoveries of many bacterial small RNAs . Using sRNA-Seq and Northern blot candidate sRNAs were identified and characterised as IGR -sRNA (intragenic region), AS-sRNAs (transcribed from the antisense strand of the open reading frame (ORF) and ORF-derived. One of the candidates from this study, IGR7, was shown to be involved in carbon metabolism and later renamed MtlS RNA . Other sRNAs identified in V. cholerae through genetic screens and computational methods include Qrr RNA , Vibrio regulatory RNA of OmpA , MicX sRNA , Vibrio cholerae ToxT activated RNAs , tfoR RNA , and VqmR sRNA .

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Cholera

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1832 Sligo cholera outbreak

The 1832 Sligo cholera outbreak was a severe outbreak of cholera in the port town of Sligo in northwestern Ireland. The outbreak resulted in an official total of 643 deaths, out of a population of 15,000. However, the official figures are considerably lower, as only Fever Hospital deaths were recorded. The outbreak was part of a second worldwide pandemic caused by the bacterium Vibrio cholerae and lasted from 1829 to 1851. The approach of the cholera epidemic was well documented at the time, but how it was spread was a mystery. In the first pandemic, the disease was first noted in India, Moscow, Russia in 1830, Finland and Poland in 1831, and Great Britain in 1831. It struck first at the ports, and Sligo was the second busiest port on the west coast at the time after Limerick . Overall, the outbreak killed at least 50,000 people in Ireland. Cholera killed those infected within hours, usually less than three, and almost certainly less than twelve. Victims' skin often showed a bluish tinge, and diarrhoea led to rapid severe dehydration and death. The only surviving medical report is by a Dr. Irwin, then attached to the Fever Hospital The first case of Cholera Asiatica (as it was known then) was noted at Rathcarrick, three miles from the town by a Dr. Coyne on Sunday 29 July. More cases then appeared at Culleenamore, suspected to have been spread by bathers. Dr. Coyne later died of the disease himself. The Board of Health had the houses of the poor whitewashed and cleaned inside and out. Tar barrels were left burning in the streets in an effort to fumigate the air. Attempts to set up extra medical facilities in the town were resisted by the townspeople, as nobody wanted the infected to be anywhere near them. People armed with clubs and sticks resisted doctors and hospitals being among them. In many cases, doctors themselves were blamed for the outbreak. The outbreak began in Sligo town on 11 August 1832, with the first official figures for Sligo town being released by Dublin Castle on 18 August. These recorded 63 new cases, 22 deaths and no recoveries. From then until the end of the month the death toll averaged fifty a day. The Fever Hospital was used for the sick, but most of the orderlies fled through fear of the plague or the mob. Mr. Fausset, the Provost of the town, described the grounds of the Fever Hospital covered in corpses and no-one to bury them. He said he felt as if the "end of the world had come". Carpenters were unable to keep up with the demand for coffins and so mass graves were dug instead. and local legend suggests that people were buried alive, so great was the haste to dispose of the corpses. An unofficial quarantine cordon was set up around the town through which no one was allowed to pass, but they were driven back to the town. Efforts to understand the source of the infection included the flying of kites to see if it had an atmospheric origin. Wells were tested. At the height of the outbreak the population was reported by the Evening Post to have dropped from 15,000 to 2,000, most having fled to the countryside. The official number of cases was recorded as 1,230, with 643 deaths, although the real toll is suspected to have been considerably higher as many did not report being ill and there was a widespread reluctance to go to a hospital. It was thought that the actual death toll was more than 1,500 people. The population of the town dropped from 15,000 to 12,000. Charlotte Blake Thornley, the mother of Bram Stoker was a witness to the cholera outbreak as the family were living on Old Market Street in the town at the time. They survived by fleeing to Ballyshannon having to break the cordon to do so. She wrote a vivid account of the beginning and aftermath of the outbreak. But gradually the terror grew on us as time by time we heard of it nearer and nearer. It was in France, it was in Germany, it was in England, and (with wild affright) we began to hear a whisper pass "it was in Ireland". Then mens' senses began failing them for fear, and deeds were done (in selfish dread) enough to call down Gods direct vengeance on us. One i vividly remember, a poor traveller was taken ill on the roadside, some miles from the town, and how did those Samaratines tend him? They dug a pit and with long poles pushed him living into it and covered him up alive. But God's hand is not to be thus stayed and severely like Sodom did our city pay for such crimes. It is believed that her descriptions of the events at the time were influential on themes and atmosphere of her son's most famous book, Dracula . Charlotte Blake Thornley, the mother of Bram Stoker was a witness to the cholera outbreak as the family were living on Old Market Street in the town at the time. They survived by fleeing to Ballyshannon having to break the cordon to do so. She wrote a vivid account of the beginning and aftermath of the outbreak. But gradually the terror grew on us as time by time we heard of it nearer and nearer. It was in France, it was in Germany, it was in England, and (with wild affright) we began to hear a whisper pass "it was in Ireland". Then mens' senses began failing them for fear, and deeds were done (in selfish dread) enough to call down Gods direct vengeance on us. One i vividly remember, a poor traveller was taken ill on the roadside, some miles from the town, and how did those Samaratines tend him? They dug a pit and with long poles pushed him living into it and covered him up alive. But God's hand is not to be thus stayed and severely like Sodom did our city pay for such crimes. It is believed that her descriptions of the events at the time were influential on themes and atmosphere of her son's most famous book, Dracula .

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Cholera

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2008 Zimbabwean cholera outbreak

The 2008 Zimbabwean cholera outbreak was an epidemic of cholera affecting much of Zimbabwe from August 2008 until June 2009. The outbreak began in Chitungwiza in Harare Metropolitan Province in August 2008, then spread throughout the country so that by December 2008, cases were being reported in all 10 provinces . In December 2008, The Zimbabwean government declared the outbreak a national emergency and requested international aid . The outbreak peaked in January 2009 with 8,500 cases reported per week. Cholera cases from this outbreak were also reported in neighboring countries South Africa , Malawi , Botswana , Mozambique , and Zambia . With the help of international agencies, the outbreak was controlled, and by July 2009, after no cases had been reported for several weeks, the Zimbabwe Ministry of Health and Child Welfare declared the outbreak over. In total, 98,596 cases of cholera and 4,369 deaths were reported, making this the largest outbreak of cholera ever recorded in Zimbabwe. The large scale and severity of the outbreak has been attributed to poor sanitation, limited access to healthcare , and insufficient healthcare infrastructure throughout Zimbabwe. The 2008 cholera outbreak was caused by widespread infection with the bacterium Vibrio cholerae which is spread through water contaminated with the feces of infected individuals. Cholera had been seen in Zimbabwe in the decade leading up to the 2008 outbreak. However, the severity of the 2008 has been attributed to a combination of societal factors including poor access to health care and poor health care infrastructure , high HIV prevalence, political instability , food shortages, high levels of displaced people , and lack of access to safe water . In 2008, Zimbabwe was suffering from an economic crisis and hyperinflation which led to shortages of food and other basic goods, disruption of public services, and a large number of refugees moving within the country and to neighboring countries. One of the major contributing factors to the outbreak was the breakdown of the municipal water supply , sanitation , and waste collection programs throughout the country, but especially in urban areas. With this, the onset of the rainy season led to cholera-contaminated faeces being washed into water sources, in particular public drains, as well as providing readily available but contaminated water. Due to a shortage of purification chemicals, such as chlorine, the capital city of Harare stopped receiving piped water on 1 December 2008. By that date, many suburbs had not had any water supply for much longer. On 4 December 2008, the Zimbabwe deputy minister for water and infrastructural development stated that there were only sufficient treatment chemicals in stock nationally for 12 weeks supply. The collapse of these systems was blamed on the then-current economic crisis ; many households cannot afford fuel to boil water. According to Médecins Sans Frontières , the spread of cholera from urban to rural areas from December 2008 onwards was due to infected city-dwellers visiting their families' rural homes for Christmas and the burial of infected city-dwellers in rural areas. The 2008 cholera epidemic in Zimbabwe had an unusually high fatality rate ; Oxfam attributed the high mortality to a population "seriously weakened by hunger, HIV and AIDS ". A major contributing factor to the severity of the outbreak was the collapse of Zimbabwe's public health system, declared a national emergency on 4 December 2008. By the end of November 2008, three of Zimbabwe's four major hospitals had shut down, along with the Zimbabwe Medical School, and the fourth major hospital had two wards and no operating theatres working. Zimbabwean hospitals still open by December 2008 lacked medicines and staff. Due to hyperinflation , hospitals were not able to buy basic drugs and medicines, and the resources of even internationally funded emergency clinics were stretched. The ongoing political and economic crisis contributed to the emigration of doctors and people with medical knowledge. Some victims were travelling to Botswana and other neighbouring countries for treatment. The 2008 outbreak began in Chitungwiza on 20 August 2008. In September, cases spread to the urban areas of Makonde and Chinhoyi . By the end of October, cases had spread to 3 provinces: Mashonaland West , Mashonaland East , and Harare city . In the first two weeks of November, the epidemic rapidly spread across Zimbabwe, appearing in a total of 9 provinces and 54 districts. The disease spread to reach all of Zimbabwe's ten provinces . The attack rate was highest in Beitbridge, Chegutu, Mudzi and Zvimba Districts (above 1,000 cases per 100,000 people or 1.0%). The number of cases reported by the United Nations Office for the Coordination of Humanitarian Affairs escalated from 30 on 1 September 2008 to 15,572 by 10 December. According to the Red Cross, around 46% of reported deaths occur en route to clinics and hospitals. The head of the British Department for International Development in Harare said that "there are probably twice as many people with cholera as turn up for treatment". The case fatality rate for the outbreak was higher than expected for such outbreaks, although it began declining by January 2009. Official estimates of fatalities have run from 484 to 800, since the outbreak in August 2008, with an upper estimate of 3,000 from an anonymous senior official in the Ministry of Health and Child Welfare . Fatality rates varied from 2.5% in Harare to 18% in Chitungwiza. In Harare , the crisis reached the extent that the city council offered free graves to cholera victims. By 7 December, Oxfam estimated 60,000 cases by the end of January 2009 and a 10% fatality rate, with UNICEF giving a similar estimate. On 4 December 2008, the Zimbabwe government declared the outbreak to be a national emergency. Assistance after the 2008 outbreak was made available by numerous international agencies, and funding for water, sanitation and hygiene programmes, epidemic response and the provision of essential drugs came from several governments and trans-governmental organisations: By 7 December 2008, UNICEF had secured international donor funding to provide sufficient water treatment chemicals for three weeks water supply for Harare and had arranged a shipment of chemical sufficient for four months supply. UNICEF distributed 360,000 litres of water per day in Harare, as well as handing out soap and buckets. Notwithstanding the contributions received, UNICEF indicated on 9 December 2008 that US$17,500,000 was needed to respond properly to the outbreak. As of 15 December, following agreement with the Zimbabwe government, the World Health Organization was procuring medical supplies to roll out a response plan to run health centres. The 2008 cholera outbreak spread to districts in Botswana , Mozambique , South Africa and Zambia bordering Zimbabwe. Cholera spread to the Zimbabwean migrant worker community in Limpopo and Mpumalanga provinces of South Africa and cholera bacteria were detected in the Limpopo River on 3 December 2008. By 12 December 2008, 11 deaths and 859 infections had been recorded in South Africa, rising to 2,100 cases and 15 deaths by 14 January 2009, and to 12,000 cases and 59 deaths by 10 March. The South African government set up medical facilities and drinking water supplies at the Beitbridge border post and deployed the National Outbreak Response Team and additional medical personnel to Musina . Anthony Turton, a political scientist and Unit Fellow with the Council for Scientific and Industrial Research (CSIR) in South Africa, who had earlier warned of the risk of cholera in South Africa and wrote a report that recommended that the South African government increase its spending on water treatments lest a cholera outbreak occur in the country, was suspended for having made "inappropriate statements to the media". On 10 December 2008, the Limpopo Provincial Government declared Vhembe District Municipality , which borders Zimbabwe at Beitbridge, Matabeleland South province, a disaster area. On a 28 January 2009 visit to Musina with high-ranking government and ruling party officials, Health Minister Barbara Hogan said Cholera is spreading... We are beginning to see a shift from Zimbabwe to South Africa. The situation is scary... I am concerned about the impact this is having on our provinces. The spread of cholera to Zimbabwe's other neighbouring countries was initially slower than in South Africa, with one death recorded in Kafue District in Zambia and none in Botswana or Namibia by 9 December 2008. In 2009, cases increased, with 4,354 cases and 55 deaths reported by 10 February 2009 in Zambia and 1,596 cases and 14 deaths in Katanga , the southernmost province of the DR Congo . In Mozambique, cholera spread to 10 out of 11 provinces, with a total of 9,533 cases by 1 Jan to 1 Mar 2009 and 119 deaths by 17 March. Four health workers also died in a mob attack, blamed on "misinformation and misunderstanding in efforts to combat cholera", and 12 of the prisoners from the incident died in jail. In Malawi 104 deaths were recorded since January, making it the worst outbreak since 2001–02 where 960 people died. Kenya , Somalia , Tanzania , DRC , and Ghana have had unrelated cholera outbreaks with between 10 and 100 deaths in 2009 as of February. Cholera spread to the Zimbabwean migrant worker community in Limpopo and Mpumalanga provinces of South Africa and cholera bacteria were detected in the Limpopo River on 3 December 2008. By 12 December 2008, 11 deaths and 859 infections had been recorded in South Africa, rising to 2,100 cases and 15 deaths by 14 January 2009, and to 12,000 cases and 59 deaths by 10 March. The South African government set up medical facilities and drinking water supplies at the Beitbridge border post and deployed the National Outbreak Response Team and additional medical personnel to Musina . Anthony Turton, a political scientist and Unit Fellow with the Council for Scientific and Industrial Research (CSIR) in South Africa, who had earlier warned of the risk of cholera in South Africa and wrote a report that recommended that the South African government increase its spending on water treatments lest a cholera outbreak occur in the country, was suspended for having made "inappropriate statements to the media". On 10 December 2008, the Limpopo Provincial Government declared Vhembe District Municipality , which borders Zimbabwe at Beitbridge, Matabeleland South province, a disaster area. On a 28 January 2009 visit to Musina with high-ranking government and ruling party officials, Health Minister Barbara Hogan said Cholera is spreading... We are beginning to see a shift from Zimbabwe to South Africa. The situation is scary... I am concerned about the impact this is having on our provinces. The spread of cholera to Zimbabwe's other neighbouring countries was initially slower than in South Africa, with one death recorded in Kafue District in Zambia and none in Botswana or Namibia by 9 December 2008. In 2009, cases increased, with 4,354 cases and 55 deaths reported by 10 February 2009 in Zambia and 1,596 cases and 14 deaths in Katanga , the southernmost province of the DR Congo . In Mozambique, cholera spread to 10 out of 11 provinces, with a total of 9,533 cases by 1 Jan to 1 Mar 2009 and 119 deaths by 17 March. Four health workers also died in a mob attack, blamed on "misinformation and misunderstanding in efforts to combat cholera", and 12 of the prisoners from the incident died in jail. In Malawi 104 deaths were recorded since January, making it the worst outbreak since 2001–02 where 960 people died. Kenya , Somalia , Tanzania , DRC , and Ghana have had unrelated cholera outbreaks with between 10 and 100 deaths in 2009 as of February. After the 2008 epidemic was declared a national emergency, the Ministry of Health and Child Welfare (MOHCW) collaborated with several other departments, governments, and non-governmental organizations to create a Cholera Command and Control Centre. This centre works to prevent cholera outbreaks in Zimbabwe by addressing broader societal factors that could contribute to cholera outbreaks, such as water sanitation and poor hygiene habits. Because of its well-organised health care system and effective water sanitation facilities, Rita R. Colwell of the James Baker Institute says Zimbabwe was historically one of the African countries least affected by cholera. A news commentary in The Lancet said that, under President Robert Mugabe , the country's health programs were negatively impacted, resulting in diminished health care for those infected with cholera. According to a draft paper from the WHO's World Conference on Social Determinants in Health, there were fewer health workers in the villages than in urban areas, which hindered early detection and isolation of cholera cases. A news commentator writing for The Lancet , Andrew Meldrum, said that President Mugabe's Youth Militia threatened health professionals that provided medical treatment to political opponents. He said that, combined with decreasing education standards, low pay, and a shortage of medical supplies like latex gloves, this led doctors to leave Zimbabwe at an alarming rate. According to Douglas Gwatidzo, the chairman of the Zimbabwe Doctors for Human Rights group, Zimbabwe had only one doctor assigned to a group of 12,000 citizens. Doctors in Zimbabwe fill only 25% of the medical posts available, and even fewer specialist positions are taken. According to Meldrum, this poses serious challenges to health care for diseases like HIV/AIDS and cholera. Similarly, the effects of cholera are exacerbated without proper nutrition, and Zimbabwe has faced food shortages for the last several years. Cholera and malnutrition keep children out of school – a serious social consequence of the outbreak. Rachel Pound, the director of Save the Children in Zimbabwe, said that attending school may be dangerous in Zimbabwe, instead of providing a ladder for self-improvement. She noted that "Sanitation is now so bad in schools that they may become a breeding ground for infection", rather than a place of valuable education. According to Meldrum, Zimbabwe's high inflation left the country with a lack of financial resources, resulting in a shortage of ambulances and pharmaceutical drugs. According to Eric Pruyt of the Delft University of Technology in The Netherlands , this was exacerbated by a shortage of international aid, as Zimbabwe's government didn't acknowledge the epidemic and accept aid until the disease was widespread. It was not contained or prevented from spreading. Until 2008, the government insisted that there was no cholera in Zimbabwe, and Pruyt says the U.N. did not provide the country with safe drinking water until after the crisis started. Meldrum says that, during Zimbabwe's continuing HIV/AIDS dilemma, some major international donors did not give much money because they believed it would help President Mugabe stay in power, which they did not want. As the outbreak and health crisis grew worse, American and British leaders cited the crisis as further proof that it was, in their view, "well past time for (President) Robert Mugabe to leave" and that Zimbabwe had become a failed state . Marian Tupy of the Cato Institute said that the crisis began in 2005 when the government took over water treatment facilities but without sufficient funding to maintain purification processes. The transfer of water treatment from local government to the Zimbabwe National Water Authority was criticized by Innocent Nhapi of the National University of Rwanda on the basis of capacity and funding of the authority. The lack of funding for water treatment chemicals, maintenance and staff salaries was cited by Colwell of the Baker Institute as a major cause of the epidemic. According to Colwell, before funds were diverted from the plants to other uses, there were only sixty-five cases and four deaths from cholera in Zimbabwe. According to an editorial by Daniel J Ncayiyana in the South African Medical Journal , President Mugabe blamed the U.S. and the U.K. for the cholera outbreak, saying that they sent the disease so that they have a reason to credibly remove him from the presidency. One Zimbabwean citizen was shown with a sign that blamed UK Prime Minister Gordan Brown for the disease; the sign expressed the horrors of "Brown's cholera". According to a news report in Al Jazeera , the Zimbabwe government and state media blamed the outbreak on European and American sanctions and a Reuters report said it accused Britain of plotting an invasion under the cover of the outbreak. Information minister Sikhanyiso Ndlovu blamed the cholera deaths on Western sanctions, saying "the cholera issue has been used to drive a wedge among us". On 12 December, Ndlovu repeated his accusation, and claimed that the cholera outbreak was actually a "serious biological-chemical weapon" attack by the United Kingdom, which Ndlovu asserted was trying to commit genocide . Said Ndlovu: Cholera is a calculated, racist, terrorist attack on Zimbabwe by the unrepentant former colonial power, which has enlisted support from its American and Western allies so that they can invade the country. In the meantime, a senior ZANU-PF official argued that the government and party leadership was more focussed on the forthcoming ZANU-PF conference than on the current crisis. On 11 December 2008, President Robert Mugabe made a speech screened on national television in which he said: I am happy to say our doctors have been assisted by others and WHO (the World Health Organization)... so now that there is no cholera... Because of cholera, Mr Brown wants a military intervention... Bush wants military intervention because of cholera... There is no cause for war any more. The cholera cause doesn't exist any more. Reports from the WHO contradicted Mugabe's view and indicated a growing death toll. According to the WHO, as of 8 December nearly 800 people had died of cholera and more than 16,000 cases were being treated. Later that same day, Zimbabwean visas were denied to six French aid workers, including three crisis management specialists, two epidemiologists and a water treatment expert. Britain's Africa minister, Mark Malloch-Brown , dismissed Mugabe's claim that the Zimbabwe cholera crisis is over, commenting as follows: I don't know what world he [Mugabe] is living in. There is a raging humanitarian crisis in Zimbabwe as well as an economic crisis and still there is no representative government able to lead the country out of this disaster. The French foreign ministry and USAID also contradicted Mugabe's statements and called on him to allow aid to reach the people in need.

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Tennessee cholera epidemic (1849–1850)

A cholera epidemic began in Nashville, Tennessee , in January 1849 and caused many deaths in the city in 1849 and 1850. [ citation needed ] The Nashville cholera epidemic was part of the third cholera pandemic that occurred between 1846 and 1860. It began in South Asia and was spread globally by travelers. In the United States, the disease outbreak was first recorded in December 1848 at two ports: New York City on December 2 and New Orleans on December 11. It spread into the interior of the country along waterways, appearing in Nashville on January 20, 1849. The number of cases increased by June 1849. The death that month, in Nashville, of former president James K. Polk may have been due to cholera, possibly acquired during travels in other parts of the South . Cholera is reported to have been prevalent in the city around the time of his funeral, in June 1849. According to an account published in 1866, there were 311 cholera deaths in Nashville in 1849, a very large death toll for a city with a population of only about 10,000. The number of cases increased dramatically again in June and July 1850. Estimates of cholera deaths in 1850 range from 316 to about 500. There were 64 deaths from cholera in just the first 4 days of July 1850. The epidemic led the University of Nashville to suspend operations and led its president, Philip Lindsley , to resign. In a letter written on July 16, 1850, Mary Hamilton House reported to her husband that the epidemic was waning, as the death rate had dropped to only "three to six or eight deaths" per day. The following month, mineralogist Gerard Troost died in Nashville from cholera. Former U.S. President James K. Polk returned to Tennessee during this outbreak. Polk was the 11th president of the United States , serving from 1845 to 1849. President Polk and his wife Sarah Polk left Washington on March 6 for a pre-arranged triumphal tour of the South, to end in Nashville. He and his wife previously arranged to buy a house in Nashville, which was afterwards dubbed Polk Place . The couple progressed down the Atlantic coast, and then westward through the Deep South . He was enthusiastically received and banqueted. By the time the Polks reached Alabama, he was suffering from a bad cold, and soon became concerned by reports of cholera —a passenger on Polk's riverboat died of it, and it was rumored to be common in New Orleans, but it was too late to change plans. Worried about his health, he would have departed the city quickly, but was overwhelmed by Louisiana hospitality. Several passengers on the riverboat up the Mississippi died of the disease, and Polk felt so ill that he went ashore for four days, staying in a hotel. A doctor assured him he did not have cholera, and Polk made the final leg, arriving in Nashville on April 2 to a huge reception. After a visit to James's mother in Columbia, the Polks settled into Polk Place. The exhausted former president seemed to gain new life, but in early June, he fell ill again, by most accounts of cholera. On the afternoon of Friday, June 15, Polk died at his Polk Place home in Nashville, Tennessee at the age of 53.

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Epidemic

An epidemic (from Greek ἐπί epi "upon or above" and δῆμος demos "people") is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infections , an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic. Epidemics of infectious disease are generally caused by several factors including a change in the ecology of the host population (e.g., increased stress or increase in the density of a vector species), a genetic change in the pathogen reservoir or the introduction of an emerging pathogen to a host population (by movement of pathogen or host). Generally, an epidemic occurs when host immunity to either an established pathogen or newly emerging novel pathogen is suddenly reduced below that found in the endemic equilibrium and the transmission threshold is exceeded. An epidemic may be restricted to one location; however, if it spreads to other countries or continents and affects a substantial number of people, it may be termed as a pandemic . : §1:72 The declaration of an epidemic usually requires a good understanding of a baseline rate of incidence ; epidemics for certain diseases, such as influenza , are defined as reaching some defined increase in incidence above this baseline. A few cases of a very rare disease may be classified as an epidemic, while many cases of a common disease (such as the common cold ) would not. An epidemic can cause enormous damage through financial and economic losses in addition to impaired health and loss of life. [ citation needed ]The United States Centers for Disease Control and Prevention defines epidemic broadly: "Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area." The term "outbreak" can also apply, but is usually restricted to smaller events. : §1:72 Any sudden increase in disease prevalence may generally be termed an epidemic. This may include contagious disease (i.e. easily spread between persons) such as influenza ; vector-borne diseases such as malaria ; water-borne diseases such as cholera ; and sexually transmitted diseases such as HIV/AIDS . The term can also be used for non-communicable health issues such as obesity . The term epidemic derives from a word form attributed to Homer 's Odyssey , which later took its medical meaning from the Epidemics , a treatise by Hippocrates . Before Hippocrates, epidemios , epidemeo , epidamos , and other variants had meanings similar to the current definitions of "indigenous" or " endemic ". Thucydides ' description of the Plague of Athens is considered one of the earliest accounts of a disease epidemic. By the early 17th century, the terms endemic and epidemic referred to contrasting conditions of population-level disease, with the endemic condition a " common sicknesse " and the epidemic " hapning in some region, or countrey, at a certaine time, ....... producing in all sorts of people, one and the same kind of sicknesse ". The term "epidemic" is often applied to diseases in non-human animals, although " epizootic " is technically preferable. There are several factors that may contribute (individually or in combination) to causing an epidemic. There may be changes in a pathogen , in the population that it can infect, in the environment, or in the interaction between all three. Factors include the following: : §1:72 An antigen is a protein on the virus' surface that host antibodies can recognize and attack. Changes in the antigenic characteristics of the agent make it easier for the changed virus to spread throughout a previously immune population. There are two natural mechanisms for change - antigenic drift and antigenic shift. Antigenic drift arises over a period of time as an accumulation of mutations in the virus genes , possibly through a series of hosts, and eventually gives rise to a new strain of virus which can evade existing immunity. Antigenic shift is abrupt - in this, two or more different strains of a virus , coinfecting a single host, combine to form a new subtype having a mixture of characteristics of the original strains. The best known and best documented example of both processes is influenza . SARS-CoV2 has demonstrated antigenic drift and possibly shift as well. Antibiotic resistance applies specifically to bacteria that become resistant to antibiotics . Resistance in bacteria can arise naturally by genetic mutation , or by one species acquiring resistance from another through horizontal gene transfer . Extended use of antibiotics appears to encourage selection for mutations which can render antibiotics ineffective. This is especially true of tuberculosis , with increasing occurrence of multiple drug-resistant tuberculosis (MDR-TB) worldwide. Pathogen transmission is a term used to describe the mechanisms by which a disease-causing agent (virus, bacterium, or parasite) spreads from one host to another. Common modes of transmission include: - The first three of these require that pathogen must survive away from its host for a period of time; an evolutionary change which increases survival time will result in increased virulence. Another possibility, although rare, is that a pathogen may adapt to take advantage of a new mode of transmission Seasonal diseases arise due to the change in the environmental conditions, especially such as humidity and temperature, during different seasons. Many diseases display seasonality , This may be due to one or more of the following underlying factors: - Changes in behaviour can affect the likelihood or severity of epidemics. The classic example is the 1854 Broad Street cholera outbreak , in which a cholera outbreak was mitigated by removing a supply of contaminated water - an event now regarded as the foundation of the science of epidemiology . Urbanisation and overcrowding (e.g. in refugee camps ) increase the likelihood of disease outbreaks. A factor which contributed to the initial rapid increase in the 2014 Ebola virus epidemic was ritual bathing of (infective) corpses; one of the control measures was an education campaign to change behaviour around funeral rites. The level of immunity to a disease in a population - herd immunity - is at its peak after a disease outbreak or a vaccination campaign. In the following years, immunity will decline, both within individuals and in the population as a whole as older individuals die and new individuals are born. Eventually, unless there is another vaccination campaign, an outbreak or epidemic will recur. It's also possible for disease which is endemic in one population to become epidemic if it is introduced into a novel setting where the host population is not immune. An example of this was the introduction European diseases such as smallpox into indigenous populations during the 16th century. A zoonosis is an infectious disease of humans caused by a pathogen that can jump from a non-human host to a human. Major diseases such as Ebola virus disease and salmonellosis are zoonoses. HIV was a zoonotic disease transmitted to humans in the early part of the 20th century, though it has now evolved into a separate human-only disease. Some strains of bird flu and swine flu are zoonoses; these viruses occasionally recombine with human strains of the flu and can cause pandemics such as the 1918 Spanish flu or the 2009 swine flu . An antigen is a protein on the virus' surface that host antibodies can recognize and attack. Changes in the antigenic characteristics of the agent make it easier for the changed virus to spread throughout a previously immune population. There are two natural mechanisms for change - antigenic drift and antigenic shift. Antigenic drift arises over a period of time as an accumulation of mutations in the virus genes , possibly through a series of hosts, and eventually gives rise to a new strain of virus which can evade existing immunity. Antigenic shift is abrupt - in this, two or more different strains of a virus , coinfecting a single host, combine to form a new subtype having a mixture of characteristics of the original strains. The best known and best documented example of both processes is influenza . SARS-CoV2 has demonstrated antigenic drift and possibly shift as well. Antibiotic resistance applies specifically to bacteria that become resistant to antibiotics . Resistance in bacteria can arise naturally by genetic mutation , or by one species acquiring resistance from another through horizontal gene transfer . Extended use of antibiotics appears to encourage selection for mutations which can render antibiotics ineffective. This is especially true of tuberculosis , with increasing occurrence of multiple drug-resistant tuberculosis (MDR-TB) worldwide. Pathogen transmission is a term used to describe the mechanisms by which a disease-causing agent (virus, bacterium, or parasite) spreads from one host to another. Common modes of transmission include: - The first three of these require that pathogen must survive away from its host for a period of time; an evolutionary change which increases survival time will result in increased virulence. Another possibility, although rare, is that a pathogen may adapt to take advantage of a new mode of transmission Seasonal diseases arise due to the change in the environmental conditions, especially such as humidity and temperature, during different seasons. Many diseases display seasonality , This may be due to one or more of the following underlying factors: - Changes in behaviour can affect the likelihood or severity of epidemics. The classic example is the 1854 Broad Street cholera outbreak , in which a cholera outbreak was mitigated by removing a supply of contaminated water - an event now regarded as the foundation of the science of epidemiology . Urbanisation and overcrowding (e.g. in refugee camps ) increase the likelihood of disease outbreaks. A factor which contributed to the initial rapid increase in the 2014 Ebola virus epidemic was ritual bathing of (infective) corpses; one of the control measures was an education campaign to change behaviour around funeral rites. The level of immunity to a disease in a population - herd immunity - is at its peak after a disease outbreak or a vaccination campaign. In the following years, immunity will decline, both within individuals and in the population as a whole as older individuals die and new individuals are born. Eventually, unless there is another vaccination campaign, an outbreak or epidemic will recur. It's also possible for disease which is endemic in one population to become epidemic if it is introduced into a novel setting where the host population is not immune. An example of this was the introduction European diseases such as smallpox into indigenous populations during the 16th century. A zoonosis is an infectious disease of humans caused by a pathogen that can jump from a non-human host to a human. Major diseases such as Ebola virus disease and salmonellosis are zoonoses. HIV was a zoonotic disease transmitted to humans in the early part of the 20th century, though it has now evolved into a separate human-only disease. Some strains of bird flu and swine flu are zoonoses; these viruses occasionally recombine with human strains of the flu and can cause pandemics such as the 1918 Spanish flu or the 2009 swine flu . In a common source outbreak epidemic, the affected individuals had an exposure to a common agent. If the exposure is singular and all of the affected individuals develop the disease over a single exposure and incubation course, it can be termed as a point source outbreak. If the exposure was continuous or variable, it can be termed as a continuous outbreak or intermittent outbreak, respectively. : 56 In a propagated outbreak, the disease spreads person-to-person. Affected individuals may become independent reservoirs leading to further exposures. : 56 Many epidemics will have characteristics of both common source and propagated outbreaks (sometimes referred to as mixed outbreak ). [ citation needed ] For example, secondary person-to-person spread may occur after a common source exposure or an environmental vector may spread a zoonotic diseases agent. : 56–58In a common source outbreak epidemic, the affected individuals had an exposure to a common agent. If the exposure is singular and all of the affected individuals develop the disease over a single exposure and incubation course, it can be termed as a point source outbreak. If the exposure was continuous or variable, it can be termed as a continuous outbreak or intermittent outbreak, respectively. : 56In a propagated outbreak, the disease spreads person-to-person. Affected individuals may become independent reservoirs leading to further exposures. : 56 Many epidemics will have characteristics of both common source and propagated outbreaks (sometimes referred to as mixed outbreak ). [ citation needed ] For example, secondary person-to-person spread may occur after a common source exposure or an environmental vector may spread a zoonotic diseases agent. : 56–58Preparations for an epidemic include having a disease surveillance system; the ability to quickly dispatch emergency workers, especially local-based emergency workers; and a legitimate way to guarantee the safety and health of health workers. Effective preparations for a response to a pandemic are multi-layered. The first layer is a disease surveillance system. Tanzania , for example, runs a national lab that runs testing for 200 health sites and tracks the spread of infectious diseases. The next layer is the actual response to an emergency. According to U.S.-based columnist Michael Gerson in 2015, only the U.S. military and NATO have the global capability to respond to such an emergency. Still, despite the most extensive preparatory measures, a fast-spreading pandemic may easily exceed and overwhelm existing health-care resources. Consequently, early and aggressive mitigation efforts, aimed at the so-called "epidemic curve flattening" need to be taken. Such measures usually consist on non-pharmacological interventions such as social/physical distancing, aggressive contact tracing, "stay-at-home" orders, as well as appropriate personal protective equipment (i.e., masks, gloves, and other physical barriers to spread).

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India

India , officially the Republic of India ( ISO : Bhārat Gaṇarājya ), is a country in South Asia . It is the seventh-largest country by area ; the most populous country as of June 2023; and from the time of its independence in 1947, the world's most populous democracy. Bounded by the Indian Ocean on the south, the Arabian Sea on the southwest, and the Bay of Bengal on the southeast, it shares land borders with Pakistan to the west; [lower-alpha 10] China , Nepal , and Bhutan to the north; and Bangladesh and Myanmar to the east. In the Indian Ocean, India is in the vicinity of Sri Lanka and the Maldives ; its Andaman and Nicobar Islands share a maritime border with Thailand , Myanmar, and Indonesia . Modern humans arrived on the Indian subcontinent from Africa no later than 55,000 years ago. Their long occupation, initially in varying forms of isolation as hunter-gatherers, has made the region highly diverse, second only to Africa in human genetic diversity . Settled life emerged on the subcontinent in the western margins of the Indus river basin 9,000 years ago, evolving gradually into the Indus Valley Civilisation of the third millennium BCE . By 1200 BCE , an archaic form of Sanskrit , an Indo-European language , had diffused into India from the northwest. Its evidence today is found in the hymns of the Rigveda . Preserved by an oral tradition that was resolutely vigilant , the Rigveda records the dawning of Hinduism in India. The Dravidian languages of India were supplanted in the northern and western regions. By 400 BCE , stratification and exclusion by caste had emerged within Hinduism, and Buddhism and Jainism had arisen, proclaiming social orders unlinked to heredity. Early political consolidations gave rise to the loose-knit Maurya and Gupta Empires based in the Ganges Basin . Their collective era was suffused with wide-ranging creativity, but also marked by the declining status of women, and the incorporation of untouchability into an organised system of belief. [lower-alpha 11] In South India , the Middle kingdoms exported Dravidian-languages scripts and religious cultures to the kingdoms of Southeast Asia . In the early medieval era, Christianity , Islam , Judaism , and Zoroastrianism became established on India's southern and western coasts. Muslim armies from Central Asia intermittently overran India's northern plains, eventually founding the Delhi Sultanate , and drawing northern India into the cosmopolitan networks of medieval Islam . In the 15th century, the Vijayanagara Empire created a long-lasting composite Hindu culture in south India. In the Punjab , Sikhism emerged, rejecting institutionalised religion. The Mughal Empire , in 1526, ushered in two centuries of relative peace, leaving a legacy of luminous architecture. [lower-alpha 12] Gradually expanding rule of the British East India Company followed, turning India into a colonial economy, but also consolidating its sovereignty . British Crown rule began in 1858. The rights promised to Indians were granted slowly, but technological changes were introduced, and modern ideas of education and the public life took root. A pioneering and influential nationalist movement emerged, which was noted for nonviolent resistance and became the major factor in ending British rule. In 1947 the British Indian Empire was partitioned into two independent dominions , a Hindu-majority Dominion of India and a Muslim-majority Dominion of Pakistan , amid large-scale loss of life and an unprecedented migration. India has been a federal republic since 1950, governed through a democratic parliamentary system . It is a pluralistic , multilingual and multi-ethnic society . India's population grew from 361 million in 1951 to almost 1.4 billion in 2022. During the same time, its nominal per capita income increased from US$64 annually to US$2,601, and its literacy rate from 16.6% to 74%. From being a comparatively destitute country in 1951, India has become a fast-growing major economy and a hub for information technology services , with an expanding middle class. India has a space programme with several planned or completed extraterrestrial missions . Indian movies , music , and spiritual teachings play an increasing role in global culture. India has substantially reduced its rate of poverty , though at the cost of increasing economic inequality. India is a nuclear-weapon state , which ranks high in military expenditure . It has disputes over Kashmir with its neighbours, Pakistan and China, unresolved since the mid-20th century. Among the socio-economic challenges India faces are gender inequality , child malnutrition , and rising levels of air pollution . India's land is megadiverse , with four biodiversity hotspots . Its forest cover comprises 21.7% of its area. India's wildlife , which has traditionally been viewed with tolerance in India's culture , is supported among these forests, and elsewhere, in protected habitats .According to the Oxford English Dictionary (third edition 2009), the name "India" is derived from the Classical Latin India , a reference to South Asia and an uncertain region to its east. In turn the name "India" derived successively from Hellenistic Greek India ( Ἰνδία ), ancient Greek Indos ( Ἰνδός ), Old Persian Hindush (an eastern province of the Achaemenid Empire ), and ultimately its cognate , the Sanskrit Sindhu , or "river", specifically the Indus River and, by implication, its well-settled southern basin. The ancient Greeks referred to the Indians as Indoi ( Ἰνδοί ), which translates as "The people of the Indus". The term Bharat ( Bhārat ; pronounced [ ˈbʱaːɾət ] ⓘ ), mentioned in both Indian epic poetry and the Constitution of India , is used in its variations by many Indian languages . A modern rendering of the historical name Bharatavarsha , which applied originally to North India , Bharat gained increased currency from the mid-19th century as a native name for India. Hindustan ( [ ɦɪndʊˈstaːn ] ⓘ ) is a Middle Persian name for India that became popular by the 13th century, and was used widely since the era of the Mughal Empire . The meaning of Hindustan has varied, referring to a region encompassing present-day northern India and Pakistan or to India in its near entirety. By 55,000 years ago, the first modern humans, or Homo sapiens , had arrived on the Indian subcontinent from Africa, where they had earlier evolved. The earliest known modern human remains in South Asia date to about 30,000 years ago. After 6500 BCE , evidence for domestication of food crops and animals, construction of permanent structures, and storage of agricultural surplus appeared in Mehrgarh and other sites in Balochistan, Pakistan . These gradually developed into the Indus Valley Civilisation , the first urban culture in South Asia, which flourished during 2500–1900 BCE in Pakistan and western India. Centred around cities such as Mohenjo-daro , Harappa , Dholavira , and Kalibangan , and relying on varied forms of subsistence, the civilisation engaged robustly in crafts production and wide-ranging trade. During the period 2000–500 BCE , many regions of the subcontinent transitioned from the Chalcolithic cultures to the Iron Age ones. The Vedas , the oldest scriptures associated with Hinduism , were composed during this period, and historians have analysed these to posit a Vedic culture in the Punjab region and the upper Gangetic Plain . Most historians also consider this period to have encompassed several waves of Indo-Aryan migration into the subcontinent from the north-west. The caste system , which created a hierarchy of priests, warriors, and free peasants, but which excluded indigenous peoples by labelling their occupations impure, arose during this period. On the Deccan Plateau , archaeological evidence from this period suggests the existence of a chiefdom stage of political organisation. In South India , a progression to sedentary life is indicated by the large number of megalithic monuments dating from this period, as well as by nearby traces of agriculture , irrigation tanks , and craft traditions. In the late Vedic period, around the 6th century BCE, the small states and chiefdoms of the Ganges Plain and the north-western regions had consolidated into 16 major oligarchies and monarchies that were known as the mahajanapadas . The emerging urbanisation gave rise to non-Vedic religious movements, two of which became independent religions. Jainism came into prominence during the life of its exemplar, Mahavira . Buddhism , based on the teachings of Gautama Buddha , attracted followers from all social classes excepting the middle class; chronicling the life of the Buddha was central to the beginnings of recorded history in India. In an age of increasing urban wealth, both religions held up renunciation as an ideal, and both established long-lasting monastic traditions. Politically, by the 3rd century BCE, the kingdom of Magadha had annexed or reduced other states to emerge as the Mauryan Empire . The empire was once thought to have controlled most of the subcontinent except the far south, but its core regions are now thought to have been separated by large autonomous areas. The Mauryan kings are known as much for their empire-building and determined management of public life as for Ashoka 's renunciation of militarism and far-flung advocacy of the Buddhist dhamma . The Sangam literature of the Tamil language reveals that, between 200 BCE and 200 CE , the southern peninsula was ruled by the Cheras , the Cholas , and the Pandyas , dynasties that traded extensively with the Roman Empire and with West and Southeast Asia . In North India, Hinduism asserted patriarchal control within the family, leading to increased subordination of women. By the 4th and 5th centuries, the Gupta Empire had created a complex system of administration and taxation in the greater Ganges Plain; this system became a model for later Indian kingdoms. Under the Guptas, a renewed Hinduism based on devotion, rather than the management of ritual, began to assert itself. This renewal was reflected in a flowering of sculpture and architecture , which found patrons among an urban elite. Classical Sanskrit literature flowered as well, and Indian science , astronomy , medicine , and mathematics made significant advances. The Indian early medieval age, from 600 to 1200 CE , is defined by regional kingdoms and cultural diversity. When Harsha of Kannauj , who ruled much of the Indo-Gangetic Plain from 606 to 647 CE , attempted to expand southwards, he was defeated by the Chalukya ruler of the Deccan. When his successor attempted to expand eastwards, he was defeated by the Pala king of Bengal . When the Chalukyas attempted to expand southwards, they were defeated by the Pallavas from farther south, who in turn were opposed by the Pandyas and the Cholas from still farther south. No ruler of this period was able to create an empire and consistently control lands much beyond their core region. During this time, pastoral peoples, whose land had been cleared to make way for the growing agricultural economy, were accommodated within caste society, as were new non-traditional ruling classes. The caste system consequently began to show regional differences. In the 6th and 7th centuries, the first devotional hymns were created in the Tamil language. They were imitated all over India and led to both the resurgence of Hinduism and the development of all modern languages of the subcontinent . Indian royalty, big and small, and the temples they patronised drew citizens in great numbers to the capital cities, which became economic hubs as well. Temple towns of various sizes began to appear everywhere as India underwent another urbanisation. By the 8th and 9th centuries, the effects were felt in Southeast Asia, as South Indian culture and political systems were exported to lands that became part of modern-day Myanmar , Thailand , Laos , Brunei , Cambodia , Vietnam , Philippines , Malaysia , and Indonesia . Indian merchants, scholars, and sometimes armies were involved in this transmission; Southeast Asians took the initiative as well, with many sojourning in Indian seminaries and translating Buddhist and Hindu texts into their languages. After the 10th century, Muslim Central Asian nomadic clans, using swift-horse cavalry and raising vast armies united by ethnicity and religion, repeatedly overran South Asia's north-western plains, leading eventually to the establishment of the Islamic Delhi Sultanate in 1206. The sultanate was to control much of North India and to make many forays into South India. Although at first disruptive for the Indian elites, the sultanate largely left its vast non-Muslim subject population to its own laws and customs. By repeatedly repulsing Mongol raiders in the 13th century, the sultanate saved India from the devastation visited on West and Central Asia, setting the scene for centuries of migration of fleeing soldiers, learned men, mystics, traders, artists, and artisans from that region into the subcontinent, thereby creating a syncretic Indo-Islamic culture in the north. The sultanate's raiding and weakening of the regional kingdoms of South India paved the way for the indigenous Vijayanagara Empire . Embracing a strong Shaivite tradition and building upon the military technology of the sultanate, the empire came to control much of peninsular India, and was to influence South Indian society for long afterwards. In the early 16th century, northern India, then under mainly Muslim rulers, fell again to the superior mobility and firepower of a new generation of Central Asian warriors. The resulting Mughal Empire did not stamp out the local societies it came to rule. Instead, it balanced and pacified them through new administrative practices and diverse and inclusive ruling elites, leading to more systematic, centralised, and uniform rule. Eschewing tribal bonds and Islamic identity, especially under Akbar , the Mughals united their far-flung realms through loyalty, expressed through a Persianised culture, to an emperor who had near-divine status. The Mughal state's economic policies, deriving most revenues from agriculture and mandating that taxes be paid in the well-regulated silver currency, caused peasants and artisans to enter larger markets. The relative peace maintained by the empire during much of the 17th century was a factor in India's economic expansion, resulting in greater patronage of painting , literary forms, textiles, and architecture . Newly coherent social groups in northern and western India, such as the Marathas , the Rajputs , and the Sikhs , gained military and governing ambitions during Mughal rule, which, through collaboration or adversity, gave them both recognition and military experience. Expanding commerce during Mughal rule gave rise to new Indian commercial and political elites along the coasts of southern and eastern India. As the empire disintegrated, many among these elites were able to seek and control their own affairs. By the early 18th century, with the lines between commercial and political dominance being increasingly blurred, a number of European trading companies, including the English East India Company , had established coastal outposts. The East India Company's control of the seas, greater resources, and more advanced military training and technology led it to increasingly assert its military strength and caused it to become attractive to a portion of the Indian elite; these factors were crucial in allowing the company to gain control over the Bengal region by 1765 and sideline the other European companies. Its further access to the riches of Bengal and the subsequent increased strength and size of its army enabled it to annex or subdue most of India by the 1820s. India was then no longer exporting manufactured goods as it long had, but was instead supplying the British Empire with raw materials. Many historians consider this to be the onset of India's colonial period. By this time, with its economic power severely curtailed by the British parliament and having effectively been made an arm of British administration, the East India Company began more consciously to enter non-economic arenas, including education, social reform, and culture. Historians consider India's modern age to have begun sometime between 1848 and 1885. The appointment in 1848 of Lord Dalhousie as Governor General of the East India Company set the stage for changes essential to a modern state. These included the consolidation and demarcation of sovereignty, the surveillance of the population, and the education of citizens. Technological changes—among them, railways, canals, and the telegraph—were introduced not long after their introduction in Europe . However, disaffection with the company also grew during this time and set off the Indian Rebellion of 1857 . Fed by diverse resentments and perceptions, including invasive British-style social reforms, harsh land taxes, and summary treatment of some rich landowners and princes, the rebellion rocked many regions of northern and central India and shook the foundations of Company rule. Although the rebellion was suppressed by 1858, it led to the dissolution of the East India Company and the direct administration of India by the British government. Proclaiming a unitary state and a gradual but limited British-style parliamentary system, the new rulers also protected princes and landed gentry as a feudal safeguard against future unrest. In the decades following, public life gradually emerged all over India, leading eventually to the founding of the Indian National Congress in 1885. The rush of technology and the commercialisation of agriculture in the second half of the 19th century was marked by economic setbacks, and many small farmers became dependent on the whims of far-away markets. There was an increase in the number of large-scale famines , and, despite the risks of infrastructure development borne by Indian taxpayers, little industrial employment was generated for Indians. There were also salutary effects: commercial cropping, especially in the newly canalled Punjab, led to increased food production for internal consumption. The railway network provided critical famine relief, notably reduced the cost of moving goods, and helped nascent Indian-owned industry. After World War I, in which approximately one million Indians served , a new period began. It was marked by British reforms but also repressive legislation , by more strident Indian calls for self-rule, and by the beginnings of a nonviolent movement of non-co-operation, of which Mahatma Gandhi would become the leader and enduring symbol. During the 1930s, slow legislative reform was enacted by the British; the Indian National Congress won victories in the resulting elections. The next decade was beset with crises: Indian participation in World War II , the Congress's final push for non-co-operation, and an upsurge of Muslim nationalism . All were capped by the advent of independence in 1947, but tempered by the partition of India into two states: India and Pakistan. Vital to India's self-image as an independent nation was its constitution, completed in 1950, which put in place a secular and democratic republic. Per the London Declaration , India retained its membership of the Commonwealth , becoming the first republic within it. Economic liberalisation, which began in the 1980s and the collaboration with Soviet Union for technical know-how, has created a large urban middle class, transformed India into one of the world's fastest-growing economies , and increased its geopolitical clout. Yet, India is also shaped by seemingly unyielding poverty, both rural and urban; by religious and caste-related violence ; by Maoist-inspired Naxalite insurgencies ; and by separatism in Jammu and Kashmir and in Northeast India . It has unresolved territorial disputes with China and with Pakistan . India's sustained democratic freedoms are unique among the world's newer nations; however, in spite of its recent economic successes, freedom from want for its disadvantaged population remains a goal yet to be achieved. By 55,000 years ago, the first modern humans, or Homo sapiens , had arrived on the Indian subcontinent from Africa, where they had earlier evolved. The earliest known modern human remains in South Asia date to about 30,000 years ago. After 6500 BCE , evidence for domestication of food crops and animals, construction of permanent structures, and storage of agricultural surplus appeared in Mehrgarh and other sites in Balochistan, Pakistan . These gradually developed into the Indus Valley Civilisation , the first urban culture in South Asia, which flourished during 2500–1900 BCE in Pakistan and western India. Centred around cities such as Mohenjo-daro , Harappa , Dholavira , and Kalibangan , and relying on varied forms of subsistence, the civilisation engaged robustly in crafts production and wide-ranging trade. During the period 2000–500 BCE , many regions of the subcontinent transitioned from the Chalcolithic cultures to the Iron Age ones. The Vedas , the oldest scriptures associated with Hinduism , were composed during this period, and historians have analysed these to posit a Vedic culture in the Punjab region and the upper Gangetic Plain . Most historians also consider this period to have encompassed several waves of Indo-Aryan migration into the subcontinent from the north-west. The caste system , which created a hierarchy of priests, warriors, and free peasants, but which excluded indigenous peoples by labelling their occupations impure, arose during this period. On the Deccan Plateau , archaeological evidence from this period suggests the existence of a chiefdom stage of political organisation. In South India , a progression to sedentary life is indicated by the large number of megalithic monuments dating from this period, as well as by nearby traces of agriculture , irrigation tanks , and craft traditions. In the late Vedic period, around the 6th century BCE, the small states and chiefdoms of the Ganges Plain and the north-western regions had consolidated into 16 major oligarchies and monarchies that were known as the mahajanapadas . The emerging urbanisation gave rise to non-Vedic religious movements, two of which became independent religions. Jainism came into prominence during the life of its exemplar, Mahavira . Buddhism , based on the teachings of Gautama Buddha , attracted followers from all social classes excepting the middle class; chronicling the life of the Buddha was central to the beginnings of recorded history in India. In an age of increasing urban wealth, both religions held up renunciation as an ideal, and both established long-lasting monastic traditions. Politically, by the 3rd century BCE, the kingdom of Magadha had annexed or reduced other states to emerge as the Mauryan Empire . The empire was once thought to have controlled most of the subcontinent except the far south, but its core regions are now thought to have been separated by large autonomous areas. The Mauryan kings are known as much for their empire-building and determined management of public life as for Ashoka 's renunciation of militarism and far-flung advocacy of the Buddhist dhamma . The Sangam literature of the Tamil language reveals that, between 200 BCE and 200 CE , the southern peninsula was ruled by the Cheras , the Cholas , and the Pandyas , dynasties that traded extensively with the Roman Empire and with West and Southeast Asia . In North India, Hinduism asserted patriarchal control within the family, leading to increased subordination of women. By the 4th and 5th centuries, the Gupta Empire had created a complex system of administration and taxation in the greater Ganges Plain; this system became a model for later Indian kingdoms. Under the Guptas, a renewed Hinduism based on devotion, rather than the management of ritual, began to assert itself. This renewal was reflected in a flowering of sculpture and architecture , which found patrons among an urban elite. Classical Sanskrit literature flowered as well, and Indian science , astronomy , medicine , and mathematics made significant advances. The Indian early medieval age, from 600 to 1200 CE , is defined by regional kingdoms and cultural diversity. When Harsha of Kannauj , who ruled much of the Indo-Gangetic Plain from 606 to 647 CE , attempted to expand southwards, he was defeated by the Chalukya ruler of the Deccan. When his successor attempted to expand eastwards, he was defeated by the Pala king of Bengal . When the Chalukyas attempted to expand southwards, they were defeated by the Pallavas from farther south, who in turn were opposed by the Pandyas and the Cholas from still farther south. No ruler of this period was able to create an empire and consistently control lands much beyond their core region. During this time, pastoral peoples, whose land had been cleared to make way for the growing agricultural economy, were accommodated within caste society, as were new non-traditional ruling classes. The caste system consequently began to show regional differences. In the 6th and 7th centuries, the first devotional hymns were created in the Tamil language. They were imitated all over India and led to both the resurgence of Hinduism and the development of all modern languages of the subcontinent . Indian royalty, big and small, and the temples they patronised drew citizens in great numbers to the capital cities, which became economic hubs as well. Temple towns of various sizes began to appear everywhere as India underwent another urbanisation. By the 8th and 9th centuries, the effects were felt in Southeast Asia, as South Indian culture and political systems were exported to lands that became part of modern-day Myanmar , Thailand , Laos , Brunei , Cambodia , Vietnam , Philippines , Malaysia , and Indonesia . Indian merchants, scholars, and sometimes armies were involved in this transmission; Southeast Asians took the initiative as well, with many sojourning in Indian seminaries and translating Buddhist and Hindu texts into their languages. After the 10th century, Muslim Central Asian nomadic clans, using swift-horse cavalry and raising vast armies united by ethnicity and religion, repeatedly overran South Asia's north-western plains, leading eventually to the establishment of the Islamic Delhi Sultanate in 1206. The sultanate was to control much of North India and to make many forays into South India. Although at first disruptive for the Indian elites, the sultanate largely left its vast non-Muslim subject population to its own laws and customs. By repeatedly repulsing Mongol raiders in the 13th century, the sultanate saved India from the devastation visited on West and Central Asia, setting the scene for centuries of migration of fleeing soldiers, learned men, mystics, traders, artists, and artisans from that region into the subcontinent, thereby creating a syncretic Indo-Islamic culture in the north. The sultanate's raiding and weakening of the regional kingdoms of South India paved the way for the indigenous Vijayanagara Empire . Embracing a strong Shaivite tradition and building upon the military technology of the sultanate, the empire came to control much of peninsular India, and was to influence South Indian society for long afterwards. In the early 16th century, northern India, then under mainly Muslim rulers, fell again to the superior mobility and firepower of a new generation of Central Asian warriors. The resulting Mughal Empire did not stamp out the local societies it came to rule. Instead, it balanced and pacified them through new administrative practices and diverse and inclusive ruling elites, leading to more systematic, centralised, and uniform rule. Eschewing tribal bonds and Islamic identity, especially under Akbar , the Mughals united their far-flung realms through loyalty, expressed through a Persianised culture, to an emperor who had near-divine status. The Mughal state's economic policies, deriving most revenues from agriculture and mandating that taxes be paid in the well-regulated silver currency, caused peasants and artisans to enter larger markets. The relative peace maintained by the empire during much of the 17th century was a factor in India's economic expansion, resulting in greater patronage of painting , literary forms, textiles, and architecture . Newly coherent social groups in northern and western India, such as the Marathas , the Rajputs , and the Sikhs , gained military and governing ambitions during Mughal rule, which, through collaboration or adversity, gave them both recognition and military experience. Expanding commerce during Mughal rule gave rise to new Indian commercial and political elites along the coasts of southern and eastern India. As the empire disintegrated, many among these elites were able to seek and control their own affairs. By the early 18th century, with the lines between commercial and political dominance being increasingly blurred, a number of European trading companies, including the English East India Company , had established coastal outposts. The East India Company's control of the seas, greater resources, and more advanced military training and technology led it to increasingly assert its military strength and caused it to become attractive to a portion of the Indian elite; these factors were crucial in allowing the company to gain control over the Bengal region by 1765 and sideline the other European companies. Its further access to the riches of Bengal and the subsequent increased strength and size of its army enabled it to annex or subdue most of India by the 1820s. India was then no longer exporting manufactured goods as it long had, but was instead supplying the British Empire with raw materials. Many historians consider this to be the onset of India's colonial period. By this time, with its economic power severely curtailed by the British parliament and having effectively been made an arm of British administration, the East India Company began more consciously to enter non-economic arenas, including education, social reform, and culture. Historians consider India's modern age to have begun sometime between 1848 and 1885. The appointment in 1848 of Lord Dalhousie as Governor General of the East India Company set the stage for changes essential to a modern state. These included the consolidation and demarcation of sovereignty, the surveillance of the population, and the education of citizens. Technological changes—among them, railways, canals, and the telegraph—were introduced not long after their introduction in Europe . However, disaffection with the company also grew during this time and set off the Indian Rebellion of 1857 . Fed by diverse resentments and perceptions, including invasive British-style social reforms, harsh land taxes, and summary treatment of some rich landowners and princes, the rebellion rocked many regions of northern and central India and shook the foundations of Company rule. Although the rebellion was suppressed by 1858, it led to the dissolution of the East India Company and the direct administration of India by the British government. Proclaiming a unitary state and a gradual but limited British-style parliamentary system, the new rulers also protected princes and landed gentry as a feudal safeguard against future unrest. In the decades following, public life gradually emerged all over India, leading eventually to the founding of the Indian National Congress in 1885. The rush of technology and the commercialisation of agriculture in the second half of the 19th century was marked by economic setbacks, and many small farmers became dependent on the whims of far-away markets. There was an increase in the number of large-scale famines , and, despite the risks of infrastructure development borne by Indian taxpayers, little industrial employment was generated for Indians. There were also salutary effects: commercial cropping, especially in the newly canalled Punjab, led to increased food production for internal consumption. The railway network provided critical famine relief, notably reduced the cost of moving goods, and helped nascent Indian-owned industry. After World War I, in which approximately one million Indians served , a new period began. It was marked by British reforms but also repressive legislation , by more strident Indian calls for self-rule, and by the beginnings of a nonviolent movement of non-co-operation, of which Mahatma Gandhi would become the leader and enduring symbol. During the 1930s, slow legislative reform was enacted by the British; the Indian National Congress won victories in the resulting elections. The next decade was beset with crises: Indian participation in World War II , the Congress's final push for non-co-operation, and an upsurge of Muslim nationalism . All were capped by the advent of independence in 1947, but tempered by the partition of India into two states: India and Pakistan. Vital to India's self-image as an independent nation was its constitution, completed in 1950, which put in place a secular and democratic republic. Per the London Declaration , India retained its membership of the Commonwealth , becoming the first republic within it. Economic liberalisation, which began in the 1980s and the collaboration with Soviet Union for technical know-how, has created a large urban middle class, transformed India into one of the world's fastest-growing economies , and increased its geopolitical clout. Yet, India is also shaped by seemingly unyielding poverty, both rural and urban; by religious and caste-related violence ; by Maoist-inspired Naxalite insurgencies ; and by separatism in Jammu and Kashmir and in Northeast India . It has unresolved territorial disputes with China and with Pakistan . India's sustained democratic freedoms are unique among the world's newer nations; however, in spite of its recent economic successes, freedom from want for its disadvantaged population remains a goal yet to be achieved. India accounts for the bulk of the Indian subcontinent, lying atop the Indian tectonic plate , a part of the Indo-Australian Plate . India's defining geological processes began 75 million years ago when the Indian Plate, then part of the southern supercontinent Gondwana , began a north-eastward drift caused by seafloor spreading to its south-west, and later, south and south-east. Simultaneously, the vast Tethyan oceanic crust , to its northeast, began to subduct under the Eurasian Plate . These dual processes, driven by convection in the Earth's mantle , both created the Indian Ocean and caused the Indian continental crust eventually to under-thrust Eurasia and to uplift the Himalayas . Immediately south of the emerging Himalayas, plate movement created a vast crescent-shaped trough that rapidly filled with river-borne sediment and now constitutes the Indo-Gangetic Plain . The original Indian plate makes its first appearance above the sediment in the ancient Aravalli range , which extends from the Delhi Ridge in a southwesterly direction. To the west lies the Thar Desert , the eastern spread of which is checked by the Aravallis. The remaining Indian Plate survives as peninsular India , the oldest and geologically most stable part of India. It extends as far north as the Satpura and Vindhya ranges in central India. These parallel chains run from the Arabian Sea coast in Gujarat in the west to the coal-rich Chota Nagpur Plateau in Jharkhand in the east. To the south, the remaining peninsular landmass, the Deccan Plateau , is flanked on the west and east by coastal ranges known as the Western and Eastern Ghats ; the plateau contains the country's oldest rock formations, some over one billion years old. Constituted in such fashion, India lies to the north of the equator between 6° 44′ and 35° 30′ north latitude [lower-alpha 13] and 68° 7′ and 97° 25′ east longitude. India's coastline measures 7,517 kilometres (4,700 mi) in length; of this distance, 5,423 kilometres (3,400 mi) belong to peninsular India and 2,094 kilometres (1,300 mi) to the Andaman, Nicobar, and Lakshadweep island chains. According to the Indian naval hydrographic charts, the mainland coastline consists of the following: 43% sandy beaches; 11% rocky shores, including cliffs; and 46% mudflats or marshy shores. Major Himalayan-origin rivers that substantially flow through India include the Ganges and the Brahmaputra , both of which drain into the Bay of Bengal . Important tributaries of the Ganges include the Yamuna and the Kosi ; the latter's extremely low gradient, caused by long-term silt deposition, leads to severe floods and course changes. Major peninsular rivers, whose steeper gradients prevent their waters from flooding, include the Godavari , the Mahanadi , the Kaveri , and the Krishna , which also drain into the Bay of Bengal; and the Narmada and the Tapti , which drain into the Arabian Sea . Coastal features include the marshy Rann of Kutch of western India and the alluvial Sundarbans delta of eastern India; the latter is shared with Bangladesh. India has two archipelagos : the Lakshadweep , coral atolls off India's south-western coast; and the Andaman and Nicobar Islands, a volcanic chain in the Andaman Sea . Indian climate is strongly influenced by the Himalayas and the Thar Desert, both of which drive the economically and culturally pivotal summer and winter monsoons . The Himalayas prevent cold Central Asian katabatic winds from blowing in, keeping the bulk of the Indian subcontinent warmer than most locations at similar latitudes. The Thar Desert plays a crucial role in attracting the moisture-laden south-west summer monsoon winds that, between June and October, provide the majority of India's rainfall. Four major climatic groupings predominate in India: tropical wet , tropical dry , subtropical humid , and montane . Temperatures in India have risen by 0.7 °C (1.3 °F) between 1901 and 2018. Climate change in India is often thought to be the cause. The retreat of Himalayan glaciers has adversely affected the flow rate of the major Himalayan rivers, including the Ganges and the Brahmaputra . According to some current projections, the number and severity of droughts in India will have markedly increased by the end of the present century. India is a megadiverse country , a term employed for 17 countries which display high biological diversity and contain many species exclusively indigenous , or endemic , to them. India is a habitat for 8.6% of all mammal species, 13.7% of bird species, 7.9% of reptile species, 6% of amphibian species, 12.2% of fish species, and 6.0% of all flowering plant species. Fully a third of Indian plant species are endemic. India also contains four of the world's 34 biodiversity hotspots , or regions that display significant habitat loss in the presence of high endemism. [lower-alpha 14] According to official statistics, India's forest cover is 713,789 km 2 (275,595 sq mi) , which is 21.71% of the country's total land area. It can be subdivided further into broad categories of canopy density , or the proportion of the area of a forest covered by its tree canopy . Very dense forest , whose canopy density is greater than 70%, occupies 3.02% of India's land area. It predominates in the tropical moist forest of the Andaman Islands , the Western Ghats , and Northeast India . Moderately dense forest , whose canopy density is between 40% and 70%, occupies 9.39% of India's land area. It predominates in the temperate coniferous forest of the Himalayas , the moist deciduous sal forest of eastern India, and the dry deciduous teak forest of central and southern India. Open forest , whose canopy density is between 10% and 40%, occupies 9.26% of India's land area. India has two natural zones of thorn forest , one in the Deccan Plateau , immediately east of the Western Ghats, and the other in the western part of the Indo-Gangetic plain, now turned into rich agricultural land by irrigation, its features no longer visible. Among the Indian subcontinent's notable indigenous trees are the astringent Azadirachta indica , or neem , which is widely used in rural Indian herbal medicine , and the luxuriant Ficus religiosa , or peepul , which is displayed on the ancient seals of Mohenjo-daro , and under which the Buddha is recorded in the Pali canon to have sought enlightenment. Many Indian species have descended from those of Gondwana , the southern supercontinent from which India separated more than 100 million years ago. India's subsequent collision with Eurasia set off a mass exchange of species. However, volcanism and climatic changes later caused the extinction of many endemic Indian forms. Still later, mammals entered India from Asia through two zoogeographical passes flanking the Himalayas. This had the effect of lowering endemism among India's mammals, which stands at 12.6%, contrasting with 45.8% among reptiles and 55.8% among amphibians. Among endemics are the vulnerable hooded leaf monkey and the threatened Beddome's toad of the Western Ghats. India contains 172 IUCN -designated threatened animal species , or 2.9% of endangered forms. These include the endangered Bengal tiger and the Ganges river dolphin . Critically endangered species include the gharial , a crocodilian ; the great Indian bustard ; and the Indian white-rumped vulture , which has become nearly extinct by having ingested the carrion of diclofenac -treated cattle. Before they were extensively used for agriculture and cleared for human settlement, the thorn forests of Punjab were mingled at intervals with open grasslands that were grazed by large herds of blackbuck preyed on by the Asiatic cheetah ; the blackbuck, no longer extant in Punjab, is now severely endangered in India, and the cheetah is extinct. The pervasive and ecologically devastating human encroachment of recent decades has critically endangered Indian wildlife. In response, the system of national parks and protected areas , first established in 1935, was expanded substantially. In 1972, India enacted the Wildlife Protection Act and Project Tiger to safeguard crucial wilderness; the Forest Conservation Act was enacted in 1980 and amendments added in 1988. India hosts more than five hundred wildlife sanctuaries and eighteen biosphere reserves , four of which are part of the World Network of Biosphere Reserves ; seventy-five wetlands are registered under the Ramsar Convention . A parliamentary republic with a multi-party system , India has six recognised national parties , including the Indian National Congress (INC) and the Bharatiya Janata Party (BJP), and more than 50 regional parties . The Congress is considered centre in Indian political culture , and the BJP right-wing . For most of the period between 1950—when India first became a republic—and the late 1980s, the Congress held a majority in the Parliament . Since then, however, it has increasingly shared the political stage with the BJP, as well as with powerful regional parties which have often forced the creation of multi-party coalition governments at the centre. In the Republic of India's first three general elections, in 1951 , 1957 , and 1962 , the Pandit Jawaharlal Nehru -led Congress won easy victories. On Nehru's death in 1964, Lal Bahadur Shastri briefly became prime minister; he was succeeded, after his own unexpected death in 1966, by Nehru's daughter Indira Gandhi , who went on to lead the Congress to election victories in 1967 and 1971 . Following public discontent with the state of emergency she declared in 1975, the Congress was voted out of power in 1977 ; the then-new Janata Party , which had opposed the emergency, was voted in. Its government lasted just over two years. There were two prime ministers during this period; Morarji Desai and Charan Singh . Voted back into power in 1980, the Congress saw a change in leadership in 1984, when Indira Gandhi was assassinated ; she was succeeded by her son Rajiv Gandhi , who won an easy victory in the general elections later that year . The Congress was voted out again in 1989 when a National Front coalition, led by the newly formed Janata Dal in alliance with the Left Front , won the elections; that government too proved relatively short-lived, lasting just under two years. There were two prime ministers during this period; V.P. Singh and Chandra Shekhar . Elections were held again in 1991 ; no party won an absolute majority. The Congress, as the largest single party, was able to form a minority government led by P. V. Narasimha Rao . A two-year period of political turmoil followed the general election of 1996 . Several short-lived alliances shared power at the centre. The BJP formed a government briefly in 1996; it was followed by two comparatively long-lasting United Front coalitions, which depended on external support. There were two prime ministers during this period; H.D. Deve Gowda and I.K. Gujral . In 1998 , the BJP was able to form a successful coalition, the National Democratic Alliance (NDA). Led by Atal Bihari Vajpayee , the NDA became the first non-Congress, coalition government to complete a five-year term. Again in the 2004 Indian general elections , no party won an absolute majority, but the Congress emerged as the largest single party, forming another successful coalition: the United Progressive Alliance (UPA). It had the support of left-leaning parties and MPs who opposed the BJP. The UPA returned to power in the 2009 general election with increased numbers, and it no longer required external support from India's communist parties . That year, Manmohan Singh became the first prime minister since Jawaharlal Nehru in 1957 and 1962 to be re-elected to a consecutive five-year term. In the 2014 general election , the BJP became the first political party since 1984 to win a majority and govern without the support of other parties. In the 2019 general election , the BJP was victorious again. The incumbent prime minister is Narendra Modi , a former chief minister of Gujarat . On 22 July 2022, Droupadi Murmu was elected India's 15th president and took the oath of office on 25 July 2022. India is a federation with a parliamentary system governed under the Constitution of India—the country's supreme legal document. It is a constitutional republic. Federalism in India defines the power distribution between the union and the states . The Constitution of India, which came into effect on 26 January 1950, originally stated India to be a " sovereign , democratic republic ;" this characterisation was amended in 1971 to "a sovereign, socialist , secular , democratic republic". India's form of government, traditionally described as "quasi-federal" with a strong centre and weak states, has grown increasingly federal since the late 1990s as a result of political, economic, and social changes. The Government of India comprises three branches: India is a federal union comprising 28 states and 8 union territories . All states, as well as the union territories of Jammu and Kashmir , Puducherry and the National Capital Territory of Delhi , have elected legislatures and governments following the Westminster system of governance. The remaining five union territories are directly ruled by the central government through appointed administrators. In 1956, under the States Reorganisation Act , states were reorganised on a linguistic basis. There are over a quarter of a million local government bodies at city, town, block, district and village levels. A parliamentary republic with a multi-party system , India has six recognised national parties , including the Indian National Congress (INC) and the Bharatiya Janata Party (BJP), and more than 50 regional parties . The Congress is considered centre in Indian political culture , and the BJP right-wing . For most of the period between 1950—when India first became a republic—and the late 1980s, the Congress held a majority in the Parliament . Since then, however, it has increasingly shared the political stage with the BJP, as well as with powerful regional parties which have often forced the creation of multi-party coalition governments at the centre. In the Republic of India's first three general elections, in 1951 , 1957 , and 1962 , the Pandit Jawaharlal Nehru -led Congress won easy victories. On Nehru's death in 1964, Lal Bahadur Shastri briefly became prime minister; he was succeeded, after his own unexpected death in 1966, by Nehru's daughter Indira Gandhi , who went on to lead the Congress to election victories in 1967 and 1971 . Following public discontent with the state of emergency she declared in 1975, the Congress was voted out of power in 1977 ; the then-new Janata Party , which had opposed the emergency, was voted in. Its government lasted just over two years. There were two prime ministers during this period; Morarji Desai and Charan Singh . Voted back into power in 1980, the Congress saw a change in leadership in 1984, when Indira Gandhi was assassinated ; she was succeeded by her son Rajiv Gandhi , who won an easy victory in the general elections later that year . The Congress was voted out again in 1989 when a National Front coalition, led by the newly formed Janata Dal in alliance with the Left Front , won the elections; that government too proved relatively short-lived, lasting just under two years. There were two prime ministers during this period; V.P. Singh and Chandra Shekhar . Elections were held again in 1991 ; no party won an absolute majority. The Congress, as the largest single party, was able to form a minority government led by P. V. Narasimha Rao . A two-year period of political turmoil followed the general election of 1996 . Several short-lived alliances shared power at the centre. The BJP formed a government briefly in 1996; it was followed by two comparatively long-lasting United Front coalitions, which depended on external support. There were two prime ministers during this period; H.D. Deve Gowda and I.K. Gujral . In 1998 , the BJP was able to form a successful coalition, the National Democratic Alliance (NDA). Led by Atal Bihari Vajpayee , the NDA became the first non-Congress, coalition government to complete a five-year term. Again in the 2004 Indian general elections , no party won an absolute majority, but the Congress emerged as the largest single party, forming another successful coalition: the United Progressive Alliance (UPA). It had the support of left-leaning parties and MPs who opposed the BJP. The UPA returned to power in the 2009 general election with increased numbers, and it no longer required external support from India's communist parties . That year, Manmohan Singh became the first prime minister since Jawaharlal Nehru in 1957 and 1962 to be re-elected to a consecutive five-year term. In the 2014 general election , the BJP became the first political party since 1984 to win a majority and govern without the support of other parties. In the 2019 general election , the BJP was victorious again. The incumbent prime minister is Narendra Modi , a former chief minister of Gujarat . On 22 July 2022, Droupadi Murmu was elected India's 15th president and took the oath of office on 25 July 2022. India is a federation with a parliamentary system governed under the Constitution of India—the country's supreme legal document. It is a constitutional republic. Federalism in India defines the power distribution between the union and the states . The Constitution of India, which came into effect on 26 January 1950, originally stated India to be a " sovereign , democratic republic ;" this characterisation was amended in 1971 to "a sovereign, socialist , secular , democratic republic". India's form of government, traditionally described as "quasi-federal" with a strong centre and weak states, has grown increasingly federal since the late 1990s as a result of political, economic, and social changes. The Government of India comprises three branches: India is a federal union comprising 28 states and 8 union territories . All states, as well as the union territories of Jammu and Kashmir , Puducherry and the National Capital Territory of Delhi , have elected legislatures and governments following the Westminster system of governance. The remaining five union territories are directly ruled by the central government through appointed administrators. In 1956, under the States Reorganisation Act , states were reorganised on a linguistic basis. There are over a quarter of a million local government bodies at city, town, block, district and village levels. In the 1950s, India strongly supported decolonisation in Africa and Asia and played a leading role in the Non-Aligned Movement . After initially cordial relations with neighbouring China, India went to war with China in 1962 and was widely thought to have been humiliated. This was followed by another military conflict in 1967 in which India successfully repelled Chinese attack. India has had tense relations with neighbouring Pakistan; the two nations have gone to war four times: in 1947 , 1965 , 1971 , and 1999 . Three of these wars were fought over the disputed territory of Kashmir , while the third, the 1971 war, followed from India's support for the independence of Bangladesh . In the late 1980s, the Indian military twice intervened abroad at the invitation of the host country: a peace-keeping operation in Sri Lanka between 1987 and 1990; and an armed intervention to prevent a 1988 coup d'état attempt in the Maldives. After the 1965 war with Pakistan, India began to pursue close military and economic ties with the Soviet Union ; by the late 1960s, the Soviet Union was its largest arms supplier. Aside from its ongoing special relationship with Russia , India has wide-ranging defence relations with Israel and France . In recent years, it has played key roles in the South Asian Association for Regional Cooperation and the World Trade Organization . The nation has provided 100,000 military and police personnel to serve in 35 UN peacekeeping operations across four continents. It participates in the East Asia Summit , the G8+5 , and other multilateral forums. India has close economic ties with countries in South America , Asia, and Africa; it pursues a "Look East" policy that seeks to strengthen partnerships with the ASEAN nations, Japan , and South Korea that revolve around many issues, but especially those involving economic investment and regional security. China's nuclear test of 1964 , as well as its repeated threats to intervene in support of Pakistan in the 1965 war, convinced India to develop nuclear weapons. India conducted its first nuclear weapons test in 1974 and carried out additional underground testing in 1998. Despite criticism and military sanctions, India has signed neither the Comprehensive Nuclear-Test-Ban Treaty nor the Nuclear Non-Proliferation Treaty , considering both to be flawed and discriminatory. India maintains a " no first use " nuclear policy and is developing a nuclear triad capability as a part of its " Minimum Credible Deterrence " doctrine. It is developing a ballistic missile defence shield and, a fifth-generation fighter jet . Other indigenous military projects involve the design and implementation of Vikrant -class aircraft carriers and Arihant -class nuclear submarines . Since the end of the Cold War , India has increased its economic, strategic, and military co-operation with the United States and the European Union . In 2008, a civilian nuclear agreement was signed between India and the United States. Although India possessed nuclear weapons at the time and was not a party to the Nuclear Non-Proliferation Treaty, it received waivers from the International Atomic Energy Agency and the Nuclear Suppliers Group , ending earlier restrictions on India's nuclear technology and commerce. As a consequence, India became the sixth de facto nuclear weapons state. India subsequently signed co-operation agreements involving civilian nuclear energy with Russia, France, the United Kingdom , and Canada . The President of India is the supreme commander of the nation's armed forces; with 1.45 million active troops, they compose the world's second-largest military . It comprises the Indian Army , the Indian Navy , the Indian Air Force , and the Indian Coast Guard . The official Indian defence budget for 2011 was US$36.03 billion, or 1.83% of GDP. Defence expenditure was pegged at US$70.12 billion for fiscal year 2022–23 and, increased 9.8% than previous fiscal year. India is the world's second-largest arms importer; between 2016 and 2020, it accounted for 9.5% of the total global arms imports. Much of the military expenditure was focused on defence against Pakistan and countering growing Chinese influence in the Indian Ocean. In May 2017, the Indian Space Research Organisation launched the South Asia Satellite , a gift from India to its neighbouring SAARC countries. In October 2018, India signed a US$5.43 billion (over ₹ 400 billion) agreement with Russia to procure four S-400 Triumf surface-to-air missile defence systems, Russia's most advanced long-range missile defence system. According to the International Monetary Fund (IMF), the Indian economy in 2022 was nominally worth $3.46 trillion; it was the fifth-largest economy by market exchange rates and is, around $11.6 trillion, the third-largest by purchasing power parity (PPP). With its average annual GDP growth rate of 5.8% over the past two decades, and reaching 6.1% during 2011–2012, India is one of the world's fastest-growing economies . However, the country ranks 139th in the world in nominal GDP per capita and 118th in GDP per capita at PPP . Until 1991, all Indian governments followed protectionist policies that were influenced by socialist economics. Widespread state intervention and regulation largely walled the economy off from the outside world. An acute balance of payments crisis in 1991 forced the nation to liberalise its economy ; since then, it has moved increasingly towards a free-market system by emphasising both foreign trade and direct investment inflows. India has been a member of World Trade Organization since 1 January 1995. The 522-million-worker Indian labour force is the world's second-largest , as of 2017 [ update ] . The service sector makes up 55.6% of GDP, the industrial sector 26.3% and the agricultural sector 18.1%. India's foreign exchange remittances of US$100 billion in 2022, highest in the world, were contributed to its economy by 32 million Indians working in foreign countries. Major agricultural products include rice, wheat, oilseed, cotton, jute, tea, sugarcane, and potatoes. Major industries include textiles, telecommunications, chemicals, pharmaceuticals, biotechnology, food processing, steel, transport equipment, cement, mining, petroleum, machinery, and software. In 2006, the share of external trade in India's GDP stood at 24%, up from 6% in 1985. In 2008, India's share of world trade was 1.7%; In 2021, India was the world's ninth-largest importer and the sixteenth-largest exporter . Major exports include petroleum products, textile goods, jewellery, software, engineering goods, chemicals, and manufactured leather goods. Major imports include crude oil, machinery, gems, fertiliser, and chemicals. Between 2001 and 2011, the contribution of petrochemical and engineering goods to total exports grew from 14% to 42%. India was the world's second-largest textile exporter after China in the 2013 calendar year. Averaging an economic growth rate of 7.5% for several years prior to 2007, India has more than doubled its hourly wage rates during the first decade of the 21st century. Some 431 million Indians have left poverty since 1985; India's middle classes are projected to number around 580 million by 2030. Though ranking 68th in global competitiveness , as of 2010 [ update ] , India ranks 17th in financial market sophistication, 24th in the banking sector, 44th in business sophistication, and 39th in innovation, ahead of several advanced economies. With seven of the world's top 15 information technology outsourcing companies based in India, as of 2009 [ update ] , the country is viewed as the second-most favourable outsourcing destination after the United States. India is ranked 40th in the Global Innovation Index in 2023. As of 2023 [ update ] , India's consumer market was the world's fifth-largest . Driven by growth, India's nominal GDP per capita increased steadily from US$308 in 1991, when economic liberalisation began, to US$1,380 in 2010, to an estimated US$1,730 in 2016. It is expected to grow to US$2,466 by 2022. However, it has remained lower than those of other Asian developing countries such as Indonesia, Malaysia, Philippines, Sri Lanka, and Thailand, and is expected to remain so in the near future. According to a 2011 PricewaterhouseCoopers ( PwC ) report, India's GDP at purchasing power parity could overtake that of the United States by 2045. During the next four decades, Indian GDP is expected to grow at an annualised average of 8%, making it potentially the world's fastest-growing major economy until 2050. The report highlights key growth factors: a young and rapidly growing working-age population; growth in the manufacturing sector because of rising education and engineering skill levels; and sustained growth of the consumer market driven by a rapidly growing middle-class. The World Bank cautions that, for India to achieve its economic potential, it must continue to focus on public sector reform, transport infrastructure , agricultural and rural development, removal of labour regulations, education , energy security , and public health and nutrition. According to the Worldwide Cost of Living Report 2017 released by the Economist Intelligence Unit (EIU) which was created by comparing more than 400 individual prices across 160 products and services, four of the cheapest cities were in India: Bangalore (3rd), Mumbai (5th), Chennai (5th) and New Delhi (8th). India's telecommunication industry is the second-largest in the world with over 1.2 billion subscribers. It contributes 6.5% to India's GDP. After the third quarter of 2017, India surpassed the US to become the second-largest smartphone market in the world after China. The Indian automotive industry , the world's second-fastest growing, increased domestic sales by 26% during 2009–2010, and exports by 36% during 2008–2009. In 2022, India became the world's third-largest vehicle market after China and the United States, surpassing Japan. At the end of 2011, the Indian IT industry employed 2.8 million professionals, generated revenues close to US$100 billion equalling 7.5% of Indian GDP, and contributed 26% of India's merchandise exports. The pharmaceutical industry in India emerged as a global player. As of 2021, with 3000 pharmaceutical companies and 10,500 manufacturing units India is the world's third-largest pharmaceutical producer, largest producer of generic medicines and supply up to 50—60% of global vaccines demand, these all contribute up to US$ 24.44 billions in exports and India's local pharmaceutical market is estimated up to US$ 42 billion. India is among the top 12 biotech destinations in the world. The Indian biotech industry grew by 15.1% in 2012–2013, increasing its revenues from ₹ 204.4 billion ( Indian rupees ) to ₹ 235.24 billion (US$3.94 billion at June 2013 exchange rates). India's capacity to generate electrical power is 300 gigawatts, of which 42 gigawatts is renewable . The country's usage of coal is a major cause of greenhouse gas emissions by India but its renewable energy is competing strongly. India emits about 7% of global greenhouse gas emissions. This equates to about 2.5 tons of carbon dioxide per person per year, which is half the world average. Increasing access to electricity and clean cooking with liquefied petroleum gas have been priorities for energy in India. Despite economic growth during recent decades, India continues to face socio-economic challenges. In 2006, India contained the largest number of people living below the World Bank's international poverty line of US$1.25 per day. The proportion decreased from 60% in 1981 to 42% in 2005. Under the World Bank's later revised poverty line, it was 21% in 2011. [lower-alpha 16] 30.7% of India's children under the age of five are underweight. According to a Food and Agriculture Organization report in 2015, 15% of the population is undernourished. The Midday Meal Scheme attempts to lower these rates. A 2018 Walk Free Foundation report estimated that nearly 8 million people in India were living in different forms of modern slavery , such as bonded labour , child labour , human trafficking, and forced begging, among others. According to the 2011 census, there were 10.1 million child labourers in the country, a decline of 2.6 million from 12.6 million in 2001. Since 1991, economic inequality between India's states has consistently grown: the per-capita net state domestic product of the richest states in 2007 was 3.2 times that of the poorest. Corruption in India is perceived to have decreased. According to the Corruption Perceptions Index , India ranked 78th out of 180 countries in 2018 with a score of 41 out of 100, an improvement from 85th in 2014. Epidemic and pandemic diseases have long been a major factor, including COVID-19 and cholera . India's telecommunication industry is the second-largest in the world with over 1.2 billion subscribers. It contributes 6.5% to India's GDP. After the third quarter of 2017, India surpassed the US to become the second-largest smartphone market in the world after China. The Indian automotive industry , the world's second-fastest growing, increased domestic sales by 26% during 2009–2010, and exports by 36% during 2008–2009. In 2022, India became the world's third-largest vehicle market after China and the United States, surpassing Japan. At the end of 2011, the Indian IT industry employed 2.8 million professionals, generated revenues close to US$100 billion equalling 7.5% of Indian GDP, and contributed 26% of India's merchandise exports. The pharmaceutical industry in India emerged as a global player. As of 2021, with 3000 pharmaceutical companies and 10,500 manufacturing units India is the world's third-largest pharmaceutical producer, largest producer of generic medicines and supply up to 50—60% of global vaccines demand, these all contribute up to US$ 24.44 billions in exports and India's local pharmaceutical market is estimated up to US$ 42 billion. India is among the top 12 biotech destinations in the world. The Indian biotech industry grew by 15.1% in 2012–2013, increasing its revenues from ₹ 204.4 billion ( Indian rupees ) to ₹ 235.24 billion (US$3.94 billion at June 2013 exchange rates). India's capacity to generate electrical power is 300 gigawatts, of which 42 gigawatts is renewable . The country's usage of coal is a major cause of greenhouse gas emissions by India but its renewable energy is competing strongly. India emits about 7% of global greenhouse gas emissions. This equates to about 2.5 tons of carbon dioxide per person per year, which is half the world average. Increasing access to electricity and clean cooking with liquefied petroleum gas have been priorities for energy in India. Despite economic growth during recent decades, India continues to face socio-economic challenges. In 2006, India contained the largest number of people living below the World Bank's international poverty line of US$1.25 per day. The proportion decreased from 60% in 1981 to 42% in 2005. Under the World Bank's later revised poverty line, it was 21% in 2011. [lower-alpha 16] 30.7% of India's children under the age of five are underweight. According to a Food and Agriculture Organization report in 2015, 15% of the population is undernourished. The Midday Meal Scheme attempts to lower these rates. A 2018 Walk Free Foundation report estimated that nearly 8 million people in India were living in different forms of modern slavery , such as bonded labour , child labour , human trafficking, and forced begging, among others. According to the 2011 census, there were 10.1 million child labourers in the country, a decline of 2.6 million from 12.6 million in 2001. Since 1991, economic inequality between India's states has consistently grown: the per-capita net state domestic product of the richest states in 2007 was 3.2 times that of the poorest. Corruption in India is perceived to have decreased. According to the Corruption Perceptions Index , India ranked 78th out of 180 countries in 2018 with a score of 41 out of 100, an improvement from 85th in 2014. Epidemic and pandemic diseases have long been a major factor, including COVID-19 and cholera . With 1,210,193,422 residents reported in the 2011 provisional census report , India was the world's second-most populous country. [lower-alpha 17] Its population grew by 17.64% from 2001 to 2011, compared to 21.54% growth in the previous decade (1991–2001). The human sex ratio, according to the 2011 census, is 940 females per 1,000 males. The median age was 28.7 as of 2020 [ update ] . The first post-colonial census, conducted in 1951, counted 361 million people. Medical advances made in the last 50 years as well as increased agricultural productivity brought about by the " Green Revolution " have caused India's population to grow rapidly. The life expectancy in India is at 70 years—71.5 years for women, 68.7 years for men. There are around 93 physicians per 100,000 people. Migration from rural to urban areas has been an important dynamic in India's recent history. The number of people living in urban areas grew by 31.2% between 1991 and 2001. Yet, in 2001, over 70% still lived in rural areas. The level of urbanisation increased further from 27.81% in the 2001 Census to 31.16% in the 2011 Census. The slowing down of the overall population growth rate was due to the sharp decline in the growth rate in rural areas since 1991. According to the 2011 census, there are 53 million-plus urban agglomerations in India ; among them Mumbai , Delhi , Kolkata , Chennai , Bangalore , Hyderabad and Ahmedabad , in decreasing order by population. The literacy rate in 2011 was 74.04%: 65.46% among females and 82.14% among males. The rural-urban literacy gap, which was 21.2 percentage points in 2001, dropped to 16.1 percentage points in 2011. The improvement in the rural literacy rate is twice that of urban areas. Kerala is the most literate state with 93.91% literacy; while Bihar the least with 63.82%. Among speakers of the Indian languages , 74% speak Indo-Aryan languages , the easternmost branch of the Indo-European languages ; 24% speak Dravidian languages , indigenous to South Asia and spoken widely before the spread of Indo-Aryan languages and 2% speak Austroasiatic languages or the Sino-Tibetan languages . India has no national language. Hindi , with the largest number of speakers, is the official language of the government. English is used extensively in business and administration and has the status of a "subsidiary official language"; it is important in education , especially as a medium of higher education. Each state and union territory has one or more official languages, and the constitution recognises in particular 22 "scheduled languages". The 2011 census reported the religion in India with the largest number of followers was Hinduism (79.80% of the population), followed by Islam (14.23%); the remaining were Christianity (2.30%), Sikhism (1.72%), Buddhism (0.70%), Jainism (0.36%) and others [lower-alpha 18] (0.9%). India has the third-largest Muslim population—the largest for a non-Muslim majority country. Indian cultural history spans more than 4,500 years . During the Vedic period ( c. 1700 BCE – c. 500 BCE ), the foundations of Hindu philosophy , mythology , theology and literature were laid, and many beliefs and practices which still exist today, such as dhárma , kárma , yóga , and mokṣa , were established. India is notable for its religious diversity , with Hinduism , Buddhism , Sikhism , Islam , Christianity , and Jainism among the nation's major religions. The predominant religion, Hinduism, has been shaped by various historical schools of thought, including those of the Upanishads , the Yoga Sutras , the Bhakti movement , and by Buddhist philosophy . India has a very ancient tradition of art, which has exchanged many influences with the rest of Eurasia , especially in the first millennium, when Buddhist art spread with Indian religions to Central , East and Southeast Asia , the last also greatly influenced by Hindu art. Thousands of seals from the Indus Valley Civilization of the third millennium BCE have been found, usually carved with animals, but a few with human figures. The "Pashupati" seal , excavated in Mohenjo-daro , Pakistan, in 1928–29, is the best known. After this there is a long period with virtually nothing surviving. Almost all surviving ancient Indian art thereafter is in various forms of religious sculpture in durable materials, or coins. There was probably originally far more in wood, which is lost. In north India Mauryan art is the first imperial movement. In the first millennium CE, Buddhist art spread with Indian religions to Central , East and Southeast Asia , the last also greatly influenced by Hindu art . Over the following centuries a distinctly Indian style of sculpting the human figure developed, with less interest in articulating precise anatomy than ancient Greek sculpture but showing smoothly flowing forms expressing prana ("breath" or life-force). This is often complicated by the need to give figures multiple arms or heads, or represent different genders on the left and right of figures, as with the Ardhanarishvara form of Shiva and Parvati . Most of the earliest large sculpture is Buddhist, either excavated from Buddhist stupas such as Sanchi , Sarnath and Amaravati , or is rock cut reliefs at sites such as Ajanta , Karla and Ellora . Hindu and Jain sites appear rather later. In spite of this complex mixture of religious traditions, generally, the prevailing artistic style at any time and place has been shared by the major religious groups, and sculptors probably usually served all communities. Gupta art , at its peak c. 300 CE – c. 500 CE , is often regarded as a classical period whose influence lingered for many centuries after; it saw a new dominance of Hindu sculpture, as at the Elephanta Caves . Across the north, this became rather stiff and formulaic after c. 800 CE , though rich with finely carved detail in the surrounds of statues. But in the South, under the Pallava and Chola dynasties , sculpture in both stone and bronze had a sustained period of great achievement ; the large bronzes with Shiva as Nataraja have become an iconic symbol of India. Ancient painting has only survived at a few sites, of which the crowded scenes of court life in the Ajanta Caves are by far the most important, but it was evidently highly developed, and is mentioned as a courtly accomplishment in Gupta times. Painted manuscripts of religious texts survive from Eastern India about the 10th century onwards, most of the earliest being Buddhist and later Jain. No doubt the style of these was used in larger paintings. The Persian-derived Deccan painting , starting just before the Mughal miniature , between them give the first large body of secular painting, with an emphasis on portraits, and the recording of princely pleasures and wars. The style spread to Hindu courts, especially among the Rajputs , and developed a variety of styles, with the smaller courts often the most innovative, with figures such as Nihâl Chand and Nainsukh . As a market developed among European residents, it was supplied by Company painting by Indian artists with considerable Western influence. In the 19th century, cheap Kalighat paintings of gods and everyday life, done on paper, were urban folk art from Calcutta , which later saw the Bengal School of Art , reflecting the art colleges founded by the British, the first movement in modern Indian painting . Much of Indian architecture, including the Taj Mahal , other works of Indo-Islamic Mughal architecture , and South Indian architecture , blends ancient local traditions with imported styles. Vernacular architecture is also regional in its flavours. Vastu shastra , literally "science of construction" or "architecture" and ascribed to Mamuni Mayan , explores how the laws of nature affect human dwellings; it employs precise geometry and directional alignments to reflect perceived cosmic constructs. As applied in Hindu temple architecture , it is influenced by the Shilpa Shastras , a series of foundational texts whose basic mythological form is the Vastu-Purusha mandala , a square that embodied the " absolute ". The Taj Mahal, built in Agra between 1631 and 1648 by orders of Mughal emperor Shah Jahan in memory of his wife, has been described in the UNESCO World Heritage List as "the jewel of Muslim art in India and one of the universally admired masterpieces of the world's heritage". Indo-Saracenic Revival architecture , developed by the British in the late 19th century, drew on Indo-Islamic architecture . The earliest literature in India, composed between 1500 BCE and 1200 CE , was in the Sanskrit language. Major works of Sanskrit literature include the Rigveda ( c. 1500 BCE – c. 1200 BCE ), the epics : Mahābhārata ( c. 400 BCE – c. 400 CE ) and the Ramayana ( c. 300 BCE and later); Abhijñānaśākuntalam ( The Recognition of Śakuntalā , and other dramas of Kālidāsa ( c. 5th century CE ) and Mahākāvya poetry. In Tamil literature , the Sangam literature ( c. 600 BCE – c. 300 BCE ) consisting of 2,381 poems, composed by 473 poets, is the earliest work. From the 14th to the 18th centuries, India's literary traditions went through a period of drastic change because of the emergence of devotional poets like Kabīr , Tulsīdās , and Guru Nānak . This period was characterised by a varied and wide spectrum of thought and expression; as a consequence, medieval Indian literary works differed significantly from classical traditions. In the 19th century, Indian writers took a new interest in social questions and psychological descriptions. In the 20th century, Indian literature was influenced by the works of the Bengali poet, author and philosopher Rabindranath Tagore , who was a recipient of the Nobel Prize in Literature . Indian music ranges over various traditions and regional styles. Classical music encompasses two genres and their various folk offshoots: the northern Hindustani and the southern Carnatic schools. Regionalised popular forms include filmi and folk music ; the syncretic tradition of the bauls is a well-known form of the latter. Indian dance also features diverse folk and classical forms. Among the better-known folk dances are: bhangra of Punjab, bihu of Assam, Jhumair and chhau of Jharkhand, Odisha and West Bengal, garba and dandiya of Gujarat, ghoomar of Rajasthan, and lavani of Maharashtra. Eight dance forms, many with narrative forms and mythological elements, have been accorded classical dance status by India's National Academy of Music, Dance, and Drama . These are: bharatanatyam of the state of Tamil Nadu, kathak of Uttar Pradesh, kathakali and mohiniyattam of Kerala, kuchipudi of Andhra Pradesh, manipuri of Manipur, odissi of Odisha , and the sattriya of Assam. Theatre in India melds music, dance, and improvised or written dialogue. Often based on Hindu mythology, but also borrowing from medieval romances or social and political events, Indian theatre includes: the bhavai of Gujarat, the jatra of West Bengal, the nautanki and ramlila of North India, tamasha of Maharashtra, burrakatha of Andhra Pradesh and Telangana, terukkuttu of Tamil Nadu, and the yakshagana of Karnataka. India has a theatre training institute the National School of Drama (NSD) that is situated at New Delhi . It is an autonomous organisation under the Ministry of culture , Government of India . The Indian film industry produces the world's most-watched cinema. Established regional cinematic traditions exist in the Assamese , Bengali , Bhojpuri , Hindi , Kannada , Malayalam , Punjabi , Gujarati , Marathi , Odia , Tamil , and Telugu languages. The Hindi language film industry ( Bollywood ) is the largest sector representing 43% of box office revenue, followed by the South Indian Telugu and Tamil film industries which represent 36% combined. Television broadcasting began in India in 1959 as a state-run medium of communication and expanded slowly for more than two decades. The state monopoly on television broadcast ended in the 1990s. Since then, satellite channels have increasingly shaped the popular culture of Indian society. Today, television is the most penetrative media in India; industry estimates indicate that as of 2012 [ update ] there are over 554 million TV consumers, 462 million with satellite or cable connections compared to other forms of mass media such as the press (350 million), radio (156 million) or internet (37 million). Traditional Indian society is sometimes defined by social hierarchy. The Indian caste system embodies much of the social stratification and many of the social restrictions found on the Indian subcontinent. Social classes are defined by thousands of endogamous hereditary groups, often termed as jātis , or "castes". India abolished untouchability in 1950 with the adoption of the constitution and has since enacted other anti-discriminatory laws and social welfare initiatives. Family values are important in the Indian tradition, and multi-generational patrilineal joint families have been the norm in India, though nuclear families are becoming common in urban areas. An overwhelming majority of Indians, with their consent, have their marriages arranged by their parents or other family elders. Marriage is thought to be for life, and the divorce rate is extremely low, with less than one in a thousand marriages ending in divorce. Child marriages are common, especially in rural areas; many women wed before reaching 18, which is their legal marriageable age. Female infanticide in India , and lately female foeticide , have created skewed gender ratios; the number of missing women in the country quadrupled from 15 million to 63 million in the 50-year period ending in 2014, faster than the population growth during the same period, and constituting 20 percent of India's female electorate. According to an Indian government study, an additional 21 million girls are unwanted and do not receive adequate care. Despite a government ban on sex-selective foeticide, the practice remains commonplace in India, the result of a preference for boys in a patriarchal society. The payment of dowry , although illegal , remains widespread across class lines. Deaths resulting from dowry , mostly from bride burning , are on the rise, despite stringent anti-dowry laws. Many Indian festivals are religious in origin. The best known include Diwali , Ganesh Chaturthi , Thai Pongal , Holi , Durga Puja , Eid ul-Fitr , Bakr-Id , Christmas , and Vaisakhi . In the 2011 census, about 73% of the population was literate, with 81% for men and 65% for women. This compares to 1981 when the respective rates were 41%, 53% and 29%. In 1951 the rates were 18%, 27% and 9%. In 1921 the rates 7%, 12% and 2%. In 1891 they were 5%, 9% and 1%, According to Latika Chaudhary, in 1911 there were under three primary schools for every ten villages. Statistically, more caste and religious diversity reduced private spending. Primary schools taught literacy, so local diversity limited its growth. The education system of India is the world's second-largest. India has over 900 universities, 40,000 colleges and 1.5 million schools. In India's higher education system, a significant number of seats are reserved under affirmative action policies for the historically disadvantaged. In recent decades India's improved education system is often cited as one of the main contributors to its economic development . From ancient times until the advent of the modern, the most widely worn traditional dress in India was draped . For women it took the form of a sari , a single piece of cloth many yards long. The sari was traditionally wrapped around the lower body and the shoulder. In its modern form, it is combined with an underskirt, or Indian petticoat , and tucked in the waist band for more secure fastening. It is also commonly worn with an Indian blouse , or choli , which serves as the primary upper-body garment, the sari's end—passing over the shoulder—serving to cover the midriff and obscure the upper body's contours. For men, a similar but shorter length of cloth, the dhoti , has served as a lower-body garment. The use of stitched clothes became widespread after Muslim rule was established at first by the Delhi sultanate ( c. 1300 CE ) and then continued by the Mughal Empire ( c. 1525 CE ). Among the garments introduced during this time and still commonly worn are: the shalwars and pyjamas , both styles of trousers, and the tunics kurta and kameez . In southern India, the traditional draped garments were to see much longer continuous use. Shalwars are atypically wide at the waist but narrow to a cuffed bottom. They are held up by a drawstring, which causes them to become pleated around the waist. The pants can be wide and baggy, or they can be cut quite narrow, on the bias , in which case they are called churidars . When they are ordinarily wide at the waist and their bottoms are hemmed but not cuffed, they are called pyjamas. The kameez is a long shirt or tunic, its side seams left open below the waist-line. The kurta is traditionally collarless and made of cotton or silk; it is worn plain or with embroidered decoration, such as chikan ; and typically falls to either just above or just below the wearer's knees. In the last 50 years, fashions have changed a great deal in India. Increasingly, in urban northern India, the sari is no longer the apparel of everyday wear, though they remain popular on formal occasions. The traditional shalwar kameez is rarely worn by younger urban women, who favour churidars or jeans. In white-collar office settings, ubiquitous air conditioning allows men to wear sports jackets year-round. For weddings and formal occasions, men in the middle- and upper classes often wear bandgala , or short Nehru jackets , with pants, with the groom and his groomsmen sporting sherwanis and churidars. The dhoti, once the universal garment of Hindu males, the wearing of which in the homespun and handwoven khadi allowed Gandhi to bring Indian nationalism to the millions, is seldom seen in the cities. The foundation of a typical Indian meal is a cereal cooked in a plain fashion and complemented with flavourful savoury dishes. The cooked cereal could be steamed rice; chapati , a thin unleavened bread made from wheat flour, or occasionally cornmeal, and griddle-cooked dry; the idli , a steamed breakfast cake, or dosa , a griddled pancake, both leavened and made from a batter of rice- and gram meal. The savoury dishes might include lentils , pulses and vegetables commonly spiced with ginger and garlic , but also with a combination of spices that may include coriander , cumin , turmeric , cinnamon , cardamon and others as informed by culinary conventions. They might also include poultry, fish, or meat dishes. In some instances, the ingredients might be mixed during the process of cooking. A platter, or thali , used for eating usually has a central place reserved for the cooked cereal, and peripheral ones for the flavourful accompaniments, which are often served in small bowls. The cereal and its accompaniments are eaten simultaneously rather than a piecemeal manner. This is accomplished by mixing—for example of rice and lentils—or folding, wrapping, scooping or dipping—such as chapati and cooked vegetables or lentils. India has distinctive vegetarian cuisines, each a feature of the geographical and cultural histories of its adherents. The appearance of ahimsa , or the avoidance of violence toward all forms of life in many religious orders early in Indian history, especially Upanishadic Hinduism , Buddhism and Jainism , is thought to have contributed to the predominance of vegetarianism among a large segment of India's Hindu population, especially in southern India, Gujarat, the Hindi -speaking belt of north-central India, as well as among Jains. Although meat is eaten widely in India, the proportional consumption of meat in the overall diet is low. Unlike China, which has increased its per capita meat consumption substantially in its years of increased economic growth, in India the strong dietary traditions have contributed to dairy, rather than meat, becoming the preferred form of animal protein consumption. The most significant import of cooking techniques into India during the last millennium occurred during the Mughal Empire . Dishes such as the pilaf , developed in the Abbasid caliphate , and cooking techniques such as the marinating of meat in yogurt, spread into northern India from regions to its northwest. To the simple yogurt marinade of Persia, onions, garlic, almonds, and spices began to be added in India. Rice was partially cooked and layered alternately with the sauteed meat, the pot sealed tightly, and slow cooked according to another Persian cooking technique, to produce what has today become the Indian biryani , a feature of festive dining in many parts of India. In the food served in Indian restaurants worldwide the diversity of Indian food has been partially concealed by the dominance of Punjabi cuisine . The popularity of tandoori chicken —cooked in the tandoor oven, which had traditionally been used for baking bread in the rural Punjab and the Delhi region, especially among Muslims, but which is originally from Central Asia —dates to the 1950s, and was caused in large part by an entrepreneurial response among people from the Punjab who had been displaced by the 1947 partition of India . Several traditional indigenous sports such as kabaddi , kho kho , pehlwani and gilli-danda , and also martial arts such as Kalarippayattu and marma adi , remain popular. Chess is commonly held to have originated in India as chaturaṠga ; in recent years, there has been a rise in the number of Indian grandmasters . Viswanathan Anand became the Chess World Champion in 2007 and held the status until 2013. He also won the Chess World Cup in 2000 and 2002. In 2023, R Praggnanandhaa finished as runners up in the tournament. Parcheesi is derived from Pachisi , another traditional Indian pastime, which in early modern times was played on a giant marble court by Mughal emperor Akbar the Great . Cricket is the most popular sport in India. Major domestic leagues include the Indian Premier League . Professional leagues in other sports include the Indian Super League ( football ) and the Pro Kabaddi league. India has won two Cricket World Cups , the 1983 edition and the 2011 edition , as well as becoming the inaugural T20 World Cup Champions in 2007 . India has also won the Champions Trophy twice, in 2002 and 2013 . The only edition of the World Championship of Cricket was won by India in 1985 . India also has eight field hockey gold medals in the summer olympics . The improved results garnered by the Indian Davis Cup team and other tennis players in the early 2010s have made tennis increasingly popular in the country. India has a comparatively strong presence in shooting sports, and has won several medals at the Olympics , the World Shooting Championships , and the Commonwealth Games. Other sports in which Indians have succeeded internationally include badminton ( Saina Nehwal and P. V. Sindhu are two of the top-ranked female badminton players in the world), boxing, and wrestling. Football is popular in West Bengal , Goa , Tamil Nadu , Kerala , and the north-eastern states .India has traditionally been the dominant country at the South Asian Games . An example of this dominance is the basketball competition where the Indian team won four out of five tournaments to date. India has hosted or co-hosted several international sporting events: the 1951 and 1982 Asian Games ; the 1987 , 1996 , 2011 and 2023 ICC Men's Cricket World Cup tournaments (and is also scheduled to host it in 2031 ); the 1978 , 1997 and 2013 ICC Women's Cricket World Cup tournaments (and is also scheduled to host it in 2025 ); the 1987 , 1985 and 2016 South Asian Games ; the 1990-91 Men's Asia Cup ; the 2002 Chess World Cup ; the 2003 Afro-Asian Games ; the 2006 ICC Cricket Champion's Trophy (and is also scheduled to host it in 2029 ); the 2006 Women's Asia Cup ; the 2009 World Badminton Championships ; the 2010 Hockey World Cup ; the 2010 Commonwealth Games ; the 2016 ICC Men's Cricket T20 World Cup (and is also scheduled to host it in 2026 ); the 2016 ICC Women's Cricket T20 World Cup and the 2017 FIFA U-17 World Cup . Major international sporting events held annually in India include the Maharashtra Open , the Mumbai Marathon , the Delhi Half Marathon , and the Indian Masters . The first Formula 1 Indian Grand Prix featured in late 2011 but has been discontinued from the F1 season calendar since 2014. India has a very ancient tradition of art, which has exchanged many influences with the rest of Eurasia , especially in the first millennium, when Buddhist art spread with Indian religions to Central , East and Southeast Asia , the last also greatly influenced by Hindu art. Thousands of seals from the Indus Valley Civilization of the third millennium BCE have been found, usually carved with animals, but a few with human figures. The "Pashupati" seal , excavated in Mohenjo-daro , Pakistan, in 1928–29, is the best known. After this there is a long period with virtually nothing surviving. Almost all surviving ancient Indian art thereafter is in various forms of religious sculpture in durable materials, or coins. There was probably originally far more in wood, which is lost. In north India Mauryan art is the first imperial movement. In the first millennium CE, Buddhist art spread with Indian religions to Central , East and Southeast Asia , the last also greatly influenced by Hindu art . Over the following centuries a distinctly Indian style of sculpting the human figure developed, with less interest in articulating precise anatomy than ancient Greek sculpture but showing smoothly flowing forms expressing prana ("breath" or life-force). This is often complicated by the need to give figures multiple arms or heads, or represent different genders on the left and right of figures, as with the Ardhanarishvara form of Shiva and Parvati . Most of the earliest large sculpture is Buddhist, either excavated from Buddhist stupas such as Sanchi , Sarnath and Amaravati , or is rock cut reliefs at sites such as Ajanta , Karla and Ellora . Hindu and Jain sites appear rather later. In spite of this complex mixture of religious traditions, generally, the prevailing artistic style at any time and place has been shared by the major religious groups, and sculptors probably usually served all communities. Gupta art , at its peak c. 300 CE – c. 500 CE , is often regarded as a classical period whose influence lingered for many centuries after; it saw a new dominance of Hindu sculpture, as at the Elephanta Caves . Across the north, this became rather stiff and formulaic after c. 800 CE , though rich with finely carved detail in the surrounds of statues. But in the South, under the Pallava and Chola dynasties , sculpture in both stone and bronze had a sustained period of great achievement ; the large bronzes with Shiva as Nataraja have become an iconic symbol of India. Ancient painting has only survived at a few sites, of which the crowded scenes of court life in the Ajanta Caves are by far the most important, but it was evidently highly developed, and is mentioned as a courtly accomplishment in Gupta times. Painted manuscripts of religious texts survive from Eastern India about the 10th century onwards, most of the earliest being Buddhist and later Jain. No doubt the style of these was used in larger paintings. The Persian-derived Deccan painting , starting just before the Mughal miniature , between them give the first large body of secular painting, with an emphasis on portraits, and the recording of princely pleasures and wars. The style spread to Hindu courts, especially among the Rajputs , and developed a variety of styles, with the smaller courts often the most innovative, with figures such as Nihâl Chand and Nainsukh . As a market developed among European residents, it was supplied by Company painting by Indian artists with considerable Western influence. In the 19th century, cheap Kalighat paintings of gods and everyday life, done on paper, were urban folk art from Calcutta , which later saw the Bengal School of Art , reflecting the art colleges founded by the British, the first movement in modern Indian painting . Much of Indian architecture, including the Taj Mahal , other works of Indo-Islamic Mughal architecture , and South Indian architecture , blends ancient local traditions with imported styles. Vernacular architecture is also regional in its flavours. Vastu shastra , literally "science of construction" or "architecture" and ascribed to Mamuni Mayan , explores how the laws of nature affect human dwellings; it employs precise geometry and directional alignments to reflect perceived cosmic constructs. As applied in Hindu temple architecture , it is influenced by the Shilpa Shastras , a series of foundational texts whose basic mythological form is the Vastu-Purusha mandala , a square that embodied the " absolute ". The Taj Mahal, built in Agra between 1631 and 1648 by orders of Mughal emperor Shah Jahan in memory of his wife, has been described in the UNESCO World Heritage List as "the jewel of Muslim art in India and one of the universally admired masterpieces of the world's heritage". Indo-Saracenic Revival architecture , developed by the British in the late 19th century, drew on Indo-Islamic architecture . The earliest literature in India, composed between 1500 BCE and 1200 CE , was in the Sanskrit language. Major works of Sanskrit literature include the Rigveda ( c. 1500 BCE – c. 1200 BCE ), the epics : Mahābhārata ( c. 400 BCE – c. 400 CE ) and the Ramayana ( c. 300 BCE and later); Abhijñānaśākuntalam ( The Recognition of Śakuntalā , and other dramas of Kālidāsa ( c. 5th century CE ) and Mahākāvya poetry. In Tamil literature , the Sangam literature ( c. 600 BCE – c. 300 BCE ) consisting of 2,381 poems, composed by 473 poets, is the earliest work. From the 14th to the 18th centuries, India's literary traditions went through a period of drastic change because of the emergence of devotional poets like Kabīr , Tulsīdās , and Guru Nānak . This period was characterised by a varied and wide spectrum of thought and expression; as a consequence, medieval Indian literary works differed significantly from classical traditions. In the 19th century, Indian writers took a new interest in social questions and psychological descriptions. In the 20th century, Indian literature was influenced by the works of the Bengali poet, author and philosopher Rabindranath Tagore , who was a recipient of the Nobel Prize in Literature .Indian music ranges over various traditions and regional styles. Classical music encompasses two genres and their various folk offshoots: the northern Hindustani and the southern Carnatic schools. Regionalised popular forms include filmi and folk music ; the syncretic tradition of the bauls is a well-known form of the latter. Indian dance also features diverse folk and classical forms. Among the better-known folk dances are: bhangra of Punjab, bihu of Assam, Jhumair and chhau of Jharkhand, Odisha and West Bengal, garba and dandiya of Gujarat, ghoomar of Rajasthan, and lavani of Maharashtra. Eight dance forms, many with narrative forms and mythological elements, have been accorded classical dance status by India's National Academy of Music, Dance, and Drama . These are: bharatanatyam of the state of Tamil Nadu, kathak of Uttar Pradesh, kathakali and mohiniyattam of Kerala, kuchipudi of Andhra Pradesh, manipuri of Manipur, odissi of Odisha , and the sattriya of Assam. Theatre in India melds music, dance, and improvised or written dialogue. Often based on Hindu mythology, but also borrowing from medieval romances or social and political events, Indian theatre includes: the bhavai of Gujarat, the jatra of West Bengal, the nautanki and ramlila of North India, tamasha of Maharashtra, burrakatha of Andhra Pradesh and Telangana, terukkuttu of Tamil Nadu, and the yakshagana of Karnataka. India has a theatre training institute the National School of Drama (NSD) that is situated at New Delhi . It is an autonomous organisation under the Ministry of culture , Government of India . The Indian film industry produces the world's most-watched cinema. Established regional cinematic traditions exist in the Assamese , Bengali , Bhojpuri , Hindi , Kannada , Malayalam , Punjabi , Gujarati , Marathi , Odia , Tamil , and Telugu languages. The Hindi language film industry ( Bollywood ) is the largest sector representing 43% of box office revenue, followed by the South Indian Telugu and Tamil film industries which represent 36% combined. Television broadcasting began in India in 1959 as a state-run medium of communication and expanded slowly for more than two decades. The state monopoly on television broadcast ended in the 1990s. Since then, satellite channels have increasingly shaped the popular culture of Indian society. Today, television is the most penetrative media in India; industry estimates indicate that as of 2012 [ update ] there are over 554 million TV consumers, 462 million with satellite or cable connections compared to other forms of mass media such as the press (350 million), radio (156 million) or internet (37 million). Traditional Indian society is sometimes defined by social hierarchy. The Indian caste system embodies much of the social stratification and many of the social restrictions found on the Indian subcontinent. Social classes are defined by thousands of endogamous hereditary groups, often termed as jātis , or "castes". India abolished untouchability in 1950 with the adoption of the constitution and has since enacted other anti-discriminatory laws and social welfare initiatives. Family values are important in the Indian tradition, and multi-generational patrilineal joint families have been the norm in India, though nuclear families are becoming common in urban areas. An overwhelming majority of Indians, with their consent, have their marriages arranged by their parents or other family elders. Marriage is thought to be for life, and the divorce rate is extremely low, with less than one in a thousand marriages ending in divorce. Child marriages are common, especially in rural areas; many women wed before reaching 18, which is their legal marriageable age. Female infanticide in India , and lately female foeticide , have created skewed gender ratios; the number of missing women in the country quadrupled from 15 million to 63 million in the 50-year period ending in 2014, faster than the population growth during the same period, and constituting 20 percent of India's female electorate. According to an Indian government study, an additional 21 million girls are unwanted and do not receive adequate care. Despite a government ban on sex-selective foeticide, the practice remains commonplace in India, the result of a preference for boys in a patriarchal society. The payment of dowry , although illegal , remains widespread across class lines. Deaths resulting from dowry , mostly from bride burning , are on the rise, despite stringent anti-dowry laws. Many Indian festivals are religious in origin. The best known include Diwali , Ganesh Chaturthi , Thai Pongal , Holi , Durga Puja , Eid ul-Fitr , Bakr-Id , Christmas , and Vaisakhi . In the 2011 census, about 73% of the population was literate, with 81% for men and 65% for women. This compares to 1981 when the respective rates were 41%, 53% and 29%. In 1951 the rates were 18%, 27% and 9%. In 1921 the rates 7%, 12% and 2%. In 1891 they were 5%, 9% and 1%, According to Latika Chaudhary, in 1911 there were under three primary schools for every ten villages. Statistically, more caste and religious diversity reduced private spending. Primary schools taught literacy, so local diversity limited its growth. The education system of India is the world's second-largest. India has over 900 universities, 40,000 colleges and 1.5 million schools. In India's higher education system, a significant number of seats are reserved under affirmative action policies for the historically disadvantaged. In recent decades India's improved education system is often cited as one of the main contributors to its economic development . From ancient times until the advent of the modern, the most widely worn traditional dress in India was draped . For women it took the form of a sari , a single piece of cloth many yards long. The sari was traditionally wrapped around the lower body and the shoulder. In its modern form, it is combined with an underskirt, or Indian petticoat , and tucked in the waist band for more secure fastening. It is also commonly worn with an Indian blouse , or choli , which serves as the primary upper-body garment, the sari's end—passing over the shoulder—serving to cover the midriff and obscure the upper body's contours. For men, a similar but shorter length of cloth, the dhoti , has served as a lower-body garment. The use of stitched clothes became widespread after Muslim rule was established at first by the Delhi sultanate ( c. 1300 CE ) and then continued by the Mughal Empire ( c. 1525 CE ). Among the garments introduced during this time and still commonly worn are: the shalwars and pyjamas , both styles of trousers, and the tunics kurta and kameez . In southern India, the traditional draped garments were to see much longer continuous use. Shalwars are atypically wide at the waist but narrow to a cuffed bottom. They are held up by a drawstring, which causes them to become pleated around the waist. The pants can be wide and baggy, or they can be cut quite narrow, on the bias , in which case they are called churidars . When they are ordinarily wide at the waist and their bottoms are hemmed but not cuffed, they are called pyjamas. The kameez is a long shirt or tunic, its side seams left open below the waist-line. The kurta is traditionally collarless and made of cotton or silk; it is worn plain or with embroidered decoration, such as chikan ; and typically falls to either just above or just below the wearer's knees. In the last 50 years, fashions have changed a great deal in India. Increasingly, in urban northern India, the sari is no longer the apparel of everyday wear, though they remain popular on formal occasions. The traditional shalwar kameez is rarely worn by younger urban women, who favour churidars or jeans. In white-collar office settings, ubiquitous air conditioning allows men to wear sports jackets year-round. For weddings and formal occasions, men in the middle- and upper classes often wear bandgala , or short Nehru jackets , with pants, with the groom and his groomsmen sporting sherwanis and churidars. The dhoti, once the universal garment of Hindu males, the wearing of which in the homespun and handwoven khadi allowed Gandhi to bring Indian nationalism to the millions, is seldom seen in the cities. The foundation of a typical Indian meal is a cereal cooked in a plain fashion and complemented with flavourful savoury dishes. The cooked cereal could be steamed rice; chapati , a thin unleavened bread made from wheat flour, or occasionally cornmeal, and griddle-cooked dry; the idli , a steamed breakfast cake, or dosa , a griddled pancake, both leavened and made from a batter of rice- and gram meal. The savoury dishes might include lentils , pulses and vegetables commonly spiced with ginger and garlic , but also with a combination of spices that may include coriander , cumin , turmeric , cinnamon , cardamon and others as informed by culinary conventions. They might also include poultry, fish, or meat dishes. In some instances, the ingredients might be mixed during the process of cooking. A platter, or thali , used for eating usually has a central place reserved for the cooked cereal, and peripheral ones for the flavourful accompaniments, which are often served in small bowls. The cereal and its accompaniments are eaten simultaneously rather than a piecemeal manner. This is accomplished by mixing—for example of rice and lentils—or folding, wrapping, scooping or dipping—such as chapati and cooked vegetables or lentils. India has distinctive vegetarian cuisines, each a feature of the geographical and cultural histories of its adherents. The appearance of ahimsa , or the avoidance of violence toward all forms of life in many religious orders early in Indian history, especially Upanishadic Hinduism , Buddhism and Jainism , is thought to have contributed to the predominance of vegetarianism among a large segment of India's Hindu population, especially in southern India, Gujarat, the Hindi -speaking belt of north-central India, as well as among Jains. Although meat is eaten widely in India, the proportional consumption of meat in the overall diet is low. Unlike China, which has increased its per capita meat consumption substantially in its years of increased economic growth, in India the strong dietary traditions have contributed to dairy, rather than meat, becoming the preferred form of animal protein consumption. The most significant import of cooking techniques into India during the last millennium occurred during the Mughal Empire . Dishes such as the pilaf , developed in the Abbasid caliphate , and cooking techniques such as the marinating of meat in yogurt, spread into northern India from regions to its northwest. To the simple yogurt marinade of Persia, onions, garlic, almonds, and spices began to be added in India. Rice was partially cooked and layered alternately with the sauteed meat, the pot sealed tightly, and slow cooked according to another Persian cooking technique, to produce what has today become the Indian biryani , a feature of festive dining in many parts of India. In the food served in Indian restaurants worldwide the diversity of Indian food has been partially concealed by the dominance of Punjabi cuisine . The popularity of tandoori chicken —cooked in the tandoor oven, which had traditionally been used for baking bread in the rural Punjab and the Delhi region, especially among Muslims, but which is originally from Central Asia —dates to the 1950s, and was caused in large part by an entrepreneurial response among people from the Punjab who had been displaced by the 1947 partition of India . Several traditional indigenous sports such as kabaddi , kho kho , pehlwani and gilli-danda , and also martial arts such as Kalarippayattu and marma adi , remain popular. Chess is commonly held to have originated in India as chaturaṠga ; in recent years, there has been a rise in the number of Indian grandmasters . Viswanathan Anand became the Chess World Champion in 2007 and held the status until 2013. He also won the Chess World Cup in 2000 and 2002. In 2023, R Praggnanandhaa finished as runners up in the tournament. Parcheesi is derived from Pachisi , another traditional Indian pastime, which in early modern times was played on a giant marble court by Mughal emperor Akbar the Great . Cricket is the most popular sport in India. Major domestic leagues include the Indian Premier League . Professional leagues in other sports include the Indian Super League ( football ) and the Pro Kabaddi league. India has won two Cricket World Cups , the 1983 edition and the 2011 edition , as well as becoming the inaugural T20 World Cup Champions in 2007 . India has also won the Champions Trophy twice, in 2002 and 2013 . The only edition of the World Championship of Cricket was won by India in 1985 . India also has eight field hockey gold medals in the summer olympics . The improved results garnered by the Indian Davis Cup team and other tennis players in the early 2010s have made tennis increasingly popular in the country. India has a comparatively strong presence in shooting sports, and has won several medals at the Olympics , the World Shooting Championships , and the Commonwealth Games. Other sports in which Indians have succeeded internationally include badminton ( Saina Nehwal and P. V. Sindhu are two of the top-ranked female badminton players in the world), boxing, and wrestling. Football is popular in West Bengal , Goa , Tamil Nadu , Kerala , and the north-eastern states .India has traditionally been the dominant country at the South Asian Games . An example of this dominance is the basketball competition where the Indian team won four out of five tournaments to date. India has hosted or co-hosted several international sporting events: the 1951 and 1982 Asian Games ; the 1987 , 1996 , 2011 and 2023 ICC Men's Cricket World Cup tournaments (and is also scheduled to host it in 2031 ); the 1978 , 1997 and 2013 ICC Women's Cricket World Cup tournaments (and is also scheduled to host it in 2025 ); the 1987 , 1985 and 2016 South Asian Games ; the 1990-91 Men's Asia Cup ; the 2002 Chess World Cup ; the 2003 Afro-Asian Games ; the 2006 ICC Cricket Champion's Trophy (and is also scheduled to host it in 2029 ); the 2006 Women's Asia Cup ; the 2009 World Badminton Championships ; the 2010 Hockey World Cup ; the 2010 Commonwealth Games ; the 2016 ICC Men's Cricket T20 World Cup (and is also scheduled to host it in 2026 ); the 2016 ICC Women's Cricket T20 World Cup and the 2017 FIFA U-17 World Cup . Major international sporting events held annually in India include the Maharashtra Open , the Mumbai Marathon , the Delhi Half Marathon , and the Indian Masters . The first Formula 1 Indian Grand Prix featured in late 2011 but has been discontinued from the F1 season calendar since 2014.

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Cholera

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Gabriel García Márquez

Novels short stories Gabriel José de la Concordia García Márquez ( Latin American Spanish: [ ɡaˈβɾjel ɣaɾˈsi.a ˈmaɾ.kes ] ⓘ ; [lower-alpha 1] 6 March 1927 – 17 April 2014) was a Colombian novelist, short-story writer , screenwriter, and journalist, known affectionately as Gabo ( [ ˈɡaβo ] ) or Gabito ( [ ɡaˈβito ] ) throughout Latin America. Considered one of the most significant authors of the 20th century, particularly in the Spanish language , he was awarded the 1972 Neustadt International Prize for Literature and the 1982 Nobel Prize in Literature . He pursued a self-directed education that resulted in leaving law school for a career in journalism. From early on he showed no inhibitions in his criticism of Colombian and foreign politics. In 1958, he married Mercedes Barcha Pardo ; they had two sons, Rodrigo and Gonzalo. García Márquez started as a journalist and wrote many acclaimed non-fiction works and short stories. He is best known for his novels, such as One Hundred Years of Solitude (1967) which sold over fifty million copies, Chronicle of a Death Foretold (1981), and Love in the Time of Cholera (1985). His works have achieved significant critical acclaim and widespread commercial success, most notably for popularizing a literary style known as magic realism , which uses magical elements and events in otherwise ordinary and realistic situations. Some of his works are set in the fictional village of Macondo (mainly inspired by his birthplace, Aracataca ), and most of them explore the theme of solitude . He is the most-translated Spanish-language author. Upon García Márquez's death in April 2014, Juan Manuel Santos , the president of Colombia, called him "the greatest Colombian who ever lived." Gabriel García Márquez was born on 6 March 1927 [lower-alpha 2] in the small town of Aracataca , in the Caribbean region of Colombia , to Gabriel Eligio García and Luisa Santiaga Márquez Iguarán. Soon after García Márquez was born, his father became a pharmacist and moved with his wife to the nearby large port city of Barranquilla , leaving young Gabriel in Aracataca. He was raised by his maternal grandparents, Doña Tranquilina Iguarán and Colonel Nicolás Ricardo Márquez Mejía. In December 1936 his father took him and his brother to Sincé but when his grandfather died in March 1937, the family moved first (back) to Barranquilla and then on to Sucre , where his father started a pharmacy. When his parents had fallen in love, their relationship was met with resistance from Luisa Santiaga Márquez's father, the Colonel. Gabriel Eligio García was not the man the Colonel had envisioned winning the heart of his daughter: Gabriel Eligio was a Conservative , and had the reputation of being a womanizer. Gabriel Eligio wooed Luisa with violin serenades, love poems, countless letters, and even telephone messages after her father sent her away with the intention of separating the young couple. Her parents tried everything to get rid of the man, but he kept coming back, and it was obvious their daughter was committed to him. Her family finally capitulated and gave her permission to marry him (The tragicomic story of their courtship would later be adapted and recast as Love in the Time of Cholera .) Since García Márquez's parents were more or less strangers to him for the first few years of his life, his grandparents influenced his early development very strongly. His grandfather, whom he called "Papalelo", was a Liberal veteran of the Thousand Days War . The Colonel was considered a hero by Colombian Liberals and was highly respected. He was well known for his refusal to remain silent about the banana massacres that took place the year after García Márquez was born. The Colonel, whom García Márquez described as his "umbilical cord with history and reality", was also an excellent storyteller. He taught García Márquez lessons from the dictionary, took him to the circus each year, and was the first to introduce his grandson to ice—a "miracle" found at the United Fruit Company store. He would also occasionally tell his young grandson "You can't imagine how much a dead man weighs", reminding him that there was no greater burden than to have killed a man, a lesson that García Márquez would later integrate into his novels. García Márquez's grandmother, Doña Tranquilina Iguarán Cotes, played an influential role in his upbringing. He was inspired by the way she "treated the extraordinary as something perfectly natural." The house was filled with stories of ghosts and premonitions, omens and portents, all of which were studiously ignored by her husband. According to García Márquez, she was "the source of the magical, superstitious and supernatural view of reality". He enjoyed his grandmother's unique way of telling stories. No matter how fantastic or improbable her statements, she always delivered them as if they were the irrefutable truth. It was a deadpan style that, some thirty years later, heavily influenced her grandson's most popular novel, One Hundred Years of Solitude . After arriving at Sucre , it was decided that García Márquez should start his formal education and he was sent to an internship in Barranquilla , a port on the mouth of the Río Magdalena . There, he gained a reputation of being a timid boy who wrote humorous poems and drew humorous comic strips. Serious and little interested in athletic activities, he was called El Viejo by his classmates. After his graduation in 1947, García Márquez stayed in Bogotá to study law at the Universidad Nacional de Colombia , but spent most of his spare time reading fiction. He was inspired by La metamorfosis by Franz Kafka , at the time incorrectly thought to have been translated by Jorge Luis Borges . His first published work, "La tercera resignación", appeared in the 13 September 1947 edition of the newspaper El Espectador . From 1947 to 1955, he wrote a series of short stories that were later published under the title of "Eyes of a Blue Dog". Though his passion was writing, he continued with law in 1948 to please his father. After the Bogotazo riots on 9 April following the assassination of a popular leader Jorge Eliécer Gaitán , the university closed indefinitely and his boarding house was burned. García Márquez transferred to the Universidad de Cartagena and began working as a reporter of El Universal . In 1950, he ended his legal studies to focus on journalism and moved again to Barranquilla to work as a columnist and reporter in the newspaper El Heraldo . Universities, including Columbia University in the City of New York , have given him an honorary doctorate in writing. García Márquez began his career as a journalist while studying law at the National University of Colombia . In 1948 and 1949, he wrote for El Universal in Cartagena . From 1950 until 1952, he wrote a "whimsical" column under the name of " Septimus " for the local paper El Heraldo in Barranquilla . García Márquez noted of his time at El Heraldo , "I'd write a piece and they'd pay me three pesos for it, and maybe an editorial for another three." During this time he became an active member of the informal group of writers and journalists known as the Barranquilla Group , an association that provided great motivation and inspiration for his literary career. He worked with inspirational figures such as Ramon Vinyes, whom García Márquez depicted as an Old Catalan who owns a bookstore in One Hundred Years of Solitude . At this time, García Márquez was also introduced to the works of writers such as Virginia Woolf and William Faulkner . Faulkner's narrative techniques, historical themes and use of rural locations influenced many Latin American authors. From 1954 to 1955, García Márquez spent time in Bogotá and regularly wrote for Bogotá's El Espectador . From 1956, he spent two years in Europe, returning to marry Mercedes Barcha in Barranquilla in 1958, and to work on magazines in Caracas , Venezuela. García Márquez was a "committed leftist" throughout his life, adhering to socialist beliefs. In 1991 he published Changing the History of Africa , an admiring study of Cuban activities in the Angolan Civil War and the larger South African Border War . He maintained a close but "nuanced" friendship with Fidel Castro , praising the achievements of the Cuban Revolution but criticizing aspects of governance and working to "soften [the] roughest edges" of the country. García Márquez's political and ideological views were shaped by his grandfather's stories. In an interview, García Márquez told his friend Plinio Apuleyo Mendoza , "my grandfather the Colonel was a Liberal. My political ideas probably came from him to begin with because, instead of telling me fairy tales when I was young, he would regale me with horrifying accounts of the last civil war that free-thinkers and anti-clerics waged against the Conservative government." This influenced his political views and his literary technique so that "in the same way that his writing career initially took shape in conscious opposition to the Colombian literary status quo, García Márquez's socialist and anti-imperialist views are in principled opposition to the global status quo dominated by the United States." Ending in controversy, his last domestically written editorial for El Espectador was a series of 14 news articles in which he revealed the hidden story of how a Colombian Navy vessel's shipwreck "occurred because the boat contained a badly stowed cargo of contraband goods that broke loose on the deck." García Márquez compiled this story through interviews with a young sailor who survived the wreck. In response to this controversy, El Espectador sent García Márquez away to Europe to be a foreign correspondent. He wrote about his experiences for El Independiente , a newspaper that briefly replaced El Espectador during the military government of General Gustavo Rojas Pinilla and was later shut down by Colombian authorities. García Márquez's background in journalism provided a foundational base for his writing career. Literary critic Bell-Villada noted, "Owing to his hands-on experiences in journalism, García Márquez is, of all the great living authors, the one who is closest to everyday reality." García Márquez was one of the original founders of QAP , a Colombian newscast that aired between 1992 and 1997. He was attracted to the project by the promise of editorial and journalistic independence. García Márquez met Mercedes Barcha while she was at school; he was 12 and she was 9. When he was sent to Europe as a foreign correspondent, Mercedes waited for him to return to Barranquilla. Finally, they married in 1958. The following year, their first son, Rodrigo García , now a television and film director, was born. In 1961, the family traveled by Greyhound bus throughout the southern United States and eventually settled in Mexico City . García Márquez had always wanted to see the Southern United States because it inspired the writings of William Faulkner . Three years later, the couple's second son, Gonzalo García, was born in Mexico. Gonzalo is currently a graphic designer in Mexico City. In January 2022, it was reported that García Márquez had a daughter, Indira Cato, from an extramarital affair with Mexican writer Susana Cato in the early 1990s. Indira is a documentary producer in Mexico City. Leaf Storm ( La Hojarasca ) is García Márquez's first novella and took seven years to find a publisher, finally being published in 1955. García Márquez notes that "of all that he had written (as of 1973), Leaf Storm was his favorite because he felt that it was the most sincere and spontaneous." All the events of the novella take place in one room, during a half-hour period on Wednesday 12 September 1928. It is the story of an old colonel (similar to García Márquez's own grandfather) who tries to give a proper Christian burial to an unpopular French doctor. The colonel is supported only by his daughter and grandson. The novella explores the child's first experience with death by following his stream of consciousness. The book reveals the perspective of Isabel, the Colonel's daughter, which provides a feminine point of view. In Evil Hour ( La mala hora ), García Márquez's second novel, was published in 1962. Its formal structure is based on novels such as Virginia Woolf 's Mrs Dalloway . The narrative begins on the saint's day of St Francis of Assisi, but the murders that follow are far from the saint's message of peace. The story interweaves characters and details from García Márquez's other writings such as Artificial Roses , and comments on literary genres such as whodunnit detective stories. Some of the characters and situations found in In Evil Hour re-appear in One Hundred Years of Solitude . From when he was 18, García Márquez had wanted to write a novel based on his grandparents' house where he grew up. However, he struggled with finding an appropriate tone and put off the idea until one day the answer hit him while driving his family to Acapulco . He turned the car around and the family returned home so he could begin writing. He sold his car so his family would have money to live on while he wrote. Writing the novel took far longer than he expected; he wrote every day for 18 months. His wife had to ask for food on credit from their butcher and baker as well as nine months of rent on credit from their landlord. During the 18 months of writing, García Márquez met with two couples, Eran Carmen and Álvaro Mutis , and María Luisa Elío and Jomí García Ascot , every night and discussed the progress of the novel, trying out different versions. When the book was published in 1967, it became his most commercially successful novel, One Hundred Years of Solitude ( Cien años de soledad ; English translation by Gregory Rabassa , 1970), selling over 50 million copies. The book was dedicated to Jomí García Ascot and María Luisa Elío. The story chronicles several generations of the Buendía family from the time they founded the fictional South American village of Macondo , through their trials and tribulations, and instances of incest, births, and deaths. The history of Macondo is often generalized by critics to represent rural towns throughout Latin America or at least near García Márquez's native Aracataca . The novel was widely popular and led to García Márquez's Nobel Prize as well as the Rómulo Gallegos Prize in 1972. William Kennedy has called it "the first piece of literature since the Book of Genesis that should be required reading for the entire human race," and hundreds of articles and books of literary critique have been published in response to it. Despite the many accolades the book received, García Márquez tended to downplay its success. He once remarked: "Most critics don't realize that a novel like One Hundred Years of Solitude is a bit of a joke, full of signals to close friends, and so, with some pre-ordained right to pontificate they take on the responsibility of decoding the book and risk making terrible fools of themselves." After writing One Hundred Years of Solitude García Márquez returned to Europe, this time bringing along his family, to live in Barcelona , Spain, for seven years. The international recognition García Márquez earned with the publication of the novel led to his ability to act as a facilitator in several negotiations between the Colombian government and the guerrillas, including the former 19th of April Movement (M-19), and the current FARC and ELN organizations. The popularity of his writing also led to friendships with powerful leaders, including one with former Cuban president Fidel Castro , which has been analyzed in Gabo and Fidel: Portrait of a Friendship. It was during this time that he was punched in the face by Mario Vargas Llosa in what became one of the largest feuds in modern literature. In an interview with Claudia Dreifus in 1982 García Márquez noted his relationship with Castro was mostly based on literature: "Ours is an intellectual friendship. It may not be widely known that Fidel is a very cultured man. When we're together, we talk a great deal about literature." This relationship was criticized by Cuban exile writer Reinaldo Arenas , in his 1992 memoir Antes de que Anochezca ( Before Night Falls ). Due to his newfound fame and his outspoken views on US imperialism , García Márquez was labeled as a subversive and for many years was denied visas by US immigration authorities. After Bill Clinton was elected US president, he lifted the travel ban and cited One Hundred Years of Solitude as his favorite novel. García Márquez was inspired to write a dictator novel when he witnessed the flight of Venezuelan dictator Marcos Pérez Jiménez . He said, "it was the first time we had seen a dictator fall in Latin America." García Márquez began writing Autumn of the Patriarch ( El otoño del patriarca ) in 1968 and said it was finished in 1971; however, he continued to embellish the dictator novel until 1975 when it was published in Spain. According to García Márquez, the novel is a "poem on the solitude of power" as it follows the life of an eternal dictator known as the General. The novel is developed through a series of anecdotes related to the life of the General, which do not appear in chronological order. Although the exact location of the story is not pin-pointed in the novel, the imaginary country is situated somewhere in the Caribbean. García Márquez gave his own explanation of the plot: My intention was always to make a synthesis of all the Latin American dictators, but especially those from the Caribbean. Nevertheless, the personality of Juan Vicente Gomez [of Venezuela] was so strong, in addition to the fact that he exercised a special fascination over me, that undoubtedly the Patriarch has much more of him than anyone else. After Autumn of the Patriarch was published García Márquez and his family moved from Barcelona to Mexico City and García Márquez pledged not to publish again until the Chilean Dictator Augusto Pinochet was deposed. All the same, he published Chronicle of a Death Foretold while Pinochet was still in power, as he "could not remain silent in the face of injustice and repression." The Incredible and Sad Tale of Innocent Eréndira and Her Heartless Grandmother ( Spanish : La increíble y triste historia de la cándida Eréndira y de su abuela desalmada ) presents the story of a young mulatto girl who dreams of freedom, but cannot escape the reach of her avaricious grandmother. Eréndira and her grandmother make an appearance in an earlier novel, One Hundred Years of Solitude . The Incredible and Sad Tale of Innocent Eréndira and Her Heartless Grandmother was published in 1972. The novella was adapted to the 1983 art film Eréndira , directed by Ruy Guerra . Chronicle of a Death Foretold ( Crónica de una muerte anunciada ), which literary critic Ruben Pelayo called a combination of journalism, realism and detective story, is inspired by a real-life murder that took place in Sucre , Colombia, in 1951, but García Márquez maintained that nothing of the actual events remains beyond the point of departure and the structure. The character of Santiago Nasar is based on a good friend from García Márquez's childhood, Cayetano Gentile Chimento. The plot of the novel revolves around Santiago Nasar's murder. The narrator acts as a detective, uncovering the events of the murder as the novel proceeds. Pelayo notes that the story "unfolds in an inverted fashion. Instead of moving forward... the plot moves backward." Chronicle of a Death Foretold was published in 1981, the year before García Márquez was awarded the 1982 Nobel Prize in Literature. The novel was also adapted into a film by Italian director Francesco Rosi in 1987. Love in the Time of Cholera ( El amor en los tiempos del cólera ) was first published in 1985. It is considered a non-traditional love story as "lovers find love in their 'golden years'—in their seventies, when death is all around them". Love in the Time of Cholera is based on the stories of two couples. The young love of Fermina Daza and Florentino Ariza is based on the love affair of García Márquez's parents. But as García Márquez explained in an interview: "The only difference is [my parents] married. And as soon as they were married, they were no longer interesting as literary figures." The love of old people is based on a newspaper story about the death of two Americans, who were almost 80 years old, who met every year in Acapulco. They were out in a boat one day and were murdered by the boatman with his oars. García Márquez notes, "Through their death, the story of their secret romance became known. I was fascinated by them. They were each married to other people." News of a Kidnapping ( Noticia de un secuestro ) was first published in 1996. It examines a series of related kidnappings and narcoterrorist actions committed in the early 1990s in Colombia by the Medellín Cartel , a drug cartel founded and operated by Pablo Escobar . The text recounts the kidnapping, imprisonment, and eventual release of prominent figures in Colombia, including politicians and members of the press. The original idea was proposed to García Márquez by the former minister for education Maruja Pachón Castro and Colombian diplomat Luis Alberto Villamizar Cárdenas , both of whom were among the many victims of Pablo Escobar's attempt to pressure the government to stop his extradition by committing a series of kidnappings, murders and terrorist actions. In 2002 García Márquez published the memoir Vivir para contarla , the first of a projected three-volume autobiography. Edith Grossman 's English translation, Living to Tell the Tale , was published in November 2003. October 2004 brought the publication of a novel, Memories of My Melancholy Whores ( Memoria de mis putas tristes ), a love story that follows the romance of a 90-year-old man and a child forced into prostitution. Memories of My Melancholy Whores caused controversy in Iran, where it was banned after an initial 5,000 copies were printed and sold. Critics often describe the language that García Márquez's imagination produces as visual or graphic, and he himself explains each of his stories is inspired by "a visual image," so it comes as no surprise that he had a long and involved history with film. He was a film critic, he founded and served as executive director of the Film Institute in Havana, was the head of the Latin American Film Foundation, and wrote several screenplays. For his first script he worked with Carlos Fuentes on Juan Rulfo's El gallo de oro . His other screenplays include the films Tiempo de morir (1966), (1985) and Un señor muy viejo con unas alas enormes (1988), as well as the television series Amores difíciles (1991). García Márquez originally wrote his Eréndira as a third screenplay, but this version was lost and replaced by the novella. Nonetheless, he worked on rewriting the script in collaboration with Ruy Guerra , and the film was released in Mexico in 1983. Several of his stories have inspired other writers and directors. In 1987, the Italian director Francesco Rosi directed the movie Cronaca di una morte annunciata based on Chronicle of a Death Foretold . Several film adaptations have been made in Mexico, including Miguel Littín 's La Viuda de Montiel (1979), Jaime Humberto Hermosillo's Maria de mi corazón (1979), and Arturo Ripstein's El coronel no tiene quien le escriba (1998). British director Mike Newell ( Four Weddings and a Funeral ) filmed Love in the Time of Cholera in Cartagena , Colombia, with the screenplay written by Ronald Harwood ( The Pianist ). The film was released in the U.S. on 16 November 2007. In 1999 García Márquez was misdiagnosed with pneumonia instead of lymphatic cancer . Chemotherapy at a hospital in Los Angeles proved to be successful, and the illness went into remission. This event prompted García Márquez to begin writing his memoirs: "I reduced relations with my friends to a minimum, disconnected the telephone, canceled the trips and all sorts of current and future plans", he told El Tiempo , the Colombian newspaper, "and locked myself in to write every day without interruption." In 2002, three years later, he published Living to Tell the Tale ( Vivir para Contarla ), the first volume in a projected trilogy of memoirs. In 2000 his impending death was incorrectly reported by Peruvian daily newspaper La República . The next day other newspapers republished his alleged farewell poem, "La Marioneta," but shortly afterward García Márquez denied being the author of the poem, which was determined to be the work of a Mexican ventriloquist. He stated that 2005 "was the first [year] in my life in which I haven't written even a line. With my experience, I could write a new novel without any problems, but people would realise my heart wasn't in it." In May 2008 it was announced that García Márquez was finishing a new "novel of love" that had yet to be given a title, to be published by the end of the year. However, in April 2009 his agent, Carmen Balcells , told the Chilean newspaper La Tercera that García Márquez was unlikely to write again. This was disputed by Random House Mondadori editor Cristobal Pera, who stated that García Márquez was completing a new novel called We'll Meet in August ( En agosto nos vemos ). In 2023 it was announced that the novel, now titled Until August would be released posthumously in 2024. In December 2008 García Márquez told fans at the Guadalajara book fair that writing had worn him out. In 2009, responding to claims by both his literary agent and his biographer that his writing career was over, he told Colombian newspaper El Tiempo : "Not only is it not true, but the only thing I do is write". In 2012 his brother Jaime announced that García Márquez was suffering from dementia . In April 2014, García Márquez was hospitalized in Mexico. He had infections in his lungs and his urinary tract, and was suffering from dehydration . He was responding well to antibiotics. Mexican president Enrique Peña Nieto wrote on Twitter, "I wish him a speedy recovery". Colombian president Juan Manuel Santos said his country was thinking of the author and said in a tweet: "All of Colombia wishes a speedy recovery to the greatest of all time: Gabriel García Márquez." García Márquez died of pneumonia at the age of 87 on 17 April 2014, in Mexico City. His death was confirmed by Fernanda Familiar on Twitter, and by his former editor Cristóbal Pera. The Colombian president Juan Manuel Santos mentioned: "One Hundred Years of Solitude and sadness for the death of the greatest Colombian of all time". The former Colombian president Álvaro Uribe Vélez said: "Master García Márquez, thanks forever, millions of people in the planet fell in love with our nation fascinated with your lines." At the time of his death, García Márquez had a wife and two sons. García Márquez was cremated at a private family ceremony in Mexico City. On 22 April the presidents of Colombia and Mexico attended a formal ceremony in Mexico City, where García Márquez had lived for more than three decades. A funeral cortege took the urn containing his ashes from his house to the Palacio de Bellas Artes , where the memorial ceremony was held. Earlier, residents in his home town of Aracataca in Colombia's Caribbean region held a symbolic funeral. In February 2015, the heirs of Gabriel García Márquez deposited a legacy of the writer in his Memoriam in the Caja de las Letras of the Instituto Cervantes . Gabriel García Márquez was born on 6 March 1927 [lower-alpha 2] in the small town of Aracataca , in the Caribbean region of Colombia , to Gabriel Eligio García and Luisa Santiaga Márquez Iguarán. Soon after García Márquez was born, his father became a pharmacist and moved with his wife to the nearby large port city of Barranquilla , leaving young Gabriel in Aracataca. He was raised by his maternal grandparents, Doña Tranquilina Iguarán and Colonel Nicolás Ricardo Márquez Mejía. In December 1936 his father took him and his brother to Sincé but when his grandfather died in March 1937, the family moved first (back) to Barranquilla and then on to Sucre , where his father started a pharmacy. When his parents had fallen in love, their relationship was met with resistance from Luisa Santiaga Márquez's father, the Colonel. Gabriel Eligio García was not the man the Colonel had envisioned winning the heart of his daughter: Gabriel Eligio was a Conservative , and had the reputation of being a womanizer. Gabriel Eligio wooed Luisa with violin serenades, love poems, countless letters, and even telephone messages after her father sent her away with the intention of separating the young couple. Her parents tried everything to get rid of the man, but he kept coming back, and it was obvious their daughter was committed to him. Her family finally capitulated and gave her permission to marry him (The tragicomic story of their courtship would later be adapted and recast as Love in the Time of Cholera .) Since García Márquez's parents were more or less strangers to him for the first few years of his life, his grandparents influenced his early development very strongly. His grandfather, whom he called "Papalelo", was a Liberal veteran of the Thousand Days War . The Colonel was considered a hero by Colombian Liberals and was highly respected. He was well known for his refusal to remain silent about the banana massacres that took place the year after García Márquez was born. The Colonel, whom García Márquez described as his "umbilical cord with history and reality", was also an excellent storyteller. He taught García Márquez lessons from the dictionary, took him to the circus each year, and was the first to introduce his grandson to ice—a "miracle" found at the United Fruit Company store. He would also occasionally tell his young grandson "You can't imagine how much a dead man weighs", reminding him that there was no greater burden than to have killed a man, a lesson that García Márquez would later integrate into his novels. García Márquez's grandmother, Doña Tranquilina Iguarán Cotes, played an influential role in his upbringing. He was inspired by the way she "treated the extraordinary as something perfectly natural." The house was filled with stories of ghosts and premonitions, omens and portents, all of which were studiously ignored by her husband. According to García Márquez, she was "the source of the magical, superstitious and supernatural view of reality". He enjoyed his grandmother's unique way of telling stories. No matter how fantastic or improbable her statements, she always delivered them as if they were the irrefutable truth. It was a deadpan style that, some thirty years later, heavily influenced her grandson's most popular novel, One Hundred Years of Solitude . After arriving at Sucre , it was decided that García Márquez should start his formal education and he was sent to an internship in Barranquilla , a port on the mouth of the Río Magdalena . There, he gained a reputation of being a timid boy who wrote humorous poems and drew humorous comic strips. Serious and little interested in athletic activities, he was called El Viejo by his classmates. After his graduation in 1947, García Márquez stayed in Bogotá to study law at the Universidad Nacional de Colombia , but spent most of his spare time reading fiction. He was inspired by La metamorfosis by Franz Kafka , at the time incorrectly thought to have been translated by Jorge Luis Borges . His first published work, "La tercera resignación", appeared in the 13 September 1947 edition of the newspaper El Espectador . From 1947 to 1955, he wrote a series of short stories that were later published under the title of "Eyes of a Blue Dog". Though his passion was writing, he continued with law in 1948 to please his father. After the Bogotazo riots on 9 April following the assassination of a popular leader Jorge Eliécer Gaitán , the university closed indefinitely and his boarding house was burned. García Márquez transferred to the Universidad de Cartagena and began working as a reporter of El Universal . In 1950, he ended his legal studies to focus on journalism and moved again to Barranquilla to work as a columnist and reporter in the newspaper El Heraldo . Universities, including Columbia University in the City of New York , have given him an honorary doctorate in writing. After arriving at Sucre , it was decided that García Márquez should start his formal education and he was sent to an internship in Barranquilla , a port on the mouth of the Río Magdalena . There, he gained a reputation of being a timid boy who wrote humorous poems and drew humorous comic strips. Serious and little interested in athletic activities, he was called El Viejo by his classmates. After his graduation in 1947, García Márquez stayed in Bogotá to study law at the Universidad Nacional de Colombia , but spent most of his spare time reading fiction. He was inspired by La metamorfosis by Franz Kafka , at the time incorrectly thought to have been translated by Jorge Luis Borges . His first published work, "La tercera resignación", appeared in the 13 September 1947 edition of the newspaper El Espectador . From 1947 to 1955, he wrote a series of short stories that were later published under the title of "Eyes of a Blue Dog". Though his passion was writing, he continued with law in 1948 to please his father. After the Bogotazo riots on 9 April following the assassination of a popular leader Jorge Eliécer Gaitán , the university closed indefinitely and his boarding house was burned. García Márquez transferred to the Universidad de Cartagena and began working as a reporter of El Universal . In 1950, he ended his legal studies to focus on journalism and moved again to Barranquilla to work as a columnist and reporter in the newspaper El Heraldo . Universities, including Columbia University in the City of New York , have given him an honorary doctorate in writing. García Márquez began his career as a journalist while studying law at the National University of Colombia . In 1948 and 1949, he wrote for El Universal in Cartagena . From 1950 until 1952, he wrote a "whimsical" column under the name of " Septimus " for the local paper El Heraldo in Barranquilla . García Márquez noted of his time at El Heraldo , "I'd write a piece and they'd pay me three pesos for it, and maybe an editorial for another three." During this time he became an active member of the informal group of writers and journalists known as the Barranquilla Group , an association that provided great motivation and inspiration for his literary career. He worked with inspirational figures such as Ramon Vinyes, whom García Márquez depicted as an Old Catalan who owns a bookstore in One Hundred Years of Solitude . At this time, García Márquez was also introduced to the works of writers such as Virginia Woolf and William Faulkner . Faulkner's narrative techniques, historical themes and use of rural locations influenced many Latin American authors. From 1954 to 1955, García Márquez spent time in Bogotá and regularly wrote for Bogotá's El Espectador . From 1956, he spent two years in Europe, returning to marry Mercedes Barcha in Barranquilla in 1958, and to work on magazines in Caracas , Venezuela. García Márquez was a "committed leftist" throughout his life, adhering to socialist beliefs. In 1991 he published Changing the History of Africa , an admiring study of Cuban activities in the Angolan Civil War and the larger South African Border War . He maintained a close but "nuanced" friendship with Fidel Castro , praising the achievements of the Cuban Revolution but criticizing aspects of governance and working to "soften [the] roughest edges" of the country. García Márquez's political and ideological views were shaped by his grandfather's stories. In an interview, García Márquez told his friend Plinio Apuleyo Mendoza , "my grandfather the Colonel was a Liberal. My political ideas probably came from him to begin with because, instead of telling me fairy tales when I was young, he would regale me with horrifying accounts of the last civil war that free-thinkers and anti-clerics waged against the Conservative government." This influenced his political views and his literary technique so that "in the same way that his writing career initially took shape in conscious opposition to the Colombian literary status quo, García Márquez's socialist and anti-imperialist views are in principled opposition to the global status quo dominated by the United States." Ending in controversy, his last domestically written editorial for El Espectador was a series of 14 news articles in which he revealed the hidden story of how a Colombian Navy vessel's shipwreck "occurred because the boat contained a badly stowed cargo of contraband goods that broke loose on the deck." García Márquez compiled this story through interviews with a young sailor who survived the wreck. In response to this controversy, El Espectador sent García Márquez away to Europe to be a foreign correspondent. He wrote about his experiences for El Independiente , a newspaper that briefly replaced El Espectador during the military government of General Gustavo Rojas Pinilla and was later shut down by Colombian authorities. García Márquez's background in journalism provided a foundational base for his writing career. Literary critic Bell-Villada noted, "Owing to his hands-on experiences in journalism, García Márquez is, of all the great living authors, the one who is closest to everyday reality." Ending in controversy, his last domestically written editorial for El Espectador was a series of 14 news articles in which he revealed the hidden story of how a Colombian Navy vessel's shipwreck "occurred because the boat contained a badly stowed cargo of contraband goods that broke loose on the deck." García Márquez compiled this story through interviews with a young sailor who survived the wreck. In response to this controversy, El Espectador sent García Márquez away to Europe to be a foreign correspondent. He wrote about his experiences for El Independiente , a newspaper that briefly replaced El Espectador during the military government of General Gustavo Rojas Pinilla and was later shut down by Colombian authorities. García Márquez's background in journalism provided a foundational base for his writing career. Literary critic Bell-Villada noted, "Owing to his hands-on experiences in journalism, García Márquez is, of all the great living authors, the one who is closest to everyday reality." García Márquez was one of the original founders of QAP , a Colombian newscast that aired between 1992 and 1997. He was attracted to the project by the promise of editorial and journalistic independence. García Márquez met Mercedes Barcha while she was at school; he was 12 and she was 9. When he was sent to Europe as a foreign correspondent, Mercedes waited for him to return to Barranquilla. Finally, they married in 1958. The following year, their first son, Rodrigo García , now a television and film director, was born. In 1961, the family traveled by Greyhound bus throughout the southern United States and eventually settled in Mexico City . García Márquez had always wanted to see the Southern United States because it inspired the writings of William Faulkner . Three years later, the couple's second son, Gonzalo García, was born in Mexico. Gonzalo is currently a graphic designer in Mexico City. In January 2022, it was reported that García Márquez had a daughter, Indira Cato, from an extramarital affair with Mexican writer Susana Cato in the early 1990s. Indira is a documentary producer in Mexico City. Leaf Storm ( La Hojarasca ) is García Márquez's first novella and took seven years to find a publisher, finally being published in 1955. García Márquez notes that "of all that he had written (as of 1973), Leaf Storm was his favorite because he felt that it was the most sincere and spontaneous." All the events of the novella take place in one room, during a half-hour period on Wednesday 12 September 1928. It is the story of an old colonel (similar to García Márquez's own grandfather) who tries to give a proper Christian burial to an unpopular French doctor. The colonel is supported only by his daughter and grandson. The novella explores the child's first experience with death by following his stream of consciousness. The book reveals the perspective of Isabel, the Colonel's daughter, which provides a feminine point of view. In Evil Hour ( La mala hora ), García Márquez's second novel, was published in 1962. Its formal structure is based on novels such as Virginia Woolf 's Mrs Dalloway . The narrative begins on the saint's day of St Francis of Assisi, but the murders that follow are far from the saint's message of peace. The story interweaves characters and details from García Márquez's other writings such as Artificial Roses , and comments on literary genres such as whodunnit detective stories. Some of the characters and situations found in In Evil Hour re-appear in One Hundred Years of Solitude . From when he was 18, García Márquez had wanted to write a novel based on his grandparents' house where he grew up. However, he struggled with finding an appropriate tone and put off the idea until one day the answer hit him while driving his family to Acapulco . He turned the car around and the family returned home so he could begin writing. He sold his car so his family would have money to live on while he wrote. Writing the novel took far longer than he expected; he wrote every day for 18 months. His wife had to ask for food on credit from their butcher and baker as well as nine months of rent on credit from their landlord. During the 18 months of writing, García Márquez met with two couples, Eran Carmen and Álvaro Mutis , and María Luisa Elío and Jomí García Ascot , every night and discussed the progress of the novel, trying out different versions. When the book was published in 1967, it became his most commercially successful novel, One Hundred Years of Solitude ( Cien años de soledad ; English translation by Gregory Rabassa , 1970), selling over 50 million copies. The book was dedicated to Jomí García Ascot and María Luisa Elío. The story chronicles several generations of the Buendía family from the time they founded the fictional South American village of Macondo , through their trials and tribulations, and instances of incest, births, and deaths. The history of Macondo is often generalized by critics to represent rural towns throughout Latin America or at least near García Márquez's native Aracataca . The novel was widely popular and led to García Márquez's Nobel Prize as well as the Rómulo Gallegos Prize in 1972. William Kennedy has called it "the first piece of literature since the Book of Genesis that should be required reading for the entire human race," and hundreds of articles and books of literary critique have been published in response to it. Despite the many accolades the book received, García Márquez tended to downplay its success. He once remarked: "Most critics don't realize that a novel like One Hundred Years of Solitude is a bit of a joke, full of signals to close friends, and so, with some pre-ordained right to pontificate they take on the responsibility of decoding the book and risk making terrible fools of themselves." After writing One Hundred Years of Solitude García Márquez returned to Europe, this time bringing along his family, to live in Barcelona , Spain, for seven years. The international recognition García Márquez earned with the publication of the novel led to his ability to act as a facilitator in several negotiations between the Colombian government and the guerrillas, including the former 19th of April Movement (M-19), and the current FARC and ELN organizations. The popularity of his writing also led to friendships with powerful leaders, including one with former Cuban president Fidel Castro , which has been analyzed in Gabo and Fidel: Portrait of a Friendship. It was during this time that he was punched in the face by Mario Vargas Llosa in what became one of the largest feuds in modern literature. In an interview with Claudia Dreifus in 1982 García Márquez noted his relationship with Castro was mostly based on literature: "Ours is an intellectual friendship. It may not be widely known that Fidel is a very cultured man. When we're together, we talk a great deal about literature." This relationship was criticized by Cuban exile writer Reinaldo Arenas , in his 1992 memoir Antes de que Anochezca ( Before Night Falls ). Due to his newfound fame and his outspoken views on US imperialism , García Márquez was labeled as a subversive and for many years was denied visas by US immigration authorities. After Bill Clinton was elected US president, he lifted the travel ban and cited One Hundred Years of Solitude as his favorite novel. García Márquez was inspired to write a dictator novel when he witnessed the flight of Venezuelan dictator Marcos Pérez Jiménez . He said, "it was the first time we had seen a dictator fall in Latin America." García Márquez began writing Autumn of the Patriarch ( El otoño del patriarca ) in 1968 and said it was finished in 1971; however, he continued to embellish the dictator novel until 1975 when it was published in Spain. According to García Márquez, the novel is a "poem on the solitude of power" as it follows the life of an eternal dictator known as the General. The novel is developed through a series of anecdotes related to the life of the General, which do not appear in chronological order. Although the exact location of the story is not pin-pointed in the novel, the imaginary country is situated somewhere in the Caribbean. García Márquez gave his own explanation of the plot: My intention was always to make a synthesis of all the Latin American dictators, but especially those from the Caribbean. Nevertheless, the personality of Juan Vicente Gomez [of Venezuela] was so strong, in addition to the fact that he exercised a special fascination over me, that undoubtedly the Patriarch has much more of him than anyone else. After Autumn of the Patriarch was published García Márquez and his family moved from Barcelona to Mexico City and García Márquez pledged not to publish again until the Chilean Dictator Augusto Pinochet was deposed. All the same, he published Chronicle of a Death Foretold while Pinochet was still in power, as he "could not remain silent in the face of injustice and repression." The Incredible and Sad Tale of Innocent Eréndira and Her Heartless Grandmother ( Spanish : La increíble y triste historia de la cándida Eréndira y de su abuela desalmada ) presents the story of a young mulatto girl who dreams of freedom, but cannot escape the reach of her avaricious grandmother. Eréndira and her grandmother make an appearance in an earlier novel, One Hundred Years of Solitude . The Incredible and Sad Tale of Innocent Eréndira and Her Heartless Grandmother was published in 1972. The novella was adapted to the 1983 art film Eréndira , directed by Ruy Guerra . Chronicle of a Death Foretold ( Crónica de una muerte anunciada ), which literary critic Ruben Pelayo called a combination of journalism, realism and detective story, is inspired by a real-life murder that took place in Sucre , Colombia, in 1951, but García Márquez maintained that nothing of the actual events remains beyond the point of departure and the structure. The character of Santiago Nasar is based on a good friend from García Márquez's childhood, Cayetano Gentile Chimento. The plot of the novel revolves around Santiago Nasar's murder. The narrator acts as a detective, uncovering the events of the murder as the novel proceeds. Pelayo notes that the story "unfolds in an inverted fashion. Instead of moving forward... the plot moves backward." Chronicle of a Death Foretold was published in 1981, the year before García Márquez was awarded the 1982 Nobel Prize in Literature. The novel was also adapted into a film by Italian director Francesco Rosi in 1987. Love in the Time of Cholera ( El amor en los tiempos del cólera ) was first published in 1985. It is considered a non-traditional love story as "lovers find love in their 'golden years'—in their seventies, when death is all around them". Love in the Time of Cholera is based on the stories of two couples. The young love of Fermina Daza and Florentino Ariza is based on the love affair of García Márquez's parents. But as García Márquez explained in an interview: "The only difference is [my parents] married. And as soon as they were married, they were no longer interesting as literary figures." The love of old people is based on a newspaper story about the death of two Americans, who were almost 80 years old, who met every year in Acapulco. They were out in a boat one day and were murdered by the boatman with his oars. García Márquez notes, "Through their death, the story of their secret romance became known. I was fascinated by them. They were each married to other people." News of a Kidnapping ( Noticia de un secuestro ) was first published in 1996. It examines a series of related kidnappings and narcoterrorist actions committed in the early 1990s in Colombia by the Medellín Cartel , a drug cartel founded and operated by Pablo Escobar . The text recounts the kidnapping, imprisonment, and eventual release of prominent figures in Colombia, including politicians and members of the press. The original idea was proposed to García Márquez by the former minister for education Maruja Pachón Castro and Colombian diplomat Luis Alberto Villamizar Cárdenas , both of whom were among the many victims of Pablo Escobar's attempt to pressure the government to stop his extradition by committing a series of kidnappings, murders and terrorist actions. In 2002 García Márquez published the memoir Vivir para contarla , the first of a projected three-volume autobiography. Edith Grossman 's English translation, Living to Tell the Tale , was published in November 2003. October 2004 brought the publication of a novel, Memories of My Melancholy Whores ( Memoria de mis putas tristes ), a love story that follows the romance of a 90-year-old man and a child forced into prostitution. Memories of My Melancholy Whores caused controversy in Iran, where it was banned after an initial 5,000 copies were printed and sold. Critics often describe the language that García Márquez's imagination produces as visual or graphic, and he himself explains each of his stories is inspired by "a visual image," so it comes as no surprise that he had a long and involved history with film. He was a film critic, he founded and served as executive director of the Film Institute in Havana, was the head of the Latin American Film Foundation, and wrote several screenplays. For his first script he worked with Carlos Fuentes on Juan Rulfo's El gallo de oro . His other screenplays include the films Tiempo de morir (1966), (1985) and Un señor muy viejo con unas alas enormes (1988), as well as the television series Amores difíciles (1991). García Márquez originally wrote his Eréndira as a third screenplay, but this version was lost and replaced by the novella. Nonetheless, he worked on rewriting the script in collaboration with Ruy Guerra , and the film was released in Mexico in 1983. Several of his stories have inspired other writers and directors. In 1987, the Italian director Francesco Rosi directed the movie Cronaca di una morte annunciata based on Chronicle of a Death Foretold . Several film adaptations have been made in Mexico, including Miguel Littín 's La Viuda de Montiel (1979), Jaime Humberto Hermosillo's Maria de mi corazón (1979), and Arturo Ripstein's El coronel no tiene quien le escriba (1998). British director Mike Newell ( Four Weddings and a Funeral ) filmed Love in the Time of Cholera in Cartagena , Colombia, with the screenplay written by Ronald Harwood ( The Pianist ). The film was released in the U.S. on 16 November 2007. In 1999 García Márquez was misdiagnosed with pneumonia instead of lymphatic cancer . Chemotherapy at a hospital in Los Angeles proved to be successful, and the illness went into remission. This event prompted García Márquez to begin writing his memoirs: "I reduced relations with my friends to a minimum, disconnected the telephone, canceled the trips and all sorts of current and future plans", he told El Tiempo , the Colombian newspaper, "and locked myself in to write every day without interruption." In 2002, three years later, he published Living to Tell the Tale ( Vivir para Contarla ), the first volume in a projected trilogy of memoirs. In 2000 his impending death was incorrectly reported by Peruvian daily newspaper La República . The next day other newspapers republished his alleged farewell poem, "La Marioneta," but shortly afterward García Márquez denied being the author of the poem, which was determined to be the work of a Mexican ventriloquist. He stated that 2005 "was the first [year] in my life in which I haven't written even a line. With my experience, I could write a new novel without any problems, but people would realise my heart wasn't in it." In May 2008 it was announced that García Márquez was finishing a new "novel of love" that had yet to be given a title, to be published by the end of the year. However, in April 2009 his agent, Carmen Balcells , told the Chilean newspaper La Tercera that García Márquez was unlikely to write again. This was disputed by Random House Mondadori editor Cristobal Pera, who stated that García Márquez was completing a new novel called We'll Meet in August ( En agosto nos vemos ). In 2023 it was announced that the novel, now titled Until August would be released posthumously in 2024. In December 2008 García Márquez told fans at the Guadalajara book fair that writing had worn him out. In 2009, responding to claims by both his literary agent and his biographer that his writing career was over, he told Colombian newspaper El Tiempo : "Not only is it not true, but the only thing I do is write". In 2012 his brother Jaime announced that García Márquez was suffering from dementia . In April 2014, García Márquez was hospitalized in Mexico. He had infections in his lungs and his urinary tract, and was suffering from dehydration . He was responding well to antibiotics. Mexican president Enrique Peña Nieto wrote on Twitter, "I wish him a speedy recovery". Colombian president Juan Manuel Santos said his country was thinking of the author and said in a tweet: "All of Colombia wishes a speedy recovery to the greatest of all time: Gabriel García Márquez." García Márquez died of pneumonia at the age of 87 on 17 April 2014, in Mexico City. His death was confirmed by Fernanda Familiar on Twitter, and by his former editor Cristóbal Pera. The Colombian president Juan Manuel Santos mentioned: "One Hundred Years of Solitude and sadness for the death of the greatest Colombian of all time". The former Colombian president Álvaro Uribe Vélez said: "Master García Márquez, thanks forever, millions of people in the planet fell in love with our nation fascinated with your lines." At the time of his death, García Márquez had a wife and two sons. García Márquez was cremated at a private family ceremony in Mexico City. On 22 April the presidents of Colombia and Mexico attended a formal ceremony in Mexico City, where García Márquez had lived for more than three decades. A funeral cortege took the urn containing his ashes from his house to the Palacio de Bellas Artes , where the memorial ceremony was held. Earlier, residents in his home town of Aracataca in Colombia's Caribbean region held a symbolic funeral. In February 2015, the heirs of Gabriel García Márquez deposited a legacy of the writer in his Memoriam in the Caja de las Letras of the Instituto Cervantes . In 1999 García Márquez was misdiagnosed with pneumonia instead of lymphatic cancer . Chemotherapy at a hospital in Los Angeles proved to be successful, and the illness went into remission. This event prompted García Márquez to begin writing his memoirs: "I reduced relations with my friends to a minimum, disconnected the telephone, canceled the trips and all sorts of current and future plans", he told El Tiempo , the Colombian newspaper, "and locked myself in to write every day without interruption." In 2002, three years later, he published Living to Tell the Tale ( Vivir para Contarla ), the first volume in a projected trilogy of memoirs. In 2000 his impending death was incorrectly reported by Peruvian daily newspaper La República . The next day other newspapers republished his alleged farewell poem, "La Marioneta," but shortly afterward García Márquez denied being the author of the poem, which was determined to be the work of a Mexican ventriloquist. He stated that 2005 "was the first [year] in my life in which I haven't written even a line. With my experience, I could write a new novel without any problems, but people would realise my heart wasn't in it." In May 2008 it was announced that García Márquez was finishing a new "novel of love" that had yet to be given a title, to be published by the end of the year. However, in April 2009 his agent, Carmen Balcells , told the Chilean newspaper La Tercera that García Márquez was unlikely to write again. This was disputed by Random House Mondadori editor Cristobal Pera, who stated that García Márquez was completing a new novel called We'll Meet in August ( En agosto nos vemos ). In 2023 it was announced that the novel, now titled Until August would be released posthumously in 2024. In December 2008 García Márquez told fans at the Guadalajara book fair that writing had worn him out. In 2009, responding to claims by both his literary agent and his biographer that his writing career was over, he told Colombian newspaper El Tiempo : "Not only is it not true, but the only thing I do is write". In 2012 his brother Jaime announced that García Márquez was suffering from dementia . In April 2014, García Márquez was hospitalized in Mexico. He had infections in his lungs and his urinary tract, and was suffering from dehydration . He was responding well to antibiotics. Mexican president Enrique Peña Nieto wrote on Twitter, "I wish him a speedy recovery". Colombian president Juan Manuel Santos said his country was thinking of the author and said in a tweet: "All of Colombia wishes a speedy recovery to the greatest of all time: Gabriel García Márquez." García Márquez died of pneumonia at the age of 87 on 17 April 2014, in Mexico City. His death was confirmed by Fernanda Familiar on Twitter, and by his former editor Cristóbal Pera. The Colombian president Juan Manuel Santos mentioned: "One Hundred Years of Solitude and sadness for the death of the greatest Colombian of all time". The former Colombian president Álvaro Uribe Vélez said: "Master García Márquez, thanks forever, millions of people in the planet fell in love with our nation fascinated with your lines." At the time of his death, García Márquez had a wife and two sons. García Márquez was cremated at a private family ceremony in Mexico City. On 22 April the presidents of Colombia and Mexico attended a formal ceremony in Mexico City, where García Márquez had lived for more than three decades. A funeral cortege took the urn containing his ashes from his house to the Palacio de Bellas Artes , where the memorial ceremony was held. Earlier, residents in his home town of Aracataca in Colombia's Caribbean region held a symbolic funeral. In February 2015, the heirs of Gabriel García Márquez deposited a legacy of the writer in his Memoriam in the Caja de las Letras of the Instituto Cervantes . In every book I try to make a different path ... . One doesn't choose the style. You can investigate and try to discover what the best style would be for a theme. But the style is determined by the subject, by the mood of the times. If you try to use something that is not suitable, it just won't work. Then the critics build theories around that and they see things I hadn't seen. I only respond to our way of life, the life of the Caribbean. García Márquez was noted for leaving out seemingly important details and events so the reader is forced into a more participatory role in the story development. For example, in No One Writes to the Colonel , the main characters are not given names. This practice is influenced by Greek tragedies, such as Antigone and Oedipus Rex , in which important events occur off-stage and are left to the audience's imagination. Reality is an important theme in all of García Márquez's works. He said of his early works (with the exception of Leaf Storm ), " Nobody Writes to the Colonel , In Evil Hour , and Big Mama's Funeral all reflect the reality of life in Colombia and this theme determines the rational structure of the books. I don't regret having written them, but they belong to a kind of premeditated literature that offers too static and exclusive a vision of reality." In his other works he experimented more with less traditional approaches to reality, so that "the most frightful, the most unusual things are told with the deadpan expression". A commonly cited example is the physical and spiritual ascending into heaven of a character while she is hanging the laundry out to dry in One Hundred Years of Solitude . The style of these works fits in the "marvellous realm" described by the Cuban writer Alejo Carpentier and was labeled as magical realism . Literary critic Michael Bell proposes an alternative understanding for García Márquez's style, as the category magic realism is criticized for being dichotomizing and exoticizing, "what is really at stake is a psychological suppleness which is able to inhabit unsentimentally the daytime world while remaining open to the promptings of those domains which modern culture has, by its own inner logic, necessarily marginalised or repressed." García Márquez and his friend Plinio Apuleyo Mendoza discuss his work in a similar way, The way you treat reality in your books ... has been called magical realism. I have the feeling your European readers are usually aware of the magic of your stories but fail to see the reality behind it .... This is surely because their rationalism prevents them seeing that reality isn't limited to the price of tomatoes and eggs. Reality is an important theme in all of García Márquez's works. He said of his early works (with the exception of Leaf Storm ), " Nobody Writes to the Colonel , In Evil Hour , and Big Mama's Funeral all reflect the reality of life in Colombia and this theme determines the rational structure of the books. I don't regret having written them, but they belong to a kind of premeditated literature that offers too static and exclusive a vision of reality." In his other works he experimented more with less traditional approaches to reality, so that "the most frightful, the most unusual things are told with the deadpan expression". A commonly cited example is the physical and spiritual ascending into heaven of a character while she is hanging the laundry out to dry in One Hundred Years of Solitude . The style of these works fits in the "marvellous realm" described by the Cuban writer Alejo Carpentier and was labeled as magical realism . Literary critic Michael Bell proposes an alternative understanding for García Márquez's style, as the category magic realism is criticized for being dichotomizing and exoticizing, "what is really at stake is a psychological suppleness which is able to inhabit unsentimentally the daytime world while remaining open to the promptings of those domains which modern culture has, by its own inner logic, necessarily marginalised or repressed." García Márquez and his friend Plinio Apuleyo Mendoza discuss his work in a similar way, The way you treat reality in your books ... has been called magical realism. I have the feeling your European readers are usually aware of the magic of your stories but fail to see the reality behind it .... This is surely because their rationalism prevents them seeing that reality isn't limited to the price of tomatoes and eggs. The theme of solitude runs through much of García Márquez's works. As Pelayo notes, " Love in the Time of Cholera , like all of Gabriel García Márquez's work, explores the solitude of the individual and of humankind...portrayed through the solitude of love and of being in love". In response to Plinio Apuleyo Mendoza's question, "If solitude is the theme of all your books, where should we look for the roots of this over-riding emotion? In your childhood perhaps?" García Márquez replied, "I think it's a problem everybody has. Everyone has his own way and means of expressing it. The feeling pervades the work of so many writers, although some of them may express it unconsciously." In his Nobel Prize acceptance speech, Solitude of Latin America , he relates this theme of solitude to the Latin American experience, "The interpretation of our reality through patterns not our own, serves only to make us ever more unknown, ever less free, ever more solitary." Another important theme in many of García Márquez's work is the setting of the village he calls Macondo . He uses his home town of Aracataca, Colombia as a cultural, historical and geographical reference to create this imaginary town, but the representation of the village is not limited to this specific area. García Márquez shares, "Macondo is not so much a place as a state of mind, which allows you to see what you want, and how you want to see it." Even when his stories do not take place in Macondo, there is often still a consistent lack of specificity to the location. So while they are often set with "a Caribbean coastline and an Andean hinterland... [the settings are] otherwise unspecified, in accordance with García Márquez's evident attempt to capture a more general regional myth rather than give a specific political analysis." This fictional town has become well known in the literary world. As Stavans notes of Macondo, "its geography and inhabitants constantly invoked by teachers, politicians, and tourist agents..." makes it "...hard to believe it is a sheer fabrication." In Leaf Storm García Márquez depicts the realities of the Banana Boom in Macondo, which include a period of great wealth during the presence of the US companies and a period of depression upon the departure of the American banana companies. One Hundred Years of Solitude takes place in Macondo and tells the complete history of the fictional town from its founding to its doom. The account of Macondo in Constance Pedoto, in " The Handsomest Drowned Man in the World " has been compared to tales from Alaska which combine the real and the surreal, deriving from an upbringing which combined superstitious beliefs and a harsh environment. In his autobiography, García Márquez explains his fascination with the word and concept Macondo. He describes a trip he made with his mother back to Aracataca as a young man: The train stopped at a station that had no town, and a short while later it passed the only banana plantation along the route that had its name written over the gate: Macondo . This word had attracted my attention ever since the first trips I had made with my grandfather, but I discovered only as an adult that I liked its poetic resonance. I never heard anyone say it and did not even ask myself what it meant...I happened to read in an encyclopedia that it is a tropical tree resembling the Ceiba . In several of García Márquez's works, including No One Writes to the Colonel , In Evil Hour , and Leaf Storm , he referenced La Violencia (the violence), "a brutal civil war between conservatives and liberals that lasted into the 1960s, causing the deaths of several hundred thousand Colombians". Throughout all of his novels there are subtle references to la violencia . For example, characters live under various unjust situations like curfew, press censorship, and underground newspapers. In Evil Hour , while not one of García Márquez's most famous novels, is notable for its portrayal of la violencia with its "fragmented portrayal of social disintegration provoked by la violencia ". Although García Márquez did portray the corrupt nature and the injustices of times like la violencia , he refused to use his work as a platform for political propaganda. "For him, the duty of the revolutionary writer is to write well, and the ideal novel is one that moves its reader by its political and social content, and, at the same time, by its power to penetrate reality and expose its other side. The theme of solitude runs through much of García Márquez's works. As Pelayo notes, " Love in the Time of Cholera , like all of Gabriel García Márquez's work, explores the solitude of the individual and of humankind...portrayed through the solitude of love and of being in love". In response to Plinio Apuleyo Mendoza's question, "If solitude is the theme of all your books, where should we look for the roots of this over-riding emotion? In your childhood perhaps?" García Márquez replied, "I think it's a problem everybody has. Everyone has his own way and means of expressing it. The feeling pervades the work of so many writers, although some of them may express it unconsciously." In his Nobel Prize acceptance speech, Solitude of Latin America , he relates this theme of solitude to the Latin American experience, "The interpretation of our reality through patterns not our own, serves only to make us ever more unknown, ever less free, ever more solitary." Another important theme in many of García Márquez's work is the setting of the village he calls Macondo . He uses his home town of Aracataca, Colombia as a cultural, historical and geographical reference to create this imaginary town, but the representation of the village is not limited to this specific area. García Márquez shares, "Macondo is not so much a place as a state of mind, which allows you to see what you want, and how you want to see it." Even when his stories do not take place in Macondo, there is often still a consistent lack of specificity to the location. So while they are often set with "a Caribbean coastline and an Andean hinterland... [the settings are] otherwise unspecified, in accordance with García Márquez's evident attempt to capture a more general regional myth rather than give a specific political analysis." This fictional town has become well known in the literary world. As Stavans notes of Macondo, "its geography and inhabitants constantly invoked by teachers, politicians, and tourist agents..." makes it "...hard to believe it is a sheer fabrication." In Leaf Storm García Márquez depicts the realities of the Banana Boom in Macondo, which include a period of great wealth during the presence of the US companies and a period of depression upon the departure of the American banana companies. One Hundred Years of Solitude takes place in Macondo and tells the complete history of the fictional town from its founding to its doom. The account of Macondo in Constance Pedoto, in " The Handsomest Drowned Man in the World " has been compared to tales from Alaska which combine the real and the surreal, deriving from an upbringing which combined superstitious beliefs and a harsh environment. In his autobiography, García Márquez explains his fascination with the word and concept Macondo. He describes a trip he made with his mother back to Aracataca as a young man: The train stopped at a station that had no town, and a short while later it passed the only banana plantation along the route that had its name written over the gate: Macondo . This word had attracted my attention ever since the first trips I had made with my grandfather, but I discovered only as an adult that I liked its poetic resonance. I never heard anyone say it and did not even ask myself what it meant...I happened to read in an encyclopedia that it is a tropical tree resembling the Ceiba . In several of García Márquez's works, including No One Writes to the Colonel , In Evil Hour , and Leaf Storm , he referenced La Violencia (the violence), "a brutal civil war between conservatives and liberals that lasted into the 1960s, causing the deaths of several hundred thousand Colombians". Throughout all of his novels there are subtle references to la violencia . For example, characters live under various unjust situations like curfew, press censorship, and underground newspapers. In Evil Hour , while not one of García Márquez's most famous novels, is notable for its portrayal of la violencia with its "fragmented portrayal of social disintegration provoked by la violencia ". Although García Márquez did portray the corrupt nature and the injustices of times like la violencia , he refused to use his work as a platform for political propaganda. "For him, the duty of the revolutionary writer is to write well, and the ideal novel is one that moves its reader by its political and social content, and, at the same time, by its power to penetrate reality and expose its other side. Whether in fiction or nonfiction, in the epic novel or the concentrated story, Márquez is now recognized in the words of Carlos Fuentes as "the most popular and perhaps the best writer in Spanish since Cervantes ". He is one of those very rare artists who succeed in chronicling not only a nation's life, culture and history, but also those of an entire continent, and a master storyteller who, as The New York Review of Books once said, "forces upon us at every page the wonder and extravagance of life." García Márquez's work is an important part of the Latin American Boom of literature, often defined around his works, and those of Julio Cortázar , Carlos Fuentes , and Mario Vargas Llosa . His work has challenged critics of Colombian literature to step out of the conservative criticism that had been dominant before the success of One Hundred Years of Solitude . In a review of literary criticism Robert Sims notes, García Márquez continues to cast a lengthy shadow in Colombia, Latin America, and the United States. Critical works on the 1982 Nobel laureate have reached industrial proportion and show no signs of abating. Moreover, García Márquez has galvanized Colombian literature in an unprecedented way by giving a tremendous impetus to Colombian literature. Indeed, he has become a touchstone for literature and criticism throughout the Americas as his work has created a certain attraction-repulsion among critics and writers while readers continue to devour new publications. No one can deny that García Márquez has helped rejuvenate, reformulate, and recontextualize literature and criticism in Colombia and the rest of Latin America. Following his death, García Márquez's family made the decision to deposit his papers and some of his personal effects at The University of Texas at Austin's Harry Ransom Center , a humanities research library and museum. In 2023, García Márquez surpassed Miguel de Cervantes as the most translated Spanish-language writer according to the World Translation Map. The ranking is based on works translated into 10 languages, including English, Arabic, Chinese, French, German, Italian, Japanese, Portuguese, Russian and Swedish. García Márquez is also the most translated Spanish-language author between 2000–2021 ahead of Mario Vargas Llosa , Isabel Allende , Jorge Luis Borges , Carlos Ruiz Zafon , Roberto Bolaño , Cervantes and more. García Márquez received the Nobel Prize in Literature on 10 December 1982 "for his novels and short stories, in which the fantastic and the realistic are combined in a richly composed world of imagination, reflecting a continent's life and conflicts". His acceptance speech was entitled " The Solitude of Latin America ". García Márquez was the first Colombian and fourth Latin American to win a Nobel Prize for Literature. After becoming a Nobel laureate, García Márquez stated to a correspondent: "I have the impression that in giving me the prize, they have taken into account the literature of the sub-continent and have awarded me as a way of awarding all of this literature". García Márquez received the Nobel Prize in Literature on 10 December 1982 "for his novels and short stories, in which the fantastic and the realistic are combined in a richly composed world of imagination, reflecting a continent's life and conflicts". His acceptance speech was entitled " The Solitude of Latin America ". García Márquez was the first Colombian and fourth Latin American to win a Nobel Prize for Literature. After becoming a Nobel laureate, García Márquez stated to a correspondent: "I have the impression that in giving me the prize, they have taken into account the literature of the sub-continent and have awarded me as a way of awarding all of this literature". A year after his death, García Márquez appears as a notable character in Claudia Amengual 's novel Cartagena , set in Uruguay and Colombia. In Giannina Braschi 's Empire of Dreams , the protagonist Mariquita Samper shoots the narrator of the Latin American Boom, presumed by critics to be the figure of García Marquez; in Braschi's Spanglish novel Yo-Yo Boing! characters debate the importance of García Márquez and Isabel Allende during a heated dinner party scene.

Wiki

Cholera

https://api.wikimedia.org/core/v1/wikipedia/en/page/National_Institute_of_Cholera_and_Enteric_Diseases/html

National Institute of Cholera and Enteric Diseases

1962 ; 62 years ago ( 1962 ) as Cholera Research Centre 1979 ; 45 years ago ( 1979 ) renamed as NICED P-33, CIT Road, Subhas Sarobar Park, Phool Bagan, Beleghata National Institute of Cholera and Enteric Diseases or NICED (also known as ICMR-NICED ) is an Indian medical institute that conducts research and develops prevention and treatment and control strategies related to enteric diseases and HIV/AIDS. The headquarter of NICED is located at Kolkata , West Bengal . NICED is affiliated to and financed by Indian Council of Medical Research . Eastern India and the Gangetic Plain have had a long history of cholera and related epidemics. Indian Council of Medical Research (ICMR) set up a cholera research centre at Kyd Street, Kolkata, West Bengal. The aim of establishing this centre was to conduct research related to cholera and other enteric diseases. In 1979, the cholera research centre was renamed to National Institute of Cholera and Enteric Diseases (NICED). In 1980 the institute received the World Health Organization 's recognition as "WHO Collaborative Centre for Research and Training on Diarrhoeal Diseases". During the COVID-19 pandemic in India (2020), NICED and their microbiologists and researchers played an important role. According to a news article published in The New Indian Express in April 2020, the scientists were working round the clock in shifts. On 2022 The institute planned open to a rural health research unit in North Bengal Medical College and Hospital .Around ₹ 4 crore will be spent on the infrastructure. For the unit, an MoU has been signed between NBMCH and ICMR, detection of acute encephalitis syndrome, alcoholic liver diseases, skin diseases found in tea gardens, diaorrhea and other localised diseases can be done faster. It will help in early intervention and treatment. In 1968 the institute was given the status of "International Reference Centre for Vibrio Phage Typing" by the World Health Organization (WHO). In 1980 the institute received the recognition as "WHO Collaborative Centre for Research and Training on Diarrhoeal Diseases".

Wiki

Cholera

https://api.wikimedia.org/core/v1/wikipedia/en/page/Germ_theory_of_disease/html

Germ theory of disease

The germ theory of disease is the currently accepted scientific theory for many diseases . It states that microorganisms known as pathogens or "germs" can cause disease. These small organisms, too small to be seen without magnification, invade humans, other animals, and other living hosts. Their growth and reproduction within their hosts can cause disease. "Germ" refers to not just a bacterium but to any type of microorganism, such as protists or fungi , or other pathogens that can cause disease, such as viruses , prions , or viroids . Diseases caused by pathogens are called infectious diseases . Even when a pathogen is the principal cause of a disease, environmental and hereditary factors often influence the severity of the disease, and whether a potential host individual becomes infected when exposed to the pathogen. Pathogens are disease-carrying agents that can pass from one individual to another, both in humans and animals. Infectious diseases are caused by biological agents such as pathogenic microorganisms (viruses, bacteria, and fungi) as well as parasites. Basic forms of germ theory were proposed by Girolamo Fracastoro in 1546, and expanded upon by Marcus von Plenciz in 1762. However, such views were held in disdain in Europe, where Galen's miasma theory remained dominant among scientists and doctors. By the early 19th century, smallpox vaccination was commonplace in Europe, though doctors were unaware of how it worked or how to extend the principle to other diseases. A transitional period began in the late 1850s with the work of Louis Pasteur . This work was later extended by Robert Koch in the 1880s. By the end of that decade, the miasma theory was struggling to compete with the germ theory of disease. Viruses were initially discovered in the 1890s. Eventually, a "golden era" of bacteriology ensued, during which the germ theory quickly led to the identification of the actual organisms that cause many diseases. The miasma theory was the predominant theory of disease transmission before the germ theory took hold towards the end of the 19th century; it is no longer accepted as a correct explanation for disease by the scientific community. It held that diseases such as cholera , chlamydia infection , or the Black Death were caused by a miasma ( μίασμα , Ancient Greek : "pollution"), a noxious form of "bad air" emanating from rotting organic matter. Miasma was considered to be a poisonous vapor or mist filled with particles from decomposed matter (miasmata) that was identifiable by its foul smell. The theory posited that diseases were the product of environmental factors such as contaminated water, foul air, and poor hygienic conditions. Such infections, according to the theory, were not passed between individuals but would affect those within a locale that gave rise to such vapors. Ancient Indian text such as Atharvaveda and Charaka samahita described tiny creatures called Krimi and their harmful effects . In Antiquity , the Greek historian Thucydides ( c. 460 – c. 400 BC ) was the first person to write, in his account of the plague of Athens , that diseases could spread from an infected person to others. One theory of the spread of contagious diseases that were not spread by direct contact was that they were spread by spore -like "seeds" ( Latin : semina ) that were present in and dispersible through the air. In his poem, De rerum natura (On the Nature of Things, c. 56 BC ), the Roman poet Lucretius ( c. 99 BC – c. 55 BC ) stated that the world contained various "seeds", some of which could sicken a person if they were inhaled or ingested. The Roman statesman Marcus Terentius Varro (116–27 BC) wrote, in his Rerum rusticarum libri III (Three Books on Agriculture, 36 BC): "Precautions must also be taken in the neighborhood of swamps... because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases." The Greek physician Galen (AD 129 – c. 200/216 ) speculated in his On Initial Causes ( c. 175 AD that some patients might have "seeds of fever". : 4 In his On the Different Types of Fever ( c. 175 AD ), Galen speculated that plagues were spread by "certain seeds of plague", which were present in the air. : 6 And in his Epidemics ( c. 176–178 AD ), Galen explained that patients might relapse during recovery from fever because some "seed of the disease" lurked in their bodies, which would cause a recurrence of the disease if the patients did not follow a physician's therapeutic regimen. : 7 A basic form of contagion theory dates back to medicine in the medieval Islamic world , where it was proposed by Persian physician Ibn Sina (known as Avicenna in Europe) in The Canon of Medicine (1025), which later became the most authoritative medical textbook in Europe up until the 16th century. In Book IV of the El-Kanun , Ibn Sina discussed epidemics , outlining the classical miasma theory and attempting to blend it with his own early contagion theory. He mentioned that people can transmit disease to others by breath, noted contagion with tuberculosis , and discussed the transmission of disease through water and dirt. The concept of invisible contagion was later discussed by several Islamic scholars in the Ayyubid Sultanate who referred to them as najasat ("impure substances"). The fiqh scholar Ibn al-Haj al-Abdari ( c. 1250 –1336), while discussing Islamic diet and hygiene , gave warnings about how contagion can contaminate water, food, and garments, and could spread through the water supply, and may have implied contagion to be unseen particles. During the early Middle Ages, Isidore of Seville ( c. 560 –636) mentioned "plague-bearing seeds" ( pestifera semina ) in his On the Nature of Things ( c. AD 613 ). : 20 Later in 1345, Tommaso del Garbo ( c. 1305 –1370) of Bologna, Italy mentioned Galen's "seeds of plague" in his work Commentaria non-parum utilia in libros Galeni (Helpful commentaries on the books of Galen). : 214 The 16th century Reformer Martin Luther appears to have had some idea of the contagion theory, commenting 'I have survived three plagues and visited several people who had two plague spots which I touched. But it did not hurt me, thank God. Afterwards when I returned home, I took up Margaret' (born 1534), 'who was then a baby, and put my unwashed hands on her face, because I had forgotten'. In 1546, Italian physician Girolamo Fracastoro published De Contagione et Contagiosis Morbis ( On Contagion and Contagious Diseases ), a set of three books covering the nature of contagious diseases, categorization of major pathogens, and theories on preventing and treating these conditions. Fracastoro blamed "seeds of disease" that propagate through direct contact with an infected host, indirect contact with fomites , or through particles in the air. In 1668, Italian physician Francesco Redi published experimental evidence rejecting spontaneous generation , the theory that living creatures arise from nonliving matter. He observed that maggots only arose from rotting meat that was uncovered. When meat was left in jars covered by gauze, the maggots would instead appear on the gauze's surface, later understood as rotting meat's smell passing through the mesh to attract flies that laid eggs. Microorganisms are said to have been first directly observed in the 1670s by Anton van Leeuwenhoek , an early pioneer in microbiology , considered "the Father of Microbiology". Leeuwenhoek is said to be the first to see and describe bacteria (1674), yeast cells, the teeming life in a drop of water (such as algae), and the circulation of blood corpuscles in capillaries. The word "bacteria" didn't exist yet, so he called these microscopic living organisms "animalcules", meaning "little animals". Those "very little animalcules" he was able to isolate from different sources, such as rainwater, pond and well water, and the human mouth and intestine. Yet German Jesuit priest and scholar Athanasius Kircher may have observed such microorganisms prior to this. One of his books written in 1646 contains a chapter in Latin, which reads in translation "Concerning the wonderful structure of things in nature, investigated by Microscope", stating "who would believe that vinegar and milk abound with an innumerable multitude of worms." Kircher defined the invisible organisms found in decaying bodies, meat, milk, and secretions as "worms." His studies with the microscope led him to the belief, which he was possibly the first to hold, that disease and putrefaction (decay) were caused by the presence of invisible living bodies. In 1646, Kircher (or "Kirchner", as it is often spelled), wrote that "a number of things might be discovered in the blood of fever patients." When Rome was struck by the bubonic plague in 1656, Kircher investigated the blood of plague victims under the microscope. He noted the presence of "little worms" or "animalcules" in the blood and concluded that the disease was caused by microorganisms. He was the first to attribute infectious disease to a microscopic pathogen, inventing the germ theory of disease, which he outlined in his Scrutinium Physico-Medicum (Rome 1658). Kircher's conclusion that disease was caused by microorganisms was correct [ citation needed ] , although it is likely that what he saw under the microscope were in fact red or white blood cells and not the plague agent itself. Kircher also proposed hygienic measures to prevent the spread of disease, such as isolation, quarantine, burning clothes worn by the infected, and wearing facemasks to prevent the inhalation of germs. It was Kircher who first proposed that living beings enter and exist in the blood. In 1700, physician Nicolas Andry argued that microorganisms he called "worms" were responsible for smallpox and other diseases. In 1720, Richard Bradley theorised that the plague and "all pestilential distempers" were caused by "poisonous insects", living creatures viewable only with the help of microscopes. In 1762, the Austrian physician Marcus Antonius von Plenciz (1705–1786) published a book titled Opera medico-physica . It outlined a theory of contagion stating that specific animalcules in the soil and the air were responsible for causing specific diseases. Von Plenciz noted the distinction between diseases which are both epidemic and contagious (like measles and dysentery), and diseases which are contagious but not epidemic (like rabies and leprosy). The book cites Anton van Leeuwenhoek to show how ubiquitous such animalcules are and was unique for describing the presence of germs in ulcerating wounds. Ultimately, the theory espoused by von Plenciz was not accepted by the scientific community. During the early 19th century, driven by economic concerns over collapsing silk production, Italian entomologist Agostino Bassi researched a silkworm disease known as "muscardine" (type of white bonbon ) in French and "calcinaccio" (rubble) or "mal del segno" (bad sign) in Italian, due to the disease causing white fungal spots along the caterpillar. From 1835 to 1836, Bassi published his findings that fungal spores transmitted the disease between individuals. In recommending the rapid removal of diseased caterpillars and disinfection of their surfaces, Bassi outlined methods used in modern preventative healthcare . Italian naturalist Giuseppe Gabriel Balsamo-Crivelli named the causative fungal species after Bassi, currently classified as Beauveria bassiana . In 1838 French specialist in tropical medicine Louis-Daniel Beauperthuy pioneered using microscopy in relation to diseases and independently developed a theory that all infectious diseases were due to parasitic infection with " animalcules " (microorganisms). With the help of his friend M. Adele de Rosseville, he presented his theory in a formal presentation before the French Academy of Sciences in Paris. By 1853, he was convinced that malaria and yellow fever were spread by mosquitos. He even identified the particular group of mosquitos that transmit yellow fever as the "domestic species" of "striped-legged mosquito", which can be recognised as Aedes aegypti , the actual vector. He published his theory in 1854 in the Gaceta Oficial de Cumana ("Official Gazette of Cumana"). His reports were assessed by an official commission, which discarded his mosquito theory. Ignaz Semmelweis , a Hungarian obstetrician working at the Vienna General Hospital ( Allgemeines Krankenhaus ) in 1847, noticed the dramatically high maternal mortality from puerperal fever following births assisted by doctors and medical students. However, those attended by midwives were relatively safe. Investigating further, Semmelweis made the connection between puerperal fever and examinations of delivering women by doctors, and further realized that these physicians had usually come directly from autopsies . Asserting that puerperal fever was a contagious disease and that matter from autopsies were implicated in its development, Semmelweis made doctors wash their hands with chlorinated lime water before examining pregnant women. He then documented a sudden reduction in the mortality rate from 18% to 2.2% over a period of a year. Despite this evidence, he and his theories were rejected by most of the contemporary medical establishment. Gideon Mantell , the Sussex doctor more famous for discovering dinosaur fossils , spent time with his microscope, and speculated in his Thoughts on Animalcules (1850) that perhaps "many of the most serious maladies which afflict humanity, are produced by peculiar states of invisible animalcular life". British physician John Snow is credited as a founder of modern epidemiology for studying the 1854 Broad Street cholera outbreak . Snow criticized the Italian anatomist Giovanni Maria Lancisi for his early 18th century writings that claimed swamp miasma spread malaria, rebutting that bad air from decomposing organisms was not present in all cases. In his 1849 pamphlet On the Mode of Communication of Cholera, Snow proposed that cholera spread through the fecal–oral route , replicating in human lower intestines . In the book's second edition, published in 1855, Snow theorized that cholera was caused by cells smaller than human epithelial cells, leading to Robert Koch's 1884 confirmation of the bacterial species Vibrio cholerae as the causative agent. In recognizing a biological origin, Snow recommended boiling and filtering water, setting the precedent for modern boil-water advisory directives. Through a statistical analysis tying cholera cases to specific water pumps associated with the Southwark and Vauxhall Waterworks Company , which supplied sewage-polluted water from the River Thames , Snow showed that areas supplied by this company experienced fourteen times as many deaths as residents using Lambeth Waterworks Company pumps that obtained water from the upriver, cleaner Seething Wells . While Snow received praise for convincing the Board of Guardians of St James's Parish to remove the handles of contaminated pumps, he noted that the outbreak's cases were already declining as scared residents fled the region. During the mid-19th century, French microbiologist Louis Pasteur showcased that treating the female genital tract with boric acid killed the microorganisms causing postpartum infections while avoiding damage to mucous membranes . Building on Redi's work, Pasteur disproved spontaneous generation by constructing swan neck flasks containing nutrient agar . Since the flask contents were only fermented when in direct contact with the external environment's air by removing the curved tubing, Pasteur demonstrated that bacteria must travel between sites of infection to colonize environments. Similar to Bassi, Pasteur extended his research on germ theory by studying pébrine , a disease that causes brown spots on silkworms. While Swiss botanist Carl Nägeli discovered the fungal species Nosema bombycis in 1857, Pasteur applied the findings to recommend improved ventilation and screening of silkworm eggs, an early form of disease surveillance . In 1884, German bacteriologist Robert Koch published four criteria for establishing causality between specific microorganisms and diseases, now known as Koch's postulates : The microorganism must be found in abundance in all organisms with the disease, but should not be found in healthy organisms. The microorganism must be isolated from a diseased organism and grown in pure culture . The cultured microorganism should cause disease when introduced into a healthy organism. The microorganism must be re-isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent. During his lifetime, Koch recognized that the postulates were not universally applicable, such as asymptomatic carriers of cholera violating the first postulate. For this same reason, the third postulate specifies "should", rather than "must", because not all host organisms exposed to an infectious agent will acquire the infection, potentially due to differences in prior exposure to the pathogen. Furthermore, viruses cannot be grown in pure cultures because they are obligate intracellular parasites, making it impossible to fulfill the second postulate. Similarly, pathogenic misfolded proteins, known as prions , only spread by transmitting their structure to other proteins, rather than self-replicating. While Koch's postulates retain historical importance for emphasizing that correlation does not imply causation , many pathogens are accepted as causative agents of specific diseases without fulfilling all of the criteria. In 1988, American microbiologist Stanley Falkow published a molecular version of Koch's postulates to establish correlation between microbial genes and virulence factors . After reading Pasteur's papers on bacterial fermentation, British surgeon Joseph Lister recognized that compound fractures , involving bones breaking through the skin, were more likely to become infected due to exposure to environmental microorganisms. He recognized that carbolic acid could be applied to the site of injury as an effective antiseptic. Ancient Indian text such as Atharvaveda and Charaka samahita described tiny creatures called Krimi and their harmful effects . In Antiquity , the Greek historian Thucydides ( c. 460 – c. 400 BC ) was the first person to write, in his account of the plague of Athens , that diseases could spread from an infected person to others. One theory of the spread of contagious diseases that were not spread by direct contact was that they were spread by spore -like "seeds" ( Latin : semina ) that were present in and dispersible through the air. In his poem, De rerum natura (On the Nature of Things, c. 56 BC ), the Roman poet Lucretius ( c. 99 BC – c. 55 BC ) stated that the world contained various "seeds", some of which could sicken a person if they were inhaled or ingested. The Roman statesman Marcus Terentius Varro (116–27 BC) wrote, in his Rerum rusticarum libri III (Three Books on Agriculture, 36 BC): "Precautions must also be taken in the neighborhood of swamps... because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases." The Greek physician Galen (AD 129 – c. 200/216 ) speculated in his On Initial Causes ( c. 175 AD that some patients might have "seeds of fever". : 4 In his On the Different Types of Fever ( c. 175 AD ), Galen speculated that plagues were spread by "certain seeds of plague", which were present in the air. : 6 And in his Epidemics ( c. 176–178 AD ), Galen explained that patients might relapse during recovery from fever because some "seed of the disease" lurked in their bodies, which would cause a recurrence of the disease if the patients did not follow a physician's therapeutic regimen. : 7A basic form of contagion theory dates back to medicine in the medieval Islamic world , where it was proposed by Persian physician Ibn Sina (known as Avicenna in Europe) in The Canon of Medicine (1025), which later became the most authoritative medical textbook in Europe up until the 16th century. In Book IV of the El-Kanun , Ibn Sina discussed epidemics , outlining the classical miasma theory and attempting to blend it with his own early contagion theory. He mentioned that people can transmit disease to others by breath, noted contagion with tuberculosis , and discussed the transmission of disease through water and dirt. The concept of invisible contagion was later discussed by several Islamic scholars in the Ayyubid Sultanate who referred to them as najasat ("impure substances"). The fiqh scholar Ibn al-Haj al-Abdari ( c. 1250 –1336), while discussing Islamic diet and hygiene , gave warnings about how contagion can contaminate water, food, and garments, and could spread through the water supply, and may have implied contagion to be unseen particles. During the early Middle Ages, Isidore of Seville ( c. 560 –636) mentioned "plague-bearing seeds" ( pestifera semina ) in his On the Nature of Things ( c. AD 613 ). : 20 Later in 1345, Tommaso del Garbo ( c. 1305 –1370) of Bologna, Italy mentioned Galen's "seeds of plague" in his work Commentaria non-parum utilia in libros Galeni (Helpful commentaries on the books of Galen). : 214 The 16th century Reformer Martin Luther appears to have had some idea of the contagion theory, commenting 'I have survived three plagues and visited several people who had two plague spots which I touched. But it did not hurt me, thank God. Afterwards when I returned home, I took up Margaret' (born 1534), 'who was then a baby, and put my unwashed hands on her face, because I had forgotten'. In 1546, Italian physician Girolamo Fracastoro published De Contagione et Contagiosis Morbis ( On Contagion and Contagious Diseases ), a set of three books covering the nature of contagious diseases, categorization of major pathogens, and theories on preventing and treating these conditions. Fracastoro blamed "seeds of disease" that propagate through direct contact with an infected host, indirect contact with fomites , or through particles in the air. In 1668, Italian physician Francesco Redi published experimental evidence rejecting spontaneous generation , the theory that living creatures arise from nonliving matter. He observed that maggots only arose from rotting meat that was uncovered. When meat was left in jars covered by gauze, the maggots would instead appear on the gauze's surface, later understood as rotting meat's smell passing through the mesh to attract flies that laid eggs. Microorganisms are said to have been first directly observed in the 1670s by Anton van Leeuwenhoek , an early pioneer in microbiology , considered "the Father of Microbiology". Leeuwenhoek is said to be the first to see and describe bacteria (1674), yeast cells, the teeming life in a drop of water (such as algae), and the circulation of blood corpuscles in capillaries. The word "bacteria" didn't exist yet, so he called these microscopic living organisms "animalcules", meaning "little animals". Those "very little animalcules" he was able to isolate from different sources, such as rainwater, pond and well water, and the human mouth and intestine. Yet German Jesuit priest and scholar Athanasius Kircher may have observed such microorganisms prior to this. One of his books written in 1646 contains a chapter in Latin, which reads in translation "Concerning the wonderful structure of things in nature, investigated by Microscope", stating "who would believe that vinegar and milk abound with an innumerable multitude of worms." Kircher defined the invisible organisms found in decaying bodies, meat, milk, and secretions as "worms." His studies with the microscope led him to the belief, which he was possibly the first to hold, that disease and putrefaction (decay) were caused by the presence of invisible living bodies. In 1646, Kircher (or "Kirchner", as it is often spelled), wrote that "a number of things might be discovered in the blood of fever patients." When Rome was struck by the bubonic plague in 1656, Kircher investigated the blood of plague victims under the microscope. He noted the presence of "little worms" or "animalcules" in the blood and concluded that the disease was caused by microorganisms. He was the first to attribute infectious disease to a microscopic pathogen, inventing the germ theory of disease, which he outlined in his Scrutinium Physico-Medicum (Rome 1658). Kircher's conclusion that disease was caused by microorganisms was correct [ citation needed ] , although it is likely that what he saw under the microscope were in fact red or white blood cells and not the plague agent itself. Kircher also proposed hygienic measures to prevent the spread of disease, such as isolation, quarantine, burning clothes worn by the infected, and wearing facemasks to prevent the inhalation of germs. It was Kircher who first proposed that living beings enter and exist in the blood. In 1700, physician Nicolas Andry argued that microorganisms he called "worms" were responsible for smallpox and other diseases. In 1720, Richard Bradley theorised that the plague and "all pestilential distempers" were caused by "poisonous insects", living creatures viewable only with the help of microscopes. In 1762, the Austrian physician Marcus Antonius von Plenciz (1705–1786) published a book titled Opera medico-physica . It outlined a theory of contagion stating that specific animalcules in the soil and the air were responsible for causing specific diseases. Von Plenciz noted the distinction between diseases which are both epidemic and contagious (like measles and dysentery), and diseases which are contagious but not epidemic (like rabies and leprosy). The book cites Anton van Leeuwenhoek to show how ubiquitous such animalcules are and was unique for describing the presence of germs in ulcerating wounds. Ultimately, the theory espoused by von Plenciz was not accepted by the scientific community.During the early 19th century, driven by economic concerns over collapsing silk production, Italian entomologist Agostino Bassi researched a silkworm disease known as "muscardine" (type of white bonbon ) in French and "calcinaccio" (rubble) or "mal del segno" (bad sign) in Italian, due to the disease causing white fungal spots along the caterpillar. From 1835 to 1836, Bassi published his findings that fungal spores transmitted the disease between individuals. In recommending the rapid removal of diseased caterpillars and disinfection of their surfaces, Bassi outlined methods used in modern preventative healthcare . Italian naturalist Giuseppe Gabriel Balsamo-Crivelli named the causative fungal species after Bassi, currently classified as Beauveria bassiana . In 1838 French specialist in tropical medicine Louis-Daniel Beauperthuy pioneered using microscopy in relation to diseases and independently developed a theory that all infectious diseases were due to parasitic infection with " animalcules " (microorganisms). With the help of his friend M. Adele de Rosseville, he presented his theory in a formal presentation before the French Academy of Sciences in Paris. By 1853, he was convinced that malaria and yellow fever were spread by mosquitos. He even identified the particular group of mosquitos that transmit yellow fever as the "domestic species" of "striped-legged mosquito", which can be recognised as Aedes aegypti , the actual vector. He published his theory in 1854 in the Gaceta Oficial de Cumana ("Official Gazette of Cumana"). His reports were assessed by an official commission, which discarded his mosquito theory. Ignaz Semmelweis , a Hungarian obstetrician working at the Vienna General Hospital ( Allgemeines Krankenhaus ) in 1847, noticed the dramatically high maternal mortality from puerperal fever following births assisted by doctors and medical students. However, those attended by midwives were relatively safe. Investigating further, Semmelweis made the connection between puerperal fever and examinations of delivering women by doctors, and further realized that these physicians had usually come directly from autopsies . Asserting that puerperal fever was a contagious disease and that matter from autopsies were implicated in its development, Semmelweis made doctors wash their hands with chlorinated lime water before examining pregnant women. He then documented a sudden reduction in the mortality rate from 18% to 2.2% over a period of a year. Despite this evidence, he and his theories were rejected by most of the contemporary medical establishment. Gideon Mantell , the Sussex doctor more famous for discovering dinosaur fossils , spent time with his microscope, and speculated in his Thoughts on Animalcules (1850) that perhaps "many of the most serious maladies which afflict humanity, are produced by peculiar states of invisible animalcular life". British physician John Snow is credited as a founder of modern epidemiology for studying the 1854 Broad Street cholera outbreak . Snow criticized the Italian anatomist Giovanni Maria Lancisi for his early 18th century writings that claimed swamp miasma spread malaria, rebutting that bad air from decomposing organisms was not present in all cases. In his 1849 pamphlet On the Mode of Communication of Cholera, Snow proposed that cholera spread through the fecal–oral route , replicating in human lower intestines . In the book's second edition, published in 1855, Snow theorized that cholera was caused by cells smaller than human epithelial cells, leading to Robert Koch's 1884 confirmation of the bacterial species Vibrio cholerae as the causative agent. In recognizing a biological origin, Snow recommended boiling and filtering water, setting the precedent for modern boil-water advisory directives. Through a statistical analysis tying cholera cases to specific water pumps associated with the Southwark and Vauxhall Waterworks Company , which supplied sewage-polluted water from the River Thames , Snow showed that areas supplied by this company experienced fourteen times as many deaths as residents using Lambeth Waterworks Company pumps that obtained water from the upriver, cleaner Seething Wells . While Snow received praise for convincing the Board of Guardians of St James's Parish to remove the handles of contaminated pumps, he noted that the outbreak's cases were already declining as scared residents fled the region. During the mid-19th century, French microbiologist Louis Pasteur showcased that treating the female genital tract with boric acid killed the microorganisms causing postpartum infections while avoiding damage to mucous membranes . Building on Redi's work, Pasteur disproved spontaneous generation by constructing swan neck flasks containing nutrient agar . Since the flask contents were only fermented when in direct contact with the external environment's air by removing the curved tubing, Pasteur demonstrated that bacteria must travel between sites of infection to colonize environments. Similar to Bassi, Pasteur extended his research on germ theory by studying pébrine , a disease that causes brown spots on silkworms. While Swiss botanist Carl Nägeli discovered the fungal species Nosema bombycis in 1857, Pasteur applied the findings to recommend improved ventilation and screening of silkworm eggs, an early form of disease surveillance . In 1884, German bacteriologist Robert Koch published four criteria for establishing causality between specific microorganisms and diseases, now known as Koch's postulates : The microorganism must be found in abundance in all organisms with the disease, but should not be found in healthy organisms. The microorganism must be isolated from a diseased organism and grown in pure culture . The cultured microorganism should cause disease when introduced into a healthy organism. The microorganism must be re-isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent. During his lifetime, Koch recognized that the postulates were not universally applicable, such as asymptomatic carriers of cholera violating the first postulate. For this same reason, the third postulate specifies "should", rather than "must", because not all host organisms exposed to an infectious agent will acquire the infection, potentially due to differences in prior exposure to the pathogen. Furthermore, viruses cannot be grown in pure cultures because they are obligate intracellular parasites, making it impossible to fulfill the second postulate. Similarly, pathogenic misfolded proteins, known as prions , only spread by transmitting their structure to other proteins, rather than self-replicating. While Koch's postulates retain historical importance for emphasizing that correlation does not imply causation , many pathogens are accepted as causative agents of specific diseases without fulfilling all of the criteria. In 1988, American microbiologist Stanley Falkow published a molecular version of Koch's postulates to establish correlation between microbial genes and virulence factors . After reading Pasteur's papers on bacterial fermentation, British surgeon Joseph Lister recognized that compound fractures , involving bones breaking through the skin, were more likely to become infected due to exposure to environmental microorganisms. He recognized that carbolic acid could be applied to the site of injury as an effective antiseptic. During the early 19th century, driven by economic concerns over collapsing silk production, Italian entomologist Agostino Bassi researched a silkworm disease known as "muscardine" (type of white bonbon ) in French and "calcinaccio" (rubble) or "mal del segno" (bad sign) in Italian, due to the disease causing white fungal spots along the caterpillar. From 1835 to 1836, Bassi published his findings that fungal spores transmitted the disease between individuals. In recommending the rapid removal of diseased caterpillars and disinfection of their surfaces, Bassi outlined methods used in modern preventative healthcare . Italian naturalist Giuseppe Gabriel Balsamo-Crivelli named the causative fungal species after Bassi, currently classified as Beauveria bassiana . In 1838 French specialist in tropical medicine Louis-Daniel Beauperthuy pioneered using microscopy in relation to diseases and independently developed a theory that all infectious diseases were due to parasitic infection with " animalcules " (microorganisms). With the help of his friend M. Adele de Rosseville, he presented his theory in a formal presentation before the French Academy of Sciences in Paris. By 1853, he was convinced that malaria and yellow fever were spread by mosquitos. He even identified the particular group of mosquitos that transmit yellow fever as the "domestic species" of "striped-legged mosquito", which can be recognised as Aedes aegypti , the actual vector. He published his theory in 1854 in the Gaceta Oficial de Cumana ("Official Gazette of Cumana"). His reports were assessed by an official commission, which discarded his mosquito theory. Ignaz Semmelweis , a Hungarian obstetrician working at the Vienna General Hospital ( Allgemeines Krankenhaus ) in 1847, noticed the dramatically high maternal mortality from puerperal fever following births assisted by doctors and medical students. However, those attended by midwives were relatively safe. Investigating further, Semmelweis made the connection between puerperal fever and examinations of delivering women by doctors, and further realized that these physicians had usually come directly from autopsies . Asserting that puerperal fever was a contagious disease and that matter from autopsies were implicated in its development, Semmelweis made doctors wash their hands with chlorinated lime water before examining pregnant women. He then documented a sudden reduction in the mortality rate from 18% to 2.2% over a period of a year. Despite this evidence, he and his theories were rejected by most of the contemporary medical establishment. Gideon Mantell , the Sussex doctor more famous for discovering dinosaur fossils , spent time with his microscope, and speculated in his Thoughts on Animalcules (1850) that perhaps "many of the most serious maladies which afflict humanity, are produced by peculiar states of invisible animalcular life". British physician John Snow is credited as a founder of modern epidemiology for studying the 1854 Broad Street cholera outbreak . Snow criticized the Italian anatomist Giovanni Maria Lancisi for his early 18th century writings that claimed swamp miasma spread malaria, rebutting that bad air from decomposing organisms was not present in all cases. In his 1849 pamphlet On the Mode of Communication of Cholera, Snow proposed that cholera spread through the fecal–oral route , replicating in human lower intestines . In the book's second edition, published in 1855, Snow theorized that cholera was caused by cells smaller than human epithelial cells, leading to Robert Koch's 1884 confirmation of the bacterial species Vibrio cholerae as the causative agent. In recognizing a biological origin, Snow recommended boiling and filtering water, setting the precedent for modern boil-water advisory directives. Through a statistical analysis tying cholera cases to specific water pumps associated with the Southwark and Vauxhall Waterworks Company , which supplied sewage-polluted water from the River Thames , Snow showed that areas supplied by this company experienced fourteen times as many deaths as residents using Lambeth Waterworks Company pumps that obtained water from the upriver, cleaner Seething Wells . While Snow received praise for convincing the Board of Guardians of St James's Parish to remove the handles of contaminated pumps, he noted that the outbreak's cases were already declining as scared residents fled the region. During the mid-19th century, French microbiologist Louis Pasteur showcased that treating the female genital tract with boric acid killed the microorganisms causing postpartum infections while avoiding damage to mucous membranes . Building on Redi's work, Pasteur disproved spontaneous generation by constructing swan neck flasks containing nutrient agar . Since the flask contents were only fermented when in direct contact with the external environment's air by removing the curved tubing, Pasteur demonstrated that bacteria must travel between sites of infection to colonize environments. Similar to Bassi, Pasteur extended his research on germ theory by studying pébrine , a disease that causes brown spots on silkworms. While Swiss botanist Carl Nägeli discovered the fungal species Nosema bombycis in 1857, Pasteur applied the findings to recommend improved ventilation and screening of silkworm eggs, an early form of disease surveillance . In 1884, German bacteriologist Robert Koch published four criteria for establishing causality between specific microorganisms and diseases, now known as Koch's postulates : The microorganism must be found in abundance in all organisms with the disease, but should not be found in healthy organisms. The microorganism must be isolated from a diseased organism and grown in pure culture . The cultured microorganism should cause disease when introduced into a healthy organism. The microorganism must be re-isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent. During his lifetime, Koch recognized that the postulates were not universally applicable, such as asymptomatic carriers of cholera violating the first postulate. For this same reason, the third postulate specifies "should", rather than "must", because not all host organisms exposed to an infectious agent will acquire the infection, potentially due to differences in prior exposure to the pathogen. Furthermore, viruses cannot be grown in pure cultures because they are obligate intracellular parasites, making it impossible to fulfill the second postulate. Similarly, pathogenic misfolded proteins, known as prions , only spread by transmitting their structure to other proteins, rather than self-replicating. While Koch's postulates retain historical importance for emphasizing that correlation does not imply causation , many pathogens are accepted as causative agents of specific diseases without fulfilling all of the criteria. In 1988, American microbiologist Stanley Falkow published a molecular version of Koch's postulates to establish correlation between microbial genes and virulence factors . After reading Pasteur's papers on bacterial fermentation, British surgeon Joseph Lister recognized that compound fractures , involving bones breaking through the skin, were more likely to become infected due to exposure to environmental microorganisms. He recognized that carbolic acid could be applied to the site of injury as an effective antiseptic.

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Saline (medicine)

[Na+].[Cl-] InChI=1S/ClH.Na/h1H;/q;+1/p-1 Key:FAPWRFPIFSIZLT-UHFFFAOYSA-M Saline (also known as saline solution ) is a mixture of sodium chloride (salt) and water . It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses , and help with dry eyes . By injection into a vein , it is used to treat dehydration such as that from gastroenteritis and diabetic ketoacidosis . Large amounts may result in fluid overload , swelling , acidosis , and high blood sodium . In those with long-standing low blood sodium , excessive use may result in osmotic demyelination syndrome . Saline is in the crystalloid family of medications. It is most commonly used as a sterile 9 g of salt per litre (0.9%) solution, known as normal saline . Higher and lower concentrations may also occasionally be used. Saline is acidic, with a pH of 5.5 (due mainly to dissolved carbon dioxide). The medical use of saline began around 1831. It is on the World Health Organization's List of Essential Medicines . In 2020, sodium was the 274th most commonly prescribed medication in the United States, with more than 1 million prescriptions. Normal saline ( NSS, NS or N/S ) is the commonly used phrase for a solution of 0.90% w/v of NaCl , 308 mOsm /L or 9.0 g per liter. Less commonly, this solution is referred to as physiological saline or isotonic saline (because it is approximately isotonic to blood serum, which makes it a physiologically normal solution). Although neither of those names is technically accurate because normal saline is not exactly like blood serum , they convey the practical effect usually seen: good fluid balance with minimal hypotonicity or hypertonicity. NS is used frequently in intravenous drips (IVs) for people who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia . NS is also used for aseptic purpose. NS is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation, and has long been believed to be the safest fluid to give quickly in large volumes. However, it is now known that rapid infusion of NS can cause metabolic acidosis . The solution is 9 grams of sodium chloride (NaCl) dissolved in water, to a total volume of 1000 ml (weight per unit volume). The mass of 1 millilitre of normal saline is 1.0046 grams at 22 °C. The molecular weight of sodium chloride is approximately 58.4 grams per mole, so 58.4 grams of sodium chloride equals 1 mole. Since normal saline contains 9 grams of NaCl, the concentration is 9 grams per litre divided by 58.4 grams per mole, or 0.154 mole per litre. Since NaCl dissociates into two ions – sodium and chloride – 1 molar NaCl is 2 osmolar. Thus, NS contains 154 mEq /L of Na + and the same amount of Cl − . This points to an osmolarity of 154 + 154 = 308, which is higher (i.e. more solute per litre) than that of blood (approximately 285). However, if the osmotic coefficient (a correction for non-ideal solutions) is taken into account, then the saline solution is much closer to isotonic. The osmotic coefficient of NaCl is about 0.93, which yields an osmolarity of 0.154 × 1000 × 2 × 0.93 = 286.44. Therefore, the osmolarity of normal saline is a close approximation to the osmolarity of blood. For medical purposes, saline is often used to flush wounds and skin abrasions . However, research indicates that it is no more effective than potable tap water. Normal saline will not burn or sting when applied. [ citation needed ] Saline is also used in I.V. therapy , intravenously supplying extra water to rehydrate people or supplying the daily water and salt needs ("maintenance" needs) of a person who is unable to take them by mouth. Because infusing a solution of low osmolality can cause problems such as hemolysis , intravenous solutions with reduced saline concentrations (less than 0.9%) typically have dextrose ( glucose ) added to maintain a safe osmolality while providing less sodium chloride. The amount of normal saline infused depends largely on the needs of the person (e.g. ongoing diarrhea or heart failure ). [ citation needed ] Saline is also often used for nasal washes to relieve some of the symptoms of rhinitis and the common cold . The solution exerts a softening and loosening influence on the mucus to make it easier to wash out and clear the nasal passages for both babies and adults. In very rare instances, fatal infection by the amoeba Naegleria fowleri can occur if it enters the body through the nose; therefore tap water must not be used for nasal irrigation. Water is only appropriate for this purpose if it is sterile, distilled, boiled, filtered, or disinfected. Sterile isotonic saline is also used to fill breast implants for use in breast augmentation surgery, to correct congenital abnormalities such as tuberous breast deformity, and to correct breast asymmetry. Saline breast implants are also used in reconstructive surgery post-mastectomy. Eye drops are saline-containing drops used on the eye . Depending on the condition being treated, they may contain steroids , antihistamines , sympathomimetics , beta receptor blockers , parasympathomimetics , parasympatholytics , prostaglandins , non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics or topical anesthetics . Eye drops sometimes do not have medications in them and are only lubricating and tear -replacing solutions. There is tentative evidence that saline nasal irrigation may help with long term cases of rhinosinusitis . Evidence for use in cases of rhinosinusitis of short duration is unclear. For medical purposes, saline is often used to flush wounds and skin abrasions . However, research indicates that it is no more effective than potable tap water. Normal saline will not burn or sting when applied. [ citation needed ] Saline is also used in I.V. therapy , intravenously supplying extra water to rehydrate people or supplying the daily water and salt needs ("maintenance" needs) of a person who is unable to take them by mouth. Because infusing a solution of low osmolality can cause problems such as hemolysis , intravenous solutions with reduced saline concentrations (less than 0.9%) typically have dextrose ( glucose ) added to maintain a safe osmolality while providing less sodium chloride. The amount of normal saline infused depends largely on the needs of the person (e.g. ongoing diarrhea or heart failure ). [ citation needed ] Saline is also often used for nasal washes to relieve some of the symptoms of rhinitis and the common cold . The solution exerts a softening and loosening influence on the mucus to make it easier to wash out and clear the nasal passages for both babies and adults. In very rare instances, fatal infection by the amoeba Naegleria fowleri can occur if it enters the body through the nose; therefore tap water must not be used for nasal irrigation. Water is only appropriate for this purpose if it is sterile, distilled, boiled, filtered, or disinfected. Sterile isotonic saline is also used to fill breast implants for use in breast augmentation surgery, to correct congenital abnormalities such as tuberous breast deformity, and to correct breast asymmetry. Saline breast implants are also used in reconstructive surgery post-mastectomy. Eye drops are saline-containing drops used on the eye . Depending on the condition being treated, they may contain steroids , antihistamines , sympathomimetics , beta receptor blockers , parasympathomimetics , parasympatholytics , prostaglandins , non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics or topical anesthetics . Eye drops sometimes do not have medications in them and are only lubricating and tear -replacing solutions. There is tentative evidence that saline nasal irrigation may help with long term cases of rhinosinusitis . Evidence for use in cases of rhinosinusitis of short duration is unclear. Eye drops are saline-containing drops used on the eye . Depending on the condition being treated, they may contain steroids , antihistamines , sympathomimetics , beta receptor blockers , parasympathomimetics , parasympatholytics , prostaglandins , non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics or topical anesthetics . Eye drops sometimes do not have medications in them and are only lubricating and tear -replacing solutions.There is tentative evidence that saline nasal irrigation may help with long term cases of rhinosinusitis . Evidence for use in cases of rhinosinusitis of short duration is unclear. Concentrations lower and higher than normal also exist. High concentrations are used rarely in medicine but frequently in molecular biology . Hypertonic saline—7% NaCl solutions are considered mucoactive agents and thus are used to hydrate thick secretions ( mucus ) in order to make it easier to cough up and out ( expectorate ). 3% hypertonic saline solutions are also used in critical care settings, acutely increased intracranial pressure , or severe hyponatremia . Inhalation of hypertonic saline has also been shown to help in other respiratory problems, specifically bronchiolitis . Hypertonic saline is currently recommended by the Cystic Fibrosis Foundation as a primary part of a cystic fibrosis treatment regimen. An 11% solution of xylitol with 0.65% saline stimulates the washing of the nasopharynx and has an effect on the nasal pathogenic bacteria. This has been used in complementary and alternative medicine. Hypertonic saline may be used in perioperative fluid management protocols to reduce excessive intravenous fluid infusions and lessen pulmonary complications. Hypertonic saline is used in treating hyponatremia and cerebral edema . Rapid correction of hyponatremia via hypertonic saline, or via any saline infusion > 40 mmol/L (Na+ having a valence of 1, 40 mmol/L = 40 mEq/L) greatly increases risk of central pontine myelinolysis (CPM), and so requires constant monitoring of the person's response. Water privation combined with diuretic block does not produce as much risk of CPM as saline administration does; however, it does not correct hyponatremia as rapidly as administration of hypertonic saline does. Due to hypertonicity, administration may result in phlebitis and tissue necrosis . As such, concentrations greater than 3% NaCl should normally be administered via a central venous catheter , also known as a 'central line'. Such hypertonic saline is normally available in two strengths, the former of which is more commonly administered: 3% NaCl has 513 mEq/L of Na and Cl. 5% NaCl has 856 mEq/L of Na and Cl. Hypertonic NaCl solutions that are less commonly used are 7% (1200 mEq/L) and 23.4% (approx 4000 mEq/L), both of which are used (also via central line), often in conjunction with supplementary diuretics, in the treatment of traumatic brain injury . Other concentrations commonly used include: Half-normal saline (0.45% NaCl), often with "D5" (5% dextrose), contains 77 mEq/L of Na and Cl and 50 g/L dextrose. Quarter-normal saline (0.22% NaCl) has 39 mEq/L of Na and Cl and almost always contains 5% dextrose for osmolality reasons. It can be used alone in neonatal intensive care units. Dextrose (glucose) 4% in 0.18% saline is used sometimes for maintenance replacement.Hypertonic saline—7% NaCl solutions are considered mucoactive agents and thus are used to hydrate thick secretions ( mucus ) in order to make it easier to cough up and out ( expectorate ). 3% hypertonic saline solutions are also used in critical care settings, acutely increased intracranial pressure , or severe hyponatremia . Inhalation of hypertonic saline has also been shown to help in other respiratory problems, specifically bronchiolitis . Hypertonic saline is currently recommended by the Cystic Fibrosis Foundation as a primary part of a cystic fibrosis treatment regimen. An 11% solution of xylitol with 0.65% saline stimulates the washing of the nasopharynx and has an effect on the nasal pathogenic bacteria. This has been used in complementary and alternative medicine. Hypertonic saline may be used in perioperative fluid management protocols to reduce excessive intravenous fluid infusions and lessen pulmonary complications. Hypertonic saline is used in treating hyponatremia and cerebral edema . Rapid correction of hyponatremia via hypertonic saline, or via any saline infusion > 40 mmol/L (Na+ having a valence of 1, 40 mmol/L = 40 mEq/L) greatly increases risk of central pontine myelinolysis (CPM), and so requires constant monitoring of the person's response. Water privation combined with diuretic block does not produce as much risk of CPM as saline administration does; however, it does not correct hyponatremia as rapidly as administration of hypertonic saline does. Due to hypertonicity, administration may result in phlebitis and tissue necrosis . As such, concentrations greater than 3% NaCl should normally be administered via a central venous catheter , also known as a 'central line'. Such hypertonic saline is normally available in two strengths, the former of which is more commonly administered: 3% NaCl has 513 mEq/L of Na and Cl. 5% NaCl has 856 mEq/L of Na and Cl. Hypertonic NaCl solutions that are less commonly used are 7% (1200 mEq/L) and 23.4% (approx 4000 mEq/L), both of which are used (also via central line), often in conjunction with supplementary diuretics, in the treatment of traumatic brain injury . Other concentrations commonly used include: Half-normal saline (0.45% NaCl), often with "D5" (5% dextrose), contains 77 mEq/L of Na and Cl and 50 g/L dextrose. Quarter-normal saline (0.22% NaCl) has 39 mEq/L of Na and Cl and almost always contains 5% dextrose for osmolality reasons. It can be used alone in neonatal intensive care units. Dextrose (glucose) 4% in 0.18% saline is used sometimes for maintenance replacement.In medicine, common types of salines include: 5% dextrose in normal saline ( D5NS ) 10% dextrose in normal saline (D10NS) 5% dextrose in half-normal saline (D5HNS) 10% dextrose in half-normal saline (D10HNS) And in cell biology, in addition to the above the following are used:Saline was believed to have originated during the Indian Blue cholera pandemic that swept across Europe in 1831. William Brooke O'Shaughnessy , a recent graduate of Edinburgh Medical School , proposed in an article to medical journal The Lancet to inject people infected with cholera with highly oxygenated salts to treat the "universal stagnation of the venous system and rapid cessation of arterialisation of the blood" seen in people with severely dehydrated cholera. He found his treatment harmless in dogs, and his proposal was soon adopted by the physician Thomas Latta in treating people with cholera to beneficial effect. In the following decades, variations and alternatives to Latta's solution were tested and used in treating people with cholera. These solutions contained a range of concentrations of sodium, chloride, potassium, carbonate, phosphate, and hydroxide. The breakthrough in achieving physiological concentrations was accomplished by Sydney Ringer in the early 1880s, when he determined the optimal salt concentrations to maintain the contractility of frog heart muscle tissue. Normal saline is considered a descendant of the pre-Ringer solutions, as Ringer's findings were not adopted and widely used until decades later. The term "normal saline" itself appears to have little historical basis, except for studies done in 1882–83 by Dutch physiologist Hartog Jacob Hamburger ; these in vitro studies of red cell lysis suggested incorrectly that 0.9% was the concentration of salt in human blood (rather than 0.6%, the true concentration). Normal saline has become widely used in modern medicine, but due to the mismatch with real blood, other solutions have proved better. The 2018 publication of a randomized, controlled trial with 15,000 people in intensive care units showed that compared to normal saline, lactated Ringer's solution reduced the combined risk of mortality, need for additional dialysis, or persistent kidney problems from 15% to 14%, which given the large number of patients is a significant reduction. Coconut water has been used in place of normal saline in areas without access to normal saline. Its use, however, has not been well studied.

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New York City

New York , often called New York City [lower-alpha 2] or simply NYC , is the most populous city in the United States , located at the southern tip of New York State on one of the world's largest natural harbors . The city comprises five boroughs , each of which is coextensive with a respective county . It is a global city and a cultural , financial , high-tech , entertainment , and media center with a significant influence on commerce, health care , scientific output , life sciences , research, technology, education , politics , tourism , dining , art, fashion , and sports . Home to the headquarters of the United Nations , New York is an important center for international diplomacy , and is sometimes described as the world's most important city and the capital of the world. With an estimated population in 2022 of 8,335,897 distributed over 300.46 square miles (778.2 km 2 ) , the city is the most densely populated major city in the United States. New York has more than double the population of Los Angeles , the nation's second-most populous city. New York is the geographical and demographic center of both the Northeast megalopolis and the New York metropolitan area , the largest metropolitan area in the U.S. by both population and urban area . With more than 20.1 million people in its metropolitan statistical area and 23.5 million in its combined statistical area as of 2020, New York City is one of the world's most populous megacities . The city and its metropolitan area are the premier gateway for legal immigration to the United States . As many as 800 languages are spoken in New York, making it the most linguistically diverse city in the world. In 2021, the city was home to nearly 3.1 million residents born outside the U.S., the largest foreign-born population of any city in the world. New York City traces its origins to Fort Amsterdam and a trading post founded on the southern tip of Manhattan Island by Dutch colonists in approximately 1624. The settlement was named New Amsterdam ( Dutch : Nieuw Amsterdam ) in 1626 and was chartered as a city in 1653. The city came under English control in 1664 and was renamed New York after King Charles II granted the lands to his brother, the Duke of York . The city was temporarily regained by the Dutch in July 1673 and was renamed New Orange; however, the city has been named New York since November 1674. New York City was the capital of the United States from 1785 until 1790. The modern city was formed by the 1898 consolidation of its five boroughs : Manhattan , Brooklyn , Queens , The Bronx , and Staten Island , and has been the largest U.S. city ever since. Anchored by Wall Street in the Financial District of Lower Manhattan , New York City has been called both the world's premier financial and fintech center and the most economically powerful city in the world. As of 2022 [ update ] , the New York metropolitan area is the largest metropolitan economy in the world with a gross metropolitan product of over US$2.16 trillion. If the New York metropolitan area were its own country , it would have the tenth-largest economy in the world. The city is home to the world's two largest stock exchanges by market capitalization of their listed companies: the New York Stock Exchange and Nasdaq . New York City is an established safe haven for global investors. As of 2023 [ update ] , New York City is the most expensive city in the world for expatriates to live. New York City is home to the highest number of billionaires , individuals of ultra-high net worth (greater than US$30 million), and millionaires of any city in the world. In 1664, New York was named in honor of the Duke of York (later King James II of England ). James's elder brother, King Charles II , appointed the Duke as proprietor of the former territory of New Netherland , including the city of New Amsterdam , when the Kingdom of England seized it from Dutch control. In the pre-Columbian era , the area of present-day New York City was inhabited by Algonquians , including the Lenape . Their homeland, known as Lenapehoking , included the present-day areas of Staten Island , Manhattan , the Bronx , the western portion of Long Island (including Brooklyn and Queens ), and the Lower Hudson Valley . The first documented visit into New York Harbor by a European was in 1524 by Giovanni da Verrazzano , an explorer from Florence in the service of the French crown . He claimed the area for France and named it Nouvelle Angoulême (New Angoulême ). A Spanish expedition, led by the Portuguese captain Estêvão Gomes sailing for Emperor Charles V , arrived in New York Harbor in January 1525 and charted the mouth of the Hudson River , which he named Río de San Antonio ('Saint Anthony's River'). In 1609, the English explorer Henry Hudson rediscovered New York Harbor while searching for the Northwest Passage to the Orient for the Dutch East India Company . He proceeded to sail up what the Dutch called North River (now the Hudson River), named first by Hudson as the Mauritius after Maurice, Prince of Orange . Hudson's first mate described the harbor as "a very good Harbour for all windes" and the river as "a mile broad" and "full of fish." Hudson claimed the region for the Dutch East India Company. In 1614, the area between Cape Cod and Delaware Bay was claimed by the Netherlands and called Nieuw-Nederland (' New Netherland '). The first non–Native American inhabitant of what became New York City was Juan Rodriguez , a merchant from Santo Domingo who arrived in Manhattan during the winter of 1613–14, trapping for pelts and trading with the local population as a representative of the Dutch colonists. A permanent European presence near New York Harbor was established in 1624, making New York the 12th-oldest continuously occupied European-established settlement in the continental United States , with the founding of a Dutch fur trading settlement on Governors Island . In 1625, construction was started on a citadel and Fort Amsterdam , later called Nieuw Amsterdam (New Amsterdam), on present-day Manhattan Island. The colony of New Amsterdam was centered on what became Lower Manhattan . Its area extended from the southern tip of Manhattan to modern-day Wall Street , where a 12-foot (3.7 m) wooden stockade was built in 1653 to protect against Native American and English raids. In 1626, the Dutch colonial Director-General Peter Minuit , acting as charged by the Dutch West India Company , purchased the island of Manhattan from the Canarsie , a small Lenape band, for "the value of 60 guilders " (about $900 in 2018). A frequently told but disproved legend claims that Manhattan was purchased for $24 worth of glass beads. Following the purchase, New Amsterdam grew slowly. To attract settlers, the Dutch instituted the patroon system in 1628, whereby wealthy Dutchmen ( patroons , or patrons) who brought 50 colonists to New Netherland would be awarded swaths of land, along with local political autonomy and rights to participate in the lucrative fur trade. This program had little success. Since 1621, the Dutch West India Company had operated as a monopoly in New Netherland, on authority granted by the Dutch States General . In 1639–1640, in an effort to bolster economic growth, the Dutch West India Company relinquished its monopoly over the fur trade, leading to growth in the production and trade of food, timber, tobacco, and slaves (particularly with the Dutch West Indies ). In 1647, Peter Stuyvesant began his tenure as the last Director-General of New Netherland. During his tenure, the population of New Netherland grew from 2,000 to 8,000. Stuyvesant has been credited with improving law and order in the colony; however, he earned a reputation as a despotic leader. He instituted regulations on liquor sales, attempted to assert control over the Dutch Reformed Church , and blocked other religious groups (including Quakers , Jews , and Lutherans ) from establishing houses of worship. The Dutch West India Company attempted to ease tensions between Stuyvesant and residents of New Amsterdam. In 1664, unable to summon any significant resistance, Stuyvesant surrendered New Amsterdam to English troops, led by Colonel Richard Nicolls , without bloodshed. The terms of the surrender permitted Dutch residents to remain in the colony and allowed for religious freedom. In 1667, during negotiations leading to the Treaty of Breda after the Second Anglo-Dutch War , the victorious Dutch decided to keep the nascent plantation colony of what is now Suriname on the northern South American coast, which they had gained from the English; and in return, the English kept New Amsterdam. The fledgling settlement was promptly renamed "New York" after the Duke of York (the future King James II and VII). After the founding, the duke gave part of the colony to proprietors George Carteret and John Berkeley . Fort Orange , 150 miles (240 km) north on the Hudson River, was renamed Albany after James's Scottish title. On August 24, 1673, during the Third Anglo-Dutch War , Anthony Colve of the Dutch navy seized New York from the English at the behest of Cornelis Evertsen the Youngest and rechristened it "New Orange" after William III , the Prince of Orange . The Dutch soon returned the island to England under the Treaty of Westminster of November 1674. Several intertribal wars among the Native Americans and some epidemics brought on by contact with the Europeans caused sizeable population losses for the Lenape between the years 1660 and 1670. By 1700, the Lenape population had diminished to 200. New York experienced several yellow fever epidemics in the 18th century, losing ten percent of its population in 1702 alone. In the early 18th century, New York grew in importance as a trading port while as a part of the colony of New York . It became a center of slavery , with 42% of households enslaving Africans by 1730. Most cases were that of domestic slavery ; others were hired out to work at labor. Slavery became integrally tied to New York's economy through the labor of slaves throughout the port, and the banking and shipping industries trading with the American South . During construction in Foley Square in the 1990s, the African Burying Ground was discovered; the cemetery included 10,000 to 20,000 of graves of colonial-era Africans, some enslaved and some free. The 1735 trial and acquittal in Manhattan of John Peter Zenger , who had been accused of seditious libel after criticizing colonial governor William Cosby , helped to establish freedom of the press in North America . In 1754, Columbia University was founded under charter by King George II as King's College in Lower Manhattan. The Stamp Act Congress met in New York in October 1765, as the Sons of Liberty organization emerged in the city and skirmished over the next ten years with British troops stationed there. The Battle of Long Island , the largest battle of the American Revolutionary War , was fought in August 1776 within the modern-day borough of Brooklyn. A British rout of the Continental Army at the Battle of Fort Washington in November 1776 eliminated the last American stronghold in Manhattan, causing George Washington and his forces to retreat across the Hudson River to New Jersey , pursued by British forces. After the battle, in which the Americans were defeated, the British made the city their military and political base of operations in North America. The city was a haven for Loyalist refugees and escaped slaves who joined the British lines for freedom newly promised by the Crown , with as many as 10,000 escaped slaves crowded into the city during the British occupation, which had become the largest such community on the continent. When the British forces evacuated New York at the close of the war in 1783, they transported thousands of freedmen for resettlement in Nova Scotia , England, and the Caribbean . The attempt at a peaceful solution to the war took place at the Conference House on Staten Island between American delegates, including Benjamin Franklin , and British general Lord Howe on September 11, 1776. Shortly after the British occupation began, the Great Fire of New York occurred, a large conflagration on the West Side of Lower Manhattan, which destroyed nearly 500 buildings, about a quarter of the structures in the city, including Trinity Church . In January 1785, the assembly of the Congress of the Confederation made New York City the national capital, shortly after the war. New York was the last capital of the U.S. under the Articles of Confederation and the first capital under the Constitution of the United States . As the U.S. capital, New York City hosted several events of national scope in 1789; the first President of the United States, George Washington , was inaugurated; the first United States Congress and the Supreme Court of the United States each assembled for the first time; and the United States Bill of Rights was drafted, all at Federal Hall on present-day Wall Street . In 1790, for the first time, New York City surpassed Philadelphia as the nation's largest city. At the end of 1790, the national capital was moved to Philadelphia . During the 19th century, New York City's population grew from 60,000 to 3.43 million. Under New York State's gradual emancipation act of 1799, children of slave mothers were to be eventually liberated but to be held in indentured servitude until their mid-to-late twenties. Together with slaves freed by their masters after the Revolutionary War and escaped slaves, a significant free-Black population gradually developed in Manhattan. Under such influential United States founders as Alexander Hamilton and John Jay , the New York Manumission Society worked for abolition and established the African Free School to educate Black children. It was not until 1827 that slavery was completely abolished in the state . Free Blacks struggled afterward with discrimination and interracial abolitionist activism continued. New York City's population jumped from 123,706 in 1820 (10,886 of whom were Black and of which 518 were enslaved) to 312,710 by 1840 (16,358 of whom were Black). Also in the 19th century, the city was transformed by both commercial and residential development relating to its status as a national and international trading center , as well as by European immigration, respectively. The city adopted the Commissioners' Plan of 1811 , which expanded the city street grid to encompass almost all of Manhattan. The 1825 completion of the Erie Canal through central New York connected the Atlantic port to the agricultural markets and commodities of the North American interior via the Hudson River and the Great Lakes . Local politics became dominated by Tammany Hall , a political machine supported by Irish and German immigrants . Several prominent American literary figures lived in New York during the 1830s and 1840s, including William Cullen Bryant , Washington Irving , Herman Melville , Rufus Wilmot Griswold , John Keese , Nathaniel Parker Willis , and Edgar Allan Poe . Public-minded members of the contemporaneous business elite lobbied for the establishment of Central Park , which in 1857 became the first landscaped park in an American city. The Great Irish Famine brought a large influx of Irish immigrants, of whom more than 200,000 were living in New York by 1860, representing upward of one-quarter of the city's population. There was also extensive immigration from the German provinces, where revolutions had disrupted societies, and Germans comprised another 25% of New York's population by 1860. Democratic Party candidates were consistently elected to local office, increasing the city's ties to the South and its dominant party. In 1861, Mayor Fernando Wood called on the aldermen to declare independence from Albany and the United States after the South seceded, but his proposal was not acted on. Anger at new military conscription laws during the American Civil War (1861–1865), which spared wealthier men who could afford to hire a substitute, led to the Draft Riots of 1863 , whose most visible participants were ethnic Irish working class. The draft riots deteriorated into attacks on New York's elite, followed by attacks on Black New Yorkers and their property after fierce competition for a decade between Irish immigrants and Black people for work. Rioters burned the Colored Orphan Asylum to the ground, with more than 200 children escaping harm due to efforts of the New York Police Department , which was mainly made up of Irish immigrants. At least 120 people were killed. Eleven Black men were lynched over five days, and the riots forced hundreds of Blacks to flee. The Black population in Manhattan fell below 10,000 by 1865. The White working class had established dominance. Violence by longshoremen against Black men was especially fierce in the docks area. It was one of the worst incidents of civil unrest in American history . In 1886, the Statue of Liberty , a gift from France , was dedicated in New York Harbor. The statue welcomed 14 million immigrants as they came to the U.S. via Ellis Island by ship in the late 19th and early 20th centuries, and is a symbol of the United States and American ideals of liberty and peace. In 1898, the City of New York was formed with the consolidation of Brooklyn (until then a separate city), the County of New York (which then included parts of the Bronx), the County of Richmond, and the western portion of the County of Queens. The opening of the New York City Subway in 1904, first built as separate private systems, helped bind the new city together. Throughout the first half of the 20th century, the city became a world center for industry, commerce, and communication. In 1904, the steamship General Slocum caught fire in the East River , killing 1,021 people on board. In 1911, the Triangle Shirtwaist Factory fire , the city's worst industrial disaster, killed 146 garment workers and spurred the growth of the International Ladies' Garment Workers' Union and major improvements in factory safety standards. New York's non-White population was 36,620 in 1890. New York City was a prime destination in the early 20th century for African Americans during the Great Migration from the American South, and by 1916, New York City had become home to the largest urban African diaspora in North America. The Harlem Renaissance of literary and cultural life flourished during the era of Prohibition . The larger economic boom generated construction of skyscrapers competing in height. New York City became the most populous urbanized area in the world in the early 1920s, overtaking London . The metropolitan area surpassed the 10 million mark in the early 1930s, becoming the first megacity in human history. The Great Depression saw the election of reformer Fiorello La Guardia as mayor and the fall of Tammany Hall after eighty years of political dominance. Returning World War II veterans created a post-war economic boom and the development of large housing tracts in eastern Queens and Nassau County . New York emerged from the war unscathed as the leading city of the world, with Wall Street leading America's place as the world's dominant economic power. The United Nations headquarters was completed in 1952, solidifying New York's global geopolitical influence, and the rise of abstract expressionism in the city precipitated New York's displacement of Paris as the center of the art world. In 1969, the Stonewall riots were a series of spontaneous, violent protests by members of the gay community against a police raid that took place in the early morning of June 28, 1969, at the Stonewall Inn in the Greenwich Village neighborhood of Lower Manhattan. They are widely considered to be the single most important event leading to the gay liberation movement and the modern fight for LGBT rights . Wayne R. Dynes , author of the Encyclopedia of Homosexuality , wrote that drag queens were the only " transgender folks around" during the June 1969 Stonewall riots. The transgender community in New York City played a significant role in fighting for LGBT equality during the period of the Stonewall riots and thereafter. In the 1970s, job losses due to industrial restructuring caused New York City to suffer from economic problems and rising crime rates. Growing fiscal deficits in 1975 led the city to appeal to the federal government for financial aid; President Gerald Ford gave a speech denying the request, which was paraphrased on the front page of the next day's issue of the New York Daily News as "FORD TO CITY: DROP DEAD." The Municipal Assistance Corporation was formed and granted oversight authority over the city's finances. While a resurgence in the financial industry greatly improved the city's economic health in the 1980s, New York's crime rate continued to increase through that decade and into the beginning of the 1990s. By the mid-1990s, crime rates started to drop dramatically due to revised police strategies, improving economic opportunities, gentrification , and new residents, both American transplants and new immigrants from Asia and Latin America. [ citation needed ] New York City's population exceeded 8 million for the first time in the 2000 United States census , breaking the previous peak census population set in the 1970 census ; further records were set in 2010 , and 2020 U.S. censuses. Important new sectors, such as Silicon Alley , emerged in the city's economy. The advent of Y2K was celebrated with fanfare in Times Square . New York City suffered the bulk of the economic damage and largest loss of human life in the aftermath of the September 11, 2001 attacks . Two of the four airliners hijacked that day were flown into the twin towers of the World Trade Center, resulting in the collapse of both buildings and the deaths of 2,753 people, including 343 first responders from the New York City Fire Department and 71 law enforcement officers. The North Tower became, and remains, the tallest building to ever be destroyed. [ citation needed ] The area was rebuilt with a new World Trade Center , the National September 11 Memorial and Museum , and other new buildings and infrastructure, including the World Trade Center Transportation Hub , the city's third-largest hub. The new One World Trade Center is the tallest skyscraper in the Western Hemisphere and the seventh-tallest building in the world by pinnacle height, with its spire reaching a symbolic 1,776 feet (541.3 m) , a reference to the year of U.S. independence . The Occupy Wall Street protests in Zuccotti Park in the Financial District of Lower Manhattan began on September 17, 2011, receiving global attention and popularizing the Occupy movement against social and economic inequality worldwide. New York City was heavily affected by Hurricane Sandy in late October 2012. Sandy's impacts included flooding that led to the days-long shutdown of the subway system and flooding of all East River subway tunnels and of all road tunnels entering Manhattan except the Lincoln Tunnel . The New York Stock Exchange closed for two consecutive days due to weather for the first time since the Great Blizzard of 1888 . At least 43 people died in New York City as a result of Sandy, and the economic losses in New York City were estimated to be roughly $19 billion. The disaster spawned long-term efforts towards infrastructural projects to counter climate change and rising seas, with $15 billion in federal funding received through 2022 towards those resiliency efforts. In March 2020, the first case of COVID-19 in the city was confirmed in Manhattan. With its great population density and its exposure to global travelers, the city rapidly replaced Wuhan , China , to become the global epicenter of the pandemic during the early phase, straining the city's healthcare infrastructure. Through March 2023, New York City had recorded more than 80,000 deaths from COVID-19-related complications. In the pre-Columbian era , the area of present-day New York City was inhabited by Algonquians , including the Lenape . Their homeland, known as Lenapehoking , included the present-day areas of Staten Island , Manhattan , the Bronx , the western portion of Long Island (including Brooklyn and Queens ), and the Lower Hudson Valley . The first documented visit into New York Harbor by a European was in 1524 by Giovanni da Verrazzano , an explorer from Florence in the service of the French crown . He claimed the area for France and named it Nouvelle Angoulême (New Angoulême ). A Spanish expedition, led by the Portuguese captain Estêvão Gomes sailing for Emperor Charles V , arrived in New York Harbor in January 1525 and charted the mouth of the Hudson River , which he named Río de San Antonio ('Saint Anthony's River'). In 1609, the English explorer Henry Hudson rediscovered New York Harbor while searching for the Northwest Passage to the Orient for the Dutch East India Company . He proceeded to sail up what the Dutch called North River (now the Hudson River), named first by Hudson as the Mauritius after Maurice, Prince of Orange . Hudson's first mate described the harbor as "a very good Harbour for all windes" and the river as "a mile broad" and "full of fish." Hudson claimed the region for the Dutch East India Company. In 1614, the area between Cape Cod and Delaware Bay was claimed by the Netherlands and called Nieuw-Nederland (' New Netherland '). The first non–Native American inhabitant of what became New York City was Juan Rodriguez , a merchant from Santo Domingo who arrived in Manhattan during the winter of 1613–14, trapping for pelts and trading with the local population as a representative of the Dutch colonists. A permanent European presence near New York Harbor was established in 1624, making New York the 12th-oldest continuously occupied European-established settlement in the continental United States , with the founding of a Dutch fur trading settlement on Governors Island . In 1625, construction was started on a citadel and Fort Amsterdam , later called Nieuw Amsterdam (New Amsterdam), on present-day Manhattan Island. The colony of New Amsterdam was centered on what became Lower Manhattan . Its area extended from the southern tip of Manhattan to modern-day Wall Street , where a 12-foot (3.7 m) wooden stockade was built in 1653 to protect against Native American and English raids. In 1626, the Dutch colonial Director-General Peter Minuit , acting as charged by the Dutch West India Company , purchased the island of Manhattan from the Canarsie , a small Lenape band, for "the value of 60 guilders " (about $900 in 2018). A frequently told but disproved legend claims that Manhattan was purchased for $24 worth of glass beads. Following the purchase, New Amsterdam grew slowly. To attract settlers, the Dutch instituted the patroon system in 1628, whereby wealthy Dutchmen ( patroons , or patrons) who brought 50 colonists to New Netherland would be awarded swaths of land, along with local political autonomy and rights to participate in the lucrative fur trade. This program had little success. Since 1621, the Dutch West India Company had operated as a monopoly in New Netherland, on authority granted by the Dutch States General . In 1639–1640, in an effort to bolster economic growth, the Dutch West India Company relinquished its monopoly over the fur trade, leading to growth in the production and trade of food, timber, tobacco, and slaves (particularly with the Dutch West Indies ). In 1647, Peter Stuyvesant began his tenure as the last Director-General of New Netherland. During his tenure, the population of New Netherland grew from 2,000 to 8,000. Stuyvesant has been credited with improving law and order in the colony; however, he earned a reputation as a despotic leader. He instituted regulations on liquor sales, attempted to assert control over the Dutch Reformed Church , and blocked other religious groups (including Quakers , Jews , and Lutherans ) from establishing houses of worship. The Dutch West India Company attempted to ease tensions between Stuyvesant and residents of New Amsterdam. In 1664, unable to summon any significant resistance, Stuyvesant surrendered New Amsterdam to English troops, led by Colonel Richard Nicolls , without bloodshed. The terms of the surrender permitted Dutch residents to remain in the colony and allowed for religious freedom. In 1667, during negotiations leading to the Treaty of Breda after the Second Anglo-Dutch War , the victorious Dutch decided to keep the nascent plantation colony of what is now Suriname on the northern South American coast, which they had gained from the English; and in return, the English kept New Amsterdam. The fledgling settlement was promptly renamed "New York" after the Duke of York (the future King James II and VII). After the founding, the duke gave part of the colony to proprietors George Carteret and John Berkeley . Fort Orange , 150 miles (240 km) north on the Hudson River, was renamed Albany after James's Scottish title. On August 24, 1673, during the Third Anglo-Dutch War , Anthony Colve of the Dutch navy seized New York from the English at the behest of Cornelis Evertsen the Youngest and rechristened it "New Orange" after William III , the Prince of Orange . The Dutch soon returned the island to England under the Treaty of Westminster of November 1674. Several intertribal wars among the Native Americans and some epidemics brought on by contact with the Europeans caused sizeable population losses for the Lenape between the years 1660 and 1670. By 1700, the Lenape population had diminished to 200. New York experienced several yellow fever epidemics in the 18th century, losing ten percent of its population in 1702 alone. In the early 18th century, New York grew in importance as a trading port while as a part of the colony of New York . It became a center of slavery , with 42% of households enslaving Africans by 1730. Most cases were that of domestic slavery ; others were hired out to work at labor. Slavery became integrally tied to New York's economy through the labor of slaves throughout the port, and the banking and shipping industries trading with the American South . During construction in Foley Square in the 1990s, the African Burying Ground was discovered; the cemetery included 10,000 to 20,000 of graves of colonial-era Africans, some enslaved and some free. The 1735 trial and acquittal in Manhattan of John Peter Zenger , who had been accused of seditious libel after criticizing colonial governor William Cosby , helped to establish freedom of the press in North America . In 1754, Columbia University was founded under charter by King George II as King's College in Lower Manhattan. The Stamp Act Congress met in New York in October 1765, as the Sons of Liberty organization emerged in the city and skirmished over the next ten years with British troops stationed there. The Battle of Long Island , the largest battle of the American Revolutionary War , was fought in August 1776 within the modern-day borough of Brooklyn. A British rout of the Continental Army at the Battle of Fort Washington in November 1776 eliminated the last American stronghold in Manhattan, causing George Washington and his forces to retreat across the Hudson River to New Jersey , pursued by British forces. After the battle, in which the Americans were defeated, the British made the city their military and political base of operations in North America. The city was a haven for Loyalist refugees and escaped slaves who joined the British lines for freedom newly promised by the Crown , with as many as 10,000 escaped slaves crowded into the city during the British occupation, which had become the largest such community on the continent. When the British forces evacuated New York at the close of the war in 1783, they transported thousands of freedmen for resettlement in Nova Scotia , England, and the Caribbean . The attempt at a peaceful solution to the war took place at the Conference House on Staten Island between American delegates, including Benjamin Franklin , and British general Lord Howe on September 11, 1776. Shortly after the British occupation began, the Great Fire of New York occurred, a large conflagration on the West Side of Lower Manhattan, which destroyed nearly 500 buildings, about a quarter of the structures in the city, including Trinity Church . In January 1785, the assembly of the Congress of the Confederation made New York City the national capital, shortly after the war. New York was the last capital of the U.S. under the Articles of Confederation and the first capital under the Constitution of the United States . As the U.S. capital, New York City hosted several events of national scope in 1789; the first President of the United States, George Washington , was inaugurated; the first United States Congress and the Supreme Court of the United States each assembled for the first time; and the United States Bill of Rights was drafted, all at Federal Hall on present-day Wall Street . In 1790, for the first time, New York City surpassed Philadelphia as the nation's largest city. At the end of 1790, the national capital was moved to Philadelphia . During the 19th century, New York City's population grew from 60,000 to 3.43 million. Under New York State's gradual emancipation act of 1799, children of slave mothers were to be eventually liberated but to be held in indentured servitude until their mid-to-late twenties. Together with slaves freed by their masters after the Revolutionary War and escaped slaves, a significant free-Black population gradually developed in Manhattan. Under such influential United States founders as Alexander Hamilton and John Jay , the New York Manumission Society worked for abolition and established the African Free School to educate Black children. It was not until 1827 that slavery was completely abolished in the state . Free Blacks struggled afterward with discrimination and interracial abolitionist activism continued. New York City's population jumped from 123,706 in 1820 (10,886 of whom were Black and of which 518 were enslaved) to 312,710 by 1840 (16,358 of whom were Black). Also in the 19th century, the city was transformed by both commercial and residential development relating to its status as a national and international trading center , as well as by European immigration, respectively. The city adopted the Commissioners' Plan of 1811 , which expanded the city street grid to encompass almost all of Manhattan. The 1825 completion of the Erie Canal through central New York connected the Atlantic port to the agricultural markets and commodities of the North American interior via the Hudson River and the Great Lakes . Local politics became dominated by Tammany Hall , a political machine supported by Irish and German immigrants . Several prominent American literary figures lived in New York during the 1830s and 1840s, including William Cullen Bryant , Washington Irving , Herman Melville , Rufus Wilmot Griswold , John Keese , Nathaniel Parker Willis , and Edgar Allan Poe . Public-minded members of the contemporaneous business elite lobbied for the establishment of Central Park , which in 1857 became the first landscaped park in an American city. The Great Irish Famine brought a large influx of Irish immigrants, of whom more than 200,000 were living in New York by 1860, representing upward of one-quarter of the city's population. There was also extensive immigration from the German provinces, where revolutions had disrupted societies, and Germans comprised another 25% of New York's population by 1860. Democratic Party candidates were consistently elected to local office, increasing the city's ties to the South and its dominant party. In 1861, Mayor Fernando Wood called on the aldermen to declare independence from Albany and the United States after the South seceded, but his proposal was not acted on. Anger at new military conscription laws during the American Civil War (1861–1865), which spared wealthier men who could afford to hire a substitute, led to the Draft Riots of 1863 , whose most visible participants were ethnic Irish working class. The draft riots deteriorated into attacks on New York's elite, followed by attacks on Black New Yorkers and their property after fierce competition for a decade between Irish immigrants and Black people for work. Rioters burned the Colored Orphan Asylum to the ground, with more than 200 children escaping harm due to efforts of the New York Police Department , which was mainly made up of Irish immigrants. At least 120 people were killed. Eleven Black men were lynched over five days, and the riots forced hundreds of Blacks to flee. The Black population in Manhattan fell below 10,000 by 1865. The White working class had established dominance. Violence by longshoremen against Black men was especially fierce in the docks area. It was one of the worst incidents of civil unrest in American history . In 1886, the Statue of Liberty , a gift from France , was dedicated in New York Harbor. The statue welcomed 14 million immigrants as they came to the U.S. via Ellis Island by ship in the late 19th and early 20th centuries, and is a symbol of the United States and American ideals of liberty and peace. In 1898, the City of New York was formed with the consolidation of Brooklyn (until then a separate city), the County of New York (which then included parts of the Bronx), the County of Richmond, and the western portion of the County of Queens. The opening of the New York City Subway in 1904, first built as separate private systems, helped bind the new city together. Throughout the first half of the 20th century, the city became a world center for industry, commerce, and communication. In 1904, the steamship General Slocum caught fire in the East River , killing 1,021 people on board. In 1911, the Triangle Shirtwaist Factory fire , the city's worst industrial disaster, killed 146 garment workers and spurred the growth of the International Ladies' Garment Workers' Union and major improvements in factory safety standards. New York's non-White population was 36,620 in 1890. New York City was a prime destination in the early 20th century for African Americans during the Great Migration from the American South, and by 1916, New York City had become home to the largest urban African diaspora in North America. The Harlem Renaissance of literary and cultural life flourished during the era of Prohibition . The larger economic boom generated construction of skyscrapers competing in height. New York City became the most populous urbanized area in the world in the early 1920s, overtaking London . The metropolitan area surpassed the 10 million mark in the early 1930s, becoming the first megacity in human history. The Great Depression saw the election of reformer Fiorello La Guardia as mayor and the fall of Tammany Hall after eighty years of political dominance. Returning World War II veterans created a post-war economic boom and the development of large housing tracts in eastern Queens and Nassau County . New York emerged from the war unscathed as the leading city of the world, with Wall Street leading America's place as the world's dominant economic power. The United Nations headquarters was completed in 1952, solidifying New York's global geopolitical influence, and the rise of abstract expressionism in the city precipitated New York's displacement of Paris as the center of the art world. In 1969, the Stonewall riots were a series of spontaneous, violent protests by members of the gay community against a police raid that took place in the early morning of June 28, 1969, at the Stonewall Inn in the Greenwich Village neighborhood of Lower Manhattan. They are widely considered to be the single most important event leading to the gay liberation movement and the modern fight for LGBT rights . Wayne R. Dynes , author of the Encyclopedia of Homosexuality , wrote that drag queens were the only " transgender folks around" during the June 1969 Stonewall riots. The transgender community in New York City played a significant role in fighting for LGBT equality during the period of the Stonewall riots and thereafter. In the 1970s, job losses due to industrial restructuring caused New York City to suffer from economic problems and rising crime rates. Growing fiscal deficits in 1975 led the city to appeal to the federal government for financial aid; President Gerald Ford gave a speech denying the request, which was paraphrased on the front page of the next day's issue of the New York Daily News as "FORD TO CITY: DROP DEAD." The Municipal Assistance Corporation was formed and granted oversight authority over the city's finances. While a resurgence in the financial industry greatly improved the city's economic health in the 1980s, New York's crime rate continued to increase through that decade and into the beginning of the 1990s. By the mid-1990s, crime rates started to drop dramatically due to revised police strategies, improving economic opportunities, gentrification , and new residents, both American transplants and new immigrants from Asia and Latin America. [ citation needed ] New York City's population exceeded 8 million for the first time in the 2000 United States census , breaking the previous peak census population set in the 1970 census ; further records were set in 2010 , and 2020 U.S. censuses. Important new sectors, such as Silicon Alley , emerged in the city's economy. The advent of Y2K was celebrated with fanfare in Times Square . New York City suffered the bulk of the economic damage and largest loss of human life in the aftermath of the September 11, 2001 attacks . Two of the four airliners hijacked that day were flown into the twin towers of the World Trade Center, resulting in the collapse of both buildings and the deaths of 2,753 people, including 343 first responders from the New York City Fire Department and 71 law enforcement officers. The North Tower became, and remains, the tallest building to ever be destroyed. [ citation needed ] The area was rebuilt with a new World Trade Center , the National September 11 Memorial and Museum , and other new buildings and infrastructure, including the World Trade Center Transportation Hub , the city's third-largest hub. The new One World Trade Center is the tallest skyscraper in the Western Hemisphere and the seventh-tallest building in the world by pinnacle height, with its spire reaching a symbolic 1,776 feet (541.3 m) , a reference to the year of U.S. independence . The Occupy Wall Street protests in Zuccotti Park in the Financial District of Lower Manhattan began on September 17, 2011, receiving global attention and popularizing the Occupy movement against social and economic inequality worldwide. New York City was heavily affected by Hurricane Sandy in late October 2012. Sandy's impacts included flooding that led to the days-long shutdown of the subway system and flooding of all East River subway tunnels and of all road tunnels entering Manhattan except the Lincoln Tunnel . The New York Stock Exchange closed for two consecutive days due to weather for the first time since the Great Blizzard of 1888 . At least 43 people died in New York City as a result of Sandy, and the economic losses in New York City were estimated to be roughly $19 billion. The disaster spawned long-term efforts towards infrastructural projects to counter climate change and rising seas, with $15 billion in federal funding received through 2022 towards those resiliency efforts. In March 2020, the first case of COVID-19 in the city was confirmed in Manhattan. With its great population density and its exposure to global travelers, the city rapidly replaced Wuhan , China , to become the global epicenter of the pandemic during the early phase, straining the city's healthcare infrastructure. Through March 2023, New York City had recorded more than 80,000 deaths from COVID-19-related complications. New York City is situated in the northeastern United States , in southeastern New York State, approximately halfway between Washington, D.C. and Boston . Its location at the mouth of the Hudson River, which feeds into a naturally sheltered harbor and then into the Atlantic Ocean, has helped the city grow in significance as a trading port. Most of the city is built on the three islands of Long Island, Manhattan, and Staten Island. During the Wisconsin glaciation , 75,000 to 11,000 years ago, the New York City area was situated at the edge of a large ice sheet . The erosive forward movement of the ice (and its subsequent retreat) contributed to the separation of what is now Long Island and Staten Island. That action left bedrock at a relatively shallow depth, providing a solid foundation for most of Manhattan's skyscrapers. The Hudson River flows through the Hudson Valley into New York Bay . Between New York City and Troy, New York , the river is an estuary . The Hudson River separates the city from the New Jersey. The East River—a tidal strait —flows from Long Island Sound and separates the Bronx and Manhattan from Long Island. The Harlem River , another tidal strait between the East and Hudson rivers, separates most of Manhattan from the Bronx. The Bronx River , which flows through the Bronx and Westchester County , is the only entirely freshwater river in the city. [ importance? ] The city's land has been altered substantially by human intervention, with considerable land reclamation along the waterfronts since Dutch colonial times; reclamation is most prominent in Lower Manhattan, with developments such as Battery Park City in the 1970s and 1980s. Some of the natural relief in topography has been evened out, especially in Manhattan. The city's total area is 468.484 square miles (1,213.37 km 2 ) . 302.643 sq mi (783.84 km 2 ) of the city is land and 165.841 sq mi (429.53 km 2 ) of it is water. The highest point in the city is Todt Hill on Staten Island, which, at 409.8 feet (124.9 m) above sea level , is the highest point on the eastern seaboard south of Maine . The summit of the ridge is mostly covered in woodlands as part of the Staten Island Greenbelt . New York City is sometimes referred to collectively as the Five Boroughs . Each borough is coextensive with a respective county of New York State, making New York City one of the U.S. municipalities in multiple counties . Manhattan (New York County) is the geographically smallest and most densely populated borough. It is home to Central Park and most of the city's skyscrapers , and is sometimes locally known as The City . Manhattan's population density of 70,450.8 inhabitants per square mile (27,201.2/km 2 ) in 2022 makes it the highest of any county in the United States and higher than the density of any individual American city . Manhattan is the cultural, administrative, and financial center of New York City and contains the headquarters of many major multinational corporations , the United Nations headquarters , Wall Street, and a number of important universities. The borough is often described as the financial and cultural center of the world. Brooklyn (Kings County), on the western tip of Long Island , is the city's most populous borough. Brooklyn is known for its cultural, social, and ethnic diversity, an independent art scene, distinct neighborhoods , and a distinctive architectural heritage. Downtown Brooklyn is the largest central core neighborhood in the Outer Boroughs. The borough has a long beachfront shoreline including Coney Island , established in the 1870s as one of the earliest amusement grounds in the U.S. Marine Park and Prospect Park are the two largest parks in Brooklyn. Since 2010, Brooklyn has evolved into a thriving hub of entrepreneurship and high technology startup firms , and of postmodern art and design. Brooklyn is also home to Fort Hamilton , the U.S. military's only active duty installation within New York City, aside from Coast Guard operations. The facility was established in 1825 on the site of a battery used during the American Revolution , and it is one of America's longest-serving military forts. Queens (Queens County), on Long Island north and east of Brooklyn, is geographically the largest borough, the most ethnically diverse county in the United States, and the most ethnically diverse urban area in the world. Queens is the site of the Citi Field , home of the New York Mets , and hosts the annual U.S. Open tennis tournament at the USTA Billie Jean King National Tennis Center in Flushing Meadows–Corona Park , with plans to build a soccer-specific stadium to be built for New York City FC . Additionally, two of the three busiest airports serving the New York metropolitan area, John F. Kennedy International Airport and LaGuardia Airport , are in Queens. The Bronx (Bronx County) is both New York City's northernmost borough and the only one that is mostly on the U.S. mainland . It is the location of Yankee Stadium , the baseball park of the New York Yankees , and home to the largest cooperatively-owned housing complex in the United States, Co-op City . It is home to the Bronx Zoo , the world's largest metropolitan zoo, which spans 265 acres (1.07 km 2 ) and houses more than 6,000 animals. The Bronx is the birthplace of hip hop music and its associated culture . Pelham Bay Park is the largest park in New York City, at 2,772 acres (1,122 ha) . Staten Island (Richmond County) is the most suburban in character of the five boroughs. It is connected to Brooklyn by the Verrazzano-Narrows Bridge , and to Manhattan by way of the free Staten Island Ferry . In central Staten Island, the Staten Island Greenbelt spans approximately 2,500 acres (10 km 2 ) , including 28 miles (45 km) of walking trails and one of the last undisturbed forests in the city. Designated in 1984 to protect the island's natural lands, the Greenbelt comprises seven city parks. Under the Köppen climate classification , New York City has a humid subtropical climate (Cfa), and is the northernmost major city on the North American continent with this categorization. The suburbs to the immediate north and west are in the transitional zone between humid subtropical and humid continental climates (Dfa). The city receives an average of 49.5 inches (1,260 mm) of precipitation annually, which is relatively evenly spread throughout the year. New York averages over 2,500 hours of sunshine annually. Winters are chilly and damp, and prevailing wind patterns that blow sea breezes offshore temper the moderating effects of the Atlantic Ocean; yet the Atlantic and the partial shielding from colder air by the Appalachian Mountains keep the city warmer in the winter than inland North American cities at similar or lesser latitudes. The daily mean temperature in January, the area's coldest month, is 33.3 °F (0.7 °C) . Temperatures usually drop to 10 °F (−12 °C) several times per winter, yet can also reach 60 °F (16 °C) for several days even in the coldest winter month. Spring and autumn are unpredictable and can range from cool to warm, although they are usually mild with low humidity. Summers are typically hot and humid, with a daily mean temperature of 77.5 °F (25.3 °C) in July. Nighttime temperatures are 9.5 °F (5.3 °C) degrees higher for the average city resident due to the urban heat island effect, caused by paved streets and tall buildings. Daytime temperatures exceed 90 °F (32 °C) on average of 17 days each summer and in some years exceed 100 °F (38 °C) , although this is a rare occurrence, last noted on July 18, 2012. Similarly, readings of 0 °F (−18 °C) are extremely rare, last occurring on February 14, 2016. Extreme temperatures have ranged from 106 °F (41 °C) , recorded on July 9, 1936, down to −15 °F (−26 °C) on February 9, 1934; the coldest recorded wind chill was −37 °F (−38 °C) on the same day as the all-time record low. Average winter snowfall between 1991 and 2020 was 29.8 inches (76 cm) ; this varies considerably between years. The record cold daily maximum was 2 °F (−17 °C) on December 30, 1917, while, conversely, the record warm daily minimum was 87 °F (31 °C) , on July 2, 1903. The average water temperature of the nearby Atlantic Ocean ranges from 39.7 °F (4.3 °C) in February to 74.1 °F (23.4 °C) in August. Hurricanes and tropical storms are rare in the New York area. Hurricane Sandy brought a destructive storm surge to New York City on the evening of October 29, 2012, flooding numerous streets, tunnels, and subway lines in Lower Manhattan and other areas of the city and cutting off electricity in many parts of the city and its suburbs. The storm and its profound impacts have prompted the discussion of constructing seawalls and other coastal barriers around the shorelines of the city and the metropolitan area to minimize the risk of destructive consequences from another such event in the future. See Climate of New York City for additional climate information from the outer boroughs. The city of New York has a complex park system, with various lands operated by the National Park Service , the New York State Office of Parks, Recreation and Historic Preservation , and the New York City Department of Parks and Recreation . In its 2023 ParkScore ranking, the Trust for Public Land reported that the park system in New York City was the tenth-best park system among the most populous U.S. cities, citing the city's park acreage, investment in parks and that 99% of residents are within 1 ⁄ 2 mile (0.80 km) of a park. Gateway National Recreation Area contains over 26,000 acres (110 km 2 ) , most of it in New York City. In Brooklyn and Queens, the park contains over 9,000 acres (36 km 2 ) of salt marsh , wetlands , islands, and water, including most of Jamaica Bay and the Jamaica Bay Wildlife Refuge . Also in Queens, the park includes a significant portion of the western Rockaway Peninsula , most notably Jacob Riis Park and Fort Tilden . In Staten Island, it includes Fort Wadsworth , with historic pre-Civil War era Battery Weed and Fort Tompkins , and Great Kills Park . The Statue of Liberty National Monument and Ellis Island Immigration Museum are managed by the National Park Service and are in both New York and New Jersey. They are joined in the harbor by Governors Island National Monument . Historic sites under federal management on Manhattan Island include Stonewall National Monument ; Castle Clinton National Monument ; Federal Hall National Memorial; Theodore Roosevelt Birthplace National Historic Site ; General Grant National Memorial (Grant's Tomb); African Burial Ground National Monument ; and Hamilton Grange National Memorial . Hundreds of properties are listed on the National Register of Historic Places or as a National Historic Landmark . There are seven state parks within the confines of New York City. They include: the Clay Pit Ponds State Park Preserve , a natural area that includes extensive riding trails ; the Riverbank State Park , a 28-acre (11 ha) facility; and the Marsha P. Johnson State Park , a state park in Brooklyn and Manhattan that borders the East River renamed in honor of Marsha P. Johnson . New York City has over 28,000 acres (110 km 2 ) of municipal parkland and 14 miles (23 km) of public beaches. The largest municipal park in the city is Pelham Bay Park in the Bronx, with 2,772 acres (1,122 ha) , and the most visited urban park is the Central Park, and one of the most filmed and visited locations in the world, with 42 million visitors in 2023. Environmental issues in New York City are affected by the city's size, density, abundant public transportation infrastructure , and its location at the mouth of the Hudson River. For example, it is one of the country's biggest sources of pollution and has the lowest per-capita greenhouse gas emissions rate and electricity usage. Governors Island is planned to host a US$1 billion research and education center to make New York City the global leader in addressing the climate crisis . As an oceanic port city, New York City is vulnerable to long-term manifestations of global warming like sea level rise exacerbated by land subsidence . Climate change has spawned the development of a significant climate resiliency and environmental sustainability economy in the city. New York City has focused on reducing its environmental impact and carbon footprint . Mass transit use is the highest in the United States. New York's high rate of public transit use , more than 610,000 daily cycling trips as of 2022 [ update ] , and many pedestrian commuters make it the most energy-efficient major city in the United States. Walk and bicycle modes of travel account for 21% of all modes for trips in the city; nationally, the rate for metro regions is about 8%. In both its 2011 and 2015 rankings, Walk Score named New York City the most walkable large city in the United States, and in 2018, Stacker ranked New York the most walkable U.S. city. Citibank sponsored public bicycles for the city's bike-share project, which became known as Citi Bike , in 2013. New York City's numerical "in-season cycling indicator" of bicycling in the city had hit an all-time high of 437 when measured in 2014. The New York City drinking water supply is extracted from the protected Catskill Mountains watershed. As a result of the watershed's integrity and undisturbed natural water filtration system, New York is one of only four major cities in the United States the majority of whose drinking water is pure enough not to require purification through water treatment plants. The city's municipal water system is the largest in the United States, moving more than 1 billion U.S. gallons (3.8 billion liters) of water daily from a watershed covering 1,900 square miles (4,900 km 2 ) According to the 2016 World Health Organization Global Urban Ambient Air Pollution Database, the annual average concentration in New York City's air of particulate matter measuring 2.5 micrometers or less (PM 2.5 ) was 7.0 micrograms per cubic meter, or 3.0 micrograms within the recommended limit of the WHO Air Quality Guidelines for the annual mean PM 2.5 . The New York City Department of Health and Mental Hygiene , in partnership with Queens College , conducts the New York Community Air Survey to measure pollutants at about 150 locations. New York City is sometimes referred to collectively as the Five Boroughs . Each borough is coextensive with a respective county of New York State, making New York City one of the U.S. municipalities in multiple counties . Manhattan (New York County) is the geographically smallest and most densely populated borough. It is home to Central Park and most of the city's skyscrapers , and is sometimes locally known as The City . Manhattan's population density of 70,450.8 inhabitants per square mile (27,201.2/km 2 ) in 2022 makes it the highest of any county in the United States and higher than the density of any individual American city . Manhattan is the cultural, administrative, and financial center of New York City and contains the headquarters of many major multinational corporations , the United Nations headquarters , Wall Street, and a number of important universities. The borough is often described as the financial and cultural center of the world. Brooklyn (Kings County), on the western tip of Long Island , is the city's most populous borough. Brooklyn is known for its cultural, social, and ethnic diversity, an independent art scene, distinct neighborhoods , and a distinctive architectural heritage. Downtown Brooklyn is the largest central core neighborhood in the Outer Boroughs. The borough has a long beachfront shoreline including Coney Island , established in the 1870s as one of the earliest amusement grounds in the U.S. Marine Park and Prospect Park are the two largest parks in Brooklyn. Since 2010, Brooklyn has evolved into a thriving hub of entrepreneurship and high technology startup firms , and of postmodern art and design. Brooklyn is also home to Fort Hamilton , the U.S. military's only active duty installation within New York City, aside from Coast Guard operations. The facility was established in 1825 on the site of a battery used during the American Revolution , and it is one of America's longest-serving military forts. Queens (Queens County), on Long Island north and east of Brooklyn, is geographically the largest borough, the most ethnically diverse county in the United States, and the most ethnically diverse urban area in the world. Queens is the site of the Citi Field , home of the New York Mets , and hosts the annual U.S. Open tennis tournament at the USTA Billie Jean King National Tennis Center in Flushing Meadows–Corona Park , with plans to build a soccer-specific stadium to be built for New York City FC . Additionally, two of the three busiest airports serving the New York metropolitan area, John F. Kennedy International Airport and LaGuardia Airport , are in Queens. The Bronx (Bronx County) is both New York City's northernmost borough and the only one that is mostly on the U.S. mainland . It is the location of Yankee Stadium , the baseball park of the New York Yankees , and home to the largest cooperatively-owned housing complex in the United States, Co-op City . It is home to the Bronx Zoo , the world's largest metropolitan zoo, which spans 265 acres (1.07 km 2 ) and houses more than 6,000 animals. The Bronx is the birthplace of hip hop music and its associated culture . Pelham Bay Park is the largest park in New York City, at 2,772 acres (1,122 ha) . Staten Island (Richmond County) is the most suburban in character of the five boroughs. It is connected to Brooklyn by the Verrazzano-Narrows Bridge , and to Manhattan by way of the free Staten Island Ferry . In central Staten Island, the Staten Island Greenbelt spans approximately 2,500 acres (10 km 2 ) , including 28 miles (45 km) of walking trails and one of the last undisturbed forests in the city. Designated in 1984 to protect the island's natural lands, the Greenbelt comprises seven city parks.Under the Köppen climate classification , New York City has a humid subtropical climate (Cfa), and is the northernmost major city on the North American continent with this categorization. The suburbs to the immediate north and west are in the transitional zone between humid subtropical and humid continental climates (Dfa). The city receives an average of 49.5 inches (1,260 mm) of precipitation annually, which is relatively evenly spread throughout the year. New York averages over 2,500 hours of sunshine annually. Winters are chilly and damp, and prevailing wind patterns that blow sea breezes offshore temper the moderating effects of the Atlantic Ocean; yet the Atlantic and the partial shielding from colder air by the Appalachian Mountains keep the city warmer in the winter than inland North American cities at similar or lesser latitudes. The daily mean temperature in January, the area's coldest month, is 33.3 °F (0.7 °C) . Temperatures usually drop to 10 °F (−12 °C) several times per winter, yet can also reach 60 °F (16 °C) for several days even in the coldest winter month. Spring and autumn are unpredictable and can range from cool to warm, although they are usually mild with low humidity. Summers are typically hot and humid, with a daily mean temperature of 77.5 °F (25.3 °C) in July. Nighttime temperatures are 9.5 °F (5.3 °C) degrees higher for the average city resident due to the urban heat island effect, caused by paved streets and tall buildings. Daytime temperatures exceed 90 °F (32 °C) on average of 17 days each summer and in some years exceed 100 °F (38 °C) , although this is a rare occurrence, last noted on July 18, 2012. Similarly, readings of 0 °F (−18 °C) are extremely rare, last occurring on February 14, 2016. Extreme temperatures have ranged from 106 °F (41 °C) , recorded on July 9, 1936, down to −15 °F (−26 °C) on February 9, 1934; the coldest recorded wind chill was −37 °F (−38 °C) on the same day as the all-time record low. Average winter snowfall between 1991 and 2020 was 29.8 inches (76 cm) ; this varies considerably between years. The record cold daily maximum was 2 °F (−17 °C) on December 30, 1917, while, conversely, the record warm daily minimum was 87 °F (31 °C) , on July 2, 1903. The average water temperature of the nearby Atlantic Ocean ranges from 39.7 °F (4.3 °C) in February to 74.1 °F (23.4 °C) in August. Hurricanes and tropical storms are rare in the New York area. Hurricane Sandy brought a destructive storm surge to New York City on the evening of October 29, 2012, flooding numerous streets, tunnels, and subway lines in Lower Manhattan and other areas of the city and cutting off electricity in many parts of the city and its suburbs. The storm and its profound impacts have prompted the discussion of constructing seawalls and other coastal barriers around the shorelines of the city and the metropolitan area to minimize the risk of destructive consequences from another such event in the future. See Climate of New York City for additional climate information from the outer boroughs.The city of New York has a complex park system, with various lands operated by the National Park Service , the New York State Office of Parks, Recreation and Historic Preservation , and the New York City Department of Parks and Recreation . In its 2023 ParkScore ranking, the Trust for Public Land reported that the park system in New York City was the tenth-best park system among the most populous U.S. cities, citing the city's park acreage, investment in parks and that 99% of residents are within 1 ⁄ 2 mile (0.80 km) of a park. Gateway National Recreation Area contains over 26,000 acres (110 km 2 ) , most of it in New York City. In Brooklyn and Queens, the park contains over 9,000 acres (36 km 2 ) of salt marsh , wetlands , islands, and water, including most of Jamaica Bay and the Jamaica Bay Wildlife Refuge . Also in Queens, the park includes a significant portion of the western Rockaway Peninsula , most notably Jacob Riis Park and Fort Tilden . In Staten Island, it includes Fort Wadsworth , with historic pre-Civil War era Battery Weed and Fort Tompkins , and Great Kills Park . The Statue of Liberty National Monument and Ellis Island Immigration Museum are managed by the National Park Service and are in both New York and New Jersey. They are joined in the harbor by Governors Island National Monument . Historic sites under federal management on Manhattan Island include Stonewall National Monument ; Castle Clinton National Monument ; Federal Hall National Memorial; Theodore Roosevelt Birthplace National Historic Site ; General Grant National Memorial (Grant's Tomb); African Burial Ground National Monument ; and Hamilton Grange National Memorial . Hundreds of properties are listed on the National Register of Historic Places or as a National Historic Landmark . There are seven state parks within the confines of New York City. They include: the Clay Pit Ponds State Park Preserve , a natural area that includes extensive riding trails ; the Riverbank State Park , a 28-acre (11 ha) facility; and the Marsha P. Johnson State Park , a state park in Brooklyn and Manhattan that borders the East River renamed in honor of Marsha P. Johnson . New York City has over 28,000 acres (110 km 2 ) of municipal parkland and 14 miles (23 km) of public beaches. The largest municipal park in the city is Pelham Bay Park in the Bronx, with 2,772 acres (1,122 ha) , and the most visited urban park is the Central Park, and one of the most filmed and visited locations in the world, with 42 million visitors in 2023. Environmental issues in New York City are affected by the city's size, density, abundant public transportation infrastructure , and its location at the mouth of the Hudson River. For example, it is one of the country's biggest sources of pollution and has the lowest per-capita greenhouse gas emissions rate and electricity usage. Governors Island is planned to host a US$1 billion research and education center to make New York City the global leader in addressing the climate crisis . As an oceanic port city, New York City is vulnerable to long-term manifestations of global warming like sea level rise exacerbated by land subsidence . Climate change has spawned the development of a significant climate resiliency and environmental sustainability economy in the city. New York City has focused on reducing its environmental impact and carbon footprint . Mass transit use is the highest in the United States. New York's high rate of public transit use , more than 610,000 daily cycling trips as of 2022 [ update ] , and many pedestrian commuters make it the most energy-efficient major city in the United States. Walk and bicycle modes of travel account for 21% of all modes for trips in the city; nationally, the rate for metro regions is about 8%. In both its 2011 and 2015 rankings, Walk Score named New York City the most walkable large city in the United States, and in 2018, Stacker ranked New York the most walkable U.S. city. Citibank sponsored public bicycles for the city's bike-share project, which became known as Citi Bike , in 2013. New York City's numerical "in-season cycling indicator" of bicycling in the city had hit an all-time high of 437 when measured in 2014. The New York City drinking water supply is extracted from the protected Catskill Mountains watershed. As a result of the watershed's integrity and undisturbed natural water filtration system, New York is one of only four major cities in the United States the majority of whose drinking water is pure enough not to require purification through water treatment plants. The city's municipal water system is the largest in the United States, moving more than 1 billion U.S. gallons (3.8 billion liters) of water daily from a watershed covering 1,900 square miles (4,900 km 2 ) According to the 2016 World Health Organization Global Urban Ambient Air Pollution Database, the annual average concentration in New York City's air of particulate matter measuring 2.5 micrometers or less (PM 2.5 ) was 7.0 micrograms per cubic meter, or 3.0 micrograms within the recommended limit of the WHO Air Quality Guidelines for the annual mean PM 2.5 . The New York City Department of Health and Mental Hygiene , in partnership with Queens College , conducts the New York Community Air Survey to measure pollutants at about 150 locations. New York City is the most populous city in the United States, with 8,804,190 residents incorporating more immigration into the city than outmigration since the 2010 United States census . More than twice as many people live in New York City as compared to Los Angeles , the second-most populous U.S. city. Between 2010 and 2020, New York City gained 629,000 residents, more than any other U.S. city, and a greater amount than the total sum of the gains over the same decade of the next four largest U.S. cities (Los Angeles, Chicago, Houston , and Phoenix ) combined. The city's population density of 27,744.1 inhabitants per square mile (10,712.1/km 2 ) makes it the densest of any American municipality with a population above 100,000. Manhattan's population density is 70,450.8 inhabitants per square mile (27,201.2/km 2 ) , the highest of any county in the United States. Based on data from the 2020 census, New York City comprises about 43.6% of the state's population of 20,202,320, and about 39% of the population of the New York metropolitan area . The majority of New York City residents in 2020 (5,141,539 or 58.4%) were living in Brooklyn or Queens, the two boroughs on Long Island. As many as 800 languages are spoken in New York, and the New York City metropolitan statistical area has the largest foreign-born population of any metropolitan region in the world. The New York region continues to be by far the leading metropolitan gateway for legal immigrants admitted into the United States, substantially exceeding the combined totals of Los Angeles and Miami . The city's population in 2020 was 31.2% White (non-Hispanic), 29.0% Hispanic or Latino , 23.1% Black or African American (non-Hispanic), 14.5% Asian , and 0.6% Native American (non-Hispanic), with 8.9% listing two or more races. A total of 3.4% of the non-Hispanic population identified with more than one race . Based on date from 2018 to 2022, approximately 36.3% of the city's population is foreign born (compared to 13.7% nationwide), and 40% of all children are born to mothers who are immigrants. Throughout its history, New York has been a major port of entry for immigrants into the United States. No single country or region of origin dominates. The ten largest sources of foreign-born individuals in the city as of 2011 [ update ] were the Dominican Republic , China , Mexico, Guyana , Jamaica , Ecuador , Haiti , India , Russia , and Trinidad and Tobago , Queens has the largest Asian American and Andean populations in the United States, and is also the most ethnically and linguistically diverse urban area in the world. The metropolitan area has the largest Asian Indian population in the Western Hemisphere; the largest Russian American, Italian American , and African American populations; the largest Dominican American , Puerto Rican American , and South American and second-largest overall Hispanic population in the United States, numbering 4.8 million. Venezuela , Ecuador, Colombia , Guyana , Peru , and Brazil , are the top source countries from South America for immigrants to the New York City region; the Dominican Republic , Jamaica , Haiti , and Trinidad and Tobago in the Caribbean ; Nigeria , Egypt , Ghana , Tanzania , Kenya , and South Africa from Africa ; and El Salvador , Honduras , and Guatemala in Central America . New York contains the highest total Asian population of any U.S. city proper. Asian Americans in New York City , according to the 2010 census, number more than 1.2 million, greater than the combined totals of San Francisco and Los Angeles . New York has the largest Chinese population of any city outside Asia, Manhattan's Chinatown is the highest concentration of Chinese people in the Western Hemisphere , and Queens is home to the largest Tibetan population outside Asia. Arab Americans number over 160,000 in New York City, with the highest concentration in Brooklyn. Central Asians , primarily Uzbek Americans , are a rapidly growing segment of the city's non-Hispanic White population. The metropolitan area is home to 20% of the nation's Indian Americans and at least twenty Little India enclaves, and 15% of all Korean Americans and four Koreatowns . New York City has the largest European and non-Hispanic white population of any American city, with 2.7 million in 2012. The European diaspora residing in the city is very diverse and many European ethnic groups have formed enclaves . New York City is home to the highest Jewish population of any city in the world, numbering 1.6 million in 2022, more than Tel Aviv and Jerusalem combined. In the borough of Brooklyn, an estimated one in four residents is Jewish. New York City has been described as the gay capital of the world and the central node of the lesbian, gay, bisexual, and transgender (LGBT) sociopolitical ecosystem , and is home to one of the world's largest LGBT populations and the most prominent. The New York metropolitan area is home to about 570,000 self-identifying gay and bisexual people, the largest in the United States . Same-sex sexual activity between consenting adults has been legal in New York since 1980's New York v. Onofre case, which invalidated the state's sodomy law . Same-sex marriage in New York was legalized on June 24, 2011, and were authorized to take place on July 23, 2011. The annual New York City Pride March proceeds southward down Fifth Avenue and ends at Greenwich Village in Lower Manhattan; the parade is the largest pride parade in the world , attracting tens of thousands of participants and millions of sidewalk spectators each June. The annual Queens Pride Parade is held in Jackson Heights and is accompanied by the ensuing Multicultural Parade . Stonewall 50 – WorldPride NYC 2019 was the largest international Pride celebration in history, commemorating the 50th anniversary of the Stonewall uprising, with 150,000 participants and five million spectators attending in Manhattan alone. New York City is home to the largest transgender population in the world, estimated at more than 50,000 in 2018, concentrated in Manhattan and Queens; however, until the June 1969 Stonewall riots, this community had felt marginalized and neglected by the gay community. Brooklyn Liberation March, the largest transgender-rights demonstration in LGBT history, took place on June 14, 2020, stretching from Grand Army Plaza to Fort Greene, Brooklyn , focused on supporting Black transgender lives, drawing an estimated 15,000 to 20,000 participants. Largely as a result of Western European missionary work and colonialism , Christianity is the largest religion (59% adherent) in New York City, which is home to the highest number of churches of any city in the world. Roman Catholicism is the largest Christian denomination (33%), followed by Protestantism (23%), and other Christian denominations (3%). The Roman Catholic population are primarily served by the Roman Catholic Archdiocese of New York and Diocese of Brooklyn . Eastern Catholics are divided into numerous jurisdictions throughout the city. Evangelical Protestantism is the largest branch of Protestantism in the city (9%), followed by Mainline Protestantism (8%), while the converse is usually true for other cities and metropolitan areas. Judaism , the second-largest religion practiced in New York City , with approximately 1.6 million adherents as of 2022, represents the largest Jewish community of any city in the world , greater than the combined totals of Tel Aviv and Jerusalem. Nearly half of the city's Jews live in Brooklyn. The ethno-religious population makes up 18.4% of the city and its religious demographic makes up 8%. Islam ranks as the third-largest religion in New York City, following Christianity and Judaism, with estimates ranging between 600,000 and 1,000,000 observers of Islam, including 10% of the city's public school children. 22.3% of American Muslims live in New York City, with 1.5 million Muslims in the greater New York metropolitan area , representing the largest metropolitan Muslim population in the Western Hemisphere —and the most ethnically diverse Muslim population of any city in the world. Powers Street Mosque in Brooklyn is one of the oldest continuously operating mosques in the U.S., and represents the first Islamic organization in both the city and the state of New York. Following these three largest religious groups in New York City are Hinduism , Buddhism , Sikhism , Zoroastrianism , and others. As of 2023, 24% of Greater New Yorkers identified with no organized religious affiliation, and 4% were self-identified atheists . New York City has the largest educational system of any city in the world. The city's educational infrastructure spans primary education , secondary education , higher education , and research . The New York City Public Schools system, managed by the New York City Department of Education , is the largest public school system in the United States, serving about 1.1 million students in approximately 1,800 separate primary and secondary schools, including charter schools , as of the 2017–2018 school year. The New York City Charter School Center assists the setup of new charter schools. There are approximately 900 additional privately run secular and religious schools in the city. The New York Public Library (NYPL) has the largest collection of any public library system in the United States. Queens is served by the Queens Borough Public Library (QPL), the nation's second-largest public library system, while the Brooklyn Public Library (BPL) serves Brooklyn. More than a million students, the highest number of any city in the United States, are enrolled in New York City's more than 120 higher education institutions, with more than half a million in the City University of New York (CUNY) system alone as of 2020 [ update ] , including both degree and professional programs. According to Academic Ranking of World Universities , New York City has, on average, the best higher education institutions of any global city . The public CUNY system comprising 25 institutions across all five boroughs: senior colleges, community colleges , and other graduate/professional schools. The public State University of New York (SUNY) system includes campuses in New York City, including SUNY Downstate Health Sciences University , Fashion Institute of Technology , SUNY Maritime College , and SUNY College of Optometry . New York City is home to such notable private universities as Barnard College , Columbia University , Cooper Union , Fordham University , New York University , New York Institute of Technology , Rockefeller University , Mercy University , Cornell Tech and Yeshiva University ; several of these universities are ranked among the top universities in the world, while some of the world's most prestigious institutions like Princeton University and Yale University remain in the New York metropolitan area . Much of the scientific research in the city is done in medicine and the life sciences . In 2019, the New York metropolitan area ranked first on the list of cities and metropolitan areas by share of published articles in life sciences . New York City has the most postgraduate life sciences degrees awarded annually in the United States, and in 2012, 43,523 licensed physicians were practicing in New York City. There are 127 Nobel laureates with roots in local institutions as of 2004 [ update ] . New York City is a center for healthcare and medical training, with employment of 750,000 in the city's health care sector. Private hospitals in New York City include the Hospital for Special Surgery , Lenox Hill Hospital Long Island Jewish Medical Center , Memorial Sloan Kettering Cancer Center , Mount Sinai Hospital , NewYork-Presbyterian Hospital and NYU Langone Health . Medical schools include SUNY Downstate College of Medicine in Brooklyn, Albert Einstein College of Medicine in the Bronx, and CUNY School of Medicine , Touro College of Osteopathic Medicine , Columbia University Vagelos College of Physicians and Surgeons , Weill Cornell Medicine , Icahn School of Medicine at Mount Sinai and New York University School of Medicine in Manhattan. NYC Health + Hospitals (HHC) is a public-benefit corporation established in 1969 which operates the city's public hospitals and a network of outpatient clinics. As of 2021 [ update ] , HHC is the largest municipal healthcare system in the United States with $10.9 billion in annual revenues. HHC serves 1.4 million patients, including more than 475,000 uninsured city residents. HHC operates eleven acute-care hospitals, four nursing homes, six diagnostic and treatment centers, and more than 70 community-based primary care sites, serving primarily the city's poor and working-class residents. HHC's MetroPlus Health Plan is one of New York City's largest providers of government-sponsored health insurance, enrolling 670,000 city residents as of June 2022. HHC's facilities annually provides service to millions of New Yorkers, interpreted in more than 190 languages. The best-known hospital in the HHC system is Bellevue Hospital , the oldest public hospital in the United States, established in 1736. Bellevue is the designated hospital for treatment of the president of the United States and other world leaders should they require care while in New York City. The city banned smoking in most parts of restaurants in 1995 and prohibited smoking in bars, restaurants and places of public employment in 2003. In August 2017, Mayor Bill de Blasio signed legislation outlawing pharmacies from selling cigarettes once their existing licenses to do so expired, beginning in 2018. [ needs update ] New York City enforces a right-to-shelter law guaranteeing shelter to anyone who needs it, regardless of their immigration, socioeconomic, or housing status, which entails providing adequate shelter and food. The New York Police Department (NYPD) is the largest police force in the United States, with more than 36,000 sworn officers, more than triple the size of the Chicago Police Department . Members of the NYPD are frequently referred to by politicians, the media, and their own police cars by the nickname, New York's Finest . The city saw a spike in crime in the 1970s through 1990s. Crime overall has trended downward in New York City since the 1990s; violent crime decreased more than 75% from 1993 to 2005, and continued decreasing during periods when the nation as a whole saw increases. The NYPD's stop-and-frisk program was declared unconstitutional in 2013 as a "policy of indirect racial profiling " of Black and Hispanic residents, although claims of disparate impact continued in subsequent years. The stop-and-frisk program had been widely credited as being behind the decline in crime, though rates continued dropping in the years after the program ended. The city set a record of 2,245 murders in 1990 and hit a near-70-year record low of 289 in 2018. The number of murders and the rate of 3.3 per 100,000 residents in 2017 was the lowest since 1951. New York City recorded 386 murders in 2023, a decline of 12% from the previous year. New York City had one of the lowest homicide rates among the ten largest U.S. cities at 5.5 per 100,000 residents in 2021, behind San Jose, California , at 3.1 per 100,000. New York City has stricter gun laws than most other cities in the U.S. —a license to own any firearm is required in New York City, and the NY SAFE Act of 2013 banned assault weapons —and New York State had the fifth-lowest gun death rate of the states in 2020. Organized crime has long been associated with New York City, beginning with the Forty Thieves and the Roach Guards in the Five Points neighborhood in the 1820s, followed by the Tongs in the same neighborhood, which ultimately evolved into Chinatown, Manhattan. The 20th century saw a rise in the Mafia , dominated by the Five Families , as well as in gangs , including the Black Spades . The Mafia and gang presence has declined in the city in the 21st century. The Fire Department of New York (FDNY) provides fire protection , technical rescue, primary response to biological, chemical, and radioactive hazards, and emergency medical services . FDNY faces multifaceted firefighting challenges in many ways unique to New York. In addition to responding to building types that range from wood-frame single family homes to high-rise structures , the FDNY responds to fires that occur in the New York City Subway . Secluded bridges and tunnels, as well as large parks and wooded areas that can give rise to brush fires, also present challenges. The FDNY is headquartered at 9 MetroTech Center in Downtown Brooklyn , and the FDNY Fire Academy is on Randalls Island . The city's population in 2020 was 31.2% White (non-Hispanic), 29.0% Hispanic or Latino , 23.1% Black or African American (non-Hispanic), 14.5% Asian , and 0.6% Native American (non-Hispanic), with 8.9% listing two or more races. A total of 3.4% of the non-Hispanic population identified with more than one race . Based on date from 2018 to 2022, approximately 36.3% of the city's population is foreign born (compared to 13.7% nationwide), and 40% of all children are born to mothers who are immigrants. Throughout its history, New York has been a major port of entry for immigrants into the United States. No single country or region of origin dominates. The ten largest sources of foreign-born individuals in the city as of 2011 [ update ] were the Dominican Republic , China , Mexico, Guyana , Jamaica , Ecuador , Haiti , India , Russia , and Trinidad and Tobago , Queens has the largest Asian American and Andean populations in the United States, and is also the most ethnically and linguistically diverse urban area in the world. The metropolitan area has the largest Asian Indian population in the Western Hemisphere; the largest Russian American, Italian American , and African American populations; the largest Dominican American , Puerto Rican American , and South American and second-largest overall Hispanic population in the United States, numbering 4.8 million. Venezuela , Ecuador, Colombia , Guyana , Peru , and Brazil , are the top source countries from South America for immigrants to the New York City region; the Dominican Republic , Jamaica , Haiti , and Trinidad and Tobago in the Caribbean ; Nigeria , Egypt , Ghana , Tanzania , Kenya , and South Africa from Africa ; and El Salvador , Honduras , and Guatemala in Central America . New York contains the highest total Asian population of any U.S. city proper. Asian Americans in New York City , according to the 2010 census, number more than 1.2 million, greater than the combined totals of San Francisco and Los Angeles . New York has the largest Chinese population of any city outside Asia, Manhattan's Chinatown is the highest concentration of Chinese people in the Western Hemisphere , and Queens is home to the largest Tibetan population outside Asia. Arab Americans number over 160,000 in New York City, with the highest concentration in Brooklyn. Central Asians , primarily Uzbek Americans , are a rapidly growing segment of the city's non-Hispanic White population. The metropolitan area is home to 20% of the nation's Indian Americans and at least twenty Little India enclaves, and 15% of all Korean Americans and four Koreatowns . New York City has the largest European and non-Hispanic white population of any American city, with 2.7 million in 2012. The European diaspora residing in the city is very diverse and many European ethnic groups have formed enclaves . New York City is home to the highest Jewish population of any city in the world, numbering 1.6 million in 2022, more than Tel Aviv and Jerusalem combined. In the borough of Brooklyn, an estimated one in four residents is Jewish. New York City has been described as the gay capital of the world and the central node of the lesbian, gay, bisexual, and transgender (LGBT) sociopolitical ecosystem , and is home to one of the world's largest LGBT populations and the most prominent. The New York metropolitan area is home to about 570,000 self-identifying gay and bisexual people, the largest in the United States . Same-sex sexual activity between consenting adults has been legal in New York since 1980's New York v. Onofre case, which invalidated the state's sodomy law . Same-sex marriage in New York was legalized on June 24, 2011, and were authorized to take place on July 23, 2011. The annual New York City Pride March proceeds southward down Fifth Avenue and ends at Greenwich Village in Lower Manhattan; the parade is the largest pride parade in the world , attracting tens of thousands of participants and millions of sidewalk spectators each June. The annual Queens Pride Parade is held in Jackson Heights and is accompanied by the ensuing Multicultural Parade . Stonewall 50 – WorldPride NYC 2019 was the largest international Pride celebration in history, commemorating the 50th anniversary of the Stonewall uprising, with 150,000 participants and five million spectators attending in Manhattan alone. New York City is home to the largest transgender population in the world, estimated at more than 50,000 in 2018, concentrated in Manhattan and Queens; however, until the June 1969 Stonewall riots, this community had felt marginalized and neglected by the gay community. Brooklyn Liberation March, the largest transgender-rights demonstration in LGBT history, took place on June 14, 2020, stretching from Grand Army Plaza to Fort Greene, Brooklyn , focused on supporting Black transgender lives, drawing an estimated 15,000 to 20,000 participants. Largely as a result of Western European missionary work and colonialism , Christianity is the largest religion (59% adherent) in New York City, which is home to the highest number of churches of any city in the world. Roman Catholicism is the largest Christian denomination (33%), followed by Protestantism (23%), and other Christian denominations (3%). The Roman Catholic population are primarily served by the Roman Catholic Archdiocese of New York and Diocese of Brooklyn . Eastern Catholics are divided into numerous jurisdictions throughout the city. Evangelical Protestantism is the largest branch of Protestantism in the city (9%), followed by Mainline Protestantism (8%), while the converse is usually true for other cities and metropolitan areas. Judaism , the second-largest religion practiced in New York City , with approximately 1.6 million adherents as of 2022, represents the largest Jewish community of any city in the world , greater than the combined totals of Tel Aviv and Jerusalem. Nearly half of the city's Jews live in Brooklyn. The ethno-religious population makes up 18.4% of the city and its religious demographic makes up 8%. Islam ranks as the third-largest religion in New York City, following Christianity and Judaism, with estimates ranging between 600,000 and 1,000,000 observers of Islam, including 10% of the city's public school children. 22.3% of American Muslims live in New York City, with 1.5 million Muslims in the greater New York metropolitan area , representing the largest metropolitan Muslim population in the Western Hemisphere —and the most ethnically diverse Muslim population of any city in the world. Powers Street Mosque in Brooklyn is one of the oldest continuously operating mosques in the U.S., and represents the first Islamic organization in both the city and the state of New York. Following these three largest religious groups in New York City are Hinduism , Buddhism , Sikhism , Zoroastrianism , and others. As of 2023, 24% of Greater New Yorkers identified with no organized religious affiliation, and 4% were self-identified atheists . New York City has the largest educational system of any city in the world. The city's educational infrastructure spans primary education , secondary education , higher education , and research . The New York City Public Schools system, managed by the New York City Department of Education , is the largest public school system in the United States, serving about 1.1 million students in approximately 1,800 separate primary and secondary schools, including charter schools , as of the 2017–2018 school year. The New York City Charter School Center assists the setup of new charter schools. There are approximately 900 additional privately run secular and religious schools in the city. The New York Public Library (NYPL) has the largest collection of any public library system in the United States. Queens is served by the Queens Borough Public Library (QPL), the nation's second-largest public library system, while the Brooklyn Public Library (BPL) serves Brooklyn. More than a million students, the highest number of any city in the United States, are enrolled in New York City's more than 120 higher education institutions, with more than half a million in the City University of New York (CUNY) system alone as of 2020 [ update ] , including both degree and professional programs. According to Academic Ranking of World Universities , New York City has, on average, the best higher education institutions of any global city . The public CUNY system comprising 25 institutions across all five boroughs: senior colleges, community colleges , and other graduate/professional schools. The public State University of New York (SUNY) system includes campuses in New York City, including SUNY Downstate Health Sciences University , Fashion Institute of Technology , SUNY Maritime College , and SUNY College of Optometry . New York City is home to such notable private universities as Barnard College , Columbia University , Cooper Union , Fordham University , New York University , New York Institute of Technology , Rockefeller University , Mercy University , Cornell Tech and Yeshiva University ; several of these universities are ranked among the top universities in the world, while some of the world's most prestigious institutions like Princeton University and Yale University remain in the New York metropolitan area . Much of the scientific research in the city is done in medicine and the life sciences . In 2019, the New York metropolitan area ranked first on the list of cities and metropolitan areas by share of published articles in life sciences . New York City has the most postgraduate life sciences degrees awarded annually in the United States, and in 2012, 43,523 licensed physicians were practicing in New York City. There are 127 Nobel laureates with roots in local institutions as of 2004 [ update ] . New York City is a center for healthcare and medical training, with employment of 750,000 in the city's health care sector. Private hospitals in New York City include the Hospital for Special Surgery , Lenox Hill Hospital Long Island Jewish Medical Center , Memorial Sloan Kettering Cancer Center , Mount Sinai Hospital , NewYork-Presbyterian Hospital and NYU Langone Health . Medical schools include SUNY Downstate College of Medicine in Brooklyn, Albert Einstein College of Medicine in the Bronx, and CUNY School of Medicine , Touro College of Osteopathic Medicine , Columbia University Vagelos College of Physicians and Surgeons , Weill Cornell Medicine , Icahn School of Medicine at Mount Sinai and New York University School of Medicine in Manhattan. NYC Health + Hospitals (HHC) is a public-benefit corporation established in 1969 which operates the city's public hospitals and a network of outpatient clinics. As of 2021 [ update ] , HHC is the largest municipal healthcare system in the United States with $10.9 billion in annual revenues. HHC serves 1.4 million patients, including more than 475,000 uninsured city residents. HHC operates eleven acute-care hospitals, four nursing homes, six diagnostic and treatment centers, and more than 70 community-based primary care sites, serving primarily the city's poor and working-class residents. HHC's MetroPlus Health Plan is one of New York City's largest providers of government-sponsored health insurance, enrolling 670,000 city residents as of June 2022. HHC's facilities annually provides service to millions of New Yorkers, interpreted in more than 190 languages. The best-known hospital in the HHC system is Bellevue Hospital , the oldest public hospital in the United States, established in 1736. Bellevue is the designated hospital for treatment of the president of the United States and other world leaders should they require care while in New York City. The city banned smoking in most parts of restaurants in 1995 and prohibited smoking in bars, restaurants and places of public employment in 2003. In August 2017, Mayor Bill de Blasio signed legislation outlawing pharmacies from selling cigarettes once their existing licenses to do so expired, beginning in 2018. [ needs update ] New York City enforces a right-to-shelter law guaranteeing shelter to anyone who needs it, regardless of their immigration, socioeconomic, or housing status, which entails providing adequate shelter and food. The New York Police Department (NYPD) is the largest police force in the United States, with more than 36,000 sworn officers, more than triple the size of the Chicago Police Department . Members of the NYPD are frequently referred to by politicians, the media, and their own police cars by the nickname, New York's Finest . The city saw a spike in crime in the 1970s through 1990s. Crime overall has trended downward in New York City since the 1990s; violent crime decreased more than 75% from 1993 to 2005, and continued decreasing during periods when the nation as a whole saw increases. The NYPD's stop-and-frisk program was declared unconstitutional in 2013 as a "policy of indirect racial profiling " of Black and Hispanic residents, although claims of disparate impact continued in subsequent years. The stop-and-frisk program had been widely credited as being behind the decline in crime, though rates continued dropping in the years after the program ended. The city set a record of 2,245 murders in 1990 and hit a near-70-year record low of 289 in 2018. The number of murders and the rate of 3.3 per 100,000 residents in 2017 was the lowest since 1951. New York City recorded 386 murders in 2023, a decline of 12% from the previous year. New York City had one of the lowest homicide rates among the ten largest U.S. cities at 5.5 per 100,000 residents in 2021, behind San Jose, California , at 3.1 per 100,000. New York City has stricter gun laws than most other cities in the U.S. —a license to own any firearm is required in New York City, and the NY SAFE Act of 2013 banned assault weapons —and New York State had the fifth-lowest gun death rate of the states in 2020. Organized crime has long been associated with New York City, beginning with the Forty Thieves and the Roach Guards in the Five Points neighborhood in the 1820s, followed by the Tongs in the same neighborhood, which ultimately evolved into Chinatown, Manhattan. The 20th century saw a rise in the Mafia , dominated by the Five Families , as well as in gangs , including the Black Spades . The Mafia and gang presence has declined in the city in the 21st century. The Fire Department of New York (FDNY) provides fire protection , technical rescue, primary response to biological, chemical, and radioactive hazards, and emergency medical services . FDNY faces multifaceted firefighting challenges in many ways unique to New York. In addition to responding to building types that range from wood-frame single family homes to high-rise structures , the FDNY responds to fires that occur in the New York City Subway . Secluded bridges and tunnels, as well as large parks and wooded areas that can give rise to brush fires, also present challenges. The FDNY is headquartered at 9 MetroTech Center in Downtown Brooklyn , and the FDNY Fire Academy is on Randalls Island . New York City is a global hub of business and commerce, and is sometimes described as the capital of the world . Greater New York is the world's largest metropolitan economy , with a gross metropolitan product estimated at US$2.16 trillion in 2022. New York is a center for worldwide banking and finance, health care and life sciences , medical technology and research , retailing, world trade, transportation, tourism, real estate, new media , traditional media , advertising, legal services , accountancy , insurance, and the arts in the United States; while Silicon Alley , metonymous for New York's broad-spectrum high technology sphere, continues to expand. The Port of New York and New Jersey is a major economic engine, benefitting post-Panamax from the expansion of the Panama Canal . Many Fortune 500 corporations are headquartered in New York City, as are a large number of multinational corporations . New York City has been ranked first among cities across the globe in attracting capital , business, and tourists. New York City's role as the top global center for the advertising industry is metonymously reflected as Madison Avenue . The city's fashion industry provides approximately 180,000 employees with $11 billion in annual wages. Significant other economic sectors include universities and non-profit institutions. Manufacturing declined over the 20th century but still accounts for significant employment. The city's apparel and garment industry , historically centered on the Garment District in Manhattan, peaked in 1950, when more than 323,000 workers were employed in the industry in New York. In 2015, fewer than 23,000 New York City residents were employed in the industry, although revival efforts were underway, and the American fashion industry continues to be metonymized as Seventh Avenue . In 2017, the city had 205,592 employer firms, of which 22.0% were owned by women, 31.3% were minority-owned and 2.7% were owned by veterans. In 2022, the gross domestic product of New York City was $1.053 trillion, of which $781 billion (74%) was produced by Manhattan. Like other large cities, New York City has a degree of income disparity , as indicated by its Gini coefficient of 0.55 as of 2022. In November 2023, the city had total employment of 4.75 million of which more than a quarter were in education and health services. Manhattan, which accounted for more than half of the city's jobs, had an average weekly wage of $2,590 in the second quarter of 2023, ranking fourth-highest among the nation's 360 largest counties. In 2022, New York City was home to the highest number of billionaires of any city in the world, with a total of 107. New York City is one of the relatively few American cities levying an income tax (about 3%) on its residents. New York City's most important economic sector lies in its role as the headquarters for the U.S. financial industry , metonymously known as Wall Street . Lower Manhattan is home to the New York Stock Exchange , at 11 Wall Street , and the Nasdaq , at 165 Broadway , representing the world's largest and second largest stock exchanges , respectively, when measured both by overall average daily trading volume and by total market capitalization of their listed companies in 2013. In fiscal year 2013–14, Wall Street's securities industry generated 19% of New York State's tax revenue. New York City remains the largest global center for trading in public equity and debt capital markets, driven in part by the size and financial development of the U.S. economy . : 31–32 New York also leads in hedge fund management; private equity ; and the monetary volume of mergers and acquisitions . Several investment banks and investment managers headquartered in Manhattan are important participants in other global financial centers. : 34–35 New York is the principal commercial banking center of the United States. Manhattan contained over 500 million square feet (46.5 million m 2 ) of office space in 2018, making it the largest office market in the United States, while Midtown Manhattan , with 400 million square feet (37.2 million m 2 ) in 2018, is the largest central business district in the world. New York is a top-tier global technology hub. Silicon Alley , once a metonym for the sphere encompassing the metropolitan region's high technology industries, is no longer a relevant moniker as the city's tech environment has expanded dramatically both in location and in scope since at least 2003, when tech business appeared in more places in Manhattan and in other boroughs, and not much silicon was involved. New York City's current tech sphere encompasses the array of applications involving universal applications of artificial intelligence (AI), broadband internet , new media , financial technology ( fintech ) and cryptocurrency , biotechnology , game design , and other fields within information technology that are supported by its entrepreneurship ecosystem and venture capital investments. Technology -driven startup companies and entrepreneurial employment are growing in New York City and the region. The technology sector has been claiming a greater share of New York City's economy since 2010. Tech:NYC , founded in 2016, is a non-profit organization which represents New York City's technology industry with government, civic institutions, in business, and in the media, and whose primary goals are to further augment New York's substantial tech talent base and to advocate for policies that will nurture tech companies to grow in the city. New York City's AI sector raised US$483.6 million in venture capital investment in 2022. In 2023, New York unveiled the first comprehensive initiative to create both a framework of rules and a chatbot to regulate the use of AI within the sphere of city government. The biotechnology sector is growing in New York City, based on the city's strength in academic scientific research and public and commercial financial support. On December 19, 2011, Mayor Michael R. Bloomberg announced his choice of Cornell University and Technion-Israel Institute of Technology to build a $2 billion graduate school of applied sciences called Cornell Tech on Roosevelt Island with the goal of transforming New York City into the world's premier technology capital. New York City real estate is a safe haven for global investors. The total value of all New York City property was assessed at US$1.479 trillion for the 2017 fiscal year , an increase of 6.1% from the previous year; of the total market value for 2024, single family homes accounted for $765 billion (51.7%), co-ops , condominiums and apartment buildings totaled $351 billion (23.7%) and commercial properties were valued at $317 billion (21.4%). Fifth Avenue in Midtown Manhattan commands the highest retail rents in the world, at $2,000 per square foot ($22,000/m 2 ) in 2023. New York City has one of the highest costs of living in the world, which is exacerbated by the city's housing shortage. In 2023, one-bedroom apartments in Manhattan rented at a median monthly price of US$4,443. The median house price city-wide is over $1 million as of 2023. As of 2023, there were 92,824 homeless people sleeping nightly in New York City's shelter system, with homelessness in the city reaching the highest levels since the Great Depression . With 33,000 units available in 2023 among the city's 2.3 million rentable apartments, the vacancy rate was 1.4%, the lowest level since 1968 and a rate that is indicative of a shortage of available units, especially among those with rents below the median monthly rental of $1,650, where 1% of units were available. Tourism is a vital industry for New York City, and NYC Tourism + Conventions represents the city's official bureau of tourism. New York has witnessed a growing combined volume of international and domestic tourists, with as many as 66.6 million visitors to the city per year, including as many as 13.5 million visitors from outside the United States, with the highest numbers from the United Kingdom, Canada, Brazil, and China. Multiple sources have called New York the most photographed city in the world. I Love New York (stylized I ❤ NY) is both a logo and a song that are the basis of an advertising campaign and have been used since 1977 to promote tourism in New York City , and later to promote New York State as well. The trademarked logo is owned by New York State Empire State Development . Many districts and monuments in New York City are major landmarks, including three of the world's ten-most-visited tourist attractions in 2023. A record 66.6 million tourists visited New York City in 2019, bringing in $47.4 billion in tourism revenue. Visitor numbers dropped by two-thirds in 2020 during the pandemic, rebounding to 63.3 million in 2023. Major landmarks in New York City include the Metropolitan Museum of Art , the Statue of Liberty , the Empire State Building , and Central Park. Times Square is the brightly illuminated hub of the Broadway Theater District , and a major center of the world's entertainment industry . that attracts 50 million visitors annually to one of the world's busiest pedestrian intersections. New York City has been described as the entertainment and digital media capital of the world. It is a center for the advertising , music , newspaper , digital media, and publishing industries and is the largest media market in North America. Many of the world's largest media conglomerates are based in the city, including Warner Bros. Discovery , the Thomson Reuters Corporation , the Associated Press , Bloomberg L.P. , the News Corp , The New York Times Company , NBCUniversal , the Hearst Corporation , AOL , Fox Corporation , and Paramount Global . Seven of the world's top eight global advertising agency networks have their headquarters in New York. More than 200 newspapers and 350 consumer magazines have an office in the city, and the publishing industry employs about 11,500 people, with an economic impact of $9.2 billion. The two national daily newspapers with the largest daily circulations in the United States are published in New York: The Wall Street Journal and The New York Times broadsheets. With 132 awards through 2022, The Times has won the most Pulitzer Prizes for journalism and is considered the U.S. media's newspaper of record . Tabloid newspapers in the city include the New York Daily News , which was founded in 1919 by Joseph Medill Patterson , and the New York Post , founded in 1801 by Alexander Hamilton . As of 2019 [ update ] , New York City was the second-largest center for filmmaking and television production in the United States, producing about 200 feature films annually. The industry employed more than 100,000 people in 2019, generating $12.2 billion in wages and a total economic impact of $64.1 billion. By volume, New York is the world leader in independent film production—one-third of all American independent films are produced there. New York is a major center for non-commercial educational media. NYC Media is the official public radio, television, and online media network and broadcasting service of New York City, and has produced several original Emmy Award -winning shows covering music and culture in city neighborhoods and city government. The oldest public-access television channel in the United States is the Manhattan Neighborhood Network , founded in 1971. WNET is the city's major public television station and produces a third of national Public Broadcasting Service (PBS) television programming. WNYC , a public radio station owned by the city until 1997, has the largest public radio audience in the United States. New York City's most important economic sector lies in its role as the headquarters for the U.S. financial industry , metonymously known as Wall Street . Lower Manhattan is home to the New York Stock Exchange , at 11 Wall Street , and the Nasdaq , at 165 Broadway , representing the world's largest and second largest stock exchanges , respectively, when measured both by overall average daily trading volume and by total market capitalization of their listed companies in 2013. In fiscal year 2013–14, Wall Street's securities industry generated 19% of New York State's tax revenue. New York City remains the largest global center for trading in public equity and debt capital markets, driven in part by the size and financial development of the U.S. economy . : 31–32 New York also leads in hedge fund management; private equity ; and the monetary volume of mergers and acquisitions . Several investment banks and investment managers headquartered in Manhattan are important participants in other global financial centers. : 34–35 New York is the principal commercial banking center of the United States. Manhattan contained over 500 million square feet (46.5 million m 2 ) of office space in 2018, making it the largest office market in the United States, while Midtown Manhattan , with 400 million square feet (37.2 million m 2 ) in 2018, is the largest central business district in the world. New York is a top-tier global technology hub. Silicon Alley , once a metonym for the sphere encompassing the metropolitan region's high technology industries, is no longer a relevant moniker as the city's tech environment has expanded dramatically both in location and in scope since at least 2003, when tech business appeared in more places in Manhattan and in other boroughs, and not much silicon was involved. New York City's current tech sphere encompasses the array of applications involving universal applications of artificial intelligence (AI), broadband internet , new media , financial technology ( fintech ) and cryptocurrency , biotechnology , game design , and other fields within information technology that are supported by its entrepreneurship ecosystem and venture capital investments. Technology -driven startup companies and entrepreneurial employment are growing in New York City and the region. The technology sector has been claiming a greater share of New York City's economy since 2010. Tech:NYC , founded in 2016, is a non-profit organization which represents New York City's technology industry with government, civic institutions, in business, and in the media, and whose primary goals are to further augment New York's substantial tech talent base and to advocate for policies that will nurture tech companies to grow in the city. New York City's AI sector raised US$483.6 million in venture capital investment in 2022. In 2023, New York unveiled the first comprehensive initiative to create both a framework of rules and a chatbot to regulate the use of AI within the sphere of city government. The biotechnology sector is growing in New York City, based on the city's strength in academic scientific research and public and commercial financial support. On December 19, 2011, Mayor Michael R. Bloomberg announced his choice of Cornell University and Technion-Israel Institute of Technology to build a $2 billion graduate school of applied sciences called Cornell Tech on Roosevelt Island with the goal of transforming New York City into the world's premier technology capital. New York City real estate is a safe haven for global investors. The total value of all New York City property was assessed at US$1.479 trillion for the 2017 fiscal year , an increase of 6.1% from the previous year; of the total market value for 2024, single family homes accounted for $765 billion (51.7%), co-ops , condominiums and apartment buildings totaled $351 billion (23.7%) and commercial properties were valued at $317 billion (21.4%). Fifth Avenue in Midtown Manhattan commands the highest retail rents in the world, at $2,000 per square foot ($22,000/m 2 ) in 2023. New York City has one of the highest costs of living in the world, which is exacerbated by the city's housing shortage. In 2023, one-bedroom apartments in Manhattan rented at a median monthly price of US$4,443. The median house price city-wide is over $1 million as of 2023. As of 2023, there were 92,824 homeless people sleeping nightly in New York City's shelter system, with homelessness in the city reaching the highest levels since the Great Depression . With 33,000 units available in 2023 among the city's 2.3 million rentable apartments, the vacancy rate was 1.4%, the lowest level since 1968 and a rate that is indicative of a shortage of available units, especially among those with rents below the median monthly rental of $1,650, where 1% of units were available. Tourism is a vital industry for New York City, and NYC Tourism + Conventions represents the city's official bureau of tourism. New York has witnessed a growing combined volume of international and domestic tourists, with as many as 66.6 million visitors to the city per year, including as many as 13.5 million visitors from outside the United States, with the highest numbers from the United Kingdom, Canada, Brazil, and China. Multiple sources have called New York the most photographed city in the world. I Love New York (stylized I ❤ NY) is both a logo and a song that are the basis of an advertising campaign and have been used since 1977 to promote tourism in New York City , and later to promote New York State as well. The trademarked logo is owned by New York State Empire State Development . Many districts and monuments in New York City are major landmarks, including three of the world's ten-most-visited tourist attractions in 2023. A record 66.6 million tourists visited New York City in 2019, bringing in $47.4 billion in tourism revenue. Visitor numbers dropped by two-thirds in 2020 during the pandemic, rebounding to 63.3 million in 2023. Major landmarks in New York City include the Metropolitan Museum of Art , the Statue of Liberty , the Empire State Building , and Central Park. Times Square is the brightly illuminated hub of the Broadway Theater District , and a major center of the world's entertainment industry . that attracts 50 million visitors annually to one of the world's busiest pedestrian intersections. New York City has been described as the entertainment and digital media capital of the world. It is a center for the advertising , music , newspaper , digital media, and publishing industries and is the largest media market in North America. Many of the world's largest media conglomerates are based in the city, including Warner Bros. Discovery , the Thomson Reuters Corporation , the Associated Press , Bloomberg L.P. , the News Corp , The New York Times Company , NBCUniversal , the Hearst Corporation , AOL , Fox Corporation , and Paramount Global . Seven of the world's top eight global advertising agency networks have their headquarters in New York. More than 200 newspapers and 350 consumer magazines have an office in the city, and the publishing industry employs about 11,500 people, with an economic impact of $9.2 billion. The two national daily newspapers with the largest daily circulations in the United States are published in New York: The Wall Street Journal and The New York Times broadsheets. With 132 awards through 2022, The Times has won the most Pulitzer Prizes for journalism and is considered the U.S. media's newspaper of record . Tabloid newspapers in the city include the New York Daily News , which was founded in 1919 by Joseph Medill Patterson , and the New York Post , founded in 1801 by Alexander Hamilton . As of 2019 [ update ] , New York City was the second-largest center for filmmaking and television production in the United States, producing about 200 feature films annually. The industry employed more than 100,000 people in 2019, generating $12.2 billion in wages and a total economic impact of $64.1 billion. By volume, New York is the world leader in independent film production—one-third of all American independent films are produced there. New York is a major center for non-commercial educational media. NYC Media is the official public radio, television, and online media network and broadcasting service of New York City, and has produced several original Emmy Award -winning shows covering music and culture in city neighborhoods and city government. The oldest public-access television channel in the United States is the Manhattan Neighborhood Network , founded in 1971. WNET is the city's major public television station and produces a third of national Public Broadcasting Service (PBS) television programming. WNYC , a public radio station owned by the city until 1997, has the largest public radio audience in the United States. New York City is frequently the setting for novels, movies, and television programs and has been described as the cultural capital of the world. In describing New York, author Tom Wolfe said, "Culture just seems to be in the air, like part of the weather." The city is the birthplace of many cultural movements, including the Harlem Renaissance in literature and visual art; abstract expressionism (known as the New York School ) in painting; and hip-hop , punk , hardcore , salsa , freestyle , Tin Pan Alley , certain forms of jazz , and (along with Philadelphia) disco in music. New York City has been considered the dance capital of the world. One of the most common traits attributed to New York City is its fast pace, which spawned the term New York minute . Journalist Walt Whitman characterized New York's streets as being traversed by "hurrying, feverish, electric crowds." New York City's residents are prominently known for their resilience historically, and more recently related to their management of the impacts of the September 11 terrorist attacks and the COVID-19 pandemic . New York was voted the world's most resilient city in 2021 and 2022, per Time Out 's global poll of urban residents. The central hub of the American theater scene is Manhattan , with its divisions of Broadway , off-Broadway , and off-off-Broadway . Many movie and television stars have gotten their big break working in New York productions. Broadway theatre is one of the premier forms of English-language theatre in the world, named after Broadway , the major thoroughfare that crosses Times Square, sometimes referred to as " The Great White Way ." Forty-one venues mostly in Midtown Manhattan's Theatre District , each with at least 500 seats, are classified as Broadway theatres. The 2018–19 Broadway theatre season set records with total attendance of 14.8 million and gross revenue of $1.83 billion Recovering from closures forced by the COVID-19 pandemic, 2022–23 revenues rebounded to $1.58 billion with total attendance of 12.3 million. The Tony Awards recognizes excellence in live Broadway theatre and are presented at an annual ceremony in Manhattan. The awards are given for Broadway productions and performances at the 41 eligible Broadway venues. One is also given for regional theatre . Several discretionary non-competitive awards are given as well, including a Special Tony Award , the Tony Honors for Excellence in Theatre , and the Isabelle Stevenson Award . The New York area is home to a distinctive regional accent and speech pattern called the New York dialect , alternatively known as Brooklynese or New Yorkese . It has been considered one of the most recognizable accents within American English . The traditional New York area speech pattern is known for its rapid delivery, and its accent is characterized as non-rhotic so that the sound [ɹ] does not appear at the end of a syllable or immediately before a consonant , therefore the pronunciation of the city name as "New Yawk." The classic version of the New York City dialect is centered on middle- and working-class New Yorkers. The influx of non-European immigrants in recent decades has led to changes in this distinctive dialect, and the traditional form of this speech pattern is no longer as prevalent. New York has architecturally noteworthy buildings in a wide range of styles and from distinct time periods, from the Dutch Colonial Pieter Claesen Wyckoff House in Brooklyn, the oldest section of which dates to 1656, to the modern One World Trade Center , the skyscraper at Ground Zero in Lower Manhattan and the most expensive office tower in the world by construction cost. Manhattan's skyline , with its many skyscrapers, has been recognized as an iconic symbol of the city, and the city has been home to several of the tallest buildings in the world . As of 2019 [ update ] , New York City had 6,455 high-rise buildings, the third most in the world after Hong Kong and Seoul . The character of New York's large residential districts is often defined by the elegant brownstone rowhouses and townhouses and shabby tenements that were built during a period of rapid expansion from 1870 to 1930. Stone and brick became the city's building materials of choice after the construction of wood-frame houses was limited in the aftermath of the Great Fire of 1835 . In contrast, New York City also has neighborhoods that are less densely populated and feature free-standing dwellings. In neighborhoods such as Riverdale (in the Bronx), Ditmas Park (in Brooklyn), and Douglaston (in Queens), large single-family homes are common in various architectural styles such as Tudor Revival and Victorian . Lincoln Center for the Performing Arts , anchoring Lincoln Square on the Upper West Side of Manhattan, is home to numerous influential arts organizations, including the Metropolitan Opera , New York City Opera , New York Philharmonic , and New York City Ballet , as well as the Vivian Beaumont Theater , the Juilliard School , Jazz at Lincoln Center , and Alice Tully Hall . The Lee Strasberg Theatre and Film Institute is in Union Square , and Tisch School of the Arts is based at New York University, while Central Park SummerStage presents free music concerts in Central Park. New York City has more than 2,000 arts and cultural organizations and more than 500 art galleries . The city government funds the arts with a larger annual budget than the National Endowment for the Arts . The city is also home to hundreds of cultural institutions and historic sites. Museum Mile is the name for a section of Fifth Avenue running from 82nd to 105th streets on the Upper East Side of Manhattan, in the upper portion of Carnegie Hill . Nine museums occupy the length of this section of Fifth Avenue, making it one of the densest displays of culture in the world. Its art museums include the Guggenheim , Metropolitan Museum of Art , Neue Galerie New York , and The Africa Center . In addition to other programming, the museums collaborate for the annual Museum Mile Festival, held each year in June, to promote the museums and increase visitation. Many of the world's most lucrative art auctions are held in New York City. The Metropolitan Museum of Art is the largest art museum in the Americas . In 2022, it welcomed 3.2 million visitors, ranking it the third-most visited U.S. museum , and eighth on the list of most-visited art museums in the world. Its permanent collection contains more than two million works, divided among 17 curatorial departments, and includes works of art from classical antiquity and ancient Egypt ; paintings and sculptures from nearly all the European masters ; and an extensive collection of American and modern art . The Met maintains extensive holdings of African , Asian , Oceanian , Byzantine , and Islamic art . New York City's food culture includes an array of international cuisines influenced by the city's immigrant history. Central and Eastern European immigrants, especially Jewish immigrants from those regions, brought New York-style bagels , cheesecake , hot dogs , knishes , and delicatessens (delis) to the city. Italian immigrants brought New York-style pizza and Italian cuisine into the city, while Jewish immigrants and Irish immigrants brought pastrami and corned beef , respectively. Chinese and other Asian restaurants, sandwich joints, trattorias , diners , and coffeehouses are ubiquitous throughout the city. Some 4,000 mobile food vendors licensed by the city, many immigrant-owned, have made Middle Eastern foods such as falafel and kebabs examples of modern New York street food . The city is home to "nearly one thousand of the finest and most diverse haute cuisine restaurants in the world," according to Michelin . The New York City Department of Health and Mental Hygiene assigns letter grades to the city's restaurants based on inspection results. As of 2019, there were 27,043 restaurants in the city, up from 24,865 in 2017. The Queens Night Market in Flushing Meadows–Corona Park attracts more than ten thousand people nightly to sample food from more than 85 countries. New York has frequently been ranked the top fashion capital of the world on the annual list compiled by the Global Language Monitor . New York Fashion Week (NYFW) is a high-profile semiannual event featuring models displaying the latest wardrobes created by prominent fashion designers worldwide in advance of these fashions proceeding to the retail marketplace. NYFW sets the tone for the global fashion industry. New York's fashion district encompasses roughly 30 city blocks in Midtown Manhattan , clustered around a stretch of Seventh Avenue nicknamed Fashion Avenue . New York's fashion calendar also includes Couture Fashion Week to showcase haute couture styles. The Met Gala is often described as "Fashion's biggest night." New York City is well known for its street parades , the majority held in Manhattan. The primary orientation of the annual street parades is typically from north to south, marching along major avenues. The annual Macy's Thanksgiving Day Parade is the world's largest parade, beginning alongside Central Park and proceeding southward to the flagship Macy's Herald Square store; the parade is viewed on telecasts worldwide and draws millions of spectators in person. Other notable parades including the annual New York City St. Patrick's Day Parade in March, the NYC LGBT Pride March in June, the LGBT-inspired Greenwich Village Halloween Parade in October, and numerous parades commemorating the independence days of many nations. Ticker-tape parades celebrating championships won by sports teams as well as other accomplishments march northward along the Canyon of Heroes on Broadway from Bowling Green to City Hall Park in Lower Manhattan. New York City is home to the headquarters of the National Football League , Major League Baseball , the National Basketball Association , the National Hockey League , and Major League Soccer . New York City hosted the 1984 Summer Paralympics and the 1998 Goodwill Games . New York City's bid to host the 2012 Summer Olympics was one of five finalists, but lost out to London . The city has played host to more than 40 major professional teams in the five sports and their respective competing leagues. Four of the ten most expensive stadiums ever built worldwide ( MetLife Stadium , the new Yankee Stadium , Madison Square Garden , and Citi Field ) are in the New York metropolitan area. The city is represented in the National Football League by the New York Giants and the New York Jets , although both teams play their home games at MetLife Stadium in nearby East Rutherford, New Jersey , which hosted Super Bowl XLVIII in 2014. The city's two Major League Baseball teams are the New York Mets , who play at 41,800-seat Citi Field in Queens and the New York Yankees , who play at Yankee Stadium in the Bronx, which has 47,400 seats. The two rivals compete in four games of interleague play every regular season that has come to be called the Subway Series . The Yankees have won an MLB-record 27 championships, while the Mets have won the World Series twice. The city was once home to the Brooklyn Dodgers (now the Los Angeles Dodgers ), who won the World Series once, and the New York Giants (now the San Francisco Giants ), who won the World Series five times. Both teams moved to California in 1958. There is one Minor League Baseball team in the city, the Mets-affiliated Brooklyn Cyclones , and the city gained a club in the independent Atlantic League when the Staten Island FerryHawks began play in 2022. The city's National Basketball Association teams are the New York Knicks , who play at Madison Square Garden , and the Brooklyn Nets , who play at the Barclays Center . The New York Liberty is the city's Women's National Basketball Association team. The first national college-level basketball championship, the National Invitation Tournament , was held in New York in 1938 and remains in the city. The metropolitan area is home to three National Hockey League teams. The New York Rangers , one of the league's Original Six , play at Madison Square Garden in Manhattan. The New York Islanders , traditionally representing Long Island , play in UBS Arena in Elmont, New York , but played in Brooklyn's Barclays Center from 2015 to 2020. The New Jersey Devils play at Prudential Center in nearby Newark, New Jersey . In soccer, New York City is represented by New York City FC of Major League Soccer, who play their home games at Yankee Stadium and the New York Red Bulls , who play their home games at Red Bull Arena in nearby Harrison, New Jersey . NJ/NY Gotham FC plays their home games in Red Bull Arena, representing the metropolitan area in the National Women's Soccer League . Brooklyn FC is a professional soccer club based in that borough, fielding a women's team in the first-division USL Super League starting in 2024 and a men's team in the second-division USL Championship in 2025. New York was a host city for the 1994 FIFA World Cup , with matches being played at Giants Stadium in neighboring East Rutherford, New Jersey . New York City will be one of eleven U.S. host cities for the 2026 FIFA World Cup , with the final set to be played at MetLife Stadium, which will be called "New York New Jersey Stadium" during the tournament. The annual United States Open Tennis Championships is one of the world's four Grand Slam tennis tournaments and is held at the National Tennis Center in Flushing Meadows–Corona Park, Queens. The New York City Marathon , which courses through all five boroughs, is the world's largest running marathon, with 51,402 finishers in 2023, who came from all 50 states and 148 nations. The Millrose Games is an annual track and field meet held at the Fort Washington Avenue Armory , whose featured event is the Wanamaker Mile . Boxing is a prominent part of the city's sporting scene, with events like the New York Golden Gloves held at Madison Square Garden each year. The central hub of the American theater scene is Manhattan , with its divisions of Broadway , off-Broadway , and off-off-Broadway . Many movie and television stars have gotten their big break working in New York productions. Broadway theatre is one of the premier forms of English-language theatre in the world, named after Broadway , the major thoroughfare that crosses Times Square, sometimes referred to as " The Great White Way ." Forty-one venues mostly in Midtown Manhattan's Theatre District , each with at least 500 seats, are classified as Broadway theatres. The 2018–19 Broadway theatre season set records with total attendance of 14.8 million and gross revenue of $1.83 billion Recovering from closures forced by the COVID-19 pandemic, 2022–23 revenues rebounded to $1.58 billion with total attendance of 12.3 million. The Tony Awards recognizes excellence in live Broadway theatre and are presented at an annual ceremony in Manhattan. The awards are given for Broadway productions and performances at the 41 eligible Broadway venues. One is also given for regional theatre . Several discretionary non-competitive awards are given as well, including a Special Tony Award , the Tony Honors for Excellence in Theatre , and the Isabelle Stevenson Award . The New York area is home to a distinctive regional accent and speech pattern called the New York dialect , alternatively known as Brooklynese or New Yorkese . It has been considered one of the most recognizable accents within American English . The traditional New York area speech pattern is known for its rapid delivery, and its accent is characterized as non-rhotic so that the sound [ɹ] does not appear at the end of a syllable or immediately before a consonant , therefore the pronunciation of the city name as "New Yawk." The classic version of the New York City dialect is centered on middle- and working-class New Yorkers. The influx of non-European immigrants in recent decades has led to changes in this distinctive dialect, and the traditional form of this speech pattern is no longer as prevalent. New York has architecturally noteworthy buildings in a wide range of styles and from distinct time periods, from the Dutch Colonial Pieter Claesen Wyckoff House in Brooklyn, the oldest section of which dates to 1656, to the modern One World Trade Center , the skyscraper at Ground Zero in Lower Manhattan and the most expensive office tower in the world by construction cost. Manhattan's skyline , with its many skyscrapers, has been recognized as an iconic symbol of the city, and the city has been home to several of the tallest buildings in the world . As of 2019 [ update ] , New York City had 6,455 high-rise buildings, the third most in the world after Hong Kong and Seoul . The character of New York's large residential districts is often defined by the elegant brownstone rowhouses and townhouses and shabby tenements that were built during a period of rapid expansion from 1870 to 1930. Stone and brick became the city's building materials of choice after the construction of wood-frame houses was limited in the aftermath of the Great Fire of 1835 . In contrast, New York City also has neighborhoods that are less densely populated and feature free-standing dwellings. In neighborhoods such as Riverdale (in the Bronx), Ditmas Park (in Brooklyn), and Douglaston (in Queens), large single-family homes are common in various architectural styles such as Tudor Revival and Victorian . Lincoln Center for the Performing Arts , anchoring Lincoln Square on the Upper West Side of Manhattan, is home to numerous influential arts organizations, including the Metropolitan Opera , New York City Opera , New York Philharmonic , and New York City Ballet , as well as the Vivian Beaumont Theater , the Juilliard School , Jazz at Lincoln Center , and Alice Tully Hall . The Lee Strasberg Theatre and Film Institute is in Union Square , and Tisch School of the Arts is based at New York University, while Central Park SummerStage presents free music concerts in Central Park. New York City has more than 2,000 arts and cultural organizations and more than 500 art galleries . The city government funds the arts with a larger annual budget than the National Endowment for the Arts . The city is also home to hundreds of cultural institutions and historic sites. Museum Mile is the name for a section of Fifth Avenue running from 82nd to 105th streets on the Upper East Side of Manhattan, in the upper portion of Carnegie Hill . Nine museums occupy the length of this section of Fifth Avenue, making it one of the densest displays of culture in the world. Its art museums include the Guggenheim , Metropolitan Museum of Art , Neue Galerie New York , and The Africa Center . In addition to other programming, the museums collaborate for the annual Museum Mile Festival, held each year in June, to promote the museums and increase visitation. Many of the world's most lucrative art auctions are held in New York City. The Metropolitan Museum of Art is the largest art museum in the Americas . In 2022, it welcomed 3.2 million visitors, ranking it the third-most visited U.S. museum , and eighth on the list of most-visited art museums in the world. Its permanent collection contains more than two million works, divided among 17 curatorial departments, and includes works of art from classical antiquity and ancient Egypt ; paintings and sculptures from nearly all the European masters ; and an extensive collection of American and modern art . The Met maintains extensive holdings of African , Asian , Oceanian , Byzantine , and Islamic art . New York City's food culture includes an array of international cuisines influenced by the city's immigrant history. Central and Eastern European immigrants, especially Jewish immigrants from those regions, brought New York-style bagels , cheesecake , hot dogs , knishes , and delicatessens (delis) to the city. Italian immigrants brought New York-style pizza and Italian cuisine into the city, while Jewish immigrants and Irish immigrants brought pastrami and corned beef , respectively. Chinese and other Asian restaurants, sandwich joints, trattorias , diners , and coffeehouses are ubiquitous throughout the city. Some 4,000 mobile food vendors licensed by the city, many immigrant-owned, have made Middle Eastern foods such as falafel and kebabs examples of modern New York street food . The city is home to "nearly one thousand of the finest and most diverse haute cuisine restaurants in the world," according to Michelin . The New York City Department of Health and Mental Hygiene assigns letter grades to the city's restaurants based on inspection results. As of 2019, there were 27,043 restaurants in the city, up from 24,865 in 2017. The Queens Night Market in Flushing Meadows–Corona Park attracts more than ten thousand people nightly to sample food from more than 85 countries. New York has frequently been ranked the top fashion capital of the world on the annual list compiled by the Global Language Monitor . New York Fashion Week (NYFW) is a high-profile semiannual event featuring models displaying the latest wardrobes created by prominent fashion designers worldwide in advance of these fashions proceeding to the retail marketplace. NYFW sets the tone for the global fashion industry. New York's fashion district encompasses roughly 30 city blocks in Midtown Manhattan , clustered around a stretch of Seventh Avenue nicknamed Fashion Avenue . New York's fashion calendar also includes Couture Fashion Week to showcase haute couture styles. The Met Gala is often described as "Fashion's biggest night." New York City is well known for its street parades , the majority held in Manhattan. The primary orientation of the annual street parades is typically from north to south, marching along major avenues. The annual Macy's Thanksgiving Day Parade is the world's largest parade, beginning alongside Central Park and proceeding southward to the flagship Macy's Herald Square store; the parade is viewed on telecasts worldwide and draws millions of spectators in person. Other notable parades including the annual New York City St. Patrick's Day Parade in March, the NYC LGBT Pride March in June, the LGBT-inspired Greenwich Village Halloween Parade in October, and numerous parades commemorating the independence days of many nations. Ticker-tape parades celebrating championships won by sports teams as well as other accomplishments march northward along the Canyon of Heroes on Broadway from Bowling Green to City Hall Park in Lower Manhattan.New York City is home to the headquarters of the National Football League , Major League Baseball , the National Basketball Association , the National Hockey League , and Major League Soccer . New York City hosted the 1984 Summer Paralympics and the 1998 Goodwill Games . New York City's bid to host the 2012 Summer Olympics was one of five finalists, but lost out to London . The city has played host to more than 40 major professional teams in the five sports and their respective competing leagues. Four of the ten most expensive stadiums ever built worldwide ( MetLife Stadium , the new Yankee Stadium , Madison Square Garden , and Citi Field ) are in the New York metropolitan area. The city is represented in the National Football League by the New York Giants and the New York Jets , although both teams play their home games at MetLife Stadium in nearby East Rutherford, New Jersey , which hosted Super Bowl XLVIII in 2014. The city's two Major League Baseball teams are the New York Mets , who play at 41,800-seat Citi Field in Queens and the New York Yankees , who play at Yankee Stadium in the Bronx, which has 47,400 seats. The two rivals compete in four games of interleague play every regular season that has come to be called the Subway Series . The Yankees have won an MLB-record 27 championships, while the Mets have won the World Series twice. The city was once home to the Brooklyn Dodgers (now the Los Angeles Dodgers ), who won the World Series once, and the New York Giants (now the San Francisco Giants ), who won the World Series five times. Both teams moved to California in 1958. There is one Minor League Baseball team in the city, the Mets-affiliated Brooklyn Cyclones , and the city gained a club in the independent Atlantic League when the Staten Island FerryHawks began play in 2022. The city's National Basketball Association teams are the New York Knicks , who play at Madison Square Garden , and the Brooklyn Nets , who play at the Barclays Center . The New York Liberty is the city's Women's National Basketball Association team. The first national college-level basketball championship, the National Invitation Tournament , was held in New York in 1938 and remains in the city. The metropolitan area is home to three National Hockey League teams. The New York Rangers , one of the league's Original Six , play at Madison Square Garden in Manhattan. The New York Islanders , traditionally representing Long Island , play in UBS Arena in Elmont, New York , but played in Brooklyn's Barclays Center from 2015 to 2020. The New Jersey Devils play at Prudential Center in nearby Newark, New Jersey . In soccer, New York City is represented by New York City FC of Major League Soccer, who play their home games at Yankee Stadium and the New York Red Bulls , who play their home games at Red Bull Arena in nearby Harrison, New Jersey . NJ/NY Gotham FC plays their home games in Red Bull Arena, representing the metropolitan area in the National Women's Soccer League . Brooklyn FC is a professional soccer club based in that borough, fielding a women's team in the first-division USL Super League starting in 2024 and a men's team in the second-division USL Championship in 2025. New York was a host city for the 1994 FIFA World Cup , with matches being played at Giants Stadium in neighboring East Rutherford, New Jersey . New York City will be one of eleven U.S. host cities for the 2026 FIFA World Cup , with the final set to be played at MetLife Stadium, which will be called "New York New Jersey Stadium" during the tournament. The annual United States Open Tennis Championships is one of the world's four Grand Slam tennis tournaments and is held at the National Tennis Center in Flushing Meadows–Corona Park, Queens. The New York City Marathon , which courses through all five boroughs, is the world's largest running marathon, with 51,402 finishers in 2023, who came from all 50 states and 148 nations. The Millrose Games is an annual track and field meet held at the Fort Washington Avenue Armory , whose featured event is the Wanamaker Mile . Boxing is a prominent part of the city's sporting scene, with events like the New York Golden Gloves held at Madison Square Garden each year. Mass transit in New York City, most of which runs 24 hours a day, accounts for one in every three users of mass transit in the United States, and two-thirds of the nation's rail riders live in the New York City metropolitan area. New York City's public bus fleet runs 24/7 and is the largest in North America. The New York City bus system serves the most passengers of any city in the nation: In 2022, MTA New York City Transit 's buses served 483.5 million trips, while MTA Regional Bus Operations handled 100.3 million trips. The Port Authority Bus Terminal is the city's main intercity bus terminal and the world's busiest bus station, serving 250,000 passengers on 7,000 buses each workday in a building opened in 1950 that was designed to accommodate 60,000 daily passengers. A 2021 plan announced by the Port Authority would spend $10 billion to expand capacity and modernize the facility. In 2024, the Port Authority announced plans for a new terminal that would feature a glass atrium at a new main entrance on 41st Street. The New York City Subway system is the largest rapid transit system in the world when measured by stations in operation, with 472 , and by length of routes. Nearly all of New York's subway system is open 24 hours a day, in contrast to the overnight shutdown common to systems in most cities. The New York City Subway is the busiest metropolitan rail transit system in the Western Hemisphere , with 1.70 billion passenger rides in 2019, while Grand Central Terminal is the world's largest railway station by number of train platforms . Public transport is widely used in New York City. 54.6% of New Yorkers commuted to work in 2005 using mass transit . This is in contrast to the rest of the United States, where 91% of commuters travel in automobiles to their workplace. According to the New York City Comptroller , workers in the New York City area spend an average of 6 hours and 18 minutes getting to work each week, the longest commute time in the nation among large cities. New York is the only U.S. city in which a majority (52%) of households do not have a car; only 22% of Manhattanites own a car. Due to their high usage of mass transit , New Yorkers spend less of their household income on transportation than the national average, saving $19 billion annually on transportation compared to other urban Americans. New York City's commuter rail network is the largest in North America. The rail network, connecting New York City to its suburbs, consists of the Long Island Rail Road , Metro-North Railroad , and New Jersey Transit . The combined systems converge at Grand Central Terminal and New York Penn Station and contain more than 250 stations and 20 rail lines. The elevated AirTrain JFK in Queens connects JFK International Airport to the New York City Subway and the Long Island Rail Road. For inter-city rail , New York City is served by Amtrak , whose busiest station by a significant margin is Penn Station on the West Side of Manhattan, from which Amtrak provides connections to Boston, Philadelphia, and Washington, D.C. along the Northeast Corridor , and long-distance train service to other North American cities. The Staten Island Railway rapid transit system solely serves Staten Island, operating 24 hours a day, with access to Manhattan from the St. George Terminal via the Staten Island Ferry . The PATH train links Midtown and Lower Manhattan with Hoboken Terminal , and Newark Penn Station in New Jersey with the World Trade Center Oculus across the Hudson River. Like the New York City Subway, the PATH operates 24 hours a day, meaning three of the five rapid transit systems in the United States which operate on 24-hour schedules are wholly or partly in New York. Multibillion-dollar heavy rail transit projects under construction in New York City include the Second Avenue Subway . New York's airspace is the busiest in the United States and one of the world's busiest air transportation corridors. The three busiest airports in the New York metropolitan area are John F. Kennedy International Airport (with 55.3 million passengers), Newark Liberty International Airport (43.6 million) and LaGuardia Airport (29.0 million); 127.9 million travelers used these three airports in 2022. JFK and Newark Liberty were the busiest and fourth-busiest U.S. gateways for international air passengers, respectively, in 2023. As of 2011 [ update ] , JFK was the busiest airport for international passengers in North America. Described in 2014 by then- Vice President Joe Biden as the kind of airport a travelers would see in "some third world country", LaGuardia Airport has undergone an $8 billion project with federal and state support that has replaced its aging facilities with modern terminals and roadways. Plans have advanced to expand passenger volume at a fourth airport, Stewart International Airport , near Newburgh, New York , by the Port Authority of New York and New Jersey . Other commercial airports in or serving the New York metropolitan area include Long Island MacArthur Airport , Trenton–Mercer Airport and Westchester County Airport . The primary general aviation airport serving the area is Teterboro Airport . The Staten Island Ferry is the world's busiest ferry route , carrying more than 23 million passengers from July 2015 through June 2016 on a 5.2-mile (8.4 km) route between Staten Island and Lower Manhattan and running 24/7. Other ferry systems shuttle commuters between Manhattan and other locales within the city and the metropolitan area. NYC Ferry , a NYCEDC initiative with routes planned to travel to all five boroughs, was launched in 2017. Identified by their color and taxi medallion , the city's 13,587 yellow taxicabs are the only vehicles allowed to pick up riders making street hails throughout the city. Apple green -colored boro taxis can pick up street hails in Upper Manhattan and the four outer boroughs. Long dominated by yellow taxis, high-volume for hire vehicles from Uber and Lyft have provided the most trips in the city since December 2016, when the for-hire vehicles and cabs each had about 10.5 million trips. By October 2023, the 78,000 vehicles-for-hire from such companies as Uber and Lyft combined for 20.3 million trips, while 3.5 million trips were in yellow taxis. The Roosevelt Island Tramway , an aerial tramway that began operation in May 1976, transports 2 million passengers per year the 3,140 feet (960 m) between Roosevelt Island and a station at 59th Street and Second Avenue on Manhattan Island. New York City has mixed cycling conditions which include urban density, relatively flat terrain, congested roadways with stop-and-go traffic, and many pedestrians. The city's large cycling population includes utility cyclists , such as delivery and messenger services; recreational cycling clubs ; and an increasing number of commuters . Cycling is increasingly popular in New York City; in 2022 there were approximately 61,200 people who commuted daily using a bicycle and 610,000 daily bike trips, with both numbers nearly doubling over the previous decade. As of 2022 [ update ] , New York City had 1,525 miles (2,454 km) of bike lanes , including 644 miles (1,036 km) of segregated or "protected" bike lanes citywide. Streets are also a defining feature of the city. The Commissioners' Plan of 1811 greatly influenced its physical development. New York City has an extensive web of freeways and parkways , which link the city's boroughs to each other and to North Jersey , Westchester County, Long Island, and southwestern Connecticut through bridges and tunnels . Because these highways serve millions of outer borough and suburban residents who commute into Manhattan, it is common for motorists to be stranded for hours in traffic congestion that are a daily occurrence, particularly during rush hour . Congestion pricing in New York City was approved in March 2024 and is expected to enter into force in mid-June if lawsuits will not overturn it. Unlike the rest of the United States, New York State prohibits right or left turns at red traffic signals in cities with a population greater than one million, to reduce traffic collisions and increase pedestrian safety. In New York City, therefore, all turns at red lights are illegal unless a sign permitting such maneuvers is present. Manhattan and Staten Island are primarily coterminous with islands of the same names, while Queens and Brooklyn are at the west end of the larger Long Island, and the Bronx is on New York State's mainland. Manhattan Island is linked to New York City's outer boroughs and to New Jersey by an extensive network of bridges and tunnels. The 14-lane George Washington Bridge , connecting Manhattan to New Jersey across the Hudson River, is the world's busiest motor vehicle bridge. The Verrazzano-Narrows Bridge , spanning the Narrows between Brooklyn and Staten Island, is the longest suspension bridge in the Americas and one of the world's longest. The Brooklyn Bridge , with its stone neo-Gothic suspension towers, is an icon of the city itself; opened in 1883, it was the first steel-wire suspension bridge and was the longest suspension bridge in the world until 1903. The Queensboro Bridge "was the longest cantilever span in North America" from 1909 to 1917. The Manhattan Bridge , opened in 1909, "is considered to be the forerunner of modern suspension bridges," and its design "served as the model for the major long-span suspension bridges" of the early 20th century. The Throgs Neck Bridge and Whitestone Bridge connect Queens and the Bronx, while the Triborough Bridge connects the three boroughs of Manhattan, Queens, and the Bronx. The Lincoln Tunnel , which carries 120,000 vehicles a day under the Hudson River between New Jersey and Midtown Manhattan, is the busiest vehicular tunnel in the world. The tunnel was built instead of a bridge to allow unfettered passage of large passenger and cargo ships that sailed through New York Harbor and up the Hudson River to Manhattan's piers. The Holland Tunnel , connecting Lower Manhattan to Jersey City, New Jersey , was the first mechanically ventilated vehicular tunnel when it opened in 1927. The Queens–Midtown Tunnel , built to relieve congestion on the bridges connecting Manhattan with Queens and Brooklyn, was the largest non-federal project in its time when it was completed in 1940. The Brooklyn–Battery Tunnel (officially known as the Hugh L. Carey Tunnel) is the longest continuous underwater vehicular tunnel in North America and runs underneath Battery Park , connecting the Financial District in Lower Manhattan to Red Hook in Brooklyn. Mass transit in New York City, most of which runs 24 hours a day, accounts for one in every three users of mass transit in the United States, and two-thirds of the nation's rail riders live in the New York City metropolitan area. New York City's public bus fleet runs 24/7 and is the largest in North America. The New York City bus system serves the most passengers of any city in the nation: In 2022, MTA New York City Transit 's buses served 483.5 million trips, while MTA Regional Bus Operations handled 100.3 million trips. The Port Authority Bus Terminal is the city's main intercity bus terminal and the world's busiest bus station, serving 250,000 passengers on 7,000 buses each workday in a building opened in 1950 that was designed to accommodate 60,000 daily passengers. A 2021 plan announced by the Port Authority would spend $10 billion to expand capacity and modernize the facility. In 2024, the Port Authority announced plans for a new terminal that would feature a glass atrium at a new main entrance on 41st Street. The New York City Subway system is the largest rapid transit system in the world when measured by stations in operation, with 472 , and by length of routes. Nearly all of New York's subway system is open 24 hours a day, in contrast to the overnight shutdown common to systems in most cities. The New York City Subway is the busiest metropolitan rail transit system in the Western Hemisphere , with 1.70 billion passenger rides in 2019, while Grand Central Terminal is the world's largest railway station by number of train platforms . Public transport is widely used in New York City. 54.6% of New Yorkers commuted to work in 2005 using mass transit . This is in contrast to the rest of the United States, where 91% of commuters travel in automobiles to their workplace. According to the New York City Comptroller , workers in the New York City area spend an average of 6 hours and 18 minutes getting to work each week, the longest commute time in the nation among large cities. New York is the only U.S. city in which a majority (52%) of households do not have a car; only 22% of Manhattanites own a car. Due to their high usage of mass transit , New Yorkers spend less of their household income on transportation than the national average, saving $19 billion annually on transportation compared to other urban Americans. New York City's commuter rail network is the largest in North America. The rail network, connecting New York City to its suburbs, consists of the Long Island Rail Road , Metro-North Railroad , and New Jersey Transit . The combined systems converge at Grand Central Terminal and New York Penn Station and contain more than 250 stations and 20 rail lines. The elevated AirTrain JFK in Queens connects JFK International Airport to the New York City Subway and the Long Island Rail Road. For inter-city rail , New York City is served by Amtrak , whose busiest station by a significant margin is Penn Station on the West Side of Manhattan, from which Amtrak provides connections to Boston, Philadelphia, and Washington, D.C. along the Northeast Corridor , and long-distance train service to other North American cities. The Staten Island Railway rapid transit system solely serves Staten Island, operating 24 hours a day, with access to Manhattan from the St. George Terminal via the Staten Island Ferry . The PATH train links Midtown and Lower Manhattan with Hoboken Terminal , and Newark Penn Station in New Jersey with the World Trade Center Oculus across the Hudson River. Like the New York City Subway, the PATH operates 24 hours a day, meaning three of the five rapid transit systems in the United States which operate on 24-hour schedules are wholly or partly in New York. Multibillion-dollar heavy rail transit projects under construction in New York City include the Second Avenue Subway . New York City's public bus fleet runs 24/7 and is the largest in North America. The New York City bus system serves the most passengers of any city in the nation: In 2022, MTA New York City Transit 's buses served 483.5 million trips, while MTA Regional Bus Operations handled 100.3 million trips. The Port Authority Bus Terminal is the city's main intercity bus terminal and the world's busiest bus station, serving 250,000 passengers on 7,000 buses each workday in a building opened in 1950 that was designed to accommodate 60,000 daily passengers. A 2021 plan announced by the Port Authority would spend $10 billion to expand capacity and modernize the facility. In 2024, the Port Authority announced plans for a new terminal that would feature a glass atrium at a new main entrance on 41st Street. The New York City Subway system is the largest rapid transit system in the world when measured by stations in operation, with 472 , and by length of routes. Nearly all of New York's subway system is open 24 hours a day, in contrast to the overnight shutdown common to systems in most cities. The New York City Subway is the busiest metropolitan rail transit system in the Western Hemisphere , with 1.70 billion passenger rides in 2019, while Grand Central Terminal is the world's largest railway station by number of train platforms . Public transport is widely used in New York City. 54.6% of New Yorkers commuted to work in 2005 using mass transit . This is in contrast to the rest of the United States, where 91% of commuters travel in automobiles to their workplace. According to the New York City Comptroller , workers in the New York City area spend an average of 6 hours and 18 minutes getting to work each week, the longest commute time in the nation among large cities. New York is the only U.S. city in which a majority (52%) of households do not have a car; only 22% of Manhattanites own a car. Due to their high usage of mass transit , New Yorkers spend less of their household income on transportation than the national average, saving $19 billion annually on transportation compared to other urban Americans. New York City's commuter rail network is the largest in North America. The rail network, connecting New York City to its suburbs, consists of the Long Island Rail Road , Metro-North Railroad , and New Jersey Transit . The combined systems converge at Grand Central Terminal and New York Penn Station and contain more than 250 stations and 20 rail lines. The elevated AirTrain JFK in Queens connects JFK International Airport to the New York City Subway and the Long Island Rail Road. For inter-city rail , New York City is served by Amtrak , whose busiest station by a significant margin is Penn Station on the West Side of Manhattan, from which Amtrak provides connections to Boston, Philadelphia, and Washington, D.C. along the Northeast Corridor , and long-distance train service to other North American cities. The Staten Island Railway rapid transit system solely serves Staten Island, operating 24 hours a day, with access to Manhattan from the St. George Terminal via the Staten Island Ferry . The PATH train links Midtown and Lower Manhattan with Hoboken Terminal , and Newark Penn Station in New Jersey with the World Trade Center Oculus across the Hudson River. Like the New York City Subway, the PATH operates 24 hours a day, meaning three of the five rapid transit systems in the United States which operate on 24-hour schedules are wholly or partly in New York. Multibillion-dollar heavy rail transit projects under construction in New York City include the Second Avenue Subway . New York's airspace is the busiest in the United States and one of the world's busiest air transportation corridors. The three busiest airports in the New York metropolitan area are John F. Kennedy International Airport (with 55.3 million passengers), Newark Liberty International Airport (43.6 million) and LaGuardia Airport (29.0 million); 127.9 million travelers used these three airports in 2022. JFK and Newark Liberty were the busiest and fourth-busiest U.S. gateways for international air passengers, respectively, in 2023. As of 2011 [ update ] , JFK was the busiest airport for international passengers in North America. Described in 2014 by then- Vice President Joe Biden as the kind of airport a travelers would see in "some third world country", LaGuardia Airport has undergone an $8 billion project with federal and state support that has replaced its aging facilities with modern terminals and roadways. Plans have advanced to expand passenger volume at a fourth airport, Stewart International Airport , near Newburgh, New York , by the Port Authority of New York and New Jersey . Other commercial airports in or serving the New York metropolitan area include Long Island MacArthur Airport , Trenton–Mercer Airport and Westchester County Airport . The primary general aviation airport serving the area is Teterboro Airport .The Staten Island Ferry is the world's busiest ferry route , carrying more than 23 million passengers from July 2015 through June 2016 on a 5.2-mile (8.4 km) route between Staten Island and Lower Manhattan and running 24/7. Other ferry systems shuttle commuters between Manhattan and other locales within the city and the metropolitan area. NYC Ferry , a NYCEDC initiative with routes planned to travel to all five boroughs, was launched in 2017. Identified by their color and taxi medallion , the city's 13,587 yellow taxicabs are the only vehicles allowed to pick up riders making street hails throughout the city. Apple green -colored boro taxis can pick up street hails in Upper Manhattan and the four outer boroughs. Long dominated by yellow taxis, high-volume for hire vehicles from Uber and Lyft have provided the most trips in the city since December 2016, when the for-hire vehicles and cabs each had about 10.5 million trips. By October 2023, the 78,000 vehicles-for-hire from such companies as Uber and Lyft combined for 20.3 million trips, while 3.5 million trips were in yellow taxis. The Roosevelt Island Tramway , an aerial tramway that began operation in May 1976, transports 2 million passengers per year the 3,140 feet (960 m) between Roosevelt Island and a station at 59th Street and Second Avenue on Manhattan Island. New York City has mixed cycling conditions which include urban density, relatively flat terrain, congested roadways with stop-and-go traffic, and many pedestrians. The city's large cycling population includes utility cyclists , such as delivery and messenger services; recreational cycling clubs ; and an increasing number of commuters . Cycling is increasingly popular in New York City; in 2022 there were approximately 61,200 people who commuted daily using a bicycle and 610,000 daily bike trips, with both numbers nearly doubling over the previous decade. As of 2022 [ update ] , New York City had 1,525 miles (2,454 km) of bike lanes , including 644 miles (1,036 km) of segregated or "protected" bike lanes citywide. Streets are also a defining feature of the city. The Commissioners' Plan of 1811 greatly influenced its physical development. New York City has an extensive web of freeways and parkways , which link the city's boroughs to each other and to North Jersey , Westchester County, Long Island, and southwestern Connecticut through bridges and tunnels . Because these highways serve millions of outer borough and suburban residents who commute into Manhattan, it is common for motorists to be stranded for hours in traffic congestion that are a daily occurrence, particularly during rush hour . Congestion pricing in New York City was approved in March 2024 and is expected to enter into force in mid-June if lawsuits will not overturn it. Unlike the rest of the United States, New York State prohibits right or left turns at red traffic signals in cities with a population greater than one million, to reduce traffic collisions and increase pedestrian safety. In New York City, therefore, all turns at red lights are illegal unless a sign permitting such maneuvers is present. Manhattan and Staten Island are primarily coterminous with islands of the same names, while Queens and Brooklyn are at the west end of the larger Long Island, and the Bronx is on New York State's mainland. Manhattan Island is linked to New York City's outer boroughs and to New Jersey by an extensive network of bridges and tunnels. The 14-lane George Washington Bridge , connecting Manhattan to New Jersey across the Hudson River, is the world's busiest motor vehicle bridge. The Verrazzano-Narrows Bridge , spanning the Narrows between Brooklyn and Staten Island, is the longest suspension bridge in the Americas and one of the world's longest. The Brooklyn Bridge , with its stone neo-Gothic suspension towers, is an icon of the city itself; opened in 1883, it was the first steel-wire suspension bridge and was the longest suspension bridge in the world until 1903. The Queensboro Bridge "was the longest cantilever span in North America" from 1909 to 1917. The Manhattan Bridge , opened in 1909, "is considered to be the forerunner of modern suspension bridges," and its design "served as the model for the major long-span suspension bridges" of the early 20th century. The Throgs Neck Bridge and Whitestone Bridge connect Queens and the Bronx, while the Triborough Bridge connects the three boroughs of Manhattan, Queens, and the Bronx. The Lincoln Tunnel , which carries 120,000 vehicles a day under the Hudson River between New Jersey and Midtown Manhattan, is the busiest vehicular tunnel in the world. The tunnel was built instead of a bridge to allow unfettered passage of large passenger and cargo ships that sailed through New York Harbor and up the Hudson River to Manhattan's piers. The Holland Tunnel , connecting Lower Manhattan to Jersey City, New Jersey , was the first mechanically ventilated vehicular tunnel when it opened in 1927. The Queens–Midtown Tunnel , built to relieve congestion on the bridges connecting Manhattan with Queens and Brooklyn, was the largest non-federal project in its time when it was completed in 1940. The Brooklyn–Battery Tunnel (officially known as the Hugh L. Carey Tunnel) is the longest continuous underwater vehicular tunnel in North America and runs underneath Battery Park , connecting the Financial District in Lower Manhattan to Red Hook in Brooklyn. New York City has been a metropolitan municipality with a strong mayor–council form of government since its consolidation in 1898. The city government is responsible for public education, correctional institutions, public safety, recreational facilities, sanitation, water supply, and welfare services. The City Council is a unicameral body of 51 council members whose districts are defined by geographic population boundaries. Each term for the mayor and council members lasts four years and has a two consecutive-term limit , which is reset after a four-year break. The New York City Administrative Code , the New York City Rules , and The City Record are the code of local laws, compilation of regulations, and official journal, respectively. Each borough is coextensive with a judicial district of the state Unified Court System , of which the Criminal Court and the Civil Court are the local courts, while the New York Supreme Court conducts major trials and appeals. Manhattan hosts the First Department of the Supreme Court, Appellate Division , while Brooklyn hosts the Second Department. There are several extrajudicial administrative courts , which are executive agencies and not part of the state Unified Court System. New York City is divided between, and is host to the main branches of, two different U.S. district courts : the District Court for the Southern District of New York , whose main courthouse is on Foley Square near City Hall in Manhattan and whose jurisdiction includes Manhattan and the Bronx; and the District Court for the Eastern District of New York , whose main courthouse is in Brooklyn and whose jurisdiction includes Brooklyn, Queens, and Staten Island. The U.S. Court of Appeals for the Second Circuit and U.S. Court of International Trade are based in New York, also on Foley Square in Manhattan. The city's mayor is Eric Adams , who was elected in 2021 with 67% of the vote and assumed office on January 1, 2022. The Democratic Party holds the majority of public offices. As of November 2023, 67% of active registered voters in the city are Democrats and 10.2% are Republicans . New York City has not been carried by a Republican presidential candidate since President Calvin Coolidge won all five boroughs in 1924 . A Republican candidate for statewide office has not won all five boroughs of the city since it was incorporated in 1898. In redistricting following the 2020 census, 14 of the 26 congressional districts in the state of New York include portions of New York City. New York City is the most important geographical source of political fundraising in the United States. From 2016 to 2020, eight of the ten ZIP Codes where residents gave the greatest number of maximum allowable contribution of $2,800 to congressional candidates were located in New York City. The city has a strong imbalance of payments with the national and state governments. It receives 83 cents in services for every $1 it sends to the federal government in taxes (or annually sends $11.4 billion more than it receives back). City residents and businesses also sent an additional $4.1 billion in the 2009–2010 fiscal year to the state of New York than the city received in return. In 2006, the sister city program was restructured and renamed New York City Global Partners . Through this program, New York City has expanded its international outreach to a network of cities worldwide. New York's historic sister cities are denoted below by the year they joined New York City's partnership network. New York City has been a metropolitan municipality with a strong mayor–council form of government since its consolidation in 1898. The city government is responsible for public education, correctional institutions, public safety, recreational facilities, sanitation, water supply, and welfare services. The City Council is a unicameral body of 51 council members whose districts are defined by geographic population boundaries. Each term for the mayor and council members lasts four years and has a two consecutive-term limit , which is reset after a four-year break. The New York City Administrative Code , the New York City Rules , and The City Record are the code of local laws, compilation of regulations, and official journal, respectively. Each borough is coextensive with a judicial district of the state Unified Court System , of which the Criminal Court and the Civil Court are the local courts, while the New York Supreme Court conducts major trials and appeals. Manhattan hosts the First Department of the Supreme Court, Appellate Division , while Brooklyn hosts the Second Department. There are several extrajudicial administrative courts , which are executive agencies and not part of the state Unified Court System. New York City is divided between, and is host to the main branches of, two different U.S. district courts : the District Court for the Southern District of New York , whose main courthouse is on Foley Square near City Hall in Manhattan and whose jurisdiction includes Manhattan and the Bronx; and the District Court for the Eastern District of New York , whose main courthouse is in Brooklyn and whose jurisdiction includes Brooklyn, Queens, and Staten Island. The U.S. Court of Appeals for the Second Circuit and U.S. Court of International Trade are based in New York, also on Foley Square in Manhattan. The city's mayor is Eric Adams , who was elected in 2021 with 67% of the vote and assumed office on January 1, 2022. The Democratic Party holds the majority of public offices. As of November 2023, 67% of active registered voters in the city are Democrats and 10.2% are Republicans . New York City has not been carried by a Republican presidential candidate since President Calvin Coolidge won all five boroughs in 1924 . A Republican candidate for statewide office has not won all five boroughs of the city since it was incorporated in 1898. In redistricting following the 2020 census, 14 of the 26 congressional districts in the state of New York include portions of New York City. New York City is the most important geographical source of political fundraising in the United States. From 2016 to 2020, eight of the ten ZIP Codes where residents gave the greatest number of maximum allowable contribution of $2,800 to congressional candidates were located in New York City. The city has a strong imbalance of payments with the national and state governments. It receives 83 cents in services for every $1 it sends to the federal government in taxes (or annually sends $11.4 billion more than it receives back). City residents and businesses also sent an additional $4.1 billion in the 2009–2010 fiscal year to the state of New York than the city received in return. In 2006, the sister city program was restructured and renamed New York City Global Partners . Through this program, New York City has expanded its international outreach to a network of cities worldwide. New York's historic sister cities are denoted below by the year they joined New York City's partnership network.

Wiki

Cholera

https://api.wikimedia.org/core/v1/wikipedia/en/page/China/html

China

China , [lower-alpha 10] officially the People's Republic of China ( PRC ), [lower-alpha 11] is a country in East Asia . With a population exceeding 1.4 billion, it is the world's second-most populous country . China spans the equivalent of five time zones and borders fourteen countries by land. [lower-alpha 12] With an area of nearly 9.6 million square kilometers (3,700,000 sq mi) , it is the third-largest country by total land area. [lower-alpha 13] The country is divided into 33 province-level divisions , [lower-alpha 14] inclusive of 22 provinces , [lower-alpha 14] five autonomous regions , four municipalities , and two semi-autonomous special administrative regions . Beijing is the national capital, while Shanghai is its most populous city and largest financial center . One of the cradles of civilization , China has been inhabited since the Paleolithic era , with the earliest dynasties emerging in the Yellow River basin before the late second millennium BCE. The eighth to third centuries BCE saw a breakdown in the authority of the Zhou dynasty , accompanied by the emergence of administrative and military techniques, literature , philosophy , and historiography . In 221 BCE, China was unified under an emperor for the first time. Appointed non-hereditary officials began ruling counties instead of the aristocracy, ushering in more than two millennia of imperial dynasties including the Qin , Han , Tang , Yuan , Ming , and Qing . With the invention of gunpowder and paper , the establishment of the Silk Road , and the building of the Great Wall , Chinese culture —including languages, traditions, architecture, philosophy and technology—flourished and has heavily influenced East Asia and beyond. After decades of struggle, the monarchy was overthrown in 1912 and the Republic of China (ROC) was established. Despite China's eventual victory in the Second Sino-Japanese War and the Pacific War in general, numerous atrocities such as the Nanjing Massacre left lasting effects on the country. Concurrently during this period, the Chinese Communist Party (CCP) and the Kuomintang (KMT) government were fighting sporadically since 1927, with a brief truce as a united front when Japan began invading the country. The second phase of the civil war resumed not long after Japan was defeated, and by 1949, the CCP had established control on most of the territories of the country. As the KMT retreated to Taiwan , the country was split with both sides claiming to be the sole legitimate government of China. After the land reforms , later attempts to realize communism failed—the Great Leap Forward led to a massive famine of millions of citizens, while the Cultural Revolution caused a chaotic period of persecution and zealous Maoist populism . In 1971, the PRC replaced the ROC as China's representation in the United Nations (UN). Following the Sino-Soviet split , the Shanghai Communiqué in 1972 marked the beginning of normalized relations with the United States . Economic reforms that began in 1978 led by reformists within the CCP moved the country away from a socialist planned economy toward an increasingly capitalist market economy , spurring significant economic growth, although liberal and democratic political reforms stalled after the June Fourth Incident in 1989. China is a unitary one-party socialist republic led by the CCP. It is a founding member of the UN and one of the five permanent members of the UN Security Council . It is a founding member of several multilateral and regional organizations such as the AIIB , the Silk Road Fund , the New Development Bank , and the RCEP . It is a member of the BRICS , the G20 , APEC , the SCO , and the East Asia Summit . Making up around one-fifth of the world economy , the Chinese economy is the world's largest economy by GDP at purchasing power parity , the second-largest economy by nominal GDP , and the second-wealthiest country , albeit ranking poorly in measures of democracy , human rights and religious freedoms . The country has been one of the fastest-growing major economies and is the world's largest manufacturer and exporter , as well as the second-largest importer . China is a nuclear-weapon state with the world's largest standing army by military personnel and the second-largest defense budget . It is a great power and a regional power . The word "China" has been used in English since the 16th century; however, it was not used by the Chinese themselves during this period. Its origin has been traced through Portuguese , Malay , and Persian back to the Sanskrit word CÄ«na , used in ancient India . "China" appears in Richard Eden 's 1555 translation [lower-alpha 15] of the 1516 journal of the Portuguese explorer Duarte Barbosa . [lower-alpha 16] Barbosa's usage was derived from Persian ChÄ«n ( چین ), which in turn derived from Sanskrit CÄ«na ( चीन ). CÄ«na was first used in early Hindu scripture, including the Mahabharata (5th century BCE) and the Laws of Manu (2nd century BCE). In 1655, Martino Martini suggested that the word China is derived ultimately from the name of the Qin dynasty (221–206 BCE). Although use in Indian sources precedes this dynasty, this derivation is still given in various sources. The origin of the Sanskrit word is a matter of debate. Alternative suggestions include the names for Yelang and the Jing or Chu state. The official name of the modern state is the "People's Republic of China" ( simplified Chinese : ä¸­åŽäººæ°‘å ±å’Œå›½ ; traditional Chinese : ä¸­è¯äººæ°‘å ±å’Œåœ‹ ; pinyin : Zhōnghuá rénmín gònghéguó ). The shorter form is "China" ( 中国 ; 中國 ; Zhōngguó ), from zhōng ('central') and guó ('state'), a term which developed under the Western Zhou dynasty in reference to its royal demesne . [lower-alpha 17] [lower-alpha 18] It was used in official documents as an synonym for the state under the Qing . The name Zhongguo is also translated as 'Middle Kingdom' in English. China is sometimes referred to as " mainland China " or "the Mainland" when distinguishing it from the Republic of China . Archaeological evidence suggests that early hominids inhabited China 2.25 million years ago. The hominid fossils of Peking Man , a Homo erectus who used fire , have been dated to between 680,000 and 780,000 years ago . The fossilized teeth of Homo sapiens (dated to 125,000–80,000 years ago) have been discovered in Fuyan Cave . Chinese proto-writing existed in Jiahu around 6600 BCE, at Damaidi around 6000 BCE, Dadiwan from 5800 to 5400 BCE, and Banpo dating from the 5th millennium BCE. Some scholars have suggested that the Jiahu symbols (7th millennium BCE) constituted the earliest Chinese writing system. According to traditional Chinese historiography , the Xia dynasty was established during the late third millennium BC, marking the beginning of the dynastic cycle that was understood to underpin China's entire political history. In the modern era, the Xia's historicity came under increasing scrutiny, in part due to the earliest known attestation of the Xia being written millennia after the date given for their collapse. In 1959, archaeologists discovered sites belonging to the Erlitou culture that existed during the early Bronze Age ; they have since been characterized as the remains of the historical Xia, but this conception is often rejected. The Shang dynasty that traditionally succeeded the Xia is the earliest for which there are both contemporary written records and undisputed archaeological evidence. The Shang ruled much of the Yellow River valley until the 11th century BCE, with the earliest hard evidence dating to c. 1300 BCE . The oracle bone script , attested from c. 1250 BCE but generally assumed to be considerably older, represents the oldest known form of written Chinese , and is the direct ancestor of modern Chinese characters . The Shang were overthrown by the Zhou , who ruled between the 11th and 5th centuries BCE, though the centralized authority of Tianzi was slowly eroded by Fengjiang lords. Some principalities eventually emerged from the weakened Zhou and continually waged war with each other during the 300-year Spring and Autumn period . By the time of the Warring States period of the 5th–3rd centuries BCE, there were seven major powerful states left. The Warring States period ended in 221 BCE after the state of Qin conquered the other six states, reunited China and established the dominant order of autocracy . King Zheng of Qin proclaimed himself the Emperor of the Qin dynasty , becoming the first emperor of a unified China. He enacted Qin's legalist reforms, notably the standardization of Chinese characters, measurements , road widths, and currency . His dynasty also conquered the Yue tribes in Guangxi , Guangdong , and Northern Vietnam . The Qin dynasty lasted only fifteen years, falling soon after the First Emperor's death. Following widespread revolts during which the imperial library was burned , [lower-alpha 19] the Han dynasty emerged to rule China between 206 BCE and CE 220, creating a cultural identity among its populace still remembered in the ethnonym of the modern Han Chinese . The Han expanded the empire's territory considerably , with military campaigns reaching Central Asia, Mongolia , Korea , and Yunnan , and the recovery of Guangdong and northern Vietnam from Nanyue . Han involvement in Central Asia and Sogdia helped establish the land route of the Silk Road , replacing the earlier path over the Himalayas to India. Han China gradually became the largest economy of the ancient world. Despite the Han's initial decentralization and the official abandonment of the Qin philosophy of Legalism in favor of Confucianism , Qin's legalist institutions and policies continued to be employed by the Han government and its successors. After the end of the Han dynasty , a period of strife known as Three Kingdoms followed, at the end of which Wei was swiftly overthrown by the Jin dynasty . The Jin fell to civil war upon the ascension of a developmentally disabled emperor ; the Five Barbarians then rebelled and ruled northern China as the Sixteen States . The Xianbei unified them as the Northern Wei , whose Emperor Xiaowen reversed his predecessors' apartheid policies and enforced a drastic sinification on his subjects . In the south, the general Liu Yu secured the abdication of the Jin in favor of the Liu Song . The various successors of these states became known as the Northern and Southern dynasties , with the two areas finally reunited by the Sui in 581. The Sui restored the Han to power through China, reformed its agriculture, economy and imperial examination system, constructed the Grand Canal , and patronized Buddhism . However, they fell quickly when their conscription for public works and a failed war in northern Korea provoked widespread unrest. Under the succeeding Tang and Song dynasties , Chinese economy, technology, and culture entered a golden age. The Tang dynasty retained control of the Western Regions and the Silk Road, which brought traders to as far as Mesopotamia and the Horn of Africa , and made the capital Chang'an a cosmopolitan urban center. However, it was devastated and weakened by the An Lushan rebellion in the 8th century. In 907, the Tang disintegrated completely when the local military governors became ungovernable. The Song dynasty ended the separatist situation in 960, leading to a balance of power between the Song and the Liao dynasty . The Song was the first government in world history to issue paper money and the first Chinese polity to establish a permanent navy which was supported by the developed shipbuilding industry along with the sea trade. Between the 10th and 11th century CE, the population of China doubled to around 100 million people, mostly because of the expansion of rice cultivation in central and southern China, and the production of abundant food surpluses. The Song dynasty also saw a revival of Confucianism , in response to the growth of Buddhism during the Tang, and a flourishing of philosophy and the arts, as landscape art and porcelain were brought to new levels of complexity. However, the military weakness of the Song army was observed by the Jin dynasty . In 1127, Emperor Huizong of Song and the capital Bianjing were captured during the Jin–Song Wars . The remnants of the Song retreated to southern China . The Mongol conquest of China began in 1205 with the gradual conquest of Western Xia by Genghis Khan , who also invaded Jin territories . In 1271, the Mongol leader Kublai Khan established the Yuan dynasty , which conquered the last remnant of the Song dynasty in 1279. Before the Mongol invasion, the population of Song China was 120 million citizens; this was reduced to 60 million by the time of the census in 1300. A peasant named Zhu Yuanzhang overthrew the Yuan in 1368 and founded the Ming dynasty as the Hongwu Emperor . Under the Ming dynasty, China enjoyed another golden age, developing one of the strongest navies in the world and a rich and prosperous economy amid a flourishing of art and culture. It was during this period that admiral Zheng He led the Ming treasure voyages throughout the Indian Ocean , reaching as far as East Africa . In the early Ming dynasty, China's capital was moved from Nanjing to Beijing. With the budding of capitalism, philosophers such as Wang Yangming critiqued and expanded Neo-Confucianism with concepts of individualism and equality of four occupations . The scholar-official stratum became a supporting force of industry and commerce in the tax boycott movements, which, together with the famines and defense against Japanese invasions of Korea (1592–1598) and Later Jin incursions led to an exhausted treasury. In 1644, Beijing was captured by a coalition of peasant rebel forces led by Li Zicheng . The Chongzhen Emperor committed suicide when the city fell. The Manchu Qing dynasty , then allied with Ming dynasty general Wu Sangui , overthrew Li's short-lived Shun dynasty and subsequently seized control of Beijing, which became the new capital of the Qing dynasty. The Qing dynasty, which lasted from 1644 until 1912, was the last imperial dynasty of China. The Ming-Qing transition (1618–1683) cost 25 million lives, but the Qing appeared to have restored China's imperial power and inaugurated another flowering of the arts. After the Southern Ming ended, the further conquest of the Dzungar Khanate added Mongolia, Tibet and Xinjiang to the empire. Meanwhile, China's population growth resumed and shortly began to accelerate. It is commonly agreed that pre-modern China's population experienced two growth spurts, one during the Northern Song period (960–1127), and other during the Qing period (around 1700–1830). By the High Qing era China was possibly the most commercialized country in the world, and imperial China experienced a second commercial revolution by the end of the 18th century. On the other hand, the centralized autocracy was strengthened in part to suppress anti-Qing sentiment with the policy of valuing agriculture and restraining commerce, like the Haijin during the early Qing period and ideological control as represented by the literary inquisition , causing some social and technological stagnation. In the mid-19th century, the Opium Wars with Britain and France forced China to pay compensation, open treaty ports, allow extraterritoriality for foreign nationals, and cede Hong Kong to the British under the 1842 Treaty of Nanking , the first of what have been termed as the " unequal treaties ". The First Sino-Japanese War (1894–1895) resulted in Qing China's loss of influence in the Korean Peninsula , as well as the cession of Taiwan to Japan . The Qing dynasty also began experiencing internal unrest in which tens of millions of people died, especially in the White Lotus Rebellion , the failed Taiping Rebellion that ravaged southern China in the 1850s and 1860s and the Dungan Revolt (1862–1877) in the northwest. The initial success of the Self-Strengthening Movement of the 1860s was frustrated by a series of military defeats in the 1880s and 1890s. In the 19th century, the great Chinese diaspora began. Losses due to emigration were added to by conflicts and catastrophes such as the Northern Chinese Famine of 1876–1879 , in which between 9 and 13 million people died. The Guangxu Emperor drafted a reform plan in 1898 to establish a modern constitutional monarchy , but these plans were thwarted by the Empress Dowager Cixi . The ill-fated anti-foreign Boxer Rebellion of 1899–1901 further weakened the dynasty. Although Cixi sponsored a program of reforms known as the late Qing reforms , the Xinhai Revolution of 1911–1912 ended the Qing dynasty and established the Republic of China . Puyi , the last Emperor, abdicated in 1912 . On 1 January 1912, the Republic of China was established, and Sun Yat-sen of the Kuomintang (KMT) was proclaimed provisional president. In March 1912, the presidency was given to Yuan Shikai , a former Qing general who in 1915 proclaimed himself Emperor of China . In the face of popular condemnation and opposition from his own Beiyang Army , he was forced to abdicate and re-establish the republic in 1916. After Yuan Shikai's death in 1916, China was politically fragmented. Its Beijing-based government was internationally recognized but virtually powerless; regional warlords controlled most of its territory. During this period , China participated in World War I and saw a far-reaching popular uprising (the May Fourth Movement ). In the late 1920s, the Kuomintang under Chiang Kai-shek was able to reunify the country under its own control with a series of deft military and political maneuverings known collectively as the Northern Expedition . The Kuomintang moved the nation's capital to Nanjing and implemented "political tutelage", an intermediate stage of political development outlined in Sun Yat-sen's Three Principles of the People program for transforming China into a modern democratic state. The Kuomintang briefly allied with the Chinese Communist Party (CCP) during the Northern Expedition, though the alliance broke down in 1927 after Chiang violently suppressed the CCP and other leftists Shanghai, marking the beginning of the Chinese Civil War . The CCP declared areas of the country as the Chinese Soviet Republic (Jiangxi Soviet) in November 1931 in Ruijin , Jiangxi . The Jiangxi Soviet was wiped out by the KMT armies in 1934, leading the CCP to initiate the Long March and relocate to Yan'an in Shaanxi . It would be the base of the communists before major combat in the Chinese Civil War ended in 1949. In 1931, Japan invaded and occupied Manchuria . Japan invaded other parts of China in 1937, precipitating the Second Sino-Japanese War (1937–1945), a theater of World War II . The war forced an uneasy alliance between the Kuomintang and the CCP. Japanese forces committed numerous war atrocities against the civilian population; as many as 20 million Chinese civilians died. An estimated 40,000 to 300,000 Chinese were massacred in Nanjing alone during the Japanese occupation. China, along with the UK, the United States, and the Soviet Union , were recognized as the Allied " Big Four " in the Declaration by United Nations . Along with the other three great powers, China was one of the four major Allies of World War II , and was later considered one of the primary victors in the war. After the surrender of Japan in 1945, Taiwan, including the Penghu , was handed over to Chinese control ; however, the validity of this handover is controversial . China emerged victorious but war-ravaged and financially drained. The continued distrust between the Kuomintang and the Communists led to the resumption of civil war. Constitutional rule was established in 1947, but because of the ongoing unrest, many provisions of the ROC constitution were never implemented in mainland China. Afterwards, the CCP took control of most of mainland China, and the ROC government retreated offshore to Taiwan . On 1 October 1949, CCP Chairman Mao Zedong formally proclaimed the People's Republic of China in Tiananmen Square , Beijing. In 1950, the PRC captured Hainan from the ROC and annexed Tibet . However, remaining Kuomintang forces continued to wage an insurgency in western China throughout the 1950s. The CCP consolidated its popularity among the peasants through the Land Reform Movement , which included the state-tolerated executions of between 1 and 2 million landlords by peasants and former tenants. Though the PRC initially allied closely with the Soviet Union, the relations between the two communist nations gradually deteriorated , leading China to develop an independent industrial system and its own nuclear weapons . The Chinese population increased from 550 million in 1950 to 900 million in 1974. However, the Great Leap Forward , an idealistic massive industrialization project, resulted in an estimated 15 to 55 million deaths between 1959 and 1961, mostly from starvation. In 1964, China's first atomic bomb exploded successfully. In 1966, Mao and his allies launched the Cultural Revolution , sparking a decade of political recrimination and social upheaval that lasted until Mao's death in 1976. In October 1971, the PRC replaced the ROC in the United Nations, and took its seat as a permanent member of the Security Council. After Mao's death, the Gang of Four was arrested by Hua Guofeng and held responsible for the Cultural Revolution. The Cultural Revolution was rebuked, with millions rehabilitated. Deng Xiaoping took power in 1978, and instituted large-scale political and economic reforms , together with the " Eight Elders ", most senior and influential members of the party. The government loosened its control and the communes were gradually disbanded. Agricultural collectivization was dismantled and farmlands privatized. While foreign trade became a major focus, special economic zones (SEZs) were created. Inefficient state-owned enterprises (SOEs) were restructured and some closed. This marked China's transition away from planned economy. China adopted its current constitution on 4 December 1982. In 1989, the country saw the protests in Tiananmen Square unfold , and later saw other protests over the entire nation. Zhao Ziyang was put under house arrest for his sympathies to the protests and was replaced by Jiang Zemin . Jiang continued economic reforms, closing many SOEs and trimming down " iron rice bowl " (life-tenure positions). China's economy grew sevenfold during this time. British Hong Kong and Portuguese Macau returned to China in 1997 and 1999 , respectively, as special administrative regions under the principle of one country, two systems . The country joined the World Trade Organization in 2001. On the 16th CCP National Congress in 2002, Hu Jintao succeeded Jiang as the general secretary. Under Hu, China maintained its high rate of economic growth, overtaking the United Kingdom, France, Germany and Japan to become the world's second-largest economy. However, the growth also severely impacted the country's resources and environment, and caused major social displacement. Xi Jinping succeeded Hu as paramount leader on the 18th CCP National Congress in 2012. Shortly after his ascension to power, Xi launched a vast anti-corruption crackdown , that prosecuted more than 2 million officials by 2022. During his tenure , Xi consolidated power unseen since the initiation of economic and political reforms. Archaeological evidence suggests that early hominids inhabited China 2.25 million years ago. The hominid fossils of Peking Man , a Homo erectus who used fire , have been dated to between 680,000 and 780,000 years ago . The fossilized teeth of Homo sapiens (dated to 125,000–80,000 years ago) have been discovered in Fuyan Cave . Chinese proto-writing existed in Jiahu around 6600 BCE, at Damaidi around 6000 BCE, Dadiwan from 5800 to 5400 BCE, and Banpo dating from the 5th millennium BCE. Some scholars have suggested that the Jiahu symbols (7th millennium BCE) constituted the earliest Chinese writing system. According to traditional Chinese historiography , the Xia dynasty was established during the late third millennium BC, marking the beginning of the dynastic cycle that was understood to underpin China's entire political history. In the modern era, the Xia's historicity came under increasing scrutiny, in part due to the earliest known attestation of the Xia being written millennia after the date given for their collapse. In 1959, archaeologists discovered sites belonging to the Erlitou culture that existed during the early Bronze Age ; they have since been characterized as the remains of the historical Xia, but this conception is often rejected. The Shang dynasty that traditionally succeeded the Xia is the earliest for which there are both contemporary written records and undisputed archaeological evidence. The Shang ruled much of the Yellow River valley until the 11th century BCE, with the earliest hard evidence dating to c. 1300 BCE . The oracle bone script , attested from c. 1250 BCE but generally assumed to be considerably older, represents the oldest known form of written Chinese , and is the direct ancestor of modern Chinese characters . The Shang were overthrown by the Zhou , who ruled between the 11th and 5th centuries BCE, though the centralized authority of Tianzi was slowly eroded by Fengjiang lords. Some principalities eventually emerged from the weakened Zhou and continually waged war with each other during the 300-year Spring and Autumn period . By the time of the Warring States period of the 5th–3rd centuries BCE, there were seven major powerful states left. The Warring States period ended in 221 BCE after the state of Qin conquered the other six states, reunited China and established the dominant order of autocracy . King Zheng of Qin proclaimed himself the Emperor of the Qin dynasty , becoming the first emperor of a unified China. He enacted Qin's legalist reforms, notably the standardization of Chinese characters, measurements , road widths, and currency . His dynasty also conquered the Yue tribes in Guangxi , Guangdong , and Northern Vietnam . The Qin dynasty lasted only fifteen years, falling soon after the First Emperor's death. Following widespread revolts during which the imperial library was burned , [lower-alpha 19] the Han dynasty emerged to rule China between 206 BCE and CE 220, creating a cultural identity among its populace still remembered in the ethnonym of the modern Han Chinese . The Han expanded the empire's territory considerably , with military campaigns reaching Central Asia, Mongolia , Korea , and Yunnan , and the recovery of Guangdong and northern Vietnam from Nanyue . Han involvement in Central Asia and Sogdia helped establish the land route of the Silk Road , replacing the earlier path over the Himalayas to India. Han China gradually became the largest economy of the ancient world. Despite the Han's initial decentralization and the official abandonment of the Qin philosophy of Legalism in favor of Confucianism , Qin's legalist institutions and policies continued to be employed by the Han government and its successors. After the end of the Han dynasty , a period of strife known as Three Kingdoms followed, at the end of which Wei was swiftly overthrown by the Jin dynasty . The Jin fell to civil war upon the ascension of a developmentally disabled emperor ; the Five Barbarians then rebelled and ruled northern China as the Sixteen States . The Xianbei unified them as the Northern Wei , whose Emperor Xiaowen reversed his predecessors' apartheid policies and enforced a drastic sinification on his subjects . In the south, the general Liu Yu secured the abdication of the Jin in favor of the Liu Song . The various successors of these states became known as the Northern and Southern dynasties , with the two areas finally reunited by the Sui in 581. The Sui restored the Han to power through China, reformed its agriculture, economy and imperial examination system, constructed the Grand Canal , and patronized Buddhism . However, they fell quickly when their conscription for public works and a failed war in northern Korea provoked widespread unrest. Under the succeeding Tang and Song dynasties , Chinese economy, technology, and culture entered a golden age. The Tang dynasty retained control of the Western Regions and the Silk Road, which brought traders to as far as Mesopotamia and the Horn of Africa , and made the capital Chang'an a cosmopolitan urban center. However, it was devastated and weakened by the An Lushan rebellion in the 8th century. In 907, the Tang disintegrated completely when the local military governors became ungovernable. The Song dynasty ended the separatist situation in 960, leading to a balance of power between the Song and the Liao dynasty . The Song was the first government in world history to issue paper money and the first Chinese polity to establish a permanent navy which was supported by the developed shipbuilding industry along with the sea trade. Between the 10th and 11th century CE, the population of China doubled to around 100 million people, mostly because of the expansion of rice cultivation in central and southern China, and the production of abundant food surpluses. The Song dynasty also saw a revival of Confucianism , in response to the growth of Buddhism during the Tang, and a flourishing of philosophy and the arts, as landscape art and porcelain were brought to new levels of complexity. However, the military weakness of the Song army was observed by the Jin dynasty . In 1127, Emperor Huizong of Song and the capital Bianjing were captured during the Jin–Song Wars . The remnants of the Song retreated to southern China . The Mongol conquest of China began in 1205 with the gradual conquest of Western Xia by Genghis Khan , who also invaded Jin territories . In 1271, the Mongol leader Kublai Khan established the Yuan dynasty , which conquered the last remnant of the Song dynasty in 1279. Before the Mongol invasion, the population of Song China was 120 million citizens; this was reduced to 60 million by the time of the census in 1300. A peasant named Zhu Yuanzhang overthrew the Yuan in 1368 and founded the Ming dynasty as the Hongwu Emperor . Under the Ming dynasty, China enjoyed another golden age, developing one of the strongest navies in the world and a rich and prosperous economy amid a flourishing of art and culture. It was during this period that admiral Zheng He led the Ming treasure voyages throughout the Indian Ocean , reaching as far as East Africa . In the early Ming dynasty, China's capital was moved from Nanjing to Beijing. With the budding of capitalism, philosophers such as Wang Yangming critiqued and expanded Neo-Confucianism with concepts of individualism and equality of four occupations . The scholar-official stratum became a supporting force of industry and commerce in the tax boycott movements, which, together with the famines and defense against Japanese invasions of Korea (1592–1598) and Later Jin incursions led to an exhausted treasury. In 1644, Beijing was captured by a coalition of peasant rebel forces led by Li Zicheng . The Chongzhen Emperor committed suicide when the city fell. The Manchu Qing dynasty , then allied with Ming dynasty general Wu Sangui , overthrew Li's short-lived Shun dynasty and subsequently seized control of Beijing, which became the new capital of the Qing dynasty. The Qing dynasty, which lasted from 1644 until 1912, was the last imperial dynasty of China. The Ming-Qing transition (1618–1683) cost 25 million lives, but the Qing appeared to have restored China's imperial power and inaugurated another flowering of the arts. After the Southern Ming ended, the further conquest of the Dzungar Khanate added Mongolia, Tibet and Xinjiang to the empire. Meanwhile, China's population growth resumed and shortly began to accelerate. It is commonly agreed that pre-modern China's population experienced two growth spurts, one during the Northern Song period (960–1127), and other during the Qing period (around 1700–1830). By the High Qing era China was possibly the most commercialized country in the world, and imperial China experienced a second commercial revolution by the end of the 18th century. On the other hand, the centralized autocracy was strengthened in part to suppress anti-Qing sentiment with the policy of valuing agriculture and restraining commerce, like the Haijin during the early Qing period and ideological control as represented by the literary inquisition , causing some social and technological stagnation. The Warring States period ended in 221 BCE after the state of Qin conquered the other six states, reunited China and established the dominant order of autocracy . King Zheng of Qin proclaimed himself the Emperor of the Qin dynasty , becoming the first emperor of a unified China. He enacted Qin's legalist reforms, notably the standardization of Chinese characters, measurements , road widths, and currency . His dynasty also conquered the Yue tribes in Guangxi , Guangdong , and Northern Vietnam . The Qin dynasty lasted only fifteen years, falling soon after the First Emperor's death. Following widespread revolts during which the imperial library was burned , [lower-alpha 19] the Han dynasty emerged to rule China between 206 BCE and CE 220, creating a cultural identity among its populace still remembered in the ethnonym of the modern Han Chinese . The Han expanded the empire's territory considerably , with military campaigns reaching Central Asia, Mongolia , Korea , and Yunnan , and the recovery of Guangdong and northern Vietnam from Nanyue . Han involvement in Central Asia and Sogdia helped establish the land route of the Silk Road , replacing the earlier path over the Himalayas to India. Han China gradually became the largest economy of the ancient world. Despite the Han's initial decentralization and the official abandonment of the Qin philosophy of Legalism in favor of Confucianism , Qin's legalist institutions and policies continued to be employed by the Han government and its successors. After the end of the Han dynasty , a period of strife known as Three Kingdoms followed, at the end of which Wei was swiftly overthrown by the Jin dynasty . The Jin fell to civil war upon the ascension of a developmentally disabled emperor ; the Five Barbarians then rebelled and ruled northern China as the Sixteen States . The Xianbei unified them as the Northern Wei , whose Emperor Xiaowen reversed his predecessors' apartheid policies and enforced a drastic sinification on his subjects . In the south, the general Liu Yu secured the abdication of the Jin in favor of the Liu Song . The various successors of these states became known as the Northern and Southern dynasties , with the two areas finally reunited by the Sui in 581.The Sui restored the Han to power through China, reformed its agriculture, economy and imperial examination system, constructed the Grand Canal , and patronized Buddhism . However, they fell quickly when their conscription for public works and a failed war in northern Korea provoked widespread unrest. Under the succeeding Tang and Song dynasties , Chinese economy, technology, and culture entered a golden age. The Tang dynasty retained control of the Western Regions and the Silk Road, which brought traders to as far as Mesopotamia and the Horn of Africa , and made the capital Chang'an a cosmopolitan urban center. However, it was devastated and weakened by the An Lushan rebellion in the 8th century. In 907, the Tang disintegrated completely when the local military governors became ungovernable. The Song dynasty ended the separatist situation in 960, leading to a balance of power between the Song and the Liao dynasty . The Song was the first government in world history to issue paper money and the first Chinese polity to establish a permanent navy which was supported by the developed shipbuilding industry along with the sea trade. Between the 10th and 11th century CE, the population of China doubled to around 100 million people, mostly because of the expansion of rice cultivation in central and southern China, and the production of abundant food surpluses. The Song dynasty also saw a revival of Confucianism , in response to the growth of Buddhism during the Tang, and a flourishing of philosophy and the arts, as landscape art and porcelain were brought to new levels of complexity. However, the military weakness of the Song army was observed by the Jin dynasty . In 1127, Emperor Huizong of Song and the capital Bianjing were captured during the Jin–Song Wars . The remnants of the Song retreated to southern China . The Mongol conquest of China began in 1205 with the gradual conquest of Western Xia by Genghis Khan , who also invaded Jin territories . In 1271, the Mongol leader Kublai Khan established the Yuan dynasty , which conquered the last remnant of the Song dynasty in 1279. Before the Mongol invasion, the population of Song China was 120 million citizens; this was reduced to 60 million by the time of the census in 1300. A peasant named Zhu Yuanzhang overthrew the Yuan in 1368 and founded the Ming dynasty as the Hongwu Emperor . Under the Ming dynasty, China enjoyed another golden age, developing one of the strongest navies in the world and a rich and prosperous economy amid a flourishing of art and culture. It was during this period that admiral Zheng He led the Ming treasure voyages throughout the Indian Ocean , reaching as far as East Africa . The Mongol conquest of China began in 1205 with the gradual conquest of Western Xia by Genghis Khan , who also invaded Jin territories . In 1271, the Mongol leader Kublai Khan established the Yuan dynasty , which conquered the last remnant of the Song dynasty in 1279. Before the Mongol invasion, the population of Song China was 120 million citizens; this was reduced to 60 million by the time of the census in 1300. A peasant named Zhu Yuanzhang overthrew the Yuan in 1368 and founded the Ming dynasty as the Hongwu Emperor . Under the Ming dynasty, China enjoyed another golden age, developing one of the strongest navies in the world and a rich and prosperous economy amid a flourishing of art and culture. It was during this period that admiral Zheng He led the Ming treasure voyages throughout the Indian Ocean , reaching as far as East Africa . In the early Ming dynasty, China's capital was moved from Nanjing to Beijing. With the budding of capitalism, philosophers such as Wang Yangming critiqued and expanded Neo-Confucianism with concepts of individualism and equality of four occupations . The scholar-official stratum became a supporting force of industry and commerce in the tax boycott movements, which, together with the famines and defense against Japanese invasions of Korea (1592–1598) and Later Jin incursions led to an exhausted treasury. In 1644, Beijing was captured by a coalition of peasant rebel forces led by Li Zicheng . The Chongzhen Emperor committed suicide when the city fell. The Manchu Qing dynasty , then allied with Ming dynasty general Wu Sangui , overthrew Li's short-lived Shun dynasty and subsequently seized control of Beijing, which became the new capital of the Qing dynasty. The Qing dynasty, which lasted from 1644 until 1912, was the last imperial dynasty of China. The Ming-Qing transition (1618–1683) cost 25 million lives, but the Qing appeared to have restored China's imperial power and inaugurated another flowering of the arts. After the Southern Ming ended, the further conquest of the Dzungar Khanate added Mongolia, Tibet and Xinjiang to the empire. Meanwhile, China's population growth resumed and shortly began to accelerate. It is commonly agreed that pre-modern China's population experienced two growth spurts, one during the Northern Song period (960–1127), and other during the Qing period (around 1700–1830). By the High Qing era China was possibly the most commercialized country in the world, and imperial China experienced a second commercial revolution by the end of the 18th century. On the other hand, the centralized autocracy was strengthened in part to suppress anti-Qing sentiment with the policy of valuing agriculture and restraining commerce, like the Haijin during the early Qing period and ideological control as represented by the literary inquisition , causing some social and technological stagnation. In the mid-19th century, the Opium Wars with Britain and France forced China to pay compensation, open treaty ports, allow extraterritoriality for foreign nationals, and cede Hong Kong to the British under the 1842 Treaty of Nanking , the first of what have been termed as the " unequal treaties ". The First Sino-Japanese War (1894–1895) resulted in Qing China's loss of influence in the Korean Peninsula , as well as the cession of Taiwan to Japan . The Qing dynasty also began experiencing internal unrest in which tens of millions of people died, especially in the White Lotus Rebellion , the failed Taiping Rebellion that ravaged southern China in the 1850s and 1860s and the Dungan Revolt (1862–1877) in the northwest. The initial success of the Self-Strengthening Movement of the 1860s was frustrated by a series of military defeats in the 1880s and 1890s. In the 19th century, the great Chinese diaspora began. Losses due to emigration were added to by conflicts and catastrophes such as the Northern Chinese Famine of 1876–1879 , in which between 9 and 13 million people died. The Guangxu Emperor drafted a reform plan in 1898 to establish a modern constitutional monarchy , but these plans were thwarted by the Empress Dowager Cixi . The ill-fated anti-foreign Boxer Rebellion of 1899–1901 further weakened the dynasty. Although Cixi sponsored a program of reforms known as the late Qing reforms , the Xinhai Revolution of 1911–1912 ended the Qing dynasty and established the Republic of China . Puyi , the last Emperor, abdicated in 1912 . On 1 January 1912, the Republic of China was established, and Sun Yat-sen of the Kuomintang (KMT) was proclaimed provisional president. In March 1912, the presidency was given to Yuan Shikai , a former Qing general who in 1915 proclaimed himself Emperor of China . In the face of popular condemnation and opposition from his own Beiyang Army , he was forced to abdicate and re-establish the republic in 1916. After Yuan Shikai's death in 1916, China was politically fragmented. Its Beijing-based government was internationally recognized but virtually powerless; regional warlords controlled most of its territory. During this period , China participated in World War I and saw a far-reaching popular uprising (the May Fourth Movement ). In the late 1920s, the Kuomintang under Chiang Kai-shek was able to reunify the country under its own control with a series of deft military and political maneuverings known collectively as the Northern Expedition . The Kuomintang moved the nation's capital to Nanjing and implemented "political tutelage", an intermediate stage of political development outlined in Sun Yat-sen's Three Principles of the People program for transforming China into a modern democratic state. The Kuomintang briefly allied with the Chinese Communist Party (CCP) during the Northern Expedition, though the alliance broke down in 1927 after Chiang violently suppressed the CCP and other leftists Shanghai, marking the beginning of the Chinese Civil War . The CCP declared areas of the country as the Chinese Soviet Republic (Jiangxi Soviet) in November 1931 in Ruijin , Jiangxi . The Jiangxi Soviet was wiped out by the KMT armies in 1934, leading the CCP to initiate the Long March and relocate to Yan'an in Shaanxi . It would be the base of the communists before major combat in the Chinese Civil War ended in 1949. In 1931, Japan invaded and occupied Manchuria . Japan invaded other parts of China in 1937, precipitating the Second Sino-Japanese War (1937–1945), a theater of World War II . The war forced an uneasy alliance between the Kuomintang and the CCP. Japanese forces committed numerous war atrocities against the civilian population; as many as 20 million Chinese civilians died. An estimated 40,000 to 300,000 Chinese were massacred in Nanjing alone during the Japanese occupation. China, along with the UK, the United States, and the Soviet Union , were recognized as the Allied " Big Four " in the Declaration by United Nations . Along with the other three great powers, China was one of the four major Allies of World War II , and was later considered one of the primary victors in the war. After the surrender of Japan in 1945, Taiwan, including the Penghu , was handed over to Chinese control ; however, the validity of this handover is controversial . China emerged victorious but war-ravaged and financially drained. The continued distrust between the Kuomintang and the Communists led to the resumption of civil war. Constitutional rule was established in 1947, but because of the ongoing unrest, many provisions of the ROC constitution were never implemented in mainland China. Afterwards, the CCP took control of most of mainland China, and the ROC government retreated offshore to Taiwan . On 1 October 1949, CCP Chairman Mao Zedong formally proclaimed the People's Republic of China in Tiananmen Square , Beijing. In 1950, the PRC captured Hainan from the ROC and annexed Tibet . However, remaining Kuomintang forces continued to wage an insurgency in western China throughout the 1950s. The CCP consolidated its popularity among the peasants through the Land Reform Movement , which included the state-tolerated executions of between 1 and 2 million landlords by peasants and former tenants. Though the PRC initially allied closely with the Soviet Union, the relations between the two communist nations gradually deteriorated , leading China to develop an independent industrial system and its own nuclear weapons . The Chinese population increased from 550 million in 1950 to 900 million in 1974. However, the Great Leap Forward , an idealistic massive industrialization project, resulted in an estimated 15 to 55 million deaths between 1959 and 1961, mostly from starvation. In 1964, China's first atomic bomb exploded successfully. In 1966, Mao and his allies launched the Cultural Revolution , sparking a decade of political recrimination and social upheaval that lasted until Mao's death in 1976. In October 1971, the PRC replaced the ROC in the United Nations, and took its seat as a permanent member of the Security Council. After Mao's death, the Gang of Four was arrested by Hua Guofeng and held responsible for the Cultural Revolution. The Cultural Revolution was rebuked, with millions rehabilitated. Deng Xiaoping took power in 1978, and instituted large-scale political and economic reforms , together with the " Eight Elders ", most senior and influential members of the party. The government loosened its control and the communes were gradually disbanded. Agricultural collectivization was dismantled and farmlands privatized. While foreign trade became a major focus, special economic zones (SEZs) were created. Inefficient state-owned enterprises (SOEs) were restructured and some closed. This marked China's transition away from planned economy. China adopted its current constitution on 4 December 1982. In 1989, the country saw the protests in Tiananmen Square unfold , and later saw other protests over the entire nation. Zhao Ziyang was put under house arrest for his sympathies to the protests and was replaced by Jiang Zemin . Jiang continued economic reforms, closing many SOEs and trimming down " iron rice bowl " (life-tenure positions). China's economy grew sevenfold during this time. British Hong Kong and Portuguese Macau returned to China in 1997 and 1999 , respectively, as special administrative regions under the principle of one country, two systems . The country joined the World Trade Organization in 2001. On the 16th CCP National Congress in 2002, Hu Jintao succeeded Jiang as the general secretary. Under Hu, China maintained its high rate of economic growth, overtaking the United Kingdom, France, Germany and Japan to become the world's second-largest economy. However, the growth also severely impacted the country's resources and environment, and caused major social displacement. Xi Jinping succeeded Hu as paramount leader on the 18th CCP National Congress in 2012. Shortly after his ascension to power, Xi launched a vast anti-corruption crackdown , that prosecuted more than 2 million officials by 2022. During his tenure , Xi consolidated power unseen since the initiation of economic and political reforms. China's landscape is vast and diverse, ranging from the Gobi and Taklamakan Deserts in the arid north to the subtropical forests in the wetter south. The Himalaya , Karakoram , Pamir and Tian Shan mountain ranges separate China from much of South and Central Asia . The Yangtze and Yellow Rivers, the third- and sixth-longest in the world, respectively, run from the Tibetan Plateau to the densely populated eastern seaboard. China's coastline along the Pacific Ocean is 14,500 km (9,000 mi) long and is bounded by the Bohai , Yellow , East China and South China seas. China connects through the Kazakh border to the Eurasian Steppe . The territory of China lies between latitudes 18° and 54° N , and longitudes 73° and 135° E . The geographical center of China is marked by the Center of the Country Monument at 35°50′40.9″N 103°27′7.5″E / 35.844694°N 103.452083°E / 35.844694; 103.452083 ( Geographical center of China ) . China's landscapes vary significantly across its vast territory. In the east, along the shores of the Yellow Sea and the East China Sea, there are extensive and densely populated alluvial plains , while on the edges of the Inner Mongolian plateau in the north, broad grasslands predominate. Southern China is dominated by hills and low mountain ranges, while the central-east hosts the deltas of China's two major rivers, the Yellow River and the Yangtze River. Other major rivers include the Xi , Mekong , Brahmaputra and Amur . To the west sit major mountain ranges, most notably the Himalayas. High plateaus feature among the more arid landscapes of the north, such as the Taklamakan and the Gobi Desert. The world's highest point, Mount Everest (8,848 m), lies on the Sino-Nepalese border. The country's lowest point, and the world's third-lowest, is the dried lake bed of Ayding Lake (−154 m) in the Turpan Depression . China's climate is mainly dominated by dry seasons and wet monsoons , which lead to pronounced temperature differences between winter and summer. In the winter, northern winds coming from high-latitude areas are cold and dry; in summer, southern winds from coastal areas at lower latitudes are warm and moist. A major environmental issue in China is the continued expansion of its deserts , particularly the Gobi Desert. Although barrier tree lines planted since the 1970s have reduced the frequency of sandstorms , prolonged drought and poor agricultural practices have resulted in dust storms plaguing northern China each spring, which then spread to other parts of East Asia, including Japan and Korea. Water quality, erosion , and pollution control have become important issues in China's relations with other countries. Melting glaciers in the Himalayas could potentially lead to water shortages for hundreds of millions of people. According to academics, in order to limit climate change in China to 1.5 °C (2.7 °F) electricity generation from coal in China without carbon capture must be phased out by 2045. With current policies, the GHG emissions of China will probably peak in 2025, and by 2030 they will return to 2022 levels. However, such pathway still leads to three-degree temperature rise. Official government statistics about Chinese agricultural productivity are considered unreliable, due to exaggeration of production at subsidiary government levels. Much of China has a climate very suitable for agriculture and the country has been the world's largest producer of rice, wheat, tomatoes, eggplant, grapes, watermelon, spinach, and many other crops. In 2021, 12 percent of global permanent meadows and pastures belonged to China, as well as 8% of global cropland. China is one of 17 megadiverse countries , lying in two of the world's major biogeographic realms : the Palearctic and the Indomalayan . By one measure, China has over 34,687 species of animals and vascular plants, making it the third-most biodiverse country in the world, after Brazil and Colombia . The country is a party to the Convention on Biological Diversity ; its National Biodiversity Strategy and Action Plan was received by the convention in 2010. China is home to at least 551 species of mammals (the third-highest in the world), 1,221 species of birds (eighth), 424 species of reptiles (seventh) and 333 species of amphibians (seventh). Wildlife in China shares habitat with, and bears acute pressure from, one of the world's largest population of humans. At least 840 animal species are threatened, vulnerable or in danger of local extinction , due mainly to human activity such as habitat destruction, pollution and poaching for food, fur and traditional Chinese medicine . Endangered wildlife is protected by law, and as of 2005 [ update ] , the country has over 2,349 nature reserves , covering a total area of 149.95 million hectares, 15 percent of China's total land area. Most wild animals have been eliminated from the core agricultural regions of east and central China, but they have fared better in the mountainous south and west. The Baiji was confirmed extinct on 12 December 2006. China has over 32,000 species of vascular plants, and is home to a variety of forest types. Cold coniferous forests predominate in the north of the country, supporting animal species such as moose and Asian black bear , along with over 120 bird species. The understory of moist conifer forests may contain thickets of bamboo . In higher montane stands of juniper and yew , the bamboo is replaced by rhododendrons . Subtropical forests, which are predominate in central and southern China, support a high density of plant species including numerous rare endemics. Tropical and seasonal rainforests , though confined to Yunnan and Hainan , contain a quarter of all the animal and plant species found in China. China has over 10,000 recorded species of fungi . In the early 2000s, China has suffered from environmental deterioration and pollution due to its rapid pace of industrialization. Regulations such as the 1979 Environmental Protection Law are fairly stringent, though they are poorly enforced, frequently disregarded in favor of rapid economic development. China has the second highest death toll because of air pollution, after India , with approximately 1 million deaths. Although China ranks as the highest CO 2 emitting country, it only emits 8 tons of CO 2 per capita , significantly lower than developed countries such as the United States (16.1), Australia (16.8) and South Korea (13.6). Greenhouse gas emissions by China are the world's largest . The country has significant water pollution problems; only 87.9% of China's national surface water was graded suitable for human consumption by the Ministry of Ecology and Environment in 2022. China has prioritized clamping down on pollution, bringing a significant decrease in air pollution in the 2010s. In 2020, the Chinese government announced its aims for the country to reach its peak emissions levels before 2030, and achieve carbon neutrality by 2060 in line with the Paris Agreement , which, according to Climate Action Tracker , would lower the expected rise in global temperature by 0.2–0.3 degrees – "the biggest single reduction ever estimated by the Climate Action Tracker". China is the world's leading investor in renewable energy and its commercialization , with $ 546 billion invested in 2022; it is a major manufacturer of renewable energy technologies and invests heavily in local-scale renewable energy projects. Long heavily relying on non-renewable energy sources such as coal, China's adaptation of renewable energy has increased significantly in recent years, with their share increasing from 26.3 percent in 2016 to 31.9 percent in 2022. In 2022, 61.2% of China's electricity came from coal (largest producer in the world), 14.9% from hydroelectric power (largest), 9.3% from wind (largest), 4.7% from solar energy (largest), 4.7% from nuclear energy (second-largest), 3.1% from natural gas (fifth-largest), and 1.9% from bioenergy (largest); in total, 30.8% of China's energy came from renewable energy sources. Despite its emphasis on renewables, China remains deeply connected to global oil markets and next to India, has been the largest importer of Russian crude oil in 2022. China is the third-largest country in the world by land area after Russia , and the third or fourth largest country in the world by total area. [lower-alpha 20] China's total area is generally stated as being approximately 9,600,000 km 2 (3,700,000 sq mi) . Specific area figures range from 9,572,900 km 2 (3,696,100 sq mi) according to the Encyclopædia Britannica , to 9,596,961 km 2 (3,705,407 sq mi) according to the UN Demographic Yearbook , and The World Factbook . China has the longest combined land border in the world , measuring 22,117 km (13,743 mi) and its coastline covers approximately 14,500 km (9,000 mi) from the mouth of the Yalu River (Amnok River) to the Gulf of Tonkin . China borders 14 nations and covers the bulk of East Asia, bordering Vietnam , Laos , and Myanmar in Southeast Asia; India , Bhutan , Nepal , Pakistan [lower-alpha 21] and Afghanistan in South Asia; Tajikistan , Kyrgyzstan and Kazakhstan in Central Asia; and Russia, Mongolia , and North Korea in Inner Asia and Northeast Asia . It is narrowly separated from Bangladesh and Thailand to the southwest and south, and has several maritime neighbors such as Japan , Philippines , Malaysia , and Indonesia . China has resolved its land borders with 12 out of 14 neighboring countries, having pursued substantial compromises in most of them. China currently has a disputed land border with India and Bhutan . China is additionally involved in maritime disputes with multiple countries over territory in the East and South China Seas , such as the Senkaku Islands and the entirety of South China Sea Islands . China's climate is mainly dominated by dry seasons and wet monsoons , which lead to pronounced temperature differences between winter and summer. In the winter, northern winds coming from high-latitude areas are cold and dry; in summer, southern winds from coastal areas at lower latitudes are warm and moist. A major environmental issue in China is the continued expansion of its deserts , particularly the Gobi Desert. Although barrier tree lines planted since the 1970s have reduced the frequency of sandstorms , prolonged drought and poor agricultural practices have resulted in dust storms plaguing northern China each spring, which then spread to other parts of East Asia, including Japan and Korea. Water quality, erosion , and pollution control have become important issues in China's relations with other countries. Melting glaciers in the Himalayas could potentially lead to water shortages for hundreds of millions of people. According to academics, in order to limit climate change in China to 1.5 °C (2.7 °F) electricity generation from coal in China without carbon capture must be phased out by 2045. With current policies, the GHG emissions of China will probably peak in 2025, and by 2030 they will return to 2022 levels. However, such pathway still leads to three-degree temperature rise. Official government statistics about Chinese agricultural productivity are considered unreliable, due to exaggeration of production at subsidiary government levels. Much of China has a climate very suitable for agriculture and the country has been the world's largest producer of rice, wheat, tomatoes, eggplant, grapes, watermelon, spinach, and many other crops. In 2021, 12 percent of global permanent meadows and pastures belonged to China, as well as 8% of global cropland. China is one of 17 megadiverse countries , lying in two of the world's major biogeographic realms : the Palearctic and the Indomalayan . By one measure, China has over 34,687 species of animals and vascular plants, making it the third-most biodiverse country in the world, after Brazil and Colombia . The country is a party to the Convention on Biological Diversity ; its National Biodiversity Strategy and Action Plan was received by the convention in 2010. China is home to at least 551 species of mammals (the third-highest in the world), 1,221 species of birds (eighth), 424 species of reptiles (seventh) and 333 species of amphibians (seventh). Wildlife in China shares habitat with, and bears acute pressure from, one of the world's largest population of humans. At least 840 animal species are threatened, vulnerable or in danger of local extinction , due mainly to human activity such as habitat destruction, pollution and poaching for food, fur and traditional Chinese medicine . Endangered wildlife is protected by law, and as of 2005 [ update ] , the country has over 2,349 nature reserves , covering a total area of 149.95 million hectares, 15 percent of China's total land area. Most wild animals have been eliminated from the core agricultural regions of east and central China, but they have fared better in the mountainous south and west. The Baiji was confirmed extinct on 12 December 2006. China has over 32,000 species of vascular plants, and is home to a variety of forest types. Cold coniferous forests predominate in the north of the country, supporting animal species such as moose and Asian black bear , along with over 120 bird species. The understory of moist conifer forests may contain thickets of bamboo . In higher montane stands of juniper and yew , the bamboo is replaced by rhododendrons . Subtropical forests, which are predominate in central and southern China, support a high density of plant species including numerous rare endemics. Tropical and seasonal rainforests , though confined to Yunnan and Hainan , contain a quarter of all the animal and plant species found in China. China has over 10,000 recorded species of fungi . In the early 2000s, China has suffered from environmental deterioration and pollution due to its rapid pace of industrialization. Regulations such as the 1979 Environmental Protection Law are fairly stringent, though they are poorly enforced, frequently disregarded in favor of rapid economic development. China has the second highest death toll because of air pollution, after India , with approximately 1 million deaths. Although China ranks as the highest CO 2 emitting country, it only emits 8 tons of CO 2 per capita , significantly lower than developed countries such as the United States (16.1), Australia (16.8) and South Korea (13.6). Greenhouse gas emissions by China are the world's largest . The country has significant water pollution problems; only 87.9% of China's national surface water was graded suitable for human consumption by the Ministry of Ecology and Environment in 2022. China has prioritized clamping down on pollution, bringing a significant decrease in air pollution in the 2010s. In 2020, the Chinese government announced its aims for the country to reach its peak emissions levels before 2030, and achieve carbon neutrality by 2060 in line with the Paris Agreement , which, according to Climate Action Tracker , would lower the expected rise in global temperature by 0.2–0.3 degrees – "the biggest single reduction ever estimated by the Climate Action Tracker". China is the world's leading investor in renewable energy and its commercialization , with $ 546 billion invested in 2022; it is a major manufacturer of renewable energy technologies and invests heavily in local-scale renewable energy projects. Long heavily relying on non-renewable energy sources such as coal, China's adaptation of renewable energy has increased significantly in recent years, with their share increasing from 26.3 percent in 2016 to 31.9 percent in 2022. In 2022, 61.2% of China's electricity came from coal (largest producer in the world), 14.9% from hydroelectric power (largest), 9.3% from wind (largest), 4.7% from solar energy (largest), 4.7% from nuclear energy (second-largest), 3.1% from natural gas (fifth-largest), and 1.9% from bioenergy (largest); in total, 30.8% of China's energy came from renewable energy sources. Despite its emphasis on renewables, China remains deeply connected to global oil markets and next to India, has been the largest importer of Russian crude oil in 2022. China is the third-largest country in the world by land area after Russia , and the third or fourth largest country in the world by total area. [lower-alpha 20] China's total area is generally stated as being approximately 9,600,000 km 2 (3,700,000 sq mi) . Specific area figures range from 9,572,900 km 2 (3,696,100 sq mi) according to the Encyclopædia Britannica , to 9,596,961 km 2 (3,705,407 sq mi) according to the UN Demographic Yearbook , and The World Factbook . China has the longest combined land border in the world , measuring 22,117 km (13,743 mi) and its coastline covers approximately 14,500 km (9,000 mi) from the mouth of the Yalu River (Amnok River) to the Gulf of Tonkin . China borders 14 nations and covers the bulk of East Asia, bordering Vietnam , Laos , and Myanmar in Southeast Asia; India , Bhutan , Nepal , Pakistan [lower-alpha 21] and Afghanistan in South Asia; Tajikistan , Kyrgyzstan and Kazakhstan in Central Asia; and Russia, Mongolia , and North Korea in Inner Asia and Northeast Asia . It is narrowly separated from Bangladesh and Thailand to the southwest and south, and has several maritime neighbors such as Japan , Philippines , Malaysia , and Indonesia . China has resolved its land borders with 12 out of 14 neighboring countries, having pursued substantial compromises in most of them. China currently has a disputed land border with India and Bhutan . China is additionally involved in maritime disputes with multiple countries over territory in the East and South China Seas , such as the Senkaku Islands and the entirety of South China Sea Islands . The People's Republic of China is a one-party state governed by the Chinese Communist Party (CCP), which considers itself to be Marxist–Leninist . This makes China one of the few countries governed by a communist party. The Chinese constitution states that the PRC "is a socialist state governed by a people's democratic dictatorship that is led by the working class and based on an alliance of workers and peasants," that the state institutions "shall practice the principle of democratic centralism ," and that "the defining feature of socialism with Chinese characteristics is the leadership of the Chinese Communist Party." The PRC officially terms itself as a democracy , using terms such as "socialist consultative democracy", and " whole-process people's democracy ". However, the country is commonly described as an authoritarian one-party state and a dictatorship , with among the heaviest restrictions worldwide in many areas, most notably against freedom of the press , freedom of assembly , reproductive rights , free formation of social organizations , freedom of religion and free access to the Internet . China has consistently been ranked amongst the lowest as an "authoritarian regime" by the Economist Intelligence Unit 's Democracy Index , ranking at 148th out of 167 countries in 2023. According to the CCP constitution , its highest body is the National Congress held every five years. The National Congress elects the Central Committee , who then elects the party's Politburo , Politburo Standing Committee and the general secretary ( party leader ), the top leadership of the country. The general secretary holds ultimate power and authority over state and government and serves as the informal paramount leader . The current general secretary is Xi Jinping , who took office on 15 November 2012. At the local level, the secretary of the CCP committee of a subdivision outranks the local government level; CCP committee secretary of a provincial division outranks the governor while the CCP committee secretary of a city outranks the mayor. The CCP is officially guided by Marxism adapted to Chinese circumstances . The government in China is under the sole control of the CCP. The CCP controls appointments in government bodies, with most senior government officials being CCP members. The National People's Congress (NPC), with nearly 3,000-members, is constitutionally the " highest organ of state power ", though it has been also described as a " rubber stamp " body. The NPC meets annually, while the NPC Standing Committee , around 150 members elected from NPC delegates, meets every couple of months. Elections are indirect and not pluralistic, with nominations at all levels being controlled by the CCP. The NPC is dominated by the CCP, with another eight minor parties having nominal representation under the condition of upholding CCP leadership. The president is elected by the NPC. The presidency is the ceremonial state representative, but not the constitutional head of state. The incumbent president is Xi Jinping, who is also the general secretary of the CCP and the chairman of the Central Military Commission , making him China's paramount leader and supreme commander of the Armed Forces. The premier is the head of government , with Li Qiang being the incumbent. The premier is officially nominated by the president and then elected by the NPC, and has generally been either the second or third-ranking member of the Politburo Standing Committee (PSC). The premier presides over the State Council , China's cabinet, composed of four vice premiers, state councilors , and the heads of ministries and commissions. The Chinese People's Political Consultative Conference (CPPCC) is a political advisory body that is critical in China's " united front " system, which aims to gather non-CCP voices to support the CCP. Similar to the people's congresses, CPPCC's exist at various division, with the National Committee of the CPPCC being chaired by Wang Huning , fourth-ranking member of the PSC. The governance of China is characterized by a high degree of political centralization but significant economic decentralization. : 7 Policy instruments or processes are often tested locally before being applied more widely, resulting in a policy that involves experimentation and feedback. : 14 Generally, central government leadership refrains from drafting specific policies, instead using the informal networks and site visits to affirm or suggest changes to the direction of local policy experiments or pilot programs. : 71 The typical approach is that central government leadership begins drafting formal policies, law, or regulations after policy has been developed at local levels. : 71 The PRC is constitutionally a unitary state divided into 23 provinces , [lower-alpha 22] five autonomous regions (each with a designated minority group), and four direct-administered municipalities —collectively referred to as "mainland China"—as well as the special administrative regions (SARs) of Hong Kong and Macau. The PRC regards the island of Taiwan as its Taiwan Province , Kinmen and Matsu as a part of Fujian Province and islands the ROC controls in the South China Sea as a part of Hainan Province and Guangdong Province , although all these territories are governed by the Republic of China (ROC). Geographically, all 31 provincial divisions of mainland China can be grouped into six regions: North China , Northeast China , East China , South Central China , Southwestern China , and Northwestern China . Taiwan ( 台湾省 ) , governed by the Republic of China The PRC has diplomatic relations with 179 United Nation members states and maintains embassies in 174 . As of 2024 [ update ] , China has one of the largest diplomatic network of any country in the world. In 1971, the PRC replaced the Republic of China (ROC) as the sole representative of China in the United Nations and as one of the five permanent members of the United Nations Security Council . It is a member of intergovernmental organizations including the G20 , the SCO , the East Asia Summit , and the APEC . China was also a former member and leader of the Non-Aligned Movement , and still considers itself an advocate for developing countries . Along with Brazil, Russia, India and South Africa, China is a member of the BRICS group of emerging major economies and hosted the group's third official summit in April 2011. The PRC officially maintains the one-China principle , which holds the view that there is only one sovereign state in the name of China, represented by the PRC, and that Taiwan is part of that China. The unique status of Taiwan has led to countries recognizing the PRC to maintain unique "one-China policies" that differ from each other; some countries explicitly recognize the PRC's claim over Taiwan, while others, including the US and Japan, only acknowledge the claim. Chinese officials have protested on numerous occasions when foreign countries have made diplomatic overtures to Taiwan, especially in the matter of armament sales. Most countries have switched recognition from the ROC to the PRC since the latter replaced the former in the UN in 1971. Much of current Chinese foreign policy is reportedly based on Premier Zhou Enlai 's Five Principles of Peaceful Coexistence , and is also driven by the concept of "harmony without uniformity", which encourages diplomatic relations between states despite ideological differences. This policy may have led China to support or maintain close ties with states that are regarded as dangerous and repressive by Western nations, such as Sudan , North Korea and Iran . China's close relationship with Myanmar has involved support for its ruling governments as well as for its ethnic rebel groups, including the Arakan Army . China has a close political, economic and military relationship with Russia, and the two states often vote in unison in the UN Security Council. China's relationship with the United States is complex, and includes deep trade ties but significant political differences. Since the early 2000s, China has followed a policy of engaging with African nations for trade and bilateral co-operation. It maintains extensive and highly diversified trade links with the European Union, and became its largest trading partner for goods. China is increasing its influence in Central Asia and South Pacific. The country has strong trade ties with ASEAN countries and major South American economies, and is the largest trading partner of Brazil, Chile, Peru, Uruguay, Argentina, and several others. In 2013, China initiated the Belt and Road Initiative (BRI), a large global infrastructure building initiative with funding on the order of $50–100 billion per year. BRI could be one of the largest development plans in modern history. It has expanded significantly over the last six years and, as of April 2020 [ update ] , includes 138 countries and 30 international organizations. In addition to intensifying foreign policy relations, the focus is particularly on building efficient transport routes, especially the maritime Silk Road with its connections to East Africa and Europe. However many loans made under the program are unsustainable and China has faced a number of calls for debt relief from debtor nations. The situation of human rights in China has attracted significant criticism from foreign governments, foreign press agencies, and non-governmental organizations, alleging widespread civil rights violations such as detention without trial, forced confessions, torture, restrictions of fundamental rights, and excessive use of the death penalty . Since its inception, Freedom House has ranked China as "not free" in its Freedom in the World survey, while Amnesty International has documented significant human rights abuses. The Chinese constitution states that the "fundamental rights" of citizens include freedom of speech , freedom of the press , the right to a fair trial , freedom of religion , universal suffrage , and property rights . However, in practice, these provisions do not afford significant protection against criminal prosecution by the state. China has limited protections regarding LGBT rights . Although some criticisms of government policies and the ruling CCP are tolerated, censorship of political speech and information are amongst the harshest in the world and routinely used to prevent collective action. China also has the most comprehensive and sophisticated Internet censorship regime in the world, with numerous websites being blocked. The government suppresses popular protests and demonstrations that it considers a potential threat to "social stability". China additionally uses a massive espionage network of cameras, facial recognition software, sensors, and surveillance of personal technology as a means of social control of persons living in the country. China is regularly accused of large-scale repression and human rights abuses in Tibet and Xinjiang, where significant numbers of ethnic minorities reside, including violent police crackdowns and religious suppression . Since 2017, the Chinese government has been engaged in a harsh crackdown in Xinjiang, with around one million Uyghurs and other ethnic and religion minorities being detained in internment camps aimed at changing the political thinking of detainees, their identities, and their religious beliefs. According to Western reports, political indoctrination, torture, physical and psychological abuse, forced sterilization , sexual abuse , and forced labor are common in these facilities. According to a 2020 Foreign Policy report, China's treatment of Uyghurs meets the UN definition of genocide, while a separate UN Human Rights Office report said they could potentially meet the definitions for crimes against humanity . The Chinese authorities have also cracked down on dissent in Hong Kong , especially after the passage of a national security law in 2020. In 2017 and 2020, the Pew Research Center ranked the severity of Chinese government restrictions on religion as being among the world's highest, despite ranking religious-related social hostilities in China as low in severity. The Global Slavery Index estimated that in 2016 more than 3.8 million people (0.25% of the population) were living in "conditions of modern slavery ", including victims of human trafficking, forced labor, forced marriage, child labor, and state-imposed forced labor. The state-imposed re-education through labor ( laojiao ) system was formally abolished in 2013, but it is not clear to what extent its practices have stopped. The much larger reform through labor ( laogai ) system includes labor prison factories, detention centers, and re-education camps; the Laogai Research Foundation has estimated in June 2008 that there were nearly 1,422 of these facilities, though it cautioned that this number was likely an underestimate. Political concerns in China include the growing gap between rich and poor and government corruption. Nonetheless, international surveys show the Chinese public have a high level of satisfaction with their government. : 137 These views are generally attributed to the material comforts and security available to large segments of the Chinese populace as well as the government's attentiveness and responsiveness. : 136 According to the World Values Survey (2022), 91% of Chinese respondents have significant confidence in their government. : 13 A Harvard University survey published in July 2020 found that citizen satisfaction with the government had increased since 2003, also rating China's government as more effective and capable than ever in the survey's history. According to the CCP constitution , its highest body is the National Congress held every five years. The National Congress elects the Central Committee , who then elects the party's Politburo , Politburo Standing Committee and the general secretary ( party leader ), the top leadership of the country. The general secretary holds ultimate power and authority over state and government and serves as the informal paramount leader . The current general secretary is Xi Jinping , who took office on 15 November 2012. At the local level, the secretary of the CCP committee of a subdivision outranks the local government level; CCP committee secretary of a provincial division outranks the governor while the CCP committee secretary of a city outranks the mayor. The CCP is officially guided by Marxism adapted to Chinese circumstances . The government in China is under the sole control of the CCP. The CCP controls appointments in government bodies, with most senior government officials being CCP members. The National People's Congress (NPC), with nearly 3,000-members, is constitutionally the " highest organ of state power ", though it has been also described as a " rubber stamp " body. The NPC meets annually, while the NPC Standing Committee , around 150 members elected from NPC delegates, meets every couple of months. Elections are indirect and not pluralistic, with nominations at all levels being controlled by the CCP. The NPC is dominated by the CCP, with another eight minor parties having nominal representation under the condition of upholding CCP leadership. The president is elected by the NPC. The presidency is the ceremonial state representative, but not the constitutional head of state. The incumbent president is Xi Jinping, who is also the general secretary of the CCP and the chairman of the Central Military Commission , making him China's paramount leader and supreme commander of the Armed Forces. The premier is the head of government , with Li Qiang being the incumbent. The premier is officially nominated by the president and then elected by the NPC, and has generally been either the second or third-ranking member of the Politburo Standing Committee (PSC). The premier presides over the State Council , China's cabinet, composed of four vice premiers, state councilors , and the heads of ministries and commissions. The Chinese People's Political Consultative Conference (CPPCC) is a political advisory body that is critical in China's " united front " system, which aims to gather non-CCP voices to support the CCP. Similar to the people's congresses, CPPCC's exist at various division, with the National Committee of the CPPCC being chaired by Wang Huning , fourth-ranking member of the PSC. The governance of China is characterized by a high degree of political centralization but significant economic decentralization. : 7 Policy instruments or processes are often tested locally before being applied more widely, resulting in a policy that involves experimentation and feedback. : 14 Generally, central government leadership refrains from drafting specific policies, instead using the informal networks and site visits to affirm or suggest changes to the direction of local policy experiments or pilot programs. : 71 The typical approach is that central government leadership begins drafting formal policies, law, or regulations after policy has been developed at local levels. : 71The PRC is constitutionally a unitary state divided into 23 provinces , [lower-alpha 22] five autonomous regions (each with a designated minority group), and four direct-administered municipalities —collectively referred to as "mainland China"—as well as the special administrative regions (SARs) of Hong Kong and Macau. The PRC regards the island of Taiwan as its Taiwan Province , Kinmen and Matsu as a part of Fujian Province and islands the ROC controls in the South China Sea as a part of Hainan Province and Guangdong Province , although all these territories are governed by the Republic of China (ROC). Geographically, all 31 provincial divisions of mainland China can be grouped into six regions: North China , Northeast China , East China , South Central China , Southwestern China , and Northwestern China . Taiwan ( 台湾省 ) , governed by the Republic of ChinaThe PRC has diplomatic relations with 179 United Nation members states and maintains embassies in 174 . As of 2024 [ update ] , China has one of the largest diplomatic network of any country in the world. In 1971, the PRC replaced the Republic of China (ROC) as the sole representative of China in the United Nations and as one of the five permanent members of the United Nations Security Council . It is a member of intergovernmental organizations including the G20 , the SCO , the East Asia Summit , and the APEC . China was also a former member and leader of the Non-Aligned Movement , and still considers itself an advocate for developing countries . Along with Brazil, Russia, India and South Africa, China is a member of the BRICS group of emerging major economies and hosted the group's third official summit in April 2011. The PRC officially maintains the one-China principle , which holds the view that there is only one sovereign state in the name of China, represented by the PRC, and that Taiwan is part of that China. The unique status of Taiwan has led to countries recognizing the PRC to maintain unique "one-China policies" that differ from each other; some countries explicitly recognize the PRC's claim over Taiwan, while others, including the US and Japan, only acknowledge the claim. Chinese officials have protested on numerous occasions when foreign countries have made diplomatic overtures to Taiwan, especially in the matter of armament sales. Most countries have switched recognition from the ROC to the PRC since the latter replaced the former in the UN in 1971. Much of current Chinese foreign policy is reportedly based on Premier Zhou Enlai 's Five Principles of Peaceful Coexistence , and is also driven by the concept of "harmony without uniformity", which encourages diplomatic relations between states despite ideological differences. This policy may have led China to support or maintain close ties with states that are regarded as dangerous and repressive by Western nations, such as Sudan , North Korea and Iran . China's close relationship with Myanmar has involved support for its ruling governments as well as for its ethnic rebel groups, including the Arakan Army . China has a close political, economic and military relationship with Russia, and the two states often vote in unison in the UN Security Council. China's relationship with the United States is complex, and includes deep trade ties but significant political differences. Since the early 2000s, China has followed a policy of engaging with African nations for trade and bilateral co-operation. It maintains extensive and highly diversified trade links with the European Union, and became its largest trading partner for goods. China is increasing its influence in Central Asia and South Pacific. The country has strong trade ties with ASEAN countries and major South American economies, and is the largest trading partner of Brazil, Chile, Peru, Uruguay, Argentina, and several others. In 2013, China initiated the Belt and Road Initiative (BRI), a large global infrastructure building initiative with funding on the order of $50–100 billion per year. BRI could be one of the largest development plans in modern history. It has expanded significantly over the last six years and, as of April 2020 [ update ] , includes 138 countries and 30 international organizations. In addition to intensifying foreign policy relations, the focus is particularly on building efficient transport routes, especially the maritime Silk Road with its connections to East Africa and Europe. However many loans made under the program are unsustainable and China has faced a number of calls for debt relief from debtor nations. The situation of human rights in China has attracted significant criticism from foreign governments, foreign press agencies, and non-governmental organizations, alleging widespread civil rights violations such as detention without trial, forced confessions, torture, restrictions of fundamental rights, and excessive use of the death penalty . Since its inception, Freedom House has ranked China as "not free" in its Freedom in the World survey, while Amnesty International has documented significant human rights abuses. The Chinese constitution states that the "fundamental rights" of citizens include freedom of speech , freedom of the press , the right to a fair trial , freedom of religion , universal suffrage , and property rights . However, in practice, these provisions do not afford significant protection against criminal prosecution by the state. China has limited protections regarding LGBT rights . Although some criticisms of government policies and the ruling CCP are tolerated, censorship of political speech and information are amongst the harshest in the world and routinely used to prevent collective action. China also has the most comprehensive and sophisticated Internet censorship regime in the world, with numerous websites being blocked. The government suppresses popular protests and demonstrations that it considers a potential threat to "social stability". China additionally uses a massive espionage network of cameras, facial recognition software, sensors, and surveillance of personal technology as a means of social control of persons living in the country. China is regularly accused of large-scale repression and human rights abuses in Tibet and Xinjiang, where significant numbers of ethnic minorities reside, including violent police crackdowns and religious suppression . Since 2017, the Chinese government has been engaged in a harsh crackdown in Xinjiang, with around one million Uyghurs and other ethnic and religion minorities being detained in internment camps aimed at changing the political thinking of detainees, their identities, and their religious beliefs. According to Western reports, political indoctrination, torture, physical and psychological abuse, forced sterilization , sexual abuse , and forced labor are common in these facilities. According to a 2020 Foreign Policy report, China's treatment of Uyghurs meets the UN definition of genocide, while a separate UN Human Rights Office report said they could potentially meet the definitions for crimes against humanity . The Chinese authorities have also cracked down on dissent in Hong Kong , especially after the passage of a national security law in 2020. In 2017 and 2020, the Pew Research Center ranked the severity of Chinese government restrictions on religion as being among the world's highest, despite ranking religious-related social hostilities in China as low in severity. The Global Slavery Index estimated that in 2016 more than 3.8 million people (0.25% of the population) were living in "conditions of modern slavery ", including victims of human trafficking, forced labor, forced marriage, child labor, and state-imposed forced labor. The state-imposed re-education through labor ( laojiao ) system was formally abolished in 2013, but it is not clear to what extent its practices have stopped. The much larger reform through labor ( laogai ) system includes labor prison factories, detention centers, and re-education camps; the Laogai Research Foundation has estimated in June 2008 that there were nearly 1,422 of these facilities, though it cautioned that this number was likely an underestimate. Political concerns in China include the growing gap between rich and poor and government corruption. Nonetheless, international surveys show the Chinese public have a high level of satisfaction with their government. : 137 These views are generally attributed to the material comforts and security available to large segments of the Chinese populace as well as the government's attentiveness and responsiveness. : 136 According to the World Values Survey (2022), 91% of Chinese respondents have significant confidence in their government. : 13 A Harvard University survey published in July 2020 found that citizen satisfaction with the government had increased since 2003, also rating China's government as more effective and capable than ever in the survey's history. The People's Liberation Army (PLA) is considered one of the world's most powerful militaries and has rapidly modernized in the recent decades. It has also been accused of technology theft by some countries. It consists of the Ground Force (PLAGF), the Navy (PLAN), the Air Force (PLAAF), the Rocket Force (PLARF) and the Strategic Support Force (PLASSF). Its nearly 2.2 million active duty personnel is the largest in the world . The PLA holds the world's third-largest stockpile of nuclear weapons , and the world's second-largest navy by tonnage. China's official military budget for 2022 totalled US$230 billion (1.45 trillion Yuan), the second-largest in the world , though SIPRI estimates that its real expenditure that year was US$292 billion. According to SIPRI, its military spending from 2012 to 2021 averaged US$215 billion per year or 1.7 per cent of GDP, behind only the United States at US$734 billion per year or 3.6 per cent of GDP. The PLA is commanded by the Central Military Commission (CMC) of the party and the state; though officially two separate organizations, the two CMCs have identical membership except during leadership transition periods and effectively function as one organization. The chairman of the CMC is the commander-in-chief of the PLA. China has the world's second-largest economy in terms of nominal GDP, and the world's largest in terms of purchasing power parity (PPP). As of 2022 [ update ] , China accounts for around 18% of global economy by nominal GDP. China is one of the world's fastest-growing major economies, with its economic growth having been almost consistently above 6 percent since the introduction of economic reforms in 1978 . According to the World Bank, China's GDP grew from $150 billion in 1978 to $17.96 trillion by 2022. It ranks at 64th at GDP (nominal) per capita , making it an upper-middle income country. Of the world's 500 largest companies , 142 are headquartered in China. China was one of the world's foremost economic powers throughout the arc of East Asian and global history . The country had one of the largest economies in the world for most of the past two millennia , during which it has seen cycles of prosperity and decline. Since economic reforms began in 1978, China has developed into a highly diversified economy and one of the most consequential players in international trade. Major sectors of competitive strength include manufacturing, retail, mining, steel , textiles, automobiles, energy generation, green energy, banking, electronics, telecommunications, real estate, e-commerce, and tourism. China has three out of the ten largest stock exchanges in the world — Shanghai , Hong Kong and Shenzhen —that together have a market capitalization of over $15.9 trillion, as of October 2020 [ update ] . China has four ( Shanghai , Hong Kong , Beijing , and Shenzhen ) out of the world's top ten most competitive financial centers, which is more than any other country in the 2020 Global Financial Centres Index . Modern-day China is often described as an example of state capitalism or party-state capitalism . The state dominates in strategic "pillar" sectors such as energy production and heavy industries , but private enterprise has expanded enormously, with around 30 million private businesses recorded in 2008. According to official statistics, privately owned companies constitute more than 60% of China's GDP. China has been the world's largest manufacturing nation since 2010, after overtaking the US, which had been the largest for the previous hundred years. China has also been the second largest in high-tech manufacturing country since 2012, according to US National Science Foundation . China is the second largest retail market after the United States. China leads the world in e-commerce, accounting for over 37% of the global market share in 2021. China is the world's leader in electric vehicle consumption and production, manufacturing and buying half of all the plug-in electric cars (BEV and PHEV) in the world as of 2022 [ update ] . China is also the leading producer of batteries for electric vehicles as well as several key raw materials for batteries. China accounted for 17.9% of the world's total wealth in 2021, second highest in the world after the US. China brought more people out of extreme poverty than any other country in history —between 1978 and 2018, China reduced extreme poverty by 800 million. : 23 From 1990 to 2018, the proportion of the Chinese population living with an income of less than $1.90 per day (2011 PPP ) decreased from 66.3% to 0.3%, the share living with an income of less than $3.20 per day from 90.0% to 2.9%, and the share living with an income of less than $5.50 per day decreased from 98.3% to 17.0%. From 1978 to 2018, the average standard of living multiplied by a factor of twenty-six. Wages in China have grown significantly in the last 40 years—real (inflation-adjusted) wages grew seven-fold from 1978 to 2007. Per capita incomes have also risen significantly – when the PRC was founded in 1949, per capita income in China was one-fifth of the world average; per capita incomes now equal the world average itself. China's development is highly uneven. Its major cities and coastal areas are far more prosperous compared to rural and interior regions. It has a high level of economic inequality, which has increased quickly after the economic reforms, though has decreased significantly in the 2010s. In 2020, China's Gini coefficient was 0.371, according to the World Bank . As of April 2023 [ update ] , China was second in the world, after the US, in total number of billionaires and total number of millionaires , with 495 Chinese billionaires and 6.2 million millionaires. In 2019, China overtook the US as the home to the highest number of people who have a net personal wealth of at least $110,000, according to the global wealth report by Credit Suisse . China had 85 female billionaires as of January 2021 [ update ] , two-thirds of the global total. China has had the world's largest middle-class population since 2015; the middle-class grew to 400 million by 2018. China has been a member of the WTO since 2001 and is the world's largest trading power. By 2016, China was the largest trading partner of 124 countries. China became the world's largest trading nation in 2013 by the sum of imports and exports, as well as the world's largest commodity importer, comprising roughly 45% of maritime's dry-bulk market . China's foreign exchange reserves reached US$3.128 trillion as of December 2022 [ update ] , making its reserves by far the world's largest. In 2022, China was amongst the world's largest recipient of inward foreign direct investment (FDI), attracting $180 billion, though most of these were speculated to be from Hong Kong. In 2021, China's foreign exchange remittances were $US53 billion making it the second largest recipient of remittances in the world. China also invests abroad, with a total outward FDI of $146.5 billion in 2022, and a number of major takeovers of foreign firms by Chinese companies. Economists have argued that the renminbi is undervalued, due to currency intervention from the Chinese government, giving China an unfair trade advantage. China has also been widely criticized for manufacturing large quantities of counterfeit goods. The US government has also alleged that China does not respect intellectual property (IP) rights and steals IP through espionage operations . In 2020, Harvard University 's Economic Complexity Index ranked complexity of China's exports 17th in the world, up from 24th in 2010. The Chinese government has promoted the internationalization of the renminbi in order to wean off of its dependence on the U.S. dollar as a result of perceived weaknesses of the international monetary system. The renminbi is a component of the IMF's special drawing rights and the world's fifth-most traded currency as of 2022 [ update ] . However, partly due to capital controls that make the renminbi fall short of being a fully convertible currency, it remains far behind the Euro, the U.S. Dollar and the Japanese Yen in international trade volumes. China accounted for 17.9% of the world's total wealth in 2021, second highest in the world after the US. China brought more people out of extreme poverty than any other country in history —between 1978 and 2018, China reduced extreme poverty by 800 million. : 23 From 1990 to 2018, the proportion of the Chinese population living with an income of less than $1.90 per day (2011 PPP ) decreased from 66.3% to 0.3%, the share living with an income of less than $3.20 per day from 90.0% to 2.9%, and the share living with an income of less than $5.50 per day decreased from 98.3% to 17.0%. From 1978 to 2018, the average standard of living multiplied by a factor of twenty-six. Wages in China have grown significantly in the last 40 years—real (inflation-adjusted) wages grew seven-fold from 1978 to 2007. Per capita incomes have also risen significantly – when the PRC was founded in 1949, per capita income in China was one-fifth of the world average; per capita incomes now equal the world average itself. China's development is highly uneven. Its major cities and coastal areas are far more prosperous compared to rural and interior regions. It has a high level of economic inequality, which has increased quickly after the economic reforms, though has decreased significantly in the 2010s. In 2020, China's Gini coefficient was 0.371, according to the World Bank . As of April 2023 [ update ] , China was second in the world, after the US, in total number of billionaires and total number of millionaires , with 495 Chinese billionaires and 6.2 million millionaires. In 2019, China overtook the US as the home to the highest number of people who have a net personal wealth of at least $110,000, according to the global wealth report by Credit Suisse . China had 85 female billionaires as of January 2021 [ update ] , two-thirds of the global total. China has had the world's largest middle-class population since 2015; the middle-class grew to 400 million by 2018. China has been a member of the WTO since 2001 and is the world's largest trading power. By 2016, China was the largest trading partner of 124 countries. China became the world's largest trading nation in 2013 by the sum of imports and exports, as well as the world's largest commodity importer, comprising roughly 45% of maritime's dry-bulk market . China's foreign exchange reserves reached US$3.128 trillion as of December 2022 [ update ] , making its reserves by far the world's largest. In 2022, China was amongst the world's largest recipient of inward foreign direct investment (FDI), attracting $180 billion, though most of these were speculated to be from Hong Kong. In 2021, China's foreign exchange remittances were $US53 billion making it the second largest recipient of remittances in the world. China also invests abroad, with a total outward FDI of $146.5 billion in 2022, and a number of major takeovers of foreign firms by Chinese companies. Economists have argued that the renminbi is undervalued, due to currency intervention from the Chinese government, giving China an unfair trade advantage. China has also been widely criticized for manufacturing large quantities of counterfeit goods. The US government has also alleged that China does not respect intellectual property (IP) rights and steals IP through espionage operations . In 2020, Harvard University 's Economic Complexity Index ranked complexity of China's exports 17th in the world, up from 24th in 2010. The Chinese government has promoted the internationalization of the renminbi in order to wean off of its dependence on the U.S. dollar as a result of perceived weaknesses of the international monetary system. The renminbi is a component of the IMF's special drawing rights and the world's fifth-most traded currency as of 2022 [ update ] . However, partly due to capital controls that make the renminbi fall short of being a fully convertible currency, it remains far behind the Euro, the U.S. Dollar and the Japanese Yen in international trade volumes. China was a world leader in science and technology until the Ming dynasty . Ancient and medieval Chinese discoveries and inventions , such as papermaking , printing , the compass , and gunpowder (the Four Great Inventions ), became widespread across East Asia, the Middle East and later Europe. Chinese mathematicians were the first to use negative numbers . By the 17th century, the Western World surpassed China in scientific and technological advancement. The causes of this early modern Great Divergence continue to be debated by scholars. After repeated military defeats by the European colonial powers and Imperial Japan in the 19th century, Chinese reformers began promoting modern science and technology as part of the Self-Strengthening Movement . After the Communists came to power in 1949, efforts were made to organize science and technology based on the model of the Soviet Union , in which scientific research was part of central planning. After Mao's death in 1976, science and technology were promoted as one of the Four Modernizations , and the Soviet-inspired academic system was gradually reformed. Since the end of the Cultural Revolution , China has made significant investments in scientific research and is quickly catching up with the US in R&D spending. China officially spent around 2.4% of its GDP on R&D in 2020, totaling to around $377.8 billion. According to the World Intellectual Property Indicators , China received more applications than the US did in 2018 and 2019 and ranked first globally in patents, utility models, trademarks, industrial designs, and creative goods exports in 2021. It was ranked 12th in the Global Innovation Index in 2023, a considerable improvement from its rank of 35th in 2013. Chinese supercomputers ranked among the fastest in the world . [lower-alpha 23] Its efforts to develop the most advanced semiconductors and jet engines have seen delays and setbacks. China is developing its education system with an emphasis on science, technology, engineering, and mathematics (STEM). It became the world's largest publisher of scientific papers in 2016. The Chinese space program started in 1958 with some technology transfers from the Soviet Union. However, it did not launch the nation's first satellite until 1970 with the Dong Fang Hong I , which made China the fifth country to do so independently. In 2003, China became the third country in the world to independently send humans into space with Yang Liwei 's spaceflight aboard Shenzhou 5 . As of 2023, eighteen Chinese nationals have journeyed into space, including two women. In 2011, China launched its first space station testbed, Tiangong-1 . In 2013, a Chinese robotic rover Yutu successfully touched down on the lunar surface as part of the Chang'e 3 mission. In 2019, China became the first country to land a probe— Chang'e 4 —on the far side of the Moon . In 2020, Chang'e 5 successfully returned Moon samples to the Earth, making China the third country to do so independently. In 2021, China became the third country to land a spacecraft on Mars and the second one to deploy a rover (Zhurong) on Mars. China completed its own modular space station , the Tiangong , in low Earth orbit on 3 November 2022. On 29 November 2022, China performed its first in-orbit crew handover aboard the Tiangong . In May 2023, China announced a plan to land humans on the Moon by 2030. To that end, China currently is developing a lunar-capable super-heavy launcher, the Long March 10 , a new crewed spacecraft , and a crewed lunar lander . China was a world leader in science and technology until the Ming dynasty . Ancient and medieval Chinese discoveries and inventions , such as papermaking , printing , the compass , and gunpowder (the Four Great Inventions ), became widespread across East Asia, the Middle East and later Europe. Chinese mathematicians were the first to use negative numbers . By the 17th century, the Western World surpassed China in scientific and technological advancement. The causes of this early modern Great Divergence continue to be debated by scholars. After repeated military defeats by the European colonial powers and Imperial Japan in the 19th century, Chinese reformers began promoting modern science and technology as part of the Self-Strengthening Movement . After the Communists came to power in 1949, efforts were made to organize science and technology based on the model of the Soviet Union , in which scientific research was part of central planning. After Mao's death in 1976, science and technology were promoted as one of the Four Modernizations , and the Soviet-inspired academic system was gradually reformed. Since the end of the Cultural Revolution , China has made significant investments in scientific research and is quickly catching up with the US in R&D spending. China officially spent around 2.4% of its GDP on R&D in 2020, totaling to around $377.8 billion. According to the World Intellectual Property Indicators , China received more applications than the US did in 2018 and 2019 and ranked first globally in patents, utility models, trademarks, industrial designs, and creative goods exports in 2021. It was ranked 12th in the Global Innovation Index in 2023, a considerable improvement from its rank of 35th in 2013. Chinese supercomputers ranked among the fastest in the world . [lower-alpha 23] Its efforts to develop the most advanced semiconductors and jet engines have seen delays and setbacks. China is developing its education system with an emphasis on science, technology, engineering, and mathematics (STEM). It became the world's largest publisher of scientific papers in 2016. The Chinese space program started in 1958 with some technology transfers from the Soviet Union. However, it did not launch the nation's first satellite until 1970 with the Dong Fang Hong I , which made China the fifth country to do so independently. In 2003, China became the third country in the world to independently send humans into space with Yang Liwei 's spaceflight aboard Shenzhou 5 . As of 2023, eighteen Chinese nationals have journeyed into space, including two women. In 2011, China launched its first space station testbed, Tiangong-1 . In 2013, a Chinese robotic rover Yutu successfully touched down on the lunar surface as part of the Chang'e 3 mission. In 2019, China became the first country to land a probe— Chang'e 4 —on the far side of the Moon . In 2020, Chang'e 5 successfully returned Moon samples to the Earth, making China the third country to do so independently. In 2021, China became the third country to land a spacecraft on Mars and the second one to deploy a rover (Zhurong) on Mars. China completed its own modular space station , the Tiangong , in low Earth orbit on 3 November 2022. On 29 November 2022, China performed its first in-orbit crew handover aboard the Tiangong . In May 2023, China announced a plan to land humans on the Moon by 2030. To that end, China currently is developing a lunar-capable super-heavy launcher, the Long March 10 , a new crewed spacecraft , and a crewed lunar lander . The Chinese space program started in 1958 with some technology transfers from the Soviet Union. However, it did not launch the nation's first satellite until 1970 with the Dong Fang Hong I , which made China the fifth country to do so independently. In 2003, China became the third country in the world to independently send humans into space with Yang Liwei 's spaceflight aboard Shenzhou 5 . As of 2023, eighteen Chinese nationals have journeyed into space, including two women. In 2011, China launched its first space station testbed, Tiangong-1 . In 2013, a Chinese robotic rover Yutu successfully touched down on the lunar surface as part of the Chang'e 3 mission. In 2019, China became the first country to land a probe— Chang'e 4 —on the far side of the Moon . In 2020, Chang'e 5 successfully returned Moon samples to the Earth, making China the third country to do so independently. In 2021, China became the third country to land a spacecraft on Mars and the second one to deploy a rover (Zhurong) on Mars. China completed its own modular space station , the Tiangong , in low Earth orbit on 3 November 2022. On 29 November 2022, China performed its first in-orbit crew handover aboard the Tiangong . In May 2023, China announced a plan to land humans on the Moon by 2030. To that end, China currently is developing a lunar-capable super-heavy launcher, the Long March 10 , a new crewed spacecraft , and a crewed lunar lander . After a decades-long infrastructural boom, China has produced numerous world-leading infrastructural projects: it has the largest high-speed rail network , the most supertall skyscrapers , the largest power plant (the Three Gorges Dam ), and a global satellite navigation system with the largest number of satellites. China is the largest telecom market in the world and currently has the largest number of active cellphones of any country, with over 1.7 billion subscribers, as of February 2023 [ update ] . It has the largest number of internet and broadband users , with over 1.05 billion Internet users since 2021 [ update ] —equivalent to around 73.7% of its population. By 2018, China had more than 1 billion 4G users, accounting for 40% of world's total. China is making rapid advances in 5G —by late 2018, China had started large-scale and commercial 5G trials. As of March 2022 [ update ] , China had over 500 million 5G users and 1.45 million base stations installed. China Mobile , China Unicom and China Telecom , are the three large providers of mobile and internet in China. China Telecom alone served more than 145 million broadband subscribers and 300 million mobile users; China Unicom had about 300 million subscribers; and China Mobile, the largest of them all, had 925 million users, as of 2018 [ update ] . Combined, the three operators had over 3.4 million 4G base-stations in China. Several Chinese telecommunications companies, most notably Huawei and ZTE , have been accused of spying for the Chinese military. China has developed its own satellite navigation system, dubbed BeiDou , which began offering commercial navigation services across Asia in 2012 as well as global services by the end of 2018. Beidou followed GPS and GLONASS as the third completed global navigation satellite. Since the late 1990s, China's national road network has been significantly expanded through the creation of a network of national highways and expressways . In 2018, China's highways had reached a total length of 161,000 km (100,000 mi) , making it the longest highway system in the world . China has the world's largest market for automobiles, having surpassed the United States in both auto sales and production . The country is the world's largest exporter of cars as of 2023. A side-effect of the rapid growth of China's road network has been a significant rise in traffic accidents. In urban areas, bicycles remain a common mode of transport, despite the increasing prevalence of automobiles – as of 2012 [ update ] , there are approximately 470 million bicycles in China. China's railways , which are operated by the state-owned China State Railway Group Company , are among the busiest in the world , handling a quarter of the world's rail traffic volume on only 6 percent of the world's tracks in 2006. As of 2021 [ update ] , the country had 150,000 km (93,206 mi) of railways, the second longest network in the world . The railways strain to meet enormous demand particularly during the Chinese New Year holiday, when the world's largest annual human migration takes place. China's high-speed rail (HSR) system started construction in the early 2000s. By the end of 2022, high speed rail in China had reached 42,000 kilometers (26,098 miles) of dedicated lines alone, making it the longest HSR network in the world . Services on the Beijing–Shanghai , Beijing–Tianjin , and Chengdu–Chongqing lines reach up to 350 km/h (217 mph) , making them the fastest conventional high speed railway services in the world. With an annual ridership of over 2.3 billion passengers in 2019, it is the world's busiest. The network includes the Beijing–Guangzhou high-speed railway , the single longest HSR line in the world, and the Beijing–Shanghai high-speed railway , which has three of longest railroad bridges in the world . The Shanghai maglev train , which reaches 431 km/h (268 mph) , is the fastest commercial train service in the world. Since 2000, the growth of rapid transit systems in Chinese cities has accelerated. As of January 2021 [ update ] , 44 Chinese cities have urban mass transit systems in operation. As of 2020 [ update ] , China boasts the five longest metro systems in the world with the networks in Shanghai , Beijing , Guangzhou , Chengdu and Shenzhen being the largest. The civil aviation industry in China is mostly state-dominated, with the Chinese government retaining a majority stake in the majority of Chinese airlines. The top three airlines in China, which collectively made up 71% of the market in 2018, are all state-owned. Air travel has expanded rapidly in the last decades, with the number of passengers increasing from 16.6 million in 1990 to 551.2 million in 2017. China had approximately 259 airports in 2024 . China has over 2,000 river and seaports , about 130 of which are open to foreign shipping. Of the fifty busiest container ports , 15 are located in China, of which the busiest is the Port of Shanghai , also the busiest port in the world. The country's inland waterways are the world's sixth-longest , and total 27,700 km (17,212 mi) . Water supply and sanitation infrastructure in China is facing challenges such as rapid urbanization, as well as water scarcity, contamination, and pollution . According to the Joint Monitoring Program for Water Supply and Sanitation in 2015, about 36% of the rural population in China still did not have access to improved sanitation . [ needs update ] The ongoing South–North Water Transfer Project intends to abate water shortage in the north. China is the largest telecom market in the world and currently has the largest number of active cellphones of any country, with over 1.7 billion subscribers, as of February 2023 [ update ] . It has the largest number of internet and broadband users , with over 1.05 billion Internet users since 2021 [ update ] —equivalent to around 73.7% of its population. By 2018, China had more than 1 billion 4G users, accounting for 40% of world's total. China is making rapid advances in 5G —by late 2018, China had started large-scale and commercial 5G trials. As of March 2022 [ update ] , China had over 500 million 5G users and 1.45 million base stations installed. China Mobile , China Unicom and China Telecom , are the three large providers of mobile and internet in China. China Telecom alone served more than 145 million broadband subscribers and 300 million mobile users; China Unicom had about 300 million subscribers; and China Mobile, the largest of them all, had 925 million users, as of 2018 [ update ] . Combined, the three operators had over 3.4 million 4G base-stations in China. Several Chinese telecommunications companies, most notably Huawei and ZTE , have been accused of spying for the Chinese military. China has developed its own satellite navigation system, dubbed BeiDou , which began offering commercial navigation services across Asia in 2012 as well as global services by the end of 2018. Beidou followed GPS and GLONASS as the third completed global navigation satellite. Since the late 1990s, China's national road network has been significantly expanded through the creation of a network of national highways and expressways . In 2018, China's highways had reached a total length of 161,000 km (100,000 mi) , making it the longest highway system in the world . China has the world's largest market for automobiles, having surpassed the United States in both auto sales and production . The country is the world's largest exporter of cars as of 2023. A side-effect of the rapid growth of China's road network has been a significant rise in traffic accidents. In urban areas, bicycles remain a common mode of transport, despite the increasing prevalence of automobiles – as of 2012 [ update ] , there are approximately 470 million bicycles in China. China's railways , which are operated by the state-owned China State Railway Group Company , are among the busiest in the world , handling a quarter of the world's rail traffic volume on only 6 percent of the world's tracks in 2006. As of 2021 [ update ] , the country had 150,000 km (93,206 mi) of railways, the second longest network in the world . The railways strain to meet enormous demand particularly during the Chinese New Year holiday, when the world's largest annual human migration takes place. China's high-speed rail (HSR) system started construction in the early 2000s. By the end of 2022, high speed rail in China had reached 42,000 kilometers (26,098 miles) of dedicated lines alone, making it the longest HSR network in the world . Services on the Beijing–Shanghai , Beijing–Tianjin , and Chengdu–Chongqing lines reach up to 350 km/h (217 mph) , making them the fastest conventional high speed railway services in the world. With an annual ridership of over 2.3 billion passengers in 2019, it is the world's busiest. The network includes the Beijing–Guangzhou high-speed railway , the single longest HSR line in the world, and the Beijing–Shanghai high-speed railway , which has three of longest railroad bridges in the world . The Shanghai maglev train , which reaches 431 km/h (268 mph) , is the fastest commercial train service in the world. Since 2000, the growth of rapid transit systems in Chinese cities has accelerated. As of January 2021 [ update ] , 44 Chinese cities have urban mass transit systems in operation. As of 2020 [ update ] , China boasts the five longest metro systems in the world with the networks in Shanghai , Beijing , Guangzhou , Chengdu and Shenzhen being the largest. The civil aviation industry in China is mostly state-dominated, with the Chinese government retaining a majority stake in the majority of Chinese airlines. The top three airlines in China, which collectively made up 71% of the market in 2018, are all state-owned. Air travel has expanded rapidly in the last decades, with the number of passengers increasing from 16.6 million in 1990 to 551.2 million in 2017. China had approximately 259 airports in 2024 . China has over 2,000 river and seaports , about 130 of which are open to foreign shipping. Of the fifty busiest container ports , 15 are located in China, of which the busiest is the Port of Shanghai , also the busiest port in the world. The country's inland waterways are the world's sixth-longest , and total 27,700 km (17,212 mi) . Water supply and sanitation infrastructure in China is facing challenges such as rapid urbanization, as well as water scarcity, contamination, and pollution . According to the Joint Monitoring Program for Water Supply and Sanitation in 2015, about 36% of the rural population in China still did not have access to improved sanitation . [ needs update ] The ongoing South–North Water Transfer Project intends to abate water shortage in the north. The 2020 Chinese census recorded the population as approximately 1,411,778,724. About 17.95% were 14 years old or younger, 63.35% were between 15 and 59 years old, and 18.7% were over 60 years old. Between 2010 and 2020, the average population growth rate was 0.53%. Given concerns about population growth, China implemented a two-child limit during the 1970s, and, in 1979, began to advocate for an even stricter limit of one child per family. Beginning in the mid-1980s, however, given the unpopularity of the strict limits, China began to allow some major exemptions, particularly in rural areas, resulting in what was actually a "1.5"-child policy from the mid-1980s to 2015; ethnic minorities were also exempt from one-child limits. The next major loosening of the policy was enacted in December 2013, allowing families to have two children if one parent is an only child. In 2016, the one-child policy was replaced in favor of a two-child policy . A three-child policy was announced on 31 May 2021, due to population aging , and in July 2021, all family size limits as well as penalties for exceeding them were removed. In 2023, the total fertility rate was reported to be 1.09, ranking among the lowest in the world . In 2023, National Bureau of Statistics estimated that the population fell 850,000 from 2021 to 2022, the first decline since 1961. According to one group of scholars, one-child limits had little effect on population growth or total population size. However, these scholars have been challenged. The policy, along with traditional preference for boys, may have contributed to an imbalance in the sex ratio at birth. The 2020 census found that males accounted for 51.2% of the total population. However, China's sex ratio is more balanced than it was in 1953, when males accounted for 51.8% of the population. China legally recognizes 56 distinct ethnic groups, who comprise the Zhonghua minzu . The largest of these nationalities are the Han Chinese , who constitute more than 91% of the total population. The Han Chinese – the world's largest single ethnic group – outnumber other ethnic groups in every place excluding Tibet , Xinjiang , Linxia , and autonomous prefectures like Xishuangbanna . Ethnic minorities account for less than 10% of the population of China, according to the 2020 census. Compared with the 2010 population census, the Han population increased by 60,378,693 persons, or 4.93%, while the population of the 55 national minorities combined increased by 11,675,179 persons, or 10.26%. The 2020 census recorded a total of 845,697 foreign nationals living in mainland China. There are as many as 292 living languages in China. The languages most commonly spoken belong to the Sinitic branch of the Sino-Tibetan language family, which contains Mandarin (spoken by 80% of the population), and other varieties of Chinese language : Jin , Wu , Min , Hakka , Yue , Xiang , Gan , Hui , Ping and unclassified Tuhua ( Shaozhou Tuhua and Xiangnan Tuhua ). Languages of the Tibeto-Burman branch , including Tibetan , Qiang , Naxi and Yi , are spoken across the Tibetan and Yunnan–Guizhou Plateau . Other ethnic minority languages in southwestern China include Zhuang , Thai , Dong and Sui of the Tai-Kadai family , Miao and Yao of the Hmong–Mien family , and Wa of the Austroasiatic family . Across northeastern and northwestern China , local ethnic groups speak Altaic languages including Manchu , Mongolian and several Turkic languages : Uyghur , Kazakh , Kyrgyz , Salar and Western Yugur . Korean is spoken natively along the border with North Korea . Sarikoli , the language of Tajiks in western Xinjiang , is an Indo-European language . Taiwanese indigenous peoples , including a small population on the mainland, speak Austronesian languages . Standard Mandarin , a variety of Mandarin based on the Beijing dialect , is the national language and de facto official language of China. It is used as a lingua franca between people of different linguistic backgrounds. In the autonomous regions of China , other languages may also serve as a lingua franca, such as Uyghur in Xinjiang, where governmental services in Uyghur are constitutionally guaranteed. China has urbanized significantly in recent decades. The percent of the country's population living in urban areas increased from 20% in 1980 to over 66% in 2023. China has over 160 cities with a population of over one million, including the 17 megacities as of 2021 [ update ] (cities with a population of over 10 million) of Chongqing , Shanghai , Beijing , Chengdu , Guangzhou , Shenzhen , Tianjin , Xi'an , Suzhou , Zhengzhou , Wuhan , Hangzhou , Linyi , Shijiazhuang , Dongguan , Qingdao and Changsha . The total permanent population of Chongqing, Shanghai, Beijing and Chengdu is above 20 million. Shanghai is China's most populous urban area while Chongqing is its largest city proper , the only city in China with a permanent population of over 30 million. The figures in the table below are from the 2020 census, and are only estimates of the urban populations within administrative city limits; a different ranking exists for total municipal populations. The large " floating populations " of migrant workers make conducting censuses in urban areas difficult; the figures below include only long-term residents. Compulsory education in China comprises primary and junior secondary school , which together last for nine years from the age of 6 and 15. The Gaokao , China's national university entrance exam, is a prerequisite for entrance into most higher education institutions. Vocational education is available to students at the secondary and tertiary level. More than 10 million Chinese students graduated from vocational colleges every year. In 2023, about 91.8 percent of students continued their education at a three-year senior secondary school, while 60.2 percent of secondary school graduates were enrolled in higher education. China has the largest education system in the world, with about 282 million students and 17.32 million full-time teachers in over 530,000 schools. Annual education investment went from less than US$50 billion in 2003 to more than US$817 billion in 2020. However, there remains an inequality in education spending. In 2010, the annual education expenditure per secondary school student in Beijing totalled Â¥20,023, while in Guizhou , one of the poorest provinces , only totalled Â¥3,204. China's literacy rate has grown dramatically, from only 20% in 1949 and 65.5% in 1979, to 97% of the population over age 15 in 2020. As of 2021 [ update ] , China has over 3,000 universities, with over 44.3 million students enrolled in mainland China and 240 million Chinese citizens have received high education, making China the largest higher education system in the world. As of 2023 [ update ] , China had the world's highest number of top universities . Currently, China trails only the United States and the United Kingdom in terms of representation on lists of the top 200 universities according to the 2023 Aggregate Ranking of Top Universities , a composite ranking system of three world-most followed university rankings ( ARWU + QS + THE ). China is home to two of the highest-ranking universities ( Tsinghua University and Peking University ) in Asia and emerging economies , according to the Times Higher Education World University Rankings and the QS World University Rankings . These universities are members of the C9 League , an alliance of elite Chinese universities offering comprehensive and leading education. The National Health Commission , together with its counterparts in the local commissions, oversees the health needs of the population. An emphasis on public health and preventive medicine has characterized Chinese health policy since the early 1950s. The Communist Party started the Patriotic Health Campaign , which was aimed at improving sanitation and hygiene, as well as treating and preventing several diseases. Diseases such as cholera , typhoid and scarlet fever , which were previously rife in China, were nearly eradicated by the campaign. After Deng Xiaoping began instituting economic reforms in 1978, the health of the Chinese public improved rapidly because of better nutrition, although many of the free public health services provided in the countryside disappeared. Healthcare in China became mostly privatized, and experienced a significant rise in quality. In 2009, the government began a three-year large-scale healthcare provision initiative worth US$124 billion. By 2011, the campaign resulted in 95% of China's population having basic health insurance coverage. By 2022, China had established itself as a key producer and exporter of pharmaceuticals , producing around 40 percent of active pharmaceutical ingredients in 2017. As of 2023 [ update ] , the life expectancy at birth exceeds 78 years. : 163 As of 2021, the infant mortality rate is 5 per thousand. Both have improved significantly since the 1950s. [lower-alpha 24] Rates of stunting , a condition caused by malnutrition , have declined from 33.1% in 1990 to 9.9% in 2010. Despite significant improvements in health and the construction of advanced medical facilities, China has several emerging public health problems, such as respiratory illnesses caused by widespread air pollution , hundreds of millions of cigarette smokers , and an increase in obesity among urban youths. In 2010, air pollution caused 1.2 million premature deaths in China. Chinese mental health services are inadequate. China's large population and densely populated cities have led to serious disease outbreaks, such as SARS in 2003, although this has since been largely contained. The COVID-19 pandemic was first identified in Wuhan in December 2019; pandemic led the government to enforce strict public health measures intended to completely eradicate the virus, a goal that was eventually abandoned in December 2022 after protests against the policy . Freedom of religion is guaranteed by China's constitution (Chapter 2, Article 36), although religious organizations that lack official approval can be subject to state persecution. The government of the country is officially atheist . Religious affairs and issues in the country are overseen by the National Religious Affairs Administration, under the United Front Work Department . Over the millennia, the Chinese civilization has been influenced by various religious movements. The " three doctrines ", including Confucianism , Taoism , and Buddhism ( Chinese Buddhism ), historically have a significant role in shaping Chinese culture, enriching a theological and spiritual framework of traditional religion which harks back to the early Shang and Zhou dynasty . Chinese folk religion , which is framed by the three doctrines and by other traditions, consists in allegiance to the shen (神), a character that signifies the " energies of generation ", who can be deities of the surrounding nature or ancestral principles of human groups, concepts of civility, culture heroes , many of whom feature in Chinese mythology and history. Amongst the most popular cults of folk religion are those of Huangdi , embodiment of the God of Heaven and one of the two divine patriarchs of the Chinese people, of Mazu (goddess of the seas), Guandi (god of war and business), Caishen (god of prosperity and richness), Pangu and many others. In the early decades of the 21st century, the Chinese government has been engaged in a rehabilitation of folk cults — formally recognizing them as "folk beliefs" (a category different from that of doctrinal religions), and often reconstructing them into forms of "highly curated" civil religion — as well as in a national and international promotion of Buddhism. China is home to many of the world's tallest religious statues , representing either deities of Chinese folk religion or enlightened beings of Buddhism; the tallest of all is the Spring Temple Buddha in Henan . Statistics on religious affiliation in China are difficult to gather due to complex and varying definitions of religion and the diffusive nature of Chinese religious traditions. Scholars note that in China there is no clear boundary between the three doctrines and local folk religious practices. Chinese religions or some of their currents are also definable as non-theistic and humanistic , since they do not hold that divine creativity is completely transcendent, but that it is inherent in the world and in particular in the human being. According to studies published in 2023, compiling reliable demographic analyses holden throughout the 2010s and the early 2020s, 70% of the Chinese population believes in or practices Chinese folk religion; among them, with an approach of non-exclusivity, 33.4% may be identified as Buddhists, 19.6% as Taoists, and 17.7% as adherents of other types of folk religion. Of the remaining population, 25.2% are fully non-believers or atheists, 2.5% are adherents of Christianity , and 1.6% are adherents of Islam . Chinese folk religion also comprises a variety of salvationist doctrinal organized movements which emerged since the Song dynasty . There are also ethnic minorities in China who maintain their own indigenous religions , while major religions characteristic of specific ethnic groups include Tibetan Buddhism among Tibetans , Mongols and Yugurs , and Islam among the Hui , Uyghur , Kazakh , and Kyrgyz peoples, and other ethnicities in the northern and northwestern regions of the country.China legally recognizes 56 distinct ethnic groups, who comprise the Zhonghua minzu . The largest of these nationalities are the Han Chinese , who constitute more than 91% of the total population. The Han Chinese – the world's largest single ethnic group – outnumber other ethnic groups in every place excluding Tibet , Xinjiang , Linxia , and autonomous prefectures like Xishuangbanna . Ethnic minorities account for less than 10% of the population of China, according to the 2020 census. Compared with the 2010 population census, the Han population increased by 60,378,693 persons, or 4.93%, while the population of the 55 national minorities combined increased by 11,675,179 persons, or 10.26%. The 2020 census recorded a total of 845,697 foreign nationals living in mainland China. There are as many as 292 living languages in China. The languages most commonly spoken belong to the Sinitic branch of the Sino-Tibetan language family, which contains Mandarin (spoken by 80% of the population), and other varieties of Chinese language : Jin , Wu , Min , Hakka , Yue , Xiang , Gan , Hui , Ping and unclassified Tuhua ( Shaozhou Tuhua and Xiangnan Tuhua ). Languages of the Tibeto-Burman branch , including Tibetan , Qiang , Naxi and Yi , are spoken across the Tibetan and Yunnan–Guizhou Plateau . Other ethnic minority languages in southwestern China include Zhuang , Thai , Dong and Sui of the Tai-Kadai family , Miao and Yao of the Hmong–Mien family , and Wa of the Austroasiatic family . Across northeastern and northwestern China , local ethnic groups speak Altaic languages including Manchu , Mongolian and several Turkic languages : Uyghur , Kazakh , Kyrgyz , Salar and Western Yugur . Korean is spoken natively along the border with North Korea . Sarikoli , the language of Tajiks in western Xinjiang , is an Indo-European language . Taiwanese indigenous peoples , including a small population on the mainland, speak Austronesian languages . Standard Mandarin , a variety of Mandarin based on the Beijing dialect , is the national language and de facto official language of China. It is used as a lingua franca between people of different linguistic backgrounds. In the autonomous regions of China , other languages may also serve as a lingua franca, such as Uyghur in Xinjiang, where governmental services in Uyghur are constitutionally guaranteed. China has urbanized significantly in recent decades. The percent of the country's population living in urban areas increased from 20% in 1980 to over 66% in 2023. China has over 160 cities with a population of over one million, including the 17 megacities as of 2021 [ update ] (cities with a population of over 10 million) of Chongqing , Shanghai , Beijing , Chengdu , Guangzhou , Shenzhen , Tianjin , Xi'an , Suzhou , Zhengzhou , Wuhan , Hangzhou , Linyi , Shijiazhuang , Dongguan , Qingdao and Changsha . The total permanent population of Chongqing, Shanghai, Beijing and Chengdu is above 20 million. Shanghai is China's most populous urban area while Chongqing is its largest city proper , the only city in China with a permanent population of over 30 million. The figures in the table below are from the 2020 census, and are only estimates of the urban populations within administrative city limits; a different ranking exists for total municipal populations. The large " floating populations " of migrant workers make conducting censuses in urban areas difficult; the figures below include only long-term residents.Compulsory education in China comprises primary and junior secondary school , which together last for nine years from the age of 6 and 15. The Gaokao , China's national university entrance exam, is a prerequisite for entrance into most higher education institutions. Vocational education is available to students at the secondary and tertiary level. More than 10 million Chinese students graduated from vocational colleges every year. In 2023, about 91.8 percent of students continued their education at a three-year senior secondary school, while 60.2 percent of secondary school graduates were enrolled in higher education. China has the largest education system in the world, with about 282 million students and 17.32 million full-time teachers in over 530,000 schools. Annual education investment went from less than US$50 billion in 2003 to more than US$817 billion in 2020. However, there remains an inequality in education spending. In 2010, the annual education expenditure per secondary school student in Beijing totalled Â¥20,023, while in Guizhou , one of the poorest provinces , only totalled Â¥3,204. China's literacy rate has grown dramatically, from only 20% in 1949 and 65.5% in 1979, to 97% of the population over age 15 in 2020. As of 2021 [ update ] , China has over 3,000 universities, with over 44.3 million students enrolled in mainland China and 240 million Chinese citizens have received high education, making China the largest higher education system in the world. As of 2023 [ update ] , China had the world's highest number of top universities . Currently, China trails only the United States and the United Kingdom in terms of representation on lists of the top 200 universities according to the 2023 Aggregate Ranking of Top Universities , a composite ranking system of three world-most followed university rankings ( ARWU + QS + THE ). China is home to two of the highest-ranking universities ( Tsinghua University and Peking University ) in Asia and emerging economies , according to the Times Higher Education World University Rankings and the QS World University Rankings . These universities are members of the C9 League , an alliance of elite Chinese universities offering comprehensive and leading education. The National Health Commission , together with its counterparts in the local commissions, oversees the health needs of the population. An emphasis on public health and preventive medicine has characterized Chinese health policy since the early 1950s. The Communist Party started the Patriotic Health Campaign , which was aimed at improving sanitation and hygiene, as well as treating and preventing several diseases. Diseases such as cholera , typhoid and scarlet fever , which were previously rife in China, were nearly eradicated by the campaign. After Deng Xiaoping began instituting economic reforms in 1978, the health of the Chinese public improved rapidly because of better nutrition, although many of the free public health services provided in the countryside disappeared. Healthcare in China became mostly privatized, and experienced a significant rise in quality. In 2009, the government began a three-year large-scale healthcare provision initiative worth US$124 billion. By 2011, the campaign resulted in 95% of China's population having basic health insurance coverage. By 2022, China had established itself as a key producer and exporter of pharmaceuticals , producing around 40 percent of active pharmaceutical ingredients in 2017. As of 2023 [ update ] , the life expectancy at birth exceeds 78 years. : 163 As of 2021, the infant mortality rate is 5 per thousand. Both have improved significantly since the 1950s. [lower-alpha 24] Rates of stunting , a condition caused by malnutrition , have declined from 33.1% in 1990 to 9.9% in 2010. Despite significant improvements in health and the construction of advanced medical facilities, China has several emerging public health problems, such as respiratory illnesses caused by widespread air pollution , hundreds of millions of cigarette smokers , and an increase in obesity among urban youths. In 2010, air pollution caused 1.2 million premature deaths in China. Chinese mental health services are inadequate. China's large population and densely populated cities have led to serious disease outbreaks, such as SARS in 2003, although this has since been largely contained. The COVID-19 pandemic was first identified in Wuhan in December 2019; pandemic led the government to enforce strict public health measures intended to completely eradicate the virus, a goal that was eventually abandoned in December 2022 after protests against the policy . Freedom of religion is guaranteed by China's constitution (Chapter 2, Article 36), although religious organizations that lack official approval can be subject to state persecution. The government of the country is officially atheist . Religious affairs and issues in the country are overseen by the National Religious Affairs Administration, under the United Front Work Department . Over the millennia, the Chinese civilization has been influenced by various religious movements. The " three doctrines ", including Confucianism , Taoism , and Buddhism ( Chinese Buddhism ), historically have a significant role in shaping Chinese culture, enriching a theological and spiritual framework of traditional religion which harks back to the early Shang and Zhou dynasty . Chinese folk religion , which is framed by the three doctrines and by other traditions, consists in allegiance to the shen (神), a character that signifies the " energies of generation ", who can be deities of the surrounding nature or ancestral principles of human groups, concepts of civility, culture heroes , many of whom feature in Chinese mythology and history. Amongst the most popular cults of folk religion are those of Huangdi , embodiment of the God of Heaven and one of the two divine patriarchs of the Chinese people, of Mazu (goddess of the seas), Guandi (god of war and business), Caishen (god of prosperity and richness), Pangu and many others. In the early decades of the 21st century, the Chinese government has been engaged in a rehabilitation of folk cults — formally recognizing them as "folk beliefs" (a category different from that of doctrinal religions), and often reconstructing them into forms of "highly curated" civil religion — as well as in a national and international promotion of Buddhism. China is home to many of the world's tallest religious statues , representing either deities of Chinese folk religion or enlightened beings of Buddhism; the tallest of all is the Spring Temple Buddha in Henan . Statistics on religious affiliation in China are difficult to gather due to complex and varying definitions of religion and the diffusive nature of Chinese religious traditions. Scholars note that in China there is no clear boundary between the three doctrines and local folk religious practices. Chinese religions or some of their currents are also definable as non-theistic and humanistic , since they do not hold that divine creativity is completely transcendent, but that it is inherent in the world and in particular in the human being. According to studies published in 2023, compiling reliable demographic analyses holden throughout the 2010s and the early 2020s, 70% of the Chinese population believes in or practices Chinese folk religion; among them, with an approach of non-exclusivity, 33.4% may be identified as Buddhists, 19.6% as Taoists, and 17.7% as adherents of other types of folk religion. Of the remaining population, 25.2% are fully non-believers or atheists, 2.5% are adherents of Christianity , and 1.6% are adherents of Islam . Chinese folk religion also comprises a variety of salvationist doctrinal organized movements which emerged since the Song dynasty . There are also ethnic minorities in China who maintain their own indigenous religions , while major religions characteristic of specific ethnic groups include Tibetan Buddhism among Tibetans , Mongols and Yugurs , and Islam among the Hui , Uyghur , Kazakh , and Kyrgyz peoples, and other ethnicities in the northern and northwestern regions of the country.Since ancient times , Chinese culture has been heavily influenced by Confucianism. Chinese culture, in turn, has heavily influenced East Asia and Southeast Asia . For much of the country's dynastic era, opportunities for social advancement could be provided by high performance in the prestigious imperial examinations , which have their origins in the Han dynasty. The literary emphasis of the exams affected the general perception of cultural refinement in China, such as the belief that calligraphy , poetry and painting were higher forms of art than dancing or drama. Chinese culture has long emphasized a sense of deep history and a largely inward-looking national perspective. Examinations and a culture of merit remain greatly valued in China today. Today, the Chinese government has accepted numerous elements of traditional Chinese culture as being integral to Chinese society. With the rise of Chinese nationalism and the end of the Cultural Revolution, various forms of traditional Chinese art, literature, music, film, fashion and architecture have seen a vigorous revival, and folk and variety art in particular have sparked interest nationally and even worldwide. Access to foreign media remains heavily restricted. China received 65.7 million international visitors in 2019, and in 2018 was the fourth-most-visited country in the world. It also experiences an enormous volume of domestic tourism ; Chinese tourists made an estimated 6 billion travels within the country in 2019. China hosts the world's second-largest number of World Heritage Sites ( 56 ) after Italy, and is one of the most popular tourist destinations ( first in the Asia-Pacific ). Chinese literature has its roots in the Zhou dynasty's literary tradition. The classical texts of China encompass a wide range of thoughts and subjects, such as the calendar , military , astrology , herbology , and geography , as well as many others. Among the most significant early works are the I Ching and the Shujing , which are part of the Four Books and Five Classics . These texts were the cornerstone of the Confucian curriculum sponsored by the state throughout the dynastic periods. Inherited from the Classic of Poetry , classical Chinese poetry developed to its floruit during the Tang dynasty. Li Bai and Du Fu opened the forking ways for the poetic circles through romanticism and realism respectively. Chinese historiography began with the Shiji , the overall scope of the historiographical tradition in China is termed the Twenty-Four Histories , which set a vast stage for Chinese fictions along with Chinese mythology and folklore . Pushed by a burgeoning citizen class in the Ming dynasty, Chinese classical fiction rose to a boom of the historical, town and gods and demons fictions as represented by the Four Great Classical Novels which include Water Margin , Romance of the Three Kingdoms , Journey to the West and Dream of the Red Chamber . Along with the wuxia fictions of Jin Yong and Liang Yusheng , it remains an enduring source of popular culture in the Chinese sphere of influence . In the wake of the New Culture Movement after the end of the Qing dynasty, Chinese literature embarked on a new era with written vernacular Chinese for ordinary citizens. Hu Shih and Lu Xun were pioneers in modern literature. Various literary genres, such as misty poetry , scar literature , young adult fiction and the xungen literature , which is influenced by magic realism , emerged following the Cultural Revolution. Mo Yan , a xungen literature author, was awarded the Nobel Prize in Literature in 2012. Chinese cuisine is highly diverse, drawing on several millennia of culinary history and geographical variety, in which the most influential are known as the "Eight Major Cuisines", including Sichuan , Cantonese , Jiangsu , Shandong , Fujian , Hunan , Anhui , and Zhejiang cuisines. Chinese cuisine is known for its breadth of cooking methods and ingredients. China's staple food is rice in the northeast and south, and wheat-based breads and noodles in the north. Bean products such as tofu and soy milk remain a popular source of protein. Pork is now the most popular meat in China, accounting for about three-fourths of the country's total meat consumption. There is also the vegetarian Buddhist cuisine and the pork-free Chinese Islamic cuisine . Chinese cuisine, due to the area's proximity to the ocean and milder climate, has a wide variety of seafood and vegetables. Offshoots of Chinese food, such as Hong Kong cuisine and American Chinese cuisine , have emerged in the Chinese diaspora . Chinese architecture has developed over millennia in China and has remained a vestigial source of perennial influence on the development of East Asian architecture, including in Japan , Korea , and Mongolia . and minor influences on the architecture of Southeast and South Asia including the countries of Malaysia , Singapore , Indonesia , Sri Lanka , Thailand, Laos, Cambodia , Vietnam and the Philippines. Chinese architecture is characterized by bilateral symmetry, use of enclosed open spaces, feng shui (e.g. directional hierarchies ), a horizontal emphasis, and an allusion to various cosmological, mythological or in general symbolic elements. Chinese architecture traditionally classifies structures according to type, ranging from pagodas to palaces . Chinese architecture varies widely based on status or affiliation, such as whether the structures were constructed for emperors, commoners, or for religious purposes. Other variations in Chinese architecture are shown in vernacular styles associated with different geographic regions and different ethnic heritages, such as the stilt houses in the south, the Yaodong buildings in the northwest, the yurt buildings of nomadic people, and the Siheyuan buildings in the north. Chinese music covers a highly diverse range of music from traditional music to modern music. Chinese music dates back before the pre-imperial times. Traditional Chinese musical instruments were traditionally grouped into eight categories known as bayin (å «éŸ³). Traditional Chinese opera is a form of musical theatre in China originating thousands of years and has regional style forms such as Beijing and Cantonese opera . Chinese pop (C-Pop) includes mandopop and cantopop . Chinese hip hop and Hong Kong hip hop have become popular. Cinema was first introduced to China in 1896 and the first Chinese film, Dingjun Mountain , was released in 1905. China has the largest number of movie screens in the world since 2016; China became the largest cinema market in 2020. The top three highest-grossing films in China as of 2023 [ update ] were The Battle at Lake Changjin (2021), Wolf Warrior 2 (2017), and Hi, Mom (2021). Hanfu is the historical clothing of the Han people in China. The qipao or cheongsam is a popular Chinese female dress. The hanfu movement has been popular in contemporary times and seeks to revitalize Hanfu clothing. China Fashion Week is the country's only national-level fashion festival. China has one of the oldest sporting cultures . There is evidence that archery ( shèjià n ) was practiced during the Western Zhou dynasty . Swordplay ( jià nshù ) and cuju , a sport loosely related to association football date back to China's early dynasties as well. Physical fitness is widely emphasized in Chinese culture, with morning exercises such as qigong and tai chi widely practiced, and commercial gyms and private fitness clubs are gaining popularity. Basketball is the most popular spectator sport in China. The Chinese Basketball Association and the American National Basketball Association also have a huge national following amongst the Chinese populace, with native-born and NBA-bound Chinese players and well-known national household names such as Yao Ming and Yi Jianlian being held in high esteem. China's professional football league, known as Chinese Super League , is the largest football market in East Asia. Other popular sports include martial arts , table tennis , badminton , swimming and snooker . China is home to a huge number of cyclists , with an estimated 470 million bicycles as of 2012 [ update ] . China has the world's largest esports market. Many more traditional sports, such as dragon boat racing, Mongolian-style wrestling and horse racing are also popular. China has participated in the Olympic Games since 1932, although it has only participated as the PRC since 1952 . China hosted the 2008 Summer Olympics in Beijing, where its athletes received 48 gold medals – the highest number of any participating nation that year. China also won the most medals at the 2012 Summer Paralympics , with 231 overall, including 95 gold. In 2011, Shenzhen hosted the 2011 Summer Universiade . China hosted the 2013 East Asian Games in Tianjin and the 2014 Summer Youth Olympics in Nanjing, the first country to host both regular and Youth Olympics. Beijing and its nearby city Zhangjiakou collaboratively hosted the 2022 Winter Olympics , making Beijing the first dual Olympic city by holding both the Summer Olympics and the Winter Olympics. China received 65.7 million international visitors in 2019, and in 2018 was the fourth-most-visited country in the world. It also experiences an enormous volume of domestic tourism ; Chinese tourists made an estimated 6 billion travels within the country in 2019. China hosts the world's second-largest number of World Heritage Sites ( 56 ) after Italy, and is one of the most popular tourist destinations ( first in the Asia-Pacific ).Chinese literature has its roots in the Zhou dynasty's literary tradition. The classical texts of China encompass a wide range of thoughts and subjects, such as the calendar , military , astrology , herbology , and geography , as well as many others. Among the most significant early works are the I Ching and the Shujing , which are part of the Four Books and Five Classics . These texts were the cornerstone of the Confucian curriculum sponsored by the state throughout the dynastic periods. Inherited from the Classic of Poetry , classical Chinese poetry developed to its floruit during the Tang dynasty. Li Bai and Du Fu opened the forking ways for the poetic circles through romanticism and realism respectively. Chinese historiography began with the Shiji , the overall scope of the historiographical tradition in China is termed the Twenty-Four Histories , which set a vast stage for Chinese fictions along with Chinese mythology and folklore . Pushed by a burgeoning citizen class in the Ming dynasty, Chinese classical fiction rose to a boom of the historical, town and gods and demons fictions as represented by the Four Great Classical Novels which include Water Margin , Romance of the Three Kingdoms , Journey to the West and Dream of the Red Chamber . Along with the wuxia fictions of Jin Yong and Liang Yusheng , it remains an enduring source of popular culture in the Chinese sphere of influence . In the wake of the New Culture Movement after the end of the Qing dynasty, Chinese literature embarked on a new era with written vernacular Chinese for ordinary citizens. Hu Shih and Lu Xun were pioneers in modern literature. Various literary genres, such as misty poetry , scar literature , young adult fiction and the xungen literature , which is influenced by magic realism , emerged following the Cultural Revolution. Mo Yan , a xungen literature author, was awarded the Nobel Prize in Literature in 2012. Chinese cuisine is highly diverse, drawing on several millennia of culinary history and geographical variety, in which the most influential are known as the "Eight Major Cuisines", including Sichuan , Cantonese , Jiangsu , Shandong , Fujian , Hunan , Anhui , and Zhejiang cuisines. Chinese cuisine is known for its breadth of cooking methods and ingredients. China's staple food is rice in the northeast and south, and wheat-based breads and noodles in the north. Bean products such as tofu and soy milk remain a popular source of protein. Pork is now the most popular meat in China, accounting for about three-fourths of the country's total meat consumption. There is also the vegetarian Buddhist cuisine and the pork-free Chinese Islamic cuisine . Chinese cuisine, due to the area's proximity to the ocean and milder climate, has a wide variety of seafood and vegetables. Offshoots of Chinese food, such as Hong Kong cuisine and American Chinese cuisine , have emerged in the Chinese diaspora .Chinese architecture has developed over millennia in China and has remained a vestigial source of perennial influence on the development of East Asian architecture, including in Japan , Korea , and Mongolia . and minor influences on the architecture of Southeast and South Asia including the countries of Malaysia , Singapore , Indonesia , Sri Lanka , Thailand, Laos, Cambodia , Vietnam and the Philippines. Chinese architecture is characterized by bilateral symmetry, use of enclosed open spaces, feng shui (e.g. directional hierarchies ), a horizontal emphasis, and an allusion to various cosmological, mythological or in general symbolic elements. Chinese architecture traditionally classifies structures according to type, ranging from pagodas to palaces . Chinese architecture varies widely based on status or affiliation, such as whether the structures were constructed for emperors, commoners, or for religious purposes. Other variations in Chinese architecture are shown in vernacular styles associated with different geographic regions and different ethnic heritages, such as the stilt houses in the south, the Yaodong buildings in the northwest, the yurt buildings of nomadic people, and the Siheyuan buildings in the north. Chinese music covers a highly diverse range of music from traditional music to modern music. Chinese music dates back before the pre-imperial times. Traditional Chinese musical instruments were traditionally grouped into eight categories known as bayin (å «éŸ³). Traditional Chinese opera is a form of musical theatre in China originating thousands of years and has regional style forms such as Beijing and Cantonese opera . Chinese pop (C-Pop) includes mandopop and cantopop . Chinese hip hop and Hong Kong hip hop have become popular. Cinema was first introduced to China in 1896 and the first Chinese film, Dingjun Mountain , was released in 1905. China has the largest number of movie screens in the world since 2016; China became the largest cinema market in 2020. The top three highest-grossing films in China as of 2023 [ update ] were The Battle at Lake Changjin (2021), Wolf Warrior 2 (2017), and Hi, Mom (2021). Hanfu is the historical clothing of the Han people in China. The qipao or cheongsam is a popular Chinese female dress. The hanfu movement has been popular in contemporary times and seeks to revitalize Hanfu clothing. China Fashion Week is the country's only national-level fashion festival. China has one of the oldest sporting cultures . There is evidence that archery ( shèjià n ) was practiced during the Western Zhou dynasty . Swordplay ( jià nshù ) and cuju , a sport loosely related to association football date back to China's early dynasties as well. Physical fitness is widely emphasized in Chinese culture, with morning exercises such as qigong and tai chi widely practiced, and commercial gyms and private fitness clubs are gaining popularity. Basketball is the most popular spectator sport in China. The Chinese Basketball Association and the American National Basketball Association also have a huge national following amongst the Chinese populace, with native-born and NBA-bound Chinese players and well-known national household names such as Yao Ming and Yi Jianlian being held in high esteem. China's professional football league, known as Chinese Super League , is the largest football market in East Asia. Other popular sports include martial arts , table tennis , badminton , swimming and snooker . China is home to a huge number of cyclists , with an estimated 470 million bicycles as of 2012 [ update ] . China has the world's largest esports market. Many more traditional sports, such as dragon boat racing, Mongolian-style wrestling and horse racing are also popular. China has participated in the Olympic Games since 1932, although it has only participated as the PRC since 1952 . China hosted the 2008 Summer Olympics in Beijing, where its athletes received 48 gold medals – the highest number of any participating nation that year. China also won the most medals at the 2012 Summer Paralympics , with 231 overall, including 95 gold. In 2011, Shenzhen hosted the 2011 Summer Universiade . China hosted the 2013 East Asian Games in Tianjin and the 2014 Summer Youth Olympics in Nanjing, the first country to host both regular and Youth Olympics. Beijing and its nearby city Zhangjiakou collaboratively hosted the 2022 Winter Olympics , making Beijing the first dual Olympic city by holding both the Summer Olympics and the Winter Olympics.

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Cholera

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CTXφ bacteriophage

The CTXφ bacteriophage is a filamentous bacteriophage . It is a positive -strand DNA virus with single-stranded DNA (ssDNA). CTXφ infects some strains of Vibrio cholerae , the bacterium that causes cholera . It carries the genes for cholera toxin (CTX), which makes cholera especially virulent . It can carry genes from one V. cholerae strain to another. CTXφ is generally present and integrated into the genome of the V. cholerae bacterium, and more rarely in a virion from outside the bacterium. While integrated into the bacterial genome, CTX prophages are found on each of the two chromosomes (in the O1 serogroup of V. cholerae ) or arranged in tandem on the larger chromosome (in the El Tor biotype of V. cholerae ). The genome of CTXφ is 7 kb long and consists of two regions. The core region, which is approximately 4,6 kb long, contains 5 genes that are associated with phage assembly and morphogenisis ( psh, cep, pIIICTX, ace, zot) and two non structural genes. The two non structural genes encoded in the core region of the phage are ctxA and ctxB which are the genes encoding for the Cholera Toxin (CT). The RS2 region, which measures 2,4 kb, contains genes that control the replication, regulation, and integration of CTXφ. The three genes encoded in the RS2 region are rstR , rstA and rstB. The insertion of the CTXφ genetic material into the V. cholerae bacterium is mediated by two receptors. The first is the toxin-coregulated pilus (TCP), which also aids the bacterium in adhering to the intestinal cell wall. The TCP is thought to bind to the minor CTXφ coat protein OrfU. The second is the TolQRA membrane protein structure. These requirements for phage membrane binding are quite similar to those of the Ff phages , which infects the bacterium Escherichia coli and requires the F pilus along with the TolQRA structure. In E. coli, the TolQRA acts to translocate the Ff phage into the periplasmic space , where a possible membrane fusion event leads to the insertion of the Ff genome into the E. coli cytoplasm. A similar mechanism is suspected in the injection of the CTXφ genetic material into the V. cholerae cell, though further research is needed to confirm this. After ssDNA insertion into the V. cholerae cytoplasm, a complementary strand of DNA is formed in order to create the plasmid form of the viral genome, pCTX. pCTX can undergo DNA replication to create new ssDNA genomes and/or be incorporated into the bacterial genome as a prophage. Because this prophage can be present in tandem in some biotypes of V. cholerae , horizontal gene transfer and vertical transmission of the added CTXφ genes are not mutually exclusive. After the production of the proteins and genomic material necessary to create new virion forms of the bacteriophage, the proteins assemble at a membranous protein complex, the EpsD secretin . Once the new ssDNA genome is inside the assembled proteins, the CTXφ virion detaches from the EpsD and is free to infect other bacteria. Phage particles are secreted from bacterial cells without lysis . Recent research suggests that at least two toxins other than CT are produced from genes of the CTXφ genome. The first of these is accessory cholera enterotoxin (Ace). Ace is currently thought to be a minor coat protein of virion stage CTXφ, though the process by which the toxin could be released from the protein coat has not yet been identified. The second non-CT toxin encoded within the CTXφ genome is zonula occludens toxin (Zot). Zot, though absolutely essential for the production of the CTXφ virion, is not actually present in the phage particle. The part that Ace and Zot play in the virulence of cholera is still quite unclear.

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Cholera

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Joseph Bazalgette

Sir Joseph William Bazalgette CB ( / ˈ b æ z əl dʒ ɛ t / ; 28 March 1819 – 15 March 1891) was a British civil engineer . As Chief Engineer of London's Metropolitan Board of Works , his major achievement was the creation (in response to the Great Stink of 1858) of a sewerage system for central London which was instrumental in relieving the city of cholera epidemics, while beginning to clean the River Thames . He later designed Hammersmith Bridge .Bazalgette was born at Hill Lodge, Clay Hill , Enfield , the son of Joseph William Bazalgette (1783–1849), a retired Royal Navy captain , and Theresa Philo née Pilton (1796–1850). His grandfather, Louis Bazalgette, a tailor and financier, was a Huguenot immigrant who developed ties to the future George IV and subsequently became wealthy. [lower-alpha 1] In 1827, when Joseph was eight years old, the family moved into a newly built house in Hamilton Terrace , St John's Wood , London. He spent his early career articled to the noted engineer Sir John Macneill , working on railway projects, and amassed sufficient experience (partly in China and Ireland) in land drainage and reclamation to enable him to set up his own London consulting practice in 1842. In 1845 the house in Hamilton Terrace was sold and Joseph married Maria Kough, from County Kilkenny in Ireland . At the time he was working so hard on expanding the railway network that two years later, in 1847, he suffered a nervous breakdown. In 1847, while he was recovering, London's Metropolitan Commission of Sewers ordered that all cesspits should be closed and that house drains should connect to sewers and empty into the Thames. A cholera epidemic ensued, killing 14,137 Londoners in 1849. Bazalgette was appointed Assistant Surveyor to the Metropolitan Commission in 1849, taking over as Engineer in 1852 after his predecessor died of "harassing fatigues and anxieties." Soon after, another cholera epidemic struck in 1853, killing 10,738. Medical opinion at the time held that cholera was caused by foul air: a so-called miasma . Physician John Snow had earlier advanced a different explanation, which is now known to be correct: cholera was spread by contaminated water, but his view was not then generally accepted. Championed by fellow engineer Isambard Kingdom Brunel , Bazalgette was promoted Chief Engineer of the Commission's successor, the Metropolitan Board of Works , in 1856 (a post which he retained until the MBW was abolished and replaced by London County Council in 1889). In 1858, the year of the Great Stink , Parliament passed an Enabling Act , despite the colossal expense of the project, and Bazalgette's proposals to revolutionise London's sewerage system began to be implemented. The expectation was that enclosed sewers would eliminate the stink ('miasma') that was thought to be the cause of cholera and, as a result, eliminate cholera epidemics .At that time, the River Thames was little more than an open sewer, empty of any fish or other wildlife, and an apparent public health hazard to Londoners. Bazalgette's solution (similar to a proposal made by painter John Martin 25 years earlier) was to construct a network of 82 miles (132 km) of enclosed underground brick main sewers to intercept sewage outflows, and 1,100 miles (1,800 km) of street sewers , to divert the raw sewage which flowed freely through the streets and thoroughfares of London to the river. The plan included major pumping stations at Deptford (1864) and at Crossness (1865) on the Erith marshes , both on the south side of the Thames and at Abbey Mills (in the River Lea valley , 1868) and on the Chelsea Embankment (close to Grosvenor Bridge ; 1875), north of the river. The outflows were diverted downstream, where they were collected in two large sewage outfall systems on the north and south sides of the Thames, called the Northern and Southern Outfall Sewers . The sewage from the Outfall Sewers was originally collected in balancing tanks in Beckton and Crossness , then dumped, untreated, into the Thames at high tide. The system was opened by Edward, Prince of Wales in 1865, although the whole project was not completed for another ten years. Partly as a result of the Princess Alice disaster , extensive sewage treatment facilities were built to replace the balancing tanks in Beckton and Crossness in 1900. The basic premise of this expensive project, that miasma spread cholera infection, was wrong. However, the new sewer system's unintended consequence was removing the causal bacterium from the water supply, thereby eliminating cholera in areas served by the sewers. Instead of the incorrect premise causing the project to fail, the new sewers mostly eliminated cholera, and also decreased the incidence of typhus and typhoid epidemics. Bazalgette's capacity for hard work was remarkable; every connection to the sewerage system by the various Vestry Councils had to be checked, and Bazalgette did this himself, and the records contain thousands of linen plans with handwritten comments in Indian ink on them "Approved JWB", "I do not like 6 " used here and 9 " should be used. JWB", and so on. [ citation needed ] Unsurprisingly, his health suffered as a result. Thames Water holds the records in large blue binders gold-blocked reading "Metropolitan Board of Works" and then dated, usually two per year. [ citation needed ]Scion of a Huguenot family , Bazalgette was brought up at 17 Hamilton Terrace, St John's Wood in North West London . In 1845, he moved to Morden , then in 1873 to Arthur Road, Wimbledon , where he died in 1891. He was buried at nearby St Mary's Church , London SW18 . Married in 1845, at Westminster , to Maria Keogh (1819–1902), daughter of Edward Keogh, JP (Ireland), Sir Joseph and Lady Bazalgette had eleven children including: Joseph William, born 20 February 1846 Charles Norman, born 3 March 1847 Edward, born 28 June 1848 Theresa Philo, born 11 August 1850 Caroline, born 17 July 1852; married George Chatterton Maria, born 1854; married Robert Wickham Henry, born 14 September 1855 Willoughby, born 18 March 1857 Maria Louise, born 1859; died unmarried Anna Constance, born 3 December 1859, married Major Frederick Blacker Evelyn, born 1 April 1861 Knighted in 1875, Bazalgette was elected President of the Institution of Civil Engineers in 1883. [ citation needed ] A Greater London Council blue plaque commemorates him at 17 Hamilton Terrace in St John's Wood in North London, as well as a formal monument on the Victoria Embankment by the River Thames in central London. In July 2020, the City of London Corporation announced that a new public space west of Blackfriars Bridge , formed following construction of the Thames Tideway Scheme , would be named the Bazalgette Embankment. Dulwich College has a scholarship in his name either for design and technology or for mathematics and science .

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Cholera

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Cholera epidemics in Luxembourg

The first major cholera outbreak in Luxembourg was in 1827, with further outbreaks in 1832, 1849, 1854 and 1865. Due to population growth, poverty and poor hygiene conditions, outbreaks were relatively frequent in Luxembourg in the 19th century. Cholera was evidently a common enough fact of life in Luxembourg at one point for the witticism " Schnaps ass gudd géint d'Cholera " — "Liquor works well against cholera" — to enter common parlance. The outbreak of 1866 was the last in the country. The various instances of cholera in the 19th century left several physical reminders in Luxembourg in the form of chapels and wayside crosses, as a memorial to the many victims.Originating from Asia, cholera entered Europe through the Caspian Sea or the Mediterranean, arriving either through France, with Marseille as the gateway, or through the German ports of the Baltic and the North Sea. Cholera outbreaks were doubly spectacular, both in terms of the number of victims and the suddenness of the attacks and their resolution. A person who was healthy one day could die of cholera the next. Recovery could be just as sudden, with the dying person suddenly regaining strength. The first cholera pandemic occurred in the Bengal region of India, near Calcutta (now Kolkata), starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa through trade routes. The second pandemic lasted from 1826 to 1837 and particularly affected North America and Europe, due to the result of advancements in transportation and global trade, and increased human migration, including soldiers. The third pandemic erupted in 1846, persisted until 1860, extended to North Africa, and reached South America, for the first time specifically affecting Brazil. The fourth pandemic lasted from 1863 to 1875, and spread from India to Naples and Spain , and to the United States in 1873.The first appearance of cholera in Luxembourg was in August 1827, with victims mainly in the city of Luxembourg. The second appearance was in 1832, spreading across Europe from Russia and Germany, causing about 20,000 deaths in Paris alone. The centre of the epidemic was in Luxembourg City, particularly the Grund quarter and the nearby communes of Eich and Hollerich , that is the areas with a poorer population. Outside the capital and its environs, there were 29 deaths in Habay-la-Neuve , 8 in Remich and 7 in Dudelange . The third epidemic occurred in 1849, with less virulence, mainly affecting the Moselle region, Echternach, and for unknown reasons, the village of Crauthem . The year 1854, marked by famine, was also afflicted by cholera originating from Denmark and Northern Germany. Cases first appeared in August in Bertrange , followed by 70 deaths in Bissen . Arlon was particularly affected, with 138 victims in a population of 5,000. The epidemic ended in October. Similar to the 1832 epidemic in Luxembourg, the poorest neighborhoods of Arlon, around Hetschegas, with narrow and not always well cleaned streets, were the epicenter of the disease. The origin of cholera was unknown, but a sophisticated name was given to the unknown: the "deleterious miasma". Various remedies were suggested, including juniper cure, intensive tobacco use among military personnel, and large fires in the streets and fumigations in rooms, all to combat "the miasma." When cholera devastated Bavaria in 1854, the priest Sébastien Kneip, renowned for fresh water cures, also recommended them against cholera, apparently with success. While fresh water applications did not harm the cholera vibrio, at least fresh water, or bodily cleanliness, reduced the risk of infection. The next outbreak occurred in 1865-1866. The first epidemic broke out in Mamer on 5 November 1865, and also shortly thereafter in Clemency . From then on, its progress was marked by macabre highpoints: it raged relentlessly in Eich, and the fortress of Luxembourg , as well as the small village of Gilsdorf . In Echternach, the second-biggest city of the country at the time, 100 people died of cholera within 2 months. Diekirch broke records, with 31 cholera deaths in one single day, and 252 during the epidemic. In late April 1866, hopes were arising that the epidemic was fading away. These cautious hopes came to an end in June, when the epidemic started its second offensive. Wiltz , in the hitherto unharmed Oesling region, was now overwhelmed. It also spread like wildfire in the Moselle region. No community there was spared, with the most casualties in the town of Remich and the villages of Gostingen and Remerschen . Similarly, the cholera epidemic returned with a vengeance in Luxembourg city and its neighbouring areas. Esch, which had previously escaped major misfortune, saw many deaths. By November 1866, the grim episode was coming to an end, and by December it was definitely eradicated. Within a year, the disease had taken the lives of 3,500 Luxembourgers, about 1,8% of the population at the time. The total number of infected was around 8,000-10,000. This outbreak left many chapels in the countryside as a testament to the disaster. Another relic was the Cholerasbrak , ("cholera shacks") which existed around 1900 on the Glacis of Luxembourg to serve as an isolation site. This was at the end of the Boulevard Emmanuel Servais, where the modern extensions of the Lycée Robert Schuman are now located; these were quarantine "shacks", erected in 1866, to shelter and isolate the cholera-infected a short distance away from the city; luckily they never had to be put to use for this purpose. Nor did the Villa Amberg, in the Municipal Park , which had similarly been turned into an isolation house in case of need. The second appearance was in 1832, spreading across Europe from Russia and Germany, causing about 20,000 deaths in Paris alone. The centre of the epidemic was in Luxembourg City, particularly the Grund quarter and the nearby communes of Eich and Hollerich , that is the areas with a poorer population. Outside the capital and its environs, there were 29 deaths in Habay-la-Neuve , 8 in Remich and 7 in Dudelange . The third epidemic occurred in 1849, with less virulence, mainly affecting the Moselle region, Echternach, and for unknown reasons, the village of Crauthem . The year 1854, marked by famine, was also afflicted by cholera originating from Denmark and Northern Germany. Cases first appeared in August in Bertrange , followed by 70 deaths in Bissen . Arlon was particularly affected, with 138 victims in a population of 5,000. The epidemic ended in October. Similar to the 1832 epidemic in Luxembourg, the poorest neighborhoods of Arlon, around Hetschegas, with narrow and not always well cleaned streets, were the epicenter of the disease. The origin of cholera was unknown, but a sophisticated name was given to the unknown: the "deleterious miasma". Various remedies were suggested, including juniper cure, intensive tobacco use among military personnel, and large fires in the streets and fumigations in rooms, all to combat "the miasma." When cholera devastated Bavaria in 1854, the priest Sébastien Kneip, renowned for fresh water cures, also recommended them against cholera, apparently with success. While fresh water applications did not harm the cholera vibrio, at least fresh water, or bodily cleanliness, reduced the risk of infection. The next outbreak occurred in 1865-1866. The first epidemic broke out in Mamer on 5 November 1865, and also shortly thereafter in Clemency . From then on, its progress was marked by macabre highpoints: it raged relentlessly in Eich, and the fortress of Luxembourg , as well as the small village of Gilsdorf . In Echternach, the second-biggest city of the country at the time, 100 people died of cholera within 2 months. Diekirch broke records, with 31 cholera deaths in one single day, and 252 during the epidemic. In late April 1866, hopes were arising that the epidemic was fading away. These cautious hopes came to an end in June, when the epidemic started its second offensive. Wiltz , in the hitherto unharmed Oesling region, was now overwhelmed. It also spread like wildfire in the Moselle region. No community there was spared, with the most casualties in the town of Remich and the villages of Gostingen and Remerschen . Similarly, the cholera epidemic returned with a vengeance in Luxembourg city and its neighbouring areas. Esch, which had previously escaped major misfortune, saw many deaths. By November 1866, the grim episode was coming to an end, and by December it was definitely eradicated. Within a year, the disease had taken the lives of 3,500 Luxembourgers, about 1,8% of the population at the time. The total number of infected was around 8,000-10,000. This outbreak left many chapels in the countryside as a testament to the disaster. Another relic was the Cholerasbrak , ("cholera shacks") which existed around 1900 on the Glacis of Luxembourg to serve as an isolation site. This was at the end of the Boulevard Emmanuel Servais, where the modern extensions of the Lycée Robert Schuman are now located; these were quarantine "shacks", erected in 1866, to shelter and isolate the cholera-infected a short distance away from the city; luckily they never had to be put to use for this purpose. Nor did the Villa Amberg, in the Municipal Park , which had similarly been turned into an isolation house in case of need. The first epidemic broke out in Mamer on 5 November 1865, and also shortly thereafter in Clemency . From then on, its progress was marked by macabre highpoints: it raged relentlessly in Eich, and the fortress of Luxembourg , as well as the small village of Gilsdorf . In Echternach, the second-biggest city of the country at the time, 100 people died of cholera within 2 months. Diekirch broke records, with 31 cholera deaths in one single day, and 252 during the epidemic. In late April 1866, hopes were arising that the epidemic was fading away. These cautious hopes came to an end in June, when the epidemic started its second offensive. Wiltz , in the hitherto unharmed Oesling region, was now overwhelmed. It also spread like wildfire in the Moselle region. No community there was spared, with the most casualties in the town of Remich and the villages of Gostingen and Remerschen . Similarly, the cholera epidemic returned with a vengeance in Luxembourg city and its neighbouring areas. Esch, which had previously escaped major misfortune, saw many deaths. By November 1866, the grim episode was coming to an end, and by December it was definitely eradicated. Within a year, the disease had taken the lives of 3,500 Luxembourgers, about 1,8% of the population at the time. The total number of infected was around 8,000-10,000. This outbreak left many chapels in the countryside as a testament to the disaster. Another relic was the Cholerasbrak , ("cholera shacks") which existed around 1900 on the Glacis of Luxembourg to serve as an isolation site. This was at the end of the Boulevard Emmanuel Servais, where the modern extensions of the Lycée Robert Schuman are now located; these were quarantine "shacks", erected in 1866, to shelter and isolate the cholera-infected a short distance away from the city; luckily they never had to be put to use for this purpose. Nor did the Villa Amberg, in the Municipal Park , which had similarly been turned into an isolation house in case of need. The epidemic of 1866 was the last in the country. Although its nature was still unknown, cholera now retreated in the face of progress in hygiene through bodily cleanliness and the construction of sewers and water pipes. Finally, in 1883, Robert Koch isolated the cholera vibrio. It was revealed that the germs were found in the vomit and feces of the sick. Infection occurred either directly, especially through the soiled hands of doctors, nurses, and laundresses, or indirectly through the use of water contaminated by the excretions of cholera patients. Until then, precautions had been focused on the corpses of cholera victims, which had to be buried immediately and in tar-coated coffins.

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Cholera

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1899–1923 cholera pandemic

The sixth cholera pandemic (1899–1923) was a major outbreak of cholera beginning in India, where it killed more than 800,000 people, and spreading to the Middle East, North Africa, Eastern Europe, and Russia. According to Leonard Rogers , following an outbreak of cholera at the Haridwar Kumbh Mela , the epidemic spread to Europe via Punjab , Afghanistan, Persia, and southern Russia. The last cholera outbreak in the United States was in 1910–1911 when the steamship Moltke brought infected people to New York City from Naples . Vigilant health authorities isolated the infected on Swinburne Island , built in the nineteenth century as a quarantine facility. Eleven people died, including a health care worker at the island hospital. In 1913, the Romanian Army , while invading Bulgaria during the Second Balkan War , suffered a cholera outbreak that provoked 1,600 deaths.

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Cholera

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Cholera Basin

The Cholera basin ( Finnish : Kolera-allas , Swedish : Kolerabassängen ) is the established name for the western harbour basin in front of the Market Square in Helsinki , Finland .The harbour basins were built in the early 19th century. At that time, the Market Square area consisted of the muddy Kaupunginlahti bay. Its shores had many shore huts and small piers . Where the edge of the Market Square is now was the Eteläinen Rantakatu street. As the city developed, the harbour needed a continuous pier. The shore was low, and this allowed the shoreline to be moved outwards by filling the shore. The work took years. For small steam ships , rowing and sailing ships, three basins were built. At the northwestern corner was built the so-called Fish basin (Kala-allas). In the city documents, the name of the basin was Stadfiskarens båthamn, meaning city fishers' boat harbour, Fiskarhamnen meaning fishers' harbour. In 1893, Johannes Michelsson, a sailor from Nagu who had come to the herring market died of cholera on his ship. Later it was found out that the excrement and vomit of the sick man had been dumped into the harbour basin. As a safety precaution, the herring ships were towed away from the harbour, and guards were briefly posted at the shore, because it was feared that the citizens might start to use the contaminated water. After the incident, the colloquial name of the basin was established as Kolerabassängen - the Cholera basin. In the 19th century, the water in the Fisher's harbour and in the entire Eteläsatama harbour was still contaminated by sewers. Rats infested the harbour. On the northern shore of Katajanokka , there was a sewage pier, also bringing dirt and stench. The products of outdoor toilets were loaded onto barges there, where they were taken to the countryside to be used as manure . There were rumours in the city that in the night, the barges silently dump their cargo straight into the water. This was even claimed to be a stinking revolt against Governor General Nikolai Bobrikov 's politics.Saint Jacob is connected with a tradition of carrying a stone on the pilgrimage to Santiago de Compostela and then throwing it away to symbolize absolution - this associates Jacob with stone-casting. Finnish tradition holds that on the name day of Jaakko (Jacob), July 25, "Jaakko throws a cold stone into the water". The swimming season peaks and waters begin to gradually cool. In order to celebrate this manifestly unscientific knowledge, the Finnish Unscientific Society ( Epätieteellinen seura ), a whimsical society with members mainly from the University of Helsinki , organizes an event where a chosen Jaakko throws a cold stone into the Cholera basin. Since 1995, various objects have been thrown into the basin, including an iron, a deep frozen rock, a cosmic meteorite , a wooden cobble stone, a lava rock from Etna , half of a runestone , a rock from the Volga river, "an egg of a mummy" (cooled by 180 degrees by transport 180 degrees west in longitude) and a blade sharpening stone. In 2017, the stone was taken from the basement of the Parliament House .

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United Nations

The United Nations ( UN ) is a diplomatic and political international organization whose stated purposes are to maintain international peace and security , develop friendly relations among nations, achieve international cooperation, and serve as a centre for harmonizing the actions of nations. It is the world's largest international organization. The UN is headquartered in New York City (in the United States, but with certain extraterritorial privileges), and the UN has other offices in Geneva , Nairobi , Vienna , and The Hague , where the International Court of Justice is headquartered at the Peace Palace . The UN was established after World War II with the aim of preventing future world wars , and succeeded the League of Nations , which was characterized as ineffective. On 25 April 1945, 50 nations met in San Francisco , California for a conference and started drafting the UN Charter , which was adopted on 25 June 1945. The charter took effect on 24 October 1945, when the UN began operations. The UN's objectives, as defined by its charter, include maintaining international peace and security, protecting human rights , delivering humanitarian aid , promoting sustainable development , and upholding international law . At its founding, the UN had 51 member states ; as of 2023 [ update ] , it has 193 – almost all of the world's sovereign states . The UN's mission to preserve world peace was complicated in its early decades due in part to Cold War tensions that existed between the United States and Soviet Union and their respective allies. Its mission has included the provision of primarily unarmed military observers and lightly armed troops charged with primarily monitoring, reporting and confidence-building roles. UN membership grew significantly following widespread decolonization in the 1960s. Since then, 80 former colonies have gained independence, including 11 trust territories that had been monitored by the Trusteeship Council . By the 1970s, the UN's budget for economic and social development programmes vastly exceeded its spending on peacekeeping . After the end of the Cold War in 1991, the UN shifted and expanded its field operations, undertaking a wide variety of complex tasks. The UN has six principal operational organizations: the General Assembly , the Security Council , the Economic and Social Council , the International Court of Justice , the UN Secretariat , and the Trusteeship Council , although the Trusteeship Council has been inactive since 1994. The UN System includes a multitude of specialized agencies , funds, and programmes, including the World Bank Group , the World Health Organization , the World Food Programme , UNESCO , and UNICEF . Additionally, non-governmental organizations may be granted consultative status with the Economic and Social Council and other agencies. The UN's chief administrative officer is the secretary-general , currently Portuguese politician and diplomat António Guterres , who began his first five year-term on 1 January 2017 and was re-elected on 8 June 2021. The organization is financed by assessed and voluntary contributions from its member states. The UN, its officers, and its agencies have won many Nobel Peace Prizes , though other evaluations of its effectiveness have been mixed. Some commentators believe the organization to be an important force for peace and human development, while others have called it ineffective, biased, and corrupt.In the century prior to the UN's creation, several international organizations such as the International Committee of the Red Cross were formed to ensure protection and assistance for victims of armed conflict and strife. During World War I , several major leaders, especially American President Woodrow Wilson , advocated for a world body to guarantee peace. The winners of the war, the Allies , met to decide on formal peace terms at the Paris Peace Conference . The League of Nations was approved, and started operations, but the United States never joined. On 10 January 1920, the League of Nations formally came into being when the Covenant of the League of Nations , ratified by 42 nations in 1919, took effect. The League Council acted as an executive body directing the Assembly's business. It began with four permanent members—the United Kingdom , France , Italy , and Japan . After some limited successes and failures during the 1920s, the League proved ineffective in the 1930s, as it failed to act against the Japanese invasion of Manchuria in 1933. Forty nations voted for Japan to withdraw from Manchuria but Japan voted against it and walked out of the League instead of withdrawing from Manchuria. It also failed to act against the Second Italo-Ethiopian War , when calls for economic sanctions against Italy failed. Italy and other nations left the League. When war broke out in 1939 , the League closed down. The first step towards the establishment of the United Nations was the Inter-Allied Conference that led to the Declaration of St James's Palace on 12 June 1941. By August 1941, American President Franklin Roosevelt and British Prime Minister Winston Churchill had drafted the Atlantic Charter ; which defined goals for the post-war world. At the subsequent meeting of the Inter-Allied Council in London on 24 September 1941, the eight governments in exile of countries under Axis occupation , together with the Soviet Union and representatives of the Free French Forces , unanimously adopted adherence to the common principles of policy set forth by Britain and the United States. Roosevelt and Churchill met at the White House in December 1941 for the Arcadia Conference . Roosevelt, considered a founder of the UN, coined the term United Nations to describe the Allied countries . Churchill accepted it, noting its use by Lord Byron . The text of the Declaration by United Nations was drafted on 29 December 1941, by Roosevelt, Churchill, and Harry Hopkins . It incorporated Soviet suggestions but included no role for France. One major change from the Atlantic Charter was the addition of a provision for religious freedom , which Stalin approved after Roosevelt insisted. Roosevelt's idea of the " Four Powers ", referring to the four major Allied countries, the United States, the United Kingdom, the Soviet Union, and China , emerged in the Declaration by the United Nations. On New Year's Day 1942, Roosevelt, Churchill, the Soviet Union's former Foreign Minister Maxim Litvinov , and the Chinese Premier T. V. Soong signed the " Declaration by United Nations ", and the next day the representatives of twenty-two other nations added their signatures. During the war, the United Nations became the official term for the Allies. In order to join, countries had to sign the Declaration and declare war on the Axis powers . The October 1943 Moscow Conference resulted in the Moscow Declarations , including the Four Power Declaration on General Security which aimed for the creation "at the earliest possible date of a general international organization". This was the first public announcement that a new international organization was being contemplated to replace the League of Nations. The Tehran Conference followed shortly afterwards at which Roosevelt, Churchill and Joseph Stalin , the leader of the Soviet Union, met and discussed the idea of a post-war international organization. The new international organisation was formulated and negotiated amongst the delegations from the Allied Big Four at the Dumbarton Oaks Conference from 21 September to 7 October 1944. They agreed on proposals for the aims, structure and functioning of the new organization. It took the conference at Yalta in February 1945, and further negotiations with the Soviet Union, before all the issues were resolved. By 1 March 1945, 21 additional states had signed the Declaration by the United Nations. After months of planning, the UN Conference on International Organization opened in San Francisco on 25 April 1945. It was attended by 50 nations' governments and a number of non-governmental organizations. The delegations of the Big Four chaired the plenary meetings. Previously, Churchill had urged Roosevelt to restore France to its status of a major power after the liberation of Paris in August 1944. The drafting of the Charter of the United Nations was completed over the following two months, and it was signed on 26 June 1945 by the representatives of the 50 countries. The UN officially came into existence on 24 October 1945, upon ratification of the Charter by the five permanent members of the Security Council : the United States, the United Kingdom, France, the Soviet Union and China — and by a majority of the other 46 nations. The first meetings of the General Assembly , with 51 nations represented, [lower-alpha 1] and the Security Council took place in London beginning in January 1946. Debates began at once, covering topical issues such as the presence of Russian troops in Iranian Azerbaijan and British forces in Greece . British diplomat Gladwyn Jebb served as interim secretary-general. The General Assembly selected New York City as the site for the headquarters of the UN. Construction began on 14 September 1948 and the facility was completed on 9 October 1952. The Norwegian Foreign Minister, Trygve Lie , was elected as the first UN secretary-general (Jebb was only in the position until a permanent secretary-general was elected). Though the UN's primary mandate was peacekeeping , the division between the United States and the Soviet Union often paralysed the organization; generally allowing it to intervene only in conflicts distant from the Cold War . Two notable exceptions were a Security Council resolution on 7 July 1950 authorizing a US-led coalition to repel the North Korean invasion of South Korea , passed in the absence of the Soviet Union, and the signing of the Korean Armistice Agreement on 27 July 1953. On 29 November 1947, the General Assembly approved a resolution to partition Palestine , approving the creation of Israel . Two years later, Ralph Bunche , a UN official, negotiated an armistice to the resulting conflict . On 7 November 1956, the first UN peacekeeping force was established to end the Suez Crisis ; however, the UN was unable to intervene against the Soviet Union's simultaneous invasion of Hungary , following the country's revolution . On 14 July 1960, the UN established the United Nations Operation in the Congo (or UNOC), the largest military force of its early decades, to bring order to Katanga , restoring it to the control of the Democratic Republic of the Congo by 11 May 1964. While travelling to meet rebel leader Moise Tshombe during the conflict, Dag Hammarskjöld , often named as one of the UN's most effective secretary-generals, died in a plane crash . Months later he was posthumously awarded the Nobel Peace Prize . In 1964, Hammarskjöld's successor, U Thant , deployed the UN Peacekeeping Force in Cyprus , which would become one of the UN's longest-running peacekeeping missions. With the spread of decolonization in the 1960s, the UN's membership shot up due to an influx of newly independent nations. In 1960 alone, 17 new states joined the UN, 16 of them from Africa. On 25 October 1971, with opposition from the United States, but with the support of many Third World nations, the People's Republic of China was given the Chinese seat on the Security Council in place of the Republic of China (also known as Taiwan). The vote was widely seen as a sign of waning American influence in the organization. Third World nations organized themselves into the Group of 77 under the leadership of Algeria, which briefly became a dominant power at the UN. On 10 November 1975, a bloc comprising the Soviet Union and Third World nations passed a resolution , over strenuous American and Israeli opposition, declaring Zionism to be a form of racism . The resolution was repealed on 16 December 1991, shortly after the end of the Cold War. With an increasing Third World presence and the failure of UN mediation in conflicts in the Middle East , Vietnam , and Kashmir , the UN increasingly shifted its attention to its secondary goals of economic development and cultural exchange. By the 1970s, the UN budget for social and economic development was far greater than its peacekeeping budget. After the Cold War, the UN saw a radical expansion in its peacekeeping duties, taking on more missions in five years than it had in the previous four decades. Between 1988 and 2000, the number of adopted Security Council resolutions more than doubled, and the peacekeeping budget increased by more than tenfold. The UN negotiated an end to the Salvadoran Civil War , launched a successful peacekeeping mission in Namibia , and oversaw democratic elections in post- apartheid South Africa and post- Khmer Rouge Cambodia. In 1991, the UN authorized a US-led coalition that repulsed Iraq's invasion of Kuwait . Brian Urquhart , the under-secretary-general of the UN from 1971 to 1985, later described the hopes raised by these successes as a "false renaissance" for the organization, given the more troubled missions that followed. Beginning in the last decades of the Cold War , critics of the UN condemned the organization for perceived mismanagement and corruption. In 1984, American President Ronald Reagan withdrew the United States' funding from the United Nations Educational, Scientific and Cultural Organisation (or UNESCO) over allegations of mismanagement, followed by the United Kingdom and Singapore. Boutros Boutros-Ghali , the secretary-general from 1992 to 1996, initiated a reform of the Secretariat, somewhat reducing the size of the organisation. His successor, Kofi Annan , initiated further management reforms in the face of threats from the US to withhold its UN dues. Though the UN Charter had been written primarily to prevent aggression by one nation against another, in the early 1990s the UN faced several simultaneous, serious crises within Somalia, Haiti, Mozambique, and the nations that previously made up Yugoslavia. The UN mission in Somalia was widely viewed as a failure after the United States' withdrawal following casualties in the Battle of Mogadishu . The UN mission to Bosnia faced worldwide ridicule for its indecisive and confused mission in the face of ethnic cleansing. In 1994, the UN Assistance Mission for Rwanda failed to intervene in the Rwandan genocide amidst indecision in the Security Council. From the late 1990s to the early 2000s, international interventions authorized by the UN took a wider variety of forms. The United Nations Security Council Resolution 1244 authorised the NATO -led Kosovo Force beginning in 1999. The UN mission in the Sierra Leone Civil War was supplemented by a British military intervention . The invasion of Afghanistan in 2001 was overseen by NATO. In 2003, the United States invaded Iraq despite failing to pass a UN Security Council resolution for authorization, prompting a new round of questioning of the UN's effectiveness. Under the eighth secretary-general, Ban Ki-moon , the UN intervened with peacekeepers in crises such as the War in Darfur in Sudan and the Kivu conflict in the Democratic Republic of the Congo and sent observers and chemical weapons inspectors to the Syrian Civil War . In 2013, an internal review of UN actions in the final battles of the Sri Lankan Civil War in 2009 concluded that the organization had suffered a "systemic failure". In 2010, the organization suffered the worst loss of life in its history, when 101 personnel died in the Haiti earthquake . Acting under the United Nations Security Council Resolution 1973 in 2011, NATO countries intervened in the First Libyan Civil War . The Millennium Summit was held in 2000 to discuss the UN's role in the 21st century. The three-day meeting was the largest gathering of world leaders in history, and it culminated in the adoption by all member states of the Millennium Development Goals (or MDGs), a commitment to achieve international development in areas such as poverty reduction , gender equality and public health . Progress towards these goals, which were to be met by 2015, was ultimately uneven. The 2005 World Summit reaffirmed the UN's focus on promoting development, peacekeeping, human rights and global security. The Sustainable Development Goals (or SDGs) were launched in 2015 to succeed the Millennium Development Goals. In addition to addressing global challenges, the UN has sought to improve its accountability and democratic legitimacy by engaging more with civil society and fostering a global constituency. In an effort to enhance transparency, in 2016 the organization held its first public debate between candidates for secretary-general. On 1 January 2017, Portuguese diplomat António Guterres , who had previously served as the UN High Commissioner for Refugees , became the ninth secretary-general. Guterres has highlighted several key goals for his administration, including an emphasis on diplomacy for preventing conflicts, more effective peacekeeping efforts, and streamlining the organization to be more responsive and versatile to international needs. On 13 June 2019, the UN signed a Strategic Partnership Framework with the World Economic Forum in order to "jointly accelerate" the implementation of the 2030 Agenda for Sustainable Development . In the century prior to the UN's creation, several international organizations such as the International Committee of the Red Cross were formed to ensure protection and assistance for victims of armed conflict and strife. During World War I , several major leaders, especially American President Woodrow Wilson , advocated for a world body to guarantee peace. The winners of the war, the Allies , met to decide on formal peace terms at the Paris Peace Conference . The League of Nations was approved, and started operations, but the United States never joined. On 10 January 1920, the League of Nations formally came into being when the Covenant of the League of Nations , ratified by 42 nations in 1919, took effect. The League Council acted as an executive body directing the Assembly's business. It began with four permanent members—the United Kingdom , France , Italy , and Japan . After some limited successes and failures during the 1920s, the League proved ineffective in the 1930s, as it failed to act against the Japanese invasion of Manchuria in 1933. Forty nations voted for Japan to withdraw from Manchuria but Japan voted against it and walked out of the League instead of withdrawing from Manchuria. It also failed to act against the Second Italo-Ethiopian War , when calls for economic sanctions against Italy failed. Italy and other nations left the League. When war broke out in 1939 , the League closed down. The first step towards the establishment of the United Nations was the Inter-Allied Conference that led to the Declaration of St James's Palace on 12 June 1941. By August 1941, American President Franklin Roosevelt and British Prime Minister Winston Churchill had drafted the Atlantic Charter ; which defined goals for the post-war world. At the subsequent meeting of the Inter-Allied Council in London on 24 September 1941, the eight governments in exile of countries under Axis occupation , together with the Soviet Union and representatives of the Free French Forces , unanimously adopted adherence to the common principles of policy set forth by Britain and the United States. Roosevelt and Churchill met at the White House in December 1941 for the Arcadia Conference . Roosevelt, considered a founder of the UN, coined the term United Nations to describe the Allied countries . Churchill accepted it, noting its use by Lord Byron . The text of the Declaration by United Nations was drafted on 29 December 1941, by Roosevelt, Churchill, and Harry Hopkins . It incorporated Soviet suggestions but included no role for France. One major change from the Atlantic Charter was the addition of a provision for religious freedom , which Stalin approved after Roosevelt insisted. Roosevelt's idea of the " Four Powers ", referring to the four major Allied countries, the United States, the United Kingdom, the Soviet Union, and China , emerged in the Declaration by the United Nations. On New Year's Day 1942, Roosevelt, Churchill, the Soviet Union's former Foreign Minister Maxim Litvinov , and the Chinese Premier T. V. Soong signed the " Declaration by United Nations ", and the next day the representatives of twenty-two other nations added their signatures. During the war, the United Nations became the official term for the Allies. In order to join, countries had to sign the Declaration and declare war on the Axis powers . The October 1943 Moscow Conference resulted in the Moscow Declarations , including the Four Power Declaration on General Security which aimed for the creation "at the earliest possible date of a general international organization". This was the first public announcement that a new international organization was being contemplated to replace the League of Nations. The Tehran Conference followed shortly afterwards at which Roosevelt, Churchill and Joseph Stalin , the leader of the Soviet Union, met and discussed the idea of a post-war international organization. The new international organisation was formulated and negotiated amongst the delegations from the Allied Big Four at the Dumbarton Oaks Conference from 21 September to 7 October 1944. They agreed on proposals for the aims, structure and functioning of the new organization. It took the conference at Yalta in February 1945, and further negotiations with the Soviet Union, before all the issues were resolved. By 1 March 1945, 21 additional states had signed the Declaration by the United Nations. After months of planning, the UN Conference on International Organization opened in San Francisco on 25 April 1945. It was attended by 50 nations' governments and a number of non-governmental organizations. The delegations of the Big Four chaired the plenary meetings. Previously, Churchill had urged Roosevelt to restore France to its status of a major power after the liberation of Paris in August 1944. The drafting of the Charter of the United Nations was completed over the following two months, and it was signed on 26 June 1945 by the representatives of the 50 countries. The UN officially came into existence on 24 October 1945, upon ratification of the Charter by the five permanent members of the Security Council : the United States, the United Kingdom, France, the Soviet Union and China — and by a majority of the other 46 nations. The first meetings of the General Assembly , with 51 nations represented, [lower-alpha 1] and the Security Council took place in London beginning in January 1946. Debates began at once, covering topical issues such as the presence of Russian troops in Iranian Azerbaijan and British forces in Greece . British diplomat Gladwyn Jebb served as interim secretary-general. The General Assembly selected New York City as the site for the headquarters of the UN. Construction began on 14 September 1948 and the facility was completed on 9 October 1952. The Norwegian Foreign Minister, Trygve Lie , was elected as the first UN secretary-general (Jebb was only in the position until a permanent secretary-general was elected). Though the UN's primary mandate was peacekeeping , the division between the United States and the Soviet Union often paralysed the organization; generally allowing it to intervene only in conflicts distant from the Cold War . Two notable exceptions were a Security Council resolution on 7 July 1950 authorizing a US-led coalition to repel the North Korean invasion of South Korea , passed in the absence of the Soviet Union, and the signing of the Korean Armistice Agreement on 27 July 1953. On 29 November 1947, the General Assembly approved a resolution to partition Palestine , approving the creation of Israel . Two years later, Ralph Bunche , a UN official, negotiated an armistice to the resulting conflict . On 7 November 1956, the first UN peacekeeping force was established to end the Suez Crisis ; however, the UN was unable to intervene against the Soviet Union's simultaneous invasion of Hungary , following the country's revolution . On 14 July 1960, the UN established the United Nations Operation in the Congo (or UNOC), the largest military force of its early decades, to bring order to Katanga , restoring it to the control of the Democratic Republic of the Congo by 11 May 1964. While travelling to meet rebel leader Moise Tshombe during the conflict, Dag Hammarskjöld , often named as one of the UN's most effective secretary-generals, died in a plane crash . Months later he was posthumously awarded the Nobel Peace Prize . In 1964, Hammarskjöld's successor, U Thant , deployed the UN Peacekeeping Force in Cyprus , which would become one of the UN's longest-running peacekeeping missions. With the spread of decolonization in the 1960s, the UN's membership shot up due to an influx of newly independent nations. In 1960 alone, 17 new states joined the UN, 16 of them from Africa. On 25 October 1971, with opposition from the United States, but with the support of many Third World nations, the People's Republic of China was given the Chinese seat on the Security Council in place of the Republic of China (also known as Taiwan). The vote was widely seen as a sign of waning American influence in the organization. Third World nations organized themselves into the Group of 77 under the leadership of Algeria, which briefly became a dominant power at the UN. On 10 November 1975, a bloc comprising the Soviet Union and Third World nations passed a resolution , over strenuous American and Israeli opposition, declaring Zionism to be a form of racism . The resolution was repealed on 16 December 1991, shortly after the end of the Cold War. With an increasing Third World presence and the failure of UN mediation in conflicts in the Middle East , Vietnam , and Kashmir , the UN increasingly shifted its attention to its secondary goals of economic development and cultural exchange. By the 1970s, the UN budget for social and economic development was far greater than its peacekeeping budget.After the Cold War, the UN saw a radical expansion in its peacekeeping duties, taking on more missions in five years than it had in the previous four decades. Between 1988 and 2000, the number of adopted Security Council resolutions more than doubled, and the peacekeeping budget increased by more than tenfold. The UN negotiated an end to the Salvadoran Civil War , launched a successful peacekeeping mission in Namibia , and oversaw democratic elections in post- apartheid South Africa and post- Khmer Rouge Cambodia. In 1991, the UN authorized a US-led coalition that repulsed Iraq's invasion of Kuwait . Brian Urquhart , the under-secretary-general of the UN from 1971 to 1985, later described the hopes raised by these successes as a "false renaissance" for the organization, given the more troubled missions that followed. Beginning in the last decades of the Cold War , critics of the UN condemned the organization for perceived mismanagement and corruption. In 1984, American President Ronald Reagan withdrew the United States' funding from the United Nations Educational, Scientific and Cultural Organisation (or UNESCO) over allegations of mismanagement, followed by the United Kingdom and Singapore. Boutros Boutros-Ghali , the secretary-general from 1992 to 1996, initiated a reform of the Secretariat, somewhat reducing the size of the organisation. His successor, Kofi Annan , initiated further management reforms in the face of threats from the US to withhold its UN dues. Though the UN Charter had been written primarily to prevent aggression by one nation against another, in the early 1990s the UN faced several simultaneous, serious crises within Somalia, Haiti, Mozambique, and the nations that previously made up Yugoslavia. The UN mission in Somalia was widely viewed as a failure after the United States' withdrawal following casualties in the Battle of Mogadishu . The UN mission to Bosnia faced worldwide ridicule for its indecisive and confused mission in the face of ethnic cleansing. In 1994, the UN Assistance Mission for Rwanda failed to intervene in the Rwandan genocide amidst indecision in the Security Council. From the late 1990s to the early 2000s, international interventions authorized by the UN took a wider variety of forms. The United Nations Security Council Resolution 1244 authorised the NATO -led Kosovo Force beginning in 1999. The UN mission in the Sierra Leone Civil War was supplemented by a British military intervention . The invasion of Afghanistan in 2001 was overseen by NATO. In 2003, the United States invaded Iraq despite failing to pass a UN Security Council resolution for authorization, prompting a new round of questioning of the UN's effectiveness. Under the eighth secretary-general, Ban Ki-moon , the UN intervened with peacekeepers in crises such as the War in Darfur in Sudan and the Kivu conflict in the Democratic Republic of the Congo and sent observers and chemical weapons inspectors to the Syrian Civil War . In 2013, an internal review of UN actions in the final battles of the Sri Lankan Civil War in 2009 concluded that the organization had suffered a "systemic failure". In 2010, the organization suffered the worst loss of life in its history, when 101 personnel died in the Haiti earthquake . Acting under the United Nations Security Council Resolution 1973 in 2011, NATO countries intervened in the First Libyan Civil War . The Millennium Summit was held in 2000 to discuss the UN's role in the 21st century. The three-day meeting was the largest gathering of world leaders in history, and it culminated in the adoption by all member states of the Millennium Development Goals (or MDGs), a commitment to achieve international development in areas such as poverty reduction , gender equality and public health . Progress towards these goals, which were to be met by 2015, was ultimately uneven. The 2005 World Summit reaffirmed the UN's focus on promoting development, peacekeeping, human rights and global security. The Sustainable Development Goals (or SDGs) were launched in 2015 to succeed the Millennium Development Goals. In addition to addressing global challenges, the UN has sought to improve its accountability and democratic legitimacy by engaging more with civil society and fostering a global constituency. In an effort to enhance transparency, in 2016 the organization held its first public debate between candidates for secretary-general. On 1 January 2017, Portuguese diplomat António Guterres , who had previously served as the UN High Commissioner for Refugees , became the ninth secretary-general. Guterres has highlighted several key goals for his administration, including an emphasis on diplomacy for preventing conflicts, more effective peacekeeping efforts, and streamlining the organization to be more responsive and versatile to international needs. On 13 June 2019, the UN signed a Strategic Partnership Framework with the World Economic Forum in order to "jointly accelerate" the implementation of the 2030 Agenda for Sustainable Development . The United Nations is part of the broader UN System, which includes an extensive network of institutions and entities. Central to the organization are five principal organs established by the UN Charter: the General Assembly , the Security Council , the Economic and Social Council , the International Court of Justice and the UN Secretariat . A sixth principal organ, the Trusteeship Council , suspended its operations on 1 November 1994 upon the independence of Palau ; the last remaining UN trustee territory. Four of the five principal organs are located at the main UN Headquarters in New York City, while the International Court of Justice is seated in The Hague . Most other major agencies are based in the UN offices at Geneva , Vienna , and Nairobi , and additional UN institutions are located throughout the world. The six official languages of the UN, used in intergovernmental meetings and documents, are Arabic , Chinese , English , French , Russian and Spanish . On the basis of the Convention on the Privileges and Immunities of the United Nations , the UN and its agencies are immune from the laws of the countries where they operate, safeguarding the UN's impartiality with regard to host and member countries. Below the six organs are, in the words of the author Linda Fasulo, "an amazing collection of entities and organizations, some of which are actually older than the UN itself and operate with almost complete independence from it". These include specialized agencies, research and training institutions, programmes and funds and other UN entities. All organizations in the UN system obey the Noblemaire principle , which calls for salaries that will attract and retain citizens of countries where compensation is highest, and which ensures equal pay for work of equal value regardless of the employee's nationality. In practice, the International Civil Service Commission , which governs the conditions of UN personnel, takes reference to the highest-paying national civil service. Staff salaries are subject to an internal tax that is administered by the UN organizations. May resolve non-compulsory recommendations to states or suggestions to the Security Council (UNSC); Decides on the admission of new members, following proposal by the UNSC; Adopts the budget; Elects the non-permanent members of the UNSC; all members of the Economic and Social Council; the UN Secretary-General (following their proposal by the UNSC); and the fifteen judges of the International Court of Justice (ICJ). Each country has one vote. Decides disputes between states that recognize its jurisdiction; Issues legal opinions; Renders judgment by relative majority . Its fifteen judges are elected by the UN General Assembly for nine-year terms. Responsible for co-operation between states as regards economic and social matters; Co-ordinates co-operation between the UN's numerous specialized agencies ; Has 54 members, elected by the General Assembly to serve staggered three-year mandates. The General Assembly is the main deliberative assembly of the UN. Composed of all UN member states , the assembly meets in regular yearly sessions at the General Assembly Hall , but emergency sessions can also be called. The assembly is led by a president , elected by the member states on a rotating regional basis, and 21 vice-presidents. The first session convened on 10 January 1946 in the Methodist Central Hall in London and included representatives of 51 nations. When the General Assembly decides on important questions such as those on peace and security, admission of new members and budgetary matters, a two-thirds majority of those present and voting is required. All other questions are decided by a majority vote. Each member has one vote. Apart from the approval of budgetary matters, resolutions are not binding on the members. The Assembly may make recommendations on any matters within the scope of the UN, except matters of peace and security that are under consideration by the Security Council. Draft resolutions can be forwarded to the General Assembly by its six main committees: As well as by the following two committees: The Security Council is charged with maintaining peace and security amongst nations. While other organs of the UN can only make recommendations to member states, the Security Council has the power to make binding decisions that member states have agreed to carry out, under the terms of Charter Article 25. The decisions of the council are known as United Nations Security Council resolutions . The Security Council is made up of fifteen member states: five permanent members (China, France, Russia, the United Kingdom and the United States) and ten non-permanent members (currently Algeria , Ecuador , Guyana , Japan , Malta , Mozambique , the Republic of Korea , Sierra Leone , Slovenia and Switzerland ). The five permanent members hold veto power over UN resolutions, allowing a permanent member to block adoption of a resolution, though not debate. The ten temporary seats are held for two-year terms, with five members elected each year by the General Assembly on a regional basis . The presidency of the Security Council rotates alphabetically each month. The UN Secretariat carries out the day-to-day duties required to operate and maintain the UN system. It is composed of tens of thousands of international civil servants worldwide and headed by the secretary-general , who is assisted by the deputy secretary-general . The Secretariat's duties include providing information and facilities needed by UN bodies for their meetings and carrying out tasks as directed by the Security Council, the General Assembly, the Economic and Social Council, and other UN bodies. The secretary-general acts as the spokesperson and leader of the UN. The position is defined in the UN Charter as the organization's chief administrative officer. Article 99 of the charter states that the secretary-general can bring to the Security Council's attention "any matter which in their opinion may threaten the maintenance of international peace and security", a phrase that secretaries-general since Trygve Lie have interpreted as giving the position broad scope for action on the world stage. The office has evolved into a dual role of an administrator of the UN organization and a diplomat and mediator addressing disputes between member states and finding consensus to global issues . The secretary-general is appointed by the General Assembly, after being recommended by the Security Council, where the permanent members have veto power. There are no specific criteria for the post, but over the years it has become accepted that the position shall be held for one or two terms of five years. The current secretary-general is António Guterres of Portugal, who replaced Ban Ki-moon in 2017. The International Court of Justice (or ICJ), sometimes known as the World Court, is the primary judicial organ of the UN. It is the successor to the Permanent Court of International Justice and occupies the body's former headquarters in the Peace Palace in The Hague, Netherlands , making it the only principal organ not based in New York City. The ICJ's main function is adjudicating disputes among nations. Examples of issues they have heard include war crimes, violations of state sovereignty and ethnic cleansing. The court can also be called upon by other UN organs to provide advisory opinions on matters of international law. All UN member states are parties to the ICJ Statute , which forms an integral part of the UN Charter, and non-members may also become parties. The ICJ's rulings are binding upon parties and, along with its advisory opinions, serve as sources of international law . The court is composed of 15 judges appointed to nine-year terms by the General Assembly. Every sitting judge must be from a different nation. The Economic and Social Council (or the ECOSOC) assists the General Assembly in promoting international economic and social co-operation and development. It was established to serve as the UN's primary forum for global issues and is the largest and most complex UN body. The ECOSOC's functions include gathering data, conducting studies and advising and making recommendations to member states. Its work is carried out primarily by subsidiary bodies focused on a wide variety of topics. These include the United Nations Permanent Forum on Indigenous Issues , which advises UN agencies on issues relating to indigenous peoples , the United Nations Forum on Forests , which coordinates and promotes sustainable forest management, the United Nations Statistical Commission , which co-ordinates information-gathering efforts between agencies, and the Commission on Sustainable Development , which co-ordinates efforts between UN agencies and NGOs working towards sustainable development . ECOSOC may also grant consultative status to non-governmental organizations. as of April 2021 almost 5,600 organizations have this status. The UN Charter stipulates that each primary organ of the United Nations can establish various specialized agencies to fulfill its duties. Specialized agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Economic and Social Council. Each was integrated into the UN system through an agreement with the UN under UN Charter article 57. There are fifteen specialized agencies, which perform functions as diverse as facilitating international travel, preventing and addressing pandemics, and promoting economic development. [lower-alpha 2] The United Nations system includes a myriad of autonomous, separately administered funds, programmes, research and training institutes, and other subsidiary bodies . Each of these entities have their own area of work, governance structure, and budget such as the World Trade Organization (or the WTO) and the International Atomic Energy Agency (or the IAEA), operate independently of the UN but maintain formal partnership agreements. The UN performs much of its humanitarian work through these institutions, such as preventing famine and malnutrition (the World Food Programme ), protecting vulnerable and displaced people (the UNHCR ), and combating the HIV/AIDS pandemic (the UNAIDS ). The General Assembly is the main deliberative assembly of the UN. Composed of all UN member states , the assembly meets in regular yearly sessions at the General Assembly Hall , but emergency sessions can also be called. The assembly is led by a president , elected by the member states on a rotating regional basis, and 21 vice-presidents. The first session convened on 10 January 1946 in the Methodist Central Hall in London and included representatives of 51 nations. When the General Assembly decides on important questions such as those on peace and security, admission of new members and budgetary matters, a two-thirds majority of those present and voting is required. All other questions are decided by a majority vote. Each member has one vote. Apart from the approval of budgetary matters, resolutions are not binding on the members. The Assembly may make recommendations on any matters within the scope of the UN, except matters of peace and security that are under consideration by the Security Council. Draft resolutions can be forwarded to the General Assembly by its six main committees: As well as by the following two committees:The Security Council is charged with maintaining peace and security amongst nations. While other organs of the UN can only make recommendations to member states, the Security Council has the power to make binding decisions that member states have agreed to carry out, under the terms of Charter Article 25. The decisions of the council are known as United Nations Security Council resolutions . The Security Council is made up of fifteen member states: five permanent members (China, France, Russia, the United Kingdom and the United States) and ten non-permanent members (currently Algeria , Ecuador , Guyana , Japan , Malta , Mozambique , the Republic of Korea , Sierra Leone , Slovenia and Switzerland ). The five permanent members hold veto power over UN resolutions, allowing a permanent member to block adoption of a resolution, though not debate. The ten temporary seats are held for two-year terms, with five members elected each year by the General Assembly on a regional basis . The presidency of the Security Council rotates alphabetically each month. The UN Secretariat carries out the day-to-day duties required to operate and maintain the UN system. It is composed of tens of thousands of international civil servants worldwide and headed by the secretary-general , who is assisted by the deputy secretary-general . The Secretariat's duties include providing information and facilities needed by UN bodies for their meetings and carrying out tasks as directed by the Security Council, the General Assembly, the Economic and Social Council, and other UN bodies. The secretary-general acts as the spokesperson and leader of the UN. The position is defined in the UN Charter as the organization's chief administrative officer. Article 99 of the charter states that the secretary-general can bring to the Security Council's attention "any matter which in their opinion may threaten the maintenance of international peace and security", a phrase that secretaries-general since Trygve Lie have interpreted as giving the position broad scope for action on the world stage. The office has evolved into a dual role of an administrator of the UN organization and a diplomat and mediator addressing disputes between member states and finding consensus to global issues . The secretary-general is appointed by the General Assembly, after being recommended by the Security Council, where the permanent members have veto power. There are no specific criteria for the post, but over the years it has become accepted that the position shall be held for one or two terms of five years. The current secretary-general is António Guterres of Portugal, who replaced Ban Ki-moon in 2017.The International Court of Justice (or ICJ), sometimes known as the World Court, is the primary judicial organ of the UN. It is the successor to the Permanent Court of International Justice and occupies the body's former headquarters in the Peace Palace in The Hague, Netherlands , making it the only principal organ not based in New York City. The ICJ's main function is adjudicating disputes among nations. Examples of issues they have heard include war crimes, violations of state sovereignty and ethnic cleansing. The court can also be called upon by other UN organs to provide advisory opinions on matters of international law. All UN member states are parties to the ICJ Statute , which forms an integral part of the UN Charter, and non-members may also become parties. The ICJ's rulings are binding upon parties and, along with its advisory opinions, serve as sources of international law . The court is composed of 15 judges appointed to nine-year terms by the General Assembly. Every sitting judge must be from a different nation. The Economic and Social Council (or the ECOSOC) assists the General Assembly in promoting international economic and social co-operation and development. It was established to serve as the UN's primary forum for global issues and is the largest and most complex UN body. The ECOSOC's functions include gathering data, conducting studies and advising and making recommendations to member states. Its work is carried out primarily by subsidiary bodies focused on a wide variety of topics. These include the United Nations Permanent Forum on Indigenous Issues , which advises UN agencies on issues relating to indigenous peoples , the United Nations Forum on Forests , which coordinates and promotes sustainable forest management, the United Nations Statistical Commission , which co-ordinates information-gathering efforts between agencies, and the Commission on Sustainable Development , which co-ordinates efforts between UN agencies and NGOs working towards sustainable development . ECOSOC may also grant consultative status to non-governmental organizations. as of April 2021 almost 5,600 organizations have this status. The UN Charter stipulates that each primary organ of the United Nations can establish various specialized agencies to fulfill its duties. Specialized agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Economic and Social Council. Each was integrated into the UN system through an agreement with the UN under UN Charter article 57. There are fifteen specialized agencies, which perform functions as diverse as facilitating international travel, preventing and addressing pandemics, and promoting economic development. [lower-alpha 2]The United Nations system includes a myriad of autonomous, separately administered funds, programmes, research and training institutes, and other subsidiary bodies . Each of these entities have their own area of work, governance structure, and budget such as the World Trade Organization (or the WTO) and the International Atomic Energy Agency (or the IAEA), operate independently of the UN but maintain formal partnership agreements. The UN performs much of its humanitarian work through these institutions, such as preventing famine and malnutrition (the World Food Programme ), protecting vulnerable and displaced people (the UNHCR ), and combating the HIV/AIDS pandemic (the UNAIDS ). All the world's undisputed independent states are members of the United Nations. South Sudan , which joined 14 July 2011, is the most recent addition, bringing a total of 193 UN member states. The UN Charter outlines the membership rules: Membership in the United Nations is open to all other peace-loving states that accept the obligations contained in the present Charter and, in the judgment of the Organization, are able and willing to carry out these obligations. The admission of any such state to membership in the United Nations will be affected by a decision of the General Assembly upon the recommendation of the Security Council. Chapter II, Article 4. In addition, there are two non-member observer states : the Holy See and Palestine . [lower-alpha 3] The Cook Islands and Niue , both states in free association with New Zealand , are full members of several UN specialized agencies and have had their "full treaty-making capacity" recognized by the Secretariat. Indonesia was the first and the only nation that attempted to withdraw its membership from the United Nations, in protest to the election of Malaysia as a non-permanent member of the Security Council in 1965 during conflict between the two countries . After forming CONEFO as a short-lived rival to the UN, Indonesia resumed its membership in 1966. The Group of 77 (or the G77) at the UN is a loose coalition of developing nations that is designed to promote its members' collective economic interests and create an enhanced joint negotiating capacity in the UN. Seventy-seven nations founded the organization, but by November 2013 the organization had since expanded to 133 member countries. The group was founded 15 June 1964 by the "Joint Declaration of the Seventy-Seven Countries" issued at the United Nations Conference on Trade and Development (or the UNCTAD). The group held its first major meeting in Algiers in 1967, where it adopted the Charter of Algiers and established the basis for permanent institutional structures. With the adoption of the New International Economic Order by developing countries in the 1970s, the work of the G77 spread throughout the UN system. Similar groupings of developing states also operate in other UN agencies, such as the Group of 24 (or the G-24), which operates in the IMF on monetary affairs. The Group of 77 (or the G77) at the UN is a loose coalition of developing nations that is designed to promote its members' collective economic interests and create an enhanced joint negotiating capacity in the UN. Seventy-seven nations founded the organization, but by November 2013 the organization had since expanded to 133 member countries. The group was founded 15 June 1964 by the "Joint Declaration of the Seventy-Seven Countries" issued at the United Nations Conference on Trade and Development (or the UNCTAD). The group held its first major meeting in Algiers in 1967, where it adopted the Charter of Algiers and established the basis for permanent institutional structures. With the adoption of the New International Economic Order by developing countries in the 1970s, the work of the G77 spread throughout the UN system. Similar groupings of developing states also operate in other UN agencies, such as the Group of 24 (or the G-24), which operates in the IMF on monetary affairs. The overarching strategy of the United Nations is captured in the United Nations Common Agenda . The UN, after approval by the Security Council, sends peacekeepers to regions where armed conflict has recently ceased or paused to enforce the terms of peace agreements and to discourage combatants from resuming hostilities. Since the UN does not maintain its own military, peacekeeping forces are voluntarily provided by member states. These soldiers are sometimes nicknamed "Blue Helmets" because they wear distinctive blue helmets. Peacekeeping forces as a whole received the Nobel Peace Prize in 1988. The UN has carried out 71 peacekeeping operations since 1947, and as of April 2021, over 88,000 peacekeeping personnel from 121 nations have been deployed on missions. The largest is the United Nations Mission in South Sudan (or UNMISS), which has close to 19,200 uniformed personnel, and the smallest, the United Nations Military Observer Group in India and Pakistan (or UNMOGIP), consists of 113 civilians and experts charged with monitoring the ceasefire in Jammu and Kashmir . UN peacekeepers with the United Nations Truce Supervision Organization (or UNTSO) have been stationed in the Middle East since 1948, the longest-running active peacekeeping mission. A study by the RAND Corporation in 2005 found the UN to be successful in two-thirds of their peacekeeping efforts. It compared efforts at nation-building by the UN to those of the United States, and found that 87.5% of UN cases are at peace, as compared with 50% of U.S. cases at peace. Also in 2005, the Human Security Report documented a decline in the number of wars, genocides , and human rights abuses since the end of the Cold War, and presented evidence, albeit circumstantial, that international activism – mostly spearheaded by the UN – has been the main cause of the decline in armed conflict. Situations in which the UN has not only acted to keep the peace but also intervened include the Korean War and the authorization of intervention in Iraq after the Gulf War. Further studies published between 2008 and 2021 determined UN peacekeeping operations to be more effective at ensuring long-lasting peace and minimizing civilian casualties. The UN has also drawn criticism for perceived failures. In many cases, member states have shown reluctance to achieve or enforce Security Council resolutions. Disagreements in the Security Council about military action and intervention are seen as having failed to prevent the Bangladesh genocide in 1971 , the Cambodian genocide in the 1970s, and the Rwandan genocide in 1994. Similarly, UN inaction is blamed for failing to either prevent the Srebrenica massacre or complete the peacekeeping operations during the Somali Civil War . UN peacekeepers have also been accused of child rape, soliciting prostitutes, and sexual abuse during various peacekeeping missions in the Democratic Republic of the Congo, Haiti, Liberia, Sudan, Burundi, and Côte d'Ivoire. Scientists cited UN peacekeepers from Nepal as the source of the 2010s Haiti cholera outbreak , which killed more than 8,000 people. In addition to peacekeeping, the UN is also active in encouraging disarmament . Regulation of armaments was included in the writing of the UN Charter in 1945 and was envisioned as a way of limiting the use of human and economic resources for their creation. The advent of nuclear weapons came only weeks after the signing of the charter, resulting in the first resolution of the first General Assembly meeting calling for specific proposals for "the elimination from national armaments of atomic weapons and of all other major weapons adaptable to mass destruction". The UN has been involved with arms-limitation treaties such as the Outer Space Treaty , the Treaty on the Non-Proliferation of Nuclear Weapons , the Seabed Arms Control Treaty , the Biological Weapons Convention , the Chemical Weapons Convention , and the Ottawa Treaty . Three UN bodies oversee arms proliferation issues: the International Atomic Energy Agency , the Organization for the Prohibition of Chemical Weapons and the Comprehensive Nuclear-Test-Ban Treaty Organization Preparatory Commission . Additionally, many peacekeeping missions focus on disarmament: several operations in West Africa disarmed roughly 250,000 former combatants and secured tens of thousands of weapons and millions of munitions. One of the UN's primary purposes is "promoting and encouraging respect for human rights and for fundamental freedoms for all without distinction as to race, sex, language, or religion", and member states pledge to undertake "joint and separate action" to protect these rights. In 1948, the General Assembly adopted a Universal Declaration of Human Rights , drafted by a committee headed by American diplomat and activist Eleanor Roosevelt , and including the French lawyer René Cassin . The document proclaims basic civil, political and economic rights common to all human beings, though its effectiveness towards achieving these ends has been disputed since its drafting. The Declaration serves as a "common standard of achievement for all people and all nations" rather than a legally binding document, but it has become the basis of two binding treaties, the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights . In practice, the UN is unable to take significant action against human rights abuses without a Security Council resolution, though it does substantial work in investigating and reporting abuses. In 1979, the General Assembly adopted the Convention on the Elimination of All Forms of Discrimination against Women ; followed by the Convention on the Rights of the Child in 1989. With the end of the Cold War, the push for human rights action took on new impetus. The United Nations Commission on Human Rights was formed in 1993 to oversee human rights issues for the UN, following the recommendation of that year's World Conference on Human Rights . Jacques Fomerand, a scholar of the UN, describes the organization's mandate as "broad and vague", with only "meagre" resources to carry it out. In 2006, it was replaced by a Human Rights Council consisting of 47 nations. Also in 2006, the General Assembly passed a Declaration on the Rights of Indigenous People , and in 2011 it passed its first resolution recognizing the rights of members of the LGBTQ+ community. Other UN bodies responsible for women's rights issues include the United Nations Commission on the Status of Women , the United Nations Development Fund for Women and the United Nations International Research and Training Institute for the Advancement of Women . The UN Permanent Forum on Indigenous Issues, one of three bodies with a mandate to oversee issues related to indigenous peoples, held its first session in 2002. Millennium Development Goals Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria, and other diseases Ensure environmental sustainability Develop a global partnership for development Another primary purpose of the UN is "to achieve international co-operation in solving international problems of an economic, social, cultural and humanitarian character". Numerous bodies have been created to work towards this goal, primarily under the authority of the General Assembly and the ECOSOC. In 2000, the 192 UN member states agreed to achieve eight Millennium Development Goals by 2015. The Sustainable Development Goals were launched in 2015 to succeed the Millennium Development Goals. The SDGs have an associated financing framework called the Addis Ababa Action Agenda . The UN Development Programme (or the UNDP), an organization for grant-based technical assistance, is one of the leading bodies in the field of international development . The organization also publishes the UN Human Development Index , a comparative measure ranking countries by poverty, literacy, education, life expectancy, and other factors. The Food and Agriculture Organization (or the FAO) promotes agricultural development and food security. The United Nations Children's Fund (or UNICEF) was created in 1946 to aid European children after the Second World War and expanded its mission to provide aid around the world and to uphold the convention on the Rights of the Child. The World Bank Group and the International Monetary Fund (or the IMF) are independent, specialized agencies and observers within the UN framework. They were initially formed separately from the UN through the Bretton Woods Agreement . The World Bank provides loans for international development, while the IMF promotes international economic co-operation and gives emergency loans to indebted countries. The World Health Organization (or WHO), which focuses on international health issues and disease eradication, is another of the UN's largest agencies. In 1980, the agency announced that the eradication of smallpox had been completed. In subsequent decades, WHO eradicated polio , river blindness , and leprosy . The Joint United Nations Programme on HIV/AIDS (or UNAIDS) co-ordinated the organization's response to the AIDS epidemic. The UN Population Fund , which also dedicates part of its resources to combating HIV, is the world's largest source of funding for reproductive health and family planning services. Along with the International Red Cross and Red Crescent Movement , the UN takes a leading role in co-ordinating emergency relief. The World Food Programme (or the WFP) provides food aid in response to famine, natural disasters, and armed conflict. The organization feeds an average of 90 million people in 80 nations per year. The Office of the United Nations High Commissioner for Refugees (or the UNHCR) works to protect the rights of refugees, asylum seekers and stateless people. The UNHCR and the WFP programmes are funded by voluntary contributions from governments, corporations, and individuals, though the UNHCR's administrative costs are paid for by the UN's primary budget. Beginning with the formation of the UN Environmental Programme (or the UNEP) in 1972, the UN has made environmental issues a prominent part of its agenda. A lack of success in the first two decades of UN work in this area led to the Earth Summit in Rio de Janeiro, Brazil, in 1992; which sought to give new impetus to these efforts. In 1988, the UNEP and the World Meteorological Organization (or the WMO), another UN organization, established the Intergovernmental Panel on Climate Change , which assesses and reports on research on global warming . The UN-sponsored Kyoto Protocol set legally binding emissions reduction targets for ratifying states. Since the UN's creation, over 80 colonies have attained independence. The General Assembly adopted the Declaration on the Granting of Independence to Colonial Countries and Peoples in 1960 with no votes against but abstentions from all major colonial powers. The UN works towards decolonization through groups including the UN Committee on Decolonization . The committee lists seventeen remaining " non-self-governing territories ", the largest and most populous of which is the Western Sahara . The UN also declares and co-ordinates international observances that bring awareness to issues of international interest or concern; examples include World Tuberculosis Day , Earth Day , and the International Year of Deserts and Desertification . The UN, after approval by the Security Council, sends peacekeepers to regions where armed conflict has recently ceased or paused to enforce the terms of peace agreements and to discourage combatants from resuming hostilities. Since the UN does not maintain its own military, peacekeeping forces are voluntarily provided by member states. These soldiers are sometimes nicknamed "Blue Helmets" because they wear distinctive blue helmets. Peacekeeping forces as a whole received the Nobel Peace Prize in 1988. The UN has carried out 71 peacekeeping operations since 1947, and as of April 2021, over 88,000 peacekeeping personnel from 121 nations have been deployed on missions. The largest is the United Nations Mission in South Sudan (or UNMISS), which has close to 19,200 uniformed personnel, and the smallest, the United Nations Military Observer Group in India and Pakistan (or UNMOGIP), consists of 113 civilians and experts charged with monitoring the ceasefire in Jammu and Kashmir . UN peacekeepers with the United Nations Truce Supervision Organization (or UNTSO) have been stationed in the Middle East since 1948, the longest-running active peacekeeping mission. A study by the RAND Corporation in 2005 found the UN to be successful in two-thirds of their peacekeeping efforts. It compared efforts at nation-building by the UN to those of the United States, and found that 87.5% of UN cases are at peace, as compared with 50% of U.S. cases at peace. Also in 2005, the Human Security Report documented a decline in the number of wars, genocides , and human rights abuses since the end of the Cold War, and presented evidence, albeit circumstantial, that international activism – mostly spearheaded by the UN – has been the main cause of the decline in armed conflict. Situations in which the UN has not only acted to keep the peace but also intervened include the Korean War and the authorization of intervention in Iraq after the Gulf War. Further studies published between 2008 and 2021 determined UN peacekeeping operations to be more effective at ensuring long-lasting peace and minimizing civilian casualties. The UN has also drawn criticism for perceived failures. In many cases, member states have shown reluctance to achieve or enforce Security Council resolutions. Disagreements in the Security Council about military action and intervention are seen as having failed to prevent the Bangladesh genocide in 1971 , the Cambodian genocide in the 1970s, and the Rwandan genocide in 1994. Similarly, UN inaction is blamed for failing to either prevent the Srebrenica massacre or complete the peacekeeping operations during the Somali Civil War . UN peacekeepers have also been accused of child rape, soliciting prostitutes, and sexual abuse during various peacekeeping missions in the Democratic Republic of the Congo, Haiti, Liberia, Sudan, Burundi, and Côte d'Ivoire. Scientists cited UN peacekeepers from Nepal as the source of the 2010s Haiti cholera outbreak , which killed more than 8,000 people. In addition to peacekeeping, the UN is also active in encouraging disarmament . Regulation of armaments was included in the writing of the UN Charter in 1945 and was envisioned as a way of limiting the use of human and economic resources for their creation. The advent of nuclear weapons came only weeks after the signing of the charter, resulting in the first resolution of the first General Assembly meeting calling for specific proposals for "the elimination from national armaments of atomic weapons and of all other major weapons adaptable to mass destruction". The UN has been involved with arms-limitation treaties such as the Outer Space Treaty , the Treaty on the Non-Proliferation of Nuclear Weapons , the Seabed Arms Control Treaty , the Biological Weapons Convention , the Chemical Weapons Convention , and the Ottawa Treaty . Three UN bodies oversee arms proliferation issues: the International Atomic Energy Agency , the Organization for the Prohibition of Chemical Weapons and the Comprehensive Nuclear-Test-Ban Treaty Organization Preparatory Commission . Additionally, many peacekeeping missions focus on disarmament: several operations in West Africa disarmed roughly 250,000 former combatants and secured tens of thousands of weapons and millions of munitions. One of the UN's primary purposes is "promoting and encouraging respect for human rights and for fundamental freedoms for all without distinction as to race, sex, language, or religion", and member states pledge to undertake "joint and separate action" to protect these rights. In 1948, the General Assembly adopted a Universal Declaration of Human Rights , drafted by a committee headed by American diplomat and activist Eleanor Roosevelt , and including the French lawyer René Cassin . The document proclaims basic civil, political and economic rights common to all human beings, though its effectiveness towards achieving these ends has been disputed since its drafting. The Declaration serves as a "common standard of achievement for all people and all nations" rather than a legally binding document, but it has become the basis of two binding treaties, the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights . In practice, the UN is unable to take significant action against human rights abuses without a Security Council resolution, though it does substantial work in investigating and reporting abuses. In 1979, the General Assembly adopted the Convention on the Elimination of All Forms of Discrimination against Women ; followed by the Convention on the Rights of the Child in 1989. With the end of the Cold War, the push for human rights action took on new impetus. The United Nations Commission on Human Rights was formed in 1993 to oversee human rights issues for the UN, following the recommendation of that year's World Conference on Human Rights . Jacques Fomerand, a scholar of the UN, describes the organization's mandate as "broad and vague", with only "meagre" resources to carry it out. In 2006, it was replaced by a Human Rights Council consisting of 47 nations. Also in 2006, the General Assembly passed a Declaration on the Rights of Indigenous People , and in 2011 it passed its first resolution recognizing the rights of members of the LGBTQ+ community. Other UN bodies responsible for women's rights issues include the United Nations Commission on the Status of Women , the United Nations Development Fund for Women and the United Nations International Research and Training Institute for the Advancement of Women . The UN Permanent Forum on Indigenous Issues, one of three bodies with a mandate to oversee issues related to indigenous peoples, held its first session in 2002. Millennium Development Goals Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria, and other diseases Ensure environmental sustainability Develop a global partnership for development Another primary purpose of the UN is "to achieve international co-operation in solving international problems of an economic, social, cultural and humanitarian character". Numerous bodies have been created to work towards this goal, primarily under the authority of the General Assembly and the ECOSOC. In 2000, the 192 UN member states agreed to achieve eight Millennium Development Goals by 2015. The Sustainable Development Goals were launched in 2015 to succeed the Millennium Development Goals. The SDGs have an associated financing framework called the Addis Ababa Action Agenda . The UN Development Programme (or the UNDP), an organization for grant-based technical assistance, is one of the leading bodies in the field of international development . The organization also publishes the UN Human Development Index , a comparative measure ranking countries by poverty, literacy, education, life expectancy, and other factors. The Food and Agriculture Organization (or the FAO) promotes agricultural development and food security. The United Nations Children's Fund (or UNICEF) was created in 1946 to aid European children after the Second World War and expanded its mission to provide aid around the world and to uphold the convention on the Rights of the Child. The World Bank Group and the International Monetary Fund (or the IMF) are independent, specialized agencies and observers within the UN framework. They were initially formed separately from the UN through the Bretton Woods Agreement . The World Bank provides loans for international development, while the IMF promotes international economic co-operation and gives emergency loans to indebted countries. The World Health Organization (or WHO), which focuses on international health issues and disease eradication, is another of the UN's largest agencies. In 1980, the agency announced that the eradication of smallpox had been completed. In subsequent decades, WHO eradicated polio , river blindness , and leprosy . The Joint United Nations Programme on HIV/AIDS (or UNAIDS) co-ordinated the organization's response to the AIDS epidemic. The UN Population Fund , which also dedicates part of its resources to combating HIV, is the world's largest source of funding for reproductive health and family planning services. Along with the International Red Cross and Red Crescent Movement , the UN takes a leading role in co-ordinating emergency relief. The World Food Programme (or the WFP) provides food aid in response to famine, natural disasters, and armed conflict. The organization feeds an average of 90 million people in 80 nations per year. The Office of the United Nations High Commissioner for Refugees (or the UNHCR) works to protect the rights of refugees, asylum seekers and stateless people. The UNHCR and the WFP programmes are funded by voluntary contributions from governments, corporations, and individuals, though the UNHCR's administrative costs are paid for by the UN's primary budget. Beginning with the formation of the UN Environmental Programme (or the UNEP) in 1972, the UN has made environmental issues a prominent part of its agenda. A lack of success in the first two decades of UN work in this area led to the Earth Summit in Rio de Janeiro, Brazil, in 1992; which sought to give new impetus to these efforts. In 1988, the UNEP and the World Meteorological Organization (or the WMO), another UN organization, established the Intergovernmental Panel on Climate Change , which assesses and reports on research on global warming . The UN-sponsored Kyoto Protocol set legally binding emissions reduction targets for ratifying states. Since the UN's creation, over 80 colonies have attained independence. The General Assembly adopted the Declaration on the Granting of Independence to Colonial Countries and Peoples in 1960 with no votes against but abstentions from all major colonial powers. The UN works towards decolonization through groups including the UN Committee on Decolonization . The committee lists seventeen remaining " non-self-governing territories ", the largest and most populous of which is the Western Sahara . The UN also declares and co-ordinates international observances that bring awareness to issues of international interest or concern; examples include World Tuberculosis Day , Earth Day , and the International Year of Deserts and Desertification . The UN budget for 2024 was $3.59 billion, not including additional resources donated by members, such as peacekeeping forces. Including specialized agencies of the UN , the UN System Chief Executives Board for Coordination reports total expenses of $67.4 billion in 2022 for 43 United Nations entities. The UN is financed from assessed and voluntary contributions from its member states. The General Assembly approves the regular budget and determines the assessment for each member. This is broadly based on the relative capacity of each nation to pay, as measured by its gross national income (or GNI), with adjustments for external debt and low per capita income. The Assembly has established the principle that the UN should not be unduly dependent on any one member to finance its operations. Thus, there is a "ceiling" rate, setting the maximum amount that any member can be assessed for the regular budget. In December 2000, the Assembly revised the scale of assessments in response to pressure from the United States. As part of that revision, the regular budget ceiling was reduced from 25% to 22%. For the least developed countries (or LDCs), a ceiling rate of 0.01% is applied. In addition to the ceiling rates, the minimum amount assessed to any member nation (or "floor" rate) is set at 0.001% of the UN budget ($31,000 for the two-year budget 2021–2022). A large share of the UN's expenditure addresses its core mission of peace and security, and this budget is assessed separately from the main organizational budget. The peacekeeping budget for the 2021–2022 fiscal year is $6.38 billion, supporting 66,839 personnel deployed in 12 missions worldwide. UN peace operations are funded by assessments, using a formula derived from the regular funding scale that includes a weighted surcharge for the five permanent Security Council members, who must approve all peacekeeping operations. This surcharge serves to offset discounted peacekeeping assessment rates for less developed countries. The largest contributors to the UN peacekeeping budget for 2023–2024 are: the United States (26.94%), China (18.68%), Japan (8.03%), Germany (6.11%), the United Kingdom (5.35%), France (5.28%), Italy (3.18%), Canada (2.62%), South Korea (2.57%) and Russia (2.28%). Special UN programmes not included in the regular budget, such as UNICEF and the World Food Programme, are financed by voluntary contributions from member governments, corporations, and private individuals. UN peacekeeping missions are assessed to be generally successful. A book looking at 47 peace operations by Virginia Page Fortna of Columbia University found that UN-led conflict resolution usually resulted in long-term peace. Political scientists Hanne Fjelde, Lisa Hultman and Desiree Nilsson of Uppsala University studied twenty years of data on peacekeeping missions, concluding that they were more effective at reducing civilian casualties than counterterrorism operations by nation states. Georgetown University professor Lise Howard postulates that UN peacekeeping operations are more effective due to their emphasis on "verbal persuasion, financial inducements and coercion short of offensive military force, including surveillance and arrest", which are likelier to change the behavior of warring parties. British historian Paul Kennedy states that while the organization has suffered some major setbacks, "when all its aspects are considered, the UN has brought great benefits to our generation and will bring benefits to our children's and grandchildren's generations as well." In 2012, then French President François Hollande stated that "France trusts the United Nations. She knows that no state, no matter how powerful, can solve urgent problems, fight for development and bring an end to all crises. France wants the UN to be the centre of global governance". In his 1953 address to the United States Committee for United Nations Day, American President Dwight D. Eisenhower expressed his view that, for all its flaws, "the United Nations represents man's best organized hope to substitute the conference table for the battlefield". Jacques Fomerand , a professor in political sciences, writes that the "accomplishments of the United Nations in the last 60 years are impressive in their own terms. Progress in human development during the 20th century has been dramatic, and the UN and its agencies have certainly helped the world become a more hospitable and livable place for millions". Reviewing the first 50 years of the UN's history, the author Stanley Meisler writes that "the United Nations never fulfilled the hopes of its founders, but it accomplished a great deal nevertheless", citing its role in decolonization and its many successful peacekeeping efforts. A number of agencies and individuals associated with the UN have won the Nobel Peace Prize in recognition of their work. Two secretaries-general, Dag Hammarskjöld and Kofi Annan, were each awarded the prize; as were Ralph Bunche, a UN negotiator, René Cassin, a contributor to the Universal Declaration of Human Rights, and the American Secretary of State Cordell Hull for his role in the organization's founding. Lester B. Pearson , the Canadian Secretary of State for External Affairs , was awarded the prize in 1957 for his role in organizing the UN's first peacekeeping force to resolve the Suez Crisis. UNICEF won the prize in 1965, the International Labour Organization in 1969, the UN Peacekeeping Forces in 1988, the International Atomic Energy Agency (which reports to the UN) in 2005, and the UN-supported Organisation for the Prohibition of Chemical Weapons in 2013. The UN High Commissioner for Refugees was awarded the prize in 1954 and 1981, becoming one of only two recipients to win the prize twice. The UN as a whole was awarded the prize in 2001, sharing it with Annan. In 2007, the IPCC received the prize "for their efforts to build up and disseminate greater knowledge about man-made climate change, and to lay the foundations for the measures that are needed to counteract such change." In a sometimes-misquoted statement, American President George W. Bush stated in February 2003—referring to UN uncertainty towards Iraqi provocations under the Saddam Hussein regime—that "free nations will not allow the UN to fade into history as an ineffective, irrelevant debating society." In 2020, former American President Barack Obama , in his memoir A Promised Land noted, "In the middle of the Cold War , the chances of reaching any consensus had been slim, which is why the UN had stood idle as Soviet tanks rolled into Hungary or U.S. planes dropped napalm on the Vietnamese countryside. Even after the Cold War, divisions within the Security Council continued to hamstring the UN's ability to tackle problems. Its member states lacked either the means or the collective will to reconstruct failing states like Somalia, or prevent an ethnic slaughter in places like Sri Lanka." Since its founding, there have been many calls for reform of the UN but little consensus on how to do so. Some want the UN to play a greater or more effective role in world affairs, while others want its role reduced to humanitarian work. Core features of the UN apparatus, such as the veto privileges of some nations in the Security Council , are often described as fundamentally undemocratic, contrary to the UN mission, and a main cause of inaction on genocides and crimes against humanity . Jacques Fomerand state that the most enduring divide in views of the UN is "the North–South split" between richer Northern nations and developing Southern nations . Southern nations tend to favour a more empowered UN with a stronger General Assembly, allowing them a greater voice in world affairs, while Northern nations prefer an economically laissez-faire UN that focuses on transnational threats such as terrorism. There have also been numerous calls for the UN Security Council's membership to be increased , for different ways of electing the UN's secretary-general, and for a UN Parliamentary Assembly . In the context of ongoing United Nations reform discussions, Noble World Foundation (NWF) proposes changing the structure of the United Nations Security Council (UNSC) by shifting membership and veto power from individual states to regional organizations like the European Union . This proposed shift is in line with the UNSC's existing practice of basing the selection of non-permanent members on regional representation. Shifting to regional organization-based membership in the UNSC aims to reduce deadlock caused by individual state vetoes. A prime example of this issue was observed on February 25, 2022, when Russia used its veto power to block a resolution against its invasion of Ukraine, thereby underscoring a significant weakness in the UNSC's functioning. NWF's proposal is intended to improve the effectiveness and decision-making process within the UNSC. After World War II , the French Committee of National Liberation was late to be recognized by the United States as the government of France, and so the country was initially excluded from the conferences that created the new organization. Future French president Charles de Gaulle criticized the UN, famously calling it a machin (contraption), and was not convinced that a global security alliance would help maintain world peace, preferring direct defence treaties between countries. Since 1971, the Republic of China , also known as Taiwan, has been excluded from the UN and consistently denied membership in its reapplications. The UN officially adheres to the " One China " policy endorsed by most member states, which recognizes the People's Republic of China as the only legitimate Chinese government. Critics allege that this position reflects a failure of the organization's development goals and guidelines, and it garnered renewed scrutiny during the COVID-19 pandemic , when Taiwan was denied membership into the World Health Organization despite its relatively effective response to the virus . Support for Taiwan's inclusion is subject to pressure from the People's Republic of China, which regards the territories administered by Taiwan as their own territory . Throughout the Cold War, both the United States and the Soviet Union repeatedly accused the UN of favouring the other. In 1950, the Soviet Union boycotted the organization in protest to China's seat at the UN Security Council being given to the anti-communist Republic of China . Three years later, the Soviets effectively forced the resignation of UN Secretary-General Trygve Lie by refusing to acknowledge his administration due to his support of the Korean War . Ironically, the United States had simultaneously scrutinized the UN for employing communists and Soviet sympathizers, following a high-profile accusation that Alger Hiss , an American who had taken part in the establishment of the UN, had been a Soviet spy. American Senator Joseph McCarthy claimed that the UN Secretariat under Secretary-General Lie harboured American communists, leading to further pressure that the UN chief resign. The United States saw nascent opposition to the UN in the 1960s, particularly amongst conservatives, with groups such as the John Birch Society stating that the organization was an instrument for communism. Popular opposition to the UN was expressed through bumper stickers and signs with slogans such as "Get the U.S. out of the U.N. and the U.N. out of the U.S.!" and "You can't spell communism without U.N." In the United States, there were concerns about supposed threats to national sovereignty, most notably promoted by the John Birch Society , which mounted a nationwide campaign in opposition to the UN during the 1960s. Beginning in the 1990s, the same concern appeared with the American Sovereignty Restoration Act , which has been introduced multiple times in the United States Congress . In 1997, an amendment containing the bill received a floor vote, with 54 representatives voting in favor. The 2007 version of the bill ( H.R. 1146 ) was authored by U.S. Representative Ron Paul , to effect the United States' withdrawal from the United Nations. It would repeal various laws pertaining to the UN, terminate authorization for funds to be spent on the UN, terminate UN presence on American property, and withdraw diplomatic immunity for UN employees. It would provide up to two years for the United States to withdraw. The Yale Law Journal cited the Act as proof that "the United States's complaints against the United Nations have intensified." The most recent iteration, as of 2022, is H.R.7806, introduced by Mike D. Rogers . The UN's attention to Israel's treatment of Palestinians is considered excessive by a range of critics, including Israeli diplomat Dore Gold , British scholar Robert S. Wistrich , American legal scholar Alan Dershowitz , Australian politician Mark Dreyfus , and the Anti-Defamation League . In September 2015, Saudi Arabia 's Faisal bin Hassan Trad was elected chair of an advisory committee in the UN Human Rights Council , a move criticized by the UN Watch . The UNHRC has likewise been accused of anti-Israel bias by Ex-President of the United States George W. Bush , who complained that the Council focused too much attention on Israel and not enough on countries such as Cuba, Venezuela, North Korea and Iran. American state lawmakers have proposed legislation to block various UN programs deemed to threaten U.S. sovereignty. In 2023, Tennessee enacted legislation to block the implementation of programs "originating in, or traceable to, the United Nations or a subsidiary entity of the United Nations," including Agenda 21 and the 2030 Agenda . According to international relations scholar Edward Luck , the United States has preferred a feeble United Nations in major projects undertaken by the organization to forestall UN interference with, or resistance to, American policies. "The last thing the U.S. wants is an independent UN throwing its weight around", Luck said. Similarly, former US Ambassador to the United Nations Daniel Patrick Moynihan explained that "The Department of State desired that the United Nations prove utterly ineffective in whatever measures it undertook. The task was given to me, and I carried it forward with not inconsiderable success." In 1994, former special representative of the secretary-general of the UN to Somalia Mohamed Sahnoun published Somalia: The Missed Opportunities , a book in which he analyses the reasons for the failure of the 1992 UN intervention in Somalia . Sahnoun claims that between the start of the Somali civil war in 1988 and the fall of the Siad Barre regime in January 1991, the UN missed at least three opportunities to prevent major human tragedies. When the UN tried to provide humanitarian assistance, they were totally outperformed by NGOs , whose competence and dedication sharply contrasted with the UN's excessive caution and bureaucratic inefficiencies. Sahnoun warned that if radical reform were not undertaken, then the UN would continue to respond to such crises with inept improvisation. Beyond specific instances or areas of alleged ineffectiveness, some scholars debate the overall effectiveness of the UN. Adherents to the realist school of international relations take a pessimistic position, arguing that the UN is not an effective organization because it is dominated and constrained by great powers. Liberal scholars counter that it is an effective organization because it has proved capable of solving many problems by working around the restrictions imposed by powerful member states. The UN is generally considered by scholars to be more effective in realms such as public health, humanitarian assistance, and conflict resolution. Critics have also accused the UN of bureaucratic inefficiency, waste, and corruption. In 1976, the General Assembly established the Joint Inspection Unit to seek out inefficiencies within the UN system. During the 1990s, the United States withheld dues citing inefficiency and only started repayment on the condition that a major reforms initiative be introduced. In 1994, the Office of Internal Oversight Services (or the OIOS) was established by the General Assembly to serve as an efficiency watchdog. In 2004, the UN faced accusations that its recently ended Oil-for-Food Programme — in which Iraq had been allowed to trade oil for basic needs to relieve the pressure of sanctions — had suffered from widespread corruption, including billions of dollars of kickbacks . An independent inquiry created by the UN found that many of its officials had been involved in the scheme , and raised significant questions about the role of Kojo Annan , the son of Kofi Annan . In a sometimes-misquoted statement, American President George W. Bush stated in February 2003—referring to UN uncertainty towards Iraqi provocations under the Saddam Hussein regime—that "free nations will not allow the UN to fade into history as an ineffective, irrelevant debating society." In 2020, former American President Barack Obama , in his memoir A Promised Land noted, "In the middle of the Cold War , the chances of reaching any consensus had been slim, which is why the UN had stood idle as Soviet tanks rolled into Hungary or U.S. planes dropped napalm on the Vietnamese countryside. Even after the Cold War, divisions within the Security Council continued to hamstring the UN's ability to tackle problems. Its member states lacked either the means or the collective will to reconstruct failing states like Somalia, or prevent an ethnic slaughter in places like Sri Lanka." Since its founding, there have been many calls for reform of the UN but little consensus on how to do so. Some want the UN to play a greater or more effective role in world affairs, while others want its role reduced to humanitarian work.Core features of the UN apparatus, such as the veto privileges of some nations in the Security Council , are often described as fundamentally undemocratic, contrary to the UN mission, and a main cause of inaction on genocides and crimes against humanity . Jacques Fomerand state that the most enduring divide in views of the UN is "the North–South split" between richer Northern nations and developing Southern nations . Southern nations tend to favour a more empowered UN with a stronger General Assembly, allowing them a greater voice in world affairs, while Northern nations prefer an economically laissez-faire UN that focuses on transnational threats such as terrorism. There have also been numerous calls for the UN Security Council's membership to be increased , for different ways of electing the UN's secretary-general, and for a UN Parliamentary Assembly . In the context of ongoing United Nations reform discussions, Noble World Foundation (NWF) proposes changing the structure of the United Nations Security Council (UNSC) by shifting membership and veto power from individual states to regional organizations like the European Union . This proposed shift is in line with the UNSC's existing practice of basing the selection of non-permanent members on regional representation. Shifting to regional organization-based membership in the UNSC aims to reduce deadlock caused by individual state vetoes. A prime example of this issue was observed on February 25, 2022, when Russia used its veto power to block a resolution against its invasion of Ukraine, thereby underscoring a significant weakness in the UNSC's functioning. NWF's proposal is intended to improve the effectiveness and decision-making process within the UNSC. After World War II , the French Committee of National Liberation was late to be recognized by the United States as the government of France, and so the country was initially excluded from the conferences that created the new organization. Future French president Charles de Gaulle criticized the UN, famously calling it a machin (contraption), and was not convinced that a global security alliance would help maintain world peace, preferring direct defence treaties between countries. Since 1971, the Republic of China , also known as Taiwan, has been excluded from the UN and consistently denied membership in its reapplications. The UN officially adheres to the " One China " policy endorsed by most member states, which recognizes the People's Republic of China as the only legitimate Chinese government. Critics allege that this position reflects a failure of the organization's development goals and guidelines, and it garnered renewed scrutiny during the COVID-19 pandemic , when Taiwan was denied membership into the World Health Organization despite its relatively effective response to the virus . Support for Taiwan's inclusion is subject to pressure from the People's Republic of China, which regards the territories administered by Taiwan as their own territory . Throughout the Cold War, both the United States and the Soviet Union repeatedly accused the UN of favouring the other. In 1950, the Soviet Union boycotted the organization in protest to China's seat at the UN Security Council being given to the anti-communist Republic of China . Three years later, the Soviets effectively forced the resignation of UN Secretary-General Trygve Lie by refusing to acknowledge his administration due to his support of the Korean War . Ironically, the United States had simultaneously scrutinized the UN for employing communists and Soviet sympathizers, following a high-profile accusation that Alger Hiss , an American who had taken part in the establishment of the UN, had been a Soviet spy. American Senator Joseph McCarthy claimed that the UN Secretariat under Secretary-General Lie harboured American communists, leading to further pressure that the UN chief resign. The United States saw nascent opposition to the UN in the 1960s, particularly amongst conservatives, with groups such as the John Birch Society stating that the organization was an instrument for communism. Popular opposition to the UN was expressed through bumper stickers and signs with slogans such as "Get the U.S. out of the U.N. and the U.N. out of the U.S.!" and "You can't spell communism without U.N." In the United States, there were concerns about supposed threats to national sovereignty, most notably promoted by the John Birch Society , which mounted a nationwide campaign in opposition to the UN during the 1960s. Beginning in the 1990s, the same concern appeared with the American Sovereignty Restoration Act , which has been introduced multiple times in the United States Congress . In 1997, an amendment containing the bill received a floor vote, with 54 representatives voting in favor. The 2007 version of the bill ( H.R. 1146 ) was authored by U.S. Representative Ron Paul , to effect the United States' withdrawal from the United Nations. It would repeal various laws pertaining to the UN, terminate authorization for funds to be spent on the UN, terminate UN presence on American property, and withdraw diplomatic immunity for UN employees. It would provide up to two years for the United States to withdraw. The Yale Law Journal cited the Act as proof that "the United States's complaints against the United Nations have intensified." The most recent iteration, as of 2022, is H.R.7806, introduced by Mike D. Rogers . The UN's attention to Israel's treatment of Palestinians is considered excessive by a range of critics, including Israeli diplomat Dore Gold , British scholar Robert S. Wistrich , American legal scholar Alan Dershowitz , Australian politician Mark Dreyfus , and the Anti-Defamation League . In September 2015, Saudi Arabia 's Faisal bin Hassan Trad was elected chair of an advisory committee in the UN Human Rights Council , a move criticized by the UN Watch . The UNHRC has likewise been accused of anti-Israel bias by Ex-President of the United States George W. Bush , who complained that the Council focused too much attention on Israel and not enough on countries such as Cuba, Venezuela, North Korea and Iran. American state lawmakers have proposed legislation to block various UN programs deemed to threaten U.S. sovereignty. In 2023, Tennessee enacted legislation to block the implementation of programs "originating in, or traceable to, the United Nations or a subsidiary entity of the United Nations," including Agenda 21 and the 2030 Agenda . According to international relations scholar Edward Luck , the United States has preferred a feeble United Nations in major projects undertaken by the organization to forestall UN interference with, or resistance to, American policies. "The last thing the U.S. wants is an independent UN throwing its weight around", Luck said. Similarly, former US Ambassador to the United Nations Daniel Patrick Moynihan explained that "The Department of State desired that the United Nations prove utterly ineffective in whatever measures it undertook. The task was given to me, and I carried it forward with not inconsiderable success." In 1994, former special representative of the secretary-general of the UN to Somalia Mohamed Sahnoun published Somalia: The Missed Opportunities , a book in which he analyses the reasons for the failure of the 1992 UN intervention in Somalia . Sahnoun claims that between the start of the Somali civil war in 1988 and the fall of the Siad Barre regime in January 1991, the UN missed at least three opportunities to prevent major human tragedies. When the UN tried to provide humanitarian assistance, they were totally outperformed by NGOs , whose competence and dedication sharply contrasted with the UN's excessive caution and bureaucratic inefficiencies. Sahnoun warned that if radical reform were not undertaken, then the UN would continue to respond to such crises with inept improvisation. Beyond specific instances or areas of alleged ineffectiveness, some scholars debate the overall effectiveness of the UN. Adherents to the realist school of international relations take a pessimistic position, arguing that the UN is not an effective organization because it is dominated and constrained by great powers. Liberal scholars counter that it is an effective organization because it has proved capable of solving many problems by working around the restrictions imposed by powerful member states. The UN is generally considered by scholars to be more effective in realms such as public health, humanitarian assistance, and conflict resolution. Critics have also accused the UN of bureaucratic inefficiency, waste, and corruption. In 1976, the General Assembly established the Joint Inspection Unit to seek out inefficiencies within the UN system. During the 1990s, the United States withheld dues citing inefficiency and only started repayment on the condition that a major reforms initiative be introduced. In 1994, the Office of Internal Oversight Services (or the OIOS) was established by the General Assembly to serve as an efficiency watchdog. In 2004, the UN faced accusations that its recently ended Oil-for-Food Programme — in which Iraq had been allowed to trade oil for basic needs to relieve the pressure of sanctions — had suffered from widespread corruption, including billions of dollars of kickbacks . An independent inquiry created by the UN found that many of its officials had been involved in the scheme , and raised significant questions about the role of Kojo Annan , the son of Kofi Annan . The United Nations has inspired the extracurricular activity Model United Nations (or MUN). MUN is a simulation of United Nations activity based on the UN agenda and following UN procedure. It is usually attended by high school and university students who organize conferences to simulate the various UN committees to discuss important issues of the day. Today, MUN educates tens of thousands on the activities of the UN around the world. MUN has many famous and notable alumni, such as the former UN Secretary-General Ban Ki-moon . On the request of then United Nations Secretary-General U Thant , a Hymn to the United Nations was performed on the occasion of its 26th anniversary, on 24 October 1971, by Pau Casals , the lyrics to which were penned by the poet W. H. Auden . Thant first approached Casals, who was a personal friend, looking to create a hymn to peace and hoping for the song to be based on the preamble of the Charter of the United Nations . Thant later commissioned Auden to write the poem after Casals requested one to set to music. Auden completed his work in three days time. The finished work, scored for chorus and orchestra, takes approximately seven minutes to play. However, there were never any plans to adopt the song as the organization's official anthem.

Wiki

Cholera

https://api.wikimedia.org/core/v1/wikipedia/en/page/Phoenix_(2023_film)/html

Phoenix (2023 film)

Phoenix is a 2023 Indian Malayalam -language horror romantic film directed by Vishnu Bharathan in his directorial debut and written by Midhun Manuel Thomas from a story by Vishnu. It stars Aju Varghese , Chandhunadh and Anoop Menon , alongside Bhagath Manuel , Abhirami Bose, Asha Aravind and Aji John in supporting roles. The music was composed by Sam C. S. . Set in the 1990s, it narrates the unusual circumstances faced by advocate John Williams and his family when they start living in a mysterious house. Principal photography commenced in May 2023 in Mahe and wrapped up in June 2023.In the 1990s, Adv. John Williams moves to a house by the sea in Thuruthikkadavu with his wife Daisy and their three children due to some personal reasons. After starting to live there, John receives several letters written to a person named Freddy from an unknown address and experiences some strange things. When John discusses the matter with his friend Amir, Amir tells him to immediately vacate the house and to go meet Thomas, the house owner, to get back the rent paid in advance. John learns from Thomas's servant that the house in which they now live is built in a place that was formerly used as a graveyard. Along with his wife and children, John temporarily moves to Amir's house and while staying there, he receives another letter and decides to go back to find out who Freddy is. One night, after returning home, John's children are frightened by something and the youngest child, Tittu, later suffers from fever. Upon Daisy's request, John meets Fr. Geo Kuttikkadan to inquire about Freddy and requests that he come to his house to pray for the cure of Tittu's fever. A doctor informs Fr. Geo Kuttikkadan that Tittu has symptoms of cholera and that it is not advisable to visit John's house. Later, Fr. Geo Kuttikkadan finds out that Freddy was mentioned as the groom in the betrothal invitation of a girl named Margaret in 1971 and informs John about her. John and Amir meet Margaret, a doctor at present, and learn that Freddy didn't marry her and that she is married to a doctor named Rajeev. With the help of Peter, a parish clerk, John and Amir meet Fr. Francis, who came back from Rome after being diagnosed with blood cancer . When John shows one of the letters he received, Fr. Francis recognises it as Anna Rose George's letter and narrates her and Freddy's story. In the 1970s, Freddy, a PhD student who is the son of a wealthy person named Mathew, falls in love with Anna Rose George, an orphan brought up by a priory in Kochi . With her savings, Anna starts a homestay in Thuruthikkadavu, while Freddy's family arranges a marriage proposal for him with Margaret, an MBBS student. Anna loses her place at the priory after the priory learns about her relationship with Freddy. Soon, Freddy leaves his house and starts living with Anna in her homestay. Upon his father's advice, Freddy goes to Madras to submit the dissertation and to defend viva. When Margaret arrives in Madras to do her post-graduation , Freddy starts a relationship with her. Cholera begins to spread in Thuruthikkadavu and Anna dies after contracting the disease from one of her guests. With believers accusing Anna of defying the church's rules, Fr. Francis buries her body near her homestay instead of the common graveyard. The next morning, when Fr. Francis opens Anna's grave , he finds scratches on the coffin and realises that she was not actually dead and that she died due to the rain and the wet mud flooding the coffin, thereby drowning her. With Fr. Francis's help, John and Amir arrive at Freddy's house and give Anna's letters to Freddy's mother. After John returns home, Anna's soul enters the body of Mariya, John's elder daughter, and she asks about Freddy. Freddy arrives there and tells Anna that he didn't intentionally avoid her, but suddenly, Anna leaves Mariya's body. John and his family later move to a new house, while Freddy stays there with the hope that Anna will someday forgive him and talk to him once again.Aju Varghese as Advocate John Williams Chandhunadh as Freddy Mathew Anoop Menon as Fr. Francis Bhagath Manuel as Ameer, John's Friend Abhirami Bose as Anna Rose George Nilja K. Baby as Daisy John Baby Aavni as Mariya Jess Sweejan as Lidiya Abram Ratheesh as Tittu Asha Aravind as Sister Aneetta Aji John as Mathew, Freddy's Father Sini Abraham as Freddy's Mother Devendranath as Dr. Tharakan Aradhya Ann as Margaret Ranjini as Margaret's Mother Rajan Pootharakkal as Peter Kapyar Zhinz Shan as Fr. Geo Kuttikadan Paul D. Joseph as Kapyar Premananandan as Kadakkaran Aroop Sivadas as Broker Rahul Nair R. as Thomas Favor Francis as Adv. Ibrahim Anju as Ameer's wife Dileep as DoctorThe film was officially announced in April 2023. Produced by Front Row Productions, it was their second production after Twenty One Gms (2022). Directed by debutant Vishnu Bharathan, Midhun Manuel Thomas wrote the screenplay for this film. Principal photography commenced in May 2023 in Mahe . It was also shot in Kannur and Thalasserry . Filming was wrapped up in June 2023. The film was released on 17 November 2023. Amazon Prime Video bought the digital rights and began streaming it on 22 December 2023. Anandu Suresh of The Indian Express gave 3.5 out of 5 stars and wrote, " Phoenix has adeptly established a new standard for Malayalam horror movies, which is still haunted by the ghosts of their past." Sajin Shrijith of Cinema Express gave 2.5 out of 5 stars and wrote, " Phoenix is yet another case of plot revelations overshadowing the performances and storytelling." Princy Alexander of Onmanorama wrote, "' Phoenix ' leaves us emotionally shaken, yet yearning for the tension and the fear that gripped us in the first half." Sanjith Sidhardhan of OTTPlay gave 4 out of 5 stars and wrote, " Phoenix steers clear of the usual cliches that accompany a horror film, and this investment of both time and layered writing, pays off brilliantly." A critic of Times Now gave 3 out of 5 stars and wrote, " Phoenix is a sure-shot hit, generating heightened expectations and excitement among audiences for this unique cinematic experience." Hari P N from Koimoi gave the film a 3 out of 5 stars and wrote, "Phoenix" transcends the ghosts of Malayalam horror, setting a new standard with its unique treatment of familiar tropes". He further added that, "A promising debut for Vishnu Bharathan and a testament to the evolving landscape of Malayalam cinema". Anandu Suresh of The Indian Express gave 3.5 out of 5 stars and wrote, " Phoenix has adeptly established a new standard for Malayalam horror movies, which is still haunted by the ghosts of their past." Sajin Shrijith of Cinema Express gave 2.5 out of 5 stars and wrote, " Phoenix is yet another case of plot revelations overshadowing the performances and storytelling." Princy Alexander of Onmanorama wrote, "' Phoenix ' leaves us emotionally shaken, yet yearning for the tension and the fear that gripped us in the first half." Sanjith Sidhardhan of OTTPlay gave 4 out of 5 stars and wrote, " Phoenix steers clear of the usual cliches that accompany a horror film, and this investment of both time and layered writing, pays off brilliantly." A critic of Times Now gave 3 out of 5 stars and wrote, " Phoenix is a sure-shot hit, generating heightened expectations and excitement among audiences for this unique cinematic experience." Hari P N from Koimoi gave the film a 3 out of 5 stars and wrote, "Phoenix" transcends the ghosts of Malayalam horror, setting a new standard with its unique treatment of familiar tropes". He further added that, "A promising debut for Vishnu Bharathan and a testament to the evolving landscape of Malayalam cinema".

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Cholera

https://api.wikimedia.org/core/v1/wikipedia/en/page/London/html

London

London is the capital and largest city of England , and the United Kingdom , with a population of around 8.8 million, and the largest city in Western Europe by metropolitan area , with a population of 14.8 million. [note 1] It stands on the River Thames in south-east England at the head of a 50-mile (80 km) estuary down to the North Sea and has been a major settlement for nearly two millennia. The City of London , its ancient core and financial centre , was founded by the Romans as Londinium and retains its medieval boundaries. [note 2] The City of Westminster , to the west of the City of London, has for centuries hosted the national government and parliament . In the 19th century , London grew rapidly, becoming the world's largest city at the time, as it expanded and absorbed the neighbouring county of Middlesex , and parts of Surrey and Kent . In 1965 it was combined with parts of Essex and Hertfordshire to create the administrative area of Greater London, which is governed by 33 local authorities and the Greater London Authority . [note 3] As one of the world's major global cities , London exerts a strong influence on world art , entertainment, fashion , commerce and finance, education , health care , media , science and technology, tourism , transport , and communications. Despite a post- Brexit exodus of stock listings from the London Stock Exchange , London is still Europe's most economically powerful city, and it remains one of the major financial centres in the world . With Europe's largest concentration of higher education institutions , it is home to some of the highest-ranked academic institutions in the world— Imperial College London in natural and applied sciences , the London School of Economics in social sciences , and the comprehensive University College London . London is the most visited city in Europe and has the busiest city airport system in the world. The London Underground is the oldest rapid transit system in the world. London's diverse cultures encompass over 300 languages. The 2023 population of Greater London of just under 10 million made it Europe's third-most populous city , accounting for 13.4% of the population of the United Kingdom and over 16% of the population of England. The Greater London Built-up Area is the fourth-most populous in Europe, with about 9.8 million inhabitants at the 2011 census. The London metropolitan area is the third-most populous in Europe, with about 14 million inhabitants in 2016, [note 4] granting London the status of a megacity . London has four World Heritage Sites : the Tower of London ; Kew Gardens ; the combined Palace of Westminster , Westminster Abbey , and St Margaret's Church ; and the historic settlement in Greenwich , where the Royal Observatory, Greenwich , defines the prime meridian (0° longitude ) and Greenwich Mean Time . Other landmarks include Buckingham Palace , the London Eye , Piccadilly Circus , St Paul's Cathedral , Tower Bridge , and Trafalgar Square . London has many museums , galleries, libraries, and cultural venues, including the British Museum , National Gallery , Natural History Museum , Tate Modern , British Library , and numerous West End theatres. Important sporting events held in London include the FA Cup Final , the Wimbledon Tennis Championships , and the London Marathon . In 2012 , London became the first city to host three Summer Olympic Games . London is an ancient name, attested in the first century AD, usually in the Latinised form Londinium . Modern scientific analyses of the name must account for the origins of the different forms found in early sources: Latin (usually Londinium ), Old English (usually Lunden ), and Welsh (usually Llundein ), with reference to the known developments over time of sounds in those different languages. It is agreed that the name came into these languages from Common Brythonic ; recent work tends to reconstruct the lost Celtic form of the name as * Londonjon or something similar. This was adapted into Latin as Londinium and borrowed into Old English. Until 1889, the name "London" applied officially only to the City of London , but since then it has also referred to the County of London and to Greater London . In 1993, remains of a Bronze Age bridge were found on the south foreshore upstream from Vauxhall Bridge . Two of the timbers were radiocarbon dated to 1750–1285 BC. In 2010, foundations of a large timber structure, dated to 4800–4500 BC, were found on the Thames's south foreshore downstream from Vauxhall Bridge. Both structures are on the south bank of the Thames, where the now-underground River Effra flows into the Thames. Despite the evidence of scattered Brythonic settlements in the area, the first major settlement was founded by the Romans around 47 AD, about four years after their invasion of 43 AD. This only lasted until about 61 AD, when the Iceni tribe led by Queen Boudica stormed it and burnt it to the ground. The next planned incarnation of Londinium prospered, superseding Colchester as the principal city of the Roman province of Britannia in 100. At its height in the 2nd century, Roman London had a population of about 60,000. With the early 5th-century collapse of Roman rule, the walled city of Londinium was effectively abandoned, although Roman civilisation continued around St Martin-in-the-Fields until about 450. From about 500, an Anglo-Saxon settlement known as Lundenwic developed slightly west of the old Roman city. By about 680 the city had become a major port again, but there is little evidence of large-scale production. From the 820s repeated Viking assaults brought decline. Three are recorded; those in 851 and 886 succeeded, while the last, in 994, was rebuffed. The Vikings applied Danelaw over much of eastern and northern England, its boundary running roughly from London to Chester as an area of political and geographical control imposed by the Viking incursions formally agreed by the Danish warlord , Guthrum and the West Saxon king Alfred the Great in 886. The Anglo-Saxon Chronicle records that Alfred "refounded" London in 886. Archaeological research shows this involved abandonment of Lundenwic and a revival of life and trade within the old Roman walls. London then grew slowly until a dramatic increase in about 950. By the 11th century, London was clearly the largest town in England. Westminster Abbey , rebuilt in Romanesque style by King Edward the Confessor , was one of the grandest churches in Europe. Winchester had been the capital of Anglo-Saxon England , but from this time London became the main forum for foreign traders and the base for defence in time of war. In the view of Frank Stenton : "It had the resources, and it was rapidly developing the dignity and the political self-consciousness appropriate to a national capital ." After winning the Battle of Hastings , William, Duke of Normandy was crowned King of England in newly completed Westminster Abbey on Christmas Day 1066. William built the Tower of London , the first of many such in England rebuilt in stone in the south-eastern corner of the city, to intimidate the inhabitants. In 1097, William II began building Westminster Hall , close by the abbey of the same name. It became the basis of a new Palace of Westminster . In the 12th century, the institutions of central government, which had hitherto followed the royal English court around the country, grew in size and sophistication and became increasingly fixed, for most purposes at Westminster , although the royal treasury came to rest in the Tower . While the City of Westminster developed into a true governmental capital, its distinct neighbour, the City of London , remained England's largest city and principal commercial centre and flourished under its own unique administration, the Corporation of London . In 1100, its population was some 18,000; by 1300 it had grown to nearly 100,000. With the Black Death in the mid-14th century, London lost nearly a third of its population. London was the focus of the Peasants' Revolt in 1381. London was a centre of England's Jewish population before their expulsion by Edward I in 1290. Violence against Jews occurred in 1190, when it was rumoured that the new king had ordered their massacre after they had presented themselves at his coronation. In 1264 during the Second Barons' War , Simon de Montfort 's rebels killed 500 Jews while attempting to seize records of debts. During the Tudor period , the Reformation produced a gradual shift to Protestantism . Much of London property passed from church to private ownership, which accelerated trade and business in the city. In 1475, the Hanseatic League set up a main trading base ( kontor ) of England in London, called the Stalhof or Steelyard . It remained until 1853, when the Hanseatic cities of Lübeck , Bremen and Hamburg sold the property to South Eastern Railway . Woollen cloth was shipped undyed and undressed from 14th/15th century London to the nearby shores of the Low Countries . Yet English maritime enterprise hardly reached beyond the seas of north-west Europe . The commercial route to Italy and the Mediterranean was normally through Antwerp and over the Alps ; any ships passing through the Strait of Gibraltar to or from England were likely to be Italian or Ragusan . The reopening of the Netherlands to English shipping in January 1565 spurred a burst of commercial activity. The Royal Exchange was founded. Mercantilism grew and monopoly traders such as the East India Company were founded as trade expanded to the New World . London became the main North Sea port, with migrants arriving from England and abroad. The population rose from about 50,000 in 1530 to about 225,000 in 1605. In the 16th century, William Shakespeare and his contemporaries lived in London during English Renaissance theatre . Shakespeare's Globe Theatre was constructed in 1599 in Southwark . Stage performances came to a halt in London when Puritan authorities shut down the theatres in the 1640s. The ban on theatre was lifted during the Restoration in 1660, and London's oldest operating theatre, Drury Lane , opened in 1663 in what is now the West End theatre district. By the end of the Tudor period in 1603, London was still compact. There was an assassination attempt on James I in Westminster, in the Gunpowder Plot of 5 November 1605. In 1637, the government of Charles I attempted to reform administration in the London area. This called for the Corporation of the city to extend its jurisdiction and administration over expanding areas around the city. Fearing an attempt by the Crown to diminish the Liberties of London , coupled with a lack of interest in administering these additional areas or concern by city guilds of having to share power, caused the Corporation's "The Great Refusal", a decision which largely continues to account for the unique governmental status of the City . In the English Civil War , the majority of Londoners supported the Parliamentary cause. After an initial advance by the Royalists in 1642, culminating in the battles of Brentford and Turnham Green , London was surrounded by a defensive perimeter wall known as the Lines of Communication . The lines were built by up to 20,000 people, and were completed in under two months. The fortifications failed their only test when the New Model Army entered London in 1647, and they were levelled by Parliament the same year. London was plagued by disease in the early 17th century, culminating in the Great Plague of 1665–1666, which killed up to 100,000 people, or a fifth of the population. The Great Fire of London broke out in 1666 in Pudding Lane in the city and quickly swept through the wooden buildings. Rebuilding took over ten years and was supervised by polymath Robert Hooke . In 1708 Christopher Wren 's masterpiece, St Paul's Cathedral , was completed. During the Georgian era , new districts such as Mayfair were formed in the west; new bridges over the Thames encouraged development in South London . In the east, the Port of London expanded downstream. London's development as an international financial centre matured for much of the 18th century. In 1762, George III acquired Buckingham House , which was enlarged over the next 75 years. During the 18th century, London was said to be dogged by crime, and the Bow Street Runners were established in 1750 as a professional police force. Epidemics during the 1720s and 30s saw most children born in the city die before reaching their fifth birthday. Coffee-houses became a popular place to debate ideas, as growing literacy and development of the printing press made news widely available, with Fleet Street becoming the centre of the British press. The invasion of Amsterdam by Napoleonic armies led many financiers to relocate to London and the first London international issue was arranged in 1817. Around the same time, the Royal Navy became the world's leading war fleet, acting as a major deterrent to potential economic adversaries. The repeal of the Corn Laws in 1846 was specifically aimed at weakening Dutch economic power. London then overtook Amsterdam as the leading international financial centre. With the onset of the Industrial Revolution in Britain, an unprecedented growth in urbanisation took place, and the number of High Streets (the primary street for retail in Britain) rapidly grew. London was the world's largest city from about 1831 to 1925, with a population density of 802 per acre (325 per hectare). In addition to the growing number of stores selling goods, such as Harding, Howell & Co. —one of the first department stores —located on Pall Mall , the streets had scores of street sellers . London's overcrowded conditions led to cholera epidemics, claiming 14,000 lives in 1848, and 6,000 in 1866. Rising traffic congestion led to the creation of the London Underground , the world's first urban rail network . The Metropolitan Board of Works oversaw infrastructure expansion in the capital and some surrounding counties; it was abolished in 1889 when the London County Council was created out of county areas surrounding the capital. From the early years of the 20th century onwards, teashops were found on High Streets across London and the rest of Britain, with Lyons , who opened the first of their chain of teashops in Piccadilly in 1894, leading the way. The tearooms, such as the Criterion in Piccadilly, became a popular meeting place for women from the suffrage movement. The city was the target of many attacks during the suffragette bombing and arson campaign , between 1912 and 1914, which saw historic landmarks such as Westminster Abbey and St Paul's Cathedral bombed. London was bombed by the Germans in the First World War , and during the Second World War , the Blitz and other bombings by the German Luftwaffe killed over 30,000 Londoners, destroying large tracts of housing and other buildings across the city. The tomb of the Unknown Warrior , an unidentified member of the British armed forces killed during the First World War, was buried in Westminster Abbey on 11 November 1920. The Cenotaph , located in Whitehall , was unveiled on the same day, and is the focal point for the National Service of Remembrance held annually on Remembrance Sunday , the closest Sunday to 11 November. The 1948 Summer Olympics were held at the original Wembley Stadium , while London was still recovering from the war. From the 1940s, London became home to many immigrants, primarily from Commonwealth countries such as Jamaica, India, Bangladesh and Pakistan, making London one of the most diverse cities in the world. In 1951, the Festival of Britain was held on the South Bank . The Great Smog of 1952 led to the Clean Air Act 1956 , which ended the " pea soup fogs " for which London had been notorious, and had earned it the nickname the "Big Smoke". Starting mainly in the mid-1960s, London became a centre for worldwide youth culture , exemplified by the Swinging London sub-culture associated with the King's Road , Chelsea and Carnaby Street . The role of trendsetter revived in the punk era. In 1965 London's political boundaries were expanded in response to the growth of the urban area and a new Greater London Council was created. During The Troubles in Northern Ireland, London was hit from 1973 by bomb attacks by the Provisional Irish Republican Army . These attacks lasted for two decades, starting with the Old Bailey bombing . Racial inequality was highlighted by the 1981 Brixton riot . Greater London's population declined in the decades after the Second World War, from an estimated peak of 8.6 million in 1939 to around 6.8 million in the 1980s. The principal ports for London moved downstream to Felixstowe and Tilbury , with the London Docklands area becoming a focus for regeneration, including the Canary Wharf development. This was born out of London's increasing role as an international financial centre in the 1980s. Located about 2 miles (3 km) east of central London, the Thames Barrier was completed in the 1980s to protect London against tidal surges from the North Sea . The Greater London Council was abolished in 1986, leaving London with no central administration until 2000 and the creation of the Greater London Authority . To mark the 21st century, the Millennium Dome , London Eye and Millennium Bridge were constructed. On 6 July 2005 London was awarded the 2012 Summer Olympics , as the first city to stage the Olympic Games three times. On 7 July 2005, three London Underground trains and a double-decker bus were bombed in a series of terrorist attacks . In 2008, Time named London alongside New York City and Hong Kong as Nylonkong , hailing them as the world's three most influential global cities . In January 2015, Greater London's population was estimated to be 8.63 million, its highest since 1939. During the Brexit referendum in 2016, the UK as a whole decided to leave the European Union , but most London constituencies voted for remaining. However, Britain's exit from the EU in early 2020 only marginally weakened London's position as an international financial centre. On 6 May 2023, the coronation of Charles III and his wife, Camilla, as king and queen of the United Kingdom and the other Commonwealth realms, took place at Westminster Abbey , London. In 1993, remains of a Bronze Age bridge were found on the south foreshore upstream from Vauxhall Bridge . Two of the timbers were radiocarbon dated to 1750–1285 BC. In 2010, foundations of a large timber structure, dated to 4800–4500 BC, were found on the Thames's south foreshore downstream from Vauxhall Bridge. Both structures are on the south bank of the Thames, where the now-underground River Effra flows into the Thames. Despite the evidence of scattered Brythonic settlements in the area, the first major settlement was founded by the Romans around 47 AD, about four years after their invasion of 43 AD. This only lasted until about 61 AD, when the Iceni tribe led by Queen Boudica stormed it and burnt it to the ground. The next planned incarnation of Londinium prospered, superseding Colchester as the principal city of the Roman province of Britannia in 100. At its height in the 2nd century, Roman London had a population of about 60,000. With the early 5th-century collapse of Roman rule, the walled city of Londinium was effectively abandoned, although Roman civilisation continued around St Martin-in-the-Fields until about 450. From about 500, an Anglo-Saxon settlement known as Lundenwic developed slightly west of the old Roman city. By about 680 the city had become a major port again, but there is little evidence of large-scale production. From the 820s repeated Viking assaults brought decline. Three are recorded; those in 851 and 886 succeeded, while the last, in 994, was rebuffed. The Vikings applied Danelaw over much of eastern and northern England, its boundary running roughly from London to Chester as an area of political and geographical control imposed by the Viking incursions formally agreed by the Danish warlord , Guthrum and the West Saxon king Alfred the Great in 886. The Anglo-Saxon Chronicle records that Alfred "refounded" London in 886. Archaeological research shows this involved abandonment of Lundenwic and a revival of life and trade within the old Roman walls. London then grew slowly until a dramatic increase in about 950. By the 11th century, London was clearly the largest town in England. Westminster Abbey , rebuilt in Romanesque style by King Edward the Confessor , was one of the grandest churches in Europe. Winchester had been the capital of Anglo-Saxon England , but from this time London became the main forum for foreign traders and the base for defence in time of war. In the view of Frank Stenton : "It had the resources, and it was rapidly developing the dignity and the political self-consciousness appropriate to a national capital ." After winning the Battle of Hastings , William, Duke of Normandy was crowned King of England in newly completed Westminster Abbey on Christmas Day 1066. William built the Tower of London , the first of many such in England rebuilt in stone in the south-eastern corner of the city, to intimidate the inhabitants. In 1097, William II began building Westminster Hall , close by the abbey of the same name. It became the basis of a new Palace of Westminster . In the 12th century, the institutions of central government, which had hitherto followed the royal English court around the country, grew in size and sophistication and became increasingly fixed, for most purposes at Westminster , although the royal treasury came to rest in the Tower . While the City of Westminster developed into a true governmental capital, its distinct neighbour, the City of London , remained England's largest city and principal commercial centre and flourished under its own unique administration, the Corporation of London . In 1100, its population was some 18,000; by 1300 it had grown to nearly 100,000. With the Black Death in the mid-14th century, London lost nearly a third of its population. London was the focus of the Peasants' Revolt in 1381. London was a centre of England's Jewish population before their expulsion by Edward I in 1290. Violence against Jews occurred in 1190, when it was rumoured that the new king had ordered their massacre after they had presented themselves at his coronation. In 1264 during the Second Barons' War , Simon de Montfort 's rebels killed 500 Jews while attempting to seize records of debts. During the Tudor period , the Reformation produced a gradual shift to Protestantism . Much of London property passed from church to private ownership, which accelerated trade and business in the city. In 1475, the Hanseatic League set up a main trading base ( kontor ) of England in London, called the Stalhof or Steelyard . It remained until 1853, when the Hanseatic cities of Lübeck , Bremen and Hamburg sold the property to South Eastern Railway . Woollen cloth was shipped undyed and undressed from 14th/15th century London to the nearby shores of the Low Countries . Yet English maritime enterprise hardly reached beyond the seas of north-west Europe . The commercial route to Italy and the Mediterranean was normally through Antwerp and over the Alps ; any ships passing through the Strait of Gibraltar to or from England were likely to be Italian or Ragusan . The reopening of the Netherlands to English shipping in January 1565 spurred a burst of commercial activity. The Royal Exchange was founded. Mercantilism grew and monopoly traders such as the East India Company were founded as trade expanded to the New World . London became the main North Sea port, with migrants arriving from England and abroad. The population rose from about 50,000 in 1530 to about 225,000 in 1605. In the 16th century, William Shakespeare and his contemporaries lived in London during English Renaissance theatre . Shakespeare's Globe Theatre was constructed in 1599 in Southwark . Stage performances came to a halt in London when Puritan authorities shut down the theatres in the 1640s. The ban on theatre was lifted during the Restoration in 1660, and London's oldest operating theatre, Drury Lane , opened in 1663 in what is now the West End theatre district. By the end of the Tudor period in 1603, London was still compact. There was an assassination attempt on James I in Westminster, in the Gunpowder Plot of 5 November 1605. In 1637, the government of Charles I attempted to reform administration in the London area. This called for the Corporation of the city to extend its jurisdiction and administration over expanding areas around the city. Fearing an attempt by the Crown to diminish the Liberties of London , coupled with a lack of interest in administering these additional areas or concern by city guilds of having to share power, caused the Corporation's "The Great Refusal", a decision which largely continues to account for the unique governmental status of the City . In the English Civil War , the majority of Londoners supported the Parliamentary cause. After an initial advance by the Royalists in 1642, culminating in the battles of Brentford and Turnham Green , London was surrounded by a defensive perimeter wall known as the Lines of Communication . The lines were built by up to 20,000 people, and were completed in under two months. The fortifications failed their only test when the New Model Army entered London in 1647, and they were levelled by Parliament the same year. London was plagued by disease in the early 17th century, culminating in the Great Plague of 1665–1666, which killed up to 100,000 people, or a fifth of the population. The Great Fire of London broke out in 1666 in Pudding Lane in the city and quickly swept through the wooden buildings. Rebuilding took over ten years and was supervised by polymath Robert Hooke . In 1708 Christopher Wren 's masterpiece, St Paul's Cathedral , was completed. During the Georgian era , new districts such as Mayfair were formed in the west; new bridges over the Thames encouraged development in South London . In the east, the Port of London expanded downstream. London's development as an international financial centre matured for much of the 18th century. In 1762, George III acquired Buckingham House , which was enlarged over the next 75 years. During the 18th century, London was said to be dogged by crime, and the Bow Street Runners were established in 1750 as a professional police force. Epidemics during the 1720s and 30s saw most children born in the city die before reaching their fifth birthday. Coffee-houses became a popular place to debate ideas, as growing literacy and development of the printing press made news widely available, with Fleet Street becoming the centre of the British press. The invasion of Amsterdam by Napoleonic armies led many financiers to relocate to London and the first London international issue was arranged in 1817. Around the same time, the Royal Navy became the world's leading war fleet, acting as a major deterrent to potential economic adversaries. The repeal of the Corn Laws in 1846 was specifically aimed at weakening Dutch economic power. London then overtook Amsterdam as the leading international financial centre. With the onset of the Industrial Revolution in Britain, an unprecedented growth in urbanisation took place, and the number of High Streets (the primary street for retail in Britain) rapidly grew. London was the world's largest city from about 1831 to 1925, with a population density of 802 per acre (325 per hectare). In addition to the growing number of stores selling goods, such as Harding, Howell & Co. —one of the first department stores —located on Pall Mall , the streets had scores of street sellers . London's overcrowded conditions led to cholera epidemics, claiming 14,000 lives in 1848, and 6,000 in 1866. Rising traffic congestion led to the creation of the London Underground , the world's first urban rail network . The Metropolitan Board of Works oversaw infrastructure expansion in the capital and some surrounding counties; it was abolished in 1889 when the London County Council was created out of county areas surrounding the capital. From the early years of the 20th century onwards, teashops were found on High Streets across London and the rest of Britain, with Lyons , who opened the first of their chain of teashops in Piccadilly in 1894, leading the way. The tearooms, such as the Criterion in Piccadilly, became a popular meeting place for women from the suffrage movement. The city was the target of many attacks during the suffragette bombing and arson campaign , between 1912 and 1914, which saw historic landmarks such as Westminster Abbey and St Paul's Cathedral bombed. London was bombed by the Germans in the First World War , and during the Second World War , the Blitz and other bombings by the German Luftwaffe killed over 30,000 Londoners, destroying large tracts of housing and other buildings across the city. The tomb of the Unknown Warrior , an unidentified member of the British armed forces killed during the First World War, was buried in Westminster Abbey on 11 November 1920. The Cenotaph , located in Whitehall , was unveiled on the same day, and is the focal point for the National Service of Remembrance held annually on Remembrance Sunday , the closest Sunday to 11 November. The 1948 Summer Olympics were held at the original Wembley Stadium , while London was still recovering from the war. From the 1940s, London became home to many immigrants, primarily from Commonwealth countries such as Jamaica, India, Bangladesh and Pakistan, making London one of the most diverse cities in the world. In 1951, the Festival of Britain was held on the South Bank . The Great Smog of 1952 led to the Clean Air Act 1956 , which ended the " pea soup fogs " for which London had been notorious, and had earned it the nickname the "Big Smoke". Starting mainly in the mid-1960s, London became a centre for worldwide youth culture , exemplified by the Swinging London sub-culture associated with the King's Road , Chelsea and Carnaby Street . The role of trendsetter revived in the punk era. In 1965 London's political boundaries were expanded in response to the growth of the urban area and a new Greater London Council was created. During The Troubles in Northern Ireland, London was hit from 1973 by bomb attacks by the Provisional Irish Republican Army . These attacks lasted for two decades, starting with the Old Bailey bombing . Racial inequality was highlighted by the 1981 Brixton riot . Greater London's population declined in the decades after the Second World War, from an estimated peak of 8.6 million in 1939 to around 6.8 million in the 1980s. The principal ports for London moved downstream to Felixstowe and Tilbury , with the London Docklands area becoming a focus for regeneration, including the Canary Wharf development. This was born out of London's increasing role as an international financial centre in the 1980s. Located about 2 miles (3 km) east of central London, the Thames Barrier was completed in the 1980s to protect London against tidal surges from the North Sea . The Greater London Council was abolished in 1986, leaving London with no central administration until 2000 and the creation of the Greater London Authority . To mark the 21st century, the Millennium Dome , London Eye and Millennium Bridge were constructed. On 6 July 2005 London was awarded the 2012 Summer Olympics , as the first city to stage the Olympic Games three times. On 7 July 2005, three London Underground trains and a double-decker bus were bombed in a series of terrorist attacks . In 2008, Time named London alongside New York City and Hong Kong as Nylonkong , hailing them as the world's three most influential global cities . In January 2015, Greater London's population was estimated to be 8.63 million, its highest since 1939. During the Brexit referendum in 2016, the UK as a whole decided to leave the European Union , but most London constituencies voted for remaining. However, Britain's exit from the EU in early 2020 only marginally weakened London's position as an international financial centre. On 6 May 2023, the coronation of Charles III and his wife, Camilla, as king and queen of the United Kingdom and the other Commonwealth realms, took place at Westminster Abbey , London. The administration of London is formed of two tiers: a citywide, strategic tier and a local tier. Citywide administration is coordinated by the Greater London Authority (GLA), while local administration is carried out by 33 smaller authorities. The GLA consists of two elected components: the mayor of London , who has executive powers , and the London Assembly , which scrutinises the mayor's decisions and can accept or reject the mayor's budget proposals each year. The GLA has responsibility for the majority of London's transport system through its functional arm Transport for London (TfL), it is responsible for overseeing the city's police and fire services, and also for setting a strategic vision for London on a range of issues. The headquarters of the GLA is City Hall , Newham. The mayor since 2016 has been Sadiq Khan , the first Muslim mayor of a major Western capital. The mayor's statutory planning strategy is published as the London Plan , which was most recently revised in 2011. The local authorities are the councils of the 32 London boroughs and the City of London Corporation . They are responsible for most local services, such as local planning, schools, libraries, leisure and recreation, social services , local roads and refuse collection. Certain functions, such as waste management , are provided through joint arrangements. In 2009–2010 the combined revenue expenditure by London councils and the GLA amounted to just over £22 billion (£14.7 billion for the boroughs and £7.4 billion for the GLA). The London Fire Brigade is the statutory fire and rescue service for Greater London, run by the London Fire and Emergency Planning Authority . It is the third largest fire service in the world. National Health Service ambulance services are provided by the London Ambulance Service (LAS) NHS Trust , the largest free-at-the-point-of-use emergency ambulance service in the world. The London Air Ambulance charity operates in conjunction with the LAS where required. Her Majesty's Coastguard and the Royal National Lifeboat Institution operate on the River Thames , which is under the jurisdiction of the Port of London Authority from Teddington Lock to the sea. London is the seat of the Government of the United Kingdom . Many government departments, as well as the prime minister's residence at 10 Downing Street , are based close to the Palace of Westminster , particularly along Whitehall . There are 73 members of Parliament (MPs) from London; As of December 2019 [ update ] , 49 are from the Labour Party , 21 are Conservatives , and three are Liberal Democrats . The ministerial post of minister for London was created in 1994 and as of 2020 is held by Paul Scully . Policing in Greater London, with the exception of the City of London , is provided by the Metropolitan Police ("The Met"), overseen by the mayor through the Mayor's Office for Policing and Crime (MOPAC). The Met is also referred to as Scotland Yard after the location of its original headquarters in a road called Great Scotland Yard in Whitehall. The City of London has its own police force – the City of London Police . First worn by Met police officers in 1863, the custodian helmet has been called a "cultural icon" and a "symbol of British law enforcement". Introduced by the Met in 1929, the blue police telephone box (basis for the TARDIS in Doctor Who ) was once a common sight throughout London and regional cities in the UK. The British Transport Police are responsible for police services on National Rail , London Underground , Docklands Light Railway and Tramlink services. The Ministry of Defence Police is a special police force in London, which does not generally become involved with policing the general public. The UK's domestic counter-intelligence service ( MI5 ) is headquartered in Thames House on the north bank of the River Thames, and the foreign intelligence service ( MI6 ) is headquartered in the SIS Building on the south bank. Crime rates vary widely across different areas of London. Crime figures are made available nationally at Local Authority and Ward level. In 2015, there were 118 homicides, a 25.5% increase over 2014. Recorded crime has been rising in London, notably violent crime and murder by stabbing and other means have risen. There were 50 murders from the start of 2018 to mid April 2018. Funding cuts to police in London are likely to have contributed to this, though other factors are involved. However, homicide figures fell in 2022 with 109 recorded for the year, and the murder rate in London is much lower than other major cities around the world. The administration of London is formed of two tiers: a citywide, strategic tier and a local tier. Citywide administration is coordinated by the Greater London Authority (GLA), while local administration is carried out by 33 smaller authorities. The GLA consists of two elected components: the mayor of London , who has executive powers , and the London Assembly , which scrutinises the mayor's decisions and can accept or reject the mayor's budget proposals each year. The GLA has responsibility for the majority of London's transport system through its functional arm Transport for London (TfL), it is responsible for overseeing the city's police and fire services, and also for setting a strategic vision for London on a range of issues. The headquarters of the GLA is City Hall , Newham. The mayor since 2016 has been Sadiq Khan , the first Muslim mayor of a major Western capital. The mayor's statutory planning strategy is published as the London Plan , which was most recently revised in 2011. The local authorities are the councils of the 32 London boroughs and the City of London Corporation . They are responsible for most local services, such as local planning, schools, libraries, leisure and recreation, social services , local roads and refuse collection. Certain functions, such as waste management , are provided through joint arrangements. In 2009–2010 the combined revenue expenditure by London councils and the GLA amounted to just over £22 billion (£14.7 billion for the boroughs and £7.4 billion for the GLA). The London Fire Brigade is the statutory fire and rescue service for Greater London, run by the London Fire and Emergency Planning Authority . It is the third largest fire service in the world. National Health Service ambulance services are provided by the London Ambulance Service (LAS) NHS Trust , the largest free-at-the-point-of-use emergency ambulance service in the world. The London Air Ambulance charity operates in conjunction with the LAS where required. Her Majesty's Coastguard and the Royal National Lifeboat Institution operate on the River Thames , which is under the jurisdiction of the Port of London Authority from Teddington Lock to the sea. London is the seat of the Government of the United Kingdom . Many government departments, as well as the prime minister's residence at 10 Downing Street , are based close to the Palace of Westminster , particularly along Whitehall . There are 73 members of Parliament (MPs) from London; As of December 2019 [ update ] , 49 are from the Labour Party , 21 are Conservatives , and three are Liberal Democrats . The ministerial post of minister for London was created in 1994 and as of 2020 is held by Paul Scully . Policing in Greater London, with the exception of the City of London , is provided by the Metropolitan Police ("The Met"), overseen by the mayor through the Mayor's Office for Policing and Crime (MOPAC). The Met is also referred to as Scotland Yard after the location of its original headquarters in a road called Great Scotland Yard in Whitehall. The City of London has its own police force – the City of London Police . First worn by Met police officers in 1863, the custodian helmet has been called a "cultural icon" and a "symbol of British law enforcement". Introduced by the Met in 1929, the blue police telephone box (basis for the TARDIS in Doctor Who ) was once a common sight throughout London and regional cities in the UK. The British Transport Police are responsible for police services on National Rail , London Underground , Docklands Light Railway and Tramlink services. The Ministry of Defence Police is a special police force in London, which does not generally become involved with policing the general public. The UK's domestic counter-intelligence service ( MI5 ) is headquartered in Thames House on the north bank of the River Thames, and the foreign intelligence service ( MI6 ) is headquartered in the SIS Building on the south bank. Crime rates vary widely across different areas of London. Crime figures are made available nationally at Local Authority and Ward level. In 2015, there were 118 homicides, a 25.5% increase over 2014. Recorded crime has been rising in London, notably violent crime and murder by stabbing and other means have risen. There were 50 murders from the start of 2018 to mid April 2018. Funding cuts to police in London are likely to have contributed to this, though other factors are involved. However, homicide figures fell in 2022 with 109 recorded for the year, and the murder rate in London is much lower than other major cities around the world. London, also known as Greater London , is one of nine regions of England and the top subdivision covering most of the city's metropolis. The City of London at its core once comprised the whole settlement, but as its urban area grew, the Corporation of London resisted attempts to amalgamate the city with its suburbs , causing "London" to be defined several ways. Forty per cent of Greater London is covered by the London post town , in which 'London' forms part of postal addresses. The London telephone area code (020) covers a larger area, similar in size to Greater London, although some outer districts are excluded and some just outside included. The Greater London boundary has been aligned to the M25 motorway in places. Further urban expansion is now prevented by the Metropolitan Green Belt , although the built-up area extends beyond the boundary in places, producing a separately defined Greater London Urban Area . Beyond this is the vast London commuter belt . Greater London is split for some purposes into Inner London and Outer London , and by the River Thames into North and South , with an informal central London area. The coordinates of the nominal centre of London, traditionally the original Eleanor Cross at Charing Cross near the junction of Trafalgar Square and Whitehall , are about 51°30′26″N 00°07′39″W / 51.50722°N 0.12750°W / 51.50722; -0.12750 . Within London, both the City of London and the City of Westminster have city status and both the City of London and the remainder of Greater London are counties for the purposes of lieutenancies . The area of Greater London includes areas that are part of the historic counties of Middlesex , Kent , Surrey , Essex and Hertfordshire . London's status as the capital of England, and later the United Kingdom, has never been granted or confirmed by statute or in written form. [note 5] Its status as a capital was established by constitutional convention , which means its status as de facto capital is a part of the UK's uncodified constitution . The capital of England was moved to London from Winchester as the Palace of Westminster developed in the 12th and 13th centuries to become the permanent location of the royal court , and thus the political capital of the nation. More recently, Greater London has been defined as a region of England and in this context is known as London . Greater London encompasses a total area of 611 square miles (1,583 km 2 ) an area which had a population of 7,172,036 in 2001 and a population density of 11,760 inhabitants per square mile (4,542/km 2 ) . The extended area known as the London Metropolitan Region or the London Metropolitan Agglomeration, comprises a total area of 3,236 square miles (8,382 km 2 ) has a population of 13,709,000 and a population density of 3,900 inhabitants per square mile (1,510/km 2 ) . Modern London stands on the Thames , its primary geographical feature, a navigable river which crosses the city from the south-west to the east. The Thames Valley is a flood plain surrounded by gently rolling hills including Parliament Hill , Addington Hills , and Primrose Hill . Historically London grew up at the lowest bridging point on the Thames. The Thames was once a much broader, shallower river with extensive marshlands ; at high tide, its shores reached five times their present width. Since the Victorian era the Thames has been extensively embanked , and many of its London tributaries now flow underground . The Thames is a tidal river, and London is vulnerable to flooding. The threat has increased over time because of a slow but continuous rise in high water level caused by climate change and by the slow 'tilting' of the British Isles as a result of post-glacial rebound . London has a temperate oceanic climate ( Köppen : Cfb ). Rainfall records have been kept in the city since at least 1697, when records began at Kew . At Kew, the most rainfall in one month is 7.4 inches (189 mm) in November 1755 and the least is 0 inches (0 mm) in both December 1788 and July 1800. Mile End also had 0 inches (0 mm) in April 1893. The wettest year on record is 1903, with a total fall of 38.1 inches (969 mm) and the driest is 1921, with a total fall of 12.1 inches (308 mm) . The average annual precipitation amounts to about 600 mm, which is half the annual rainfall of New York City . Despite relatively low annual precipitation, London receives 109.6 rainy days on the 1.0 mm threshold annually. London is vulnerable to climate change , and there is concern among hydrological experts that households may run out of water before 2050. Temperature extremes in London range from 40.2 °C (104.4 °F) at Heathrow on 19 July 2022 down to −17.4 °C (0.7 °F) at Northolt on 13 December 1981. Records for atmospheric pressure have been kept at London since 1692. The highest pressure ever reported is 1,049.8 millibars (31.00 inHg) on 20 January 2020. Summers are generally warm, sometimes hot. London's average July high is 23.5 °C (74.3 °F). On average each year, London experiences 31 days above 25 °C (77.0 °F) and 4.2 days above 30.0 °C (86.0 °F) . During the 2003 European heat wave , prolonged heat led to hundreds of heat-related deaths. A previous spell of 15 consecutive days above 32.2 °C (90.0 °F) in England in 1976 also caused many heat related deaths. A previous temperature of 37.8 °C (100.0 °F) in August 1911 at the Greenwich station was later disregarded as non-standard. Droughts can also, occasionally, be a problem, especially in summer, most recently in summer 2018, and with much drier than average conditions prevailing from May to December. However, the most consecutive days without rain was 73 days in the spring of 1893. Winters are generally cool with little temperature variation. Heavy snow is rare but snow usually falls at least once each winter. Spring and autumn can be pleasant. As a large city, London has a considerable urban heat island effect, making the centre of London at times 5 °C (9 °F) warmer than the suburbs and outskirts. See Climate of London for additional climate information. Places within London's vast urban area are identified using area names, such as Mayfair , Southwark , Wembley , and Whitechapel . These are either informal designations, reflect the names of villages that have been absorbed by sprawl, or are superseded administrative units such as parishes or former boroughs . Such names have remained in use through tradition, each referring to a local area with its own distinctive character, but without official boundaries. Since 1965, Greater London has been divided into 32 London boroughs in addition to the ancient City of London. The City of London is the main financial district, and Canary Wharf has recently developed into a new financial and commercial hub in the Docklands to the east. The West End is London's main entertainment and shopping district, attracting tourists. West London includes expensive residential areas where properties can sell for tens of millions of pounds. The average price for properties in Kensington and Chelsea is over £2 million with a similarly high outlay in most of central London. The East End is the area closest to the original Port of London , known for its high immigrant population, as well as for being one of the poorest areas in London. The surrounding East London area saw much of London's early industrial development; now, brownfield sites throughout the area are being redeveloped as part of the Thames Gateway including the London Riverside and Lower Lea Valley , which was developed into the Olympic Park for the 2012 Olympics and Paralympics . London's buildings are too diverse to be characterised by any particular architectural style, partly because of their varying ages. Many grand houses and public buildings, such as the National Gallery , are constructed from Portland stone . Some areas of the city, particularly those just west of the centre, are characterised by white stucco or whitewashed buildings. Few structures in central London pre-date the Great Fire of 1666, these being a few trace Roman remains, the Tower of London and a few scattered Tudor survivors in the city. Further out is, for example, the Tudor-period Hampton Court Palace . Part of the varied architectural heritage are the 17th-century churches by Christopher Wren , neoclassical financial institutions such as the Royal Exchange and the Bank of England , to the early 20th century Old Bailey courthouse and the 1960s Barbican Estate . The 1939 Battersea Power Station by the river in the south-west is a local landmark, while some railway termini are excellent examples of Victorian architecture , most notably St. Pancras and Paddington . The density of London varies, with high employment density in the central area and Canary Wharf , high residential densities in inner London , and lower densities in Outer London . The Monument in the City of London provides views of the surrounding area while commemorating the Great Fire of London , which originated nearby. Marble Arch and Wellington Arch , at the north and south ends of Park Lane , respectively, have royal connections, as do the Albert Memorial and Royal Albert Hall in Kensington . Nelson's Column (built to commemorate Admiral Horatio Nelson ) is a nationally recognised monument in Trafalgar Square , one of the focal points of central London. Older buildings are mainly brick, commonly the yellow London stock brick . In the dense areas, most of the concentration is via medium- and high-rise buildings. London's skyscrapers, such as 30 St Mary Axe (dubbed "The Gherkin"), Tower 42 , the Broadgate Tower and One Canada Square , are mostly in the two financial districts, the City of London and Canary Wharf . High-rise development is restricted at certain sites if it would obstruct protected views of St Paul's Cathedral and other historic buildings. This protective policy, known as 'St Paul's Heights', has been in operation by the City of London since 1937. Nevertheless, there are a number of tall skyscrapers in central London, including the 95-storey Shard London Bridge , the tallest building in the United Kingdom and Western Europe. Other notable modern buildings include The Scalpel , 20 Fenchurch Street (dubbed "The Walkie-Talkie"), the former City Hall in Southwark , the Art Deco BBC Broadcasting House plus the Postmodernist British Library in Somers Town / Kings Cross and No 1 Poultry by James Stirling . The BT Tower stands at 620 feet (189 m) and has a 360 degree coloured LED screen near the top. What was formerly the Millennium Dome , by the Thames to the east of Canary Wharf, is now an entertainment venue called the O 2 Arena . The London Natural History Society suggests that London is "one of the World's Greenest Cities" with more than 40 per cent green space or open water. They indicate that 2000 species of flowering plant have been found growing there and that the tidal Thames supports 120 species of fish. They state that over 60 species of bird nest in central London and that their members have recorded 47 species of butterfly, 1173 moths and more than 270 kinds of spider around London. London's wetland areas support nationally important populations of many water birds. London has 38 Sites of Special Scientific Interest (SSSIs), two national nature reserves and 76 local nature reserves . Amphibians are common in the capital, including smooth newts living by the Tate Modern , and common frogs , common toads , palmate newts and great crested newts . On the other hand, native reptiles such as slowworms , common lizards , barred grass snakes and adders , are mostly only seen in Outer London . Among other inhabitants of London are 10,000 red foxes , so that there are now 16 foxes for every square mile (6 per square kilometre) of London. Other mammals found in Greater London are hedgehog , brown rat , mice, rabbit , shrew , vole , and grey squirrel . In wilder areas of Outer London, such as Epping Forest , a wide variety of mammals are found, including European hare , badger , field , bank and water vole , wood mouse , yellow-necked mouse , mole , shrew, and weasel , in addition to red fox, grey squirrel and hedgehog. A dead otter was found at The Highway, in Wapping , about a mile from the Tower Bridge , which would suggest that they have begun to move back after being absent a hundred years from the city. Ten of England's eighteen species of bats have been recorded in Epping Forest: soprano , Nathusius' and common pipistrelles , common noctule , serotine , barbastelle , Daubenton's , brown long-eared , Natterer's and Leisler's . Herds of red and fallow deer roam freely within much of Richmond and Bushy Park . A cull takes place each November and February to ensure numbers can be sustained. Epping Forest is also known for its fallow deer, which can frequently be seen in herds to the north of the Forest. A rare population of melanistic , black fallow deer is also maintained at the Deer Sanctuary near Theydon Bois . Muntjac deer are also found in the forest. While Londoners are accustomed to wildlife such as birds and foxes sharing the city, more recently urban deer have started becoming a regular feature, and whole herds of fallow deer come into residential areas at night to take advantage of London's green spaces. London, also known as Greater London , is one of nine regions of England and the top subdivision covering most of the city's metropolis. The City of London at its core once comprised the whole settlement, but as its urban area grew, the Corporation of London resisted attempts to amalgamate the city with its suburbs , causing "London" to be defined several ways. Forty per cent of Greater London is covered by the London post town , in which 'London' forms part of postal addresses. The London telephone area code (020) covers a larger area, similar in size to Greater London, although some outer districts are excluded and some just outside included. The Greater London boundary has been aligned to the M25 motorway in places. Further urban expansion is now prevented by the Metropolitan Green Belt , although the built-up area extends beyond the boundary in places, producing a separately defined Greater London Urban Area . Beyond this is the vast London commuter belt . Greater London is split for some purposes into Inner London and Outer London , and by the River Thames into North and South , with an informal central London area. The coordinates of the nominal centre of London, traditionally the original Eleanor Cross at Charing Cross near the junction of Trafalgar Square and Whitehall , are about 51°30′26″N 00°07′39″W / 51.50722°N 0.12750°W / 51.50722; -0.12750 . Within London, both the City of London and the City of Westminster have city status and both the City of London and the remainder of Greater London are counties for the purposes of lieutenancies . The area of Greater London includes areas that are part of the historic counties of Middlesex , Kent , Surrey , Essex and Hertfordshire . London's status as the capital of England, and later the United Kingdom, has never been granted or confirmed by statute or in written form. [note 5] Its status as a capital was established by constitutional convention , which means its status as de facto capital is a part of the UK's uncodified constitution . The capital of England was moved to London from Winchester as the Palace of Westminster developed in the 12th and 13th centuries to become the permanent location of the royal court , and thus the political capital of the nation. More recently, Greater London has been defined as a region of England and in this context is known as London . Greater London encompasses a total area of 611 square miles (1,583 km 2 ) an area which had a population of 7,172,036 in 2001 and a population density of 11,760 inhabitants per square mile (4,542/km 2 ) . The extended area known as the London Metropolitan Region or the London Metropolitan Agglomeration, comprises a total area of 3,236 square miles (8,382 km 2 ) has a population of 13,709,000 and a population density of 3,900 inhabitants per square mile (1,510/km 2 ) . Modern London stands on the Thames , its primary geographical feature, a navigable river which crosses the city from the south-west to the east. The Thames Valley is a flood plain surrounded by gently rolling hills including Parliament Hill , Addington Hills , and Primrose Hill . Historically London grew up at the lowest bridging point on the Thames. The Thames was once a much broader, shallower river with extensive marshlands ; at high tide, its shores reached five times their present width. Since the Victorian era the Thames has been extensively embanked , and many of its London tributaries now flow underground . The Thames is a tidal river, and London is vulnerable to flooding. The threat has increased over time because of a slow but continuous rise in high water level caused by climate change and by the slow 'tilting' of the British Isles as a result of post-glacial rebound . London has a temperate oceanic climate ( Köppen : Cfb ). Rainfall records have been kept in the city since at least 1697, when records began at Kew . At Kew, the most rainfall in one month is 7.4 inches (189 mm) in November 1755 and the least is 0 inches (0 mm) in both December 1788 and July 1800. Mile End also had 0 inches (0 mm) in April 1893. The wettest year on record is 1903, with a total fall of 38.1 inches (969 mm) and the driest is 1921, with a total fall of 12.1 inches (308 mm) . The average annual precipitation amounts to about 600 mm, which is half the annual rainfall of New York City . Despite relatively low annual precipitation, London receives 109.6 rainy days on the 1.0 mm threshold annually. London is vulnerable to climate change , and there is concern among hydrological experts that households may run out of water before 2050. Temperature extremes in London range from 40.2 °C (104.4 °F) at Heathrow on 19 July 2022 down to −17.4 °C (0.7 °F) at Northolt on 13 December 1981. Records for atmospheric pressure have been kept at London since 1692. The highest pressure ever reported is 1,049.8 millibars (31.00 inHg) on 20 January 2020. Summers are generally warm, sometimes hot. London's average July high is 23.5 °C (74.3 °F). On average each year, London experiences 31 days above 25 °C (77.0 °F) and 4.2 days above 30.0 °C (86.0 °F) . During the 2003 European heat wave , prolonged heat led to hundreds of heat-related deaths. A previous spell of 15 consecutive days above 32.2 °C (90.0 °F) in England in 1976 also caused many heat related deaths. A previous temperature of 37.8 °C (100.0 °F) in August 1911 at the Greenwich station was later disregarded as non-standard. Droughts can also, occasionally, be a problem, especially in summer, most recently in summer 2018, and with much drier than average conditions prevailing from May to December. However, the most consecutive days without rain was 73 days in the spring of 1893. Winters are generally cool with little temperature variation. Heavy snow is rare but snow usually falls at least once each winter. Spring and autumn can be pleasant. As a large city, London has a considerable urban heat island effect, making the centre of London at times 5 °C (9 °F) warmer than the suburbs and outskirts. See Climate of London for additional climate information.Places within London's vast urban area are identified using area names, such as Mayfair , Southwark , Wembley , and Whitechapel . These are either informal designations, reflect the names of villages that have been absorbed by sprawl, or are superseded administrative units such as parishes or former boroughs . Such names have remained in use through tradition, each referring to a local area with its own distinctive character, but without official boundaries. Since 1965, Greater London has been divided into 32 London boroughs in addition to the ancient City of London. The City of London is the main financial district, and Canary Wharf has recently developed into a new financial and commercial hub in the Docklands to the east. The West End is London's main entertainment and shopping district, attracting tourists. West London includes expensive residential areas where properties can sell for tens of millions of pounds. The average price for properties in Kensington and Chelsea is over £2 million with a similarly high outlay in most of central London. The East End is the area closest to the original Port of London , known for its high immigrant population, as well as for being one of the poorest areas in London. The surrounding East London area saw much of London's early industrial development; now, brownfield sites throughout the area are being redeveloped as part of the Thames Gateway including the London Riverside and Lower Lea Valley , which was developed into the Olympic Park for the 2012 Olympics and Paralympics . London's buildings are too diverse to be characterised by any particular architectural style, partly because of their varying ages. Many grand houses and public buildings, such as the National Gallery , are constructed from Portland stone . Some areas of the city, particularly those just west of the centre, are characterised by white stucco or whitewashed buildings. Few structures in central London pre-date the Great Fire of 1666, these being a few trace Roman remains, the Tower of London and a few scattered Tudor survivors in the city. Further out is, for example, the Tudor-period Hampton Court Palace . Part of the varied architectural heritage are the 17th-century churches by Christopher Wren , neoclassical financial institutions such as the Royal Exchange and the Bank of England , to the early 20th century Old Bailey courthouse and the 1960s Barbican Estate . The 1939 Battersea Power Station by the river in the south-west is a local landmark, while some railway termini are excellent examples of Victorian architecture , most notably St. Pancras and Paddington . The density of London varies, with high employment density in the central area and Canary Wharf , high residential densities in inner London , and lower densities in Outer London . The Monument in the City of London provides views of the surrounding area while commemorating the Great Fire of London , which originated nearby. Marble Arch and Wellington Arch , at the north and south ends of Park Lane , respectively, have royal connections, as do the Albert Memorial and Royal Albert Hall in Kensington . Nelson's Column (built to commemorate Admiral Horatio Nelson ) is a nationally recognised monument in Trafalgar Square , one of the focal points of central London. Older buildings are mainly brick, commonly the yellow London stock brick . In the dense areas, most of the concentration is via medium- and high-rise buildings. London's skyscrapers, such as 30 St Mary Axe (dubbed "The Gherkin"), Tower 42 , the Broadgate Tower and One Canada Square , are mostly in the two financial districts, the City of London and Canary Wharf . High-rise development is restricted at certain sites if it would obstruct protected views of St Paul's Cathedral and other historic buildings. This protective policy, known as 'St Paul's Heights', has been in operation by the City of London since 1937. Nevertheless, there are a number of tall skyscrapers in central London, including the 95-storey Shard London Bridge , the tallest building in the United Kingdom and Western Europe. Other notable modern buildings include The Scalpel , 20 Fenchurch Street (dubbed "The Walkie-Talkie"), the former City Hall in Southwark , the Art Deco BBC Broadcasting House plus the Postmodernist British Library in Somers Town / Kings Cross and No 1 Poultry by James Stirling . The BT Tower stands at 620 feet (189 m) and has a 360 degree coloured LED screen near the top. What was formerly the Millennium Dome , by the Thames to the east of Canary Wharf, is now an entertainment venue called the O 2 Arena . The London Natural History Society suggests that London is "one of the World's Greenest Cities" with more than 40 per cent green space or open water. They indicate that 2000 species of flowering plant have been found growing there and that the tidal Thames supports 120 species of fish. They state that over 60 species of bird nest in central London and that their members have recorded 47 species of butterfly, 1173 moths and more than 270 kinds of spider around London. London's wetland areas support nationally important populations of many water birds. London has 38 Sites of Special Scientific Interest (SSSIs), two national nature reserves and 76 local nature reserves . Amphibians are common in the capital, including smooth newts living by the Tate Modern , and common frogs , common toads , palmate newts and great crested newts . On the other hand, native reptiles such as slowworms , common lizards , barred grass snakes and adders , are mostly only seen in Outer London . Among other inhabitants of London are 10,000 red foxes , so that there are now 16 foxes for every square mile (6 per square kilometre) of London. Other mammals found in Greater London are hedgehog , brown rat , mice, rabbit , shrew , vole , and grey squirrel . In wilder areas of Outer London, such as Epping Forest , a wide variety of mammals are found, including European hare , badger , field , bank and water vole , wood mouse , yellow-necked mouse , mole , shrew, and weasel , in addition to red fox, grey squirrel and hedgehog. A dead otter was found at The Highway, in Wapping , about a mile from the Tower Bridge , which would suggest that they have begun to move back after being absent a hundred years from the city. Ten of England's eighteen species of bats have been recorded in Epping Forest: soprano , Nathusius' and common pipistrelles , common noctule , serotine , barbastelle , Daubenton's , brown long-eared , Natterer's and Leisler's . Herds of red and fallow deer roam freely within much of Richmond and Bushy Park . A cull takes place each November and February to ensure numbers can be sustained. Epping Forest is also known for its fallow deer, which can frequently be seen in herds to the north of the Forest. A rare population of melanistic , black fallow deer is also maintained at the Deer Sanctuary near Theydon Bois . Muntjac deer are also found in the forest. While Londoners are accustomed to wildlife such as birds and foxes sharing the city, more recently urban deer have started becoming a regular feature, and whole herds of fallow deer come into residential areas at night to take advantage of London's green spaces. London's continuous urban area extends beyond Greater London and numbered 9,787,426 people in 2011, while its wider metropolitan area had a population of 12–14 million, depending on the definition used. According to Eurostat , London is the second most populous metropolitan area in Europe. A net 726,000 immigrants arrived there in the period 1991–2001. The region covers 610 square miles (1,579 km 2 ) , giving a population density of 13,410 inhabitants per square mile (5,177/km 2 ) more than ten times that of any other British region . In population terms, London is the 19th largest city and the 18th largest metropolitan region . In tenure, 23.1% socially rent within London, 46.8% either own their house outright or with a mortgage or loan and 30% privately rent at the 2021 census. Many Londoner's work from home, 42.9% did so at the 2021 census while 20.6% drive a car to work. The biggest decrease in method of transportation was seen within those who take the train and underground, declining from 22.6% in 2011 to 9.6% in 2021. In qualifications, 46.7% of London had census classified Level 4 qualifications or higher, which is predominately university degrees. 16.2% had no qualifications at all. London's median age is one of the youngest regions in the UK. It was recorded in 2018 that London's residents were 36.5 years old, which was younger than the UK median of 40.3. Children younger than 14 constituted 20.6% of the population in Outer London in 2018, and 18% in Inner London. The 15–24 age group was 11.1% in Outer and 10.2% in Inner London, those aged 25–44 years 30.6% in Outer London and 39.7% in Inner London, those aged 45–64 years 24% and 20.7% in Outer and Inner London respectively. Those aged 65 and over are 13.6% in Outer London, but only 9.3% in Inner London. The 2021 census recorded that 3,575,739 people or 40.6% of London's population were foreign-born , making it among the cities with the largest immigrant population in terms of absolute numbers and a growth of roughly 3 million since 1971 when the foreign born population was 668,373. 13% of the total population were Asian born (32.1% of the total foreign born population), 7.1% are African born (17.5%), 15.5% are Other European born (38.2%) and 4.2% were born in the Americas and Caribbean (10.3%). The 5 largest single countries of origin were respectively India, Romania, Poland, Bangladesh and Pakistan. About 56.8% of children born in London in 2021 were born to a mother who was born abroad. This trend has been increasing in the past two decades when foreign born mothers made up 43.3% of births in 2001 in London, becoming the majority in the middle of the 2000s by 2006 comprising 52.5%. A large degree of the foreign born population who were present at the 2021 census had arrived relatively recently. Of the total population, those that arrived between the years of 2011 and 2021 account for 16.6% of London. Those who arrived between 2001 and 2010 are 10.4%, between 1991 and 2001, 5.7%, and prior to 1990, 7.3%. According to the Office for National Statistics , based on the 2021 census, 53.8 per cent of the 8,173,941 inhabitants of London were White , with 36.8% White British , 1.8% White Irish , 0.1% Gypsy / Irish Traveller , 0.4 Roma and 14.7% classified as Other White . Meanwhile, 22.2% of Londoners were of Asian or mixed-Asian descent, with 20.8% being of full Asian descents and 1.4% being of mixed-Asian heritage. Indians accounted for 7.5% of the population, followed by Pakistanis and Bangladeshis at 3.3% and 3.7% respectively. Chinese people accounted for 1.7%, and Arabs for 1.6%. A further 4.6% were classified as "Other Asian". 15.9% of London's population were of Black or mixed-Black descent. 13.5% were of full Black descent, with persons of mixed-Black heritage comprising 2.4%. Black Africans accounted for 7.9% of London's population; 3.9% identified as Black Caribbean , and 1.7% as "Other Black". 5.7% were of mixed race . This ethnic structure has changed considerably since the 1960s. Estimates for 1961 put the total non-White ethnic minority population at 179,109 comprising 2.3% of the population at the time, having risen since then to 1,346,119 and 20.2% in 1991 and 4,068,553 and 46.2% in 2021. Of those of a White British background, estimates for 1971 put the population at 6,500,000 and 87% of the total population, of since fell to 3,239,281 and 36.8% in 2021. As of 2021, the majority of London's school pupils come from ethnic minority backgrounds. 23.9% were White British, 14% Other White, 23.2% Asian, 17.9% Black, 11.3% Mixed, 6.3% Other and 2.3% unclassified. Altogether at the 2021 census, of London's 1,695,741 population aged 0 to 15, 42% were White in total, spliting it down into 30.9% who were White British, 0.5% Irish, 10.6% Other White, 23% Asian, 16.4% Black, 12% Mixed and 6.6% another ethnic group. In January 2005, a survey of London's ethnic and religious diversity claimed that more than 300 languages were spoken in London and more than 50 non-indigenous communities had populations of more than 10,000. At the 2021 census, 78.4% spoke English as their first language. The 5 biggest languages outside of English were Romanian, Spanish, Polish, Bengali and Portuguese. Religion in London (2021) According to the 2021 Census , the largest religious groupings were Christians (40.66%), followed by those of no religion (20.7%), Muslims (15%), no response (8.5%), Hindus (5.15%), Jews (1.65%), Sikhs (1.64%), Buddhists (1.0%) and other (0.8%). London has traditionally been Christian, and has a large number of churches , particularly in the City of London. The well-known St Paul's Cathedral in the City and Southwark Cathedral south of the river are Anglican administrative centres, while the Archbishop of Canterbury , principal bishop of the Church of England and worldwide Anglican Communion , has his main residence at Lambeth Palace in the London Borough of Lambeth . Important national and royal ceremonies are shared between St Paul's and Westminster Abbey . The Abbey is not to be confused with nearby Westminster Cathedral , the largest Roman Catholic cathedral in England and Wales . Despite the prevalence of Anglican churches, observance is low within the denomination. Anglican Church attendance continues a long, steady decline, according to Church of England statistics. Notable mosques include the East London Mosque in Tower Hamlets, which is allowed to give the Islamic call to prayer through loudspeakers, the London Central Mosque on the edge of Regent's Park and the Baitul Futuh of the Ahmadiyya Muslim Community . After the oil boom, increasing numbers of wealthy Middle-Eastern Arab Muslims based themselves around Mayfair , Kensington and Knightsbridge in West London. There are large Bengali Muslim communities in the eastern boroughs of Tower Hamlets and Newham . Large Hindu communities are found in the north-western boroughs of Harrow and Brent , the latter hosting what was until 2006 Europe's largest Hindu temple , Neasden Temple . London is home to 44 Hindu temples, including the BAPS Shri Swaminarayan Mandir London . There are Sikh communities in East and West London, particularly in Southall, home to one of the largest Sikh populations and the largest Sikh temple outside India. The majority of British Jews live in London, with notable Jewish communities in Stamford Hill , Stanmore , Golders Green , Finchley , Hampstead , Hendon and Edgware , all in North London . Bevis Marks Synagogue in the City of London is affiliated to London's historic Sephardic Jewish community. It is the only synagogue in Europe to have held regular services continually for over 300 years. Stanmore and Canons Park Synagogue has the largest membership of any Orthodox synagogue in Europe. The London Jewish Forum was set up in 2006 in response to the growing significance of devolved London Government. Cockney is an accent heard across London, mainly spoken by working-class and lower-middle class Londoners. It is mainly attributed to the East End and wider East London, having originated there in the 18th century, although it has been suggested that the Cockney style of speech is much older. Some features of Cockney include, Th -fronting (pronouncing "th" as "f"), "th" inside a word is pronounced with a "v", H -dropping , and, like most English accents, a Cockney accent drops the "r" after a vowel. John Camden Hotten, in his Slang Dictionary of 1859, makes reference to Cockney "use of a peculiar slang language" ( Cockney rhyming slang ) when describing the costermongers of the East End. Since the start of the 21st century the extreme form of the Cockney dialect is less common in parts of the East End itself, with modern strongholds including other parts of London and suburbs in the home counties . This is particularly pronounced in areas like Romford (in the London Borough of Havering) and Southend (in Essex) which have received significant inflows of older East End residents in recent decades. Estuary English is an intermediate accent between Cockney and Received Pronunciation . It is widely spoken by people of all classes. Multicultural London English (MLE) is a multiethnolect becoming increasingly common in multicultural areas amongst young, working-class people from diverse backgrounds. It is a fusion of an array of ethnic accents, in particular Afro-Caribbean and South Asian, with a significant Cockney influence. Received Pronunciation (RP) is the accent traditionally regarded as the standard for British English . It has no specific geographical correlate, although it is also traditionally defined as the standard speech used in London and south-eastern England. It is mainly spoken by upper-class and upper-middle class Londoners. London's median age is one of the youngest regions in the UK. It was recorded in 2018 that London's residents were 36.5 years old, which was younger than the UK median of 40.3. Children younger than 14 constituted 20.6% of the population in Outer London in 2018, and 18% in Inner London. The 15–24 age group was 11.1% in Outer and 10.2% in Inner London, those aged 25–44 years 30.6% in Outer London and 39.7% in Inner London, those aged 45–64 years 24% and 20.7% in Outer and Inner London respectively. Those aged 65 and over are 13.6% in Outer London, but only 9.3% in Inner London. The 2021 census recorded that 3,575,739 people or 40.6% of London's population were foreign-born , making it among the cities with the largest immigrant population in terms of absolute numbers and a growth of roughly 3 million since 1971 when the foreign born population was 668,373. 13% of the total population were Asian born (32.1% of the total foreign born population), 7.1% are African born (17.5%), 15.5% are Other European born (38.2%) and 4.2% were born in the Americas and Caribbean (10.3%). The 5 largest single countries of origin were respectively India, Romania, Poland, Bangladesh and Pakistan. About 56.8% of children born in London in 2021 were born to a mother who was born abroad. This trend has been increasing in the past two decades when foreign born mothers made up 43.3% of births in 2001 in London, becoming the majority in the middle of the 2000s by 2006 comprising 52.5%. A large degree of the foreign born population who were present at the 2021 census had arrived relatively recently. Of the total population, those that arrived between the years of 2011 and 2021 account for 16.6% of London. Those who arrived between 2001 and 2010 are 10.4%, between 1991 and 2001, 5.7%, and prior to 1990, 7.3%. According to the Office for National Statistics , based on the 2021 census, 53.8 per cent of the 8,173,941 inhabitants of London were White , with 36.8% White British , 1.8% White Irish , 0.1% Gypsy / Irish Traveller , 0.4 Roma and 14.7% classified as Other White . Meanwhile, 22.2% of Londoners were of Asian or mixed-Asian descent, with 20.8% being of full Asian descents and 1.4% being of mixed-Asian heritage. Indians accounted for 7.5% of the population, followed by Pakistanis and Bangladeshis at 3.3% and 3.7% respectively. Chinese people accounted for 1.7%, and Arabs for 1.6%. A further 4.6% were classified as "Other Asian". 15.9% of London's population were of Black or mixed-Black descent. 13.5% were of full Black descent, with persons of mixed-Black heritage comprising 2.4%. Black Africans accounted for 7.9% of London's population; 3.9% identified as Black Caribbean , and 1.7% as "Other Black". 5.7% were of mixed race . This ethnic structure has changed considerably since the 1960s. Estimates for 1961 put the total non-White ethnic minority population at 179,109 comprising 2.3% of the population at the time, having risen since then to 1,346,119 and 20.2% in 1991 and 4,068,553 and 46.2% in 2021. Of those of a White British background, estimates for 1971 put the population at 6,500,000 and 87% of the total population, of since fell to 3,239,281 and 36.8% in 2021. As of 2021, the majority of London's school pupils come from ethnic minority backgrounds. 23.9% were White British, 14% Other White, 23.2% Asian, 17.9% Black, 11.3% Mixed, 6.3% Other and 2.3% unclassified. Altogether at the 2021 census, of London's 1,695,741 population aged 0 to 15, 42% were White in total, spliting it down into 30.9% who were White British, 0.5% Irish, 10.6% Other White, 23% Asian, 16.4% Black, 12% Mixed and 6.6% another ethnic group. In January 2005, a survey of London's ethnic and religious diversity claimed that more than 300 languages were spoken in London and more than 50 non-indigenous communities had populations of more than 10,000. At the 2021 census, 78.4% spoke English as their first language. The 5 biggest languages outside of English were Romanian, Spanish, Polish, Bengali and Portuguese. Religion in London (2021) According to the 2021 Census , the largest religious groupings were Christians (40.66%), followed by those of no religion (20.7%), Muslims (15%), no response (8.5%), Hindus (5.15%), Jews (1.65%), Sikhs (1.64%), Buddhists (1.0%) and other (0.8%). London has traditionally been Christian, and has a large number of churches , particularly in the City of London. The well-known St Paul's Cathedral in the City and Southwark Cathedral south of the river are Anglican administrative centres, while the Archbishop of Canterbury , principal bishop of the Church of England and worldwide Anglican Communion , has his main residence at Lambeth Palace in the London Borough of Lambeth . Important national and royal ceremonies are shared between St Paul's and Westminster Abbey . The Abbey is not to be confused with nearby Westminster Cathedral , the largest Roman Catholic cathedral in England and Wales . Despite the prevalence of Anglican churches, observance is low within the denomination. Anglican Church attendance continues a long, steady decline, according to Church of England statistics. Notable mosques include the East London Mosque in Tower Hamlets, which is allowed to give the Islamic call to prayer through loudspeakers, the London Central Mosque on the edge of Regent's Park and the Baitul Futuh of the Ahmadiyya Muslim Community . After the oil boom, increasing numbers of wealthy Middle-Eastern Arab Muslims based themselves around Mayfair , Kensington and Knightsbridge in West London. There are large Bengali Muslim communities in the eastern boroughs of Tower Hamlets and Newham . Large Hindu communities are found in the north-western boroughs of Harrow and Brent , the latter hosting what was until 2006 Europe's largest Hindu temple , Neasden Temple . London is home to 44 Hindu temples, including the BAPS Shri Swaminarayan Mandir London . There are Sikh communities in East and West London, particularly in Southall, home to one of the largest Sikh populations and the largest Sikh temple outside India. The majority of British Jews live in London, with notable Jewish communities in Stamford Hill , Stanmore , Golders Green , Finchley , Hampstead , Hendon and Edgware , all in North London . Bevis Marks Synagogue in the City of London is affiliated to London's historic Sephardic Jewish community. It is the only synagogue in Europe to have held regular services continually for over 300 years. Stanmore and Canons Park Synagogue has the largest membership of any Orthodox synagogue in Europe. The London Jewish Forum was set up in 2006 in response to the growing significance of devolved London Government. Cockney is an accent heard across London, mainly spoken by working-class and lower-middle class Londoners. It is mainly attributed to the East End and wider East London, having originated there in the 18th century, although it has been suggested that the Cockney style of speech is much older. Some features of Cockney include, Th -fronting (pronouncing "th" as "f"), "th" inside a word is pronounced with a "v", H -dropping , and, like most English accents, a Cockney accent drops the "r" after a vowel. John Camden Hotten, in his Slang Dictionary of 1859, makes reference to Cockney "use of a peculiar slang language" ( Cockney rhyming slang ) when describing the costermongers of the East End. Since the start of the 21st century the extreme form of the Cockney dialect is less common in parts of the East End itself, with modern strongholds including other parts of London and suburbs in the home counties . This is particularly pronounced in areas like Romford (in the London Borough of Havering) and Southend (in Essex) which have received significant inflows of older East End residents in recent decades. Estuary English is an intermediate accent between Cockney and Received Pronunciation . It is widely spoken by people of all classes. Multicultural London English (MLE) is a multiethnolect becoming increasingly common in multicultural areas amongst young, working-class people from diverse backgrounds. It is a fusion of an array of ethnic accents, in particular Afro-Caribbean and South Asian, with a significant Cockney influence. Received Pronunciation (RP) is the accent traditionally regarded as the standard for British English . It has no specific geographical correlate, although it is also traditionally defined as the standard speech used in London and south-eastern England. It is mainly spoken by upper-class and upper-middle class Londoners. London's gross regional product in 2019 was £503 billion, around a quarter of UK GDP . London has five major business districts: the city, Westminster, Canary Wharf, Camden & Islington and Lambeth & Southwark. One way to get an idea of their relative importance is to look at relative amounts of office space: Greater London had 27 million m 2 of office space in 2001, and the City contains the most space, with 8 million m 2 of office space. London has some of the highest real estate prices in the world. London's finance industry is based in the City of London and Canary Wharf , the two major business districts . London is one of the pre-eminent financial centres of the world as the most important location for international finance. London took over as a major financial centre shortly after 1795 when the Dutch Republic collapsed before the Napoleonic armies. This caused many bankers established in Amsterdam (e.g. Hope, Baring I'm), to move to London. Also, London's market-centred system (as opposed to the bank-centred one in Amsterdam) grew more dominant in the 18th century. The London financial elite was strengthened by a strong Jewish community from all over Europe capable of mastering the most sophisticated financial tools of the time. This economic strength of the city was attributed to its diversity. By the mid-19th century, London was the leading financial centre, and at the end of the century over half the world's trade was financed in British currency. Still, as of 2016 [ update ] London tops the world rankings on the Global Financial Centres Index (GFCI), and it ranked second in A.T. Kearney's 2018 Global Cities Index. London's largest industry is finance, and its financial exports make it a large contributor to the UK's balance of payments . Notwithstanding a post- Brexit exodus of stock listings from the London Stock Exchange , London is still one of Europe's most economically powerful cities, and it remains one of the major financial centres of the world . It is the world's biggest currency trading centre, accounting for some 37 per cent of the $5.1 trillion average daily volume, according to the BIS. Over 85 per cent (3.2 million) of the employed population of greater London works in the services industries. Because of its prominent global role, London's economy had been affected by the financial crisis of 2007–2008 . However, by 2010 the city had recovered, put in place new regulatory powers, proceeded to regain lost ground and re-established London's economic dominance. Along with professional services headquarters, the City of London is home to the Bank of England , London Stock Exchange , and Lloyd's of London insurance market. Over half the UK's top 100 listed companies (the FTSE 100 ) and over 100 of Europe's 500 largest companies have their headquarters in central London. Over 70 per cent of the FTSE 100 are within London's metropolitan area, and 75 per cent of Fortune 500 companies have offices in London. In a 1992 report commissioned by the London Stock Exchange, Sir Adrian Cadbury , chairman of his family's confectionery company Cadbury , produced the Cadbury Report , a code of best practice which served as a basis for reform of corporate governance around the world. Media companies are concentrated in London, and the media distribution industry is London's second most competitive sector. The BBC , the world's oldest national broadcaster, is a significant employer, while other broadcasters, including ITV , Channel 4 , Channel 5 , and Sky , also have headquarters around the city. Many national newspapers , including The Times , founded in 1785, are edited in London; the term Fleet Street (where most national newspapers operated) remains a metonym for the British national press. The communications company WPP is the world's largest advertising agency. A large number of technology companies are based in London, notably in East London Tech City , also known as Silicon Roundabout. In 2014 the city was among the first to receive a geoTLD . In February 2014 London was ranked as the European City of the Future in the 2014/15 list by fDi Intelligence . A museum in Bletchley Park , where Alan Turing was based during World War II, is in Bletchley , 40 miles (64 km) north of central London, as is The National Museum of Computing . The gas and electricity distribution networks that manage and operate the towers, cables and pressure systems that deliver energy to consumers across the city are managed by National Grid plc , SGN and UK Power Networks . London is one of the leading tourist destinations in the world and in 2015 was ranked as the most visited city in the world with over 65 million visits. It is also the top city in the world by visitor cross-border spending, estimated at US$20.23 billion in 2015. Tourism is one of London's prime industries, employing 700,000 full-time workers in 2016, and contributes £36 billion a year to the economy. The city accounts for 54% of all inbound visitor spending in the UK. As of 2016 [ update ] London was the world top city destination as ranked by TripAdvisor users. In 2015 the top most-visited attractions in the UK were all in London. The top 10 most visited attractions were (with visits per venue): The number of hotel rooms in London in 2023 stood at 155,700 and is expected to grow to 183,600 rooms, the most of any city outside China. Luxury hotels in London include the Savoy (opened in 1889), Claridge's (opened in 1812 and rebuilt in 1898), the Ritz (opened in 1906) and the Dorchester (opened in 1931), while budget hotel chains include Premier Inn and Travelodge . London's finance industry is based in the City of London and Canary Wharf , the two major business districts . London is one of the pre-eminent financial centres of the world as the most important location for international finance. London took over as a major financial centre shortly after 1795 when the Dutch Republic collapsed before the Napoleonic armies. This caused many bankers established in Amsterdam (e.g. Hope, Baring I'm), to move to London. Also, London's market-centred system (as opposed to the bank-centred one in Amsterdam) grew more dominant in the 18th century. The London financial elite was strengthened by a strong Jewish community from all over Europe capable of mastering the most sophisticated financial tools of the time. This economic strength of the city was attributed to its diversity. By the mid-19th century, London was the leading financial centre, and at the end of the century over half the world's trade was financed in British currency. Still, as of 2016 [ update ] London tops the world rankings on the Global Financial Centres Index (GFCI), and it ranked second in A.T. Kearney's 2018 Global Cities Index. London's largest industry is finance, and its financial exports make it a large contributor to the UK's balance of payments . Notwithstanding a post- Brexit exodus of stock listings from the London Stock Exchange , London is still one of Europe's most economically powerful cities, and it remains one of the major financial centres of the world . It is the world's biggest currency trading centre, accounting for some 37 per cent of the $5.1 trillion average daily volume, according to the BIS. Over 85 per cent (3.2 million) of the employed population of greater London works in the services industries. Because of its prominent global role, London's economy had been affected by the financial crisis of 2007–2008 . However, by 2010 the city had recovered, put in place new regulatory powers, proceeded to regain lost ground and re-established London's economic dominance. Along with professional services headquarters, the City of London is home to the Bank of England , London Stock Exchange , and Lloyd's of London insurance market. Over half the UK's top 100 listed companies (the FTSE 100 ) and over 100 of Europe's 500 largest companies have their headquarters in central London. Over 70 per cent of the FTSE 100 are within London's metropolitan area, and 75 per cent of Fortune 500 companies have offices in London. In a 1992 report commissioned by the London Stock Exchange, Sir Adrian Cadbury , chairman of his family's confectionery company Cadbury , produced the Cadbury Report , a code of best practice which served as a basis for reform of corporate governance around the world. Media companies are concentrated in London, and the media distribution industry is London's second most competitive sector. The BBC , the world's oldest national broadcaster, is a significant employer, while other broadcasters, including ITV , Channel 4 , Channel 5 , and Sky , also have headquarters around the city. Many national newspapers , including The Times , founded in 1785, are edited in London; the term Fleet Street (where most national newspapers operated) remains a metonym for the British national press. The communications company WPP is the world's largest advertising agency. A large number of technology companies are based in London, notably in East London Tech City , also known as Silicon Roundabout. In 2014 the city was among the first to receive a geoTLD . In February 2014 London was ranked as the European City of the Future in the 2014/15 list by fDi Intelligence . A museum in Bletchley Park , where Alan Turing was based during World War II, is in Bletchley , 40 miles (64 km) north of central London, as is The National Museum of Computing . The gas and electricity distribution networks that manage and operate the towers, cables and pressure systems that deliver energy to consumers across the city are managed by National Grid plc , SGN and UK Power Networks . London is one of the leading tourist destinations in the world and in 2015 was ranked as the most visited city in the world with over 65 million visits. It is also the top city in the world by visitor cross-border spending, estimated at US$20.23 billion in 2015. Tourism is one of London's prime industries, employing 700,000 full-time workers in 2016, and contributes £36 billion a year to the economy. The city accounts for 54% of all inbound visitor spending in the UK. As of 2016 [ update ] London was the world top city destination as ranked by TripAdvisor users. In 2015 the top most-visited attractions in the UK were all in London. The top 10 most visited attractions were (with visits per venue): The number of hotel rooms in London in 2023 stood at 155,700 and is expected to grow to 183,600 rooms, the most of any city outside China. Luxury hotels in London include the Savoy (opened in 1889), Claridge's (opened in 1812 and rebuilt in 1898), the Ritz (opened in 1906) and the Dorchester (opened in 1931), while budget hotel chains include Premier Inn and Travelodge . Transport is one of the four main areas of policy administered by the Mayor of London, but the mayor's financial control does not extend to the longer-distance rail network that enters London. In 2007 the Mayor of London assumed responsibility for some local lines, which now form the London Overground network, adding to the existing responsibility for the London Underground, trams and buses. The public transport network is administered by Transport for London (TfL). The lines that formed the London Underground, as well as trams and buses, became part of an integrated transport system in 1933 when the London Passenger Transport Board or London Transport was created. Transport for London is now the statutory corporation responsible for most aspects of the transport system in Greater London, and is run by a board and a commissioner appointed by the Mayor of London . London is a major international air transport hub with the busiest city airspace in the world . Eight airports use the word London in their name, but most traffic passes through six of these. Additionally, various other airports also serve London, catering primarily to general aviation flights. Opened in 1863, the London Underground , commonly referred to as the Tube or just the Underground, is the oldest and third longest metro system in the world. The system serves 272 stations , and was formed from several private companies, including the world's first underground electric line, the City and South London Railway , which opened in 1890. Over four million journeys are made every day on the Underground network, over 1 billion each year. An investment programme is attempting to reduce congestion and improve reliability, including £6.5 billion (€7.7 billion) spent before the 2012 Summer Olympics . The Docklands Light Railway (DLR) , which opened in 1987, is a second, more local metro system using smaller and lighter tram-type vehicles that serve the Docklands , Greenwich and Lewisham . There are 368 railway stations in the London Travelcard Zones on an extensive above-ground suburban railway network. South London, particularly, has a high concentration of railways as it has fewer Underground lines. Most rail lines terminate around the centre of London, running into eighteen terminal stations , with the exception of the Thameslink trains connecting Bedford in the north and Brighton in the south via Luton and Gatwick airports. London has Britain's busiest station by number of passengers— Waterloo , with over 184 million people using the interchange station complex (which includes Waterloo East station) each year. Clapham Junction is one of Europe's busiest rail interchanges. With the need for more rail capacity, the Elizabeth Line (also known as Crossrail) opened in May 2022. It is a new railway line running east to west through London and into the Home Counties with a branch to Heathrow Airport . It was Europe's biggest construction project, with a £15 billion projected cost. London is the centre of the National Rail network, with 70 per cent of rail journeys starting or ending in London. King's Cross station and Euston station , both in London, are the starting points of the East Coast Main Line and the West Coast Main Line – the two main railway lines in Britain. Like suburban rail services, regional and inter-city trains depart from several termini around the city centre, directly linking London with most of Great Britain's major cities and towns. The Flying Scotsman is an express passenger train service that has operated between London and Edinburgh since 1862; the world famous steam locomotive named after this service, Flying Scotsman , was the first locomotive to reach the officially authenticated speed of 100 miles per hour (161 km/h) in 1934. Some international railway services to Continental Europe were operated during the 20th century as boat trains . The opening of the Channel Tunnel in 1994 connected London directly to the continental rail network, allowing Eurostar services to begin. Since 2007, high-speed trains link St. Pancras International with Lille , Calais , Paris, Disneyland Paris , Brussels, Amsterdam and other European tourist destinations via the High Speed 1 rail link and the Channel Tunnel . The first high-speed domestic trains started in June 2009 linking Kent to London. There are plans for a second high speed line linking London to the Midlands, North West England, and Yorkshire. London's bus network runs 24 hours a day with about 9,300 vehicles, over 675 bus routes and about 19,000 bus stops. In 2019 the network had over 2 billion commuter trips per year. Since 2010 an average of £1.2 billion is taken in revenue each year. London has one of the largest wheelchair-accessible networks in the world and from the third quarter of 2007, became more accessible to hearing and visually impaired passengers as audio-visual announcements were introduced. An emblem of London, the red double-decker bus first appeared in the city in 1947 with the AEC Regent III RT (predecessor to the AEC Routemaster ). London's coach hub is Victoria Coach Station , opened in 1932. Nationalised in 1970 and then purchased by London Transport (now Transport for London ), Victoria Coach Station has over 14 million passengers a year and provides services across the UK and continental Europe. London has a modern tram network, known as Tramlink . It has 39 stops and four routes, and carried 28 million people in 2013. Since June 2008, Transport for London has completely owned and operated Tramlink. London's first and to date only cable car is the London Cable Car , which opened in June 2012. The cable car crosses the Thames and links Greenwich Peninsula with the Royal Docks in the east of the city. It is able to carry up to 2,500 passengers per hour in each direction at peak times. In the Greater London Area, around 670,000 people use a bike every day, meaning around 7% of the total population of around 8.8 million use a bike on an average day. Cycling has become an increasingly popular way to get around London. The launch of a bicycle hire scheme in July 2010 was successful and generally well received. The Port of London , once the largest in the world, is now only the second-largest in the United Kingdom, handling 45 million tonnes of cargo each year as of 2009. Most of this cargo passes through the Port of Tilbury , outside the boundary of Greater London. London has river boat services on the Thames known as Thames Clippers , which offer both commuter and tourist boat services. At major piers including Canary Wharf , London Bridge City , Battersea Power Station and London Eye (Waterloo), services depart at least every 20 minutes during commuter times. The Woolwich Ferry , with 2.5 million passengers every year, is a frequent service linking the North and South Circular Roads. Although the majority of journeys in central London are made by public transport, car travel is common in the suburbs. The inner ring road (around the city centre), the North and South Circular roads (just within the suburbs), and the outer orbital motorway (the M25 , just outside the built-up area in most places) encircle the city and are intersected by a number of busy radial routes—but very few motorways penetrate into inner London . The M25 is the second-longest ring-road motorway in Europe at 117 miles (188 km) long. The A1 and M1 connect London to Leeds , and Newcastle and Edinburgh . The Austin Motor Company began making hackney carriages (London taxis) in 1929, and models include Austin FX3 from 1948, Austin FX4 from 1958, with more recent models TXII and TX4 manufactured by London Taxis International . The BBC states, "ubiquitous black cabs and red double-decker buses all have long and tangled stories that are deeply embedded in London's traditions". London is notorious for its traffic congestion; in 2009, the average speed of a car in the rush hour was recorded at 10.6 mph (17.1 km/h) . In 2003, a congestion charge was introduced to reduce traffic volumes in the city centre. With a few exceptions, motorists are required to pay to drive within a defined zone encompassing much of central London. Motorists who are residents of the defined zone can buy a greatly reduced season pass. Over the course of several years, the average number of cars entering the centre of London on a weekday was reduced from 195,000 to 125,000. Low Traffic Neighbourhoods (LTN) were widely introduced in London, but in 2023 the Department for Transport stopped funding them, even though the benefits outweighed the costs by approximately 100 times in the first 20 years and the difference is growing over time. London is a major international air transport hub with the busiest city airspace in the world . Eight airports use the word London in their name, but most traffic passes through six of these. Additionally, various other airports also serve London, catering primarily to general aviation flights.Opened in 1863, the London Underground , commonly referred to as the Tube or just the Underground, is the oldest and third longest metro system in the world. The system serves 272 stations , and was formed from several private companies, including the world's first underground electric line, the City and South London Railway , which opened in 1890. Over four million journeys are made every day on the Underground network, over 1 billion each year. An investment programme is attempting to reduce congestion and improve reliability, including £6.5 billion (€7.7 billion) spent before the 2012 Summer Olympics . The Docklands Light Railway (DLR) , which opened in 1987, is a second, more local metro system using smaller and lighter tram-type vehicles that serve the Docklands , Greenwich and Lewisham . There are 368 railway stations in the London Travelcard Zones on an extensive above-ground suburban railway network. South London, particularly, has a high concentration of railways as it has fewer Underground lines. Most rail lines terminate around the centre of London, running into eighteen terminal stations , with the exception of the Thameslink trains connecting Bedford in the north and Brighton in the south via Luton and Gatwick airports. London has Britain's busiest station by number of passengers— Waterloo , with over 184 million people using the interchange station complex (which includes Waterloo East station) each year. Clapham Junction is one of Europe's busiest rail interchanges. With the need for more rail capacity, the Elizabeth Line (also known as Crossrail) opened in May 2022. It is a new railway line running east to west through London and into the Home Counties with a branch to Heathrow Airport . It was Europe's biggest construction project, with a £15 billion projected cost. London is the centre of the National Rail network, with 70 per cent of rail journeys starting or ending in London. King's Cross station and Euston station , both in London, are the starting points of the East Coast Main Line and the West Coast Main Line – the two main railway lines in Britain. Like suburban rail services, regional and inter-city trains depart from several termini around the city centre, directly linking London with most of Great Britain's major cities and towns. The Flying Scotsman is an express passenger train service that has operated between London and Edinburgh since 1862; the world famous steam locomotive named after this service, Flying Scotsman , was the first locomotive to reach the officially authenticated speed of 100 miles per hour (161 km/h) in 1934. Some international railway services to Continental Europe were operated during the 20th century as boat trains . The opening of the Channel Tunnel in 1994 connected London directly to the continental rail network, allowing Eurostar services to begin. Since 2007, high-speed trains link St. Pancras International with Lille , Calais , Paris, Disneyland Paris , Brussels, Amsterdam and other European tourist destinations via the High Speed 1 rail link and the Channel Tunnel . The first high-speed domestic trains started in June 2009 linking Kent to London. There are plans for a second high speed line linking London to the Midlands, North West England, and Yorkshire. Opened in 1863, the London Underground , commonly referred to as the Tube or just the Underground, is the oldest and third longest metro system in the world. The system serves 272 stations , and was formed from several private companies, including the world's first underground electric line, the City and South London Railway , which opened in 1890. Over four million journeys are made every day on the Underground network, over 1 billion each year. An investment programme is attempting to reduce congestion and improve reliability, including £6.5 billion (€7.7 billion) spent before the 2012 Summer Olympics . The Docklands Light Railway (DLR) , which opened in 1987, is a second, more local metro system using smaller and lighter tram-type vehicles that serve the Docklands , Greenwich and Lewisham . There are 368 railway stations in the London Travelcard Zones on an extensive above-ground suburban railway network. South London, particularly, has a high concentration of railways as it has fewer Underground lines. Most rail lines terminate around the centre of London, running into eighteen terminal stations , with the exception of the Thameslink trains connecting Bedford in the north and Brighton in the south via Luton and Gatwick airports. London has Britain's busiest station by number of passengers— Waterloo , with over 184 million people using the interchange station complex (which includes Waterloo East station) each year. Clapham Junction is one of Europe's busiest rail interchanges. With the need for more rail capacity, the Elizabeth Line (also known as Crossrail) opened in May 2022. It is a new railway line running east to west through London and into the Home Counties with a branch to Heathrow Airport . It was Europe's biggest construction project, with a £15 billion projected cost. London is the centre of the National Rail network, with 70 per cent of rail journeys starting or ending in London. King's Cross station and Euston station , both in London, are the starting points of the East Coast Main Line and the West Coast Main Line – the two main railway lines in Britain. Like suburban rail services, regional and inter-city trains depart from several termini around the city centre, directly linking London with most of Great Britain's major cities and towns. The Flying Scotsman is an express passenger train service that has operated between London and Edinburgh since 1862; the world famous steam locomotive named after this service, Flying Scotsman , was the first locomotive to reach the officially authenticated speed of 100 miles per hour (161 km/h) in 1934. Some international railway services to Continental Europe were operated during the 20th century as boat trains . The opening of the Channel Tunnel in 1994 connected London directly to the continental rail network, allowing Eurostar services to begin. Since 2007, high-speed trains link St. Pancras International with Lille , Calais , Paris, Disneyland Paris , Brussels, Amsterdam and other European tourist destinations via the High Speed 1 rail link and the Channel Tunnel . The first high-speed domestic trains started in June 2009 linking Kent to London. There are plans for a second high speed line linking London to the Midlands, North West England, and Yorkshire. London's bus network runs 24 hours a day with about 9,300 vehicles, over 675 bus routes and about 19,000 bus stops. In 2019 the network had over 2 billion commuter trips per year. Since 2010 an average of £1.2 billion is taken in revenue each year. London has one of the largest wheelchair-accessible networks in the world and from the third quarter of 2007, became more accessible to hearing and visually impaired passengers as audio-visual announcements were introduced. An emblem of London, the red double-decker bus first appeared in the city in 1947 with the AEC Regent III RT (predecessor to the AEC Routemaster ). London's coach hub is Victoria Coach Station , opened in 1932. Nationalised in 1970 and then purchased by London Transport (now Transport for London ), Victoria Coach Station has over 14 million passengers a year and provides services across the UK and continental Europe. London has a modern tram network, known as Tramlink . It has 39 stops and four routes, and carried 28 million people in 2013. Since June 2008, Transport for London has completely owned and operated Tramlink. London's first and to date only cable car is the London Cable Car , which opened in June 2012. The cable car crosses the Thames and links Greenwich Peninsula with the Royal Docks in the east of the city. It is able to carry up to 2,500 passengers per hour in each direction at peak times. In the Greater London Area, around 670,000 people use a bike every day, meaning around 7% of the total population of around 8.8 million use a bike on an average day. Cycling has become an increasingly popular way to get around London. The launch of a bicycle hire scheme in July 2010 was successful and generally well received. The Port of London , once the largest in the world, is now only the second-largest in the United Kingdom, handling 45 million tonnes of cargo each year as of 2009. Most of this cargo passes through the Port of Tilbury , outside the boundary of Greater London. London has river boat services on the Thames known as Thames Clippers , which offer both commuter and tourist boat services. At major piers including Canary Wharf , London Bridge City , Battersea Power Station and London Eye (Waterloo), services depart at least every 20 minutes during commuter times. The Woolwich Ferry , with 2.5 million passengers every year, is a frequent service linking the North and South Circular Roads. Although the majority of journeys in central London are made by public transport, car travel is common in the suburbs. The inner ring road (around the city centre), the North and South Circular roads (just within the suburbs), and the outer orbital motorway (the M25 , just outside the built-up area in most places) encircle the city and are intersected by a number of busy radial routes—but very few motorways penetrate into inner London . The M25 is the second-longest ring-road motorway in Europe at 117 miles (188 km) long. The A1 and M1 connect London to Leeds , and Newcastle and Edinburgh . The Austin Motor Company began making hackney carriages (London taxis) in 1929, and models include Austin FX3 from 1948, Austin FX4 from 1958, with more recent models TXII and TX4 manufactured by London Taxis International . The BBC states, "ubiquitous black cabs and red double-decker buses all have long and tangled stories that are deeply embedded in London's traditions". London is notorious for its traffic congestion; in 2009, the average speed of a car in the rush hour was recorded at 10.6 mph (17.1 km/h) . In 2003, a congestion charge was introduced to reduce traffic volumes in the city centre. With a few exceptions, motorists are required to pay to drive within a defined zone encompassing much of central London. Motorists who are residents of the defined zone can buy a greatly reduced season pass. Over the course of several years, the average number of cars entering the centre of London on a weekday was reduced from 195,000 to 125,000. Low Traffic Neighbourhoods (LTN) were widely introduced in London, but in 2023 the Department for Transport stopped funding them, even though the benefits outweighed the costs by approximately 100 times in the first 20 years and the difference is growing over time. London is a major global centre of higher education teaching and research and has the largest concentration of higher education institutes in Europe. According to the QS World University Rankings 2015/16, London has the greatest concentration of top class universities in the world and its international student population of around 110,000 is larger than any other city in the world. A 2014 PricewaterhouseCoopers report termed London the global capital of higher education. A number of world-leading education institutions are based in London. In the 2022 QS World University Rankings , Imperial College London is ranked No. 6 in the world, University College London (UCL) is ranked 8th, and King's College London (KCL) is ranked 37th. All are regularly ranked highly, with Imperial College being the UK's leading university in the Research Excellence Framework ranking 2021. The London School of Economics (LSE) has been described as the world's leading social science institution for both teaching and research. The London Business School is considered one of the world's leading business schools and in 2015 its MBA programme was ranked second-best in the world by the Financial Times . The city is also home to three of the world's top ten performing arts schools (as ranked by the 2020 QS World University Rankings ): the Royal College of Music (ranking 2nd in the world), the Royal Academy of Music (ranking 4th) and the Guildhall School of Music and Drama (ranking 6th). With students in London and around 48,000 in University of London Worldwide , the federal University of London is the largest contact teaching university in the UK. It includes five multi-faculty universities – City , King's College London, Queen Mary , Royal Holloway and UCL – and a number of smaller and more specialised institutions including Birkbeck , the Courtauld Institute of Art , Goldsmiths , the London Business School, the London School of Economics, the London School of Hygiene & Tropical Medicine , the Royal Academy of Music , the Central School of Speech and Drama , the Royal Veterinary College and the School of Oriental and African Studies . Universities in London outside the University of London system include Brunel University , Imperial College London , [note 6] Kingston University , London Metropolitan University , University of East London , University of West London , University of Westminster , London South Bank University , Middlesex University , and University of the Arts London (the largest university of art, design, fashion, communication and the performing arts in Europe). In addition, there are three international universities – Regent's University London , Richmond, The American International University in London and Schiller International University . London is home to five major medical schools – Barts and The London School of Medicine and Dentistry (part of Queen Mary ), King's College London School of Medicine (the largest medical school in Europe), Imperial College School of Medicine , UCL Medical School and St George's, University of London – and has many affiliated teaching hospitals. It is also a major centre for biomedical research, and three of the UK's eight academic health science centres are based in the city – Imperial College Healthcare , King's Health Partners and UCL Partners (the largest such centre in Europe). Additionally, many biomedical and biotechnology spin out companies from these research institutions are based around the city, most prominently in White City . Founded by pioneering nurse Florence Nightingale at St Thomas' Hospital in 1860, the first nursing school is now part of King's College London. It was at King's in 1952 where a team led by Rosalind Franklin captured Photo 51 , the critical evidence in identifying the structure of DNA . There are a number of business schools in London, including the London School of Business and Finance , Cass Business School (part of City University London ), Hult International Business School , ESCP Europe , European Business School London , Imperial College Business School , the London Business School and the UCL School of Management . London is also home to many specialist arts education institutions, including the Royal Academy of Dramatic Art (RADA), Central School of Ballet , London Academy of Music and Dramatic Art (LAMDA), London College of Contemporary Arts (LCCA), London Contemporary Dance School , National Centre for Circus Arts , Rambert School of Ballet and Contemporary Dance , the Royal College of Art , Sylvia Young Theatre School and Trinity Laban . The BRIT School in the London borough of Croydon provides training for the performing arts and technologies. The majority of primary and secondary schools and further-education colleges in London are controlled by the London boroughs or otherwise state-funded; leading examples include Ashbourne College , Bethnal Green Academy , Brampton Manor Academy , City and Islington College , City of Westminster College , David Game College , Ealing, Hammersmith and West London College , Leyton Sixth Form College , London Academy of Excellence , Tower Hamlets College , and Newham Collegiate Sixth Form Centre . There are also a number of private schools and colleges in London, some old and famous, such as City of London School , Harrow , St Paul's School , Haberdashers' Aske's Boys' School , University College School , The John Lyon School , Highgate School and Westminster School . Founded in 1675, the Royal Observatory in Greenwich was established to address the problem of calculating longitude for navigational purposes. This pioneering work in solving longitude featured in astronomer royal Nevil Maskelyne 's Nautical Almanac which made the Greenwich meridian the universal reference point, and helped lead to the international adoption of Greenwich as the prime meridian (0° longitude) in 1884. Important scientific learned societies based in London include the Royal Society —the UK's national academy of sciences and the oldest national scientific institution in the world—founded in 1660, and the Royal Institution , founded in 1799. Since 1825, the Royal Institution Christmas Lectures have presented scientific subjects to a general audience, and speakers have included physicist and inventor Michael Faraday , aerospace engineer Frank Whittle , naturalist David Attenborough and evolutionary biologist Richard Dawkins . London is a major global centre of higher education teaching and research and has the largest concentration of higher education institutes in Europe. According to the QS World University Rankings 2015/16, London has the greatest concentration of top class universities in the world and its international student population of around 110,000 is larger than any other city in the world. A 2014 PricewaterhouseCoopers report termed London the global capital of higher education. A number of world-leading education institutions are based in London. In the 2022 QS World University Rankings , Imperial College London is ranked No. 6 in the world, University College London (UCL) is ranked 8th, and King's College London (KCL) is ranked 37th. All are regularly ranked highly, with Imperial College being the UK's leading university in the Research Excellence Framework ranking 2021. The London School of Economics (LSE) has been described as the world's leading social science institution for both teaching and research. The London Business School is considered one of the world's leading business schools and in 2015 its MBA programme was ranked second-best in the world by the Financial Times . The city is also home to three of the world's top ten performing arts schools (as ranked by the 2020 QS World University Rankings ): the Royal College of Music (ranking 2nd in the world), the Royal Academy of Music (ranking 4th) and the Guildhall School of Music and Drama (ranking 6th). With students in London and around 48,000 in University of London Worldwide , the federal University of London is the largest contact teaching university in the UK. It includes five multi-faculty universities – City , King's College London, Queen Mary , Royal Holloway and UCL – and a number of smaller and more specialised institutions including Birkbeck , the Courtauld Institute of Art , Goldsmiths , the London Business School, the London School of Economics, the London School of Hygiene & Tropical Medicine , the Royal Academy of Music , the Central School of Speech and Drama , the Royal Veterinary College and the School of Oriental and African Studies . Universities in London outside the University of London system include Brunel University , Imperial College London , [note 6] Kingston University , London Metropolitan University , University of East London , University of West London , University of Westminster , London South Bank University , Middlesex University , and University of the Arts London (the largest university of art, design, fashion, communication and the performing arts in Europe). In addition, there are three international universities – Regent's University London , Richmond, The American International University in London and Schiller International University . London is home to five major medical schools – Barts and The London School of Medicine and Dentistry (part of Queen Mary ), King's College London School of Medicine (the largest medical school in Europe), Imperial College School of Medicine , UCL Medical School and St George's, University of London – and has many affiliated teaching hospitals. It is also a major centre for biomedical research, and three of the UK's eight academic health science centres are based in the city – Imperial College Healthcare , King's Health Partners and UCL Partners (the largest such centre in Europe). Additionally, many biomedical and biotechnology spin out companies from these research institutions are based around the city, most prominently in White City . Founded by pioneering nurse Florence Nightingale at St Thomas' Hospital in 1860, the first nursing school is now part of King's College London. It was at King's in 1952 where a team led by Rosalind Franklin captured Photo 51 , the critical evidence in identifying the structure of DNA . There are a number of business schools in London, including the London School of Business and Finance , Cass Business School (part of City University London ), Hult International Business School , ESCP Europe , European Business School London , Imperial College Business School , the London Business School and the UCL School of Management . London is also home to many specialist arts education institutions, including the Royal Academy of Dramatic Art (RADA), Central School of Ballet , London Academy of Music and Dramatic Art (LAMDA), London College of Contemporary Arts (LCCA), London Contemporary Dance School , National Centre for Circus Arts , Rambert School of Ballet and Contemporary Dance , the Royal College of Art , Sylvia Young Theatre School and Trinity Laban . The BRIT School in the London borough of Croydon provides training for the performing arts and technologies. The majority of primary and secondary schools and further-education colleges in London are controlled by the London boroughs or otherwise state-funded; leading examples include Ashbourne College , Bethnal Green Academy , Brampton Manor Academy , City and Islington College , City of Westminster College , David Game College , Ealing, Hammersmith and West London College , Leyton Sixth Form College , London Academy of Excellence , Tower Hamlets College , and Newham Collegiate Sixth Form Centre . There are also a number of private schools and colleges in London, some old and famous, such as City of London School , Harrow , St Paul's School , Haberdashers' Aske's Boys' School , University College School , The John Lyon School , Highgate School and Westminster School .Founded in 1675, the Royal Observatory in Greenwich was established to address the problem of calculating longitude for navigational purposes. This pioneering work in solving longitude featured in astronomer royal Nevil Maskelyne 's Nautical Almanac which made the Greenwich meridian the universal reference point, and helped lead to the international adoption of Greenwich as the prime meridian (0° longitude) in 1884. Important scientific learned societies based in London include the Royal Society —the UK's national academy of sciences and the oldest national scientific institution in the world—founded in 1660, and the Royal Institution , founded in 1799. Since 1825, the Royal Institution Christmas Lectures have presented scientific subjects to a general audience, and speakers have included physicist and inventor Michael Faraday , aerospace engineer Frank Whittle , naturalist David Attenborough and evolutionary biologist Richard Dawkins . Leisure is a major part of the London economy. A 2003 report attributed a quarter of the entire UK leisure economy to London at 25.6 events per 1000 people. The city is one of the four fashion capitals of the world, and, according to official statistics, is the world's third-busiest film production centre, presents more live comedy than any other city, and has the biggest theatre audience of any city in the world. Within the City of Westminster in London, the entertainment district of the West End has its focus around Leicester Square , where London and world film premieres are held, and Piccadilly Circus , with its giant electronic advertisements. London's theatre district is here, as are many cinemas, bars, clubs, and restaurants, including the city's Chinatown district (in Soho ), and just to the east is Covent Garden , an area housing speciality shops. The city is the home of Andrew Lloyd Webber , whose musicals have dominated West End theatre since the late 20th century. Agatha Christie 's The Mousetrap , the world's longest-running play, has been performed in the West End since 1952. The Laurence Olivier Awards –named after Laurence Olivier –are given annually by the Society of London Theatre . The Royal Ballet , English National Ballet , Royal Opera , and English National Opera are based in London and perform at the Royal Opera House , the London Coliseum , Sadler's Wells Theatre , and the Royal Albert Hall , as well as touring the country. Islington 's 1 mile (1.6 km) long Upper Street, extending northwards from Angel , has more bars and restaurants than any other street in the UK. Europe's busiest shopping area is Oxford Street , a shopping street nearly 1 mile (1.6 km) long, making it the longest shopping street in the UK. It is home to vast numbers of retailers and department stores , including Selfridges flagship store . Knightsbridge , home to the equally renowned Harrods department store, lies to the south-west. One of the world's largest retail destinations, London frequently ranks at or near the top of retail sales of any city. Opened in 1760 with its flagship store on Regent Street since 1881, Hamleys is the oldest toy store in the world. Madame Tussauds wax museum opened in Baker Street in 1835, an era viewed as being when London's tourism industry began. London is home to designers John Galliano , Stella McCartney , Manolo Blahnik , and Jimmy Choo , among others; its renowned art and fashion schools make it one of the four international centres of fashion. Mary Quant designed the miniskirt in her King's Road boutique in Swinging Sixties London . In 2017, London was ranked the top city for luxury store openings. London Fashion Week takes place twice a year, in February and September; Londoners on the catwalk have included Naomi Campbell , Kate Moss and Cara Delevingne . London offers a great variety of cuisine as a result of its ethnically diverse population. Gastronomic centres include the Bangladeshi restaurants of Brick Lane and the Chinese restaurants of Chinatown . There are Chinese takeaways throughout London, as are Indian restaurants which provide Indian and Anglo-Indian cuisine . Around 1860, the first fish and chips shop in London was opened by Joseph Malin, a Jewish immigrant, in Bow . The full English breakfast dates from the Victorian era, and many cafes in London serve a full English throughout the day. London has five 3-Michelin star restaurants, including Restaurant Gordon Ramsay in Chelsea . Many hotels in London provide a traditional afternoon tea service, such as the Oscar Wilde Lounge at the Hotel Café Royal in Piccadilly, and a themed tea service is also available, for example an Alice in Wonderland themed afternoon tea served at the Egerton House Hotel , and Charlie and the Chocolate Factory themed afternoon tea at One Aldwych in Covent Garden. The nation's most popular biscuit to dunk in tea, chocolate digestives have been manufactured by McVitie's at their Harlesden factory in north-west London since 1925. There is a variety of annual events , beginning with the relatively new New Year's Day Parade , a fireworks display at the London Eye ; the world's second largest street party , the Notting Hill Carnival , is held on the late August Bank Holiday each year. Traditional parades include November's Lord Mayor's Show , a centuries-old event celebrating the annual appointment of a new Lord Mayor of the City of London with a procession along the streets of the city, and June's Trooping the Colour , a formal military pageant performed by regiments of the Commonwealth and British armies to celebrate the King's Official Birthday . The Boishakhi Mela is a Bengali New Year festival celebrated by the British Bangladeshi community. It is the largest open-air Asian festival in Europe. After the Notting Hill Carnival, it is the second-largest street festival in the United Kingdom attracting over 80,000 visitors. First held in 1862, the RHS Chelsea Flower Show (run by the Royal Horticultural Society ) takes place in May every year. The first gay bar in London in the modern sense was The Cave of the Golden Calf , established as a night club in an underground location at 9 Heddon Street, just off Regent Street , in 1912 and "which developed a reputation for sexual freedom and tolerance of same-sex relations." While London has been an LGBT tourism destination, after homosexuality was decriminalised in England in 1967 gay bar culture became more visible, and from the early 1970s Soho (and in particular Old Compton Street ) became the centre of the London LGBT community . G-A-Y , previously based at the Astoria , and now Heaven , is a long-running night club. Wider British cultural movements have influenced LGBT culture: for example, the emergence of glam rock in the UK in the early 1970s, via Marc Bolan and David Bowie , saw a generation of teenagers begin playing with the idea of androgyny, and the West End musical The Rocky Horror Show , which debuted in London in 1973, is also widely said to have been an influence on countercultural and sexual liberation movements. The Blitz Kids (which included Boy George ) frequented the Tuesday club-night at Blitz in Covent Garden , helping launch the New Romantic subcultural movement in the late 1970s. Today, the annual London Pride Parade and the London Lesbian and Gay Film Festival are held in the city. London has been the setting for many works of literature. The pilgrims in Geoffrey Chaucer 's late 14th-century Canterbury Tales set out for Canterbury from London. William Shakespeare spent a large part of his life living and working in London; his contemporary Ben Jonson was also based there, and some of his work, most notably his play The Alchemist , was set in the city. A Journal of the Plague Year (1722) by Daniel Defoe is a fictionalisation of the events of the 1665 Great Plague . The literary centres of London have traditionally been hilly Hampstead and (since the early 20th century) Bloomsbury . Writers closely associated with the city are the diarist Samuel Pepys , noted for his eyewitness account of the Great Fire ; Charles Dickens , whose representation of a foggy, snowy, grimy London of street sweepers and pickpockets has influenced people's vision of early Victorian London; and Virginia Woolf , regarded as one of the foremost modernist literary figures of the 20th century. Later important depictions of London from the 19th and early 20th centuries are Arthur Conan Doyle 's Sherlock Holmes stories. Robert Louis Stevenson mixed in London literary circles, and in 1886 he wrote the Strange Case of Dr Jekyll and Mr Hyde , a gothic novella set in Victorian London. In 1898, H. G. Wells ' sci-fi novel The War of the Worlds sees London (and southern England) invaded by Martians. Letitia Elizabeth Landon wrote Calendar of the London Seasons in 1834. Modern writers influenced by the city include Peter Ackroyd , author of London: The Biography , and Iain Sinclair , who writes in the genre of psychogeography . In the 1940s, George Orwell wrote essays in the London Evening Standard , including " A Nice Cup of Tea " (method for making tea) and " The Moon Under Water " (an ideal pub ). The WWII evacuation of children from London is depicted in C. S. Lewis ' first Narnia book The Lion, the Witch and the Wardrobe (1950). On Christmas Eve 1925, Winnie-the-Pooh debuted in London's Evening News , with the character based on a stuffed toy A. A. Milne bought for his son Christopher Robin in Harrods. In 1958, author Michael Bond created Paddington Bear , a refugee found in Paddington station . A screen adaptation, Paddington (2014), features the calypso song " London is the Place for Me ". London has played a significant role in the film industry. Major studios within or bordering London include Pinewood , Elstree , Ealing , Shepperton , Twickenham , and Leavesden , with the James Bond and Harry Potter series among many notable films produced here. Working Title Films has its headquarters in London. A post-production community is centred in Soho , and London houses six of the world's largest visual effects companies, such as Framestore . The Imaginarium , a digital performance-capture studio, was founded by Andy Serkis . London has been the setting for films including Oliver Twist (1948), Scrooge (1951), Peter Pan (1953), One Hundred and One Dalmatians (1961), My Fair Lady (1964), Mary Poppins (1964), Blowup (1966), A Clockwork Orange (1971), The Long Good Friday (1980), The Great Mouse Detective (1986), Notting Hill (1999), Love Actually (2003), V for Vendetta (2005), Sweeney Todd: The Demon Barber of Fleet Street (2008) and The King's Speech (2010). Notable actors and filmmakers from London include Charlie Chaplin , Alfred Hitchcock , Michael Caine , Julie Andrews , Peter Sellers , David Lean , Julie Christie , Gary Oldman , Emma Thompson , Guy Ritchie , Christopher Nolan , Alan Rickman , Jude Law , Helena Bonham Carter , Idris Elba , Tom Hardy , Daniel Radcliffe , Keira Knightley , Riz Ahmed , Dev Patel , Daniel Kaluuya , Tom Holland and Daniel Day-Lewis . Post-war Ealing comedies featured Alec Guinness , from the 1950s Hammer Horrors starred Christopher Lee , films by Michael Powell included the London-set early slasher Peeping Tom (1960), the 1970s comedy troupe Monty Python had film editing suites in Covent Garden, while since the 1990s Richard Curtis 's rom-coms have featured Hugh Grant . The largest cinema chain in the country, Odeon Cinemas was founded in London in 1928 by Oscar Deutsch . The British Academy Film Awards (BAFTAs) have been held in London since 1949, with the BAFTA Fellowship the Academy's highest accolade. Founded in 1957, the BFI London Film Festival takes place over two weeks every October. London is a major centre for television production, with studios including Television Centre , ITV Studios , Sky Campus and Fountain Studios ; the latter hosted the original talent shows, Pop Idol , The X Factor , and Britain's Got Talent , before each format was exported around the world. Formerly a franchise of ITV, Thames Television featured comedians such as Benny Hill and Rowan Atkinson ( Mr. Bean was first screened by Thames), while Talkback produced Da Ali G Show which featured Sacha Baron Cohen as Ali G . Many television shows have been set in London, including the popular television soap opera EastEnders . London is home to many museums , galleries, and other institutions, many of which are free of admission charges and are major tourist attractions as well as playing a research role. The first of these to be established was the British Museum in Bloomsbury , in 1753. Originally containing antiquities, natural history specimens, and the national library, the museum now has 7 million artefacts from around the globe. In 1824, the National Gallery was founded to house the British national collection of Western paintings; this now occupies a prominent position in Trafalgar Square . The British Library is the second largest library in the world , and the national library of the United Kingdom. There are many other research libraries, including the Wellcome Library and Dana Centre , as well as university libraries , including the British Library of Political and Economic Science at LSE , the Abdus Salam Library at Imperial , the Maughan Library at King's , and the Senate House Libraries at the University of London . In the latter half of the 19th century the locale of South Kensington was developed as " Albertopolis ", a cultural and scientific quarter. Three major national museums are there: the Victoria and Albert Museum , the Natural History Museum , and the Science Museum . The National Portrait Gallery was founded in 1856 to house depictions of figures from British history; its holdings now comprise the world's most extensive collection of portraits. The national gallery of British art is at Tate Britain , originally established as an annexe of the National Gallery in 1897. The Tate Gallery, as it was formerly known, also became a major centre for modern art. In 2000, this collection moved to Tate Modern , a new gallery housed in the former Bankside Power Station which is accessed by pedestrians north of the Thames via the Millennium Bridge . London is one of the major classical and popular music capitals of the world and hosts major music corporations, such as Universal Music Group International and Warner Music Group , and countless bands, musicians and industry professionals. The city is also home to many orchestras and concert halls, such as the Barbican Arts Centre (principal base of the London Symphony Orchestra and the London Symphony Chorus ), the Southbank Centre ( London Philharmonic Orchestra and the Philharmonia Orchestra ), Cadogan Hall ( Royal Philharmonic Orchestra ) and the Royal Albert Hall ( The Proms ). The Proms, an eight-week summer season of daily orchestral classical music first held in 1895, ends with the Last Night of the Proms . London's two main opera houses are the Royal Opera House and the London Coliseum (home to the English National Opera ). The UK's largest pipe organ is at the Royal Albert Hall. Other significant instruments are in cathedrals and major churches—the church bells of St Clement Danes feature in the 1744 nursery rhyme " Oranges and Lemons ". Several conservatoires are within the city: Royal Academy of Music , Royal College of Music , Guildhall School of Music and Drama and Trinity Laban . The record label EMI was formed in the city in 1931, and an early employee for the company, Alan Blumlein , created stereo sound that year. London has numerous venues for rock and pop concerts, including the world's busiest indoor venue, the O 2 Arena , and Wembley Arena , as well as many mid-sized venues, such as Brixton Academy , the Hammersmith Apollo and the Shepherd's Bush Empire . Several music festivals , including the Wireless Festival , Lovebox and Hyde Park 's British Summer Time , are held in London. The city is home to the original Hard Rock Cafe and the Abbey Road Studios , where the Beatles recorded many of their hits. In the 1960s, 1970s and 1980s, musicians and groups like Elton John , Pink Floyd , David Bowie , the Rolling Stones , the Kinks , Queen , Eric Clapton , the Who , Cliff Richard , Led Zeppelin , Iron Maiden , Deep Purple , T. Rex , the Police , Elvis Costello , Dire Straits , Cat Stevens , Fleetwood Mac , the Cure , Madness , Culture Club , Dusty Springfield , Phil Collins , Rod Stewart , Status Quo and Sade , derived their sound from the streets and rhythms of London. London was instrumental in the development of punk music , with figures such as the Sex Pistols , the Clash and fashion designer Vivienne Westwood all based in the city. Other artists to emerge from the London music scene include George Michael , Kate Bush , Seal , Siouxsie and the Banshees , Bush , the Spice Girls , Jamiroquai , Blur , the Prodigy , Gorillaz , Mumford & Sons , Coldplay , Dido , Amy Winehouse , Adele , Sam Smith , Ed Sheeran , Leona Lewis , Ellie Goulding , Dua Lipa and Florence and the Machine . Artists from London played a prominent role in the development of synth-pop , including Gary Numan , Depeche Mode , the Pet Shop Boys and Eurythmics ; the latter's " Sweet Dreams (Are Made of This) " was recorded in the attic of their north London home, heralding a trend for home recording methods. Artists from London with a Caribbean influence include Hot Chocolate , Billy Ocean , Soul II Soul and Eddy Grant , with the latter fusing reggae , soul and samba with rock and pop. London is also a centre for urban music. In particular the genres UK garage , drum and bass , dubstep and grime evolved in the city from the foreign genres of house , hip hop , and reggae, alongside local drum and bass . Urban acts from London include Stormzy , M.I.A. , Jay Sean and Rita Ora . Music station BBC Radio 1Xtra was set up to support the rise of local urban contemporary music both in London and in the rest of the United Kingdom. The British Phonographic Industry 's annual popular music awards, the Brit Awards , are held in London. Leisure is a major part of the London economy. A 2003 report attributed a quarter of the entire UK leisure economy to London at 25.6 events per 1000 people. The city is one of the four fashion capitals of the world, and, according to official statistics, is the world's third-busiest film production centre, presents more live comedy than any other city, and has the biggest theatre audience of any city in the world. Within the City of Westminster in London, the entertainment district of the West End has its focus around Leicester Square , where London and world film premieres are held, and Piccadilly Circus , with its giant electronic advertisements. London's theatre district is here, as are many cinemas, bars, clubs, and restaurants, including the city's Chinatown district (in Soho ), and just to the east is Covent Garden , an area housing speciality shops. The city is the home of Andrew Lloyd Webber , whose musicals have dominated West End theatre since the late 20th century. Agatha Christie 's The Mousetrap , the world's longest-running play, has been performed in the West End since 1952. The Laurence Olivier Awards –named after Laurence Olivier –are given annually by the Society of London Theatre . The Royal Ballet , English National Ballet , Royal Opera , and English National Opera are based in London and perform at the Royal Opera House , the London Coliseum , Sadler's Wells Theatre , and the Royal Albert Hall , as well as touring the country. Islington 's 1 mile (1.6 km) long Upper Street, extending northwards from Angel , has more bars and restaurants than any other street in the UK. Europe's busiest shopping area is Oxford Street , a shopping street nearly 1 mile (1.6 km) long, making it the longest shopping street in the UK. It is home to vast numbers of retailers and department stores , including Selfridges flagship store . Knightsbridge , home to the equally renowned Harrods department store, lies to the south-west. One of the world's largest retail destinations, London frequently ranks at or near the top of retail sales of any city. Opened in 1760 with its flagship store on Regent Street since 1881, Hamleys is the oldest toy store in the world. Madame Tussauds wax museum opened in Baker Street in 1835, an era viewed as being when London's tourism industry began. London is home to designers John Galliano , Stella McCartney , Manolo Blahnik , and Jimmy Choo , among others; its renowned art and fashion schools make it one of the four international centres of fashion. Mary Quant designed the miniskirt in her King's Road boutique in Swinging Sixties London . In 2017, London was ranked the top city for luxury store openings. London Fashion Week takes place twice a year, in February and September; Londoners on the catwalk have included Naomi Campbell , Kate Moss and Cara Delevingne . London offers a great variety of cuisine as a result of its ethnically diverse population. Gastronomic centres include the Bangladeshi restaurants of Brick Lane and the Chinese restaurants of Chinatown . There are Chinese takeaways throughout London, as are Indian restaurants which provide Indian and Anglo-Indian cuisine . Around 1860, the first fish and chips shop in London was opened by Joseph Malin, a Jewish immigrant, in Bow . The full English breakfast dates from the Victorian era, and many cafes in London serve a full English throughout the day. London has five 3-Michelin star restaurants, including Restaurant Gordon Ramsay in Chelsea . Many hotels in London provide a traditional afternoon tea service, such as the Oscar Wilde Lounge at the Hotel Café Royal in Piccadilly, and a themed tea service is also available, for example an Alice in Wonderland themed afternoon tea served at the Egerton House Hotel , and Charlie and the Chocolate Factory themed afternoon tea at One Aldwych in Covent Garden. The nation's most popular biscuit to dunk in tea, chocolate digestives have been manufactured by McVitie's at their Harlesden factory in north-west London since 1925. There is a variety of annual events , beginning with the relatively new New Year's Day Parade , a fireworks display at the London Eye ; the world's second largest street party , the Notting Hill Carnival , is held on the late August Bank Holiday each year. Traditional parades include November's Lord Mayor's Show , a centuries-old event celebrating the annual appointment of a new Lord Mayor of the City of London with a procession along the streets of the city, and June's Trooping the Colour , a formal military pageant performed by regiments of the Commonwealth and British armies to celebrate the King's Official Birthday . The Boishakhi Mela is a Bengali New Year festival celebrated by the British Bangladeshi community. It is the largest open-air Asian festival in Europe. After the Notting Hill Carnival, it is the second-largest street festival in the United Kingdom attracting over 80,000 visitors. First held in 1862, the RHS Chelsea Flower Show (run by the Royal Horticultural Society ) takes place in May every year. The first gay bar in London in the modern sense was The Cave of the Golden Calf , established as a night club in an underground location at 9 Heddon Street, just off Regent Street , in 1912 and "which developed a reputation for sexual freedom and tolerance of same-sex relations." While London has been an LGBT tourism destination, after homosexuality was decriminalised in England in 1967 gay bar culture became more visible, and from the early 1970s Soho (and in particular Old Compton Street ) became the centre of the London LGBT community . G-A-Y , previously based at the Astoria , and now Heaven , is a long-running night club. Wider British cultural movements have influenced LGBT culture: for example, the emergence of glam rock in the UK in the early 1970s, via Marc Bolan and David Bowie , saw a generation of teenagers begin playing with the idea of androgyny, and the West End musical The Rocky Horror Show , which debuted in London in 1973, is also widely said to have been an influence on countercultural and sexual liberation movements. The Blitz Kids (which included Boy George ) frequented the Tuesday club-night at Blitz in Covent Garden , helping launch the New Romantic subcultural movement in the late 1970s. Today, the annual London Pride Parade and the London Lesbian and Gay Film Festival are held in the city. London has been the setting for many works of literature. The pilgrims in Geoffrey Chaucer 's late 14th-century Canterbury Tales set out for Canterbury from London. William Shakespeare spent a large part of his life living and working in London; his contemporary Ben Jonson was also based there, and some of his work, most notably his play The Alchemist , was set in the city. A Journal of the Plague Year (1722) by Daniel Defoe is a fictionalisation of the events of the 1665 Great Plague . The literary centres of London have traditionally been hilly Hampstead and (since the early 20th century) Bloomsbury . Writers closely associated with the city are the diarist Samuel Pepys , noted for his eyewitness account of the Great Fire ; Charles Dickens , whose representation of a foggy, snowy, grimy London of street sweepers and pickpockets has influenced people's vision of early Victorian London; and Virginia Woolf , regarded as one of the foremost modernist literary figures of the 20th century. Later important depictions of London from the 19th and early 20th centuries are Arthur Conan Doyle 's Sherlock Holmes stories. Robert Louis Stevenson mixed in London literary circles, and in 1886 he wrote the Strange Case of Dr Jekyll and Mr Hyde , a gothic novella set in Victorian London. In 1898, H. G. Wells ' sci-fi novel The War of the Worlds sees London (and southern England) invaded by Martians. Letitia Elizabeth Landon wrote Calendar of the London Seasons in 1834. Modern writers influenced by the city include Peter Ackroyd , author of London: The Biography , and Iain Sinclair , who writes in the genre of psychogeography . In the 1940s, George Orwell wrote essays in the London Evening Standard , including " A Nice Cup of Tea " (method for making tea) and " The Moon Under Water " (an ideal pub ). The WWII evacuation of children from London is depicted in C. S. Lewis ' first Narnia book The Lion, the Witch and the Wardrobe (1950). On Christmas Eve 1925, Winnie-the-Pooh debuted in London's Evening News , with the character based on a stuffed toy A. A. Milne bought for his son Christopher Robin in Harrods. In 1958, author Michael Bond created Paddington Bear , a refugee found in Paddington station . A screen adaptation, Paddington (2014), features the calypso song " London is the Place for Me ". London has played a significant role in the film industry. Major studios within or bordering London include Pinewood , Elstree , Ealing , Shepperton , Twickenham , and Leavesden , with the James Bond and Harry Potter series among many notable films produced here. Working Title Films has its headquarters in London. A post-production community is centred in Soho , and London houses six of the world's largest visual effects companies, such as Framestore . The Imaginarium , a digital performance-capture studio, was founded by Andy Serkis . London has been the setting for films including Oliver Twist (1948), Scrooge (1951), Peter Pan (1953), One Hundred and One Dalmatians (1961), My Fair Lady (1964), Mary Poppins (1964), Blowup (1966), A Clockwork Orange (1971), The Long Good Friday (1980), The Great Mouse Detective (1986), Notting Hill (1999), Love Actually (2003), V for Vendetta (2005), Sweeney Todd: The Demon Barber of Fleet Street (2008) and The King's Speech (2010). Notable actors and filmmakers from London include Charlie Chaplin , Alfred Hitchcock , Michael Caine , Julie Andrews , Peter Sellers , David Lean , Julie Christie , Gary Oldman , Emma Thompson , Guy Ritchie , Christopher Nolan , Alan Rickman , Jude Law , Helena Bonham Carter , Idris Elba , Tom Hardy , Daniel Radcliffe , Keira Knightley , Riz Ahmed , Dev Patel , Daniel Kaluuya , Tom Holland and Daniel Day-Lewis . Post-war Ealing comedies featured Alec Guinness , from the 1950s Hammer Horrors starred Christopher Lee , films by Michael Powell included the London-set early slasher Peeping Tom (1960), the 1970s comedy troupe Monty Python had film editing suites in Covent Garden, while since the 1990s Richard Curtis 's rom-coms have featured Hugh Grant . The largest cinema chain in the country, Odeon Cinemas was founded in London in 1928 by Oscar Deutsch . The British Academy Film Awards (BAFTAs) have been held in London since 1949, with the BAFTA Fellowship the Academy's highest accolade. Founded in 1957, the BFI London Film Festival takes place over two weeks every October. London is a major centre for television production, with studios including Television Centre , ITV Studios , Sky Campus and Fountain Studios ; the latter hosted the original talent shows, Pop Idol , The X Factor , and Britain's Got Talent , before each format was exported around the world. Formerly a franchise of ITV, Thames Television featured comedians such as Benny Hill and Rowan Atkinson ( Mr. Bean was first screened by Thames), while Talkback produced Da Ali G Show which featured Sacha Baron Cohen as Ali G . Many television shows have been set in London, including the popular television soap opera EastEnders . London is home to many museums , galleries, and other institutions, many of which are free of admission charges and are major tourist attractions as well as playing a research role. The first of these to be established was the British Museum in Bloomsbury , in 1753. Originally containing antiquities, natural history specimens, and the national library, the museum now has 7 million artefacts from around the globe. In 1824, the National Gallery was founded to house the British national collection of Western paintings; this now occupies a prominent position in Trafalgar Square . The British Library is the second largest library in the world , and the national library of the United Kingdom. There are many other research libraries, including the Wellcome Library and Dana Centre , as well as university libraries , including the British Library of Political and Economic Science at LSE , the Abdus Salam Library at Imperial , the Maughan Library at King's , and the Senate House Libraries at the University of London . In the latter half of the 19th century the locale of South Kensington was developed as " Albertopolis ", a cultural and scientific quarter. Three major national museums are there: the Victoria and Albert Museum , the Natural History Museum , and the Science Museum . The National Portrait Gallery was founded in 1856 to house depictions of figures from British history; its holdings now comprise the world's most extensive collection of portraits. The national gallery of British art is at Tate Britain , originally established as an annexe of the National Gallery in 1897. The Tate Gallery, as it was formerly known, also became a major centre for modern art. In 2000, this collection moved to Tate Modern , a new gallery housed in the former Bankside Power Station which is accessed by pedestrians north of the Thames via the Millennium Bridge . London is one of the major classical and popular music capitals of the world and hosts major music corporations, such as Universal Music Group International and Warner Music Group , and countless bands, musicians and industry professionals. The city is also home to many orchestras and concert halls, such as the Barbican Arts Centre (principal base of the London Symphony Orchestra and the London Symphony Chorus ), the Southbank Centre ( London Philharmonic Orchestra and the Philharmonia Orchestra ), Cadogan Hall ( Royal Philharmonic Orchestra ) and the Royal Albert Hall ( The Proms ). The Proms, an eight-week summer season of daily orchestral classical music first held in 1895, ends with the Last Night of the Proms . London's two main opera houses are the Royal Opera House and the London Coliseum (home to the English National Opera ). The UK's largest pipe organ is at the Royal Albert Hall. Other significant instruments are in cathedrals and major churches—the church bells of St Clement Danes feature in the 1744 nursery rhyme " Oranges and Lemons ". Several conservatoires are within the city: Royal Academy of Music , Royal College of Music , Guildhall School of Music and Drama and Trinity Laban . The record label EMI was formed in the city in 1931, and an early employee for the company, Alan Blumlein , created stereo sound that year. London has numerous venues for rock and pop concerts, including the world's busiest indoor venue, the O 2 Arena , and Wembley Arena , as well as many mid-sized venues, such as Brixton Academy , the Hammersmith Apollo and the Shepherd's Bush Empire . Several music festivals , including the Wireless Festival , Lovebox and Hyde Park 's British Summer Time , are held in London. The city is home to the original Hard Rock Cafe and the Abbey Road Studios , where the Beatles recorded many of their hits. In the 1960s, 1970s and 1980s, musicians and groups like Elton John , Pink Floyd , David Bowie , the Rolling Stones , the Kinks , Queen , Eric Clapton , the Who , Cliff Richard , Led Zeppelin , Iron Maiden , Deep Purple , T. Rex , the Police , Elvis Costello , Dire Straits , Cat Stevens , Fleetwood Mac , the Cure , Madness , Culture Club , Dusty Springfield , Phil Collins , Rod Stewart , Status Quo and Sade , derived their sound from the streets and rhythms of London. London was instrumental in the development of punk music , with figures such as the Sex Pistols , the Clash and fashion designer Vivienne Westwood all based in the city. Other artists to emerge from the London music scene include George Michael , Kate Bush , Seal , Siouxsie and the Banshees , Bush , the Spice Girls , Jamiroquai , Blur , the Prodigy , Gorillaz , Mumford & Sons , Coldplay , Dido , Amy Winehouse , Adele , Sam Smith , Ed Sheeran , Leona Lewis , Ellie Goulding , Dua Lipa and Florence and the Machine . Artists from London played a prominent role in the development of synth-pop , including Gary Numan , Depeche Mode , the Pet Shop Boys and Eurythmics ; the latter's " Sweet Dreams (Are Made of This) " was recorded in the attic of their north London home, heralding a trend for home recording methods. Artists from London with a Caribbean influence include Hot Chocolate , Billy Ocean , Soul II Soul and Eddy Grant , with the latter fusing reggae , soul and samba with rock and pop. London is also a centre for urban music. In particular the genres UK garage , drum and bass , dubstep and grime evolved in the city from the foreign genres of house , hip hop , and reggae, alongside local drum and bass . Urban acts from London include Stormzy , M.I.A. , Jay Sean and Rita Ora . Music station BBC Radio 1Xtra was set up to support the rise of local urban contemporary music both in London and in the rest of the United Kingdom. The British Phonographic Industry 's annual popular music awards, the Brit Awards , are held in London. A 2013 report by the City of London Corporation said that London is the "greenest city" in Europe with 35,000 acres (14,164 hectares) of public parks, woodlands and gardens. The largest parks in the central area of London are three of the eight Royal Parks , namely Hyde Park and its neighbour Kensington Gardens in the west, and Regent's Park to the north. Hyde Park in particular is popular for sports and sometimes hosts open-air concerts. Regent's Park contains London Zoo , the world's oldest scientific zoo, and is near Madame Tussauds wax museum. Primrose Hill is a popular spot from which to view the city skyline. Close to Hyde Park are smaller Royal Parks, Green Park and St. James's Park . A number of large parks lie outside the city centre, including Hampstead Heath and the remaining Royal Parks of Greenwich Park to the southeast, and Bushy Park and Richmond Park (the largest) to the southwest. Hampton Court Park is also a royal park, but, because it contains a palace, it is administered by the Historic Royal Palaces , unlike the eight Royal Parks . Close to Richmond Park is Kew Gardens , which has the world's largest collection of living plants. In 2003, the gardens were put on the UNESCO list of World Heritage Sites . There are also parks administered by London's borough Councils, including Victoria Park in the East End and Battersea Park in the centre. Some more informal, semi-natural open spaces also exist, including Hampstead Heath and Epping Forest , both controlled by the City of London Corporation . Hampstead Heath incorporates Kenwood House , a former stately home and a popular location in the summer months when classical musical concerts are held by the lake. Epping Forest is a popular venue for various outdoor activities, including mountain biking, walking, horse riding, golf, angling, and orienteering. Three of the UK's most-visited theme parks, Thorpe Park near Staines-upon-Thames, Chessington World of Adventures in Chessington and Legoland Windsor , are located within 20 miles (32 km) of London. Walking is a popular recreational activity in London . Areas that provide for walks include Wimbledon Common , Epping Forest , Hampton Court Park , Hampstead Heath , the eight Royal Parks , canals and disused railway tracks. Access to canals and rivers has improved recently, including the creation of the Thames Path , some 28 miles (45 km) of which is within Greater London , and The Wandle Trail along the River Wandle . Other long-distance paths , linking green spaces, have also been created, including the Capital Ring , the Green Chain Walk , London Outer Orbital Path ("Loop"), Jubilee Walkway , Lea Valley Walk , and the Diana, Princess of Wales Memorial Walk . A 2013 report by the City of London Corporation said that London is the "greenest city" in Europe with 35,000 acres (14,164 hectares) of public parks, woodlands and gardens. The largest parks in the central area of London are three of the eight Royal Parks , namely Hyde Park and its neighbour Kensington Gardens in the west, and Regent's Park to the north. Hyde Park in particular is popular for sports and sometimes hosts open-air concerts. Regent's Park contains London Zoo , the world's oldest scientific zoo, and is near Madame Tussauds wax museum. Primrose Hill is a popular spot from which to view the city skyline. Close to Hyde Park are smaller Royal Parks, Green Park and St. James's Park . A number of large parks lie outside the city centre, including Hampstead Heath and the remaining Royal Parks of Greenwich Park to the southeast, and Bushy Park and Richmond Park (the largest) to the southwest. Hampton Court Park is also a royal park, but, because it contains a palace, it is administered by the Historic Royal Palaces , unlike the eight Royal Parks . Close to Richmond Park is Kew Gardens , which has the world's largest collection of living plants. In 2003, the gardens were put on the UNESCO list of World Heritage Sites . There are also parks administered by London's borough Councils, including Victoria Park in the East End and Battersea Park in the centre. Some more informal, semi-natural open spaces also exist, including Hampstead Heath and Epping Forest , both controlled by the City of London Corporation . Hampstead Heath incorporates Kenwood House , a former stately home and a popular location in the summer months when classical musical concerts are held by the lake. Epping Forest is a popular venue for various outdoor activities, including mountain biking, walking, horse riding, golf, angling, and orienteering. Three of the UK's most-visited theme parks, Thorpe Park near Staines-upon-Thames, Chessington World of Adventures in Chessington and Legoland Windsor , are located within 20 miles (32 km) of London. Walking is a popular recreational activity in London . Areas that provide for walks include Wimbledon Common , Epping Forest , Hampton Court Park , Hampstead Heath , the eight Royal Parks , canals and disused railway tracks. Access to canals and rivers has improved recently, including the creation of the Thames Path , some 28 miles (45 km) of which is within Greater London , and The Wandle Trail along the River Wandle . Other long-distance paths , linking green spaces, have also been created, including the Capital Ring , the Green Chain Walk , London Outer Orbital Path ("Loop"), Jubilee Walkway , Lea Valley Walk , and the Diana, Princess of Wales Memorial Walk . London has hosted the Summer Olympics three times: in 1908 , 1948 , and 2012 , making it the first city to host the modern Games three times. The city was also the host of the British Empire Games in 1934 . In 2017, London hosted the World Championships in Athletics for the first time. London's most popular sport is football , and it has seven clubs in the Premier League in the 2022–23 season : Arsenal , Brentford , Chelsea , Crystal Palace , Fulham , Tottenham Hotspur , and West Ham United . Other professional men's teams in London are AFC Wimbledon , Barnet , Bromley , Charlton Athletic , Dagenham & Redbridge , Leyton Orient , Millwall , Queens Park Rangers and Sutton United . Four London-based teams are in the Women's Super League : Arsenal , Chelsea , Tottenham and West Ham United . Two Premiership Rugby union teams are based in Greater London: Harlequins and Saracens . Ealing Trailfinders and London Scottish play in the RFU Championship ; other rugby union clubs in the city include Richmond , Rosslyn Park , Westcombe Park and Blackheath . Twickenham Stadium in south-west London hosts home matches for the England national rugby union team . While rugby league is more popular in the north of England, the sport has one professional club in London – the London Broncos who play in the Super League . One of London's best-known annual sports competitions is the Wimbledon Tennis Championships , held at the All England Club in the south-western suburb of Wimbledon since 1877. Played in late June to early July, it is the oldest tennis tournament in the world and widely considered the most prestigious. London has two Test cricket grounds which host the England cricket team , Lord's (home of Middlesex C.C.C. ) and the Oval (home of Surrey C.C.C. ). Lord's has hosted four finals of the Cricket World Cup and is known as the Home of Cricket . In golf, the Wentworth Club is located in Virginia Water , Surrey on the south-west fringes of London, while the closest venue to London that is used as one of the courses for the Open Championship , the oldest major and tournament in golf, is Royal St George's in Sandwich, Kent. Alexandra Palace in north London hosts the PDC World Darts Championship and the Masters snooker tournament. Other key annual events are the mass-participation London Marathon and the University Boat Race on the Thames contested between Oxford and Cambridge .

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Cholera

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Health in the Democratic Republic of the Congo

Health problems have been a long-standing issue limiting development in the Democratic Republic of the Congo (DR Congo). The Human Rights Measurement Initiative finds that the Democratic Republic of the Congo is fulfilling 73.1% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, the Democratic Republic of the Congo achieves 96.6% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves 100.0% of what is expected based on the nation's level of income. The Democratic Republic of the Congo falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 22.8% of what the nation is expected to achieve based on the resources (income) it has available. Medical facilities are severely limited, medical materials are in short supply. An adequate supply of prescription or over-the-counter drugs in local stores or pharmacies is also generally not available. Payment for any medical services is expected in cash in the DR Congo, in advance of treatment. [ citation needed ]In 2018, the CIA estimated the average life expectancy in the DR Congo to be 60.3 years: 59 for the male population and 61.6 for females (est. 2017.) Malaria is a major health problem in the DR Congo. Malaria is the principal cause of morbidity and mortality, accounting for more than 40 percent of all outpatient visits and for 19 percent of deaths among children under five years of age. Given that the majority of the population lives in high transmission zones, it has been estimated that the DRC accounts for 11 percent of all cases of malaria in sub-Saharan Africa . The National Malaria Control Strategic Plan 2016–2020 (NSP) introduced the stratification of provinces based on parasite prevalence as measured by the 2013 Demographic and Health Survey (DHS). This approach allows the NSP to focus high-impact interventions in the areas that bear the greatest disease burden. In line with this strategy, international donors are concentrating their efforts in 9 out of 26 provinces ( Kasai Oriental , Haut Katanga , Haut Lomami , Tanganyika , Lualaba , Sankuru , Lomami , Kasai Central , and Sud Kivu ). According to the 2013 DHS, progress is being made in key malaria interventions, such as insecticide-treated net ownership and use. Additionally, mortality rates for children under five years of age fell by 34 percent and the incidence rate fell by 40 percent between 2010 and 2018. Yellow fever and any other insect-borne illnesses are present as well. [ citation needed ] HIV/Aids is the most serious health problem in the DR Congo due to the incurable nature of the disease. By the end of 2003, UNAIDS estimated that 1.1 million people were living with HIV/AIDS, for an overall adult HIV prevalence of 4.2%. Life expectancy in the DR Congo dropped 9% in the 1990s as a result of HIV/AIDS.According to UNAIDS, several factors fuel the spread of HIV in the DR Congo, including the movement of large numbers of refugees and soldiers, scarcity and high cost of safe blood transfusions in rural areas, a lack of counseling , few HIV testing sites , high levels of untreated sexually transmitted infections among sex workers and their clients, and low availability of condoms outside Kinshasa and one or two provincial capitals. [ citation needed ] With an eventual end of hostilities and a government in transition, population movements associated with increased stability and economic revitalization will exacerbate the spread of HIV, which is now localized in areas most directly affected by the presence of troops and war-displaced populations. Consecutive wars have made it nearly impossible to conduct effective and sustainable HIV/AIDS prevention activities. [ citation needed ] Although incidence and mortality from cholera can be difficult to estimate, particularly given the DRC's lack of resources and inadequate surveillance systems, several studies demonstrate that the DRC experiences a significant burden of disease. In 2015, 19,705 cases of cholera were reported in the DRC. Few cases are laboratory-confirmed, so the incidence of cholera can be under-estimated. The highest annual attack rates occurred in 2011 in the Eastern provinces of the Democratic Republic of Congo that border the Great Lakes. These provinces are Orientale, North and South Kivu, Katanga and Kasai Oriental. North and South Kivu as well as Katanga had the highest attack rate with over 10 cases per 100,000 people, every year between 2000 and 2011. The high annual attack rates occurred in the Eastern provinces because there is an environmental reservoir for V. cholerae in the lakes of the rift valley. Additionally, there are seasonal peaks that usually occur during the first quarter of the year which also increases the attack rate. Furthermore, fishermen travel from the eastern lakes in the Democratic Republic of Congo to larger cities at the end of the dry season which gives way to seasonal variations in incidence of Cholera. Cross-border cholera remains difficult to track due to the lack of collaboration and communication between the Sub-Saharan countries. There have been 10 outbreaks of the Ebola virus disease in the Democratic Republic of the Congo. Additionally, hemorrhagic fever , polio , cholera , and typhoid , while tuberculosis is an increasingly serious health concern in the DR Congo. [ citation needed ] In 2019 a measles outbreak claimed more deaths than Ebola. People are at risk of onchocerciasis (River blindness) in parts of the DR Congo. [ citation needed ] The 2010 maternal mortality rate per 100,000 births for Democratic Republic of the Congo is 670. This is compared with 533.6 in 2008 and 550 in 1990. The under 5 mortality rate, per 1,000 births is 199 and the neonatal mortality as a percentage of under 5's mortality is 26. In Democratic Republic of the Congo the number of midwives per 1,000 live births is 2 and the lifetime risk of death for pregnant women 1 in 24. The DRC nutritional situation is still alarming despite global health progress. More than half (69%) of its population suffers from undernutrition The prevalence of stunting is 43% among children under 5 years old, with 14% of women in childbearing age; 8% for wasting with 3% of Severe Acute Malnutrition in children under 5 years old and finally 23% for underweight in children of the same age group. Stunting prevalence still higher and remains the most common of undernutrition in the country according to the Demographic and Health Survey 2013–2014 of DRC. Undernutrition has significant long term impact on the cognitive development of children, particularly those under 5 years old and of women in childbearing age previously malnourished. Consequently, affect human capital and the country's economic productivity. Undernutrition common indicators recommended by WHO include anthropometric measurements, biochemical indicators and clinical signs of undernutrition. Micronutrient deficiencies in DRC are caused mostly by food deprivation and poverty, with a particularly high incidence of vitamin A deficiency 61%; iron deficiency with 47% among children under 5 years old, 38% among women in reproductive age and 23% men. The improvement of the nutritional status of the population, particularly those of children under 5 and women of childbearing age, would reduce the mortality rate in this age group and make progress on Health Outcome Indicators specially the achievement of objective 3 of sustainable development, which aims to ensure a healthy life and promote the well-being of all at all ages. Hence on human capital, economic productivity and development. In 2018, the CIA estimated the average life expectancy in the DR Congo to be 60.3 years: 59 for the male population and 61.6 for females (est. 2017.) Malaria is a major health problem in the DR Congo. Malaria is the principal cause of morbidity and mortality, accounting for more than 40 percent of all outpatient visits and for 19 percent of deaths among children under five years of age. Given that the majority of the population lives in high transmission zones, it has been estimated that the DRC accounts for 11 percent of all cases of malaria in sub-Saharan Africa . The National Malaria Control Strategic Plan 2016–2020 (NSP) introduced the stratification of provinces based on parasite prevalence as measured by the 2013 Demographic and Health Survey (DHS). This approach allows the NSP to focus high-impact interventions in the areas that bear the greatest disease burden. In line with this strategy, international donors are concentrating their efforts in 9 out of 26 provinces ( Kasai Oriental , Haut Katanga , Haut Lomami , Tanganyika , Lualaba , Sankuru , Lomami , Kasai Central , and Sud Kivu ). According to the 2013 DHS, progress is being made in key malaria interventions, such as insecticide-treated net ownership and use. Additionally, mortality rates for children under five years of age fell by 34 percent and the incidence rate fell by 40 percent between 2010 and 2018. Yellow fever and any other insect-borne illnesses are present as well. [ citation needed ]HIV/Aids is the most serious health problem in the DR Congo due to the incurable nature of the disease. By the end of 2003, UNAIDS estimated that 1.1 million people were living with HIV/AIDS, for an overall adult HIV prevalence of 4.2%. Life expectancy in the DR Congo dropped 9% in the 1990s as a result of HIV/AIDS.According to UNAIDS, several factors fuel the spread of HIV in the DR Congo, including the movement of large numbers of refugees and soldiers, scarcity and high cost of safe blood transfusions in rural areas, a lack of counseling , few HIV testing sites , high levels of untreated sexually transmitted infections among sex workers and their clients, and low availability of condoms outside Kinshasa and one or two provincial capitals. [ citation needed ] With an eventual end of hostilities and a government in transition, population movements associated with increased stability and economic revitalization will exacerbate the spread of HIV, which is now localized in areas most directly affected by the presence of troops and war-displaced populations. Consecutive wars have made it nearly impossible to conduct effective and sustainable HIV/AIDS prevention activities. [ citation needed ]Although incidence and mortality from cholera can be difficult to estimate, particularly given the DRC's lack of resources and inadequate surveillance systems, several studies demonstrate that the DRC experiences a significant burden of disease. In 2015, 19,705 cases of cholera were reported in the DRC. Few cases are laboratory-confirmed, so the incidence of cholera can be under-estimated. The highest annual attack rates occurred in 2011 in the Eastern provinces of the Democratic Republic of Congo that border the Great Lakes. These provinces are Orientale, North and South Kivu, Katanga and Kasai Oriental. North and South Kivu as well as Katanga had the highest attack rate with over 10 cases per 100,000 people, every year between 2000 and 2011. The high annual attack rates occurred in the Eastern provinces because there is an environmental reservoir for V. cholerae in the lakes of the rift valley. Additionally, there are seasonal peaks that usually occur during the first quarter of the year which also increases the attack rate. Furthermore, fishermen travel from the eastern lakes in the Democratic Republic of Congo to larger cities at the end of the dry season which gives way to seasonal variations in incidence of Cholera. Cross-border cholera remains difficult to track due to the lack of collaboration and communication between the Sub-Saharan countries. There have been 10 outbreaks of the Ebola virus disease in the Democratic Republic of the Congo. Additionally, hemorrhagic fever , polio , cholera , and typhoid , while tuberculosis is an increasingly serious health concern in the DR Congo. [ citation needed ] In 2019 a measles outbreak claimed more deaths than Ebola. People are at risk of onchocerciasis (River blindness) in parts of the DR Congo. [ citation needed ]The 2010 maternal mortality rate per 100,000 births for Democratic Republic of the Congo is 670. This is compared with 533.6 in 2008 and 550 in 1990. The under 5 mortality rate, per 1,000 births is 199 and the neonatal mortality as a percentage of under 5's mortality is 26. In Democratic Republic of the Congo the number of midwives per 1,000 live births is 2 and the lifetime risk of death for pregnant women 1 in 24. The DRC nutritional situation is still alarming despite global health progress. More than half (69%) of its population suffers from undernutrition The prevalence of stunting is 43% among children under 5 years old, with 14% of women in childbearing age; 8% for wasting with 3% of Severe Acute Malnutrition in children under 5 years old and finally 23% for underweight in children of the same age group. Stunting prevalence still higher and remains the most common of undernutrition in the country according to the Demographic and Health Survey 2013–2014 of DRC. Undernutrition has significant long term impact on the cognitive development of children, particularly those under 5 years old and of women in childbearing age previously malnourished. Consequently, affect human capital and the country's economic productivity. Undernutrition common indicators recommended by WHO include anthropometric measurements, biochemical indicators and clinical signs of undernutrition. Micronutrient deficiencies in DRC are caused mostly by food deprivation and poverty, with a particularly high incidence of vitamin A deficiency 61%; iron deficiency with 47% among children under 5 years old, 38% among women in reproductive age and 23% men. The improvement of the nutritional status of the population, particularly those of children under 5 and women of childbearing age, would reduce the mortality rate in this age group and make progress on Health Outcome Indicators specially the achievement of objective 3 of sustainable development, which aims to ensure a healthy life and promote the well-being of all at all ages. Hence on human capital, economic productivity and development. The DRC nutritional situation is still alarming despite global health progress. More than half (69%) of its population suffers from undernutrition The prevalence of stunting is 43% among children under 5 years old, with 14% of women in childbearing age; 8% for wasting with 3% of Severe Acute Malnutrition in children under 5 years old and finally 23% for underweight in children of the same age group. Stunting prevalence still higher and remains the most common of undernutrition in the country according to the Demographic and Health Survey 2013–2014 of DRC. Undernutrition has significant long term impact on the cognitive development of children, particularly those under 5 years old and of women in childbearing age previously malnourished. Consequently, affect human capital and the country's economic productivity. Undernutrition common indicators recommended by WHO include anthropometric measurements, biochemical indicators and clinical signs of undernutrition. Micronutrient deficiencies in DRC are caused mostly by food deprivation and poverty, with a particularly high incidence of vitamin A deficiency 61%; iron deficiency with 47% among children under 5 years old, 38% among women in reproductive age and 23% men. The improvement of the nutritional status of the population, particularly those of children under 5 and women of childbearing age, would reduce the mortality rate in this age group and make progress on Health Outcome Indicators specially the achievement of objective 3 of sustainable development, which aims to ensure a healthy life and promote the well-being of all at all ages. Hence on human capital, economic productivity and development.

Wiki

Cholera

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Thomas Shapter

Thomas Shapter LLD MD FRCP (1809–1902) was born in Gibraltar , graduated from the University of Edinburgh , and arrived in Exeter in the year cholera arrived, 1832. Today, Shapter is best known for the account he wrote of this devastating cholera outbreak, entitled The History of the Cholera in Exeter in 1832 . He also served one term as Mayor of Exeter .Shapter developed a medical practice in Exeter and was a member of the governing body of the City, the Chamber, in 1835. As Newton puts it "his early admission into the restricted governing class of a cathedral city is a measure of his personality, as well as of his political and religious orthodoxy". Such ties were further cemented by his marriage in 1840 to the Reverend Samuel Blackhall's daughter. He was later to become Mayor (twice) and Sheriff of the City. He was appointed physician in 1847 at the Devon and Exeter Hospital and also worked at the Magdalen Hospital, The Lying-in Charity and St Thomas' Hospital for Lunatics (1845). He led an active public life and was elected Mayor of Exeter in 1848. When cholera again posed a threat in 1867 he opposed plans to transfer the powers of the Improvement Commissioners to the Board of Health under the 1858 Health Act. He appears to have still believed in the efficacy of the measures and institutions established during the 1830s. He retired from the staff of the Devon and Exeter Hospital in 1876 and later moved to London. Newton states that his departure from the city was under something of a cloud "His reputation seems to have suffered locally from the injudicious acceptance of a legacy from a mental patient under his care". In old age he went blind and died in 1902 aged 93. Apart from his famous work on cholera he also published books a number of other books which included. Leprosy in the Middle Ages and Climate of the South of Devon . He was also a collector of art which he used to furnish his home at no. 1 Barnfield Crescent.Shapter is best known for his interest in environment and disease through his work "History of the Cholera in Exeter in 1832" which was published in 1849. This account was described in the British Medical Journal of 8 April 1933 as "one of the best descriptions extant of an historical epidemic". It is one of the longest and most thorough of the local cholera histories written and interest in it was probably enhanced by the fact that it was published in the middle of a later outbreak of the disease. The compilation of the book was far from easy as the official records had already been lost by the time Shapter began the book in the 1840s, and he was dependent upon any other sources he could locate plus the reminiscences of those who lived through the disease or were involved in its treatment or prevention. The book describes the arrival of cholera in the city, the reactions of the citizens and authorities to the disease and the efforts of the Board of Health in coping with the outbreak. The book paints a vivid picture of the local conditions which helped to foster the spread of the disease in the city. It clearly describes the problems faced by nineteenth-century towns with their inadequate administrative arrangements, organisation and financial resources in trying to cope with the cholera outbreak. One of the fascinating features of the book are the engravings provided for it by the Exeter artist John Gendall . These were added quite late on in the publication process with Shapter commenting that he was pleased to include "these interesting sketches of old parts of Exeter".John Snow is well known for his study of the cholera outbreak in London and his use of a map to illustrate the locality of deaths to a public water source on Broad Street. The so-called "Ghost Map" is cited as a kind of watershed moment in the history of epidemiology and to some extent also in Information Design and GIS . [ citation needed ] The high profile of this work has led to research into the historicity of modern accounts and Thomas Shapter's influence on Snow: Snow may have realised that a spot map would be a useful illustration for his report to the parish committee and for his own book. The first edition of on the mode of communication of cholera, published in 1849, contained no maps and only one table. By 1854 Snow had seen the excellent map in Shapter's work on the cholera in Exeter, which Shapter included as a frontispiece but hardly discussed in his text. Shapter's book, which Snow cited in the second edition of his own work, may have persuaded Snow of the value of a map as an illustration.

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Cholera

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Soho

Soho is an area of the City of Westminster in the West End of London . Originally a fashionable district for the aristocracy, it has been one of the main entertainment districts in the capital since the 19th century. The area was developed from farmland by Henry VIII in 1536, when it became a royal park. It became a parish in its own right in the late 17th century, when buildings started to be developed for the upper class, including the laying out of Soho Square in the 1680s. St Anne's Church was established during the late 17th century, and remains a significant local landmark; other churches are the Church of Our Lady of the Assumption and St Gregory and St Patrick's Church in Soho Square. The aristocracy had mostly moved away by the mid-19th century, when Soho was particularly badly hit by an outbreak of cholera in 1854. For much of the 20th century Soho had a reputation as a base for the sex industry in addition to its night life and its location for the headquarters of leading film companies. Since the 1980s, the area has undergone considerable gentrification . It is now predominantly a fashionable district of upmarket restaurants and media offices, with only a small remnant of sex industry venues. London's gay community is centred on Old Compton Street in Soho. Soho's reputation as a major entertainment district of London stems from theatres such as the Windmill Theatre on Great Windmill Street and the Raymond Revuebar owned by entrepreneur Paul Raymond , and music clubs such as the 2i's Coffee Bar and the Marquee Club . Trident Studios was based in Soho, and the nearby Denmark Street has hosted numerous music publishing houses and instrument shops from the 20th century onwards. The independent British film industry is centred around Soho, including the British headquarters of Twentieth Century Fox and the British Board of Film Classification offices. The area has been popular for restaurants since the 19th century, including the long-standing Kettner's which was visited by numerous celebrities. Near to Soho is London's Chinatown , centred on Gerrard Street and containing several restaurants and shops.The name "Soho" first appears in the 17th century. The name is derived from a former hunting cry. James Scott, 1st Duke of Monmouth , used "soho" as a rallying call for his men at the Battle of Sedgemoor on 6 July 1685, half a century after the name was first used for this area of London. The Soho name has been reused by other entertainment and restaurant districts such as the Soho, Hong Kong entertainment zone and the cultural and commercial area of Soho in Málaga . The New York City neighbourhood of SoHo, Manhattan , gets its name from its location south of Houston Street , but is also a reference to London's Soho. The Pittsburgh neighbourhood of Uptown was also formerly called Soho, most likely having been named by its founder James Tustin after the London district, though it may refer to Soho, West Midlands . Soho has never been an administrative unit with formally defined boundaries; it is about 1 square mile (2.6 km 2 ) in area, and is usually considered to be bounded by Shaftesbury Avenue to the south, Oxford Street to the north, Regent Street to the west, and Charing Cross Road to the east. Apart from Oxford Street, all of these roads are 19th-century metropolitan improvements. The area to the west is known as Mayfair , to the north Fitzrovia , to the east St Giles and Covent Garden , and to the south St James's . Soho is part of the West End electoral ward which elects three councillors to Westminster City Council . The nearest London Underground stations are Oxford Circus , Piccadilly Circus , Tottenham Court Road , Leicester Square and Covent Garden . During the Middle Ages , the area that is now Soho was farmland that belonged to the Abbot and Convent of Abingdon and the master of Burton St Lazar Hospital in Leicestershire , who managed a leper hospital in St Giles in the Fields . In 1536, the land was taken by Henry VIII as a royal park for the Palace of Whitehall . The area south of what is now Shaftesbury Avenue did not stay in the Crown possession for long; Queen Mary sold around 7 acres (2.8 ha) in 1554, and most of the remainder was sold between 1590 and 1623. A small 2-acre (0.81 ha) section of land remained, until sold by Charles II in 1676. In the 1660s, ownership of Soho Fields passed to Henry Jermyn, 1st Earl of St Albans , who leased 19 out of the 22 acres (89,000 m 2 ) of land to Joseph Girle. He was granted permission to develop property and quickly passed the lease and development to bricklayer Richard Frith. Much of the land was granted freehold in 1698 by William III to William Bentinck, 1st Earl of Portland , while the southern part of Soho was sold piecemeal in the 16th and 17th centuries, partly to Robert Sidney, Earl of Leicester . Soho was part of the ancient parish of St Martin in the Fields , forming part of the Liberty of Westminster . As the population started to grow, a new church was provided, and in 1687 a new parish of St Anne was established for it. The parish stretched from Oxford Street in the north to Leicester Square in the south and from what is now Charing Cross Road in the east to Wardour Street in the west; it therefore included all of contemporary eastern Soho, including the Chinatown area. The western portion of modern Soho, around Carnaby Street, was part of the parish of St James , which was split off from St Martin in 1686. Building progressed rapidly in the late 17th century, with large properties such as Monmouth House (built for James Scott, 1st Duke of Monmouth, Charles II's eldest illegitimate son), Leicester House , Fauconberg House, Carlisle House and Newport House. Soho Square was first laid out in the 1680s on the former Soho Fields; by 1691, 41 houses had been completed there. It was originally called King Square in honour of Charles II, and a statue of him was based in the centre. Several upper-class families moved into the area, including those of Richard Graham, 1st Viscount Preston , and Edward Howard, 2nd Earl of Carlisle . The square had become known as Soho Square by 1720, at which point it had fashionable houses on all sides. Only No 10 and No 15 from this period have survived into the 21st century. Though the Earls of Leicester and Portland had intended Soho to be an upper-class estate comparable to Bloomsbury , Marylebone and Mayfair , it never developed as such. Immigrants began to settle in the area from around 1680 onwards, particularly French Huguenots after 1688. The area became known as London's French quarter. The French church in Soho Square was founded by Huguenots and opened on 25 March 1893, with a façade of terracotta and coloured brick designed by Aston Webb . A significant event in the history of epidemiology and public health was John Snow 's study of an 1854 outbreak of cholera in Soho. He identified the cause of the outbreak as water from the public pump at the junction of Broad Street (now Broadwick Street ) and Cambridge Street (now Lexington Street), close to the rear wall of what is today the John Snow public house . Snow mapped the addresses of the sick and noted that they were mostly people whose nearest access to water was the Broad Street pump. He persuaded the authorities to remove the handle of the pump, thus preventing any more of the infected water from being collected. The spring below the pump was later found to have been contaminated with sewage. This is an early example of epidemiology, public health medicine and the application of science—the germ theory of disease —in a real-life crisis. Science writer Steven Johnson has written about the changes related to the cholera outbreak, and notes that almost every building on the street that existed in 1854 has since been replaced. A replica of the pump, with a memorial plaque and without a handle (to signify Snow's action to halt the outbreak) was erected in 1992 near the location of the original. By the mid-18th century, the aristocrats who had been living in Soho Square or Gerrard Street had moved away, as more fashionable areas such as Mayfair became available. The historian and topographer William Maitland wrote that the parish "so greatly abound with French that is an easy Matter for a Stranger to imagine himself in France." Soho's character stems partly from the ensuing neglect by rich and fashionable London, and the lack of the redevelopment that characterised the neighbouring areas. The aristocracy had mostly disappeared from Soho by the 19th century, to be replaced by prostitutes, music halls and small theatres. The population increased significantly, reaching 327 inhabitants per acre by 1851, making the area one of the most densely populated areas of London. Houses became divided into tenements with chronic overcrowding and disease. The 1854 cholera outbreak caused the remaining upper-class families to leave the area. Numerous hospitals were built to cope with the health problem; six were constructed between 1851 and 1874. Businesses catering to household essentials were established at the same time. The restaurant trade in Soho improved dramatically in the early 20th century. The construction of new theatres along Shaftesbury Avenue and Charing Cross Road improved the reputation of the area, and a meal for theatre-goers became common. Public houses in Soho increased in popularity during the 1930s and were frequented by struggling authors, poets and artists. Since the decline of the sex industry in Soho in the 1980s, the area has returned to being more residential. The Soho Housing Association was established in 1976 to provide reasonable rented accommodation. By the 21st century, it had acquired around 400 flats. St Anne's Church in Dean Street was refurbished after decades of neglect, and a Museum of Soho was established. On 30 April 1999, the Admiral Duncan pub on Old Compton Street, which serves the gay community, was damaged by a nail bomb that left three dead and 30 injured. The bomb was the third that had been planted by David Copeland , a neo-Nazi who was attempting to stir up ethnic and homophobic tensions by carrying out a series of bombings. In early February 2020, parts of an unexploded Second World War bomb was discovered by construction workers developing a new mixed residential building in Richmond Mews, near Dean Street . Residents, employees, and pedestrians on Richmond Mews, Dean Street , Meard Street and St Anne's Court were evacuated on both the 3rd and 4th of February 2020. All road junctions connecting to the streets closed during retrieval of the bomb fragments as well. During the Middle Ages , the area that is now Soho was farmland that belonged to the Abbot and Convent of Abingdon and the master of Burton St Lazar Hospital in Leicestershire , who managed a leper hospital in St Giles in the Fields . In 1536, the land was taken by Henry VIII as a royal park for the Palace of Whitehall . The area south of what is now Shaftesbury Avenue did not stay in the Crown possession for long; Queen Mary sold around 7 acres (2.8 ha) in 1554, and most of the remainder was sold between 1590 and 1623. A small 2-acre (0.81 ha) section of land remained, until sold by Charles II in 1676. In the 1660s, ownership of Soho Fields passed to Henry Jermyn, 1st Earl of St Albans , who leased 19 out of the 22 acres (89,000 m 2 ) of land to Joseph Girle. He was granted permission to develop property and quickly passed the lease and development to bricklayer Richard Frith. Much of the land was granted freehold in 1698 by William III to William Bentinck, 1st Earl of Portland , while the southern part of Soho was sold piecemeal in the 16th and 17th centuries, partly to Robert Sidney, Earl of Leicester . Soho was part of the ancient parish of St Martin in the Fields , forming part of the Liberty of Westminster . As the population started to grow, a new church was provided, and in 1687 a new parish of St Anne was established for it. The parish stretched from Oxford Street in the north to Leicester Square in the south and from what is now Charing Cross Road in the east to Wardour Street in the west; it therefore included all of contemporary eastern Soho, including the Chinatown area. The western portion of modern Soho, around Carnaby Street, was part of the parish of St James , which was split off from St Martin in 1686. Building progressed rapidly in the late 17th century, with large properties such as Monmouth House (built for James Scott, 1st Duke of Monmouth, Charles II's eldest illegitimate son), Leicester House , Fauconberg House, Carlisle House and Newport House. Soho Square was first laid out in the 1680s on the former Soho Fields; by 1691, 41 houses had been completed there. It was originally called King Square in honour of Charles II, and a statue of him was based in the centre. Several upper-class families moved into the area, including those of Richard Graham, 1st Viscount Preston , and Edward Howard, 2nd Earl of Carlisle . The square had become known as Soho Square by 1720, at which point it had fashionable houses on all sides. Only No 10 and No 15 from this period have survived into the 21st century. Though the Earls of Leicester and Portland had intended Soho to be an upper-class estate comparable to Bloomsbury , Marylebone and Mayfair , it never developed as such. Immigrants began to settle in the area from around 1680 onwards, particularly French Huguenots after 1688. The area became known as London's French quarter. The French church in Soho Square was founded by Huguenots and opened on 25 March 1893, with a façade of terracotta and coloured brick designed by Aston Webb . A significant event in the history of epidemiology and public health was John Snow 's study of an 1854 outbreak of cholera in Soho. He identified the cause of the outbreak as water from the public pump at the junction of Broad Street (now Broadwick Street ) and Cambridge Street (now Lexington Street), close to the rear wall of what is today the John Snow public house . Snow mapped the addresses of the sick and noted that they were mostly people whose nearest access to water was the Broad Street pump. He persuaded the authorities to remove the handle of the pump, thus preventing any more of the infected water from being collected. The spring below the pump was later found to have been contaminated with sewage. This is an early example of epidemiology, public health medicine and the application of science—the germ theory of disease —in a real-life crisis. Science writer Steven Johnson has written about the changes related to the cholera outbreak, and notes that almost every building on the street that existed in 1854 has since been replaced. A replica of the pump, with a memorial plaque and without a handle (to signify Snow's action to halt the outbreak) was erected in 1992 near the location of the original. By the mid-18th century, the aristocrats who had been living in Soho Square or Gerrard Street had moved away, as more fashionable areas such as Mayfair became available. The historian and topographer William Maitland wrote that the parish "so greatly abound with French that is an easy Matter for a Stranger to imagine himself in France." Soho's character stems partly from the ensuing neglect by rich and fashionable London, and the lack of the redevelopment that characterised the neighbouring areas. The aristocracy had mostly disappeared from Soho by the 19th century, to be replaced by prostitutes, music halls and small theatres. The population increased significantly, reaching 327 inhabitants per acre by 1851, making the area one of the most densely populated areas of London. Houses became divided into tenements with chronic overcrowding and disease. The 1854 cholera outbreak caused the remaining upper-class families to leave the area. Numerous hospitals were built to cope with the health problem; six were constructed between 1851 and 1874. Businesses catering to household essentials were established at the same time. The restaurant trade in Soho improved dramatically in the early 20th century. The construction of new theatres along Shaftesbury Avenue and Charing Cross Road improved the reputation of the area, and a meal for theatre-goers became common. Public houses in Soho increased in popularity during the 1930s and were frequented by struggling authors, poets and artists. Since the decline of the sex industry in Soho in the 1980s, the area has returned to being more residential. The Soho Housing Association was established in 1976 to provide reasonable rented accommodation. By the 21st century, it had acquired around 400 flats. St Anne's Church in Dean Street was refurbished after decades of neglect, and a Museum of Soho was established. On 30 April 1999, the Admiral Duncan pub on Old Compton Street, which serves the gay community, was damaged by a nail bomb that left three dead and 30 injured. The bomb was the third that had been planted by David Copeland , a neo-Nazi who was attempting to stir up ethnic and homophobic tensions by carrying out a series of bombings. In early February 2020, parts of an unexploded Second World War bomb was discovered by construction workers developing a new mixed residential building in Richmond Mews, near Dean Street . Residents, employees, and pedestrians on Richmond Mews, Dean Street , Meard Street and St Anne's Court were evacuated on both the 3rd and 4th of February 2020. All road junctions connecting to the streets closed during retrieval of the bomb fragments as well. Soho is near the heart of London's theatre area . It is home to the Soho Theatre , built in 2000 to present new plays and comedy. The Windmill Theatre was based on Great Windmill Street, and was named after a windmill at this location that was demolished in the 18th century. It initially opened as the Palais de Luxe in 1910 as a small cinema, but was unable to compete with larger venues and was converted into a theatre by Howard Jones. It re-opened in December 1931, but was still unsuccessful. In 1932, the general manager Vivian Van Damm introduced a non-stop variety show throughout the afternoon and evening. It was famous for its nude tableaux vivants , in which the models had to remain motionless to avoid the censorship laws then in place. The theatre claimed that, aside from a compulsory closure between 4 and 16 September 1939, it was the only theatre in London which did not close during the Second World War; this led it to use the slogan "We never closed". Several prominent comedians including Harry Secombe , Jimmy Edwards and Tony Hancock began their careers at the Windmill. It closed on 31 October 1964 and was again turned into a cinema. The Raymond Revuebar at No. 11 Walker's Court was a small theatre specialising in striptease and nude dancing. It was owned by Paul Raymond and opened in 1958. The facade supported a brightly lit sign declaring it to be the "World Centre of Erotic Entertainment". Raymond subsequently bought the lease of the Windmill and ran it as a "nude entertainment" venue until 1981. The upstairs became known as the Boulevard Theatre and in 1980 was adopted as a comedy club called " The Comic Strip " by a small group of alternative comedians including Rik Mayall , Dawn French , Jennifer Saunders , Alexei Sayle and Adrian Edmondson , before they found wider recognition with the series The Comic Strip Presents on Channel 4 . The name and control of the theatre (but not the property itself) were bought by Raymond's business associate Gérard Simi in 1996. The theatre suffered financial difficulties owing to increasing rent, leading to its closure in 2004. It became a gay bar and cabaret venue called Too2Much; in 2005, Elton John staged a joint bachelor party there with his longtime partner David Furnish in anticipation of their civil partnership . The venue was subsequently renamed to the Soho Revue Bar, but closed in 2009. Soho is a centre of the independent film and video industry as well as the television and film post-production industry. Audio post duo White Lightning (Robbie Weston and Rick Dzendzera) opened two audio post-production facilities in different parts of Soho in 1986: Silk Sound at 13 Berwick Street , and The Bridge Facilities at 55-57 Great Marlborough Street . Silk Sound is still in operation, but The Bridge was sold to Miloco Studios in 2009, and relocated to the Orinoco Complex at 36 Leroy Street in Greater London. White Lightning also opened a third studio at 16 Dufours Place, named Space Facilities, in late 1995, but it closed in the same year The Bridge was sold. Twentieth Century House in Soho Square was built in 1937 for Twentieth Century Fox . The British Board of Film Classification , formerly known as the British Board of Film Censors, has been based in Soho Square since 1950. Soho's key fibre communications network has been managed by Sohonet since 1995, which connects the Soho media and post-production community to British film studios such as Pinewood and Shepperton , along with other locations worldwide include HBO and Warner Brothers . In the 2010s, research commissioned by Westminster City Council showed 23 per cent of the workforce in Soho worked in the creative industries. Many small and easily affordable restaurants and cafes were established in Soho during the 19th century, particularly as a result of Greek and Italian immigration. The restaurants were not looked upon favourably at first, but their reputation changed at the start of the 20th century. In 1924, a guide reported "of late years, the inexpensive restaurants of Soho have enjoyed an extraordinary vogue." Arthur Ransome 's Bohemia in London (1907) mentions Old and New Soho, including details about Soho coffee-houses including The Moorish Café and The Algerian. Kettner's was a restaurant on Romilly Street, established in 1867 by Napoleon III 's chef Auguste Kettner. It was frequently visited by Albert, Prince of Wales (where he is alleged to have dined with his mistress, Lillie Langtry ) and Oscar Wilde . The restaurant survived both World Wars without incident, and was regularly visited by Agatha Christie and Bing Crosby . In the 20th century, several Soho pubs and private members clubs gained notoriety for both their proprietors and clientele. Clive Jennings says of regular clientele such as Jeffrey Barnard and Francis Bacon that "the lethal triangle of The French , The Coach & Horses and The Colony were the staging points of the Dean Street shuffle, with occasional forays into other joints such as The Gargoyle or the Mandrake ... The Groucho or Blacks". Christopher Howse notes of the coterie of bohemian heavy drinkers that "There was no worry about pensions in Soho. People didn't live that long." The Gargoyle Club opened at 69 Dean Street in 1925. It was founded by the socialite the Hon David Tennant as a place where writers, artists and musicians could mingle with the upper crust and eat and drink at affordable prices for the next three decades. In May 1979 the Gargoyle's uppermost room started hosting a weekly club-night on Saturdays called the Comedy Store , which made the reputations of many of the UK's upcoming " alternative comedians ". Among the original lineup here were Alexei Sayle , Rik Mayall and Adrian Edmondson who broke away in 1980 to establish The Comic Strip team at Raymond's Revue Bar, before they found wider recognition with the series The Comic Strip Presents on Channel 4 . The Gargoyle's success and Bohemian clientele led to other restaurants being founded around Soho, including the Eiffel Tower and Bellotti's. During the 1970s the building at 69 Dean Street housed another nightspot in its cellars, initially known as Billy's, and run by Soho's only Jamaican club owner, Vince Howard. The Blitz Kids , a group of London clubgoers who spearheaded the New Romantic movement in the early 1980s, originally met at Billy's. The club changed its name to Gossip's and became part of London's clubland heritage by spawning several weekly club-nights that influenced British music and fashion during the 1980s. Gerrard Street is the centre of London's Chinatown , and along with Lisle Street and Little Newport Street, house a mix of import companies, oriental food shops and restaurants. Street festivals are held throughout the year, particularly on the Chinese New Year . In March 2022, Cadbury opened a temporary vegan chocolate shop at 15 Bateman Street. Soho Radio is an internet radio station on Great Windmill Street, next to the Windmill Theatre . Since May 2014 it has been streaming live and pre-recorded programming from its premises, which also function as a retail space and coffee shop. The station states on its website that it aims "to reflect the culture of Soho through our vibrant and diverse content". There is no playlist policy, and presenters are allowed to play any music they like. In 2016, it was voted the world's best radio station at Mixcloud 's Online Radio Awards. Soho is home to numerous religious and spiritual groups. St Anne's Church on Wardour Street was built between 1677 and 1686, possibly to the design of Sir Christopher Wren or William Talman . An additional tower was built in 1717 by Talman and reconstructed in 1803. The church was damaged by a V1 flying bomb during World War II in 1940, but the tower survived. In 1976, John Betjeman campaigned to save the building. The church was fully restored in the late 1980s and formally re-opened by the Princess Royal on 12 March 1990. The Church of Our Lady of the Assumption and St Gregory on Warwick Street was built in 1788 and is the only remaining 18th-century Roman Catholic embassy chapel in London and principal church of the Personal Ordinariate of Our Lady of Walsingham . St Patrick's Church in Soho Square was built in 1792 to accommodate Irish immigrants who had moved to the area. Other religious buildings in Soho include the Hare Krishna Temple off Soho Square, which was part-funded by George Harrison and opened in 1979. There exists a small mosque on Berwick Street. The French Protestant Church of London , the only one of its kind in the city and constructed in the Flemish Gothic style, has been at Nos. 8–9 Soho Square since 1893. The music scene in Soho can be traced back to 1948 and Club Eleven , generally regarded as the first venue where modern jazz, or bebop , was performed in the UK. It closed in 1950 following a drugs raid. The Harmony Inn was a hang-out for musicians on Archer Street operating during the 1940s and 1950s. The Ken Colyer Band's 51 Club, a venue for traditional jazz , opened on Great Newport Street in 1951. Blues guitarist and harmonica player Cyril Davies and guitarist Bob Watson launched the London Skiffle Centre, London's first skiffle club, on the first floor of the Roundhouse pub on Wardour Street in 1952. It was renamed the London Blues and Barrelhouse Club in the late 1950s, and closed in 1964. In the early 1950s, Soho became the centre of the beatnik culture in London. The first coffee bar to open was Moka at No. 29 Frith Street. It was formally opened in 1953 by the film star Gina Lollobrigida , and the frothed coffee produced from stainless steel machines was pioneering in British culture. Le Macabre on Wardour Street, had coffin-shaped tables, fostered beat poetry, jive dance and political debate. The Goings On, in Archer Street, was a Sunday afternoon club organised by the beat poet Pete Brown , active in the mid-1960s. For the rest of the week, it operated as an illegal gambling den . Pink Floyd played at the club at the beginning of their career. The 2i's Coffee Bar was one of the first rock clubs in Europe. It initially opened on No. 44 Gerard Street in 1956, but soon moved to its more famous venue of No. 59 Old Compton Street. Soho quickly became the centre of the fledgling rock scene in London. Clubs included the Flamingo Club , a regular gig for Georgie Fame , Ronan O'Rahilly 's The Scene , which opened in 1963 and catered for the Mod movement with regular attendees including Steve Marriot and Andrew Loog Oldham , and jazz clubs like Ronnie Scott's , which opened in 1959 at 39 Gerrard Street and moved to 47 Frith Street in 1965. Soho's Wardour Street was the home of the Marquee Club , which opened in 1958. In the 1960s, numerous major rock bands played at the venue, including early performances from the Rolling Stones in July 1962 and The Who in late 1964, Jimi Hendrix , David Bowie , Led Zeppelin , Pink Floyd , Jethro Tull , AC/DC and Iron Maiden . Eric Clapton and Brian Jones both lived for a time in Soho, sharing a flat with future rock publicist, Tony Brainsby . Trident Studios was based at 17 St Anne's Court , Soho and was a major London recording studio. It was established by Norman and Barry Sheffield in 1968, who wanted expand from the small studio they had above their music shop. It became immediately successful after The Beatles decided to record several tracks on The White Album there, as the facilities were better than Abbey Road studios . Queen were originally managed by the Sheffields, and recorded their first four albums and filmed the video for Bohemian Rhapsody at Trident. Other artists who recorded at Trident include David Bowie , Elton John , Free and Thin Lizzy . It closed as a general-purpose recording studio in 1981, but has since reopened in various guises, including providing sound and mixing services for television. Although technically not part of Soho, the adjacent Denmark Street is known for its connections with British popular music , and is nicknamed the British Tin Pan Alley due to its large concentration of shops selling musical instruments. The Sex Pistols lived beneath No. 6 and recorded their first demos there. Jimi Hendrix , the Rolling Stones and David Bowie have all recorded at studios on Denmark Street and Elton John wrote his hit " Your Song " in the street. Led Zeppelin 's first rehearsal in 1968 was in a basement studio on Gerrard Street. The Soho area has been at the heart of London's sex industry for more than 200 years; between 1778 and 1801, 21 Soho Square was location of the White House, a brothel described by the magistrate Henry Mayhew as "a notorious place of ill-fame". Shortly before World War I, two rival gangs, one led by Chan Nan (also called " Brilliant Chang ") and the other by Eddie Manning, controlled drugs and prostitution in Soho. Both were eventually arrested and imprisoned; Manning died midway through a three-year sentence in 1933. Following World War II, gangs set up rings of prostitutes in the area, concentrated around Brewer Street and Rupert Street. Photographers also visited Soho in the hope of being able to blackmail people caught in the act of visiting prostitutes. When the Street Offences Act 1959 drove prostitution off the streets, many clubs such as the Blue Lagoon at No. 50 Carnaby Street became fronts for it. Gangs controlled the clubs and the prostitutes, and the police were bribed. In 1960 London's first sex cinema, the Compton Cinema Club (a members-only club to get around the law), opened at 56 Old Compton Street. It was owned by Michael Klinger and Tony Tenser who later produced two early Roman Polanski films, including Repulsion (1965). As post-war austerity relaxed into the "swinging '60s", clip joints also surfaced; these unlicensed establishments sold coloured water as champagne with the promise of sex to follow, thus fleecing tourists looking for a "good time". Harrison Marks , a "glamour photographer" and girlie magazine publisher, had a photographic gallery on Gerrard Street and published several magazines in the 1950s and '60s. The model Pamela Green prompted him to take up nude photography, and she remained the creative force in their business. By the 1970s, the sex shops had grown from the handful opened by Carl Slack in the early 1960s. From 1976 to 1982, Soho had 54 sex shops, 39 sex cinemas and cinema clubs, 16 strip and peep shows, 11 sex-oriented clubs and 12 licensed massage parlours. The proliferation of sex shops dissuaded some people from visiting Soho. The growth of the sex industry in Soho during this time was partly caused by corruption in the Metropolitan Police . The vice squad at the time suffered from police officers enforcing against organised crime in the area, while simultaneously accepting bribes. This changed following the appointment of Robert Mark as chief constable, who began to crack down on corruption. In 1972 local residents started the Soho Society in order to control the increasing expansion of the sex industry in the area and improve it with a comprehensive redevelopment plan. This led to a series of corruption trials in 1975, following which several senior police officers were imprisoned. This caused a small recession in Soho which depressed property values at the time Paul Raymond had started buying freeholds there. By the 1980s, purges of the police force along with pressure from the Soho Society and new and tighter licensing controls by the City of Westminster led to a crackdown on illegal premises. The number of sex industry premises dropped from 185 in 1982 to around 30 in 1991. By 2000, substantial relaxation of general censorship , the ready availability of non-commercial sex, and the licensing or closing of unlicensed sex shops had reduced the red-light area to just a small area around Berwick Street. Much of the business has been reported to have been run by Albanian gangs. By the end of 2014, gentrification and competition from the internet had reduced the number of flats in Soho used for prostitution (see Soho walk-up ), but the area remains a red-light district and a centre of the sex industry in London. The National Hospital for Diseases of the Heart and Paralysis was established at No. 32 Soho Square in 1874. The property had previously been owned by the naturalist and botanist Sir Joseph Banks . It moved to Westmoreland Street in 1914, and then to Fulham Road in 1991. In July 2019, Soho was reported to be the unhealthiest place to live in Britain. Researchers from the University of Liverpool found that the area had the greatest access to takeaways, pubs and off-licences and these were combined with high levels of air pollution and low levels of parks and green spaces. Soho is near the heart of London's theatre area . It is home to the Soho Theatre , built in 2000 to present new plays and comedy. The Windmill Theatre was based on Great Windmill Street, and was named after a windmill at this location that was demolished in the 18th century. It initially opened as the Palais de Luxe in 1910 as a small cinema, but was unable to compete with larger venues and was converted into a theatre by Howard Jones. It re-opened in December 1931, but was still unsuccessful. In 1932, the general manager Vivian Van Damm introduced a non-stop variety show throughout the afternoon and evening. It was famous for its nude tableaux vivants , in which the models had to remain motionless to avoid the censorship laws then in place. The theatre claimed that, aside from a compulsory closure between 4 and 16 September 1939, it was the only theatre in London which did not close during the Second World War; this led it to use the slogan "We never closed". Several prominent comedians including Harry Secombe , Jimmy Edwards and Tony Hancock began their careers at the Windmill. It closed on 31 October 1964 and was again turned into a cinema. The Raymond Revuebar at No. 11 Walker's Court was a small theatre specialising in striptease and nude dancing. It was owned by Paul Raymond and opened in 1958. The facade supported a brightly lit sign declaring it to be the "World Centre of Erotic Entertainment". Raymond subsequently bought the lease of the Windmill and ran it as a "nude entertainment" venue until 1981. The upstairs became known as the Boulevard Theatre and in 1980 was adopted as a comedy club called " The Comic Strip " by a small group of alternative comedians including Rik Mayall , Dawn French , Jennifer Saunders , Alexei Sayle and Adrian Edmondson , before they found wider recognition with the series The Comic Strip Presents on Channel 4 . The name and control of the theatre (but not the property itself) were bought by Raymond's business associate Gérard Simi in 1996. The theatre suffered financial difficulties owing to increasing rent, leading to its closure in 2004. It became a gay bar and cabaret venue called Too2Much; in 2005, Elton John staged a joint bachelor party there with his longtime partner David Furnish in anticipation of their civil partnership . The venue was subsequently renamed to the Soho Revue Bar, but closed in 2009. Soho is a centre of the independent film and video industry as well as the television and film post-production industry. Audio post duo White Lightning (Robbie Weston and Rick Dzendzera) opened two audio post-production facilities in different parts of Soho in 1986: Silk Sound at 13 Berwick Street , and The Bridge Facilities at 55-57 Great Marlborough Street . Silk Sound is still in operation, but The Bridge was sold to Miloco Studios in 2009, and relocated to the Orinoco Complex at 36 Leroy Street in Greater London. White Lightning also opened a third studio at 16 Dufours Place, named Space Facilities, in late 1995, but it closed in the same year The Bridge was sold. Twentieth Century House in Soho Square was built in 1937 for Twentieth Century Fox . The British Board of Film Classification , formerly known as the British Board of Film Censors, has been based in Soho Square since 1950. Soho's key fibre communications network has been managed by Sohonet since 1995, which connects the Soho media and post-production community to British film studios such as Pinewood and Shepperton , along with other locations worldwide include HBO and Warner Brothers . In the 2010s, research commissioned by Westminster City Council showed 23 per cent of the workforce in Soho worked in the creative industries. Many small and easily affordable restaurants and cafes were established in Soho during the 19th century, particularly as a result of Greek and Italian immigration. The restaurants were not looked upon favourably at first, but their reputation changed at the start of the 20th century. In 1924, a guide reported "of late years, the inexpensive restaurants of Soho have enjoyed an extraordinary vogue." Arthur Ransome 's Bohemia in London (1907) mentions Old and New Soho, including details about Soho coffee-houses including The Moorish Café and The Algerian. Kettner's was a restaurant on Romilly Street, established in 1867 by Napoleon III 's chef Auguste Kettner. It was frequently visited by Albert, Prince of Wales (where he is alleged to have dined with his mistress, Lillie Langtry ) and Oscar Wilde . The restaurant survived both World Wars without incident, and was regularly visited by Agatha Christie and Bing Crosby . In the 20th century, several Soho pubs and private members clubs gained notoriety for both their proprietors and clientele. Clive Jennings says of regular clientele such as Jeffrey Barnard and Francis Bacon that "the lethal triangle of The French , The Coach & Horses and The Colony were the staging points of the Dean Street shuffle, with occasional forays into other joints such as The Gargoyle or the Mandrake ... The Groucho or Blacks". Christopher Howse notes of the coterie of bohemian heavy drinkers that "There was no worry about pensions in Soho. People didn't live that long." The Gargoyle Club opened at 69 Dean Street in 1925. It was founded by the socialite the Hon David Tennant as a place where writers, artists and musicians could mingle with the upper crust and eat and drink at affordable prices for the next three decades. In May 1979 the Gargoyle's uppermost room started hosting a weekly club-night on Saturdays called the Comedy Store , which made the reputations of many of the UK's upcoming " alternative comedians ". Among the original lineup here were Alexei Sayle , Rik Mayall and Adrian Edmondson who broke away in 1980 to establish The Comic Strip team at Raymond's Revue Bar, before they found wider recognition with the series The Comic Strip Presents on Channel 4 . The Gargoyle's success and Bohemian clientele led to other restaurants being founded around Soho, including the Eiffel Tower and Bellotti's. During the 1970s the building at 69 Dean Street housed another nightspot in its cellars, initially known as Billy's, and run by Soho's only Jamaican club owner, Vince Howard. The Blitz Kids , a group of London clubgoers who spearheaded the New Romantic movement in the early 1980s, originally met at Billy's. The club changed its name to Gossip's and became part of London's clubland heritage by spawning several weekly club-nights that influenced British music and fashion during the 1980s. Gerrard Street is the centre of London's Chinatown , and along with Lisle Street and Little Newport Street, house a mix of import companies, oriental food shops and restaurants. Street festivals are held throughout the year, particularly on the Chinese New Year . In March 2022, Cadbury opened a temporary vegan chocolate shop at 15 Bateman Street. Soho Radio is an internet radio station on Great Windmill Street, next to the Windmill Theatre . Since May 2014 it has been streaming live and pre-recorded programming from its premises, which also function as a retail space and coffee shop. The station states on its website that it aims "to reflect the culture of Soho through our vibrant and diverse content". There is no playlist policy, and presenters are allowed to play any music they like. In 2016, it was voted the world's best radio station at Mixcloud 's Online Radio Awards. Soho is home to numerous religious and spiritual groups. St Anne's Church on Wardour Street was built between 1677 and 1686, possibly to the design of Sir Christopher Wren or William Talman . An additional tower was built in 1717 by Talman and reconstructed in 1803. The church was damaged by a V1 flying bomb during World War II in 1940, but the tower survived. In 1976, John Betjeman campaigned to save the building. The church was fully restored in the late 1980s and formally re-opened by the Princess Royal on 12 March 1990. The Church of Our Lady of the Assumption and St Gregory on Warwick Street was built in 1788 and is the only remaining 18th-century Roman Catholic embassy chapel in London and principal church of the Personal Ordinariate of Our Lady of Walsingham . St Patrick's Church in Soho Square was built in 1792 to accommodate Irish immigrants who had moved to the area. Other religious buildings in Soho include the Hare Krishna Temple off Soho Square, which was part-funded by George Harrison and opened in 1979. There exists a small mosque on Berwick Street. The French Protestant Church of London , the only one of its kind in the city and constructed in the Flemish Gothic style, has been at Nos. 8–9 Soho Square since 1893. The music scene in Soho can be traced back to 1948 and Club Eleven , generally regarded as the first venue where modern jazz, or bebop , was performed in the UK. It closed in 1950 following a drugs raid. The Harmony Inn was a hang-out for musicians on Archer Street operating during the 1940s and 1950s. The Ken Colyer Band's 51 Club, a venue for traditional jazz , opened on Great Newport Street in 1951. Blues guitarist and harmonica player Cyril Davies and guitarist Bob Watson launched the London Skiffle Centre, London's first skiffle club, on the first floor of the Roundhouse pub on Wardour Street in 1952. It was renamed the London Blues and Barrelhouse Club in the late 1950s, and closed in 1964. In the early 1950s, Soho became the centre of the beatnik culture in London. The first coffee bar to open was Moka at No. 29 Frith Street. It was formally opened in 1953 by the film star Gina Lollobrigida , and the frothed coffee produced from stainless steel machines was pioneering in British culture. Le Macabre on Wardour Street, had coffin-shaped tables, fostered beat poetry, jive dance and political debate. The Goings On, in Archer Street, was a Sunday afternoon club organised by the beat poet Pete Brown , active in the mid-1960s. For the rest of the week, it operated as an illegal gambling den . Pink Floyd played at the club at the beginning of their career. The 2i's Coffee Bar was one of the first rock clubs in Europe. It initially opened on No. 44 Gerard Street in 1956, but soon moved to its more famous venue of No. 59 Old Compton Street. Soho quickly became the centre of the fledgling rock scene in London. Clubs included the Flamingo Club , a regular gig for Georgie Fame , Ronan O'Rahilly 's The Scene , which opened in 1963 and catered for the Mod movement with regular attendees including Steve Marriot and Andrew Loog Oldham , and jazz clubs like Ronnie Scott's , which opened in 1959 at 39 Gerrard Street and moved to 47 Frith Street in 1965. Soho's Wardour Street was the home of the Marquee Club , which opened in 1958. In the 1960s, numerous major rock bands played at the venue, including early performances from the Rolling Stones in July 1962 and The Who in late 1964, Jimi Hendrix , David Bowie , Led Zeppelin , Pink Floyd , Jethro Tull , AC/DC and Iron Maiden . Eric Clapton and Brian Jones both lived for a time in Soho, sharing a flat with future rock publicist, Tony Brainsby . Trident Studios was based at 17 St Anne's Court , Soho and was a major London recording studio. It was established by Norman and Barry Sheffield in 1968, who wanted expand from the small studio they had above their music shop. It became immediately successful after The Beatles decided to record several tracks on The White Album there, as the facilities were better than Abbey Road studios . Queen were originally managed by the Sheffields, and recorded their first four albums and filmed the video for Bohemian Rhapsody at Trident. Other artists who recorded at Trident include David Bowie , Elton John , Free and Thin Lizzy . It closed as a general-purpose recording studio in 1981, but has since reopened in various guises, including providing sound and mixing services for television. Although technically not part of Soho, the adjacent Denmark Street is known for its connections with British popular music , and is nicknamed the British Tin Pan Alley due to its large concentration of shops selling musical instruments. The Sex Pistols lived beneath No. 6 and recorded their first demos there. Jimi Hendrix , the Rolling Stones and David Bowie have all recorded at studios on Denmark Street and Elton John wrote his hit " Your Song " in the street. Led Zeppelin 's first rehearsal in 1968 was in a basement studio on Gerrard Street. The Soho area has been at the heart of London's sex industry for more than 200 years; between 1778 and 1801, 21 Soho Square was location of the White House, a brothel described by the magistrate Henry Mayhew as "a notorious place of ill-fame". Shortly before World War I, two rival gangs, one led by Chan Nan (also called " Brilliant Chang ") and the other by Eddie Manning, controlled drugs and prostitution in Soho. Both were eventually arrested and imprisoned; Manning died midway through a three-year sentence in 1933. Following World War II, gangs set up rings of prostitutes in the area, concentrated around Brewer Street and Rupert Street. Photographers also visited Soho in the hope of being able to blackmail people caught in the act of visiting prostitutes. When the Street Offences Act 1959 drove prostitution off the streets, many clubs such as the Blue Lagoon at No. 50 Carnaby Street became fronts for it. Gangs controlled the clubs and the prostitutes, and the police were bribed. In 1960 London's first sex cinema, the Compton Cinema Club (a members-only club to get around the law), opened at 56 Old Compton Street. It was owned by Michael Klinger and Tony Tenser who later produced two early Roman Polanski films, including Repulsion (1965). As post-war austerity relaxed into the "swinging '60s", clip joints also surfaced; these unlicensed establishments sold coloured water as champagne with the promise of sex to follow, thus fleecing tourists looking for a "good time". Harrison Marks , a "glamour photographer" and girlie magazine publisher, had a photographic gallery on Gerrard Street and published several magazines in the 1950s and '60s. The model Pamela Green prompted him to take up nude photography, and she remained the creative force in their business. By the 1970s, the sex shops had grown from the handful opened by Carl Slack in the early 1960s. From 1976 to 1982, Soho had 54 sex shops, 39 sex cinemas and cinema clubs, 16 strip and peep shows, 11 sex-oriented clubs and 12 licensed massage parlours. The proliferation of sex shops dissuaded some people from visiting Soho. The growth of the sex industry in Soho during this time was partly caused by corruption in the Metropolitan Police . The vice squad at the time suffered from police officers enforcing against organised crime in the area, while simultaneously accepting bribes. This changed following the appointment of Robert Mark as chief constable, who began to crack down on corruption. In 1972 local residents started the Soho Society in order to control the increasing expansion of the sex industry in the area and improve it with a comprehensive redevelopment plan. This led to a series of corruption trials in 1975, following which several senior police officers were imprisoned. This caused a small recession in Soho which depressed property values at the time Paul Raymond had started buying freeholds there. By the 1980s, purges of the police force along with pressure from the Soho Society and new and tighter licensing controls by the City of Westminster led to a crackdown on illegal premises. The number of sex industry premises dropped from 185 in 1982 to around 30 in 1991. By 2000, substantial relaxation of general censorship , the ready availability of non-commercial sex, and the licensing or closing of unlicensed sex shops had reduced the red-light area to just a small area around Berwick Street. Much of the business has been reported to have been run by Albanian gangs. By the end of 2014, gentrification and competition from the internet had reduced the number of flats in Soho used for prostitution (see Soho walk-up ), but the area remains a red-light district and a centre of the sex industry in London. The National Hospital for Diseases of the Heart and Paralysis was established at No. 32 Soho Square in 1874. The property had previously been owned by the naturalist and botanist Sir Joseph Banks . It moved to Westmoreland Street in 1914, and then to Fulham Road in 1991. In July 2019, Soho was reported to be the unhealthiest place to live in Britain. Researchers from the University of Liverpool found that the area had the greatest access to takeaways, pubs and off-licences and these were combined with high levels of air pollution and low levels of parks and green spaces. Berwick Street was built between 1687 and 1703, and is probably named after James FitzJames, 1st Duke of Berwick , the illegitimate son of James II of England . It has held a street market since the early 18th century, which has been formally organised since 1892. Carnaby Street was laid out in the late 17th century. It was named after Karnaby House, built on the street's eastern side in 1683. It was a popular residence for Huguenots at first, before becoming populated by shops in the 19th century. In 1957, a fashion boutique was opened, and Carnaby Street became the fashion centre of 1960s Swinging London , although it quickly became known for poor quality " kitsch " products. D'Arblay Street was laid out between 1735 and 1744. It was originally known as Portland Street after William Bentinck, 2nd Duke of Portland , and given its current named in 1909 in commemoration of Frances Burney , Madame D'Arblay, who had lived in Poland Street nearby, when she was young. The George public house at No. 1 was opened in 1889, but there has been a tavern on this site since 1739. Several of the original houses have survived into the 21st century. Dean Street was built in the 1680s and was originally settled by French immigrants. It is home to the Soho Theatre and a pub known as The French House , which during the Second World War was popular with the French government-in-exile. Karl Marx lived at No. 64 Dean Street around 1850. The Colony Club was founded by Muriel Belcher and based at No. 41 Dean Street from 1948 to 2008. It was frequented by several important artists including Francis Bacon , Lucian Freud and Frank Auerbach . Frith Street was named after Richard Frith, a local builder. On Rocque's Map of London it is marked as Thrift Street. It was a popular aristocratic residence, although without as many foreign residents as some other streets. A plaque above the stage door of the Prince Edward Theatre identifies the site where Mozart lived as a child between 1764 and 1765. John Logie Baird first demonstrated television in his laboratory at No 22 in 1926; the site is now the location of Bar Italia . Ronnie Scott's Jazz Club is located at No 46 Frith Street, having moved there from Gerrard Street in 1965. Greek Street was first laid out around 1680 and was named after a nearby Greek church. It initially housed several upper-class tenants including Arthur Annesley, 5th Earl of Anglesey , and Peter Plunket, 4th Earl of Fingall . Thomas De Quincey lived in the street after running away from Manchester Grammar School in 1802. Josiah Wedgwood ran his main pottery warehouse and showrooms at Nos. 12–13 between 1774 and 1797. The street now mostly contains restaurants, and several historical buildings from the early 18th century are still standing. Gerrard Street was built between 1677 and 1685 on land, called the Military Ground, which was owned by Charles Gerard, 1st Earl of Macclesfield . The initial development contained a large house belonging to the Earl of Devonshire , which was subsequently occupied by Charles Montagu, 4th Earl of Manchester , Thomas Wharton, Baron Wharton , and Richard Lumley, 1st Earl of Scarbrough . Several foreign restaurants had become established on Gerrard Street by the end of the 19th century, including the Hotel des Etrangers and the Mont Blanc. Ronnie Scott's Jazz Club opened at 39 Gerrard Street in 1959 and remained there until its move to No 47 Frith Street in 1965. Scott kept 39 Gerrard Street open for up-and-coming British jazz musicians (referred to as 'the Old Place') until the lease ran out in 1967. The 43 Club was based on Gerrard Street. It was one of the most notorious clubs in Soho, run as a cover for organised crime and illegal after-hours selling of alcohol; following a police investigation, the owner Kate Meyrick was jailed in 1928. During the 1950s, the cheap rents on Gerrard Street attracted Chinese Londoners, many who moved from Poplar . By 1970, the street had become the centre of London's Chinatown , and it became pedestrianised and decorated with a Chinese gateway and lanterns. It continues to host numerous Chinese restaurants and shops into the 21st century. Golden Square is a garden square to the southwest of Soho. Built over land formerly used for grazing, its name is a corruption of gelding . Building began in 1675 and it was complete by the early 18th century. It was originally home to several upper-class residents, including Barbara Villiers, Duchess of Cleveland , James Brydges (later to become 1st Duke of Chandos ), and Henry St John, 1st Viscount St John . By the mid-18th century the aristocracy had moved west towards Mayfair , and a number of foreign embassies were established around the square. In the 19th century, it became a popular residence for local musicians and instrument makers, while by the 20th it had become an established centre of woollen merchants. A statue of King George II sits in the centre of the square, designed by John Van Nost and constructed in 1753. Great Marlborough Street was first laid out in the early 18th century, and named after the military commander John Churchill, 1st Duke of Marlborough . The street was initially fashionable and was home to numerous peers. The London College of Music was based at No. 47 from 1896 to 1990, while the department store Liberty is on the corner with Regent Street. The street was the location of Philip Morris 's original London factory and gave its name to the Marlboro brand of cigarettes. Marlborough Street Magistrates Court was based at No. 20–21 and had become one of the country's most important magistrates courts by the late 19th century. The Marquess of Queensbury 's libel trial against Oscar Wilde took place here in 1895. The Rolling Stones ' Mick Jagger and Keith Richards were tried for drugs possession at the court in 1967, with fellow band member Brian Jones being similarly charged a year later. Great Windmill Street [lower-alpha 1] was named after a 17th-century windmill on this location. The Scottish anatomist William Hunter opened his anatomical theatre at No. 16 in 1766, running it until his death in 1783. It continued to be used for anatomical lectures until 1831. The principles of The Communist Manifesto were laid out by Karl Marx in 1850 at a meeting in the Red Lion pub. Old Compton Street is named after the Bishop of London Henry Compton , and was first laid out in the 1670s, fully developed by 1683. During the late 18th and 19th centuries, it became a popular meeting place for French exiles. The street was the birthplace of Europe's rock club circuit ( 2i's club) and contained the first adult cinema in England (The Compton Cinema Club). Dougie Millings , who was the famous tailor for The Beatles , had his first shop at 63 Old Compton Street, which opened in 1962. Old Compton Street is now the core of London's main gay village , where there are several businesses catering for the gay community. Poland Street was named for the King of Poland pub which stood at one end. It was destroyed by a bomb in 1940. Henry Howard, 6th Earl of Suffolk lived at No. 15 in 1717, while Percy Bysshe Shelley briefly lodged in the street in 1811. William Blake lived at No. 28 from 1785 to 1791, and wrote several works there, including Songs of Innocence and The Book of Thel . The street was the site of the St James Workhouse whose infirmary is believed to be the predecessor to the St. James Infirmary . The first multi-storey car park in London opened on Poland Street in 1934. Wardour Street dates back to 1585, when it was known as Commonhedge Lane and connected Oxford Street to the King's Mews (now part of Trafalgar Square ). It began to be built up in the 1680s and was named after local landowner Edward Wardour. Most of the original houses were rebuilt in the 18th century, and the street became known for antiques and furniture dealers. Several music publishers were established along Wardour Street in the early 20th century, including Novello and Co at Nos. 152–160. The most famous location of the Marquee Club was at No. 90 Wardour Street between 1964 and 1988. Another seventies rock hangout was The Intrepid Fox pub (at 97/99 Wardour Street), originally dedicated to Charles James Fox (who is featured on a relief on the outside of the building). It subsequently became a haven for the Goth subculture before closing in 2006.

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Ghosts (American TV series)

Joe Port Joe Wiseman Joe Port Joe Wiseman Mathew Baynton Jim Howick Simon Farnaby Laurence Rickard Ben Willbond Martha Howe-Douglas Alison Carpenter Debra Hayward Alison Owen Angie Stephenson Joe vs. Joe Monumental Television Them There (season 3) Lionsgate Television BBC Studios America CBS Studios Ghosts is an American television sitcom . It was adapted to American television for CBS by Joe Port and Joe Wiseman from the British series of the same name . Port & Wiseman serve as showrunners . The American series premiered on October 7, 2021. In October 2021, the series was picked up for a full season. In January 2022, the series was renewed for a second season; which premiered on September 29, 2022. In January 2023, the series was renewed for a third season; which began filming in Montreal on December 2, 2023. The third season premiered on February 15, 2024. In March 2024, the series was renewed for a fourth season. Married New Yorkers Samantha and Jay Arondekar believe that their dreams have come true when they inherit a beautiful country house from Sophie Woodstone, Sam's great aunt, only to find that it is falling apart and inhabited by ghosts who died on the property and are now bound to the area, appearing as they did at the times of their deaths, until they can reach the afterlife . Jay cannot see or hear the ghosts, but Sam can after a near-death experience .Alice Manning as Young Hetty, who could see ghosts as a small child. Sam Ashe Arnold as Young Trevor. John Hartman as Nigel Chessum, the leader of the trio, whom Isaac accidentally shot. They have had secret romantic feelings for one another since they were alive, and they begin a relationship at the end of the first season. Chad Andrews (Season 1) and Steven Yaffee (Seasons 3-present) as Baxter, Nigel's subordinate who plays a fife. Christian Daoust as Jenkins, Nigel's subordinate who possesses a musket. He and Nigel had a physical relationship before Nigel and Isaac started dating, and they "liaison" once more when Isaac and Nigel go "on a respite". Louis Labonville as Young Bjorn. Emily Mitchell as Young Laura. David Kohlsmith as Young Jeremy.Alice Manning as Young Hetty, who could see ghosts as a small child. Sam Ashe Arnold as Young Trevor.Alice Manning as Young Hetty, who could see ghosts as a small child. Sam Ashe Arnold as Young Trevor.John Hartman as Nigel Chessum, the leader of the trio, whom Isaac accidentally shot. They have had secret romantic feelings for one another since they were alive, and they begin a relationship at the end of the first season. Chad Andrews (Season 1) and Steven Yaffee (Seasons 3-present) as Baxter, Nigel's subordinate who plays a fife. Christian Daoust as Jenkins, Nigel's subordinate who possesses a musket. He and Nigel had a physical relationship before Nigel and Isaac started dating, and they "liaison" once more when Isaac and Nigel go "on a respite". Louis Labonville as Young Bjorn.John Hartman as Nigel Chessum, the leader of the trio, whom Isaac accidentally shot. They have had secret romantic feelings for one another since they were alive, and they begin a relationship at the end of the first season. Chad Andrews (Season 1) and Steven Yaffee (Seasons 3-present) as Baxter, Nigel's subordinate who plays a fife. Christian Daoust as Jenkins, Nigel's subordinate who possesses a musket. He and Nigel had a physical relationship before Nigel and Isaac started dating, and they "liaison" once more when Isaac and Nigel go "on a respite". Louis Labonville as Young Bjorn.Emily Mitchell as Young Laura. David Kohlsmith as Young Jeremy.Sam and Jay meet the Farnsbys, an older couple living on an adjacent property, who attempt to sabotage their renovations, which leads them to invite them over for dinner. At the dinner party, the ghosts attempt to sabotage Sam until she points out they need her to maintain a connection to the world of the living. In the end, with the help of the ghosts, especially Pete's knowledge of 1980s television, the Farnsbys promise to support their permit applications for their renovations. The ghosts are unable to get into the Halloween spirit, being unable to participate and believing it to be insulting to ghosts. Taking advantage of Sam's ability to see and hear them, Isaac, Hetty, Sasappis and Thorfinn guard the mansion against trick-or-treating vandals. Meanwhile, Alberta, Pete and Trevor are horrified by media depictions of ghosts as they watch Ghostbusters . After Thorfinn uses his powers to accidentally set the front yard gazebo on fire and Isaac blames one of the young vandals, the ghosts argue over whether to tell Sam the truth. As Sam introduces the ghosts to the Internet and social media, Trevor believes that he fathered a child from one of his one-night stands in 2000. After Sam locates Pete's wife Carol online, she invites her to the mansion at Pete's insistence, using his old Trooper's manual as an excuse. Pete finds that his wife and best friend were not only involved before his death, but are now married and he is furious until Sam reads one of his notes from his manual on forgiveness. Pete's daughter, Laura, then reveals his grandson has been named after him in his honor. Meanwhile, Thorfinn and Sasappis become obsessed with a reality show , which the former binge-watches without the latter. To land a permanent job at a local magazine, Sam decides to write a human interest article about a ' Robin Hood -esque' bank robbery carried out by Flower during her time in a 'commune', but Flower refuses to be interviewed as she swore to secrecy. Having heard about the incident ad nauseam since Flower's death, Isaac and Alberta decide to learn about the robbery on Sam's behalf. Meanwhile, Sam encounters Shiki: the ghost of a Lenape woman on whom Sasappis had a crush, and she and Jay try to establish long-distance communication between them. Sam volunteers to help Jay and the ghosts play Dungeons & Dragons together when Jay's D&D group abandons him. Also, Sam discovers that an old shed on the mansion's grounds was a British barracks during the Revolutionary War , now occupied by three ghosts of British soldiers, one of whom, Nigel, learns that Isaac, who has secretly requited feelings for him, accidentally shot and killed him. Todd Pearlman, an obsessive fan of Alberta's, visits the mansion to do research for a biography he is writing about her and discovers that her briefcase contains vintage moonshine. He nearly dies from drinking it, as it was poisoned, confirming Alberta's suspicions that she was murdered. Elsewhere, Thorfinn tries reconnecting with Hetty during walks outside the mansion, as he remembers that she could see and hear ghosts as a child, which is a rare gift among living human children. While trying to repair a sconce, Jay accidentally falls on top of Hetty, who possesses him and takes on-and-off control of his body. Sam struggles to keep this a secret from a wedding planner who is difficult to impress and visits the mansion to sample Jay's cooking. Refusing to be exorcised , Hetty attempts to escape the mansion in Jay's car, only to be separated from him because she cannot leave the mansion's grounds. Jay's sister, Bela, comes to visit after a break up, but reveals that she's been having great conversations with someone online. Sam and Jay are shocked when they realize that it's Trevor. Trevor reveals that he used their iPad to make a dating account. When Bela discovers the account on the iPad, she assumes that Jay created the profile and is furious. Sam tells her the truth about her talking to ghosts, and while Bela is as first skeptical, Sam is able to convince her with the help of the ghosts. Meanwhile, Nancy, still pretending to be Pete's girlfriend, threatens to tell Alberta the truth if Pete doesn't start to be more assertive. While Pete initially listens to her, he becomes upset when it leads to the other ghosts fighting. When Pete assertively tells Nancy that he enjoys being the one who keeps the peace, Nancy is proud of him for standing up for himself and pretends to break up with him and goes back to the cholera pit. Paula, a producer behind the documentary TV series Dumb Deaths , wants to make a short film about Flower's death, although Flower is reluctant to having her image used in an unflattering light to raise money for the B&B. A chat between Sam and Paula leads the latter to prepare for a short film about Pete's death instead, but Pete does not want to be remembered as a failed scout leader. Sam and Jay reach out to Jennifer, a now-grown former member of Pete's troop, so she can provide a positive eye witness case for him. The ghosts plot to sabotage the production, and after Thorfinn runs out of energy from draining a camera battery, a production crew member gets high from passing through Flower, then shoots an arrow into Jay's rear. Jennifer follows safety precautions needed to remove the arrow that she learned from Pete, reminding him that he was a good leader after all. Meanwhile, Sam's interview with Isaac and Nigel about the American Revolution causes their old sentiments from the war to resurface, but she resolves their tensions by reminding Isaac of the U.S. and Britain's much friendlier present-day relations. At the end of the day, the ghosts gather to watch Sam portray Flower in a televised Dumb Deaths episode. Part 1 – When Jay's sister Bela and her friend Eric visit the manor on Christmas Eve, Sam is inspired by her love of made-for-TV Christmas movies to bring them together romantically. Trevor, previously Bela's "boyfriend", hatches a plan to possess Eric so he can be intimate with her for one night, and Bela agrees to his text invitation. After learning from Jay about how he was possessed by Hetty, Bela convinces Eric, who is genuinely interested in her, to go forward with the plan as well. That night, Jay catches Bela and Eric attempting to recreate the circumstances that led to Jay's possession and orders them to stop. Meanwhile, Isaac attempts to kiss Nigel for the first time under some mistletoe, but his nerves cause Nigel to leave for the shed. On Christmas Morning, Sam converses with Thorfinn, who despises Christmas for appropriating elements from Norse traditions, as she attempts to fix the sconce that caused Hetty's possession, gets shocked, and falls onto Thor, making him possess her.Sam and Jay meet the Farnsbys, an older couple living on an adjacent property, who attempt to sabotage their renovations, which leads them to invite them over for dinner. At the dinner party, the ghosts attempt to sabotage Sam until she points out they need her to maintain a connection to the world of the living. In the end, with the help of the ghosts, especially Pete's knowledge of 1980s television, the Farnsbys promise to support their permit applications for their renovations. The ghosts are unable to get into the Halloween spirit, being unable to participate and believing it to be insulting to ghosts. Taking advantage of Sam's ability to see and hear them, Isaac, Hetty, Sasappis and Thorfinn guard the mansion against trick-or-treating vandals. Meanwhile, Alberta, Pete and Trevor are horrified by media depictions of ghosts as they watch Ghostbusters . After Thorfinn uses his powers to accidentally set the front yard gazebo on fire and Isaac blames one of the young vandals, the ghosts argue over whether to tell Sam the truth. As Sam introduces the ghosts to the Internet and social media, Trevor believes that he fathered a child from one of his one-night stands in 2000. After Sam locates Pete's wife Carol online, she invites her to the mansion at Pete's insistence, using his old Trooper's manual as an excuse. Pete finds that his wife and best friend were not only involved before his death, but are now married and he is furious until Sam reads one of his notes from his manual on forgiveness. Pete's daughter, Laura, then reveals his grandson has been named after him in his honor. Meanwhile, Thorfinn and Sasappis become obsessed with a reality show , which the former binge-watches without the latter. To land a permanent job at a local magazine, Sam decides to write a human interest article about a ' Robin Hood -esque' bank robbery carried out by Flower during her time in a 'commune', but Flower refuses to be interviewed as she swore to secrecy. Having heard about the incident ad nauseam since Flower's death, Isaac and Alberta decide to learn about the robbery on Sam's behalf. Meanwhile, Sam encounters Shiki: the ghost of a Lenape woman on whom Sasappis had a crush, and she and Jay try to establish long-distance communication between them. Sam volunteers to help Jay and the ghosts play Dungeons & Dragons together when Jay's D&D group abandons him. Also, Sam discovers that an old shed on the mansion's grounds was a British barracks during the Revolutionary War , now occupied by three ghosts of British soldiers, one of whom, Nigel, learns that Isaac, who has secretly requited feelings for him, accidentally shot and killed him. Todd Pearlman, an obsessive fan of Alberta's, visits the mansion to do research for a biography he is writing about her and discovers that her briefcase contains vintage moonshine. He nearly dies from drinking it, as it was poisoned, confirming Alberta's suspicions that she was murdered. Elsewhere, Thorfinn tries reconnecting with Hetty during walks outside the mansion, as he remembers that she could see and hear ghosts as a child, which is a rare gift among living human children. While trying to repair a sconce, Jay accidentally falls on top of Hetty, who possesses him and takes on-and-off control of his body. Sam struggles to keep this a secret from a wedding planner who is difficult to impress and visits the mansion to sample Jay's cooking. Refusing to be exorcised , Hetty attempts to escape the mansion in Jay's car, only to be separated from him because she cannot leave the mansion's grounds. Jay's sister, Bela, comes to visit after a break up, but reveals that she's been having great conversations with someone online. Sam and Jay are shocked when they realize that it's Trevor. Trevor reveals that he used their iPad to make a dating account. When Bela discovers the account on the iPad, she assumes that Jay created the profile and is furious. Sam tells her the truth about her talking to ghosts, and while Bela is as first skeptical, Sam is able to convince her with the help of the ghosts. Meanwhile, Nancy, still pretending to be Pete's girlfriend, threatens to tell Alberta the truth if Pete doesn't start to be more assertive. While Pete initially listens to her, he becomes upset when it leads to the other ghosts fighting. When Pete assertively tells Nancy that he enjoys being the one who keeps the peace, Nancy is proud of him for standing up for himself and pretends to break up with him and goes back to the cholera pit.Paula, a producer behind the documentary TV series Dumb Deaths , wants to make a short film about Flower's death, although Flower is reluctant to having her image used in an unflattering light to raise money for the B&B. A chat between Sam and Paula leads the latter to prepare for a short film about Pete's death instead, but Pete does not want to be remembered as a failed scout leader. Sam and Jay reach out to Jennifer, a now-grown former member of Pete's troop, so she can provide a positive eye witness case for him. The ghosts plot to sabotage the production, and after Thorfinn runs out of energy from draining a camera battery, a production crew member gets high from passing through Flower, then shoots an arrow into Jay's rear. Jennifer follows safety precautions needed to remove the arrow that she learned from Pete, reminding him that he was a good leader after all. Meanwhile, Sam's interview with Isaac and Nigel about the American Revolution causes their old sentiments from the war to resurface, but she resolves their tensions by reminding Isaac of the U.S. and Britain's much friendlier present-day relations. At the end of the day, the ghosts gather to watch Sam portray Flower in a televised Dumb Deaths episode. Part 1 – When Jay's sister Bela and her friend Eric visit the manor on Christmas Eve, Sam is inspired by her love of made-for-TV Christmas movies to bring them together romantically. Trevor, previously Bela's "boyfriend", hatches a plan to possess Eric so he can be intimate with her for one night, and Bela agrees to his text invitation. After learning from Jay about how he was possessed by Hetty, Bela convinces Eric, who is genuinely interested in her, to go forward with the plan as well. That night, Jay catches Bela and Eric attempting to recreate the circumstances that led to Jay's possession and orders them to stop. Meanwhile, Isaac attempts to kiss Nigel for the first time under some mistletoe, but his nerves cause Nigel to leave for the shed. On Christmas Morning, Sam converses with Thorfinn, who despises Christmas for appropriating elements from Norse traditions, as she attempts to fix the sconce that caused Hetty's possession, gets shocked, and falls onto Thor, making him possess her.On November 29, 2019, CBS announced that they were developing an adaptation of the BBC One series Ghosts . The original British series upon which the series is based was created by Mathew Baynton , Simon Farnaby , Martha Howe-Douglas , Jim Howick , Laurence Rickard , and Ben Willbond for BBC. On February 4, 2020, it was announced that the pilot had been picked up by CBS Studios and was co-produced with BBC Studios and Lionsgate Television . On March 31, 2021, it was announced that the adaptation has been picked up for a full series. In July 2021, it was announced that the series would premiere as a Thursday-night entry on October 7, 2021. On September 23, 2021, CBS changed the premiere to back-to-back episodes. On October 21, 2021, CBS picked up the series for a full season. On December 17, 2021, it was reported that production has been temporarily halted due to a positive case of COVID-19 on the set of the series. On January 24, 2022, CBS renewed the series for a second season which premiered on September 29, 2022. On November 8, 2022, it was announced that the BBC would be airing Ghosts in the United Kingdom under the name of 'Ghosts US' on BBC Three & BBC iPlayer on November 20, 2022. On January 12, 2023, CBS renewed the series for a third season, which premiered on February 15, 2024. On March 12, 2024, the series was renewed for a fourth season. On March 4, 2020, Rose McIver was cast in a leading role for the pilot. On July 1, 2020, Utkarsh Ambudkar was cast in a main role for the pilot. On December 9, 2020, Brandon Scott Jones, Richie Moriarty, Asher Grodman , Rebecca Wisocky , Sheila Carrasco, Danielle Pinnock and Roman Zaragoza were cast in main roles for the pilot. On May 12, 2021, Devan Chandler Long joined the cast as a series regular. Filming for the third season began in Montreal on December 2, 2023. On November 29, 2019, CBS announced that they were developing an adaptation of the BBC One series Ghosts . The original British series upon which the series is based was created by Mathew Baynton , Simon Farnaby , Martha Howe-Douglas , Jim Howick , Laurence Rickard , and Ben Willbond for BBC. On February 4, 2020, it was announced that the pilot had been picked up by CBS Studios and was co-produced with BBC Studios and Lionsgate Television . On March 31, 2021, it was announced that the adaptation has been picked up for a full series. In July 2021, it was announced that the series would premiere as a Thursday-night entry on October 7, 2021. On September 23, 2021, CBS changed the premiere to back-to-back episodes. On October 21, 2021, CBS picked up the series for a full season. On December 17, 2021, it was reported that production has been temporarily halted due to a positive case of COVID-19 on the set of the series. On January 24, 2022, CBS renewed the series for a second season which premiered on September 29, 2022. On November 8, 2022, it was announced that the BBC would be airing Ghosts in the United Kingdom under the name of 'Ghosts US' on BBC Three & BBC iPlayer on November 20, 2022. On January 12, 2023, CBS renewed the series for a third season, which premiered on February 15, 2024. On March 12, 2024, the series was renewed for a fourth season. On March 4, 2020, Rose McIver was cast in a leading role for the pilot. On July 1, 2020, Utkarsh Ambudkar was cast in a main role for the pilot. On December 9, 2020, Brandon Scott Jones, Richie Moriarty, Asher Grodman , Rebecca Wisocky , Sheila Carrasco, Danielle Pinnock and Roman Zaragoza were cast in main roles for the pilot. On May 12, 2021, Devan Chandler Long joined the cast as a series regular. Filming for the third season began in Montreal on December 2, 2023. For the first season, the review aggregator website Rotten Tomatoes reported a 93% approval rating with an average rating of 7.3/10, based on 27 critic reviews. The website's critics consensus reads, " Ghosts could stand to ask more of its characters, but an excellent ensemble and a genial wit make for easy, softly spooky viewing." Metacritic , which uses a weighted average, assigned a score of 69 out of 100 based on 13 critics, indicating "generally favorable reviews". On Rotten Tomatoes, the second season has received an approval rating of 100% with an average rating of 7/10, based on seven critic reviews. The first season was recognized with The ReFrame Stamp for hiring people of underrepresented gender identities, and of color. For the first season, the review aggregator website Rotten Tomatoes reported a 93% approval rating with an average rating of 7.3/10, based on 27 critic reviews. The website's critics consensus reads, " Ghosts could stand to ask more of its characters, but an excellent ensemble and a genial wit make for easy, softly spooky viewing." Metacritic , which uses a weighted average, assigned a score of 69 out of 100 based on 13 critics, indicating "generally favorable reviews". On Rotten Tomatoes, the second season has received an approval rating of 100% with an average rating of 7/10, based on seven critic reviews. The first season was recognized with The ReFrame Stamp for hiring people of underrepresented gender identities, and of color. Lionsgate Home Entertainment released the complete first season on Blu-ray and DVD on November 29, 2022.

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https://api.wikimedia.org/core/v1/wikipedia/en/page/Ottoman_Empire/html

Ottoman Empire

دولت عليه عث٠انیه Devlet-i ʿAlīye-i ʿO s mānīye دولت ابد ٠دت Devlet-i Ebed-müddet "The Eternal State" The Ottoman Empire , [lower-alpha 10] historically and colloquially known as the Turkish Empire , was an imperial realm [lower-alpha 11] that spanned much of Southeast Europe , West Asia , and North Africa from the 14th to early 20th centuries; it also controlled parts of southeastern Central Europe between the early 16th and early 18th centuries. The empire emerged from a beylik , or principality , founded in northwestern Anatolia in 1299 by the Turkoman tribal leader Osman I . His successors conquered much of Anatolia and expanded into the Balkans by the mid 14th century, transforming their petty kingdom into a transcontinental empire. The Ottomans ended the Byzantine Empire with the conquest of Constantinople in 1453 by Mehmed II , which marked the Ottomans' emergence as a major regional power. Under Suleiman the Magnificent (1520–1566), the empire reached the peak of its power, prosperity, and political development. By the start of the 17th century, the Ottomans presided over 32 provinces and numerous vassal states , which over time were either absorbed into the Empire or granted various degrees of autonomy. [lower-alpha 12] With its capital at Constantinople (modern-day Istanbul ) and control over a significant portion of the Mediterranean Basin , the Ottoman Empire was at the centre of interactions between the Middle East and Europe for six centuries. While the Ottoman Empire was once thought to have entered a period of decline after the death of Suleiman the Magnificent, modern academic consensus posits that the empire continued to maintain a flexible and strong economy, society and military into much of the 18th century. However, during a long period of peace from 1740 to 1768, the Ottoman military system fell behind those of its chief European rivals, the Habsburg and Russian empires. The Ottomans consequently suffered severe military defeats in the late 18th and early 19th centuries, culminating in the loss of both territory and global prestige . This prompted a comprehensive process of reform and modernization known as the Tanzimat ; over the course of the 19th century, the Ottoman state became vastly more powerful and organized internally, despite suffering further territorial losses, especially in the Balkans, where a number of new states emerged. Beginning in the late 19th century, various Ottoman intellectuals sought to further liberalize society and politics along European lines, culminating in the Young Turk Revolution of 1908 led by the Committee of Union and Progress (CUP), which established the Second Constitutional Era and introduced competitive multi-party elections under a constitutional monarchy. However, following the disastrous Balkan Wars , the CUP became increasingly radicalized and nationalistic, leading a coup d'état in 1913 that established a one-party regime. The CUP allied the empire with Germany , hoping to escape from the diplomatic isolation that had contributed to its recent territorial losses; it thus joined World War I on the side of the Central Powers . While the empire was able to largely hold its own during the conflict, it struggled with internal dissent, especially the Arab Revolt . During this period, the Ottoman government engaged in genocide against Armenians , Assyrians , and Greeks . In the aftermath of World War I , the victorious Allied Powers occupied and partitioned the Ottoman Empire, which lost its southern territories to the United Kingdom and France . The successful Turkish War of Independence , led by Mustafa Kemal Atatürk against the occupying Allies, led to the emergence of the Republic of Turkey in the Anatolian heartland and the abolition of the Ottoman monarchy in 1922, formally ending the Ottoman Empire.The word Ottoman is a historical anglicisation of the name of Osman I , the founder of the Empire and of the ruling House of Osman (also known as the Ottoman dynasty). Osman's name in turn was the Turkish form of the Arabic name ʿUthmān ( عث٠ان ). In Ottoman Turkish , the empire was referred to as Devlet-i ʿAlīye-yi ʿO s mānīye ( دولت عليه عث٠انیه ), lit. ' Sublime Ottoman State ' , or simply Devlet-i ʿO s mānīye ( دولت عث٠انيه‎ ), lit. ' Ottoman State ' . The Turkish word for "Ottoman" ( Osmanlı ) originally referred to the tribal followers of Osman in the fourteenth century. The word subsequently came to be used to refer to the empire's military-administrative elite. In contrast, the term "Turk" ( Türk ) was used to refer to the Anatolian peasant and tribal population and was seen as a disparaging term when applied to urban, educated individuals. : 26 In the early modern period , an educated, urban-dwelling Turkish-speaker who was not a member of the military-administrative class typically referred to themselves neither as an Osmanlı nor as a Türk , but rather as a Rūmī ( رو٠ى ), or "Roman", meaning an inhabitant of the territory of the former Byzantine Empire in the Balkans and Anatolia. The term Rūmī was also used to refer to Turkish speakers by the other Muslim peoples of the empire and beyond. : 11 As applied to Ottoman Turkish-speakers, this term began to fall out of use at the end of the seventeenth century, and instead the word increasingly became associated with the Greek population of the empire, a meaning that it still bears in Turkey today. : 51 In Western Europe, the names Ottoman Empire, Turkish Empire and Turkey were often used interchangeably, with Turkey being increasingly favoured both in formal and informal situations. This dichotomy was officially ended in 1920–1923, when the newly established Ankara -based Turkish government chose Turkey as the sole official name. At present, most scholarly historians avoid the terms "Turkey", "Turks", and "Turkish" when referring to the Ottomans, due to the empire's multinational character. As the Rum Sultanate declined well into the 13th century, Anatolia was divided into a patchwork of independent Turkish principalities known as the Anatolian Beyliks . One of these beyliks, in the region of Bithynia on the frontier of the Byzantine Empire, was led by the Turkish tribal leader Osman I ( d. 1323/4), a figure of obscure origins from whom the name Ottoman is derived. : 444 Osman's early followers consisted both of Turkish tribal groups and Byzantine renegades, with many but not all converts to Islam. : 59 : 127 Osman extended the control of his principality by conquering Byzantine towns along the Sakarya River . A Byzantine defeat at the Battle of Bapheus in 1302 contributed to Osman's rise as well. It is not well understood how the early Ottomans came to dominate their neighbors, due to the lack of sources surviving from this period. The Ghaza thesis popular during the twentieth century credited their success to their rallying of religious warriors to fight for them in the name of Islam , but it is no longer generally accepted. No other hypothesis has attracted broad acceptance. : 5, 10 : 104 In the century after the death of Osman I, Ottoman rule had begun to extend over Anatolia and the Balkans . The earliest conflicts began during the Byzantine–Ottoman wars , waged in Anatolia in the late 13th century before entering Europe in the mid-14th century, followed by the Bulgarian–Ottoman wars and the Serbian–Ottoman wars waged beginning in the mid 14th century. Much of this period was characterised by Ottoman expansion into the Balkans . Osman's son, Orhan , captured the northwestern Anatolian city of Bursa in 1326, making it the new capital of the Ottoman state and supplanting Byzantine control in the region. The important port city of Thessaloniki was captured from the Venetians in 1387 and sacked. The Ottoman victory in Kosovo in 1389 effectively marked the end of Serbian power in the region, paving the way for Ottoman expansion into Europe. : 95–96 The Battle of Nicopolis for the Bulgarian Tsardom of Vidin in 1396, widely regarded as the last large-scale crusade of the Middle Ages , failed to stop the advance of the victorious Ottoman Turks. As the Turks expanded into the Balkans, the conquest of Constantinople became a crucial objective. The Ottomans had already wrested control of nearly all former Byzantine lands surrounding the city, but the strong defense of Constantinople's strategic position on the Bosporus Strait made it difficult to conquer. In 1402, the Byzantines were temporarily relieved when the Turco-Mongol leader Timur , founder of the Timurid Empire , invaded Ottoman Anatolia from the east. In the Battle of Ankara in 1402, Timur defeated the Ottoman forces and took Sultan Bayezid I as a prisoner, throwing the empire into disorder. The ensuing civil war , also known as the Fetret Devri , lasted from 1402 to 1413 as Bayezid's sons fought over succession. It ended when Mehmed I emerged as the sultan and restored Ottoman power. : 363 The Balkan territories lost by the Ottomans after 1402, including Thessaloniki, Macedonia, and Kosovo, were later recovered by Murad II between the 1430s and 1450s. On 10 November 1444, Murad repelled the Crusade of Varna by defeating the Hungarian, Polish, and Wallachian armies under Władysław III of Poland (also King of Hungary) and John Hunyadi at the Battle of Varna , although Albanians under Skanderbeg continued to resist. Four years later, John Hunyadi prepared another army of Hungarian and Wallachian forces to attack the Turks, but was again defeated at the Second Battle of Kosovo in 1448. : 29 According to modern historiography, there is a direct connection between the fast Ottoman military advance and the consequences of the Black Death from the mid-fourteenth century onwards. Byzantine territories, where the initial Ottoman conquests were carried out, were exhausted demographically and militarily due to the plague outbreaks, which facilitated the Ottoman expansion. In addition, the slave hunting — executed at first by akinci irregulars expediting before the Ottoman army — was the main economic driving force behind the Ottoman conquest. Some 21st-century authors re-periodize the Ottoman conquest of the Balkans into the akıncı phase , which spanned 8 to 13 decades, characterized by continuous slave hunting and destruction, followed by the phase of administrative integration into the Ottoman Empire. where the bubonic plague pandemic occurred between 1347 and 1349. The son of Murad II, Mehmed the Conqueror , reorganized both state and military, and on 29 May 1453 conquered Constantinople , ending the Byzantine Empire. Mehmed allowed the Eastern Orthodox Church to maintain its autonomy and land in exchange for accepting Ottoman authority. Due to tension between the states of western Europe and the later Byzantine Empire, the majority of the Orthodox population accepted Ottoman rule as preferable to Venetian rule. Albanian resistance was a major obstacle to Ottoman expansion on the Italian peninsula. In the 15th and 16th centuries, the Ottoman Empire entered a period of expansion . The Empire prospered under the rule of a line of committed and effective Sultans . It also flourished economically due to its control of the major overland trade routes between Europe and Asia. : 111 [lower-alpha 13] Sultan Selim I (1512–1520) dramatically expanded the Empire's eastern and southern frontiers by defeating Shah Ismail of Safavid Iran , in the Battle of Chaldiran . : 91–105 Selim I established Ottoman rule in Egypt by defeating and annexing the Mamluk Sultanate of Egypt and created a naval presence on the Red Sea . After this Ottoman expansion, competition began between the Portuguese Empire and the Ottoman Empire to become the dominant power in the region. : 55–76 Suleiman the Magnificent (1520–1566) captured Belgrade in 1521, conquered the southern and central parts of the Kingdom of Hungary as part of the Ottoman–Hungarian Wars , and, after his historic victory in the Battle of Mohács in 1526, he established Ottoman rule in the territory of present-day Hungary (except the western part) and other Central European territories. He then laid siege to Vienna in 1529, but failed to take the city. : 50 In 1532, he made another attack on Vienna, but was repulsed in the siege of Güns . Transylvania , Wallachia and, intermittently, Moldavia , became tributary principalities of the Ottoman Empire. In the east, the Ottoman Turks took Baghdad from the Persians in 1535, gaining control of Mesopotamia and naval access to the Persian Gulf . In 1555, the Caucasus became officially partitioned for the first time between the Safavids and the Ottomans, a status quo that remained until the end of the Russo-Turkish War (1768–1774) . By this partitioning of the Caucasus as signed in the Peace of Amasya , Western Armenia , western Kurdistan , and Western Georgia (including western Samtskhe ) fell into Ottoman hands, while southern Dagestan , Eastern Armenia , Eastern Georgia , and Azerbaijan remained Persian. In 1539, a 60,000-strong Ottoman army besieged the Spanish garrison of Castelnuovo on the Adriatic coast ; the successful siege cost the Ottomans 8,000 casualties, but Venice agreed to terms in 1540, surrendering most of its empire in the Aegean and the Morea . France and the Ottoman Empire, united by mutual opposition to Habsburg rule, became strong allies. The French conquests of Nice (1543) and Corsica (1553) occurred as a joint venture between the forces of the French king Francis I and Suleiman, and were commanded by the Ottoman admirals Hayreddin Barbarossa and Dragut . A month before the siege of Nice, France supported the Ottomans with an artillery unit during the 1543 Ottoman conquest of Esztergom in northern Hungary. After further advances by the Turks, the Habsburg ruler Ferdinand officially recognized Ottoman ascendancy in Hungary in 1547. Suleiman I died of natural causes in his tent during the siege of Szigetvár in 1566. Following his death, the Ottomans were said to be declining, although this has been rejected by many scholars. By the end of Suleiman 's reign, the Empire spanned approximately 877,888 sq mi (2,273,720 km 2 ) , extending over three continents. : 545 In addition, the Empire became a dominant naval force, controlling much of the Mediterranean Sea . : 61 By this time, the Ottoman Empire was a major part of the European political sphere. The Ottomans became involved in multi-continental religious wars when Spain and Portugal were united under the Iberian Union . The Ottomans were holders of the Caliph title, meaning they were the leaders of all Muslims worldwide. The Iberians were leaders of the Christian crusaders, and so the two were locked in a worldwide conflict. There were zones of operations in the Mediterranean Sea and Indian Ocean , where Iberians circumnavigated Africa to reach India and, on their way, wage war upon the Ottomans and their local Muslim allies. Likewise, the Iberians passed through newly-Christianized Latin America and had sent expeditions that traversed the Pacific in order to Christianize the formerly Muslim Philippines and use it as a base to further attack the Muslims in the Far East . In this case, the Ottomans sent armies to aid its easternmost vassal and territory, the Sultanate of Aceh in Southeast Asia. : 84 During the 1600s, the worldwide conflict between the Ottoman Caliphate and Iberian Union was a stalemate since both powers were at similar population, technology and economic levels. Nevertheless, the success of the Ottoman political and military establishment was compared to the Roman Empire , despite the difference in the size of their respective territories, by the likes of the contemporary Italian scholar Francesco Sansovino and the French political philosopher Jean Bodin . In the second half of the sixteenth century, the Ottoman Empire came under increasing strain from inflation and the rapidly rising costs of warfare that were impacting both Europe and the Middle East. These pressures led to a series of crises around the year 1600, placing great strain upon the Ottoman system of government. : 413–414 The empire underwent a series of transformations of its political and military institutions in response to these challenges, enabling it to successfully adapt to the new conditions of the seventeenth century and remain powerful, both militarily and economically. : 10 Historians of the mid-twentieth century once characterised this period as one of stagnation and decline, but this view is now rejected by the majority of academics. The discovery of new maritime trade routes by Western European states allowed them to avoid the Ottoman trade monopoly. The Portuguese discovery of the Cape of Good Hope in 1488 initiated a series of Ottoman-Portuguese naval wars in the Indian Ocean throughout the 16th century. Despite the growing European presence in the Indian Ocean, Ottoman trade with the east continued to flourish. Cairo, in particular, benefitted from the rise of Yemeni coffee as a popular consumer commodity. As coffeehouses appeared in cities and towns across the empire, Cairo developed into a major center for its trade, contributing to its continued prosperity throughout the seventeenth and much of the eighteenth century. : 507–508 Under Ivan IV (1533–1584), the Tsardom of Russia expanded into the Volga and Caspian regions at the expense of the Tatar khanates. In 1571, the Crimean khan Devlet I Giray , commanded by the Ottomans, burned Moscow . The next year, the invasion was repeated but repelled at the Battle of Molodi . The Ottoman Empire continued to invade Eastern Europe in a series of slave raids , and remained a significant power in Eastern Europe until the end of the 17th century. The Ottomans decided to conquer Venetian Cyprus and on 22 July 1570, Nicosia was besieged; 50,000 Christians died, and 180,000 were enslaved. : 67 On 15 September 1570, the Ottoman cavalry appeared before the last Venetian stronghold in Cyprus, Famagusta. The Venetian defenders held out for 11 months against a force that at its peak numbered 200,000 men with 145 cannons; 163,000 cannonballs struck the walls of Famagusta before it fell to the Ottomans in August 1571. The Siege of Famagusta claimed 50,000 Ottoman casualties. : 328 Meanwhile, the Holy League consisting of mostly Spanish and Venetian fleets won a victory over the Ottoman fleet at the Battle of Lepanto (1571), off southwestern Greece; Catholic forces killed over 30,000 Turks and destroyed 200 of their ships. : 24 It was a startling, if mostly symbolic, blow to the image of Ottoman invincibility, an image which the victory of the Knights of Malta over the Ottoman invaders in the 1565 siege of Malta had recently set about eroding. The battle was far more damaging to the Ottoman navy in sapping experienced manpower than the loss of ships, which were rapidly replaced. : 53 The Ottoman navy recovered quickly, persuading Venice to sign a peace treaty in 1573, allowing the Ottomans to expand and consolidate their position in North Africa. By contrast, the Habsburg frontier had settled somewhat, a stalemate caused by a stiffening of the Habsburg defenses. The Long Turkish War against Habsburg Austria (1593–1606) created the need for greater numbers of Ottoman infantry equipped with firearms, resulting in a relaxation of recruitment policy. This contributed to problems of indiscipline and outright rebelliousness within the corps, which were never fully solved. [ obsolete source ] Irregular sharpshooters ( Sekban ) were also recruited, and on demobilisation turned to brigandage in the Celali rebellions (1590–1610), which engendered widespread anarchy in Anatolia in the late 16th and early 17th centuries. : 24 With the Empire's population reaching 30 million people by 1600, the shortage of land placed further pressure on the government. [ obsolete source ] In spite of these problems, the Ottoman state remained strong, and its army did not collapse or suffer crushing defeats. The only exceptions were campaigns against the Safavid dynasty of Persia, where many of the Ottoman eastern provinces were lost, some permanently. This 1603–1618 war eventually resulted in the Treaty of Nasuh Pasha , which ceded the entire Caucasus, except westernmost Georgia, back into the possession of Safavid Iran . The treaty ending the Cretan War cost Venice much of Dalmatia , its Aegean island possessions, and Crete . (Losses from the war totalled 30,985 Venetian soldiers and 118,754 Turkish soldiers.) : 33 During his brief majority reign, Murad IV (1623–1640) reasserted central authority and recaptured Iraq (1639) from the Safavids. The resulting Treaty of Zuhab of that same year decisively divided the Caucasus and adjacent regions between the two neighbouring empires as it had already been defined in the 1555 Peace of Amasya. The Sultanate of Women (1533–1656) was a period in which the mothers of young sultans exercised power on behalf of their sons. The most prominent women of this period were Kösem Sultan and her daughter-in-law Turhan Hatice , whose political rivalry culminated in Kösem's murder in 1651. During the Köprülü era (1656–1703), effective control of the Empire was exercised by a sequence of grand viziers from the Köprülü family. The Köprülü Vizierate saw renewed military success with authority restored in Transylvania, the conquest of Crete completed in 1669, and expansion into Polish southern Ukraine , with the strongholds of Khotyn , and Kamianets-Podilskyi and the territory of Podolia ceding to Ottoman control in 1676. This period of renewed assertiveness came to a calamitous end in 1683 when Grand Vizier Kara Mustafa Pasha led a huge army to attempt a second Ottoman siege of Vienna in the Great Turkish War of 1683–1699. The final assault being fatally delayed, the Ottoman forces were swept away by allied Habsburg, German, and Polish forces spearheaded by the Polish king John III Sobieski at the Battle of Vienna . The alliance of the Holy League pressed home the advantage of the defeat at Vienna, culminating in the Treaty of Karlowitz (26 January 1699), which ended the Great Turkish War. The Ottomans surrendered control of significant territories, many permanently. Mustafa II (1695–1703) led the counterattack of 1695–1696 against the Habsburgs in Hungary, but was undone at the disastrous defeat at Zenta (in modern Serbia), 11 September 1697. Aside from the loss of the Banat and the temporary loss of Belgrade (1717–1739), the Ottoman border on the Danube and Sava remained stable during the eighteenth century. Russian expansion , however, presented a large and growing threat. Accordingly, King Charles XII of Sweden was welcomed as an ally in the Ottoman Empire following his defeat by the Russians at the Battle of Poltava of 1709 in central Ukraine (part of the Great Northern War of 1700–1721). Charles XII persuaded the Ottoman Sultan Ahmed III to declare war on Russia, which resulted in an Ottoman victory in the Pruth River Campaign of 1710–1711, in Moldavia. After the Austro-Turkish War , the Treaty of Passarowitz confirmed the loss of the Banat, Serbia, and "Little Walachia" (Oltenia) to Austria. The Treaty also revealed that the Ottoman Empire was on the defensive and unlikely to present any further aggression in Europe. The Austro-Russian–Turkish War (1735–1739), which was ended by the Treaty of Belgrade in 1739, resulted in the Ottoman recovery of northern Bosnia , Habsburg Serbia (including Belgrade), Oltenia and the southern parts of the Banat of Temeswar ; but the Empire lost the port of Azov , north of the Crimean Peninsula, to the Russians. After this treaty the Ottoman Empire was able to enjoy a generation of peace, as Austria and Russia were forced to deal with the rise of Prussia . Educational and technological reforms came about, including the establishment of higher education institutions such as the Istanbul Technical University . In 1734 an artillery school was established to impart Western-style artillery methods, but the Islamic clergy successfully objected under the grounds of theodicy . In 1754 the artillery school was reopened on a semi-secret basis. In 1726, Ibrahim Muteferrika convinced the Grand Vizier Nevşehirli Damat Ibrahim Pasha , the Grand Mufti , and the clergy on the efficiency of the printing press, and Muteferrika was later granted by Sultan Ahmed III permission to publish non-religious books (despite opposition from some calligraphers and religious leaders). Muteferrika's press published its first book in 1729 and, by 1743, issued 17 works in 23 volumes, each having between 500 and 1,000 copies. In North Africa, Spain conquered Oran from the autonomous Deylik of Algiers . The Bey of Oran received an army from Algiers, but it failed to recapture Oran ; the siege caused the deaths of 1,500 Spaniards, and even more Algerians. The Spanish also massacred many Muslim soldiers. In 1792, Spain abandoned Oran, selling it to the Deylik of Algiers. In 1768 Russian-backed Ukrainian Haidamakas , pursuing Polish confederates, entered Balta , an Ottoman-controlled town on the border of Bessarabia in Ukraine, massacred its citizens, and burned the town to the ground. This action provoked the Ottoman Empire into the Russo-Turkish War of 1768–1774 . The Treaty of Küçük Kaynarca of 1774 ended the war and provided freedom of worship for the Christian citizens of the Ottoman-controlled provinces of Wallachia and Moldavia. By the late 18th century, after a number of defeats in the wars with Russia, some people in the Ottoman Empire began to conclude that the reforms of Peter the Great had given the Russians an edge, and the Ottomans would have to keep up with Western technology in order to avoid further defeats. Selim III (1789–1807) made the first major attempts to modernise the army , but his reforms were hampered by the religious leadership and the Janissary corps. Jealous of their privileges and firmly opposed to change, the Janissary revolted . Selim's efforts cost him his throne and his life, but were resolved in spectacular and bloody fashion by his successor, the dynamic Mahmud II , who eliminated the Janissary corps in 1826. The Serbian revolution (1804–1815) marked the beginning of an era of national awakening in the Balkans during the Eastern Question . In 1811, the fundamentalist Wahhabis of Arabia, led by the al-Saud family, revolted against the Ottomans. Unable to defeat the Wahhabi rebels, the Sublime Porte had Muhammad Ali Pasha of Kavala , the vali (governor) of the Eyalet of Egypt , tasked with retaking Arabia, which ended with the destruction of the Emirate of Diriyah in 1818. The suzerainty of Serbia as a hereditary monarchy under its own dynasty was acknowledged de jure in 1830. In 1821, the Greeks declared war on the Sultan. A rebellion that originated in Moldavia as a diversion was followed by the main revolution in the Peloponnese , which, along with the northern part of the Gulf of Corinth , became the first parts of the Ottoman Empire to achieve independence (in 1829). In 1830, the French invaded the Deylik of Algiers . The campaign that took 21 days, resulted in over 5,000 Algerian military casualties, and about 2,600 French ones. Before the French invasion the total population of Algeria was most likely between 3,000,000 and 5,000,000. By 1873, the population of Algeria (excluding several hundred thousand newly arrived French settlers) decreased to a drastic 2,172,000. In 1831, Muhammad Ali of Egypt revolted against Sultan Mahmud II due to the latter's refusal to grant him the governorships of Greater Syria and Crete , which the Sultan had promised him in exchange for sending military assistance to put down the Greek revolt (1821–1829) that ultimately ended with the formal independence of Greece in 1830. It was a costly enterprise for Muhammad Ali, who had lost his fleet at the Battle of Navarino in 1827. Thus began the first Egyptian–Ottoman War (1831–1833) , during which the French-trained army of Muhammad Ali, under the command of his son Ibrahim Pasha , defeated the Ottoman Army as it marched into Anatolia , reaching the city of Kütahya within 320 km (200 mi) of the capital, Constantinople. : 95 In desperation, Sultan Mahmud II appealed to the empire's traditional arch-rival Russia for help, asking Emperor Nicholas I to send an expeditionary force to assist him. : 96 In return for signing the Treaty of Hünkâr İskelesi , the Russians sent the expeditionary force which deterred Ibrahim Pasha from marching any further towards Constantinople. : 96 Under the terms of the Convention of Kütahya , signed on 5 May 1833, Muhammad Ali agreed to abandon his campaign against the Sultan, in exchange for which he was made the vali (governor) of the vilayets (provinces) of Crete , Aleppo , Tripoli , Damascus and Sidon (the latter four comprising modern Syria and Lebanon ), and given the right to collect taxes in Adana . : 96 Had it not been for the Russian intervention, Sultan Mahmud II could have faced the risk of being overthrown and Muhammad Ali could have even become the new Sultan. These events marked the beginning of a recurring pattern where the Sublime Porte needed the help of foreign powers to protect itself. : 95–96 In 1839, the Sublime Porte attempted to take back what it lost to the de facto autonomous, but de jure still Ottoman Eyalet of Egypt , but its forces were initially defeated, which led to the Oriental Crisis of 1840 . Muhammad Ali had close relations with France , and the prospect of him becoming the Sultan of Egypt was widely viewed as putting the entire Levant into the French sphere of influence. : 96 As the Sublime Porte had proved itself incapable of defeating Muhammad Ali, the British Empire and Austrian Empire provided military assistance, and the second Egyptian–Ottoman War (1839–1841) ended with Ottoman victory and the restoration of Ottoman suzerainty over Egypt Eyalet and the Levant . : 96 By the mid-19th century, the Ottoman Empire was called the " sick man of Europe ". Three suzerain states – the Principality of Serbia , Wallachia and Moldavia – moved towards de jure independence during the 1860s and 1870s. During the Tanzimat period (1839–1876), the government's series of constitutional reforms led to a fairly modern conscripted army , banking system reforms, the decriminalization of homosexuality, the replacement of religious law with secular law, and guilds with modern factories. The Ottoman Ministry of Post was established in Istanbul in 1840. American inventor Samuel Morse received an Ottoman patent for the telegraph in 1847, issued by Sultan Abdülmecid , who personally tested the invention. The reformist period peaked with the Constitution, called the Kanûn-u Esâsî . The empire's First Constitutional era was short-lived. The parliament survived for only two years before the sultan suspended it. The empire's Christian population, owing to their higher educational levels, started to pull ahead of the Muslim majority, leading to much resentment. In 1861, there were 571 primary and 94 secondary schools for Ottoman Christians, with 140,000 pupils in total, a figure that vastly exceeded the number of Muslim children in school at the time, who were further hindered by the amount of time spent learning Arabic and Islamic theology. Author Norman Stone suggests that the Arabic alphabet, in which Turkish was written until 1928 , was ill-suited to reflect the sounds of Turkish (which is a Turkic as opposed to Semitic language), which imposed further difficulty on Turkish children. In turn, Christians' higher educational levels allowed them to play a larger role in the economy, with the rise in prominence of groups such as the Sursock family indicative of this. In 1911, of the 654 wholesale companies in Istanbul, 528 were owned by ethnic Greeks. In many cases, Christians and Jews gained protection from European consuls and citizenship, meaning they were protected from Ottoman law and not subject to the same economic regulations as their Muslim counterparts. The Crimean War (1853–1856) was part of a long-running contest between the major European powers for influence over territories of the declining Ottoman Empire. The financial burden of the war led the Ottoman state to issue foreign loans amounting to 5 million pounds sterling on 4 August 1854. : 32 : 71 The war caused an exodus of the Crimean Tatars , about 200,000 of whom moved to the Ottoman Empire in continuing waves of emigration. : 79–108 Toward the end of the Caucasian Wars , 90% of the Circassians were ethnically cleansed and exiled from their homelands in the Caucasus, fleeing to the Ottoman Empire, resulting in the settlement of 500,000 to 700,000 Circassians in Turkey. [ page needed ] Some Circassian organisations give much higher numbers, totalling 1–1.5 million deported or killed. Crimean Tatar refugees in the late 19th century played an especially notable role in seeking to modernise Ottoman education and in first promoting both Pan-Turkism and a sense of Turkish nationalism. In this period, the Ottoman Empire spent only small amounts of public funds on education; for example, in 1860–1861 only 0.2% of the total budget was invested in education. : 50 As the Ottoman state attempted to modernize its infrastructure and army in response to outside threats, it opened itself up to a different kind of threat: that of creditors. As the historian Eugene Rogan has written, "the single greatest threat to the independence of the Middle East" in the 19th century "was not the armies of Europe but its banks". The Ottoman state, which had begun taking on debt with the Crimean War, was forced to declare bankruptcy in 1875. By 1881, the Ottoman Empire agreed to have its debt controlled by the Ottoman Public Debt Administration , a council of European men with presidency alternating between France and Britain. The body controlled swaths of the Ottoman economy, and used its position to ensure that European capital continued to penetrate the empire, often to the detriment of local Ottoman interests. The Ottoman bashi-bazouks suppressed the Bulgarian uprising of 1876, massacring up to 100,000 people in the process. : 139 The Russo-Turkish War (1877–1878) ended with a decisive victory for Russia. As a result, Ottoman holdings in Europe declined sharply: Bulgaria was established as an independent principality inside the Ottoman Empire; Romania achieved full independence; and Serbia and Montenegro finally gained complete independence, but with smaller territories. In 1878, Austria-Hungary unilaterally occupied the Ottoman provinces of Bosnia-Herzegovina and Novi Pazar . British Prime Minister Benjamin Disraeli advocated restoring the Ottoman territories on the Balkan Peninsula during the Congress of Berlin , and in return, Britain assumed the administration of Cyprus in 1878. : 228–254 Britain later sent troops to Egypt in 1882 to put down the Urabi Revolt (Sultan Abdul Hamid II was too paranoid to mobilize his own army, fearing this would result in a coup d'état), effectively gaining control in both territories. Abdul Hamid II was so fearful of a coup that he did not allow his army to conduct war games, lest this serve as cover for a coup, but he did see the need for military mobilization. In 1883, a German military mission under General Baron Colmar von der Goltz arrived to train the Ottoman Army, leading to the so-called "Goltz generation" of German-trained officers, who played a notable role in the politics of the empire's last years. : 24 From 1894 to 1896, between 100,000 and 300,000 Armenians living throughout the empire were killed in what became known as the Hamidian massacres . : 42 In 1897 the population was 19 million, of whom 14 million (74%) were Muslim. An additional 20 million lived in provinces that remained under the sultan's nominal suzerainty but were entirely outside his actual power. One by one the Porte lost nominal authority. They included Egypt, Tunisia, Bulgaria, Cyprus, Bosnia-Herzegovina, and Lebanon. As the Ottoman Empire gradually shrank, 7–9 million Muslims from its former territories in the Caucasus, Crimea , Balkans, and the Mediterranean islands migrated to Anatolia and Eastern Thrace . After the Empire lost the First Balkan War (1912–1913), it lost all its Balkan territories except East Thrace (European Turkey). This resulted in around 400,000 Muslims fleeing with the retreating Ottoman armies (with many dying from cholera brought by the soldiers), and 400,000 non-Muslims fled territory still under Ottoman rule. Justin McCarthy estimates that from 1821 to 1922, 5.5 million Muslims died in southeastern Europe, with the expulsion of 5 million. The defeat and dissolution of the Ottoman Empire (1908 — 1922) began with the Second Constitutional Era , a moment of hope and promise established with the Young Turk Revolution . It restored the Constitution of the Ottoman Empire and brought in multi-party politics with a two-stage electoral system ( electoral law ) under the Ottoman parliament . The constitution offered hope by freeing the empire's citizens to modernise the state's institutions, rejuvenate its strength, and enable it to hold its own against outside powers. Its guarantee of liberties promised to dissolve inter-communal tensions and transform the empire into a more harmonious place. Instead, this period became the story of the twilight struggle of the Empire. Members of Young Turks movement who had once gone underground now established their parties. Among them " Committee of Union and Progress ", and " Freedom and Accord Party " were major parties. On the other end of the spectrum were ethnic parties, which included Poale Zion , Al-Fatat , and Armenian national movement organised under Armenian Revolutionary Federation . Profiting from the civil strife, Austria-Hungary officially annexed Bosnia and Herzegovina in 1908. The last of the Ottoman censuses was performed in 1914 . Despite military reforms which reconstituted the Ottoman Modern Army , the Empire lost its North African territories and the Dodecanese in the Italo-Turkish War (1911) and almost all of its European territories in the Balkan Wars (1912–1913). The Empire faced continuous unrest in the years leading up to World War I , including the 31 March Incident and two further coups in 1912 and 1913 . The Ottoman Empire entered World War I on the side of the Central Powers and was ultimately defeated. The Ottoman participation in the war began with the combined German-Ottoman surprise attack on the Black Sea coast of the Russian Empire on 29 October 1914. Following the attack, the Russian Empire (2 November 1914) and its allies France (5 November 1914) and the British Empire (5 November 1914) declared war on the Ottoman Empire (also on 5 November 1914, the British government changed the status of the Khedivate of Egypt and Cyprus , which were de jure Ottoman territories prior to the war, as British protectorates .) The Ottomans successfully defended the Dardanelles strait during the Gallipoli campaign (1915–1916) and achieved initial victories against British forces in the first two years of the Mesopotamian campaign , such as the Siege of Kut (1915–1916); but the Arab Revolt (1916–1918) turned the tide against the Ottomans in the Middle East. In the Caucasus campaign , however, the Russian forces had the upper hand from the beginning, especially after the Battle of Sarikamish (1914–1915). Russian forces advanced into northeastern Anatolia and controlled the major cities there until retreating from World War I with the Treaty of Brest-Litovsk following the Russian Revolution in 1917. In 1915 the Ottoman government and Kurdish tribes in the region started the extermination of its ethnic Armenian population, resulting in the deaths of up to 1.5 million Armenians in the Armenian genocide . The genocide was carried out during and after World War I and implemented in two phases: the wholesale killing of the able-bodied male population through massacre and subjection of army conscripts to forced labour, followed by the deportation of women, children, the elderly and infirm on death marches leading to the Syrian desert . Driven forward by military escorts, the deportees were deprived of food and water and subjected to periodic robbery, rape , and systematic massacre. Large-scale massacres were also committed against the Empire's Greek and Assyrian minorities as part of the same campaign of ethnic cleansing. The Arab Revolt began in 1916 with British support. It turned the tide against the Ottomans on the Middle Eastern front, where they seemed to have the upper hand during the first two years of the war. On the basis of the McMahon–Hussein Correspondence , an agreement between the British government and Hussein bin Ali, Sharif of Mecca , the revolt was officially initiated at Mecca on 10 June 1916. [lower-alpha 14] The Arab nationalist goal was to create a single unified and independent Arab state stretching from Aleppo , Syria , to Aden , Yemen , which the British promised to recognise. The Sharifian Army , led by Hussein and the Hashemites , with military backing from the British Egyptian Expeditionary Force , successfully fought and expelled the Ottoman military presence from much of the Hejaz and Transjordan . The rebellion eventually took Damascus and set up a short-lived monarchy led by Faisal , a son of Hussein. Following the terms of the 1916 Sykes–Picot Agreement , the British and French later partitioned the Middle East into mandate territories . There was no unified Arab state, much to Arab nationalists' anger. Defeated in World War I, the Ottoman Empire signed the Armistice of Mudros on 30 October 1918. Istanbul was occupied by combined British, French, Italian, and Greek forces. In May 1919, Greece also took control of the area around Smyrna (now İzmir). The partition of the Ottoman Empire was finalized under the terms of the 1920 Treaty of Sèvres . This treaty, as designed in the Conference of London , allowed the Sultan to retain his position and title. Anatolia's status was problematic given the occupied forces. A nationalist opposition arose in the Turkish national movement . It won the Turkish War of Independence (1919–1923) under the leadership of Mustafa Kemal (later given the surname "Atatürk"). The sultanate was abolished on 1 November 1922, and the last sultan, Mehmed VI (reigned 1918–1922), left the country on 17 November 1922. The Republic of Turkey was established in its place on 29 October 1923, in the new capital city of Ankara . The caliphate was abolished on 3 March 1924. As the Rum Sultanate declined well into the 13th century, Anatolia was divided into a patchwork of independent Turkish principalities known as the Anatolian Beyliks . One of these beyliks, in the region of Bithynia on the frontier of the Byzantine Empire, was led by the Turkish tribal leader Osman I ( d. 1323/4), a figure of obscure origins from whom the name Ottoman is derived. : 444 Osman's early followers consisted both of Turkish tribal groups and Byzantine renegades, with many but not all converts to Islam. : 59 : 127 Osman extended the control of his principality by conquering Byzantine towns along the Sakarya River . A Byzantine defeat at the Battle of Bapheus in 1302 contributed to Osman's rise as well. It is not well understood how the early Ottomans came to dominate their neighbors, due to the lack of sources surviving from this period. The Ghaza thesis popular during the twentieth century credited their success to their rallying of religious warriors to fight for them in the name of Islam , but it is no longer generally accepted. No other hypothesis has attracted broad acceptance. : 5, 10 : 104 In the century after the death of Osman I, Ottoman rule had begun to extend over Anatolia and the Balkans . The earliest conflicts began during the Byzantine–Ottoman wars , waged in Anatolia in the late 13th century before entering Europe in the mid-14th century, followed by the Bulgarian–Ottoman wars and the Serbian–Ottoman wars waged beginning in the mid 14th century. Much of this period was characterised by Ottoman expansion into the Balkans . Osman's son, Orhan , captured the northwestern Anatolian city of Bursa in 1326, making it the new capital of the Ottoman state and supplanting Byzantine control in the region. The important port city of Thessaloniki was captured from the Venetians in 1387 and sacked. The Ottoman victory in Kosovo in 1389 effectively marked the end of Serbian power in the region, paving the way for Ottoman expansion into Europe. : 95–96 The Battle of Nicopolis for the Bulgarian Tsardom of Vidin in 1396, widely regarded as the last large-scale crusade of the Middle Ages , failed to stop the advance of the victorious Ottoman Turks. As the Turks expanded into the Balkans, the conquest of Constantinople became a crucial objective. The Ottomans had already wrested control of nearly all former Byzantine lands surrounding the city, but the strong defense of Constantinople's strategic position on the Bosporus Strait made it difficult to conquer. In 1402, the Byzantines were temporarily relieved when the Turco-Mongol leader Timur , founder of the Timurid Empire , invaded Ottoman Anatolia from the east. In the Battle of Ankara in 1402, Timur defeated the Ottoman forces and took Sultan Bayezid I as a prisoner, throwing the empire into disorder. The ensuing civil war , also known as the Fetret Devri , lasted from 1402 to 1413 as Bayezid's sons fought over succession. It ended when Mehmed I emerged as the sultan and restored Ottoman power. : 363 The Balkan territories lost by the Ottomans after 1402, including Thessaloniki, Macedonia, and Kosovo, were later recovered by Murad II between the 1430s and 1450s. On 10 November 1444, Murad repelled the Crusade of Varna by defeating the Hungarian, Polish, and Wallachian armies under Władysław III of Poland (also King of Hungary) and John Hunyadi at the Battle of Varna , although Albanians under Skanderbeg continued to resist. Four years later, John Hunyadi prepared another army of Hungarian and Wallachian forces to attack the Turks, but was again defeated at the Second Battle of Kosovo in 1448. : 29 According to modern historiography, there is a direct connection between the fast Ottoman military advance and the consequences of the Black Death from the mid-fourteenth century onwards. Byzantine territories, where the initial Ottoman conquests were carried out, were exhausted demographically and militarily due to the plague outbreaks, which facilitated the Ottoman expansion. In addition, the slave hunting — executed at first by akinci irregulars expediting before the Ottoman army — was the main economic driving force behind the Ottoman conquest. Some 21st-century authors re-periodize the Ottoman conquest of the Balkans into the akıncı phase , which spanned 8 to 13 decades, characterized by continuous slave hunting and destruction, followed by the phase of administrative integration into the Ottoman Empire. where the bubonic plague pandemic occurred between 1347 and 1349. The son of Murad II, Mehmed the Conqueror , reorganized both state and military, and on 29 May 1453 conquered Constantinople , ending the Byzantine Empire. Mehmed allowed the Eastern Orthodox Church to maintain its autonomy and land in exchange for accepting Ottoman authority. Due to tension between the states of western Europe and the later Byzantine Empire, the majority of the Orthodox population accepted Ottoman rule as preferable to Venetian rule. Albanian resistance was a major obstacle to Ottoman expansion on the Italian peninsula. In the 15th and 16th centuries, the Ottoman Empire entered a period of expansion . The Empire prospered under the rule of a line of committed and effective Sultans . It also flourished economically due to its control of the major overland trade routes between Europe and Asia. : 111 [lower-alpha 13] Sultan Selim I (1512–1520) dramatically expanded the Empire's eastern and southern frontiers by defeating Shah Ismail of Safavid Iran , in the Battle of Chaldiran . : 91–105 Selim I established Ottoman rule in Egypt by defeating and annexing the Mamluk Sultanate of Egypt and created a naval presence on the Red Sea . After this Ottoman expansion, competition began between the Portuguese Empire and the Ottoman Empire to become the dominant power in the region. : 55–76 Suleiman the Magnificent (1520–1566) captured Belgrade in 1521, conquered the southern and central parts of the Kingdom of Hungary as part of the Ottoman–Hungarian Wars , and, after his historic victory in the Battle of Mohács in 1526, he established Ottoman rule in the territory of present-day Hungary (except the western part) and other Central European territories. He then laid siege to Vienna in 1529, but failed to take the city. : 50 In 1532, he made another attack on Vienna, but was repulsed in the siege of Güns . Transylvania , Wallachia and, intermittently, Moldavia , became tributary principalities of the Ottoman Empire. In the east, the Ottoman Turks took Baghdad from the Persians in 1535, gaining control of Mesopotamia and naval access to the Persian Gulf . In 1555, the Caucasus became officially partitioned for the first time between the Safavids and the Ottomans, a status quo that remained until the end of the Russo-Turkish War (1768–1774) . By this partitioning of the Caucasus as signed in the Peace of Amasya , Western Armenia , western Kurdistan , and Western Georgia (including western Samtskhe ) fell into Ottoman hands, while southern Dagestan , Eastern Armenia , Eastern Georgia , and Azerbaijan remained Persian. In 1539, a 60,000-strong Ottoman army besieged the Spanish garrison of Castelnuovo on the Adriatic coast ; the successful siege cost the Ottomans 8,000 casualties, but Venice agreed to terms in 1540, surrendering most of its empire in the Aegean and the Morea . France and the Ottoman Empire, united by mutual opposition to Habsburg rule, became strong allies. The French conquests of Nice (1543) and Corsica (1553) occurred as a joint venture between the forces of the French king Francis I and Suleiman, and were commanded by the Ottoman admirals Hayreddin Barbarossa and Dragut . A month before the siege of Nice, France supported the Ottomans with an artillery unit during the 1543 Ottoman conquest of Esztergom in northern Hungary. After further advances by the Turks, the Habsburg ruler Ferdinand officially recognized Ottoman ascendancy in Hungary in 1547. Suleiman I died of natural causes in his tent during the siege of Szigetvár in 1566. Following his death, the Ottomans were said to be declining, although this has been rejected by many scholars. By the end of Suleiman 's reign, the Empire spanned approximately 877,888 sq mi (2,273,720 km 2 ) , extending over three continents. : 545 In addition, the Empire became a dominant naval force, controlling much of the Mediterranean Sea . : 61 By this time, the Ottoman Empire was a major part of the European political sphere. The Ottomans became involved in multi-continental religious wars when Spain and Portugal were united under the Iberian Union . The Ottomans were holders of the Caliph title, meaning they were the leaders of all Muslims worldwide. The Iberians were leaders of the Christian crusaders, and so the two were locked in a worldwide conflict. There were zones of operations in the Mediterranean Sea and Indian Ocean , where Iberians circumnavigated Africa to reach India and, on their way, wage war upon the Ottomans and their local Muslim allies. Likewise, the Iberians passed through newly-Christianized Latin America and had sent expeditions that traversed the Pacific in order to Christianize the formerly Muslim Philippines and use it as a base to further attack the Muslims in the Far East . In this case, the Ottomans sent armies to aid its easternmost vassal and territory, the Sultanate of Aceh in Southeast Asia. : 84 During the 1600s, the worldwide conflict between the Ottoman Caliphate and Iberian Union was a stalemate since both powers were at similar population, technology and economic levels. Nevertheless, the success of the Ottoman political and military establishment was compared to the Roman Empire , despite the difference in the size of their respective territories, by the likes of the contemporary Italian scholar Francesco Sansovino and the French political philosopher Jean Bodin . In the second half of the sixteenth century, the Ottoman Empire came under increasing strain from inflation and the rapidly rising costs of warfare that were impacting both Europe and the Middle East. These pressures led to a series of crises around the year 1600, placing great strain upon the Ottoman system of government. : 413–414 The empire underwent a series of transformations of its political and military institutions in response to these challenges, enabling it to successfully adapt to the new conditions of the seventeenth century and remain powerful, both militarily and economically. : 10 Historians of the mid-twentieth century once characterised this period as one of stagnation and decline, but this view is now rejected by the majority of academics. The discovery of new maritime trade routes by Western European states allowed them to avoid the Ottoman trade monopoly. The Portuguese discovery of the Cape of Good Hope in 1488 initiated a series of Ottoman-Portuguese naval wars in the Indian Ocean throughout the 16th century. Despite the growing European presence in the Indian Ocean, Ottoman trade with the east continued to flourish. Cairo, in particular, benefitted from the rise of Yemeni coffee as a popular consumer commodity. As coffeehouses appeared in cities and towns across the empire, Cairo developed into a major center for its trade, contributing to its continued prosperity throughout the seventeenth and much of the eighteenth century. : 507–508 Under Ivan IV (1533–1584), the Tsardom of Russia expanded into the Volga and Caspian regions at the expense of the Tatar khanates. In 1571, the Crimean khan Devlet I Giray , commanded by the Ottomans, burned Moscow . The next year, the invasion was repeated but repelled at the Battle of Molodi . The Ottoman Empire continued to invade Eastern Europe in a series of slave raids , and remained a significant power in Eastern Europe until the end of the 17th century. The Ottomans decided to conquer Venetian Cyprus and on 22 July 1570, Nicosia was besieged; 50,000 Christians died, and 180,000 were enslaved. : 67 On 15 September 1570, the Ottoman cavalry appeared before the last Venetian stronghold in Cyprus, Famagusta. The Venetian defenders held out for 11 months against a force that at its peak numbered 200,000 men with 145 cannons; 163,000 cannonballs struck the walls of Famagusta before it fell to the Ottomans in August 1571. The Siege of Famagusta claimed 50,000 Ottoman casualties. : 328 Meanwhile, the Holy League consisting of mostly Spanish and Venetian fleets won a victory over the Ottoman fleet at the Battle of Lepanto (1571), off southwestern Greece; Catholic forces killed over 30,000 Turks and destroyed 200 of their ships. : 24 It was a startling, if mostly symbolic, blow to the image of Ottoman invincibility, an image which the victory of the Knights of Malta over the Ottoman invaders in the 1565 siege of Malta had recently set about eroding. The battle was far more damaging to the Ottoman navy in sapping experienced manpower than the loss of ships, which were rapidly replaced. : 53 The Ottoman navy recovered quickly, persuading Venice to sign a peace treaty in 1573, allowing the Ottomans to expand and consolidate their position in North Africa. By contrast, the Habsburg frontier had settled somewhat, a stalemate caused by a stiffening of the Habsburg defenses. The Long Turkish War against Habsburg Austria (1593–1606) created the need for greater numbers of Ottoman infantry equipped with firearms, resulting in a relaxation of recruitment policy. This contributed to problems of indiscipline and outright rebelliousness within the corps, which were never fully solved. [ obsolete source ] Irregular sharpshooters ( Sekban ) were also recruited, and on demobilisation turned to brigandage in the Celali rebellions (1590–1610), which engendered widespread anarchy in Anatolia in the late 16th and early 17th centuries. : 24 With the Empire's population reaching 30 million people by 1600, the shortage of land placed further pressure on the government. [ obsolete source ] In spite of these problems, the Ottoman state remained strong, and its army did not collapse or suffer crushing defeats. The only exceptions were campaigns against the Safavid dynasty of Persia, where many of the Ottoman eastern provinces were lost, some permanently. This 1603–1618 war eventually resulted in the Treaty of Nasuh Pasha , which ceded the entire Caucasus, except westernmost Georgia, back into the possession of Safavid Iran . The treaty ending the Cretan War cost Venice much of Dalmatia , its Aegean island possessions, and Crete . (Losses from the war totalled 30,985 Venetian soldiers and 118,754 Turkish soldiers.) : 33 During his brief majority reign, Murad IV (1623–1640) reasserted central authority and recaptured Iraq (1639) from the Safavids. The resulting Treaty of Zuhab of that same year decisively divided the Caucasus and adjacent regions between the two neighbouring empires as it had already been defined in the 1555 Peace of Amasya. The Sultanate of Women (1533–1656) was a period in which the mothers of young sultans exercised power on behalf of their sons. The most prominent women of this period were Kösem Sultan and her daughter-in-law Turhan Hatice , whose political rivalry culminated in Kösem's murder in 1651. During the Köprülü era (1656–1703), effective control of the Empire was exercised by a sequence of grand viziers from the Köprülü family. The Köprülü Vizierate saw renewed military success with authority restored in Transylvania, the conquest of Crete completed in 1669, and expansion into Polish southern Ukraine , with the strongholds of Khotyn , and Kamianets-Podilskyi and the territory of Podolia ceding to Ottoman control in 1676. This period of renewed assertiveness came to a calamitous end in 1683 when Grand Vizier Kara Mustafa Pasha led a huge army to attempt a second Ottoman siege of Vienna in the Great Turkish War of 1683–1699. The final assault being fatally delayed, the Ottoman forces were swept away by allied Habsburg, German, and Polish forces spearheaded by the Polish king John III Sobieski at the Battle of Vienna . The alliance of the Holy League pressed home the advantage of the defeat at Vienna, culminating in the Treaty of Karlowitz (26 January 1699), which ended the Great Turkish War. The Ottomans surrendered control of significant territories, many permanently. Mustafa II (1695–1703) led the counterattack of 1695–1696 against the Habsburgs in Hungary, but was undone at the disastrous defeat at Zenta (in modern Serbia), 11 September 1697. Aside from the loss of the Banat and the temporary loss of Belgrade (1717–1739), the Ottoman border on the Danube and Sava remained stable during the eighteenth century. Russian expansion , however, presented a large and growing threat. Accordingly, King Charles XII of Sweden was welcomed as an ally in the Ottoman Empire following his defeat by the Russians at the Battle of Poltava of 1709 in central Ukraine (part of the Great Northern War of 1700–1721). Charles XII persuaded the Ottoman Sultan Ahmed III to declare war on Russia, which resulted in an Ottoman victory in the Pruth River Campaign of 1710–1711, in Moldavia. After the Austro-Turkish War , the Treaty of Passarowitz confirmed the loss of the Banat, Serbia, and "Little Walachia" (Oltenia) to Austria. The Treaty also revealed that the Ottoman Empire was on the defensive and unlikely to present any further aggression in Europe. The Austro-Russian–Turkish War (1735–1739), which was ended by the Treaty of Belgrade in 1739, resulted in the Ottoman recovery of northern Bosnia , Habsburg Serbia (including Belgrade), Oltenia and the southern parts of the Banat of Temeswar ; but the Empire lost the port of Azov , north of the Crimean Peninsula, to the Russians. After this treaty the Ottoman Empire was able to enjoy a generation of peace, as Austria and Russia were forced to deal with the rise of Prussia . Educational and technological reforms came about, including the establishment of higher education institutions such as the Istanbul Technical University . In 1734 an artillery school was established to impart Western-style artillery methods, but the Islamic clergy successfully objected under the grounds of theodicy . In 1754 the artillery school was reopened on a semi-secret basis. In 1726, Ibrahim Muteferrika convinced the Grand Vizier Nevşehirli Damat Ibrahim Pasha , the Grand Mufti , and the clergy on the efficiency of the printing press, and Muteferrika was later granted by Sultan Ahmed III permission to publish non-religious books (despite opposition from some calligraphers and religious leaders). Muteferrika's press published its first book in 1729 and, by 1743, issued 17 works in 23 volumes, each having between 500 and 1,000 copies. In North Africa, Spain conquered Oran from the autonomous Deylik of Algiers . The Bey of Oran received an army from Algiers, but it failed to recapture Oran ; the siege caused the deaths of 1,500 Spaniards, and even more Algerians. The Spanish also massacred many Muslim soldiers. In 1792, Spain abandoned Oran, selling it to the Deylik of Algiers. In 1768 Russian-backed Ukrainian Haidamakas , pursuing Polish confederates, entered Balta , an Ottoman-controlled town on the border of Bessarabia in Ukraine, massacred its citizens, and burned the town to the ground. This action provoked the Ottoman Empire into the Russo-Turkish War of 1768–1774 . The Treaty of Küçük Kaynarca of 1774 ended the war and provided freedom of worship for the Christian citizens of the Ottoman-controlled provinces of Wallachia and Moldavia. By the late 18th century, after a number of defeats in the wars with Russia, some people in the Ottoman Empire began to conclude that the reforms of Peter the Great had given the Russians an edge, and the Ottomans would have to keep up with Western technology in order to avoid further defeats. Selim III (1789–1807) made the first major attempts to modernise the army , but his reforms were hampered by the religious leadership and the Janissary corps. Jealous of their privileges and firmly opposed to change, the Janissary revolted . Selim's efforts cost him his throne and his life, but were resolved in spectacular and bloody fashion by his successor, the dynamic Mahmud II , who eliminated the Janissary corps in 1826. The Serbian revolution (1804–1815) marked the beginning of an era of national awakening in the Balkans during the Eastern Question . In 1811, the fundamentalist Wahhabis of Arabia, led by the al-Saud family, revolted against the Ottomans. Unable to defeat the Wahhabi rebels, the Sublime Porte had Muhammad Ali Pasha of Kavala , the vali (governor) of the Eyalet of Egypt , tasked with retaking Arabia, which ended with the destruction of the Emirate of Diriyah in 1818. The suzerainty of Serbia as a hereditary monarchy under its own dynasty was acknowledged de jure in 1830. In 1821, the Greeks declared war on the Sultan. A rebellion that originated in Moldavia as a diversion was followed by the main revolution in the Peloponnese , which, along with the northern part of the Gulf of Corinth , became the first parts of the Ottoman Empire to achieve independence (in 1829). In 1830, the French invaded the Deylik of Algiers . The campaign that took 21 days, resulted in over 5,000 Algerian military casualties, and about 2,600 French ones. Before the French invasion the total population of Algeria was most likely between 3,000,000 and 5,000,000. By 1873, the population of Algeria (excluding several hundred thousand newly arrived French settlers) decreased to a drastic 2,172,000. In 1831, Muhammad Ali of Egypt revolted against Sultan Mahmud II due to the latter's refusal to grant him the governorships of Greater Syria and Crete , which the Sultan had promised him in exchange for sending military assistance to put down the Greek revolt (1821–1829) that ultimately ended with the formal independence of Greece in 1830. It was a costly enterprise for Muhammad Ali, who had lost his fleet at the Battle of Navarino in 1827. Thus began the first Egyptian–Ottoman War (1831–1833) , during which the French-trained army of Muhammad Ali, under the command of his son Ibrahim Pasha , defeated the Ottoman Army as it marched into Anatolia , reaching the city of Kütahya within 320 km (200 mi) of the capital, Constantinople. : 95 In desperation, Sultan Mahmud II appealed to the empire's traditional arch-rival Russia for help, asking Emperor Nicholas I to send an expeditionary force to assist him. : 96 In return for signing the Treaty of Hünkâr İskelesi , the Russians sent the expeditionary force which deterred Ibrahim Pasha from marching any further towards Constantinople. : 96 Under the terms of the Convention of Kütahya , signed on 5 May 1833, Muhammad Ali agreed to abandon his campaign against the Sultan, in exchange for which he was made the vali (governor) of the vilayets (provinces) of Crete , Aleppo , Tripoli , Damascus and Sidon (the latter four comprising modern Syria and Lebanon ), and given the right to collect taxes in Adana . : 96 Had it not been for the Russian intervention, Sultan Mahmud II could have faced the risk of being overthrown and Muhammad Ali could have even become the new Sultan. These events marked the beginning of a recurring pattern where the Sublime Porte needed the help of foreign powers to protect itself. : 95–96 In 1839, the Sublime Porte attempted to take back what it lost to the de facto autonomous, but de jure still Ottoman Eyalet of Egypt , but its forces were initially defeated, which led to the Oriental Crisis of 1840 . Muhammad Ali had close relations with France , and the prospect of him becoming the Sultan of Egypt was widely viewed as putting the entire Levant into the French sphere of influence. : 96 As the Sublime Porte had proved itself incapable of defeating Muhammad Ali, the British Empire and Austrian Empire provided military assistance, and the second Egyptian–Ottoman War (1839–1841) ended with Ottoman victory and the restoration of Ottoman suzerainty over Egypt Eyalet and the Levant . : 96 By the mid-19th century, the Ottoman Empire was called the " sick man of Europe ". Three suzerain states – the Principality of Serbia , Wallachia and Moldavia – moved towards de jure independence during the 1860s and 1870s.In the second half of the sixteenth century, the Ottoman Empire came under increasing strain from inflation and the rapidly rising costs of warfare that were impacting both Europe and the Middle East. These pressures led to a series of crises around the year 1600, placing great strain upon the Ottoman system of government. : 413–414 The empire underwent a series of transformations of its political and military institutions in response to these challenges, enabling it to successfully adapt to the new conditions of the seventeenth century and remain powerful, both militarily and economically. : 10 Historians of the mid-twentieth century once characterised this period as one of stagnation and decline, but this view is now rejected by the majority of academics. The discovery of new maritime trade routes by Western European states allowed them to avoid the Ottoman trade monopoly. The Portuguese discovery of the Cape of Good Hope in 1488 initiated a series of Ottoman-Portuguese naval wars in the Indian Ocean throughout the 16th century. Despite the growing European presence in the Indian Ocean, Ottoman trade with the east continued to flourish. Cairo, in particular, benefitted from the rise of Yemeni coffee as a popular consumer commodity. As coffeehouses appeared in cities and towns across the empire, Cairo developed into a major center for its trade, contributing to its continued prosperity throughout the seventeenth and much of the eighteenth century. : 507–508 Under Ivan IV (1533–1584), the Tsardom of Russia expanded into the Volga and Caspian regions at the expense of the Tatar khanates. In 1571, the Crimean khan Devlet I Giray , commanded by the Ottomans, burned Moscow . The next year, the invasion was repeated but repelled at the Battle of Molodi . The Ottoman Empire continued to invade Eastern Europe in a series of slave raids , and remained a significant power in Eastern Europe until the end of the 17th century. The Ottomans decided to conquer Venetian Cyprus and on 22 July 1570, Nicosia was besieged; 50,000 Christians died, and 180,000 were enslaved. : 67 On 15 September 1570, the Ottoman cavalry appeared before the last Venetian stronghold in Cyprus, Famagusta. The Venetian defenders held out for 11 months against a force that at its peak numbered 200,000 men with 145 cannons; 163,000 cannonballs struck the walls of Famagusta before it fell to the Ottomans in August 1571. The Siege of Famagusta claimed 50,000 Ottoman casualties. : 328 Meanwhile, the Holy League consisting of mostly Spanish and Venetian fleets won a victory over the Ottoman fleet at the Battle of Lepanto (1571), off southwestern Greece; Catholic forces killed over 30,000 Turks and destroyed 200 of their ships. : 24 It was a startling, if mostly symbolic, blow to the image of Ottoman invincibility, an image which the victory of the Knights of Malta over the Ottoman invaders in the 1565 siege of Malta had recently set about eroding. The battle was far more damaging to the Ottoman navy in sapping experienced manpower than the loss of ships, which were rapidly replaced. : 53 The Ottoman navy recovered quickly, persuading Venice to sign a peace treaty in 1573, allowing the Ottomans to expand and consolidate their position in North Africa. By contrast, the Habsburg frontier had settled somewhat, a stalemate caused by a stiffening of the Habsburg defenses. The Long Turkish War against Habsburg Austria (1593–1606) created the need for greater numbers of Ottoman infantry equipped with firearms, resulting in a relaxation of recruitment policy. This contributed to problems of indiscipline and outright rebelliousness within the corps, which were never fully solved. [ obsolete source ] Irregular sharpshooters ( Sekban ) were also recruited, and on demobilisation turned to brigandage in the Celali rebellions (1590–1610), which engendered widespread anarchy in Anatolia in the late 16th and early 17th centuries. : 24 With the Empire's population reaching 30 million people by 1600, the shortage of land placed further pressure on the government. [ obsolete source ] In spite of these problems, the Ottoman state remained strong, and its army did not collapse or suffer crushing defeats. The only exceptions were campaigns against the Safavid dynasty of Persia, where many of the Ottoman eastern provinces were lost, some permanently. This 1603–1618 war eventually resulted in the Treaty of Nasuh Pasha , which ceded the entire Caucasus, except westernmost Georgia, back into the possession of Safavid Iran . The treaty ending the Cretan War cost Venice much of Dalmatia , its Aegean island possessions, and Crete . (Losses from the war totalled 30,985 Venetian soldiers and 118,754 Turkish soldiers.) : 33 During his brief majority reign, Murad IV (1623–1640) reasserted central authority and recaptured Iraq (1639) from the Safavids. The resulting Treaty of Zuhab of that same year decisively divided the Caucasus and adjacent regions between the two neighbouring empires as it had already been defined in the 1555 Peace of Amasya. The Sultanate of Women (1533–1656) was a period in which the mothers of young sultans exercised power on behalf of their sons. The most prominent women of this period were Kösem Sultan and her daughter-in-law Turhan Hatice , whose political rivalry culminated in Kösem's murder in 1651. During the Köprülü era (1656–1703), effective control of the Empire was exercised by a sequence of grand viziers from the Köprülü family. The Köprülü Vizierate saw renewed military success with authority restored in Transylvania, the conquest of Crete completed in 1669, and expansion into Polish southern Ukraine , with the strongholds of Khotyn , and Kamianets-Podilskyi and the territory of Podolia ceding to Ottoman control in 1676. This period of renewed assertiveness came to a calamitous end in 1683 when Grand Vizier Kara Mustafa Pasha led a huge army to attempt a second Ottoman siege of Vienna in the Great Turkish War of 1683–1699. The final assault being fatally delayed, the Ottoman forces were swept away by allied Habsburg, German, and Polish forces spearheaded by the Polish king John III Sobieski at the Battle of Vienna . The alliance of the Holy League pressed home the advantage of the defeat at Vienna, culminating in the Treaty of Karlowitz (26 January 1699), which ended the Great Turkish War. The Ottomans surrendered control of significant territories, many permanently. Mustafa II (1695–1703) led the counterattack of 1695–1696 against the Habsburgs in Hungary, but was undone at the disastrous defeat at Zenta (in modern Serbia), 11 September 1697. Aside from the loss of the Banat and the temporary loss of Belgrade (1717–1739), the Ottoman border on the Danube and Sava remained stable during the eighteenth century. Russian expansion , however, presented a large and growing threat. Accordingly, King Charles XII of Sweden was welcomed as an ally in the Ottoman Empire following his defeat by the Russians at the Battle of Poltava of 1709 in central Ukraine (part of the Great Northern War of 1700–1721). Charles XII persuaded the Ottoman Sultan Ahmed III to declare war on Russia, which resulted in an Ottoman victory in the Pruth River Campaign of 1710–1711, in Moldavia. After the Austro-Turkish War , the Treaty of Passarowitz confirmed the loss of the Banat, Serbia, and "Little Walachia" (Oltenia) to Austria. The Treaty also revealed that the Ottoman Empire was on the defensive and unlikely to present any further aggression in Europe. The Austro-Russian–Turkish War (1735–1739), which was ended by the Treaty of Belgrade in 1739, resulted in the Ottoman recovery of northern Bosnia , Habsburg Serbia (including Belgrade), Oltenia and the southern parts of the Banat of Temeswar ; but the Empire lost the port of Azov , north of the Crimean Peninsula, to the Russians. After this treaty the Ottoman Empire was able to enjoy a generation of peace, as Austria and Russia were forced to deal with the rise of Prussia . Educational and technological reforms came about, including the establishment of higher education institutions such as the Istanbul Technical University . In 1734 an artillery school was established to impart Western-style artillery methods, but the Islamic clergy successfully objected under the grounds of theodicy . In 1754 the artillery school was reopened on a semi-secret basis. In 1726, Ibrahim Muteferrika convinced the Grand Vizier Nevşehirli Damat Ibrahim Pasha , the Grand Mufti , and the clergy on the efficiency of the printing press, and Muteferrika was later granted by Sultan Ahmed III permission to publish non-religious books (despite opposition from some calligraphers and religious leaders). Muteferrika's press published its first book in 1729 and, by 1743, issued 17 works in 23 volumes, each having between 500 and 1,000 copies. In North Africa, Spain conquered Oran from the autonomous Deylik of Algiers . The Bey of Oran received an army from Algiers, but it failed to recapture Oran ; the siege caused the deaths of 1,500 Spaniards, and even more Algerians. The Spanish also massacred many Muslim soldiers. In 1792, Spain abandoned Oran, selling it to the Deylik of Algiers. In 1768 Russian-backed Ukrainian Haidamakas , pursuing Polish confederates, entered Balta , an Ottoman-controlled town on the border of Bessarabia in Ukraine, massacred its citizens, and burned the town to the ground. This action provoked the Ottoman Empire into the Russo-Turkish War of 1768–1774 . The Treaty of Küçük Kaynarca of 1774 ended the war and provided freedom of worship for the Christian citizens of the Ottoman-controlled provinces of Wallachia and Moldavia. By the late 18th century, after a number of defeats in the wars with Russia, some people in the Ottoman Empire began to conclude that the reforms of Peter the Great had given the Russians an edge, and the Ottomans would have to keep up with Western technology in order to avoid further defeats. Selim III (1789–1807) made the first major attempts to modernise the army , but his reforms were hampered by the religious leadership and the Janissary corps. Jealous of their privileges and firmly opposed to change, the Janissary revolted . Selim's efforts cost him his throne and his life, but were resolved in spectacular and bloody fashion by his successor, the dynamic Mahmud II , who eliminated the Janissary corps in 1826. The Serbian revolution (1804–1815) marked the beginning of an era of national awakening in the Balkans during the Eastern Question . In 1811, the fundamentalist Wahhabis of Arabia, led by the al-Saud family, revolted against the Ottomans. Unable to defeat the Wahhabi rebels, the Sublime Porte had Muhammad Ali Pasha of Kavala , the vali (governor) of the Eyalet of Egypt , tasked with retaking Arabia, which ended with the destruction of the Emirate of Diriyah in 1818. The suzerainty of Serbia as a hereditary monarchy under its own dynasty was acknowledged de jure in 1830. In 1821, the Greeks declared war on the Sultan. A rebellion that originated in Moldavia as a diversion was followed by the main revolution in the Peloponnese , which, along with the northern part of the Gulf of Corinth , became the first parts of the Ottoman Empire to achieve independence (in 1829). In 1830, the French invaded the Deylik of Algiers . The campaign that took 21 days, resulted in over 5,000 Algerian military casualties, and about 2,600 French ones. Before the French invasion the total population of Algeria was most likely between 3,000,000 and 5,000,000. By 1873, the population of Algeria (excluding several hundred thousand newly arrived French settlers) decreased to a drastic 2,172,000. In 1831, Muhammad Ali of Egypt revolted against Sultan Mahmud II due to the latter's refusal to grant him the governorships of Greater Syria and Crete , which the Sultan had promised him in exchange for sending military assistance to put down the Greek revolt (1821–1829) that ultimately ended with the formal independence of Greece in 1830. It was a costly enterprise for Muhammad Ali, who had lost his fleet at the Battle of Navarino in 1827. Thus began the first Egyptian–Ottoman War (1831–1833) , during which the French-trained army of Muhammad Ali, under the command of his son Ibrahim Pasha , defeated the Ottoman Army as it marched into Anatolia , reaching the city of Kütahya within 320 km (200 mi) of the capital, Constantinople. : 95 In desperation, Sultan Mahmud II appealed to the empire's traditional arch-rival Russia for help, asking Emperor Nicholas I to send an expeditionary force to assist him. : 96 In return for signing the Treaty of Hünkâr İskelesi , the Russians sent the expeditionary force which deterred Ibrahim Pasha from marching any further towards Constantinople. : 96 Under the terms of the Convention of Kütahya , signed on 5 May 1833, Muhammad Ali agreed to abandon his campaign against the Sultan, in exchange for which he was made the vali (governor) of the vilayets (provinces) of Crete , Aleppo , Tripoli , Damascus and Sidon (the latter four comprising modern Syria and Lebanon ), and given the right to collect taxes in Adana . : 96 Had it not been for the Russian intervention, Sultan Mahmud II could have faced the risk of being overthrown and Muhammad Ali could have even become the new Sultan. These events marked the beginning of a recurring pattern where the Sublime Porte needed the help of foreign powers to protect itself. : 95–96 In 1839, the Sublime Porte attempted to take back what it lost to the de facto autonomous, but de jure still Ottoman Eyalet of Egypt , but its forces were initially defeated, which led to the Oriental Crisis of 1840 . Muhammad Ali had close relations with France , and the prospect of him becoming the Sultan of Egypt was widely viewed as putting the entire Levant into the French sphere of influence. : 96 As the Sublime Porte had proved itself incapable of defeating Muhammad Ali, the British Empire and Austrian Empire provided military assistance, and the second Egyptian–Ottoman War (1839–1841) ended with Ottoman victory and the restoration of Ottoman suzerainty over Egypt Eyalet and the Levant . : 96 By the mid-19th century, the Ottoman Empire was called the " sick man of Europe ". Three suzerain states – the Principality of Serbia , Wallachia and Moldavia – moved towards de jure independence during the 1860s and 1870s.During the Tanzimat period (1839–1876), the government's series of constitutional reforms led to a fairly modern conscripted army , banking system reforms, the decriminalization of homosexuality, the replacement of religious law with secular law, and guilds with modern factories. The Ottoman Ministry of Post was established in Istanbul in 1840. American inventor Samuel Morse received an Ottoman patent for the telegraph in 1847, issued by Sultan Abdülmecid , who personally tested the invention. The reformist period peaked with the Constitution, called the Kanûn-u Esâsî . The empire's First Constitutional era was short-lived. The parliament survived for only two years before the sultan suspended it. The empire's Christian population, owing to their higher educational levels, started to pull ahead of the Muslim majority, leading to much resentment. In 1861, there were 571 primary and 94 secondary schools for Ottoman Christians, with 140,000 pupils in total, a figure that vastly exceeded the number of Muslim children in school at the time, who were further hindered by the amount of time spent learning Arabic and Islamic theology. Author Norman Stone suggests that the Arabic alphabet, in which Turkish was written until 1928 , was ill-suited to reflect the sounds of Turkish (which is a Turkic as opposed to Semitic language), which imposed further difficulty on Turkish children. In turn, Christians' higher educational levels allowed them to play a larger role in the economy, with the rise in prominence of groups such as the Sursock family indicative of this. In 1911, of the 654 wholesale companies in Istanbul, 528 were owned by ethnic Greeks. In many cases, Christians and Jews gained protection from European consuls and citizenship, meaning they were protected from Ottoman law and not subject to the same economic regulations as their Muslim counterparts. The Crimean War (1853–1856) was part of a long-running contest between the major European powers for influence over territories of the declining Ottoman Empire. The financial burden of the war led the Ottoman state to issue foreign loans amounting to 5 million pounds sterling on 4 August 1854. : 32 : 71 The war caused an exodus of the Crimean Tatars , about 200,000 of whom moved to the Ottoman Empire in continuing waves of emigration. : 79–108 Toward the end of the Caucasian Wars , 90% of the Circassians were ethnically cleansed and exiled from their homelands in the Caucasus, fleeing to the Ottoman Empire, resulting in the settlement of 500,000 to 700,000 Circassians in Turkey. [ page needed ] Some Circassian organisations give much higher numbers, totalling 1–1.5 million deported or killed. Crimean Tatar refugees in the late 19th century played an especially notable role in seeking to modernise Ottoman education and in first promoting both Pan-Turkism and a sense of Turkish nationalism. In this period, the Ottoman Empire spent only small amounts of public funds on education; for example, in 1860–1861 only 0.2% of the total budget was invested in education. : 50 As the Ottoman state attempted to modernize its infrastructure and army in response to outside threats, it opened itself up to a different kind of threat: that of creditors. As the historian Eugene Rogan has written, "the single greatest threat to the independence of the Middle East" in the 19th century "was not the armies of Europe but its banks". The Ottoman state, which had begun taking on debt with the Crimean War, was forced to declare bankruptcy in 1875. By 1881, the Ottoman Empire agreed to have its debt controlled by the Ottoman Public Debt Administration , a council of European men with presidency alternating between France and Britain. The body controlled swaths of the Ottoman economy, and used its position to ensure that European capital continued to penetrate the empire, often to the detriment of local Ottoman interests. The Ottoman bashi-bazouks suppressed the Bulgarian uprising of 1876, massacring up to 100,000 people in the process. : 139 The Russo-Turkish War (1877–1878) ended with a decisive victory for Russia. As a result, Ottoman holdings in Europe declined sharply: Bulgaria was established as an independent principality inside the Ottoman Empire; Romania achieved full independence; and Serbia and Montenegro finally gained complete independence, but with smaller territories. In 1878, Austria-Hungary unilaterally occupied the Ottoman provinces of Bosnia-Herzegovina and Novi Pazar . British Prime Minister Benjamin Disraeli advocated restoring the Ottoman territories on the Balkan Peninsula during the Congress of Berlin , and in return, Britain assumed the administration of Cyprus in 1878. : 228–254 Britain later sent troops to Egypt in 1882 to put down the Urabi Revolt (Sultan Abdul Hamid II was too paranoid to mobilize his own army, fearing this would result in a coup d'état), effectively gaining control in both territories. Abdul Hamid II was so fearful of a coup that he did not allow his army to conduct war games, lest this serve as cover for a coup, but he did see the need for military mobilization. In 1883, a German military mission under General Baron Colmar von der Goltz arrived to train the Ottoman Army, leading to the so-called "Goltz generation" of German-trained officers, who played a notable role in the politics of the empire's last years. : 24 From 1894 to 1896, between 100,000 and 300,000 Armenians living throughout the empire were killed in what became known as the Hamidian massacres . : 42 In 1897 the population was 19 million, of whom 14 million (74%) were Muslim. An additional 20 million lived in provinces that remained under the sultan's nominal suzerainty but were entirely outside his actual power. One by one the Porte lost nominal authority. They included Egypt, Tunisia, Bulgaria, Cyprus, Bosnia-Herzegovina, and Lebanon. As the Ottoman Empire gradually shrank, 7–9 million Muslims from its former territories in the Caucasus, Crimea , Balkans, and the Mediterranean islands migrated to Anatolia and Eastern Thrace . After the Empire lost the First Balkan War (1912–1913), it lost all its Balkan territories except East Thrace (European Turkey). This resulted in around 400,000 Muslims fleeing with the retreating Ottoman armies (with many dying from cholera brought by the soldiers), and 400,000 non-Muslims fled territory still under Ottoman rule. Justin McCarthy estimates that from 1821 to 1922, 5.5 million Muslims died in southeastern Europe, with the expulsion of 5 million. The defeat and dissolution of the Ottoman Empire (1908 — 1922) began with the Second Constitutional Era , a moment of hope and promise established with the Young Turk Revolution . It restored the Constitution of the Ottoman Empire and brought in multi-party politics with a two-stage electoral system ( electoral law ) under the Ottoman parliament . The constitution offered hope by freeing the empire's citizens to modernise the state's institutions, rejuvenate its strength, and enable it to hold its own against outside powers. Its guarantee of liberties promised to dissolve inter-communal tensions and transform the empire into a more harmonious place. Instead, this period became the story of the twilight struggle of the Empire. Members of Young Turks movement who had once gone underground now established their parties. Among them " Committee of Union and Progress ", and " Freedom and Accord Party " were major parties. On the other end of the spectrum were ethnic parties, which included Poale Zion , Al-Fatat , and Armenian national movement organised under Armenian Revolutionary Federation . Profiting from the civil strife, Austria-Hungary officially annexed Bosnia and Herzegovina in 1908. The last of the Ottoman censuses was performed in 1914 . Despite military reforms which reconstituted the Ottoman Modern Army , the Empire lost its North African territories and the Dodecanese in the Italo-Turkish War (1911) and almost all of its European territories in the Balkan Wars (1912–1913). The Empire faced continuous unrest in the years leading up to World War I , including the 31 March Incident and two further coups in 1912 and 1913 . The Ottoman Empire entered World War I on the side of the Central Powers and was ultimately defeated. The Ottoman participation in the war began with the combined German-Ottoman surprise attack on the Black Sea coast of the Russian Empire on 29 October 1914. Following the attack, the Russian Empire (2 November 1914) and its allies France (5 November 1914) and the British Empire (5 November 1914) declared war on the Ottoman Empire (also on 5 November 1914, the British government changed the status of the Khedivate of Egypt and Cyprus , which were de jure Ottoman territories prior to the war, as British protectorates .) The Ottomans successfully defended the Dardanelles strait during the Gallipoli campaign (1915–1916) and achieved initial victories against British forces in the first two years of the Mesopotamian campaign , such as the Siege of Kut (1915–1916); but the Arab Revolt (1916–1918) turned the tide against the Ottomans in the Middle East. In the Caucasus campaign , however, the Russian forces had the upper hand from the beginning, especially after the Battle of Sarikamish (1914–1915). Russian forces advanced into northeastern Anatolia and controlled the major cities there until retreating from World War I with the Treaty of Brest-Litovsk following the Russian Revolution in 1917. In 1915 the Ottoman government and Kurdish tribes in the region started the extermination of its ethnic Armenian population, resulting in the deaths of up to 1.5 million Armenians in the Armenian genocide . The genocide was carried out during and after World War I and implemented in two phases: the wholesale killing of the able-bodied male population through massacre and subjection of army conscripts to forced labour, followed by the deportation of women, children, the elderly and infirm on death marches leading to the Syrian desert . Driven forward by military escorts, the deportees were deprived of food and water and subjected to periodic robbery, rape , and systematic massacre. Large-scale massacres were also committed against the Empire's Greek and Assyrian minorities as part of the same campaign of ethnic cleansing. The Arab Revolt began in 1916 with British support. It turned the tide against the Ottomans on the Middle Eastern front, where they seemed to have the upper hand during the first two years of the war. On the basis of the McMahon–Hussein Correspondence , an agreement between the British government and Hussein bin Ali, Sharif of Mecca , the revolt was officially initiated at Mecca on 10 June 1916. [lower-alpha 14] The Arab nationalist goal was to create a single unified and independent Arab state stretching from Aleppo , Syria , to Aden , Yemen , which the British promised to recognise. The Sharifian Army , led by Hussein and the Hashemites , with military backing from the British Egyptian Expeditionary Force , successfully fought and expelled the Ottoman military presence from much of the Hejaz and Transjordan . The rebellion eventually took Damascus and set up a short-lived monarchy led by Faisal , a son of Hussein. Following the terms of the 1916 Sykes–Picot Agreement , the British and French later partitioned the Middle East into mandate territories . There was no unified Arab state, much to Arab nationalists' anger. Defeated in World War I, the Ottoman Empire signed the Armistice of Mudros on 30 October 1918. Istanbul was occupied by combined British, French, Italian, and Greek forces. In May 1919, Greece also took control of the area around Smyrna (now İzmir). The partition of the Ottoman Empire was finalized under the terms of the 1920 Treaty of Sèvres . This treaty, as designed in the Conference of London , allowed the Sultan to retain his position and title. Anatolia's status was problematic given the occupied forces. A nationalist opposition arose in the Turkish national movement . It won the Turkish War of Independence (1919–1923) under the leadership of Mustafa Kemal (later given the surname "Atatürk"). The sultanate was abolished on 1 November 1922, and the last sultan, Mehmed VI (reigned 1918–1922), left the country on 17 November 1922. The Republic of Turkey was established in its place on 29 October 1923, in the new capital city of Ankara . The caliphate was abolished on 3 March 1924. The defeat and dissolution of the Ottoman Empire (1908 — 1922) began with the Second Constitutional Era , a moment of hope and promise established with the Young Turk Revolution . It restored the Constitution of the Ottoman Empire and brought in multi-party politics with a two-stage electoral system ( electoral law ) under the Ottoman parliament . The constitution offered hope by freeing the empire's citizens to modernise the state's institutions, rejuvenate its strength, and enable it to hold its own against outside powers. Its guarantee of liberties promised to dissolve inter-communal tensions and transform the empire into a more harmonious place. Instead, this period became the story of the twilight struggle of the Empire. Members of Young Turks movement who had once gone underground now established their parties. Among them " Committee of Union and Progress ", and " Freedom and Accord Party " were major parties. On the other end of the spectrum were ethnic parties, which included Poale Zion , Al-Fatat , and Armenian national movement organised under Armenian Revolutionary Federation . Profiting from the civil strife, Austria-Hungary officially annexed Bosnia and Herzegovina in 1908. The last of the Ottoman censuses was performed in 1914 . Despite military reforms which reconstituted the Ottoman Modern Army , the Empire lost its North African territories and the Dodecanese in the Italo-Turkish War (1911) and almost all of its European territories in the Balkan Wars (1912–1913). The Empire faced continuous unrest in the years leading up to World War I , including the 31 March Incident and two further coups in 1912 and 1913 .The Ottoman Empire entered World War I on the side of the Central Powers and was ultimately defeated. The Ottoman participation in the war began with the combined German-Ottoman surprise attack on the Black Sea coast of the Russian Empire on 29 October 1914. Following the attack, the Russian Empire (2 November 1914) and its allies France (5 November 1914) and the British Empire (5 November 1914) declared war on the Ottoman Empire (also on 5 November 1914, the British government changed the status of the Khedivate of Egypt and Cyprus , which were de jure Ottoman territories prior to the war, as British protectorates .) The Ottomans successfully defended the Dardanelles strait during the Gallipoli campaign (1915–1916) and achieved initial victories against British forces in the first two years of the Mesopotamian campaign , such as the Siege of Kut (1915–1916); but the Arab Revolt (1916–1918) turned the tide against the Ottomans in the Middle East. In the Caucasus campaign , however, the Russian forces had the upper hand from the beginning, especially after the Battle of Sarikamish (1914–1915). Russian forces advanced into northeastern Anatolia and controlled the major cities there until retreating from World War I with the Treaty of Brest-Litovsk following the Russian Revolution in 1917. In 1915 the Ottoman government and Kurdish tribes in the region started the extermination of its ethnic Armenian population, resulting in the deaths of up to 1.5 million Armenians in the Armenian genocide . The genocide was carried out during and after World War I and implemented in two phases: the wholesale killing of the able-bodied male population through massacre and subjection of army conscripts to forced labour, followed by the deportation of women, children, the elderly and infirm on death marches leading to the Syrian desert . Driven forward by military escorts, the deportees were deprived of food and water and subjected to periodic robbery, rape , and systematic massacre. Large-scale massacres were also committed against the Empire's Greek and Assyrian minorities as part of the same campaign of ethnic cleansing. The Arab Revolt began in 1916 with British support. It turned the tide against the Ottomans on the Middle Eastern front, where they seemed to have the upper hand during the first two years of the war. On the basis of the McMahon–Hussein Correspondence , an agreement between the British government and Hussein bin Ali, Sharif of Mecca , the revolt was officially initiated at Mecca on 10 June 1916. [lower-alpha 14] The Arab nationalist goal was to create a single unified and independent Arab state stretching from Aleppo , Syria , to Aden , Yemen , which the British promised to recognise. The Sharifian Army , led by Hussein and the Hashemites , with military backing from the British Egyptian Expeditionary Force , successfully fought and expelled the Ottoman military presence from much of the Hejaz and Transjordan . The rebellion eventually took Damascus and set up a short-lived monarchy led by Faisal , a son of Hussein. Following the terms of the 1916 Sykes–Picot Agreement , the British and French later partitioned the Middle East into mandate territories . There was no unified Arab state, much to Arab nationalists' anger. Defeated in World War I, the Ottoman Empire signed the Armistice of Mudros on 30 October 1918. Istanbul was occupied by combined British, French, Italian, and Greek forces. In May 1919, Greece also took control of the area around Smyrna (now İzmir). The partition of the Ottoman Empire was finalized under the terms of the 1920 Treaty of Sèvres . This treaty, as designed in the Conference of London , allowed the Sultan to retain his position and title. Anatolia's status was problematic given the occupied forces. A nationalist opposition arose in the Turkish national movement . It won the Turkish War of Independence (1919–1923) under the leadership of Mustafa Kemal (later given the surname "Atatürk"). The sultanate was abolished on 1 November 1922, and the last sultan, Mehmed VI (reigned 1918–1922), left the country on 17 November 1922. The Republic of Turkey was established in its place on 29 October 1923, in the new capital city of Ankara . The caliphate was abolished on 3 March 1924. In 1915 the Ottoman government and Kurdish tribes in the region started the extermination of its ethnic Armenian population, resulting in the deaths of up to 1.5 million Armenians in the Armenian genocide . The genocide was carried out during and after World War I and implemented in two phases: the wholesale killing of the able-bodied male population through massacre and subjection of army conscripts to forced labour, followed by the deportation of women, children, the elderly and infirm on death marches leading to the Syrian desert . Driven forward by military escorts, the deportees were deprived of food and water and subjected to periodic robbery, rape , and systematic massacre. Large-scale massacres were also committed against the Empire's Greek and Assyrian minorities as part of the same campaign of ethnic cleansing. The Arab Revolt began in 1916 with British support. It turned the tide against the Ottomans on the Middle Eastern front, where they seemed to have the upper hand during the first two years of the war. On the basis of the McMahon–Hussein Correspondence , an agreement between the British government and Hussein bin Ali, Sharif of Mecca , the revolt was officially initiated at Mecca on 10 June 1916. [lower-alpha 14] The Arab nationalist goal was to create a single unified and independent Arab state stretching from Aleppo , Syria , to Aden , Yemen , which the British promised to recognise. The Sharifian Army , led by Hussein and the Hashemites , with military backing from the British Egyptian Expeditionary Force , successfully fought and expelled the Ottoman military presence from much of the Hejaz and Transjordan . The rebellion eventually took Damascus and set up a short-lived monarchy led by Faisal , a son of Hussein. Following the terms of the 1916 Sykes–Picot Agreement , the British and French later partitioned the Middle East into mandate territories . There was no unified Arab state, much to Arab nationalists' anger.Defeated in World War I, the Ottoman Empire signed the Armistice of Mudros on 30 October 1918. Istanbul was occupied by combined British, French, Italian, and Greek forces. In May 1919, Greece also took control of the area around Smyrna (now İzmir). The partition of the Ottoman Empire was finalized under the terms of the 1920 Treaty of Sèvres . This treaty, as designed in the Conference of London , allowed the Sultan to retain his position and title. Anatolia's status was problematic given the occupied forces. A nationalist opposition arose in the Turkish national movement . It won the Turkish War of Independence (1919–1923) under the leadership of Mustafa Kemal (later given the surname "Atatürk"). The sultanate was abolished on 1 November 1922, and the last sultan, Mehmed VI (reigned 1918–1922), left the country on 17 November 1922. The Republic of Turkey was established in its place on 29 October 1923, in the new capital city of Ankara . The caliphate was abolished on 3 March 1924. Several historians, such as British historian Edward Gibbon and the Greek historian Dimitri Kitsikis , have argued that after the fall of Constantinople, the Ottoman state took over the machinery of the Byzantine (Roman) state and that the Ottoman Empire was in essence a continuation of the Eastern Roman Empire under a Turkish Muslim guise. The American historian Speros Vryonis writes that the Ottoman state centered on "a Byzantine-Balkan base with a veneer of the Turkish language and the Islamic religion". Kitsikis and the American historian Heath Lowry posit that the early Ottoman state was a predatory confederacy open to both Byzantine Christians and Turkish Muslims whose primary goal was attaining booty and slaves, rather than spreading Islam, and that Islam only later became the empire's primary characteristic. Other historians have followed the lead of the Austrian historian Paul Wittek , who emphasizes the early Ottoman state's Islamic character, seeing it as a " jihad state" dedicated to expanding the Muslim world . Many historians led in 1937 by the Turkish historian Mehmet Fuat Köprülü championed the Ghaza thesis , according to which the early Ottoman state was a continuation of the way of life of the nomadic Turkic tribes who had come from East Asia to Anatolia via Central Asia and the Middle East on a much larger scale. They argued that the most important cultural influences on the Ottoman state came from Persia . The British historian Norman Stone suggests many continuities between the Eastern Roman and Ottoman empires, such as that the zeugarion tax of Byzantium became the Ottoman Resm-i çift tax, that the pronoia land-holding system that linked the amount of land one owned with one's ability to raise cavalry became the Ottoman timar system, and that the Ottoman land measurement the dönüm was the same as the Byzantine stremma . Stone also argues that although Sunni Islam was the state religion, the Ottoman state supported and controlled the Eastern Orthodox Church , which in return for accepting that control became the Ottoman Empire's largest land-holder. Despite the similarities, Stone argues that a crucial difference is that the land grants under the timar system were not hereditary at first. Even after they became inheritable, land ownership in the Ottoman Empire remained highly insecure, and the sultan revoked land grants whenever he wished. Stone argued this insecurity in land tenure strongly discouraged Timariots from seeking long-term development of their land, and instead led them to adopt a strategy of short-term exploitation, which had deleterious effects on the Ottoman economy. Before the reforms of the 19th and 20th centuries, the state organisation of the Ottoman Empire was a system with two main dimensions, the military administration, and the civil administration. The Sultan was in the highest position in the system. The civil system was based on local administrative units based on the region's characteristics. The state had control over the clergy. Certain pre-Islamic Turkish traditions that had survived the adoption of administrative and legal practices from Islamic Iran remained important in Ottoman administrative circles. According to Ottoman understanding, the state's primary responsibility was to defend and extend the land of the Muslims and to ensure security and harmony within its borders in the overarching context of orthodox Islamic practice and dynastic sovereignty. The Ottoman Empire, or as a dynastic institution, the House of Osman, was unprecedented and unequaled in the Islamic world for its size and duration. In Europe, only the House of Habsburg had a similarly unbroken line of sovereigns (kings/emperors) from the same family who ruled for so long, and during the same period, between the late 13th and early 20th centuries. The Ottoman dynasty was Turkish in origin. On eleven occasions, the sultan was deposed (replaced by another sultan of the Ottoman dynasty, who were either the former sultan's brother, son or nephew) because he was perceived by his enemies as a threat to the state. There were only two attempts in Ottoman history to unseat the ruling Ottoman dynasty, both failures, which suggests a political system that for an extended period was able to manage its revolutions without unnecessary instability. As such, the last Ottoman sultan Mehmed VI ( r. 1918–1922 ) was a direct patrilineal (male-line) descendant of the first Ottoman sultan Osman I ( d. 1323/4), which was unparalleled in both Europe (e.g., the male line of the House of Habsburg became extinct in 1740) and in the Islamic world. The primary purpose of the Imperial Harem was to ensure the birth of male heirs to the Ottoman throne and secure the continuation of the direct patrilineal (male-line) power of the Ottoman sultans in the future generations. The highest position in Islam, caliph , was claimed by the sultans starting with Selim I , which was established as the Ottoman Caliphate. The Ottoman sultan, pâdişâh or "lord of kings", served as the Empire's sole regent and was considered to be the embodiment of its government, though he did not always exercise complete control. The Imperial Harem was one of the most important powers of the Ottoman court. It was ruled by the valide sultan . On occasion, the valide sultan became involved in state politics. For a time, the women of the Harem effectively controlled the state in what was termed the " Sultanate of Women ". New sultans were always chosen from the sons of the previous sultan. [ dubious – discuss ] The strong educational system of the palace school was geared towards eliminating the unfit potential heirs and establishing support among the ruling elite for a successor. The palace schools, which also educated the future administrators of the state, were not a single track. First, the Madrasa ( Medrese ) was designated for the Muslims, and educated scholars and state officials according to Islamic tradition. The financial burden of the Medrese was supported by vakif s, allowing children of poor families to move to higher social levels and income. The second track was a free boarding school for the Christians, the Enderûn , which recruited 3,000 students annually from Christian boys between eight and twenty years old from one in forty families among the communities settled in Rumelia or the Balkans, a process known as Devshirme ( Devşirme ). Though the sultan was the supreme monarch, the sultan's political and executive authority was delegated. The politics of the state had a number of advisors and ministers gathered around a council known as Divan . The Divan, in the years when the Ottoman state was still a Beylik , was composed of the elders of the tribe. Its composition was later modified to include military officers and local elites (such as religious and political advisors). Later still, beginning in 1320, a Grand Vizier was appointed to assume certain of the sultan's responsibilities. The Grand Vizier had considerable independence from the sultan with almost unlimited powers of appointment, dismissal, and supervision. Beginning with the late 16th century, sultans withdrew from politics and the Grand Vizier became the de facto head of state. Throughout Ottoman history, there were many instances in which local governors acted independently, and even in opposition to the ruler. After the Young Turk Revolution of 1908, the Ottoman state became a constitutional monarchy. The sultan no longer had executive powers. A parliament was formed, with representatives chosen from the provinces. The representatives formed the Imperial Government of the Ottoman Empire . This eclectic administration was apparent even in the diplomatic correspondence of the Empire, which was initially undertaken in the Greek language to the west. The Tughra were calligraphic monograms, or signatures, of the Ottoman Sultans, of which there were 35. Carved on the Sultan's seal, they bore the names of the Sultan and his father. The statement and prayer, "ever victorious", was also present in most. The earliest belonged to Orhan Gazi. The ornately stylized Tughra spawned a branch of Ottoman-Turkish calligraphy . The Ottoman legal system accepted the religious law over its subjects. At the same time the Qanun (or Kanun ), dynastic law, co-existed with religious law or Sharia . The Ottoman Empire was always organized around a system of local jurisprudence . Legal administration in the Ottoman Empire was part of a larger scheme of balancing central and local authority. Ottoman power revolved crucially around the administration of the rights to land, which gave a space for the local authority to develop the needs of the local millet . The jurisdictional complexity of the Ottoman Empire was aimed to permit the integration of culturally and religiously different groups. The Ottoman system had three court systems: one for Muslims, one for non-Muslims, involving appointed Jews and Christians ruling over their respective religious communities, and the "trade court". The entire system was regulated from above by means of the administrative Qanun , i.e., laws, a system based upon the Turkic Yassa and Töre , which were developed in the pre-Islamic era. These court categories were not, however, wholly exclusive; for instance, the Islamic courts, which were the Empire's primary courts, could also be used to settle a trade conflict or disputes between litigants of differing religions, and Jews and Christians often went to them to obtain a more forceful ruling on an issue. The Ottoman state tended not to interfere with non-Muslim religious law systems, despite legally having a voice to do so through local governors. The Islamic Sharia law system had been developed from a combination of the Qur'an ; the Hadīth , or words of the prophet Muhammad ; ijmā' , or consensus of the members of the Muslim community ; qiyas , a system of analogical reasoning from earlier precedents; and local customs. Both systems were taught at the Empire's law schools, which were in Istanbul and Bursa . The Ottoman Islamic legal system was set up differently from traditional European courts. Presiding over Islamic courts was a Qadi , or judge. Since the closing of the ijtihad , or 'Gate of Interpretation', Qadi s throughout the Ottoman Empire focused less on legal precedent, and more with local customs and traditions in the areas that they administered. However, the Ottoman court system lacked an appellate structure, leading to jurisdictional case strategies where plaintiffs could take their disputes from one court system to another until they achieved a ruling that was in their favour. In the late 19th century, the Ottoman legal system saw substantial reform. This process of legal modernisation began with the Edict of Gülhane of 1839. These reforms included the "fair and public trial[s] of all accused regardless of religion", the creation of a system of "separate competences, religious and civil", and the validation of testimony on non-Muslims. Specific land codes (1858), civil codes (1869–1876), and a code of civil procedure also were enacted. These reforms were based heavily on French models, as indicated by the adoption of a three-tiered court system. Referred to as Nizamiye , this system was extended to the local magistrate level with the final promulgation of the Mecelle , a civil code that regulated marriage, divorce, alimony, will, and other matters of personal status. In an attempt to clarify the division of judicial competences, an administrative council laid down that religious matters were to be handled by religious courts, and statute matters were to be handled by the Nizamiye courts. The first military unit of the Ottoman State was an army that was organized by Osman I from the tribesmen inhabiting the hills of western Anatolia in the late 13th century. The military system became an intricate organization with the advance of the Empire. The Ottoman military was a complex system of recruiting and fief-holding. The main corps of the Ottoman Army included Janissary, Sipahi , Akıncı and Mehterân . The Ottoman army was once among the most advanced fighting forces in the world, being one of the first to use muskets and cannons. The Ottoman Turks began using falconets , which were short but wide cannons, during the Siege of Constantinople . The Ottoman cavalry depended on high speed and mobility rather than heavy armor, using bows and short swords on fast Turkoman and Arabian horses (progenitors of the Thoroughbred racing horse), and often applied tactics similar to those of the Mongol Empire , such as pretending to retreat while surrounding the enemy forces inside a crescent-shaped formation and then making the real attack. The Ottoman army continued to be an effective fighting force throughout the seventeenth and early eighteenth centuries, falling behind the empire's European rivals only during a long period of peace from 1740 to 1768. The modernization of the Ottoman Empire in the 19th century started with the military. In 1826 Sultan Mahmud II abolished the Janissary corps and established the modern Ottoman army. He named them as the Nizam-ı Cedid (New Order). The Ottoman army was also the first institution to hire foreign experts and send its officers for training in western European countries. Consequently, the Young Turks movement began when these relatively young and newly trained men returned with their education. The Ottoman Navy vastly contributed to the expansion of the Empire's territories on the European continent. It initiated the conquest of North Africa, with the addition of Algeria and Egypt to the Ottoman Empire in 1517. Starting with the loss of Greece in 1821 and Algeria in 1830, Ottoman naval power and control over the Empire's distant overseas territories began to decline. Sultan Abdülaziz (reigned 1861–1876) attempted to reestablish a strong Ottoman navy, building the largest fleet after those of Britain and France. The shipyard at Barrow, England, built its first submarine in 1886 for the Ottoman Empire. However, the collapsing Ottoman economy could not sustain the fleet's strength for long. Sultan Abdülhamid II distrusted the admirals who sided with the reformist Midhat Pasha and claimed that the large and expensive fleet was of no use against the Russians during the Russo-Turkish War. He locked most of the fleet inside the Golden Horn , where the ships decayed for the next 30 years. Following the Young Turk Revolution in 1908, the Committee of Union and Progress sought to develop a strong Ottoman naval force. The Ottoman Navy Foundation was established in 1910 to buy new ships through public donations. The establishment of Ottoman military aviation dates back to between June 1909 and July 1911. The Ottoman Empire started preparing its first pilots and planes, and with the founding of the Aviation School ( Tayyare Mektebi ) in Yeşilköy on 3 July 1912, the Empire began to tutor its own flight officers. The founding of the Aviation School quickened advancement in the military aviation program, increased the number of enlisted persons within it, and gave the new pilots an active role in the Ottoman Army and Navy. In May 1913, the world's first specialized Reconnaissance Training Program was started by the Aviation School, and the first separate reconnaissance division was established. [ citation needed ] In June 1914 a new military academy, the Naval Aviation School ( Bahriye Tayyare Mektebi ) was founded. With the outbreak of World War I, the modernization process stopped abruptly. The Ottoman Aviation Squadrons fought on many fronts during World War I, from Galicia in the west to the Caucasus in the east and Yemen in the south.The Ottoman legal system accepted the religious law over its subjects. At the same time the Qanun (or Kanun ), dynastic law, co-existed with religious law or Sharia . The Ottoman Empire was always organized around a system of local jurisprudence . Legal administration in the Ottoman Empire was part of a larger scheme of balancing central and local authority. Ottoman power revolved crucially around the administration of the rights to land, which gave a space for the local authority to develop the needs of the local millet . The jurisdictional complexity of the Ottoman Empire was aimed to permit the integration of culturally and religiously different groups. The Ottoman system had three court systems: one for Muslims, one for non-Muslims, involving appointed Jews and Christians ruling over their respective religious communities, and the "trade court". The entire system was regulated from above by means of the administrative Qanun , i.e., laws, a system based upon the Turkic Yassa and Töre , which were developed in the pre-Islamic era. These court categories were not, however, wholly exclusive; for instance, the Islamic courts, which were the Empire's primary courts, could also be used to settle a trade conflict or disputes between litigants of differing religions, and Jews and Christians often went to them to obtain a more forceful ruling on an issue. The Ottoman state tended not to interfere with non-Muslim religious law systems, despite legally having a voice to do so through local governors. The Islamic Sharia law system had been developed from a combination of the Qur'an ; the Hadīth , or words of the prophet Muhammad ; ijmā' , or consensus of the members of the Muslim community ; qiyas , a system of analogical reasoning from earlier precedents; and local customs. Both systems were taught at the Empire's law schools, which were in Istanbul and Bursa . The Ottoman Islamic legal system was set up differently from traditional European courts. Presiding over Islamic courts was a Qadi , or judge. Since the closing of the ijtihad , or 'Gate of Interpretation', Qadi s throughout the Ottoman Empire focused less on legal precedent, and more with local customs and traditions in the areas that they administered. However, the Ottoman court system lacked an appellate structure, leading to jurisdictional case strategies where plaintiffs could take their disputes from one court system to another until they achieved a ruling that was in their favour. In the late 19th century, the Ottoman legal system saw substantial reform. This process of legal modernisation began with the Edict of Gülhane of 1839. These reforms included the "fair and public trial[s] of all accused regardless of religion", the creation of a system of "separate competences, religious and civil", and the validation of testimony on non-Muslims. Specific land codes (1858), civil codes (1869–1876), and a code of civil procedure also were enacted. These reforms were based heavily on French models, as indicated by the adoption of a three-tiered court system. Referred to as Nizamiye , this system was extended to the local magistrate level with the final promulgation of the Mecelle , a civil code that regulated marriage, divorce, alimony, will, and other matters of personal status. In an attempt to clarify the division of judicial competences, an administrative council laid down that religious matters were to be handled by religious courts, and statute matters were to be handled by the Nizamiye courts. The first military unit of the Ottoman State was an army that was organized by Osman I from the tribesmen inhabiting the hills of western Anatolia in the late 13th century. The military system became an intricate organization with the advance of the Empire. The Ottoman military was a complex system of recruiting and fief-holding. The main corps of the Ottoman Army included Janissary, Sipahi , Akıncı and Mehterân . The Ottoman army was once among the most advanced fighting forces in the world, being one of the first to use muskets and cannons. The Ottoman Turks began using falconets , which were short but wide cannons, during the Siege of Constantinople . The Ottoman cavalry depended on high speed and mobility rather than heavy armor, using bows and short swords on fast Turkoman and Arabian horses (progenitors of the Thoroughbred racing horse), and often applied tactics similar to those of the Mongol Empire , such as pretending to retreat while surrounding the enemy forces inside a crescent-shaped formation and then making the real attack. The Ottoman army continued to be an effective fighting force throughout the seventeenth and early eighteenth centuries, falling behind the empire's European rivals only during a long period of peace from 1740 to 1768. The modernization of the Ottoman Empire in the 19th century started with the military. In 1826 Sultan Mahmud II abolished the Janissary corps and established the modern Ottoman army. He named them as the Nizam-ı Cedid (New Order). The Ottoman army was also the first institution to hire foreign experts and send its officers for training in western European countries. Consequently, the Young Turks movement began when these relatively young and newly trained men returned with their education. The Ottoman Navy vastly contributed to the expansion of the Empire's territories on the European continent. It initiated the conquest of North Africa, with the addition of Algeria and Egypt to the Ottoman Empire in 1517. Starting with the loss of Greece in 1821 and Algeria in 1830, Ottoman naval power and control over the Empire's distant overseas territories began to decline. Sultan Abdülaziz (reigned 1861–1876) attempted to reestablish a strong Ottoman navy, building the largest fleet after those of Britain and France. The shipyard at Barrow, England, built its first submarine in 1886 for the Ottoman Empire. However, the collapsing Ottoman economy could not sustain the fleet's strength for long. Sultan Abdülhamid II distrusted the admirals who sided with the reformist Midhat Pasha and claimed that the large and expensive fleet was of no use against the Russians during the Russo-Turkish War. He locked most of the fleet inside the Golden Horn , where the ships decayed for the next 30 years. Following the Young Turk Revolution in 1908, the Committee of Union and Progress sought to develop a strong Ottoman naval force. The Ottoman Navy Foundation was established in 1910 to buy new ships through public donations. The establishment of Ottoman military aviation dates back to between June 1909 and July 1911. The Ottoman Empire started preparing its first pilots and planes, and with the founding of the Aviation School ( Tayyare Mektebi ) in Yeşilköy on 3 July 1912, the Empire began to tutor its own flight officers. The founding of the Aviation School quickened advancement in the military aviation program, increased the number of enlisted persons within it, and gave the new pilots an active role in the Ottoman Army and Navy. In May 1913, the world's first specialized Reconnaissance Training Program was started by the Aviation School, and the first separate reconnaissance division was established. [ citation needed ] In June 1914 a new military academy, the Naval Aviation School ( Bahriye Tayyare Mektebi ) was founded. With the outbreak of World War I, the modernization process stopped abruptly. The Ottoman Aviation Squadrons fought on many fronts during World War I, from Galicia in the west to the Caucasus in the east and Yemen in the south.The Ottoman Empire was first subdivided into provinces, in the sense of fixed territorial units with governors appointed by the sultan, in the late 14th century. The Eyalet (also Pashalik or Beylerbeylik ) was the territory of office of a Beylerbey ("lord of lords" or governor), and was further subdivided into Sanjaks . The Vilayets were introduced with the promulgation of the "Vilayet Law" ( Teskil-i Vilayet Nizamnamesi ) in 1864, as part of the Tanzimat reforms. Unlike the previous eyalet system, the 1864 law established a hierarchy of administrative units: the vilayet, liva / sanjak / mutasarrifate , kaza and village council , to which the 1871 Vilayet Law added the nahiye . Ottoman government deliberately pursued a policy for the development of Bursa, Edirne, and Istanbul, successive Ottoman capitals, into major commercial and industrial centers, considering that merchants and artisans were indispensable in creating a new metropolis. To this end, Mehmed and his successor Bayezid, also encouraged and welcomed migration of the Jews from different parts of Europe, who were settled in Istanbul and other port cities like Salonica. In many places in Europe, Jews were suffering persecution at the hands of their Christian counterparts, such as in Spain, after the conclusion of the Reconquista . The tolerance displayed by the Turks was welcomed by the immigrants. The Ottoman economic mind was closely related to the basic concepts of state and society in the Middle East in which the ultimate goal of a state was consolidation and extension of the ruler's power, and the way to reach it was to get rich resources of revenues by making the productive classes prosperous. The ultimate aim was to increase the state revenues without damaging the prosperity of subjects to prevent the emergence of social disorder and to keep the traditional organization of the society intact. The Ottoman economy greatly expanded during the early modern period, with particularly high growth rates during the first half of the eighteenth century. The empire's annual income quadrupled between 1523 and 1748, adjusted for inflation. The organization of the treasury and chancery were developed under the Ottoman Empire more than any other Islamic government and, until the 17th century, they were the leading organization among all their contemporaries. This organisation developed a scribal bureaucracy (known as "men of the pen") as a distinct group, partly highly trained ulama, which developed into a professional body. The effectiveness of this professional financial body stands behind the success of many great Ottoman statesmen. Modern Ottoman studies indicate that the change in relations between the Ottoman Turks and central Europe was caused by the opening of the new sea routes. It is possible to see the decline in the significance of the land routes to the East as Western Europe opened the ocean routes that bypassed the Middle East and the Mediterranean as parallel to the decline of the Ottoman Empire itself. [ failed verification ] The Anglo-Ottoman Treaty , also known as the Treaty of Balta Liman that opened the Ottoman markets directly to English and French competitors, can be seen as one of the staging posts along with this development. By developing commercial centers and routes, encouraging people to extend the area of cultivated land in the country and international trade through its dominions, the state performed basic economic functions in the Empire. But in all this, the financial and political interests of the state were dominant. Within the social and political system they were living in, Ottoman administrators could not see the desirability of the dynamics and principles of the capitalist and mercantile economies developing in Western Europe. Economic historian Paul Bairoch argues that free trade contributed to deindustrialisation in the Ottoman Empire. In contrast to the protectionism of China, Japan, and Spain, the Ottoman Empire had a liberal trade policy, open to foreign imports. This has origins in capitulations of the Ottoman Empire , dating back to the first commercial treaties signed with France in 1536 and taken further with capitulations in 1673 and 1740, which lowered duties to 3% for imports and exports. The liberal Ottoman policies were praised by British economists, such as John Ramsay McCulloch in his Dictionary of Commerce (1834), but later criticized by British politicians such as Prime Minister Benjamin Disraeli, who cited the Ottoman Empire as "an instance of the injury done by unrestrained competition" in the 1846 Corn Laws debate. A population estimate for the empire of 11,692,480 for the 1520–1535 period was obtained by counting the households in Ottoman tithe registers, and multiplying this number by 5. For unclear reasons, the population in the 18th century was lower than that in the 16th century. An estimate of 7,230,660 for the first census held in 1831 is considered a serious undercount, as this census was meant only to register possible conscripts. Censuses of Ottoman territories only began in the early 19th century. Figures from 1831 onwards are available as official census results, but the censuses did not cover the whole population. For example, the 1831 census only counted men and did not cover the whole empire. For earlier periods estimates of size and distribution of the population are based on observed demographic patterns. However, it began to rise to reach 25–32 million by 1800, with around 10 million in the European provinces (primarily in the Balkans), 11 million in the Asiatic provinces, and around 3 million in the African provinces. Population densities were higher in the European provinces, double those in Anatolia, which in turn were triple the population densities of Iraq and Syria and five times the population density of Arabia. Towards the end of the empire's existence life expectancy was 49 years, compared to the mid-twenties in Serbia at the beginning of the 19th century. Epidemic diseases and famine caused major disruption and demographic changes. In 1785 around one-sixth of the Egyptian population died from the plague and Aleppo saw its population reduced by twenty percent in the 18th century. Six famines hit Egypt alone between 1687 and 1731 and the last famine to hit Anatolia was four decades later. The rise of port cities saw the clustering of populations caused by the development of steamships and railroads. Urbanization increased from 1700 to 1922, with towns and cities growing. Improvements in health and sanitation made them more attractive to live and work in. Port cities like Salonica, in Greece, saw its population rise from 55,000 in 1800 to 160,000 in 1912 and İzmir which had a population of 150,000 in 1800 grew to 300,000 by 1914. Some regions conversely had population falls—Belgrade saw its population drop from 25,000 to 8,000 mainly due to political strife. Economic and political migrations made an impact across the empire. For example, the Russian and Austria-Habsburg annexation of the Crimean and Balkan regions respectively saw large influxes of Muslim refugees—200,000 Crimean Tartars fleeing to Dobruja. Between 1783 and 1913, approximately 5–7 million refugees flooded into the Ottoman Empire, at least 3.8 million of whom were from Russia. Some migrations left indelible marks such as political tension between parts of the empire (e.g., Turkey and Bulgaria), whereas centrifugal effects were noticed in other territories, simpler demographics emerging from diverse populations. Economies were also impacted by the loss of artisans, merchants, manufacturers, and agriculturists. Since the 19th century, a large proportion of Muslim peoples from the Balkans emigrated to present-day Turkey. These people are called Muhacir . By the time the Ottoman Empire came to an end in 1922, half of the urban population of Turkey was descended from Muslim refugees from Russia. Ottoman Turkish was the official language of the Empire. It was an Oghuz Turkic language highly influenced by Persian and Arabic , though lower registries spoken by the common people had fewer influences from other languages compared to higher varieties used by upper classes and governmental authorities. Turkish, in its Ottoman variation, was a language of military and administration since the nascent days of the Ottomans. The Ottoman constitution of 1876 did officially cement the official imperial status of Turkish. The Ottomans had several influential languages: Turkish, spoken by the majority of the people in Anatolia and by the majority of Muslims of the Balkans except some regions such as Albania , Bosnia and the Megleno-Romanian -inhabited Nânti ; Persian, only spoken by the educated; Arabic, spoken mainly in Egypt, the Levant , Arabia , Iraq, North Africa, Kuwait and parts of the Horn of Africa and Berber in North Africa. In the last two centuries, usage of these became limited, though, and specific: Persian served mainly as a literary language for the educated, while Arabic was used for Islamic prayers. In the post- Tanzimat period French became the common Western language among the educated. Because of a low literacy rate among the public (about 2–3% until the early 19th century and just about 15% at the end of the 19th century), ordinary people had to hire scribes as "special request-writers" ( arzuhâlci s) to be able to communicate with the government. Some ethnic groups continued to speak within their families and neighborhoods ( mahalles ) with their own languages, though many non-Muslim minorities such as Greeks and Armenians only spoke Turkish. In villages where two or more populations lived together, the inhabitants often spoke each other's language. In cosmopolitan cities, people often spoke their family languages; many of those who were not ethnic Turks spoke Turkish as a second language. [ citation needed ] Shi'a Non-denominational Sunni Islam was the prevailing Dīn (customs, legal traditions, and religion) of the Ottoman Empire; the official Madh'hab (school of Islamic jurisprudence ) was Hanafi . From the early 16th century until the early 20th century, the Ottoman sultan also served as the caliph , or politico-religious leader, of the Muslim world . Most of the Ottoman Sultans adhered to Sufism and followed Sufi orders , and believed Sufism was the correct way to reach God. Non-Muslims, particularly Christians and Jews, were present throughout the empire's history. The Ottoman imperial system was charactised by an intricate combination of official Muslim hegemony over non-Muslims and a wide degree of religious tolerance. While religious minorities were never equal under the law, they were granted recognition, protection, and limited freedoms under both Islamic and Ottoman tradition. Until the second half of the 15th century, the majority of Ottoman subjects were Christian. Non-Muslims remained a significant and economically influential minority, albeit declining significantly by the 19th century, due largely to migration and secession . The proportion of Muslims amounted to 60% in the 1820s, gradually increasing to 69% in the 1870s and 76% in the 1890s. By 1914, less than a fifth of the empire's population (19.1%) was non-Muslim, mostly made up of Jews and Christian Greeks, Assyrians, and Armenians. Turkic peoples practiced a form of shamanism before adopting Islam. The Muslim conquest of Transoxiana under the Abbasids facilitated the spread of Islam into the Turkic heartland of Central Asia. Many Turkic tribes—including the Oghuz Turks , who were the ancestors of both the Seljuks and the Ottomans—gradually converted to Islam and brought religion to Anatolia through their migrations beginning in the 11th century. From its founding, the Ottoman Empire officially supported the Maturidi school of Islamic theology , which emphasized human reason , rationality , the pursuit of science and philosophy ( falsafa ). The Ottomans were among the earliest and most enthusiastic adopters of the Hanafi school of Islamic jurisprudence, which was comparatively more flexible and discretionary in its rulings. The Ottoman Empire had a wide variety of Islamic sects, including Druze , Ismailis , Alevis , and Alawites . Sufism , a diverse body of Islamic mysticism , found fertile ground in Ottoman lands; many Sufi religious orders ( tariqa ), such as the Bektashi and Mevlevi , were either established, or saw significant growth, throughout the empire's history. However, some heterodox Muslim groups were viewed as heretical and even ranked below Jews and Christians in terms of legal protection; Druze were frequent targets of persecution, with Ottoman authorities often citing the controversial rulings of Ibn Taymiyya , a member of the conservative Hanbali school . In 1514, Sultan Selim I ordered the massacre of 40,000 Anatolian Alevis ( Qizilbash ), whom he considered a fifth column for the rival Safavid Empire . During Selim's reign, the Ottoman Empire saw an unprecedented and rapid expansion into the Middle East, particularly the conquest of the entire Mamluk Sultanate of Egypt on the early 16th century. These conquests further solidified the Ottoman claim of being an Islamic caliphate , although Ottoman sultans had been claiming the title of caliph since the reign of Murad I (1362–1389). The caliphate was officially transferred from the Mamluks to the Ottoman sultanate in 1517, whose members were recognized as caliphs until the office's abolition on 3 March 1924 by the Republic of Turkey (and the exile of the last caliph, Abdülmecid II , to France). In accordance with the Muslim dhimmi system, the Ottoman Empire guaranteed limited freedoms to Christians, Jews, and other " people of the book ", such as the right to worship, own property, and be exempt from the obligatory alms ( z akat ) required of Muslims. However, non-Muslims (or dhimmi ) were subject to various legal restrictions, including being forbidden to carry weapons, ride on horseback, or have their homes overlook those of Muslims; likewise, they were required to pay higher taxes than Muslim subjects, including the jizya , which was a key source of state revenue. Many Christians and Jews converted to Islam to secure full social and legal status, though most continued to practice their faith without restriction. The Ottomans developed a unique sociopolitical system known as the millet , which granted non-Muslim communities a large degree of political, legal, and religious autonomy; in essence, members of a millet were subjects of the empire but not subject to the Muslim faith or Islamic law. A millet could govern its own affairs, such as raising taxes and resolving internal legal disputes, with little or no interference from Ottoman authorities, so long as its members were loyal to the sultan and adhered to the rules concerning dhimmi. A quintessential example is the ancient Orthodox community of Mount Athos , which was permitted to retain its autonomy and was never subject to occupation or forced conversion; even special laws were enacted to protect it from outsiders. The Rum Millet , which encompassed most Eastern Orthodox Christians, was governed by the Byzantine-era Corpus Juris Civilis (Code of Justinian), with the Ecumenical Patriarch designated the highest religious and political authority ( millet-bashi , or ethnarch ). Likewise, Ottoman Jews came under the authority of the Haham Başı , or Ottoman Chief Rabbi , while Armenians were under the authority of the chief bishop of the Armenian Apostolic Church . As the largest group of non-Muslim subjects, the Rum Millet enjoyed several special privileges in politics and commerce; however, Jews and Armenians were also well represented among the wealthy merchant class, as well as in public administration. Some modern scholars consider the millet system to be an early example of religious pluralism , as it accorded minority religious groups official recognition and tolerance. Beginning in the early 19th century, society, government, and religion were interrelated in a complex, overlapping way that was deemed inefficient by Atatürk, who systematically dismantled it after 1922. In Constantinople, the Sultan ruled two distinct domains: the secular government and the religious hierarchy. Religious officials formed the Ulama, who had control of religious teachings and theology, and also the Empire's judicial system, giving them a major voice in day-to-day affairs in communities across the Empire (but not including the non-Muslim millets). They were powerful enough to reject the military reforms proposed by Sultan Selim III . His successor Sultan Mahmud II (r. 1808–1839) first won ulama approval before proposing similar reforms. The secularisation program brought by Atatürk ended the ulema and their institutions. The caliphate was abolished, madrasas were closed down, and the sharia courts were abolished. He replaced the Arabic alphabet with Latin letters, ended the religious school system, and gave women some political rights. Many rural traditionalists never accepted this secularisation, and by the 1990s they were reasserting a demand for a larger role for Islam. The Janissaries were a highly formidable military unit in the early years, but as Western Europe modernized its military organization technology, the Janissaries became a reactionary force that resisted all change. Steadily the Ottoman military power became outdated, but when the Janissaries felt their privileges were being threatened, or outsiders wanted to modernize them, or they might be superseded by the cavalrymen, they rose in rebellion. The rebellions were highly violent on both sides, but by the time the Janissaries were suppressed, it was far too late for Ottoman military power to catch up with the West. The political system was transformed by the destruction of the Janissaries , a powerful military/governmental/police force, which revolted in the Auspicious Incident of 1826. Sultan Mahmud II crushed the revolt executed the leaders and disbanded the large organization. That set the stage for a slow process of modernization of government functions, as the government sought, with mixed success, to adopt the main elements of Western bureaucracy and military technology. The Janissaries had been recruited from Christians and other minorities; their abolition enabled the emergence of a Turkish elite to control the Ottoman Empire. A large number of ethnic and religious minorities were tolerated in their own separate segregated domains called millets. They were primarily Greek , Armenian , or Jewish . In each locality, they governed themselves, spoke their own language, ran their own schools, cultural and religious institutions, and paid somewhat higher taxes. They had no power outside the millet. The Imperial government protected them and prevented major violent clashes between ethnic groups. Ethnic nationalism, based on distinctive religion and language, provided a centripetal force that eventually destroyed the Ottoman Empire. In addition, Muslim ethnic groups, which were not part of the millet system, especially the Arabs and the Kurds, were outside the Turkish culture and developed their own separate nationalism. The British sponsored Arab nationalism in the First World War, promising an independent Arab state in return for Arab support. Most Arabs supported the Sultan, but those near Mecca believed in and supported the British promise. At the local level, power was held beyond the control of the Sultan by the ayans or local notables. The ayan collected taxes, formed local armies to compete with other notables, took a reactionary attitude toward political or economic change, and often defied policies handed down by the Sultan. After the 18th century, the Ottoman Empire was shrinking, as Russia put on heavy pressure and expanded to its south; Egypt became effectively independent in 1805, and the British later took it over, along with Cyprus. Greece became independent, and Serbia and other Balkan areas became highly restive as the force of nationalism pushed against imperialism. The French took over Algeria and Tunisia. The Europeans all thought that the empire was a sick man in rapid decline. Only the Germans seemed helpful, and their support led to the Ottoman Empire joining the central powers in 1915, with the result that they came out as one of the heaviest losers of the First World War in 1918. Ottoman Turkish was the official language of the Empire. It was an Oghuz Turkic language highly influenced by Persian and Arabic , though lower registries spoken by the common people had fewer influences from other languages compared to higher varieties used by upper classes and governmental authorities. Turkish, in its Ottoman variation, was a language of military and administration since the nascent days of the Ottomans. The Ottoman constitution of 1876 did officially cement the official imperial status of Turkish. The Ottomans had several influential languages: Turkish, spoken by the majority of the people in Anatolia and by the majority of Muslims of the Balkans except some regions such as Albania , Bosnia and the Megleno-Romanian -inhabited Nânti ; Persian, only spoken by the educated; Arabic, spoken mainly in Egypt, the Levant , Arabia , Iraq, North Africa, Kuwait and parts of the Horn of Africa and Berber in North Africa. In the last two centuries, usage of these became limited, though, and specific: Persian served mainly as a literary language for the educated, while Arabic was used for Islamic prayers. In the post- Tanzimat period French became the common Western language among the educated. Because of a low literacy rate among the public (about 2–3% until the early 19th century and just about 15% at the end of the 19th century), ordinary people had to hire scribes as "special request-writers" ( arzuhâlci s) to be able to communicate with the government. Some ethnic groups continued to speak within their families and neighborhoods ( mahalles ) with their own languages, though many non-Muslim minorities such as Greeks and Armenians only spoke Turkish. In villages where two or more populations lived together, the inhabitants often spoke each other's language. In cosmopolitan cities, people often spoke their family languages; many of those who were not ethnic Turks spoke Turkish as a second language. [ citation needed ]Shi'a Non-denominational Sunni Islam was the prevailing Dīn (customs, legal traditions, and religion) of the Ottoman Empire; the official Madh'hab (school of Islamic jurisprudence ) was Hanafi . From the early 16th century until the early 20th century, the Ottoman sultan also served as the caliph , or politico-religious leader, of the Muslim world . Most of the Ottoman Sultans adhered to Sufism and followed Sufi orders , and believed Sufism was the correct way to reach God. Non-Muslims, particularly Christians and Jews, were present throughout the empire's history. The Ottoman imperial system was charactised by an intricate combination of official Muslim hegemony over non-Muslims and a wide degree of religious tolerance. While religious minorities were never equal under the law, they were granted recognition, protection, and limited freedoms under both Islamic and Ottoman tradition. Until the second half of the 15th century, the majority of Ottoman subjects were Christian. Non-Muslims remained a significant and economically influential minority, albeit declining significantly by the 19th century, due largely to migration and secession . The proportion of Muslims amounted to 60% in the 1820s, gradually increasing to 69% in the 1870s and 76% in the 1890s. By 1914, less than a fifth of the empire's population (19.1%) was non-Muslim, mostly made up of Jews and Christian Greeks, Assyrians, and Armenians. Turkic peoples practiced a form of shamanism before adopting Islam. The Muslim conquest of Transoxiana under the Abbasids facilitated the spread of Islam into the Turkic heartland of Central Asia. Many Turkic tribes—including the Oghuz Turks , who were the ancestors of both the Seljuks and the Ottomans—gradually converted to Islam and brought religion to Anatolia through their migrations beginning in the 11th century. From its founding, the Ottoman Empire officially supported the Maturidi school of Islamic theology , which emphasized human reason , rationality , the pursuit of science and philosophy ( falsafa ). The Ottomans were among the earliest and most enthusiastic adopters of the Hanafi school of Islamic jurisprudence, which was comparatively more flexible and discretionary in its rulings. The Ottoman Empire had a wide variety of Islamic sects, including Druze , Ismailis , Alevis , and Alawites . Sufism , a diverse body of Islamic mysticism , found fertile ground in Ottoman lands; many Sufi religious orders ( tariqa ), such as the Bektashi and Mevlevi , were either established, or saw significant growth, throughout the empire's history. However, some heterodox Muslim groups were viewed as heretical and even ranked below Jews and Christians in terms of legal protection; Druze were frequent targets of persecution, with Ottoman authorities often citing the controversial rulings of Ibn Taymiyya , a member of the conservative Hanbali school . In 1514, Sultan Selim I ordered the massacre of 40,000 Anatolian Alevis ( Qizilbash ), whom he considered a fifth column for the rival Safavid Empire . During Selim's reign, the Ottoman Empire saw an unprecedented and rapid expansion into the Middle East, particularly the conquest of the entire Mamluk Sultanate of Egypt on the early 16th century. These conquests further solidified the Ottoman claim of being an Islamic caliphate , although Ottoman sultans had been claiming the title of caliph since the reign of Murad I (1362–1389). The caliphate was officially transferred from the Mamluks to the Ottoman sultanate in 1517, whose members were recognized as caliphs until the office's abolition on 3 March 1924 by the Republic of Turkey (and the exile of the last caliph, Abdülmecid II , to France). In accordance with the Muslim dhimmi system, the Ottoman Empire guaranteed limited freedoms to Christians, Jews, and other " people of the book ", such as the right to worship, own property, and be exempt from the obligatory alms ( z akat ) required of Muslims. However, non-Muslims (or dhimmi ) were subject to various legal restrictions, including being forbidden to carry weapons, ride on horseback, or have their homes overlook those of Muslims; likewise, they were required to pay higher taxes than Muslim subjects, including the jizya , which was a key source of state revenue. Many Christians and Jews converted to Islam to secure full social and legal status, though most continued to practice their faith without restriction. The Ottomans developed a unique sociopolitical system known as the millet , which granted non-Muslim communities a large degree of political, legal, and religious autonomy; in essence, members of a millet were subjects of the empire but not subject to the Muslim faith or Islamic law. A millet could govern its own affairs, such as raising taxes and resolving internal legal disputes, with little or no interference from Ottoman authorities, so long as its members were loyal to the sultan and adhered to the rules concerning dhimmi. A quintessential example is the ancient Orthodox community of Mount Athos , which was permitted to retain its autonomy and was never subject to occupation or forced conversion; even special laws were enacted to protect it from outsiders. The Rum Millet , which encompassed most Eastern Orthodox Christians, was governed by the Byzantine-era Corpus Juris Civilis (Code of Justinian), with the Ecumenical Patriarch designated the highest religious and political authority ( millet-bashi , or ethnarch ). Likewise, Ottoman Jews came under the authority of the Haham Başı , or Ottoman Chief Rabbi , while Armenians were under the authority of the chief bishop of the Armenian Apostolic Church . As the largest group of non-Muslim subjects, the Rum Millet enjoyed several special privileges in politics and commerce; however, Jews and Armenians were also well represented among the wealthy merchant class, as well as in public administration. Some modern scholars consider the millet system to be an early example of religious pluralism , as it accorded minority religious groups official recognition and tolerance. Turkic peoples practiced a form of shamanism before adopting Islam. The Muslim conquest of Transoxiana under the Abbasids facilitated the spread of Islam into the Turkic heartland of Central Asia. Many Turkic tribes—including the Oghuz Turks , who were the ancestors of both the Seljuks and the Ottomans—gradually converted to Islam and brought religion to Anatolia through their migrations beginning in the 11th century. From its founding, the Ottoman Empire officially supported the Maturidi school of Islamic theology , which emphasized human reason , rationality , the pursuit of science and philosophy ( falsafa ). The Ottomans were among the earliest and most enthusiastic adopters of the Hanafi school of Islamic jurisprudence, which was comparatively more flexible and discretionary in its rulings. The Ottoman Empire had a wide variety of Islamic sects, including Druze , Ismailis , Alevis , and Alawites . Sufism , a diverse body of Islamic mysticism , found fertile ground in Ottoman lands; many Sufi religious orders ( tariqa ), such as the Bektashi and Mevlevi , were either established, or saw significant growth, throughout the empire's history. However, some heterodox Muslim groups were viewed as heretical and even ranked below Jews and Christians in terms of legal protection; Druze were frequent targets of persecution, with Ottoman authorities often citing the controversial rulings of Ibn Taymiyya , a member of the conservative Hanbali school . In 1514, Sultan Selim I ordered the massacre of 40,000 Anatolian Alevis ( Qizilbash ), whom he considered a fifth column for the rival Safavid Empire . During Selim's reign, the Ottoman Empire saw an unprecedented and rapid expansion into the Middle East, particularly the conquest of the entire Mamluk Sultanate of Egypt on the early 16th century. These conquests further solidified the Ottoman claim of being an Islamic caliphate , although Ottoman sultans had been claiming the title of caliph since the reign of Murad I (1362–1389). The caliphate was officially transferred from the Mamluks to the Ottoman sultanate in 1517, whose members were recognized as caliphs until the office's abolition on 3 March 1924 by the Republic of Turkey (and the exile of the last caliph, Abdülmecid II , to France).In accordance with the Muslim dhimmi system, the Ottoman Empire guaranteed limited freedoms to Christians, Jews, and other " people of the book ", such as the right to worship, own property, and be exempt from the obligatory alms ( z akat ) required of Muslims. However, non-Muslims (or dhimmi ) were subject to various legal restrictions, including being forbidden to carry weapons, ride on horseback, or have their homes overlook those of Muslims; likewise, they were required to pay higher taxes than Muslim subjects, including the jizya , which was a key source of state revenue. Many Christians and Jews converted to Islam to secure full social and legal status, though most continued to practice their faith without restriction. The Ottomans developed a unique sociopolitical system known as the millet , which granted non-Muslim communities a large degree of political, legal, and religious autonomy; in essence, members of a millet were subjects of the empire but not subject to the Muslim faith or Islamic law. A millet could govern its own affairs, such as raising taxes and resolving internal legal disputes, with little or no interference from Ottoman authorities, so long as its members were loyal to the sultan and adhered to the rules concerning dhimmi. A quintessential example is the ancient Orthodox community of Mount Athos , which was permitted to retain its autonomy and was never subject to occupation or forced conversion; even special laws were enacted to protect it from outsiders. The Rum Millet , which encompassed most Eastern Orthodox Christians, was governed by the Byzantine-era Corpus Juris Civilis (Code of Justinian), with the Ecumenical Patriarch designated the highest religious and political authority ( millet-bashi , or ethnarch ). Likewise, Ottoman Jews came under the authority of the Haham Başı , or Ottoman Chief Rabbi , while Armenians were under the authority of the chief bishop of the Armenian Apostolic Church . As the largest group of non-Muslim subjects, the Rum Millet enjoyed several special privileges in politics and commerce; however, Jews and Armenians were also well represented among the wealthy merchant class, as well as in public administration. Some modern scholars consider the millet system to be an early example of religious pluralism , as it accorded minority religious groups official recognition and tolerance. Beginning in the early 19th century, society, government, and religion were interrelated in a complex, overlapping way that was deemed inefficient by Atatürk, who systematically dismantled it after 1922. In Constantinople, the Sultan ruled two distinct domains: the secular government and the religious hierarchy. Religious officials formed the Ulama, who had control of religious teachings and theology, and also the Empire's judicial system, giving them a major voice in day-to-day affairs in communities across the Empire (but not including the non-Muslim millets). They were powerful enough to reject the military reforms proposed by Sultan Selim III . His successor Sultan Mahmud II (r. 1808–1839) first won ulama approval before proposing similar reforms. The secularisation program brought by Atatürk ended the ulema and their institutions. The caliphate was abolished, madrasas were closed down, and the sharia courts were abolished. He replaced the Arabic alphabet with Latin letters, ended the religious school system, and gave women some political rights. Many rural traditionalists never accepted this secularisation, and by the 1990s they were reasserting a demand for a larger role for Islam. The Janissaries were a highly formidable military unit in the early years, but as Western Europe modernized its military organization technology, the Janissaries became a reactionary force that resisted all change. Steadily the Ottoman military power became outdated, but when the Janissaries felt their privileges were being threatened, or outsiders wanted to modernize them, or they might be superseded by the cavalrymen, they rose in rebellion. The rebellions were highly violent on both sides, but by the time the Janissaries were suppressed, it was far too late for Ottoman military power to catch up with the West. The political system was transformed by the destruction of the Janissaries , a powerful military/governmental/police force, which revolted in the Auspicious Incident of 1826. Sultan Mahmud II crushed the revolt executed the leaders and disbanded the large organization. That set the stage for a slow process of modernization of government functions, as the government sought, with mixed success, to adopt the main elements of Western bureaucracy and military technology. The Janissaries had been recruited from Christians and other minorities; their abolition enabled the emergence of a Turkish elite to control the Ottoman Empire. A large number of ethnic and religious minorities were tolerated in their own separate segregated domains called millets. They were primarily Greek , Armenian , or Jewish . In each locality, they governed themselves, spoke their own language, ran their own schools, cultural and religious institutions, and paid somewhat higher taxes. They had no power outside the millet. The Imperial government protected them and prevented major violent clashes between ethnic groups. Ethnic nationalism, based on distinctive religion and language, provided a centripetal force that eventually destroyed the Ottoman Empire. In addition, Muslim ethnic groups, which were not part of the millet system, especially the Arabs and the Kurds, were outside the Turkish culture and developed their own separate nationalism. The British sponsored Arab nationalism in the First World War, promising an independent Arab state in return for Arab support. Most Arabs supported the Sultan, but those near Mecca believed in and supported the British promise. At the local level, power was held beyond the control of the Sultan by the ayans or local notables. The ayan collected taxes, formed local armies to compete with other notables, took a reactionary attitude toward political or economic change, and often defied policies handed down by the Sultan. After the 18th century, the Ottoman Empire was shrinking, as Russia put on heavy pressure and expanded to its south; Egypt became effectively independent in 1805, and the British later took it over, along with Cyprus. Greece became independent, and Serbia and other Balkan areas became highly restive as the force of nationalism pushed against imperialism. The French took over Algeria and Tunisia. The Europeans all thought that the empire was a sick man in rapid decline. Only the Germans seemed helpful, and their support led to the Ottoman Empire joining the central powers in 1915, with the result that they came out as one of the heaviest losers of the First World War in 1918. The Ottomans absorbed some of the traditions, art, and institutions of cultures in the regions they conquered and added new dimensions to them. Numerous traditions and cultural traits of previous empires (in fields such as architecture, cuisine, music, leisure, and government) were adopted by the Ottoman Turks, who developed them into new forms, resulting in a new and distinctively Ottoman cultural identity. Although the predominant literary language of the Ottoman Empire was Turkish, Persian was the preferred vehicle for the projection of an imperial image. Slavery was part of Ottoman society, with most slaves employed as domestic servants. Agricultural slavery, like that in the Americas, was relatively rare. Unlike systems of chattel slavery , slaves under Islamic law were not regarded as movable property, and the children of female slaves were born legally free. Female slaves were still sold in the Empire as late as 1908. During the 19th century the Empire came under pressure from Western European countries to outlaw the practice. Policies developed by various sultans throughout the 19th century attempted to curtail the Ottoman slave trade but slavery had centuries of religious backing and sanction and so was never abolished in the Empire. Plague remained a major scourge in Ottoman society until the second quarter of the 19th century. "Between 1701 and 1750, 37 larger and smaller plague epidemics were recorded in Istanbul , and 31 between 1751 and 1801." Ottomans adopted Persian bureaucratic traditions and culture. The sultans also made an important contribution in the development of Persian literature. Language was not an obvious sign of group connection and identity in the 16th century among the rulers of the Ottoman Empire, Safavid Iran and Abu'l-Khayrid Shibanids of Central Asia . Hence the ruling classes of all three polities were bilingual in varieties of Persian and Turkic. But in the century's final quarter, linguistic adjustments occurred in the Ottoman and Safavid realms defined by a new rigidity that favoured Ottoman Turkish and Persian, respectively. In the Ottoman Empire, each millet established a schooling system serving its members. Education was therefore largely divided on ethnic and religious lines: few non-Muslims attended schools for Muslim students, and vice versa. Most institutions that served all ethnic and religious groups taught in French or other languages. Several "foreign schools" ( Frerler mektebleri ) operated by religious clergy primarily served Christians, although some Muslim students attended. Garnett described the schools for Christians and Jews as "organised upon European models", with "voluntary contributions" supporting their operation and most of them "well attended" and with "a high standard of education". The two primary streams of Ottoman written literature are poetry and prose . Poetry was by far the dominant stream. The earliest work of Ottoman historiography for example, the İskendernâme , was composed by the poet Taceddin Ahmedi (1334–1413). Until the 19th century, Ottoman prose did not contain any examples of fiction: there were no counterparts to, for instance, the European romance , short story, or novel. Analog genres did exist, though, in both Turkish folk literature and in Divan poetry . Ottoman Divan poetry was a highly ritualized and symbolic art form. From the Persian poetry that largely inspired it, it inherited a wealth of symbols whose meanings and interrelationships—both of similitude ( ٠راعات نظير mura'ât-i nazîr / تناسب tenâsüb ) and opposition ( تضاد tezâd ) were more or less prescribed. Divan poetry was composed through the constant juxtaposition of many such images within a strict metrical framework, allowing numerous potential meanings to emerge. The vast majority of Divan poetry was lyric in nature: either gazels (which make up the greatest part of the repertoire of the tradition), or kasîdes. But there were other common genres, especially the mesnevî, a kind of verse romance and thus a variety of narrative poetry ; the two most notable examples of this form are the Leyli and Majnun of Fuzuli and the Hüsn ü Aşk of Şeyh Gâlib . The Seyahatnâme of Evliya Çelebi (1611–1682) is an outstanding example of travel literature. Until the 19th century, Ottoman prose did not develop to the extent that contemporary Divan poetry did. A large part of the reason was that much prose was expected to adhere to the rules of sec ( سجع , also transliterated as seci ), or rhymed prose , a type of writing descended from the Arabic saj' that prescribed that between each adjective and noun in a string of words, such as a sentence, there must be a rhyme. Nevertheless, there was a tradition of prose in the literature of the time, though it was exclusively nonfictional. One apparent exception was Muhayyelât ( Fancies ) by Giritli Ali Aziz Efendi , a collection of stories of the fantastic written in 1796, though not published until 1867. The first novel published in the Ottoman Empire was Vartan Pasha 's 1851 The Story of Akabi (Turkish: Akabi Hikyayesi ). It was written in Turkish but with Armenian script. Due to historically close ties with France, French literature constituted the major Western influence on Ottoman literature in the latter half of the 19th century. As a result, many of the same movements prevalent in France during this period had Ottoman equivalents; in the developing Ottoman prose tradition, for instance, the influence of Romanticism can be seen during the Tanzimat period, and that of the Realist and Naturalist movements in subsequent periods; in the poetic tradition, on the other hand, the influence of the Symbolist and Parnassian movements was paramount. Many of the writers in the Tanzimat period wrote in several different genres simultaneously; for instance, the poet Namık Kemal also wrote the important 1876 novel İntibâh ( Awakening ), while the journalist İbrahim Şinasi is noted for writing, in 1860, the first modern Turkish play, the one-act comedy Şair Evlenmesi ( The Poet's Marriage ). An earlier play, a farce titled Vakâyi'-i 'Acibe ve Havâdis-i Garibe-yi Kefşger Ahmed ( The Strange Events and Bizarre Occurrences of the Cobbler Ahmed ), dates from the beginning of the 19th century, but there is doubt about its authenticity. In a similar vein, the novelist Ahmed Midhat Efendi wrote important novels in each of the major movements: Romanticism ( Hasan Mellâh yâhud Sırr İçinde Esrâr , 1873; Hasan the Sailor, or The Mystery Within the Mystery ), Realism ( Henüz on Yedi Yaşında , 1881; Just Seventeen Years Old ), and Naturalism ( Müşâhedât , 1891; Observations ). This diversity was, in part, due to Tanzimat writers' wish to disseminate as much of the new literature as possible, in the hopes that it would contribute to a revitalization of Ottoman social structures . The media of the Ottoman Empire was diverse, with newspapers and journals published in languages including French , Greek , and German . Many of these publications were centered in Constantinople , but there were also French-language newspapers produced in Beirut , Salonika , and Smyrna . Non-Muslim ethnic minorities in the empire used French as a lingua franca and used French-language publications, while some provincial newspapers were published in Arabic . The use of French in the media persisted until the end of the empire in 1923 and for a few years thereafter in the Republic of Turkey . The architecture of the empire developed from earlier Seljuk Turkish architecture , with influences from Byzantine and Iranian architecture and other architectural traditions in the Middle East. Early Ottoman architecture experimented with multiple building types over the course of the 13th to 15th centuries, progressively evolving into the Classical Ottoman style of the 16th and 17th centuries, which was also strongly influenced by the Hagia Sophia . The most important architect of the Classical period is Mimar Sinan , whose major works include the Şehzade Mosque , Süleymaniye Mosque , and Selimiye Mosque . The greatest of the court artists enriched the Ottoman Empire with many pluralistic artistic influences, such as mixing traditional Byzantine art with elements of Chinese art . The second half of the 16th century also saw the apogee of certain decorative arts, most notably in the use of Iznik tiles . Beginning in the 18th century, Ottoman architecture was influenced by the Baroque architecture in Western Europe, resulting in the Ottoman Baroque style. Nuruosmaniye Mosque is one of the most important examples from this period. The last Ottoman period saw more influences from Western Europe, brought in by architects such as those from the Balyan family . Empire style and Neoclassical motifs were introduced and a trend towards eclecticism was evident in many types of buildings, such as the Dolmabaçe Palace . The last decades of the Ottoman Empire also saw the development of a new architectural style called neo-Ottoman or Ottoman revivalism, also known as the First National Architectural Movement , by architects such as Mimar Kemaleddin and Vedat Tek . Ottoman dynastic patronage was concentrated in the historic capitals of Bursa, Edirne, and Istanbul (Constantinople), as well as in several other important administrative centers such as Amasya and Manisa . It was in these centers that most important developments in Ottoman architecture occurred and that the most monumental Ottoman architecture can be found. Major religious monuments were typically architectural complexes, known as a külliye , that had multiple components providing different services or amenities. In addition to a mosque, these could include a madrasa , a hammam , an imaret , a sebil , a market, a caravanserai , a primary school , or others. These complexes were governed and managed with the help of a vakıf agreement (Arabic waqf ). Ottoman constructions were still abundant in Anatolia and in the Balkans (Rumelia), but in the more distant Middle Eastern and North African provinces older Islamic architectural styles continued to hold strong influence and were sometimes blended with Ottoman styles. The tradition of Ottoman miniatures , painted to illustrate manuscripts or used in dedicated albums, was heavily influenced by the Persian art form, though it also included elements of the Byzantine tradition of illumination and painting. A Greek academy of painters, the Nakkashane-i-Rum , was established in the Topkapi Palace in the 15th century, while early in the following century a similar Persian academy, the Nakkashane-i-Irani , was added. Surname-i Hümayun (Imperial Festival Books) were albums that commemorated celebrations in the Ottoman Empire in pictorial and textual detail. Ottoman illumination covers non-figurative painted or drawn decorative art in books or on sheets in muraqqa or albums, as opposed to the figurative images of the Ottoman miniature . It was a part of the Ottoman Book Arts together with the Ottoman miniature ( taswir ), calligraphy ( hat ), Islamic calligraphy , bookbinding ( cilt ) and paper marbling ( ebru ). In the Ottoman Empire, illuminated and illustrated manuscripts were commissioned by the Sultan or the administrators of the court. In Topkapi Palace, these manuscripts were created by the artists working in Nakkashane , the atelier of the miniature and illumination artists. Both religious and non-religious books could be illuminated. Also, sheets for albums levha consisted of illuminated calligraphy ( hat ) of tughra , religious texts, verses from poems or proverbs, and purely decorative drawings. The art of carpet weaving was particularly significant in the Ottoman Empire, carpets having an immense importance both as decorative furnishings, rich in religious and other symbolism and as a practical consideration, as it was customary to remove one's shoes in living quarters. The weaving of such carpets originated in the nomadic cultures of central Asia (carpets being an easily transportable form of furnishing), and eventually spread to the settled societies of Anatolia. Turks used carpets, rugs, and kilims not just on the floors of a room but also as a hanging on walls and doorways, where they provided additional insulation. They were also commonly donated to mosques, which often amassed large collections of them. Ottoman classical music was an important part of the education of the Ottoman elite. A number of the Ottoman sultans have accomplished musicians and composers themselves, such as Selim III , whose compositions are often still performed today. Ottoman classical music arose largely from a confluence of Byzantine music , Armenian music , Arabic music , and Persian music . Compositionally, it is organized around rhythmic units called usul , which are somewhat similar to meter in Western music, and melodic units called makam , which bear some resemblance to Western musical modes . The instruments used are a mixture of Anatolian and Central Asian instruments (the saz , the bağlama , the kemence ), other Middle Eastern instruments (the ud , the tanbur , the kanun , the ney ), and—later in the tradition—Western instruments (the violin and the piano). Because of a geographic and cultural divide between the capital and other areas, two broadly distinct styles of music arose in the Ottoman Empire: Ottoman classical music and folk music. In the provinces, several different kinds of folk music were created. The most dominant regions with their distinguished musical styles are Balkan-Thracian Türküs, North-Eastern ( Laz ) Türküs, Aegean Türküs, Central Anatolian Türküs, Eastern Anatolian Türküs, and Caucasian Türküs. Some of the distinctive styles were: Janissary music , Roma music , Belly dance , Turkish folk music . The traditional shadow play called Karagöz and Hacivat was widespread throughout the Ottoman Empire and featured characters representing all of the major ethnic and social groups in that culture. It was performed by a single puppet master, who voiced all of the characters, and accompanied by tambourine ( def ). Its origins are obscure, deriving perhaps from an older Egyptian tradition, or possibly from an Asian source. Ottoman cuisine is the cuisine of the capital, Constantinople ( Istanbul ), and the regional capital cities, where the melting pot of cultures created a common cuisine that most of the population regardless of ethnicity shared. This diverse cuisine was honed in the Imperial Palace's kitchens by chefs brought from certain parts of the Empire to create and experiment with different ingredients. The creations of the Ottoman Palace's kitchens filtered to the population, for instance through Ramadan events, and through the cooking at the Yalıs of the Pashas , and from there on spread to the rest of the population. Much of the cuisine of former Ottoman territories today is descended from a shared Ottoman cuisine, especially Turkish , and including Greek , Balkan , Armenian , and Middle Eastern cuisines. Many common dishes in the region, descendants of the once-common Ottoman cuisine, include yogurt , döner kebab / gyro / shawarma , cacık /tzatziki, ayran , pita bread, feta cheese, baklava , lahmacun , moussaka , yuvarlak , köfte /keftés/kofta, börek /boureki, rakı / rakia / tsipouro / tsikoudia , meze , dolma , sarma , rice pilaf , Turkish coffee , sujuk , kashk , keşkek , manti , lavash , kanafeh , and more. The main sports Ottomans were engaged in were Turkish wrestling , hunting, Turkish archery , horseback riding, equestrian javelin throw , arm wrestling, and swimming. European model sports clubs were formed with the spreading popularity of football matches in 19th century Constantinople. The leading clubs, according to timeline, were Beşiktaş Gymnastics Club (1903), Galatasaray Sports Club (1905), Fenerbahçe Sports Club (1907), MKE Ankaragücü (formerly Turan Sanatkarangücü) (1910) in Constantinople . Football clubs were formed in other provinces too, such as Karşıyaka Sports Club (1912), Altay Sports Club (1914) and Turkish Fatherland Football Club (later Ülküspor ) (1914) of İzmir .In the Ottoman Empire, each millet established a schooling system serving its members. Education was therefore largely divided on ethnic and religious lines: few non-Muslims attended schools for Muslim students, and vice versa. Most institutions that served all ethnic and religious groups taught in French or other languages. Several "foreign schools" ( Frerler mektebleri ) operated by religious clergy primarily served Christians, although some Muslim students attended. Garnett described the schools for Christians and Jews as "organised upon European models", with "voluntary contributions" supporting their operation and most of them "well attended" and with "a high standard of education". The two primary streams of Ottoman written literature are poetry and prose . Poetry was by far the dominant stream. The earliest work of Ottoman historiography for example, the İskendernâme , was composed by the poet Taceddin Ahmedi (1334–1413). Until the 19th century, Ottoman prose did not contain any examples of fiction: there were no counterparts to, for instance, the European romance , short story, or novel. Analog genres did exist, though, in both Turkish folk literature and in Divan poetry . Ottoman Divan poetry was a highly ritualized and symbolic art form. From the Persian poetry that largely inspired it, it inherited a wealth of symbols whose meanings and interrelationships—both of similitude ( ٠راعات نظير mura'ât-i nazîr / تناسب tenâsüb ) and opposition ( تضاد tezâd ) were more or less prescribed. Divan poetry was composed through the constant juxtaposition of many such images within a strict metrical framework, allowing numerous potential meanings to emerge. The vast majority of Divan poetry was lyric in nature: either gazels (which make up the greatest part of the repertoire of the tradition), or kasîdes. But there were other common genres, especially the mesnevî, a kind of verse romance and thus a variety of narrative poetry ; the two most notable examples of this form are the Leyli and Majnun of Fuzuli and the Hüsn ü Aşk of Şeyh Gâlib . The Seyahatnâme of Evliya Çelebi (1611–1682) is an outstanding example of travel literature. Until the 19th century, Ottoman prose did not develop to the extent that contemporary Divan poetry did. A large part of the reason was that much prose was expected to adhere to the rules of sec ( سجع , also transliterated as seci ), or rhymed prose , a type of writing descended from the Arabic saj' that prescribed that between each adjective and noun in a string of words, such as a sentence, there must be a rhyme. Nevertheless, there was a tradition of prose in the literature of the time, though it was exclusively nonfictional. One apparent exception was Muhayyelât ( Fancies ) by Giritli Ali Aziz Efendi , a collection of stories of the fantastic written in 1796, though not published until 1867. The first novel published in the Ottoman Empire was Vartan Pasha 's 1851 The Story of Akabi (Turkish: Akabi Hikyayesi ). It was written in Turkish but with Armenian script. Due to historically close ties with France, French literature constituted the major Western influence on Ottoman literature in the latter half of the 19th century. As a result, many of the same movements prevalent in France during this period had Ottoman equivalents; in the developing Ottoman prose tradition, for instance, the influence of Romanticism can be seen during the Tanzimat period, and that of the Realist and Naturalist movements in subsequent periods; in the poetic tradition, on the other hand, the influence of the Symbolist and Parnassian movements was paramount. Many of the writers in the Tanzimat period wrote in several different genres simultaneously; for instance, the poet Namık Kemal also wrote the important 1876 novel İntibâh ( Awakening ), while the journalist İbrahim Şinasi is noted for writing, in 1860, the first modern Turkish play, the one-act comedy Şair Evlenmesi ( The Poet's Marriage ). An earlier play, a farce titled Vakâyi'-i 'Acibe ve Havâdis-i Garibe-yi Kefşger Ahmed ( The Strange Events and Bizarre Occurrences of the Cobbler Ahmed ), dates from the beginning of the 19th century, but there is doubt about its authenticity. In a similar vein, the novelist Ahmed Midhat Efendi wrote important novels in each of the major movements: Romanticism ( Hasan Mellâh yâhud Sırr İçinde Esrâr , 1873; Hasan the Sailor, or The Mystery Within the Mystery ), Realism ( Henüz on Yedi Yaşında , 1881; Just Seventeen Years Old ), and Naturalism ( Müşâhedât , 1891; Observations ). This diversity was, in part, due to Tanzimat writers' wish to disseminate as much of the new literature as possible, in the hopes that it would contribute to a revitalization of Ottoman social structures . The media of the Ottoman Empire was diverse, with newspapers and journals published in languages including French , Greek , and German . Many of these publications were centered in Constantinople , but there were also French-language newspapers produced in Beirut , Salonika , and Smyrna . Non-Muslim ethnic minorities in the empire used French as a lingua franca and used French-language publications, while some provincial newspapers were published in Arabic . The use of French in the media persisted until the end of the empire in 1923 and for a few years thereafter in the Republic of Turkey . The architecture of the empire developed from earlier Seljuk Turkish architecture , with influences from Byzantine and Iranian architecture and other architectural traditions in the Middle East. Early Ottoman architecture experimented with multiple building types over the course of the 13th to 15th centuries, progressively evolving into the Classical Ottoman style of the 16th and 17th centuries, which was also strongly influenced by the Hagia Sophia . The most important architect of the Classical period is Mimar Sinan , whose major works include the Şehzade Mosque , Süleymaniye Mosque , and Selimiye Mosque . The greatest of the court artists enriched the Ottoman Empire with many pluralistic artistic influences, such as mixing traditional Byzantine art with elements of Chinese art . The second half of the 16th century also saw the apogee of certain decorative arts, most notably in the use of Iznik tiles . Beginning in the 18th century, Ottoman architecture was influenced by the Baroque architecture in Western Europe, resulting in the Ottoman Baroque style. Nuruosmaniye Mosque is one of the most important examples from this period. The last Ottoman period saw more influences from Western Europe, brought in by architects such as those from the Balyan family . Empire style and Neoclassical motifs were introduced and a trend towards eclecticism was evident in many types of buildings, such as the Dolmabaçe Palace . The last decades of the Ottoman Empire also saw the development of a new architectural style called neo-Ottoman or Ottoman revivalism, also known as the First National Architectural Movement , by architects such as Mimar Kemaleddin and Vedat Tek . Ottoman dynastic patronage was concentrated in the historic capitals of Bursa, Edirne, and Istanbul (Constantinople), as well as in several other important administrative centers such as Amasya and Manisa . It was in these centers that most important developments in Ottoman architecture occurred and that the most monumental Ottoman architecture can be found. Major religious monuments were typically architectural complexes, known as a külliye , that had multiple components providing different services or amenities. In addition to a mosque, these could include a madrasa , a hammam , an imaret , a sebil , a market, a caravanserai , a primary school , or others. These complexes were governed and managed with the help of a vakıf agreement (Arabic waqf ). Ottoman constructions were still abundant in Anatolia and in the Balkans (Rumelia), but in the more distant Middle Eastern and North African provinces older Islamic architectural styles continued to hold strong influence and were sometimes blended with Ottoman styles. The tradition of Ottoman miniatures , painted to illustrate manuscripts or used in dedicated albums, was heavily influenced by the Persian art form, though it also included elements of the Byzantine tradition of illumination and painting. A Greek academy of painters, the Nakkashane-i-Rum , was established in the Topkapi Palace in the 15th century, while early in the following century a similar Persian academy, the Nakkashane-i-Irani , was added. Surname-i Hümayun (Imperial Festival Books) were albums that commemorated celebrations in the Ottoman Empire in pictorial and textual detail. Ottoman illumination covers non-figurative painted or drawn decorative art in books or on sheets in muraqqa or albums, as opposed to the figurative images of the Ottoman miniature . It was a part of the Ottoman Book Arts together with the Ottoman miniature ( taswir ), calligraphy ( hat ), Islamic calligraphy , bookbinding ( cilt ) and paper marbling ( ebru ). In the Ottoman Empire, illuminated and illustrated manuscripts were commissioned by the Sultan or the administrators of the court. In Topkapi Palace, these manuscripts were created by the artists working in Nakkashane , the atelier of the miniature and illumination artists. Both religious and non-religious books could be illuminated. Also, sheets for albums levha consisted of illuminated calligraphy ( hat ) of tughra , religious texts, verses from poems or proverbs, and purely decorative drawings. The art of carpet weaving was particularly significant in the Ottoman Empire, carpets having an immense importance both as decorative furnishings, rich in religious and other symbolism and as a practical consideration, as it was customary to remove one's shoes in living quarters. The weaving of such carpets originated in the nomadic cultures of central Asia (carpets being an easily transportable form of furnishing), and eventually spread to the settled societies of Anatolia. Turks used carpets, rugs, and kilims not just on the floors of a room but also as a hanging on walls and doorways, where they provided additional insulation. They were also commonly donated to mosques, which often amassed large collections of them. Ottoman classical music was an important part of the education of the Ottoman elite. A number of the Ottoman sultans have accomplished musicians and composers themselves, such as Selim III , whose compositions are often still performed today. Ottoman classical music arose largely from a confluence of Byzantine music , Armenian music , Arabic music , and Persian music . Compositionally, it is organized around rhythmic units called usul , which are somewhat similar to meter in Western music, and melodic units called makam , which bear some resemblance to Western musical modes . The instruments used are a mixture of Anatolian and Central Asian instruments (the saz , the bağlama , the kemence ), other Middle Eastern instruments (the ud , the tanbur , the kanun , the ney ), and—later in the tradition—Western instruments (the violin and the piano). Because of a geographic and cultural divide between the capital and other areas, two broadly distinct styles of music arose in the Ottoman Empire: Ottoman classical music and folk music. In the provinces, several different kinds of folk music were created. The most dominant regions with their distinguished musical styles are Balkan-Thracian Türküs, North-Eastern ( Laz ) Türküs, Aegean Türküs, Central Anatolian Türküs, Eastern Anatolian Türküs, and Caucasian Türküs. Some of the distinctive styles were: Janissary music , Roma music , Belly dance , Turkish folk music . The traditional shadow play called Karagöz and Hacivat was widespread throughout the Ottoman Empire and featured characters representing all of the major ethnic and social groups in that culture. It was performed by a single puppet master, who voiced all of the characters, and accompanied by tambourine ( def ). Its origins are obscure, deriving perhaps from an older Egyptian tradition, or possibly from an Asian source.Ottoman cuisine is the cuisine of the capital, Constantinople ( Istanbul ), and the regional capital cities, where the melting pot of cultures created a common cuisine that most of the population regardless of ethnicity shared. This diverse cuisine was honed in the Imperial Palace's kitchens by chefs brought from certain parts of the Empire to create and experiment with different ingredients. The creations of the Ottoman Palace's kitchens filtered to the population, for instance through Ramadan events, and through the cooking at the Yalıs of the Pashas , and from there on spread to the rest of the population. Much of the cuisine of former Ottoman territories today is descended from a shared Ottoman cuisine, especially Turkish , and including Greek , Balkan , Armenian , and Middle Eastern cuisines. Many common dishes in the region, descendants of the once-common Ottoman cuisine, include yogurt , döner kebab / gyro / shawarma , cacık /tzatziki, ayran , pita bread, feta cheese, baklava , lahmacun , moussaka , yuvarlak , köfte /keftés/kofta, börek /boureki, rakı / rakia / tsipouro / tsikoudia , meze , dolma , sarma , rice pilaf , Turkish coffee , sujuk , kashk , keşkek , manti , lavash , kanafeh , and more.The main sports Ottomans were engaged in were Turkish wrestling , hunting, Turkish archery , horseback riding, equestrian javelin throw , arm wrestling, and swimming. European model sports clubs were formed with the spreading popularity of football matches in 19th century Constantinople. The leading clubs, according to timeline, were Beşiktaş Gymnastics Club (1903), Galatasaray Sports Club (1905), Fenerbahçe Sports Club (1907), MKE Ankaragücü (formerly Turan Sanatkarangücü) (1910) in Constantinople . Football clubs were formed in other provinces too, such as Karşıyaka Sports Club (1912), Altay Sports Club (1914) and Turkish Fatherland Football Club (later Ülküspor ) (1914) of İzmir .Over the course of Ottoman history, the Ottomans managed to build a large collection of libraries complete with translations of books from other cultures, as well as original manuscripts. A great part of this desire for local and foreign manuscripts arose in the 15th century. Sultan Mehmet II ordered Georgios Amiroutzes , a Greek scholar from Trabzon , to translate and make available to Ottoman educational institutions the geography book of Ptolemy . Another example is Ali Qushji – an astronomer , mathematician and physicist originally from Samarkand – who became a professor in two madrasas and influenced Ottoman circles as a result of his writings and the activities of his students, even though he only spent two or three years in Constantinople before his death. Taqi al-Din built the Constantinople observatory of Taqi al-Din in 1577, where he carried out observations until 1580. He calculated the eccentricity of the Sun's orbit and the annual motion of the apogee . However, the observatory's primary purpose was almost certainly astrological rather than astronomical, leading to its destruction in 1580 due to the rise of a clerical faction that opposed its use for that purpose. He also experimented with steam power in Ottoman Egypt in 1551, when he described a steam jack driven by a rudimentary steam turbine . In 1660 the Ottoman scholar Ibrahim Efendi al-Zigetvari Tezkireci translated Noël Duret 's French astronomical work (written in 1637) into Arabic. Şerafeddin Sabuncuoğlu was the author of the first surgical atlas and the last major medical encyclopaedia from the Islamic world . Though his work was largely based on Abu al-Qasim al-Zahrawi 's Al-Tasrif , Sabuncuoğlu introduced many innovations of his own. Female surgeons were also illustrated for the first time. Since, the Ottoman Empire is credited with the invention of several surgical instruments in use such as forceps , catheters , scalpels and lancets as well as pincers . [ better source needed ] An example of a watch that measured time in minutes was created by an Ottoman watchmaker, Meshur Sheyh Dede , in 1702. In the early 19th century, Egypt under Muhammad Ali began using steam engines for industrial manufacturing, with industries such as ironworks , textile manufacturing , paper mills and hulling mills moving towards steam power. Economic historian Jean Batou argues that the necessary economic conditions existed in Egypt for the adoption of oil as a potential energy source for its steam engines later in the 19th century. In the 19th century, Ishak Efendi is credited with introducing the then current Western scientific ideas and developments to the Ottoman and wider Muslim world, as well as the invention of a suitable Turkish and Arabic scientific terminology, through his translations of Western works.

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Robert Koch

Heinrich Hermann Robert Koch ( English: / k ɒ x / KOKH , German: [ ˈʁoːbɛʁt ˈkɔx ] ⓘ ; 11 December 1843 – 27 May 1910) was a German physician and microbiologist . As the discoverer of the specific causative agents of deadly infectious diseases including tuberculosis , cholera and anthrax , he is regarded as one of the main founders of modern bacteriology . As such he is popularly nicknamed the father of microbiology (with Louis Pasteur ), and as the father of medical bacteriology. His discovery of the anthrax bacterium ( Bacillus anthracis ) in 1876 is considered as the birth of modern bacteriology. Koch used his discoveries to establish that germs "could cause a specific disease" and directly provided proofs for the germ theory of diseases , therefore creating the scientific basis of public health , saving millions of lives. For his life's work Koch is seen as one of the founders of modern medicine. While working as a private physician, Koch developed many innovative techniques in microbiology. He was the first to use the oil immersion lens , condenser , and microphotography in microscopy. His invention of the bacterial culture method using agar and glass plates (later developed as the Petri dish by his assistant Julius Richard Petri ) made him the first to grow bacteria in the laboratory. In appreciation of his work, he was appointed to government advisor at the Imperial Health Office in 1880, promoted to a senior executive position ( Geheimer Regierungsrat ) in 1882, Director of Hygienic Institute and Chair (Professor of hygiene) of the Faculty of Medicine at Berlin University in 1885, and the Royal Prussian Institute for Infectious Diseases (later renamed Robert Koch Institute after his death) in 1891. The methods Koch used in bacteriology led to establishment of a medical concept known as Koch's postulates , four generalized medical principles to ascertain the relationship of pathogens with specific diseases. The concept is still in use in most situations and influences subsequent epidemiological principles such as the Bradford Hill criteria . A major controversy followed when Koch discovered tuberculin as a medication for tuberculosis which was proven to be ineffective, but developed for diagnosis of tuberculosis after his death. For his research on tuberculosis, he received the Nobel Prize in Physiology or Medicine in 1905. The day he announced the discovery of the tuberculosis bacterium, 24 March 1882, has been observed by the World Health Organization as " World Tuberculosis Day " every year since 1982.Koch was born in Clausthal, Germany , on 11 December 1843, to Hermann Koch (1814–1877) and Mathilde Julie Henriette (née Biewend; 1818–1871). His father was a mining engineer. He was the third of thirteen siblings. He excelled academically from an early age. Before entering school in 1848, he had taught himself how to read and write. He completed secondary education in 1862, having excelled in science and math. At the age of 19, in 1862, Koch entered the University of Göttingen to study natural science. He took up mathematics, physics and botany. He was appointed assistant in the university's Pathological Museum. After three semesters, he decided to change his area of study to medicine, as he aspired to be a physician. During his fifth semester at the medical school, Jacob Henle , an anatomist who had published a theory of contagion in 1840, asked him to participate in his research project on uterine nerve structure. This research won him a research prize from the university and enabled him to briefly study under Rudolf Virchow , who was at the time considered as "Germany's most renowned physician." In his sixth semester, Koch began to research at the Physiological Institute, where he studied the secretion of succinic acid , which is a signaling molecule that is also involved in the metabolism of the mitochondria . This would eventually form the basis of his dissertation. In January 1866, he graduated from the medical school, earning honours of the highest distinction, maxima cum laude . Robert Koch is widely known for his work with anthrax , discovering the causative agent of the fatal disease to be Bacillus anthracis . After officially becoming a district physician in Wollstein (today's Wolsztyn), Poland, in 1872, Robert began to delve into the disease called Anthrax. Near Wollstein, anthrax disease was regularly taking the lives of humans and livestock without evidence explaining why. Eventually, in 1876, Koch was able to make an incredible discovery that anthrax was triggered by one singular pathogen. Koch's discovery of the dormant stage, the anthrax spores, allowed him to successfully unravel the mystery behind the anthrax disease. By gaining a better understanding of this pathogen, he was able to shed light on the bacterium's remarkable resistance against environmental factors ("Robert Koch – Nobel Lecture" 2018). This groundbreaking achievement marked Koch as the pioneer scientist to discover that a microscopic organism was causing a disease to spread. His findings were especially impressive as they were done in a poorly equipped laboratory in Wollstein. He published the discovery in a booklet as " Die Ätiologie der Milzbrand-Krankheit, Begründet auf die Entwicklungsgeschichte des Bacillus Anthracis " ( The Etiology of Anthrax Disease, Based on the Developmental History of Bacillus Anthracis ) in 1876 while working at in Wöllstein. His publication in 1877 on the structure of anthrax bacterium marked the first photography of a bacterium. He discovered the formation of spores in anthrax bacteria, which could remain dormant under specific conditions. However, under optimal conditions, the spores were activated and caused disease. To determine this causative agent, he dry-fixed bacterial cultures onto glass slides, used dyes to stain the cultures, and observed them through a microscope. His work with anthrax is notable in that he was the first to link a specific microorganism with a specific disease, rejecting the idea of spontaneous generation and supporting the germ theory of disease . Robert Koch is widely known for his work with anthrax , discovering the causative agent of the fatal disease to be Bacillus anthracis . After officially becoming a district physician in Wollstein (today's Wolsztyn), Poland, in 1872, Robert began to delve into the disease called Anthrax. Near Wollstein, anthrax disease was regularly taking the lives of humans and livestock without evidence explaining why. Eventually, in 1876, Koch was able to make an incredible discovery that anthrax was triggered by one singular pathogen. Koch's discovery of the dormant stage, the anthrax spores, allowed him to successfully unravel the mystery behind the anthrax disease. By gaining a better understanding of this pathogen, he was able to shed light on the bacterium's remarkable resistance against environmental factors ("Robert Koch – Nobel Lecture" 2018). This groundbreaking achievement marked Koch as the pioneer scientist to discover that a microscopic organism was causing a disease to spread. His findings were especially impressive as they were done in a poorly equipped laboratory in Wollstein. He published the discovery in a booklet as " Die Ätiologie der Milzbrand-Krankheit, Begründet auf die Entwicklungsgeschichte des Bacillus Anthracis " ( The Etiology of Anthrax Disease, Based on the Developmental History of Bacillus Anthracis ) in 1876 while working at in Wöllstein. His publication in 1877 on the structure of anthrax bacterium marked the first photography of a bacterium. He discovered the formation of spores in anthrax bacteria, which could remain dormant under specific conditions. However, under optimal conditions, the spores were activated and caused disease. To determine this causative agent, he dry-fixed bacterial cultures onto glass slides, used dyes to stain the cultures, and observed them through a microscope. His work with anthrax is notable in that he was the first to link a specific microorganism with a specific disease, rejecting the idea of spontaneous generation and supporting the germ theory of disease . After graduation in 1866, Koch briefly worked as an assistant in the General Hospital of Hamburg. In October that year he moved to Idiot's Hospital of Langenhagen, near Hanover, as a general physician. In 1868, he moved to Neimegk and then to Rakwitz in 1869. As the Franco-Prussian War started in 1870, he enlisted in the German army as a volunteer surgeon in 1871 to support the war effort. He was discharged a year later and was appointed as a district physician ( Kreisphysikus ) in Wollstein in Prussian Posen (now Wolsztyn , Poland). As his family settled there, his wife gave him a microscope as a birthday gift. With the microscope, he set up a private laboratory and started his career in microbiology. Koch began conducting research on microorganisms in a laboratory connected to his patient examination room. His early research in this laboratory yielded one of his major contributions to the field of microbiology, as he developed the technique of growing bacteria. Furthermore, he managed to isolate and grow selected pathogens in a pure laboratory culture . His discovery of the anthrax bacillus (later named Bacillus anthracis ) hugely impressed Ferdinand Julius Cohn , professor at the University of Breslau (now the University of Wrocław ), who helped him publish the discovery in 1876. Cohn had established the Institute of Plant Physiology and invited Koch to demonstrate his new bacterium there in 1877. Koch was transferred to Breslau as district physician in 1879. A year after, he left for Berlin when he was appointed a government advisor at the Imperial Health Office, where he worked from 1880 to 1885. Following his discovery of the tuberculosis bacterium, he was promoted to Geheimer Regierungsrat , a senior executive position, in June 1882. In 1885, Koch received two appointments as an administrator and professor at Berlin University . He became Director of Hygienic Institute and Chair (Professor of hygiene) of the Faculty of Medicine. In 1891, he relinquished his professorship and became a director of the Royal Prussian Institute for Infectious Diseases (now the Robert Koch Institute ) which consisted of a clinical division and beds for the division of clinical research. For this he accepted harsh conditions. The Prussian Ministry of Health insisted after the 1890 scandal with tuberculin , which Koch had discovered and intended as a remedy for tuberculosis, that any of Koch's inventions would unconditionally belong to the government and he would not be compensated. Koch lost the right to apply for patent protection. In 1906, he moved to East Africa to research a cure for trypanosomiasis (sleeping sickness). He established the Bugula research camp where up to 1000 people a day were treated with the experimental drug Atoxyl . Robert Koch made two important developments in microscopy; he was the first to use an oil immersion lens and a condenser that enabled smaller objects to be seen. In addition, he was also the first to effectively use photography ( microphotography ) for microscopic observation. He introduced the "bedrock methods" of bacterial staining using methylene blue and Bismarck (Vesuvin) brown dye . In an attempt to grow bacteria, Koch began to use solid nutrients such as potato slices. Through these initial experiments, Koch observed individual colonies of identical, pure cells. He found that potato slices were not suitable media for all organisms, and later began to use nutrient solutions with gelatin . However, he soon realized that gelatin, like potato slices, was not the optimal medium for bacterial growth, as it did not remain solid at 37 °C, the ideal temperature for growth of most human pathogens. And also many bacteria can hydrolyze gelatin making it a liquid. As suggested to him by his post-doctoral assistant Walther Hesse , who got the idea from his wife Fanny Hesse , in 1881, Koch started using agar to grow and isolate pure cultures. Agar is a polysaccharide that remains solid at 37 °C, is not degraded by most bacteria, and results in a stable transparent medium. Koch's booklet published in 1881 titled " Zur Untersuchung von Pathogenen Organismen " ( Methods for the Study of Pathogenic Organisms ) has been known as the "Bible of Bacteriology." In it he described a novel method of using glass slide with agar to grow bacteria. The method involved pouring a liquid agar on to the glass slide and then spreading a thin layer of gelatin over. The gelatin made the culture medium solidify, in which bacterial samples could be spread uniformly. The whole bacterial culture was then put in a glass plate together with a small wet paper. Koch named this container as feuchte Kammer (moist chamber). The typical chamber was a circular glass dish 20 cm in diameter and 5 cm in height and had a lid to prevent contamination. The glass plate and the transparent culture media made observation of the bacterial growth easy. Koch publicly demonstrated his plating method at the Seventh International Medical Congress in London in August 1881. There, Louis Pasteur exclaimed, "C'est un grand progrès, Monsieur !" ("What a great progress, Sir!") It was using Koch's microscopy and agar-plate culture method that his students discovered new bacteria. Friedrich Loeffler discovered the bacteria of glanders ( Burkholderia mallei ) in 1882 and diphtheria ( Corynebacterium diphtheriae ) in 1884; and Georg Theodor August Gaffky , the bacterium of typhoid ( Salmonella enterica ) in 1884. Koch's assistant Julius Richard Petri developed an improved method and published it in 1887 as " Eine kleine Modification des Koch'schen Plattenverfahrens " (A minor modification of the plating technique of Koch). The culture plate was given an eponymous name Petri dish . It is often asserted that Petri developed a new culture plate, but this was not so. He simply discarded the use of glass plate and instead used the circular glass dish directly, not just as moist chamber, but as the main culture container. This further reduced chances of contaminations. It would also have been appropriate if the name "Koch dish" had been given. During his time as the government advisor with the Imperial Health Agency in Berlin in the 1880s, Koch became interested in tuberculosis research. At the time, it was widely believed that tuberculosis was an inherited disease. However Koch was convinced that the disease was caused by a bacterium and was infectious. In 1882, he published his findings on tuberculosis, in which he reported the causative agent of the disease to be the slow-growing Mycobacterium tuberculosis . He published the discovery as " Die Ätiologie der Tuberkulose " ( The Etiology of Tuberculosis ), and presented before the German Physiological Society at Berlin on 24 March 1882. Koch said, When the cover-glasses were exposed to this staining fluid [methylene blue mixed with potassium hydroxide ] for 24 hours, very fine rod-like forms became apparent in the tubercular mass for the first time, having, as further observations showed, the power of multiplication and of spore formation and hence belonging to the same group of organisms as the anthrax bacillus... Microscopic examination then showed that only the previously blue-stained cell nuclei and detritus became brown, while the tubercle bacilli remained a beautiful blue. There was no particular reaction to this announcement. Eminent scientists such as Rudolf Virchow remained skeptical. Virchow clung to his theory that all diseases are due to faulty cellular activities. On the other hand, Paul Ehrlich later recollected that this moment was his "single greatest scientific experience." Koch expanded the report and published under the same title as a booklet in 1884, in which he concluded that the discovery of tuberculosis bacterium fulfilled the three principles, eventually known as Koch's postulates , which were formulated by his assistant Friedrich Loeffler in 1883, saying: All these factors together allow me to conclude that the bacilli present in the tuberculous lesions do not only accompany tuberculosis, but rather cause it. These bacilli are the true agents of tuberculosis. In August 1883, the German government sent a medical team led by Koch to Alexandria, Egypt , to investigate a cholera epidemic there. Koch soon found that the intestinal mucosa of people who died of cholera always had bacterial infection, yet could not confirm whether the bacteria were the causative pathogens. As the outbreak in Egypt declined, he was transferred to Calcutta (now Kolkata ) India, where there was a more severe outbreak. He soon found that the river Ganges was the source of cholera. He performed autopsies of almost 100 bodies, and found in each bacterial infection. He identified the same bacteria from water tanks, linking the source of the infection. He isolated the bacterium in pure culture on 7 January 1884. He subsequently confirmed that the bacterium was a new species, and described as "a little bent, like a comma." His experiment using fresh blood samples indicated that the bacterium could kill red blood cells, and he hypothesized that some sort of poison was used by the bacterium to cause the disease. In 1959, Indian scientist Sambhu Nath De discovered this poison, the cholera toxin . Koch reported his discovery to the German Secretary of State for the Interior on 2 February, and published it in the Deutsche Medizinische Wochenschrift ( German Medical Weekly ) the following month. Although Koch was convinced that the bacterium was the cholera pathogen, he could not entirely establish a critical evidence the bacterium produced the symptoms in healthy subjects (following Koch's postulates ). His experiment on animals using his pure bacteria culture did not cause the disease, and correctly explained that animals are immune to human pathogen. The bacterium was then known as "the comma bacillus", and scientifically as Bacillus comma . It was later realised that the bacterium was already described by an Italian physician Filippo Pacini in 1854, and was also observed by the Catalan physician Joaquim Balcells i Pascual around the same time. But they failed to identify the bacterium as the causative agent of cholera. Koch's colleague Richard Friedrich Johannes Pfeiffer correctly identified the comma bacillus as Pacini's vibrioni and renamed it as Vibrio cholera in 1896. Koch gave much of his research attention on tuberculosis throughout his career. After medical expeditions to various parts of the world, he again focussed on tuberculosis from the mid-1880s. By that time the Imperial Health Office was carrying out a project for disinfection of sputum of tuberculosis patients. Koch experimented with arsenic and creosote as possible disinfectants. These chemicals and other available drugs did not work. His report in 1883 also mentioned a failed experiment on an attempt to make tuberculosis vaccine. By 1888, Koch turned his attention to synthetic dyes as antibacterial chemicals. He developed a method for examining antibacterial activity by mixing the gelatin-based culture media with a yellow dye, auramin . His notebook indicates that by February 1890, he tested hundreds of compounds. In one of such tests, he found that an extract from the tuberculosis bacterium culture dissolved in glycerine could cure tuberculosis in guinea pigs. Based on a series of experiments from April to July 1891, he could conclude that the extract did not kill the tuberculosis bacterium, but destroyed (by necrosis ) the infected tissues, thereby depriving bacterial growth. He made a vague announcement in August 1890 at the Tenth International Medical Congress in Berlin, saying, In a communication which I made a few months ago to the International Medical Congress [in London in 1881], I described a substance of which the result is to make laboratory animals insensitive to inoculation of tubercle bacilli, and in the case of already infected animals, to bring the tuberculous process to a halt. I can tell […] that much, that guinea pigs, which are highly susceptible to the disease [tuberculosis], no longer react upon inoculation with tubercle virus [bacterium] when treated with that substance and that in guinea pigs, which are sick (with tuberculosis), the pathological process can be brought to a complete standstill. By November 1890, Koch demonstrated the effectiveness of the extract in treating humans by administering the vaccine through the Bacillus Calmette-Guerin (BCG) technique. This absorbs the vaccine through the skin by means of multiple shallow punctures on the skin and many patients and doctors went to Berlin to get Koch's remedy. While this was effective in humans, his experiments also revealed that when the substance was inoculated into his tuberculosis-infected test guinea pigs, they presented with severe symptoms. This outcome, characterized by an exaggerated immune response, coined the term "Koch's phenomenon." This is known as an extreme skin reaction that manifests itself at the BCG vaccination site within a few days after the vaccine is administered to an individual infected with tuberculosis. When a normal guinea pig was inoculated with pure tubercle bacillus , the wound would close rapidly and heal within several days. Afterwards, the site of the injection would open and form an ulcer until the animal died. However, if the same inoculated culture was injected into a guinea pig that was previously infected with tuberculosis, the site of the injection becomes dark, and eventually heals normally and quickly (Moreland, 2024). The uncertainty in the chemical nature coined the term phenomenon in the name "Koch's phenomenon." Koch published his experiments in the 15 January 1891 issue of Deutsche Medizinische Wochenschrift , and The British Medical Journal immediately published the English version simultaneously. The English version was also reproduced in Nature , and The Lancet in the same month. The Lancet presented it as "glad tidings of great joy." Koch simply referred to the medication as "brownish, transparent fluid." Josephs Pohl-Pincus had used the name tuberculin in 1844 for tuberculosis culture media, and Koch subsequently adopted as "tuberkulin." The first report on the clinical trial in 1891 was disappointing. By then 1061 patients with tuberculosis of internal organs and of 708 patients with tuberculosis of external tissues were given the treatment. An attempt to use tuberculin as a therapeutic drug is regarded as Koch's "greatest failure." With it his reputation greatly waned. But he devoted the rest of his life trying to make tuberculin as a usable medication. His discovery was not a total failure: the substance is now used to test for hypersensitivity in tuberculosis patients. Koch observed the phenomenon of acquired immunity . On 26 December 1900, he arrived as part of an expedition to German New Guinea , which was then a protectorate of the German Reich. Koch serially examined the Papuan people , the indigenous inhabitants, and their blood samples and noticed they contained Plasmodium parasites, the cause of malaria , but their bouts of malaria were mild or could not even be noticed, i.e. were subclinical . On the contrary, German settlers and Chinese workers, who had been brought to New Guinea, fell sick immediately. The longer they had stayed in the country, however, the more they too seemed to develop a resistance against it. During his time as government advisor, Koch published a report on how he discovered and experimentally showed tuberculosis bacterium as the pathogen of tuberculosis. He described the importance of pure cultures in isolating disease-causing organisms and explained the necessary steps to obtain these cultures, methods which are summarized in Koch's four postulates . Koch's discovery of the causative agent of anthrax led to the formation of a generic set of postulates which can be used in the determination of the cause of most infectious diseases. These postulates, which not only outlined a method for linking cause and effect of an infectious disease but also established the significance of laboratory culture of infectious agents, became the "gold standard" in infectious diseases. Although Koch worked out the principles, he did not formulate the postulates, which were introduced by his assistant Friedrich Loeffler. Loeffler, reporting his discovery of diphtheria bacillus in 1883, stated three postulates as follows: The fourth postulate was added by an American plant pathologist Erwin Frink Smith in 1905, and is stated as: Robert Koch made two important developments in microscopy; he was the first to use an oil immersion lens and a condenser that enabled smaller objects to be seen. In addition, he was also the first to effectively use photography ( microphotography ) for microscopic observation. He introduced the "bedrock methods" of bacterial staining using methylene blue and Bismarck (Vesuvin) brown dye . In an attempt to grow bacteria, Koch began to use solid nutrients such as potato slices. Through these initial experiments, Koch observed individual colonies of identical, pure cells. He found that potato slices were not suitable media for all organisms, and later began to use nutrient solutions with gelatin . However, he soon realized that gelatin, like potato slices, was not the optimal medium for bacterial growth, as it did not remain solid at 37 °C, the ideal temperature for growth of most human pathogens. And also many bacteria can hydrolyze gelatin making it a liquid. As suggested to him by his post-doctoral assistant Walther Hesse , who got the idea from his wife Fanny Hesse , in 1881, Koch started using agar to grow and isolate pure cultures. Agar is a polysaccharide that remains solid at 37 °C, is not degraded by most bacteria, and results in a stable transparent medium. Koch's booklet published in 1881 titled " Zur Untersuchung von Pathogenen Organismen " ( Methods for the Study of Pathogenic Organisms ) has been known as the "Bible of Bacteriology." In it he described a novel method of using glass slide with agar to grow bacteria. The method involved pouring a liquid agar on to the glass slide and then spreading a thin layer of gelatin over. The gelatin made the culture medium solidify, in which bacterial samples could be spread uniformly. The whole bacterial culture was then put in a glass plate together with a small wet paper. Koch named this container as feuchte Kammer (moist chamber). The typical chamber was a circular glass dish 20 cm in diameter and 5 cm in height and had a lid to prevent contamination. The glass plate and the transparent culture media made observation of the bacterial growth easy. Koch publicly demonstrated his plating method at the Seventh International Medical Congress in London in August 1881. There, Louis Pasteur exclaimed, "C'est un grand progrès, Monsieur !" ("What a great progress, Sir!") It was using Koch's microscopy and agar-plate culture method that his students discovered new bacteria. Friedrich Loeffler discovered the bacteria of glanders ( Burkholderia mallei ) in 1882 and diphtheria ( Corynebacterium diphtheriae ) in 1884; and Georg Theodor August Gaffky , the bacterium of typhoid ( Salmonella enterica ) in 1884. Koch's assistant Julius Richard Petri developed an improved method and published it in 1887 as " Eine kleine Modification des Koch'schen Plattenverfahrens " (A minor modification of the plating technique of Koch). The culture plate was given an eponymous name Petri dish . It is often asserted that Petri developed a new culture plate, but this was not so. He simply discarded the use of glass plate and instead used the circular glass dish directly, not just as moist chamber, but as the main culture container. This further reduced chances of contaminations. It would also have been appropriate if the name "Koch dish" had been given. Koch's booklet published in 1881 titled " Zur Untersuchung von Pathogenen Organismen " ( Methods for the Study of Pathogenic Organisms ) has been known as the "Bible of Bacteriology." In it he described a novel method of using glass slide with agar to grow bacteria. The method involved pouring a liquid agar on to the glass slide and then spreading a thin layer of gelatin over. The gelatin made the culture medium solidify, in which bacterial samples could be spread uniformly. The whole bacterial culture was then put in a glass plate together with a small wet paper. Koch named this container as feuchte Kammer (moist chamber). The typical chamber was a circular glass dish 20 cm in diameter and 5 cm in height and had a lid to prevent contamination. The glass plate and the transparent culture media made observation of the bacterial growth easy. Koch publicly demonstrated his plating method at the Seventh International Medical Congress in London in August 1881. There, Louis Pasteur exclaimed, "C'est un grand progrès, Monsieur !" ("What a great progress, Sir!") It was using Koch's microscopy and agar-plate culture method that his students discovered new bacteria. Friedrich Loeffler discovered the bacteria of glanders ( Burkholderia mallei ) in 1882 and diphtheria ( Corynebacterium diphtheriae ) in 1884; and Georg Theodor August Gaffky , the bacterium of typhoid ( Salmonella enterica ) in 1884. Koch's assistant Julius Richard Petri developed an improved method and published it in 1887 as " Eine kleine Modification des Koch'schen Plattenverfahrens " (A minor modification of the plating technique of Koch). The culture plate was given an eponymous name Petri dish . It is often asserted that Petri developed a new culture plate, but this was not so. He simply discarded the use of glass plate and instead used the circular glass dish directly, not just as moist chamber, but as the main culture container. This further reduced chances of contaminations. It would also have been appropriate if the name "Koch dish" had been given. During his time as the government advisor with the Imperial Health Agency in Berlin in the 1880s, Koch became interested in tuberculosis research. At the time, it was widely believed that tuberculosis was an inherited disease. However Koch was convinced that the disease was caused by a bacterium and was infectious. In 1882, he published his findings on tuberculosis, in which he reported the causative agent of the disease to be the slow-growing Mycobacterium tuberculosis . He published the discovery as " Die Ätiologie der Tuberkulose " ( The Etiology of Tuberculosis ), and presented before the German Physiological Society at Berlin on 24 March 1882. Koch said, When the cover-glasses were exposed to this staining fluid [methylene blue mixed with potassium hydroxide ] for 24 hours, very fine rod-like forms became apparent in the tubercular mass for the first time, having, as further observations showed, the power of multiplication and of spore formation and hence belonging to the same group of organisms as the anthrax bacillus... Microscopic examination then showed that only the previously blue-stained cell nuclei and detritus became brown, while the tubercle bacilli remained a beautiful blue. There was no particular reaction to this announcement. Eminent scientists such as Rudolf Virchow remained skeptical. Virchow clung to his theory that all diseases are due to faulty cellular activities. On the other hand, Paul Ehrlich later recollected that this moment was his "single greatest scientific experience." Koch expanded the report and published under the same title as a booklet in 1884, in which he concluded that the discovery of tuberculosis bacterium fulfilled the three principles, eventually known as Koch's postulates , which were formulated by his assistant Friedrich Loeffler in 1883, saying: All these factors together allow me to conclude that the bacilli present in the tuberculous lesions do not only accompany tuberculosis, but rather cause it. These bacilli are the true agents of tuberculosis. In August 1883, the German government sent a medical team led by Koch to Alexandria, Egypt , to investigate a cholera epidemic there. Koch soon found that the intestinal mucosa of people who died of cholera always had bacterial infection, yet could not confirm whether the bacteria were the causative pathogens. As the outbreak in Egypt declined, he was transferred to Calcutta (now Kolkata ) India, where there was a more severe outbreak. He soon found that the river Ganges was the source of cholera. He performed autopsies of almost 100 bodies, and found in each bacterial infection. He identified the same bacteria from water tanks, linking the source of the infection. He isolated the bacterium in pure culture on 7 January 1884. He subsequently confirmed that the bacterium was a new species, and described as "a little bent, like a comma." His experiment using fresh blood samples indicated that the bacterium could kill red blood cells, and he hypothesized that some sort of poison was used by the bacterium to cause the disease. In 1959, Indian scientist Sambhu Nath De discovered this poison, the cholera toxin . Koch reported his discovery to the German Secretary of State for the Interior on 2 February, and published it in the Deutsche Medizinische Wochenschrift ( German Medical Weekly ) the following month. Although Koch was convinced that the bacterium was the cholera pathogen, he could not entirely establish a critical evidence the bacterium produced the symptoms in healthy subjects (following Koch's postulates ). His experiment on animals using his pure bacteria culture did not cause the disease, and correctly explained that animals are immune to human pathogen. The bacterium was then known as "the comma bacillus", and scientifically as Bacillus comma . It was later realised that the bacterium was already described by an Italian physician Filippo Pacini in 1854, and was also observed by the Catalan physician Joaquim Balcells i Pascual around the same time. But they failed to identify the bacterium as the causative agent of cholera. Koch's colleague Richard Friedrich Johannes Pfeiffer correctly identified the comma bacillus as Pacini's vibrioni and renamed it as Vibrio cholera in 1896. Koch gave much of his research attention on tuberculosis throughout his career. After medical expeditions to various parts of the world, he again focussed on tuberculosis from the mid-1880s. By that time the Imperial Health Office was carrying out a project for disinfection of sputum of tuberculosis patients. Koch experimented with arsenic and creosote as possible disinfectants. These chemicals and other available drugs did not work. His report in 1883 also mentioned a failed experiment on an attempt to make tuberculosis vaccine. By 1888, Koch turned his attention to synthetic dyes as antibacterial chemicals. He developed a method for examining antibacterial activity by mixing the gelatin-based culture media with a yellow dye, auramin . His notebook indicates that by February 1890, he tested hundreds of compounds. In one of such tests, he found that an extract from the tuberculosis bacterium culture dissolved in glycerine could cure tuberculosis in guinea pigs. Based on a series of experiments from April to July 1891, he could conclude that the extract did not kill the tuberculosis bacterium, but destroyed (by necrosis ) the infected tissues, thereby depriving bacterial growth. He made a vague announcement in August 1890 at the Tenth International Medical Congress in Berlin, saying, In a communication which I made a few months ago to the International Medical Congress [in London in 1881], I described a substance of which the result is to make laboratory animals insensitive to inoculation of tubercle bacilli, and in the case of already infected animals, to bring the tuberculous process to a halt. I can tell […] that much, that guinea pigs, which are highly susceptible to the disease [tuberculosis], no longer react upon inoculation with tubercle virus [bacterium] when treated with that substance and that in guinea pigs, which are sick (with tuberculosis), the pathological process can be brought to a complete standstill. By November 1890, Koch demonstrated the effectiveness of the extract in treating humans by administering the vaccine through the Bacillus Calmette-Guerin (BCG) technique. This absorbs the vaccine through the skin by means of multiple shallow punctures on the skin and many patients and doctors went to Berlin to get Koch's remedy. While this was effective in humans, his experiments also revealed that when the substance was inoculated into his tuberculosis-infected test guinea pigs, they presented with severe symptoms. This outcome, characterized by an exaggerated immune response, coined the term "Koch's phenomenon." This is known as an extreme skin reaction that manifests itself at the BCG vaccination site within a few days after the vaccine is administered to an individual infected with tuberculosis. When a normal guinea pig was inoculated with pure tubercle bacillus , the wound would close rapidly and heal within several days. Afterwards, the site of the injection would open and form an ulcer until the animal died. However, if the same inoculated culture was injected into a guinea pig that was previously infected with tuberculosis, the site of the injection becomes dark, and eventually heals normally and quickly (Moreland, 2024). The uncertainty in the chemical nature coined the term phenomenon in the name "Koch's phenomenon." Koch published his experiments in the 15 January 1891 issue of Deutsche Medizinische Wochenschrift , and The British Medical Journal immediately published the English version simultaneously. The English version was also reproduced in Nature , and The Lancet in the same month. The Lancet presented it as "glad tidings of great joy." Koch simply referred to the medication as "brownish, transparent fluid." Josephs Pohl-Pincus had used the name tuberculin in 1844 for tuberculosis culture media, and Koch subsequently adopted as "tuberkulin." The first report on the clinical trial in 1891 was disappointing. By then 1061 patients with tuberculosis of internal organs and of 708 patients with tuberculosis of external tissues were given the treatment. An attempt to use tuberculin as a therapeutic drug is regarded as Koch's "greatest failure." With it his reputation greatly waned. But he devoted the rest of his life trying to make tuberculin as a usable medication. His discovery was not a total failure: the substance is now used to test for hypersensitivity in tuberculosis patients. Koch observed the phenomenon of acquired immunity . On 26 December 1900, he arrived as part of an expedition to German New Guinea , which was then a protectorate of the German Reich. Koch serially examined the Papuan people , the indigenous inhabitants, and their blood samples and noticed they contained Plasmodium parasites, the cause of malaria , but their bouts of malaria were mild or could not even be noticed, i.e. were subclinical . On the contrary, German settlers and Chinese workers, who had been brought to New Guinea, fell sick immediately. The longer they had stayed in the country, however, the more they too seemed to develop a resistance against it. During his time as government advisor, Koch published a report on how he discovered and experimentally showed tuberculosis bacterium as the pathogen of tuberculosis. He described the importance of pure cultures in isolating disease-causing organisms and explained the necessary steps to obtain these cultures, methods which are summarized in Koch's four postulates . Koch's discovery of the causative agent of anthrax led to the formation of a generic set of postulates which can be used in the determination of the cause of most infectious diseases. These postulates, which not only outlined a method for linking cause and effect of an infectious disease but also established the significance of laboratory culture of infectious agents, became the "gold standard" in infectious diseases. Although Koch worked out the principles, he did not formulate the postulates, which were introduced by his assistant Friedrich Loeffler. Loeffler, reporting his discovery of diphtheria bacillus in 1883, stated three postulates as follows: The fourth postulate was added by an American plant pathologist Erwin Frink Smith in 1905, and is stated as: In July 1867, Koch married Emma (Emmy) Adolfine Josephine Fraatz, and the two had a daughter, Gertrude, in 1868. Their marriage ended after 26 years in 1893, and later that same year, he married actress Hedwig Freiberg (1872–1945). On 9 April 1910, Koch suffered a heart attack and never made a complete recovery. On 27 May, three days after giving a lecture on his tuberculosis research at the Prussian Academy of Sciences , Koch died in Baden-Baden at the age of 66. Following his death, the Institute named its establishment after him in his honour. He was irreligious. Koch was made a Knight Grand Cross in the Prussian Order of the Red Eagle on 19 November 1890, and was elected a Foreign Member of the Royal Society (ForMemRS) in 1897. In 1905, he was awarded the Nobel Prize in Physiology and Medicine "for his investigations and discoveries in relation to tuberculosis." In 1906, research on tuberculosis and tropical diseases won him the Order Pour le Merite and in 1908, the Robert Koch Medal , established to honour the greatest living physicians. Emperor Wilhelm I awarded him the Order of the Crown, 100,000 marks and appointment as Privy Imperial Councillor, Surgeon-General of Health Service, and Fellow of the Science Senate of Kaiser Wilhelm Society. Koch established the Royal Prussian Institute for Infectious Diseases in Berlin 1891. After his death it was renamed Robert Koch Institute in his honour. The World Health Organization observes " World Tuberculosis Day " every 24 March since 1982 to commemorate the day Koch discovered tuberculosis bacterium. Koch's name is one of 23 from the fields of hygiene and tropical medicine featured on the frieze of the London School of Hygiene & Tropical Medicine building in Keppel Street , Bloomsbury . A large marble statue of Koch stands in a small park known as Robert Koch Platz, just north of the Charity Hospital , in the Mitte section of Berlin . His life was the subject of a 1939 German produced motion picture that featured Oscar winning actor Emil Jannings in the title role. On 10 December 2017, Google showed a Doodle in celebration of Koch's birthday. Koch and his relationship to Paul Ehrlich , who developed a mechanism to diagnose TB, were portrayed in the 1940 movie Dr. Ehrlich's Magic Bullet .At their first meeting at the Seventh International Medical Congress in London in August 1881, Koch and Pasteur were friendly towards each other. But the rest of their careers followed with scientific disputes. The conflict started when Koch interpreted his discovery of anthrax bacillus in 1876 as causality, that is, the germ caused the anthrax infections. Although his postulates were not yet formulated, he did not establish the bacterium as the cause of the disease: it was an inference. Pasteur therefore argued that Koch's discovery was not the full proof of causality, but Pasteur's anthrax vaccine developed in 1881 was. Koch published his conclusion in 1881 with a statement: "anthrax never occurs without viable anthrax bacilli or spores. In my opinion no more conclusive proof can be given that anthrax bacilli are the true and only cause of anthrax," and that vaccination such as claimed by Pasteur would be impossible. To prove his vaccine, Pasteur sent his assistant Louis Thuillier to Germany for demonstration and disproved Koch's idea. They had a heated public debate at the International Congress for Hygiene in Geneva in 1882, where Koch criticised Pasteur's methods as "unreliable," and claimed they "are false and [as such ] they inevitably lead to false conclusions." Koch later continued to attack Pasteur, saying, "Pasteur is not a physician, and one cannot expect him to make sound judgments about pathological processes and the symptoms of disease." When Koch discovered tuberculin in 1890 as a medication for tuberculosis, he kept the experiment secret and avoided disclosing the source. It was only after a year under public pressure that he publicly announced the experiment and the source. Clinical trials with tuberculin were disastrous and complete failures. Rudolf Virchow's autopsy report of 21 subjects treated with tuberculin to the Berlin Medical Society on 7 January 1891 revealed that instead of healing tuberculosis, the subjects died because of the treatment. One week later, Koch publicised that the drug was a glycerine extract of a pure cultivation of the tuberculosis bacilli. The German official report in late 1891 declared that tuberculosis was not cured with tuberculin. From this moment onwards, Koch's prestige fell apart. The reason for his initial secrecy was due to an ambition for monetary benefits for the new drug, and with that establishment of his own research institute. Since 1885, he had tried to leave government service and create an independent state-run institute of his own. Following the disappointment, he was released from the University of Berlin and forced to work as Director of the Royal Prussian Institute for Infectious Diseases, a newly established institute, in 1891. He was prohibited from working on tuberculin and from claim for patent rights in any of his subsequent works. Koch initially believed that human ( Mycobacterium tuberculosis ) and cattle tuberculosis bacilli (now called Mycobacterium bovis ) were different pathogens when he made the discovery in 1882. Two years later, he revoked that position and asserted that the two bacilli were the same type. This later assumption was taken as a fact in veterinary practice. Based on it, legislations were made in US for inspection of meat and milk. In 1898, an American veterinarian Theobald Smith published a detailed comparative study and found that the tuberculosis bacteria are different based on their structure, growth patterns, and pathogenicity. In addition he also discovered that there were variations in each type. In his conclusion, he made two important points: Human tuberculosis bacillus cannot infect cattle. But cattle bacillus may infect humans since it is very pathogenic. By that time, there was evidence that cattle tuberculosis was transmitted to humans through meat and milk. Upon these reports, Koch conceded that the two bacilli were different but still advocated that cattle tuberculosis was of no health concern. Speaking at the Third International Congress on Tuberculosis , held in London in July 1901, he said that cattle tuberculosis is not dangerous to humans and there is no need for medical attention. He said, "I therefore consider it unnecessary to take any measures against this form of TB. The fight against TB clearly has to concentrate on the human bacillus. " Chair of the congress, Joseph Lister reprimanded Koch and explained the medical evidences of cattle tuberculosis in humans. The Nobel Committee selected the 1902 Nobel Prize in Physiology or Medicine to be awarded for the discovery of the transmission of malaria. But it could not make the final decision on whom to give it to — the British surgeon Ronald Ross or the Italian biologist Giovanni Battista Grassi . Ross had discovered that the human malarial parasite was carried by certain mosquitoes in 1897, and the next year that bird malaria could be transmitted from infected to healthy birds by the bite of a mosquito. Grassi had discovered Plasmodium vivax and the bird malaria parasite, and towards the end of 1898 the transmission of Plasmodium falciparum between humans through mosquitoes Anopheles claviger . To the surprise of the Nobel Committee, the two nominees exchanged polemic arguments against each other publicly justifying the importance of their own works. Robert Koch was then appointed as a "neutral arbitrator" to make the final decision. To his disadvantage, Grassi had criticised Koch on his malaria research in 1898 during an investigation of the epidemic, while Ross had established a cordial relationship with Koch. Ross was selected for the award, as Koch "threw the full weight of his considerable authority in insisting that Grassi did not deserve the honor." At their first meeting at the Seventh International Medical Congress in London in August 1881, Koch and Pasteur were friendly towards each other. But the rest of their careers followed with scientific disputes. The conflict started when Koch interpreted his discovery of anthrax bacillus in 1876 as causality, that is, the germ caused the anthrax infections. Although his postulates were not yet formulated, he did not establish the bacterium as the cause of the disease: it was an inference. Pasteur therefore argued that Koch's discovery was not the full proof of causality, but Pasteur's anthrax vaccine developed in 1881 was. Koch published his conclusion in 1881 with a statement: "anthrax never occurs without viable anthrax bacilli or spores. In my opinion no more conclusive proof can be given that anthrax bacilli are the true and only cause of anthrax," and that vaccination such as claimed by Pasteur would be impossible. To prove his vaccine, Pasteur sent his assistant Louis Thuillier to Germany for demonstration and disproved Koch's idea. They had a heated public debate at the International Congress for Hygiene in Geneva in 1882, where Koch criticised Pasteur's methods as "unreliable," and claimed they "are false and [as such ] they inevitably lead to false conclusions." Koch later continued to attack Pasteur, saying, "Pasteur is not a physician, and one cannot expect him to make sound judgments about pathological processes and the symptoms of disease." When Koch discovered tuberculin in 1890 as a medication for tuberculosis, he kept the experiment secret and avoided disclosing the source. It was only after a year under public pressure that he publicly announced the experiment and the source. Clinical trials with tuberculin were disastrous and complete failures. Rudolf Virchow's autopsy report of 21 subjects treated with tuberculin to the Berlin Medical Society on 7 January 1891 revealed that instead of healing tuberculosis, the subjects died because of the treatment. One week later, Koch publicised that the drug was a glycerine extract of a pure cultivation of the tuberculosis bacilli. The German official report in late 1891 declared that tuberculosis was not cured with tuberculin. From this moment onwards, Koch's prestige fell apart. The reason for his initial secrecy was due to an ambition for monetary benefits for the new drug, and with that establishment of his own research institute. Since 1885, he had tried to leave government service and create an independent state-run institute of his own. Following the disappointment, he was released from the University of Berlin and forced to work as Director of the Royal Prussian Institute for Infectious Diseases, a newly established institute, in 1891. He was prohibited from working on tuberculin and from claim for patent rights in any of his subsequent works. Koch initially believed that human ( Mycobacterium tuberculosis ) and cattle tuberculosis bacilli (now called Mycobacterium bovis ) were different pathogens when he made the discovery in 1882. Two years later, he revoked that position and asserted that the two bacilli were the same type. This later assumption was taken as a fact in veterinary practice. Based on it, legislations were made in US for inspection of meat and milk. In 1898, an American veterinarian Theobald Smith published a detailed comparative study and found that the tuberculosis bacteria are different based on their structure, growth patterns, and pathogenicity. In addition he also discovered that there were variations in each type. In his conclusion, he made two important points: Human tuberculosis bacillus cannot infect cattle. But cattle bacillus may infect humans since it is very pathogenic. By that time, there was evidence that cattle tuberculosis was transmitted to humans through meat and milk. Upon these reports, Koch conceded that the two bacilli were different but still advocated that cattle tuberculosis was of no health concern. Speaking at the Third International Congress on Tuberculosis , held in London in July 1901, he said that cattle tuberculosis is not dangerous to humans and there is no need for medical attention. He said, "I therefore consider it unnecessary to take any measures against this form of TB. The fight against TB clearly has to concentrate on the human bacillus. " Chair of the congress, Joseph Lister reprimanded Koch and explained the medical evidences of cattle tuberculosis in humans. The Nobel Committee selected the 1902 Nobel Prize in Physiology or Medicine to be awarded for the discovery of the transmission of malaria. But it could not make the final decision on whom to give it to — the British surgeon Ronald Ross or the Italian biologist Giovanni Battista Grassi . Ross had discovered that the human malarial parasite was carried by certain mosquitoes in 1897, and the next year that bird malaria could be transmitted from infected to healthy birds by the bite of a mosquito. Grassi had discovered Plasmodium vivax and the bird malaria parasite, and towards the end of 1898 the transmission of Plasmodium falciparum between humans through mosquitoes Anopheles claviger . To the surprise of the Nobel Committee, the two nominees exchanged polemic arguments against each other publicly justifying the importance of their own works. Robert Koch was then appointed as a "neutral arbitrator" to make the final decision. To his disadvantage, Grassi had criticised Koch on his malaria research in 1898 during an investigation of the epidemic, while Ross had established a cordial relationship with Koch. Ross was selected for the award, as Koch "threw the full weight of his considerable authority in insisting that Grassi did not deserve the honor."

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Haiti

Haiti , [lower-alpha 3] officially the Republic of Haiti , [lower-alpha 4] [lower-alpha 5] is a country on the island of Hispaniola in the Caribbean Sea , east of Cuba and Jamaica , and south of The Bahamas . It occupies the western three-eighths of the island which it shares with the Dominican Republic . Haiti is 27,750 km 2 (10,714 sq mi) , the third largest country in the Caribbean , and has an estimated population of 11.4 million, making it the most populous Caribbean country. The capital is Port-au-Prince . The island was originally inhabited by the Taíno people. The first Europeans arrived in December 1492 during the first voyage of Christopher Columbus . Columbus founded the first European settlement in the Americas, La Navidad , on what is now the northeastern coast of Haiti. The island was claimed by Spain , forming part of the Spanish Empire until the early 17th century. Competing claims and settlements led to the west of the island being ceded to France in 1697, which was subsequently named Saint-Domingue . French colonists established sugarcane plantations , worked by enslaved persons brought from Africa, which made the colony one of the world's richest. In the midst of the French Revolution , enslaved persons, maroons , and free people of color launched the Haitian Revolution (1791–1804), led by a former slave and general of the French Army , Toussaint Louverture . Napoleon 's forces were defeated by Louverture's successor, Jean-Jacques Dessalines (later Emperor Jacques I), who declared Haiti's sovereignty on 1 January 1804, leading to a massacre of the French . The country became the first independent nation of the Caribbean , the second republic in the Americas, the first country in the Americas to officially abolish slavery, and only country established by a slave revolt . President Jean-Pierre Boyer decided to invade and occupy Santo Domingo in February 1822, which eventually led to the long Haitian–Dominican war . Defeated, Haiti recognized Dominican independence in 1867, following their declaration in 1844. Haiti's first century of independence was characterized by political instability, ostracism by the international community, payment of a crippling debt to France and the vast cost of the war and the occupation of Santo Domingo. Political volatility and foreign economic influence prompted the US to occupy the country between 1915 and 1934 . The last contingent of US Marines departed on August 15, 1934, after a formal transfer of authority to the Garde and Haïti regained its independence. François 'Papa Doc' Duvalier took power in 1957, ushering in a long period of autocratic rule continued by his son, Jean-Claude 'Baby Doc' Duvalier , that lasted until 1986; the period was characterized by state-sanctioned violence against the opposition and civilians, corruption, and economic stagnation. The country endured a 2004 coup d'état , which prompted U.N. intervention , as well as a catastrophic earthquake in 2010 that killed over 250,000 people and a cholera outbreak . Many countries canceled Haiti's debt, including France and the United States. With its deteriorating economic situation, Haiti has experienced a socioeconomic and political crisis marked by riots and protests, widespread hunger, and increased gang activity. As of February 2023, Haiti has no remaining elected government officials and has been described as a failed state . Haiti is a founding member of the United Nations , Organization of American States (OAS), Association of Caribbean States , and the Organisation internationale de la Francophonie . In addition to CARICOM , it is a member of the International Monetary Fund , World Trade Organization , and Community of Latin American and Caribbean States . Historically poor and politically unstable, Haiti has the lowest Human Development Index in the Americas, as well as widespread slavery .Haiti (also earlier Hayti ) [lower-alpha 5] comes from the indigenous Taíno language , and means "land of high mountains"; it was the native name [lower-alpha 6] for the entire island of Hispaniola . The name was restored by Haitian revolutionary Jean-Jacques Dessalines as the official name of independent Saint-Domingue, as a tribute to the Amerindian predecessors. In French, the ï in Ha ï ti has a diacritical mark (used to show that the second vowel is pronounced separately, as in the word na ï ve ), while the H is silent. (In English, this rule for the pronunciation is often disregarded, thus the spelling Haiti is used.) There are different anglicizations for its pronunciation such as HIGH-ti , high-EE-ti and haa-EE-ti , which are still in use, but HAY-ti is the most widespread and best-established. In French, Haiti's nickname means the "Pearl of the Antilles" ( La Perle des Antilles ) because of both its natural beauty and the amount of wealth it accumulated for the Kingdom of France . In Haitian Creole , it is spelled and pronounced with a y but no H : Ayiti . Another theory on the name Haiti is its origin in African tradition, in Fon language one of the most spoken by the bossales (Haitians born in Africa), Ayiti-Tomè means: From nowadays this land is our land. [ citation needed ] In the Haitian community the country has multiple nicknames: Ayiti-Toma (as its origin in Ayiti Tomè), Ayiti-Cheri (Ayiti my Darling), Tè-Desalin (Dessalines' Land) or Lakay (Home).The island of Hispaniola , of which Haiti occupies the western three-eighths, has been inhabited since about 5000 BC by groups of Native Americans thought to have arrived from Central or South America. Genetic studies show that some of these groups were related to the Yanomami of the Amazon Basin . Amongst these early settlers were the Ciboney peoples, followed by the Taíno , speakers of an Arawakan language , elements of which have been preserved in Haitian Creole . The Taíno name for the entire island was Haiti , or alternatively Quisqeya . In Taíno society the largest unit of political organization was led by a cacique , or chief, as the Europeans understood them. The island of Hispaniola was divided among five 'caciquedoms': the Magua in the north east, the Marien in the north west, the Jaragua in the south west, the Maguana in the central regions of Cibao, and the Higüey in the south east. Taíno cultural artifacts include cave paintings in several locations in the country. These have become national symbols of Haiti and tourist attractions. Modern-day Léogâne , started as a French colonial town in the southwest, is beside the former capital of the caciquedom of Xaragua. Navigator Christopher Columbus landed in Haiti on 6 December 1492, in an area that he named Môle-Saint-Nicolas , and claimed the island for the Crown of Castile . Nineteen days later, his ship the Santa María ran aground near the present site of Cap-Haïtien . Columbus left 39 men on the island, who founded the settlement of La Navidad on 25 December 1492. Relations with the native peoples, initially good, broke down and the settlers were later killed by the Taíno. The sailors carried endemic Eurasian infectious diseases , causing epidemics that killed a large number of native people. The first recorded smallpox epidemic in the Americas erupted on Hispaniola in 1507. Their numbers were further reduced by the harshness of the encomienda system, in which the Spanish forced natives to work in gold mines and plantations. The Spanish passed the Laws of Burgos (1512–1513), which forbade the maltreatment of natives, endorsed their conversion to Catholicism, and gave legal framework to encomiendas . The natives were brought to these sites to work in specific plantations or industries. As the Spanish re-focused their colonization efforts on the greater riches of mainland Central and South America, Hispaniola became reduced largely to a trading and refueling post. As a result piracy became widespread, encouraged by European powers hostile to Spain such as France (based on Île de la Tortue ) and England. The Spanish largely abandoned the western third of the island, focusing their colonization effort on the eastern two-thirds. The western part of the island was thus gradually settled by French buccaneers ; among them was Bertrand d'Ogeron, who succeeded in growing tobacco and recruited many French colonial families from Martinique and Guadeloupe . In 1697 France and Spain settled their hostilities on the island by way of the Treaty of Ryswick of 1697, which divided Hispaniola between them. France received the western third and subsequently named it Saint-Domingue, the French equivalent of Santo Domingo , the Spanish colony on Hispaniola . The French set about creating sugar and coffee plantations, worked by vast numbers of those enslaved imported from Africa , and Saint-Domingue grew to become their richest colonial possession, generating 40% of France's foreign trade and doubling the wealth generation of all of England's colonies, combined. The French settlers were outnumbered by enslaved persons by almost 10 to 1. According to the 1788 Census, Haiti's population consisted of nearly 25,000 Europeans, 22,000 free coloreds and 700,000 Africans in slavery. In contrast, by 1763 the white population of French Canada , a far larger territory, had numbered only 65,000. In the north of the island, those enslaved were able to retain many ties to African cultures, religion and language; these ties were continually being renewed by newly imported Africans. Some West Africans in slavery held on to their traditional Vodou beliefs by secretly syncretizing it with Catholicism. The French enacted the Code Noir ("Black Code"), prepared by Jean-Baptiste Colbert and ratified by Louis XIV , which established rules on slave treatment and permissible freedoms. Saint-Domingue has been described as one of the most brutally efficient slave colonies; at the end of the eighteenth century it was supplying two-thirds of Europe's tropical produce while one-third of newly imported Africans died within a few years. Many enslaved persons died from diseases such as smallpox and typhoid fever . They had low birth rates , and there is evidence that some women aborted fetuses rather than give birth to children within the bonds of slavery . The colony's environment also suffered, as forests were cleared to make way for plantations and the land was overworked so as to extract maximum profit for French plantation owners. As in its Louisiana colony , the French colonial government allowed some rights to free people of color ( gens de couleur ), the mixed-race descendants of European male colonists and African enslaved females (and later, mixed-race women). Over time, many were released from slavery and they established a separate social class . White French Creole fathers frequently sent their mixed-race sons to France for their education. Some men of color were admitted into the military. More of the free people of color lived in the south of the island, near Port-au-Prince , and many intermarried within their community. They frequently worked as artisans and tradesmen, and began to own some property, including enslaved persons of their own. The free people of color petitioned the colonial government to expand their rights. The brutality of slave life led many people in bondage to escape to mountainous regions, where they set up their own autonomous communities and became known as maroons . One maroon leader, François Mackandal , led a rebellion in the 1750s; however, he was later captured and executed by the French. Inspired by the French Revolution of 1789 and principles of the rights of man , the French settlers and free people of color pressed for greater political freedom and more civil rights . Tensions between these two groups led to conflict, as a militia of free-coloreds was set up in 1790 by Vincent Ogé , resulting in his capture, torture and execution. Sensing an opportunity, in August 1791 the first slave armies were established in northern Haiti under the leadership of Toussaint Louverture inspired by the Vodou houngan (priest) Boukman, and backed by the Spanish in Santo Domingo – soon a full-blown slave rebellion had broken out across the entire colony. In 1792, the French government sent three commissioners with troops to re-establish control; to build an alliance with the gens de couleur and enslaved persons commissioners Léger-Félicité Sonthonax and Étienne Polverel abolished slavery in the colony. Six months later, the National Convention , led by Maximilien de Robespierre and the Jacobins , endorsed abolition and extended it to all the French colonies. The United States , which was a new republic itself, oscillated between supporting or not supporting Toussaint Louverture and the emerging country of Haiti, depending on who was President of the US. Washington, who was a slave holder and isolationist, kept the United States neutral, although private US citizens at times provided aid to French planters trying to put down the revolt. John Adams, a vocal opponent of slavery, fully supported the slave revolt by providing diplomatic recognition, financial support, munitions and warships (including the USS Constitution ) beginning in 1798. This support ended in 1801 when Jefferson, another slave-holding president, took office and recalled the US Navy. With slavery abolished, Toussaint Louverture pledged allegiance to France, and he fought off the British and Spanish forces who had taken advantage of the situation and invaded Saint-Domingue. The Spanish were later forced to cede their part of the island to France under the terms of the Peace of Basel in 1795, uniting the island under one government. However, an insurgency against French rule broke out in the east, and in the west there was fighting between Louverture's forces and the free people of color led by André Rigaud in the War of the Knives (1799–1800). The United States' support for the blacks in the war contributed to their victory over the mulattoes. More than 25,000 whites and free blacks left the island as refugees. After Louverture created a separatist constitution and proclaimed himself governor-general for life, Napoléon Bonaparte in 1802 sent an expedition of 20,000 soldiers and as many sailors under the command of his brother-in-law, Charles Leclerc , to reassert French control. The French achieved some victories, but within a few months most of their army had died from yellow fever . Ultimately more than 50,000 French troops died in an attempt to retake the colony, including 18 generals. The French managed to capture Louverture, transporting him to France for trial. He was imprisoned at Fort de Joux , where he died in 1803 of exposure and possibly tuberculosis . The enslaved persons, along with free gens de couleur and allies, continued their fight for independence, led by generals Jean-Jacques Dessalines , Alexandre Pétion and Henry Christophe . The rebels finally managed to decisively defeat the French troops at the Battle of Vertières on 18 November 1803, establishing the first nation ever to successfully gain independence through a slave revolt. Under the overall command of Dessalines, the Haitian armies avoided open battle, and instead conducted a successful guerrilla campaign against the Napoleonic forces, working with diseases such as yellow fever to reduce the numbers of French soldiers. Later that year France withdrew its remaining 7,000 troops from the island and Napoleon gave up his idea of re-establishing a North American empire, selling Louisiana (New France) to the United States , in the Louisiana Purchase . Throughout the revolution, an estimated 20,000 French troops succumbed to yellow fever, while another 37,000 were killed in action , exceeding the total French soldiers killed in action across various 19th-century colonial campaigns in Algeria, Mexico, Indochina, Tunisia, and West Africa, which resulted in approximately 10,000 French soldiers killed in action combined. The British sustained 100,000 casualties. Additionally, 350,000 ex-enslaved Haitians died. In the process, Dessalines became arguably the most successful military commander in the struggle against Napoleonic France. The independence of Saint-Domingue was proclaimed under the native name 'Haiti' by Jean-Jacques Dessalines on 1 January 1804 in Gonaïves and he was proclaimed "Emperor for Life" as Emperor Jacques I by his troops. Dessalines at first offered protection to the white planters and others. However, once in power, he ordered the genocide of nearly all the remaining white men, women, children; between January and April 1804, 3,000 to 5,000 whites were killed, including those who had been friendly and sympathetic to the black population. Only three categories of white people were selected out as exceptions and spared: Polish soldiers, the majority of whom had deserted from the French army and fought alongside the Haitian rebels; the small group of German colonists invited to the north-west region ; and a group of medical doctors and professionals. Reportedly, people with connections to officers in the Haitian army were also spared, as well as the women who agreed to marry non-white men. Fearful of the potential impact the slave rebellion could have in the slave states , U.S. President Thomas Jefferson refused to recognize the new republic. The Southern politicians who were a powerful voting bloc in the American Congress prevented U.S. recognition for decades until they withdrew in 1861 to form the Confederacy . The revolution led to a wave of emigration. In 1809, 9,000 refugees from Saint-Domingue, both white planters and people of color, settled en masse in New Orleans , doubling the city's population, having been expelled from their initial refuge in Cuba by Spanish authorities. In addition, the newly arrived enslaved persons added to the city's African population. The plantation system was re-established in Haiti, albeit for wages; however, many Haitians were marginalized and resented the heavy-handed manner in which this was enforced in the new nation's politics. The rebel movement splintered, and Dessalines was assassinated by rivals on 17 October 1806. [ Link to precise page ] After Dessalines' death Haiti became split into two, with the Kingdom of Haiti in the north directed by Henri Christophe, later declaring himself Henri I , and a republic in the south centered on Port-au-Prince, directed by Alexandre Pétion , an homme de couleur . Christophe established a semi-feudal corvée system, with a rigid education and economic code. Pétion's republic was less absolutist, and he initiated a series of land reforms which benefited the peasant class. President Pétion also gave military and financial assistance to the revolutionary leader Simón Bolívar , which were critical in enabling him to liberate the Viceroyalty of New Granada . Meanwhile, the French, who had managed to maintain a precarious control of eastern Hispaniola, were defeated by insurgents led by Juan Sánchez Ramírez , with the area returning to Spanish rule in 1809 following the Battle of Palo Hincado . Beginning in 1821, President Jean-Pierre Boyer , also an homme de couleur and successor to Pétion, reunified the island following the suicide of Henry Christophe. After Santo Domingo declared its independence from Spain on 30 November 1821, Boyer invaded, seeking to unite the entire island by force and ending slavery in Santo Domingo. Struggling to revive the agricultural economy to produce commodity crops , Boyer passed the Code Rural, which denied peasant laborers the right to leave the land, enter the towns, or start farms or shops of their own, causing much resentment as most peasants wished to have their own farms rather than work on plantations. Starting in September 1824, more than 6,000 African Americans migrated to Haiti, with transportation paid by an American philanthropic group similar in function to the American Colonization Society and its efforts in Liberia . Many found the conditions too harsh and returned to the United States. In July 1825, King Charles X of France , during a period of restoration of the French monarchy , sent a fleet to reconquer Haiti. Under pressure, President Boyer agreed to a treaty by which France formally recognized the independence of the nation in exchange for a payment of 150 million francs . By an order of 17 April 1826, the King of France renounced his rights of sovereignty and formally recognized the independence of Haiti. The enforced payments to France hampered Haiti's economic growth for years, exacerbated by the fact that many Western nations continued to refuse formal diplomatic recognition to Haiti; Britain recognized Haitian independence in 1833, and the United States not until 1862. Haiti borrowed heavily from Western banks at extremely high interest rates to repay the debt. Although the amount of the reparations was reduced to 90 million in 1838, by 1900 80% of Haiti's government spending was debt repayment and the country did not finish repaying it until 1947. After losing the support of Haiti's elite, Boyer was ousted in 1843, with Charles Rivière-Hérard replacing him as president. Nationalist Dominican forces in eastern Hispaniola led by Juan Pablo Duarte seized control of Santo Domingo on 27 February 1844. The Haitian forces, unprepared for a significant uprising, capitulated to the rebels, effectively ending Haitian rule of eastern Hispaniola. In March Rivière-Hérard attempted to reimpose his authority, but the Dominicans inflicted heavy losses. Rivière-Hérard was removed from office by the mulatto hierarchy and replaced with the aged general Philippe Guerrier , who assumed the presidency on 3 May 1844. Guerrier died in April 1845, and was succeeded by General Jean-Louis Pierrot . Pierrot's most pressing duty as the new president was to check the incursions of the Dominicans, who were harassing the Haitian troops. Dominican gunboats were also making depredations on Haiti's coasts. President Pierrot decided to open a campaign against the Dominicans, whom he considered merely as insurgents; however, the Haitian offensive of 1845 was stopped on the frontier. On 1 January 1846 Pierrot announced a fresh campaign to reimpose Haitian suzerainty over eastern Hispaniola, but his officers and men greeted this fresh summons with contempt. Thus, a month later – February 1846 – when Pierrot ordered his troops to march against the Dominicans, the Haitian army mutinied, and its soldiers proclaimed his overthrow as president of the republic. With the war against the Dominicans having become very unpopular in Haiti, it was beyond the power of the new president, General Jean-Baptiste Riché , to stage another invasion. On 27 February 1847, President Riché died after only a year in power and was replaced by an obscure officer, General Faustin Soulouque . During the first two years of Soulouque's administration the conspiracies and opposition he faced in retaining power were so manifold that the Dominicans were given a further breathing space in which to consolidate their independence. But, when in 1848 France finally recognized the Dominican Republic as a free and independent state and provisionally signed a treaty of peace, friendship, commerce and navigation, Haiti immediately protested, claiming the treaty was an attack upon their own security. Soulouque decided to invade the new Republic before the French Government could ratify the treaty. On 21 March 1849, Haitian soldiers attacked the Dominican garrison at Las Matas . The demoralized defenders offered almost no resistance before abandoning their weapons. Soulouque pressed on, capturing San Juan . This left only the town of Azua as the remaining Dominican stronghold between the Haitian army and the capital. On 6 April, Azua fell to the 18,000-strong Haitian army, with a 5,000-man Dominican counterattack failing to oust them. The way to Santo Domingo was now clear. But the news of discontent existing at Port-au-Prince, which reached Soulouque, arrested his further progress and caused him to return with the army to his capital. Emboldened by the sudden retreat of the Haitian army, the Dominicans counter-attacked. Their flotilla went as far as Dame-Marie on the west coast of Haiti, which they plundered and set on fire. After another Haitian campaign in 1855, Britain and France intervened and obtained an armistice on behalf of the Dominicans, who declared independence as the Dominican Republic. The sufferings endured by the soldiers during the campaign of 1855, and the losses and sacrifices inflicted on the country without yielding any compensation or any practical results provoked great discontent. In 1858 a revolution began, led by General Fabre Geffrard , Duke of Tabara. In December of that year, Geffrard defeated the Imperial Army and seized control of most of the country. As a result, the Emperor abdicated his throne on 15 January 1859. Faustin was taken into exile and General Geffrard succeeded him as president. The period following Soulouque's overthrow down to the turn of the century was a turbulent one for Haiti, with repeated bouts of political instability. President Geffrard was overthrown in a coup in 1867, as was his successor, Sylvain Salnave , in 1869. Under the Presidency of Michel Domingue (1874–76) relations with the Dominican Republic were dramatically improved by the signing of a treaty, in which both parties acknowledged the independence of the other. Some modernisation of the economy and infrastructure also occurred in this period, especially under the Presidencies of Lysius Salomon (1879–1888) and Florvil Hyppolite (1889–1896). Haiti's relations with outside powers were often strained. In 1889 the United States attempted to force Haiti to permit the building of a naval base at Môle Saint-Nicolas , which was firmly resisted by President Hyppolite. In 1892 the German government supported suppression of the reform movement of Anténor Firmin , and in 1897, the Germans used gunboat diplomacy to intimidate and then humiliate the Haitian government of President Tirésias Simon Sam (1896–1902) during the Lüders Affair . In the first decades of the 20th century, Haiti experienced great political instability and was heavily in debt to France, Germany and the United States. A series of short lived presidencies came and went: President Pierre Nord Alexis was forced from power in 1908, as was his successor François C. Antoine Simon in 1911; President Cincinnatus Leconte (1911–12) was killed in a (possibly deliberate) explosion at the National Palace; Michel Oreste (1913–14) was ousted in a coup, as was his successor Oreste Zamor in 1914. Germany increased its influence in Haiti in this period, with a small community of German settlers wielding disproportionate influence in Haiti's economy. The German influence prompted anxieties in the United States, who had also invested heavily in the country, and whose government defended their right to oppose foreign interference in the Americas under the Monroe Doctrine . In December 1914, the Americans removed $500,000 from the Haitian National Bank, but rather than seize it to help pay the debt, it was removed for safe-keeping in New York, thus giving the United States control of the bank and preventing other powers from doing so. This gave a stable financial base on which to build the economy, and so enable the debt to be repaid. In 1915, Haiti's new President Vilbrun Guillaume Sam sought to strengthen his tenuous rule by a mass execution of 167 political prisoners. Outrage at the killings led to riots, and Sam was captured and killed by a lynch mob. Fearing possible foreign intervention, or the emergence of a new government led by the anti-American Haitian politician Rosalvo Bobo , President Woodrow Wilson sent U.S. Marines into Haiti in July 1915. The USS Washington , under Rear Admiral Caperton , arrived in Port-au-Prince in an attempt to restore order and protect U.S. interests. Within days, the Marines had taken control of the capital city and its banks and customs house. The Marines declared martial law and severely censored the press. Within weeks, a new pro-U.S. Haitian president, Philippe Sudré Dartiguenave , was installed and a new constitution written that was favorable to the interests of the United States. The constitution (written by future US President Franklin D. Roosevelt ) included a clause that allowed, for the first time, foreign ownership of land in Haiti, which was bitterly opposed by the Haitian legislature and citizenry. The occupation improved some of Haiti's infrastructure and centralized power in Port-au-Prince. 1700 km of roads were made usable, 189 bridges were built, many irrigation canals were rehabilitated, hospitals, schools, and public buildings were constructed, and drinking water was brought to the main cities. [ citation needed ] Agricultural education was organized, with a central school of agriculture and 69 farms in the country. [ incomplete short citation ] However, many infrastructure projects were built using the corvée system that allowed the government/occupying forces to take people from their homes and farms, at gunpoint if necessary, to build roads, bridges etc. by force, a process that was deeply resented by ordinary Haitians. Sisal was also introduced to Haiti, and sugarcane and cotton became significant exports, boosting prosperity. Haitian traditionalists, based in rural areas, were highly resistant to U.S.-backed changes, while the urban elites, typically mixed-race, welcomed the growing economy, but wanted more political control. Together they helped secure an end to the occupation in 1934, under the Presidency of Sténio Vincent (1930–1941). The debts were still outstanding, though less due to increased prosperity, and the U.S. financial advisor-general receiver handled the budget until 1941. The U.S. Marines were instilled with a special brand of paternalism towards Haitians "expressed in the metaphor of a father's relationship with his children." Armed opposition to the US presence was led by the cacos under the command of Charlemagne Péralte ; his capture and execution in 1919 earned him the status of a national martyr. During Senate hearings in 1921, the commandant of the Marine Corps reported that, in the 20 months of active unrest, 2,250 Haitians had been killed. However, in a report to the Secretary of the Navy, he reported the death toll as being 3,250. Haitian historians have claimed the true number was much higher, but this is not supported by most historians outside Haiti. After US forces left in 1934, Dominican dictator Rafael Trujillo used anti-Haitian sentiment as a nationalist tool. In an event that became known as the Parsley Massacre , he ordered his army to kill Haitians living on the Dominican side of the border. Few bullets were used; instead, 20,000–30,000 Haitians were bludgeoned and bayoneted, then herded into the sea, where sharks finished what Trujillo had begun. The indiscriminate massacre occurred over a period of five days. President Vincent became increasingly dictatorial, and resigned under US pressure in 1941, being replaced by Élie Lescot (1941–46). In 1941, during the Second World War , Lescot declared war on Japan (8 December), Germany (12 December), Italy (12 December), Bulgaria (24 December), Hungary (24 December) and Romania (24 December). Out of these six Axis countries, only Romania reciprocated, declaring war on Haiti on the same day (24 December 1941). On 27 September 1945, Haiti became a founding member of the United Nations (the successor to the League of Nations , of which Haiti was also a founding member). In 1946 Lescot was overthrown by the military, with Dumarsais Estimé later becoming the new president (1946–50). He sought to improve the economy and education, and to boost the role of black Haitians; however, as he sought to consolidate his rule he too was overthrown in a coup led by Paul Magloire , who replaced him as president (1950–56). Firmly anti-Communist, he was supported by the United States; with greater political stability tourists started to visit Haiti. The waterfront area of Port-au-Prince was redeveloped to allow cruise ship passengers to walk to cultural attractions. In 1956–57 Haiti underwent severe political turmoil; Magloire was forced to resign and leave the country in 1956 and he was followed by four short-lived presidencies. In the September 1957 election François Duvalier was elected President of Haiti. Known as 'Papa Doc' and initially popular, Duvalier remained President until his death in 1971. He advanced black interests in the public sector, where over time, people of color had predominated as the educated urban elite. Not trusting the army, despite his frequent purges of officers deemed disloyal, Duvalier created a private militia known as Tontons Macoutes ("Bogeymen"), which maintained order by terrorizing the populace and political opponents. In 1964 Duvalier proclaimed himself 'President for Life'; an uprising against his rule that year in Jérémie was violently suppressed, with the ringleaders publicly executed and hundreds of mixed-raced citizens in the town killed. The bulk of the educated and professional class began leaving the country, and corruption became widespread. Duvalier sought to create a personality cult, identifying himself with Baron Samedi , one of the loa (or lwa ), or spirits, of Haitian Vodou . Despite the well-publicized abuses under his rule, Duvalier's firm anti-Communism earned him the support of the Americans, who furnished the country with aid. In 1971 Duvalier died, and he was succeeded by his son Jean-Claude Duvalier , nicknamed 'Baby Doc', who ruled until 1986. He largely continued his father's policies, though curbed some of the worst excesses in order to court international respectability. Tourism, which had nosedived in Papa Doc's time, again became a growing industry. However, as the economy continued to decline, Baby Doc's grip on power began to weaken. Haiti's pig population was slaughtered following an outbreak of swine fever in the late 1970s, causing hardship to rural communities who used them as an investment. The opposition became more vocal, bolstered by a visit to the country by Pope John Paul II in 1983, who publicly lambasted the president. Demonstrations occurred in Gonaïves in 1985 which then spread across the country; under pressure from the United States, Duvalier left the country for France in February 1986. In total, roughly 40,000 to 60,000 Haitians are estimated to have been killed during the reign of the Duvaliers. Through the use of his intimidation tactics and executions, many intellectual Haitians had fled, leaving the country with a massive brain-drain from which it has yet to recover. Following Duvalier's departure, army leader General Henri Namphy headed a new National Governing Council . Elections scheduled for November 1987 were aborted after dozens of inhabitants were shot in the capital by soldiers and Tontons Macoutes . Fraudulent elections followed in 1988, in which only 4% of the citizenry voted. The newly elected president, Leslie Manigat , was then overthrown some months later in the June 1988 Haitian coup d'état . Another coup followed in September 1988, after the St. Jean Bosco massacre in which approximately 13 to 50 people attending a mass led by prominent government critic and Catholic priest Jean-Bertrand Aristide were killed. General Prosper Avril subsequently led a military regime until March 1990. Avril transferred power to the army chief of staff, Gen. Hérard Abraham , on March 10, 1990. Abraham gave up power three days later, becoming the only military leader in Haiti during the twentieth century to voluntarily give up power. Abraham later helped to secure the 1990–91 Haitian general election . In December 1990, Jean-Bertrand Aristide was elected president in the Haitian general election . However, his ambitious reformist agenda worried the elites, and in September of the following year he was overthrown by the military, led by Raoul Cédras , in the 1991 Haitian coup d'état . Amidst the continuing turmoil many Haitians attempted to flee the country. In September 1994, the United States negotiated the departure of Haiti's military leaders and the peaceful entry of 20,000 US troops under Operation Uphold Democracy . This enabled the restoration of the democratically elected Jean-Bertrand Aristide as president, who returned to Haiti in October to complete his term. As part of the deal Aristide had to implement free market reforms in an attempt to improve the Haitian economy, with mixed results. In November 1994, Hurricane Gordon brushed Haiti, dumping heavy rain and creating flash flooding that triggered mudslides. Gordon killed an estimated 1,122 people, although some estimates go as high as 2,200. Elections were held in 1995 which were won by René Préval , gaining 88% of the popular vote, albeit on a low turnout. Aristide subsequently formed his own party, Fanmi Lavalas , and political deadlock ensued; the November 2000 election returned Aristide to the presidency with 92% of the vote. The election had been boycotted by the opposition, then organized into the Convergence Démocratique , over a dispute in the May legislative elections . In subsequent years, there was increasing violence between rival political factions and human rights abuses . Aristide spent years negotiating with the Convergence Démocratique on new elections, but the Convergence's inability to develop a sufficient electoral base made elections unattractive. [ citation needed ] In 2004 an anti-Aristide revolt began in northern Haiti. The rebellion eventually reached the capital, and Aristide was forced into exile. The precise nature of the events are disputed; some, including Aristide and his bodyguard, Franz Gabriel, stated that he was the victim of a "new coup d'état or modern kidnapping" by U.S. forces. These charges were denied by the US government. As political violence and crime continued to grow, a United Nations Stabilisation Mission (MINUSTAH) was brought in to maintain order. However, MINUSTAH proved controversial, since their periodically heavy-handed approach to maintaining law and order and several instances of abuses, including the alleged sexual abuse of civilians, provoked resentment and distrust among ordinary Haitians. Boniface Alexandre assumed interim authority until 2006, when René Préval was re-elected President following elections . Amidst the continuing political chaos, a series of natural disasters hit Haiti. In 2004 Tropical Storm Jeanne skimmed the north coast, leaving 3,006 people dead in flooding and mudslides , mostly in the city of Gonaïves . In 2008 Haiti was again struck by tropical storms; Tropical Storm Fay , Hurricane Gustav , Hurricane Hanna and Hurricane Ike all produced heavy winds and rain, resulting in 331 deaths and about 800,000 in need of humanitarian aid. The state of affairs produced by these storms was intensified by already high food and fuel prices that had caused a food crisis and political unrest in April 2008. On 12 January 2010, at 4:53 pm local time, Haiti was struck by a magnitude -7.0 earthquake . This was the country's most severe earthquake in over 200 years. The earthquake was reported to have left between 160,000 and 300,000 people dead and up to 1.6 million homeless, making it one of the deadliest natural disasters ever recorded . It is also one of the deadliest earthquakes ever recorded. The situation was exacerbated by a subsequent massive cholera outbreak that was triggered when cholera-infected waste from a United Nations peacekeeping station contaminated the country's main river, the Artibonite . In 2017, it was reported that roughly 10,000 Haitians had died and nearly a million had been made ill. After years of denial, the United Nations apologized in 2016, but as of 2017 [ update ] , they have refused to acknowledge fault, thus avoiding financial responsibility. General elections had been planned for January 2010 but were postponed due to the earthquake. Elections were held on 28 November 2010 for the senate, the parliament and the first round of the presidential elections. The run-off between Michel Martelly and Mirlande Manigat took place on 20 March 2011, and preliminary results, released on 4 April, named Michel Martelly the winner. In 2011 both former dictator Jean-Claude Duvalier and Jean-Bertrand Aristide returned to Haiti; attempts to try Duvalier for crimes committed under his rule were shelved following his death in 2014. In 2013, Haiti called for European nations to pay reparations for slavery and establish an official commission for the settlement of past wrongdoings. Meanwhile, after continuing political wrangling with the opposition and allegations of electoral fraud, Martelly agreed to step down in 2016 without a successor in place. After numerous postponements, partly owing to the effects of devastating Hurricane Matthew , elections were held in November 2016. The victor, Jovenel Moïse of the Haitian Tèt Kale Party , was sworn in as president in 2017. Protests began on 7 July 2018, in response to increased fuel prices. Over time these protests evolved into demands for the resignation of president Moïse. On 7 July 2021, President Moïse was assassinated in an attack on his private residence, and First Lady Martine Moïse was hospitalized. Amid the political crisis, the government of Haiti installed Ariel Henry as both the Prime Minister and the President on 20 July 2021. On 14 August 2021, Haiti suffered another huge earthquake , with many casualties. The earthquake has also damaged Haiti's economic conditions and led to a rise in gang violence which by May 2020 had escalated to a long-lasting full-blown gang war and other violent crimes. As of March 2022, Haiti still had no president, no parliamentary quorum, and a dysfunctional high court due to a lack of judges. In 2022, protests against the government and rising fuel prices intensified. In 2023, kidnapping jumped 72% from the first quarter of the previous year. Doctors, lawyers, and other wealthy members of society were kidnapped and held for ransom. Many victims were killed when ransom demands were not met, leading those with the means to do so to flee the country, further hampering efforts to pull the country out of the crisis. It is estimated that amidst the crisis up to 20% of qualified medical staff had left Haiti by the end of 2023. In March 2024, Ariel Henry was prevented by gangs from returning to Haiti, following a visit to Kenya. Henry agreed to resign once a transitional government had been formed. As of that month, nearly half of Haiti's population was living under acute food insecurity , according to the World Food Programme . The island of Hispaniola , of which Haiti occupies the western three-eighths, has been inhabited since about 5000 BC by groups of Native Americans thought to have arrived from Central or South America. Genetic studies show that some of these groups were related to the Yanomami of the Amazon Basin . Amongst these early settlers were the Ciboney peoples, followed by the Taíno , speakers of an Arawakan language , elements of which have been preserved in Haitian Creole . The Taíno name for the entire island was Haiti , or alternatively Quisqeya . In Taíno society the largest unit of political organization was led by a cacique , or chief, as the Europeans understood them. The island of Hispaniola was divided among five 'caciquedoms': the Magua in the north east, the Marien in the north west, the Jaragua in the south west, the Maguana in the central regions of Cibao, and the Higüey in the south east. Taíno cultural artifacts include cave paintings in several locations in the country. These have become national symbols of Haiti and tourist attractions. Modern-day Léogâne , started as a French colonial town in the southwest, is beside the former capital of the caciquedom of Xaragua. Navigator Christopher Columbus landed in Haiti on 6 December 1492, in an area that he named Môle-Saint-Nicolas , and claimed the island for the Crown of Castile . Nineteen days later, his ship the Santa María ran aground near the present site of Cap-Haïtien . Columbus left 39 men on the island, who founded the settlement of La Navidad on 25 December 1492. Relations with the native peoples, initially good, broke down and the settlers were later killed by the Taíno. The sailors carried endemic Eurasian infectious diseases , causing epidemics that killed a large number of native people. The first recorded smallpox epidemic in the Americas erupted on Hispaniola in 1507. Their numbers were further reduced by the harshness of the encomienda system, in which the Spanish forced natives to work in gold mines and plantations. The Spanish passed the Laws of Burgos (1512–1513), which forbade the maltreatment of natives, endorsed their conversion to Catholicism, and gave legal framework to encomiendas . The natives were brought to these sites to work in specific plantations or industries. As the Spanish re-focused their colonization efforts on the greater riches of mainland Central and South America, Hispaniola became reduced largely to a trading and refueling post. As a result piracy became widespread, encouraged by European powers hostile to Spain such as France (based on Île de la Tortue ) and England. The Spanish largely abandoned the western third of the island, focusing their colonization effort on the eastern two-thirds. The western part of the island was thus gradually settled by French buccaneers ; among them was Bertrand d'Ogeron, who succeeded in growing tobacco and recruited many French colonial families from Martinique and Guadeloupe . In 1697 France and Spain settled their hostilities on the island by way of the Treaty of Ryswick of 1697, which divided Hispaniola between them. France received the western third and subsequently named it Saint-Domingue, the French equivalent of Santo Domingo , the Spanish colony on Hispaniola . The French set about creating sugar and coffee plantations, worked by vast numbers of those enslaved imported from Africa , and Saint-Domingue grew to become their richest colonial possession, generating 40% of France's foreign trade and doubling the wealth generation of all of England's colonies, combined. The French settlers were outnumbered by enslaved persons by almost 10 to 1. According to the 1788 Census, Haiti's population consisted of nearly 25,000 Europeans, 22,000 free coloreds and 700,000 Africans in slavery. In contrast, by 1763 the white population of French Canada , a far larger territory, had numbered only 65,000. In the north of the island, those enslaved were able to retain many ties to African cultures, religion and language; these ties were continually being renewed by newly imported Africans. Some West Africans in slavery held on to their traditional Vodou beliefs by secretly syncretizing it with Catholicism. The French enacted the Code Noir ("Black Code"), prepared by Jean-Baptiste Colbert and ratified by Louis XIV , which established rules on slave treatment and permissible freedoms. Saint-Domingue has been described as one of the most brutally efficient slave colonies; at the end of the eighteenth century it was supplying two-thirds of Europe's tropical produce while one-third of newly imported Africans died within a few years. Many enslaved persons died from diseases such as smallpox and typhoid fever . They had low birth rates , and there is evidence that some women aborted fetuses rather than give birth to children within the bonds of slavery . The colony's environment also suffered, as forests were cleared to make way for plantations and the land was overworked so as to extract maximum profit for French plantation owners. As in its Louisiana colony , the French colonial government allowed some rights to free people of color ( gens de couleur ), the mixed-race descendants of European male colonists and African enslaved females (and later, mixed-race women). Over time, many were released from slavery and they established a separate social class . White French Creole fathers frequently sent their mixed-race sons to France for their education. Some men of color were admitted into the military. More of the free people of color lived in the south of the island, near Port-au-Prince , and many intermarried within their community. They frequently worked as artisans and tradesmen, and began to own some property, including enslaved persons of their own. The free people of color petitioned the colonial government to expand their rights. The brutality of slave life led many people in bondage to escape to mountainous regions, where they set up their own autonomous communities and became known as maroons . One maroon leader, François Mackandal , led a rebellion in the 1750s; however, he was later captured and executed by the French. Inspired by the French Revolution of 1789 and principles of the rights of man , the French settlers and free people of color pressed for greater political freedom and more civil rights . Tensions between these two groups led to conflict, as a militia of free-coloreds was set up in 1790 by Vincent Ogé , resulting in his capture, torture and execution. Sensing an opportunity, in August 1791 the first slave armies were established in northern Haiti under the leadership of Toussaint Louverture inspired by the Vodou houngan (priest) Boukman, and backed by the Spanish in Santo Domingo – soon a full-blown slave rebellion had broken out across the entire colony. In 1792, the French government sent three commissioners with troops to re-establish control; to build an alliance with the gens de couleur and enslaved persons commissioners Léger-Félicité Sonthonax and Étienne Polverel abolished slavery in the colony. Six months later, the National Convention , led by Maximilien de Robespierre and the Jacobins , endorsed abolition and extended it to all the French colonies. The United States , which was a new republic itself, oscillated between supporting or not supporting Toussaint Louverture and the emerging country of Haiti, depending on who was President of the US. Washington, who was a slave holder and isolationist, kept the United States neutral, although private US citizens at times provided aid to French planters trying to put down the revolt. John Adams, a vocal opponent of slavery, fully supported the slave revolt by providing diplomatic recognition, financial support, munitions and warships (including the USS Constitution ) beginning in 1798. This support ended in 1801 when Jefferson, another slave-holding president, took office and recalled the US Navy. With slavery abolished, Toussaint Louverture pledged allegiance to France, and he fought off the British and Spanish forces who had taken advantage of the situation and invaded Saint-Domingue. The Spanish were later forced to cede their part of the island to France under the terms of the Peace of Basel in 1795, uniting the island under one government. However, an insurgency against French rule broke out in the east, and in the west there was fighting between Louverture's forces and the free people of color led by André Rigaud in the War of the Knives (1799–1800). The United States' support for the blacks in the war contributed to their victory over the mulattoes. More than 25,000 whites and free blacks left the island as refugees. After Louverture created a separatist constitution and proclaimed himself governor-general for life, Napoléon Bonaparte in 1802 sent an expedition of 20,000 soldiers and as many sailors under the command of his brother-in-law, Charles Leclerc , to reassert French control. The French achieved some victories, but within a few months most of their army had died from yellow fever . Ultimately more than 50,000 French troops died in an attempt to retake the colony, including 18 generals. The French managed to capture Louverture, transporting him to France for trial. He was imprisoned at Fort de Joux , where he died in 1803 of exposure and possibly tuberculosis . The enslaved persons, along with free gens de couleur and allies, continued their fight for independence, led by generals Jean-Jacques Dessalines , Alexandre Pétion and Henry Christophe . The rebels finally managed to decisively defeat the French troops at the Battle of Vertières on 18 November 1803, establishing the first nation ever to successfully gain independence through a slave revolt. Under the overall command of Dessalines, the Haitian armies avoided open battle, and instead conducted a successful guerrilla campaign against the Napoleonic forces, working with diseases such as yellow fever to reduce the numbers of French soldiers. Later that year France withdrew its remaining 7,000 troops from the island and Napoleon gave up his idea of re-establishing a North American empire, selling Louisiana (New France) to the United States , in the Louisiana Purchase . Throughout the revolution, an estimated 20,000 French troops succumbed to yellow fever, while another 37,000 were killed in action , exceeding the total French soldiers killed in action across various 19th-century colonial campaigns in Algeria, Mexico, Indochina, Tunisia, and West Africa, which resulted in approximately 10,000 French soldiers killed in action combined. The British sustained 100,000 casualties. Additionally, 350,000 ex-enslaved Haitians died. In the process, Dessalines became arguably the most successful military commander in the struggle against Napoleonic France. Navigator Christopher Columbus landed in Haiti on 6 December 1492, in an area that he named Môle-Saint-Nicolas , and claimed the island for the Crown of Castile . Nineteen days later, his ship the Santa María ran aground near the present site of Cap-Haïtien . Columbus left 39 men on the island, who founded the settlement of La Navidad on 25 December 1492. Relations with the native peoples, initially good, broke down and the settlers were later killed by the Taíno. The sailors carried endemic Eurasian infectious diseases , causing epidemics that killed a large number of native people. The first recorded smallpox epidemic in the Americas erupted on Hispaniola in 1507. Their numbers were further reduced by the harshness of the encomienda system, in which the Spanish forced natives to work in gold mines and plantations. The Spanish passed the Laws of Burgos (1512–1513), which forbade the maltreatment of natives, endorsed their conversion to Catholicism, and gave legal framework to encomiendas . The natives were brought to these sites to work in specific plantations or industries. As the Spanish re-focused their colonization efforts on the greater riches of mainland Central and South America, Hispaniola became reduced largely to a trading and refueling post. As a result piracy became widespread, encouraged by European powers hostile to Spain such as France (based on Île de la Tortue ) and England. The Spanish largely abandoned the western third of the island, focusing their colonization effort on the eastern two-thirds. The western part of the island was thus gradually settled by French buccaneers ; among them was Bertrand d'Ogeron, who succeeded in growing tobacco and recruited many French colonial families from Martinique and Guadeloupe . In 1697 France and Spain settled their hostilities on the island by way of the Treaty of Ryswick of 1697, which divided Hispaniola between them. France received the western third and subsequently named it Saint-Domingue, the French equivalent of Santo Domingo , the Spanish colony on Hispaniola . The French set about creating sugar and coffee plantations, worked by vast numbers of those enslaved imported from Africa , and Saint-Domingue grew to become their richest colonial possession, generating 40% of France's foreign trade and doubling the wealth generation of all of England's colonies, combined. The French settlers were outnumbered by enslaved persons by almost 10 to 1. According to the 1788 Census, Haiti's population consisted of nearly 25,000 Europeans, 22,000 free coloreds and 700,000 Africans in slavery. In contrast, by 1763 the white population of French Canada , a far larger territory, had numbered only 65,000. In the north of the island, those enslaved were able to retain many ties to African cultures, religion and language; these ties were continually being renewed by newly imported Africans. Some West Africans in slavery held on to their traditional Vodou beliefs by secretly syncretizing it with Catholicism. The French enacted the Code Noir ("Black Code"), prepared by Jean-Baptiste Colbert and ratified by Louis XIV , which established rules on slave treatment and permissible freedoms. Saint-Domingue has been described as one of the most brutally efficient slave colonies; at the end of the eighteenth century it was supplying two-thirds of Europe's tropical produce while one-third of newly imported Africans died within a few years. Many enslaved persons died from diseases such as smallpox and typhoid fever . They had low birth rates , and there is evidence that some women aborted fetuses rather than give birth to children within the bonds of slavery . The colony's environment also suffered, as forests were cleared to make way for plantations and the land was overworked so as to extract maximum profit for French plantation owners. As in its Louisiana colony , the French colonial government allowed some rights to free people of color ( gens de couleur ), the mixed-race descendants of European male colonists and African enslaved females (and later, mixed-race women). Over time, many were released from slavery and they established a separate social class . White French Creole fathers frequently sent their mixed-race sons to France for their education. Some men of color were admitted into the military. More of the free people of color lived in the south of the island, near Port-au-Prince , and many intermarried within their community. They frequently worked as artisans and tradesmen, and began to own some property, including enslaved persons of their own. The free people of color petitioned the colonial government to expand their rights. The brutality of slave life led many people in bondage to escape to mountainous regions, where they set up their own autonomous communities and became known as maroons . One maroon leader, François Mackandal , led a rebellion in the 1750s; however, he was later captured and executed by the French. Inspired by the French Revolution of 1789 and principles of the rights of man , the French settlers and free people of color pressed for greater political freedom and more civil rights . Tensions between these two groups led to conflict, as a militia of free-coloreds was set up in 1790 by Vincent Ogé , resulting in his capture, torture and execution. Sensing an opportunity, in August 1791 the first slave armies were established in northern Haiti under the leadership of Toussaint Louverture inspired by the Vodou houngan (priest) Boukman, and backed by the Spanish in Santo Domingo – soon a full-blown slave rebellion had broken out across the entire colony. In 1792, the French government sent three commissioners with troops to re-establish control; to build an alliance with the gens de couleur and enslaved persons commissioners Léger-Félicité Sonthonax and Étienne Polverel abolished slavery in the colony. Six months later, the National Convention , led by Maximilien de Robespierre and the Jacobins , endorsed abolition and extended it to all the French colonies. The United States , which was a new republic itself, oscillated between supporting or not supporting Toussaint Louverture and the emerging country of Haiti, depending on who was President of the US. Washington, who was a slave holder and isolationist, kept the United States neutral, although private US citizens at times provided aid to French planters trying to put down the revolt. John Adams, a vocal opponent of slavery, fully supported the slave revolt by providing diplomatic recognition, financial support, munitions and warships (including the USS Constitution ) beginning in 1798. This support ended in 1801 when Jefferson, another slave-holding president, took office and recalled the US Navy. With slavery abolished, Toussaint Louverture pledged allegiance to France, and he fought off the British and Spanish forces who had taken advantage of the situation and invaded Saint-Domingue. The Spanish were later forced to cede their part of the island to France under the terms of the Peace of Basel in 1795, uniting the island under one government. However, an insurgency against French rule broke out in the east, and in the west there was fighting between Louverture's forces and the free people of color led by André Rigaud in the War of the Knives (1799–1800). The United States' support for the blacks in the war contributed to their victory over the mulattoes. More than 25,000 whites and free blacks left the island as refugees. After Louverture created a separatist constitution and proclaimed himself governor-general for life, Napoléon Bonaparte in 1802 sent an expedition of 20,000 soldiers and as many sailors under the command of his brother-in-law, Charles Leclerc , to reassert French control. The French achieved some victories, but within a few months most of their army had died from yellow fever . Ultimately more than 50,000 French troops died in an attempt to retake the colony, including 18 generals. The French managed to capture Louverture, transporting him to France for trial. He was imprisoned at Fort de Joux , where he died in 1803 of exposure and possibly tuberculosis . The enslaved persons, along with free gens de couleur and allies, continued their fight for independence, led by generals Jean-Jacques Dessalines , Alexandre Pétion and Henry Christophe . The rebels finally managed to decisively defeat the French troops at the Battle of Vertières on 18 November 1803, establishing the first nation ever to successfully gain independence through a slave revolt. Under the overall command of Dessalines, the Haitian armies avoided open battle, and instead conducted a successful guerrilla campaign against the Napoleonic forces, working with diseases such as yellow fever to reduce the numbers of French soldiers. Later that year France withdrew its remaining 7,000 troops from the island and Napoleon gave up his idea of re-establishing a North American empire, selling Louisiana (New France) to the United States , in the Louisiana Purchase . Throughout the revolution, an estimated 20,000 French troops succumbed to yellow fever, while another 37,000 were killed in action , exceeding the total French soldiers killed in action across various 19th-century colonial campaigns in Algeria, Mexico, Indochina, Tunisia, and West Africa, which resulted in approximately 10,000 French soldiers killed in action combined. The British sustained 100,000 casualties. Additionally, 350,000 ex-enslaved Haitians died. In the process, Dessalines became arguably the most successful military commander in the struggle against Napoleonic France. The independence of Saint-Domingue was proclaimed under the native name 'Haiti' by Jean-Jacques Dessalines on 1 January 1804 in Gonaïves and he was proclaimed "Emperor for Life" as Emperor Jacques I by his troops. Dessalines at first offered protection to the white planters and others. However, once in power, he ordered the genocide of nearly all the remaining white men, women, children; between January and April 1804, 3,000 to 5,000 whites were killed, including those who had been friendly and sympathetic to the black population. Only three categories of white people were selected out as exceptions and spared: Polish soldiers, the majority of whom had deserted from the French army and fought alongside the Haitian rebels; the small group of German colonists invited to the north-west region ; and a group of medical doctors and professionals. Reportedly, people with connections to officers in the Haitian army were also spared, as well as the women who agreed to marry non-white men. Fearful of the potential impact the slave rebellion could have in the slave states , U.S. President Thomas Jefferson refused to recognize the new republic. The Southern politicians who were a powerful voting bloc in the American Congress prevented U.S. recognition for decades until they withdrew in 1861 to form the Confederacy . The revolution led to a wave of emigration. In 1809, 9,000 refugees from Saint-Domingue, both white planters and people of color, settled en masse in New Orleans , doubling the city's population, having been expelled from their initial refuge in Cuba by Spanish authorities. In addition, the newly arrived enslaved persons added to the city's African population. The plantation system was re-established in Haiti, albeit for wages; however, many Haitians were marginalized and resented the heavy-handed manner in which this was enforced in the new nation's politics. The rebel movement splintered, and Dessalines was assassinated by rivals on 17 October 1806. [ Link to precise page ] After Dessalines' death Haiti became split into two, with the Kingdom of Haiti in the north directed by Henri Christophe, later declaring himself Henri I , and a republic in the south centered on Port-au-Prince, directed by Alexandre Pétion , an homme de couleur . Christophe established a semi-feudal corvée system, with a rigid education and economic code. Pétion's republic was less absolutist, and he initiated a series of land reforms which benefited the peasant class. President Pétion also gave military and financial assistance to the revolutionary leader Simón Bolívar , which were critical in enabling him to liberate the Viceroyalty of New Granada . Meanwhile, the French, who had managed to maintain a precarious control of eastern Hispaniola, were defeated by insurgents led by Juan Sánchez Ramírez , with the area returning to Spanish rule in 1809 following the Battle of Palo Hincado . Beginning in 1821, President Jean-Pierre Boyer , also an homme de couleur and successor to Pétion, reunified the island following the suicide of Henry Christophe. After Santo Domingo declared its independence from Spain on 30 November 1821, Boyer invaded, seeking to unite the entire island by force and ending slavery in Santo Domingo. Struggling to revive the agricultural economy to produce commodity crops , Boyer passed the Code Rural, which denied peasant laborers the right to leave the land, enter the towns, or start farms or shops of their own, causing much resentment as most peasants wished to have their own farms rather than work on plantations. Starting in September 1824, more than 6,000 African Americans migrated to Haiti, with transportation paid by an American philanthropic group similar in function to the American Colonization Society and its efforts in Liberia . Many found the conditions too harsh and returned to the United States. In July 1825, King Charles X of France , during a period of restoration of the French monarchy , sent a fleet to reconquer Haiti. Under pressure, President Boyer agreed to a treaty by which France formally recognized the independence of the nation in exchange for a payment of 150 million francs . By an order of 17 April 1826, the King of France renounced his rights of sovereignty and formally recognized the independence of Haiti. The enforced payments to France hampered Haiti's economic growth for years, exacerbated by the fact that many Western nations continued to refuse formal diplomatic recognition to Haiti; Britain recognized Haitian independence in 1833, and the United States not until 1862. Haiti borrowed heavily from Western banks at extremely high interest rates to repay the debt. Although the amount of the reparations was reduced to 90 million in 1838, by 1900 80% of Haiti's government spending was debt repayment and the country did not finish repaying it until 1947. After losing the support of Haiti's elite, Boyer was ousted in 1843, with Charles Rivière-Hérard replacing him as president. Nationalist Dominican forces in eastern Hispaniola led by Juan Pablo Duarte seized control of Santo Domingo on 27 February 1844. The Haitian forces, unprepared for a significant uprising, capitulated to the rebels, effectively ending Haitian rule of eastern Hispaniola. In March Rivière-Hérard attempted to reimpose his authority, but the Dominicans inflicted heavy losses. Rivière-Hérard was removed from office by the mulatto hierarchy and replaced with the aged general Philippe Guerrier , who assumed the presidency on 3 May 1844. Guerrier died in April 1845, and was succeeded by General Jean-Louis Pierrot . Pierrot's most pressing duty as the new president was to check the incursions of the Dominicans, who were harassing the Haitian troops. Dominican gunboats were also making depredations on Haiti's coasts. President Pierrot decided to open a campaign against the Dominicans, whom he considered merely as insurgents; however, the Haitian offensive of 1845 was stopped on the frontier. On 1 January 1846 Pierrot announced a fresh campaign to reimpose Haitian suzerainty over eastern Hispaniola, but his officers and men greeted this fresh summons with contempt. Thus, a month later – February 1846 – when Pierrot ordered his troops to march against the Dominicans, the Haitian army mutinied, and its soldiers proclaimed his overthrow as president of the republic. With the war against the Dominicans having become very unpopular in Haiti, it was beyond the power of the new president, General Jean-Baptiste Riché , to stage another invasion. On 27 February 1847, President Riché died after only a year in power and was replaced by an obscure officer, General Faustin Soulouque . During the first two years of Soulouque's administration the conspiracies and opposition he faced in retaining power were so manifold that the Dominicans were given a further breathing space in which to consolidate their independence. But, when in 1848 France finally recognized the Dominican Republic as a free and independent state and provisionally signed a treaty of peace, friendship, commerce and navigation, Haiti immediately protested, claiming the treaty was an attack upon their own security. Soulouque decided to invade the new Republic before the French Government could ratify the treaty. On 21 March 1849, Haitian soldiers attacked the Dominican garrison at Las Matas . The demoralized defenders offered almost no resistance before abandoning their weapons. Soulouque pressed on, capturing San Juan . This left only the town of Azua as the remaining Dominican stronghold between the Haitian army and the capital. On 6 April, Azua fell to the 18,000-strong Haitian army, with a 5,000-man Dominican counterattack failing to oust them. The way to Santo Domingo was now clear. But the news of discontent existing at Port-au-Prince, which reached Soulouque, arrested his further progress and caused him to return with the army to his capital. Emboldened by the sudden retreat of the Haitian army, the Dominicans counter-attacked. Their flotilla went as far as Dame-Marie on the west coast of Haiti, which they plundered and set on fire. After another Haitian campaign in 1855, Britain and France intervened and obtained an armistice on behalf of the Dominicans, who declared independence as the Dominican Republic. The sufferings endured by the soldiers during the campaign of 1855, and the losses and sacrifices inflicted on the country without yielding any compensation or any practical results provoked great discontent. In 1858 a revolution began, led by General Fabre Geffrard , Duke of Tabara. In December of that year, Geffrard defeated the Imperial Army and seized control of most of the country. As a result, the Emperor abdicated his throne on 15 January 1859. Faustin was taken into exile and General Geffrard succeeded him as president. The period following Soulouque's overthrow down to the turn of the century was a turbulent one for Haiti, with repeated bouts of political instability. President Geffrard was overthrown in a coup in 1867, as was his successor, Sylvain Salnave , in 1869. Under the Presidency of Michel Domingue (1874–76) relations with the Dominican Republic were dramatically improved by the signing of a treaty, in which both parties acknowledged the independence of the other. Some modernisation of the economy and infrastructure also occurred in this period, especially under the Presidencies of Lysius Salomon (1879–1888) and Florvil Hyppolite (1889–1896). Haiti's relations with outside powers were often strained. In 1889 the United States attempted to force Haiti to permit the building of a naval base at Môle Saint-Nicolas , which was firmly resisted by President Hyppolite. In 1892 the German government supported suppression of the reform movement of Anténor Firmin , and in 1897, the Germans used gunboat diplomacy to intimidate and then humiliate the Haitian government of President Tirésias Simon Sam (1896–1902) during the Lüders Affair . In the first decades of the 20th century, Haiti experienced great political instability and was heavily in debt to France, Germany and the United States. A series of short lived presidencies came and went: President Pierre Nord Alexis was forced from power in 1908, as was his successor François C. Antoine Simon in 1911; President Cincinnatus Leconte (1911–12) was killed in a (possibly deliberate) explosion at the National Palace; Michel Oreste (1913–14) was ousted in a coup, as was his successor Oreste Zamor in 1914. Germany increased its influence in Haiti in this period, with a small community of German settlers wielding disproportionate influence in Haiti's economy. The German influence prompted anxieties in the United States, who had also invested heavily in the country, and whose government defended their right to oppose foreign interference in the Americas under the Monroe Doctrine . In December 1914, the Americans removed $500,000 from the Haitian National Bank, but rather than seize it to help pay the debt, it was removed for safe-keeping in New York, thus giving the United States control of the bank and preventing other powers from doing so. This gave a stable financial base on which to build the economy, and so enable the debt to be repaid. In 1915, Haiti's new President Vilbrun Guillaume Sam sought to strengthen his tenuous rule by a mass execution of 167 political prisoners. Outrage at the killings led to riots, and Sam was captured and killed by a lynch mob. Fearing possible foreign intervention, or the emergence of a new government led by the anti-American Haitian politician Rosalvo Bobo , President Woodrow Wilson sent U.S. Marines into Haiti in July 1915. The USS Washington , under Rear Admiral Caperton , arrived in Port-au-Prince in an attempt to restore order and protect U.S. interests. Within days, the Marines had taken control of the capital city and its banks and customs house. The Marines declared martial law and severely censored the press. Within weeks, a new pro-U.S. Haitian president, Philippe Sudré Dartiguenave , was installed and a new constitution written that was favorable to the interests of the United States. The constitution (written by future US President Franklin D. Roosevelt ) included a clause that allowed, for the first time, foreign ownership of land in Haiti, which was bitterly opposed by the Haitian legislature and citizenry. The occupation improved some of Haiti's infrastructure and centralized power in Port-au-Prince. 1700 km of roads were made usable, 189 bridges were built, many irrigation canals were rehabilitated, hospitals, schools, and public buildings were constructed, and drinking water was brought to the main cities. [ citation needed ] Agricultural education was organized, with a central school of agriculture and 69 farms in the country. [ incomplete short citation ] However, many infrastructure projects were built using the corvée system that allowed the government/occupying forces to take people from their homes and farms, at gunpoint if necessary, to build roads, bridges etc. by force, a process that was deeply resented by ordinary Haitians. Sisal was also introduced to Haiti, and sugarcane and cotton became significant exports, boosting prosperity. Haitian traditionalists, based in rural areas, were highly resistant to U.S.-backed changes, while the urban elites, typically mixed-race, welcomed the growing economy, but wanted more political control. Together they helped secure an end to the occupation in 1934, under the Presidency of Sténio Vincent (1930–1941). The debts were still outstanding, though less due to increased prosperity, and the U.S. financial advisor-general receiver handled the budget until 1941. The U.S. Marines were instilled with a special brand of paternalism towards Haitians "expressed in the metaphor of a father's relationship with his children." Armed opposition to the US presence was led by the cacos under the command of Charlemagne Péralte ; his capture and execution in 1919 earned him the status of a national martyr. During Senate hearings in 1921, the commandant of the Marine Corps reported that, in the 20 months of active unrest, 2,250 Haitians had been killed. However, in a report to the Secretary of the Navy, he reported the death toll as being 3,250. Haitian historians have claimed the true number was much higher, but this is not supported by most historians outside Haiti. After US forces left in 1934, Dominican dictator Rafael Trujillo used anti-Haitian sentiment as a nationalist tool. In an event that became known as the Parsley Massacre , he ordered his army to kill Haitians living on the Dominican side of the border. Few bullets were used; instead, 20,000–30,000 Haitians were bludgeoned and bayoneted, then herded into the sea, where sharks finished what Trujillo had begun. The indiscriminate massacre occurred over a period of five days. President Vincent became increasingly dictatorial, and resigned under US pressure in 1941, being replaced by Élie Lescot (1941–46). In 1941, during the Second World War , Lescot declared war on Japan (8 December), Germany (12 December), Italy (12 December), Bulgaria (24 December), Hungary (24 December) and Romania (24 December). Out of these six Axis countries, only Romania reciprocated, declaring war on Haiti on the same day (24 December 1941). On 27 September 1945, Haiti became a founding member of the United Nations (the successor to the League of Nations , of which Haiti was also a founding member). In 1946 Lescot was overthrown by the military, with Dumarsais Estimé later becoming the new president (1946–50). He sought to improve the economy and education, and to boost the role of black Haitians; however, as he sought to consolidate his rule he too was overthrown in a coup led by Paul Magloire , who replaced him as president (1950–56). Firmly anti-Communist, he was supported by the United States; with greater political stability tourists started to visit Haiti. The waterfront area of Port-au-Prince was redeveloped to allow cruise ship passengers to walk to cultural attractions. In 1956–57 Haiti underwent severe political turmoil; Magloire was forced to resign and leave the country in 1956 and he was followed by four short-lived presidencies. In the September 1957 election François Duvalier was elected President of Haiti. Known as 'Papa Doc' and initially popular, Duvalier remained President until his death in 1971. He advanced black interests in the public sector, where over time, people of color had predominated as the educated urban elite. Not trusting the army, despite his frequent purges of officers deemed disloyal, Duvalier created a private militia known as Tontons Macoutes ("Bogeymen"), which maintained order by terrorizing the populace and political opponents. In 1964 Duvalier proclaimed himself 'President for Life'; an uprising against his rule that year in Jérémie was violently suppressed, with the ringleaders publicly executed and hundreds of mixed-raced citizens in the town killed. The bulk of the educated and professional class began leaving the country, and corruption became widespread. Duvalier sought to create a personality cult, identifying himself with Baron Samedi , one of the loa (or lwa ), or spirits, of Haitian Vodou . Despite the well-publicized abuses under his rule, Duvalier's firm anti-Communism earned him the support of the Americans, who furnished the country with aid. In 1971 Duvalier died, and he was succeeded by his son Jean-Claude Duvalier , nicknamed 'Baby Doc', who ruled until 1986. He largely continued his father's policies, though curbed some of the worst excesses in order to court international respectability. Tourism, which had nosedived in Papa Doc's time, again became a growing industry. However, as the economy continued to decline, Baby Doc's grip on power began to weaken. Haiti's pig population was slaughtered following an outbreak of swine fever in the late 1970s, causing hardship to rural communities who used them as an investment. The opposition became more vocal, bolstered by a visit to the country by Pope John Paul II in 1983, who publicly lambasted the president. Demonstrations occurred in Gonaïves in 1985 which then spread across the country; under pressure from the United States, Duvalier left the country for France in February 1986. In total, roughly 40,000 to 60,000 Haitians are estimated to have been killed during the reign of the Duvaliers. Through the use of his intimidation tactics and executions, many intellectual Haitians had fled, leaving the country with a massive brain-drain from which it has yet to recover. Following Duvalier's departure, army leader General Henri Namphy headed a new National Governing Council . Elections scheduled for November 1987 were aborted after dozens of inhabitants were shot in the capital by soldiers and Tontons Macoutes . Fraudulent elections followed in 1988, in which only 4% of the citizenry voted. The newly elected president, Leslie Manigat , was then overthrown some months later in the June 1988 Haitian coup d'état . Another coup followed in September 1988, after the St. Jean Bosco massacre in which approximately 13 to 50 people attending a mass led by prominent government critic and Catholic priest Jean-Bertrand Aristide were killed. General Prosper Avril subsequently led a military regime until March 1990. Avril transferred power to the army chief of staff, Gen. Hérard Abraham , on March 10, 1990. Abraham gave up power three days later, becoming the only military leader in Haiti during the twentieth century to voluntarily give up power. Abraham later helped to secure the 1990–91 Haitian general election . In December 1990, Jean-Bertrand Aristide was elected president in the Haitian general election . However, his ambitious reformist agenda worried the elites, and in September of the following year he was overthrown by the military, led by Raoul Cédras , in the 1991 Haitian coup d'état . Amidst the continuing turmoil many Haitians attempted to flee the country. In September 1994, the United States negotiated the departure of Haiti's military leaders and the peaceful entry of 20,000 US troops under Operation Uphold Democracy . This enabled the restoration of the democratically elected Jean-Bertrand Aristide as president, who returned to Haiti in October to complete his term. As part of the deal Aristide had to implement free market reforms in an attempt to improve the Haitian economy, with mixed results. In November 1994, Hurricane Gordon brushed Haiti, dumping heavy rain and creating flash flooding that triggered mudslides. Gordon killed an estimated 1,122 people, although some estimates go as high as 2,200. Elections were held in 1995 which were won by René Préval , gaining 88% of the popular vote, albeit on a low turnout. Aristide subsequently formed his own party, Fanmi Lavalas , and political deadlock ensued; the November 2000 election returned Aristide to the presidency with 92% of the vote. The election had been boycotted by the opposition, then organized into the Convergence Démocratique , over a dispute in the May legislative elections . In subsequent years, there was increasing violence between rival political factions and human rights abuses . Aristide spent years negotiating with the Convergence Démocratique on new elections, but the Convergence's inability to develop a sufficient electoral base made elections unattractive. [ citation needed ] In 2004 an anti-Aristide revolt began in northern Haiti. The rebellion eventually reached the capital, and Aristide was forced into exile. The precise nature of the events are disputed; some, including Aristide and his bodyguard, Franz Gabriel, stated that he was the victim of a "new coup d'état or modern kidnapping" by U.S. forces. These charges were denied by the US government. As political violence and crime continued to grow, a United Nations Stabilisation Mission (MINUSTAH) was brought in to maintain order. However, MINUSTAH proved controversial, since their periodically heavy-handed approach to maintaining law and order and several instances of abuses, including the alleged sexual abuse of civilians, provoked resentment and distrust among ordinary Haitians. Boniface Alexandre assumed interim authority until 2006, when René Préval was re-elected President following elections . Amidst the continuing political chaos, a series of natural disasters hit Haiti. In 2004 Tropical Storm Jeanne skimmed the north coast, leaving 3,006 people dead in flooding and mudslides , mostly in the city of Gonaïves . In 2008 Haiti was again struck by tropical storms; Tropical Storm Fay , Hurricane Gustav , Hurricane Hanna and Hurricane Ike all produced heavy winds and rain, resulting in 331 deaths and about 800,000 in need of humanitarian aid. The state of affairs produced by these storms was intensified by already high food and fuel prices that had caused a food crisis and political unrest in April 2008. On 12 January 2010, at 4:53 pm local time, Haiti was struck by a magnitude -7.0 earthquake . This was the country's most severe earthquake in over 200 years. The earthquake was reported to have left between 160,000 and 300,000 people dead and up to 1.6 million homeless, making it one of the deadliest natural disasters ever recorded . It is also one of the deadliest earthquakes ever recorded. The situation was exacerbated by a subsequent massive cholera outbreak that was triggered when cholera-infected waste from a United Nations peacekeeping station contaminated the country's main river, the Artibonite . In 2017, it was reported that roughly 10,000 Haitians had died and nearly a million had been made ill. After years of denial, the United Nations apologized in 2016, but as of 2017 [ update ] , they have refused to acknowledge fault, thus avoiding financial responsibility. General elections had been planned for January 2010 but were postponed due to the earthquake. Elections were held on 28 November 2010 for the senate, the parliament and the first round of the presidential elections. The run-off between Michel Martelly and Mirlande Manigat took place on 20 March 2011, and preliminary results, released on 4 April, named Michel Martelly the winner. In 2011 both former dictator Jean-Claude Duvalier and Jean-Bertrand Aristide returned to Haiti; attempts to try Duvalier for crimes committed under his rule were shelved following his death in 2014. In 2013, Haiti called for European nations to pay reparations for slavery and establish an official commission for the settlement of past wrongdoings. Meanwhile, after continuing political wrangling with the opposition and allegations of electoral fraud, Martelly agreed to step down in 2016 without a successor in place. After numerous postponements, partly owing to the effects of devastating Hurricane Matthew , elections were held in November 2016. The victor, Jovenel Moïse of the Haitian Tèt Kale Party , was sworn in as president in 2017. Protests began on 7 July 2018, in response to increased fuel prices. Over time these protests evolved into demands for the resignation of president Moïse. On 7 July 2021, President Moïse was assassinated in an attack on his private residence, and First Lady Martine Moïse was hospitalized. Amid the political crisis, the government of Haiti installed Ariel Henry as both the Prime Minister and the President on 20 July 2021. On 14 August 2021, Haiti suffered another huge earthquake , with many casualties. The earthquake has also damaged Haiti's economic conditions and led to a rise in gang violence which by May 2020 had escalated to a long-lasting full-blown gang war and other violent crimes. As of March 2022, Haiti still had no president, no parliamentary quorum, and a dysfunctional high court due to a lack of judges. In 2022, protests against the government and rising fuel prices intensified. In 2023, kidnapping jumped 72% from the first quarter of the previous year. Doctors, lawyers, and other wealthy members of society were kidnapped and held for ransom. Many victims were killed when ransom demands were not met, leading those with the means to do so to flee the country, further hampering efforts to pull the country out of the crisis. It is estimated that amidst the crisis up to 20% of qualified medical staff had left Haiti by the end of 2023. In March 2024, Ariel Henry was prevented by gangs from returning to Haiti, following a visit to Kenya. Henry agreed to resign once a transitional government had been formed. As of that month, nearly half of Haiti's population was living under acute food insecurity , according to the World Food Programme . The independence of Saint-Domingue was proclaimed under the native name 'Haiti' by Jean-Jacques Dessalines on 1 January 1804 in Gonaïves and he was proclaimed "Emperor for Life" as Emperor Jacques I by his troops. Dessalines at first offered protection to the white planters and others. However, once in power, he ordered the genocide of nearly all the remaining white men, women, children; between January and April 1804, 3,000 to 5,000 whites were killed, including those who had been friendly and sympathetic to the black population. Only three categories of white people were selected out as exceptions and spared: Polish soldiers, the majority of whom had deserted from the French army and fought alongside the Haitian rebels; the small group of German colonists invited to the north-west region ; and a group of medical doctors and professionals. Reportedly, people with connections to officers in the Haitian army were also spared, as well as the women who agreed to marry non-white men. Fearful of the potential impact the slave rebellion could have in the slave states , U.S. President Thomas Jefferson refused to recognize the new republic. The Southern politicians who were a powerful voting bloc in the American Congress prevented U.S. recognition for decades until they withdrew in 1861 to form the Confederacy . The revolution led to a wave of emigration. In 1809, 9,000 refugees from Saint-Domingue, both white planters and people of color, settled en masse in New Orleans , doubling the city's population, having been expelled from their initial refuge in Cuba by Spanish authorities. In addition, the newly arrived enslaved persons added to the city's African population. The plantation system was re-established in Haiti, albeit for wages; however, many Haitians were marginalized and resented the heavy-handed manner in which this was enforced in the new nation's politics. The rebel movement splintered, and Dessalines was assassinated by rivals on 17 October 1806. [ Link to precise page ] After Dessalines' death Haiti became split into two, with the Kingdom of Haiti in the north directed by Henri Christophe, later declaring himself Henri I , and a republic in the south centered on Port-au-Prince, directed by Alexandre Pétion , an homme de couleur . Christophe established a semi-feudal corvée system, with a rigid education and economic code. Pétion's republic was less absolutist, and he initiated a series of land reforms which benefited the peasant class. President Pétion also gave military and financial assistance to the revolutionary leader Simón Bolívar , which were critical in enabling him to liberate the Viceroyalty of New Granada . Meanwhile, the French, who had managed to maintain a precarious control of eastern Hispaniola, were defeated by insurgents led by Juan Sánchez Ramírez , with the area returning to Spanish rule in 1809 following the Battle of Palo Hincado . Beginning in 1821, President Jean-Pierre Boyer , also an homme de couleur and successor to Pétion, reunified the island following the suicide of Henry Christophe. After Santo Domingo declared its independence from Spain on 30 November 1821, Boyer invaded, seeking to unite the entire island by force and ending slavery in Santo Domingo. Struggling to revive the agricultural economy to produce commodity crops , Boyer passed the Code Rural, which denied peasant laborers the right to leave the land, enter the towns, or start farms or shops of their own, causing much resentment as most peasants wished to have their own farms rather than work on plantations. Starting in September 1824, more than 6,000 African Americans migrated to Haiti, with transportation paid by an American philanthropic group similar in function to the American Colonization Society and its efforts in Liberia . Many found the conditions too harsh and returned to the United States. In July 1825, King Charles X of France , during a period of restoration of the French monarchy , sent a fleet to reconquer Haiti. Under pressure, President Boyer agreed to a treaty by which France formally recognized the independence of the nation in exchange for a payment of 150 million francs . By an order of 17 April 1826, the King of France renounced his rights of sovereignty and formally recognized the independence of Haiti. The enforced payments to France hampered Haiti's economic growth for years, exacerbated by the fact that many Western nations continued to refuse formal diplomatic recognition to Haiti; Britain recognized Haitian independence in 1833, and the United States not until 1862. Haiti borrowed heavily from Western banks at extremely high interest rates to repay the debt. Although the amount of the reparations was reduced to 90 million in 1838, by 1900 80% of Haiti's government spending was debt repayment and the country did not finish repaying it until 1947. After losing the support of Haiti's elite, Boyer was ousted in 1843, with Charles Rivière-Hérard replacing him as president. Nationalist Dominican forces in eastern Hispaniola led by Juan Pablo Duarte seized control of Santo Domingo on 27 February 1844. The Haitian forces, unprepared for a significant uprising, capitulated to the rebels, effectively ending Haitian rule of eastern Hispaniola. In March Rivière-Hérard attempted to reimpose his authority, but the Dominicans inflicted heavy losses. Rivière-Hérard was removed from office by the mulatto hierarchy and replaced with the aged general Philippe Guerrier , who assumed the presidency on 3 May 1844. Guerrier died in April 1845, and was succeeded by General Jean-Louis Pierrot . Pierrot's most pressing duty as the new president was to check the incursions of the Dominicans, who were harassing the Haitian troops. Dominican gunboats were also making depredations on Haiti's coasts. President Pierrot decided to open a campaign against the Dominicans, whom he considered merely as insurgents; however, the Haitian offensive of 1845 was stopped on the frontier. On 1 January 1846 Pierrot announced a fresh campaign to reimpose Haitian suzerainty over eastern Hispaniola, but his officers and men greeted this fresh summons with contempt. Thus, a month later – February 1846 – when Pierrot ordered his troops to march against the Dominicans, the Haitian army mutinied, and its soldiers proclaimed his overthrow as president of the republic. With the war against the Dominicans having become very unpopular in Haiti, it was beyond the power of the new president, General Jean-Baptiste Riché , to stage another invasion. On 27 February 1847, President Riché died after only a year in power and was replaced by an obscure officer, General Faustin Soulouque . During the first two years of Soulouque's administration the conspiracies and opposition he faced in retaining power were so manifold that the Dominicans were given a further breathing space in which to consolidate their independence. But, when in 1848 France finally recognized the Dominican Republic as a free and independent state and provisionally signed a treaty of peace, friendship, commerce and navigation, Haiti immediately protested, claiming the treaty was an attack upon their own security. Soulouque decided to invade the new Republic before the French Government could ratify the treaty. On 21 March 1849, Haitian soldiers attacked the Dominican garrison at Las Matas . The demoralized defenders offered almost no resistance before abandoning their weapons. Soulouque pressed on, capturing San Juan . This left only the town of Azua as the remaining Dominican stronghold between the Haitian army and the capital. On 6 April, Azua fell to the 18,000-strong Haitian army, with a 5,000-man Dominican counterattack failing to oust them. The way to Santo Domingo was now clear. But the news of discontent existing at Port-au-Prince, which reached Soulouque, arrested his further progress and caused him to return with the army to his capital. Emboldened by the sudden retreat of the Haitian army, the Dominicans counter-attacked. Their flotilla went as far as Dame-Marie on the west coast of Haiti, which they plundered and set on fire. After another Haitian campaign in 1855, Britain and France intervened and obtained an armistice on behalf of the Dominicans, who declared independence as the Dominican Republic. The sufferings endured by the soldiers during the campaign of 1855, and the losses and sacrifices inflicted on the country without yielding any compensation or any practical results provoked great discontent. In 1858 a revolution began, led by General Fabre Geffrard , Duke of Tabara. In December of that year, Geffrard defeated the Imperial Army and seized control of most of the country. As a result, the Emperor abdicated his throne on 15 January 1859. Faustin was taken into exile and General Geffrard succeeded him as president.The period following Soulouque's overthrow down to the turn of the century was a turbulent one for Haiti, with repeated bouts of political instability. President Geffrard was overthrown in a coup in 1867, as was his successor, Sylvain Salnave , in 1869. Under the Presidency of Michel Domingue (1874–76) relations with the Dominican Republic were dramatically improved by the signing of a treaty, in which both parties acknowledged the independence of the other. Some modernisation of the economy and infrastructure also occurred in this period, especially under the Presidencies of Lysius Salomon (1879–1888) and Florvil Hyppolite (1889–1896). Haiti's relations with outside powers were often strained. In 1889 the United States attempted to force Haiti to permit the building of a naval base at Môle Saint-Nicolas , which was firmly resisted by President Hyppolite. In 1892 the German government supported suppression of the reform movement of Anténor Firmin , and in 1897, the Germans used gunboat diplomacy to intimidate and then humiliate the Haitian government of President Tirésias Simon Sam (1896–1902) during the Lüders Affair . In the first decades of the 20th century, Haiti experienced great political instability and was heavily in debt to France, Germany and the United States. A series of short lived presidencies came and went: President Pierre Nord Alexis was forced from power in 1908, as was his successor François C. Antoine Simon in 1911; President Cincinnatus Leconte (1911–12) was killed in a (possibly deliberate) explosion at the National Palace; Michel Oreste (1913–14) was ousted in a coup, as was his successor Oreste Zamor in 1914. Germany increased its influence in Haiti in this period, with a small community of German settlers wielding disproportionate influence in Haiti's economy. The German influence prompted anxieties in the United States, who had also invested heavily in the country, and whose government defended their right to oppose foreign interference in the Americas under the Monroe Doctrine . In December 1914, the Americans removed $500,000 from the Haitian National Bank, but rather than seize it to help pay the debt, it was removed for safe-keeping in New York, thus giving the United States control of the bank and preventing other powers from doing so. This gave a stable financial base on which to build the economy, and so enable the debt to be repaid. In 1915, Haiti's new President Vilbrun Guillaume Sam sought to strengthen his tenuous rule by a mass execution of 167 political prisoners. Outrage at the killings led to riots, and Sam was captured and killed by a lynch mob. Fearing possible foreign intervention, or the emergence of a new government led by the anti-American Haitian politician Rosalvo Bobo , President Woodrow Wilson sent U.S. Marines into Haiti in July 1915. The USS Washington , under Rear Admiral Caperton , arrived in Port-au-Prince in an attempt to restore order and protect U.S. interests. Within days, the Marines had taken control of the capital city and its banks and customs house. The Marines declared martial law and severely censored the press. Within weeks, a new pro-U.S. Haitian president, Philippe Sudré Dartiguenave , was installed and a new constitution written that was favorable to the interests of the United States. The constitution (written by future US President Franklin D. Roosevelt ) included a clause that allowed, for the first time, foreign ownership of land in Haiti, which was bitterly opposed by the Haitian legislature and citizenry. The occupation improved some of Haiti's infrastructure and centralized power in Port-au-Prince. 1700 km of roads were made usable, 189 bridges were built, many irrigation canals were rehabilitated, hospitals, schools, and public buildings were constructed, and drinking water was brought to the main cities. [ citation needed ] Agricultural education was organized, with a central school of agriculture and 69 farms in the country. [ incomplete short citation ] However, many infrastructure projects were built using the corvée system that allowed the government/occupying forces to take people from their homes and farms, at gunpoint if necessary, to build roads, bridges etc. by force, a process that was deeply resented by ordinary Haitians. Sisal was also introduced to Haiti, and sugarcane and cotton became significant exports, boosting prosperity. Haitian traditionalists, based in rural areas, were highly resistant to U.S.-backed changes, while the urban elites, typically mixed-race, welcomed the growing economy, but wanted more political control. Together they helped secure an end to the occupation in 1934, under the Presidency of Sténio Vincent (1930–1941). The debts were still outstanding, though less due to increased prosperity, and the U.S. financial advisor-general receiver handled the budget until 1941. The U.S. Marines were instilled with a special brand of paternalism towards Haitians "expressed in the metaphor of a father's relationship with his children." Armed opposition to the US presence was led by the cacos under the command of Charlemagne Péralte ; his capture and execution in 1919 earned him the status of a national martyr. During Senate hearings in 1921, the commandant of the Marine Corps reported that, in the 20 months of active unrest, 2,250 Haitians had been killed. However, in a report to the Secretary of the Navy, he reported the death toll as being 3,250. Haitian historians have claimed the true number was much higher, but this is not supported by most historians outside Haiti. After US forces left in 1934, Dominican dictator Rafael Trujillo used anti-Haitian sentiment as a nationalist tool. In an event that became known as the Parsley Massacre , he ordered his army to kill Haitians living on the Dominican side of the border. Few bullets were used; instead, 20,000–30,000 Haitians were bludgeoned and bayoneted, then herded into the sea, where sharks finished what Trujillo had begun. The indiscriminate massacre occurred over a period of five days. President Vincent became increasingly dictatorial, and resigned under US pressure in 1941, being replaced by Élie Lescot (1941–46). In 1941, during the Second World War , Lescot declared war on Japan (8 December), Germany (12 December), Italy (12 December), Bulgaria (24 December), Hungary (24 December) and Romania (24 December). Out of these six Axis countries, only Romania reciprocated, declaring war on Haiti on the same day (24 December 1941). On 27 September 1945, Haiti became a founding member of the United Nations (the successor to the League of Nations , of which Haiti was also a founding member). In 1946 Lescot was overthrown by the military, with Dumarsais Estimé later becoming the new president (1946–50). He sought to improve the economy and education, and to boost the role of black Haitians; however, as he sought to consolidate his rule he too was overthrown in a coup led by Paul Magloire , who replaced him as president (1950–56). Firmly anti-Communist, he was supported by the United States; with greater political stability tourists started to visit Haiti. The waterfront area of Port-au-Prince was redeveloped to allow cruise ship passengers to walk to cultural attractions.In 1956–57 Haiti underwent severe political turmoil; Magloire was forced to resign and leave the country in 1956 and he was followed by four short-lived presidencies. In the September 1957 election François Duvalier was elected President of Haiti. Known as 'Papa Doc' and initially popular, Duvalier remained President until his death in 1971. He advanced black interests in the public sector, where over time, people of color had predominated as the educated urban elite. Not trusting the army, despite his frequent purges of officers deemed disloyal, Duvalier created a private militia known as Tontons Macoutes ("Bogeymen"), which maintained order by terrorizing the populace and political opponents. In 1964 Duvalier proclaimed himself 'President for Life'; an uprising against his rule that year in Jérémie was violently suppressed, with the ringleaders publicly executed and hundreds of mixed-raced citizens in the town killed. The bulk of the educated and professional class began leaving the country, and corruption became widespread. Duvalier sought to create a personality cult, identifying himself with Baron Samedi , one of the loa (or lwa ), or spirits, of Haitian Vodou . Despite the well-publicized abuses under his rule, Duvalier's firm anti-Communism earned him the support of the Americans, who furnished the country with aid. In 1971 Duvalier died, and he was succeeded by his son Jean-Claude Duvalier , nicknamed 'Baby Doc', who ruled until 1986. He largely continued his father's policies, though curbed some of the worst excesses in order to court international respectability. Tourism, which had nosedived in Papa Doc's time, again became a growing industry. However, as the economy continued to decline, Baby Doc's grip on power began to weaken. Haiti's pig population was slaughtered following an outbreak of swine fever in the late 1970s, causing hardship to rural communities who used them as an investment. The opposition became more vocal, bolstered by a visit to the country by Pope John Paul II in 1983, who publicly lambasted the president. Demonstrations occurred in Gonaïves in 1985 which then spread across the country; under pressure from the United States, Duvalier left the country for France in February 1986. In total, roughly 40,000 to 60,000 Haitians are estimated to have been killed during the reign of the Duvaliers. Through the use of his intimidation tactics and executions, many intellectual Haitians had fled, leaving the country with a massive brain-drain from which it has yet to recover. Following Duvalier's departure, army leader General Henri Namphy headed a new National Governing Council . Elections scheduled for November 1987 were aborted after dozens of inhabitants were shot in the capital by soldiers and Tontons Macoutes . Fraudulent elections followed in 1988, in which only 4% of the citizenry voted. The newly elected president, Leslie Manigat , was then overthrown some months later in the June 1988 Haitian coup d'état . Another coup followed in September 1988, after the St. Jean Bosco massacre in which approximately 13 to 50 people attending a mass led by prominent government critic and Catholic priest Jean-Bertrand Aristide were killed. General Prosper Avril subsequently led a military regime until March 1990. Avril transferred power to the army chief of staff, Gen. Hérard Abraham , on March 10, 1990. Abraham gave up power three days later, becoming the only military leader in Haiti during the twentieth century to voluntarily give up power. Abraham later helped to secure the 1990–91 Haitian general election . In December 1990, Jean-Bertrand Aristide was elected president in the Haitian general election . However, his ambitious reformist agenda worried the elites, and in September of the following year he was overthrown by the military, led by Raoul Cédras , in the 1991 Haitian coup d'état . Amidst the continuing turmoil many Haitians attempted to flee the country. In September 1994, the United States negotiated the departure of Haiti's military leaders and the peaceful entry of 20,000 US troops under Operation Uphold Democracy . This enabled the restoration of the democratically elected Jean-Bertrand Aristide as president, who returned to Haiti in October to complete his term. As part of the deal Aristide had to implement free market reforms in an attempt to improve the Haitian economy, with mixed results. In November 1994, Hurricane Gordon brushed Haiti, dumping heavy rain and creating flash flooding that triggered mudslides. Gordon killed an estimated 1,122 people, although some estimates go as high as 2,200. Elections were held in 1995 which were won by René Préval , gaining 88% of the popular vote, albeit on a low turnout. Aristide subsequently formed his own party, Fanmi Lavalas , and political deadlock ensued; the November 2000 election returned Aristide to the presidency with 92% of the vote. The election had been boycotted by the opposition, then organized into the Convergence Démocratique , over a dispute in the May legislative elections . In subsequent years, there was increasing violence between rival political factions and human rights abuses . Aristide spent years negotiating with the Convergence Démocratique on new elections, but the Convergence's inability to develop a sufficient electoral base made elections unattractive. [ citation needed ] In 2004 an anti-Aristide revolt began in northern Haiti. The rebellion eventually reached the capital, and Aristide was forced into exile. The precise nature of the events are disputed; some, including Aristide and his bodyguard, Franz Gabriel, stated that he was the victim of a "new coup d'état or modern kidnapping" by U.S. forces. These charges were denied by the US government. As political violence and crime continued to grow, a United Nations Stabilisation Mission (MINUSTAH) was brought in to maintain order. However, MINUSTAH proved controversial, since their periodically heavy-handed approach to maintaining law and order and several instances of abuses, including the alleged sexual abuse of civilians, provoked resentment and distrust among ordinary Haitians. Boniface Alexandre assumed interim authority until 2006, when René Préval was re-elected President following elections . Amidst the continuing political chaos, a series of natural disasters hit Haiti. In 2004 Tropical Storm Jeanne skimmed the north coast, leaving 3,006 people dead in flooding and mudslides , mostly in the city of Gonaïves . In 2008 Haiti was again struck by tropical storms; Tropical Storm Fay , Hurricane Gustav , Hurricane Hanna and Hurricane Ike all produced heavy winds and rain, resulting in 331 deaths and about 800,000 in need of humanitarian aid. The state of affairs produced by these storms was intensified by already high food and fuel prices that had caused a food crisis and political unrest in April 2008. On 12 January 2010, at 4:53 pm local time, Haiti was struck by a magnitude -7.0 earthquake . This was the country's most severe earthquake in over 200 years. The earthquake was reported to have left between 160,000 and 300,000 people dead and up to 1.6 million homeless, making it one of the deadliest natural disasters ever recorded . It is also one of the deadliest earthquakes ever recorded. The situation was exacerbated by a subsequent massive cholera outbreak that was triggered when cholera-infected waste from a United Nations peacekeeping station contaminated the country's main river, the Artibonite . In 2017, it was reported that roughly 10,000 Haitians had died and nearly a million had been made ill. After years of denial, the United Nations apologized in 2016, but as of 2017 [ update ] , they have refused to acknowledge fault, thus avoiding financial responsibility. General elections had been planned for January 2010 but were postponed due to the earthquake. Elections were held on 28 November 2010 for the senate, the parliament and the first round of the presidential elections. The run-off between Michel Martelly and Mirlande Manigat took place on 20 March 2011, and preliminary results, released on 4 April, named Michel Martelly the winner. In 2011 both former dictator Jean-Claude Duvalier and Jean-Bertrand Aristide returned to Haiti; attempts to try Duvalier for crimes committed under his rule were shelved following his death in 2014. In 2013, Haiti called for European nations to pay reparations for slavery and establish an official commission for the settlement of past wrongdoings. Meanwhile, after continuing political wrangling with the opposition and allegations of electoral fraud, Martelly agreed to step down in 2016 without a successor in place. After numerous postponements, partly owing to the effects of devastating Hurricane Matthew , elections were held in November 2016. The victor, Jovenel Moïse of the Haitian Tèt Kale Party , was sworn in as president in 2017. Protests began on 7 July 2018, in response to increased fuel prices. Over time these protests evolved into demands for the resignation of president Moïse. On 7 July 2021, President Moïse was assassinated in an attack on his private residence, and First Lady Martine Moïse was hospitalized. Amid the political crisis, the government of Haiti installed Ariel Henry as both the Prime Minister and the President on 20 July 2021. On 14 August 2021, Haiti suffered another huge earthquake , with many casualties. The earthquake has also damaged Haiti's economic conditions and led to a rise in gang violence which by May 2020 had escalated to a long-lasting full-blown gang war and other violent crimes. As of March 2022, Haiti still had no president, no parliamentary quorum, and a dysfunctional high court due to a lack of judges. In 2022, protests against the government and rising fuel prices intensified. In 2023, kidnapping jumped 72% from the first quarter of the previous year. Doctors, lawyers, and other wealthy members of society were kidnapped and held for ransom. Many victims were killed when ransom demands were not met, leading those with the means to do so to flee the country, further hampering efforts to pull the country out of the crisis. It is estimated that amidst the crisis up to 20% of qualified medical staff had left Haiti by the end of 2023. In March 2024, Ariel Henry was prevented by gangs from returning to Haiti, following a visit to Kenya. Henry agreed to resign once a transitional government had been formed. As of that month, nearly half of Haiti's population was living under acute food insecurity , according to the World Food Programme . Haiti forms the western three-eighths of Hispaniola , the second largest island in the Greater Antilles . At 27,750 km 2 (10,710 sq mi) Haiti is the third largest country in the Caribbean behind Cuba and the Dominican Republic , the latter sharing a 360-kilometer (224 mi) border with Haiti. The country has a roughly horseshoe shape and because of this it has a disproportionately long coastline, second in length ( 1,771 km or 1,100 mi ) behind Cuba in the Greater Antilles. Haiti is the most mountainous nation in the Caribbean, its terrain consists of mountains interspersed with small coastal plains and river valleys. The climate is tropical, with some variation depending on altitude. The highest point is Pic la Selle , at 2,680 meters (8,793 ft) . The northern region or Marien Region consists of the Massif du Nord (Northern Massif) and the Plaine du Nord (Northern Plain). The Massif du Nord is an extension of the Cordillera Central in the Dominican Republic. It begins at Haiti's eastern border, north of the Guayamouc River , and extends to the northwest through the northern peninsula. The lowlands of the Plaine du Nord lie along the northern border with the Dominican Republic, between the Massif du Nord and the North Atlantic Ocean. The central region or Artibonite Region consists of two plains and two sets of mountain ranges. The Plateau Central (Central Plateau) extends along both sides of the Guayamouc River, south of the Massif du Nord . It runs from the southeast to the northwest. To the southwest of the Plateau Central are the Montagnes Noires , whose most northwestern part merges with the Massif du Nord . Haiti's most important valley in terms of crops is the Plaine de l'Artibonite, which lies between the Montagnes Noires and the Chaîne des Matheux . This region supports the country's longest river, the Riviere l'Artibonite , which begins in the western region of the Dominican Republic and continues for most of its length through central Haiti, where it then empties into the Golfe de la Gonâve . Also in this valley lies Haiti's second largest lake, Lac de Péligre , formed as a result of the construction of the Péligre Dam in the mid-1950s. The southern region or Xaragua Region consists of the Plaine du Cul-de-Sac (the southeast) and the mountainous southern peninsula (the Tiburon Peninsula ). The Plaine du Cul-de-Sac is a natural depression that harbors the country's saline lakes, such as Trou Caïman and Haiti's largest lake, Étang Saumatre . The Chaîne de la Selle mountain range – an extension of the southern mountain chain of the Dominican Republic (the Sierra de Baoruco) – extends from the Massif de la Selle in the east to the Massif de la Hotte in the west. Haiti also includes several offshore islands. The island of Tortuga is located off the coast of northern Haiti. The arrondissement of La Gonâve is located on the island of the same name, in the Golfe de la Gonâve ; Haiti's largest island, Gonâve is moderately populated by rural villagers. Île à Vache is located off the southwest coast; also part of Haiti are the Cayemites , located in the Gulf of Gonâve north of Pestel . Navassa Island , located 40 nautical miles (46 mi; 74 km) west of Jérémie on the south west peninsula of Haiti, is subject to an ongoing territorial dispute with the United States, who currently administer the island. Haiti's climate is tropical with some variation depending on altitude. Port-au-Prince ranges in January from an average minimum of 23 °C (73.4 °F) to an average maximum of 31 °C (87.8 °F) ; in July, from 25–35 °C (77–95 °F) . The rainfall pattern is varied, with rain heavier in some of the lowlands and the northern and eastern slopes of the mountains. Haiti's dry season occurs from November to January. Port-au-Prince receives an average annual rainfall of 1,370 mm (53.9 in) . There are two rainy seasons, April–June and October–November. Haiti is subject to periodic droughts and floods, made more severe by deforestation. Hurricanes are a menace, and the country is also prone to flooding and earthquakes. There are blind thrust faults associated with the Enriquillo-Plantain Garden fault system over which Haiti lies. After the earthquake of 2010, there was no evidence of surface rupture and geologists' findings were based on seismological, geological and ground deformation data. The northern boundary of the fault is where the Caribbean tectonic plate shifts eastwards by about 20 mm (0.79 inches) per year in relation to the North American plate . The strike-slip fault system in the region has two branches in Haiti, the Septentrional-Oriente fault in the north and the Enriquillo-Plantain Garden fault in the south. A 2007 earthquake hazard study, noted that the Enriquillo-Plantain Garden fault zone could be at the end of its seismic cycle and concluded that a worst-case forecast would involve a 7.2 M w earthquake, similar in size to the 1692 Jamaica earthquake . A study team performing a hazard assessment of the fault system recommended "high priority" historical geologic rupture studies, as the fault was fully locked and had recorded few earthquakes in the preceding 40 years. The magnitude 7.0 2010 Haiti earthquake happened on this fault zone on 12 January 2010. Haiti also has rare elements such as gold , which can be found at The Mont Organisé gold mine . Haiti has no currently active volcanoes. "In the Terre-Neuve Mountains, about 12 kilometers from the Eaux Boynes, small intrusions at least as late as Oligocene and probably of Miocene age are known. No other volcanic activity of as late a date is known near any of the other warm springs." The soil erosion released from the upper catchments and deforestation have caused periodic and severe flooding, as experienced, for example, on 17 September 2004. Earlier in May that year, floods had killed over 3,000 people on Haiti's southern border with the Dominican Republic. Haiti's forests covered 60% of the country as recently as 50 years ago, but that has been halved to a current estimate of 30% tree cover. This estimate poses a stark difference from the erroneous figure of 2% which has been oft-cited in discourse concerning the country's environmental condition. Haiti had a 2019 Forest Landscape Integrity Index mean score of 4.01/10, ranking it 137th globally out of 172 countries. Scientists at the Columbia University's Center for International Earth Science Information Network and the United Nations Environment Programme are working on the Haiti Regenerative Initiative, an initiative aiming to reduce poverty and natural disaster vulnerability through ecosystem restoration and sustainable resource management. Haiti is home to four ecoregions: Hispaniolan moist forests , Hispaniolan dry forests , Hispaniolan pine forests , and Greater Antilles mangroves . Despite its small size, Haiti's mountainous terrain and resultant multiple climatic zones has resulted in a wide variety of plant life. Notable tree species include the breadfruit tree , mango tree , acacia , mahogany , coconut palm , royal palm and West Indian cedar . The forests were formerly much more extensive, but have been subject to severe deforestation. Most mammal species are not native, having been brought to the island since colonial times. However, there are various native bat species, as well as the endemic Hispaniolan hutia and Hispaniolan solenodon . Whale and dolphin species can also be found off Haiti's coast. There are over 260 species of birds, 31 endemic to Hispaniola. Notable endemic species include the Hispaniolan trogon , Hispaniolan parakeet , grey-crowned tanager and the Hispaniolan Amazon . There are also several raptors , as well as pelicans, ibis, hummingbirds and ducks. Reptiles are common, with species such as the rhinoceros iguana , Haitian boa , American crocodile and gecko . Haiti's climate is tropical with some variation depending on altitude. Port-au-Prince ranges in January from an average minimum of 23 °C (73.4 °F) to an average maximum of 31 °C (87.8 °F) ; in July, from 25–35 °C (77–95 °F) . The rainfall pattern is varied, with rain heavier in some of the lowlands and the northern and eastern slopes of the mountains. Haiti's dry season occurs from November to January. Port-au-Prince receives an average annual rainfall of 1,370 mm (53.9 in) . There are two rainy seasons, April–June and October–November. Haiti is subject to periodic droughts and floods, made more severe by deforestation. Hurricanes are a menace, and the country is also prone to flooding and earthquakes. There are blind thrust faults associated with the Enriquillo-Plantain Garden fault system over which Haiti lies. After the earthquake of 2010, there was no evidence of surface rupture and geologists' findings were based on seismological, geological and ground deformation data. The northern boundary of the fault is where the Caribbean tectonic plate shifts eastwards by about 20 mm (0.79 inches) per year in relation to the North American plate . The strike-slip fault system in the region has two branches in Haiti, the Septentrional-Oriente fault in the north and the Enriquillo-Plantain Garden fault in the south. A 2007 earthquake hazard study, noted that the Enriquillo-Plantain Garden fault zone could be at the end of its seismic cycle and concluded that a worst-case forecast would involve a 7.2 M w earthquake, similar in size to the 1692 Jamaica earthquake . A study team performing a hazard assessment of the fault system recommended "high priority" historical geologic rupture studies, as the fault was fully locked and had recorded few earthquakes in the preceding 40 years. The magnitude 7.0 2010 Haiti earthquake happened on this fault zone on 12 January 2010. Haiti also has rare elements such as gold , which can be found at The Mont Organisé gold mine . Haiti has no currently active volcanoes. "In the Terre-Neuve Mountains, about 12 kilometers from the Eaux Boynes, small intrusions at least as late as Oligocene and probably of Miocene age are known. No other volcanic activity of as late a date is known near any of the other warm springs." The soil erosion released from the upper catchments and deforestation have caused periodic and severe flooding, as experienced, for example, on 17 September 2004. Earlier in May that year, floods had killed over 3,000 people on Haiti's southern border with the Dominican Republic. Haiti's forests covered 60% of the country as recently as 50 years ago, but that has been halved to a current estimate of 30% tree cover. This estimate poses a stark difference from the erroneous figure of 2% which has been oft-cited in discourse concerning the country's environmental condition. Haiti had a 2019 Forest Landscape Integrity Index mean score of 4.01/10, ranking it 137th globally out of 172 countries. Scientists at the Columbia University's Center for International Earth Science Information Network and the United Nations Environment Programme are working on the Haiti Regenerative Initiative, an initiative aiming to reduce poverty and natural disaster vulnerability through ecosystem restoration and sustainable resource management. Haiti is home to four ecoregions: Hispaniolan moist forests , Hispaniolan dry forests , Hispaniolan pine forests , and Greater Antilles mangroves . Despite its small size, Haiti's mountainous terrain and resultant multiple climatic zones has resulted in a wide variety of plant life. Notable tree species include the breadfruit tree , mango tree , acacia , mahogany , coconut palm , royal palm and West Indian cedar . The forests were formerly much more extensive, but have been subject to severe deforestation. Most mammal species are not native, having been brought to the island since colonial times. However, there are various native bat species, as well as the endemic Hispaniolan hutia and Hispaniolan solenodon . Whale and dolphin species can also be found off Haiti's coast. There are over 260 species of birds, 31 endemic to Hispaniola. Notable endemic species include the Hispaniolan trogon , Hispaniolan parakeet , grey-crowned tanager and the Hispaniolan Amazon . There are also several raptors , as well as pelicans, ibis, hummingbirds and ducks. Reptiles are common, with species such as the rhinoceros iguana , Haitian boa , American crocodile and gecko . Haiti is home to four ecoregions: Hispaniolan moist forests , Hispaniolan dry forests , Hispaniolan pine forests , and Greater Antilles mangroves . Despite its small size, Haiti's mountainous terrain and resultant multiple climatic zones has resulted in a wide variety of plant life. Notable tree species include the breadfruit tree , mango tree , acacia , mahogany , coconut palm , royal palm and West Indian cedar . The forests were formerly much more extensive, but have been subject to severe deforestation. Most mammal species are not native, having been brought to the island since colonial times. However, there are various native bat species, as well as the endemic Hispaniolan hutia and Hispaniolan solenodon . Whale and dolphin species can also be found off Haiti's coast. There are over 260 species of birds, 31 endemic to Hispaniola. Notable endemic species include the Hispaniolan trogon , Hispaniolan parakeet , grey-crowned tanager and the Hispaniolan Amazon . There are also several raptors , as well as pelicans, ibis, hummingbirds and ducks. Reptiles are common, with species such as the rhinoceros iguana , Haitian boa , American crocodile and gecko . The government of Haiti is a semi-presidential republic, a multiparty system wherein the president of Haiti is head of state and elected directly by popular elections held every five years. The prime minister of Haiti acts as head of government and is appointed by the president, chosen from the majority party in the National Assembly. Executive power is exercised by the president and prime minister who together constitute the government. Legislative power is vested in both the government and the two chambers of the National Assembly of Haiti , the Senate (Sénat) and the Chamber of Deputies (Chambre des Députés). The government is organized unitarily , thus the central government delegates powers to the departments without a constitutional need for consent. The current structure of Haiti's political system was set forth in the Constitution of Haiti on 29 March 1987. Haitian politics have been contentious: since independence, Haiti has suffered 32 coups . Haiti is the only country in the Western Hemisphere to undergo a successful slave revolution ; however, a long history of oppression by dictators such as François Duvalier and his son Jean-Claude Duvalier has markedly affected the nation. Since the end of the Duvalier era Haiti has been transitioning to a democratic system. Administratively, Haiti is divided into ten departments . The departments are listed below, with the departmental capital cities in parentheses. The departments are further divided into 42 arrondissements , 145 communes and 571 communal sections . These serve as, respectively, second- and third-level administrative divisions. Haiti is a member of a wide range of international and regional organizations, such as the United Nations, CARICOM, Community of Latin American and Caribbean States , International Monetary Fund , Organisation of American States , Organisation internationale de la Francophonie , OPANAL and the World Trade Organization . In February 2012, Haiti signaled it would seek to upgrade its observer status to full associate member status of the African Union (AU). The AU was reported to be planning to upgrade Haiti's status from observer to associate at its June 2013 summit but the application had still not been ratified by May 2016. Haiti has a strong military history dating to the pre-independence struggle. The Indigenous Army is essential in the construction of the state the management of land and public finances. Up to the 20th century, every Haitian president was an officer in the army. During the US intervention, the army was remodeled as Gendarmerie d'Haiti and later on as Force Armée d'Haiti (FAdH). In the early 1990s, the army was unconstitutionally decommissioned and replaced by the Haitian National Police (PNH). In 2018, Président Jovenel Moise reactivated the FAdH. Haiti's Ministry of Defense is the main body of the armed forces. The former Haitian Armed Forces were demobilized in 1995; however, efforts to reconstitute it are currently underway . The current defense force for Haiti is the Haitian National Police , which has a highly trained SWAT team, and works alongside the Haitian Coast Guard . In 2010, the Haitian National Police force numbered 7,000. As of 2023, the Haitian army includes one infantry battalion that is in the process of being formed, with 700 personnel. The legal system is based on a modified version of the Napoleonic Code . Haiti has consistently ranked among the most corrupt countries in the world on the Corruption Perceptions Index . According to a 2006 report by the Corruption Perceptions Index , there is a strong correlation between corruption and poverty in Haiti. The nation ranked first of all countries surveyed for levels of perceived domestic corruption. It is estimated that President "Baby Doc" Duvalier , his wife Michele , and their agents stole US $504 million from the treasury between 1971 and 1986. Similarly, after the Haitian Army folded in 1995, the Haitian National Police (HNP) gained sole power of authority on the Haitian citizens. Many Haitians as well as observers believe that this monopolized power could have given way to a corrupt police force. Some media outlets alleged that millions were stolen by former president Jean-Bertrand Aristide . The BBC also described pyramid schemes , in which Haitians lost hundreds of millions in 2002, as the "only real economic initiative" of the Aristide years. Conversely, according to the 2013 United Nations Office on Drugs and Crime ( UNODC ) report, murder rates (10.2 per 100,000) are far below the regional average (26 per 100,000); less than 1 / 4 that of Jamaica (39.3 per 100,000) and nearly 1 / 2 that of the Dominican Republic (22.1 per 100,000), making it among the safer countries in the region. In large part, this is due to the country's ability to fulfil a pledge by increasing its national police yearly by 50%, a four-year initiative that was started in 2012. In addition to the yearly recruits, the Haitian National Police (HNP) has been using innovative technologies to crack down on crime. A notable bust in recent years [ when? ] led to the dismantlement of the largest kidnapping ring in the country with the use of an advanced software program developed by a West Point -trained Haitian official that proved to be so effective that it has led to its foreign advisers to make inquiries. In 2010, the New York City Police Department (NYPD) sent a team of officers to Haiti to assist in the rebuilding of its police force with special training in investigative techniques, anti-kidnapping strategies and community outreach. It has also helped the HNP set up a police unit in Delmas , a neighborhood of Port-au-Prince. In 2012 and 2013, 150 HNP officers received specialized training funded by the US government, which also contributed to the infrastructure and communications support by upgrading radio capacity and constructing new police stations from the most violent-prone neighborhoods of Cité Soleil and Grande Ravine in Port-au-Prince to the new northern industrial park at Caracol . Port-au-Prince penitentiary is home to half of Haiti's prisoners. The prison has a capacity of 1,200 detainees but as of November 2017 [ update ] the penitentiary was obliged to keep 4,359 detainees, a 363% occupancy level. The inability to receive sufficient funds has caused deadly cases of malnutrition , combined with the tight living conditions, increases the risk of infectious diseases such as tuberculosis . Haitian law states that once arrested, one must go before a judge within 48 hours; however, this is very rare. In an interview with Unreported World , the prison governor stated that around 529 detainees were never sentenced, and there are 3,830 detainees who are in prolonged detained trial detention. Therefore, 80% are not convicted. Unless families are able to provide the necessary funds for inmates to appear before a judge there is a very slim chance the inmate would have a trial, on average, within 10 years. In confined living spaces for 22–23 hours a day, inmates are not provided with latrines and are forced to defecate into plastic bags. These conditions were considered inhumane by the Inter-American Court of Human Rights in 2008. On 3 March 2024, armed gangs stormed the main prison in Port-au-Prince and around 3700 inmates escaped, while 12 people were killed. Administratively, Haiti is divided into ten departments . The departments are listed below, with the departmental capital cities in parentheses. The departments are further divided into 42 arrondissements , 145 communes and 571 communal sections . These serve as, respectively, second- and third-level administrative divisions. Haiti is a member of a wide range of international and regional organizations, such as the United Nations, CARICOM, Community of Latin American and Caribbean States , International Monetary Fund , Organisation of American States , Organisation internationale de la Francophonie , OPANAL and the World Trade Organization . In February 2012, Haiti signaled it would seek to upgrade its observer status to full associate member status of the African Union (AU). The AU was reported to be planning to upgrade Haiti's status from observer to associate at its June 2013 summit but the application had still not been ratified by May 2016. Haiti has a strong military history dating to the pre-independence struggle. The Indigenous Army is essential in the construction of the state the management of land and public finances. Up to the 20th century, every Haitian president was an officer in the army. During the US intervention, the army was remodeled as Gendarmerie d'Haiti and later on as Force Armée d'Haiti (FAdH). In the early 1990s, the army was unconstitutionally decommissioned and replaced by the Haitian National Police (PNH). In 2018, Président Jovenel Moise reactivated the FAdH. Haiti's Ministry of Defense is the main body of the armed forces. The former Haitian Armed Forces were demobilized in 1995; however, efforts to reconstitute it are currently underway . The current defense force for Haiti is the Haitian National Police , which has a highly trained SWAT team, and works alongside the Haitian Coast Guard . In 2010, the Haitian National Police force numbered 7,000. As of 2023, the Haitian army includes one infantry battalion that is in the process of being formed, with 700 personnel. The legal system is based on a modified version of the Napoleonic Code . Haiti has consistently ranked among the most corrupt countries in the world on the Corruption Perceptions Index . According to a 2006 report by the Corruption Perceptions Index , there is a strong correlation between corruption and poverty in Haiti. The nation ranked first of all countries surveyed for levels of perceived domestic corruption. It is estimated that President "Baby Doc" Duvalier , his wife Michele , and their agents stole US $504 million from the treasury between 1971 and 1986. Similarly, after the Haitian Army folded in 1995, the Haitian National Police (HNP) gained sole power of authority on the Haitian citizens. Many Haitians as well as observers believe that this monopolized power could have given way to a corrupt police force. Some media outlets alleged that millions were stolen by former president Jean-Bertrand Aristide . The BBC also described pyramid schemes , in which Haitians lost hundreds of millions in 2002, as the "only real economic initiative" of the Aristide years. Conversely, according to the 2013 United Nations Office on Drugs and Crime ( UNODC ) report, murder rates (10.2 per 100,000) are far below the regional average (26 per 100,000); less than 1 / 4 that of Jamaica (39.3 per 100,000) and nearly 1 / 2 that of the Dominican Republic (22.1 per 100,000), making it among the safer countries in the region. In large part, this is due to the country's ability to fulfil a pledge by increasing its national police yearly by 50%, a four-year initiative that was started in 2012. In addition to the yearly recruits, the Haitian National Police (HNP) has been using innovative technologies to crack down on crime. A notable bust in recent years [ when? ] led to the dismantlement of the largest kidnapping ring in the country with the use of an advanced software program developed by a West Point -trained Haitian official that proved to be so effective that it has led to its foreign advisers to make inquiries. In 2010, the New York City Police Department (NYPD) sent a team of officers to Haiti to assist in the rebuilding of its police force with special training in investigative techniques, anti-kidnapping strategies and community outreach. It has also helped the HNP set up a police unit in Delmas , a neighborhood of Port-au-Prince. In 2012 and 2013, 150 HNP officers received specialized training funded by the US government, which also contributed to the infrastructure and communications support by upgrading radio capacity and constructing new police stations from the most violent-prone neighborhoods of Cité Soleil and Grande Ravine in Port-au-Prince to the new northern industrial park at Caracol . Port-au-Prince penitentiary is home to half of Haiti's prisoners. The prison has a capacity of 1,200 detainees but as of November 2017 [ update ] the penitentiary was obliged to keep 4,359 detainees, a 363% occupancy level. The inability to receive sufficient funds has caused deadly cases of malnutrition , combined with the tight living conditions, increases the risk of infectious diseases such as tuberculosis . Haitian law states that once arrested, one must go before a judge within 48 hours; however, this is very rare. In an interview with Unreported World , the prison governor stated that around 529 detainees were never sentenced, and there are 3,830 detainees who are in prolonged detained trial detention. Therefore, 80% are not convicted. Unless families are able to provide the necessary funds for inmates to appear before a judge there is a very slim chance the inmate would have a trial, on average, within 10 years. In confined living spaces for 22–23 hours a day, inmates are not provided with latrines and are forced to defecate into plastic bags. These conditions were considered inhumane by the Inter-American Court of Human Rights in 2008. On 3 March 2024, armed gangs stormed the main prison in Port-au-Prince and around 3700 inmates escaped, while 12 people were killed. Haiti has a highly regulated, predominantly state-controlled economy, ranking 145th out of the 177 countries given a " freedom index " by the Heritage Foundation . Haiti's per capita GDP is $1,800 and its GDP is $19.97 billion (2017 estimates). The country uses the Haitian gourde as its currency. Despite its tourism industry, Haiti is one of the poorest countries in the Americas, with corruption, political instability, poor infrastructure, lack of health care and lack of education cited as the main causes. Unemployment is high and many Haitians seek to emigrate. Trade declined dramatically after the 2010 earthquake and subsequent outbreak of cholera , with the country's purchasing power parity GDP falling by 8% (from US$12.15 billion to US$11.18 billion). Haiti ranked 145th of 182 countries in the 2010 United Nations Human Development Index , with 57.3% of the population being deprived in at least three of the HDI's poverty measures. Following the disputed 2000 election and accusations about President Aristide's rule, US aid to the Haitian government was cut off between 2001 and 2004. After Aristide's departure in 2004, aid was restored and the Brazilian army led a United Nations Stabilization Mission in Haiti peacekeeping operation. After almost four years of recession, the economy grew by 1.5% in 2005. In September 2009, Haiti met the conditions set out by the IMF and World Bank 's Heavily Indebted Poor Countries program to qualify for cancellation of its external debt. More than 90 percent of the government's budget comes from an agreement with Petrocaribe , a Venezuela-led oil alliance. Haiti received more than US$4 billion in aid from 1990 to 2003, including US$1.5 billion from the United States. The largest donor is the US, followed by Canada and the European Union . In January 2010, following the earthquake, US President Barack Obama promised US$1.15 billion in assistance. European Union nations pledged more than €400 million (US$616 million). Neighboring Dominican Republic has also provided extensive humanitarian aid to Haiti, including the funding and construction of a public university, human capital, free healthcare services in the border region, and logistical support after the 2010 earthquake. The United Nations states that US$13.34 billion has been earmarked for post-earthquake reconstruction through 2020, though two years after the 2010 quake, less than half of that amount had actually been released. As of 2015 [ update ] , the US government has allocated US$4 billion, US$3 billion has already been spent, and the rest is dedicated to longer-term projects. According to the 2015 CIA World Factbook , Haiti's main import partners are: Dominican Republic 35%, US 26.8%, Netherlands Antilles 8.7%, China 7% (est. 2013). Haiti's main export partner is the US 83.5% (est. 2013). Haiti had a trade deficit of US$3 billion in 2011, or 41% of GDP. Haiti relies heavily on an oil alliance with Petrocaribe for much of its energy requirements. In recent years, hydroelectric, solar and wind energy have been explored as possible sustainable energy sources. As of 2017, among all the countries in the Americas, Haiti is producing the least energy. Less than a quarter of the country has electric coverage. Most regions of Haiti that do have energy are powered by generators. These generators are often expensive and produce a lot of pollution. The areas that do get electricity experience power cuts on a daily basis, and some areas are limited to 12 hours of electricity a day. Electricity is provided by a small number of independent companies: Sogener, E-power, and Haytrac. There is no national electricity grid . The most common source of energy is wood, along with charcoal. About 4 million metric tons of wood products are consumed yearly. Like charcoal and wood, petroleum is also an important source of energy. Since Haiti cannot produce its own fuel, all fuel is imported. Yearly, around 691,000 tons of oil is imported into the country. In 2018, a 24-hour electricity project was announced; for this purpose 236 MW needs to installed in Port-au-Prince alone, with an additional 75 MW needed in all other regions. Presently only 27.5% of the population has access to electricity; moreover, the national energy agency l'Électricité d'Haïti (Ed'H) is only able to meet 62% of overall electricity demand. Haiti suffers from a shortage of skilled labor, widespread unemployment, and underemployment. Most Haitians in the labor force have informal jobs. Three-quarters of the population lives on US$2 or less per day. Remittances from Haitians living abroad are the primary source of foreign exchange, equaling one-fifth (20%) of GDP and more than five times the earnings from exports as of 2012. In 2004, 80% or more of college graduates from Haiti were living abroad. Occasionally, families who are unable to care for children may send them to live with a wealthier family as a restavek , or house servant . In return the family are supposed to ensure that the child is educated and provided with food and shelter; however, the system is open to abuse and has proved controversial, with some likening it to child slavery. In rural areas, people often live in wooden huts with corrugated iron roofs. Outhouses are located in back of the huts. In Port-au-Prince, colorful shantytowns surround the central city and go up the mountainsides. The middle and upper classes live in suburbs, or in the central part of the bigger cities in apartments, where there is urban planning. Many of the houses they live in are like miniature fortresses, located behind walls embedded with metal spikes, barbed wire, broken glass, and sometimes all three. The houses have backup generators, because the electrical grid is unreliable. Some even have rooftop reservoirs for water. Haiti is the world's leading producer of vetiver , a root plant used to make luxury perfumes, essential oils and fragrances, providing for half the world's supply. Roughly 40–50% of Haitians work in the agricultural sector. However, according to soil surveys by the United States Department of Agriculture in the early 1980s, only 11.3 percent of the land was highly suitable for crops. Haiti relies upon imports for half its food needs and 80% of its rice. Haiti exports crops such as mangoes , cacao , coffee , papayas , mahogany nuts, spinach , and watercress . Agricultural products constitute 6% of all exports. In addition, local agricultural products include maize , beans , cassava , sweet potato , peanuts , pistachios , bananas , millet , pigeon peas , sugarcane, rice , sorghum , and wood . The Haitian gourde (HTG) is the national currency. The " Haitian dollar " equates to 5 gourdes ( goud ), which is a fixed exchange rate that exists in concept only , but are commonly used as informal prices. [ citation needed ] The vast majority of the business sector and individuals will also accept US dollars, though at the outdoor markets gourdes may be preferred. Locals may refer to the USD as "dollar américain" ( dola ameriken ) or "dollar US" (pronounced oo-es ). The tourism market in Haiti is undeveloped and the government is heavily promoting this sector. Haiti has many of the features that attract tourists to other Caribbean destinations, such as white sand beaches, mountainous scenery and a year-round warm climate. However, the country's poor image overseas, at times exaggerated, has hampered the development of this sector. In 2014, the country received 1,250,000 tourists (mostly from cruise ships), and the industry generated US$200 million in 2014. [ citation needed ] Several hotels were opened in 2014, including an upscale Best Western Premier , a five-star Royal Oasis hotel by Occidental Hotel and Resorts in Pétion-Ville , a four-star Marriott Hotel in the Turgeau area of Port-au-Prince and other new hotel developments in Port-au-Prince, Les Cayes , Cap-Haïtien and Jacmel . [ citation needed ] On 21 October 2012, Haitian President Michel Martelly , US Secretary of State Hillary Clinton , Bill Clinton, Richard Branson , Ben Stiller and Sean Penn inaugurated the 240-hectare (600-acre) Caracol industrial park, the largest in the Caribbean . The project cost US$300 million and included a 10-megawatt power plant , a water-treatment plant and worker housing. The plan for the park pre-dated the 2010 earthquake but was fast-tracked as part of US foreign aid strategy to help Haiti recover. The park was part of a "master plan" for Haiti's North and North-East departments, including the expansion of the Cap-Haïtien International Airport to accommodate large international flights, the construction of an international seaport in Fort-Liberté and the opening of the $50 million Roi Henri Christophe Campus of a new university in Limonade (near Cap-Haïtien) on 12 January 2012. In 2012, USAID believed the park had the potential to create as many as 65,000 jobs once fully developed. South Korean clothing manufacturer Sae-A Trading Co. Ltd , the park's only major tenant, created 5,000 permanent jobs out of the 20,000 it had projected and promised to build 5,000 houses yet only 750 homes had been built near Caracol by 2014. Ten years later, the park was considered to have failed to uphold its promise to deliver the transformation the Clintons had promised. The US invested tens of millions of dollars into the port project but eventually abandoned it. In order to establish the park, hundreds of families of small farmers had to be removed from the land, approximately 3,500 people overall. An audit by the United States Government Accountability Office uncovered that the port project lacked "staff with technical expertise in planning, construction, and oversight of a port" and revealed that USAid hadn't constructed a port anywhere since the 1970s. A USAid feasability study in 2015 found that "a new port was not viable for a variety of technical, environmental and economic reasons", that the US was short US$72m in funds to cover the majority of the projected costs, and that private companies USAid had wanted to attact "had no interest in supporting the construction of a new port in northern Haiti". Haiti received more than US$4 billion in aid from 1990 to 2003, including US$1.5 billion from the United States. The largest donor is the US, followed by Canada and the European Union . In January 2010, following the earthquake, US President Barack Obama promised US$1.15 billion in assistance. European Union nations pledged more than €400 million (US$616 million). Neighboring Dominican Republic has also provided extensive humanitarian aid to Haiti, including the funding and construction of a public university, human capital, free healthcare services in the border region, and logistical support after the 2010 earthquake. The United Nations states that US$13.34 billion has been earmarked for post-earthquake reconstruction through 2020, though two years after the 2010 quake, less than half of that amount had actually been released. As of 2015 [ update ] , the US government has allocated US$4 billion, US$3 billion has already been spent, and the rest is dedicated to longer-term projects. According to the 2015 CIA World Factbook , Haiti's main import partners are: Dominican Republic 35%, US 26.8%, Netherlands Antilles 8.7%, China 7% (est. 2013). Haiti's main export partner is the US 83.5% (est. 2013). Haiti had a trade deficit of US$3 billion in 2011, or 41% of GDP. Haiti relies heavily on an oil alliance with Petrocaribe for much of its energy requirements. In recent years, hydroelectric, solar and wind energy have been explored as possible sustainable energy sources. As of 2017, among all the countries in the Americas, Haiti is producing the least energy. Less than a quarter of the country has electric coverage. Most regions of Haiti that do have energy are powered by generators. These generators are often expensive and produce a lot of pollution. The areas that do get electricity experience power cuts on a daily basis, and some areas are limited to 12 hours of electricity a day. Electricity is provided by a small number of independent companies: Sogener, E-power, and Haytrac. There is no national electricity grid . The most common source of energy is wood, along with charcoal. About 4 million metric tons of wood products are consumed yearly. Like charcoal and wood, petroleum is also an important source of energy. Since Haiti cannot produce its own fuel, all fuel is imported. Yearly, around 691,000 tons of oil is imported into the country. In 2018, a 24-hour electricity project was announced; for this purpose 236 MW needs to installed in Port-au-Prince alone, with an additional 75 MW needed in all other regions. Presently only 27.5% of the population has access to electricity; moreover, the national energy agency l'Électricité d'Haïti (Ed'H) is only able to meet 62% of overall electricity demand. Haiti suffers from a shortage of skilled labor, widespread unemployment, and underemployment. Most Haitians in the labor force have informal jobs. Three-quarters of the population lives on US$2 or less per day. Remittances from Haitians living abroad are the primary source of foreign exchange, equaling one-fifth (20%) of GDP and more than five times the earnings from exports as of 2012. In 2004, 80% or more of college graduates from Haiti were living abroad. Occasionally, families who are unable to care for children may send them to live with a wealthier family as a restavek , or house servant . In return the family are supposed to ensure that the child is educated and provided with food and shelter; however, the system is open to abuse and has proved controversial, with some likening it to child slavery. In rural areas, people often live in wooden huts with corrugated iron roofs. Outhouses are located in back of the huts. In Port-au-Prince, colorful shantytowns surround the central city and go up the mountainsides. The middle and upper classes live in suburbs, or in the central part of the bigger cities in apartments, where there is urban planning. Many of the houses they live in are like miniature fortresses, located behind walls embedded with metal spikes, barbed wire, broken glass, and sometimes all three. The houses have backup generators, because the electrical grid is unreliable. Some even have rooftop reservoirs for water. Haiti is the world's leading producer of vetiver , a root plant used to make luxury perfumes, essential oils and fragrances, providing for half the world's supply. Roughly 40–50% of Haitians work in the agricultural sector. However, according to soil surveys by the United States Department of Agriculture in the early 1980s, only 11.3 percent of the land was highly suitable for crops. Haiti relies upon imports for half its food needs and 80% of its rice. Haiti exports crops such as mangoes , cacao , coffee , papayas , mahogany nuts, spinach , and watercress . Agricultural products constitute 6% of all exports. In addition, local agricultural products include maize , beans , cassava , sweet potato , peanuts , pistachios , bananas , millet , pigeon peas , sugarcane, rice , sorghum , and wood . The Haitian gourde (HTG) is the national currency. The " Haitian dollar " equates to 5 gourdes ( goud ), which is a fixed exchange rate that exists in concept only , but are commonly used as informal prices. [ citation needed ] The vast majority of the business sector and individuals will also accept US dollars, though at the outdoor markets gourdes may be preferred. Locals may refer to the USD as "dollar américain" ( dola ameriken ) or "dollar US" (pronounced oo-es ). The tourism market in Haiti is undeveloped and the government is heavily promoting this sector. Haiti has many of the features that attract tourists to other Caribbean destinations, such as white sand beaches, mountainous scenery and a year-round warm climate. However, the country's poor image overseas, at times exaggerated, has hampered the development of this sector. In 2014, the country received 1,250,000 tourists (mostly from cruise ships), and the industry generated US$200 million in 2014. [ citation needed ] Several hotels were opened in 2014, including an upscale Best Western Premier , a five-star Royal Oasis hotel by Occidental Hotel and Resorts in Pétion-Ville , a four-star Marriott Hotel in the Turgeau area of Port-au-Prince and other new hotel developments in Port-au-Prince, Les Cayes , Cap-Haïtien and Jacmel . [ citation needed ]On 21 October 2012, Haitian President Michel Martelly , US Secretary of State Hillary Clinton , Bill Clinton, Richard Branson , Ben Stiller and Sean Penn inaugurated the 240-hectare (600-acre) Caracol industrial park, the largest in the Caribbean . The project cost US$300 million and included a 10-megawatt power plant , a water-treatment plant and worker housing. The plan for the park pre-dated the 2010 earthquake but was fast-tracked as part of US foreign aid strategy to help Haiti recover. The park was part of a "master plan" for Haiti's North and North-East departments, including the expansion of the Cap-Haïtien International Airport to accommodate large international flights, the construction of an international seaport in Fort-Liberté and the opening of the $50 million Roi Henri Christophe Campus of a new university in Limonade (near Cap-Haïtien) on 12 January 2012. In 2012, USAID believed the park had the potential to create as many as 65,000 jobs once fully developed. South Korean clothing manufacturer Sae-A Trading Co. Ltd , the park's only major tenant, created 5,000 permanent jobs out of the 20,000 it had projected and promised to build 5,000 houses yet only 750 homes had been built near Caracol by 2014. Ten years later, the park was considered to have failed to uphold its promise to deliver the transformation the Clintons had promised. The US invested tens of millions of dollars into the port project but eventually abandoned it. In order to establish the park, hundreds of families of small farmers had to be removed from the land, approximately 3,500 people overall. An audit by the United States Government Accountability Office uncovered that the port project lacked "staff with technical expertise in planning, construction, and oversight of a port" and revealed that USAid hadn't constructed a port anywhere since the 1970s. A USAid feasability study in 2015 found that "a new port was not viable for a variety of technical, environmental and economic reasons", that the US was short US$72m in funds to cover the majority of the projected costs, and that private companies USAid had wanted to attact "had no interest in supporting the construction of a new port in northern Haiti". Haiti has two main highways that run from one end of the country to the other. The northern highway, Route Nationale No. 1 (National Highway One), originates in Port-au-Prince, winding through the coastal towns of Montrouis and Gonaïves , before reaching its terminus at the northern port Cap-Haïtien . The southern highway, Route Nationale No. 2, links Port-au-Prince with Les Cayes via Léogâne and Petit-Goâve . The state of Haiti's roads are generally poor, many being potholed and becoming impassable in rough weather. The port at Port-au-Prince, Port international de Port-au-Prince , has more registered shipping than any of the other dozen ports in the country. The port's facilities include cranes , large berths , and warehouses , but these facilities are not in good condition. The port is underused, possibly due to the substantially high port fees. The port of Saint-Marc is currently the preferred port of entry for consumer goods. In the past, Haiti used rail transport; however, the rail infrastructure was poorly maintained when in use and cost of rehabilitation is beyond the means of the Haitian economy. In 2018 the Regional Development Council of the Dominican Republic proposed a "trans-Hispaniola" railway between both countries. Toussaint Louverture International Airport , located ten kilometers (six miles) north-northeast of Port-au-Prince proper in the commune of Tabarre , is the primary hub for entry and exit into the country. It has Haiti's main jetway , and along with Cap-Haïtien International Airport handles the vast majority of the country's international flights. Cities such as Jacmel, Jérémie, Les Cayes, and Port-de-Paix have smaller, less accessible airports that are serviced by regional airlines and private aircraft. In 2013, plans for the development of an international airport on Île-à -Vache were introduced by the Prime Minister. Tap tap buses are colorfully painted buses or pick-up trucks that serve as shared taxis. The "tap tap" name comes from the sound of passengers tapping on the metal bus body to indicate they want off. These vehicles for hire are often privately owned and extensively decorated. They follow fixed routes, do not leave until filled with passengers, and riders can usually disembark at any point. The decorations are a typically Haitian form of art. In Haiti, communications include the radio, television, fixed and mobile telephones, and the Internet. Haiti ranked last among North American countries in the World Economic Forum's Network Readiness Index (NRI) – an indicator for determining the development level of a country's information and communication technologies. Haiti ranked number 143 out of 148 overall in the 2014 NRI ranking, down from 141 in 2013. Haiti faces key challenges in the water supply and sanitation sector. Notably, access to public services is very low, their quality is inadequate and public institutions remain very weak despite foreign aid and the government's declared intent to strengthen the sector's institutions. Foreign and Haitian NGOs play an important role in the sector, especially in rural and urban slum areas.Haiti has two main highways that run from one end of the country to the other. The northern highway, Route Nationale No. 1 (National Highway One), originates in Port-au-Prince, winding through the coastal towns of Montrouis and Gonaïves , before reaching its terminus at the northern port Cap-Haïtien . The southern highway, Route Nationale No. 2, links Port-au-Prince with Les Cayes via Léogâne and Petit-Goâve . The state of Haiti's roads are generally poor, many being potholed and becoming impassable in rough weather. The port at Port-au-Prince, Port international de Port-au-Prince , has more registered shipping than any of the other dozen ports in the country. The port's facilities include cranes , large berths , and warehouses , but these facilities are not in good condition. The port is underused, possibly due to the substantially high port fees. The port of Saint-Marc is currently the preferred port of entry for consumer goods. In the past, Haiti used rail transport; however, the rail infrastructure was poorly maintained when in use and cost of rehabilitation is beyond the means of the Haitian economy. In 2018 the Regional Development Council of the Dominican Republic proposed a "trans-Hispaniola" railway between both countries. Toussaint Louverture International Airport , located ten kilometers (six miles) north-northeast of Port-au-Prince proper in the commune of Tabarre , is the primary hub for entry and exit into the country. It has Haiti's main jetway , and along with Cap-Haïtien International Airport handles the vast majority of the country's international flights. Cities such as Jacmel, Jérémie, Les Cayes, and Port-de-Paix have smaller, less accessible airports that are serviced by regional airlines and private aircraft. In 2013, plans for the development of an international airport on Île-à -Vache were introduced by the Prime Minister. Tap tap buses are colorfully painted buses or pick-up trucks that serve as shared taxis. The "tap tap" name comes from the sound of passengers tapping on the metal bus body to indicate they want off. These vehicles for hire are often privately owned and extensively decorated. They follow fixed routes, do not leave until filled with passengers, and riders can usually disembark at any point. The decorations are a typically Haitian form of art. In Haiti, communications include the radio, television, fixed and mobile telephones, and the Internet. Haiti ranked last among North American countries in the World Economic Forum's Network Readiness Index (NRI) – an indicator for determining the development level of a country's information and communication technologies. Haiti ranked number 143 out of 148 overall in the 2014 NRI ranking, down from 141 in 2013. Haiti faces key challenges in the water supply and sanitation sector. Notably, access to public services is very low, their quality is inadequate and public institutions remain very weak despite foreign aid and the government's declared intent to strengthen the sector's institutions. Foreign and Haitian NGOs play an important role in the sector, especially in rural and urban slum areas.In 2018, Haiti's population was estimated to be about 10,788,000. In 2006, half of the population was younger than age 20. In 1950, the first formal census gave a total population of 3.1 million. Haiti averages approximately 350 people per square kilometer (910 people/sq mi) , with its population concentrated most heavily in urban areas, coastal plains, and valleys. Most Haitians are descendants of black Africans who were enslaved and trafficked from Africa during the Atlantic slave trade . Many are also descendants of Mulattoes who are mixed-race . The remainder are primarily of European or Arab descent . Millions of Haitian descent live abroad in the United States , Dominican Republic , Cuba , Canada (primarily Montreal ), the Bahamas , France , the French Antilles , the Turks and Caicos , Jamaica , Puerto Rico , Venezuela , Brazil , Suriname and French Guiana . There were an estimated 881,500 people of Haitian ancestry in the United States in 2015, while in the Dominican Republic there were an estimated 800,000 in 2007. There were 300,000 in Cuba in 2013, 100,000 in Canada in 2006, 80,000 in Metropolitan France (2010), and up to 80,000 in the Bahamas (2009). In 2018, the life expectancy at birth was 63.66 years. Under colonial rule, Haitian mulattoes were generally privileged above the black majority, though they possessed fewer rights than the white population. Following the country's independence, they became the nation's social elite. Numerous leaders throughout Haiti's history have been mulattoes. During this time, the enslaved persons and the affranchis were given limited opportunities toward education, income, and occupations, but even after gaining independence, the social structure remains a legacy today as the disparity between the upper and lower classes have not been reformed significantly since the colonial days. Making up 5% of the nation's population, mulattoes have retained their preeminence, evident in the political, economic, social and cultural hierarchy in Haiti. As a result, the elite class today consists of a small group of influential people who are generally light in color. Religion in Haiti according to the Pew Research Center (2010) The 2018 CIA World Factbook reported that 55% of Haitians were Catholics and 29% were Protestants (Baptist 15.4%, Pentecostal 7.9%, Seventh-day Adventist 3%, Methodist 1.5%, other 0.7%). Other sources put the Protestant population higher, suggesting that it might have formed one-third of the population in 2001. Like other countries in Latin America, Haiti has witnessed a general Protestant expansion, which is largely Evangelical and Pentecostal in nature. Haitian Cardinal Chibly Langlois is president of the National Bishops Conference of the Catholic Church. Vodou , a religion with West African roots similar to those of Cuba and Brazil , is formally practiced by 2.1% of the population; however, it is estimated that 50-80% of Haitians incorporate some elements of Vodou belief or practices into their religion, particularly with Catholicism. This reflect Vodou's colonial origins, when enslaved persons were obliged to disguise their traditional loa ( lwa ), or spirits, as Catholic saints, as part of a process called syncretism . As such, it is difficult to estimate the number of Vodouists in Haiti, especially given the legacy of historic persecution and misrepresentation in popular media and culture, as well as modern stigmatization among segments of the growing Protestant population. Nonetheless, Vodou was officially recognized by the Haitian government in 2003. Reflecting the ubiquity of Vodou culture and beliefs, while many Catholics and Protestants in Haiti denounce Vodou as devil worship , they do not deny the power or existence of its spirits; rather, they are regarded as " evil " and " satanic " adversaries that require intervention through Christian prayer . Protestants view Catholic veneration of saints as idol worship , and some Protestants would often destroy statues and other Catholic paraphernalia. Minority religions in Haiti include Islam , Bahá'í Faith , Judaism , and Buddhism . The two official languages of Haiti are French and Haitian Creole . French is the principal written and administratively authorized language (as well as the main language of the press) and is spoken by 42% of Haitians . It is spoken by all educated Haitians, is the medium of instruction in most schools, and is used in the business sector. It is also used in ceremonial events such as weddings, graduations and church Masses. Haiti is one of two independent nations in the Americas (along with Canada) to designate French as an official language ; the other French-speaking areas are all overseas départements , or collectivités , of France, such as French Guiana . Haitian Creole is spoken by nearly all of the Haitian population. French, the base language for Haitian Creole, is popular among the Haitian elite and upper classes. French is also popular in the business sector, and to a far lesser degree, English due to American influence . Spanish is spoken by some Haitians who live along the Haitian-Dominican border . English and Spanish may also be spoken by Haitian deportees from the United States and various Latin American countries. Overall, about 90–95% of Haitians only speak Haitian Creole/French fluently, with over half only knowing Creole. Haitian Creole, locally called Kreyòl , has recently undergone standardization and is spoken by virtually the entire population. One of the French-based creole languages , Haitian Creole has a vocabulary overwhelmingly derived from French, but its grammar resembles that of some West African languages. It also has influences from Taino , Spanish , and Portuguese . Haitian Creole is related to the other French creoles, and in particular to the Antillean and Louisiana Creole variants. There is a large Haitian diaspora community, predominantly based in the US and Canada, France, and the wealthier Caribbean islands. Emigrants from Haiti have constituted a segment of American and Canadian society since before the independence of Haiti from France in 1804. Many influential early American settlers and black freemen, including Jean Baptiste Point du Sable and W. E. B. Du Bois , were of Haitian origin. The educational system of Haiti is based on the French system . Higher education, under the responsibility of the Ministry of Education, is provided by universities and other public and private institutions. More than 80% of primary schools are privately managed by nongovernmental organizations, churches, communities, and for-profit operators, with minimal government oversight. According to the 2013 Millennium Development Goals Report, Haiti has steadily boosted net enrollment rate in primary education from 47% in 1993 to 88% in 2011, achieving equal participation of boys and girls in education. Charity organizations, including Food for the Poor and Haitian Health Foundation , are building schools for children and providing necessary school supplies. According to the 2015 World Factbook , Haiti's literacy rate is 60.7% . Many reformers have advocated the creation of a free, public and universal education system for all primary school-age students in Haiti. The Inter-American Development Bank estimates that the government will need at least US$3 billion to create an adequately funded system. Upon successful graduation of secondary school, students may continue into higher education . The higher education schools in Haiti include the University of Haiti . There are also medical schools and law schools offered at both the University of Haiti and abroad. Brown University is cooperating with L'Hôpital Saint-Damien in Haiti to coordinate a pediatric health care curriculum. As of 2012 [ update ] , 60% of children in Haiti under the age of 10 were vaccinated , compared to 93–95% in other countries. Recently there have been mass vaccination campaigns claiming to vaccinate as many as 91% of a target population against specific diseases (measles and rubella in this case). Most people have no transportation or access to Haitian hospitals . The World Health Organization cites diarrheal diseases, HIV/AIDS , meningitis , and respiratory infections as common causes of death in Haiti. Ninety percent of Haiti's children suffer from waterborne diseases and intestinal parasites . HIV infection is found in 1.71% of Haiti's population (est. 2015). The incidence of tuberculosis (TB) in Haiti is more than ten times as high as in the rest of Latin America. [ citation needed ] Approximately 30,000 Haitians fall ill with malaria each year. Roughly 75% of Haitian households lack running water. Unsafe water, along with inadequate housing and unsanitary living conditions, contributes to the high incidence of infectious diseases. There is a chronic shortage of health care personnel and hospitals lack resources, a situation that became readily apparent after the January 2010 earthquake. The infant mortality rate in Haiti in 2019 was 48.2 deaths per 1,000 live births, compared to 5.6 per 1,000 in the United States. After the 2010 earthquake, Partners In Health founded the Hôpital Universitaire de Mirebalais , the largest solar-powered hospital in the world. Under colonial rule, Haitian mulattoes were generally privileged above the black majority, though they possessed fewer rights than the white population. Following the country's independence, they became the nation's social elite. Numerous leaders throughout Haiti's history have been mulattoes. During this time, the enslaved persons and the affranchis were given limited opportunities toward education, income, and occupations, but even after gaining independence, the social structure remains a legacy today as the disparity between the upper and lower classes have not been reformed significantly since the colonial days. Making up 5% of the nation's population, mulattoes have retained their preeminence, evident in the political, economic, social and cultural hierarchy in Haiti. As a result, the elite class today consists of a small group of influential people who are generally light in color. Religion in Haiti according to the Pew Research Center (2010) The 2018 CIA World Factbook reported that 55% of Haitians were Catholics and 29% were Protestants (Baptist 15.4%, Pentecostal 7.9%, Seventh-day Adventist 3%, Methodist 1.5%, other 0.7%). Other sources put the Protestant population higher, suggesting that it might have formed one-third of the population in 2001. Like other countries in Latin America, Haiti has witnessed a general Protestant expansion, which is largely Evangelical and Pentecostal in nature. Haitian Cardinal Chibly Langlois is president of the National Bishops Conference of the Catholic Church. Vodou , a religion with West African roots similar to those of Cuba and Brazil , is formally practiced by 2.1% of the population; however, it is estimated that 50-80% of Haitians incorporate some elements of Vodou belief or practices into their religion, particularly with Catholicism. This reflect Vodou's colonial origins, when enslaved persons were obliged to disguise their traditional loa ( lwa ), or spirits, as Catholic saints, as part of a process called syncretism . As such, it is difficult to estimate the number of Vodouists in Haiti, especially given the legacy of historic persecution and misrepresentation in popular media and culture, as well as modern stigmatization among segments of the growing Protestant population. Nonetheless, Vodou was officially recognized by the Haitian government in 2003. Reflecting the ubiquity of Vodou culture and beliefs, while many Catholics and Protestants in Haiti denounce Vodou as devil worship , they do not deny the power or existence of its spirits; rather, they are regarded as " evil " and " satanic " adversaries that require intervention through Christian prayer . Protestants view Catholic veneration of saints as idol worship , and some Protestants would often destroy statues and other Catholic paraphernalia. Minority religions in Haiti include Islam , Bahá'í Faith , Judaism , and Buddhism . The two official languages of Haiti are French and Haitian Creole . French is the principal written and administratively authorized language (as well as the main language of the press) and is spoken by 42% of Haitians . It is spoken by all educated Haitians, is the medium of instruction in most schools, and is used in the business sector. It is also used in ceremonial events such as weddings, graduations and church Masses. Haiti is one of two independent nations in the Americas (along with Canada) to designate French as an official language ; the other French-speaking areas are all overseas départements , or collectivités , of France, such as French Guiana . Haitian Creole is spoken by nearly all of the Haitian population. French, the base language for Haitian Creole, is popular among the Haitian elite and upper classes. French is also popular in the business sector, and to a far lesser degree, English due to American influence . Spanish is spoken by some Haitians who live along the Haitian-Dominican border . English and Spanish may also be spoken by Haitian deportees from the United States and various Latin American countries. Overall, about 90–95% of Haitians only speak Haitian Creole/French fluently, with over half only knowing Creole. Haitian Creole, locally called Kreyòl , has recently undergone standardization and is spoken by virtually the entire population. One of the French-based creole languages , Haitian Creole has a vocabulary overwhelmingly derived from French, but its grammar resembles that of some West African languages. It also has influences from Taino , Spanish , and Portuguese . Haitian Creole is related to the other French creoles, and in particular to the Antillean and Louisiana Creole variants.There is a large Haitian diaspora community, predominantly based in the US and Canada, France, and the wealthier Caribbean islands. Emigrants from Haiti have constituted a segment of American and Canadian society since before the independence of Haiti from France in 1804. Many influential early American settlers and black freemen, including Jean Baptiste Point du Sable and W. E. B. Du Bois , were of Haitian origin. The educational system of Haiti is based on the French system . Higher education, under the responsibility of the Ministry of Education, is provided by universities and other public and private institutions. More than 80% of primary schools are privately managed by nongovernmental organizations, churches, communities, and for-profit operators, with minimal government oversight. According to the 2013 Millennium Development Goals Report, Haiti has steadily boosted net enrollment rate in primary education from 47% in 1993 to 88% in 2011, achieving equal participation of boys and girls in education. Charity organizations, including Food for the Poor and Haitian Health Foundation , are building schools for children and providing necessary school supplies. According to the 2015 World Factbook , Haiti's literacy rate is 60.7% . Many reformers have advocated the creation of a free, public and universal education system for all primary school-age students in Haiti. The Inter-American Development Bank estimates that the government will need at least US$3 billion to create an adequately funded system. Upon successful graduation of secondary school, students may continue into higher education . The higher education schools in Haiti include the University of Haiti . There are also medical schools and law schools offered at both the University of Haiti and abroad. Brown University is cooperating with L'Hôpital Saint-Damien in Haiti to coordinate a pediatric health care curriculum. As of 2012 [ update ] , 60% of children in Haiti under the age of 10 were vaccinated , compared to 93–95% in other countries. Recently there have been mass vaccination campaigns claiming to vaccinate as many as 91% of a target population against specific diseases (measles and rubella in this case). Most people have no transportation or access to Haitian hospitals . The World Health Organization cites diarrheal diseases, HIV/AIDS , meningitis , and respiratory infections as common causes of death in Haiti. Ninety percent of Haiti's children suffer from waterborne diseases and intestinal parasites . HIV infection is found in 1.71% of Haiti's population (est. 2015). The incidence of tuberculosis (TB) in Haiti is more than ten times as high as in the rest of Latin America. [ citation needed ] Approximately 30,000 Haitians fall ill with malaria each year. Roughly 75% of Haitian households lack running water. Unsafe water, along with inadequate housing and unsanitary living conditions, contributes to the high incidence of infectious diseases. There is a chronic shortage of health care personnel and hospitals lack resources, a situation that became readily apparent after the January 2010 earthquake. The infant mortality rate in Haiti in 2019 was 48.2 deaths per 1,000 live births, compared to 5.6 per 1,000 in the United States. After the 2010 earthquake, Partners In Health founded the Hôpital Universitaire de Mirebalais , the largest solar-powered hospital in the world. Haiti has a lasting and unique cultural identity, blending traditional French and African customs, mixed with sizable acquirements from the Spanish and indigenous Taíno cultures. Haitian art is distinctive , particularly through its paintings and sculptures. Brilliant colors, naïve perspectives, and sly humor characterize Haitian art . Frequent subjects in Haitian art include big, foods, landscapes, market activities, jungle animals, rituals, dances, and gods. As a result of a deep history and strong African ties, symbols take on great meaning within Haitian society. Many artists cluster in 'schools' of painting, such as the Cap-Haïtien school, which features depictions of daily life in the city, the Jacmel School, which reflects the steep mountains and bays of that coastal town, or the Saint-Soleil School, which is characterized by abstracted human forms and is heavily influenced by Vodou symbolism. [ citation needed ] In the 1920s the indigéniste movement gained international acclaim, with its expressionist paintings inspired by Haiti's culture and African roots. Notable painters of this movement include Hector Hyppolite , Philomé Oban and Préfète Duffaut . Some notable artists of more recent times include Edouard Duval-Carrié , Frantz Zéphirin, Leroy Exil, Prosper Pierre Louis and Louisiane Saint Fleurant . Sculpture is also practiced in Haiti; noted artists in this form include George Liautaud and Serge Jolimeau . Haitian music combines a wide range of influences drawn from the many people who have settled here. It reflects French, African and Spanish elements and others who have inhabited the island of Hispaniola , and minor native Taino influences. Styles of music unique to the nation of Haiti include music derived from Vodou ceremonial traditions, Rara parading music, Twoubadou ballads , mini-jazz rock bands, Rasin movement, Hip hop kreyòl, méringue , and compas . Youth attend parties at nightclubs called discos , and attend Bal (ball, as in a formal dance). Compas (konpa) is a complex, ever-changing music that arose from African rhythms and European ballroom dancing, mixed with Haiti's bourgeois culture. It is a refined music, with méringue as its basic rhythm. Haiti had no recorded music until 1937 when Jazz Guignard was recorded non-commercially. Haiti has always been a literary nation that has produced poetry, novels, and plays of international recognition. The French colonial experience established the French language as the venue of culture and prestige, and since then it has dominated the literary circles and the literary production. However, since the 18th century there has been a sustained effort to write in Haitian Creole . The recognition of Creole as an official language has led to an expansion of novels, poems, and plays in Creole. In 1975, Franketienne was the first to break with the French tradition in fiction with the publication of Dezafi , the first novel written entirely in Haitian Creole. Other well known Haitian authors include Jean Price-Mars , Jacques Roumain , Jacques Stephen Alexis , Marie Vieux-Chauvet , Pierre Clitandre, René Depestre , Edwidge Danticat , Lyonel Trouillot and Dany Laferrière . Haiti has a small though growing cinema industry. Well-known directors working primarily in documentary film-making include Raoul Peck and Arnold Antonin . Directors producing fictional films include Patricia Benoît , Wilkenson Bruna and Richard Senecal. Haiti is famous for its creole cuisine (related to Cajun cuisine ), and its soup joumou . Monuments include the Sans-Souci Palace and the Citadelle Laferrière , inscribed as a World Heritage Site in 1982. Situated in the Northern Massif du Nord , in the National History Park , the structures date from the early 19th century. The buildings were among the first built after Haiti's independence from France. The Citadelle Laferrière , the largest fortress in the Americas, is located in northern Haiti. It was built between 1805 and 1820 and is today referred to by some Haitians as the eighth wonder of the world . The Institute for the Protection of National Heritage has preserved 33 historical monuments and the historic center of Cap-Haïtien. Jacmel , a colonial city that was tentatively accepted as a World Heritage Site, was extensively damaged by the 2010 earthquake. The anchor of Christopher Columbus's largest ship, the Santa María rests in the Musée du Panthéon National Haïtien (MUPANAH), in Port-au-Prince. Haiti is known for its folklore traditions. Much of this is rooted in Haitian Vodou tradition. Belief in zombies is also common. Other folkloric creatures include the lougarou . The Haitian Carnival has been one of the most popular carnivals in the Caribbean. In 2010, the government decided to stage the event in a different city outside Port-au-Prince every year. The National Carnival follows the popular Jacmel Carnival, which takes place a week earlier in February or March. Rara is a festival celebrated before Easter . The festival has generated a style of Carnival music . Football (soccer) is the most popular sport in Haiti with hundreds of small clubs competing at the local level. Basketball and baseball are growing in popularity. Stade Sylvio Cator is the multi-purpose stadium in Port-au-Prince, currently used mostly for association football matches. In 1974 , the Haiti national football team were only the second Caribbean team to make the World Cup . The national team won the 2007 Caribbean Nations Cup . Haiti has participated in the Olympic Games since the year 1900 and won a number of medals. Haitian footballer Joe Gaetjens played for the United States national team in the 1950 FIFA World Cup , scoring the winning goal in the 1–0 upset of England . Haitian art is distinctive , particularly through its paintings and sculptures. Brilliant colors, naïve perspectives, and sly humor characterize Haitian art . Frequent subjects in Haitian art include big, foods, landscapes, market activities, jungle animals, rituals, dances, and gods. As a result of a deep history and strong African ties, symbols take on great meaning within Haitian society. Many artists cluster in 'schools' of painting, such as the Cap-Haïtien school, which features depictions of daily life in the city, the Jacmel School, which reflects the steep mountains and bays of that coastal town, or the Saint-Soleil School, which is characterized by abstracted human forms and is heavily influenced by Vodou symbolism. [ citation needed ] In the 1920s the indigéniste movement gained international acclaim, with its expressionist paintings inspired by Haiti's culture and African roots. Notable painters of this movement include Hector Hyppolite , Philomé Oban and Préfète Duffaut . Some notable artists of more recent times include Edouard Duval-Carrié , Frantz Zéphirin, Leroy Exil, Prosper Pierre Louis and Louisiane Saint Fleurant . Sculpture is also practiced in Haiti; noted artists in this form include George Liautaud and Serge Jolimeau . Haitian music combines a wide range of influences drawn from the many people who have settled here. It reflects French, African and Spanish elements and others who have inhabited the island of Hispaniola , and minor native Taino influences. Styles of music unique to the nation of Haiti include music derived from Vodou ceremonial traditions, Rara parading music, Twoubadou ballads , mini-jazz rock bands, Rasin movement, Hip hop kreyòl, méringue , and compas . Youth attend parties at nightclubs called discos , and attend Bal (ball, as in a formal dance). Compas (konpa) is a complex, ever-changing music that arose from African rhythms and European ballroom dancing, mixed with Haiti's bourgeois culture. It is a refined music, with méringue as its basic rhythm. Haiti had no recorded music until 1937 when Jazz Guignard was recorded non-commercially. Haiti has always been a literary nation that has produced poetry, novels, and plays of international recognition. The French colonial experience established the French language as the venue of culture and prestige, and since then it has dominated the literary circles and the literary production. However, since the 18th century there has been a sustained effort to write in Haitian Creole . The recognition of Creole as an official language has led to an expansion of novels, poems, and plays in Creole. In 1975, Franketienne was the first to break with the French tradition in fiction with the publication of Dezafi , the first novel written entirely in Haitian Creole. Other well known Haitian authors include Jean Price-Mars , Jacques Roumain , Jacques Stephen Alexis , Marie Vieux-Chauvet , Pierre Clitandre, René Depestre , Edwidge Danticat , Lyonel Trouillot and Dany Laferrière .Haiti has a small though growing cinema industry. Well-known directors working primarily in documentary film-making include Raoul Peck and Arnold Antonin . Directors producing fictional films include Patricia Benoît , Wilkenson Bruna and Richard Senecal.Haiti is famous for its creole cuisine (related to Cajun cuisine ), and its soup joumou . Monuments include the Sans-Souci Palace and the Citadelle Laferrière , inscribed as a World Heritage Site in 1982. Situated in the Northern Massif du Nord , in the National History Park , the structures date from the early 19th century. The buildings were among the first built after Haiti's independence from France. The Citadelle Laferrière , the largest fortress in the Americas, is located in northern Haiti. It was built between 1805 and 1820 and is today referred to by some Haitians as the eighth wonder of the world . The Institute for the Protection of National Heritage has preserved 33 historical monuments and the historic center of Cap-Haïtien. Jacmel , a colonial city that was tentatively accepted as a World Heritage Site, was extensively damaged by the 2010 earthquake. The anchor of Christopher Columbus's largest ship, the Santa María rests in the Musée du Panthéon National Haïtien (MUPANAH), in Port-au-Prince. Haiti is known for its folklore traditions. Much of this is rooted in Haitian Vodou tradition. Belief in zombies is also common. Other folkloric creatures include the lougarou . The Haitian Carnival has been one of the most popular carnivals in the Caribbean. In 2010, the government decided to stage the event in a different city outside Port-au-Prince every year. The National Carnival follows the popular Jacmel Carnival, which takes place a week earlier in February or March. Rara is a festival celebrated before Easter . The festival has generated a style of Carnival music . Football (soccer) is the most popular sport in Haiti with hundreds of small clubs competing at the local level. Basketball and baseball are growing in popularity. Stade Sylvio Cator is the multi-purpose stadium in Port-au-Prince, currently used mostly for association football matches. In 1974 , the Haiti national football team were only the second Caribbean team to make the World Cup . The national team won the 2007 Caribbean Nations Cup . Haiti has participated in the Olympic Games since the year 1900 and won a number of medals. Haitian footballer Joe Gaetjens played for the United States national team in the 1950 FIFA World Cup , scoring the winning goal in the 1–0 upset of England .

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Mecca

The Holy Capital ( العاص٠ة ال٠قدسة ) Mother of all Settlements ( أ٠القرى ) Mecca ( / ˈ m ɛ k ə / ; officially Makkah al-Mukarramah , [lower-alpha 1] commonly shortened to Makkah [lower-alpha 2] ) is the capital of Mecca Province in the Hejaz region of western Saudi Arabia and the holiest city in Islam . It is 70 km (43 mi) inland from Jeddah on the Red Sea , in a narrow valley 277 m (909 ft) above sea level. Its last recorded population was 2,385,509 in 2022. Its metropolitan population in 2022 is 2.4 million, making it the third-most populated city in Saudi Arabia after Riyadh and Jeddah. Around 44.5% of the population are Saudi citizens and around 55.5% are foreigners from other Muslim countries . Pilgrims more than triple the population number every year during the Ḥajj pilgrimage , observed in the twelfth Hijri month of Dhūl-Ḥijjah . [ citation needed ] With over 10.8 million international visitors in 2023, Mecca was one of the 10 most visited cities in the world. Mecca is generally considered "the fountainhead and cradle of Islam ". Mecca is revered in Islam as the birthplace of the Islamic prophet Muhammad . The Hira cave atop the Jabal al-Nur ("Mountain of Light"), just outside the city, is where Muslims believe the Quran was first revealed to Muhammad. Visiting Mecca for the Ḥajj is an obligation upon all able Muslims. The Great Mosque of Mecca , known as the Masjid al-Haram , is home to the Ka'bah , believed by Muslims to have been built by Abraham and Ishmael . It is Islam's holiest site and the direction of prayer ( qibla ) for all Muslims worldwide. Muslim rulers from in and around the region long tried to take the city and keep it in their control, and thus, much like most of the Hejaz region, the city has seen several regime changes . The city was most recently conquered in the Saudi conquest of Hejaz by Ibn Saud and his allies in 1925. Since then, Mecca has seen a tremendous expansion in size and infrastructure, with newer, modern buildings such as the Abraj Al Bait , the world's fourth-tallest building and third-largest by floor area , [ citation needed ] towering over the Great Mosque. The Saudi government has also carried out the destruction of several historical structures and archaeological sites , such as the Ajyad Fortress . However, many of the demolitions have officially been part of the continued expansion of the Masjid al-Haram at Mecca and the Prophet's Mosque in Medina and their auxiliary service facilities in order to accommodate the ever-increasing number of Muslims performing the pilgrimage ( hajj ). Non-Muslims are strictly prohibited from entering the city . Under the Saudi government, Mecca is governed by the Mecca Regional Municipality, a municipal council of 14 locally elected members headed by the mayor (called Amin in Arabic) appointed by the Saudi government . In 2015, the mayor of the city was Osama bin Fadhel Al-Barr; as of January 2022 [ update ] , the mayor is Saleh Al-Turki. The City of Mecca amanah , which constitutes Mecca and the surrounding region, is the capital of the Mecca Province, which includes the neighbouring cities of Jeddah and Ta'if , even though Jeddah is considerably larger in population compared to Mecca. The Provincial Governor of the province since 16 May 2007 is Prince Khalid bin Faisal Al Saud . Mecca has been referred to by many names. As with many Arabic words, its etymology is obscure. Widely believed to be a synonym for Makkah , it is said to be more specifically the early name for the valley located therein, while Muslim scholars generally use it to refer to the sacred area of the city that immediately surrounds and includes the Ka'bah . The Quran refers to the city as Bakkah in Surah Al Imran (3), verse 96: "Indeed the first House [of worship] , established for mankind was that at Bakkah". This is said to have been the name of the city at the time of Abraham (Ibrahim in Islamic tradition ) and it is also transliterated as Baca, Baka, Bakah, Bakka, Becca and Bekka , among others. It was a name for the city in the ancient world. Makkah is the official transliteration used by the Saudi government and is closer to the Arabic pronunciation. The government adopted Makkah as the official spelling in the 1980s, but it is not universally known or used worldwide. The full official name is Makkah al-Mukarramah ( Arabic : ٠كة ال٠كر٠ة , lit. ' Makkah the Honored ' ). Makkah is used to refer to the city in the Quran in Surah Al-Fath (48), verse 24. The word Mecca in English has come to be used to refer to any place that draws large numbers of people, and because of this some English-speaking Muslims have come to regard the use of this spelling for the city as offensive. Nonetheless, Mecca is the familiar form of the English transliteration for the Arabic name of the city. Macoraba, another ancient city name mentioned by Claudius Ptolemy Felix' Arabia Felix , was also claimed to be Mecca. Some studies have questioned this association. Many etymologies have been proposed: the traditional one is that it is derived from the Old South Arabian root M-K-R-B which means "temple". Another name used for Mecca in the Quran is at 6:92 where it is called Umm al-Qurā ( أُ٠ّ ٱلْقُرَى ‎ , meaning "Mother of all Settlements"). The city has been called several other names in both the Quran and ahadith . Another name used historically for Mecca is Tihāmah . According to an Islamic suggestion, another name for Mecca, Fārān , is synonymous with the Desert of Paran mentioned in the Old Testament at Genesis 21 :21. Arab and Islamic tradition holds that the wilderness of Paran, broadly speaking, is the Tihamah coastal plain and the site where Ishmael settled was Mecca. Yaqut al-Hamawi , the 12th-century Syrian geographer, wrote that Fārān was "an arabized Hebrew word, one of the names of Mecca mentioned in the Torah." (See also: Wadi Faran )The Quran refers to the city as Bakkah in Surah Al Imran (3), verse 96: "Indeed the first House [of worship] , established for mankind was that at Bakkah". This is said to have been the name of the city at the time of Abraham (Ibrahim in Islamic tradition ) and it is also transliterated as Baca, Baka, Bakah, Bakka, Becca and Bekka , among others. It was a name for the city in the ancient world. Makkah is the official transliteration used by the Saudi government and is closer to the Arabic pronunciation. The government adopted Makkah as the official spelling in the 1980s, but it is not universally known or used worldwide. The full official name is Makkah al-Mukarramah ( Arabic : ٠كة ال٠كر٠ة , lit. ' Makkah the Honored ' ). Makkah is used to refer to the city in the Quran in Surah Al-Fath (48), verse 24. The word Mecca in English has come to be used to refer to any place that draws large numbers of people, and because of this some English-speaking Muslims have come to regard the use of this spelling for the city as offensive. Nonetheless, Mecca is the familiar form of the English transliteration for the Arabic name of the city. Macoraba, another ancient city name mentioned by Claudius Ptolemy Felix' Arabia Felix , was also claimed to be Mecca. Some studies have questioned this association. Many etymologies have been proposed: the traditional one is that it is derived from the Old South Arabian root M-K-R-B which means "temple". Another name used for Mecca in the Quran is at 6:92 where it is called Umm al-Qurā ( أُ٠ّ ٱلْقُرَى ‎ , meaning "Mother of all Settlements"). The city has been called several other names in both the Quran and ahadith . Another name used historically for Mecca is Tihāmah . According to an Islamic suggestion, another name for Mecca, Fārān , is synonymous with the Desert of Paran mentioned in the Old Testament at Genesis 21 :21. Arab and Islamic tradition holds that the wilderness of Paran, broadly speaking, is the Tihamah coastal plain and the site where Ishmael settled was Mecca. Yaqut al-Hamawi , the 12th-century Syrian geographer, wrote that Fārān was "an arabized Hebrew word, one of the names of Mecca mentioned in the Torah." (See also: Wadi Faran )In 2010, Mecca and the surrounding area became an important site for paleontology with respect to primate evolution, with the discovery of a Saadanius fossil. Saadanius is considered to be a primate closely related to the common ancestor of the Old World monkeys and apes . The fossil habitat, near what is now the Red Sea in western Saudi Arabia, was a damp forest area between 28 million and 29 million years ago. Paleontologists involved in the research hope to find further fossils in the area. The early history of Mecca is still largely shrouded by a lack of clear evidence. The city lies in the hinterland of the middle part of western Arabia of which there are sparse textual or archaeological sources available. Contrary to the thousands of years of history suggested by the Islamic tradition, there are no known unambiguous references to Mecca in ancient literature prior to the rise of Islam. [ unreliable source? ] This lack of knowledge is in contrast to both the northern and southern areas of western Arabia, specifically the Syro-Palestinian frontier and Yemen, where historians have various sources available such as physical remains of shrines, inscriptions, observations by Greco-Roman authors, and information collected by church historians. The area of Hejaz that surrounds Mecca was characterized by its remote, rocky, and inhospitable nature, supporting only meagre settled populations in scattered oases and occasional stretches of fertile land. The Red Sea coast offered no easily accessible ports and the oasis dwellers and bedouins in the region were illiterate. Recent research suggests that Mecca was a small town and its population at the time of Muhammad has been estimated to be around 550. The first clear reference to Mecca in non-Islamic literature appears in 741 CE, long after the death of Muhammad, in the Byzantine-Arab Chronicle, though here the author places the region in Mesopotamia rather than the Hejaz. [ unreliable source? ] Possible earlier mentions are not unambiguous. The Greek historian Diodorus Siculus writes about Arabia in the 1st century BCE in his work Bibliotheca historica , describing a holy shrine: "And a temple has been set up there, which is very holy and exceedingly revered by all Arabians". Claims have been made this could be a reference to the Ka'bah in Mecca. However, the geographic location Diodorus describes is located in northwest Arabia, around the area of Leuke Kome , within the former Nabataean Kingdom and the Roman province of Arabia Petraea . Ptolemy lists the names of 50 cities in Arabia, one going by the name of Macoraba. There has been speculation since 1646 that this could be a reference to Mecca. Historically, there has been a general consensus in scholarship that Macoraba mentioned by Ptolemy in the 2nd century CE is indeed Mecca, but more recently, this has been questioned. Bowersock favors the identity of the former, with his theory being that "Macoraba" is the word " Makkah" followed by the aggrandizing Aramaic adjective rabb (great). The Roman historian Ammianus Marcellinus also enumerated many cities of Western Arabia, most of which can be identified. According to Bowersock, he did mention Mecca as "Geapolis" or "Hierapolis", the latter one meaning "holy city" potentially referring to the sanctuary of the Kaaba . Patricia Crone , from the Revisionist school of Islamic studies on the other hand, writes that "the plain truth is that the name Macoraba has nothing to do with that of Mecca [...] if Ptolemy mentions Mecca at all, he calls it Moka, a town in Arabia Petraea ". Procopius ' 6th century statement that the Ma'ad tribe possessed the coast of western Arabia between the Ghassanids and the Himyarites of the south supports the Arabic sources tradition that associates Quraysh as a branch of the Ma'add and Muhammad as a direct descendant of Ma'ad ibn Adnan . Historian Patricia Crone has cast doubt on the claim that Mecca was a major historical trading outpost. However, other scholars such as Glen W. Bowersock disagree and assert that Mecca was a major trading outpost. Crone later on disregarded some of her theories. She argues that Meccan trade relied on skins, hides, manufactured leather goods, clarified butter, Hijazi woollens, and camels. She suggests that most of these goods were destined for the Roman army, which is known to have required colossal quantities of leather and hides for its equipment. Mecca is mentioned in the following early Quranic manuscripts: Codex Is. 1615 I, folio 47v, radiocarbon dated to 591–643 CE. Codex Ṣanʿāʾ DAM 01–29.1, folio 29a, radiocarbon dated between 633 and 665 CE. Codex Arabe 331, folio 40 v, radiocarbon dated between 652 and 765 CE. The earliest Muslim inscriptions are from the Mecca- Ta'if area. Islamic narrative In the Islamic view, the beginnings of Mecca are attributed to the Biblical figures , Adam , Abraham , Hagar and Ishmael . It was Adam himself who built the first God's house in Mecca according to a heavenly prototype but this building was destroyed in the Noahic Flood . The civilization of Mecca is believed to have started after Ibrāhīm (Abraham) left his son Ismāʿīl (Ishmael) and wife Hājar (Hagar) in the valley at Allah 's command. [ citation needed ] Some people from the Yemeni tribe of Jurhum settled with them, and Isma'il reportedly married two women, one after divorcing the first, on Ibrahim's advice. At least one man of the Jurhum helped Ismāʿīl and his father to construct or according to Islamic narratives, reconstruct, the Ka'bah ('Cube'), which would have social, religious, political and historical implications for the site and region. Muslims see the mention of a pilgrimage at the Valley of the Bakha in the Old Testament chapter Psalm 84 :3–6 as a reference to Mecca, similar to the Quran at Surah 3:96 In the Sharḥ al-Asāṭīr , a commentary on the Samaritan midrashic chronology of the Patriarchs, of unknown date but probably composed in the 10th century CE, it is claimed that Mecca was built by the sons of Nebaioth , the eldest son of Ismāʿīl or Ishmael . Thamudic inscriptions Some Thamudic inscriptions which were discovered in the south Jordan contained names of some individuals such as ʿAbd Mekkat ( عَبْد ٠َكَّة ‎ , "Servant of Mecca"). There were also some other inscriptions which contained personal names such as Makki ( ٠َكِّي , "Makkan, of Makkah"), but Jawwad Ali from the University of Baghdad suggested that there's also a probability of a tribe named "Makkah". Sometime in the 5th century, the Ka'bah was a place of worship for the deities of Arabia's pagan tribes . Mecca's most important pagan deity was Hubal , which had been placed there by the ruling Quraish tribe. and remained until the Conquest of Mecca by Muhammad . [ citation needed ] In the 5th century, the Quraish took control of Mecca, and became skilled merchants and traders. In the 6th century, they joined the lucrative spice trade , since battles elsewhere were diverting trade routes from dangerous sea routes to more secure overland routes. The Byzantine Empire had previously controlled the Red Sea , but piracy had been increasing. [ citation needed ] Another previous route that ran through the Persian Gulf via the Tigris and Euphrates rivers was also being threatened by exploitations from the Sassanid Empire , and was being disrupted by the Lakhmids , the Ghassanids , and the Roman–Persian Wars . Mecca's prominence as a trading center also surpassed the cities of Petra and Palmyra . The Sassanids however did not always pose a threat to Mecca, as in 575 CE they protected it from a Yemeni invasion, led by its Christian leader Abraha . The tribes of southern Arabia asked the Persian king Khosrau I for aid, in response to which he came south to Arabia with foot-soldiers and a fleet of ships near Mecca. By the middle of the 6th century, there were three major settlements in northern Arabia , all along the south-western coast that borders the Red Sea, in a habitable region between the sea and the Hejaz mountains to the east. Although the area around Mecca was completely barren, it was the wealthiest of the three settlements with abundant water from the renowned Zamzam Well and a position at the crossroads of major caravan routes. The harsh conditions and terrain of the Arabian peninsula meant a near-constant state of conflict between the local tribes , but once a year they would declare a truce and converge upon Mecca in an annual pilgrimage. Up to the 7th century, this journey was intended for religious reasons by the pagan Arabs to pay homage to their shrine, and to drink Zamzam . However, it was also the time each year that disputes would be arbitrated, debts would be resolved, and trading would occur at Meccan fairs. These annual events gave the tribes a sense of common identity and made Mecca an important focus for the peninsula. The Year of the Elephant (570 CE) The " Year of the Elephant " is the name in Islamic history for the year approximately equating to 570–572 CE , when, according to Islamic sources such as Ibn Ishaq , Abraha descended upon Mecca, riding an elephant, with a large army after building a cathedral at San'aa , named al-Qullays in honor of the Negus of Axum . It gained widespread fame, even gaining attention from the Byzantine Empire . Abraha attempted to divert the pilgrimage of the Arabs from the Ka'bah to al-Qullays, effectively converting them to Christianity. According to Islamic tradition, this was the year of Muhammad 's birth. Abraha allegedly sent a messenger named Muhammad ibn Khuza'i to Mecca and Tihamah with a message that al-Qullays was both much better than other houses of worship and purer, having not been defiled by the housing of idols. When Muhammad ibn Khuza'i got as far as the land of Kinana , the people of the lowland, knowing what he had come for, sent a man of Hudhayl called ʿUrwa bin Hayyad al-Milasi, who shot him with an arrow, killing him. His brother Qays who was with him, fled to Abraha and told him the news, which increased his rage and fury and he swore to raid the Kinana tribe and destroy the Ka'bah. Ibn Ishaq further states that one of the men of the Quraysh tribe was angered by this, and going to Sana'a, entering the church at night and defiling it; widely assumed to have done so by defecating in it. Abraha marched upon the Ka'bah with a large army, which included one or more war elephants , intending to demolish it. When news of the advance of his army came, the Arab tribes of Quraysh, Kinanah, Khuza'a and Hudhayl united in the defense of the Ka'bah and the city. A man from the Himyarite Kingdom was sent by Abraha to advise them that Abraha only wished to demolish the Ka'bah and if they resisted, they would be crushed. Abdul Muttalib told the Meccans to seek refuge in the hills while he and some members of the Quraysh remained within the precincts of the Kaaba. Abraha sent a dispatch inviting Abdul-Muttalib to meet with Abraha and discuss matters. When Abdul-Muttalib left the meeting he was heard saying: "The Owner of this House is its Defender, and I am sure he will save it from the attack of the adversaries and will not dishonor the servants of His House." Abraha eventually attacked Mecca. However, the lead elephant, known as Mahmud, is said to have stopped at the boundary around Mecca and refused to enter. It has been theorized that an epidemic such as by smallpox could have caused such a failed invasion of Mecca. The reference to the story in Quran is rather short. According to the 105th Surah of the Quran, Al-Fil , the next day, a dark cloud of small birds sent by Allah appeared. The birds carried small rocks in their beaks, and bombarded the Ethiopian forces, and smashed them to a state like that of eaten straw. Economy Camel caravans, said to have first been used by Muhammad's great-grandfather, were a major part of Mecca's bustling economy. Alliances were struck between the merchants in Mecca and the local nomadic tribes, who would bring goods – leather, livestock, and metals mined in the local mountains – to Mecca to be loaded on the caravans and carried to cities in Shaam and Iraq . Historical accounts also provide some indication that goods from other continents may also have flowed through Mecca. Goods from Africa and the Far East passed through en route to Syria including spices, leather, medicine, cloth, and slaves; in return Mecca received money, weapons, cereals and wine, which in turn were distributed throughout Arabia. [ citation needed ] The Meccans signed treaties with both the Byzantines and the Bedouins , and negotiated safe passages for caravans, giving them water and pasture rights. Mecca became the center of a loose confederation of client tribes, which included those of the Banu Tamim . Other regional powers such as the Abyssinians , Ghassanids, and Lakhmids were in decline leaving Meccan trade to be the primary binding force in Arabia in the late 6th century. Muhammad was born in Mecca in 570 CE, and thus Islam has been inextricably linked with it ever since. He was born into the faction of Banu Hashim in the ruling tribe of Quraysh . It was in the nearby mountain cave of Hira on Jabal al-Nour that Muhammad began receiving divine revelations from God through the archangel Jibreel in 610 CE, according to Islamic tradition. Advocating his form of Abrahamic monotheism against Meccan paganism, and after enduring persecution from the pagan tribes for 13 years, Muhammad emigrated to Medina ( hijrah ) in 622 CE with his companions, the Muhajirun , to Yathrib (later renamed Medina ). The conflict between the Quraysh and the Muslims is accepted to have begun at this point. Overall, Meccan efforts to annihilate Islam failed and proved to be costly and unsuccessful. [ citation needed ] During the Battle of the Trench in 627 CE, the combined armies of Arabia were unable to defeat Muhammad's forces (as the trench surrounding Muhammad's forces protected them from harm and a storm was sent to breach the Quraysh tribe). In 628 CE, Muhammad and his followers wanted to enter Mecca for pilgrimage, but were blocked by the Quraysh. Subsequently, Muslims and Meccans entered into the Treaty of Hudaybiyyah , whereby the Quraysh and their allies promised to cease fighting Muslims and their allies and promised that Muslims would be allowed into the city to perform the pilgrimage the following year. It was meant to be a ceasefire for 10 years; however, just two years later, the Banu Bakr , allies of the Quraish, violated the truce by slaughtering a group of the Banu Khuza'ah, allies of the Muslims. Muhammad and his companions, now 10,000 strong, marched into Mecca and conquered the city. The pagan imagery was destroyed by Muhammad's followers and the location Islamized and rededicated to the worship of Allah alone. Mecca was declared the holiest site in Islam ordaining it as the center of Muslim pilgrimage ( Hajj ), one of the Islamic faith's Five Pillars . Muhammad then returned to Medina, after assigning ' Akib ibn Usaid as governor of the city. His other activities in Arabia led to the unification of the Arabian Peninsula under the banner of Islam. Muhammad died in 632 CE. Within the next few hundred years, the area under the banner of Islam stretched from North Africa into Asia and parts of Europe. As the Islamic realm grew, Mecca continued to attract pilgrims from all across the Muslim world and beyond, as Muslims came to perform the annual Hajj pilgrimage. Mecca also attracted a year-round population of scholars, pious Muslims who wished to live close to the Kaaba, and local inhabitants who served the pilgrims. Due to the difficulty and expense of the Hajj, pilgrims arrived by boat at Jeddah, and came overland, or joined the annual caravans from Syria or Iraq. [ citation needed ] Mecca was never the capital of any of the Islamic states . Muslim rulers did contribute to its upkeep, such as during the reigns of ' Umar (r. 634–644 CE) and ' Uthman ibn Affan (r. 644–656 CE) when concerns of flooding caused the caliphs to bring in Christian engineers to build barrages in the low-lying quarters and construct dykes and embankments to protect the area around the Kaaba. Muhammad's return to Medina shifted the focus away from Mecca and later even further away when ' Ali , the fourth caliph, took power and chose Kufa as his capital. The Umayyad Caliphate moved the capital to Damascus in Syria and the Abbasid Caliphate to Baghdad , in modern-day Iraq, which remained the center of the Islamic Empire for nearly 500 years. Mecca re-entered Islamic political history during the Second Fitna , when it was held by Abdullah ibn az-Zubayr and the Zubayrids. [ citation needed ] The city was twice besieged by the Umayyads in 683 CE and 692 CE, and for some time thereafter, the city figured little in politics, remaining a city of devotion and scholarship governed by various other factions. In 930 CE, Mecca was attacked and sacked by Qarmatians , a millenarian Shi'a Isma'ili Muslim sect led by Abū-Tāhir Al-Jannābī and centered in eastern Arabia. The Black Death pandemic hit Mecca in 1349 CE. One of the most famous travelers to Mecca in the 14th century was a Moroccan scholar and traveler, Ibn Battuta . In his rihla (account), he provides a vast description of the city. Around the year 1327 CE or 729 AH, Ibn Battuta arrived at the holy city. Immediately, he says, it felt like a holy sanctuary, and thus he started the rites of the pilgrimage. He remained in Mecca for three years and left in 1330 CE. During his second year in the holy city, he says his caravan arrived "with a great quantity of alms for the support of those who were staying in Mecca and Medina". While in Mecca, prayers were made for (not to) the King of Iraq and also for Salaheddin al-Ayyubi , Sultan of Egypt and Syria at the Ka'bah. Battuta says the Ka'bah was large, but was destroyed and rebuilt smaller than the original. According to Ibn Battuta, the original Kaaba, prior to the conquest of Makkah by the Prophet, contained images of angels and prophets including Jesus (Isa in Islamic tradition), his mother Mary (Maryam in Islamic tradition), and many others - Ibn Battuta however states these were all destroyed by the Prophet in the year of victory. Battuta describes the Ka'bah in his time as an important part of Mecca due to the fact that many people make the pilgrimage to it. Battuta describes the people of the city as being humble and kind, and also willing to give a part of everything they had to someone who had nothing. The inhabitants of Mecca and the village itself, he says, were very clean. There was also a sense of elegance to the village. Under the Ottomans In 1517, the then Sharif of Mecca, Barakat bin Muhammad, acknowledged the supremacy of the Ottoman Caliph but retained a great degree of local autonomy. In 1803 the city was captured by the First Saudi State , which held Mecca until 1813, destroying some of the historic tombs and domes in and around the city. The Ottomans assigned the task of bringing Mecca back under Ottoman control to their powerful Khedive (viceroy) and Wali of Egypt, Muhammad Ali Pasha . Muhammad Ali Pasha successfully returned Mecca to Ottoman control in 1813 . In 1818, the Saud were defeated again but survived and founded the Second Saudi State that lasted until 1891 and led on to the present country of Saudi Arabia. In 1853, Sir Richard Francis Burton undertook the Muslim pilgrimage to Mecca and Medina disguised as a Muslim. Although Burton was certainly not the first non-Muslim European to make the Hajj ( Ludovico di Varthema did this in 1503), his pilgrimage remains one of the most famous and documented of modern times. Mecca was regularly hit by cholera outbreaks . Between 1830 and 1930, cholera broke out among pilgrims at Mecca 27 times. Hashemite Revolt and subsequent control by the Sharifate of Mecca In World War I , the Ottoman Empire was at war with the Allies . It had successfully repulsed an attack on Istanbul in the Gallipoli campaign and on Baghdad in the Siege of Kut . The British intelligence agent T.E. Lawrence conspired with the Ottoman governor, Hussain bin Ali , the Sharif of Mecca to revolt against the Ottoman Empire and it was the first city captured by his forces in the 1916 Battle of Mecca . Sharif's revolt proved a turning point of the war on the eastern front. Hussein declared a new state, the Kingdom of Hejaz , declaring himself the Sharif of the state and Mecca his capital. News reports in November 1916 via contact in Cairo with returning Hajj pilgrims, stated that with the Ottoman Turkish authorities gone, the Hajj of 1916 was free of the previous massive extortion and monetary demands made by the Turks who were agents of the Ottoman government. Saudi Arabian conquest and modern history Following the 1924 Battle of Mecca , the Sharif of Mecca was overthrown by the Saud family, and Mecca was incorporated into Saudi Arabia. Under Saudi rule, much of the historic city has been demolished as a result of the Saudi government fearing these sites might become sites of association in worship besides Allah ( shirk ). The city has been expanded to include several towns previously considered to be separate from the holy city and now is just a few kilometers outside the main sites of the Hajj, Mina, Muzdalifah and Arafat. Mecca is not served by any airport, due to concerns about the city's safety. It is instead served by the King Abdulaziz International Airport in Jeddah (approx. 70 km away) internationally and the Ta'if Regional Airport (approx. 120 km away) for domestic flights. [ citation needed ] The city today is at the junction of the two most important highways in all of the Saudi Arabian highway system, Highway 40, which connects the city to Jeddah in the west and the capital, Riyadh and Dammam in the east and Highway 15, which connects it to Medina , Tabuk and onward to Jordan in the north and Abha and Jizan in the south. The Ottomans had planned to extend their railway network to the holy city, but were forced to abandon this plan due to their entry into the First World War . This plan was later carried out by the Saudi government, which connected the two holy cities of Medina and Mecca with the modern Haramain high-speed railway system which runs at 300 km/h (190 mph) and connects the two cities via Jeddah, King Abdulaziz International Airport and King Abdullah Economic City near Rabigh within two hours. [ citation needed ] The haram area of Mecca, in which the entry of non-Muslims is forbidden, is much larger than that of Medina. 1979 Grand Mosque seizure On 20 November 1979, two hundred armed dissidents led by Juhayman al-Otaibi , seized the Grand Mosque , claiming the Saudi royal family no longer represented pure Islam and that the Masjid al-Haram and the Ka'bah, must be held by those of true faith. The rebels seized tens of thousands of pilgrims as hostages and barricaded themselves in the mosque. The siege lasted two weeks, and resulted in several hundred deaths and significant damage to the shrine, especially the Safa-Marwah gallery. A multinational force was finally able to retake the mosque from the dissidents. Since then, the Grand Mosque has been expanded several times, with many other expansions being undertaken in the present day. Destruction of Islamic heritage sites Under Saudi rule, it has been estimated that since 1985, about 95% of Mecca's historic buildings, most over a thousand years old, have been demolished. It has been reported that there are now fewer than 20 structures remaining in Mecca that date back to the time of Muhammad. Some important buildings that have been destroyed include the house of Khadijah , the wife of Muhammad, the house of Abu Bakr , Muhammad's birthplace and the Ottoman-era Ajyad Fortress . The reason for much of the destruction of historic buildings has been for the construction of hotels, apartments, parking lots, and other infrastructure facilities for Hajj pilgrims. Incidents during pilgrimage Mecca has been the site of several incidents and failures of crowd control because of the large numbers of people who come to make the Hajj. For example, on 2 July 1990, a pilgrimage to Mecca ended in tragedy when the ventilation system failed in a crowded pedestrian tunnel and 1,426 people were either suffocated or trampled to death in a stampede . On 24 September 2015, 700 pilgrims were killed in a stampede at Mina during the stoning-the-Devil ritual at Jamarat. 2027 Total Solar Eclipse Mecca will experience a total solar eclipse on Monday, August 2, 2027, for a duration of 5 minutes and 8 seconds. In 2010, Mecca and the surrounding area became an important site for paleontology with respect to primate evolution, with the discovery of a Saadanius fossil. Saadanius is considered to be a primate closely related to the common ancestor of the Old World monkeys and apes . The fossil habitat, near what is now the Red Sea in western Saudi Arabia, was a damp forest area between 28 million and 29 million years ago. Paleontologists involved in the research hope to find further fossils in the area. The early history of Mecca is still largely shrouded by a lack of clear evidence. The city lies in the hinterland of the middle part of western Arabia of which there are sparse textual or archaeological sources available. Contrary to the thousands of years of history suggested by the Islamic tradition, there are no known unambiguous references to Mecca in ancient literature prior to the rise of Islam. [ unreliable source? ] This lack of knowledge is in contrast to both the northern and southern areas of western Arabia, specifically the Syro-Palestinian frontier and Yemen, where historians have various sources available such as physical remains of shrines, inscriptions, observations by Greco-Roman authors, and information collected by church historians. The area of Hejaz that surrounds Mecca was characterized by its remote, rocky, and inhospitable nature, supporting only meagre settled populations in scattered oases and occasional stretches of fertile land. The Red Sea coast offered no easily accessible ports and the oasis dwellers and bedouins in the region were illiterate. Recent research suggests that Mecca was a small town and its population at the time of Muhammad has been estimated to be around 550. The first clear reference to Mecca in non-Islamic literature appears in 741 CE, long after the death of Muhammad, in the Byzantine-Arab Chronicle, though here the author places the region in Mesopotamia rather than the Hejaz. [ unreliable source? ] Possible earlier mentions are not unambiguous. The Greek historian Diodorus Siculus writes about Arabia in the 1st century BCE in his work Bibliotheca historica , describing a holy shrine: "And a temple has been set up there, which is very holy and exceedingly revered by all Arabians". Claims have been made this could be a reference to the Ka'bah in Mecca. However, the geographic location Diodorus describes is located in northwest Arabia, around the area of Leuke Kome , within the former Nabataean Kingdom and the Roman province of Arabia Petraea . Ptolemy lists the names of 50 cities in Arabia, one going by the name of Macoraba. There has been speculation since 1646 that this could be a reference to Mecca. Historically, there has been a general consensus in scholarship that Macoraba mentioned by Ptolemy in the 2nd century CE is indeed Mecca, but more recently, this has been questioned. Bowersock favors the identity of the former, with his theory being that "Macoraba" is the word " Makkah" followed by the aggrandizing Aramaic adjective rabb (great). The Roman historian Ammianus Marcellinus also enumerated many cities of Western Arabia, most of which can be identified. According to Bowersock, he did mention Mecca as "Geapolis" or "Hierapolis", the latter one meaning "holy city" potentially referring to the sanctuary of the Kaaba . Patricia Crone , from the Revisionist school of Islamic studies on the other hand, writes that "the plain truth is that the name Macoraba has nothing to do with that of Mecca [...] if Ptolemy mentions Mecca at all, he calls it Moka, a town in Arabia Petraea ". Procopius ' 6th century statement that the Ma'ad tribe possessed the coast of western Arabia between the Ghassanids and the Himyarites of the south supports the Arabic sources tradition that associates Quraysh as a branch of the Ma'add and Muhammad as a direct descendant of Ma'ad ibn Adnan . Historian Patricia Crone has cast doubt on the claim that Mecca was a major historical trading outpost. However, other scholars such as Glen W. Bowersock disagree and assert that Mecca was a major trading outpost. Crone later on disregarded some of her theories. She argues that Meccan trade relied on skins, hides, manufactured leather goods, clarified butter, Hijazi woollens, and camels. She suggests that most of these goods were destined for the Roman army, which is known to have required colossal quantities of leather and hides for its equipment. Mecca is mentioned in the following early Quranic manuscripts: Codex Is. 1615 I, folio 47v, radiocarbon dated to 591–643 CE. Codex Ṣanʿāʾ DAM 01–29.1, folio 29a, radiocarbon dated between 633 and 665 CE. Codex Arabe 331, folio 40 v, radiocarbon dated between 652 and 765 CE. The earliest Muslim inscriptions are from the Mecca- Ta'if area. Islamic narrative In the Islamic view, the beginnings of Mecca are attributed to the Biblical figures , Adam , Abraham , Hagar and Ishmael . It was Adam himself who built the first God's house in Mecca according to a heavenly prototype but this building was destroyed in the Noahic Flood . The civilization of Mecca is believed to have started after Ibrāhīm (Abraham) left his son Ismāʿīl (Ishmael) and wife Hājar (Hagar) in the valley at Allah 's command. [ citation needed ] Some people from the Yemeni tribe of Jurhum settled with them, and Isma'il reportedly married two women, one after divorcing the first, on Ibrahim's advice. At least one man of the Jurhum helped Ismāʿīl and his father to construct or according to Islamic narratives, reconstruct, the Ka'bah ('Cube'), which would have social, religious, political and historical implications for the site and region. Muslims see the mention of a pilgrimage at the Valley of the Bakha in the Old Testament chapter Psalm 84 :3–6 as a reference to Mecca, similar to the Quran at Surah 3:96 In the Sharḥ al-Asāṭīr , a commentary on the Samaritan midrashic chronology of the Patriarchs, of unknown date but probably composed in the 10th century CE, it is claimed that Mecca was built by the sons of Nebaioth , the eldest son of Ismāʿīl or Ishmael . Thamudic inscriptions Some Thamudic inscriptions which were discovered in the south Jordan contained names of some individuals such as ʿAbd Mekkat ( عَبْد ٠َكَّة ‎ , "Servant of Mecca"). There were also some other inscriptions which contained personal names such as Makki ( ٠َكِّي , "Makkan, of Makkah"), but Jawwad Ali from the University of Baghdad suggested that there's also a probability of a tribe named "Makkah". Sometime in the 5th century, the Ka'bah was a place of worship for the deities of Arabia's pagan tribes . Mecca's most important pagan deity was Hubal , which had been placed there by the ruling Quraish tribe. and remained until the Conquest of Mecca by Muhammad . [ citation needed ] In the 5th century, the Quraish took control of Mecca, and became skilled merchants and traders. In the 6th century, they joined the lucrative spice trade , since battles elsewhere were diverting trade routes from dangerous sea routes to more secure overland routes. The Byzantine Empire had previously controlled the Red Sea , but piracy had been increasing. [ citation needed ] Another previous route that ran through the Persian Gulf via the Tigris and Euphrates rivers was also being threatened by exploitations from the Sassanid Empire , and was being disrupted by the Lakhmids , the Ghassanids , and the Roman–Persian Wars . Mecca's prominence as a trading center also surpassed the cities of Petra and Palmyra . The Sassanids however did not always pose a threat to Mecca, as in 575 CE they protected it from a Yemeni invasion, led by its Christian leader Abraha . The tribes of southern Arabia asked the Persian king Khosrau I for aid, in response to which he came south to Arabia with foot-soldiers and a fleet of ships near Mecca. By the middle of the 6th century, there were three major settlements in northern Arabia , all along the south-western coast that borders the Red Sea, in a habitable region between the sea and the Hejaz mountains to the east. Although the area around Mecca was completely barren, it was the wealthiest of the three settlements with abundant water from the renowned Zamzam Well and a position at the crossroads of major caravan routes. The harsh conditions and terrain of the Arabian peninsula meant a near-constant state of conflict between the local tribes , but once a year they would declare a truce and converge upon Mecca in an annual pilgrimage. Up to the 7th century, this journey was intended for religious reasons by the pagan Arabs to pay homage to their shrine, and to drink Zamzam . However, it was also the time each year that disputes would be arbitrated, debts would be resolved, and trading would occur at Meccan fairs. These annual events gave the tribes a sense of common identity and made Mecca an important focus for the peninsula. The Year of the Elephant (570 CE) The " Year of the Elephant " is the name in Islamic history for the year approximately equating to 570–572 CE , when, according to Islamic sources such as Ibn Ishaq , Abraha descended upon Mecca, riding an elephant, with a large army after building a cathedral at San'aa , named al-Qullays in honor of the Negus of Axum . It gained widespread fame, even gaining attention from the Byzantine Empire . Abraha attempted to divert the pilgrimage of the Arabs from the Ka'bah to al-Qullays, effectively converting them to Christianity. According to Islamic tradition, this was the year of Muhammad 's birth. Abraha allegedly sent a messenger named Muhammad ibn Khuza'i to Mecca and Tihamah with a message that al-Qullays was both much better than other houses of worship and purer, having not been defiled by the housing of idols. When Muhammad ibn Khuza'i got as far as the land of Kinana , the people of the lowland, knowing what he had come for, sent a man of Hudhayl called ʿUrwa bin Hayyad al-Milasi, who shot him with an arrow, killing him. His brother Qays who was with him, fled to Abraha and told him the news, which increased his rage and fury and he swore to raid the Kinana tribe and destroy the Ka'bah. Ibn Ishaq further states that one of the men of the Quraysh tribe was angered by this, and going to Sana'a, entering the church at night and defiling it; widely assumed to have done so by defecating in it. Abraha marched upon the Ka'bah with a large army, which included one or more war elephants , intending to demolish it. When news of the advance of his army came, the Arab tribes of Quraysh, Kinanah, Khuza'a and Hudhayl united in the defense of the Ka'bah and the city. A man from the Himyarite Kingdom was sent by Abraha to advise them that Abraha only wished to demolish the Ka'bah and if they resisted, they would be crushed. Abdul Muttalib told the Meccans to seek refuge in the hills while he and some members of the Quraysh remained within the precincts of the Kaaba. Abraha sent a dispatch inviting Abdul-Muttalib to meet with Abraha and discuss matters. When Abdul-Muttalib left the meeting he was heard saying: "The Owner of this House is its Defender, and I am sure he will save it from the attack of the adversaries and will not dishonor the servants of His House." Abraha eventually attacked Mecca. However, the lead elephant, known as Mahmud, is said to have stopped at the boundary around Mecca and refused to enter. It has been theorized that an epidemic such as by smallpox could have caused such a failed invasion of Mecca. The reference to the story in Quran is rather short. According to the 105th Surah of the Quran, Al-Fil , the next day, a dark cloud of small birds sent by Allah appeared. The birds carried small rocks in their beaks, and bombarded the Ethiopian forces, and smashed them to a state like that of eaten straw. Economy Camel caravans, said to have first been used by Muhammad's great-grandfather, were a major part of Mecca's bustling economy. Alliances were struck between the merchants in Mecca and the local nomadic tribes, who would bring goods – leather, livestock, and metals mined in the local mountains – to Mecca to be loaded on the caravans and carried to cities in Shaam and Iraq . Historical accounts also provide some indication that goods from other continents may also have flowed through Mecca. Goods from Africa and the Far East passed through en route to Syria including spices, leather, medicine, cloth, and slaves; in return Mecca received money, weapons, cereals and wine, which in turn were distributed throughout Arabia. [ citation needed ] The Meccans signed treaties with both the Byzantines and the Bedouins , and negotiated safe passages for caravans, giving them water and pasture rights. Mecca became the center of a loose confederation of client tribes, which included those of the Banu Tamim . Other regional powers such as the Abyssinians , Ghassanids, and Lakhmids were in decline leaving Meccan trade to be the primary binding force in Arabia in the late 6th century. Muhammad was born in Mecca in 570 CE, and thus Islam has been inextricably linked with it ever since. He was born into the faction of Banu Hashim in the ruling tribe of Quraysh . It was in the nearby mountain cave of Hira on Jabal al-Nour that Muhammad began receiving divine revelations from God through the archangel Jibreel in 610 CE, according to Islamic tradition. Advocating his form of Abrahamic monotheism against Meccan paganism, and after enduring persecution from the pagan tribes for 13 years, Muhammad emigrated to Medina ( hijrah ) in 622 CE with his companions, the Muhajirun , to Yathrib (later renamed Medina ). The conflict between the Quraysh and the Muslims is accepted to have begun at this point. Overall, Meccan efforts to annihilate Islam failed and proved to be costly and unsuccessful. [ citation needed ] During the Battle of the Trench in 627 CE, the combined armies of Arabia were unable to defeat Muhammad's forces (as the trench surrounding Muhammad's forces protected them from harm and a storm was sent to breach the Quraysh tribe). In 628 CE, Muhammad and his followers wanted to enter Mecca for pilgrimage, but were blocked by the Quraysh. Subsequently, Muslims and Meccans entered into the Treaty of Hudaybiyyah , whereby the Quraysh and their allies promised to cease fighting Muslims and their allies and promised that Muslims would be allowed into the city to perform the pilgrimage the following year. It was meant to be a ceasefire for 10 years; however, just two years later, the Banu Bakr , allies of the Quraish, violated the truce by slaughtering a group of the Banu Khuza'ah, allies of the Muslims. Muhammad and his companions, now 10,000 strong, marched into Mecca and conquered the city. The pagan imagery was destroyed by Muhammad's followers and the location Islamized and rededicated to the worship of Allah alone. Mecca was declared the holiest site in Islam ordaining it as the center of Muslim pilgrimage ( Hajj ), one of the Islamic faith's Five Pillars . Muhammad then returned to Medina, after assigning ' Akib ibn Usaid as governor of the city. His other activities in Arabia led to the unification of the Arabian Peninsula under the banner of Islam. Muhammad died in 632 CE. Within the next few hundred years, the area under the banner of Islam stretched from North Africa into Asia and parts of Europe. As the Islamic realm grew, Mecca continued to attract pilgrims from all across the Muslim world and beyond, as Muslims came to perform the annual Hajj pilgrimage. Mecca also attracted a year-round population of scholars, pious Muslims who wished to live close to the Kaaba, and local inhabitants who served the pilgrims. Due to the difficulty and expense of the Hajj, pilgrims arrived by boat at Jeddah, and came overland, or joined the annual caravans from Syria or Iraq. [ citation needed ]Mecca was never the capital of any of the Islamic states . Muslim rulers did contribute to its upkeep, such as during the reigns of ' Umar (r. 634–644 CE) and ' Uthman ibn Affan (r. 644–656 CE) when concerns of flooding caused the caliphs to bring in Christian engineers to build barrages in the low-lying quarters and construct dykes and embankments to protect the area around the Kaaba. Muhammad's return to Medina shifted the focus away from Mecca and later even further away when ' Ali , the fourth caliph, took power and chose Kufa as his capital. The Umayyad Caliphate moved the capital to Damascus in Syria and the Abbasid Caliphate to Baghdad , in modern-day Iraq, which remained the center of the Islamic Empire for nearly 500 years. Mecca re-entered Islamic political history during the Second Fitna , when it was held by Abdullah ibn az-Zubayr and the Zubayrids. [ citation needed ] The city was twice besieged by the Umayyads in 683 CE and 692 CE, and for some time thereafter, the city figured little in politics, remaining a city of devotion and scholarship governed by various other factions. In 930 CE, Mecca was attacked and sacked by Qarmatians , a millenarian Shi'a Isma'ili Muslim sect led by Abū-Tāhir Al-Jannābī and centered in eastern Arabia. The Black Death pandemic hit Mecca in 1349 CE. One of the most famous travelers to Mecca in the 14th century was a Moroccan scholar and traveler, Ibn Battuta . In his rihla (account), he provides a vast description of the city. Around the year 1327 CE or 729 AH, Ibn Battuta arrived at the holy city. Immediately, he says, it felt like a holy sanctuary, and thus he started the rites of the pilgrimage. He remained in Mecca for three years and left in 1330 CE. During his second year in the holy city, he says his caravan arrived "with a great quantity of alms for the support of those who were staying in Mecca and Medina". While in Mecca, prayers were made for (not to) the King of Iraq and also for Salaheddin al-Ayyubi , Sultan of Egypt and Syria at the Ka'bah. Battuta says the Ka'bah was large, but was destroyed and rebuilt smaller than the original. According to Ibn Battuta, the original Kaaba, prior to the conquest of Makkah by the Prophet, contained images of angels and prophets including Jesus (Isa in Islamic tradition), his mother Mary (Maryam in Islamic tradition), and many others - Ibn Battuta however states these were all destroyed by the Prophet in the year of victory. Battuta describes the Ka'bah in his time as an important part of Mecca due to the fact that many people make the pilgrimage to it. Battuta describes the people of the city as being humble and kind, and also willing to give a part of everything they had to someone who had nothing. The inhabitants of Mecca and the village itself, he says, were very clean. There was also a sense of elegance to the village. Under the Ottomans In 1517, the then Sharif of Mecca, Barakat bin Muhammad, acknowledged the supremacy of the Ottoman Caliph but retained a great degree of local autonomy. In 1803 the city was captured by the First Saudi State , which held Mecca until 1813, destroying some of the historic tombs and domes in and around the city. The Ottomans assigned the task of bringing Mecca back under Ottoman control to their powerful Khedive (viceroy) and Wali of Egypt, Muhammad Ali Pasha . Muhammad Ali Pasha successfully returned Mecca to Ottoman control in 1813 . In 1818, the Saud were defeated again but survived and founded the Second Saudi State that lasted until 1891 and led on to the present country of Saudi Arabia. In 1853, Sir Richard Francis Burton undertook the Muslim pilgrimage to Mecca and Medina disguised as a Muslim. Although Burton was certainly not the first non-Muslim European to make the Hajj ( Ludovico di Varthema did this in 1503), his pilgrimage remains one of the most famous and documented of modern times. Mecca was regularly hit by cholera outbreaks . Between 1830 and 1930, cholera broke out among pilgrims at Mecca 27 times. One of the most famous travelers to Mecca in the 14th century was a Moroccan scholar and traveler, Ibn Battuta . In his rihla (account), he provides a vast description of the city. Around the year 1327 CE or 729 AH, Ibn Battuta arrived at the holy city. Immediately, he says, it felt like a holy sanctuary, and thus he started the rites of the pilgrimage. He remained in Mecca for three years and left in 1330 CE. During his second year in the holy city, he says his caravan arrived "with a great quantity of alms for the support of those who were staying in Mecca and Medina". While in Mecca, prayers were made for (not to) the King of Iraq and also for Salaheddin al-Ayyubi , Sultan of Egypt and Syria at the Ka'bah. Battuta says the Ka'bah was large, but was destroyed and rebuilt smaller than the original. According to Ibn Battuta, the original Kaaba, prior to the conquest of Makkah by the Prophet, contained images of angels and prophets including Jesus (Isa in Islamic tradition), his mother Mary (Maryam in Islamic tradition), and many others - Ibn Battuta however states these were all destroyed by the Prophet in the year of victory. Battuta describes the Ka'bah in his time as an important part of Mecca due to the fact that many people make the pilgrimage to it. Battuta describes the people of the city as being humble and kind, and also willing to give a part of everything they had to someone who had nothing. The inhabitants of Mecca and the village itself, he says, were very clean. There was also a sense of elegance to the village. Under the Ottomans In 1517, the then Sharif of Mecca, Barakat bin Muhammad, acknowledged the supremacy of the Ottoman Caliph but retained a great degree of local autonomy. In 1803 the city was captured by the First Saudi State , which held Mecca until 1813, destroying some of the historic tombs and domes in and around the city. The Ottomans assigned the task of bringing Mecca back under Ottoman control to their powerful Khedive (viceroy) and Wali of Egypt, Muhammad Ali Pasha . Muhammad Ali Pasha successfully returned Mecca to Ottoman control in 1813 . In 1818, the Saud were defeated again but survived and founded the Second Saudi State that lasted until 1891 and led on to the present country of Saudi Arabia. In 1853, Sir Richard Francis Burton undertook the Muslim pilgrimage to Mecca and Medina disguised as a Muslim. Although Burton was certainly not the first non-Muslim European to make the Hajj ( Ludovico di Varthema did this in 1503), his pilgrimage remains one of the most famous and documented of modern times. Mecca was regularly hit by cholera outbreaks . Between 1830 and 1930, cholera broke out among pilgrims at Mecca 27 times. Hashemite Revolt and subsequent control by the Sharifate of Mecca In World War I , the Ottoman Empire was at war with the Allies . It had successfully repulsed an attack on Istanbul in the Gallipoli campaign and on Baghdad in the Siege of Kut . The British intelligence agent T.E. Lawrence conspired with the Ottoman governor, Hussain bin Ali , the Sharif of Mecca to revolt against the Ottoman Empire and it was the first city captured by his forces in the 1916 Battle of Mecca . Sharif's revolt proved a turning point of the war on the eastern front. Hussein declared a new state, the Kingdom of Hejaz , declaring himself the Sharif of the state and Mecca his capital. News reports in November 1916 via contact in Cairo with returning Hajj pilgrims, stated that with the Ottoman Turkish authorities gone, the Hajj of 1916 was free of the previous massive extortion and monetary demands made by the Turks who were agents of the Ottoman government. Saudi Arabian conquest and modern history Following the 1924 Battle of Mecca , the Sharif of Mecca was overthrown by the Saud family, and Mecca was incorporated into Saudi Arabia. Under Saudi rule, much of the historic city has been demolished as a result of the Saudi government fearing these sites might become sites of association in worship besides Allah ( shirk ). The city has been expanded to include several towns previously considered to be separate from the holy city and now is just a few kilometers outside the main sites of the Hajj, Mina, Muzdalifah and Arafat. Mecca is not served by any airport, due to concerns about the city's safety. It is instead served by the King Abdulaziz International Airport in Jeddah (approx. 70 km away) internationally and the Ta'if Regional Airport (approx. 120 km away) for domestic flights. [ citation needed ] The city today is at the junction of the two most important highways in all of the Saudi Arabian highway system, Highway 40, which connects the city to Jeddah in the west and the capital, Riyadh and Dammam in the east and Highway 15, which connects it to Medina , Tabuk and onward to Jordan in the north and Abha and Jizan in the south. The Ottomans had planned to extend their railway network to the holy city, but were forced to abandon this plan due to their entry into the First World War . This plan was later carried out by the Saudi government, which connected the two holy cities of Medina and Mecca with the modern Haramain high-speed railway system which runs at 300 km/h (190 mph) and connects the two cities via Jeddah, King Abdulaziz International Airport and King Abdullah Economic City near Rabigh within two hours. [ citation needed ] The haram area of Mecca, in which the entry of non-Muslims is forbidden, is much larger than that of Medina. 1979 Grand Mosque seizure On 20 November 1979, two hundred armed dissidents led by Juhayman al-Otaibi , seized the Grand Mosque , claiming the Saudi royal family no longer represented pure Islam and that the Masjid al-Haram and the Ka'bah, must be held by those of true faith. The rebels seized tens of thousands of pilgrims as hostages and barricaded themselves in the mosque. The siege lasted two weeks, and resulted in several hundred deaths and significant damage to the shrine, especially the Safa-Marwah gallery. A multinational force was finally able to retake the mosque from the dissidents. Since then, the Grand Mosque has been expanded several times, with many other expansions being undertaken in the present day. Destruction of Islamic heritage sites Under Saudi rule, it has been estimated that since 1985, about 95% of Mecca's historic buildings, most over a thousand years old, have been demolished. It has been reported that there are now fewer than 20 structures remaining in Mecca that date back to the time of Muhammad. Some important buildings that have been destroyed include the house of Khadijah , the wife of Muhammad, the house of Abu Bakr , Muhammad's birthplace and the Ottoman-era Ajyad Fortress . The reason for much of the destruction of historic buildings has been for the construction of hotels, apartments, parking lots, and other infrastructure facilities for Hajj pilgrims. Incidents during pilgrimage Mecca has been the site of several incidents and failures of crowd control because of the large numbers of people who come to make the Hajj. For example, on 2 July 1990, a pilgrimage to Mecca ended in tragedy when the ventilation system failed in a crowded pedestrian tunnel and 1,426 people were either suffocated or trampled to death in a stampede . On 24 September 2015, 700 pilgrims were killed in a stampede at Mina during the stoning-the-Devil ritual at Jamarat. 2027 Total Solar Eclipse Mecca will experience a total solar eclipse on Monday, August 2, 2027, for a duration of 5 minutes and 8 seconds. Mecca holds an important place in Islam and is considered the holiest city in all branches of the religion. The city derives its importance from the role it plays in the Hajj and ' Umrah and for its status as the birthplace of Muhammad. The Masjid al-Haram is the site of two of the most important rites of both the Hajj and of the Umrah, the circumambulation around the Ka'bah ( tawaf ) and the walking between the two mounts of Safa and Marwa ( sa'ee ). The masjid is also the site of the Zamzam Well . According to Islamic tradition, a prayer in the masjid is equal to 100,000 prayers in any other masjid around the world. There is a difference of opinion between Islamic scholars upon who first built the Ka'bah , some believe it was built by the angels while others believe it was built by Adam . Regardless, it was built several times before reaching its current state. The Ka'bah is also the common direction of prayer ( qibla ) for all Muslims. The surface surrounding the Ka'bah on which Muslims circumambulate it is known as the Mataf. The Black Stone is a stone, considered by scientists to be a meteorite or of similar origin and believed by Muslims to be of divine origin. It is set in the eastern corner of the Ka'bah and it is Sunnah to touch and kiss the stone. The area around the stone is generally always crowded and guarded by policemen to ensure the pilgrims' safety. In Islamic tradition, the stone was sent down from Jannah (Paradise) and used to build the Ka'bah. It used to be a white stone (and was whiter than milk). Because of the worldly sins of man, it slowly changed color to black over the years after it was brought down to Earth. This is the stone that Ibrahim (Abraham) stood on to build the higher parts of the Ka'bah. It contains two footprints that are comparatively larger than average modern-day human feet. The stone is raised and housed in a golden hexagonal chamber beside the Ka'bah on the Mataf plate. The stone inside the casing is square shaped and measures 40 cm (16 in) in length and width, and 20 cm (7.9 in) in height. It used to be enclosed by a structure called the Maqsurat Ibrahim which was covered by a sitara : an ornamental, embroidered curtain that was replaced annually. Currently, it is placed inside a golden-metal enclosure. The outer casing has changed a number of times over the years; historic photographs show that the arch of the Banu Shaybah Gate stood next to it. Muslims believe that in the divine revelation to Muhammad, the Quran, Allah describes the mountains of Safa and Marwah as symbols of His divinity. Walking between the two mountains seven times, 4 times from Safa to Marwah and 3 times from Marwah interchangeably, is considered a mandatory pillar ( rukn ) of ' Umrah . The Hajj pilgrimage, also called the greater pilgrimage, attracts millions of Muslims from all over the world and almost triples Mecca's population for one week in the twelfth and final Islamic month of Dhu al-Hijjah . In 2019, the Hajj attracted 2,489,406 pilgrims to the holy city. The 'Umrah, or the lesser pilgrimage, can be done at anytime during the year. Every adult, healthy Muslim who has the financial and physical capacity to travel to Mecca must perform the Hajj at least once in a lifetime. Umrah, the lesser pilgrimage, is not obligatory, but is recommended in the Quran. In addition to the Masjid al-Haram , pilgrims also must visit the nearby towns of Mina/Muna , Muzdalifah and Mount Arafat for various rituals that are part of the Hajj. This is a mountain believed by Muslims to have been the place where Muhammad spent his time away from the bustling city of Mecca in seclusion. The mountain is located on the eastern entrance of the city and is the highest point in the city at 642 meters (2,106 feet). Situated atop Jabal an-Nur, this is the cave where Muslims believe Muhammad received the first revelation from Allah through the archangel Gabriel ( Jibril in Islamic tradition) at the age of 40. The Masjid al-Haram is the site of two of the most important rites of both the Hajj and of the Umrah, the circumambulation around the Ka'bah ( tawaf ) and the walking between the two mounts of Safa and Marwa ( sa'ee ). The masjid is also the site of the Zamzam Well . According to Islamic tradition, a prayer in the masjid is equal to 100,000 prayers in any other masjid around the world. There is a difference of opinion between Islamic scholars upon who first built the Ka'bah , some believe it was built by the angels while others believe it was built by Adam . Regardless, it was built several times before reaching its current state. The Ka'bah is also the common direction of prayer ( qibla ) for all Muslims. The surface surrounding the Ka'bah on which Muslims circumambulate it is known as the Mataf. The Black Stone is a stone, considered by scientists to be a meteorite or of similar origin and believed by Muslims to be of divine origin. It is set in the eastern corner of the Ka'bah and it is Sunnah to touch and kiss the stone. The area around the stone is generally always crowded and guarded by policemen to ensure the pilgrims' safety. In Islamic tradition, the stone was sent down from Jannah (Paradise) and used to build the Ka'bah. It used to be a white stone (and was whiter than milk). Because of the worldly sins of man, it slowly changed color to black over the years after it was brought down to Earth. This is the stone that Ibrahim (Abraham) stood on to build the higher parts of the Ka'bah. It contains two footprints that are comparatively larger than average modern-day human feet. The stone is raised and housed in a golden hexagonal chamber beside the Ka'bah on the Mataf plate. The stone inside the casing is square shaped and measures 40 cm (16 in) in length and width, and 20 cm (7.9 in) in height. It used to be enclosed by a structure called the Maqsurat Ibrahim which was covered by a sitara : an ornamental, embroidered curtain that was replaced annually. Currently, it is placed inside a golden-metal enclosure. The outer casing has changed a number of times over the years; historic photographs show that the arch of the Banu Shaybah Gate stood next to it. Muslims believe that in the divine revelation to Muhammad, the Quran, Allah describes the mountains of Safa and Marwah as symbols of His divinity. Walking between the two mountains seven times, 4 times from Safa to Marwah and 3 times from Marwah interchangeably, is considered a mandatory pillar ( rukn ) of ' Umrah .There is a difference of opinion between Islamic scholars upon who first built the Ka'bah , some believe it was built by the angels while others believe it was built by Adam . Regardless, it was built several times before reaching its current state. The Ka'bah is also the common direction of prayer ( qibla ) for all Muslims. The surface surrounding the Ka'bah on which Muslims circumambulate it is known as the Mataf.The Black Stone is a stone, considered by scientists to be a meteorite or of similar origin and believed by Muslims to be of divine origin. It is set in the eastern corner of the Ka'bah and it is Sunnah to touch and kiss the stone. The area around the stone is generally always crowded and guarded by policemen to ensure the pilgrims' safety. In Islamic tradition, the stone was sent down from Jannah (Paradise) and used to build the Ka'bah. It used to be a white stone (and was whiter than milk). Because of the worldly sins of man, it slowly changed color to black over the years after it was brought down to Earth.This is the stone that Ibrahim (Abraham) stood on to build the higher parts of the Ka'bah. It contains two footprints that are comparatively larger than average modern-day human feet. The stone is raised and housed in a golden hexagonal chamber beside the Ka'bah on the Mataf plate. The stone inside the casing is square shaped and measures 40 cm (16 in) in length and width, and 20 cm (7.9 in) in height. It used to be enclosed by a structure called the Maqsurat Ibrahim which was covered by a sitara : an ornamental, embroidered curtain that was replaced annually. Currently, it is placed inside a golden-metal enclosure. The outer casing has changed a number of times over the years; historic photographs show that the arch of the Banu Shaybah Gate stood next to it. Muslims believe that in the divine revelation to Muhammad, the Quran, Allah describes the mountains of Safa and Marwah as symbols of His divinity. Walking between the two mountains seven times, 4 times from Safa to Marwah and 3 times from Marwah interchangeably, is considered a mandatory pillar ( rukn ) of ' Umrah .The Hajj pilgrimage, also called the greater pilgrimage, attracts millions of Muslims from all over the world and almost triples Mecca's population for one week in the twelfth and final Islamic month of Dhu al-Hijjah . In 2019, the Hajj attracted 2,489,406 pilgrims to the holy city. The 'Umrah, or the lesser pilgrimage, can be done at anytime during the year. Every adult, healthy Muslim who has the financial and physical capacity to travel to Mecca must perform the Hajj at least once in a lifetime. Umrah, the lesser pilgrimage, is not obligatory, but is recommended in the Quran. In addition to the Masjid al-Haram , pilgrims also must visit the nearby towns of Mina/Muna , Muzdalifah and Mount Arafat for various rituals that are part of the Hajj.This is a mountain believed by Muslims to have been the place where Muhammad spent his time away from the bustling city of Mecca in seclusion. The mountain is located on the eastern entrance of the city and is the highest point in the city at 642 meters (2,106 feet). Situated atop Jabal an-Nur, this is the cave where Muslims believe Muhammad received the first revelation from Allah through the archangel Gabriel ( Jibril in Islamic tradition) at the age of 40. Situated atop Jabal an-Nur, this is the cave where Muslims believe Muhammad received the first revelation from Allah through the archangel Gabriel ( Jibril in Islamic tradition) at the age of 40. Mecca is located in the Hejaz region , a 200 km (124 mi) wide strip of mountains separating the Nafud desert from the Red Sea . The city is situated in a valley with the same name around 70 km (44 mi) east of the port city of Jeddah . Mecca is one of the lowest cities in elevation in the Hejaz region, located at an elevation of 277 m (909 ft) above sea level at 21º23' north latitude and 39º51' east longitude. Mecca is divided into 34 districts. The city centers on the al-Haram area, which contains the Masjid al-Haram. The area around the mosque is the old city and contains the most famous district of Mecca, Ajyad. The main street that runs to al-Haram is the Ibrahim al-Khalil Street, named after Ibrahim . Traditional, historical homes built of local rock, two to three stories long are still present within the city's central area, within view of modern hotels and shopping complexes. The total area of modern Mecca is over 1,200 km 2 (460 sq mi) . Mecca is at an elevation of 277 m (909 ft) above sea level, and approximately 70 km (44 mi) inland from the Red Sea. It is one of the lowest in the Hejaz region. Although some mountain peaks in Mecca reach 1,000m in height. The city center lies in a corridor between mountains, which is often called the "Hollow of Mecca". The area contains the valley of al-Taneem, the valley of Bakkah and the valley of Abqar. This mountainous location has defined the contemporary expansion of the city. Due to Mecca's climatic conditions water scarcity has been an issue throughout its history. In pre-modern Mecca, the city used a few chief sources of water. Among them were local wells, such as the Zamzam Well , that produced generally brackish water. Finding a sustainable water source to supply Mecca's permanent population and the large number of annual pilgrims was an undertaking that began in the Abbasid era under the auspices of Zubayda , the wife of the caliph Harun ar-Rashid . [lower-alpha 3] She donated funds for the deepening of Zamzam Well and funded a massive construction project likely costing 1.75 Million gold dinars . The project encompassed the construction of an underground aqueduct from the Arabic : عين حنين , romanized : ʿAyn Ḥunayn , lit. ' Spring of Hunayn ' and smaller water sources in the area to Mecca in addition to the construction of a waterworks on Mount Arafat called Arabic : عين زبيدة , romanized : ʿAyn Zubayda , lit. ' Spring of Zubayda ' using a separate conduit to connect it to Mecca and the Masjid al-Haram. Over time however the system deteriorated and failed to fulfil its function. Thus in 1245 CE, 1361 CE, 1400 CE, 1474 CE, and 1510 CE different rulers invested into extensive repairs of the system. In 1525 CE due to the system's troubles persisting however the Ottoman sultan Suleiman the Magnificent began a construction project to rebuild the aqueduct in its entirety, the project took until 1571 CE to be completed. Its water quality was greatly lacking during the 19th century until a restoration and cleaning project by Osman Pasha began. Another source which sporadically provided water was rainfall which was stored by the people in small reservoirs or cisterns . According to al-Kurdī, there had been 89 floods by 1965. In the last century, the most severe flood was that of 1942. Since then, dams have been built to ameliorate this problem. In the modern day water treatment plants and desalination facilities have been constructed and are being constructed to provide suitable amounts of water fit for human consumption to the city. Mecca features a hot desert climate ( Köppen : BWh ), in three different plant hardiness zones : 10, 11 and 12. Like most Saudi Arabian cities, Mecca retains warm to hot temperatures even in winter, which can range from 19 °C (66 °F) at night to 30 °C (86 °F) in the afternoon. Summer temperatures are extremely hot and consistently break the 40 °C (104 °F) mark in the afternoon, dropping to 30 °C (86 °F) in the evening, but humidity remains relatively low, at 30–40%. Rain usually falls in Mecca in small amounts scattered between November and January, with heavy thunderstorms also common during the winter. Occasional summer rainfall is associated with the northward movement of the Intertropical convergence zone .Mecca is at an elevation of 277 m (909 ft) above sea level, and approximately 70 km (44 mi) inland from the Red Sea. It is one of the lowest in the Hejaz region. Although some mountain peaks in Mecca reach 1,000m in height.The city center lies in a corridor between mountains, which is often called the "Hollow of Mecca". The area contains the valley of al-Taneem, the valley of Bakkah and the valley of Abqar. This mountainous location has defined the contemporary expansion of the city.Due to Mecca's climatic conditions water scarcity has been an issue throughout its history. In pre-modern Mecca, the city used a few chief sources of water. Among them were local wells, such as the Zamzam Well , that produced generally brackish water. Finding a sustainable water source to supply Mecca's permanent population and the large number of annual pilgrims was an undertaking that began in the Abbasid era under the auspices of Zubayda , the wife of the caliph Harun ar-Rashid . [lower-alpha 3] She donated funds for the deepening of Zamzam Well and funded a massive construction project likely costing 1.75 Million gold dinars . The project encompassed the construction of an underground aqueduct from the Arabic : عين حنين , romanized : ʿAyn Ḥunayn , lit. ' Spring of Hunayn ' and smaller water sources in the area to Mecca in addition to the construction of a waterworks on Mount Arafat called Arabic : عين زبيدة , romanized : ʿAyn Zubayda , lit. ' Spring of Zubayda ' using a separate conduit to connect it to Mecca and the Masjid al-Haram. Over time however the system deteriorated and failed to fulfil its function. Thus in 1245 CE, 1361 CE, 1400 CE, 1474 CE, and 1510 CE different rulers invested into extensive repairs of the system. In 1525 CE due to the system's troubles persisting however the Ottoman sultan Suleiman the Magnificent began a construction project to rebuild the aqueduct in its entirety, the project took until 1571 CE to be completed. Its water quality was greatly lacking during the 19th century until a restoration and cleaning project by Osman Pasha began. Another source which sporadically provided water was rainfall which was stored by the people in small reservoirs or cisterns . According to al-Kurdī, there had been 89 floods by 1965. In the last century, the most severe flood was that of 1942. Since then, dams have been built to ameliorate this problem. In the modern day water treatment plants and desalination facilities have been constructed and are being constructed to provide suitable amounts of water fit for human consumption to the city. Mecca features a hot desert climate ( Köppen : BWh ), in three different plant hardiness zones : 10, 11 and 12. Like most Saudi Arabian cities, Mecca retains warm to hot temperatures even in winter, which can range from 19 °C (66 °F) at night to 30 °C (86 °F) in the afternoon. Summer temperatures are extremely hot and consistently break the 40 °C (104 °F) mark in the afternoon, dropping to 30 °C (86 °F) in the evening, but humidity remains relatively low, at 30–40%. Rain usually falls in Mecca in small amounts scattered between November and January, with heavy thunderstorms also common during the winter. Occasional summer rainfall is associated with the northward movement of the Intertropical convergence zone .The Meccan economy has been heavily dependent on pilgrimages coming for Umrah and Hajj. Income generated through pilgrims not only powers the Meccan economy but has historically had far-reaching effects on the economy of the entire Arabian Peninsula . The income was generated in a number of ways. One method was taxing the pilgrims. Taxes were especially increased during the Great Depression , and many of these taxes existed to as late as 1972. Another way the Hajj generates income is through services to pilgrims. For example, the Saudi flag carrier , Saudia , generates 12% of its income from the pilgrimage. Fares paid by pilgrims to reach Mecca by land also generate income; as do the hotels and lodging companies that house them. The city takes in more than $100 million, while the Saudi government spends about $50 million on services for the Hajj. There are some industries and factories in the city, but Mecca no longer plays a major role in Saudi Arabia's economy , which is mainly based on oil exports. The few industries operating in Mecca include textiles, furniture, and utensils. The majority of the economy is service-oriented. Nevertheless, many industries have been set up in Mecca. Various types of enterprises that have existed since 1970 in the city include corrugated iron manufacturing , copper extraction , carpentry, upholstery , bakeries, farming and banking. The city has grown substantially in the 20th and 21st centuries, as the convenience and affordability of jet travel has increased the number of pilgrims participating in the Hajj . Thousands of Saudis are employed year-round to oversee the Hajj and staff the hotels and shops that cater to pilgrims; these workers in turn have increased the demand for housing and services. The city is now ringed by freeways and contains shopping malls and skyscrapers. A new industrial city is being developed in Al Akashiya district of Makkah by the Saudi Authority for Industrial Cities and Technology Zones . It covers an area of 45 square kilometres (11,000 acres) . Formal education started to be developed in the late Ottoman period continuing slowly into Hashemite times. The first major attempt to improve the situation was made by a Jeddah merchant, Muhammad ʿAlī Zaynal Riḍā, who founded the Madrasat al-Falāḥ in Mecca in 1911–12 that cost £400,000. The school system in Mecca has many public and private schools for both males and females. As of 2005, there were 532 public and private schools for males and another 681 public and private schools for female students. The medium of instruction in both public and private schools is Arabic with emphasis on English as a second language , but some private schools founded by foreign entities such as International schools use the English language as the medium of instruction. Some of these are coeducational while other schools are not. For higher education, the city has only one university, Umm Al-Qura University , which was established in 1949 as a college and became a public university in 1981. Healthcare is provided by the Saudi government free of charge to all pilgrims. There are ten main hospitals in Mecca: Ajyad Hospital ( ٠ُسْتَشْفَى أَجْيَاد ‎ ) King Faisal Hospital ( ٠ُسْتَشْفَى ٱلْ٠َلِك فَيْصَل بِحَي ٱلشّشه ‎ ) King Abdulaziz Hospital ( Arabic : ٠ُسْتَشْفَى ٱلْ٠َلِك عَبْد ٱلْعَزِيْز بِحَي ٱلـزَّاهِر ‎ ) Al Noor Specialist Hospital ( ٠ُسْتَشْفَى ٱلنُّوْر ٱلتَّخَصُّصِي ‎ ) Hira'a Hospital ( ٠ُسْتَشْفَى حِرَاء ‎ ) Maternity and Children's Hospital ( ٠ُسْتَشْفَى ٱلْوِلَادَة وَٱلْأَطْفَال ‎ ) King Abdullah Medical City ( ٠َدِيْنَة ٱلْ٠َلِك عَبْد ٱلله ٱلطِّبِيَّة ‎ ) Khulais General Hospital ( ٠ُسْتَشْفَى خُلَيْص ٱلْعَا٠‎ ) Al Kamel General Hospital ( ٠ُسْتَشْفَى ٱلْكَا٠ِل ٱلْعَا٠‎ ) Ibn Sina Hospital ( ٠ُسْتَشْفَى ابْن سِيْنَا بِحَدَاء / بَحْرَه ‎ ) There are also many walk-in clinics available for both residents and pilgrims. Several temporary clinics are set up during the Hajj to tend to wounded pilgrims.Mecca is very densely populated. Most long-term residents live in the Old City, the area around the Great Mosque and many work to support pilgrims, known locally as the Hajj industry. 'Iyad Madani, the Saudi Arabian Minister for Hajj, was quoted saying, "We never stop preparing for the Hajj." Year-round, pilgrims stream into the city to perform the rites of ' Umrah , and during the last weeks of eleventh Islamic month, Dhu al-Qi'dah , on average 2–4 million Muslims arrive in the city to take part in the rites known as Hajj. Pilgrims are from varying ethnicities and backgrounds, mainly South and Southeast Asia, Europe and Africa. Many of these pilgrims have remained and become residents of the city. By the 19th century, people of South Asian origin had come to constitute 20% of the population. The Burmese are an older, more established community who number roughly 250,000. Adding to this, the discovery of oil in the past 50 years has brought hundreds of thousands of working immigrants. Non-Muslims are not permitted to enter Mecca under Saudi law , and using fraudulent documents to do so may result in arrest and prosecution. The prohibition extends to Ahmadis , as they are considered non-Muslims. Nevertheless, many non-Muslims and Ahmadis have visited the city as these restrictions are loosely enforced. The first such recorded example of a non-Muslim entering the city is that of Ludovico di Varthema of Bologna in 1503. Guru Nanak , the founder of Sikhism, is said to have visited Mecca in December 1518. One of the most famous was Richard Francis Burton , who traveled as a Qadiriyya Sufi from Afghanistan in 1853. Mecca Province is the only province where expatriates outnumber Saudis . Mecca's culture has been affected by the large number of pilgrims that arrive annually, and thus boasts a rich cultural heritage . As a result of the vast numbers of pilgrims coming to the city each year, Mecca has become by far the most diverse city in the Muslim world. Al Baik , a local fast-food chain, is very popular among pilgrims and locals alike. Until 2018, it was available only in Mecca, Medina and Jeddah , and traveling to Jeddah just to get a taste of the fried chicken was common. In pre-modern Mecca, the most common sports were impromptu wrestling and foot races. Football is now the most popular sport in Mecca and the kingdom, and the city hosts some of the oldest sport clubs in Saudi Arabia such as Al Wahda FC (established in 1945). King Abdulaziz Stadium is the largest stadium in Mecca with a capacity of 38,000. Adorning the southern facade of the Masjid al-Haram is the Abraj al-Bait Complex ; towering over the Great Mosque, it is a seven-building complex with the central clock tower having a length of 601 m (1,972 feet), making it the world's fourth-tallest building. All seven buildings in the complex also form the third-largest building by floor area . The Mecca Gate , known popularly as the Quran Gate, sits on the western entrance of the city, which is the route from Jeddah. Located on Highway 40, it marks the boundary of the Haram area where non-Muslims are prohibited from entering. The gate was designed in 1979 by an Egyptian architect, Samir Elabd, for the architectural firm IDEA Center. The structure is that of a book, representing the Quran, sitting on a rehal , or bookrest. In pre-modern Mecca, the most common sports were impromptu wrestling and foot races. Football is now the most popular sport in Mecca and the kingdom, and the city hosts some of the oldest sport clubs in Saudi Arabia such as Al Wahda FC (established in 1945). King Abdulaziz Stadium is the largest stadium in Mecca with a capacity of 38,000. Adorning the southern facade of the Masjid al-Haram is the Abraj al-Bait Complex ; towering over the Great Mosque, it is a seven-building complex with the central clock tower having a length of 601 m (1,972 feet), making it the world's fourth-tallest building. All seven buildings in the complex also form the third-largest building by floor area . The Mecca Gate , known popularly as the Quran Gate, sits on the western entrance of the city, which is the route from Jeddah. Located on Highway 40, it marks the boundary of the Haram area where non-Muslims are prohibited from entering. The gate was designed in 1979 by an Egyptian architect, Samir Elabd, for the architectural firm IDEA Center. The structure is that of a book, representing the Quran, sitting on a rehal , or bookrest. The first press was brought to Mecca in 1885 by Osman Nuri Pasha , an Ottoman Wāli . During the Hashemite period, it was used to print the city's official gazette, Al Qibla . The Saudi regime expanded this press into a larger operation, introducing the new Saudi official gazette of Mecca, Umm al-Qurā . Mecca also has its own paper owned by the city, Al Nadwa . However, other Saudi newspapers are also provided in Mecca such as the Saudi Gazette , Al Madinah , Okaz and Al Bilad , in addition to other international newspapers. Telecommunications in the city were emphasized early under the Saudi reign. King Abdulaziz pressed them forward as he saw them as a means of convenience and better governance. While under Hussein bin Ali , there were about 20 public telephones in the entire city; in 1936, the number jumped to 450, totaling about half the telephones in the country. During that time, telephone lines were extended to Jeddah and Ta'if, but not to the capital, Riyadh . By 1985, Mecca, like other Saudi cities, possessed modern telephone, telex, radio and television communications. Many television stations serve the city area, including Saudi TV1 , Saudi TV2 , Saudi TV Sports , Al-Ekhbariya , Arab Radio and Television Network and various cable, satellite and other specialty television providers. Limited radio communication was established within the Kingdom under the Hashemites. In 1929, wireless stations were set up in various towns in the region, creating a network that would become fully functional by 1932. Soon after World War II , the existing network was greatly expanded and improved. Since then, radio communication has been used extensively in directing the pilgrimage and addressing the pilgrims. This practice started in 1950, with the initiation of broadcasts on the Day of 'Arafah (9 Dhu al-Hijjah), and increased until 1957, at which time Radio Makkah became the most powerful station in the Middle East at 50 kW. Later, power was increased 9-fold to 450 kW. Music was not immediately broadcast, but gradually folk music was introduced. The first press was brought to Mecca in 1885 by Osman Nuri Pasha , an Ottoman Wāli . During the Hashemite period, it was used to print the city's official gazette, Al Qibla . The Saudi regime expanded this press into a larger operation, introducing the new Saudi official gazette of Mecca, Umm al-Qurā . Mecca also has its own paper owned by the city, Al Nadwa . However, other Saudi newspapers are also provided in Mecca such as the Saudi Gazette , Al Madinah , Okaz and Al Bilad , in addition to other international newspapers.Telecommunications in the city were emphasized early under the Saudi reign. King Abdulaziz pressed them forward as he saw them as a means of convenience and better governance. While under Hussein bin Ali , there were about 20 public telephones in the entire city; in 1936, the number jumped to 450, totaling about half the telephones in the country. During that time, telephone lines were extended to Jeddah and Ta'if, but not to the capital, Riyadh . By 1985, Mecca, like other Saudi cities, possessed modern telephone, telex, radio and television communications. Many television stations serve the city area, including Saudi TV1 , Saudi TV2 , Saudi TV Sports , Al-Ekhbariya , Arab Radio and Television Network and various cable, satellite and other specialty television providers.Limited radio communication was established within the Kingdom under the Hashemites. In 1929, wireless stations were set up in various towns in the region, creating a network that would become fully functional by 1932. Soon after World War II , the existing network was greatly expanded and improved. Since then, radio communication has been used extensively in directing the pilgrimage and addressing the pilgrims. This practice started in 1950, with the initiation of broadcasts on the Day of 'Arafah (9 Dhu al-Hijjah), and increased until 1957, at which time Radio Makkah became the most powerful station in the Middle East at 50 kW. Later, power was increased 9-fold to 450 kW. Music was not immediately broadcast, but gradually folk music was introduced. The only airport near the city is the Mecca East airport, which is not active. Mecca is primarily served by King Abdulaziz International Airport in Jeddah for international and regional connections and Ta'if Regional Airport for regional connections. To cater to the large number of Hajj pilgrims, Jeddah Airport has a Hajj Terminal, specifically for use during the Hajj season; the terminal can accommodate 47 planes simultaneously while receiving 3,800 pilgrims per hour during the Hajj season. Mecca, similar to Medina, lies at the junction of two of the most important highways in Saudi Arabia, Highway 40 , connecting it to the important port city of Jeddah in the west and the capital of Riyadh and the other major port city, Dammam , in the east. The other, Highway 15, connects Mecca to the other holy Islamic city of Medina approximately 400 km (250 mi) in the north and onward to Tabuk and Jordan . While in the south, it connects Mecca to Abha and Jizan . Mecca is served by four ring roads, and these are very crowded compared to the three ring roads of Medina. Mecca also has many tunnels. Al Masha'er Al Muqaddassah Metro The Al Masha'er Al Muqaddassah Metro is a metro line in Mecca opened on 13 November 2010. The 18.1-kilometer (11.2-mile) elevated metro transports pilgrims to the holy sites of ' Arafat , Muzdalifah and Mina in the city to reduce congestion on the road and is only operational during the Hajj season. It consists of nine stations, three in each of the aforementioned towns. Mecca Metro The Mecca Metro , officially known as Makkah Mass Rail Transit , is a planned four-line metro system for the city. This will be in addition to the Al Masha'er Al Muqaddassah Metro which carries pilgrims. In 2018, a high speed intercity rail line, part of the Haramain High Speed Rail Project , named the Haramain high-speed railway line entered operation, connecting the holy cities of Mecca and Medina together via Jeddah , King Abdulaziz International Airport and King Abdullah Economic City in Rabigh . The railway consists of 35 electric trains and is capable of transporting 60 million passengers annually. Each train can achieve speeds of up to 300 kmh (190 mph), traveling a total distance of 450 km (280 mi), reducing the travel time between the two cities to less than two hours. The only airport near the city is the Mecca East airport, which is not active. Mecca is primarily served by King Abdulaziz International Airport in Jeddah for international and regional connections and Ta'if Regional Airport for regional connections. To cater to the large number of Hajj pilgrims, Jeddah Airport has a Hajj Terminal, specifically for use during the Hajj season; the terminal can accommodate 47 planes simultaneously while receiving 3,800 pilgrims per hour during the Hajj season. Mecca, similar to Medina, lies at the junction of two of the most important highways in Saudi Arabia, Highway 40 , connecting it to the important port city of Jeddah in the west and the capital of Riyadh and the other major port city, Dammam , in the east. The other, Highway 15, connects Mecca to the other holy Islamic city of Medina approximately 400 km (250 mi) in the north and onward to Tabuk and Jordan . While in the south, it connects Mecca to Abha and Jizan . Mecca is served by four ring roads, and these are very crowded compared to the three ring roads of Medina. Mecca also has many tunnels. Al Masha'er Al Muqaddassah Metro The Al Masha'er Al Muqaddassah Metro is a metro line in Mecca opened on 13 November 2010. The 18.1-kilometer (11.2-mile) elevated metro transports pilgrims to the holy sites of ' Arafat , Muzdalifah and Mina in the city to reduce congestion on the road and is only operational during the Hajj season. It consists of nine stations, three in each of the aforementioned towns. Mecca Metro The Mecca Metro , officially known as Makkah Mass Rail Transit , is a planned four-line metro system for the city. This will be in addition to the Al Masha'er Al Muqaddassah Metro which carries pilgrims.In 2018, a high speed intercity rail line, part of the Haramain High Speed Rail Project , named the Haramain high-speed railway line entered operation, connecting the holy cities of Mecca and Medina together via Jeddah , King Abdulaziz International Airport and King Abdullah Economic City in Rabigh . The railway consists of 35 electric trains and is capable of transporting 60 million passengers annually. Each train can achieve speeds of up to 300 kmh (190 mph), traveling a total distance of 450 km (280 mi), reducing the travel time between the two cities to less than two hours. In 2018, a high speed intercity rail line, part of the Haramain High Speed Rail Project , named the Haramain high-speed railway line entered operation, connecting the holy cities of Mecca and Medina together via Jeddah , King Abdulaziz International Airport and King Abdullah Economic City in Rabigh . The railway consists of 35 electric trains and is capable of transporting 60 million passengers annually. Each train can achieve speeds of up to 300 kmh (190 mph), traveling a total distance of 450 km (280 mi), reducing the travel time between the two cities to less than two hours.

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Cholera

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Death of Pyotr Ilyich Tchaikovsky

On 6 November 1893 [ O.S. 25 October ] , [a 1] nine days after the premiere of his Sixth Symphony , the Pathétique , Pyotr Ilyich Tchaikovsky died in Saint Petersburg , at the age of 53. The official cause of death was reported to be cholera , most probably contracted through drinking contaminated water several days earlier. This explanation was accepted by many biographers of the composer. However, even at the time of Tchaikovsky's death, there were many questions about this diagnosis. [ citation needed ] The timeline between Tchaikovsky's drinking unboiled water and the emergence of symptoms was brought into question, as well as the composer's procurement of unboiled water, in a reputable restaurant (according to one account), in the midst of a cholera epidemic with strict health regulations in effect. While cholera actually attacked all levels of Russian society, it was considered a disease of the lower classes. The resulting stigma from such a demise for a personage as famous as Tchaikovsky was considerable, to the point where its possibility was inconceivable for many people. The accuracy of the medical reports from the two physicians who had treated Tchaikovsky was questioned. The handling of Tchaikovsky's corpse was also scrutinised as it was reportedly not in accordance with official regulations for victims of cholera. This was remarked upon by, among others, Nikolai Rimsky-Korsakov in his autobiography, though some editions censored this section. [ citation needed ] Theories that Tchaikovsky's death was a suicide soon began to surface. Postulations ranged from reckless action on the composer's part to orders from Tsar Alexander III of Russia , with the reporters ranging from Tchaikovsky's family members to composer Alexander Glazunov . Since 1979, one variation of the theory has gained some ground—a sentence of suicide imposed in a " court of honor " by Tchaikovsky's fellow alumni of the Imperial School of Jurisprudence , as a censure of the composer's homosexuality . Nonetheless, the cause of Tchaikovsky's death remains highly contested, and it may never actually be solved.Biographer Alexander Poznansky writes that on 1 November 1893 [ O.S. 20 October ] (Wednesday) Tchaikovsky had gone to the theatre to see Alexander Ostrovsky 's play The Ardent Heart . Afterwards, he went with his brother Modest , his nephew Vladimir "Bob" Davydov , the composer Alexander Glazunov , and other friends to a restaurant named Leiner's , located in Kotomin House at Nevsky Prospekt , Saint Petersburg . During the meal, Tchaikovsky ordered a glass of water. Due to an outbreak of cholera in the city, health regulations required water served in restaurants to be boiled before being served. Tchaikovsky was told by the waiter that no boiled water was then available. He then reportedly requested cold unboiled water, which was brought. Warned by others in his party not to drink it, the composer said he did not fear contracting cholera and drank the water anyway. The next morning, at Modest's apartment, Pyotr was not in the sitting room drinking tea as usual, but in bed complaining of diarrhea and an upset stomach. Modest asked about calling a doctor. Tchaikovsky refused, instead taking cod liver oil to no avail. Three days later, he developed signs of cholera. His condition worsened, but he still refused to see a doctor. A doctor was finally sent for but was not home, so another one was called. The diagnosis of cholera was finally made by Dr. Lev Bertenson. In the meantime, Tchaikovsky would seem to improve but then would regress and get much worse. His kidneys began to fail. A priest was called from St. Isaac's Cathedral to administer last rites , but the composer was too far gone to recognise what was going on around him. He died at 3 a.m. on 6 November 1893. Tchaikovsky biographer David Brown argues that, even before the doctors' accounts on the composer's death had appeared, what happened at his brother Modest's flat had been totally inconsistent with standard procedures for a death from cholera. Regulations stipulated the corpse was to be removed from the scene of death immediately in a closed coffin. Instead, Tchaikovsky's body was displayed in Modest's flat, and the flat freely opened to visitors wishing to pay their last respects. Among the guests, composer Nikolai Rimsky-Korsakov was seemingly bewildered by what he saw: "How strange that, although death had resulted from cholera, still admission to the Mass for the dead was free to all! I remember how [Alexander] Verzhbilovich [a cellist and professor at the St. Petersburg Conservatory ], totally drunk ... kept kissing the deceased man's head and face." This passage was edited out of some later version of Rimsky-Korsakov's book. Rimsky-Korsakov's own comments, however, would seem to conflict with his actions as later told by Sergei Diaghilev . Diaghilev, who would become known as the founder and impresario of the Ballets Russes , was at that time a university student in St. Petersburg and had met and occasionally conversed with the composer, to whom he was distantly related by marriage. On hearing of Tchaikovsky's death, Diaghilev recalls, In despair I rushed out of the house, and although I realized Tchaikovsky had died of cholera I made straight for Malaya Morskaya, where he lived. The doors were wide open and there was no one to be found.... I heard voices from another room, and on entering I saw Pyotr Ilyich in a black morning coat stretched on a sofa. Rimsky-Korsakov and the singer Nikolay Figner were arranging a table to put him on. We lifted the body of Tchaikovsky, myself holding the feet, and laid it on the table. The three of us were alone in the flat, for after Tchaikovsky's death the whole household had fled.... Poznansky counters Brown's views by saying that, despite Rimsky-Korsakov's comment, there was nothing odd about what went on. He writes that, despite lingering prejudice, the prevailing medical opinion was that cholera was less contagious than previously supposed. Though public gatherings for cholera victims had previously been discouraged, the Central Medical Council in the spring of 1893 specifically allowed public services and rituals in connection with the funerals of cholera victims. Also, the medical opinion printed by the Petersburg Gazette stated that Tchaikovsky had died from a subsequent blood infection, not from the disease itself. (The disease had reportedly been arrested on Friday, 3 November, three days before the composer's passing.) According to Poznansky, with the added precaution of constant disinfectant to the lips and nostrils of the body, even the drunken cellist kissing the face of the deceased had little cause for worry. Alexander III volunteered to pay the costs of the composer's funeral himself and instructed the Directorate of the Imperial Theatres to organise the event. According to Poznansky, this action showed the exceptional regard with which the Tsar regarded the composer. Only twice before had a Russian monarch shown such favor toward a fallen artistic or scholarly figure. Nicholas I had written a letter to the dying Alexander Pushkin following the poet's fatal duel. Nicholas also came personally to pay his final respects to historian Nikolay Karamzin on the eve of his burial. Moreover, Alexander III gave special permission for Tchaikovsky's memorial service to be held at Kazan Cathedral . Tchaikovsky's funeral took place on 9 November 1893 in St. Petersburg. Kazan Cathedral holds 6,000 people, but 60,000 people applied for tickets to attend the service. Finally, 8,000 people were crammed in. The composer was interred in Tikhvin Cemetery at the Alexander Nevsky Monastery, near the graves of fellow-composers Alexander Borodin , Mikhail Glinka and Modest Mussorgsky ; eventually Rimsky-Korsakov and Mily Balakirev would be buried nearby, as well. Biographer Anthony Holden writes that cholera had arrived in Europe less than a century before Tchaikovsky's death. An initial pandemic had hit the continent in 1818. Three others had followed and a fifth, which had begun in 1881, was raging. The disease had been imported by pilgrims from Bombay to Arabia , and from there crossed the Russian border. The first reported cases in Russia from this pandemic occurred in Vladivostok in 1888. By 1892, Russia was by far the worst hit of the 21 countries affected. In 1893, no fewer than 70 regions and provinces were combatting epidemics. Holden adds that, according to contemporary Russian medical records, the specific epidemic which claimed Tchaikovsky's life began on 14 May 1892 and ended on 11 February 1896. During this time, 504,924 people contracted cholera. From that number, 226,940 (44.9 percent) died from it. Even with these numbers, the attribution of Tchaikovsky's death to cholera was as surprising to many as the suddenness of his demise. While cholera touched all levels of society, it was largely considered a disease of the poor. This stigma made cholera a vulgar and socially demeaning manner of demise. The fact Tchaikovsky died from such a cause appeared to degrade his reputation among the upper classes and struck many as inconceivable. True to its reputed form, the cholera outbreak that had begun in the summer of 1893 in St. Petersburg had been confined primarily to the city's slums, where the poor "lived in crowded, insanitary conditions without observing elementary medical conditions." The disease did not affect more affluent and educated families because they observed the medical protocols forbidding the use or drinking of unboiled water. Moreover, this epidemic had begun waning with the arrival of the cold autumn weather. On 13 October, 200 cases of cholera were reported. By 6 November, the day of Tchaikovsky's death, this number had been reduced to 68 cases, accompanied by "a sharp decline in mortality". Though these figures were taken from Novosti i Birzhevaya Gazeta , Poznansky challenges them as inaccurate. Also, Tchaikovsky's friend Hermann Laroche reported that the composer was scrupulous in his personal hygiene. In the hope of avoiding doctors, Laroche writes, "he relied above all on hygiene, of which he seemed (to my layman's view) to be a true master". The media noted this as they questioned the composer's death. "How could Tchaikovsky, having just arrived in Petersburg and living in excellent hygienic conditions, have contracted the infection?" asked a reporter for the Petersburg Gazette . A writer for Russian Life noted, "[E]veryone is astounded by the uncommon occurrence of the lightning-fast infection with Asiatic cholera of a man so very temperate, modest, and austere in his daily habits." Holden maintains that, since cholera was rarely encountered in the upper echelons in which they practiced, it is possible that physicians Vasily and Lev Bertenson had never treated or even seen a case of cholera previous to the composer's case. All they might have known of the disease was what they had read in textbooks and medical journals. Poznansky cites Vasily Bertenson as later admitting that he "had not had occasion to witness an actual case of cholera", despite saying the composer had contracted a "classic case" of the disease. Holden also questions whether Lev Bertenson's description of Tchaikovsky's condition came from his observation of the patient or from what he had once read. If the latter, it would mean he could have used the terminology in the wrong sequence in describing Tchaikovsky's diagnosis. If Tchaikovsky did contract cholera, it is unknown precisely when or how he became infected. Newspapers printed accounts given by confused relatives of Tchaikovsky's drinking a glass of unboiled water at Leiner's restaurant. Modest, by contrast, suggests that his brother drank the fateful glass at Modest's apartment during lunch on Thursday. If so, what was a pitcher of unboiled water doing on the table? "[I]t was right in the middle of our conversation about the medication he had taken that he poured a glass of water and took a sip from it. The water was unboiled. We were all frightened: he alone was indifferent to it and told us not to worry." The incubation period for cholera is between one and three days according to some authorities, and from two hours to five days according to others. Tchaikovsky reportedly started showing symptoms early Thursday morning. If the one-to-three-day interval is taken as 24 to 72 hours, the latest the composer could have been infected would have been Wednesday morning, earlier than either the dinner at Leiner's that evening or lunch at Modest's the following afternoon. The possibility of unboiled water available at a restaurant such as Leiner's was a surprise to some. "We find it extremely strange that a good restaurant could have served unboiled water during an epidemic", wrote a reporter for the newspaper Son of the Fatherland . "There exists, as far as we can recollect, a binding decree that commercial establishments, eating houses, restaurants, etc., should have boiled water". Poznansky suggests the same lack of credibility holds true for Modest's story. It was also well known that Tchaikovsky preferred to drink mineral water. "Are we to suppose that Leiner's had run out of both mineral and boiled water?" Newspaper reporters were not the only ones questioning these accounts. Diaghilev recalls: "Various myths soon sprang up about the death of Tchaikovsky. Some said he caught cholera by drinking a glass of tap water at the Restaurant Leiner. Certainly, we used to see Pyotr Ilyich eating there almost every day, but nobody at that time drank unboiled water, and it seemed inconceivable to us that Tchaikovsky should have done so". Even with these numbers, the attribution of Tchaikovsky's death to cholera was as surprising to many as the suddenness of his demise. While cholera touched all levels of society, it was largely considered a disease of the poor. This stigma made cholera a vulgar and socially demeaning manner of demise. The fact Tchaikovsky died from such a cause appeared to degrade his reputation among the upper classes and struck many as inconceivable. True to its reputed form, the cholera outbreak that had begun in the summer of 1893 in St. Petersburg had been confined primarily to the city's slums, where the poor "lived in crowded, insanitary conditions without observing elementary medical conditions." The disease did not affect more affluent and educated families because they observed the medical protocols forbidding the use or drinking of unboiled water. Moreover, this epidemic had begun waning with the arrival of the cold autumn weather. On 13 October, 200 cases of cholera were reported. By 6 November, the day of Tchaikovsky's death, this number had been reduced to 68 cases, accompanied by "a sharp decline in mortality". Though these figures were taken from Novosti i Birzhevaya Gazeta , Poznansky challenges them as inaccurate. Also, Tchaikovsky's friend Hermann Laroche reported that the composer was scrupulous in his personal hygiene. In the hope of avoiding doctors, Laroche writes, "he relied above all on hygiene, of which he seemed (to my layman's view) to be a true master". The media noted this as they questioned the composer's death. "How could Tchaikovsky, having just arrived in Petersburg and living in excellent hygienic conditions, have contracted the infection?" asked a reporter for the Petersburg Gazette . A writer for Russian Life noted, "[E]veryone is astounded by the uncommon occurrence of the lightning-fast infection with Asiatic cholera of a man so very temperate, modest, and austere in his daily habits." Holden maintains that, since cholera was rarely encountered in the upper echelons in which they practiced, it is possible that physicians Vasily and Lev Bertenson had never treated or even seen a case of cholera previous to the composer's case. All they might have known of the disease was what they had read in textbooks and medical journals. Poznansky cites Vasily Bertenson as later admitting that he "had not had occasion to witness an actual case of cholera", despite saying the composer had contracted a "classic case" of the disease. Holden also questions whether Lev Bertenson's description of Tchaikovsky's condition came from his observation of the patient or from what he had once read. If the latter, it would mean he could have used the terminology in the wrong sequence in describing Tchaikovsky's diagnosis. If Tchaikovsky did contract cholera, it is unknown precisely when or how he became infected. Newspapers printed accounts given by confused relatives of Tchaikovsky's drinking a glass of unboiled water at Leiner's restaurant. Modest, by contrast, suggests that his brother drank the fateful glass at Modest's apartment during lunch on Thursday. If so, what was a pitcher of unboiled water doing on the table? "[I]t was right in the middle of our conversation about the medication he had taken that he poured a glass of water and took a sip from it. The water was unboiled. We were all frightened: he alone was indifferent to it and told us not to worry." The incubation period for cholera is between one and three days according to some authorities, and from two hours to five days according to others. Tchaikovsky reportedly started showing symptoms early Thursday morning. If the one-to-three-day interval is taken as 24 to 72 hours, the latest the composer could have been infected would have been Wednesday morning, earlier than either the dinner at Leiner's that evening or lunch at Modest's the following afternoon. The possibility of unboiled water available at a restaurant such as Leiner's was a surprise to some. "We find it extremely strange that a good restaurant could have served unboiled water during an epidemic", wrote a reporter for the newspaper Son of the Fatherland . "There exists, as far as we can recollect, a binding decree that commercial establishments, eating houses, restaurants, etc., should have boiled water". Poznansky suggests the same lack of credibility holds true for Modest's story. It was also well known that Tchaikovsky preferred to drink mineral water. "Are we to suppose that Leiner's had run out of both mineral and boiled water?" Newspaper reporters were not the only ones questioning these accounts. Diaghilev recalls: "Various myths soon sprang up about the death of Tchaikovsky. Some said he caught cholera by drinking a glass of tap water at the Restaurant Leiner. Certainly, we used to see Pyotr Ilyich eating there almost every day, but nobody at that time drank unboiled water, and it seemed inconceivable to us that Tchaikovsky should have done so". Poznansky does not rule out Tchaikovsky's contracting cholera from drinking contaminated water. He ventures that Tchaikovsky could have possibly drunk it before the Wednesday supper at Leiner's, as the composer habitually drank cold water at meals. On this point, he and Holden concur. Holden adds that Tchaikovsky may have even known he had contracted cholera before the dinner at Leiner's Wednesday night. Poznansky also says that the cholera bacillus was more prevalent in the St. Petersburg water supply than anyone had imagined before Tchaikovsky's death. Weeks after the composer's passing, both the Neva River and the water supply of the Winter Palace were found to be contaminated, and a special sanitary commission discovered that some restaurants mixed boiled and unboiled water to cool it more quickly for patrons. Another factor Pozansky mentions is that Tchaikovsky, already in gastric distress Thursday morning, drank a glass of the alkaline mineral water "Hunyadi János" in an attempt to ease his stomach. The alkaline in the mineral water would have neutralised the acid in Tchaikovsky's stomach. This would have stimulated any cholera bacillus present by giving it a more favorable environment in which to flourish. Referencing cholera specialist Dr. Valentin Pokovsky, Holden mentions another way Tchaikovsky could have contracted cholera—the "faecal-oral route", from less-than-hygienic sexual practices with male prostitutes in St. Petersburg. This theory was advanced separately in The Times of London by its then veteran medical specialist, Dr. Thomas Stuttaford. While Holden admits no further evidence supports this theory, he asserts that had it actually been the case, Tchaikovsky and Modest would have both gone to great pains to conceal the truth. They could have staged Tchaikovsky's drinking unboiled water at Leiner's by mutual agreement for the sake of family, friends, admirers and posterity. Since Tchaikovsky was an almost sacred national figure by this time in his life, Holden suggests the doctors involved with the composer's case might have gone along with this deception. Another theory was first broached publicly by Russian musicologist Alexandra Orlova in 1979 when she emigrated to the West. The key witness for Orlova's account was Alexander Voitrov, a pupil at the School of Jurisprudence before World War I who had reportedly amassed much about the history and people of his alma mater . Among these people was Nikolay Borisovich Jacobi, Senior Procurator to the Senate in the 1890s. Jacobi's widow, Elizaveta Karlovna, reportedly told Voitrov in 1913 that a Duke Stenbok-Fermor was disturbed by the attention which Tchaikovsky was paying to his young nephew. Stenbok-Fernor wrote a letter of accusation to the Tsar in the autumn of 1893 and gave the letter to Jacobi to deliver. Jacobi wanted to avoid a public scandal. He therefore invited all of Tchaikovsky's former schoolmates that he could locate in St. Petersburg—eight people altogether—to serve in a "court of honor" to discuss the charge. This meeting, held in Jacobi's study, lasted almost five hours. At the end of that time, Tchaikovsky rushed out, pale and agitated, without saying a word. Once everyone else had left, Jacobi told his wife that they had decided that Tchaikovsky should kill himself. Within a day or two of this meeting, news of the composer's illness was circulating in St. Petersburg. Orlova suggests this court of honor could have been convened on 31 October. This is the only day during which nothing is known about Tchaikovsky's activities until evening. Brown suggests that perhaps it is significant that Modest records his brother's last days from that evening, when Tchaikovsky attended Anton Rubinstein 's opera Die Maccabäer . In November 1993 the BBC aired a documentary entitled Pride or Prejudice , which investigated various theories regarding Tchaikovsky's death. Among those interviewed were Orlova, Brown and Poznansky, along with various experts on Russian history. Dr John Henry of Guy's Hospital , an expert witness working in the British National Poison Unit at the time, concluded in the documentary that all the reported symptoms of Tchaikovsky's illness "fit very closely with arsenic poisoning ." He suggested that people would have known that acute diarrhoea, dehydration and kidney failure resembled the manifestations of cholera. This would help bolster a potential illusion of the death as a case of cholera. The conclusion reached in the documentary leaned largely in favor of the "court of honor" theory. Other well-respected studies of the composer have challenged Orlova's statements in detail and concluded that the composer's death was due to natural causes. Among other challenges to Orlova's thesis, Poznansky revealed that there was no Duke Stenbok-Fermor, but there was a count of that name. However, he was an equerry to Tsar Alexander III and would not have needed an intermediary to deliver a letter to his own employer. As for the supposed threat to the reputation of the St Petersburg School of Jurisprudence represented by Tchaikovsky's homosexual affairs, Poznansky depicts the school as a hotbed of all-male debauchery which even had its own song hymning the delights of homosexuality. One other theory regarding Tchaikovsky's death is that it was ordered by Tsar Alexander III himself. This story was told by Swiss musicologist Robert-Aloys Mooser , who supposedly learned it from two others— Riccardo Drigo , composer and kapellmeister to the St. Petersburg Imperial Theatres, and the composer Alexander Glazunov . According to their scenario, the composer had seduced the son of the caretaker of his brother Modest's apartment block. The plausibility of this story for many people was that Glazunov reportedly confirmed it. Mooser considered Glazunov a reliable witness, stressing his "upright moral character, veneration for the composer and friendship with Tchaikovsky." More recently the French scholar André Lischke has confirmed Glazunov's confession. Lischke's father was a student of the composer in Petrograd in the 1920s. Glazunov confided the story to Lischke's father, who in turn passed it to his son. However, Poznansky counters, Glazunov could not have confirmed the suicide story unless he were absolutely certain of its truth. The only way that could have been possible, though, was if he had been told by someone in Tchaikovsky's innermost circle—in other words, someone who was present at the composer's deathbed. It was exactly this circle of intimates, however, that Drigo accused of concealing the "truth", [Poznansky's quotation marks for emphasis] demanding false testimonies from authorities, physicians and priests. Only by swearing Glazunov to the strictest secrecy would anyone in this circle have revealed the "truth". That Glazunov would then share this information with Mooser, Poznansky concludes, is virtually inconceivable since it would have compromised Glazunov entirely. Another version holds that Tchaikovsky had been undergoing a severe personal crisis. This crisis was precipitated, according to some accounts, by his infatuation for his nephew, Vladimir Davydov , who was frequently referred to by the nickname "Bob" by the Davydov family and the composer. This would reportedly explain the agonies expressed in the Sixth Symphony , as well as the mystery surrounding its program. Many analysts, working from this tangent, have since read the Pathétique as intensely autobiographical. According to this theory, Tchaikovsky realised the full extent of his feelings for Bob, plus the unlikelihood of their physical fulfillment. He supposedly poured his misery onto this one last great work as a conscious prelude to suicide, then drank unboiled water in the hope of contracting cholera. In this way, as with his wading into the Moscow river in 1877 in frustration over his marriage, Tchaikovsky could commit suicide without bringing disgrace upon his family. Poznansky does not rule out Tchaikovsky's contracting cholera from drinking contaminated water. He ventures that Tchaikovsky could have possibly drunk it before the Wednesday supper at Leiner's, as the composer habitually drank cold water at meals. On this point, he and Holden concur. Holden adds that Tchaikovsky may have even known he had contracted cholera before the dinner at Leiner's Wednesday night. Poznansky also says that the cholera bacillus was more prevalent in the St. Petersburg water supply than anyone had imagined before Tchaikovsky's death. Weeks after the composer's passing, both the Neva River and the water supply of the Winter Palace were found to be contaminated, and a special sanitary commission discovered that some restaurants mixed boiled and unboiled water to cool it more quickly for patrons. Another factor Pozansky mentions is that Tchaikovsky, already in gastric distress Thursday morning, drank a glass of the alkaline mineral water "Hunyadi János" in an attempt to ease his stomach. The alkaline in the mineral water would have neutralised the acid in Tchaikovsky's stomach. This would have stimulated any cholera bacillus present by giving it a more favorable environment in which to flourish. Referencing cholera specialist Dr. Valentin Pokovsky, Holden mentions another way Tchaikovsky could have contracted cholera—the "faecal-oral route", from less-than-hygienic sexual practices with male prostitutes in St. Petersburg. This theory was advanced separately in The Times of London by its then veteran medical specialist, Dr. Thomas Stuttaford. While Holden admits no further evidence supports this theory, he asserts that had it actually been the case, Tchaikovsky and Modest would have both gone to great pains to conceal the truth. They could have staged Tchaikovsky's drinking unboiled water at Leiner's by mutual agreement for the sake of family, friends, admirers and posterity. Since Tchaikovsky was an almost sacred national figure by this time in his life, Holden suggests the doctors involved with the composer's case might have gone along with this deception. Another theory was first broached publicly by Russian musicologist Alexandra Orlova in 1979 when she emigrated to the West. The key witness for Orlova's account was Alexander Voitrov, a pupil at the School of Jurisprudence before World War I who had reportedly amassed much about the history and people of his alma mater . Among these people was Nikolay Borisovich Jacobi, Senior Procurator to the Senate in the 1890s. Jacobi's widow, Elizaveta Karlovna, reportedly told Voitrov in 1913 that a Duke Stenbok-Fermor was disturbed by the attention which Tchaikovsky was paying to his young nephew. Stenbok-Fernor wrote a letter of accusation to the Tsar in the autumn of 1893 and gave the letter to Jacobi to deliver. Jacobi wanted to avoid a public scandal. He therefore invited all of Tchaikovsky's former schoolmates that he could locate in St. Petersburg—eight people altogether—to serve in a "court of honor" to discuss the charge. This meeting, held in Jacobi's study, lasted almost five hours. At the end of that time, Tchaikovsky rushed out, pale and agitated, without saying a word. Once everyone else had left, Jacobi told his wife that they had decided that Tchaikovsky should kill himself. Within a day or two of this meeting, news of the composer's illness was circulating in St. Petersburg. Orlova suggests this court of honor could have been convened on 31 October. This is the only day during which nothing is known about Tchaikovsky's activities until evening. Brown suggests that perhaps it is significant that Modest records his brother's last days from that evening, when Tchaikovsky attended Anton Rubinstein 's opera Die Maccabäer . In November 1993 the BBC aired a documentary entitled Pride or Prejudice , which investigated various theories regarding Tchaikovsky's death. Among those interviewed were Orlova, Brown and Poznansky, along with various experts on Russian history. Dr John Henry of Guy's Hospital , an expert witness working in the British National Poison Unit at the time, concluded in the documentary that all the reported symptoms of Tchaikovsky's illness "fit very closely with arsenic poisoning ." He suggested that people would have known that acute diarrhoea, dehydration and kidney failure resembled the manifestations of cholera. This would help bolster a potential illusion of the death as a case of cholera. The conclusion reached in the documentary leaned largely in favor of the "court of honor" theory. Other well-respected studies of the composer have challenged Orlova's statements in detail and concluded that the composer's death was due to natural causes. Among other challenges to Orlova's thesis, Poznansky revealed that there was no Duke Stenbok-Fermor, but there was a count of that name. However, he was an equerry to Tsar Alexander III and would not have needed an intermediary to deliver a letter to his own employer. As for the supposed threat to the reputation of the St Petersburg School of Jurisprudence represented by Tchaikovsky's homosexual affairs, Poznansky depicts the school as a hotbed of all-male debauchery which even had its own song hymning the delights of homosexuality. One other theory regarding Tchaikovsky's death is that it was ordered by Tsar Alexander III himself. This story was told by Swiss musicologist Robert-Aloys Mooser , who supposedly learned it from two others— Riccardo Drigo , composer and kapellmeister to the St. Petersburg Imperial Theatres, and the composer Alexander Glazunov . According to their scenario, the composer had seduced the son of the caretaker of his brother Modest's apartment block. The plausibility of this story for many people was that Glazunov reportedly confirmed it. Mooser considered Glazunov a reliable witness, stressing his "upright moral character, veneration for the composer and friendship with Tchaikovsky." More recently the French scholar André Lischke has confirmed Glazunov's confession. Lischke's father was a student of the composer in Petrograd in the 1920s. Glazunov confided the story to Lischke's father, who in turn passed it to his son. However, Poznansky counters, Glazunov could not have confirmed the suicide story unless he were absolutely certain of its truth. The only way that could have been possible, though, was if he had been told by someone in Tchaikovsky's innermost circle—in other words, someone who was present at the composer's deathbed. It was exactly this circle of intimates, however, that Drigo accused of concealing the "truth", [Poznansky's quotation marks for emphasis] demanding false testimonies from authorities, physicians and priests. Only by swearing Glazunov to the strictest secrecy would anyone in this circle have revealed the "truth". That Glazunov would then share this information with Mooser, Poznansky concludes, is virtually inconceivable since it would have compromised Glazunov entirely. Another version holds that Tchaikovsky had been undergoing a severe personal crisis. This crisis was precipitated, according to some accounts, by his infatuation for his nephew, Vladimir Davydov , who was frequently referred to by the nickname "Bob" by the Davydov family and the composer. This would reportedly explain the agonies expressed in the Sixth Symphony , as well as the mystery surrounding its program. Many analysts, working from this tangent, have since read the Pathétique as intensely autobiographical. According to this theory, Tchaikovsky realised the full extent of his feelings for Bob, plus the unlikelihood of their physical fulfillment. He supposedly poured his misery onto this one last great work as a conscious prelude to suicide, then drank unboiled water in the hope of contracting cholera. In this way, as with his wading into the Moscow river in 1877 in frustration over his marriage, Tchaikovsky could commit suicide without bringing disgrace upon his family. Without strong evidence for any of these cases, it is possible that no definite conclusion may be drawn and that the true nature of the composer's end may never be known. Conclusive evidence, Holden suggests, would mean exhuming Tchaikovsky's corpse for tests to determine the presence of arsenic , as has been done with the body of Napoleon Bonaparte , since arsenic can remain in the human body even after 100 years. Musicologist Roland John Wiley writes, "The polemics over [Tchaikovsky's] death have reached an impasse ... Rumor attached to the famous die hard ... As for illness, problems of evidence offer little hope of satisfactory resolution: the state of diagnosis; the confusion of witnesses; disregard of long-term effects of smoking and alcohol. We do not know how Tchaikovsky died. We may never find out...." In the early 1980s, Canadian composer Claude Vivier had begun working on an opera entitled Tchaïkovski, un réquiem Russe (lit. Tchaikovsky, a Russian Requiem ), which would have advanced the theory of suicide at the orders of Alexander III. Vivier announced the project to UNESCO music organizations and had begun writing a libretto, but he was murdered in a 1983 homophobic hate crime before the opera could be completed. English composer Michael Finnissy composed a short opera, Shameful Vice (1995), about Tchaikovsky's last days and death. Volkov writes that even before Tchaikovsky's death, his Symphony No. 6 Pathetique , was heard by at least some as the composer's artistic farewell to this world. After the last rehearsal of the symphony under its composer's baton, Grand Duke Konstantin Konstantinovich , a talented poet and fervent admirer of the composer, ran into the greenroom weeping and exclaiming, "What have you done, it's a requiem, a requiem!" As for the première itself, Volkov writes: Tchaikovsky began conducting with the baton held tightly in his fist ... in his usual manner. But when the final sounds of the symphony had died away and Tchaikovsky slowly lowered the baton, there was dead silence in the audience. Instead of applause, stifled sobs came from various parts of the hall. The audience was stunned and Tchaikovsky stood there, motionless, his head bowed. This would seem to contradict descriptions of this event by other biographers. Holden, for example, writes that the work had been greeted with respectful applause for its composer but general bewilderment about the work itself. However, Diaghilev apparently confirms Volkov's account. Though he mentions "At the rehearsal opinions were greatly divided....", he adds: "The concert's success was naturally overwhelming." Regardless of its initial reception, two weeks after Tchaikovsky's death, on 18 November 1893, the composer's longtime friend, conductor Eduard Nápravník , led the second performance of the Pathétique Symphony at a memorial concert in St. Petersburg . This was three weeks to the day after the composer had led the première in the same hall, before much the same audience. "It is indeed a sort of swan song, a presentiment of impending death, and hence its tragic impression" wrote the reviewer for the Russkaya Muzykal'naya Gazeta . Nikolai Rimsky-Korsakov , who attended both performances, attributed the public's change in opinion to "the composer's sudden death ... stories about his presentiments of approaching demise (to which mankind is so prone), and a tendency to link these presentiments with the gloomy mood of the last movement of this splendid ... famed, even fashionable work." Diaghilev adds that Nápravník wept throughout the performance. Though some modern musicologists, such as David Brown, dispute the view that Tchaikovsky wrote the Pathétique as his own requiem, many others, notably Milton Cross, David Ewen and Michael Paul Smith, accord it credence. The musical clues include one in the development section of the first movement, where the rapidly progressing evolution of the transformed first theme suddenly "shifts into neutral" in the strings, and a rather quiet, harmonised chorale emerges in the trombones. The trombone theme bears no relation to the music that either precedes or follows it. It appears to be a musical "non sequitur"—but it is from the Russian Orthodox Mass for the Dead, in which it is sung to the words: "And may his soul rest with the souls of all the saints." [ citation needed ]

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Louis Pasteur

Louis Pasteur ForMemRS ( / ˈ l uː i p æ ˈ s t ɜːr / , French: [ lwi pastœʁ ] ; 27 December 1822 – 28 September 1895) was a French chemist , pharmacist , and microbiologist renowned for his discoveries of the principles of vaccination , microbial fermentation , and pasteurization , the last of which was named after him. His research in chemistry led to remarkable breakthroughs in the understanding of the causes and preventions of diseases , which laid down the foundations of hygiene, public health and much of modern medicine. Pasteur's works are credited with saving millions of lives through the developments of vaccines for rabies and anthrax . He is regarded as one of the founders of modern bacteriology and has been honored as the "father of bacteriology" and the "father of microbiology " (together with Robert Koch ; the latter epithet also attributed to Antonie van Leeuwenhoek ). Pasteur was responsible for disproving the doctrine of spontaneous generation . Under the auspices of the French Academy of Sciences , his experiment demonstrated that in sterilized and sealed flasks, nothing ever developed; conversely, in sterilized but open flasks, microorganisms could grow. For this experiment, the academy awarded him the Alhumbert Prize carrying 2,500 francs in 1862. Pasteur is also regarded as one of the fathers of germ theory of diseases , which was a minor medical concept at the time. His many experiments showed that diseases could be prevented by killing or stopping germs, thereby directly supporting the germ theory and its application in clinical medicine. He is best known to the general public for his invention of the technique of treating milk and wine to stop bacterial contamination, a process now called pasteurization. Pasteur also made significant discoveries in chemistry, most notably on the molecular basis for the asymmetry of certain crystals and racemization . Early in his career, his investigation of sodium ammonium tartrate initiated the field of optical isomerism . This work had a profound effect on structural chemistry, with eventual implications for many areas including medicinal chemistry . He was the director of the Pasteur Institute , established in 1887, until his death, and his body was interred in a vault beneath the institute. Although Pasteur made groundbreaking experiments, his reputation became associated with various controversies. Historical reassessment of his notebook revealed that he practiced deception to overcome his rivals. Louis Pasteur was born on 27 December 1822, in Dole, Jura , France, to a Catholic family of a poor tanner . He was the third child of Jean-Joseph Pasteur and Jeanne-Etiennette Roqui. The family moved to Marnoz in 1826 and then to Arbois in 1827. Pasteur entered primary school in 1831. He was dyslexic and dysgraphic . He was an average student in his early years, and not particularly academic, as his interests were fishing and sketching . He drew many pastels and portraits of his parents, friends and neighbors. Pasteur attended secondary school at the Collège d'Arbois. In October 1838, he left for Paris to enroll in a boarding school , but became homesick and returned in November. In 1839, he entered the Collège Royal at Besançon to study philosophy and earned his Bachelor of Letters degree in 1840. He was appointed a tutor at the Besançon college while continuing a degree science course with special mathematics. He failed his first examination in 1841. He managed to pass the baccalauréat scientifique (general science) degree from Dijon , where he earned his Bachelor of Science in Mathematics degree (Bachelier ès Sciences Mathématiques) in 1842, but with a mediocre grade in chemistry. Later in 1842, Pasteur took the entrance test for the École Normale Supérieure . During the test, he had to fight fatigue and only felt comfortable with physics and mathematics. He passed the first set of tests, but because his ranking was low, Pasteur decided not to continue and try again next year. He went back to the Parisian boarding school to prepare for the test. He also attended classes at the Lycée Saint-Louis and lectures of Jean-Baptiste Dumas at the Sorbonne . In 1843, he passed the test with a high ranking and entered the École Normale Supérieure . In 1845 he received the licencié ès sciences degree. In 1846, he was appointed professor of physics at the Collège de Tournon (now called Lycée Gabriel-Faure ) in Ardèche . But the chemist Antoine Jérôme Balard wanted him back at the École Normale Supérieure as a graduate laboratory assistant ( agrégé préparateur ). He joined Balard and simultaneously started his research in crystallography and in 1847, he submitted his two theses, one in chemistry and the other in physics: (a) Chemistry Thesis: "Recherches sur la capacité de saturation de l'acide arsénieux. Etudes des arsénites de potasse, de soude et d'ammoniaque."; (b) Physics Thesis: "1. Études des phénomènes relatifs à la polarisation rotatoire des liquides. 2. Application de la polarisation rotatoire des liquides à la solution de diverses questions de chimie." After serving briefly as professor of physics at the Dijon Lycée in 1848, he became professor of chemistry at the University of Strasbourg , where he met and courted Marie Laurent , daughter of the university's rector in 1849. They were married on 29 May 1849, and together had five children, only two of whom survived to adulthood; the other three died of typhoid .Pasteur was appointed professor of chemistry at the University of Strasbourg in 1848, and became the chair of chemistry in 1852. In February 1854, so that he would have time to carry out work that could earn him the title of correspondent of the Institute, he got three months' paid leave with the help of a medical certificate of convenience. He extended the leave until 1 August, the date of the start of the exams. "I tell the Minister that I will go and do the examinations so as not to increase the embarrassment of the service. It is also so as not to leave to another a sum of 6 or 700 francs". In this same year 1854, he was named dean of the new faculty of sciences at University of Lille , where he began his studies on fermentation. It was on this occasion that Pasteur uttered his oft-quoted remark: " dans les champs de l'observation, le hasard ne favorise que les esprits préparés " ("In the field of observation, chance favors only the prepared mind"). In 1857, he moved to Paris as the director of scientific studies at the École Normale Supérieure where he took control from 1858 to 1867 and introduced a series of reforms to improve the standard of scientific work. The examinations became more rigid, which led to better results, greater competition, and increased prestige. Many of his decrees, however, were rigid and authoritarian, leading to two serious student revolts. During "the bean revolt" he decreed that a mutton stew, which students had refused to eat, would be served and eaten every Monday. On another occasion he threatened to expel any student caught smoking, and 73 of the 80 students in the school resigned. In 1863, he was appointed professor of geology, physics, and chemistry at the École nationale supérieure des Beaux-Arts , a position he held until his resignation in 1867. In 1867, he became the chair of organic chemistry at the Sorbonne, but he later gave up the position because of poor health. In 1867, the École Normale's laboratory of physiological chemistry was created at Pasteur's request, and he was the laboratory's director from 1867 to 1888. In Paris, he established the Pasteur Institute in 1887, in which he was its director for the rest of his life. In Pasteur's early work as a chemist , beginning at the École Normale Supérieure , and continuing at Strasbourg and Lille, he examined the chemical, optical and crystallographic properties of a group of compounds known as tartrates . He resolved a problem concerning the nature of tartaric acid in 1848. A solution of this compound derived from living things rotated the plane of polarization of light passing through it. The problem was that tartaric acid derived by chemical synthesis had no such effect, even though its chemical reactions were identical and its elemental composition was the same. Pasteur noticed that crystals of tartrates had small faces. Then he observed that, in racemic mixtures of tartrates, half of the crystals were right-handed and half were left-handed. In solution, the right-handed compound was dextrorotatory , and the left-handed one was levorotatory. Pasteur determined that optical activity related to the shape of the crystals, and that an asymmetric internal arrangement of the molecules of the compound was responsible for twisting the light. The (2 R ,3 R )- and (2 S ,3 S )- tartrates were isometric, non-superposable mirror images of each other. This was the first time anyone had demonstrated molecular chirality , and also the first explanation of isomerism . Some historians consider Pasteur's work in this area to be his "most profound and most original contributions to science", and his "greatest scientific discovery." Pasteur was motivated to investigate fermentation while working at Lille. In 1856 a local wine manufacturer, M. Bigot, whose son was one of Pasteur's students, sought for his advice on the problems of making beetroot alcohol and souring. Pasteur began his research in the topic by repeating and confirming works of Theodor Schwann , who demonstrated a decade earlier that yeast were alive. According to his son-in-law, René Vallery-Radot, in August 1857 Pasteur sent a paper about lactic acid fermentation to the Société des Sciences de Lille, but the paper was read three months later. A memoire was subsequently published on 30 November 1857. In the memoir, he developed his ideas stating that: "I intend to establish that, just as there is an alcoholic ferment, the yeast of beer, which is found everywhere that sugar is decomposed into alcohol and carbonic acid, so also there is a particular ferment, a lactic yeast , always present when sugar becomes lactic acid ." Pasteur also wrote about alcoholic fermentation. It was published in full form in 1858. Jöns Jacob Berzelius and Justus von Liebig had proposed the theory that fermentation was caused by decomposition. Pasteur demonstrated that this theory was incorrect, and that yeast was responsible for fermentation to produce alcohol from sugar. He also demonstrated that, when a different microorganism contaminated the wine, lactic acid was produced, making the wine sour. In 1861, Pasteur observed that less sugar fermented per part of yeast when the yeast was exposed to air. The lower rate of fermentation aerobically became known as the Pasteur effect . Pasteur's research also showed that the growth of micro-organisms was responsible for spoiling beverages, such as beer, wine and milk. With this established, he invented a process in which liquids such as milk were heated to a temperature between 60 and 100 °C. This killed most bacteria and moulds already present within them. Pasteur and Claude Bernard completed tests on blood and urine on 20 April 1862. Pasteur patented the process, to fight the "diseases" of wine, in 1865. The method became known as pasteurization , and was soon applied to beer and milk. Beverage contamination led Pasteur to the idea that micro-organisms infecting animals and humans cause disease. He proposed preventing the entry of micro-organisms into the human body, leading Joseph Lister to develop antiseptic methods in surgery. In 1866, Pasteur published Etudes sur le Vin , about the diseases of wine, and he published Etudes sur la Bière in 1876, concerning the diseases of beer. In the early 19th century, Agostino Bassi had shown that muscardine was caused by a fungus that infected silkworms. Since 1853, two diseases called pébrine and flacherie had been infecting great numbers of silkworms in southern France, and by 1865 they were causing huge losses to farmers. In 1865, Pasteur went to Alès and worked for five years until 1870. Silkworms with pébrine were covered in corpuscles. In the first three years, Pasteur thought that the corpuscles were a symptom of the disease. In 1870, he concluded that the corpuscles were the cause of pébrine (it is now known that the cause is a microsporidian ). Pasteur also showed that the disease was hereditary. Pasteur developed a system to prevent pébrine: after the female moths laid their eggs, the moths were turned into a pulp. The pulp was examined with a microscope, and if corpuscles were observed, the eggs were destroyed. Pasteur concluded that bacteria caused flacherie. The primary cause is currently thought to be viruses. The spread of flacherie could be accidental or hereditary. Hygiene could be used to prevent accidental flacherie. Moths whose digestive cavities did not contain the microorganisms causing flacherie were used to lay eggs, preventing hereditary flacherie. Following his fermentation experiments, Pasteur demonstrated that the skin of grapes was the natural source of yeasts, and that sterilized grapes and grape juice never fermented. He drew grape juice from under the skin with sterilized needles, and also covered grapes with sterilized cloth. Both experiments could not produce wine in sterilized containers. His findings and ideas were against the prevailing notion of spontaneous generation . He received a particularly stern criticism from Félix Archimède Pouchet , who was director of the Rouen Museum of Natural History . To settle the debate between the eminent scientists, the French Academy of Sciences offered the Alhumbert Prize carrying 2,500 francs to whoever could experimentally demonstrate for or against the doctrine. Pouchet stated that air everywhere could cause spontaneous generation of living organisms in liquids. In the late 1850s, he performed experiments and claimed that they were evidence of spontaneous generation. Francesco Redi and Lazzaro Spallanzani had provided some evidence against spontaneous generation in the 17th and 18th centuries, respectively. Spallanzani's experiments in 1765 suggested that air contaminated broths with bacteria. In the 1860s, Pasteur repeated Spallanzani's experiments, but Pouchet reported a different result using a different broth. Pasteur performed several experiments to disprove spontaneous generation. He placed boiled liquid in a flask and let hot air enter the flask. Then he closed the flask, and no organisms grew in it. In another experiment, when he opened flasks containing boiled liquid, dust entered the flasks, causing organisms to grow in some of them. The number of flasks in which organisms grew was lower at higher altitudes, showing that air at high altitudes contained less dust and fewer organisms. Pasteur also used swan neck flasks containing a fermentable liquid. Air was allowed to enter the flask via a long curving tube that made dust particles stick to it. Nothing grew in the broths unless the flasks were tilted, making the liquid touch the contaminated walls of the neck. This showed that the living organisms that grew in such broths came from outside, on dust, rather than spontaneously generating within the liquid or from the action of pure air. These were some of the most important experiments disproving the theory of spontaneous generation. Pasteur gave a series of five presentations of his findings before the French Academy of Sciences in 1881, which were published in 1882 as Mémoire Sur les corpuscules organisés qui existent dans l'atmosphère: Examen de la doctrine des générations spontanées ( Account of Organized Corpuscles Existing in the Atmosphere: Examining the Doctrine of Spontaneous Generation ). Pasteur won the Alhumbert Prize in 1862. He concluded that: Never will the doctrine of spontaneous generation recover from the mortal blow of this simple experiment. There is no known circumstance in which it can be confirmed that microscopic beings came into the world without germs, without parents similar to themselves. In 1865, Jean-Baptiste Dumas , chemist, senator and former Minister of Agriculture and Commerce, asked Pasteur to study a new disease that was decimating silkworm farms from the south of France and Europe, the pébrine , characterized on a macroscopic scale by black spots and on a microscopic scale by the " Cornalia corpuscles". Pasteur accepted and made five long stays in Alès , between 7 June 1865 and 1869. Arriving in Alès, Pasteur familiarized himself with pébrine and also with another disease of the silkworm, known earlier than pebrine: flacherie or dead-flat disease. Contrary, for example, to Quatrefages , who coined the new word pébrine , Pasteur made the mistake of believing that the two diseases were the same and even that most of the diseases of silkworms known up to that time were identical with each other and with pébrine. It was in letters of 30 April and 21 May 1867 to Dumas that he first made the distinction between pébrine and flacherie. He made another mistake: he began by denying the "parasitic" (microbial) nature of pébrine, which several scholars (notably Antoine Béchamp ) considered well established. Even a note published on 27 August 1866 by Balbiani , which Pasteur at first seemed to welcome favourably had no effect, at least immediately. "Pasteur is mistaken. He would only change his mind in the course of 1867". At a time where Pasteur had not yet understood the cause of the pébrine, he propagated an effective process to stop infections: a sample of chrysalises was chosen, they were crushed and the corpuscles were searched for in the crushed material; if the proportion of corpuscular pupae in the sample was very low, the chamber was considered good for reproduction. This method of sorting "seeds" (eggs) is close to a method that Osimo had proposed a few years earlier, but whose trials had not been conclusive. By this process, Pasteur curbs pébrine and saves many of the silk industry in the Cévennes. In 1878, at the Congrès international séricicole , Pasteur admitted that "if pébrine is overcome, flacherie still exerts its ravages". He attributed the persistence of flacherie to the fact that the farmers had not followed his advice. In 1884, Balbiani , who disregarded the theoretical value of Pasteur's work on silkworm diseases, acknowledged that his practical process had remedied the ravages of pébrine, but added that this result tended to be counterbalanced by the development of flacherie, which was less well known and more difficult to prevent. Despite Pasteur's success against pébrine, French sericulture had not been saved from damage. (See fr:Sériciculture in the French Wikipedia.) Pasteur's first work on vaccine development was on chicken cholera . He received the bacteria samples (later called Pasteurella multocida after him) from Henry Toussaint . He started the study in 1877, and by the next year, was able to maintain a stable culture using broths. After another year of continuous culturing, he found that the bacteria were less pathogenic. Some of his culture samples could no longer induce the disease in healthy chickens . In 1879, Pasteur, planning for holiday, instructed his assistant, Charles Chamberland to inoculate the chickens with fresh bacteria culture. Chamberland forgot and went on holiday himself. On his return, he injected the month-old cultures to healthy chickens. The chickens showed some symptoms of infection, but instead of the infections being fatal, as they usually were, the chickens recovered completely. Chamberland assumed an error had been made, and wanted to discard the apparently faulty culture, but Pasteur stopped him. Pasteur injected the freshly recovered chickens with fresh bacteria that normally would kill other chickens; the chickens no longer showed any sign of infection. It was clear to him that the weakened bacteria had caused the chickens to become immune to the disease. In December 1880, Pasteur presented his results to the French Academy of Sciences as " Sur les maladies virulentes et en particulier sur la maladie appelée vulgairement choléra des poules (On virulent diseases, and in particular on the disease commonly called chicken cholera)" and published it in the academy's journal ( Comptes-Rendus hebdomadaires des séances de l'Académie des Sciences ). He attributed that the bacteria were weakened by contact with oxygen. He explained that bacteria kept in sealed containers never lost their virulence, and only those exposed to air in culture media could be used as vaccine. Pasteur introduced the term "attenuation" for this weakening of virulence as he presented before the academy, saying: We can diminish the microbe's virulence by changing the mode of culturing. This is the crucial point of my subject. I ask the Academy not to criticize, for the time being, the confidence of my proceedings that permit me to determine the microbe's attenuation, in order to save the independence of my studies and to better assure their progress... [In conclusion] I would like to point out to the Academy two main consequences to the facts presented: the hope to culture all microbes and to find a vaccine for all infectious diseases that have repeatedly afflicted humanity, and are a major burden on agriculture and breeding of domestic animals. In fact, Pasteur's vaccine against chicken cholera was not regular in its effects and was a failure. In the 1870s, he applied this immunization method to anthrax , which affected cattle , and aroused interest in combating other diseases. Pasteur cultivated bacteria from the blood of animals infected with anthrax. When he inoculated animals with the bacteria, anthrax occurred, proving that the bacteria was the cause of the disease. Many cattle were dying of anthrax in "cursed fields". Pasteur was told that sheep that died from anthrax were buried in the field. Pasteur thought that earthworms might have brought the bacteria to the surface. He found anthrax bacteria in earthworms' excrement, showing that he was correct. He told the farmers not to bury dead animals in the fields. Pasteur had been trying to develop the anthrax vaccine since 1877, soon after Robert Koch's discovery of the bacterium. On 12 July 1880, Henri Bouley read before the French Academy of Sciences a report from Henry Toussaint , a veterinary surgeon , who was not member of the academy. Toussaint had developed anthrax vaccine by killing the bacilli by heating at 55 °C for 10  minutes. He tested on eight dogs and 11 sheep, half of which died after inoculation. It was not a great success. Upon hearing the news, Pasteur immediately wrote to the academy that he could not believe that dead vaccine would work and that Toussaint's claim "overturns all the ideas I had on viruses, vaccines, etc." Following Pasteur's criticism, Toussaint switched to carbolic acid to kill anthrax bacilli and tested the vaccine on sheep in August 1880. Pasteur thought that this type of killed vaccine should not work because he believed that attenuated bacteria used up nutrients that the bacteria needed to grow. He thought oxidizing bacteria made them less virulent. But Pasteur found that anthrax bacillus was not easily weakened by culturing in air as it formed spores – unlike chicken cholera bacillus. In early 1881, he discovered that growing anthrax bacilli at about 42 °C made them unable to produce spores, and he described this method in a speech to the French Academy of Sciences on 28 February. On 21 March, he announced successful vaccination of sheep. To this news, veterinarian Hippolyte Rossignol proposed that the Société d'agriculture de Melun organize an experiment to test Pasteur's vaccine. Pasteur signed agreement of the challenge on 28 April. A public experiment was conducted in May at Pouilly-le-Fort. 58 sheep, 2 goats and 10 cattle were used, half of which were given the vaccine on 5 and 17 May; while the other half was untreated. All the animals were injected with the fresh virulent culture of anthrax bacillus on 31 May. The official result was observed and analysed on 2 June in the presence of over 200 spectators. All cattle survived, vaccinated or not. Pasteur had bravely predicted: "I hypothesized that the six vaccinated cows would not become very ill, while the four unvaccinated cows would perish or at least become very ill." However, all vaccinated sheep and goats survived, while unvaccinated ones had died or were dying before the viewers. His report to the French Academy of Sciences on 13 June concludes: [By] looking at everything from the scientific point of view, the development of a vaccination against anthrax constitutes significant progress beyond the first vaccine developed by Jenner, since the latter had never been obtained experimentally. Pasteur did not directly disclose how he prepared the vaccines used at Pouilly-le-Fort. Although his report indicated it as a "live vaccine", his laboratory notebooks show that he actually used potassium dichromate -killed vaccine, as developed by Chamberland, quite similar to Toussaint's method. The notion of a weak form of a disease causing immunity to the virulent version was not new; this had been known for a long time for smallpox . Inoculation with smallpox ( variolation ) was known to result in a much less severe disease, and greatly reduced mortality, in comparison with the naturally acquired disease. Edward Jenner had also studied vaccination using cowpox ( vaccinia ) to give cross-immunity to smallpox in the late 1790s, and by the early 1800s vaccination had spread to most of Europe. The difference between smallpox vaccination and anthrax or chicken cholera vaccination was that the latter two disease organisms had been artificially weakened, so a naturally weak form of the disease organism did not need to be found. This discovery revolutionized work in infectious diseases, and Pasteur gave these artificially weakened diseases the generic name of " vaccines ", in honour of Jenner's discovery. In 1876, Robert Koch had shown that Bacillus anthracis caused anthrax. In his papers published between 1878 and 1880, Pasteur only mentioned Koch's work in a footnote. Koch met Pasteur at the Seventh International Medical Congress in 1881. A few months later, Koch wrote that Pasteur had used impure cultures and made errors. In 1882, Pasteur replied to Koch in a speech, to which Koch responded aggressively. Koch stated that Pasteur tested his vaccine on unsuitable animals and that Pasteur's research was not properly scientific. In 1882, Koch wrote "On the Anthrax Inoculation", in which he refuted several of Pasteur's conclusions about anthrax and criticized Pasteur for keeping his methods secret, jumping to conclusions, and being imprecise. In 1883, Pasteur wrote that he used cultures prepared in a similar way to his successful fermentation experiments and that Koch misinterpreted statistics and ignored Pasteur's work on silkworms. In 1882, Pasteur sent his assistant Louis Thuillier to southern France because of an epizootic of swine erysipelas . Thuillier identified the bacillus that caused the disease in March 1883. Pasteur and Thuillier increased the bacillus's virulence after passing it through pigeons. Then they passed the bacillus through rabbits, weakening it and obtaining a vaccine. Pasteur and Thuillier incorrectly described the bacterium as a figure-eight shape. Roux described the bacterium as stick-shaped in 1884. Pasteur produced the first vaccine for rabies by growing the virus in rabbits, and then weakening it by drying the affected nerve tissue. The rabies vaccine was initially created by Emile Roux , a French doctor and a colleague of Pasteur, who had produced a killed vaccine using this method. The vaccine had been tested in 50 dogs before its first human trial. This vaccine was used on 9-year-old Joseph Meister , on 6 July 1885, after the boy was badly mauled by a rabid dog. This was done at some personal risk for Pasteur, since he was not a licensed physician and could have faced prosecution for treating the boy. After consulting with physicians, he decided to go ahead with the treatment. Over 11 days, Meister received 13 inoculations, each inoculation using viruses that had been weakened for a shorter period of time. Three months later he examined Meister and found that he was in good health. Pasteur was hailed as a hero and the legal matter was not pursued. Analysis of his laboratory notebooks shows that Pasteur had treated two people before his vaccination of Meister. One survived but may not actually have had rabies, and the other died of rabies. Pasteur began treatment of Jean-Baptiste Jupille on 20 October 1885, and the treatment was successful. Later in 1885, people, including four children from the United States, went to Pasteur's laboratory to be inoculated. In 1886, he treated 350 people, of which only one developed rabies. The treatment's success laid the foundations for the manufacture of many other vaccines. The first of the Pasteur Institutes was also built on the basis of this achievement. In The Story of San Michele , Axel Munthe writes of some risks Pasteur undertook in the rabies vaccine research: Pasteur himself was absolutely fearless. Anxious to secure a sample of saliva straight from the jaws of a rabid dog, I once saw him with the glass tube held between his lips draw a few drops of the deadly saliva from the mouth of a rabid bull-dog, held on the table by two assistants, their hands protected by leather gloves. Because of his study in germs, Pasteur encouraged doctors to sanitize their hands and equipment before surgery. Prior to this, few doctors or their assistants practiced these procedures. Ignaz Semmelweis and Joseph Lister had earlier practiced hand sanitizing in medical contexts in the 1860s. In Pasteur's early work as a chemist , beginning at the École Normale Supérieure , and continuing at Strasbourg and Lille, he examined the chemical, optical and crystallographic properties of a group of compounds known as tartrates . He resolved a problem concerning the nature of tartaric acid in 1848. A solution of this compound derived from living things rotated the plane of polarization of light passing through it. The problem was that tartaric acid derived by chemical synthesis had no such effect, even though its chemical reactions were identical and its elemental composition was the same. Pasteur noticed that crystals of tartrates had small faces. Then he observed that, in racemic mixtures of tartrates, half of the crystals were right-handed and half were left-handed. In solution, the right-handed compound was dextrorotatory , and the left-handed one was levorotatory. Pasteur determined that optical activity related to the shape of the crystals, and that an asymmetric internal arrangement of the molecules of the compound was responsible for twisting the light. The (2 R ,3 R )- and (2 S ,3 S )- tartrates were isometric, non-superposable mirror images of each other. This was the first time anyone had demonstrated molecular chirality , and also the first explanation of isomerism . Some historians consider Pasteur's work in this area to be his "most profound and most original contributions to science", and his "greatest scientific discovery." Pasteur was motivated to investigate fermentation while working at Lille. In 1856 a local wine manufacturer, M. Bigot, whose son was one of Pasteur's students, sought for his advice on the problems of making beetroot alcohol and souring. Pasteur began his research in the topic by repeating and confirming works of Theodor Schwann , who demonstrated a decade earlier that yeast were alive. According to his son-in-law, René Vallery-Radot, in August 1857 Pasteur sent a paper about lactic acid fermentation to the Société des Sciences de Lille, but the paper was read three months later. A memoire was subsequently published on 30 November 1857. In the memoir, he developed his ideas stating that: "I intend to establish that, just as there is an alcoholic ferment, the yeast of beer, which is found everywhere that sugar is decomposed into alcohol and carbonic acid, so also there is a particular ferment, a lactic yeast , always present when sugar becomes lactic acid ." Pasteur also wrote about alcoholic fermentation. It was published in full form in 1858. Jöns Jacob Berzelius and Justus von Liebig had proposed the theory that fermentation was caused by decomposition. Pasteur demonstrated that this theory was incorrect, and that yeast was responsible for fermentation to produce alcohol from sugar. He also demonstrated that, when a different microorganism contaminated the wine, lactic acid was produced, making the wine sour. In 1861, Pasteur observed that less sugar fermented per part of yeast when the yeast was exposed to air. The lower rate of fermentation aerobically became known as the Pasteur effect . Pasteur's research also showed that the growth of micro-organisms was responsible for spoiling beverages, such as beer, wine and milk. With this established, he invented a process in which liquids such as milk were heated to a temperature between 60 and 100 °C. This killed most bacteria and moulds already present within them. Pasteur and Claude Bernard completed tests on blood and urine on 20 April 1862. Pasteur patented the process, to fight the "diseases" of wine, in 1865. The method became known as pasteurization , and was soon applied to beer and milk. Beverage contamination led Pasteur to the idea that micro-organisms infecting animals and humans cause disease. He proposed preventing the entry of micro-organisms into the human body, leading Joseph Lister to develop antiseptic methods in surgery. In 1866, Pasteur published Etudes sur le Vin , about the diseases of wine, and he published Etudes sur la Bière in 1876, concerning the diseases of beer. In the early 19th century, Agostino Bassi had shown that muscardine was caused by a fungus that infected silkworms. Since 1853, two diseases called pébrine and flacherie had been infecting great numbers of silkworms in southern France, and by 1865 they were causing huge losses to farmers. In 1865, Pasteur went to Alès and worked for five years until 1870. Silkworms with pébrine were covered in corpuscles. In the first three years, Pasteur thought that the corpuscles were a symptom of the disease. In 1870, he concluded that the corpuscles were the cause of pébrine (it is now known that the cause is a microsporidian ). Pasteur also showed that the disease was hereditary. Pasteur developed a system to prevent pébrine: after the female moths laid their eggs, the moths were turned into a pulp. The pulp was examined with a microscope, and if corpuscles were observed, the eggs were destroyed. Pasteur concluded that bacteria caused flacherie. The primary cause is currently thought to be viruses. The spread of flacherie could be accidental or hereditary. Hygiene could be used to prevent accidental flacherie. Moths whose digestive cavities did not contain the microorganisms causing flacherie were used to lay eggs, preventing hereditary flacherie. Following his fermentation experiments, Pasteur demonstrated that the skin of grapes was the natural source of yeasts, and that sterilized grapes and grape juice never fermented. He drew grape juice from under the skin with sterilized needles, and also covered grapes with sterilized cloth. Both experiments could not produce wine in sterilized containers. His findings and ideas were against the prevailing notion of spontaneous generation . He received a particularly stern criticism from Félix Archimède Pouchet , who was director of the Rouen Museum of Natural History . To settle the debate between the eminent scientists, the French Academy of Sciences offered the Alhumbert Prize carrying 2,500 francs to whoever could experimentally demonstrate for or against the doctrine. Pouchet stated that air everywhere could cause spontaneous generation of living organisms in liquids. In the late 1850s, he performed experiments and claimed that they were evidence of spontaneous generation. Francesco Redi and Lazzaro Spallanzani had provided some evidence against spontaneous generation in the 17th and 18th centuries, respectively. Spallanzani's experiments in 1765 suggested that air contaminated broths with bacteria. In the 1860s, Pasteur repeated Spallanzani's experiments, but Pouchet reported a different result using a different broth. Pasteur performed several experiments to disprove spontaneous generation. He placed boiled liquid in a flask and let hot air enter the flask. Then he closed the flask, and no organisms grew in it. In another experiment, when he opened flasks containing boiled liquid, dust entered the flasks, causing organisms to grow in some of them. The number of flasks in which organisms grew was lower at higher altitudes, showing that air at high altitudes contained less dust and fewer organisms. Pasteur also used swan neck flasks containing a fermentable liquid. Air was allowed to enter the flask via a long curving tube that made dust particles stick to it. Nothing grew in the broths unless the flasks were tilted, making the liquid touch the contaminated walls of the neck. This showed that the living organisms that grew in such broths came from outside, on dust, rather than spontaneously generating within the liquid or from the action of pure air. These were some of the most important experiments disproving the theory of spontaneous generation. Pasteur gave a series of five presentations of his findings before the French Academy of Sciences in 1881, which were published in 1882 as Mémoire Sur les corpuscules organisés qui existent dans l'atmosphère: Examen de la doctrine des générations spontanées ( Account of Organized Corpuscles Existing in the Atmosphere: Examining the Doctrine of Spontaneous Generation ). Pasteur won the Alhumbert Prize in 1862. He concluded that: Never will the doctrine of spontaneous generation recover from the mortal blow of this simple experiment. There is no known circumstance in which it can be confirmed that microscopic beings came into the world without germs, without parents similar to themselves. In 1865, Jean-Baptiste Dumas , chemist, senator and former Minister of Agriculture and Commerce, asked Pasteur to study a new disease that was decimating silkworm farms from the south of France and Europe, the pébrine , characterized on a macroscopic scale by black spots and on a microscopic scale by the " Cornalia corpuscles". Pasteur accepted and made five long stays in Alès , between 7 June 1865 and 1869. Arriving in Alès, Pasteur familiarized himself with pébrine and also with another disease of the silkworm, known earlier than pebrine: flacherie or dead-flat disease. Contrary, for example, to Quatrefages , who coined the new word pébrine , Pasteur made the mistake of believing that the two diseases were the same and even that most of the diseases of silkworms known up to that time were identical with each other and with pébrine. It was in letters of 30 April and 21 May 1867 to Dumas that he first made the distinction between pébrine and flacherie. He made another mistake: he began by denying the "parasitic" (microbial) nature of pébrine, which several scholars (notably Antoine Béchamp ) considered well established. Even a note published on 27 August 1866 by Balbiani , which Pasteur at first seemed to welcome favourably had no effect, at least immediately. "Pasteur is mistaken. He would only change his mind in the course of 1867". At a time where Pasteur had not yet understood the cause of the pébrine, he propagated an effective process to stop infections: a sample of chrysalises was chosen, they were crushed and the corpuscles were searched for in the crushed material; if the proportion of corpuscular pupae in the sample was very low, the chamber was considered good for reproduction. This method of sorting "seeds" (eggs) is close to a method that Osimo had proposed a few years earlier, but whose trials had not been conclusive. By this process, Pasteur curbs pébrine and saves many of the silk industry in the Cévennes. In 1878, at the Congrès international séricicole , Pasteur admitted that "if pébrine is overcome, flacherie still exerts its ravages". He attributed the persistence of flacherie to the fact that the farmers had not followed his advice. In 1884, Balbiani , who disregarded the theoretical value of Pasteur's work on silkworm diseases, acknowledged that his practical process had remedied the ravages of pébrine, but added that this result tended to be counterbalanced by the development of flacherie, which was less well known and more difficult to prevent. Despite Pasteur's success against pébrine, French sericulture had not been saved from damage. (See fr:Sériciculture in the French Wikipedia.)Arriving in Alès, Pasteur familiarized himself with pébrine and also with another disease of the silkworm, known earlier than pebrine: flacherie or dead-flat disease. Contrary, for example, to Quatrefages , who coined the new word pébrine , Pasteur made the mistake of believing that the two diseases were the same and even that most of the diseases of silkworms known up to that time were identical with each other and with pébrine. It was in letters of 30 April and 21 May 1867 to Dumas that he first made the distinction between pébrine and flacherie. He made another mistake: he began by denying the "parasitic" (microbial) nature of pébrine, which several scholars (notably Antoine Béchamp ) considered well established. Even a note published on 27 August 1866 by Balbiani , which Pasteur at first seemed to welcome favourably had no effect, at least immediately. "Pasteur is mistaken. He would only change his mind in the course of 1867". At a time where Pasteur had not yet understood the cause of the pébrine, he propagated an effective process to stop infections: a sample of chrysalises was chosen, they were crushed and the corpuscles were searched for in the crushed material; if the proportion of corpuscular pupae in the sample was very low, the chamber was considered good for reproduction. This method of sorting "seeds" (eggs) is close to a method that Osimo had proposed a few years earlier, but whose trials had not been conclusive. By this process, Pasteur curbs pébrine and saves many of the silk industry in the Cévennes. In 1878, at the Congrès international séricicole , Pasteur admitted that "if pébrine is overcome, flacherie still exerts its ravages". He attributed the persistence of flacherie to the fact that the farmers had not followed his advice. In 1884, Balbiani , who disregarded the theoretical value of Pasteur's work on silkworm diseases, acknowledged that his practical process had remedied the ravages of pébrine, but added that this result tended to be counterbalanced by the development of flacherie, which was less well known and more difficult to prevent. Despite Pasteur's success against pébrine, French sericulture had not been saved from damage. (See fr:Sériciculture in the French Wikipedia.)Pasteur's first work on vaccine development was on chicken cholera . He received the bacteria samples (later called Pasteurella multocida after him) from Henry Toussaint . He started the study in 1877, and by the next year, was able to maintain a stable culture using broths. After another year of continuous culturing, he found that the bacteria were less pathogenic. Some of his culture samples could no longer induce the disease in healthy chickens . In 1879, Pasteur, planning for holiday, instructed his assistant, Charles Chamberland to inoculate the chickens with fresh bacteria culture. Chamberland forgot and went on holiday himself. On his return, he injected the month-old cultures to healthy chickens. The chickens showed some symptoms of infection, but instead of the infections being fatal, as they usually were, the chickens recovered completely. Chamberland assumed an error had been made, and wanted to discard the apparently faulty culture, but Pasteur stopped him. Pasteur injected the freshly recovered chickens with fresh bacteria that normally would kill other chickens; the chickens no longer showed any sign of infection. It was clear to him that the weakened bacteria had caused the chickens to become immune to the disease. In December 1880, Pasteur presented his results to the French Academy of Sciences as " Sur les maladies virulentes et en particulier sur la maladie appelée vulgairement choléra des poules (On virulent diseases, and in particular on the disease commonly called chicken cholera)" and published it in the academy's journal ( Comptes-Rendus hebdomadaires des séances de l'Académie des Sciences ). He attributed that the bacteria were weakened by contact with oxygen. He explained that bacteria kept in sealed containers never lost their virulence, and only those exposed to air in culture media could be used as vaccine. Pasteur introduced the term "attenuation" for this weakening of virulence as he presented before the academy, saying: We can diminish the microbe's virulence by changing the mode of culturing. This is the crucial point of my subject. I ask the Academy not to criticize, for the time being, the confidence of my proceedings that permit me to determine the microbe's attenuation, in order to save the independence of my studies and to better assure their progress... [In conclusion] I would like to point out to the Academy two main consequences to the facts presented: the hope to culture all microbes and to find a vaccine for all infectious diseases that have repeatedly afflicted humanity, and are a major burden on agriculture and breeding of domestic animals. In fact, Pasteur's vaccine against chicken cholera was not regular in its effects and was a failure. In the 1870s, he applied this immunization method to anthrax , which affected cattle , and aroused interest in combating other diseases. Pasteur cultivated bacteria from the blood of animals infected with anthrax. When he inoculated animals with the bacteria, anthrax occurred, proving that the bacteria was the cause of the disease. Many cattle were dying of anthrax in "cursed fields". Pasteur was told that sheep that died from anthrax were buried in the field. Pasteur thought that earthworms might have brought the bacteria to the surface. He found anthrax bacteria in earthworms' excrement, showing that he was correct. He told the farmers not to bury dead animals in the fields. Pasteur had been trying to develop the anthrax vaccine since 1877, soon after Robert Koch's discovery of the bacterium. On 12 July 1880, Henri Bouley read before the French Academy of Sciences a report from Henry Toussaint , a veterinary surgeon , who was not member of the academy. Toussaint had developed anthrax vaccine by killing the bacilli by heating at 55 °C for 10  minutes. He tested on eight dogs and 11 sheep, half of which died after inoculation. It was not a great success. Upon hearing the news, Pasteur immediately wrote to the academy that he could not believe that dead vaccine would work and that Toussaint's claim "overturns all the ideas I had on viruses, vaccines, etc." Following Pasteur's criticism, Toussaint switched to carbolic acid to kill anthrax bacilli and tested the vaccine on sheep in August 1880. Pasteur thought that this type of killed vaccine should not work because he believed that attenuated bacteria used up nutrients that the bacteria needed to grow. He thought oxidizing bacteria made them less virulent. But Pasteur found that anthrax bacillus was not easily weakened by culturing in air as it formed spores – unlike chicken cholera bacillus. In early 1881, he discovered that growing anthrax bacilli at about 42 °C made them unable to produce spores, and he described this method in a speech to the French Academy of Sciences on 28 February. On 21 March, he announced successful vaccination of sheep. To this news, veterinarian Hippolyte Rossignol proposed that the Société d'agriculture de Melun organize an experiment to test Pasteur's vaccine. Pasteur signed agreement of the challenge on 28 April. A public experiment was conducted in May at Pouilly-le-Fort. 58 sheep, 2 goats and 10 cattle were used, half of which were given the vaccine on 5 and 17 May; while the other half was untreated. All the animals were injected with the fresh virulent culture of anthrax bacillus on 31 May. The official result was observed and analysed on 2 June in the presence of over 200 spectators. All cattle survived, vaccinated or not. Pasteur had bravely predicted: "I hypothesized that the six vaccinated cows would not become very ill, while the four unvaccinated cows would perish or at least become very ill." However, all vaccinated sheep and goats survived, while unvaccinated ones had died or were dying before the viewers. His report to the French Academy of Sciences on 13 June concludes: [By] looking at everything from the scientific point of view, the development of a vaccination against anthrax constitutes significant progress beyond the first vaccine developed by Jenner, since the latter had never been obtained experimentally. Pasteur did not directly disclose how he prepared the vaccines used at Pouilly-le-Fort. Although his report indicated it as a "live vaccine", his laboratory notebooks show that he actually used potassium dichromate -killed vaccine, as developed by Chamberland, quite similar to Toussaint's method. The notion of a weak form of a disease causing immunity to the virulent version was not new; this had been known for a long time for smallpox . Inoculation with smallpox ( variolation ) was known to result in a much less severe disease, and greatly reduced mortality, in comparison with the naturally acquired disease. Edward Jenner had also studied vaccination using cowpox ( vaccinia ) to give cross-immunity to smallpox in the late 1790s, and by the early 1800s vaccination had spread to most of Europe. The difference between smallpox vaccination and anthrax or chicken cholera vaccination was that the latter two disease organisms had been artificially weakened, so a naturally weak form of the disease organism did not need to be found. This discovery revolutionized work in infectious diseases, and Pasteur gave these artificially weakened diseases the generic name of " vaccines ", in honour of Jenner's discovery. In 1876, Robert Koch had shown that Bacillus anthracis caused anthrax. In his papers published between 1878 and 1880, Pasteur only mentioned Koch's work in a footnote. Koch met Pasteur at the Seventh International Medical Congress in 1881. A few months later, Koch wrote that Pasteur had used impure cultures and made errors. In 1882, Pasteur replied to Koch in a speech, to which Koch responded aggressively. Koch stated that Pasteur tested his vaccine on unsuitable animals and that Pasteur's research was not properly scientific. In 1882, Koch wrote "On the Anthrax Inoculation", in which he refuted several of Pasteur's conclusions about anthrax and criticized Pasteur for keeping his methods secret, jumping to conclusions, and being imprecise. In 1883, Pasteur wrote that he used cultures prepared in a similar way to his successful fermentation experiments and that Koch misinterpreted statistics and ignored Pasteur's work on silkworms. In 1882, Pasteur sent his assistant Louis Thuillier to southern France because of an epizootic of swine erysipelas . Thuillier identified the bacillus that caused the disease in March 1883. Pasteur and Thuillier increased the bacillus's virulence after passing it through pigeons. Then they passed the bacillus through rabbits, weakening it and obtaining a vaccine. Pasteur and Thuillier incorrectly described the bacterium as a figure-eight shape. Roux described the bacterium as stick-shaped in 1884. Pasteur produced the first vaccine for rabies by growing the virus in rabbits, and then weakening it by drying the affected nerve tissue. The rabies vaccine was initially created by Emile Roux , a French doctor and a colleague of Pasteur, who had produced a killed vaccine using this method. The vaccine had been tested in 50 dogs before its first human trial. This vaccine was used on 9-year-old Joseph Meister , on 6 July 1885, after the boy was badly mauled by a rabid dog. This was done at some personal risk for Pasteur, since he was not a licensed physician and could have faced prosecution for treating the boy. After consulting with physicians, he decided to go ahead with the treatment. Over 11 days, Meister received 13 inoculations, each inoculation using viruses that had been weakened for a shorter period of time. Three months later he examined Meister and found that he was in good health. Pasteur was hailed as a hero and the legal matter was not pursued. Analysis of his laboratory notebooks shows that Pasteur had treated two people before his vaccination of Meister. One survived but may not actually have had rabies, and the other died of rabies. Pasteur began treatment of Jean-Baptiste Jupille on 20 October 1885, and the treatment was successful. Later in 1885, people, including four children from the United States, went to Pasteur's laboratory to be inoculated. In 1886, he treated 350 people, of which only one developed rabies. The treatment's success laid the foundations for the manufacture of many other vaccines. The first of the Pasteur Institutes was also built on the basis of this achievement. In The Story of San Michele , Axel Munthe writes of some risks Pasteur undertook in the rabies vaccine research: Pasteur himself was absolutely fearless. Anxious to secure a sample of saliva straight from the jaws of a rabid dog, I once saw him with the glass tube held between his lips draw a few drops of the deadly saliva from the mouth of a rabid bull-dog, held on the table by two assistants, their hands protected by leather gloves. Because of his study in germs, Pasteur encouraged doctors to sanitize their hands and equipment before surgery. Prior to this, few doctors or their assistants practiced these procedures. Ignaz Semmelweis and Joseph Lister had earlier practiced hand sanitizing in medical contexts in the 1860s. Pasteur's first work on vaccine development was on chicken cholera . He received the bacteria samples (later called Pasteurella multocida after him) from Henry Toussaint . He started the study in 1877, and by the next year, was able to maintain a stable culture using broths. After another year of continuous culturing, he found that the bacteria were less pathogenic. Some of his culture samples could no longer induce the disease in healthy chickens . In 1879, Pasteur, planning for holiday, instructed his assistant, Charles Chamberland to inoculate the chickens with fresh bacteria culture. Chamberland forgot and went on holiday himself. On his return, he injected the month-old cultures to healthy chickens. The chickens showed some symptoms of infection, but instead of the infections being fatal, as they usually were, the chickens recovered completely. Chamberland assumed an error had been made, and wanted to discard the apparently faulty culture, but Pasteur stopped him. Pasteur injected the freshly recovered chickens with fresh bacteria that normally would kill other chickens; the chickens no longer showed any sign of infection. It was clear to him that the weakened bacteria had caused the chickens to become immune to the disease. In December 1880, Pasteur presented his results to the French Academy of Sciences as " Sur les maladies virulentes et en particulier sur la maladie appelée vulgairement choléra des poules (On virulent diseases, and in particular on the disease commonly called chicken cholera)" and published it in the academy's journal ( Comptes-Rendus hebdomadaires des séances de l'Académie des Sciences ). He attributed that the bacteria were weakened by contact with oxygen. He explained that bacteria kept in sealed containers never lost their virulence, and only those exposed to air in culture media could be used as vaccine. Pasteur introduced the term "attenuation" for this weakening of virulence as he presented before the academy, saying: We can diminish the microbe's virulence by changing the mode of culturing. This is the crucial point of my subject. I ask the Academy not to criticize, for the time being, the confidence of my proceedings that permit me to determine the microbe's attenuation, in order to save the independence of my studies and to better assure their progress... [In conclusion] I would like to point out to the Academy two main consequences to the facts presented: the hope to culture all microbes and to find a vaccine for all infectious diseases that have repeatedly afflicted humanity, and are a major burden on agriculture and breeding of domestic animals. In fact, Pasteur's vaccine against chicken cholera was not regular in its effects and was a failure. In the 1870s, he applied this immunization method to anthrax , which affected cattle , and aroused interest in combating other diseases. Pasteur cultivated bacteria from the blood of animals infected with anthrax. When he inoculated animals with the bacteria, anthrax occurred, proving that the bacteria was the cause of the disease. Many cattle were dying of anthrax in "cursed fields". Pasteur was told that sheep that died from anthrax were buried in the field. Pasteur thought that earthworms might have brought the bacteria to the surface. He found anthrax bacteria in earthworms' excrement, showing that he was correct. He told the farmers not to bury dead animals in the fields. Pasteur had been trying to develop the anthrax vaccine since 1877, soon after Robert Koch's discovery of the bacterium. On 12 July 1880, Henri Bouley read before the French Academy of Sciences a report from Henry Toussaint , a veterinary surgeon , who was not member of the academy. Toussaint had developed anthrax vaccine by killing the bacilli by heating at 55 °C for 10  minutes. He tested on eight dogs and 11 sheep, half of which died after inoculation. It was not a great success. Upon hearing the news, Pasteur immediately wrote to the academy that he could not believe that dead vaccine would work and that Toussaint's claim "overturns all the ideas I had on viruses, vaccines, etc." Following Pasteur's criticism, Toussaint switched to carbolic acid to kill anthrax bacilli and tested the vaccine on sheep in August 1880. Pasteur thought that this type of killed vaccine should not work because he believed that attenuated bacteria used up nutrients that the bacteria needed to grow. He thought oxidizing bacteria made them less virulent. But Pasteur found that anthrax bacillus was not easily weakened by culturing in air as it formed spores – unlike chicken cholera bacillus. In early 1881, he discovered that growing anthrax bacilli at about 42 °C made them unable to produce spores, and he described this method in a speech to the French Academy of Sciences on 28 February. On 21 March, he announced successful vaccination of sheep. To this news, veterinarian Hippolyte Rossignol proposed that the Société d'agriculture de Melun organize an experiment to test Pasteur's vaccine. Pasteur signed agreement of the challenge on 28 April. A public experiment was conducted in May at Pouilly-le-Fort. 58 sheep, 2 goats and 10 cattle were used, half of which were given the vaccine on 5 and 17 May; while the other half was untreated. All the animals were injected with the fresh virulent culture of anthrax bacillus on 31 May. The official result was observed and analysed on 2 June in the presence of over 200 spectators. All cattle survived, vaccinated or not. Pasteur had bravely predicted: "I hypothesized that the six vaccinated cows would not become very ill, while the four unvaccinated cows would perish or at least become very ill." However, all vaccinated sheep and goats survived, while unvaccinated ones had died or were dying before the viewers. His report to the French Academy of Sciences on 13 June concludes: [By] looking at everything from the scientific point of view, the development of a vaccination against anthrax constitutes significant progress beyond the first vaccine developed by Jenner, since the latter had never been obtained experimentally. Pasteur did not directly disclose how he prepared the vaccines used at Pouilly-le-Fort. Although his report indicated it as a "live vaccine", his laboratory notebooks show that he actually used potassium dichromate -killed vaccine, as developed by Chamberland, quite similar to Toussaint's method. The notion of a weak form of a disease causing immunity to the virulent version was not new; this had been known for a long time for smallpox . Inoculation with smallpox ( variolation ) was known to result in a much less severe disease, and greatly reduced mortality, in comparison with the naturally acquired disease. Edward Jenner had also studied vaccination using cowpox ( vaccinia ) to give cross-immunity to smallpox in the late 1790s, and by the early 1800s vaccination had spread to most of Europe. The difference between smallpox vaccination and anthrax or chicken cholera vaccination was that the latter two disease organisms had been artificially weakened, so a naturally weak form of the disease organism did not need to be found. This discovery revolutionized work in infectious diseases, and Pasteur gave these artificially weakened diseases the generic name of " vaccines ", in honour of Jenner's discovery. In 1876, Robert Koch had shown that Bacillus anthracis caused anthrax. In his papers published between 1878 and 1880, Pasteur only mentioned Koch's work in a footnote. Koch met Pasteur at the Seventh International Medical Congress in 1881. A few months later, Koch wrote that Pasteur had used impure cultures and made errors. In 1882, Pasteur replied to Koch in a speech, to which Koch responded aggressively. Koch stated that Pasteur tested his vaccine on unsuitable animals and that Pasteur's research was not properly scientific. In 1882, Koch wrote "On the Anthrax Inoculation", in which he refuted several of Pasteur's conclusions about anthrax and criticized Pasteur for keeping his methods secret, jumping to conclusions, and being imprecise. In 1883, Pasteur wrote that he used cultures prepared in a similar way to his successful fermentation experiments and that Koch misinterpreted statistics and ignored Pasteur's work on silkworms. In 1882, Pasteur sent his assistant Louis Thuillier to southern France because of an epizootic of swine erysipelas . Thuillier identified the bacillus that caused the disease in March 1883. Pasteur and Thuillier increased the bacillus's virulence after passing it through pigeons. Then they passed the bacillus through rabbits, weakening it and obtaining a vaccine. Pasteur and Thuillier incorrectly described the bacterium as a figure-eight shape. Roux described the bacterium as stick-shaped in 1884. Pasteur produced the first vaccine for rabies by growing the virus in rabbits, and then weakening it by drying the affected nerve tissue. The rabies vaccine was initially created by Emile Roux , a French doctor and a colleague of Pasteur, who had produced a killed vaccine using this method. The vaccine had been tested in 50 dogs before its first human trial. This vaccine was used on 9-year-old Joseph Meister , on 6 July 1885, after the boy was badly mauled by a rabid dog. This was done at some personal risk for Pasteur, since he was not a licensed physician and could have faced prosecution for treating the boy. After consulting with physicians, he decided to go ahead with the treatment. Over 11 days, Meister received 13 inoculations, each inoculation using viruses that had been weakened for a shorter period of time. Three months later he examined Meister and found that he was in good health. Pasteur was hailed as a hero and the legal matter was not pursued. Analysis of his laboratory notebooks shows that Pasteur had treated two people before his vaccination of Meister. One survived but may not actually have had rabies, and the other died of rabies. Pasteur began treatment of Jean-Baptiste Jupille on 20 October 1885, and the treatment was successful. Later in 1885, people, including four children from the United States, went to Pasteur's laboratory to be inoculated. In 1886, he treated 350 people, of which only one developed rabies. The treatment's success laid the foundations for the manufacture of many other vaccines. The first of the Pasteur Institutes was also built on the basis of this achievement. In The Story of San Michele , Axel Munthe writes of some risks Pasteur undertook in the rabies vaccine research: Pasteur himself was absolutely fearless. Anxious to secure a sample of saliva straight from the jaws of a rabid dog, I once saw him with the glass tube held between his lips draw a few drops of the deadly saliva from the mouth of a rabid bull-dog, held on the table by two assistants, their hands protected by leather gloves. Because of his study in germs, Pasteur encouraged doctors to sanitize their hands and equipment before surgery. Prior to this, few doctors or their assistants practiced these procedures. Ignaz Semmelweis and Joseph Lister had earlier practiced hand sanitizing in medical contexts in the 1860s. A French national hero at age 55, in 1878 Pasteur discreetly told his family to never reveal his laboratory notebooks to anyone. His family obeyed, and all his documents were held and inherited in secrecy. Finally, in 1964 Pasteur's grandson and last surviving male descendant, Pasteur Vallery-Radot, donated the papers to the French national library . Yet the papers were restricted for historical studies until the death of Vallery-Radot in 1971. The documents were given a catalogue number only in 1985. In 1995, the centennial of the death of Louis Pasteur, a historian of science Gerald L. Geison published an analysis of Pasteur's private notebooks in his The Private Science of Louis Pasteur , and declared that Pasteur had given several misleading accounts and played deceptions in his most important discoveries. Max Perutz published a defense of Pasteur in The New York Review of Books . Based on further examinations of Pasteur's documents, French immunologist Patrice Debré concluded in his book Louis Pasteur (1998) that, in spite of his genius, Pasteur had some faults. A book review states that Debré "sometimes finds him unfair, combative, arrogant, unattractive in attitude, inflexible and even dogmatic". Scientists before Pasteur had studied fermentation. In the 1830s, Charles Cagniard-Latour , Friedrich Traugott Kützing and Theodor Schwann used microscopes to study yeasts and concluded that yeasts were living organisms. In 1839, Justus von Liebig , Friedrich Wöhler and Jöns Jacob Berzelius stated that yeast was not an organism and was produced when air acted on plant juice. In 1855, Antoine Béchamp , Professor of Chemistry at the University of Montpellier , conducted experiments with sucrose solutions and concluded that water was the factor for fermentation. He changed his conclusion in 1858, stating that fermentation was directly related to the growth of moulds, which required air for growth. He regarded himself as the first to show the role of microorganisms in fermentation. Pasteur started his experiments in 1857 and published his findings in 1858 (April issue of Comptes Rendus Chimie , Béchamp's paper appeared in January issue). Béchamp noted that Pasteur did not bring any novel idea or experiments. On the other hand, Béchamp was probably aware of Pasteur's 1857 preliminary works. With both scientists claiming priority on the discovery, a dispute, extending to several areas, lasted throughout their lives. However, Béchamp was on the losing side, as the BMJ obituary remarked: His name was "associated with bygone controversies as to priority which it would be unprofitable to recall". Béchamp proposed the incorrect theory of microzymes . According to K. L. Manchester, anti-vivisectionists and proponents of alternative medicine promoted Béchamp and microzymes, unjustifiably claiming that Pasteur plagiarized Béchamp. Pasteur thought that succinic acid inverted sucrose. In 1860, Marcellin Berthelot isolated invertase and showed that succinic acid did not invert sucrose. Pasteur believed that fermentation was only due to living cells. He and Berthelot engaged in a long argument subject of vitalism, in which Berthelot was vehemently opposed to any idea of vitalism. Hans Buchner discovered that zymase (not an enzyme, but a mixture of enzymes) catalyzed fermentation, showing that fermentation was catalyzed by enzymes within cells. Eduard Buchner also discovered that fermentation could take place outside living cells. Pasteur publicly claimed his success in developing the anthrax vaccine in 1881. However, his admirer-turned-rival Henry Toussaint was the one who developed the first vaccine. Toussaint isolated the bacteria that caused chicken cholera (later named Pasteurella in honour of Pasteur) in 1879 and gave samples to Pasteur who used them for his own works. On 12 July 1880, Toussaint presented his successful result to the French Academy of Sciences, using an attenuated vaccine against anthrax in dogs and sheep. Pasteur on grounds of jealousy contested the discovery by publicly displaying his vaccination method at Pouilly-le-Fort on 5 May 1881. Pasteur then gave a misleading account of the preparation of the anthrax vaccine used in the experiment. He claimed that he made a "live vaccine", but used potassium dichromate to inactivate anthrax spores, a method similar to Toussaint's. The promotional experiment was a success and helped Pasteur sell his products, getting the benefits and glory. Pasteur's experiments are often cited as against medical ethics , especially on his vaccination of Meister. He did not have any experience in medical practice, and more importantly, lacked a medical license . This is often cited as a serious threat to his professional and personal reputation. His closest partner Émile Roux , who had medical qualifications, refused to participate in the clinical trial , likely because he considered it unjust. However, Pasteur executed vaccination of the boy under the close watch of practising physicians Jacques-Joseph Grancher , head of the Paris Children's Hospital's paediatric clinic, and Alfred Vulpian , a member of the Commission on Rabies. He was not allowed to hold the syringe, although the inoculations were entirely under his supervision. It was Grancher who was responsible for the injections, and he defended Pasteur before the French National Academy of Medicine in the issue. Pasteur has also been criticized for keeping secrecy of his procedure and not giving proper pre-clinical trials on animals. Pasteur stated that he kept his procedure secret in order to control its quality. He later disclosed his procedures to a small group of scientists. Pasteur wrote that he had successfully vaccinated 50 rabid dogs before using it on Meister. According to Geison, Pasteur's laboratory notebooks show that he had vaccinated only 11 dogs. Meister never showed any symptoms of rabies, but the vaccination has not been proved to be the reason. One source estimates the probability of Meister contracting rabies at 10%. Scientists before Pasteur had studied fermentation. In the 1830s, Charles Cagniard-Latour , Friedrich Traugott Kützing and Theodor Schwann used microscopes to study yeasts and concluded that yeasts were living organisms. In 1839, Justus von Liebig , Friedrich Wöhler and Jöns Jacob Berzelius stated that yeast was not an organism and was produced when air acted on plant juice. In 1855, Antoine Béchamp , Professor of Chemistry at the University of Montpellier , conducted experiments with sucrose solutions and concluded that water was the factor for fermentation. He changed his conclusion in 1858, stating that fermentation was directly related to the growth of moulds, which required air for growth. He regarded himself as the first to show the role of microorganisms in fermentation. Pasteur started his experiments in 1857 and published his findings in 1858 (April issue of Comptes Rendus Chimie , Béchamp's paper appeared in January issue). Béchamp noted that Pasteur did not bring any novel idea or experiments. On the other hand, Béchamp was probably aware of Pasteur's 1857 preliminary works. With both scientists claiming priority on the discovery, a dispute, extending to several areas, lasted throughout their lives. However, Béchamp was on the losing side, as the BMJ obituary remarked: His name was "associated with bygone controversies as to priority which it would be unprofitable to recall". Béchamp proposed the incorrect theory of microzymes . According to K. L. Manchester, anti-vivisectionists and proponents of alternative medicine promoted Béchamp and microzymes, unjustifiably claiming that Pasteur plagiarized Béchamp. Pasteur thought that succinic acid inverted sucrose. In 1860, Marcellin Berthelot isolated invertase and showed that succinic acid did not invert sucrose. Pasteur believed that fermentation was only due to living cells. He and Berthelot engaged in a long argument subject of vitalism, in which Berthelot was vehemently opposed to any idea of vitalism. Hans Buchner discovered that zymase (not an enzyme, but a mixture of enzymes) catalyzed fermentation, showing that fermentation was catalyzed by enzymes within cells. Eduard Buchner also discovered that fermentation could take place outside living cells. Pasteur publicly claimed his success in developing the anthrax vaccine in 1881. However, his admirer-turned-rival Henry Toussaint was the one who developed the first vaccine. Toussaint isolated the bacteria that caused chicken cholera (later named Pasteurella in honour of Pasteur) in 1879 and gave samples to Pasteur who used them for his own works. On 12 July 1880, Toussaint presented his successful result to the French Academy of Sciences, using an attenuated vaccine against anthrax in dogs and sheep. Pasteur on grounds of jealousy contested the discovery by publicly displaying his vaccination method at Pouilly-le-Fort on 5 May 1881. Pasteur then gave a misleading account of the preparation of the anthrax vaccine used in the experiment. He claimed that he made a "live vaccine", but used potassium dichromate to inactivate anthrax spores, a method similar to Toussaint's. The promotional experiment was a success and helped Pasteur sell his products, getting the benefits and glory. Pasteur's experiments are often cited as against medical ethics , especially on his vaccination of Meister. He did not have any experience in medical practice, and more importantly, lacked a medical license . This is often cited as a serious threat to his professional and personal reputation. His closest partner Émile Roux , who had medical qualifications, refused to participate in the clinical trial , likely because he considered it unjust. However, Pasteur executed vaccination of the boy under the close watch of practising physicians Jacques-Joseph Grancher , head of the Paris Children's Hospital's paediatric clinic, and Alfred Vulpian , a member of the Commission on Rabies. He was not allowed to hold the syringe, although the inoculations were entirely under his supervision. It was Grancher who was responsible for the injections, and he defended Pasteur before the French National Academy of Medicine in the issue. Pasteur has also been criticized for keeping secrecy of his procedure and not giving proper pre-clinical trials on animals. Pasteur stated that he kept his procedure secret in order to control its quality. He later disclosed his procedures to a small group of scientists. Pasteur wrote that he had successfully vaccinated 50 rabid dogs before using it on Meister. According to Geison, Pasteur's laboratory notebooks show that he had vaccinated only 11 dogs. Meister never showed any symptoms of rabies, but the vaccination has not been proved to be the reason. One source estimates the probability of Meister contracting rabies at 10%. Pasteur was awarded 1,500 francs in 1853 by the Pharmaceutical Society for the synthesis of racemic acid . In 1856 the Royal Society of London presented him the Rumford Medal for his discovery of the nature of racemic acid and its relations to polarized light, and the Copley Medal in 1874 for his work on fermentation. He was elected a Foreign Member of the Royal Society (ForMemRS) in 1869 . The French Academy of Sciences awarded Pasteur the 1859 Montyon Prize for experimental physiology in 1860, and the Jecker Prize in 1861 and the Alhumbert Prize in 1862 for his experimental refutation of spontaneous generation. Though he lost elections in 1857 and 1861 for membership to the French Academy of Sciences, he won the 1862 election for membership to the mineralogy section. He was elected to permanent secretary of the physical science section of the academy in 1887 and held the position until 1889. In 1873, Pasteur was elected to the Académie Nationale de Médecine and was made the commander in the Brazilian Order of the Rose . In 1881 he was elected to a seat at the Académie française left vacant by Émile Littré . Pasteur received the Albert Medal from the Royal Society of Arts in 1882. In 1883 he became foreign member of the Royal Netherlands Academy of Arts and Sciences . In 1885, he was elected as a member to the American Philosophical Society . On 8 June 1886, the Ottoman Sultan Abdul Hamid II awarded Pasteur with the Order of the Medjidie (I Class) and 10000 Ottoman liras. He was awarded the Cameron Prize for Therapeutics of the University of Edinburgh in 1889. Pasteur won the Leeuwenhoek Medal from the Royal Netherlands Academy of Arts and Sciences for his contributions to microbiology in 1895. Pasteur was made a Chevalier of the Legion of Honour in 1853, promoted to Officer in 1863, to Commander in 1868, to Grand Officer in 1878 and made a Grand Cross of the Legion of Honor in 1881. In many localities worldwide, streets are named in his honor. For example, in the US: Palo Alto and Irvine, California , Boston and Polk, Florida, adjacent to the University of Texas Health Science Center at San Antonio ; Jonquière, Québec; San Salvador de Jujuy and Buenos Aires ( Argentina ), Great Yarmouth in Norfolk, in the United Kingdom, Jericho and Wulguru in Queensland, Australia; Phnom Penh in Cambodia; Ho Chi Minh City and Da Nang , Vietnam; Batna in Algeria ; Bandung in Indonesia, Tehran in Iran, near the central campus of the Warsaw University in Warsaw , Poland; adjacent to the Odesa State Medical University in Odesa , Ukraine; Milan in Italy and Bucharest , Cluj-Napoca and Timișoara in Romania. The Avenue Pasteur in Saigon, Vietnam, is one of the few streets in that city to retain its French name. Avenue Louis Pasteur in the Longwood Medical and Academic Area in Boston was named in his honor in the French manner with "Avenue" preceding the name of the dedicatee. Both the Institut Pasteur and Université Louis Pasteur were named after Pasteur. The schools Lycée Pasteur in Neuilly-sur-Seine , France, and Lycée Louis Pasteur in Calgary, Alberta , Canada, are named after him. In South Africa, the Louis Pasteur Private Hospital in Pretoria , and Life Louis Pasteur Private Hospital, Bloemfontein , are named after him. Louis Pasteur University Hospital in Košice , Slovakia is also named after Pasteur. A statue of Pasteur is erected at San Rafael High School in San Rafael, California . A bronze bust of him resides on the French Campus of Kaiser Permanente 's San Francisco Medical Center in San Francisco . The sculpture was designed by Harriet G. Moore and cast in 1984 by Artworks Foundry. The UNESCO/Institut Pasteur Medal was created on the centenary of Pasteur's death, and is given every two years in his name, "in recognition of outstanding research contributing to a beneficial impact on human health". The French Academician Henri Mondor stated: " Louis Pasteur was neither a physician nor a surgeon, but no one has done as much for medicine and surgery as he has ." After developing the rabies vaccine, Pasteur proposed an institute for the vaccine. In 1887, fundraising for the Pasteur Institute began, with donations from many countries. The official statute was registered in 1887, stating that the institute's purposes were "the treatment of rabies according to the method developed by M. Pasteur" and "the study of virulent and contagious diseases". The institute was inaugurated on 14 November 1888. He brought together scientists with various specialties. The first five departments were directed by two graduates of the École Normale Supérieure : Émile Duclaux (general microbiology research) and Charles Chamberland (microbe research applied to hygiene ), as well as a biologist, Élie Metchnikoff (morphological microbe research) and two physicians , Jacques-Joseph Grancher ( rabies ) and Émile Roux (technical microbe research). One year after the inauguration of the institute, Roux set up the first course of microbiology ever taught in the world, then entitled Cours de Microbie Technique (Course of microbe research techniques). Since 1891 the Pasteur Institute had been extended to different countries, and currently there are 32 institutes in 29 countries in various parts of the world. In many localities worldwide, streets are named in his honor. For example, in the US: Palo Alto and Irvine, California , Boston and Polk, Florida, adjacent to the University of Texas Health Science Center at San Antonio ; Jonquière, Québec; San Salvador de Jujuy and Buenos Aires ( Argentina ), Great Yarmouth in Norfolk, in the United Kingdom, Jericho and Wulguru in Queensland, Australia; Phnom Penh in Cambodia; Ho Chi Minh City and Da Nang , Vietnam; Batna in Algeria ; Bandung in Indonesia, Tehran in Iran, near the central campus of the Warsaw University in Warsaw , Poland; adjacent to the Odesa State Medical University in Odesa , Ukraine; Milan in Italy and Bucharest , Cluj-Napoca and Timișoara in Romania. The Avenue Pasteur in Saigon, Vietnam, is one of the few streets in that city to retain its French name. Avenue Louis Pasteur in the Longwood Medical and Academic Area in Boston was named in his honor in the French manner with "Avenue" preceding the name of the dedicatee. Both the Institut Pasteur and Université Louis Pasteur were named after Pasteur. The schools Lycée Pasteur in Neuilly-sur-Seine , France, and Lycée Louis Pasteur in Calgary, Alberta , Canada, are named after him. In South Africa, the Louis Pasteur Private Hospital in Pretoria , and Life Louis Pasteur Private Hospital, Bloemfontein , are named after him. Louis Pasteur University Hospital in Košice , Slovakia is also named after Pasteur. A statue of Pasteur is erected at San Rafael High School in San Rafael, California . A bronze bust of him resides on the French Campus of Kaiser Permanente 's San Francisco Medical Center in San Francisco . The sculpture was designed by Harriet G. Moore and cast in 1984 by Artworks Foundry. The UNESCO/Institut Pasteur Medal was created on the centenary of Pasteur's death, and is given every two years in his name, "in recognition of outstanding research contributing to a beneficial impact on human health". The French Academician Henri Mondor stated: " Louis Pasteur was neither a physician nor a surgeon, but no one has done as much for medicine and surgery as he has ." After developing the rabies vaccine, Pasteur proposed an institute for the vaccine. In 1887, fundraising for the Pasteur Institute began, with donations from many countries. The official statute was registered in 1887, stating that the institute's purposes were "the treatment of rabies according to the method developed by M. Pasteur" and "the study of virulent and contagious diseases". The institute was inaugurated on 14 November 1888. He brought together scientists with various specialties. The first five departments were directed by two graduates of the École Normale Supérieure : Émile Duclaux (general microbiology research) and Charles Chamberland (microbe research applied to hygiene ), as well as a biologist, Élie Metchnikoff (morphological microbe research) and two physicians , Jacques-Joseph Grancher ( rabies ) and Émile Roux (technical microbe research). One year after the inauguration of the institute, Roux set up the first course of microbiology ever taught in the world, then entitled Cours de Microbie Technique (Course of microbe research techniques). Since 1891 the Pasteur Institute had been extended to different countries, and currently there are 32 institutes in 29 countries in various parts of the world. Pasteur married Marie Pasteur (née Laurent) in 1849. She was the daughter of the rector of the University of Strasbourg, and was Pasteur's scientific assistant. They had five children together, three of whom died as children. Their eldest daughter, Jeanne, was born in 1850. She died from typhoid fever , aged 9, whilst at the boarding school Arbois in 1859. In 1865, 2-year-old Camille died of a liver tumour. Shortly after they decided to bring Cécile home from boarding school, but she too died of typhoid fever on 23 May 1866 at the age of 12. Only Jean Baptiste (b. 1851) and Marie Louise (b. 1858) survived to adulthood. Jean Baptiste would be a soldier in the Franco-Prussian War between France and Prussia . His grandson, Louis Pasteur Vallery-Radot , wrote that Pasteur had kept from his Catholic background only a spiritualism without religious practice. However, Catholic observers often said that Pasteur remained an ardent Christian throughout his whole life, and his son-in-law wrote, in a biography of him: Absolute faith in God and in Eternity, and a conviction that the power for good given to us in this world will be continued beyond it, were feelings which pervaded his whole life; the virtues of the gospel had ever been present to him. Full of respect for the form of religion which had been that of his forefathers, he came simply to it and naturally for spiritual help in these last weeks of his life. The Literary Digest of 18 October 1902 gives this statement from Pasteur that he prayed while he worked: Posterity will one day laugh at the foolishness of modern materialistic philosophers. The more I study nature, the more I stand amazed at the work of the Creator. I pray while I am engaged at my work in the laboratory. Maurice Vallery-Radot, grandson of the brother of the son-in-law of Pasteur and outspoken Catholic, also holds that Pasteur fundamentally remained Catholic. According to both Pasteur Vallery-Radot and Maurice Vallery-Radot, the following well-known quotation attributed to Pasteur is apocryphal: "The more I know, the more nearly is my faith that of the Breton peasant. Could I but know all I would have the faith of a Breton peasant's wife". According to Maurice Vallery-Radot, the false quotation appeared for the first time shortly after the death of Pasteur. However, despite his belief in God, it has been said that his views were that of a freethinker rather than a Catholic, a spiritual more than a religious man. He was also against mixing science with religion. In 1868, Pasteur suffered a severe brain stroke that paralysed the left side of his body, but he recovered. A stroke or uremia in 1894 severely impaired his health. Failing to fully recover, he died on 28 September 1895, near Paris. He was given a state funeral and was buried in the Cathedral of Notre Dame , but his remains were reinterred in the Pasteur Institute in Paris, in a vault covered in depictions of his accomplishments in Byzantine mosaics . His grandson, Louis Pasteur Vallery-Radot , wrote that Pasteur had kept from his Catholic background only a spiritualism without religious practice. However, Catholic observers often said that Pasteur remained an ardent Christian throughout his whole life, and his son-in-law wrote, in a biography of him: Absolute faith in God and in Eternity, and a conviction that the power for good given to us in this world will be continued beyond it, were feelings which pervaded his whole life; the virtues of the gospel had ever been present to him. Full of respect for the form of religion which had been that of his forefathers, he came simply to it and naturally for spiritual help in these last weeks of his life. The Literary Digest of 18 October 1902 gives this statement from Pasteur that he prayed while he worked: Posterity will one day laugh at the foolishness of modern materialistic philosophers. The more I study nature, the more I stand amazed at the work of the Creator. I pray while I am engaged at my work in the laboratory. Maurice Vallery-Radot, grandson of the brother of the son-in-law of Pasteur and outspoken Catholic, also holds that Pasteur fundamentally remained Catholic. According to both Pasteur Vallery-Radot and Maurice Vallery-Radot, the following well-known quotation attributed to Pasteur is apocryphal: "The more I know, the more nearly is my faith that of the Breton peasant. Could I but know all I would have the faith of a Breton peasant's wife". According to Maurice Vallery-Radot, the false quotation appeared for the first time shortly after the death of Pasteur. However, despite his belief in God, it has been said that his views were that of a freethinker rather than a Catholic, a spiritual more than a religious man. He was also against mixing science with religion. In 1868, Pasteur suffered a severe brain stroke that paralysed the left side of his body, but he recovered. A stroke or uremia in 1894 severely impaired his health. Failing to fully recover, he died on 28 September 1895, near Paris. He was given a state funeral and was buried in the Cathedral of Notre Dame , but his remains were reinterred in the Pasteur Institute in Paris, in a vault covered in depictions of his accomplishments in Byzantine mosaics . Pasteur's principal published works are:

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Yemen

Yemen ( / ˈ j ɛ m ən / ⓘ ; Arabic : ٱلْيَ٠َنْ , romanized : al-Yaman ), officially the Republic of Yemen , [lower-alpha 2] is a sovereign state in West Asia . Located in the southern Arabian Peninsula , it borders Saudi Arabia to the north, Oman to the northeast, and the Indian Ocean to the south, sharing maritime borders with Eritrea , Djibouti and Somalia across the Horn of Africa . Covering roughly 528,000 square kilometres (203,861 square miles), with a coastline of approximately 2,000 kilometres (1,200 miles) , Yemen is the second largest country on the Arabian Peninsula. Sanaa is its constitutional capital and largest city. Yemen's estimated population is 34.7 million, comprised mostly of Arab Muslims . It is a member of the Arab League , the United Nations , the Non-Aligned Movement and the Organisation of Islamic Cooperation . Owing to its geographic location, Yemen has been at the crossroads of many civilisations for over 7,000 years. In 1200 BCE, the Sabaeans formed a thriving commercial kingdom that included parts of modern Ethiopia and Eritrea. In 275 CE, it was succeeded by the Himyarite Kingdom , which spanned much of Yemen's present-day territory and was heavily influenced by Judaism. Christianity arrived in the fourth century, followed by the rapid spread of Islam in the seventh century. Yemenite troops playing a crucial role in early Islamic conquests. Various dynasties emerged between the 9th and 16th centuries. During the 19th century, the country was divided between the Ottoman and British empires. After World War I , the Mutawakkilite Kingdom of Yemen was established, which in 1962 became the Yemen Arab Republic (North Yemen) following a coup. In 1967, the British Aden Protectorate became the independent People's Democratic Republic of Yemen (South Yemen), the first and only officially socialist state in the Arab world. In 1990, the two Yemeni states united to form the modern Republic of Yemen ( al-Jumhūrīyah al-Yamanīyah ), with Ali Abdullah Saleh serving as the first president until his resignation in 2012 in the wake of the Arab Spring . Since 2011, Yemen has been enduring a political crisis , marked by street protests against poverty, unemployment, corruption, and President Saleh's plan to amend Yemen's constitution and eliminate the presidential term limit. By 2015, the country became engulfed by an ongoing civil war with multiple entities vying for governance, including the Presidential Leadership Council of the internationally recognized government, the Houthi movement 's Supreme Political Council , and the separatist Southern Movement's Southern Transitional Council . This conflict, which has escalated to involve various foreign powers, has led to a severe humanitarian crisis . Yemen is one of the least developed countries in the world , facing significant obstacles to sustainable development , and is one of the poorest countries in the Middle East and North Africa . In 2019, the United Nations reported that Yemen had the highest number of people in need of humanitarian aid, amounting to about 24 million individuals, or nearly 75% of its population. As of 2020, Yemen ranked highest on the Fragile States Index and second-worst on the Global Hunger Index , surpassed only by the Central African Republic . Additionally, it has the lowest Human Development Index out of all non-African countries.The term Yamnat was first mentioned in the Old South Arabian inscriptions on the title of one of the kings of the second Himyarite Kingdom known as Shammar Yahri'sh . The term probably referred to the southwestern coastline of the Arabian Peninsula and the southern coastline between Aden and Hadhramaut . The historical Yemen included much greater territory than the current nation, stretching from northern 'Asir in southwestern Saudi Arabia to Dhofar in southern Oman . One etymology derives Yemen from ymnt , meaning literally " South [of the Arabian Peninsula ]", and significantly plays on the notion of the land to the right ( 𐩺𐩣𐩬 ). Other sources claim that Yemen is related to yamn or yumn , meaning "felicity" or "blessed", as much of the country is fertile, in contrast to the barren land of most of Arabia. The Romans called it Arabia Felix ("happy" or "fortunate" Arabia "), as opposed to Arabia Deserta ("deserted Arabia"). Latin and Greek writers referred to ancient Yemen as "India", which arose from the Persians calling the Abyssinians whom they came into contact with in South Arabia by the name of the black-skinned people who lived next to them. Yemen has existed at the crossroads of its civilisations for more than 7,000 years. The country was home to figures such as the Queen of Sheba who brought a caravan of gifts for King Solomon . For centuries, it became a primary producer of coffee exported in the port of Mocha . From its conversion to Islam in the 7th century, Yemen became a center of Islamic learning, and much of its architecture survived until modern times. With its long sea border between eastern and western civilizations, Yemen has long existed at a crossroads of cultures with a strategic location in terms of trade on the west of the Arabian Peninsula. Large settlements for their era existed in the mountains of northern Yemen as early as 5000 BC. The Sabaean Kingdom came into existence in at least the 12th century BC. The four major kingdoms or tribal confederations in South Arabia were Saba, Hadhramaut , Qataban , and Ma'in . Sabaʾ ( Arabic : سَـبَـأ ) is thought to be biblical Sheba and was the most prominent federation. The Sabaean rulers adopted the title Mukarrib generally thought to mean unifier , or a priest-king , or the head of the confederation of South Arabian kingdoms, the "king of the kings". The role of the Mukarrib was to bring the various tribes under the kingdom and preside over them all. The Sabaeans built the Great Dam of Marib around 940 BC. The dam was built to withstand the seasonal flash floods surging down the valley. By the third century BC, Qataban, Hadhramaut, and Ma'in became independent from Saba and established themselves in the Yemeni arena. Minaean rule stretched as far as Dedan , with their capital at Baraqish . The Sabaeans regained their control over Ma'in after the collapse of Qataban in 50 BC. By the time of the Roman expedition to Arabia Felix in 25 BC, the Sabaeans were once again the dominating power in Southern Arabia. Aelius Gallus was ordered to lead a military campaign to establish Roman dominance over the Sabaeans. The Romans had a vague and contradictory geographical knowledge about Arabia Felix. A Roman army of 10,000 men was defeated before Marib . Strabo 's close relationship with Aelius Gallus led him to attempt to justify his friend's defeat in his writings. It took the Romans six months to reach Marib and 60 days to return to Egypt . The Romans blamed their Nabataean guide and executed him for treachery. No direct mention in Sabaean inscriptions of the Roman expedition has yet been found. After the Roman expedition (perhaps earlier) the country fell into chaos, and two clans, namely Hamdan and Himyar , claimed kingship, assuming the title King of Sheba and Dhu Raydan . Dhu Raydan, i.e. , Himyarites, allied themselves with Aksum in Ethiopia against the Sabaeans. The chief of Bakil and king of Saba and Dhu Raydan, El Sharih Yahdhib , launched successful campaigns against the Himyarites and Habashat, i.e. , Aksum , El Sharih took pride in his campaigns and added the title Yahdhib to his name, which means "suppressor"; he used to kill his enemies by cutting them to pieces. Sana'a came into prominence during his reign, as he built the Ghumdan Palace as his place of residence. The Himyarite annexed Sana'a from Hamdan around 100 AD. Hashdi tribesmen rebelled against them and regained Sana'a around 180. Shammar Yahri'sh had conquered Hadhramaut, Najran , and Tihamah by 275, thus unifying Yemen and consolidating Himyarite rule. The Himyarites rejected polytheism and adhered to a consensual form of monotheism called Rahmanism . In 354, Roman Emperor Constantius II sent an embassy headed by Theophilos the Indian to convert the Himyarites to Christianity. According to Philostorgius , the mission was resisted by local Jews. Several inscriptions have been found in Hebrew and Sabaean praising the ruling house in Jewish terms for "...helping and empowering the People of Israel." According to Islamic traditions, King As'ad the Perfect mounted a military expedition to support the Jews of Yathrib . Abu Kariba As'ad, as known from the inscriptions, led a military campaign to central Arabia or Najd to support the vassal Kingdom of Kinda against the Lakhmids . However, no direct reference to Judaism or Yathrib was discovered from his lengthy reign. Abu Kariba died in 445, having reigned for almost 50 years. By 515, Himyar became increasingly divided along religious lines and a bitter conflict between different factions paved the way for an Aksumite intervention. The last Himyarite king Ma'adikarib Ya'fur was supported by Aksum against his Jewish rivals. Ma'adikarib was Christian and launched a campaign against the Lakhmids in southern Iraq , with the support of other Arab allies of Byzantium . The Lakhmids were a bulwark of Persia , which was intolerant to a proselytizing religion like Christianity. After the death of Ma'adikarib Ya'fur around 521, a Himyarite Jewish warlord called Dhu Nuwas rose to power. Emperor Justinian I sent an embassy to Yemen. He wanted the officially Christian Himyarites to use their influence on the tribes in inner Arabia to launch military operations against Persia. Justinian I bestowed the "dignity of king" upon the Arab sheikhs of Kindah and Ghassan in central and northern Arabia. From early on, Roman and Byzantine policy was to develop close links with the powers of the coast of the Red Sea . They were successful in converting [ clarification needed ] Aksum and influencing their culture. The results concerning to Yemen were rather disappointing. A Kendite prince called Yazid bin Kabshat rebelled against Abraha and his Arab Christian allies. A truce was reached once the Great Dam of Marib had suffered a breach. Abraha died around 570. The Sasanid Empire annexed Aden around 570. Under their rule, most of Yemen enjoyed great autonomy except for Aden and Sana'a. This era marked the collapse of ancient South Arabian civilization, since the greater part of the country was under several independent clans until the arrival of Islam in 630. Muhammad sent his cousin Ali to Sana'a and its surroundings around 630. At the time, Yemen was the most advanced region in Arabia. The Banu Hamdan confederation was among the first to accept Islam. Muhammad sent Muadh ibn Jabal , as well to Al-Janad, in present-day Taiz , and dispatched letters to various tribal leaders. Major tribes, including Himyar, sent delegations to Medina during the "year of delegations" around 630–631. Several Yemenis accepted Islam before 630, such as Ammar ibn Yasir , Al-Ala'a Al-Hadrami , Miqdad ibn Aswad , Abu Musa Ashaari , and Sharhabeel ibn Hasana . A man named 'Abhala ibn Ka'ab Al-Ansi expelled the remaining Persians and claimed he was a prophet of Rahman . He was assassinated by a Yemeni of Persian origin called Fayruz al-Daylami . Christians, who were mainly staying in Najran along with Jews, agreed to pay jizyah ( Arabic : جِـزْيَـة ), although some Jews converted to Islam, such as Wahb ibn Munabbih and Ka'ab al-Ahbar . Yemen was stable during the Rashidun Caliphate . Yemeni tribes played a pivotal role in the Islamic expansion into Egypt, Iraq, Persia, the Levant , Anatolia , North Africa , Sicily , and Andalusia . Yemeni tribes who settled in Syria contributed significantly to the solidification of Umayyad rule, especially during the reign of Marwan I . Powerful Yemenite tribes such as Kinda were on his side during the Battle of Marj Rahit . Muhammad ibn Abdullah ibn Ziyad founded the Ziyadid dynasty in Tihamah around 818. The state stretched from Haly (in present-day Saudi Arabia) to Aden. They nominally recognized the Abbasid Caliphate but ruled independently from Zabid . By virtue of its location, they developed a special relationship with Abyssinia . The chief of the Dahlak islands exported slaves, as well as amber and leopard hides, to the ruler of Yemen. They controlled only a small portion of the coastal strip in Tihamah along the Red Sea, and never exercised control over the highlands and Hadhramaut. A Himyarite clan called the Yufirids established their rule over the highlands from Saada to Taiz , while Hadhramaut was an Ibadi stronghold and rejected all allegiance to the Abbasids in Baghdad . The first Zaidi imam, Yahya ibn al-Husayn , arrived in Yemen in 893. He was a religious cleric and judge who was invited to come to Saada from Medina to arbitrate tribal disputes. Yahya persuaded local tribesmen to follow his teachings. The sect slowly spread across the highlands, as the tribes of Hashid and Bakil , later known as "the twin wings of the imamate", accepted his authority. He founded the Zaidi imamate in 897. Yahya established his influence in Saada and Najran. He also tried to capture Sana'a from the Yufirids in 901 but failed miserably. The Sulayhid dynasty was founded in the northern highlands around 1040; at the time, Yemen was ruled by different local dynasties. In 1060, Ali ibn Muhammad Al-Sulayhi conquered Zabid and killed its ruler Al-Najah, founder of the Najahid dynasty. His sons were forced to flee to Dahlak. Hadhramaut fell into Sulayhid hands after their capture of Aden in 1162. By 1063, Ali had subjugated Greater Yemen . He then marched toward Hejaz and occupied Makkah . Ali was married to Asma bint Shihab , who governed Yemen with her husband. The Khutba during Friday prayers was proclaimed in both her husband's name and hers. No other Arab woman had this honor since the advent of Islam. Ali al-Sulayhi was killed by Najah's sons on his way to Mecca in 1084. His son Ahmed Al-Mukarram led an army to Zabid and killed 8,000 of its inhabitants. He later installed the Zurayids to govern Aden. al-Mukarram, who had been afflicted with facial paralysis resulting from war injuries, retired in 1087 and handed over power to his wife Arwa al-Sulayhi . Queen Arwa moved the seat of the Sulayhid dynasty from Sana'a to Jibla , a small town in central Yemen near Ibb . She sent Ismaili missionaries to India, where a significant Ismaili community was formed that exists to this day. Queen Arwa continued to rule securely until her death in 1138. She is still remembered as a great and much-loved sovereign, as attested in Yemeni historiography, literature, and popular lore, where she is referred to as Balqis al-sughra ("the junior queen of Sheba"). Shortly after Arwa's death, the country was split between five competing petty dynasties along religious lines. The Ayyubid dynasty overthrew the Fatimid Caliphate in Egypt. A few years after their rise to power, Saladin dispatched his brother Turan Shah to conquer Yemen in 1174. Turan Shah conquered Zabid from the Mahdids in 1174, then marched toward Aden in June and captured it from the Zurayids. The Hamdanid sultans of Sana'a resisted the Ayyubid in 1175, and the Ayyubids did not manage to secure Sana'a until 1189. The Ayyubid rule was stable in southern and central Yemen, where they succeeded in eliminating the ministates of that region, while Ismaili and Zaidi tribesmen continued to hold out in several fortresses. The Ayyubids failed to capture the Zaydis stronghold in northern Yemen. In 1191, Zaydis of Shibam Kawkaban rebelled and killed 700 Ayyubid soldiers. Imam Abdullah bin Hamza proclaimed the imamate in 1197 and fought al-Mu'izz Ismail, the Ayyubid Sultan of Yemen. Imam Abdullah was defeated at first but was able to conquer Sana'a and Dhamar in 1198, and al-Mu'izz Ismail was assassinated in 1202. Abdullah bin Hamza carried on the struggle against the Ayyubid until his death in 1217. After his demise, the Zaidi community was split between two rival imams. The Zaydis were dispersed, and a truce was signed with the Ayyubid in 1219. The Ayyubid army was defeated in Dhamar in 1226. Ayyubid Sultan Mas'ud Yusuf left for Mecca in 1228, never to return. Other sources suggest that he was forced to leave for Egypt instead in 1223. The Rasulid dynasty was established in 1229 by Umar ibn Rasul, who was appointed deputy governor by the Ayyubids in 1223. When the last Ayyubid ruler left Yemen in 1229, Umar stayed in the country as caretaker. He subsequently declared himself an independent king by assuming the title "al-Malik Al-Mansur" (the king assisted by Allah ). Umar first established himself at Zabid, then moved into the mountainous interior, taking the important highland centre Sana'a. However, the Rasulid capitals were Zabid and Taiz. He was assassinated by his nephew in 1249. Omar's son Yousef defeated the faction led by his father's assassins and crushed several counterattacks by the Zaydi imams who still held on in the northern highland. Mainly because of the victories he scored over his rivals, he assumed the honorific title "al-Muzaffar" (the victorious). After the fall of Baghdad to the Mongols in 1258, al-Muzaffar Yusuf I appropriated the title of caliph . He chose the city of Taiz to become the political capital of the kingdom because of its strategic location and proximity to Aden. The Rasulid sultans built numerous Madrasas to solidify the Shafi'i school of thought, which is still the dominant school of jurisprudence amongst Yemenis today. Under their rule, Taiz and Zabid became major international centres of Islamic learning. The kings were educated men in their own right, who not only had important libraries but also wrote treatises on a wide array of subjects, ranging from astrology and medicine to agriculture and genealogy. They had a difficult relationship with the Mamluks of Egypt because the latter considered them a vassal state. Their competition centred over the Hejaz and the right to provide kiswa of the Ka'aba in Mecca. The dynasty became increasingly threatened by disgruntled family members over the problem of succession, combined with periodic tribal revolts, as they were locked in a war of attrition with the Zaydi imams in the northern highlands. During the last 12 years of Rasulid rule, the country was torn between several contenders for the kingdom. The weakening of the Rasulid provided an opportunity for the Banu Taher clan to take over and establish themselves as the new rulers of Yemen in 1454 AD. The Tahirids were a local clan based in Rada'a . They built schools, mosques, and irrigation channels, as well as water cisterns and bridges in Zabid, Aden, Rada'a , and Juban. Their best-known monument is the Amiriya Madrasa in Rada' District , which was built in 1504. The Tahiride were too weak either to contain the Zaydi imams or to defend themselves against foreign attacks. Realizing how rich the Tahiride realm was, the Mamluks decided to conquer it. The Mamluk army, with the support of forces loyal to Zaydi Imam Al-Mutawakkil Yahya Sharaf ad-Din , conquered the entire realm of the Tahiride but failed to capture Aden in 1517. The Mamluk victory was short-lived. The Ottoman Empire conquered Egypt, hanging the last Mamluk Sultan in Cairo . The Ottomans had not decided to conquer Yemen until 1538. The Zaydi highland tribes emerged as national heroes by offering stiff, vigorous resistance to the Turkish occupation. The Mamluks tried to attach Yemen to Egypt and the Portuguese led by Afonso de Albuquerque , occupied the island of Socotra and made an unsuccessful attack on Aden in 1513. Starting in the 15th century, Portugal intervened, dominating the port of Aden for about 20 years and maintaining a fortified enclave on the island of Socotra during this period. From the 16th century, the Portuguese posed an immediate threat to Indian Ocean trade. The Mamluks therefore sent an army under Hussein al-Kurdi to fight the intruders The Mamluk sultan went to Zabid in 1515 and entered into diplomatic talks with the Tahiri sultan 'Amir bin Abdulwahab for money that would be needed for the jihad against the Portuguese. Instead of confronting them, the Mamluks, who were running out of food and water, landed on the coast of Yemen and began harassing the villagers of Tihamah to obtain the supplies they needed. The interest of Portugal on the Red Sea consisted on the one hand of guaranteeing contacts with a Christian ally in Ethiopia and on the other of being able to attack Mecca and the Arab territories from the rear, while still having absolute dominance over trade of spices, the main intention was to dominate the commerce of the cities on the coast of Africa and Arabia. To this end, Portugal sought to influence and dominate by force or persuasion all the ports and kingdoms that fought among themselves. It was common for Portugal to keep under its influence the Arab allies that were interested in maintaining independence from other Arab states in the region. The Ottomans had two fundamental interests to safeguard in Yemen: The Islamic holy cities of Mecca and Medina, and the trade route with India in spices and textiles—both threatened, and the latter virtually eclipsed, by the arrival of the Portuguese in the Indian Ocean and the Red Sea in the early 16th century. Hadım Suleiman Pasha , the Ottoman governor of Egypt , was ordered to command a fleet of 90 ships to conquer Yemen. The country was in a state of incessant anarchy and discord as Pasha described it by saying: Yemen is a land with no lord, an empty province. It would be not only possible but easy to capture, and should it be captured, it would be master of the lands of India and send every year a great amount of gold and jewels to Constantinople . Imam al-Mutawakkil Yahya Sharaf ad-Din ruled over the northern highlands including Sana'a, while Aden was held by the last Tahiride Sultan 'Amir ibn Dauod. Pasha stormed Aden in 1538, killing its ruler, and extended Ottoman authority to include Zabid in 1539 and eventually Tihamah in its entirety. Zabid became the administrative headquarters of Yemen Eyalet . The Ottoman governors did not exercise much control over the highlands. They held sway mainly in the southern coastal region, particularly around Zabid, Mocha, and Aden. Of 80,000 soldiers sent to Yemen from Egypt between 1539 and 1547, only 7,000 survived. The Ottoman accountant-general in Egypt remarked: We have seen no foundry like Yemen for our soldiers. Each time we have sent an expeditionary force there, it has melted away like salt dissolved in water. The Ottomans sent yet another expeditionary force to Zabid in 1547, while Imam al-Mutawakkil Yahya Sharaf ad-Din was ruling the highlands independently. Yahya chose his son Ali to succeed him, a decision that infuriated his other son al-Mutahhar ibn Yahya. Al-Mutahhar was lame, so he was not qualified for the imamate. He urged Oais Pasha, the Ottoman colonial governor in Zabid , to attack his father. Indeed, Ottoman troops supported by tribal forces loyal to Imam al-Mutahhar stormed Taiz and marched north toward Sana'a in August 1547. The Turks officially made Imam al-Mutahhar a Sanjak-bey with authority over 'Amran . Imam al-Mutahhar assassinated the Ottoman colonial governor and recaptured Sana'a, but the Ottomans, led by Özdemir Pasha , forced al-Mutahhar to retreat to his fortress in Thula . Özdemir Pasha effectively put Yemen under Ottoman rule between 1552 and 1560. Özdemir died in Sana'a in 1561 and was succeeded by Mahmud Pasha . Mahmud Pasha was described by other Ottoman officials as a corrupt and unscrupulous governor, and he was displaced by Ridvan Pasha in 1564. By 1565, Yemen was split into two provinces, the highlands under the command of Ridvan Pasha and Tihamah under Murad Pasha. Imam al-Mutahhar launched a propaganda campaign in which he claimed that the prophet Mohammed came to him in a dream and advised him to wage jihad against the Ottomans. Al-Mutahhar led the tribes to capture Sana'a from Ridvan Pasha in 1567. When Murad tried to relieve Sana'a, highland tribesmen ambushed his unit and slaughtered all of them. Over 80 battles were fought. The last decisive encounter took place in Dhamar around 1568, in which Murad Pasha was beheaded and his head sent to al-Mutahhar in Sana'a. By 1568, only Zabid remained under the possession of the Turks. In 1632, Al-Mu'ayyad Muhammad sent an expeditionary force of 1,000 men to conquer Mecca. The army entered the city in triumph and killed its governor. The Ottomans sent an army from Egypt to fight the Yemenites. Seeing that the Turkish army was too numerous to overcome, the Yemeni army retreated to a valley outside Mecca. Ottoman troops attacked the Yemenis by hiding at the wells that supplied them with water. This plan proceeded successfully, causing the Yemenis over 200 casualties, most from thirst. The tribesmen eventually surrendered and returned to Yemen. Al-Mu'ayyad Muhammad died in 1644. He was succeeded by Al-Mutawakkil Isma'il , another son of al-Mansur al-Qasim, who conquered Yemen in its entirety. Yemen became the sole coffee producer in the world. The country established diplomatic relations with the Safavid dynasty of Persia, Ottomans of Hejaz, Mughal Empire in India, and Ethiopia, as well. In the first half of the 18th century, the Europeans broke Yemen's monopoly on coffee by smuggling coffee trees and cultivating them in their own colonies in the East Indies, East Africa, the West Indies, and Latin America. The imamate did not follow a cohesive mechanism for succession, and family quarrels and tribal insubordination led to the political decline of the Qasimi dynasty in the 18th century. The British were looking for a coal depot to service their steamers en route to India. It took 700 tons of coal for a round-trip from Suez to Bombay . East India Company officials decided on Aden . The British Empire tried to reach an agreement with the Zaydi imam of Sana'a, permitting them a foothold in Mocha, and when unable to secure their position, they extracted a similar agreement from the Sultan of Lahej , enabling them to consolidate a position in Aden. The British managed to occupy Aden and evicted the Sultan of Lahej from Aden and forced him to accept their "protection". In November 1839, 5,000 tribesmen tried to retake the town but were repulsed and 200 were killed. With emigrants from India, East Africa, and Southeast Asia, Aden grew into a world city. In 1850, only 980 Arabs were registered as original inhabitants of the city. The English presence in Aden put them at odds with the Ottomans. The Turks asserted to the British that they held sovereignty over the whole of Arabia, including Yemen as the successor of Mohammed and the Chief of the Universal Caliphate. The Ottomans were concerned about the British expansion from the British ruled subcontinent to the Red Sea and Arabia. They returned to the Tihamah in 1849 after an absence of two centuries. Rivalries and disturbances continued among the Zaydi imams, between them and their deputies, with the ulema , with the heads of tribes, as well as with those who belonged to other sects. Some citizens of Sana'a were desperate to return law and order to Yemen and asked the Ottoman Pasha in Tihamah to pacify the country. The opening of the Suez Canal in 1869 strengthened the Ottoman decision to remain in Yemen. By 1873, the Ottomans succeeded in conquering the northern highlands. Sana'a became the administrative capital of Yemen Vilayet . The Ottomans learned from their previous experience and worked on the disempowerment of local lords in the highland regions. They even attempted to secularize the Yemeni society, while Yemenite Jews came to perceive themselves in Yemeni nationalist terms. The Ottomans appeased the tribes by forgiving their rebellious chiefs and appointing them to administrative posts. They introduced a series of reforms to enhance the country's economic welfare. However, corruption was widespread in the Ottoman administration in Yemen. This was because only the worst of the officials were appointed because those who could avoid serving in Yemen did so. The Ottomans had reasserted control over the highlands for a temporary duration. The so-called Tanzimat reforms were considered heretic by the Zaydi tribes. In 1876, the Hashid and Bakil tribes rebelled against the Ottomans; the Turks had to appease them with gifts to end the uprising. The tribal chiefs were difficult to appease and an endless cycle of violence curbed Ottoman efforts to pacify the land. Ahmed Izzet Pasha proposed that the Ottoman army evacuate the highlands and confine itself to Tihamah, and not unnecessarily burden itself with continuing military operation against the Zaydi tribes. Imam Yahya Hamidaddin led a rebellion against the Turks in 1904; the rebels disrupted the Ottoman ability to govern. The revolts between 1904 and 1911 were especially damaging to the Ottomans, costing them as many as 10,000 soldiers and as much as 500,000 pounds per year. The Ottomans signed a treaty with imam Yahya Hamidaddin in 1911. Under the treaty, Imam Yahya was recognized as an autonomous leader of the Zaydi northern highlands. The Ottomans continued to rule Shafi'i areas in the mid-south until their departure in 1918. Imam Yahya hamid ed-Din al-Mutawakkil was ruling the northern highlands independently from 1911, from which he began a conquest of the Yemen lands. In 1925 Yahya captured al-Hudaydah from the Idrisids . In 1927, Yahya's forces were about 50 km (30 mi) away from Aden, Taiz, and Ibb, and were bombed by the British for five days; the imam had to pull back. Small Bedouin forces, mainly from the Madh'hij confederation of Marib , attacked Shabwah but were bombed by the British and had to retreat. The Italian Empire was the first to recognize Yahya as the king of Yemen in 1926. This created a great deal of anxiety for the British, who interpreted it as recognition of Imam Yahya's claim to sovereignty over Greater Yemen, which included the Aden protectorate and Asir. The Idrisis turned to Ibn Saud seeking his protection from Yahya. However, in 1932, the Idrisis broke their accord with Ibn Saud and went back to Yahya seeking help against Ibn Saud, who had begun liquidating their authority and expressed his desire to annex those territories into his own Saudi domain. Yahya demanded the return of all Idrisi dominion. Negotiations between Yahya and Ibn Saud proved fruitless. After the 1934 Saudi-Yemeni war, Ibn Saud announced a ceasefire in May 1934. Imam Yahya agreed to release Saudi hostages and the surrender of the Idrisis to Saudi custody. Imam Yahya ceded the three provinces of Najran, Asir, and Jazan for 20 years. and signed another treaty with the British government in 1934. The imam recognized the British sovereignty over Aden protectorate for 40 years. Out of fear for Hudaydah , Yahya did submit to these demands. Starting in 1890, hundreds of Yemeni people from Hajz, Al-Baetha, and Taiz migrated to Aden to work at ports, and as labourers. This helped the population of Aden once again become predominantly Arab after, having been declared a free zone, it had become mostly foreigners. During World War II, Aden had increasing economic growth and became the second-busiest port in the world after New York City . After the rise of labour unions, a rift was apparent between the sectors of workers and the first signs of resistance to the occupation started in 1943. Muhammad Ali Luqman founded the first Arabic club and school in Aden, and was the first to start working towards a union. The Colony of Aden was divided into an eastern colony and a western colony. Those were further divided into 23 sultanates and emirates, and several independent tribes that had no relationships with the sultanates. The deal between the sultanates and Britain detailed protection and complete control of foreign relations by the British. The Sultanate of Lahej was the only one in which the sultan was referred to as His Highness . The Federation of South Arabia was created by the British to counter Arab nationalism by giving more freedom to the rulers of the nations. The North Yemen Civil War inspired many in the south to rise against the British rule. The National Liberation Front (NLF) of Yemen was formed with the leadership of Qahtan Muhammad Al-Shaabi . The NLF hoped to destroy all the sultanates and eventually unite with the Yemen Arab Republic . Most of the support for the NLF came from Radfan and Yafa, so the British launched Operation Nutcracker, which completely burned Radfan in January 1964. Arab nationalism made an impact in some circles who opposed the lack of modernization efforts in the Mutawakkilite monarchy. This became apparent when Imam Ahmad bin Yahya died in 1962. He was succeeded by his son, but army officers attempted to seize power, sparking the North Yemen Civil War . The Hamidaddin royalists were supported by Saudi Arabia, Britain, and Jordan (mostly with weapons and financial aid, but also with small military forces), whilst the military rebels were backed by Egypt. Egypt provided the rebels with weapons and financial assistance, but also sent a large military force to participate in the fighting. Israel covertly supplied weapons to the royalists to keep the Egyptian military busy in Yemen and make Nasser less likely to initiate a conflict in the Sinai. After six years of civil war, the military rebels formed the Yemen Arab Republic . The revolution in the north coincided with the Aden Emergency , which hastened the end of British rule in the south. On 30 November 1967, the state of South Yemen was formed, comprising Aden and the former Protectorate of South Arabia. This socialist state was later officially known as the People's Democratic Republic of Yemen and a programme of nationalisation was begun. Relations between the two Yemeni states fluctuated between peaceful and hostile. The South was supported by the Eastern bloc. The North, however, was not able to get the same connections. In 1972, the two states fought a war. The war was resolved with a ceasefire and negotiations brokered by the Arab League , where it was declared that unification would eventually occur. In 1978, Ali Abdullah Saleh was named as president of the Yemen Arab Republic. After the war, the North complained about the South's help from foreign countries. This included Saudi Arabia. In 1979, fresh fighting between the two states resumed and efforts were renewed to bring about unification. Thousands were killed in 1986 in the South Yemen Civil War . President Ali Nasser Muhammad fled to the north and was later sentenced to death for treason. A new government formed. In 1990, the two governments reached a full agreement on the joint governing of Yemen, and the countries were merged on 22 May 1990, with Saleh as president. The president of South Yemen, Ali Salim al-Beidh , became vice president. A unified parliament was formed and a unity constitution was agreed upon. In the 1993 parliamentary election , the first held after unification, the General People's Congress won 122 of 301 seats. : 309 After the invasion of Kuwait crisis in 1990, Yemen's president opposed military intervention from non-Arab states. As a member of the United Nations Security Council for 1990 and 1991, Yemen abstained on a number of UNSC resolutions concerning Iraq and Kuwait and voted against the "...use of force resolution." The vote outraged the U.S., and Saudi Arabia expelled 800,000 Yemenis in 1990 and 1991 to punish Yemen for its opposition to the intervention. In the absence of strong state institutions, elite politics in Yemen constituted a de facto form of collaborative governance , where competing tribal, regional, religious, and political interests agreed to hold themselves in check through tacit acceptance of the balance it produced. The informal political settlement was held together by a power-sharing deal among three men: President Saleh, who controlled the state; major general Ali Mohsen al-Ahmar , who controlled the largest share of the Republic of Yemen Armed Forces ; and Abdullah ibn Husayn al-Ahmar , figurehead of the Islamist al-Islah party and Saudi Arabia's chosen broker of transnational patronage payments to various political players, including tribal sheikhs . The Saudi payments have been intended to facilitate the tribes' autonomy from the Yemeni government and to give the Saudi government a mechanism with which to weigh in on Yemen's political decision-making. Following food riots in major towns in 1992, a new coalition government made up of the ruling parties from both the former Yemeni states was formed in 1993. However, Vice President al-Beidh withdrew to Aden in August 1993 and said he would not return to the government until his grievances were addressed. These included northern violence against his Yemeni Socialist Party , as well as the economic marginalization of the south. Negotiations to end the political deadlock dragged on into 1994. The government of Prime Minister Haydar Abu Bakr Al-Attas became ineffective due to political infighting. An accord between northern and southern leaders was signed in Amman , Jordan on 20 February 1994, but this could not stop the civil war. During these tensions, both the northern and southern armies (which had never integrated) gathered on their respective frontiers. Ali Abdullah Saleh became Yemen's first directly elected president in the 1999 presidential election , winning 96% of the vote. : 310 The only other candidate, Najeeb Qahtan Al-Sha'abi , was the son of Qahtan Muhammad al-Sha'abi, a former president of South Yemen. Though a member of Saleh's General People's Congress (GPC) party, Najeeb ran as an independent. In October 2000, 17 U.S. personnel died after an al-Qaeda suicide attack on the U.S. naval vessel USS Cole in Aden . After the September 11 attacks on the United States, President Saleh assured U.S. President George W. Bush that Yemen was a partner in his War on Terror . In 2001, violence surrounded a referendum , which apparently supported extending Saleh's rule and powers. The Shia insurgency in Yemen began in June 2004 when dissident cleric Hussein Badreddin al-Houthi , head of the Zaidi Shia sect, launched an uprising against the Yemeni government. The Yemeni government alleged that the Houthis were seeking to overthrow it and to implement Shī'ite religious law . The rebels countered that they were "defending their community against discrimination" and government aggression. In 2005, at least 36 people were killed in clashes across the country between police and protesters over rising fuel prices. In the 2006 presidential election , Saleh won with 77% of the vote. His main rival, Faisal bin Shamlan , received 22%. Saleh was sworn in for another term on 27 September. A suicide bomber killed eight Spanish tourists and two Yemenis in the province of Marib in July 2007. A series of bomb attacks occurred on police, official, diplomatic, foreign business, and tourism targets in 2008. Car bombings outside the U.S. embassy in Sana'a killed 18 people, including six of the assailants in September 2008. In 2008, an opposition rally in Sana'a demanding electoral reform was met with police gunfire. There is a system of social stratification in Yemen that was officially abolished at the creation of the Republic of Yemen in 1962, but in practice this system has not disappeared and Yemeni society is still organized around hierarchical ranks. The difference between ranks is manifested by descent and occupation and is consolidated by marriages between people of the same ranks. There are five status groups. At the top of hierarchy, there are the religious elites, also called sada . These are then followed by the strata of judges ( quad ). The third hierarchical status is the qaba'il , who are the peasants who belong to tribes and who live mainly from agriculture and trading. The fourth group is called the mazayanah . This group is composed of people who had no land and provide different kinds of services such as butchers and craftsmen. Finally, at the bottom of the hierarchy are the slaves ( a'bid ) and even further below them Al-Akhdam , which means servants. In January 2009, the Saudi Arabian and Yemeni al-Qaeda branches merged to form Al-Qaeda in the Arabian Peninsula , which is based in Yemen, and many of its members were Saudi nationals who had been released from Guantanamo Bay detention camp . Saleh released 176 al-Qaeda suspects on condition of good behaviour, but terrorist activities continued. The Yemeni army launched a fresh offensive against the Shia insurgents in 2009, assisted by Saudi forces. Tens of thousands of people were displaced by the fighting. A ceasefire was agreed upon in February 2010. However, by the end of the year, Yemen claimed that 3,000 soldiers had been killed in renewed fighting. The Shia rebels accused Saudi Arabia of providing support to salafi groups to suppress Zaidism in Yemen. On orders from U.S. President Barack Obama , U.S. warplanes fired cruise missiles at what officials in Washington claimed were Al Qaeda training camps in the provinces of Sana'a and Abyan on 17 December 2009. Instead of hitting Al-Qaeda operatives, it hit a village, killing 55 civilians. Officials in Yemen said that the attacks claimed the lives of more than 60 civilians, 28 of them children. Another airstrike was carried out on 24 December. The U.S. launched a series of drone attacks in Yemen to curb a perceived growing terror threat due to political chaos in Yemen. Controversy over U.S. policy for drone attacks swelled after a September 2011 drone strike in Yemen killed Anwar al-Awlaki and Samir Khan , both U.S. citizens. Another drone strike in October 2011 killed Anwar's teenage son, Abdulrahman al-Awlaki . In 2010, the Obama administration policy allowed targeting of people whose names are not known. The U.S. government increased military aid to $140 million in 2010. U.S. drone strikes continued after the ousting of President Saleh. As of 2015 [ update ] , Shi'a Houthis are fighting against the Islamic State , Al Qaeda, and Saudi Arabia. The U.S. supports the Saudi-led military intervention in Yemen against the Houthis, but many in US SOCOM reportedly favor Houthis , as they have been an effective force to roll back al-Qaeda and recently ISIL in Yemen. The Guardian reported that "The only groups poised to benefit from the war dragging on are the jihadis of Islamic State (ISIL) and Al-Qaeda in the Arabian Peninsula (AQAP), the latter's most powerful franchise, who are likely to gain influence amid the chaos. ISIL has claimed recent, bloody suicide bombings in Houthi mosques and Sana'a when it once had no known presence in the country, while AQAP has continued to seize territory in eastern Yemen unhindered by American drone strikes." In February 2016 Al-Qaeda forces and Saudi-led coalition forces were both seen fighting Houthi rebels in the same battle. The 2011 Yemeni revolution followed other Arab Spring mass protests in early 2011. The uprising was initially against unemployment, economic conditions, and corruption, as well as against the government's proposals to modify the constitution of Yemen so that Saleh's son could inherit the presidency. In March 2011, police snipers opened fire on a pro-democracy camp in Sana'a, killing more than 50 people. In May, dozens were killed in clashes between troops and tribal fighters in Sana'a. By this point, Saleh began to lose international support. In October 2011, Yemeni human rights activist Tawakul Karman won the Nobel Peace Prize , and the UN Security Council condemned the violence and called for a transfer of power. On 23 November 2011, Saleh flew to Riyadh , in neighbouring Saudi Arabia, to sign the Gulf Co-operation Council plan for political transition, which he had previously spurned. Upon signing the document, he agreed to legally transfer the office and powers of the presidency to his deputy, Vice President Abdrabbuh Mansur Hadi . Hadi took office for a two-year term upon winning the uncontested presidential elections in February 2012. A unity government—including a prime minister from the opposition—was formed. Al-Hadi would oversee the drafting of a new constitution, followed by parliamentary and presidential elections in 2014. Saleh returned in February 2012. In the face of objections from thousands of street protesters, parliament granted him full immunity from prosecution. Saleh's son, General Ahmed Ali Abdullah Saleh , continues to exercise a strong hold on sections of the military and security forces. AQAP claimed responsibility for a February 2012 suicide attack on the presidential palace that killed 26 Republican Guards on the day that President Hadi was sworn in. AQAP was also behind a suicide bombing that killed 96 soldiers in Sana'a three months later. In September 2012, a car bomb attack in Sana'a killed 11 people, a day after a local al-Qaeda leader Said al-Shihri was reported killed in the south. By 2012, there was a "small contingent of U.S. special-operations troops"—in addition to CIA and "unofficially acknowledged" U.S. military presence—in response to increasing terror attacks by AQAP on Yemeni citizens. Many analysts have pointed out the former Yemeni government role in cultivating terrorist activity in the country. Following the election of President Abdrabbuh Mansur Hadi , the Yemeni military was able to push Ansar al-Sharia back and recapture the Shabwah Governorate . The central government in Sana'a remained weak, staving off challenges from southern separatists and Houthis as well as AQAP. The Shia insurgency intensified after Hadi took power, escalating in September 2014 as anti-government forces led by Abdul-Malik al-Houthi swept into the capital and forced Hadi to agree to a "unity" government. The Houthis then refused to participate in the government, although they continued to apply pressure on Hadi and his ministers, even shelling the president's private residence and placing him under house arrest, until the government's mass resignation in January 2015. The following month, the Houthis dissolved parliament and declared that a Revolutionary Committee under Mohammed Ali al-Houthi was the interim authority in Yemen. Abdul-Malik al-Houthi, a cousin of the acting president, called the takeover a "glorious revolution". However, the "constitutional declaration" of 6 February 2015 was widely rejected by opposition politicians and foreign governments, including the United Nations . Hadi managed to flee from Sana'a to Aden, his hometown and stronghold in the south, on 21 February 2015. He promptly gave a televised speech rescinding his resignation, condemning the coup, and calling for recognition as the constitutional president of Yemen. The following month, Hadi declared Aden Yemen's "temporary" capital. The Houthis, however, rebuffed an initiative by the Gulf Cooperation Council and continued to move south toward Aden. All U.S. personnel were evacuated, and President Hadi was forced to flee the country to Saudi Arabia. On 26 March 2015, Saudi Arabia announced Operation Decisive Storm and began airstrikes and announced its intentions to lead a military coalition against the Houthis, whom they claimed were being aided by Iran and began a force buildup along the Yemeni border. The coalition included the United Arab Emirates , Kuwait , Qatar , Bahrain , Jordan , Morocco , Sudan , Egypt , and Pakistan . The United States announced that it was assisting with intelligence, targeting, and logistics. After Hadi troops took control of Aden from Houthis, jihadist groups became active in the city, and some terrorist incidents were linked to them such as Missionaries of Charity attack in Aden on 4 March 2016. In February 2018, Aden was seized by the UAE-backed separatist Southern Transitional Council . Yemen has been suffering from a famine since 2016 as a result of the civil war. More than 50,000 children in Yemen died from starvation in 2017. Numerous commentators have condemned the Saudi-led coalition's military campaign, including its blockade of Yemen , as genocide . The famine is being compounded by an outbreak of cholera that has affected more than one million people. The Saudi Arabian-led intervention in Yemen and blockade of Yemen have contributed to the famine and cholera epidemic. The UN estimated that by the end of 2021, the war in Yemen would have caused over 377,000 deaths, and roughly 70% of deaths were children under age 5. On 4 December 2017, deposed strongman and former president Ali Abdullah Saleh , accused of treason, was assassinated by Houthis whilst attempting to flee clashes near rebel-held Sana'a between Houthi and pro-Saleh forces. After losing the support of the Saudi-led coalition, Yemen's President Abd Rabbuh Mansur Hadi resigned, and the Presidential Leadership Council took power in April 2022. Following the outbreak of the 2023 Israel–Hamas war , the Houthis began to fire missiles at Israel and attack ships off Yemen's coast in the Red Sea, which they say is in solidarity with the Palestinians and aiming to facilitate entry of humanitarian aid into the Gaza Strip . With its long sea border between eastern and western civilizations, Yemen has long existed at a crossroads of cultures with a strategic location in terms of trade on the west of the Arabian Peninsula. Large settlements for their era existed in the mountains of northern Yemen as early as 5000 BC. The Sabaean Kingdom came into existence in at least the 12th century BC. The four major kingdoms or tribal confederations in South Arabia were Saba, Hadhramaut , Qataban , and Ma'in . Sabaʾ ( Arabic : سَـبَـأ ) is thought to be biblical Sheba and was the most prominent federation. The Sabaean rulers adopted the title Mukarrib generally thought to mean unifier , or a priest-king , or the head of the confederation of South Arabian kingdoms, the "king of the kings". The role of the Mukarrib was to bring the various tribes under the kingdom and preside over them all. The Sabaeans built the Great Dam of Marib around 940 BC. The dam was built to withstand the seasonal flash floods surging down the valley. By the third century BC, Qataban, Hadhramaut, and Ma'in became independent from Saba and established themselves in the Yemeni arena. Minaean rule stretched as far as Dedan , with their capital at Baraqish . The Sabaeans regained their control over Ma'in after the collapse of Qataban in 50 BC. By the time of the Roman expedition to Arabia Felix in 25 BC, the Sabaeans were once again the dominating power in Southern Arabia. Aelius Gallus was ordered to lead a military campaign to establish Roman dominance over the Sabaeans. The Romans had a vague and contradictory geographical knowledge about Arabia Felix. A Roman army of 10,000 men was defeated before Marib . Strabo 's close relationship with Aelius Gallus led him to attempt to justify his friend's defeat in his writings. It took the Romans six months to reach Marib and 60 days to return to Egypt . The Romans blamed their Nabataean guide and executed him for treachery. No direct mention in Sabaean inscriptions of the Roman expedition has yet been found. After the Roman expedition (perhaps earlier) the country fell into chaos, and two clans, namely Hamdan and Himyar , claimed kingship, assuming the title King of Sheba and Dhu Raydan . Dhu Raydan, i.e. , Himyarites, allied themselves with Aksum in Ethiopia against the Sabaeans. The chief of Bakil and king of Saba and Dhu Raydan, El Sharih Yahdhib , launched successful campaigns against the Himyarites and Habashat, i.e. , Aksum , El Sharih took pride in his campaigns and added the title Yahdhib to his name, which means "suppressor"; he used to kill his enemies by cutting them to pieces. Sana'a came into prominence during his reign, as he built the Ghumdan Palace as his place of residence. The Himyarite annexed Sana'a from Hamdan around 100 AD. Hashdi tribesmen rebelled against them and regained Sana'a around 180. Shammar Yahri'sh had conquered Hadhramaut, Najran , and Tihamah by 275, thus unifying Yemen and consolidating Himyarite rule. The Himyarites rejected polytheism and adhered to a consensual form of monotheism called Rahmanism . In 354, Roman Emperor Constantius II sent an embassy headed by Theophilos the Indian to convert the Himyarites to Christianity. According to Philostorgius , the mission was resisted by local Jews. Several inscriptions have been found in Hebrew and Sabaean praising the ruling house in Jewish terms for "...helping and empowering the People of Israel." According to Islamic traditions, King As'ad the Perfect mounted a military expedition to support the Jews of Yathrib . Abu Kariba As'ad, as known from the inscriptions, led a military campaign to central Arabia or Najd to support the vassal Kingdom of Kinda against the Lakhmids . However, no direct reference to Judaism or Yathrib was discovered from his lengthy reign. Abu Kariba died in 445, having reigned for almost 50 years. By 515, Himyar became increasingly divided along religious lines and a bitter conflict between different factions paved the way for an Aksumite intervention. The last Himyarite king Ma'adikarib Ya'fur was supported by Aksum against his Jewish rivals. Ma'adikarib was Christian and launched a campaign against the Lakhmids in southern Iraq , with the support of other Arab allies of Byzantium . The Lakhmids were a bulwark of Persia , which was intolerant to a proselytizing religion like Christianity. After the death of Ma'adikarib Ya'fur around 521, a Himyarite Jewish warlord called Dhu Nuwas rose to power. Emperor Justinian I sent an embassy to Yemen. He wanted the officially Christian Himyarites to use their influence on the tribes in inner Arabia to launch military operations against Persia. Justinian I bestowed the "dignity of king" upon the Arab sheikhs of Kindah and Ghassan in central and northern Arabia. From early on, Roman and Byzantine policy was to develop close links with the powers of the coast of the Red Sea . They were successful in converting [ clarification needed ] Aksum and influencing their culture. The results concerning to Yemen were rather disappointing. A Kendite prince called Yazid bin Kabshat rebelled against Abraha and his Arab Christian allies. A truce was reached once the Great Dam of Marib had suffered a breach. Abraha died around 570. The Sasanid Empire annexed Aden around 570. Under their rule, most of Yemen enjoyed great autonomy except for Aden and Sana'a. This era marked the collapse of ancient South Arabian civilization, since the greater part of the country was under several independent clans until the arrival of Islam in 630. Muhammad sent his cousin Ali to Sana'a and its surroundings around 630. At the time, Yemen was the most advanced region in Arabia. The Banu Hamdan confederation was among the first to accept Islam. Muhammad sent Muadh ibn Jabal , as well to Al-Janad, in present-day Taiz , and dispatched letters to various tribal leaders. Major tribes, including Himyar, sent delegations to Medina during the "year of delegations" around 630–631. Several Yemenis accepted Islam before 630, such as Ammar ibn Yasir , Al-Ala'a Al-Hadrami , Miqdad ibn Aswad , Abu Musa Ashaari , and Sharhabeel ibn Hasana . A man named 'Abhala ibn Ka'ab Al-Ansi expelled the remaining Persians and claimed he was a prophet of Rahman . He was assassinated by a Yemeni of Persian origin called Fayruz al-Daylami . Christians, who were mainly staying in Najran along with Jews, agreed to pay jizyah ( Arabic : جِـزْيَـة ), although some Jews converted to Islam, such as Wahb ibn Munabbih and Ka'ab al-Ahbar . Yemen was stable during the Rashidun Caliphate . Yemeni tribes played a pivotal role in the Islamic expansion into Egypt, Iraq, Persia, the Levant , Anatolia , North Africa , Sicily , and Andalusia . Yemeni tribes who settled in Syria contributed significantly to the solidification of Umayyad rule, especially during the reign of Marwan I . Powerful Yemenite tribes such as Kinda were on his side during the Battle of Marj Rahit . Muhammad ibn Abdullah ibn Ziyad founded the Ziyadid dynasty in Tihamah around 818. The state stretched from Haly (in present-day Saudi Arabia) to Aden. They nominally recognized the Abbasid Caliphate but ruled independently from Zabid . By virtue of its location, they developed a special relationship with Abyssinia . The chief of the Dahlak islands exported slaves, as well as amber and leopard hides, to the ruler of Yemen. They controlled only a small portion of the coastal strip in Tihamah along the Red Sea, and never exercised control over the highlands and Hadhramaut. A Himyarite clan called the Yufirids established their rule over the highlands from Saada to Taiz , while Hadhramaut was an Ibadi stronghold and rejected all allegiance to the Abbasids in Baghdad . The first Zaidi imam, Yahya ibn al-Husayn , arrived in Yemen in 893. He was a religious cleric and judge who was invited to come to Saada from Medina to arbitrate tribal disputes. Yahya persuaded local tribesmen to follow his teachings. The sect slowly spread across the highlands, as the tribes of Hashid and Bakil , later known as "the twin wings of the imamate", accepted his authority. He founded the Zaidi imamate in 897. Yahya established his influence in Saada and Najran. He also tried to capture Sana'a from the Yufirids in 901 but failed miserably. The Sulayhid dynasty was founded in the northern highlands around 1040; at the time, Yemen was ruled by different local dynasties. In 1060, Ali ibn Muhammad Al-Sulayhi conquered Zabid and killed its ruler Al-Najah, founder of the Najahid dynasty. His sons were forced to flee to Dahlak. Hadhramaut fell into Sulayhid hands after their capture of Aden in 1162. By 1063, Ali had subjugated Greater Yemen . He then marched toward Hejaz and occupied Makkah . Ali was married to Asma bint Shihab , who governed Yemen with her husband. The Khutba during Friday prayers was proclaimed in both her husband's name and hers. No other Arab woman had this honor since the advent of Islam. Ali al-Sulayhi was killed by Najah's sons on his way to Mecca in 1084. His son Ahmed Al-Mukarram led an army to Zabid and killed 8,000 of its inhabitants. He later installed the Zurayids to govern Aden. al-Mukarram, who had been afflicted with facial paralysis resulting from war injuries, retired in 1087 and handed over power to his wife Arwa al-Sulayhi . Queen Arwa moved the seat of the Sulayhid dynasty from Sana'a to Jibla , a small town in central Yemen near Ibb . She sent Ismaili missionaries to India, where a significant Ismaili community was formed that exists to this day. Queen Arwa continued to rule securely until her death in 1138. She is still remembered as a great and much-loved sovereign, as attested in Yemeni historiography, literature, and popular lore, where she is referred to as Balqis al-sughra ("the junior queen of Sheba"). Shortly after Arwa's death, the country was split between five competing petty dynasties along religious lines. The Ayyubid dynasty overthrew the Fatimid Caliphate in Egypt. A few years after their rise to power, Saladin dispatched his brother Turan Shah to conquer Yemen in 1174. Turan Shah conquered Zabid from the Mahdids in 1174, then marched toward Aden in June and captured it from the Zurayids. The Hamdanid sultans of Sana'a resisted the Ayyubid in 1175, and the Ayyubids did not manage to secure Sana'a until 1189. The Ayyubid rule was stable in southern and central Yemen, where they succeeded in eliminating the ministates of that region, while Ismaili and Zaidi tribesmen continued to hold out in several fortresses. The Ayyubids failed to capture the Zaydis stronghold in northern Yemen. In 1191, Zaydis of Shibam Kawkaban rebelled and killed 700 Ayyubid soldiers. Imam Abdullah bin Hamza proclaimed the imamate in 1197 and fought al-Mu'izz Ismail, the Ayyubid Sultan of Yemen. Imam Abdullah was defeated at first but was able to conquer Sana'a and Dhamar in 1198, and al-Mu'izz Ismail was assassinated in 1202. Abdullah bin Hamza carried on the struggle against the Ayyubid until his death in 1217. After his demise, the Zaidi community was split between two rival imams. The Zaydis were dispersed, and a truce was signed with the Ayyubid in 1219. The Ayyubid army was defeated in Dhamar in 1226. Ayyubid Sultan Mas'ud Yusuf left for Mecca in 1228, never to return. Other sources suggest that he was forced to leave for Egypt instead in 1223. The Rasulid dynasty was established in 1229 by Umar ibn Rasul, who was appointed deputy governor by the Ayyubids in 1223. When the last Ayyubid ruler left Yemen in 1229, Umar stayed in the country as caretaker. He subsequently declared himself an independent king by assuming the title "al-Malik Al-Mansur" (the king assisted by Allah ). Umar first established himself at Zabid, then moved into the mountainous interior, taking the important highland centre Sana'a. However, the Rasulid capitals were Zabid and Taiz. He was assassinated by his nephew in 1249. Omar's son Yousef defeated the faction led by his father's assassins and crushed several counterattacks by the Zaydi imams who still held on in the northern highland. Mainly because of the victories he scored over his rivals, he assumed the honorific title "al-Muzaffar" (the victorious). After the fall of Baghdad to the Mongols in 1258, al-Muzaffar Yusuf I appropriated the title of caliph . He chose the city of Taiz to become the political capital of the kingdom because of its strategic location and proximity to Aden. The Rasulid sultans built numerous Madrasas to solidify the Shafi'i school of thought, which is still the dominant school of jurisprudence amongst Yemenis today. Under their rule, Taiz and Zabid became major international centres of Islamic learning. The kings were educated men in their own right, who not only had important libraries but also wrote treatises on a wide array of subjects, ranging from astrology and medicine to agriculture and genealogy. They had a difficult relationship with the Mamluks of Egypt because the latter considered them a vassal state. Their competition centred over the Hejaz and the right to provide kiswa of the Ka'aba in Mecca. The dynasty became increasingly threatened by disgruntled family members over the problem of succession, combined with periodic tribal revolts, as they were locked in a war of attrition with the Zaydi imams in the northern highlands. During the last 12 years of Rasulid rule, the country was torn between several contenders for the kingdom. The weakening of the Rasulid provided an opportunity for the Banu Taher clan to take over and establish themselves as the new rulers of Yemen in 1454 AD. The Tahirids were a local clan based in Rada'a . They built schools, mosques, and irrigation channels, as well as water cisterns and bridges in Zabid, Aden, Rada'a , and Juban. Their best-known monument is the Amiriya Madrasa in Rada' District , which was built in 1504. The Tahiride were too weak either to contain the Zaydi imams or to defend themselves against foreign attacks. Realizing how rich the Tahiride realm was, the Mamluks decided to conquer it. The Mamluk army, with the support of forces loyal to Zaydi Imam Al-Mutawakkil Yahya Sharaf ad-Din , conquered the entire realm of the Tahiride but failed to capture Aden in 1517. The Mamluk victory was short-lived. The Ottoman Empire conquered Egypt, hanging the last Mamluk Sultan in Cairo . The Ottomans had not decided to conquer Yemen until 1538. The Zaydi highland tribes emerged as national heroes by offering stiff, vigorous resistance to the Turkish occupation. The Mamluks tried to attach Yemen to Egypt and the Portuguese led by Afonso de Albuquerque , occupied the island of Socotra and made an unsuccessful attack on Aden in 1513. Muhammad sent his cousin Ali to Sana'a and its surroundings around 630. At the time, Yemen was the most advanced region in Arabia. The Banu Hamdan confederation was among the first to accept Islam. Muhammad sent Muadh ibn Jabal , as well to Al-Janad, in present-day Taiz , and dispatched letters to various tribal leaders. Major tribes, including Himyar, sent delegations to Medina during the "year of delegations" around 630–631. Several Yemenis accepted Islam before 630, such as Ammar ibn Yasir , Al-Ala'a Al-Hadrami , Miqdad ibn Aswad , Abu Musa Ashaari , and Sharhabeel ibn Hasana . A man named 'Abhala ibn Ka'ab Al-Ansi expelled the remaining Persians and claimed he was a prophet of Rahman . He was assassinated by a Yemeni of Persian origin called Fayruz al-Daylami . Christians, who were mainly staying in Najran along with Jews, agreed to pay jizyah ( Arabic : جِـزْيَـة ), although some Jews converted to Islam, such as Wahb ibn Munabbih and Ka'ab al-Ahbar . Yemen was stable during the Rashidun Caliphate . Yemeni tribes played a pivotal role in the Islamic expansion into Egypt, Iraq, Persia, the Levant , Anatolia , North Africa , Sicily , and Andalusia . Yemeni tribes who settled in Syria contributed significantly to the solidification of Umayyad rule, especially during the reign of Marwan I . Powerful Yemenite tribes such as Kinda were on his side during the Battle of Marj Rahit . Muhammad ibn Abdullah ibn Ziyad founded the Ziyadid dynasty in Tihamah around 818. The state stretched from Haly (in present-day Saudi Arabia) to Aden. They nominally recognized the Abbasid Caliphate but ruled independently from Zabid . By virtue of its location, they developed a special relationship with Abyssinia . The chief of the Dahlak islands exported slaves, as well as amber and leopard hides, to the ruler of Yemen. They controlled only a small portion of the coastal strip in Tihamah along the Red Sea, and never exercised control over the highlands and Hadhramaut. A Himyarite clan called the Yufirids established their rule over the highlands from Saada to Taiz , while Hadhramaut was an Ibadi stronghold and rejected all allegiance to the Abbasids in Baghdad . The first Zaidi imam, Yahya ibn al-Husayn , arrived in Yemen in 893. He was a religious cleric and judge who was invited to come to Saada from Medina to arbitrate tribal disputes. Yahya persuaded local tribesmen to follow his teachings. The sect slowly spread across the highlands, as the tribes of Hashid and Bakil , later known as "the twin wings of the imamate", accepted his authority. He founded the Zaidi imamate in 897. Yahya established his influence in Saada and Najran. He also tried to capture Sana'a from the Yufirids in 901 but failed miserably.The Sulayhid dynasty was founded in the northern highlands around 1040; at the time, Yemen was ruled by different local dynasties. In 1060, Ali ibn Muhammad Al-Sulayhi conquered Zabid and killed its ruler Al-Najah, founder of the Najahid dynasty. His sons were forced to flee to Dahlak. Hadhramaut fell into Sulayhid hands after their capture of Aden in 1162. By 1063, Ali had subjugated Greater Yemen . He then marched toward Hejaz and occupied Makkah . Ali was married to Asma bint Shihab , who governed Yemen with her husband. The Khutba during Friday prayers was proclaimed in both her husband's name and hers. No other Arab woman had this honor since the advent of Islam. Ali al-Sulayhi was killed by Najah's sons on his way to Mecca in 1084. His son Ahmed Al-Mukarram led an army to Zabid and killed 8,000 of its inhabitants. He later installed the Zurayids to govern Aden. al-Mukarram, who had been afflicted with facial paralysis resulting from war injuries, retired in 1087 and handed over power to his wife Arwa al-Sulayhi . Queen Arwa moved the seat of the Sulayhid dynasty from Sana'a to Jibla , a small town in central Yemen near Ibb . She sent Ismaili missionaries to India, where a significant Ismaili community was formed that exists to this day. Queen Arwa continued to rule securely until her death in 1138. She is still remembered as a great and much-loved sovereign, as attested in Yemeni historiography, literature, and popular lore, where she is referred to as Balqis al-sughra ("the junior queen of Sheba"). Shortly after Arwa's death, the country was split between five competing petty dynasties along religious lines. The Ayyubid dynasty overthrew the Fatimid Caliphate in Egypt. A few years after their rise to power, Saladin dispatched his brother Turan Shah to conquer Yemen in 1174. Turan Shah conquered Zabid from the Mahdids in 1174, then marched toward Aden in June and captured it from the Zurayids. The Hamdanid sultans of Sana'a resisted the Ayyubid in 1175, and the Ayyubids did not manage to secure Sana'a until 1189. The Ayyubid rule was stable in southern and central Yemen, where they succeeded in eliminating the ministates of that region, while Ismaili and Zaidi tribesmen continued to hold out in several fortresses. The Ayyubids failed to capture the Zaydis stronghold in northern Yemen. In 1191, Zaydis of Shibam Kawkaban rebelled and killed 700 Ayyubid soldiers. Imam Abdullah bin Hamza proclaimed the imamate in 1197 and fought al-Mu'izz Ismail, the Ayyubid Sultan of Yemen. Imam Abdullah was defeated at first but was able to conquer Sana'a and Dhamar in 1198, and al-Mu'izz Ismail was assassinated in 1202. Abdullah bin Hamza carried on the struggle against the Ayyubid until his death in 1217. After his demise, the Zaidi community was split between two rival imams. The Zaydis were dispersed, and a truce was signed with the Ayyubid in 1219. The Ayyubid army was defeated in Dhamar in 1226. Ayyubid Sultan Mas'ud Yusuf left for Mecca in 1228, never to return. Other sources suggest that he was forced to leave for Egypt instead in 1223. The Rasulid dynasty was established in 1229 by Umar ibn Rasul, who was appointed deputy governor by the Ayyubids in 1223. When the last Ayyubid ruler left Yemen in 1229, Umar stayed in the country as caretaker. He subsequently declared himself an independent king by assuming the title "al-Malik Al-Mansur" (the king assisted by Allah ). Umar first established himself at Zabid, then moved into the mountainous interior, taking the important highland centre Sana'a. However, the Rasulid capitals were Zabid and Taiz. He was assassinated by his nephew in 1249. Omar's son Yousef defeated the faction led by his father's assassins and crushed several counterattacks by the Zaydi imams who still held on in the northern highland. Mainly because of the victories he scored over his rivals, he assumed the honorific title "al-Muzaffar" (the victorious). After the fall of Baghdad to the Mongols in 1258, al-Muzaffar Yusuf I appropriated the title of caliph . He chose the city of Taiz to become the political capital of the kingdom because of its strategic location and proximity to Aden. The Rasulid sultans built numerous Madrasas to solidify the Shafi'i school of thought, which is still the dominant school of jurisprudence amongst Yemenis today. Under their rule, Taiz and Zabid became major international centres of Islamic learning. The kings were educated men in their own right, who not only had important libraries but also wrote treatises on a wide array of subjects, ranging from astrology and medicine to agriculture and genealogy. They had a difficult relationship with the Mamluks of Egypt because the latter considered them a vassal state. Their competition centred over the Hejaz and the right to provide kiswa of the Ka'aba in Mecca. The dynasty became increasingly threatened by disgruntled family members over the problem of succession, combined with periodic tribal revolts, as they were locked in a war of attrition with the Zaydi imams in the northern highlands. During the last 12 years of Rasulid rule, the country was torn between several contenders for the kingdom. The weakening of the Rasulid provided an opportunity for the Banu Taher clan to take over and establish themselves as the new rulers of Yemen in 1454 AD. The Tahirids were a local clan based in Rada'a . They built schools, mosques, and irrigation channels, as well as water cisterns and bridges in Zabid, Aden, Rada'a , and Juban. Their best-known monument is the Amiriya Madrasa in Rada' District , which was built in 1504. The Tahiride were too weak either to contain the Zaydi imams or to defend themselves against foreign attacks. Realizing how rich the Tahiride realm was, the Mamluks decided to conquer it. The Mamluk army, with the support of forces loyal to Zaydi Imam Al-Mutawakkil Yahya Sharaf ad-Din , conquered the entire realm of the Tahiride but failed to capture Aden in 1517. The Mamluk victory was short-lived. The Ottoman Empire conquered Egypt, hanging the last Mamluk Sultan in Cairo . The Ottomans had not decided to conquer Yemen until 1538. The Zaydi highland tribes emerged as national heroes by offering stiff, vigorous resistance to the Turkish occupation. The Mamluks tried to attach Yemen to Egypt and the Portuguese led by Afonso de Albuquerque , occupied the island of Socotra and made an unsuccessful attack on Aden in 1513. Starting in the 15th century, Portugal intervened, dominating the port of Aden for about 20 years and maintaining a fortified enclave on the island of Socotra during this period. From the 16th century, the Portuguese posed an immediate threat to Indian Ocean trade. The Mamluks therefore sent an army under Hussein al-Kurdi to fight the intruders The Mamluk sultan went to Zabid in 1515 and entered into diplomatic talks with the Tahiri sultan 'Amir bin Abdulwahab for money that would be needed for the jihad against the Portuguese. Instead of confronting them, the Mamluks, who were running out of food and water, landed on the coast of Yemen and began harassing the villagers of Tihamah to obtain the supplies they needed. The interest of Portugal on the Red Sea consisted on the one hand of guaranteeing contacts with a Christian ally in Ethiopia and on the other of being able to attack Mecca and the Arab territories from the rear, while still having absolute dominance over trade of spices, the main intention was to dominate the commerce of the cities on the coast of Africa and Arabia. To this end, Portugal sought to influence and dominate by force or persuasion all the ports and kingdoms that fought among themselves. It was common for Portugal to keep under its influence the Arab allies that were interested in maintaining independence from other Arab states in the region. The Ottomans had two fundamental interests to safeguard in Yemen: The Islamic holy cities of Mecca and Medina, and the trade route with India in spices and textiles—both threatened, and the latter virtually eclipsed, by the arrival of the Portuguese in the Indian Ocean and the Red Sea in the early 16th century. Hadım Suleiman Pasha , the Ottoman governor of Egypt , was ordered to command a fleet of 90 ships to conquer Yemen. The country was in a state of incessant anarchy and discord as Pasha described it by saying: Yemen is a land with no lord, an empty province. It would be not only possible but easy to capture, and should it be captured, it would be master of the lands of India and send every year a great amount of gold and jewels to Constantinople . Imam al-Mutawakkil Yahya Sharaf ad-Din ruled over the northern highlands including Sana'a, while Aden was held by the last Tahiride Sultan 'Amir ibn Dauod. Pasha stormed Aden in 1538, killing its ruler, and extended Ottoman authority to include Zabid in 1539 and eventually Tihamah in its entirety. Zabid became the administrative headquarters of Yemen Eyalet . The Ottoman governors did not exercise much control over the highlands. They held sway mainly in the southern coastal region, particularly around Zabid, Mocha, and Aden. Of 80,000 soldiers sent to Yemen from Egypt between 1539 and 1547, only 7,000 survived. The Ottoman accountant-general in Egypt remarked: We have seen no foundry like Yemen for our soldiers. Each time we have sent an expeditionary force there, it has melted away like salt dissolved in water. The Ottomans sent yet another expeditionary force to Zabid in 1547, while Imam al-Mutawakkil Yahya Sharaf ad-Din was ruling the highlands independently. Yahya chose his son Ali to succeed him, a decision that infuriated his other son al-Mutahhar ibn Yahya. Al-Mutahhar was lame, so he was not qualified for the imamate. He urged Oais Pasha, the Ottoman colonial governor in Zabid , to attack his father. Indeed, Ottoman troops supported by tribal forces loyal to Imam al-Mutahhar stormed Taiz and marched north toward Sana'a in August 1547. The Turks officially made Imam al-Mutahhar a Sanjak-bey with authority over 'Amran . Imam al-Mutahhar assassinated the Ottoman colonial governor and recaptured Sana'a, but the Ottomans, led by Özdemir Pasha , forced al-Mutahhar to retreat to his fortress in Thula . Özdemir Pasha effectively put Yemen under Ottoman rule between 1552 and 1560. Özdemir died in Sana'a in 1561 and was succeeded by Mahmud Pasha . Mahmud Pasha was described by other Ottoman officials as a corrupt and unscrupulous governor, and he was displaced by Ridvan Pasha in 1564. By 1565, Yemen was split into two provinces, the highlands under the command of Ridvan Pasha and Tihamah under Murad Pasha. Imam al-Mutahhar launched a propaganda campaign in which he claimed that the prophet Mohammed came to him in a dream and advised him to wage jihad against the Ottomans. Al-Mutahhar led the tribes to capture Sana'a from Ridvan Pasha in 1567. When Murad tried to relieve Sana'a, highland tribesmen ambushed his unit and slaughtered all of them. Over 80 battles were fought. The last decisive encounter took place in Dhamar around 1568, in which Murad Pasha was beheaded and his head sent to al-Mutahhar in Sana'a. By 1568, only Zabid remained under the possession of the Turks. In 1632, Al-Mu'ayyad Muhammad sent an expeditionary force of 1,000 men to conquer Mecca. The army entered the city in triumph and killed its governor. The Ottomans sent an army from Egypt to fight the Yemenites. Seeing that the Turkish army was too numerous to overcome, the Yemeni army retreated to a valley outside Mecca. Ottoman troops attacked the Yemenis by hiding at the wells that supplied them with water. This plan proceeded successfully, causing the Yemenis over 200 casualties, most from thirst. The tribesmen eventually surrendered and returned to Yemen. Al-Mu'ayyad Muhammad died in 1644. He was succeeded by Al-Mutawakkil Isma'il , another son of al-Mansur al-Qasim, who conquered Yemen in its entirety. Yemen became the sole coffee producer in the world. The country established diplomatic relations with the Safavid dynasty of Persia, Ottomans of Hejaz, Mughal Empire in India, and Ethiopia, as well. In the first half of the 18th century, the Europeans broke Yemen's monopoly on coffee by smuggling coffee trees and cultivating them in their own colonies in the East Indies, East Africa, the West Indies, and Latin America. The imamate did not follow a cohesive mechanism for succession, and family quarrels and tribal insubordination led to the political decline of the Qasimi dynasty in the 18th century. The British were looking for a coal depot to service their steamers en route to India. It took 700 tons of coal for a round-trip from Suez to Bombay . East India Company officials decided on Aden . The British Empire tried to reach an agreement with the Zaydi imam of Sana'a, permitting them a foothold in Mocha, and when unable to secure their position, they extracted a similar agreement from the Sultan of Lahej , enabling them to consolidate a position in Aden. The British managed to occupy Aden and evicted the Sultan of Lahej from Aden and forced him to accept their "protection". In November 1839, 5,000 tribesmen tried to retake the town but were repulsed and 200 were killed. With emigrants from India, East Africa, and Southeast Asia, Aden grew into a world city. In 1850, only 980 Arabs were registered as original inhabitants of the city. The English presence in Aden put them at odds with the Ottomans. The Turks asserted to the British that they held sovereignty over the whole of Arabia, including Yemen as the successor of Mohammed and the Chief of the Universal Caliphate. The Ottomans were concerned about the British expansion from the British ruled subcontinent to the Red Sea and Arabia. They returned to the Tihamah in 1849 after an absence of two centuries. Rivalries and disturbances continued among the Zaydi imams, between them and their deputies, with the ulema , with the heads of tribes, as well as with those who belonged to other sects. Some citizens of Sana'a were desperate to return law and order to Yemen and asked the Ottoman Pasha in Tihamah to pacify the country. The opening of the Suez Canal in 1869 strengthened the Ottoman decision to remain in Yemen. By 1873, the Ottomans succeeded in conquering the northern highlands. Sana'a became the administrative capital of Yemen Vilayet . The Ottomans learned from their previous experience and worked on the disempowerment of local lords in the highland regions. They even attempted to secularize the Yemeni society, while Yemenite Jews came to perceive themselves in Yemeni nationalist terms. The Ottomans appeased the tribes by forgiving their rebellious chiefs and appointing them to administrative posts. They introduced a series of reforms to enhance the country's economic welfare. However, corruption was widespread in the Ottoman administration in Yemen. This was because only the worst of the officials were appointed because those who could avoid serving in Yemen did so. The Ottomans had reasserted control over the highlands for a temporary duration. The so-called Tanzimat reforms were considered heretic by the Zaydi tribes. In 1876, the Hashid and Bakil tribes rebelled against the Ottomans; the Turks had to appease them with gifts to end the uprising. The tribal chiefs were difficult to appease and an endless cycle of violence curbed Ottoman efforts to pacify the land. Ahmed Izzet Pasha proposed that the Ottoman army evacuate the highlands and confine itself to Tihamah, and not unnecessarily burden itself with continuing military operation against the Zaydi tribes. Imam Yahya Hamidaddin led a rebellion against the Turks in 1904; the rebels disrupted the Ottoman ability to govern. The revolts between 1904 and 1911 were especially damaging to the Ottomans, costing them as many as 10,000 soldiers and as much as 500,000 pounds per year. The Ottomans signed a treaty with imam Yahya Hamidaddin in 1911. Under the treaty, Imam Yahya was recognized as an autonomous leader of the Zaydi northern highlands. The Ottomans continued to rule Shafi'i areas in the mid-south until their departure in 1918. Imam Yahya hamid ed-Din al-Mutawakkil was ruling the northern highlands independently from 1911, from which he began a conquest of the Yemen lands. In 1925 Yahya captured al-Hudaydah from the Idrisids . In 1927, Yahya's forces were about 50 km (30 mi) away from Aden, Taiz, and Ibb, and were bombed by the British for five days; the imam had to pull back. Small Bedouin forces, mainly from the Madh'hij confederation of Marib , attacked Shabwah but were bombed by the British and had to retreat. The Italian Empire was the first to recognize Yahya as the king of Yemen in 1926. This created a great deal of anxiety for the British, who interpreted it as recognition of Imam Yahya's claim to sovereignty over Greater Yemen, which included the Aden protectorate and Asir. The Idrisis turned to Ibn Saud seeking his protection from Yahya. However, in 1932, the Idrisis broke their accord with Ibn Saud and went back to Yahya seeking help against Ibn Saud, who had begun liquidating their authority and expressed his desire to annex those territories into his own Saudi domain. Yahya demanded the return of all Idrisi dominion. Negotiations between Yahya and Ibn Saud proved fruitless. After the 1934 Saudi-Yemeni war, Ibn Saud announced a ceasefire in May 1934. Imam Yahya agreed to release Saudi hostages and the surrender of the Idrisis to Saudi custody. Imam Yahya ceded the three provinces of Najran, Asir, and Jazan for 20 years. and signed another treaty with the British government in 1934. The imam recognized the British sovereignty over Aden protectorate for 40 years. Out of fear for Hudaydah , Yahya did submit to these demands. Starting in 1890, hundreds of Yemeni people from Hajz, Al-Baetha, and Taiz migrated to Aden to work at ports, and as labourers. This helped the population of Aden once again become predominantly Arab after, having been declared a free zone, it had become mostly foreigners. During World War II, Aden had increasing economic growth and became the second-busiest port in the world after New York City . After the rise of labour unions, a rift was apparent between the sectors of workers and the first signs of resistance to the occupation started in 1943. Muhammad Ali Luqman founded the first Arabic club and school in Aden, and was the first to start working towards a union. The Colony of Aden was divided into an eastern colony and a western colony. Those were further divided into 23 sultanates and emirates, and several independent tribes that had no relationships with the sultanates. The deal between the sultanates and Britain detailed protection and complete control of foreign relations by the British. The Sultanate of Lahej was the only one in which the sultan was referred to as His Highness . The Federation of South Arabia was created by the British to counter Arab nationalism by giving more freedom to the rulers of the nations. The North Yemen Civil War inspired many in the south to rise against the British rule. The National Liberation Front (NLF) of Yemen was formed with the leadership of Qahtan Muhammad Al-Shaabi . The NLF hoped to destroy all the sultanates and eventually unite with the Yemen Arab Republic . Most of the support for the NLF came from Radfan and Yafa, so the British launched Operation Nutcracker, which completely burned Radfan in January 1964. Arab nationalism made an impact in some circles who opposed the lack of modernization efforts in the Mutawakkilite monarchy. This became apparent when Imam Ahmad bin Yahya died in 1962. He was succeeded by his son, but army officers attempted to seize power, sparking the North Yemen Civil War . The Hamidaddin royalists were supported by Saudi Arabia, Britain, and Jordan (mostly with weapons and financial aid, but also with small military forces), whilst the military rebels were backed by Egypt. Egypt provided the rebels with weapons and financial assistance, but also sent a large military force to participate in the fighting. Israel covertly supplied weapons to the royalists to keep the Egyptian military busy in Yemen and make Nasser less likely to initiate a conflict in the Sinai. After six years of civil war, the military rebels formed the Yemen Arab Republic . The revolution in the north coincided with the Aden Emergency , which hastened the end of British rule in the south. On 30 November 1967, the state of South Yemen was formed, comprising Aden and the former Protectorate of South Arabia. This socialist state was later officially known as the People's Democratic Republic of Yemen and a programme of nationalisation was begun. Relations between the two Yemeni states fluctuated between peaceful and hostile. The South was supported by the Eastern bloc. The North, however, was not able to get the same connections. In 1972, the two states fought a war. The war was resolved with a ceasefire and negotiations brokered by the Arab League , where it was declared that unification would eventually occur. In 1978, Ali Abdullah Saleh was named as president of the Yemen Arab Republic. After the war, the North complained about the South's help from foreign countries. This included Saudi Arabia. In 1979, fresh fighting between the two states resumed and efforts were renewed to bring about unification. Thousands were killed in 1986 in the South Yemen Civil War . President Ali Nasser Muhammad fled to the north and was later sentenced to death for treason. A new government formed. In 1990, the two governments reached a full agreement on the joint governing of Yemen, and the countries were merged on 22 May 1990, with Saleh as president. The president of South Yemen, Ali Salim al-Beidh , became vice president. A unified parliament was formed and a unity constitution was agreed upon. In the 1993 parliamentary election , the first held after unification, the General People's Congress won 122 of 301 seats. : 309 After the invasion of Kuwait crisis in 1990, Yemen's president opposed military intervention from non-Arab states. As a member of the United Nations Security Council for 1990 and 1991, Yemen abstained on a number of UNSC resolutions concerning Iraq and Kuwait and voted against the "...use of force resolution." The vote outraged the U.S., and Saudi Arabia expelled 800,000 Yemenis in 1990 and 1991 to punish Yemen for its opposition to the intervention. In the absence of strong state institutions, elite politics in Yemen constituted a de facto form of collaborative governance , where competing tribal, regional, religious, and political interests agreed to hold themselves in check through tacit acceptance of the balance it produced. The informal political settlement was held together by a power-sharing deal among three men: President Saleh, who controlled the state; major general Ali Mohsen al-Ahmar , who controlled the largest share of the Republic of Yemen Armed Forces ; and Abdullah ibn Husayn al-Ahmar , figurehead of the Islamist al-Islah party and Saudi Arabia's chosen broker of transnational patronage payments to various political players, including tribal sheikhs . The Saudi payments have been intended to facilitate the tribes' autonomy from the Yemeni government and to give the Saudi government a mechanism with which to weigh in on Yemen's political decision-making. Following food riots in major towns in 1992, a new coalition government made up of the ruling parties from both the former Yemeni states was formed in 1993. However, Vice President al-Beidh withdrew to Aden in August 1993 and said he would not return to the government until his grievances were addressed. These included northern violence against his Yemeni Socialist Party , as well as the economic marginalization of the south. Negotiations to end the political deadlock dragged on into 1994. The government of Prime Minister Haydar Abu Bakr Al-Attas became ineffective due to political infighting. An accord between northern and southern leaders was signed in Amman , Jordan on 20 February 1994, but this could not stop the civil war. During these tensions, both the northern and southern armies (which had never integrated) gathered on their respective frontiers. The Ottomans had two fundamental interests to safeguard in Yemen: The Islamic holy cities of Mecca and Medina, and the trade route with India in spices and textiles—both threatened, and the latter virtually eclipsed, by the arrival of the Portuguese in the Indian Ocean and the Red Sea in the early 16th century. Hadım Suleiman Pasha , the Ottoman governor of Egypt , was ordered to command a fleet of 90 ships to conquer Yemen. The country was in a state of incessant anarchy and discord as Pasha described it by saying: Yemen is a land with no lord, an empty province. It would be not only possible but easy to capture, and should it be captured, it would be master of the lands of India and send every year a great amount of gold and jewels to Constantinople . Imam al-Mutawakkil Yahya Sharaf ad-Din ruled over the northern highlands including Sana'a, while Aden was held by the last Tahiride Sultan 'Amir ibn Dauod. Pasha stormed Aden in 1538, killing its ruler, and extended Ottoman authority to include Zabid in 1539 and eventually Tihamah in its entirety. Zabid became the administrative headquarters of Yemen Eyalet . The Ottoman governors did not exercise much control over the highlands. They held sway mainly in the southern coastal region, particularly around Zabid, Mocha, and Aden. Of 80,000 soldiers sent to Yemen from Egypt between 1539 and 1547, only 7,000 survived. The Ottoman accountant-general in Egypt remarked: We have seen no foundry like Yemen for our soldiers. Each time we have sent an expeditionary force there, it has melted away like salt dissolved in water. The Ottomans sent yet another expeditionary force to Zabid in 1547, while Imam al-Mutawakkil Yahya Sharaf ad-Din was ruling the highlands independently. Yahya chose his son Ali to succeed him, a decision that infuriated his other son al-Mutahhar ibn Yahya. Al-Mutahhar was lame, so he was not qualified for the imamate. He urged Oais Pasha, the Ottoman colonial governor in Zabid , to attack his father. Indeed, Ottoman troops supported by tribal forces loyal to Imam al-Mutahhar stormed Taiz and marched north toward Sana'a in August 1547. The Turks officially made Imam al-Mutahhar a Sanjak-bey with authority over 'Amran . Imam al-Mutahhar assassinated the Ottoman colonial governor and recaptured Sana'a, but the Ottomans, led by Özdemir Pasha , forced al-Mutahhar to retreat to his fortress in Thula . Özdemir Pasha effectively put Yemen under Ottoman rule between 1552 and 1560. Özdemir died in Sana'a in 1561 and was succeeded by Mahmud Pasha . Mahmud Pasha was described by other Ottoman officials as a corrupt and unscrupulous governor, and he was displaced by Ridvan Pasha in 1564. By 1565, Yemen was split into two provinces, the highlands under the command of Ridvan Pasha and Tihamah under Murad Pasha. Imam al-Mutahhar launched a propaganda campaign in which he claimed that the prophet Mohammed came to him in a dream and advised him to wage jihad against the Ottomans. Al-Mutahhar led the tribes to capture Sana'a from Ridvan Pasha in 1567. When Murad tried to relieve Sana'a, highland tribesmen ambushed his unit and slaughtered all of them. Over 80 battles were fought. The last decisive encounter took place in Dhamar around 1568, in which Murad Pasha was beheaded and his head sent to al-Mutahhar in Sana'a. By 1568, only Zabid remained under the possession of the Turks. In 1632, Al-Mu'ayyad Muhammad sent an expeditionary force of 1,000 men to conquer Mecca. The army entered the city in triumph and killed its governor. The Ottomans sent an army from Egypt to fight the Yemenites. Seeing that the Turkish army was too numerous to overcome, the Yemeni army retreated to a valley outside Mecca. Ottoman troops attacked the Yemenis by hiding at the wells that supplied them with water. This plan proceeded successfully, causing the Yemenis over 200 casualties, most from thirst. The tribesmen eventually surrendered and returned to Yemen. Al-Mu'ayyad Muhammad died in 1644. He was succeeded by Al-Mutawakkil Isma'il , another son of al-Mansur al-Qasim, who conquered Yemen in its entirety. Yemen became the sole coffee producer in the world. The country established diplomatic relations with the Safavid dynasty of Persia, Ottomans of Hejaz, Mughal Empire in India, and Ethiopia, as well. In the first half of the 18th century, the Europeans broke Yemen's monopoly on coffee by smuggling coffee trees and cultivating them in their own colonies in the East Indies, East Africa, the West Indies, and Latin America. The imamate did not follow a cohesive mechanism for succession, and family quarrels and tribal insubordination led to the political decline of the Qasimi dynasty in the 18th century. The British were looking for a coal depot to service their steamers en route to India. It took 700 tons of coal for a round-trip from Suez to Bombay . East India Company officials decided on Aden . The British Empire tried to reach an agreement with the Zaydi imam of Sana'a, permitting them a foothold in Mocha, and when unable to secure their position, they extracted a similar agreement from the Sultan of Lahej , enabling them to consolidate a position in Aden. The British managed to occupy Aden and evicted the Sultan of Lahej from Aden and forced him to accept their "protection". In November 1839, 5,000 tribesmen tried to retake the town but were repulsed and 200 were killed. With emigrants from India, East Africa, and Southeast Asia, Aden grew into a world city. In 1850, only 980 Arabs were registered as original inhabitants of the city. The English presence in Aden put them at odds with the Ottomans. The Turks asserted to the British that they held sovereignty over the whole of Arabia, including Yemen as the successor of Mohammed and the Chief of the Universal Caliphate. The Ottomans were concerned about the British expansion from the British ruled subcontinent to the Red Sea and Arabia. They returned to the Tihamah in 1849 after an absence of two centuries. Rivalries and disturbances continued among the Zaydi imams, between them and their deputies, with the ulema , with the heads of tribes, as well as with those who belonged to other sects. Some citizens of Sana'a were desperate to return law and order to Yemen and asked the Ottoman Pasha in Tihamah to pacify the country. The opening of the Suez Canal in 1869 strengthened the Ottoman decision to remain in Yemen. By 1873, the Ottomans succeeded in conquering the northern highlands. Sana'a became the administrative capital of Yemen Vilayet . The Ottomans learned from their previous experience and worked on the disempowerment of local lords in the highland regions. They even attempted to secularize the Yemeni society, while Yemenite Jews came to perceive themselves in Yemeni nationalist terms. The Ottomans appeased the tribes by forgiving their rebellious chiefs and appointing them to administrative posts. They introduced a series of reforms to enhance the country's economic welfare. However, corruption was widespread in the Ottoman administration in Yemen. This was because only the worst of the officials were appointed because those who could avoid serving in Yemen did so. The Ottomans had reasserted control over the highlands for a temporary duration. The so-called Tanzimat reforms were considered heretic by the Zaydi tribes. In 1876, the Hashid and Bakil tribes rebelled against the Ottomans; the Turks had to appease them with gifts to end the uprising. The tribal chiefs were difficult to appease and an endless cycle of violence curbed Ottoman efforts to pacify the land. Ahmed Izzet Pasha proposed that the Ottoman army evacuate the highlands and confine itself to Tihamah, and not unnecessarily burden itself with continuing military operation against the Zaydi tribes. Imam Yahya Hamidaddin led a rebellion against the Turks in 1904; the rebels disrupted the Ottoman ability to govern. The revolts between 1904 and 1911 were especially damaging to the Ottomans, costing them as many as 10,000 soldiers and as much as 500,000 pounds per year. The Ottomans signed a treaty with imam Yahya Hamidaddin in 1911. Under the treaty, Imam Yahya was recognized as an autonomous leader of the Zaydi northern highlands. The Ottomans continued to rule Shafi'i areas in the mid-south until their departure in 1918.Imam Yahya hamid ed-Din al-Mutawakkil was ruling the northern highlands independently from 1911, from which he began a conquest of the Yemen lands. In 1925 Yahya captured al-Hudaydah from the Idrisids . In 1927, Yahya's forces were about 50 km (30 mi) away from Aden, Taiz, and Ibb, and were bombed by the British for five days; the imam had to pull back. Small Bedouin forces, mainly from the Madh'hij confederation of Marib , attacked Shabwah but were bombed by the British and had to retreat. The Italian Empire was the first to recognize Yahya as the king of Yemen in 1926. This created a great deal of anxiety for the British, who interpreted it as recognition of Imam Yahya's claim to sovereignty over Greater Yemen, which included the Aden protectorate and Asir. The Idrisis turned to Ibn Saud seeking his protection from Yahya. However, in 1932, the Idrisis broke their accord with Ibn Saud and went back to Yahya seeking help against Ibn Saud, who had begun liquidating their authority and expressed his desire to annex those territories into his own Saudi domain. Yahya demanded the return of all Idrisi dominion. Negotiations between Yahya and Ibn Saud proved fruitless. After the 1934 Saudi-Yemeni war, Ibn Saud announced a ceasefire in May 1934. Imam Yahya agreed to release Saudi hostages and the surrender of the Idrisis to Saudi custody. Imam Yahya ceded the three provinces of Najran, Asir, and Jazan for 20 years. and signed another treaty with the British government in 1934. The imam recognized the British sovereignty over Aden protectorate for 40 years. Out of fear for Hudaydah , Yahya did submit to these demands.Starting in 1890, hundreds of Yemeni people from Hajz, Al-Baetha, and Taiz migrated to Aden to work at ports, and as labourers. This helped the population of Aden once again become predominantly Arab after, having been declared a free zone, it had become mostly foreigners. During World War II, Aden had increasing economic growth and became the second-busiest port in the world after New York City . After the rise of labour unions, a rift was apparent between the sectors of workers and the first signs of resistance to the occupation started in 1943. Muhammad Ali Luqman founded the first Arabic club and school in Aden, and was the first to start working towards a union. The Colony of Aden was divided into an eastern colony and a western colony. Those were further divided into 23 sultanates and emirates, and several independent tribes that had no relationships with the sultanates. The deal between the sultanates and Britain detailed protection and complete control of foreign relations by the British. The Sultanate of Lahej was the only one in which the sultan was referred to as His Highness . The Federation of South Arabia was created by the British to counter Arab nationalism by giving more freedom to the rulers of the nations. The North Yemen Civil War inspired many in the south to rise against the British rule. The National Liberation Front (NLF) of Yemen was formed with the leadership of Qahtan Muhammad Al-Shaabi . The NLF hoped to destroy all the sultanates and eventually unite with the Yemen Arab Republic . Most of the support for the NLF came from Radfan and Yafa, so the British launched Operation Nutcracker, which completely burned Radfan in January 1964. Arab nationalism made an impact in some circles who opposed the lack of modernization efforts in the Mutawakkilite monarchy. This became apparent when Imam Ahmad bin Yahya died in 1962. He was succeeded by his son, but army officers attempted to seize power, sparking the North Yemen Civil War . The Hamidaddin royalists were supported by Saudi Arabia, Britain, and Jordan (mostly with weapons and financial aid, but also with small military forces), whilst the military rebels were backed by Egypt. Egypt provided the rebels with weapons and financial assistance, but also sent a large military force to participate in the fighting. Israel covertly supplied weapons to the royalists to keep the Egyptian military busy in Yemen and make Nasser less likely to initiate a conflict in the Sinai. After six years of civil war, the military rebels formed the Yemen Arab Republic . The revolution in the north coincided with the Aden Emergency , which hastened the end of British rule in the south. On 30 November 1967, the state of South Yemen was formed, comprising Aden and the former Protectorate of South Arabia. This socialist state was later officially known as the People's Democratic Republic of Yemen and a programme of nationalisation was begun. Relations between the two Yemeni states fluctuated between peaceful and hostile. The South was supported by the Eastern bloc. The North, however, was not able to get the same connections. In 1972, the two states fought a war. The war was resolved with a ceasefire and negotiations brokered by the Arab League , where it was declared that unification would eventually occur. In 1978, Ali Abdullah Saleh was named as president of the Yemen Arab Republic. After the war, the North complained about the South's help from foreign countries. This included Saudi Arabia. In 1979, fresh fighting between the two states resumed and efforts were renewed to bring about unification. Thousands were killed in 1986 in the South Yemen Civil War . President Ali Nasser Muhammad fled to the north and was later sentenced to death for treason. A new government formed. In 1990, the two governments reached a full agreement on the joint governing of Yemen, and the countries were merged on 22 May 1990, with Saleh as president. The president of South Yemen, Ali Salim al-Beidh , became vice president. A unified parliament was formed and a unity constitution was agreed upon. In the 1993 parliamentary election , the first held after unification, the General People's Congress won 122 of 301 seats. : 309 After the invasion of Kuwait crisis in 1990, Yemen's president opposed military intervention from non-Arab states. As a member of the United Nations Security Council for 1990 and 1991, Yemen abstained on a number of UNSC resolutions concerning Iraq and Kuwait and voted against the "...use of force resolution." The vote outraged the U.S., and Saudi Arabia expelled 800,000 Yemenis in 1990 and 1991 to punish Yemen for its opposition to the intervention. In the absence of strong state institutions, elite politics in Yemen constituted a de facto form of collaborative governance , where competing tribal, regional, religious, and political interests agreed to hold themselves in check through tacit acceptance of the balance it produced. The informal political settlement was held together by a power-sharing deal among three men: President Saleh, who controlled the state; major general Ali Mohsen al-Ahmar , who controlled the largest share of the Republic of Yemen Armed Forces ; and Abdullah ibn Husayn al-Ahmar , figurehead of the Islamist al-Islah party and Saudi Arabia's chosen broker of transnational patronage payments to various political players, including tribal sheikhs . The Saudi payments have been intended to facilitate the tribes' autonomy from the Yemeni government and to give the Saudi government a mechanism with which to weigh in on Yemen's political decision-making. Following food riots in major towns in 1992, a new coalition government made up of the ruling parties from both the former Yemeni states was formed in 1993. However, Vice President al-Beidh withdrew to Aden in August 1993 and said he would not return to the government until his grievances were addressed. These included northern violence against his Yemeni Socialist Party , as well as the economic marginalization of the south. Negotiations to end the political deadlock dragged on into 1994. The government of Prime Minister Haydar Abu Bakr Al-Attas became ineffective due to political infighting. An accord between northern and southern leaders was signed in Amman , Jordan on 20 February 1994, but this could not stop the civil war. During these tensions, both the northern and southern armies (which had never integrated) gathered on their respective frontiers. Ali Abdullah Saleh became Yemen's first directly elected president in the 1999 presidential election , winning 96% of the vote. : 310 The only other candidate, Najeeb Qahtan Al-Sha'abi , was the son of Qahtan Muhammad al-Sha'abi, a former president of South Yemen. Though a member of Saleh's General People's Congress (GPC) party, Najeeb ran as an independent. In October 2000, 17 U.S. personnel died after an al-Qaeda suicide attack on the U.S. naval vessel USS Cole in Aden . After the September 11 attacks on the United States, President Saleh assured U.S. President George W. Bush that Yemen was a partner in his War on Terror . In 2001, violence surrounded a referendum , which apparently supported extending Saleh's rule and powers. The Shia insurgency in Yemen began in June 2004 when dissident cleric Hussein Badreddin al-Houthi , head of the Zaidi Shia sect, launched an uprising against the Yemeni government. The Yemeni government alleged that the Houthis were seeking to overthrow it and to implement Shī'ite religious law . The rebels countered that they were "defending their community against discrimination" and government aggression. In 2005, at least 36 people were killed in clashes across the country between police and protesters over rising fuel prices. In the 2006 presidential election , Saleh won with 77% of the vote. His main rival, Faisal bin Shamlan , received 22%. Saleh was sworn in for another term on 27 September. A suicide bomber killed eight Spanish tourists and two Yemenis in the province of Marib in July 2007. A series of bomb attacks occurred on police, official, diplomatic, foreign business, and tourism targets in 2008. Car bombings outside the U.S. embassy in Sana'a killed 18 people, including six of the assailants in September 2008. In 2008, an opposition rally in Sana'a demanding electoral reform was met with police gunfire. There is a system of social stratification in Yemen that was officially abolished at the creation of the Republic of Yemen in 1962, but in practice this system has not disappeared and Yemeni society is still organized around hierarchical ranks. The difference between ranks is manifested by descent and occupation and is consolidated by marriages between people of the same ranks. There are five status groups. At the top of hierarchy, there are the religious elites, also called sada . These are then followed by the strata of judges ( quad ). The third hierarchical status is the qaba'il , who are the peasants who belong to tribes and who live mainly from agriculture and trading. The fourth group is called the mazayanah . This group is composed of people who had no land and provide different kinds of services such as butchers and craftsmen. Finally, at the bottom of the hierarchy are the slaves ( a'bid ) and even further below them Al-Akhdam , which means servants. In January 2009, the Saudi Arabian and Yemeni al-Qaeda branches merged to form Al-Qaeda in the Arabian Peninsula , which is based in Yemen, and many of its members were Saudi nationals who had been released from Guantanamo Bay detention camp . Saleh released 176 al-Qaeda suspects on condition of good behaviour, but terrorist activities continued. The Yemeni army launched a fresh offensive against the Shia insurgents in 2009, assisted by Saudi forces. Tens of thousands of people were displaced by the fighting. A ceasefire was agreed upon in February 2010. However, by the end of the year, Yemen claimed that 3,000 soldiers had been killed in renewed fighting. The Shia rebels accused Saudi Arabia of providing support to salafi groups to suppress Zaidism in Yemen. On orders from U.S. President Barack Obama , U.S. warplanes fired cruise missiles at what officials in Washington claimed were Al Qaeda training camps in the provinces of Sana'a and Abyan on 17 December 2009. Instead of hitting Al-Qaeda operatives, it hit a village, killing 55 civilians. Officials in Yemen said that the attacks claimed the lives of more than 60 civilians, 28 of them children. Another airstrike was carried out on 24 December. The U.S. launched a series of drone attacks in Yemen to curb a perceived growing terror threat due to political chaos in Yemen. Controversy over U.S. policy for drone attacks swelled after a September 2011 drone strike in Yemen killed Anwar al-Awlaki and Samir Khan , both U.S. citizens. Another drone strike in October 2011 killed Anwar's teenage son, Abdulrahman al-Awlaki . In 2010, the Obama administration policy allowed targeting of people whose names are not known. The U.S. government increased military aid to $140 million in 2010. U.S. drone strikes continued after the ousting of President Saleh. As of 2015 [ update ] , Shi'a Houthis are fighting against the Islamic State , Al Qaeda, and Saudi Arabia. The U.S. supports the Saudi-led military intervention in Yemen against the Houthis, but many in US SOCOM reportedly favor Houthis , as they have been an effective force to roll back al-Qaeda and recently ISIL in Yemen. The Guardian reported that "The only groups poised to benefit from the war dragging on are the jihadis of Islamic State (ISIL) and Al-Qaeda in the Arabian Peninsula (AQAP), the latter's most powerful franchise, who are likely to gain influence amid the chaos. ISIL has claimed recent, bloody suicide bombings in Houthi mosques and Sana'a when it once had no known presence in the country, while AQAP has continued to seize territory in eastern Yemen unhindered by American drone strikes." In February 2016 Al-Qaeda forces and Saudi-led coalition forces were both seen fighting Houthi rebels in the same battle. There is a system of social stratification in Yemen that was officially abolished at the creation of the Republic of Yemen in 1962, but in practice this system has not disappeared and Yemeni society is still organized around hierarchical ranks. The difference between ranks is manifested by descent and occupation and is consolidated by marriages between people of the same ranks. There are five status groups. At the top of hierarchy, there are the religious elites, also called sada . These are then followed by the strata of judges ( quad ). The third hierarchical status is the qaba'il , who are the peasants who belong to tribes and who live mainly from agriculture and trading. The fourth group is called the mazayanah . This group is composed of people who had no land and provide different kinds of services such as butchers and craftsmen. Finally, at the bottom of the hierarchy are the slaves ( a'bid ) and even further below them Al-Akhdam , which means servants. In January 2009, the Saudi Arabian and Yemeni al-Qaeda branches merged to form Al-Qaeda in the Arabian Peninsula , which is based in Yemen, and many of its members were Saudi nationals who had been released from Guantanamo Bay detention camp . Saleh released 176 al-Qaeda suspects on condition of good behaviour, but terrorist activities continued. The Yemeni army launched a fresh offensive against the Shia insurgents in 2009, assisted by Saudi forces. Tens of thousands of people were displaced by the fighting. A ceasefire was agreed upon in February 2010. However, by the end of the year, Yemen claimed that 3,000 soldiers had been killed in renewed fighting. The Shia rebels accused Saudi Arabia of providing support to salafi groups to suppress Zaidism in Yemen. On orders from U.S. President Barack Obama , U.S. warplanes fired cruise missiles at what officials in Washington claimed were Al Qaeda training camps in the provinces of Sana'a and Abyan on 17 December 2009. Instead of hitting Al-Qaeda operatives, it hit a village, killing 55 civilians. Officials in Yemen said that the attacks claimed the lives of more than 60 civilians, 28 of them children. Another airstrike was carried out on 24 December. The U.S. launched a series of drone attacks in Yemen to curb a perceived growing terror threat due to political chaos in Yemen. Controversy over U.S. policy for drone attacks swelled after a September 2011 drone strike in Yemen killed Anwar al-Awlaki and Samir Khan , both U.S. citizens. Another drone strike in October 2011 killed Anwar's teenage son, Abdulrahman al-Awlaki . In 2010, the Obama administration policy allowed targeting of people whose names are not known. The U.S. government increased military aid to $140 million in 2010. U.S. drone strikes continued after the ousting of President Saleh. As of 2015 [ update ] , Shi'a Houthis are fighting against the Islamic State , Al Qaeda, and Saudi Arabia. The U.S. supports the Saudi-led military intervention in Yemen against the Houthis, but many in US SOCOM reportedly favor Houthis , as they have been an effective force to roll back al-Qaeda and recently ISIL in Yemen. The Guardian reported that "The only groups poised to benefit from the war dragging on are the jihadis of Islamic State (ISIL) and Al-Qaeda in the Arabian Peninsula (AQAP), the latter's most powerful franchise, who are likely to gain influence amid the chaos. ISIL has claimed recent, bloody suicide bombings in Houthi mosques and Sana'a when it once had no known presence in the country, while AQAP has continued to seize territory in eastern Yemen unhindered by American drone strikes." In February 2016 Al-Qaeda forces and Saudi-led coalition forces were both seen fighting Houthi rebels in the same battle. The 2011 Yemeni revolution followed other Arab Spring mass protests in early 2011. The uprising was initially against unemployment, economic conditions, and corruption, as well as against the government's proposals to modify the constitution of Yemen so that Saleh's son could inherit the presidency. In March 2011, police snipers opened fire on a pro-democracy camp in Sana'a, killing more than 50 people. In May, dozens were killed in clashes between troops and tribal fighters in Sana'a. By this point, Saleh began to lose international support. In October 2011, Yemeni human rights activist Tawakul Karman won the Nobel Peace Prize , and the UN Security Council condemned the violence and called for a transfer of power. On 23 November 2011, Saleh flew to Riyadh , in neighbouring Saudi Arabia, to sign the Gulf Co-operation Council plan for political transition, which he had previously spurned. Upon signing the document, he agreed to legally transfer the office and powers of the presidency to his deputy, Vice President Abdrabbuh Mansur Hadi . Hadi took office for a two-year term upon winning the uncontested presidential elections in February 2012. A unity government—including a prime minister from the opposition—was formed. Al-Hadi would oversee the drafting of a new constitution, followed by parliamentary and presidential elections in 2014. Saleh returned in February 2012. In the face of objections from thousands of street protesters, parliament granted him full immunity from prosecution. Saleh's son, General Ahmed Ali Abdullah Saleh , continues to exercise a strong hold on sections of the military and security forces. AQAP claimed responsibility for a February 2012 suicide attack on the presidential palace that killed 26 Republican Guards on the day that President Hadi was sworn in. AQAP was also behind a suicide bombing that killed 96 soldiers in Sana'a three months later. In September 2012, a car bomb attack in Sana'a killed 11 people, a day after a local al-Qaeda leader Said al-Shihri was reported killed in the south. By 2012, there was a "small contingent of U.S. special-operations troops"—in addition to CIA and "unofficially acknowledged" U.S. military presence—in response to increasing terror attacks by AQAP on Yemeni citizens. Many analysts have pointed out the former Yemeni government role in cultivating terrorist activity in the country. Following the election of President Abdrabbuh Mansur Hadi , the Yemeni military was able to push Ansar al-Sharia back and recapture the Shabwah Governorate . The central government in Sana'a remained weak, staving off challenges from southern separatists and Houthis as well as AQAP. The Shia insurgency intensified after Hadi took power, escalating in September 2014 as anti-government forces led by Abdul-Malik al-Houthi swept into the capital and forced Hadi to agree to a "unity" government. The Houthis then refused to participate in the government, although they continued to apply pressure on Hadi and his ministers, even shelling the president's private residence and placing him under house arrest, until the government's mass resignation in January 2015. The following month, the Houthis dissolved parliament and declared that a Revolutionary Committee under Mohammed Ali al-Houthi was the interim authority in Yemen. Abdul-Malik al-Houthi, a cousin of the acting president, called the takeover a "glorious revolution". However, the "constitutional declaration" of 6 February 2015 was widely rejected by opposition politicians and foreign governments, including the United Nations . Hadi managed to flee from Sana'a to Aden, his hometown and stronghold in the south, on 21 February 2015. He promptly gave a televised speech rescinding his resignation, condemning the coup, and calling for recognition as the constitutional president of Yemen. The following month, Hadi declared Aden Yemen's "temporary" capital. The Houthis, however, rebuffed an initiative by the Gulf Cooperation Council and continued to move south toward Aden. All U.S. personnel were evacuated, and President Hadi was forced to flee the country to Saudi Arabia. On 26 March 2015, Saudi Arabia announced Operation Decisive Storm and began airstrikes and announced its intentions to lead a military coalition against the Houthis, whom they claimed were being aided by Iran and began a force buildup along the Yemeni border. The coalition included the United Arab Emirates , Kuwait , Qatar , Bahrain , Jordan , Morocco , Sudan , Egypt , and Pakistan . The United States announced that it was assisting with intelligence, targeting, and logistics. After Hadi troops took control of Aden from Houthis, jihadist groups became active in the city, and some terrorist incidents were linked to them such as Missionaries of Charity attack in Aden on 4 March 2016. In February 2018, Aden was seized by the UAE-backed separatist Southern Transitional Council . Yemen has been suffering from a famine since 2016 as a result of the civil war. More than 50,000 children in Yemen died from starvation in 2017. Numerous commentators have condemned the Saudi-led coalition's military campaign, including its blockade of Yemen , as genocide . The famine is being compounded by an outbreak of cholera that has affected more than one million people. The Saudi Arabian-led intervention in Yemen and blockade of Yemen have contributed to the famine and cholera epidemic. The UN estimated that by the end of 2021, the war in Yemen would have caused over 377,000 deaths, and roughly 70% of deaths were children under age 5. On 4 December 2017, deposed strongman and former president Ali Abdullah Saleh , accused of treason, was assassinated by Houthis whilst attempting to flee clashes near rebel-held Sana'a between Houthi and pro-Saleh forces. After losing the support of the Saudi-led coalition, Yemen's President Abd Rabbuh Mansur Hadi resigned, and the Presidential Leadership Council took power in April 2022. Following the outbreak of the 2023 Israel–Hamas war , the Houthis began to fire missiles at Israel and attack ships off Yemen's coast in the Red Sea, which they say is in solidarity with the Palestinians and aiming to facilitate entry of humanitarian aid into the Gaza Strip . Yemen covers 530,000 km 2 (204,634 sq mi) and is located at the southern part of the Arabian Peninsula. It is bordered by Saudi Arabia to the north , the Red Sea to the west, the Gulf of Aden and Guardafui Channel to the south, and Oman to the east . Several Red Sea islands, including the Hanish Islands , Kamaran , and Perim , as well as Socotra in the Arabian Sea , belong to Yemen; the largest of these is Socotra. Many of the islands are volcanic; Jabal al-Tair Island had volcanic eruptions in 1883 and 2007. Although mainland Yemen is in the southern Arabian Peninsula and thus part of Asia, and its Hanish Islands and Perim in the Red Sea are associated with Asia, the archipelago of Socotra, which lies east of the horn of Somalia and is much closer to Africa than to Asia, is geographically and biogeographically associated with Africa. Yemen can be divided geographically into four main regions: the coastal plains in the west, the western highlands, the eastern highlands, and the Rub' al Khali in the east. The Tihamah ("hot lands" or "hot earth") form a very arid and flat coastal plain along Yemen's entire Red Sea coastline. Despite the aridity, the presence of many lagoons makes this region very marshy and a suitable breeding ground for malaria -borne mosquitos. Extensive crescent-shaped sand dunes are present. The evaporation in the Tihamah is so great that streams from the highlands never reach the sea, but they do contribute to extensive groundwater reserves. Today, these are heavily exploited for agricultural use. Near the village of Madar about 50 km (30 mi) north of Sana'a, dinosaur footprints were found, indicating that the area was once a muddy flat. The Tihamah ends abruptly at the escarpment of the western highlands. This area, now heavily terraced to meet the demand for food, receives the highest rainfall in Arabia, rapidly increasing from 100 mm (3.9 in) per year to about 760 mm (29.9 in) in Taiz and over 1,000 mm (39.4 in) in Ibb. Temperatures are warm in the day but fall dramatically at night. The central highlands are an extensive high plateau over 2,000 m (6,562 ft) in elevation. This area is drier than the western highlands because of rain-shadow influences, but still receives sufficient rain in wet years for extensive cropping. Water storage allows for irrigation and the growing of wheat and barley . Sana'a is in this region. The highest point in Yemen and Arabia is Jabal An-Nabi Shu'ayb , at about 3,666 m (12,028 ft) . Yemen's portion of the Rub al Khali desert in the east is much lower, generally below 1,000 m (3,281 ft) , and receives almost no rain. It is populated only by Bedouin herders of camels . Yemen contains six terrestrial ecoregions: Arabian Peninsula coastal fog desert , Socotra Island xeric shrublands , Southwestern Arabian foothills savanna , Southwestern Arabian montane woodlands , Arabian Desert , and Red Sea Nubo-Sindian tropical desert and semi-desert . The flora is a mixture of the tropical African, Sudanian plant geographical region and the Saharo-Arabian region. The Sudanian element—characterized by relatively high rainfall—dominates the western mountains and parts of the highland plains. The Saharo-Arabian element dominates in the coastal plains, eastern mountain, and the eastern and northern desert plains. A high percentage of Yemen plants belong to tropical African plants of Sudanian regions. Among the Sudanian element species, the following may be mentioned: Ficus spp., Acacia mellifera , Grewia villosa , Commiphora spp., Rosa abyssinica , Cadaba farinosa and others. Among the Saharo-Arabian species, these may be mentioned: Panicum turgidum , Aerva javanica , Zygophyllum simplex, Fagonia indica, Salsola spp., Acacia tortilis , A. hamulos, A. ehrenbergiana , Phoenix dactylifera , Hyphaene thebaica , Capparis decidua , Salvadora persica , Balanites aegyptiaca , and many others. Many of the Saharo-Arabian species are endemic to the extensive sandy coastal plain (the Tihamah). Among the fauna, the Arabian leopard , which would inhabit the mountains, is considered rare here. Yemen can be divided geographically into four main regions: the coastal plains in the west, the western highlands, the eastern highlands, and the Rub' al Khali in the east. The Tihamah ("hot lands" or "hot earth") form a very arid and flat coastal plain along Yemen's entire Red Sea coastline. Despite the aridity, the presence of many lagoons makes this region very marshy and a suitable breeding ground for malaria -borne mosquitos. Extensive crescent-shaped sand dunes are present. The evaporation in the Tihamah is so great that streams from the highlands never reach the sea, but they do contribute to extensive groundwater reserves. Today, these are heavily exploited for agricultural use. Near the village of Madar about 50 km (30 mi) north of Sana'a, dinosaur footprints were found, indicating that the area was once a muddy flat. The Tihamah ends abruptly at the escarpment of the western highlands. This area, now heavily terraced to meet the demand for food, receives the highest rainfall in Arabia, rapidly increasing from 100 mm (3.9 in) per year to about 760 mm (29.9 in) in Taiz and over 1,000 mm (39.4 in) in Ibb. Temperatures are warm in the day but fall dramatically at night. The central highlands are an extensive high plateau over 2,000 m (6,562 ft) in elevation. This area is drier than the western highlands because of rain-shadow influences, but still receives sufficient rain in wet years for extensive cropping. Water storage allows for irrigation and the growing of wheat and barley . Sana'a is in this region. The highest point in Yemen and Arabia is Jabal An-Nabi Shu'ayb , at about 3,666 m (12,028 ft) . Yemen's portion of the Rub al Khali desert in the east is much lower, generally below 1,000 m (3,281 ft) , and receives almost no rain. It is populated only by Bedouin herders of camels .Yemen contains six terrestrial ecoregions: Arabian Peninsula coastal fog desert , Socotra Island xeric shrublands , Southwestern Arabian foothills savanna , Southwestern Arabian montane woodlands , Arabian Desert , and Red Sea Nubo-Sindian tropical desert and semi-desert . The flora is a mixture of the tropical African, Sudanian plant geographical region and the Saharo-Arabian region. The Sudanian element—characterized by relatively high rainfall—dominates the western mountains and parts of the highland plains. The Saharo-Arabian element dominates in the coastal plains, eastern mountain, and the eastern and northern desert plains. A high percentage of Yemen plants belong to tropical African plants of Sudanian regions. Among the Sudanian element species, the following may be mentioned: Ficus spp., Acacia mellifera , Grewia villosa , Commiphora spp., Rosa abyssinica , Cadaba farinosa and others. Among the Saharo-Arabian species, these may be mentioned: Panicum turgidum , Aerva javanica , Zygophyllum simplex, Fagonia indica, Salsola spp., Acacia tortilis , A. hamulos, A. ehrenbergiana , Phoenix dactylifera , Hyphaene thebaica , Capparis decidua , Salvadora persica , Balanites aegyptiaca , and many others. Many of the Saharo-Arabian species are endemic to the extensive sandy coastal plain (the Tihamah). Among the fauna, the Arabian leopard , which would inhabit the mountains, is considered rare here. Yemen is a republic with a bicameral legislature. Under the 1991 constitution, an elected president, an elected 301-seat Assembly of Representatives , and an appointed 111-member Shura Council share power. The president is the head of state , and the prime minister is the head of government . In Sana'a, a Supreme Political Council (not recognized internationally) forms the government. The 1991 constitution provides that the president be elected by popular vote from at least two candidates endorsed by at least 15 members of the Parliament. The prime minister, in turn, is appointed by the president and must be approved by two-thirds of the Parliament. The presidential term of office is seven years, and the parliamentary term of elected office is six years. Suffrage is universal for people aged 18 and older, but only Muslims may hold elected office. President Ali Abdullah Saleh became the first elected president in reunified Yemen in 1999 (though he had been president of unified Yemen since 1990 and president of North Yemen since 1978). He was re-elected to office in September 2006. Saleh's victory was marked by an election that international observers judged was "partly free", though the election was accompanied by violence, violations of press freedoms, and allegations of fraud. Parliamentary elections were held in April 2003, and the General People's Congress maintained an absolute majority. Saleh remained almost uncontested in his seat of power until 2011, when local frustration at his refusal to hold another round of elections, as combined with the impact of the 2011 Arab Spring, resulted in mass protests. In 2012, he was forced to resign from power, though he remained an important factor in Yemeni politics, allying with the Houthis during their takeover in the mid-2010s. The constitution calls for an independent judiciary. The former northern and southern legal codes have been unified. The legal system includes separate commercial courts and a Supreme Court based in Sana'a. Sharia is the main source of laws, with many court cases being debated according to the religious basis of law and many judges being religious scholars as well as legal authorities. The Prison Authority Organization Act, Republican decree no. 48 (1981), and Prison Act regulations, provide the legal framework for management of the country's prison system. Yemen is a member of the United Nations, the Arab League , and the Organisation of Islamic Cooperation , and also participates in the nonaligned movement . Yemen has acceded to the Treaty on the Non-Proliferation of Nuclear Weapons . Since the end of the 1994 civil war, tangible progress has been made on the diplomatic front in restoring normal relations with Yemen's neighbors. In the summer of 2000, Yemen and Saudi Arabia signed an International Border Treaty settling a 50-year-old dispute over the location of the border between the two countries. Yemen's northern border had been undefined; the Arabian Desert prevented any human habitation there. The Saudi – Yemen barrier was constructed by Saudi Arabia against an influx of illegal immigrants and against the smuggling of drugs and weapons. The Independent headed an article with "Saudi Arabia, one of the most vocal critics in the Arab world of Israel's "security fence" in the West Bank , is quietly emulating the Israeli example by erecting a barrier along its porous border with Yemen." [ unreliable source? ] In March 2020, the Trump administration and key U.S. allies, including Saudi Arabia and the United Arab Emirates, cut off tens of millions of dollars for health care programs and other aid to the United Nations' appeal for Yemen. As a result of funding cuts, the United Nations Office for the Coordination of Humanitarian Affairs stated that the UN agencies were forced to either close or reduce more than 75 per cent of its programs that year alone, affecting more than 8 million people. Saudi Arabia had been leading a Western-backed military coalition, including the United Arab Emirates as a key member, which intervened in Yemen in 2015, in a bid to restore the government ousted from power by the Houthi movement. The United Nations described the situation in Yemen, where the war killed tens of thousands of people and left millions on the brink of famine, as the world's worst humanitarian crisis. In January 2024, President Joe Biden announced that the United States, Britain and allies Australia, Bahrain, Canada and the Netherlands had launched a military assault on Houthi militant targets in Yemen. The armed forces of Yemen include the Yemen Army (includes Republican Guard ), Navy (includes Marines), Yemeni Air Force (Al Quwwat al Jawwiya al Yamaniya; includes Air Defense Force). A major reorganization of the armed forces continues. The unified air forces and air defenses are now under one command. The navy has concentration in Aden. Total armed forces manning numbers about 401,000 active personnel, including moreover especially conscripts. The number of military personnel is relatively high; in sum, Yemen has the second largest military force on the Arabian Peninsula after Saudi Arabia. In 2012, total active troops were estimated as follows: army, 390,000; navy, 7,000; and air force, 5,000. In September 2007, the government announced the reinstatement of compulsory military service. Yemen's defense budget, which in 2006 represented approximately 40 percent of the total government budget, is expected to remain high for the near term, as the military draft takes effect and internal security threats continue to escalate. By 2012, Yemen had 401,000 active personnel. Corruption in Yemen is such that it ranked 176 out of 180 countries in the 2022 Corruption Perceptions Index . The government and its security forces have been responsible for torture, inhumane treatment, and extrajudicial executions. There are arbitrary arrests of citizens, especially in the south, as well as arbitrary searches of homes. Prolonged pretrial detention is a serious problem, and judicial corruption, inefficiency, and executive interference undermine due process. Freedom of speech, the press, and religion are all restricted. Journalists critical of the government are often harassed and threatened by the police. Homosexuality is illegal, punishable by death. Yemen is ranked last of 135 countries in the 2012 Global Gender Gap Report . Human Rights Watch reported on discrimination and violence against women as well as on the abolition of the minimum marriage age of 15 for women. The onset of puberty (interpreted by some to be as low as the age of nine) was set as a requirement for marriage instead. Publicity about the case of ten-year-old Yemeni divorcee Nujood Ali brought the child marriage issue to the forefront worldwide. In 2017, the UN Human Rights Council voted to create a team of experts to investigate suspected breaches of humanitarian law and human rights in Yemen. In December 2021, The Guardian revealed, Saudi Arabia used "incentives and threats" as part of a pressure campaign to end a UN inquiry into human rights infringements in Yemen. In June 2020, a human rights group revealed the scale of torture and deaths in Yemen's unofficial detention centres. UAE and Saudi forces were responsible for some of the most shocking treatment of prisoners, including being hung upside down for hours and sexual torture such as the burning of genitals. According to 2020 United Nations Population Fund (UNFPA) estimates, 6.1 million girls and women were in need of gender-based violence services. The UNFPA also reported a rise in gender-based violence cases amid COVID-19 pandemic, increase in rate of child marriages, most acutely among internally displaced persons (IDPs). One in five girls aged 10 to 19 were married in IDP camps, compared to 1 in 8 in host communities. The United States Department of State 2013 Trafficking in Persons report classified Yemen as a Tier 3 country, meaning that its government does not fully comply with the minimum standards against human trafficking and is not making significant efforts to do so. Yemen officially abolished slavery in Yemen in 1962, but it is still being practiced. On 22 June 2020, Human Rights Watch wrote an open letter to the UN Secretary-General on "Children and Armed Conflict" report to improve the protection of children in Yemen and in Myanmar . Amnesty said, United Nations Security Council must urgently fix its monitoring and reporting mechanism for children impacted by armed conflict. On 14 September 2020, Human Rights Watch demanded an end to the interference caused by Houthi rebels and other authorities in Yemen aid operations, as millions of lives dependent on the aid operations were being put at risk. Yemen is divided into twenty governorates ( muhafazat – the latest being Raymah Governorate, which was created during 2004) plus one municipality called "Amanat Al-Asemah" (the latter containing the constitutional capital, Sana'a). An additional governorate ( Soqatra Governorate ) was created in December 2013 comprising Socotra Island, previously part of Hadramaut Governorate. The governorates are subdivided into 333 districts ( muderiah ), which are subdivided into 2,210 sub-districts, and then into 38,284 villages (as of 2001). In 2014, a constitutional panel decided to divide the country into six regions—four in the north, two in the south, and capital Sana'a outside of any region—creating a federalist model of governance. This federal proposal was a contributing factor toward the Houthis' subsequent coup d'état against the government. Yemen is a member of the United Nations, the Arab League , and the Organisation of Islamic Cooperation , and also participates in the nonaligned movement . Yemen has acceded to the Treaty on the Non-Proliferation of Nuclear Weapons . Since the end of the 1994 civil war, tangible progress has been made on the diplomatic front in restoring normal relations with Yemen's neighbors. In the summer of 2000, Yemen and Saudi Arabia signed an International Border Treaty settling a 50-year-old dispute over the location of the border between the two countries. Yemen's northern border had been undefined; the Arabian Desert prevented any human habitation there. The Saudi – Yemen barrier was constructed by Saudi Arabia against an influx of illegal immigrants and against the smuggling of drugs and weapons. The Independent headed an article with "Saudi Arabia, one of the most vocal critics in the Arab world of Israel's "security fence" in the West Bank , is quietly emulating the Israeli example by erecting a barrier along its porous border with Yemen." [ unreliable source? ] In March 2020, the Trump administration and key U.S. allies, including Saudi Arabia and the United Arab Emirates, cut off tens of millions of dollars for health care programs and other aid to the United Nations' appeal for Yemen. As a result of funding cuts, the United Nations Office for the Coordination of Humanitarian Affairs stated that the UN agencies were forced to either close or reduce more than 75 per cent of its programs that year alone, affecting more than 8 million people. Saudi Arabia had been leading a Western-backed military coalition, including the United Arab Emirates as a key member, which intervened in Yemen in 2015, in a bid to restore the government ousted from power by the Houthi movement. The United Nations described the situation in Yemen, where the war killed tens of thousands of people and left millions on the brink of famine, as the world's worst humanitarian crisis. In January 2024, President Joe Biden announced that the United States, Britain and allies Australia, Bahrain, Canada and the Netherlands had launched a military assault on Houthi militant targets in Yemen. The armed forces of Yemen include the Yemen Army (includes Republican Guard ), Navy (includes Marines), Yemeni Air Force (Al Quwwat al Jawwiya al Yamaniya; includes Air Defense Force). A major reorganization of the armed forces continues. The unified air forces and air defenses are now under one command. The navy has concentration in Aden. Total armed forces manning numbers about 401,000 active personnel, including moreover especially conscripts. The number of military personnel is relatively high; in sum, Yemen has the second largest military force on the Arabian Peninsula after Saudi Arabia. In 2012, total active troops were estimated as follows: army, 390,000; navy, 7,000; and air force, 5,000. In September 2007, the government announced the reinstatement of compulsory military service. Yemen's defense budget, which in 2006 represented approximately 40 percent of the total government budget, is expected to remain high for the near term, as the military draft takes effect and internal security threats continue to escalate. By 2012, Yemen had 401,000 active personnel.Corruption in Yemen is such that it ranked 176 out of 180 countries in the 2022 Corruption Perceptions Index . The government and its security forces have been responsible for torture, inhumane treatment, and extrajudicial executions. There are arbitrary arrests of citizens, especially in the south, as well as arbitrary searches of homes. Prolonged pretrial detention is a serious problem, and judicial corruption, inefficiency, and executive interference undermine due process. Freedom of speech, the press, and religion are all restricted. Journalists critical of the government are often harassed and threatened by the police. Homosexuality is illegal, punishable by death. Yemen is ranked last of 135 countries in the 2012 Global Gender Gap Report . Human Rights Watch reported on discrimination and violence against women as well as on the abolition of the minimum marriage age of 15 for women. The onset of puberty (interpreted by some to be as low as the age of nine) was set as a requirement for marriage instead. Publicity about the case of ten-year-old Yemeni divorcee Nujood Ali brought the child marriage issue to the forefront worldwide. In 2017, the UN Human Rights Council voted to create a team of experts to investigate suspected breaches of humanitarian law and human rights in Yemen. In December 2021, The Guardian revealed, Saudi Arabia used "incentives and threats" as part of a pressure campaign to end a UN inquiry into human rights infringements in Yemen. In June 2020, a human rights group revealed the scale of torture and deaths in Yemen's unofficial detention centres. UAE and Saudi forces were responsible for some of the most shocking treatment of prisoners, including being hung upside down for hours and sexual torture such as the burning of genitals. According to 2020 United Nations Population Fund (UNFPA) estimates, 6.1 million girls and women were in need of gender-based violence services. The UNFPA also reported a rise in gender-based violence cases amid COVID-19 pandemic, increase in rate of child marriages, most acutely among internally displaced persons (IDPs). One in five girls aged 10 to 19 were married in IDP camps, compared to 1 in 8 in host communities. The United States Department of State 2013 Trafficking in Persons report classified Yemen as a Tier 3 country, meaning that its government does not fully comply with the minimum standards against human trafficking and is not making significant efforts to do so. Yemen officially abolished slavery in Yemen in 1962, but it is still being practiced. On 22 June 2020, Human Rights Watch wrote an open letter to the UN Secretary-General on "Children and Armed Conflict" report to improve the protection of children in Yemen and in Myanmar . Amnesty said, United Nations Security Council must urgently fix its monitoring and reporting mechanism for children impacted by armed conflict. On 14 September 2020, Human Rights Watch demanded an end to the interference caused by Houthi rebels and other authorities in Yemen aid operations, as millions of lives dependent on the aid operations were being put at risk. Yemen is divided into twenty governorates ( muhafazat – the latest being Raymah Governorate, which was created during 2004) plus one municipality called "Amanat Al-Asemah" (the latter containing the constitutional capital, Sana'a). An additional governorate ( Soqatra Governorate ) was created in December 2013 comprising Socotra Island, previously part of Hadramaut Governorate. The governorates are subdivided into 333 districts ( muderiah ), which are subdivided into 2,210 sub-districts, and then into 38,284 villages (as of 2001). In 2014, a constitutional panel decided to divide the country into six regions—four in the north, two in the south, and capital Sana'a outside of any region—creating a federalist model of governance. This federal proposal was a contributing factor toward the Houthis' subsequent coup d'état against the government. Since its unification in 1990, Yemen has been one of the poorest countries in the Middle East. As of 2013 [ update ] Yemen had a GDP (PPP) of US$61.63 billion, with an income per capita of $2,500. Services are the largest economic sector (61.4% of GDP), followed by the industrial sector (30.9%), and agriculture (7.7%). Of these, petroleum production represents around 25% of GDP and 63% of the government's revenue. After the start of the civil war in 2014, its GDP dropped rapidly by over 50%, thanks to the blockade led by Saudi Arabia and an effective embargo on oil exports imposed by the Houthis. Principal agricultural commodities produced include grain, vegetables, fruits, pulses , qat , coffee , cotton, dairy products, fish, livestock (sheep, goats, cattle, camels), and poultry. Most Yemenis are employed in agriculture. However, the role of agricultural sector is limited by the relatively low share of the sector in GDP and the large share of net food-buying households (97%). Sorghum is the most common crop. Cotton and many fruit trees are also grown, with mangoes being the most valuable. A big problem in Yemen is the cultivation of Khat (or qat), a psychoactive plant that releases a stimulant when chewed, and accounts for up to 40 percent of the water drawn from the Sana'a Basin each year, and that figure is rising. Some agricultural practices are drying the Sana'a Basin and displaced vital crops, which has resulted in increasing food prices . Rising food prices, in turn, pushed an additional six percent of the country into poverty in 2008 alone, and led to food riots starting in 2008 in poorer cities. Efforts are being made by the government and Dawoodi Bohra community at northern governorates to replace qat with coffee plantations. The industrial sector is centred on crude oil production and petroleum refining, food processing, handicrafts, small-scale production of cotton textiles and leather goods, aluminum products, commercial ship repair, cement, and natural gas production. In 2013, Yemen had an industrial production growth rate of 4.8%. It also has large proven reserves of natural gas. Yemen's first liquified natural gas plant began production in October 2009. In 2013, exports totaled $6.694 billion. The main export commodities are crude oil, coffee, dried and salted fish, liquefied natural gas. These products were mainly sent to China (41%), Thailand (19.2%), India (11.4%), and South Korea (4.4%). Imports totaled $10.97 billion. The main imported commodities are machinery and equipment, foodstuffs, livestock, and chemicals. These products were mainly imported from the EU (48.8%), UAE (9.8%), Switzerland (8.8%), China (7.4%), and India (5.8%). As of 2013 [ update ] , the government's budget consisted of $7.769 billion in revenues and $12.31 billion in expenditures. Taxes and other revenues constituted roughly 17.7% of the GDP, with a budget deficit of 10.3%. The public debt was 47.1% of GDP. Yemen had reserves of foreign exchange and gold of around $5.538 billion in 2013. Its inflation rate over the same period based on consumer prices was 11.8%. The external debt totaled $7.806 billion. A key challenge is severe water scarcity , especially in the Highlands, prompting The Times , in 2009, to write "Yemen could become first nation to run out of water." A second key challenge is a high level of poverty, making it difficult to recover the costs of service provision. Access to water supply sanitation is low. Yemen is both the poorest country and the most water-scarce country in the Arab world . Third, the capacity of sector institutions to plan, build, operate and maintain infrastructure remains limited. Last but not least the security situation makes it even more difficult to improve or even maintain existing levels of service. The average Yemeni has access to only 140 cubic meters of water per year (101 gallons per day) for all uses, while the Middle Eastern average is 1,000 m 3 /yr, and the internationally defined threshold for water stress is 1,700 cubic meters per year. Groundwater is the main source of water in the country, but the water tables have dropped severely leaving Yemen without a viable source of water. For example, in Sana'a, the water table was 30 metres (98 feet) below surface in the 1970s but had dropped to 1,200 metres (3,900 feet) below the surface by 2012. The groundwater has not been regulated by Yemen's governments. Even before the revolution, Yemen's water situation had been described as increasingly dire by experts who worried that Yemen would be the first country to run out of water. In part due to the 2015 Yemeni civil war, the infrastructure required to build better access to water has been delayed in construction. It is estimated that as many as 80% of the population struggles to access water to drink and bathe. Bombing has forced many Yemenis to leave their homes for other areas, leaving wells in the new areas under increasing demands. Together with partners, UNICEF has advanced its efforts and provided access to safe and sustained drinking water to 8.8 million people (5.3 million children). It scaled up its emergency WASH assistance in Yemen to ensure sustainable WASH services through capacity building of local WASH authorities, solarisation of water systems and rainwater harvesting. Principal agricultural commodities produced include grain, vegetables, fruits, pulses , qat , coffee , cotton, dairy products, fish, livestock (sheep, goats, cattle, camels), and poultry. Most Yemenis are employed in agriculture. However, the role of agricultural sector is limited by the relatively low share of the sector in GDP and the large share of net food-buying households (97%). Sorghum is the most common crop. Cotton and many fruit trees are also grown, with mangoes being the most valuable. A big problem in Yemen is the cultivation of Khat (or qat), a psychoactive plant that releases a stimulant when chewed, and accounts for up to 40 percent of the water drawn from the Sana'a Basin each year, and that figure is rising. Some agricultural practices are drying the Sana'a Basin and displaced vital crops, which has resulted in increasing food prices . Rising food prices, in turn, pushed an additional six percent of the country into poverty in 2008 alone, and led to food riots starting in 2008 in poorer cities. Efforts are being made by the government and Dawoodi Bohra community at northern governorates to replace qat with coffee plantations. The industrial sector is centred on crude oil production and petroleum refining, food processing, handicrafts, small-scale production of cotton textiles and leather goods, aluminum products, commercial ship repair, cement, and natural gas production. In 2013, Yemen had an industrial production growth rate of 4.8%. It also has large proven reserves of natural gas. Yemen's first liquified natural gas plant began production in October 2009.In 2013, exports totaled $6.694 billion. The main export commodities are crude oil, coffee, dried and salted fish, liquefied natural gas. These products were mainly sent to China (41%), Thailand (19.2%), India (11.4%), and South Korea (4.4%). Imports totaled $10.97 billion. The main imported commodities are machinery and equipment, foodstuffs, livestock, and chemicals. These products were mainly imported from the EU (48.8%), UAE (9.8%), Switzerland (8.8%), China (7.4%), and India (5.8%). As of 2013 [ update ] , the government's budget consisted of $7.769 billion in revenues and $12.31 billion in expenditures. Taxes and other revenues constituted roughly 17.7% of the GDP, with a budget deficit of 10.3%. The public debt was 47.1% of GDP. Yemen had reserves of foreign exchange and gold of around $5.538 billion in 2013. Its inflation rate over the same period based on consumer prices was 11.8%. The external debt totaled $7.806 billion. A key challenge is severe water scarcity , especially in the Highlands, prompting The Times , in 2009, to write "Yemen could become first nation to run out of water." A second key challenge is a high level of poverty, making it difficult to recover the costs of service provision. Access to water supply sanitation is low. Yemen is both the poorest country and the most water-scarce country in the Arab world . Third, the capacity of sector institutions to plan, build, operate and maintain infrastructure remains limited. Last but not least the security situation makes it even more difficult to improve or even maintain existing levels of service. The average Yemeni has access to only 140 cubic meters of water per year (101 gallons per day) for all uses, while the Middle Eastern average is 1,000 m 3 /yr, and the internationally defined threshold for water stress is 1,700 cubic meters per year. Groundwater is the main source of water in the country, but the water tables have dropped severely leaving Yemen without a viable source of water. For example, in Sana'a, the water table was 30 metres (98 feet) below surface in the 1970s but had dropped to 1,200 metres (3,900 feet) below the surface by 2012. The groundwater has not been regulated by Yemen's governments. Even before the revolution, Yemen's water situation had been described as increasingly dire by experts who worried that Yemen would be the first country to run out of water. In part due to the 2015 Yemeni civil war, the infrastructure required to build better access to water has been delayed in construction. It is estimated that as many as 80% of the population struggles to access water to drink and bathe. Bombing has forced many Yemenis to leave their homes for other areas, leaving wells in the new areas under increasing demands. Together with partners, UNICEF has advanced its efforts and provided access to safe and sustained drinking water to 8.8 million people (5.3 million children). It scaled up its emergency WASH assistance in Yemen to ensure sustainable WASH services through capacity building of local WASH authorities, solarisation of water systems and rainwater harvesting. Yemen's population is 33 million by 2021 estimates, with 46% of the population being under 15 years old and 2.7% above 65 years. In 1950, it was 4.3 million. By 2050, the population is estimated to increase to about 60 million. Yemen has a high total fertility rate , at 4.45 children per woman. Sana'a's population has increased rapidly, from roughly 55,000 in 1978 to nearly 1 million in the early 21st century. When the states of North and South Yemen were established, most resident minority groups departed. Yemen is a largely tribal society. There are also hereditary caste groups in urban areas such as Al-Akhdam . There are also Yemenis of Persian origin . According to Muqaddasi , Persians formed the majority of Aden's population in the 10th century. Yemenite Jews once formed a sizable minority with a distinct culture from other Jewish communities in the world. Most emigrated to Israel in the mid-20th century, following the Jewish exodus from Arab and Muslim countries and Operation Magic Carpet . An estimated 100,000 people of Indian origin are concentrated in the southern part of the country, around Aden, Mukalla, Shihr, Lahaj, Mokha and Hodeidah. Most of the prominent Indonesians , Malaysians , and Singaporeans of Arab descent are Hadhrami people with origins in southern Yemen in the Hadhramaut coastal region. Today there are almost 10,000 Hadramis in Singapore. The Hadramis migrated to Southeast Asia, East Africa and the Indian subcontinent . The Maqil were a collection of Arab Bedouin tribes of Yemeni origin who migrated westwards via Egypt. Several groups of Yemeni Arabs turned south to Mauritania , and by the end of the 17th century, they dominated the entire country. They can also be found throughout Morocco and in Algeria as well as in other North African countries. Yemen is the birthplace of the Arabs and the language ; Qahtanite Arabs —the original Arabs — originated in Yemen. According to Arab tradition, Ishmael son of Abraham married a woman from the Jurhum tribe. Yemen is the only country in the Arabian Peninsula that is signatory to two international accords dating back to 1951 and 1967 governing the protection of refugees. Yemen hosted a population of refugees and asylum seekers numbering approximately 124,600 in 2007. Refugees and asylum seekers were predominantly from Somalia (110,600), Iraq (11,000), Ethiopia (2,000), and Syria . Additionally, more than 334,000 Yemenis have been internally displaced by conflict. The Yemeni diaspora is largely concentrated in neighbouring Saudi Arabia, where between 800,000 and 1 million Yemenis reside, and the United Kingdom, home to between 70,000 and 80,000 Yemenis. Modern Standard Arabic is the official language, while Yemeni Arabic is used as the vernacular. In al Mahrah Governorate in the far east and the island of Socotra , several non-Arabic languages are spoken. Yemeni Sign Language is used by the deaf community. Yemen is part of the homeland of the South Semitic languages . Mehri is the largest South Semitic language spoken in the nation, with more than 70,000 speakers. The ethnic group is called Mahra. Soqotri is another South Semitic language, with speakers on the island of Socotra isolated from the pressures of Arabic on the Yemeni mainland. According to the 1990 census, the number of speakers was 57,000. Yemen was home of the Old South Arabian languages. The Razihi language appears to be the only remaining Old South Arabian language. English is the most important foreign language, being widely taught and spoken mostly in the south, a former British protectorate. Islam is the state religion . Religion in Yemen consists primarily of two Islamic religious groups. According to a UNHCR report, the Shia "Zaydis make up about 45 percent of the population, Sunnis 53 percent and there are also tiny minorities of other Shia groups—the Ismaili and Twelver communities." Sunnis are primarily Shafi'i but also include significant groups of Malikis and Hanbalis . Shias are primarily Zaydi and also have significant minorities of Ismaili and Twelver Shias. The Sunnis are predominantly in the south and southeast which traditionally have less population. The Zaidis/Shias are predominantly in the north and northwest where the vast majority of the Yemeni population traditionally lives whilst the Ismailis are in the main centres such as Sana'a and Ma'rib. There are mixed communities in the larger cities. According to WIN/Gallup International polls, Yemen has the highest share of the population identifying as religious among Arab countries, and one of the highest in the world. About .05 percent of Yemenis are non-Muslim—adhering to Christianity, Judaism , or Hinduism or having no religious affiliation. Yemen is number five on Open Doors' 2022 World Watch List, an annual ranking of the 50 countries where Christians face the most extreme persecution. Estimates of the number of Christians in Yemen range from 25,000 to 41,000. A 2015 study estimates 400 Christians from a Muslim background reside in the country. There are approximately 50 or fewer Jews left in Yemen . Some 200 Yemeni Jews were brought to Israel by the Jewish Agency c. 2016 . According to a 2020 estimate, as few as 26 Jews remain in Yemen. However, in 2022 it was estimated that only one Yemeni Jew remained according to a United Nations report about the treatment of religious minorities in conflict zones; however, there are reportedly a handful of "hidden Jews" who have converted to Islam but secretly continue to practice Judaism. The adult literacy rate in 2010 was 64%. The government has committed to reduce illiteracy to less than 10% by 2025. Although the government provides for universal, compulsory, free education for children ages six through 15, the U.S. Department of State reports that compulsory attendance is not enforced. The government developed the National Basic Education Development Strategy in 2003 that aimed at providing education to 95% of children between the ages of six and 14 years and also at decreasing the gap between males and females in urban and rural areas. A seven-year project to improve gender equity and the quality and efficiency of secondary education, focusing on girls in rural areas, was approved by the World Bank in March 2008. Following this, Yemen has increased its education spending from 5% of GDP in 1995 to 10% in 2005. According to the Webometrics Ranking of World Universities , the top-ranking universities in the country are the Yemeni University of Science & Technology (6532nd worldwide), Al Ahgaff University (8930th) and Sanaa University (11043rd). Yemen was ranked 131st in the Global Innovation Index in 2021, down from 129th in 2019. Despite the significant progress the government has made to expand and improve its health care system over the past decade, the system remains severely underdeveloped. Total expenditures on health care in 2002 constituted 3.7 percent of GDP. In that same year, the per capita expenditure for health care was very low, as compared with other Middle Eastern countries—US$58 according to United Nations statistics and US$23 according to the World Health Organization . According to the World Bank , the number of doctors rose by an average of more than 7 percent between 1995 and 2000, but as of 2004, there were still only three doctors per 10,000 persons. In 2003, Yemen had only 0.6 hospital beds available per 1,000 persons. Health care services are particularly scarce in rural areas. Only 25 percent of rural areas are covered by health services, as compared with 80 percent of urban areas. Emergency services , such as ambulance service and blood banks , are non-existent. When the states of North and South Yemen were established, most resident minority groups departed. Yemen is a largely tribal society. There are also hereditary caste groups in urban areas such as Al-Akhdam . There are also Yemenis of Persian origin . According to Muqaddasi , Persians formed the majority of Aden's population in the 10th century. Yemenite Jews once formed a sizable minority with a distinct culture from other Jewish communities in the world. Most emigrated to Israel in the mid-20th century, following the Jewish exodus from Arab and Muslim countries and Operation Magic Carpet . An estimated 100,000 people of Indian origin are concentrated in the southern part of the country, around Aden, Mukalla, Shihr, Lahaj, Mokha and Hodeidah. Most of the prominent Indonesians , Malaysians , and Singaporeans of Arab descent are Hadhrami people with origins in southern Yemen in the Hadhramaut coastal region. Today there are almost 10,000 Hadramis in Singapore. The Hadramis migrated to Southeast Asia, East Africa and the Indian subcontinent . The Maqil were a collection of Arab Bedouin tribes of Yemeni origin who migrated westwards via Egypt. Several groups of Yemeni Arabs turned south to Mauritania , and by the end of the 17th century, they dominated the entire country. They can also be found throughout Morocco and in Algeria as well as in other North African countries. Yemen is the birthplace of the Arabs and the language ; Qahtanite Arabs —the original Arabs — originated in Yemen. According to Arab tradition, Ishmael son of Abraham married a woman from the Jurhum tribe. Yemen is the only country in the Arabian Peninsula that is signatory to two international accords dating back to 1951 and 1967 governing the protection of refugees. Yemen hosted a population of refugees and asylum seekers numbering approximately 124,600 in 2007. Refugees and asylum seekers were predominantly from Somalia (110,600), Iraq (11,000), Ethiopia (2,000), and Syria . Additionally, more than 334,000 Yemenis have been internally displaced by conflict. The Yemeni diaspora is largely concentrated in neighbouring Saudi Arabia, where between 800,000 and 1 million Yemenis reside, and the United Kingdom, home to between 70,000 and 80,000 Yemenis. Modern Standard Arabic is the official language, while Yemeni Arabic is used as the vernacular. In al Mahrah Governorate in the far east and the island of Socotra , several non-Arabic languages are spoken. Yemeni Sign Language is used by the deaf community. Yemen is part of the homeland of the South Semitic languages . Mehri is the largest South Semitic language spoken in the nation, with more than 70,000 speakers. The ethnic group is called Mahra. Soqotri is another South Semitic language, with speakers on the island of Socotra isolated from the pressures of Arabic on the Yemeni mainland. According to the 1990 census, the number of speakers was 57,000. Yemen was home of the Old South Arabian languages. The Razihi language appears to be the only remaining Old South Arabian language. English is the most important foreign language, being widely taught and spoken mostly in the south, a former British protectorate. Islam is the state religion . Religion in Yemen consists primarily of two Islamic religious groups. According to a UNHCR report, the Shia "Zaydis make up about 45 percent of the population, Sunnis 53 percent and there are also tiny minorities of other Shia groups—the Ismaili and Twelver communities." Sunnis are primarily Shafi'i but also include significant groups of Malikis and Hanbalis . Shias are primarily Zaydi and also have significant minorities of Ismaili and Twelver Shias. The Sunnis are predominantly in the south and southeast which traditionally have less population. The Zaidis/Shias are predominantly in the north and northwest where the vast majority of the Yemeni population traditionally lives whilst the Ismailis are in the main centres such as Sana'a and Ma'rib. There are mixed communities in the larger cities. According to WIN/Gallup International polls, Yemen has the highest share of the population identifying as religious among Arab countries, and one of the highest in the world. About .05 percent of Yemenis are non-Muslim—adhering to Christianity, Judaism , or Hinduism or having no religious affiliation. Yemen is number five on Open Doors' 2022 World Watch List, an annual ranking of the 50 countries where Christians face the most extreme persecution. Estimates of the number of Christians in Yemen range from 25,000 to 41,000. A 2015 study estimates 400 Christians from a Muslim background reside in the country. There are approximately 50 or fewer Jews left in Yemen . Some 200 Yemeni Jews were brought to Israel by the Jewish Agency c. 2016 . According to a 2020 estimate, as few as 26 Jews remain in Yemen. However, in 2022 it was estimated that only one Yemeni Jew remained according to a United Nations report about the treatment of religious minorities in conflict zones; however, there are reportedly a handful of "hidden Jews" who have converted to Islam but secretly continue to practice Judaism. The adult literacy rate in 2010 was 64%. The government has committed to reduce illiteracy to less than 10% by 2025. Although the government provides for universal, compulsory, free education for children ages six through 15, the U.S. Department of State reports that compulsory attendance is not enforced. The government developed the National Basic Education Development Strategy in 2003 that aimed at providing education to 95% of children between the ages of six and 14 years and also at decreasing the gap between males and females in urban and rural areas. A seven-year project to improve gender equity and the quality and efficiency of secondary education, focusing on girls in rural areas, was approved by the World Bank in March 2008. Following this, Yemen has increased its education spending from 5% of GDP in 1995 to 10% in 2005. According to the Webometrics Ranking of World Universities , the top-ranking universities in the country are the Yemeni University of Science & Technology (6532nd worldwide), Al Ahgaff University (8930th) and Sanaa University (11043rd). Yemen was ranked 131st in the Global Innovation Index in 2021, down from 129th in 2019. Despite the significant progress the government has made to expand and improve its health care system over the past decade, the system remains severely underdeveloped. Total expenditures on health care in 2002 constituted 3.7 percent of GDP. In that same year, the per capita expenditure for health care was very low, as compared with other Middle Eastern countries—US$58 according to United Nations statistics and US$23 according to the World Health Organization . According to the World Bank , the number of doctors rose by an average of more than 7 percent between 1995 and 2000, but as of 2004, there were still only three doctors per 10,000 persons. In 2003, Yemen had only 0.6 hospital beds available per 1,000 persons. Health care services are particularly scarce in rural areas. Only 25 percent of rural areas are covered by health services, as compared with 80 percent of urban areas. Emergency services , such as ambulance service and blood banks , are non-existent. Radio broadcasting in Yemen began in the 1940s. After unification in 1990, the government reformed its corporations and founded some additional radio stations that broadcast locally. However, it drew back after 1994, due to destroyed infrastructure resulting from the 1994 civil war. Television is the most significant media platform. Given the low literacy rate in the country, television is the main source of news. There are six free-to-air channels currently headquartered in Yemen, of which four are state-owned. The Yemeni film industry is in its early stages; only eight Yemeni films have been released as of 2023 [ update ] . Yemeni theatre dates to the early 20th century. Both amateur and professional (government-sponsored) theatre troupes perform in the country's major urban centres. Many significant poets and authors, like Ali Ahmed Ba Kathir, Muhammad al-Sharafi, and Wajdi al-Ahdal , have written dramatic works; poems, novels, and short stories by Yemeni authors like Mohammad Abdul-Wali and Abdulaziz Al-Maqaleh have also been adapted for the stage. There have been Yemeni productions of plays by Arab authors such as Tawfiq al-Hakim and Saadallah Wannous and by Western authors, including Shakespeare , Pirandello , Brecht , and Tennessee Williams . Historically speaking, Aden is the cradle of Yemeni theatre; in recent decades Sana'a has hosted numerous theatre festivals, often in conjunction with World Theatre Day . Football is the most popular sport. The Yemen Football Association is a member of FIFA and AFC . The Yemeni national football team participates internationally. The country also hosts many football clubs. They compete in the national and international leagues. Yemen's mountains provide many opportunities for outdoor sports, such as biking , rock climbing , trekking , hiking , and other more challenging sports, including mountain climbing . Mountain climbing and hiking tours to the Sarawat Mountains , including peaks of 3,000 m (9,800 ft) and above, particularly that of An-Nabi Shu'ayb, are seasonally organized by local and international alpine agencies. The coastal areas and Socotra provide many opportunities for water sports, such as surfing , bodyboarding , sailing , swimming , and scuba diving . Socotra is home to some of the best surfing destinations in the world. Camel jumping is a traditional sport that is becoming increasingly popular among the Zaraniq tribe on the west coast. Camels are placed side to side and victory goes to the competitor who leaps, from a running start, over the most camels. Tribesmen (women may not compete) tuck their robes around their waists for freedom of movement while running and leaping. Yemen's biggest sports event was hosting the 20th Arabian Gulf Cup in Aden and Abyan in 2010. Yemen was defeated in the first three matches of the tournament. Among its natural and cultural attractions are four World Heritage sites. The Old Walled City of Shibam in Wadi Hadhramaut, inscribed by UNESCO in 1982, two years after Yemen joined the World Heritage Committee, is nicknamed "Manhattan of the Desert" because of its skyscrapers. Surrounded by a fortified wall made of mud and straw, the 16th-century city is one of the oldest examples of urban planning based on the principle of vertical construction. The Old City of Sana'a, at an altitude of more than 2,100 metres (7,000 ft) , has been inhabited for over two and a half millennia, and was inscribed in 1986. Sana'a became a major Islamic centre in the seventh century, and the 103 mosques, 14 hammams (traditional bathhouses), and more than 6,000 houses that survive all date from before the 11th century. Close to the Red Sea coast, the historic town of Zabid , inscribed in 1993, was Yemen's capital from the 13th to the 15th century, and is an archaeological and historical site. It played an important role for many centuries because of its university, which was a centre of learning for the whole Arab and Islamic world. The latest addition to Yemen's list of World Heritage Sites is the Socotra Archipelago. Mentioned by Marco Polo in the 13th century, this remote and isolated archipelago consists of four islands and two rocky islets delineating the southern limit of the Gulf of Aden. The site has a rich biodiversity. Nowhere else in the world do 37% of Socotra's 825 plants, 90% of its reptiles and 95% of its snails occur. It is home to 192 bird species, 253 species of coral, 730 species of coastal fish, and 300 species of crab and lobster, as well as the Dragon's Blood Tree ( Dracaena cinnabari ). The cultural heritage of Socotra includes the unique Soqotri language .Radio broadcasting in Yemen began in the 1940s. After unification in 1990, the government reformed its corporations and founded some additional radio stations that broadcast locally. However, it drew back after 1994, due to destroyed infrastructure resulting from the 1994 civil war. Television is the most significant media platform. Given the low literacy rate in the country, television is the main source of news. There are six free-to-air channels currently headquartered in Yemen, of which four are state-owned. The Yemeni film industry is in its early stages; only eight Yemeni films have been released as of 2023 [ update ] .Yemeni theatre dates to the early 20th century. Both amateur and professional (government-sponsored) theatre troupes perform in the country's major urban centres. Many significant poets and authors, like Ali Ahmed Ba Kathir, Muhammad al-Sharafi, and Wajdi al-Ahdal , have written dramatic works; poems, novels, and short stories by Yemeni authors like Mohammad Abdul-Wali and Abdulaziz Al-Maqaleh have also been adapted for the stage. There have been Yemeni productions of plays by Arab authors such as Tawfiq al-Hakim and Saadallah Wannous and by Western authors, including Shakespeare , Pirandello , Brecht , and Tennessee Williams . Historically speaking, Aden is the cradle of Yemeni theatre; in recent decades Sana'a has hosted numerous theatre festivals, often in conjunction with World Theatre Day .Football is the most popular sport. The Yemen Football Association is a member of FIFA and AFC . The Yemeni national football team participates internationally. The country also hosts many football clubs. They compete in the national and international leagues. Yemen's mountains provide many opportunities for outdoor sports, such as biking , rock climbing , trekking , hiking , and other more challenging sports, including mountain climbing . Mountain climbing and hiking tours to the Sarawat Mountains , including peaks of 3,000 m (9,800 ft) and above, particularly that of An-Nabi Shu'ayb, are seasonally organized by local and international alpine agencies. The coastal areas and Socotra provide many opportunities for water sports, such as surfing , bodyboarding , sailing , swimming , and scuba diving . Socotra is home to some of the best surfing destinations in the world. Camel jumping is a traditional sport that is becoming increasingly popular among the Zaraniq tribe on the west coast. Camels are placed side to side and victory goes to the competitor who leaps, from a running start, over the most camels. Tribesmen (women may not compete) tuck their robes around their waists for freedom of movement while running and leaping. Yemen's biggest sports event was hosting the 20th Arabian Gulf Cup in Aden and Abyan in 2010. Yemen was defeated in the first three matches of the tournament. Among its natural and cultural attractions are four World Heritage sites. The Old Walled City of Shibam in Wadi Hadhramaut, inscribed by UNESCO in 1982, two years after Yemen joined the World Heritage Committee, is nicknamed "Manhattan of the Desert" because of its skyscrapers. Surrounded by a fortified wall made of mud and straw, the 16th-century city is one of the oldest examples of urban planning based on the principle of vertical construction. The Old City of Sana'a, at an altitude of more than 2,100 metres (7,000 ft) , has been inhabited for over two and a half millennia, and was inscribed in 1986. Sana'a became a major Islamic centre in the seventh century, and the 103 mosques, 14 hammams (traditional bathhouses), and more than 6,000 houses that survive all date from before the 11th century. Close to the Red Sea coast, the historic town of Zabid , inscribed in 1993, was Yemen's capital from the 13th to the 15th century, and is an archaeological and historical site. It played an important role for many centuries because of its university, which was a centre of learning for the whole Arab and Islamic world. The latest addition to Yemen's list of World Heritage Sites is the Socotra Archipelago. Mentioned by Marco Polo in the 13th century, this remote and isolated archipelago consists of four islands and two rocky islets delineating the southern limit of the Gulf of Aden. The site has a rich biodiversity. Nowhere else in the world do 37% of Socotra's 825 plants, 90% of its reptiles and 95% of its snails occur. It is home to 192 bird species, 253 species of coral, 730 species of coastal fish, and 300 species of crab and lobster, as well as the Dragon's Blood Tree ( Dracaena cinnabari ). The cultural heritage of Socotra includes the unique Soqotri language .

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A Gentleman in Moscow

A Gentleman in Moscow is a 2016 novel by Amor Towles . It is his second novel, published five years after Rules of Civility (2011).The protagonist is the fictional Count Alexander Ilyich Rostov, born in Saint Petersburg , Russia , on 24 October 1889. He was raised on his Rostov family's estate "Idlehour" in Nizhny Novgorod . Rostov's godfather was his father's comrade in the cavalry, Grand Duke Demidov. When the Count's parents died of cholera within hours of each other in 1900, Grand Duke Demidov became the 11-year-old's guardian. Demidov counseled him to be strong for his sister Helena, because "...adversity presents itself in many forms, and if a man does not master his circumstances, then he is bound to be mastered by them." The Rostov siblings are aristocrats and making social visits to nearby estates by horse-drawn troika or sleigh. As a young man, the Count was sent out of the country by his grandmother for wounding a cad in defense of his sister - events covered through flashbacks . Upon returning home from Paris after the Bolshevik revolution of 1917, the Count was arrested, beginning the narrative. Each of the book's chapters is set according to a doubling then halving chronological structure. The first chapter is the day after the Count's arrest, the second is two days after, and subsequent chapters are set five days, ten days, three weeks, six weeks, three months, six months, one year, two years, four years, eight years, and sixteen years after the beginning of the narrative. At this point, the structure reverses, with the time between chapters progressively halving until the final day of the narrative.Towles's inspiration for the novel was his experience staying at luxury hotels, specifically, a hotel in Geneva , Switzerland , where some guests were permanent residents. He combined the idea of luxury hotels with his knowledge of Russia's long-time historical tradition of house arrest . The Count is charged as a social parasite before a Bolshevik tribunal, with the expectation that he will be found guilty and shot. He is unrepentant, and eloquently refuses to confess. Because of a revolutionary poem attributed to him, for which some senior Bolsheviks consider him one of the heroes of the struggle against the Tsarist regime, the Count is spared a death sentence. Instead, he is placed under house arrest for life at his current residence, the Hotel Metropol in central Moscow. A military guard escorts the Count back to the Hotel Metropol, where he is ordered to vacate his luxurious suite and move to the cramped servants' quarters on the sixth floor. As time goes on, the Count cultivates a social circle of friends from his youth as well as selected residents, staff, and customers of the Hotel and its restaurants. These include a one-eyed cat, a seamstress, a Russian chef, a French maître d'hotel and former circus juggler, a poet, an actress, an underemployed architect, an orchestra conductor, a prince, a former Red Army colonel, and an aide-de-camp of an American general. Due to his diminished circumstances and restricted freedom, the Count has time for self-reflection. He is a brilliant conversationalist, readily discussing diverse subjects such as evolution, philosophy, Impressionism, Russian writers and poetry, food, post-revolutionary Russian society, and Russia's contributions to the world. An early acquaintance at the hotel is nine-year-old Nina Kulikova, the daughter of a widowed Ukrainian bureaucrat, who is fascinated by princesses. In 1938, an unexpected arrival changes the Count's circumstances. Nina Kulikova, now a married woman, visits the Count. She confides that her husband Leo was arrested and sentenced to five years of forced labor in the Gulag . Nina decides to follow her husband to Sevvostlag in Kolyma , a remote region of the Soviet Union bounded by the East Siberian Sea and the Arctic Ocean . She begs the Count to accept temporary custody of her young daughter Sofia, while she makes arrangements for the child to join her in Siberia to be near her father. This is the last time the Count sees Nina, so at the age of 49, he becomes Sofia's surrogate father. Sofia is a quiet, highly intelligent child. Her potential manifests itself through various escapades, including games of hide-and-seek as a young girl and quickly navigating the hotel in order to surprise her foster father. Later, Sofia takes piano lessons. She surprises the Count by playing a Chopin nocturne (Opus 9, number 2, in E-flat major) after only a few lessons. It is clear to both the piano teacher and the Count that Sofia is a musical prodigy. The Count's experiences with the various forces of the Revolution, the Soviet state, and foreign guests provide opportunities for reflection on different historic moments through the Cold War. The Count's views are particularly affected by the experience of his childhood friend after being asked to censor one of Chekhov's letters, which culminates alongside Sofia's artistry in the climax of the book. Due to many events of the book taking place at one of the Metropol's restaurants, the Count's interactions with other characters often center around food and beverage choices. Many classic French and world wines are mentioned in the book. Châteauneuf-du-Pape is especially key to the storyline. The Count is charged as a social parasite before a Bolshevik tribunal, with the expectation that he will be found guilty and shot. He is unrepentant, and eloquently refuses to confess. Because of a revolutionary poem attributed to him, for which some senior Bolsheviks consider him one of the heroes of the struggle against the Tsarist regime, the Count is spared a death sentence. Instead, he is placed under house arrest for life at his current residence, the Hotel Metropol in central Moscow.A military guard escorts the Count back to the Hotel Metropol, where he is ordered to vacate his luxurious suite and move to the cramped servants' quarters on the sixth floor. As time goes on, the Count cultivates a social circle of friends from his youth as well as selected residents, staff, and customers of the Hotel and its restaurants. These include a one-eyed cat, a seamstress, a Russian chef, a French maître d'hotel and former circus juggler, a poet, an actress, an underemployed architect, an orchestra conductor, a prince, a former Red Army colonel, and an aide-de-camp of an American general. Due to his diminished circumstances and restricted freedom, the Count has time for self-reflection. He is a brilliant conversationalist, readily discussing diverse subjects such as evolution, philosophy, Impressionism, Russian writers and poetry, food, post-revolutionary Russian society, and Russia's contributions to the world. An early acquaintance at the hotel is nine-year-old Nina Kulikova, the daughter of a widowed Ukrainian bureaucrat, who is fascinated by princesses.In 1938, an unexpected arrival changes the Count's circumstances. Nina Kulikova, now a married woman, visits the Count. She confides that her husband Leo was arrested and sentenced to five years of forced labor in the Gulag . Nina decides to follow her husband to Sevvostlag in Kolyma , a remote region of the Soviet Union bounded by the East Siberian Sea and the Arctic Ocean . She begs the Count to accept temporary custody of her young daughter Sofia, while she makes arrangements for the child to join her in Siberia to be near her father. This is the last time the Count sees Nina, so at the age of 49, he becomes Sofia's surrogate father. Sofia is a quiet, highly intelligent child. Her potential manifests itself through various escapades, including games of hide-and-seek as a young girl and quickly navigating the hotel in order to surprise her foster father. Later, Sofia takes piano lessons. She surprises the Count by playing a Chopin nocturne (Opus 9, number 2, in E-flat major) after only a few lessons. It is clear to both the piano teacher and the Count that Sofia is a musical prodigy.The Count's experiences with the various forces of the Revolution, the Soviet state, and foreign guests provide opportunities for reflection on different historic moments through the Cold War. The Count's views are particularly affected by the experience of his childhood friend after being asked to censor one of Chekhov's letters, which culminates alongside Sofia's artistry in the climax of the book.Due to many events of the book taking place at one of the Metropol's restaurants, the Count's interactions with other characters often center around food and beverage choices. Many classic French and world wines are mentioned in the book. Châteauneuf-du-Pape is especially key to the storyline. Towles's approach in A Gentleman in Moscow was described as a "gorgeous sleight of hand" by The New York Times : What saves the book is the gorgeous sleight of hand that draws it to a satisfying end, and the way he chooses themes that run deeper than mere sociopolitical commentary: parental duty, friendship, romance, the call of home. Human beings, after all, 'deserve not only our consideration but our reconsideration' – even those from the leisured class. Who will save Rostov from the intrusions of the state if not the seamstresses, chefs, bartenders, and doormen? In the end, Towles's greatest narrative effect is not the moments of wonder and synchronicity but the free transformation of these peripheral workers, over decades, into confidants, equals, and, finally, friends. With them around, a life sentence in these gilded halls might make Rostov the luckiest man in Russia. Kirkus Reviews found the book to be "a great novel, a nonstop pleasure brimming with charm, personal wisdom, and philosophic insight. This book more than fulfills the promise of Towles' stylish debut, Rules of Civility ." NPR opined that " A Gentleman in Moscow is a novel that aims to charm ... and the result is winning, stylish ... Flair is always the goal – Towles never lets anyone merely say goodbye when they could bid adieu, never puts a period where an exclamation point or dramatic ellipsis could stand." At Book Marks , a review aggregator website, the novel received a cumulative "Positive" rating based on 11 reviews: 3 "Rave", 5 "Positive", and 3 "Mixed". Queen Camilla, then Camilla, Duchess of Cornwall , recommended the book to those in isolation during the COVID-19 pandemic. A Gentleman in Moscow was a finalist for the 2016 Kirkus Prize in Fiction & Literature. It was also an International Dublin Literary Award nominee (2018 longlist). The audiobook, narrated by Nicholas Guy Smith, was an AudioFile Magazine Earphones Award winner in 2016. In August 2017, an adaptation of the book in the form of a limited series was announced to be in development. In April 2018, Kenneth Branagh joined the production to star as Count Rostov, with Tom Harper attached to direct. Both of them left by August 2022, when Ewan McGregor replaced Branagh. The series premiered in March 2024, on Paramount+ internationally and Showtime in the US.

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https://api.wikimedia.org/core/v1/wikipedia/en/page/Fish/html

Fish

A fish ( pl. : fish or fishes ) is an aquatic , anamniotic , gill -bearing vertebrate animal with swimming fins and a hard skull , but lacking limbs with digits . Fish can be grouped into the more basal jawless fish and the more common jawed fish , the latter including all living cartilaginous and bony fish , as well as the extinct placoderms and acanthodians . Most fish are cold-blooded , their body temperature varying with the surrounding water, though some large active swimmers like white shark and tuna can hold a higher core temperature . Many fish can communicate acoustically with each other, such as during courtship displays . The earliest fish appeared during the Cambrian as small filter feeders ; they continued to evolve through the Paleozoic , diversifying into many forms. The earliest fish with dedicated respiratory gills and paired fins , the ostracoderms , had heavy bony plates that served as protective exoskeletons against invertebrate predators . The first fish with jaws appeared in the Silurian and greatly diversified during the Devonian , the "Age of Fishes". Bony fish, distinguished by the presence of swim bladders , emerged as the dominant group of fish after the end-Devonian extinction wiped out the apex placoderms. Bony fish are further divided into the lobe-finned and ray-finned fish . About 96% of all living fish species today are teleosts , a crown group of ray-finned fish that can protrude their jaws . The tetrapods , a mostly terrestrial clade of vertebrates that have dominated the top trophic levels in both aquatic and terrestrial ecosystems since the Late Paleozoic , evolved from lobe-finned fish during the Carboniferous , developing air-breathing lungs homologous to swim bladders. Tetrapods are usually not considered to be fish, making "fish" a paraphyletic group . Fish have been an important natural resource for humans since prehistoric times, especially as food . Commercial and subsistence fishers harvest fish in wild fisheries or farm them in ponds or in breeding cages in the ocean. Fish are caught for recreation , or raised by fishkeepers as ornaments for private and public exhibition in aquaria and garden ponds . Fish have had a role in human culture through the ages, serving as deities, religious symbols, and as the subjects of art, books and movies.The word fish is inherited from Proto-Germanic , and is related to German Fisch , the Latin piscis and Old Irish īasc , though the exact root is unknown; some authorities reconstruct a Proto-Indo-European root * peysk- , attested only in Italic , Celtic , and Germanic . About 530 million years ago during the Cambrian explosion , fishlike animals with a notochord and eyes at the front of the body, such as Haikouichthys , appear in the fossil record . During the late Cambrian , other jawless forms such as conodonts appear. Jawed vertebrates appear in the Silurian , with giant armoured placoderms such as Dunkleosteus . Jawed fish, too, appeared during the Silurian: the cartilaginous Chondrichthyes and the bony Osteichthyes . During the Devonian , fish diversity greatly increased, including among the placoderms, lobe-finned fishes, and early sharks, earning the Devonian the epithet "the age of fishes". Fishes are a paraphyletic group, since any clade containing all fish, such as the Gnathostomata or (for bony fish) Osteichthyes , also contains the clade of tetrapods (four-limbed vertebrates, mostly terrestrial), which used not to be considered to be fish. Some tetrapods, such as cetaceans and ichthyosaurs , have secondarily acquired a fish-like body shape through convergent evolution . Fishes of the World comments that "it is increasingly widely accepted that tetrapods, including ourselves, are simply modified bony fishes, and so we are comfortable with using the taxon Osteichthyes as a clade, which now includes all tetrapods". The biodiversity of extant fish is unevenly distributed among the various groups; teleosts , bony fishes able to protrude their jaws , make up 96% of fish species. The cladogram shows the evolutionary relationships of all groups of living fishes (with their respective diversity ) and the tetrapods. Extinct groups are marked with a dagger (†); groups of uncertain placement are labelled with a question mark (?) and dashed lines (- - - - -). Jawless fishes (118 species: hagfish , lampreys ) †Thelodonti , †Conodonta , †Anaspida †Galeaspida †Osteostraci †Placodermi †Acanthodii (>1,100 species: sharks , rays , chimaeras ) (2 species: coelacanths ) Dipnoi (6 species: lungfish ) Tetrapoda (>38,000 species, not considered fish: amphibians, reptiles, birds, mammals) (14 species: bichirs , reedfish ) (27 species: sturgeons , paddlefish ) Ginglymodi (7 species: gars , alligator gars ) Halecomorphi (2 species: bowfin , eyetail bowfin ) (>32,000 species) Fishes (without tetrapods) are a paraphyletic group and for this reason, the class Pisces seen in older reference works is no longer used in formal classifications. Traditional classification divides fish into three extant classes (Agnatha, Chondrichthyes, and Osteichthyes), and with extinct forms sometimes classified within those groups, sometimes as their own classes. Fish account for more than half of vertebrate species. As of 2016, there are over 32,000 described species of bony fish, over 1,100 species of cartilaginous fish, and over 100 hagfish and lampreys. A third of these fall within the nine largest families; from largest to smallest, these are Cyprinidae , Gobiidae , Cichlidae , Characidae , Loricariidae , Balitoridae , Serranidae , Labridae , and Scorpaenidae . About 64 families are monotypic , containing only one species. Fish range in size from the huge 16-metre (52 ft) whale shark to some tiny teleosts only 8-millimetre (0.3 in) long, such as the cyprinid Paedocypris progenetica and the stout infantfish . Swimming performance varies from fish such as tuna, salmon , and jacks that can cover 10–20 body-lengths per second to species such as eels and rays that swim no more than 0.5 body-lengths per second. A typical fish is cold-blooded , has a streamlined body for rapid swimming, extracts oxygen from water using gills, has two sets of paired fins, one or two dorsal fins, an anal fin and a tail fin, jaws, skin covered with scales , and lays eggs. Each criterion has exceptions, creating a wide diversity in body shape and way of life. For example, some fast-swimming fish are warm-blooded, while some slow-swimming fish have abandoned streamlining in favour of other body shapes. About 530 million years ago during the Cambrian explosion , fishlike animals with a notochord and eyes at the front of the body, such as Haikouichthys , appear in the fossil record . During the late Cambrian , other jawless forms such as conodonts appear. Jawed vertebrates appear in the Silurian , with giant armoured placoderms such as Dunkleosteus . Jawed fish, too, appeared during the Silurian: the cartilaginous Chondrichthyes and the bony Osteichthyes . During the Devonian , fish diversity greatly increased, including among the placoderms, lobe-finned fishes, and early sharks, earning the Devonian the epithet "the age of fishes". Fishes are a paraphyletic group, since any clade containing all fish, such as the Gnathostomata or (for bony fish) Osteichthyes , also contains the clade of tetrapods (four-limbed vertebrates, mostly terrestrial), which used not to be considered to be fish. Some tetrapods, such as cetaceans and ichthyosaurs , have secondarily acquired a fish-like body shape through convergent evolution . Fishes of the World comments that "it is increasingly widely accepted that tetrapods, including ourselves, are simply modified bony fishes, and so we are comfortable with using the taxon Osteichthyes as a clade, which now includes all tetrapods". The biodiversity of extant fish is unevenly distributed among the various groups; teleosts , bony fishes able to protrude their jaws , make up 96% of fish species. The cladogram shows the evolutionary relationships of all groups of living fishes (with their respective diversity ) and the tetrapods. Extinct groups are marked with a dagger (†); groups of uncertain placement are labelled with a question mark (?) and dashed lines (- - - - -). Jawless fishes (118 species: hagfish , lampreys ) †Thelodonti , †Conodonta , †Anaspida †Galeaspida †Osteostraci †Placodermi †Acanthodii (>1,100 species: sharks , rays , chimaeras ) (2 species: coelacanths ) Dipnoi (6 species: lungfish ) Tetrapoda (>38,000 species, not considered fish: amphibians, reptiles, birds, mammals) (14 species: bichirs , reedfish ) (27 species: sturgeons , paddlefish ) Ginglymodi (7 species: gars , alligator gars ) Halecomorphi (2 species: bowfin , eyetail bowfin ) (>32,000 species)Fishes (without tetrapods) are a paraphyletic group and for this reason, the class Pisces seen in older reference works is no longer used in formal classifications. Traditional classification divides fish into three extant classes (Agnatha, Chondrichthyes, and Osteichthyes), and with extinct forms sometimes classified within those groups, sometimes as their own classes. Fish account for more than half of vertebrate species. As of 2016, there are over 32,000 described species of bony fish, over 1,100 species of cartilaginous fish, and over 100 hagfish and lampreys. A third of these fall within the nine largest families; from largest to smallest, these are Cyprinidae , Gobiidae , Cichlidae , Characidae , Loricariidae , Balitoridae , Serranidae , Labridae , and Scorpaenidae . About 64 families are monotypic , containing only one species. Fish range in size from the huge 16-metre (52 ft) whale shark to some tiny teleosts only 8-millimetre (0.3 in) long, such as the cyprinid Paedocypris progenetica and the stout infantfish . Swimming performance varies from fish such as tuna, salmon , and jacks that can cover 10–20 body-lengths per second to species such as eels and rays that swim no more than 0.5 body-lengths per second. A typical fish is cold-blooded , has a streamlined body for rapid swimming, extracts oxygen from water using gills, has two sets of paired fins, one or two dorsal fins, an anal fin and a tail fin, jaws, skin covered with scales , and lays eggs. Each criterion has exceptions, creating a wide diversity in body shape and way of life. For example, some fast-swimming fish are warm-blooded, while some slow-swimming fish have abandoned streamlining in favour of other body shapes. Fish species are roughly divided equally between freshwater and marine (oceanic) ecosystems; there are some 15,200 freshwater species and around 14,800 marine species. Coral reefs in the Indo-Pacific constitute the center of diversity for marine fishes, whereas continental freshwater fishes are most diverse in large river basins of tropical rainforests , especially the Amazon , Congo , and Mekong basins. More than 5,600 fish species inhabit Neotropical freshwaters alone, such that Neotropical fishes represent about 10% of all vertebrate species on the Earth. Fish are abundant in most bodies of water. They can be found in nearly all aquatic environments, from high mountain streams (e.g., char and gudgeon ) to the abyssal and even hadal depths of the deepest oceans (e.g., cusk-eels and snailfish ), although none have been found in the deepest 25% of the ocean. The deepest living fish in the ocean so far found is a cusk-eel, Abyssobrotula galatheae , recorded at the bottom of the Puerto Rico trench at 8,370 m (27,460 ft) . In terms of temperature, Jonah's icefish live in cold [lower-alpha 1] waters of the Southern Ocean, including under the Filchner–Ronne Ice Shelf at a latitude of 79°S, while desert pupfish live in desert springs, streams, and marshes, sometimes highly saline, with water temperatures as high as 36 C. A few fish live mostly on land or lay their eggs on land near water. Mudskippers feed and interact with one another on mudflats and go underwater to hide in their burrows. A single undescribed species of Phreatobius has been called a true "land fish" as this worm-like catfish strictly lives among waterlogged leaf litter . Cavefish of multiple families live in underground lakes , underground rivers or aquifers . Like other animals, fish suffer from parasitism . Some species use cleaner fish to remove external parasites. The best known of these are the bluestreak cleaner wrasses of coral reefs in the Indian and Pacific oceans. These small fish maintain cleaning stations where other fish congregate and perform specific movements to attract the attention of the cleaners. Cleaning behaviors have been observed in a number of fish groups, including an interesting case between two cichlids of the same genus, Etroplus maculatus , the cleaner, and the much larger E. suratensis . Fish occupy many trophic levels in freshwater and marine food webs . Fish at the higher levels are predatory , and a substantial part of their prey consists of other fish. In addition, mammals such as dolphins and seals feed on fish, alongside birds such as gannets and cormorants . Fish species are roughly divided equally between freshwater and marine (oceanic) ecosystems; there are some 15,200 freshwater species and around 14,800 marine species. Coral reefs in the Indo-Pacific constitute the center of diversity for marine fishes, whereas continental freshwater fishes are most diverse in large river basins of tropical rainforests , especially the Amazon , Congo , and Mekong basins. More than 5,600 fish species inhabit Neotropical freshwaters alone, such that Neotropical fishes represent about 10% of all vertebrate species on the Earth. Fish are abundant in most bodies of water. They can be found in nearly all aquatic environments, from high mountain streams (e.g., char and gudgeon ) to the abyssal and even hadal depths of the deepest oceans (e.g., cusk-eels and snailfish ), although none have been found in the deepest 25% of the ocean. The deepest living fish in the ocean so far found is a cusk-eel, Abyssobrotula galatheae , recorded at the bottom of the Puerto Rico trench at 8,370 m (27,460 ft) . In terms of temperature, Jonah's icefish live in cold [lower-alpha 1] waters of the Southern Ocean, including under the Filchner–Ronne Ice Shelf at a latitude of 79°S, while desert pupfish live in desert springs, streams, and marshes, sometimes highly saline, with water temperatures as high as 36 C. A few fish live mostly on land or lay their eggs on land near water. Mudskippers feed and interact with one another on mudflats and go underwater to hide in their burrows. A single undescribed species of Phreatobius has been called a true "land fish" as this worm-like catfish strictly lives among waterlogged leaf litter . Cavefish of multiple families live in underground lakes , underground rivers or aquifers . Like other animals, fish suffer from parasitism . Some species use cleaner fish to remove external parasites. The best known of these are the bluestreak cleaner wrasses of coral reefs in the Indian and Pacific oceans. These small fish maintain cleaning stations where other fish congregate and perform specific movements to attract the attention of the cleaners. Cleaning behaviors have been observed in a number of fish groups, including an interesting case between two cichlids of the same genus, Etroplus maculatus , the cleaner, and the much larger E. suratensis . Fish occupy many trophic levels in freshwater and marine food webs . Fish at the higher levels are predatory , and a substantial part of their prey consists of other fish. In addition, mammals such as dolphins and seals feed on fish, alongside birds such as gannets and cormorants . The body of a typical fish is adapted for efficient swimming by alternately contracting paired sets of muscles on either side of the backbone. These contractions form S-shaped curves that move down the body. As each curve reaches the tail fin, force is applied to the water, moving the fish forward. The other fins act as control surfaces like an aircraft's flaps, enabling the fish to steer in any direction. Since body tissue is denser than water, fish must compensate for the difference or they will sink. Many bony fish have an internal organ called a swim bladder that allows them to adjust their buoyancy by increasing or decreasing the amount of gas it contains. The scales of fish provide protection from predators at the cost of adding stiffness and weight. Fish scales are often highly reflective; this silvering provides camouflage in the open ocean. Because the water all around is the same colour, reflecting an image of the water offers near-invisibility. Fish have a closed-loop circulatory system . The heart pumps the blood in a single loop throughout the body; for comparison, the mammal heart has two loops, one for the lungs to pick up oxygen, one for the body to deliver the oxygen. In fish, the heart pumps blood through the gills. Oxygen-rich blood then flows without further pumping, unlike in mammals, to the body tissues. Finally, oxygen-depleted blood returns to the heart. Fish exchange gases using gills on either side of the pharynx . Gills consist of comblike structures called filaments. Each filament contains a capillary network that provides a large surface area for exchanging oxygen and carbon dioxide . Fish exchange gases by pulling oxygen-rich water through their mouths and pumping it over their gills. Capillary blood in the gills flows in the opposite direction to the water, resulting in efficient countercurrent exchange . The gills push the oxygen-poor water out through openings in the sides of the pharynx. Cartilaginous fish have multiple gill openings: sharks usually have five, sometimes six or seven pairs; they often have to swim to oxygenate their gills. Bony fish have a single gill opening on each side, hidden beneath a protective bony cover or operculum . They are able to oxygenate their gills using muscles in the head. Some 400 species of fish in 50 families can breathe air, enabling them to live in oxygen-poor water or to emerge on to land. The ability of fish to do this is potentially limited by their single-loop circulation, as oxygenated blood from their air-breathing organ will mix with deoxygenated blood returning to the heart from the rest of the body. Lungfish, bichirs, ropefish, bowfins, snakefish, and the African knifefish have evolved to reduce such mixing, and to reduce oxygen loss from the gills to oxygen-poor water. Bichirs and lungfish have tetrapod-like paired lungs, requiring them to surface to gulp air, and making them obligate air breathers. Many other fish, including inhabitants of rock pools and the intertidal zone , are facultative air breathers, able to breathe air when out of water, as may occur daily at low tide , and to use their gills when in water. Some coastal fish like rockskippers and mudskippers choose to leave the water to feed in habitats temporarily exposed to the air. Some catfish absorb air through their digestive tracts. The digestive system consists of a tube, the gut, leading from the mouth to the anus. The mouth of most fishes contains teeth to grip prey, bite off or scrape plant material, or crush the food. An esophagus carries foot to the stomach where food may be stored and partially digested. A sphincter, the pylorus, releases food to the intestine at intervals. Many fish have finger-shaped pouches, pyloric caeca , around the pylorus, of doubtful function. The pancreas secretes enzymes into the intestine to digest the food; other enzymes are secreted directly by the intestine itself. The liver produces bile which helps to break up fat into an emulsion which can be absorbed in the intestine. Most fish release their nitrogenous wastes as ammonia . This may be excreted through the gills or filtered by the kidneys . Salt is excreted by the rectal gland. Saltwater fish tend to lose water by osmosis ; their kidneys return water to the body, and produce a concentrated urine. The reverse happens in freshwater fish : they tend to gain water osmotically, and produce a dilute urine. Some fish have kidneys able to operate in both freshwater and saltwater. Fish have small brains relative to body size compared with other vertebrates, typically one-fifteenth the brain mass of a similarly sized bird or mammal. However, some fish have relatively large brains, notably mormyrids and sharks , which have brains about as large for their body weight as birds and marsupials . At the front of the brain are the olfactory lobes , a pair of structures that receive and process signals from the nostrils via the two olfactory nerves . Fish that hunt primarily by smell, such as hagfish and sharks, have very large olfactory lobes. Behind these is the telencephalon , which in fish deals mostly with olfaction. Together these structures form the forebrain. Connecting the forebrain to the midbrain is the diencephalon ; it works with hormones and homeostasis . The pineal body is just above the diencephalon; it detects light, maintains circadian rhythms, and controls color changes. The midbrain contains the two optic lobes . These are very large in species that hunt by sight, such as rainbow trout and cichlids . The hindbrain controls swimming and balance.The single-lobed cerebellum is the biggest part of the brain; it is small in hagfish and lampreys , but very large in mormyrids , processing their electrical sense . The brain stem or myelencephalon controls some muscles and body organs, and governs respiration and osmoregulation . The lateral line system is a network of sensors in the skin which detects gentle currents and vibrations, and senses the motion of nearby fish, whether predators or prey. This can be considered both a sense of touch and of hearing . Blind cave fish navigate almost entirely through the sensations from their lateral line system. Some fish, such as catfish and sharks, have the ampullae of Lorenzini , electroreceptors that detect weak electric currents on the order of millivolt. Vision is an important sensory system in fish. Fish eyes are similar to those of terrestrial vertebrates like birds and mammals, but have a more spherical lens . Their retinas generally have both rods and cones (for scotopic and photopic vision ); many species have colour vision , often with three types of cone. Teleosts can see polarized light ; some such as cyprinids have a fourth type of cone that detects ultraviolet . Amongst jawless fish , the lamprey has well-developed eyes, while the hagfish has only primitive eye spots. Hearing too is an important sensory system in fish. Fish sense sound using their lateral lines and otoliths in their ears, inside their heads. Some can detect sound through the swim bladder. Some fish, including salmon, are capable of magnetoreception ; when the axis of a magnetic field is changed around a circular tank of young fish, they reorient themselves in line with the field. The mechanism of fish magnetoreception remains unknown; experiments in birds imply a quantum radical pair mechanism . The cognitive capacities of fish include self-awareness , as seen in mirror tests . Manta rays and wrasses placed in front of a mirror repeatedly check whether their reflection's behavior mimics their body movement. Choerodon wrasse, archerfish , and Atlantic cod can solve problems and invent tools. The monogamous cichlid Amatitlania siquia exhibits pessimistic behavior when prevented from being with its partner. Fish orient themselves using landmarks; they may use mental maps based on multiple landmarks. Fish are able to learn to traverse mazes, showing that they possess spatial memory and visual discrimination. Electric fish such as elephantfishes , the African knifefish , and electric eels have some of their muscles adapted to generate electric fields . They use the field to locate and identify objects such as prey in the waters around them, which may be turbid or dark. Strongly electric fish like the electric eel can in addition use their electric organs to generate shocks powerful enough to stun their prey. Most fish are exclusively cold-blooded or ectothermic . However, the Scombroidei are warm-blooded (endothermic), including the billfishes and tunas. The opah , a lampriform , uses whole-body endothermy, generating heat with its swimming muscles to warm its body while countercurrent exchange minimizes heat loss. Among the cartilaginous fishes, sharks of the families Lamnidae (such as the great white shark) and Alopiidae (thresher sharks) are endothermic. The degree of endothermy varies from the billfishes, which warm only their eyes and brain, to the bluefin tuna and the porbeagle shark , which maintain body temperatures more than 20 °C (68 °F) above the ambient water. The primary reproductive organs are paired testicles and ovaries . Eggs are released from the ovary to the oviducts . Over 97% of fish, including salmon and goldfish, are oviparous , meaning that the eggs are shed into the water and develop outside the mother's body. The eggs are usually fertilized outside the mother's body, with the male and female fish shedding their gametes into the surrounding water. In a few oviparous fish, such as the skates , fertilization is internal: the male uses an intromittent organ to deliver sperm into the female's genital opening of the female. Marine fish release large numbers of small eggs into the open water column. Newly hatched young of oviparous fish are planktonic larvae . They have a large yolk sac and do not resemble juvenile or adult fish. The larval period in oviparous fish is usually only some weeks, and larvae rapidly grow and change in structure to become juveniles. During this transition, larvae must switch from their yolk sac to feeding on zooplankton prey. Some fish such as surf-perches , splitfins , and lemon sharks are viviparous or live-bearing, meaning that the mother retains the eggs and nourishes the embryos via a structure analogous to the placenta to connect the mother's blood supply with the embryo's. Fish have both non-specific and immune defenses against disease. Non-specific defenses include the skin and scales, as well as the mucus layer secreted by the epidermis that traps and inhibits the growth of microorganisms . If pathogens breach these defenses, the innate immune system can mount an inflammatory response that increases blood flow to the infected region and delivers white blood cells that attempt to destroy pathogens, non-specifically. Specific defenses respond to particular antigens, such as proteins on the surfaces of pathogenic bacteria , recognised by the adaptive immune system . Immune systems evolved in deuterostomes as shown in the cladogram. Echinoderms , hemichordates , cephalochordates , urochordates Jawless fishes Jawed fishes and tetrapods Immune organs vary by type of fish. The jawless fish have lymphoid tissue within the anterior kidney , and granulocytes in the gut. They have their own type of adaptive immune system ; it makes use of variable lymphocyte receptors (VLR) to generate immunity to a wide range of antigens, The result is much like that of jawed fishes and tetrapods, but it may have evolved separately . All jawed fishes have an adaptive immune system with B and T lymphocytes bearing immunoglobulins and T cell receptors respectively. This makes use of Variable–Diversity–Joining rearrangement (V(D)J) to create immunity to a wide range of antigens. This system evolved once and is basal to the jawed vertebrate clade. Cartilaginous fish have three specialized organs that contain immune system cells: the epigonal organs around the gonads, Leydig's organ within the esophagus, and a spiral valve in their intestine, while their thymus and spleen have similar functions to those of the same organs in the immune systems of tetrapods. Teleosts have lymphocytes in the thymus, and other immune cells in the spleen and other organs. The body of a typical fish is adapted for efficient swimming by alternately contracting paired sets of muscles on either side of the backbone. These contractions form S-shaped curves that move down the body. As each curve reaches the tail fin, force is applied to the water, moving the fish forward. The other fins act as control surfaces like an aircraft's flaps, enabling the fish to steer in any direction. Since body tissue is denser than water, fish must compensate for the difference or they will sink. Many bony fish have an internal organ called a swim bladder that allows them to adjust their buoyancy by increasing or decreasing the amount of gas it contains. The scales of fish provide protection from predators at the cost of adding stiffness and weight. Fish scales are often highly reflective; this silvering provides camouflage in the open ocean. Because the water all around is the same colour, reflecting an image of the water offers near-invisibility. Fish have a closed-loop circulatory system . The heart pumps the blood in a single loop throughout the body; for comparison, the mammal heart has two loops, one for the lungs to pick up oxygen, one for the body to deliver the oxygen. In fish, the heart pumps blood through the gills. Oxygen-rich blood then flows without further pumping, unlike in mammals, to the body tissues. Finally, oxygen-depleted blood returns to the heart. Fish exchange gases using gills on either side of the pharynx . Gills consist of comblike structures called filaments. Each filament contains a capillary network that provides a large surface area for exchanging oxygen and carbon dioxide . Fish exchange gases by pulling oxygen-rich water through their mouths and pumping it over their gills. Capillary blood in the gills flows in the opposite direction to the water, resulting in efficient countercurrent exchange . The gills push the oxygen-poor water out through openings in the sides of the pharynx. Cartilaginous fish have multiple gill openings: sharks usually have five, sometimes six or seven pairs; they often have to swim to oxygenate their gills. Bony fish have a single gill opening on each side, hidden beneath a protective bony cover or operculum . They are able to oxygenate their gills using muscles in the head. Some 400 species of fish in 50 families can breathe air, enabling them to live in oxygen-poor water or to emerge on to land. The ability of fish to do this is potentially limited by their single-loop circulation, as oxygenated blood from their air-breathing organ will mix with deoxygenated blood returning to the heart from the rest of the body. Lungfish, bichirs, ropefish, bowfins, snakefish, and the African knifefish have evolved to reduce such mixing, and to reduce oxygen loss from the gills to oxygen-poor water. Bichirs and lungfish have tetrapod-like paired lungs, requiring them to surface to gulp air, and making them obligate air breathers. Many other fish, including inhabitants of rock pools and the intertidal zone , are facultative air breathers, able to breathe air when out of water, as may occur daily at low tide , and to use their gills when in water. Some coastal fish like rockskippers and mudskippers choose to leave the water to feed in habitats temporarily exposed to the air. Some catfish absorb air through their digestive tracts. Fish exchange gases using gills on either side of the pharynx . Gills consist of comblike structures called filaments. Each filament contains a capillary network that provides a large surface area for exchanging oxygen and carbon dioxide . Fish exchange gases by pulling oxygen-rich water through their mouths and pumping it over their gills. Capillary blood in the gills flows in the opposite direction to the water, resulting in efficient countercurrent exchange . The gills push the oxygen-poor water out through openings in the sides of the pharynx. Cartilaginous fish have multiple gill openings: sharks usually have five, sometimes six or seven pairs; they often have to swim to oxygenate their gills. Bony fish have a single gill opening on each side, hidden beneath a protective bony cover or operculum . They are able to oxygenate their gills using muscles in the head. Some 400 species of fish in 50 families can breathe air, enabling them to live in oxygen-poor water or to emerge on to land. The ability of fish to do this is potentially limited by their single-loop circulation, as oxygenated blood from their air-breathing organ will mix with deoxygenated blood returning to the heart from the rest of the body. Lungfish, bichirs, ropefish, bowfins, snakefish, and the African knifefish have evolved to reduce such mixing, and to reduce oxygen loss from the gills to oxygen-poor water. Bichirs and lungfish have tetrapod-like paired lungs, requiring them to surface to gulp air, and making them obligate air breathers. Many other fish, including inhabitants of rock pools and the intertidal zone , are facultative air breathers, able to breathe air when out of water, as may occur daily at low tide , and to use their gills when in water. Some coastal fish like rockskippers and mudskippers choose to leave the water to feed in habitats temporarily exposed to the air. Some catfish absorb air through their digestive tracts. The digestive system consists of a tube, the gut, leading from the mouth to the anus. The mouth of most fishes contains teeth to grip prey, bite off or scrape plant material, or crush the food. An esophagus carries foot to the stomach where food may be stored and partially digested. A sphincter, the pylorus, releases food to the intestine at intervals. Many fish have finger-shaped pouches, pyloric caeca , around the pylorus, of doubtful function. The pancreas secretes enzymes into the intestine to digest the food; other enzymes are secreted directly by the intestine itself. The liver produces bile which helps to break up fat into an emulsion which can be absorbed in the intestine. Most fish release their nitrogenous wastes as ammonia . This may be excreted through the gills or filtered by the kidneys . Salt is excreted by the rectal gland. Saltwater fish tend to lose water by osmosis ; their kidneys return water to the body, and produce a concentrated urine. The reverse happens in freshwater fish : they tend to gain water osmotically, and produce a dilute urine. Some fish have kidneys able to operate in both freshwater and saltwater. Fish have small brains relative to body size compared with other vertebrates, typically one-fifteenth the brain mass of a similarly sized bird or mammal. However, some fish have relatively large brains, notably mormyrids and sharks , which have brains about as large for their body weight as birds and marsupials . At the front of the brain are the olfactory lobes , a pair of structures that receive and process signals from the nostrils via the two olfactory nerves . Fish that hunt primarily by smell, such as hagfish and sharks, have very large olfactory lobes. Behind these is the telencephalon , which in fish deals mostly with olfaction. Together these structures form the forebrain. Connecting the forebrain to the midbrain is the diencephalon ; it works with hormones and homeostasis . The pineal body is just above the diencephalon; it detects light, maintains circadian rhythms, and controls color changes. The midbrain contains the two optic lobes . These are very large in species that hunt by sight, such as rainbow trout and cichlids . The hindbrain controls swimming and balance.The single-lobed cerebellum is the biggest part of the brain; it is small in hagfish and lampreys , but very large in mormyrids , processing their electrical sense . The brain stem or myelencephalon controls some muscles and body organs, and governs respiration and osmoregulation . The lateral line system is a network of sensors in the skin which detects gentle currents and vibrations, and senses the motion of nearby fish, whether predators or prey. This can be considered both a sense of touch and of hearing . Blind cave fish navigate almost entirely through the sensations from their lateral line system. Some fish, such as catfish and sharks, have the ampullae of Lorenzini , electroreceptors that detect weak electric currents on the order of millivolt. Vision is an important sensory system in fish. Fish eyes are similar to those of terrestrial vertebrates like birds and mammals, but have a more spherical lens . Their retinas generally have both rods and cones (for scotopic and photopic vision ); many species have colour vision , often with three types of cone. Teleosts can see polarized light ; some such as cyprinids have a fourth type of cone that detects ultraviolet . Amongst jawless fish , the lamprey has well-developed eyes, while the hagfish has only primitive eye spots. Hearing too is an important sensory system in fish. Fish sense sound using their lateral lines and otoliths in their ears, inside their heads. Some can detect sound through the swim bladder. Some fish, including salmon, are capable of magnetoreception ; when the axis of a magnetic field is changed around a circular tank of young fish, they reorient themselves in line with the field. The mechanism of fish magnetoreception remains unknown; experiments in birds imply a quantum radical pair mechanism . The cognitive capacities of fish include self-awareness , as seen in mirror tests . Manta rays and wrasses placed in front of a mirror repeatedly check whether their reflection's behavior mimics their body movement. Choerodon wrasse, archerfish , and Atlantic cod can solve problems and invent tools. The monogamous cichlid Amatitlania siquia exhibits pessimistic behavior when prevented from being with its partner. Fish orient themselves using landmarks; they may use mental maps based on multiple landmarks. Fish are able to learn to traverse mazes, showing that they possess spatial memory and visual discrimination. Electric fish such as elephantfishes , the African knifefish , and electric eels have some of their muscles adapted to generate electric fields . They use the field to locate and identify objects such as prey in the waters around them, which may be turbid or dark. Strongly electric fish like the electric eel can in addition use their electric organs to generate shocks powerful enough to stun their prey. Most fish are exclusively cold-blooded or ectothermic . However, the Scombroidei are warm-blooded (endothermic), including the billfishes and tunas. The opah , a lampriform , uses whole-body endothermy, generating heat with its swimming muscles to warm its body while countercurrent exchange minimizes heat loss. Among the cartilaginous fishes, sharks of the families Lamnidae (such as the great white shark) and Alopiidae (thresher sharks) are endothermic. The degree of endothermy varies from the billfishes, which warm only their eyes and brain, to the bluefin tuna and the porbeagle shark , which maintain body temperatures more than 20 °C (68 °F) above the ambient water. The primary reproductive organs are paired testicles and ovaries . Eggs are released from the ovary to the oviducts . Over 97% of fish, including salmon and goldfish, are oviparous , meaning that the eggs are shed into the water and develop outside the mother's body. The eggs are usually fertilized outside the mother's body, with the male and female fish shedding their gametes into the surrounding water. In a few oviparous fish, such as the skates , fertilization is internal: the male uses an intromittent organ to deliver sperm into the female's genital opening of the female. Marine fish release large numbers of small eggs into the open water column. Newly hatched young of oviparous fish are planktonic larvae . They have a large yolk sac and do not resemble juvenile or adult fish. The larval period in oviparous fish is usually only some weeks, and larvae rapidly grow and change in structure to become juveniles. During this transition, larvae must switch from their yolk sac to feeding on zooplankton prey. Some fish such as surf-perches , splitfins , and lemon sharks are viviparous or live-bearing, meaning that the mother retains the eggs and nourishes the embryos via a structure analogous to the placenta to connect the mother's blood supply with the embryo's. Fish have both non-specific and immune defenses against disease. Non-specific defenses include the skin and scales, as well as the mucus layer secreted by the epidermis that traps and inhibits the growth of microorganisms . If pathogens breach these defenses, the innate immune system can mount an inflammatory response that increases blood flow to the infected region and delivers white blood cells that attempt to destroy pathogens, non-specifically. Specific defenses respond to particular antigens, such as proteins on the surfaces of pathogenic bacteria , recognised by the adaptive immune system . Immune systems evolved in deuterostomes as shown in the cladogram. Echinoderms , hemichordates , cephalochordates , urochordates Jawless fishes Jawed fishes and tetrapods Immune organs vary by type of fish. The jawless fish have lymphoid tissue within the anterior kidney , and granulocytes in the gut. They have their own type of adaptive immune system ; it makes use of variable lymphocyte receptors (VLR) to generate immunity to a wide range of antigens, The result is much like that of jawed fishes and tetrapods, but it may have evolved separately . All jawed fishes have an adaptive immune system with B and T lymphocytes bearing immunoglobulins and T cell receptors respectively. This makes use of Variable–Diversity–Joining rearrangement (V(D)J) to create immunity to a wide range of antigens. This system evolved once and is basal to the jawed vertebrate clade. Cartilaginous fish have three specialized organs that contain immune system cells: the epigonal organs around the gonads, Leydig's organ within the esophagus, and a spiral valve in their intestine, while their thymus and spleen have similar functions to those of the same organs in the immune systems of tetrapods. Teleosts have lymphocytes in the thymus, and other immune cells in the spleen and other organs. A shoal is a loosely organised group where each fish swims and forages independently but is attracted to other members of the group and adjusts its behaviour, such as swimming speed, so that it remains close to the other members of the group. A school is a much more tightly organised group, synchronising its swimming so that all fish move at the same speed and in the same direction. Schooling is sometimes an antipredator adaptation , offering improved vigilance against predators. It is often more efficient to gather food by working as a group, and individual fish optimise their strategies by choosing to join or leave a shoal. When a predator has been noticed, prey fish respond defensively, resulting in collective shoal behaviours such as synchronised movements. Responses do not consist only of attempting to hide or flee; antipredator tactics include for example scattering and reassembling. Fish also aggregate in shoals to spawn. The capelin migrates annually in large schools between its feeding areas and its spawning grounds. Fish communicate by transmitting acoustic signals (sounds) to each other. This is most often in the context of feeding, aggression or courtship. The sounds emitted vary with the species and stimulus involved. Fish can produce either stridulatory sounds by moving components of the skeletal system, or can produce non-stridulatory sounds by manipulating specialized organs such as the swimbladder. Some fish produce sounds by rubbing or grinding their bones together. These sounds are stridulatory. In Haemulon flavolineatum , the French grunt fish, as it produces a grunting noise by grinding its teeth together, especially when in distress. The grunts are at a frequency of around 700 Hz, and last approximately 47 milliseconds. The longsnout seahorse, Hippocampus reidi produces two categories of sounds, 'clicks' and 'growls', by rubbing their coronet bone across the grooved section of their neurocranium. Clicks are produced during courtship and feeding, and the frequencies of clicks were within the range of 50 Hz-800 Hz. The frequencies are at the higher end of the range during spawning, when the female and male fishes were less than fifteen centimeters apart. Growls are produced when the H. reidi are stressed. The 'growl' sounds consist of a series of sound pulses and are emitted simultaneously with body vibrations. Some fish species create noise by engaging specialized muscles that contract and cause swimbladder vibrations. Oyster toadfish produce loud grunts by contracting sonic muscles along the sides of the swim bladder. Female and male toadfishes emit short-duration grunts, often as a fright response. In addition to short-duration grunts, male toadfishes produce "boat whistle calls". These calls are longer in duration, lower in frequency, and are primarily used to attract mates. The various sounds have frequency range of 140 Hz to 260 Hz. The frequencies of the calls depend on the rate at which the sonic muscles contract. The red drum, Sciaenops ocellatus , produces drumming sounds by vibrating its swimbladder. Vibrations are caused by the rapid contraction of sonic muscles that surround the dorsal aspect of the swimbladder. These vibrations result in repeated sounds with frequencies from 100 to >200 Hz. S. ocellatus produces different calls depending on the stimuli involved, such as courtship or a predator's attack. Females do not produce sounds, and lack sound-producing (sonic) muscles. A shoal is a loosely organised group where each fish swims and forages independently but is attracted to other members of the group and adjusts its behaviour, such as swimming speed, so that it remains close to the other members of the group. A school is a much more tightly organised group, synchronising its swimming so that all fish move at the same speed and in the same direction. Schooling is sometimes an antipredator adaptation , offering improved vigilance against predators. It is often more efficient to gather food by working as a group, and individual fish optimise their strategies by choosing to join or leave a shoal. When a predator has been noticed, prey fish respond defensively, resulting in collective shoal behaviours such as synchronised movements. Responses do not consist only of attempting to hide or flee; antipredator tactics include for example scattering and reassembling. Fish also aggregate in shoals to spawn. The capelin migrates annually in large schools between its feeding areas and its spawning grounds. Fish communicate by transmitting acoustic signals (sounds) to each other. This is most often in the context of feeding, aggression or courtship. The sounds emitted vary with the species and stimulus involved. Fish can produce either stridulatory sounds by moving components of the skeletal system, or can produce non-stridulatory sounds by manipulating specialized organs such as the swimbladder. Some fish produce sounds by rubbing or grinding their bones together. These sounds are stridulatory. In Haemulon flavolineatum , the French grunt fish, as it produces a grunting noise by grinding its teeth together, especially when in distress. The grunts are at a frequency of around 700 Hz, and last approximately 47 milliseconds. The longsnout seahorse, Hippocampus reidi produces two categories of sounds, 'clicks' and 'growls', by rubbing their coronet bone across the grooved section of their neurocranium. Clicks are produced during courtship and feeding, and the frequencies of clicks were within the range of 50 Hz-800 Hz. The frequencies are at the higher end of the range during spawning, when the female and male fishes were less than fifteen centimeters apart. Growls are produced when the H. reidi are stressed. The 'growl' sounds consist of a series of sound pulses and are emitted simultaneously with body vibrations. Some fish species create noise by engaging specialized muscles that contract and cause swimbladder vibrations. Oyster toadfish produce loud grunts by contracting sonic muscles along the sides of the swim bladder. Female and male toadfishes emit short-duration grunts, often as a fright response. In addition to short-duration grunts, male toadfishes produce "boat whistle calls". These calls are longer in duration, lower in frequency, and are primarily used to attract mates. The various sounds have frequency range of 140 Hz to 260 Hz. The frequencies of the calls depend on the rate at which the sonic muscles contract. The red drum, Sciaenops ocellatus , produces drumming sounds by vibrating its swimbladder. Vibrations are caused by the rapid contraction of sonic muscles that surround the dorsal aspect of the swimbladder. These vibrations result in repeated sounds with frequencies from 100 to >200 Hz. S. ocellatus produces different calls depending on the stimuli involved, such as courtship or a predator's attack. Females do not produce sounds, and lack sound-producing (sonic) muscles. The 2024 IUCN Red List names 2,168 fish species that are endangered or critically endangered. Included are species such as Atlantic cod , Devil's Hole pupfish , coelacanths , and great white sharks . Because fish live underwater they are more difficult to study than terrestrial animals and plants, and information about fish populations is often lacking. However, freshwater fish seem particularly threatened because they often live in relatively small water bodies. For example, the Devil's Hole pupfish occupies only a single 3 by 6 metres (10 by 20 ft) pool. The Food and Agriculture Organization reports that "in 2017, 34 percent of the fish stocks of the world's marine fisheries were classified as overfished". Overfishing is a major threat to edible fish such as cod and tuna . Overfishing eventually causes fish stocks to collapse, because the survivors cannot produce enough young to replace those removed. Such commercial extinction does not mean that the species is extinct, merely that it can no longer sustain a fishery. In the case of the Pacific sardine fishery off the California coast, the catch steadily declined from a 1937 peak of 800,000 tonnes to an economically inviable 24,000 tonnes in 1968. In the case of the Atlantic northwest cod fishery , overfishing reduced the fish population to 1% of its historical level by 1992. Fisheries scientists and the fishing industry have sharply differing views on the resiliency of fisheries to intensive fishing. In many coastal regions the fishing industry is a major employer, so governments are predisposed to support it. On the other hand, scientists and conservationists push for stringent protection, warning that many stocks could be destroyed within fifty years. A key stress on both freshwater and marine ecosystems is habitat degradation including water pollution , the building of dams, removal of water for use by humans, and the introduction of exotic species including predators. Freshwater fish, especially if endemic to a region (occurring nowhere else), may be threatened with extinction for all these reasons, as is the case for three of Spain's ten endemic freshwater fishes. River dams, especially major schemes like the Kariba Dam (Zambezi river) and the Aswan Dam ( River Nile ) on rivers with economically important fisheries, have caused large reductions in fish catch. Industrial bottom trawling can damage seabed habitats , as has occurred on the Georges Bank in the North Atlantic. Introduction of aquatic invasive species is widespread. It modifies ecosystems, causing biodiversity loss, and can harm fisheries. Harmful species include fish but are not limited to them; the arrival of a comb jelly in the Black Sea damaged the anchovy fishery there. The opening of the Suez Canal in 1869 has created Lessepsian migration , in which hundreds of species of fish, algae, and invertebrates have entered the Mediterranean Sea , changing its ecology. The predatory Nile perch was deliberately introduced to Lake Victoria in the 1960s as a commercial and sports fish. The lake had high biodiversity, with some 500 endemic species of cichlid fish. It drastically altered the lake's ecology, and simplified the fishery from multi-species to just three: the Nile perch, the silver cyprinid , and another introduced fish, the Nile tilapia . The haplochromine cichlid populations have collapsed. The Food and Agriculture Organization reports that "in 2017, 34 percent of the fish stocks of the world's marine fisheries were classified as overfished". Overfishing is a major threat to edible fish such as cod and tuna . Overfishing eventually causes fish stocks to collapse, because the survivors cannot produce enough young to replace those removed. Such commercial extinction does not mean that the species is extinct, merely that it can no longer sustain a fishery. In the case of the Pacific sardine fishery off the California coast, the catch steadily declined from a 1937 peak of 800,000 tonnes to an economically inviable 24,000 tonnes in 1968. In the case of the Atlantic northwest cod fishery , overfishing reduced the fish population to 1% of its historical level by 1992. Fisheries scientists and the fishing industry have sharply differing views on the resiliency of fisheries to intensive fishing. In many coastal regions the fishing industry is a major employer, so governments are predisposed to support it. On the other hand, scientists and conservationists push for stringent protection, warning that many stocks could be destroyed within fifty years. A key stress on both freshwater and marine ecosystems is habitat degradation including water pollution , the building of dams, removal of water for use by humans, and the introduction of exotic species including predators. Freshwater fish, especially if endemic to a region (occurring nowhere else), may be threatened with extinction for all these reasons, as is the case for three of Spain's ten endemic freshwater fishes. River dams, especially major schemes like the Kariba Dam (Zambezi river) and the Aswan Dam ( River Nile ) on rivers with economically important fisheries, have caused large reductions in fish catch. Industrial bottom trawling can damage seabed habitats , as has occurred on the Georges Bank in the North Atlantic. Introduction of aquatic invasive species is widespread. It modifies ecosystems, causing biodiversity loss, and can harm fisheries. Harmful species include fish but are not limited to them; the arrival of a comb jelly in the Black Sea damaged the anchovy fishery there. The opening of the Suez Canal in 1869 has created Lessepsian migration , in which hundreds of species of fish, algae, and invertebrates have entered the Mediterranean Sea , changing its ecology. The predatory Nile perch was deliberately introduced to Lake Victoria in the 1960s as a commercial and sports fish. The lake had high biodiversity, with some 500 endemic species of cichlid fish. It drastically altered the lake's ecology, and simplified the fishery from multi-species to just three: the Nile perch, the silver cyprinid , and another introduced fish, the Nile tilapia . The haplochromine cichlid populations have collapsed. Throughout history, humans have used fish as a food source for dietary protein . Historically and today, most fish harvested for human consumption has come by means of catching wild fish. However, fish farming, which has been practiced since about 3,500 BCE in ancient China, is becoming increasingly important in many nations. Overall, about one-sixth of the world's protein is estimated to be provided by fish. Fishing is accordingly a large global business which provides income for millions of people. The Environmental Defense Fund has a guide on which fish are safe to eat, given the state of pollution in today's world, and which fish are obtained in a sustainable way. As of 2020, over 65 million tonnes (Mt) of marine fish and 10 Mt of freshwater fish were captured, while some 50 Mt of fish, mainly freshwater, were farmed. Of the marine species captured in 2020, anchoveta represented 4.9 Mt, Alaska pollock 3.5 Mt, skipjack tuna 2.8 Mt, and Atlantic herring and yellowfin tuna 1.6 Mt each; eight more species had catches over 1 Mt. Fish have been recognized as a source of beauty for almost as long as used for food, appearing in cave art , being raised as ornamental fish in ponds, and displayed in aquariums in homes, offices, or public settings. Recreational fishing is fishing primarily for pleasure or competition; it can be contrasted with commercial fishing, which is fishing for profit, or artisanal fishing , which is fishing primarily for food. The most common form of recreational fishing employs a rod , reel , line , hooks , and a wide range of baits . Recreational fishing is particularly popular in North America and Europe; government agencies often actively manage target fish species. Fish themes have symbolic significance in many religions. In ancient Mesopotamia , fish offerings were made to the gods from the very earliest times. Fish were also a major symbol of Enki , the god of water. Fish frequently appear as filling motifs in cylinder seals from the Old Babylonian ( c. 1830 BC – c. 1531 BC) and Neo-Assyrian (911–609 BC) periods. Starting during the Kassite Period ( c. 1600 BC – c. 1155 BC) and lasting until the early Persian Period (550–30 BC), healers and exorcists dressed in ritual garb resembling the bodies of fish. During the Seleucid Period (312–63 BC), the legendary Babylonian culture hero Oannes was said to have dressed in the skin of a fish. Fish were sacred to the Syrian goddess Atargatis and, during her festivals, only her priests were permitted to eat them. In the Book of Jonah , the central figure, a prophet named Jonah , is swallowed by a giant fish after being thrown overboard by the crew of the ship he is travelling on. Early Christians used the ichthys , a symbol of a fish, to represent Jesus. Among the deities said to take the form of a fish are Ikatere of the Polynesians , the shark-god Kāmohoaliʻi of Hawai ʻ i , and Matsya of the Hindus. The constellation Pisces ("The Fishes") is associated with a legend from Ancient Rome that Venus and her son Cupid were rescued by two fishes. Fish feature prominently in art, in films such as Finding Nemo and books such as The Old Man and the Sea . Large fish, particularly sharks, have frequently been the subject of horror movies and thrillers , notably the novel Jaws , made into a film which in turn has been parodied and imitated many times. Piranhas are shown in a similar light to sharks in films such as Piranha . Throughout history, humans have used fish as a food source for dietary protein . Historically and today, most fish harvested for human consumption has come by means of catching wild fish. However, fish farming, which has been practiced since about 3,500 BCE in ancient China, is becoming increasingly important in many nations. Overall, about one-sixth of the world's protein is estimated to be provided by fish. Fishing is accordingly a large global business which provides income for millions of people. The Environmental Defense Fund has a guide on which fish are safe to eat, given the state of pollution in today's world, and which fish are obtained in a sustainable way. As of 2020, over 65 million tonnes (Mt) of marine fish and 10 Mt of freshwater fish were captured, while some 50 Mt of fish, mainly freshwater, were farmed. Of the marine species captured in 2020, anchoveta represented 4.9 Mt, Alaska pollock 3.5 Mt, skipjack tuna 2.8 Mt, and Atlantic herring and yellowfin tuna 1.6 Mt each; eight more species had catches over 1 Mt. Fish have been recognized as a source of beauty for almost as long as used for food, appearing in cave art , being raised as ornamental fish in ponds, and displayed in aquariums in homes, offices, or public settings. Recreational fishing is fishing primarily for pleasure or competition; it can be contrasted with commercial fishing, which is fishing for profit, or artisanal fishing , which is fishing primarily for food. The most common form of recreational fishing employs a rod , reel , line , hooks , and a wide range of baits . Recreational fishing is particularly popular in North America and Europe; government agencies often actively manage target fish species. Fish themes have symbolic significance in many religions. In ancient Mesopotamia , fish offerings were made to the gods from the very earliest times. Fish were also a major symbol of Enki , the god of water. Fish frequently appear as filling motifs in cylinder seals from the Old Babylonian ( c. 1830 BC – c. 1531 BC) and Neo-Assyrian (911–609 BC) periods. Starting during the Kassite Period ( c. 1600 BC – c. 1155 BC) and lasting until the early Persian Period (550–30 BC), healers and exorcists dressed in ritual garb resembling the bodies of fish. During the Seleucid Period (312–63 BC), the legendary Babylonian culture hero Oannes was said to have dressed in the skin of a fish. Fish were sacred to the Syrian goddess Atargatis and, during her festivals, only her priests were permitted to eat them. In the Book of Jonah , the central figure, a prophet named Jonah , is swallowed by a giant fish after being thrown overboard by the crew of the ship he is travelling on. Early Christians used the ichthys , a symbol of a fish, to represent Jesus. Among the deities said to take the form of a fish are Ikatere of the Polynesians , the shark-god Kāmohoaliʻi of Hawai ʻ i , and Matsya of the Hindus. The constellation Pisces ("The Fishes") is associated with a legend from Ancient Rome that Venus and her son Cupid were rescued by two fishes. Fish feature prominently in art, in films such as Finding Nemo and books such as The Old Man and the Sea . Large fish, particularly sharks, have frequently been the subject of horror movies and thrillers , notably the novel Jaws , made into a film which in turn has been parodied and imitated many times. Piranhas are shown in a similar light to sharks in films such as Piranha .

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Berlin

Berlin ( / b ɜːr ˈ l ɪ n / , bur- LIN ; German: [ bɛʁˈliːn ] ⓘ ) is the capital and largest city of Germany , both by area and by population . Its more than 3.85 million inhabitants make it the European Union 's most populous city , as measured by population within city limits. Simultaneously, the city is one of the states of Germany and is the third smallest state in the country in terms of area. Berlin is surrounded by the state of Brandenburg , and Brandenburg's capital Potsdam is nearby. The urban area of Berlin has a population of 4.5 million and is therefore the most populous urban area in Germany. The Berlin-Brandenburg capital region has around 6.2 million inhabitants and is Germany's second-largest metropolitan region after the Rhine-Ruhr region, and the fifth-biggest metropolitan region by GDP in the European Union. Berlin was built along the banks of the Spree river, which flows into the Havel in the western borough of Spandau . The city incorporates lakes in the western and southeastern boroughs, the largest of which is Müggelsee . About one-third of the city's area is composed of forests, parks and gardens , rivers, canals, and lakes. First documented in the 13th century and at the crossing of two important historic trade routes , Berlin was designated the capital of the Margraviate of Brandenburg (1417–1701), Kingdom of Prussia (1701–1918), German Empire (1871–1918), Weimar Republic (1919–1933), and Nazi Germany (1933–1945). Berlin has served as a scientific, artistic, and philosophical hub during the Age of Enlightenment , Neoclassicism , and the German revolutions of 1848–1849 . During the Gründerzeit , an industrialization-induced economic boom triggered a rapid population increase in Berlin. 1920s Berlin was the third-largest city in the world by population. After World War II and following Berlin's occupation, the city was split into West Berlin and East Berlin , divided by the Berlin Wall . East Berlin was declared the capital of East Germany, while Bonn became the West German capital. Following German reunification in 1990, Berlin once again became the capital of all of Germany. The economy of Berlin is based on high tech and the service sector , encompassing a diverse range of creative industries , startup companies , research facilities, and media corporations. Berlin serves as a continental hub for air and rail traffic and has a complex public transportation network. Tourism in Berlin make the city a popular global destination. Significant industries include information technology, the healthcare industry , biomedical engineering , biotechnology , the automotive industry , and electronics . Berlin is home to several universities such as the Humboldt University of Berlin , the Technical University of Berlin , the Berlin University of the Arts and the Free University of Berlin . The Berlin Zoological Garden is the most visited zoo in Europe. Babelsberg Studio is the world's first large-scale movie studio complex and the list of films set in Berlin is long. Berlin is also home to three World Heritage Sites . Museum Island , the Palaces and Parks of Potsdam and Berlin , and the Berlin Modernism Housing Estates . Other landmarks include the Brandenburg Gate , the Reichstag building , Potsdamer Platz , the Memorial to the Murdered Jews of Europe , and the Berlin Wall Memorial . Berlin has numerous museums, galleries, and libraries.Margraviate of Brandenburg 1237–1618 Brandenburg-Prussia 1618–1701 Kingdom of Prussia 1701–1867 North German Confederation 1867–1871 German Empire 1871–1918 Weimar Republic 1918–1933 Nazi Germany 1933–1945 Allied-occupied Germany 1945–1949 West Germany 1949–1990 East Germany 1949–1990 Germany 1990–present Berlin lies in northeastern Germany. Most of the cities and villages in northeastern Germany bear Slavic languages -derived names. Typical Germanization for place name suffixes of Slavic origin are -ow, -itz, -vitz, -witz, -itzsch and -in , prefixes are Windisch and Wendisch . The name Berlin has its roots in the language of the West Slavs , and may be related to the Old Polabian stem berl-/birl- ("swamp"). Of Berlin's twelve boroughs , five bear a Slavic-derived name: Pankow , Steglitz-Zehlendorf , Marzahn-Hellersdorf , Treptow-Köpenick , and Spandau . Of Berlin's ninety-six neighborhoods, twenty-two bear a Slavic-derived name: Altglienicke , Alt-Treptow , Britz , Buch , Buckow , Gatow , Karow , Kladow , Köpenick , Lankwitz , Lübars , Malchow , Marzahn , Pankow , Prenzlauer Berg , Rudow , Schmöckwitz , Spandau , Stadtrandsiedlung Malchow , Steglitz , Tegel and Zehlendorf . The earliest human settlements in the area of modern Berlin are dated around 60,000 BC. A deer mask, dated to 9,000 BC, is attributed to the Maglemosian culture . In 2,000 BC dense human settlements along the Spree and Havel rivers gave rise to the Lusatian culture . Starting around 500 BC Germanic tribes settled in a number of villages in the higher situated areas of today's Berlin. After the Semnones left around 200 AD, the Burgundians followed. In the 7th century Slavic tribes, the later known Hevelli and Sprevane , reached the region. In the 12th century the region came under German rule as part of the Margraviate of Brandenburg , founded by Albert the Bear in 1157. Early evidence of middle age settlements in the area of today's Berlin are remnants of a house foundation dated 1270 to 1290, found in excavations in Berlin Mitte . The first written records of towns in the area of present-day Berlin date from the late 12th century. Spandau is first mentioned in 1197 and Köpenick in 1209. 1237 is considered the founding date of the city. The two towns over time formed close economic and social ties, and profited from the staple right on the two important trade routes , one was known as Via Imperii , and the other trade route reached from Bruges to Novgorod . In 1307 the two towns formed an alliance with a common external policy, their internal administrations still being separated. Members of the Hohenzollern family ruled in Berlin until 1918, first as electors of Brandenburg, then as kings of Prussia , and eventually as German emperors . In 1443, Frederick II Irontooth started the construction of a new royal palace in the twin city Berlin-Cölln. The protests of the town citizens against the building culminated in 1448, in the "Berlin Indignation" ("Berliner Unwille"). Officially, the Berlin-Cölln palace became permanent residence of the Brandenburg electors of the Hohenzollerns from 1486, when John Cicero came to power. Berlin-Cölln, however, had to give up its status as a free Hanseatic League city. In 1539, the electors and the city officially became Lutheran . The Thirty Years' War between 1618 and 1648 devastated Berlin. One third of its houses were damaged or destroyed, and the city lost half of its population. Frederick William , known as the "Great Elector", who had succeeded his father George William as ruler in 1640, initiated a policy of promoting immigration and religious tolerance. With the Edict of Potsdam in 1685, Frederick William offered asylum to the French Huguenots . By 1700, approximately 30 percent of Berlin's residents were French, because of the Huguenot immigration. Many other immigrants came from Bohemia , Poland , and Salzburg . Since 1618, the Margraviate of Brandenburg had been in personal union with the Duchy of Prussia . In 1701, the dual state formed the Kingdom of Prussia , as Frederick III, Elector of Brandenburg , crowned himself as king Frederick I in Prussia . Berlin became the capital of the new Kingdom, replacing Königsberg . This was a successful attempt to centralise the capital in the very far-flung state, and it was the first time the city began to grow. In 1709, Berlin merged with the four cities of Cölln, Friedrichswerder, Friedrichstadt and Dorotheenstadt under the name Berlin, "Haupt- und Residenzstadt Berlin". In 1740, Frederick II, known as Frederick the Great (1740–1786), came to power. Under the rule of Frederick II, Berlin became a center of the Enlightenment , but also, was briefly occupied during the Seven Years' War by the Russian army. Following France's victory in the War of the Fourth Coalition , Napoleon Bonaparte marched into Berlin in 1806 , but granted self-government to the city. In 1815, the city became part of the new Province of Brandenburg . The Industrial Revolution transformed Berlin during the 19th century; the city's economy and population expanded dramatically, and it became the main railway hub and economic center of Germany. Additional suburbs soon developed and increased the area and population of Berlin. In 1861, neighboring suburbs including Wedding , Moabit and several others were incorporated into Berlin. In 1871, Berlin became capital of the newly founded German Empire . In 1881, it became a city district separate from Brandenburg. In the early 20th century, Berlin had become a fertile ground for the German Expressionist movement. In fields such as architecture, painting and cinema new forms of artistic styles were invented. At the end of the First World War in 1918, a republic was proclaimed by Philipp Scheidemann at the Reichstag building . In 1920, the Greater Berlin Act incorporated dozens of suburban cities, villages, and estates around Berlin into an expanded city. The act increased the area of Berlin from 66 to 883 km 2 (25 to 341 sq mi) . The population almost doubled, and Berlin had a population of around four million. During the Weimar era , Berlin underwent political unrest due to economic uncertainties but also became a renowned center of the Roaring Twenties . The metropolis experienced its heyday as a major world capital and was known for its leadership roles in science, technology, arts, the humanities, city planning, film, higher education, government, and industries. Albert Einstein rose to public prominence during his years in Berlin, being awarded the Nobel Prize for Physics in 1921. In 1933, Adolf Hitler and the Nazi Party came to power . Hitler was inspired by the architecture he had experienced in Vienna , and he wished for a German Empire with a capital city that had a monumental ensemble. The National Socialist regime embarked on monumental construction projects in Berlin as a way to express their power and authority through architecture . Adolf Hitler and Albert Speer developed architectural concepts for the conversion of the city into World Capital Germania ; these were never implemented. NSDAP rule diminished Berlin's Jewish community from 160,000 (one-third of all Jews in the country) to about 80,000 due to emigration between 1933 and 1939. After Kristallnacht in 1938, thousands of the city's Jews were imprisoned in the nearby Sachsenhausen concentration camp . Starting in early 1943, many were deported to ghettos like Łódź , and to concentration and extermination camps such as Auschwitz . Berlin hosted the 1936 Summer Olympics for which the Olympic stadium was built. During World War II , Berlin was the location of multiple Nazi prisons, forced labour camps, 17 subcamps of the Sachsenhausen concentration camp for men and women, including teenagers, of various nationalities, including Polish, Jewish, French, Belgian, Czechoslovak, Russian, Ukrainian, Romani, Dutch, Greek, Norwegian, Spanish, Luxembourgish, German, Austrian, Italian, Yugoslavian, Bulgarian, Hungarian, a camp for Sinti and Romani people (see Romani Holocaust ), and the Stalag III-D prisoner-of-war camp for Allied POWs of various nationalities. During World War II, large parts of Berlin were destroyed during 1943–45 Allied air raids and the 1945 Battle of Berlin . The Allies dropped 67,607 tons of bombs on the city, destroying 6,427 acres of the built-up area. Around 125,000 civilians were killed. After the end of World War II in Europe in May 1945, Berlin received large numbers of refugees from the Eastern provinces. The victorious powers divided the city into four sectors, analogous to Allied-occupied Germany the sectors of the Allies of World War II (the United States, the United Kingdom, and France) formed West Berlin , while the Soviet Union formed East Berlin . All four Allies of World War II shared administrative responsibilities for Berlin. However, in 1948, when the Western Allies extended the currency reform in the Western zones of Germany to the three western sectors of Berlin, the Soviet Union imposed the Berlin Blockade on the access routes to and from West Berlin, which lay entirely inside Soviet-controlled territory. The Berlin airlift , conducted by the three western Allies, overcame this blockade by supplying food and other supplies to the city from June 1948 to May 1949. In 1949, the Federal Republic of Germany was founded in West Germany and eventually included all of the American, British and French zones, excluding those three countries' zones in Berlin, while the Marxist–Leninist German Democratic Republic was proclaimed in East Germany . West Berlin officially remained an occupied city, but it politically was aligned with the Federal Republic of Germany despite West Berlin's geographic isolation. Airline service to West Berlin was granted only to American, British and French airlines. The founding of the two German states increased Cold War tensions. West Berlin was surrounded by East German territory, and East Germany proclaimed the Eastern part as its capital, a move the western powers did not recognize. East Berlin included most of the city's historic center. The West German government established itself in Bonn . In 1961, East Germany began to build the Berlin Wall around West Berlin, and events escalated to a tank standoff at Checkpoint Charlie . West Berlin was now de facto a part of West Germany with a unique legal status, while East Berlin was de facto a part of East Germany. John F. Kennedy gave his " Ich bin ein Berliner " speech on 26 June 1963, in front of the Schöneberg city hall, located in the city's western part, underlining the US support for West Berlin. Berlin was completely divided. Although it was possible for Westerners to pass to the other side through strictly controlled checkpoints, for most Easterners, travel to West Berlin or West Germany was prohibited by the government of East Germany. In 1971, a Four-Power agreement guaranteed access to and from West Berlin by car or train through East Germany. In 1989, with the end of the Cold War and pressure from the East German population, the Berlin Wall fell on 9 November and was subsequently mostly demolished. Today, the East Side Gallery preserves a large portion of the wall. On 3 October 1990, the two parts of Germany were reunified as the Federal Republic of Germany, and Berlin again became a reunified city. After the fall of the Berlin Wall, the city experienced significant urban development and still impacts urban planning decisions. Walter Momper, the mayor of West Berlin, became the first mayor of the reunified city in the interim. City-wide elections in December 1990 resulted in the first "all Berlin" mayor being elected to take office in January 1991, with the separate offices of mayors in East and West Berlin expiring by that time, and Eberhard Diepgen (a former mayor of West Berlin) became the first elected mayor of a reunited Berlin. On 18 June 1994, soldiers from the United States, France and Britain marched in a parade which was part of the ceremonies to mark the withdrawal of allied occupation troops allowing a reunified Berlin (the last Russian troops departed on 31 August, while the final departure of Western Allies forces was on 8 September 1994). On 20 June 1991, the Bundestag (German Parliament) voted to move the seat of the German capital from Bonn to Berlin, which was completed in 1999, during the chancellorship of Gerhard Schröder . Berlin's 2001 administrative reform merged several boroughs, reducing their number from 23 to 12. In 2006, the FIFA World Cup Final was held in Berlin. Construction of the "Berlin Wall Trail" (Berliner Mauerweg) began in 2002 and was completed in 2006. In a 2016 terrorist attack linked to ISIL , a truck was deliberately driven into a Christmas market next to the Kaiser Wilhelm Memorial Church , leaving 13 people dead and 55 others injured. In 2018, more than 200,000 protestors took to the streets in Berlin with demonstrations of solidarity against racism, in response to the emergence of far-right politics in Germany . Berlin Brandenburg Airport (BER) opened in 2020, nine years later than planned, with Terminal 1 coming into service at the end of October, and flights to and from Tegel Airport ending in November. Due to the fall in passenger numbers resulting from the COVID-19 pandemic , plans were announced to temporarily close BER's Terminal 5, the former Schönefeld Airport , beginning in March 2021 for up to one year. The connecting link of U-Bahn line U5 from Alexanderplatz to Hauptbahnhof, along with the new stations Rotes Rathaus and Unter den Linden, opened on 4 December 2020, with the Museumsinsel U-Bahn station expected to open around March 2021, which would complete all new works on the U5. A partial opening by the end of 2020 of the Humboldt Forum museum, housed in the reconstructed Berlin Palace , which had been announced in June, was postponed until March 2021. On 16 September 2022, the opening of the eastern wing, the last section of the Humboldt Forum museum, meant the Humboldt Forum museum was finally completed. It became Germany's currently most expensive cultural project. The legal basis for a combined state of Berlin and Brandenburg is different from other state fusion proposals. Normally, Article 29 of the Basic Law stipulates that a state fusion requires a federal law. However, a clause added to the Basic Law in 1994, Article 118a, allows Berlin and Brandenburg to unify without federal approval, requiring a referendum and a ratification by both state parliaments. In 1996, there was an unsuccessful attempt of unifying the states of Berlin and Brandenburg. Both share a common history, dialect and culture and in 2020, there are over 225.000 residents of Brandenburg that commute to Berlin. The fusion had the near-unanimous support by a broad coalition of both state governments, political parties, media, business associations, trade unions and churches. Though Berlin voted in favor by a small margin, largely based on support in former West Berlin , Brandenburg voters disapproved of the fusion by a large margin. It failed largely due to Brandenburg voters not wanting to take on Berlin's large and growing public debt and fearing losing identity and influence to the capital. Berlin lies in northeastern Germany. Most of the cities and villages in northeastern Germany bear Slavic languages -derived names. Typical Germanization for place name suffixes of Slavic origin are -ow, -itz, -vitz, -witz, -itzsch and -in , prefixes are Windisch and Wendisch . The name Berlin has its roots in the language of the West Slavs , and may be related to the Old Polabian stem berl-/birl- ("swamp"). Of Berlin's twelve boroughs , five bear a Slavic-derived name: Pankow , Steglitz-Zehlendorf , Marzahn-Hellersdorf , Treptow-Köpenick , and Spandau . Of Berlin's ninety-six neighborhoods, twenty-two bear a Slavic-derived name: Altglienicke , Alt-Treptow , Britz , Buch , Buckow , Gatow , Karow , Kladow , Köpenick , Lankwitz , Lübars , Malchow , Marzahn , Pankow , Prenzlauer Berg , Rudow , Schmöckwitz , Spandau , Stadtrandsiedlung Malchow , Steglitz , Tegel and Zehlendorf .The earliest human settlements in the area of modern Berlin are dated around 60,000 BC. A deer mask, dated to 9,000 BC, is attributed to the Maglemosian culture . In 2,000 BC dense human settlements along the Spree and Havel rivers gave rise to the Lusatian culture . Starting around 500 BC Germanic tribes settled in a number of villages in the higher situated areas of today's Berlin. After the Semnones left around 200 AD, the Burgundians followed. In the 7th century Slavic tribes, the later known Hevelli and Sprevane , reached the region.In the 12th century the region came under German rule as part of the Margraviate of Brandenburg , founded by Albert the Bear in 1157. Early evidence of middle age settlements in the area of today's Berlin are remnants of a house foundation dated 1270 to 1290, found in excavations in Berlin Mitte . The first written records of towns in the area of present-day Berlin date from the late 12th century. Spandau is first mentioned in 1197 and Köpenick in 1209. 1237 is considered the founding date of the city. The two towns over time formed close economic and social ties, and profited from the staple right on the two important trade routes , one was known as Via Imperii , and the other trade route reached from Bruges to Novgorod . In 1307 the two towns formed an alliance with a common external policy, their internal administrations still being separated. Members of the Hohenzollern family ruled in Berlin until 1918, first as electors of Brandenburg, then as kings of Prussia , and eventually as German emperors . In 1443, Frederick II Irontooth started the construction of a new royal palace in the twin city Berlin-Cölln. The protests of the town citizens against the building culminated in 1448, in the "Berlin Indignation" ("Berliner Unwille"). Officially, the Berlin-Cölln palace became permanent residence of the Brandenburg electors of the Hohenzollerns from 1486, when John Cicero came to power. Berlin-Cölln, however, had to give up its status as a free Hanseatic League city. In 1539, the electors and the city officially became Lutheran . The Thirty Years' War between 1618 and 1648 devastated Berlin. One third of its houses were damaged or destroyed, and the city lost half of its population. Frederick William , known as the "Great Elector", who had succeeded his father George William as ruler in 1640, initiated a policy of promoting immigration and religious tolerance. With the Edict of Potsdam in 1685, Frederick William offered asylum to the French Huguenots . By 1700, approximately 30 percent of Berlin's residents were French, because of the Huguenot immigration. Many other immigrants came from Bohemia , Poland , and Salzburg . Since 1618, the Margraviate of Brandenburg had been in personal union with the Duchy of Prussia . In 1701, the dual state formed the Kingdom of Prussia , as Frederick III, Elector of Brandenburg , crowned himself as king Frederick I in Prussia . Berlin became the capital of the new Kingdom, replacing Königsberg . This was a successful attempt to centralise the capital in the very far-flung state, and it was the first time the city began to grow. In 1709, Berlin merged with the four cities of Cölln, Friedrichswerder, Friedrichstadt and Dorotheenstadt under the name Berlin, "Haupt- und Residenzstadt Berlin". In 1740, Frederick II, known as Frederick the Great (1740–1786), came to power. Under the rule of Frederick II, Berlin became a center of the Enlightenment , but also, was briefly occupied during the Seven Years' War by the Russian army. Following France's victory in the War of the Fourth Coalition , Napoleon Bonaparte marched into Berlin in 1806 , but granted self-government to the city. In 1815, the city became part of the new Province of Brandenburg . The Industrial Revolution transformed Berlin during the 19th century; the city's economy and population expanded dramatically, and it became the main railway hub and economic center of Germany. Additional suburbs soon developed and increased the area and population of Berlin. In 1861, neighboring suburbs including Wedding , Moabit and several others were incorporated into Berlin. In 1871, Berlin became capital of the newly founded German Empire . In 1881, it became a city district separate from Brandenburg. In the early 20th century, Berlin had become a fertile ground for the German Expressionist movement. In fields such as architecture, painting and cinema new forms of artistic styles were invented. At the end of the First World War in 1918, a republic was proclaimed by Philipp Scheidemann at the Reichstag building . In 1920, the Greater Berlin Act incorporated dozens of suburban cities, villages, and estates around Berlin into an expanded city. The act increased the area of Berlin from 66 to 883 km 2 (25 to 341 sq mi) . The population almost doubled, and Berlin had a population of around four million. During the Weimar era , Berlin underwent political unrest due to economic uncertainties but also became a renowned center of the Roaring Twenties . The metropolis experienced its heyday as a major world capital and was known for its leadership roles in science, technology, arts, the humanities, city planning, film, higher education, government, and industries. Albert Einstein rose to public prominence during his years in Berlin, being awarded the Nobel Prize for Physics in 1921. In 1933, Adolf Hitler and the Nazi Party came to power . Hitler was inspired by the architecture he had experienced in Vienna , and he wished for a German Empire with a capital city that had a monumental ensemble. The National Socialist regime embarked on monumental construction projects in Berlin as a way to express their power and authority through architecture . Adolf Hitler and Albert Speer developed architectural concepts for the conversion of the city into World Capital Germania ; these were never implemented. NSDAP rule diminished Berlin's Jewish community from 160,000 (one-third of all Jews in the country) to about 80,000 due to emigration between 1933 and 1939. After Kristallnacht in 1938, thousands of the city's Jews were imprisoned in the nearby Sachsenhausen concentration camp . Starting in early 1943, many were deported to ghettos like Łódź , and to concentration and extermination camps such as Auschwitz . Berlin hosted the 1936 Summer Olympics for which the Olympic stadium was built. During World War II , Berlin was the location of multiple Nazi prisons, forced labour camps, 17 subcamps of the Sachsenhausen concentration camp for men and women, including teenagers, of various nationalities, including Polish, Jewish, French, Belgian, Czechoslovak, Russian, Ukrainian, Romani, Dutch, Greek, Norwegian, Spanish, Luxembourgish, German, Austrian, Italian, Yugoslavian, Bulgarian, Hungarian, a camp for Sinti and Romani people (see Romani Holocaust ), and the Stalag III-D prisoner-of-war camp for Allied POWs of various nationalities. During World War II, large parts of Berlin were destroyed during 1943–45 Allied air raids and the 1945 Battle of Berlin . The Allies dropped 67,607 tons of bombs on the city, destroying 6,427 acres of the built-up area. Around 125,000 civilians were killed. After the end of World War II in Europe in May 1945, Berlin received large numbers of refugees from the Eastern provinces. The victorious powers divided the city into four sectors, analogous to Allied-occupied Germany the sectors of the Allies of World War II (the United States, the United Kingdom, and France) formed West Berlin , while the Soviet Union formed East Berlin . All four Allies of World War II shared administrative responsibilities for Berlin. However, in 1948, when the Western Allies extended the currency reform in the Western zones of Germany to the three western sectors of Berlin, the Soviet Union imposed the Berlin Blockade on the access routes to and from West Berlin, which lay entirely inside Soviet-controlled territory. The Berlin airlift , conducted by the three western Allies, overcame this blockade by supplying food and other supplies to the city from June 1948 to May 1949. In 1949, the Federal Republic of Germany was founded in West Germany and eventually included all of the American, British and French zones, excluding those three countries' zones in Berlin, while the Marxist–Leninist German Democratic Republic was proclaimed in East Germany . West Berlin officially remained an occupied city, but it politically was aligned with the Federal Republic of Germany despite West Berlin's geographic isolation. Airline service to West Berlin was granted only to American, British and French airlines. The founding of the two German states increased Cold War tensions. West Berlin was surrounded by East German territory, and East Germany proclaimed the Eastern part as its capital, a move the western powers did not recognize. East Berlin included most of the city's historic center. The West German government established itself in Bonn . In 1961, East Germany began to build the Berlin Wall around West Berlin, and events escalated to a tank standoff at Checkpoint Charlie . West Berlin was now de facto a part of West Germany with a unique legal status, while East Berlin was de facto a part of East Germany. John F. Kennedy gave his " Ich bin ein Berliner " speech on 26 June 1963, in front of the Schöneberg city hall, located in the city's western part, underlining the US support for West Berlin. Berlin was completely divided. Although it was possible for Westerners to pass to the other side through strictly controlled checkpoints, for most Easterners, travel to West Berlin or West Germany was prohibited by the government of East Germany. In 1971, a Four-Power agreement guaranteed access to and from West Berlin by car or train through East Germany. In 1989, with the end of the Cold War and pressure from the East German population, the Berlin Wall fell on 9 November and was subsequently mostly demolished. Today, the East Side Gallery preserves a large portion of the wall. On 3 October 1990, the two parts of Germany were reunified as the Federal Republic of Germany, and Berlin again became a reunified city. After the fall of the Berlin Wall, the city experienced significant urban development and still impacts urban planning decisions. Walter Momper, the mayor of West Berlin, became the first mayor of the reunified city in the interim. City-wide elections in December 1990 resulted in the first "all Berlin" mayor being elected to take office in January 1991, with the separate offices of mayors in East and West Berlin expiring by that time, and Eberhard Diepgen (a former mayor of West Berlin) became the first elected mayor of a reunited Berlin. On 18 June 1994, soldiers from the United States, France and Britain marched in a parade which was part of the ceremonies to mark the withdrawal of allied occupation troops allowing a reunified Berlin (the last Russian troops departed on 31 August, while the final departure of Western Allies forces was on 8 September 1994). On 20 June 1991, the Bundestag (German Parliament) voted to move the seat of the German capital from Bonn to Berlin, which was completed in 1999, during the chancellorship of Gerhard Schröder . Berlin's 2001 administrative reform merged several boroughs, reducing their number from 23 to 12. In 2006, the FIFA World Cup Final was held in Berlin. Construction of the "Berlin Wall Trail" (Berliner Mauerweg) began in 2002 and was completed in 2006. In a 2016 terrorist attack linked to ISIL , a truck was deliberately driven into a Christmas market next to the Kaiser Wilhelm Memorial Church , leaving 13 people dead and 55 others injured. In 2018, more than 200,000 protestors took to the streets in Berlin with demonstrations of solidarity against racism, in response to the emergence of far-right politics in Germany . Berlin Brandenburg Airport (BER) opened in 2020, nine years later than planned, with Terminal 1 coming into service at the end of October, and flights to and from Tegel Airport ending in November. Due to the fall in passenger numbers resulting from the COVID-19 pandemic , plans were announced to temporarily close BER's Terminal 5, the former Schönefeld Airport , beginning in March 2021 for up to one year. The connecting link of U-Bahn line U5 from Alexanderplatz to Hauptbahnhof, along with the new stations Rotes Rathaus and Unter den Linden, opened on 4 December 2020, with the Museumsinsel U-Bahn station expected to open around March 2021, which would complete all new works on the U5. A partial opening by the end of 2020 of the Humboldt Forum museum, housed in the reconstructed Berlin Palace , which had been announced in June, was postponed until March 2021. On 16 September 2022, the opening of the eastern wing, the last section of the Humboldt Forum museum, meant the Humboldt Forum museum was finally completed. It became Germany's currently most expensive cultural project. The legal basis for a combined state of Berlin and Brandenburg is different from other state fusion proposals. Normally, Article 29 of the Basic Law stipulates that a state fusion requires a federal law. However, a clause added to the Basic Law in 1994, Article 118a, allows Berlin and Brandenburg to unify without federal approval, requiring a referendum and a ratification by both state parliaments. In 1996, there was an unsuccessful attempt of unifying the states of Berlin and Brandenburg. Both share a common history, dialect and culture and in 2020, there are over 225.000 residents of Brandenburg that commute to Berlin. The fusion had the near-unanimous support by a broad coalition of both state governments, political parties, media, business associations, trade unions and churches. Though Berlin voted in favor by a small margin, largely based on support in former West Berlin , Brandenburg voters disapproved of the fusion by a large margin. It failed largely due to Brandenburg voters not wanting to take on Berlin's large and growing public debt and fearing losing identity and influence to the capital. Berlin is in northeastern Germany, in an area of low-lying marshy woodlands with a mainly flat topography , part of the vast Northern European Plain which stretches all the way from northern France to western Russia. The Berliner Urstromtal (an ice age glacial valley ), between the low Barnim Plateau to the north and the Teltow plateau to the south, was formed by meltwater flowing from ice sheets at the end of the last Weichselian glaciation . The Spree follows this valley now. In Spandau, a borough in the west of Berlin, the Spree empties into the river Havel , which flows from north to south through western Berlin. The course of the Havel is more like a chain of lakes, the largest being the Tegeler See and the Großer Wannsee . A series of lakes also feeds into the upper Spree, which flows through the Großer Müggelsee in eastern Berlin. Substantial parts of present-day Berlin extend onto the low plateaus on both sides of the Spree Valley. Large parts of the boroughs Reinickendorf and Pankow lie on the Barnim Plateau, while most of the boroughs of Charlottenburg-Wilmersdorf , Steglitz-Zehlendorf , Tempelhof-Schöneberg , and Neukölln lie on the Teltow Plateau. The borough of Spandau lies partly within the Berlin Glacial Valley and partly on the Nauen Plain, which stretches to the west of Berlin. Since 2015, the Arkenberge hills in Pankow at 122 meters (400 ft) elevation, have been the highest point in Berlin. Through the disposal of construction debris they surpassed Teufelsberg ( 120.1 m or 394 ft ), which itself was made up of rubble from the ruins of the Second World War. The Müggelberge at 114.7 meters (376 ft) elevation is the highest natural point and the lowest is the Spektesee in Spandau, at 28.1 meters (92 ft) elevation. Berlin has an oceanic climate ( Köppen : Cfb ) bordering on a humid continental climate ( Dfb ). This type of climate features mild to very warm summer temperatures and cold, though not very severe, winters. Annual precipitation is modest. Frosts are common in winter, and there are larger temperature differences between seasons than typical for many oceanic climates . Summers are warm and sometimes humid with average high temperatures of 22–25 °C (72–77 °F) and lows of 12–14 °C (54–57 °F) . Winters are cold with average high temperatures of 3 °C (37 °F) and lows of −2 to 0 °C (28 to 32 °F) . Spring and autumn are generally chilly to mild. Berlin's built-up area creates a microclimate, with heat stored by the city's buildings and pavement . Temperatures can be 4 °C (7 °F) higher in the city than in the surrounding areas. Annual precipitation is 570 millimeters (22 in) with moderate rainfall throughout the year. Snowfall mainly occurs from December through March. The hottest month in Berlin was July 1834, with a mean temperature of 23.0 °C (73.4 °F) and the coldest was January 1709 , with a mean temperature of −13.2 °C (8.2 °F) . The wettest month on record was July 1907, with 230 millimeters (9.1 in) of rainfall, whereas the driest were October 1866, November 1902, October 1908 and September 1928, all with 1 millimeter (0.039 in) of rainfall. Berlin's history has left the city with a polycentric metropolitan area and an eclectic mix of architecture. The city's appearance today has been predominantly shaped by German history during the 20th century. 17% of Berlin's buildings are Gründerzeit or earlier and nearly 25% are of the 1920s and 1930s, when Berlin played a part in the origin of modern architecture . Devastated by the bombing of Berlin in World War II many of the buildings that had survived in both East and West were demolished during the postwar period. After the reunification, many important heritage structures have been reconstructed , including the Forum Fridericianum along with, the Berlin State Opera , Charlottenburg Palace , Gendarmenmarkt , Alte Kommandantur , as well as the City Palace . The list of tallest buildings in Berlin spreads across the urban area, they can be found for example at Potsdamer Platz , the City West , and Alexanderplatz . Over one-third of the city area consists of green space, woodlands, and water. Berlin's second-largest and most popular park, the Großer Tiergarten , is located right in the center of the city. The Fernsehturm (TV tower) at Alexanderplatz in Mitte is among the tallest structures in the European Union at 368 m (1,207 ft) . Built in 1969, it is visible throughout most of the central districts of Berlin. The city can be viewed from its 204-meter-high (669 ft) observation floor. Starting here, the Karl-Marx-Allee heads east, an avenue lined by monumental residential buildings, designed in the Socialist Classicism style. Adjacent to this area is the Rotes Rathaus (City Hall), with its distinctive red-brick architecture. In front of it is the Neptunbrunnen , a fountain featuring a mythological group of Tritons , personifications of the four main Prussian rivers, and Neptune on top of it. The Brandenburg Gate is an iconic landmark of Berlin and Germany; it stands as a symbol of eventful European history and of unity and peace. The Reichstag building is the traditional seat of the German Parliament. It was remodeled by British architect Norman Foster in the 1990s and features a glass dome over the session area, which allows free public access to the parliamentary proceedings and magnificent views of the city. The East Side Gallery is an open-air exhibition of art painted directly on the last existing portions of the Berlin Wall. It is the largest remaining evidence of the city's historical division. The Gendarmenmarkt is a neoclassical square in Berlin, the name of which derives from the headquarters of the famous Gens d'armes regiment located here in the 18th century. Two similarly designed cathedrals border it, the Französischer Dom with its observation platform and the Deutscher Dom . The Konzerthaus (Concert Hall), home of the Berlin Symphony Orchestra, stands between the two cathedrals. The Museum Island in the River Spree houses five museums built from 1830 to 1930 and is a UNESCO World Heritage site. Restoration and construction of a main entrance to all museums, as well as reconstruction of the Stadtschloss continues. Also on the island and next to the Lustgarten and palace is Berlin Cathedral , emperor William II's ambitious attempt to create a Protestant counterpart to St. Peter's Basilica in Rome. A large crypt houses the remains of some of the earlier Prussian royal family. St. Hedwig's Cathedral is Berlin's Roman Catholic cathedral. Unter den Linden is a tree-lined east–west avenue from the Brandenburg Gate to the site of the former Berliner Stadtschloss, and was once Berlin's premier promenade. Many Classical buildings line the street, and part of Humboldt University is there. Friedrichstraße was Berlin's legendary street during the Golden Twenties . It combines 20th-century traditions with the modern architecture of today's Berlin. Potsdamer Platz is an entire quarter built from scratch after the Wall came down. To the west of Potsdamer Platz is the Kulturforum, which houses the Gemäldegalerie , and is flanked by the Neue Nationalgalerie and the Berliner Philharmonie . The Memorial to the Murdered Jews of Europe , a Holocaust memorial, is to the north. The area around Hackescher Markt is home to fashionable culture, with countless clothing outlets, clubs, bars, and galleries. This includes the Hackesche Höfe , a conglomeration of buildings around several courtyards, reconstructed around 1996. The nearby New Synagogue is the center of Jewish culture. The Straße des 17. Juni , connecting the Brandenburg Gate and Ernst-Reuter-Platz, serves as the central east–west axis. Its name commemorates the uprisings in East Berlin of 17 June 1953 . Approximately halfway from the Brandenburg Gate is the Großer Stern, a circular traffic island on which the Siegessäule (Victory Column) is situated. This monument, built to commemorate Prussia's victories, was relocated in 1938–39 from its previous position in front of the Reichstag. The Kurfürstendamm is home to some of Berlin's luxurious stores with the Kaiser Wilhelm Memorial Church at its eastern end on Breitscheidplatz . The church was destroyed in the Second World War and left in ruins. Nearby on Tauentzienstraße is KaDeWe , claimed to be continental Europe's largest department store. The Rathaus Schöneberg , where John F. Kennedy made his famous " Ich bin ein Berliner !" speech, is in Tempelhof-Schöneberg . West of the center, Bellevue Palace is the residence of the German President. Charlottenburg Palace , which was burnt out in the Second World War, is the largest historical palace in Berlin. The Funkturm Berlin is a 150-meter-tall (490 ft) lattice radio tower in the fairground area, built between 1924 and 1926. It is the only observation tower which stands on insulators and has a restaurant 55 m (180 ft) and an observation deck 126 m (413 ft) above ground, which is reachable by a windowed elevator. The Oberbaumbrücke over the Spree river is Berlin's most iconic bridge, connecting the now-combined boroughs of Friedrichshain and Kreuzberg . It carries vehicles, pedestrians, and the U1 Berlin U-Bahn line. The bridge was completed in a brick gothic style in 1896, replacing the former wooden bridge with an upper deck for the U-Bahn. The center portion was demolished in 1945 to stop the Red Army from crossing. After the war, the repaired bridge served as a checkpoint and border crossing between the Soviet and American sectors, and later between East and West Berlin. In the mid-1950s, it was closed to vehicles, and after the construction of the Berlin Wall in 1961, pedestrian traffic was heavily restricted. Following German reunification, the center portion was reconstructed with a steel frame, and U-Bahn service resumed in 1995.Berlin is in northeastern Germany, in an area of low-lying marshy woodlands with a mainly flat topography , part of the vast Northern European Plain which stretches all the way from northern France to western Russia. The Berliner Urstromtal (an ice age glacial valley ), between the low Barnim Plateau to the north and the Teltow plateau to the south, was formed by meltwater flowing from ice sheets at the end of the last Weichselian glaciation . The Spree follows this valley now. In Spandau, a borough in the west of Berlin, the Spree empties into the river Havel , which flows from north to south through western Berlin. The course of the Havel is more like a chain of lakes, the largest being the Tegeler See and the Großer Wannsee . A series of lakes also feeds into the upper Spree, which flows through the Großer Müggelsee in eastern Berlin. Substantial parts of present-day Berlin extend onto the low plateaus on both sides of the Spree Valley. Large parts of the boroughs Reinickendorf and Pankow lie on the Barnim Plateau, while most of the boroughs of Charlottenburg-Wilmersdorf , Steglitz-Zehlendorf , Tempelhof-Schöneberg , and Neukölln lie on the Teltow Plateau. The borough of Spandau lies partly within the Berlin Glacial Valley and partly on the Nauen Plain, which stretches to the west of Berlin. Since 2015, the Arkenberge hills in Pankow at 122 meters (400 ft) elevation, have been the highest point in Berlin. Through the disposal of construction debris they surpassed Teufelsberg ( 120.1 m or 394 ft ), which itself was made up of rubble from the ruins of the Second World War. The Müggelberge at 114.7 meters (376 ft) elevation is the highest natural point and the lowest is the Spektesee in Spandau, at 28.1 meters (92 ft) elevation. Berlin has an oceanic climate ( Köppen : Cfb ) bordering on a humid continental climate ( Dfb ). This type of climate features mild to very warm summer temperatures and cold, though not very severe, winters. Annual precipitation is modest. Frosts are common in winter, and there are larger temperature differences between seasons than typical for many oceanic climates . Summers are warm and sometimes humid with average high temperatures of 22–25 °C (72–77 °F) and lows of 12–14 °C (54–57 °F) . Winters are cold with average high temperatures of 3 °C (37 °F) and lows of −2 to 0 °C (28 to 32 °F) . Spring and autumn are generally chilly to mild. Berlin's built-up area creates a microclimate, with heat stored by the city's buildings and pavement . Temperatures can be 4 °C (7 °F) higher in the city than in the surrounding areas. Annual precipitation is 570 millimeters (22 in) with moderate rainfall throughout the year. Snowfall mainly occurs from December through March. The hottest month in Berlin was July 1834, with a mean temperature of 23.0 °C (73.4 °F) and the coldest was January 1709 , with a mean temperature of −13.2 °C (8.2 °F) . The wettest month on record was July 1907, with 230 millimeters (9.1 in) of rainfall, whereas the driest were October 1866, November 1902, October 1908 and September 1928, all with 1 millimeter (0.039 in) of rainfall. Berlin's history has left the city with a polycentric metropolitan area and an eclectic mix of architecture. The city's appearance today has been predominantly shaped by German history during the 20th century. 17% of Berlin's buildings are Gründerzeit or earlier and nearly 25% are of the 1920s and 1930s, when Berlin played a part in the origin of modern architecture . Devastated by the bombing of Berlin in World War II many of the buildings that had survived in both East and West were demolished during the postwar period. After the reunification, many important heritage structures have been reconstructed , including the Forum Fridericianum along with, the Berlin State Opera , Charlottenburg Palace , Gendarmenmarkt , Alte Kommandantur , as well as the City Palace . The list of tallest buildings in Berlin spreads across the urban area, they can be found for example at Potsdamer Platz , the City West , and Alexanderplatz . Over one-third of the city area consists of green space, woodlands, and water. Berlin's second-largest and most popular park, the Großer Tiergarten , is located right in the center of the city.The Fernsehturm (TV tower) at Alexanderplatz in Mitte is among the tallest structures in the European Union at 368 m (1,207 ft) . Built in 1969, it is visible throughout most of the central districts of Berlin. The city can be viewed from its 204-meter-high (669 ft) observation floor. Starting here, the Karl-Marx-Allee heads east, an avenue lined by monumental residential buildings, designed in the Socialist Classicism style. Adjacent to this area is the Rotes Rathaus (City Hall), with its distinctive red-brick architecture. In front of it is the Neptunbrunnen , a fountain featuring a mythological group of Tritons , personifications of the four main Prussian rivers, and Neptune on top of it. The Brandenburg Gate is an iconic landmark of Berlin and Germany; it stands as a symbol of eventful European history and of unity and peace. The Reichstag building is the traditional seat of the German Parliament. It was remodeled by British architect Norman Foster in the 1990s and features a glass dome over the session area, which allows free public access to the parliamentary proceedings and magnificent views of the city. The East Side Gallery is an open-air exhibition of art painted directly on the last existing portions of the Berlin Wall. It is the largest remaining evidence of the city's historical division. The Gendarmenmarkt is a neoclassical square in Berlin, the name of which derives from the headquarters of the famous Gens d'armes regiment located here in the 18th century. Two similarly designed cathedrals border it, the Französischer Dom with its observation platform and the Deutscher Dom . The Konzerthaus (Concert Hall), home of the Berlin Symphony Orchestra, stands between the two cathedrals. The Museum Island in the River Spree houses five museums built from 1830 to 1930 and is a UNESCO World Heritage site. Restoration and construction of a main entrance to all museums, as well as reconstruction of the Stadtschloss continues. Also on the island and next to the Lustgarten and palace is Berlin Cathedral , emperor William II's ambitious attempt to create a Protestant counterpart to St. Peter's Basilica in Rome. A large crypt houses the remains of some of the earlier Prussian royal family. St. Hedwig's Cathedral is Berlin's Roman Catholic cathedral. Unter den Linden is a tree-lined east–west avenue from the Brandenburg Gate to the site of the former Berliner Stadtschloss, and was once Berlin's premier promenade. Many Classical buildings line the street, and part of Humboldt University is there. Friedrichstraße was Berlin's legendary street during the Golden Twenties . It combines 20th-century traditions with the modern architecture of today's Berlin. Potsdamer Platz is an entire quarter built from scratch after the Wall came down. To the west of Potsdamer Platz is the Kulturforum, which houses the Gemäldegalerie , and is flanked by the Neue Nationalgalerie and the Berliner Philharmonie . The Memorial to the Murdered Jews of Europe , a Holocaust memorial, is to the north. The area around Hackescher Markt is home to fashionable culture, with countless clothing outlets, clubs, bars, and galleries. This includes the Hackesche Höfe , a conglomeration of buildings around several courtyards, reconstructed around 1996. The nearby New Synagogue is the center of Jewish culture. The Straße des 17. Juni , connecting the Brandenburg Gate and Ernst-Reuter-Platz, serves as the central east–west axis. Its name commemorates the uprisings in East Berlin of 17 June 1953 . Approximately halfway from the Brandenburg Gate is the Großer Stern, a circular traffic island on which the Siegessäule (Victory Column) is situated. This monument, built to commemorate Prussia's victories, was relocated in 1938–39 from its previous position in front of the Reichstag. The Kurfürstendamm is home to some of Berlin's luxurious stores with the Kaiser Wilhelm Memorial Church at its eastern end on Breitscheidplatz . The church was destroyed in the Second World War and left in ruins. Nearby on Tauentzienstraße is KaDeWe , claimed to be continental Europe's largest department store. The Rathaus Schöneberg , where John F. Kennedy made his famous " Ich bin ein Berliner !" speech, is in Tempelhof-Schöneberg . West of the center, Bellevue Palace is the residence of the German President. Charlottenburg Palace , which was burnt out in the Second World War, is the largest historical palace in Berlin. The Funkturm Berlin is a 150-meter-tall (490 ft) lattice radio tower in the fairground area, built between 1924 and 1926. It is the only observation tower which stands on insulators and has a restaurant 55 m (180 ft) and an observation deck 126 m (413 ft) above ground, which is reachable by a windowed elevator. The Oberbaumbrücke over the Spree river is Berlin's most iconic bridge, connecting the now-combined boroughs of Friedrichshain and Kreuzberg . It carries vehicles, pedestrians, and the U1 Berlin U-Bahn line. The bridge was completed in a brick gothic style in 1896, replacing the former wooden bridge with an upper deck for the U-Bahn. The center portion was demolished in 1945 to stop the Red Army from crossing. After the war, the repaired bridge served as a checkpoint and border crossing between the Soviet and American sectors, and later between East and West Berlin. In the mid-1950s, it was closed to vehicles, and after the construction of the Berlin Wall in 1961, pedestrian traffic was heavily restricted. Following German reunification, the center portion was reconstructed with a steel frame, and U-Bahn service resumed in 1995.At the end of 2018, the city-state of Berlin had 3.75 million registered inhabitants in an area of 891.1 km 2 (344.1 sq mi) . The city's population density was 4,206 inhabitants per km 2 . Berlin is the most populous city proper in the European Union . In 2019, the urban area of Berlin had about 4.5 million inhabitants. As of 2019 [ update ] , the functional urban area was home to about 5.2 million people. The entire Berlin-Brandenburg capital region has a population of more than 6 million in an area of 30,546 km 2 (11,794 sq mi) . In 2014, the city-state Berlin had 37,368 live births (+6.6%), a record number since 1991. The number of deaths was 32,314. Almost 2.0 million households were counted in the city. 54 percent of them were single-person households. More than 337,000 families with children under the age of 18 lived in Berlin. In 2014, the German capital registered a migration surplus of approximately 40,000 people. National and international migration into the city has a long history. In 1685, after the revocation of the Edict of Nantes in France, the city responded with the Edict of Potsdam , which guaranteed religious freedom and tax-free status to French Huguenot refugees for ten years. The Greater Berlin Act in 1920 incorporated many suburbs and surrounding cities of Berlin. It formed most of the territory that comprises modern Berlin and increased the population from 1.9 million to 4 million. Active immigration and asylum politics in West Berlin triggered waves of immigration in the 1960s and 1970s. Berlin is home to at least 180,000 Turkish and Turkish German residents, making it the largest Turkish community outside of Turkey. In the 1990s the Aussiedlergesetze enabled immigration to Germany of some residents from the former Soviet Union . Today ethnic Germans from countries of the former Soviet Union make up the largest portion of the Russian-speaking community. The last decade experienced an influx from various Western countries and some African regions. A portion of the African immigrants have settled in the Afrikanisches Viertel . Young Germans, EU-Europeans and Israelis have also settled in the city. In December 2019 there were 777,345 registered residents of foreign nationality and another 542,975 German citizens with a "migration background" (Migrationshintergrund, MH) , meaning they or one of their parents immigrated to Germany after 1955. Foreign residents of Berlin originate from about 190 countries. 48 percent of the residents under the age of 15 have a migration background in 2017. Berlin in 2009 was estimated to have 100,000 to 250,000 unregistered inhabitants. Boroughs of Berlin with a significant number of migrants or foreign born population are Mitte , Neukölln and Friedrichshain-Kreuzberg . The number of Arabic speakers in Berlin could be higher than 150,000. There are at least 40,000 Berliners with Syrian citizenship, third only behind Turkish and Polish citizens. The 2015 refugee crisis made Berlin Europe's capital of Arab culture. Berlin is among the cities in Germany that have received the biggest amount of refugees after the 2022 Russian invasion of Ukraine . As of November 2022, an estimated 85,000 Ukrainian refugees were registered in Berlin, making Berlin the most popular destination of Ukrainian refugees in Germany. Berlin has a vibrant expatriate community involving precarious immigrants, illegal immigrants, seasonal workers, and refugees. Therefore, Berlin sustains a broad variety of English-based speakers. Speaking a particular type of English does attract prestige and cultural capital in Berlin. German is the official and predominant spoken language in Berlin. It is a West Germanic language that derives most of its vocabulary from the Germanic branch of the Indo-European language family. German is one of 24 languages of the European Union, and one of the three working languages of the European Commission . Berlinerisch or Berlinisch is not a dialect linguistically. It is spoken in Berlin and the surrounding metropolitan area . It originates from a Brandenburgish variant. The dialect is now seen more like a sociolect , largely through increased immigration and trends among the educated population to speak standard German in everyday life. The most commonly spoken foreign languages in Berlin are Turkish, Polish, English, Persian, Arabic, Italian, Bulgarian, Russian, Romanian, Kurdish, Serbo-Croatian, French, Spanish and Vietnamese. Turkish, Arabic, Kurdish, and Serbo-Croatian are heard more often in the western part due to the large Middle Eastern and former-Yugoslavian communities. Polish, English, Russian, and Vietnamese have more native speakers in East Berlin. Religion in Berlin (2022) On the report of the 2011 census, approximately 37 percent of the population reported being members of a legally-recognized church or religious organization. The rest either did not belong to such an organization, or there was no information available about them. The largest religious denomination recorded in 2010 was the Protestant regional church body —the Evangelical Church of Berlin-Brandenburg-Silesian Upper Lusatia (EKBO) —a united church . EKBO is a member of the Protestant Church in Germany (EKD) and of the Union of Protestant Churches in the EKD (UEK) . According to the EKBO, their membership accounted for 18.7 percent of the local population, while the Roman Catholic Church had 9.1 percent of residents registered as its members. About 2.7% of the population identify with other Christian denominations (mostly Eastern Orthodox , but also various Protestants). According to the Berlin residents register, in 2018 14.9 percent were members of the Evangelical Church, and 8.5 percent were members of the Catholic Church. The government keeps a register of members of these churches for tax purposes, because it collects church tax on behalf of the churches. It does not keep records of members of other religious organizations which may collect their own church tax, in this way. In 2009, approximately 249,000 Muslims were reported by the Office of Statistics to be members of mosques and Islamic religious organizations in Berlin, while in 2016, the newspaper Der Tagesspiegel estimated that about 350,000 Muslims observed Ramadan in Berlin. In 2019, about 437,000 registered residents, 11.6% of the total, reported having a migration background from one of the Member states of the Organization of Islamic Cooperation . Between 1992 and 2011 the Muslim population almost doubled. About 0.9% of Berliners belong to other religions. Of the estimated population of 30,000–45,000 Jewish residents, approximately 12,000 are registered members of religious organizations. Berlin is the seat of the Roman Catholic archbishop of Berlin and EKBO 's elected chairperson is titled the bishop of EKBO. Furthermore, Berlin is the seat of many Orthodox cathedrals, such as the Cathedral of St. Boris the Baptist, one of the two seats of the Bulgarian Orthodox Diocese of Western and Central Europe, and the Resurrection of Christ Cathedral of the Diocese of Berlin (Patriarchate of Moscow). The faithful of the different religions and denominations maintain many places of worship in Berlin . The Independent Evangelical Lutheran Church has eight parishes of different sizes in Berlin. There are 36 Baptist congregations (within Union of Evangelical Free Church Congregations in Germany ), 29 New Apostolic Churches , 15 United Methodist churches, eight Free Evangelical Congregations, four Churches of Christ, Scientist (1st, 2nd, 3rd, and 11th), six congregations of the Church of Jesus Christ of Latter-day Saints , an Old Catholic church, and an Anglican church in Berlin. Berlin has more than 80 mosques, ten synagogues, and two Buddhist as well as two Hindu temples.National and international migration into the city has a long history. In 1685, after the revocation of the Edict of Nantes in France, the city responded with the Edict of Potsdam , which guaranteed religious freedom and tax-free status to French Huguenot refugees for ten years. The Greater Berlin Act in 1920 incorporated many suburbs and surrounding cities of Berlin. It formed most of the territory that comprises modern Berlin and increased the population from 1.9 million to 4 million. Active immigration and asylum politics in West Berlin triggered waves of immigration in the 1960s and 1970s. Berlin is home to at least 180,000 Turkish and Turkish German residents, making it the largest Turkish community outside of Turkey. In the 1990s the Aussiedlergesetze enabled immigration to Germany of some residents from the former Soviet Union . Today ethnic Germans from countries of the former Soviet Union make up the largest portion of the Russian-speaking community. The last decade experienced an influx from various Western countries and some African regions. A portion of the African immigrants have settled in the Afrikanisches Viertel . Young Germans, EU-Europeans and Israelis have also settled in the city. In December 2019 there were 777,345 registered residents of foreign nationality and another 542,975 German citizens with a "migration background" (Migrationshintergrund, MH) , meaning they or one of their parents immigrated to Germany after 1955. Foreign residents of Berlin originate from about 190 countries. 48 percent of the residents under the age of 15 have a migration background in 2017. Berlin in 2009 was estimated to have 100,000 to 250,000 unregistered inhabitants. Boroughs of Berlin with a significant number of migrants or foreign born population are Mitte , Neukölln and Friedrichshain-Kreuzberg . The number of Arabic speakers in Berlin could be higher than 150,000. There are at least 40,000 Berliners with Syrian citizenship, third only behind Turkish and Polish citizens. The 2015 refugee crisis made Berlin Europe's capital of Arab culture. Berlin is among the cities in Germany that have received the biggest amount of refugees after the 2022 Russian invasion of Ukraine . As of November 2022, an estimated 85,000 Ukrainian refugees were registered in Berlin, making Berlin the most popular destination of Ukrainian refugees in Germany. Berlin has a vibrant expatriate community involving precarious immigrants, illegal immigrants, seasonal workers, and refugees. Therefore, Berlin sustains a broad variety of English-based speakers. Speaking a particular type of English does attract prestige and cultural capital in Berlin. German is the official and predominant spoken language in Berlin. It is a West Germanic language that derives most of its vocabulary from the Germanic branch of the Indo-European language family. German is one of 24 languages of the European Union, and one of the three working languages of the European Commission . Berlinerisch or Berlinisch is not a dialect linguistically. It is spoken in Berlin and the surrounding metropolitan area . It originates from a Brandenburgish variant. The dialect is now seen more like a sociolect , largely through increased immigration and trends among the educated population to speak standard German in everyday life. The most commonly spoken foreign languages in Berlin are Turkish, Polish, English, Persian, Arabic, Italian, Bulgarian, Russian, Romanian, Kurdish, Serbo-Croatian, French, Spanish and Vietnamese. Turkish, Arabic, Kurdish, and Serbo-Croatian are heard more often in the western part due to the large Middle Eastern and former-Yugoslavian communities. Polish, English, Russian, and Vietnamese have more native speakers in East Berlin. Religion in Berlin (2022) On the report of the 2011 census, approximately 37 percent of the population reported being members of a legally-recognized church or religious organization. The rest either did not belong to such an organization, or there was no information available about them. The largest religious denomination recorded in 2010 was the Protestant regional church body —the Evangelical Church of Berlin-Brandenburg-Silesian Upper Lusatia (EKBO) —a united church . EKBO is a member of the Protestant Church in Germany (EKD) and of the Union of Protestant Churches in the EKD (UEK) . According to the EKBO, their membership accounted for 18.7 percent of the local population, while the Roman Catholic Church had 9.1 percent of residents registered as its members. About 2.7% of the population identify with other Christian denominations (mostly Eastern Orthodox , but also various Protestants). According to the Berlin residents register, in 2018 14.9 percent were members of the Evangelical Church, and 8.5 percent were members of the Catholic Church. The government keeps a register of members of these churches for tax purposes, because it collects church tax on behalf of the churches. It does not keep records of members of other religious organizations which may collect their own church tax, in this way. In 2009, approximately 249,000 Muslims were reported by the Office of Statistics to be members of mosques and Islamic religious organizations in Berlin, while in 2016, the newspaper Der Tagesspiegel estimated that about 350,000 Muslims observed Ramadan in Berlin. In 2019, about 437,000 registered residents, 11.6% of the total, reported having a migration background from one of the Member states of the Organization of Islamic Cooperation . Between 1992 and 2011 the Muslim population almost doubled. About 0.9% of Berliners belong to other religions. Of the estimated population of 30,000–45,000 Jewish residents, approximately 12,000 are registered members of religious organizations. Berlin is the seat of the Roman Catholic archbishop of Berlin and EKBO 's elected chairperson is titled the bishop of EKBO. Furthermore, Berlin is the seat of many Orthodox cathedrals, such as the Cathedral of St. Boris the Baptist, one of the two seats of the Bulgarian Orthodox Diocese of Western and Central Europe, and the Resurrection of Christ Cathedral of the Diocese of Berlin (Patriarchate of Moscow). The faithful of the different religions and denominations maintain many places of worship in Berlin . The Independent Evangelical Lutheran Church has eight parishes of different sizes in Berlin. There are 36 Baptist congregations (within Union of Evangelical Free Church Congregations in Germany ), 29 New Apostolic Churches , 15 United Methodist churches, eight Free Evangelical Congregations, four Churches of Christ, Scientist (1st, 2nd, 3rd, and 11th), six congregations of the Church of Jesus Christ of Latter-day Saints , an Old Catholic church, and an Anglican church in Berlin. Berlin has more than 80 mosques, ten synagogues, and two Buddhist as well as two Hindu temples.Since the German reunification on 3 October 1990, Berlin has been one of the three city- states of Germany among the present 16 federal states of Germany. The Abgeordnetenhaus von Berlin ( House of Representatives ) functions as the city and state parliament, which has 141 seats. Berlin's executive body is the Senate of Berlin ( Senat von Berlin ). The Senate consists of the Governing Mayor of Berlin ( Regierender Bürgermeister ), and up to ten senators holding ministerial positions, two of them holding the title of "Mayor" ( Bürgermeister ) as deputy to the Governing Mayor. The total annual budget of Berlin in 2015 exceeded €24.5 ($30.0) billion including a budget surplus of €205 ($240) million. The German Federal city state of Berlin owns extensive assets, including administrative and government buildings, real estate companies, as well as stakes in the Olympic Stadium, swimming pools, housing companies, and numerous public enterprises and subsidiary companies. The federal state of Berlin runs a real estate portal to advertise commercial spaces or land suitable for redevelopment. The Social Democratic Party (SPD) and The Left (Die Linke) took control of the city government after the 2001 state election and won another term in the 2006 state election . From the 2016 state election until the 2023 state election , there was a coalition between the Social Democratic Party, the Greens and the Left Party. Since April 2023, the government has been formed by a coalition between the Christian Democrats and the Social Democrats. The Governing Mayor is simultaneously Lord Mayor of the City of Berlin ( Oberbürgermeister der Stadt ) and Minister President of the State of Berlin ( Ministerpräsident des Bundeslandes ). The office of the Governing Mayor is in the Rotes Rathaus (Red City Hall) . Since 2023, this office has been held by Kai Wegner of the Christian Democrats. He is the first conservative mayor in Berlin in more than two decades. Berlin is subdivided into 12 boroughs or districts ( Bezirke ). Each borough has several subdistricts or neighborhoods ( Ortsteile ), which have roots in much older municipalities that predate the formation of Greater Berlin on 1 October 1920. These subdistricts became urbanized and incorporated into the city later on. Many residents strongly identify with their neighborhoods, colloquially called Kiez . At present, Berlin consists of 96 subdistricts, which are commonly made up of several smaller residential areas or quarters. Each borough is governed by a borough council ( Bezirksamt ) consisting of five councilors ( Bezirksstadträte ) including the borough's mayor ( Bezirksbürgermeister ). The council is elected by the borough assembly ( Bezirksverordnetenversammlung ). However, the individual boroughs are not independent municipalities, but subordinate to the Senate of Berlin. The borough's mayors make up the council of mayors ( Rat der Bürgermeister ), which is led by the city's Governing Mayor and advises the Senate. The neighborhoods have no local government bodies. Berlin to this day maintains official partnerships with 17 cities. Town twinning between West Berlin and other cities began with its sister city Los Angeles, California, in 1967. East Berlin 's partnerships were canceled at the time of German reunification . Berlin is the capital of the Federal Republic of Germany. The President of Germany , whose functions are mainly ceremonial under the German constitution , has their official residence in Bellevue Palace . Berlin is the seat of the German Chancellor (Prime Minister), housed in the Chancellery building , the Bundeskanzleramt . Facing the Chancellery is the Bundestag , the German Parliament, housed in the renovated Reichstag building since the government's relocation to Berlin in 1998. The Bundesrat ("federal council", performing the function of an upper house ) is the representation of the 16 constituent states ( Länder ) of Germany and has its seat at the former Prussian House of Lords . The total annual federal budget managed by the German government exceeded €310 ($375) billion in 2013. The relocation of the federal government and Bundestag to Berlin was mostly completed in 1999. However, some ministries, as well as some minor departments, stayed in the federal city Bonn , the former capital of West Germany. Discussions about moving the remaining ministries and departments to Berlin continue. The Federal Foreign Office and the ministries and departments of Defense , Justice and Consumer Protection , Finance , Interior , Economic Affairs and Energy , Labor and Social Affairs , Family Affairs, Senior Citizens, Women and Youth , Environment, Nature Conservation and Nuclear Safety , Food and Agriculture , Economic Cooperation and Development , Health , Transport and Digital Infrastructure and Education and Research are based in the capital. Berlin hosts in total 158 foreign embassies as well as the headquarters of many think tanks, trade unions, nonprofit organizations, lobbying groups, and professional associations. Frequent official visits and diplomatic consultations among governmental representatives and national leaders are common in contemporary Berlin.Since the German reunification on 3 October 1990, Berlin has been one of the three city- states of Germany among the present 16 federal states of Germany. The Abgeordnetenhaus von Berlin ( House of Representatives ) functions as the city and state parliament, which has 141 seats. Berlin's executive body is the Senate of Berlin ( Senat von Berlin ). The Senate consists of the Governing Mayor of Berlin ( Regierender Bürgermeister ), and up to ten senators holding ministerial positions, two of them holding the title of "Mayor" ( Bürgermeister ) as deputy to the Governing Mayor. The total annual budget of Berlin in 2015 exceeded €24.5 ($30.0) billion including a budget surplus of €205 ($240) million. The German Federal city state of Berlin owns extensive assets, including administrative and government buildings, real estate companies, as well as stakes in the Olympic Stadium, swimming pools, housing companies, and numerous public enterprises and subsidiary companies. The federal state of Berlin runs a real estate portal to advertise commercial spaces or land suitable for redevelopment. The Social Democratic Party (SPD) and The Left (Die Linke) took control of the city government after the 2001 state election and won another term in the 2006 state election . From the 2016 state election until the 2023 state election , there was a coalition between the Social Democratic Party, the Greens and the Left Party. Since April 2023, the government has been formed by a coalition between the Christian Democrats and the Social Democrats. The Governing Mayor is simultaneously Lord Mayor of the City of Berlin ( Oberbürgermeister der Stadt ) and Minister President of the State of Berlin ( Ministerpräsident des Bundeslandes ). The office of the Governing Mayor is in the Rotes Rathaus (Red City Hall) . Since 2023, this office has been held by Kai Wegner of the Christian Democrats. He is the first conservative mayor in Berlin in more than two decades. Berlin is subdivided into 12 boroughs or districts ( Bezirke ). Each borough has several subdistricts or neighborhoods ( Ortsteile ), which have roots in much older municipalities that predate the formation of Greater Berlin on 1 October 1920. These subdistricts became urbanized and incorporated into the city later on. Many residents strongly identify with their neighborhoods, colloquially called Kiez . At present, Berlin consists of 96 subdistricts, which are commonly made up of several smaller residential areas or quarters. Each borough is governed by a borough council ( Bezirksamt ) consisting of five councilors ( Bezirksstadträte ) including the borough's mayor ( Bezirksbürgermeister ). The council is elected by the borough assembly ( Bezirksverordnetenversammlung ). However, the individual boroughs are not independent municipalities, but subordinate to the Senate of Berlin. The borough's mayors make up the council of mayors ( Rat der Bürgermeister ), which is led by the city's Governing Mayor and advises the Senate. The neighborhoods have no local government bodies.Berlin to this day maintains official partnerships with 17 cities. Town twinning between West Berlin and other cities began with its sister city Los Angeles, California, in 1967. East Berlin 's partnerships were canceled at the time of German reunification .Berlin is the capital of the Federal Republic of Germany. The President of Germany , whose functions are mainly ceremonial under the German constitution , has their official residence in Bellevue Palace . Berlin is the seat of the German Chancellor (Prime Minister), housed in the Chancellery building , the Bundeskanzleramt . Facing the Chancellery is the Bundestag , the German Parliament, housed in the renovated Reichstag building since the government's relocation to Berlin in 1998. The Bundesrat ("federal council", performing the function of an upper house ) is the representation of the 16 constituent states ( Länder ) of Germany and has its seat at the former Prussian House of Lords . The total annual federal budget managed by the German government exceeded €310 ($375) billion in 2013. The relocation of the federal government and Bundestag to Berlin was mostly completed in 1999. However, some ministries, as well as some minor departments, stayed in the federal city Bonn , the former capital of West Germany. Discussions about moving the remaining ministries and departments to Berlin continue. The Federal Foreign Office and the ministries and departments of Defense , Justice and Consumer Protection , Finance , Interior , Economic Affairs and Energy , Labor and Social Affairs , Family Affairs, Senior Citizens, Women and Youth , Environment, Nature Conservation and Nuclear Safety , Food and Agriculture , Economic Cooperation and Development , Health , Transport and Digital Infrastructure and Education and Research are based in the capital.Berlin hosts in total 158 foreign embassies as well as the headquarters of many think tanks, trade unions, nonprofit organizations, lobbying groups, and professional associations. Frequent official visits and diplomatic consultations among governmental representatives and national leaders are common in contemporary Berlin.In 2018, the GDP of Berlin totaled €147 billion, an increase of 3.1% over the previous year. Berlin's economy is dominated by the service sector , with around 84% of all companies doing business in services. In 2015, the total labor force in Berlin was 1.85 million. The unemployment rate reached a 24-year low in November 2015 and stood at 10.0%. From 2012 to 2015 Berlin, as a German state, had the highest annual employment growth rate. Around 130,000 jobs were added in this period. Important economic sectors in Berlin include life sciences, transportation, information and communication technologies, media and music, advertising and design, biotechnology, environmental services, construction, e-commerce, retail, hotel business, and medical engineering. Research and development have economic significance for the city. Several major corporations like Volkswagen, Pfizer, and SAP operate innovation laboratories in the city. The Science and Business Park in Adlershof is the largest technology park in Germany measured by revenue. Within the Eurozone , Berlin has become a center for business relocation and international investments . Many German and international companies have business or service centers in the city. For several years Berlin has been recognized as a major center of business founders . In 2015, Berlin generated the most venture capital for young startup companies in Europe. Among the 10 largest employers in Berlin are the City-State of Berlin, Deutsche Bahn , largest railway company in the world, the hospital providers Charité and Vivantes , the Federal Government of Germany, the local public transport provider BVG , Siemens and Deutsche Telekom . Siemens, a Global 500 and DAX -listed company is partly headquartered in Berlin. Other DAX-listed companies headquartered in Berlin are the property company Deutsche Wohnen and the online food delivery service Delivery Hero . The national railway operator Deutsche Bahn , Europe's largest digital publisher Axel Springer as well as the MDAX -listed firms Zalando and HelloFresh and also have their main headquarters in the city. Among the largest international corporations who have their German or European headquarters in Berlin are Bombardier Transportation , Securing Energy for Europe , Coca-Cola , Pfizer , Sony and TotalEnergies . As of 2023, Sparkassen-Finanzgruppe , a network of public banks that together form the largest financial services group in Germany and in all of Europe, is headquartered in Berlin. The Bundesverband der Deutschen Volksbanken und Raiffeisenbanken has its headquarters in Berlin, managing around 1.200 trillion euros. The three largest banks in the capital are Deutsche Kreditbank , Landesbank Berlin and Berlin Hyp . Mercedes-Benz Group manufactures cars, and BMW builds motorcycles in Berlin. In 2022, American electric car manufacturer Tesla opened its first European Gigafactory outside the city borders in Grünheide (Mark) , Brandenburg. The Pharmaceuticals division of Bayer and Berlin Chemie are major pharmaceutical companies in the city. Berlin had 788 hotels with 134,399 beds in 2014. The city recorded 28.7 million overnight hotel stays and 11.9 million hotel guests in 2014. Tourism figures have more than doubled within the last ten years and Berlin has become the third-most-visited city destination in Europe. Some of the most visited places in Berlin include: Potsdamer Platz , Brandenburger Tor , the Berlin wall , Alexanderplatz , Museumsinsel , Fernsehturm , the East-Side Gallery , Schloss-Charlottenburg , Zoologischer Garten , Siegessäule , Gedenkstätte Berliner Mauer , Mauerpark , Botanical Garden , Französischer Dom , Deutscher Dom and Holocaust-Mahnmal . The largest visitor groups are from Germany, the United Kingdom, the Netherlands, Italy, Spain and the United States. According to figures from the International Congress and Convention Association in 2015, Berlin became the leading organizer of conferences globally, hosting 195 international meetings. Some of these congress events take place on venues such as CityCube Berlin or the Berlin Congress Center (bcc). The Messe Berlin (also known as Berlin ExpoCenter City) is the main convention organizing company in the city. Its main exhibition area covers more than 160,000 square meters (1,722,226 sq ft) . Several large-scale trade fairs like the consumer electronics trade fair IFA , where the first practical audio tape recorder and the first completely electronic television system were first introduced to the public, the ILA Berlin Air Show , the Berlin Fashion Week (including the Premium Berlin and the Panorama Berlin ), the Green Week , the Fruit Logistica , the transport fair InnoTrans , the tourism fair ITB and the adult entertainment and erotic fair Venus are held annually in the city, attracting a significant number of business visitors. The creative arts and entertainment business is an important part of Berlin's economy. The sector comprises music, film, advertising, architecture, art, design, fashion , performing arts, publishing, R&D , software, TV, radio, and video games . In 2014, around 30,500 creative companies operated in the Berlin-Brandenburg metropolitan region, predominantly SMEs . Generating a revenue of 15.6 billion Euro and 6% of all private economic sales, the culture industry grew from 2009 to 2014 at an average rate of 5.5% per year. Berlin is an important European and German film industry hub. It is home to more than 1,000 film and television production companies, 270 movie theaters, and around 300 national and international co-productions are filmed in the region every year. The historic Babelsberg Studios and the production company UFA are adjacent to Berlin in Potsdam . The city is also home of the German Film Academy (Deutsche Filmakademie), founded in 2003, and the European Film Academy , founded in 1988. Berlin is home to many magazine, newspaper, book, and scientific/academic publishers and their associated service industries. In addition, around 20 news agencies, more than 90 regional daily newspapers and their websites, as well as the Berlin offices of more than 22 national publications such as Der Spiegel , and Die Zeit reinforce the capital's position as Germany's epicenter for influential debate. Therefore, many international journalists, bloggers, and writers live and work in the city. Berlin is the central location to several international and regional television and radio stations. The public broadcaster RBB has its headquarters in Berlin as well as the commercial broadcasters MTV Europe and Welt . German international public broadcaster Deutsche Welle has its TV production unit in Berlin, and most national German broadcasters have a studio in the city, including ZDF and RTL . Berlin has Germany's largest number of daily newspapers, with numerous local broadsheets ( Berliner Morgenpost , Berliner Zeitung , Der Tagesspiegel ), and three major tabloids , as well as national dailies of varying sizes, each with a different political affiliation, such as Die Welt , Neues Deutschland , and Die Tageszeitung . The Exberliner , a monthly magazine, is Berlin's English-language periodical and La Gazette de Berlin a French-language newspaper. Berlin is also the headquarter of major German-language publishing houses like Walter de Gruyter , Springer , the Ullstein Verlagsgruppe (publishing group), Suhrkamp , and Cornelsen are all based in Berlin. Each of which publishes books, periodicals, and multimedia products.Many German and international companies have business or service centers in the city. For several years Berlin has been recognized as a major center of business founders . In 2015, Berlin generated the most venture capital for young startup companies in Europe. Among the 10 largest employers in Berlin are the City-State of Berlin, Deutsche Bahn , largest railway company in the world, the hospital providers Charité and Vivantes , the Federal Government of Germany, the local public transport provider BVG , Siemens and Deutsche Telekom . Siemens, a Global 500 and DAX -listed company is partly headquartered in Berlin. Other DAX-listed companies headquartered in Berlin are the property company Deutsche Wohnen and the online food delivery service Delivery Hero . The national railway operator Deutsche Bahn , Europe's largest digital publisher Axel Springer as well as the MDAX -listed firms Zalando and HelloFresh and also have their main headquarters in the city. Among the largest international corporations who have their German or European headquarters in Berlin are Bombardier Transportation , Securing Energy for Europe , Coca-Cola , Pfizer , Sony and TotalEnergies . As of 2023, Sparkassen-Finanzgruppe , a network of public banks that together form the largest financial services group in Germany and in all of Europe, is headquartered in Berlin. The Bundesverband der Deutschen Volksbanken und Raiffeisenbanken has its headquarters in Berlin, managing around 1.200 trillion euros. The three largest banks in the capital are Deutsche Kreditbank , Landesbank Berlin and Berlin Hyp . Mercedes-Benz Group manufactures cars, and BMW builds motorcycles in Berlin. In 2022, American electric car manufacturer Tesla opened its first European Gigafactory outside the city borders in Grünheide (Mark) , Brandenburg. The Pharmaceuticals division of Bayer and Berlin Chemie are major pharmaceutical companies in the city.Berlin had 788 hotels with 134,399 beds in 2014. The city recorded 28.7 million overnight hotel stays and 11.9 million hotel guests in 2014. Tourism figures have more than doubled within the last ten years and Berlin has become the third-most-visited city destination in Europe. Some of the most visited places in Berlin include: Potsdamer Platz , Brandenburger Tor , the Berlin wall , Alexanderplatz , Museumsinsel , Fernsehturm , the East-Side Gallery , Schloss-Charlottenburg , Zoologischer Garten , Siegessäule , Gedenkstätte Berliner Mauer , Mauerpark , Botanical Garden , Französischer Dom , Deutscher Dom and Holocaust-Mahnmal . The largest visitor groups are from Germany, the United Kingdom, the Netherlands, Italy, Spain and the United States. According to figures from the International Congress and Convention Association in 2015, Berlin became the leading organizer of conferences globally, hosting 195 international meetings. Some of these congress events take place on venues such as CityCube Berlin or the Berlin Congress Center (bcc). The Messe Berlin (also known as Berlin ExpoCenter City) is the main convention organizing company in the city. Its main exhibition area covers more than 160,000 square meters (1,722,226 sq ft) . Several large-scale trade fairs like the consumer electronics trade fair IFA , where the first practical audio tape recorder and the first completely electronic television system were first introduced to the public, the ILA Berlin Air Show , the Berlin Fashion Week (including the Premium Berlin and the Panorama Berlin ), the Green Week , the Fruit Logistica , the transport fair InnoTrans , the tourism fair ITB and the adult entertainment and erotic fair Venus are held annually in the city, attracting a significant number of business visitors.The creative arts and entertainment business is an important part of Berlin's economy. The sector comprises music, film, advertising, architecture, art, design, fashion , performing arts, publishing, R&D , software, TV, radio, and video games . In 2014, around 30,500 creative companies operated in the Berlin-Brandenburg metropolitan region, predominantly SMEs . Generating a revenue of 15.6 billion Euro and 6% of all private economic sales, the culture industry grew from 2009 to 2014 at an average rate of 5.5% per year. Berlin is an important European and German film industry hub. It is home to more than 1,000 film and television production companies, 270 movie theaters, and around 300 national and international co-productions are filmed in the region every year. The historic Babelsberg Studios and the production company UFA are adjacent to Berlin in Potsdam . The city is also home of the German Film Academy (Deutsche Filmakademie), founded in 2003, and the European Film Academy , founded in 1988.Berlin is home to many magazine, newspaper, book, and scientific/academic publishers and their associated service industries. In addition, around 20 news agencies, more than 90 regional daily newspapers and their websites, as well as the Berlin offices of more than 22 national publications such as Der Spiegel , and Die Zeit reinforce the capital's position as Germany's epicenter for influential debate. Therefore, many international journalists, bloggers, and writers live and work in the city. Berlin is the central location to several international and regional television and radio stations. The public broadcaster RBB has its headquarters in Berlin as well as the commercial broadcasters MTV Europe and Welt . German international public broadcaster Deutsche Welle has its TV production unit in Berlin, and most national German broadcasters have a studio in the city, including ZDF and RTL . Berlin has Germany's largest number of daily newspapers, with numerous local broadsheets ( Berliner Morgenpost , Berliner Zeitung , Der Tagesspiegel ), and three major tabloids , as well as national dailies of varying sizes, each with a different political affiliation, such as Die Welt , Neues Deutschland , and Die Tageszeitung . The Exberliner , a monthly magazine, is Berlin's English-language periodical and La Gazette de Berlin a French-language newspaper. Berlin is also the headquarter of major German-language publishing houses like Walter de Gruyter , Springer , the Ullstein Verlagsgruppe (publishing group), Suhrkamp , and Cornelsen are all based in Berlin. Each of which publishes books, periodicals, and multimedia products.According to Mercer , Berlin ranked number 13 in the Quality of living city ranking in 2019. Also in 2019, according to Monocle , Berlin occupied the position of the 6th-most-livable city in the world. Economist Intelligence Unit ranked Berlin number 21 of all global cities for livability . In 2019 Berlin was also number 8 on the Global Power City Index. In the same year Berlin was honored for having the best future prospects of all cities in Germany. Berlin's transport infrastructure provides a diverse range of urban mobility. A total of 979 bridges cross 197 km (122 miles) the inner-city waterways. Berlin roads total 5,422 km (3,369 miles) of which 77 km (48 miles) are motorways (known as Autobahn ). The AVUS was the first automobile-only road and served as an inspiration for the first motorways in the world. In 2013 only 1.344 million motor vehicles were registered in the city. With 377 cars per 1000 residents in 2013 (570/1000 in Germany), Berlin as a Western global city has one of the lowest numbers of cars per capita. Berlin is well known for its highly developed bicycle lane system. It is estimated Berlin has 710 bicycles per 1,000 residents. Around 500,000 daily bike riders accounted for 13 percent of total traffic in 2010. Cyclists in Berlin have access to 620 km of bicycle paths including approximately 150 km of mandatory bicycle paths, 190 km of off-road bicycle routes, 60 km of bicycle lanes on roads, 70 km of shared bus lanes which are also open to cyclists, 100 km of combined pedestrian/bike paths and 50 km of marked bicycle lanes on roadside pavements or sidewalks. Riders are allowed to carry their bicycles on Regionalbahn (RE), S-Bahn and U-Bahn trains, on trams, and on night buses if a bike ticket is purchased. In 2012 around 7,600 mostly colored taxicabs were in service. Since 2011 a number of app based sharing cab services , including electric vehicles as well as electric motorcycles and scooters , have evolved. [ citation needed ] Long-distance rail lines directly connect Berlin with all of the major cities of Germany. the regional rail lines of the Verkehrsverbund Berlin-Brandenburg provide access to Brandenburg and to the Baltic Sea . The Berlin Hauptbahnhof is the largest grade-separated railway station in Europe. The Deutsche Bahn runs the high speed Intercity-Express (ICE) to domestic destinations, including Hamburg , Munich, Cologne , Stuttgart , and Frankfurt am Main . The Spree and the Havel rivers cross Berlin. There are no frequent passenger connections to and from Berlin by water. Berlin's largest harbour, the Westhafen , is located in the district of Moabit . It is a transhipment and storage site for inland shipping with a growing importance. There is an increasing quantity of intercity bus services . Berlin city has more than 10 stations that run buses to destinations throughout Berlin. Destinations in Germany and Europe are connected via the intercity bus exchange Zentraler Omnibusbahnhof Berlin . The Berliner Verkehrsbetriebe (BVG) and the German State-owned Deutsche Bahn (DB) manage several extensive urban public transport systems. Public transport in Berlin has a long and complicated history because of the 20th-century division of the city, where movement between the two halves was not served. Since 1989, the transport network has been developed extensively. However, it still contains early 20th century traits, such as the U1. Berlin is served by one commercial international airport: Berlin Brandenburg Airport (BER), located just outside Berlin's south-eastern border, in the state of Brandenburg. It began construction in 2006, with the intention of replacing Tegel Airport (TXL) and Schönefeld Airport (SXF) as the single commercial airport of Berlin. Previously set to open in 2012, after extensive delays and cost overruns, it opened for commercial operations in October 2020. The planned initial capacity of around 27 million passengers per year is to be further developed to bring the terminal capacity to approximately 55 million per year by 2040. Before the opening of the BER in Brandenburg, Berlin was served by Tegel Airport and Schönefeld Airport. Tegel Airport was within the city limits, and Schönefeld Airport was located at the same site as the BER. Both airports together handled 29.5 million passengers in 2015. In 2014, 67 airlines served 163 destinations in 50 countries from Berlin. Tegel Airport was a focus city for Lufthansa and Eurowings while Schönefeld served as an important destination for airlines like Germania , easyJet and Ryanair . Until 2008, Berlin was also served by the smaller Tempelhof Airport , which functioned as a city airport, with a convenient location near the city center, allowing for quick transit times between the central business district and the airport. The airport grounds have since been turned into a city park.Berlin's transport infrastructure provides a diverse range of urban mobility. A total of 979 bridges cross 197 km (122 miles) the inner-city waterways. Berlin roads total 5,422 km (3,369 miles) of which 77 km (48 miles) are motorways (known as Autobahn ). The AVUS was the first automobile-only road and served as an inspiration for the first motorways in the world. In 2013 only 1.344 million motor vehicles were registered in the city. With 377 cars per 1000 residents in 2013 (570/1000 in Germany), Berlin as a Western global city has one of the lowest numbers of cars per capita. Berlin is well known for its highly developed bicycle lane system. It is estimated Berlin has 710 bicycles per 1,000 residents. Around 500,000 daily bike riders accounted for 13 percent of total traffic in 2010. Cyclists in Berlin have access to 620 km of bicycle paths including approximately 150 km of mandatory bicycle paths, 190 km of off-road bicycle routes, 60 km of bicycle lanes on roads, 70 km of shared bus lanes which are also open to cyclists, 100 km of combined pedestrian/bike paths and 50 km of marked bicycle lanes on roadside pavements or sidewalks. Riders are allowed to carry their bicycles on Regionalbahn (RE), S-Bahn and U-Bahn trains, on trams, and on night buses if a bike ticket is purchased. In 2012 around 7,600 mostly colored taxicabs were in service. Since 2011 a number of app based sharing cab services , including electric vehicles as well as electric motorcycles and scooters , have evolved. [ citation needed ]Long-distance rail lines directly connect Berlin with all of the major cities of Germany. the regional rail lines of the Verkehrsverbund Berlin-Brandenburg provide access to Brandenburg and to the Baltic Sea . The Berlin Hauptbahnhof is the largest grade-separated railway station in Europe. The Deutsche Bahn runs the high speed Intercity-Express (ICE) to domestic destinations, including Hamburg , Munich, Cologne , Stuttgart , and Frankfurt am Main .The Spree and the Havel rivers cross Berlin. There are no frequent passenger connections to and from Berlin by water. Berlin's largest harbour, the Westhafen , is located in the district of Moabit . It is a transhipment and storage site for inland shipping with a growing importance. There is an increasing quantity of intercity bus services . Berlin city has more than 10 stations that run buses to destinations throughout Berlin. Destinations in Germany and Europe are connected via the intercity bus exchange Zentraler Omnibusbahnhof Berlin .The Berliner Verkehrsbetriebe (BVG) and the German State-owned Deutsche Bahn (DB) manage several extensive urban public transport systems. Public transport in Berlin has a long and complicated history because of the 20th-century division of the city, where movement between the two halves was not served. Since 1989, the transport network has been developed extensively. However, it still contains early 20th century traits, such as the U1. Berlin is served by one commercial international airport: Berlin Brandenburg Airport (BER), located just outside Berlin's south-eastern border, in the state of Brandenburg. It began construction in 2006, with the intention of replacing Tegel Airport (TXL) and Schönefeld Airport (SXF) as the single commercial airport of Berlin. Previously set to open in 2012, after extensive delays and cost overruns, it opened for commercial operations in October 2020. The planned initial capacity of around 27 million passengers per year is to be further developed to bring the terminal capacity to approximately 55 million per year by 2040. Before the opening of the BER in Brandenburg, Berlin was served by Tegel Airport and Schönefeld Airport. Tegel Airport was within the city limits, and Schönefeld Airport was located at the same site as the BER. Both airports together handled 29.5 million passengers in 2015. In 2014, 67 airlines served 163 destinations in 50 countries from Berlin. Tegel Airport was a focus city for Lufthansa and Eurowings while Schönefeld served as an important destination for airlines like Germania , easyJet and Ryanair . Until 2008, Berlin was also served by the smaller Tempelhof Airport , which functioned as a city airport, with a convenient location near the city center, allowing for quick transit times between the central business district and the airport. The airport grounds have since been turned into a city park.From 1865 to 1976, Berlin operated an expansive pneumatic postal network , reaching a maximum length of 400 kilometers (roughly 250 miles) by 1940. The system was divided into two distinct networks after 1949. The West Berlin system remained in public use until 1963, and continued to be utilized for government correspondence until 1972. Conversely, the East Berlin system, which incorporated the Hauptelegraphenamt —the central hub of the operation—remained functional until 1976.Berlin's two largest energy provider for private households are the Swedish firm Vattenfall and the Berlin-based company GASAG . Both offer electric power and natural gas supply. Some of the city's electric energy is imported from nearby power plants in southern Brandenburg . As of 2015 [ update ] the five largest power plants measured by capacity are the Heizkraftwerk Reuter West, the Heizkraftwerk Lichterfelde, the Heizkraftwerk Mitte, the Heizkraftwerk Wilmersdorf, and the Heizkraftwerk Charlottenburg. All of these power stations generate electricity and useful heat at the same time to facilitate buffering during load peaks. In 1993 the power grid connections in the Berlin-Brandenburg capital region were renewed. In most of the inner districts of Berlin power lines are underground cables; only a 380 kV and a 110 kV line, which run from Reuter substation to the urban Autobahn , use overhead lines. The Berlin 380-kV electric line is the backbone of the city's energy grid.Berlin has a long history of discoveries in medicine and innovations in medical technology. The modern history of medicine has been significantly influenced by scientists from Berlin. Rudolf Virchow was the founder of cellular pathology, while Robert Koch developed vaccines for anthrax, cholera, and tuberculosis. For his life's work Koch is seen as one of the founders of modern medicine. The Charité complex (Universitätsklinik Charité) is the largest university hospital in Europe, tracing back its origins to the year 1710. More than half of all German Nobel Prize winners in Physiology or Medicine, including Emil von Behring , Robert Koch and Paul Ehrlich , have worked at the Charité. The Charité is spread over four campuses and comprises around 3,000 beds, 15,500 staff, 8,000 students, and more than 60 operating theaters, and it has a turnover of two billion euros annually. Since 2017, the digital television standard in Berlin and Germany is DVB-T2 . This system transmits compressed digital audio , digital video and other data in an MPEG transport stream . Berlin has installed several hundred free public Wireless LAN sites across the capital since 2016. The wireless networks are concentrated mostly in central districts; 650 hotspots (325 indoor and 325 outdoor access points) are installed. The UMTS (3G) and LTE (4G) networks of the three major cellular operators Vodafone , T-Mobile and O2 enable the use of mobile broadband applications citywide.As of 2014 [ update ] , Berlin had 878 schools, teaching 340,658 students in 13,727 classes and 56,787 trainees in businesses and elsewhere. The city has a 6-year primary education program. After completing primary school, students continue to the Sekundarschule (a comprehensive school) or Gymnasium (college preparatory school). Berlin has a special bilingual school program in the Europaschule , in which children are taught the curriculum in German and a foreign language, starting in primary school and continuing in high school. The Französisches Gymnasium Berlin , which was founded in 1689 to teach the children of Huguenot refugees, offers (German/French) instruction. The John F. Kennedy School , a bilingual German–American public school in Zehlendorf , is particularly popular with children of diplomats and the English-speaking expatriate community. 82 Gymnasien teach Latin and 8 teach Classical Greek . The Berlin-Brandenburg capital region is one of the most prolific centers of higher education and research in Germany and Europe. Historically, 67 Nobel Prize winners are affiliated with the Berlin-based universities. The city has four public research universities and more than 30 private, professional, and technical colleges (Hochschulen) , offering a wide range of disciplines. A record number of 175,651 students were enrolled in the winter term of 2015/16. Among them around 18% have an international background. The three largest universities combined have approximately 103,000 enrolled students. There are the Freie Universität Berlin (Free University of Berlin, FU Berlin) with about 33,000 students, the Humboldt Universität zu Berlin (HU Berlin) with 35,000 students, and the Technische Universität Berlin (TU Berlin) with 35,000 students. The Charité Medical School has around 8,000 students. The FU, the HU, the TU, and the Charité make up the Berlin University Alliance , which has received funding from the Excellence Strategy program of the German government. The Universität der Künste (UdK) has about 4,000 students and ESMT Berlin is only one of four business schools in Germany with triple accreditation . The Hertie School , a private public policy school located in Mitte, has more than 900 students and doctoral students. The Berlin School of Economics and Law has an enrollment of about 11,000 students, the Berlin University of Applied Sciences and Technology of about 12,000 students, and the Hochschule für Technik und Wirtschaft (University of Applied Sciences for Engineering and Economics) of about 14,000 students. The city has a high density of internationally renowned research institutions, such as the Fraunhofer Society , the Leibniz Association , the Helmholtz Association , and the Max Planck Society , which are independent of, or only loosely connected to its universities. In 2012, around 65,000 professional scientists were working in research and development in the city. Berlin is one of the knowledge and innovation communities (KIC) of the European Institute of Innovation and Technology (EIT). The KIC is based at the Center for Entrepreneurship at TU Berlin and has a focus in the development of IT industries. It partners with major multinational companies such as Siemens , Deutsche Telekom , and SAP . One of Europe's successful research, business and technology clusters is based at WISTA in Berlin-Adlershof , with more than 1,000 affiliated firms, university departments and scientific institutions. In addition to the university-affiliated libraries, the Staatsbibliothek zu Berlin is a major research library. Its two main locations are on Potsdamer Straße and on Unter den Linden . There are also 86 public libraries in the city. ResearchGate , a global social networking site for scientists, is based in Berlin.The Berlin-Brandenburg capital region is one of the most prolific centers of higher education and research in Germany and Europe. Historically, 67 Nobel Prize winners are affiliated with the Berlin-based universities. The city has four public research universities and more than 30 private, professional, and technical colleges (Hochschulen) , offering a wide range of disciplines. A record number of 175,651 students were enrolled in the winter term of 2015/16. Among them around 18% have an international background. The three largest universities combined have approximately 103,000 enrolled students. There are the Freie Universität Berlin (Free University of Berlin, FU Berlin) with about 33,000 students, the Humboldt Universität zu Berlin (HU Berlin) with 35,000 students, and the Technische Universität Berlin (TU Berlin) with 35,000 students. The Charité Medical School has around 8,000 students. The FU, the HU, the TU, and the Charité make up the Berlin University Alliance , which has received funding from the Excellence Strategy program of the German government. The Universität der Künste (UdK) has about 4,000 students and ESMT Berlin is only one of four business schools in Germany with triple accreditation . The Hertie School , a private public policy school located in Mitte, has more than 900 students and doctoral students. The Berlin School of Economics and Law has an enrollment of about 11,000 students, the Berlin University of Applied Sciences and Technology of about 12,000 students, and the Hochschule für Technik und Wirtschaft (University of Applied Sciences for Engineering and Economics) of about 14,000 students.The city has a high density of internationally renowned research institutions, such as the Fraunhofer Society , the Leibniz Association , the Helmholtz Association , and the Max Planck Society , which are independent of, or only loosely connected to its universities. In 2012, around 65,000 professional scientists were working in research and development in the city. Berlin is one of the knowledge and innovation communities (KIC) of the European Institute of Innovation and Technology (EIT). The KIC is based at the Center for Entrepreneurship at TU Berlin and has a focus in the development of IT industries. It partners with major multinational companies such as Siemens , Deutsche Telekom , and SAP . One of Europe's successful research, business and technology clusters is based at WISTA in Berlin-Adlershof , with more than 1,000 affiliated firms, university departments and scientific institutions. In addition to the university-affiliated libraries, the Staatsbibliothek zu Berlin is a major research library. Its two main locations are on Potsdamer Straße and on Unter den Linden . There are also 86 public libraries in the city. ResearchGate , a global social networking site for scientists, is based in Berlin.Berlin is known for its numerous cultural institutions, many of which enjoy international reputation. The diversity and vivacity of the metropolis led to a trendsetting atmosphere. An innovative music, dance and art scene has developed in the 21st century. Young people, international artists and entrepreneurs continued to settle in the city and made Berlin a popular entertainment center in the world. The expanding cultural performance of the city was underscored by the relocation of the Universal Music Group who decided to move their headquarters to the banks of the River Spree. In 2005, Berlin was named "City of Design" by UNESCO and has been part of the Creative Cities Network ever since. Many German and International films were shot in Berlin, including M , One, Two, Three , Cabaret , Christiane F. , Possession , Octopussy , Wings of Desire , Run Lola Run , The Bourne Trilogy , Good Bye, Lenin! , The Lives of Others , Inglourious Basterds , Hanna , Unknown and Bridge of Spies . As of 2011 [ update ] Berlin is home to 138 museums and more than 400 art galleries. The ensemble on the Museum Island is a UNESCO World Heritage Site and is in the northern part of the Spree Island between the Spree and the Kupfergraben. As early as 1841 it was designated a "district dedicated to art and antiquities" by a royal decree. Subsequently, the Altes Museum was built in the Lustgarten. The Neues Museum , which displays the bust of Queen Nefertiti , Alte Nationalgalerie , Pergamon Museum , and Bode Museum were built there. Apart from the Museum Island, there are many additional museums in the city. The Gemäldegalerie (Painting Gallery) focuses on the paintings of the "old masters" from the 13th to the 18th centuries, while the Neue Nationalgalerie (New National Gallery, built by Ludwig Mies van der Rohe ) specializes in 20th-century European painting. The Hamburger Bahnhof , in Moabit , exhibits a major collection of modern and contemporary art. The expanded Deutsches Historisches Museum reopened in the Zeughaus with an overview of German history spanning more than a millennium. The Bauhaus Archive is a museum of 20th-century design from the famous Bauhaus school. Museum Berggruen houses the collection of noted 20th century collector Heinz Berggruen , and features an extensive assortment of works by Picasso , Matisse , Cézanne , and Giacometti , among others. The Kupferstichkabinett Berlin (Museum of Prints and Drawings) is part of the Staatlichen Museen zu Berlin (Berlin State Museums) and the Kulturforum at Potsdamer Platz in the Tiergarten district of Berlin's Mitte district. It is the largest museum of the graphic arts in Germany and at the same time one of the four most important collections of its kind in the world. The collection includes Friedrich Gilly 's design for the monument to Frederick II of Prussia. The Jewish Museum has a standing exhibition on two millennia of German-Jewish history. The German Museum of Technology in Kreuzberg has a large collection of historical technical artifacts. The Museum für Naturkunde (Berlin's natural history museum ) exhibits natural history near Berlin Hauptbahnhof . It has the largest mounted dinosaur in the world (a Giraffatitan skeleton). A well-preserved specimen of Tyrannosaurus rex and the early bird Archaeopteryx are at display as well. In Dahlem , there are several museums of world art and culture, such as the Museum of Asian Art , the Ethnological Museum , the Museum of European Cultures , as well as the Allied Museum . The Brücke Museum features one of the largest collection of works by artist of the early 20th-century expressionist movement. In Lichtenberg , on the grounds of the former East German Ministry for State Security , is the Stasi Museum . The site of Checkpoint Charlie , one of the most renowned crossing points of the Berlin Wall, is still preserved. A private museum venture exhibits a comprehensive documentation of detailed plans and strategies devised by people who tried to flee from the East. The Beate Uhse Erotic Museum claimed to be the largest erotic museum in the world until it closed in 2014. The cityscape of Berlin displays large quantities of urban street art . It has become a significant part of the city's cultural heritage and has its roots in the graffiti scene of Kreuzberg of the 1980s. The Berlin Wall itself has become one of the largest open-air canvasses in the world. The leftover stretch along the Spree river in Friedrichshain remains as the East Side Gallery . Berlin today is consistently rated as an important world city for street art culture. Berlin has galleries which are quite rich in contemporary art. Located in Mitte, KW Institute for Contemporary Art, KOW, Sprüth Magers; Kreuzberg there are a few galleries as well such as Blain Southern, Esther Schipper , Future Gallery, König Gallerie. Berlin's nightlife has been celebrated as one of the most diverse and vibrant of its kind. In the 1970s and 80s, the SO36 in Kreuzberg was a center for punk music and culture. The SOUND and the Dschungel gained notoriety. Throughout the 1990s, people in their 20s from all over the world, particularly those in Western and Central Europe, made Berlin's club scene a premier nightlife venue. After the fall of the Berlin Wall in 1989, many historic buildings in Mitte, the former city center of East Berlin, were illegally occupied and re-built by young squatters and became a fertile ground for underground and counterculture gatherings. The central boroughs are home to many nightclubs, including the Watergate, Tresor and Berghain . The KitKatClub and several other locations are known for their sexually uninhibited parties. Clubs are not required to close at a fixed time during the weekends, and many parties last well into the morning or even all weekend. The Weekend Club near Alexanderplatz features a roof terrace that allows partying at night. Several venues have become a popular stage for the Neo-Burlesque scene. Berlin has a long history of gay culture, and is an important birthplace of the LGBT rights movement . Same-sex bars and dance halls operated freely as early as the 1880s, and the first gay magazine, Der Eigene , started in 1896. By the 1920s, gays and lesbians had an unprecedented visibility. Today, in addition to a positive atmosphere in the wider club scene, the city again has a huge number of queer clubs and festivals. The most famous and largest are Berlin Pride , the Christopher Street Day , the Lesbian and Gay City Festival in Berlin-Schöneberg, the Kreuzberg Pride and Hustlaball . The annual Berlin International Film Festival (Berlinale) with around 500,000 admissions is considered to be the largest publicly attended film festival in the world. The Karneval der Kulturen ( Carnival of Cultures ), a multi-ethnic street parade, is celebrated every Pentecost weekend. Berlin is also well known for the cultural festival Berliner Festspiele , which includes the jazz festival JazzFest Berlin , and Young Euro Classic , the largest international festival of youth orchestras in the world. Several technology and media art festivals and conferences are held in the city, including Transmediale and Chaos Communication Congress . The annual Berlin Festival focuses on indie rock, electronic music and synthpop and is part of the International Berlin Music Week. Every year Berlin hosts one of the largest New Year's Eve celebrations in the world, attended by well over a million people. The focal point is the Brandenburg Gate, where midnight fireworks are centered, but various private fireworks displays take place throughout the entire city. Partygoers in Germany often toast the New Year with a glass of sparkling wine . Berlin is home to 44 theaters and stages. The Deutsches Theater in Mitte was built in 1849–50 and has operated almost continuously since then. The Volksbühne at Rosa-Luxemburg-Platz was built in 1913–14, though the company had been founded in 1890. The Berliner Ensemble , famous for performing the works of Bertolt Brecht , was established in 1949. The Schaubühne was founded in 1962 and moved to the building of the former Universum Cinema on Kurfürstendamm in 1981. With a seating capacity of 1,895 and a stage floor of 2,854 square meters (30,720 sq ft) , the Friedrichstadt-Palast in Berlin Mitte is the largest show palace in Europe. For Berlin's independent dance and theatre scene, venues such as the Sophiensäle in Mitte and the three houses of the Hebbel am Ufer (HAU) in Kreuzberg are important. Most productions there are also accessible to an English-speaking audience. Some of the dance and theatre groups that also work internationally ( Gob Squad , Rimini Protokoll ) are based there, as well as festivals such as the international festival Dance in August . Berlin has three major opera houses : the Deutsche Oper , the Berlin State Opera , and the Komische Oper . The Berlin State Opera on Unter den Linden opened in 1742 and is the oldest of the three. Its musical director is Daniel Barenboim . The Komische Oper has traditionally specialized in operettas and is also at Unter den Linden. The Deutsche Oper opened in 1912 in Charlottenburg. The city's main venue for musical theater performances are the Theater am Potsdamer Platz and Theater des Westens (built in 1895). Contemporary dance can be seen at the Radialsystem V . The Tempodrom is host to concerts and circus-inspired entertainment. It also houses a multi-sensory spa experience. The Admiralspalast in Mitte has a vibrant program of variety and music events. There are seven symphony orchestras in Berlin. The Berlin Philharmonic Orchestra is one of the preeminent orchestras in the world; it is housed in the Berliner Philharmonie near Potsdamer Platz on a street named for the orchestra's longest-serving conductor, Herbert von Karajan . Simon Rattle was its principal conductor from 1999 to 2018, a position now held by Kirill Petrenko . The Konzerthausorchester Berlin was founded in 1952 as the orchestra for East Berlin. Christoph Eschenbach is its principal conductor. The Haus der Kulturen der Welt presents exhibitions dealing with intercultural issues and stages world music and conferences. The Kookaburra and the Quatsch Comedy Club are known for satire and comedy shows. In 2018, the New York Times described Berlin as "arguably the world capital of underground electronic music ". The cuisine and culinary offerings of Berlin vary greatly. 23 restaurants in Berlin have been awarded one or more Michelin stars in the Michelin Guide of 2021, which ranks the city at the top for the number of restaurants having this distinction in Germany. Berlin is well known for its offerings of vegetarian and vegan cuisine and is home to an innovative entrepreneurial food scene promoting cosmopolitan flavors, local and sustainable ingredients, pop-up street food markets, supper clubs, as well as food festivals, such as Berlin Food Week. Many local foods originated from north German culinary traditions and include rustic and hearty dishes with pork, goose, fish, peas, beans, cucumbers, or potatoes. Typical Berliner fare include popular street food like the Currywurst (which gained popularity with postwar construction workers rebuilding the city), Buletten and the Berliner donut, known in Berlin as Pfannkuchen ( German: [ ˈp͡fanˌkuːxn̩ ] ⓘ ). German bakeries offering a variety of breads and pastries are widespread. One of Europe's largest delicatessen markets is found at the KaDeWe , and among the world's largest chocolate stores is Rausch . Berlin is also home to a diverse gastronomy scene reflecting the immigrant history of the city. Turkish and Arab immigrants brought their culinary traditions to the city, such as the lahmajoun and falafel , which have become common fast food staples. The modern fast-food version of the doner kebab sandwich which evolved in Berlin in the 1970s, has since become a favorite dish in Germany and elsewhere in the world. Asian cuisine like Chinese, Vietnamese, Thai, Indian, Korean, and Japanese restaurants, as well as Spanish tapas bars, Italian, and Greek cuisine, can be found in many parts of the city. Zoologischer Garten Berlin , the older of two zoos in the city, was founded in 1844. It is the most visited zoo in Europe and presents the most diverse range of species in the world. It was the home of the captive-born celebrity polar bear Knut . The city's other zoo, Tierpark Friedrichsfelde , was founded in 1955. Berlin's Botanischer Garten includes the Botanic Museum Berlin. With an area of 43 hectares (110 acres) and around 22,000 different plant species, it is one of the largest and most diverse collections of botanical life in the world. Other gardens in the city include the Britzer Garten , and the Gärten der Welt (Gardens of the World) in Marzahn. The Tiergarten park in Mitte, with landscape design by Peter Joseph Lenné , is one of Berlin's largest and most popular parks. In Kreuzberg, the Viktoriapark provides a viewing point over the southern part of inner-city Berlin. Treptower Park , beside the Spree in Treptow , features a large Soviet War Memorial . The Volkspark in Friedrichshain , which opened in 1848, is the oldest park in the city, with monuments, a summer outdoor cinema and several sports areas. Tempelhofer Feld , the site of the former city airport , is the world's largest inner-city open space. Potsdam is on the southwestern periphery of Berlin. The city was a residence of the Prussian kings and the German Kaiser , until 1918. The area around Potsdam in particular Sanssouci is known for a series of interconnected lakes and cultural landmarks. The Palaces and Parks of Potsdam and Berlin are the largest World Heritage Site in Germany. Berlin is also well known for its numerous cafés, street musicians, beach bars along the Spree River, flea markets, boutique shops and pop-up stores , which are a source for recreation and leisure. As of 2011 [ update ] Berlin is home to 138 museums and more than 400 art galleries. The ensemble on the Museum Island is a UNESCO World Heritage Site and is in the northern part of the Spree Island between the Spree and the Kupfergraben. As early as 1841 it was designated a "district dedicated to art and antiquities" by a royal decree. Subsequently, the Altes Museum was built in the Lustgarten. The Neues Museum , which displays the bust of Queen Nefertiti , Alte Nationalgalerie , Pergamon Museum , and Bode Museum were built there. Apart from the Museum Island, there are many additional museums in the city. The Gemäldegalerie (Painting Gallery) focuses on the paintings of the "old masters" from the 13th to the 18th centuries, while the Neue Nationalgalerie (New National Gallery, built by Ludwig Mies van der Rohe ) specializes in 20th-century European painting. The Hamburger Bahnhof , in Moabit , exhibits a major collection of modern and contemporary art. The expanded Deutsches Historisches Museum reopened in the Zeughaus with an overview of German history spanning more than a millennium. The Bauhaus Archive is a museum of 20th-century design from the famous Bauhaus school. Museum Berggruen houses the collection of noted 20th century collector Heinz Berggruen , and features an extensive assortment of works by Picasso , Matisse , Cézanne , and Giacometti , among others. The Kupferstichkabinett Berlin (Museum of Prints and Drawings) is part of the Staatlichen Museen zu Berlin (Berlin State Museums) and the Kulturforum at Potsdamer Platz in the Tiergarten district of Berlin's Mitte district. It is the largest museum of the graphic arts in Germany and at the same time one of the four most important collections of its kind in the world. The collection includes Friedrich Gilly 's design for the monument to Frederick II of Prussia. The Jewish Museum has a standing exhibition on two millennia of German-Jewish history. The German Museum of Technology in Kreuzberg has a large collection of historical technical artifacts. The Museum für Naturkunde (Berlin's natural history museum ) exhibits natural history near Berlin Hauptbahnhof . It has the largest mounted dinosaur in the world (a Giraffatitan skeleton). A well-preserved specimen of Tyrannosaurus rex and the early bird Archaeopteryx are at display as well. In Dahlem , there are several museums of world art and culture, such as the Museum of Asian Art , the Ethnological Museum , the Museum of European Cultures , as well as the Allied Museum . The Brücke Museum features one of the largest collection of works by artist of the early 20th-century expressionist movement. In Lichtenberg , on the grounds of the former East German Ministry for State Security , is the Stasi Museum . The site of Checkpoint Charlie , one of the most renowned crossing points of the Berlin Wall, is still preserved. A private museum venture exhibits a comprehensive documentation of detailed plans and strategies devised by people who tried to flee from the East. The Beate Uhse Erotic Museum claimed to be the largest erotic museum in the world until it closed in 2014. The cityscape of Berlin displays large quantities of urban street art . It has become a significant part of the city's cultural heritage and has its roots in the graffiti scene of Kreuzberg of the 1980s. The Berlin Wall itself has become one of the largest open-air canvasses in the world. The leftover stretch along the Spree river in Friedrichshain remains as the East Side Gallery . Berlin today is consistently rated as an important world city for street art culture. Berlin has galleries which are quite rich in contemporary art. Located in Mitte, KW Institute for Contemporary Art, KOW, Sprüth Magers; Kreuzberg there are a few galleries as well such as Blain Southern, Esther Schipper , Future Gallery, König Gallerie.Berlin's nightlife has been celebrated as one of the most diverse and vibrant of its kind. In the 1970s and 80s, the SO36 in Kreuzberg was a center for punk music and culture. The SOUND and the Dschungel gained notoriety. Throughout the 1990s, people in their 20s from all over the world, particularly those in Western and Central Europe, made Berlin's club scene a premier nightlife venue. After the fall of the Berlin Wall in 1989, many historic buildings in Mitte, the former city center of East Berlin, were illegally occupied and re-built by young squatters and became a fertile ground for underground and counterculture gatherings. The central boroughs are home to many nightclubs, including the Watergate, Tresor and Berghain . The KitKatClub and several other locations are known for their sexually uninhibited parties. Clubs are not required to close at a fixed time during the weekends, and many parties last well into the morning or even all weekend. The Weekend Club near Alexanderplatz features a roof terrace that allows partying at night. Several venues have become a popular stage for the Neo-Burlesque scene. Berlin has a long history of gay culture, and is an important birthplace of the LGBT rights movement . Same-sex bars and dance halls operated freely as early as the 1880s, and the first gay magazine, Der Eigene , started in 1896. By the 1920s, gays and lesbians had an unprecedented visibility. Today, in addition to a positive atmosphere in the wider club scene, the city again has a huge number of queer clubs and festivals. The most famous and largest are Berlin Pride , the Christopher Street Day , the Lesbian and Gay City Festival in Berlin-Schöneberg, the Kreuzberg Pride and Hustlaball . The annual Berlin International Film Festival (Berlinale) with around 500,000 admissions is considered to be the largest publicly attended film festival in the world. The Karneval der Kulturen ( Carnival of Cultures ), a multi-ethnic street parade, is celebrated every Pentecost weekend. Berlin is also well known for the cultural festival Berliner Festspiele , which includes the jazz festival JazzFest Berlin , and Young Euro Classic , the largest international festival of youth orchestras in the world. Several technology and media art festivals and conferences are held in the city, including Transmediale and Chaos Communication Congress . The annual Berlin Festival focuses on indie rock, electronic music and synthpop and is part of the International Berlin Music Week. Every year Berlin hosts one of the largest New Year's Eve celebrations in the world, attended by well over a million people. The focal point is the Brandenburg Gate, where midnight fireworks are centered, but various private fireworks displays take place throughout the entire city. Partygoers in Germany often toast the New Year with a glass of sparkling wine .Berlin is home to 44 theaters and stages. The Deutsches Theater in Mitte was built in 1849–50 and has operated almost continuously since then. The Volksbühne at Rosa-Luxemburg-Platz was built in 1913–14, though the company had been founded in 1890. The Berliner Ensemble , famous for performing the works of Bertolt Brecht , was established in 1949. The Schaubühne was founded in 1962 and moved to the building of the former Universum Cinema on Kurfürstendamm in 1981. With a seating capacity of 1,895 and a stage floor of 2,854 square meters (30,720 sq ft) , the Friedrichstadt-Palast in Berlin Mitte is the largest show palace in Europe. For Berlin's independent dance and theatre scene, venues such as the Sophiensäle in Mitte and the three houses of the Hebbel am Ufer (HAU) in Kreuzberg are important. Most productions there are also accessible to an English-speaking audience. Some of the dance and theatre groups that also work internationally ( Gob Squad , Rimini Protokoll ) are based there, as well as festivals such as the international festival Dance in August . Berlin has three major opera houses : the Deutsche Oper , the Berlin State Opera , and the Komische Oper . The Berlin State Opera on Unter den Linden opened in 1742 and is the oldest of the three. Its musical director is Daniel Barenboim . The Komische Oper has traditionally specialized in operettas and is also at Unter den Linden. The Deutsche Oper opened in 1912 in Charlottenburg. The city's main venue for musical theater performances are the Theater am Potsdamer Platz and Theater des Westens (built in 1895). Contemporary dance can be seen at the Radialsystem V . The Tempodrom is host to concerts and circus-inspired entertainment. It also houses a multi-sensory spa experience. The Admiralspalast in Mitte has a vibrant program of variety and music events. There are seven symphony orchestras in Berlin. The Berlin Philharmonic Orchestra is one of the preeminent orchestras in the world; it is housed in the Berliner Philharmonie near Potsdamer Platz on a street named for the orchestra's longest-serving conductor, Herbert von Karajan . Simon Rattle was its principal conductor from 1999 to 2018, a position now held by Kirill Petrenko . The Konzerthausorchester Berlin was founded in 1952 as the orchestra for East Berlin. Christoph Eschenbach is its principal conductor. The Haus der Kulturen der Welt presents exhibitions dealing with intercultural issues and stages world music and conferences. The Kookaburra and the Quatsch Comedy Club are known for satire and comedy shows. In 2018, the New York Times described Berlin as "arguably the world capital of underground electronic music ". The cuisine and culinary offerings of Berlin vary greatly. 23 restaurants in Berlin have been awarded one or more Michelin stars in the Michelin Guide of 2021, which ranks the city at the top for the number of restaurants having this distinction in Germany. Berlin is well known for its offerings of vegetarian and vegan cuisine and is home to an innovative entrepreneurial food scene promoting cosmopolitan flavors, local and sustainable ingredients, pop-up street food markets, supper clubs, as well as food festivals, such as Berlin Food Week. Many local foods originated from north German culinary traditions and include rustic and hearty dishes with pork, goose, fish, peas, beans, cucumbers, or potatoes. Typical Berliner fare include popular street food like the Currywurst (which gained popularity with postwar construction workers rebuilding the city), Buletten and the Berliner donut, known in Berlin as Pfannkuchen ( German: [ ˈp͡fanˌkuːxn̩ ] ⓘ ). German bakeries offering a variety of breads and pastries are widespread. One of Europe's largest delicatessen markets is found at the KaDeWe , and among the world's largest chocolate stores is Rausch . Berlin is also home to a diverse gastronomy scene reflecting the immigrant history of the city. Turkish and Arab immigrants brought their culinary traditions to the city, such as the lahmajoun and falafel , which have become common fast food staples. The modern fast-food version of the doner kebab sandwich which evolved in Berlin in the 1970s, has since become a favorite dish in Germany and elsewhere in the world. Asian cuisine like Chinese, Vietnamese, Thai, Indian, Korean, and Japanese restaurants, as well as Spanish tapas bars, Italian, and Greek cuisine, can be found in many parts of the city.Zoologischer Garten Berlin , the older of two zoos in the city, was founded in 1844. It is the most visited zoo in Europe and presents the most diverse range of species in the world. It was the home of the captive-born celebrity polar bear Knut . The city's other zoo, Tierpark Friedrichsfelde , was founded in 1955. Berlin's Botanischer Garten includes the Botanic Museum Berlin. With an area of 43 hectares (110 acres) and around 22,000 different plant species, it is one of the largest and most diverse collections of botanical life in the world. Other gardens in the city include the Britzer Garten , and the Gärten der Welt (Gardens of the World) in Marzahn. The Tiergarten park in Mitte, with landscape design by Peter Joseph Lenné , is one of Berlin's largest and most popular parks. In Kreuzberg, the Viktoriapark provides a viewing point over the southern part of inner-city Berlin. Treptower Park , beside the Spree in Treptow , features a large Soviet War Memorial . The Volkspark in Friedrichshain , which opened in 1848, is the oldest park in the city, with monuments, a summer outdoor cinema and several sports areas. Tempelhofer Feld , the site of the former city airport , is the world's largest inner-city open space. Potsdam is on the southwestern periphery of Berlin. The city was a residence of the Prussian kings and the German Kaiser , until 1918. The area around Potsdam in particular Sanssouci is known for a series of interconnected lakes and cultural landmarks. The Palaces and Parks of Potsdam and Berlin are the largest World Heritage Site in Germany. Berlin is also well known for its numerous cafés, street musicians, beach bars along the Spree River, flea markets, boutique shops and pop-up stores , which are a source for recreation and leisure. Berlin has established a high-profile as a host city of major international sporting events. The city hosted the 1936 Summer Olympics and was the host city for the 2006 FIFA World Cup final. The World Athletics Championships was held in the Olympiastadion in 2009 and 2025 . The city hosted the Basketball Euroleague Final Four in 2009 and 2016 . and was one of the hosts of the FIBA EuroBasket 2015 . In 2015 Berlin became the venue for the UEFA Champions League Final . Berlin will host the 2023 Special Olympics World Summer Games. This will be the first time Germany has ever hosted the Special Olympics World Games. The annual Berlin Marathon – a course that holds the most top-10 world record runs – and the ISTAF are well-established athletic events in the city. The Mellowpark in Köpenick is one of the biggest skate and BMX parks in Europe. A Fan Fest at Brandenburg Gate, which attracts several hundred-thousand spectators, has become popular during international football competitions, like the UEFA European Championship . Friedrich Ludwig Jahn , who is often hailed as the "father of modern gymnastics", invented the Horizontal bar , parallel bars , rings and the vault around 1811 in Berlin. Jahn's Turners movement, first realized at Volkspark Hasenheide , was the origin of the modern sports clubs . 2013 around 600,000 Berliners were registered in one of the more than 2,300 sport and fitness clubs. The city of Berlin operates more than 60 public indoor and outdoor swimming pools. Berlin is the largest Olympic training center in Germany. About 500 top athletes (15% of all German top athletes) are based there. Forty-seven elite athletes participated in the 2012 Summer Olympics. Berliners would achieve seven gold, twelve silver and three bronze medals. Several professional clubs representing the most important spectator team sports in Germany have their base in Berlin. The oldest and most popular first division team based in Berlin is the football club Hertha BSC . The team represented Berlin as a founding member of the Bundesliga in 1963. Other professional team sport clubs include:

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Angie Cepeda

Angélica María Cepeda Jiménez (born 2 August 1974), professionally known as Angie Cepeda , is a Colombian actress . She is best known for her roles in the telenovela Pobre Diabla and the films Captain Pantoja and the Special Services and Love in the Time of Cholera . She is the younger sister of actress Lorna Cepeda .Cepeda was born in Cartagena de Indias, Colombia , and raised in Barranquilla . After her parents divorced she lived with her mother and two older sisters (one of whom is actress Lorna Paz ).When she discovered her vocation in drama, she moved out to Bogotá . After starting her drama courses, she was contracted by a beer company and made some advertisements for it. Next, she played some bit parts in several soap operas and movies in Colombia. Cepeda got a role in the soap opera Las Juanas , getting the attention of some TV producers who offered her jobs in prime time shows, such as the leading role in Luz Maria (1998), co-starring Christian Meier and Rosalinda Serfaty, and that as Fiorella Morelli Flores de Mejía Guzmán in Pobre Diabla (2000), opposite Salvador del Solar and Santiago Magill . In the cinematic world, Peruvian director Francisco Lombardi convinced her to portray a prostitute called "La Colombiana" in Pantaleón y las Visitadoras (released in English as Captain Pantoja and the Special Services ). In 2021, she voiced Julieta Madrigal in the English, Spanish and Italian language versions of the Disney animated musical film Encanto .

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Algeria

Algeria , [lower-alpha 3] officially the People's Democratic Republic of Algeria , [lower-alpha 4] is a country in North Africa . Algeria is bordered to the northeast by Tunisia ; to the east by Libya ; to the southeast by Niger ; to the southwest by Mali , Mauritania , and Western Sahara ; to the west by Morocco ; and to the north by the Mediterranean Sea . It is considered part of the Maghreb region of North Africa. It has a semi-arid climate, with most of the population living in the fertile north and the Sahara dominating the geography of the south. Algeria covers an area of 2,381,741 square kilometres (919,595 sq mi) , making it the world's tenth largest nation by area , and the largest nation in Africa , more than 200 times as large as the continent's smallest country, The Gambia . With a population of 44 million, Algeria is the tenth-most populous country in Africa, and the 32nd-most populous country in the world. The capital and largest city is Algiers , located in the far north on the Mediterranean coast. Centuries of Arab migration to the Maghreb since the 7th century shifted the demographic scope in Algeria. The Spanish expansionism led to the establishment of the Regency of Algiers in 1516, a state that attracted people from all over the Mediterranean, making its capital Algiers one of the largest, wealthiest, and most cosmopolitan cities in the world. Its decline in the 19th century resulted in its invasion by the French in 1830. The conquest and subsequent pacification of the country that ensued lasted until 1903 and led to Algeria becoming an integral part of France in 1848 and home to over a million European settlers . While the native Algerians remained the majority of the population during this period, it is estimated that they fell by up to one-third due to warfare, disease and starvation. The Sétif and Guelma massacre in 1945 marked a turning point in Franco-Algerian relations and sparked the Algerian War which concluded with Algeria gaining its independence on 5 July 1962 and the proclamation of the People's Democratic Republic on 25 September of that year. The official languages of Algeria are Arabic and Tamazight . The majority of Algeria's population is Arab , practicing Islam . The native Algerian Arabic is the main spoken language. French also serves as an administrative and educational language in some contexts, but it has no official status. Algeria is a semi-presidential republic , with local constituencies consisting of 58 provinces , known locally as wilayas , and 1,541 communes . Algeria is a regional power in North Africa, and a middle power in global affairs. It has the highest Human Development Index of all continental African countries and one of the largest economies on the continent , based largely on energy exports. Algeria has the world's sixteenth-largest oil reserves and the ninth-largest reserves of natural gas. Sonatrach , the national oil company, is the largest company in Africa, supplying large amounts of natural gas to Europe. Algeria's military is one of the largest in Africa, and has the largest defence budget on the continent. It is a member of the African Union , the Arab League , the OIC , OPEC , the United Nations, and the Arab Maghreb Union , of which it is a founding member.Other forms of the name are: Arabic : الجزائر , romanized : al-Jazāʾir , Algerian Arabic : الدزاير , romanized: al-dzāyīr , French : Algérie . It is officially the People's Democratic Republic of Algeria ( Arabic : الج٠هورية الجزائرية الدي٠قراطية الشعبية , romanized : al-Jumhūriyah al-Jazāʾiriyah ad-Dīmuqrāṭiyah ash‑Shaʿbiyah ; French : République algérienne démocratique et populaire , abbreviated as RADP). [nb 1] Algeria's name derives from the city of Algiers which in turn derives from the Arabic al-Jazāʾir ( الجزائر , "the islands") in reference to four small islands off its coast, a truncated form of the older Jazāʾir Banī Mazghanna ( جزائر بني ٠زغنة , "islands of Bani Mazghanna"). [ page needed ] [ page needed ] The name was given by Buluggin ibn Ziri after he established the city on the ruins of the Phoenician city of Icosium in 950. It was employed by medieval geographers such as Muhammad al-Idrisi and Yaqut al-Hamawi . The Ottoman Empire extended the name of al-Jazā'ir over the entire country, deriving it from the name of the capital city. Thus, it shares its etymology with numerous other places, such as Alzira in Valencia , Algeciras in Andalusia, Lezíria in Portugal, Cizre in Turkey, Gżira in Malta, the Nile island of Gezira in Egypt, and the state of Gezira in Sudan.Algeria's name derives from the city of Algiers which in turn derives from the Arabic al-Jazāʾir ( الجزائر , "the islands") in reference to four small islands off its coast, a truncated form of the older Jazāʾir Banī Mazghanna ( جزائر بني ٠زغنة , "islands of Bani Mazghanna"). [ page needed ] [ page needed ] The name was given by Buluggin ibn Ziri after he established the city on the ruins of the Phoenician city of Icosium in 950. It was employed by medieval geographers such as Muhammad al-Idrisi and Yaqut al-Hamawi . The Ottoman Empire extended the name of al-Jazā'ir over the entire country, deriving it from the name of the capital city. Thus, it shares its etymology with numerous other places, such as Alzira in Valencia , Algeciras in Andalusia, Lezíria in Portugal, Cizre in Turkey, Gżira in Malta, the Nile island of Gezira in Egypt, and the state of Gezira in Sudan.Around ~1.8-million-year-old stone artifacts from Ain Hanech (Algeria) were considered to represent the oldest archaeological materials in North Africa. Stone artifacts and cut-marked bones that were excavated from two nearby deposits at Ain Boucherit are estimated to be ~1.9 million years old, and even older stone artifacts to be as old as ~2.4 million years. Hence, the Ain Boucherit evidence shows that ancestral hominins inhabited the Mediterranean fringe in northern Africa much earlier than previously thought. The evidence strongly argues for early dispersal of stone tool manufacture and use from East Africa, or a possible multiple-origin scenario of stone technology in both East and North Africa. Neanderthal tool makers produced hand axes in the Levalloisian and Mousterian styles (43,000 BC) similar to those in the Levant . Algeria was the site of the highest state of development of Middle Paleolithic Flake tool techniques. Tools of this era, starting about 30,000 BC, are called Aterian (after the archaeological site of Bir el Ater , south of Tebessa ). The earliest blade industries in North Africa are called Iberomaurusian (located mainly in the Oran region). This industry appears to have spread throughout the coastal regions of the Maghreb between 15,000 and 10,000 BC. Neolithic civilization (animal domestication and agriculture) developed in the Saharan and Mediterranean Maghreb perhaps as early as 11,000 BC or as late as between 6000 and 2000 BC. This life, richly depicted in the Tassili n'Ajjer paintings, predominated in Algeria until the classical period. The mixture of peoples of North Africa coalesced eventually into a distinct native population that came to be called Berbers , who are the indigenous peoples of northern Africa. From their principal center of power at Carthage , the Carthaginians expanded and established small settlements along the North African coast; by 600 BC, a Phoenician presence existed at Tipasa , east of Cherchell , Hippo Regius (modern Annaba ) and Rusicade (modern Skikda ). These settlements served as market towns as well as anchorages. As Carthaginian power grew, its impact on the indigenous population increased dramatically. Berber civilisation was already at a stage in which agriculture, manufacturing, trade, and political organisation supported several states. Trade links between Carthage and the Berbers in the interior grew, but territorial expansion also resulted in the enslavement or military recruitment of some Berbers and in the extraction of tribute from others. By the early 4th century BC, Berbers formed the single largest element of the Carthaginian army. In the Revolt of the Mercenaries , Berber soldiers rebelled from 241 to 238 BC after being unpaid following the defeat of Carthage in the First Punic War . They succeeded in obtaining control of much of Carthage's North African territory, and they minted coins bearing the name Libyan, used in Greek to describe natives of North Africa. The Carthaginian state declined because of successive defeats by the Romans in the Punic Wars . In 146 BC the city of Carthage was destroyed. As Carthaginian power waned, the influence of Berber leaders in the hinterland grew. By the 2nd century BC, several large but loosely administered Berber kingdoms had emerged. Two of them were established in Numidia , behind the coastal areas controlled by Carthage. West of Numidia lay Mauretania , which extended across the Moulouya River in modern-day Morocco to the Atlantic Ocean. The high point of Berber civilisation, unequalled until the coming of the Almohads and Almoravids more than a millennium later, was reached during the reign of Masinissa in the 2nd century BC. After Masinissa's death in 148 BC, the Berber kingdoms were divided and reunited several times. Masinissa's line survived until 24 AD, when the remaining Berber territory was annexed to the Roman Empire . For several centuries Algeria was ruled by the Romans, who founded many colonies in the region, Algeria is the second country in the world after Italy, home to the largest number of Roman sites and remains among the most alive and well preserved. Rome, after getting rid of its powerful rival Carthage in the year 146 BC, decided a century later to include Numidia to become the new master of North Africa. They built more than 500 cities. Like the rest of North Africa, Algeria was one of the breadbaskets of the empire, exporting cereals and other agricultural products. Saint Augustine was the bishop of Hippo Regius (modern-day Annaba, Algeria), located in the Roman province of Africa . The Germanic Vandals of Geiseric moved into North Africa in 429, and by 435 controlled coastal Numidia. They did not make any significant settlement on the land, as they were harassed by local tribes. [ citation needed ] In fact, by the time the Byzantines arrived Leptis Magna was abandoned and the Msellata region was occupied by the indigenous Laguatan who had been busy facilitating an Amazigh political, military and cultural revival. Furthermore, during the rule of the Romans, Byzantines, Vandals, Carthaginians, and Ottomans the Berber people were the only or one of the few in North Africa who remained independent. The Berber people were so resistant that even during the Muslim conquest of North Africa they still had control and possession over their mountains. The collapse of the Western Roman Empire led to the establishment of a native Kingdom based in Altava (modern-day Algeria) known as the Mauro-Roman Kingdom . It was succeeded by another Kingdom based in Altava, the Kingdom of Altava . During the reign of Kusaila its territory extended from the region of modern-day Fez in the west to the western Aurès and later Kairaouan and the interior of Ifriqiya in the east. After negligible resistance from the locals, Muslim Arabs of the Umayyad Caliphate conquered Algeria in the early 8th century. Large numbers of the indigenous Berber people converted to Islam. Christians, Berber and Latin speakers remained in the great majority in Tunisia until the end of the 9th century and Muslims only became a vast majority some time in the 10th. After the fall of the Umayyad Caliphate, numerous local dynasties emerged, including the Rustamids , Aghlabids , Fatimids , Zirids , Hammadids , Almoravids , Almohads and the Zayyanids . The Christians left in three waves: after the initial conquest, in the 10th century and the 11th. The last were evacuated to Sicily by the Normans and the few remaining died out in the 14th century. During the Middle Ages , North Africa was home to many great scholars, saints and sovereigns including Judah Ibn Quraysh , the first grammarian to mention Semitic and Berber languages, the great Sufi masters Sidi Boumediene (Abu Madyan) and Sidi El Houari , and the Emirs Abd Al Mu'min and Yāghmūrasen . It was during this time that the Fatimids or children of Fatima , daughter of Muhammad , came to the Maghreb . These "Fatimids" went on to found a long lasting dynasty stretching across the Maghreb, Hejaz and the Levant , boasting a secular inner government, as well as a powerful army and navy, made up primarily of Arabs and Levantines extending from Algeria to their capital state of Cairo . The Fatimid caliphate began to collapse when its governors the Zirids seceded. To punish them the Fatimids sent the Arab Banu Hilal and Banu Sulaym against them. The resultant war is recounted in the epic Tāghribāt . In Al-Tāghrībāt the Amazigh Zirid Hero Khālīfā Al-Zānatī asks daily, for duels, to defeat the Hilalan hero Ābu Zayd al-Hilalī and many other Arab knights in a string of victories. The Zirids , however, were ultimately defeated ushering in an adoption of Arab customs and culture. The indigenous Amazigh tribes, however, remained largely independent, and depending on tribe, location and time controlled varying parts of the Maghreb, at times unifying it (as under the Fatimids). The Fatimid Islamic state, also known as Fatimid Caliphate made an Islamic empire that included North Africa, Sicily, Palestine , Jordan , Lebanon , Syria , Egypt , the Red Sea coast of Africa, Tihamah, Hejaz and Yemen . Caliphates from Northern Africa traded with the other empires of their time, as well as forming part of a confederated support and trade network with other Islamic states during the Islamic Era. The Berber people historically consisted of several tribes. The two main branches were the Botr and Barnès tribes, who were divided into tribes, and again into sub-tribes. Each region of the Maghreb contained several tribes (for example, Sanhadja , Houara , Zenata , Masmouda , Kutama , Awarba, and Berghwata ). All these tribes made independent territorial decisions. Several Amazigh dynasties emerged during the Middle Ages in the Maghreb and other nearby lands. Ibn Khaldun provides a table summarising the Amazigh dynasties of the Maghreb region, the Zirid , Ifranid , Maghrawa , Almoravid , Hammadid , Almohad , Merinid , Abdalwadid , Wattasid , Meknassa and Hafsid dynasties. Both of the Hammadid and Zirid empires as well as the Fatimids established their rule in all of the Maghreb countries. The Zirids ruled land in what is now Algeria, Tunisia, Morocco, Libya, Spain, Malta and Italy. The Hammadids captured and held important regions such as Ouargla, Constantine, Sfax, Susa, Algiers, Tripoli and Fez establishing their rule in every country in the Maghreb region. The Fatimids which was created and established by the Kutama Berbers conquered all of North Africa as well as Sicily and parts of the Middle East. Following the Berber revolt numerous independent states emerged across the Maghreb. In Algeria the Rustamid Kingdom was established. The Rustamid realm stretched from Tafilalt in Morocco to the Nafusa mountains in Libya including south, central and western Tunisia therefore including territory in all of the modern day Maghreb countries, in the south the Rustamid realm expanded to the modern borders of Mali and included territory in Mauritania . Once extending their control over all of the Maghreb, part of Spain and briefly over Sicily, originating from modern Algeria, the Zirids only controlled modern Ifriqiya by the 11th century. The Zirids recognized nominal suzerainty of the Fatimid caliphs of Cairo. El Mu'izz the Zirid ruler decided to end this recognition and declared his independence. The Zirids also fought against other Zenata Kingdoms, for example the Maghrawa , a Berber dynasty originating from Algeria and which at one point was a dominant power in the Maghreb ruling over much of Morocco and western Algeria including Fez, Sijilmasa , Aghmat , Oujda , most of the Sous and Draa and reaching as far as M'sila and the Zab in Algeria. As the Fatimid state was at the time too weak to attempt a direct invasion, they found another means of revenge. Between the Nile and the Red Sea were living Bedouin nomad tribes expelled from Arabia for their disruption and turbulency. The Banu Hilal and the Banu Sulaym for example, who regularly disrupted farmers in the Nile Valley since the nomads would often loot their farms. The then Fatimid vizier decided to destroy what he could not control, and broke a deal with the chiefs of these Beduouin tribes. The Fatimids even gave them money to leave. Whole tribes set off with women, children, elders, animals and camping equipment. Some stopped on the way, especially in Cyrenaica , where they are still one of the essential elements of the settlement but most arrived in Ifriqiya by the Gabes region, arriving 1051. The Zirid ruler tried to stop this rising tide, but with each encounter, the last under the walls of Kairouan , his troops were defeated and the Arabs remained masters of the battlefield. The Arabs usually did not take control over the cities, instead looting them and destroying them. The invasion kept going, and in 1057 the Arabs spread on the high plains of Constantine where they encircled the Qalaa of Banu Hammad (capital of the Hammadid Emirate ), as they had done in Kairouan a few decades ago. From there they gradually gained the upper Algiers and Oran plains. Some of these territories were forcibly taken back by the Almohads in the second half of the 12th century. The influx of Bedouin tribes was a major factor in the linguistic, cultural Arabization of the Maghreb and in the spread of nomadism in areas where agriculture had previously been dominant. Ibn Khaldun noted that the lands ravaged by Banu Hilal tribes had become completely arid desert. The Almohads originating from modern day Morocco, although founded by a man originating from modern day Algeria known as Abd al-Mu'min would soon take control over the Maghreb. During the time of the Almohad Dynasty Abd al-Mu'min 's tribe, the Koumïa, were the main supporters of the throne and the most important body of the empire. Defeating the weakening Almoravid Empire and taking control over Morocco in 1147, they pushed into Algeria in 1152, taking control over Tlemcen, Oran, and Algiers, wrestling control from the Hilian Arabs, and by the same year they defeated Hammadids who controlled Eastern Algeria. Following their decisive defeat in the Battle of Las Navas de Tolosa in 1212 the Almohads began collapsing, and in 1235 the governor of modern-day Western Algeria, Yaghmurasen Ibn Zyan declared his independence and established the Kingdom of Tlemcen and the Zayyanid dynasty . Warring with the Almohad forces attempting to restore control over Algeria for 13 years, they defeated the Almohads in 1248 after killing their Caliph in a successful ambush near Oujda. The Zayyanids retained their control over Algeria for 3 centuries. Much of the eastern territories of Algeria were under the authority of the Hafsid dynasty , although the Emirate of Bejaia encompassing the Algerian territories of the Hafsids would occasionally be independent from central Tunisian control. At their peak the Zayyanid kingdom included all of Morocco as its vassal to the west and in the east reached as far as Tunis which they captured during the reign of Abu Tashfin. After several conflicts with local Barbary pirates sponsored by the Zayyanid sultans, Spain decided to invade Algeria and defeat the native Kingdom of Tlemcen. In 1505, they invaded and captured Mers el Kébir , and in 1509 after a bloody siege, they conquered Oran . Following their decisive victories over the Algerians in the western-coastal areas of Algeria, the Spanish decided to get bolder, and invaded more Algerian cities. In 1510, they led a series of sieges and attacks, taking over Bejaia in a large siege , and leading a semi-successful siege against Algiers . They also besieged Tlemcen. In 1511, they took control over Cherchell and Jijel , and attacked Mostaganem where although they were not able to conquer the city, they were able to force a tribute on them. In 1516, the Turkish privateer brothers Aruj and Hayreddin Barbarossa , who operated successfully under the Hafsids , moved their base of operations to Algiers. They succeeded in conquering Jijel and Algiers from the Spaniards with help from the locals who saw them as liberators from the Christians, but the brothers eventually assassinated the local noble Salim al-Tumi and took control over the city and the surrounding regions. Their state is known as the Regency of Algiers . When Aruj was killed in 1518 during his invasion of Tlemcen , Hayreddin succeeded him as military commander of Algiers. The Ottoman sultan gave him the title of beylerbey and a contingent of some 2,000 janissaries . With the aid of this force and native Algerians, Hayreddin conquered the whole area between Constantine and Oran (although the city of Oran remained in Spanish hands until 1792). The next beylerbey was Hayreddin's son Hasan , who assumed the position in 1544. He was a Kouloughli or of mixed origins, as his mother was an Algerian Mooresse. Until 1587 Beylerbeylik of Algiers was governed by Beylerbeys who served terms with no fixed limits. Subsequently, with the institution of a regular administration, governors with the title of pasha ruled for three-year terms. The pasha was assisted by an autonomous janissary unit, known in Algeria as the Ojaq who were led by an agha . Discontent among the ojaq rose in the mid-1600s because they were not paid regularly, and they repeatedly revolted against the pasha. As a result, the agha charged the pasha with corruption and incompetence and seized power in 1659. Plague had repeatedly struck the cities of North Africa. Algiers lost between 30,000 and 50,000 inhabitants to the plague in 1620–21, and had high fatalities in 1654–57, 1665, 1691 and 1740–42. The Barbary pirates preyed on Christian and other non-Islamic shipping in the western Mediterranean Sea. The pirates often took the passengers and crew on the ships and sold them or used them as slaves . They also did a brisk business in ransoming some of the captives. According to Robert Davis, from the 16th to 19th century, pirates captured 1 million to 1.25 million Europeans as slaves. They often made raids on European coastal towns to capture Christian slaves to sell at slave markets in North Africa and other parts of the Ottoman Empire . In 1544, for example, Hayreddin Barbarossa captured the island of Ischia , taking 4,000 prisoners, and enslaved some 9,000 inhabitants of Lipari , almost the entire population. In 1551, the Ottoman governor of Algiers, Turgut Reis , enslaved the entire population of the Maltese island of Gozo . Barbary pirates often attacked the Balearic Islands . The threat was so severe that residents abandoned the island of Formentera . The introduction of broad-sail ships from the beginning of the 17th century allowed them to branch out into the Atlantic. In July 1627 two pirate ships from Algiers under the command of Dutch pirate Jan Janszoon sailed as far as Iceland , raiding and capturing slaves . Two weeks earlier another pirate ship from Salé in Morocco had also raided in Iceland. Some of the slaves brought to Algiers were later ransomed back to Iceland, but some chose to stay in Algeria. In 1629, pirate ships from Algeria raided the Faroe Islands . In 1659, the Janissaries stationned in Algiers, also known commonly as the Odjak of Algiers; and the Reis or the company of corsair captains rebelled, they removed the Ottoman viceroy from power, and placed one of its own in power. The new leader received the title of "Agha" then " Dey " in 1671, and the right to select passed to the divan , a council of some sixty military senior officers. Thus Algiers became a sovereign military republic. It was at first dominated by the odjak; but by the 18th century, it had become the dey's instrument. Although Algiers remained nominally part of the Ottoman Empire, in reality they acted independently from the rest of the Empire, and often had wars with other Ottoman subjects and territories such as the Beylik of Tunis . The dey was in effect a constitutional autocrat. The dey was elected for a life term, but in the 159 years (1671–1830) that the system was in place, fourteen of the twenty-nine deys were assassinated. Despite usurpation, military coups and occasional mob rule, the day-to-day operation of the Deylikal government was remarkably orderly. Although the regency patronised the tribal chieftains, it never had the unanimous allegiance of the countryside, where heavy taxation frequently provoked unrest. Autonomous tribal states were tolerated, and the regency's authority was seldom applied in the Kabylia , although in 1730 the Regency was able to take control over the Kingdom of Kuku in western Kabylia. Many cities in the northern parts of the Algerian desert paid taxes to Algiers or one of its Beys. Barbary raids in the Mediterranean continued to attack Spanish merchant shipping, and as a result, the Spanish Empire launched an invasion in 1775 , then the Spanish Navy bombarded Algiers in 1783 and 1784 . For the attack in 1784, the Spanish fleet was to be joined by ships from such traditional enemies of Algiers as Naples , Portugal and the Knights of Malta . Over 20,000 cannonballs were fired, but all these military campaigns were doomed and Spain had to ask for peace in 1786 and paid 1 million pesos to the Dey. In 1792, Algiers took back Oran and Mers el Kébir, the two last Spanish strongholds in Algeria. In the same year, they conquered the Moroccan Rif and Oujda , which they then abandoned in 1795. In the 19th century, Algerian pirates forged affiliations with Caribbean powers, paying a "license tax" in exchange for safe harbor of their vessels. Attacks by Algerian pirates on American merchantmen resulted in the First and Second Barbary Wars , which ended the attacks on U.S. ships in 1815. A year later, a combined Anglo - Dutch fleet, under the command of Lord Exmouth bombarded Algiers to stop similar attacks on European fishermen. These efforts proved successful, although Algerian piracy would continue until the French conquest in 1830. Under the pretext of a slight to their consul, the French invaded and captured Algiers in 1830. According to several historians, the methods used by the French to establish control over Algeria reached genocidal proportions. Historian Ben Kiernan wrote on the French conquest of Algeria: "By 1875, the French conquest was complete. The war had killed approximately 825,000 indigenous Algerians since 1830." French losses from 1831 to 1851 were 92,329 dead in the hospital and only 3,336 killed in action. In 1872, The Algerian population stood at about 2.9 million. [ unreliable source? ] French policy was predicated on "civilising" the country. The slave trade and piracy in Algeria ceased following the French conquest. The conquest of Algeria by the French took some time and resulted in considerable bloodshed. A combination of violence and disease epidemics caused the indigenous Algerian population to decline by nearly one-third from 1830 to 1872. [ unreliable source? ] On 17 September 1860, Napoleon III declared "Our first duty is to take care of the happiness of the three million Arabs, whom the fate of arms has brought under our domination." During this time, only Kabylia resisted, the Kabylians were not colonized until after the Mokrani Revolt in 1871. [ citation needed ] Alexis de Tocqueville wrote and never completed an unpublished essay outlining his ideas for how to transform Algeria from an occupied tributary state to a colonial regime, wherein he advocated for a mixed system of "total domination and total colonization" whereby French military would wage total war against civilian populations while a colonial administration would provide rule of law and property rights to settlers within French occupied cities. From 1848 until independence, France administered the whole Mediterranean region of Algeria as an integral part and département of the nation. One of France's longest-held overseas territories, Algeria became a destination for hundreds of thousands of European immigrants, who became known as colons and later, as Pied-Noirs . Between 1825 and 1847, 50,000 French people emigrated to Algeria. These settlers benefited from the French government's confiscation of communal land from tribal peoples, and the application of modern agricultural techniques that increased the amount of arable land. Many Europeans settled in Oran and Algiers , and by the early 20th century they formed a majority of the population in both cities. During the late 19th and early 20th century, the European share was almost a fifth of the population. The French government aimed at making Algeria an assimilated part of France, and this included substantial educational investments especially after 1900. The indigenous cultural and religious resistance heavily opposed this tendency, but in contrast to the other colonized countries' path in central Asia and Caucasus , Algeria kept its individual skills and a relatively human-capital intensive agriculture. During the Second World War , Algeria came under Vichy control before being liberated by the Allies in Operation Torch , which saw the first large-scale deployment of American troops in the North African campaign . Gradually, dissatisfaction among the Muslim population, which lacked political and economic status under the colonial system, gave rise to demands for greater political autonomy and eventually independence from France . In May 1945, the uprising against the occupying French forces was suppressed through what is now known as the Sétif and Guelma massacre . Tensions between the two population groups came to a head in 1954, when the first violent events of what was later called the Algerian War began after the publication of the Declaration of 1 November 1954 . Historians have estimated that between 30,000 and 150,000 Harkis and their dependents were killed by the National Liberation Front (FLN) or by lynch mobs in Algeria. The FLN used hit and run attacks in Algeria and France as part of its war, and the French conducted severe reprisals . In addition, the French destroyed over 8,000 villages and relocated over 2 million Algerians to concentration camps . The war led to the death of hundreds of thousands of Algerians and hundreds of thousands of injuries. Historians, like Alistair Horne and Raymond Aron , state that the actual number of Algerian Muslim war dead was far greater than the original FLN and official French estimates but was less than the 1 million deaths claimed by the Algerian government after independence. Horne estimated Algerian casualties during the span of eight years to be around 700,000. The war uprooted more than 2 million Algerians. The war against French rule concluded in 1962, when Algeria gained complete independence following the March 1962 Evian agreements and the July 1962 self-determination referendum . The number of European Pied-Noirs who fled Algeria totaled more than 900,000 between 1962 and 1964. The exodus to mainland France accelerated after the Oran massacre of 1962 , in which hundreds of militants entered European sections of the city, and began attacking civilians. Algeria's first president was the Front de Libération Nationale ( FLN ) leader Ahmed Ben Bella . Morocco's claim to portions of western Algeria led to the Sand War in 1963. Ben Bella was overthrown in 1965 by Houari Boumédiène , his former ally and defence minister. Under Ben Bella, the government had become increasingly socialist and authoritarian; Boumédienne continued this trend. However, he relied much more on the army for his support, and reduced the sole legal party to a symbolic role. He collectivised agriculture and launched a massive industrialisation drive. Oil extraction facilities were nationalised. This was especially beneficial to the leadership after the international 1973 oil crisis . Boumédienne's successor, Chadli Bendjedid , introduced some liberal economic reforms. He promoted a policy of Arabisation in Algerian society and public life. Teachers of Arabic, brought in from other Muslim countries, spread conventional Islamic thought in schools and sowed the seeds of a return to Orthodox Islam. The Algerian economy became increasingly dependent on oil, leading to hardship when the price collapsed during the 1980s oil glut . Economic recession caused by the crash in world oil prices resulted in Algerian social unrest during the 1980s; by the end of the decade, Bendjedid introduced a multi-party system. Political parties developed, such as the Islamic Salvation Front (FIS), a broad coalition of Muslim groups. In December 1991 the Islamic Salvation Front dominated the first of two rounds of legislative elections . Fearing the election of an Islamist government, the authorities intervened on 11 January 1992, cancelling the elections. Bendjedid resigned and a High Council of State was installed to act as the Presidency. It banned the FIS, triggering a civil insurgency between the Front's armed wing, the Armed Islamic Group , and the national armed forces, in which more than 100,000 people are thought to have died. The Islamist militants conducted a violent campaign of civilian massacres . [ failed verification ] At several points in the conflict, the situation in Algeria became a point of international concern, most notably during the crisis surrounding Air France Flight 8969 , a hijacking perpetrated by the Armed Islamic Group. The Armed Islamic Group declared a ceasefire in October 1997. Algeria held elections in 1999 , considered biased by international observers and most opposition groups which were won by President Abdelaziz Bouteflika . He worked to restore political stability to the country and announced a "Civil Concord" initiative, approved in a referendum , under which many political prisoners were pardoned, and several thousand members of armed groups were granted exemption from prosecution under a limited amnesty, in force until 13 January 2000. The AIS disbanded and levels of insurgent violence fell rapidly. The Groupe Salafiste pour la Prédication et le Combat (GSPC), a splinter group of the Armed Islamic Group, continued a terrorist campaign against the Government. Bouteflika was re-elected in the April 2004 presidential election after campaigning on a programme of national reconciliation. The programme comprised economic, institutional, political and social reform to modernise the country, raise living standards, and tackle the causes of alienation. It also included a second amnesty initiative, the Charter for Peace and National Reconciliation , which was approved in a referendum in September 2005 . It offered amnesty to most guerrillas and Government security forces. In November 2008, the Algerian Constitution was amended following a vote in Parliament, removing the two-term limit on Presidential incumbents. This change enabled Bouteflika to stand for re-election in the 2009 presidential elections , and he was re-elected in April 2009. During his election campaign and following his re-election, Bouteflika promised to extend the programme of national reconciliation and a $150-billion spending programme to create three million new jobs, the construction of one million new housing units, and to continue public sector and infrastructure modernisation programmes. A continuing series of protests throughout the country started on 28 December 2010, inspired by similar protests across the Middle East and North Africa . On 24 February 2011, the government lifted Algeria's 19-year-old state of emergency . The government enacted legislation dealing with political parties, the electoral code, and the representation of women in elected bodies. In April 2011, Bouteflika promised further constitutional and political reform. However, elections are routinely criticised by opposition groups as unfair and international human rights groups say that media censorship and harassment of political opponents continue. On 2 April 2019, Bouteflika resigned from the presidency after mass protests against his candidacy for a fifth term in office. In December 2019, Abdelmadjid Tebboune became Algeria's president, after winning the first round of the presidential election with a record abstention rate – the highest of all presidential elections since Algeria's democracy in 1989. Tebboune is accused to be close to the military and being loyal to the deposed president. Tebboune rejects these accusations, claiming to be the victim of a witch hunt. He also reminds his detractors that he was expelled from the Government in August 2017 at the instigation of oligarchs languishing in prison. Around ~1.8-million-year-old stone artifacts from Ain Hanech (Algeria) were considered to represent the oldest archaeological materials in North Africa. Stone artifacts and cut-marked bones that were excavated from two nearby deposits at Ain Boucherit are estimated to be ~1.9 million years old, and even older stone artifacts to be as old as ~2.4 million years. Hence, the Ain Boucherit evidence shows that ancestral hominins inhabited the Mediterranean fringe in northern Africa much earlier than previously thought. The evidence strongly argues for early dispersal of stone tool manufacture and use from East Africa, or a possible multiple-origin scenario of stone technology in both East and North Africa. Neanderthal tool makers produced hand axes in the Levalloisian and Mousterian styles (43,000 BC) similar to those in the Levant . Algeria was the site of the highest state of development of Middle Paleolithic Flake tool techniques. Tools of this era, starting about 30,000 BC, are called Aterian (after the archaeological site of Bir el Ater , south of Tebessa ). The earliest blade industries in North Africa are called Iberomaurusian (located mainly in the Oran region). This industry appears to have spread throughout the coastal regions of the Maghreb between 15,000 and 10,000 BC. Neolithic civilization (animal domestication and agriculture) developed in the Saharan and Mediterranean Maghreb perhaps as early as 11,000 BC or as late as between 6000 and 2000 BC. This life, richly depicted in the Tassili n'Ajjer paintings, predominated in Algeria until the classical period. The mixture of peoples of North Africa coalesced eventually into a distinct native population that came to be called Berbers , who are the indigenous peoples of northern Africa. From their principal center of power at Carthage , the Carthaginians expanded and established small settlements along the North African coast; by 600 BC, a Phoenician presence existed at Tipasa , east of Cherchell , Hippo Regius (modern Annaba ) and Rusicade (modern Skikda ). These settlements served as market towns as well as anchorages. As Carthaginian power grew, its impact on the indigenous population increased dramatically. Berber civilisation was already at a stage in which agriculture, manufacturing, trade, and political organisation supported several states. Trade links between Carthage and the Berbers in the interior grew, but territorial expansion also resulted in the enslavement or military recruitment of some Berbers and in the extraction of tribute from others. By the early 4th century BC, Berbers formed the single largest element of the Carthaginian army. In the Revolt of the Mercenaries , Berber soldiers rebelled from 241 to 238 BC after being unpaid following the defeat of Carthage in the First Punic War . They succeeded in obtaining control of much of Carthage's North African territory, and they minted coins bearing the name Libyan, used in Greek to describe natives of North Africa. The Carthaginian state declined because of successive defeats by the Romans in the Punic Wars . In 146 BC the city of Carthage was destroyed. As Carthaginian power waned, the influence of Berber leaders in the hinterland grew. By the 2nd century BC, several large but loosely administered Berber kingdoms had emerged. Two of them were established in Numidia , behind the coastal areas controlled by Carthage. West of Numidia lay Mauretania , which extended across the Moulouya River in modern-day Morocco to the Atlantic Ocean. The high point of Berber civilisation, unequalled until the coming of the Almohads and Almoravids more than a millennium later, was reached during the reign of Masinissa in the 2nd century BC. After Masinissa's death in 148 BC, the Berber kingdoms were divided and reunited several times. Masinissa's line survived until 24 AD, when the remaining Berber territory was annexed to the Roman Empire . For several centuries Algeria was ruled by the Romans, who founded many colonies in the region, Algeria is the second country in the world after Italy, home to the largest number of Roman sites and remains among the most alive and well preserved. Rome, after getting rid of its powerful rival Carthage in the year 146 BC, decided a century later to include Numidia to become the new master of North Africa. They built more than 500 cities. Like the rest of North Africa, Algeria was one of the breadbaskets of the empire, exporting cereals and other agricultural products. Saint Augustine was the bishop of Hippo Regius (modern-day Annaba, Algeria), located in the Roman province of Africa . The Germanic Vandals of Geiseric moved into North Africa in 429, and by 435 controlled coastal Numidia. They did not make any significant settlement on the land, as they were harassed by local tribes. [ citation needed ] In fact, by the time the Byzantines arrived Leptis Magna was abandoned and the Msellata region was occupied by the indigenous Laguatan who had been busy facilitating an Amazigh political, military and cultural revival. Furthermore, during the rule of the Romans, Byzantines, Vandals, Carthaginians, and Ottomans the Berber people were the only or one of the few in North Africa who remained independent. The Berber people were so resistant that even during the Muslim conquest of North Africa they still had control and possession over their mountains. The collapse of the Western Roman Empire led to the establishment of a native Kingdom based in Altava (modern-day Algeria) known as the Mauro-Roman Kingdom . It was succeeded by another Kingdom based in Altava, the Kingdom of Altava . During the reign of Kusaila its territory extended from the region of modern-day Fez in the west to the western Aurès and later Kairaouan and the interior of Ifriqiya in the east. After negligible resistance from the locals, Muslim Arabs of the Umayyad Caliphate conquered Algeria in the early 8th century. Large numbers of the indigenous Berber people converted to Islam. Christians, Berber and Latin speakers remained in the great majority in Tunisia until the end of the 9th century and Muslims only became a vast majority some time in the 10th. After the fall of the Umayyad Caliphate, numerous local dynasties emerged, including the Rustamids , Aghlabids , Fatimids , Zirids , Hammadids , Almoravids , Almohads and the Zayyanids . The Christians left in three waves: after the initial conquest, in the 10th century and the 11th. The last were evacuated to Sicily by the Normans and the few remaining died out in the 14th century. During the Middle Ages , North Africa was home to many great scholars, saints and sovereigns including Judah Ibn Quraysh , the first grammarian to mention Semitic and Berber languages, the great Sufi masters Sidi Boumediene (Abu Madyan) and Sidi El Houari , and the Emirs Abd Al Mu'min and Yāghmūrasen . It was during this time that the Fatimids or children of Fatima , daughter of Muhammad , came to the Maghreb . These "Fatimids" went on to found a long lasting dynasty stretching across the Maghreb, Hejaz and the Levant , boasting a secular inner government, as well as a powerful army and navy, made up primarily of Arabs and Levantines extending from Algeria to their capital state of Cairo . The Fatimid caliphate began to collapse when its governors the Zirids seceded. To punish them the Fatimids sent the Arab Banu Hilal and Banu Sulaym against them. The resultant war is recounted in the epic Tāghribāt . In Al-Tāghrībāt the Amazigh Zirid Hero Khālīfā Al-Zānatī asks daily, for duels, to defeat the Hilalan hero Ābu Zayd al-Hilalī and many other Arab knights in a string of victories. The Zirids , however, were ultimately defeated ushering in an adoption of Arab customs and culture. The indigenous Amazigh tribes, however, remained largely independent, and depending on tribe, location and time controlled varying parts of the Maghreb, at times unifying it (as under the Fatimids). The Fatimid Islamic state, also known as Fatimid Caliphate made an Islamic empire that included North Africa, Sicily, Palestine , Jordan , Lebanon , Syria , Egypt , the Red Sea coast of Africa, Tihamah, Hejaz and Yemen . Caliphates from Northern Africa traded with the other empires of their time, as well as forming part of a confederated support and trade network with other Islamic states during the Islamic Era. The Berber people historically consisted of several tribes. The two main branches were the Botr and Barnès tribes, who were divided into tribes, and again into sub-tribes. Each region of the Maghreb contained several tribes (for example, Sanhadja , Houara , Zenata , Masmouda , Kutama , Awarba, and Berghwata ). All these tribes made independent territorial decisions. Several Amazigh dynasties emerged during the Middle Ages in the Maghreb and other nearby lands. Ibn Khaldun provides a table summarising the Amazigh dynasties of the Maghreb region, the Zirid , Ifranid , Maghrawa , Almoravid , Hammadid , Almohad , Merinid , Abdalwadid , Wattasid , Meknassa and Hafsid dynasties. Both of the Hammadid and Zirid empires as well as the Fatimids established their rule in all of the Maghreb countries. The Zirids ruled land in what is now Algeria, Tunisia, Morocco, Libya, Spain, Malta and Italy. The Hammadids captured and held important regions such as Ouargla, Constantine, Sfax, Susa, Algiers, Tripoli and Fez establishing their rule in every country in the Maghreb region. The Fatimids which was created and established by the Kutama Berbers conquered all of North Africa as well as Sicily and parts of the Middle East. Following the Berber revolt numerous independent states emerged across the Maghreb. In Algeria the Rustamid Kingdom was established. The Rustamid realm stretched from Tafilalt in Morocco to the Nafusa mountains in Libya including south, central and western Tunisia therefore including territory in all of the modern day Maghreb countries, in the south the Rustamid realm expanded to the modern borders of Mali and included territory in Mauritania . Once extending their control over all of the Maghreb, part of Spain and briefly over Sicily, originating from modern Algeria, the Zirids only controlled modern Ifriqiya by the 11th century. The Zirids recognized nominal suzerainty of the Fatimid caliphs of Cairo. El Mu'izz the Zirid ruler decided to end this recognition and declared his independence. The Zirids also fought against other Zenata Kingdoms, for example the Maghrawa , a Berber dynasty originating from Algeria and which at one point was a dominant power in the Maghreb ruling over much of Morocco and western Algeria including Fez, Sijilmasa , Aghmat , Oujda , most of the Sous and Draa and reaching as far as M'sila and the Zab in Algeria. As the Fatimid state was at the time too weak to attempt a direct invasion, they found another means of revenge. Between the Nile and the Red Sea were living Bedouin nomad tribes expelled from Arabia for their disruption and turbulency. The Banu Hilal and the Banu Sulaym for example, who regularly disrupted farmers in the Nile Valley since the nomads would often loot their farms. The then Fatimid vizier decided to destroy what he could not control, and broke a deal with the chiefs of these Beduouin tribes. The Fatimids even gave them money to leave. Whole tribes set off with women, children, elders, animals and camping equipment. Some stopped on the way, especially in Cyrenaica , where they are still one of the essential elements of the settlement but most arrived in Ifriqiya by the Gabes region, arriving 1051. The Zirid ruler tried to stop this rising tide, but with each encounter, the last under the walls of Kairouan , his troops were defeated and the Arabs remained masters of the battlefield. The Arabs usually did not take control over the cities, instead looting them and destroying them. The invasion kept going, and in 1057 the Arabs spread on the high plains of Constantine where they encircled the Qalaa of Banu Hammad (capital of the Hammadid Emirate ), as they had done in Kairouan a few decades ago. From there they gradually gained the upper Algiers and Oran plains. Some of these territories were forcibly taken back by the Almohads in the second half of the 12th century. The influx of Bedouin tribes was a major factor in the linguistic, cultural Arabization of the Maghreb and in the spread of nomadism in areas where agriculture had previously been dominant. Ibn Khaldun noted that the lands ravaged by Banu Hilal tribes had become completely arid desert. The Almohads originating from modern day Morocco, although founded by a man originating from modern day Algeria known as Abd al-Mu'min would soon take control over the Maghreb. During the time of the Almohad Dynasty Abd al-Mu'min 's tribe, the Koumïa, were the main supporters of the throne and the most important body of the empire. Defeating the weakening Almoravid Empire and taking control over Morocco in 1147, they pushed into Algeria in 1152, taking control over Tlemcen, Oran, and Algiers, wrestling control from the Hilian Arabs, and by the same year they defeated Hammadids who controlled Eastern Algeria. Following their decisive defeat in the Battle of Las Navas de Tolosa in 1212 the Almohads began collapsing, and in 1235 the governor of modern-day Western Algeria, Yaghmurasen Ibn Zyan declared his independence and established the Kingdom of Tlemcen and the Zayyanid dynasty . Warring with the Almohad forces attempting to restore control over Algeria for 13 years, they defeated the Almohads in 1248 after killing their Caliph in a successful ambush near Oujda. The Zayyanids retained their control over Algeria for 3 centuries. Much of the eastern territories of Algeria were under the authority of the Hafsid dynasty , although the Emirate of Bejaia encompassing the Algerian territories of the Hafsids would occasionally be independent from central Tunisian control. At their peak the Zayyanid kingdom included all of Morocco as its vassal to the west and in the east reached as far as Tunis which they captured during the reign of Abu Tashfin. After several conflicts with local Barbary pirates sponsored by the Zayyanid sultans, Spain decided to invade Algeria and defeat the native Kingdom of Tlemcen. In 1505, they invaded and captured Mers el Kébir , and in 1509 after a bloody siege, they conquered Oran . Following their decisive victories over the Algerians in the western-coastal areas of Algeria, the Spanish decided to get bolder, and invaded more Algerian cities. In 1510, they led a series of sieges and attacks, taking over Bejaia in a large siege , and leading a semi-successful siege against Algiers . They also besieged Tlemcen. In 1511, they took control over Cherchell and Jijel , and attacked Mostaganem where although they were not able to conquer the city, they were able to force a tribute on them.In 1516, the Turkish privateer brothers Aruj and Hayreddin Barbarossa , who operated successfully under the Hafsids , moved their base of operations to Algiers. They succeeded in conquering Jijel and Algiers from the Spaniards with help from the locals who saw them as liberators from the Christians, but the brothers eventually assassinated the local noble Salim al-Tumi and took control over the city and the surrounding regions. Their state is known as the Regency of Algiers . When Aruj was killed in 1518 during his invasion of Tlemcen , Hayreddin succeeded him as military commander of Algiers. The Ottoman sultan gave him the title of beylerbey and a contingent of some 2,000 janissaries . With the aid of this force and native Algerians, Hayreddin conquered the whole area between Constantine and Oran (although the city of Oran remained in Spanish hands until 1792). The next beylerbey was Hayreddin's son Hasan , who assumed the position in 1544. He was a Kouloughli or of mixed origins, as his mother was an Algerian Mooresse. Until 1587 Beylerbeylik of Algiers was governed by Beylerbeys who served terms with no fixed limits. Subsequently, with the institution of a regular administration, governors with the title of pasha ruled for three-year terms. The pasha was assisted by an autonomous janissary unit, known in Algeria as the Ojaq who were led by an agha . Discontent among the ojaq rose in the mid-1600s because they were not paid regularly, and they repeatedly revolted against the pasha. As a result, the agha charged the pasha with corruption and incompetence and seized power in 1659. Plague had repeatedly struck the cities of North Africa. Algiers lost between 30,000 and 50,000 inhabitants to the plague in 1620–21, and had high fatalities in 1654–57, 1665, 1691 and 1740–42. The Barbary pirates preyed on Christian and other non-Islamic shipping in the western Mediterranean Sea. The pirates often took the passengers and crew on the ships and sold them or used them as slaves . They also did a brisk business in ransoming some of the captives. According to Robert Davis, from the 16th to 19th century, pirates captured 1 million to 1.25 million Europeans as slaves. They often made raids on European coastal towns to capture Christian slaves to sell at slave markets in North Africa and other parts of the Ottoman Empire . In 1544, for example, Hayreddin Barbarossa captured the island of Ischia , taking 4,000 prisoners, and enslaved some 9,000 inhabitants of Lipari , almost the entire population. In 1551, the Ottoman governor of Algiers, Turgut Reis , enslaved the entire population of the Maltese island of Gozo . Barbary pirates often attacked the Balearic Islands . The threat was so severe that residents abandoned the island of Formentera . The introduction of broad-sail ships from the beginning of the 17th century allowed them to branch out into the Atlantic. In July 1627 two pirate ships from Algiers under the command of Dutch pirate Jan Janszoon sailed as far as Iceland , raiding and capturing slaves . Two weeks earlier another pirate ship from Salé in Morocco had also raided in Iceland. Some of the slaves brought to Algiers were later ransomed back to Iceland, but some chose to stay in Algeria. In 1629, pirate ships from Algeria raided the Faroe Islands . In 1659, the Janissaries stationned in Algiers, also known commonly as the Odjak of Algiers; and the Reis or the company of corsair captains rebelled, they removed the Ottoman viceroy from power, and placed one of its own in power. The new leader received the title of "Agha" then " Dey " in 1671, and the right to select passed to the divan , a council of some sixty military senior officers. Thus Algiers became a sovereign military republic. It was at first dominated by the odjak; but by the 18th century, it had become the dey's instrument. Although Algiers remained nominally part of the Ottoman Empire, in reality they acted independently from the rest of the Empire, and often had wars with other Ottoman subjects and territories such as the Beylik of Tunis . The dey was in effect a constitutional autocrat. The dey was elected for a life term, but in the 159 years (1671–1830) that the system was in place, fourteen of the twenty-nine deys were assassinated. Despite usurpation, military coups and occasional mob rule, the day-to-day operation of the Deylikal government was remarkably orderly. Although the regency patronised the tribal chieftains, it never had the unanimous allegiance of the countryside, where heavy taxation frequently provoked unrest. Autonomous tribal states were tolerated, and the regency's authority was seldom applied in the Kabylia , although in 1730 the Regency was able to take control over the Kingdom of Kuku in western Kabylia. Many cities in the northern parts of the Algerian desert paid taxes to Algiers or one of its Beys. Barbary raids in the Mediterranean continued to attack Spanish merchant shipping, and as a result, the Spanish Empire launched an invasion in 1775 , then the Spanish Navy bombarded Algiers in 1783 and 1784 . For the attack in 1784, the Spanish fleet was to be joined by ships from such traditional enemies of Algiers as Naples , Portugal and the Knights of Malta . Over 20,000 cannonballs were fired, but all these military campaigns were doomed and Spain had to ask for peace in 1786 and paid 1 million pesos to the Dey. In 1792, Algiers took back Oran and Mers el Kébir, the two last Spanish strongholds in Algeria. In the same year, they conquered the Moroccan Rif and Oujda , which they then abandoned in 1795. In the 19th century, Algerian pirates forged affiliations with Caribbean powers, paying a "license tax" in exchange for safe harbor of their vessels. Attacks by Algerian pirates on American merchantmen resulted in the First and Second Barbary Wars , which ended the attacks on U.S. ships in 1815. A year later, a combined Anglo - Dutch fleet, under the command of Lord Exmouth bombarded Algiers to stop similar attacks on European fishermen. These efforts proved successful, although Algerian piracy would continue until the French conquest in 1830. Under the pretext of a slight to their consul, the French invaded and captured Algiers in 1830. According to several historians, the methods used by the French to establish control over Algeria reached genocidal proportions. Historian Ben Kiernan wrote on the French conquest of Algeria: "By 1875, the French conquest was complete. The war had killed approximately 825,000 indigenous Algerians since 1830." French losses from 1831 to 1851 were 92,329 dead in the hospital and only 3,336 killed in action. In 1872, The Algerian population stood at about 2.9 million. [ unreliable source? ] French policy was predicated on "civilising" the country. The slave trade and piracy in Algeria ceased following the French conquest. The conquest of Algeria by the French took some time and resulted in considerable bloodshed. A combination of violence and disease epidemics caused the indigenous Algerian population to decline by nearly one-third from 1830 to 1872. [ unreliable source? ] On 17 September 1860, Napoleon III declared "Our first duty is to take care of the happiness of the three million Arabs, whom the fate of arms has brought under our domination." During this time, only Kabylia resisted, the Kabylians were not colonized until after the Mokrani Revolt in 1871. [ citation needed ] Alexis de Tocqueville wrote and never completed an unpublished essay outlining his ideas for how to transform Algeria from an occupied tributary state to a colonial regime, wherein he advocated for a mixed system of "total domination and total colonization" whereby French military would wage total war against civilian populations while a colonial administration would provide rule of law and property rights to settlers within French occupied cities. From 1848 until independence, France administered the whole Mediterranean region of Algeria as an integral part and département of the nation. One of France's longest-held overseas territories, Algeria became a destination for hundreds of thousands of European immigrants, who became known as colons and later, as Pied-Noirs . Between 1825 and 1847, 50,000 French people emigrated to Algeria. These settlers benefited from the French government's confiscation of communal land from tribal peoples, and the application of modern agricultural techniques that increased the amount of arable land. Many Europeans settled in Oran and Algiers , and by the early 20th century they formed a majority of the population in both cities. During the late 19th and early 20th century, the European share was almost a fifth of the population. The French government aimed at making Algeria an assimilated part of France, and this included substantial educational investments especially after 1900. The indigenous cultural and religious resistance heavily opposed this tendency, but in contrast to the other colonized countries' path in central Asia and Caucasus , Algeria kept its individual skills and a relatively human-capital intensive agriculture. During the Second World War , Algeria came under Vichy control before being liberated by the Allies in Operation Torch , which saw the first large-scale deployment of American troops in the North African campaign . Gradually, dissatisfaction among the Muslim population, which lacked political and economic status under the colonial system, gave rise to demands for greater political autonomy and eventually independence from France . In May 1945, the uprising against the occupying French forces was suppressed through what is now known as the Sétif and Guelma massacre . Tensions between the two population groups came to a head in 1954, when the first violent events of what was later called the Algerian War began after the publication of the Declaration of 1 November 1954 . Historians have estimated that between 30,000 and 150,000 Harkis and their dependents were killed by the National Liberation Front (FLN) or by lynch mobs in Algeria. The FLN used hit and run attacks in Algeria and France as part of its war, and the French conducted severe reprisals . In addition, the French destroyed over 8,000 villages and relocated over 2 million Algerians to concentration camps . The war led to the death of hundreds of thousands of Algerians and hundreds of thousands of injuries. Historians, like Alistair Horne and Raymond Aron , state that the actual number of Algerian Muslim war dead was far greater than the original FLN and official French estimates but was less than the 1 million deaths claimed by the Algerian government after independence. Horne estimated Algerian casualties during the span of eight years to be around 700,000. The war uprooted more than 2 million Algerians. The war against French rule concluded in 1962, when Algeria gained complete independence following the March 1962 Evian agreements and the July 1962 self-determination referendum .The number of European Pied-Noirs who fled Algeria totaled more than 900,000 between 1962 and 1964. The exodus to mainland France accelerated after the Oran massacre of 1962 , in which hundreds of militants entered European sections of the city, and began attacking civilians. Algeria's first president was the Front de Libération Nationale ( FLN ) leader Ahmed Ben Bella . Morocco's claim to portions of western Algeria led to the Sand War in 1963. Ben Bella was overthrown in 1965 by Houari Boumédiène , his former ally and defence minister. Under Ben Bella, the government had become increasingly socialist and authoritarian; Boumédienne continued this trend. However, he relied much more on the army for his support, and reduced the sole legal party to a symbolic role. He collectivised agriculture and launched a massive industrialisation drive. Oil extraction facilities were nationalised. This was especially beneficial to the leadership after the international 1973 oil crisis . Boumédienne's successor, Chadli Bendjedid , introduced some liberal economic reforms. He promoted a policy of Arabisation in Algerian society and public life. Teachers of Arabic, brought in from other Muslim countries, spread conventional Islamic thought in schools and sowed the seeds of a return to Orthodox Islam. The Algerian economy became increasingly dependent on oil, leading to hardship when the price collapsed during the 1980s oil glut . Economic recession caused by the crash in world oil prices resulted in Algerian social unrest during the 1980s; by the end of the decade, Bendjedid introduced a multi-party system. Political parties developed, such as the Islamic Salvation Front (FIS), a broad coalition of Muslim groups. In December 1991 the Islamic Salvation Front dominated the first of two rounds of legislative elections . Fearing the election of an Islamist government, the authorities intervened on 11 January 1992, cancelling the elections. Bendjedid resigned and a High Council of State was installed to act as the Presidency. It banned the FIS, triggering a civil insurgency between the Front's armed wing, the Armed Islamic Group , and the national armed forces, in which more than 100,000 people are thought to have died. The Islamist militants conducted a violent campaign of civilian massacres . [ failed verification ] At several points in the conflict, the situation in Algeria became a point of international concern, most notably during the crisis surrounding Air France Flight 8969 , a hijacking perpetrated by the Armed Islamic Group. The Armed Islamic Group declared a ceasefire in October 1997. Algeria held elections in 1999 , considered biased by international observers and most opposition groups which were won by President Abdelaziz Bouteflika . He worked to restore political stability to the country and announced a "Civil Concord" initiative, approved in a referendum , under which many political prisoners were pardoned, and several thousand members of armed groups were granted exemption from prosecution under a limited amnesty, in force until 13 January 2000. The AIS disbanded and levels of insurgent violence fell rapidly. The Groupe Salafiste pour la Prédication et le Combat (GSPC), a splinter group of the Armed Islamic Group, continued a terrorist campaign against the Government. Bouteflika was re-elected in the April 2004 presidential election after campaigning on a programme of national reconciliation. The programme comprised economic, institutional, political and social reform to modernise the country, raise living standards, and tackle the causes of alienation. It also included a second amnesty initiative, the Charter for Peace and National Reconciliation , which was approved in a referendum in September 2005 . It offered amnesty to most guerrillas and Government security forces. In November 2008, the Algerian Constitution was amended following a vote in Parliament, removing the two-term limit on Presidential incumbents. This change enabled Bouteflika to stand for re-election in the 2009 presidential elections , and he was re-elected in April 2009. During his election campaign and following his re-election, Bouteflika promised to extend the programme of national reconciliation and a $150-billion spending programme to create three million new jobs, the construction of one million new housing units, and to continue public sector and infrastructure modernisation programmes. A continuing series of protests throughout the country started on 28 December 2010, inspired by similar protests across the Middle East and North Africa . On 24 February 2011, the government lifted Algeria's 19-year-old state of emergency . The government enacted legislation dealing with political parties, the electoral code, and the representation of women in elected bodies. In April 2011, Bouteflika promised further constitutional and political reform. However, elections are routinely criticised by opposition groups as unfair and international human rights groups say that media censorship and harassment of political opponents continue. On 2 April 2019, Bouteflika resigned from the presidency after mass protests against his candidacy for a fifth term in office. In December 2019, Abdelmadjid Tebboune became Algeria's president, after winning the first round of the presidential election with a record abstention rate – the highest of all presidential elections since Algeria's democracy in 1989. Tebboune is accused to be close to the military and being loyal to the deposed president. Tebboune rejects these accusations, claiming to be the victim of a witch hunt. He also reminds his detractors that he was expelled from the Government in August 2017 at the instigation of oligarchs languishing in prison. Since the 2011 breakup of Sudan, and the creation of South Sudan, Algeria has been the largest country in Africa, and the Mediterranean Basin . Its southern part includes a significant portion of the Sahara . To the north, the Tell Atlas form with the Saharan Atlas , further south, two parallel sets of reliefs in approaching eastbound, and between which are inserted vast plains and highlands. Both Atlas tend to merge in eastern Algeria. The vast mountain ranges of Aures and Nememcha occupy the entire northeastern Algeria and are delineated by the Tunisian border. The highest point is Mount Tahat ( 3,003 metres or 9,852 feet ). Algeria lies mostly between latitudes 19° and 37°N (a small area is north of 37°N and south of 19°N), and longitudes 9°W and 12°E . Most of the coastal area is hilly, sometimes even mountainous, and there are a few natural harbours . The area from the coast to the Tell Atlas is fertile. South of the Tell Atlas is a steppe landscape ending with the Saharan Atlas ; farther south, there is the Sahara desert. The Hoggar Mountains ( Arabic : جبال هقار ), also known as the Hoggar, are a highland region in central Sahara, southern Algeria. They are located about 1,500 km (932 mi) south of the capital, Algiers, and just east of Tamanghasset . Algiers, Oran , Constantine , and Annaba are Algeria's main cities. In this region, midday desert temperatures can be hot year round. After sunset, however, the clear, dry air permits rapid loss of heat, and the nights are cool to chilly. Enormous daily ranges in temperature are recorded. Rainfall is fairly plentiful along the coastal part of the Tell Atlas, ranging from 400 to 670 mm (15.7 to 26.4 in) annually, the amount of precipitation increasing from west to east. Precipitation is heaviest in the northern part of eastern Algeria, where it reaches as much as 1,000 mm (39.4 in) in some years. Farther inland, the rainfall is less plentiful. Algeria also has ergs , or sand dunes, between mountains. Among these, in the summer time when winds are heavy and gusty, temperatures can go up to 43.3 °C (110 °F) . The varied vegetation of Algeria includes coastal , mountainous and grassy desert -like regions which all support a wide range of wildlife. Many of the creatures comprising the Algerian wildlife live in close proximity to civilisation. The most commonly seen animals include the wild boars , jackals , and gazelles , although it is not uncommon to spot fennecs (foxes), and jerboas . Algeria also has a small African leopard and Saharan cheetah population, but these are seldom seen. A species of deer, the Barbary stag , inhabits the dense humid forests in the north-eastern areas. The fennec fox is the national animal of Algeria. A variety of bird species makes the country an attraction for bird watchers. The forests are inhabited by boars and jackals. Barbary macaques are the sole native monkey. Snakes, monitor lizards , and numerous other reptiles can be found living among an array of rodents throughout the semi arid regions of Algeria. Many animals are now extinct, including the Barbary lions , Atlas bears and crocodiles . In the north, some of the native flora includes Macchia scrub, olive trees , oaks , cedars and other conifers . The mountain regions contain large forests of evergreens ( Aleppo pine , juniper , and evergreen oak ) and some deciduous trees. Fig , eucalyptus , agave , and various palm trees grow in the warmer areas. The grape vine is indigenous to the coast. In the Sahara region, some oases have palm trees. Acacias with wild olives are the predominant flora in the remainder of the Sahara . Algeria had a 2018 Forest Landscape Integrity Index mean score of 5.22/10, ranking it 106th globally out of 172 countries. Camels are used extensively; the desert also abounds with venomous and nonvenomous snakes, scorpions , and numerous insects.In this region, midday desert temperatures can be hot year round. After sunset, however, the clear, dry air permits rapid loss of heat, and the nights are cool to chilly. Enormous daily ranges in temperature are recorded. Rainfall is fairly plentiful along the coastal part of the Tell Atlas, ranging from 400 to 670 mm (15.7 to 26.4 in) annually, the amount of precipitation increasing from west to east. Precipitation is heaviest in the northern part of eastern Algeria, where it reaches as much as 1,000 mm (39.4 in) in some years. Farther inland, the rainfall is less plentiful. Algeria also has ergs , or sand dunes, between mountains. Among these, in the summer time when winds are heavy and gusty, temperatures can go up to 43.3 °C (110 °F) .The varied vegetation of Algeria includes coastal , mountainous and grassy desert -like regions which all support a wide range of wildlife. Many of the creatures comprising the Algerian wildlife live in close proximity to civilisation. The most commonly seen animals include the wild boars , jackals , and gazelles , although it is not uncommon to spot fennecs (foxes), and jerboas . Algeria also has a small African leopard and Saharan cheetah population, but these are seldom seen. A species of deer, the Barbary stag , inhabits the dense humid forests in the north-eastern areas. The fennec fox is the national animal of Algeria. A variety of bird species makes the country an attraction for bird watchers. The forests are inhabited by boars and jackals. Barbary macaques are the sole native monkey. Snakes, monitor lizards , and numerous other reptiles can be found living among an array of rodents throughout the semi arid regions of Algeria. Many animals are now extinct, including the Barbary lions , Atlas bears and crocodiles . In the north, some of the native flora includes Macchia scrub, olive trees , oaks , cedars and other conifers . The mountain regions contain large forests of evergreens ( Aleppo pine , juniper , and evergreen oak ) and some deciduous trees. Fig , eucalyptus , agave , and various palm trees grow in the warmer areas. The grape vine is indigenous to the coast. In the Sahara region, some oases have palm trees. Acacias with wild olives are the predominant flora in the remainder of the Sahara . Algeria had a 2018 Forest Landscape Integrity Index mean score of 5.22/10, ranking it 106th globally out of 172 countries. Camels are used extensively; the desert also abounds with venomous and nonvenomous snakes, scorpions , and numerous insects.Elected politicians have relatively little sway over Algeria. Instead, a group of unelected civilian and military "décideurs" ("deciders"), known as "le pouvoir" ("the power"), actually rule the country, even deciding who should be president. The most powerful man might have been Mohamed Mediène , the head of military intelligence, before he was brought down during the 2019 protests . In recent years, many of these generals have died, retired, or been imprisoned. After the death of General Larbi Belkheir , previous president Bouteflika put loyalists in key posts, notably at Sonatrach , and secured constitutional amendments that made him re-electable indefinitely, until he was brought down in 2019 during protests . The head of state is the President of Algeria , who is elected for a five-year term. The president is limited to two five-year terms. The most recent presidential election was planned to be in April 2019, but widespread protests erupted on 22 February against the president's decision to participate in the election, which resulted in President Bouteflika announcing his resignation on 3 April. Abdelmadjid Tebboune , an independent candidate, was elected as president after the election eventually took place on 12 December 2019. Protestors refused to recognise Tebboune as president, citing demands for comprehensive reform of the political system. Algeria has universal suffrage at 18 years of age. The President is the head of the army , the Council of Ministers and the High Security Council . He appoints the Prime Minister who is also the head of government. The Algerian parliament is bicameral ; the lower house, the People's National Assembly , has 462 members who are directly elected for five-year terms, while the upper house, the Council of the Nation , has 144 members serving six-year terms, of which 96 members are chosen by local assemblies and 48 are appointed by the president. According to the constitution , no political association may be formed if it is "based on differences in religion, language, race, gender, profession, or region". In addition, political campaigns must be exempt from the aforementioned subjects. Parliamentary elections were last held in May 2017 . In the elections, the FLN lost 44 of its seats, but remained the largest party with 164 seats, the military-backed National Rally for Democracy won 100, and the Muslim Brotherhood-linked Movement of the Society for Peace won 33. Algeria is included in the European Union 's European Neighbourhood Policy (ENP) which aims at bringing the EU and its neighbours closer. Giving incentives and rewarding best performers, as well as offering funds in a faster and more flexible manner, are the two main principles underlying the European Neighbourhood Instrument (ENI) that came into force in 2014. It has a budget of €15.4 billion and provides the bulk of funding through a number of programmes. In 2009, the French government agreed to compensate victims of nuclear tests in Algeria. Defence Minister Herve Morin stated that "It's time for our country to be at peace with itself, at peace thanks to a system of compensation and reparations," when presenting the draft law on the payouts. Algerian officials and activists believe that this is a good first step and hope that this move would encourage broader reparation. Tensions between Algeria and Morocco in relation to the Western Sahara have been an obstacle to tightening the Arab Maghreb Union , nominally established in 1989, but which has carried little practical weight. On 24 August 2021, Algeria announced the break of diplomatic relations with Morocco. The military of Algeria consists of the People's National Army (ANP), the Algerian National Navy (MRA), and the Algerian Air Force (QJJ), plus the Territorial Air Defence Forces . It is the direct successor of the National Liberation Army (Armée de Libération Nationale or ALN), the armed wing of the nationalist National Liberation Front which fought French colonial occupation during the Algerian War of Independence (1954–62). Total military personnel include 147,000 active, 150,000 reserve, and 187,000 paramilitary staff (2008 estimate). Service in the military is compulsory for men aged 19–30, for a total of 12 months. The military expenditure was 4.3% of the gross domestic product (GDP) in 2012. Algeria has the second largest military in North Africa with the largest defence budget in Africa ($10 billion). Most of Algeria's weapons are imported from Russia, with whom they are a close ally . In 2007, the Algerian Air Force signed a deal with Russia to purchase 49 MiG-29 SMT and 6 MiG-29UBT at an estimated cost of $1.9 billion. Russia is also building two 636-type diesel submarines for Algeria. Algeria has been categorised by the US government funded Freedom House as "not free" since it began publishing such ratings in 1972, with the exception of 1989, 1990, and 1991, when the country was labelled "partly free." In December 2016, the Euro-Mediterranean Human Rights Monitor issued a report regarding violation of media freedom in Algeria. It clarified that the Algerian government imposed restrictions on freedom of the press ; expression; and right to peaceful demonstration, protest and assembly as well as intensified censorship of the media and websites. Due to the fact that the journalists and activists criticise the ruling government, some media organisations' licenses are cancelled. Independent and autonomous trade unions face routine harassment from the government, with many leaders imprisoned and protests suppressed. In 2016, a number of unions, many of which were involved in the 2010–2012 Algerian Protests, have been deregistered by the government. Homosexuality is illegal in Algeria. Public homosexual behavior is punishable by up to two years in prison. Despite this, about 26% of Algerians think that homosexuality should be accepted, according to the survey conducted by the BBC News Arabic -Arab Barometer in 2019. Algeria showed largest LGBT acceptance compared to other Arab countries where the survey was conducted. Human Rights Watch has accused the Algerian authorities of using the COVID-19 pandemic as an excuse to prevent pro-democracy movements and protests in the country, leading to the arrest of youths as part of social distancing . Algeria is divided into 58 provinces ( wilayas ), 553 districts ( daïras ) and 1,541 municipalities ( baladiyahs ). Each province, district, and municipality is named after its seat , which is usually the largest city. The administrative divisions have changed several times since independence. When introducing new provinces, the numbers of old provinces are kept, hence the non-alphabetical order. With their official numbers, currently (since 1983) they are: Algeria is included in the European Union 's European Neighbourhood Policy (ENP) which aims at bringing the EU and its neighbours closer. Giving incentives and rewarding best performers, as well as offering funds in a faster and more flexible manner, are the two main principles underlying the European Neighbourhood Instrument (ENI) that came into force in 2014. It has a budget of €15.4 billion and provides the bulk of funding through a number of programmes. In 2009, the French government agreed to compensate victims of nuclear tests in Algeria. Defence Minister Herve Morin stated that "It's time for our country to be at peace with itself, at peace thanks to a system of compensation and reparations," when presenting the draft law on the payouts. Algerian officials and activists believe that this is a good first step and hope that this move would encourage broader reparation. Tensions between Algeria and Morocco in relation to the Western Sahara have been an obstacle to tightening the Arab Maghreb Union , nominally established in 1989, but which has carried little practical weight. On 24 August 2021, Algeria announced the break of diplomatic relations with Morocco. The military of Algeria consists of the People's National Army (ANP), the Algerian National Navy (MRA), and the Algerian Air Force (QJJ), plus the Territorial Air Defence Forces . It is the direct successor of the National Liberation Army (Armée de Libération Nationale or ALN), the armed wing of the nationalist National Liberation Front which fought French colonial occupation during the Algerian War of Independence (1954–62). Total military personnel include 147,000 active, 150,000 reserve, and 187,000 paramilitary staff (2008 estimate). Service in the military is compulsory for men aged 19–30, for a total of 12 months. The military expenditure was 4.3% of the gross domestic product (GDP) in 2012. Algeria has the second largest military in North Africa with the largest defence budget in Africa ($10 billion). Most of Algeria's weapons are imported from Russia, with whom they are a close ally . In 2007, the Algerian Air Force signed a deal with Russia to purchase 49 MiG-29 SMT and 6 MiG-29UBT at an estimated cost of $1.9 billion. Russia is also building two 636-type diesel submarines for Algeria. Algeria has been categorised by the US government funded Freedom House as "not free" since it began publishing such ratings in 1972, with the exception of 1989, 1990, and 1991, when the country was labelled "partly free." In December 2016, the Euro-Mediterranean Human Rights Monitor issued a report regarding violation of media freedom in Algeria. It clarified that the Algerian government imposed restrictions on freedom of the press ; expression; and right to peaceful demonstration, protest and assembly as well as intensified censorship of the media and websites. Due to the fact that the journalists and activists criticise the ruling government, some media organisations' licenses are cancelled. Independent and autonomous trade unions face routine harassment from the government, with many leaders imprisoned and protests suppressed. In 2016, a number of unions, many of which were involved in the 2010–2012 Algerian Protests, have been deregistered by the government. Homosexuality is illegal in Algeria. Public homosexual behavior is punishable by up to two years in prison. Despite this, about 26% of Algerians think that homosexuality should be accepted, according to the survey conducted by the BBC News Arabic -Arab Barometer in 2019. Algeria showed largest LGBT acceptance compared to other Arab countries where the survey was conducted. Human Rights Watch has accused the Algerian authorities of using the COVID-19 pandemic as an excuse to prevent pro-democracy movements and protests in the country, leading to the arrest of youths as part of social distancing . Algeria is divided into 58 provinces ( wilayas ), 553 districts ( daïras ) and 1,541 municipalities ( baladiyahs ). Each province, district, and municipality is named after its seat , which is usually the largest city. The administrative divisions have changed several times since independence. When introducing new provinces, the numbers of old provinces are kept, hence the non-alphabetical order. With their official numbers, currently (since 1983) they are: Algeria's currency is the dinar (DZD). The economy remains dominated by the state, a legacy of the country's socialist post-independence development model. In recent years, the Algerian government has halted the privatization of state-owned industries and imposed restrictions on imports and foreign involvement in its economy. These restrictions are just starting to be lifted off recently although questions about Algeria's slowly-diversifying economy remain. [ citation needed ] Algeria has struggled to develop industries outside hydrocarbons in part because of high costs and an inert state bureaucracy. The government's efforts to diversify the economy by attracting foreign and domestic investment outside the energy sector have done little to reduce high youth unemployment rates or to address housing shortages. The country is facing a number of short-term and medium-term problems, including the need to diversify the economy, strengthen political, economic and financial reforms, improve the business climate and reduce inequalities among regions. A wave of economic protests in February and March 2011 prompted the Algerian government to offer more than $23 billion in public grants and retroactive salary and benefit increases. Public spending has increased by 27% annually during the past five years. The 2010–14 public-investment programme will cost US$286 billion, 40% of which will go to human development. Thanks to strong hydrocarbon revenues, Algeria has a cushion of $173 billion in foreign currency reserves and a large hydrocarbon stabilisation fund. In addition, Algeria's external debt is extremely low at about 2% of GDP. The economy remains very dependent on hydrocarbon wealth, and, despite high foreign exchange reserves (US$178 billion, equivalent to three years of imports), current expenditure growth makes Algeria's budget more vulnerable to the risk of prolonged lower hydrocarbon revenues. Algeria has not joined the WTO , despite several years of negotiations but is a member of the Greater Arab Free Trade Area and the African Continental Free Trade Area , and has an association agreement with the European Union Turkish direct investments have accelerated in Algeria, with total value reaching $5 billion. As of 2022, the number of Turkish companies present in Algeria has reached 1,400. In 2020, despite the pandemic, more than 130 Turkish companies were created in Algeria. Algeria, whose economy is reliant on petroleum, has been an OPEC member since 1969. Its crude oil production stands at around 1.1 million barrels/day, but it is also a major gas producer and exporter, with important links to Europe. Hydrocarbons have long been the backbone of the economy, accounting for roughly 60% of budget revenues, 30% of GDP, and 87.7% of export earnings. Algeria has the 10th-largest reserves of natural gas in the world and is the sixth-largest gas exporter . The U.S. Energy Information Administration reported that in 2005, Algeria had 4.5 trillion cubic metres (160 × 10 ^ 12 cu ft) of proven natural-gas reserves . It also ranks 16th in oil reserves . Non-hydrocarbon growth for 2011 was projected at 5%. To cope with social demands, the authorities raised expenditure, especially on basic food support, employment creation, support for SMEs, and higher salaries. High hydrocarbon prices have improved the current account and the already large international reserves position. Income from oil and gas rose in 2011 as a result of continuing high oil prices, though the trend in production volume is downward. Production from the oil and gas sector in terms of volume, continues to decline, dropping from 43.2 million tonnes to 32 million tonnes between 2007 and 2011. Nevertheless, the sector accounted for 98% of the total volume of exports in 2011, against 48% in 1962, and 70% of budgetary receipts, or US$71.4 billion. The Algerian national oil company is Sonatrach , which plays a key role in all aspects of the oil and natural gas sectors in Algeria. All foreign operators must work in partnership with Sonatrach, which usually has majority ownership in production-sharing agreements. Access to biocapacity in Algeria is lower than world average. In 2016, Algeria had 0.53 global hectares of biocapacity per person within its territory, much less than the world average of 1.6 global hectares per person. In 2016, Algeria used 2.4 global hectares of biocapacity per person – their ecological footprint of consumption. This means they use just under 4.5 times as much biocapacity as Algeria contains. As a result, Algeria is running a biocapacity deficit. In April 2022, diplomats from Italy and Spain held talks after Rome's move to secure large volume of Algerian gas stoked concerns in Madrid. Under the deal between Algeria's Sonatrach and Italy's Eni, Algeria will send an additional 9 billion cubic metres of gas to Italy by next year and in 2024. Algeria has invested an estimated 100 billion dinars towards developing research facilities and paying researchers. This development program is meant to advance alternative energy production, especially solar and wind power. Algeria is estimated to have the largest solar energy potential in the Mediterranean, so the government has funded the creation of a solar science park in Hassi R'Mel. Currently, Algeria has 20,000 research professors at various universities and over 780 research labs, with state-set goals to expand to 1,000. Besides solar energy, areas of research in Algeria include space and satellite telecommunications, nuclear power and medical research. The overall rate of unemployment was 10% in 2011, but remained higher among young people, with a rate of 21.5% for those aged between 15 and 24. The government strengthened in 2011 the job programs introduced in 1988, in particular in the framework of the program to aid those seeking work (Dispositif d'Aide à l'Insertion Professionnelle). Despite a decline in total unemployment, youth and women unemployment is high. The development of the tourism sector in Algeria had previously been hampered by a lack of facilities, but since 2004 a broad tourism development strategy has been implemented resulting in many hotels of a high modern standard being built. There are several UNESCO World Heritage Sites in Algeria including Al Qal'a of Beni Hammad , the first capital of the Hammadid empire; Tipasa , a Phoenician and later Roman town; and Djémila and Timgad , both Roman ruins; M'Zab Valley , a limestone valley containing a large urbanized oasis ; and the Casbah of Algiers, an important citadel. The only natural World Heritage Site is the Tassili n'Ajjer , a mountain range. Two trans-African automobile routes pass through Algeria: The Algerian road network is the densest in Africa; its length is estimated at 180,000 km (110,000 mi) of highways, with more than 3,756 structures and a paving rate of 85%. This network will be complemented by the East-West Highway , a major infrastructure project currently under construction. It is a 3-way, 1,216-kilometre-long (756 mi) highway, linking Annaba in the extreme east to the Tlemcen in the far west. Algeria is also crossed by the Trans-Sahara Highway , which is now completely paved. This road is supported by the Algerian government to increase trade between the six countries crossed: Algeria, Mali , Niger , Nigeria , Chad , and Tunisia .Algeria, whose economy is reliant on petroleum, has been an OPEC member since 1969. Its crude oil production stands at around 1.1 million barrels/day, but it is also a major gas producer and exporter, with important links to Europe. Hydrocarbons have long been the backbone of the economy, accounting for roughly 60% of budget revenues, 30% of GDP, and 87.7% of export earnings. Algeria has the 10th-largest reserves of natural gas in the world and is the sixth-largest gas exporter . The U.S. Energy Information Administration reported that in 2005, Algeria had 4.5 trillion cubic metres (160 × 10 ^ 12 cu ft) of proven natural-gas reserves . It also ranks 16th in oil reserves . Non-hydrocarbon growth for 2011 was projected at 5%. To cope with social demands, the authorities raised expenditure, especially on basic food support, employment creation, support for SMEs, and higher salaries. High hydrocarbon prices have improved the current account and the already large international reserves position. Income from oil and gas rose in 2011 as a result of continuing high oil prices, though the trend in production volume is downward. Production from the oil and gas sector in terms of volume, continues to decline, dropping from 43.2 million tonnes to 32 million tonnes between 2007 and 2011. Nevertheless, the sector accounted for 98% of the total volume of exports in 2011, against 48% in 1962, and 70% of budgetary receipts, or US$71.4 billion. The Algerian national oil company is Sonatrach , which plays a key role in all aspects of the oil and natural gas sectors in Algeria. All foreign operators must work in partnership with Sonatrach, which usually has majority ownership in production-sharing agreements. Access to biocapacity in Algeria is lower than world average. In 2016, Algeria had 0.53 global hectares of biocapacity per person within its territory, much less than the world average of 1.6 global hectares per person. In 2016, Algeria used 2.4 global hectares of biocapacity per person – their ecological footprint of consumption. This means they use just under 4.5 times as much biocapacity as Algeria contains. As a result, Algeria is running a biocapacity deficit. In April 2022, diplomats from Italy and Spain held talks after Rome's move to secure large volume of Algerian gas stoked concerns in Madrid. Under the deal between Algeria's Sonatrach and Italy's Eni, Algeria will send an additional 9 billion cubic metres of gas to Italy by next year and in 2024. Algeria has invested an estimated 100 billion dinars towards developing research facilities and paying researchers. This development program is meant to advance alternative energy production, especially solar and wind power. Algeria is estimated to have the largest solar energy potential in the Mediterranean, so the government has funded the creation of a solar science park in Hassi R'Mel. Currently, Algeria has 20,000 research professors at various universities and over 780 research labs, with state-set goals to expand to 1,000. Besides solar energy, areas of research in Algeria include space and satellite telecommunications, nuclear power and medical research.The overall rate of unemployment was 10% in 2011, but remained higher among young people, with a rate of 21.5% for those aged between 15 and 24. The government strengthened in 2011 the job programs introduced in 1988, in particular in the framework of the program to aid those seeking work (Dispositif d'Aide à l'Insertion Professionnelle). Despite a decline in total unemployment, youth and women unemployment is high. The development of the tourism sector in Algeria had previously been hampered by a lack of facilities, but since 2004 a broad tourism development strategy has been implemented resulting in many hotels of a high modern standard being built. There are several UNESCO World Heritage Sites in Algeria including Al Qal'a of Beni Hammad , the first capital of the Hammadid empire; Tipasa , a Phoenician and later Roman town; and Djémila and Timgad , both Roman ruins; M'Zab Valley , a limestone valley containing a large urbanized oasis ; and the Casbah of Algiers, an important citadel. The only natural World Heritage Site is the Tassili n'Ajjer , a mountain range.Two trans-African automobile routes pass through Algeria: The Algerian road network is the densest in Africa; its length is estimated at 180,000 km (110,000 mi) of highways, with more than 3,756 structures and a paving rate of 85%. This network will be complemented by the East-West Highway , a major infrastructure project currently under construction. It is a 3-way, 1,216-kilometre-long (756 mi) highway, linking Annaba in the extreme east to the Tlemcen in the far west. Algeria is also crossed by the Trans-Sahara Highway , which is now completely paved. This road is supported by the Algerian government to increase trade between the six countries crossed: Algeria, Mali , Niger , Nigeria , Chad , and Tunisia .Algeria has a population of an estimated 44 million, of which the majority, 75% to 85% are ethnically Arab . At the outset of the 20th century, its population was approximately four million. About 90% of Algerians live in the northern, coastal area; the inhabitants of the Sahara desert are mainly concentrated in oases , although some 1.5 million remain nomadic or partly nomadic. 28.1% of Algerians are under the age of 15. Between 90,000 and 165,000 Sahrawis from Western Sahara live in the Sahrawi refugee camps , in the western Algerian Sahara desert. There are also more than 4,000 Palestinian refugees , who are well integrated and have not asked for assistance from the United Nations High Commissioner for Refugees (UNHCR). In 2009, 35,000 Chinese migrant workers lived in Algeria. The largest concentration of Algerian migrants outside Algeria is in France, which has reportedly over 1.7 million Algerians of up to the second generation. Arabs and indigenous Berbers as well as Phoenicians , Romans , Vandals , Byzantine Greeks , Turks , various Sub-Saharan Africans , and French have contributed to the history and culture of Algeria. Descendants of Andalusi refugees are also present in the population of Algiers and other cities. Moreover, Spanish was spoken by these Aragonese and Castillian Morisco descendants deep into the 18th century, and even Catalan was spoken at the same time by Catalan Morisco descendants in the small town of Grish El-Oued. Centuries of Arab migration to the Maghreb since the 7th century shifted the demographic scope in Algeria. The majority of the population of Algeria are Arabs (75% to 85% of the population). Berbers who make up 15% to 20% of the population are divided into many groups with varying languages. The largest of these are the Kabyles , who live in the Kabylie region east of Algiers, the Chaoui of Northeast Algeria, the Tuaregs in the southern desert and the Shenwa people of North Algeria. [ page needed ] During the colonial period, there was a large (10% in 1960) European population who became known as Pied-Noirs . They were primarily of French, Spanish and Italian origin . Almost all of this population left during the war of independence or immediately after its end. Modern Standard Arabic and Berber are the official languages. Algerian Arabic (Darja) is the language used by the majority of the population. Colloquial Algerian Arabic has some Berber loanwords which represent 8% to 9% of its vocabulary. Berber has been recognised as a "national language" by the constitutional amendment of 8 May 2002. Kabyle , the predominant Berber language, is taught and is partially co-official (with a few restrictions) in parts of Kabylie . Kabyle has a significant Arabic , French , Latin , Greek , Phoenician and Punic substratum, and Arabic loanwords represent 35% of the total Kabyle vocabulary. In February 2016, the Algerian constitution passed a resolution that made Berber an official language alongside Arabic. Algeria emerged as a bilingual state after 1962. Colloquial Algerian Arabic is spoken by about 83% of the population and Berber by 27%. Although French has no official status in Algeria, it has one of the largest Francophone populations in the world, and French is widely used in government, media (newspapers, radio, local television), and both the education system (from primary school onwards) and academia due to Algeria's colonial history . It can be regarded as a lingua franca of Algeria. In 2008, 11.2 million Algerians could read and write in French. In 2013, it was estimated that 60% of the population could speak or understand French. In 2022, it was estimated that 33% of the population was Francophone. The use of English in Algeria , though limited in comparison to the previously mentioned languages, has increased due to globalization. In 2022 it was announced that English would be taught in elementary schools. Islam is the predominant religion in Algeria, with its adherents, mostly Sunnis, accounting for 99% of the population according to a 2021 CIA World Factbook estimate, and 97.9% according to Pew Research in 2020. There are about 290,000 Ibadis in the M'zab Valley in the region of Ghardaia . Prior to independence, Algeria was home to more than 1.3 million Christians (mostly of European ancestry ). Most of the Christian settlers left to France after the country's independence. Today, estimates of the Christian population range from 20,000 to 200,000. Algerian citizens who are Christians predominantly belong to Protestant groups, which have seen increased pressure from the government in recent years including many forced closures. According to the Arab Barometer in 2018–2019, the vast majority of Algerians (99.1%) continue to identify as Muslim. The June 2019 Arab Barometer - BBC News report found that the percentage of Algerians identifying as non-religious has grown from around 8% in 2013 to around 15% in 2018. The Arab Barometer December 2019, found that the growth in the percentage of Algerians identifying as non-religious is largely driven by young Algerians, with roughly 25% describing themselves as non-religious. However, the 2021 Arab Barometer report found that those who said they were not religious among Algerians has decreased, with just 2.6% identifying as non-religious. In that same report, 69.5% of Algerians identified as religious and another 27.8% identifying as somewhat religious. Algeria has given the Muslim world a number of prominent thinkers, including Emir Abdelkader , Abdelhamid Ben Badis , Mouloud Kacem Naît Belkacem , Malek Bennabi and Mohamed Arkoun . In 2018, Algeria had the highest numbers of physicians in the Maghreb region (1.72 per 1,000 people), nurses (2.23 per 1,000 people), and dentists (0.31 per 1,000 people). Access to "improved water sources" was around 97.4% of the population in urban areas and 98.7% of the population in the rural areas. Some 99% of Algerians living in urban areas, and around 93.4% of those living in rural areas, had access to "improved sanitation". According to the World Bank, Algeria is making progress toward its goal of "reducing by half the number of people without sustainable access to improved drinking water and basic sanitation by 2015". Given Algeria's young population, policy favours preventive health care and clinics over hospitals. In keeping with this policy, the government maintains an immunisation program. However, poor sanitation and unclean water still cause tuberculosis , hepatitis , measles , typhoid fever , cholera and dysentery . The poor generally receive health care free of charge. Health records have been maintained in Algeria since 1882 and began adding Muslims living in the south to their vital record database in 1905 during French rule. Since the 1970s, in a centralised system that was designed to significantly reduce the rate of illiteracy, the Algerian government introduced a decree by which school attendance became compulsory for all children aged between 6 and 15 years who have the ability to track their learning through the 20 facilities built since independence, now the literacy rate is around 92.6%. Since 1972, Arabic is used as the language of instruction during the first nine years of schooling. From the third year, French is taught and it is also the language of instruction for science classes. The students can also learn English, Italian, Spanish and German. In 2008, new programs at the elementary appeared, therefore the compulsory schooling does not start at the age of six anymore, but at the age of five. Apart from the 122 private schools, the Universities of the State are free of charge. After nine years of primary school, students can go to the high school or to an educational institution. The school offers two programs: general or technical. At the end of the third year of secondary school, students pass the exam of the baccalaureate, which allows once it is successful to pursue graduate studies in universities and institutes. Education is officially compulsory for children between the ages of six and 15. In 2008, the illiteracy rate for people over 10 was 22.3%, 15.6% for men and 29.0% for women. The province with the lowest rate of illiteracy was Algiers Province at 11.6%, while the province with the highest rate was Djelfa Province at 35.5%. Algeria has 26 universities and 67 institutions of higher education, which must accommodate a million Algerians and 80,000 foreign students in 2008. The University of Algiers , founded in 1879, is the oldest, it offers education in various disciplines (law, medicine, science and letters). Twenty-five of these universities and almost all of the institutions of higher education were founded after the independence of the country. Even if some of them offer instruction in Arabic like areas of law and the economy, most of the other sectors as science and medicine continue to be provided in French and English. Among the most important universities, there are the University of Sciences and Technology Houari Boumediene , the University of Mentouri Constantine, and University of Oran Es-Senia. The University of Abou Bekr Belkaïd in Tlemcen and University of Batna Hadj Lakhdar occupy the 26th and 45th row in Africa. Algeria was ranked 119th in the Global Innovation Index in 2023. Arabs and indigenous Berbers as well as Phoenicians , Romans , Vandals , Byzantine Greeks , Turks , various Sub-Saharan Africans , and French have contributed to the history and culture of Algeria. Descendants of Andalusi refugees are also present in the population of Algiers and other cities. Moreover, Spanish was spoken by these Aragonese and Castillian Morisco descendants deep into the 18th century, and even Catalan was spoken at the same time by Catalan Morisco descendants in the small town of Grish El-Oued. Centuries of Arab migration to the Maghreb since the 7th century shifted the demographic scope in Algeria. The majority of the population of Algeria are Arabs (75% to 85% of the population). Berbers who make up 15% to 20% of the population are divided into many groups with varying languages. The largest of these are the Kabyles , who live in the Kabylie region east of Algiers, the Chaoui of Northeast Algeria, the Tuaregs in the southern desert and the Shenwa people of North Algeria. [ page needed ] During the colonial period, there was a large (10% in 1960) European population who became known as Pied-Noirs . They were primarily of French, Spanish and Italian origin . Almost all of this population left during the war of independence or immediately after its end. Modern Standard Arabic and Berber are the official languages. Algerian Arabic (Darja) is the language used by the majority of the population. Colloquial Algerian Arabic has some Berber loanwords which represent 8% to 9% of its vocabulary. Berber has been recognised as a "national language" by the constitutional amendment of 8 May 2002. Kabyle , the predominant Berber language, is taught and is partially co-official (with a few restrictions) in parts of Kabylie . Kabyle has a significant Arabic , French , Latin , Greek , Phoenician and Punic substratum, and Arabic loanwords represent 35% of the total Kabyle vocabulary. In February 2016, the Algerian constitution passed a resolution that made Berber an official language alongside Arabic. Algeria emerged as a bilingual state after 1962. Colloquial Algerian Arabic is spoken by about 83% of the population and Berber by 27%. Although French has no official status in Algeria, it has one of the largest Francophone populations in the world, and French is widely used in government, media (newspapers, radio, local television), and both the education system (from primary school onwards) and academia due to Algeria's colonial history . It can be regarded as a lingua franca of Algeria. In 2008, 11.2 million Algerians could read and write in French. In 2013, it was estimated that 60% of the population could speak or understand French. In 2022, it was estimated that 33% of the population was Francophone. The use of English in Algeria , though limited in comparison to the previously mentioned languages, has increased due to globalization. In 2022 it was announced that English would be taught in elementary schools. Islam is the predominant religion in Algeria, with its adherents, mostly Sunnis, accounting for 99% of the population according to a 2021 CIA World Factbook estimate, and 97.9% according to Pew Research in 2020. There are about 290,000 Ibadis in the M'zab Valley in the region of Ghardaia . Prior to independence, Algeria was home to more than 1.3 million Christians (mostly of European ancestry ). Most of the Christian settlers left to France after the country's independence. Today, estimates of the Christian population range from 20,000 to 200,000. Algerian citizens who are Christians predominantly belong to Protestant groups, which have seen increased pressure from the government in recent years including many forced closures. According to the Arab Barometer in 2018–2019, the vast majority of Algerians (99.1%) continue to identify as Muslim. The June 2019 Arab Barometer - BBC News report found that the percentage of Algerians identifying as non-religious has grown from around 8% in 2013 to around 15% in 2018. The Arab Barometer December 2019, found that the growth in the percentage of Algerians identifying as non-religious is largely driven by young Algerians, with roughly 25% describing themselves as non-religious. However, the 2021 Arab Barometer report found that those who said they were not religious among Algerians has decreased, with just 2.6% identifying as non-religious. In that same report, 69.5% of Algerians identified as religious and another 27.8% identifying as somewhat religious. Algeria has given the Muslim world a number of prominent thinkers, including Emir Abdelkader , Abdelhamid Ben Badis , Mouloud Kacem Naît Belkacem , Malek Bennabi and Mohamed Arkoun .In 2018, Algeria had the highest numbers of physicians in the Maghreb region (1.72 per 1,000 people), nurses (2.23 per 1,000 people), and dentists (0.31 per 1,000 people). Access to "improved water sources" was around 97.4% of the population in urban areas and 98.7% of the population in the rural areas. Some 99% of Algerians living in urban areas, and around 93.4% of those living in rural areas, had access to "improved sanitation". According to the World Bank, Algeria is making progress toward its goal of "reducing by half the number of people without sustainable access to improved drinking water and basic sanitation by 2015". Given Algeria's young population, policy favours preventive health care and clinics over hospitals. In keeping with this policy, the government maintains an immunisation program. However, poor sanitation and unclean water still cause tuberculosis , hepatitis , measles , typhoid fever , cholera and dysentery . The poor generally receive health care free of charge. Health records have been maintained in Algeria since 1882 and began adding Muslims living in the south to their vital record database in 1905 during French rule. Since the 1970s, in a centralised system that was designed to significantly reduce the rate of illiteracy, the Algerian government introduced a decree by which school attendance became compulsory for all children aged between 6 and 15 years who have the ability to track their learning through the 20 facilities built since independence, now the literacy rate is around 92.6%. Since 1972, Arabic is used as the language of instruction during the first nine years of schooling. From the third year, French is taught and it is also the language of instruction for science classes. The students can also learn English, Italian, Spanish and German. In 2008, new programs at the elementary appeared, therefore the compulsory schooling does not start at the age of six anymore, but at the age of five. Apart from the 122 private schools, the Universities of the State are free of charge. After nine years of primary school, students can go to the high school or to an educational institution. The school offers two programs: general or technical. At the end of the third year of secondary school, students pass the exam of the baccalaureate, which allows once it is successful to pursue graduate studies in universities and institutes. Education is officially compulsory for children between the ages of six and 15. In 2008, the illiteracy rate for people over 10 was 22.3%, 15.6% for men and 29.0% for women. The province with the lowest rate of illiteracy was Algiers Province at 11.6%, while the province with the highest rate was Djelfa Province at 35.5%. Algeria has 26 universities and 67 institutions of higher education, which must accommodate a million Algerians and 80,000 foreign students in 2008. The University of Algiers , founded in 1879, is the oldest, it offers education in various disciplines (law, medicine, science and letters). Twenty-five of these universities and almost all of the institutions of higher education were founded after the independence of the country. Even if some of them offer instruction in Arabic like areas of law and the economy, most of the other sectors as science and medicine continue to be provided in French and English. Among the most important universities, there are the University of Sciences and Technology Houari Boumediene , the University of Mentouri Constantine, and University of Oran Es-Senia. The University of Abou Bekr Belkaïd in Tlemcen and University of Batna Hadj Lakhdar occupy the 26th and 45th row in Africa. Algeria was ranked 119th in the Global Innovation Index in 2023. Modern Algerian literature, split between Arabic , Tamazight and French, has been strongly influenced by the country's recent history. Famous novelists of the 20th century include Mohammed Dib , Albert Camus , Kateb Yacine and Ahlam Mosteghanemi while Assia Djebar is widely translated. Among the important novelists of the 1980s were Rachid Mimouni , later vice-president of Amnesty International , and Tahar Djaout , murdered by an Islamist group in 1993 for his secularist views. Malek Bennabi and Frantz Fanon are noted for their thoughts on decolonization ; Augustine of Hippo was born in Tagaste (modern-day Souk Ahras ); and Ibn Khaldun , though born in Tunis , wrote the Muqaddima while staying in Algeria. The works of the Sanusi family in pre-colonial times, and of Emir Abdelkader and Sheikh Ben Badis in colonial times, are widely noted. The Latin author Apuleius was born in Madaurus (Mdaourouch), in what later became Algeria. Contemporary Algerian cinema is various in terms of genre, exploring a wider range of themes and issues. There has been a transition from cinema which focused on the war of independence to films more concerned with the everyday lives of Algerians. Algerian painters, like Mohammed Racim and Baya , attempted to revive the prestigious Algerian past prior to French colonisation, at the same time that they have contributed to the preservation of the authentic values of Algeria. In this line, Mohamed Temam , Abdelkhader Houamel have also returned through this art, scenes from the history of the country, the habits and customs of the past and the country life. Other new artistic currents including the one of M'hamed Issiakhem , Mohammed Khadda and Bachir Yelles , appeared on the scene of Algerian painting, abandoning figurative classical painting to find new pictorial ways, to adapt Algerian paintings to the new realities of the country through its struggle and its aspirations. Mohammed Khadda and M'hamed Issiakhem have been notable in recent years. The historic roots of Algerian literature go back to the Numidian and Roman African era, when Apuleius wrote The Golden Ass , the only Latin novel to survive in its entirety. This period had also known Augustine of Hippo , Nonius Marcellus and Martianus Capella , among many others. The Middle Ages have known many Arabic writers who revolutionised the Arab world literature, with authors like Ahmad al-Buni , Ibn Manzur and Ibn Khaldoun , who wrote the Muqaddimah while staying in Algeria, and many others. Albert Camus was an Algerian-born French Pied-Noir author. In 1957, he was awarded the Nobel Prize in literature . Today Algeria contains, in its literary landscape, big names having not only marked the Algerian literature, but also the universal literary heritage in Arabic and French. As a first step, Algerian literature was marked by works whose main concern was the assertion of the Algerian national entity, there is the publication of novels as the Algerian trilogy of Mohammed Dib , or even Nedjma of Kateb Yacine novel which is often regarded as a monumental and major work. Other known writers will contribute to the emergence of Algerian literature whom include Mouloud Feraoun , Malek Bennabi , Malek Haddad , Moufdi Zakaria , Abdelhamid Ben Badis, Mohamed Laïd Al-Khalifa, Mouloud Mammeri , Frantz Fanon , and Assia Djebar . In the aftermath of the independence, several new authors emerged on the Algerian literary scene, they will attempt through their works to expose a number of social problems, among them there are Rachid Boudjedra , Rachid Mimouni , Leila Sebbar , Tahar Djaout and Tahir Wattar . Currently, a part of Algerian writers tends to be defined in a literature of shocking expression, due to the terrorism that occurred during the 1990s, the other party is defined in a different style of literature who staged an individualistic conception of the human adventure. Among the most noted recent works, there is the writer, the swallows of Kabul and the attack of Yasmina Khadra , the oath of barbarians of Boualem Sansal , memory of the flesh of Ahlam Mosteghanemi and the last novel by Assia Djebar nowhere in my father's House . Chaâbi music is a typically Algerian musical genre characterized by specific rhythms and of Qacidate (popular poems) in Arabic dialect. El Hadj M'Hamed El Anka is considered the greatest master of the art in modern times. He wrote over 350 songs and produced some 130 records before his death in 1978. Many of his pupils went on to be renowned musicians. The Constantinois Malouf style is saved by musician from whom Mohamed Tahar Fergani is a performer. Folk music styles include Bedouin music , characterized by the poetic songs based on long kacida (poems); Kabyle music, based on a rich repertoire that is poetry and old tales passed through generations; Shawiya music, a folklore from diverse areas of the Aurès Mountains . Rahaba music style is unique to the Aures. Souad Massi is a rising Algerian folk singer. Other Algerian singers of the diaspora include Manel Filali in Germany and Kenza Farah in France. Tergui music is sung in Tuareg languages generally, Tinariwen had a worldwide success. Finally, the staïfi music is born in Sétif and remains a unique style of its kind. Modern music is available in several facets, Raï music is a style typical of western Algeria. Rap , a relatively recent style in Algeria, is experiencing significant growth. The Algerian state's interest in film-industry activities can be seen in the annual budget of DZD 200 million (EUR 1.3 million) allocated to production, specific measures and an ambitious programme plan implemented by the Ministry of Culture to promote national production, renovate the cinema stock and remedy the weak links in distribution and exploitation. The financial support provided by the state, through the Fund for the Development of the Arts, Techniques and the Film Industry (FDATIC) and the Algerian Agency for Cultural Influence (AARC), plays a key role in the promotion of national production. Between 2007 and 2013, FDATIC subsidised 98 films (feature films, documentaries and short films). In mid-2013, AARC had already supported a total of 78 films, including 42 feature films, 6 short films and 30 documentaries. According to the European Audiovisual Observatory's LUMIERE database, 41 Algerian films were distributed in Europe between 1996 and 2013; 21 films in this repertoire were Algerian-French co-productions. Days of Glory (2006) and Outside the Law (2010) recorded the highest number of admissions in the European Union, 3,172,612 and 474,722, respectively. Algeria won the Palme d'Or for Chronicle of the Years of Fire (1975), two Oscars for Z (1969) , and other awards for the Italian-Algerian movie The Battle of Algiers . Algerian cuisine is rich and diverse as a result of interactions and exchanges with other cultures and nations over the centuries. It is based on both land and sea products. Conquests or demographic movement towards the Algerian territory were two of the main factors of exchanges between the different peoples and cultures. The Algerian cuisine is a mix of Arab , Berber , Turkish and French roots. Algerian cuisine offers a variety of dishes depending on the region and the season, but vegetables and cereals remain at its core. Most of the Algerian dishes are centered around bread, meats (lamb, beef or poultry), olive oil, vegetables, and fresh herbs. Vegetables are often used for salads, soups, tajines , couscous , and sauce-based dishes. Of all the Algerian traditional dishes available, the most famous one is couscous , recognized as a national dish. Various games have existed in Algeria since antiquity. In the Aures , people played several games such as El Kherba or El khergueba ( chess variant). Playing cards, checkers and chess games are part of Algerian culture. Racing ( fantasia ) and rifle shooting are part of cultural recreation of the Algerians. Football is the most popular sport in the country. The Algerian national football team , known as the Desert Foxes, has a strong fan base and has achieved success both domestically and internationally. Algeria has a long history in other sports such as athletics , boxing , volleyball , handball and the study of martial arts . Algerian athletes have competed in the Olympic Games and have won medals in various events. Many sports clubs and organizations exist in Algeria to promote and develop sports among young people. The Ministry of Youth and Sports in Algeria manages sport-related activities. Algerian painters, like Mohammed Racim and Baya , attempted to revive the prestigious Algerian past prior to French colonisation, at the same time that they have contributed to the preservation of the authentic values of Algeria. In this line, Mohamed Temam , Abdelkhader Houamel have also returned through this art, scenes from the history of the country, the habits and customs of the past and the country life. Other new artistic currents including the one of M'hamed Issiakhem , Mohammed Khadda and Bachir Yelles , appeared on the scene of Algerian painting, abandoning figurative classical painting to find new pictorial ways, to adapt Algerian paintings to the new realities of the country through its struggle and its aspirations. Mohammed Khadda and M'hamed Issiakhem have been notable in recent years. The historic roots of Algerian literature go back to the Numidian and Roman African era, when Apuleius wrote The Golden Ass , the only Latin novel to survive in its entirety. This period had also known Augustine of Hippo , Nonius Marcellus and Martianus Capella , among many others. The Middle Ages have known many Arabic writers who revolutionised the Arab world literature, with authors like Ahmad al-Buni , Ibn Manzur and Ibn Khaldoun , who wrote the Muqaddimah while staying in Algeria, and many others. Albert Camus was an Algerian-born French Pied-Noir author. In 1957, he was awarded the Nobel Prize in literature . Today Algeria contains, in its literary landscape, big names having not only marked the Algerian literature, but also the universal literary heritage in Arabic and French. As a first step, Algerian literature was marked by works whose main concern was the assertion of the Algerian national entity, there is the publication of novels as the Algerian trilogy of Mohammed Dib , or even Nedjma of Kateb Yacine novel which is often regarded as a monumental and major work. Other known writers will contribute to the emergence of Algerian literature whom include Mouloud Feraoun , Malek Bennabi , Malek Haddad , Moufdi Zakaria , Abdelhamid Ben Badis, Mohamed Laïd Al-Khalifa, Mouloud Mammeri , Frantz Fanon , and Assia Djebar . In the aftermath of the independence, several new authors emerged on the Algerian literary scene, they will attempt through their works to expose a number of social problems, among them there are Rachid Boudjedra , Rachid Mimouni , Leila Sebbar , Tahar Djaout and Tahir Wattar . Currently, a part of Algerian writers tends to be defined in a literature of shocking expression, due to the terrorism that occurred during the 1990s, the other party is defined in a different style of literature who staged an individualistic conception of the human adventure. Among the most noted recent works, there is the writer, the swallows of Kabul and the attack of Yasmina Khadra , the oath of barbarians of Boualem Sansal , memory of the flesh of Ahlam Mosteghanemi and the last novel by Assia Djebar nowhere in my father's House .Chaâbi music is a typically Algerian musical genre characterized by specific rhythms and of Qacidate (popular poems) in Arabic dialect. El Hadj M'Hamed El Anka is considered the greatest master of the art in modern times. He wrote over 350 songs and produced some 130 records before his death in 1978. Many of his pupils went on to be renowned musicians. The Constantinois Malouf style is saved by musician from whom Mohamed Tahar Fergani is a performer. Folk music styles include Bedouin music , characterized by the poetic songs based on long kacida (poems); Kabyle music, based on a rich repertoire that is poetry and old tales passed through generations; Shawiya music, a folklore from diverse areas of the Aurès Mountains . Rahaba music style is unique to the Aures. Souad Massi is a rising Algerian folk singer. Other Algerian singers of the diaspora include Manel Filali in Germany and Kenza Farah in France. Tergui music is sung in Tuareg languages generally, Tinariwen had a worldwide success. Finally, the staïfi music is born in Sétif and remains a unique style of its kind. Modern music is available in several facets, Raï music is a style typical of western Algeria. Rap , a relatively recent style in Algeria, is experiencing significant growth.The Algerian state's interest in film-industry activities can be seen in the annual budget of DZD 200 million (EUR 1.3 million) allocated to production, specific measures and an ambitious programme plan implemented by the Ministry of Culture to promote national production, renovate the cinema stock and remedy the weak links in distribution and exploitation. The financial support provided by the state, through the Fund for the Development of the Arts, Techniques and the Film Industry (FDATIC) and the Algerian Agency for Cultural Influence (AARC), plays a key role in the promotion of national production. Between 2007 and 2013, FDATIC subsidised 98 films (feature films, documentaries and short films). In mid-2013, AARC had already supported a total of 78 films, including 42 feature films, 6 short films and 30 documentaries. According to the European Audiovisual Observatory's LUMIERE database, 41 Algerian films were distributed in Europe between 1996 and 2013; 21 films in this repertoire were Algerian-French co-productions. Days of Glory (2006) and Outside the Law (2010) recorded the highest number of admissions in the European Union, 3,172,612 and 474,722, respectively. Algeria won the Palme d'Or for Chronicle of the Years of Fire (1975), two Oscars for Z (1969) , and other awards for the Italian-Algerian movie The Battle of Algiers .Algerian cuisine is rich and diverse as a result of interactions and exchanges with other cultures and nations over the centuries. It is based on both land and sea products. Conquests or demographic movement towards the Algerian territory were two of the main factors of exchanges between the different peoples and cultures. The Algerian cuisine is a mix of Arab , Berber , Turkish and French roots. Algerian cuisine offers a variety of dishes depending on the region and the season, but vegetables and cereals remain at its core. Most of the Algerian dishes are centered around bread, meats (lamb, beef or poultry), olive oil, vegetables, and fresh herbs. Vegetables are often used for salads, soups, tajines , couscous , and sauce-based dishes. Of all the Algerian traditional dishes available, the most famous one is couscous , recognized as a national dish. Various games have existed in Algeria since antiquity. In the Aures , people played several games such as El Kherba or El khergueba ( chess variant). Playing cards, checkers and chess games are part of Algerian culture. Racing ( fantasia ) and rifle shooting are part of cultural recreation of the Algerians. Football is the most popular sport in the country. The Algerian national football team , known as the Desert Foxes, has a strong fan base and has achieved success both domestically and internationally. Algeria has a long history in other sports such as athletics , boxing , volleyball , handball and the study of martial arts . Algerian athletes have competed in the Olympic Games and have won medals in various events. Many sports clubs and organizations exist in Algeria to promote and develop sports among young people. The Ministry of Youth and Sports in Algeria manages sport-related activities.

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Venezuela

Venezuela , [lower-alpha 1] officially the Bolivarian Republic of Venezuela , [lower-alpha 2] is a country on the northern coast of South America , consisting of a continental landmass and many islands and islets in the Caribbean Sea . Venezuela comprises an area of 916,445 km 2 (353,841 sq mi) , and its population was estimated at 29 million in 2022. The capital and largest urban agglomeration is the city of Caracas . The continental territory is bordered on the north by the Caribbean Sea and the Atlantic Ocean , on the west by Colombia , Brazil on the south, Trinidad and Tobago to the north-east and on the east by Guyana . Venezuela is a presidential republic consisting of 23 states , the Capital District and federal dependencies covering Venezuela's offshore islands. Venezuela is among the most urbanized countries in Latin America; the vast majority of Venezuelans live in the cities of the north and in the capital. The territory of Venezuela was colonized by Spain in 1522 amid resistance from Indigenous peoples. In 1811, it became one of the first Spanish-American territories to declare independence from the Spanish and to form part of the first federal Republic of Colombia ( Gran Colombia ). It separated as a full sovereign country in 1830. During the 19th century, Venezuela suffered political turmoil and autocracy, remaining dominated by regional military dictators until the mid-20th century. Since 1958, the country has had a series of democratic governments, as an exception where most of the region was ruled by military dictatorships, and the period was characterized by economic prosperity. Economic shocks in the 1980s and 1990s led to major political crises and widespread social unrest, including the deadly Caracazo riots of 1989, two attempted coups in 1992 , and the impeachment of a President for embezzlement of public funds charges in 1993. The collapse in confidence in the existing parties saw the 1998 Venezuelan presidential election , the catalyst for the Bolivarian Revolution , which began with a 1999 Constituent Assembly , where a new Constitution of Venezuela was imposed. The government's populist social welfare policies were bolstered by soaring oil prices, temporarily increasing social spending, and reducing economic inequality and poverty in the early years of the regime. However, poverty began to rapidly increase in the 2010s. The 2013 Venezuelan presidential election was widely disputed leading to widespread protest , which triggered another nationwide crisis that continues to this day. Venezuela has experienced democratic backsliding , shifting into an authoritarian state . It ranks low in international measurements of freedom of the press and civil liberties and has high levels of perceived corruption . Venezuela is a developing country having the world's largest known oil reserves and has been one of the world's leading exporters of oil . Previously, the country was an underdeveloped exporter of agricultural commodities such as coffee and cocoa , but oil quickly came to dominate exports and government revenues. The excesses and poor policies of the incumbent government led to the collapse of Venezuela's entire economy. The country struggles with record hyperinflation , shortages of basic goods , unemployment, poverty, disease, high child mortality, malnutrition , severe crime and corruption. These factors have precipitated the Venezuelan refugee crisis where more than seven million people have fled the country. By 2017, Venezuela was declared to be in default regarding debt payments by credit rating agencies . The crisis in Venezuela has contributed to a rapidly deteriorating human rights situation . Venezuela is a charter member of the United Nations (UN), Organization of American States (OAS), Union of South American Nations (UNASUR), Bolivarian Alliance for the Peoples of Our America (ALBA), Mercosur , Latin American Integration Association (LAIA) and Organization of Ibero-American States (OEI).According to the most popular and accepted version, in 1499, an expedition led by Alonso de Ojeda visited the Venezuelan coast. The stilt houses in the area of Lake Maracaibo reminded the Italian navigator, Amerigo Vespucci , of the city of Venice , Italy, so he named the region Veneziola , or "Little Venice". The Spanish version of Veneziola is Venezuela . Martín Fernández de Enciso , a member of the Vespucci and Ojeda crew, gave a different account. In his work Summa de geografía , he states that the crew found Indigenous peoples who called themselves the Veneciuela. Thus, the name "Venezuela" may have evolved from the native word. Previously, the official name was Estado de Venezuela (1830–1856), República de Venezuela (1856–1864), Estados Unidos de Venezuela (1864–1953), and again República de Venezuela (1953–1999).Evidence exists of human habitation in the area now known as Venezuela from about 15,000 years ago. Tools from this period have been found on the high riverine terraces of the Rio Pedregal in western Venezuela. Late Pleistocene hunting artifacts, including spear tips, have been found at a similar series of sites in northwestern Venezuela known as "El Jobo"; according to radiocarbon dating , these date from 13,000 to 7,000 BC. It is not known how many people lived in Venezuela before the Spanish conquest; it has been estimated at one million. In addition to Indigenous peoples known today, the population included historical groups such as the Kalina (Caribs), Auaké , Caquetio , Mariche , and Timoto–Cuicas . The Timoto–Cuica culture was the most complex society in Pre-Columbian Venezuela, with pre-planned permanent villages, surrounded by irrigated, terraced fields. Their houses were made primarily of stone and wood with thatched roofs. They were peaceful, for the most part, and depended on growing crops. Regional crops included potatoes and ullucos . They left behind works of art, particularly anthropomorphic ceramics, but no major monuments. They spun vegetable fibers to weave into textiles and mats for housing. They are credited with having invented the arepa , a staple in Venezuelan cuisine . After the conquest, the population dropped markedly, mainly through the spread of new infectious diseases from Europe. Two main north–south axes of pre-Columbian population were present, who cultivated maize in the west and manioc in the east. Large parts of the llanos were cultivated through a combination of slash and burn and permanent settled agriculture. In 1498, during his third voyage to the Americas, Christopher Columbus sailed near the Orinoco Delta and landed in the Gulf of Paria . Amazed by the great offshore current of freshwater which deflected his course eastward, Columbus expressed in a letter to Isabella and Ferdinand that he must have reached Heaven on Earth (terrestrial paradise): Great signs are these of the Terrestrial Paradise... for I have never read or heard of such a large quantity of fresh water being inside and in such close proximity to salt water; the very mild temperateness also corroborates this; and if the water of which I speak does not proceed from Paradise then it is an even greater marvel, because I do not believe such a large and deep river has ever been known to exist in this world. Spain's colonization of mainland Venezuela started in 1522 , establishing its first permanent South American settlement in the present-day [ update ] city of Cumaná . In the 16th century, the king of Spain granted a concession in Venezuela to the German Welser family. Klein-Venedig became the most extensive initiative in the German colonization of the Americas from 1528 to 1546. The Welser family were bankers to the Habsburgs and financiers of Charles V , Holy Roman Emperor , who was also King of Spain and had borrowed heavily from them to pay bribes for his Imperial election . In 1528, Charles V granted the Welsers the right to explore, rule and colonize the territory, as well as to seek the mythical golden town of El Dorado . The first expedition was led by Ambrosius Ehinger , who established Maracaibo in 1529. After the deaths of first Ehinger (1533), then Nikolaus Federmann , and Georg von Speyer (1540), Philipp von Hutten persisted in exploring of the interior. In absence of von Hutten from the capital of the province, the crown of Spain claimed the right to appoint a governor. On Hutten's return to the capital, Santa Ana de Coro , in 1546, the Spanish governor Juan de Carvajal had Hutten and Bartholomeus VI. Welser executed. Subsequently, Charles V revoked Welser's concession. The Welsers transported German miners to the colony, in addition to 4,000 African slaves to plant sugar cane plantations. Many of the German colonists died from tropical diseases, to which they had no immunity , or through frequent wars with the Indigenous inhabitants . Native caciques (leaders) such as Guaicaipuro ( c. 1530–1568 ) and Tamanaco (died 1573) attempted to resist Spanish incursions, but the newcomers ultimately subdued them; Tamanaco was put to death by order of Caracas ' founder, Diego de Losada . In the 16th century, during the Spanish colonization, indigenous peoples such as many of the Mariches , themselves descendants of the Kalina, were converted to Roman Catholicism . Some of the resisting tribes or leaders are commemorated in place names, including Caracas, Chacao and Los Teques . The early colonial settlements focused on the northern coast, but in the mid-18th century, the Spanish pushed farther inland along the Orinoco River . Here, the Ye'kuana (then known as the Makiritare) organized serious resistance in 1775 and 1776. Spain's eastern Venezuelan settlements were incorporated into New Andalusia Province . Administered by the Royal Audiencia of Santo Domingo from the early 16th century, most of Venezuela became part of the Viceroyalty of New Granada in the early 18th century, and was then reorganized as an autonomous Captaincy General starting in 1777. The town of Caracas, founded in the central coastal region in 1567, was well-placed to become a key location, being near the coastal port of La Guaira whilst itself being located in a valley in a mountain range, providing defensive strength against pirates and a more fertile and healthy climate. After a series of unsuccessful uprisings, Venezuela, under the leadership of Francisco de Miranda , a Venezuelan marshal who had fought in the American Revolution and the French Revolution , declared independence as the First Republic of Venezuela on 5 July 1811. This began the Venezuelan War of Independence . A devastating earthquake that struck Caracas in 1812 , together with the rebellion of the Venezuelan llaneros , helped bring down the republic. Simón Bolívar , new leader of the independentist forces, launched his Admirable Campaign in 1813 from New Granada , retaking most of the territory and being proclaimed as El Libertador ("The Liberator"). A second Venezuelan republic was proclaimed on 7 August 1813, but lasted only a few months before being crushed at the hands of royalist caudillo José Tomás Boves and his personal army of llaneros . The end of the French invasion of homeland Spain in 1814 allowed the preparation of a large expeditionary force to the American provinces under general Pablo Morillo , with the goal to regain the lost territory in Venezuela and New Granada. As the war reached a stalemate on 1817, Bolívar reestablished the Third Republic of Venezuela on the territory still controlled by the patriots, mainly in the Guayana and Llanos regions. This republic was short-lived as only two years later, during the Congress of Angostura of 1819, the union of Venezuela with New Granada was decreed to form the Republic of Colombia (historiographically Republic of Gran Colombia ). The war continued for some years, until full victory and sovereignty was attained after the Battle of Carabobo on 24 June 1821. On 24 July 1823, José Prudencio Padilla and Rafael Urdaneta helped seal Venezuelan independence with their victory in the Battle of Lake Maracaibo . New Granada's congress gave Bolívar control of the Granadian army; leading it, he liberated several countries and founded the Republic of Colombia ( Gran Colombia ). Sucre went on to liberate Ecuador and become the second president of Bolivia . Venezuela remained part of Gran Colombia until 1830, when a rebellion led by José Antonio Páez allowed the proclamation of a newly independent Venezuela, on 22 September; Páez became the first president of the new State of Venezuela . Between one-quarter and one-third of Venezuela's population was lost during these two decades of warfare (including perhaps one-half of the Venezuelans of European descent ), which by 1830, was estimated at 800,000. The colors of the Venezuelan flag are yellow, blue, and red: the yellow stands for land wealth, the blue for the sea that separates Venezuela from Spain, and the red for the blood shed by the heroes of independence. Slavery in Venezuela was abolished in 1854. Much of Venezuela's 19th-century history was characterized by political turmoil and dictatorial rule, including the Independence leader José Antonio Páez, who gained the presidency three times and served a total of 11 years between 1830 and 1863. This culminated in the Federal War (1859–1863). In the latter half of the century, Antonio Guzmán Blanco , another caudillo , served a total of 13 years between 1870 and 1887, with three other presidents interspersed. In 1895, a longstanding dispute with Great Britain about the Essequibo territory, which Britain claimed as part of British Guiana and Venezuela saw as Venezuelan territory, erupted into the Venezuela Crisis of 1895 . The dispute became a diplomatic crisis when Venezuela's lobbyist, William L. Scruggs , sought to argue that British behavior over the issue violated the United States ' Monroe Doctrine of 1823, and used his influence in Washington, D.C., to pursue the matter. Then, U.S. president Grover Cleveland adopted a broad interpretation of the doctrine that declared an American interest in any matter within the hemisphere. Britain ultimately accepted arbitration, but in negotiations over its terms was able to persuade the U.S. on many of the details. A tribunal convened in Paris in 1898 to decide the issue and in 1899 awarded the bulk of the disputed territory to British Guiana. In 1899, Cipriano Castro , assisted by his friend Juan Vicente Gómez , seized power in Caracas, marching an army from his base in the Andean state of Táchira . Castro defaulted on Venezuela's considerable foreign debts and declined to pay compensation to foreigners caught up in Venezuela's civil wars . This led to the Venezuela Crisis of 1902–1903 , in which Britain, Germany and Italy imposed a naval blockade of several months before international arbitration at the new Permanent Court of Arbitration was agreed. In 1908, another dispute broke out with the Netherlands, which was resolved when Castro left for medical treatment in Germany and was promptly overthrown by Juan Vicente Gómez (1908–1935). The discovery of massive oil deposits in Lake Maracaibo during World War I proved to be pivotal for Venezuela and transformed the basis of its economy from a heavy dependence on agricultural exports. It prompted an economic boom that lasted into the 1980s; by 1935, Venezuela's per capita gross domestic product was Latin America's highest. Gómez benefited handsomely from this, as corruption thrived, but at the same time, the new source of income helped him centralize the Venezuelan state and develop its authority. He remained the most powerful man in Venezuela until his death in 1935, although at times he ceded the presidency to others. The gomecista dictatorship (1935–1945) system largely continued under Eleazar López Contreras , but from 1941, under Isaías Medina Angarita , was relaxed. Angarita granted a range of reforms, including the legalization of all political parties. After World War II , immigration from Southern Europe (mainly from Spain, Italy , Portugal, and France) and poorer Latin American countries markedly diversified Venezuelan society. In 1945, a civilian-military coup overthrew Medina Angarita and ushered in a three-year period of democratic rule (1945–1948) under the mass membership party Democratic Action , initially under Rómulo Betancourt , until Rómulo Gallegos won the 1947 Venezuelan presidential election (generally believed to be the first free and fair elections in Venezuela). Gallegos governed until overthrown by a military junta led by the triumvirate Luis Felipe Llovera Páez [ es ] , Marcos Pérez Jiménez , and Gallegos' Defense Minister, Carlos Delgado Chalbaud , in the 1948 Venezuelan coup d'état . The most powerful man in the military junta (1948–1958) was Pérez Jiménez (though Chalbaud was its titular president) and was suspected of being behind the death in office of Chalbaud, who died in a bungled kidnapping in 1950. When the junta unexpectedly lost the 1952 presidential election , it ignored the results and Pérez Jiménez was installed as president [ citation needed ] The military dictator Pérez Jiménez was forced out on 23 January 1958. In an effort to consolidate a young democracy, the three major political parties ( Acción Democrática (AD), COPEI and Unión Republicana Democrática (URD), with the notable exception of the Communist Party of Venezuela ), signed the Puntofijo Pact power-sharing agreement. The two first parties would dominate the political landscape for four decades. During the presidencies of Rómulo Betancourt (1959–1964, his second term) and Raúl Leoni (1964–1969) in the 1960s, substantial guerilla movements occurred, including the Armed Forces of National Liberation and the Revolutionary Left Movement , which had split from AD in 1960. Most of these movements laid down their arms under Rafael Caldera 's first presidency (1969–1974); Caldera had won the 1968 election for COPEI, being the first time a party other than Democratic Action took the presidency through a democratic election. The new democratic order had its antagonists. Betancourt suffered an attack planned by the Dominican dictator Rafael Trujillo in 1960, and the leftists excluded from the Pact initiated an armed insurgency by organizing themselves in the Armed Forces of National Liberation, sponsored by the Communist Party and Fidel Castro. In 1962 they tried to destabilize the military corps, with failed revolts in Carúpano and Puerto Cabello. At the same time, Betancourt promoted a foreign policy, the Betancourt Doctrine , in which he only recognized elected governments by popular vote. [ need quotation to verify ] The election in 1973 of Carlos Andrés Pérez coincided with an oil crisis , in which Venezuela's income exploded as oil prices soared; oil industries were nationalized in 1976. This led to massive increases in public spending, but also increases in external debts, until the collapse of oil prices during the 1980s crippled the Venezuelan economy. As the government started to devalue the currency in February 1983 to face its financial obligations, Venezuelans' real standards of living fell dramatically. A number of failed economic policies and increasing corruption in government led to rising poverty and crime, worsening social indicators, and increased political instability. In the 1980s, the Presidential Commission for State Reform (COPRE) emerged as a mechanism of political innovation. Venezuela was preparing for the decentralization of its political system and the diversification of its economy, reducing the large size of the State. The COPRE operated as an innovation mechanism, also by incorporating issues into the political agenda that were generally excluded from public deliberation by the main actors of the Venezuelan democratic system. The most discussed topics were incorporated into the public agenda: decentralization, political participation, municipalization, judicial order reforms and the role of the State in a new economic strategy. The social reality of the country made the changes difficult to apply. Economic crises in the 1980s and 1990s led to a political crisis. Hundreds of people were killed by Venezuelan security forces and the military in the Caracazo riots of 1989 during the second presidential term of Carlos Andrés Pérez (1989–1993) and after the implementation of economic austerity measures. Hugo Chávez , who in 1982 had promised to depose the bipartisanship governments, used the growing anger at economic austerity measures to justify a coup d'état attempt in February 1992 ; a second coup d'état attempt occurred in November . President Carlos Andrés Pérez (re-elected in 1988) was impeached under embezzlement charges in 1993, leading to the interim presidency of Ramón José Velásquez (1993–1994). Coup leader Chávez was pardoned in March 1994 by president Rafael Caldera (1994–1999, his second term), with a clean slate and his political rights reinstated, allowing Chávez to win and maintain the presidency continuously from 1999 until his death in 2013. Chávez won the elections of 1998, 2000, 2006 and 2012 and the presidential referendum of 2004. The only gaps in his presidency occurred during the two-day de facto government of Pedro Carmona Estanga in 2002 and when Diosdado Cabello Rondón acted as interim president for a few hours. [ citation needed ] A collapse in confidence in the existing parties led to Hugo Chávez being elected president in 1998 and the subsequent launch of a "Bolivarian Revolution", beginning with a 1999 constituent assembly to write a new Constitution of Venezuela. The Bolivarian Revolution refers to a left-wing populism social movement and political process in Venezuela led by Chávez, who founded the Fifth Republic Movement in 1997 and the United Socialist Party of Venezuela in 2007. The "Bolivarian Revolution" is named after Simón Bolívar . According to Chávez and other supporters, the "Bolivarian Revolution" seeks to build a mass movement to implement Bolivarianism — popular democracy , economic independence, equitable distribution of revenues, and an end to political corruption—in Venezuela. They interpret Bolívar's ideas from a populist perspective, using socialist rhetoric. This led to formation of the Fifth Republic of Venezuela ( Spanish : Quinta República de Venezuela ), commonly known as the Bolivarian Republic of Venezuela ( Spanish : República Bolivariana de Venezuela ), that continues to the present day. Venezuela has been considered the Bolivarian Republic following the adoption of the new Constitution of 1999 . Following Chávez's election to office, Venezuela developed into a dominant-party system , dominated by the United Socialist Party of Venezuela . In April 2002, Chávez was briefly ousted from power in the 2002 Venezuelan coup d'état attempt following popular demonstrations by his opponents, but Chavez returned to power after two days as a result of demonstrations by poor Chávez supporters in Caracas and actions by the military. Chávez also remained in power after an all-out national strike that lasted from December 2002 to February 2003 , including a strike/lockout in the state oil company PDVSA . Capital flight before and during the strike led to the reimposition of currency controls (which had been abolished in 1989), managed by the CADIVI agency. In the subsequent decade, the government was forced into several currency devaluations. These devaluations have done little to improve the situation of the Venezuelan people who rely on imported products or locally produced products that depend on imported inputs while dollar-denominated oil sales account for the vast majority of Venezuela's exports. According to Sebastian Boyd writing at Bloomberg News , the profits of the oil industry have been lost to "social engineering" and corruption, instead of investments needed to maintain oil production. Chávez survived several further political tests, including an August 2004 recall referendum . He was elected for another term in December 2006 and re-elected for a third term in October 2012. However, he was never sworn in for his third period, due to medical complications; he died on 5 March 2013. The presidential election that took place on Sunday, 14 April 2013, was the first since Chávez took office in 1999 in which his name did not appear on the ballot. [ self-published source? ] Under the Bolivarian government, Venezuela went from being one of the richest countries in Latin America to one of the poorest. Hugo Chávez's socioeconomic policies of relying on oil sales and importing goods resulted in large amounts of debt, no change to corruption in Venezuela and culminated into the crisis in Venezuela . As a result of the crisis, the Venezuelan refugee crisis , the largest emigration of people in Latin America's history, occurred, with over 7 million Venezuelans – about 20% of the country's population – emigrating. Chávez also initiated Bolivarian missions , programs aimed at helping the poor. Poverty and inflation began to increase into the 2010s. Nicolás Maduro was elected in 2013 after the death of Chavez. Chavez picked Maduro as his successor and appointed him vice president in 2013. Maduro was elected president in 2013 following Chavez's death. Nicolás Maduro has been the president of Venezuela since 14 April 2013, when he won the second presidential election after Chávez's death , with 50.61% of the votes against the opposition's candidate Henrique Capriles Radonski , who had 49.12% of the votes. The Democratic Unity Roundtable contested his election as fraud and as a violation of the constitution. An audit of 56% of the vote showed no discrepancies, and the Supreme Court of Venezuela ruled that under Venezuela's Constitution, Nicolás Maduro was the legitimate president. Opposition leaders and some international media consider the government of Maduro to be a dictatorship. Since February 2014, hundreds of thousands of Venezuelans have protested over high levels of criminal violence, corruption, hyperinflation, and chronic scarcity of basic goods due to policies of the federal government. Demonstrations and riots have resulted in over 40 fatalities in the unrest between Chavistas and opposition protesters and opposition leaders, including Leopoldo López and Antonio Ledezma were arrested. Human rights groups condemned the arrest of Leopoldo López . In the 2015 Venezuelan parliamentary election , the opposition gained a majority. Venezuela devalued its currency in February 2013 due to rising shortages in the country, which included those of milk, flour, and other necessities. This led to an increase in malnutrition, especially among children. Venezuela's economy had become strongly dependent on the exportation of oil, with crude accounting for 86% of exports, and a high price per barrel to support social programs. Beginning in 2014 the price of oil plummeted from over $100/bbl to $40/bbl a year and a half later. This placed pressure on the Venezuelan economy, which was no longer able to afford vast social programs. To counter the decrease in oil prices, the Venezuelan Government began taking more money from PDVSA , the state oil company, to meet budgets, resulting in a lack of reinvestment in fields and employees. Venezuela's oil production decreased from its height of nearly 3 to 1 million barrels (480 to 160 thousand cubic metres ) per day. In 2014, Venezuela entered an economic recession . In 2015, Venezuela had the world's highest inflation rate with the rate surpassing 100%, which was the highest in the country's history. In 2017, Donald Trump 's administration imposed more economic sanctions against Venezuela's state-owned oil company PDVSA and Venezuelan officials. Economic problems, as well as crime and corruption, were some of the main causes of the 2014–present Venezuelan protests . Since 2014, roughly 5.6 million people have fled Venezuela . In January 2016, President Maduro decreed an "economic emergency", revealing the extent of the crisis and expanding his powers. In July 2016, Colombian border crossings were temporarily opened to allow Venezuelans to purchase food and basic household and health items in Colombia. In September 2016, a study published in the Spanish-language Diario Las Américas indicated that 15% of Venezuelans are eating " food waste discarded by commercial establishments". Close to 200 riots had occurred in Venezuelan prisons by October 2016, according to Una Ventana a la Libertad, an advocacy group for better prison conditions. In 2017, Venezuela experienced a constitutional crisis in the country . In March 2017, opposition leaders branded President Maduro a dictator after the Maduro-aligned Supreme Tribunal , which had been overturning most National Assembly decisions since the opposition took control of the body, took over the functions of the assembly, pushing a lengthy political standoff to new heights. The Supreme Court backed down and reversed its decision on 1 April 2017. [ citation needed ] A month later, President Maduro announced the 2017 Venezuelan Constituent Assembly election and on 30 August 2017, the 2017 Constituent National Assembly was elected into office and quickly stripped the National Assembly of its powers. [ citation needed ] The election raised concerns of an emerging dictatorship. In December 2017, President Maduro declared that leading opposition parties would be barred from taking part in the following year's presidential vote after they boycotted mayoral polls. Maduro won the 2018 election with 67.8% of the vote. The result was challenged by countries including Argentina, Chile, Colombia, Brazil, Canada, Germany, France and the United States who deemed it fraudulent and moved to recognize Juan Guaidó as president. Other countries continued to recognize Maduro as president, although China, facing financial pressure over its position, reportedly began hedging its position by decreasing loans given, cancelling joint ventures, and signaling willingness to work with all parties. In January 2019 the Permanent Council of the Organization of American States (OAS) approved a resolution "to not recognize the legitimacy of Nicolas Maduro's new term as of the 10th of January of 2019". In August 2019, United States President Donald Trump signed an executive order to impose a total economic embargo against Venezuela. In March 2020, the Trump administration indicted Maduro and several Venezuelan officials, including the Chief Justice of the Supreme Tribunal, on charges of drug trafficking, narcoterrorism , and corruption. [ non-primary source needed ] In June 2020, a report by the US organisation Robert F. Kennedy Human Rights documented enforced disappearances in Venezuela that occurred in the years 2018 and 2019. During the period, 724 enforced disappearances of political detainees were reported. The report stated that Venezuelan security forces subjected victims, who had been disappeared, to illegal interrogation processes accompanied by torture and cruel or inhuman treatment. The report stated that the Venezuelan government strategically used enforced disappearances to silence political opponents and other critical voices it deemed a threat. Evidence exists of human habitation in the area now known as Venezuela from about 15,000 years ago. Tools from this period have been found on the high riverine terraces of the Rio Pedregal in western Venezuela. Late Pleistocene hunting artifacts, including spear tips, have been found at a similar series of sites in northwestern Venezuela known as "El Jobo"; according to radiocarbon dating , these date from 13,000 to 7,000 BC. It is not known how many people lived in Venezuela before the Spanish conquest; it has been estimated at one million. In addition to Indigenous peoples known today, the population included historical groups such as the Kalina (Caribs), Auaké , Caquetio , Mariche , and Timoto–Cuicas . The Timoto–Cuica culture was the most complex society in Pre-Columbian Venezuela, with pre-planned permanent villages, surrounded by irrigated, terraced fields. Their houses were made primarily of stone and wood with thatched roofs. They were peaceful, for the most part, and depended on growing crops. Regional crops included potatoes and ullucos . They left behind works of art, particularly anthropomorphic ceramics, but no major monuments. They spun vegetable fibers to weave into textiles and mats for housing. They are credited with having invented the arepa , a staple in Venezuelan cuisine . After the conquest, the population dropped markedly, mainly through the spread of new infectious diseases from Europe. Two main north–south axes of pre-Columbian population were present, who cultivated maize in the west and manioc in the east. Large parts of the llanos were cultivated through a combination of slash and burn and permanent settled agriculture. In 1498, during his third voyage to the Americas, Christopher Columbus sailed near the Orinoco Delta and landed in the Gulf of Paria . Amazed by the great offshore current of freshwater which deflected his course eastward, Columbus expressed in a letter to Isabella and Ferdinand that he must have reached Heaven on Earth (terrestrial paradise): Great signs are these of the Terrestrial Paradise... for I have never read or heard of such a large quantity of fresh water being inside and in such close proximity to salt water; the very mild temperateness also corroborates this; and if the water of which I speak does not proceed from Paradise then it is an even greater marvel, because I do not believe such a large and deep river has ever been known to exist in this world. Spain's colonization of mainland Venezuela started in 1522 , establishing its first permanent South American settlement in the present-day [ update ] city of Cumaná . In the 16th century, the king of Spain granted a concession in Venezuela to the German Welser family. Klein-Venedig became the most extensive initiative in the German colonization of the Americas from 1528 to 1546. The Welser family were bankers to the Habsburgs and financiers of Charles V , Holy Roman Emperor , who was also King of Spain and had borrowed heavily from them to pay bribes for his Imperial election . In 1528, Charles V granted the Welsers the right to explore, rule and colonize the territory, as well as to seek the mythical golden town of El Dorado . The first expedition was led by Ambrosius Ehinger , who established Maracaibo in 1529. After the deaths of first Ehinger (1533), then Nikolaus Federmann , and Georg von Speyer (1540), Philipp von Hutten persisted in exploring of the interior. In absence of von Hutten from the capital of the province, the crown of Spain claimed the right to appoint a governor. On Hutten's return to the capital, Santa Ana de Coro , in 1546, the Spanish governor Juan de Carvajal had Hutten and Bartholomeus VI. Welser executed. Subsequently, Charles V revoked Welser's concession. The Welsers transported German miners to the colony, in addition to 4,000 African slaves to plant sugar cane plantations. Many of the German colonists died from tropical diseases, to which they had no immunity , or through frequent wars with the Indigenous inhabitants .In the 16th century, the king of Spain granted a concession in Venezuela to the German Welser family. Klein-Venedig became the most extensive initiative in the German colonization of the Americas from 1528 to 1546. The Welser family were bankers to the Habsburgs and financiers of Charles V , Holy Roman Emperor , who was also King of Spain and had borrowed heavily from them to pay bribes for his Imperial election . In 1528, Charles V granted the Welsers the right to explore, rule and colonize the territory, as well as to seek the mythical golden town of El Dorado . The first expedition was led by Ambrosius Ehinger , who established Maracaibo in 1529. After the deaths of first Ehinger (1533), then Nikolaus Federmann , and Georg von Speyer (1540), Philipp von Hutten persisted in exploring of the interior. In absence of von Hutten from the capital of the province, the crown of Spain claimed the right to appoint a governor. On Hutten's return to the capital, Santa Ana de Coro , in 1546, the Spanish governor Juan de Carvajal had Hutten and Bartholomeus VI. Welser executed. Subsequently, Charles V revoked Welser's concession. The Welsers transported German miners to the colony, in addition to 4,000 African slaves to plant sugar cane plantations. Many of the German colonists died from tropical diseases, to which they had no immunity , or through frequent wars with the Indigenous inhabitants .Native caciques (leaders) such as Guaicaipuro ( c. 1530–1568 ) and Tamanaco (died 1573) attempted to resist Spanish incursions, but the newcomers ultimately subdued them; Tamanaco was put to death by order of Caracas ' founder, Diego de Losada . In the 16th century, during the Spanish colonization, indigenous peoples such as many of the Mariches , themselves descendants of the Kalina, were converted to Roman Catholicism . Some of the resisting tribes or leaders are commemorated in place names, including Caracas, Chacao and Los Teques . The early colonial settlements focused on the northern coast, but in the mid-18th century, the Spanish pushed farther inland along the Orinoco River . Here, the Ye'kuana (then known as the Makiritare) organized serious resistance in 1775 and 1776. Spain's eastern Venezuelan settlements were incorporated into New Andalusia Province . Administered by the Royal Audiencia of Santo Domingo from the early 16th century, most of Venezuela became part of the Viceroyalty of New Granada in the early 18th century, and was then reorganized as an autonomous Captaincy General starting in 1777. The town of Caracas, founded in the central coastal region in 1567, was well-placed to become a key location, being near the coastal port of La Guaira whilst itself being located in a valley in a mountain range, providing defensive strength against pirates and a more fertile and healthy climate. After a series of unsuccessful uprisings, Venezuela, under the leadership of Francisco de Miranda , a Venezuelan marshal who had fought in the American Revolution and the French Revolution , declared independence as the First Republic of Venezuela on 5 July 1811. This began the Venezuelan War of Independence . A devastating earthquake that struck Caracas in 1812 , together with the rebellion of the Venezuelan llaneros , helped bring down the republic. Simón Bolívar , new leader of the independentist forces, launched his Admirable Campaign in 1813 from New Granada , retaking most of the territory and being proclaimed as El Libertador ("The Liberator"). A second Venezuelan republic was proclaimed on 7 August 1813, but lasted only a few months before being crushed at the hands of royalist caudillo José Tomás Boves and his personal army of llaneros . The end of the French invasion of homeland Spain in 1814 allowed the preparation of a large expeditionary force to the American provinces under general Pablo Morillo , with the goal to regain the lost territory in Venezuela and New Granada. As the war reached a stalemate on 1817, Bolívar reestablished the Third Republic of Venezuela on the territory still controlled by the patriots, mainly in the Guayana and Llanos regions. This republic was short-lived as only two years later, during the Congress of Angostura of 1819, the union of Venezuela with New Granada was decreed to form the Republic of Colombia (historiographically Republic of Gran Colombia ). The war continued for some years, until full victory and sovereignty was attained after the Battle of Carabobo on 24 June 1821. On 24 July 1823, José Prudencio Padilla and Rafael Urdaneta helped seal Venezuelan independence with their victory in the Battle of Lake Maracaibo . New Granada's congress gave Bolívar control of the Granadian army; leading it, he liberated several countries and founded the Republic of Colombia ( Gran Colombia ). Sucre went on to liberate Ecuador and become the second president of Bolivia . Venezuela remained part of Gran Colombia until 1830, when a rebellion led by José Antonio Páez allowed the proclamation of a newly independent Venezuela, on 22 September; Páez became the first president of the new State of Venezuela . Between one-quarter and one-third of Venezuela's population was lost during these two decades of warfare (including perhaps one-half of the Venezuelans of European descent ), which by 1830, was estimated at 800,000. The colors of the Venezuelan flag are yellow, blue, and red: the yellow stands for land wealth, the blue for the sea that separates Venezuela from Spain, and the red for the blood shed by the heroes of independence. Slavery in Venezuela was abolished in 1854. Much of Venezuela's 19th-century history was characterized by political turmoil and dictatorial rule, including the Independence leader José Antonio Páez, who gained the presidency three times and served a total of 11 years between 1830 and 1863. This culminated in the Federal War (1859–1863). In the latter half of the century, Antonio Guzmán Blanco , another caudillo , served a total of 13 years between 1870 and 1887, with three other presidents interspersed. In 1895, a longstanding dispute with Great Britain about the Essequibo territory, which Britain claimed as part of British Guiana and Venezuela saw as Venezuelan territory, erupted into the Venezuela Crisis of 1895 . The dispute became a diplomatic crisis when Venezuela's lobbyist, William L. Scruggs , sought to argue that British behavior over the issue violated the United States ' Monroe Doctrine of 1823, and used his influence in Washington, D.C., to pursue the matter. Then, U.S. president Grover Cleveland adopted a broad interpretation of the doctrine that declared an American interest in any matter within the hemisphere. Britain ultimately accepted arbitration, but in negotiations over its terms was able to persuade the U.S. on many of the details. A tribunal convened in Paris in 1898 to decide the issue and in 1899 awarded the bulk of the disputed territory to British Guiana. In 1899, Cipriano Castro , assisted by his friend Juan Vicente Gómez , seized power in Caracas, marching an army from his base in the Andean state of Táchira . Castro defaulted on Venezuela's considerable foreign debts and declined to pay compensation to foreigners caught up in Venezuela's civil wars . This led to the Venezuela Crisis of 1902–1903 , in which Britain, Germany and Italy imposed a naval blockade of several months before international arbitration at the new Permanent Court of Arbitration was agreed. In 1908, another dispute broke out with the Netherlands, which was resolved when Castro left for medical treatment in Germany and was promptly overthrown by Juan Vicente Gómez (1908–1935).The discovery of massive oil deposits in Lake Maracaibo during World War I proved to be pivotal for Venezuela and transformed the basis of its economy from a heavy dependence on agricultural exports. It prompted an economic boom that lasted into the 1980s; by 1935, Venezuela's per capita gross domestic product was Latin America's highest. Gómez benefited handsomely from this, as corruption thrived, but at the same time, the new source of income helped him centralize the Venezuelan state and develop its authority. He remained the most powerful man in Venezuela until his death in 1935, although at times he ceded the presidency to others. The gomecista dictatorship (1935–1945) system largely continued under Eleazar López Contreras , but from 1941, under Isaías Medina Angarita , was relaxed. Angarita granted a range of reforms, including the legalization of all political parties. After World War II , immigration from Southern Europe (mainly from Spain, Italy , Portugal, and France) and poorer Latin American countries markedly diversified Venezuelan society. In 1945, a civilian-military coup overthrew Medina Angarita and ushered in a three-year period of democratic rule (1945–1948) under the mass membership party Democratic Action , initially under Rómulo Betancourt , until Rómulo Gallegos won the 1947 Venezuelan presidential election (generally believed to be the first free and fair elections in Venezuela). Gallegos governed until overthrown by a military junta led by the triumvirate Luis Felipe Llovera Páez [ es ] , Marcos Pérez Jiménez , and Gallegos' Defense Minister, Carlos Delgado Chalbaud , in the 1948 Venezuelan coup d'état . The most powerful man in the military junta (1948–1958) was Pérez Jiménez (though Chalbaud was its titular president) and was suspected of being behind the death in office of Chalbaud, who died in a bungled kidnapping in 1950. When the junta unexpectedly lost the 1952 presidential election , it ignored the results and Pérez Jiménez was installed as president [ citation needed ] The military dictator Pérez Jiménez was forced out on 23 January 1958. In an effort to consolidate a young democracy, the three major political parties ( Acción Democrática (AD), COPEI and Unión Republicana Democrática (URD), with the notable exception of the Communist Party of Venezuela ), signed the Puntofijo Pact power-sharing agreement. The two first parties would dominate the political landscape for four decades. During the presidencies of Rómulo Betancourt (1959–1964, his second term) and Raúl Leoni (1964–1969) in the 1960s, substantial guerilla movements occurred, including the Armed Forces of National Liberation and the Revolutionary Left Movement , which had split from AD in 1960. Most of these movements laid down their arms under Rafael Caldera 's first presidency (1969–1974); Caldera had won the 1968 election for COPEI, being the first time a party other than Democratic Action took the presidency through a democratic election. The new democratic order had its antagonists. Betancourt suffered an attack planned by the Dominican dictator Rafael Trujillo in 1960, and the leftists excluded from the Pact initiated an armed insurgency by organizing themselves in the Armed Forces of National Liberation, sponsored by the Communist Party and Fidel Castro. In 1962 they tried to destabilize the military corps, with failed revolts in Carúpano and Puerto Cabello. At the same time, Betancourt promoted a foreign policy, the Betancourt Doctrine , in which he only recognized elected governments by popular vote. [ need quotation to verify ] The election in 1973 of Carlos Andrés Pérez coincided with an oil crisis , in which Venezuela's income exploded as oil prices soared; oil industries were nationalized in 1976. This led to massive increases in public spending, but also increases in external debts, until the collapse of oil prices during the 1980s crippled the Venezuelan economy. As the government started to devalue the currency in February 1983 to face its financial obligations, Venezuelans' real standards of living fell dramatically. A number of failed economic policies and increasing corruption in government led to rising poverty and crime, worsening social indicators, and increased political instability. In the 1980s, the Presidential Commission for State Reform (COPRE) emerged as a mechanism of political innovation. Venezuela was preparing for the decentralization of its political system and the diversification of its economy, reducing the large size of the State. The COPRE operated as an innovation mechanism, also by incorporating issues into the political agenda that were generally excluded from public deliberation by the main actors of the Venezuelan democratic system. The most discussed topics were incorporated into the public agenda: decentralization, political participation, municipalization, judicial order reforms and the role of the State in a new economic strategy. The social reality of the country made the changes difficult to apply. Economic crises in the 1980s and 1990s led to a political crisis. Hundreds of people were killed by Venezuelan security forces and the military in the Caracazo riots of 1989 during the second presidential term of Carlos Andrés Pérez (1989–1993) and after the implementation of economic austerity measures. Hugo Chávez , who in 1982 had promised to depose the bipartisanship governments, used the growing anger at economic austerity measures to justify a coup d'état attempt in February 1992 ; a second coup d'état attempt occurred in November . President Carlos Andrés Pérez (re-elected in 1988) was impeached under embezzlement charges in 1993, leading to the interim presidency of Ramón José Velásquez (1993–1994). Coup leader Chávez was pardoned in March 1994 by president Rafael Caldera (1994–1999, his second term), with a clean slate and his political rights reinstated, allowing Chávez to win and maintain the presidency continuously from 1999 until his death in 2013. Chávez won the elections of 1998, 2000, 2006 and 2012 and the presidential referendum of 2004. The only gaps in his presidency occurred during the two-day de facto government of Pedro Carmona Estanga in 2002 and when Diosdado Cabello Rondón acted as interim president for a few hours. [ citation needed ]A collapse in confidence in the existing parties led to Hugo Chávez being elected president in 1998 and the subsequent launch of a "Bolivarian Revolution", beginning with a 1999 constituent assembly to write a new Constitution of Venezuela. The Bolivarian Revolution refers to a left-wing populism social movement and political process in Venezuela led by Chávez, who founded the Fifth Republic Movement in 1997 and the United Socialist Party of Venezuela in 2007. The "Bolivarian Revolution" is named after Simón Bolívar . According to Chávez and other supporters, the "Bolivarian Revolution" seeks to build a mass movement to implement Bolivarianism — popular democracy , economic independence, equitable distribution of revenues, and an end to political corruption—in Venezuela. They interpret Bolívar's ideas from a populist perspective, using socialist rhetoric. This led to formation of the Fifth Republic of Venezuela ( Spanish : Quinta República de Venezuela ), commonly known as the Bolivarian Republic of Venezuela ( Spanish : República Bolivariana de Venezuela ), that continues to the present day. Venezuela has been considered the Bolivarian Republic following the adoption of the new Constitution of 1999 . Following Chávez's election to office, Venezuela developed into a dominant-party system , dominated by the United Socialist Party of Venezuela . In April 2002, Chávez was briefly ousted from power in the 2002 Venezuelan coup d'état attempt following popular demonstrations by his opponents, but Chavez returned to power after two days as a result of demonstrations by poor Chávez supporters in Caracas and actions by the military. Chávez also remained in power after an all-out national strike that lasted from December 2002 to February 2003 , including a strike/lockout in the state oil company PDVSA . Capital flight before and during the strike led to the reimposition of currency controls (which had been abolished in 1989), managed by the CADIVI agency. In the subsequent decade, the government was forced into several currency devaluations. These devaluations have done little to improve the situation of the Venezuelan people who rely on imported products or locally produced products that depend on imported inputs while dollar-denominated oil sales account for the vast majority of Venezuela's exports. According to Sebastian Boyd writing at Bloomberg News , the profits of the oil industry have been lost to "social engineering" and corruption, instead of investments needed to maintain oil production. Chávez survived several further political tests, including an August 2004 recall referendum . He was elected for another term in December 2006 and re-elected for a third term in October 2012. However, he was never sworn in for his third period, due to medical complications; he died on 5 March 2013. The presidential election that took place on Sunday, 14 April 2013, was the first since Chávez took office in 1999 in which his name did not appear on the ballot. [ self-published source? ] Under the Bolivarian government, Venezuela went from being one of the richest countries in Latin America to one of the poorest. Hugo Chávez's socioeconomic policies of relying on oil sales and importing goods resulted in large amounts of debt, no change to corruption in Venezuela and culminated into the crisis in Venezuela . As a result of the crisis, the Venezuelan refugee crisis , the largest emigration of people in Latin America's history, occurred, with over 7 million Venezuelans – about 20% of the country's population – emigrating. Chávez also initiated Bolivarian missions , programs aimed at helping the poor. Poverty and inflation began to increase into the 2010s. Nicolás Maduro was elected in 2013 after the death of Chavez. Chavez picked Maduro as his successor and appointed him vice president in 2013. Maduro was elected president in 2013 following Chavez's death. Nicolás Maduro has been the president of Venezuela since 14 April 2013, when he won the second presidential election after Chávez's death , with 50.61% of the votes against the opposition's candidate Henrique Capriles Radonski , who had 49.12% of the votes. The Democratic Unity Roundtable contested his election as fraud and as a violation of the constitution. An audit of 56% of the vote showed no discrepancies, and the Supreme Court of Venezuela ruled that under Venezuela's Constitution, Nicolás Maduro was the legitimate president. Opposition leaders and some international media consider the government of Maduro to be a dictatorship. Since February 2014, hundreds of thousands of Venezuelans have protested over high levels of criminal violence, corruption, hyperinflation, and chronic scarcity of basic goods due to policies of the federal government. Demonstrations and riots have resulted in over 40 fatalities in the unrest between Chavistas and opposition protesters and opposition leaders, including Leopoldo López and Antonio Ledezma were arrested. Human rights groups condemned the arrest of Leopoldo López . In the 2015 Venezuelan parliamentary election , the opposition gained a majority. Venezuela devalued its currency in February 2013 due to rising shortages in the country, which included those of milk, flour, and other necessities. This led to an increase in malnutrition, especially among children. Venezuela's economy had become strongly dependent on the exportation of oil, with crude accounting for 86% of exports, and a high price per barrel to support social programs. Beginning in 2014 the price of oil plummeted from over $100/bbl to $40/bbl a year and a half later. This placed pressure on the Venezuelan economy, which was no longer able to afford vast social programs. To counter the decrease in oil prices, the Venezuelan Government began taking more money from PDVSA , the state oil company, to meet budgets, resulting in a lack of reinvestment in fields and employees. Venezuela's oil production decreased from its height of nearly 3 to 1 million barrels (480 to 160 thousand cubic metres ) per day. In 2014, Venezuela entered an economic recession . In 2015, Venezuela had the world's highest inflation rate with the rate surpassing 100%, which was the highest in the country's history. In 2017, Donald Trump 's administration imposed more economic sanctions against Venezuela's state-owned oil company PDVSA and Venezuelan officials. Economic problems, as well as crime and corruption, were some of the main causes of the 2014–present Venezuelan protests . Since 2014, roughly 5.6 million people have fled Venezuela . In January 2016, President Maduro decreed an "economic emergency", revealing the extent of the crisis and expanding his powers. In July 2016, Colombian border crossings were temporarily opened to allow Venezuelans to purchase food and basic household and health items in Colombia. In September 2016, a study published in the Spanish-language Diario Las Américas indicated that 15% of Venezuelans are eating " food waste discarded by commercial establishments". Close to 200 riots had occurred in Venezuelan prisons by October 2016, according to Una Ventana a la Libertad, an advocacy group for better prison conditions. In 2017, Venezuela experienced a constitutional crisis in the country . In March 2017, opposition leaders branded President Maduro a dictator after the Maduro-aligned Supreme Tribunal , which had been overturning most National Assembly decisions since the opposition took control of the body, took over the functions of the assembly, pushing a lengthy political standoff to new heights. The Supreme Court backed down and reversed its decision on 1 April 2017. [ citation needed ] A month later, President Maduro announced the 2017 Venezuelan Constituent Assembly election and on 30 August 2017, the 2017 Constituent National Assembly was elected into office and quickly stripped the National Assembly of its powers. [ citation needed ] The election raised concerns of an emerging dictatorship. In December 2017, President Maduro declared that leading opposition parties would be barred from taking part in the following year's presidential vote after they boycotted mayoral polls. Maduro won the 2018 election with 67.8% of the vote. The result was challenged by countries including Argentina, Chile, Colombia, Brazil, Canada, Germany, France and the United States who deemed it fraudulent and moved to recognize Juan Guaidó as president. Other countries continued to recognize Maduro as president, although China, facing financial pressure over its position, reportedly began hedging its position by decreasing loans given, cancelling joint ventures, and signaling willingness to work with all parties. In January 2019 the Permanent Council of the Organization of American States (OAS) approved a resolution "to not recognize the legitimacy of Nicolas Maduro's new term as of the 10th of January of 2019". In August 2019, United States President Donald Trump signed an executive order to impose a total economic embargo against Venezuela. In March 2020, the Trump administration indicted Maduro and several Venezuelan officials, including the Chief Justice of the Supreme Tribunal, on charges of drug trafficking, narcoterrorism , and corruption. [ non-primary source needed ] In June 2020, a report by the US organisation Robert F. Kennedy Human Rights documented enforced disappearances in Venezuela that occurred in the years 2018 and 2019. During the period, 724 enforced disappearances of political detainees were reported. The report stated that Venezuelan security forces subjected victims, who had been disappeared, to illegal interrogation processes accompanied by torture and cruel or inhuman treatment. The report stated that the Venezuelan government strategically used enforced disappearances to silence political opponents and other critical voices it deemed a threat. Poverty and inflation began to increase into the 2010s. Nicolás Maduro was elected in 2013 after the death of Chavez. Chavez picked Maduro as his successor and appointed him vice president in 2013. Maduro was elected president in 2013 following Chavez's death. Nicolás Maduro has been the president of Venezuela since 14 April 2013, when he won the second presidential election after Chávez's death , with 50.61% of the votes against the opposition's candidate Henrique Capriles Radonski , who had 49.12% of the votes. The Democratic Unity Roundtable contested his election as fraud and as a violation of the constitution. An audit of 56% of the vote showed no discrepancies, and the Supreme Court of Venezuela ruled that under Venezuela's Constitution, Nicolás Maduro was the legitimate president. Opposition leaders and some international media consider the government of Maduro to be a dictatorship. Since February 2014, hundreds of thousands of Venezuelans have protested over high levels of criminal violence, corruption, hyperinflation, and chronic scarcity of basic goods due to policies of the federal government. Demonstrations and riots have resulted in over 40 fatalities in the unrest between Chavistas and opposition protesters and opposition leaders, including Leopoldo López and Antonio Ledezma were arrested. Human rights groups condemned the arrest of Leopoldo López . In the 2015 Venezuelan parliamentary election , the opposition gained a majority. Venezuela devalued its currency in February 2013 due to rising shortages in the country, which included those of milk, flour, and other necessities. This led to an increase in malnutrition, especially among children. Venezuela's economy had become strongly dependent on the exportation of oil, with crude accounting for 86% of exports, and a high price per barrel to support social programs. Beginning in 2014 the price of oil plummeted from over $100/bbl to $40/bbl a year and a half later. This placed pressure on the Venezuelan economy, which was no longer able to afford vast social programs. To counter the decrease in oil prices, the Venezuelan Government began taking more money from PDVSA , the state oil company, to meet budgets, resulting in a lack of reinvestment in fields and employees. Venezuela's oil production decreased from its height of nearly 3 to 1 million barrels (480 to 160 thousand cubic metres ) per day. In 2014, Venezuela entered an economic recession . In 2015, Venezuela had the world's highest inflation rate with the rate surpassing 100%, which was the highest in the country's history. In 2017, Donald Trump 's administration imposed more economic sanctions against Venezuela's state-owned oil company PDVSA and Venezuelan officials. Economic problems, as well as crime and corruption, were some of the main causes of the 2014–present Venezuelan protests . Since 2014, roughly 5.6 million people have fled Venezuela . In January 2016, President Maduro decreed an "economic emergency", revealing the extent of the crisis and expanding his powers. In July 2016, Colombian border crossings were temporarily opened to allow Venezuelans to purchase food and basic household and health items in Colombia. In September 2016, a study published in the Spanish-language Diario Las Américas indicated that 15% of Venezuelans are eating " food waste discarded by commercial establishments". Close to 200 riots had occurred in Venezuelan prisons by October 2016, according to Una Ventana a la Libertad, an advocacy group for better prison conditions. In 2017, Venezuela experienced a constitutional crisis in the country . In March 2017, opposition leaders branded President Maduro a dictator after the Maduro-aligned Supreme Tribunal , which had been overturning most National Assembly decisions since the opposition took control of the body, took over the functions of the assembly, pushing a lengthy political standoff to new heights. The Supreme Court backed down and reversed its decision on 1 April 2017. [ citation needed ] A month later, President Maduro announced the 2017 Venezuelan Constituent Assembly election and on 30 August 2017, the 2017 Constituent National Assembly was elected into office and quickly stripped the National Assembly of its powers. [ citation needed ] The election raised concerns of an emerging dictatorship. In December 2017, President Maduro declared that leading opposition parties would be barred from taking part in the following year's presidential vote after they boycotted mayoral polls. Maduro won the 2018 election with 67.8% of the vote. The result was challenged by countries including Argentina, Chile, Colombia, Brazil, Canada, Germany, France and the United States who deemed it fraudulent and moved to recognize Juan Guaidó as president. Other countries continued to recognize Maduro as president, although China, facing financial pressure over its position, reportedly began hedging its position by decreasing loans given, cancelling joint ventures, and signaling willingness to work with all parties. In January 2019 the Permanent Council of the Organization of American States (OAS) approved a resolution "to not recognize the legitimacy of Nicolas Maduro's new term as of the 10th of January of 2019". In August 2019, United States President Donald Trump signed an executive order to impose a total economic embargo against Venezuela. In March 2020, the Trump administration indicted Maduro and several Venezuelan officials, including the Chief Justice of the Supreme Tribunal, on charges of drug trafficking, narcoterrorism , and corruption. [ non-primary source needed ] In June 2020, a report by the US organisation Robert F. Kennedy Human Rights documented enforced disappearances in Venezuela that occurred in the years 2018 and 2019. During the period, 724 enforced disappearances of political detainees were reported. The report stated that Venezuelan security forces subjected victims, who had been disappeared, to illegal interrogation processes accompanied by torture and cruel or inhuman treatment. The report stated that the Venezuelan government strategically used enforced disappearances to silence political opponents and other critical voices it deemed a threat. Venezuela is located in the north of South America; geologically, its mainland rests on the South American Plate . It has a total area of 916,445 km 2 (353,841 sq mi) and a land area of 882,050 km 2 (340,560 sq mi) , making Venezuela the 33rd largest country in the world . The territory it controls lies between latitudes 0° and 16°N and longitudes 59° and 74°W . Shaped roughly like a triangle, the country has a 2,800 km (1,700 mi) coastline in the north, which includes numerous islands in the Caribbean and the northeast borders the northern Atlantic Ocean. Most observers describe Venezuela in terms of four fairly well defined topographical regions: the Maracaibo lowlands in the northwest, the northern mountains extending in a broad east–west arc from the Colombian border along the northern Caribbean coast, the wide plains in central Venezuela, and the Guiana Highlands in the southeast. The northern mountains are the extreme northeastern extensions of South America's Andes mountain range. Pico Bolívar , the nation's highest point at 4,979 m (16,335 ft) , lies in this region. To the south, the dissected Guiana Highlands contain the northern fringes of the Amazon Basin and Angel Falls , the world's highest waterfall, as well as tepuis , large table-like mountains. The country's center is characterized by the llanos , which are extensive plains that stretch from the Colombian border in the far west to the Orinoco River delta in the east. The Orinoco, with its rich alluvial soils , binds the largest and most important river system of the country; it originates in one of the largest watersheds in Latin America. The Caroní and the Apure are other major rivers. Venezuela borders Colombia to the west, Guyana to the east, and Brazil to the south. Caribbean islands such as Trinidad and Tobago , Grenada , Curaçao , Aruba , and the Leeward Antilles lie near the Venezuelan coast. Venezuela has territorial disputes with Guyana, formerly United Kingdom, largely concerning the Essequibo area and with Colombia concerning the Gulf of Venezuela . In 1895, after years of diplomatic attempts to solve the border dispute, the dispute over the Essequibo River border flared up. It was submitted to a "neutral" commission (composed of British, American, and Russian representatives and without a direct Venezuelan representative), which in 1899 decided mostly against Venezuela's claim. [ citation needed ] Venezuela is entirely located in the tropics over the Equator to around 12° N. Its climate varies from humid low-elevation plains, where average annual temperatures range as high as 35 °C (95.0 °F) , to glaciers and highlands (the páramos ) with an average yearly temperature of 8 °C (46.4 °F) . Annual rainfall varies from 430 mm (16.9 in) in the semiarid portions of the northwest to over 1,000 mm (39.4 in) in the Orinoco Delta of the far east and the Amazonian Jungle in the south. The precipitation level is lower in the period from August through April. These periods are referred to as hot-humid and cold-dry seasons. Another characteristic of the climate is this variation throughout the country by the existence of a mountain range called "Cordillera de la Costa" which crosses the country from east to west. The majority of the population lives in these mountains. The country falls into four horizontal temperature zones based primarily on elevation, having tropical, dry, temperate with dry winters, and polar ( alpine tundra ) climates, amongst others. In the tropical zone—below 800 m (2,625 ft) —temperatures are hot, with yearly averages ranging between 26 and 28 °C (78.8 and 82.4 °F) . The temperate zone ranges between 800 and 2,000 m (2,625 and 6,562 ft) with averages from 12 to 25 °C (53.6 to 77.0 °F) ; many of Venezuela's cities, including the capital, lie in this region. Colder conditions with temperatures from 9 to 11 °C (48.2 to 51.8 °F) are found in the cool zone between 2,000 and 3,000 m (6,562 and 9,843 ft) , especially in the Venezuelan Andes, where pastureland and permanent snowfield with yearly averages below 8 °C (46 °F) cover land above 3,000 meters (9,843 ft) in the páramos . The highest temperature recorded was 42 °C (108 °F) in Machiques , and the lowest temperature recorded was −11 °C (12 °F) , reported from an uninhabited high altitude at Páramo de Piedras Blancas ( Mérida state ). Venezuela lies within the Neotropical realm ; large portions of the country were originally covered by moist broadleaf forests . One of 17 megadiverse countries , Venezuela's habitats range from the Andes Mountains in the west to the Amazon Basin rainforest in the south, via extensive llanos plains and Caribbean coast in the center and the Orinoco River Delta in the east. They include xeric scrublands in the extreme northwest and coastal mangrove forests in the northeast. Its cloud forests and lowland rainforests are particularly rich. Animals of Venezuela are diverse and include manatees , three-toed sloth , two-toed sloth , Amazon river dolphins , and Orinoco Crocodiles , which have been reported to reach up to 6.6 m (22 ft) in length. Venezuela hosts a total of 1,417 bird species, 48 of which are endemic. Important birds include ibises , ospreys , kingfishers , and the yellow-orange Venezuelan troupial , the national bird. Notable mammals include the giant anteater , jaguar , and the capybara , the world's largest rodent . More than half of Venezuelan avian and mammalian species are found in the Amazonian forests south of the Orinoco. For the fungi, an account was provided by R.W.G. Dennis which has been digitized and the records made available on-line as part of the Cybertruffle Robigalia database. That database includes nearly 3,900 species of fungi recorded from Venezuela, but is far from complete, and the true total number of fungal species already known from Venezuela is likely higher, given the generally accepted estimate that only about 7% of all fungi worldwide have so far been discovered. Among plants of Venezuela, over 25,000 species of orchids are found in the country's cloud forest and lowland rainforest ecosystems. These include the flor de mayo orchid ( Cattleya mossiae ), the national flower. Venezuela's national tree is the araguaney . The tops of the tepuis are also home to several carnivorous plants including the marsh pitcher plant, Heliamphora , and the insectivorous bromeliad, Brocchinia reducta . Venezuela is among the top 20 countries in terms of endemism . Among its animals, 23% of reptilian and 50% of amphibian species, including the Trinidad poison frog , are endemic. Although the available information is still very small, a first effort has been made to estimate the number of fungal species endemic to Venezuela: 1334 species of fungi have been tentatively identified as possibly endemic. Some 38% of the over 21,000 plant species known from Venezuela are unique to the country. Venezuela is one of the 10 most biodiverse countries on the planet, yet it is one of the leaders of deforestation due to economic and political factors. Each year, roughly 287,600 hectares of forest are permanently destroyed, and other areas are degraded by mining, oil extraction, and logging. Between 1990 and 2005, Venezuela officially lost 8.3% of its forest cover, which is about 4.3 million ha. In response, federal protections for critical habitat were implemented; for example, 20% to 33% of forested land is protected. Venezuela had a 2019 Forest Landscape Integrity Index mean score of 8.78/10, ranking it 19th globally out of 172 countries. The country's biosphere reserve is part of the World Network of Biosphere Reserves ; five wetlands are registered under the Ramsar Convention . In 2003, 70% of the nation's land was under conservation management in over 200 protected areas, including 43 national parks. Venezuela's 43 national parks include Canaima National Park, Morrocoy National Park , and Mochima National Park . In the far south is a reserve for the country's Yanomami tribes. Covering 32,000 square miles (82,880 square kilometres) , the area is off-limits to farmers, miners, and all non-Yanomami settlers. Venezuela was one of the few countries that did not enter an INDC at COP21 . Many terrestrial ecosystems are considered endangered , specially the dry forest in the northern regions of the country and the coral reefs in the Caribbean coast. There are 105 protected areas in Venezuela, which cover around 26% of the country's continental, marine and insular surface. [ citation needed ] The country is made up of three river basins: the Caribbean Sea , the Atlantic Ocean and Lake Valencia, which forms an endorheic basin. On the Atlantic side it drains most of Venezuela's river waters. The largest basin in this area is the extensive Orinoco basin whose surface area, close to one million km 2 , is greater than that of the whole of Venezuela, although it has a presence of 65% in the country. The size of this basin - similar to that of the Danube - makes it the third largest in South America, and it gives rise to a flow of some 33,000 m 3 /s, making the Orinoco the third largest in the world, and also one of the most valuable from the point of view of renewable natural resources. The Rio or Brazo Casiquiare is unique in the world, as it is a natural derivation of the Orinoco that, after some 500 km in length, connects it to the Negro River, which in turn is a tributary of the Amazon . The Orinoco receives directly or indirectly rivers such as the Ventuari, the Caura, the Caroní , the Meta, the Arauca , the Apure and many others. Other Venezuelan rivers that empty into the Atlantic are the waters of the San Juan and Cuyuní basins. Finally, there is the Amazon River, which receives the Guainía, the Negro and others. Other basins are the Gulf of Paria and the Esequibo River . The second most important watershed is the Caribbean Sea. The rivers of this region are usually short and of scarce and irregular flow, with some exceptions such as the Catatumbo , which originates in Colombia and drains into the Maracaibo Lake basin. Among the rivers that reach the Maracaibo lake basin are the Chama, the Escalante, the Catatumbo, and the contributions of the smaller basins of the Tocuyo, Yaracuy, Neverí and Manzanares rivers. A minimum drains to the Lake Valencia basin. Of the total extension of the rivers, a total of 5400 km are navigable. Other rivers worth mentioning are the Apure, Arauca, Caura, Meta, Barima, Portuguesa , Ventuari and Zulia, among others. The country's main lakes are Lake Maracaibo -the largest in South America- open to the sea through the natural channel, but with fresh water, and Lake Valencia with its endorheic system. Other noteworthy bodies of water are the Guri reservoir , the Altagracia lagoon, the Camatagua reservoir and the Mucubají lagoon in the Andes. The Venezuelan natural landscape is the product of the interaction of tectonic plates that since the Paleozoic have contributed to its current appearance. On the formed structures, seven physical-natural units have been modeled, differentiated in their relief and in their natural resources . The relief of Venezuela has the following characteristics: coastline with several peninsulas and islands , adenas of the Andes mountain range (north and northwest), Lake Maracaibo (between the chains, on the coast); Orinoco river delta, region of peneplains and plateaus (tepui, east of the Orinoco) that together form the Guyanas massif (plateaus, southeast of the country). The oldest rock formations in South America are found in the complex basement of the Guyanas highlands and in the crystalline line of the Maritime and Cordillera massifs in Venezuela. The Venezuelan part of the Guyanas Altiplano consists of a large granite block of gneiss and other crystalline Archean rocks, with underlying layers of sandstone and shale clay. The core of granite and cordillera is, to a large extent, flanked by sedimentary layers from the Cretaceous , folded in an anticline structure. Between these orographic systems there are plains covered with tertiary and quaternary layers of gravel, sands and clayey marls . The depression contains lagoons and lakes, among which is that of Maracaibo , and presents, on the surface, alluvial deposits from the Quaternary . Also known as the Cordillera de la Costa, stretches along Venezuela's northern coast. This region is known for its lush tropical rainforests, stunning coastal views, and a rich variety of flora and fauna. The intermountain depressions, or valleys, between the mountain ranges are often home to fertile agricultural land and vibrant communities. These valleys offer a stark contrast to the rugged mountains that rise dramatically from the coast. Situated in northwestern Venezuela, the Lara-Falcón Highlands exhibit a terrain defined by plateaus and rolling hills. These highlands provide a significant contrast to the surrounding lowlands and coastal areas. The relief is characterized by gently sloping plateaus that support agriculture, including coffee and cacao cultivation. This region's semi-arid climate and picturesque landscapes make it an important agricultural and tourism center. Encompass the basin of Lake Maracaibo and the plains surrounding the Gulf of Venezuela . This region offers two distinct plains—the northern one is relatively dry, while the southern one is humid and dotted with swamps. The relief here is primarily characterized by flat terrain, with the exception of some elevated areas near the lake. Lake Maracaibo itself sits in a depression, surrounded by oil-rich lands and productive agricultural areas. The Venezuelan Andes, part of the broader Andes mountain range, offer a striking relief with towering peaks, deep valleys, and fertile intermontane basins. Dominated by these corpulent mountain ranges, including Venezuela's highest peak, Bolívar Peak , the region's rugged and picturesque landscapes are defined by its high-altitude terrain. The unique relief of this area finds its origins in the Last Glacial Period , where the interplay of repeated glacier advances and retreats sculpted the landscape, shaped by the cold, high-altitude climate. This glacial heritage has left a lasting imprint, with glaciers carving deep valleys and polishing rugged peaks, while sheltered intramontane valleys offer fertile soils and temperate microclimates, creating ideal conditions for agriculture and human settlement. Los Llanos, or "the plains", are expansive sedimentary basins characterized by predominantly flat relief. However, the eastern Llanos feature low-plateaus and the Unare depression, created through mesa erosion, adding diversity to the terrain. This region is subject to seasonal flooding, transforming the flat plains into a vast wetland during the rainy season. The relief here influences the region's unique ecosystems, including extensive grasslands and abundant wildlife. The Guiana Shield boasts a varied relief shaped by geological processes over millions of years. This region encompasses peneplains, rugged mountain ranges, foothills, and the iconic tepuis , or table-top mountains. The tepuis stand as isolated, flat-topped plateaus that rise dramatically from the surrounding terrain. This unique relief contributes to the region's remarkable biodiversity and scientific significance. The Orinoco Delta's relief is characterized by a complex system of lands and waters. It consists of numerous channels, islands, and shifting sedimentary deposits. While the relief may appear relatively uniform, it conceals a dynamic environment influenced by seasonal flooding and sediment deposition. This complex deltaic relief supports diverse aquatic life and the livelihoods of Indigenous communities adapted to its ever-changing landscapes. The valleys are undoubtedly the most important type of landscape in the Venezuelan territory, not because of their spatial extension, but because they are the environment where most of the country's population and economic activities are concentrated. On the other hand, there are valleys throughout almost all the national space, except in the great sedimentary basins of the Llanos and the depression of the Maracaibo Lake , except also in the Amazonian peneplains. By their modeling, the valleys of the Venezuelan territory belong mainly to two types: valleys of fluvial type and valleys of glacial type. Much more frequent, the former largely dominate the latter, which are restricted to the highest parts of the Andes. Moreover, most glacial valleys are relics of a past geologic epoch, which culminated some 10,000 to 12,000 years ago. The deep and narrow Andean valleys are very different from the wide depressions of Aragua and Carabobo, in the Cordillera de la Costa , or from the valleys nestled in the Mesas de Monagas . These examples indicate that the configuration of the local relief is decisive in identifying regional types of valleys. Likewise, due to their warm climate, the Guayana valleys are distinguished from the temperate or cold Andean valleys by their humid environment. Both are, in turn, different from the semi-arid depressions of the states of Lara and Falcón. The Andean valleys, essentially agricultural, precociously populated but nowadays in loss of speed, do not confront the same problems of space occupation as the strongly urbanized and industrialized valleys of the central section of the Cordillera de la Costa. On the other hand, the unpopulated and practically untouched Guiana valleys are another category this area is called the Lost World ( Mundo Perdido ). The Andean valleys are undoubtedly the most impressive of the Venezuelan territory because of the energy of the encasing reliefs, whose summits often dominate the valley bottoms by 3,000 to 3,500 meters of relative altitude . They are also the most picturesque in terms of their style of habitat, forms of land use, handicraft production and all the traditions linked to these activities. Venezuela has a great diversity of landscapes and climates, including arid and dry areas. The main desert in the country is in the state of Falcon near the city of Coro. It is now a protected park, the Médanos de Coro National Park . The park is the largest of its kind in Venezuela, covering 91 square kilometres. The landscape is dotted with cacti and other xerophytic plants that can survive in humidity-free conditions near the desert. Desert wildlife includes mostly lizards, iguanas and other reptiles. Although less frequent, the desert is home to some foxes, giant anteaters and rabbits. There are also some native bird populations, such as the sparrowhawk, tropical mockingbird, scaly dove and crested quail. Other desert areas in the country include part of the Guajira Desert in the Guajira Municipality in the north of Zulia State and facing the Gulf of Venezuela , the Médanos de Capanaparo in the Santos Luzardo National Park in Apure State , the Medanos de la Isla de Zapara in Zulia State, the so-called Hundición de Yay in the Andrés Eloy Blanco Municipality of Lara State, and the Urumaco Formation also in Falcón State.Venezuela is entirely located in the tropics over the Equator to around 12° N. Its climate varies from humid low-elevation plains, where average annual temperatures range as high as 35 °C (95.0 °F) , to glaciers and highlands (the páramos ) with an average yearly temperature of 8 °C (46.4 °F) . Annual rainfall varies from 430 mm (16.9 in) in the semiarid portions of the northwest to over 1,000 mm (39.4 in) in the Orinoco Delta of the far east and the Amazonian Jungle in the south. The precipitation level is lower in the period from August through April. These periods are referred to as hot-humid and cold-dry seasons. Another characteristic of the climate is this variation throughout the country by the existence of a mountain range called "Cordillera de la Costa" which crosses the country from east to west. The majority of the population lives in these mountains. The country falls into four horizontal temperature zones based primarily on elevation, having tropical, dry, temperate with dry winters, and polar ( alpine tundra ) climates, amongst others. In the tropical zone—below 800 m (2,625 ft) —temperatures are hot, with yearly averages ranging between 26 and 28 °C (78.8 and 82.4 °F) . The temperate zone ranges between 800 and 2,000 m (2,625 and 6,562 ft) with averages from 12 to 25 °C (53.6 to 77.0 °F) ; many of Venezuela's cities, including the capital, lie in this region. Colder conditions with temperatures from 9 to 11 °C (48.2 to 51.8 °F) are found in the cool zone between 2,000 and 3,000 m (6,562 and 9,843 ft) , especially in the Venezuelan Andes, where pastureland and permanent snowfield with yearly averages below 8 °C (46 °F) cover land above 3,000 meters (9,843 ft) in the páramos . The highest temperature recorded was 42 °C (108 °F) in Machiques , and the lowest temperature recorded was −11 °C (12 °F) , reported from an uninhabited high altitude at Páramo de Piedras Blancas ( Mérida state ). Venezuela lies within the Neotropical realm ; large portions of the country were originally covered by moist broadleaf forests . One of 17 megadiverse countries , Venezuela's habitats range from the Andes Mountains in the west to the Amazon Basin rainforest in the south, via extensive llanos plains and Caribbean coast in the center and the Orinoco River Delta in the east. They include xeric scrublands in the extreme northwest and coastal mangrove forests in the northeast. Its cloud forests and lowland rainforests are particularly rich. Animals of Venezuela are diverse and include manatees , three-toed sloth , two-toed sloth , Amazon river dolphins , and Orinoco Crocodiles , which have been reported to reach up to 6.6 m (22 ft) in length. Venezuela hosts a total of 1,417 bird species, 48 of which are endemic. Important birds include ibises , ospreys , kingfishers , and the yellow-orange Venezuelan troupial , the national bird. Notable mammals include the giant anteater , jaguar , and the capybara , the world's largest rodent . More than half of Venezuelan avian and mammalian species are found in the Amazonian forests south of the Orinoco. For the fungi, an account was provided by R.W.G. Dennis which has been digitized and the records made available on-line as part of the Cybertruffle Robigalia database. That database includes nearly 3,900 species of fungi recorded from Venezuela, but is far from complete, and the true total number of fungal species already known from Venezuela is likely higher, given the generally accepted estimate that only about 7% of all fungi worldwide have so far been discovered. Among plants of Venezuela, over 25,000 species of orchids are found in the country's cloud forest and lowland rainforest ecosystems. These include the flor de mayo orchid ( Cattleya mossiae ), the national flower. Venezuela's national tree is the araguaney . The tops of the tepuis are also home to several carnivorous plants including the marsh pitcher plant, Heliamphora , and the insectivorous bromeliad, Brocchinia reducta . Venezuela is among the top 20 countries in terms of endemism . Among its animals, 23% of reptilian and 50% of amphibian species, including the Trinidad poison frog , are endemic. Although the available information is still very small, a first effort has been made to estimate the number of fungal species endemic to Venezuela: 1334 species of fungi have been tentatively identified as possibly endemic. Some 38% of the over 21,000 plant species known from Venezuela are unique to the country. Venezuela is one of the 10 most biodiverse countries on the planet, yet it is one of the leaders of deforestation due to economic and political factors. Each year, roughly 287,600 hectares of forest are permanently destroyed, and other areas are degraded by mining, oil extraction, and logging. Between 1990 and 2005, Venezuela officially lost 8.3% of its forest cover, which is about 4.3 million ha. In response, federal protections for critical habitat were implemented; for example, 20% to 33% of forested land is protected. Venezuela had a 2019 Forest Landscape Integrity Index mean score of 8.78/10, ranking it 19th globally out of 172 countries. The country's biosphere reserve is part of the World Network of Biosphere Reserves ; five wetlands are registered under the Ramsar Convention . In 2003, 70% of the nation's land was under conservation management in over 200 protected areas, including 43 national parks. Venezuela's 43 national parks include Canaima National Park, Morrocoy National Park , and Mochima National Park . In the far south is a reserve for the country's Yanomami tribes. Covering 32,000 square miles (82,880 square kilometres) , the area is off-limits to farmers, miners, and all non-Yanomami settlers. Venezuela was one of the few countries that did not enter an INDC at COP21 . Many terrestrial ecosystems are considered endangered , specially the dry forest in the northern regions of the country and the coral reefs in the Caribbean coast. There are 105 protected areas in Venezuela, which cover around 26% of the country's continental, marine and insular surface. [ citation needed ]The country is made up of three river basins: the Caribbean Sea , the Atlantic Ocean and Lake Valencia, which forms an endorheic basin. On the Atlantic side it drains most of Venezuela's river waters. The largest basin in this area is the extensive Orinoco basin whose surface area, close to one million km 2 , is greater than that of the whole of Venezuela, although it has a presence of 65% in the country. The size of this basin - similar to that of the Danube - makes it the third largest in South America, and it gives rise to a flow of some 33,000 m 3 /s, making the Orinoco the third largest in the world, and also one of the most valuable from the point of view of renewable natural resources. The Rio or Brazo Casiquiare is unique in the world, as it is a natural derivation of the Orinoco that, after some 500 km in length, connects it to the Negro River, which in turn is a tributary of the Amazon . The Orinoco receives directly or indirectly rivers such as the Ventuari, the Caura, the Caroní , the Meta, the Arauca , the Apure and many others. Other Venezuelan rivers that empty into the Atlantic are the waters of the San Juan and Cuyuní basins. Finally, there is the Amazon River, which receives the Guainía, the Negro and others. Other basins are the Gulf of Paria and the Esequibo River . The second most important watershed is the Caribbean Sea. The rivers of this region are usually short and of scarce and irregular flow, with some exceptions such as the Catatumbo , which originates in Colombia and drains into the Maracaibo Lake basin. Among the rivers that reach the Maracaibo lake basin are the Chama, the Escalante, the Catatumbo, and the contributions of the smaller basins of the Tocuyo, Yaracuy, Neverí and Manzanares rivers. A minimum drains to the Lake Valencia basin. Of the total extension of the rivers, a total of 5400 km are navigable. Other rivers worth mentioning are the Apure, Arauca, Caura, Meta, Barima, Portuguesa , Ventuari and Zulia, among others. The country's main lakes are Lake Maracaibo -the largest in South America- open to the sea through the natural channel, but with fresh water, and Lake Valencia with its endorheic system. Other noteworthy bodies of water are the Guri reservoir , the Altagracia lagoon, the Camatagua reservoir and the Mucubají lagoon in the Andes.The Venezuelan natural landscape is the product of the interaction of tectonic plates that since the Paleozoic have contributed to its current appearance. On the formed structures, seven physical-natural units have been modeled, differentiated in their relief and in their natural resources . The relief of Venezuela has the following characteristics: coastline with several peninsulas and islands , adenas of the Andes mountain range (north and northwest), Lake Maracaibo (between the chains, on the coast); Orinoco river delta, region of peneplains and plateaus (tepui, east of the Orinoco) that together form the Guyanas massif (plateaus, southeast of the country). The oldest rock formations in South America are found in the complex basement of the Guyanas highlands and in the crystalline line of the Maritime and Cordillera massifs in Venezuela. The Venezuelan part of the Guyanas Altiplano consists of a large granite block of gneiss and other crystalline Archean rocks, with underlying layers of sandstone and shale clay. The core of granite and cordillera is, to a large extent, flanked by sedimentary layers from the Cretaceous , folded in an anticline structure. Between these orographic systems there are plains covered with tertiary and quaternary layers of gravel, sands and clayey marls . The depression contains lagoons and lakes, among which is that of Maracaibo , and presents, on the surface, alluvial deposits from the Quaternary . Also known as the Cordillera de la Costa, stretches along Venezuela's northern coast. This region is known for its lush tropical rainforests, stunning coastal views, and a rich variety of flora and fauna. The intermountain depressions, or valleys, between the mountain ranges are often home to fertile agricultural land and vibrant communities. These valleys offer a stark contrast to the rugged mountains that rise dramatically from the coast. Situated in northwestern Venezuela, the Lara-Falcón Highlands exhibit a terrain defined by plateaus and rolling hills. These highlands provide a significant contrast to the surrounding lowlands and coastal areas. The relief is characterized by gently sloping plateaus that support agriculture, including coffee and cacao cultivation. This region's semi-arid climate and picturesque landscapes make it an important agricultural and tourism center. Encompass the basin of Lake Maracaibo and the plains surrounding the Gulf of Venezuela . This region offers two distinct plains—the northern one is relatively dry, while the southern one is humid and dotted with swamps. The relief here is primarily characterized by flat terrain, with the exception of some elevated areas near the lake. Lake Maracaibo itself sits in a depression, surrounded by oil-rich lands and productive agricultural areas. The Venezuelan Andes, part of the broader Andes mountain range, offer a striking relief with towering peaks, deep valleys, and fertile intermontane basins. Dominated by these corpulent mountain ranges, including Venezuela's highest peak, Bolívar Peak , the region's rugged and picturesque landscapes are defined by its high-altitude terrain. The unique relief of this area finds its origins in the Last Glacial Period , where the interplay of repeated glacier advances and retreats sculpted the landscape, shaped by the cold, high-altitude climate. This glacial heritage has left a lasting imprint, with glaciers carving deep valleys and polishing rugged peaks, while sheltered intramontane valleys offer fertile soils and temperate microclimates, creating ideal conditions for agriculture and human settlement. Los Llanos, or "the plains", are expansive sedimentary basins characterized by predominantly flat relief. However, the eastern Llanos feature low-plateaus and the Unare depression, created through mesa erosion, adding diversity to the terrain. This region is subject to seasonal flooding, transforming the flat plains into a vast wetland during the rainy season. The relief here influences the region's unique ecosystems, including extensive grasslands and abundant wildlife. The Guiana Shield boasts a varied relief shaped by geological processes over millions of years. This region encompasses peneplains, rugged mountain ranges, foothills, and the iconic tepuis , or table-top mountains. The tepuis stand as isolated, flat-topped plateaus that rise dramatically from the surrounding terrain. This unique relief contributes to the region's remarkable biodiversity and scientific significance. The Orinoco Delta's relief is characterized by a complex system of lands and waters. It consists of numerous channels, islands, and shifting sedimentary deposits. While the relief may appear relatively uniform, it conceals a dynamic environment influenced by seasonal flooding and sediment deposition. This complex deltaic relief supports diverse aquatic life and the livelihoods of Indigenous communities adapted to its ever-changing landscapes. The valleys are undoubtedly the most important type of landscape in the Venezuelan territory, not because of their spatial extension, but because they are the environment where most of the country's population and economic activities are concentrated. On the other hand, there are valleys throughout almost all the national space, except in the great sedimentary basins of the Llanos and the depression of the Maracaibo Lake , except also in the Amazonian peneplains. By their modeling, the valleys of the Venezuelan territory belong mainly to two types: valleys of fluvial type and valleys of glacial type. Much more frequent, the former largely dominate the latter, which are restricted to the highest parts of the Andes. Moreover, most glacial valleys are relics of a past geologic epoch, which culminated some 10,000 to 12,000 years ago. The deep and narrow Andean valleys are very different from the wide depressions of Aragua and Carabobo, in the Cordillera de la Costa , or from the valleys nestled in the Mesas de Monagas . These examples indicate that the configuration of the local relief is decisive in identifying regional types of valleys. Likewise, due to their warm climate, the Guayana valleys are distinguished from the temperate or cold Andean valleys by their humid environment. Both are, in turn, different from the semi-arid depressions of the states of Lara and Falcón. The Andean valleys, essentially agricultural, precociously populated but nowadays in loss of speed, do not confront the same problems of space occupation as the strongly urbanized and industrialized valleys of the central section of the Cordillera de la Costa. On the other hand, the unpopulated and practically untouched Guiana valleys are another category this area is called the Lost World ( Mundo Perdido ). The Andean valleys are undoubtedly the most impressive of the Venezuelan territory because of the energy of the encasing reliefs, whose summits often dominate the valley bottoms by 3,000 to 3,500 meters of relative altitude . They are also the most picturesque in terms of their style of habitat, forms of land use, handicraft production and all the traditions linked to these activities. Venezuela has a great diversity of landscapes and climates, including arid and dry areas. The main desert in the country is in the state of Falcon near the city of Coro. It is now a protected park, the Médanos de Coro National Park . The park is the largest of its kind in Venezuela, covering 91 square kilometres. The landscape is dotted with cacti and other xerophytic plants that can survive in humidity-free conditions near the desert. Desert wildlife includes mostly lizards, iguanas and other reptiles. Although less frequent, the desert is home to some foxes, giant anteaters and rabbits. There are also some native bird populations, such as the sparrowhawk, tropical mockingbird, scaly dove and crested quail. Other desert areas in the country include part of the Guajira Desert in the Guajira Municipality in the north of Zulia State and facing the Gulf of Venezuela , the Médanos de Capanaparo in the Santos Luzardo National Park in Apure State , the Medanos de la Isla de Zapara in Zulia State, the so-called Hundición de Yay in the Andrés Eloy Blanco Municipality of Lara State, and the Urumaco Formation also in Falcón State.Two major blocs of political parties are in Venezuela: the incumbent leftist bloc United Socialist Party of Venezuela (PSUV), its major allies Fatherland for All (PPT) and the Communist Party of Venezuela (PCV), and the opposition bloc grouped into the electoral coalition Mesa de la Unidad Democrática . This includes A New Era (UNT) together with allied parties Project Venezuela , Justice First , Movement for Socialism (MAS) and others. The Venezuelan president is elected by a vote, with direct and universal suffrage , and is both head of state and head of government . The term of office is six years, and (as of 15 February 2009) a president may be re-elected an unlimited number of times. The president appoints the vice president and decides the size and composition of the cabinet and makes appointments to it with the involvement of the legislature. The president can ask the legislature to reconsider portions of laws he finds objectionable, but a simple parliamentary majority can override these objections. The president may ask the National Assembly to pass an enabling act granting the ability to rule by decree in specified policy areas; this requires a two-thirds majority in the Assembly. Since 1959, six Venezuelan presidents have been granted such powers. The unicameral Venezuelan parliament is the Asamblea Nacional ("National Assembly"). The number of members is variable – each state and the Capital district elect three representatives plus the result of dividing the state population by 1.1% of the total population of the country. Three seats are reserved for representatives of Venezuela's Indigenous peoples. For the 2011–2016 period the number of seats is 165. All deputies serve five-year terms. The voting age in Venezuela is 18. Voting is not compulsory . The legal system of Venezuela belongs to the Continental Law tradition. The highest judicial body is the Supreme Tribunal of Justice or Tribunal Supremo de Justicia , whose magistrates are elected by parliament for a single twelve-year term. The National Electoral Council ( Consejo Nacional Electoral , or CNE ) is in charge of electoral processes; it is formed by five main directors elected by the National Assembly. Supreme Court president Luisa Estela Morales said in December 2009 that Venezuela had moved away from "a rigid division of powers" toward a system characterized by "intense coordination" between the branches of government. Morales clarified that each power must be independent. The 2015 parliamentary elections were held on 6 December 2015 to elect the 164 deputies and three Indigenous representatives of the National Assembly. In 2014, a series of protest and demonstrations began in Venezuela, attributed [ by whom? ] to inflation, violence and shortages in Venezuela. The protests were largely peaceful. [ better source needed ] The government has accused the protest of being motivated by fascists , opposition leaders, capitalism and foreign influence, President Maduro acknowledged PSUV defeat but attributed the opposition's victory to an intensification of an economic war. Despite this, Maduro said "I will stop by hook or by crook the opposition coming to power, whatever the costs, in any way". In the following months, Maduro fulfilled his promise of preventing the elected National Assembly from legislating. The first steps taken by PSUV and government were the substitution of the entire Supreme court a day after the Parliamentary Elections contrary to the Constitution of Venezuela, acclaimed as a fraud by the majority of the Venezuelan and international press. The Financial Times described the function of the Supreme Court in Venezuela as "rubber stamping executive whims and vetoing legislation". The PSUV government used this violation to suspend several elected opponents. Maduro said that "the Amnesty law (approved by the Parliament) will not be executed" and asked the Supreme Court to declare it unconstitutional. On 16 January 2016, Maduro approved an unconstitutional economic emergency decree, relegating to his own figure the legislative and executive powers, while also holding judiciary power through the fraudulent designation of judges the day after the election on 6 December 2015. From these events, Maduro effectively controls all three branches of government. On 14 May 2016, constitutional guarantees were in fact suspended when Maduro decreed the extension of the economic emergency decree for another 60 days and declared a State of Emergency, which is a clear violation of the Constitution of Venezuela in the Article 338th: "The approval of the extension of States of emergency corresponds to the National Assembly." Thus, constitutional rights in Venezuela are considered suspended in fact by many publications and public figures. On 14 May 2016, the Organization of American States was considering the application of the Inter-American Democratic Charter sanctions for non-compliance to its own constitution. In March 2017, the Venezuelan Supreme Court took over law making powers from the National Assembly but reversed its decision the following day. Throughout most of the 20th century, Venezuela maintained friendly relations with most Latin American and Western nations. Relations between Venezuela and the United States government worsened in 2002, after the 2002 Venezuelan coup d'état attempt during which the U.S. government recognized the short-lived interim presidency of Pedro Carmona . In 2015, Venezuela was declared a national security threat by U.S. president Barack Obama . Correspondingly, ties to various Latin American and Middle Eastern countries not allied to the U.S. have strengthened. [ citation needed ] Venezuela seeks alternative hemispheric integration via such proposals as the Bolivarian Alternative for the Americas trade proposal and the newly launched Latin American television network teleSUR . Venezuela is one of five nations in the world—along with Russia, Nicaragua, Nauru, and Syria—to have recognized the independence of Abkhazia and South Ossetia . Venezuela was a proponent of OAS 's decision to adopt its Anti-Corruption Convention and is actively working in the Mercosur trade bloc to push increased trade and energy integration. Globally, it seeks a " multi-polar " world based on strengthened ties among undeveloped countries. [ citation needed ] On 26 April 2017, Venezuela announced its intention to withdraw from the OAS. Venezuelan Foreign Minister Delcy Rodríguez said that President Nicolás Maduro plans to publicly renounce Venezuela's membership on 27 April 2017. It will take two years for the country to formally leave. During this period, the country does not plan on participating in the OAS. Venezuela is involved in a long-standing disagreement about the control of the Guayana Esequiba area. Venezuela may suffer a deterioration of its power in international affairs if the global transition to renewable energy is completed. It is ranked 151 out of 156 countries in the index of Geopolitical Gains and Losses after energy transition (GeGaLo). The Bolivarian National Armed Forces of the Bolivarian Republic of Venezuela (Fuerza Armada Nacional Bolivariana, FANB) are the overall unified military forces of Venezuela. It includes over 320,150 men and women, under Article 328 of the Constitution, in 5 components of Ground, Sea and Air. The components of the Bolivarian National Armed Forces are: the Venezuelan Army , the Venezuelan Navy , the Venezuelan Air Force , the Venezuelan National Guard , and the Venezuelan National Militia . As of 2008 [ update ] , a further 600,000 soldiers were incorporated into a new branch, known as the Armed Reserve. The president of Venezuela is the commander-in-chief of the national armed forces. The main roles of the armed forces are to defend the sovereign national territory of Venezuela, airspace, and islands, fight against drug trafficking, to search and rescue and, in the case of a natural disaster, civil protection. All male citizens of Venezuela have a constitutional duty to register for the military service at 18, which is the age of majority . In Venezuela, a person is murdered every 21 minutes. Violent crimes have been so prevalent in Venezuela that the government no longer produces the crime data. In 2013, the homicide rate was approximately 79 per 100,000, one of the world's highest, having quadrupled in the past 15 years with over 200,000 people murdered. By 2015, it had risen to 90 per 100,000. The capital Caracas has one of the greatest homicide rates of any large city in the world, with 122 homicides per 100,000 residents. In 2008, polls indicated that crime was the number one concern of voters. Attempts at fighting crime such as Operation Liberation of the People were implemented to crack down on gang-controlled areas but, of reported criminal acts, less than 2% are prosecuted. In 2017, the Financial Times noted that some of the arms procured by the government over the previous two decades had been diverted to paramilitary civilian groups and criminal syndicates. Venezuela is especially dangerous for foreign travelers and investors who are visiting. The United States Department of State and the Government of Canada have warned foreign visitors that they may be subjected to robbery, kidnapping and murder, and that their own diplomatic travelers are required to travel in armored vehicles . The United Kingdom's Foreign and Commonwealth Office has advised against all travel to Venezuela. Visitors have been murdered during robberies. There are approximately 33 prisons holding about 50,000 inmates. Venezuela's prison system is heavily overcrowded; its facilities have capacity for only 14,000 prisoners. Human rights organizations such as Human Rights Watch and Amnesty International have increasingly criticized Venezuela's human rights record, with the former organization noting in 2017 that the Chavez and subsequently the Maduro government have increasingly concentrated power in the executive branch, eroded constitutional human rights protections and allowed the government to persecute and repress its critics and opposition. Other persistent concerns as noted by the report included poor prison conditions, the continuous harassment of independent media and human rights defenders by the government. In 2006, the Economist Intelligence Unit rated Venezuela a "hybrid regime" and the third least democratic regime in Latin America on the Democracy Index . The Democracy index downgraded Venezuela to an authoritarian regime in 2017, citing continued increasingly dictatorial behaviors by the Maduro government. Corruption in Venezuela is high by world standards and was so for much of the 20th century. The discovery of oil worsened political corruption, and by the late 1970s, Juan Pablo Pérez Alfonso 's description of oil as "the Devil's excrement" had become a common expression in Venezuela. Venezuela has been ranked one of the most corrupt countries on the Corruption Perceptions Index since the survey started in 1995. The 2010 ranking placed Venezuela at number 164, out of 178 ranked countries in government transparency. By 2016, the rank had increased to 166 out of 178. Similarly, the World Justice Project ranked Venezuela 99th out of 99 countries surveyed in its 2014 Rule of Law Index. This corruption is shown with Venezuela's significant involvement in drug trafficking , with Colombian cocaine and other drugs transiting Venezuela towards the United States and Europe. In the period 2003–2008 Venezuelan authorities seized the fifth-largest total quantity of cocaine in the world, behind Colombia, the United States, Spain and Panama . In 2006, the government's agency for combating illegal drug trade in Venezuela, ONA , was incorporated into the office of the vice-president. However, many major government and military officials have been known for their involvement with drug trafficking. The 2015 parliamentary elections were held on 6 December 2015 to elect the 164 deputies and three Indigenous representatives of the National Assembly. In 2014, a series of protest and demonstrations began in Venezuela, attributed [ by whom? ] to inflation, violence and shortages in Venezuela. The protests were largely peaceful. [ better source needed ] The government has accused the protest of being motivated by fascists , opposition leaders, capitalism and foreign influence, President Maduro acknowledged PSUV defeat but attributed the opposition's victory to an intensification of an economic war. Despite this, Maduro said "I will stop by hook or by crook the opposition coming to power, whatever the costs, in any way". In the following months, Maduro fulfilled his promise of preventing the elected National Assembly from legislating. The first steps taken by PSUV and government were the substitution of the entire Supreme court a day after the Parliamentary Elections contrary to the Constitution of Venezuela, acclaimed as a fraud by the majority of the Venezuelan and international press. The Financial Times described the function of the Supreme Court in Venezuela as "rubber stamping executive whims and vetoing legislation". The PSUV government used this violation to suspend several elected opponents. Maduro said that "the Amnesty law (approved by the Parliament) will not be executed" and asked the Supreme Court to declare it unconstitutional. On 16 January 2016, Maduro approved an unconstitutional economic emergency decree, relegating to his own figure the legislative and executive powers, while also holding judiciary power through the fraudulent designation of judges the day after the election on 6 December 2015. From these events, Maduro effectively controls all three branches of government. On 14 May 2016, constitutional guarantees were in fact suspended when Maduro decreed the extension of the economic emergency decree for another 60 days and declared a State of Emergency, which is a clear violation of the Constitution of Venezuela in the Article 338th: "The approval of the extension of States of emergency corresponds to the National Assembly." Thus, constitutional rights in Venezuela are considered suspended in fact by many publications and public figures. On 14 May 2016, the Organization of American States was considering the application of the Inter-American Democratic Charter sanctions for non-compliance to its own constitution. In March 2017, the Venezuelan Supreme Court took over law making powers from the National Assembly but reversed its decision the following day. Throughout most of the 20th century, Venezuela maintained friendly relations with most Latin American and Western nations. Relations between Venezuela and the United States government worsened in 2002, after the 2002 Venezuelan coup d'état attempt during which the U.S. government recognized the short-lived interim presidency of Pedro Carmona . In 2015, Venezuela was declared a national security threat by U.S. president Barack Obama . Correspondingly, ties to various Latin American and Middle Eastern countries not allied to the U.S. have strengthened. [ citation needed ] Venezuela seeks alternative hemispheric integration via such proposals as the Bolivarian Alternative for the Americas trade proposal and the newly launched Latin American television network teleSUR . Venezuela is one of five nations in the world—along with Russia, Nicaragua, Nauru, and Syria—to have recognized the independence of Abkhazia and South Ossetia . Venezuela was a proponent of OAS 's decision to adopt its Anti-Corruption Convention and is actively working in the Mercosur trade bloc to push increased trade and energy integration. Globally, it seeks a " multi-polar " world based on strengthened ties among undeveloped countries. [ citation needed ] On 26 April 2017, Venezuela announced its intention to withdraw from the OAS. Venezuelan Foreign Minister Delcy Rodríguez said that President Nicolás Maduro plans to publicly renounce Venezuela's membership on 27 April 2017. It will take two years for the country to formally leave. During this period, the country does not plan on participating in the OAS. Venezuela is involved in a long-standing disagreement about the control of the Guayana Esequiba area. Venezuela may suffer a deterioration of its power in international affairs if the global transition to renewable energy is completed. It is ranked 151 out of 156 countries in the index of Geopolitical Gains and Losses after energy transition (GeGaLo). The Bolivarian National Armed Forces of the Bolivarian Republic of Venezuela (Fuerza Armada Nacional Bolivariana, FANB) are the overall unified military forces of Venezuela. It includes over 320,150 men and women, under Article 328 of the Constitution, in 5 components of Ground, Sea and Air. The components of the Bolivarian National Armed Forces are: the Venezuelan Army , the Venezuelan Navy , the Venezuelan Air Force , the Venezuelan National Guard , and the Venezuelan National Militia . As of 2008 [ update ] , a further 600,000 soldiers were incorporated into a new branch, known as the Armed Reserve. The president of Venezuela is the commander-in-chief of the national armed forces. The main roles of the armed forces are to defend the sovereign national territory of Venezuela, airspace, and islands, fight against drug trafficking, to search and rescue and, in the case of a natural disaster, civil protection. All male citizens of Venezuela have a constitutional duty to register for the military service at 18, which is the age of majority .In Venezuela, a person is murdered every 21 minutes. Violent crimes have been so prevalent in Venezuela that the government no longer produces the crime data. In 2013, the homicide rate was approximately 79 per 100,000, one of the world's highest, having quadrupled in the past 15 years with over 200,000 people murdered. By 2015, it had risen to 90 per 100,000. The capital Caracas has one of the greatest homicide rates of any large city in the world, with 122 homicides per 100,000 residents. In 2008, polls indicated that crime was the number one concern of voters. Attempts at fighting crime such as Operation Liberation of the People were implemented to crack down on gang-controlled areas but, of reported criminal acts, less than 2% are prosecuted. In 2017, the Financial Times noted that some of the arms procured by the government over the previous two decades had been diverted to paramilitary civilian groups and criminal syndicates. Venezuela is especially dangerous for foreign travelers and investors who are visiting. The United States Department of State and the Government of Canada have warned foreign visitors that they may be subjected to robbery, kidnapping and murder, and that their own diplomatic travelers are required to travel in armored vehicles . The United Kingdom's Foreign and Commonwealth Office has advised against all travel to Venezuela. Visitors have been murdered during robberies. There are approximately 33 prisons holding about 50,000 inmates. Venezuela's prison system is heavily overcrowded; its facilities have capacity for only 14,000 prisoners. Human rights organizations such as Human Rights Watch and Amnesty International have increasingly criticized Venezuela's human rights record, with the former organization noting in 2017 that the Chavez and subsequently the Maduro government have increasingly concentrated power in the executive branch, eroded constitutional human rights protections and allowed the government to persecute and repress its critics and opposition. Other persistent concerns as noted by the report included poor prison conditions, the continuous harassment of independent media and human rights defenders by the government. In 2006, the Economist Intelligence Unit rated Venezuela a "hybrid regime" and the third least democratic regime in Latin America on the Democracy Index . The Democracy index downgraded Venezuela to an authoritarian regime in 2017, citing continued increasingly dictatorial behaviors by the Maduro government. Corruption in Venezuela is high by world standards and was so for much of the 20th century. The discovery of oil worsened political corruption, and by the late 1970s, Juan Pablo Pérez Alfonso 's description of oil as "the Devil's excrement" had become a common expression in Venezuela. Venezuela has been ranked one of the most corrupt countries on the Corruption Perceptions Index since the survey started in 1995. The 2010 ranking placed Venezuela at number 164, out of 178 ranked countries in government transparency. By 2016, the rank had increased to 166 out of 178. Similarly, the World Justice Project ranked Venezuela 99th out of 99 countries surveyed in its 2014 Rule of Law Index. This corruption is shown with Venezuela's significant involvement in drug trafficking , with Colombian cocaine and other drugs transiting Venezuela towards the United States and Europe. In the period 2003–2008 Venezuelan authorities seized the fifth-largest total quantity of cocaine in the world, behind Colombia, the United States, Spain and Panama . In 2006, the government's agency for combating illegal drug trade in Venezuela, ONA , was incorporated into the office of the vice-president. However, many major government and military officials have been known for their involvement with drug trafficking. Venezuela is divided into 23 states ( estados ), a capital district ( distrito capital ) corresponding to the city of Caracas, and the Federal Dependencies ( Dependencias Federales , a special territory). Venezuela is further subdivided into 335 municipalities ( municipios ); these are subdivided into over one thousand parishes ( parroquias ). The states are grouped into nine administrative regions ( regiones administrativas ), which were established in 1969 by presidential decree. [ citation needed ] The country can be further divided into ten geographical areas, some corresponding to climatic and biogeographical regions. In the north are the Venezuelan Andes and the Coro region , a mountainous tract in the northwest, holds several sierras and valleys. East of it are lowlands abutting Lake Maracaibo and the Gulf of Venezuela . [ citation needed ] The Central Range runs parallel to the coast and includes the hills surrounding Caracas ; the Eastern Range, separated from the Central Range by the Gulf of Cariaco , covers all of Sucre and northern Monagas . The Insular Region includes all of Venezuela's island possessions: Nueva Esparta and the various Federal Dependencies . The Orinoco Delta, which forms a triangle covering Delta Amacuro , projects northeast into the Atlantic Ocean. [ citation needed ] The country maintains a claim on the territory it calls "Guayana Esequiba", the territory administered by Guyana west of the Esequibo River. In 1966 the British and Venezuelan governments signed the Geneva Agreement to resolve the conflict peacefully. The Port of Spain Protocol of 1970 set a deadline to try to resolve the issue, without success to date. [ citation needed ]Venezuela has a market-based mixed economy dominated by the petroleum sector, which accounts for roughly a third of GDP, around 80% of exports, and more than half of government revenues. Per capita GDP for 2016 was estimated to be US$15,100, ranking 109th in the world. Venezuela has the least expensive petrol in the world because the consumer price of petrol is heavily subsidized. The private sector controls two-thirds of Venezuela's economy. A part of the Venezuelan economy depends on remittances . The Central Bank of Venezuela is responsible for developing monetary policy for the Venezuelan bolívar which is used as currency. The president of the Central Bank of Venezuela serves as the country's representative in the International Monetary Fund . The U.S.-based conservative think tank The Heritage Foundation claims Venezuela has the weakest property rights in the world, scoring only 5.0 on a scale of 100; expropriation without compensation is not uncommon. As of 2011, more than 60% of Venezuela's international reserves was in gold, eight times more than the average for the region. Most of Venezuela's gold held abroad was located in London. On 25 November 2011, the first of US$11 billion of repatriated gold bullion arrived in Caracas; Chávez called the repatriation of gold a "sovereign" step that will help protect the country's foreign reserves from the turmoil in the U.S. and Europe. However government policies quickly spent down this returned gold and in 2013 the government was forced to add the dollar reserves of state owned companies to those of the national bank to reassure the international bond market. Manufacturing contributed 17% of GDP in 2006. Venezuela manufactures and exports heavy industry products such as steel, aluminium and cement, with production concentrated around Ciudad Guayana , near the Guri Dam , one of the largest in the world and the provider of about three-quarters of Venezuela's electricity. Other notable manufacturing includes electronics and automobiles , as well as beverages, and foodstuffs . Agriculture in Venezuela accounts for approximately 3% of GDP, 10% of the labor force, and at least a quarter of Venezuela's land area. The country is not self-sufficient in most areas of agriculture. [ citation needed ] Since the discovery of oil in the early 20th century, Venezuela has been one of the world's leading exporters of oil, and it is a founding member of OPEC . Previously an underdeveloped exporter of agricultural commodities, oil quickly came to dominate exports and government revenues. The 1980s oil glut led to an external debt crisis and a long-running economic crisis, which saw inflation peak at 100% in 1996. The 1990s also saw Venezuela experience a major banking crisis in 1994 . The recovery of oil prices after 2001 boosted the Venezuelan economy and facilitated social spending. With social programs such as the Bolivarian Missions , Venezuela initially made progress in social development in the 2000s, particularly in areas such as health, education, and poverty. Many of the social policies pursued by Chávez and his administration were jump-started by the Millennium Development Goals , eight goals that Venezuela and 188 other nations agreed to in September 2000. The sustainability of the Bolivarian Missions has been questioned due to the Bolivarian state's overspending on public works and because the Chávez government did not save funds for future economic hardships, with economic issues and poverty rising as a result of their policies in the 2010s. In 2003 the government of Hugo Chávez implemented currency controls after capital flight led to a devaluation of the currency. This led to the development of a parallel market of dollars in the subsequent years. The fallout of the 2008 global financial crisis saw a renewed economic downturn. Despite controversial data shared by the Venezuelan government showing that the country had halved malnutrition following one of the UN's Millennium Development Goals, shortages of staple goods began to occur in Venezuela and malnutrition began to increase. In early 2013, Venezuela devalued its currency due to growing shortages in the country. The shortages included, and still include, necessities such as toilet paper, milk, and flour. Fears rose so high due to the toilet paper shortage that the government occupied a toilet paper factory, and continued plans to nationalize other industrial aspects like food distribution. Venezuela's bond ratings have also decreased multiple times in 2013 due to decisions by the president Nicolás Maduro. In 2016, consumer prices in Venezuela increased 800% and the economy declined by 18.6%, entering an economic depression . Venezuela's outlook was deemed negative by most bond-rating services in 2017. For 2018 an inflation rate of 1,000,000 percent was projected, putting Venezuela in a similar situation to that in Germany in 1923 or Zimbabwe in the late 2000s. Tourism has been developed considerably in recent decades, particularly because of its favorable geographical position, the variety of landscapes, the richness of plant and wildlife , the culture and the tropical climate. Margarita Island is one of the top tourist destinations. It is an island with a modern infrastructure, bordered by beaches suitable for extreme sports, and features castles, fortresses and churches of great cultural value. Los Roques Archipelago is made up of a set of islands and keys that constitute one of the main tourist attractions in the country. With exotic crystalline beaches, Morrocoy is a national park, formed by small keys very close to the mainland, which have grown rapidly as one of the greatest tourist attractions in the Venezuelan Caribbean. Canaima National Park extends over 30,000 km 2 to the border with Guyana and Brazil; due to its size it is considered the sixth largest national park in the world. Its steep cliffs and waterfalls (including Angel Falls, which is the highest waterfall in the world, at 1,002 m) form spectacular landscapes. The state of Mérida is one of the main tourist centers of Venezuela. It has an extensive network of hotels not only in its capital city, but also throughout the state. Starting from the same city of Mérida is the longest and highest cable car in the world, which reaches the Pico Espejo of 4,765 m. Shortages in Venezuela have been prevalent following the enactment of price controls and other policies during the economic policy of the Hugo Chávez government . Under the economic policy of the Nicolás Maduro government , greater shortages occurred due to the Venezuelan government's policy of withholding United States dollars from importers with price controls. Shortages occur in regulated products, such as milk, various types of meat, coffee, rice, oil, flour, butter, and other goods including basic necessities like toilet paper, personal hygiene products, and even medicine. As a result of the shortages, Venezuelans must search for food, wait in lines for hours and sometimes do without certain products. A drought, combined with a lack of planning and maintenance, has caused a hydroelectricity shortage. To deal with lack of power supply, in April 2016 the Maduro government announced rolling blackouts and reduced the government workweek to only Monday and Tuesday. A multi-university study found that, in 2016 alone, about 75% of Venezuelans lost weight due to hunger, with the average losing about 8.6 kg (19 lbs) due to the lack of food. In March 2017, Venezuela began having shortages of gasoline in some regions. Venezuela has the largest oil reserves, and the eighth largest natural gas reserves in the world. Compared to the preceding year another 40.4% in crude oil reserves were proven in 2010, allowing Venezuela to surpass Saudi Arabia as the country with the largest reserves of this type. The country's main petroleum deposits are located around and beneath Lake Maracaibo, the Gulf of Venezuela (both in Zulia ), and in the Orinoco River basin ( eastern Venezuela ), where the country's largest reserve is located. Besides the largest conventional oil reserves and the second-largest natural gas reserves in the Western Hemisphere, Venezuela has non-conventional oil deposits ( extra-heavy crude oil , bitumen and tar sands ) approximately equal to the world's reserves of conventional oil. The electricity sector in Venezuela is one of the few to rely primarily on hydropower , and includes the Guri Dam, one of the largest in the world. In the first half of the 20th century, U.S. oil companies were heavily involved in Venezuela, initially interested only in purchasing concessions. In 1943 a new government introduced a 50/50 split in profits between the government and the oil industry. In 1960, with a newly installed democratic government, Hydrocarbons Minister Juan Pablo Pérez Alfonso led the creation of OPEC, the consortium of oil-producing countries aiming to support the price of oil. In 1973, Venezuela voted to nationalize its oil industry outright, effective 1 January 1976, with Petróleos de Venezuela (PDVSA) taking over and presiding over a number of holding companies; in subsequent years, Venezuela built a vast refining and marketing system in the U.S. and Europe. In the 1990s PDVSA became more independent from the government and presided over an apertura (opening) in which it invited in foreign investment. Under Hugo Chávez a 2001 law placed limits on foreign investment. PDVSA played a key role in the December 2002 – February 2003 national strike. As a result of the strike, around 40% of the company's workforce (around 18,000 workers) were dismissed. Tourism has been developed considerably in recent decades, particularly because of its favorable geographical position, the variety of landscapes, the richness of plant and wildlife , the culture and the tropical climate. Margarita Island is one of the top tourist destinations. It is an island with a modern infrastructure, bordered by beaches suitable for extreme sports, and features castles, fortresses and churches of great cultural value. Los Roques Archipelago is made up of a set of islands and keys that constitute one of the main tourist attractions in the country. With exotic crystalline beaches, Morrocoy is a national park, formed by small keys very close to the mainland, which have grown rapidly as one of the greatest tourist attractions in the Venezuelan Caribbean. Canaima National Park extends over 30,000 km 2 to the border with Guyana and Brazil; due to its size it is considered the sixth largest national park in the world. Its steep cliffs and waterfalls (including Angel Falls, which is the highest waterfall in the world, at 1,002 m) form spectacular landscapes. The state of Mérida is one of the main tourist centers of Venezuela. It has an extensive network of hotels not only in its capital city, but also throughout the state. Starting from the same city of Mérida is the longest and highest cable car in the world, which reaches the Pico Espejo of 4,765 m.Shortages in Venezuela have been prevalent following the enactment of price controls and other policies during the economic policy of the Hugo Chávez government . Under the economic policy of the Nicolás Maduro government , greater shortages occurred due to the Venezuelan government's policy of withholding United States dollars from importers with price controls. Shortages occur in regulated products, such as milk, various types of meat, coffee, rice, oil, flour, butter, and other goods including basic necessities like toilet paper, personal hygiene products, and even medicine. As a result of the shortages, Venezuelans must search for food, wait in lines for hours and sometimes do without certain products. A drought, combined with a lack of planning and maintenance, has caused a hydroelectricity shortage. To deal with lack of power supply, in April 2016 the Maduro government announced rolling blackouts and reduced the government workweek to only Monday and Tuesday. A multi-university study found that, in 2016 alone, about 75% of Venezuelans lost weight due to hunger, with the average losing about 8.6 kg (19 lbs) due to the lack of food. In March 2017, Venezuela began having shortages of gasoline in some regions. Venezuela has the largest oil reserves, and the eighth largest natural gas reserves in the world. Compared to the preceding year another 40.4% in crude oil reserves were proven in 2010, allowing Venezuela to surpass Saudi Arabia as the country with the largest reserves of this type. The country's main petroleum deposits are located around and beneath Lake Maracaibo, the Gulf of Venezuela (both in Zulia ), and in the Orinoco River basin ( eastern Venezuela ), where the country's largest reserve is located. Besides the largest conventional oil reserves and the second-largest natural gas reserves in the Western Hemisphere, Venezuela has non-conventional oil deposits ( extra-heavy crude oil , bitumen and tar sands ) approximately equal to the world's reserves of conventional oil. The electricity sector in Venezuela is one of the few to rely primarily on hydropower , and includes the Guri Dam, one of the largest in the world. In the first half of the 20th century, U.S. oil companies were heavily involved in Venezuela, initially interested only in purchasing concessions. In 1943 a new government introduced a 50/50 split in profits between the government and the oil industry. In 1960, with a newly installed democratic government, Hydrocarbons Minister Juan Pablo Pérez Alfonso led the creation of OPEC, the consortium of oil-producing countries aiming to support the price of oil. In 1973, Venezuela voted to nationalize its oil industry outright, effective 1 January 1976, with Petróleos de Venezuela (PDVSA) taking over and presiding over a number of holding companies; in subsequent years, Venezuela built a vast refining and marketing system in the U.S. and Europe. In the 1990s PDVSA became more independent from the government and presided over an apertura (opening) in which it invited in foreign investment. Under Hugo Chávez a 2001 law placed limits on foreign investment. PDVSA played a key role in the December 2002 – February 2003 national strike. As a result of the strike, around 40% of the company's workforce (around 18,000 workers) were dismissed. Venezuela is connected to the world primarily via air ( Venezuela's airports include the Simón Bolívar International Airport in Maiquetía, near Caracas and La Chinita International Airport near Maracaibo ) and sea (with major seaports at La Guaira, Maracaibo and Puerto Cabello ). In the south and east the Amazon rainforest region has limited cross-border transport; in the west, there is a mountainous border of over 2,213 kilometres (1,375 mi) shared with Colombia. The Orinoco River is navigable by oceangoing vessels up to 400 kilometres (250 mi) inland and connects the major industrial city of Ciudad Guayana to the Atlantic Ocean. Venezuela has a limited national railway system , which has no active rail connections to other countries. The government of Hugo Chávez tried to invest in expanding it, but Venezuela's rail project is on hold due to Venezuela not being able to pay the $7.5 billion [ clarification needed ] and owing China Railway nearly $500 million. Several major cities have metro systems; the Caracas Metro has been operating since 1983. The Maracaibo Metro and Valencia Metro were opened more recently. Venezuela has a road network of nearly 100,000 kilometres (62,000 mi) , placing the country around 45th in the world ; around a third of roads are paved.Venezuela is among the most urbanized countries in Latin America; the vast majority of Venezuelans live in the cities of the north, especially in the capital Caracas, which is also the largest city. About 93% of the population lives in urban areas in northern Venezuela; 73% live less than 100 kilometres (62 mi) from the coastline. Though almost half of Venezuela's land area lies south of the Orinoco, only 5% of Venezuelans live there. The largest and most important city south of the Orinoco is Ciudad Guayana , which is the sixth most populous conurbation . Other major cities include Barquisimeto , Valencia , Maracay , Maracaibo , Barcelona-Puerto La Cruz , Mérida and San Cristóbal . According to the 2022 revision of the World Population Prospects the total population was 28,199,867 in 2021 . A 2014 study by sociologists of the Central University of Venezuela found over 1.5 million Venezuelans, or about 4% to 6% of the country's population, have left Venezuela since 1999. The people of Venezuela come from a variety of ancestries. It is estimated that the majority of the population is of pardo , or mixed, ethnic ancestry. In the 2011 census, which Venezuelans were asked to identify themselves according to their customs and ancestry, the term pardo was excluded from the answers. The majority claimed to be moreno or white —51.6% and 43.6%, respectively. Practically half of the population claimed to be moreno , a term used throughout Ibero-America that in this case means "dark-skinned" or "brown-skinned", as opposed to having a lighter skin . Ethnic minorities in Venezuela consist of groups that descend mainly from African or Indigenous peoples; 2.8% identified themselves as "black" and 0.7% as afrodescendiente (Afro-descendant), 2.6% claimed to belong to Indigenous peoples, and 1.2% answered "other races". Among Indigenous people, 58% were Wayúu , 7% Warao , 5% Kariña , 4% Pemón , 3% Piaroa , 3% Jivi , 3% Añu , 3% Cumanágoto , 2% Yukpa , 2% Chaima and 1% Yanomami ; the remaining 9% consisted of other Indigenous nations. According to an autosomal DNA study conducted in 2008 by the University of Brasília , the composition of Venezuela's population is 60.60% European, 23% Indigenous, and 16.30% African. During the colonial period and until after the Second World War, many of the European immigrants to Venezuela came from the Canary Islands and Spain with a relevant amount of Galicians and Asturians . These immigrants from Spain had a significant cultural impact on the cuisine and customs of Venezuela. These influences on Venezuela have led to the nation being called the 8th island of the Canaries. With the start of oil exploitation in the early 20th century, companies from the United States began establishing operations in Venezuela, bringing with them U.S. citizens. Later, during and after the war, new waves of immigrants from other parts of Europe, the Middle East, and China began; many were encouraged by government-established immigration programs and lenient immigration policies. During the 20th century, Venezuela, along with the rest of Latin America, received millions of immigrants from Europe. This was especially true post-World War II, as a consequence of war-ridden Europe. During the 1970s, while experiencing an oil-export boom, Venezuela received millions of immigrants from Ecuador, Colombia, and the Dominican Republic. Due to the belief that this immigration influx depressed wages, some Venezuelans opposed European immigration. The Venezuelan government, however, were actively recruiting immigrants from Eastern Europe to fill a need for engineers. Millions of Colombians, as well as Middle Eastern and Haitian populations would continue immigrating to Venezuela into the early 21st century. According to the World Refugee Survey 2008 , published by the U.S. Committee for Refugees and Immigrants, Venezuela hosted a population of refugee and asylum seekers from Colombia numbering 252,200 in 2007, and 10,600 new asylum seekers entered Venezuela in 2007. Between 500,000 and one million illegal immigrants are estimated to be living in the country. The total Indigenous population of the country is estimated at 500 thousand people (2.8% of the total), distributed among 40 Indigenous peoples. There are three uncontacted tribes living in Venezuela. The Constitution recognizes the multi-ethnic, pluri-cultural, and multilingual character of the country and includes a chapter devoted to Indigenous peoples' rights, which opened up spaces for their political inclusion at national and local level in 1999. Most Indigenous peoples are concentrated in eight states along Venezuela's borders with Brazil, Guyana, and Colombia, and the majority groups are the Wayuu in the west, the Warao in the east, the Yanomami installed in the south, and the Pemon which are mostly in the southeast of Venezuela. Although most residents are monolingual Spanish speakers, many languages are spoken in Venezuela. In addition to Spanish, the Constitution recognizes more than thirty Indigenous languages, including Wayuu , Warao , Pemón , and many others for the official use of the Indigenous peoples, mostly with few speakers – less than 1% of the total population. Wayuu is the most spoken Indigenous language, with 170,000 speakers. Immigrants, in addition to Spanish, speak their own languages. Chinese (400,000), Portuguese (254,000), and Italian (200,000) are the most-spoken languages in Venezuela after the official language of Spanish. Arabic is spoken by Lebanese and Syrian colonies on Isla de Margarita , Maracaibo, Punto Fijo , Puerto la Cruz , El Tigre, Maracay , and Caracas. Portuguese is spoken not only by the Portuguese community in Santa Elena de Uairén but also by much of the population due to its proximity to Brazil. The German community speaks their native language, while the people of Colonia Tovar speak mostly an Alemannic dialect of German called alemán coloniero . English is the most widely used foreign language in demand and is spoken by many professionals, academics, and members of the upper and middle classes as a result of the oil exploration by foreign companies, in addition to its acceptance as a lingua franca . Culturally, English is common in southern towns like El Callao , and the native English-speaking influence is evident in folk and calypso songs from the region. English was brought to Venezuela by Trinidadian and other British West Indies immigrants. A variety of Antillean Creole is spoken by a small community in El Callao and Paria . Italian language teaching is delivered by private Venezuelan schools and institutions. Other languages spoken by large communities in the country are Basque and Galician , among others. Religion in Venezuela (2011) According to a 2011 poll, 88% of the population is Christian, primarily Roman Catholic (71%), and the remaining 17% Protestant , primarily Evangelicals (in Latin America Protestants are usually called "evangélicos" ). 8% of Venezuelans are irreligious. Almost 3% of the population follow another religion (1% of these people practice Santería ). There are small but influential Muslim , Druze , Buddhist , and Jewish communities. The Muslim community of more than 100,000 is concentrated among persons of Lebanese and Syrian descent living in Nueva Esparta state, Punto Fijo and the Caracas area. Venezuela is home of the largest Druze communities outside the Middle East, the Druze community are estimated around 60,000, and concentrated among persons of Lebanese and Syrian descent. Buddhism is practiced by over 52,000 people. The Buddhist community is made up mainly of Chinese, Japanese, and Korean people. The Jewish community has shrunk in recent years due to rising economic pressures and antisemitism in Venezuela , with the population declining from 22,000 in 1999 to less than 7,000 in 2015. Venezuela has a national universal health care system. The current government has created a program to expand access to health care known as Misión Barrio Adentro , although its efficiency and work conditions have been criticized. As of December 2014 an estimated 80% of Barrio Adentro establishments in Venezuela are abandoned. Infant mortality in Venezuela was 19 deaths per 1,000 births for 2014 which was lower than the South American average (To compare: The U.S. figure was 6 deaths per 1,000 births in 2013). Child malnutrition was 17%. Delta Amacuro and Amazonas had the nation's highest rates. According to the United Nations, 32% of Venezuelans lacked adequate sanitation, primarily those living in rural areas. Diseases ranging from diphtheria , plague , malaria , typhoid fever, yellow fever , cholera , hepatitis A , hepatitis B , and hepatitis D were present in the country. Obesity was prevalent in approximately 30% of the adult population. Venezuela had a total of 150 sewage treatment plants ; 13% of the population lacked access to drinking water, but this number had been dropping. [ non-primary source needed ] During the economic crisis observed under President Maduro's presidency, medical professionals were forced to perform outdated treatments on patients. In 2008, 95.2% of the adult population was literate. The net primary school enrollment rate was at 91% and the net secondary school enrollment rate was at 63% in 2005. Venezuela has a number of universities, of which the most prestigious are the Central University of Venezuela founded in 1721, the University of Zulia , the University of the Andes , Simón Bolívar University , and the University of the East . Currently, many Venezuelan graduates seek a future abroad because of the country's troubled economy and heavy crime rate. Over 1.35 million Venezuelan college graduates have left the country since the beginning of the Bolivarian Revolution . It is believed that nearly 12% of Venezuelans live abroad, with Ireland becoming a popular destination for students. According to Claudio Bifano, president of the Venezuelan Academy of Physical, Mathematical, and Natural Sciences, more than half of all medical graduates had left Venezuela in 2013. By 2018, over half of all Venezuelan children had dropped out of school, with 58% of students quitting nationwide while areas near bordering countries saw more than 80% of their students leave. Nationwide, about 93% of schools do not meet the minimum requirements to operate and 77% do not have utilities such as food, water or electricity. The people of Venezuela come from a variety of ancestries. It is estimated that the majority of the population is of pardo , or mixed, ethnic ancestry. In the 2011 census, which Venezuelans were asked to identify themselves according to their customs and ancestry, the term pardo was excluded from the answers. The majority claimed to be moreno or white —51.6% and 43.6%, respectively. Practically half of the population claimed to be moreno , a term used throughout Ibero-America that in this case means "dark-skinned" or "brown-skinned", as opposed to having a lighter skin . Ethnic minorities in Venezuela consist of groups that descend mainly from African or Indigenous peoples; 2.8% identified themselves as "black" and 0.7% as afrodescendiente (Afro-descendant), 2.6% claimed to belong to Indigenous peoples, and 1.2% answered "other races". Among Indigenous people, 58% were Wayúu , 7% Warao , 5% Kariña , 4% Pemón , 3% Piaroa , 3% Jivi , 3% Añu , 3% Cumanágoto , 2% Yukpa , 2% Chaima and 1% Yanomami ; the remaining 9% consisted of other Indigenous nations. According to an autosomal DNA study conducted in 2008 by the University of Brasília , the composition of Venezuela's population is 60.60% European, 23% Indigenous, and 16.30% African. During the colonial period and until after the Second World War, many of the European immigrants to Venezuela came from the Canary Islands and Spain with a relevant amount of Galicians and Asturians . These immigrants from Spain had a significant cultural impact on the cuisine and customs of Venezuela. These influences on Venezuela have led to the nation being called the 8th island of the Canaries. With the start of oil exploitation in the early 20th century, companies from the United States began establishing operations in Venezuela, bringing with them U.S. citizens. Later, during and after the war, new waves of immigrants from other parts of Europe, the Middle East, and China began; many were encouraged by government-established immigration programs and lenient immigration policies. During the 20th century, Venezuela, along with the rest of Latin America, received millions of immigrants from Europe. This was especially true post-World War II, as a consequence of war-ridden Europe. During the 1970s, while experiencing an oil-export boom, Venezuela received millions of immigrants from Ecuador, Colombia, and the Dominican Republic. Due to the belief that this immigration influx depressed wages, some Venezuelans opposed European immigration. The Venezuelan government, however, were actively recruiting immigrants from Eastern Europe to fill a need for engineers. Millions of Colombians, as well as Middle Eastern and Haitian populations would continue immigrating to Venezuela into the early 21st century. According to the World Refugee Survey 2008 , published by the U.S. Committee for Refugees and Immigrants, Venezuela hosted a population of refugee and asylum seekers from Colombia numbering 252,200 in 2007, and 10,600 new asylum seekers entered Venezuela in 2007. Between 500,000 and one million illegal immigrants are estimated to be living in the country. The total Indigenous population of the country is estimated at 500 thousand people (2.8% of the total), distributed among 40 Indigenous peoples. There are three uncontacted tribes living in Venezuela. The Constitution recognizes the multi-ethnic, pluri-cultural, and multilingual character of the country and includes a chapter devoted to Indigenous peoples' rights, which opened up spaces for their political inclusion at national and local level in 1999. Most Indigenous peoples are concentrated in eight states along Venezuela's borders with Brazil, Guyana, and Colombia, and the majority groups are the Wayuu in the west, the Warao in the east, the Yanomami installed in the south, and the Pemon which are mostly in the southeast of Venezuela.Although most residents are monolingual Spanish speakers, many languages are spoken in Venezuela. In addition to Spanish, the Constitution recognizes more than thirty Indigenous languages, including Wayuu , Warao , Pemón , and many others for the official use of the Indigenous peoples, mostly with few speakers – less than 1% of the total population. Wayuu is the most spoken Indigenous language, with 170,000 speakers. Immigrants, in addition to Spanish, speak their own languages. Chinese (400,000), Portuguese (254,000), and Italian (200,000) are the most-spoken languages in Venezuela after the official language of Spanish. Arabic is spoken by Lebanese and Syrian colonies on Isla de Margarita , Maracaibo, Punto Fijo , Puerto la Cruz , El Tigre, Maracay , and Caracas. Portuguese is spoken not only by the Portuguese community in Santa Elena de Uairén but also by much of the population due to its proximity to Brazil. The German community speaks their native language, while the people of Colonia Tovar speak mostly an Alemannic dialect of German called alemán coloniero . English is the most widely used foreign language in demand and is spoken by many professionals, academics, and members of the upper and middle classes as a result of the oil exploration by foreign companies, in addition to its acceptance as a lingua franca . Culturally, English is common in southern towns like El Callao , and the native English-speaking influence is evident in folk and calypso songs from the region. English was brought to Venezuela by Trinidadian and other British West Indies immigrants. A variety of Antillean Creole is spoken by a small community in El Callao and Paria . Italian language teaching is delivered by private Venezuelan schools and institutions. Other languages spoken by large communities in the country are Basque and Galician , among others.Religion in Venezuela (2011) According to a 2011 poll, 88% of the population is Christian, primarily Roman Catholic (71%), and the remaining 17% Protestant , primarily Evangelicals (in Latin America Protestants are usually called "evangélicos" ). 8% of Venezuelans are irreligious. Almost 3% of the population follow another religion (1% of these people practice Santería ). There are small but influential Muslim , Druze , Buddhist , and Jewish communities. The Muslim community of more than 100,000 is concentrated among persons of Lebanese and Syrian descent living in Nueva Esparta state, Punto Fijo and the Caracas area. Venezuela is home of the largest Druze communities outside the Middle East, the Druze community are estimated around 60,000, and concentrated among persons of Lebanese and Syrian descent. Buddhism is practiced by over 52,000 people. The Buddhist community is made up mainly of Chinese, Japanese, and Korean people. The Jewish community has shrunk in recent years due to rising economic pressures and antisemitism in Venezuela , with the population declining from 22,000 in 1999 to less than 7,000 in 2015. Venezuela has a national universal health care system. The current government has created a program to expand access to health care known as Misión Barrio Adentro , although its efficiency and work conditions have been criticized. As of December 2014 an estimated 80% of Barrio Adentro establishments in Venezuela are abandoned. Infant mortality in Venezuela was 19 deaths per 1,000 births for 2014 which was lower than the South American average (To compare: The U.S. figure was 6 deaths per 1,000 births in 2013). Child malnutrition was 17%. Delta Amacuro and Amazonas had the nation's highest rates. According to the United Nations, 32% of Venezuelans lacked adequate sanitation, primarily those living in rural areas. Diseases ranging from diphtheria , plague , malaria , typhoid fever, yellow fever , cholera , hepatitis A , hepatitis B , and hepatitis D were present in the country. Obesity was prevalent in approximately 30% of the adult population. Venezuela had a total of 150 sewage treatment plants ; 13% of the population lacked access to drinking water, but this number had been dropping. [ non-primary source needed ] During the economic crisis observed under President Maduro's presidency, medical professionals were forced to perform outdated treatments on patients. In 2008, 95.2% of the adult population was literate. The net primary school enrollment rate was at 91% and the net secondary school enrollment rate was at 63% in 2005. Venezuela has a number of universities, of which the most prestigious are the Central University of Venezuela founded in 1721, the University of Zulia , the University of the Andes , Simón Bolívar University , and the University of the East . Currently, many Venezuelan graduates seek a future abroad because of the country's troubled economy and heavy crime rate. Over 1.35 million Venezuelan college graduates have left the country since the beginning of the Bolivarian Revolution . It is believed that nearly 12% of Venezuelans live abroad, with Ireland becoming a popular destination for students. According to Claudio Bifano, president of the Venezuelan Academy of Physical, Mathematical, and Natural Sciences, more than half of all medical graduates had left Venezuela in 2013. By 2018, over half of all Venezuelan children had dropped out of school, with 58% of students quitting nationwide while areas near bordering countries saw more than 80% of their students leave. Nationwide, about 93% of schools do not meet the minimum requirements to operate and 77% do not have utilities such as food, water or electricity. The culture of Venezuela is a melting pot made up of three main groups: The Indigenous Venezuelans, the Africans, and the Spanish. The Africans brought in many musical influences, especially introduction of the drum. The Spanish influence predominantes due to the colonization process and the socioeconomic structure it created. Spanish influences can be seen in the country's architecture, music, religion, and language. Venezuela was also enriched by immigration streams of Indian and European origin in the 19th century, especially from France. Most recently, immigration from the United States, Spain, Italy, and Portugal has enriched the already complex cultural mosaic. [ citation needed ] Carlos Raúl Villanueva was the most important Venezuelan architect of the modern era; he designed the Central University of Venezuela, (a World Heritage Site ) and its Aula Magna. Other notable architectural works include the Capitolio, the Baralt Theatre , the Teresa Carreño Cultural Complex , and the General Rafael Urdaneta Bridge . In Venezuela, prehistoric man began to build useful architecture from approximately 1000 BC to the 15th century AD, in the period known as the "Neo-Indian". Neo-Indian architecture consisted of incipient constructions, such as agricultural terraces and vaults lined by stones, called mintoyes, which were used as tombs and silos for the storage of agricultural products. The Indo-Hispanic architecture is the one that begins to develop from the year 1498 AD. Venezuelan colonial architecture is built from the 16th century, when Venezuela began to be a dependent colony of the Spanish Empire , until 1810, when the process of Venezuelan independence began. The architecture of this period is characterized by its discreet modesty, with the exception of some cities. The explanation lies in the socioeconomic conditions of the country . Venezuela did not offer then to the colonizers the immense riches kept by nature for later times. The simplification of technical problems, the renunciation of most of the decorative elements and variegated ostentations of fanciful baroque, the impossibility of using expensive materials and the consequent lack of craftsmen, contributed to establish a modest but well-defined physiognomy of the colonial architecture of Venezuela. During the colonial period, there were eventually confrontations between the Spanish conquerors and the barbarians and pirates that sailed along the Venezuelan coasts, in order to take over the provinces located on the coasts of the country. Christian temples from the colonial era were constituted by an almost invariable, arrangement consisting of a rectangular plan, three naves separated by arches of alfarje roofing composed of religious architecture in colonial times. The Venezuelan society dedicated a great amount of resources to erect religious monuments comparable to those of other countries of the continent. The XVII century was of reconstruction of the Catholic churches that had been destroyed by the earthquake of 1641. In the 18th century, specifically between 1728 and 1785, the prosperity that Venezuela enjoyed due to the opening of the Compañía Guipuzcoana de Caracas was also reflected in the construction of new architecture, especially of a religious nature. Venezuelan art was initially dominated by religious motifs. However, in the late 19th century, artists began emphasizing historical and heroic representations of the country's struggle for independence. This move was led by Martín Tovar y Tovar . Modernism took over in the 20th century. Notable Venezuelan artists include Arturo Michelena , Cristóbal Rojas , Armando Reverón , Manuel Cabré ; the kinetic artists Jesús Soto , Gego and Carlos Cruz-Diez ; and contemporary artists such as Marisol and Yucef Merhi . Venezuelan literature originated soon after the Spanish conquest of the mostly pre-literate Indigenous societies. It was originally dominated by Spanish influences . Following the rise of political literature during the Venezuelan War of Independence, Venezuelan Romanticism , notably expounded by Juan Vicente González, emerged as the first important genre in the region. Although mainly focused on narrative writing, Venezuelan literature was advanced by poets such as Andrés Eloy Blanco and Fermín Toro . Major writers and novelists include Rómulo Gallegos , Teresa de la Parra , Arturo Uslar Pietri , Adriano González León , Miguel Otero Silva , and Mariano Picón Salas . The great poet and humanist Andrés Bello was also an educator and intellectual (He was also a childhood tutor and mentor of Simón Bolívar ). Others, such as Laureano Vallenilla Lanz and José Gil Fortoul , contributed to Venezuelan Positivism . The Indigenous musical styles of Venezuela are exemplified by groups like Un Solo Pueblo and Serenata Guayanesa . The national musical instrument is the cuatro . Traditional musical styles and songs mainly emerged in and around the llanos region, including "Alma llanera" (by Pedro Elías Gutiérrez and Rafael Bolívar Coronado ), "Florentino y el diablo" (by Alberto Arvelo Torrealba ), "Concierto en la llanura" by Juan Vicente Torrealba , and "Caballo viejo" (by Simón Díaz ). The Zulian gaita is also a very popular genre, generally performed during Christmas. The national dance is the joropo . Venezuela has always been a melting pot of cultures and this can be seen in the richness and variety of its musical styles and dances: calipso , bambuco , fulía , cantos de pilado de maíz, cantos de lavanderas, sebucán, and maremare. Teresa Carreño was a world-famous 19th century piano virtuoso. Recently, great classical music performances have come out of Venezuela. The Simón Bolívar Youth Orchestra has hosted a number of excellent concerts in many European concert halls, most notably at the 2007 London Proms , and has received several honors. The orchestra is the pinnacle of El Sistema , a publicly financed, voluntary music education program now being emulated in other countries. In the early 21st century, a movement known as "Movida Acústica Urbana" featured musicians trying to save some national traditions, creating their own original songs but using traditional instruments. Some groups following this movement are Tambor Urbano, Los Sinverguenzas, C4Trío, and Orozco Jam. Afro-Venezuelan musical traditions are most intimately related to the festivals of the "black folk saints" San Juan and St. Benedict the Moor . Specific songs are related to the different stages of their festivals and processions, when the saints start their yearly " paseo" – stroll – through the community. The origins of baseball in Venezuela are unclear, although it is known that the sport was being played in the country by the late 19th century. In the early 20th century, North American immigrants who came to Venezuela to work in the nation's oil industry helped to popularize the sport in Venezuela. During the 1930s, baseball's popularity continued to rise in the country, leading to the foundation of the Venezuelan Professional Baseball League (LVBP) in 1945, and the sport would soon become the nation's most popular. The popularity of baseball in the country makes Venezuela a rarity among its South American neighbors—association football is the dominant sport in the continent. However, football, as well as basketball , are among the more popular sports played in Venezuela. Venezuela hosted the 2012 Basketball World Olympic Qualifying Tournament and the 2013 FIBA Basketball Americas Championship , which took place in the Poliedro de Caracas . Although not as popular in Venezuela as the rest of South America, football, spearheaded by the Venezuela national football team is gaining popularity as well. The sport is also noted for having an increased focus during the World Cup. Venezuela is scheduled to host the Copa América every 40 years. Venezuela is also home to former Formula 1 driver, Pastor Maldonado . Maldonado has increased the reception of Formula 1 in Venezuela, helping to popularize the sport in the country. In the 2012 Summer Olympics , Rubén Limardo won a gold medal in fencing . In the Winter Sports, Cesar Baena had represented the country since 2008 in Nordic Skiing, the first South American skier to compete in a FIS Cross Country Ski World Cup on Düsseldorf 2009.Carlos Raúl Villanueva was the most important Venezuelan architect of the modern era; he designed the Central University of Venezuela, (a World Heritage Site ) and its Aula Magna. Other notable architectural works include the Capitolio, the Baralt Theatre , the Teresa Carreño Cultural Complex , and the General Rafael Urdaneta Bridge . In Venezuela, prehistoric man began to build useful architecture from approximately 1000 BC to the 15th century AD, in the period known as the "Neo-Indian". Neo-Indian architecture consisted of incipient constructions, such as agricultural terraces and vaults lined by stones, called mintoyes, which were used as tombs and silos for the storage of agricultural products. The Indo-Hispanic architecture is the one that begins to develop from the year 1498 AD. Venezuelan colonial architecture is built from the 16th century, when Venezuela began to be a dependent colony of the Spanish Empire , until 1810, when the process of Venezuelan independence began. The architecture of this period is characterized by its discreet modesty, with the exception of some cities. The explanation lies in the socioeconomic conditions of the country . Venezuela did not offer then to the colonizers the immense riches kept by nature for later times. The simplification of technical problems, the renunciation of most of the decorative elements and variegated ostentations of fanciful baroque, the impossibility of using expensive materials and the consequent lack of craftsmen, contributed to establish a modest but well-defined physiognomy of the colonial architecture of Venezuela. During the colonial period, there were eventually confrontations between the Spanish conquerors and the barbarians and pirates that sailed along the Venezuelan coasts, in order to take over the provinces located on the coasts of the country. Christian temples from the colonial era were constituted by an almost invariable, arrangement consisting of a rectangular plan, three naves separated by arches of alfarje roofing composed of religious architecture in colonial times. The Venezuelan society dedicated a great amount of resources to erect religious monuments comparable to those of other countries of the continent. The XVII century was of reconstruction of the Catholic churches that had been destroyed by the earthquake of 1641. In the 18th century, specifically between 1728 and 1785, the prosperity that Venezuela enjoyed due to the opening of the Compañía Guipuzcoana de Caracas was also reflected in the construction of new architecture, especially of a religious nature.Venezuelan art was initially dominated by religious motifs. However, in the late 19th century, artists began emphasizing historical and heroic representations of the country's struggle for independence. This move was led by Martín Tovar y Tovar . Modernism took over in the 20th century. Notable Venezuelan artists include Arturo Michelena , Cristóbal Rojas , Armando Reverón , Manuel Cabré ; the kinetic artists Jesús Soto , Gego and Carlos Cruz-Diez ; and contemporary artists such as Marisol and Yucef Merhi . Venezuelan literature originated soon after the Spanish conquest of the mostly pre-literate Indigenous societies. It was originally dominated by Spanish influences . Following the rise of political literature during the Venezuelan War of Independence, Venezuelan Romanticism , notably expounded by Juan Vicente González, emerged as the first important genre in the region. Although mainly focused on narrative writing, Venezuelan literature was advanced by poets such as Andrés Eloy Blanco and Fermín Toro . Major writers and novelists include Rómulo Gallegos , Teresa de la Parra , Arturo Uslar Pietri , Adriano González León , Miguel Otero Silva , and Mariano Picón Salas . The great poet and humanist Andrés Bello was also an educator and intellectual (He was also a childhood tutor and mentor of Simón Bolívar ). Others, such as Laureano Vallenilla Lanz and José Gil Fortoul , contributed to Venezuelan Positivism .The Indigenous musical styles of Venezuela are exemplified by groups like Un Solo Pueblo and Serenata Guayanesa . The national musical instrument is the cuatro . Traditional musical styles and songs mainly emerged in and around the llanos region, including "Alma llanera" (by Pedro Elías Gutiérrez and Rafael Bolívar Coronado ), "Florentino y el diablo" (by Alberto Arvelo Torrealba ), "Concierto en la llanura" by Juan Vicente Torrealba , and "Caballo viejo" (by Simón Díaz ). The Zulian gaita is also a very popular genre, generally performed during Christmas. The national dance is the joropo . Venezuela has always been a melting pot of cultures and this can be seen in the richness and variety of its musical styles and dances: calipso , bambuco , fulía , cantos de pilado de maíz, cantos de lavanderas, sebucán, and maremare. Teresa Carreño was a world-famous 19th century piano virtuoso. Recently, great classical music performances have come out of Venezuela. The Simón Bolívar Youth Orchestra has hosted a number of excellent concerts in many European concert halls, most notably at the 2007 London Proms , and has received several honors. The orchestra is the pinnacle of El Sistema , a publicly financed, voluntary music education program now being emulated in other countries. In the early 21st century, a movement known as "Movida Acústica Urbana" featured musicians trying to save some national traditions, creating their own original songs but using traditional instruments. Some groups following this movement are Tambor Urbano, Los Sinverguenzas, C4Trío, and Orozco Jam. Afro-Venezuelan musical traditions are most intimately related to the festivals of the "black folk saints" San Juan and St. Benedict the Moor . Specific songs are related to the different stages of their festivals and processions, when the saints start their yearly " paseo" – stroll – through the community.The origins of baseball in Venezuela are unclear, although it is known that the sport was being played in the country by the late 19th century. In the early 20th century, North American immigrants who came to Venezuela to work in the nation's oil industry helped to popularize the sport in Venezuela. During the 1930s, baseball's popularity continued to rise in the country, leading to the foundation of the Venezuelan Professional Baseball League (LVBP) in 1945, and the sport would soon become the nation's most popular. The popularity of baseball in the country makes Venezuela a rarity among its South American neighbors—association football is the dominant sport in the continent. However, football, as well as basketball , are among the more popular sports played in Venezuela. Venezuela hosted the 2012 Basketball World Olympic Qualifying Tournament and the 2013 FIBA Basketball Americas Championship , which took place in the Poliedro de Caracas . Although not as popular in Venezuela as the rest of South America, football, spearheaded by the Venezuela national football team is gaining popularity as well. The sport is also noted for having an increased focus during the World Cup. Venezuela is scheduled to host the Copa América every 40 years. Venezuela is also home to former Formula 1 driver, Pastor Maldonado . Maldonado has increased the reception of Formula 1 in Venezuela, helping to popularize the sport in the country. In the 2012 Summer Olympics , Rubén Limardo won a gold medal in fencing . In the Winter Sports, Cesar Baena had represented the country since 2008 in Nordic Skiing, the first South American skier to compete in a FIS Cross Country Ski World Cup on Düsseldorf 2009.

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Unit 731

Biological weapons Chemical weapons Explosives 400,000 or higher from biological warfare Over 3,000 from inside experiments from each unit (not including branches, 1940–1945 only) : 20 At least 10,000 prisoners died No documented survivors Unit 731 ( Japanese : 731部隊 , Hepburn : Nana-san-ichi Butai ) , [note 1] short for Manshu Detachment 731 and also known as the Kamo Detachment : 198 and the Ishii Unit , was a covert biological and chemical warfare research and development unit of the Imperial Japanese Army that engaged in lethal human experimentation and biological weapons manufacturing during the Second Sino-Japanese War (1937–1945) and World War II . It killed an estimated 200,000 to 300,000 people. It was based in the Pingfang district of Harbin , the largest city in the Japanese puppet state of Manchukuo (now Northeast China ) and had active branch offices throughout China and Southeast Asia . Unit 731 was responsible for some of the most notorious war crimes committed by the Japanese armed forces . It routinely conducted tests on people who were dehumanized and internally referred to as "logs". Experiments included disease injections, controlled dehydration, biological weapons testing, hypobaric pressure chamber testing, vivisection , organ harvesting , amputation , and standard weapons testing. Victims included not only kidnapped men, women (including pregnant women) and children but also babies born from the systemic rape perpetrated by the staff inside the compound. The victims also came from different nationalities, with the majority being Chinese and a significant minority being Russian . Additionally, Unit 731 produced biological weapons that were used in areas of China not occupied by Japanese forces, which included Chinese cities and towns, water sources, and fields. Estimates of those killed by Unit 731 and its related programs range up to half a million people, and none of the inmates survived. In the final moments of the Second World War, all prisoners were killed to conceal evidence. Originally set up by the military police of the Empire of Japan , Unit 731 was taken over and commanded until the end of the war by General Shirō Ishii , a combat medic officer. The facility itself was built in 1935 as a replacement for the Zhongma Fortress , a prison and experimentation camp. Ishii and his team used it to expand their capabilities. The program received generous support from the Japanese government until the end of the war in 1945. While Unit 731 researchers arrested by Soviet forces were tried at the December 1949 Khabarovsk war crimes trials , those captured by the United States were secretly given immunity in exchange for the data gathered during their human experiments. The United States helped cover up the human experimentations and handed stipends to the perpetrators. The Americans co-opted the researchers' bioweapons information and experience for use in their own biological warfare program , much like what had been done with Nazi German researchers in Operation Paperclip . On 28 August 2002, Tokyo District Court ruled that Japan had committed biological warfare in China and consequently had slaughtered many residents. Japan initiated its biological weapons program during the 1930s, in part due to the prohibition of biological weapons in interstate conflicts by the Geneva Protocol of 1925. They reasoned that the ban verified its effectiveness as a weapon. Japan's occupation of Manchuria began in 1931 after the Japanese invasion of Manchuria . Japan decided to build Unit 731 in Manchuria because the occupation not only gave the Japanese an advantage of separating the research station from their island, but also gave them access to as many Chinese individuals as they wanted for use as test subjects. They viewed the Chinese as no-cost assets, and hoped this would give them a competitive advantage in biological warfare. Most of the victims were Chinese, but many victims were also from different nationalities. In 1932, Surgeon General Shirō Ishii , chief medical officer of the Imperial Japanese Army and protégé of Army Minister Sadao Araki , was placed in command of the Army Epidemic Prevention Research Laboratory ( AEPRL ). Ishii organized a secret research group, the "Tōgō Unit," for chemical and biological experimentation in Manchuria. Ishii had proposed the creation of a Japanese biological and chemical research unit in 1930, after a two-year study trip abroad, on the grounds that Western powers were developing their own programs. One of Ishii's main supporters inside the army was Colonel Chikahiko Koizumi , who later served as Japan's Health Minister from 1941 to 1945. Koizumi had joined a secret poison gas research committee in 1915, during World War I , when he and other Imperial Japanese Army officers were impressed by the successful German use of chlorine gas at the Second Battle of Ypres , in which the Allies suffered 6,000 deaths and 15,000 wounded as a result of the chemical attack. Unit Tōgō was set into motion in the Zhongma Fortress , a prison and experimentation camp in Beiyinhe, a village 100 kilometers (62 mi) south of Harbin on the South Manchuria Railway . The prisoners brought to Zhongma included common criminals , captured bandits, anti-Japanese partisans, as well as political prisoners and people rounded up on trumped up charges by the Kempeitai . Prisoners were generally well fed on a diet of rice or wheat , meat , fish , and occasionally even alcohol in order to be in normal health at the beginning of experiments. Then, over several days, prisoners were eventually drained of blood and deprived of nutrients and water. Their deteriorating health was recorded. Some were also vivisected . Others were deliberately infected with plague bacteria and other microbes . A prison break in the autumn of 1934, which jeopardized the facility's secrecy, and an explosion in 1935 (believed to be sabotage) led Ishii to shut down Zhongma Fortress. He then received authorization to move to Pingfang, approximately 24 kilometers (15 mi) south of Harbin, to set up a new, much larger facility. In 1936, Emperor Hirohito issued a decree authorizing the expansion of the unit and its integration into the Kwantung Army as the Epidemic Prevention Department. It was divided at that time into the "Ishii Unit" and "Wakamatsu Unit", with a base in Xinjing . From August 1940 on, the units were known collectively as the "Epidemic Prevention and Water Purification Department of the Kwantung Army" or "Unit 731" short. His younger brother, Prince Mikasa , toured the Unit 731 headquarters in China, and wrote in his memoir that he watched films showing how Chinese prisoners were "made to march on the plains of Manchuria for poison gas experiments on humans." Hideki Tojo , who later became Prime Minister in 1941, was also shown films of the experiments, which he described as "unpleasant." In addition to the establishment of Unit 731, the decree also called for the creation of an additional biological warfare development unit, called the Kwantung Army Military Horse Epidemic Prevention Workshop (later referred to as Manchuria Unit 100 ), and a chemical warfare development unit called the Kwantung Army Technical Testing Department (later referred to as Manchuria Unit 516 ). After the Japanese invasion of China in 1937, sister chemical and biological warfare units were founded in major Chinese cities and were referred to as Epidemic Prevention and Water Supply Units. Detachments included Unit 1855 in Beijing , Unit Ei 1644 in Nanjing , Unit 8604 in Guangzhou , and later Unit 9420 in Singapore . All of these units comprised Ishii's network, which, at its height in 1939, oversaw over 10,000 personnel. Medical doctors and professors from Japan were attracted to join Unit 731 both by the rare opportunity to conduct human experimentation and the Army's strong financial backing. Unit Tōgō was set into motion in the Zhongma Fortress , a prison and experimentation camp in Beiyinhe, a village 100 kilometers (62 mi) south of Harbin on the South Manchuria Railway . The prisoners brought to Zhongma included common criminals , captured bandits, anti-Japanese partisans, as well as political prisoners and people rounded up on trumped up charges by the Kempeitai . Prisoners were generally well fed on a diet of rice or wheat , meat , fish , and occasionally even alcohol in order to be in normal health at the beginning of experiments. Then, over several days, prisoners were eventually drained of blood and deprived of nutrients and water. Their deteriorating health was recorded. Some were also vivisected . Others were deliberately infected with plague bacteria and other microbes . A prison break in the autumn of 1934, which jeopardized the facility's secrecy, and an explosion in 1935 (believed to be sabotage) led Ishii to shut down Zhongma Fortress. He then received authorization to move to Pingfang, approximately 24 kilometers (15 mi) south of Harbin, to set up a new, much larger facility. In 1936, Emperor Hirohito issued a decree authorizing the expansion of the unit and its integration into the Kwantung Army as the Epidemic Prevention Department. It was divided at that time into the "Ishii Unit" and "Wakamatsu Unit", with a base in Xinjing . From August 1940 on, the units were known collectively as the "Epidemic Prevention and Water Purification Department of the Kwantung Army" or "Unit 731" short. His younger brother, Prince Mikasa , toured the Unit 731 headquarters in China, and wrote in his memoir that he watched films showing how Chinese prisoners were "made to march on the plains of Manchuria for poison gas experiments on humans." Hideki Tojo , who later became Prime Minister in 1941, was also shown films of the experiments, which he described as "unpleasant." In addition to the establishment of Unit 731, the decree also called for the creation of an additional biological warfare development unit, called the Kwantung Army Military Horse Epidemic Prevention Workshop (later referred to as Manchuria Unit 100 ), and a chemical warfare development unit called the Kwantung Army Technical Testing Department (later referred to as Manchuria Unit 516 ). After the Japanese invasion of China in 1937, sister chemical and biological warfare units were founded in major Chinese cities and were referred to as Epidemic Prevention and Water Supply Units. Detachments included Unit 1855 in Beijing , Unit Ei 1644 in Nanjing , Unit 8604 in Guangzhou , and later Unit 9420 in Singapore . All of these units comprised Ishii's network, which, at its height in 1939, oversaw over 10,000 personnel. Medical doctors and professors from Japan were attracted to join Unit 731 both by the rare opportunity to conduct human experimentation and the Army's strong financial backing. A special project, codenamed Maruta , used human beings for experiments. Test subjects were gathered from the surrounding population and sometimes euphemistically referred to as "logs" ( 丸太 , maruta ) , used in such contexts as "How many logs fell?" This term originated as a joke on the part of the staff because the official cover story for the facility given to local authorities was that it was a lumber mill . According to a junior uniformed civilian employee of the Imperial Japanese Army working in Unit 731, the project was internally called "Holzklotz", German for log. In a further parallel, the corpses of "sacrificed" subjects were disposed of by incineration . Researchers in Unit 731 also published some of their results in peer-reviewed journals , writing as though the research had been conducted on nonhuman primates called "Manchurian monkeys" or "long-tailed monkeys." According to American historian Sheldon H. Harris : The Togo Unit employed gruesome tactics to secure specimens of select body organs. If Ishii or one of his co-workers wished to do research on the human brain, then they would order the guards to find them a useful sample. A prisoner would be taken from his cell. Guards would hold him while another guard would smash the victim's head open with an ax. His brain would be extracted off to the pathologist, and then to the crematorium for the usual disposal. Nakagawa Yonezo [ ja ] , professor emeritus at Osaka University , studied at Kyoto University during the war. While he was there, he watched footage of human experiments and executions from Unit 731. He later testified about the playfulness of the experimenters: Some of the experiments had nothing to do with advancing the capability of germ warfare , or of medicine. There is such a thing as professional curiosity: 'What would happen if we did such and such?' What medical purpose was served by performing and studying beheadings? None at all. That was just playing around. Professional people, too, like to play." Prisoners were injected with diseases, disguised as vaccinations , to study their effects. To study the effects of untreated venereal diseases , male and female prisoners were deliberately infected with syphilis and gonorrhea , then studied. Prisoners were also repeatedly subjected to rape by guards. Thousands of men, women, children, and infants interned at prisoner of war camps were subjected to vivisection , often performed without anesthesia and usually lethal. In a video interview, former Unit 731 member Okawa Fukumatsu admitted to having vivisected a pregnant woman. Vivisections were performed on prisoners after infecting them with various diseases. Researchers performed invasive surgery on prisoners, removing organs to study the effects of disease on the human body. Prisoners had limbs amputated in order to study blood loss . Limbs removed were sometimes reattached to the opposite side of victims' bodies. Some prisoners had their stomachs surgically removed and their esophagus reattached to the intestines . Parts of organs, such as the brain, lungs, and liver, were removed from others. Imperial Japanese Army surgeon Ken Yuasa suggests that practising vivisection on human subjects was widespread even outside Unit 731, estimating that at least 1,000 Japanese personnel were involved in the practice in mainland China. Yuasa said that when he performed vivisections on captives, they were "all for practice rather than for research," and that such practises were "routine" among Japanese doctors stationed in China during the war. The New York Times interviewed a former member of Unit 731. Insisting on anonymity, the former Japanese medical assistant recounted his first experience in vivisecting a live human being, who had been deliberately infected with the plague , for the purpose of developing "plague bombs" for war. "The fellow knew that it was over for him, and so he didn't struggle when they led him into the room and tied him down, but when I picked up the scalpel, that's when he began screaming. I cut him open from the chest to the stomach, and he screamed terribly, and his face was all twisted in agony. He made this unimaginable sound, he was screaming so horribly. But then finally he stopped. This was all in a day's work for the surgeons, but it really left an impression on me because it was my first time." Other sources suggest that it was the usual practice in the Unit for surgeons to stuff a rag (or medical gauze) into the mouth of prisoners before commencing vivisection in order to stifle any screaming. Unit 731 and its affiliated units ( Unit 1644 and Unit 100 , among others) were involved in research, development and experimental deployment of epidemic-creating biological weapons in assaults against the Chinese populace (both military and civilian) throughout World War II. Plague -infected fleas , bred in the laboratories of Unit 731 and Unit 1644, were spread by low-flying airplanes over Chinese cities, including coastal Ningbo and Changde , Hunan Province , in 1940 and 1941. These operations killed tens of thousands with bubonic plague epidemics. An expedition to Nanjing involved spreading typhoid and paratyphoid germs into the wells , marshes , and houses of the city, as well as infusing them in snacks distributed to locals. Epidemics broke out shortly after, to the elation of many researchers, who concluded that paratyphoid fever was "the most effective" of the pathogens. : xii, 173 At least 12 large-scale bioweapon field trials were carried out, and at least 11 Chinese cities attacked with biological agents. An attack on Changde in 1941 reportedly led to approximately 10,000 biological casualties and 1,700 deaths among ill-prepared Japanese troops, in most cases due to cholera . Japanese researchers performed tests on prisoners with bubonic plague , cholera , smallpox , botulism , and other diseases. This research led to the development of the defoliation bacilli bomb and the flea bomb used to spread bubonic plague. Some of these bombs were designed with porcelain shells, an idea proposed by Ishii in 1938. These bombs enabled Japanese soldiers to launch biological attacks, infecting agriculture, reservoirs , wells, as well as other areas, with anthrax - and plague -carrier fleas, typhoid , cholera , or other deadly pathogens. During biological bomb experiments, researchers dressed in protective suits would examine the dying victims. Infected food supplies and clothing were dropped by airplane into areas of China not occupied by Japanese forces. In addition, poisoned food and candy were given to unsuspecting victims. Plague fleas, infected clothing, and infected supplies encased in bombs were dropped on various targets. The resulting cholera , anthrax , and plague were estimated to have killed at least 400,000 Chinese civilians. Tularemia was also tested on Chinese civilians. Due to pressure from numerous accounts of the biowarfare attacks, Chiang Kai-shek sent a delegation of army and foreign medical personnel in November 1941 to document evidence and treat the afflicted. A report on the Japanese use of plague-infected fleas on Changde was made widely available the following year but was not addressed by the Allied Powers until Franklin D. Roosevelt issued a public warning in 1943 condemning the attacks. In December 1944, the Japanese Navy explored the possibility of attacking cities in California with biological weapons, known as Operation PX or Operation Cherry Blossoms at Night. The plan for the attack involved Seiran aircraft launched by submarine aircraft carriers upon the West Coast of the United States—specifically, the cities of San Diego, Los Angeles, and San Francisco. The planes would spread weaponized bubonic plague , cholera , typhus , dengue fever , and other pathogens in a biological terror attack upon the population. The submarine crews would infect themselves and run ashore in a suicide mission. Planning for Operation PX was finalized on March 26, 1945, but shelved shortly thereafter due to the strong opposition of Chief of General Staff Yoshijirō Umezu . Umezu later explained his decision as such: "If bacteriological warfare is conducted, it will grow from the dimension of war between Japan and America to an endless battle of humanity against bacteria. Japan will earn the derision of the world." Human targets were used to test grenades positioned at various distances and in various positions. Flamethrowers were tested on people. Victims were also tied to stakes and used as targets to test pathogen-releasing bombs , chemical weapons , shrapnel bombs with varying amounts of fragments, and explosive bombs as well as bayonets and knives. To determine the best course of treatment for varying degrees of shrapnel wounds sustained on the field by Japanese Soldiers, Chinese prisoners were exposed to direct bomb blasts. They were strapped, unprotected, to wooden planks that were staked into the ground at increasing distances around a bomb that was then detonated. It was surgery for most, autopsies for the rest. In other tests, subjects were deprived of food and water to determine the amount of time until death; placed into low-pressure chambers until their eyes popped from the sockets ; experimented upon to determine the relationship between temperature, burns, and human survival; hung upside down until death; crushed with heavy objects ; electrocuted ; dehydrated with hot fans; placed into centrifuges and spun until death; injected with animal blood, notably with horse blood; exposed to lethal doses of X-rays ; subjected to various chemical weapons inside gas chambers; injected with seawater; and burned or buried alive . In addition to chemical agents, the properties of many different toxins were also investigated by the Unit. To name a few, prisoners were exposed to tetrodotoxin ( pufferfish or fugu poison), heroin , Korean bindweed , bactal , and castor-oil seeds ( ricin ). Massive amounts of blood were drained from some prisoners in order to study the effects of blood loss according to former Unit 731 vivisectionist Okawa Fukumatsu. In one case, at least half a liter of blood was drawn at two-to-three-day intervals. As stated above, dehydration experiments were performed on the victims. The purpose of these tests was to determine the amount of water in an individual's body and to see how long one could survive with a very low to no water intake. It is known that victims were also starved before these tests began. The deteriorating physical states of these victims were documented by staff at a periodic interval. "It was said that a small number of these poor men, women, and children who became marutas were also mummified alive in total dehydration experiments. They sweated themselves to death under the heat of several hot dry fans. At death, the corpses would only weigh ≈1/5 normal bodyweight." Unit 731 also performed transfusion experiments with different blood types . Unit member Naeo Ikeda wrote: In my experience, when A type blood 100 cc was transfused to an O type subject, whose pulse was 87 per minute and temperature was 35.4 degrees C, 30 minutes later the temperature rose to 38.6 degrees with slight trepidation. Sixty minutes later the pulse was 106 per minute and the temperature was 39.4 degrees. Two hours later the temperature was 37.7 degrees, and three hours later the subject recovered. When AB type blood 120 cc was transfused to an O type subject, an hour later the subject described malaise and psychroesthesia in both legs. When AB type blood 100 cc was transfused to a B type subject, there seemed to be no side effect. Unit 731 tested many different chemical agents on prisoners and had a building dedicated to gas experiments. Some of the agents tested were mustard gas , lewisite , cyanic acid gas , white phosphorus , adamsite , and phosgene gas . A former army major and technician gave the following testimony anonymously (at the time of the interview, this man was a professor emeritus at a national university): In 1943, I attended a poison gas test held at the Unit 731 test facilities. A glass-walled chamber about three meters square [97 sq ft] and two meters [6.6 ft] high was used. Inside of it, a Chinese man was blindfolded, with his hands tied around a post behind him. The gas was adamsite (sneezing gas), and as the gas filled the chamber the man went into violent coughing convulsions and began to suffer excruciating pain. More than ten doctors and technicians were present. After I had watched for about ten minutes, I could not stand it any more, and left the area. I understand that other types of gasses were also tested there. Takeo Wano, a former medical worker in Unit 731, said that he saw a Western man, who was vertically cut into two pieces, pickled in a jar of formaldehyde . Wano guessed that the man was Russian because there were many Russians living in the area at that time. Unit 100 also experimented with toxic gas. Phone booth-like tanks were used as portable gas chambers for the prisoners. Some were forced to wear various types of gas masks ; others wore military uniforms, and some wore no clothes at all. Some of the tests have been described as "psychopathically sadistic, with no conceivable military application". For example, one experiment documented the time it took for three-day-old babies to freeze to death. Unit 731 also tested chemical weapons on prisoners in field conditions. A report authored by unknown researcher in the Kamo Unit (Unit 731) describes a large human experiment of yperite gas ( mustard gas ) on 7–10 September 1940. Twenty subjects were divided into three groups and placed in combat emplacements, trenches , gazebos, and observatories. One group was clothed with Chinese underwear, no hat, and no mask and was subjected to as much as 1,800 field gun rounds of yperite gas over 25 minutes. Another group was clothed in summer military uniform and shoes; three had masks and another three had no mask. They also were exposed to as much as 1,800 rounds of yperite gas. A third group was clothed in summer military uniform, three with masks and two without masks, and were exposed to as much as 4,800 rounds. Then their general symptoms and damage to skin, eye, respiratory organs , and digestive organs were observed at 4 hours, 24 hours, and 2, 3, and 5 days after the shots. Injecting the blister fluid from one subject into another subject and analyses of blood and soil were also performed. Five subjects were forced to drink a solution of yperite and lewisite gas in water, with or without decontamination . The report describes conditions of every subject precisely without mentioning what happened to them in the long run. The following is an excerpt of one of these reports: Number 376, dugout of the first area: September 7, 1940, 6 pm: Tired and exhausted. Looks with hollow eyes. Weeping redness of the skin of the upper part of the body. Eyelids edematous, swollen. Epiphora. Hyperemic conjunctivae. September 8, 6 am: Neck, breast, upper abdomen and scrotum weeping, reddened, swollen. Covered with millet-seed-size to bean-size blisters. Eyelids and conjunctivae hyperemic and edematous. Had difficulties opening the eyes. September 8, 6 pm: Tired and exhausted. Feels sick. Body temperature 37 degrees Celsius. Mucous and bloody erosions across the shoulder girdle. Abundant mucous nose secretions. Abdominal pain. Mucous and bloody diarrhea. Proteinuria. September 9, 7 am: Tired and exhausted. Weakness of all four extremities. Low morale. Body temperature 37 degrees Celsius. Skin of the face still weeping. Army Engineer Hisato Yoshimura conducted experiments by taking captives outside, dipping various appendages into water of varying temperatures, and allowing the limb to freeze . Once frozen, Yoshimura would strike their affected limbs with a short stick, "emitting a sound resembling that which a board gives when it is struck." Ice was then chipped away, with the affected area being subjected to various treatments, such as being doused in water, exposed to the heat of fire, etc. Members of the Unit referred to Yoshimura as a "scientific devil" and a "cold-blooded animal" because he would conduct his work with strictness. Naoji Uezono, a member of Unit 731, described in a 1980s interview a grisly scene where Yoshimura had "two naked men put in an area 40–50 degrees below zero and researchers filmed the whole process until [the subjects] died. [The subjects] suffered such agony they were digging their nails into each other's flesh." Yoshimura's lack of remorse was evident in an article he wrote for the Japanese Journal of Physiology in 1950 in which he admitted to using 20 children and a three-day-old infant in experiments which exposed them to zero-degree-Celsius ice and salt water. Although this article drew criticism, Yoshimura denied any guilt when contacted by a reporter from the Mainichi Shimbun . [ user-generated source? ] Yoshimura developed a "resistance index of frostbite" based on the mean temperature 5 to 30 minutes after immersion in freezing water, the temperature of the first rise after immersion, and the time until the temperature first rises after immersion. In a number of separate experiments it was then determined how these parameters depend on the time of day a victim's body part was immersed in freezing water, the surrounding temperature and humidity during immersion, how the victim had been treated before the immersion ("after keeping awake for a night", "after hunger for 24 hours", "after hunger for 48 hours", "immediately after heavy meal", "immediately after hot meal", "immediately after muscular exercise", "immediately after cold bath", "immediately after hot bath"), what type of food the victim had been fed over the five days preceding the immersions with regard to dietary nutrient intake ("high protein (of animal nature)", "high protein (of vegetable nature)", "low protein intake", and "standard diet"), and salt intake (45 g NaCl per day, 15 g NaCl per day, no salt). This original data is seen in the attached figure. Unit members orchestrated forced sex acts between infected and non-infected prisoners to transmit the disease, as the testimony of a prison guard on the subject of devising a method for transmission of syphilis between patients shows: Infection of venereal disease by injection was abandoned, and the researchers started forcing the prisoners into sexual acts with each other. Four or five unit members, dressed in white laboratory clothing completely covering the body with only eyes and mouth visible, rest covered, handled the tests. A male and female, one infected with syphilis, would be brought together in a cell and forced into sex with each other. It was made clear that anyone resisting would be shot. After victims were infected, they were vivisected at different stages of infection, so that internal and external organs could be observed as the disease progressed. Testimony from multiple guards blames the female victims as being hosts of the diseases, even as they were forcibly infected. Genitals of female prisoners that were infected with syphilis were called "jam-filled buns" by guards. Some children grew up inside the walls of Unit 731, infected with syphilis. A Youth Corps member deployed to train at Unit 731 recalled viewing a batch of subjects that would undergo syphilis testing: "one was a Chinese woman holding an infant, one was a White Russian woman with a daughter of four or five years of age, and the last was a White Russian woman with a boy of about six or seven." The children of these women were tested in ways similar to their parents, with specific emphasis on determining how longer infection periods affected the effectiveness of treatments. Female prisoners were forced to become pregnant for use in experiments. The hypothetical possibility of vertical transmission (from mother to child) of diseases, particularly syphilis, was the stated reason for the torture. Fetal survival and damage to mother's reproductive organs were objects of interest. Though "a large number of babies were born in captivity," there have been no accounts of any survivors of Unit 731, children included. It is suspected that the children of female prisoners were killed after birth or aborted . While male prisoners were often used in single studies, so that the results of the experimentation on them would not be clouded by other variables, women were sometimes used in bacteriological or physiological experiments, sex experiments, and as the victims of sex crimes . The testimony of a unit member that served as a guard graphically demonstrated this reality: One of the former researchers I located told me that one day he had a human experiment scheduled, but there was still time to kill. So he and another unit member took the keys to the cells and opened one that housed a Chinese woman. One of the unit members raped her; the other member took the keys and opened another cell. There was a Chinese woman in there who had been used in a frostbite experiment. She had several fingers missing and her bones were black, with gangrene set in. He was about to rape her anyway, then he saw that her sex organ was festering, with pus oozing to the surface. He gave up the idea, left and locked the door, then later went on to his experimental work. Thousands of men, women, children, and infants interned at prisoner of war camps were subjected to vivisection , often performed without anesthesia and usually lethal. In a video interview, former Unit 731 member Okawa Fukumatsu admitted to having vivisected a pregnant woman. Vivisections were performed on prisoners after infecting them with various diseases. Researchers performed invasive surgery on prisoners, removing organs to study the effects of disease on the human body. Prisoners had limbs amputated in order to study blood loss . Limbs removed were sometimes reattached to the opposite side of victims' bodies. Some prisoners had their stomachs surgically removed and their esophagus reattached to the intestines . Parts of organs, such as the brain, lungs, and liver, were removed from others. Imperial Japanese Army surgeon Ken Yuasa suggests that practising vivisection on human subjects was widespread even outside Unit 731, estimating that at least 1,000 Japanese personnel were involved in the practice in mainland China. Yuasa said that when he performed vivisections on captives, they were "all for practice rather than for research," and that such practises were "routine" among Japanese doctors stationed in China during the war. The New York Times interviewed a former member of Unit 731. Insisting on anonymity, the former Japanese medical assistant recounted his first experience in vivisecting a live human being, who had been deliberately infected with the plague , for the purpose of developing "plague bombs" for war. "The fellow knew that it was over for him, and so he didn't struggle when they led him into the room and tied him down, but when I picked up the scalpel, that's when he began screaming. I cut him open from the chest to the stomach, and he screamed terribly, and his face was all twisted in agony. He made this unimaginable sound, he was screaming so horribly. But then finally he stopped. This was all in a day's work for the surgeons, but it really left an impression on me because it was my first time." Other sources suggest that it was the usual practice in the Unit for surgeons to stuff a rag (or medical gauze) into the mouth of prisoners before commencing vivisection in order to stifle any screaming. Unit 731 and its affiliated units ( Unit 1644 and Unit 100 , among others) were involved in research, development and experimental deployment of epidemic-creating biological weapons in assaults against the Chinese populace (both military and civilian) throughout World War II. Plague -infected fleas , bred in the laboratories of Unit 731 and Unit 1644, were spread by low-flying airplanes over Chinese cities, including coastal Ningbo and Changde , Hunan Province , in 1940 and 1941. These operations killed tens of thousands with bubonic plague epidemics. An expedition to Nanjing involved spreading typhoid and paratyphoid germs into the wells , marshes , and houses of the city, as well as infusing them in snacks distributed to locals. Epidemics broke out shortly after, to the elation of many researchers, who concluded that paratyphoid fever was "the most effective" of the pathogens. : xii, 173 At least 12 large-scale bioweapon field trials were carried out, and at least 11 Chinese cities attacked with biological agents. An attack on Changde in 1941 reportedly led to approximately 10,000 biological casualties and 1,700 deaths among ill-prepared Japanese troops, in most cases due to cholera . Japanese researchers performed tests on prisoners with bubonic plague , cholera , smallpox , botulism , and other diseases. This research led to the development of the defoliation bacilli bomb and the flea bomb used to spread bubonic plague. Some of these bombs were designed with porcelain shells, an idea proposed by Ishii in 1938. These bombs enabled Japanese soldiers to launch biological attacks, infecting agriculture, reservoirs , wells, as well as other areas, with anthrax - and plague -carrier fleas, typhoid , cholera , or other deadly pathogens. During biological bomb experiments, researchers dressed in protective suits would examine the dying victims. Infected food supplies and clothing were dropped by airplane into areas of China not occupied by Japanese forces. In addition, poisoned food and candy were given to unsuspecting victims. Plague fleas, infected clothing, and infected supplies encased in bombs were dropped on various targets. The resulting cholera , anthrax , and plague were estimated to have killed at least 400,000 Chinese civilians. Tularemia was also tested on Chinese civilians. Due to pressure from numerous accounts of the biowarfare attacks, Chiang Kai-shek sent a delegation of army and foreign medical personnel in November 1941 to document evidence and treat the afflicted. A report on the Japanese use of plague-infected fleas on Changde was made widely available the following year but was not addressed by the Allied Powers until Franklin D. Roosevelt issued a public warning in 1943 condemning the attacks. In December 1944, the Japanese Navy explored the possibility of attacking cities in California with biological weapons, known as Operation PX or Operation Cherry Blossoms at Night. The plan for the attack involved Seiran aircraft launched by submarine aircraft carriers upon the West Coast of the United States—specifically, the cities of San Diego, Los Angeles, and San Francisco. The planes would spread weaponized bubonic plague , cholera , typhus , dengue fever , and other pathogens in a biological terror attack upon the population. The submarine crews would infect themselves and run ashore in a suicide mission. Planning for Operation PX was finalized on March 26, 1945, but shelved shortly thereafter due to the strong opposition of Chief of General Staff Yoshijirō Umezu . Umezu later explained his decision as such: "If bacteriological warfare is conducted, it will grow from the dimension of war between Japan and America to an endless battle of humanity against bacteria. Japan will earn the derision of the world." Human targets were used to test grenades positioned at various distances and in various positions. Flamethrowers were tested on people. Victims were also tied to stakes and used as targets to test pathogen-releasing bombs , chemical weapons , shrapnel bombs with varying amounts of fragments, and explosive bombs as well as bayonets and knives. To determine the best course of treatment for varying degrees of shrapnel wounds sustained on the field by Japanese Soldiers, Chinese prisoners were exposed to direct bomb blasts. They were strapped, unprotected, to wooden planks that were staked into the ground at increasing distances around a bomb that was then detonated. It was surgery for most, autopsies for the rest.In other tests, subjects were deprived of food and water to determine the amount of time until death; placed into low-pressure chambers until their eyes popped from the sockets ; experimented upon to determine the relationship between temperature, burns, and human survival; hung upside down until death; crushed with heavy objects ; electrocuted ; dehydrated with hot fans; placed into centrifuges and spun until death; injected with animal blood, notably with horse blood; exposed to lethal doses of X-rays ; subjected to various chemical weapons inside gas chambers; injected with seawater; and burned or buried alive . In addition to chemical agents, the properties of many different toxins were also investigated by the Unit. To name a few, prisoners were exposed to tetrodotoxin ( pufferfish or fugu poison), heroin , Korean bindweed , bactal , and castor-oil seeds ( ricin ). Massive amounts of blood were drained from some prisoners in order to study the effects of blood loss according to former Unit 731 vivisectionist Okawa Fukumatsu. In one case, at least half a liter of blood was drawn at two-to-three-day intervals. As stated above, dehydration experiments were performed on the victims. The purpose of these tests was to determine the amount of water in an individual's body and to see how long one could survive with a very low to no water intake. It is known that victims were also starved before these tests began. The deteriorating physical states of these victims were documented by staff at a periodic interval. "It was said that a small number of these poor men, women, and children who became marutas were also mummified alive in total dehydration experiments. They sweated themselves to death under the heat of several hot dry fans. At death, the corpses would only weigh ≈1/5 normal bodyweight." Unit 731 also performed transfusion experiments with different blood types . Unit member Naeo Ikeda wrote: In my experience, when A type blood 100 cc was transfused to an O type subject, whose pulse was 87 per minute and temperature was 35.4 degrees C, 30 minutes later the temperature rose to 38.6 degrees with slight trepidation. Sixty minutes later the pulse was 106 per minute and the temperature was 39.4 degrees. Two hours later the temperature was 37.7 degrees, and three hours later the subject recovered. When AB type blood 120 cc was transfused to an O type subject, an hour later the subject described malaise and psychroesthesia in both legs. When AB type blood 100 cc was transfused to a B type subject, there seemed to be no side effect. Unit 731 tested many different chemical agents on prisoners and had a building dedicated to gas experiments. Some of the agents tested were mustard gas , lewisite , cyanic acid gas , white phosphorus , adamsite , and phosgene gas . A former army major and technician gave the following testimony anonymously (at the time of the interview, this man was a professor emeritus at a national university): In 1943, I attended a poison gas test held at the Unit 731 test facilities. A glass-walled chamber about three meters square [97 sq ft] and two meters [6.6 ft] high was used. Inside of it, a Chinese man was blindfolded, with his hands tied around a post behind him. The gas was adamsite (sneezing gas), and as the gas filled the chamber the man went into violent coughing convulsions and began to suffer excruciating pain. More than ten doctors and technicians were present. After I had watched for about ten minutes, I could not stand it any more, and left the area. I understand that other types of gasses were also tested there. Takeo Wano, a former medical worker in Unit 731, said that he saw a Western man, who was vertically cut into two pieces, pickled in a jar of formaldehyde . Wano guessed that the man was Russian because there were many Russians living in the area at that time. Unit 100 also experimented with toxic gas. Phone booth-like tanks were used as portable gas chambers for the prisoners. Some were forced to wear various types of gas masks ; others wore military uniforms, and some wore no clothes at all. Some of the tests have been described as "psychopathically sadistic, with no conceivable military application". For example, one experiment documented the time it took for three-day-old babies to freeze to death. Unit 731 also tested chemical weapons on prisoners in field conditions. A report authored by unknown researcher in the Kamo Unit (Unit 731) describes a large human experiment of yperite gas ( mustard gas ) on 7–10 September 1940. Twenty subjects were divided into three groups and placed in combat emplacements, trenches , gazebos, and observatories. One group was clothed with Chinese underwear, no hat, and no mask and was subjected to as much as 1,800 field gun rounds of yperite gas over 25 minutes. Another group was clothed in summer military uniform and shoes; three had masks and another three had no mask. They also were exposed to as much as 1,800 rounds of yperite gas. A third group was clothed in summer military uniform, three with masks and two without masks, and were exposed to as much as 4,800 rounds. Then their general symptoms and damage to skin, eye, respiratory organs , and digestive organs were observed at 4 hours, 24 hours, and 2, 3, and 5 days after the shots. Injecting the blister fluid from one subject into another subject and analyses of blood and soil were also performed. Five subjects were forced to drink a solution of yperite and lewisite gas in water, with or without decontamination . The report describes conditions of every subject precisely without mentioning what happened to them in the long run. The following is an excerpt of one of these reports: Number 376, dugout of the first area: September 7, 1940, 6 pm: Tired and exhausted. Looks with hollow eyes. Weeping redness of the skin of the upper part of the body. Eyelids edematous, swollen. Epiphora. Hyperemic conjunctivae. September 8, 6 am: Neck, breast, upper abdomen and scrotum weeping, reddened, swollen. Covered with millet-seed-size to bean-size blisters. Eyelids and conjunctivae hyperemic and edematous. Had difficulties opening the eyes. September 8, 6 pm: Tired and exhausted. Feels sick. Body temperature 37 degrees Celsius. Mucous and bloody erosions across the shoulder girdle. Abundant mucous nose secretions. Abdominal pain. Mucous and bloody diarrhea. Proteinuria. September 9, 7 am: Tired and exhausted. Weakness of all four extremities. Low morale. Body temperature 37 degrees Celsius. Skin of the face still weeping. Army Engineer Hisato Yoshimura conducted experiments by taking captives outside, dipping various appendages into water of varying temperatures, and allowing the limb to freeze . Once frozen, Yoshimura would strike their affected limbs with a short stick, "emitting a sound resembling that which a board gives when it is struck." Ice was then chipped away, with the affected area being subjected to various treatments, such as being doused in water, exposed to the heat of fire, etc. Members of the Unit referred to Yoshimura as a "scientific devil" and a "cold-blooded animal" because he would conduct his work with strictness. Naoji Uezono, a member of Unit 731, described in a 1980s interview a grisly scene where Yoshimura had "two naked men put in an area 40–50 degrees below zero and researchers filmed the whole process until [the subjects] died. [The subjects] suffered such agony they were digging their nails into each other's flesh." Yoshimura's lack of remorse was evident in an article he wrote for the Japanese Journal of Physiology in 1950 in which he admitted to using 20 children and a three-day-old infant in experiments which exposed them to zero-degree-Celsius ice and salt water. Although this article drew criticism, Yoshimura denied any guilt when contacted by a reporter from the Mainichi Shimbun . [ user-generated source? ] Yoshimura developed a "resistance index of frostbite" based on the mean temperature 5 to 30 minutes after immersion in freezing water, the temperature of the first rise after immersion, and the time until the temperature first rises after immersion. In a number of separate experiments it was then determined how these parameters depend on the time of day a victim's body part was immersed in freezing water, the surrounding temperature and humidity during immersion, how the victim had been treated before the immersion ("after keeping awake for a night", "after hunger for 24 hours", "after hunger for 48 hours", "immediately after heavy meal", "immediately after hot meal", "immediately after muscular exercise", "immediately after cold bath", "immediately after hot bath"), what type of food the victim had been fed over the five days preceding the immersions with regard to dietary nutrient intake ("high protein (of animal nature)", "high protein (of vegetable nature)", "low protein intake", and "standard diet"), and salt intake (45 g NaCl per day, 15 g NaCl per day, no salt). This original data is seen in the attached figure. Unit members orchestrated forced sex acts between infected and non-infected prisoners to transmit the disease, as the testimony of a prison guard on the subject of devising a method for transmission of syphilis between patients shows: Infection of venereal disease by injection was abandoned, and the researchers started forcing the prisoners into sexual acts with each other. Four or five unit members, dressed in white laboratory clothing completely covering the body with only eyes and mouth visible, rest covered, handled the tests. A male and female, one infected with syphilis, would be brought together in a cell and forced into sex with each other. It was made clear that anyone resisting would be shot. After victims were infected, they were vivisected at different stages of infection, so that internal and external organs could be observed as the disease progressed. Testimony from multiple guards blames the female victims as being hosts of the diseases, even as they were forcibly infected. Genitals of female prisoners that were infected with syphilis were called "jam-filled buns" by guards. Some children grew up inside the walls of Unit 731, infected with syphilis. A Youth Corps member deployed to train at Unit 731 recalled viewing a batch of subjects that would undergo syphilis testing: "one was a Chinese woman holding an infant, one was a White Russian woman with a daughter of four or five years of age, and the last was a White Russian woman with a boy of about six or seven." The children of these women were tested in ways similar to their parents, with specific emphasis on determining how longer infection periods affected the effectiveness of treatments. Female prisoners were forced to become pregnant for use in experiments. The hypothetical possibility of vertical transmission (from mother to child) of diseases, particularly syphilis, was the stated reason for the torture. Fetal survival and damage to mother's reproductive organs were objects of interest. Though "a large number of babies were born in captivity," there have been no accounts of any survivors of Unit 731, children included. It is suspected that the children of female prisoners were killed after birth or aborted . While male prisoners were often used in single studies, so that the results of the experimentation on them would not be clouded by other variables, women were sometimes used in bacteriological or physiological experiments, sex experiments, and as the victims of sex crimes . The testimony of a unit member that served as a guard graphically demonstrated this reality: One of the former researchers I located told me that one day he had a human experiment scheduled, but there was still time to kill. So he and another unit member took the keys to the cells and opened one that housed a Chinese woman. One of the unit members raped her; the other member took the keys and opened another cell. There was a Chinese woman in there who had been used in a frostbite experiment. She had several fingers missing and her bones were black, with gangrene set in. He was about to rape her anyway, then he saw that her sex organ was festering, with pus oozing to the surface. He gave up the idea, left and locked the door, then later went on to his experimental work. Army Engineer Hisato Yoshimura conducted experiments by taking captives outside, dipping various appendages into water of varying temperatures, and allowing the limb to freeze . Once frozen, Yoshimura would strike their affected limbs with a short stick, "emitting a sound resembling that which a board gives when it is struck." Ice was then chipped away, with the affected area being subjected to various treatments, such as being doused in water, exposed to the heat of fire, etc. Members of the Unit referred to Yoshimura as a "scientific devil" and a "cold-blooded animal" because he would conduct his work with strictness. Naoji Uezono, a member of Unit 731, described in a 1980s interview a grisly scene where Yoshimura had "two naked men put in an area 40–50 degrees below zero and researchers filmed the whole process until [the subjects] died. [The subjects] suffered such agony they were digging their nails into each other's flesh." Yoshimura's lack of remorse was evident in an article he wrote for the Japanese Journal of Physiology in 1950 in which he admitted to using 20 children and a three-day-old infant in experiments which exposed them to zero-degree-Celsius ice and salt water. Although this article drew criticism, Yoshimura denied any guilt when contacted by a reporter from the Mainichi Shimbun . [ user-generated source? ] Yoshimura developed a "resistance index of frostbite" based on the mean temperature 5 to 30 minutes after immersion in freezing water, the temperature of the first rise after immersion, and the time until the temperature first rises after immersion. In a number of separate experiments it was then determined how these parameters depend on the time of day a victim's body part was immersed in freezing water, the surrounding temperature and humidity during immersion, how the victim had been treated before the immersion ("after keeping awake for a night", "after hunger for 24 hours", "after hunger for 48 hours", "immediately after heavy meal", "immediately after hot meal", "immediately after muscular exercise", "immediately after cold bath", "immediately after hot bath"), what type of food the victim had been fed over the five days preceding the immersions with regard to dietary nutrient intake ("high protein (of animal nature)", "high protein (of vegetable nature)", "low protein intake", and "standard diet"), and salt intake (45 g NaCl per day, 15 g NaCl per day, no salt). This original data is seen in the attached figure.Unit members orchestrated forced sex acts between infected and non-infected prisoners to transmit the disease, as the testimony of a prison guard on the subject of devising a method for transmission of syphilis between patients shows: Infection of venereal disease by injection was abandoned, and the researchers started forcing the prisoners into sexual acts with each other. Four or five unit members, dressed in white laboratory clothing completely covering the body with only eyes and mouth visible, rest covered, handled the tests. A male and female, one infected with syphilis, would be brought together in a cell and forced into sex with each other. It was made clear that anyone resisting would be shot. After victims were infected, they were vivisected at different stages of infection, so that internal and external organs could be observed as the disease progressed. Testimony from multiple guards blames the female victims as being hosts of the diseases, even as they were forcibly infected. Genitals of female prisoners that were infected with syphilis were called "jam-filled buns" by guards. Some children grew up inside the walls of Unit 731, infected with syphilis. A Youth Corps member deployed to train at Unit 731 recalled viewing a batch of subjects that would undergo syphilis testing: "one was a Chinese woman holding an infant, one was a White Russian woman with a daughter of four or five years of age, and the last was a White Russian woman with a boy of about six or seven." The children of these women were tested in ways similar to their parents, with specific emphasis on determining how longer infection periods affected the effectiveness of treatments.Female prisoners were forced to become pregnant for use in experiments. The hypothetical possibility of vertical transmission (from mother to child) of diseases, particularly syphilis, was the stated reason for the torture. Fetal survival and damage to mother's reproductive organs were objects of interest. Though "a large number of babies were born in captivity," there have been no accounts of any survivors of Unit 731, children included. It is suspected that the children of female prisoners were killed after birth or aborted . While male prisoners were often used in single studies, so that the results of the experimentation on them would not be clouded by other variables, women were sometimes used in bacteriological or physiological experiments, sex experiments, and as the victims of sex crimes . The testimony of a unit member that served as a guard graphically demonstrated this reality: One of the former researchers I located told me that one day he had a human experiment scheduled, but there was still time to kill. So he and another unit member took the keys to the cells and opened one that housed a Chinese woman. One of the unit members raped her; the other member took the keys and opened another cell. There was a Chinese woman in there who had been used in a frostbite experiment. She had several fingers missing and her bones were black, with gangrene set in. He was about to rape her anyway, then he saw that her sex organ was festering, with pus oozing to the surface. He gave up the idea, left and locked the door, then later went on to his experimental work. In 2002, Changde , China, site of the plague flea bombing, held an "International Symposium on the Crimes of Bacteriological Warfare," which estimated that the number of people slaughtered by the Imperial Japanese Army germ warfare and other human experiments was around 580,000. : xii, 173 The American historian Sheldon H. Harris states that over 200,000 died. In addition to Chinese casualties, 1,700 Japanese troops in Zhejiang during Zhejiang-Jiangxi campaign were killed by their own biological weapons while attempting to unleash the biological agent, indicating serious issues with distribution. Harris also said plague-infected animals were released near the end of the war, and caused plague outbreaks that killed at least 30,000 people in the Harbin area from 1946 to 1948. Some test subjects were selected to gather a wide cross-section of the population and included common criminals, captured bandits, anti-Japanese partisans , political prisoners , homeless and mentally disabled people, which included infants, men, the elderly and pregnant women, as well as those rounded up by the Kenpeitai military police for alleged "suspicious activities." Unit 731 staff included approximately 300 researchers, including doctors and bacteriologists . At least 3,000 men, women, and children : 117 —of which at least 600 every year were provided by the Kenpeitai —were subjected to Unit 731 experimentation conducted at the Pingfang camp alone, not including victims from other medical experimentation sites such as Unit 100 . Although 3,000 internal victims is the widely accepted figure in the literature, former Unit member Okawa Fukumatsu claims that there were at least 10,000 victims of internal experiments at the Unit, he himself vivisecting thousands. According to A. S. Wells, the majority of victims were Chinese , with a lesser percentage being Russian , Mongolian , and Korean . They may also have included a small number of European, American, Indian, Australian, and New Zealander prisoners of war . A member of the Yokusan Sonendan paramilitary political youth branch, who worked for Unit 731, stated that not only were Chinese, Russians, and Koreans present, but also Americans, British, and French people. Sheldon H. Harris documented that the victims were generally political dissidents , communist sympathizers, ordinary criminals, impoverished civilians, and the mentally disabled. Author Seiichi Morimura estimates that almost 70 percent of the victims who died in the Pingfang camp were Chinese (both military and civilian), while close to 30 percent of the victims were Russian. No one who entered Unit 731 came out alive. Prisoners were usually received into Unit 731 at night in motor vehicles painted black with a ventilation hole but no windows. The vehicle would pull up at the main gates and one of the drivers would go to the guardroom and report to the guard. That guard would then telephone to the "Special Team" in the inner-prison ( Shiro Ishii's brother was head of this Special Team). Then, the prisoners would be transported through a secret tunnel dug under the facade of the central building to the inner-prisons. One of the prisons housed women and children (Building 8), while the other prison housed men (Building 7). Once at the inner-prison, technicians would take samples of the prisoners' blood and stool, test their kidney function , and collect other physical data. Once deemed healthy and fit for experimentation, prisoners lost their names and were given a three-digit number, which they retained until their death. Whenever prisoners died after the experiments they had been subjected to, a clerk of the 1st Division struck their numbers off an index card and took the deceased prisoner's manacles to be put on new arrivals to the prison. There is at least one recorded instance of "friendly" social interaction between prisoners and Unit 731 staff. Technician Naokata Ishibashi interacted with two female prisoners, a 21-year-old Chinese woman and a 19-year-old Ukrainian woman. The two prisoners told Ishibashi that they had not seen their faces in a mirror since being captured and begged him to get one. Ishibashi snuck a mirror to them through a hole in the cell door. The prison cells had wooden floors and a squat toilet in each. There was space between the outer walls of the cells and the outer walls of the prison, enabling the guards to walk behind the cells. Each cell door had a small window in it. Chief of the Personnel Division of the Kwantung Army Headquarters Tamura Tadashi testified that, when he was shown the inner-prison, he looked into the cells and saw living people in chains, some moved around, others were lying on the bare floor and were in a very sick and helpless condition. Former Unit 731 Youth Corps member Yoshio Shinozuka testified that the windows in these prison doors were so small that it was difficult to see in. The inner-prison was a highly secured building complete with cast iron doors. No one could enter without special permits and an ID pass with a photograph, and the entry/exit times were recorded. The "special team" worked in these two inner-prison buildings. This team wore white overall suits, army hats, rubber boots, and pistols strapped to their sides. Despite the prison's status as a highly secure building, at least one unsuccessful escape attempt did occur. Corporal Kikuchi Norimitsu testified that he was told by another unit member that a prisoner "had shown violence and had struck the experimenter with a door handle" and then "jumped out of the cell and ran down the corridor, seized the keys and opened the iron doors and some of the cells. Some of the prisoners managed to jump out but these were only the bold ones. These bold ones were shot." Seiichi Morimura in his book The Devil's Feast went into some greater detail regarding this escape attempt. Two Russian male prisoners were in a cell with handcuffs on, one of them lay flat on the floor pretending to be sick. This got the attention of a staff member who saw it as an unusual condition. That staff member decided to enter the cell. The Russian lying on the floor suddenly sprang up and knocked the guard down. The two Russians opened their handcuffs, took the keys, and opened some other cells while yelling. Some prisoners, including Russian and Chinese, were frantically roaming the corridors and kept yelling and shouting. One Russian shouted to the members of Unit 731, demanding to be shot rather than used as an experimental object. This Russian was shot to death. One staff member, who was an eyewitness at this escape attempt, recalled: "spiritually we were all lost in front of the 'marutas' who had no freedom and no weapons. At that time we understood in our hearts that justice was not on our side." Unfortunately for the prisoners of Unit 731, escape was an impossibility. Even if they had managed to escape the quadrangle (itself a heavily fortified building full of staff), they would have had to get over a three-meter-high (9.8 ft) brick wall surrounding the complex, and then across a dry moat filled with electrified wire running around the perimeter of the complex. Members of Unit 731 were not immune from being subjects of experiments. Yoshio Tamura, an assistant in the Special Team, recalled that Yoshio Sudō, an employee of the first division at Unit 731, became infected with bubonic plague as a result of the production of plague bacteria. The Special Team was then ordered to vivisect Sudō. Tamura recalled: Sudō had, a few days previously, been interested in talking about women, but now he was thin as a rake, with many purple spots over his body. A large area of scratches on his chest were bleeding. He painfully cried and breathed with difficulty. I sanitised his whole body with disinfectant. Whenever he moved, a rope around his neck tightened. After Sudō's body was carefully checked [by the surgeon], I handed a scalpel to [the surgeon] who, reversely gripping the scalpel, touched Sudō's stomach skin and sliced downward. Sudō shouted "brute!" and died with this last word. Additionally, Unit 731 Youth Corps member Yoshio Shinozuka testified that his friend junior assistant Mitsuo Hirakawa was vivisected as a result of being accidentally infected with plague. Despite the prison's status as a highly secure building, at least one unsuccessful escape attempt did occur. Corporal Kikuchi Norimitsu testified that he was told by another unit member that a prisoner "had shown violence and had struck the experimenter with a door handle" and then "jumped out of the cell and ran down the corridor, seized the keys and opened the iron doors and some of the cells. Some of the prisoners managed to jump out but these were only the bold ones. These bold ones were shot." Seiichi Morimura in his book The Devil's Feast went into some greater detail regarding this escape attempt. Two Russian male prisoners were in a cell with handcuffs on, one of them lay flat on the floor pretending to be sick. This got the attention of a staff member who saw it as an unusual condition. That staff member decided to enter the cell. The Russian lying on the floor suddenly sprang up and knocked the guard down. The two Russians opened their handcuffs, took the keys, and opened some other cells while yelling. Some prisoners, including Russian and Chinese, were frantically roaming the corridors and kept yelling and shouting. One Russian shouted to the members of Unit 731, demanding to be shot rather than used as an experimental object. This Russian was shot to death. One staff member, who was an eyewitness at this escape attempt, recalled: "spiritually we were all lost in front of the 'marutas' who had no freedom and no weapons. At that time we understood in our hearts that justice was not on our side." Unfortunately for the prisoners of Unit 731, escape was an impossibility. Even if they had managed to escape the quadrangle (itself a heavily fortified building full of staff), they would have had to get over a three-meter-high (9.8 ft) brick wall surrounding the complex, and then across a dry moat filled with electrified wire running around the perimeter of the complex. Members of Unit 731 were not immune from being subjects of experiments. Yoshio Tamura, an assistant in the Special Team, recalled that Yoshio Sudō, an employee of the first division at Unit 731, became infected with bubonic plague as a result of the production of plague bacteria. The Special Team was then ordered to vivisect Sudō. Tamura recalled: Sudō had, a few days previously, been interested in talking about women, but now he was thin as a rake, with many purple spots over his body. A large area of scratches on his chest were bleeding. He painfully cried and breathed with difficulty. I sanitised his whole body with disinfectant. Whenever he moved, a rope around his neck tightened. After Sudō's body was carefully checked [by the surgeon], I handed a scalpel to [the surgeon] who, reversely gripping the scalpel, touched Sudō's stomach skin and sliced downward. Sudō shouted "brute!" and died with this last word. Additionally, Unit 731 Youth Corps member Yoshio Shinozuka testified that his friend junior assistant Mitsuo Hirakawa was vivisected as a result of being accidentally infected with plague. There are unit members who were known to be interned at the Fushun War Criminals Management Centre and Taiyuan War Criminals Management Centre after the war, who then went on to be repatriated to Japan and founded the Association of Returnees from China and testified about Unit 731 and the crimes perpetrated there. Some members included: In April 2018, the National Archives of Japan disclosed a nearly complete list of 3,607 members of Unit 731 to Katsuo Nishiyama , a professor at Shiga University of Medical Science . Nishiyama reportedly intended to publish the list online to encourage further study into the unit. Previously disclosed members included: Twelve members were formally tried and sentenced in the Khabarovsk war crimes trials :Unit 731 was divided into eight divisions:Unit 731 had other units underneath it in the chain of command ; there were several other units under the auspice of Japan's biological weapons programs . Most or all Units had branch offices, which were also often referred to as "Units." The term Unit 731 can refer to the Harbin complex, or it can refer to the organization and its branches, sub-Units and their branches. The Unit 731 complex covered six square kilometers (2.3 sq mi) and consisted of more than 150 buildings. The design of the facilities made them hard to destroy by bombing. The complex contained various factories. It had around 4,500 containers to be used to raise fleas , six cauldrons to produce various chemicals, and around 1,800 containers to produce biological agents. Approximately 30 kilograms (66 lb) of bubonic plague bacteria could be produced in a few days. Some of Unit 731's satellite (branch) facilities are still in use by various Chinese industrial companies. A portion has been preserved and is open to visitors as a museum . Unit 731 had branches in Linkou (Branch 162), Mudanjiang , Hailin (Branch 643), Sunwu (Branch 673), Toan , and Hailar (Branch 543). : 60, 84, 124, 310 A medical school and research facility belonging to Unit 731 operated in the Shinjuku District of Tokyo during World War II. In 2006, Toyo Ishii—a nurse who worked at the school during the war—revealed that she had helped bury bodies and pieces of bodies on the school's grounds shortly after Japan's surrender in 1945. In response, in February 2011 the Ministry of Health began to excavate the site. While Tokyo courts acknowledged in 2002 that Unit 731 has been involved in biological warfare research, as of 2011 [ update ] the Japanese government had made no official acknowledgment of the atrocities committed against test subjects and rejected the Chinese government's requests for DNA samples to identify human remains (including skulls and bones) found near an army medical school. At Tokyo's Kyushu Imperial University in 1945, US POWs from a shot down B-29 were subjected to fatal medical experimentation . Unit 731 had branches in Linkou (Branch 162), Mudanjiang , Hailin (Branch 643), Sunwu (Branch 673), Toan , and Hailar (Branch 543). : 60, 84, 124, 310A medical school and research facility belonging to Unit 731 operated in the Shinjuku District of Tokyo during World War II. In 2006, Toyo Ishii—a nurse who worked at the school during the war—revealed that she had helped bury bodies and pieces of bodies on the school's grounds shortly after Japan's surrender in 1945. In response, in February 2011 the Ministry of Health began to excavate the site. While Tokyo courts acknowledged in 2002 that Unit 731 has been involved in biological warfare research, as of 2011 [ update ] the Japanese government had made no official acknowledgment of the atrocities committed against test subjects and rejected the Chinese government's requests for DNA samples to identify human remains (including skulls and bones) found near an army medical school. At Tokyo's Kyushu Imperial University in 1945, US POWs from a shot down B-29 were subjected to fatal medical experimentation . Operations and experiments continued until the end of the war. Ishii had wanted to use biological weapons in the Pacific War since May 1944, but his attempts were repeatedly snubbed. As the Second World War started to come to an end, all prisoners within the compound were killed to conceal evidence, and there were no documented survivors. With the coming of the Red Army in August 1945, the unit had to abandon their work in haste. Ministries in Tokyo ordered the destruction of all incriminating materials, including those in Pingfang . Potential witnesses, such as the 300 remaining prisoners, were either gassed or fed poison while the 600 Chinese and Manchurian laborers were shot. Ishii ordered every member of the group to disappear and "take the secret to the grave." Potassium cyanide vials were issued for use in case the remaining personnel were captured. Skeleton crews of Ishii's Japanese troops blew up the compound in the final days of the war to destroy evidence of their activities, but many were sturdy enough to remain somewhat intact. Among the individuals in Japan after its 1945 surrender was Lieutenant Colonel Murray Sanders , who arrived in Yokohama via the American ship Sturgess in September 1945. Sanders was a highly regarded microbiologist and a member of America's military center for biological weapons. Sanders' duty was to investigate Japanese biological warfare activity. At the time of his arrival in Japan, he had no knowledge of what Unit 731 was. Until Sanders finally threatened the Japanese with bringing the Soviets into the picture, little information about biological warfare was being shared with the Americans. The Japanese wanted to avoid prosecution under the Soviet legal system , so, the morning after he made his threat, Sanders received a manuscript describing Japan's involvement in biological warfare. Sanders took this information to General Douglas MacArthur , who was the Supreme Commander of the Allied Powers and responsible for rebuilding Japan during the Allied occupations. MacArthur struck a deal with Japanese informants : he secretly granted immunity to the physicians of Unit 731, including their leader, in exchange for providing exclusive American access to their research on biological warfare and data from human experimentation. American occupation authorities monitored the activities of former unit members, including reading and censoring their mail. The Americans believed that the research data was valuable and did not want other nations, particularly the Soviet Union, to acquire data on biological weapons. The Tokyo War Crimes Tribunal heard only one reference to Japanese experiments with "poisonous serums" on Chinese civilians. This took place in August 1946 and was instigated by David Sutton, assistant to the Chinese prosecutor. The Japanese defense counsel argued that the claim was vague and uncorroborated and it was dismissed by the tribunal president, Sir William Webb , for lack of evidence. The subject was not pursued further by Sutton, who was probably unaware of Unit 731's activities. His reference to it at the trial is believed to have been accidental. Later in 1981, one of the last surviving members of the Tokyo Tribunal, Judge Röling, had expressed bitterness in not being made aware of the suppression of evidence of Unit 731 and wrote, "It is a bitter experience for me to be informed now that centrally ordered Japanese war criminality of the most disgusting kind was kept secret from the court by the U.S. government." While German physicians were brought to trial and had their crimes publicized, the U.S. concealed information about Japanese biological warfare experiments and secured immunity for the perpetrators. Critics argue that racism led to the double standard in the American postwar responses to the experiments conducted on different nationalities. Whereas the perpetrators of Unit 731 were exempt from prosecution, the U.S. held a tribunal in Yokohama in 1948 that indicted nine Japanese physician professors and medical students for conducting vivisection upon captured American pilots; two professors were sentenced to death and others to 15–20 years' imprisonment. Although publicly silent on the issue at the Tokyo Trials, the Soviet Union pursued the case and prosecuted 12 top military leaders and scientists from Unit 731 and its affiliated biological-war prisons Unit 1644 in Nanjing and Unit 100 in Changchun in the Khabarovsk war crimes trials . Among those accused of war crimes , including germ warfare, was General Otozō Yamada , commander-in-chief of the million-man Kwantung Army occupying Manchuria. The trial of the Japanese perpetrators was held in Khabarovsk in December 1949; a lengthy partial transcript of trial proceedings was published in different languages the following year by the Moscow foreign languages press, including an English-language edition. The lead prosecuting attorney at the Khabarovsk trial was Lev Smirnov , who had been one of the top Soviet prosecutors at the Nuremberg Trials . The Japanese doctors and army commanders who had perpetrated the Unit 731 experiments received sentences from the Khabarovsk court ranging from 2 to 25 years in a Siberian labor camp . The United States refused to acknowledge the trials, branding them communist propaganda. The sentences doled out to the Japanese perpetrators were unusually lenient by Soviet standards, and all but two of the defendants returned to Japan by the 1950s (with one prisoner dying in prison and the other committing suicide inside his cell). In addition to the accusations of propaganda, the US also asserted that the trials were to only serve as a distraction from the Soviet treatment of several hundred thousand Japanese prisoners of war; meanwhile, the USSR asserted that the US had given the Japanese diplomatic leniency in exchange for information about their human experimentation. However, former Unit 731 members had also passed information about their biological experimentation to the Soviet government in exchange for judicial leniency. This was evidenced by the Soviet Union building a biological weapons facility in Sverdlovsk using documentation captured from Unit 731 in Manchuria. As above, during the United States occupation of Japan, the members of Unit 731 and the members of other experimental units were allowed to go free. On 6 May 1947, Douglas MacArthur , the Supreme Commander of the Allied Forces , wrote to Washington in order to inform it that "additional data, possibly some statements from Ishii, can probably be obtained by informing Japanese involved that information will be retained in intelligence channels and will not be employed as 'war crimes' evidence". According to an investigation by The Guardian , after the end of the war, under the pretense of vaccine development, former members of Unit 731 conducted human experiments on Japanese prisoners, babies and mental patients, with secret funding from the U.S. Government. One graduate of Unit 1644 , Masami Kitaoka, continued to perform experiments on unwilling Japanese subjects from 1947 to 1956. He performed his experiments while he was working for Japan's National Institute of Health Sciences. He infected prisoners with rickettsia and infected mentally-ill patients with typhus . As the chief of the unit, Shiro Ishii was granted immunity from prosecution for war crimes by the American occupation authorities, because he had provided human experimentation research materials to them. From 1948 to 1958, less than five percent of the documents were transferred onto microfilm and stored in the US National Archives before they were shipped back to Japan. Japanese discussions of Unit 731's activity began in the 1950s, after the end of the American occupation of Japan . In 1952, an infant girl at Nagoya City Pediatric Hospital died after being infected with E coli bacteria; the incident was publicly tied to former Unit 731 scientists. Later in that decade, journalists suspected that the murders attributed by the government to Sadamichi Hirasawa were actually carried out by members of Unit 731. In 1958, Japanese author Shūsaku Endō published the book The Sea and Poison about human experimentation in Fukuoka , which is thought to have been based on a real incident. In 1950, former members of Unit 731 including Masaji Kitano founded the blood bank and pharmaceutical company Green Cross , for which Murray Sanders also served as a consultant. The company became the target of a scandal in the 1980s after up to 3,000 Japanese contracted HIV through the distribution and use of its blood products, which were deemed unsafe. The author Seiichi Morimura published The Devil's Gluttony [ ja ] (悪魔の飽食) in 1981, followed by The Devil's Gluttony: A Sequel in 1983. These books purported to reveal the "true" operations of Unit 731, but falsely attributed unrelated photos to the Unit, which raised questions about their accuracy. Also in 1981, the first direct testimony of human vivisection in China was given by Ken Yuasa . Since then, much more in depth testimony has been given in Japan. The 2001 documentary Japanese Devils largely consists of interviews with fourteen Unit 731 staff members taken prisoner by China and later released. Japanese biological warfare operations were by far the largest during WWII, and "possibly with more people and resources than the BW producing nations of France , Hungary , Italy , Poland , and the Soviet Union combined, between the world wars. Despite the apparent success, Unit 731 lacked adequate scientific and engineering foundations to further maximize its effectiveness. Harris speculated that US scientists generally wanted to acquire it due to the concept of forbidden fruit , believing that lawful and ethical prohibitions could affect the outcomes of their research. During the COVID-19 pandemic , some scientists called for experimental data from Unit 731 to be publicly released to the international medical community because the data available on human-pathogen interactions could have helped epidemiologists with pandemic control. The information has been withheld by both the US and Japanese government. In 1983, the Japanese Ministry of Education asked Japanese historian Saburō Ienaga to remove a reference from one of his textbooks that stated Unit 731 conducted experiments on thousands of Chinese. The ministry alleged that no academic research supported the claim. In 1984, Japanese historian Tsuneishi Keiichi translated and published over 4,000 pages of U.S. documents on Japanese biological warfare. The ministry backed down after new studies were published in Japan and important evidence surfaced in the United States. Japanese history textbooks usually contain references to Unit 731, but do not go into detail about allegations, in accordance with this principle. Saburō Ienaga's New History of Japan included a detailed description, based on officers' testimony. The Ministry for Education attempted to remove this passage from his textbook before it was taught in public schools, on the basis that the testimony was insufficient. The Supreme Court of Japan ruled in 1997 that the testimony was indeed sufficient and that requiring it to be removed was an illegal violation of freedom of speech . In 1997, international lawyer Kōnen Tsuchiya filed a class action suit against the Japanese government, demanding reparations for the actions of Unit 731, using evidence filed by Professor Makoto Ueda of Rikkyo University . All levels of the Japanese court system found the suit baseless. No findings of fact were made about the existence of human experimentation, but the courts' ruling was that reparations are determined by international treaties , not national courts. [ citation needed ] In August 2002, the Tokyo district court ruled for the first time that Japan had engaged in biological warfare. Presiding judge Koji Iwata ruled that Unit 731, on the orders of the Imperial Japanese Army headquarters, used bacteriological weapons on Chinese civilians between 1940 and 1942, spreading diseases, including plague and typhoid , in the cities of Quzhou , Ningbo , and Changde . He rejected victims' compensation claims on the grounds that they had already been settled by international peace treaties. In October 2003, a member of Japan's House of Representatives filed an inquiry. Prime Minister Junichiro Koizumi responded that the Japanese government did not then possess any records related to Unit 731, but recognized the gravity of the matter and would publicize any records located in the future. In April 2018, the National Archives of Japan released the names of 3,607 members of Unit 731, in response to a request by Professor Katsuo Nishiyama of the Shiga University of Medical Science . After World War II, the Office of Special Investigations created a watchlist of suspected Axis collaborators and persecutors who are banned from entering the United States. While they have added over 60,000 names to the watchlist, they have only been able to identify under 100 Japanese participants. In a 1998 correspondence letter between the DOJ and Rabbi Abraham Cooper, Eli Rosenbaum, director of OSI, stated that this was due to two factors:As the Second World War started to come to an end, all prisoners within the compound were killed to conceal evidence, and there were no documented survivors. With the coming of the Red Army in August 1945, the unit had to abandon their work in haste. Ministries in Tokyo ordered the destruction of all incriminating materials, including those in Pingfang . Potential witnesses, such as the 300 remaining prisoners, were either gassed or fed poison while the 600 Chinese and Manchurian laborers were shot. Ishii ordered every member of the group to disappear and "take the secret to the grave." Potassium cyanide vials were issued for use in case the remaining personnel were captured. Skeleton crews of Ishii's Japanese troops blew up the compound in the final days of the war to destroy evidence of their activities, but many were sturdy enough to remain somewhat intact.Among the individuals in Japan after its 1945 surrender was Lieutenant Colonel Murray Sanders , who arrived in Yokohama via the American ship Sturgess in September 1945. Sanders was a highly regarded microbiologist and a member of America's military center for biological weapons. Sanders' duty was to investigate Japanese biological warfare activity. At the time of his arrival in Japan, he had no knowledge of what Unit 731 was. Until Sanders finally threatened the Japanese with bringing the Soviets into the picture, little information about biological warfare was being shared with the Americans. The Japanese wanted to avoid prosecution under the Soviet legal system , so, the morning after he made his threat, Sanders received a manuscript describing Japan's involvement in biological warfare. Sanders took this information to General Douglas MacArthur , who was the Supreme Commander of the Allied Powers and responsible for rebuilding Japan during the Allied occupations. MacArthur struck a deal with Japanese informants : he secretly granted immunity to the physicians of Unit 731, including their leader, in exchange for providing exclusive American access to their research on biological warfare and data from human experimentation. American occupation authorities monitored the activities of former unit members, including reading and censoring their mail. The Americans believed that the research data was valuable and did not want other nations, particularly the Soviet Union, to acquire data on biological weapons. The Tokyo War Crimes Tribunal heard only one reference to Japanese experiments with "poisonous serums" on Chinese civilians. This took place in August 1946 and was instigated by David Sutton, assistant to the Chinese prosecutor. The Japanese defense counsel argued that the claim was vague and uncorroborated and it was dismissed by the tribunal president, Sir William Webb , for lack of evidence. The subject was not pursued further by Sutton, who was probably unaware of Unit 731's activities. His reference to it at the trial is believed to have been accidental. Later in 1981, one of the last surviving members of the Tokyo Tribunal, Judge Röling, had expressed bitterness in not being made aware of the suppression of evidence of Unit 731 and wrote, "It is a bitter experience for me to be informed now that centrally ordered Japanese war criminality of the most disgusting kind was kept secret from the court by the U.S. government." While German physicians were brought to trial and had their crimes publicized, the U.S. concealed information about Japanese biological warfare experiments and secured immunity for the perpetrators. Critics argue that racism led to the double standard in the American postwar responses to the experiments conducted on different nationalities. Whereas the perpetrators of Unit 731 were exempt from prosecution, the U.S. held a tribunal in Yokohama in 1948 that indicted nine Japanese physician professors and medical students for conducting vivisection upon captured American pilots; two professors were sentenced to death and others to 15–20 years' imprisonment. Although publicly silent on the issue at the Tokyo Trials, the Soviet Union pursued the case and prosecuted 12 top military leaders and scientists from Unit 731 and its affiliated biological-war prisons Unit 1644 in Nanjing and Unit 100 in Changchun in the Khabarovsk war crimes trials . Among those accused of war crimes , including germ warfare, was General Otozō Yamada , commander-in-chief of the million-man Kwantung Army occupying Manchuria. The trial of the Japanese perpetrators was held in Khabarovsk in December 1949; a lengthy partial transcript of trial proceedings was published in different languages the following year by the Moscow foreign languages press, including an English-language edition. The lead prosecuting attorney at the Khabarovsk trial was Lev Smirnov , who had been one of the top Soviet prosecutors at the Nuremberg Trials . The Japanese doctors and army commanders who had perpetrated the Unit 731 experiments received sentences from the Khabarovsk court ranging from 2 to 25 years in a Siberian labor camp . The United States refused to acknowledge the trials, branding them communist propaganda. The sentences doled out to the Japanese perpetrators were unusually lenient by Soviet standards, and all but two of the defendants returned to Japan by the 1950s (with one prisoner dying in prison and the other committing suicide inside his cell). In addition to the accusations of propaganda, the US also asserted that the trials were to only serve as a distraction from the Soviet treatment of several hundred thousand Japanese prisoners of war; meanwhile, the USSR asserted that the US had given the Japanese diplomatic leniency in exchange for information about their human experimentation. However, former Unit 731 members had also passed information about their biological experimentation to the Soviet government in exchange for judicial leniency. This was evidenced by the Soviet Union building a biological weapons facility in Sverdlovsk using documentation captured from Unit 731 in Manchuria. As above, during the United States occupation of Japan, the members of Unit 731 and the members of other experimental units were allowed to go free. On 6 May 1947, Douglas MacArthur , the Supreme Commander of the Allied Forces , wrote to Washington in order to inform it that "additional data, possibly some statements from Ishii, can probably be obtained by informing Japanese involved that information will be retained in intelligence channels and will not be employed as 'war crimes' evidence". According to an investigation by The Guardian , after the end of the war, under the pretense of vaccine development, former members of Unit 731 conducted human experiments on Japanese prisoners, babies and mental patients, with secret funding from the U.S. Government. One graduate of Unit 1644 , Masami Kitaoka, continued to perform experiments on unwilling Japanese subjects from 1947 to 1956. He performed his experiments while he was working for Japan's National Institute of Health Sciences. He infected prisoners with rickettsia and infected mentally-ill patients with typhus . As the chief of the unit, Shiro Ishii was granted immunity from prosecution for war crimes by the American occupation authorities, because he had provided human experimentation research materials to them. From 1948 to 1958, less than five percent of the documents were transferred onto microfilm and stored in the US National Archives before they were shipped back to Japan. Japanese discussions of Unit 731's activity began in the 1950s, after the end of the American occupation of Japan . In 1952, an infant girl at Nagoya City Pediatric Hospital died after being infected with E coli bacteria; the incident was publicly tied to former Unit 731 scientists. Later in that decade, journalists suspected that the murders attributed by the government to Sadamichi Hirasawa were actually carried out by members of Unit 731. In 1958, Japanese author Shūsaku Endō published the book The Sea and Poison about human experimentation in Fukuoka , which is thought to have been based on a real incident. In 1950, former members of Unit 731 including Masaji Kitano founded the blood bank and pharmaceutical company Green Cross , for which Murray Sanders also served as a consultant. The company became the target of a scandal in the 1980s after up to 3,000 Japanese contracted HIV through the distribution and use of its blood products, which were deemed unsafe. The author Seiichi Morimura published The Devil's Gluttony [ ja ] (悪魔の飽食) in 1981, followed by The Devil's Gluttony: A Sequel in 1983. These books purported to reveal the "true" operations of Unit 731, but falsely attributed unrelated photos to the Unit, which raised questions about their accuracy. Also in 1981, the first direct testimony of human vivisection in China was given by Ken Yuasa . Since then, much more in depth testimony has been given in Japan. The 2001 documentary Japanese Devils largely consists of interviews with fourteen Unit 731 staff members taken prisoner by China and later released. Japanese biological warfare operations were by far the largest during WWII, and "possibly with more people and resources than the BW producing nations of France , Hungary , Italy , Poland , and the Soviet Union combined, between the world wars. Despite the apparent success, Unit 731 lacked adequate scientific and engineering foundations to further maximize its effectiveness. Harris speculated that US scientists generally wanted to acquire it due to the concept of forbidden fruit , believing that lawful and ethical prohibitions could affect the outcomes of their research. During the COVID-19 pandemic , some scientists called for experimental data from Unit 731 to be publicly released to the international medical community because the data available on human-pathogen interactions could have helped epidemiologists with pandemic control. The information has been withheld by both the US and Japanese government.In 1983, the Japanese Ministry of Education asked Japanese historian Saburō Ienaga to remove a reference from one of his textbooks that stated Unit 731 conducted experiments on thousands of Chinese. The ministry alleged that no academic research supported the claim. In 1984, Japanese historian Tsuneishi Keiichi translated and published over 4,000 pages of U.S. documents on Japanese biological warfare. The ministry backed down after new studies were published in Japan and important evidence surfaced in the United States. Japanese history textbooks usually contain references to Unit 731, but do not go into detail about allegations, in accordance with this principle. Saburō Ienaga's New History of Japan included a detailed description, based on officers' testimony. The Ministry for Education attempted to remove this passage from his textbook before it was taught in public schools, on the basis that the testimony was insufficient. The Supreme Court of Japan ruled in 1997 that the testimony was indeed sufficient and that requiring it to be removed was an illegal violation of freedom of speech . In 1997, international lawyer Kōnen Tsuchiya filed a class action suit against the Japanese government, demanding reparations for the actions of Unit 731, using evidence filed by Professor Makoto Ueda of Rikkyo University . All levels of the Japanese court system found the suit baseless. No findings of fact were made about the existence of human experimentation, but the courts' ruling was that reparations are determined by international treaties , not national courts. [ citation needed ] In August 2002, the Tokyo district court ruled for the first time that Japan had engaged in biological warfare. Presiding judge Koji Iwata ruled that Unit 731, on the orders of the Imperial Japanese Army headquarters, used bacteriological weapons on Chinese civilians between 1940 and 1942, spreading diseases, including plague and typhoid , in the cities of Quzhou , Ningbo , and Changde . He rejected victims' compensation claims on the grounds that they had already been settled by international peace treaties. In October 2003, a member of Japan's House of Representatives filed an inquiry. Prime Minister Junichiro Koizumi responded that the Japanese government did not then possess any records related to Unit 731, but recognized the gravity of the matter and would publicize any records located in the future. In April 2018, the National Archives of Japan released the names of 3,607 members of Unit 731, in response to a request by Professor Katsuo Nishiyama of the Shiga University of Medical Science . After World War II, the Office of Special Investigations created a watchlist of suspected Axis collaborators and persecutors who are banned from entering the United States. While they have added over 60,000 names to the watchlist, they have only been able to identify under 100 Japanese participants. In a 1998 correspondence letter between the DOJ and Rabbi Abraham Cooper, Eli Rosenbaum, director of OSI, stated that this was due to two factors:There have been several films about the atrocities of Unit 731. In Call of Duty: Black Ops III , the Zombies map included in the second DLC pack, "Zetsubou no Shima", is loosely inspired by Unit 731's divisions, with the story playing on the idea of a ninth hidden one aptly named 'Division 9'. In the indie horror game Spooky's Jumpscare Mansion , the Unit 731 experiments are explicitly referenced multiple times in terms of Specimen 9 (specifically stated to be a survivor of the Unit 731 experiments), as well as the labeling of human bodies as "logs": "I'm taking all those 'logs' they keep throwing out, and I'm nailing them together."There have been several films about the atrocities of Unit 731.In Call of Duty: Black Ops III , the Zombies map included in the second DLC pack, "Zetsubou no Shima", is loosely inspired by Unit 731's divisions, with the story playing on the idea of a ninth hidden one aptly named 'Division 9'. In the indie horror game Spooky's Jumpscare Mansion , the Unit 731 experiments are explicitly referenced multiple times in terms of Specimen 9 (specifically stated to be a survivor of the Unit 731 experiments), as well as the labeling of human bodies as "logs": "I'm taking all those 'logs' they keep throwing out, and I'm nailing them together."

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Demographics of India

India is the most populous country in the world with one-sixth of the world's population . According to estimates from the United Nations (UN), India has overtaken China as the country with the largest population in the world , with a population of 1,425,775,850 at the end of April 2023. Between 1975 and 2010, the population doubled to 1.2 billion, reaching the billion mark in 2000. According to the UN's World Population dashboard, India's population now stands at slightly over 1.428 billion, edging past China's population of 1.425 billion people, as reported by the news agency Bloomberg. its population is set to reach 1.7 billion by 2050. In 2017 its population growth rate was 0.98%, ranking 112th in the world; in contrast, from 1972 to 1983, India's population grew by an annual rate of 2.3%. In 2022, the median age of an Indian was 28.7 years, compared to 38.4 for China and 48.6 for Japan; and, by 2030; India's dependency ratio will be just over 0.4. However, the number of children in India peaked more than a decade ago and is now falling. The number of children under the age of five peaked in 2007, and since then the number has been falling. The number of Indians under 15 years old peaked slightly later (in 2011) and is now also declining. India has more than two thousand ethnic groups, and every major religion is represented, as are four major families of languages ( Indo-European , Dravidian , Austroasiatic and Sino-Tibetan languages ) as well as two language isolates : the Nihali language , spoken in parts of Maharashtra , and the Burushaski language, spoken in parts of Jammu and Kashmir . 1,000,000 people in India are Anglo-Indians and 700,000 United States citizens are living in India. They represent over 0.1% of the total population of India. Overall, only the continent of Africa exceeds the linguistic, genetic and cultural diversity of the nation of India. The sex ratio was 944 females for 1000 males in 2016, and 940 per 1000 in 2011. This ratio has been showing an upwards trend for the last two decades after a continuous decline in the 20th century. The following table lists estimates for the population of India (including what are now Pakistan and Bangladesh ) from prehistory up until 1820. It includes estimates and growth rates according to five economic historians, along with interpolated estimates and overall aggregate averages derived from their estimates. The population grew from the South Asian Stone Age in 10,000 BC to the Maurya Empire in 200 BC at a steadily increasing growth rate, before population growth slowed down in the classical era up to 500 AD, and then became largely stagnant during the early medieval era era up to 1000 AD. The population growth rate then increased in the late medieval era (during the Delhi Sultanate ) from 1000 to 1500. Under the Mughal Empire , India experienced a high economic and demographic upsurge, due to Mughal agrarian reforms that intensified agricultural production. 15% of the population lived in urban centres, higher than the percentage of the population in 19th-century British India and contemporary Europe up until the 19th century. These estimates by Abraham Eraly and Paolo Malanima have been criticised by Tim Dyson , who considers them exaggerations and estimates urbanisation of the Mughal Empire to be less than 9% of the population. Under the reign of Akbar (reigned 1556–1605) in 1600, the Mughal Empire's urban population was up to 17 million people, larger than the urban population in Europe. By 1700, Mughal India had an urban population of 23 million people, larger than British India's urban population of 22.3 million in 1871. Nizamuddin Ahmad (1551–1621) reported that, under Akbar's reign, Mughal India had 120 large cities and 3,200 townships. A number of cities in India had a population between a quarter-million and half-million people, with larger cities including Agra (in Agra Subah ) with up to 800,000 people and Dhaka (in Bengal Subah ) with over 1 million people. Mughal India also had a large number of villages, with 455,698 villages by the time of Aurangzeb (reigned 1658–1707). The total fertility rate is the number of children born per woman. It is based on fairly good data for the entire years. Sources: Our World in Data and Gapminder Foundation . Life expectancy from 1881 to 1950 The population of India under the British Raj (including what are now Pakistan and Bangladesh) according to censuses: Studies of India's population since 1881 have focused on such topics as total population, birth and death rates, geographic distribution, literacy, the rural and urban divide, cities of a million, and the three cities with populations over eight million: Delhi, Greater Mumbai (Bombay), and Kolkata (Calcutta). Mortality rates fell in the period 1920–45, primarily due to biological immunisation. Suggestions that it was the benefits of colonialism are refuted by academic thinking: "There can be no serious, informed belief… that… late colonial era mortality diminished and population grew rapidly because of improvements in income, living standards, nutrition, environmental standards, sanitation or health policies, nor was there a cultural transformation…". The following table lists estimates for the population of India (including what are now Pakistan and Bangladesh ) from prehistory up until 1820. It includes estimates and growth rates according to five economic historians, along with interpolated estimates and overall aggregate averages derived from their estimates. The population grew from the South Asian Stone Age in 10,000 BC to the Maurya Empire in 200 BC at a steadily increasing growth rate, before population growth slowed down in the classical era up to 500 AD, and then became largely stagnant during the early medieval era era up to 1000 AD. The population growth rate then increased in the late medieval era (during the Delhi Sultanate ) from 1000 to 1500. Under the Mughal Empire , India experienced a high economic and demographic upsurge, due to Mughal agrarian reforms that intensified agricultural production. 15% of the population lived in urban centres, higher than the percentage of the population in 19th-century British India and contemporary Europe up until the 19th century. These estimates by Abraham Eraly and Paolo Malanima have been criticised by Tim Dyson , who considers them exaggerations and estimates urbanisation of the Mughal Empire to be less than 9% of the population. Under the reign of Akbar (reigned 1556–1605) in 1600, the Mughal Empire's urban population was up to 17 million people, larger than the urban population in Europe. By 1700, Mughal India had an urban population of 23 million people, larger than British India's urban population of 22.3 million in 1871. Nizamuddin Ahmad (1551–1621) reported that, under Akbar's reign, Mughal India had 120 large cities and 3,200 townships. A number of cities in India had a population between a quarter-million and half-million people, with larger cities including Agra (in Agra Subah ) with up to 800,000 people and Dhaka (in Bengal Subah ) with over 1 million people. Mughal India also had a large number of villages, with 455,698 villages by the time of Aurangzeb (reigned 1658–1707). The total fertility rate is the number of children born per woman. It is based on fairly good data for the entire years. Sources: Our World in Data and Gapminder Foundation . Life expectancy from 1881 to 1950 The population of India under the British Raj (including what are now Pakistan and Bangladesh) according to censuses: Studies of India's population since 1881 have focused on such topics as total population, birth and death rates, geographic distribution, literacy, the rural and urban divide, cities of a million, and the three cities with populations over eight million: Delhi, Greater Mumbai (Bombay), and Kolkata (Calcutta). Mortality rates fell in the period 1920–45, primarily due to biological immunisation. Suggestions that it was the benefits of colonialism are refuted by academic thinking: "There can be no serious, informed belief… that… late colonial era mortality diminished and population grew rapidly because of improvements in income, living standards, nutrition, environmental standards, sanitation or health policies, nor was there a cultural transformation…". India occupies 2.41% of the world's land area but supports over 18% of the world's population. At the 2001 census 72.2% of the population lived in about 638,000 villages and the remaining 27.8% lived in more than 5,100 towns and over 380 urban agglomerations . India's population exceeded that of the entire continent of Africa by 200 million people in 2010. However, because Africa's population growth is extremely high compared to the rest of the world, it is expected to surpass both China and India by the early 2030s. The table below summarises India's demographics (excluding the Mao-Maram, Paomata and Purul subdivisions of Senapati district of Manipur state due to cancellation of census results) according to religion at the 2011 census in per cent. The data are "unadjusted" (without excluding Assam and Jammu and Kashmir ); the 1981 census was not conducted in Assam and the 1991 census was not conducted in Jammu and Kashmir. Missing citing/reference for "Changes in religious demagraphics over time" table below. The table below represents the infant mortality rate trends in India, based on sex, over the last 15 years. In the urban areas of India, average male infant mortality rates are slightly higher than average female infant mortality rates. India's 2011 census shows a serious decline in the number of girls under the age of seven – activists posit that eight million female fetuses may have been aborted between 2001 and 2011. Mother tongue languages of India ( 2011 ) According to the 2001 census, 41.03% of the Indians spoke Hindi natively, while the rest spoke Assamese , Bengali , Gujarati , Maithili , Kannada , Malayalam , Marathi , Odia , Punjabi , Tamil , Telugu , Urdu and a variety of other languages. There are a total of 122 languages and 234 mother tongues spoken in India. Of these, 22 languages are specified in the Eighth Schedule of Indian Constitution , while 100 are non-specified. The table below excludes Mao-Maram, Paomata and Purul subdivisions of Senapati District of Manipur state due to cancellation of census results.The table below summarises India's demographics (excluding the Mao-Maram, Paomata and Purul subdivisions of Senapati district of Manipur state due to cancellation of census results) according to religion at the 2011 census in per cent. The data are "unadjusted" (without excluding Assam and Jammu and Kashmir ); the 1981 census was not conducted in Assam and the 1991 census was not conducted in Jammu and Kashmir. Missing citing/reference for "Changes in religious demagraphics over time" table below.The table below represents the infant mortality rate trends in India, based on sex, over the last 15 years. In the urban areas of India, average male infant mortality rates are slightly higher than average female infant mortality rates. India's 2011 census shows a serious decline in the number of girls under the age of seven – activists posit that eight million female fetuses may have been aborted between 2001 and 2011. Mother tongue languages of India ( 2011 ) According to the 2001 census, 41.03% of the Indians spoke Hindi natively, while the rest spoke Assamese , Bengali , Gujarati , Maithili , Kannada , Malayalam , Marathi , Odia , Punjabi , Tamil , Telugu , Urdu and a variety of other languages. There are a total of 122 languages and 234 mother tongues spoken in India. Of these, 22 languages are specified in the Eighth Schedule of Indian Constitution , while 100 are non-specified. The table below excludes Mao-Maram, Paomata and Purul subdivisions of Senapati District of Manipur state due to cancellation of census results.Source: UN World Population Prospects Structure of the population (Census 9.II.2011) Population Estimates by Sex and Age Group (03.III.2016) (Data are projections based on the 2011 Population Census.): Population Estimates by Sex and Age Group (01.III.2021) (Includes data for the Indian-held part of Jammu and Kashmir, the final status of which has not yet been determined. Data are projections based on the 2011 Population Census.): From the Demographic Health Survey: Source: UN World Population Prospects Structure of the population (Census 9.II.2011) Population Estimates by Sex and Age Group (03.III.2016) (Data are projections based on the 2011 Population Census.): Population Estimates by Sex and Age Group (01.III.2021) (Includes data for the Indian-held part of Jammu and Kashmir, the final status of which has not yet been determined. Data are projections based on the 2011 Population Census.): From the Demographic Health Survey: The following demographic statistics are from the CIA World Factbook , unless otherwise indicated. 1,166,079,217 (July 2009 est. CIA), 1,210 million (2011 census), 1,389,637,446 (May 2022 est.) 62.2%; male: 381,668,992, female: 360,948,755 0–14 years: 27.34% (male 186,087,665/female 164,398,204) 15–24 years: 17.9% (male 121,879,786/female 107,583,437) 25–54 years: 41.08% (male 271,744,709/female 254,834,569) 55–64 years: 7.45% (male 47,846,122/female 47,632,532) 65+ years: 6.24% (male 37,837,801/female 42,091,086) (2017 est.) Total: 28.7 years Male: 28 years female: 29.5 years (2020 est.) 0.67% (2022 est) 74% (age 7 and above, in 2011) 81.4% (total population, age 15–25, in 2006) 22% (2006 est.) 7.8% 0.00 migrant(s)/1,000 population (2020 est.) At birth: 1.12 male(s)/female Under 10 years: 1.13 male(s)/female 15–24 years: 1.13 male(s)/female 24–64 years: 1.06 male(s)/female 65 years and over: 0.9 male(s)/female Total population: 1.08 male(s)/female (2017 est.) Total population: 69.7 years Male: 68.4 years Female: 71.2 years (2020 est.) 2.35 (2020 est.) The TFR (total number of children born per women) by religion in 2005–2006 was: Hindus, 2.7; Muslims, 3.1; Christians, 2.4; and Sikhs, 2.0. Hindus 79.5%, Muslims 15%, Christian 2.3%, Sikh 1.7%, other and unspecified 2% (2011 est.) Scheduled castes: 16.6% (2011 census); scheduled tribes: 8.6% (2011 census) See Languages of India and List of languages by number of native speakers in India . There are 216 languages with more than 10,000 native speakers in India. The largest of these is Hindi with some 337 million, and the second largest is Bengali with 238 million. 22 languages are recognised as official languages . In India, there are 1,652 languages and dialects in total. Caste and community statistics as recorded from "Socially and Educationally Backward Classes Commission" (SEBC) or Mandal Commission of 1979. This was completed in 1983. India has chosen not to officially count caste population since then. The following data are from the Mandal report: [ citation needed ]The national Census of India does not recognise racial or ethnic groups within India, but recognises many of the tribal groups as Scheduled Castes and Tribes (see list of Scheduled Tribes in India ). According to a 2009 study published by Reich et al. ., the modern Indian population is composed of two genetically divergent and heterogeneous populations which mixed in ancient times (about 1,200–3,500 BP), known as Ancestral North Indians (ANI) and Ancestral South Indians (ASI). ASI corresponds to the Dravidian-speaking population of southern India, whereas ANI corresponds to the Indo-Aryan-speaking population of northern India. 700,000 people from the United States of any race live in India. Between 300,000 and 1 million Anglo-Indians live in India. For a list of ethnic groups in the Republic of India (as well as neighbouring countries), see South Asian ethnic groups . Linguistic groups in India chart Y-Chromosome DNA Y-DNA represents the male lineage, The Indian Y-chromosome pool may be summarised as follows where haplogroups R-M420 , H , R2 , L and NOP comprise generally more than 80% of the total chromosomes. Mitochondrial DNA mtDNA represents the female lineage. The Indian mitochondrial DNA is primarily made up of Haplogroup M Numerous genomic studies have been conducted in the last 15 years to seek insights into India's demographic and cultural diversity. These studies paint a complex and conflicting picture. Y-Chromosome DNA Y-DNA represents the male lineage, The Indian Y-chromosome pool may be summarised as follows where haplogroups R-M420 , H , R2 , L and NOP comprise generally more than 80% of the total chromosomes. Mitochondrial DNA mtDNA represents the female lineage. The Indian mitochondrial DNA is primarily made up of Haplogroup M Numerous genomic studies have been conducted in the last 15 years to seek insights into India's demographic and cultural diversity. These studies paint a complex and conflicting picture.

Wiki

Cholera

https://api.wikimedia.org/core/v1/wikipedia/en/page/GM1/html

GM1

InChI=1S/C73H131N3O31/c1-5-7-9-11-13-15-17-19-20-22-24-26-28-30-32-34-52(87)76-44(45(84)33-31-29-27-25-23-21-18-16-14-12-10-8-6-2)41-98-69-61(94)59(92)63(50(39-80)101-69)103-71-62(95)67(107-73(72(96)97)35-46(85)53(74-42(3)82)66(106-73)55(88)47(86)36-77)64(51(40-81)102-71)104-68-54(75-43(4)83)65(57(90)49(38-79)99-68)105-70-60(93)58(91)56(89)48(37-78)100-70/h31,33,44-51,53-71,77-81,84-86,88-95H,5-30,32,34-41H2,1-4H3,(H,74,82)(H,75,83)(H,76,87)(H,96,97)/b33-31+/t44?,45?,46-,47?,48+,49+,50+,51+,53+,54+,55?,56-,57-,58-,59+,60+,61+,62+,63+,64-,65+,66-,67+,68-,69+,70-,71-,73-/m0/s1 Y Key: QPJBWNIQKHGLAU-BVLUPYCXSA-N Y InChI=1/C73H131N3O31/c1-5-7-9-11-13-15-17-19-20-22-24-26-28-30-32-34-52(87)76-44(45(84)33-31-29-27-25-23-21-18-16-14-12-10-8-6-2)41-98-69-61(94)59(92)63(50(39-80)101-69)103-71-62(95)67(107-73(72(96)97)35-46(85)53(74-42(3)82)66(106-73)55(88)47(86)36-77)64(51(40-81)102-71)104-68-54(75-43(4)83)65(57(90)49(38-79)99-68)105-70-60(93)58(91)56(89)48(37-78)100-70/h31,33,44-51,53-71,77-81,84-86,88-95H,5-30,32,34-41H2,1-4H3,(H,74,82)(H,75,83)(H,76,87)(H,96,97)/b33-31+/t44?,45?,46-,47?,48+,49+,50+,51+,53+,54+,55?,56-,57-,58-,59+,60+,61+,62+,63+,64-,65+,66-,67+,68-,69+,70-,71-,73-/m0/s1 Key: QPJBWNIQKHGLAU-BVLUPYCXBP O[C@H]1[C@H](O[C@@H]2O[C@H](CO)[C@H](O[C@@H]3O[C@H](CO)[C@H](O)[C@H](O[C@@H]4O[C@H](CO)[C@H](O)[C@H](O)[C@H]4O)[C@H]3NC(C)=O)[C@H](O[C@@]5(C(O)=O)O[C@@]([H])([C@H](O)[C@H](O)CO)[C@H](NC(C)=O)[C@@H](O)C5)[C@H]2O)[C@@H](CO)O[C@@H](OC[C@@H]([C@@H](O)/C=C/CCCCCCCCCCCCCCC)NC(CCCCCCCCCCCCCCCCCCC)=O)[C@@H]1O GM1 ( monosialotetrahexosylganglioside ) the "prototype" ganglioside , is a member of the ganglio series of gangliosides which contain one sialic acid residue. GM1 has important physiological properties and impacts neuronal plasticity and repair mechanisms, and the release of neurotrophins in the brain . Besides its function in the physiology of the brain, GM1 acts as the site of binding for both cholera toxin and E. coli heat-labile enterotoxin ( Traveller's diarrhea ). Galactosidases are enzymes that break down GM1, and the failure to remove GM1 results in GM1 gangliosidosis. GM1 gangliosidosis are inherited disorders that progressively destroy neurons in the brain and spinal cord as GM1 accumulates. Without treatment, this results in developmental decline and muscle weakness, eventually leading to severe retardation and death.Antibodies to GM1 are increased in Guillain–Barré syndrome , dementia and lupus but their function is not clear. There is some evidence to suggest antibodies against GM1 are associated with diarrhea in Guillain–Barré syndrome. GM1 antibodies are also seen in Multifocal Motor Neuropathy (MMN) , a rare antibody-mediated inflammatory neuropathy.The bacteria Vibrio cholerae produces a multimeric toxin called the cholera toxin . The secreted toxin attaches to the surface of the host mucosa cell by binding to GM1 gangliosides. GM1 consists of a sialic acid-containing oligosaccharide covalently attached to a ceramide lipid. The A1 subunit of this toxin will gain entry to intestinal epithelial cells with the assistance of the B subunit via the GM1 ganglioside receptor. Once inside, the A1 subunit will ADP ribosylate the Gs alpha subunit , which will prevent its GTPase activity. This will lock it in the active state and it will continuously stimulate adenylate cyclase. The sustained adenylate cyclase activity will lead to a sustained increase of cAMP which will cause electrolyte and water loss, causing diarrhea . [ citation needed ] The SGLT1 receptor is present in the small intestine. When the cholera patient is given a solution containing water, sodium and glucose , the SGLT1 receptor will reabsorb sodium and glucose, while water will be passively absorbed with the sodium. This will replace the water and electrolyte loss in the cholera-induced diarrhea.Because of GM1's close role in neuron repair mechanisms, it has been investigated as a possible drug to slow or even reverse the progression of a wide range of neurodegenerative conditions . Controlled phase II studies have indicated that GM1 can ease the symptoms of Parkinson's disease , presumably by countering degeneration of the substantia nigra , and a similar methodology has been pursued to try and limit cellular damage from necrosis and apoptosis occurring after acute spinal cord injury .

Wiki

Cholera

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Great Stink

The Great Stink was an event in Central London during July and August 1858 in which the hot weather exacerbated the smell of untreated human waste and industrial effluent that was present on the banks of the River Thames . The problem had been mounting for some years, with an ageing and inadequate sewer system that emptied directly into the Thames. The miasma from the effluent was thought to transmit contagious diseases, and three outbreaks of cholera before the Great Stink were blamed on the ongoing problems with the river. The smell, and fears of its possible effects, prompted action from the national and local administrators who had been considering possible solutions for the problem. The authorities accepted a proposal from the civil engineer Joseph Bazalgette to move the effluent eastwards along a series of interconnecting sewers that sloped towards outfalls beyond the metropolitan area. Work on high-, mid- and low-level systems for the new Northern and Southern Outfall Sewers started at the beginning of 1859 and lasted until 1875. To aid the drainage, pumping stations were placed to lift the sewage from lower levels into higher pipes. Two of the more ornate stations, Abbey Mills in Stratford and Crossness on the Erith Marshes , with architectural designs from the consultant engineer, Charles Driver , are listed for protection by English Heritage . Bazalgette's plan introduced the three embankments to London in which the sewers ran—the Victoria , Chelsea and Albert Embankments . Bazalgette's work ensured that sewage was no longer dumped onto the shores of the Thames and brought an end to the cholera outbreaks; his actions are thought to have saved more lives than the efforts of any other Victorian official. His sewer system operates into the 21st century, servicing a city that has grown to a population of over eight million. The historian Peter Ackroyd argues that Bazalgette should be considered a hero of London.Brick sewers had been built in London from the 17th century when sections of the Fleet and Walbrook rivers were covered for that purpose. [lower-alpha 1] In the century preceding 1856, over a hundred sewers were constructed in London, and at that date the city had around 200,000 cesspits and 360 sewers. Some cesspits leaked methane and other gases, which often caught fire and exploded, while many of the sewers were in a poor state of repair. During the early 19th century improvements had been undertaken in the supply of water to Londoners, and by 1858 many of the city's medieval wooden water pipes were being replaced with iron ones. This, combined with the introduction of flushing toilets and the rising of the city's population from just under one million to three million, [lower-alpha 2] led to more water being flushed into the sewers, along with the associated effluent . The outfalls from factories, slaughterhouses and other industrial activities put further strain on the already failing system. Much of this outflow either overflowed, or discharged directly, into the Thames. The scientist Michael Faraday described the situation in a letter to The Times in July 1855: shocked at the state of the Thames, he dropped pieces of white paper into the river to "test the degree of opacity". His conclusion was that "Near the bridges the feculence rolled up in clouds so dense that they were visible at the surface, even in water of this kind. ... The smell was very bad, and common to the whole of the water; it was the same as that which now comes up from the gully-holes in the streets; the whole river was for the time a real sewer." The smell from the river was so bad that in 1857 the government poured chalk lime, chloride of lime and carbolic acid into the river to ease the stench. The prevailing thought in Victorian healthcare concerning the transmission of contagious diseases was the miasma theory , which held that most communicable diseases were caused by the inhalation of contaminated air. This contamination could take the form of the odour of rotting corpses or sewage, but also rotting vegetation, or the exhaled breath of someone already diseased. Miasma was believed by most to be the vector of transmission of cholera , which was on the rise in 19th-century Europe. The disease was deeply feared by all, because of the speed with which it could spread, and its high fatality rates. London's first major cholera epidemic struck in 1831 when the disease claimed 6,536 victims. In 1848–49 there was a second outbreak in which 14,137 London residents died, and this was followed by a further outbreak in 1853–54 in which 10,738 died. During the second outbreak, John Snow , a London-based physician, noticed that the rates of death were higher in those areas supplied by the Lambeth and the Southwark and Vauxhall water companies. In 1849 he published a paper, On the Mode of Communication of Cholera , which posited the theory of the water-borne transmission of disease, rather than the miasma theory; little attention was paid to the paper. Following the third cholera outbreak in 1854 , Snow published an update to his treatise, after he focused on the effects in Broad Street, Soho. Snow had removed the handle from the local water pump, thus preventing access to the contaminated water, with a resulting fall in deaths. It was later established that a leaking sewer ran near the well from which the water was drawn. The civic infrastructure overseeing the management of London's sewers had gone through several changes in the 19th century. In 1848 the Metropolitan Commission of Sewers (MCS) was established at the urging of the social reformer Edwin Chadwick and a Royal Commission. [lower-alpha 3] The Commission superseded seven of the eight authorities that had managed London's sewers since the time of Henry VIII ; [lower-alpha 4] it was the first time that a unitary power had full control over the capital's sanitation facilities. The Building Act 1844 had ensured that all new buildings had to be connected to a sewer, not a cesspool, and the commission set about connecting cesspools to sewers, or removing them altogether. Because of the fear that the miasma from the sewers would cause the spread of disease, Chadwick and his successor, the pathologist John Simon , ensured that the sewers were regularly flushed through, a policy that resulted in more sewage being discharged into the Thames. In August 1849 the MCS appointed Joseph Bazalgette to the position of assistant surveyor. He had been working as a consultant engineer in the railway industry until overwork had brought about a serious breakdown in his health; his appointment to the commission was his first position on his return to employment. Working under the chief engineer, Frank Foster, he began to develop a more systematic plan for the city's sewers. The stress of the position was too much for Foster and he died in 1852; Bazalgette was promoted into his position, and continued refining and developing the plans for the development of the sewerage system. The Metropolis Management Act 1855 replaced the commission with the Metropolitan Board of Works (MBW), which took control of the sewers. [lower-alpha 5] By June 1856 Bazalgette completed his definitive plans, which provided for small, local sewers about 3 feet (0.9 m) in diameter to feed into a series of larger sewers until they drained into main outflow pipes 11 feet (3.4 m) high. A Northern and Southern Outfall Sewer were planned to manage the waste for each side of the river. London was mapped into high-, middle- and low-level areas, with a main sewer servicing each; a series of pumping stations was planned to remove the waste towards the east of the city. Bazalgette's plan was based on that of Foster, but was larger in scale, and allowed for more of a rise in population than Foster's – from 3 to 4.5 million. Bazalgette submitted his plans to Sir Benjamin Hall , the First Commissioner of Works . [lower-alpha 6] Hall had reservations about the outfalls—the discharge points of waste outlets into other bodies of water—from the sewers, which he said were still within the bounds of the capital, and were therefore unacceptable. During the ongoing discussions, Bazalgette refined and modified his plans, in line with Hall's demands. In December 1856 Hall submitted the plans to a group of three consultant engineers, Captain Douglas Strutt Galton of the Royal Engineers , James Simpson , an engineer with two water companies, and Thomas Blackwood, the chief engineer on the Kennet and Avon Canal . The trio reported back to Hall in July 1857 with proposed changes to the positions of the outfall, which he passed on to the MBW in October. The new proposed discharge points were to be open sewers, running 15 miles (24 km) beyond the positions proposed by the board; the cost of their plans was to be over £5.4 million, considerably more than the maximum estimate of Bazalgette's plan, which was £2.4 million. [lower-alpha 7] In February 1858 a general election saw the fall of Lord Palmerston 's Whig government , which was replaced by Lord Derby 's second Conservative ministry ; Lord John Manners replaced Hall, and Benjamin Disraeli was appointed Leader of the House of Commons and Chancellor of the Exchequer . By mid-1858 the problems with the Thames had been building for several years. In his novel Little Dorrit —published as a serial between 1855 and 1857— Charles Dickens wrote that the Thames was "a deadly sewer ... in the place of a fine, fresh river". In a letter to a friend, Dickens said: "I can certify that the offensive smells, even in that short whiff, have been of a most head-and-stomach-distending nature", while the social scientist and journalist George Godwin wrote that "in parts the deposit is more than six feet deep" on the Thames foreshore, and that "the whole of this is thickly impregnated with impure matter". In June 1858 the temperatures in the shade in London averaged 34–36 °C (93–97 °F) —rising to 48 °C (118 °F) in the sun. Combined with an extended spell of dry weather, the level of the Thames dropped and raw effluent from the sewers remained on the banks of the river. Queen Victoria and Prince Albert attempted to take a pleasure cruise on the Thames, but returned to shore within a few minutes because the smell was so terrible. The press soon began calling the event "The Great Stink"; the leading article in the City Press observed that "Gentility of speech is at an end—it stinks, and whoso once inhales the stink can never forget it and can count himself lucky if he lives to remember it". A writer for The Standard concurred with the opinion. One of its reporters described the river as a "pestiferous and typhus breeding abomination", while a second wrote that "the amount of poisonous gases which is thrown off is proportionate to the increase of the sewage which is passed into the stream". The leading article in The Illustrated London News commented that: We can colonise the remotest ends of the earth; we can conquer India; we can pay the interest of the most enormous debt ever contracted; we can spread our name, and our fame, and our fructifying wealth to every part of the world; but we cannot clean the River Thames. By June the stench from the river had become so bad that business in Parliament was affected, and the curtains on the river side of the building were soaked in lime chloride to overcome the smell. The measure was not successful, and discussions were held about possibly moving the business of government to Oxford or St Albans . The Examiner reported that Disraeli, on attending one of the committee rooms, left shortly afterwards with the other members of the committee, "with a mass of papers in one hand, and with his pocket handkerchief applied to his nose" because the smell was so bad. The disruption to its legislative work led to questions being raised in the House of Commons. According to Hansard , the Member of Parliament (MP) John Brady informed Manners that members were unable to use either the Committee Rooms or the Library because of the stench, and asked the minister "if the noble Lord has taken any measures for mitigating the effluvium and discontinuing the nuisance". Manners replied that the Thames was not under his jurisdiction. Four days later a second MP said to Manners that "By a perverse ingenuity, one of the noblest of rivers has been changed into a cesspool, and I wish to ask whether Her Majesty's Government intend to take any steps to remedy the evil?" Manners pointed out "that Her Majesty's Government have nothing whatever to do with the state of the Thames". The satirical magazine Punch commented that "The one absorbing topic in both Houses of Parliament ... was the Conspiracy to Poison question. Of the guilt of that old offender, Father Thames, there was the most ample evidence". At the height of the stink, 200 to 250 long tons (220 to 280 short tons) of lime were being used near the mouths of the sewers that discharged into the Thames, and men were employed spreading lime onto the Thames foreshore at low tide; the cost was £1,500 per week. [lower-alpha 8] On 15 June Disraeli tabled the Metropolis Local Management Amendment Bill, a proposed amendment to the 1855 Act; in the opening debate he called the Thames "a Stygian pool, reeking with ineffable and intolerable horrors". The Bill put the responsibility to clear up the Thames on the MBW, and stated that "as far as may be possible" the sewerage outlets should not be within the boundaries of London; it also allowed the Board to borrow £3 million, which was to be repaid from a three-penny levy on all London households for the next forty years. The terms favoured Bazalgette's original 1856 plan, and overcame Hall's objection to it. The leading article in The Times observed that "Parliament was all but compelled to legislate upon the great London nuisance by the force of sheer stench". The bill was debated in late July and was passed into law on 2 August. Bazalgette's plans for the 1,100 miles (1,800 km) of additional street sewers (collecting both effluent and rainwater), which would feed into 82 miles (132 km) of main interconnecting sewers, were put out to tender between 1859 and 1865. Four hundred draftsmen worked on the detailed plans and sectional views for the first phase of the building process. There were several engineering challenges to be overcome, particularly the fact that parts of London—including the area around Lambeth and Pimlico —lie below the high-water mark. Bazalgette's plan for the low-level areas was to lift the sewage from low-lying sewers at key points into the mid- and high-level sewers, which would then drain with the aid of gravity, out towards the eastern outfalls at a gradient of 2 feet per mile (38 cm/km) . Bazalgette was a proponent of the use of Portland cement , a material stronger than standard cement, but with a weakness when over-heated. To overcome the problem he instituted a quality control system to test batches of cement, that is described by the historian Stephen Halliday as both "elaborate" and "draconian". The results were fed back to the manufacturers, who altered their production processes to further improve the product. One of the cement manufacturers commented that the MBW were the first public body to use such testing processes. The progress of Bazalgette's works was reported favourably in the press. Paul Dobraszczyk , the architectural historian, describes the coverage as presenting many of the workers "in a positive, even heroic, light", and in 1861 The Observer described the progress on the sewers as "the most expensive and wonderful work of modern times". Construction costs were so high that in July 1863 an additional £1.2 million was lent to the MBW to cover the cost of the work. The southern system, across the less populated suburbs of London, was the smaller and easier part of the system to build. Three main sewers ran from Putney , Wandsworth and Norwood until they linked together in Deptford . At that point a pumping station lifted the effluent 21 feet (6.4 m) into the main outflow sewer, which ran to the Crossness Pumping Station on the Erith Marshes , where it was discharged into the Thames at high tide. The newly built station at Crossness was designed by Bazalgette and a consultant engineer, Charles Driver , a proponent of the use of cast iron as a building material. The building was in a Romanesque style and the interior contains architectural cast ironwork which English Heritage describe as important. The power for pumping the large amount of sewage was provided by four massive beam engines , named Victoria, Prince Consort, Albert Edward and Alexandra, which were manufactured by James Watt and Co. The station was opened in April 1865 by the Prince of Wales —the future King Edward VII —who officially started the engines. The ceremony, which was attended by other members of royalty, MPs, the Lord Mayor of London and the Archbishops of Canterbury and York , was followed by a dinner for 500 within the building. The ceremony marked the completion of construction of the Southern Outfall Sewers, and the beginning of their operation. With the successful completion of the southern outflow, one of the board members of the MBW, an MP named Miller, proposed a bonus for Bazalgette. The board agreed and were prepared to pay the engineer £6,000—three times his annual salary—with an additional £4,000 to be shared among his three assistants. Although the idea was subsequently dropped following criticism, Halliday observes that the large amounts discussed "at a time when parsimony was the dominant characteristic of public expenditure is a firm indication of the depth of public interest and approval that appears to have characterised the work." [lower-alpha 9] The northern side of the Thames was the more populous, housing two-thirds of London's population, and the works had to proceed through congested streets and overcome such urban hurdles as canals, bridges and railway lines. Work began on the system on 31 January 1859, but the builders encountered numerous problems in construction, including a labourers' strike in 1859–60, hard frosts in winter, and heavier than normal rainfall. The rain was so heavy in June 1862 that an accident occurred at the works re-building the Fleet sewer. The deep excavations were running parallel to the excavation of a cutting at Clerkenwell for the Metropolitan Railway (now the Metropolitan line ), and the 8 + 1 ⁄ 2 -foot (2.6 m) wall dividing the two trenches collapsed, spilling the waters of the Fleet onto Victoria Street, damaging the gas and water mains. The high-level sewer—the most northern of the works—ran from Hampstead Heath to Stoke Newington and across Victoria Park , where it joined with the eastern end of the mid-level sewer. The mid-level sewer began in the west at Bayswater and ran along Oxford Street , through Clerkenwell and Bethnal Green , before the connection. This combined main sewer ran to the Abbey Mills Pumping Station in Stratford , where it was joined by the eastern end of the low-level sewer. The pumps at Abbey Mills lifted the effluent from the low-level sewer 36 feet (11 m) into the main sewer. This main sewer ran 5 miles (8 km) —along what is now known as the Greenway —to the outfall at Beckton . Like the Crossness Pumping Station, Abbey Mills was a joint design by Bazalgette and Driver. Above the centre of the engine-house was an ornate dome that, Dobraszczyk considers, gives the building a "superficial resemblance ... to a Byzantine church". The architectural historian Nikolaus Pevsner , in his Buildings of England , thought the building showed "exciting architecture applied to the most foul purposes"; he went on to describe it as "an unorthodox mix, vaguely Italian Gothic in style but with tiers of Byzantine windows and a central octagonal lantern that adds a gracious Russian flavour". To provide the drainage for the low-level sewers, in February 1864 Bazalgette began building three embankments along the shores of the Thames. On the northern side he built the Victoria Embankment , which runs from Westminster to Blackfriars Bridge , and the Chelsea Embankment , running from Millbank to the Cadogan Pier at Chelsea. The southern side contains the Albert Embankment , from the Lambeth end of Westminster Bridge to Vauxhall . He ran the sewers along the banks of the Thames, building up walls on the foreshore, running the sewer pipes inside and infilling around them. The works claimed over 52 acres (21 ha) of land from the Thames; the Victoria Embankment had the added benefit of relieving the congestion on the pre-existing roads between Westminster and the City of London . The cost of building the embankments was estimated at £1.71 million, of which £450,000 was used for purchasing the necessary river-front properties, which tended to be for light industrial use. [lower-alpha 10] The Embankment project was seen as being nationally important and, with the Queen unable to attend because of illness, the Victoria Embankment was opened by the Prince of Wales in July 1870. The Albert Embankment had been completed in November 1869, while the Chelsea Embankment was opened in July 1874. Bazalgette considered the Embankment project "one of the most difficult and intricate things the ... [MBW] have had to do", and shortly after the Chelsea Embankment was opened, he was knighted . In 1875 the work on the western drainage was completed, and the system became operational. The building work had required 318 million bricks and 880,000 cubic yards (670,000 m 3 ) of concrete and mortar; the final cost was approximately £6.5 million. [lower-alpha 11]The southern system, across the less populated suburbs of London, was the smaller and easier part of the system to build. Three main sewers ran from Putney , Wandsworth and Norwood until they linked together in Deptford . At that point a pumping station lifted the effluent 21 feet (6.4 m) into the main outflow sewer, which ran to the Crossness Pumping Station on the Erith Marshes , where it was discharged into the Thames at high tide. The newly built station at Crossness was designed by Bazalgette and a consultant engineer, Charles Driver , a proponent of the use of cast iron as a building material. The building was in a Romanesque style and the interior contains architectural cast ironwork which English Heritage describe as important. The power for pumping the large amount of sewage was provided by four massive beam engines , named Victoria, Prince Consort, Albert Edward and Alexandra, which were manufactured by James Watt and Co. The station was opened in April 1865 by the Prince of Wales —the future King Edward VII —who officially started the engines. The ceremony, which was attended by other members of royalty, MPs, the Lord Mayor of London and the Archbishops of Canterbury and York , was followed by a dinner for 500 within the building. The ceremony marked the completion of construction of the Southern Outfall Sewers, and the beginning of their operation. With the successful completion of the southern outflow, one of the board members of the MBW, an MP named Miller, proposed a bonus for Bazalgette. The board agreed and were prepared to pay the engineer £6,000—three times his annual salary—with an additional £4,000 to be shared among his three assistants. Although the idea was subsequently dropped following criticism, Halliday observes that the large amounts discussed "at a time when parsimony was the dominant characteristic of public expenditure is a firm indication of the depth of public interest and approval that appears to have characterised the work." [lower-alpha 9]The northern side of the Thames was the more populous, housing two-thirds of London's population, and the works had to proceed through congested streets and overcome such urban hurdles as canals, bridges and railway lines. Work began on the system on 31 January 1859, but the builders encountered numerous problems in construction, including a labourers' strike in 1859–60, hard frosts in winter, and heavier than normal rainfall. The rain was so heavy in June 1862 that an accident occurred at the works re-building the Fleet sewer. The deep excavations were running parallel to the excavation of a cutting at Clerkenwell for the Metropolitan Railway (now the Metropolitan line ), and the 8 + 1 ⁄ 2 -foot (2.6 m) wall dividing the two trenches collapsed, spilling the waters of the Fleet onto Victoria Street, damaging the gas and water mains. The high-level sewer—the most northern of the works—ran from Hampstead Heath to Stoke Newington and across Victoria Park , where it joined with the eastern end of the mid-level sewer. The mid-level sewer began in the west at Bayswater and ran along Oxford Street , through Clerkenwell and Bethnal Green , before the connection. This combined main sewer ran to the Abbey Mills Pumping Station in Stratford , where it was joined by the eastern end of the low-level sewer. The pumps at Abbey Mills lifted the effluent from the low-level sewer 36 feet (11 m) into the main sewer. This main sewer ran 5 miles (8 km) —along what is now known as the Greenway —to the outfall at Beckton . Like the Crossness Pumping Station, Abbey Mills was a joint design by Bazalgette and Driver. Above the centre of the engine-house was an ornate dome that, Dobraszczyk considers, gives the building a "superficial resemblance ... to a Byzantine church". The architectural historian Nikolaus Pevsner , in his Buildings of England , thought the building showed "exciting architecture applied to the most foul purposes"; he went on to describe it as "an unorthodox mix, vaguely Italian Gothic in style but with tiers of Byzantine windows and a central octagonal lantern that adds a gracious Russian flavour". To provide the drainage for the low-level sewers, in February 1864 Bazalgette began building three embankments along the shores of the Thames. On the northern side he built the Victoria Embankment , which runs from Westminster to Blackfriars Bridge , and the Chelsea Embankment , running from Millbank to the Cadogan Pier at Chelsea. The southern side contains the Albert Embankment , from the Lambeth end of Westminster Bridge to Vauxhall . He ran the sewers along the banks of the Thames, building up walls on the foreshore, running the sewer pipes inside and infilling around them. The works claimed over 52 acres (21 ha) of land from the Thames; the Victoria Embankment had the added benefit of relieving the congestion on the pre-existing roads between Westminster and the City of London . The cost of building the embankments was estimated at £1.71 million, of which £450,000 was used for purchasing the necessary river-front properties, which tended to be for light industrial use. [lower-alpha 10] The Embankment project was seen as being nationally important and, with the Queen unable to attend because of illness, the Victoria Embankment was opened by the Prince of Wales in July 1870. The Albert Embankment had been completed in November 1869, while the Chelsea Embankment was opened in July 1874. Bazalgette considered the Embankment project "one of the most difficult and intricate things the ... [MBW] have had to do", and shortly after the Chelsea Embankment was opened, he was knighted . In 1875 the work on the western drainage was completed, and the system became operational. The building work had required 318 million bricks and 880,000 cubic yards (670,000 m 3 ) of concrete and mortar; the final cost was approximately £6.5 million. [lower-alpha 11]In 1866 there was a further cholera outbreak in London that claimed 5,596 lives, although it was confined to an area of the East End between Aldgate and Bow . At the time that was a part of London which had not been connected to Bazalgette's system, and 93 per cent of the fatalities occurred within the area. The fault lay with the East London Water Company, who discharged their sewage half a mile ( 800 m ) downriver from their reservoir: the sewage was being carried upriver into the reservoir on the incoming tide, contaminating the area's drinking water. The outbreak and the diagnosis of its causes led to the acceptance that cholera was water-borne, not transmitted by miasma. The Lancet , relating details of the investigation into the incident by Dr William Farr , stated that his report "will render irresistible the conclusions at which he has arrived in regard to the influence of the water-supply in causation of the epidemic." It was the last outbreak of the disease in the capital. In 1878 a Thames pleasure-steamer, the SS Princess Alice , collided with the collier Bywell Castle and sank, causing over 650 deaths. The accident took place close to the outfalls and questions were raised in the British press over whether the sewage was responsible for some of the deaths. In the 1880s further fears over possible health concerns because of the outfalls led to the MBW purifying sewage at Crossness and Beckton, rather than dumping the untreated waste into the river, and a series of six sludge boats were ordered to ship effluent into the North Sea for dumping. The first boat commissioned in 1887 was named the SS Bazalgette ; the procedure remained in service until December 1998, when the dumping stopped and an incinerator was used to dispose of the waste. The sewers were expanded in the late 19th century and again in the early 20th century. The drainage network is, as at 2015, managed by Thames Water , and is used by up to eight million people a day. The company said in 2014 that "the system is struggling to cope with the demands of 21st-century London". Crossness Pumping Station remained in use until the mid-1950s when it was replaced. The engines were too large to remove and were left in situ , although they fell into a state of disrepair. The station itself became a grade I listed building with the Ministry of Public Building and Works in June 1970 (since replaced by English Heritage). [lower-alpha 12] The building and its engines are, as of 2015 [ update ] , under restoration by the Crossness Engines Trust. The president of the trust is the British television producer Peter Bazalgette , the great-great-grandson of Joseph. As at 2015 part of the Abbey Mill facility continues to operate as a sewage pumping station. The building's large double chimneys were removed during the Second World War following fears that they could be used by the Luftwaffe as landmarks for navigation, and the building became a grade II* listed building with the Ministry of Works in November 1974. The provision of an integrated and fully functioning sewer system for the capital, together with the associated drop in cholera cases, led the historian John Doxat to state that Bazalgette "probably did more good, and saved more lives, than any single Victorian official". Bazalgette continued to work at the MBW until 1889, during which time he replaced three of London's bridges: Putney in 1886, Hammersmith in 1887 and Battersea in 1890. He was appointed president of the Institution of Civil Engineers (ICE) in 1884, and in 1901 a monument commemorating his life was opened on the Victoria Embankment. [lower-alpha 13] When he died in March 1891, his obituarist in The Illustrated London News wrote that Bazalgette's "two great titles to fame are that he beautified London and drained it", while Sir John Coode , the president of ICE at the time, said that Bazalgette's work "will ever remain as monuments to his skill and professional ability". The obituarist for The Times opined that "when the New Zealander comes to London a thousand years hence ... the magnificent solidity and the faultless symmetry of the great granite blocks which form the wall of the Thames-embankment will still remain." He continued, "the great sewer that runs beneath Londoners ... has added some 20 years to their chance of life". The historian Peter Ackroyd , in his history of subterranean London , considers that "with [John] Nash and [Christopher] Wren , Bazalgette enters the pantheon of London heroes" because of his work, particularly the building of the Victoria and Albert Embankments.

Wiki

Cholera

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2018–2019 Zimbabwe cholera outbreak

The 2018–2019 Zimbabwe cholera outbreak began on 1 September 2018, and the last reported case occurred on 12 March 2019. The Zimbabwean government declared a national emergency on 6 September 2018. The cholera outbreak originated in Glenview , a suburb in Harare , Zimbabwe's capital city, and then spread to the following provinces in Zimbabwe: Manicaland , Mashonaland East , Mashonaland West , Bulawayo , Mashonaland Central , Midlands , Masvingo and Matebeleland South . The last report from the World Health Organization (WHO) Afro regional office has listed the outbreak as a closed event with the outbreak running from 6 September 2018 to 12 March 2019. They were a total of 10,730 suspected cases however the confirmed cases were only 371. There were several risk factors associated with the outbreak described by the WHO, including intermittent supplies in Harare, particularly in high-density suburbs such as Glenview, the epicenter of the outbreak. The city council was also unable to supply enough water for Harare, creating shortages due to the increasing urban population. These shortages led to sanitation issues as people began to use unregulated wells and boreholes, leading people in Harare drinking contaminated water. The deteriorating sanitation infrastructure is leading to issues such as raw sewage flowing in areas of Harare. Another sanitation issue was the informal traders selling items such as fruit exacerbating the outbreak. Four cholera treatment centers were set up in Harare to deal with the initial outbreaking cholera. The WHO began a campaign to vaccinate 1.4 million people in Harare against cholera for people living in areas at most risk of contracting the disease in October 2018. To address the water supply issues in key hotspots affected by cholera through increasing water supply through water trucking, adding water tanks, and repairing existing water infrastructure. To address sanitation issues, items such as soap and chlorination tablets were distributed to households in hotspot areas.

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Cholera

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Diarrhea

Diarrhea ( American English ), also spelled diarrhoea or diarrhœa ( British English ), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination , loss of skin color , a fast heart rate , and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed , however, are normal. The most common cause is an infection of the intestines due to either a virus , bacterium , or parasite —a condition also known as gastroenteritis . These infections are often acquired from food or water that has been contaminated by feces , or directly from another person who is infected. The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody). The short duration watery diarrhea may be due to cholera , although this is rare in the developed world. If blood is present, it is also known as dysentery . A number of non-infectious causes can result in diarrhea. These include lactose intolerance , irritable bowel syndrome , non-celiac gluten sensitivity , celiac disease , inflammatory bowel disease such as ulcerative colitis , hyperthyroidism , bile acid diarrhea , and a number of medications. In most cases, stool cultures to confirm the exact cause are not required. Diarrhea can be prevented by improved sanitation , clean drinking water , and hand washing with soap. Breastfeeding for at least six months and vaccination against rotavirus is also recommended. Oral rehydration solution (ORS)—clean water with modest amounts of salts and sugar —is the treatment of choice. Zinc tablets are also recommended. These treatments have been estimated to have saved 50 million children in the past 25 years. When people have diarrhea it is recommended that they continue to eat healthy food, and babies continue to be breastfed. If commercial ORS is not available, homemade solutions may be used. In those with severe dehydration, intravenous fluids may be required. Most cases, however, can be managed well with fluids by mouth. Antibiotics , while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling , and those who grow specific bacteria or parasites in their stool. Loperamide may help decrease the number of bowel movements but is not recommended in those with severe disease. About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing countries , where young children get diarrhea on average three times a year. Total deaths from diarrhea are estimated at 1.53 million in 2019—down from 2.9 million in 1990. In 2012, it was the second most common cause of deaths in children younger than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age. Other long term problems that can result include stunted growth and poor intellectual development. The word diarrhea is from the Ancient Greek διάρροια from διά dia "through" and ῥέω rheo "flow". Diarrhea is the spelling in American English , whereas diarrhoea is the spelling in British English . Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain ) and "the trots". The word is often pronounced as / ˌ d aɪ ə ˈ r iː ə / DY -ə- REE -ə .Diarrhea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organization . Acute diarrhea that is watery may be known as AWD (Acute Watery Diarrhoea.) Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions , especially chloride ions (Cl – ). Therefore, to maintain a charge balance in the gastrointestinal tract , sodium (Na + ) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is isotonic with plasma even during fasting. It continues even when there is no oral food intake. Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also result from maldigestion, e.g. pancreatic disease or coeliac disease , in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption , excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when the offending agent, e.g. milk or sorbitol, is stopped. Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases , such as Crohn's disease or ulcerative colitis , and other severe infections such as E. coli or other forms of food poisoning. Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis. If there is blood visible in the stools, it is also known as dysentery . The blood is a trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, Shigella , Entamoeba histolytica , and Salmonella . Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions , especially chloride ions (Cl – ). Therefore, to maintain a charge balance in the gastrointestinal tract , sodium (Na + ) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is isotonic with plasma even during fasting. It continues even when there is no oral food intake.Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also result from maldigestion, e.g. pancreatic disease or coeliac disease , in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption , excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when the offending agent, e.g. milk or sorbitol, is stopped.Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases , such as Crohn's disease or ulcerative colitis , and other severe infections such as E. coli or other forms of food poisoning. Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis. If there is blood visible in the stools, it is also known as dysentery . The blood is a trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, Shigella , Entamoeba histolytica , and Salmonella . Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults," and diarrhea is a primary cause of childhood malnutrition. Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for helminth infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on a series of tests of intelligence. Diarrhea can cause electrolyte imbalances , kidney impairment , dehydration , and defective immune system responses. When oral drugs are administered, the efficiency of the drug is to produce a therapeutic effect and the lack of this effect may be due to the medication travelling too quickly through the digestive system, limiting the time that it can be absorbed. Clinicians try to treat the diarrheas by reducing the dosage of medication, changing the dosing schedule, discontinuation of the drug, and rehydration. The interventions to control the diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the leading factors for placing older adults in long term care facilities (nursing homes). In the latter stages of human digestion, ingested materials are inundated with water and digestive fluids such as gastric acid , bile , and digestive enzymes in order to break them down into their nutrient components, which are then absorbed into the bloodstream via the intestinal tract in the small intestine. Prior to defecation, the large intestine reabsorbs the water and other digestive solvents in the waste product in order to maintain proper hydration and overall equilibrium. Diarrhea occurs when the large intestine is prevented, for any number of reasons, from sufficiently absorbing the water or other digestive fluids from fecal matter, resulting in a liquid, or "loose", bowel movement. Acute diarrhea is most commonly due to viral gastroenteritis with rotavirus , which accounts for 40% of cases in children under five. In travelers , however, bacterial infections predominate. Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea. Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include ulcerative colitis , Crohn's disease , microscopic colitis , celiac disease , irritable bowel syndrome , and bile acid malabsorption . There are many causes of infectious diarrhea, which include viruses , bacteria and parasites. Infectious diarrhea is frequently referred to as gastroenteritis . Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections. Shiga-toxin producing Escherichia coli , such as E coli o157:h7 , are the most common cause of infectious bloody diarrhea in the United States. Campylobacter spp. are a common cause of bacterial diarrhea, but infections by Salmonella spp., Shigella spp. and some strains of Escherichia coli are also a frequent cause. In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridioides difficile often causes severe diarrhea. Parasites, particularly protozoa e.g., Cryptosporidium spp., Giardia spp., Entamoeba histolytica , Blastocystis spp., Cyclospora cayetanensis , are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent nitazoxanide has shown efficacy against many diarrhea-causing parasites. Other infectious agents, such as parasites or bacterial toxins, may exacerbate symptoms. In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening. Open defecation is a leading cause of infectious diarrhea leading to death. Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste ( sanitation ), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea ... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care." One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human pathogens . Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency , a condition often found in children in developing countries can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can cause an increase in the severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, Others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction. Malabsorption is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the pancreas . Causes include: [ citation needed ] The two overlapping types here are of unknown origin: Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation ) for at least three days a week over the previous three months. Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as loperamide or codeine . About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test. Diarrhea can be caused by other diseases and conditions, namely: Over 700 medications, such as penicillin , are known to cause diarrhea. The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements. There are many causes of infectious diarrhea, which include viruses , bacteria and parasites. Infectious diarrhea is frequently referred to as gastroenteritis . Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections. Shiga-toxin producing Escherichia coli , such as E coli o157:h7 , are the most common cause of infectious bloody diarrhea in the United States. Campylobacter spp. are a common cause of bacterial diarrhea, but infections by Salmonella spp., Shigella spp. and some strains of Escherichia coli are also a frequent cause. In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridioides difficile often causes severe diarrhea. Parasites, particularly protozoa e.g., Cryptosporidium spp., Giardia spp., Entamoeba histolytica , Blastocystis spp., Cyclospora cayetanensis , are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent nitazoxanide has shown efficacy against many diarrhea-causing parasites. Other infectious agents, such as parasites or bacterial toxins, may exacerbate symptoms. In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening. Open defecation is a leading cause of infectious diarrhea leading to death. Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste ( sanitation ), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea ... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care." One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human pathogens . Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency , a condition often found in children in developing countries can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can cause an increase in the severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, Others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction. Open defecation is a leading cause of infectious diarrhea leading to death. Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste ( sanitation ), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea ... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care." One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human pathogens . Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency , a condition often found in children in developing countries can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can cause an increase in the severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, Others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction. Malabsorption is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the pancreas . Causes include: [ citation needed ]The two overlapping types here are of unknown origin:Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation ) for at least three days a week over the previous three months. Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as loperamide or codeine . About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test. Diarrhea can be caused by other diseases and conditions, namely:Over 700 medications, such as penicillin , are known to cause diarrhea. The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements. According to two researchers, Nesse and Williams , diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery. They cite in support of this argument research published in 1973 that found that treating Shigella with the anti-diarrhea drug (Co-phenotrope, Lomotil ) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism". According to two researchers, Nesse and Williams , diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery. They cite in support of this argument research published in 1973 that found that treating Shigella with the anti-diarrhea drug (Co-phenotrope, Lomotil ) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism". The following types of diarrhea may indicate further investigation is needed: In infants Moderate or severe diarrhea in young children Associated with blood Continues for more than two days Associated non-cramping abdominal pain , fever , weight loss , etc. In travelers In food handlers, because of the potential to infect others; In institutions such as hospitals, child care centers, or geriatric and convalescent homes. A severity score is used to aid diagnosis in children. When diarrhea lasts for more than four weeks a number of further tests may be recommended including: A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for giardia . Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not recommended. Worldwide in 2004, approximately 2.5 billion cases of diarrhea occurred, which resulted in 1.5 million deaths among children under the age of five. Greater than half of these were in Africa and South Asia. This is down from a death rate of 4.5 million in 1980 for gastroenteritis. Diarrhea remains the second leading cause of infant mortality (16%) after pneumonia (17%) in this age group. The majority of such cases occur in the developing world, with over half of the recorded cases of childhood diarrhea occurring in Africa and Asia , with 696 million and 1.2 billion cases, respectively, compared to only 480 million in the rest of the world. Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days. In the Americas, diarrheal disease accounts for a total of 10% of deaths among children aged 1–59 months while in South East Asia, it accounts for 31.3% of deaths. It is estimated that around 21% of child mortalities in developing countries are due to diarrheal disease. Numerous studies have shown that improvements in drinking water and sanitation ( WASH ) lead to decreased risks of diarrhoea. Such improvements might include for example use of water filters, provision of high-quality piped water and sewer connections. In institutions, communities, and households, interventions that promote hand washing with soap lead to significant reductions in the incidence of diarrhea. The same applies to preventing open defecation at a community-wide level and providing access to improved sanitation . This includes use of toilets and implementation of the entire sanitation chain connected to the toilets (collection, transport, disposal or reuse of human excreta ). There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease. Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30–48%. Hand washing in developing countries, however, is compromised by poverty as acknowledged by the CDC : "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours. Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean water supply and improved sanitation have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene. Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a 21–30% reduction in mortality rate associated with diarrheal disease. Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens. Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2–3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6–10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease. Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society. Rotavirus vaccine decreases the rates of diarrhea in a population. New vaccines against rotavirus, Shigella , Enterotoxigenic Escherichia coli (ETEC) , and cholera are under development, as well as other causes of infectious diarrhea. [ medical citation needed ] Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group. The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence. Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective. Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive exclusive breastfeeding during their first 6 months of life are better protected against infection with diarrheal diseases. One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants. Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the WHO , with continued breastfeeding until at least two years of age. Probiotics decrease the risk of diarrhea in those taking antibiotics . Insecticide spraying may reduce fly numbers and the risk of diarrhea in children in a setting where there is seasonal variations in fly numbers throughout the year. Numerous studies have shown that improvements in drinking water and sanitation ( WASH ) lead to decreased risks of diarrhoea. Such improvements might include for example use of water filters, provision of high-quality piped water and sewer connections. In institutions, communities, and households, interventions that promote hand washing with soap lead to significant reductions in the incidence of diarrhea. The same applies to preventing open defecation at a community-wide level and providing access to improved sanitation . This includes use of toilets and implementation of the entire sanitation chain connected to the toilets (collection, transport, disposal or reuse of human excreta ). There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease. Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30–48%. Hand washing in developing countries, however, is compromised by poverty as acknowledged by the CDC : "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours. Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean water supply and improved sanitation have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene. Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a 21–30% reduction in mortality rate associated with diarrheal disease. Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens. Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30–48%. Hand washing in developing countries, however, is compromised by poverty as acknowledged by the CDC : "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours. Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean water supply and improved sanitation have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene. Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a 21–30% reduction in mortality rate associated with diarrheal disease. Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens. Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2–3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6–10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease. Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society. Rotavirus vaccine decreases the rates of diarrhea in a population. New vaccines against rotavirus, Shigella , Enterotoxigenic Escherichia coli (ETEC) , and cholera are under development, as well as other causes of infectious diarrhea. [ medical citation needed ]Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group. The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence. Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective. Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive exclusive breastfeeding during their first 6 months of life are better protected against infection with diarrheal diseases. One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants. Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the WHO , with continued breastfeeding until at least two years of age. Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive exclusive breastfeeding during their first 6 months of life are better protected against infection with diarrheal diseases. One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants. Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the WHO , with continued breastfeeding until at least two years of age. Probiotics decrease the risk of diarrhea in those taking antibiotics . Insecticide spraying may reduce fly numbers and the risk of diarrhea in children in a setting where there is seasonal variations in fly numbers throughout the year. In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in severe cases, intravenously . Diet restrictions such as the BRAT diet are no longer recommended. Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea. To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain, and that continuing to eat also speeds up recovery of normal intestinal functioning. CDC recommends that children and adults with cholera also continue to eat. There is no evidence that early refeeding in children can cause an increase in inappropriate use of intravenous fluid, episodes of vomiting, and risk of having persistent diarrhea. Medications such as loperamide (Imodium) and bismuth subsalicylate may be beneficial; however they may be contraindicated in certain situations. Oral rehydration solution (ORS) (a slightly sweetened and salty water) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given. There are commercial solutions such as Pedialyte , and relief agencies such as UNICEF widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added (approximately the "taste of tears" ). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness. Both agree that drinks with too much sugar or salt can make dehydration worse. Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible. In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment. Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly. Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under five as they may increase dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water. Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable. Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall. A nasogastric tube can be used in young children to administer fluids if warranted. The WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. The WHO states "Food should never be withheld and the child's usual foods should not be diluted. Breastfeeding should always be continued." In the specific example of cholera, the CDC makes the same recommendation. Breast-fed infants with diarrhea often choose to breastfeed more, and should be encouraged to do so. In young children who are not breast-fed and live in the developed world, a lactose-free diet may be useful to speed recovery. Eating food containing fibers may help. Antidiarrheal agents can be classified into four different groups: antimotility, antisecretory, adsorbent, and anti-infectious. While antibiotics are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations. There are concerns that antibiotics may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7 . In resource-poor countries, treatment with antibiotics may be beneficial. However, some bacteria are developing antibiotic resistance , particularly Shigella . Antibiotics can also cause diarrhea, and antibiotic-associated diarrhea is the most common adverse effect of treatment with general antibiotics. While bismuth compounds ( Pepto-Bismol ) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness. Anti-motility agents like loperamide are also effective at reducing the number of stools but not the duration of disease. These agents should be used only if bloody diarrhea is not present. Diosmectite , a natural aluminomagnesium silicate clay, is effective in alleviating symptoms of acute diarrhea in children, and also has some effects in chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Another absorbent agent used for the treatment of mild diarrhea is kaopectate . Racecadotril an antisecretory medication may be used to treat diarrhea in children and adults. It has better tolerability than loperamide , as it causes less constipation and flatulence . However, it has little benefit in improving acute diarrhea in children. Bile acid sequestrants such as cholestyramine can be effective in chronic diarrhea due to bile acid malabsorption . Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as SeHCAT retention. Zinc supplementation may benefit children over six months old with diarrhea in areas with high rates of malnourishment or zinc deficiency. This supports the World Health Organization guidelines for zinc, but not in the very young. A Cochrane Review from 2020 concludes that probiotics make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration. The probiotic lactobacillus can help prevent antibiotic-associated diarrhea in adults but possibly not children. For those with lactose intolerance , taking digestive enzymes containing lactase when consuming dairy products often improves symptoms.Oral rehydration solution (ORS) (a slightly sweetened and salty water) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given. There are commercial solutions such as Pedialyte , and relief agencies such as UNICEF widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added (approximately the "taste of tears" ). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness. Both agree that drinks with too much sugar or salt can make dehydration worse. Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible. In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment. Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly. Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under five as they may increase dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water. Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable. Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall. A nasogastric tube can be used in young children to administer fluids if warranted. The WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. The WHO states "Food should never be withheld and the child's usual foods should not be diluted. Breastfeeding should always be continued." In the specific example of cholera, the CDC makes the same recommendation. Breast-fed infants with diarrhea often choose to breastfeed more, and should be encouraged to do so. In young children who are not breast-fed and live in the developed world, a lactose-free diet may be useful to speed recovery. Eating food containing fibers may help. Antidiarrheal agents can be classified into four different groups: antimotility, antisecretory, adsorbent, and anti-infectious. While antibiotics are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations. There are concerns that antibiotics may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7 . In resource-poor countries, treatment with antibiotics may be beneficial. However, some bacteria are developing antibiotic resistance , particularly Shigella . Antibiotics can also cause diarrhea, and antibiotic-associated diarrhea is the most common adverse effect of treatment with general antibiotics. While bismuth compounds ( Pepto-Bismol ) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness. Anti-motility agents like loperamide are also effective at reducing the number of stools but not the duration of disease. These agents should be used only if bloody diarrhea is not present. Diosmectite , a natural aluminomagnesium silicate clay, is effective in alleviating symptoms of acute diarrhea in children, and also has some effects in chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Another absorbent agent used for the treatment of mild diarrhea is kaopectate . Racecadotril an antisecretory medication may be used to treat diarrhea in children and adults. It has better tolerability than loperamide , as it causes less constipation and flatulence . However, it has little benefit in improving acute diarrhea in children. Bile acid sequestrants such as cholestyramine can be effective in chronic diarrhea due to bile acid malabsorption . Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as SeHCAT retention. Zinc supplementation may benefit children over six months old with diarrhea in areas with high rates of malnourishment or zinc deficiency. This supports the World Health Organization guidelines for zinc, but not in the very young. A Cochrane Review from 2020 concludes that probiotics make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration. The probiotic lactobacillus can help prevent antibiotic-associated diarrhea in adults but possibly not children. For those with lactose intolerance , taking digestive enzymes containing lactase when consuming dairy products often improves symptoms.

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Cholera

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COVID-19 pandemic

>10% 3–10% 1–3% 0.3–1% 0.1–0.3% 0.03–0.1% 0–0.03% None or no data The COVID-19 pandemic , also known as the coronavirus pandemic , is a global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identified in an outbreak in Wuhan , the capital of Hubei , China, in December 2019, before it spread to other areas of Asia, and then worldwide in early 2020. The World Health Organization (WHO) declared the outbreak a public health emergency of international concern (PHEIC) on 30 January 2020, and assessed the outbreak had become a pandemic on 11 March 2020. The WHO ended the PHEIC on 5 May 2023. As of 19 April 2024 , the pandemic has caused 7,043,660 confirmed deaths, making it the fifth- deadliest pandemic or epidemic in history . COVID-19 symptoms range from asymptomatic to deadly, but most commonly include fever, sore throat , nocturnal cough , and fatigue. Transmission of the virus is often through airborne particles . Mutations have produced many strains (variants) with varying degrees of infectivity and virulence . COVID-19 vaccines were widely deployed in various countries beginning in December 2020. Treatments include novel antiviral drugs and symptom control. Common mitigation measures during the public health emergency included travel restrictions , lockdowns , business restrictions and closures, workplace hazard controls , mask mandates , quarantines, testing systems, and contact tracing of the infected. The pandemic caused severe social and economic disruption around the world, including the largest global recession since the Great Depression . Widespread supply shortages , including food shortages , were caused by supply chain disruptions and panic buying . Reduced human activity led to an unprecedented temporary decrease in pollution . Educational institutions and public areas were partially or fully closed in many jurisdictions, and many events were cancelled or postponed during 2020 and 2021. Telework became much more common for white-collar workers as the pandemic evolved. Misinformation circulated through social media and mass media , and political tensions intensified . The pandemic raised issues of racial and geographic discrimination , health equity , and the balance between public health imperatives and individual rights.In epidemiology , a pandemic is defined as "an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people". During the COVID-19 pandemic, as with other pandemics, the meaning of this term has been challenged. During the initial outbreak in Wuhan , the virus and disease were commonly referred to as "coronavirus", "Wuhan coronavirus", "the coronavirus outbreak" and the "Wuhan coronavirus outbreak", with the disease sometimes called "Wuhan pneumonia ". In January 2020, the WHO recommended 2019-nCoV and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma . WHO finalized the official names COVID-19 and SARS-CoV-2 on 11 February 2020. Tedros Adhanom Ghebreyesus explained: CO for corona , VI for virus , D for disease and 19 for when the outbreak was first identified (31 December 2019). WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications. WHO named variants of concern and variants of interest using Greek letters . The initial practice of naming them according to where the variants were identified (e.g. Delta began as the "Indian variant") is no longer common. A more systematic naming scheme reflects the variant's PANGO lineage (e.g., Omicron 's lineage is B.1.1.529) and is used for other variants. SARS-CoV-2 is a virus closely related to bat coronaviruses , pangolin coronaviruses, and SARS-CoV . The first known outbreak (the 2019–2020 COVID-19 outbreak in mainland China ) started in Wuhan , Hubei, China, in December 2019. Many early cases were linked to people who had visited the Huanan Seafood Wholesale Market there, but it is possible that human-to-human transmission began earlier. Molecular clock analysis suggests that the first cases were likely to have been between October and November 2019. The scientific consensus is that the virus is most likely of a zoonotic origin, from bats or another closely related mammal. While other explanations such as speculations that SARS-CoV-2 was accidentally released from a laboratory have been proposed, these are not supported by evidence. Official "case" counts refer to the number of people who have been tested for COVID-19 and whose test has been confirmed positive according to official protocols whether or not they experienced symptomatic disease. Due to the effect of sampling bias , studies which obtain a more accurate number by extrapolating from a random sample have consistently found that total infections considerably exceed the reported case counts. Many countries, early on, had official policies to not test those with only mild symptoms. The strongest risk factors for severe illness are obesity, complications of diabetes , anxiety disorders, and the total number of conditions. During the start of the COVID-19 pandemic it was not clear whether young people were less likely to be infected, or less likely to develop symptoms and be tested. A retrospective cohort study in China found that children and adults were just as likely to be infected. Among more thorough studies, preliminary results from 9 April 2020, found that in Gangelt , the centre of a major infection cluster in Germany, 15 percent of a population sample tested positive for antibodies . Screening for COVID-19 in pregnant women in New York City , and blood donors in the Netherlands, found rates of positive antibody tests that indicated more infections than reported. Seroprevalence -based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies. Initial estimates of the basic reproduction number (R 0 ) for COVID-19 in January 2020 were between 1.4 and 2.5, but a subsequent analysis claimed that it may be about 5.7 (with a 95 percent confidence interval of 3.8 to 8.9). In December 2021, the number of cases continued to climb due to several factors, including new COVID-19 variants. As of that 28 December, 282,790,822 individuals worldwide had been confirmed as infected. As of 14 April 2022 [ update ] , over 500 million cases were confirmed globally. Most cases are unconfirmed, with the Institute for Health Metrics and Evaluation estimating the true number of cases as of early 2022 to be in the billions. As of 10 March 2023 , more than 6.88 million deaths had been attributed to COVID-19. The first confirmed death was in Wuhan on 9 January 2020. These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response, time since the initial outbreak, and population characteristics, such as age, sex, and overall health. Multiple measures are used to quantify mortality. Official death counts typically include people who died after testing positive. Such counts exclude deaths without a test. Conversely, deaths of people who died from underlying conditions following a positive test may be included. Countries such as Belgium include deaths from suspected cases, including those without a test, thereby increasing counts. Official death counts have been claimed to underreport the actual death toll, because excess mortality (the number of deaths in a period compared to a long-term average) data show an increase in deaths that is not explained by COVID-19 deaths alone. Using such data, estimates of the true number of deaths from COVID-19 worldwide have included a range from 18.2 to 33.5 million (≈27.4 million) by 18 November 2023 by The Economist , as well as over 18.5 million by 1 April 2023 by the Institute for Health Metrics and Evaluation and ≈18.2 million (earlier) deaths between 1 January 2020, and 31 December 2021, by a comprehensive international study. Such deaths include deaths due to healthcare capacity constraints and priorities, as well as reluctance to seek care (to avoid possible infection). Further research may help distinguish the proportions directly caused by COVID-19 from those caused by indirect consequences of the pandemic. In May 2022, the WHO estimated the number of excess deaths by the end of 2021 to be 14.9 million compared to 5.4 million reported COVID-19 deaths, with the majority of the unreported 9.5 million deaths believed to be direct deaths due the virus, rather than indirect deaths. Some deaths were because people with other conditions could not access medical services . A December 2022 WHO study estimated excess deaths from the pandemic during 2020 and 2021, again concluding ≈14.8 million excess early deaths occurred, reaffirming and detailing their prior calculations from May as well as updating them, addressing criticisms. These numbers do not include measures like years of potential life lost and may make the pandemic 2021's leading cause of death . The time between symptom onset and death ranges from 6 to 41 days, typically about 14 days. Mortality rates increase as a function of age. People at the greatest mortality risk are the elderly and those with underlying conditions. The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points. Other studies refer to this metric as the infection fatality risk . In November 2020, a review article in Nature reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%. IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from seasonal influenza . In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections. There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV. For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19. Another metric in assessing death rate is the case fatality ratio (CFR), [lower-alpha 1] which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals. Based on Johns Hopkins University statistics, the global CFR is 1.02 percent ( 6,881,955 deaths for 676,609,955 cases) as of 10 March 2023 . The number varies by region and has generally declined over time. SARS-CoV-2 is a virus closely related to bat coronaviruses , pangolin coronaviruses, and SARS-CoV . The first known outbreak (the 2019–2020 COVID-19 outbreak in mainland China ) started in Wuhan , Hubei, China, in December 2019. Many early cases were linked to people who had visited the Huanan Seafood Wholesale Market there, but it is possible that human-to-human transmission began earlier. Molecular clock analysis suggests that the first cases were likely to have been between October and November 2019. The scientific consensus is that the virus is most likely of a zoonotic origin, from bats or another closely related mammal. While other explanations such as speculations that SARS-CoV-2 was accidentally released from a laboratory have been proposed, these are not supported by evidence. Official "case" counts refer to the number of people who have been tested for COVID-19 and whose test has been confirmed positive according to official protocols whether or not they experienced symptomatic disease. Due to the effect of sampling bias , studies which obtain a more accurate number by extrapolating from a random sample have consistently found that total infections considerably exceed the reported case counts. Many countries, early on, had official policies to not test those with only mild symptoms. The strongest risk factors for severe illness are obesity, complications of diabetes , anxiety disorders, and the total number of conditions. During the start of the COVID-19 pandemic it was not clear whether young people were less likely to be infected, or less likely to develop symptoms and be tested. A retrospective cohort study in China found that children and adults were just as likely to be infected. Among more thorough studies, preliminary results from 9 April 2020, found that in Gangelt , the centre of a major infection cluster in Germany, 15 percent of a population sample tested positive for antibodies . Screening for COVID-19 in pregnant women in New York City , and blood donors in the Netherlands, found rates of positive antibody tests that indicated more infections than reported. Seroprevalence -based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies. Initial estimates of the basic reproduction number (R 0 ) for COVID-19 in January 2020 were between 1.4 and 2.5, but a subsequent analysis claimed that it may be about 5.7 (with a 95 percent confidence interval of 3.8 to 8.9). In December 2021, the number of cases continued to climb due to several factors, including new COVID-19 variants. As of that 28 December, 282,790,822 individuals worldwide had been confirmed as infected. As of 14 April 2022 [ update ] , over 500 million cases were confirmed globally. Most cases are unconfirmed, with the Institute for Health Metrics and Evaluation estimating the true number of cases as of early 2022 to be in the billions. As of 10 March 2023 , more than 6.88 million deaths had been attributed to COVID-19. The first confirmed death was in Wuhan on 9 January 2020. These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response, time since the initial outbreak, and population characteristics, such as age, sex, and overall health. Multiple measures are used to quantify mortality. Official death counts typically include people who died after testing positive. Such counts exclude deaths without a test. Conversely, deaths of people who died from underlying conditions following a positive test may be included. Countries such as Belgium include deaths from suspected cases, including those without a test, thereby increasing counts. Official death counts have been claimed to underreport the actual death toll, because excess mortality (the number of deaths in a period compared to a long-term average) data show an increase in deaths that is not explained by COVID-19 deaths alone. Using such data, estimates of the true number of deaths from COVID-19 worldwide have included a range from 18.2 to 33.5 million (≈27.4 million) by 18 November 2023 by The Economist , as well as over 18.5 million by 1 April 2023 by the Institute for Health Metrics and Evaluation and ≈18.2 million (earlier) deaths between 1 January 2020, and 31 December 2021, by a comprehensive international study. Such deaths include deaths due to healthcare capacity constraints and priorities, as well as reluctance to seek care (to avoid possible infection). Further research may help distinguish the proportions directly caused by COVID-19 from those caused by indirect consequences of the pandemic. In May 2022, the WHO estimated the number of excess deaths by the end of 2021 to be 14.9 million compared to 5.4 million reported COVID-19 deaths, with the majority of the unreported 9.5 million deaths believed to be direct deaths due the virus, rather than indirect deaths. Some deaths were because people with other conditions could not access medical services . A December 2022 WHO study estimated excess deaths from the pandemic during 2020 and 2021, again concluding ≈14.8 million excess early deaths occurred, reaffirming and detailing their prior calculations from May as well as updating them, addressing criticisms. These numbers do not include measures like years of potential life lost and may make the pandemic 2021's leading cause of death . The time between symptom onset and death ranges from 6 to 41 days, typically about 14 days. Mortality rates increase as a function of age. People at the greatest mortality risk are the elderly and those with underlying conditions. The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points. Other studies refer to this metric as the infection fatality risk . In November 2020, a review article in Nature reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%. IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from seasonal influenza . In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections. There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV. For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19. Another metric in assessing death rate is the case fatality ratio (CFR), [lower-alpha 1] which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals. Based on Johns Hopkins University statistics, the global CFR is 1.02 percent ( 6,881,955 deaths for 676,609,955 cases) as of 10 March 2023 . The number varies by region and has generally declined over time. The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points. Other studies refer to this metric as the infection fatality risk . In November 2020, a review article in Nature reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%. IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from seasonal influenza . In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections. There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV. For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19. Another metric in assessing death rate is the case fatality ratio (CFR), [lower-alpha 1] which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals. Based on Johns Hopkins University statistics, the global CFR is 1.02 percent ( 6,881,955 deaths for 676,609,955 cases) as of 10 March 2023 . The number varies by region and has generally declined over time. Several variants have been named by WHO and labelled as a variant of concern (VoC) or a variant of interest (VoI). Many of these variants have shared the more infectious D614G . As of May 2023, the WHO had downgraded all variants of concern to previously circulating as these were no longer detected in new infections. Sub-lineages of the Omicron variant (BA.1 – BA.5) were considered separate VoCs by the WHO until they were downgraded in March 2023 as no longer widely circulating. Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste , nasal congestion and runny nose , cough, muscle pain , sore throat , fever, diarrhoea , and breathing difficulties . People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum , shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhoea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of cases. The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an aerosol ) that infected people exhale as they breathe, talk, cough, sneeze, or sing. Infected people are more likely to transmit COVID-19 when they are physically close to other non-infected individuals. However, infection can occur over longer distances, particularly indoors. SARS‑CoV‑2 belongs to the broad family of viruses known as coronaviruses . It is a positive-sense single-stranded RNA (+ssRNA) virus, with a single linear RNA segment. Coronaviruses infect humans, other mammals, including livestock and companion animals, and avian species. Human coronaviruses are capable of causing illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS, fatality rate ≈34%). SARS-CoV-2 is the seventh known coronavirus to infect people, after 229E , NL63 , OC43 , HKU1 , MERS-CoV , and the original SARS-CoV . The standard method of testing for presence of SARS-CoV-2 is a nucleic acid test , which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab ; however, a nasal swab or sputum sample may also be used. The WHO has published several testing protocols for the disease. Preventive measures to reduce the chances of infection include getting vaccinated, staying at home or spending more time outdoors, avoiding crowded places, keeping distance from others, wearing a mask in public, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practicing good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands. Those diagnosed with COVID-19 or who believe they may be infected are advised by healthcare authorities to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items. A COVID-19 vaccine is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID-19 ). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19. As of March 2023, more than 5.5 billion people had received one or more doses (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021. On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster Nuvaxovid ) was authorized for use in adults in the United Kingdom. It has subsequently received endorsement/authorization from the WHO, US, European Union, and Australia. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines. On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics , in the city of Shanghai, China. For the first two years of the pandemic, no specific and effective treatment or cure was available. In 2021, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) approved the oral antiviral protease inhibitor , Paxlovid (nirmatrelvir plus the HIV antiviral ritonavir ), to treat adult patients. FDA later gave it an EUA. Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), adequate intake of oral fluids and rest. Good personal hygiene and a healthy diet are also recommended. Supportive care in severe cases includes treatment to relieve symptoms , fluid therapy , oxygen support and prone positioning , and medications or devices to support other affected vital organs. More severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is recommended to reduce mortality. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure. Existing drugs such as hydroxychloroquine , lopinavir/ritonavir , and ivermectin are not recommended by US or European health authorities, as there is no good evidence they have any useful effect. The antiviral remdesivir is available in the US, Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for use with mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy. The severity of COVID-19 varies. It may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold . In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to intensive care units (ICU). Between 5% and 50% of COVID-19 patients experience long COVID , a condition characterized by long-term consequences persisting after the typical convalescence period of the disease. The most commonly reported clinical presentations are fatigue and memory problems, as well as malaise , headaches, shortness of breath , loss of smell, muscle weakness , low fever and cognitive dysfunction . Several variants have been named by WHO and labelled as a variant of concern (VoC) or a variant of interest (VoI). Many of these variants have shared the more infectious D614G . As of May 2023, the WHO had downgraded all variants of concern to previously circulating as these were no longer detected in new infections. Sub-lineages of the Omicron variant (BA.1 – BA.5) were considered separate VoCs by the WHO until they were downgraded in March 2023 as no longer widely circulating. Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste , nasal congestion and runny nose , cough, muscle pain , sore throat , fever, diarrhoea , and breathing difficulties . People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum , shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhoea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of cases. The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an aerosol ) that infected people exhale as they breathe, talk, cough, sneeze, or sing. Infected people are more likely to transmit COVID-19 when they are physically close to other non-infected individuals. However, infection can occur over longer distances, particularly indoors. SARS‑CoV‑2 belongs to the broad family of viruses known as coronaviruses . It is a positive-sense single-stranded RNA (+ssRNA) virus, with a single linear RNA segment. Coronaviruses infect humans, other mammals, including livestock and companion animals, and avian species. Human coronaviruses are capable of causing illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS, fatality rate ≈34%). SARS-CoV-2 is the seventh known coronavirus to infect people, after 229E , NL63 , OC43 , HKU1 , MERS-CoV , and the original SARS-CoV . The standard method of testing for presence of SARS-CoV-2 is a nucleic acid test , which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab ; however, a nasal swab or sputum sample may also be used. The WHO has published several testing protocols for the disease. Preventive measures to reduce the chances of infection include getting vaccinated, staying at home or spending more time outdoors, avoiding crowded places, keeping distance from others, wearing a mask in public, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practicing good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands. Those diagnosed with COVID-19 or who believe they may be infected are advised by healthcare authorities to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items. A COVID-19 vaccine is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID-19 ). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19. As of March 2023, more than 5.5 billion people had received one or more doses (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021. On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster Nuvaxovid ) was authorized for use in adults in the United Kingdom. It has subsequently received endorsement/authorization from the WHO, US, European Union, and Australia. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines. On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics , in the city of Shanghai, China. A COVID-19 vaccine is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID-19 ). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19. As of March 2023, more than 5.5 billion people had received one or more doses (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021. On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster Nuvaxovid ) was authorized for use in adults in the United Kingdom. It has subsequently received endorsement/authorization from the WHO, US, European Union, and Australia. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines. On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics , in the city of Shanghai, China. For the first two years of the pandemic, no specific and effective treatment or cure was available. In 2021, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) approved the oral antiviral protease inhibitor , Paxlovid (nirmatrelvir plus the HIV antiviral ritonavir ), to treat adult patients. FDA later gave it an EUA. Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), adequate intake of oral fluids and rest. Good personal hygiene and a healthy diet are also recommended. Supportive care in severe cases includes treatment to relieve symptoms , fluid therapy , oxygen support and prone positioning , and medications or devices to support other affected vital organs. More severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is recommended to reduce mortality. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure. Existing drugs such as hydroxychloroquine , lopinavir/ritonavir , and ivermectin are not recommended by US or European health authorities, as there is no good evidence they have any useful effect. The antiviral remdesivir is available in the US, Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for use with mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy. The severity of COVID-19 varies. It may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold . In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to intensive care units (ICU). Between 5% and 50% of COVID-19 patients experience long COVID , a condition characterized by long-term consequences persisting after the typical convalescence period of the disease. The most commonly reported clinical presentations are fatigue and memory problems, as well as malaise , headaches, shortness of breath , loss of smell, muscle weakness , low fever and cognitive dysfunction . Many countries attempted to slow or stop the spread of COVID-19 by recommending, mandating or prohibiting behaviour changes, while others relied primarily on providing information. Measures ranged from public advisories to stringent lockdowns. Outbreak control strategies are divided into elimination and mitigation. Experts differentiate between elimination strategies (known as " zero-COVID ") that aim to completely stop the spread of the virus within the community, and mitigation strategies (commonly known as " flattening the curve ") that attempt to lessen the effects of the virus on society, but which still tolerate some level of transmission within the community. These initial strategies can be pursued sequentially or simultaneously during the acquired immunity phase through natural and vaccine-induced immunity . Nature reported in 2021 that 90 percent of researchers who responded to a survey "think that the coronavirus will become endemic ". Containment is undertaken to stop an outbreak from spreading into the general population. Infected individuals are isolated while they are infectious. The people they have interacted with are contacted and isolated for long enough to ensure that they are either not infected or no longer contagious. Screening is the starting point for containment. Screening is done by checking for symptoms to identify infected individuals, who can then be isolated or offered treatment. The Zero-COVID strategy involves using public health measures such as contact tracing , mass testing , border quarantine , lockdowns and mitigation software to stop community transmission of COVID-19 as soon as it is detected, with the goal of getting the area back to zero detected infections and resuming normal economic and social activities. Successful containment or suppression reduces Rt to less than 1. Should containment fail, efforts focus on mitigation: measures taken to slow the spread and limit its effects on the healthcare system and society. Successful mitigation delays and decreases the epidemic peak, known as "flattening the epidemic curve ". This decreases the risk of overwhelming health services and provides more time for developing vaccines and treatments. Individual behaviour changed in many jurisdictions. Many people worked from home instead of at their traditional workplaces. Non-pharmaceutical interventions that may reduce spread include personal actions such as wearing face masks , self-quarantine, and hand hygiene ; community measures aimed at reducing interpersonal contacts such as closing workplaces and schools and cancelling large gatherings; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such as surface cleaning. More drastic actions, such as quarantining entire populations and strict travel bans have been attempted in various jurisdictions. The Chinese and Australian government approaches have included many lockdowns and are widely considered the most strict. The New Zealand government response included the most severe travel restrictions. As part of its K-Quarantine program, South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. The Singaporean government's response included so-called " circuit breaker lockdowns " and financial support for those affected while also imposing large fines for those who broke quarantine. Contact tracing attempts to identify recent contacts of newly infected individuals, and to screen them for infection; the traditional approach is to request a list of contacts from infectees, and then telephone or visit the contacts. Contact tracing was widely used during the Western African Ebola virus epidemic in 2014. Another approach is to collect location data from mobile devices to identify those who have come in significant contact with infectees, which prompted privacy concerns. On 10 April 2020, Google and Apple announced an initiative for privacy-preserving contact tracing. In Europe and in the US, Palantir Technologies initially provided COVID-19 tracking services. WHO described increasing capacity and adapting healthcare as a fundamental mitigation. The ECDC and WHO's European regional office issued guidelines for hospitals and primary healthcare services for shifting resources at multiple levels, including focusing laboratory services towards testing, cancelling elective procedures, separating and isolating patients, and increasing intensive care capabilities by training personnel and increasing ventilators and beds. The pandemic drove widespread adoption of telehealth . Due to supply chain capacity limitations, some manufacturers began 3D printing material such as nasal swabs and ventilator parts. In one example, an Italian startup received legal threats due to alleged patent infringement after reverse-engineering and printing one hundred requested ventilator valves overnight. Individuals and groups of makers created and shared open source designs, and manufacturing devices using locally sourced materials, sewing, and 3D printing. Millions of face shields , protective gowns, and masks were made. Other ad hoc medical supplies included shoe covers, surgical caps, powered air-purifying respirators , and hand sanitizer . Novel devices were created such as ear savers , non-invasive ventilation helmets, and ventilator splitters. In July 2021, several experts expressed concern that achieving herd immunity may not be possible because Delta can transmit among vaccinated individuals. CDC published data showing that vaccinated people could transmit Delta, something officials believed was less likely with other variants. Consequently, WHO and CDC encouraged vaccinated people to continue with non-pharmaceutical interventions such as masking, social distancing, and quarantining if exposed. Containment is undertaken to stop an outbreak from spreading into the general population. Infected individuals are isolated while they are infectious. The people they have interacted with are contacted and isolated for long enough to ensure that they are either not infected or no longer contagious. Screening is the starting point for containment. Screening is done by checking for symptoms to identify infected individuals, who can then be isolated or offered treatment. The Zero-COVID strategy involves using public health measures such as contact tracing , mass testing , border quarantine , lockdowns and mitigation software to stop community transmission of COVID-19 as soon as it is detected, with the goal of getting the area back to zero detected infections and resuming normal economic and social activities. Successful containment or suppression reduces Rt to less than 1. Should containment fail, efforts focus on mitigation: measures taken to slow the spread and limit its effects on the healthcare system and society. Successful mitigation delays and decreases the epidemic peak, known as "flattening the epidemic curve ". This decreases the risk of overwhelming health services and provides more time for developing vaccines and treatments. Individual behaviour changed in many jurisdictions. Many people worked from home instead of at their traditional workplaces. Non-pharmaceutical interventions that may reduce spread include personal actions such as wearing face masks , self-quarantine, and hand hygiene ; community measures aimed at reducing interpersonal contacts such as closing workplaces and schools and cancelling large gatherings; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such as surface cleaning. More drastic actions, such as quarantining entire populations and strict travel bans have been attempted in various jurisdictions. The Chinese and Australian government approaches have included many lockdowns and are widely considered the most strict. The New Zealand government response included the most severe travel restrictions. As part of its K-Quarantine program, South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. The Singaporean government's response included so-called " circuit breaker lockdowns " and financial support for those affected while also imposing large fines for those who broke quarantine. Contact tracing attempts to identify recent contacts of newly infected individuals, and to screen them for infection; the traditional approach is to request a list of contacts from infectees, and then telephone or visit the contacts. Contact tracing was widely used during the Western African Ebola virus epidemic in 2014. Another approach is to collect location data from mobile devices to identify those who have come in significant contact with infectees, which prompted privacy concerns. On 10 April 2020, Google and Apple announced an initiative for privacy-preserving contact tracing. In Europe and in the US, Palantir Technologies initially provided COVID-19 tracking services. Non-pharmaceutical interventions that may reduce spread include personal actions such as wearing face masks , self-quarantine, and hand hygiene ; community measures aimed at reducing interpersonal contacts such as closing workplaces and schools and cancelling large gatherings; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such as surface cleaning. More drastic actions, such as quarantining entire populations and strict travel bans have been attempted in various jurisdictions. The Chinese and Australian government approaches have included many lockdowns and are widely considered the most strict. The New Zealand government response included the most severe travel restrictions. As part of its K-Quarantine program, South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. The Singaporean government's response included so-called " circuit breaker lockdowns " and financial support for those affected while also imposing large fines for those who broke quarantine. Contact tracing attempts to identify recent contacts of newly infected individuals, and to screen them for infection; the traditional approach is to request a list of contacts from infectees, and then telephone or visit the contacts. Contact tracing was widely used during the Western African Ebola virus epidemic in 2014. Another approach is to collect location data from mobile devices to identify those who have come in significant contact with infectees, which prompted privacy concerns. On 10 April 2020, Google and Apple announced an initiative for privacy-preserving contact tracing. In Europe and in the US, Palantir Technologies initially provided COVID-19 tracking services. WHO described increasing capacity and adapting healthcare as a fundamental mitigation. The ECDC and WHO's European regional office issued guidelines for hospitals and primary healthcare services for shifting resources at multiple levels, including focusing laboratory services towards testing, cancelling elective procedures, separating and isolating patients, and increasing intensive care capabilities by training personnel and increasing ventilators and beds. The pandemic drove widespread adoption of telehealth . Due to supply chain capacity limitations, some manufacturers began 3D printing material such as nasal swabs and ventilator parts. In one example, an Italian startup received legal threats due to alleged patent infringement after reverse-engineering and printing one hundred requested ventilator valves overnight. Individuals and groups of makers created and shared open source designs, and manufacturing devices using locally sourced materials, sewing, and 3D printing. Millions of face shields , protective gowns, and masks were made. Other ad hoc medical supplies included shoe covers, surgical caps, powered air-purifying respirators , and hand sanitizer . Novel devices were created such as ear savers , non-invasive ventilation helmets, and ventilator splitters. Due to supply chain capacity limitations, some manufacturers began 3D printing material such as nasal swabs and ventilator parts. In one example, an Italian startup received legal threats due to alleged patent infringement after reverse-engineering and printing one hundred requested ventilator valves overnight. Individuals and groups of makers created and shared open source designs, and manufacturing devices using locally sourced materials, sewing, and 3D printing. Millions of face shields , protective gowns, and masks were made. Other ad hoc medical supplies included shoe covers, surgical caps, powered air-purifying respirators , and hand sanitizer . Novel devices were created such as ear savers , non-invasive ventilation helmets, and ventilator splitters. In July 2021, several experts expressed concern that achieving herd immunity may not be possible because Delta can transmit among vaccinated individuals. CDC published data showing that vaccinated people could transmit Delta, something officials believed was less likely with other variants. Consequently, WHO and CDC encouraged vaccinated people to continue with non-pharmaceutical interventions such as masking, social distancing, and quarantining if exposed. The outbreak was discovered in Wuhan in November 2019. It is possible that human-to-human transmission was happening before the discovery. Based on a retrospective analysis starting from December 2019, the number of cases in Hubei gradually increased, reaching 60 by 20 December and at least 266 by 31 December. A pneumonia cluster was observed on 26 December and treated by Chinese pulmonologist Zhang Jixian . She informed the Wuhan Jianghan CDC on 27 December. After analyzing pneumonia patient samples, a genetic sequencing company named Vision Medicals reported the discovery of a novel coronavirus to the China CDC (CCDC) on 28 December. On 30 December, a test report from CapitalBio Medlab addressed to Wuhan Central Hospital reported an erroneous positive result for SARS , causing doctors there to alert authorities. Eight of those doctors, including Li Wenliang (who was also punished on 3 January), were later admonished by the police for spreading false rumours. Director of the Emergency Department at the Central Hospital of Wuhan, Ai Fen, was also reprimanded. That evening, Wuhan Municipal Health Commission (WMHC) issued a notice about "the treatment of pneumonia of unknown cause". The next day, WMHC made the announcement public, confirming 27 cases —enough to trigger an investigation. On 31 December, the WHO office in China was notified about the cluster of unknown pneumonia cases and immediately launched an investigation. Official Chinese sources claimed that the early cases were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020, CCDC director George Gao initially ruled out the market as a possible origin, as animal samples collected there had tested negative. On 11 January, WHO was notified by the Chinese National Health Commission that the outbreak was associated with exposures in the market, and that China had identified a new type of coronavirus, which it isolated on 7 January. Initially, the number of cases doubled approximately every seven and a half days. In early and mid-January, the virus spread to other Chinese provinces , helped by the Chinese New Year migration . Wuhan was a transport hub and major rail interchange. On 10 January, the virus' genome was shared publicly. A retrospective study published in March found that 6,174 people had reported symptoms by 20 January. A 24 January report indicated human transmission was likely occurring, and recommended personal protective equipment for health workers. It also advocated testing, given the outbreak's "pandemic potential". On 31 January, the first published modelling study warned of inevitable "independent self-sustaining outbreaks in major cities globally" and called for "large-scale public health interventions." On 30 January, 7,818 infections had been confirmed, leading WHO to declare the outbreak a Public Health Emergency of International Concern (PHEIC). On 11 March, WHO announced its assessment that the situation could be characterized as a pandemic. By 31 January, Italy indicated its first confirmed infections had occurred, in two tourists from China. On 19 March, Italy overtook China as the country with the most reported deaths. By 26 March, the United States had overtaken China and Italy as the country with the highest number of confirmed infections. Genomic analysis indicated that the majority of New York 's confirmed infections came from Europe, rather than directly from Asia. Testing of prior samples revealed a person who was infected in France on 27 December 2019 and a person in the United States who died from the disease on 6 February. In October, WHO reported that one in ten people around the world may have been infected, or 780 million people, while only 35 million infections had been confirmed. On 9 November, Pfizer released trial results for a candidate vaccine, showing a 90 percent effectiveness in preventing infection. That day, Novavax submitted an FDA Fast Track application for their vaccine. On 14 December, Public Health England reported that a variant had been discovered in the UK's southeast, predominantly in Kent . The variant, later named Alpha , showed changes to the spike protein that could make the virus more infectious. As of 13 December, 1,108 infections had been confirmed in the UK. On 4 February 2020, US Secretary of Health and Human Services Alex Azar waived liability for vaccine manufacturers in all cases except those involving "willful misconduct". On 2 January, the Alpha variant, first discovered in the UK, had been identified in 33 countries. On 6 January, the Gamma variant was first identified in Japanese travellers returning from Brazil. On 29 January, it was reported that the Novavax vaccine was 49 percent effective against the Beta variant in a clinical trial in South Africa. The CoronaVac vaccine was reported to be 50.4 percent effective in a Brazil clinical trial. On 12 March, several countries stopped using the Oxford-AstraZeneca COVID-19 vaccine - due to blood clotting problems, specifically cerebral venous sinus thrombosis (CVST). On 20 March, the WHO and European Medicines Agency found no link to thrombosis , leading several countries to resume administering the vaccine. In March WHO reported that an animal host was the most likely origin, without ruling out other possibilities. The Delta variant was first identified in India. In mid-April, the variant was first detected in the UK and two months later it had become a full-fledged third wave in the country, forcing the government to delay reopening that was originally scheduled for June. On 10 November, Germany advised against the Moderna vaccine for people under 30, due to a possible association with myocarditis . On 24 November, the Omicron variant was detected in South Africa; a few days later the World Health Organization declared it a VoC (variant of concern). The new variant is more infectious than the Delta variant. On 1 January, Europe passed 100 million cases amidst a surge in the Omicron variant . Later that month, the WHO recommended the rheumatoid arthritis drug Baricitinib for severe or critical patients. It also recommended the monoclonal antibody Sotrovimab in patients with non-severe disease, but only those who are at highest risk of hospitalization. On 24 January, the Institute for Health Metrics and Evaluation estimated that about 57% of the world's population had been infected by COVID-19. By 6 March, it was reported that the total worldwide death count had surpassed 6 million people. By 6 July, Omicron subvariants BA.4 and BA.5 had spread worldwide. WHO Director-General Tedros Ghebreyesus stated on 14 September 2022, that "[The world has] never been in a better position to end the pandemic", citing the lowest number of weekly reported deaths since March 2020. He continued, "We are not there yet. But the end is in sight—we can see the finish line". On 21 October, the United States surpassed 99 million cases of COVID-19, the most cases of any country. By 30 October, the worldwide daily death toll was 424, the lowest since 385 deaths were reported on 12 March 2020. 17 November marked the three-year anniversary since health officials in China first detected COVID-19. On 11 November, the WHO reported that deaths since the month of February had dropped 90 percent. Director-General Tedros said this was "cause for optimism". On 3 December, the WHO indicated that, "at least 90% of the world's population has some level of immunity to Sars-CoV-2". In early December, China began lifting some of its most stringent lockdown measures. Subsequent data from China's health authorities revealed that 248 million people, nearly 18 percent of its population, had been infected in the first 20 days of that month. On 29 December, the US joined Italy, Japan, Taiwan and India in requiring negative COVID-19 test results from all people traveling from China due to the new surge in cases. The EU refused similar measures, stating that the BF7 omicron variant had already spread throughout Europe without becoming dominant. On 4 January 2023, the World Health Organization said the information shared by China during the recent surge in infections lacked data, such as hospitalization rates. On 10 January, the WHO's Europe office said the recent viral surge in China posed "no immediate threat." On 16 January, the WHO recommended that China monitor excess mortality to provide "a more comprehensive understanding of the impact of COVID-19." On 30 January, the three-year anniversary of the original declaration, the World Health Organization determined that COVID-19 still met the criteria for a public health emergency of international concern (PHEIC). On 19 March, WHO Director-General Tedros indicated he was "confident" the COVID-19 pandemic would cease to be a public health emergency by the end of the year. On 5 May, the WHO downgraded COVID-19 from being a global health emergency, though it continued to refer to it as a pandemic. The WHO does not make official declarations of when pandemics end. The decision came after Tedros convened with the International Health Regulations Emergency Committee, wherein the Committee noted that due to the decrease in deaths and hospitalisations, and the prevalence of vaccinations and the level of general immunity, it was time to remove the emergency designation and "transition to long-term management". Tedros agreed, and the WHO reduced the classification to an "established and ongoing health issue". In a press conference, Tedros remarked that the diminishing threat from COVID-19 had "allowed most countries to return to life as we knew it before COVID-19". In September the WHO said it had observed "concerning" trends in COVID-19 case numbers and hospitalisations, although analysis was hampered because many countries were no longer recording COVID-19 case statistics. In November 2023, in response to viral mutations and changing characteristics of infection, the WHO adjusted its treatment guidelines. Among other changes, remdesivir and molnupiravir were now recommended only for the most severe cases, and deuremidevir and ivermectin were recommended against. The outbreak was discovered in Wuhan in November 2019. It is possible that human-to-human transmission was happening before the discovery. Based on a retrospective analysis starting from December 2019, the number of cases in Hubei gradually increased, reaching 60 by 20 December and at least 266 by 31 December. A pneumonia cluster was observed on 26 December and treated by Chinese pulmonologist Zhang Jixian . She informed the Wuhan Jianghan CDC on 27 December. After analyzing pneumonia patient samples, a genetic sequencing company named Vision Medicals reported the discovery of a novel coronavirus to the China CDC (CCDC) on 28 December. On 30 December, a test report from CapitalBio Medlab addressed to Wuhan Central Hospital reported an erroneous positive result for SARS , causing doctors there to alert authorities. Eight of those doctors, including Li Wenliang (who was also punished on 3 January), were later admonished by the police for spreading false rumours. Director of the Emergency Department at the Central Hospital of Wuhan, Ai Fen, was also reprimanded. That evening, Wuhan Municipal Health Commission (WMHC) issued a notice about "the treatment of pneumonia of unknown cause". The next day, WMHC made the announcement public, confirming 27 cases —enough to trigger an investigation. On 31 December, the WHO office in China was notified about the cluster of unknown pneumonia cases and immediately launched an investigation. Official Chinese sources claimed that the early cases were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020, CCDC director George Gao initially ruled out the market as a possible origin, as animal samples collected there had tested negative. On 11 January, WHO was notified by the Chinese National Health Commission that the outbreak was associated with exposures in the market, and that China had identified a new type of coronavirus, which it isolated on 7 January. Initially, the number of cases doubled approximately every seven and a half days. In early and mid-January, the virus spread to other Chinese provinces , helped by the Chinese New Year migration . Wuhan was a transport hub and major rail interchange. On 10 January, the virus' genome was shared publicly. A retrospective study published in March found that 6,174 people had reported symptoms by 20 January. A 24 January report indicated human transmission was likely occurring, and recommended personal protective equipment for health workers. It also advocated testing, given the outbreak's "pandemic potential". On 31 January, the first published modelling study warned of inevitable "independent self-sustaining outbreaks in major cities globally" and called for "large-scale public health interventions." On 30 January, 7,818 infections had been confirmed, leading WHO to declare the outbreak a Public Health Emergency of International Concern (PHEIC). On 11 March, WHO announced its assessment that the situation could be characterized as a pandemic. By 31 January, Italy indicated its first confirmed infections had occurred, in two tourists from China. On 19 March, Italy overtook China as the country with the most reported deaths. By 26 March, the United States had overtaken China and Italy as the country with the highest number of confirmed infections. Genomic analysis indicated that the majority of New York 's confirmed infections came from Europe, rather than directly from Asia. Testing of prior samples revealed a person who was infected in France on 27 December 2019 and a person in the United States who died from the disease on 6 February. In October, WHO reported that one in ten people around the world may have been infected, or 780 million people, while only 35 million infections had been confirmed. On 9 November, Pfizer released trial results for a candidate vaccine, showing a 90 percent effectiveness in preventing infection. That day, Novavax submitted an FDA Fast Track application for their vaccine. On 14 December, Public Health England reported that a variant had been discovered in the UK's southeast, predominantly in Kent . The variant, later named Alpha , showed changes to the spike protein that could make the virus more infectious. As of 13 December, 1,108 infections had been confirmed in the UK. On 4 February 2020, US Secretary of Health and Human Services Alex Azar waived liability for vaccine manufacturers in all cases except those involving "willful misconduct". On 2 January, the Alpha variant, first discovered in the UK, had been identified in 33 countries. On 6 January, the Gamma variant was first identified in Japanese travellers returning from Brazil. On 29 January, it was reported that the Novavax vaccine was 49 percent effective against the Beta variant in a clinical trial in South Africa. The CoronaVac vaccine was reported to be 50.4 percent effective in a Brazil clinical trial. On 12 March, several countries stopped using the Oxford-AstraZeneca COVID-19 vaccine - due to blood clotting problems, specifically cerebral venous sinus thrombosis (CVST). On 20 March, the WHO and European Medicines Agency found no link to thrombosis , leading several countries to resume administering the vaccine. In March WHO reported that an animal host was the most likely origin, without ruling out other possibilities. The Delta variant was first identified in India. In mid-April, the variant was first detected in the UK and two months later it had become a full-fledged third wave in the country, forcing the government to delay reopening that was originally scheduled for June. On 10 November, Germany advised against the Moderna vaccine for people under 30, due to a possible association with myocarditis . On 24 November, the Omicron variant was detected in South Africa; a few days later the World Health Organization declared it a VoC (variant of concern). The new variant is more infectious than the Delta variant. On 1 January, Europe passed 100 million cases amidst a surge in the Omicron variant . Later that month, the WHO recommended the rheumatoid arthritis drug Baricitinib for severe or critical patients. It also recommended the monoclonal antibody Sotrovimab in patients with non-severe disease, but only those who are at highest risk of hospitalization. On 24 January, the Institute for Health Metrics and Evaluation estimated that about 57% of the world's population had been infected by COVID-19. By 6 March, it was reported that the total worldwide death count had surpassed 6 million people. By 6 July, Omicron subvariants BA.4 and BA.5 had spread worldwide. WHO Director-General Tedros Ghebreyesus stated on 14 September 2022, that "[The world has] never been in a better position to end the pandemic", citing the lowest number of weekly reported deaths since March 2020. He continued, "We are not there yet. But the end is in sight—we can see the finish line". On 21 October, the United States surpassed 99 million cases of COVID-19, the most cases of any country. By 30 October, the worldwide daily death toll was 424, the lowest since 385 deaths were reported on 12 March 2020. 17 November marked the three-year anniversary since health officials in China first detected COVID-19. On 11 November, the WHO reported that deaths since the month of February had dropped 90 percent. Director-General Tedros said this was "cause for optimism". On 3 December, the WHO indicated that, "at least 90% of the world's population has some level of immunity to Sars-CoV-2". In early December, China began lifting some of its most stringent lockdown measures. Subsequent data from China's health authorities revealed that 248 million people, nearly 18 percent of its population, had been infected in the first 20 days of that month. On 29 December, the US joined Italy, Japan, Taiwan and India in requiring negative COVID-19 test results from all people traveling from China due to the new surge in cases. The EU refused similar measures, stating that the BF7 omicron variant had already spread throughout Europe without becoming dominant. On 4 January 2023, the World Health Organization said the information shared by China during the recent surge in infections lacked data, such as hospitalization rates. On 10 January, the WHO's Europe office said the recent viral surge in China posed "no immediate threat." On 16 January, the WHO recommended that China monitor excess mortality to provide "a more comprehensive understanding of the impact of COVID-19." On 30 January, the three-year anniversary of the original declaration, the World Health Organization determined that COVID-19 still met the criteria for a public health emergency of international concern (PHEIC). On 19 March, WHO Director-General Tedros indicated he was "confident" the COVID-19 pandemic would cease to be a public health emergency by the end of the year. On 5 May, the WHO downgraded COVID-19 from being a global health emergency, though it continued to refer to it as a pandemic. The WHO does not make official declarations of when pandemics end. The decision came after Tedros convened with the International Health Regulations Emergency Committee, wherein the Committee noted that due to the decrease in deaths and hospitalisations, and the prevalence of vaccinations and the level of general immunity, it was time to remove the emergency designation and "transition to long-term management". Tedros agreed, and the WHO reduced the classification to an "established and ongoing health issue". In a press conference, Tedros remarked that the diminishing threat from COVID-19 had "allowed most countries to return to life as we knew it before COVID-19". In September the WHO said it had observed "concerning" trends in COVID-19 case numbers and hospitalisations, although analysis was hampered because many countries were no longer recording COVID-19 case statistics. In November 2023, in response to viral mutations and changing characteristics of infection, the WHO adjusted its treatment guidelines. Among other changes, remdesivir and molnupiravir were now recommended only for the most severe cases, and deuremidevir and ivermectin were recommended against. National reactions ranged from strict lockdowns to public education campaigns. WHO recommended that curfews and lockdowns should be short-term measures to reorganise, regroup, rebalance resources, and protect the health care system. As of 26 March 2020, 1.7 billion people worldwide were under some form of lockdown. This increased to 3.9 billion people by the first week of April—more than half the world's population . In several countries, protests rose against restrictions such as lockdowns. A February 2021 study found that protests against restrictions were likely to directly increase the spread of the virus. As of the end of 2021, Asia's peak had come at the same time and at the same level as the world as a whole, in May 2021. However, cumulatively they had experienced only half of the global average in cases. China opted for containment, instituting strict lockdowns to eliminate viral spread. The vaccines distributed in China included the BIBP , WIBP , and CoronaVac . It was reported on 11 December 2021, that China had vaccinated 1.162 billion of its citizens, or 82.5% of the total population of the country against COVID-19. China's large-scale adoption of zero-COVID had largely contained the first waves of infections of the disease. When the waves of infections due to the Omicron variant followed, China was almost alone in pursuing the strategy of zero-Covid to combat the spread of the virus in 2022. Lockdown continued to be employed in November to combat a new wave of cases; however, protests erupted in cities across China over the country's stringent measures, and in December that year, the country relaxed its zero-COVID policy. On 20 December 2022, the Chinese State Council narrowed its definition of what would be counted as a COVID-19 death to include solely respiratory failure, which led to skepticism by health experts of the government's total death count at a time when hospitals reported being overwhelmed with cases following the abrupt discontinuation of zero-COVID. The first case in India was reported on 30 January 2020. India ordered a nationwide lockdown starting 24 March 2020, with a phased unlock beginning 1 June 2020. Six cities accounted for around half of reported cases— Mumbai , Delhi , Ahmedabad , Chennai , Pune and Kolkata . Post-lockdown, the Government of India introduced a contact tracking app called Aarogya Setu to help authorities manage contact tracing and vaccine distribution. India's vaccination program was considered to be the world's largest and most successful with over 90% of citizens getting the first dose and another 65% getting the second dose. A second wave hit India in April 2021, straining healthcare services. On 21 October 2021, it was reported that the country had surpassed 1 billion vaccinations. Iran reported its first confirmed cases on 19 February 2020, in Qom . Early measures included the cancellation/closure of concerts and other cultural events, Friday prayers, and school and university campuses. Iran became a centre of the pandemic in February 2020. More than ten countries had traced their outbreaks to Iran by 28 February, indicating a more severe outbreak than the 388 reported cases. The Iranian Parliament closed, after 23 of its 290 members tested positive on 3 March 2020. At least twelve sitting or former Iranian politicians and government officials had died by 17 March 2020. By August 2021, the pandemic's fifth wave peaked, with more than 400 deaths in 1 day. COVID-19 was confirmed in South Korea on 20 January 2020. Military bases were quarantined after tests showed three infected soldiers. South Korea introduced what was then considered the world's largest and best-organised screening programme, isolating infected people, and tracing and quarantining contacts. Screening methods included mandatory self-reporting by new international arrivals through mobile application, combined with drive-through testing, and increasing testing capability to 20,000 people/day. Despite some early criticisms, South Korea's programme was considered a success in controlling the outbreak without quarantining entire cities. The COVID-19 pandemic arrived in Europe with its first confirmed case in Bordeaux , France , on 24 January 2020, and subsequently spread widely across the continent. By 17 March 2020, every country in Europe had confirmed a case, and all had reported at least one death, with the exception of Vatican City . Italy was the first European nation to experience a major outbreak in early 2020, becoming the first country worldwide to introduce a national lockdown . By 13 March 2020, the World Health Organization (WHO) declared Europe the epicentre of the pandemic and it remained so until the WHO announced it had been overtaken by South America on 22 May. By 18 March 2020, more than 250 million people were in lockdown in Europe. Despite deployment of COVID-19 vaccines , Europe became the pandemic's epicentre once again in late 2021. The Italian outbreak began on 31 January 2020, when two Chinese tourists tested positive for SARS-CoV-2 in Rome. Cases began to rise sharply, which prompted the government to suspend flights to and from China and declare a state of emergency. On 22 February 2020, the Council of Ministers announced a new decree-law to contain the outbreak, which quarantined more than 50,000 people in northern Italy. On 4 March, the Italian government ordered schools and universities closed as Italy reached a hundred deaths. Sport was suspended completely for at least one month. On 11 March, Italian Prime Minister Giuseppe Conte closed down nearly all commercial activity except supermarkets and pharmacies. On 19 April, the first wave ebbed, as 7-day deaths declined to 433. On 13 October, the Italian government again issued restrictive rules to contain the second wave. On 10 November, Italy surpassed 1 million confirmed infections. On 23 November, it was reported that the second wave of the virus had led some hospitals to stop accepting patients. The virus was first confirmed to have spread to Spain on 31 January 2020, when a German tourist tested positive for SARS-CoV-2 on La Gomera in the Canary Islands. Post-hoc genetic analysis has shown that at least 15 strains of the virus had been imported, and community transmission began by mid-February. On 29 March, it was announced that, beginning the following day, all non-essential workers were ordered to remain at home for the next 14 days. The number of cases increased again in July in a number of cities including Barcelona , Zaragoza and Madrid , which led to reimposition of some restrictions but no national lockdown. By September 2021, Spain was one of the countries with the highest percentage of its population vaccinated (76% fully vaccinated and 79% with the first dose). Italy is ranked second at 75%. Sweden differed from most other European countries in that it mostly remained open. Per the Swedish constitution , the Public Health Agency of Sweden has autonomy that prevents political interference and the agency favoured remaining open. The Swedish strategy focused on longer-term measures, based on the assumption that after lockdown the virus would resume spreading, with the same result. By the end of June, Sweden no longer had excess mortality . Devolution in the United Kingdom meant that each of its four countries developed its own response. England's restrictions were shorter-lived than the others. The UK government started enforcing social distancing and quarantine measures on 18 March 2020. On 16 March, Prime Minister Boris Johnson advised against non-essential travel and social contact, praising work from home and avoiding venues such as pubs, restaurants, and theatres. On 20 March, the government ordered all leisure establishments to close, and promised to prevent unemployment. On 23 March, Johnson banned gatherings and restricted non-essential travel and outdoor activity. Unlike previous measures, these restrictions were enforceable by police through fines and dispersal of gatherings. Most non-essential businesses were ordered to close. On 24 April 2020, it was reported that a promising vaccine trial had begun in England; the government pledged more than £50 million towards research. On 16 April 2020, it was reported that the UK would have first access to the Oxford vaccine, due to a prior contract; should the trial be successful, some 30 million doses would be available. On 2 December 2020, the UK became the first developed country to approve the Pfizer vaccine; 800,000 doses were immediately available for use. In August 2022 it was reported that viral infection cases had declined in the UK. The virus arrived in the United States on 13 January 2020. Cases were reported in all North American countries after Saint Kitts and Nevis confirmed a case on 25 March, and in all North American territories after Bonaire confirmed a case on 16 April. Per Our World in Data , 103,436,829 confirmed cases have been reported in the United States with 1,184,148 deaths, the most of any country, and the nineteenth-highest per capita worldwide. COVID-19 is the deadliest pandemic in US history ; it was the third-leading cause of death in the US in 2020, behind heart disease and cancer. From 2019 to 2020, US life expectancy dropped by 3 years for Hispanic Americans, 2.9 years for African Americans, and 1.2 years for white Americans. These effects have persisted as US deaths due to COVID-19 in 2021 exceeded those in 2020. In the United States, COVID-19 vaccines became available under emergency use in December 2020, beginning the national vaccination program . The first COVID-19 vaccine was officially approved by the Food and Drug Administration on 23 August 2021. By 18 November 2022, while cases in the U.S. had declined, COVID variants BQ.1/BQ.1.1 had become dominant in the country. In March 2020, as cases of community transmission were confirmed across Canada , all of its provinces and territories declared states of emergency. Provinces and territories, to varying degrees, implemented school and daycare closures, prohibitions on gatherings, closures of non-essential businesses and restrictions on entry. Canada severely restricted its border access, barring travellers from all countries with some exceptions. Cases surged across Canada, notably in the provinces of British Columbia , Alberta , Quebec and Ontario , with the formation of the Atlantic Bubble , a travel-restricted area of the country (formed of the four Atlantic provinces ). Vaccine passports were adopted in all provinces and two of the territories. Per a report on 11 November 2022, Canadian health authorities saw a surge in influenza, while COVID-19 was expected to rise during winter. The COVID-19 pandemic was confirmed to have reached South America on 26 February 2020, when Brazil confirmed a case in São Paulo . By 3 April, all countries and territories in South America had recorded at least one case. On 13 May 2020, it was reported that Latin America and the Caribbean had reported over 400,000 cases of COVID-19 infection with 23,091 deaths. On 22 May 2020, citing the rapid increase of infections in Brazil , the World Health Organization WHO declared South America the epicentre of the pandemic. As of 16 July 2021, South America had recorded 34,359,631 confirmed cases and 1,047,229 deaths from COVID-19. Due to a shortage of testing and medical facilities, it is believed that the outbreak is far larger than the official numbers show. The virus was confirmed to have spread to Brazil on 25 February 2020, when a man from São Paulo who had traveled to Italy tested positive for the virus. The disease had spread to every federative unit of Brazil by 21 March. On 19 June 2020, the country reported its one millionth case and nearly 49,000 reported deaths. One estimate of under-reporting was 22.62% of total reported COVID-19 mortality in 2020. As of 19 April 2024 , Brazil, with 37,519,960 confirmed cases and 702,116 deaths, has the third-highest number of confirmed cases and second-highest death toll from COVID-19 in the world, behind only those of the United States and India . The COVID-19 pandemic was confirmed to have spread to Africa on 14 February 2020, with the first confirmed case announced in Egypt . The first confirmed case in sub-Saharan Africa was announced in Nigeria at the end of February 2020. Within three months, the virus had spread throughout the continent; Lesotho , the last African sovereign state to have remained free of the virus, reported its first case on 13 May 2020. By 26 May, it appeared that most African countries were experiencing community transmission, although testing capacity was limited. Most of the identified imported cases arrived from Europe and the United States rather than from China where the virus originated. Many preventive measures were implemented by different countries in Africa including travel restrictions, flight cancellations, and event cancellations. Despite fears, Africa reported lower death rates than other, more economically developed regions. In early June 2021, Africa faced a third wave of COVID infections with cases rising in 14 countries. By 4 July the continent recorded more than 251,000 new COVID cases, a 20% increase from the prior week and a 12% increase from the January peak. More than sixteen African countries, including Malawi and Senegal , recorded an uptick in new cases. The World Health Organization labelled it Africa's 'Worst Pandemic Week Ever'. In October 2022, WHO reported that most countries on the African continent will miss the goal of 70 percent vaccination by the end of 2022. The COVID-19 pandemic was confirmed to have reached Oceania on 25 January 2020, with the first confirmed case reported in Melbourne , Australia . It has since spread elsewhere in the region. Australia and New Zealand were praised for their handling of the pandemic in comparison to other Western nations, with New Zealand and each state in Australia wiping out all community transmission of the virus several times even after re-introduction into the community. As a result of the high transmissibility of the Delta variant, however, by August 2021, the Australian states of New South Wales and Victoria had conceded defeat in their eradication efforts. In early October 2021, New Zealand also abandoned its elimination strategy. In November and December, following vaccination efforts, the remaining states of Australia, excluding Western Australia, voluntarily gave up COVID-zero to open up state and international borders. The open borders allowed the Omicron Variant of COVID-19 to enter quickly and cases subsequently exceeded 120,000 a day. By early March 2022, with cases exceeding 1,000 a day, Western Australia conceded defeat in its eradication strategy and opened its borders. Despite record cases, Australian jurisdictions slowly removed restrictions such as close contact isolation, mask wearing and density limits by April 2022. On 9 September 2022 restrictions were significantly relaxed. The aircraft mask mandate was scrapped nationwide and daily reporting transitioned to weekly reporting. On 14 September, COVID-19 disaster payment for isolating persons was extended for mandatory isolation. By 22 September, all states had ended mask mandates on public transport, including in Victoria, where the mandate had lasted for approximately 800 days. On 30 September 2022, all Australian leaders declared the emergency response finished and announced the end of isolation requirements. These changes were due in part to high levels of 'hybrid immunity' and low case numbers. Due to its remoteness and sparse population, Antarctica was the last continent to have confirmed cases of COVID-19. The first cases were reported in December 2020, almost a year after the first cases of COVID-19 were detected in China. At least 36 people were infected in the first outbreak in 2020, with several other outbreaks taking place in 2021 and 2022. The United Nations Conference on Trade and Development (UNSC) was criticised for its slow response, especially regarding the UN's global ceasefire , which aimed to open up humanitarian access to conflict zones. The United Nations Security Council was criticized due to the inadequate manner in which it dealt with the COVID-19 pandemic, namely the poor ability to create international collaboration during this crisis. On 23 March 2020, United Nations Secretary-General António Manuel de Oliveira Guterres appealed for a global ceasefire ; 172 UN member states and observers signed a non-binding supporting statement in June, and the UN Security Council passed a resolution supporting it in July. On 29 September 2020, Guterres urged the International Monetary Fund to help certain countries via debt relief and also call for countries to increase contributions to develop vaccines. The WHO spearheaded initiatives such as the COVID-19 Solidarity Response Fund to raise money for the pandemic response, the UN COVID-19 Supply Chain Task Force , and the solidarity trial for investigating potential treatment options for the disease. The COVAX program, co-led by the WHO, GAVI , and the Coalition for Epidemic Preparedness Innovations (CEPI), aimed to accelerate the development, manufacture, and distribution of COVID-19 vaccines, and to guarantee fair and equitable access across the world. As of the end of 2021, Asia's peak had come at the same time and at the same level as the world as a whole, in May 2021. However, cumulatively they had experienced only half of the global average in cases. China opted for containment, instituting strict lockdowns to eliminate viral spread. The vaccines distributed in China included the BIBP , WIBP , and CoronaVac . It was reported on 11 December 2021, that China had vaccinated 1.162 billion of its citizens, or 82.5% of the total population of the country against COVID-19. China's large-scale adoption of zero-COVID had largely contained the first waves of infections of the disease. When the waves of infections due to the Omicron variant followed, China was almost alone in pursuing the strategy of zero-Covid to combat the spread of the virus in 2022. Lockdown continued to be employed in November to combat a new wave of cases; however, protests erupted in cities across China over the country's stringent measures, and in December that year, the country relaxed its zero-COVID policy. On 20 December 2022, the Chinese State Council narrowed its definition of what would be counted as a COVID-19 death to include solely respiratory failure, which led to skepticism by health experts of the government's total death count at a time when hospitals reported being overwhelmed with cases following the abrupt discontinuation of zero-COVID. The first case in India was reported on 30 January 2020. India ordered a nationwide lockdown starting 24 March 2020, with a phased unlock beginning 1 June 2020. Six cities accounted for around half of reported cases— Mumbai , Delhi , Ahmedabad , Chennai , Pune and Kolkata . Post-lockdown, the Government of India introduced a contact tracking app called Aarogya Setu to help authorities manage contact tracing and vaccine distribution. India's vaccination program was considered to be the world's largest and most successful with over 90% of citizens getting the first dose and another 65% getting the second dose. A second wave hit India in April 2021, straining healthcare services. On 21 October 2021, it was reported that the country had surpassed 1 billion vaccinations. Iran reported its first confirmed cases on 19 February 2020, in Qom . Early measures included the cancellation/closure of concerts and other cultural events, Friday prayers, and school and university campuses. Iran became a centre of the pandemic in February 2020. More than ten countries had traced their outbreaks to Iran by 28 February, indicating a more severe outbreak than the 388 reported cases. The Iranian Parliament closed, after 23 of its 290 members tested positive on 3 March 2020. At least twelve sitting or former Iranian politicians and government officials had died by 17 March 2020. By August 2021, the pandemic's fifth wave peaked, with more than 400 deaths in 1 day. COVID-19 was confirmed in South Korea on 20 January 2020. Military bases were quarantined after tests showed three infected soldiers. South Korea introduced what was then considered the world's largest and best-organised screening programme, isolating infected people, and tracing and quarantining contacts. Screening methods included mandatory self-reporting by new international arrivals through mobile application, combined with drive-through testing, and increasing testing capability to 20,000 people/day. Despite some early criticisms, South Korea's programme was considered a success in controlling the outbreak without quarantining entire cities. The COVID-19 pandemic arrived in Europe with its first confirmed case in Bordeaux , France , on 24 January 2020, and subsequently spread widely across the continent. By 17 March 2020, every country in Europe had confirmed a case, and all had reported at least one death, with the exception of Vatican City . Italy was the first European nation to experience a major outbreak in early 2020, becoming the first country worldwide to introduce a national lockdown . By 13 March 2020, the World Health Organization (WHO) declared Europe the epicentre of the pandemic and it remained so until the WHO announced it had been overtaken by South America on 22 May. By 18 March 2020, more than 250 million people were in lockdown in Europe. Despite deployment of COVID-19 vaccines , Europe became the pandemic's epicentre once again in late 2021. The Italian outbreak began on 31 January 2020, when two Chinese tourists tested positive for SARS-CoV-2 in Rome. Cases began to rise sharply, which prompted the government to suspend flights to and from China and declare a state of emergency. On 22 February 2020, the Council of Ministers announced a new decree-law to contain the outbreak, which quarantined more than 50,000 people in northern Italy. On 4 March, the Italian government ordered schools and universities closed as Italy reached a hundred deaths. Sport was suspended completely for at least one month. On 11 March, Italian Prime Minister Giuseppe Conte closed down nearly all commercial activity except supermarkets and pharmacies. On 19 April, the first wave ebbed, as 7-day deaths declined to 433. On 13 October, the Italian government again issued restrictive rules to contain the second wave. On 10 November, Italy surpassed 1 million confirmed infections. On 23 November, it was reported that the second wave of the virus had led some hospitals to stop accepting patients. The virus was first confirmed to have spread to Spain on 31 January 2020, when a German tourist tested positive for SARS-CoV-2 on La Gomera in the Canary Islands. Post-hoc genetic analysis has shown that at least 15 strains of the virus had been imported, and community transmission began by mid-February. On 29 March, it was announced that, beginning the following day, all non-essential workers were ordered to remain at home for the next 14 days. The number of cases increased again in July in a number of cities including Barcelona , Zaragoza and Madrid , which led to reimposition of some restrictions but no national lockdown. By September 2021, Spain was one of the countries with the highest percentage of its population vaccinated (76% fully vaccinated and 79% with the first dose). Italy is ranked second at 75%. Sweden differed from most other European countries in that it mostly remained open. Per the Swedish constitution , the Public Health Agency of Sweden has autonomy that prevents political interference and the agency favoured remaining open. The Swedish strategy focused on longer-term measures, based on the assumption that after lockdown the virus would resume spreading, with the same result. By the end of June, Sweden no longer had excess mortality . Devolution in the United Kingdom meant that each of its four countries developed its own response. England's restrictions were shorter-lived than the others. The UK government started enforcing social distancing and quarantine measures on 18 March 2020. On 16 March, Prime Minister Boris Johnson advised against non-essential travel and social contact, praising work from home and avoiding venues such as pubs, restaurants, and theatres. On 20 March, the government ordered all leisure establishments to close, and promised to prevent unemployment. On 23 March, Johnson banned gatherings and restricted non-essential travel and outdoor activity. Unlike previous measures, these restrictions were enforceable by police through fines and dispersal of gatherings. Most non-essential businesses were ordered to close. On 24 April 2020, it was reported that a promising vaccine trial had begun in England; the government pledged more than £50 million towards research. On 16 April 2020, it was reported that the UK would have first access to the Oxford vaccine, due to a prior contract; should the trial be successful, some 30 million doses would be available. On 2 December 2020, the UK became the first developed country to approve the Pfizer vaccine; 800,000 doses were immediately available for use. In August 2022 it was reported that viral infection cases had declined in the UK. The virus arrived in the United States on 13 January 2020. Cases were reported in all North American countries after Saint Kitts and Nevis confirmed a case on 25 March, and in all North American territories after Bonaire confirmed a case on 16 April. Per Our World in Data , 103,436,829 confirmed cases have been reported in the United States with 1,184,148 deaths, the most of any country, and the nineteenth-highest per capita worldwide. COVID-19 is the deadliest pandemic in US history ; it was the third-leading cause of death in the US in 2020, behind heart disease and cancer. From 2019 to 2020, US life expectancy dropped by 3 years for Hispanic Americans, 2.9 years for African Americans, and 1.2 years for white Americans. These effects have persisted as US deaths due to COVID-19 in 2021 exceeded those in 2020. In the United States, COVID-19 vaccines became available under emergency use in December 2020, beginning the national vaccination program . The first COVID-19 vaccine was officially approved by the Food and Drug Administration on 23 August 2021. By 18 November 2022, while cases in the U.S. had declined, COVID variants BQ.1/BQ.1.1 had become dominant in the country. In March 2020, as cases of community transmission were confirmed across Canada , all of its provinces and territories declared states of emergency. Provinces and territories, to varying degrees, implemented school and daycare closures, prohibitions on gatherings, closures of non-essential businesses and restrictions on entry. Canada severely restricted its border access, barring travellers from all countries with some exceptions. Cases surged across Canada, notably in the provinces of British Columbia , Alberta , Quebec and Ontario , with the formation of the Atlantic Bubble , a travel-restricted area of the country (formed of the four Atlantic provinces ). Vaccine passports were adopted in all provinces and two of the territories. Per a report on 11 November 2022, Canadian health authorities saw a surge in influenza, while COVID-19 was expected to rise during winter. The COVID-19 pandemic was confirmed to have reached South America on 26 February 2020, when Brazil confirmed a case in São Paulo . By 3 April, all countries and territories in South America had recorded at least one case. On 13 May 2020, it was reported that Latin America and the Caribbean had reported over 400,000 cases of COVID-19 infection with 23,091 deaths. On 22 May 2020, citing the rapid increase of infections in Brazil , the World Health Organization WHO declared South America the epicentre of the pandemic. As of 16 July 2021, South America had recorded 34,359,631 confirmed cases and 1,047,229 deaths from COVID-19. Due to a shortage of testing and medical facilities, it is believed that the outbreak is far larger than the official numbers show. The virus was confirmed to have spread to Brazil on 25 February 2020, when a man from São Paulo who had traveled to Italy tested positive for the virus. The disease had spread to every federative unit of Brazil by 21 March. On 19 June 2020, the country reported its one millionth case and nearly 49,000 reported deaths. One estimate of under-reporting was 22.62% of total reported COVID-19 mortality in 2020. As of 19 April 2024 , Brazil, with 37,519,960 confirmed cases and 702,116 deaths, has the third-highest number of confirmed cases and second-highest death toll from COVID-19 in the world, behind only those of the United States and India . The COVID-19 pandemic was confirmed to have spread to Africa on 14 February 2020, with the first confirmed case announced in Egypt . The first confirmed case in sub-Saharan Africa was announced in Nigeria at the end of February 2020. Within three months, the virus had spread throughout the continent; Lesotho , the last African sovereign state to have remained free of the virus, reported its first case on 13 May 2020. By 26 May, it appeared that most African countries were experiencing community transmission, although testing capacity was limited. Most of the identified imported cases arrived from Europe and the United States rather than from China where the virus originated. Many preventive measures were implemented by different countries in Africa including travel restrictions, flight cancellations, and event cancellations. Despite fears, Africa reported lower death rates than other, more economically developed regions. In early June 2021, Africa faced a third wave of COVID infections with cases rising in 14 countries. By 4 July the continent recorded more than 251,000 new COVID cases, a 20% increase from the prior week and a 12% increase from the January peak. More than sixteen African countries, including Malawi and Senegal , recorded an uptick in new cases. The World Health Organization labelled it Africa's 'Worst Pandemic Week Ever'. In October 2022, WHO reported that most countries on the African continent will miss the goal of 70 percent vaccination by the end of 2022. The COVID-19 pandemic was confirmed to have reached Oceania on 25 January 2020, with the first confirmed case reported in Melbourne , Australia . It has since spread elsewhere in the region. Australia and New Zealand were praised for their handling of the pandemic in comparison to other Western nations, with New Zealand and each state in Australia wiping out all community transmission of the virus several times even after re-introduction into the community. As a result of the high transmissibility of the Delta variant, however, by August 2021, the Australian states of New South Wales and Victoria had conceded defeat in their eradication efforts. In early October 2021, New Zealand also abandoned its elimination strategy. In November and December, following vaccination efforts, the remaining states of Australia, excluding Western Australia, voluntarily gave up COVID-zero to open up state and international borders. The open borders allowed the Omicron Variant of COVID-19 to enter quickly and cases subsequently exceeded 120,000 a day. By early March 2022, with cases exceeding 1,000 a day, Western Australia conceded defeat in its eradication strategy and opened its borders. Despite record cases, Australian jurisdictions slowly removed restrictions such as close contact isolation, mask wearing and density limits by April 2022. On 9 September 2022 restrictions were significantly relaxed. The aircraft mask mandate was scrapped nationwide and daily reporting transitioned to weekly reporting. On 14 September, COVID-19 disaster payment for isolating persons was extended for mandatory isolation. By 22 September, all states had ended mask mandates on public transport, including in Victoria, where the mandate had lasted for approximately 800 days. On 30 September 2022, all Australian leaders declared the emergency response finished and announced the end of isolation requirements. These changes were due in part to high levels of 'hybrid immunity' and low case numbers. Due to its remoteness and sparse population, Antarctica was the last continent to have confirmed cases of COVID-19. The first cases were reported in December 2020, almost a year after the first cases of COVID-19 were detected in China. At least 36 people were infected in the first outbreak in 2020, with several other outbreaks taking place in 2021 and 2022. The United Nations Conference on Trade and Development (UNSC) was criticised for its slow response, especially regarding the UN's global ceasefire , which aimed to open up humanitarian access to conflict zones. The United Nations Security Council was criticized due to the inadequate manner in which it dealt with the COVID-19 pandemic, namely the poor ability to create international collaboration during this crisis. On 23 March 2020, United Nations Secretary-General António Manuel de Oliveira Guterres appealed for a global ceasefire ; 172 UN member states and observers signed a non-binding supporting statement in June, and the UN Security Council passed a resolution supporting it in July. On 29 September 2020, Guterres urged the International Monetary Fund to help certain countries via debt relief and also call for countries to increase contributions to develop vaccines. The WHO spearheaded initiatives such as the COVID-19 Solidarity Response Fund to raise money for the pandemic response, the UN COVID-19 Supply Chain Task Force , and the solidarity trial for investigating potential treatment options for the disease. The COVAX program, co-led by the WHO, GAVI , and the Coalition for Epidemic Preparedness Innovations (CEPI), aimed to accelerate the development, manufacture, and distribution of COVID-19 vaccines, and to guarantee fair and equitable access across the world. The pandemic shook the world's economy, with especially severe economic damage in the United States, Europe and Latin America. A consensus report by American intelligence agencies in April 2021 concluded, "Efforts to contain and manage the virus have reinforced nationalist trends globally, as some states turned inward to protect their citizens and sometimes cast blame on marginalized groups." COVID-19 inflamed partisanship and polarisation around the world as bitter arguments exploded over how to respond. International trade was disrupted amid the formation of no-entry enclaves. The pandemic led many countries and regions to impose quarantines, entry bans, or other restrictions, either for citizens, recent travellers to affected areas, or for all travellers. Travel collapsed worldwide, damaging the travel sector. The effectiveness of travel restrictions was questioned as the virus spread across the world. One study found that travel restrictions only modestly affected the initial spread, unless combined with other infection prevention and control measures. Researchers concluded that "travel restrictions are most useful in the early and late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late". The European Union rejected the idea of suspending the Schengen free travel zone . Several countries repatriated their citizens and diplomatic staff from Wuhan and surrounding areas, primarily through charter flights . Canada, the United States, Japan, India, Sri Lanka, Australia, France, Argentina, Germany and Thailand were among the first to do so. Brazil and New Zealand evacuated their own nationals and others. On 14 March, South Africa repatriated 112 South Africans who tested negative, while four who showed symptoms were left behind. Pakistan declined to evacuate its citizens. On 15 February, the US announced it would evacuate Americans aboard the Diamond Princess cruise ship, and on 21 February, Canada evacuated 129 Canadians from the ship. In early March, the Indian government began repatriating its citizens from Iran. On 20 March, the United States began to withdraw some troops from Iraq. The pandemic led many countries and regions to impose quarantines, entry bans, or other restrictions, either for citizens, recent travellers to affected areas, or for all travellers. Travel collapsed worldwide, damaging the travel sector. The effectiveness of travel restrictions was questioned as the virus spread across the world. One study found that travel restrictions only modestly affected the initial spread, unless combined with other infection prevention and control measures. Researchers concluded that "travel restrictions are most useful in the early and late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late". The European Union rejected the idea of suspending the Schengen free travel zone . Several countries repatriated their citizens and diplomatic staff from Wuhan and surrounding areas, primarily through charter flights . Canada, the United States, Japan, India, Sri Lanka, Australia, France, Argentina, Germany and Thailand were among the first to do so. Brazil and New Zealand evacuated their own nationals and others. On 14 March, South Africa repatriated 112 South Africans who tested negative, while four who showed symptoms were left behind. Pakistan declined to evacuate its citizens. On 15 February, the US announced it would evacuate Americans aboard the Diamond Princess cruise ship, and on 21 February, Canada evacuated 129 Canadians from the ship. In early March, the Indian government began repatriating its citizens from Iran. On 20 March, the United States began to withdraw some troops from Iraq. The pandemic and responses to it damaged the global economy. On 27 February 2020, worries about the outbreak crushed US stock indexes, which posted their sharpest falls since 2008. Tourism collapsed due to travel restrictions, closing of public places including travel attractions, and advice of governments against travel. Airlines cancelled flights, while British regional airline Flybe collapsed. The cruise line industry was hard hit, and train stations and ferry ports closed. International mail stopped or was delayed. The retail sector faced reductions in store hours or closures. Retailers in Europe and Latin America faced traffic declines of 40 percent. North America and Middle East retailers saw a 50–60 percent drop. Shopping centres faced a 33–43 percent drop in foot traffic in March compared to February. Mall operators around the world coped by increasing sanitation, installing thermal scanners to check the temperature of shoppers, and cancelling events. Hundreds of millions of jobs were lost, including more than 40 million jobs in the US. According to a report by Yelp , about 60% of US businesses that closed will stay shut permanently. The International Labour Organization (ILO) reported that the income generated in the first nine months of 2020 from work across the world dropped by 10.7 percent, or $3.5 trillion. Pandemic fears led to panic buying , emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust). Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain disruptions from factory and port shutdowns, and labour shortages. Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products. According to WHO Secretary-General Tedros Ghebreyesus, demand for personal protective equipment (PPE) rose one hundredfold, pushing prices up twentyfold. PPE stocks were exhausted everywhere. In September 2021, the World Bank reported that food prices remained generally stable and the supply outlook remained positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began. The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021. By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips. The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia. The performing arts and cultural heritage sectors were profoundly affected by the pandemic. Both organisations' and individuals' operations have been impacted globally. By March 2020, across the world and to varying degrees, museums, libraries, performance venues, and other cultural institutions had been indefinitely closed with their exhibitions, events and performances cancelled or postponed. A 2021 UNESCO report estimated ten million job losses worldwide in the culture and creative industries. Some services continued through digital platforms, such as live streaming concerts or web-based arts festivals. The pandemic affected political systems, causing suspensions of legislative activities, isolations or deaths of politicians, and rescheduled elections. Although they developed broad support among epidemiologists, NPIs (non-pharmaceutical interventions) were controversial in many countries. Intellectual opposition came primarily from other fields, along with heterodox epidemiologists. The pandemic (and the response of Brazilian politicians to it) led to widespread panic, confusion, and pessimism in Brazil. When questioned regarding record deaths in the country in April 2020, Brazilian President Jair Bolsonaro said "So what? I'm sorry. What do you want me to do about it?" Bolsonaro disregarded WHO-recommended mitigation techniques and instead downplayed the risks of the virus , promoted increased economic activity, spread misinformation about the efficacy of masks, vaccines and public health measures, and distributed unproven treatments including hydroxychloroquine and ivermectin . A series of federal health ministers resigned or were dismissed after they refused to implement Bolsonaro's policies. Disagreements between federal and state governments led to a chaotic and delayed response to the rapid spread of the virus, exacerbated by preexisting social and economic disparities in the country. Employment, investment and valuation of the Brazilian real plummeted to record lows. Brazil was also heavily affected by the Delta and Omicron variants. At the height of the outbreak in the spring of 2021, 3,000+ Brazilians were dying per day. Bolsonaro's loss to Lula da Silva in the 2022 presidential election is widely credited to the former's mishandling of the pandemic . Multiple provincial-level administrators of the Chinese Communist Party (CCP) were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary Xi Jinping . The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload. The Chinese government maintained that it acted swiftly and transparently. Journalists and activists in China who reported on the pandemic were detained by authorities, including Zhang Zhan , who was arrested and tortured. In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy. On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte , Russian President Vladimir Putin ordered the Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy. In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant, and European Commission President Ursula von der Leyen offered an official apology to the country . Beginning in mid-April 2020, protestors objected to government-imposed business closures and restrictions on personal movement and assembly. Simultaneously, essential workers protested unsafe conditions and low wages by participating in a brief general strike . Some political analysts claimed that the pandemic contributed to President Donald Trump 's 2020 defeat. The COVID-19 pandemic in the United States prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care , universal child care , paid sick leave , and higher levels of funding for public health. The Kaiser Family Foundation estimated that preventable hospitalizations of unvaccinated Americans in the second half of 2021 cost US$13.8 billion. There were also protest in regards to vaccine mandates in the United States. In January 2022, the US Supreme Court struck down an OSHA rule that mandated vaccination or a testing regimen for all companies with greater than 100 employees. The number of journalists imprisoned or detained increased worldwide; some detentions were related to the pandemic. The planned NATO " Defender 2020 " military exercise in Germany, Poland and the Baltic states , the largest NATO war exercise since the end of the Cold War , was held on a reduced scale. The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures. Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets. Saudi Arabia, which had launched a military intervention in Yemen in March 2015, declared a ceasefire. Diplomatic relations between Japan and South Korea worsened. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks. South Korean society was initially polarised on President Moon Jae-in 's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response. Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power. In Hungary, the parliament voted to allow Prime Minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information. In countries such as Egypt , Turkey , and Thailand , opposition activists and government critics were arrested for allegedly spreading fake news . In India, journalists criticising the government's response were arrested or issued warnings by police and authorities. The pandemic disrupted food systems worldwide, hitting at a time when hunger and undernourishment were rising- an estimated 690 million people lacked food security in 2019. Food access fell – driven by falling incomes, lost remittances, and disruptions to food production. In some cases, food prices rose. The pandemic and its accompanying lockdowns and travel restrictions slowed movement of food aid. According to the WHO, 811 million people were undernourished in 2020, "likely related to the fallout of COVID-19". The pandemic impacted educational systems in many countries. Many governments temporarily closed educational institutions, often replaced by online education . Other countries, such as Sweden, kept their schools open. As of September 2020, approximately 1.077 billion learners were affected due to school closures. School closures impacted students, teachers, and families with far-reaching economic and societal consequences. They shed light on social and economic issues, including student debt , digital learning , food insecurity, and homelessness , as well as access to childcare , health care, housing, internet, and disability services . The impact was more severe for disadvantaged children. The Higher Education Policy Institute reported that around 63% of students claimed worsened mental health as a result of the pandemic. The pandemic impacted global health for many conditions. Hospital visits fell. Visits for heart attack symptoms declined by 38% in the US and 40% in Spain. The head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home because they're too scared to go to the hospital." People with strokes and appendicitis were less likely to seek treatment. Medical supply shortages impacted many people. The pandemic impacted mental health , increasing anxiety , depression, and post-traumatic stress disorder , affecting healthcare workers, patients and quarantined individuals. In late 2022, during the first northern hemisphere autumn and winter seasons following the widespread relaxation of global public health measures, North America and Europe experienced a surge in respiratory viruses and coinfections in both adults and children. This formed the beginnings of the 2022–2023 pediatric care crisis and what some experts have termed a " tripledemic " of seasonal influenza, Respiratory Syncytial Virus (RSV) , and SARS-CoV-2 throughout North America. In the United Kingdom, pediatric infections also began to spike beyond pre-pandemic levels, albeit with different illnesses, such as Group A streptococcal infection and resultant scarlet fever . As of mid-December 2022, 19 children in the UK had died due to Strep A and the wave of infections had begun to spread into North America and Mainland Europe. The B/Yamagata lineage of influenza B might have become extinct in 2020/2021 due to COVID-19 pandemic measures. There have been no naturally occurring cases confirmed since March 2020. In 2023, the World Health Organization concluded that protection against the Yamagata lineage was no longer necessary in the seasonal flu vaccine , reducing the number of lineages targeted by the vaccine from four to three. The pandemic and the reaction to it positively affected the environment and climate as a result of reduced human activity. During the " anthropause ", fossil fuel use decreased, resource consumption declined, and waste disposal improved, generating less pollution. Planned air travel and vehicle transportation declined. In China, lockdowns and other measures resulted in a 26% decrease in coal consumption, and a 50% reduction in nitrogen oxides emissions. In 2020, a worldwide study on mammalian wildlife responses to human presence during COVID lockdowns found complex patterns of animal behavior. Carnivores were generally less active when humans were around, while herbivores in developed areas were more active. Among other findings, this suggested that herbivores may view humans as a shield against predators, highlighting the importance of location and human presence history in understanding wildlife responses to changes in human activity in a given area. A wide variety of largely mammalian species, both captive and wild, have been shown to be susceptible to SARS-CoV-2, with some encountering a particularly high degree of fatal outcomes. In particular, both farmed and wild mink have developed highly symptomatic and severe COVID-19 infections, with a mortality rate as high as 35–55% according to one study. White-tailed deer , on the other hand, have largely avoided severe outcomes but have effectively become natural reservoirs of the virus, with large numbers of free-ranging deer infected throughout the US and Canada, including approximately 80% of Iowa 's wild deer herd. An August 2023 study appeared to confirm the status of white-tailed deer as a disease reservoir, noting that the viral evolution of SARS-CoV-2 in deer occurs at triple the rate of its evolution in humans and that infection rates remained high, even in areas rarely frequented by humans. Heightened prejudice, xenophobia , and racism toward people of Chinese and East Asian descent were documented around the world. Reports from February 2020, when most confirmed cases were confined to China, cited racist sentiments about Chinese people 'deserving' the virus. Individuals of Asian descent in Europe and North America reported increasing instances of racially-motivated abuse and assaults as a result of the pandemic. US President Donald Trump was criticised for referring to SARS-CoV-2 as the "Chinese Virus" and "Kung Flu", terms which were condemned as being racist and xenophobic. Age-based discrimination against older adults increased during the pandemic. This was attributed to their perceived vulnerability and subsequent physical and social isolation measures, which, coupled with their reduced social activity, increased dependency on others. Similarly, limited digital literacy left the elderly more vulnerable to isolation, depression, and loneliness. In a correspondence published in The Lancet in 2021, German epidemiologist Günter Kampf described the harmful effects of "inappropriate stigmatisation of unvaccinated people, who include our patients, colleagues, and other fellow citizens", noting the evidence that vaccinated individuals play a large role in transmission. American bioethicist Arthur Caplan responded to Kampf, writing "Criticising [the unvaccinated] who... wind up in hospitals and morgues in huge numbers, put stress on finite resources, and prolong the pandemic... is not stigmatising, it is deserved moral condemnation." In January 2022, Amnesty International urged Italy to change their anti-COVID-19 restrictions to avoid discrimination against unvaccinated people, saying that "the government must continue to ensure that the entire population can enjoy its fundamental rights." The restrictions included mandatory vaccination over the age of 50, and mandatory vaccination to use public transport. The pandemic triggered massive changes in behaviour, from increased Internet commerce to cultural changes in the workplace. Online retailers in the US posted $791.70 billion in sales in 2020, an increase of 32.4% from $598.02 billion the year before. Home delivery orders increased, while indoor restaurant dining shut down due to lockdown orders or low sales. Hackers, cybercriminals and scammers took advantage of the changes to launch new online attacks. Education in some countries temporarily shifted from physical attendance to video conferencing. Massive layoffs shrank the airline, travel, hospitality, and other industries. Despite most corporations implementing measures to address COVID-19 in the workplace, a poll from Catalyst found that as many as 68% of employees around the world felt that these policies were only performative and "not genuine". The pandemic led to a surge in remote work . According to a Gallup poll , only 4% of US employees were fully remote before the pandemic, compared to 43% in May 2020. Among white collar workers, that shift was more pronounced, with 6% increasing to 65% in the same period. That trend continued in later stages of the pandemic, with many workers choosing to remain remote even after workplaces reopened. Many Nordic, European, and Asian companies increased their recruitment of international remote workers even as the pandemic waned, partially to save on labor costs. This also led to a talent drain in the global south and in remote areas in the global north. High cost of living and dense urban areas also lost office real estate value due to remote worker exodus. By May 2023, due to increasing layoffs and concerns over productivity, some white collar workplaces in the US had resorted to performance review penalties and indirect incentives (e.g. donations to charity) to encourage workers to return to the office. A 2021 study noted that the COVID-19 pandemic had increased interest in epidemics and infectious diseases among both historians and the general public. Prior to the pandemic, these topics were usually overlooked by "general" history and only received attention in the history of medicine . Many comparisons were made between the COVID-19 and 1918 influenza pandemics , including the development of anti-mask movements, the widespread promotion of misinformation and the impact of socioeconomic disparities . In some areas, religious groups exacerbated the spread of the virus, through large gatherings and the dissemination of misinformation. Some religious leaders decried what they saw as violations of religious freedom. In other cases, religious identity was a beneficial factor for health, increasing compliance with public health measures and protecting against the negative effects of isolation on mental wellbeing. The pandemic and responses to it damaged the global economy. On 27 February 2020, worries about the outbreak crushed US stock indexes, which posted their sharpest falls since 2008. Tourism collapsed due to travel restrictions, closing of public places including travel attractions, and advice of governments against travel. Airlines cancelled flights, while British regional airline Flybe collapsed. The cruise line industry was hard hit, and train stations and ferry ports closed. International mail stopped or was delayed. The retail sector faced reductions in store hours or closures. Retailers in Europe and Latin America faced traffic declines of 40 percent. North America and Middle East retailers saw a 50–60 percent drop. Shopping centres faced a 33–43 percent drop in foot traffic in March compared to February. Mall operators around the world coped by increasing sanitation, installing thermal scanners to check the temperature of shoppers, and cancelling events. Hundreds of millions of jobs were lost, including more than 40 million jobs in the US. According to a report by Yelp , about 60% of US businesses that closed will stay shut permanently. The International Labour Organization (ILO) reported that the income generated in the first nine months of 2020 from work across the world dropped by 10.7 percent, or $3.5 trillion. Pandemic fears led to panic buying , emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust). Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain disruptions from factory and port shutdowns, and labour shortages. Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products. According to WHO Secretary-General Tedros Ghebreyesus, demand for personal protective equipment (PPE) rose one hundredfold, pushing prices up twentyfold. PPE stocks were exhausted everywhere. In September 2021, the World Bank reported that food prices remained generally stable and the supply outlook remained positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began. The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021. By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips. The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia. Pandemic fears led to panic buying , emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust). Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain disruptions from factory and port shutdowns, and labour shortages. Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products. According to WHO Secretary-General Tedros Ghebreyesus, demand for personal protective equipment (PPE) rose one hundredfold, pushing prices up twentyfold. PPE stocks were exhausted everywhere. In September 2021, the World Bank reported that food prices remained generally stable and the supply outlook remained positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began. The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021. By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips. The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia. The performing arts and cultural heritage sectors were profoundly affected by the pandemic. Both organisations' and individuals' operations have been impacted globally. By March 2020, across the world and to varying degrees, museums, libraries, performance venues, and other cultural institutions had been indefinitely closed with their exhibitions, events and performances cancelled or postponed. A 2021 UNESCO report estimated ten million job losses worldwide in the culture and creative industries. Some services continued through digital platforms, such as live streaming concerts or web-based arts festivals. The pandemic affected political systems, causing suspensions of legislative activities, isolations or deaths of politicians, and rescheduled elections. Although they developed broad support among epidemiologists, NPIs (non-pharmaceutical interventions) were controversial in many countries. Intellectual opposition came primarily from other fields, along with heterodox epidemiologists. The pandemic (and the response of Brazilian politicians to it) led to widespread panic, confusion, and pessimism in Brazil. When questioned regarding record deaths in the country in April 2020, Brazilian President Jair Bolsonaro said "So what? I'm sorry. What do you want me to do about it?" Bolsonaro disregarded WHO-recommended mitigation techniques and instead downplayed the risks of the virus , promoted increased economic activity, spread misinformation about the efficacy of masks, vaccines and public health measures, and distributed unproven treatments including hydroxychloroquine and ivermectin . A series of federal health ministers resigned or were dismissed after they refused to implement Bolsonaro's policies. Disagreements between federal and state governments led to a chaotic and delayed response to the rapid spread of the virus, exacerbated by preexisting social and economic disparities in the country. Employment, investment and valuation of the Brazilian real plummeted to record lows. Brazil was also heavily affected by the Delta and Omicron variants. At the height of the outbreak in the spring of 2021, 3,000+ Brazilians were dying per day. Bolsonaro's loss to Lula da Silva in the 2022 presidential election is widely credited to the former's mishandling of the pandemic . Multiple provincial-level administrators of the Chinese Communist Party (CCP) were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary Xi Jinping . The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload. The Chinese government maintained that it acted swiftly and transparently. Journalists and activists in China who reported on the pandemic were detained by authorities, including Zhang Zhan , who was arrested and tortured. In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy. On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte , Russian President Vladimir Putin ordered the Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy. In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant, and European Commission President Ursula von der Leyen offered an official apology to the country . Beginning in mid-April 2020, protestors objected to government-imposed business closures and restrictions on personal movement and assembly. Simultaneously, essential workers protested unsafe conditions and low wages by participating in a brief general strike . Some political analysts claimed that the pandemic contributed to President Donald Trump 's 2020 defeat. The COVID-19 pandemic in the United States prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care , universal child care , paid sick leave , and higher levels of funding for public health. The Kaiser Family Foundation estimated that preventable hospitalizations of unvaccinated Americans in the second half of 2021 cost US$13.8 billion. There were also protest in regards to vaccine mandates in the United States. In January 2022, the US Supreme Court struck down an OSHA rule that mandated vaccination or a testing regimen for all companies with greater than 100 employees. The number of journalists imprisoned or detained increased worldwide; some detentions were related to the pandemic. The planned NATO " Defender 2020 " military exercise in Germany, Poland and the Baltic states , the largest NATO war exercise since the end of the Cold War , was held on a reduced scale. The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures. Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets. Saudi Arabia, which had launched a military intervention in Yemen in March 2015, declared a ceasefire. Diplomatic relations between Japan and South Korea worsened. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks. South Korean society was initially polarised on President Moon Jae-in 's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response. Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power. In Hungary, the parliament voted to allow Prime Minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information. In countries such as Egypt , Turkey , and Thailand , opposition activists and government critics were arrested for allegedly spreading fake news . In India, journalists criticising the government's response were arrested or issued warnings by police and authorities. The pandemic (and the response of Brazilian politicians to it) led to widespread panic, confusion, and pessimism in Brazil. When questioned regarding record deaths in the country in April 2020, Brazilian President Jair Bolsonaro said "So what? I'm sorry. What do you want me to do about it?" Bolsonaro disregarded WHO-recommended mitigation techniques and instead downplayed the risks of the virus , promoted increased economic activity, spread misinformation about the efficacy of masks, vaccines and public health measures, and distributed unproven treatments including hydroxychloroquine and ivermectin . A series of federal health ministers resigned or were dismissed after they refused to implement Bolsonaro's policies. Disagreements between federal and state governments led to a chaotic and delayed response to the rapid spread of the virus, exacerbated by preexisting social and economic disparities in the country. Employment, investment and valuation of the Brazilian real plummeted to record lows. Brazil was also heavily affected by the Delta and Omicron variants. At the height of the outbreak in the spring of 2021, 3,000+ Brazilians were dying per day. Bolsonaro's loss to Lula da Silva in the 2022 presidential election is widely credited to the former's mishandling of the pandemic . Multiple provincial-level administrators of the Chinese Communist Party (CCP) were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary Xi Jinping . The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload. The Chinese government maintained that it acted swiftly and transparently. Journalists and activists in China who reported on the pandemic were detained by authorities, including Zhang Zhan , who was arrested and tortured. In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy. On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte , Russian President Vladimir Putin ordered the Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy. In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant, and European Commission President Ursula von der Leyen offered an official apology to the country . Beginning in mid-April 2020, protestors objected to government-imposed business closures and restrictions on personal movement and assembly. Simultaneously, essential workers protested unsafe conditions and low wages by participating in a brief general strike . Some political analysts claimed that the pandemic contributed to President Donald Trump 's 2020 defeat. The COVID-19 pandemic in the United States prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care , universal child care , paid sick leave , and higher levels of funding for public health. The Kaiser Family Foundation estimated that preventable hospitalizations of unvaccinated Americans in the second half of 2021 cost US$13.8 billion. There were also protest in regards to vaccine mandates in the United States. In January 2022, the US Supreme Court struck down an OSHA rule that mandated vaccination or a testing regimen for all companies with greater than 100 employees. The number of journalists imprisoned or detained increased worldwide; some detentions were related to the pandemic. The planned NATO " Defender 2020 " military exercise in Germany, Poland and the Baltic states , the largest NATO war exercise since the end of the Cold War , was held on a reduced scale. The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures. Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets. Saudi Arabia, which had launched a military intervention in Yemen in March 2015, declared a ceasefire. Diplomatic relations between Japan and South Korea worsened. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks. South Korean society was initially polarised on President Moon Jae-in 's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response. Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power. In Hungary, the parliament voted to allow Prime Minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information. In countries such as Egypt , Turkey , and Thailand , opposition activists and government critics were arrested for allegedly spreading fake news . In India, journalists criticising the government's response were arrested or issued warnings by police and authorities. The pandemic disrupted food systems worldwide, hitting at a time when hunger and undernourishment were rising- an estimated 690 million people lacked food security in 2019. Food access fell – driven by falling incomes, lost remittances, and disruptions to food production. In some cases, food prices rose. The pandemic and its accompanying lockdowns and travel restrictions slowed movement of food aid. According to the WHO, 811 million people were undernourished in 2020, "likely related to the fallout of COVID-19". The pandemic impacted educational systems in many countries. Many governments temporarily closed educational institutions, often replaced by online education . Other countries, such as Sweden, kept their schools open. As of September 2020, approximately 1.077 billion learners were affected due to school closures. School closures impacted students, teachers, and families with far-reaching economic and societal consequences. They shed light on social and economic issues, including student debt , digital learning , food insecurity, and homelessness , as well as access to childcare , health care, housing, internet, and disability services . The impact was more severe for disadvantaged children. The Higher Education Policy Institute reported that around 63% of students claimed worsened mental health as a result of the pandemic. The pandemic impacted global health for many conditions. Hospital visits fell. Visits for heart attack symptoms declined by 38% in the US and 40% in Spain. The head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home because they're too scared to go to the hospital." People with strokes and appendicitis were less likely to seek treatment. Medical supply shortages impacted many people. The pandemic impacted mental health , increasing anxiety , depression, and post-traumatic stress disorder , affecting healthcare workers, patients and quarantined individuals. In late 2022, during the first northern hemisphere autumn and winter seasons following the widespread relaxation of global public health measures, North America and Europe experienced a surge in respiratory viruses and coinfections in both adults and children. This formed the beginnings of the 2022–2023 pediatric care crisis and what some experts have termed a " tripledemic " of seasonal influenza, Respiratory Syncytial Virus (RSV) , and SARS-CoV-2 throughout North America. In the United Kingdom, pediatric infections also began to spike beyond pre-pandemic levels, albeit with different illnesses, such as Group A streptococcal infection and resultant scarlet fever . As of mid-December 2022, 19 children in the UK had died due to Strep A and the wave of infections had begun to spread into North America and Mainland Europe. The B/Yamagata lineage of influenza B might have become extinct in 2020/2021 due to COVID-19 pandemic measures. There have been no naturally occurring cases confirmed since March 2020. In 2023, the World Health Organization concluded that protection against the Yamagata lineage was no longer necessary in the seasonal flu vaccine , reducing the number of lineages targeted by the vaccine from four to three. The pandemic and the reaction to it positively affected the environment and climate as a result of reduced human activity. During the " anthropause ", fossil fuel use decreased, resource consumption declined, and waste disposal improved, generating less pollution. Planned air travel and vehicle transportation declined. In China, lockdowns and other measures resulted in a 26% decrease in coal consumption, and a 50% reduction in nitrogen oxides emissions. In 2020, a worldwide study on mammalian wildlife responses to human presence during COVID lockdowns found complex patterns of animal behavior. Carnivores were generally less active when humans were around, while herbivores in developed areas were more active. Among other findings, this suggested that herbivores may view humans as a shield against predators, highlighting the importance of location and human presence history in understanding wildlife responses to changes in human activity in a given area. A wide variety of largely mammalian species, both captive and wild, have been shown to be susceptible to SARS-CoV-2, with some encountering a particularly high degree of fatal outcomes. In particular, both farmed and wild mink have developed highly symptomatic and severe COVID-19 infections, with a mortality rate as high as 35–55% according to one study. White-tailed deer , on the other hand, have largely avoided severe outcomes but have effectively become natural reservoirs of the virus, with large numbers of free-ranging deer infected throughout the US and Canada, including approximately 80% of Iowa 's wild deer herd. An August 2023 study appeared to confirm the status of white-tailed deer as a disease reservoir, noting that the viral evolution of SARS-CoV-2 in deer occurs at triple the rate of its evolution in humans and that infection rates remained high, even in areas rarely frequented by humans. Heightened prejudice, xenophobia , and racism toward people of Chinese and East Asian descent were documented around the world. Reports from February 2020, when most confirmed cases were confined to China, cited racist sentiments about Chinese people 'deserving' the virus. Individuals of Asian descent in Europe and North America reported increasing instances of racially-motivated abuse and assaults as a result of the pandemic. US President Donald Trump was criticised for referring to SARS-CoV-2 as the "Chinese Virus" and "Kung Flu", terms which were condemned as being racist and xenophobic. Age-based discrimination against older adults increased during the pandemic. This was attributed to their perceived vulnerability and subsequent physical and social isolation measures, which, coupled with their reduced social activity, increased dependency on others. Similarly, limited digital literacy left the elderly more vulnerable to isolation, depression, and loneliness. In a correspondence published in The Lancet in 2021, German epidemiologist Günter Kampf described the harmful effects of "inappropriate stigmatisation of unvaccinated people, who include our patients, colleagues, and other fellow citizens", noting the evidence that vaccinated individuals play a large role in transmission. American bioethicist Arthur Caplan responded to Kampf, writing "Criticising [the unvaccinated] who... wind up in hospitals and morgues in huge numbers, put stress on finite resources, and prolong the pandemic... is not stigmatising, it is deserved moral condemnation." In January 2022, Amnesty International urged Italy to change their anti-COVID-19 restrictions to avoid discrimination against unvaccinated people, saying that "the government must continue to ensure that the entire population can enjoy its fundamental rights." The restrictions included mandatory vaccination over the age of 50, and mandatory vaccination to use public transport. The pandemic triggered massive changes in behaviour, from increased Internet commerce to cultural changes in the workplace. Online retailers in the US posted $791.70 billion in sales in 2020, an increase of 32.4% from $598.02 billion the year before. Home delivery orders increased, while indoor restaurant dining shut down due to lockdown orders or low sales. Hackers, cybercriminals and scammers took advantage of the changes to launch new online attacks. Education in some countries temporarily shifted from physical attendance to video conferencing. Massive layoffs shrank the airline, travel, hospitality, and other industries. Despite most corporations implementing measures to address COVID-19 in the workplace, a poll from Catalyst found that as many as 68% of employees around the world felt that these policies were only performative and "not genuine". The pandemic led to a surge in remote work . According to a Gallup poll , only 4% of US employees were fully remote before the pandemic, compared to 43% in May 2020. Among white collar workers, that shift was more pronounced, with 6% increasing to 65% in the same period. That trend continued in later stages of the pandemic, with many workers choosing to remain remote even after workplaces reopened. Many Nordic, European, and Asian companies increased their recruitment of international remote workers even as the pandemic waned, partially to save on labor costs. This also led to a talent drain in the global south and in remote areas in the global north. High cost of living and dense urban areas also lost office real estate value due to remote worker exodus. By May 2023, due to increasing layoffs and concerns over productivity, some white collar workplaces in the US had resorted to performance review penalties and indirect incentives (e.g. donations to charity) to encourage workers to return to the office. A 2021 study noted that the COVID-19 pandemic had increased interest in epidemics and infectious diseases among both historians and the general public. Prior to the pandemic, these topics were usually overlooked by "general" history and only received attention in the history of medicine . Many comparisons were made between the COVID-19 and 1918 influenza pandemics , including the development of anti-mask movements, the widespread promotion of misinformation and the impact of socioeconomic disparities . In some areas, religious groups exacerbated the spread of the virus, through large gatherings and the dissemination of misinformation. Some religious leaders decried what they saw as violations of religious freedom. In other cases, religious identity was a beneficial factor for health, increasing compliance with public health measures and protecting against the negative effects of isolation on mental wellbeing. Some news organizations removed their online paywalls for some or all of their pandemic-related articles and posts. Many scientific publishers provided pandemic-related journal articles to the public free of charge as part of the National Institutes of Health's COVID-19 Public Health Emergency Initiative. According to one estimate from researchers at the University of Rome, 89.5% of COVID-19-related papers were open access, compared to an average of 48.8% for the ten most deadly human diseases. The share of papers published on preprint servers prior to peer review increased dramatically. Misinformation and conspiracy theories about the pandemic have been widespread; they travel through mass media , social media and text messaging. In March 2020, WHO declared an " infodemic " of incorrect information. Cognitive biases , such as confirmation bias , are linked to conspiracy beliefs, including COVID-19 vaccine hesitancy . Misinformation and conspiracy theories about the pandemic have been widespread; they travel through mass media , social media and text messaging. In March 2020, WHO declared an " infodemic " of incorrect information. Cognitive biases , such as confirmation bias , are linked to conspiracy beliefs, including COVID-19 vaccine hesitancy . The COVID-19 pandemic had a major impact on popular culture. It was included in the narratives of ongoing pre-pandemic television series and become a central narrative in new ones, with mixed results. Writing for The New York Times about the then-upcoming BBC sitcom Pandemonium on 16 December 2020, David Segal asked, "Are we ready to laugh about Covid-19? Or rather, is there anything amusing, or recognizable in a humorous way, about life during a plague, with all of its indignities and setbacks, not to mention its rituals and rules." The pandemic had driven some people to seek peaceful escapism in media, while others were drawn towards fictional pandemics (e.g. zombie apocalypses ) as an alternate form of escapism. Common themes have included contagion , isolation and loss of control . Many drew comparisons to the fictional film Contagion (2011), praising its accuracies while noting some differences, such as the lack of an orderly vaccine rollout. As people turned to music to relieve emotions evoked by the pandemic, Spotify listenership showed that classical, ambient and children's genres grew, while pop, country and dance remained relatively stable. On 5 May 2023, the WHO declared that the pandemic was no longer a public health emergency of international concern . This led several media outlets to incorrectly report that this meant the pandemic was "over". The WHO commented to Full Fact that it was unlikely to declare the pandemic over "in the near future" and mentioned cholera , which it considers to have continued to be a pandemic since 1961 . The WHO does not have an official category for pandemics or make declarations of when pandemics start or end. In June 2023, Hans Kluge , director of the WHO in Europe, commented that "While the international public health emergency may have ended, the pandemic certainly has not". The WHO in Europe launched a transition plan to manage the public health response to COVID-19 in the coming years and prepare for possible future emergencies. In June 2022, an article in Human Genomics said that the pandemic was still "raging", but that "now is the time to explore the transition from the pandemic to the endemic phase." A March 2022 review declared the transition to endemic status to be "inevitable". A June 2022 review predicted that the virus that causes COVID-19 would become the fifth endemic seasonal coronavirus, alongside four other human coronaviruses . A February 2023 review of the four common cold coronaviruses concluded that the virus would become seasonal and, like the common cold, cause less severe disease for most people. As of 2023 [ update ] the transition to endemic COVID-19 may take years or decades. In June 2022, an article in Human Genomics said that the pandemic was still "raging", but that "now is the time to explore the transition from the pandemic to the endemic phase." A March 2022 review declared the transition to endemic status to be "inevitable". A June 2022 review predicted that the virus that causes COVID-19 would become the fifth endemic seasonal coronavirus, alongside four other human coronaviruses . A February 2023 review of the four common cold coronaviruses concluded that the virus would become seasonal and, like the common cold, cause less severe disease for most people. As of 2023 [ update ] the transition to endemic COVID-19 may take years or decades. Despite strong economic rebounds following the initial lockdowns in early 2020, towards the latter phases of the pandemic, many countries began to experience long-term economic effects. Several countries saw high inflation rates which had global impacts, particularly in developing countries. Some economic impacts such as supply chain and trade operations were seen as more permanent as the pandemic exposed major weaknesses in these systems. In Australia, the pandemic caused an increase in occupational burnout in 2022. During the pandemic, a large percentage of workers in Canada came to prefer working from home, which had an impact on the traditional work model. Some corporations made efforts to force workers to return to work on-site, while some embraced the idea. There was a "travel boom" causing air travel to recover at rates faster than anticipated, and the aviation industry became profitable in 2023 for the first time since 2019, before the pandemic. However, economic issues meant some predicted that the boom would begin to slow down. Business travel on airlines was still below pre-pandemic levels and is predicted not to recover. An increase in excess deaths from underlying causes not related to COVID-19 has been largely blamed on systematic issues causing delays in health care and screening during the pandemic, which has resulted in an increase of non-COVID-19 related deaths. During the pandemic, millions of children missed out on vaccinations as countries focused efforts on combating COVID-19. Efforts were made to increase vaccination rates among children in low-income countries . These efforts were successful in increasing vaccination rates for some diseases, though the UN noted that post-pandemic measles vaccinations were still falling behind. Some of the decrease in immunization was driven by an increase in mistrust of public health officials. This was seen in both low-income and high-income countries. Several African countries saw a decline in vaccinations due to misinformation around the pandemic flowing into other areas. Immunization rates have yet to recover in the United States and the United Kingdom. Despite strong economic rebounds following the initial lockdowns in early 2020, towards the latter phases of the pandemic, many countries began to experience long-term economic effects. Several countries saw high inflation rates which had global impacts, particularly in developing countries. Some economic impacts such as supply chain and trade operations were seen as more permanent as the pandemic exposed major weaknesses in these systems. In Australia, the pandemic caused an increase in occupational burnout in 2022. During the pandemic, a large percentage of workers in Canada came to prefer working from home, which had an impact on the traditional work model. Some corporations made efforts to force workers to return to work on-site, while some embraced the idea. There was a "travel boom" causing air travel to recover at rates faster than anticipated, and the aviation industry became profitable in 2023 for the first time since 2019, before the pandemic. However, economic issues meant some predicted that the boom would begin to slow down. Business travel on airlines was still below pre-pandemic levels and is predicted not to recover. An increase in excess deaths from underlying causes not related to COVID-19 has been largely blamed on systematic issues causing delays in health care and screening during the pandemic, which has resulted in an increase of non-COVID-19 related deaths. During the pandemic, millions of children missed out on vaccinations as countries focused efforts on combating COVID-19. Efforts were made to increase vaccination rates among children in low-income countries . These efforts were successful in increasing vaccination rates for some diseases, though the UN noted that post-pandemic measles vaccinations were still falling behind. Some of the decrease in immunization was driven by an increase in mistrust of public health officials. This was seen in both low-income and high-income countries. Several African countries saw a decline in vaccinations due to misinformation around the pandemic flowing into other areas. Immunization rates have yet to recover in the United States and the United Kingdom.

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Cholera

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Cholera epidemic in Lexington, Kentucky

Cholera epidemic in Lexington, Kentucky was a major cholera epidemic in 1833. An estimated 502 out of 7,000 people died as a result of this epidemic and resulted in major changes in the city. Cholera is "an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139". In 1833, Lexington, KY was a city that had approximately 7,000 people living in it. There were farmers who owned slaves who worked as domestic servants and artisans. The major crops that Lexington produced were tobacco and hemp. These crops were distributed across the United States and the globe by ships. Lexington used the Ohio River ports to get their trade ships from Lexington to the Mississippi River and then eventually the Atlantic Ocean where their goods could be transported to Europe. This trade system is hypothesized to be the main reason that the cholera epidemic made its way to the United States and to different states such as Ohio and Kentucky. This illness has sub-Asian roots and due to the trading system throughout the globe, the illness made its way to the United States and eventually to Lexington, KY. Cholera is "caused by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates water and/or food. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water". This is an extremely important factor of how the cholera epidemic was able to spread throughout the city of Lexington, KY. There were 7,000 people living in this city and clean water was not a main priority in the 1800s. It is important to note that there were usually wells that farmers and slaves got their water from. These wells were shared by many which made the cholera epidemic nearly impossible to prevent. [ citation needed ]

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Cholera

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Kolkata

Kolkata ( UK : / k ɒ l ˈ k ɑː t ə / or / k ɒ l ˈ k ʌ t ə / , US : / k oʊ l ˈ k ɑː t ɑː / , Bengali: [ kolˈkata ] ⓘ , IAST : Kōlkātā ; also known as Calcutta / k æ l ˈ k ʌ t ə / which was the official name until 2001 ) is the capital and largest city of the Indian state of West Bengal . It lies on the eastern bank of the Hooghly River , 80 km (50 mi) west of the border with Bangladesh . It is the primary financial and commercial centre of eastern and northeastern India . Kolkata is the seventh most populous city of India with an estimated city proper population of 4.5 million (0.45 crore). It is the centre of the Kolkata Metropolitan Region , one of the most populous metropolitan areas in the world with a population of over 15 million (1.5 crore) residents. Kolkata is the de facto cultural capital of India and a historically and culturally significant city in the historic region of Bengal . It is the second largest Bengali-speaking city in the world. It has the highest number of Nobel laureates among all cities in India. The three villages that predated Calcutta were ruled by the Nawab of Bengal under Mughal suzerainty . After the Nawab granted the East India Company a trading licence in 1690, the area was developed by the Company into Fort William . Nawab Siraj ud-Daulah occupied the fort in 1756 but was defeated at the Battle of Plassey in 1757, after his general Mir Jafar mutinied in support of the company, and was later made the Nawab for a brief time. Under company and later crown rule , Calcutta served as the de facto capital of India until 1911. Calcutta was the second largest city in the British Empire , after London , and was the centre of bureaucracy, politics, law, education, science and the arts in India. The city was associated with many of the figures and movements of the Bengali Renaissance . It was the hotbed of the Indian nationalist movement . The University of Calcutta and its affiliated colleges produced many leading figures of South Asia. Kolkata's architecture includes many imperial landmarks, including the Victoria Memorial , Howrah Bridge and the Grand Hotel . The city's heritage includes India's only Chinatown and remnants of Jewish , Armenian, Greek and Anglo-Indian communities. The city is closely linked with Bhadralok culture and the Zamindars of Bengal , including Bengali Hindu , Bengali Muslim and tribal aristocrats. The partition of Bengal affected the fortunes of the city. In the late 20th century, the city hosted the government-in-exile of Bangladesh during the Bangladesh Liberation War in 1971; it built India's first subway ; and it was overtaken by Mumbai (formerly Bombay) as India's largest city. The Port of Kolkata is India's oldest operating port. The city is often regarded as India's cultural capital. Following independence in 1947, Kolkata, which was once the premier centre of Indian commerce, culture, and politics, suffered many decades of political violence and economic stagnation before it rebounded. The city was also flooded with Hindu refugees from East Bengal (present-day Bangladesh) in the decades following the 1947 partition of India , transforming its landscape and shaping its politics. A demographically diverse city, the culture of Kolkata features idiosyncrasies that include distinctively close-knit neighbourhoods ( paras ) and freestyle conversations ( adda ). Kolkata is home to venerable institutions of national importance, including the Academy of Fine Arts , the Asiatic Society , the Indian Museum and the National Library of India . It is the centre of the Indian Bengali film industry, which is known as Tollywood . Among scientific institutions, Kolkata hosts the Geological Survey of India , the Botanical Survey of India , the Calcutta Mathematical Society , the Indian Science Congress Association , the Zoological Survey of India , the Horticultural Society , the Institution of Engineers , the Anthropological Survey of India and the Indian Public Health Association . Four Nobel laureates and two Nobel Memorial Prize winners are associated with the city. Though home to major cricketing venues and franchises, Kolkata stands out in India for being the country's centre of association football. Kolkata is known for its grand celebrations of the Hindu festival of Durga Puja , which is recognized by UNESCO for its importance to world heritage. Hence, Kolkata is also known as the 'City of Joy'. The word Kolkata ( Bengali : কলকাতা [ kolˈkata ] ) derives from Kôlikata ( Bengali: কলিকাতা [ ˈkɔliˌkata ] ), the Bengali language name of one of three villages that predated the arrival of the British; the other two villages were Sutanuti and Govindapur . There are several explanations for the etymology of this name: Although the city's name has always been pronounced Kolkata or Kôlikata in Bengali, the anglicised form Calcutta was the official name until 2001, when it was changed to Kolkata in order to match Bengali pronunciation. The discovery and archaeological study of Chandraketugarh , 35 km (22 mi) north of Kolkata, provide evidence that the region in which the city stands has been inhabited for over two millennia. Kolkata or Kalikata in its earliest mentions, is described to be a village surrounded with jungle on the bank of river Ganga as a renowned port, commercial hub and a hindu pilgrimage site for Kalighat Temple . The first mention of the Kalikata village was found in Bipradas Pipilai's Manasa Vijay (1495), where he describes how Chand Sadagar used to stop in Kalighat to worship Goddess Kali during in his path to trade voyage. Later Kalikata was also found to be mentioned in Mukundaram Chakrabarti 's Chandimangal (1594), Todar Mal's taxation-list in 1596 and Krishnaram Das's Kalikamangal (1676-77). Kolkata's recorded history began in 1690 with the arrival of the English East India Company , which was consolidating its trade business in Bengal. Job Charnock is often regarded as the founder of the city; however, in response to a public petition, the Calcutta High Court ruled in 2003 that the city does not have a founder. The area occupied by the present-day city encompassed three villages: Kalikata , Gobindapur and Sutanuti . Kalikata was a fishing village; Sutanuti was a riverside weavers' village; and Gobindapur was a trading post for Indian merchant princes. These villages were part of an estate belonging to the Sabarna Roy Choudhury family of zamindars . The estate was sold to the East India Company in 1698. : 1 In 1712, the British completed the construction of Fort William , located on the east bank of the Hooghly River to protect their trading factory. Facing frequent skirmishes with French forces , the British began to upgrade their fortifications in 1756. The Nawab of Bengal, Siraj-ud-Daulah , condemned the militarisation and tax evasion by the company. His warning went unheeded, and the Nawab attacked; his capture of Fort William led to the killings of several East India company officials in the Black Hole of Calcutta . A force of Company soldiers ( sepoys ) and British troops led by Robert Clive recaptured the city the following year. Per the 1765 Treaty of Allahabad following the battle of Buxar , East India company was appointed imperial tax collector of the Mughal emperor in the province of Bengal, Bihar and Orissa, while Mughal-appointed Nawabs continued to rule the province. Declared a presidency city , Calcutta became the headquarters of the East India Company by 1773. In 1793, ruling power of the Nawabs were abolished, and East India company took complete control of the city and the province. In the early 19th century, the marshes surrounding the city were drained; the government area was laid out along the banks of the Hooghly River. Richard Wellesley , Governor-General of the Presidency of Fort William between 1797 and 1805, was largely responsible for the development of the city and its public architecture. Throughout the late 18th and 19th century, the city was a centre of the East India Company's opium trade. A census in 1837 records the population of the city proper as 229,700, of which the British residents made up only 3,138. The same source says another 177,000 resided in the suburbs and neighbouring villages, making the entire population of greater Calcutta 406,700. In 1864, a typhoon struck the city and killed about 60,000 in Kolkata. By the 1850s, Calcutta had two areas: White Town, which was primarily British and centred on Chowringhee and Dalhousie Square ; and Black Town, mainly Indian and centred on North Calcutta. The city underwent rapid industrial growth starting in the early 1850s, especially in the textile and jute industries; this encouraged British companies to massively invest in infrastructure projects, which included telegraph connections and Howrah railway station . The coalescence of British and Indian culture resulted in the emergence of a new babu class of urbane Indians, whose members were often bureaucrats, professionals, newspaper readers, and Anglophiles; they usually belonged to upper-caste Hindu communities. In the 19th century, the Bengal Renaissance brought about an increased sociocultural sophistication among city denizens. In 1883, Calcutta was host to the first national conference of the Indian National Association , which was the first avowed nationalist organisation in India. The partition of Bengal in 1905 along religious lines led to mass protests, making Calcutta a less hospitable place for the British. The capital was moved to New Delhi in 1911. Calcutta continued to be a centre for revolutionary organisations associated with the Indian independence movement . The city and its port were bombed several times by the Japanese between 1942 and 1944, during World War II . Millions starved to death during the Bengal famine of 1943 (at the same time of the war) due to a combination of military, administrative, and natural factors. Demands for the creation of a Muslim state led in 1946 to an episode of communal violence that killed over 4,000. The partition of India led to further clashes and a demographic shift—many Muslims left for East Pakistan (present day Bangladesh ), while hundreds of thousands of Hindus fled into the city. During the 1960s and 1970s, severe power shortages, strikes and a violent Marxist – Maoist movement by groups known as the Naxalites damaged much of the city's infrastructure, resulting in economic stagnation. During East Pakistan's secessionist war of independence in 1971, the city was home to the government-in-exile of Bangladesh . During the war, refugees poured into West Bengal and strained Kolkata's infrastructure. The Eastern Command of the Indian military, which is based in Fort William, played a pivotal role in the Indo-Pakistani War of 1971 and securing the surrender of Pakistan . During the mid-1980s, Mumbai (then called Bombay) overtook Kolkata as India's most populous city. In 1985, Prime Minister Rajiv Gandhi dubbed Kolkata a "dying city" in light of its socio-political woes. In the period 1977–2011, West Bengal was governed from Kolkata by the Left Front , which was dominated by the Communist Party of India (CPM). It was the world's longest-serving democratically elected communist government, during which Kolkata was a key base for Indian communism . In the 2011 West Bengal Legislative Assembly election , Left Front was defeated by the Trinamool Congress . The city's economic recovery gathered momentum after the 1990s, when India began to institute pro-market reforms . Since 2000, the information technology (IT) services sector has revitalised Kolkata's stagnant economy. The city is also experiencing marked growth in its manufacturing base. Spread roughly north–south along the east bank of the Hooghly River , Kolkata sits within the lower Ganges Delta of eastern India approximately 75 km (47 mi) west of the international border with Bangladesh; the city's elevation is 1.5–9 m (5–30 ft) . Much of the city was originally a wetland that was reclaimed over the decades to accommodate a burgeoning population. The remaining undeveloped areas, known as the East Kolkata Wetlands , were designated a "wetland of international importance" by the Ramsar Convention (1975). As with most of the Indo-Gangetic Plain , the soil and water are predominantly alluvial in origin. Kolkata is located over the "Bengal basin", a pericratonic tertiary basin. Bengal basin comprises three structural units: shelf or platform in the west; central hinge or shelf/slope break; and deep basinal part in the east and southeast. Kolkata is located atop the western part of the hinge zone which is about 25 km (16 mi) wide at a depth of about 45,000 m (148,000 ft) below the surface. The shelf and hinge zones have many faults, among them some are active. Total thickness of sediment below Kolkata is nearly 7,500 m (24,600 ft) above the crystalline basement ; of these the top 350–450 m (1,150–1,480 ft) is Quaternary , followed by 4,500–5,500 m (14,760–18,040 ft) of Tertiary sediments, 500–700 m (1,640–2,300 ft) trap wash of Cretaceous trap and 600–800 m (1,970–2,620 ft) Permian - Carboniferous Gondwana rocks. The quaternary sediments consist of clay, silt and several grades of sand and gravel. These sediments are sandwiched between two clay beds: the lower one at a depth of 250–650 m (820–2,130 ft) ; the upper one 10–40 m (30–130 ft) in thickness. According to the Bureau of Indian Standards , on a scale ranging from I to V in order of increasing susceptibility to earthquakes, the city lies inside seismic zone III . Kolkata is subject to a tropical wet-and-dry climate that is designated Aw under the Köppen climate classification . According to a United Nations Development Programme report, its wind and cyclone zone is "very high damage risk". The annual mean temperature is 26.8 °C (80.2 °F) ; monthly mean temperatures are 19–30 °C (66–86 °F) . Summers (March–June) are hot and humid, with temperatures in the low 30s Celsius; during dry spells, maximum temperatures sometime exceed 40 °C (104 °F) in May and June. Winter lasts for roughly 2 + 1 ⁄ 2 months, with seasonal lows dipping to 9–11 °C (48–52 °F) in December and January. May is the hottest month, with daily temperatures ranging from 27–37 °C (81–99 °F) ; January, the coldest month, has temperatures varying from 12–23 °C (54–73 °F) . The highest recorded temperature is 43.9 °C (111.0 °F) , and the lowest is 5 °C (41 °F) . The winter is mild and very comfortable weather pertains over the city throughout this season. Often, in April–June, the city is struck by heavy rains or dusty squalls that are followed by thunderstorms or hailstorms, bringing cooling relief from the prevailing humidity. These thunderstorms are convective in nature, and are known locally as kal bôishakhi ( কালবৈশাখী ), or "Nor'westers" in English. Rains brought by the Bay of Bengal branch of the south-west summer monsoon lash Kolkata between June and September, supplying it with most of its annual rainfall of about 1,850 mm (73 in) . The highest monthly rainfall total occurs in July and August. In these months often incessant rain for days brings life to a stall for the city dwellers. The city receives 2,107 hours of sunshine per year, with maximum sunlight exposure occurring in April. Kolkata has been hit by several cyclones; these include systems occurring in 1737 and 1864 that killed thousands. More recently, Cyclone Aila in 2009 and Cyclone Amphan in 2020 caused widespread damage to Kolkata by bringing catastrophic winds and torrential rainfall. Pollution is a major concern in Kolkata. As of 2008 [ update ] , sulphur dioxide and nitrogen dioxide annual concentration were within the national ambient air quality standards of India, but respirable suspended particulate matter levels were high, and on an increasing trend for five consecutive years, causing smog and haze. Severe air pollution in the city has caused a rise in pollution-related respiratory ailments, such as lung cancer. Kolkata is subject to a tropical wet-and-dry climate that is designated Aw under the Köppen climate classification . According to a United Nations Development Programme report, its wind and cyclone zone is "very high damage risk". The annual mean temperature is 26.8 °C (80.2 °F) ; monthly mean temperatures are 19–30 °C (66–86 °F) . Summers (March–June) are hot and humid, with temperatures in the low 30s Celsius; during dry spells, maximum temperatures sometime exceed 40 °C (104 °F) in May and June. Winter lasts for roughly 2 + 1 ⁄ 2 months, with seasonal lows dipping to 9–11 °C (48–52 °F) in December and January. May is the hottest month, with daily temperatures ranging from 27–37 °C (81–99 °F) ; January, the coldest month, has temperatures varying from 12–23 °C (54–73 °F) . The highest recorded temperature is 43.9 °C (111.0 °F) , and the lowest is 5 °C (41 °F) . The winter is mild and very comfortable weather pertains over the city throughout this season. Often, in April–June, the city is struck by heavy rains or dusty squalls that are followed by thunderstorms or hailstorms, bringing cooling relief from the prevailing humidity. These thunderstorms are convective in nature, and are known locally as kal bôishakhi ( কালবৈশাখী ), or "Nor'westers" in English. Rains brought by the Bay of Bengal branch of the south-west summer monsoon lash Kolkata between June and September, supplying it with most of its annual rainfall of about 1,850 mm (73 in) . The highest monthly rainfall total occurs in July and August. In these months often incessant rain for days brings life to a stall for the city dwellers. The city receives 2,107 hours of sunshine per year, with maximum sunlight exposure occurring in April. Kolkata has been hit by several cyclones; these include systems occurring in 1737 and 1864 that killed thousands. More recently, Cyclone Aila in 2009 and Cyclone Amphan in 2020 caused widespread damage to Kolkata by bringing catastrophic winds and torrential rainfall.The annual mean temperature is 26.8 °C (80.2 °F) ; monthly mean temperatures are 19–30 °C (66–86 °F) . Summers (March–June) are hot and humid, with temperatures in the low 30s Celsius; during dry spells, maximum temperatures sometime exceed 40 °C (104 °F) in May and June. Winter lasts for roughly 2 + 1 ⁄ 2 months, with seasonal lows dipping to 9–11 °C (48–52 °F) in December and January. May is the hottest month, with daily temperatures ranging from 27–37 °C (81–99 °F) ; January, the coldest month, has temperatures varying from 12–23 °C (54–73 °F) . The highest recorded temperature is 43.9 °C (111.0 °F) , and the lowest is 5 °C (41 °F) . The winter is mild and very comfortable weather pertains over the city throughout this season. Often, in April–June, the city is struck by heavy rains or dusty squalls that are followed by thunderstorms or hailstorms, bringing cooling relief from the prevailing humidity. These thunderstorms are convective in nature, and are known locally as kal bôishakhi ( কালবৈশাখী ), or "Nor'westers" in English. Rains brought by the Bay of Bengal branch of the south-west summer monsoon lash Kolkata between June and September, supplying it with most of its annual rainfall of about 1,850 mm (73 in) . The highest monthly rainfall total occurs in July and August. In these months often incessant rain for days brings life to a stall for the city dwellers. The city receives 2,107 hours of sunshine per year, with maximum sunlight exposure occurring in April. Kolkata has been hit by several cyclones; these include systems occurring in 1737 and 1864 that killed thousands. More recently, Cyclone Aila in 2009 and Cyclone Amphan in 2020 caused widespread damage to Kolkata by bringing catastrophic winds and torrential rainfall.Pollution is a major concern in Kolkata. As of 2008 [ update ] , sulphur dioxide and nitrogen dioxide annual concentration were within the national ambient air quality standards of India, but respirable suspended particulate matter levels were high, and on an increasing trend for five consecutive years, causing smog and haze. Severe air pollution in the city has caused a rise in pollution-related respiratory ailments, such as lung cancer. Kolkata, which is under the jurisdiction of the Kolkata Municipal Corporation (KMC), has an area of 206.08 km 2 (80 sq mi) . The east–west dimension of the city is comparatively narrow, stretching from the Hooghly River in the west to roughly the Eastern Metropolitan Bypass in the east—a span of 9–10 km (5.6–6.2 mi) . The north–south distance is greater, and its axis is used to section the city into North, Central, South and East Kolkata. North Kolkata is the oldest part of the city. Characterised by 19th-century architecture and narrow alleyways, it includes areas such as Jorasanko , Rajabazar , Maniktala , Ultadanga , Shyambazar , Shobhabazar , Bagbazar , Cossipore , Sinthee etc. The north suburban areas like Dum Dum , Baranagar , Belgharia , Sodepur , Khardaha , New Barrackpore , Madhyamgram , Barrackpore , Barasat etc. are also within the city of Kolkata (as a metropolitan structure). : 65–66 Central Kolkata hosts the central business district. It contains B. B. D. Bagh , formerly known as Dalhousie Square, and the Esplanade on its east; Rajiv Gandhi Sarani is on its west. The West Bengal Secretariat , General Post Office , Reserve Bank of India , Calcutta High Court , Lalbazar Police Headquarters and several other government and private offices are located there. Another business hub is the area south of Park Street , which comprises thoroughfares such as Jawahar Lal Nehru Road , Abanindra Nath Tagore Sarani , Dr. Martin Luther King Sarani, Dr. Upendra Nath Brahmachari Sarani, Shakespeare Sarani and Acharay Jagadish Chandra Basu Road . South Kolkata developed after India gained independence in 1947; it includes upscale neighbourhoods such as Bhowanipore , Alipore , Ballygunge , Kasba , Dhakuria , Santoshpur , Garia , Golf Green , Tollygunge , New Alipore , Behala , Barisha etc. The south suburban areas like Maheshtala , Budge Budge , Rajpur Sonarpur , Baruipur etc. are also within the city of Kolkata (as a metropolitan structure). The Maidan is a large open field in the heart of the city that has been called the "lungs of Kolkata" and accommodates sporting events and public meetings. The Victoria Memorial and Kolkata Race Course are located at the southern end of the Maidan. Among the other parks are Central Park in Bidhannagar and Millennium Park on Rajiv Gandhi Sarani, along the Hooghly River. The Kolkata metropolitan area is spread over 1,886.67 km 2 (728.45 sq mi) : 7 and comprises 4 municipal corporations (including Kolkata Municipal Corporation), 37 local municipalities and 24 panchayat samitis , as of 2011. : 7 The urban agglomeration encompassed 72 cities and 527 towns and villages, as of 2006. Suburban areas in the Kolkata metropolitan area incorporate parts of the following districts: North 24 Parganas , South 24 Parganas , Howrah , Hooghly and Nadia . : 15 Two planned townships in the greater Kolkata region are Bidhannagar , also known as Salt Lake City and located north-east of the city; and Rajarhat , also called New Town and located east of Bidhannagar. In the 2000s, Sector 5 in Bidhannagar developed into a business hub for information technology and telecommunication companies. Both Bidhannagar and New Town are situated outside the Kolkata Municipal Corporation limits, in their own municipalities. Kolkata, which is under the jurisdiction of the Kolkata Municipal Corporation (KMC), has an area of 206.08 km 2 (80 sq mi) . The east–west dimension of the city is comparatively narrow, stretching from the Hooghly River in the west to roughly the Eastern Metropolitan Bypass in the east—a span of 9–10 km (5.6–6.2 mi) . The north–south distance is greater, and its axis is used to section the city into North, Central, South and East Kolkata. North Kolkata is the oldest part of the city. Characterised by 19th-century architecture and narrow alleyways, it includes areas such as Jorasanko , Rajabazar , Maniktala , Ultadanga , Shyambazar , Shobhabazar , Bagbazar , Cossipore , Sinthee etc. The north suburban areas like Dum Dum , Baranagar , Belgharia , Sodepur , Khardaha , New Barrackpore , Madhyamgram , Barrackpore , Barasat etc. are also within the city of Kolkata (as a metropolitan structure). : 65–66 Central Kolkata hosts the central business district. It contains B. B. D. Bagh , formerly known as Dalhousie Square, and the Esplanade on its east; Rajiv Gandhi Sarani is on its west. The West Bengal Secretariat , General Post Office , Reserve Bank of India , Calcutta High Court , Lalbazar Police Headquarters and several other government and private offices are located there. Another business hub is the area south of Park Street , which comprises thoroughfares such as Jawahar Lal Nehru Road , Abanindra Nath Tagore Sarani , Dr. Martin Luther King Sarani, Dr. Upendra Nath Brahmachari Sarani, Shakespeare Sarani and Acharay Jagadish Chandra Basu Road . South Kolkata developed after India gained independence in 1947; it includes upscale neighbourhoods such as Bhowanipore , Alipore , Ballygunge , Kasba , Dhakuria , Santoshpur , Garia , Golf Green , Tollygunge , New Alipore , Behala , Barisha etc. The south suburban areas like Maheshtala , Budge Budge , Rajpur Sonarpur , Baruipur etc. are also within the city of Kolkata (as a metropolitan structure). The Maidan is a large open field in the heart of the city that has been called the "lungs of Kolkata" and accommodates sporting events and public meetings. The Victoria Memorial and Kolkata Race Course are located at the southern end of the Maidan. Among the other parks are Central Park in Bidhannagar and Millennium Park on Rajiv Gandhi Sarani, along the Hooghly River.The Kolkata metropolitan area is spread over 1,886.67 km 2 (728.45 sq mi) : 7 and comprises 4 municipal corporations (including Kolkata Municipal Corporation), 37 local municipalities and 24 panchayat samitis , as of 2011. : 7 The urban agglomeration encompassed 72 cities and 527 towns and villages, as of 2006. Suburban areas in the Kolkata metropolitan area incorporate parts of the following districts: North 24 Parganas , South 24 Parganas , Howrah , Hooghly and Nadia . : 15 Two planned townships in the greater Kolkata region are Bidhannagar , also known as Salt Lake City and located north-east of the city; and Rajarhat , also called New Town and located east of Bidhannagar. In the 2000s, Sector 5 in Bidhannagar developed into a business hub for information technology and telecommunication companies. Both Bidhannagar and New Town are situated outside the Kolkata Municipal Corporation limits, in their own municipalities. Kolkata is the commercial and financial hub of East and North-East India and home to the Calcutta Stock Exchange . It is a major commercial and military port, and is one of five cities in eastern India (alongside Bhubaneswar , Guwahati , Imphal , and Kushinagar ) to have an international airport. Once India's leading city, Kolkata experienced a steady economic decline in the decades following India's independence due to steep population increases and a rise in militant trade-unionism , which included frequent strikes that were backed by left-wing parties. From the 1960s to the late 1990s, several factories were closed and businesses relocated. The lack of capital and resources added to the depressed state of the city's economy and gave rise to an unwelcome sobriquet: the "dying city". The city's fortunes improved after the Indian economy was liberalised in the 1990s and changes in economic policy were enacted by the West Bengal state government. Recent estimates of the economy of Kolkata's metropolitan area have ranged from $150 to $250 billion ( PPP GDP), and have ranked it third-most productive metro area of India. Flexible production has been the norm in Kolkata, which has an informal sector that employs more than 40% of the labour force. One unorganised group, roadside hawkers , generated business worth ₹ 87.72 billion ( US$ 2 billion) in 2005. As of 2001 [ update ] , around 0.81% of the city's workforce was employed in the primary sector (agriculture, forestry, mining, etc.); 15.49% worked in the secondary sector (industrial and manufacturing); and 83.69% worked in the tertiary sector (service industries). : 19 As of 2003 [ update ] , the majority of households in slums were engaged in occupations belonging to the informal sector; 36.5% were involved in servicing the urban middle class (as maids, drivers, etc.) and 22.2% were casual labourers . : 11 About 34% of the available labour force in Kolkata slums were unemployed. : 11 According to one estimate, almost a quarter of the population live on less than 27 rupees (equivalent to 45 US cents) per day. Major manufacturing companies in the city are Alstom , Larsen & Toubro , Fosroc , Videocon . As in many other Indian cities, information technology became a high-growth sector in Kolkata starting in the late 1990s; the city's IT sector grew at 70% per annum—a rate that was twice the national average. The 2000s saw a surge of investments in the real estate, infrastructure, retail, and hospitality sectors; several large shopping malls and hotels were launched. Companies such as ITC Limited , CESC Limited , Exide Industries , Emami , Eveready Industries India , Lux Industries , Rupa Company , Berger Paints , Birla Corporation , Britannia Industries and Purushottam Publishers are headquartered in the city. Philips India, PricewaterhouseCoopers India, Tata Global Beverages , and Tata Steel have their registered office and zonal headquarters in Kolkata. Kolkata hosts the headquarters of two major banks: UCO Bank , and Bandhan Bank . Reserve Bank of India , State Bank of India have its eastern zonal office in Kolkata. India Government Mint, Kolkata is one of the four mints in India. Some of the oldest public sector companies are headquartered in the city such as the Coal India Limited , National Insurance Company , Garden Reach Shipbuilders & Engineers , Tea Board of India , Geological Survey of India , Zoological Survey of India , Botanical Survey of India , Jute Corporation of India , National Test House, Hindustan Copper and the Ordnance Factories Board of the Indian Ministry of Defence .The demonym for residents of Kolkata are Calcuttan and Kolkatan . According to provisional results of the 2011 national census, Kolkata district, which occupies an area of 185 km 2 (71 sq mi) , had a population of 4,486,679; its population density was 24,252/km 2 (62,810/sq mi) . This represents a decline of 1.88% during the decade 2001–11. The sex ratio is 899 females per 1000 males—lower than the national average. The ratio is depressed by the influx of working males from surrounding rural areas, from the rest of West Bengal; these men commonly leave their families behind. Kolkata's literacy rate of 87.14% exceeds the national average of 74%. The final population totals of census 2011 stated the population of city as 4,496,694. The urban agglomeration had a population of 14,112,536 in 2011. As of 2003 [ update ] , about one-third of the population, or 15 lakh (1.5 million) people, lived in 3,500 unregistered squatter-occupied and 2,011 registered slums . : 4 : 92 The authorised slums (with access to basic services like water, latrines, trash removal by the Kolkata Municipal Corporation) can be broadly divided into two groups— bustees , in which slum dwellers have some long term tenancy agreement with the landowners; and udbastu colonies , settlements which had been leased to refugees from present-day Bangladesh by the government. : 5 The unauthorised slums (devoid of basic services provided by the municipality) are occupied by squatters who started living on encroached lands—mainly along canals, railway lines and roads. : 92 : 5 According to the 2005 National Family Health Survey, around 14% of the households in Kolkata were poor, while 33% lived in slums, indicating a substantial proportion of households in slum areas were better off economically than the bottom quarter of urban households in terms of wealth status. : 23 Mother Teresa was awarded the Nobel Peace Prize for founding and working with the Missionaries of Charity in Kolkata—an organisation "whose primary task was to love and care for those persons nobody was prepared to look after". Languages spoken in Kolkata city (2011 census) Bengali , the official state language, is the dominant language in Kolkata. English is also used, particularly by the white-collar workforce. Hindi and Urdu are spoken by a sizeable minority. Bengali Hindus form the majority of Kolkata's population; Marwaris , Biharis and Urdu-speaking Muslims compose large minorities. Among Kolkata's smaller communities are Chinese , Tamils , Nepalis , Pathans/Afghans (locally known as Kabuliwala ) Odias , Telugus , Gujaratis , Anglo-Indians , Armenians , Bengali Muslims , Greeks , Tibetans , Maharashtrians , Konkanis , Malayalees , Punjabis and Parsis . : 3 The number of Armenians, Greeks, Jews and other foreign-origin groups declined during the 20th century. The Jewish population of Kolkata was 5,000 during World War II, but declined after Indian independence and the establishment of Israel; by 2013, there were 25 Jews in the city. India's sole Chinatown is in eastern Kolkata; once home to 20,000 ethnic Chinese, its population dropped to around 2,000 as of 2009 [ update ] as a result of multiple factors including repatriation and denial of Indian citizenship following the 1962 Sino-Indian War , and immigration to foreign countries for better economic opportunities. The Chinese community traditionally worked in the local tanning industry and ran Chinese restaurants. According to the 2011 census, 76.51% of the population is Hindu , 20.60% Muslim , 0.88% Christian and 0.47% Jain . The remainder of the population includes Sikhs , Buddhists , and other religions which accounts for 0.45% of the population; 1.09% did not state a religion in the census. Kolkata reported 67.6% of Special and Local Laws crimes registered in 35 large Indian cities during 2004. The demonym for residents of Kolkata are Calcuttan and Kolkatan . According to provisional results of the 2011 national census, Kolkata district, which occupies an area of 185 km 2 (71 sq mi) , had a population of 4,486,679; its population density was 24,252/km 2 (62,810/sq mi) . This represents a decline of 1.88% during the decade 2001–11. The sex ratio is 899 females per 1000 males—lower than the national average. The ratio is depressed by the influx of working males from surrounding rural areas, from the rest of West Bengal; these men commonly leave their families behind. Kolkata's literacy rate of 87.14% exceeds the national average of 74%. The final population totals of census 2011 stated the population of city as 4,496,694. The urban agglomeration had a population of 14,112,536 in 2011. As of 2003 [ update ] , about one-third of the population, or 15 lakh (1.5 million) people, lived in 3,500 unregistered squatter-occupied and 2,011 registered slums . : 4 : 92 The authorised slums (with access to basic services like water, latrines, trash removal by the Kolkata Municipal Corporation) can be broadly divided into two groups— bustees , in which slum dwellers have some long term tenancy agreement with the landowners; and udbastu colonies , settlements which had been leased to refugees from present-day Bangladesh by the government. : 5 The unauthorised slums (devoid of basic services provided by the municipality) are occupied by squatters who started living on encroached lands—mainly along canals, railway lines and roads. : 92 : 5 According to the 2005 National Family Health Survey, around 14% of the households in Kolkata were poor, while 33% lived in slums, indicating a substantial proportion of households in slum areas were better off economically than the bottom quarter of urban households in terms of wealth status. : 23 Mother Teresa was awarded the Nobel Peace Prize for founding and working with the Missionaries of Charity in Kolkata—an organisation "whose primary task was to love and care for those persons nobody was prepared to look after". Languages spoken in Kolkata city (2011 census) Bengali , the official state language, is the dominant language in Kolkata. English is also used, particularly by the white-collar workforce. Hindi and Urdu are spoken by a sizeable minority. Bengali Hindus form the majority of Kolkata's population; Marwaris , Biharis and Urdu-speaking Muslims compose large minorities. Among Kolkata's smaller communities are Chinese , Tamils , Nepalis , Pathans/Afghans (locally known as Kabuliwala ) Odias , Telugus , Gujaratis , Anglo-Indians , Armenians , Bengali Muslims , Greeks , Tibetans , Maharashtrians , Konkanis , Malayalees , Punjabis and Parsis . : 3 The number of Armenians, Greeks, Jews and other foreign-origin groups declined during the 20th century. The Jewish population of Kolkata was 5,000 during World War II, but declined after Indian independence and the establishment of Israel; by 2013, there were 25 Jews in the city. India's sole Chinatown is in eastern Kolkata; once home to 20,000 ethnic Chinese, its population dropped to around 2,000 as of 2009 [ update ] as a result of multiple factors including repatriation and denial of Indian citizenship following the 1962 Sino-Indian War , and immigration to foreign countries for better economic opportunities. The Chinese community traditionally worked in the local tanning industry and ran Chinese restaurants. According to the 2011 census, 76.51% of the population is Hindu , 20.60% Muslim , 0.88% Christian and 0.47% Jain . The remainder of the population includes Sikhs , Buddhists , and other religions which accounts for 0.45% of the population; 1.09% did not state a religion in the census. Kolkata reported 67.6% of Special and Local Laws crimes registered in 35 large Indian cities during 2004. Kolkata is administered by several government agencies. The Kolkata Municipal Corporation , or KMC, oversees and manages the civic infrastructure of the city's 16 boroughs, which together encompass 144 wards. Each ward elects a councillor to the KMC. Each borough has a committee of councillors, each of whom is elected to represent a ward. By means of the borough committees, the corporation undertakes urban planning and maintains roads, government-aided schools, hospitals, and municipal markets. As Kolkata's apex body, the corporation discharges its functions through the mayor-in-council, which comprises a mayor , a deputy mayor, and ten other elected members of the KMC. The functions of the KMC include water supply, drainage and sewerage, sanitation, solid waste management, street lighting, and building regulation. Kolkata's administrative agencies have areas of jurisdiction that do not coincide. Listed in ascending order by area, they are: Kolkata district ; the Kolkata Police area and the Kolkata Municipal Corporation area, or "Kolkata city"; and the Kolkata metropolitan area , which is the city's urban agglomeration. The agency overseeing the latter, the Kolkata Metropolitan Development Authority , is responsible for the statutory planning and development of greater Kolkata. The Kolkata Municipal Corporation was ranked first out of 21 cities for best governance and administrative practices in India in 2014. It scored 4.0 on 10 compared to the national average of 3.3. The Kolkata Port Trust, an agency of the central government, manages the city's river port. As of 2023 [ update ] , the All India Trinamool Congress controls the KMC; the mayor is Firhad Hakim , while the deputy mayor is Atin Ghosh. The city has an apolitical titular post, that of the Sheriff of Kolkata , which presides over various city-related functions and conferences. As the seat of the Government of West Bengal , Kolkata is home to not only the offices of the local governing agencies, but also the West Bengal Legislative Assembly ; the state secretariat, which is housed in the Writers' Building; and the Calcutta High Court . Most government establishments and institutions are housed in the centre of the city in B. B. D. Bagh (formerly known as Dalhousie Square). The Calcutta High Court is the oldest High Court in India. It was preceded by the Supreme Court of Judicature at Fort William which was established in 1774. The Calcutta High Court has jurisdiction over the state of West Bengal and the Union Territory of the Andaman and Nicobar Islands . Kolkata has lower courts: the Court of Small Causes and the City Civil Court decide civil matters; the Sessions Court rules in criminal cases. The Kolkata Police , headed by a police commissioner, is overseen by the West Bengal Ministry of Home Affairs . The Kolkata district elects two representatives to India's lower house, the Lok Sabha , and 11 representatives to the state legislative assembly. The Kolkata police district registered 15,510 Indian Penal Code cases in 2010, the 8th-highest total in the country. In 2010, the crime rate was 117.3 per 100,000, below the national rate of 187.6; it was the lowest rate among India's largest cities. The Kolkata Municipal Corporation supplies the city with potable water that is sourced from the Hooghly River; most of it is treated and purified at the Palta pumping station located in North 24 Parganas district. [ failed verification ] Roughly 95% of the 4,000 tonnes of refuse produced daily by the city is transported to the dumping grounds in Dhapa , which is east of the town. To promote the recycling of garbage and sewer water, agriculture is encouraged on the dumping grounds. Parts of the city lack proper sewerage, leading to unsanitary methods of waste disposal. In 1856, the Bengal Government appointed George Turnbull to be the Commissioner of Drainage and Sewerage to improve the city's sewerage. Turnbull's main job was to be the Chief Engineer of the East Indian Railway Company responsible for building the first railway 541 miles (871 km) from Howrah to Varanasi (then Benares ). Electricity is supplied by the privately operated Calcutta Electric Supply Corporation , or CESC, to the city proper; the West Bengal State Electricity Board supplies it in the suburbs. Fire services are handled by the West Bengal Fire Service , a state agency. As of 2012 [ update ] , the city had 16 fire stations. State-owned Bharat Sanchar Nigam Limited , or BSNL, as well as private enterprises, among them Vodafone Idea , Bharti Airtel , Reliance Jio are the leading telephone and cell phone service providers in the city. : 25–26 : 179 with Kolkata being the first city in India to have cell phone and 4G connectivity, the GSM and CDMA cellular coverage is extensive. As of 2010 [ update ] , Kolkata has 7 percent of the total broadband internet consumers in India; BSNL, VSNL, Tata Indicom, Sify, Hathway, Airtel, and Jio are among the main vendors. The Eastern Command of the Indian Army is based in the city. Being one of India's major city and the largest city in eastern and north-eastern India, Kolkata hosts diplomatic missions of many countries such as Australia, Bangladesh, Bhutan, Canada, People's Republic of China, France, Germany, Italy, Japan, Myanmar, Nepal, Russia, Sri Lanka, Switzerland, Thailand, United Kingdom and United States . The U.S Consulate in Kolkata is the US Department of State 's second-oldest Consulate and dates from 19 November 1792. The Diplomatic representation of more than 65 Countries and International Organization is present in Kolkata as Consulate office, honorary Consulate office, Cultural Centre, Deputy High Commission and Economic section and Trade Representation office. Kolkata is administered by several government agencies. The Kolkata Municipal Corporation , or KMC, oversees and manages the civic infrastructure of the city's 16 boroughs, which together encompass 144 wards. Each ward elects a councillor to the KMC. Each borough has a committee of councillors, each of whom is elected to represent a ward. By means of the borough committees, the corporation undertakes urban planning and maintains roads, government-aided schools, hospitals, and municipal markets. As Kolkata's apex body, the corporation discharges its functions through the mayor-in-council, which comprises a mayor , a deputy mayor, and ten other elected members of the KMC. The functions of the KMC include water supply, drainage and sewerage, sanitation, solid waste management, street lighting, and building regulation. Kolkata's administrative agencies have areas of jurisdiction that do not coincide. Listed in ascending order by area, they are: Kolkata district ; the Kolkata Police area and the Kolkata Municipal Corporation area, or "Kolkata city"; and the Kolkata metropolitan area , which is the city's urban agglomeration. The agency overseeing the latter, the Kolkata Metropolitan Development Authority , is responsible for the statutory planning and development of greater Kolkata. The Kolkata Municipal Corporation was ranked first out of 21 cities for best governance and administrative practices in India in 2014. It scored 4.0 on 10 compared to the national average of 3.3. The Kolkata Port Trust, an agency of the central government, manages the city's river port. As of 2023 [ update ] , the All India Trinamool Congress controls the KMC; the mayor is Firhad Hakim , while the deputy mayor is Atin Ghosh. The city has an apolitical titular post, that of the Sheriff of Kolkata , which presides over various city-related functions and conferences. As the seat of the Government of West Bengal , Kolkata is home to not only the offices of the local governing agencies, but also the West Bengal Legislative Assembly ; the state secretariat, which is housed in the Writers' Building; and the Calcutta High Court . Most government establishments and institutions are housed in the centre of the city in B. B. D. Bagh (formerly known as Dalhousie Square). The Calcutta High Court is the oldest High Court in India. It was preceded by the Supreme Court of Judicature at Fort William which was established in 1774. The Calcutta High Court has jurisdiction over the state of West Bengal and the Union Territory of the Andaman and Nicobar Islands . Kolkata has lower courts: the Court of Small Causes and the City Civil Court decide civil matters; the Sessions Court rules in criminal cases. The Kolkata Police , headed by a police commissioner, is overseen by the West Bengal Ministry of Home Affairs . The Kolkata district elects two representatives to India's lower house, the Lok Sabha , and 11 representatives to the state legislative assembly. The Kolkata police district registered 15,510 Indian Penal Code cases in 2010, the 8th-highest total in the country. In 2010, the crime rate was 117.3 per 100,000, below the national rate of 187.6; it was the lowest rate among India's largest cities. The Kolkata Municipal Corporation supplies the city with potable water that is sourced from the Hooghly River; most of it is treated and purified at the Palta pumping station located in North 24 Parganas district. [ failed verification ] Roughly 95% of the 4,000 tonnes of refuse produced daily by the city is transported to the dumping grounds in Dhapa , which is east of the town. To promote the recycling of garbage and sewer water, agriculture is encouraged on the dumping grounds. Parts of the city lack proper sewerage, leading to unsanitary methods of waste disposal. In 1856, the Bengal Government appointed George Turnbull to be the Commissioner of Drainage and Sewerage to improve the city's sewerage. Turnbull's main job was to be the Chief Engineer of the East Indian Railway Company responsible for building the first railway 541 miles (871 km) from Howrah to Varanasi (then Benares ). Electricity is supplied by the privately operated Calcutta Electric Supply Corporation , or CESC, to the city proper; the West Bengal State Electricity Board supplies it in the suburbs. Fire services are handled by the West Bengal Fire Service , a state agency. As of 2012 [ update ] , the city had 16 fire stations. State-owned Bharat Sanchar Nigam Limited , or BSNL, as well as private enterprises, among them Vodafone Idea , Bharti Airtel , Reliance Jio are the leading telephone and cell phone service providers in the city. : 25–26 : 179 with Kolkata being the first city in India to have cell phone and 4G connectivity, the GSM and CDMA cellular coverage is extensive. As of 2010 [ update ] , Kolkata has 7 percent of the total broadband internet consumers in India; BSNL, VSNL, Tata Indicom, Sify, Hathway, Airtel, and Jio are among the main vendors. The Eastern Command of the Indian Army is based in the city. Being one of India's major city and the largest city in eastern and north-eastern India, Kolkata hosts diplomatic missions of many countries such as Australia, Bangladesh, Bhutan, Canada, People's Republic of China, France, Germany, Italy, Japan, Myanmar, Nepal, Russia, Sri Lanka, Switzerland, Thailand, United Kingdom and United States . The U.S Consulate in Kolkata is the US Department of State 's second-oldest Consulate and dates from 19 November 1792. The Diplomatic representation of more than 65 Countries and International Organization is present in Kolkata as Consulate office, honorary Consulate office, Cultural Centre, Deputy High Commission and Economic section and Trade Representation office. Public transport is provided by the Kolkata Suburban Railway , the Kolkata Metro , trams , rickshaws , taxis and buses. The suburban rail network connects the city's distant suburbs. Kolkata Metro is the oldest rapid transit system in India. According to a 2013 survey conducted by the International Association of Public Transport , in terms of a public transport system, Kolkata ranks among the top of the six Indian cities surveyed. The Kolkata Metro, in operation since 1984, is the oldest underground mass transit system in India. It spans the north–south length of the city. In 2020, part of the Second line was inaugurated to cover part of Salt Lake. This east–west line will connect Salt Lake with Howrah. The two lines cover a distance of 33.02 km (21 mi) . As of 2020 [ update ] , four Metro rail lines were under construction. Kolkata has five long-distance railway stations, located at Howrah (the largest railway complex in India), Sealdah , Kolkata , Shalimar and Santragachi , which connect Kolkata by rail to most cities in West Bengal and to other major cities in India. The city serves as the headquarters of three railway zones out of eighteen of the Indian Railways regional divisions—the Kolkata Metro Railways, Eastern Railway and the South-Eastern Railway . Kolkata has rail and road connectivity with Dhaka , the capital of Bangladesh. Buses, which are the most commonly used mode of transport, are run by government agencies and private operators. Kolkata is the only Indian city with a tram network, which was operated by the Calcutta Tramways Company . It has now renamed to West Bengal Transport Corporation . The slow-moving tram services are restricted to certain areas of the city. Water-logging, caused by heavy rains during the summer monsoon , sometimes interrupt transportation networks. The city has witnessed a steady increase in the number of registered vehicles; 2002 data showed an increase of 44% over a period of seven years. As of 2004 [ update ] , after adjusting for population density, the city's "road space" was only 6% compared to 23% in Delhi and 17% in Mumbai. The Kolkata Metro has somewhat eased traffic congestion, as has the addition of new roads and flyovers . Agencies operating long-distance bus services include the West Bengal Transport Corporation and various private operators. The city's main bus terminals are located at Esplanade and Babughat . The Kolkata–Delhi and Kolkata– Chennai prongs of the Golden Quadrilateral , and National Highway 12 start from the city. At present, Kolkata has two expressways , but they are not considered to be as separate dedicated expressways in the national level, as both are parts of the National Highway 16 (NH-16). They are Belghoria and Kona expressways. In the coming years, Kolkata will get dedicated expressways and will be connected directly with many major metropolises and cities of India, also internationally, to Nepal . They are as follows: Hired public conveyances include auto rickshaws , which often ply specific routes, and yellow metered taxis. Almost all of Kolkata's taxis are antiquated Hindustan Ambassadors by make; newer air-conditioned radio taxis are in service as well. In parts of the city, cycle rickshaws and hand-pulled rickshaws are patronised by the public for short trips. Netaji Subhas Chandra Bose International Airport , located in Dum Dum, about 16 km (9.9 mi) north-east of the city centre, operates domestic and international flights. In 2013, the airport was upgraded to handle increased air traffic. The Port of Kolkata , established in 1870, is India's oldest and the only major river port. The Kolkata Port Trust manages docks in Kolkata and Haldia . The port hosts passenger services to Port Blair , capital of the Andaman and Nicobar Islands; freighter service to ports throughout India and around the world is operated by the Shipping Corporation of India . Ferry services connect Kolkata with its twin city of Howrah , located across the Hooghly River. Kolkata Metro is the oldest rapid transit system in India. According to a 2013 survey conducted by the International Association of Public Transport , in terms of a public transport system, Kolkata ranks among the top of the six Indian cities surveyed. The Kolkata Metro, in operation since 1984, is the oldest underground mass transit system in India. It spans the north–south length of the city. In 2020, part of the Second line was inaugurated to cover part of Salt Lake. This east–west line will connect Salt Lake with Howrah. The two lines cover a distance of 33.02 km (21 mi) . As of 2020 [ update ] , four Metro rail lines were under construction. Kolkata has five long-distance railway stations, located at Howrah (the largest railway complex in India), Sealdah , Kolkata , Shalimar and Santragachi , which connect Kolkata by rail to most cities in West Bengal and to other major cities in India. The city serves as the headquarters of three railway zones out of eighteen of the Indian Railways regional divisions—the Kolkata Metro Railways, Eastern Railway and the South-Eastern Railway . Kolkata has rail and road connectivity with Dhaka , the capital of Bangladesh. Buses, which are the most commonly used mode of transport, are run by government agencies and private operators. Kolkata is the only Indian city with a tram network, which was operated by the Calcutta Tramways Company . It has now renamed to West Bengal Transport Corporation . The slow-moving tram services are restricted to certain areas of the city. Water-logging, caused by heavy rains during the summer monsoon , sometimes interrupt transportation networks. The city has witnessed a steady increase in the number of registered vehicles; 2002 data showed an increase of 44% over a period of seven years. As of 2004 [ update ] , after adjusting for population density, the city's "road space" was only 6% compared to 23% in Delhi and 17% in Mumbai. The Kolkata Metro has somewhat eased traffic congestion, as has the addition of new roads and flyovers . Agencies operating long-distance bus services include the West Bengal Transport Corporation and various private operators. The city's main bus terminals are located at Esplanade and Babughat . The Kolkata–Delhi and Kolkata– Chennai prongs of the Golden Quadrilateral , and National Highway 12 start from the city. At present, Kolkata has two expressways , but they are not considered to be as separate dedicated expressways in the national level, as both are parts of the National Highway 16 (NH-16). They are Belghoria and Kona expressways. In the coming years, Kolkata will get dedicated expressways and will be connected directly with many major metropolises and cities of India, also internationally, to Nepal . They are as follows: Hired public conveyances include auto rickshaws , which often ply specific routes, and yellow metered taxis. Almost all of Kolkata's taxis are antiquated Hindustan Ambassadors by make; newer air-conditioned radio taxis are in service as well. In parts of the city, cycle rickshaws and hand-pulled rickshaws are patronised by the public for short trips. Netaji Subhas Chandra Bose International Airport , located in Dum Dum, about 16 km (9.9 mi) north-east of the city centre, operates domestic and international flights. In 2013, the airport was upgraded to handle increased air traffic. The Port of Kolkata , established in 1870, is India's oldest and the only major river port. The Kolkata Port Trust manages docks in Kolkata and Haldia . The port hosts passenger services to Port Blair , capital of the Andaman and Nicobar Islands; freighter service to ports throughout India and around the world is operated by the Shipping Corporation of India . Ferry services connect Kolkata with its twin city of Howrah , located across the Hooghly River. As of 2011 [ update ] , the healthcare system in Kolkata consists of 48 government hospitals, mostly under the Department of Health & Family Welfare , Government of West Bengal, and 366 private medical establishments; these establishments provide the city with 27,687 hospital beds. For every 10,000 people in the city, there are 61.7 hospital beds, which is higher than the national average of 9 hospital beds per 10,000. Ten medical and dental colleges are located in the Kolkata metropolitan area which act as tertiary referral hospitals in the state. The Calcutta Medical College , founded in 1835, was the first institution in Asia to teach modern medicine. However, These facilities are inadequate to meet the healthcare needs of the city. More than 78% in Kolkata prefer the private medical sector over the public medical sector, : 109 due to the overburdening of the public health sector, the lack of a nearby facility, and excessive waiting times at government facilities. : 61 According to the Indian 2005 National Family Health Survey, only a small proportion of Kolkata households were covered under any health scheme or health insurance . : 41 The total fertility rate in Kolkata was 1.4, the lowest among the eight cities surveyed. : 45 In Kolkata, 77% of the married women used contraceptives , which was the highest among the cities surveyed, but use of modern contraceptive methods was the lowest (46%). : 47 The infant mortality rate in Kolkata was 41 per 1,000 live births, and the mortality rate for children under five was 49 per 1,000 live births. : 48 Among the surveyed cities, Kolkata stood second (5%) for children who had not had any vaccinations under the Universal Immunization Programme as of 2005 [ update ] . : 48 Kolkata ranked second with access to an anganwadi centre under the Integrated Child Development Services (ICDS) programme for 57% of the children between 0 and 71 months. : 51 The proportion of malnourished , anaemic and underweight children in Kolkata was less in comparison to other surveyed cities. : 54–55 About 18% of the men and 30% of the women in Kolkata are obese —the majority of them belonging to the non-poor strata of society. : 105 In 2005, Kolkata had the highest percentage (55%) among the surveyed cities of anaemic women, while 20% of the men in Kolkata were anaemic. : 56–57 Diseases like diabetes , asthma , goitre and other thyroid disorders were found in large numbers of people. : 57–59 Tropical diseases like malaria , dengue and chikungunya are prevalent in Kolkata, though their incidence is decreasing. Kolkata is one of the districts in India with a high number of people with AIDS ; it has been designated a district prone to high risk. As of 2014, because of higher air pollution , the life expectancy of a person born in the city is four years fewer than in the suburbs. Kolkata's schools are run by the state government or private organisations, many of which are religious. Bengali and English are the primary languages of instruction; Urdu and Hindi are also used, particularly in central Kolkata. Schools in Kolkata follow the "10+2+3" plan . After completing their secondary education, students typically enroll in schools that have a higher secondary facility and are affiliated with the West Bengal Council of Higher Secondary Education , the ICSE , or the CBSE . They usually choose a focus on liberal arts, business, or science. Vocational programs are also available. Some Kolkata schools, for example South Point School , La Martiniere Calcutta , Calcutta Boys' School , St. James' School (Kolkata) , St. Xavier's Collegiate School and Loreto House , have been ranked amongst the best schools in the country. As of 2010 [ update ] , the Kolkata urban agglomeration is home to 14 universities run by the state government. The colleges are each affiliated with a university or institution based either in Kolkata or elsewhere in India. Aliah University which was founded in 1780 as Mohammedan College of Calcutta is the oldest post-secondary educational institution of the city. The University of Calcutta , founded in 1857, is the first modern university in South Asia. Presidency College, Kolkata (formerly Hindu College between 1817 and 1855), founded in 1855, was one of the oldest colleges in India. It was affiliated with the University of Calcutta until 2010 when it was converted to Presidency University, Kolkata in 2010. Bengal Engineering and Science University (BESU) is the second oldest engineering institution of the country located in Howrah. An Institute of National Importance , BESU was converted to India's first IIEST . Jadavpur University is known for its arts, science, and engineering faculties. The Indian Institute of Management Calcutta , which was the first of the Indian Institutes of Management , was established in 1961 at Joka , a locality in the south-western suburbs. Kolkata also houses the Indian Institute of Foreign Trade , which was started here in the year 2006. The West Bengal National University of Juridical Sciences is one of India's autonomous law schools , and the Indian Statistical Institute is a public research institute and university. State owned Maulana Abul Kalam Azad University of Technology , West Bengal (MAKAUT, WB), formerly West Bengal University of Technology (WBUT) is the largest Technological University in terms of student enrollment and number of Institutions affiliated by it. Private institutions include the Ramakrishna Mission Vivekananda Educational and Research Institute and University of Engineering & Management (UEM) . Notable scholars who were born, worked or studied in Kolkata include physicists Satyendra Nath Bose , Meghnad Saha , and Jagadish Chandra Bose ; chemist Prafulla Chandra Roy ; statisticians Prasanta Chandra Mahalanobis and Anil Kumar Gain ; physician Upendranath Brahmachari ; educator Ashutosh Mukherjee ; and Nobel laureates Rabindranath Tagore , C. V. Raman , and Amartya Sen . Kolkata houses many research institutes like Indian Association for the Cultivation of Science (IACS), Indian Institute of Chemical Biology (IICB), Indian Institute of Science Education and Research (IISER), Bose Institute , Saha Institute of Nuclear Physics (SINP), Centre for Studies in Social Sciences, Calcutta , All India Institute of Hygiene and Public Health , Central Glass and Ceramic Research Institute (CGCRI), S.N. Bose National Centre for Basic Sciences (SNBNCBS), Indian Institute of Social Welfare and Business Management (IISWBM), National Institute of Pharmaceutical Education and Research, Kolkata , Variable Energy Cyclotron Centre (VECC) and Indian Centre for Space Physics . Nobel laureate Sir C. V. Raman did his groundbreaking work in Raman effect in IACS.Kolkata is known for its literary, artistic and revolutionary heritage; as the former capital of India, it was the birthplace of modern Indian literary and artistic thought. Kolkata has been called the "City of Furious, Creative Energy" as well as the "cultural [or literary] capital of India". The presence of paras , which are neighbourhoods that possess a strong sense of community, is characteristic of the city. Typically, each para has its own community club and on occasion, a playing field. Residents engage in addas , or leisurely chats, that often take the form of freestyle intellectual conversation. The city has a tradition of political graffiti depicting everything from outrageous slander to witty banter and limericks, caricatures and propaganda. Kolkata has many buildings adorned with Indo-Islamic and Indo-Saracenic architectural motifs. Several well-maintained major buildings from the colonial period have been declared "heritage structures"; others are in various stages of decay. Established in 1814 as the nation's oldest museum, the Indian Museum houses large collections that showcase Indian natural history and Indian art . Marble Palace is a classic example of a European mansion that was built in the city. The Victoria Memorial , a place of interest in Kolkata , has a museum documenting the city's history. The National Library of India is the leading public library in the country while Science City is the largest science centre in the Indian subcontinent . The popularity of commercial theatres in the city has declined since the 1980s. : 99 Group theatres of Kolkata , a cultural movement that started in the 1940s contrasting with the then-popular commercial theatres, are theatres that are not professional or commercial, and are centres of various experiments in theme, content, and production; group theatres use the proscenium stage to highlight socially relevant messages. : 99 Chitpur locality of the city houses multiple production companies of jatra , a tradition of folk drama popular in rural Bengal. Kolkata is the home of the Bengali cinema industry, dubbed "Tollywood" for Tollygunj , where most of the state's film studios are located. Its long tradition of art films includes globally acclaimed film directors such as Academy Award -winning director Satyajit Ray , Ritwik Ghatak , Mrinal Sen , Tapan Sinha and contemporary directors such as Aparna Sen , Buddhadeb Dasgupta , Goutam Ghose and Rituparno Ghosh . During the 19th and 20th centuries, Bengali literature was modernised through the works of authors such as Ishwar Chandra Vidyasagar , Bankim Chandra Chattopadhyay , Michael Madhusudan Dutt , Rabindranath Tagore , Kazi Nazrul Islam and Sarat Chandra Chattopadhyay . Coupled with social reforms led by Ram Mohan Roy , Swami Vivekananda and others, this constituted a major part of the Bengal Renaissance . The middle and latter parts of the 20th century witnessed the arrival of post-modernism, as well as literary movements such as those espoused by the Kallol movement, hungryalists and the little magazines . Large majority of publishers of the city is concentrated in and around College Street , "... a half-mile of bookshops and bookstalls spilling over onto the pavement", selling new and used books. Kalighat painting originated in 19th century Kolkata as a local style that reflected a variety of themes including mythology and quotidian life. The Government College of Art and Craft , founded in 1864, has been the cradle as well as workplace of eminent artists including Abanindranath Tagore , Jamini Roy and Nandalal Bose . The art college was the birthplace of the Bengal school of art that arose as an avant garde and nationalist movement reacting against the prevalent academic art styles in the early 20th century. The Academy of Fine Arts and other art galleries hold regular art exhibitions. The city is recognised for its appreciation of Rabindra sangeet (songs written by Rabindranath Tagore) and Indian classical music , with important concerts and recitals, such as Dover Lane Music Conference , being held throughout the year; Bengali popular music, including baul folk ballads , kirtans and Gajan festival music; and modern music, including Bengali-language adhunik songs. Since the early 1990s, new genres have emerged, including one comprising alternative folk–rock Bengali bands . Another new style, jibonmukhi gaan ("songs about life"), is based on realism . : 105 Key elements of Kolkata's cuisine include rice and a fish curry known as machher jhol , which can be accompanied by desserts such as roshogolla , sandesh , and a sweet yoghurt known as mishti dohi . Bengal's large repertoire of seafood dishes includes various preparations of ilish , a fish that is a favourite among Calcuttans. Street foods such as beguni (fried battered eggplant slices), kati roll (flatbread roll with vegetable or chicken, mutton or egg stuffing), phuchka (a deep-fried crêpe with tamarind sauce) and Indian Chinese cuisine from Chinatown are popular. Though Bengali women traditionally wear the sari , the shalwar kameez and Western attire is gaining acceptance among younger women. Western-style dress has greater acceptance among men, although the traditional dhoti and kurta are seen during festivals. Durga Puja , held in September–October, is Kolkata's most important and largest festival; it is an occasion for glamorous celebrations and artistic decorations. The Bengali New Year, known as Poila Boishak , as well as the harvest festival of Poush Parbon are among the city's other festivals; also celebrated are Kali Puja , Diwali , Chhaith , Jitiya , Holi , Jagaddhatri Puja, Saraswati Puja , Rathayatra , Janmashtami , Maha Shivratri , Vishwakarma Puja , Lakshmi Puja , Ganesh Chathurthi , Makar Sankranti , Gajan , Kalpataru Day , Bhai Phonta , Maghotsab, Eid , Muharram , Christmas , Buddha Purnima and Mahavir Jayanti . Cultural events include the Rabindra Jayanti , Independence Day (15 August), Republic Day (26 January), Kolkata Book Fair , the Dover Lane Music Festival, the Kolkata Film Festival , Nandikar's National Theatre Festival , Statesman Vintage & Classic Car Rally and Gandhi Jayanti .The first newspaper in India, the Bengal Gazette started publishing from the city in 1780. Among Kolkata's widely circulated Bengali-language newspapers are Anandabazar Patrika , Bartaman , Ei Samay Sangbadpatra , Sangbad Pratidin , Aajkaal , Dainik Statesman and Ganashakti . The Statesman and The Telegraph are two major English-language newspapers that are produced and published from Kolkata. Other popular English-language newspapers published and sold in Kolkata include The Times of India , Hindustan Times , The Hindu , The Indian Express and the Asian Age . As the largest trading centre in East India, Kolkata has several high-circulation financial dailies, including The Economic Times , The Financial Express , Business Line and Business Standard . Vernacular newspapers, such as those in the Hindi , Urdu , Gujarati , Odia , Punjabi and Chinese languages, are read by minorities. Major periodicals based in Kolkata include Desh , Sananda , Saptahik Bartaman , Unish-Kuri , Anandalok and Anandamela . Historically, Kolkata has been the centre of the Bengali little magazine movement . All India Radio , the national state-owned radio broadcaster, airs several AM radio stations in the city. Kolkata has 10 local radio stations broadcasting on FM , including three from AIR. India's state-owned television broadcaster, Doordarshan , provides two free-to-air terrestrial channels, while a mix of Bengali, Hindi, English, and other regional channels are accessible via cable subscription , direct-broadcast satellite services, or internet-based television . Bengali-language 24-hour television news channels include ABP Ananda , News18 Bangla , Kolkata TV , Zee 24 Ghanta , TV9 Bangla and Republic Bangla . The most popular sports in Kolkata are football and cricket . Unlike most parts of India, the residents show significant passion for football. Indian Football Association , the oldest football association of the country is based here. It administers football in West Bengal. Kolkata is home to India's top football clubs such as Mohun Bagan A.C. , East Bengal Club and the Mohammedan Sporting Club . The Calcutta Football League , which is the oldest football league in Asia was started in 1898. Mohun Bagan A.C., one of the oldest football clubs in Asia, is the only organisation to be dubbed as "National Club of India". Two clubs of the city - Mohun Bagan Super Giant and East Bengal FC compete in the Indian Super League (ISL). Football matches between Mohun Bagan and East Bengal, called as the Kolkata Derby , witness large audience attendance and rivalry between patrons. The multi-use Salt Lake Stadium , also known as Vivekananda Yuba Bharati Krirangan, is India's second largest stadium by seating capacity . Most matches of the 2017 FIFA U-17 World Cup were played in this stadium including both Semi-final matches and the Final match. Kolkata also accounted for 45% of total attendance in 2017 FIFA U-17 World Cup with an average of 55,345 spectators. The Calcutta Cricket and Football Club is the second-oldest cricket club in the world. As in the rest of India, cricket is popular in Kolkata and is played on various grounds throughout the city. Kolkata is home to Indian Premier League (IPL) franchise Kolkata Knight Riders and also the Cricket Association of Bengal which regulates cricket in West Bengal and the Bengal cricket team . Tournaments, especially those involving cricket, football, badminton and carrom , are regularly organised here on an inter-locality or inter-club basis. The Maidan, a vast field that serves as the city's largest park, hosts several minor football and cricket clubs and coaching institutes. Eden Gardens , which has a capacity of 80,000 as of 2017 [ update ] , hosted the final match of the 1987 Cricket World Cup . Kolkata's Netaji Indoor Stadium served as host of the 1981 Asian Basketball Championship , where India's national basketball team finished 5th, ahead of teams that belong to Asia's basketball elite, such as Iran . The city has three 18-hole golf courses. The oldest is at the Royal Calcutta Golf Club , the first golf club built outside the United Kingdom. The other two are located at the Tollygunge Club and at Fort William . The Royal Calcutta Turf Club hosts horse racing and polo matches. The Calcutta Polo Club is considered the oldest extant polo club in the world. The Calcutta Racket Club is a squash and racquet club in Kolkata. It was founded in 1793, making it one of the oldest rackets clubs in the world, and the first in the Indian subcontinent. The Calcutta South Club is a venue for national and international tennis tournaments; it held the first grass-court national championship in 1946. In the period 2005–2007, Sunfeast Open , a tier-III tournament on the Women's Tennis Association circuit, was held in the Netaji Indoor Stadium; it has since been discontinued. The Calcutta Rowing Club hosts rowing heats and training events. Kolkata, considered the leading centre of rugby union in India , gives its name to the oldest international tournament in rugby union, the Calcutta Cup . The Automobile Association of Eastern India, established in 1904, and the Bengal Motor Sports Club are involved in promoting motor sports and car rallies in Kolkata and West Bengal. The Beighton Cup , an event organised by the Bengal Hockey Association and first played in 1895, is India's oldest field hockey tournament; it is usually held on the Mohun Bagan Ground of the Maidan. Athletes from Kolkata include Sourav Ganguly , Pankaj Roy and Jhulan Goswami , who are former captains of the Indian national cricket team ; Olympic tennis bronze medalist Leander Paes , golfer Arjun Atwal , and former footballers Sailen Manna , Chuni Goswami , P. K. Banerjee and Subrata Bhattacharya .

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Pyotr Ilyich Tchaikovsky

Pyotr Ilyich Tchaikovsky [n 1] ( / tʃ aɪ ˈ k ɒ f s k i / chy- KOF -skee ; 7 May 1840 – 6 November 1893) [n 2] was a Russian composer of the Romantic period . He was the first Russian composer whose music would make a lasting impression internationally. Tchaikovsky wrote some of the most popular concert and theatrical music in the current classical repertoire, including the ballets Swan Lake and The Nutcracker , the 1812 Overture , his First Piano Concerto , Violin Concerto , the Romeo and Juliet Overture-Fantasy, several symphonies , and the opera Eugene Onegin . Although musically precocious, Tchaikovsky was educated for a career as a civil servant as there was little opportunity for a musical career in Russia at the time and no system of public music education. When an opportunity for such an education arose, he entered the nascent Saint Petersburg Conservatory , from which he graduated in 1865. The formal Western-oriented teaching that Tchaikovsky received there set him apart from composers of the contemporary nationalist movement embodied by the Russian composers of The Five with whom his professional relationship was mixed . Tchaikovsky's training set him on a path to reconcile what he had learned with the native musical practices to which he had been exposed from childhood. From that reconciliation, he forged a personal but unmistakably Russian style. The principles that governed melody, harmony, and other fundamentals of Russian music diverged from those that governed Western European music, which seemed to defeat the potential for using Russian music in large-scale Western composition or for forming a composite style, and it caused personal antipathies that dented Tchaikovsky's self-confidence. Russian culture exhibited a split personality, with its native and adopted elements having drifted apart increasingly since the time of Peter the Great . That resulted in uncertainty among the intelligentsia about the country's national identity, an ambiguity mirrored in Tchaikovsky's career. Despite his many popular successes, Tchaikovsky's life was punctuated by personal crises and depression. Contributory factors included his early separation from his mother for boarding school followed by his mother's early death, the death of his close friend and colleague Nikolai Rubinstein , his failed marriage with Antonina Miliukova , and the collapse of his 13-year association with the wealthy patroness Nadezhda von Meck . Tchaikovsky's homosexuality, which he kept private, has traditionally also been considered a major factor though some scholars have played down its importance. His dedication of his Sixth symphony to his nephew Vladimir "Bob" Davydov and his feelings expressed about Davydov in letters to others, especially following Davydov's suicide, have been cited as evidence for a romantic love between the two. Tchaikovsky's sudden death at the age of 53 is generally ascribed to cholera , but there is an ongoing debate as to whether cholera was indeed the cause and whether the death was accidental or intentional. While his music has remained popular among audiences, critical opinions were initially mixed. Some Russians did not feel it was sufficiently representative of native musical values and expressed suspicion that Europeans accepted the music for its Western elements. In an apparent reinforcement of the latter claim, some Europeans lauded Tchaikovsky for offering music more substantive than exoticism , and said he transcended the stereotypes of Russian classical music. Others dismissed Tchaikovsky's music as deficient because it did not stringently follow Western principles.Pyotr Ilyich Tchaikovsky was born on 7 May 1840 in Votkinsk , a small town in Vyatka Governorate (present-day Udmurtia ) near the banks of the Kama River , and not far from the Ural Mountains in the Russian Empire , into a family with a long history of military service. His father, Ilya Petrovich Tchaikovsky, had served as a lieutenant colonel and engineer in the Department of Mines, and would manage the Kamsko-Votkinsk Ironworks. His grandfather, Pyotr Fedorovich Tchaikovsky, was born in the village of Nikolaevka, Yekaterinoslav Governorate , Russian Empire (present-day Mykolaivka , Luhansk Oblast, Ukraine ), and served first as a physician's assistant in the army and later as city governor of Glazov in Vyatka. His great-grandfather, a Zaporozhian Cossack named Fyodor Chaika, distinguished himself under Peter the Great at the Battle of Poltava in 1709. Tchaikovsky's mother, Alexandra Andreyevna (née d'Assier), was the second of Ilya's three wives, the first having died years before. She was 18 years her husband's junior and French and German on her father's side. Both Ilya and Alexandra were trained in the arts, including music—a necessity as a posting to a remote area of Russia also meant a need for entertainment, whether in private or at social gatherings. Of his six siblings, [n 3] Tchaikovsky was close to his sister Alexandra and twin brothers Anatoly and Modest . Alexandra's marriage to Lev Davydov would produce seven children and lend Tchaikovsky the only real family life he would know as an adult, especially during his years of wandering. One of those children, Vladimir Davydov , who went by the nickname 'Bob', would become very close to him. In 1844, the family hired Fanny Dürbach, a 22-year-old French governess. Four-and-a-half-year-old Tchaikovsky was initially thought too young to study alongside his older brother Nikolai and a niece of the family. His insistence convinced Dürbach otherwise. By the age of six, he had become fluent in French and German. Tchaikovsky also became attached to the young woman; her affection for him was reportedly a counter to his mother's coldness and emotional distance from him, though others assert that the mother doted on her son. Dürbach saved much of Tchaikovsky's work from this period, including his earliest known compositions, and became a source of several childhood anecdotes. Tchaikovsky began piano lessons at age five. Precocious, within three years he had become as adept at reading sheet music as his teacher. Tchaikovsky's parents, initially supportive, hired a tutor, bought an orchestrion (a form of barrel organ that could imitate elaborate orchestral effects), and encouraged his piano study for both aesthetic and practical reasons. However, they decided in 1850 to send Tchaikovsky to the Imperial School of Jurisprudence in Saint Petersburg. They had both graduated from institutes in Saint Petersburg and the School of Jurisprudence, which mainly served the lesser nobility and thought that this education would prepare Tchaikovsky for a career as a civil servant. Regardless of talent, the only musical careers available in Russia at that time—except for the affluent aristocracy—were as a teacher in an academy or as an instrumentalist in one of the Imperial Theaters. Both were considered on the lowest rank of the social ladder, with individuals in them enjoying no more rights than peasants. Tchaikovsky's father's income was also growing increasingly uncertain, so both parents may have wanted Tchaikovsky to become independent as soon as possible. As the minimum age for acceptance was 12 and Tchaikovsky was only 10 at the time, he was required to spend two years boarding at the Imperial School of Jurisprudence's preparatory school, 1,300 kilometres (800 mi) from his family. Once those two years had passed, Tchaikovsky transferred to the Imperial School of Jurisprudence to begin a seven-year course of studies. Tchaikovsky's early separation from his mother, despite the aforementioned alleged distant relationship, caused an emotional trauma that lasted the rest of his life and was intensified by her death from cholera in 1854 when he was 14. [n 4] The loss of his mother also prompted Tchaikovsky to make his first serious attempt at composition, a waltz in her memory. Tchaikovsky's father, who had also contracted cholera but recovered fully, sent him back to school immediately in the hope that classwork would occupy the boy's mind. Isolated, Tchaikovsky compensated with friendships with fellow students that became lifelong; these included Aleksey Apukhtin and Vladimir Gerard. Music, while not an official priority at school, also bridged the gap between Tchaikovsky and his peers. They regularly attended the opera and Tchaikovsky would improvise at the school's harmonium on themes he and his friends had sung during choir practice. "We were amused," Vladimir Gerard later remembered, "but not imbued with any expectations of his future glory". Tchaikovsky also continued his piano studies through Franz Becker, an instrument manufacturer who made occasional visits to the school; however, the results, according to musicologist David Brown , were "negligible". In 1855, Tchaikovsky's father funded private lessons with Rudolph Kündinger and questioned him about a musical career for his son. While impressed with the boy's talent, Kündinger said he saw nothing to suggest a future composer or performer. He later admitted that his assessment was also based on his own negative experiences as a musician in Russia and his unwillingness for Tchaikovsky to be treated likewise. Tchaikovsky was told to finish his course and then try for a post in the Ministry of Justice. On 10 June 1859, the 19-year-old Tchaikovsky graduated as a titular counselor, a low rung on the civil service ladder. Appointed to the Ministry of Justice, he became a junior assistant within six months and a senior assistant two months after that. He remained a senior assistant for the rest of his three-year civil service career. Meanwhile, the Russian Musical Society (RMS) was founded in 1859 by the Grand Duchess Elena Pavlovna (a German-born aunt of Tsar Alexander II ) and her protégé, pianist and composer Anton Rubinstein . Previous tsars and the aristocracy had focused almost exclusively on importing European talent. The aim of the RMS was to fulfill Alexander II's wish to foster native talent. It hosted a regular season of public concerts (previously held only during the six weeks of Lent when the Imperial Theaters were closed) and provided basic professional training in music. In 1861, Tchaikovsky attended RMS classes in music theory taught by Nikolai Zaremba at the Mikhailovsky Palace (now the Russian Museum ). These classes were a precursor to the Saint Petersburg Conservatory , which opened in 1862. Tchaikovsky enrolled at the Conservatory as part of its premiere class. He studied harmony and counterpoint with Zaremba and instrumentation and composition with Rubinstein. He was awarded a silver medal for his thesis, a cantata on Schiller's " Ode to Joy ". The Conservatory benefited Tchaikovsky in two ways. It transformed him into a musical professional, with tools to help him thrive as a composer, and the in-depth exposure to European principles and musical forms gave him a sense that his art was not exclusively Russian or Western. This mindset became important in Tchaikovsky's reconciliation of Russian and European influences in his compositional style. He believed and attempted to show that both these aspects were "intertwined and mutually dependent". His efforts became both an inspiration and a starting point for other Russian composers to build their own individual styles. Rubinstein was impressed by Tchaikovsky's musical talent on the whole and cited him as "a composer of genius" in his autobiography. He was less pleased with the more progressive tendencies of some of Tchaikovsky's student work. Nor did he change his opinion as Tchaikovsky's reputation grew. [n 5] [n 6] He and Zaremba clashed with Tchaikovsky when he submitted his First Symphony for performance by the Russian Musical Society in Saint Petersburg. Rubinstein and Zaremba refused to consider the work unless substantial changes were made. Tchaikovsky complied but they still refused to perform the symphony. Tchaikovsky, distressed that he had been treated as though he were still their student, withdrew the symphony. It was given its first complete performance, minus the changes Rubinstein and Zaremba had requested, in Moscow in February 1868. Once Tchaikovsky graduated in 1865, Rubinstein's brother Nikolai offered him the post of Professor of Music Theory at the soon-to-open Moscow Conservatory . While the salary for his professorship was only 50 rubles a month, the offer itself boosted Tchaikovsky's morale and he accepted the post eagerly. He was further heartened by news of the first public performance of one of his works, his Characteristic Dances , conducted by Johann Strauss II at a concert in Pavlovsk Park on 11 September 1865 (Tchaikovsky later included this work, re-titled Dances of the Hay Maidens , in his opera The Voyevoda ). From 1867 to 1878, Tchaikovsky combined his professorial duties with music criticism while continuing to compose. This activity exposed him to a range of contemporary music and afforded him the opportunity to travel abroad. In his reviews, he praised Beethoven , considered Brahms overrated and, despite his admiration, took Schumann to task for poor orchestration. [n 7] He appreciated the staging of Wagner's Der Ring des Nibelungen at its inaugural performance in Bayreuth (Germany), but not the music, calling Das Rheingold "unlikely nonsense, through which, from time to time, sparkle unusually beautiful and astonishing details". A recurring theme he addressed was the poor state of Russian opera . In 1856, while Tchaikovsky was still at the School of Jurisprudence and Anton Rubinstein lobbied aristocrats to form the Russian Musical Society , critic Vladimir Stasov and an 18-year-old pianist, Mily Balakirev , met and agreed upon a nationalist agenda for Russian music, one that would take the operas of Mikhail Glinka as a model and incorporate elements from folk music, reject traditional Western practices and use non-Western harmonic devices such as the whole tone and octatonic scales . They saw Western-style conservatories as unnecessary and antipathetic to fostering native talent. Eventually, Balakirev , César Cui , Modest Mussorgsky , Nikolai Rimsky-Korsakov and Alexander Borodin became known as the moguchaya kuchka , translated into English as the "Mighty Handful" or "The Five" . Rubinstein criticized their emphasis on amateur efforts in musical composition; Balakirev and later Mussorgsky attacked Rubinstein for his musical conservatism and his belief in professional music training. Tchaikovsky and his fellow conservatory students were caught in the middle. While ambivalent about much of The Five's music, Tchaikovsky remained on friendly terms with most of its members. In 1869, he and Balakirev worked together on what became Tchaikovsky's first recognized masterpiece, the fantasy-overture Romeo and Juliet , a work which The Five wholeheartedly embraced. The group also welcomed his Second Symphony , subtitled the Little Russian . Despite their support, Tchaikovsky made considerable efforts to ensure his musical independence from the group as well as from the conservative faction at the Saint Petersburg Conservatory. The infrequency of Tchaikovsky's musical successes, won with tremendous effort, exacerbated his lifelong sensitivity to criticism. Nikolai Rubinstein's private fits of rage critiquing his music, such as attacking the First Piano Concerto , did not help matters. His popularity grew, however, as several first-rate artists became willing to perform his compositions. Hans von Bülow premiered the First Piano Concerto and championed other Tchaikovsky works both as pianist and conductor. Other artists included Adele aus der Ohe , Max Erdmannsdörfer , Eduard Nápravník and Sergei Taneyev . Another factor that helped Tchaikovsky's music become popular was a shift in attitude among Russian audiences. Whereas they had previously been satisfied with flashy virtuoso performances of technically demanding but musically lightweight works, they gradually began listening with increasing appreciation of the composition itself. Tchaikovsky's works were performed frequently, with few delays between their composition and first performances; the publication from 1867 onward of his songs and great piano music for the home market also helped boost the composer's popularity. During the late 1860s, Tchaikovsky began to compose operas. His first, The Voyevoda , based on a play by Alexander Ostrovsky , premiered in 1869. The composer became dissatisfied with it, however, and, having re-used parts of it in later works, destroyed the manuscript. Undina followed in 1870. Only excerpts were performed and it, too, was destroyed. Between these projects, Tchaikovsky started to compose an opera called Mandragora , to a libretto by Sergei Rachinskii; the only music he completed was a short chorus of Flowers and Insects. The first Tchaikovsky opera to survive intact, The Oprichnik , premiered in 1874. During its composition, he lost Ostrovsky's part-finished libretto. Tchaikovsky, too embarrassed to ask for another copy, decided to write the libretto himself, modeling his dramatic technique on that of Eugène Scribe . Cui wrote a "characteristically savage press attack" on the opera. Mussorgsky, writing to Vladimir Stasov , disapproved of the opera as pandering to the public. Nevertheless, The Oprichnik continues to be performed from time to time in Russia. The last of the early operas, Vakula the Smith (Op. 14), was composed in the second half of 1874. The libretto, based on Gogol 's Christmas Eve , was to have been set to music by Alexander Serov . With Serov's death, the libretto was opened to a competition with a guarantee that the winning entry would be premiered by the Imperial Mariinsky Theatre . Tchaikovsky was declared the winner, but at the 1876 premiere, the opera enjoyed only a lukewarm reception. After Tchaikovsky's death, Rimsky-Korsakov wrote the opera Christmas Eve , based on the same story. Other works of this period include the Variations on a Rococo Theme for cello and orchestra, the Third and Fourth Symphonies , the ballet Swan Lake , and the opera Eugene Onegin . Discussion of Tchaikovsky's personal life, especially his sexuality, has perhaps been the most extensive of any composer in the 19th century and certainly of any Russian composer of his time. It has also at times caused considerable confusion, from Soviet efforts to expunge all references to homosexuality and portray him as a heterosexual, to efforts at analysis by Western biographers. Biographers have generally agreed that Tchaikovsky was homosexual. He sought the company of other men in his circle for extended periods, "associating openly and establishing professional connections with them." His first love was reportedly Sergey Kireyev, a younger fellow student at the Imperial School of Jurisprudence. According to Modest Tchaikovsky , this was Pyotr Ilyich's "strongest, longest and purest love". Tchaikovsky's dedication of his Sixth symphony to his nephew Vladimir "Bob" Davydov (21 at the time) and his feelings expressed about Davydov in letters to others, especially following Davydov's suicide, has been cited as evidence for romantic love between the two. The degree to which the composer might have felt comfortable with his sexual desires has, however, remained open to debate. It is still unknown whether Tchaikovsky, according to musicologist and biographer David Brown , "felt tainted within himself, defiled by something from which he finally realized he could never escape" or whether, according to Alexander Poznansky , he experienced "no unbearable guilt" over his sexual desires and "eventually came to see his sexual peculiarities as an insurmountable and even natural part of his personality ... without experiencing any serious psychological damage". Relevant portions of his brother Modest's autobiography, where he tells of the composer's same-sex attraction, have been published, as have letters previously suppressed by Soviet censors in which Tchaikovsky openly writes of it. Such censorship has persisted in the Russian government, resulting in many officials, including the former culture minister Vladimir Medinsky , denying his homosexuality outright. Passages in Tchaikovsky's letters which reveal his homosexual desires have been censored in Russia. In one such passage he said of a homosexual acquaintance: "Petashenka used to drop by with the criminal intention of observing the Cadet Corps, which is right opposite our windows, but I've been trying to discourage these compromising visits—and with some success." In another one, he wrote: "After our walk, I offered him some money, which was refused. He does it for the love of art and adores men with beards." Tchaikovsky lived as a bachelor for most of his life. In 1868, he met Belgian soprano Désirée Artôt with whom he considered marriage, but, owing to various circumstances, the relationship ended. Tchaikovsky later claimed she was the only woman he ever loved. In 1877, at the age of 37, he wed a former student, Antonina Miliukova . The marriage was a disaster. Mismatched psychologically and sexually, the couple lived together for only two and a half months before Tchaikovsky left, overwrought emotionally and suffering from acute writer's block . Tchaikovsky's family remained supportive of him during this crisis and throughout his life. Tchaikovsky's marital debacle may have forced him to face the full truth about his sexuality; he never blamed Antonina for the failure of their marriage. Tchaikovsky was also aided by Nadezhda von Meck , the widow of a railway magnate, who had begun contact with him not long before the marriage. As well as an important friend and emotional support, she became his patroness for the next 13 years, which allowed him to focus exclusively on composition. Although Tchaikovsky called her his "best friend", they agreed never to meet under any circumstances. Tchaikovsky remained abroad for a year after the disintegration of his marriage. During this time, he completed Eugene Onegin , orchestrated his Fourth Symphony, and composed the Violin Concerto . He returned briefly to the Moscow Conservatory in the autumn of 1879. [n 8] For the next few years, assured of a regular income from von Meck, he traveled incessantly throughout Europe and rural Russia, mainly alone, and avoided social contact whenever possible. During this time, Tchaikovsky's foreign reputation grew and a positive reassessment of his music also took place in Russia, thanks in part to Russian novelist Fyodor Dostoevsky 's call for "universal unity" with the West at the unveiling of the Pushkin Monument in Moscow in 1880. Before Dostoevsky's speech, Tchaikovsky's music had been considered "overly dependent on the West". As Dostoevsky's message spread throughout Russia, this stigma toward Tchaikovsky's music evaporated. The unprecedented acclaim for him even drew a cult following among the young intelligentsia of Saint Petersburg, including Alexandre Benois , Léon Bakst and Sergei Diaghilev . Two musical works from this period stand out. With the Cathedral of Christ the Saviour nearing completion in Moscow in 1880, the 25th anniversary of the coronation of Alexander II in 1881, [n 9] and the 1882 Moscow Arts and Industry Exhibition in the planning stage, Nikolai Rubinstein suggested that Tchaikovsky compose a grand commemorative piece. Tchaikovsky agreed and finished it within six weeks. He wrote to Nadezhda von Meck that this piece, the 1812 Overture , would be "very loud and noisy, but I wrote it with no warm feeling of love, and therefore there will probably be no artistic merits in it". He also warned conductor Eduard Nápravník that "I shan't be at all surprised and offended if you find that it is in a style unsuitable for symphony concerts". Nevertheless, the overture became, for many, "the piece by Tchaikovsky they know best", particularly well-known for the use of cannon in the scores. On 23 March 1881, Nikolai Rubinstein died in Paris. That December, Tchaikovsky started work on his Piano Trio in A minor , "dedicated to the memory of a great artist". First performed privately at the Moscow Conservatory on the first anniversary of Rubinstein's death, the piece became extremely popular during the composer's lifetime; in November 1893, it would become Tchaikovsky's own elegy at memorial concerts in Moscow and St. Petersburg. [n 10] In 1884, Tchaikovsky began to shed his unsociability and restlessness. That March, Emperor Alexander III conferred upon him the Order of Saint Vladimir (fourth class), which included a title of hereditary nobility and a personal audience with the Tsar. This was seen as a seal of official approval which advanced Tchaikovsky's social standing and might have been cemented in the composer's mind by the success of his Orchestral Suite No. 3 at its January 1885 premiere in Saint Petersburg. In 1885, Alexander III requested a new production of Eugene Onegin at the Bolshoi Kamenny Theatre in Saint Petersburg. [n 11] By having the opera staged there and not at the Mariinsky Theatre , he served notice that Tchaikovsky's music was replacing Italian opera as the official imperial art. In addition, at the instigation of Ivan Vsevolozhsky , Director of the Imperial Theaters and a patron of the composer, Tchaikovsky was awarded a lifetime annual pension of 3,000 rubles from the Tsar. This made him the premier court composer, in practice if not in the actual title. Despite Tchaikovsky's disdain for public life, he now participated in it as part of his increasing celebrity and out of a duty he felt to promote Russian music. He helped support his former pupil Sergei Taneyev , who was now director of Moscow Conservatory, by attending student examinations and negotiating the sometimes sensitive relations among various members of the staff. He served as director of the Moscow branch of the Russian Musical Society during the 1889–1890 season. In this post, he invited many international celebrities to conduct, including Johannes Brahms , Antonín Dvořák and Jules Massenet . During this period, Tchaikovsky also began promoting Russian music as a conductor, In January 1887, he substituted, on short notice, at the Bolshoi Theater in Moscow for performances of his opera Cherevichki . Within a year, he was in considerable demand throughout Europe and Russia. These appearances helped him overcome life-long stage fright and boosted his self-assurance. In 1888, Tchaikovsky led the premiere of his Fifth Symphony in Saint Petersburg, repeating the work a week later with the first performance of his tone poem Hamlet . Although critics proved hostile, with César Cui calling the symphony "routine" and "meretricious", both works were received with extreme enthusiasm by audiences and Tchaikovsky, undeterred, continued to conduct the symphony in Russia and Europe. Conducting brought him to the United States in 1891, where he led the New York Music Society's orchestra in his Festival Coronation March at the inaugural concert of Carnegie Hall . In November 1887, Tchaikovsky arrived at Saint Petersburg in time to hear several of the Russian Symphony Concerts , devoted exclusively to the music of Russian composers. One included the first complete performance of his revised First Symphony; another featured the final version of Third Symphony of Nikolai Rimsky-Korsakov , with whose circle Tchaikovsky was already in touch. Rimsky-Korsakov, with Alexander Glazunov , Anatoly Lyadov and several other nationalistically-minded composers and musicians, had formed a group known as the Belyayev circle , named after a merchant and amateur musician who became an influential music patron and publisher. Tchaikovsky spent much time in this circle, becoming far more at ease with them than he had been with the 'Five' and increasingly confident in showcasing his music alongside theirs. This relationship lasted until Tchaikovsky's death. In 1892, Tchaikovsky was voted a member of the Académie des Beaux-Arts in France, only the second Russian subject to be so honored (the first was sculptor Mark Antokolsky ). The following year, the University of Cambridge in England awarded Tchaikovsky an honorary Doctor of Music degree. On 16/28 October 1893, Tchaikovsky conducted the premiere of his Sixth Symphony , the Pathétique , in Saint Petersburg. Nine days later, on 6 November, Tchaikovsky died there, aged 53. He was interred in Tikhvin Cemetery at the Alexander Nevsky Monastery , near the graves of fellow-composers Alexander Borodin , Mikhail Glinka , and Modest Mussorgsky ; later, Nikolai Rimsky-Korsakov and Mily Balakirev were also buried nearby. Tchaikovsky's death is attributed to cholera , caused by drinking unboiled water at a local restaurant . In the 1980s in Britain, however, there was academic speculation that he killed himself, either with poison or by contracting cholera intentionally; in the New Grove Dictionary of Music , Roland John Wiley wrote: "the polemics over Tchaikovsky's death have reached an impasse … . As for illness, problems of evidence offer little hope of satisfactory resolution: the state of diagnosis; the confusion of witnesses; disregard of long-term effects of smoking and alcohol. We do not know how Tchaikovsky died. We may never find out." Pyotr Ilyich Tchaikovsky was born on 7 May 1840 in Votkinsk , a small town in Vyatka Governorate (present-day Udmurtia ) near the banks of the Kama River , and not far from the Ural Mountains in the Russian Empire , into a family with a long history of military service. His father, Ilya Petrovich Tchaikovsky, had served as a lieutenant colonel and engineer in the Department of Mines, and would manage the Kamsko-Votkinsk Ironworks. His grandfather, Pyotr Fedorovich Tchaikovsky, was born in the village of Nikolaevka, Yekaterinoslav Governorate , Russian Empire (present-day Mykolaivka , Luhansk Oblast, Ukraine ), and served first as a physician's assistant in the army and later as city governor of Glazov in Vyatka. His great-grandfather, a Zaporozhian Cossack named Fyodor Chaika, distinguished himself under Peter the Great at the Battle of Poltava in 1709. Tchaikovsky's mother, Alexandra Andreyevna (née d'Assier), was the second of Ilya's three wives, the first having died years before. She was 18 years her husband's junior and French and German on her father's side. Both Ilya and Alexandra were trained in the arts, including music—a necessity as a posting to a remote area of Russia also meant a need for entertainment, whether in private or at social gatherings. Of his six siblings, [n 3] Tchaikovsky was close to his sister Alexandra and twin brothers Anatoly and Modest . Alexandra's marriage to Lev Davydov would produce seven children and lend Tchaikovsky the only real family life he would know as an adult, especially during his years of wandering. One of those children, Vladimir Davydov , who went by the nickname 'Bob', would become very close to him. In 1844, the family hired Fanny Dürbach, a 22-year-old French governess. Four-and-a-half-year-old Tchaikovsky was initially thought too young to study alongside his older brother Nikolai and a niece of the family. His insistence convinced Dürbach otherwise. By the age of six, he had become fluent in French and German. Tchaikovsky also became attached to the young woman; her affection for him was reportedly a counter to his mother's coldness and emotional distance from him, though others assert that the mother doted on her son. Dürbach saved much of Tchaikovsky's work from this period, including his earliest known compositions, and became a source of several childhood anecdotes. Tchaikovsky began piano lessons at age five. Precocious, within three years he had become as adept at reading sheet music as his teacher. Tchaikovsky's parents, initially supportive, hired a tutor, bought an orchestrion (a form of barrel organ that could imitate elaborate orchestral effects), and encouraged his piano study for both aesthetic and practical reasons. However, they decided in 1850 to send Tchaikovsky to the Imperial School of Jurisprudence in Saint Petersburg. They had both graduated from institutes in Saint Petersburg and the School of Jurisprudence, which mainly served the lesser nobility and thought that this education would prepare Tchaikovsky for a career as a civil servant. Regardless of talent, the only musical careers available in Russia at that time—except for the affluent aristocracy—were as a teacher in an academy or as an instrumentalist in one of the Imperial Theaters. Both were considered on the lowest rank of the social ladder, with individuals in them enjoying no more rights than peasants. Tchaikovsky's father's income was also growing increasingly uncertain, so both parents may have wanted Tchaikovsky to become independent as soon as possible. As the minimum age for acceptance was 12 and Tchaikovsky was only 10 at the time, he was required to spend two years boarding at the Imperial School of Jurisprudence's preparatory school, 1,300 kilometres (800 mi) from his family. Once those two years had passed, Tchaikovsky transferred to the Imperial School of Jurisprudence to begin a seven-year course of studies. Tchaikovsky's early separation from his mother, despite the aforementioned alleged distant relationship, caused an emotional trauma that lasted the rest of his life and was intensified by her death from cholera in 1854 when he was 14. [n 4] The loss of his mother also prompted Tchaikovsky to make his first serious attempt at composition, a waltz in her memory. Tchaikovsky's father, who had also contracted cholera but recovered fully, sent him back to school immediately in the hope that classwork would occupy the boy's mind. Isolated, Tchaikovsky compensated with friendships with fellow students that became lifelong; these included Aleksey Apukhtin and Vladimir Gerard. Music, while not an official priority at school, also bridged the gap between Tchaikovsky and his peers. They regularly attended the opera and Tchaikovsky would improvise at the school's harmonium on themes he and his friends had sung during choir practice. "We were amused," Vladimir Gerard later remembered, "but not imbued with any expectations of his future glory". Tchaikovsky also continued his piano studies through Franz Becker, an instrument manufacturer who made occasional visits to the school; however, the results, according to musicologist David Brown , were "negligible". In 1855, Tchaikovsky's father funded private lessons with Rudolph Kündinger and questioned him about a musical career for his son. While impressed with the boy's talent, Kündinger said he saw nothing to suggest a future composer or performer. He later admitted that his assessment was also based on his own negative experiences as a musician in Russia and his unwillingness for Tchaikovsky to be treated likewise. Tchaikovsky was told to finish his course and then try for a post in the Ministry of Justice. On 10 June 1859, the 19-year-old Tchaikovsky graduated as a titular counselor, a low rung on the civil service ladder. Appointed to the Ministry of Justice, he became a junior assistant within six months and a senior assistant two months after that. He remained a senior assistant for the rest of his three-year civil service career. Meanwhile, the Russian Musical Society (RMS) was founded in 1859 by the Grand Duchess Elena Pavlovna (a German-born aunt of Tsar Alexander II ) and her protégé, pianist and composer Anton Rubinstein . Previous tsars and the aristocracy had focused almost exclusively on importing European talent. The aim of the RMS was to fulfill Alexander II's wish to foster native talent. It hosted a regular season of public concerts (previously held only during the six weeks of Lent when the Imperial Theaters were closed) and provided basic professional training in music. In 1861, Tchaikovsky attended RMS classes in music theory taught by Nikolai Zaremba at the Mikhailovsky Palace (now the Russian Museum ). These classes were a precursor to the Saint Petersburg Conservatory , which opened in 1862. Tchaikovsky enrolled at the Conservatory as part of its premiere class. He studied harmony and counterpoint with Zaremba and instrumentation and composition with Rubinstein. He was awarded a silver medal for his thesis, a cantata on Schiller's " Ode to Joy ". The Conservatory benefited Tchaikovsky in two ways. It transformed him into a musical professional, with tools to help him thrive as a composer, and the in-depth exposure to European principles and musical forms gave him a sense that his art was not exclusively Russian or Western. This mindset became important in Tchaikovsky's reconciliation of Russian and European influences in his compositional style. He believed and attempted to show that both these aspects were "intertwined and mutually dependent". His efforts became both an inspiration and a starting point for other Russian composers to build their own individual styles. Rubinstein was impressed by Tchaikovsky's musical talent on the whole and cited him as "a composer of genius" in his autobiography. He was less pleased with the more progressive tendencies of some of Tchaikovsky's student work. Nor did he change his opinion as Tchaikovsky's reputation grew. [n 5] [n 6] He and Zaremba clashed with Tchaikovsky when he submitted his First Symphony for performance by the Russian Musical Society in Saint Petersburg. Rubinstein and Zaremba refused to consider the work unless substantial changes were made. Tchaikovsky complied but they still refused to perform the symphony. Tchaikovsky, distressed that he had been treated as though he were still their student, withdrew the symphony. It was given its first complete performance, minus the changes Rubinstein and Zaremba had requested, in Moscow in February 1868. Once Tchaikovsky graduated in 1865, Rubinstein's brother Nikolai offered him the post of Professor of Music Theory at the soon-to-open Moscow Conservatory . While the salary for his professorship was only 50 rubles a month, the offer itself boosted Tchaikovsky's morale and he accepted the post eagerly. He was further heartened by news of the first public performance of one of his works, his Characteristic Dances , conducted by Johann Strauss II at a concert in Pavlovsk Park on 11 September 1865 (Tchaikovsky later included this work, re-titled Dances of the Hay Maidens , in his opera The Voyevoda ). From 1867 to 1878, Tchaikovsky combined his professorial duties with music criticism while continuing to compose. This activity exposed him to a range of contemporary music and afforded him the opportunity to travel abroad. In his reviews, he praised Beethoven , considered Brahms overrated and, despite his admiration, took Schumann to task for poor orchestration. [n 7] He appreciated the staging of Wagner's Der Ring des Nibelungen at its inaugural performance in Bayreuth (Germany), but not the music, calling Das Rheingold "unlikely nonsense, through which, from time to time, sparkle unusually beautiful and astonishing details". A recurring theme he addressed was the poor state of Russian opera . In 1856, while Tchaikovsky was still at the School of Jurisprudence and Anton Rubinstein lobbied aristocrats to form the Russian Musical Society , critic Vladimir Stasov and an 18-year-old pianist, Mily Balakirev , met and agreed upon a nationalist agenda for Russian music, one that would take the operas of Mikhail Glinka as a model and incorporate elements from folk music, reject traditional Western practices and use non-Western harmonic devices such as the whole tone and octatonic scales . They saw Western-style conservatories as unnecessary and antipathetic to fostering native talent. Eventually, Balakirev , César Cui , Modest Mussorgsky , Nikolai Rimsky-Korsakov and Alexander Borodin became known as the moguchaya kuchka , translated into English as the "Mighty Handful" or "The Five" . Rubinstein criticized their emphasis on amateur efforts in musical composition; Balakirev and later Mussorgsky attacked Rubinstein for his musical conservatism and his belief in professional music training. Tchaikovsky and his fellow conservatory students were caught in the middle. While ambivalent about much of The Five's music, Tchaikovsky remained on friendly terms with most of its members. In 1869, he and Balakirev worked together on what became Tchaikovsky's first recognized masterpiece, the fantasy-overture Romeo and Juliet , a work which The Five wholeheartedly embraced. The group also welcomed his Second Symphony , subtitled the Little Russian . Despite their support, Tchaikovsky made considerable efforts to ensure his musical independence from the group as well as from the conservative faction at the Saint Petersburg Conservatory. The infrequency of Tchaikovsky's musical successes, won with tremendous effort, exacerbated his lifelong sensitivity to criticism. Nikolai Rubinstein's private fits of rage critiquing his music, such as attacking the First Piano Concerto , did not help matters. His popularity grew, however, as several first-rate artists became willing to perform his compositions. Hans von Bülow premiered the First Piano Concerto and championed other Tchaikovsky works both as pianist and conductor. Other artists included Adele aus der Ohe , Max Erdmannsdörfer , Eduard Nápravník and Sergei Taneyev . Another factor that helped Tchaikovsky's music become popular was a shift in attitude among Russian audiences. Whereas they had previously been satisfied with flashy virtuoso performances of technically demanding but musically lightweight works, they gradually began listening with increasing appreciation of the composition itself. Tchaikovsky's works were performed frequently, with few delays between their composition and first performances; the publication from 1867 onward of his songs and great piano music for the home market also helped boost the composer's popularity. During the late 1860s, Tchaikovsky began to compose operas. His first, The Voyevoda , based on a play by Alexander Ostrovsky , premiered in 1869. The composer became dissatisfied with it, however, and, having re-used parts of it in later works, destroyed the manuscript. Undina followed in 1870. Only excerpts were performed and it, too, was destroyed. Between these projects, Tchaikovsky started to compose an opera called Mandragora , to a libretto by Sergei Rachinskii; the only music he completed was a short chorus of Flowers and Insects. The first Tchaikovsky opera to survive intact, The Oprichnik , premiered in 1874. During its composition, he lost Ostrovsky's part-finished libretto. Tchaikovsky, too embarrassed to ask for another copy, decided to write the libretto himself, modeling his dramatic technique on that of Eugène Scribe . Cui wrote a "characteristically savage press attack" on the opera. Mussorgsky, writing to Vladimir Stasov , disapproved of the opera as pandering to the public. Nevertheless, The Oprichnik continues to be performed from time to time in Russia. The last of the early operas, Vakula the Smith (Op. 14), was composed in the second half of 1874. The libretto, based on Gogol 's Christmas Eve , was to have been set to music by Alexander Serov . With Serov's death, the libretto was opened to a competition with a guarantee that the winning entry would be premiered by the Imperial Mariinsky Theatre . Tchaikovsky was declared the winner, but at the 1876 premiere, the opera enjoyed only a lukewarm reception. After Tchaikovsky's death, Rimsky-Korsakov wrote the opera Christmas Eve , based on the same story. Other works of this period include the Variations on a Rococo Theme for cello and orchestra, the Third and Fourth Symphonies , the ballet Swan Lake , and the opera Eugene Onegin .In 1856, while Tchaikovsky was still at the School of Jurisprudence and Anton Rubinstein lobbied aristocrats to form the Russian Musical Society , critic Vladimir Stasov and an 18-year-old pianist, Mily Balakirev , met and agreed upon a nationalist agenda for Russian music, one that would take the operas of Mikhail Glinka as a model and incorporate elements from folk music, reject traditional Western practices and use non-Western harmonic devices such as the whole tone and octatonic scales . They saw Western-style conservatories as unnecessary and antipathetic to fostering native talent. Eventually, Balakirev , César Cui , Modest Mussorgsky , Nikolai Rimsky-Korsakov and Alexander Borodin became known as the moguchaya kuchka , translated into English as the "Mighty Handful" or "The Five" . Rubinstein criticized their emphasis on amateur efforts in musical composition; Balakirev and later Mussorgsky attacked Rubinstein for his musical conservatism and his belief in professional music training. Tchaikovsky and his fellow conservatory students were caught in the middle. While ambivalent about much of The Five's music, Tchaikovsky remained on friendly terms with most of its members. In 1869, he and Balakirev worked together on what became Tchaikovsky's first recognized masterpiece, the fantasy-overture Romeo and Juliet , a work which The Five wholeheartedly embraced. The group also welcomed his Second Symphony , subtitled the Little Russian . Despite their support, Tchaikovsky made considerable efforts to ensure his musical independence from the group as well as from the conservative faction at the Saint Petersburg Conservatory. The infrequency of Tchaikovsky's musical successes, won with tremendous effort, exacerbated his lifelong sensitivity to criticism. Nikolai Rubinstein's private fits of rage critiquing his music, such as attacking the First Piano Concerto , did not help matters. His popularity grew, however, as several first-rate artists became willing to perform his compositions. Hans von Bülow premiered the First Piano Concerto and championed other Tchaikovsky works both as pianist and conductor. Other artists included Adele aus der Ohe , Max Erdmannsdörfer , Eduard Nápravník and Sergei Taneyev . Another factor that helped Tchaikovsky's music become popular was a shift in attitude among Russian audiences. Whereas they had previously been satisfied with flashy virtuoso performances of technically demanding but musically lightweight works, they gradually began listening with increasing appreciation of the composition itself. Tchaikovsky's works were performed frequently, with few delays between their composition and first performances; the publication from 1867 onward of his songs and great piano music for the home market also helped boost the composer's popularity. During the late 1860s, Tchaikovsky began to compose operas. His first, The Voyevoda , based on a play by Alexander Ostrovsky , premiered in 1869. The composer became dissatisfied with it, however, and, having re-used parts of it in later works, destroyed the manuscript. Undina followed in 1870. Only excerpts were performed and it, too, was destroyed. Between these projects, Tchaikovsky started to compose an opera called Mandragora , to a libretto by Sergei Rachinskii; the only music he completed was a short chorus of Flowers and Insects. The first Tchaikovsky opera to survive intact, The Oprichnik , premiered in 1874. During its composition, he lost Ostrovsky's part-finished libretto. Tchaikovsky, too embarrassed to ask for another copy, decided to write the libretto himself, modeling his dramatic technique on that of Eugène Scribe . Cui wrote a "characteristically savage press attack" on the opera. Mussorgsky, writing to Vladimir Stasov , disapproved of the opera as pandering to the public. Nevertheless, The Oprichnik continues to be performed from time to time in Russia. The last of the early operas, Vakula the Smith (Op. 14), was composed in the second half of 1874. The libretto, based on Gogol 's Christmas Eve , was to have been set to music by Alexander Serov . With Serov's death, the libretto was opened to a competition with a guarantee that the winning entry would be premiered by the Imperial Mariinsky Theatre . Tchaikovsky was declared the winner, but at the 1876 premiere, the opera enjoyed only a lukewarm reception. After Tchaikovsky's death, Rimsky-Korsakov wrote the opera Christmas Eve , based on the same story. Other works of this period include the Variations on a Rococo Theme for cello and orchestra, the Third and Fourth Symphonies , the ballet Swan Lake , and the opera Eugene Onegin .Discussion of Tchaikovsky's personal life, especially his sexuality, has perhaps been the most extensive of any composer in the 19th century and certainly of any Russian composer of his time. It has also at times caused considerable confusion, from Soviet efforts to expunge all references to homosexuality and portray him as a heterosexual, to efforts at analysis by Western biographers. Biographers have generally agreed that Tchaikovsky was homosexual. He sought the company of other men in his circle for extended periods, "associating openly and establishing professional connections with them." His first love was reportedly Sergey Kireyev, a younger fellow student at the Imperial School of Jurisprudence. According to Modest Tchaikovsky , this was Pyotr Ilyich's "strongest, longest and purest love". Tchaikovsky's dedication of his Sixth symphony to his nephew Vladimir "Bob" Davydov (21 at the time) and his feelings expressed about Davydov in letters to others, especially following Davydov's suicide, has been cited as evidence for romantic love between the two. The degree to which the composer might have felt comfortable with his sexual desires has, however, remained open to debate. It is still unknown whether Tchaikovsky, according to musicologist and biographer David Brown , "felt tainted within himself, defiled by something from which he finally realized he could never escape" or whether, according to Alexander Poznansky , he experienced "no unbearable guilt" over his sexual desires and "eventually came to see his sexual peculiarities as an insurmountable and even natural part of his personality ... without experiencing any serious psychological damage". Relevant portions of his brother Modest's autobiography, where he tells of the composer's same-sex attraction, have been published, as have letters previously suppressed by Soviet censors in which Tchaikovsky openly writes of it. Such censorship has persisted in the Russian government, resulting in many officials, including the former culture minister Vladimir Medinsky , denying his homosexuality outright. Passages in Tchaikovsky's letters which reveal his homosexual desires have been censored in Russia. In one such passage he said of a homosexual acquaintance: "Petashenka used to drop by with the criminal intention of observing the Cadet Corps, which is right opposite our windows, but I've been trying to discourage these compromising visits—and with some success." In another one, he wrote: "After our walk, I offered him some money, which was refused. He does it for the love of art and adores men with beards." Tchaikovsky lived as a bachelor for most of his life. In 1868, he met Belgian soprano Désirée Artôt with whom he considered marriage, but, owing to various circumstances, the relationship ended. Tchaikovsky later claimed she was the only woman he ever loved. In 1877, at the age of 37, he wed a former student, Antonina Miliukova . The marriage was a disaster. Mismatched psychologically and sexually, the couple lived together for only two and a half months before Tchaikovsky left, overwrought emotionally and suffering from acute writer's block . Tchaikovsky's family remained supportive of him during this crisis and throughout his life. Tchaikovsky's marital debacle may have forced him to face the full truth about his sexuality; he never blamed Antonina for the failure of their marriage. Tchaikovsky was also aided by Nadezhda von Meck , the widow of a railway magnate, who had begun contact with him not long before the marriage. As well as an important friend and emotional support, she became his patroness for the next 13 years, which allowed him to focus exclusively on composition. Although Tchaikovsky called her his "best friend", they agreed never to meet under any circumstances.Tchaikovsky remained abroad for a year after the disintegration of his marriage. During this time, he completed Eugene Onegin , orchestrated his Fourth Symphony, and composed the Violin Concerto . He returned briefly to the Moscow Conservatory in the autumn of 1879. [n 8] For the next few years, assured of a regular income from von Meck, he traveled incessantly throughout Europe and rural Russia, mainly alone, and avoided social contact whenever possible. During this time, Tchaikovsky's foreign reputation grew and a positive reassessment of his music also took place in Russia, thanks in part to Russian novelist Fyodor Dostoevsky 's call for "universal unity" with the West at the unveiling of the Pushkin Monument in Moscow in 1880. Before Dostoevsky's speech, Tchaikovsky's music had been considered "overly dependent on the West". As Dostoevsky's message spread throughout Russia, this stigma toward Tchaikovsky's music evaporated. The unprecedented acclaim for him even drew a cult following among the young intelligentsia of Saint Petersburg, including Alexandre Benois , Léon Bakst and Sergei Diaghilev . Two musical works from this period stand out. With the Cathedral of Christ the Saviour nearing completion in Moscow in 1880, the 25th anniversary of the coronation of Alexander II in 1881, [n 9] and the 1882 Moscow Arts and Industry Exhibition in the planning stage, Nikolai Rubinstein suggested that Tchaikovsky compose a grand commemorative piece. Tchaikovsky agreed and finished it within six weeks. He wrote to Nadezhda von Meck that this piece, the 1812 Overture , would be "very loud and noisy, but I wrote it with no warm feeling of love, and therefore there will probably be no artistic merits in it". He also warned conductor Eduard Nápravník that "I shan't be at all surprised and offended if you find that it is in a style unsuitable for symphony concerts". Nevertheless, the overture became, for many, "the piece by Tchaikovsky they know best", particularly well-known for the use of cannon in the scores. On 23 March 1881, Nikolai Rubinstein died in Paris. That December, Tchaikovsky started work on his Piano Trio in A minor , "dedicated to the memory of a great artist". First performed privately at the Moscow Conservatory on the first anniversary of Rubinstein's death, the piece became extremely popular during the composer's lifetime; in November 1893, it would become Tchaikovsky's own elegy at memorial concerts in Moscow and St. Petersburg. [n 10]In 1884, Tchaikovsky began to shed his unsociability and restlessness. That March, Emperor Alexander III conferred upon him the Order of Saint Vladimir (fourth class), which included a title of hereditary nobility and a personal audience with the Tsar. This was seen as a seal of official approval which advanced Tchaikovsky's social standing and might have been cemented in the composer's mind by the success of his Orchestral Suite No. 3 at its January 1885 premiere in Saint Petersburg. In 1885, Alexander III requested a new production of Eugene Onegin at the Bolshoi Kamenny Theatre in Saint Petersburg. [n 11] By having the opera staged there and not at the Mariinsky Theatre , he served notice that Tchaikovsky's music was replacing Italian opera as the official imperial art. In addition, at the instigation of Ivan Vsevolozhsky , Director of the Imperial Theaters and a patron of the composer, Tchaikovsky was awarded a lifetime annual pension of 3,000 rubles from the Tsar. This made him the premier court composer, in practice if not in the actual title. Despite Tchaikovsky's disdain for public life, he now participated in it as part of his increasing celebrity and out of a duty he felt to promote Russian music. He helped support his former pupil Sergei Taneyev , who was now director of Moscow Conservatory, by attending student examinations and negotiating the sometimes sensitive relations among various members of the staff. He served as director of the Moscow branch of the Russian Musical Society during the 1889–1890 season. In this post, he invited many international celebrities to conduct, including Johannes Brahms , Antonín Dvořák and Jules Massenet . During this period, Tchaikovsky also began promoting Russian music as a conductor, In January 1887, he substituted, on short notice, at the Bolshoi Theater in Moscow for performances of his opera Cherevichki . Within a year, he was in considerable demand throughout Europe and Russia. These appearances helped him overcome life-long stage fright and boosted his self-assurance. In 1888, Tchaikovsky led the premiere of his Fifth Symphony in Saint Petersburg, repeating the work a week later with the first performance of his tone poem Hamlet . Although critics proved hostile, with César Cui calling the symphony "routine" and "meretricious", both works were received with extreme enthusiasm by audiences and Tchaikovsky, undeterred, continued to conduct the symphony in Russia and Europe. Conducting brought him to the United States in 1891, where he led the New York Music Society's orchestra in his Festival Coronation March at the inaugural concert of Carnegie Hall . In November 1887, Tchaikovsky arrived at Saint Petersburg in time to hear several of the Russian Symphony Concerts , devoted exclusively to the music of Russian composers. One included the first complete performance of his revised First Symphony; another featured the final version of Third Symphony of Nikolai Rimsky-Korsakov , with whose circle Tchaikovsky was already in touch. Rimsky-Korsakov, with Alexander Glazunov , Anatoly Lyadov and several other nationalistically-minded composers and musicians, had formed a group known as the Belyayev circle , named after a merchant and amateur musician who became an influential music patron and publisher. Tchaikovsky spent much time in this circle, becoming far more at ease with them than he had been with the 'Five' and increasingly confident in showcasing his music alongside theirs. This relationship lasted until Tchaikovsky's death. In 1892, Tchaikovsky was voted a member of the Académie des Beaux-Arts in France, only the second Russian subject to be so honored (the first was sculptor Mark Antokolsky ). The following year, the University of Cambridge in England awarded Tchaikovsky an honorary Doctor of Music degree. On 16/28 October 1893, Tchaikovsky conducted the premiere of his Sixth Symphony , the Pathétique , in Saint Petersburg. Nine days later, on 6 November, Tchaikovsky died there, aged 53. He was interred in Tikhvin Cemetery at the Alexander Nevsky Monastery , near the graves of fellow-composers Alexander Borodin , Mikhail Glinka , and Modest Mussorgsky ; later, Nikolai Rimsky-Korsakov and Mily Balakirev were also buried nearby. Tchaikovsky's death is attributed to cholera , caused by drinking unboiled water at a local restaurant . In the 1980s in Britain, however, there was academic speculation that he killed himself, either with poison or by contracting cholera intentionally; in the New Grove Dictionary of Music , Roland John Wiley wrote: "the polemics over Tchaikovsky's death have reached an impasse … . As for illness, problems of evidence offer little hope of satisfactory resolution: the state of diagnosis; the confusion of witnesses; disregard of long-term effects of smoking and alcohol. We do not know how Tchaikovsky died. We may never find out." Of Tchaikovsky's Western predecessors, Robert Schumann stands out as an influence in formal structure, harmonic practices, and piano writing, according to Brown and musicologist Roland John Wiley . Boris Asafyev comments that Schumann left his mark on Tchaikovsky not just as a formal influence but also as an example of musical dramaturgy and self-expression. Leon Botstein argues the music of Franz Liszt and Richard Wagner also left their imprints on Tchaikovsky's orchestral style. [n 12] The late-Romantic trend for writing orchestral suites, begun by Franz Lachner , Jules Massenet , and Joachim Raff after the rediscovery of Bach 's works in that genre, may have influenced Tchaikovsky to try his own hand at them. Tchaikovsky's teacher Anton Rubinstein's opera The Demon became a model for the final tableau of Eugene Onegin . So did Léo Delibes ' ballets Coppélia and Sylvia for The Sleeping Beauty [n 13] and Georges Bizet 's opera Carmen (a work Tchaikovsky admired tremendously) for The Queen of Spades . Otherwise, it was to composers of the past that Tchaikovsky turned—Beethoven, whose music he respected; Mozart, whose music he loved; Glinka, whose opera A Life for the Tsar made an indelible impression on him as a child and whose scoring he studied assiduously; and Adolphe Adam , whose ballet Giselle was a favorite of his from his student days and whose score he consulted while working on The Sleeping Beauty . Beethoven's string quartets may have influenced Tchaikovsky's attempts in that medium. Other composers whose work interested Tchaikovsky included Hector Berlioz , Felix Mendelssohn , Giacomo Meyerbeer , Gioachino Rossini , Giuseppe Verdi , Vincenzo Bellini , Carl Maria von Weber and Henry Litolff . Tchaikovsky displayed a wide stylistic and emotional range, from light salon works to grand symphonies. Some of his works, such as the Variations on a Rococo Theme , employ a "Classical" form reminiscent of 18th-century composers such as Mozart (his favorite composer). Other compositions, such as his Little Russian symphony and his opera Vakula the Smith , flirt with musical practices more akin to those of the 'Five', especially in their use of folk song. Other works, such as Tchaikovsky's last three symphonies, employ a personal musical idiom that facilitated intense emotional expression. American music critic and journalist Harold C. Schonberg wrote of Tchaikovsky's "sweet, inexhaustible, supersensuous fund of melody ", a feature that has ensured his music's continued success with audiences. Tchaikovsky's complete range of melodic styles was as wide as that of his compositions. Sometimes he used Western-style melodies, sometimes original melodies written in the style of Russian folk song; sometimes he used actual folk songs. According to The New Grove , Tchaikovsky's melodic gift could also become his worst enemy in two ways. The first challenge arose from his ethnic heritage. Unlike Western themes, the melodies that Russian composers wrote tended to be self-contained: they functioned with a mindset of stasis and repetition rather than one of progress and ongoing development. On a technical level, it made modulating to a new key to introduce a contrasting second theme exceedingly difficult, as this was literally a foreign concept that did not exist in Russian music. The second way melody worked against Tchaikovsky was a challenge that he shared with the majority of Romantic-age composers. They did not write in the regular, symmetrical melodic shapes that worked well with sonata form , such as those favored by Classical composers such as Haydn, Mozart or Beethoven; rather, the themes favored by Romantics were complete and independent in themselves. This completeness hindered their use as structural elements in combination with one another. This challenge was why the Romantics "were never natural symphonists". All a composer like Tchaikovsky could do with them was to essentially repeat them, even when he modified them to generate tension, maintain interest, and satisfy listeners. Harmony could be a potential trap for Tchaikovsky, according to Brown, since Russian creativity tended to focus on inertia and self-enclosed tableaux, while Western harmony worked against this to propel the music onward and, on a larger scale, shape it. Modulation , the shifting from one key to another, was a driving principle in both harmony and sonata form , the primary Western large-scale musical structure since the middle of the 18th century. Modulation maintained harmonic interest over an extended time scale, provided a clear contrast between musical themes, and showed how those themes were related to each other. One point in Tchaikovsky's favor was "a flair for harmony" that "astonished" Rudolph Kündinger, Tchaikovsky's music tutor during his time at the School of Jurisprudence. Added to what he learned at the Saint Petersburg Conservatory studies, this talent allowed Tchaikovsky to employ a varied range of harmony in his music, from the Western harmonic and textural practices of his first two string quartets to the use of the whole-tone scale in the center of the finale of the Second Symphony, a practice more typically used by The Five. Rhythmically , Tchaikovsky sometimes experimented with unusual meters . More often, he used a firm, regular meter, a practice that served him well in dance music. At times, his rhythms became pronounced enough to become the main expressive agent of the music. They also became a means, found typically in Russian folk music, of simulating movement or progression in large-scale symphonic movements—a "synthetic propulsion", as Brown phrases it, which substituted for the momentum that would be created in strict sonata form by the interaction of melodic or motivic elements. This interaction generally does not take place in Russian music. (For more on this, please see Repetition below.) Tchaikovsky struggled with sonata form. Its principle of organic growth through the interplay of musical themes was alien to Russian practice. The traditional argument that Tchaikovsky seemed unable to develop themes in this manner fails to consider this point; it also discounts the possibility that Tchaikovsky might have intended the development passages in his large-scale works to act as "enforced hiatuses" to build tension, rather than grow organically as smoothly progressive musical arguments. According to Brown and musicologists Hans Keller and Daniel Zhitomirsky , Tchaikovsky found his solution to large-scale structure while composing the Fourth Symphony. He essentially sidestepped thematic interaction and kept sonata form only as an "outline", as Zhitomirsky phrases it. Within this outline, the focus centered on periodic alternation and juxtaposition. Tchaikovsky placed blocks of dissimilar tonal and thematic material alongside one another, with what Keller calls "new and violent contrasts" between musical themes , keys , and harmonies. This process, according to Brown and Keller, builds momentum and adds intense drama. While the result, Warrack charges, is still "an ingenious episodic treatment of two tunes rather than a symphonic development of them" in the Germanic sense, Brown counters that it took the listener of the period "through a succession of often highly charged sections which added up to a radically new kind of symphonic experience" (italics Brown), one that functioned not on the basis of summation, as Austro-German symphonies did, but on one of accumulation. Partly owing to the melodic and structural intricacies involved in this accumulation and partly due to the composer's nature, Tchaikovsky's music became intensely expressive. This intensity was entirely new to Russian music and prompted some Russians to place Tchaikovsky's name alongside that of Dostoevsky. German musicologist Hermann Kretzschmar credits Tchaikovsky in his later symphonies with offering "full images of life, developed freely, sometimes even dramatically, around psychological contrasts ... This music has the mark of the truly lived and felt experience". Leon Botstein , in elaborating on this comment, suggests that listening to Tchaikovsky's music "became a psychological mirror connected to everyday experience, one that reflected on the dynamic nature of the listener's own emotional self". This active engagement with the music "opened for the listener a vista of emotional and psychological tension and an extremity of feeling that possessed relevance because it seemed reminiscent of one's own 'truly lived and felt experience' or one's search for intensity in a deeply personal sense". As mentioned above, repetition was a natural part of Tchaikovsky's music, just as it is an integral part of Russian music. His use of sequences within melodies ( repeating a tune at a higher or lower pitch in the same voice) could go on for extreme length. The problem with repetition is that, over a period of time, the melody being repeated remains static, even when there is a surface level of rhythmic activity added to it. Tchaikovsky kept the musical conversation flowing by treating melody, tonality, rhythm and sound color as one integrated unit, rather than as separate elements. By making subtle but noticeable changes in the rhythm or phrasing of a tune, modulating to another key, changing the melody itself or varying the instruments playing it, Tchaikovsky could keep a listener's interest from flagging. By extending the number of repetitions, he could increase the musical and dramatic tension of a passage, building "into an emotional experience of almost unbearable intensity", as Brown phrases it, controlling when the peak and release of that tension would take place. Musicologist Martin Cooper calls this practice a subtle form of unifying a piece of music and adds that Tchaikovsky brought it to a high point of refinement. (For more on this practice, see the next section.) Like other late Romantic composers, Tchaikovsky relied heavily on orchestration for musical effects. Tchaikovsky, however, became noted for the "sensual opulence" and "voluptuous timbrel virtuosity" of his orchestration. Like Glinka, Tchaikovsky tended toward bright primary colors and sharply delineated contrasts of texture . However, beginning with the Third Symphony , Tchaikovsky experimented with an increased range of timbres Tchaikovsky's scoring was noted and admired by some of his peers. Rimsky-Korsakov regularly referred his students at the Saint Petersburg Conservatory to it and called it "devoid of all striving after effect, [to] give a healthy, beautiful sonority". This sonority, musicologist Richard Taruskin pointed out, is essentially Germanic in effect. Tchaikovsky's expert use of having two or more instruments play a melody simultaneously (a practice called doubling ) and his ear for uncanny combinations of instruments resulted in "a generalized orchestral sonority in which the individual timbres of the instruments, being thoroughly mixed, would vanish". In works like the "Serenade for Strings" and the Variations on a Rococo Theme , Tchaikovsky showed he was highly gifted at writing in a style of 18th-century European pastiche . Tchaikovsky graduated from imitation to full-scale evocation in the ballet The Sleeping Beauty and the opera The Queen of Spades . This practice, which Alexandre Benois calls "passé-ism", lends an air of timelessness and immediacy, making the past seem as though it were the present. On a practical level, Tchaikovsky was drawn to past styles because he felt he might find the solution to certain structural problems within them. His Rococo pastiches also may have offered escape into a musical world purer than his own, into which he felt himself irresistibly drawn. (In this sense, Tchaikovsky operated in the opposite manner to Igor Stravinsky , who turned to Neoclassicism partly as a form of compositional self-discovery.) Tchaikovsky's attraction to ballet might have allowed a similar refuge into a fairy-tale world, where he could freely write dance music within a tradition of French elegance. Maes maintains that, regardless of what he was writing, Tchaikovsky's main concern was how his music impacted his listeners on an aesthetic level, at specific moments in the piece, and on a cumulative level once the music had finished. What his listeners experienced on an emotional or visceral level became an end in itself. Tchaikovsky's focus on pleasing his audience might be considered closer to that of Mendelssohn or Mozart. Considering that he lived and worked in what was probably the last 19th-century feudal nation, the statement is not actually that surprising. And yet, even when writing so-called 'programme' music, for example, his Romeo and Juliet fantasy overture, he cast it in sonata form. His use of stylized 18th-century melodies and patriotic themes was geared toward the values of Russian aristocracy. He was aided in this by Ivan Vsevolozhsky, who commissioned The Sleeping Beauty from Tchaikovsky and the libretto for The Queen of Spades from Modest with their use of 18th-century settings stipulated firmly. [n 14] Tchaikovsky also used the polonaise frequently, the dance being a musical code for the Romanov dynasty and a symbol of Russian patriotism. Using it in the finale of a work could assure its success with Russian listeners. Of Tchaikovsky's Western predecessors, Robert Schumann stands out as an influence in formal structure, harmonic practices, and piano writing, according to Brown and musicologist Roland John Wiley . Boris Asafyev comments that Schumann left his mark on Tchaikovsky not just as a formal influence but also as an example of musical dramaturgy and self-expression. Leon Botstein argues the music of Franz Liszt and Richard Wagner also left their imprints on Tchaikovsky's orchestral style. [n 12] The late-Romantic trend for writing orchestral suites, begun by Franz Lachner , Jules Massenet , and Joachim Raff after the rediscovery of Bach 's works in that genre, may have influenced Tchaikovsky to try his own hand at them. Tchaikovsky's teacher Anton Rubinstein's opera The Demon became a model for the final tableau of Eugene Onegin . So did Léo Delibes ' ballets Coppélia and Sylvia for The Sleeping Beauty [n 13] and Georges Bizet 's opera Carmen (a work Tchaikovsky admired tremendously) for The Queen of Spades . Otherwise, it was to composers of the past that Tchaikovsky turned—Beethoven, whose music he respected; Mozart, whose music he loved; Glinka, whose opera A Life for the Tsar made an indelible impression on him as a child and whose scoring he studied assiduously; and Adolphe Adam , whose ballet Giselle was a favorite of his from his student days and whose score he consulted while working on The Sleeping Beauty . Beethoven's string quartets may have influenced Tchaikovsky's attempts in that medium. Other composers whose work interested Tchaikovsky included Hector Berlioz , Felix Mendelssohn , Giacomo Meyerbeer , Gioachino Rossini , Giuseppe Verdi , Vincenzo Bellini , Carl Maria von Weber and Henry Litolff . Tchaikovsky displayed a wide stylistic and emotional range, from light salon works to grand symphonies. Some of his works, such as the Variations on a Rococo Theme , employ a "Classical" form reminiscent of 18th-century composers such as Mozart (his favorite composer). Other compositions, such as his Little Russian symphony and his opera Vakula the Smith , flirt with musical practices more akin to those of the 'Five', especially in their use of folk song. Other works, such as Tchaikovsky's last three symphonies, employ a personal musical idiom that facilitated intense emotional expression. American music critic and journalist Harold C. Schonberg wrote of Tchaikovsky's "sweet, inexhaustible, supersensuous fund of melody ", a feature that has ensured his music's continued success with audiences. Tchaikovsky's complete range of melodic styles was as wide as that of his compositions. Sometimes he used Western-style melodies, sometimes original melodies written in the style of Russian folk song; sometimes he used actual folk songs. According to The New Grove , Tchaikovsky's melodic gift could also become his worst enemy in two ways. The first challenge arose from his ethnic heritage. Unlike Western themes, the melodies that Russian composers wrote tended to be self-contained: they functioned with a mindset of stasis and repetition rather than one of progress and ongoing development. On a technical level, it made modulating to a new key to introduce a contrasting second theme exceedingly difficult, as this was literally a foreign concept that did not exist in Russian music. The second way melody worked against Tchaikovsky was a challenge that he shared with the majority of Romantic-age composers. They did not write in the regular, symmetrical melodic shapes that worked well with sonata form , such as those favored by Classical composers such as Haydn, Mozart or Beethoven; rather, the themes favored by Romantics were complete and independent in themselves. This completeness hindered their use as structural elements in combination with one another. This challenge was why the Romantics "were never natural symphonists". All a composer like Tchaikovsky could do with them was to essentially repeat them, even when he modified them to generate tension, maintain interest, and satisfy listeners. Harmony could be a potential trap for Tchaikovsky, according to Brown, since Russian creativity tended to focus on inertia and self-enclosed tableaux, while Western harmony worked against this to propel the music onward and, on a larger scale, shape it. Modulation , the shifting from one key to another, was a driving principle in both harmony and sonata form , the primary Western large-scale musical structure since the middle of the 18th century. Modulation maintained harmonic interest over an extended time scale, provided a clear contrast between musical themes, and showed how those themes were related to each other. One point in Tchaikovsky's favor was "a flair for harmony" that "astonished" Rudolph Kündinger, Tchaikovsky's music tutor during his time at the School of Jurisprudence. Added to what he learned at the Saint Petersburg Conservatory studies, this talent allowed Tchaikovsky to employ a varied range of harmony in his music, from the Western harmonic and textural practices of his first two string quartets to the use of the whole-tone scale in the center of the finale of the Second Symphony, a practice more typically used by The Five. Rhythmically , Tchaikovsky sometimes experimented with unusual meters . More often, he used a firm, regular meter, a practice that served him well in dance music. At times, his rhythms became pronounced enough to become the main expressive agent of the music. They also became a means, found typically in Russian folk music, of simulating movement or progression in large-scale symphonic movements—a "synthetic propulsion", as Brown phrases it, which substituted for the momentum that would be created in strict sonata form by the interaction of melodic or motivic elements. This interaction generally does not take place in Russian music. (For more on this, please see Repetition below.) Tchaikovsky struggled with sonata form. Its principle of organic growth through the interplay of musical themes was alien to Russian practice. The traditional argument that Tchaikovsky seemed unable to develop themes in this manner fails to consider this point; it also discounts the possibility that Tchaikovsky might have intended the development passages in his large-scale works to act as "enforced hiatuses" to build tension, rather than grow organically as smoothly progressive musical arguments. According to Brown and musicologists Hans Keller and Daniel Zhitomirsky , Tchaikovsky found his solution to large-scale structure while composing the Fourth Symphony. He essentially sidestepped thematic interaction and kept sonata form only as an "outline", as Zhitomirsky phrases it. Within this outline, the focus centered on periodic alternation and juxtaposition. Tchaikovsky placed blocks of dissimilar tonal and thematic material alongside one another, with what Keller calls "new and violent contrasts" between musical themes , keys , and harmonies. This process, according to Brown and Keller, builds momentum and adds intense drama. While the result, Warrack charges, is still "an ingenious episodic treatment of two tunes rather than a symphonic development of them" in the Germanic sense, Brown counters that it took the listener of the period "through a succession of often highly charged sections which added up to a radically new kind of symphonic experience" (italics Brown), one that functioned not on the basis of summation, as Austro-German symphonies did, but on one of accumulation. Partly owing to the melodic and structural intricacies involved in this accumulation and partly due to the composer's nature, Tchaikovsky's music became intensely expressive. This intensity was entirely new to Russian music and prompted some Russians to place Tchaikovsky's name alongside that of Dostoevsky. German musicologist Hermann Kretzschmar credits Tchaikovsky in his later symphonies with offering "full images of life, developed freely, sometimes even dramatically, around psychological contrasts ... This music has the mark of the truly lived and felt experience". Leon Botstein , in elaborating on this comment, suggests that listening to Tchaikovsky's music "became a psychological mirror connected to everyday experience, one that reflected on the dynamic nature of the listener's own emotional self". This active engagement with the music "opened for the listener a vista of emotional and psychological tension and an extremity of feeling that possessed relevance because it seemed reminiscent of one's own 'truly lived and felt experience' or one's search for intensity in a deeply personal sense". As mentioned above, repetition was a natural part of Tchaikovsky's music, just as it is an integral part of Russian music. His use of sequences within melodies ( repeating a tune at a higher or lower pitch in the same voice) could go on for extreme length. The problem with repetition is that, over a period of time, the melody being repeated remains static, even when there is a surface level of rhythmic activity added to it. Tchaikovsky kept the musical conversation flowing by treating melody, tonality, rhythm and sound color as one integrated unit, rather than as separate elements. By making subtle but noticeable changes in the rhythm or phrasing of a tune, modulating to another key, changing the melody itself or varying the instruments playing it, Tchaikovsky could keep a listener's interest from flagging. By extending the number of repetitions, he could increase the musical and dramatic tension of a passage, building "into an emotional experience of almost unbearable intensity", as Brown phrases it, controlling when the peak and release of that tension would take place. Musicologist Martin Cooper calls this practice a subtle form of unifying a piece of music and adds that Tchaikovsky brought it to a high point of refinement. (For more on this practice, see the next section.) Like other late Romantic composers, Tchaikovsky relied heavily on orchestration for musical effects. Tchaikovsky, however, became noted for the "sensual opulence" and "voluptuous timbrel virtuosity" of his orchestration. Like Glinka, Tchaikovsky tended toward bright primary colors and sharply delineated contrasts of texture . However, beginning with the Third Symphony , Tchaikovsky experimented with an increased range of timbres Tchaikovsky's scoring was noted and admired by some of his peers. Rimsky-Korsakov regularly referred his students at the Saint Petersburg Conservatory to it and called it "devoid of all striving after effect, [to] give a healthy, beautiful sonority". This sonority, musicologist Richard Taruskin pointed out, is essentially Germanic in effect. Tchaikovsky's expert use of having two or more instruments play a melody simultaneously (a practice called doubling ) and his ear for uncanny combinations of instruments resulted in "a generalized orchestral sonority in which the individual timbres of the instruments, being thoroughly mixed, would vanish". In works like the "Serenade for Strings" and the Variations on a Rococo Theme , Tchaikovsky showed he was highly gifted at writing in a style of 18th-century European pastiche . Tchaikovsky graduated from imitation to full-scale evocation in the ballet The Sleeping Beauty and the opera The Queen of Spades . This practice, which Alexandre Benois calls "passé-ism", lends an air of timelessness and immediacy, making the past seem as though it were the present. On a practical level, Tchaikovsky was drawn to past styles because he felt he might find the solution to certain structural problems within them. His Rococo pastiches also may have offered escape into a musical world purer than his own, into which he felt himself irresistibly drawn. (In this sense, Tchaikovsky operated in the opposite manner to Igor Stravinsky , who turned to Neoclassicism partly as a form of compositional self-discovery.) Tchaikovsky's attraction to ballet might have allowed a similar refuge into a fairy-tale world, where he could freely write dance music within a tradition of French elegance. American music critic and journalist Harold C. Schonberg wrote of Tchaikovsky's "sweet, inexhaustible, supersensuous fund of melody ", a feature that has ensured his music's continued success with audiences. Tchaikovsky's complete range of melodic styles was as wide as that of his compositions. Sometimes he used Western-style melodies, sometimes original melodies written in the style of Russian folk song; sometimes he used actual folk songs. According to The New Grove , Tchaikovsky's melodic gift could also become his worst enemy in two ways. The first challenge arose from his ethnic heritage. Unlike Western themes, the melodies that Russian composers wrote tended to be self-contained: they functioned with a mindset of stasis and repetition rather than one of progress and ongoing development. On a technical level, it made modulating to a new key to introduce a contrasting second theme exceedingly difficult, as this was literally a foreign concept that did not exist in Russian music. The second way melody worked against Tchaikovsky was a challenge that he shared with the majority of Romantic-age composers. They did not write in the regular, symmetrical melodic shapes that worked well with sonata form , such as those favored by Classical composers such as Haydn, Mozart or Beethoven; rather, the themes favored by Romantics were complete and independent in themselves. This completeness hindered their use as structural elements in combination with one another. This challenge was why the Romantics "were never natural symphonists". All a composer like Tchaikovsky could do with them was to essentially repeat them, even when he modified them to generate tension, maintain interest, and satisfy listeners. Harmony could be a potential trap for Tchaikovsky, according to Brown, since Russian creativity tended to focus on inertia and self-enclosed tableaux, while Western harmony worked against this to propel the music onward and, on a larger scale, shape it. Modulation , the shifting from one key to another, was a driving principle in both harmony and sonata form , the primary Western large-scale musical structure since the middle of the 18th century. Modulation maintained harmonic interest over an extended time scale, provided a clear contrast between musical themes, and showed how those themes were related to each other. One point in Tchaikovsky's favor was "a flair for harmony" that "astonished" Rudolph Kündinger, Tchaikovsky's music tutor during his time at the School of Jurisprudence. Added to what he learned at the Saint Petersburg Conservatory studies, this talent allowed Tchaikovsky to employ a varied range of harmony in his music, from the Western harmonic and textural practices of his first two string quartets to the use of the whole-tone scale in the center of the finale of the Second Symphony, a practice more typically used by The Five. Rhythmically , Tchaikovsky sometimes experimented with unusual meters . More often, he used a firm, regular meter, a practice that served him well in dance music. At times, his rhythms became pronounced enough to become the main expressive agent of the music. They also became a means, found typically in Russian folk music, of simulating movement or progression in large-scale symphonic movements—a "synthetic propulsion", as Brown phrases it, which substituted for the momentum that would be created in strict sonata form by the interaction of melodic or motivic elements. This interaction generally does not take place in Russian music. (For more on this, please see Repetition below.)Tchaikovsky struggled with sonata form. Its principle of organic growth through the interplay of musical themes was alien to Russian practice. The traditional argument that Tchaikovsky seemed unable to develop themes in this manner fails to consider this point; it also discounts the possibility that Tchaikovsky might have intended the development passages in his large-scale works to act as "enforced hiatuses" to build tension, rather than grow organically as smoothly progressive musical arguments. According to Brown and musicologists Hans Keller and Daniel Zhitomirsky , Tchaikovsky found his solution to large-scale structure while composing the Fourth Symphony. He essentially sidestepped thematic interaction and kept sonata form only as an "outline", as Zhitomirsky phrases it. Within this outline, the focus centered on periodic alternation and juxtaposition. Tchaikovsky placed blocks of dissimilar tonal and thematic material alongside one another, with what Keller calls "new and violent contrasts" between musical themes , keys , and harmonies. This process, according to Brown and Keller, builds momentum and adds intense drama. While the result, Warrack charges, is still "an ingenious episodic treatment of two tunes rather than a symphonic development of them" in the Germanic sense, Brown counters that it took the listener of the period "through a succession of often highly charged sections which added up to a radically new kind of symphonic experience" (italics Brown), one that functioned not on the basis of summation, as Austro-German symphonies did, but on one of accumulation. Partly owing to the melodic and structural intricacies involved in this accumulation and partly due to the composer's nature, Tchaikovsky's music became intensely expressive. This intensity was entirely new to Russian music and prompted some Russians to place Tchaikovsky's name alongside that of Dostoevsky. German musicologist Hermann Kretzschmar credits Tchaikovsky in his later symphonies with offering "full images of life, developed freely, sometimes even dramatically, around psychological contrasts ... This music has the mark of the truly lived and felt experience". Leon Botstein , in elaborating on this comment, suggests that listening to Tchaikovsky's music "became a psychological mirror connected to everyday experience, one that reflected on the dynamic nature of the listener's own emotional self". This active engagement with the music "opened for the listener a vista of emotional and psychological tension and an extremity of feeling that possessed relevance because it seemed reminiscent of one's own 'truly lived and felt experience' or one's search for intensity in a deeply personal sense". As mentioned above, repetition was a natural part of Tchaikovsky's music, just as it is an integral part of Russian music. His use of sequences within melodies ( repeating a tune at a higher or lower pitch in the same voice) could go on for extreme length. The problem with repetition is that, over a period of time, the melody being repeated remains static, even when there is a surface level of rhythmic activity added to it. Tchaikovsky kept the musical conversation flowing by treating melody, tonality, rhythm and sound color as one integrated unit, rather than as separate elements. By making subtle but noticeable changes in the rhythm or phrasing of a tune, modulating to another key, changing the melody itself or varying the instruments playing it, Tchaikovsky could keep a listener's interest from flagging. By extending the number of repetitions, he could increase the musical and dramatic tension of a passage, building "into an emotional experience of almost unbearable intensity", as Brown phrases it, controlling when the peak and release of that tension would take place. Musicologist Martin Cooper calls this practice a subtle form of unifying a piece of music and adds that Tchaikovsky brought it to a high point of refinement. (For more on this practice, see the next section.)Like other late Romantic composers, Tchaikovsky relied heavily on orchestration for musical effects. Tchaikovsky, however, became noted for the "sensual opulence" and "voluptuous timbrel virtuosity" of his orchestration. Like Glinka, Tchaikovsky tended toward bright primary colors and sharply delineated contrasts of texture . However, beginning with the Third Symphony , Tchaikovsky experimented with an increased range of timbres Tchaikovsky's scoring was noted and admired by some of his peers. Rimsky-Korsakov regularly referred his students at the Saint Petersburg Conservatory to it and called it "devoid of all striving after effect, [to] give a healthy, beautiful sonority". This sonority, musicologist Richard Taruskin pointed out, is essentially Germanic in effect. Tchaikovsky's expert use of having two or more instruments play a melody simultaneously (a practice called doubling ) and his ear for uncanny combinations of instruments resulted in "a generalized orchestral sonority in which the individual timbres of the instruments, being thoroughly mixed, would vanish". In works like the "Serenade for Strings" and the Variations on a Rococo Theme , Tchaikovsky showed he was highly gifted at writing in a style of 18th-century European pastiche . Tchaikovsky graduated from imitation to full-scale evocation in the ballet The Sleeping Beauty and the opera The Queen of Spades . This practice, which Alexandre Benois calls "passé-ism", lends an air of timelessness and immediacy, making the past seem as though it were the present. On a practical level, Tchaikovsky was drawn to past styles because he felt he might find the solution to certain structural problems within them. His Rococo pastiches also may have offered escape into a musical world purer than his own, into which he felt himself irresistibly drawn. (In this sense, Tchaikovsky operated in the opposite manner to Igor Stravinsky , who turned to Neoclassicism partly as a form of compositional self-discovery.) Tchaikovsky's attraction to ballet might have allowed a similar refuge into a fairy-tale world, where he could freely write dance music within a tradition of French elegance. Maes maintains that, regardless of what he was writing, Tchaikovsky's main concern was how his music impacted his listeners on an aesthetic level, at specific moments in the piece, and on a cumulative level once the music had finished. What his listeners experienced on an emotional or visceral level became an end in itself. Tchaikovsky's focus on pleasing his audience might be considered closer to that of Mendelssohn or Mozart. Considering that he lived and worked in what was probably the last 19th-century feudal nation, the statement is not actually that surprising. And yet, even when writing so-called 'programme' music, for example, his Romeo and Juliet fantasy overture, he cast it in sonata form. His use of stylized 18th-century melodies and patriotic themes was geared toward the values of Russian aristocracy. He was aided in this by Ivan Vsevolozhsky, who commissioned The Sleeping Beauty from Tchaikovsky and the libretto for The Queen of Spades from Modest with their use of 18th-century settings stipulated firmly. [n 14] Tchaikovsky also used the polonaise frequently, the dance being a musical code for the Romanov dynasty and a symbol of Russian patriotism. Using it in the finale of a work could assure its success with Russian listeners. Tchaikovsky's relationship with collaborators was mixed. Like Nikolai Rubinstein with the First Piano Concerto, virtuoso and pedagogue Leopold Auer rejected the Violin Concerto initially but changed his mind; he played it to great public success and taught it to his students, who included Jascha Heifetz and Nathan Milstein . Wilhelm Fitzenhagen "intervened considerably in shaping what he considered 'his' piece", the Variations on a Rococo Theme , according to music critic Michael Steinberg . Tchaikovsky was angered by Fitzenhagen's license but did nothing; the Rococo Variations were published with the cellist's amendments. [n 15] His collaboration on the three ballets went better and in Marius Petipa , who worked with him on the last two, he might have found an advocate. [n 16] When The Sleeping Beauty was seen by its dancers as needlessly complicated, Petipa convinced them to put in the extra effort. Tchaikovsky compromised to make his music as practical as possible for the dancers and was accorded more creative freedom than ballet composers were usually accorded at the time. He responded with scores that minimized the rhythmic subtleties normally present in his work but were inventive and rich in melody, with more refined and imaginative orchestration than in the average ballet score. Critical reception to Tchaikovsky's music was varied but also improved over time. Even after 1880, some inside Russia held it suspect for not being nationalistic enough and thought Western European critics lauded it for exactly that reason. There might have been a grain of truth in the latter, according to musicologist and conductor Leon Botstein , as German critics especially wrote of the "indeterminacy of [Tchaikovsky's] artistic character ... being truly at home in the non-Russian". Of the foreign critics who did not care for his music, Eduard Hanslick lambasted the Violin Concerto as a musical composition "whose stink one can hear" and William Forster Abtrop wrote of the Fifth Symphony, "The furious peroration sounds like nothing so much as a horde of demons struggling in a torrent of brandy, the music growing drunker and drunker. Pandemonium, delirium tremens , raving, and above all, noise worse confounded!" The division between Russian and Western critics remained through much of the 20th century but for a different reason. According to Brown and Wiley, the prevailing view of Western critics was that the same qualities in Tchaikovsky's music that appealed to audiences—its strong emotions, directness and eloquence and colorful orchestration—added up to compositional shallowness. The music's use in popular and film music, Brown says, lowered its esteem in their eyes still further. There was also the fact, pointed out earlier, that Tchaikovsky's music demanded active engagement from the listener and, as Botstein phrases it, "spoke to the listener's imaginative interior life, regardless of nationality". Conservative critics, he adds, may have felt threatened by the "violence and 'hysteria'" they detected and felt such emotive displays "attacked the boundaries of conventional aesthetic appreciation—the cultured reception of art as an act of formalist discernment—and the polite engagement of art as an act of amusement". There has also been the fact that the composer did not follow sonata form strictly, relying instead on juxtaposing blocks of tonalities and thematic groups. Maes states this point has been seen at times as a weakness rather than a sign of originality. Even with what Schonberg termed "a professional reevaluation" of Tchaikovsky's work, the practice of faulting Tchaikovsky for not following in the steps of the Viennese masters has not gone away entirely, while his intention of writing music that would please his audiences is also sometimes taken to task. In a 1992 article, New York Times critic Allan Kozinn writes, "It is Tchaikovsky's flexibility, after all, that has given us a sense of his variability.... Tchaikovsky was capable of turning out music—entertaining and widely beloved though it is—that seems superficial, manipulative and trivial when regarded in the context of the whole literature. The First Piano Concerto is a case in point. It makes a joyful noise, it swims in pretty tunes and its dramatic rhetoric allows (or even requires) a soloist to make a grand, swashbuckling impression. But it is entirely hollow". In the 21st century, however, critics are reacting more positively to Tchaikovsky's tunefulness, originality, and craftsmanship. "Tchaikovsky is being viewed again as a composer of the first rank, writing music of depth, innovation and influence," according to cultural historian and author Joseph Horowitz . Important in this reevaluation is a shift in attitude away from the disdain for overt emotionalism that marked half of the 20th century. "We have acquired a different view of Romantic 'excess,'" Horowitz says. "Tchaikovsky is today more admired than deplored for his emotional frankness; if his music seems harried and insecure, so are we all". Horowitz maintains that, while the standing of Tchaikovsky's music has fluctuated among critics, for the public, "it never went out of style, and his most popular works have yielded iconic sound-bytes [ sic ] , such as the love theme from Romeo and Juliet ". Along with those tunes, Botstein adds, "Tchaikovsky appealed to audiences outside of Russia with an immediacy and directness that were startling even for music, an art form often associated with emotion". Tchaikovsky's melodies, stated with eloquence and matched by his inventive use of harmony and orchestration, have always ensured audience appeal. His popularity is considered secure, with his following in many countries, including the United States and the United Kingdom, second only to that of Beethoven. His music has also been used frequently in popular music and film. Tchaikovsky's relationship with collaborators was mixed. Like Nikolai Rubinstein with the First Piano Concerto, virtuoso and pedagogue Leopold Auer rejected the Violin Concerto initially but changed his mind; he played it to great public success and taught it to his students, who included Jascha Heifetz and Nathan Milstein . Wilhelm Fitzenhagen "intervened considerably in shaping what he considered 'his' piece", the Variations on a Rococo Theme , according to music critic Michael Steinberg . Tchaikovsky was angered by Fitzenhagen's license but did nothing; the Rococo Variations were published with the cellist's amendments. [n 15] His collaboration on the three ballets went better and in Marius Petipa , who worked with him on the last two, he might have found an advocate. [n 16] When The Sleeping Beauty was seen by its dancers as needlessly complicated, Petipa convinced them to put in the extra effort. Tchaikovsky compromised to make his music as practical as possible for the dancers and was accorded more creative freedom than ballet composers were usually accorded at the time. He responded with scores that minimized the rhythmic subtleties normally present in his work but were inventive and rich in melody, with more refined and imaginative orchestration than in the average ballet score. Critical reception to Tchaikovsky's music was varied but also improved over time. Even after 1880, some inside Russia held it suspect for not being nationalistic enough and thought Western European critics lauded it for exactly that reason. There might have been a grain of truth in the latter, according to musicologist and conductor Leon Botstein , as German critics especially wrote of the "indeterminacy of [Tchaikovsky's] artistic character ... being truly at home in the non-Russian". Of the foreign critics who did not care for his music, Eduard Hanslick lambasted the Violin Concerto as a musical composition "whose stink one can hear" and William Forster Abtrop wrote of the Fifth Symphony, "The furious peroration sounds like nothing so much as a horde of demons struggling in a torrent of brandy, the music growing drunker and drunker. Pandemonium, delirium tremens , raving, and above all, noise worse confounded!" The division between Russian and Western critics remained through much of the 20th century but for a different reason. According to Brown and Wiley, the prevailing view of Western critics was that the same qualities in Tchaikovsky's music that appealed to audiences—its strong emotions, directness and eloquence and colorful orchestration—added up to compositional shallowness. The music's use in popular and film music, Brown says, lowered its esteem in their eyes still further. There was also the fact, pointed out earlier, that Tchaikovsky's music demanded active engagement from the listener and, as Botstein phrases it, "spoke to the listener's imaginative interior life, regardless of nationality". Conservative critics, he adds, may have felt threatened by the "violence and 'hysteria'" they detected and felt such emotive displays "attacked the boundaries of conventional aesthetic appreciation—the cultured reception of art as an act of formalist discernment—and the polite engagement of art as an act of amusement". There has also been the fact that the composer did not follow sonata form strictly, relying instead on juxtaposing blocks of tonalities and thematic groups. Maes states this point has been seen at times as a weakness rather than a sign of originality. Even with what Schonberg termed "a professional reevaluation" of Tchaikovsky's work, the practice of faulting Tchaikovsky for not following in the steps of the Viennese masters has not gone away entirely, while his intention of writing music that would please his audiences is also sometimes taken to task. In a 1992 article, New York Times critic Allan Kozinn writes, "It is Tchaikovsky's flexibility, after all, that has given us a sense of his variability.... Tchaikovsky was capable of turning out music—entertaining and widely beloved though it is—that seems superficial, manipulative and trivial when regarded in the context of the whole literature. The First Piano Concerto is a case in point. It makes a joyful noise, it swims in pretty tunes and its dramatic rhetoric allows (or even requires) a soloist to make a grand, swashbuckling impression. But it is entirely hollow". In the 21st century, however, critics are reacting more positively to Tchaikovsky's tunefulness, originality, and craftsmanship. "Tchaikovsky is being viewed again as a composer of the first rank, writing music of depth, innovation and influence," according to cultural historian and author Joseph Horowitz . Important in this reevaluation is a shift in attitude away from the disdain for overt emotionalism that marked half of the 20th century. "We have acquired a different view of Romantic 'excess,'" Horowitz says. "Tchaikovsky is today more admired than deplored for his emotional frankness; if his music seems harried and insecure, so are we all". Horowitz maintains that, while the standing of Tchaikovsky's music has fluctuated among critics, for the public, "it never went out of style, and his most popular works have yielded iconic sound-bytes [ sic ] , such as the love theme from Romeo and Juliet ". Along with those tunes, Botstein adds, "Tchaikovsky appealed to audiences outside of Russia with an immediacy and directness that were startling even for music, an art form often associated with emotion". Tchaikovsky's melodies, stated with eloquence and matched by his inventive use of harmony and orchestration, have always ensured audience appeal. His popularity is considered secure, with his following in many countries, including the United States and the United Kingdom, second only to that of Beethoven. His music has also been used frequently in popular music and film. According to Wiley, Tchaikovsky was a pioneer in several ways. "Thanks in large part to Nadezhda von Meck", Wiley writes, "he became the first full-time professional Russian composer". This, Wiley adds, allowed him the time and freedom to consolidate the Western compositional practices he had learned at the Saint Petersburg Conservatory with Russian folk song and other native musical elements to fulfill his own expressive goals and forge an original, deeply personal style. He made an impact in not only complete works such as the symphony but also program music and, as Wiley phrases it, "transformed Liszt's and Berlioz's achievements ... into matters of Shakespearean elevation and psychological import". Wiley and Holden both note that Tchaikovsky did all this without a native school of composition upon which to fall back. They point out that only Glinka had preceded him in combining Russian and Western practices and his teachers in Saint Petersburg had been thoroughly Germanic in their musical outlook. He was, they write, for all intents and purposes alone in his artistic quest. Maes and Taruskin write that Tchaikovsky believed that his professionalism in combining skill and high standards in his musical works separated him from his contemporaries in The Five. Maes adds that, like them, he wanted to produce music that reflected Russian national character but which did so to the highest European standards of quality. Tchaikovsky, according to Maes, came along at a time when the nation itself was deeply divided as to what that character truly was. Like his country, Maes writes, it took him time to discover how to express his Russianness in a way that was true to himself and what he had learned. Because of his professionalism, Maes says, he worked hard at this goal and succeeded. The composer's friend, music critic Herman Laroche , wrote of The Sleeping Beauty that the score contained "an element deeper and more general than color, in the internal structure of the music, above all in the foundation of the element of melody. This basic element is undoubtedly Russian". Tchaikovsky was inspired to reach beyond Russia with his music, according to Maes and Taruskin. His exposure to Western music, they write, encouraged him to think it belonged to not just Russia but also the world at large. Volkov adds that this mindset made him think seriously about Russia's place in European musical culture—the first Russian composer to do so. It steeled him to become the first Russian composer to acquaint foreign audiences personally with his own works, Warrack writes, as well as those of other Russian composers. In his biography of Tchaikovsky, Anthony Holden recalls the dearth of Russian classical music before Tchaikovsky's birth, then places the composer's achievements into historical perspective: "Twenty years after Tchaikovsky's death, in 1913, Igor Stravinsky 's The Rite of Spring erupted onto the musical scene, signaling Russia's arrival into 20th-century music . Between these two very different worlds, Tchaikovsky's music became the sole bridge". A recording was made in Moscow in January 1890, by Julius Block [ ru ] on behalf of Thomas Edison . A transcript of the recording follows (identification of the speakers is speculative ): According to musicologist Leonid Sabaneyev , Tchaikovsky was not comfortable with being recorded for posterity and tried to shy away from it. On an apparently separate visit from the one related above, Block asked the composer to play something on a piano or at least say something. Tchaikovsky refused. He told Block, "I am a bad pianist and my voice is raspy. Why should one eternalize it?"

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Tennessee

Tennessee ( / ˌ t ɛ n ɪ ˈ s iː / ⓘ TEN -iss- EE , locally / ˈ t ɛ n ɪ s i / TEN -iss-ee ), officially the State of Tennessee , is a landlocked state in the Southeastern region of the United States . It borders Kentucky to the north, Virginia to the northeast, North Carolina to the east, Georgia , Alabama , and Mississippi to the south, Arkansas to the southwest, and Missouri to the northwest. Tennessee is the 36th-largest by area and the 15th-most populous of the 50 states. Tennessee is geographically, culturally, and legally divided into three Grand Divisions of East , Middle , and West Tennessee . Nashville is the state's capital and largest city, and anchors its largest metropolitan area. Other major cities include Memphis , Knoxville , Chattanooga , and Clarksville . Tennessee's population as of the 2020 United States census is approximately 6.9 million. Tennessee is rooted in the Watauga Association , a 1772 frontier pact generally regarded as the first constitutional government west of the Appalachian Mountains . Its name derives from Tanasi ( ᏔᎾᏏ ), a Cherokee town in the eastern part of the state that existed before the first European American settlement. Tennessee was initially part of North Carolina, and later the Southwest Territory , before its admission to the Union as the 16th state on June 1, 1796. It earned the nickname "The Volunteer State" early in its history due to a strong tradition of military service. A slave state until the American Civil War , Tennessee was politically divided, with its western and middle parts supporting the Confederacy and the eastern region harboring pro - Union sentiment. As a result, Tennessee was the last state to secede and the first readmitted to the Union after the war. During the 20th century, Tennessee transitioned from a predominantly agrarian society to a more diversified economy. This was aided in part by massive federal investment in the Tennessee Valley Authority (TVA) and the city of Oak Ridge , which was established during World War II to house the Manhattan Project 's uranium enrichment facilities for the construction of the world's first atomic bombs . After the war, the Oak Ridge National Laboratory became a key center of scientific research. In 2016, the element tennessine was named for the state, largely in recognition of the roles played by Oak Ridge, Vanderbilt University , and the University of Tennessee in its discovery. Tennessee has also played a major role in the development of many forms of popular music , including country , blues , rock and roll , soul , and gospel . Tennessee has diverse terrain and landforms, and from east to west, contains a mix of cultural features characteristic of Appalachia , the Upland South , and the Deep South . The Blue Ridge Mountains along the eastern border reach some of the highest elevations in eastern North America, and the Cumberland Plateau contains many scenic valleys and waterfalls . The central part of the state is marked by cavernous bedrock and irregular rolling hills, and level, fertile plains define West Tennessee. The state is twice bisected by the Tennessee River , and the Mississippi River forms its western border. Its economy is dominated by the health care , music , finance , automotive , chemical , electronics , and tourism sectors, and cattle , soybeans , corn , poultry , and cotton are its primary agricultural products. The Great Smoky Mountains National Park , the nation's most visited national park, is in eastern Tennessee. Tennessee derives its name most directly from the Cherokee town of Tanasi (or "Tanase", in syllabary : ᏔᎾᏏ) in present-day Monroe County, Tennessee , on the Tanasi River, now known as the Little Tennessee River . This town appeared on British maps as early as 1725. In 1567, Spanish explorer Captain Juan Pardo and his party encountered a Native American village named "Tanasqui" in the area while traveling inland from modern-day South Carolina ; however, it is unknown if this was the same settlement as Tanasi. [lower-alpha 2] Recent research suggests that the Cherokees adapted the name from the Yuchi word Tana-tsee-dgee , meaning "brother-waters-place" or "where-the-waters-meet". The modern spelling, Tennessee , is attributed to Governor James Glen of South Carolina, who used this spelling in his official correspondence during the 1750s. In 1788, North Carolina created " Tennessee County ", and in 1796, a constitutional convention , organizing the new state out of the Southwest Territory , adopted "Tennessee" as the state's name. The first inhabitants of Tennessee were Paleo-Indians who arrived about 12,000 years ago at the end of the Last Glacial Period . Archaeological excavations indicate that the lower Tennessee Valley was heavily populated by Ice Age hunter-gatherers , and Middle Tennessee is believed to have been rich with game animals such as mastodons . The names of the cultural groups who inhabited the area before European contact are unknown, but archaeologists have named several distinct cultural phases, including the Archaic (8000–1000 BC), Woodland (1000 BC–1000 AD), and Mississippian (1000–1600 AD) periods. The Archaic peoples first domesticated dogs, and plants such as squash , corn , gourds , and sunflowers were first grown in Tennessee during the Woodland period. Later generations of Woodland peoples constructed the first mounds. Rapid civilizational development occurred during the Mississippian period, when Indigenous peoples developed organized chiefdoms and constructed numerous ceremonial structures throughout the state. Spanish conquistadors who explored the region in the 16th century encountered some of the Mississippian peoples, including the Muscogee Creek , Yuchi , and Shawnee . By the early 18th century, most Natives in Tennessee had disappeared, most likely wiped out by diseases introduced by the Spaniards. The Cherokee began migrating into what is now eastern Tennessee from what is now Virginia in the latter 17th century, possibly to escape expanding European settlement and diseases in the north. They forced the Creek, Yuchi, and Shawnee out of the state in the early 18th century. The Chickasaw remained confined to West Tennessee, and the middle part of the state contained few Native Americans, although both the Cherokee and the Shawnee claimed the region as their hunting ground. Cherokee peoples in Tennessee were known by European settlers as the Overhill Cherokee because they lived west of the Blue Ridge Mountains. Overhill settlements grew along the rivers in East Tennessee in the early 18th century. The first recorded European expeditions into what is now Tennessee were led by Spanish explorers Hernando de Soto in 1540–1541, Tristan de Luna in 1559, and Juan Pardo in 1566–1567. In 1673, English fur trader Abraham Wood sent an expedition from the Colony of Virginia into Overhill Cherokee territory in modern-day northeastern Tennessee. That same year, a French expedition led by missionary Jacques Marquette and Louis Jolliet explored the Mississippi River and became the first Europeans to map the Mississippi Valley. In 1682, an expedition led by René-Robert Cavelier, Sieur de La Salle constructed Fort Prudhomme on the Chickasaw Bluffs in West Tennessee. By the late 17th century, French traders began to explore the Cumberland River valley, and in 1714, under Charles Charleville's command, established French Lick, a fur trading settlement at the present location of Nashville near the Cumberland River . In 1739, the French constructed Fort Assumption under Jean-Baptiste Le Moyne de Bienville on the Mississippi River at the present location of Memphis, which they used as a base against the Chickasaw during the 1739 Campaign of the Chickasaw Wars . In the 1750s and 1760s, longhunters from Virginia explored much of East and Middle Tennessee. Settlers from the Colony of South Carolina built Fort Loudoun on the Little Tennessee River in 1756, the first British settlement in what is now Tennessee and the westernmost British outpost to that date. Hostilities erupted between the British and the Cherokees into an armed conflict , and a siege of the fort ended with its surrender in 1760. After the French and Indian War , Britain issued the Royal Proclamation of 1763 , which forbade settlements west of the Appalachian Mountains in an effort to mitigate conflicts with the Natives. But migration across the mountains continued, and the first permanent European settlers began arriving in northeastern Tennessee in the late 1760s. Most of them were English , but nearly 20% were Scotch-Irish . They formed the Watauga Association in 1772, a semi-autonomous representative government, and three years later reorganized themselves into the Washington District to support the cause of the American Revolutionary War . The next year, after an unsuccessful petition to Virginia, North Carolina agreed to annex the Washington District to provide protection from Native American attacks. In 1775, Richard Henderson negotiated a series of treaties with the Cherokee to sell the lands of the Watauga settlements at Sycamore Shoals on the banks of the Watauga River . An agreement to sell land for the Transylvania Colony , which included the territory in Tennessee north of the Cumberland River, was also signed. Later that year, Daniel Boone , under Henderson's employment, blazed a trail from Fort Chiswell in Virginia through the Cumberland Gap , which became part of the Wilderness Road , a major thoroughfare into Tennessee and Kentucky. The Chickamauga, a Cherokee faction loyal to the British led by Dragging Canoe , opposed the settling of the Washington District and Transylvania Colony, and in 1776 attacked Fort Watauga at Sycamore Shoals. The warnings of Dragging Canoe's cousin Nancy Ward spared many settlers' lives from the initial attacks. In 1779, James Robertson and John Donelson led two groups of settlers from the Washington District to the French Lick. These settlers constructed Fort Nashborough , which they named for Francis Nash , a brigadier general of the Continental Army . The next year, the settlers signed the Cumberland Compact , which established a representative government for the colony called the Cumberland Association . This settlement later grew into the city of Nashville. That same year John Sevier led a group of Overmountain Men from Fort Watauga to the Battle of Kings Mountain in South Carolina, where they defeated the British. Three counties of the Washington District broke off from North Carolina in 1784 and formed the State of Franklin . Efforts to obtain admission to the Union failed, and the counties, now numbering eight, rejoined North Carolina by 1788. North Carolina ceded the area to the federal government in 1790, after which it was organized into the Southwest Territory on May 26 of that year. The act allowed the territory to petition for statehood once the population reached 60,000. Administration of the territory was divided between the Washington District and the Mero District, the latter of which consisted of the Cumberland Association and was named for Spanish territorial governor Esteban Rodríguez Miró . President George Washington appointed William Blount as territorial governor. The Southwest Territory recorded a population of 35,691 in the first United States census that year, including 3,417 slaves. As support for statehood grew among the settlers, Governor Blount called for elections, which were held in December 1793. The 13-member territorial House of Representatives first convened in Knoxville on February 24, 1794, to select ten members for the legislature's upper house, the council. The full legislature convened on August 25, 1794. In June 1795, the legislature conducted a census of the territory, which recorded a population of 77,263, including 10,613 slaves, and a poll that showed 6,504 in favor of statehood and 2,562 opposed. Elections for a constitutional convention were held in December 1795, and the delegates convened in Knoxville on January 17, 1796, to begin drafting a state constitution. During this convention, the name Tennessee was chosen for the new state. The constitution was completed on February 6, which authorized elections for the state's new legislature, the Tennessee General Assembly . The legislature convened on March 28, 1796, and the next day, John Sevier was announced as the state's first governor. Tennessee was admitted to the Union on June 1, 1796, as the 16th state and the first created from federal territory. Tennessee reportedly earned the nickname "The Volunteer State" during the War of 1812 , when 3,500 Tennesseans answered a recruitment call by the General Assembly for the war effort. These soldiers, under Andrew Jackson 's command, played a major role in the American victory at the Battle of New Orleans in 1815, the last major battle of the war. Several Tennesseans took part in the Texas Revolution of 1835–36, including Governor Sam Houston and Congressman and frontiersman Davy Crockett , who was killed at the Battle of the Alamo . The state's nickname was solidified during the Mexican–American War when President James K. Polk of Tennessee issued a call for 2,800 soldiers from the state, and more than 30,000 volunteered. Between the 1790s and 1820s, additional land cessions were negotiated with the Cherokee, who had established a national government modeled on the U.S. Constitution . In 1818, Jackson and Kentucky governor Isaac Shelby reached an agreement with the Chickasaw to sell the land between the Mississippi and Tennessee Rivers to the United States, which included all of West Tennessee and became known as the " Jackson Purchase ". The Cherokee moved their capital from Georgia to the Red Clay Council Grounds in southeastern Tennessee in 1832, due to new laws forcing them from their previous capital at New Echota . In 1838 and 1839, U.S. troops forcibly removed thousands of Cherokees and their black slaves from their homes in southeastern Tennessee and forced them to march to Indian Territory in modern-day Oklahoma . This event is known as the Trail of Tears , and an estimated 4,000 died along the way. As settlers pushed west of the Cumberland Plateau, a slavery-based agrarian economy took hold in these regions. Cotton planters used extensive slave labor on large plantation complexes in West Tennessee's fertile and flat terrain after the Jackson Purchase. Cotton also took hold in the Nashville Basin during this time. Entrepreneurs such as Montgomery Bell used slaves in the production of iron in the Western Highland Rim, and slaves also cultivated such crops as tobacco and corn throughout the Highland Rim. East Tennessee's geography did not allow for large plantations as in the middle and western parts of the state, and as a result, slavery became increasingly rare in the region. A strong abolition movement developed in East Tennessee, beginning as early as 1797, and in 1819, Elihu Embree of Jonesborough began publishing the Manumission Intelligencier (later The Emancipator ), the nation's first exclusively anti-slavery newspaper. At the onset of the American Civil War , most Middle and West Tennesseans favored efforts to preserve their slavery-based economies, but many Middle Tennesseans were initially skeptical of secession. In East Tennessee, most people favored remaining in the Union. In 1860, slaves composed about 25% of Tennessee's population, the lowest share among the states that joined the Confederacy . Tennessee provided more Union troops than any other Confederate state, and the second-highest number of Confederate troops, behind Virginia. Due to its central location, Tennessee was a crucial state during the war and saw more military engagements than any state except Virginia. After Abraham Lincoln was elected president in 1860 , secessionists in the state government led by Governor Isham Harris sought voter approval to sever ties with the United States, which was rejected in a referendum by a 54–46% margin in February 1861. After the Confederate attack on Fort Sumter in April and Lincoln's call for troops in response, the legislature ratified an agreement to enter a military league with the Confederacy on May 7, 1861. On June 8, with Middle Tennesseans having significantly changed their position, voters approved a second referendum on secession by a 69–31% margin, becoming the last state to secede. In response, East Tennessee Unionists organized a convention in Knoxville with the goal of splitting the region to form a new state loyal to the Union. In the fall of 1861, Unionist guerrillas in East Tennessee burned bridges and attacked Confederate sympathizers, leading the Confederacy to invoke martial law in parts of the region. In March 1862, Lincoln appointed native Tennessean and War Democrat Andrew Johnson as military governor of the state. General Ulysses S. Grant and the U.S. Navy captured the Tennessee and Cumberland rivers in February 1862 at the battles of Fort Henry and Fort Donelson . Grant then proceeded south to Pittsburg Landing and held off a Confederate counterattack at Shiloh in April in what was at the time the bloodiest battle of the war. Memphis fell to the Union in June after a naval battle on the Mississippi River. Union strength in Middle Tennessee was tested in a series of Confederate offensives beginning in the summer of 1862, which culminated in General William Rosecrans 's Army of the Cumberland routing General Braxton Bragg 's Army of Tennessee at Stones River , another one of the war's costliest engagements. The next summer, Rosecrans's Tullahoma campaign forced Bragg's remaining troops in Middle Tennessee to retreat to Chattanooga with little fighting. During the Chattanooga campaign , Confederates attempted to besiege the Army of the Cumberland into surrendering, but reinforcements from the Army of the Tennessee under the command of Grant, William Tecumseh Sherman , and Joseph Hooker arrived. The Confederates were driven from the city at the battles of Lookout Mountain and Missionary Ridge in November 1863. Despite Unionist sentiment in East Tennessee, Confederates held the area for most of the war. A few days after the fall of Chattanooga, Confederates led by James Longstreet unsuccessfully campaigned to take control of Knoxville by attacking Union General Ambrose Burnside 's Fort Sanders . The capture of Chattanooga allowed Sherman to launch the Atlanta campaign from the city in May 1864. The last major battles in the state came when Army of Tennessee regiments under John Bell Hood invaded Middle Tennessee in the fall of 1864 in an effort to draw Sherman back. They were checked by John Schofield at Franklin in November and completely dispersed by George Thomas at Nashville in December. On April 27, 1865, the worst maritime disaster in American history occurred when the Sultana steamboat, which was transporting freed Union prisoners, exploded in the Mississippi River north of Memphis, killing 1,168 people. When the Emancipation Proclamation was announced, Tennessee was largely held by Union forces and thus not among the states enumerated, so it freed no slaves there. Andrew Johnson declared all slaves in Tennessee free on October 24, 1864. On February 22, 1865, the legislature approved an amendment to the state constitution prohibiting slavery, which was approved by voters the following month, making Tennessee the only Southern state to abolish slavery. Tennessee ratified the Thirteenth Amendment , which outlawed slavery in every state, on April 7, 1865, and the Fourteenth Amendment , which granted citizenship and equal protection under the law to former slaves, on July 18, 1866. Johnson became vice president when Lincoln was reelected , and president after Lincoln's assassination in May 1865. On July 24, 1866, Tennessee became the first Confederate state to have its elected members readmitted to Congress. The years after the Civil War were characterized by tension and unrest between blacks and former Confederates, the worst of which occurred in Memphis in 1866 . Because Tennessee had ratified the Fourteenth Amendment before its readmission to the Union, it was the only former secessionist state that did not have a military governor during Reconstruction . The Radical Republicans seized control of the state government toward the end of the war, and appointed William G. "Parson" Brownlow governor. Under Brownlow's administration from 1865 to 1869, the legislature allowed African American men to vote, disenfranchised former Confederates, and took action against the Ku Klux Klan , which was founded in December 1865 in Pulaski as a vigilante group to advance former Confederates' interests. In 1870, Southern Democrats regained control of the state legislature, and over the next two decades, passed Jim Crow laws to enforce racial segregation . A total of 251 lynchings , predominately of Black people, took place in Tennessee. A number of epidemics swept through Tennessee in the years after the Civil War, including cholera in 1873, which devastated the Nashville area, and yellow fever in 1878, which killed more than one-tenth of Memphis's residents. Reformers worked to modernize Tennessee into a " New South " economy during this time. With the help of Northern investors, Chattanooga became one of the first industrialized cities in the South. Memphis became known as the "Cotton Capital of the World" during the late 19th century, and Nashville, Knoxville, and several smaller cities saw modest industrialization. Northerners also began exploiting the coalfields and mineral resources in the Appalachian Mountains. To pay off debts and alleviate overcrowded prisons, the state turned to convict leasing , providing prisoners to mining companies as strikebreakers , which was protested by miners forced to compete with the system. An armed uprising in the Cumberland Mountains known as the Coal Creek War in 1891 and 1892 resulted in the state ending convict leasing. Despite New South promoters' efforts, agriculture continued to dominate Tennessee's economy. The majority of freed slaves were forced into sharecropping during the latter 19th century, and many others worked as agricultural wage laborers. In 1897, Tennessee celebrated its statehood centennial one year late with the Tennessee Centennial and International Exposition in Nashville. A full-scale replica of the Parthenon in Athens was designed by architect William Crawford Smith and constructed for the celebration, owing to the city's reputation as the "Athens of the South". Due to increasing racial segregation and poor standards of living, many black Tennesseans fled to industrial cities in the Northeast and Midwest as part of the first wave of the Great Migration between 1915 and 1930. Many residents of rural parts of Tennessee relocated to larger cities during this time for more lucrative employment opportunities. As part of the Temperance movement , Tennessee became the first state in the nation to effectively ban the sale, transportation, and production of alcohol in a series of laws passed between 1907 and 1917. During Prohibition , illicit production of moonshine became extremely common in East Tennessee, particularly in the mountains, and continued for many decades afterward. Sgt. Alvin C. York of Fentress County became one of the most famous and honored American soldiers of World War I . He received the Congressional Medal of Honor for single-handedly capturing an entire German machine gun regiment during the Meuse–Argonne offensive . On July 9, 1918, Tennessee suffered the worst rail accident in U.S. history when two passenger trains collided head on in Nashville, killing 101 and injuring 171. On August 18, 1920, Tennessee became the 36th and final state necessary to ratify the Nineteenth Amendment to the United States Constitution , which gave women the right to vote . In 1925, John T. Scopes , a high school teacher in Dayton , was tried and convicted for teaching evolution in violation of the state's recently passed Butler Act . Scopes was prosecuted by former Secretary of State and presidential candidate William Jennings Bryan and defended by attorney Clarence Darrow . The case was intentionally publicized, and highlighted the creationism-evolution controversy among religious groups. In 1926, Congress authorized the establishment of a national park in the Great Smoky Mountains , which was officially established in 1934 and dedicated in 1940. When the Great Depression struck in 1929, much of Tennessee was severely impoverished even by national standards. As part of President Franklin D. Roosevelt 's New Deal , the Tennessee Valley Authority (TVA) was created in 1933 to provide electricity, jobs, flood control, improved waterway navigation, agricultural development, and economic modernization to the Tennessee River Valley . The TVA built several hydroelectric dams in the state in the 1930s and 1940s, which inundated communities and thousands of farmland acreage, and forcibly displaced families via eminent domain . The agency quickly grew into the country's largest electric utility and initiated a period of dramatic economic growth and transformation that brought many new industries and employment opportunities to the state. During World War II , East Tennessee was chosen for the production of weapons-grade fissile enriched uranium as part of the Manhattan Project , a research and development undertaking led by the U.S. to produce the world's first atomic bombs . The planned community of Oak Ridge was built to provide accommodations for the facilities and workers; the site was chosen due to the abundance of TVA electric power, its low population density, and its inland geography and topography, which allowed for the natural separation of the facilities and a low vulnerability to attack. The Clinton Engineer Works was established as the production arm of the Manhattan Project in Oak Ridge, which enriched uranium at three major facilities for use in atomic bombs. The first of the bombs was detonated in Los Alamos, New Mexico , in a test code-named Trinity , and the second, nicknamed " Little Boy ", was dropped on Imperial Japan at the end of World War II. After the war, the Oak Ridge National Laboratory became an institution for scientific and technological research. After the U.S. Supreme Court ruled racial segregation in public schools unconstitutional in Brown v. Board of Education in 1954, Oak Ridge High School in 1955 became the first school in Tennessee to be integrated . The next year, nearby Clinton High School was integrated, and Tennessee National Guard troops were sent in after pro-segregationists threatened violence. Between February and May 1960, a series of sit-ins at segregated lunch counters in Nashville organized by the Nashville Student Movement resulted in the desegregation of facilities in the city. On April 4, 1968, James Earl Ray assassinated civil rights leader Martin Luther King Jr. in Memphis. King had traveled there to support striking African American sanitation workers . The 1962 U.S. Supreme Court case Baker v. Carr arose out of a challenge to the longstanding rural bias of apportionment of seats in the Tennessee legislature and established the principle of " one man, one vote ". The construction of Interstate 40 through Memphis became a national talking point on the issue of eminent domain and grassroots lobbying when the Tennessee Department of Transportation (TDOT) attempted to construct the highway through the city's Overton Park . A local activist group spent many years contesting the project, and in 1971, the U.S. Supreme Court sided with the group and established the framework for judicial review of government agencies in the landmark case of Citizens to Preserve Overton Park v. Volpe . TVA's construction of the Tellico Dam in Loudon County became the subject of national controversy in the 1970s when the endangered snail darter fish was reported to be affected by the project. After lawsuits by environmental groups, the debate was decided by the U.S. Supreme Court case Tennessee Valley Authority v. Hill in 1978, leading to amendments of the Endangered Species Act . The 1982 World's Fair was held in Knoxville. Also known as the Knoxville International Energy Exposition, the fair's theme was "Energy Turns the World". The exposition was one of the most successful, and the most recent world's fair to be held in the U.S. In 1986, Tennessee held a yearlong celebration of the state's heritage and culture called "Homecoming '86". Tennessee celebrated its bicentennial in 1996 with a yearlong celebration called "Tennessee 200". A new state park that traces the state's history, Bicentennial Mall , was opened at the foot of Capitol Hill in Nashville. The same year, the whitewater slalom events at the Atlanta Summer Olympic Games were held on the Ocoee River in Polk County . In 2002, Tennessee amended its constitution to establish a lottery . In 2006, the state constitution was amended to outlaw same-sex marriage . This amendment was invalidated by the 2015 U.S. Supreme Court case Obergefell v. Hodges . On December 23, 2008, the largest industrial waste spill in United States history occurred at TVA's Kingston Fossil Plant when more than 1.1 billion gallons of coal ash slurry was accidentally released into the Emory and Clinch Rivers . The cleanup cost more than $1 billion and lasted until 2015. The first inhabitants of Tennessee were Paleo-Indians who arrived about 12,000 years ago at the end of the Last Glacial Period . Archaeological excavations indicate that the lower Tennessee Valley was heavily populated by Ice Age hunter-gatherers , and Middle Tennessee is believed to have been rich with game animals such as mastodons . The names of the cultural groups who inhabited the area before European contact are unknown, but archaeologists have named several distinct cultural phases, including the Archaic (8000–1000 BC), Woodland (1000 BC–1000 AD), and Mississippian (1000–1600 AD) periods. The Archaic peoples first domesticated dogs, and plants such as squash , corn , gourds , and sunflowers were first grown in Tennessee during the Woodland period. Later generations of Woodland peoples constructed the first mounds. Rapid civilizational development occurred during the Mississippian period, when Indigenous peoples developed organized chiefdoms and constructed numerous ceremonial structures throughout the state. Spanish conquistadors who explored the region in the 16th century encountered some of the Mississippian peoples, including the Muscogee Creek , Yuchi , and Shawnee . By the early 18th century, most Natives in Tennessee had disappeared, most likely wiped out by diseases introduced by the Spaniards. The Cherokee began migrating into what is now eastern Tennessee from what is now Virginia in the latter 17th century, possibly to escape expanding European settlement and diseases in the north. They forced the Creek, Yuchi, and Shawnee out of the state in the early 18th century. The Chickasaw remained confined to West Tennessee, and the middle part of the state contained few Native Americans, although both the Cherokee and the Shawnee claimed the region as their hunting ground. Cherokee peoples in Tennessee were known by European settlers as the Overhill Cherokee because they lived west of the Blue Ridge Mountains. Overhill settlements grew along the rivers in East Tennessee in the early 18th century. The first recorded European expeditions into what is now Tennessee were led by Spanish explorers Hernando de Soto in 1540–1541, Tristan de Luna in 1559, and Juan Pardo in 1566–1567. In 1673, English fur trader Abraham Wood sent an expedition from the Colony of Virginia into Overhill Cherokee territory in modern-day northeastern Tennessee. That same year, a French expedition led by missionary Jacques Marquette and Louis Jolliet explored the Mississippi River and became the first Europeans to map the Mississippi Valley. In 1682, an expedition led by René-Robert Cavelier, Sieur de La Salle constructed Fort Prudhomme on the Chickasaw Bluffs in West Tennessee. By the late 17th century, French traders began to explore the Cumberland River valley, and in 1714, under Charles Charleville's command, established French Lick, a fur trading settlement at the present location of Nashville near the Cumberland River . In 1739, the French constructed Fort Assumption under Jean-Baptiste Le Moyne de Bienville on the Mississippi River at the present location of Memphis, which they used as a base against the Chickasaw during the 1739 Campaign of the Chickasaw Wars . In the 1750s and 1760s, longhunters from Virginia explored much of East and Middle Tennessee. Settlers from the Colony of South Carolina built Fort Loudoun on the Little Tennessee River in 1756, the first British settlement in what is now Tennessee and the westernmost British outpost to that date. Hostilities erupted between the British and the Cherokees into an armed conflict , and a siege of the fort ended with its surrender in 1760. After the French and Indian War , Britain issued the Royal Proclamation of 1763 , which forbade settlements west of the Appalachian Mountains in an effort to mitigate conflicts with the Natives. But migration across the mountains continued, and the first permanent European settlers began arriving in northeastern Tennessee in the late 1760s. Most of them were English , but nearly 20% were Scotch-Irish . They formed the Watauga Association in 1772, a semi-autonomous representative government, and three years later reorganized themselves into the Washington District to support the cause of the American Revolutionary War . The next year, after an unsuccessful petition to Virginia, North Carolina agreed to annex the Washington District to provide protection from Native American attacks. In 1775, Richard Henderson negotiated a series of treaties with the Cherokee to sell the lands of the Watauga settlements at Sycamore Shoals on the banks of the Watauga River . An agreement to sell land for the Transylvania Colony , which included the territory in Tennessee north of the Cumberland River, was also signed. Later that year, Daniel Boone , under Henderson's employment, blazed a trail from Fort Chiswell in Virginia through the Cumberland Gap , which became part of the Wilderness Road , a major thoroughfare into Tennessee and Kentucky. The Chickamauga, a Cherokee faction loyal to the British led by Dragging Canoe , opposed the settling of the Washington District and Transylvania Colony, and in 1776 attacked Fort Watauga at Sycamore Shoals. The warnings of Dragging Canoe's cousin Nancy Ward spared many settlers' lives from the initial attacks. In 1779, James Robertson and John Donelson led two groups of settlers from the Washington District to the French Lick. These settlers constructed Fort Nashborough , which they named for Francis Nash , a brigadier general of the Continental Army . The next year, the settlers signed the Cumberland Compact , which established a representative government for the colony called the Cumberland Association . This settlement later grew into the city of Nashville. That same year John Sevier led a group of Overmountain Men from Fort Watauga to the Battle of Kings Mountain in South Carolina, where they defeated the British. Three counties of the Washington District broke off from North Carolina in 1784 and formed the State of Franklin . Efforts to obtain admission to the Union failed, and the counties, now numbering eight, rejoined North Carolina by 1788. North Carolina ceded the area to the federal government in 1790, after which it was organized into the Southwest Territory on May 26 of that year. The act allowed the territory to petition for statehood once the population reached 60,000. Administration of the territory was divided between the Washington District and the Mero District, the latter of which consisted of the Cumberland Association and was named for Spanish territorial governor Esteban Rodríguez Miró . President George Washington appointed William Blount as territorial governor. The Southwest Territory recorded a population of 35,691 in the first United States census that year, including 3,417 slaves. As support for statehood grew among the settlers, Governor Blount called for elections, which were held in December 1793. The 13-member territorial House of Representatives first convened in Knoxville on February 24, 1794, to select ten members for the legislature's upper house, the council. The full legislature convened on August 25, 1794. In June 1795, the legislature conducted a census of the territory, which recorded a population of 77,263, including 10,613 slaves, and a poll that showed 6,504 in favor of statehood and 2,562 opposed. Elections for a constitutional convention were held in December 1795, and the delegates convened in Knoxville on January 17, 1796, to begin drafting a state constitution. During this convention, the name Tennessee was chosen for the new state. The constitution was completed on February 6, which authorized elections for the state's new legislature, the Tennessee General Assembly . The legislature convened on March 28, 1796, and the next day, John Sevier was announced as the state's first governor. Tennessee was admitted to the Union on June 1, 1796, as the 16th state and the first created from federal territory. Tennessee reportedly earned the nickname "The Volunteer State" during the War of 1812 , when 3,500 Tennesseans answered a recruitment call by the General Assembly for the war effort. These soldiers, under Andrew Jackson 's command, played a major role in the American victory at the Battle of New Orleans in 1815, the last major battle of the war. Several Tennesseans took part in the Texas Revolution of 1835–36, including Governor Sam Houston and Congressman and frontiersman Davy Crockett , who was killed at the Battle of the Alamo . The state's nickname was solidified during the Mexican–American War when President James K. Polk of Tennessee issued a call for 2,800 soldiers from the state, and more than 30,000 volunteered. Between the 1790s and 1820s, additional land cessions were negotiated with the Cherokee, who had established a national government modeled on the U.S. Constitution . In 1818, Jackson and Kentucky governor Isaac Shelby reached an agreement with the Chickasaw to sell the land between the Mississippi and Tennessee Rivers to the United States, which included all of West Tennessee and became known as the " Jackson Purchase ". The Cherokee moved their capital from Georgia to the Red Clay Council Grounds in southeastern Tennessee in 1832, due to new laws forcing them from their previous capital at New Echota . In 1838 and 1839, U.S. troops forcibly removed thousands of Cherokees and their black slaves from their homes in southeastern Tennessee and forced them to march to Indian Territory in modern-day Oklahoma . This event is known as the Trail of Tears , and an estimated 4,000 died along the way. As settlers pushed west of the Cumberland Plateau, a slavery-based agrarian economy took hold in these regions. Cotton planters used extensive slave labor on large plantation complexes in West Tennessee's fertile and flat terrain after the Jackson Purchase. Cotton also took hold in the Nashville Basin during this time. Entrepreneurs such as Montgomery Bell used slaves in the production of iron in the Western Highland Rim, and slaves also cultivated such crops as tobacco and corn throughout the Highland Rim. East Tennessee's geography did not allow for large plantations as in the middle and western parts of the state, and as a result, slavery became increasingly rare in the region. A strong abolition movement developed in East Tennessee, beginning as early as 1797, and in 1819, Elihu Embree of Jonesborough began publishing the Manumission Intelligencier (later The Emancipator ), the nation's first exclusively anti-slavery newspaper. At the onset of the American Civil War , most Middle and West Tennesseans favored efforts to preserve their slavery-based economies, but many Middle Tennesseans were initially skeptical of secession. In East Tennessee, most people favored remaining in the Union. In 1860, slaves composed about 25% of Tennessee's population, the lowest share among the states that joined the Confederacy . Tennessee provided more Union troops than any other Confederate state, and the second-highest number of Confederate troops, behind Virginia. Due to its central location, Tennessee was a crucial state during the war and saw more military engagements than any state except Virginia. After Abraham Lincoln was elected president in 1860 , secessionists in the state government led by Governor Isham Harris sought voter approval to sever ties with the United States, which was rejected in a referendum by a 54–46% margin in February 1861. After the Confederate attack on Fort Sumter in April and Lincoln's call for troops in response, the legislature ratified an agreement to enter a military league with the Confederacy on May 7, 1861. On June 8, with Middle Tennesseans having significantly changed their position, voters approved a second referendum on secession by a 69–31% margin, becoming the last state to secede. In response, East Tennessee Unionists organized a convention in Knoxville with the goal of splitting the region to form a new state loyal to the Union. In the fall of 1861, Unionist guerrillas in East Tennessee burned bridges and attacked Confederate sympathizers, leading the Confederacy to invoke martial law in parts of the region. In March 1862, Lincoln appointed native Tennessean and War Democrat Andrew Johnson as military governor of the state. General Ulysses S. Grant and the U.S. Navy captured the Tennessee and Cumberland rivers in February 1862 at the battles of Fort Henry and Fort Donelson . Grant then proceeded south to Pittsburg Landing and held off a Confederate counterattack at Shiloh in April in what was at the time the bloodiest battle of the war. Memphis fell to the Union in June after a naval battle on the Mississippi River. Union strength in Middle Tennessee was tested in a series of Confederate offensives beginning in the summer of 1862, which culminated in General William Rosecrans 's Army of the Cumberland routing General Braxton Bragg 's Army of Tennessee at Stones River , another one of the war's costliest engagements. The next summer, Rosecrans's Tullahoma campaign forced Bragg's remaining troops in Middle Tennessee to retreat to Chattanooga with little fighting. During the Chattanooga campaign , Confederates attempted to besiege the Army of the Cumberland into surrendering, but reinforcements from the Army of the Tennessee under the command of Grant, William Tecumseh Sherman , and Joseph Hooker arrived. The Confederates were driven from the city at the battles of Lookout Mountain and Missionary Ridge in November 1863. Despite Unionist sentiment in East Tennessee, Confederates held the area for most of the war. A few days after the fall of Chattanooga, Confederates led by James Longstreet unsuccessfully campaigned to take control of Knoxville by attacking Union General Ambrose Burnside 's Fort Sanders . The capture of Chattanooga allowed Sherman to launch the Atlanta campaign from the city in May 1864. The last major battles in the state came when Army of Tennessee regiments under John Bell Hood invaded Middle Tennessee in the fall of 1864 in an effort to draw Sherman back. They were checked by John Schofield at Franklin in November and completely dispersed by George Thomas at Nashville in December. On April 27, 1865, the worst maritime disaster in American history occurred when the Sultana steamboat, which was transporting freed Union prisoners, exploded in the Mississippi River north of Memphis, killing 1,168 people. When the Emancipation Proclamation was announced, Tennessee was largely held by Union forces and thus not among the states enumerated, so it freed no slaves there. Andrew Johnson declared all slaves in Tennessee free on October 24, 1864. On February 22, 1865, the legislature approved an amendment to the state constitution prohibiting slavery, which was approved by voters the following month, making Tennessee the only Southern state to abolish slavery. Tennessee ratified the Thirteenth Amendment , which outlawed slavery in every state, on April 7, 1865, and the Fourteenth Amendment , which granted citizenship and equal protection under the law to former slaves, on July 18, 1866. Johnson became vice president when Lincoln was reelected , and president after Lincoln's assassination in May 1865. On July 24, 1866, Tennessee became the first Confederate state to have its elected members readmitted to Congress. The years after the Civil War were characterized by tension and unrest between blacks and former Confederates, the worst of which occurred in Memphis in 1866 . Because Tennessee had ratified the Fourteenth Amendment before its readmission to the Union, it was the only former secessionist state that did not have a military governor during Reconstruction . The Radical Republicans seized control of the state government toward the end of the war, and appointed William G. "Parson" Brownlow governor. Under Brownlow's administration from 1865 to 1869, the legislature allowed African American men to vote, disenfranchised former Confederates, and took action against the Ku Klux Klan , which was founded in December 1865 in Pulaski as a vigilante group to advance former Confederates' interests. In 1870, Southern Democrats regained control of the state legislature, and over the next two decades, passed Jim Crow laws to enforce racial segregation . A total of 251 lynchings , predominately of Black people, took place in Tennessee. A number of epidemics swept through Tennessee in the years after the Civil War, including cholera in 1873, which devastated the Nashville area, and yellow fever in 1878, which killed more than one-tenth of Memphis's residents. Reformers worked to modernize Tennessee into a " New South " economy during this time. With the help of Northern investors, Chattanooga became one of the first industrialized cities in the South. Memphis became known as the "Cotton Capital of the World" during the late 19th century, and Nashville, Knoxville, and several smaller cities saw modest industrialization. Northerners also began exploiting the coalfields and mineral resources in the Appalachian Mountains. To pay off debts and alleviate overcrowded prisons, the state turned to convict leasing , providing prisoners to mining companies as strikebreakers , which was protested by miners forced to compete with the system. An armed uprising in the Cumberland Mountains known as the Coal Creek War in 1891 and 1892 resulted in the state ending convict leasing. Despite New South promoters' efforts, agriculture continued to dominate Tennessee's economy. The majority of freed slaves were forced into sharecropping during the latter 19th century, and many others worked as agricultural wage laborers. In 1897, Tennessee celebrated its statehood centennial one year late with the Tennessee Centennial and International Exposition in Nashville. A full-scale replica of the Parthenon in Athens was designed by architect William Crawford Smith and constructed for the celebration, owing to the city's reputation as the "Athens of the South". Due to increasing racial segregation and poor standards of living, many black Tennesseans fled to industrial cities in the Northeast and Midwest as part of the first wave of the Great Migration between 1915 and 1930. Many residents of rural parts of Tennessee relocated to larger cities during this time for more lucrative employment opportunities. As part of the Temperance movement , Tennessee became the first state in the nation to effectively ban the sale, transportation, and production of alcohol in a series of laws passed between 1907 and 1917. During Prohibition , illicit production of moonshine became extremely common in East Tennessee, particularly in the mountains, and continued for many decades afterward. Sgt. Alvin C. York of Fentress County became one of the most famous and honored American soldiers of World War I . He received the Congressional Medal of Honor for single-handedly capturing an entire German machine gun regiment during the Meuse–Argonne offensive . On July 9, 1918, Tennessee suffered the worst rail accident in U.S. history when two passenger trains collided head on in Nashville, killing 101 and injuring 171. On August 18, 1920, Tennessee became the 36th and final state necessary to ratify the Nineteenth Amendment to the United States Constitution , which gave women the right to vote . In 1925, John T. Scopes , a high school teacher in Dayton , was tried and convicted for teaching evolution in violation of the state's recently passed Butler Act . Scopes was prosecuted by former Secretary of State and presidential candidate William Jennings Bryan and defended by attorney Clarence Darrow . The case was intentionally publicized, and highlighted the creationism-evolution controversy among religious groups. In 1926, Congress authorized the establishment of a national park in the Great Smoky Mountains , which was officially established in 1934 and dedicated in 1940. When the Great Depression struck in 1929, much of Tennessee was severely impoverished even by national standards. As part of President Franklin D. Roosevelt 's New Deal , the Tennessee Valley Authority (TVA) was created in 1933 to provide electricity, jobs, flood control, improved waterway navigation, agricultural development, and economic modernization to the Tennessee River Valley . The TVA built several hydroelectric dams in the state in the 1930s and 1940s, which inundated communities and thousands of farmland acreage, and forcibly displaced families via eminent domain . The agency quickly grew into the country's largest electric utility and initiated a period of dramatic economic growth and transformation that brought many new industries and employment opportunities to the state. During World War II , East Tennessee was chosen for the production of weapons-grade fissile enriched uranium as part of the Manhattan Project , a research and development undertaking led by the U.S. to produce the world's first atomic bombs . The planned community of Oak Ridge was built to provide accommodations for the facilities and workers; the site was chosen due to the abundance of TVA electric power, its low population density, and its inland geography and topography, which allowed for the natural separation of the facilities and a low vulnerability to attack. The Clinton Engineer Works was established as the production arm of the Manhattan Project in Oak Ridge, which enriched uranium at three major facilities for use in atomic bombs. The first of the bombs was detonated in Los Alamos, New Mexico , in a test code-named Trinity , and the second, nicknamed " Little Boy ", was dropped on Imperial Japan at the end of World War II. After the war, the Oak Ridge National Laboratory became an institution for scientific and technological research. After the U.S. Supreme Court ruled racial segregation in public schools unconstitutional in Brown v. Board of Education in 1954, Oak Ridge High School in 1955 became the first school in Tennessee to be integrated . The next year, nearby Clinton High School was integrated, and Tennessee National Guard troops were sent in after pro-segregationists threatened violence. Between February and May 1960, a series of sit-ins at segregated lunch counters in Nashville organized by the Nashville Student Movement resulted in the desegregation of facilities in the city. On April 4, 1968, James Earl Ray assassinated civil rights leader Martin Luther King Jr. in Memphis. King had traveled there to support striking African American sanitation workers . The 1962 U.S. Supreme Court case Baker v. Carr arose out of a challenge to the longstanding rural bias of apportionment of seats in the Tennessee legislature and established the principle of " one man, one vote ". The construction of Interstate 40 through Memphis became a national talking point on the issue of eminent domain and grassroots lobbying when the Tennessee Department of Transportation (TDOT) attempted to construct the highway through the city's Overton Park . A local activist group spent many years contesting the project, and in 1971, the U.S. Supreme Court sided with the group and established the framework for judicial review of government agencies in the landmark case of Citizens to Preserve Overton Park v. Volpe . TVA's construction of the Tellico Dam in Loudon County became the subject of national controversy in the 1970s when the endangered snail darter fish was reported to be affected by the project. After lawsuits by environmental groups, the debate was decided by the U.S. Supreme Court case Tennessee Valley Authority v. Hill in 1978, leading to amendments of the Endangered Species Act . The 1982 World's Fair was held in Knoxville. Also known as the Knoxville International Energy Exposition, the fair's theme was "Energy Turns the World". The exposition was one of the most successful, and the most recent world's fair to be held in the U.S. In 1986, Tennessee held a yearlong celebration of the state's heritage and culture called "Homecoming '86". Tennessee celebrated its bicentennial in 1996 with a yearlong celebration called "Tennessee 200". A new state park that traces the state's history, Bicentennial Mall , was opened at the foot of Capitol Hill in Nashville. The same year, the whitewater slalom events at the Atlanta Summer Olympic Games were held on the Ocoee River in Polk County . In 2002, Tennessee amended its constitution to establish a lottery . In 2006, the state constitution was amended to outlaw same-sex marriage . This amendment was invalidated by the 2015 U.S. Supreme Court case Obergefell v. Hodges . On December 23, 2008, the largest industrial waste spill in United States history occurred at TVA's Kingston Fossil Plant when more than 1.1 billion gallons of coal ash slurry was accidentally released into the Emory and Clinch Rivers . The cleanup cost more than $1 billion and lasted until 2015. Tennessee is in the Southeastern United States . Culturally, most of the state is considered part of the Upland South , and the eastern third is part of Appalachia . Tennessee covers roughly 42,143 square miles (109,150 km 2 ) , of which 926 square miles (2,400 km 2 ) , or 2.2%, is water. It is the 16th smallest state in land area. The state is about 440 miles (710 km) long from east to west and 112 miles (180 km) wide from north to south. Tennessee is geographically, culturally, economically, and legally divided into three Grand Divisions : East Tennessee , Middle Tennessee , and West Tennessee . It borders eight other states: Kentucky and Virginia to the north, North Carolina to the east, Georgia , Alabama , and Mississippi on the south, and Arkansas and Missouri on the west. It is tied with Missouri as the state bordering the most other states. Tennessee is trisected by the Tennessee River , and its geographical center is in Murfreesboro . Nearly three–fourths of the state is in the Central Time Zone , with most of East Tennessee on Eastern Time . The Tennessee River forms most of the division between Middle and West Tennessee. Tennessee's eastern boundary roughly follows the highest crests of the Blue Ridge Mountains , and the Mississippi River forms its western boundary. Due to flooding of the Mississippi that has changed its path, the state's western boundary deviates from the river in some places. The northern border was originally defined as 36°30′ north latitude and the Royal Colonial Boundary of 1665 , but due to faulty surveys, begins north of this line in the east, and to the west, gradually veers north before shifting south onto the actual 36°30′ parallel at the Tennessee River in West Tennessee. Uncertainties in the latter 19th century over the location of the state's border with Virginia culminated in the U.S. Supreme Court settling the matter in 1893 , which resulted in the division of Bristol between the two states. An 1818 survey erroneously placed Tennessee's southern border 1 mile (1.6 km) south of the 35th parallel ; Georgia legislators continue to dispute this placement , as it prevents Georgia from accessing the Tennessee River. Marked by a diversity of landforms and topographies, Tennessee features six principal physiographic provinces , from east to west, which are part of three larger regions: the Blue Ridge Mountains , Ridge-and-Valley Appalachians , and Cumberland Plateau , part of the Appalachian Mountains ; the Highland Rim and Nashville Basin , part of the Interior Low Plateaus of the Interior Plains ; and the East Gulf Coastal Plain , part of the Atlantic Plains . Other regions include the southern tip of the Cumberland Mountains , the Western Tennessee Valley , and the Mississippi Alluvial Plain . The state's highest point, which is also the third-highest peak in eastern North America, is Clingmans Dome , at 6,643 feet (2,025 m) above sea level. Its lowest point, 178 feet (54 m) , is on the Mississippi River at the Mississippi state line in Memphis. Tennessee has the most caves in the United States, with more than 10,000 documented. Geological formations in Tennessee largely correspond with the state's topographic features, and, in general, decrease in age from east to west. The state's oldest rocks are igneous strata more than 1 billion years old found in the Blue Ridge Mountains, and the youngest deposits in Tennessee are sands and silts in the Mississippi Alluvial Plain and river valleys that drain into the Mississippi River. Tennessee is considered seismically active and contains two major seismic zones, although destructive earthquakes rarely occur there. The Eastern Tennessee Seismic Zone spans the entirety of East Tennessee from northwestern Alabama to southwestern Virginia, and is considered one of the most active zones in the Southeastern United States, frequently producing low-magnitude earthquakes. The New Madrid Seismic Zone in the northwestern part of the state produced a series of devastating earthquakes between December 1811 and February 1812 that formed Reelfoot Lake near Tiptonville . The southwestern Blue Ridge Mountains lie within Tennessee's eastern edge, and are divided into several subranges, namely the Great Smoky Mountains , Bald Mountains , Unicoi Mountains , Unaka Mountains , and Iron Mountains . These mountains, which average 5,000 feet (1,500 m) above sea level in Tennessee, contain some of the highest elevations in eastern North America. The state's border with North Carolina roughly follows the highest peaks of this range, including Clingmans Dome. Most of the Blue Ridge area is protected by the Cherokee National Forest , the Great Smoky Mountains National Park , and several federal wilderness areas and state parks. The Appalachian Trail roughly follows the North Carolina state line before shifting westward into Tennessee. Stretching west from the Blue Ridge Mountains for about 55 miles (89 km) are the Ridge-and-Valley Appalachians , also known as the Tennessee Valley [lower-alpha 3] or Great Valley of East Tennessee. This area consists of linear parallel ridges separated by valleys that trend northeast to southwest, the general direction of the entire Appalachian range. Most of these ridges are low, but some of the higher ones are commonly called mountains. Numerous tributaries join to form the Tennessee River in the Ridge and Valley region. The Cumberland Plateau rises to the west of the Tennessee Valley, with an average elevation of 2,000 feet (610 m) . This landform is part of the larger Appalachian Plateau and consists mostly of flat-topped tablelands . The plateau's eastern edge is relatively distinct, but the western escarpment is irregular, containing several long, crooked stream valleys separated by rocky cliffs with numerous waterfalls . The Cumberland Mountains , with peaks above 3,500 feet (1,100 m) , comprise the northeastern part of the Appalachian Plateau in Tennessee, and the southeastern part of the Cumberland Plateau is divided by the Sequatchie Valley . The Cumberland Trail traverses the eastern escarpment of the Cumberland Plateau and Cumberland Mountains. West of the Cumberland Plateau is the Highland Rim , an elevated plain that surrounds the Nashville Basin , a geological dome . Both of these physiographic provinces are part of the Interior Low Plateaus of the larger Interior Plains . The Highland Rim is Tennessee's largest geographic region, and is often split into eastern and western halves. The Eastern Highland Rim is characterized by relatively level plains dotted by rolling hills, and the Western Highland Rim and western Nashville Basin are covered with uneven rounded knobs with steep ravines separated by meandering streams. The Nashville Basin has rich, fertile farmland, and porous limestone bedrock very close to the surface underlies both the Nashville Basin and Eastern Highland Rim. This results in karst that forms numerous caves, sinkholes, depressions, and underground streams. West of the Highland Rim is the Western Tennessee Valley , which consists of about 10 miles (16 km) in width of hilly land along the banks of the Tennessee River. West of this is the Gulf Coastal Plain , a broad feature that begins at the Gulf of Mexico and extends northward into southern Illinois . The plain begins in the east with low rolling hills and wide stream valleys, known as the West Tennessee Highlands, and gradually levels out to the west. It ends at steep loess bluffs overlooking the Mississippi embayment , the westernmost physiographic division of Tennessee, which is part of the larger Mississippi Alluvial Plain . This flat 10 to 14 miles (16 to 23 km) wide strip is commonly known as the Mississippi Bottoms, and contains lowlands, floodplains , and swamps . Tennessee is drained by three major rivers , the Tennessee , Cumberland , and Mississippi . The Tennessee River begins at the juncture of the Holston and French Broad rivers in Knoxville, flows southwest to Chattanooga, and exits into Alabama before reemerging in the western part of the state and flowing north into Kentucky. Its major tributaries include the Clinch , Little Tennessee , Hiwassee , Sequatchie , Elk , Beech , Buffalo , Duck , and Big Sandy rivers. The Cumberland River flows through the north-central part of the state, emerging in the northeastern Highland Rim, passing through Nashville, turning northwest to Clarksville, and entering Kentucky east of the Tennessee River. Its principal branches in Tennessee are the Obey , Caney Fork , Stones , Harpeth , and Red rivers. The Mississippi River drains nearly all of West Tennessee. Its tributaries are the Obion , Forked Deer , Hatchie , Loosahatchie , and Wolf rivers. The Tennessee Valley Authority (TVA) and the U.S. Army Corps of Engineers operate many hydroelectric dams on the Tennessee and Cumberland rivers and their tributaries, which form large reservoirs throughout the state. About half the state's land area is in the Tennessee Valley drainage basin of the Tennessee River. The Cumberland River basin covers the northern half of Middle Tennessee and a small portion of East Tennessee. A small part of north-central Tennessee is in the Green River watershed. All three of these basins are tributaries of the Ohio River watershed. Most of West Tennessee is in the Lower Mississippi River watershed. The entirety of the state is in the Mississippi River watershed , except for a small sliver near the southeastern corner traversed by the Conasauga River , which is part of the Mobile Bay watershed. Tennessee is within a temperate deciduous forest biome commonly known as the Eastern Deciduous Forest. It has eight ecoregions : the Blue Ridge , Ridge and Valley , Central Appalachian, Southwestern Appalachian, Interior Low Plateaus , Southeastern Plains, Mississippi Valley Loess Plains, and Mississippi Alluvial Plain regions. Tennessee is the most biodiverse inland state, the Great Smoky Mountains National Park is the most biodiverse national park, and the Duck River is the most biologically diverse waterway in North America. The Nashville Basin is renowned for its diversity of flora and fauna. Tennessee is home to 340 species of birds, 325 freshwater fish species, 89 mammals, 77 amphibians, and 61 reptiles. Forests cover about 52% of Tennessee's land area, with oak–hickory the dominant type. Appalachian oak–pine and cove hardwood forests are found in the Blue Ridge Mountains and Cumberland Plateau, and bottomland hardwood forests are common throughout the Gulf Coastal Plain. Pine forests are also found throughout the state. The Southern Appalachian spruce–fir forest in the highest elevations of the Blue Ridge Mountains is considered the second-most endangered ecosystem in the country. Some of the last remaining large American chestnut trees grow in the Nashville Basin and are being used to help breed blight -resistant trees. Middle Tennessee is home to many unusual and rare ecosystems known as cedar glades , which occur in areas with shallow limestone bedrock that is largely barren of overlying soil and contain many endemic plant species. Common mammals found throughout Tennessee include white-tailed deer , red and gray foxes , coyotes , raccoons , opossums , wild turkeys , rabbits , and squirrels . Black bears are found in the Blue Ridge Mountains and on the Cumberland Plateau. Tennessee has the third-highest number of amphibian species, with the Great Smoky Mountains home to the most salamander species in the world. The state ranks second in the nation for the diversity of its freshwater fish species. Most of Tennessee has a humid subtropical climate , with the exception of some of the higher elevations in the Appalachians, which are classified as a cooler mountain temperate or humid continental climate . The Gulf of Mexico is the dominant factor in Tennessee's climate, with winds from the south responsible for most of the state's annual precipitation. Generally, the state has hot summers and mild to cool winters with generous precipitation throughout the year. The highest average monthly precipitation usually occurs between December and April. The driest months, on average, are August to October. The state receives an average of 50 inches (130 cm) of precipitation annually. Snowfall ranges from 5 inches (13 cm) in West Tennessee to over 80 inches (200 cm) in East Tennessee's highest mountains. Summers are generally hot and humid, with most of the state averaging a high of around 90 °F (32 °C) . Winters tend to be mild to cool, decreasing in temperature at higher elevations. For areas outside the highest mountains, the average overnight lows are generally near freezing. The highest recorded temperature was 113 °F (45 °C) at Perryville on August 9, 1930, while the lowest recorded temperature was −32 °F (−36 °C) at Mountain City on December 30, 1917. While Tennessee is far enough from the coast to avoid any direct impact from a hurricane, its location makes it susceptible to the remnants of tropical cyclones , which weaken over land and can cause significant rainfall. The state annually averages about 50 days of thunderstorms, which can be severe with large hail and damaging winds. Tornadoes are possible throughout the state, with West and Middle Tennessee the most vulnerable. The state averages 15 tornadoes annually. They can be severe, and the state leads the nation in the percentage of total tornadoes that have fatalities. Winter storms such as in 1993 and 2021 occur occasionally, and ice storms are fairly common. Fog is a persistent problem in some areas, especially in East Tennessee. The southwestern Blue Ridge Mountains lie within Tennessee's eastern edge, and are divided into several subranges, namely the Great Smoky Mountains , Bald Mountains , Unicoi Mountains , Unaka Mountains , and Iron Mountains . These mountains, which average 5,000 feet (1,500 m) above sea level in Tennessee, contain some of the highest elevations in eastern North America. The state's border with North Carolina roughly follows the highest peaks of this range, including Clingmans Dome. Most of the Blue Ridge area is protected by the Cherokee National Forest , the Great Smoky Mountains National Park , and several federal wilderness areas and state parks. The Appalachian Trail roughly follows the North Carolina state line before shifting westward into Tennessee. Stretching west from the Blue Ridge Mountains for about 55 miles (89 km) are the Ridge-and-Valley Appalachians , also known as the Tennessee Valley [lower-alpha 3] or Great Valley of East Tennessee. This area consists of linear parallel ridges separated by valleys that trend northeast to southwest, the general direction of the entire Appalachian range. Most of these ridges are low, but some of the higher ones are commonly called mountains. Numerous tributaries join to form the Tennessee River in the Ridge and Valley region. The Cumberland Plateau rises to the west of the Tennessee Valley, with an average elevation of 2,000 feet (610 m) . This landform is part of the larger Appalachian Plateau and consists mostly of flat-topped tablelands . The plateau's eastern edge is relatively distinct, but the western escarpment is irregular, containing several long, crooked stream valleys separated by rocky cliffs with numerous waterfalls . The Cumberland Mountains , with peaks above 3,500 feet (1,100 m) , comprise the northeastern part of the Appalachian Plateau in Tennessee, and the southeastern part of the Cumberland Plateau is divided by the Sequatchie Valley . The Cumberland Trail traverses the eastern escarpment of the Cumberland Plateau and Cumberland Mountains. West of the Cumberland Plateau is the Highland Rim , an elevated plain that surrounds the Nashville Basin , a geological dome . Both of these physiographic provinces are part of the Interior Low Plateaus of the larger Interior Plains . The Highland Rim is Tennessee's largest geographic region, and is often split into eastern and western halves. The Eastern Highland Rim is characterized by relatively level plains dotted by rolling hills, and the Western Highland Rim and western Nashville Basin are covered with uneven rounded knobs with steep ravines separated by meandering streams. The Nashville Basin has rich, fertile farmland, and porous limestone bedrock very close to the surface underlies both the Nashville Basin and Eastern Highland Rim. This results in karst that forms numerous caves, sinkholes, depressions, and underground streams. West of the Highland Rim is the Western Tennessee Valley , which consists of about 10 miles (16 km) in width of hilly land along the banks of the Tennessee River. West of this is the Gulf Coastal Plain , a broad feature that begins at the Gulf of Mexico and extends northward into southern Illinois . The plain begins in the east with low rolling hills and wide stream valleys, known as the West Tennessee Highlands, and gradually levels out to the west. It ends at steep loess bluffs overlooking the Mississippi embayment , the westernmost physiographic division of Tennessee, which is part of the larger Mississippi Alluvial Plain . This flat 10 to 14 miles (16 to 23 km) wide strip is commonly known as the Mississippi Bottoms, and contains lowlands, floodplains , and swamps . Tennessee is drained by three major rivers , the Tennessee , Cumberland , and Mississippi . The Tennessee River begins at the juncture of the Holston and French Broad rivers in Knoxville, flows southwest to Chattanooga, and exits into Alabama before reemerging in the western part of the state and flowing north into Kentucky. Its major tributaries include the Clinch , Little Tennessee , Hiwassee , Sequatchie , Elk , Beech , Buffalo , Duck , and Big Sandy rivers. The Cumberland River flows through the north-central part of the state, emerging in the northeastern Highland Rim, passing through Nashville, turning northwest to Clarksville, and entering Kentucky east of the Tennessee River. Its principal branches in Tennessee are the Obey , Caney Fork , Stones , Harpeth , and Red rivers. The Mississippi River drains nearly all of West Tennessee. Its tributaries are the Obion , Forked Deer , Hatchie , Loosahatchie , and Wolf rivers. The Tennessee Valley Authority (TVA) and the U.S. Army Corps of Engineers operate many hydroelectric dams on the Tennessee and Cumberland rivers and their tributaries, which form large reservoirs throughout the state. About half the state's land area is in the Tennessee Valley drainage basin of the Tennessee River. The Cumberland River basin covers the northern half of Middle Tennessee and a small portion of East Tennessee. A small part of north-central Tennessee is in the Green River watershed. All three of these basins are tributaries of the Ohio River watershed. Most of West Tennessee is in the Lower Mississippi River watershed. The entirety of the state is in the Mississippi River watershed , except for a small sliver near the southeastern corner traversed by the Conasauga River , which is part of the Mobile Bay watershed. Tennessee is within a temperate deciduous forest biome commonly known as the Eastern Deciduous Forest. It has eight ecoregions : the Blue Ridge , Ridge and Valley , Central Appalachian, Southwestern Appalachian, Interior Low Plateaus , Southeastern Plains, Mississippi Valley Loess Plains, and Mississippi Alluvial Plain regions. Tennessee is the most biodiverse inland state, the Great Smoky Mountains National Park is the most biodiverse national park, and the Duck River is the most biologically diverse waterway in North America. The Nashville Basin is renowned for its diversity of flora and fauna. Tennessee is home to 340 species of birds, 325 freshwater fish species, 89 mammals, 77 amphibians, and 61 reptiles. Forests cover about 52% of Tennessee's land area, with oak–hickory the dominant type. Appalachian oak–pine and cove hardwood forests are found in the Blue Ridge Mountains and Cumberland Plateau, and bottomland hardwood forests are common throughout the Gulf Coastal Plain. Pine forests are also found throughout the state. The Southern Appalachian spruce–fir forest in the highest elevations of the Blue Ridge Mountains is considered the second-most endangered ecosystem in the country. Some of the last remaining large American chestnut trees grow in the Nashville Basin and are being used to help breed blight -resistant trees. Middle Tennessee is home to many unusual and rare ecosystems known as cedar glades , which occur in areas with shallow limestone bedrock that is largely barren of overlying soil and contain many endemic plant species. Common mammals found throughout Tennessee include white-tailed deer , red and gray foxes , coyotes , raccoons , opossums , wild turkeys , rabbits , and squirrels . Black bears are found in the Blue Ridge Mountains and on the Cumberland Plateau. Tennessee has the third-highest number of amphibian species, with the Great Smoky Mountains home to the most salamander species in the world. The state ranks second in the nation for the diversity of its freshwater fish species. Most of Tennessee has a humid subtropical climate , with the exception of some of the higher elevations in the Appalachians, which are classified as a cooler mountain temperate or humid continental climate . The Gulf of Mexico is the dominant factor in Tennessee's climate, with winds from the south responsible for most of the state's annual precipitation. Generally, the state has hot summers and mild to cool winters with generous precipitation throughout the year. The highest average monthly precipitation usually occurs between December and April. The driest months, on average, are August to October. The state receives an average of 50 inches (130 cm) of precipitation annually. Snowfall ranges from 5 inches (13 cm) in West Tennessee to over 80 inches (200 cm) in East Tennessee's highest mountains. Summers are generally hot and humid, with most of the state averaging a high of around 90 °F (32 °C) . Winters tend to be mild to cool, decreasing in temperature at higher elevations. For areas outside the highest mountains, the average overnight lows are generally near freezing. The highest recorded temperature was 113 °F (45 °C) at Perryville on August 9, 1930, while the lowest recorded temperature was −32 °F (−36 °C) at Mountain City on December 30, 1917. While Tennessee is far enough from the coast to avoid any direct impact from a hurricane, its location makes it susceptible to the remnants of tropical cyclones , which weaken over land and can cause significant rainfall. The state annually averages about 50 days of thunderstorms, which can be severe with large hail and damaging winds. Tornadoes are possible throughout the state, with West and Middle Tennessee the most vulnerable. The state averages 15 tornadoes annually. They can be severe, and the state leads the nation in the percentage of total tornadoes that have fatalities. Winter storms such as in 1993 and 2021 occur occasionally, and ice storms are fairly common. Fog is a persistent problem in some areas, especially in East Tennessee. Tennessee is divided into 95 counties , each of which has a county seat . The state has 340 municipalities in total. The Office of Management and Budget designates ten metropolitan areas in Tennessee, four of which extend into neighboring states. Nashville is Tennessee's capital and largest city, with nearly 700,000 residents. Its 13-county metropolitan area has been the state's largest since the early 1990s and is one of the nation's fastest-growing metropolitan areas, with about 2 million residents. Memphis, with more than 630,000 inhabitants, was the state's largest city until 2016, when Nashville surpassed it. It is in Shelby County , Tennessee's largest county in both population and land area. Knoxville , with about 190,000 inhabitants, and Chattanooga , with about 180,000 residents, are the third- and fourth-largest cities, respectively. Clarksville is a significant population center, with about 170,000 residents. Murfreesboro is the sixth-largest city and Nashville's largest suburb , with more than 150,000 residents. In addition to the major cities, the Tri-Cities of Kingsport , Bristol , and Johnson City are considered the sixth major population center. The 2020 United States census reported Tennessee's population at 6,910,840, an increase of 564,735, or 8.90%, since the 2010 census . Between 2010 and 2019, the state received a natural increase of 143,253 (744,274 births minus 601,021 deaths), and an increase from net migration of 338,428 people into the state. Immigration from outside the U.S. resulted in a net increase of 79,086, and migration within the country produced a net increase of 259,342. Tennessee's center of population is in Murfreesboro in Rutherford County . According to the 2020 census, 5.7% of Tennessee's population were under age 5, 22.1% were under 18, and 17.1% were 65 or older. In recent years, Tennessee has been a top source of domestic migration, receiving an influx of people relocating from places such as California , the Northeast , and the Midwest due to the low cost of living and booming employment opportunities. In 2019, about 5.5% of Tennessee's population was foreign-born. Of the foreign-born population, approximately 42.7% were naturalized citizens and 57.3% non-citizens. The foreign-born population consisted of approximately 49.9% from Latin America , 27.1% from Asia , 11.9% from Europe , 7.7% from Africa , 2.7% from Northern America , and 0.6% from Oceania . In 2018, The top countries of origin for Tennessee's immigrants were Mexico , India , Honduras , China and Egypt . With the exception of a slump in the 1980s, Tennessee has been one of the fastest-growing states in the nation since 1970, benefiting from the larger Sun Belt phenomenon. The state has been a top destination for people relocating from Northeastern and Midwestern states. This time period has seen the birth of new economic sectors in the state and has positioned the Nashville and Clarksville metropolitan areas as two of the fastest-growing regions in the country. According to HUD 's 2022 Annual Homeless Assessment Report , there were an estimated 10,567 homeless people in Tennessee. Non-Hispanic White 50–60% 60–70% 70–80% 80–90% 90%+ Black or African American 50–60% In 2020, 6.9% of the total population was of Hispanic or Latino origin (of any race), up from 4.6% in 2010. Between 2000 and 2010, Tennessee's Hispanic population grew by 134.2%, the third-highest rate of any state. In 2020, Non-Hispanic or Latino Whites were 70.9% of the population, compared to 57.7% of the population nationwide. In 2010, the five most common self-reported ethnic groups in the state were American (26.5%), English (8.2%), Irish (6.6%), German (5.5%), and Scotch-Irish (2.7%). Most Tennesseans who self-identify as having American ancestry are of English and Scotch-Irish ancestry. An estimated 21–24% of Tennesseans are of predominantly English ancestry. Since colonization, Tennessee has always been predominantly Christian . About 81% of the population identifies as Christian, with Protestants making up 73% of the population. Of the Protestants in the state, Evangelical Protestants compose 52% of the population, Mainline Protestants 13%, and Historically Black Protestants 8%. Roman Catholics make up 6%, Mormons 1%, and Orthodox Christians less than 1%. The largest denominations by number of adherents are the Southern Baptist Convention , the United Methodist Church , the Roman Catholic Church, and the Churches of Christ . Muslims and Jews each make up about 1% of the population, and adherents of other religions make up about 3% of the population. About 14% of Tennesseans are non-religious , with 11% identifying as "Nothing in particular", 3% as agnostics , and 1% as atheists . Tennessee is included in most definitions of the Bible Belt , and is ranked as one of the nation's most religious states . Several Protestant denominations have their headquarters in Tennessee, including the Southern Baptist Convention and National Baptist Convention (in Nashville); the Church of God in Christ and the Cumberland Presbyterian Church (in Memphis); and the Church of God and the Church of God of Prophecy (in Cleveland ); and the National Association of Free Will Baptists (in Antioch ). Nashville has publishing houses of several denominations. Non-Hispanic White 50–60% 60–70% 70–80% 80–90% 90%+ Black or African American 50–60% In 2020, 6.9% of the total population was of Hispanic or Latino origin (of any race), up from 4.6% in 2010. Between 2000 and 2010, Tennessee's Hispanic population grew by 134.2%, the third-highest rate of any state. In 2020, Non-Hispanic or Latino Whites were 70.9% of the population, compared to 57.7% of the population nationwide. In 2010, the five most common self-reported ethnic groups in the state were American (26.5%), English (8.2%), Irish (6.6%), German (5.5%), and Scotch-Irish (2.7%). Most Tennesseans who self-identify as having American ancestry are of English and Scotch-Irish ancestry. An estimated 21–24% of Tennesseans are of predominantly English ancestry. Since colonization, Tennessee has always been predominantly Christian . About 81% of the population identifies as Christian, with Protestants making up 73% of the population. Of the Protestants in the state, Evangelical Protestants compose 52% of the population, Mainline Protestants 13%, and Historically Black Protestants 8%. Roman Catholics make up 6%, Mormons 1%, and Orthodox Christians less than 1%. The largest denominations by number of adherents are the Southern Baptist Convention , the United Methodist Church , the Roman Catholic Church, and the Churches of Christ . Muslims and Jews each make up about 1% of the population, and adherents of other religions make up about 3% of the population. About 14% of Tennesseans are non-religious , with 11% identifying as "Nothing in particular", 3% as agnostics , and 1% as atheists . Tennessee is included in most definitions of the Bible Belt , and is ranked as one of the nation's most religious states . Several Protestant denominations have their headquarters in Tennessee, including the Southern Baptist Convention and National Baptist Convention (in Nashville); the Church of God in Christ and the Cumberland Presbyterian Church (in Memphis); and the Church of God and the Church of God of Prophecy (in Cleveland ); and the National Association of Free Will Baptists (in Antioch ). Nashville has publishing houses of several denominations. As of 2021, Tennessee had a gross state product of $418.3 billion. In 2020, the state's per capita personal income was $30,869. The median household income was $54,833. About 13.6% percent of the population was below the poverty line . In 2019, the state reported a total employment of 2,724,545 and a total number of 139,760 employer establishments. Tennessee is a right-to-work state, like most of its Southern neighbors. Unionization has historically been low and continues to decline, as in most of the U.S. Tennessee has a reputation as a low-tax state and is usually ranked as one of the five states with the lowest tax burden on residents. Despite being low-tax, it is ranked third among U.S. states for fiscal health. It is one of nine states that do not have a general income tax ; the sales tax is the primary means of funding the government. The Hall income tax was imposed on most dividends and interest at a rate of 6% but was completely phased out by 2021. The first $1,250 of individual income and $2,500 of joint income was exempt from this tax. Property taxes are the primary source of revenue for local governments. The state's sales and use tax rate for most items is 7%, the second-highest in the nation, along with Mississippi, Rhode Island, New Jersey, and Indiana. Food is taxed at 4%, but candy, dietary supplements, and prepared foods are taxed at 7%. Local sales taxes are collected in most jurisdictions at rates varying from 1.5% to 2.75%, bringing the total sales tax between 8.5% and 9.75%. The average combined rate is about 9.5%, the nation's highest average sales tax. Intangible property tax is assessed on the shares of stockholders of any loan, investment, insurance, or for-profit cemetery companies. The assessment ratio is 40% of the value times the jurisdiction's tax rate. Since 2016, Tennessee has had no inheritance tax. Tennessee has the eighth-most farms in the nation , which cover more than 40% of its land area and have an average size of about 155 acres (0.63 km 2 ) . Cash receipts for crops and livestock have an estimated annual value of $3.5 billion, and the agriculture sector has an estimated annual impact of $81 billion on the state's economy. Beef cattle is the state's largest agricultural commodity, followed by broilers and poultry . Tennessee ranks 12th in the nation for the number of cattle, with more than half of its farmland dedicated to cattle grazing. Soybeans and corn are the state's first and second-most common crops, respectively, and are most heavily grown in West and Middle Tennessee, especially the northwestern corner of the state. Tennessee ranks seventh in the nation in cotton production, most of which is grown in the fertile soils of central West Tennessee. The state ranks fourth nationwide in the production of tobacco , which is predominantly grown in the Ridge-and-Valley region of East Tennessee. Tennessee farmers are also known worldwide for their cultivation of tomatoes and horticultural plants. Other important cash crops in the state include hay , wheat , eggs , and snap beans . The Nashville Basin is a top equestrian region, due to soils that produce grass favored by horses. The Tennessee Walking Horse , first bred in the region in the late 18th century, is one of the world's most recognized horse breeds. Tennessee also ranks second nationwide for mule breeding and the production of goat meat . The state's timber industry is largely concentrated on the Cumberland Plateau and ranks as one of the top producers of hardwood nationwide. Until World War II , Tennessee, like most Southern states, remained predominantly agrarian. Chattanooga became one of the first industrial cities in the south in the decades after the Civil War , when many factories, including iron foundries, steel mills, and textile mills were constructed there. But most of Tennessee's industrial growth began with the federal investments in the Tennessee Valley Authority (TVA) and the Manhattan Project in the 1930s and 1940s. The state's industrial and manufacturing sector continued to expand in the succeeding decades, and Tennessee is now home to more than 2,400 advanced manufacturing establishments, which produce a total of more than $29 billion worth of goods annually. The automotive industry is Tennessee's largest manufacturing sector and one of the nation's largest. Nissan 's assembly plant in Smyrna is the largest automotive assembly plant in North America. Two other automakers have assembly plants in Tennessee: General Motors in Spring Hill and Volkswagen in Chattanooga . Ford is constructing an assembly plant in Stanton that is expected to be operational in 2025. In addition, the state contains more than 900 automotive suppliers. Nissan and Mitsubishi Motors have their North American corporate headquarters in Franklin . The state is also one of the top producers of food and drink products , its second-largest manufacturing sector. A number of well-known brands originated in Tennessee, and even more are produced there. Tennessee also ranks as one of the largest producers of chemicals . Chemical products manufactured in Tennessee include industrial chemicals , paints , pharmaceuticals , plastic resins , and soaps and hygiene products . Additional important products manufactured in Tennessee include fabricated metal products, electrical equipment , consumer electronics and electrical appliances , and nonelectrical machinery. Tennessee's commercial sector is dominated by a wide variety of companies, but its largest service industries include health care, transportation, music and entertainment, banking, and finance. Large corporations with headquarters in Tennessee include FedEx , AutoZone , International Paper , and First Horizon Corporation , all based in Memphis; Pilot Corporation and Regal Entertainment Group in Knoxville; Hospital Corporation of America based in Nashville; Unum in Chattanooga; Acadia Senior Living and Community Health Systems in Franklin; Eastman Chemical headquartered in Kingsport; Dollar General in Goodlettsville, and LifePoint Health, Tractor Supply Company , and Delek US in Brentwood. Since the 1990s, the geographical area between Oak Ridge and Knoxville has been known as the Tennessee Technology Corridor, with more than 500 high-tech firms in the region. The research and development industry in Tennessee is also one of the largest employment sectors, mainly due to the prominence of Oak Ridge National Laboratory (ORNL) and the Y-12 National Security Complex in the city of Oak Ridge . ORNL conducts scientific research in materials science , nuclear physics , energy, high-performance computing , systems biology , and national security , and is the largest national laboratory in the Department of Energy (DOE) system by size. The technology sector is also a rapidly growing industry in Middle Tennessee, particularly in the Nashville metropolitan area. Tennessee's electric utilities are regulated monopolies, as in many other states. The Tennessee Valley Authority (TVA) owns over 90% of the state's generating capacity. Nuclear power is Tennessee's largest source of electricity generation, producing about 43.4% of its power in 2021. The same year, 22.4% of the power was produced from coal , 17.8% from natural gas , 15.8% from hydroelectricity , and 1.3% from other renewables . About 59.7% of the electricity generated in Tennessee produces no greenhouse gas emissions . Tennessee is home to the first nuclear power reactor in the U.S. to begin operation in the 21st century, which is at the Watts Bar Nuclear Plant in Rhea County . Tennessee was also an early leader in hydroelectric power, and today is the third-largest hydroelectric power-producing state east of the Rocky Mountains . Tennessee is a net consumer of electricity, receiving power from other TVA facilities in neighboring states. Tennessee has very little petroleum and natural gas reserves, but is home to one oil refinery, in Memphis. Bituminous coal is mined in small quantities in the Cumberland Plateau and Cumberland Mountains. There are sizable reserves of lignite coal in West Tennessee that remain untapped. Coal production in Tennessee peaked in 1972, and today less than 0.1% of coal in the U.S. comes from Tennessee. Tennessee is the nation's leading producer of ball clay . Other major mineral products produced in Tennessee include sand , gravel , crushed stone , Portland cement , marble , sandstone , common clay , lime , and zinc . The Copper Basin , in Tennessee's southeastern corner in Polk County, was one of the nation's most productive copper mining districts between the 1840s and 1980s, and supplied about 90% of the copper the Confederacy used during the Civil War. Mining activities in the basin resulted in a major environmental disaster, which left the surrounding landscape barren for more than a century. Iron ore was another major mineral mined in Tennessee until the early 20th century. Tennessee was also a top producer of phosphate until the early 1990s. Tennessee is the 11th-most visited state in the nation, receiving a record of 126 million tourists in 2019. Its top tourist attraction is the Great Smoky Mountains National Park , the most visited national park in the U.S., with more than 14 million visitors annually. The park anchors a large tourism industry based primarily in nearby Gatlinburg and Pigeon Forge , which includes Dollywood , the most visited ticketed attraction in Tennessee. Attractions related to Tennessee's musical heritage are spread throughout the state. Other top attractions include the Tennessee State Museum and Parthenon in Nashville; the National Civil Rights Museum and Graceland in Memphis; Lookout Mountain , the Chattanooga Choo-Choo Hotel , Ruby Falls , and the Tennessee Aquarium in Chattanooga; the American Museum of Science and Energy in Oak Ridge, the Bristol Motor Speedway , Jack Daniel's Distillery in Lynchburg, and the Hiwassee and Ocoee rivers in Polk County. The National Park Service preserves four Civil War battlefields in Tennessee: Chickamauga and Chattanooga National Military Park , Stones River National Battlefield , Shiloh National Military Park , and Fort Donelson National Battlefield . The NPS also operates Big South Fork National River and Recreation Area , Cumberland Gap National Historical Park , Overmountain Victory National Historic Trail , Trail of Tears National Historic Trail , Andrew Johnson National Historic Site , and the Manhattan Project National Historical Park . Tennessee is home to eight National Scenic Byways , including the Natchez Trace Parkway , the East Tennessee Crossing Byway , the Great River Road , the Norris Freeway , Cumberland National Scenic Byway , Sequatchie Valley Scenic Byway , The Trace , and the Cherohala Skyway . Tennessee maintains 56 state parks, covering 132,000 acres (530 km 2 ) . Many reservoirs created by TVA dams have also generated water-based tourist attractions. Tennessee has a reputation as a low-tax state and is usually ranked as one of the five states with the lowest tax burden on residents. Despite being low-tax, it is ranked third among U.S. states for fiscal health. It is one of nine states that do not have a general income tax ; the sales tax is the primary means of funding the government. The Hall income tax was imposed on most dividends and interest at a rate of 6% but was completely phased out by 2021. The first $1,250 of individual income and $2,500 of joint income was exempt from this tax. Property taxes are the primary source of revenue for local governments. The state's sales and use tax rate for most items is 7%, the second-highest in the nation, along with Mississippi, Rhode Island, New Jersey, and Indiana. Food is taxed at 4%, but candy, dietary supplements, and prepared foods are taxed at 7%. Local sales taxes are collected in most jurisdictions at rates varying from 1.5% to 2.75%, bringing the total sales tax between 8.5% and 9.75%. The average combined rate is about 9.5%, the nation's highest average sales tax. Intangible property tax is assessed on the shares of stockholders of any loan, investment, insurance, or for-profit cemetery companies. The assessment ratio is 40% of the value times the jurisdiction's tax rate. Since 2016, Tennessee has had no inheritance tax. Tennessee has the eighth-most farms in the nation , which cover more than 40% of its land area and have an average size of about 155 acres (0.63 km 2 ) . Cash receipts for crops and livestock have an estimated annual value of $3.5 billion, and the agriculture sector has an estimated annual impact of $81 billion on the state's economy. Beef cattle is the state's largest agricultural commodity, followed by broilers and poultry . Tennessee ranks 12th in the nation for the number of cattle, with more than half of its farmland dedicated to cattle grazing. Soybeans and corn are the state's first and second-most common crops, respectively, and are most heavily grown in West and Middle Tennessee, especially the northwestern corner of the state. Tennessee ranks seventh in the nation in cotton production, most of which is grown in the fertile soils of central West Tennessee. The state ranks fourth nationwide in the production of tobacco , which is predominantly grown in the Ridge-and-Valley region of East Tennessee. Tennessee farmers are also known worldwide for their cultivation of tomatoes and horticultural plants. Other important cash crops in the state include hay , wheat , eggs , and snap beans . The Nashville Basin is a top equestrian region, due to soils that produce grass favored by horses. The Tennessee Walking Horse , first bred in the region in the late 18th century, is one of the world's most recognized horse breeds. Tennessee also ranks second nationwide for mule breeding and the production of goat meat . The state's timber industry is largely concentrated on the Cumberland Plateau and ranks as one of the top producers of hardwood nationwide. Until World War II , Tennessee, like most Southern states, remained predominantly agrarian. Chattanooga became one of the first industrial cities in the south in the decades after the Civil War , when many factories, including iron foundries, steel mills, and textile mills were constructed there. But most of Tennessee's industrial growth began with the federal investments in the Tennessee Valley Authority (TVA) and the Manhattan Project in the 1930s and 1940s. The state's industrial and manufacturing sector continued to expand in the succeeding decades, and Tennessee is now home to more than 2,400 advanced manufacturing establishments, which produce a total of more than $29 billion worth of goods annually. The automotive industry is Tennessee's largest manufacturing sector and one of the nation's largest. Nissan 's assembly plant in Smyrna is the largest automotive assembly plant in North America. Two other automakers have assembly plants in Tennessee: General Motors in Spring Hill and Volkswagen in Chattanooga . Ford is constructing an assembly plant in Stanton that is expected to be operational in 2025. In addition, the state contains more than 900 automotive suppliers. Nissan and Mitsubishi Motors have their North American corporate headquarters in Franklin . The state is also one of the top producers of food and drink products , its second-largest manufacturing sector. A number of well-known brands originated in Tennessee, and even more are produced there. Tennessee also ranks as one of the largest producers of chemicals . Chemical products manufactured in Tennessee include industrial chemicals , paints , pharmaceuticals , plastic resins , and soaps and hygiene products . Additional important products manufactured in Tennessee include fabricated metal products, electrical equipment , consumer electronics and electrical appliances , and nonelectrical machinery. Tennessee's commercial sector is dominated by a wide variety of companies, but its largest service industries include health care, transportation, music and entertainment, banking, and finance. Large corporations with headquarters in Tennessee include FedEx , AutoZone , International Paper , and First Horizon Corporation , all based in Memphis; Pilot Corporation and Regal Entertainment Group in Knoxville; Hospital Corporation of America based in Nashville; Unum in Chattanooga; Acadia Senior Living and Community Health Systems in Franklin; Eastman Chemical headquartered in Kingsport; Dollar General in Goodlettsville, and LifePoint Health, Tractor Supply Company , and Delek US in Brentwood. Since the 1990s, the geographical area between Oak Ridge and Knoxville has been known as the Tennessee Technology Corridor, with more than 500 high-tech firms in the region. The research and development industry in Tennessee is also one of the largest employment sectors, mainly due to the prominence of Oak Ridge National Laboratory (ORNL) and the Y-12 National Security Complex in the city of Oak Ridge . ORNL conducts scientific research in materials science , nuclear physics , energy, high-performance computing , systems biology , and national security , and is the largest national laboratory in the Department of Energy (DOE) system by size. The technology sector is also a rapidly growing industry in Middle Tennessee, particularly in the Nashville metropolitan area. Tennessee's electric utilities are regulated monopolies, as in many other states. The Tennessee Valley Authority (TVA) owns over 90% of the state's generating capacity. Nuclear power is Tennessee's largest source of electricity generation, producing about 43.4% of its power in 2021. The same year, 22.4% of the power was produced from coal , 17.8% from natural gas , 15.8% from hydroelectricity , and 1.3% from other renewables . About 59.7% of the electricity generated in Tennessee produces no greenhouse gas emissions . Tennessee is home to the first nuclear power reactor in the U.S. to begin operation in the 21st century, which is at the Watts Bar Nuclear Plant in Rhea County . Tennessee was also an early leader in hydroelectric power, and today is the third-largest hydroelectric power-producing state east of the Rocky Mountains . Tennessee is a net consumer of electricity, receiving power from other TVA facilities in neighboring states. Tennessee has very little petroleum and natural gas reserves, but is home to one oil refinery, in Memphis. Bituminous coal is mined in small quantities in the Cumberland Plateau and Cumberland Mountains. There are sizable reserves of lignite coal in West Tennessee that remain untapped. Coal production in Tennessee peaked in 1972, and today less than 0.1% of coal in the U.S. comes from Tennessee. Tennessee is the nation's leading producer of ball clay . Other major mineral products produced in Tennessee include sand , gravel , crushed stone , Portland cement , marble , sandstone , common clay , lime , and zinc . The Copper Basin , in Tennessee's southeastern corner in Polk County, was one of the nation's most productive copper mining districts between the 1840s and 1980s, and supplied about 90% of the copper the Confederacy used during the Civil War. Mining activities in the basin resulted in a major environmental disaster, which left the surrounding landscape barren for more than a century. Iron ore was another major mineral mined in Tennessee until the early 20th century. Tennessee was also a top producer of phosphate until the early 1990s. Tennessee is the 11th-most visited state in the nation, receiving a record of 126 million tourists in 2019. Its top tourist attraction is the Great Smoky Mountains National Park , the most visited national park in the U.S., with more than 14 million visitors annually. The park anchors a large tourism industry based primarily in nearby Gatlinburg and Pigeon Forge , which includes Dollywood , the most visited ticketed attraction in Tennessee. Attractions related to Tennessee's musical heritage are spread throughout the state. Other top attractions include the Tennessee State Museum and Parthenon in Nashville; the National Civil Rights Museum and Graceland in Memphis; Lookout Mountain , the Chattanooga Choo-Choo Hotel , Ruby Falls , and the Tennessee Aquarium in Chattanooga; the American Museum of Science and Energy in Oak Ridge, the Bristol Motor Speedway , Jack Daniel's Distillery in Lynchburg, and the Hiwassee and Ocoee rivers in Polk County. The National Park Service preserves four Civil War battlefields in Tennessee: Chickamauga and Chattanooga National Military Park , Stones River National Battlefield , Shiloh National Military Park , and Fort Donelson National Battlefield . The NPS also operates Big South Fork National River and Recreation Area , Cumberland Gap National Historical Park , Overmountain Victory National Historic Trail , Trail of Tears National Historic Trail , Andrew Johnson National Historic Site , and the Manhattan Project National Historical Park . Tennessee is home to eight National Scenic Byways , including the Natchez Trace Parkway , the East Tennessee Crossing Byway , the Great River Road , the Norris Freeway , Cumberland National Scenic Byway , Sequatchie Valley Scenic Byway , The Trace , and the Cherohala Skyway . Tennessee maintains 56 state parks, covering 132,000 acres (530 km 2 ) . Many reservoirs created by TVA dams have also generated water-based tourist attractions. A culturally diverse state, Tennessee blends Appalachian and Southern flavors, which originate from its English, Scotch-Irish, and African roots, and has evolved as it has grown. Its Grand Divisions also manifest into distinct cultural regions, with East Tennessee commonly associated with Southern Appalachia, and Middle and West Tennessee commonly associated with Upland Southern culture . Parts of West Tennessee, especially Memphis, are sometimes considered part of the Deep South . The Tennessee State Museum in Nashville chronicles the state's history and culture. Tennessee is perhaps best known culturally for its musical heritage and contributions to the development of many forms of popular music . Notable authors with ties to Tennessee include Cormac McCarthy , Peter Taylor , James Agee , Francis Hodgson Burnett , Thomas S. Stribling , Ida B. Wells , Nikki Giovanni , Shelby Foote , Ann Patchett , Ishmael Reed , and Randall Jarrell . The state's well-known contributions to Southern cuisine include Memphis-style barbecue , Nashville hot chicken , and Tennessee whiskey . Tennessee has played a critical role in the development of many forms of American popular music, including blues , country , rock and roll , rockabilly , soul , bluegrass , Contemporary Christian , and gospel . Many consider Memphis's Beale Street the epicenter of the blues, with musicians such as W. C. Handy performing in its clubs as early as 1909. Memphis was historically home to Sun Records , where musicians such as Elvis Presley , Johnny Cash , Carl Perkins , Jerry Lee Lewis , Roy Orbison , and Charlie Rich began their recording careers, and where rock and roll took shape in the 1950s. Stax Records in Memphis became one of the most important labels for soul artists in the late 1950s and 1960s, and a subgenre known as Memphis soul emerged. The 1927 Victor recording sessions in Bristol generally mark the beginning of the country music genre and the rise of the Grand Ole Opry in the 1930s helped make Nashville the center of the country music recording industry. Nashville became known as "Music City", and the Grand Ole Opry remains the nation's longest-running radio show. Many museums and historic sites recognize Tennessee's role in nurturing various forms of popular music, including Sun Studio , Memphis Rock N' Soul Museum , Stax Museum of American Soul Music , and Blues Hall of Fame in Memphis, the Ryman Auditorium , Country Music Hall of Fame and Museum , Musicians Hall of Fame and Museum , National Museum of African American Music , and Music Row in Nashville, the International Rock-A-Billy Museum in Jackson, the Mountain Music Museum in Kingsport, and the Birthplace of Country Music Museum in Bristol. The Rockabilly Hall of Fame , an online site recognizing the development of rockabilly, is also based in Nashville. Several annual music festivals take place throughout the state, the largest of which are the Beale Street Music Festival in Memphis, the CMA Music Festival in Nashville, Bonnaroo in Manchester , and Riverbend in Chattanooga. Tennessee has played a critical role in the development of many forms of American popular music, including blues , country , rock and roll , rockabilly , soul , bluegrass , Contemporary Christian , and gospel . Many consider Memphis's Beale Street the epicenter of the blues, with musicians such as W. C. Handy performing in its clubs as early as 1909. Memphis was historically home to Sun Records , where musicians such as Elvis Presley , Johnny Cash , Carl Perkins , Jerry Lee Lewis , Roy Orbison , and Charlie Rich began their recording careers, and where rock and roll took shape in the 1950s. Stax Records in Memphis became one of the most important labels for soul artists in the late 1950s and 1960s, and a subgenre known as Memphis soul emerged. The 1927 Victor recording sessions in Bristol generally mark the beginning of the country music genre and the rise of the Grand Ole Opry in the 1930s helped make Nashville the center of the country music recording industry. Nashville became known as "Music City", and the Grand Ole Opry remains the nation's longest-running radio show. Many museums and historic sites recognize Tennessee's role in nurturing various forms of popular music, including Sun Studio , Memphis Rock N' Soul Museum , Stax Museum of American Soul Music , and Blues Hall of Fame in Memphis, the Ryman Auditorium , Country Music Hall of Fame and Museum , Musicians Hall of Fame and Museum , National Museum of African American Music , and Music Row in Nashville, the International Rock-A-Billy Museum in Jackson, the Mountain Music Museum in Kingsport, and the Birthplace of Country Music Museum in Bristol. The Rockabilly Hall of Fame , an online site recognizing the development of rockabilly, is also based in Nashville. Several annual music festivals take place throughout the state, the largest of which are the Beale Street Music Festival in Memphis, the CMA Music Festival in Nashville, Bonnaroo in Manchester , and Riverbend in Chattanooga. Education in Tennessee is administered by the Tennessee Department of Education. The state Board of Education has 11 members: one from each Congressional district, a student member, and the executive director of the Tennessee Higher Education Commission (THEC), who serves as ex-officio nonvoting member. Public primary and secondary education systems are operated by county, city, or special school districts to provide education at the local level, and operate under the direction of the Tennessee Department of Education. The state also has many private schools. The state enrolls approximately 1 million K–12 students in 137 districts. In 2021, the four-year high school graduation rate was 88.7%, a decrease of 1.2% from the previous year. According to the most recent data, Tennessee spends $9,544 per student, the 8th lowest in the nation. Public higher education is overseen by the Tennessee Higher Education Commission (THEC), which provides guidance to the state's two public university systems. The University of Tennessee system operates four primary campuses in Knoxville , Chattanooga , Martin , and Pulaski ; a Health Sciences Center in Memphis; and an aerospace research facility in Tullahoma. The Tennessee Board of Regents (TBR), also known as The College System of Tennessee, operates 13 community colleges and 27 campuses of the Tennessee Colleges of Applied Technology (TCAT). Until 2017, the TBR also operated six public universities in the state; it now only gives them administrative support. In 2014, the Tennessee General Assembly created the Tennessee Promise , which allows in-state high school graduates to enroll in two-year post-secondary education programs such as associate degrees and certificates at community colleges and trade schools in Tennessee tuition-free, funded by the state lottery, if they meet certain requirements. The Tennessee Promise was created as part of then-governor Bill Haslam 's "Drive to 55" program, which set a goal of increasing the number of college-educated residents to at least 55% of the state's population. The program has also received national attention, with multiple states having since created similar programs modeled on the Tennessee Promise. Tennessee has 107 private institutions. Vanderbilt University in Nashville is consistently ranked as one of the nation's leading research institutions. Nashville is often called the "Athens of the South" due to its many colleges and universities. Tennessee is also home to six historically Black colleges and universities (HBCUs). Public higher education is overseen by the Tennessee Higher Education Commission (THEC), which provides guidance to the state's two public university systems. The University of Tennessee system operates four primary campuses in Knoxville , Chattanooga , Martin , and Pulaski ; a Health Sciences Center in Memphis; and an aerospace research facility in Tullahoma. The Tennessee Board of Regents (TBR), also known as The College System of Tennessee, operates 13 community colleges and 27 campuses of the Tennessee Colleges of Applied Technology (TCAT). Until 2017, the TBR also operated six public universities in the state; it now only gives them administrative support. In 2014, the Tennessee General Assembly created the Tennessee Promise , which allows in-state high school graduates to enroll in two-year post-secondary education programs such as associate degrees and certificates at community colleges and trade schools in Tennessee tuition-free, funded by the state lottery, if they meet certain requirements. The Tennessee Promise was created as part of then-governor Bill Haslam 's "Drive to 55" program, which set a goal of increasing the number of college-educated residents to at least 55% of the state's population. The program has also received national attention, with multiple states having since created similar programs modeled on the Tennessee Promise. Tennessee has 107 private institutions. Vanderbilt University in Nashville is consistently ranked as one of the nation's leading research institutions. Nashville is often called the "Athens of the South" due to its many colleges and universities. Tennessee is also home to six historically Black colleges and universities (HBCUs). Tennessee is home to more than 120 newspapers. The most-circulated paid newspapers in the state include The Tennessean in Nashville, The Commercial Appeal in Memphis, the Knoxville News Sentinel , the Chattanooga Times Free Press , and The Leaf-Chronicle in Clarksville, The Jackson Sun , and The Daily News Journal in Murfreesboro. All of these except the Times Free Press are owned by Gannett . Six television media markets —Nashville, Memphis, Knoxville, Chattanooga, Tri-Cities, and Jackson—are based in Tennessee. The Nashville market is the third-largest in the Upland South and the ninth-largest in the southeastern United States, according to Nielsen Media Research . Small sections of the Huntsville, Alabama and Paducah, Kentucky - Cape Girardeau, Missouri - Harrisburg, Illinois markets also extend into the state. Tennessee has 43 full-power and 41 low-power television stations and more than 450 Federal Communications Commission (FCC)-licensed radio stations. The Grand Ole Opry , based in Nashville, is the longest-running radio show in the country, having broadcast continuously since 1925. The Tennessee Department of Transportation (TDOT) is the primary agency that is tasked with regulating and maintaining Tennessee's transportation infrastructure. Tennessee is currently one of five states with no transportation-related debts. Tennessee has 96,167 miles (154,766 km) of roads, of which 14,109 miles (22,706 km) are maintained by the state. Of the state's highways, 1,233 miles (1,984 km) are part of the Interstate Highway System . Tennessee has no tolled roads or bridges but has the sixth-highest mileage of high-occupancy vehicle (HOV) lanes , which are utilized on freeways in the congestion-prone Nashville and Memphis metropolitan areas. Interstate 40 (I-40) is the longest Interstate Highway in Tennessee, traversing the state for 455 miles (732 km) . Known as "Tennessee's Main Street", I-40 serves the major cities of Memphis, Nashville, and Knoxville, and throughout its entire length in Tennessee, one can observe the diversity of the state's geography and landforms. I-40's branch interstates include I-240 in Memphis; I-440 in Nashville; I-840 around Nashville; I-140 from Knoxville to Maryville ; and I-640 in Knoxville. In a north–south orientation, from west to east, are interstates 55 , which serves Memphis; 65 , which passes through Nashville; 75 , which serves Chattanooga and Knoxville; and 81 , which begins east of Knoxville, and serves Bristol to the northeast. I-24 is an east–west interstate that enters the state in Clarksville, passes through Nashville, and terminates in Chattanooga. I-26 , although technically an east–west interstate, begins in Kingsport and runs southwardly through Johnson City before exiting into North Carolina. I-155 is a branch route of I-55 that serves the northwestern part of the state. I-275 is a short spur route in Knoxville. I-269 runs from Millington to Collierville , serving as an outer bypass of Memphis. Major airports in Tennessee include Nashville International Airport (BNA), Memphis International Airport (MEM), McGhee Tyson Airport (TYS) outside of Knoxville, Chattanooga Metropolitan Airport (CHA), Tri-Cities Regional Airport (TRI) in Blountville , and McKellar-Sipes Regional Airport (MKL) in Jackson. Because Memphis International Airport is the hub of FedEx Corporation , it is the world's second-busiest cargo airport . The state also has 74 general aviation airports and 148 heliports . For passenger rail service, Memphis and Newbern are served by the Amtrak City of New Orleans line on its run between Chicago and New Orleans . Nashville is served by the WeGo Star commuter rail service. Tennessee currently has 2,604 miles (4,191 km) of freight trackage in operation, most of which are owned by CSX Transportation . Norfolk Southern Railway also operates lines in East and southwestern Tennessee. BNSF operates a major intermodal facility in Memphis. Tennessee has a total of 976 miles (1,571 km) of navigable waterways , the 11th highest in the nation. These include the Mississippi , Tennessee , and Cumberland rivers. Five inland ports are located in the state, including the Port of Memphis , which is the fifth-largest in the United States and the second largest on the Mississippi River. Tennessee has 96,167 miles (154,766 km) of roads, of which 14,109 miles (22,706 km) are maintained by the state. Of the state's highways, 1,233 miles (1,984 km) are part of the Interstate Highway System . Tennessee has no tolled roads or bridges but has the sixth-highest mileage of high-occupancy vehicle (HOV) lanes , which are utilized on freeways in the congestion-prone Nashville and Memphis metropolitan areas. Interstate 40 (I-40) is the longest Interstate Highway in Tennessee, traversing the state for 455 miles (732 km) . Known as "Tennessee's Main Street", I-40 serves the major cities of Memphis, Nashville, and Knoxville, and throughout its entire length in Tennessee, one can observe the diversity of the state's geography and landforms. I-40's branch interstates include I-240 in Memphis; I-440 in Nashville; I-840 around Nashville; I-140 from Knoxville to Maryville ; and I-640 in Knoxville. In a north–south orientation, from west to east, are interstates 55 , which serves Memphis; 65 , which passes through Nashville; 75 , which serves Chattanooga and Knoxville; and 81 , which begins east of Knoxville, and serves Bristol to the northeast. I-24 is an east–west interstate that enters the state in Clarksville, passes through Nashville, and terminates in Chattanooga. I-26 , although technically an east–west interstate, begins in Kingsport and runs southwardly through Johnson City before exiting into North Carolina. I-155 is a branch route of I-55 that serves the northwestern part of the state. I-275 is a short spur route in Knoxville. I-269 runs from Millington to Collierville , serving as an outer bypass of Memphis. Major airports in Tennessee include Nashville International Airport (BNA), Memphis International Airport (MEM), McGhee Tyson Airport (TYS) outside of Knoxville, Chattanooga Metropolitan Airport (CHA), Tri-Cities Regional Airport (TRI) in Blountville , and McKellar-Sipes Regional Airport (MKL) in Jackson. Because Memphis International Airport is the hub of FedEx Corporation , it is the world's second-busiest cargo airport . The state also has 74 general aviation airports and 148 heliports . For passenger rail service, Memphis and Newbern are served by the Amtrak City of New Orleans line on its run between Chicago and New Orleans . Nashville is served by the WeGo Star commuter rail service. Tennessee currently has 2,604 miles (4,191 km) of freight trackage in operation, most of which are owned by CSX Transportation . Norfolk Southern Railway also operates lines in East and southwestern Tennessee. BNSF operates a major intermodal facility in Memphis.Tennessee has a total of 976 miles (1,571 km) of navigable waterways , the 11th highest in the nation. These include the Mississippi , Tennessee , and Cumberland rivers. Five inland ports are located in the state, including the Port of Memphis , which is the fifth-largest in the United States and the second largest on the Mississippi River. The Constitution of Tennessee was adopted in 1870. The state had two previous constitutions. The first was adopted in 1796, the year Tennessee was admitted to the union, and the second in 1834. Since 1826, Nashville has been the capital of Tennessee. The capital was previously in three other cities. Knoxville was the capital from statehood in 1796 until 1812, except for September 21, 1807, when the legislature met in Kingston for a day. The capital was relocated to Nashville in 1812, where it remained until it was relocated back to Knoxville in 1817. The next year, the capital was moved to Murfreesboro , where it remained until 1826. Nashville was officially named Tennessee's permanent capital in 1843. Like the federal government, Tennessee's government has three branches. The executive branch is led by the governor , who holds office for a four-year term and may serve a maximum of two consecutive terms. The governor is the only official elected statewide. The current governor is Bill Lee , a Republican . The governor is supported by 22 cabinet-level departments, most headed by a commissioner the governor appoints. The executive branch also includes several agencies, boards, and commissions, some of which are under the auspices of one of the cabinet-level departments. The bicameral legislative branch, the Tennessee General Assembly , consists of the 33-member Senate and the 99-member House of Representatives . Senators serve four-year terms and House members serve two-year terms. Each chamber chooses a Speaker, who is elected by a joint session of the legislature. The Speaker of the Senate also serves as the lieutenant governor , a practice found only in one other state, and the House Speaker is third in line for the governorship. The legislature can override a veto by a simple majority, and the state has no " pocket veto ". The legislature convenes at noon on the second Tuesday in January and meets for a total of 90 days over two sessions, usually adjourning in late April or early May. Special sessions may be called by the governor or by two-thirds of the members of both chambers. Tennessee's highest court is the state Supreme Court . It has a chief justice and four associate justices . No more than two justices can be from the same Grand Division . The Supreme Court of Tennessee appoints the state's Attorney General , a practice only found in Tennessee. Both the Court of Appeals and the Court of Criminal Appeals have 12 judges, who are evenly from each Grand Division. Under the Tennessee Plan , the governor appoints justices on all three courts to eight-year terms; they must be retained by the voters during the first general election after appointment and at the end of their term. Tennessee is divided into 31 judicial districts, each with a circuit and chancery court, and a district attorney and judges elected to eight-year terms. Separate criminal courts serve 13 of the 31 judicial districts; circuit courts handle criminal cases in the remaining districts. Local courts include general sessions, juvenile and domestic, and municipal courts. Tennessee maintains four dedicated law enforcement agencies: the Tennessee Highway Patrol (THP), the Tennessee Wildlife Resources Agency (TWRA), the Tennessee Bureau of Investigation (TBI), and the Tennessee Department of Environment and Conservation (TDEC). The Highway Patrol is the primary entity that enforces highway safety regulations and general non- wildlife state laws. It is under the jurisdiction of the Department of Safety. The TWRA is an independent agency tasked with enforcing all wildlife, boating, and fishery regulations outside of state parks. TDEC enforces state environmental laws and regulations. The TBI is the primary state-level criminal investigative department. State park rangers are responsible for all activities and law enforcement inside the Tennessee State Parks system. Capital punishment is legal in Tennessee and has existed at various times since statehood. Lethal injection is the primary means of execution, but electrocution is also allowed. Tennessee is divided into 95 counties , with 92 county governments that use a county commission legislative body and a separately elected county executive. The governments of Davidson (Nashville), Moore ( Lynchburg ), and Trousdale ( Hartsville ) are consolidated with their county seats . Each county elects a sheriff, property assessor, trustee, register of deeds, and county clerk. Tennessee has more than 340 municipalities. Most cities and towns use the weak mayor-council (mayor-aldermen), strong-mayor council , city commission , or council–manager forms of government. Local law enforcement is divided between county sheriff's offices and municipal police departments. In every county except Davidson, the sheriff is the chief law enforcement officer. Tennessee sends nine representatives to the United States House of Representatives . The current delegation consists of eight Republicans and one Democrat . Its U.S. senators are Marsha Blackburn and Bill Hagerty , both Republicans. Tennessee is under the jurisdiction of the Sixth Circuit Court of Appeals , which has jurisdiction over three district courts in the state : the Eastern , Middle , and Western districts. The Mississippi Band of Choctaw Indians is Tennessee's only federally recognized Native American tribe . It owns 79 acres (32 ha) in Henning , which the tribe placed into federal trust in 2012. This is governed directly by the tribe. Like the federal government, Tennessee's government has three branches. The executive branch is led by the governor , who holds office for a four-year term and may serve a maximum of two consecutive terms. The governor is the only official elected statewide. The current governor is Bill Lee , a Republican . The governor is supported by 22 cabinet-level departments, most headed by a commissioner the governor appoints. The executive branch also includes several agencies, boards, and commissions, some of which are under the auspices of one of the cabinet-level departments. The bicameral legislative branch, the Tennessee General Assembly , consists of the 33-member Senate and the 99-member House of Representatives . Senators serve four-year terms and House members serve two-year terms. Each chamber chooses a Speaker, who is elected by a joint session of the legislature. The Speaker of the Senate also serves as the lieutenant governor , a practice found only in one other state, and the House Speaker is third in line for the governorship. The legislature can override a veto by a simple majority, and the state has no " pocket veto ". The legislature convenes at noon on the second Tuesday in January and meets for a total of 90 days over two sessions, usually adjourning in late April or early May. Special sessions may be called by the governor or by two-thirds of the members of both chambers. Tennessee's highest court is the state Supreme Court . It has a chief justice and four associate justices . No more than two justices can be from the same Grand Division . The Supreme Court of Tennessee appoints the state's Attorney General , a practice only found in Tennessee. Both the Court of Appeals and the Court of Criminal Appeals have 12 judges, who are evenly from each Grand Division. Under the Tennessee Plan , the governor appoints justices on all three courts to eight-year terms; they must be retained by the voters during the first general election after appointment and at the end of their term. Tennessee is divided into 31 judicial districts, each with a circuit and chancery court, and a district attorney and judges elected to eight-year terms. Separate criminal courts serve 13 of the 31 judicial districts; circuit courts handle criminal cases in the remaining districts. Local courts include general sessions, juvenile and domestic, and municipal courts. Tennessee maintains four dedicated law enforcement agencies: the Tennessee Highway Patrol (THP), the Tennessee Wildlife Resources Agency (TWRA), the Tennessee Bureau of Investigation (TBI), and the Tennessee Department of Environment and Conservation (TDEC). The Highway Patrol is the primary entity that enforces highway safety regulations and general non- wildlife state laws. It is under the jurisdiction of the Department of Safety. The TWRA is an independent agency tasked with enforcing all wildlife, boating, and fishery regulations outside of state parks. TDEC enforces state environmental laws and regulations. The TBI is the primary state-level criminal investigative department. State park rangers are responsible for all activities and law enforcement inside the Tennessee State Parks system. Capital punishment is legal in Tennessee and has existed at various times since statehood. Lethal injection is the primary means of execution, but electrocution is also allowed. Tennessee is divided into 95 counties , with 92 county governments that use a county commission legislative body and a separately elected county executive. The governments of Davidson (Nashville), Moore ( Lynchburg ), and Trousdale ( Hartsville ) are consolidated with their county seats . Each county elects a sheriff, property assessor, trustee, register of deeds, and county clerk. Tennessee has more than 340 municipalities. Most cities and towns use the weak mayor-council (mayor-aldermen), strong-mayor council , city commission , or council–manager forms of government. Local law enforcement is divided between county sheriff's offices and municipal police departments. In every county except Davidson, the sheriff is the chief law enforcement officer. Tennessee sends nine representatives to the United States House of Representatives . The current delegation consists of eight Republicans and one Democrat . Its U.S. senators are Marsha Blackburn and Bill Hagerty , both Republicans. Tennessee is under the jurisdiction of the Sixth Circuit Court of Appeals , which has jurisdiction over three district courts in the state : the Eastern , Middle , and Western districts. The Mississippi Band of Choctaw Indians is Tennessee's only federally recognized Native American tribe . It owns 79 acres (32 ha) in Henning , which the tribe placed into federal trust in 2012. This is governed directly by the tribe. Tennessee's politics are currently dominated by the Republican Party . Republicans currently hold both of the state's U.S. Senate seats , 8 out of 9 Congressional seats , 75 out of 99 state House seats , and 27 out of 33 state Senate seats . Democratic strength is largely concentrated in Nashville , Memphis , and parts of Knoxville , Chattanooga , and Clarksville . Several suburban areas of Nashville and Memphis also contain significant Democratic minorities. Tennessee is one of thirteen states which holds its presidential primaries on Super Tuesday . Tennessee does not require voters to declare a party affiliation when registering. The state is one of eight states which require voters to present a form of photo identification . Tennessee has one of the highest rates of felony disenfranchisement , with nearly 10% of its voting-age population ineligible to vote. The state also has the highest rate of Black and Latino felony disenfranchisement. Between the end of the Civil War and the mid-20th century, Tennessee was part of the Democratic Solid South , but had the largest Republican minority of any former Confederate state. During this time, East Tennessee was heavily Republican and the western two-thirds mostly voted Democratic, with the latter dominating the state. This division was related to the state's pattern of Unionist and Confederate loyalism during the Civil War. Tennessee's 1st and 2nd congressional districts, based in the Tri-Cities and Knoxville, respectively, are among the few historically Republican districts in the South. The first has been in Republican hands continuously since 1881, and Republicans or their antecedents have held it for all but four years since 1859. The second has been held continuously by Republicans or their antecedents since 1855. During Reconstruction, freedmen and former free blacks were granted the right to vote; most joined the Republican Party. Numerous African Americans were elected to local offices, and some to state office. Following Reconstruction, Tennessee continued to have competitive party politics, but in the 1880s, the White-dominated state government passed Jim Crow laws , one of which imposed a poll tax requirement for voter registration. These served to disenfranchise most African Americans, and their power in state and local politics was markedly reduced. After the disenfranchisement of blacks, the Republican Party became a primarily white sectional party supported mostly in East Tennessee. In the early 1900s, the state legislature approved legislation allowing cities to adopt a commission form of government based on at-large voting as a means to limit African American political participation. Not until after passage of the Voting Rights Act of 1965 were African Americans able to regain their full voting rights. Between the end of Reconstruction and the mid-20th century, Tennessee voted consistently Democratic in Presidential elections, except in two nationwide Republican landslides in the 1920s. Tennesseans narrowly supported Warren G. Harding over Ohio Governor James Cox in 1920, and more decisively voted for Herbert Hoover over New York Governor Al Smith in 1928. During the first half of the 20th century, state politics were dominated by the Democratic Crump machine in Memphis. For most of the second half of the 20th century, Tennessee was a swing state in presidential elections. During this time, Democratic presidential nominees from Southern states, including Lyndon B. Johnson , Jimmy Carter , and Bill Clinton , tended to fare better in Tennessee than their Northern counterparts, especially among split-ticket voters outside the metropolitan areas. In the 1950s, Tennessee twice voted for Republican Dwight D. Eisenhower , former Allied Commander of the Armed Forces during World War II. Howard Baker , first elected in 1966, became the first Republican U.S. Senator from Tennessee since Reconstruction. The Republican Southern strategy did not have as much of an effect in Tennessee as in most Southern states, but the elections of Winfield Dunn as governor and Bill Brock to the U.S. Senate in 1970 further helped make the GOP competitive among Whites in statewide elections. In the 2000 presidential election , Vice President Al Gore , who had previously served as a Democratic U.S. Senator from Tennessee, failed to carry his home state, an unusual occurrence but indicative of strengthening Republican support. Beginning in the early 21st century, Tennessee transitioned into a solid Republican state, primarily due to rural white voters who have rejected the increasing liberalism of the Democratic Party. In 2004 , Republican President George W. Bush increased his margin of victory in the state from a 4% to a 14% margin in 2000. In 2007, Ron Ramsey became the first Republican Speaker of the State Senate since Reconstruction, and the following year the Republicans gained control of both houses of the state legislature for the first time since Reconstruction. Voters, however, continued to elect moderate Republicans, such as centrists Bill Haslam and Lamar Alexander , until the late 2010s with the rise of Trumpism in the GOP at a nationwide scale. Since 2016, Tennessee has been the most populous state to vote Republican by more than 60% in presidential elections, and in 2020 voted Republican by the largest margin of any state in terms of number of votes. Tennessee is home to four major professional sports franchises: the Tennessee Titans have played in the National Football League (NFL) since 1997, the Nashville Predators have played in the National Hockey League (NHL) since 1998, the Memphis Grizzlies have played in the National Basketball Association (NBA) since 2001, and Nashville SC has played in Major League Soccer (MLS) since 2020. The state is also home to eight minor league teams. Four of these are Minor League Baseball clubs. The Nashville Sounds , which began play in 1978, and Memphis Redbirds , which began in 1998, each compete in the International League at the Triple-A level, the highest before Major League Baseball . The Tennessee Smokies , which have played continuously since 1972, and Chattanooga Lookouts , which have played continuously since 1976, are members of the Double-A classification Southern League . Tennessee has three minor league soccer teams. Memphis 901 FC has played in the second-tier USL Championship since 2019. Chattanooga Red Wolves SC has been a member of the third-tier USL League One since 2019. Founded in 2009, Chattanooga FC began playing in the third-tier National Independent Soccer Association in 2020. The state has one minor league ice hockey team: the Knoxville Ice Bears , which began play in 2002 and are members of the Southern Professional Hockey League . The state is home to 12 NCAA Division I programs. Four of these participate in the top level of college football, the Football Bowl Subdivision . In Knoxville, the Tennessee Volunteers college teams play in the Southeastern Conference (SEC) of the National Collegiate Athletic Association (NCAA). In Nashville, the Vanderbilt Commodores are also members of the SEC. The Memphis Tigers are members of the American Athletic Conference , and Murfreesboro's Middle Tennessee Blue Raiders play in Conference USA . Nashville is also home to the Belmont Bruins , members of the Ohio Valley Conference (OVC) but moving to the Missouri Valley Conference (MVC) in July 2022; Tennessee State Tigers , OVC members with no plans to change conferences; and the Lipscomb Bisons , members of the ASUN Conference . Tennessee State plays football in Division I's second level, the Football Championship Subdivision , while Belmont and Lipscomb do not have football teams . Through the 2021–22 school year, the OVC also includes the Austin Peay Governors from Clarksville, the UT Martin Skyhawks from Martin, and the Tennessee Tech Golden Eagles from Cookeville . UT Martin and Tennessee Tech will remain in the OVC, while Peay will move to the ASUN. The Chattanooga Mocs and Johnson City's East Tennessee State Buccaneers are full members, including football, of the Southern Conference . Tennessee is also home to the Bristol Motor Speedway , which features NASCAR Cup Series racing two weekends a year, routinely selling out more than 160,000 seats on each date. The Nashville Superspeedway in Lebanon, which previously held Nationwide and IndyCar races until it was shut down in 2011, reopened to host the NASCAR Cup Series in 2021. Tennessee's only graded stakes horserace, the Iroquois Steeplechase , is held in Nashville each May. The WGC Invitational is a PGA Tour golf tournament that has been held in Memphis since 1958.

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Edgar Allan Poe

Edgar Allan Poe ( né Edgar Poe ; January 19, 1809 – October 7, 1849) was an American writer, poet, author, editor, and literary critic who is best known for his poetry and short stories, particularly his tales of mystery and the macabre . He is widely regarded as a central figure of Romanticism and Gothic fiction in the United States, and of American literature . Poe was one of the country's earliest practitioners of the short story, and is considered the inventor of the detective fiction genre, as well as a significant contributor to the emerging genre of science fiction . He is the first well-known American writer to earn a living through writing alone, resulting in a financially difficult life and career. Poe was born in Boston , the second child of actors David and Elizabeth "Eliza" Poe . His father abandoned the family in 1810, and when his mother died the following year, Poe was taken in by John and Frances Allan of Richmond, Virginia . They never formally adopted him, but he was with them well into young adulthood. He attended the University of Virginia but left after a year due to lack of money. He quarreled with John Allan over the funds for his education, and his gambling debts. In 1827, having enlisted in the United States Army under an assumed name, he published his first collection, Tamerlane and Other Poems , credited only to "a Bostonian". Poe and Allan reached a temporary rapprochement after the death of Allan's wife in 1829. Poe later failed as an officer cadet at West Point , declared a firm wish to be a poet and writer, and parted ways with Allan. Poe switched his focus to prose, and spent the next several years working for literary journals and periodicals, becoming known for his own style of literary criticism. His work forced him to move between several cities, including Baltimore , Philadelphia , and New York City. In 1836, he married his 13-year-old cousin, Virginia Clemm , but she died of tuberculosis in 1847. In January 1845, he published his poem " The Raven " to instant success. He planned for years to produce his own journal The Penn , later renamed The Stylus . But before it began publishing, Poe died in Baltimore in 1849, aged 40, under mysterious circumstances . The cause of his death remains unknown, and has been variously attributed to many causes including disease, alcoholism, substance abuse , and suicide. Poe and his works influenced literature around the world, as well as specialized fields such as cosmology and cryptography . He and his work appear throughout popular culture in literature, music, films, and television . A number of his homes are dedicated museums. The Mystery Writers of America present an annual Edgar Award for distinguished work in the mystery genre.Edgar Poe was born in Boston , Massachusetts , on January 19, 1809, the second child of American actor David Poe Jr. and English -born actress Elizabeth Arnold Hopkins Poe . He had an elder brother, Henry , and a younger sister, Rosalie . Their grandfather, David Poe, had emigrated from County Cavan , Ireland, around 1750. His father abandoned the family in 1810, and his mother died a year later from pulmonary tuberculosis . Poe was then taken into the home of John Allan, a successful merchant in Richmond, Virginia , who dealt in a variety of goods, including cloth, wheat, tombstones, tobacco, and slaves. The Allans served as a foster family and gave him the name "Edgar Allan Poe", although they never formally adopted him. The Allan family had Poe baptized into the Episcopal Church in 1812. John Allan alternately spoiled and aggressively disciplined his foster son. The family sailed to the United Kingdom in 1815, and Poe attended the grammar school for a short period in Irvine, Ayrshire , Scotland, where Allan was born, before rejoining the family in London in 1816. There he studied at a boarding school in Chelsea until summer 1817. He was subsequently entered at the Reverend John Bransby 's Manor House School at Stoke Newington , then a suburb 4 miles (6 km) north of London. Poe moved with the Allans back to Richmond in 1820. In 1824, he served as the lieutenant of the Richmond youth honor guard as the city celebrated the visit of the Marquis de Lafayette . In March 1825, Allan's uncle and business benefactor William Galt died, who was said to be one of the wealthiest men in Richmond, leaving Allan several acres of real estate. The inheritance was estimated at $750,000 ( equivalent to $20,000,000 in 2023 ). By summer 1825, Allan celebrated his expansive wealth by purchasing a two-story brick house called Moldavia. Poe may have become engaged to Sarah Elmira Royster before he registered at the University of Virginia in February 1826 to study ancient and modern languages. The university was in its infancy, established on the ideals of its founder, Thomas Jefferson . It had strict rules against gambling, horses, guns, tobacco, and alcohol, but these rules were mostly ignored. Jefferson enacted a system of student self-government, allowing students to choose their own studies, make their own arrangements for boarding, and report all wrongdoing to the faculty. The unique system was still in chaos, and there was a high dropout rate. During his time there, Poe lost touch with Royster and also became estranged from his foster father over gambling debts. He claimed that Allan had not given him sufficient money to register for classes, purchase texts, and procure and furnish a dormitory. Allan did send additional money and clothes, but Poe's debts increased. Poe gave up on the university after a year but did not feel welcome returning to Richmond, especially when he learned that his sweetheart Royster had married another man, Alexander Shelton. He traveled to Boston in April 1827, sustaining himself with odd jobs as a clerk and newspaper writer, and started using the pseudonym Henri Le Rennet during this period. Poe was unable to support himself, so he enlisted in the United States Army as a private on May 27, 1827, using the name "Edgar A. Perry". He claimed that he was 22 years old even though he was 18. He first served at Fort Independence in Boston Harbor for five dollars a month. That year, he released his first book, a 40-page collection of poetry titled Tamerlane and Other Poems , attributed with the byline "by a Bostonian". Only 50 copies were printed, and the book received virtually no attention. Poe's regiment was posted to Fort Moultrie in Charleston, South Carolina , and traveled by ship on the brig Waltham on November 8, 1827. Poe was promoted to "artificer", an enlisted tradesman who prepared shells for artillery, and had his monthly pay doubled. He served for two years and attained the rank of Sergeant Major for Artillery, the highest rank that a non-commissioned officer could achieve; he then sought to end his five-year enlistment early. He revealed his real name and his circumstances to his commanding officer, Lieutenant Howard, who would allow Poe to be discharged only if he reconciled with Allan. Poe wrote a letter to Allan, who was unsympathetic and spent several months ignoring Poe's pleas; Allan may not have written to Poe even to make him aware of his foster mother's illness. Frances Allan died on February 28, 1829, and Poe visited the day after her burial. Perhaps softened by his wife's death, Allan agreed to support Poe's attempt to be discharged in order to receive an appointment to the United States Military Academy at West Point, New York . Poe was finally discharged on April 15, 1829, after securing a replacement to finish his enlisted term for him. Before entering West Point, he moved to Baltimore for a time to stay with his widowed aunt Maria Clemm, her daughter Virginia Eliza Clemm (Poe's first cousin), his brother Henry, and his invalid grandmother Elizabeth Cairnes Poe. In September of that year, Poe received "the very first words of encouragement I ever remember to have heard" in a review of his poetry by influential critic John Neal , prompting Poe to dedicate one of the poems to Neal in his second book Al Aaraaf, Tamerlane and Minor Poems , published in Baltimore in 1829. Poe traveled to West Point and matriculated as a cadet on July 1, 1830. In October 1830, Allan married his second wife Louisa Patterson. The marriage and bitter quarrels with Poe over the children born to Allan out of extramarital affairs led to the foster father finally disowning Poe. Poe decided to leave West Point by purposely getting court-martialed . On February 8, 1831, he was tried for gross neglect of duty and disobedience of orders for refusing to attend formations, classes, or church. He tactically pleaded not guilty to induce dismissal, knowing that he would be found guilty. Poe left for New York in February 1831 and released a third volume of poems, simply titled Poems . The book was financed with help from his fellow cadets at West Point, many of whom donated 75 cents to the cause, raising a total of $170. They may have been expecting verses similar to the satirical ones Poe had written about commanding officers. It was printed by Elam Bliss of New York, labeled as "Second Edition", and including a page saying, "To the U.S. Corps of Cadets this volume is respectfully dedicated". The book once again reprinted the long poems "Tamerlane" and "Al Aaraaf" but also six previously unpublished poems, including early versions of " To Helen ", " Israfel ", and " The City in the Sea ". Poe returned to Baltimore to his aunt, brother, and cousin in March 1831. His elder brother Henry had been in ill health, in part due to problems with alcoholism, and he died on August 1, 1831. After his brother's death, Poe began more earnest attempts to start his career as a writer, but he chose a difficult time in American publishing to do so. He was one of the first Americans to live by writing alone and was hampered by the lack of an international copyright law . American publishers often produced unauthorized copies of British works rather than paying for new work by Americans. The industry was also particularly hurt by the Panic of 1837 . There was a booming growth in American periodicals around this time, fueled in part by new technology, but many did not last beyond a few issues. Publishers often refused to pay their writers or paid them much later than they promised, and Poe repeatedly resorted to humiliating pleas for money and other assistance. After his early attempts at poetry, Poe had turned his attention to prose, likely based on John Neal's critiques in The Yankee magazine. He placed a few stories with a Philadelphia publication and began work on his only drama Politian . The Baltimore Saturday Visiter awarded him a prize in October 1833 for his short story " MS. Found in a Bottle ". The story brought him to the attention of John P. Kennedy , a Baltimorean of considerable means who helped Poe place some of his stories and introduced him to Thomas W. White, editor of the Southern Literary Messenger in Richmond. In 1835, Poe became assistant editor of the Southern Literary Messenger , but White discharged him within a few weeks for being drunk on the job. Poe returned to Baltimore , where he obtained a license to marry his cousin Virginia on September 22, 1835, though it is unknown if they were married at that time. He was 26 and she was 13. Poe was reinstated by White after promising good behavior, and he returned to Richmond with Virginia and her mother. He remained at the Messenger until January 1837. During this period, Poe claimed that its circulation increased from 700 to 3,500. He published several poems, book reviews, critiques, and stories in the paper. On May 16, 1836, he and Virginia held a Presbyterian wedding ceremony performed by Amasa Converse at their Richmond boarding house, with a witness falsely attesting Clemm's age as 21. In 1838, Poe relocated to Philadelphia , where he lived at four different residences between 1838 and 1844, one of which at 532 N. 7th Street has been preserved as a National Historic Landmark . That same year, Poe's novel The Narrative of Arthur Gordon Pym of Nantucket was published and widely reviewed. In the summer of 1839, he became assistant editor of Burton's Gentleman's Magazine . He published numerous articles, stories, and reviews, enhancing his reputation as a trenchant critic which he had established at the Messenger . Also in 1839, the collection Tales of the Grotesque and Arabesque was published in two volumes, though he made little money from it and it received mixed reviews. In June 1840, Poe published a prospectus announcing his intentions to start his own journal called The Stylus , although he originally intended to call it The Penn , since it would have been based in Philadelphia. He bought advertising space for his prospectus in the June 6, 1840, issue of Philadelphia's Saturday Evening Post : "Prospectus of the Penn Magazine, a Monthly Literary journal to be edited and published in the city of Philadelphia by Edgar A. Poe." The journal was never produced before Poe's death. Poe left Burton's after about a year and found a position as writer and co-editor at Graham's Magazine , a successful monthly publication. In the last number of Graham's for 1841, Poe was among the co-signatories to an editorial note of celebration of the tremendous success the magazine had achieved in the past year: "Perhaps the editors of no magazine, either in America or in Europe, ever sat down, at the close of a year, to contemplate the progress of their work with more satisfaction than we do now. Our success has been unexampled, almost incredible. We may assert without fear of contradiction that no periodical ever witnessed the same increase during so short a period." Around this time, Poe attempted to secure a position in the administration of John Tyler , claiming that he was a member of the Whig Party . He hoped to be appointed to the United States Custom House in Philadelphia with help from President Tyler's son Robert , an acquaintance of Poe's friend Frederick Thomas. Poe failed to show up for a meeting with Thomas to discuss the appointment in mid-September 1842, claiming to have been sick, though Thomas believed that he had been drunk. Poe was promised an appointment, but all positions were filled by others. One evening in January 1842, Virginia showed the first signs of consumption, or tuberculosis , while singing and playing the piano, which Poe described as breaking a blood vessel in her throat. She only partially recovered, and Poe began to drink more heavily under the stress of her illness. He left Graham's and attempted to find a new position, for a time angling for a government post. He returned to New York where he worked briefly at the Evening Mirror before becoming editor of the Broadway Journal , and later its owner. There Poe alienated himself from other writers by publicly accusing Henry Wadsworth Longfellow of plagiarism , though Longfellow never responded. On January 29, 1845, Poe's poem " The Raven " appeared in the Evening Mirror and became a popular sensation. It made Poe a household name almost instantly, though he was paid only $9 for its publication. It was concurrently published in The American Review: A Whig Journal under the pseudonym "Quarles". The Broadway Journal failed in 1846, and Poe moved to a cottage in Fordham, New York , in the Bronx . That home, now known as the Edgar Allan Poe Cottage , was relocated in later years to a park near the southeast corner of the Grand Concourse and Kingsbridge Road. Nearby, Poe befriended the Jesuits at St. John's College, now Fordham University . Virginia died at the cottage on January 30, 1847. Biographers and critics often suggest that Poe's frequent theme of the "death of a beautiful woman" stems from the repeated loss of women throughout his life, including his wife. Poe was increasingly unstable after his wife's death. He attempted to court poet Sarah Helen Whitman , who lived in Providence, Rhode Island . Their engagement failed, purportedly because of Poe's drinking and erratic behavior. There is also strong evidence that Whitman's mother intervened and did much to derail the relationship. Poe then returned to Richmond and resumed a relationship with his childhood sweetheart Sarah Elmira Royster. In 1838, Poe relocated to Philadelphia , where he lived at four different residences between 1838 and 1844, one of which at 532 N. 7th Street has been preserved as a National Historic Landmark . That same year, Poe's novel The Narrative of Arthur Gordon Pym of Nantucket was published and widely reviewed. In the summer of 1839, he became assistant editor of Burton's Gentleman's Magazine . He published numerous articles, stories, and reviews, enhancing his reputation as a trenchant critic which he had established at the Messenger . Also in 1839, the collection Tales of the Grotesque and Arabesque was published in two volumes, though he made little money from it and it received mixed reviews. In June 1840, Poe published a prospectus announcing his intentions to start his own journal called The Stylus , although he originally intended to call it The Penn , since it would have been based in Philadelphia. He bought advertising space for his prospectus in the June 6, 1840, issue of Philadelphia's Saturday Evening Post : "Prospectus of the Penn Magazine, a Monthly Literary journal to be edited and published in the city of Philadelphia by Edgar A. Poe." The journal was never produced before Poe's death. Poe left Burton's after about a year and found a position as writer and co-editor at Graham's Magazine , a successful monthly publication. In the last number of Graham's for 1841, Poe was among the co-signatories to an editorial note of celebration of the tremendous success the magazine had achieved in the past year: "Perhaps the editors of no magazine, either in America or in Europe, ever sat down, at the close of a year, to contemplate the progress of their work with more satisfaction than we do now. Our success has been unexampled, almost incredible. We may assert without fear of contradiction that no periodical ever witnessed the same increase during so short a period." Around this time, Poe attempted to secure a position in the administration of John Tyler , claiming that he was a member of the Whig Party . He hoped to be appointed to the United States Custom House in Philadelphia with help from President Tyler's son Robert , an acquaintance of Poe's friend Frederick Thomas. Poe failed to show up for a meeting with Thomas to discuss the appointment in mid-September 1842, claiming to have been sick, though Thomas believed that he had been drunk. Poe was promised an appointment, but all positions were filled by others. One evening in January 1842, Virginia showed the first signs of consumption, or tuberculosis , while singing and playing the piano, which Poe described as breaking a blood vessel in her throat. She only partially recovered, and Poe began to drink more heavily under the stress of her illness. He left Graham's and attempted to find a new position, for a time angling for a government post. He returned to New York where he worked briefly at the Evening Mirror before becoming editor of the Broadway Journal , and later its owner. There Poe alienated himself from other writers by publicly accusing Henry Wadsworth Longfellow of plagiarism , though Longfellow never responded. On January 29, 1845, Poe's poem " The Raven " appeared in the Evening Mirror and became a popular sensation. It made Poe a household name almost instantly, though he was paid only $9 for its publication. It was concurrently published in The American Review: A Whig Journal under the pseudonym "Quarles". The Broadway Journal failed in 1846, and Poe moved to a cottage in Fordham, New York , in the Bronx . That home, now known as the Edgar Allan Poe Cottage , was relocated in later years to a park near the southeast corner of the Grand Concourse and Kingsbridge Road. Nearby, Poe befriended the Jesuits at St. John's College, now Fordham University . Virginia died at the cottage on January 30, 1847. Biographers and critics often suggest that Poe's frequent theme of the "death of a beautiful woman" stems from the repeated loss of women throughout his life, including his wife. Poe was increasingly unstable after his wife's death. He attempted to court poet Sarah Helen Whitman , who lived in Providence, Rhode Island . Their engagement failed, purportedly because of Poe's drinking and erratic behavior. There is also strong evidence that Whitman's mother intervened and did much to derail the relationship. Poe then returned to Richmond and resumed a relationship with his childhood sweetheart Sarah Elmira Royster. On October 3, 1849, Poe was found semiconscious in Baltimore , "in great distress, and... in need of immediate assistance", according to Joseph W. Walker, who found him. He was taken to the Washington Medical College , where he died on Sunday, October 7, 1849, at 5:00 in the morning. Poe was not coherent long enough to explain how he came to be in his dire condition and why he was wearing clothes that were not his own. He is said to have repeatedly called out the name "Reynolds" on the night before his death, though it is unclear to whom he was referring. His attending physician said that Poe's final words were, "Lord help my poor soul". All of the relevant medical records have been lost, including Poe's death certificate . Newspapers at the time reported Poe's death as "congestion of the brain" or "cerebral inflammation", common euphemisms for death from disreputable causes such as alcoholism. The actual cause of death remains a mystery. Speculation has included delirium tremens , heart disease , epilepsy , syphilis , meningeal inflammation , cholera , carbon monoxide poisoning , and rabies . One theory dating from 1872 suggests that Poe's death resulted from cooping , a form of electoral fraud in which citizens were forced to vote for a particular candidate, sometimes leading to violence and even murder. Immediately after Poe's death, his literary rival Rufus Wilmot Griswold wrote a slanted high-profile obituary under a pseudonym, filled with falsehoods that cast Poe as a lunatic, and which described him as a person who "walked the streets, in madness or melancholy, with lips moving in indistinct curses, or with eyes upturned in passionate prayers, (never for himself, for he felt, or professed to feel, that he was already damned)". The long obituary appeared in the New York Tribune , signed "Ludwig" on the day that Poe was buried in Baltimore . It was further published throughout the country. The obituary began, "Edgar Allan Poe is dead. He died in Baltimore the day before yesterday. This announcement will startle many, but few will be grieved by it." "Ludwig" was soon identified as Griswold, an editor, critic, and anthologist who had borne a grudge against Poe since 1842. Griswold somehow became Poe's literary executor and attempted to destroy his enemy's reputation after his death. Griswold wrote a biographical article of Poe called "Memoir of the Author", which he included in an 1850 volume of the collected works. There he depicted Poe as a depraved, drunken, drug-addled madman and included Poe's letters as evidence. Many of his claims were either lies or distortions; for example, it is seriously disputed that Poe was a drug addict. Griswold's book was denounced by those who knew Poe well, including John Neal, who published an article defending Poe and attacking Griswold as a " Rhadamanthus , who is not to be bilked of his fee, a thimble-full of newspaper notoriety". Griswold's book nevertheless became a popularly accepted biographical source. This was in part because it was the only full biography available and was widely reprinted, and in part because readers thrilled at the thought of reading works by an "evil" man. Letters that Griswold presented as proof were later revealed as forgeries . Immediately after Poe's death, his literary rival Rufus Wilmot Griswold wrote a slanted high-profile obituary under a pseudonym, filled with falsehoods that cast Poe as a lunatic, and which described him as a person who "walked the streets, in madness or melancholy, with lips moving in indistinct curses, or with eyes upturned in passionate prayers, (never for himself, for he felt, or professed to feel, that he was already damned)". The long obituary appeared in the New York Tribune , signed "Ludwig" on the day that Poe was buried in Baltimore . It was further published throughout the country. The obituary began, "Edgar Allan Poe is dead. He died in Baltimore the day before yesterday. This announcement will startle many, but few will be grieved by it." "Ludwig" was soon identified as Griswold, an editor, critic, and anthologist who had borne a grudge against Poe since 1842. Griswold somehow became Poe's literary executor and attempted to destroy his enemy's reputation after his death. Griswold wrote a biographical article of Poe called "Memoir of the Author", which he included in an 1850 volume of the collected works. There he depicted Poe as a depraved, drunken, drug-addled madman and included Poe's letters as evidence. Many of his claims were either lies or distortions; for example, it is seriously disputed that Poe was a drug addict. Griswold's book was denounced by those who knew Poe well, including John Neal, who published an article defending Poe and attacking Griswold as a " Rhadamanthus , who is not to be bilked of his fee, a thimble-full of newspaper notoriety". Griswold's book nevertheless became a popularly accepted biographical source. This was in part because it was the only full biography available and was widely reprinted, and in part because readers thrilled at the thought of reading works by an "evil" man. Letters that Griswold presented as proof were later revealed as forgeries . Poe's best-known fiction works are Gothic horror, adhering to the genre's conventions to appeal to the public taste. His most recurring themes deal with questions of death, including its physical signs, the effects of decomposition , concerns of premature burial , the reanimation of the dead, and mourning. Many of his works are generally considered part of the dark romanticism genre, a literary reaction to transcendentalism which Poe strongly disliked. He referred to followers of the transcendental movement as "Frog-Pondians", after the pond on Boston Common , and ridiculed their writings as "metaphor—run mad," lapsing into "obscurity for obscurity's sake" or "mysticism for mysticism's sake". Poe once wrote in a letter to Thomas Holley Chivers that he did not dislike transcendentalists, "only the pretenders and sophists among them". Beyond horror, Poe also wrote satires , humor tales, and hoaxes. For comic effect, he used irony and ludicrous extravagance, often in an attempt to liberate the reader from cultural conformity. " Metzengerstein " is the first story that Poe is known to have published and his first foray into horror, but it was originally intended as a burlesque satirizing the popular genre. Poe also reinvented science fiction , responding in his writing to emerging technologies such as hot air balloons in " The Balloon-Hoax ". Poe wrote much of his work using themes aimed specifically at mass-market tastes. To that end, his fiction often included elements of popular pseudosciences , such as phrenology and physiognomy . Poe's writing reflects his literary theories, which he presented in his criticism and also in essays such as " The Poetic Principle ". He disliked didacticism and allegory , though he believed that meaning in literature should be an undercurrent just beneath the surface. Works with obvious meanings, he wrote, cease to be art. He believed that work of quality should be brief and focus on a specific single effect. To that end, he believed that the writer should carefully calculate every sentiment and idea. Poe describes his method in writing "The Raven" in the essay " The Philosophy of Composition ", and he claims to have strictly followed this method. It has been questioned whether he really followed this system, however. T. S. Eliot said: "It is difficult for us to read that essay without reflecting that if Poe plotted out his poem with such calculation, he might have taken a little more pains over it: the result hardly does credit to the method." Biographer Joseph Wood Krutch described the essay as "a rather highly ingenious exercise in the art of rationalization". Poe's best-known fiction works are Gothic horror, adhering to the genre's conventions to appeal to the public taste. His most recurring themes deal with questions of death, including its physical signs, the effects of decomposition , concerns of premature burial , the reanimation of the dead, and mourning. Many of his works are generally considered part of the dark romanticism genre, a literary reaction to transcendentalism which Poe strongly disliked. He referred to followers of the transcendental movement as "Frog-Pondians", after the pond on Boston Common , and ridiculed their writings as "metaphor—run mad," lapsing into "obscurity for obscurity's sake" or "mysticism for mysticism's sake". Poe once wrote in a letter to Thomas Holley Chivers that he did not dislike transcendentalists, "only the pretenders and sophists among them". Beyond horror, Poe also wrote satires , humor tales, and hoaxes. For comic effect, he used irony and ludicrous extravagance, often in an attempt to liberate the reader from cultural conformity. " Metzengerstein " is the first story that Poe is known to have published and his first foray into horror, but it was originally intended as a burlesque satirizing the popular genre. Poe also reinvented science fiction , responding in his writing to emerging technologies such as hot air balloons in " The Balloon-Hoax ". Poe wrote much of his work using themes aimed specifically at mass-market tastes. To that end, his fiction often included elements of popular pseudosciences , such as phrenology and physiognomy . Poe's writing reflects his literary theories, which he presented in his criticism and also in essays such as " The Poetic Principle ". He disliked didacticism and allegory , though he believed that meaning in literature should be an undercurrent just beneath the surface. Works with obvious meanings, he wrote, cease to be art. He believed that work of quality should be brief and focus on a specific single effect. To that end, he believed that the writer should carefully calculate every sentiment and idea. Poe describes his method in writing "The Raven" in the essay " The Philosophy of Composition ", and he claims to have strictly followed this method. It has been questioned whether he really followed this system, however. T. S. Eliot said: "It is difficult for us to read that essay without reflecting that if Poe plotted out his poem with such calculation, he might have taken a little more pains over it: the result hardly does credit to the method." Biographer Joseph Wood Krutch described the essay as "a rather highly ingenious exercise in the art of rationalization". During his lifetime, Poe was mostly recognized as a literary critic. Fellow critic James Russell Lowell called him "the most discriminating, philosophical, and fearless critic upon imaginative works who has written in America", suggesting—rhetorically—that he occasionally used prussic acid instead of ink. Poe's caustic reviews earned him the reputation of being a "tomahawk man". A favorite target of Poe's criticism was Boston's acclaimed poet Henry Wadsworth Longfellow , who was often defended by his literary friends in what was later called "The Longfellow War". Poe accused Longfellow of "the heresy of the didactic", writing poetry that was preachy, derivative, and thematically plagiarized. Poe correctly predicted that Longfellow's reputation and style of poetry would decline, concluding, "We grant him high qualities, but deny him the Future". Poe was also known as a writer of fiction and became one of the first American authors of the 19th century to become more popular in Europe than in the United States. Poe is particularly respected in France, in part due to early translations by Charles Baudelaire . Baudelaire's translations became definitive renditions of Poe's work in Continental Europe. Poe's early detective fiction tales featuring C. Auguste Dupin laid the groundwork for future detectives in literature. Sir Arthur Conan Doyle said, "Each [of Poe's detective stories] is a root from which a whole literature has developed.... Where was the detective story until Poe breathed the breath of life into it?" The Mystery Writers of America have named their awards for excellence in the genre the " Edgars ". Poe's work also influenced science fiction, notably Jules Verne , who wrote a sequel to Poe's novel The Narrative of Arthur Gordon Pym of Nantucket called An Antarctic Mystery , also known as The Sphinx of the Ice Fields . Science fiction author H. G. Wells noted, " Pym tells what a very intelligent mind could imagine about the south polar region a century ago". In 2013, The Guardian cited Pym as one of the greatest novels ever written in the English language, and noted its influence on later authors such as Doyle, Henry James , B. Traven , and David Morrell . Horror author and historian H. P. Lovecraft was heavily influenced by Poe's horror tales, dedicating an entire section of his long essay, " Supernatural Horror in Literature ", to his influence on the genre. In his letters, Lovecraft described Poe as his "God of Fiction". Lovecraft's earlier stories express a significant influence from Poe. A later work, At the Mountains of Madness , quotes him and was influenced by The Narrative of Arthur Gordon Pym of Nantucket . Lovecraft also made extensive use of Poe's unity of effect in his fiction. Alfred Hitchcock once said, "It's because I liked Edgar Allan Poe's stories so much that I began to make suspense films". Many references to Poe's works are present in Vladimir Nabokov 's novels. Like many famous artists, Poe's works have spawned imitators. One trend among imitators of Poe has been claims by clairvoyants or psychics to be "channeling" poems from Poe's spirit. One of the most notable of these was Lizzie Doten , who published Poems from the Inner Life in 1863, in which she claimed to have "received" new compositions by Poe's spirit. The compositions were re-workings of famous Poe poems such as " The Bells ", but which reflected a new, positive outlook. Poe has also received criticism. This is partly because of the negative perception of his personal character and its influence upon his reputation. William Butler Yeats was occasionally critical of Poe and once called him "vulgar". Transcendentalist Ralph Waldo Emerson reacted to "The Raven" by saying, "I see nothing in it", and derisively referred to Poe as "the jingle man". Aldous Huxley wrote that Poe's writing "falls into vulgarity" by being "too poetical"—the equivalent of wearing a diamond ring on every finger. It is believed that only twelve copies have survived of Poe's first book Tamerlane and Other Poems . In December 2009, one copy sold at Christie's auctioneers in New York City for $662,500, a record price paid for a work of American literature. Eureka: A Prose Poem , an essay written in 1848, included a cosmological theory that presaged the Big Bang theory by 80 years, as well as the first plausible solution to Olbers' paradox . Poe eschewed the scientific method in Eureka and instead wrote from pure intuition . For this reason, he considered it a work of art, not science, but insisted that it was still true and considered it to be his career masterpiece. Even so, Eureka is full of scientific errors. In particular, Poe's suggestions ignored Newtonian principles regarding the density and rotation of planets. Poe had a keen interest in cryptography . He had placed a notice of his abilities in the Philadelphia paper Alexander's Weekly (Express) Messenger , inviting submissions of ciphers which he proceeded to solve. In July 1841, Poe had published an essay called "A Few Words on Secret Writing" in Graham's Magazine . Capitalizing on public interest in the topic, he wrote " The Gold-Bug " incorporating ciphers as an essential part of the story. Poe's success with cryptography relied not so much on his deep knowledge of that field (his method was limited to the simple substitution cryptogram ) as on his knowledge of the magazine and newspaper culture. His keen analytical abilities, which were so evident in his detective stories, allowed him to see that the general public was largely ignorant of the methods by which a simple substitution cryptogram can be solved, and he used this to his advantage. The sensation that Poe created with his cryptography stunts played a major role in popularizing cryptograms in newspapers and magazines. Two ciphers he published in 1841 under the name "W. B. Tyler" were not solved until 1992 and 2000 respectively. One was a quote from Joseph Addison 's play Cato ; the other is probably based on a poem by Hester Thrale . Poe had an influence on cryptography beyond increasing public interest during his lifetime. William Friedman , America's foremost cryptologist, was heavily influenced by Poe. Friedman's initial interest in cryptography came from reading "The Gold-Bug" as a child, an interest that he later put to use in deciphering Japan's PURPLE code during World War II . During his lifetime, Poe was mostly recognized as a literary critic. Fellow critic James Russell Lowell called him "the most discriminating, philosophical, and fearless critic upon imaginative works who has written in America", suggesting—rhetorically—that he occasionally used prussic acid instead of ink. Poe's caustic reviews earned him the reputation of being a "tomahawk man". A favorite target of Poe's criticism was Boston's acclaimed poet Henry Wadsworth Longfellow , who was often defended by his literary friends in what was later called "The Longfellow War". Poe accused Longfellow of "the heresy of the didactic", writing poetry that was preachy, derivative, and thematically plagiarized. Poe correctly predicted that Longfellow's reputation and style of poetry would decline, concluding, "We grant him high qualities, but deny him the Future". Poe was also known as a writer of fiction and became one of the first American authors of the 19th century to become more popular in Europe than in the United States. Poe is particularly respected in France, in part due to early translations by Charles Baudelaire . Baudelaire's translations became definitive renditions of Poe's work in Continental Europe. Poe's early detective fiction tales featuring C. Auguste Dupin laid the groundwork for future detectives in literature. Sir Arthur Conan Doyle said, "Each [of Poe's detective stories] is a root from which a whole literature has developed.... Where was the detective story until Poe breathed the breath of life into it?" The Mystery Writers of America have named their awards for excellence in the genre the " Edgars ". Poe's work also influenced science fiction, notably Jules Verne , who wrote a sequel to Poe's novel The Narrative of Arthur Gordon Pym of Nantucket called An Antarctic Mystery , also known as The Sphinx of the Ice Fields . Science fiction author H. G. Wells noted, " Pym tells what a very intelligent mind could imagine about the south polar region a century ago". In 2013, The Guardian cited Pym as one of the greatest novels ever written in the English language, and noted its influence on later authors such as Doyle, Henry James , B. Traven , and David Morrell . Horror author and historian H. P. Lovecraft was heavily influenced by Poe's horror tales, dedicating an entire section of his long essay, " Supernatural Horror in Literature ", to his influence on the genre. In his letters, Lovecraft described Poe as his "God of Fiction". Lovecraft's earlier stories express a significant influence from Poe. A later work, At the Mountains of Madness , quotes him and was influenced by The Narrative of Arthur Gordon Pym of Nantucket . Lovecraft also made extensive use of Poe's unity of effect in his fiction. Alfred Hitchcock once said, "It's because I liked Edgar Allan Poe's stories so much that I began to make suspense films". Many references to Poe's works are present in Vladimir Nabokov 's novels. Like many famous artists, Poe's works have spawned imitators. One trend among imitators of Poe has been claims by clairvoyants or psychics to be "channeling" poems from Poe's spirit. One of the most notable of these was Lizzie Doten , who published Poems from the Inner Life in 1863, in which she claimed to have "received" new compositions by Poe's spirit. The compositions were re-workings of famous Poe poems such as " The Bells ", but which reflected a new, positive outlook. Poe has also received criticism. This is partly because of the negative perception of his personal character and its influence upon his reputation. William Butler Yeats was occasionally critical of Poe and once called him "vulgar". Transcendentalist Ralph Waldo Emerson reacted to "The Raven" by saying, "I see nothing in it", and derisively referred to Poe as "the jingle man". Aldous Huxley wrote that Poe's writing "falls into vulgarity" by being "too poetical"—the equivalent of wearing a diamond ring on every finger. It is believed that only twelve copies have survived of Poe's first book Tamerlane and Other Poems . In December 2009, one copy sold at Christie's auctioneers in New York City for $662,500, a record price paid for a work of American literature. Eureka: A Prose Poem , an essay written in 1848, included a cosmological theory that presaged the Big Bang theory by 80 years, as well as the first plausible solution to Olbers' paradox . Poe eschewed the scientific method in Eureka and instead wrote from pure intuition . For this reason, he considered it a work of art, not science, but insisted that it was still true and considered it to be his career masterpiece. Even so, Eureka is full of scientific errors. In particular, Poe's suggestions ignored Newtonian principles regarding the density and rotation of planets. Poe had a keen interest in cryptography . He had placed a notice of his abilities in the Philadelphia paper Alexander's Weekly (Express) Messenger , inviting submissions of ciphers which he proceeded to solve. In July 1841, Poe had published an essay called "A Few Words on Secret Writing" in Graham's Magazine . Capitalizing on public interest in the topic, he wrote " The Gold-Bug " incorporating ciphers as an essential part of the story. Poe's success with cryptography relied not so much on his deep knowledge of that field (his method was limited to the simple substitution cryptogram ) as on his knowledge of the magazine and newspaper culture. His keen analytical abilities, which were so evident in his detective stories, allowed him to see that the general public was largely ignorant of the methods by which a simple substitution cryptogram can be solved, and he used this to his advantage. The sensation that Poe created with his cryptography stunts played a major role in popularizing cryptograms in newspapers and magazines. Two ciphers he published in 1841 under the name "W. B. Tyler" were not solved until 1992 and 2000 respectively. One was a quote from Joseph Addison 's play Cato ; the other is probably based on a poem by Hester Thrale . Poe had an influence on cryptography beyond increasing public interest during his lifetime. William Friedman , America's foremost cryptologist, was heavily influenced by Poe. Friedman's initial interest in cryptography came from reading "The Gold-Bug" as a child, an interest that he later put to use in deciphering Japan's PURPLE code during World War II . The historical Edgar Allan Poe has appeared as a fictionalized character, often in order to represent the "mad genius" or "tormented artist" and in order to exploit his personal struggles. Many such depictions also blend in with characters from his stories, suggesting that Poe and his characters share identities. Often, fictional depictions of Poe use his mystery-solving skills in such novels as The Poe Shadow by Matthew Pearl . No childhood home of Poe is still standing, including the Allan family's Moldavia estate. The oldest standing home in Richmond , the Old Stone House, is in use as the Edgar Allan Poe Museum , though Poe never lived there. The collection includes many items that Poe used during his time with the Allan family, and also features several rare first printings of Poe works. 13 West Range is the dorm room that Poe is believed to have used while studying at the University of Virginia in 1826; it is preserved and available for visits. Its upkeep is overseen by a group of students and staff known as the Raven Society . The earliest surviving home in which Poe lived is at 203 North Amity St. in Baltimore , which is preserved as the Edgar Allan Poe House and Museum . Poe is believed to have lived in the home at the age of 23 when he first lived with Maria Clemm and Virginia and possibly his grandmother and possibly his brother William Henry Leonard Poe. It is open to the public and is also the home of the Edgar Allan Poe Society. While in Philadelphia between 1838 and 1844, Poe lived at at least four different residences, including the Indian Queen Hotel at 15 S. 4th Street, at a residence at 16th and Locust Streets , at 2502 Fairmount Street, and then in the Spring Garden section of the city at 532 N. 7th Street, a residence that has been preserved by the National Park Service as the Edgar Allan Poe National Historic Site . Poe's final home in Bronx , New York City, is preserved as the Edgar Allan Poe Cottage . In Boston , a commemorative plaque on Boylston Street is several blocks away from the actual location of Poe's birth. The house which was his birthplace at 62 Carver Street no longer exists; also, the street has since been renamed "Charles Street South". A "square" at the intersection of Broadway, Fayette, and Carver Streets had once been named in his honor, but it disappeared when the streets were rearranged. In 2009, the intersection of Charles and Boylston Streets (two blocks north of his birthplace) was designated "Edgar Allan Poe Square". In March 2014, fundraising was completed for construction of a permanent memorial sculpture, known as Poe Returning to Boston , at this location. The winning design by Stefanie Rocknak depicts a life-sized Poe striding against the wind, accompanied by a flying raven; his suitcase lid has fallen open, leaving a "paper trail" of literary works embedded in the sidewalk behind him. The public unveiling on October 5, 2014, was attended by former U.S. poet laureate Robert Pinsky . Other Poe landmarks include a building on the Upper West Side , where Poe temporarily lived when he first moved to New York City. A plaque suggests that Poe wrote " The Raven " here. On Sullivan's Island in Charleston County, South Carolina , the setting of Poe's tale " The Gold-Bug " and where Poe served in the Army in 1827 at Fort Moultrie , there is a restaurant called Poe's Tavern. In the Fell's Point section of Baltimore , a bar still stands where legend says that Poe was last seen drinking before his death. Known as "The Horse You Came in On", local lore insists that a ghost whom they call "Edgar" haunts the rooms above. Early daguerreotypes of Poe continue to arouse great interest among literary historians. Notable among them are: Between 1949 and 2009, a bottle of cognac and three roses were left at Poe's original grave marker every January 19 by an unknown visitor affectionately referred to as the "Poe Toaster". Sam Porpora was a historian at the Westminster Church in Baltimore , where Poe is buried; he claimed on August 15, 2007, that he had started the tradition in 1949. Porpora said that the tradition began in order to raise money and enhance the profile of the church. His story has not been confirmed, and some details which he gave to the press are factually inaccurate. The Poe Toaster's last appearance was on January 19, 2009, the day of Poe's bicentennial. The historical Edgar Allan Poe has appeared as a fictionalized character, often in order to represent the "mad genius" or "tormented artist" and in order to exploit his personal struggles. Many such depictions also blend in with characters from his stories, suggesting that Poe and his characters share identities. Often, fictional depictions of Poe use his mystery-solving skills in such novels as The Poe Shadow by Matthew Pearl . No childhood home of Poe is still standing, including the Allan family's Moldavia estate. The oldest standing home in Richmond , the Old Stone House, is in use as the Edgar Allan Poe Museum , though Poe never lived there. The collection includes many items that Poe used during his time with the Allan family, and also features several rare first printings of Poe works. 13 West Range is the dorm room that Poe is believed to have used while studying at the University of Virginia in 1826; it is preserved and available for visits. Its upkeep is overseen by a group of students and staff known as the Raven Society . The earliest surviving home in which Poe lived is at 203 North Amity St. in Baltimore , which is preserved as the Edgar Allan Poe House and Museum . Poe is believed to have lived in the home at the age of 23 when he first lived with Maria Clemm and Virginia and possibly his grandmother and possibly his brother William Henry Leonard Poe. It is open to the public and is also the home of the Edgar Allan Poe Society. While in Philadelphia between 1838 and 1844, Poe lived at at least four different residences, including the Indian Queen Hotel at 15 S. 4th Street, at a residence at 16th and Locust Streets , at 2502 Fairmount Street, and then in the Spring Garden section of the city at 532 N. 7th Street, a residence that has been preserved by the National Park Service as the Edgar Allan Poe National Historic Site . Poe's final home in Bronx , New York City, is preserved as the Edgar Allan Poe Cottage . In Boston , a commemorative plaque on Boylston Street is several blocks away from the actual location of Poe's birth. The house which was his birthplace at 62 Carver Street no longer exists; also, the street has since been renamed "Charles Street South". A "square" at the intersection of Broadway, Fayette, and Carver Streets had once been named in his honor, but it disappeared when the streets were rearranged. In 2009, the intersection of Charles and Boylston Streets (two blocks north of his birthplace) was designated "Edgar Allan Poe Square". In March 2014, fundraising was completed for construction of a permanent memorial sculpture, known as Poe Returning to Boston , at this location. The winning design by Stefanie Rocknak depicts a life-sized Poe striding against the wind, accompanied by a flying raven; his suitcase lid has fallen open, leaving a "paper trail" of literary works embedded in the sidewalk behind him. The public unveiling on October 5, 2014, was attended by former U.S. poet laureate Robert Pinsky . Other Poe landmarks include a building on the Upper West Side , where Poe temporarily lived when he first moved to New York City. A plaque suggests that Poe wrote " The Raven " here. On Sullivan's Island in Charleston County, South Carolina , the setting of Poe's tale " The Gold-Bug " and where Poe served in the Army in 1827 at Fort Moultrie , there is a restaurant called Poe's Tavern. In the Fell's Point section of Baltimore , a bar still stands where legend says that Poe was last seen drinking before his death. Known as "The Horse You Came in On", local lore insists that a ghost whom they call "Edgar" haunts the rooms above. Early daguerreotypes of Poe continue to arouse great interest among literary historians. Notable among them are:Between 1949 and 2009, a bottle of cognac and three roses were left at Poe's original grave marker every January 19 by an unknown visitor affectionately referred to as the "Poe Toaster". Sam Porpora was a historian at the Westminster Church in Baltimore , where Poe is buried; he claimed on August 15, 2007, that he had started the tradition in 1949. Porpora said that the tradition began in order to raise money and enhance the profile of the church. His story has not been confirmed, and some details which he gave to the press are factually inaccurate. The Poe Toaster's last appearance was on January 19, 2009, the day of Poe's bicentennial. Short stories Poetry Other works

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Cholera

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2009 Papua New Guinea cholera outbreak

The Papua New Guinea cholera outbreak was an outbreak of cholera along the Northern Coast of Papua New Guinea . It was the country's first outbreak of cholera in 50 years, and spread across the country from two coastal villages near Lae to villages around MAdang and to remote areas along the Sepik River. [ citation needed ]The outbreak began in Morobe Province in July 2009, but by February 2010, it had spread to Madang and East Sepik , according to World Health Organization representative Eigil Sorensen . The rapid spread of the disease was due to poor water sanitation, and travel by infected people who did not show symptoms. According to Sorensen, many areas of Papua New Guinea, often crowded settlements or the outskirts of cities with no proper sewage systems, provided the "ideal conditions" for a nationwide cholera epidemic, and the disease was "gradually spreading" all over the country. An estimated 2,000 cases have been confirmed, but only 50 people have died.

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Cholera

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Haridwar Kumbh Mela

Haridwar Kumbh Mela is a mela , associated with Hinduism and held in the city of Haridwar , India held every 12 years. The exact date is determined according to Hindu astrology : the Mela is held when Jupiter is in Aquarius and the Sun enters Aries . The event possesses deep religious significance to Hindus as well as other spiritual seekers. Historically, it was an important commercial event and was attended by merchants from as far as Arabia . The Haridwar Kumbh Mela had happened from 1 April to 30 April in the year 2021 amidst the COVID-19 pandemic . An Ardh Kumbh ("Half Kumbh") Mela is held six years after a Kumbh Mela. The last Ardh Kumbh Mela took place in 2016. Haridwar is one of the four sites of Kumbh Mela, the others being Prayag (Allahabad), Trimbak (Nashik), and Ujjain . Although there are several references to riverside bathing festivals in ancient Indian literature, the exact age of the Kumbh Mela is uncertain. [ citation needed ] The fair at Haridwar appears to be the original Kumbh Mela, since it is held according to the astrological sign Kumbha (Aquarius), and because there are several references to a 12-year cycle for it. The Haridwar Kumbh Mela dates at least from the early 1600s. The earliest extant texts that use the name "Kumbha Mela" are Khulasat-ut-Tawarikh (1695) and Chahar Gulshan (1789). Both these texts use the term "Kumbh Mela" to describe only Haridwar's fair, although they mention the similar fairs at Allahabad (the annual Magh Mela) and Nashik (the Simhastha ). The Kumbh Mela at the other three places seems to be an adaptation of Haridwar's Kumbh Mela to the pre-existing local festivals. The Muslim conqueror Timur invaded Haridwar in 1398, and massacred a number of pilgrims, possibly at a Kumbh Mela. Dabestan-e Mazaheb (c. 1655) of Mohsin Fani mentions a battle at Haridwar between competing akharas in 1640, possibly at a Kumbh Mela. The Khulasat-ut-Tawarikh (1695), mentions the mela in its description of the Delhi subah of the Mughal Empire. It states that every year when Sun entered Aries during Vaisakhi , people from nearby rural areas would assemble at Haridwar. Once in 12 years, when the Sun entered Aquarius (Kumbh), people from far away would assemble at Haridwar. On this occasion, bathing in the river, giving alms and shaving hair would be considered as acts of merit. People would throw the bones of their dead into the river for their salvation of the deceased. The Chahar Gulshan (1759) also states that the mela at Haridwar is held in the Baisakh month when Jupiter enters Aquarius. It specifically mentions that the fair was called Kumbh Mela and that lakhs of laymen, faqirs and sanyasis attended it. It states that the local sanyasis attacked the fakirs of Prayag who came to attend the mela. By the mid-18th century, the Haridwar Kumbh Mela had become a major commercial event in north-western India. The 1760 festival saw a violent clash between the Shaivite Gosains and the Vaishnavite Bairagis (ascetics). After the 1760 clash, the Vaishnavite sadhus were not allowed to bathe at Haridwar for years, until the British took control of the festival and disarmed the Saivites. According to an 1808 account by East India Company geographer Captain Francis Raper, 18,000 Bairagis were killed in the 1760 clash. Raper stated this in context of stressing the importance of deploying security forces at the event. In 1888, the District Magistrate of Allahabad wrote that the number of deaths "must doubtless have been greatly exaggerated" by Raper. According to historian Michael Cook , the number could have been 1800. A cholera epidemic broke out during the 1783 Kumbh Mela in Haridwar. An estimated 1–2 million visitors attended the fair this year. Out of these, more than 20,000 died of cholera within the first eight days. The epidemic was confined to the Haridwar city and ended with the fair. The neighbouring village of Jwalapur (now a town), which was around 8 miles away from the city, did not see any cases of cholera. The first eyewitness British account of the Kumbh mela was an article by Captain Thomas Hardwicke in Asiatick Researches . At this time, Haridwar was part of the Maratha territory. Based on a register of taxes collected from the pilgrims, Hardwicke estimated the scale of the mela at 2-2.5 million people. According to Hardwicke, the Shaivite Gosains were the most dominant, "in point of numbers and power". The next most powerful sect were the Vaishnavite Bairagis. The Gosains carried swords, shields and managed the entire Mela. Their mahants held daily councils to hear and decide on all the complaints. The Gosains levied and collected the taxes, and did not remit any money to the Maratha treasury. The Sikh contingent at the mela included a large number of Udasi ascetics, who were accompanied by around 12,000-14,000 Khalsa cavalrymen. The cavalry was led by Sahib Singh of Patiala , Rai Singh Bhangi and Sher Singh Bhangi. The Sikh soldiers encamped at Jwalapur, while the Udasis chose a place close to the festival site for their camp. The Udasi chief erected their flag on the selected site, without taking permission from the Gosain mahant. Offended by this, the Gosains pulled down the Udasis' flag and drove them away. When Udasis resisted, the Gosains responded violently, and plundered the Udasi camp. The Udasi chief then complained to Sahib Singh. The three Sikh chiefs held a meeting, and sent a vakeel (agent) to the Gosain mahants, demanding retribution for the plundered material, plus free access to the river. The chief Mahant agreed to the Sikh demands, and there was no confrontation between the two groups over the next few days. However, at about 8 am on 10 April 1796 (the last day of the Mela), Sikhs attacked the Gosains and other non-Udasi pilgrims. Prior to this, they had moved the women and children in their camp to a village near Haridwar. The Sikhs killed around 500 Gosains, including Maunpuri, one of the mahants. Many drowned while crossing the river in an attempt to escape the massacre. The British Captain Murray, whose battalion was stationed at one of the ghats, sent two companies of sepoys to check the advance of Sikh cavalry. The Sikhs left by 3 pm; they had lost around 20 men in the clash. The next morning, the pilgrims offered prayers for the English, who they believed, had been instrumental in dispersing the Sikhs. The 1760 festival saw a violent clash between the Shaivite Gosains and the Vaishnavite Bairagis (ascetics). After the 1760 clash, the Vaishnavite sadhus were not allowed to bathe at Haridwar for years, until the British took control of the festival and disarmed the Saivites. According to an 1808 account by East India Company geographer Captain Francis Raper, 18,000 Bairagis were killed in the 1760 clash. Raper stated this in context of stressing the importance of deploying security forces at the event. In 1888, the District Magistrate of Allahabad wrote that the number of deaths "must doubtless have been greatly exaggerated" by Raper. According to historian Michael Cook , the number could have been 1800. A cholera epidemic broke out during the 1783 Kumbh Mela in Haridwar. An estimated 1–2 million visitors attended the fair this year. Out of these, more than 20,000 died of cholera within the first eight days. The epidemic was confined to the Haridwar city and ended with the fair. The neighbouring village of Jwalapur (now a town), which was around 8 miles away from the city, did not see any cases of cholera. The first eyewitness British account of the Kumbh mela was an article by Captain Thomas Hardwicke in Asiatick Researches . At this time, Haridwar was part of the Maratha territory. Based on a register of taxes collected from the pilgrims, Hardwicke estimated the scale of the mela at 2-2.5 million people. According to Hardwicke, the Shaivite Gosains were the most dominant, "in point of numbers and power". The next most powerful sect were the Vaishnavite Bairagis. The Gosains carried swords, shields and managed the entire Mela. Their mahants held daily councils to hear and decide on all the complaints. The Gosains levied and collected the taxes, and did not remit any money to the Maratha treasury. The Sikh contingent at the mela included a large number of Udasi ascetics, who were accompanied by around 12,000-14,000 Khalsa cavalrymen. The cavalry was led by Sahib Singh of Patiala , Rai Singh Bhangi and Sher Singh Bhangi. The Sikh soldiers encamped at Jwalapur, while the Udasis chose a place close to the festival site for their camp. The Udasi chief erected their flag on the selected site, without taking permission from the Gosain mahant. Offended by this, the Gosains pulled down the Udasis' flag and drove them away. When Udasis resisted, the Gosains responded violently, and plundered the Udasi camp. The Udasi chief then complained to Sahib Singh. The three Sikh chiefs held a meeting, and sent a vakeel (agent) to the Gosain mahants, demanding retribution for the plundered material, plus free access to the river. The chief Mahant agreed to the Sikh demands, and there was no confrontation between the two groups over the next few days. However, at about 8 am on 10 April 1796 (the last day of the Mela), Sikhs attacked the Gosains and other non-Udasi pilgrims. Prior to this, they had moved the women and children in their camp to a village near Haridwar. The Sikhs killed around 500 Gosains, including Maunpuri, one of the mahants. Many drowned while crossing the river in an attempt to escape the massacre. The British Captain Murray, whose battalion was stationed at one of the ghats, sent two companies of sepoys to check the advance of Sikh cavalry. The Sikhs left by 3 pm; they had lost around 20 men in the clash. The next morning, the pilgrims offered prayers for the English, who they believed, had been instrumental in dispersing the Sikhs. In 1804, the Marathas ceded the Saharanpur district (of which Haridwar was a part at that time) to the East India Company . Before the Company rule , the Kumbh Mela at Haridwar was managed by the akharas (sects) of Hindu ascetics known as the sadhus . The Marathas taxed the vehicles and goods coming to all other melas, but during the Kumbh Mela, they temporarily transferred all the power to the akharas. The Sadhus were both traders and warriors. Besides collecting taxes, they also carried out policing and judicial duties. The Company administration severely limited the trader-warrior role of the Sadhus, who were increasingly reduced to begging. After the 1857 uprising , the East India Company was dissolved and its territories came under the control of British crown. British civil servant Robert Montgomery Martin , in his book The Indian Empire (1858), remarked that "it is difficult to convey an adequate idea of the grandeur and beauty" of the Kumbh Mela at Haridwar. According to him, the visitors at the fair included people from a large number of races and regions. Besides priests, soldiers, and religious mendicants, the fair was attended by a large number of merchants: horse traders , elephant dealers, grain merchants ( banias ), confectioners ( Halwais ), cloth merchants and toy sellers. The horse dealers came from as far as Bukhara , Kabul , Turkistan , Arabia and Persia . Besides horses and elephants, several other animals were sold at the fair, including "bears, leopards, tigers, deer of all kinds, monkeys, Persian greyhounds, beautiful cats, and rare birds". Europeans also sold their merchandise at the fair. The fair was also attended by the dancing girls , who performed for the rich visitors. Several Hindu rajas , Muslim Nawabs and the Sikh royals also visited the fair. Begum Samru of Sardhana would often come to the fair, with her retinue of 1,000 horse cavalry and 1,500 infantry. A few Christian missionaries also visited the Mela, and distributed copies of the Bible translated into "the various dialects of the East". Martin mentions that the Brahmins collected the taxes, but did not perform any sacerdotal role in the bathing rites, which were performed without any priestly ceremonies. He states that in the earlier years, a number of people died in stampedes as devotees rushed towards the river bank. However, the danger of stampedes had reduced since the government constructed a new ghat and widened the road leading to it. The police and civil magistrates were deployed to maintain law and order. The Sirmoor battalion of Gurkha soldiers from Dehradun was deployed to maintain peace. The pilgrim camp for the 1867 Mela was located a 9-mile strip of river-side land, and varied 2 to 6 miles in width at different places. According to a rough census of the pilgrim camp, taken on the night of 9 April 1867 by the British, the number of pilgrims was 2,855,966. The total number of pilgrims, including those who visited the camp before and after 9 April, was estimated at around 3 million. H.D. Robertson, the Magistrate of Saharanpur, led the Mela management. The administration strictly controlled the food supplies to prevent inflated prices, and ordered destruction of contaminated food to prevent outbreak of diseases. The 1867 Kumbh Mela was the first fair to officially involve the sanitary department of the British Indian government. Native policemen were deployed to detect cases of infectious disease, which people hid to avoid being quarantined and isolated from their relatives. In accordance with the Contagious Diseases Acts , the policemen also hunted down unregistered prostitutes and forced them to undergo medical tests. Public latrines and trenches for waste disposal were introduced during the 1867 Mela. However, they were not very popular with the pilgrims, many of whom continued open defecation near the fair site and in the nearby woods. A number of policemen were assigned to the "conservancy" duty, which involved preventing people from defecating in the open, and herding them to latrines. Many pilgrims, especially women, would abstain from relieving themselves during their 2-3-day stay at the fair. Like the previous Melas, cases of cholera were reported at the 1867 Mela, but an epidemic was prevented. On 9 April, a grass-cutter belonging to the 14th Bengal Cavalry 's station near Kankhal suffered from cholera. He recovered quickly under treatment. On 13 April, 8 cases of cholera were reported at the pilgrim camp. By 15 April, the number of cases had increased to 19, but this was a small number compared to the 20,000 cholera-related deaths in 1783. While the sanitary conditions and waste disposal facilities had improved, the containment of a potential cholera epidemic can be attributed to the fact that the ceremonies were largely over by the time the disease broke out. Pilgrims had started departing on the noon of 12 April, and by 15 April, the campground was vacant. It is possible that several of the departing pilgrims had been infected, and disseminated the disease across northern India. In the subsequent Melas, there was a large number of cholera-related deaths. The 1867 Mela was also noted for improved traffic management. Special bridges were constructed to ensure a smooth flow of pilgrims from camps to the bathing ghat. Separate routes were designated for going to and return from the ghat, and a unidirectional traffic was maintained to avoid any stampede. For the first time, animals were not permitted in the town on the day of the shahi snan . During the next Kumbh Mela in 1879, the traffic arrangements were further controlled. The pilgrims were "marshalled in orderly lines" by the police. During the 1885 Ardh Kumbh fair, the policemen set up entry barriers for the ghats, in order to avoid stampedes. The next few Kumbh Melas played a major role in the spread of cholera outbreaks and pandemics . Mass bathing, as well as the practice of pilgrims bringing back Ganges water (which was contaminated) for sipping by relatives, transmitted the disease widely. Although the Waldemar Haffkine developed a Cholera vaccine , the British Indian government rejected the suggestions of compulsory vaccination for a long time, fearing possible public protests and political fallout. Following another cholera outbreak in 1945, compulsory cholera vaccinations were ordered at the 1945 Haridwar Kumbh Mela. The pilgrim camp for the 1867 Mela was located a 9-mile strip of river-side land, and varied 2 to 6 miles in width at different places. According to a rough census of the pilgrim camp, taken on the night of 9 April 1867 by the British, the number of pilgrims was 2,855,966. The total number of pilgrims, including those who visited the camp before and after 9 April, was estimated at around 3 million. H.D. Robertson, the Magistrate of Saharanpur, led the Mela management. The administration strictly controlled the food supplies to prevent inflated prices, and ordered destruction of contaminated food to prevent outbreak of diseases. The 1867 Kumbh Mela was the first fair to officially involve the sanitary department of the British Indian government. Native policemen were deployed to detect cases of infectious disease, which people hid to avoid being quarantined and isolated from their relatives. In accordance with the Contagious Diseases Acts , the policemen also hunted down unregistered prostitutes and forced them to undergo medical tests. Public latrines and trenches for waste disposal were introduced during the 1867 Mela. However, they were not very popular with the pilgrims, many of whom continued open defecation near the fair site and in the nearby woods. A number of policemen were assigned to the "conservancy" duty, which involved preventing people from defecating in the open, and herding them to latrines. Many pilgrims, especially women, would abstain from relieving themselves during their 2-3-day stay at the fair. Like the previous Melas, cases of cholera were reported at the 1867 Mela, but an epidemic was prevented. On 9 April, a grass-cutter belonging to the 14th Bengal Cavalry 's station near Kankhal suffered from cholera. He recovered quickly under treatment. On 13 April, 8 cases of cholera were reported at the pilgrim camp. By 15 April, the number of cases had increased to 19, but this was a small number compared to the 20,000 cholera-related deaths in 1783. While the sanitary conditions and waste disposal facilities had improved, the containment of a potential cholera epidemic can be attributed to the fact that the ceremonies were largely over by the time the disease broke out. Pilgrims had started departing on the noon of 12 April, and by 15 April, the campground was vacant. It is possible that several of the departing pilgrims had been infected, and disseminated the disease across northern India. In the subsequent Melas, there was a large number of cholera-related deaths. The 1867 Mela was also noted for improved traffic management. Special bridges were constructed to ensure a smooth flow of pilgrims from camps to the bathing ghat. Separate routes were designated for going to and return from the ghat, and a unidirectional traffic was maintained to avoid any stampede. For the first time, animals were not permitted in the town on the day of the shahi snan . During the next Kumbh Mela in 1879, the traffic arrangements were further controlled. The pilgrims were "marshalled in orderly lines" by the police. During the 1885 Ardh Kumbh fair, the policemen set up entry barriers for the ghats, in order to avoid stampedes. The next few Kumbh Melas played a major role in the spread of cholera outbreaks and pandemics . Mass bathing, as well as the practice of pilgrims bringing back Ganges water (which was contaminated) for sipping by relatives, transmitted the disease widely. Although the Waldemar Haffkine developed a Cholera vaccine , the British Indian government rejected the suggestions of compulsory vaccination for a long time, fearing possible public protests and political fallout. Following another cholera outbreak in 1945, compulsory cholera vaccinations were ordered at the 1945 Haridwar Kumbh Mela. Around forty-seven people were killed in a stampede on 14 April during the 1986 Kumbh Mela. For two hours, around 20,000 pilgrims had been waiting in a police cordon, to cross a bridge near Pant Dweep island to go to Har Ki Pauri . When some of them surged forward, the police resorted to a mild lathi charge . The stampede began when a person slipped near the Pant Dweep. However, Inderjit Bhadwar of India Today praised the overall Mela arrangements, stating that Haridwar was "cleaner, and more sanitary than it has ever been". The administration, led by District Magistrate Arun Kumar Mishra, hired 5,000 sweepers to clean the 35 km 2 Mela area daily. Thousands of urinals and outhouses were constructed. The administration constructed 20 bridges and several temporary roads. Tented colonies were established and rented at a rate of 5 paise per square foot. Ten filtration wells were constructed and the water pumping capacity was raised to 69 million litres per day. The power capacity was doubled with 100 km of electrical wiring and backup generators. Eighty new ration shops and over a hundred milk booths were set up. Forty first aid stations with eighty-five doctors were established. 10,000 policemen, including commando units and intelligence squad, were deployed to maintain law and order. [ additional citation(s) needed ] The Government of India used the Kumbh Mela to promote tourism. Newspaper ads described it as "a rare opportunity for a soul-purifying experience". The Mela featured luxury tent facilities offered by private businesses, restaurants, badminton courts, bonfire pits, whitewater rafting and a Tyrannosaurus rex display. Haridwar hosted the Purna Kumbh mela from Makar Sankranti (14 January 2010) to Shakh Purnima Snan (28 April 2010). Millions of Hindu pilgrims attended the mela . On 14 April 2010, alone approximately 10 million people bathed in the Ganges river. According to officials by mid April about 40 million people had bathed since 14 January 2010. Hundreds of foreigners joined Indian pilgrims in the festival which is thought to be the largest religious gathering in the world. To accommodate the large number of pilgrims Indian Railways ran special trains. At least 5 people died in a stampede after clashes between holy men and devotees. Indian Space Research Organisation took satellite pictures of the crowds with the hope of improving the conduct of the festival in the future. Despite environmental improvements, the MahaKumbh mela remained a highly unsanitary event. The 2021 Haridwar Kumbh Mela was held during the COVID pandemic , leading to concerns that large crowds would contribute to the rise in COVID cases, making it a super spreader event. The government refused to cancel or cut short the event. On 5 April 2021, government officials expressed concern that the event might become a superspreader. When this was reported in the press, the Ministry of Health and Family Welfare responded with a tweet that it was "fake news". The Union Health Ministry issued a list of Standard Operating Procedures to prevent the spread of COVID during the event, including a mandatory negative RT-PCR test report for the attendees. However, many attendees refused to follow the guidelines, refusing to wear masks or practice social distancing. On 14 April 2021, 943,452 people took a holy dip in the River Ganges. Between 5 and 15 April 2021, 68 seers in Haridwar tested positive for COVID-19. During 10–14 April, 1701 attendees tested positive for COVID. An unnamed senior Uttarakhand official said: "It is already a super-spreader because there is no space to test hundreds of thousands in a crammed city and the government neither has the facilities nor the manpower". Mahamandaleshwar Kapil Dev Das, head of one of the Hindu akhadas, or ascetic councils, died on 15 April 2021 from COVID-19. According to a report from Madhya Pradesh, 59 out 60 of Kumbh Mela returnees from Haridwar had tested positive for COVID-19 and 22 pilgrims could not be traced. The Niranjani Akhara withdrew from the Shahi Snan scheduled on 27 April due to the rising COVID cases in Uttarakhand. After a number of sadhus tested positive, Prime Minister Narendra Modi appealed through the telephonic call with Acharya Mahamandleshwar Swami Avdheshanand Giri, of the oldest and largest Juna Akhara , and to the attendees to keep the Kumbh Mela symbolic. After which, within just a few hours of the call with PM, Swami Avdheshanand Giri announced the closure of Kumbh Mela, giving respect to the PM's appeal and with a belief that saving lives is a holy deed. Normally, Kumbh Mela lasts four months; Kumbh Mela at Haridwar had been limited to 30 days in April 2021. Around forty-seven people were killed in a stampede on 14 April during the 1986 Kumbh Mela. For two hours, around 20,000 pilgrims had been waiting in a police cordon, to cross a bridge near Pant Dweep island to go to Har Ki Pauri . When some of them surged forward, the police resorted to a mild lathi charge . The stampede began when a person slipped near the Pant Dweep. However, Inderjit Bhadwar of India Today praised the overall Mela arrangements, stating that Haridwar was "cleaner, and more sanitary than it has ever been". The administration, led by District Magistrate Arun Kumar Mishra, hired 5,000 sweepers to clean the 35 km 2 Mela area daily. Thousands of urinals and outhouses were constructed. The administration constructed 20 bridges and several temporary roads. Tented colonies were established and rented at a rate of 5 paise per square foot. Ten filtration wells were constructed and the water pumping capacity was raised to 69 million litres per day. The power capacity was doubled with 100 km of electrical wiring and backup generators. Eighty new ration shops and over a hundred milk booths were set up. Forty first aid stations with eighty-five doctors were established. 10,000 policemen, including commando units and intelligence squad, were deployed to maintain law and order. [ additional citation(s) needed ]The Government of India used the Kumbh Mela to promote tourism. Newspaper ads described it as "a rare opportunity for a soul-purifying experience". The Mela featured luxury tent facilities offered by private businesses, restaurants, badminton courts, bonfire pits, whitewater rafting and a Tyrannosaurus rex display. Haridwar hosted the Purna Kumbh mela from Makar Sankranti (14 January 2010) to Shakh Purnima Snan (28 April 2010). Millions of Hindu pilgrims attended the mela . On 14 April 2010, alone approximately 10 million people bathed in the Ganges river. According to officials by mid April about 40 million people had bathed since 14 January 2010. Hundreds of foreigners joined Indian pilgrims in the festival which is thought to be the largest religious gathering in the world. To accommodate the large number of pilgrims Indian Railways ran special trains. At least 5 people died in a stampede after clashes between holy men and devotees. Indian Space Research Organisation took satellite pictures of the crowds with the hope of improving the conduct of the festival in the future. Despite environmental improvements, the MahaKumbh mela remained a highly unsanitary event. The 2021 Haridwar Kumbh Mela was held during the COVID pandemic , leading to concerns that large crowds would contribute to the rise in COVID cases, making it a super spreader event. The government refused to cancel or cut short the event. On 5 April 2021, government officials expressed concern that the event might become a superspreader. When this was reported in the press, the Ministry of Health and Family Welfare responded with a tweet that it was "fake news". The Union Health Ministry issued a list of Standard Operating Procedures to prevent the spread of COVID during the event, including a mandatory negative RT-PCR test report for the attendees. However, many attendees refused to follow the guidelines, refusing to wear masks or practice social distancing. On 14 April 2021, 943,452 people took a holy dip in the River Ganges. Between 5 and 15 April 2021, 68 seers in Haridwar tested positive for COVID-19. During 10–14 April, 1701 attendees tested positive for COVID. An unnamed senior Uttarakhand official said: "It is already a super-spreader because there is no space to test hundreds of thousands in a crammed city and the government neither has the facilities nor the manpower". Mahamandaleshwar Kapil Dev Das, head of one of the Hindu akhadas, or ascetic councils, died on 15 April 2021 from COVID-19. According to a report from Madhya Pradesh, 59 out 60 of Kumbh Mela returnees from Haridwar had tested positive for COVID-19 and 22 pilgrims could not be traced. The Niranjani Akhara withdrew from the Shahi Snan scheduled on 27 April due to the rising COVID cases in Uttarakhand. After a number of sadhus tested positive, Prime Minister Narendra Modi appealed through the telephonic call with Acharya Mahamandleshwar Swami Avdheshanand Giri, of the oldest and largest Juna Akhara , and to the attendees to keep the Kumbh Mela symbolic. After which, within just a few hours of the call with PM, Swami Avdheshanand Giri announced the closure of Kumbh Mela, giving respect to the PM's appeal and with a belief that saving lives is a holy deed. Normally, Kumbh Mela lasts four months; Kumbh Mela at Haridwar had been limited to 30 days in April 2021.

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Zamzam Well

The Zamzam Well ( Arabic : بئر ز٠ز٠, romanized : Biʾru Zamzam Arabic pronunciation: [ biʔru zam.zam ] ) is a well located within the Masjid al-Haram in Mecca , Saudi Arabia. It is located 20 m (66 ft) east of the Kaaba , the holiest place in Islam . According to Islamic narratives, the well is a miraculously generated source of water, which opened up thousands of years ago when the son of Ibrahim ( Abraham ), Ismaʿil ( Ishmael ), was left with his mother Hajar ( Hagar ) in the desert. It is stated to have dried up during the settlement of the Jurhum in the area and to have been rediscovered in the 6th century by Abd al-Muttalib , grandfather of Muhammad . Millions of pilgrims visit Mecca and Medina each year to perform the hajj or umrah and drink water from the zamzam well.The origin of the name is uncertain. According to historian Jacqueline Chabbi , the noun Arabic : ز٠ز٠, romanized : Zamzam is an onomatopoeia . She associates the noun with the adjectives Arabic : ز٠ز٠, romanized : zamzam and Arabic : ز٠از٠, romanized : zumāzim which are onomatopoeic denoting a dull sound stemming from either a distant roll (of thunder) or a guttural sound emitted with a closed mouth by animals or people, however meaning either 'an abundant supply of water' or 'a source of water which does not dry up' if applied to Arabic : ٠اء , romanized : māʾ , lit. ' water ' . She states that this latter meaning of an unintelligible guttural sound encompasses a layer of meaning associated with the sacred and mystical, in addition to the basic notion of the sound possibly being related to the concept of an abundant flow of water. Early Islamic sources use the terms Arabic : ز٠ز٠, romanized : zamzama and Arabic : ز٠از٠, romanized : zamāzima to refer to the religious rites of Zoroastrianism and the Zoroastrians. The terms are onomatopoeic and derive from what Arabs perceived to be an indistinct, droning sound of the recitation of Avestan prayers and scriptures by Magi . [lower-alpha 1] Mediaeval Arabic writers like al-Masʿūdī generally state the well is named on the account of Arabic : ز٠ز٠, romanized : zamzama , lit. ' prayers recited by Zoroastrians ' . They argue that based on their "kinship with Abraham " Zoroastrians regularly made pilgrimages to Mecca to pray over the well. A later account by al-ʿAynī claims that the well is named after Arabic : ز٠از٠, romanized : zamāzima supposedly meaning "bridles" which had been donated to the well by and named after Sasan , the Zoroastrian progenitor of the Sasanian Empire . Other medieval Arabic sources connect the name to the Angel Gabriel being the source of the murmuring being captured by this onomatopoeia. Hughes additionally identifies a tradition of deriving the name from an exclamation supposedly made by Hajar either being Arabic : ز٠، ز٠! , romanized : zamm, zamm! , lit. ' fill, fill! ' or supposedly Egyptian meaning "Stop, stop!". [lower-alpha 2] Islamic tradition states that the Zamzam Well was opened up in some form by God to assist Hajar , the second wife of Ibrahim and mother of Ismaʿil . In Islamic narratives Ibrahim, commanded by God, led Hajar and Ismaʿil to the area of present-day Mecca, there he left them alone in the desert. The two are narrated to have been suffering severely from thirst. In some versions of the story Hajar walks back and forth between the two hills of Safa and Marwah in search of water. [lower-alpha 3] The story of the appearance of the well either involves the infant Isma'il scraping the ground with his feet and water springing out or God sending Gabriel ( Jibra'il ) who consequently opens up the well using a variety of methods depending on the narration. The wealth of mystic discourses discussing the history of the well is from the Abbasid era and largely extra-Quranic, as the well is not referred to directly by the Quran. According to Islamic tradition, Ibrahim rebuilt a shrine called Arabic : بيت ٱللَّٰه , romanized : Baytu 'l-llah , lit. ' House of God ' near the site of the well. A building supposedly first constructed by Adam , which Muslim tradition regards as the origin of the Kaʿba . [lower-alpha 4] The well is meant to have dried up (possibly as punishment) during the settlement of the tribe of the Jurhum , who initially are meant to have migrated to the area from Yemen. In some narrations focused on the objects deposited in Zamzam the well simply dries up, then prior to the Jurhum being forced to leave Mecca because of God expelling them for their misdeeds their leader buries sacred objects from the Kaʿba in the location of Zamzam. In others, focused on the well itself, the objects are placed in Zamzam itself, with the well ultimately being buried by the leader of the Jurhum. According to traditional Muslim accounts, ʿAbd al-Muṭṭalib , grandfather of Muhammad , is responsible for the rediscovery of the well. He purportedly had a divine precognition about the well at some point in his life. A common narrative relayed by Ibn Ishaq via Ibn Hisham involves four dreams, the first three concern mysterious objects called Arabic : طيبة , romanized : Ṭayba , Arabic : برة , romanized : Barra and Arabic : ال٠ضنونة , romanized : al-Maḍnūna he is meant to dig for, the fourth then names Zamzam. Other accounts omit the third dream naming Arabic : ال٠ضنونة , romanized : al-Maḍnūna . [lower-alpha 5] Following ʿAbd al-Muṭṭalib's precognitions to dig, he is claimed to have found a number of artefacts: golden gazelle figurines, armour, and several specimens of a type of sword called Arabic : السيف القلعى , romanized : as-Sayf al-Qalaʿī , lit. ' Qalaʿī sword ' . Ibn Saʿd relays two separate traditions regarding the discovery of a well by ʿAbd al-Muṭṭalib, one involving Zamzam's discovery and water disputes among the Quraysh , the other involving the series of dreams and said artefacts but neither water nor the name Zamzam. Hawting's analysis argues that the oral traditions surrounding the Arabic : بئر الكعبة , romanized : Biʾru 'l-Kaʿba , lit. ' Well of the Kaʿba ' , a dry well inside the Kaʿba reputed to have been used as the treasury of the Kaʿba and as a place for religious offerings in pre-Islamic Mecca and Zamzam merged at some point with stories concerning the former being adapted to feature the latter. Commentators of the Abbasid-era mystic discourses surrounding the well, like al-Masʿūdī expanded on these extra-Quranic accounts. They further connect the site to Zoroastrianism via what they interpret to be Zoroastrian religious artefacts uncovered by ʿAbd al-Muṭṭalib in combination with their etymological analyses. Ultimately arguing that due to the well's history supposedly being related to (what they perceive to have been) the true religion of the peoples of Iran , the Islamisation of Iran is to be understood and framed as a rediscovery. The traditional Islamic account of the well's history relayed by al-Azraqī traces the lineage of its management via to Abū Tālib as inherited from its (re)-discoverer and his father ʿAbd al-Muṭṭalib . The usage rights to the well were then supposedly sold due to Abū Tālib's financial troubles to his brother, al-ʿAbbās , who is meant to have instituted the first new ordinance concerning the well by banning all non-religious body-hygienic uses of it. Thus the management of the Zamzam Well (a responsibility called Arabic : سقاية , romanized : siqāya , lit. ' giving of water ' ) was reputedly a hereditary position of the Abbasids , i.e. the progeny of al-ʿAbbās, who ended up seizing control over Mecca as a whole using their caliphate . Buildings called the Arabic : بيت الشراب‎ , romanized : Baytu 'š-Šarrāb , lit. ' House of Drinking ' , variously referred to also as the Arabic : قبات الشراب , romanized : Qubbātu 'š-Šarāb , lit. ' Domes of Drinking ' , were structures used to store jars of Zamzam water away from the heat. One of which is claimed to have been initially built on orders from and named after Abbas , founder of the Abbasid dynasty himself. [lower-alpha 6] However, al-Azraqī describes the well being fully in the open during the age of ʿAbdallāh , son of ʿAbbās. He reports it being surrounded by two pools: one pool between the well and a corner of the Kaʿba, used for quenching the thirst of pilgrims; and another pool behind the well used for wuḍūʾ , i.e. religious ritual cleaning, with a subterranean drainage channel leading the waste water out of the Masjid al-Haram's courtyard. He describes the well's operators pouring the water drawn alternately between the pools using waterskins . In the years 775–778 the second Abbasid caliph, al-Mansur , sponsored extensive construction projects in the Masjid al-Haram, which included paving the area around Zamzam with marble . Beginning in the years 833-855, during the rule of al-Muʿtasim , a civil servant called ʿUmar ibn Faraǧ ar-Ruḫḫaǧī began a series of construction projects related to the well, all marked by their intricate use of mosaics . He ended up constructing a dome covering the well and demolishing a previous structure surrounding it. [lower-alpha 7] Additionally a dome connecting the new dome over the well and the House of Drinking was constructed. Ar-Ruḫḫaǧī had the House of Drinking demolished in 843–844, during the rule of al-Wathiq , and went on to have three small domes surrounding the dome covering Zamzam built in its stead. In the year 930 a minority branch of Ismaʿilism called the Qarmatians launched an attack on Mecca . They had previously attacked many caravans of the Abbasid Caliphate, including those of pilgrims travelling to the city. They would conquer the Black Stone and move it to the capital of their own state in Bahrayn for 22 years. They were briefly led in 931 by a Persian, al-Isfahani , whom they believed to be God incarnate who unsuccessfully attempted to convert the Qarmatian state to Zoroastrianism. They destroyed the dome covering Zamzam. It is relayed by historians such as Qutb ad-Dīn [ de ] that in the aftermath of their attack on the city, the Well Zamzam, as well as all other wells in the city were filled with corpses of pilgrims. Following the Abbasid relinquishment of the management of the well a quasi-guild called Zamzamis emerged and remained in place at least until the end of the 19th century. While theoretically anyone could go to the well and fill a vessel they brought at the well, in practice this group of specialised men ended up being primarily responsible for distributing the well's water. They did so by storing two kinds of filled jugs, some on wooden podiums with metal cups attached others hidden in the shade. They performed this service in theory without demanding payment. In 19th century practice however a pilgrim would be assigned a Zamzami upon his arrival and would have been obliged to pay him a small initial sum of $1 for a jug to bear his name. This jug would then be kept by the Zamzami for the pilgrim. Payment was in practice also expected for the further services of the Zamzami. These included bringing the pilgrim water throughout his pilgrimage and pouring it over his body for purposes of ritual cleaning ( wuḍūʾ ) among others. To nudge the pilgrim into donating adequately the Zamzami would show the pilgrim the bad state of the prayer mats he laid out in the Masjid for the pilgrims and explain his dire need for donations. The more generous the pilgrim's donations were, the more expansive the Zamzami's services became; with services such as procuring bottled Zamzam water to be taken home after the pilgrimage and bringing jugs right to the pilgrim's abode in Mecca being reserved for the most generous. To be allowed into the trade of being a Zamzami a costly license from the Grand Sharif was required. During the reign of Awn ar-Rafiq as Grand Sharif for example such a license cost £50. In the 15th century the Mamluk Sultan Qaitbay invested into improving the well's water quality, as well as funding the construction of a new dome covering the well. In 1489, during the reign of Mamluk Sultan Malik an-Nāṣir, reconstruction of the Dome of Abbas, i.e. one of the two Domes of Drinking, occurred. There had been structures bearing this name and function again at least since 1183. The new structure featured a large painted gate made from yellow stone, a large fountain in its middle, three iron windows, and two metal fountains for pilgrims to drink from all housed under a large dome. Following the Ottoman conquest of the Mamluk Sultanate and their assumption of power in Mecca, Suleiman the Magnificent funded many construction and renovation works in the city. One of these began in 1540 with the destruction of the roof covering the well, which had remained intact since Qaitbay's rule. While construction was disrupted by a flood, completion of the new roof occurred in January 1542. In 1621 the Ottoman Sultan Ahmed I had an iron cage constructed around the well. In 1660 Ottoman authorities constructed a new building over Zamzam. Following their conquest of Mecca in 1803, during the reign of Selim III , the Wahhabis , led by Abdulaziz bin Muhammad Al Saud , destroyed the dome covering the well. In 1964 the last building covering the well of Zamzam, which had been rebuilt by Ottoman authorities following the destruction of the building housing Zamzam by the first Saudi State , was demolished by authorities of the third Saudi State (known at that time already as the Kingdom of Saudi Arabia ). In its place the opening of the well was moved to a basement, 2.5 metres (8') deep, to free up space above ground for pilgrims. Islamic tradition states that the Zamzam Well was opened up in some form by God to assist Hajar , the second wife of Ibrahim and mother of Ismaʿil . In Islamic narratives Ibrahim, commanded by God, led Hajar and Ismaʿil to the area of present-day Mecca, there he left them alone in the desert. The two are narrated to have been suffering severely from thirst. In some versions of the story Hajar walks back and forth between the two hills of Safa and Marwah in search of water. [lower-alpha 3] The story of the appearance of the well either involves the infant Isma'il scraping the ground with his feet and water springing out or God sending Gabriel ( Jibra'il ) who consequently opens up the well using a variety of methods depending on the narration. The wealth of mystic discourses discussing the history of the well is from the Abbasid era and largely extra-Quranic, as the well is not referred to directly by the Quran. According to Islamic tradition, Ibrahim rebuilt a shrine called Arabic : بيت ٱللَّٰه , romanized : Baytu 'l-llah , lit. ' House of God ' near the site of the well. A building supposedly first constructed by Adam , which Muslim tradition regards as the origin of the Kaʿba . [lower-alpha 4] The well is meant to have dried up (possibly as punishment) during the settlement of the tribe of the Jurhum , who initially are meant to have migrated to the area from Yemen. In some narrations focused on the objects deposited in Zamzam the well simply dries up, then prior to the Jurhum being forced to leave Mecca because of God expelling them for their misdeeds their leader buries sacred objects from the Kaʿba in the location of Zamzam. In others, focused on the well itself, the objects are placed in Zamzam itself, with the well ultimately being buried by the leader of the Jurhum. According to traditional Muslim accounts, ʿAbd al-Muṭṭalib , grandfather of Muhammad , is responsible for the rediscovery of the well. He purportedly had a divine precognition about the well at some point in his life. A common narrative relayed by Ibn Ishaq via Ibn Hisham involves four dreams, the first three concern mysterious objects called Arabic : طيبة , romanized : Ṭayba , Arabic : برة , romanized : Barra and Arabic : ال٠ضنونة , romanized : al-Maḍnūna he is meant to dig for, the fourth then names Zamzam. Other accounts omit the third dream naming Arabic : ال٠ضنونة , romanized : al-Maḍnūna . [lower-alpha 5] Following ʿAbd al-Muṭṭalib's precognitions to dig, he is claimed to have found a number of artefacts: golden gazelle figurines, armour, and several specimens of a type of sword called Arabic : السيف القلعى , romanized : as-Sayf al-Qalaʿī , lit. ' Qalaʿī sword ' . Ibn Saʿd relays two separate traditions regarding the discovery of a well by ʿAbd al-Muṭṭalib, one involving Zamzam's discovery and water disputes among the Quraysh , the other involving the series of dreams and said artefacts but neither water nor the name Zamzam. Hawting's analysis argues that the oral traditions surrounding the Arabic : بئر الكعبة , romanized : Biʾru 'l-Kaʿba , lit. ' Well of the Kaʿba ' , a dry well inside the Kaʿba reputed to have been used as the treasury of the Kaʿba and as a place for religious offerings in pre-Islamic Mecca and Zamzam merged at some point with stories concerning the former being adapted to feature the latter. Commentators of the Abbasid-era mystic discourses surrounding the well, like al-Masʿūdī expanded on these extra-Quranic accounts. They further connect the site to Zoroastrianism via what they interpret to be Zoroastrian religious artefacts uncovered by ʿAbd al-Muṭṭalib in combination with their etymological analyses. Ultimately arguing that due to the well's history supposedly being related to (what they perceive to have been) the true religion of the peoples of Iran , the Islamisation of Iran is to be understood and framed as a rediscovery. The traditional Islamic account of the well's history relayed by al-Azraqī traces the lineage of its management via to Abū Tālib as inherited from its (re)-discoverer and his father ʿAbd al-Muṭṭalib . The usage rights to the well were then supposedly sold due to Abū Tālib's financial troubles to his brother, al-ʿAbbās , who is meant to have instituted the first new ordinance concerning the well by banning all non-religious body-hygienic uses of it. Thus the management of the Zamzam Well (a responsibility called Arabic : سقاية , romanized : siqāya , lit. ' giving of water ' ) was reputedly a hereditary position of the Abbasids , i.e. the progeny of al-ʿAbbās, who ended up seizing control over Mecca as a whole using their caliphate . Buildings called the Arabic : بيت الشراب‎ , romanized : Baytu 'š-Šarrāb , lit. ' House of Drinking ' , variously referred to also as the Arabic : قبات الشراب , romanized : Qubbātu 'š-Šarāb , lit. ' Domes of Drinking ' , were structures used to store jars of Zamzam water away from the heat. One of which is claimed to have been initially built on orders from and named after Abbas , founder of the Abbasid dynasty himself. [lower-alpha 6] However, al-Azraqī describes the well being fully in the open during the age of ʿAbdallāh , son of ʿAbbās. He reports it being surrounded by two pools: one pool between the well and a corner of the Kaʿba, used for quenching the thirst of pilgrims; and another pool behind the well used for wuḍūʾ , i.e. religious ritual cleaning, with a subterranean drainage channel leading the waste water out of the Masjid al-Haram's courtyard. He describes the well's operators pouring the water drawn alternately between the pools using waterskins . In the years 775–778 the second Abbasid caliph, al-Mansur , sponsored extensive construction projects in the Masjid al-Haram, which included paving the area around Zamzam with marble . Beginning in the years 833-855, during the rule of al-Muʿtasim , a civil servant called ʿUmar ibn Faraǧ ar-Ruḫḫaǧī began a series of construction projects related to the well, all marked by their intricate use of mosaics . He ended up constructing a dome covering the well and demolishing a previous structure surrounding it. [lower-alpha 7] Additionally a dome connecting the new dome over the well and the House of Drinking was constructed. Ar-Ruḫḫaǧī had the House of Drinking demolished in 843–844, during the rule of al-Wathiq , and went on to have three small domes surrounding the dome covering Zamzam built in its stead. In the year 930 a minority branch of Ismaʿilism called the Qarmatians launched an attack on Mecca . They had previously attacked many caravans of the Abbasid Caliphate, including those of pilgrims travelling to the city. They would conquer the Black Stone and move it to the capital of their own state in Bahrayn for 22 years. They were briefly led in 931 by a Persian, al-Isfahani , whom they believed to be God incarnate who unsuccessfully attempted to convert the Qarmatian state to Zoroastrianism. They destroyed the dome covering Zamzam. It is relayed by historians such as Qutb ad-Dīn [ de ] that in the aftermath of their attack on the city, the Well Zamzam, as well as all other wells in the city were filled with corpses of pilgrims. Following the Abbasid relinquishment of the management of the well a quasi-guild called Zamzamis emerged and remained in place at least until the end of the 19th century. While theoretically anyone could go to the well and fill a vessel they brought at the well, in practice this group of specialised men ended up being primarily responsible for distributing the well's water. They did so by storing two kinds of filled jugs, some on wooden podiums with metal cups attached others hidden in the shade. They performed this service in theory without demanding payment. In 19th century practice however a pilgrim would be assigned a Zamzami upon his arrival and would have been obliged to pay him a small initial sum of $1 for a jug to bear his name. This jug would then be kept by the Zamzami for the pilgrim. Payment was in practice also expected for the further services of the Zamzami. These included bringing the pilgrim water throughout his pilgrimage and pouring it over his body for purposes of ritual cleaning ( wuḍūʾ ) among others. To nudge the pilgrim into donating adequately the Zamzami would show the pilgrim the bad state of the prayer mats he laid out in the Masjid for the pilgrims and explain his dire need for donations. The more generous the pilgrim's donations were, the more expansive the Zamzami's services became; with services such as procuring bottled Zamzam water to be taken home after the pilgrimage and bringing jugs right to the pilgrim's abode in Mecca being reserved for the most generous. To be allowed into the trade of being a Zamzami a costly license from the Grand Sharif was required. During the reign of Awn ar-Rafiq as Grand Sharif for example such a license cost £50. In the 15th century the Mamluk Sultan Qaitbay invested into improving the well's water quality, as well as funding the construction of a new dome covering the well. In 1489, during the reign of Mamluk Sultan Malik an-Nāṣir, reconstruction of the Dome of Abbas, i.e. one of the two Domes of Drinking, occurred. There had been structures bearing this name and function again at least since 1183. The new structure featured a large painted gate made from yellow stone, a large fountain in its middle, three iron windows, and two metal fountains for pilgrims to drink from all housed under a large dome. Following the Ottoman conquest of the Mamluk Sultanate and their assumption of power in Mecca, Suleiman the Magnificent funded many construction and renovation works in the city. One of these began in 1540 with the destruction of the roof covering the well, which had remained intact since Qaitbay's rule. While construction was disrupted by a flood, completion of the new roof occurred in January 1542. In 1621 the Ottoman Sultan Ahmed I had an iron cage constructed around the well. In 1660 Ottoman authorities constructed a new building over Zamzam. Following their conquest of Mecca in 1803, during the reign of Selim III , the Wahhabis , led by Abdulaziz bin Muhammad Al Saud , destroyed the dome covering the well. In 1964 the last building covering the well of Zamzam, which had been rebuilt by Ottoman authorities following the destruction of the building housing Zamzam by the first Saudi State , was demolished by authorities of the third Saudi State (known at that time already as the Kingdom of Saudi Arabia ). In its place the opening of the well was moved to a basement, 2.5 metres (8') deep, to free up space above ground for pilgrims. The well of Zamzam was excavated by hand, and is about 30 m (100 ft) deep and 1.08 to 2.66 m (3 ft 7 in to 8 ft 9 in) in diameter. It taps groundwater from the wadi alluvium and some from the bedrock . Historically water from the well was drawn via ropes and buckets, but since 1964 the well's opening itself is in a basement room inaccessible to the public, where it can be seen behind glass panels. Two electric pumps, operating alternately, move the water 5 km (3 miles) southwards at a pace of between 11 and 18.5 litres (2½ and 4½ gallons) per second to the King Abdullah bin Abdulaziz Zamzam Water Project in Kudai. The center opened in September 2010 costing 700 million Saudi Riyal to construct and being operated by the National Water Company of Saudi Arabia. In this location treatment using filters and ultraviolet light, storage, and distribution take place. Once treated the water is stored in one of two reservoirs, the first at the plant's location in Kudai can hold 10,000 cubic meters (13,000 cu. yd.) of water, the other, the King Abdulaziz Sabeel Reservoir in Medina , has a larger capacity of 16,000 cubic meters (20,000 cu. yd.). The Kudai location is connected via pipes to drinking fountains in the Masjid al-Haram. The Medina location supplies the Prophet's Mosque . Aside from the system of pipes unbottled water is distributed using tanker trucks which transport 150,000 litres (35,000 gal.) per day at normal times and up to 400,000 litres per day (100,000 gal.) during pilgrimage seasons to the Medina location. Unbottled water is available through the before-mentioned drinking fountains, a fountain meant for pilgrims wishing to fill larger containers not intended for immediate consumption, and sterilised containers placed by authorities throughout the holy sites in Mecca and Medina. These latter containers come in several variants, chilled and unchilled, as well as being either stationary or worn as a backpack by employees of the complexes with disposable plastic cups provided in any case. Small filtered water bottles are also distributed free of charge at the holy sites. The water distributed this way in the Masjid al-Haram totals ca. 700,000 litres (175,000 gal.) per day outside of pilgrimage season and 2,000,000 litres (500,000 gal.) per day during said season. Distribution outside the Islamic holy sites within the Kingdom of Saudi Arabia occurs with the water being bottled in 10-litre (2½ gallon) containers which are sold directly at a warehouse at the site of the King Abdullah bin Abdulaziz Zamzam Water Project or via hypermarkets and super stores throughout the state. In 2018 the number of 10-litre (2½ gallon) containers distributed per day was 1.5 million. In 2010 the annual limit on how much water can be extracted from the well was stated as c. 500,000 cubic meters (700,000 cu. yd) per year, though due to annual variations in rainfall patterns there exists a lot of deviation with regards to how much water can be extracted without lowering the well's water level too drastically each year. Hydrogeologically , the well is in the Wadi Ibrahim (Valley of Abraham). The upper half of the well is in the sandy alluvium of the valley, lined with stone masonry except for the top metre (3 ft) which has a concrete "collar". The lower half is in the bedrock. Between the alluvium and the bedrock is a 1 ⁄ 2 -metre (1 ft 8 in) section of permeable weathered rock, lined with stone, and it is this section that provides the main water entry into the well. Water in the well comes from absorbed rainfall in the Wadi Ibrahim, as well as run-off from the local hills. Since the area has become more and more settled, water from absorbed rainfall on the Wadi Ibrahim has decreased. The Saudi Geological Survey has a "Zamzam Studies and Research Centre" which analyses the technical properties of the well in detail. Water levels were monitored by hydrograph , which in more recent times has changed to a digital monitoring system that tracks the water level, electric conductivity, pH , Eh , and temperature. All of this information is made continuously available via the Internet. Other wells throughout the valley have also been established, some with digital recorders, to monitor the response of the local aquifer system. Zamzam water is colourless and odorless, but has a distinctive taste, with a pH of 7.9–8, and so is slightly alkaline. The Zamzam Well is tested on a daily basis, in a process which involves the taking of three samples from the well. These samples are then examined at the King Abdullah Zamzam Water Distribution Center in Mecca, which is equipped with advanced facilities. The Zamzam well was recently renovated in 2018 by the Saudi authorities. The project involved cleaning of the areas around the Zamzam well by removing the debris of concrete and steel used in the old cellar of the Grand Mosque . During Ramadan , 100 samples are tested every day to ensure the water's good quality. Cholera epidemics and the Hajj had become an issue of debate since a 1866 International Sanitary Conference in Istanbul . The conference however identified British steam-ships transporting Indian Muslims to the Hajj as mainly responsible for the globalisation of cholera . The Ottoman state consequently instituted a quarantine system using the Red Sea to protect public health. Britain tried to undermine this system in the coming decades fearing public backlash in India and restrictions on its ability to engage in free trade . The first controversy surrounding the safety of water from the Zamzam Well began in 1883. In 1881, James Zohrab, British Consul in Jeddah sent samples of Zamzam water to Edward Frankland , who published his findings in 1883. Frankland claimed the water from the well to be six times more contaminated by animal waste than sewage in London . Arguing that due to human waste being simply buried in the ground in Mecca, the groundwater had become highly contaminated and a source of cholera. This situation, coupled with the city's visitors from all around the Muslim world , is meant to have spread the disease effectively throughout it. He ultimately called for the closure of Zamzam as a public health measure to protect the people of Asia and Europe. Frankland's report became the basis for a treatise presented to the Ottoman Board of Health by the Dutch emissary thereto. The treaty was received very negatively and interpreted to be anti-Islamic propaganda. Mehmed Şakir Bey, an epidemiologist , was so outraged that he consulted Bonkowski Paşa [ tr ] , the Sultan's head chemist, and Ahmet Efendi , professor of chemistry at the Ottoman War College , for further scientific inquiry. Their testing revealed nothing dangerous about the water of Zamzam. By comparing their results to the results Frankland had published they began to publicly doubt the authenticity of his sample, as his sample was almost as saline as sea water. Additionally they explained that the water in Mecca's aqueducts and that from Zamzam came from entirely different sources, that pilgrims did not so much as bathe near the Masjid al-Haram, and that Zamzam could not be a cholera source because Mecca did not see annual cholera epidemics during the Hajj. Related to their doubts of the water's authenticity they began to speculate that Yusuf Kudzi, a British protected person and associate of Zohrab, had been the source of the water and had contaminated the water to embarrass the Muslim world. Kudzi was of Russian-Jewish ancestry, he had been born in Jerusalem and was a convert to Islam. The Ottoman establishment of that time had grown to doubt the authenticity of any Muslim cooperating with the British, conceptualising them as not truly Muslim and possibly as being spies. Britain's intellectuals ended up rejecting Robert Koch 's (presently widely accepted) findings of cholera being caused by bacteria. They kept arguing that cholera must be caused by local factors and in a manner which cannot be mediated via quarantine. British scientists would continue publishing anti-Zamzam and anti-contagionist articles up to 1895. Their anti-contagionist views would fall further and further away from scientific consensus in the following decades. Concurrently Ottoman authorities continued to invest into persistent and successful efforts seeking to maintain and improve water quality throughout Arabia. In May 2011, a BBC London investigation alleged that water taken from taps connected to the Zamzam Well contained high levels of nitrate and arsenic at levels three times the legal limit in the UK, the same levels found in illegal water purchased in the UK. The Saudi authorities rejected the BBC's claim and said that the water is fit for human consumption. An official from the Saudi Arabian embassy in London stated: "...water from the Zamzam well is not contaminated and is fit for human consumption. Genuine Zamzam water does not contain arsenic." The president of the Saudi Geological Survey (SGS), Zuhair Nawab, has stated that the Zamzam Well is tested on a daily basis, in a process involving the taking of three samples from the well. The BBC article concentrated on bottled water supplied by individuals rather than the Presidency of the Two Holy Mosques' Affairs, according to Fahd Turkistani, advisor to the General Authority of Meteorology and Environmental Protection . Turkistani stated that the Zamzam water pollution may have been caused by unsterilized containers used by illegal workers selling Zamzam water at Makkah gates. In the same month that the BBC report was released, the Council of British Hajjis later declared that drinking Zamzam water was safe, contradicting the BBC report. The council noted that the Government of Saudi Arabia does not allow the export of Zamzam water for resale. They also stated that it was unknown whether the water being sold in the UK was genuine and that people should not buy it and should report the sellers to the Trading Standards if they saw it for sale. Cholera epidemics and the Hajj had become an issue of debate since a 1866 International Sanitary Conference in Istanbul . The conference however identified British steam-ships transporting Indian Muslims to the Hajj as mainly responsible for the globalisation of cholera . The Ottoman state consequently instituted a quarantine system using the Red Sea to protect public health. Britain tried to undermine this system in the coming decades fearing public backlash in India and restrictions on its ability to engage in free trade . The first controversy surrounding the safety of water from the Zamzam Well began in 1883. In 1881, James Zohrab, British Consul in Jeddah sent samples of Zamzam water to Edward Frankland , who published his findings in 1883. Frankland claimed the water from the well to be six times more contaminated by animal waste than sewage in London . Arguing that due to human waste being simply buried in the ground in Mecca, the groundwater had become highly contaminated and a source of cholera. This situation, coupled with the city's visitors from all around the Muslim world , is meant to have spread the disease effectively throughout it. He ultimately called for the closure of Zamzam as a public health measure to protect the people of Asia and Europe. Frankland's report became the basis for a treatise presented to the Ottoman Board of Health by the Dutch emissary thereto. The treaty was received very negatively and interpreted to be anti-Islamic propaganda. Mehmed Şakir Bey, an epidemiologist , was so outraged that he consulted Bonkowski Paşa [ tr ] , the Sultan's head chemist, and Ahmet Efendi , professor of chemistry at the Ottoman War College , for further scientific inquiry. Their testing revealed nothing dangerous about the water of Zamzam. By comparing their results to the results Frankland had published they began to publicly doubt the authenticity of his sample, as his sample was almost as saline as sea water. Additionally they explained that the water in Mecca's aqueducts and that from Zamzam came from entirely different sources, that pilgrims did not so much as bathe near the Masjid al-Haram, and that Zamzam could not be a cholera source because Mecca did not see annual cholera epidemics during the Hajj. Related to their doubts of the water's authenticity they began to speculate that Yusuf Kudzi, a British protected person and associate of Zohrab, had been the source of the water and had contaminated the water to embarrass the Muslim world. Kudzi was of Russian-Jewish ancestry, he had been born in Jerusalem and was a convert to Islam. The Ottoman establishment of that time had grown to doubt the authenticity of any Muslim cooperating with the British, conceptualising them as not truly Muslim and possibly as being spies. Britain's intellectuals ended up rejecting Robert Koch 's (presently widely accepted) findings of cholera being caused by bacteria. They kept arguing that cholera must be caused by local factors and in a manner which cannot be mediated via quarantine. British scientists would continue publishing anti-Zamzam and anti-contagionist articles up to 1895. Their anti-contagionist views would fall further and further away from scientific consensus in the following decades. Concurrently Ottoman authorities continued to invest into persistent and successful efforts seeking to maintain and improve water quality throughout Arabia. In May 2011, a BBC London investigation alleged that water taken from taps connected to the Zamzam Well contained high levels of nitrate and arsenic at levels three times the legal limit in the UK, the same levels found in illegal water purchased in the UK. The Saudi authorities rejected the BBC's claim and said that the water is fit for human consumption. An official from the Saudi Arabian embassy in London stated: "...water from the Zamzam well is not contaminated and is fit for human consumption. Genuine Zamzam water does not contain arsenic." The president of the Saudi Geological Survey (SGS), Zuhair Nawab, has stated that the Zamzam Well is tested on a daily basis, in a process involving the taking of three samples from the well. The BBC article concentrated on bottled water supplied by individuals rather than the Presidency of the Two Holy Mosques' Affairs, according to Fahd Turkistani, advisor to the General Authority of Meteorology and Environmental Protection . Turkistani stated that the Zamzam water pollution may have been caused by unsterilized containers used by illegal workers selling Zamzam water at Makkah gates. In the same month that the BBC report was released, the Council of British Hajjis later declared that drinking Zamzam water was safe, contradicting the BBC report. The council noted that the Government of Saudi Arabia does not allow the export of Zamzam water for resale. They also stated that it was unknown whether the water being sold in the UK was genuine and that people should not buy it and should report the sellers to the Trading Standards if they saw it for sale. The Saudi authorities rejected the BBC's claim and said that the water is fit for human consumption. An official from the Saudi Arabian embassy in London stated: "...water from the Zamzam well is not contaminated and is fit for human consumption. Genuine Zamzam water does not contain arsenic." The president of the Saudi Geological Survey (SGS), Zuhair Nawab, has stated that the Zamzam Well is tested on a daily basis, in a process involving the taking of three samples from the well. The BBC article concentrated on bottled water supplied by individuals rather than the Presidency of the Two Holy Mosques' Affairs, according to Fahd Turkistani, advisor to the General Authority of Meteorology and Environmental Protection . Turkistani stated that the Zamzam water pollution may have been caused by unsterilized containers used by illegal workers selling Zamzam water at Makkah gates. In the same month that the BBC report was released, the Council of British Hajjis later declared that drinking Zamzam water was safe, contradicting the BBC report. The council noted that the Government of Saudi Arabia does not allow the export of Zamzam water for resale. They also stated that it was unknown whether the water being sold in the UK was genuine and that people should not buy it and should report the sellers to the Trading Standards if they saw it for sale.

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Zimbabwe

Zimbabwe ( / z ɪ m ˈ b ɑː b w eɪ , - w i / ; Shona pronunciation: [ zi.ᵐba.ɓwe ] ), officially the Republic of Zimbabwe , is a landlocked country in Southern Africa , between the Zambezi and Limpopo Rivers , bordered by South Africa to the south, Botswana to the southwest, Zambia to the north, and Mozambique to the east. The capital and largest city is Harare , and the second largest is Bulawayo . A country of roughly 15 million people as per 2022 census, Zimbabwe's largest ethnic group are the Shona , who make up 80% of the population, followed by the Northern Ndebele and other smaller minorities . Zimbabwe has 16 official languages , with English, Shona , and Ndebele the most common. Zimbabwe is a member of the United Nations , the Southern African Development Community , the African Union , and the Common Market for Eastern and Southern Africa . Beginning in the 9th century, during its late Iron Age , the Bantu people (who would become the ethnic Shona) built the city-state of Great Zimbabwe ; the city-state became one of the major African trade centres by the 11th century but was abandoned by the mid 15th century. From there, the Kingdom of Zimbabwe was established, followed by the Rozvi and Mutapa empires. The British South Africa Company of Cecil Rhodes demarcated the Rhodesia region in 1890 when they conquered Mashonaland and later in 1893 Matabeleland after the First Matabele War . Company rule ended in 1923 with the establishment of Southern Rhodesia as a self-governing British colony . In 1965, the white minority government unilaterally declared independence as Rhodesia . The state endured international isolation and a 15-year guerrilla war with black nationalist forces; this culminated in a peace agreement that established de jure sovereignty as Zimbabwe in April 1980. Robert Mugabe became Prime Minister of Zimbabwe in 1980, when his ZANU–PF party won the general election following the end of white minority rule and has remained the country's dominant party since. He was the President of Zimbabwe from 1987, after converting the country's initial parliamentary system into a presidential one , until his resignation in 2017. Under Mugabe's authoritarian regime, the state security apparatus dominated the country and was responsible for widespread human rights violations. From 1997 to 2008 the economy experienced consistent decline (and in the latter years, hyperinflation ), though it has since seen rapid growth after the use of currencies other than the Zimbabwean dollar was permitted. In 2017, in the wake of over a year of protests against his government as well as Zimbabwe's rapidly declining economy, a coup d'état resulted in Mugabe's resignation. Emmerson Mnangagwa has since served as Zimbabwe's president.The name "Zimbabwe" stems from a Shona term for Great Zimbabwe , a medieval city ( Masvingo ) in the country's south-east. Two different theories address the origin of the word. Many sources hold that "Zimbabwe" derives from dzimba-dza-mabwe , translated from the Karanga dialect of Shona as "houses of stones" ( dzimba = plural of imba , "house"; mabwe = plural of ibwe , "stone"). The Karanga-speaking Shona people live around Great Zimbabwe in the modern-day Masvingo province. Archaeologist Peter Garlake claims that "Zimbabwe" represents a contracted form of dzimba-hwe , which means "venerated houses" in the Zezuru dialect of Shona and usually references chiefs' houses or graves. Zimbabwe was formerly known as Southern Rhodesia (1898), Rhodesia (1965), and Zimbabwe Rhodesia (1979). The first recorded use of "Zimbabwe" as a term of national reference dates from 1960 as a coinage by the black nationalist Michael Mawema, whose Zimbabwe National Party became the first to officially use the name in 1961. The term "Rhodesia"—derived from the surname of Cecil Rhodes , the primary instigator of British colonisation of the territory—was perceived by African nationalists as inappropriate because of its colonial origin and connotations. According to Mawema, black nationalists held a meeting in 1960 to choose an alternative name for the country, proposing names such as "Matshobana" and " Monomotapa " before his suggestion, "Zimbabwe", prevailed. It was initially unclear how the chosen term was to be used—a letter written by Mawema in 1961 refers to "Zimbabweland" — but "Zimbabwe" was sufficiently established by 1962 to become the generally preferred term of the black nationalist movement. Like those of many African countries that gained independence during the Cold War , Zimbabwe is an ethnically neutral name. It is debatable to what extent Zimbabwe, being over 80% homogenously Shona and dominated by them in various, can be described as a nation state . The constitution acknowledges 16 languages, but only embraces two of them nationally, Shona and English. Shona is taught widely in schools, unlike Ndebele . Zimbabwe has additionally never had a non-Shona head of state. Archaeological records date archaic human settlement of present-day Zimbabwe to at least 500,000 years ago. Zimbabwe's earliest known inhabitants were most likely the San people , who left behind a legacy of arrowheads and cave paintings. Approximately 2,000 years ago, the first Bantu-speaking farmers arrived during the Bantu expansion. Societies speaking proto- Shona languages first emerged in the middle Limpopo River valley in the 9th century before moving on to the Zimbabwean highlands. The Zimbabwean plateau became the centre of subsequent Shona states, beginning around the 10th century. Around the early 10th century, trade developed with Arab merchants on the Indian Ocean coast, helping to develop the Kingdom of Mapungubwe in the 11th century. This was the precursor to the Shona civilisations that dominated the region during the 13th to 15th centuries, evidenced by ruins at Great Zimbabwe , near Masvingo , and by other smaller sites. The main archaeological site used a unique dry stone architecture. The Kingdom of Mapungubwe was the first in a series of trading states which had developed in Zimbabwe by the time the first European explorers arrived from Portugal. These states traded gold, ivory, and copper for cloth and glass. By 1220, the Kingdom of Zimbabwe eclipsed Mapungubwe. This Shona state further refined and expanded upon Mapungubwe's stone architecture. From c. 1450 to 1760, the Kingdom of Mutapa ruled much of the area of present-day Zimbabwe, plus parts of central Mozambique. It is known by many names including the Mutapa Empire, also known as Mwene Mutapa or Monomotapa as well as "Munhumutapa", and was renowned for its strategic trade routes with the Arabs and Portugal. The Portuguese sought to monopolise this influence and began a series of wars which left the empire in near collapse in the early 17th century. As a direct response to increased European presence in the interior a new Shona state emerged, known as the Rozwi Empire . Relying on centuries of military, political and religious development, the Rozwi (meaning "destroyers") expelled the Portuguese from the Zimbabwean plateau in 1683. Around 1821 the Zulu general Mzilikazi of the Khumalo clan successfully rebelled against King Shaka and established his own clan, the Ndebele . The Ndebele fought their way northwards into the Transvaal , leaving a trail of destruction in their wake and beginning an era of widespread devastation known as the Mfecane . When Dutch trekboers converged on the Transvaal in 1836, they drove the tribe even further northward, with the assistance of Tswana Barolong warriors and Griqua commandos. By 1838 the Ndebele had conquered the Rozwi Empire, along with the other smaller Shona states, and reduced them to vassaldom . After losing their remaining South African lands in 1840, Mzilikazi and his tribe permanently settled in the southwest of present-day Zimbabwe in what became known as Matabeleland, establishing Bulawayo as their capital. Mzilikazi then organised his society into a military system with regimental kraals , similar to those of Shaka, which was stable enough to repel further Boer incursions. Mzilikazi died in 1868; following a violent power struggle, his son Lobengula succeeded him. In the 1880s, European colonists arrived with Cecil Rhodes 's British South Africa Company (chartered in 1889). In 1888, Rhodes obtained a concession for mining rights from King Lobengula of the Ndebele peoples. He presented this concession to persuade the government of the United Kingdom to grant a royal charter to the company over Matabeleland, and its subject states such as Mashonaland as well. Rhodes used this document in 1890 to justify sending the Pioneer Column , a group of Europeans protected by well-armed British South Africa Police (BSAP) through Matabeleland and into Shona territory to establish Fort Salisbury (present-day Harare ), and thereby establish company rule over the area. In 1893 and 1894, with the help of their new Maxim guns, the BSAP would go on to defeat the Ndebele in the First Matabele War . Rhodes additionally sought permission to negotiate similar concessions covering all territory between the Limpopo River and Lake Tanganyika , then known as "Zambesia". In accordance with the terms of aforementioned concessions and treaties, mass settlement was encouraged, with the British maintaining control over labour as well as over precious metals and other mineral resources. In 1895, the BSAC adopted the name "Rhodesia" for the territory, in honour of Rhodes. In 1898 "Southern Rhodesia" became the official name for the region south of the Zambezi, which later adopted the name "Zimbabwe". The region to the north, administered separately, was later termed Northern Rhodesia (present-day Zambia). Shortly after the disastrous Rhodes-sponsored Jameson Raid on the South African Republic , the Ndebele rebelled against white rule, led by their charismatic religious leader, Mlimo. The Second Matabele War of 1896–1897 lasted in Matabeleland until 1896, when Mlimo was assassinated by American scout Frederick Russell Burnham . Shona agitators staged unsuccessful revolts (known as Chimurenga ) against company rule during 1896 and 1897. [ citation needed ] Following these failed insurrections, the Rhodes administration subdued the Ndebele and Shona groups and organised the land with a disproportionate bias favouring Europeans, thus displacing many indigenous peoples. The United Kingdom annexed Southern Rhodesia on 12 September 1923. Shortly after annexation, on 1 October 1923, the first constitution for the new Colony of Southern Rhodesia came into force. Under the new constitution, Southern Rhodesia became a self-governing British colony , subsequent to a 1922 referendum . Rhodesians of all races served on behalf of the United Kingdom during the two World Wars in the early-20th century. Proportional to the white population, Southern Rhodesia contributed more per capita to both the First and Second World Wars than any other part of the empire, including Britain. The 1930 Land Apportionment Act restricted black land ownership to certain segments of the country, setting aside large areas solely for the purchase of the white minority. This act, which led to rapidly rising inequality, became the subject of frequent calls for subsequent land reform. In 1953, in the face of African opposition, Britain consolidated the two Rhodesias with Nyasaland (Malawi) in the ill-fated Central African Federation , which Southern Rhodesia essentially dominated. Growing African nationalism and general dissent, particularly in Nyasaland, persuaded Britain to dissolve the union in 1963, forming three separate divisions. While multiracial democracy was finally introduced to Northern Rhodesia and Nyasaland, Southern Rhodesians of European ancestry continued to enjoy minority rule . Following Zambian independence (effective from October 1964), Ian Smith 's Rhodesian Front government in Salisbury dropped the designation "Southern" in 1964 (once Northern Rhodesia had changed its name to Zambia , having the word Southern before the name Rhodesia became unnecessary and the country simply became known as Rhodesia afterwards). Intent on effectively repudiating the recently adopted British policy of " no independence before majority rule ", Smith issued a Unilateral Declaration of Independence (UDI) from the United Kingdom on 11 November 1965. This marked the first such course taken by a rebel British colony since the American declaration of 1776, which Smith and others indeed claimed provided a suitable precedent to their own actions. The United Kingdom deemed the Rhodesian declaration an act of rebellion but did not re-establish control by force. The British government petitioned the United Nations for sanctions against Rhodesia pending unsuccessful talks with Smith's administration in 1966 and 1968. In December 1966, the organisation complied, imposing the first mandatory trade embargo on an autonomous state. These sanctions were expanded again in 1968. A civil war ensued when Joshua Nkomo 's Zimbabwe African People's Union (ZAPU) and Robert Mugabe's Zimbabwe African National Union (ZANU), supported actively by communist powers and neighbouring African nations, initiated guerrilla operations against Rhodesia's predominantly white government. ZAPU was supported by the Soviet Union , the Warsaw Pact and associated nations such as Cuba, and adopted a Marxist–Leninist ideology; ZANU meanwhile aligned itself with Maoism and the bloc headed by the People's Republic of China. Smith declared Rhodesia a republic in 1970, following the results of a referendum the previous year , but this went unrecognised internationally. Meanwhile, Rhodesia's internal conflict intensified, eventually forcing him to open negotiations with the militant communists. In March 1978, Smith reached an accord with three African leaders, led by Bishop Abel Muzorewa , who offered to leave the white population comfortably entrenched in exchange for the establishment of a biracial democracy. As a result of the Internal Settlement , elections were held in April 1979 , concluding with the United African National Council (UANC) carrying a majority of parliamentary seats. On 1 June 1979, Muzorewa, the UANC head, became prime minister and the country's name was changed to Zimbabwe Rhodesia. The Internal Settlement left control of the Rhodesian Security Forces , civil service, judiciary, and a third of parliament seats to whites. On 12 June, the United States Senate voted to lift economic pressure on the former Rhodesia. Following the fifth Commonwealth Heads of Government Meeting , held in Lusaka , Zambia, from 1 to 7 August in 1979, the British government invited Muzorewa, Mugabe, and Nkomo to participate in a constitutional conference at Lancaster House . The purpose of the conference was to discuss and reach an agreement on the terms of an independence constitution, and provide for elections supervised under British authority allowing Zimbabwe Rhodesia to proceed to legal independence. With Lord Carrington, Secretary of State for Foreign and Commonwealth Affairs of the United Kingdom, in the chair, these discussions were mounted from 10 September to 15 December in 1979, producing a total of 47 plenary sessions . On 21 December 1979, delegations from every major interest represented reached the Lancaster House Agreement , effectively ending the guerrilla war. On 11 December 1979, the Rhodesian House of Assembly voted 90 to nil to revert to British colonial status. With the arrival of Christopher Soames , the new governor on 12 December 1979, Britain formally took control of Zimbabwe Rhodesia as the Colony of Southern Rhodesia. Britain lifted sanctions on 12 December and the United Nations on 16 December. During the elections of February 1980 , Mugabe and the ZANU party secured a landslide victory. Prince Charles , as the representative of Britain, formally granted independence to the new nation of Zimbabwe at a ceremony in Harare in April 1980. Zimbabwe's first president after its independence was Canaan Banana in what was originally a mainly ceremonial role as head of state . Mugabe was the country's first prime minister and head of government. In 1980, Samora Machel told Mugabe that Zimbabwe was the "Jewel of Africa" but added: "Don't tarnish it!". New names for 32 places were gazetted on 18 April 1982 and by February 1984, there had been 42 changes, which included three rivers (Umniati/ Munyati ; Lundi/ Runde ; Nuanetsi/ Mwenezi ), and several changes from colonial names (such as Salisbury/Harare; Enkeldoorn/ Chivhu ; Essexvale/ Esigodini ; Fort Victoria/ Masvingo ) Opposition to what was perceived as a Shona takeover immediately erupted around Matabeleland. The Matabele unrest led to what has become known as Gukurahundi (Shona: 'the early rain which washes away the chaff before the spring rains'). The Fifth Brigade , a North Korean-trained elite unit that reported directly to Mugabe, entered Matabeleland and massacred thousands of civilians accused of supporting "dissidents". Estimates for the number of deaths during the five-year Gukurahundi campaign ranged from 3,750 to 80,000. Thousands of others were tortured in military internment camps. The campaign officially ended in 1987 after Nkomo and Mugabe reached a unity agreement that merged their respective parties, creating the Zimbabwe African National Union – Patriotic Front ( ZANU–PF ). Elections in March 1990 resulted in another victory for Mugabe and the ZANU–PF party, which claimed 117 of the 120 contested seats. During the 1990s, students, trade unionists, and other workers often demonstrated to express their growing discontent with Mugabe and ZANU–PF party policies. In 1996, civil servants, nurses, and junior doctors went on strike over salary issues. The general health of the population also began to significantly decline; by 1997 an estimated 25% of the population had been infected by HIV in a pandemic that was affecting most of southern Africa. Land redistribution re-emerged as the main issue for the ZANU–PF government around 1997. Despite the existence of a "willing-buyer-willing-seller" land reform programme since the 1980s, the minority white Zimbabwean population of around 0.6% continued to hold 70% of the country's most fertile agricultural land. In 2000, the government pressed ahead with its Fast Track Land Reform programme, a policy involving compulsory land acquisition aimed at redistributing land from the minority white population to the majority black population. Confiscations of white farmland, continuous droughts, and a serious drop in external finance and other support led to a sharp decline in agricultural exports, which were traditionally the country's leading export-producing sector. Some 58,000 independent black farmers have since experienced limited success in reviving the gutted cash crop sectors through efforts on a smaller scale. President Mugabe and the ZANU–PF party leadership found themselves beset by a wide range of international sanctions. In 2002, the nation was suspended from the Commonwealth of Nations due to the reckless farm seizures and blatant election tampering . The following year, Zimbabwean officials voluntarily terminated its Commonwealth membership. In 2001, the United States enacted the Zimbabwe Democracy and Economic Recovery Act (ZDERA). It came into effect in 2002 and froze credit to the Zimbabwean government. By 2003, the country's economy had collapsed. It is estimated that up to a quarter of Zimbabwe's 11 million people had fled the country. Three-quarters of the remaining Zimbabweans were living on less than one U.S. dollar a day. Following elections in 2005 , the government initiated " Operation Murambatsvina ", an effort to crack down on illegal markets and slums emerging in towns and cities, leaving a substantial section of urban poor homeless. The Zimbabwean government has described the operation as an attempt to provide decent housing to the population, although according to critics such as Amnesty International , authorities have yet to properly substantiate their claims. On 29 March 2008, Zimbabwe held a presidential election along with a parliamentary election . The results of this election were withheld for two weeks, after which it was generally acknowledged that the Movement for Democratic Change – Tsvangirai (MDC-T) had achieved a majority of one seat in the lower house of parliament. In September 2008, a power-sharing agreement was reached between Tsvangirai and President Mugabe, permitting the former to hold the office of prime minister. Due to ministerial differences between their respective political parties, the agreement was not fully implemented until 13 February 2009. By December 2010, Mugabe was threatening to completely expropriate remaining privately owned companies in Zimbabwe unless "western sanctions" were lifted. In late 2008, problems in Zimbabwe reached crisis proportions in the areas of living standards, public health (with a major cholera outbreak in December) and various basic affairs. During this period, NGOs took over from government as a primary provider of food during this period of food insecurity in Zimbabwe. A 2011 survey by Freedom House suggested that living conditions had improved since the power-sharing agreement. The United Nations Office for the Coordination of Humanitarian Affairs stated in its 2012–2013 planning document that the "humanitarian situation has improved in Zimbabwe since 2009, but conditions remain precarious for many people". A new constitution approved in the Zimbabwean constitutional referendum, 2013 curtails presidential powers. Mugabe was re-elected president in the July 2013 Zimbabwean general election which The Economist described as "rigged" and the Daily Telegraph as "stolen". The Movement for Democratic Change alleged massive fraud and tried to seek relief through the courts. In a surprising moment of candour at the ZANU–PF congress in December 2014, President Robert Mugabe accidentally let slip that the opposition had in fact won the contentious 2008 polls by an astounding 73%. After winning the election, the Mugabe ZANU–PF government re-instituted one party rule , doubled the civil service and, according to The Economist , embarked on "misrule and dazzling corruption". A 2017 study conducted by the Institute for Security Studies (ISS) concluded that due to the deterioration of government and the economy "the government encourages corruption to make up for its inability to fund its own institutions" with widespread and informal police roadblocks to issue fines to travellers being one manifestation of this. In July 2016 nationwide protests took place regarding the economic collapse in the country. In November 2017, the army led a coup d'état following the dismissal of Vice-president Emmerson Mnangagwa , placing Mugabe under house arrest. The army denied that their actions constituted a coup . On 19 November 2017, ZANU–PF sacked Robert Mugabe as party leader and appointed former Vice-president Emmerson Mnangagwa in his place. On 21 November 2017, Mugabe tendered his resignation prior to impeachment proceedings being completed. Although under the Constitution of Zimbabwe Mugabe should be succeeded by Vice-president Phelekezela Mphoko , a supporter of Grace Mugabe , ZANU–PF chief whip Lovemore Matuke stated to the Reuters news agency that Mnangagwa would be appointed as president. On 30 July 2018 Zimbabwe held its general elections , which were won by the ZANU-PF party led by Mnangagwa. Nelson Chamisa who was leading the main opposition party MDC Alliance contested the election results claiming voter fraud, and subsequently filed a petition to the Constitution Court of Zimbabwe. The court confirmed Mnangagwa's victory, making him the newly elected president after Mugabe. In December 2017 the website Zimbabwe News, calculating the cost of the Mugabe era using various statistics, said that at the time of independence in 1980, the country was growing economically at about five per cent a year, and had done so for quite a long time. If this rate of growth had been maintained for the next 37 years, Zimbabwe would have in 2016 a GDP of US$52 billion. Instead it had a formal sector GDP of only US$14 billion, a cost of US$38 billion in lost growth. The population growth in 1980 was among the highest in Africa at about 3.5 per cent per annum, doubling every 21 years. Had this growth been maintained, the population would have been 31 million. Instead, as of 2018, it is about 13 million. The discrepancies were believed to be partly caused by death from starvation and disease, and partly due to decreased fertility. The life expectancy has halved, and deaths from politically motivated violence sponsored by the government exceed 200,000 since 1980. The Mugabe government has directly or indirectly caused the deaths of at least three million Zimbabweans in 37 years. According to World Food Programme, over two million people are facing starvation because of the recent droughts the country is going through. In 2018, President Mnangagwa announced that his government would seek to rejoin the Commonwealth , which is as of 2023 conducting a fact-finding mission prior to asking the Secretary-General to issue a recommendation. In August 2023, President Emmerson Mnangagwa won a second term in an outcome of the election rejected by the opposition and questioned by observers. Archaeological records date archaic human settlement of present-day Zimbabwe to at least 500,000 years ago. Zimbabwe's earliest known inhabitants were most likely the San people , who left behind a legacy of arrowheads and cave paintings. Approximately 2,000 years ago, the first Bantu-speaking farmers arrived during the Bantu expansion. Societies speaking proto- Shona languages first emerged in the middle Limpopo River valley in the 9th century before moving on to the Zimbabwean highlands. The Zimbabwean plateau became the centre of subsequent Shona states, beginning around the 10th century. Around the early 10th century, trade developed with Arab merchants on the Indian Ocean coast, helping to develop the Kingdom of Mapungubwe in the 11th century. This was the precursor to the Shona civilisations that dominated the region during the 13th to 15th centuries, evidenced by ruins at Great Zimbabwe , near Masvingo , and by other smaller sites. The main archaeological site used a unique dry stone architecture. The Kingdom of Mapungubwe was the first in a series of trading states which had developed in Zimbabwe by the time the first European explorers arrived from Portugal. These states traded gold, ivory, and copper for cloth and glass. By 1220, the Kingdom of Zimbabwe eclipsed Mapungubwe. This Shona state further refined and expanded upon Mapungubwe's stone architecture. From c. 1450 to 1760, the Kingdom of Mutapa ruled much of the area of present-day Zimbabwe, plus parts of central Mozambique. It is known by many names including the Mutapa Empire, also known as Mwene Mutapa or Monomotapa as well as "Munhumutapa", and was renowned for its strategic trade routes with the Arabs and Portugal. The Portuguese sought to monopolise this influence and began a series of wars which left the empire in near collapse in the early 17th century. As a direct response to increased European presence in the interior a new Shona state emerged, known as the Rozwi Empire . Relying on centuries of military, political and religious development, the Rozwi (meaning "destroyers") expelled the Portuguese from the Zimbabwean plateau in 1683. Around 1821 the Zulu general Mzilikazi of the Khumalo clan successfully rebelled against King Shaka and established his own clan, the Ndebele . The Ndebele fought their way northwards into the Transvaal , leaving a trail of destruction in their wake and beginning an era of widespread devastation known as the Mfecane . When Dutch trekboers converged on the Transvaal in 1836, they drove the tribe even further northward, with the assistance of Tswana Barolong warriors and Griqua commandos. By 1838 the Ndebele had conquered the Rozwi Empire, along with the other smaller Shona states, and reduced them to vassaldom . After losing their remaining South African lands in 1840, Mzilikazi and his tribe permanently settled in the southwest of present-day Zimbabwe in what became known as Matabeleland, establishing Bulawayo as their capital. Mzilikazi then organised his society into a military system with regimental kraals , similar to those of Shaka, which was stable enough to repel further Boer incursions. Mzilikazi died in 1868; following a violent power struggle, his son Lobengula succeeded him.In the 1880s, European colonists arrived with Cecil Rhodes 's British South Africa Company (chartered in 1889). In 1888, Rhodes obtained a concession for mining rights from King Lobengula of the Ndebele peoples. He presented this concession to persuade the government of the United Kingdom to grant a royal charter to the company over Matabeleland, and its subject states such as Mashonaland as well. Rhodes used this document in 1890 to justify sending the Pioneer Column , a group of Europeans protected by well-armed British South Africa Police (BSAP) through Matabeleland and into Shona territory to establish Fort Salisbury (present-day Harare ), and thereby establish company rule over the area. In 1893 and 1894, with the help of their new Maxim guns, the BSAP would go on to defeat the Ndebele in the First Matabele War . Rhodes additionally sought permission to negotiate similar concessions covering all territory between the Limpopo River and Lake Tanganyika , then known as "Zambesia". In accordance with the terms of aforementioned concessions and treaties, mass settlement was encouraged, with the British maintaining control over labour as well as over precious metals and other mineral resources. In 1895, the BSAC adopted the name "Rhodesia" for the territory, in honour of Rhodes. In 1898 "Southern Rhodesia" became the official name for the region south of the Zambezi, which later adopted the name "Zimbabwe". The region to the north, administered separately, was later termed Northern Rhodesia (present-day Zambia). Shortly after the disastrous Rhodes-sponsored Jameson Raid on the South African Republic , the Ndebele rebelled against white rule, led by their charismatic religious leader, Mlimo. The Second Matabele War of 1896–1897 lasted in Matabeleland until 1896, when Mlimo was assassinated by American scout Frederick Russell Burnham . Shona agitators staged unsuccessful revolts (known as Chimurenga ) against company rule during 1896 and 1897. [ citation needed ] Following these failed insurrections, the Rhodes administration subdued the Ndebele and Shona groups and organised the land with a disproportionate bias favouring Europeans, thus displacing many indigenous peoples. The United Kingdom annexed Southern Rhodesia on 12 September 1923. Shortly after annexation, on 1 October 1923, the first constitution for the new Colony of Southern Rhodesia came into force. Under the new constitution, Southern Rhodesia became a self-governing British colony , subsequent to a 1922 referendum . Rhodesians of all races served on behalf of the United Kingdom during the two World Wars in the early-20th century. Proportional to the white population, Southern Rhodesia contributed more per capita to both the First and Second World Wars than any other part of the empire, including Britain. The 1930 Land Apportionment Act restricted black land ownership to certain segments of the country, setting aside large areas solely for the purchase of the white minority. This act, which led to rapidly rising inequality, became the subject of frequent calls for subsequent land reform. In 1953, in the face of African opposition, Britain consolidated the two Rhodesias with Nyasaland (Malawi) in the ill-fated Central African Federation , which Southern Rhodesia essentially dominated. Growing African nationalism and general dissent, particularly in Nyasaland, persuaded Britain to dissolve the union in 1963, forming three separate divisions. While multiracial democracy was finally introduced to Northern Rhodesia and Nyasaland, Southern Rhodesians of European ancestry continued to enjoy minority rule . Following Zambian independence (effective from October 1964), Ian Smith 's Rhodesian Front government in Salisbury dropped the designation "Southern" in 1964 (once Northern Rhodesia had changed its name to Zambia , having the word Southern before the name Rhodesia became unnecessary and the country simply became known as Rhodesia afterwards). Intent on effectively repudiating the recently adopted British policy of " no independence before majority rule ", Smith issued a Unilateral Declaration of Independence (UDI) from the United Kingdom on 11 November 1965. This marked the first such course taken by a rebel British colony since the American declaration of 1776, which Smith and others indeed claimed provided a suitable precedent to their own actions. The United Kingdom deemed the Rhodesian declaration an act of rebellion but did not re-establish control by force. The British government petitioned the United Nations for sanctions against Rhodesia pending unsuccessful talks with Smith's administration in 1966 and 1968. In December 1966, the organisation complied, imposing the first mandatory trade embargo on an autonomous state. These sanctions were expanded again in 1968. A civil war ensued when Joshua Nkomo 's Zimbabwe African People's Union (ZAPU) and Robert Mugabe's Zimbabwe African National Union (ZANU), supported actively by communist powers and neighbouring African nations, initiated guerrilla operations against Rhodesia's predominantly white government. ZAPU was supported by the Soviet Union , the Warsaw Pact and associated nations such as Cuba, and adopted a Marxist–Leninist ideology; ZANU meanwhile aligned itself with Maoism and the bloc headed by the People's Republic of China. Smith declared Rhodesia a republic in 1970, following the results of a referendum the previous year , but this went unrecognised internationally. Meanwhile, Rhodesia's internal conflict intensified, eventually forcing him to open negotiations with the militant communists. In March 1978, Smith reached an accord with three African leaders, led by Bishop Abel Muzorewa , who offered to leave the white population comfortably entrenched in exchange for the establishment of a biracial democracy. As a result of the Internal Settlement , elections were held in April 1979 , concluding with the United African National Council (UANC) carrying a majority of parliamentary seats. On 1 June 1979, Muzorewa, the UANC head, became prime minister and the country's name was changed to Zimbabwe Rhodesia. The Internal Settlement left control of the Rhodesian Security Forces , civil service, judiciary, and a third of parliament seats to whites. On 12 June, the United States Senate voted to lift economic pressure on the former Rhodesia. Following the fifth Commonwealth Heads of Government Meeting , held in Lusaka , Zambia, from 1 to 7 August in 1979, the British government invited Muzorewa, Mugabe, and Nkomo to participate in a constitutional conference at Lancaster House . The purpose of the conference was to discuss and reach an agreement on the terms of an independence constitution, and provide for elections supervised under British authority allowing Zimbabwe Rhodesia to proceed to legal independence. With Lord Carrington, Secretary of State for Foreign and Commonwealth Affairs of the United Kingdom, in the chair, these discussions were mounted from 10 September to 15 December in 1979, producing a total of 47 plenary sessions . On 21 December 1979, delegations from every major interest represented reached the Lancaster House Agreement , effectively ending the guerrilla war. On 11 December 1979, the Rhodesian House of Assembly voted 90 to nil to revert to British colonial status. With the arrival of Christopher Soames , the new governor on 12 December 1979, Britain formally took control of Zimbabwe Rhodesia as the Colony of Southern Rhodesia. Britain lifted sanctions on 12 December and the United Nations on 16 December. During the elections of February 1980 , Mugabe and the ZANU party secured a landslide victory. Prince Charles , as the representative of Britain, formally granted independence to the new nation of Zimbabwe at a ceremony in Harare in April 1980. Zimbabwe's first president after its independence was Canaan Banana in what was originally a mainly ceremonial role as head of state . Mugabe was the country's first prime minister and head of government. In 1980, Samora Machel told Mugabe that Zimbabwe was the "Jewel of Africa" but added: "Don't tarnish it!". New names for 32 places were gazetted on 18 April 1982 and by February 1984, there had been 42 changes, which included three rivers (Umniati/ Munyati ; Lundi/ Runde ; Nuanetsi/ Mwenezi ), and several changes from colonial names (such as Salisbury/Harare; Enkeldoorn/ Chivhu ; Essexvale/ Esigodini ; Fort Victoria/ Masvingo ) Opposition to what was perceived as a Shona takeover immediately erupted around Matabeleland. The Matabele unrest led to what has become known as Gukurahundi (Shona: 'the early rain which washes away the chaff before the spring rains'). The Fifth Brigade , a North Korean-trained elite unit that reported directly to Mugabe, entered Matabeleland and massacred thousands of civilians accused of supporting "dissidents". Estimates for the number of deaths during the five-year Gukurahundi campaign ranged from 3,750 to 80,000. Thousands of others were tortured in military internment camps. The campaign officially ended in 1987 after Nkomo and Mugabe reached a unity agreement that merged their respective parties, creating the Zimbabwe African National Union – Patriotic Front ( ZANU–PF ). Elections in March 1990 resulted in another victory for Mugabe and the ZANU–PF party, which claimed 117 of the 120 contested seats. During the 1990s, students, trade unionists, and other workers often demonstrated to express their growing discontent with Mugabe and ZANU–PF party policies. In 1996, civil servants, nurses, and junior doctors went on strike over salary issues. The general health of the population also began to significantly decline; by 1997 an estimated 25% of the population had been infected by HIV in a pandemic that was affecting most of southern Africa. Land redistribution re-emerged as the main issue for the ZANU–PF government around 1997. Despite the existence of a "willing-buyer-willing-seller" land reform programme since the 1980s, the minority white Zimbabwean population of around 0.6% continued to hold 70% of the country's most fertile agricultural land. In 2000, the government pressed ahead with its Fast Track Land Reform programme, a policy involving compulsory land acquisition aimed at redistributing land from the minority white population to the majority black population. Confiscations of white farmland, continuous droughts, and a serious drop in external finance and other support led to a sharp decline in agricultural exports, which were traditionally the country's leading export-producing sector. Some 58,000 independent black farmers have since experienced limited success in reviving the gutted cash crop sectors through efforts on a smaller scale. President Mugabe and the ZANU–PF party leadership found themselves beset by a wide range of international sanctions. In 2002, the nation was suspended from the Commonwealth of Nations due to the reckless farm seizures and blatant election tampering . The following year, Zimbabwean officials voluntarily terminated its Commonwealth membership. In 2001, the United States enacted the Zimbabwe Democracy and Economic Recovery Act (ZDERA). It came into effect in 2002 and froze credit to the Zimbabwean government. By 2003, the country's economy had collapsed. It is estimated that up to a quarter of Zimbabwe's 11 million people had fled the country. Three-quarters of the remaining Zimbabweans were living on less than one U.S. dollar a day. Following elections in 2005 , the government initiated " Operation Murambatsvina ", an effort to crack down on illegal markets and slums emerging in towns and cities, leaving a substantial section of urban poor homeless. The Zimbabwean government has described the operation as an attempt to provide decent housing to the population, although according to critics such as Amnesty International , authorities have yet to properly substantiate their claims. On 29 March 2008, Zimbabwe held a presidential election along with a parliamentary election . The results of this election were withheld for two weeks, after which it was generally acknowledged that the Movement for Democratic Change – Tsvangirai (MDC-T) had achieved a majority of one seat in the lower house of parliament. In September 2008, a power-sharing agreement was reached between Tsvangirai and President Mugabe, permitting the former to hold the office of prime minister. Due to ministerial differences between their respective political parties, the agreement was not fully implemented until 13 February 2009. By December 2010, Mugabe was threatening to completely expropriate remaining privately owned companies in Zimbabwe unless "western sanctions" were lifted. In late 2008, problems in Zimbabwe reached crisis proportions in the areas of living standards, public health (with a major cholera outbreak in December) and various basic affairs. During this period, NGOs took over from government as a primary provider of food during this period of food insecurity in Zimbabwe. A 2011 survey by Freedom House suggested that living conditions had improved since the power-sharing agreement. The United Nations Office for the Coordination of Humanitarian Affairs stated in its 2012–2013 planning document that the "humanitarian situation has improved in Zimbabwe since 2009, but conditions remain precarious for many people". A new constitution approved in the Zimbabwean constitutional referendum, 2013 curtails presidential powers. Mugabe was re-elected president in the July 2013 Zimbabwean general election which The Economist described as "rigged" and the Daily Telegraph as "stolen". The Movement for Democratic Change alleged massive fraud and tried to seek relief through the courts. In a surprising moment of candour at the ZANU–PF congress in December 2014, President Robert Mugabe accidentally let slip that the opposition had in fact won the contentious 2008 polls by an astounding 73%. After winning the election, the Mugabe ZANU–PF government re-instituted one party rule , doubled the civil service and, according to The Economist , embarked on "misrule and dazzling corruption". A 2017 study conducted by the Institute for Security Studies (ISS) concluded that due to the deterioration of government and the economy "the government encourages corruption to make up for its inability to fund its own institutions" with widespread and informal police roadblocks to issue fines to travellers being one manifestation of this. In July 2016 nationwide protests took place regarding the economic collapse in the country. In November 2017, the army led a coup d'état following the dismissal of Vice-president Emmerson Mnangagwa , placing Mugabe under house arrest. The army denied that their actions constituted a coup . On 19 November 2017, ZANU–PF sacked Robert Mugabe as party leader and appointed former Vice-president Emmerson Mnangagwa in his place. On 21 November 2017, Mugabe tendered his resignation prior to impeachment proceedings being completed. Although under the Constitution of Zimbabwe Mugabe should be succeeded by Vice-president Phelekezela Mphoko , a supporter of Grace Mugabe , ZANU–PF chief whip Lovemore Matuke stated to the Reuters news agency that Mnangagwa would be appointed as president. On 30 July 2018 Zimbabwe held its general elections , which were won by the ZANU-PF party led by Mnangagwa. Nelson Chamisa who was leading the main opposition party MDC Alliance contested the election results claiming voter fraud, and subsequently filed a petition to the Constitution Court of Zimbabwe. The court confirmed Mnangagwa's victory, making him the newly elected president after Mugabe. In December 2017 the website Zimbabwe News, calculating the cost of the Mugabe era using various statistics, said that at the time of independence in 1980, the country was growing economically at about five per cent a year, and had done so for quite a long time. If this rate of growth had been maintained for the next 37 years, Zimbabwe would have in 2016 a GDP of US$52 billion. Instead it had a formal sector GDP of only US$14 billion, a cost of US$38 billion in lost growth. The population growth in 1980 was among the highest in Africa at about 3.5 per cent per annum, doubling every 21 years. Had this growth been maintained, the population would have been 31 million. Instead, as of 2018, it is about 13 million. The discrepancies were believed to be partly caused by death from starvation and disease, and partly due to decreased fertility. The life expectancy has halved, and deaths from politically motivated violence sponsored by the government exceed 200,000 since 1980. The Mugabe government has directly or indirectly caused the deaths of at least three million Zimbabweans in 37 years. According to World Food Programme, over two million people are facing starvation because of the recent droughts the country is going through. In 2018, President Mnangagwa announced that his government would seek to rejoin the Commonwealth , which is as of 2023 conducting a fact-finding mission prior to asking the Secretary-General to issue a recommendation. In August 2023, President Emmerson Mnangagwa won a second term in an outcome of the election rejected by the opposition and questioned by observers. Zimbabwe is a landlocked country in southern Africa, lying between latitudes 15° and 23°S , and longitudes 25° and 34°E . It is bordered by South Africa to the south, Botswana to the west and southwest, Zambia to the northwest, and Mozambique to the east and northeast. Its northwest corner is roughly 150 meters from Namibia , nearly forming a four-nation quadripoint . Most of the country is elevated, consisting of a central plateau (high veld) stretching from the southwest northwards with altitudes between 1,000 and 1,600 m. The country's extreme east is mountainous, this area being known as the Eastern Highlands , with Mount Nyangani as the highest point at 2,592 m. The highlands are known for their natural environment, with tourist destinations such as Nyanga , Troutbeck, Chimanimani , Vumba and Chirinda Forest at Mount Selinda . About 20% of the country consists of low-lying areas, (the low veld) under 900m. Victoria Falls , one of the world's largest and most spectacular waterfalls, is located in the country's extreme northwest and is part of the Zambezi river. Over geological time Zimbabwe has experienced two major post- Gondwana erosion cycles (known as African and post-African), and a very subordinate Plio-Pleistocene cycle. Zimbabwe has a subtropical climate with many local variations. The southern areas are known for their heat and aridity, while parts of the central plateau receive frost in winter. The Zambezi valley is known for its extreme heat, and the Eastern Highlands usually experience cool temperatures and the highest rainfall in the country. The country's rainy season generally runs from late October to March, and the hot climate is moderated by increasing altitude. Zimbabwe is faced with recurring droughts. In 2019, at least 55 elephants died because of drought. Severe storms are rare. Zimbabwe contains seven terrestrial ecoregions: Kalahari acacia–baikiaea woodlands , Southern Africa bushveld , Southern miombo woodlands , Zambezian Baikiaea woodlands , Zambezian and mopane woodlands , Zambezian halophytics , and Eastern Zimbabwe montane forest-grassland mosaic in the Eastern Highlands. The country is mostly savanna , although the moist and mountainous Eastern Highlands support areas of tropical evergreen and hardwood forests. Trees found in the Eastern Highlands include teak , mahogany , enormous specimens of strangler fig , forest Newtonia , big leaf, white stinkwood , chirinda stinkwood, knobthorn and many others. In the low-lying parts of the country fever trees , mopane , combretum and baobabs abound. Much of the country is covered by miombo woodland, dominated by brachystegia species and others. Among the numerous flowers and shrubs are hibiscus , flame lily , snake lily , spider lily , leonotis , cassia , tree wisteria and dombeya . There are around 350 species of mammals that can be found in Zimbabwe. There are also many snakes and lizards, over 500 bird species, and 131 fish species. Large parts of Zimbabwe were once covered by forests with abundant wildlife. Deforestation and poaching has reduced the amount of wildlife. Woodland degradation and deforestation caused by population growth , urban expansion and use for fuel are major concerns and have led to erosion which diminishes the amount of fertile soil. Local farmers have been criticised by environmentalists for burning off vegetation to heat their tobacco barns. The country had a 2019 Forest Landscape Integrity Index mean score of 6.31/10, ranking it 81st globally out of 172 countries. Over geological time Zimbabwe has experienced two major post- Gondwana erosion cycles (known as African and post-African), and a very subordinate Plio-Pleistocene cycle. Zimbabwe has a subtropical climate with many local variations. The southern areas are known for their heat and aridity, while parts of the central plateau receive frost in winter. The Zambezi valley is known for its extreme heat, and the Eastern Highlands usually experience cool temperatures and the highest rainfall in the country. The country's rainy season generally runs from late October to March, and the hot climate is moderated by increasing altitude. Zimbabwe is faced with recurring droughts. In 2019, at least 55 elephants died because of drought. Severe storms are rare. Zimbabwe contains seven terrestrial ecoregions: Kalahari acacia–baikiaea woodlands , Southern Africa bushveld , Southern miombo woodlands , Zambezian Baikiaea woodlands , Zambezian and mopane woodlands , Zambezian halophytics , and Eastern Zimbabwe montane forest-grassland mosaic in the Eastern Highlands. The country is mostly savanna , although the moist and mountainous Eastern Highlands support areas of tropical evergreen and hardwood forests. Trees found in the Eastern Highlands include teak , mahogany , enormous specimens of strangler fig , forest Newtonia , big leaf, white stinkwood , chirinda stinkwood, knobthorn and many others. In the low-lying parts of the country fever trees , mopane , combretum and baobabs abound. Much of the country is covered by miombo woodland, dominated by brachystegia species and others. Among the numerous flowers and shrubs are hibiscus , flame lily , snake lily , spider lily , leonotis , cassia , tree wisteria and dombeya . There are around 350 species of mammals that can be found in Zimbabwe. There are also many snakes and lizards, over 500 bird species, and 131 fish species. Large parts of Zimbabwe were once covered by forests with abundant wildlife. Deforestation and poaching has reduced the amount of wildlife. Woodland degradation and deforestation caused by population growth , urban expansion and use for fuel are major concerns and have led to erosion which diminishes the amount of fertile soil. Local farmers have been criticised by environmentalists for burning off vegetation to heat their tobacco barns. The country had a 2019 Forest Landscape Integrity Index mean score of 6.31/10, ranking it 81st globally out of 172 countries. Zimbabwe is a republic with a presidential system of government. The semi-presidential system was abolished with the adoption of a new constitution after a referendum in 2013 . Under the constitutional changes in 2005, an upper chamber , the Senate , was reinstated. The House of Assembly is the lower chamber of Parliament. In 1987 Mugabe revised the constitution, abolishing the ceremonial presidency and the prime ministerial posts to form an executive president—a presidential system. His ZANU-PF party has won every election since independence—in the 1990 election the second-placed party, Edgar Tekere 's Zimbabwe Unity Movement (ZUM), obtained 20% of the vote. During the 1995 parliamentary elections, most opposition parties, including the ZUM, boycotted the voting, resulting in a near sweep by the ruling party. When the opposition returned to the polls in 2000, they won 57 seats, only five fewer than ZANU-PF. Presidential elections were again held in 2002 amid allegations of vote-rigging, intimidation and fraud. The 2005 Zimbabwe parliamentary elections were held on 31 March, and multiple claims of vote rigging, election fraud and intimidation were made by the Movement for Democratic Change party and Jonathan Moyo , calling for investigations into 32 of the 120 constituencies. Moyo participated in the elections despite the allegations and won a seat as an independent member of Parliament. In 2005, the MDC split into two factions: the Movement for Democratic Change – Mutambara ( MDC-M ), led by Arthur Mutambara which contested the elections to the Senate, and the Movement for Democratic Change – Tsvangirai (MDC-T) led by Morgan Tsvangirai which was opposed to contesting the elections, stating that participation in a rigged election is tantamount to endorsing Mugabe's claim that past elections were free and fair. The two MDC camps had their congresses in 2006 with Tsvangirai being elected to lead MDC-T, which became more popular than the other group. In the 2008 general election , the official results required a run-off between Mugabe and Tsvangirai. The MDC-T challenged these results, claiming widespread election fraud by the Mugabe government. The run-off was scheduled for 27 June 2008. On 22 June, citing the continuing unfairness of the process and refusing to participate in a "violent, illegitimate sham of an election process", Tsvangirai pulled out of the presidential run-off, the election commission held the run-off, and President Mugabe received a landslide majority. The MDC-T did not participate in the Senate elections, while the MDC-M won five seats in the Senate. The MDC-M was weakened by defections from members of parliament and individuals who were disillusioned by their manifesto. On 28 April 2008, Tsvangirai and Mutambara announced at a joint news conference in Johannesburg that the two MDC formations were co-operating, enabling the MDC to have a clear parliamentary majority. Tsvangirai said that Mugabe could not remain president without a parliamentary majority. In mid-September 2008, after protracted negotiations overseen by the leaders of South Africa and Mozambique, Mugabe and Tsvangirai signed a power-sharing deal in which Mugabe retained control over the army. Donor nations adopted a 'wait-and-see' attitude, wanting to see real change being brought about by this merger before committing themselves to funding rebuilding efforts, which were estimated to take at least five years. On 11 February 2009 Tsvangirai was sworn in as prime minister by Mugabe. In November 2008, the government of Zimbabwe spent US$7.3 million donated by The Global Fund to Fight AIDS, Tuberculosis and Malaria . A representative of the organisation declined to speculate on how the money was spent, except that it was not for the intended purpose, and the government has failed to honour requests to return the money. The status of Zimbabwe politics has been thrown into question by a coup taking place in November 2017, ending Mugabe's 30-year presidential incumbency. Emmerson Mnangagwa was appointed president following this coup and was officially elected with 50.8% of the vote in the 2018 Zimbabwean general election , avoiding a run-off and making him the third president of Zimbabwe. The government has received negative comments among its citizens for always shutting down the internet in the past amid protests such as the one planned on 31 July 2020. In July 2023, Zimbabwean President Emmerson Mnangagwa voiced support for the Russian invasion of Ukraine . The Zimbabwe Defence Forces were set up by unifying three insurrectionist forces – the Zimbabwe African National Liberation Army (ZANLA), the Zimbabwe People's Revolutionary Army (ZIPRA), and the Rhodesian Security Forces (RSF) – after the Second Chimurenga and Zimbabwean independence in 1980. The integration period saw the formation of the Zimbabwe National Army (ZNA) and Air Force of Zimbabwe (AFZ) as separate entities under the command of General Solomon Mujuru and Air Marshal Norman Walsh , who retired in 1982 and was replaced by Air Marshal Azim Daudpota who handed over command to Air Chief Marshal Josiah Tungamirai in 1985. In 2003, General Constantine Chiwenga , was promoted and appointed Commander of the Zimbabwe Defence Forces. Lieutenant General P. V. Sibanda replaced him as Commander of the Army. The ZNA has an active duty strength of 30,000. The Air Force has about 5,139 standing personnel. The Zimbabwe Republic Police (includes Police Support Unit, Paramilitary Police) is part of the Zimbabwe Defence Forces and numbers 25,000. Following majority rule in early 1980, British Army trainers oversaw the integration of guerrilla fighters into a battalion structure overlaid on the existing Rhodesian armed forces. For the first year, a system was followed where the top-performing candidate became battalion commander. If he or she was from ZANLA, then his or her second-in-command was the top-performing ZIPRA candidate, and vice versa. This ensured a balance between the two movements in the command structure. The ZNA was originally formed into four brigades , composed of a total of 28 battalions. The brigade support units were composed almost entirely of specialists of the former Rhodesian Army, while unintegrated battalions of the Rhodesian African Rifles were assigned to the 1st, 3rd and 4th Brigades. The Fifth Brigade was formed in 1981 and disbanded in 1988 after the demonstration of mass brutality and murder during the brigade's occupation of Matabeleland in what became known as Gukurahundi . The brigade had been re-formed by 2006, with its commander, Brigadier General John Mupande praising its "rich history". There are widespread reports of systematic and escalating violations of human rights in Zimbabwe under the Mugabe administration and the dominant ZANU–PF party. According to human rights organisations such as Amnesty International and Human Rights Watch the government of Zimbabwe violates the rights to shelter, food, freedom of movement and residence, freedom of assembly and the protection of the law . In 2009, Gregory Stanton, president of the International Association of Genocide Scholars, stated there was "clear evidence that Mugabe government was guilty of crimes against humanity and that there was sufficient evidence of crimes against humanity to bring Mugabe to trial in front of the International Criminal Court ." Male homosexuality is illegal in Zimbabwe . Since 1995, the government has carried out campaigns against both homosexual men and women. President Mugabe has blamed gays for many of Zimbabwe's problems and viewed homosexuality as an "un-African" and immoral culture brought by European colonists and practised by only "a few whites" in his country. Opposition gatherings are frequently the subject of reprisals by the police force, such as the crackdown on an 11 March 2007 MDC rally and several others during the 2008 election campaign. Police actions have been strongly condemned by the UN Secretary-General Ban Ki-moon , the European Union, and the United States. There are also concerns over Fox Southwest media rights and access. The Zimbabwean government is accused of suppressing freedom of the press and freedom of speech. It has been repeatedly accused of using the public broadcaster, the Zimbabwe Broadcasting Corporation , as a propaganda tool. Newspapers critical of the government, such as the Daily News , closed after bombs exploded at their offices and the government refused to renew their licence. BBC News , Sky News , and CNN were banned from filming or reporting from Zimbabwe. In 2009 reporting restrictions on the BBC and CNN were lifted. Sky News continues to report on happenings within Zimbabwe from neighbouring countries like South Africa. On 24 July 2020, the Office of the United Nations High Commissioner for Human Rights (OHCHR) expressed concerns over allegations suggesting that Zimbabwean authorities may have used the COVID-19 crisis as a pretext to suppress freedom of expression and peaceful assembly on the streets. OHCHR spokesperson Liz Throssell stated that people have a right to protest corruption or anything else. The authorities in Zimbabwe used force to disperse and arrest nurses and health workers, who were peacefully protesting for better salaries and work conditions. The reports suggest that a few members of opposition party and investigative journalists were also arbitrarily arrested and detained for taking part in a protest. On 5 August 2020, the #ZimbabweanLivesMatter campaign on Twitter drew attention of international celebrities and politicians towards human rights abuses in the country, mounting pressure on Emmerson Mnangagwa's government. The campaign was in response to arrests, abductions and torture of political activists and the incarceration of journalist Hopewell Chin'ono and the Booker Prize shortlisted author Tsitsi Dangarembga . Zimbabwe has a centralised government and is divided into eight provinces and two cities with provincial status, for administrative purposes. Each province has a provincial capital from where government administration is usually carried out. The names of most of the provinces were generated from the Mashonaland and Matabeleland divide at the time of colonisation: Mashonaland was the territory occupied first by the British South Africa Company Pioneer Column and Matabeleland the territory conquered during the First Matabele War. This corresponds roughly to the precolonial territory of the Shona people and the Matabele people, although there are significant ethnic minorities in most provinces. Each province is headed by a provincial governor, appointed by the president. The provincial government is run by a provincial administrator, appointed by the Public Service Commission. Other government functions at provincial level are carried out by provincial offices of national government departments. The provinces are subdivided into 59 districts and 1,200 wards (sometimes referred to as municipalities). Each district is headed by a district administrator, appointed by the Public Service Commission. There is also a Rural District Council, which appoints a chief executive officer. The Rural District Council is composed of elected ward councillors, the district administrator, and one representative of the chiefs (traditional leaders appointed under customary law) in the district. Other government functions at district level are carried out by district offices of national government departments. At the ward level there is a Ward Development Committee, comprising the elected ward councillor, the kraalheads (traditional leaders subordinate to chiefs) and representatives of Village Development Committees. Wards are subdivided into villages, each of which has an elected Village Development Committee and a headman (traditional leader subordinate to the kraalhead). Since the early 2000s, Zimbabwe has been under sanctions imposed by the United States and the European Union that have shaped Zimbabwe's domestic politics as well as the country's relations with the Western nations . In 2002, Zimbabwe held general elections and ahead of that election the EU sent observers, but the election observer team was forced to leave the country. In February 2002 the EU placed targeted or restrictive measures on Zimbabwe. At least 20 government officials were banned from entering Europe, and EU funding was halted. Prior to the elections there was $128 million that was budgeted for the Zimbabwean government from 2002 to 2007, this was cancelled. Nevertheless, the EU only stopped funding the government directly but it continued sending money only through aid agencies and NGOs. After some years, the EU and Zimbabwe resolved some of their disputes and a lot of the EU sanctions were removed. Only Mugabe and his wife remained on the list while other government officials were removed. However, the EU still did not give Zimbabwe money. So, the government channels money through NGOs as it was seen on 4 March 2019 – 21 March 2019 Cyclone Idai . The United States also imposed sanctions on Zimbabwe. There are two types of U.S. sanctions on Zimbabwe. The first one is Zimbabwe Democracy and Economic Recovery Act (ZIDERA) and the second one is the Targeted Sanctions Program. ZIDERA made several demands, the first one was that Zimbabwe must respect human rights, second Zimbabwe must stop its interference in the Democratic Republic of the Congo , third Zimbabwe must stop the expropriation of white farms. If none of these demands were met, the U.S. would block the IMF and the World Bank from lending money to Zimbabwe. A new ZIDERA came into effect in 2018 with the motto that, Restore Democracy or there won't be any friendship, there must be free elections, free media and human rights, Zimbabwe must enforce the ruling of the SADC Tribunal . The Targeted Sanctions Program was implemented in 2003, which lists Zimbabwean companies and people who are not allowed to deal with U.S. companies. The sanctions on Zimbabwe have been in place for more than two decades. In March 2021, the U.S. renewed its sanctions on Zimbabwe. During the 1995 parliamentary elections, most opposition parties, including the ZUM, boycotted the voting, resulting in a near sweep by the ruling party. When the opposition returned to the polls in 2000, they won 57 seats, only five fewer than ZANU-PF. Presidential elections were again held in 2002 amid allegations of vote-rigging, intimidation and fraud. The 2005 Zimbabwe parliamentary elections were held on 31 March, and multiple claims of vote rigging, election fraud and intimidation were made by the Movement for Democratic Change party and Jonathan Moyo , calling for investigations into 32 of the 120 constituencies. Moyo participated in the elections despite the allegations and won a seat as an independent member of Parliament. In 2005, the MDC split into two factions: the Movement for Democratic Change – Mutambara ( MDC-M ), led by Arthur Mutambara which contested the elections to the Senate, and the Movement for Democratic Change – Tsvangirai (MDC-T) led by Morgan Tsvangirai which was opposed to contesting the elections, stating that participation in a rigged election is tantamount to endorsing Mugabe's claim that past elections were free and fair. The two MDC camps had their congresses in 2006 with Tsvangirai being elected to lead MDC-T, which became more popular than the other group. In the 2008 general election , the official results required a run-off between Mugabe and Tsvangirai. The MDC-T challenged these results, claiming widespread election fraud by the Mugabe government. The run-off was scheduled for 27 June 2008. On 22 June, citing the continuing unfairness of the process and refusing to participate in a "violent, illegitimate sham of an election process", Tsvangirai pulled out of the presidential run-off, the election commission held the run-off, and President Mugabe received a landslide majority. The MDC-T did not participate in the Senate elections, while the MDC-M won five seats in the Senate. The MDC-M was weakened by defections from members of parliament and individuals who were disillusioned by their manifesto. On 28 April 2008, Tsvangirai and Mutambara announced at a joint news conference in Johannesburg that the two MDC formations were co-operating, enabling the MDC to have a clear parliamentary majority. Tsvangirai said that Mugabe could not remain president without a parliamentary majority. In mid-September 2008, after protracted negotiations overseen by the leaders of South Africa and Mozambique, Mugabe and Tsvangirai signed a power-sharing deal in which Mugabe retained control over the army. Donor nations adopted a 'wait-and-see' attitude, wanting to see real change being brought about by this merger before committing themselves to funding rebuilding efforts, which were estimated to take at least five years. On 11 February 2009 Tsvangirai was sworn in as prime minister by Mugabe. In November 2008, the government of Zimbabwe spent US$7.3 million donated by The Global Fund to Fight AIDS, Tuberculosis and Malaria . A representative of the organisation declined to speculate on how the money was spent, except that it was not for the intended purpose, and the government has failed to honour requests to return the money. The status of Zimbabwe politics has been thrown into question by a coup taking place in November 2017, ending Mugabe's 30-year presidential incumbency. Emmerson Mnangagwa was appointed president following this coup and was officially elected with 50.8% of the vote in the 2018 Zimbabwean general election , avoiding a run-off and making him the third president of Zimbabwe. The government has received negative comments among its citizens for always shutting down the internet in the past amid protests such as the one planned on 31 July 2020. In July 2023, Zimbabwean President Emmerson Mnangagwa voiced support for the Russian invasion of Ukraine . The Zimbabwe Defence Forces were set up by unifying three insurrectionist forces – the Zimbabwe African National Liberation Army (ZANLA), the Zimbabwe People's Revolutionary Army (ZIPRA), and the Rhodesian Security Forces (RSF) – after the Second Chimurenga and Zimbabwean independence in 1980. The integration period saw the formation of the Zimbabwe National Army (ZNA) and Air Force of Zimbabwe (AFZ) as separate entities under the command of General Solomon Mujuru and Air Marshal Norman Walsh , who retired in 1982 and was replaced by Air Marshal Azim Daudpota who handed over command to Air Chief Marshal Josiah Tungamirai in 1985. In 2003, General Constantine Chiwenga , was promoted and appointed Commander of the Zimbabwe Defence Forces. Lieutenant General P. V. Sibanda replaced him as Commander of the Army. The ZNA has an active duty strength of 30,000. The Air Force has about 5,139 standing personnel. The Zimbabwe Republic Police (includes Police Support Unit, Paramilitary Police) is part of the Zimbabwe Defence Forces and numbers 25,000. Following majority rule in early 1980, British Army trainers oversaw the integration of guerrilla fighters into a battalion structure overlaid on the existing Rhodesian armed forces. For the first year, a system was followed where the top-performing candidate became battalion commander. If he or she was from ZANLA, then his or her second-in-command was the top-performing ZIPRA candidate, and vice versa. This ensured a balance between the two movements in the command structure. The ZNA was originally formed into four brigades , composed of a total of 28 battalions. The brigade support units were composed almost entirely of specialists of the former Rhodesian Army, while unintegrated battalions of the Rhodesian African Rifles were assigned to the 1st, 3rd and 4th Brigades. The Fifth Brigade was formed in 1981 and disbanded in 1988 after the demonstration of mass brutality and murder during the brigade's occupation of Matabeleland in what became known as Gukurahundi . The brigade had been re-formed by 2006, with its commander, Brigadier General John Mupande praising its "rich history". There are widespread reports of systematic and escalating violations of human rights in Zimbabwe under the Mugabe administration and the dominant ZANU–PF party. According to human rights organisations such as Amnesty International and Human Rights Watch the government of Zimbabwe violates the rights to shelter, food, freedom of movement and residence, freedom of assembly and the protection of the law . In 2009, Gregory Stanton, president of the International Association of Genocide Scholars, stated there was "clear evidence that Mugabe government was guilty of crimes against humanity and that there was sufficient evidence of crimes against humanity to bring Mugabe to trial in front of the International Criminal Court ." Male homosexuality is illegal in Zimbabwe . Since 1995, the government has carried out campaigns against both homosexual men and women. President Mugabe has blamed gays for many of Zimbabwe's problems and viewed homosexuality as an "un-African" and immoral culture brought by European colonists and practised by only "a few whites" in his country. Opposition gatherings are frequently the subject of reprisals by the police force, such as the crackdown on an 11 March 2007 MDC rally and several others during the 2008 election campaign. Police actions have been strongly condemned by the UN Secretary-General Ban Ki-moon , the European Union, and the United States. There are also concerns over Fox Southwest media rights and access. The Zimbabwean government is accused of suppressing freedom of the press and freedom of speech. It has been repeatedly accused of using the public broadcaster, the Zimbabwe Broadcasting Corporation , as a propaganda tool. Newspapers critical of the government, such as the Daily News , closed after bombs exploded at their offices and the government refused to renew their licence. BBC News , Sky News , and CNN were banned from filming or reporting from Zimbabwe. In 2009 reporting restrictions on the BBC and CNN were lifted. Sky News continues to report on happenings within Zimbabwe from neighbouring countries like South Africa. On 24 July 2020, the Office of the United Nations High Commissioner for Human Rights (OHCHR) expressed concerns over allegations suggesting that Zimbabwean authorities may have used the COVID-19 crisis as a pretext to suppress freedom of expression and peaceful assembly on the streets. OHCHR spokesperson Liz Throssell stated that people have a right to protest corruption or anything else. The authorities in Zimbabwe used force to disperse and arrest nurses and health workers, who were peacefully protesting for better salaries and work conditions. The reports suggest that a few members of opposition party and investigative journalists were also arbitrarily arrested and detained for taking part in a protest. On 5 August 2020, the #ZimbabweanLivesMatter campaign on Twitter drew attention of international celebrities and politicians towards human rights abuses in the country, mounting pressure on Emmerson Mnangagwa's government. The campaign was in response to arrests, abductions and torture of political activists and the incarceration of journalist Hopewell Chin'ono and the Booker Prize shortlisted author Tsitsi Dangarembga . Zimbabwe has a centralised government and is divided into eight provinces and two cities with provincial status, for administrative purposes. Each province has a provincial capital from where government administration is usually carried out. The names of most of the provinces were generated from the Mashonaland and Matabeleland divide at the time of colonisation: Mashonaland was the territory occupied first by the British South Africa Company Pioneer Column and Matabeleland the territory conquered during the First Matabele War. This corresponds roughly to the precolonial territory of the Shona people and the Matabele people, although there are significant ethnic minorities in most provinces. Each province is headed by a provincial governor, appointed by the president. The provincial government is run by a provincial administrator, appointed by the Public Service Commission. Other government functions at provincial level are carried out by provincial offices of national government departments. The provinces are subdivided into 59 districts and 1,200 wards (sometimes referred to as municipalities). Each district is headed by a district administrator, appointed by the Public Service Commission. There is also a Rural District Council, which appoints a chief executive officer. The Rural District Council is composed of elected ward councillors, the district administrator, and one representative of the chiefs (traditional leaders appointed under customary law) in the district. Other government functions at district level are carried out by district offices of national government departments. At the ward level there is a Ward Development Committee, comprising the elected ward councillor, the kraalheads (traditional leaders subordinate to chiefs) and representatives of Village Development Committees. Wards are subdivided into villages, each of which has an elected Village Development Committee and a headman (traditional leader subordinate to the kraalhead). Since the early 2000s, Zimbabwe has been under sanctions imposed by the United States and the European Union that have shaped Zimbabwe's domestic politics as well as the country's relations with the Western nations . In 2002, Zimbabwe held general elections and ahead of that election the EU sent observers, but the election observer team was forced to leave the country. In February 2002 the EU placed targeted or restrictive measures on Zimbabwe. At least 20 government officials were banned from entering Europe, and EU funding was halted. Prior to the elections there was $128 million that was budgeted for the Zimbabwean government from 2002 to 2007, this was cancelled. Nevertheless, the EU only stopped funding the government directly but it continued sending money only through aid agencies and NGOs. After some years, the EU and Zimbabwe resolved some of their disputes and a lot of the EU sanctions were removed. Only Mugabe and his wife remained on the list while other government officials were removed. However, the EU still did not give Zimbabwe money. So, the government channels money through NGOs as it was seen on 4 March 2019 – 21 March 2019 Cyclone Idai . The United States also imposed sanctions on Zimbabwe. There are two types of U.S. sanctions on Zimbabwe. The first one is Zimbabwe Democracy and Economic Recovery Act (ZIDERA) and the second one is the Targeted Sanctions Program. ZIDERA made several demands, the first one was that Zimbabwe must respect human rights, second Zimbabwe must stop its interference in the Democratic Republic of the Congo , third Zimbabwe must stop the expropriation of white farms. If none of these demands were met, the U.S. would block the IMF and the World Bank from lending money to Zimbabwe. A new ZIDERA came into effect in 2018 with the motto that, Restore Democracy or there won't be any friendship, there must be free elections, free media and human rights, Zimbabwe must enforce the ruling of the SADC Tribunal . The Targeted Sanctions Program was implemented in 2003, which lists Zimbabwean companies and people who are not allowed to deal with U.S. companies. The sanctions on Zimbabwe have been in place for more than two decades. In March 2021, the U.S. renewed its sanctions on Zimbabwe. The main foreign exports of Zimbabwe are minerals, gold, and agriculture. Zimbabwe is crossed by two trans-African automobile routes: the Cairo-Cape Town Highway and the Beira-Lobito Highway . Zimbabwe is the largest trading partner of South Africa on the continent. Taxes and tariffs are high for private enterprises, while state enterprises are strongly subsidised. State regulation is costly to companies; starting or closing a business is slow and expensive. Tourism also plays a key role in the economy but has been failing in recent years. The Zimbabwe Conservation Task Force released a report in June 2007, estimating that 60% of Zimbabwe's wildlife had died since 2000 as a result of poaching and deforestation. The report warns that the loss of life combined with widespread deforestation is potentially disastrous for the tourism industry. The information and communications technology sector has been growing at a fast pace. A report by the mobile internet browser company Opera in 2011 ranked Zimbabwe as Africa's fastest growing market. Since January 2002, the government has had its lines of credit at international financial institutions frozen, through U.S. legislation called the Zimbabwe Democracy and Economic Recovery Act of 2001 (ZDERA). Section 4C instructs the secretary of the treasury to direct international financial institutions to veto the extension of loans and credit to the Zimbabwean government. According to the United States, these sanctions target only seven specific businesses owned or controlled by government officials and not ordinary citizens. Zimbabwe maintained positive economic growth throughout the 1980s (5% GDP growth per year) and 1990s (4.3% GDP growth per year). The economy declined from 2000: 5% decline in 2000, 8% in 2001, 12% in 2002 and 18% in 2003. Zimbabwe's involvement from 1998 to 2002 in the war in the Democratic Republic of the Congo drained hundreds of millions of dollars from the economy. From 1999 to 2009, Zimbabwe saw the lowest ever economic growth with an annual GDP decrease of 6.1%. The downward spiral of the economy has been attributed mainly to mismanagement and corruption by the government and the eviction of more than 4,000 white farmers in the controversial land confiscations of 2000. The Zimbabwean government and its supporters attest that it was Western policies to avenge the expulsion of their kin that sabotaged the economy. By 2005, the purchasing power of the average Zimbabwean had dropped to the same levels in real terms as 1953. In 2005, the government, led by central bank governor Gideon Gono , started making overtures that white farmers could come back. There were 400 to 500 still left in the country, but much of the land that had been confiscated was no longer productive. By 2016, there remained about 300 of the original 4,500 farms owned by white farmers. The farms that left were either too remote or their owners had paid for protection or collaborated with the regime. In January 2007, the government issued long-term leases to some white farmers. At the same time, however, the government also continued to demand that all remaining white farmers, who were given eviction notices earlier, vacate the land or risk being arrested. Mugabe pointed to foreign governments and alleged "sabotage" as the cause of the fall of the Zimbabwean economy, as well as the country's 80% formal unemployment rate. Inflation rose from an annual rate of 32% in 1998, to an estimated high of 11,200,000% in August 2008 according to the Central Statistical Office. This represented a state of hyperinflation , and the central bank introduced a new 100 trillion dollar note. In January 2009, in an effort to counteract runaway inflation, acting Finance Minister Patrick Chinamasa announced that Zimbabweans would be permitted to use other, more stable currencies to do business, alongside the Zimbabwean dollar . In an effort to combat inflation and foster economic growth, the Zimbabwean dollar was suspended indefinitely in April 2009. In 2016, Zimbabwe allowed trade in the United States dollar and various other currencies such as the rand (South Africa), the pula (Botswana), the euro , and the pound sterling (UK). In February 2019, Reserve Bank of Zimbabwe Governor John Mangudya introduced a new local currency, the Real Time Gross Settlement dollar , in a move to address some of the Zimbabwean economic and financial challenges. After the formation of the Unity Government and the adoption of several currencies instead of the Zimbabwe dollar in 2009, the Zimbabwean economy rebounded. GDP grew by 8–9% per year between 2009 and 2012. In November 2010, the International Monetary Fund described the Zimbabwean economy as "completing its second year of buoyant economic growth". The pan-African investment bank IMARA released a favourable report in February 2011 on investment prospects in Zimbabwe, citing an improved revenue base and higher tax receipts. In January 2013, the finance ministry reported that they had only $217 in their treasury and would apply for donations to finance the coming elections. By 2014, Zimbabwe had recovered to levels seen in the 1990s but growth faltered between 2012 and 2016. Inflation was 42% in 2018; in June 2019, the inflation rate reached 175%, leading to mass unrest across the country. The mining sector is lucrative, with some of the world's largest platinum reserves being mined by Anglo American plc , Zimplats, and Impala Platinum. Zimplats, the nation's largest platinum company, has proceeded with US$500 million in expansions, and is also continuing a separate US$2 billion project, despite threats by Mugabe to nationalise the company. The Marange diamond fields , discovered in 2006, are considered the biggest diamond find in over a century. They have the potential to improve the fiscal situation of the country considerably, but almost all revenues from the field have disappeared into the pockets of army officers and ZANU–PF politicians. In terms of carats produced, the Marange field is one of the largest diamond-producing projects in the world, estimated to have produced 12 million carats in 2014 worth over $350 million. As of October 2014 [ update ] , Metallon Corporation was Zimbabwe's largest gold miner. Zimbabwe's commercial farming sector was traditionally a source of exports and foreign exchange and provided 400,000 jobs. However, the government's land reform program badly damaged the sector, turning Zimbabwe into a net importer of food products. For example, between 2000 and 2016, annual wheat production fell from 250,000 tons to 60,000 tons, maize was reduced from two million tons to 500,000 tons and cattle slaughtered for beef fell from 605,000 head to 244,000 head. Coffee production, once a prized export commodity, came to a virtual halt after seizure or expropriation of white-owned coffee farms in 2000 and has never recovered. For the past ten years, the International Crops Research Institute for the Semi-Arid Tropics has been assisting Zimbabwe's farmers to adopt conservation agriculture techniques, a sustainable method of farming that can help increase yields. By applying the three principles of minimum soil disturbance, legume-based cropping and the use of organic mulch, farmers can improve infiltration, reduce evaporation and soil erosion, and build up organic soil content. Between 2005 and 2011, the number of smallholders practicing conservation agriculture in Zimbabwe increased from 5,000 to more than 150,000. Cereal yields rose between 15 and 100 per cent across different regions. The government declared potato a national strategic food security crop in 2012. Since the land reform programme in 2000, tourism in Zimbabwe has steadily declined. In 2018, tourism peaked with 2.6 million tourists. In 2016, the total contribution of tourism to Zimbabwe was $1.1 billion (USD), or about 8.1% of Zimbabwe's GDP. Employment in travel and tourism, as well as the industries indirectly supported by travel and tourism, was 5.2% of national employment. Several airlines pulled out of Zimbabwe between 2000 and 2007. Australia's Qantas , Germany's Lufthansa , and Austrian Airlines were among the first to pull out and in 2007 British Airways suspended all direct flights to Harare. The country's flagship airline, Air Zimbabwe , which operated flights throughout Africa and a few destinations in Europe and Asia, ceased operations in February 2012. [ needs update ] As of 2017, several major commercial airlines had resumed flights to Zimbabwe. Zimbabwe has several major tourist attractions. Victoria Falls on the Zambezi, which are shared with Zambia, are located in the north-west of Zimbabwe. Victoria Falls is considered to be the largest waterfall in the world. Before the economic changes, much of the tourism for these locations came to the Zimbabwe side, but now Zambia is the main beneficiary. The Victoria Falls National Park is also in this area and is one of the eight main national parks in Zimbabwe, the largest of which is Hwange National Park . Lake Kariba, another site for tourism, is the largest reservoir in the world. The Eastern Highlands are a series of mountainous areas near the border with Mozambique. The highest peak in Zimbabwe, Mount Nyangani at 2,593 m (8,507 ft) is located there as well as the Bvumba Mountains and the Nyanga National Park . World's View is in these mountains, and it is from here that places as far away as 60–70 km (37–43 mi) are visible and, on clear days, the town of Rusape can be seen. Zimbabwe is unusual in Africa in that there are a number of ancient and medieval ruined cities built in a unique dry stone style. Among the most famous of these are the Great Zimbabwe ruins in Masvingo. Other ruins include Khami , Dhlo-Dhlo and Naletale . The Matobo Hills are an area of granite kopjes and wooded valleys commencing some 35 km (22 mi) south of Bulawayo in southern Zimbabwe. The hills were formed over two billion years ago with granite being forced to the surface, then being eroded to produce smooth "whaleback dwalas" and broken kopjes, strewn with boulders and interspersed with thickets of vegetation. Mzilikazi, founder of the Ndebele nation, gave the area its name, meaning 'Bald Heads'. They have become a tourist attraction because of their ancient shapes and local wildlife. Cecil Rhodes and other early white colonists like Leander Starr Jameson are buried in these hills at World's View. There are many successful small-scale water supply and sanitation programs, but there is an overall lack of improved water and sanitation systems for the majority of Zimbabwe. According to the World Health Organization in 2012, 80% of Zimbabweans had access to improved (i.e. clean) drinking water sources, and only 40% of Zimbabweans had access to improved sanitation facilities. Access to improved water supply and sanitation is noticeably limited in rural areas. There are many factors that continue to determine the nature of water supply and sanitation in Zimbabwe for the foreseeable future; three major factors are the severely depressed state of the Zimbabwean economy, the reluctance of foreign aid organisations to build and finance infrastructure projects, and the political instability of the state. Zimbabwe has relatively well-developed national infrastructure and a long-standing tradition of promoting research and development, as evidenced by the levy imposed on tobacco-growers since the 1930s to promote market research. The country has a well-developed education system, with one in 11 adults holding a tertiary degree. Given the country's solid knowledge base and abundant natural resources, Zimbabwe has great growth potential. Zimbabwe was ranked 117th in the Global Innovation Index in 2023, down from rank 107 in 2022. To achieve its growth potential, Zimbabwe will need to correct several structural weaknesses. For instance, it lacks the critical mass of researchers needed to trigger innovation. Although the infrastructure is in place to harness research and development to Zimbabwe's socio-economic development, universities and research institutions lack the financial and human resources to conduct research and the regulatory environment hampers the transfer of new technologies to the business sector. The economic crisis has precipitated an exodus of university students and professionals in key areas of expertise (medicine, engineering, etc.) that is of growing concern. More than 22% of Zimbabwean tertiary students were completing their degrees abroad in 2012, compared to a 4% average for sub-Saharan Africa as a whole. In 2012, there were 200 researchers (head count) employed in the public sector, one-quarter of whom were women. This is double the continental average (91 in 2013) but only one-quarter the researcher density of South Africa (818 per million inhabitants). The government has created the Zimbabwe Human Capital Website to provide information for the diaspora on job and investment opportunities in Zimbabwe. The country's Second Science and Technology Policy was launched in June 2012, after being elaborated with UNESCO assistance. It replaces the earlier policy dating from 2002. The 2012 policy prioritizes biotechnology, information and communication technologies (ICTs), space sciences, nanotechnology, indigenous knowledge systems, technologies yet to emerge and scientific solutions to emergent environmental challenges. The Second Science and Technology Policy also asserts the government's commitment to allocating at least 1% of GDP to research and development, focusing at least 60% of university education on developing skills in science and technology and ensuring that school pupils devote at least 30% of their time to studying science subjects. In 2014, Zimbabwe counted 21 publications per million inhabitants in internationally cataloged journals, according to Thomson Reuters' Web of Science (Science Citation Index Expanded). This placed Zimbabwe sixth out of the 15 SADC countries, behind Namibia (59), Mauritius (71), Botswana (103) and, above all, South Africa (175) and the Seychelles (364). The average for sub-Saharan Africa was 20 scientific publications per million inhabitants, compared to a global average of 176 per million. The mining sector is lucrative, with some of the world's largest platinum reserves being mined by Anglo American plc , Zimplats, and Impala Platinum. Zimplats, the nation's largest platinum company, has proceeded with US$500 million in expansions, and is also continuing a separate US$2 billion project, despite threats by Mugabe to nationalise the company. The Marange diamond fields , discovered in 2006, are considered the biggest diamond find in over a century. They have the potential to improve the fiscal situation of the country considerably, but almost all revenues from the field have disappeared into the pockets of army officers and ZANU–PF politicians. In terms of carats produced, the Marange field is one of the largest diamond-producing projects in the world, estimated to have produced 12 million carats in 2014 worth over $350 million. As of October 2014 [ update ] , Metallon Corporation was Zimbabwe's largest gold miner. Zimbabwe's commercial farming sector was traditionally a source of exports and foreign exchange and provided 400,000 jobs. However, the government's land reform program badly damaged the sector, turning Zimbabwe into a net importer of food products. For example, between 2000 and 2016, annual wheat production fell from 250,000 tons to 60,000 tons, maize was reduced from two million tons to 500,000 tons and cattle slaughtered for beef fell from 605,000 head to 244,000 head. Coffee production, once a prized export commodity, came to a virtual halt after seizure or expropriation of white-owned coffee farms in 2000 and has never recovered. For the past ten years, the International Crops Research Institute for the Semi-Arid Tropics has been assisting Zimbabwe's farmers to adopt conservation agriculture techniques, a sustainable method of farming that can help increase yields. By applying the three principles of minimum soil disturbance, legume-based cropping and the use of organic mulch, farmers can improve infiltration, reduce evaporation and soil erosion, and build up organic soil content. Between 2005 and 2011, the number of smallholders practicing conservation agriculture in Zimbabwe increased from 5,000 to more than 150,000. Cereal yields rose between 15 and 100 per cent across different regions. The government declared potato a national strategic food security crop in 2012. Since the land reform programme in 2000, tourism in Zimbabwe has steadily declined. In 2018, tourism peaked with 2.6 million tourists. In 2016, the total contribution of tourism to Zimbabwe was $1.1 billion (USD), or about 8.1% of Zimbabwe's GDP. Employment in travel and tourism, as well as the industries indirectly supported by travel and tourism, was 5.2% of national employment. Several airlines pulled out of Zimbabwe between 2000 and 2007. Australia's Qantas , Germany's Lufthansa , and Austrian Airlines were among the first to pull out and in 2007 British Airways suspended all direct flights to Harare. The country's flagship airline, Air Zimbabwe , which operated flights throughout Africa and a few destinations in Europe and Asia, ceased operations in February 2012. [ needs update ] As of 2017, several major commercial airlines had resumed flights to Zimbabwe. Zimbabwe has several major tourist attractions. Victoria Falls on the Zambezi, which are shared with Zambia, are located in the north-west of Zimbabwe. Victoria Falls is considered to be the largest waterfall in the world. Before the economic changes, much of the tourism for these locations came to the Zimbabwe side, but now Zambia is the main beneficiary. The Victoria Falls National Park is also in this area and is one of the eight main national parks in Zimbabwe, the largest of which is Hwange National Park . Lake Kariba, another site for tourism, is the largest reservoir in the world. The Eastern Highlands are a series of mountainous areas near the border with Mozambique. The highest peak in Zimbabwe, Mount Nyangani at 2,593 m (8,507 ft) is located there as well as the Bvumba Mountains and the Nyanga National Park . World's View is in these mountains, and it is from here that places as far away as 60–70 km (37–43 mi) are visible and, on clear days, the town of Rusape can be seen. Zimbabwe is unusual in Africa in that there are a number of ancient and medieval ruined cities built in a unique dry stone style. Among the most famous of these are the Great Zimbabwe ruins in Masvingo. Other ruins include Khami , Dhlo-Dhlo and Naletale . The Matobo Hills are an area of granite kopjes and wooded valleys commencing some 35 km (22 mi) south of Bulawayo in southern Zimbabwe. The hills were formed over two billion years ago with granite being forced to the surface, then being eroded to produce smooth "whaleback dwalas" and broken kopjes, strewn with boulders and interspersed with thickets of vegetation. Mzilikazi, founder of the Ndebele nation, gave the area its name, meaning 'Bald Heads'. They have become a tourist attraction because of their ancient shapes and local wildlife. Cecil Rhodes and other early white colonists like Leander Starr Jameson are buried in these hills at World's View. There are many successful small-scale water supply and sanitation programs, but there is an overall lack of improved water and sanitation systems for the majority of Zimbabwe. According to the World Health Organization in 2012, 80% of Zimbabweans had access to improved (i.e. clean) drinking water sources, and only 40% of Zimbabweans had access to improved sanitation facilities. Access to improved water supply and sanitation is noticeably limited in rural areas. There are many factors that continue to determine the nature of water supply and sanitation in Zimbabwe for the foreseeable future; three major factors are the severely depressed state of the Zimbabwean economy, the reluctance of foreign aid organisations to build and finance infrastructure projects, and the political instability of the state. Zimbabwe has relatively well-developed national infrastructure and a long-standing tradition of promoting research and development, as evidenced by the levy imposed on tobacco-growers since the 1930s to promote market research. The country has a well-developed education system, with one in 11 adults holding a tertiary degree. Given the country's solid knowledge base and abundant natural resources, Zimbabwe has great growth potential. Zimbabwe was ranked 117th in the Global Innovation Index in 2023, down from rank 107 in 2022. To achieve its growth potential, Zimbabwe will need to correct several structural weaknesses. For instance, it lacks the critical mass of researchers needed to trigger innovation. Although the infrastructure is in place to harness research and development to Zimbabwe's socio-economic development, universities and research institutions lack the financial and human resources to conduct research and the regulatory environment hampers the transfer of new technologies to the business sector. The economic crisis has precipitated an exodus of university students and professionals in key areas of expertise (medicine, engineering, etc.) that is of growing concern. More than 22% of Zimbabwean tertiary students were completing their degrees abroad in 2012, compared to a 4% average for sub-Saharan Africa as a whole. In 2012, there were 200 researchers (head count) employed in the public sector, one-quarter of whom were women. This is double the continental average (91 in 2013) but only one-quarter the researcher density of South Africa (818 per million inhabitants). The government has created the Zimbabwe Human Capital Website to provide information for the diaspora on job and investment opportunities in Zimbabwe. The country's Second Science and Technology Policy was launched in June 2012, after being elaborated with UNESCO assistance. It replaces the earlier policy dating from 2002. The 2012 policy prioritizes biotechnology, information and communication technologies (ICTs), space sciences, nanotechnology, indigenous knowledge systems, technologies yet to emerge and scientific solutions to emergent environmental challenges. The Second Science and Technology Policy also asserts the government's commitment to allocating at least 1% of GDP to research and development, focusing at least 60% of university education on developing skills in science and technology and ensuring that school pupils devote at least 30% of their time to studying science subjects. In 2014, Zimbabwe counted 21 publications per million inhabitants in internationally cataloged journals, according to Thomson Reuters' Web of Science (Science Citation Index Expanded). This placed Zimbabwe sixth out of the 15 SADC countries, behind Namibia (59), Mauritius (71), Botswana (103) and, above all, South Africa (175) and the Seychelles (364). The average for sub-Saharan Africa was 20 scientific publications per million inhabitants, compared to a global average of 176 per million. Expanding from a population of 2,746,396 in 1950, Zimbabwe's population has rapidly increased. Based on the 2022 revision of the World Population Prospects , the population of Zimbabwe was estimated by the United Nations at 15,993,524 in 2021 . According to the 2012 census report, 99.7% of the population is of African origin. The majority people, the Shona, comprise 82%, while Ndebele make up 14% of the population. The Ndebele descended from Zulu migrations in the 19th century and the other tribes with which they intermarried. Up to one million Ndebele may have left the country over the last five years, [ when? ] mainly for South Africa. Other ethnic groups include Venda , Tonga , Tsonga , Kalanga , Sotho , Ndau , Nambya , Tswana , Xhosa and Lozi . Minority ethnic groups include white Zimbabweans , who make up less than 1% of the total population. White Zimbabweans are mostly of British origin, but there are also Afrikaner , Greek , Portuguese , French and Dutch communities. The white population dropped from a peak of around 278,000, or 4.3% of the population, in 1975. The 2012 census lists the total white population at 28,782 (roughly 0.22% of the population), one-twentieth of its peak. Most emigration has been to the United Kingdom (between 200,000 and 500,000 Britons are of Rhodesian or Zimbabwean origin), South Africa, Botswana, Zambia , Mozambique, Canada, Australia and New Zealand. Coloureds form 0.5% of the population, and various Asian ethnic groups, mostly of Indian and Chinese origin, are also 0.5%. Zimbabwe has 16 official languages and under the constitution, an Act of Parliament may prescribe other languages as officially recognised languages. English is the main language used in the education and judicial systems. The Bantu languages Shona and Ndebele are the principal indigenous languages of Zimbabwe. Shona is spoken by 78% of the population, Ndebele by 20%. Other minority Bantu languages include Venda, Tsonga , Shangaan, Kalanga, Sotho, Ndau and Nambya. Less than 2.5%, mainly the white and "coloured" (mixed race) minorities, consider English their native language. Shona has a rich oral tradition, which was incorporated into the first Shona novel, Feso by Solomon Mutswairo , published in 1956. English is primarily spoken in the cities but less so in rural areas. Radio and television news are broadcast in Shona, Sindebele and English. [ citation needed ] There is a large community of Portuguese speakers in Zimbabwe, mainly in the border areas with Mozambique and in major cities. Beginning in 2017, teaching Portuguese was included in secondary education of Zimbabwe. According to the 2017 Inter Censal Demography Survey by the Zimbabwe National Statistics Agency , 84% of Zimbabweans are Christian, 10% do not belong to any religion, and 0.7% are Muslim . An estimated 62% of the population attend religious services regularly. Approximately 69% of Zimbabweans belong to Protestant Christianity, while 8% are Roman Catholic. Pentecostal-charismatic forms of Christianity, in particular, have grown rapidly in recent years and are playing a prominent role in public, social and political life. The largest Christian churches are Anglican , Roman Catholic , Seventh-day Adventist and Methodist . As in other African countries, Christianity may be mixed with enduring traditional beliefs. Indigenous religion , which predates colonialism, has become relatively marginal but continues to be an important part of the Zimbabwean religious field. Ancestral worship is the most practised non-Christian religion, involving spiritual intercession; central to many ceremonial proceedings is the mbira dzavadzimu , meaning "voice of the ancestors", which is an instrument related to many lamellophones ubiquitous throughout Africa. At independence, the policies of racial inequality were reflected in the disease patterns of the black majority. The first five years after independence saw rapid gains in areas such as immunisation coverage, access to health care, and contraceptive prevalence rate. Zimbabwe was thus considered internationally to have achieved a good record of health development. Zimbabwe suffered occasional outbreaks of acute diseases. The gains on the national health were eroded by structural adjustment in the 1990s, the impact of the HIV/AIDS pandemic and the economic crisis since 2000. In 2006, Zimbabwe had one of the lowest life expectancies in the world according to UN figure—44 for men and 43 for women, down from 60 in 1990, but recovered to 60 in 2015. The rapid drop was ascribed mainly to the HIV/AIDS pandemic. Infant mortality rose from 6% in the late 1990s to 12.3% by 2004. Official fertility rates over the last decade were 3.6 (2002), 3.8 (2006) and 3.8 (2012). The 2014 maternal mortality rate per 100,000 births for Zimbabwe was 614 compared to 960 in 2010–11 and 232 in 1990. The under five mortality rate, per 1,000 births was 75 in 2014 (94 in 2009). The number of midwives per 1,000 live births was unavailable in 2016 and the lifetime risk of death for pregnant women 1 in 42. In 2006 an association of doctors in Zimbabwe made calls for Mugabe to make moves to assist the ailing health service. The HIV infection rate in Zimbabwe was estimated to be 14% for people aged 15–49 in 2009. UNESCO reported a decline in HIV prevalence among pregnant women from 26% in 2002 to 21% in 2004. By 2016 HIV/AIDS prevalence had been reduced to 13.5% compared to 40% in 1998. At the end of November 2008, some operations at three of Zimbabwe's four major referral hospitals had shut down, along with the Zimbabwe Medical School, and the fourth major hospital had two wards and no operating theatres working. Those hospitals still open were not able to obtain basic drugs and medicines. The situation changed drastically after the Unity Government and the introduction of the multi-currency system in February 2009 although the political and economic crisis also contributed to the emigration of the doctors and people with medical knowledge. In August 2008 large areas of Zimbabwe were struck by the ongoing cholera epidemic. By December 2008 more than 10,000 people had been infected in all but one of Zimbabwe's provinces, and the outbreak had spread to Botswana, Mozambique, South Africa and Zambia. On 4 December 2008 the Zimbabwe government declared the outbreak to be a national emergency and asked for international aid. By 9 March 2009 The World Health Organization estimated that 4,011 people had succumbed to the waterborne disease since the outbreak began, and the total number of cases recorded had reached 89,018. In Harare, the city council offered free graves to cholera victims. Large investments in education since independence has resulted in the highest adult literacy rate in Africa which in 2013 was 90.70%. This is lower than the 92% recorded in 2010 by the United Nations Development Programme and the 97.0% recorded in the 2002 census, while still substantially higher than 80.4% recorded in the 1992 census. The wealthier portion of the population usually send their children to independent schools as opposed to the government-run schools which are attended by the majority as these are subsidised by the government. School education was made free in 1980, but since 1988, the government has steadily increased the charges attached to school enrolment until they now greatly exceed the real value of fees in 1980. The Ministry of Education of Zimbabwe maintains and operates the government schools, but the fees charged by independent schools are regulated by the cabinet of Zimbabwe. The education department has stated that 20,000 teachers have left Zimbabwe since 2007 and that half of Zimbabwe's children have not progressed beyond primary school. Education came under threat since the economic changes in 2000, with teachers going on strike because of low pay, students unable to concentrate because of hunger, and the price of uniforms soaring making this standard a luxury. Teachers were also one of the main targets of Mugabe's attacks because he thought they were not strong supporters. Zimbabwe's education system consists of two years of pre-school, seven years of primary and six years of secondary schooling before students can enter university in the country or abroad. The academic year in Zimbabwe runs from January to December, with three terms, separated by one-month breaks, with a total of 40 weeks of school per year. National examinations are written during the third term in November, with "O" level and "A" level subjects also offered in June. There are seven public (government) universities as well as four church-related universities in Zimbabwe that are internationally accredited. The University of Zimbabwe , the first and largest, was built in 1952 and is located in the Harare suburb of Mount Pleasant . Notable alumni from Zimbabwean universities include Welshman Ncube, Peter Moyo , Tendai Biti , Chenjerai Hove and Arthur Mutambara. Many of the politicians in the government of Zimbabwe have obtained degrees from universities in the United States or other universities abroad. National University of Science and Technology is the second largest public research university in Zimbabwe located in Bulawayo. It was established in 1991. The National University of Science and Technology strives to become a flourishing and reputable institution not only in Zimbabwe and in Southern Africa but also among the international fraternity of universities. Africa University is a United Methodist university in Manicaland which attracts students from at least 36 African countries. Women in Zimbabwe are disadvantaged in many facets including economic, political, and social spheres, and experience sex and gender based violence. A 2014 UN report found that deep rooted cultural issues, patriarchal attitudes, and religious practices negatively impacted women's rights and freedoms in the country. These negative views toward women as well as societal norms impact the incentive for women to participate in the economy and hinder their economic production. Zimbabwe's constitution has provisions in it that provide incentive to achieve greater gender equality, but the data shows that enforcement has been lax and adoption slow. In December 2016 the International Federation of Red Cross and Red Crescent Societies conducted a case study to determine how to best implement effective policy to address issues such as gender violence and implementation of equality laws. It was found that sex and gender based violence against women and girls was increasing in areas that had experienced disasters (floods, drought, disease) but could not quantify the extent of the increase. Some of the obstacles in combating these issues are that there are economic barriers to declaring sex and gender based violence to be unacceptable as well as social barriers. Additionally, governmental services which were installed to help educate the populace about these issues as well as provide services to victims are underfunded and unable to carry out their duties. The UN also provided economic incentive to adopt policies which would discourage these practices which negatively impacted women in Zimbabwe. Women are often seen as inferior, treated as objects, and viewed in subordinate roles in history and philosophy. Ubuntu , an African philosophy's spiritual aspect, instills the belief that boys should be more valued than girls as boys pass on lineage, and the belief system places high value in respecting one's ancestors. A common expression used in court, " vakadzi ngavanyarare ", translates to " women should keep quiet, " and as a result women are not consulted in decision-making; they must implement the men's wishes. The subordination of women in Zimbabwe, and the cultural forces which dictate what they must be, have led to deaths and the sacrifice of professional advancement in order for them to fulfill their roles as wives, mothers, and subordinates. Women are taught that they must never refuse their husband's sexual advances, even if they know they are infected with HIV from being unfaithful. As a result of this practice, Zimbabwean women aged 15–49 have an HIV prevalence rate of 16.1% and make up 62% of the total population infected with HIV in that age group. Expanding from a population of 2,746,396 in 1950, Zimbabwe's population has rapidly increased. Based on the 2022 revision of the World Population Prospects , the population of Zimbabwe was estimated by the United Nations at 15,993,524 in 2021 .According to the 2012 census report, 99.7% of the population is of African origin. The majority people, the Shona, comprise 82%, while Ndebele make up 14% of the population. The Ndebele descended from Zulu migrations in the 19th century and the other tribes with which they intermarried. Up to one million Ndebele may have left the country over the last five years, [ when? ] mainly for South Africa. Other ethnic groups include Venda , Tonga , Tsonga , Kalanga , Sotho , Ndau , Nambya , Tswana , Xhosa and Lozi . Minority ethnic groups include white Zimbabweans , who make up less than 1% of the total population. White Zimbabweans are mostly of British origin, but there are also Afrikaner , Greek , Portuguese , French and Dutch communities. The white population dropped from a peak of around 278,000, or 4.3% of the population, in 1975. The 2012 census lists the total white population at 28,782 (roughly 0.22% of the population), one-twentieth of its peak. Most emigration has been to the United Kingdom (between 200,000 and 500,000 Britons are of Rhodesian or Zimbabwean origin), South Africa, Botswana, Zambia , Mozambique, Canada, Australia and New Zealand. Coloureds form 0.5% of the population, and various Asian ethnic groups, mostly of Indian and Chinese origin, are also 0.5%. Zimbabwe has 16 official languages and under the constitution, an Act of Parliament may prescribe other languages as officially recognised languages. English is the main language used in the education and judicial systems. The Bantu languages Shona and Ndebele are the principal indigenous languages of Zimbabwe. Shona is spoken by 78% of the population, Ndebele by 20%. Other minority Bantu languages include Venda, Tsonga , Shangaan, Kalanga, Sotho, Ndau and Nambya. Less than 2.5%, mainly the white and "coloured" (mixed race) minorities, consider English their native language. Shona has a rich oral tradition, which was incorporated into the first Shona novel, Feso by Solomon Mutswairo , published in 1956. English is primarily spoken in the cities but less so in rural areas. Radio and television news are broadcast in Shona, Sindebele and English. [ citation needed ] There is a large community of Portuguese speakers in Zimbabwe, mainly in the border areas with Mozambique and in major cities. Beginning in 2017, teaching Portuguese was included in secondary education of Zimbabwe. According to the 2017 Inter Censal Demography Survey by the Zimbabwe National Statistics Agency , 84% of Zimbabweans are Christian, 10% do not belong to any religion, and 0.7% are Muslim . An estimated 62% of the population attend religious services regularly. Approximately 69% of Zimbabweans belong to Protestant Christianity, while 8% are Roman Catholic. Pentecostal-charismatic forms of Christianity, in particular, have grown rapidly in recent years and are playing a prominent role in public, social and political life. The largest Christian churches are Anglican , Roman Catholic , Seventh-day Adventist and Methodist . As in other African countries, Christianity may be mixed with enduring traditional beliefs. Indigenous religion , which predates colonialism, has become relatively marginal but continues to be an important part of the Zimbabwean religious field. Ancestral worship is the most practised non-Christian religion, involving spiritual intercession; central to many ceremonial proceedings is the mbira dzavadzimu , meaning "voice of the ancestors", which is an instrument related to many lamellophones ubiquitous throughout Africa.At independence, the policies of racial inequality were reflected in the disease patterns of the black majority. The first five years after independence saw rapid gains in areas such as immunisation coverage, access to health care, and contraceptive prevalence rate. Zimbabwe was thus considered internationally to have achieved a good record of health development. Zimbabwe suffered occasional outbreaks of acute diseases. The gains on the national health were eroded by structural adjustment in the 1990s, the impact of the HIV/AIDS pandemic and the economic crisis since 2000. In 2006, Zimbabwe had one of the lowest life expectancies in the world according to UN figure—44 for men and 43 for women, down from 60 in 1990, but recovered to 60 in 2015. The rapid drop was ascribed mainly to the HIV/AIDS pandemic. Infant mortality rose from 6% in the late 1990s to 12.3% by 2004. Official fertility rates over the last decade were 3.6 (2002), 3.8 (2006) and 3.8 (2012). The 2014 maternal mortality rate per 100,000 births for Zimbabwe was 614 compared to 960 in 2010–11 and 232 in 1990. The under five mortality rate, per 1,000 births was 75 in 2014 (94 in 2009). The number of midwives per 1,000 live births was unavailable in 2016 and the lifetime risk of death for pregnant women 1 in 42. In 2006 an association of doctors in Zimbabwe made calls for Mugabe to make moves to assist the ailing health service. The HIV infection rate in Zimbabwe was estimated to be 14% for people aged 15–49 in 2009. UNESCO reported a decline in HIV prevalence among pregnant women from 26% in 2002 to 21% in 2004. By 2016 HIV/AIDS prevalence had been reduced to 13.5% compared to 40% in 1998. At the end of November 2008, some operations at three of Zimbabwe's four major referral hospitals had shut down, along with the Zimbabwe Medical School, and the fourth major hospital had two wards and no operating theatres working. Those hospitals still open were not able to obtain basic drugs and medicines. The situation changed drastically after the Unity Government and the introduction of the multi-currency system in February 2009 although the political and economic crisis also contributed to the emigration of the doctors and people with medical knowledge. In August 2008 large areas of Zimbabwe were struck by the ongoing cholera epidemic. By December 2008 more than 10,000 people had been infected in all but one of Zimbabwe's provinces, and the outbreak had spread to Botswana, Mozambique, South Africa and Zambia. On 4 December 2008 the Zimbabwe government declared the outbreak to be a national emergency and asked for international aid. By 9 March 2009 The World Health Organization estimated that 4,011 people had succumbed to the waterborne disease since the outbreak began, and the total number of cases recorded had reached 89,018. In Harare, the city council offered free graves to cholera victims. Large investments in education since independence has resulted in the highest adult literacy rate in Africa which in 2013 was 90.70%. This is lower than the 92% recorded in 2010 by the United Nations Development Programme and the 97.0% recorded in the 2002 census, while still substantially higher than 80.4% recorded in the 1992 census. The wealthier portion of the population usually send their children to independent schools as opposed to the government-run schools which are attended by the majority as these are subsidised by the government. School education was made free in 1980, but since 1988, the government has steadily increased the charges attached to school enrolment until they now greatly exceed the real value of fees in 1980. The Ministry of Education of Zimbabwe maintains and operates the government schools, but the fees charged by independent schools are regulated by the cabinet of Zimbabwe. The education department has stated that 20,000 teachers have left Zimbabwe since 2007 and that half of Zimbabwe's children have not progressed beyond primary school. Education came under threat since the economic changes in 2000, with teachers going on strike because of low pay, students unable to concentrate because of hunger, and the price of uniforms soaring making this standard a luxury. Teachers were also one of the main targets of Mugabe's attacks because he thought they were not strong supporters. Zimbabwe's education system consists of two years of pre-school, seven years of primary and six years of secondary schooling before students can enter university in the country or abroad. The academic year in Zimbabwe runs from January to December, with three terms, separated by one-month breaks, with a total of 40 weeks of school per year. National examinations are written during the third term in November, with "O" level and "A" level subjects also offered in June. There are seven public (government) universities as well as four church-related universities in Zimbabwe that are internationally accredited. The University of Zimbabwe , the first and largest, was built in 1952 and is located in the Harare suburb of Mount Pleasant . Notable alumni from Zimbabwean universities include Welshman Ncube, Peter Moyo , Tendai Biti , Chenjerai Hove and Arthur Mutambara. Many of the politicians in the government of Zimbabwe have obtained degrees from universities in the United States or other universities abroad. National University of Science and Technology is the second largest public research university in Zimbabwe located in Bulawayo. It was established in 1991. The National University of Science and Technology strives to become a flourishing and reputable institution not only in Zimbabwe and in Southern Africa but also among the international fraternity of universities. Africa University is a United Methodist university in Manicaland which attracts students from at least 36 African countries.Women in Zimbabwe are disadvantaged in many facets including economic, political, and social spheres, and experience sex and gender based violence. A 2014 UN report found that deep rooted cultural issues, patriarchal attitudes, and religious practices negatively impacted women's rights and freedoms in the country. These negative views toward women as well as societal norms impact the incentive for women to participate in the economy and hinder their economic production. Zimbabwe's constitution has provisions in it that provide incentive to achieve greater gender equality, but the data shows that enforcement has been lax and adoption slow. In December 2016 the International Federation of Red Cross and Red Crescent Societies conducted a case study to determine how to best implement effective policy to address issues such as gender violence and implementation of equality laws. It was found that sex and gender based violence against women and girls was increasing in areas that had experienced disasters (floods, drought, disease) but could not quantify the extent of the increase. Some of the obstacles in combating these issues are that there are economic barriers to declaring sex and gender based violence to be unacceptable as well as social barriers. Additionally, governmental services which were installed to help educate the populace about these issues as well as provide services to victims are underfunded and unable to carry out their duties. The UN also provided economic incentive to adopt policies which would discourage these practices which negatively impacted women in Zimbabwe. Women are often seen as inferior, treated as objects, and viewed in subordinate roles in history and philosophy. Ubuntu , an African philosophy's spiritual aspect, instills the belief that boys should be more valued than girls as boys pass on lineage, and the belief system places high value in respecting one's ancestors. A common expression used in court, " vakadzi ngavanyarare ", translates to " women should keep quiet, " and as a result women are not consulted in decision-making; they must implement the men's wishes. The subordination of women in Zimbabwe, and the cultural forces which dictate what they must be, have led to deaths and the sacrifice of professional advancement in order for them to fulfill their roles as wives, mothers, and subordinates. Women are taught that they must never refuse their husband's sexual advances, even if they know they are infected with HIV from being unfaithful. As a result of this practice, Zimbabwean women aged 15–49 have an HIV prevalence rate of 16.1% and make up 62% of the total population infected with HIV in that age group. Zimbabwe has many different cultures, with Shona beliefs and ceremonies being prominent. The Shona people have many types of sculptures and carvings. Zimbabwe first celebrated its independence on 18 April 1980. Celebrations are held at either the National Sports Stadium or Rufaro Stadium in Harare. The first independence celebrations were held in 1980 at the Zimbabwe Grounds. At these celebrations, doves are released to symbolise peace, fighter jets fly over, and the national anthem is sung. The flame of independence is lit by the president after parades by the presidential family and members of the armed forces of Zimbabwe. The president also gives a speech to the people of Zimbabwe which is televised for those unable to attend the stadium. Zimbabwe also has a national beauty pageant, the Miss Heritage Zimbabwe contest, which has been held annually since 2012. Traditional arts in Zimbabwe include pottery , basketry , textiles, jewellery and carving. Among the distinctive qualities are symmetrically patterned woven baskets and stools carved out of a single piece of wood. Shona sculpture, which has a long cultural history, began evolving into its modern form in the mid 20th century and gained increasing international popularity. Most subjects of carved figures of stylised birds and human figures among others are made with sedimentary rock such as soapstone , as well as harder igneous rocks such as serpentine and the rare stone verdite . Zimbabwean artefacts can be found in countries like Singapore, China and Canada. e.g. Dominic Benhura 's statue in the Singapore Botanic Gardens . Shona sculpture has survived through the ages, and the modern style is a fusion of African folklore with European influences. World-renowned Zimbabwean sculptors include Nicholas Nesbert and Anderson Mukomberanwa, Tapfuma Gutsa, Henry Munyaradzi and Locardia Ndandarika. Several authors are well known within Zimbabwe and abroad. Charles Mungoshi is renowned in Zimbabwe for writing traditional stories in English and in Shona, and his poems and books have sold well with both the black and white communities. Catherine Buckle has achieved international recognition with her two books African Tears and Beyond Tears which tell of the ordeal she went through under the 2000 Land Reform. The first Prime Minister of Rhodesia , Ian Smith, wrote two books – The Great Betrayal and Bitter Harvest . The book The House of Hunger by Dambudzo Marechera won the Guardian Fiction Prize in the UK in 1979. The Nobel Prize-winning author Doris Lessing 's first novel The Grass Is Singing is set in Rhodesia, as are the first four volumes of her Children of Violence sequence and her collection of short stories entitled African Stories . In 2013 NoViolet Bulawayo 's novel We Need New Names was shortlisted for the Booker Prize . The novel was inspired by a photograph of a child who lost their home in Operation Murambatsvina , Mugabe's slum clearance programme which began in 2005. Bulawayo's second novel, Glory , a satire based on the 2017 coup against Robert Mugabe , was also shortlisted for the Booker Prize. Zimbabwean author Tsitsi Dangarembga 's novels have received widespread critical acclaim and her third, This Mournable Body , was shortlisted for the Booker Prize in 2020. Notable Zimbabwean artists include Henry Mudzengerere and Nicolas Mukomberanwa. A recurring theme in Zimbabwean art is the metamorphosis of man into beast. Zimbabwean musicians like Thomas Mapfumo , Oliver Mtukudzi , the Bhundu Boys ; Stella Chiweshe , Alick Macheso and Audius Mtawarira have achieved international recognition. Among members of the white minority community, Theatre has a large following, with numerous theatrical companies performing in Zimbabwe's urban areas. Like in many African countries, the majority of Zimbabweans depend on a few staple foods. "Mealie meal", also known as cornmeal , is used to prepare sadza or isitshwala , as well as porridge known as bota or ilambazi . Sadza is made by mixing the cornmeal with water to produce a thick paste/porridge. After the paste has been cooking for several minutes, more cornmeal is added to thicken the paste. This is usually eaten as lunch or dinner, usually with sides such as gravy, vegetables (spinach, chomolia , or spring greens /collard greens), beans, and meat (stewed, grilled, roasted, or sundried). Sadza is also commonly eaten with curdled milk ( sour milk ), commonly known as "lacto" ( mukaka wakakora ), or dried Tanganyika sardine , known locally as kapenta or matemba . Bota is a thinner porridge, cooked without the additional cornmeal and usually flavoured with peanut butter, milk, butter, or jam. Bota is usually eaten for breakfast. Graduations, weddings, and any other family gatherings will usually be celebrated with the killing of a goat or cow, which will be barbecued or roasted by the family. Even though the Afrikaners are a small group (10%) within the white minority group, Afrikaner recipes are popular. Biltong , a type of jerky, is a popular snack, prepared by hanging bits of spiced raw meat to dry in the shade. Boerewors is served with sadza . It is a long sausage, often well-spiced, composed of beef rather than pork, and barbecued. [ citation needed ] As Zimbabwe was a British colony, some people there have adopted some colonial-era English eating habits. For example, most people will have porridge in the morning, as well as 10 o'clock tea (midday tea). They will have lunch, often leftovers from the night before, freshly cooked sadza , or sandwiches (which is more common in the cities). After lunch, there is usually 4 o'clock tea (afternoon tea), which is served before dinner. It is not uncommon for tea to be had after dinner. [ citation needed ] Rice, pasta, and potato-based foods (French fries and mashed potato) also make up part of Zimbabwean cuisine. A local favourite is rice cooked with peanut butter, which is taken with thick gravy, mixed vegetables and meat. [ citation needed ] A potpourri of peanuts known as nzungu , boiled and sundried maize, black-eyed peas known as nyemba , and Bambara groundnuts known as nyimo makes a traditional dish called mutakura . Football (also known as soccer) is the most popular sport in Zimbabwe. The Warriors have qualified for the Africa Cup of Nations five times (2004, 2006, 2017, 2019, 2021), and won the Southern Africa championship on six occasions (2000, 2003, 2005, 2009, 2017, 2018) and the Eastern Africa cup once (1985). The team is ranked 68th in 2022. Rugby union is a significant sport in Zimbabwe. The national side have represented the country at 2 Rugby World Cup tournaments in 1987 and 1991. Cricket is also a very popular sport in Zimbabwe. It used to have a following mostly among the white minority, but it has recently grown to become a widely popular sport among most Zimbabweans. It is one of twelve Test cricket playing nations and an ICC full member as well. Notable cricket players from Zimbabwe include Andy Flower , Heath Streak and Brendan Taylor . Zimbabwe has won eight Olympic medals, one in field hockey with the women's team at the 1980 Summer Olympics in Moscow, and seven by swimmer Kirsty Coventry , three at the 2004 Summer Olympics and four at the 2008 Summer Olympics . Zimbabwe has done well in the Commonwealth Games and All-Africa Games in swimming with Coventry obtaining 11 gold medals in the different competitions. Zimbabwe has competed at Wimbledon and the Davis Cup in tennis, most notably with the Black family, which comprises Wayne Black , Byron Black and Cara Black . The Zimbabwean Nick Price held the official World Number 1 golf status longer than any player from Africa has done. Other sports played in Zimbabwe are basketball, volleyball, netball , and water polo , as well as squash , motorsport , martial arts, chess , cycling, polocrosse , kayaking and horse racing . However, most of these sports do not have international representatives but instead stay at a junior or national level. Zimbabwean professional rugby league players playing overseas are Masimbaashe Motongo and Judah Mazive . Former players include now SANZAAR CEO Andy Marinos who made an appearance for South Africa at the Super League World Nines and featured for the Sydney Bulldogs as well as Zimbabwe-born former Scotland rugby union international Scott Gray , who spent time at the Brisbane Broncos . Zimbabwe has had success in karate as Zimbabwe's Samson Muripo became Kyokushin world champion in Osaka, Japan in 2009. Muripo is a two-time World Kyokushi Karate Champion and was the first black African to become the World Kyokushin Karate Champion. The media of Zimbabwe is now once again diverse, having come under tight restriction between 2002 and 2008 by the government during the economic and political crisis. The Zimbabwean constitution promises freedom of the media and expression. Since the appointment of a new media and information minister in 2013 the media is facing less political interference, and the supreme court has ruled some sections of the strict media laws as unconstitutional. In July 2009 the BBC and CNN were able to resume operations and report legally and openly from Zimbabwe. The Zimbabwe Ministry of Media, Information and Publicity stated that, "the Zimbabwe government never banned the BBC from carrying out lawful activities inside Zimbabwe". In 2010 the Zimbabwe Media Commission was established by the inclusive, power-sharing government. In May 2010 the commission licensed three privately owned newspapers, including the previously banned Daily News , for publication. Reporters Without Borders described the decisions as a "major advance". In June 2010 NewsDay became the first independent daily newspaper to be published in Zimbabwe in seven years. ZBC 's monopoly in the broadcasting sector was ended with the licensing of two private radio stations in 2012. The main published newspapers are The Herald and The Chronicle which are printed in Harare and Bulawayo respectively. Since the 2002 Access to Information and Protection of Privacy Act was passed, a number of privately owned news outlets were shut down by the government, including Daily News whose managing director Wilf Mbanga went on to form the influential The Zimbabwean . As a result, many press organisations have been set up in both neighbouring and Western countries by exiled Zimbabweans. Because the internet is unrestricted, many Zimbabweans are allowed to access online news sites set up by exiled journalists. Reporters Without Borders claims the media environment in Zimbabwe involves "surveillance, threats, imprisonment, censorship, blackmail, abuse of power and denial of justice are all brought to bear to keep firm control over the news." In its 2021 report, Reporters Without Borders ranked the Zimbabwean media as 130th out of 180, noting that "access to information has improved and self-censorship has declined, but journalists are still often attacked or arrested". The government also bans many foreign broadcasting stations from Zimbabwe, including the CBC , Sky News, Channel 4 , American Broadcasting Company , Australian Broadcasting Corporation , and Fox News . News agencies and newspapers from other Western countries and South Africa have also been banned from the country. [ citation needed ] The stone-carved Zimbabwe Bird appears on the national flags and the coats of arms of both Zimbabwe and Rhodesia, as well as on banknotes and coins (first on Rhodesian pound and then Rhodesian dollar ). It probably represents the bateleur eagle or the African fish eagle . The famous soapstone bird carvings stood on walls and monoliths of the ancient city of Great Zimbabwe. Balancing rocks are geological formations all over Zimbabwe. The rocks are perfectly balanced without other supports. They are created when ancient granite intrusions are exposed to weathering, as softer rocks surrounding them erode away. They have been depicted on both the banknotes of Zimbabwe and the Rhodesian dollar banknotes. The ones found on the current notes of Zimbabwe, named the Banknote Rocks, are located in Epworth , approximately 14 km (9 mi) southeast of Harare. There are many different formations of the rocks, incorporating single and paired columns of three or more rocks. These formations are a feature of south and east tropical Africa from northern South Africa northwards to Sudan. The most notable formations in Zimbabwe are located in the Matobo National Park in Matabeleland. The national anthem of Zimbabwe is "Raise the Flag of Zimbabwe" ( Shona : Simudzai Mureza wedu WeZimbabwe ; Northern Ndebele : Kalibusiswe Ilizwe leZimbabwe ). It was introduced in March 1994 after a nationwide competition to replace Ishe Komborera Africa as a distinctly Zimbabwean song. The winning entry was a song written by Professor Solomon Mutswairo and composed by Fred Changundega. It has been translated into all three of the main languages of Zimbabwe. Traditional arts in Zimbabwe include pottery , basketry , textiles, jewellery and carving. Among the distinctive qualities are symmetrically patterned woven baskets and stools carved out of a single piece of wood. Shona sculpture, which has a long cultural history, began evolving into its modern form in the mid 20th century and gained increasing international popularity. Most subjects of carved figures of stylised birds and human figures among others are made with sedimentary rock such as soapstone , as well as harder igneous rocks such as serpentine and the rare stone verdite . Zimbabwean artefacts can be found in countries like Singapore, China and Canada. e.g. Dominic Benhura 's statue in the Singapore Botanic Gardens . Shona sculpture has survived through the ages, and the modern style is a fusion of African folklore with European influences. World-renowned Zimbabwean sculptors include Nicholas Nesbert and Anderson Mukomberanwa, Tapfuma Gutsa, Henry Munyaradzi and Locardia Ndandarika. Several authors are well known within Zimbabwe and abroad. Charles Mungoshi is renowned in Zimbabwe for writing traditional stories in English and in Shona, and his poems and books have sold well with both the black and white communities. Catherine Buckle has achieved international recognition with her two books African Tears and Beyond Tears which tell of the ordeal she went through under the 2000 Land Reform. The first Prime Minister of Rhodesia , Ian Smith, wrote two books – The Great Betrayal and Bitter Harvest . The book The House of Hunger by Dambudzo Marechera won the Guardian Fiction Prize in the UK in 1979. The Nobel Prize-winning author Doris Lessing 's first novel The Grass Is Singing is set in Rhodesia, as are the first four volumes of her Children of Violence sequence and her collection of short stories entitled African Stories . In 2013 NoViolet Bulawayo 's novel We Need New Names was shortlisted for the Booker Prize . The novel was inspired by a photograph of a child who lost their home in Operation Murambatsvina , Mugabe's slum clearance programme which began in 2005. Bulawayo's second novel, Glory , a satire based on the 2017 coup against Robert Mugabe , was also shortlisted for the Booker Prize. Zimbabwean author Tsitsi Dangarembga 's novels have received widespread critical acclaim and her third, This Mournable Body , was shortlisted for the Booker Prize in 2020. Notable Zimbabwean artists include Henry Mudzengerere and Nicolas Mukomberanwa. A recurring theme in Zimbabwean art is the metamorphosis of man into beast. Zimbabwean musicians like Thomas Mapfumo , Oliver Mtukudzi , the Bhundu Boys ; Stella Chiweshe , Alick Macheso and Audius Mtawarira have achieved international recognition. Among members of the white minority community, Theatre has a large following, with numerous theatrical companies performing in Zimbabwe's urban areas. Like in many African countries, the majority of Zimbabweans depend on a few staple foods. "Mealie meal", also known as cornmeal , is used to prepare sadza or isitshwala , as well as porridge known as bota or ilambazi . Sadza is made by mixing the cornmeal with water to produce a thick paste/porridge. After the paste has been cooking for several minutes, more cornmeal is added to thicken the paste. This is usually eaten as lunch or dinner, usually with sides such as gravy, vegetables (spinach, chomolia , or spring greens /collard greens), beans, and meat (stewed, grilled, roasted, or sundried). Sadza is also commonly eaten with curdled milk ( sour milk ), commonly known as "lacto" ( mukaka wakakora ), or dried Tanganyika sardine , known locally as kapenta or matemba . Bota is a thinner porridge, cooked without the additional cornmeal and usually flavoured with peanut butter, milk, butter, or jam. Bota is usually eaten for breakfast. Graduations, weddings, and any other family gatherings will usually be celebrated with the killing of a goat or cow, which will be barbecued or roasted by the family. Even though the Afrikaners are a small group (10%) within the white minority group, Afrikaner recipes are popular. Biltong , a type of jerky, is a popular snack, prepared by hanging bits of spiced raw meat to dry in the shade. Boerewors is served with sadza . It is a long sausage, often well-spiced, composed of beef rather than pork, and barbecued. [ citation needed ] As Zimbabwe was a British colony, some people there have adopted some colonial-era English eating habits. For example, most people will have porridge in the morning, as well as 10 o'clock tea (midday tea). They will have lunch, often leftovers from the night before, freshly cooked sadza , or sandwiches (which is more common in the cities). After lunch, there is usually 4 o'clock tea (afternoon tea), which is served before dinner. It is not uncommon for tea to be had after dinner. [ citation needed ] Rice, pasta, and potato-based foods (French fries and mashed potato) also make up part of Zimbabwean cuisine. A local favourite is rice cooked with peanut butter, which is taken with thick gravy, mixed vegetables and meat. [ citation needed ] A potpourri of peanuts known as nzungu , boiled and sundried maize, black-eyed peas known as nyemba , and Bambara groundnuts known as nyimo makes a traditional dish called mutakura .Football (also known as soccer) is the most popular sport in Zimbabwe. The Warriors have qualified for the Africa Cup of Nations five times (2004, 2006, 2017, 2019, 2021), and won the Southern Africa championship on six occasions (2000, 2003, 2005, 2009, 2017, 2018) and the Eastern Africa cup once (1985). The team is ranked 68th in 2022. Rugby union is a significant sport in Zimbabwe. The national side have represented the country at 2 Rugby World Cup tournaments in 1987 and 1991. Cricket is also a very popular sport in Zimbabwe. It used to have a following mostly among the white minority, but it has recently grown to become a widely popular sport among most Zimbabweans. It is one of twelve Test cricket playing nations and an ICC full member as well. Notable cricket players from Zimbabwe include Andy Flower , Heath Streak and Brendan Taylor . Zimbabwe has won eight Olympic medals, one in field hockey with the women's team at the 1980 Summer Olympics in Moscow, and seven by swimmer Kirsty Coventry , three at the 2004 Summer Olympics and four at the 2008 Summer Olympics . Zimbabwe has done well in the Commonwealth Games and All-Africa Games in swimming with Coventry obtaining 11 gold medals in the different competitions. Zimbabwe has competed at Wimbledon and the Davis Cup in tennis, most notably with the Black family, which comprises Wayne Black , Byron Black and Cara Black . The Zimbabwean Nick Price held the official World Number 1 golf status longer than any player from Africa has done. Other sports played in Zimbabwe are basketball, volleyball, netball , and water polo , as well as squash , motorsport , martial arts, chess , cycling, polocrosse , kayaking and horse racing . However, most of these sports do not have international representatives but instead stay at a junior or national level. Zimbabwean professional rugby league players playing overseas are Masimbaashe Motongo and Judah Mazive . Former players include now SANZAAR CEO Andy Marinos who made an appearance for South Africa at the Super League World Nines and featured for the Sydney Bulldogs as well as Zimbabwe-born former Scotland rugby union international Scott Gray , who spent time at the Brisbane Broncos . Zimbabwe has had success in karate as Zimbabwe's Samson Muripo became Kyokushin world champion in Osaka, Japan in 2009. Muripo is a two-time World Kyokushi Karate Champion and was the first black African to become the World Kyokushin Karate Champion. The media of Zimbabwe is now once again diverse, having come under tight restriction between 2002 and 2008 by the government during the economic and political crisis. The Zimbabwean constitution promises freedom of the media and expression. Since the appointment of a new media and information minister in 2013 the media is facing less political interference, and the supreme court has ruled some sections of the strict media laws as unconstitutional. In July 2009 the BBC and CNN were able to resume operations and report legally and openly from Zimbabwe. The Zimbabwe Ministry of Media, Information and Publicity stated that, "the Zimbabwe government never banned the BBC from carrying out lawful activities inside Zimbabwe". In 2010 the Zimbabwe Media Commission was established by the inclusive, power-sharing government. In May 2010 the commission licensed three privately owned newspapers, including the previously banned Daily News , for publication. Reporters Without Borders described the decisions as a "major advance". In June 2010 NewsDay became the first independent daily newspaper to be published in Zimbabwe in seven years. ZBC 's monopoly in the broadcasting sector was ended with the licensing of two private radio stations in 2012. The main published newspapers are The Herald and The Chronicle which are printed in Harare and Bulawayo respectively. Since the 2002 Access to Information and Protection of Privacy Act was passed, a number of privately owned news outlets were shut down by the government, including Daily News whose managing director Wilf Mbanga went on to form the influential The Zimbabwean . As a result, many press organisations have been set up in both neighbouring and Western countries by exiled Zimbabweans. Because the internet is unrestricted, many Zimbabweans are allowed to access online news sites set up by exiled journalists. Reporters Without Borders claims the media environment in Zimbabwe involves "surveillance, threats, imprisonment, censorship, blackmail, abuse of power and denial of justice are all brought to bear to keep firm control over the news." In its 2021 report, Reporters Without Borders ranked the Zimbabwean media as 130th out of 180, noting that "access to information has improved and self-censorship has declined, but journalists are still often attacked or arrested". The government also bans many foreign broadcasting stations from Zimbabwe, including the CBC , Sky News, Channel 4 , American Broadcasting Company , Australian Broadcasting Corporation , and Fox News . News agencies and newspapers from other Western countries and South Africa have also been banned from the country. [ citation needed ]The stone-carved Zimbabwe Bird appears on the national flags and the coats of arms of both Zimbabwe and Rhodesia, as well as on banknotes and coins (first on Rhodesian pound and then Rhodesian dollar ). It probably represents the bateleur eagle or the African fish eagle . The famous soapstone bird carvings stood on walls and monoliths of the ancient city of Great Zimbabwe. Balancing rocks are geological formations all over Zimbabwe. The rocks are perfectly balanced without other supports. They are created when ancient granite intrusions are exposed to weathering, as softer rocks surrounding them erode away. They have been depicted on both the banknotes of Zimbabwe and the Rhodesian dollar banknotes. The ones found on the current notes of Zimbabwe, named the Banknote Rocks, are located in Epworth , approximately 14 km (9 mi) southeast of Harare. There are many different formations of the rocks, incorporating single and paired columns of three or more rocks. These formations are a feature of south and east tropical Africa from northern South Africa northwards to Sudan. The most notable formations in Zimbabwe are located in the Matobo National Park in Matabeleland. The national anthem of Zimbabwe is "Raise the Flag of Zimbabwe" ( Shona : Simudzai Mureza wedu WeZimbabwe ; Northern Ndebele : Kalibusiswe Ilizwe leZimbabwe ). It was introduced in March 1994 after a nationwide competition to replace Ishe Komborera Africa as a distinctly Zimbabwean song. The winning entry was a song written by Professor Solomon Mutswairo and composed by Fred Changundega. It has been translated into all three of the main languages of Zimbabwe.

Wiki

Cholera

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ICDDR,B

ICDDR,B (formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh ) is an international health research organisation located in Dhaka , Bangladesh . Dedicated to saving lives through research and treatment, ICDDR,B addresses some of the most critical health concerns facing the world today, ranging from improving neonatal survival to HIV/AIDS . In collaboration with academic and research institutions over the world, ICDDR,B conducts research, training and extension activities, as well as programme-based activities, to develop and share knowledge for global lifesaving solutions. ICDDR,B is one of the leading research institutes of the Global South, releasing, according to the Thomson Reuters Web of Science , 18 percent of the Bangladesh's publications. ICDDR,B has a mix of national and international staff, including public health scientists, laboratory scientists, clinicians, nutritionists, epidemiologists, demographers, social and behavioural scientists, IT professionals, and experts in emerging and re- emerging infectious diseases , and vaccine sciences. ICDDR,B is supported by about 55 donor countries and organisations, including Sweden (SIDA), Canada, UK, Bangladesh, USA, UN specialised agencies, foundations, universities, research institutes and private sector organisations and companies that share the centre's concern for the health problems of developing countries and who value its proven experience in helping solve those problems. The centre is governed by a distinguished multinational Board of Trustees comprising 17 members from all over the world.ICDDR,B has its roots in the SEATO Cholera Research Laboratory formed in 1960. When Bangladesh became independent in 1971, activities were scaled down due to a scarcity of funds. Subsequently, a bilateral agreement was signed by Bangladesh and USAID for direct fund flow to the organisation. Until 1978, there were number research accomplishments such as ORS, Patho-Physiology of shigellosis, Rotavirus, uplifting family planning program etc. In 1978 proposal by an international group of scientists was put forward to elevate the organisation to an international research centre. The organisation was established in its current form via an ordinance promulgated by President Ziaur Rahman and then that was ratified in parliament in 1979. The centre has, among its other accomplishments, played a major role in the discovery and implementation of oral rehydration therapy for the treatment of diarrhoea and cholera . Oral rehydration therapy is thought to have saved over 50 million people worldwide. Since 1978, the centre has trained more than 27,000 health professionals from over 78 countries. Courses provide practical training in hospital management of diarrhoeal diseases , epidemiology , biostatistics , family planning , demographic surveillance, and child survival strategies. As child deaths from disease have been reduced, deaths from injuries, such as drowning, have become a proportionately greater threat to child survival. In 2017, ICDDR,B won the Conrad N. Hilton Humanitarian Prize with $2 million in prize money in recognition of the institute's innovative approach to solving global health issues impacting the world's most impoverished communities. In 2016, former UN Secretary-General Ban Ki-moon noted that ICDDR,B's innovations are directly contributing to sustainable development, helping reduce infant, child and maternal mortality significantly in Bangladesh and beyond. In 2001, ICDDR,B received the first Gates Award for Global Health from the Bill & Melinda Gates Foundation. In 2002 the first Pollin Prize for Pediatric Research was awarded to Drs. Norbert Hirschhorn, Nathaniel Pierce, Dilip Mahalanabis and David Nalin for their contributions to the development and implementation of oral rehydration therapy. The work of Drs. Hirschhorn and Nalin was done at the Cholera Research Laboratory beginning in 1967. Dr. Dilip Mahalanabis made his major contribution to oral rehydration therapy in 1971 while working in Calcutta and served as Director of Clinical Research at ICDDR,B in the 1990s. In 2006, the Prince Mahidol Award for public health was given jointly to Drs. Mahalanabis, Richard A. Cash , David Nalin , and Stanley Schultz for their work on oral rehydration therapy . In 2007, ICDDR,B received the Leadership Award from the Alliance for the Prudent Use of Antibiotics . It won the $2 million 2017 Conrad N. Hilton Humanitarian Prize from the Conrad N. Hilton Foundation . 1960: Cholera Research Laboratory begins. 1963: Population surveillance – the world's longest running field site starts in Matlab Bazaar . 1966: Cholera fatality reduced to less than 1%. 1967: Work leading to the development of oral rehydration therapy begins. 1969: Relationship between breastfeeding and menstruation resumption is demonstrated. 1974: Tetanus toxoid vaccine recommended for pregnant women, reducing neonatal mortality by 30%. 1978: Rotavirus identified as the most common cause of diarrhoea in infants in Bangladesh, and as highest priority for new vaccines. 1982: Rice-based ORS shown to be fully effective alternative to glucose-based ORS and preferred for routine use at ICDDR,B. 1982: Matlab Maternal Child Health and Family Planning project shares its success in lowering national fertility rates with the Government of Bangladesh. 1983: Epidemic Control and Preparedness Programme begins. 1984: Full Expanded Programme on Immunization data is validated (and begins). Benefit of measles vaccine demonstrated, leading to inclusion in EPI. 1985: Cholera vaccine trial launched. 1988: Treatment of, and research into, acute respiratory infections/pneumonia begins. 1989: Matlab record keeping system, specially adapted for Government use, extended to the national family planning programme. 1993: New Vibrio cholerae 0139 (Bengal strain) identified and characterised by ICDDR,B. 1994: ICDDR,B epidemic response team goes to Goma, Zaire to assist cholera-stricken Rwandan refugees and helps reduce case fatality rate from as high as 49% to less than 1%. 1995: Maternal immunisation with pneumococcal vaccine shown likely to protect infants up to 22 weeks. 1998: HIV sero-surveillance begins in Bangladesh on behalf of Ministry of Health and Family Welfare, Government of Bangladesh. 1999: Protocolized Management of Severely Malnourished Children decreases case fatality from 20% to less than 5%. Published in Lancet. 2000: ICDDR,B assists Government of Bangladesh with control of major dengue epidemic in Dhaka. 2000: International, peer-reviewed and indexed ICDDR,B journal is renamed Journal of Health, Population, and Nutrition. 2001: Studies on violence against women in Bangladesh are initiated. 2001: ICDDR,B opens the first tuberculosis laboratory in Bangladesh. 2001: Oral cholera vaccine, tested at ICDDR,B, is approved for use by WHO. 2001: Studies on the effects of arsenic on health begin. 2002: ICDDR,B studies establish that zinc treatment of diarrhoea reduces under-5 mortality by 50%. 2002: First HIV voluntary counselling and testing unit in Bangladesh opens at ICDDR,B. 2003: New research programmes on HIV/AIDS and Poverty & Health. 2004: Studies on preventing high levels of childhood drowning begin. 2005: ICDDR,B team assists in post-tsunami health needs assessment in Sri Lanka. 2006: Dispersible zinc tablets launched through unique public-private partnership in national scale-up to treat diarrhoea in children under five years. 2006: Studies on abortion and menstrual regulation initiated. 2007: Oral cholera vaccine Dukoral, tested at Matlab in 1985, launched in Bangladesh. 2008: Introduce SHEBA (an integrated Hospital Management System) and start the journey as a paperless hospital 2009: ICDDR,B opens a ward for ARI (Swine Flu) patients. 2010: ICDDR,B celebrates 50 years of operations. Sends teams to combat deadly cholera outbreaks in Pakistan and Haiti. Research team discovers and characterise the "TLC phage" which changes the chromosomal sequence of the cholera bacterium, enabling incoming toxigenic CTX phage genome to be incorporated and transforming a harmless strain of V. cholerae to a dangerous killer. Issued its first patent from the Director of United States Patent and Trademark Office (United States Patent US7638271) for inventing a new diagnostic method for tuberculosis, called Antibodies from lymphocyte secretions or ALS. 2011: "Continuum of Care" (a concept involving a system that guides and tracks patients over time through a comprehensive array of health services) approach achieves 36% drop in perinatalmortality. 2014: Oral cholera vaccine in Bangladesh was found to have significant impact on cholera incidence when delivered through Bangladesh's existing immunisation infrastructure. 2015: ICDDR,B published a three-year strategic plan 2015–2018, aiming to achieve broader objectives by developing a greater international focus, promoting the growth of South-South collaborations and increasing engagement with the private sector. 2016: Former UN Secretary-General Ban Ki-moon acknowledged that ICDDR,B interventions are directly contributing to sustainable development, which helped to significantly reduce infant, child and maternal mortality in Bangladesh and beyond. 2017: ICDDR,B wins the 2017 Conrad N. Hilton Humanitarian Prize for its commitment to solving key public health problems facing the world's most vulnerable through innovative scientific research since 1960.1960: Cholera Research Laboratory begins. 1963: Population surveillance – the world's longest running field site starts in Matlab Bazaar . 1966: Cholera fatality reduced to less than 1%. 1967: Work leading to the development of oral rehydration therapy begins. 1969: Relationship between breastfeeding and menstruation resumption is demonstrated. 1974: Tetanus toxoid vaccine recommended for pregnant women, reducing neonatal mortality by 30%. 1978: Rotavirus identified as the most common cause of diarrhoea in infants in Bangladesh, and as highest priority for new vaccines. 1982: Rice-based ORS shown to be fully effective alternative to glucose-based ORS and preferred for routine use at ICDDR,B. 1982: Matlab Maternal Child Health and Family Planning project shares its success in lowering national fertility rates with the Government of Bangladesh. 1983: Epidemic Control and Preparedness Programme begins. 1984: Full Expanded Programme on Immunization data is validated (and begins). Benefit of measles vaccine demonstrated, leading to inclusion in EPI. 1985: Cholera vaccine trial launched. 1988: Treatment of, and research into, acute respiratory infections/pneumonia begins. 1989: Matlab record keeping system, specially adapted for Government use, extended to the national family planning programme. 1993: New Vibrio cholerae 0139 (Bengal strain) identified and characterised by ICDDR,B. 1994: ICDDR,B epidemic response team goes to Goma, Zaire to assist cholera-stricken Rwandan refugees and helps reduce case fatality rate from as high as 49% to less than 1%. 1995: Maternal immunisation with pneumococcal vaccine shown likely to protect infants up to 22 weeks. 1998: HIV sero-surveillance begins in Bangladesh on behalf of Ministry of Health and Family Welfare, Government of Bangladesh. 1999: Protocolized Management of Severely Malnourished Children decreases case fatality from 20% to less than 5%. Published in Lancet. 2000: ICDDR,B assists Government of Bangladesh with control of major dengue epidemic in Dhaka. 2000: International, peer-reviewed and indexed ICDDR,B journal is renamed Journal of Health, Population, and Nutrition. 2001: Studies on violence against women in Bangladesh are initiated. 2001: ICDDR,B opens the first tuberculosis laboratory in Bangladesh. 2001: Oral cholera vaccine, tested at ICDDR,B, is approved for use by WHO. 2001: Studies on the effects of arsenic on health begin. 2002: ICDDR,B studies establish that zinc treatment of diarrhoea reduces under-5 mortality by 50%. 2002: First HIV voluntary counselling and testing unit in Bangladesh opens at ICDDR,B. 2003: New research programmes on HIV/AIDS and Poverty & Health. 2004: Studies on preventing high levels of childhood drowning begin. 2005: ICDDR,B team assists in post-tsunami health needs assessment in Sri Lanka. 2006: Dispersible zinc tablets launched through unique public-private partnership in national scale-up to treat diarrhoea in children under five years. 2006: Studies on abortion and menstrual regulation initiated. 2007: Oral cholera vaccine Dukoral, tested at Matlab in 1985, launched in Bangladesh. 2008: Introduce SHEBA (an integrated Hospital Management System) and start the journey as a paperless hospital 2009: ICDDR,B opens a ward for ARI (Swine Flu) patients. 2010: ICDDR,B celebrates 50 years of operations. Sends teams to combat deadly cholera outbreaks in Pakistan and Haiti. Research team discovers and characterise the "TLC phage" which changes the chromosomal sequence of the cholera bacterium, enabling incoming toxigenic CTX phage genome to be incorporated and transforming a harmless strain of V. cholerae to a dangerous killer. Issued its first patent from the Director of United States Patent and Trademark Office (United States Patent US7638271) for inventing a new diagnostic method for tuberculosis, called Antibodies from lymphocyte secretions or ALS. 2011: "Continuum of Care" (a concept involving a system that guides and tracks patients over time through a comprehensive array of health services) approach achieves 36% drop in perinatalmortality. 2014: Oral cholera vaccine in Bangladesh was found to have significant impact on cholera incidence when delivered through Bangladesh's existing immunisation infrastructure. 2015: ICDDR,B published a three-year strategic plan 2015–2018, aiming to achieve broader objectives by developing a greater international focus, promoting the growth of South-South collaborations and increasing engagement with the private sector. 2016: Former UN Secretary-General Ban Ki-moon acknowledged that ICDDR,B interventions are directly contributing to sustainable development, which helped to significantly reduce infant, child and maternal mortality in Bangladesh and beyond. 2017: ICDDR,B wins the 2017 Conrad N. Hilton Humanitarian Prize for its commitment to solving key public health problems facing the world's most vulnerable through innovative scientific research since 1960.icddr,b's headquarters in the Dhaka is located at Mohakhali with modern laboratories and hospital, and training centers. Dhaka Hospital was established by icddr,b in 1962 primarily for diarrhoeal disease. It has since grown into a nationally important centre treating more than 140,000 patients a year. Dhaka Hospital provides an infrastructure for a wide range of clinical research projects. It has pioneered numerous innovations, including a paperless patient record system, which has also been adopted at Matlab Hospital. The 120-bed icddr,b-run Matlab Hospital is located within the Health and Demographic Surveillance Site at Matlab, about 50 km south of Dhaka. It provides free clinical care for diarrhoeal disease, maternal and child health care services, treating more than 30,000 people a year. It played a key role in community trials of oral rehydration solution (ORS) and early cholera vaccine studies.

Wiki

Dengue fever

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Dengue fever

Dengue fever is a mosquito-borne tropical disease caused by dengue virus . It is frequently asymptomatic ; if symptoms appear they typically begin 3 to 14 days after infection. These may include a high fever , headache , vomiting , muscle and joint pains , and a characteristic skin itching and skin rash . Recovery generally takes two to seven days. In a small proportion of cases, the disease develops into severe dengue (previously known as dengue hemorrhagic fever or dengue shock syndrome) with bleeding , low levels of blood platelets , blood plasma leakage, and dangerously low blood pressure . Dengue virus has four confirmed serotypes ; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. The symptoms of dengue resemble many other diseases including malaria , influenza , and Zika . Blood tests are available to confirm the diagnosis including detecting viral RNA , or antibodies to the virus. There is no specific treatment for dengue fever. In mild cases, treatment is focused on treating pain symptoms. Severe cases of dengue require hospitalisation; treatment of acute dengue is supportive and includes giving fluid either by mouth or intravenously . Dengue is spread by several species of female mosquitoes of the Aedes genus , principally Aedes aegypti . Infection can be prevented by mosquito elimination and the prevention of bites. Two types of dengue vaccine have been approved and are commercially available. Dengvaxia became available in 2016 but it is only recommended to prevent re-infection in individuals who have been previously infected. The second vaccine, Qdenga, became available in 2022 and is suitable for adults, adolescents and children from four years of age. The earliest descriptions of a dengue outbreak date from 1779; its viral cause and spread were understood by the early 20th century. Already endemic in more than one hundred countries, dengue is spreading from tropical and subtropical regions to the Iberian Peninsula and the southern states of the US, partly attributed to climate change. It is classified as a neglected tropical disease . During 2023, more than 5 million infections were reported, with more than 5,000 dengue-related deaths. As most cases are asymptomatic or mild, the actual numbers of dengue cases and deaths are under-reported. Typically, people infected with dengue virus are asymptomatic (80%) or have only mild symptoms such as an uncomplicated fever. Others have more severe illness (5%), and in a small proportion it is life-threatening. The incubation period (time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days. The characteristic symptoms of mild dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, nausea, vomiting, swollen glands and a rash. If this progresses to severe dengue the symptoms are severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool, extreme thirst, pale and cold skin, and feelings of weakness. The course of infection is divided into three phases: febrile, critical, and recovery. The febrile phase involves high fever (40 °C/104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days. There may also be nausea, vomiting, a rash, and pains in the muscle and joints. Most people recover within a week or so. In about 5% of cases, symptoms worsen and can become life-threatening. This is called severe dengue , (formerly called dengue hemorrhagic fever or dengue shock syndrome ). Severe dengue can lead to shock, internal bleeding, organ failure and even death. Warning signs include severe stomach pain, vomiting, difficulty breathing, and blood in the nose, gums, vomit or stools. During this period, there is leakage of plasma from the blood vessels, together with a reduction in platelets . This may result in fluid accumulation in the chest and abdominal cavity as well as depletion of fluid from the circulation and decreased blood supply to vital organs . The recovery phase usually lasts two to three days. The improvement is often striking, and can be accompanied with severe itching and a slow heart rate . Complications following severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment. A pregnant woman who develops dengue is at higher risk of miscarriage , low birth weight birth, and premature birth . The course of infection is divided into three phases: febrile, critical, and recovery. The febrile phase involves high fever (40 °C/104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days. There may also be nausea, vomiting, a rash, and pains in the muscle and joints. Most people recover within a week or so. In about 5% of cases, symptoms worsen and can become life-threatening. This is called severe dengue , (formerly called dengue hemorrhagic fever or dengue shock syndrome ). Severe dengue can lead to shock, internal bleeding, organ failure and even death. Warning signs include severe stomach pain, vomiting, difficulty breathing, and blood in the nose, gums, vomit or stools. During this period, there is leakage of plasma from the blood vessels, together with a reduction in platelets . This may result in fluid accumulation in the chest and abdominal cavity as well as depletion of fluid from the circulation and decreased blood supply to vital organs . The recovery phase usually lasts two to three days. The improvement is often striking, and can be accompanied with severe itching and a slow heart rate . Complications following severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment. A pregnant woman who develops dengue is at higher risk of miscarriage , low birth weight birth, and premature birth . Complications following severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment. A pregnant woman who develops dengue is at higher risk of miscarriage , low birth weight birth, and premature birth . Dengue virus (DENV) is an RNA virus of the family Flaviviridae ; genus Flavivirus . Other members of the same genus include yellow fever virus , West Nile virus , and Zika virus . Dengue virus genome (genetic material) contains about 11,000 nucleotide bases , which code for the three structural protein molecules (C, prM and E) that form the virus particle and seven other protein molecules that are required for replication of the virus. There are four confirmed strains of the virus, called serotypes , referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The distinctions between the serotypes are based on their antigenicity . Dengue virus is most frequently transmitted by the bite of mosquitos in the Aedes genus, particularly A. aegypti . They prefer to feed at dusk and dawn, but they may bite and thus spread infection at any time of day. Other Aedes species that may transmit the disease include A. albopictus , A. polynesiensis and A. scutellaris . Humans are the primary host of the virus, but it also circulates in nonhuman primates , and can infect other mammals. An infection can be acquired via a single bite. For 2 to 10 days after becoming newly infected, a person's bloodstream will contain a high level of virus particles (the viremic period). A female mosquito that takes a blood meal from the infected host then propagates the virus in the cells lining its gut. Over the next few days, the virus spreads to other tissues including the mosquito's salivary glands and is released into its saliva. Next time the mosquito feeds, the infectious saliva will be injected into the bloodstream of its victim, thus spreading the disease. The virus seems to have no detrimental effect on the mosquito, which remains infected for life. Dengue can also be transmitted via infected blood products and through organ donation . Vertical transmission (from mother to child) during pregnancy or at birth has been reported. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent ( DEET being the most effective). Chronic diseases – such as asthma, sickle cell anemia, and diabetes mellitus – increase the risk of developing a severe form of the disease. Other risk factors for severe disease include female sex, and high body mass index , Infection with one serotype is thought to produce lifelong immunity to that type, but only short-term protection against the other three. Subsequent re-infection with a different serotype increases the risk of severe complications due to phenomenon known as antibody-dependent enhancement (ADE). The exact mechanism of ADE is not fully understood. It appears that ADE occurs when the antibodies generated during an immune response recognize and bind to a pathogen, but they fail to neutralize it. Instead, the antibody-virus complex has an enhanced ability to bind to the Fcγ receptors of the target immune cells, enabling the virus to infect the cell and reproduce itself. When a mosquito carrying dengue virus bites a person, the virus enters the skin together with the mosquito's saliva. The virus infects nearby skin cells called keratinocytes , as well as specialized immune cell located in the skin, called a Langerhans cells . The Langerhans cells migrate to the lymph nodes , where the infection spreads to white blood cells , and reproduces inside the cells while they move throughout the body. The white blood cells respond by producing several signaling proteins, such as cytokines and interferons , which are responsible for many of the symptoms, such as the fever, the flu-like symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the liver and the bone marrow ) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into body cavities due to increased capillary permeability . As a result, blood volume decreases, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. The spread of the virus to the bone marrow leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent (DEET being the most effective); it's also advisable to treat clothing, nets and tents with 0.5% permethrin . Protection of the home can be achieved with door and window screens, by using air conditioning, and by regularly emptying and cleaning all receptacles both indoors and outdoors which may accumulate water (such as buckets, planters, pools or trashcans). The primary method of controlling A. aegypti is by eliminating its habitats . This is done by eliminating open sources of water, or if this is not possible, by adding insecticides or biological control agents to these areas. Generalized spraying with organophosphate or pyrethroid insecticides, while sometimes done, is not thought to be effective. Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effects from insecticides and greater logistical difficulties with control agents. Ideally, mosquito control would be a community activity, e.g. when all members of a community clear blocked gutters and street drains and keep their yards free of containers with standing water. If residences have direct water connections this eliminates the need for wells or street pumps and water-carrying containers. As of March 2024, there are two vaccines to protect against dengue infection; Dengvaxia and Qdenga . Dengvaxia (formerly CYD-TDV) became available in 2015, and is approved for use in the US, EU and in some Asian and Latin American countries. It is an attenuated virus, is suitable for individuals aged 6–45 years and protects against all four serotypes of dengue. Due to safety concerns about antibody-dependent enhancement (ADE), it should only be given to individuals who have previously been infected with dengue, in order to protect them from reinfection. It is given subcutaneously as three doses at six month intervals. Qdenga (formerly TAK-003) completed clinical trials in 2022 and was approved for use in the European Union in December 2022; it has been approved by a number of other countries including Indonesia and Brazil, and has been recommended by the SAGE committee of the World Health Organization. It is indicated for the prevention of dengue disease in individuals four years of age and older, and can be administered to people who have not been previously infected with dengue. It is a live attenuated vaccine containing the four serotypes of dengue virus, administered subcutaneously as two doses three months apart. Dengue virus (DENV) is an RNA virus of the family Flaviviridae ; genus Flavivirus . Other members of the same genus include yellow fever virus , West Nile virus , and Zika virus . Dengue virus genome (genetic material) contains about 11,000 nucleotide bases , which code for the three structural protein molecules (C, prM and E) that form the virus particle and seven other protein molecules that are required for replication of the virus. There are four confirmed strains of the virus, called serotypes , referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The distinctions between the serotypes are based on their antigenicity . Dengue virus is most frequently transmitted by the bite of mosquitos in the Aedes genus, particularly A. aegypti . They prefer to feed at dusk and dawn, but they may bite and thus spread infection at any time of day. Other Aedes species that may transmit the disease include A. albopictus , A. polynesiensis and A. scutellaris . Humans are the primary host of the virus, but it also circulates in nonhuman primates , and can infect other mammals. An infection can be acquired via a single bite. For 2 to 10 days after becoming newly infected, a person's bloodstream will contain a high level of virus particles (the viremic period). A female mosquito that takes a blood meal from the infected host then propagates the virus in the cells lining its gut. Over the next few days, the virus spreads to other tissues including the mosquito's salivary glands and is released into its saliva. Next time the mosquito feeds, the infectious saliva will be injected into the bloodstream of its victim, thus spreading the disease. The virus seems to have no detrimental effect on the mosquito, which remains infected for life. Dengue can also be transmitted via infected blood products and through organ donation . Vertical transmission (from mother to child) during pregnancy or at birth has been reported. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent ( DEET being the most effective). Chronic diseases – such as asthma, sickle cell anemia, and diabetes mellitus – increase the risk of developing a severe form of the disease. Other risk factors for severe disease include female sex, and high body mass index , Infection with one serotype is thought to produce lifelong immunity to that type, but only short-term protection against the other three. Subsequent re-infection with a different serotype increases the risk of severe complications due to phenomenon known as antibody-dependent enhancement (ADE). The exact mechanism of ADE is not fully understood. It appears that ADE occurs when the antibodies generated during an immune response recognize and bind to a pathogen, but they fail to neutralize it. Instead, the antibody-virus complex has an enhanced ability to bind to the Fcγ receptors of the target immune cells, enabling the virus to infect the cell and reproduce itself. When a mosquito carrying dengue virus bites a person, the virus enters the skin together with the mosquito's saliva. The virus infects nearby skin cells called keratinocytes , as well as specialized immune cell located in the skin, called a Langerhans cells . The Langerhans cells migrate to the lymph nodes , where the infection spreads to white blood cells , and reproduces inside the cells while they move throughout the body. The white blood cells respond by producing several signaling proteins, such as cytokines and interferons , which are responsible for many of the symptoms, such as the fever, the flu-like symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the liver and the bone marrow ) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into body cavities due to increased capillary permeability . As a result, blood volume decreases, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. The spread of the virus to the bone marrow leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent (DEET being the most effective); it's also advisable to treat clothing, nets and tents with 0.5% permethrin . Protection of the home can be achieved with door and window screens, by using air conditioning, and by regularly emptying and cleaning all receptacles both indoors and outdoors which may accumulate water (such as buckets, planters, pools or trashcans). The primary method of controlling A. aegypti is by eliminating its habitats . This is done by eliminating open sources of water, or if this is not possible, by adding insecticides or biological control agents to these areas. Generalized spraying with organophosphate or pyrethroid insecticides, while sometimes done, is not thought to be effective. Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effects from insecticides and greater logistical difficulties with control agents. Ideally, mosquito control would be a community activity, e.g. when all members of a community clear blocked gutters and street drains and keep their yards free of containers with standing water. If residences have direct water connections this eliminates the need for wells or street pumps and water-carrying containers. As of March 2024, there are two vaccines to protect against dengue infection; Dengvaxia and Qdenga . Dengvaxia (formerly CYD-TDV) became available in 2015, and is approved for use in the US, EU and in some Asian and Latin American countries. It is an attenuated virus, is suitable for individuals aged 6–45 years and protects against all four serotypes of dengue. Due to safety concerns about antibody-dependent enhancement (ADE), it should only be given to individuals who have previously been infected with dengue, in order to protect them from reinfection. It is given subcutaneously as three doses at six month intervals. Qdenga (formerly TAK-003) completed clinical trials in 2022 and was approved for use in the European Union in December 2022; it has been approved by a number of other countries including Indonesia and Brazil, and has been recommended by the SAGE committee of the World Health Organization. It is indicated for the prevention of dengue disease in individuals four years of age and older, and can be administered to people who have not been previously infected with dengue. It is a live attenuated vaccine containing the four serotypes of dengue virus, administered subcutaneously as two doses three months apart. The World Health Organization 's International Classification of Diseases divides dengue fever into two classes: uncomplicated and severe. Severe dengue is defined as that associated with severe bleeding, severe organ dysfunction, or severe plasma leakage. Severe dengue can develop suddenly, sometimes after a few days as the fever subsides. Leakage of plasma from the capillaries results in extreme low blood pressure and hypovolemic shock ; Patients with severe plasma leakage may have fluid accumulation in the lungs or abdomen , insufficient protein in the blood , or thickening of the blood . Severe dengue is a medical emergency which can cause damage to organs, leading to multiple organ failure and death. Mild cases of dengue fever can easily be confused with several common diseases including Influenza , measles , chikungunya , and zika . Dengue, chikungunya and zika share the same mode of transmission ( Aedes mosquitoes) and are often endemic in the same regions, so that it is possible to be infected simultaneously by more than one disease. For travellers, dengue fever diagnosis should be considered in anyone who develops a fever within two weeks of being in the tropics or subtropics . Warning symptoms of severe dengue include abdominal pain, persistent vomiting, odema, bleeding, lethargy, and liver enlargement. Once again, these symptoms can be confused with other diseases such as malaria, gastroenteritis, leptospirosis, and typhus. Blood tests can be used to confirm a diagnosis of dengue. During the first few days of infection, enzyme-linked immunosorbent assay ( ELISA ) can be used to detect the NS1 antigen ; however this antigen is produced by all flaviviruses. Four or five days into the infection, it is possible to reliably detect anti-dengue IgM antibodies, but this does not determine the serotype. Nucleic acid amplification tests provide the most reliable method of diagnosis. As of March 2024, there is no specific antiviral treatment available for dengue fever. Most cases of dengue fever have mild symptoms, and recovery takes place in a few days. No treatment is required for these cases. Acetaminophen (Paracetamol, Tylenol ) may be used to relieve mild fever or pain. Other common pain relievers, including aspirin , ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) should be avoided as they can increase the risk of bleeding complications. For moderate illness, those who can drink, are passing urine, have no warning signs and are otherwise reasonably healthy can be monitored carefully at home. Supportive care with analgesics, fluid replacement, and bed rest are recommended. Severe dengue is a life-threatening emergency, requiring hospitalization and potentially intensive care. Warning signs include dehydration , decreasing platelets and increasing hematocrit . Treatment modes include intravenous fluids, and transfusion with platelets or plasma. Most people with dengue recover without any ongoing problems. The risk of death among those with severe dengue is 0.8% to 2.5%, and with adequate treatment this is less than 1%. However, those who develop significantly low blood pressure may have a fatality rate of up to 26%. The risk of death among children less than five years old is four times greater than among those over the age of 10. Elderly people are also at higher risk of a poor outcome. As of March 2023, dengue is endemic in more than 100 countries with cases reported in every continent with the exception of Antarctica. The Americas, Southeast Asia and the Western Pacific regions are the most seriously affected. It is difficult to estimate the full extent of the disease, as many cases are mild and not correctly diagnosed. WHO currently estimates that 3.9 billion people are at risk of dengue infection. In 2013, it was estimated that 390 million dengue infections occur every year, with 500,000 of these developing severe symptoms and 25,000 deaths. Generally, areas where dengue is endemic have only one serotype of the virus in circulation. The disease is said to be hyperendemic in areas where more than one serotype is circulating; this increases the risk of severe disease on a second or subsequent infection. Infections are most commonly acquired in urban environments where the virus is primarily transmitted by the mosquito species Aedes aegypti . This species has adapted to the urban environment, is generally found close to human habitation, prefers humans as its host, and takes advantage of small bodies of standing water (such as tanks and buckets) in which to breed. In rural settings the virus is transmitted to humans by A. aegypti and other related mosquitoes such as Aedes albopictus . Both these species have expanding ranges. Dengue has increased in incidence in recent decades, with WHO recording a ten fold increase between 2010 and 2019 (from 500,000 to 5 million recorded cases). This increase is tied closely to the increasing range of Aedes mosquitoes, which is attributed to a combination of urbanization , population growth, and an increasingly warm climate . In endemic areas, dengue infections peak when rainfall is optimal for mosquito breeding. The disease infects all races, sexes, and ages equally. In endemic areas, the infection is most commonly seen in children who then acquire a lifelong partial immunity. The first historical record of a case of probable dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty (266–420) which referred to a "water poison" associated with flying insects. The principal mosquito vector of dengue, Aedes aegypti , spread out of Africa in the 15th to 19th centuries due to the slave trade and consequent expansion of international trading. There have been descriptions of epidemics of dengue-like illness in the 17th century, and it is likely that epidemics in Jakarta , Cairo , and Philadelphia during the 18th century were caused by dengue. It is assumed that dengue was constantly present in many tropical urban centres throughout the 19th and early 20th centuries, even though significant outbreaks were infrequent. The marked spread of dengue during and after the Second World War has been attributed partly to disruption caused by the war, and partly to subsequent urbanisation in south-east Asia. As novel serotypes were introduced to regions already endemic with dengue, outbreaks of severe disease followed. The severe hemorrhagic form of the disease was first reported in the Philippines in 1953; by the 1970s, it had become recognised as a major cause of child mortality in Southeast Asia. In Central and South America, the Aedes mosquito had been eradicated in the 1950s; however the eradication program was discontinued in the 1970s and the diesase re-established itself in the region during the 1980s, becoming hyperendemic and causing significant epidemics. Dengue has continued to increase in prevalence during the 21st century, as the mosquito vector continues to expand its range. This is attributed partly to continuing urbanisation, and partly to the impact of a warmer climate. The name came into English in the early 19th century from West Indian Spanish, which borrowed it from the Kiswahili term dinga (in full kidingapopo , "disease caused by an evil spirit"). The borrowed term changed to dengue in Spanish due to this word existing in Spanish with the meaning "fastidiousness" and this folk etymology referring to the dislike of movement by affected patients. Slaves in the West Indies having contracted dengue were said to have the posture and gait of a dandy , and the disease was known as "dandy fever". The term break-bone fever was applied by physician and United States Founding Father Benjamin Rush , in a 1789 report of the 1780 epidemic in Philadelphia , due to the associated muscle and joint pains. In the report title he uses the more formal term "bilious remitting fever". The term dengue fever came into general use only after 1828. Other historical terms include "breakheart fever" and "la dengue". Terms for severe disease include "infectious thrombocytopenic purpura" and "Philippine", "Thai", or "Singapore hemorrhagic fever". The name came into English in the early 19th century from West Indian Spanish, which borrowed it from the Kiswahili term dinga (in full kidingapopo , "disease caused by an evil spirit"). The borrowed term changed to dengue in Spanish due to this word existing in Spanish with the meaning "fastidiousness" and this folk etymology referring to the dislike of movement by affected patients. Slaves in the West Indies having contracted dengue were said to have the posture and gait of a dandy , and the disease was known as "dandy fever". The term break-bone fever was applied by physician and United States Founding Father Benjamin Rush , in a 1789 report of the 1780 epidemic in Philadelphia , due to the associated muscle and joint pains. In the report title he uses the more formal term "bilious remitting fever". The term dengue fever came into general use only after 1828. Other historical terms include "breakheart fever" and "la dengue". Terms for severe disease include "infectious thrombocytopenic purpura" and "Philippine", "Thai", or "Singapore hemorrhagic fever". Research directions include dengue pathogenesis (the process by which the disease develops in humans), as well as the biology, ecology and behaviour of the mosquito vector. Improved diagnostics would enable faster and more appropriate treatment. Attempts are ongoing to develop an antiviral medicine targeting the NS3 or NS5 proteins. In addition to the two vaccines which are already available, several vaccine candidates are in development. Outbreaks of dengue fever increase the need for blood products while decreasing the number of potential blood donors due to potential infection with the virus. Someone who has a dengue infection is typically not allowed to donate blood for at least the next six months. International Anti-Dengue Day is observed every year on 15 June in a number of countries. The idea was first agreed upon in 2010 with the first event held in Jakarta , Indonesia, in 2011. Further events were held in 2012 in Yangon , Myanmar, and in 2013 in Vietnam . Goals are to increase public awareness about dengue, mobilize resources for its prevention and control and, to demonstrate the Southeast Asian region's commitment in tackling the disease. Efforts are ongoing as of 2019 to make it a global event. The Philippines has an awareness month in June since 1998. A National Dengue Day is held in India annually on 16 May. A study estimate that the global burden of dengue in 2013 amounted to US$8·9 billion. Outbreaks of dengue fever increase the need for blood products while decreasing the number of potential blood donors due to potential infection with the virus. Someone who has a dengue infection is typically not allowed to donate blood for at least the next six months. International Anti-Dengue Day is observed every year on 15 June in a number of countries. The idea was first agreed upon in 2010 with the first event held in Jakarta , Indonesia, in 2011. Further events were held in 2012 in Yangon , Myanmar, and in 2013 in Vietnam . Goals are to increase public awareness about dengue, mobilize resources for its prevention and control and, to demonstrate the Southeast Asian region's commitment in tackling the disease. Efforts are ongoing as of 2019 to make it a global event. The Philippines has an awareness month in June since 1998. A National Dengue Day is held in India annually on 16 May. A study estimate that the global burden of dengue in 2013 amounted to US$8·9 billion.

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Dengue fever

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Dengue Fever (band)

Dengue Fever is an American band from Los Angeles who combine Cambodian rock and pop music of the 1960s and 70s with psychedelic rock and other world music styles. Their most recent album, Ting Mong , was released in September 2023.In the late 1990s, keyboardist Ethan Holtzman discovered Cambodian psychedelic rock music while traveling in that country. Coincidentally, his guitarist brother Zac Holtzman (then with the band Dieselhed ) had discovered the same music while working at a record store. The brothers formed Dengue Fever in 2001 to perform songs recorded by Cambodian artists like Sinn Sisamouth , Ros Serey Sothea , Pen Ran , and others, most of whom died or disappeared during the Khmer Rouge regime. The band first recruited bassist Senon Williams (also a member of Radar Bros. until 2009), former Beck saxophonist/flutist David Rallicke, and drummer Paul Smith. The band then decided to add a vocalist who could sing the Khmer lyrics of the Cambodian songs they hoped to play, and auditioned singers in the Little Phnom Penh area of Long Beach . The band selected Chhom Nimol , who had previously been a well-known singer in Cambodia before emigrating to the United States. Their self-titled debut album was released in 2003. The album consisted mostly of 1960s-70s Cambodian rock songs discovered by the Holtzman brothers, plus two original songs in the same style. Nimol sang all lyrics in Khmer. The band's later albums are mostly made up of originals, first written in English by the Holtzmans before being translated; while Nimol still usually sings in Khmer but occasionally in English as well. Their second album Escape from Dragon House was released in 2005. Also in 2005, the band toured Cambodia during the Bon Om Thook water festival, to critical acclaim. The 2009 documentary film Sleepwalking Through the Mekong by producer John Pirozzi documents the tour, with coverage of concert performances, collaborations with master musicians, and Chhom Nimol's success in reconnecting with Cambodian fans who had not seen her perform in person for five years. The documentary finds that the 1960s-70s Cambodian rock music played by the band was still very popular in that country, and fans were interested in seeing a mostly-American band perform the songs. John Pirozzi, also a fan of that music, later produced the documentary film Don't Think I've Forgotten with involvement from some of the members of Dengue Fever. In 2008, Real World Records released Venus On Earth in all territories outside of the U.S. and Canada. Peter Gabriel , founder of their new label, said of the deal, "We have Dengue Fever coming out on Real World Records (outside of the USA) - it's really cool stuff, with the small Cambodian singer and big American guys behind! They're California based but have taken 60's Cambodian pop as their main source of inspiration and it's done with a lot of style. It's spirited, impassioned stuff." The album won the award for Best Fusion Album at the 2009 Independent Music Awards. In 2011 the band released the album Cannibal Courtship , which was noted for incorporating more world music elements beyond the band's established Cambodian influences. Their fifth full-length album, The Deepest Lake , was released in 2015 and was noted for expanding the band's sound even further into girl group pop, surf music, jazz, African rhythms, and other styles while retaining its roots in Cambodian psychedelic rock. In 2017, Dengue Fever embarked on their longest-ever American tour as the support act for Tinariwen . In 2018, Dengue Fever contributed several songs to the theater production Cambodian Rock Band by Lauren Yee , a play about a young Cambodian-American whose father was a musician persecuted by the Khmer Rouge . The band's first new album in eight years, Ting Mong , was released in September 2023. Dengue Fever has entered into partnerships with a number of charitable organizations to support causes in Cambodia. As one example, they are involved with the wildlife and forest conservation organization Wildlife Alliance . The band compiled an album of original 1960s-70s Cambodian rock songs titled Electric Cambodia in 2010, with all proceeds donated to Cambodian Living Arts, an organization that seeks to preserve the traditional and popular Cambodian music that was nearly lost during the country's recent historical struggles. The band has also donated songs for benefit records produced by Sweet Relief Musicians Fund , a charity that provides financial assistance to musicians dealing with illness, disability, or age-related issues. Dengue Fever (2003) Dengue Fever (EP, 2005) Escape from Dragon House (2005) Sip Off the Mekong (EP, 2006) Venus On Earth (2008) Sleepwalking Through the Mekong (Soundtrack, 2009) In the Ley Lines (Live, 2009) Cannibal Courtship (2011) Girl From the North (EP, 2013) The Deepest Lake (2015) Ganadaramaba (EP, 2016) Ting Mong (2023)

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Dengue fever

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Dengue fever outbreaks

As of 2010 [ update ] , dengue fever is believed to infect 50 to 100 million people worldwide a year with 1/2 million life-threatening infections. It dramatically increased in frequency between 1960 and 2010, by 30 fold. This increase is believed to be due to a combination of urbanization, population growth, increased international travel, and global warming . The geographical distribution is around the equator with 70% of the total 2.5 billion people living in endemic areas from Asia and the Pacific. Many of the infected people during outbreaks are not virally tested, therefore their infections may also be due to chikungunya , a coinfection of both, or even other similar viruses.The first recognized dengue epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s, shortly after the identification and naming of the disease in 1779. A pandemic began in Southeast Asia in the 1950s, and by 1975 dengue haemorrhagic fever (DHF) had become a leading cause of death among children in the region. The first case of DHF was reported in Manila around 1953 through 1954. A small child with dengue fever started to bleed uncontrollably. Other children then became victims to the new symptom. Epidemic dengue has become more common since the 1980s. By the late 1990s, dengue was the most important mosquito-borne disease affecting humans after malaria, with around 40 million cases of dengue fever and several hundred thousand cases of dengue hemorrhagic fever each year. Significant outbreaks of dengue fever tend to occur every five or six months. The cyclical rise and fall in numbers of dengue cases is thought to be the result of seasonal cycles interacting with a short-lived cross-immunity [ clarification needed ] for all four strains in people who have had dengue. When the cross-immunity wears off the population is more susceptible to transmission whenever the next seasonal peak occurs. Thus over time there remain large numbers of susceptible people in affected populations despite previous outbreaks due to the four different serotypes of dengue virus and the presence of unexposed individuals from childbirth or immigration. [ citation needed ] There is significant evidence, originally suggested by S.B. Halstead in the 1970s, that dengue hemorrhagic fever is more likely to occur in people who have secondary infections by another one of dengue fever's four serotypes. One model to explain this process is known as antibody-dependent enhancement (ADE), which allows for increased uptake and virion replication during a secondary infection with a different strain. Through an immunological phenomenon, known as original antigenic sin , the immune system is not able to adequately respond to the stronger infection, and the secondary infection becomes far more serious. Reported cases of dengue are an under-representation of all cases when accounting for subclinical cases and cases where the patient did receive medical treatment. [ citation needed ] There was a serious outbreak in Rio de Janeiro during the summer of 2002 with 288,245 reported cases. On March 20, 2008, the secretary of health of the state of Rio de Janeiro , Sérgio Côrtes, announced that 23,555 cases of dengue, including 30 deaths, had been recorded in the state in less than three months. Côrtes said, "I am treating this as an epidemic because the number of cases is extremely high." Federal Minister of Health, José Gomes Temporão also announced that he was forming a panel to respond to the situation. Cesar Maia , mayor of the city of Rio de Janeiro , denied that there was serious cause for concern, saying that the incidence of cases was in fact declining from a peak at the beginning of February. By April 3, 2008, the number of cases reported rose to 55,000 In Singapore , the worst dengue outbreak is currently occurring. By 2 October 2020, there were more than 33,500 confirmed cases, and at least 29 deaths. This figure has exceeded the numbers of Singapore's previously worst dengue fever outbreak . Dengue fever occurs widely in the tropics, including the southern United States , northern Argentina , northern Australia , Bangladesh , Barbados , Bolivia , Belize , Brazil , Cambodia , Colombia , Costa Rica , Cuba , Dominican Republic , French Polynesia , Guadeloupe , El Salvador , Grenada , Guatemala , Guyana , Haiti , Honduras , India , Indonesia , Jamaica , Laos , Malaysia , Melanesia, [ clarification needed ] Mexico , Micronesia , Nicaragua , Pakistan , Panama , Paraguay , the Philippines , Puerto Rico , Samoa , Western Saudi Arabia , Singapore , Sri Lanka , Suriname , Taiwan , Thailand , Trinidad and Tobago , Venezuela and Vietnam , and increasingly in southern China . A 2010 outbreak in Puerto Rico resulted in 5382 confirmed infections and 20 deaths. Nearby Guadeloupe and Martinique , in the French Caribbean, were affected as well: over 40000 clinical cases in each island required medical assistance (the outbreak peaked in August 2010 and was practically over by October). A considerable number of cases were recorded in the French/Dutch island of St.Martin/Sint Marteen as well, where dengue is endemic. There was an outbreak in Pakistan with more than 5000 confirmed infections and a mortality rate of 31. The 2009 and 2010 dengue outbreaks in Key West Florida are similar to the 2005 Texas (25 cases) and 2001 Hawaii (122 cases) outbreaks, which were locally sustained on American soil and not a result of travelers returning from endemic areas. American visitors to and visitors from dengue-endemic regions will continue to present a potential pathway for the dengue virus to enter the United States and infect populations that have not been exposed to the virus for several decades. The health risks and rapidly escalating costs to the United States of unmonitored, unvaccinated and disease carrying travelers, legal and illegal, has been recently considered. An outbreak of dengue fever was declared in Cairns , located in the tropical north of Queensland , Australia on 1 December 2008. As of 3 March 2009 there were 503 confirmed cases of dengue fever, in a residential population of 152,137. Outbreaks were subsequently declared the neighbouring cities and towns of Townsville (outbreak declared 5 January 2009), Port Douglas (6 February 2009), Yarrabah (19 February 2009), Injinoo (24 February 2009), Innisfail (27 February 2009) and Rockhampton (10 March 2009). There have been occurrences of dengue types one, two, three, and four in the region. On March 4, 2009, Queensland Health had confirmed an elderly woman had died from dengue fever in Cairns, in the first fatality since the epidemic began last year. The statement said that although the woman had other health problems, she tested positive for dengue and the disease probably contributed to her death. [ citation needed ] An epidemic broke out in Bolivia in early 2009, in which 18 people died and 31,000 were infected. In 2009, in Argentina , a dengue outbreak was declared the northern provinces of Chaco , Catamarca , Salta , Jujuy , and Corrientes , with over 9673 cases reported as of April 11, 2009 by the Health Ministry. Some travelers from the affected zones have spread the fever as far south as Buenos Aires . Major efforts to control the epidemic in Argentina are focused on preventing its vector (the Aedes mosquitoes) from reproducing. This is addressed by asking people to dry out all possible water reservoirs from where mosquitoes could proliferate (which is, in other countries, known as "descacharrado"). There were information campaigns concerning prevention of the dengue fever; and the government is fumigating with insecticide in order to control the mosquito population. [ citation needed ] One of the South Asian countries still suffering highly from this problem is Sri Lanka. An outbreak caused by serotype DENV-1 occurred in 2002 on Easter Island . Subsequent outbreaks occurred in 2006–2007 and 2008, 2009 and 2011 with decreasing magnitude over time. The male:female ratio in reported cases was approximately 1:1 and the average age at infection was 31.38 ± 18.37 in both sexes. In many undeveloped regions, "authorities do not have adequate facilities to detect dengue cases." Notably, in the Philippines where patients seek herbal medication in lieu of hospitals for treating dengue, death rates as evidenced below are statistically far greater than other affected areas. As many cases go unreported, higher statistics here do not necessarily indicate a larger outbreak. In 2010, Latin America alone reported a sum of 1.5 million cases. Philippines dengue case load for Q1 2011 was some 5% higher than the preceding year, at 18,885 cases and 115 deaths. For 2011 until April 16, Brazil has recorded some 56,882 cases with 39 deaths, Paraguay with 27,000 cases and 31 deaths. A notable case was that of Trinidad and Tobago 's first female Prime Minister , Kamla Persad-Bissessar , who was diagnosed with dengue fever in August 2011, prompting investigation into the possibility of an epidemic on the twin-island republic. In 2012 the Island of Madeira experienced its first outbreak of dengue with 1080 confirmed cases. Some 52,008 cases of dengue fever were recorded in Thailand from Jan to Oct 16, 2012, with 50 deaths. Record dengue outbreaks reported in 2013 in many countries: Brazil (double deaths over 2012), Singapore, and Thailand (worst in 20 years), among others. San Pedro Sula , Honduras declared a dengue 'state of emergency', and Central America had its worst outbreaks since 2008. Polynesia experienced an 'unprecedented' series of outbreaks (14), along with Chikungunya and Zika virus . [ citation needed ] In only 7 weeks, in Brazil some 205,000 cases of dengue were reported, a record. In Peru , nearly 400 cases have been reported until March 2013; two of them were fatal. Since the beginning of 2013, in Paraguay 35 people have died after contracting dengue fever and almost 70,000 are still infected. As of June, 150,000 people in Thailand have come down with it, with 50 deaths, and some 44 deaths in Laos and 11,000 cases, 14,000 cases in Singapore but only 6 deaths, 22 deaths in Malaysia and 10,500 cases while 42,500 cases in Philippines with about 200 deaths. Dengue deaths have tripled in Malaysia until Feb 2014 over 2013, after tripling 2013 over 2012. Due to Typhoon Haiyan striking the Philippines early 2014, stagnant waters and heavy rain have been on constant watch due to mosquitoes breeding and causing epidemics around the area. Yoyogi Park in Tokyo became a breeding ground for dengue fever carrying mosquitoes. On September 2, the Japanese health ministry confirmed that 34 people had been infected. A study claims India has 6 million unreported dengue cases annually, while in Guangdong , China, a 15-fold increase over last year and 5-fold increase of mosquitos has left the normally lightly hit region stunned. Likewise Taiwan also had a 10-fold increase in cases this year. 2015 saw a dengue outbreak in Taiwan. [ citation needed ] Outbreaks intensified in nearly all tropical areas, with endemic extent, deaths, and caseloads all reported at new highs, with the Americas reporting 2 million symptomatic cases. In tropical/subtropical Asia, nearly all nations had reported explosive increases. With one sole exception, China's caseload has plunged to less than a tenth of the prior year due to massive releases of sterilized mosquitos . [ citation needed ] Dengue appeared in the Hawaiian Islands in late 2015, with at least 190 cases confirmed by year end. Most cases were reported on the island of Hawaii (the "Big Island"). Argentina registered a Dengue fever outbreak in late January 2016 with 13 of 24 provinces affected. In Thailand, officials anticipated as many cases in 2016 as occurred during a large outbreak in 1978, the largest ever recorded. From the beginning of the year to March, more than 8,000 cases had occurred, compared with just over 4,000 cases over the same period in 2015. A Dengue fever outbreak in the Indian state of Kerala in May and June 2017 had caused 6808 confirmed infections and 13 deaths by June 16. In Sri Lanka, there were 180,000 reported cases in 2017. The majority of cases being reported from the Western province. The highest numbers of dengue cases were reported during the 20 week of 2017. Sri Lankan health authorities warned that the country was facing a dengue epidemic with at least 301 patients dead. A dengue fever outbreak in Bangladesh starting April 2019 has caused 18,484 infected patients and 57 death. A dengue epidemic has been declared in the Philippines after 600 dead and over 150,000 cases reported. In the summer of 2019 an outbreak was confirmed in Oceania. 276 cases and one death were reported in the Marshall Islands , resulting in the government halting travel between the urban centers of Ebeye and Majuro to the outer islands. Outbreaks were also reported in Palau , Federated States of Micronesia , the Cook Islands , Tuvalu , and the Philippines . In end of December 2018, a man who had no recent travel history tested positive for dengue fever in Oman. It is thought the Aedes Aegypti mosquito, which had been reportedly seen in some parts of Muscat, is the cause of the outbreak of dengue fever in parts of Oman. The outbreak was easily controlled though, with only 343 suspected cases and 59 confirmed cases by April 2019. [ citation needed ] Mexico reported 41,505 cases and 191 deaths, with Jalisco being the state with the most infections (11,727) and deaths (49). 1,346,991 cases of dengue fever have been reported in Latin America between January 2019 and March 2020; 1,530 people have died. The countries with the highest rates are Nicaragua (2,271 cases per 100,000 inhabitants), Belize (1,021), Honduras (995.5), and El Salvador (375). Bolivia has reported 7,700 cases. [ citation needed ] Mexico had 24,313 cases and 79 deaths; the state of Jalisco reported the highest numbers (5,362 cases and 20 deaths), followed by Tabasco (9 deaths), and Michoacán (2,517 cases). Health authorities warn that efforts to combat the COVID-19 pandemic hampered efforts to combat dengue. At least 1.1 million cases of dengue and nearly 400 deaths from the disease have been reported in Brazil, where there are over 3.1 million COVID-19 infections . In September 2023 The Ministry of Health and Wellness , Jamaica declared a dengue outbreak after a significant rise in the number of dengue fever cases were reported. The Guardian reported that the outbreak was influenced by the heat as summer of 2023 was recorded as the highest temperature in 100,000 years. Brazil is currently facing a significant outbreak of dengue fever, which public health experts are indicating that this surge is a precursor to an increase in cases across the Americas, including Puerto Rico. Brazil's Health Ministry anticipates over 4.2 million cases this year, surpassing the 4.1 million cases reported by the Pan American Health Organization for all 42 countries in the region last year. While Brazil typically experiences fluctuations in dengue cases on a four-year cycle, experts attribute the intensified problem this year to various factors such as El Niño and climate change. Argentina is currently experiencing its worst dengue outbreak in history, with more than 100,000 positive cases in the first three months of the year, a figure 11 times higher than the same period in 2023. Interviewed by Página/12 , infectologist Leda Guzzi noted that the outbreak can be explained with five main points: "The exponential increase in the number of cases with a number up to 11 times higher than last year; the early timing of the outbreak, which was anticipated by at least four weeks; a 2023 that during the winter continued with viral transmission; the existence of co-circulation of three serotypes; and the fact that we have already had several epidemics in the last decade, which leads to the accumulation of people who have already had an episode of dengue fever." The new government of Javier Milei , who took office as president in December 2023, has refused to carry out awareness campaigns or guarantee access to free vaccination against the disease (unlike Brazil), due to its intransigent policy of drastically reducing public spending. When asked about this, presidential spokesperson Manuel Adorni argued that "the effectiveness [of the vaccine] has not been proven", although it was approved in Argentina in April 2023. In general terms, the government's official position has been to ignore the epidemic and its health minister Mario Russo made almost no reference to the situation, centralizing communication on the figure of Adorni. As of March 20, 69 deaths from the disease have been recorded so far in 2024. Eventually, the severity of the epidemic led the government to launch its first advertising spot providing basic prevention information on March 21. For his part, Russo, who had had no public presence in the 13 weeks of government, met on March 25 with the health ministers of all the provinces at the first meeting of the Federal Health Council ( Consejo Federal de Salud ; COFESA).

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Dengue fever

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Dengue vaccine

none Dengue vaccine is a vaccine used to prevent dengue fever in humans. Development of dengue vaccines began in the 1920s, but was hindered by the need to create immunity against all four dengue serotypes . As of 2023, there are two commercially available vaccines, sold under the brand names Dengvaxia and Qdenga . Dengvaxia is only recommended in those who have previously had dengue fever or populations in which most people have been previously infected due to phenomenon known as antibody-dependent enhancement . The value of Dengavaxia is limited by the fact that it may increase the risk of severe dengue in those who have not previously been infected. In 2017, more than 733,000 children and more than 50,000 adult volunteers were vaccinated with Dengvaxia regardless of serostatus , which led to a controversy . Qdenga is designated for people not previously infected. There are other vaccine candidates in development including live attenuated , inactivated , DNA and subunit vaccines . In December 2018, Dengvaxia was approved in the European Union. In May 2019, Dengvaxia was approved in the United States as the first vaccine approved for the prevention of dengue disease caused by all dengue virus serotypes (1, 2, 3 and 4) in people ages nine through 16 who have laboratory-confirmed previous dengue infection and who live in endemic areas. Dengue is endemic in the US territories of American Samoa, Guam, Puerto Rico, and the US Virgin Islands. The safety and effectiveness of the vaccine was determined in three randomized, placebo-controlled studies involving approximately 35,000 individuals in dengue-endemic areas, including Puerto Rico, Latin America and the Asia Pacific region. The vaccine was determined to be approximately 76 percent effective in preventing symptomatic, laboratory-confirmed dengue disease in individuals 9 through 16 years of age who previously had laboratory-confirmed dengue disease. In March 2021, the European Medicines Agency the filing package for TAK-003 (Qdenga) intended for markets outside of the EU. In August 2022, the Indonesian FDA approved Qdenga for use in individuals six years to 45 years of age and become the first authority in the world to approve Qdenga. Qdenga was approved in the European Union in December 2022. CYD-TDV, sold under the brand name Dengvaxia and made by Sanofi Pasteur , is a live attenuated tetravalent vaccine that is administered as three separate injections, with the initial dose followed by two additional shots given six and twelve months later. The US Food and Drug Administration (FDA) granted the application for Dengvaxia priority review designation and a tropical disease priority review voucher. The approval of Dengvaxia was granted to Sanofi Pasteur. The vaccine has been approved in 19 countries and the European Union, but it is not approved in the US for use in individuals not previously infected by any dengue virus serotype or for whom this information is unknown. Dengvaxia is a chimeric vaccine made using recombinant DNA technology by replacing the PrM (pre-membrane) and E (envelope) structural genes of the yellow fever attenuated 17D strain vaccine with those from the four dengue serotypes. Evidence indicates that CYD-TDV is partially effective in preventing infection, but may lead to a higher risk of severe disease in those who have not been previously infected and then do go on to contract the disease. It is not clear why the vaccinated seronegative population have more serious adverse outcomes. A plausible hypothesis is the phenomenon of antibody-dependent enhancement (ADE). American virologist Scott Halstead was one of the first researchers to identify the ADE phenomenon. Dr. Halstead and his colleague Dr. Phillip Russell proposed that the vaccine only be used after antibody testing, to check for prior dengue exposure and avoid vaccination of sero-negative individuals. Common side effects include headache, pain at the site of injection, and general muscle pains. Severe side effects may include anaphylaxis . Use is not recommended in people with poor immune function . Safety of use during pregnancy is unclear. Dengvaxia is a weakened but live vaccine and works by triggering an immune response against four types of dengue virus. Dengvaxia became commercially available in 2016 in 11 countries: Mexico, the Philippines, Indonesia, Brazil, El Salvador, Costa Rica, Paraguay, Guatemala, Peru, Thailand, and Singapore. In 2019 it was approved for medical use in the United States. It is on the World Health Organization's List of Essential Medicines . In 2017, the manufacturer recommended that the vaccine only be used in people who have previously had a dengue infection, as outcomes may be worsened in those who have not been previously infected due to antibody-dependent enhancement . This led to a controversy in the Philippines where more than 733,000 children and more than 50,000 adult volunteers were vaccinated regardless of serostatus . The World Health Organization (WHO) recommends that countries should consider vaccination with the dengue vaccine CYD-TDV only if the risk of severe dengue in seronegative individuals can be minimized either through pre-vaccination screening or recent documentation of high seroprevalence rates in the area (at least 80% by age nine years). The WHO updated its recommendations regarding the use of Dengvaxia in 2018, based on long-term safety data stratified by serostatus on 29 November 2017. Seronegative vaccine recipients have an excess risk of severe dengue compared to unvaccinated seronegative individuals. For every 13 hospitalizations prevented in seropositive vaccinees, there would be 1 excess hospitalization in seronegative vaccinees per 1,000 vaccinees. WHO recommends serological testing for past dengue infection In 2017, the manufacturer recommended that the vaccine only be used in people who have previously had a dengue infection as otherwise there was evidence it may worsen subsequent infections. The initial protocol did not require baseline blood samples prior to vaccination in order to establish an understanding of increased risk of severe dengue in participants who had not been previously exposed. In November 2017, Sanofi acknowledged that some participants were put at risk of severe dengue if they had no prior exposure to the infection; subsequently the Philippine government suspended the mass immunization program with the backing of the WHO which began a review of the safety data. Phase III trials in Latin America and Asia involved over 31,000 children between the ages of two and 14 years. In the first reports from the trials, vaccine efficacy was 56.5% in the Asian study and 64.7% in the Latin American study in patients who received at least one injection of the vaccine. Efficacy varied by serotype. In both trials vaccine reduced by about 80% the number of severe dengue cases. An analysis of both the Latin American and Asian studies at the 3rd year of follow-up showed that the efficacy of the vaccine was 65.6% in preventing hospitalization in children older than nine years of age, but considerably greater (81.9%) for children who were seropositive (indicating previous dengue infection) at baseline. The vaccination series consists of three injections at 0, 6 and 12 months. The vaccine was approved in Mexico, the Philippines, and Brazil in December 2015, and in El Salvador, Costa Rica, Paraguay, Guatemala, Peru, Indonesia, Thailand, and Singapore in 2016. Under the brand name Dengvaxia, it is approved for use for those aged nine years of age and older and can prevent all four serotypes. TAK-003 or DENVax, sold under the brand name Qdenga and made by Takeda , is a recombinant chimeric attenuated vaccine with DENV1, DENV3, and DENV4 components on a dengue virus type 2 (DENV2) backbone originally developed at Mahidol University in Bangkok and now funded by Inviragen (DENVax) and (TAK-003). Phase I and II trials were conducted in the United States, Colombia, Puerto Rico, Singapore and Thailand. Based on the 18-month data published in the journal Lancet Infectious Diseases , indicated that TAK-003 produced sustained antibody responses against all four virus strains, regardless of previous dengue exposure and dosing schedule. Data from the phase III trial, which began in September 2016, show that TAK-003 was efficacious against symptomatic dengue. TAK-003 appears to not lack efficacy in seronegative people or potentially cause them harm, unlike CYD-TDV. The data appear to show only moderate efficacy in other dengue serotypes than DENV2. Qdenga received approval for use in the European Union in 2022 for people aged 4 and above, and is also approved in the United Kingdom, Brazil, Argentina, Indonesia, and Thailand. Takeda voluntarily withdrew their application for the vaccination's approval in the United States in July 2023 after the FDA sought further data from the firm, which the company stated could not be addressed during the current review cycle. TV-003/005 is a tetravalent admixture of monovalent vaccines, that was developed by NIAID , that were tested separately for safety and immunogenicity. The vaccine passed phase I trials and phase II studies in the US, Thailand, Bangladesh, India, and Brazil. NIH has conducted phase I and phase II studies in over 1,000 participants in the US. It has also conducted human challenge studies while having conducted NHP model studies successfully. NIH has licensed their technology for further development and commercial scale manufacturing to Panacea Biotec , Serum Institute of India , Instituto Butantan , Vabiotech, Merck , and Medigen. In Brazil, phase III studies are being conducted by Instituto Butantan in-collaboration with NIH . Panacea Biotec has conducted phase II clinical studies in India. A company in Vietnam (Vabiotech) is conducting safety tests and developing a clinical trial plan. All four companies are involved in studies of a TetraVax-DV vaccine in conjunction with the US National Institutes of Health . TDENV PIV (tetravalent dengue virus purified inactivated vaccine) is undergoing phase I trials as part of a collaboration between GlaxoSmithKline (GSK) and the Walter Reed Army Institute of Research (WRAIR). A synergistic formulation with another live attenuated candidate vaccine (prime-boost strategy) is also being evaluated in a phase II study. In prime-boosting, one type of vaccine is followed by a boost with another type in an attempt to improve immunogenicity. Merck is studying recombinant subunit vaccines expressed in Drosophila cells. As of 2019 [ update ] , it had completed phase I stage and V180 formulations found to be generally well tolerated. In 2011, the Naval Medical Research Center attempted to develop a monovalent DNA plasmid vaccine, but early results showed it to be only moderately immunogenic. [ needs update ]TV-003/005 is a tetravalent admixture of monovalent vaccines, that was developed by NIAID , that were tested separately for safety and immunogenicity. The vaccine passed phase I trials and phase II studies in the US, Thailand, Bangladesh, India, and Brazil. NIH has conducted phase I and phase II studies in over 1,000 participants in the US. It has also conducted human challenge studies while having conducted NHP model studies successfully. NIH has licensed their technology for further development and commercial scale manufacturing to Panacea Biotec , Serum Institute of India , Instituto Butantan , Vabiotech, Merck , and Medigen. In Brazil, phase III studies are being conducted by Instituto Butantan in-collaboration with NIH . Panacea Biotec has conducted phase II clinical studies in India. A company in Vietnam (Vabiotech) is conducting safety tests and developing a clinical trial plan. All four companies are involved in studies of a TetraVax-DV vaccine in conjunction with the US National Institutes of Health . TDENV PIV (tetravalent dengue virus purified inactivated vaccine) is undergoing phase I trials as part of a collaboration between GlaxoSmithKline (GSK) and the Walter Reed Army Institute of Research (WRAIR). A synergistic formulation with another live attenuated candidate vaccine (prime-boost strategy) is also being evaluated in a phase II study. In prime-boosting, one type of vaccine is followed by a boost with another type in an attempt to improve immunogenicity. Merck is studying recombinant subunit vaccines expressed in Drosophila cells. As of 2019 [ update ] , it had completed phase I stage and V180 formulations found to be generally well tolerated. In 2011, the Naval Medical Research Center attempted to develop a monovalent DNA plasmid vaccine, but early results showed it to be only moderately immunogenic. [ needs update ]On 13 October 2022, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Qdenga, intended for prophylaxis against dengue disease. The applicant for this medicinal product is Takeda GmbH. The active substance of Qdenga is dengue tetravalent vaccine (live, attenuated), a viral vaccine containing live attenuated dengue viruses which replicate locally and elicit humoral and cellular immune responses against the four dengue virus serotypes. Qdenga was approved for medical use in the European Union in December 2022. In February 2023, Qdenga was approved by the UK Medicines and Healthcare products Regulatory Agency (MHRA) for people aged four years and older. In July 2023, Takeda withdrew its application for Qdenga before the FDA, citing the FDA's requirement for additional data not captured in the phase III studies. In Indonesia, Dengvaxia cost about US$207 for the recommended three doses as of 2016. Indonesia was the first country to approve Qdenga, in late 2022. The 2017 dengue vaccine controversy in the Philippines involved a vaccination program run by the Philippines Department of Health (DOH). The DOH vaccinated schoolchildren with Sanofi Pasteur's CYD-TDV (Dengvaxia) dengue vaccine. Some of the children who received the vaccine had never been infected by the dengue virus before. The program was stopped when Sanofi Pasteur advised the government that the vaccine could put previously uninfected people at a somewhat higher risk of a severe case of dengue fever. A political controversy erupted over whether the program was run with sufficient care and who should be held responsible for the alleged harm to the vaccinated children. On 13 October 2022, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Qdenga, intended for prophylaxis against dengue disease. The applicant for this medicinal product is Takeda GmbH. The active substance of Qdenga is dengue tetravalent vaccine (live, attenuated), a viral vaccine containing live attenuated dengue viruses which replicate locally and elicit humoral and cellular immune responses against the four dengue virus serotypes. Qdenga was approved for medical use in the European Union in December 2022. In February 2023, Qdenga was approved by the UK Medicines and Healthcare products Regulatory Agency (MHRA) for people aged four years and older. In July 2023, Takeda withdrew its application for Qdenga before the FDA, citing the FDA's requirement for additional data not captured in the phase III studies. In Indonesia, Dengvaxia cost about US$207 for the recommended three doses as of 2016. Indonesia was the first country to approve Qdenga, in late 2022. The 2017 dengue vaccine controversy in the Philippines involved a vaccination program run by the Philippines Department of Health (DOH). The DOH vaccinated schoolchildren with Sanofi Pasteur's CYD-TDV (Dengvaxia) dengue vaccine. Some of the children who received the vaccine had never been infected by the dengue virus before. The program was stopped when Sanofi Pasteur advised the government that the vaccine could put previously uninfected people at a somewhat higher risk of a severe case of dengue fever. A political controversy erupted over whether the program was run with sufficient care and who should be held responsible for the alleged harm to the vaccinated children. The 2017 dengue vaccine controversy in the Philippines involved a vaccination program run by the Philippines Department of Health (DOH). The DOH vaccinated schoolchildren with Sanofi Pasteur's CYD-TDV (Dengvaxia) dengue vaccine. Some of the children who received the vaccine had never been infected by the dengue virus before. The program was stopped when Sanofi Pasteur advised the government that the vaccine could put previously uninfected people at a somewhat higher risk of a severe case of dengue fever. A political controversy erupted over whether the program was run with sufficient care and who should be held responsible for the alleged harm to the vaccinated children.

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Dengue fever

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Dengue virus

Dengue virus ( DENV ) is the cause of dengue fever . It is a mosquito -borne, single positive-stranded RNA virus of the family Flaviviridae ; genus Flavivirus . Four serotypes of the virus have been found, and a reported fifth has yet to be confirmed, all of which can cause the full spectrum of disease. Nevertheless, scientists' understanding of dengue virus may be simplistic as, rather than distinct antigenic groups, a continuum appears to exist. This same study identified 47 strains of dengue virus . Additionally, coinfection with and lack of rapid tests for Zika virus and chikungunya complicate matters in real-world infections. Dengue virus has increased dramatically within the last 20 years, becoming one of the worst mosquito-borne human pathogens that tropical countries have to deal with. Current estimates indicate that as many as 390 million infections occur each year, and many dengue infections are increasingly understood to be asymptomatic or subclinical. Based on the analysis of the envelope protein, at least three genotypes (1 to 3) are known. In 2013, a fourth serotype was reported. A single report of a fifth serotype DEN-5 in 2015 has not been replicated or further reported on. The rate of nucleotide substitution for this virus has been estimated to be 6.5 × 10 −4 per nucleotide per year, a rate similar to other RNA viruses. The American African genotype has been estimated to have evolved between 1907 and 1949. This period includes World War I and World War II , which were associated with considerable movement of populations and environmental disturbance, factors known to promote the evolution of new vector-borne viral species . [ citation needed ] A Bayesian analysis of all four serotypes estimated that their most recent common ancestor existed about 340 AD (95% confidence interval: 280 BC–850 AD). Until a few hundred years ago, dengue virus was transmitted in sylvatic cycles in Africa , Southeast Asia and South Asia between mosquitoes of the genus Aedes and nonhuman primates , with rare emergences into human populations. The global spread of dengue virus , however, has followed its emergence from sylvatic cycles and the primary lifecycle now exclusively involves transmission between humans and Aedes mosquitoes. Vertical transmission from mosquito to mosquito has also been observed in some vector species. Dogs have been found to be infected by the virus, but more research is needed to determine if dogs or other animals can serve as reservoirs or are just incidental hosts. Recent findings suggest that as the virus infects human cells, host homeostatic processes such as autophagy and ER stress response, not to mention apoptosis, are triggered depending on the infected cell type. The activation of autophagy and ER stress during infection enhances virus reproduction. Attempts to provide detailed summaries of the life cycle of dengue at the cellular level are published in review articles from different research groups. The DENV genome is about 11000 bases of positive-sense, single-stranded RNA (ssRNA) that codes for three structural proteins ( capsid protein C, membrane protein M, envelope protein E) and seven nonstructural proteins (NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5). It also includes short noncoding regions on both the 5' and 3' ends. The DENV E (envelope) protein, found as a dimer on the surface of the mature viral particle, is important in the initial attachment of this particle to the host cell. Each E protein monomer comprises three ectodomains, ED1 to ED3, and a transmembrane segment. ED2 includes the dimerization interface, two glycosylation sites, and the peptide of fusion with the cellular membrane. ED3 is a continuous polypeptide segment; its fold is compact and immunoglobulin-like. Dengue virus is transmitted by species of the mosquito genus Aedes . Several molecules that interact with the viral E protein (ICAM3-grabbing nonintegrin, CD209, Rab 5, GRP 78, and the mannose receptor ) have been shown to be important factors mediating attachment and viral entry. The membrane form of ribosomal protein SA may also be involved in the attachment. E protein is known to contain physicochemically conserved B cells and T cells specific epitopes, which can be exploited to design vaccine. Recombinant domains of the E protein are used as well-defined antigens in the serological detection of antibodies directed against dengue virus and as immunogens in vaccine candidates. The DENV prM (membrane) protein, which is important in the formation and maturation of the viral particle, consists of seven antiparallel β-strands stabilized by three disulfide bonds. The glycoprotein shell of the mature DENV virion consists of 180 copies each of the E and M proteins. The immature virion starts out with the E and prM proteins forming 90 heterodimers that give a spiky exterior to the viral particle. This immature viral particle buds into the endoplasmic reticulum and eventually travels via the secretory pathway to the Golgi apparatus. As the virion passes through the trans-Golgi network, it is exposed to low pH. This acidic environment causes a conformational change in the E protein, which disassociates it from the prM protein and causes it to form E homodimers, which lie flat against the viral surface, giving the maturing virion a smooth appearance. During this maturation, pr peptide is cleaved from the M peptide by the host protease, furin . The M protein then acts as a transmembrane protein under the E-protein shell of the mature virion. The pr peptide stays associated with the E protein until the viral particle is released into the extracellular environment. This pr peptide acts like a cap, covering the hydrophobic fusion loop of the E protein until the viral particle has exited the cell. The DENV NS3 is a serine protease, as well as an RNA helicase and RTPase/NTPase. The protease domain consists of six β-strands arranged into two β-barrels formed by residues 1–180 of the protein. The catalytic triad (His-51, Asp-75 and Ser-135) is found between these two β-barrels, and activity is dependent on the presence of a 43 amino acid segment of the NS2B cofactor. This cofactor wraps around the NS3 protease domain and becomes part of the active site. The remaining NS2B residues before and after the cofactor region contain helical domains involved in membrane binding. The remaining NS3 residues (180–618) form the three subdomains of the DENV helicase. A six-stranded parallel β-sheet surrounded by four α-helices makes up subdomains I and II, and subdomain III is composed of four α-helices surrounded by three shorter α-helices and two antiparallel β-strands. DENV NS4A is a nonstructural protein involved in altering cell membrane curvature and induction of autophagy. In addition to its membrane altering property, NS4A is a scaffold for the virus replication complex and undergoes oligomerization. Mutations of NS4A that affect interaction with NS4B abolished or severely reduced virus replication indicating the importance of NS4A and its interaction with NS4B in dengue reproduction. The DENV NS5 protein is a 900-residue peptide with a methyltransferase domain at its N-terminal end (residues 1–296) and a RNA-dependent RNA polymerase (RdRp) at its C-terminal end (residues 320–900). The methyltransferase domain consists of an α/β/β sandwich flanked by N-and C-terminal subdomains. The DENV RdRp is similar to other RdRps containing palm, finger, and thumb subdomains and a GDD motif for incorporating nucleotides. Crystal structures of complexes between antibodies and either the ectodomain (sE) of the viral E protein or its domain 3 (ED3) have helped understand the molecular bases of the virus recognition and neutralization. Some of the epitopes are partially or totally inaccessible in the known structure of the mature virion. The corresponding antibodies are, therefore, assumed to bind to alternate or transitional conformations of the virus at 37 °C. [ citation needed ]The DENV E (envelope) protein, found as a dimer on the surface of the mature viral particle, is important in the initial attachment of this particle to the host cell. Each E protein monomer comprises three ectodomains, ED1 to ED3, and a transmembrane segment. ED2 includes the dimerization interface, two glycosylation sites, and the peptide of fusion with the cellular membrane. ED3 is a continuous polypeptide segment; its fold is compact and immunoglobulin-like. Dengue virus is transmitted by species of the mosquito genus Aedes . Several molecules that interact with the viral E protein (ICAM3-grabbing nonintegrin, CD209, Rab 5, GRP 78, and the mannose receptor ) have been shown to be important factors mediating attachment and viral entry. The membrane form of ribosomal protein SA may also be involved in the attachment. E protein is known to contain physicochemically conserved B cells and T cells specific epitopes, which can be exploited to design vaccine. Recombinant domains of the E protein are used as well-defined antigens in the serological detection of antibodies directed against dengue virus and as immunogens in vaccine candidates. The DENV prM (membrane) protein, which is important in the formation and maturation of the viral particle, consists of seven antiparallel β-strands stabilized by three disulfide bonds. The glycoprotein shell of the mature DENV virion consists of 180 copies each of the E and M proteins. The immature virion starts out with the E and prM proteins forming 90 heterodimers that give a spiky exterior to the viral particle. This immature viral particle buds into the endoplasmic reticulum and eventually travels via the secretory pathway to the Golgi apparatus. As the virion passes through the trans-Golgi network, it is exposed to low pH. This acidic environment causes a conformational change in the E protein, which disassociates it from the prM protein and causes it to form E homodimers, which lie flat against the viral surface, giving the maturing virion a smooth appearance. During this maturation, pr peptide is cleaved from the M peptide by the host protease, furin . The M protein then acts as a transmembrane protein under the E-protein shell of the mature virion. The pr peptide stays associated with the E protein until the viral particle is released into the extracellular environment. This pr peptide acts like a cap, covering the hydrophobic fusion loop of the E protein until the viral particle has exited the cell. The DENV NS3 is a serine protease, as well as an RNA helicase and RTPase/NTPase. The protease domain consists of six β-strands arranged into two β-barrels formed by residues 1–180 of the protein. The catalytic triad (His-51, Asp-75 and Ser-135) is found between these two β-barrels, and activity is dependent on the presence of a 43 amino acid segment of the NS2B cofactor. This cofactor wraps around the NS3 protease domain and becomes part of the active site. The remaining NS2B residues before and after the cofactor region contain helical domains involved in membrane binding. The remaining NS3 residues (180–618) form the three subdomains of the DENV helicase. A six-stranded parallel β-sheet surrounded by four α-helices makes up subdomains I and II, and subdomain III is composed of four α-helices surrounded by three shorter α-helices and two antiparallel β-strands. DENV NS4A is a nonstructural protein involved in altering cell membrane curvature and induction of autophagy. In addition to its membrane altering property, NS4A is a scaffold for the virus replication complex and undergoes oligomerization. Mutations of NS4A that affect interaction with NS4B abolished or severely reduced virus replication indicating the importance of NS4A and its interaction with NS4B in dengue reproduction. The DENV NS5 protein is a 900-residue peptide with a methyltransferase domain at its N-terminal end (residues 1–296) and a RNA-dependent RNA polymerase (RdRp) at its C-terminal end (residues 320–900). The methyltransferase domain consists of an α/β/β sandwich flanked by N-and C-terminal subdomains. The DENV RdRp is similar to other RdRps containing palm, finger, and thumb subdomains and a GDD motif for incorporating nucleotides. Crystal structures of complexes between antibodies and either the ectodomain (sE) of the viral E protein or its domain 3 (ED3) have helped understand the molecular bases of the virus recognition and neutralization. Some of the epitopes are partially or totally inaccessible in the known structure of the mature virion. The corresponding antibodies are, therefore, assumed to bind to alternate or transitional conformations of the virus at 37 °C. [ citation needed ]Common names for dengue fever include breakbone fever , vomiting and dandy fever; dengue hemorrhagic fever and dengue shock syndrome are the severe forms. Dengue is found in tropical and subtropical climates worldwide, mostly in urban and semiurban areas. People of all ages who are exposed to infected mosquitoes are at risk of developing dengue fever. The disease occurs most often during the rainy season in tropical countries in Southeast Asia , South Asia and South America , with high numbers of infected mosquitoes. The virus is transmitted to humans through the bites of infected female mosquitoes, though humans are not capable of transmitting the disease and are not contagious. The incubation period is 3 to 14 days, while the period of the illness is 3–7 days. Signs and symptoms may include severe headache; retro-orbital pain; muscle, joint, and bone pain; macular or maculopapular rash; and minor hemorrhagic manifestations, including petechiae, ecchymosis, purpura, epistaxis, bleeding gums, hematuria, or a positive tourniquet test result. A recent systematic review and meta-analysis showed that allergic symptoms are one of the core symptoms that are highly associated with dengue severity. Dengue virus' (DENV) E envelope protein binds to a cellular receptor. The exact nature of the cellular receptor has not been fully elucidated. DENV undergoes endocytosis. Acidification of the endosome leads to a conformational change of E, exposing a fusion peptide sequence that facilitates fusion of the envelope with the endosomal membrane, releasing the virion capsid into the cytoplasm. Uncoating occurs in the cytoplasm Host translational machinery (ribosomes) translates the (+)ssRNA into a single polypeptide Cellular and viral proteinases cleave the polypeptide into 10 proteins (E, M, C and 7 nonstructural/enzymatic proteins) while embedded on the ER membrane. As soon as functional RNA-dependent RNA polymerase is synthesized, RNA replication can commence. Synthesis is asymmetrical, making 10 times more of the positive-sense strand than the negative. Assembly occurs on intracellular membranes, which bud into the ER (forming the envelope from the ER membrane). Subsequent budding from the ER through the Golgi and into vesicles allows maturation via posttranslational modifications, e.g. glycosylation and pH transformational rearrangements Egress occurs via exocytosis Some people develop more severe forms of dengue, such as dengue hemorrhagic fever. Different strains of viruses interacting with people with different immune backgrounds lead to a complex interaction. Among the possible causes are cross-serotypic immune response, through a mechanism known as antibody-dependent enhancement , which happens when a person who has been previously infected with dengue gets infected for the second, third, or fourth time. The previous antibodies to the old strain of dengue virus now interfere with the immune response to the current strain, paradoxically leading to more virus entry and uptake. Some people develop more severe forms of dengue, such as dengue hemorrhagic fever. Different strains of viruses interacting with people with different immune backgrounds lead to a complex interaction. Among the possible causes are cross-serotypic immune response, through a mechanism known as antibody-dependent enhancement , which happens when a person who has been previously infected with dengue gets infected for the second, third, or fourth time. The previous antibodies to the old strain of dengue virus now interfere with the immune response to the current strain, paradoxically leading to more virus entry and uptake. In recent years, many studies have shown that flaviviruses, especially dengue virus , has the ability to inhibit the innate immune response during the infection. Indeed, dengue virus has many nonstructural proteins that allow the inhibition of various mediators of the innate immune system response. [ citation needed ] These proteins act on two levels : NS4B is a small, hydrophobic protein located in association with the endoplasmic reticulum. It may block the phosphorylation of STAT 1 after induction by interferons type I alpha & beta. In fact, as the activity of Tyk2 kinase decreases in association with dengue virus , so too does STAT 1 phosphorylation. Furthermore, the innate immune system's response to the virus is further damped as expression of interferon-stimulating gene(s) (ISG) is restricted by the aforementioned 'NS4B' protein. NS2A and NS4A cofactor may also take part in the STAT 1 inhibition. NS5 - the presence of this 105-kDa protein results in inactivation of STAT2 (via the signal transduction of the response to interferon) when it is expressed alone. When NS5 is cleaved with NS4B by a protease (NS2B3), it can degrade STAT2. In fact, after the cleavage of NS5 by the protease, an E3 ligase association with STAT2 occurs, and the E3 ligase targets STAT2 for the degradation. NS2B3-b protease complex is a proteolytic core consisting of the last 40 amino acids of NS2B and the first 180 amino acids of NS3. Cleavage of the NS2B3 precursor activates the protease complex. This protease complex allows the inhibition of the production of type I interferon by reducing the activity of IFN-beta promoter; NS2B3 protease complex is involved in inhibiting the phosphorylation of IRF3. The NS2B3 protease complex inhibits (by cleaving) protein MITA which allows the IRF3 activation. Dengue virus is transmitted by the mosquito species Aedes aegypti , which produces saliva that contains over 100 unique proteins, including the protein family D7. Scientists used to believe that A. aegypti saliva, when being transmitted, actually enhanced dengue virus in the body. The mosquito's saliva was thought to make the virus spread faster due to the weakened immune response of its host. However, a current study has found that the protein D7 hinders the virus transmission into the host cells. The immune responses of antibodies that are trying to fight off the foreign virus actually increase transmission and make the infection worse. Levels of protein D7 are more prevalent in salivary glands of dengue-infected mosquitoes compared to those uninfected ones. D7 is found in mosquito saliva and was thought to assist the process of blood feeding. Despite the prior assumptions, D7 can modulate the host cell and act against the virus to prevent viral infection. Unfortunately, D7 proteins provoke immune responses, which raise anti-D7 antibody levels. These antibodies inhibit the function of D7 proteins, which enhance transmission of dengue virus [ citation needed ] . Although immune responses against D7 proteins might impair their antiviral activity, a study showed that non-DENV subjects have slightly higher anti-D7 IgG levels than infected ones, although it was not statistically significant. Thus, more studies over D7 protein family are needed do elucidate its role on DENV infection and its applicability in medicine. Two types of dengue vaccine have been approved and are commercially available. On 5 December 2022 the European Medicines Agency approved Qdenga, a live tetravalent attenuated vaccine for adults, adolescents and children from four years of age. The 2016 vaccine Dengvaxia is only recommended in individuals who have been previously infected, or in populations with a high rate of prior infection by age nine. Dengvaxia has been approved in 11 countries (Mexico, the Philippines, Indonesia, Brazil, El Salvador, Costa Rica, Paraguay, Guatemala, Peru, Thailand, and Singapore). Several vaccines are under development by private and public researchers. Developing a vaccine against the disease is challenging. With four different serotypes of the virus that can cause the disease, the vaccine must immunize against all four types to be effective. Vaccination against only one serotype could possibly lead to severe dengue hemorrhagic shock when infected with another serotype due to antibody-dependent enhancement. When infected with dengue virus , the immune system produces cross-reactive antibodies that provide immunity to that particular serotype. However, these antibodies are incapable of neutralizing other serotypes upon reinfection and actually increase viral replication . When macrophages consume the 'neutralized' virus, the virus is able to replicate within the macrophage, causing disease. These cross-reactive, ineffective antibodies ease access of the virus into macrophages, which induces more severe disease (dengue hemorrhagic fever, dengue shock syndrome). A common problem faced in dengue-endemic regions is when mothers become infected with dengue; after giving birth, offspring carry the immunity from their mother and are susceptible to hemorrhagic fever if infected with any of the other three serotypes. One vaccine was in phase III trials in 2012 and planning for vaccine usage and effectiveness surveillance had started. In 2009, Sanofi-Pasteur started building a new facility in Neuville-sur-Saône ' ( fr ) , a suburb of Lyon (France). This unit produces four-serotype vaccine for phase III trials. In September 2014, the Sanofi-Pasteur CEO gave early results of the phase III trial efficacy study in Latin America. The efficacy per serotype (ST) varied widely, 42.3% for ST2, 50.3% for ST1, 74.0% for ST3, and 77.7% for ST4. The full analysis of data from the phase III Latin American-Caribbean study will be reviewed by external experts before being published in a peer-reviewed scientific journal. Primary results has to be presented at the American Society of Tropical Medicine and Hygiene Annual Meeting, held November 2–6, 2014, in New Orleans. In September 2012, one of the vaccines was reported to not have done well in clinical trials. In late 2015 and early 2016, the first dengue vaccine, Dengvaxia (CYD-TDV) by Sanofi-Pasteur, was registered in several countries for use in individuals 9–45 years of age living in endemic areas. [ citation needed ] On May 1, 2019, the U.S. Food and Drug Administration announced the approval of Dengvaxia, the first vaccine for the prevention of dengue disease caused by all dengue virus serotypes in people ages 9 through 16 who have laboratory-confirmed previous dengue infection and who live in endemic areas. Dengue is endemic in the U.S. territories of American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands. There are no approved direct antiviral treatments for Dengue fever. Most antiviral drug research for Dengue infections has focussed on inhibition of the NS2B/NS3 protease or NS5 proteins. Reported protease inhibitor approaches have focussed mainly on targeted covalent inhibitors . One drug, Balapiravir , a repurposed hepatitis C NS5 polymerase inhibitor progressed to a Phase II clinical trial before being stopped due to lack of efficacy. NS4B is a small, hydrophobic protein located in association with the endoplasmic reticulum. It may block the phosphorylation of STAT 1 after induction by interferons type I alpha & beta. In fact, as the activity of Tyk2 kinase decreases in association with dengue virus , so too does STAT 1 phosphorylation. Furthermore, the innate immune system's response to the virus is further damped as expression of interferon-stimulating gene(s) (ISG) is restricted by the aforementioned 'NS4B' protein. NS2A and NS4A cofactor may also take part in the STAT 1 inhibition. NS5 - the presence of this 105-kDa protein results in inactivation of STAT2 (via the signal transduction of the response to interferon) when it is expressed alone. When NS5 is cleaved with NS4B by a protease (NS2B3), it can degrade STAT2. In fact, after the cleavage of NS5 by the protease, an E3 ligase association with STAT2 occurs, and the E3 ligase targets STAT2 for the degradation. NS2B3-b protease complex is a proteolytic core consisting of the last 40 amino acids of NS2B and the first 180 amino acids of NS3. Cleavage of the NS2B3 precursor activates the protease complex. This protease complex allows the inhibition of the production of type I interferon by reducing the activity of IFN-beta promoter; NS2B3 protease complex is involved in inhibiting the phosphorylation of IRF3. The NS2B3 protease complex inhibits (by cleaving) protein MITA which allows the IRF3 activation. Dengue virus is transmitted by the mosquito species Aedes aegypti , which produces saliva that contains over 100 unique proteins, including the protein family D7. Scientists used to believe that A. aegypti saliva, when being transmitted, actually enhanced dengue virus in the body. The mosquito's saliva was thought to make the virus spread faster due to the weakened immune response of its host. However, a current study has found that the protein D7 hinders the virus transmission into the host cells. The immune responses of antibodies that are trying to fight off the foreign virus actually increase transmission and make the infection worse. Levels of protein D7 are more prevalent in salivary glands of dengue-infected mosquitoes compared to those uninfected ones. D7 is found in mosquito saliva and was thought to assist the process of blood feeding. Despite the prior assumptions, D7 can modulate the host cell and act against the virus to prevent viral infection. Unfortunately, D7 proteins provoke immune responses, which raise anti-D7 antibody levels. These antibodies inhibit the function of D7 proteins, which enhance transmission of dengue virus [ citation needed ] . Although immune responses against D7 proteins might impair their antiviral activity, a study showed that non-DENV subjects have slightly higher anti-D7 IgG levels than infected ones, although it was not statistically significant. Thus, more studies over D7 protein family are needed do elucidate its role on DENV infection and its applicability in medicine.Two types of dengue vaccine have been approved and are commercially available. On 5 December 2022 the European Medicines Agency approved Qdenga, a live tetravalent attenuated vaccine for adults, adolescents and children from four years of age. The 2016 vaccine Dengvaxia is only recommended in individuals who have been previously infected, or in populations with a high rate of prior infection by age nine. Dengvaxia has been approved in 11 countries (Mexico, the Philippines, Indonesia, Brazil, El Salvador, Costa Rica, Paraguay, Guatemala, Peru, Thailand, and Singapore). Several vaccines are under development by private and public researchers. Developing a vaccine against the disease is challenging. With four different serotypes of the virus that can cause the disease, the vaccine must immunize against all four types to be effective. Vaccination against only one serotype could possibly lead to severe dengue hemorrhagic shock when infected with another serotype due to antibody-dependent enhancement. When infected with dengue virus , the immune system produces cross-reactive antibodies that provide immunity to that particular serotype. However, these antibodies are incapable of neutralizing other serotypes upon reinfection and actually increase viral replication . When macrophages consume the 'neutralized' virus, the virus is able to replicate within the macrophage, causing disease. These cross-reactive, ineffective antibodies ease access of the virus into macrophages, which induces more severe disease (dengue hemorrhagic fever, dengue shock syndrome). A common problem faced in dengue-endemic regions is when mothers become infected with dengue; after giving birth, offspring carry the immunity from their mother and are susceptible to hemorrhagic fever if infected with any of the other three serotypes. One vaccine was in phase III trials in 2012 and planning for vaccine usage and effectiveness surveillance had started. In 2009, Sanofi-Pasteur started building a new facility in Neuville-sur-Saône ' ( fr ) , a suburb of Lyon (France). This unit produces four-serotype vaccine for phase III trials. In September 2014, the Sanofi-Pasteur CEO gave early results of the phase III trial efficacy study in Latin America. The efficacy per serotype (ST) varied widely, 42.3% for ST2, 50.3% for ST1, 74.0% for ST3, and 77.7% for ST4. The full analysis of data from the phase III Latin American-Caribbean study will be reviewed by external experts before being published in a peer-reviewed scientific journal. Primary results has to be presented at the American Society of Tropical Medicine and Hygiene Annual Meeting, held November 2–6, 2014, in New Orleans. In September 2012, one of the vaccines was reported to not have done well in clinical trials. In late 2015 and early 2016, the first dengue vaccine, Dengvaxia (CYD-TDV) by Sanofi-Pasteur, was registered in several countries for use in individuals 9–45 years of age living in endemic areas. [ citation needed ] On May 1, 2019, the U.S. Food and Drug Administration announced the approval of Dengvaxia, the first vaccine for the prevention of dengue disease caused by all dengue virus serotypes in people ages 9 through 16 who have laboratory-confirmed previous dengue infection and who live in endemic areas. Dengue is endemic in the U.S. territories of American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands. There are no approved direct antiviral treatments for Dengue fever. Most antiviral drug research for Dengue infections has focussed on inhibition of the NS2B/NS3 protease or NS5 proteins. Reported protease inhibitor approaches have focussed mainly on targeted covalent inhibitors . One drug, Balapiravir , a repurposed hepatitis C NS5 polymerase inhibitor progressed to a Phase II clinical trial before being stopped due to lack of efficacy.

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Dengue fever

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Mosquito-borne disease

Mosquito-borne diseases or mosquito-borne illnesses are diseases caused by bacteria, viruses or parasites transmitted by mosquitoes . Nearly 700 million people get a mosquito-borne illness each year, resulting in over 725,000 deaths. Diseases transmitted by mosquitoes include malaria , dengue , West Nile virus , chikungunya , yellow fever , filariasis , tularemia , dirofilariasis , Japanese encephalitis , Saint Louis encephalitis , Western equine encephalitis , Eastern equine encephalitis , Venezuelan equine encephalitis , Ross River fever , Barmah Forest fever , La Crosse encephalitis , and Zika fever , as well as newly detected Keystone virus and Rift Valley fever . In January 2024, an Australian research group proved that Mycobacterium ulcerans , the causative pathogen of Buruli ulcer is transmitted by mosquitos. This is the first described mosquito-borne transmission of a bacterial disease. There is no evidence as of April 2020 that COVID-19 can be transmitted by mosquitoes, and it is extremely unlikely this could occur. The female mosquito of the genus Anopheles may carry the malaria parasite . Four different species of protozoa cause malaria: Plasmodium falciparum , Plasmodium malariae , Plasmodium ovale and Plasmodium vivax (see Plasmodium ). Worldwide, malaria is a leading cause of premature mortality, particularly in children under the age of five, with an estimated 207 million cases and more than half a million deaths in 2012, according to the World Malaria Report 2013 published by the World Health Organization (WHO). The death toll increased to one million as of 2018 according to the American Mosquito Control Association. In January 2024, a publication by an Australian research group demonstrated significant genetic similarity between Mycobacterium ulcerans in humans and possums, compared to PCR screening of M. ulcerans from trapped Aedes notoscriptus mosquitoes, and concluded that Mycobacterium ulcerans , the causative pathogen of Buruli ulcer , is transmitted by mosquitos. Botflies are known to parasitize humans or other mammalians, causing myiasis , and to use mosquitoes as intermediate vector agents to deposit eggs on a host. The human botfly Dermatobia hominis attaches its eggs to the underside of a mosquito, and when the mosquito takes a blood meal from a human or an animal, the body heat of the mammalian host induces hatching of the larvae. [ citation needed ] Some species of mosquito can carry the filariasis worm, a parasite that causes a disfiguring condition (often referred to as elephantiasis ) characterized by a great swelling of several parts of the body; worldwide, around 40 million people are living with a filariasis disability. [ citation needed ] The viral diseases yellow fever , dengue fever , Zika fever and chikungunya are transmitted mostly by Aedes aegypti mosquitoes. [ citation needed ] Other viral diseases like epidemic polyarthritis , Rift Valley fever , Ross River fever , St. Louis encephalitis , West Nile fever , Japanese encephalitis , La Crosse encephalitis and several other encephalitic diseases are carried by several different mosquitoes. Eastern equine encephalitis (EEE) and Western equine encephalitis (WEE) occur in the United States where they cause disease in humans, horses, and some bird species. Because of the high mortality rate, EEE and WEE are regarded as two of the most serious mosquito-borne diseases in the United States. Symptoms range from mild flu-like illness to encephalitis, coma, and death. Viruses carried by arthropods such as mosquitoes or ticks are known collectively as arboviruses . West Nile virus was accidentally introduced into the US in 1999 and by 2003 had spread to almost every state with over 3,000 cases in 2006. Other species of Aedes as well as Culex and Culiseta are also involved in the transmission of disease. [ citation needed ] Myxomatosis is spread by biting insects, including mosquitoes. The female mosquito of the genus Anopheles may carry the malaria parasite . Four different species of protozoa cause malaria: Plasmodium falciparum , Plasmodium malariae , Plasmodium ovale and Plasmodium vivax (see Plasmodium ). Worldwide, malaria is a leading cause of premature mortality, particularly in children under the age of five, with an estimated 207 million cases and more than half a million deaths in 2012, according to the World Malaria Report 2013 published by the World Health Organization (WHO). The death toll increased to one million as of 2018 according to the American Mosquito Control Association. In January 2024, a publication by an Australian research group demonstrated significant genetic similarity between Mycobacterium ulcerans in humans and possums, compared to PCR screening of M. ulcerans from trapped Aedes notoscriptus mosquitoes, and concluded that Mycobacterium ulcerans , the causative pathogen of Buruli ulcer , is transmitted by mosquitos. Botflies are known to parasitize humans or other mammalians, causing myiasis , and to use mosquitoes as intermediate vector agents to deposit eggs on a host. The human botfly Dermatobia hominis attaches its eggs to the underside of a mosquito, and when the mosquito takes a blood meal from a human or an animal, the body heat of the mammalian host induces hatching of the larvae. [ citation needed ]Some species of mosquito can carry the filariasis worm, a parasite that causes a disfiguring condition (often referred to as elephantiasis ) characterized by a great swelling of several parts of the body; worldwide, around 40 million people are living with a filariasis disability. [ citation needed ]The viral diseases yellow fever , dengue fever , Zika fever and chikungunya are transmitted mostly by Aedes aegypti mosquitoes. [ citation needed ] Other viral diseases like epidemic polyarthritis , Rift Valley fever , Ross River fever , St. Louis encephalitis , West Nile fever , Japanese encephalitis , La Crosse encephalitis and several other encephalitic diseases are carried by several different mosquitoes. Eastern equine encephalitis (EEE) and Western equine encephalitis (WEE) occur in the United States where they cause disease in humans, horses, and some bird species. Because of the high mortality rate, EEE and WEE are regarded as two of the most serious mosquito-borne diseases in the United States. Symptoms range from mild flu-like illness to encephalitis, coma, and death. Viruses carried by arthropods such as mosquitoes or ticks are known collectively as arboviruses . West Nile virus was accidentally introduced into the US in 1999 and by 2003 had spread to almost every state with over 3,000 cases in 2006. Other species of Aedes as well as Culex and Culiseta are also involved in the transmission of disease. [ citation needed ] Myxomatosis is spread by biting insects, including mosquitoes. A mosquito's period of feeding is often undetected; the bite only becomes apparent because of the immune reaction it provokes. When a mosquito bites a human, it injects saliva and anti-coagulants . With the initial bite to an individual, there is no reaction, but with subsequent bites, the body's immune system develops antibodies . The bites become inflamed and itchy within 24 hours. This is the usual reaction in young children. With more bites, the sensitivity of the human immune system increases, and an itchy red hive appears in minutes where the immune response has broken capillary blood vessels and fluid has collected under the skin. This type of reaction is common in older children and adults. Some adults can become desensitized to mosquitoes and have little or no reaction to their bites, while others can become hyper-sensitive with bites causing blistering, bruising, and large inflammatory reactions, a response known as skeeter syndrome . One study found Dengue virus and Zika virus altered the skin bacteria of rats in a way that caused their body odor to be more attractive to mosquitoes. Symptoms of illness are specific to the type of viral infection and vary in severity, based on the individuals infected. Symptoms vary in severity, from mild unnoticeable symptoms to more common symptoms like fever, rash, headache, achy muscle and joints, and conjunctivitis. Symptoms can last several days to weeks, but death resulting from this infection is rare. Most people infected with the West Nile virus usually do not develop symptoms. However, some individuals can develop cases of severe fatigue, weakness, headaches, body aches, joint and muscle pain, vomiting, diarrhea, and rash, which can last for weeks or months. More serious symptoms have a greater risk of appearing in people over 60 years of age, or those with cancer, diabetes, hypertension, and kidney disease. Dengue fever is mostly characterized by high fever, headaches, joint pain, and rash. However, more severe instances can lead to hemorrhagic fever, internal bleeding, and breathing difficulty, which can be fatal. People infected with this virus can develop sudden onset fever along with debilitating joint and muscle pain, rash, headache, nausea, and fatigue. Symptoms can last a few days or be prolonged to weeks and months. Although patients can recover completely, there have been cases in which joint pain has persisted for several months and can extend beyond that for years. Other people can develop heart complications, eye problems, and even neurological complications. Symptoms vary in severity, from mild unnoticeable symptoms to more common symptoms like fever, rash, headache, achy muscle and joints, and conjunctivitis. Symptoms can last several days to weeks, but death resulting from this infection is rare. Most people infected with the West Nile virus usually do not develop symptoms. However, some individuals can develop cases of severe fatigue, weakness, headaches, body aches, joint and muscle pain, vomiting, diarrhea, and rash, which can last for weeks or months. More serious symptoms have a greater risk of appearing in people over 60 years of age, or those with cancer, diabetes, hypertension, and kidney disease. Dengue fever is mostly characterized by high fever, headaches, joint pain, and rash. However, more severe instances can lead to hemorrhagic fever, internal bleeding, and breathing difficulty, which can be fatal. People infected with this virus can develop sudden onset fever along with debilitating joint and muscle pain, rash, headache, nausea, and fatigue. Symptoms can last a few days or be prolonged to weeks and months. Although patients can recover completely, there have been cases in which joint pain has persisted for several months and can extend beyond that for years. Other people can develop heart complications, eye problems, and even neurological complications. Mosquitoes carrying such arboviruses stay healthy because their immune systems recognizes the virions as foreign particles and "chop off" the virus' genetic coding, rendering it inert. Human infection with a mosquito-borne virus occurs when a female mosquito bites someone while its immune system is still in the process of destroying the virus's harmful coding. [ clarification needed ] It is not completely known how mosquitoes handle eukaryotic parasites to carry them without being harmed. Data has shown that the malaria parasite Plasmodium falciparum alters the mosquito vector's feeding behavior by increasing frequency of biting in infected mosquitoes, thus increasing the chance of transmitting the parasite. The mechanism of transmission of this disease starts with the injection of the parasite into the victim's blood when malaria-infected female Anopheles mosquitoes bite into a human being. The parasite uses human liver cells as hosts for maturation where it will continue to replicate and grow, moving into other areas of the body via the bloodstream. The spread of this infection cycle then continues when other mosquitoes bite the same individual. The result will cause that mosquito to ingest the parasite and allow it to transmit the Malaria disease into another person through the same mode of bite injection. Flaviviridae viruses transmissible via vectors like mosquitoes include West Nile virus and yellow fever virus, which are single stranded, positive-sense RNA viruses enveloped in a protein coat. Once inside the host's body, the virus will attach itself to a cell's surface through receptor-mediated endocytosis. This essentially means that the proteins and DNA material of the virus are ingested into the host cell. The viral RNA material will undergo several changes and processes inside the host's cell so that it can release more viral RNA that can then be replicated and assembled to infect neighboring host cells. Mosquito-borne flaviviruses also encode viral antagonists to the innate immune system in order to cause persistent infection in mosquitoes and a broad spectrum of diseases in humans. The data on transmissibility via insect vectors of hepatitis C virus, also belonging to family Flaviviridae (as well as for hepatitis B virus, belonging to family Hepadnaviridae ) are inconclusive. WHO states that "There is no insect vector or animal reservoir for HCV", while there are experimental data supporting at least the presence of [PCR]-detectable hepatitis C viral RNA in Culex mosquitoes for up to 13 days. Currently, there are no specific vaccine therapies for West Nile virus approved for humans; however, vaccines are available and some show promise for animals, as a means to intervene with the mechanism of spreading such pathogens. Doctors can typically identify a mosquito bite by sight. A doctor will perform a physical examination and ask about medical history as well as any travel history. Be ready to give details on any international trips, including the dates you were traveling, the countries you visited and any contact you had with mosquitoes. Diagnosing dengue fever can be difficult, as its symptoms often overlap with many other diseases such as malaria and typhoid fever . Laboratory tests can detect evidence of the dengue viruses, however the results often come back too late to assist in directing treatment. Medical testing can confirm the presence of West Nile fever or a West Nile-related illness, such as meningitis or encephalitis. If infected, a blood test may show a rising level of antibodies to the West Nile virus. A lumbar puncture (spinal tap) is the most common way to diagnose meningitis, by analyzing the cerebrospinal fluid surrounding your brain and spinal cord. The fluid sample may show an elevated white cell count and antibodies to the West Nile virus if you were exposed. In some cases, an electroencephalography (EEG) or magnetic resonance imaging (MRI) scan can help detect brain inflammation. A Zika virus infection might be suspected if symptoms are present and an individual has traveled to an area with known Zika virus transmission. Zika virus can only be confirmed by a laboratory test of body fluids, such as urine or saliva, or by blood test. Laboratory blood tests can identify evidence of chikungunya or other similar viruses such as dengue and Zika. Blood test may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibodies are highest 3 to 5 weeks after the beginning of symptoms and will continue be present for about 2 months. Diagnosing dengue fever can be difficult, as its symptoms often overlap with many other diseases such as malaria and typhoid fever . Laboratory tests can detect evidence of the dengue viruses, however the results often come back too late to assist in directing treatment. Medical testing can confirm the presence of West Nile fever or a West Nile-related illness, such as meningitis or encephalitis. If infected, a blood test may show a rising level of antibodies to the West Nile virus. A lumbar puncture (spinal tap) is the most common way to diagnose meningitis, by analyzing the cerebrospinal fluid surrounding your brain and spinal cord. The fluid sample may show an elevated white cell count and antibodies to the West Nile virus if you were exposed. In some cases, an electroencephalography (EEG) or magnetic resonance imaging (MRI) scan can help detect brain inflammation. A Zika virus infection might be suspected if symptoms are present and an individual has traveled to an area with known Zika virus transmission. Zika virus can only be confirmed by a laboratory test of body fluids, such as urine or saliva, or by blood test. Laboratory blood tests can identify evidence of chikungunya or other similar viruses such as dengue and Zika. Blood test may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibodies are highest 3 to 5 weeks after the beginning of symptoms and will continue be present for about 2 months. There is a re-emergence of mosquito vectored viruses (arthropod-borne viruses) called arboviruses carried by the Aedes aegypti mosquito. Examples are the Zika virus, chikungunya virus, yellow fever and dengue fever. The re-emergence of the viruses has been at a faster rate, and over a wider geographic area, than in the past. The rapid re-emergence is due to expanding global transportation networks, the mosquito's increasing ability to adapt to urban settings, the disruption of traditional land use and the inability to control expanding mosquito populations. Like malaria, arboviruses do not have a vaccine. (The only exception is yellow fever.) Prevention is focused on reducing the adult mosquito populations, controlling mosquito larvae and protecting individuals from mosquito bites. Depending on the mosquito vector, and the affected community, a variety of prevention methods may be deployed at one time. The use of insecticide treated mosquito nets (ITNs) are at the forefront of preventing mosquito bites that cause malaria. The prevalence of ITNs in sub-Saharan Africa has grown from 3% of households to 50% of households from 2000 to 2010 with over 254 million insecticide treated nets distributed throughout sub-Saharan Africa for use against the mosquito vectors Anopheles gambiae and Anopheles funestus which carry malaria. Because the Anopheles gambiae feeds indoors (endophagic) and rests indoors after feeding (endophilic), insecticide treated nets (ITNs) interrupt the mosquito's feeding pattern. The ITNs continue to offer protection, even after there are holes in the nets, because of their excito-repellency properties which reduce the number of mosquitoes that enter the home. The World Health Organization (WHO) recommends treating ITNs with the pyrethroid class of insecticides. There is an emerging concern of mosquito resistance to insecticides used in ITNs. Twenty-seven (27) sub-Saharan African countries have reported Anopheles vector resistance to pyrethroid insecticides. Indoor spraying of insecticides is another prevention method widely used to control mosquito vectors. To help control the Aedes aegypti mosquito, homes are sprayed indoors with residual insecticide applications. Indoor residual spraying (IRS) reduces the female mosquito population and mitigates the risk of dengue virus transmission. Indoor residual spraying is completed usually once or twice a year. Mosquitoes rest on walls and ceilings after feeding and are killed by the insecticide. Indoor spraying can be combined with spraying the exterior of the building to help reduce the number of mosquito larvae and subsequently, the number of adult mosquitoes. There are other methods that an individual can use to protect themselves from mosquito bites. Limiting exposure to mosquitoes from dusk to dawn when the majority of mosquitoes are active and wearing long sleeves and long pants during the period mosquitoes are most active. Placing screens on windows and doors is a simple and effective means of reducing the number of mosquitoes indoors. Anticipating mosquito contact and using a topical mosquito repellant with icaridin or DEET is also recommended. Draining or covering water receptacles, both indoor and outdoors, is also a simple but effective prevention method. Removing debris and tires, cleaning drains, and cleaning gutters help larval control and reduce the number of adult mosquitoes. There is a vaccine for yellow fever which was developed in the 1930s, the yellow 17D vaccine , and it is still in use today. The initial yellow fever vaccination provides lifelong protection for most people and provides immunity within 30 days of the vaccine. Reactions to the yellow fever vaccine have included mild headache and fever, and muscle aches. There are rare cases of individuals presenting with symptoms that mirror the disease itself. The risk of complications from the vaccine are greater for individuals over 60 years of age. In addition, the vaccine is not usually administered to babies under nine months of age, pregnant women, people with allergies to egg protein, and individuals living with AIDS/HIV . The World Health Organization (WHO) reports that 105 million people have been vaccinated for yellow fever in West Africa from 2000 to 2015. To date, there are relatively few vaccines against mosquito-borne diseases, this is due to the fact that most viruses and bacteria caused by mosquitos are highly mutatable. The National Institute of Allergy and Infectious Disease (NIAID) began Phase 1 clinical trials of a new vaccine that would be nearly universal in protecting against the majority of mosquito-borne diseases. The arboviruses have expanded their geographic range and infected populations that had no recent community knowledge of the diseases carried by the Aedes aegypti mosquito. Education and community awareness campaigns are necessary for prevention to be effective. Communities are educated on how the disease is spread, how they can protect themselves from infection and the symptoms of infection. Community health education programs can identify and address the social/economic and cultural issues that can hinder preventative measures. Community outreach and education programs can identify which preventative measures a community is most likely to employ. Leading to a targeted prevention method that has a higher chance of success in that particular community. Community outreach and education includes engaging community health workers and local healthcare providers, local schools and community organizations to educate the public on mosquito vector control and disease prevention. The use of insecticide treated mosquito nets (ITNs) are at the forefront of preventing mosquito bites that cause malaria. The prevalence of ITNs in sub-Saharan Africa has grown from 3% of households to 50% of households from 2000 to 2010 with over 254 million insecticide treated nets distributed throughout sub-Saharan Africa for use against the mosquito vectors Anopheles gambiae and Anopheles funestus which carry malaria. Because the Anopheles gambiae feeds indoors (endophagic) and rests indoors after feeding (endophilic), insecticide treated nets (ITNs) interrupt the mosquito's feeding pattern. The ITNs continue to offer protection, even after there are holes in the nets, because of their excito-repellency properties which reduce the number of mosquitoes that enter the home. The World Health Organization (WHO) recommends treating ITNs with the pyrethroid class of insecticides. There is an emerging concern of mosquito resistance to insecticides used in ITNs. Twenty-seven (27) sub-Saharan African countries have reported Anopheles vector resistance to pyrethroid insecticides. Indoor spraying of insecticides is another prevention method widely used to control mosquito vectors. To help control the Aedes aegypti mosquito, homes are sprayed indoors with residual insecticide applications. Indoor residual spraying (IRS) reduces the female mosquito population and mitigates the risk of dengue virus transmission. Indoor residual spraying is completed usually once or twice a year. Mosquitoes rest on walls and ceilings after feeding and are killed by the insecticide. Indoor spraying can be combined with spraying the exterior of the building to help reduce the number of mosquito larvae and subsequently, the number of adult mosquitoes. There are other methods that an individual can use to protect themselves from mosquito bites. Limiting exposure to mosquitoes from dusk to dawn when the majority of mosquitoes are active and wearing long sleeves and long pants during the period mosquitoes are most active. Placing screens on windows and doors is a simple and effective means of reducing the number of mosquitoes indoors. Anticipating mosquito contact and using a topical mosquito repellant with icaridin or DEET is also recommended. Draining or covering water receptacles, both indoor and outdoors, is also a simple but effective prevention method. Removing debris and tires, cleaning drains, and cleaning gutters help larval control and reduce the number of adult mosquitoes. There is a vaccine for yellow fever which was developed in the 1930s, the yellow 17D vaccine , and it is still in use today. The initial yellow fever vaccination provides lifelong protection for most people and provides immunity within 30 days of the vaccine. Reactions to the yellow fever vaccine have included mild headache and fever, and muscle aches. There are rare cases of individuals presenting with symptoms that mirror the disease itself. The risk of complications from the vaccine are greater for individuals over 60 years of age. In addition, the vaccine is not usually administered to babies under nine months of age, pregnant women, people with allergies to egg protein, and individuals living with AIDS/HIV . The World Health Organization (WHO) reports that 105 million people have been vaccinated for yellow fever in West Africa from 2000 to 2015. To date, there are relatively few vaccines against mosquito-borne diseases, this is due to the fact that most viruses and bacteria caused by mosquitos are highly mutatable. The National Institute of Allergy and Infectious Disease (NIAID) began Phase 1 clinical trials of a new vaccine that would be nearly universal in protecting against the majority of mosquito-borne diseases. The arboviruses have expanded their geographic range and infected populations that had no recent community knowledge of the diseases carried by the Aedes aegypti mosquito. Education and community awareness campaigns are necessary for prevention to be effective. Communities are educated on how the disease is spread, how they can protect themselves from infection and the symptoms of infection. Community health education programs can identify and address the social/economic and cultural issues that can hinder preventative measures. Community outreach and education programs can identify which preventative measures a community is most likely to employ. Leading to a targeted prevention method that has a higher chance of success in that particular community. Community outreach and education includes engaging community health workers and local healthcare providers, local schools and community organizations to educate the public on mosquito vector control and disease prevention. Numerous drugs have been used to treat yellow fever disease with minimal satisfaction to date. Patients with multisystem organ involvement will require critical care support such as possible hemodialysis or mechanical ventilation . Rest, fluids, and acetaminophen are also known to relieve milder symptoms of fever and muscle pain. Due to hemorrhagic complications, aspirin should be avoided. Infected individuals should avoid mosquito exposure by staying indoors or using a mosquito net . Dengue infection's therapeutic management is simple, cost effective and successful in saving lives by adequately performing timely institutionalized interventions. Treatment options are restricted, while no effective antiviral drugs for this infection have been accessible to date. Patients in the early phase of the dengue virus may recover without hospitalization. However, ongoing clinical research is in the works to find specific anti-dengue drugs. Dengue fever occurs via Aedes aegypti mosquito (it acts as a vector). Zika virus vaccine clinical trials are to be conducted and established. There are efforts being put toward advancing antiviral therapeutics against zika virus for swift control. Present day Zika virus treatment is symptomatic through antipyretics and analgesics . Currently there are no publications regarding viral drug screening. Nevertheless, therapeutics for this infection have been used. There are no treatment modalities for acute and chronic chikungunya that currently exist. Most treatment plans use supportive and symptomatic care like analgesics for pain and anti-inflammatories for inflammation caused by arthritis . In acute stages of this virus, rest, antipyretics and analgesics are used to subside symptoms. Most use non-steroidal anti-inflammatory drugs (NSAIDs). In some cases, joint pain may resolve from treatment but stiffness remains. The sterile insect technique (SIT) uses irradiation to sterilize insect pests before releasing them in large numbers to mate with wild females. Since they do not produce any offspring, the population, and consequently the disease incidence, is reduced over time. Used successfully for decades to combat fruit flies and livestock pests such as screwworm and tsetse flies , the technique can be adapted also for some disease-transmitting mosquito species. Pilot projects are being initiated or are under way in different parts of the world. Numerous drugs have been used to treat yellow fever disease with minimal satisfaction to date. Patients with multisystem organ involvement will require critical care support such as possible hemodialysis or mechanical ventilation . Rest, fluids, and acetaminophen are also known to relieve milder symptoms of fever and muscle pain. Due to hemorrhagic complications, aspirin should be avoided. Infected individuals should avoid mosquito exposure by staying indoors or using a mosquito net . Dengue infection's therapeutic management is simple, cost effective and successful in saving lives by adequately performing timely institutionalized interventions. Treatment options are restricted, while no effective antiviral drugs for this infection have been accessible to date. Patients in the early phase of the dengue virus may recover without hospitalization. However, ongoing clinical research is in the works to find specific anti-dengue drugs. Dengue fever occurs via Aedes aegypti mosquito (it acts as a vector).Zika virus vaccine clinical trials are to be conducted and established. There are efforts being put toward advancing antiviral therapeutics against zika virus for swift control. Present day Zika virus treatment is symptomatic through antipyretics and analgesics . Currently there are no publications regarding viral drug screening. Nevertheless, therapeutics for this infection have been used. There are no treatment modalities for acute and chronic chikungunya that currently exist. Most treatment plans use supportive and symptomatic care like analgesics for pain and anti-inflammatories for inflammation caused by arthritis . In acute stages of this virus, rest, antipyretics and analgesics are used to subside symptoms. Most use non-steroidal anti-inflammatory drugs (NSAIDs). In some cases, joint pain may resolve from treatment but stiffness remains. The sterile insect technique (SIT) uses irradiation to sterilize insect pests before releasing them in large numbers to mate with wild females. Since they do not produce any offspring, the population, and consequently the disease incidence, is reduced over time. Used successfully for decades to combat fruit flies and livestock pests such as screwworm and tsetse flies , the technique can be adapted also for some disease-transmitting mosquito species. Pilot projects are being initiated or are under way in different parts of the world. Mosquito-borne diseases, such as dengue fever and malaria , typically affect developing countries and areas with tropical climates. Mosquito vectors are sensitive to climate changes and tend to follow seasonal patterns. Between years there are often dramatic shifts in incidence rates. The occurrence of this phenomenon in endemic areas makes mosquito-borne viruses difficult to treat. Dengue fever is caused by infection through viruses of the family Flaviviridae. The illness is most commonly transmitted by Aedes aegypti mosquitoes in tropical and subtropical regions. Dengue virus has four different serotypes, each of which are antigenically related but have limited cross-immunity to reinfection. Although dengue fever has a global incidence of 50–100 million cases, only several hundreds of thousands of these cases are life-threatening. The geographic prevalence of the disease can be examined by the spread of Aedes aegypti . Over the last twenty years, there has been a geographic spread of the disease. Dengue incidence rates have risen sharply within urban areas which have recently become endemic hot spots for the disease. The recent spread of Dengue can also be attributed to rapid population growth, increased coagulation in urban areas, and global travel. Without sufficient vector control, the dengue virus has evolved rapidly over time, posing challenges to both government and public health officials. [ citation needed ] Malaria is caused by a protozoan called Plasmodium falciparum . P. falciparum parasites are transmitted mainly by the Anopheles gambiae complex in rural Africa. In just this area, P. falciparum infections comprise an estimated 200 million clinical cases and 1 million annual deaths. 75% of individuals affected in this region are children. As with dengue, changing environmental conditions have led to novel disease characteristics. Due to increased illness severity, treatment complications, and mortality rates, many public health officials concede that malaria patterns are rapidly transforming in Africa. Scarcity of health services, rising instances of drug resistance, and changing vector migration patterns are factors that public health officials believe contribute to malaria's dissemination. Climate heavily affects mosquito vectors of malaria and dengue. Climate patterns influence the lifespan of mosquitos as well as the rate and frequency of reproduction. Climate change impacts have been of great interest to those studying these diseases and their vectors. Additionally, climate impacts mosquito blood feeding patterns as well as extrinsic incubation periods. Climate consistency gives researchers an ability to accurately predict annual cycling of the disease but recent climate unpredictability has eroded researchers' ability to track the disease with such precision.In many insect species, such as Drosophila melanogaster , researchers found that a natural infection with the bacteria strain Wolbachia pipientis increases the fitness of the host by increasing resistance to RNA viral infections. Robert L. Glaser and Mark A. Meola investigated Wolbachia -induced resistance to West Nile virus (WNV) in Drosophila melanogaster (fruit flies). Two groups of fruit flies were naturally infected with Wolbachia . Glaser and Meola then cured one group of fruit flies of Wolbachia using tetracycline. Both the infected group and the cured groups were then infected with WNV. Flies infected with Wolbachia were found to have a changed phenotype that caused resistance to WNV. The phenotype was found to be caused by a "dominant, maternally transmitted, cytoplasmic factor". The WNV-resistance phenotype was then reversed by curing the fruit flies of Wolbachia . Since Wolbachia is also maternally transmitted, it was found that the WNV-resistant phenotype is directly related to the Wolbachia infection. West Nile virus is transmitted to humans and animals through the Southern house mosquito, Culex quinquefasciatus . Glaser and Meola knew vector compatibility could be reduced through Wolbachia infection due to studies done with other species of mosquitoes, mainly, Aedes aegypti . Their goal was to transfer WNV resistance to Cx. quinquefasciatus by inoculating the embryos of the mosquito with the same strain of Wolbachia that naturally occurred in the fruit flies. Upon infection, Cx. quinquefasciatus showed an increased resistance to WNV that was transferable to offspring. The ability to genetically modify mosquitoes in the lab and then have the infected mosquitoes transmit it to their offspring showed that it was possible to transmit the bacteria to wild populations to decrease human infections. [ citation needed ] In 2011, Ary Hoffmann and associates produced the first case of Wolbachia -induced arbovirus resistance in wild populations of Aedes aegypti through a small project called Eliminate Dengue: Our Challenge. This was made possible by an engineered strain of Wolbachia termed w Mel that came from D. melanogaster . The transfer of w Mel from D. melanogaster into field-caged populations of the mosquito Aedes aegypti induced resistance to dengue, yellow fever, and chikungunya viruses. Although other strains of Wolbachia also reduced susceptibility to dengue infection, they also put a greater demand on the fitness of Ae. aegypti . w Mel was different in that it was thought to only cost the organism a small portion of its fitness. w Mel-infected Ae. aegypti were released into two residential areas in the city of Cairns, Australia over a 14-week period. Hoffmann and associates, released a total of 141,600 infected adult mosquitoes in Yorkeys Knob suburb and 157,300 in Gordonvale suburb. After release, the populations were monitored for three years to record the spread of w Mel. Population monitoring was gauged by measuring larvae laid in traps. At the beginning of the monitoring period but still within the release period, it was found that w Mel-infected Ae. aegypti had doubled in Yorkeys Knob and increased 1.5-fold in Gordonvale. Uninfected Ae. aegypti populations were in decline. By the end of the three years, w Mel-infected Ae. aegypti had stable populations of about 90%. However, these populations were isolated to the Yorkeys Knob and Gordonvale suburbs due to unsuitable habitat surrounding the neighborhoods. Although populations flourished in these areas with nearly 100% transmission, no signs of spread were noted, proving disappointing for some. Following this experiment, Tom L. Schmidt and his colleagues conducted an experiment releasing Wolbachia -infected Aedes aegypti using different site selection methods occurred in different areas of Cairns during 2013. The release sites were monitored over two years. This time the release was done in urban areas that were adjacent to adequate habitat to encourage mosquito dispersal. Over the two years, the population doubled, and spatial spread was also increased, unlike the first release, giving ample satisfactory results. By increasing the spread of the Wolbachia -infected mosquitoes, the researchers were able to establish that population of a large city was possible if the mosquitoes were given adequate habitat to spread into upon release in different local locations throughout the city. In both of these studies, no adverse effects on public health or the natural ecosystem occurred. This made it an extremely attractive alternative to traditional insecticide methods given the increased pesticide resistance occurring from heavy use. From the success seen in Australia, the researchers were able to begin operating in more threatened portions of the world. The Eliminate Dengue program spread to 10 countries throughout Asia, Latin America, and the Western Pacific blooming into the non-profit organization, World Mosquito Program, as of September 2017. They still use the same technique of infecting wild populations of Ae. aegypti as they did in Australia, but their target diseases now include Zika, chikungunya and yellow fever as well as dengue. Although not alone in their efforts to use Wolbachia- infected mosquitoes to reduce mosquito-borne disease, the World Mosquito Program method is praised for being self-sustaining in that it causes permanent phenotype change rather than reducing mosquito populations through cytoplasmic incompatibility through male-only dispersal.

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Dengue fever

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Dengue fever (disambiguation)

Dengue fever is an endemic viral infectious disease. Dengue fever may also refer to:

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Dengue fever

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List of epidemics and pandemics

This is a list of the largest known epidemics and pandemics caused by an infectious disease . Widespread non-communicable diseases such as cardiovascular disease and cancer are not included. An epidemic is the rapid spread of disease to a large number of people in a given population within a short period of time; in meningococcal infections , an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic. Due to the long time spans, the first plague pandemic (6th century – 8th century) and the second plague pandemic (14th century – early 19th century) are shown by individual outbreaks, such as the Plague of Justinian (first pandemic) and the Black Death (second pandemic). Infectious diseases with high prevalence are listed separately (sometimes in addition to their epidemics), such as malaria , which may have killed 50–60 billion people throughout history, or about half of all humans that have ever lived. Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain. There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain.There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Events in boldface are ongoing.

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Aedes aegypti

Aedes aegypti aegypti Aedes aegypti formosus Aedes aegypti ( /ˈiːdiːz/ from Greek αηδής : "hateful" and /aɪˈdʒɛpti/ from Latin , meaning "of Egypt"), the yellow fever mosquito , is a mosquito that can spread dengue fever , chikungunya , Zika fever , Mayaro and yellow fever viruses, and other disease agents. The mosquito can be recognized by black and white markings on its legs and a marking in the form of a lyre on the upper surface of its thorax . This mosquito originated in Africa, but is now found in tropical , subtropical and temperate regions throughout the world.Aedes aegypti is a 4–7 millimetres ( 5 ⁄ 32 – 35 ⁄ 128 in) long, dark mosquito which can be recognized by white markings on its legs and a marking in the form of a lyre on the upper surface of its thorax . Females are larger than males. Microscopically females possess small palps tipped with silver or white scales, and their antennae have sparse short hairs, whereas those of males are feathery. Aedes aegypti can be confused with Aedes albopictus without a magnifying glass: the latter have a white stripe on the top of the mid thorax. Males live off fruit and only the female bites for blood, which she needs to mature her eggs. To find a host, she is attracted to chemical compounds emitted by mammals, including ammonia , carbon dioxide , lactic acid , and octenol . Scientists at The United States Department of Agriculture (USDA) Agricultural Research Service studied the specific chemical structure of octenol to better understand why this chemical attracts the mosquito to its host and found the mosquito has a preference for "right-handed" ( dextrorotatory ) octenol molecules. The preference for biting humans is dependent on expression of the odorant receptor AaegOr4 . The white eggs are laid separately into water and not together, unlike most other mosquitoes, and soon turn black. The larvae feed on bacteria, growing over a period of weeks until they reach the pupa stage. The lifespan of an adult Ae. aegypti is two to four weeks depending on conditions, but the eggs can be viable for over a year in a dry state, which allows the mosquito to re-emerge after a cold winter or dry spell. Mammalian hosts include domesticated horses , and feral and wild horses and equids more generally. As of 2009 birds were found to be the best food supply for Ae. aegypti among all taxa . Mammalian hosts include domesticated horses , and feral and wild horses and equids more generally. As of 2009 birds were found to be the best food supply for Ae. aegypti among all taxa . Aedes aegypti originated in Africa and was spread to the New World through slave trade, but is now found in tropical , subtropical and temperate regions throughout the world. Ae. aegypti ' s distribution has increased in the past two to three decades worldwide, and it is considered to be among the most widespread mosquito species. In 2016, Zika virus -capable mosquito populations have been found adapting for persistence in warm temperate climates. Such a population has been identified to exist in parts of Washington, DC , and genetic evidence suggests they survived at least the last four winters in the region. One of the study researchers noted, "...some mosquito species are finding ways to survive in normally restrictive environments by taking advantage of underground refugia". As the world's climate becomes warmer, the range of Aedes aegypti and a hardier species originating in Asia, the tiger mosquito Aedes albopictus , which can expand its range to relatively cooler climates, will inexorably spread north and south. Sadie Ryan of the University of Florida was the lead author in a 2019 study that estimated the vulnerability of naïve populations in geographic regions that currently do not harbor vectors i.e., for Zika in the Old World. Ryan's co-author, Georgetown University's Colin Carlson remarked,"Plain and simple, climate change is going to kill a lot of people." As of 2020, the Northern Territory Government Australia and the Darwin City Council have recommended tropical cities initiate rectification programs to rid their cities of potential mosquito breeding stormwater sumps. A 2019 study found that accelerating urbanization and human movement would also contribute to the spread of Aedes mosquitoes. In continental Europe, Aedes aegypti is not established but it has been found in localities close to Europe such as the Asian part of Turkey . However, a single adult female specimen was found in Marseille (Southern France) in 2018. On the basis of a genetic study and an analysis of the movements of commercial ships, the origin of the specimen could be traced as coming from Cameroon , in Central Africa. In 2007, the genome of Aedes aegypti was published, after it had been sequenced and analyzed by a consortium including scientists at The Institute for Genomic Research (now part of the J. Craig Venter Institute ), the European Bioinformatics Institute , the Broad Institute , and the University of Notre Dame . The effort in sequencing its DNA was intended to provide new avenues for research into insecticides and possible genetic modification to prevent the spread of virus. This was the second mosquito species to have its genome sequenced in full (the first was Anopheles gambiae ). The published data included the 1.38 billion base pairs containing the insect's estimated 15,419 protein -encoding genes. The sequence indicates the species diverged from Drosophila melanogaster (the common fruit fly) about 250 million years ago , and Anopheles gambiae and this species diverged about 150 million years ago . Matthews et al. , 2018 finds A. aegypti to carry a large and diverse number of transposable elements . Their analysis suggests this is common to all mosquitoes. Aedes aegypti is a vector for transmitting numerous pathogens . According to the Walter Reed Biosystematics Units as of 2022, it is associated with the following 54 viruses and 2 species of Plasmodium : Aino virus (AINOV), African horse sickness virus (AHSV), Bozo virus (BOZOV), Bussuquara virus (BSQV), Bunyamwera virus (BUNV), Catu virus (CATUV), Chikungunya virus (CHIKV), Chandipura vesiculovirus (CHPV), Cypovirus (unnamed), Cache Valley virus (CVV), Dengue virus (DENV), Eastern Equine Encephalitis virus (EEEV), Epizootic hemorrhagic disease virus (EHDV), Guaroa virus (GROV), Hart Park virus (HPV), Ilheus virus (ILHV), Irituia virus (IRIV), Israel Turkey Meningoencephalitis virus (ITV), Japanaut virus (JAPV), Joinjakaka (JOIV), Japanese encephalitis virus (JBEV), Ketapang virus (KETV), Kunjin virus (KUNV), La Crosse virus (LACV), Mayaro virus (MAYV), Marburg virus (MBGV), Marco virus (MCOV), Melao virus (MELV), Marituba virus (MTBV), Mount Elgon bat virus (MEBV), Mucambo virus (MUCV), Murray Valley Encephalitis virus (MVEV), Navarro virus (NAVV), Nepuyo virus (NEPV), Nola virus (NOLV), Ntaya virus (NTAV), Oriboca virus (ORIV), Orungo virus (ORUV), Restan virus (RESV), Rift Valley fever virus (RVFV), Semliki Forest virus (SFV), Sindbis virus (SINV), Tahyna virus (TAHV), Tsuruse virus (TSUV), Tyuleniy virus (TYUV), Venezuelan equine encephalitis virus (VEEV), Vesicular stomatitis virus (Indiana serotype), Warrego virus (WARV), West Nile virus (WNV), Wesselsbron virus (WSLV), Yaounde virus (YAOV), Yellow fever virus (YFV), Zegla virus (ZEGV), Zika virus , as well as Plasmodium gallinaceum and Plasmodium lophurae . This mosquito also mechanically transmits some veterinary diseases . In 1952 Fenner et al. , found it transmitting the myxoma virus between rabbits and in 2001 Chihota et al. , the lumpy skin disease virus between cattle . The yellow fever mosquito can contribute to the spread of reticular cell sarcoma among Syrian hamsters . The Centers for Disease Control and Prevention traveler's page on preventing dengue fever suggests using mosquito repellents that contain DEET (N, N-diethylmetatoluamide, 20% to 30%). It also suggests: Insect repellents containing DEET (particularly concentrated products) or p -menthane-3,8-diol (from lemon eucalyptus ) were effective in repelling Ae. aegypti mosquitoes, while others were less effective or ineffective in a scientific study. The Centers for Disease Control and Prevention article on "Protection against Mosquitoes, Ticks, & Other Arthropods" notes that "Studies suggest that concentrations of DEET above approximately 50% do not offer a marked increase in protection time against mosquitoes; DEET efficacy tends to plateau at a concentration of approximately 50%". Other insect repellents recommended by the CDC include Picaridin (KBR 3023/ icaridin ), IR3535 , and 2-undecanone . Pyrethroids are commonly used. This widespread use of pyrethroids and DDT has caused Knockdown resistance ( kdr ) mutations. Almost no research has been done on the fitness implications. studies by Kumar et al. , 2009 on deltamethrin in India, Plernsub et al. , 2013 on permethrin in Thailand, by Jaramillo-O et al. , 2014 on λ-cyhalothrin in Colombia, by Alvarez-Gonzalez et al. , 2017 on deltamethrin in Venezuela, are all substantially confounded . As of 2019, understanding of selective pressure under withdrawal of insecticide is hence limited. Ae. aegypti has been genetically modified to suppress its own species in an approach similar to the sterile insect technique , thereby reducing the risk of disease. The mosquitoes, known as OX513A , were developed by Oxitec , a spinout of Oxford University . Field trials in the Cayman Islands , in Juazeiro , Brazil, by Carvalho et al. , 2015, and in Panama by Neira et al. , 2014 have shown that the OX513A mosquitoes reduced the target mosquito populations by more than 90%. This mosquito suppression effect is achieved by a self-limiting gene that prevents the offspring from surviving. Male modified mosquitoes, which do not bite or spread disease, are released to mate with the pest females. Their offspring inherit the self-limiting gene and die before reaching adulthood—before they can reproduce or spread disease. The OX513A mosquitoes and their offspring also carry a fluorescent marker for simple monitoring. To produce more OX513A mosquitoes for control projects, the self-limiting gene is switched off (using the Tet-Off system ) in the mosquito production facility using an antidote (the antibiotic tetracycline ), allowing the mosquitoes to reproduce naturally. In the environment, the antidote is unavailable to rescue mosquito reproduction, so the pest population is suppressed. The mosquito control effect is nontoxic and species-specific, as the OX513A mosquitoes are Ae. aegypti and only breed with Ae. aegypti . The result of the self-limiting approach is that the released insects and their offspring die and do not persist in the environment. In Brazil, the modified mosquitoes were approved by the National Biosecurity Technical Commission for releases throughout the country. Insects were released into the wild populations of Brazil, Malaysia, and the Cayman Islands in 2012. In July 2015, the city of Piracicaba , São Paulo, started releasing the OX513A mosquitoes. In 2015, the UK House of Lords called on the government to support more work on genetically modified insects in the interest of global health. In 2016, the United States Food and Drug Administration granted preliminary approval for the use of modified mosquitoes to prevent the spread of the Zika virus. Another proposed method consists in using radiation to sterilize male larvae so that when they mate, they produce no progeny. Male mosquitoes do not bite or spread disease. Using CRISPR/Cas9 based genome editing to engineer the genome of Aedes aegypti genes like ECFP (enhanced cyan fluorescent protein), Nix (male-determining factor gene), Aaeg-wtrw (Ae. aegypti water witch locus), Kmo (kynurenine 3-monoxygenase), loqs (loquacious), r2d2 (r2d2 protein), ku70 (ku heterodimer protein gene) and lig4 (ligase4) were targeted to modify the genome of Aedes aegypti . The new mutant will become incapable of pathogen transmission or result in population control. In 2016 research into the use of a bacterium called Wolbachia as a method of biocontrol was published showing that invasion of Ae. aegypti by the endosymbiotic bacteria allows mosquitos to be resistant to certain arboviruses such as dengue fever and Zika virus strains currently circulating. In 2017 Alphabet, Inc. started the Debug Project to infect males of this species with Wolbachia bacteria, interrupting the reproductive cycle of these animals. Pyrethroids are commonly used. This widespread use of pyrethroids and DDT has caused Knockdown resistance ( kdr ) mutations. Almost no research has been done on the fitness implications. studies by Kumar et al. , 2009 on deltamethrin in India, Plernsub et al. , 2013 on permethrin in Thailand, by Jaramillo-O et al. , 2014 on λ-cyhalothrin in Colombia, by Alvarez-Gonzalez et al. , 2017 on deltamethrin in Venezuela, are all substantially confounded . As of 2019, understanding of selective pressure under withdrawal of insecticide is hence limited. Ae. aegypti has been genetically modified to suppress its own species in an approach similar to the sterile insect technique , thereby reducing the risk of disease. The mosquitoes, known as OX513A , were developed by Oxitec , a spinout of Oxford University . Field trials in the Cayman Islands , in Juazeiro , Brazil, by Carvalho et al. , 2015, and in Panama by Neira et al. , 2014 have shown that the OX513A mosquitoes reduced the target mosquito populations by more than 90%. This mosquito suppression effect is achieved by a self-limiting gene that prevents the offspring from surviving. Male modified mosquitoes, which do not bite or spread disease, are released to mate with the pest females. Their offspring inherit the self-limiting gene and die before reaching adulthood—before they can reproduce or spread disease. The OX513A mosquitoes and their offspring also carry a fluorescent marker for simple monitoring. To produce more OX513A mosquitoes for control projects, the self-limiting gene is switched off (using the Tet-Off system ) in the mosquito production facility using an antidote (the antibiotic tetracycline ), allowing the mosquitoes to reproduce naturally. In the environment, the antidote is unavailable to rescue mosquito reproduction, so the pest population is suppressed. The mosquito control effect is nontoxic and species-specific, as the OX513A mosquitoes are Ae. aegypti and only breed with Ae. aegypti . The result of the self-limiting approach is that the released insects and their offspring die and do not persist in the environment. In Brazil, the modified mosquitoes were approved by the National Biosecurity Technical Commission for releases throughout the country. Insects were released into the wild populations of Brazil, Malaysia, and the Cayman Islands in 2012. In July 2015, the city of Piracicaba , São Paulo, started releasing the OX513A mosquitoes. In 2015, the UK House of Lords called on the government to support more work on genetically modified insects in the interest of global health. In 2016, the United States Food and Drug Administration granted preliminary approval for the use of modified mosquitoes to prevent the spread of the Zika virus. Another proposed method consists in using radiation to sterilize male larvae so that when they mate, they produce no progeny. Male mosquitoes do not bite or spread disease. Using CRISPR/Cas9 based genome editing to engineer the genome of Aedes aegypti genes like ECFP (enhanced cyan fluorescent protein), Nix (male-determining factor gene), Aaeg-wtrw (Ae. aegypti water witch locus), Kmo (kynurenine 3-monoxygenase), loqs (loquacious), r2d2 (r2d2 protein), ku70 (ku heterodimer protein gene) and lig4 (ligase4) were targeted to modify the genome of Aedes aegypti . The new mutant will become incapable of pathogen transmission or result in population control. In 2016 research into the use of a bacterium called Wolbachia as a method of biocontrol was published showing that invasion of Ae. aegypti by the endosymbiotic bacteria allows mosquitos to be resistant to certain arboviruses such as dengue fever and Zika virus strains currently circulating. In 2017 Alphabet, Inc. started the Debug Project to infect males of this species with Wolbachia bacteria, interrupting the reproductive cycle of these animals. Fungal species Erynia conica (from the family Entomophthoraceae ) infects (and kills) two types of mosquitos: Aedes aegypti and Culex restuans . Studies on the fungus have been carried out on its potiential use as a biological control of the mosquitos. The species was first named (as Culex aegypti ) in 1757 by Fredric Hasselquist in his treatise Iter Palaestinum . Hasselquist was provided with the names and descriptions by his mentor, Carl Linnaeus . This work was later translated into German and published in 1762 as Reise nach Palästina . Since the latter is an uncritical reproduction of the former, they are both considered to antedate the starting point for zoological nomenclature in 1758. Nonetheless, the name Aedes aegypti was frequently used, starting with H. G. Dyar in 1920. [ citation needed ] To stabilise the nomenclature, a petition to the International Commission on Zoological Nomenclature was made by P. F. Mattingly, Alan Stone, and Kenneth L. Knight in 1962. It also transpired that, although the name Aedes aegypti was universally used for the yellow fever mosquito, Linnaeus had actually described a species now known as Aedes ( Ochlerotatus ) caspius . In 1964, the commission ruled in favour of the proposal, validating Linnaeus' name, and transferring it to the species for which it was in general use. The yellow fever mosquito belongs to the tribe Aedini of the dipteran family Culicidae and to the genus Aedes and subgenus Stegomyia . According to one recent analysis, the subgenus Stegomyia of the genus Aedes should be raised to the level of genus. The proposed name change has been ignored by most scientists; at least one scientific journal, the Journal of Medical Entomology , has officially encouraged authors dealing with aedile mosquitoes to continue to use the traditional names, unless they have particular reasons for not doing so. The generic name comes from the Ancient Greek ἀηδής , aēdēs , meaning "unpleasant" or "odious". Two subspecies are commonly recognized: This classification is complicated by the results of Gloria-Soria et al. , 2016. Although confirming the existence of these two major subspecies, Gloria-Sora et al. finds greater worldwide diversity than previously recognized and a large number of distinct populations separated by various geographic factors. Two subspecies are commonly recognized: This classification is complicated by the results of Gloria-Soria et al. , 2016. Although confirming the existence of these two major subspecies, Gloria-Sora et al. finds greater worldwide diversity than previously recognized and a large number of distinct populations separated by various geographic factors.

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Dengue fever

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Dengvaxia controversy

The Dengvaxia controversy ( locally [ dɛŋˈvakʃa ] ) occurred in the Philippines when the dengue vaccine Dengvaxia was found to increase the risk of disease severity for some people who had received it. A vaccination program run by the Philippine Department of Health (DOH) administered Sanofi Pasteur 's Dengvaxia to schoolchildren. The program was stopped when Sanofi Pasteur advised the government that the vaccine could put previously uninfected people at a somewhat higher risk of a severe case of dengue fever through antibody-dependent enhancement . A political controversy erupted over whether the program was run with sufficient care and who should be held responsible for the alleged harm to the vaccinated children. In late November 2017, the DOH suspended the school-based vaccination program. The DOH subsequently banned the vaccine's use and sale in the Philippines. The scare caused by the controversy has been suggested as a factor in the country's loss of confidence in vaccines and low immunization rates, resulting in an infectious disease crisis in the country in 2019, including a measles outbreak . On December 1, 2015, former President Benigno Aquino III met with executives of Sanofi Pasteur in a courtesy call in Paris, making the Philippines the first Asian country to approve the commercial sale of Dengvaxia. In April 2016, the DOH launched the dengue vaccination campaign in Central Luzon , Calabarzon and Metro Manila , where about 700,000 individuals received at least one dose of the vaccine. The government paid P3.5-billion for the vaccine. On November 29, 2017, French drugmaker Sanofi Pasteur released a statement stating that their dengue vaccine, Dengvaxia, posed risk to individuals vaccinated without having a prior dengue infection. Soon after, the Philippine Department of Health (DOH) suspended the vaccination on FCS program based in schools owing to the said concern, with DOH Secretary Francisco Duque saying "In the light of this new analysis, the DOH will place the dengue vaccination on hold while review and consultation is ongoing with experts, key stakeholders and the World Health Organization." On December 2, 2017, the government of Makati immediately suspended its anti-dengue vaccination drive following its statement. In its statement, pharmaceutical company Sanofi Pasteur reported concerns that Filipinos , mostly schoolchildren, could potentially be at risk of a more severe disease, where the recipient of the vaccine had not had a previous dengue infection; however, a medical director of Sanofi said that the dengue vaccination would not cause "severe dengue." On December 4, 2017, Sanofi also denied that they made Filipinos into " guinea pigs ," explaining that the vaccine program was conducted by the DOH and not them. Senator JV Ejercito , chair of the Senate Committee on Health and Demography, sought to identify by January 2018 whether there was an irregularity in the procurement of the vaccine, while Senator Risa Hontiveros urged the government to address the health threats posed by the vaccine. The Food and Drug Administration of the Philippines ordered Sanofi to stop distributing of Dengvaxia into the country. Former Health Secretary Janette Garin said she welcomed the investigation which will be conducted by the Philippine Department of Justice . Presidential spokesperson Harry Roque told the media that 10 percent of the 733,000 to 830,000 schoolchildren were at risk of dengue infection. Since then, the Philippine Department of Education has closely monitored the students who have been injected by the vaccine. Hontiveros said that Sanofi should take liability for the medical expenses of those who contracted severe dengue fever after receiving doses of the vaccine. Sanofi representative Thomas Triomphe "was forced to apologize" during the House of Representatives hearing on the Dengvaxia dengue vaccine. Former President Benigno Aquino III, who approved the vaccination program in 2016, expressed interest in attending the Senate hearing. On December 16, Aquino told reporters that "With the announcement of Sanofi and the reactions to it, there has been a lot of tension building up and I think it is incumbent upon me even as a citizen to try and allay certain fears, to put it in the proper perspective, to put it on the proper level." Secretary Duque reminded the public, especially parents, that "the vaccine is not a 'standalone' preventive measure against dengue." On December 15, 2017, former Education and Skills Development chief Augusto Syjuco Jr filed "mass murder and plunder" complaints against Aquino and former health secretary Janette Garin over the controversial vaccination program. Former health secretary Enrique Ona blamed his successor Janette Garin, who advised former president Benigno Aquino lll to purchase the Dengvaxia. On February 2, 2018, the University of the Philippines-Philippine General Hospital (UP-PGH) issued a report stating that three out of 14 children who died after receiving Dengvaxia indicated dengue despite immunization. On February 3, a group of doctors, including former health secretary Esperanza Cabral, urged the Public Attorney's Office (PAO) to stop conducting autopsies. On February 5, 2018, during a probe at the House of Representatives, mothers of children who took part in a mass vaccination program confronted Garin, screaming at her and accusing her of killing their children. The women would later admit to the media that none of their children died after vaccination. On February 21, 2018, Senator Richard Gordon said that the DOH must be liable for the controversy. On March 13, Senator Gordon formally terminated the investigation of the controversy. On February 26, 2018, Aquino appeared for the first time at a House inquiry about the controversy; he said that the controversy has been "politicized," but the Malacañang Palace distanced itself from Aquino's allegations. On February 27, 2018, the opposition Representatives such as Gary Alejano of Magdalo and Edcel Lagman of Albay urged President Rodrigo Duterte to intervene in the dispute between the PAO and DOH. On March 3, about 200 families of Dengvaxia vacinees joined the advocacy run held in Quezon Memorial Circle. In 2018, Dengvaxia was approved in Europe and US in 2019, only for use in people who have been infected with dengue virus before and who live in areas where this infection is endemic. On April 5, 2018, Public Attorney's Office filed the criminal charges (reckless imprudence resulting in homicide under Article 365 of the Revised Penal Code and violation of Republic Act No. 9745 (Anti-Torture Act) and torture) against the Former Health Secretary Janette Garin and other former officials. However, Garin said that the charges have no basis and vowed to file a counter-charge against PAO. The families of four children — Aejay Bautista (11), Lenard Baldonado (10), Zandro Colite (11), and Angelica Pestilos (10), whose deaths had been linked to Dengvaxia — also filed the charges. On April 19, 2018, PAO filed criminal complaints before the Department of Justice (DOJ), including the incumbent Health Secretary Francisco Duque III, following the death of the 13-year-old girl after receiving Dengvaxia on November 17, 2017. Duque described the charges against him as "malicious and oppressive " and he also said that he has nothing to do with the implementation of the dengue immunization program since he was seated as the secretary in October 2017. On April 15, 2018, Gordon said he expected at least 10 senators to sign his report holding former President Benigno Aquino III and other officials liable. Senator Panfilo Lacson will not sign the report due to "unreasonable comments" about him. On April 17, Aside from Gordon, who already signed the report, Senators Ralph Recto , Manny Pacquiao , Win Gatchalian , Tito Sotto , Gregorio Honasan , Juan Miguel Zubiri , JV Ejercito, Nancy Binay , and Grace Poe have signed. On April 20, Senator Sonny Angara also signed. On April 5, 2018, Public Attorney's Office filed the criminal charges (reckless imprudence resulting in homicide under Article 365 of the Revised Penal Code and violation of Republic Act No. 9745 (Anti-Torture Act) and torture) against the Former Health Secretary Janette Garin and other former officials. However, Garin said that the charges have no basis and vowed to file a counter-charge against PAO. The families of four children — Aejay Bautista (11), Lenard Baldonado (10), Zandro Colite (11), and Angelica Pestilos (10), whose deaths had been linked to Dengvaxia — also filed the charges. On April 19, 2018, PAO filed criminal complaints before the Department of Justice (DOJ), including the incumbent Health Secretary Francisco Duque III, following the death of the 13-year-old girl after receiving Dengvaxia on November 17, 2017. Duque described the charges against him as "malicious and oppressive " and he also said that he has nothing to do with the implementation of the dengue immunization program since he was seated as the secretary in October 2017. On April 15, 2018, Gordon said he expected at least 10 senators to sign his report holding former President Benigno Aquino III and other officials liable. Senator Panfilo Lacson will not sign the report due to "unreasonable comments" about him. On April 17, Aside from Gordon, who already signed the report, Senators Ralph Recto , Manny Pacquiao , Win Gatchalian , Tito Sotto , Gregorio Honasan , Juan Miguel Zubiri , JV Ejercito, Nancy Binay , and Grace Poe have signed. On April 20, Senator Sonny Angara also signed. Approximately 800,000 schoolchildren received the Dengvaxia vaccine and benefit from the protection it grants against dengue fever. However around 10% of those 800,000 had not had dengue fever before and therefore are at risk of severe infection because of the vaccine. In the Philippines, the Dengvaxia controversy has contributed to overall vaccine hesitancy because of heightened concerns about vaccine safety. While concerns about vaccine safety are usually rational, in the case of Dengvaxia there was a basis in evidence. Many parents of children who died blamed the vaccine. Most of the deaths were caused by internal bleeding in the heart, lungs and brain, which are symptoms of hemorrhagic dengue. According to the DOH, 729,105 grade 4 students from selected regions have received the first dose of the vaccine. Of these, 534,303 students had approved parental consent but only 491,990 students received the first dose of the vaccine. A study published by the University of the Philippines College of Medicine directly attributes the Dengvaxia controversy as one of the major factors for the vaccine hesitancy of Filipinos affecting the COVID-19 vaccination program. Citizens, as well as Senator Ejercito, expressed frustration on February 5, 2018, blaming the PAO for panic in dengue vaccination. Attorney Persida Acosta of the PAO said that the PAO should not be blamed for that panic but Sanofi Pasteur itself. Employees of the Public Attorneys Office have asked the Office of the Ombudsman to issue a preventive suspension order against PAO chief Persida Acosta and her forensics chief Dr. Erwin Erfe for alleged corruption in the agency. It was alleged that Acosta has two "loyal" certified public accountants named Lira Hosea Suangco and Maveric Sales who are tasked to maintain office supplies such as bond paper to be used for the Dengvaxia cases. The funds, however, were used for other purposes. It was also alleged that Acosta and Erfe are using PAO funds to purchase tarpaulins, t-shirts, and coffins to be used in rallies. In January 2021, the Ombudsman cleared Acosta and Erfe of criminal and administrative charges relating to the Dengvaxia issue, saying there was "no probable cause for malversation of public funds or property and illegal use of public funds or property." Employees of the Public Attorneys Office have asked the Office of the Ombudsman to issue a preventive suspension order against PAO chief Persida Acosta and her forensics chief Dr. Erwin Erfe for alleged corruption in the agency. It was alleged that Acosta has two "loyal" certified public accountants named Lira Hosea Suangco and Maveric Sales who are tasked to maintain office supplies such as bond paper to be used for the Dengvaxia cases. The funds, however, were used for other purposes. It was also alleged that Acosta and Erfe are using PAO funds to purchase tarpaulins, t-shirts, and coffins to be used in rallies. In January 2021, the Ombudsman cleared Acosta and Erfe of criminal and administrative charges relating to the Dengvaxia issue, saying there was "no probable cause for malversation of public funds or property and illegal use of public funds or property."

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Dengue fever

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Viral hemorrhagic fever

Viral hemorrhagic fevers ( VHFs ) are a diverse group of animal and human illnesses . VHFs may be caused by five distinct families of RNA viruses : the families Filoviridae , Flaviviridae , Rhabdoviridae , and several member families of the Bunyavirales order such as Arenaviridae , and Hantaviridae . All types of VHF are characterized by fever and bleeding disorders and all can progress to high fever, shock and death in many cases. Some of the VHF agents cause relatively mild illnesses, such as the Scandinavian nephropathia epidemica (a hantavirus ), while others, such as Ebola virus , can cause severe, life-threatening disease.Signs and symptoms of VHFs include (by definition) fever and bleeding: The severity of symptoms varies with the type of virus. The "VHF syndrome" (capillary leak, bleeding diathesis , and circulatory compromise leading to shock) appears in a majority of people with filoviral hemorrhagic fevers (e.g., Ebola and Marburg virus ), Crimean–Congo hemorrhagic fever (CCHF), and the South American hemorrhagic fevers caused by arenaviruses , but only in a small minority of patients with dengue or Rift Valley fever .Five families of RNA viruses have been recognised as being able to cause hemorrhagic fevers. [ citation needed ] The pathogen that caused the cocoliztli epidemics in Mexico of 1545 and 1576 is still unknown, and the 1545 epidemic may have been bacterial rather than viral. Different hemorrhagic fever viruses act on the body in different ways, resulting in different symptoms. In most VHFs, it is likely that several mechanisms contribute to symptoms, including liver damage, disseminated intravascular coagulation (DIC), and bone marrow dysfunction. In DIC, small blood clots form in blood vessels throughout the body, removing platelets necessary for clotting from the bloodstream and reducing clotting ability. DIC is thought to cause bleeding in Rift Valley, Marburg, and Ebola fevers. For filoviral hemorrhagic fevers, there are four general mechanisms of pathogenesis. The first mechanism is dissemination of virus due to suppressed responses by macrophages and dendritic cell (antigen presenting cells). The second mechanism is prevention of antigen specific immune response. The third mechanism is apoptosis of lymphocytes. The fourth mechanism is when infected macrophages interact with toxic cytokines , leading to diapedesis and coagulation deficiency. From the vascular perspective, the virus will infect vascular endothelial cells, leading to the reorganization of the VE-cadherin catenin complex (a protein important in cell adhesion). This reorganization creates intercellular gaps in endothelial cells. The gaps lead to increased endothelial permeability and allow blood to escape from the vascular circulatory system. [ citation needed ] The reasons for variation among patients infected with the same virus are unknown but stem from a complex system of virus-host interactions. Dengue fever becomes more virulent during a second infection by means of antibody-dependent enhancement . After the first infection, macrophages display antibodies on their cell membranes specific to the dengue virus. By attaching to these antibodies, dengue viruses from a second infection are better able to infect the macrophages, thus reducing the immune system's ability to fight off infection. [ citation needed ]Definitive diagnosis is usually made at a reference laboratory with advanced biocontainment capabilities. The findings of laboratory investigation vary somewhat between the viruses but in general, there is a decrease in the total white cell count (particularly the lymphocytes ), a decrease in the platelet count, an increase in the blood serum liver enzymes , and reduced blood clotting ability measured as an increase in both the prothrombin (PT) and activated partial thromboplastin times (PTT). The hematocrit may be elevated. The serum urea and creatine may be raised but this is dependent on the hydration status of the patient. The bleeding time tends to be prolonged. [ citation needed ]With the exception of yellow fever vaccine and Ebola vaccines , vaccines for VHF-associated viruses are generally not available. Post-exposure prophylactic (preventive) ribavirin may be effective for some bunyavirus and arenavirus infections. VHF isolation guidelines dictate that all VHF patients (with the exception of dengue patients) should be cared for using strict contact precautions, including hand hygiene, double gloves, gowns, shoe and leg coverings, and face shield or goggles. Lassa, CCHF, Ebola, and Marburg viruses may be particularly prone to nosocomial (hospital-based) spread. Airborne precautions should be utilized including, at a minimum, a fit-tested , HEPA filter-equipped respirator (such as an N95 mask ), a battery-powered, air-purifying respirator, or a positive pressure supplied air respirator to be worn by personnel coming within 1.8 meter (six feet) of a VHF patient. Groups of patients should be cohorted (sequestered) to a separate building or a ward with an isolated air-handling system. Environmental decontamination is typically accomplished with hypochlorite (e.g. bleach) or phenolic disinfectants . Medical management of VHF patients may require intensive supportive care. Antiviral therapy with intravenous ribavirin may be useful in Bunyaviridae and Arenaviridae infections (specifically Lassa fever, RVF, CCHF, and HFRS due to Old World Hantavirus infection) and can be used only under an experimental protocol as IND approved by the U.S. Food and Drug Administration (FDA). Interferon may be effective in Argentine or Bolivian hemorrhagic fevers (also available only as IND). [ citation needed ]The VHF viruses are spread in a variety of ways. Some may be transmitted to humans through a respiratory route. [ citation needed ] The virus is considered by military medical planners to have a potential for aerosol dissemination, weaponization, or likelihood for confusion with similar agents that might be weaponized.

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Dengue fever

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Zac Holtzman

Zac Holtzman is an American guitarist and co-founder of the band Dengue Fever . He also played Dr. San in the web series On Cinema, At The Cinema.From 1989 to 2000 Holtzman was guitarist, co-vocalist, and co-songwriter for the group Dieselhed , a San Francisco -based rock band. Holtzman formed Dengue Fever in 2001 with his brother, Ethan Holtzman. In the 1990s Ethan became interested in Cambodian pop and rock through the compilation album Cambodian Rocks and eventually visited the country, returning with several cassette tapes he purchased there. Some time later, Ethan heard Zac listening to the same music and had an idea for a band based on the psychedelic, surf, garage rock and pop of pre- Khmer Rouge Cambodia. Holtzman plays Luther "Dr. San" Sanchez on the Adult Swim comedy web series On Cinema starring Tim Heidecker and Gregg Turkington .

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Dengue fever

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Arbovirus

Arbovirus is an informal name for any virus that is transmitted by arthropod vectors . The term arbovirus is a portmanteau word ( ar thropod- bo rne virus ). Tibovirus ( ti ck- bo rne virus ) is sometimes used to more specifically describe viruses transmitted by ticks , a superorder within the arthropods. Arboviruses can affect both animals (including humans) and plants. In humans, symptoms of arbovirus infection generally occur 3–15 days after exposure to the virus and last three or four days. The most common clinical features of infection are fever , headache , and malaise , but encephalitis and viral hemorrhagic fever may also occur. The incubation period – the time between when infection occurs and when symptoms appear – varies from virus to virus, but is usually limited between 2 and 15 days for arboviruses. The majority of infections, however, are asymptomatic. Among cases in which symptoms do appear, symptoms tend to be non-specific, resembling a flu-like illness , and are not indicative of a specific causative agent. These symptoms include fever, headache, malaise, rash and fatigue. Rarely, vomiting and hemorrhagic fever may occur. The central nervous system can also be affected by infection, as encephalitis and meningitis are sometimes observed. Prognosis is good for most people, but is poor in those who develop severe symptoms, with up to a 20% mortality rate in this population depending on the virus. The very young, elderly, pregnant women, and people with immune deficiencies are more likely to develop severe symptoms. [ citation needed ]Arboviruses maintain themselves in nature by going through a cycle between a host , an organism that carries the virus, and a vector , an organism that carries and transmits the virus to other organisms. For arboviruses, vectors are commonly mosquitoes, ticks, sandflies and other arthropods that consume the blood of vertebrates for nutritious or developmental purposes. Vertebrates which have their blood consumed act as the hosts, with each vector generally having an affinity for the blood of specific species, making those species the hosts. Transmission between the vector and the host occurs when the vector feeds on the blood of the vertebrate, wherein the virus that has established an infection in the salivary glands of the vector comes into contact with the host's blood. While the virus is inside the host, it undergoes a process called amplification, where the virus replicates at sufficient levels to induce viremia , a condition in which there are large numbers of virions present in the blood. The abundance of virions in the host's blood allows the host to transmit the virus to other organisms if its blood is consumed by them. When uninfected vectors become infected from feeding, they are then capable of transmitting the virus to uninfected hosts, resuming amplification of virus populations. If viremia is not achieved in a vertebrate, the species can be called a "dead-end host", as the virus cannot be transmitted back to the vector. An example of this vector-host relationship can be observed in the transmission of the West Nile virus. Female mosquitoes of the genus Culex prefer to consume the blood of passerine birds, making them the hosts of the virus. When these birds are infected, the virus amplifies, potentially infecting multiple mosquitoes that feed on its blood. These infected mosquitoes may go on to further transmit the virus to more birds. If the mosquito is unable to find its preferred food source, it will choose another. Human blood is sometimes consumed, but since the West Nile virus does not replicate that well in mammals , humans are considered a dead-end host. Person-to-person transmission of arboviruses is not common, but can occur. Blood transfusions , organ transplantation , and the use of blood products can transmit arboviruses if the virus is present in the donor's blood or organs. Because of this, blood and organs are often screened for viruses before being administered. Rarely, vertical transmission , or mother-to-child transmission, has been observed in infected pregnant and breastfeeding women. Exposure to used needles may also transmit arboviruses if they have been used by an infected person or animal. This puts intravenous drug users and healthcare workers at risk for infection in regions where the arbovirus may be spreading in human populations. Arboviruses are a polyphyletic group , belonging to various viral genera and therefore exhibiting different virologic characteristics.Arboviruses maintain themselves in nature by going through a cycle between a host , an organism that carries the virus, and a vector , an organism that carries and transmits the virus to other organisms. For arboviruses, vectors are commonly mosquitoes, ticks, sandflies and other arthropods that consume the blood of vertebrates for nutritious or developmental purposes. Vertebrates which have their blood consumed act as the hosts, with each vector generally having an affinity for the blood of specific species, making those species the hosts. Transmission between the vector and the host occurs when the vector feeds on the blood of the vertebrate, wherein the virus that has established an infection in the salivary glands of the vector comes into contact with the host's blood. While the virus is inside the host, it undergoes a process called amplification, where the virus replicates at sufficient levels to induce viremia , a condition in which there are large numbers of virions present in the blood. The abundance of virions in the host's blood allows the host to transmit the virus to other organisms if its blood is consumed by them. When uninfected vectors become infected from feeding, they are then capable of transmitting the virus to uninfected hosts, resuming amplification of virus populations. If viremia is not achieved in a vertebrate, the species can be called a "dead-end host", as the virus cannot be transmitted back to the vector. An example of this vector-host relationship can be observed in the transmission of the West Nile virus. Female mosquitoes of the genus Culex prefer to consume the blood of passerine birds, making them the hosts of the virus. When these birds are infected, the virus amplifies, potentially infecting multiple mosquitoes that feed on its blood. These infected mosquitoes may go on to further transmit the virus to more birds. If the mosquito is unable to find its preferred food source, it will choose another. Human blood is sometimes consumed, but since the West Nile virus does not replicate that well in mammals , humans are considered a dead-end host. Person-to-person transmission of arboviruses is not common, but can occur. Blood transfusions , organ transplantation , and the use of blood products can transmit arboviruses if the virus is present in the donor's blood or organs. Because of this, blood and organs are often screened for viruses before being administered. Rarely, vertical transmission , or mother-to-child transmission, has been observed in infected pregnant and breastfeeding women. Exposure to used needles may also transmit arboviruses if they have been used by an infected person or animal. This puts intravenous drug users and healthcare workers at risk for infection in regions where the arbovirus may be spreading in human populations. Arboviruses are a polyphyletic group , belonging to various viral genera and therefore exhibiting different virologic characteristics.Preliminary diagnosis of arbovirus infection is usually based on clinical presentations of symptoms, places and dates of travel, activities, and epidemiological history of the location where infection occurred. Definitive diagnosis is typically made in a laboratory by employing some combination of blood tests , particularly immunologic , serologic and/or virologic techniques such as ELISA , complement fixation , polymerase chain reaction , neutralization test , and hemagglutination-inhibition test . In the past, arboviruses were organized into one of four groups: A, B, C, and D. Group A denoted members of the genus Alphavirus , Group B were members of the genus Flavivirus , and Group C remains as the Group C serogroup of the genus Orthobunyavirus . Group D was renamed in the mid-1950s to the Guama group and is currently the Guama serogroup in the genus Orthobunyavirus . Currently, viruses are jointly classified according to Baltimore classification and a virus-specific system based on standard biological classification . With the exception of the African swine fever virus , which belongs to the Asfarviridae family of viruses, all major clinically important arboviruses belong to one of the following four groups: [ citation needed ]In the past, arboviruses were organized into one of four groups: A, B, C, and D. Group A denoted members of the genus Alphavirus , Group B were members of the genus Flavivirus , and Group C remains as the Group C serogroup of the genus Orthobunyavirus . Group D was renamed in the mid-1950s to the Guama group and is currently the Guama serogroup in the genus Orthobunyavirus . Currently, viruses are jointly classified according to Baltimore classification and a virus-specific system based on standard biological classification . With the exception of the African swine fever virus , which belongs to the Asfarviridae family of viruses, all major clinically important arboviruses belong to one of the following four groups: [ citation needed ]Vector control measures, especially mosquito control , are essential to reducing the transmission of disease by arboviruses. Habitat control involves draining swamps and removal of other pools of stagnant water (such as old tires, large outdoor potted plants, empty cans, etc.) that often serve as breeding grounds for mosquitoes. Insecticides can be applied in rural and urban areas, inside houses and other buildings, or in outdoor environments. They are often quite effective for controlling arthropod populations, though use of some of these chemicals is controversial, and some organophosphates and organochlorides (such as DDT ) have been banned in many countries. Infertile male mosquitoes have been introduced in some areas in order to reduce the breeding rate of relevant mosquito species. Larvicides are also used worldwide in mosquito abatement programs. Temefos is a common mosquito larvicide. People can also reduce the risk of getting bitten by arthropods by employing personal protective measures such as sleeping under mosquito nets , wearing protective clothing , applying insect repellents such as permethrin and DEET to clothing and exposed skin, and (where possible) avoiding areas known to harbor high arthropod populations. Arboviral encephalitis can be prevented in two major ways: personal protective measures and public health measures to reduce the population of infected mosquitoes. Personal measures include reducing time outdoors particularly in early evening hours, wearing long pants and long sleeved shirts and applying mosquito repellent to exposed skin areas. Public health measures often require spraying of insecticides to kill juvenile (larvae) and adult mosquitoes. Vaccines are available for the following arboviral diseases: Vaccines are in development for the following arboviral diseases:Vaccines are available for the following arboviral diseases: Vaccines are in development for the following arboviral diseases:Because the arboviral encephalitides are viral diseases, antibiotics are not an effective form of treatment and no effective antiviral drugs have yet been discovered. Treatment is supportive, attempting to deal with problems such as swelling of the brain, loss of the automatic breathing activity of the brain and other treatable complications like bacterial pneumonia . The WHO caution against the use of aspirin and ibuprofen as they can increase the risk of bleeding. Most arboviruses are located in tropical areas, however as a group they have a global distribution. The warm climate conditions found in tropical areas allows for year-round transmission by the arthropod vectors. Other important factors determining geographic distribution of arthropod vectors include rainfall, humidity, and vegetation. Mapping methods such as GIS and GPS have allowed for spatial and temporal analyses of arboviruses. Tagging cases or breeding sites geographically has allowed for deeper examination of vector transmission. To see the epidemiology of specific arboviruses, the following resources hold maps, fact sheets, and reports on arboviruses and arboviral epidemics. The WHO also hosts DengueNet, a database which can be queried about Dengue cases. Arboviruses were not known to exist until the rise of modern medicine , with the germ theory and an understanding that viruses were distinct from other microorganisms . The connection between arthropods and disease was not postulated until 1881 when Cuban doctor and scientist Carlos Finlay proposed that yellow fever may be transmitted by mosquitoes instead of human contact, a reality that was verified by Major Walter Reed in 1901. The primary vector, Aedes aegypti , had spread globally from the 15th to the 19th centuries as a result of globalization and the slave trade . This geographic spreading caused dengue fever epidemics throughout the 18th and 19th centuries, and later, in 1906, transmission by the Aedes mosquitoes was confirmed, making yellow fever and dengue fever the first two diseases known to be caused by viruses. Thomas Milton Rivers published the first clear description of a virus as distinct from a bacterium in 1927. The discovery of the West Nile virus came in 1937, and has since been found in Culex populations causing epidemics throughout Africa , the Middle East , and Europe . The virus was introduced into the Western Hemisphere in 1999, sparking a series of epidemics. During the latter half of the 20th century, Dengue fever reemerged as a global disease, with the virus spreading geographically due to urbanization , population growth , increased international travel, and global warming , and continues to cause at least 50 million infections per year, making Dengue fever the most common and clinically important arboviral disease. Yellow fever , alongside malaria , was a major obstacle in the construction of the Panama Canal . French supervision of the project in the 1880s was unsuccessful because of these diseases, forcing the abandonment of the project in 1889. During the American effort to construct the canal in the early 1900s, William C. Gorgas , the Chief Sanitary Officer of Havana , was tasked with overseeing the health of the workers. He had past success in eradicating the disease in Florida and Havana by reducing mosquito populations through draining nearby pools of water, cutting grass, applying oil to the edges of ponds and swamps to kill larvae , and capturing adult mosquitoes that remained indoors during the daytime. Joseph Augustin LePrince , the Chief Sanitary Inspector of the Canal Zone , invented the first commercial larvicide , a mixture of carbolic acid , resin , and caustic soda , to be used throughout the Canal Zone . The combined implementation of these sanitation measures led to a dramatic decline in the number of workers dying and the eventual eradication of yellow fever in the Canal Zone as well as the containment of malaria during the 10-year construction period. Because of the success of these methods at preventing disease, they were adopted and improved upon in other regions of the world.

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Dengue fever

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Yoyogi Park

Yoyogi Park ( ä»£ã€ æœ¨å ¬åœ’ , Yoyogi kōen ) is a park in Shibuya , Tokyo , Japan. It is located adjacent to Harajuku Station and Meiji Shrine in Yoyogikamizonochō . The park is a popular Tokyo destination, especially on Sundays when it is used as a gathering place for Japanese rock music fans, jugglers, comedians, martial arts clubs, cosplayers and other subculture and hobby groups. In spring, thousands of people visit the park to enjoy the cherry blossom during hanami . The landscaped park has picnic areas, bike paths, cycle rentals, public sport courts, and a dog run. Yoyogi Park stands on the site from where the first successful powered aircraft flight in Japan took place by Captain Yoshitoshi Tokugawa on 19 December 1910. The area later became an army parade ground. From September 1945, the site became a U.S. officers housing area known as Washington Heights during the Allied occupation of Japan . The area was used for the 1964 Summer Olympics housing the main Olympic village and the Yoyogi National Gymnasium . The distinctive building, which was designed by Kenzo Tange , hosted swimming and diving , with an annex for basketball . In 1967 most of the area north of the gymnasium complex and south of Meiji Shrine was absorbed by Yoyogi Park. Tokyo's failed bid to host the 2016 Summer Olympics included a proposal to redevelop Yoyogi Park. A new volleyball arena was to be built west of the Yoyogi National Gymnasium . It would have replaced a small stadium with a football and athletics arena. Yoyogi National Gymnasium later served as the venue for handball events during the 2020 Summer Olympics . In 2014, Tokyo experienced one of its worst dengue fever outbreaks in 100 years and the first recorded cases in 70 years, with nearly 200 confirmed cases. The first case was reported on August 27, 2014. Using gene sequencing techniques, scientists determined that the outbreak originated in Yoyogi Park. Dozens of visitors to the area contracted the disease, leading to the park's closure on September 4. No further cases were discovered after September 18, and the park re-opened to the public on October 31. In 2014, Tokyo experienced one of its worst dengue fever outbreaks in 100 years and the first recorded cases in 70 years, with nearly 200 confirmed cases. The first case was reported on August 27, 2014. Using gene sequencing techniques, scientists determined that the outbreak originated in Yoyogi Park. Dozens of visitors to the area contracted the disease, leading to the park's closure on September 4. No further cases were discovered after September 18, and the park re-opened to the public on October 31.

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Dengue fever

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Continuous fever

Continuous fever is a type or pattern of fever in which temperature does not touch the baseline and remains above normal throughout the day. The variation between maximum and minimum temperature in 24 hours is less than 1°C (1.5°F). It usually occurs due to some infectious disease . Diagnosis of continuous fever is usually based on the clinical signs and symptoms but some biological tests, chest X-ray and CT scan are also used. Typhoid fever is an example of continuous fever and it shows a characteristic step-ladder pattern, a step-wise increase in temperature with a high plateau. Continuous fever is manifested in following diseases. Typhoid fever Fungal diseases.Management is usually symptomatic. Antipyretics like ibuprofen and paracetamol are used for lowering body temperature and body aches. Antibiotics are also recommended for treating infectious diseases. Antibiotics used in treatment of infectious diseases include chloramphenicol , cefotaxime , ciprofloxacin , gentamicin and amikacin .

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Dengue fever

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Yellow fever

Yellow fever is a viral disease of typically short duration . In most cases, symptoms include fever , chills , loss of appetite , nausea , muscle pains—particularly in the back—and headaches . Symptoms typically improve within five days. In about 15% of people, within a day of improving the fever comes back, abdominal pain occurs, and liver damage begins causing yellow skin . If this occurs, the risk of bleeding and kidney problems is increased. The disease is caused by the yellow fever virus and is spread by the bite of an infected mosquito . It infects humans, other primates , and several types of mosquitoes. In cities, it is spread primarily by Aedes aegypti , a type of mosquito found throughout the tropics and subtropics . The virus is an RNA virus of the genus Flavivirus . The disease may be difficult to tell apart from other illnesses, especially in the early stages. To confirm a suspected case, blood-sample testing with a polymerase chain reaction is required. A safe and effective vaccine against yellow fever exists, and some countries require vaccinations for travelers. Other efforts to prevent infection include reducing the population of the transmitting mosquitoes. In areas where yellow fever is common, early diagnosis of cases and immunization of large parts of the population are important to prevent outbreaks . Once a person is infected, management is symptomatic; no specific measures are effective against the virus. Death occurs in up to half of those who get severe disease. In 2013, yellow fever was estimated to have caused 130,000 severe infections and 78,000 deaths in Africa. Approximately 90 percent of an estimated 200,000 cases of yellow fever per year occur in Africa. Nearly a billion people live in an area of the world where the disease is common. It is common in tropical areas of the continents of South America and Africa, but not in Asia. Since the 1980s, the number of cases of yellow fever has been increasing. This is believed to be due to fewer people being immune, more people living in cities, people moving frequently, and changing climate increasing the habitat for mosquitoes. The disease originated in Africa and spread to the Americas starting in the 17th century with the European trafficking of enslaved Africans from sub-Saharan Africa. Since the 17th century, several major outbreaks of the disease have occurred in the Americas, Africa, and Europe. In the 18th and 19th centuries, yellow fever was considered one of the most dangerous infectious diseases ; numerous epidemics swept through major cities of the US and in other parts of the world. In 1927, yellow fever virus became the first human virus to be isolated. Yellow fever begins after an incubation period of three to six days. Most cases cause only mild infection with fever, headache, chills, back pain, fatigue, loss of appetite, muscle pain, nausea, and vomiting. In these cases, the infection lasts only three to six days. But in 15% of cases, people enter a second, toxic phase of the disease characterized by recurring fever, this time accompanied by jaundice due to liver damage , as well as abdominal pain . Bleeding in the mouth, nose, eyes, and the gastrointestinal tract cause vomit containing blood , hence one of the names in Spanish for yellow fever, vómito negro ("black vomit"). There may also be kidney failure, hiccups, and delirium. Among those who develop jaundice, the fatality rate is 20 to 50%, while the overall fatality rate is about 3 to 7.5%. Severe cases may have a mortality rate greater than 50%. Surviving the infection provides lifelong immunity , and normally results in no permanent organ damage. Yellow fever can lead to death for 20% to 50% of those who develop severe disease. Jaundice, fatigue, heart rhythm problems, seizures and internal bleeding may also appear as complications of yellow fever during recovery time. Yellow fever can lead to death for 20% to 50% of those who develop severe disease. Jaundice, fatigue, heart rhythm problems, seizures and internal bleeding may also appear as complications of yellow fever during recovery time. {| class="infobox biota" style="text-align: left; width: 200px; font-size: 100%" |- ! Yellow fever virus |- | |- | Flavivirus structure and genome |- |- |- |- ! Virus classification |- |(unranked): | Virus |- | Realm : | Riboviria |- |Kingdom: | Orthornavirae |- |Phylum: | Kitrinoviricota |- |Class: | Flasuviricetes |- |Order: | Amarillovirales |- |Family: | Flaviviridae |- |Genus: | Flavivirus |- | Species: | |- |- |- |- |- |- |- |- |- |- |- |- |- |- |- |} Yellow fever is caused by Yellow fever virus (YFV), an enveloped RNA virus 40–50 nm in width, the type species and namesake of the family Flaviviridae . It was the first illness shown to be transmissible by filtered human serum and transmitted by mosquitoes, by American doctor Walter Reed around 1900. The positive- sense , single-stranded RNA is around 10,862 nucleotides long and has a single open reading frame encoding a polyprotein . Host proteases cut this polyprotein into three structural (C, prM, E) and seven nonstructural proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, NS5); the enumeration corresponds to the arrangement of the protein coding genes in the genome . Minimal YFV 3 ′ UTR region is required for stalling of the host 5 ′ -3 ′ exonuclease XRN1. The UTR contains PKS3 pseudoknot structure, which serves as a molecular signal to stall the exonuclease and is the only viral requirement for subgenomic flavivirus RNA (sfRNA) production. The sfRNAs are a result of incomplete degradation of the viral genome by the exonuclease and are important for viral pathogenicity. Yellow fever belongs to the group of hemorrhagic fevers . The viruses infect, amongst others, monocytes , macrophages , Schwann cells , and dendritic cells . They attach to the cell surfaces via specific receptors and are taken up by an endosomal vesicle . Inside the endosome , the decreased pH induces the fusion of the endosomal membrane with the virus envelope . The capsid enters the cytosol , decays, and releases the genome. Receptor binding, as well as membrane fusion, are catalyzed by the protein E, which changes its conformation at low pH, causing a rearrangement of the 90 homo dimers to 60 homo trimers . After entering the host cell, the viral genome is replicated in the rough endoplasmic reticulum (ER) and in the so-called vesicle packets. At first, an immature form of the virus particle is produced inside the ER, whose M-protein is not yet cleaved to its mature form, so is denoted as precursor M (prM) and forms a complex with protein E. The immature particles are processed in the Golgi apparatus by the host protein furin , which cleaves prM to M. This releases E from the complex, which can now take its place in the mature, infectious virion . Yellow fever virus is mainly transmitted through the bite of the yellow fever mosquito Aedes aegypti , but other mostly Aedes mosquitoes such as the tiger mosquito ( Aedes albopictus ) can also serve as a vector for this virus. Like other arboviruses , which are transmitted by mosquitoes, yellow fever virus is taken up by a female mosquito when it ingests the blood of an infected human or another primate. Viruses reach the stomach of the mosquito, and if the virus concentration is high enough, the virions can infect epithelial cells and replicate there. From there, they reach the haemocoel (the blood system of mosquitoes) and from there the salivary glands . When the mosquito next sucks blood, it injects its saliva into the wound, and the virus reaches the bloodstream of the bitten person. Transovarial transmissionial and transstadial transmission of yellow fever virus within A. aegypti , that is, the transmission from a female mosquito to its eggs and then larvae, are indicated. This infection of vectors without a previous blood meal seems to play a role in single, sudden breakouts of the disease. Three epidemiologically different infectious cycles occur in which the virus is transmitted from mosquitoes to humans or other primates. In the "urban cycle", only the yellow fever mosquito A. aegypti is involved. It is well adapted to urban areas, and can also transmit other diseases, including Zika fever , dengue fever , and chikungunya . The urban cycle is responsible for the major outbreaks of yellow fever that occur in Africa. Except for an outbreak in Bolivia in 1999, this urban cycle no longer exists in South America. Besides the urban cycle, both in Africa and South America, a sylvatic cycle (forest or jungle cycle) is present, where Aedes africanus (in Africa) or mosquitoes of the genus Haemagogus and Sabethes (in South America) serve as vectors. In the jungle, the mosquitoes infect mainly nonhuman primates; the disease is mostly asymptomatic in African primates. In South America, the sylvatic cycle is currently the only way unvaccinated humans can become infected, which explains the low incidence of yellow fever cases on the continent. People who become infected in the jungle can carry the virus to urban areas, where A. aegypti acts as a vector. Because of this sylvatic cycle, yellow fever cannot be eradicated except by eradicating the mosquitoes that serve as vectors. In Africa, a third infectious cycle known as "savannah cycle" or intermediate cycle, occurs between the jungle and urban cycles. Different mosquitoes of the genus Aedes are involved. In recent years, this has been the most common form of transmission of yellow fever in Africa. Concern exists about yellow fever spreading to southeast Asia, where its vector A. aegypti already occurs. Yellow fever virus is mainly transmitted through the bite of the yellow fever mosquito Aedes aegypti , but other mostly Aedes mosquitoes such as the tiger mosquito ( Aedes albopictus ) can also serve as a vector for this virus. Like other arboviruses , which are transmitted by mosquitoes, yellow fever virus is taken up by a female mosquito when it ingests the blood of an infected human or another primate. Viruses reach the stomach of the mosquito, and if the virus concentration is high enough, the virions can infect epithelial cells and replicate there. From there, they reach the haemocoel (the blood system of mosquitoes) and from there the salivary glands . When the mosquito next sucks blood, it injects its saliva into the wound, and the virus reaches the bloodstream of the bitten person. Transovarial transmissionial and transstadial transmission of yellow fever virus within A. aegypti , that is, the transmission from a female mosquito to its eggs and then larvae, are indicated. This infection of vectors without a previous blood meal seems to play a role in single, sudden breakouts of the disease. Three epidemiologically different infectious cycles occur in which the virus is transmitted from mosquitoes to humans or other primates. In the "urban cycle", only the yellow fever mosquito A. aegypti is involved. It is well adapted to urban areas, and can also transmit other diseases, including Zika fever , dengue fever , and chikungunya . The urban cycle is responsible for the major outbreaks of yellow fever that occur in Africa. Except for an outbreak in Bolivia in 1999, this urban cycle no longer exists in South America. Besides the urban cycle, both in Africa and South America, a sylvatic cycle (forest or jungle cycle) is present, where Aedes africanus (in Africa) or mosquitoes of the genus Haemagogus and Sabethes (in South America) serve as vectors. In the jungle, the mosquitoes infect mainly nonhuman primates; the disease is mostly asymptomatic in African primates. In South America, the sylvatic cycle is currently the only way unvaccinated humans can become infected, which explains the low incidence of yellow fever cases on the continent. People who become infected in the jungle can carry the virus to urban areas, where A. aegypti acts as a vector. Because of this sylvatic cycle, yellow fever cannot be eradicated except by eradicating the mosquitoes that serve as vectors. In Africa, a third infectious cycle known as "savannah cycle" or intermediate cycle, occurs between the jungle and urban cycles. Different mosquitoes of the genus Aedes are involved. In recent years, this has been the most common form of transmission of yellow fever in Africa. Concern exists about yellow fever spreading to southeast Asia, where its vector A. aegypti already occurs. After transmission from a mosquito, the viruses replicate in the lymph nodes and infect dendritic cells in particular. From there, they reach the liver and infect hepatocytes (probably indirectly via Kupffer cells ), which leads to eosinophilic degradation of these cells and to the release of cytokines . Apoptotic masses known as Councilman bodies appear in the cytoplasm of hepatocytes. Fatality may occur when cytokine storm , shock , and multiple organ failure follow. Yellow fever is most frequently a clinical diagnosis , based on symptomatology and travel history. Mild cases of the disease can only be confirmed virologically. Since mild cases of yellow fever can also contribute significantly to regional outbreaks, every suspected case of yellow fever (involving symptoms of fever, pain, nausea, and vomiting 6–10 days after leaving the affected area) is treated seriously. If yellow fever is suspected, the virus cannot be confirmed until 6–10 days following the illness. A direct confirmation can be obtained by reverse transcription polymerase chain reaction , where the genome of the virus is amplified. Another direct approach is the isolation of the virus and its growth in cell culture using blood plasma ; this can take 1–4 weeks. Serologically, an enzyme-linked immunosorbent assay during the acute phase of the disease using specific IgM against yellow fever or an increase in specific IgG titer (compared to an earlier sample) can confirm yellow fever. Together with clinical symptoms, the detection of IgM or a four-fold increase in IgG titer is considered sufficient indication for yellow fever. As these tests can cross-react with other flaviviruses, such as dengue virus , these indirect methods cannot conclusively prove yellow fever infection. Liver biopsy can verify inflammation and necrosis of hepatocytes and detect viral antigens . Because of the bleeding tendency of yellow fever patients, a biopsy is only advisable post mortem to confirm the cause of death. In a differential diagnosis , infections with yellow fever must be distinguished from other feverish illnesses such as malaria . Other viral hemorrhagic fevers , such as Ebola virus , Lassa virus , Marburg virus , and Junin virus , must be excluded as the cause. Personal prevention of yellow fever includes vaccination and avoidance of mosquito bites in areas where yellow fever is endemic. Institutional measures for prevention of yellow fever include vaccination programmes and measures to control mosquitoes. Programmes for distribution of mosquito nets for use in homes produce reductions in cases of both malaria and yellow fever. Use of EPA-registered insect repellent is recommended when outdoors. Exposure for even a short time is enough for a potential mosquito bite. Long-sleeved clothing, long pants, and socks are useful for prevention. The application of larvicides to water-storage containers can help eliminate potential mosquito breeding sites. EPA-registered insecticide spray decreases the transmission of yellow fever. Vaccination is recommended for those traveling to affected areas, because non-native people tend to develop more severe illness when infected. Protection begins by the 10th day after vaccine administration in 95% of people, and had been reported to last for at least 10 years. The World Health Organization (WHO) now states that a single dose of vaccine is sufficient to confer lifelong immunity against yellow fever disease. The attenuated live vaccine stem 17D was developed in 1937 by Max Theiler . The WHO recommends routine vaccination for people living in affected areas between the 9th and 12th month after birth. Up to one in four people experience fever, aches, and local soreness and redness at the site of injection. In rare cases (less than one in 200,000 to 300,000), the vaccination can cause yellow fever vaccine-associated viscerotropic disease, which is fatal in 60% of cases. It is probably due to the genetic morphology of the immune system. Another possible side effect is an infection of the nervous system, which occurs in one in 200,000 to 300,000 cases, causing yellow fever vaccine-associated neurotropic disease, which can lead to meningoencephalitis and is fatal in less than 5% of cases. The Yellow Fever Initiative, launched by the WHO in 2006, vaccinated more than 105 million people in 14 countries in West Africa. No outbreaks were reported during 2015. The campaign was supported by the GAVI alliance and governmental organizations in Europe and Africa. According to the WHO, mass vaccination cannot eliminate yellow fever because of the vast number of infected mosquitoes in urban areas of the target countries, but it will significantly reduce the number of people infected. Demand for yellow fever vaccine has continued to increase due to the growing number of countries implementing yellow fever vaccination as part of their routine immunization programmes. Recent upsurges in yellow fever outbreaks in Angola (2015), the Democratic Republic of Congo (2016), Uganda (2016), and more recently in Nigeria and Brazil in 2017 have further increased demand, while straining global vaccine supply. Therefore, to vaccinate susceptible populations in preventive mass immunization campaigns during outbreaks, fractional dosing of the vaccine is being considered as a dose-sparing strategy to maximize limited vaccine supplies. Fractional dose yellow fever vaccination refers to administration of a reduced volume of vaccine dose, which has been reconstituted as per manufacturer recommendations. The first practical use of fractional dose yellow fever vaccination was in response to a large yellow fever outbreak in the Democratic Republic of the Congo in mid-2016. Available evidence shows that fractional dose yellow fever vaccination induces a level of immune response similar to that of the standard full dose. In March 2017, the WHO launched a vaccination campaign in Brazil with 3.5 million doses from an emergency stockpile. In March 2017 the WHO recommended vaccination for travellers to certain parts of Brazil. In March 2018, Brazil shifted its policy and announced it planned to vaccinate all 77.5 million currently unvaccinated citizens by April 2019. Some countries in Asia are considered to be potentially in danger of yellow fever epidemics, as both mosquitoes with the capability to transmit yellow fever as well as susceptible monkeys are present. The disease does not yet occur in Asia. To prevent introduction of the virus, some countries demand previous vaccination of foreign visitors who have passed through yellow fever areas. Vaccination has to be proved by a vaccination certificate, which is valid 10 days after the vaccination and lasts for 10 years. Although the WHO on 17 May 2013 advised that subsequent booster vaccinations are unnecessary, an older (than 10 years) certificate may not be acceptable at all border posts in all affected countries. A list of the countries that require yellow fever vaccination is published by the WHO. If the vaccination cannot be given for some reason, dispensation may be possible. In this case, an exemption certificate issued by a WHO-approved vaccination center is required. Although 32 of 44 countries where yellow fever occurs endemically do have vaccination programmes, in many of these countries, less than 50% of their population is vaccinated. Control of the yellow fever mosquito A. aegypti is of major importance, especially because the same mosquito can also transmit dengue fever and chikungunya disease. A. aegypti breeds preferentially in water, for example, in installations by inhabitants of areas with precarious drinking water supplies, or in domestic refuse, especially tires, cans, and plastic bottles. These conditions are common in urban areas in developing countries. Two main strategies are employed to reduce A. aegypti populations. One approach is to kill the developing larvae. Measures are taken to reduce the water accumulations in which the larvae develop. Larvicides are used, along with larvae-eating fish and copepods , which reduce the number of larvae. For many years, copepods of the genus Mesocyclops have been used in Vietnam for preventing dengue fever. This eradicated the mosquito vector in several areas. Similar efforts may prove effective against yellow fever. Pyriproxyfen is recommended as a chemical larvicide, mainly because it is safe for humans and effective in small doses. The second strategy is to reduce populations of the adult yellow fever mosquito. Lethal ovitraps can reduce Aedes populations, using lesser amounts of pesticide because it targets the pest directly. Curtains and lids of water tanks can be sprayed with insecticides, but application inside houses is not recommended by the WHO. Insecticide-treated mosquito nets are effective, just as they are against the Anopheles mosquito that carries malaria. Vaccination is recommended for those traveling to affected areas, because non-native people tend to develop more severe illness when infected. Protection begins by the 10th day after vaccine administration in 95% of people, and had been reported to last for at least 10 years. The World Health Organization (WHO) now states that a single dose of vaccine is sufficient to confer lifelong immunity against yellow fever disease. The attenuated live vaccine stem 17D was developed in 1937 by Max Theiler . The WHO recommends routine vaccination for people living in affected areas between the 9th and 12th month after birth. Up to one in four people experience fever, aches, and local soreness and redness at the site of injection. In rare cases (less than one in 200,000 to 300,000), the vaccination can cause yellow fever vaccine-associated viscerotropic disease, which is fatal in 60% of cases. It is probably due to the genetic morphology of the immune system. Another possible side effect is an infection of the nervous system, which occurs in one in 200,000 to 300,000 cases, causing yellow fever vaccine-associated neurotropic disease, which can lead to meningoencephalitis and is fatal in less than 5% of cases. The Yellow Fever Initiative, launched by the WHO in 2006, vaccinated more than 105 million people in 14 countries in West Africa. No outbreaks were reported during 2015. The campaign was supported by the GAVI alliance and governmental organizations in Europe and Africa. According to the WHO, mass vaccination cannot eliminate yellow fever because of the vast number of infected mosquitoes in urban areas of the target countries, but it will significantly reduce the number of people infected. Demand for yellow fever vaccine has continued to increase due to the growing number of countries implementing yellow fever vaccination as part of their routine immunization programmes. Recent upsurges in yellow fever outbreaks in Angola (2015), the Democratic Republic of Congo (2016), Uganda (2016), and more recently in Nigeria and Brazil in 2017 have further increased demand, while straining global vaccine supply. Therefore, to vaccinate susceptible populations in preventive mass immunization campaigns during outbreaks, fractional dosing of the vaccine is being considered as a dose-sparing strategy to maximize limited vaccine supplies. Fractional dose yellow fever vaccination refers to administration of a reduced volume of vaccine dose, which has been reconstituted as per manufacturer recommendations. The first practical use of fractional dose yellow fever vaccination was in response to a large yellow fever outbreak in the Democratic Republic of the Congo in mid-2016. Available evidence shows that fractional dose yellow fever vaccination induces a level of immune response similar to that of the standard full dose. In March 2017, the WHO launched a vaccination campaign in Brazil with 3.5 million doses from an emergency stockpile. In March 2017 the WHO recommended vaccination for travellers to certain parts of Brazil. In March 2018, Brazil shifted its policy and announced it planned to vaccinate all 77.5 million currently unvaccinated citizens by April 2019. Some countries in Asia are considered to be potentially in danger of yellow fever epidemics, as both mosquitoes with the capability to transmit yellow fever as well as susceptible monkeys are present. The disease does not yet occur in Asia. To prevent introduction of the virus, some countries demand previous vaccination of foreign visitors who have passed through yellow fever areas. Vaccination has to be proved by a vaccination certificate, which is valid 10 days after the vaccination and lasts for 10 years. Although the WHO on 17 May 2013 advised that subsequent booster vaccinations are unnecessary, an older (than 10 years) certificate may not be acceptable at all border posts in all affected countries. A list of the countries that require yellow fever vaccination is published by the WHO. If the vaccination cannot be given for some reason, dispensation may be possible. In this case, an exemption certificate issued by a WHO-approved vaccination center is required. Although 32 of 44 countries where yellow fever occurs endemically do have vaccination programmes, in many of these countries, less than 50% of their population is vaccinated. Some countries in Asia are considered to be potentially in danger of yellow fever epidemics, as both mosquitoes with the capability to transmit yellow fever as well as susceptible monkeys are present. The disease does not yet occur in Asia. To prevent introduction of the virus, some countries demand previous vaccination of foreign visitors who have passed through yellow fever areas. Vaccination has to be proved by a vaccination certificate, which is valid 10 days after the vaccination and lasts for 10 years. Although the WHO on 17 May 2013 advised that subsequent booster vaccinations are unnecessary, an older (than 10 years) certificate may not be acceptable at all border posts in all affected countries. A list of the countries that require yellow fever vaccination is published by the WHO. If the vaccination cannot be given for some reason, dispensation may be possible. In this case, an exemption certificate issued by a WHO-approved vaccination center is required. Although 32 of 44 countries where yellow fever occurs endemically do have vaccination programmes, in many of these countries, less than 50% of their population is vaccinated. Control of the yellow fever mosquito A. aegypti is of major importance, especially because the same mosquito can also transmit dengue fever and chikungunya disease. A. aegypti breeds preferentially in water, for example, in installations by inhabitants of areas with precarious drinking water supplies, or in domestic refuse, especially tires, cans, and plastic bottles. These conditions are common in urban areas in developing countries. Two main strategies are employed to reduce A. aegypti populations. One approach is to kill the developing larvae. Measures are taken to reduce the water accumulations in which the larvae develop. Larvicides are used, along with larvae-eating fish and copepods , which reduce the number of larvae. For many years, copepods of the genus Mesocyclops have been used in Vietnam for preventing dengue fever. This eradicated the mosquito vector in several areas. Similar efforts may prove effective against yellow fever. Pyriproxyfen is recommended as a chemical larvicide, mainly because it is safe for humans and effective in small doses. The second strategy is to reduce populations of the adult yellow fever mosquito. Lethal ovitraps can reduce Aedes populations, using lesser amounts of pesticide because it targets the pest directly. Curtains and lids of water tanks can be sprayed with insecticides, but application inside houses is not recommended by the WHO. Insecticide-treated mosquito nets are effective, just as they are against the Anopheles mosquito that carries malaria. As with other Flavivirus infections, no cure is known for yellow fever. Hospitalization is advisable and intensive care may be necessary because of rapid deterioration in some cases. Certain acute treatment methods lack efficacy: passive immunization after the emergence of symptoms is probably without effect; ribavirin and other antiviral drugs , as well as treatment with interferons , are ineffective in yellow fever patients. Symptomatic treatment includes rehydration and pain relief with drugs such as paracetamol (acetaminophen). However, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are often avoided because of an increased risk of gastrointestinal bleeding due to their anticoagulant effects. Yellow fever is common in tropical and subtropical areas of South America and Africa. Worldwide, about 600 million people live in endemic areas. The WHO estimates 200,000 cases of yellow fever worldwide each year. About 15% of people infected with yellow fever progress to a severe form of the illness, and up to half of those will die, as there is no cure for yellow fever. An estimated 90% of yellow fever infections occur on the African continent. In 2016, a large outbreak originated in Angola and spread to neighboring countries before being contained by a massive vaccination campaign. In March and April 2016, 11 imported cases of the Angola genotype in unvaccinated Chinese nationals were reported in China, the first appearance of the disease in Asia in recorded history. Phylogenetic analysis has identified seven genotypes of yellow fever viruses, and they are assumed to be differently adapted to humans and to the vector A. aegypti . Five genotypes (Angola, Central/East Africa, East Africa, West Africa I, and West Africa II) occur only in Africa. West Africa genotype I is found in Nigeria and the surrounding region. West Africa genotype I appears to be especially infectious, as it is often associated with major outbreaks. The three genotypes found outside of Nigeria and Angola occur in areas where outbreaks are rare. Two outbreaks, in Kenya (1992–1993) and Sudan (2003 and 2005), involved the East African genotype, which had remained undetected in the previous 40 years. In South America, two genotypes have been identified (South American genotypes I and II). Based on phylogenetic analysis these two genotypes appear to have originated in West Africa and were first introduced into Brazil. The date of introduction of the predecessor African genotype which gave rise to the South American genotypes appears to be 1822 (95% confidence interval 1701 to 1911). The historical record shows an outbreak of yellow fever occurred in Recife, Brazil, between 1685 and 1690. The disease seems to have disappeared, with the next outbreak occurring in 1849. It was likely introduced with the trafficking of slaves through the slave trade from Africa. Genotype I has been divided into five subclades, A through E. In late 2016, a large outbreak began in Minas Gerais state of Brazil that was characterized as a sylvatic or jungle epizootic . Real-time phylogenetic investigations at the epicentre of the outbreak revealed that the outbreak was caused by the introduction of a virus lineage from the Amazon region into the southeast region around July 2016, spreading rapidly across several neotropical monkey species, including brown howler monkeys, which serve as a sentinel species for yellow fever. No cases had been transmitted between humans by the A. aegypti mosquito, which can sustain urban outbreaks that can spread rapidly. In April 2017, the sylvatic outbreak continued moving toward the Brazilian coast, where most people were unvaccinated. By the end of May the outbreak appeared to be declining after more than 3,000 suspected cases, 758 confirmed and 264 deaths confirmed to be yellow fever. The Health Ministry launched a vaccination campaign and was concerned about spread during the Carnival season in February and March. The CDC issued a Level 2 alert (practice enhanced precautions.) A Bayesian analysis of genotypes I and II has shown that genotype I accounts for virtually all the current infections in Brazil , Colombia , Venezuela , and Trinidad and Tobago , while genotype II accounted for all cases in Peru . Genotype I originated in the northern Brazilian region around 1908 (95% highest posterior density interval [HPD]: 1870–1936). Genotype II originated in Peru in 1920 (95% HPD: 1867–1958). The estimated rate of mutation for both genotypes was about 5 × 10 −4 substitutions/site/year, similar to that of other RNA viruses. The main vector ( A. aegypti ) also occurs in tropical and subtropical regions of Asia, the Pacific, and Australia, but yellow fever had never occurred there until jet travel introduced 11 cases from the 2016 Angola and DR Congo yellow fever outbreak in Africa. Proposed explanations include: But none is considered satisfactory. Another proposal is the absence of a slave trade to Asia on the scale of that to the Americas. The trans-Atlantic slave trade probably introduced yellow fever into the Western Hemisphere from Africa. An estimated 90% of yellow fever infections occur on the African continent. In 2016, a large outbreak originated in Angola and spread to neighboring countries before being contained by a massive vaccination campaign. In March and April 2016, 11 imported cases of the Angola genotype in unvaccinated Chinese nationals were reported in China, the first appearance of the disease in Asia in recorded history. Phylogenetic analysis has identified seven genotypes of yellow fever viruses, and they are assumed to be differently adapted to humans and to the vector A. aegypti . Five genotypes (Angola, Central/East Africa, East Africa, West Africa I, and West Africa II) occur only in Africa. West Africa genotype I is found in Nigeria and the surrounding region. West Africa genotype I appears to be especially infectious, as it is often associated with major outbreaks. The three genotypes found outside of Nigeria and Angola occur in areas where outbreaks are rare. Two outbreaks, in Kenya (1992–1993) and Sudan (2003 and 2005), involved the East African genotype, which had remained undetected in the previous 40 years. In South America, two genotypes have been identified (South American genotypes I and II). Based on phylogenetic analysis these two genotypes appear to have originated in West Africa and were first introduced into Brazil. The date of introduction of the predecessor African genotype which gave rise to the South American genotypes appears to be 1822 (95% confidence interval 1701 to 1911). The historical record shows an outbreak of yellow fever occurred in Recife, Brazil, between 1685 and 1690. The disease seems to have disappeared, with the next outbreak occurring in 1849. It was likely introduced with the trafficking of slaves through the slave trade from Africa. Genotype I has been divided into five subclades, A through E. In late 2016, a large outbreak began in Minas Gerais state of Brazil that was characterized as a sylvatic or jungle epizootic . Real-time phylogenetic investigations at the epicentre of the outbreak revealed that the outbreak was caused by the introduction of a virus lineage from the Amazon region into the southeast region around July 2016, spreading rapidly across several neotropical monkey species, including brown howler monkeys, which serve as a sentinel species for yellow fever. No cases had been transmitted between humans by the A. aegypti mosquito, which can sustain urban outbreaks that can spread rapidly. In April 2017, the sylvatic outbreak continued moving toward the Brazilian coast, where most people were unvaccinated. By the end of May the outbreak appeared to be declining after more than 3,000 suspected cases, 758 confirmed and 264 deaths confirmed to be yellow fever. The Health Ministry launched a vaccination campaign and was concerned about spread during the Carnival season in February and March. The CDC issued a Level 2 alert (practice enhanced precautions.) A Bayesian analysis of genotypes I and II has shown that genotype I accounts for virtually all the current infections in Brazil , Colombia , Venezuela , and Trinidad and Tobago , while genotype II accounted for all cases in Peru . Genotype I originated in the northern Brazilian region around 1908 (95% highest posterior density interval [HPD]: 1870–1936). Genotype II originated in Peru in 1920 (95% HPD: 1867–1958). The estimated rate of mutation for both genotypes was about 5 × 10 −4 substitutions/site/year, similar to that of other RNA viruses. The main vector ( A. aegypti ) also occurs in tropical and subtropical regions of Asia, the Pacific, and Australia, but yellow fever had never occurred there until jet travel introduced 11 cases from the 2016 Angola and DR Congo yellow fever outbreak in Africa. Proposed explanations include: But none is considered satisfactory. Another proposal is the absence of a slave trade to Asia on the scale of that to the Americas. The trans-Atlantic slave trade probably introduced yellow fever into the Western Hemisphere from Africa. The evolutionary origins of yellow fever most likely lie in Africa, with transmission of the disease from nonhuman primates to humans. The virus is thought to have originated in East or Central Africa and spread from there to West Africa. As it was endemic in Africa, local populations had developed some immunity to it. When an outbreak of yellow fever would occur in an African community where colonists resided, most Europeans died, while the indigenous Africans usually developed nonlethal symptoms resembling influenza . This phenomenon, in which certain populations develop immunity to yellow fever due to prolonged exposure in their childhood, is known as acquired immunity . The virus, as well as the vector A. aegypti, were probably transferred to North and South America with the trafficking of slaves from Africa, part of the Columbian exchange following European exploration and colonization. However, some researchers have argued that yellow fever might have existed in the Americas during the pre-Columbian period as mosquitoes of the genus Haemagogus , which is indigenous to the Americas, have been known to carry the disease. The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados . An outbreak was recorded by Spanish colonists in 1648 in the Yucatán Peninsula , where the indigenous Mayan people called the illness xekik ("blood vomit"). In 1685, Brazil suffered its first epidemic in Recife . The first mention of the disease by the name "yellow fever" occurred in 1744. However, Dr. Mitchell misdiagnosed the disease that he observed and treated, and the disease was probably Weil's disease or hepatitis. McNeill argues that the environmental and ecological disruption caused by the introduction of sugar plantations created the conditions for mosquito and viral reproduction, and subsequent outbreaks of yellow fever. Deforestation reduced populations of insectivorous birds and other creatures that fed on mosquitoes and their eggs. In Colonial times and during the Napoleonic Wars , the West Indies were known as a particularly dangerous posting for soldiers due to yellow fever being endemic in the area. The mortality rate in British garrisons in Jamaica was seven times that of garrisons in Canada, mostly because of yellow fever and other tropical diseases. Both English and French forces posted there were seriously affected by the "yellow jack" . Wanting to regain control of the lucrative sugar trade in Saint-Domingue (Hispaniola), and with an eye on regaining France's New World empire, Napoleon sent an army under the command of his brother-in-law General Charles Leclerc to Saint-Domingue to seize control after a slave revolt. The historian J. R. McNeill asserts that yellow fever accounted for about 35,000 to 45,000 casualties of these forces during the fighting. Only one third of the French troops survived for withdrawal and return to France. Napoleon gave up on the island and his plans for North America, selling the Louisiana Purchase to the US in 1803. In 1804, Haiti proclaimed its independence as the second republic in the Western Hemisphere. Considerable debate exists over whether the number of deaths caused by disease in the Haitian Revolution was exaggerated. Although yellow fever is most prevalent in tropical-like climates, the northern United States were not exempted from the fever. The first outbreak in English-speaking North America occurred in New York City in 1668. English colonists in Philadelphia and the French in the Mississippi River Valley recorded major outbreaks in 1669, as well as additional yellow fever epidemics in Philadelphia, Baltimore , and New York City in the 18th and 19th centuries. The disease traveled along steamboat routes from New Orleans, causing some 100,000–150,000 deaths in total. The yellow fever epidemic of 1793 in Philadelphia, which was then the capital of the United States, resulted in the deaths of several thousand people, more than 9% of the population. One of these deaths was James Hutchinson , a physician helping to treat the population of the city. The national government fled the city to Trenton, New Jersey, including President George Washington . The southern city of New Orleans was plagued with major epidemics during the 19th century, most notably in 1833 and 1853. A major epidemic occurred in both New Orleans and Shreveport, Louisiana in 1873. Its residents called the disease "yellow jack". Urban epidemics continued in the United States until 1905, with the last outbreak affecting New Orleans. At least 25 major outbreaks took place in the Americas during the 18th and 19th centuries, including particularly serious ones in Cartagena, Chile , in 1741; Cuba in 1762 and 1900; Santo Domingo in 1803; and Memphis, Tennessee , in 1878. In the early 19th century, the prevalence of yellow fever in the Caribbean "led to serious health problems" and alarmed the United States Navy as numerous deaths and sickness curtailed naval operations and destroyed morale. One episode began in April 1822 when the frigate USS Macedonian left Boston and became part of Commodore James Biddle's West India Squadron. Unbeknownst to all, they were about to embark on a cruise to disaster and their assignment "would prove a cruise through hell". Secretary of the Navy Smith Thompson had assigned the squadron to guard United States merchant shipping and suppress piracy. During their time on deployment from 26 May to 3 August 1822, 76 of the Macedonian's officers and men died, including John Cadle, surgeon USN. Seventy-four of these deaths were attributed to yellow fever. Biddle reported that another 52 of his crew were on sick-list. In their report to the secretary of the Navy, Biddle and Surgeon's Mate Charles Chase stated the cause as "fever". As a consequence of this loss, Biddle noted that his squadron was forced to return to Norfolk Navy Yard early. Upon arrival, the Macedonian's crew were provided medical care and quarantined at Craney Island, Virginia. In 1853, Cloutierville, Louisiana , had a late-summer outbreak of yellow fever that quickly killed 68 of the 91 inhabitants. A local doctor concluded that some unspecified infectious agent had arrived in a package from New Orleans. In 1854, 650 residents of Savannah, Georgia , died from yellow fever. In 1858, St. Matthew's German Evangelical Lutheran Church in Charleston, South Carolina , had 308 yellow fever deaths, reducing the congregation by half. A ship carrying persons infected with the virus arrived in Hampton Roads in southeastern Virginia in June 1855. The disease spread quickly through the community, eventually killing over 3,000 people, mostly residents of Norfolk and Portsmouth . In 1873, Shreveport, Louisiana , lost 759 citizens in an 80-day period to a yellow fever epidemic, with over 400 additional victims eventually succumbing. The total death toll from August through November was approximately 1,200. In 1878, about 20,000 people died in a widespread epidemic in the Mississippi River Valley. That year, Memphis had an unusually large amount of rain, which led to an increase in the mosquito population. The result was a huge epidemic of yellow fever. The steamship John D. Porter took people fleeing Memphis northward in hopes of escaping the disease, but passengers were not allowed to disembark due to concerns of spreading yellow fever. The ship roamed the Mississippi River for the next two months before unloading her passengers. Major outbreaks have also occurred in southern Europe. Gibraltar lost many lives to outbreaks in 1804, 1814, and 1828. Barcelona suffered the loss of several thousand citizens during an outbreak in 1821. The Duke de Richelieu deployed 30,000 French troops to the border between France and Spain in the Pyrenees Mountains , to establish a cordon sanitaire in order to prevent the epidemic from spreading from Spain into France. Ezekiel Stone Wiggins , known as the Ottawa Prophet, proposed that the cause of a yellow fever epidemic in Jacksonville, Florida , in 1888, was astrological. The planets were in the same line as the sun and earth and this produced, besides Cyclones, Earthquakes, etc., a denser atmosphere holding more carbon and creating microbes. Mars had an uncommonly dense atmosphere, but its inhabitants were probably protected from the fever by their newly discovered canals , which were perhaps made to absorb carbon and prevent the disease. In 1848, Josiah C. Nott suggested that yellow fever was spread by insects such as moths or mosquitoes, basing his ideas on the pattern of transmission of the disease. Carlos Finlay , a Cuban-Spanish doctor and scientist, proposed in 1881 that yellow fever might be transmitted by previously infected mosquitoes rather than by direct contact from person to person, as had long been believed. Since the losses from yellow fever in the Spanish–American War in the 1890s were extremely high, U.S. Army doctors began research experiments with a team led by Walter Reed , and composed of doctors James Carroll , Aristides Agramonte , and Jesse William Lazear . They successfully proved Finlay's "mosquito hypothesis". Yellow fever was the first virus shown to be transmitted by mosquitoes. The physician William Gorgas applied these insights and eradicated yellow fever from Havana . He also campaigned against yellow fever during the construction of the Panama Canal . A previous effort of canal building by the French had failed in part due to mortality from the high incidence of yellow fever and malaria, which killed many workers. Although Reed has received much of the credit in United States history books for "beating" yellow fever, he had fully credited Finlay with the discovery of the yellow fever vector, and how it might be controlled. Reed often cited Finlay's papers in his own articles, and also credited him for the discovery in his personal correspondence. The acceptance of Finlay's work was one of the most important and far-reaching effects of the U.S. Army Yellow Fever Commission of 1900. Applying methods first suggested by Finlay, the United States government and Army eradicated yellow fever in Cuba and later in Panama, allowing completion of the Panama Canal. While Reed built on the research of Finlay, historian François Delaporte notes that yellow fever research was a contentious issue. Scientists, including Finlay and Reed, became successful by building on the work of less prominent scientists, without always giving them the credit they were due. Reed's research was essential in the fight against yellow fever. He is also credited for using the first type of medical consent form during his experiments in Cuba, an attempt to ensure that participants knew they were taking a risk by being part of testing. Like Cuba and Panama, Brazil also led a highly successful sanitation campaign against mosquitoes and yellow fever. Beginning in 1903, the campaign led by Oswaldo Cruz , then director general of public health, resulted not only in eradicating the disease but also in reshaping the physical landscape of Brazilian cities such as Rio de Janeiro. During rainy seasons, Rio de Janeiro had regularly suffered floods, as water from the bay surrounding the city overflowed into Rio's narrow streets. Coupled with the poor drainage systems found throughout Rio, this created swampy conditions in the city's neighborhoods. Pools of stagnant water stood year-long in city streets and proved to be a fertile ground for disease-carrying mosquitoes. Thus, under Cruz's direction, public health units known as "mosquito inspectors" fiercely worked to combat yellow fever throughout Rio by spraying, exterminating rats, improving drainage, and destroying unsanitary housing. Ultimately, the city's sanitation and renovation campaigns reshaped Rio de Janeiro's neighborhoods. Its poor residents were pushed from city centers to Rio's suburbs, or to towns found in the outskirts of the city. In later years, Rio's most impoverished inhabitants would come to reside in favelas . During 1920–1923, the Rockefeller Foundation 's International Health Board undertook an expensive and successful yellow fever eradication campaign in Mexico. The IHB gained the respect of Mexico's federal government because of the success. The eradication of yellow fever strengthened the relationship between the US and Mexico, which had not been very good in the years prior. The eradication of yellow fever was also a major step toward better global health. In 1927, scientists isolated the yellow fever virus in West Africa. Following this, two vaccines were developed in the 1930s. Max Theiler led the completion of the 17D yellow fever vaccine in 1937, for which he was subsequently awarded the Nobel Prize in Physiology or Medicine . That vaccine, 17D, is still in use, although newer vaccines, based on vero cells , are in development (as of 2018). Using vector control and strict vaccination programs, the urban cycle of yellow fever was nearly eradicated from South America. Since 1943, only a single urban outbreak in Santa Cruz de la Sierra , Bolivia, has occurred. Since the 1980s, however, the number of yellow fever cases has been increasing again, and A. aegypti has returned to the urban centers of South America. This is partly due to limitations on available insecticides, as well as habitat dislocations caused by climate change. It is also because the vector control program was abandoned. Although no new urban cycle has yet been established, scientists believe this could happen again at any point. An outbreak in Paraguay in 2008 was thought to be urban in nature, but this ultimately proved not to be the case. In Africa, virus eradication programs have mostly relied upon vaccination. These programs have largely been unsuccessful because they were unable to break the sylvatic cycle involving wild primates. With few countries establishing regular vaccination programs, measures to fight yellow fever have been neglected, making the future spread of the virus more likely. The evolutionary origins of yellow fever most likely lie in Africa, with transmission of the disease from nonhuman primates to humans. The virus is thought to have originated in East or Central Africa and spread from there to West Africa. As it was endemic in Africa, local populations had developed some immunity to it. When an outbreak of yellow fever would occur in an African community where colonists resided, most Europeans died, while the indigenous Africans usually developed nonlethal symptoms resembling influenza . This phenomenon, in which certain populations develop immunity to yellow fever due to prolonged exposure in their childhood, is known as acquired immunity . The virus, as well as the vector A. aegypti, were probably transferred to North and South America with the trafficking of slaves from Africa, part of the Columbian exchange following European exploration and colonization. However, some researchers have argued that yellow fever might have existed in the Americas during the pre-Columbian period as mosquitoes of the genus Haemagogus , which is indigenous to the Americas, have been known to carry the disease. The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados . An outbreak was recorded by Spanish colonists in 1648 in the Yucatán Peninsula , where the indigenous Mayan people called the illness xekik ("blood vomit"). In 1685, Brazil suffered its first epidemic in Recife . The first mention of the disease by the name "yellow fever" occurred in 1744. However, Dr. Mitchell misdiagnosed the disease that he observed and treated, and the disease was probably Weil's disease or hepatitis. McNeill argues that the environmental and ecological disruption caused by the introduction of sugar plantations created the conditions for mosquito and viral reproduction, and subsequent outbreaks of yellow fever. Deforestation reduced populations of insectivorous birds and other creatures that fed on mosquitoes and their eggs. In Colonial times and during the Napoleonic Wars , the West Indies were known as a particularly dangerous posting for soldiers due to yellow fever being endemic in the area. The mortality rate in British garrisons in Jamaica was seven times that of garrisons in Canada, mostly because of yellow fever and other tropical diseases. Both English and French forces posted there were seriously affected by the "yellow jack" . Wanting to regain control of the lucrative sugar trade in Saint-Domingue (Hispaniola), and with an eye on regaining France's New World empire, Napoleon sent an army under the command of his brother-in-law General Charles Leclerc to Saint-Domingue to seize control after a slave revolt. The historian J. R. McNeill asserts that yellow fever accounted for about 35,000 to 45,000 casualties of these forces during the fighting. Only one third of the French troops survived for withdrawal and return to France. Napoleon gave up on the island and his plans for North America, selling the Louisiana Purchase to the US in 1803. In 1804, Haiti proclaimed its independence as the second republic in the Western Hemisphere. Considerable debate exists over whether the number of deaths caused by disease in the Haitian Revolution was exaggerated. Although yellow fever is most prevalent in tropical-like climates, the northern United States were not exempted from the fever. The first outbreak in English-speaking North America occurred in New York City in 1668. English colonists in Philadelphia and the French in the Mississippi River Valley recorded major outbreaks in 1669, as well as additional yellow fever epidemics in Philadelphia, Baltimore , and New York City in the 18th and 19th centuries. The disease traveled along steamboat routes from New Orleans, causing some 100,000–150,000 deaths in total. The yellow fever epidemic of 1793 in Philadelphia, which was then the capital of the United States, resulted in the deaths of several thousand people, more than 9% of the population. One of these deaths was James Hutchinson , a physician helping to treat the population of the city. The national government fled the city to Trenton, New Jersey, including President George Washington . The southern city of New Orleans was plagued with major epidemics during the 19th century, most notably in 1833 and 1853. A major epidemic occurred in both New Orleans and Shreveport, Louisiana in 1873. Its residents called the disease "yellow jack". Urban epidemics continued in the United States until 1905, with the last outbreak affecting New Orleans. At least 25 major outbreaks took place in the Americas during the 18th and 19th centuries, including particularly serious ones in Cartagena, Chile , in 1741; Cuba in 1762 and 1900; Santo Domingo in 1803; and Memphis, Tennessee , in 1878. In the early 19th century, the prevalence of yellow fever in the Caribbean "led to serious health problems" and alarmed the United States Navy as numerous deaths and sickness curtailed naval operations and destroyed morale. One episode began in April 1822 when the frigate USS Macedonian left Boston and became part of Commodore James Biddle's West India Squadron. Unbeknownst to all, they were about to embark on a cruise to disaster and their assignment "would prove a cruise through hell". Secretary of the Navy Smith Thompson had assigned the squadron to guard United States merchant shipping and suppress piracy. During their time on deployment from 26 May to 3 August 1822, 76 of the Macedonian's officers and men died, including John Cadle, surgeon USN. Seventy-four of these deaths were attributed to yellow fever. Biddle reported that another 52 of his crew were on sick-list. In their report to the secretary of the Navy, Biddle and Surgeon's Mate Charles Chase stated the cause as "fever". As a consequence of this loss, Biddle noted that his squadron was forced to return to Norfolk Navy Yard early. Upon arrival, the Macedonian's crew were provided medical care and quarantined at Craney Island, Virginia. In 1853, Cloutierville, Louisiana , had a late-summer outbreak of yellow fever that quickly killed 68 of the 91 inhabitants. A local doctor concluded that some unspecified infectious agent had arrived in a package from New Orleans. In 1854, 650 residents of Savannah, Georgia , died from yellow fever. In 1858, St. Matthew's German Evangelical Lutheran Church in Charleston, South Carolina , had 308 yellow fever deaths, reducing the congregation by half. A ship carrying persons infected with the virus arrived in Hampton Roads in southeastern Virginia in June 1855. The disease spread quickly through the community, eventually killing over 3,000 people, mostly residents of Norfolk and Portsmouth . In 1873, Shreveport, Louisiana , lost 759 citizens in an 80-day period to a yellow fever epidemic, with over 400 additional victims eventually succumbing. The total death toll from August through November was approximately 1,200. In 1878, about 20,000 people died in a widespread epidemic in the Mississippi River Valley. That year, Memphis had an unusually large amount of rain, which led to an increase in the mosquito population. The result was a huge epidemic of yellow fever. The steamship John D. Porter took people fleeing Memphis northward in hopes of escaping the disease, but passengers were not allowed to disembark due to concerns of spreading yellow fever. The ship roamed the Mississippi River for the next two months before unloading her passengers. Major outbreaks have also occurred in southern Europe. Gibraltar lost many lives to outbreaks in 1804, 1814, and 1828. Barcelona suffered the loss of several thousand citizens during an outbreak in 1821. The Duke de Richelieu deployed 30,000 French troops to the border between France and Spain in the Pyrenees Mountains , to establish a cordon sanitaire in order to prevent the epidemic from spreading from Spain into France. Ezekiel Stone Wiggins , known as the Ottawa Prophet, proposed that the cause of a yellow fever epidemic in Jacksonville, Florida , in 1888, was astrological. The planets were in the same line as the sun and earth and this produced, besides Cyclones, Earthquakes, etc., a denser atmosphere holding more carbon and creating microbes. Mars had an uncommonly dense atmosphere, but its inhabitants were probably protected from the fever by their newly discovered canals , which were perhaps made to absorb carbon and prevent the disease. In 1848, Josiah C. Nott suggested that yellow fever was spread by insects such as moths or mosquitoes, basing his ideas on the pattern of transmission of the disease. Carlos Finlay , a Cuban-Spanish doctor and scientist, proposed in 1881 that yellow fever might be transmitted by previously infected mosquitoes rather than by direct contact from person to person, as had long been believed. Since the losses from yellow fever in the Spanish–American War in the 1890s were extremely high, U.S. Army doctors began research experiments with a team led by Walter Reed , and composed of doctors James Carroll , Aristides Agramonte , and Jesse William Lazear . They successfully proved Finlay's "mosquito hypothesis". Yellow fever was the first virus shown to be transmitted by mosquitoes. The physician William Gorgas applied these insights and eradicated yellow fever from Havana . He also campaigned against yellow fever during the construction of the Panama Canal . A previous effort of canal building by the French had failed in part due to mortality from the high incidence of yellow fever and malaria, which killed many workers. Although Reed has received much of the credit in United States history books for "beating" yellow fever, he had fully credited Finlay with the discovery of the yellow fever vector, and how it might be controlled. Reed often cited Finlay's papers in his own articles, and also credited him for the discovery in his personal correspondence. The acceptance of Finlay's work was one of the most important and far-reaching effects of the U.S. Army Yellow Fever Commission of 1900. Applying methods first suggested by Finlay, the United States government and Army eradicated yellow fever in Cuba and later in Panama, allowing completion of the Panama Canal. While Reed built on the research of Finlay, historian François Delaporte notes that yellow fever research was a contentious issue. Scientists, including Finlay and Reed, became successful by building on the work of less prominent scientists, without always giving them the credit they were due. Reed's research was essential in the fight against yellow fever. He is also credited for using the first type of medical consent form during his experiments in Cuba, an attempt to ensure that participants knew they were taking a risk by being part of testing. Like Cuba and Panama, Brazil also led a highly successful sanitation campaign against mosquitoes and yellow fever. Beginning in 1903, the campaign led by Oswaldo Cruz , then director general of public health, resulted not only in eradicating the disease but also in reshaping the physical landscape of Brazilian cities such as Rio de Janeiro. During rainy seasons, Rio de Janeiro had regularly suffered floods, as water from the bay surrounding the city overflowed into Rio's narrow streets. Coupled with the poor drainage systems found throughout Rio, this created swampy conditions in the city's neighborhoods. Pools of stagnant water stood year-long in city streets and proved to be a fertile ground for disease-carrying mosquitoes. Thus, under Cruz's direction, public health units known as "mosquito inspectors" fiercely worked to combat yellow fever throughout Rio by spraying, exterminating rats, improving drainage, and destroying unsanitary housing. Ultimately, the city's sanitation and renovation campaigns reshaped Rio de Janeiro's neighborhoods. Its poor residents were pushed from city centers to Rio's suburbs, or to towns found in the outskirts of the city. In later years, Rio's most impoverished inhabitants would come to reside in favelas . During 1920–1923, the Rockefeller Foundation 's International Health Board undertook an expensive and successful yellow fever eradication campaign in Mexico. The IHB gained the respect of Mexico's federal government because of the success. The eradication of yellow fever strengthened the relationship between the US and Mexico, which had not been very good in the years prior. The eradication of yellow fever was also a major step toward better global health. In 1927, scientists isolated the yellow fever virus in West Africa. Following this, two vaccines were developed in the 1930s. Max Theiler led the completion of the 17D yellow fever vaccine in 1937, for which he was subsequently awarded the Nobel Prize in Physiology or Medicine . That vaccine, 17D, is still in use, although newer vaccines, based on vero cells , are in development (as of 2018). Using vector control and strict vaccination programs, the urban cycle of yellow fever was nearly eradicated from South America. Since 1943, only a single urban outbreak in Santa Cruz de la Sierra , Bolivia, has occurred. Since the 1980s, however, the number of yellow fever cases has been increasing again, and A. aegypti has returned to the urban centers of South America. This is partly due to limitations on available insecticides, as well as habitat dislocations caused by climate change. It is also because the vector control program was abandoned. Although no new urban cycle has yet been established, scientists believe this could happen again at any point. An outbreak in Paraguay in 2008 was thought to be urban in nature, but this ultimately proved not to be the case. In Africa, virus eradication programs have mostly relied upon vaccination. These programs have largely been unsuccessful because they were unable to break the sylvatic cycle involving wild primates. With few countries establishing regular vaccination programs, measures to fight yellow fever have been neglected, making the future spread of the virus more likely. In the hamster model of yellow fever, early administration of the antiviral ribavirin is an effective treatment of many pathological features of the disease. Ribavirin treatment during the first five days after virus infection improved survival rates, reduced tissue damage in the liver and spleen , prevented hepatocellular steatosis , and normalised levels of alanine aminotransferase, a liver damage marker. The mechanism of action of ribavirin in reducing liver pathology in yellow fever virus infection may be similar to its activity in treatment of hepatitis C , a related virus. Because ribavirin had failed to improve survival in a virulent rhesus model of yellow fever infection, it had been previously discounted as a possible therapy. Infection was reduced in mosquitoes with the wMel strain of Wolbachia . Yellow fever has been researched by several countries as a potential biological weapon .

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Dengue fever

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Climate change and infectious diseases

Global climate change has increased the occurrence of some infectious diseases . Infectious diseases whose transmission is impacted by climate change include, for example, vector-borne diseases like dengue fever , malaria , tick-borne diseases , leishmaniasis , zika fever , chikungunya and Ebola . One mechanism contributing to increased disease transmission is that climate change is altering the geographic range and seasonality of the insects (or disease vectors ) that can carry the diseases. Scientists stated a clear observation in 2022: "the occurrence of climate-related food-borne and waterborne diseases has increased (very high confidence)." : 11 Infectious diseases that are sensitive to climate can be grouped into: vector-borne diseases (transmitted via mosquitos , ticks etc.), waterborne diseases (transmitted via viruses or bacteria through water), and food-borne diseases. : 1107 Climate change is affecting the distribution of these diseases due to the expanding geographic range and seasonality of these diseases and their vectors. : 9 Like other ways in which climate change affects on human health , climate change exacerbates existing inequalities and challenges in managing infectious disease. Mosquito-borne diseases that are sensitive to climate include malaria , lymphatic filariasis , Rift Valley fever , yellow fever , dengue fever, Zika virus , and chikungunya . Scientists found in 2022 that rising temperatures are increasing the areas where dengue fever, malaria and other mosquito-carried diseases are able to spread. : 1062 Warmer temperatures are also advancing to higher elevations, allowing mosquitoes to survive in places that were previously inhospitable to them. : 1045 This risks malaria making a return to areas where it was previously eradicated. Ticks are changing their geographic range because of rising temperatures, and this puts new populations at risk. Ticks can spread lyme disease and tick-borne encephalitis . It is expected that climate change will increase the incidence of these diseases in the Northern Hemisphere. : 1094 For example, a review of the literature found that "In the USA, a 2°C warming could increase the number of lyme disease cases by over 20% over the coming decades and lead to an earlier onset and longer length of the annual Lyme disease season". : 1094 Waterborne diseases are caused by a pathogen transmitted through water. The symptoms of waterborne diseases typically include diarrhea , fever and other flu-like symptoms, neurological disorders, and liver damage. Changes in climate have a large effect on the distribution of microbial species. These communities are very complex and can be extremely sensitive to external climate stimuli. There are a range of waterborne diseases and parasites that will pose greater health risks in future. This will vary by region. For example, in Africa Cryptosporidium spp. and Giardia duodenalis ( protozoan parasites ) will increase. This is due to increasing temperatures and drought. : 1095 Scientist also expect that disease outbreaks caused by vibrio (in particular the bacterium that causes cholera , called vibrio cholerae ) are increasing in occurrence and intensity. : 1107 One reason is that the area of coastline with suitable conditions for vibrio bacteria has increased due to changes in sea surface temperature and sea surface salinity caused by climate change. : 12 These pathogens can cause gastroenteritis , cholera, wound infections, and sepsis . The increasing occurrence of higher temperature days, heavy rainfall events and flooding due to climate change could lead to an increase in cholera risks. : 1045In 1988, little was known about the effects of climate change on human health . As of 2023, the evidence has grown significantly and is for example summarised in the Sixth Assessment Report of the Intergovernmental Panel on Climate Change . The scientific understanding about the potential health risks and observed health impacts caused by climate change is now better understood. One category of health risks is that of infectious diseases . A study concluded in 2022 that "58% (that is, 218 out of 375) of infectious diseases confronted by humanity worldwide have been at some point aggravated by climatic hazards". The World Health Organization considers climate change as one of the greatest threats to human health. Infectious diseases have played a significant role in human history, impacting the rise and fall of civilizations and facilitating the conquest of new territories. During recent decades, there are significant regional changes in vector and pathogen distribution reported in temperate, peri‐Arctic, Arctic, and tropical highland regions. Climate change is only one factor in the spread of human diseases. Many other key factors affect the spread and severity of human diseases as well, including mobility of people, animals, and goods; control measures in place; availability of effective drugs; quality of public health services; human behavior; and political stability and conflicts. The effects of climate change on health will impact most populations over the next few decades. However, Africa, and specifically, the African Highlands, are susceptible to being particularly negatively affected. For example, with regards to malaria, in 2010, 91% of the global burden due to malaria deaths occurred in Africa. Several spatiotemporal models have been studied to assess the potential effect of projected climate scenarios on malaria transmission in Africa. It is expected that the most significant climate change effects are confined to specific regions, including the African Highlands. Climate change may lead to dramatic increases in prevalence of a variety of infectious diseases. Beginning in the mid-'70s, an "emergence, resurgence and redistribution of infectious diseases" has occurred. Reasons for this are likely multi-causal, dependent on a variety of social, environmental and climatic factors, however, many argue that the "volatility of infectious disease may be one of the earliest biological expressions of climate instability". Infectious diseases (also called pathogenic diseases) depend on "a pathogen and a person coming into contact, and the extent to which peoples' resistance is diminished, or the pathogen is strengthened, by a climatic hazard ." Climatic hazards, which can be strengthened by climate change, include for example warming of land and oceans, heatwaves and marine heatwaves , floods, drought, storms, land cover change, fires and so forth. Possible pathways that can increase the infectious disease occurrence and which are affected by climate change include: Infectious diseases that are sensitive to climate can be grouped into: Climate change is affecting the distribution of these diseases due to the expanding geographic range and seasonality of these diseases and their vectors. : 9 Though many infectious diseases are affected by changes in climate, vector-borne diseases, such as malaria, dengue fever and leishmaniasis, present the strongest causal relationship. One reason for that is that temperature and rainfall play a key role in the distribution, magnitude, and viral capacity of mosquitoes, who are primary vectors for many vectors borne diseases. Observation and research detect a shift of pests and pathogens in the distribution away from the equator and towards Earth's poles. Climate change affects vector-borne diseases by affecting the survival, distribution and behavior of vectors such as mosquitoes, ticks and rodents. : 29 The viruses, bacteria and protozoa are carried by these vectors transferring them from one carrier to another. Vector and pathogen can adapt to the climate fluctuations by shifting and expanding their geographic ranges, which can alter the rate of new cases of disease depending on vector-host interaction, host immunity and pathogen evolution. This means that climate change affects infectious diseases by changing the length of the transmission season and their geographical range. Climate change is leading to latitudinal and altitudinal temperature increases. Global warming projections indicate that surface air warming for a "high scenario" is 4 C, with a likely range of 2.4–6.4 C by 2100. A temperature increase of this size would alter the biology and the ecology of many mosquito vectors and the dynamics of the diseases they transmit such as malaria. Changes in climate and global warming have significant influences on the biology and distribution of vector-borne diseases , parasites , fungi , and their associated illnesses. Regional changes resulting from changing weather conditions and patterns within temperate climates will stimulate the reproduction of certain insect species that are vectors for disease. One major disease-spreading insect is the mosquito , which can carry diseases like malaria , West Nile virus , and dengue fever . With regional temperatures changing due to climate change the range of mosquitos will change as well. The range of mosquitoes will move farther north and south, and places will have a longer period of mosquito habitability than at present, leading to an increase in the mosquito population in these areas. This range shift has already been seen in highland Africa. Since 1970, the incidence of malaria in high elevation areas in East Africa has increased greatly. This has been proven to be caused by the warming of regional climates. The vectors of transmission are the major reason for the increased ranges and infection of these diseases. If the vector has a range shift, so do the associated diseases; if the vector increases in activity due to changes in climate, then there is an effect on the transmission of disease. However it will be hard to classify exactly why the range shifts or an increase in infection rates occurs as there are many other factors to consider besides climate change, such as human migration , poverty , infrastructure quality, and land usage ; but climate change is still potentially a key factor. Environmental changes, climate variability , and climate change are such factors that could affect biology and disease ecology of Anopheles vectors and their disease transmission potential. Anopheles mosquitoes in highland areas are to experience a larger shift in their metabolic rate due to climate change. This climate change is due to the deforestation in the highland areas where these mosquitos' dwell. When the temperature rises, the larvae take a shorter time to mature and, consequently, a greater capacity to produce more offspring. In turn this could potentially lead to an increase in malaria transmission when infected humans are available. Environmental changes such as deforestation could also increase local temperatures in the highlands thus could enhance the vectorial capacity of the anopheles. Anopheles mosquitoes are responsible for the transmission of a number of diseases in the world, such as, malaria, lymphatic filariasis and viruses that can cause such ailments, like the O'nyong'nyong virus . High temperatures can alter the survival, replication, and virulence of a pathogen. Higher temperatures can also increase the pathogen yields in animal reservoirs. During the warmer summer months an increase in yield of bacteria from drinking water delivery systems has been recorded. During times of warmer temperatures water consumption rates are also typically higher. These together increase the probability of pathogen ingestion and infection. With an increase in not only temperature, but also higher nutrient concentrations due to runoff there will be an increase in cyanobacterial blooms. The warming oceans and lakes are leading to more frequent harmful algal blooms . Also, during droughts, surface waters are even more susceptible to harmful algal blooms and microorganisms. Algal blooms increase water turbidity, suffocating aquatic plants, and can deplete oxygen, killing fish. Some kinds of blue-green algae (cyanobacteria) create neurotoxins , hepatoxins, cytotoxins or endotoxins that can cause serious and sometimes fatal neurological, liver and digestive diseases in humans. Cyanobacteria grow best in warmer temperatures (especially above 25 degrees Celsius), and so areas of the world that are experiencing general warming as a result of climate change are also experiencing harmful algal blooms more frequently and for longer periods of time. Climate change is forecast to have substantial effects on the water cycle , with an increase in both frequency and intensity of droughts and heavy precipitation events. A literature review in 2016 found that generally there is an increase in diarrheal disease (except for viral diarrheal disease) during or after certain weather conditions: elevated ambient temperature, heavy rainfall, and flooding. These three weather conditions are predicted to increase (or to intensify) with climate change in future. There is already now a high current baseline rate of the diarrheal diseases in developing countries. Climate change therefore poses a real risk of an uptick in these diseases for those regions. Climate change affects vector-borne diseases by affecting the survival, distribution and behavior of vectors such as mosquitoes, ticks and rodents. : 29 The viruses, bacteria and protozoa are carried by these vectors transferring them from one carrier to another. Vector and pathogen can adapt to the climate fluctuations by shifting and expanding their geographic ranges, which can alter the rate of new cases of disease depending on vector-host interaction, host immunity and pathogen evolution. This means that climate change affects infectious diseases by changing the length of the transmission season and their geographical range. Climate change is leading to latitudinal and altitudinal temperature increases. Global warming projections indicate that surface air warming for a "high scenario" is 4 C, with a likely range of 2.4–6.4 C by 2100. A temperature increase of this size would alter the biology and the ecology of many mosquito vectors and the dynamics of the diseases they transmit such as malaria. Changes in climate and global warming have significant influences on the biology and distribution of vector-borne diseases , parasites , fungi , and their associated illnesses. Regional changes resulting from changing weather conditions and patterns within temperate climates will stimulate the reproduction of certain insect species that are vectors for disease. One major disease-spreading insect is the mosquito , which can carry diseases like malaria , West Nile virus , and dengue fever . With regional temperatures changing due to climate change the range of mosquitos will change as well. The range of mosquitoes will move farther north and south, and places will have a longer period of mosquito habitability than at present, leading to an increase in the mosquito population in these areas. This range shift has already been seen in highland Africa. Since 1970, the incidence of malaria in high elevation areas in East Africa has increased greatly. This has been proven to be caused by the warming of regional climates. The vectors of transmission are the major reason for the increased ranges and infection of these diseases. If the vector has a range shift, so do the associated diseases; if the vector increases in activity due to changes in climate, then there is an effect on the transmission of disease. However it will be hard to classify exactly why the range shifts or an increase in infection rates occurs as there are many other factors to consider besides climate change, such as human migration , poverty , infrastructure quality, and land usage ; but climate change is still potentially a key factor. Environmental changes, climate variability , and climate change are such factors that could affect biology and disease ecology of Anopheles vectors and their disease transmission potential. Anopheles mosquitoes in highland areas are to experience a larger shift in their metabolic rate due to climate change. This climate change is due to the deforestation in the highland areas where these mosquitos' dwell. When the temperature rises, the larvae take a shorter time to mature and, consequently, a greater capacity to produce more offspring. In turn this could potentially lead to an increase in malaria transmission when infected humans are available. Environmental changes such as deforestation could also increase local temperatures in the highlands thus could enhance the vectorial capacity of the anopheles. Anopheles mosquitoes are responsible for the transmission of a number of diseases in the world, such as, malaria, lymphatic filariasis and viruses that can cause such ailments, like the O'nyong'nyong virus . High temperatures can alter the survival, replication, and virulence of a pathogen. Higher temperatures can also increase the pathogen yields in animal reservoirs. During the warmer summer months an increase in yield of bacteria from drinking water delivery systems has been recorded. During times of warmer temperatures water consumption rates are also typically higher. These together increase the probability of pathogen ingestion and infection. With an increase in not only temperature, but also higher nutrient concentrations due to runoff there will be an increase in cyanobacterial blooms. The warming oceans and lakes are leading to more frequent harmful algal blooms . Also, during droughts, surface waters are even more susceptible to harmful algal blooms and microorganisms. Algal blooms increase water turbidity, suffocating aquatic plants, and can deplete oxygen, killing fish. Some kinds of blue-green algae (cyanobacteria) create neurotoxins , hepatoxins, cytotoxins or endotoxins that can cause serious and sometimes fatal neurological, liver and digestive diseases in humans. Cyanobacteria grow best in warmer temperatures (especially above 25 degrees Celsius), and so areas of the world that are experiencing general warming as a result of climate change are also experiencing harmful algal blooms more frequently and for longer periods of time. Climate change is forecast to have substantial effects on the water cycle , with an increase in both frequency and intensity of droughts and heavy precipitation events. A literature review in 2016 found that generally there is an increase in diarrheal disease (except for viral diarrheal disease) during or after certain weather conditions: elevated ambient temperature, heavy rainfall, and flooding. These three weather conditions are predicted to increase (or to intensify) with climate change in future. There is already now a high current baseline rate of the diarrheal diseases in developing countries. Climate change therefore poses a real risk of an uptick in these diseases for those regions. Increased rainfall could increase the number of mosquitos indirectly by expanding larval habitat and food supply. Malaria, which kills about 300,000 children (under age 5) annually, poses an imminent threat through temperature increase. Models suggest, conservatively, that the risk of malaria will increase 5–15% by 2100 due to climate change. In Africa alone, according to the MARA Project (Mapping Malaria Risk in Africa), there is a projected increase of 16–28% in person-month exposures to malaria by 2100. Climate is an influential driving force of vector-borne diseases such as malaria. Malaria is especially susceptible to the effects of climate change because mosquitoes lack the mechanisms to regulate their internal temperature. This implies that there is a limited range of climatic conditions within which the pathogen (malaria) and vector (a mosquito) can survive, reproduce, and infect hosts. Vector-borne diseases, such as malaria, have distinctive characteristics that determine pathogenicity . These include the survival and reproduction rate of the vector, the level of vector activity (i.e. the biting or feeding rate), and the development and reproduction rate of the pathogen within the vector or host. Changes in climate factors substantially affect reproduction, development, distribution, and seasonal transmissions of malaria. Malaria is a mosquito-borne parasitic disease that infects humans and other animals caused by microorganisms in the Plasmodium family. It begins with a bite from an infected female mosquito, which introduces the parasite through its saliva and into the infected host's circulatory system. It then travels through the bloodstream into the liver, where it can mature and reproduce. Dengue fever is an infectious disease caused by dengue viruses known to be in the tropical regions. It is transmitted by the mosquito Aedes , or A. aegypti. Dengue incidence has increased in the last few decades and is projected to continue to do so with changing climate conditions. > Dengue can be fatal. Dengue fever is spread by the bite of the female mosquito known as Aedes aegypti. The female mosquito is a highly effective vector of this disease. The evidence for the spread of dengue fever is that climate change is altering the geographic range and seasonality of the mosquito that can carry dengue. Because there are multiple drivers of transmission, it is easier to model and project changes in the geographic range and seasonality. The drivers for the recent spread of this disease are globalization, trade, urbanization, population growth, increased international travel, and climate change. The same trends also led to the spread of different serotypes of the disease to new areas, and to the emergence of dengue hemorrhagic fever . The World Health Organization (WHO) has reported an increase from a thousand to one million confirmed cases between 1955 and 2007. The presence and number of Aedes aegypti mosquitoes is strongly influenced by the amount of water-bearing containers or pockets of stagnant water in an area, daily temperature and variation in temperature, moisture, and solar radiation. While dengue fever is primarily considered a tropical and subtropical disease , the geographic ranges of the Aedes aegypti are expanding. The cases of dengue fever have increased dramatically since the 1970s and it continues to become more prevalent. Dengue is ranked as the most important vector-borne viral disease in the world. An estimated 50–100 million dengue fever infections occur annually. In just the past 50 years, transmission has increased drastically with new cases of the disease (incidence) increasing 30-fold. The number of reported cases has continually increased along with dengue spreading to new areas. Tick-borne disease , which affect humans and other animals, are caused by infectious agents transmitted by tick bites. A high humidity of greater than 85% is ideal for a tick to start and finish its life cycle. Studies have indicated that temperature and vapor play a significant role in determining the range for tick population. More specifically, maximum temperature has been found to play the most influential variable in sustaining tick populations. Higher temperatures augment both hatching and developmental rates while hindering overall survival. Temperature is so important to overall survival that an average monthly minimum temperature of below -7 °C in the winter can prevent an area from maintaining established populations. The effect of climate on the tick life cycle is one of the more difficult projections to make in relation to climate and vector-borne disease. Unlike other vectors, tick life cycles span multiple seasons as they mature from larva to nymph to adult. Further, infection and spread of diseases such as Lyme disease happens across the multiple stages and different classes of vertebrate hosts, adding additional variables to consider. Although it is a European species from the Lyme borreliosis spirochetes, Borrelia garinii was documented from infected ticks on seabirds in North America. Further research is needed to improve evolutionary models predicting distributional changes in this tick-borne system in the face of climate change. Infection of ticks happen in the larval/nymph stage (after the first blood meal) when they are exposed to Borrelia burgdorferi (the spirochete responsible for Lyme disease ), but transmission to humans doesn't occur until the adult stages. The expansion of tick populations is concurrent with global climatic change. Species distribution models of recent years indicate that the deer tick, known as I. scapularis, is pushing its distribution to higher latitudes of the Northeastern United States and Canada, as well as pushing and maintaining populations in the South Central and Northern Midwest regions of the United States. Climate models project further expansion of tick habit north into Canada as progressing Northwest from the Northeastern United States. Additionally, however, tick populations are expected to retreat from the Southeastern coast of the U.S., but this has not yet been observed. It's estimated that coinciding with this expansion, increased average temperatures may double tick populations by 2020 as well as bring an earlier start to the tick exposure season. In the face of these expanding threats, strong collaboration between government officials and environmental scientists is necessary for advancing preventive and reactive response measures. Without acknowledging the climate changes that make environments more habitable for disease carriers, policy and infrastructure will lag behind vector borne disease spread. In the United States, the Centers for Disease Control and Prevention (CDC) is conducting a grant program called Building Resilience Against Climate Effects (BRACE) which details a 5 step process for combating climate effects like tick borne disease spread. As in other vector-borne diseases , one of the reasons climate changes can affect the incidence of leishmaniasis is the susceptibility of the sandfly vectors to changes in temperature, rainfall and humidity; these conditions will alter their range of distribution and seasonality. For example, modelling studies have predicted that climate change will increase suitable conditions for Phlebotomus vector species in Central Europe. Another model that looked at the distribution of Lutzomyia longipalpis , an important visceral leishmaniasis vector, suggested an increased range of this species in the Amazon Basin. A different study model that factored data on climate, policy and socio-economic changes of land use, found that the effects were different for cutaneous and visceral leishmaniasis, emphasizing the importance of considering each disease and region separately. Parasite development inside the sandfly can also be affected by temperature changes. For instance, Leishmania peruviana infections were lost during sandfly defecation when the infected vector was kept at higher temperatures, whereas in the same experiment Leishmania infantum and Leishmania braziliensis temperature seemed to make no difference. Leishmaniasis is a neglected tropical disease , caused by parasites of the genus Leishmania and transmitted by sandflies; it is distributed mostly in tropical and subtropical regions around the world, wherever the sand fly vector and reservoir hosts are present. The WHO estimates 12 million people around the world are living with leishmaniasis. Risk factors for the spread of this disease include poverty, urbanization, deforestation , and climate change. The Ebola virus has been infecting people from time to time, leading to outbreaks in several African countries. The average case fatality rate of the Ebola virus is approximately 40% and there have been more than 28,600 cases with 11,310 deaths. Many researchers are linking deforestation to the disease, observing that change in the landscape increases wildlife contact with humans. Recent studies are holding climate change indirectly liable for the uptick in Ebola: Seasonal droughts alongside strong winds, thunderstorms, heat waves, floods, landslides, and a change in rainfall patterns also impact wildlife migration. These conditions pull them away from their natural environment and closer to human proximity. One example of an Ebola outbreak caused by climate change or a shift in nature was seen during the drought of Central Africa. This ultimately amplified food insecurity leading West African communities to eat animals such as bats who were infected with the virus. Zika virus , a vector-borne virus was historically presented in cluster outbreaks in the tropical regions of Africa and Asia. Zika fever epidemics have affected larger populations including Micronesia and South Pacific Islands in 2007, and the Americas in 2013. Brazil has experienced one of the largest outbreaks of Zika virus with approximately 1.5 million cases reported in 2015. Pregnant women infected with Zika virus are at a higher risk of giving birth to children with congenital malformations, including microcephaly. In the context of climate change and temperature rise, it is predicted that Zika virus will affect more than 1.3 billion people by 2050. This is largely due to the expansion of environments conducive to vector growth and life cycles, such as those with temperatures ranging from 23.9 °C to 34 °C. Mosquito behaviors are also affected by the change in temperature including increased breeding and biting rates. Furthermore, extreme climate patterns, including drought, floods and heatwaves are known to exacerbate the proliferation of mosquito breeding ground and as a result, escalate the rate of virus-borne diseases. There is no direct evidence that the spread of COVID-19 is worsened or is caused by climate change, although investigations continue. As of 2020 [ update ] , the World Health Organization summarized the current knowledge about the issue as follows: "There is no evidence of a direct connection between climate change and the emergence or transmission of COVID-19 disease. [...] However, climate change may indirectly affect the COVID-19 response, as it undermines environmental determinants of health, and places additional stress on health systems." A 2021 study found possible links between climate change and transmission of COVID-19 by bats. The authors found that climate-driven changes in the distribution and richness of bat species increased the likelihood of bat-borne coronaviruses in the Yunnan province, Myanmar, and Laos. This region was also the habitat of Sunda pangolins and masked palm civits which were suspected as intermediate hosts of COVID-19 between bats and humans. The authors suggest, therefore, that climate change possibly contributed to some extent to the emergence of the pandemic. Climate changed might induce changes to bat habitats which may have driven them closer to populated areas. Increased aridity and drought periods are predicted to push bats out of their endemic areas and into populated areas. This creates a knock-on effect of increasing their interactions with humans and hence the likelihood of zoonotic disease transfer. Scientist expect that disease outbreaks caused by vibrio (in particular the bacterium that causes cholera , called vibrio cholerae ) are increasing in occurrence and intensity. : 1107 One reason is that the area of coastline with suitable conditions for vibrio bacteria has increased due to changes in sea surface temperature and sea surface salinity caused by climate change. : 12 These pathogens can cause gastroenteritis , cholera , wound infections, and sepsis . It has been observed that in the period of 2011–21, the "area of coastline suitable for Vibrio bacterial transmission has increased by 35% in the Baltics , 25% in the Atlantic Northeast, and 4% in the Pacific Northwest. : 12 Furthermore, the increasing occurrence of higher temperature days, heavy rainfall events and flooding due to climate change could lead to an increase in cholera risks. : 1045 Vibrio illnesses are a waterborne disease and are increasing worldwide. Vibrio infections are recently being reported where historically it did not occur. The warming climate seems to be playing a substantial role in the increase in cases and area of occurrence. Vibrio infections are caused by consuming raw or undercooked seafood, or by exposing an open wound to contaminated sea water. Vibrio infections are most likely to occur during the warm season, May through October. One of the most commonly transmitted waterborne disease categories are the diarrhea diseases. These diseases are transmitted through unsafe drinking water or recreational water contact. Diarrheal diseases account for 10–12% of deaths in children under five, as the second leading cause of death in children this age. They are also the second leading cause of death in low and middle income countries. Diarrhea diseases account for an estimated 1.4–1.9 million deaths worldwide. Fungal infections will also see an increase due to the warming of certain climates. For example, the fungus Cryptococcus gattii has been found in Canada but is normally found in warmer climates such as in Australia . There are now two strains of this fungus in the northwestern part of North America, affecting many terrestrial animals. The spread of this fungus is hypothesized to be linked to climate change. There is concern about the emergence of new diseases from the fungal kingdom. Mammals have endothermy and homeothermy , which allows them to maintain elevated body temperature through life; but it can be defeated if the fungi were to adapt to higher temperatures and survive in the body. Fungi that are pathogenic for insects can be experimentally adapted to replicate at mammalian temperatures through cycles of progressive warming. This demonstrates that fungi are able to adapt rapidly to higher temperatures. The emergence of Candida auris on three continents is proposed to be as a result of global warming and has raised the danger that increased warmth by itself will trigger adaptations on certain microbes to make them pathogenic for humans. It is projected that interspecies viral sharing , that can lead to novel viral spillovers , will increase due to ongoing climate change-caused geographic range-shifts of mammals (most importantly bats ). Risk hotspots would mainly be located at "high elevations, in biodiversity hotspots, and in areas of high human population density in Asia and Africa". Climate change may also lead to new infectious diseases due to changes in microbial and vector geographic range. Microbes that are harmful to humans can adapt to higher temperatures, which will allow them to build better tolerance against human endothermy defences. Increased rainfall could increase the number of mosquitos indirectly by expanding larval habitat and food supply. Malaria, which kills about 300,000 children (under age 5) annually, poses an imminent threat through temperature increase. Models suggest, conservatively, that the risk of malaria will increase 5–15% by 2100 due to climate change. In Africa alone, according to the MARA Project (Mapping Malaria Risk in Africa), there is a projected increase of 16–28% in person-month exposures to malaria by 2100. Climate is an influential driving force of vector-borne diseases such as malaria. Malaria is especially susceptible to the effects of climate change because mosquitoes lack the mechanisms to regulate their internal temperature. This implies that there is a limited range of climatic conditions within which the pathogen (malaria) and vector (a mosquito) can survive, reproduce, and infect hosts. Vector-borne diseases, such as malaria, have distinctive characteristics that determine pathogenicity . These include the survival and reproduction rate of the vector, the level of vector activity (i.e. the biting or feeding rate), and the development and reproduction rate of the pathogen within the vector or host. Changes in climate factors substantially affect reproduction, development, distribution, and seasonal transmissions of malaria. Malaria is a mosquito-borne parasitic disease that infects humans and other animals caused by microorganisms in the Plasmodium family. It begins with a bite from an infected female mosquito, which introduces the parasite through its saliva and into the infected host's circulatory system. It then travels through the bloodstream into the liver, where it can mature and reproduce. Dengue fever is an infectious disease caused by dengue viruses known to be in the tropical regions. It is transmitted by the mosquito Aedes , or A. aegypti. Dengue incidence has increased in the last few decades and is projected to continue to do so with changing climate conditions. > Dengue can be fatal. Dengue fever is spread by the bite of the female mosquito known as Aedes aegypti. The female mosquito is a highly effective vector of this disease. The evidence for the spread of dengue fever is that climate change is altering the geographic range and seasonality of the mosquito that can carry dengue. Because there are multiple drivers of transmission, it is easier to model and project changes in the geographic range and seasonality. The drivers for the recent spread of this disease are globalization, trade, urbanization, population growth, increased international travel, and climate change. The same trends also led to the spread of different serotypes of the disease to new areas, and to the emergence of dengue hemorrhagic fever . The World Health Organization (WHO) has reported an increase from a thousand to one million confirmed cases between 1955 and 2007. The presence and number of Aedes aegypti mosquitoes is strongly influenced by the amount of water-bearing containers or pockets of stagnant water in an area, daily temperature and variation in temperature, moisture, and solar radiation. While dengue fever is primarily considered a tropical and subtropical disease , the geographic ranges of the Aedes aegypti are expanding. The cases of dengue fever have increased dramatically since the 1970s and it continues to become more prevalent. Dengue is ranked as the most important vector-borne viral disease in the world. An estimated 50–100 million dengue fever infections occur annually. In just the past 50 years, transmission has increased drastically with new cases of the disease (incidence) increasing 30-fold. The number of reported cases has continually increased along with dengue spreading to new areas.Tick-borne disease , which affect humans and other animals, are caused by infectious agents transmitted by tick bites. A high humidity of greater than 85% is ideal for a tick to start and finish its life cycle. Studies have indicated that temperature and vapor play a significant role in determining the range for tick population. More specifically, maximum temperature has been found to play the most influential variable in sustaining tick populations. Higher temperatures augment both hatching and developmental rates while hindering overall survival. Temperature is so important to overall survival that an average monthly minimum temperature of below -7 °C in the winter can prevent an area from maintaining established populations. The effect of climate on the tick life cycle is one of the more difficult projections to make in relation to climate and vector-borne disease. Unlike other vectors, tick life cycles span multiple seasons as they mature from larva to nymph to adult. Further, infection and spread of diseases such as Lyme disease happens across the multiple stages and different classes of vertebrate hosts, adding additional variables to consider. Although it is a European species from the Lyme borreliosis spirochetes, Borrelia garinii was documented from infected ticks on seabirds in North America. Further research is needed to improve evolutionary models predicting distributional changes in this tick-borne system in the face of climate change. Infection of ticks happen in the larval/nymph stage (after the first blood meal) when they are exposed to Borrelia burgdorferi (the spirochete responsible for Lyme disease ), but transmission to humans doesn't occur until the adult stages. The expansion of tick populations is concurrent with global climatic change. Species distribution models of recent years indicate that the deer tick, known as I. scapularis, is pushing its distribution to higher latitudes of the Northeastern United States and Canada, as well as pushing and maintaining populations in the South Central and Northern Midwest regions of the United States. Climate models project further expansion of tick habit north into Canada as progressing Northwest from the Northeastern United States. Additionally, however, tick populations are expected to retreat from the Southeastern coast of the U.S., but this has not yet been observed. It's estimated that coinciding with this expansion, increased average temperatures may double tick populations by 2020 as well as bring an earlier start to the tick exposure season. In the face of these expanding threats, strong collaboration between government officials and environmental scientists is necessary for advancing preventive and reactive response measures. Without acknowledging the climate changes that make environments more habitable for disease carriers, policy and infrastructure will lag behind vector borne disease spread. In the United States, the Centers for Disease Control and Prevention (CDC) is conducting a grant program called Building Resilience Against Climate Effects (BRACE) which details a 5 step process for combating climate effects like tick borne disease spread. As in other vector-borne diseases , one of the reasons climate changes can affect the incidence of leishmaniasis is the susceptibility of the sandfly vectors to changes in temperature, rainfall and humidity; these conditions will alter their range of distribution and seasonality. For example, modelling studies have predicted that climate change will increase suitable conditions for Phlebotomus vector species in Central Europe. Another model that looked at the distribution of Lutzomyia longipalpis , an important visceral leishmaniasis vector, suggested an increased range of this species in the Amazon Basin. A different study model that factored data on climate, policy and socio-economic changes of land use, found that the effects were different for cutaneous and visceral leishmaniasis, emphasizing the importance of considering each disease and region separately. Parasite development inside the sandfly can also be affected by temperature changes. For instance, Leishmania peruviana infections were lost during sandfly defecation when the infected vector was kept at higher temperatures, whereas in the same experiment Leishmania infantum and Leishmania braziliensis temperature seemed to make no difference. Leishmaniasis is a neglected tropical disease , caused by parasites of the genus Leishmania and transmitted by sandflies; it is distributed mostly in tropical and subtropical regions around the world, wherever the sand fly vector and reservoir hosts are present. The WHO estimates 12 million people around the world are living with leishmaniasis. Risk factors for the spread of this disease include poverty, urbanization, deforestation , and climate change. The Ebola virus has been infecting people from time to time, leading to outbreaks in several African countries. The average case fatality rate of the Ebola virus is approximately 40% and there have been more than 28,600 cases with 11,310 deaths. Many researchers are linking deforestation to the disease, observing that change in the landscape increases wildlife contact with humans. Recent studies are holding climate change indirectly liable for the uptick in Ebola: Seasonal droughts alongside strong winds, thunderstorms, heat waves, floods, landslides, and a change in rainfall patterns also impact wildlife migration. These conditions pull them away from their natural environment and closer to human proximity. One example of an Ebola outbreak caused by climate change or a shift in nature was seen during the drought of Central Africa. This ultimately amplified food insecurity leading West African communities to eat animals such as bats who were infected with the virus. Zika virus , a vector-borne virus was historically presented in cluster outbreaks in the tropical regions of Africa and Asia. Zika fever epidemics have affected larger populations including Micronesia and South Pacific Islands in 2007, and the Americas in 2013. Brazil has experienced one of the largest outbreaks of Zika virus with approximately 1.5 million cases reported in 2015. Pregnant women infected with Zika virus are at a higher risk of giving birth to children with congenital malformations, including microcephaly. In the context of climate change and temperature rise, it is predicted that Zika virus will affect more than 1.3 billion people by 2050. This is largely due to the expansion of environments conducive to vector growth and life cycles, such as those with temperatures ranging from 23.9 °C to 34 °C. Mosquito behaviors are also affected by the change in temperature including increased breeding and biting rates. Furthermore, extreme climate patterns, including drought, floods and heatwaves are known to exacerbate the proliferation of mosquito breeding ground and as a result, escalate the rate of virus-borne diseases. There is no direct evidence that the spread of COVID-19 is worsened or is caused by climate change, although investigations continue. As of 2020 [ update ] , the World Health Organization summarized the current knowledge about the issue as follows: "There is no evidence of a direct connection between climate change and the emergence or transmission of COVID-19 disease. [...] However, climate change may indirectly affect the COVID-19 response, as it undermines environmental determinants of health, and places additional stress on health systems." A 2021 study found possible links between climate change and transmission of COVID-19 by bats. The authors found that climate-driven changes in the distribution and richness of bat species increased the likelihood of bat-borne coronaviruses in the Yunnan province, Myanmar, and Laos. This region was also the habitat of Sunda pangolins and masked palm civits which were suspected as intermediate hosts of COVID-19 between bats and humans. The authors suggest, therefore, that climate change possibly contributed to some extent to the emergence of the pandemic. Climate changed might induce changes to bat habitats which may have driven them closer to populated areas. Increased aridity and drought periods are predicted to push bats out of their endemic areas and into populated areas. This creates a knock-on effect of increasing their interactions with humans and hence the likelihood of zoonotic disease transfer. Scientist expect that disease outbreaks caused by vibrio (in particular the bacterium that causes cholera , called vibrio cholerae ) are increasing in occurrence and intensity. : 1107 One reason is that the area of coastline with suitable conditions for vibrio bacteria has increased due to changes in sea surface temperature and sea surface salinity caused by climate change. : 12 These pathogens can cause gastroenteritis , cholera , wound infections, and sepsis . It has been observed that in the period of 2011–21, the "area of coastline suitable for Vibrio bacterial transmission has increased by 35% in the Baltics , 25% in the Atlantic Northeast, and 4% in the Pacific Northwest. : 12 Furthermore, the increasing occurrence of higher temperature days, heavy rainfall events and flooding due to climate change could lead to an increase in cholera risks. : 1045 Vibrio illnesses are a waterborne disease and are increasing worldwide. Vibrio infections are recently being reported where historically it did not occur. The warming climate seems to be playing a substantial role in the increase in cases and area of occurrence. Vibrio infections are caused by consuming raw or undercooked seafood, or by exposing an open wound to contaminated sea water. Vibrio infections are most likely to occur during the warm season, May through October. One of the most commonly transmitted waterborne disease categories are the diarrhea diseases. These diseases are transmitted through unsafe drinking water or recreational water contact. Diarrheal diseases account for 10–12% of deaths in children under five, as the second leading cause of death in children this age. They are also the second leading cause of death in low and middle income countries. Diarrhea diseases account for an estimated 1.4–1.9 million deaths worldwide. Fungal infections will also see an increase due to the warming of certain climates. For example, the fungus Cryptococcus gattii has been found in Canada but is normally found in warmer climates such as in Australia . There are now two strains of this fungus in the northwestern part of North America, affecting many terrestrial animals. The spread of this fungus is hypothesized to be linked to climate change. There is concern about the emergence of new diseases from the fungal kingdom. Mammals have endothermy and homeothermy , which allows them to maintain elevated body temperature through life; but it can be defeated if the fungi were to adapt to higher temperatures and survive in the body. Fungi that are pathogenic for insects can be experimentally adapted to replicate at mammalian temperatures through cycles of progressive warming. This demonstrates that fungi are able to adapt rapidly to higher temperatures. The emergence of Candida auris on three continents is proposed to be as a result of global warming and has raised the danger that increased warmth by itself will trigger adaptations on certain microbes to make them pathogenic for humans. It is projected that interspecies viral sharing , that can lead to novel viral spillovers , will increase due to ongoing climate change-caused geographic range-shifts of mammals (most importantly bats ). Risk hotspots would mainly be located at "high elevations, in biodiversity hotspots, and in areas of high human population density in Asia and Africa". Climate change may also lead to new infectious diseases due to changes in microbial and vector geographic range. Microbes that are harmful to humans can adapt to higher temperatures, which will allow them to build better tolerance against human endothermy defences. Climate change and increasing temperatures will also impact the health of wildlife animals as well. Specifically, climate change will impact wildlife disease, specifically affecting "geographic range and distribution of wildlife diseases, plant and animal phenology, wildlife host-pathogen interactions, and disease patterns in wildlife". The health of wild animals, particularly birds, is assumed to be a better indicator of early climate change effects because very little or no control measures are undertaken to protect them. Northern geographic shifts of disease vectors and parasitic disease in the Northern Hemisphere have likely been due to global warming. The geographic range of a lung parasite that impacts ungulates like caribou and mountain goats, Parelaphostrongylus odocoilei , has been shifting northward since 1995, and a tick vector for Lyme disease and other tick-borne zoonotic diseases known as Ixodes scapularis has been expanding its presence northward as well. It is also predicted that climate warming will also lead to changes in disease distribution at certain altitudes. At high elevation in the Hawaiian Islands, for example, it is expected that climate warming will allow for year-round transmission of avian malaria . This increased opportunity for transmission will likely be devastating to endangered native Hawaiian birds at those altitudes that have little or no resistance to the disease. Phenology is the study of seasonal cycles, and with climate change the seasonal biologic cycles of many animals have already been affected. For example, the transmission of tick-borne encephalitis (TBE) is higher to humans when early spring temperatures are warmer. The warmer temperatures result in an overlap in feeding activity of ticks who are infected with the virus (nymphal) with ticks who aren't (larval). This overlapped feeding leads to more of the uninfected larval ticks acquiring the infection and therefore increases the risk of humans being infected with TBE. On the other hand, cooler spring temperatures would result in less overlapped feeding activity, and would therefore decrease the risk of zoonotic transmission of TBE. The transmission of pathogens can be achieved through either direct contact from a diseased animal to another, or indirectly through a host like infected prey or a vector. Higher temperatures as a result of climate change results in an increased presence of disease producing agents in hosts and vectors, and also increases the "survival of animals that harbor disease". Survival of Parelaphostrongylus tenuis , a brain worm of white-tailed deer that affects moose, could be increased due to the higher temperatures and milder winters that are caused by climate change. In moose, this brain causes neurological disease and eventually ends up being fatal. Moose are already facing heat stress due to climate change, and may have increased susceptibility to parasitic and infectious diseases like the brain worm. Predicting the impact climate change might have on disease patterns in different geographic regions can be difficult, because its effects likely have high variability. This has been more evident in marine ecosystems than terrestrial environments, where massive decline in coral reefs has been observed due to disease spread. Northern geographic shifts of disease vectors and parasitic disease in the Northern Hemisphere have likely been due to global warming. The geographic range of a lung parasite that impacts ungulates like caribou and mountain goats, Parelaphostrongylus odocoilei , has been shifting northward since 1995, and a tick vector for Lyme disease and other tick-borne zoonotic diseases known as Ixodes scapularis has been expanding its presence northward as well. It is also predicted that climate warming will also lead to changes in disease distribution at certain altitudes. At high elevation in the Hawaiian Islands, for example, it is expected that climate warming will allow for year-round transmission of avian malaria . This increased opportunity for transmission will likely be devastating to endangered native Hawaiian birds at those altitudes that have little or no resistance to the disease. Phenology is the study of seasonal cycles, and with climate change the seasonal biologic cycles of many animals have already been affected. For example, the transmission of tick-borne encephalitis (TBE) is higher to humans when early spring temperatures are warmer. The warmer temperatures result in an overlap in feeding activity of ticks who are infected with the virus (nymphal) with ticks who aren't (larval). This overlapped feeding leads to more of the uninfected larval ticks acquiring the infection and therefore increases the risk of humans being infected with TBE. On the other hand, cooler spring temperatures would result in less overlapped feeding activity, and would therefore decrease the risk of zoonotic transmission of TBE. The transmission of pathogens can be achieved through either direct contact from a diseased animal to another, or indirectly through a host like infected prey or a vector. Higher temperatures as a result of climate change results in an increased presence of disease producing agents in hosts and vectors, and also increases the "survival of animals that harbor disease". Survival of Parelaphostrongylus tenuis , a brain worm of white-tailed deer that affects moose, could be increased due to the higher temperatures and milder winters that are caused by climate change. In moose, this brain causes neurological disease and eventually ends up being fatal. Moose are already facing heat stress due to climate change, and may have increased susceptibility to parasitic and infectious diseases like the brain worm. Predicting the impact climate change might have on disease patterns in different geographic regions can be difficult, because its effects likely have high variability. This has been more evident in marine ecosystems than terrestrial environments, where massive decline in coral reefs has been observed due to disease spread. Vector-borne diseases seriously affect the health of domestic animals and livestock (e.g., trypanosomiasis , Rift Valley Fever , and bluetongue ). Therefore, climate change will also indirectly affect the health of humans through its multifaceted impacts on food security, including livestock and plant crops. Mosquitoes also carry diseases like Dirofilaria immitis which affect dogs (dog heartworm). Therefore, tropical diseases will probably migrate and become endemic in many other ecosystems due to an increase in mosquito range. While climate-induced heat stress can directly reduce domestic animals' immunity against all diseases, climatic factors also impact the distribution of many livestock pathogens themselves. For instance, Rift Valley fever outbreaks in East Africa are known to be more intense during the times of drought or when there is an El Nino . Another example is that of helminths in Europe which have now spread further towards the poles, with higher survival rate and higher reproductive capacity ( fecundity ). : 231 Detailed long-term records of both livestock diseases and various agricultural interventions in Europe mean that demonstrating the role of climate change in the increased helminth burden in livestock is actually easier than attributing the impact of climate change on diseases which affect humans. : 231 Temperature increases are also likely to benefit Culicoides imicola , a species of midge which spreads bluetongue virus . Without a significant improvement in epidemiological control measures, what is currently considered an once-in-20-years outbreak of bluetongue would occur as frequently as once in five or seven years by midcentury under all but the most optimistic warming scenario. Rift Valley Fever outbreaks in East African livestock are also expected to increase. : 747 Ixodes ricinus , a tick which spreads pathogens like Lyme disease and tick-borne encephalitis , is predicted to become 5–7% more prevalent on livestock farms in Great Britain, depending on the extent of future climate change. The policy implications of climate change and infectious diseases fall into two categories: Enacting policy that will reduce greenhouse gas emissions, thus slowing down climate change, and Mitigating problems that have already arisen, and will inevitably continue to develop, due to climate change. Addressing both of these areas is of importance, as those in the poorest countries face the greatest burden. Additionally, when countries are forced to contend with a disease like malaria (for example), their prospects for economic growth are slowed. This contributes to continued and worsening global inequality. Policies are required that will significantly increase investments in public health in developing countries. This achieves two goals, the first being better outcomes related to diseases like malaria in the affected area, and the second being an overall better health environment for populations. It is also important to focus on " one-health approaches." This means collaborating on an interdisciplinary level, across various geographic areas, to come up with workable solutions. As is the case when responding to the effects of climate change, vulnerable populations including children and the elderly will need to be prioritized by any intervention. The United Nations Environment Programme states that: "The most fundamental way to protect ourselves from zoonotic diseases is to prevent destruction of nature. Where ecosystems are healthy and bio-diverse, they are resilient, adaptable and help to regulate diseases." Significant progress has been achieved in terms of surveillance systems, disease and vector control measures, vaccine development, diagnostic tests, and mathematical risk modeling/mapping in recent decades. A tool that has been used to predict this distribution trend is the Dynamic Mosquito Simulation Process (DyMSiM). DyMSiM uses epidemiological and entomological data and practices to model future mosquito distributions based upon climate conditions and mosquitos living in the area. This modeling technique helps identify the distribution of specific species of mosquito, some of which are more susceptible to viral infection than others. [ citation needed ] Scientists are carrying out attribution studies, to find the degree to which climate change affects the spread of infectious diseases. There is also a need for scenario modeling which can help further our understanding of future climate change consequences on infectious disease rates. Surveillance and monitoring of infectious diseases and their vectors is important to better understand these diseases. Governments should accurately model changes in vector populations as well as the burden of disease, educate the public on ways to mitigate infection, and prepare health systems for the increasing disease load.Significant progress has been achieved in terms of surveillance systems, disease and vector control measures, vaccine development, diagnostic tests, and mathematical risk modeling/mapping in recent decades. A tool that has been used to predict this distribution trend is the Dynamic Mosquito Simulation Process (DyMSiM). DyMSiM uses epidemiological and entomological data and practices to model future mosquito distributions based upon climate conditions and mosquitos living in the area. This modeling technique helps identify the distribution of specific species of mosquito, some of which are more susceptible to viral infection than others. [ citation needed ] Scientists are carrying out attribution studies, to find the degree to which climate change affects the spread of infectious diseases. There is also a need for scenario modeling which can help further our understanding of future climate change consequences on infectious disease rates. Surveillance and monitoring of infectious diseases and their vectors is important to better understand these diseases. Governments should accurately model changes in vector populations as well as the burden of disease, educate the public on ways to mitigate infection, and prepare health systems for the increasing disease load.

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Dengue fever

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Tourniquet test

A tourniquet test (also known as a Rumpel-Leede capillary-fragility test or simply a capillary fragility test ) determines capillary fragility. It is a clinical diagnostic method to determine a patient's haemorrhagic tendency. It assesses fragility of capillary walls and is used to identify thrombocytopenia (a reduced platelet count). A blood pressure cuff is applied and inflated to the midpoint between the systolic and diastolic blood pressures for five minutes. The test is positive if there are more than 10 to 20 petechiae per square inch. The test was once part of the World Health Organization (WHO) algorithm for diagnosis of dengue fever , however it is no longer used in the latest WHO guidance. Studies have shown that the tourniquet test has low predictive value for dengue fever and should be used in conjunction with other tests for a reliable diagnosis.

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Dengue fever

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NS1 antigen test

NS1 antigen test (nonstructural protein 1) is a test for dengue , introduced in 2006. It allows rapid detection on the first day of fever, before antibodies appear some 5 or more days later. It has been adopted for use in some 40 nations. The method of detection is through enzyme-linked immunosorbent assay . India has introduced in 2010 the NS1 test costing 1,600 rupees at a private hospital in Mumbai . The medical use of the NS1 antigen test can be defined to diagnose dengue infections and is effective to 1st day detection. Additionally, NS1 assay is useful for differential diagnostics in regards to flaviviruses . NS1 is present in the serum of infected persons directly at the onset of clinical symptoms in primary dengue infection and produces a strong humoral response. It is detectable before the appearance of IgM antibodies. DENV by NS1 antigen is laboratory confirmation of dengue in people also assessing clinical aspects (as well as, taking into account where the individual may have traveled recently). Serological tests such as an immunoglobulin M antibody capture–enzyme-linked immunosorbent assay (MAC-ELISA) and viral RNA detection by reverse transcriptase ( RT-PCR ) can also be used to diagnose dengue fever.

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Dengue fever

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Langerhans cell

A Langerhans cell ( LC ) is a tissue-resident macrophage of the skin once thought to be a resident dendritic cell. These cells contain organelles called Birbeck granules . They are present in all layers of the epidermis and are most prominent in the stratum spinosum . They also occur in the papillary dermis , particularly around blood vessels, as well as in the mucosa of the mouth , foreskin , and vaginal epithelium . They can be found in other tissues, such as lymph nodes , particularly in association with the condition Langerhans cell histiocytosis (LCH).In skin infections , the local Langerhans cells take up and process microbial antigens to become fully functional antigen-presenting cells . Generally, tissue-resident macrophages are involved in immune homeostasis and the uptake of apoptotic bodies . However, Langerhans cells can also take on a dendritic cell -like phenotype and migrate to lymph nodes to interact with naive T-cells . [ medical citation needed ] Langerhans cells derive from primitive erythro-myeloid progenitors that arise in the yolk sac outside the embryo in the first trimester of pregnancy, and under normal circumstances persist throughout life, being replenished by local proliferation as necessary. If the skin becomes severely inflamed, perhaps because of infection, blood monocytes are recruited to the affected region and differentiate into replacement LCs. Langerin is a protein found in Langerhans cells, and dendritic cells . LCs contain a large amount of cannabinoid receptor type 2 (CB2), that by activation by agonists , attenuate both the recruitment of eosinophils and ear swelling in chronic contact dermatitis induced by repeated challenge. In the rare disease Langerhans cell histiocytosis (LCH), an excess of cells similar to these cells are produced. However LCH cells stain positive to CD14 which is a monocyte marker and shows a different, hematopoietic origin for the disorder. LCH can cause damage to skin , bone and other organs. [ citation needed ] Langerhans cells may be initial cellular targets in the sexual transmission of HIV, and may be a target, reservoir, and vector of dissemination. Langerhans cells have been observed in foreskin, vaginal, and oral mucosa of humans; the lower concentrations in oral mucosa suggest that it is not a likely source of HIV infection relative to foreskin and vaginal mucosa. High-risk human papillomaviruses (HPV) are sexually transmitted viruses causally associated with several cancers including cervical, vaginal, anal, and head and neck cancers that cause significant morbidity and mortality worldwide. Over half of all cervical cancer cases are associated with HPV16, the most common of the cancer-causing high-risk genotypes. During its natural life cycle, HPV16 infects the basal cells of the epithelium and interacts with Langerhans cells within the epithelial layer, which are responsible for initiating immune responses against epithelial invading pathogens. However, HPV does not activate Langerhans cells in vitro , and this may represent a key mechanism by which HPV evades immune detection in vivo . Specifically, HPV16 entry into Langerhans cells via the annexin A2 / S100A10 heterotetramer results in suppressive signaling and lack of Langerhans cell-mediated immune responses. This Langerhans cell-targeted immune escape mechanism seems to be conserved among different HPV genotypes enabling these viruses to remain undetected in the absence of other inflammatory events. T cells exposed to these inactivated Langerhans cells are not anergic, and can be activated against HPV upon receiving the appropriate stimuli at a later time point. It was demonstrated that Langerhans cells in HPV-induced cervical lesions were spherical, lacked dendrites, and secreted the suppressive cytokine IL-10 in vivo . The authors further demonstrated that the number of IL-10 secreting immunosuppressive Langerhans cells, and the amount of IL-10 produced in lesions, corresponded with the severity of histopathology and HPV viral load, providing evidence of an active immunosuppressive mechanism employed by HPV that targets Langerhans cells in vivo . [ citation needed ] Langerhans cells are also the initial target of the virus that causes dengue fever during its development. During ageing the capacity of Langerhans cells to migrate declines. This compromises immunity and exposes the skin to infectious diseases and cancer. [ citation needed ]In the rare disease Langerhans cell histiocytosis (LCH), an excess of cells similar to these cells are produced. However LCH cells stain positive to CD14 which is a monocyte marker and shows a different, hematopoietic origin for the disorder. LCH can cause damage to skin , bone and other organs. [ citation needed ]Langerhans cells may be initial cellular targets in the sexual transmission of HIV, and may be a target, reservoir, and vector of dissemination. Langerhans cells have been observed in foreskin, vaginal, and oral mucosa of humans; the lower concentrations in oral mucosa suggest that it is not a likely source of HIV infection relative to foreskin and vaginal mucosa. High-risk human papillomaviruses (HPV) are sexually transmitted viruses causally associated with several cancers including cervical, vaginal, anal, and head and neck cancers that cause significant morbidity and mortality worldwide. Over half of all cervical cancer cases are associated with HPV16, the most common of the cancer-causing high-risk genotypes. During its natural life cycle, HPV16 infects the basal cells of the epithelium and interacts with Langerhans cells within the epithelial layer, which are responsible for initiating immune responses against epithelial invading pathogens. However, HPV does not activate Langerhans cells in vitro , and this may represent a key mechanism by which HPV evades immune detection in vivo . Specifically, HPV16 entry into Langerhans cells via the annexin A2 / S100A10 heterotetramer results in suppressive signaling and lack of Langerhans cell-mediated immune responses. This Langerhans cell-targeted immune escape mechanism seems to be conserved among different HPV genotypes enabling these viruses to remain undetected in the absence of other inflammatory events. T cells exposed to these inactivated Langerhans cells are not anergic, and can be activated against HPV upon receiving the appropriate stimuli at a later time point. It was demonstrated that Langerhans cells in HPV-induced cervical lesions were spherical, lacked dendrites, and secreted the suppressive cytokine IL-10 in vivo . The authors further demonstrated that the number of IL-10 secreting immunosuppressive Langerhans cells, and the amount of IL-10 produced in lesions, corresponded with the severity of histopathology and HPV viral load, providing evidence of an active immunosuppressive mechanism employed by HPV that targets Langerhans cells in vivo . [ citation needed ]Langerhans cells are also the initial target of the virus that causes dengue fever during its development. During ageing the capacity of Langerhans cells to migrate declines. This compromises immunity and exposes the skin to infectious diseases and cancer. [ citation needed ]Langerhans cells are named after Paul Langerhans , a German physician and anatomist , who discovered the cells at the age of 21 while he was a medical student . Because of their dendrite -like appearance, he mistakenly identified the cells as part of the nervous system .

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Dengue fever

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Zika fever

Zika fever , also known as Zika virus disease or simply Zika , is an infectious disease caused by the Zika virus . Most cases have no symptoms, but when present they are usually mild and can resemble dengue fever . Symptoms may include fever , red eyes , joint pain , headache, and a maculopapular rash . Symptoms generally last less than seven days. It has not caused any reported deaths during the initial infection. Mother-to-child transmission during pregnancy can cause microcephaly and other brain malformations in some babies. Infections in adults have been linked to Guillain–Barré syndrome (GBS). Zika fever is mainly spread via the bite of mosquitoes of the Aedes type. It can also be sexually transmitted and potentially spread by blood transfusions . Infections in pregnant women can spread to the baby. Diagnosis is by testing the blood, urine, or saliva for the presence of the virus's RNA when the person is sick, or the blood for antibodies after symptoms are present more than a week. Prevention involves decreasing mosquito bites in areas where the disease occurs and proper use of condoms. Efforts to prevent bites include the use of insect repellent , covering much of the body with clothing, mosquito nets , and getting rid of standing water where mosquitoes reproduce. There is no effective vaccine . Health officials recommended that women in areas affected by the 2015–16 Zika outbreak consider putting off pregnancy and that pregnant women not travel to these areas. While there is no specific treatment, paracetamol (acetaminophen) may help with the symptoms. Admission to hospital is rarely necessary. The virus that causes the disease was first isolated in Africa in 1947. The first documented outbreak among people occurred in 2007 in the Federated States of Micronesia . An outbreak started in Brazil in 2015, and spread to the Americas, Pacific, Asia, and Africa. This led the World Health Organization to declare it a Public Health Emergency of International Concern in February 2016. The emergency was lifted in November 2016, but 84 countries still reported cases as of March 2017. The last proven case of Zika spread in the Continental United States was in 2017. Most people who are infected have no or few symptoms. Otherwise the most common signs and symptoms of Zika fever are fever , rash , conjunctivitis (red eyes), muscle and joint pain , and headache, which are similar to signs and symptoms of dengue and chikungunya fever. The time from a mosquito bite to developing symptoms is not yet known, but is probably a few days to a week. The disease lasts for several days to a week and is usually mild enough that people do not have to go to a hospital. Due to being in the same family as dengue, there has been concern that it could cause similar bleeding disorders. However that has only been documented in one case, with blood seen in semen, also known as hematospermia . Zika virus infections have been strongly associated with Guillain–Barré syndrome (GBS), which is a rapid onset of muscle weakness caused by the immune system damaging the peripheral nervous system, and which can progress to paralysis. While both GBS and Zika infection can simultaneously occur in the same individual, it is difficult to definitively identify Zika virus as the cause of GBS. Though Zika virus has been shown to infect human Schwann cells . Several countries affected by Zika outbreaks have reported increases in the rate of new cases of GBS. During the 2013–2014 outbreak in French Polynesia there were 42 reported cases of GBS over a 3-month period, compared to between 3 and 10 annually prior to the outbreak. The disease spreads from mother to child in the womb and can cause multiple problems, most notably microcephaly , in the baby. The full range of birth defects caused by infection during pregnancy is not known, but they appear to be common, with large scale abnormalities seen in up to 42% of live births. The most common observed associations have been abnormalities with brain and eye development such as microcephaly and chorioretinal scarring. Less commonly there have been systemic abnormalities such as hydrops fetalis , where there is abnormal accumulation of fluid in the fetus. These abnormalities can lead to intellectual problems, seizures , vision problems , hearing problems , problems feeding and slow development. Whether the stage of pregnancy at which the mother becomes infected affects the risk to the fetus is not well understood, nor is whether other risk factors affect outcomes. One group has estimated the risk of a baby developing microcephaly at about 1% when the mother is infected during the first trimester, with the risk of developing microcephaly becoming uncertain beyond the first trimester. Affected babies might appear normal but actually have brain abnormalities; infection in newborns could also lead to brain damage. Zika virus infections have been strongly associated with Guillain–Barré syndrome (GBS), which is a rapid onset of muscle weakness caused by the immune system damaging the peripheral nervous system, and which can progress to paralysis. While both GBS and Zika infection can simultaneously occur in the same individual, it is difficult to definitively identify Zika virus as the cause of GBS. Though Zika virus has been shown to infect human Schwann cells . Several countries affected by Zika outbreaks have reported increases in the rate of new cases of GBS. During the 2013–2014 outbreak in French Polynesia there were 42 reported cases of GBS over a 3-month period, compared to between 3 and 10 annually prior to the outbreak. The disease spreads from mother to child in the womb and can cause multiple problems, most notably microcephaly , in the baby. The full range of birth defects caused by infection during pregnancy is not known, but they appear to be common, with large scale abnormalities seen in up to 42% of live births. The most common observed associations have been abnormalities with brain and eye development such as microcephaly and chorioretinal scarring. Less commonly there have been systemic abnormalities such as hydrops fetalis , where there is abnormal accumulation of fluid in the fetus. These abnormalities can lead to intellectual problems, seizures , vision problems , hearing problems , problems feeding and slow development. Whether the stage of pregnancy at which the mother becomes infected affects the risk to the fetus is not well understood, nor is whether other risk factors affect outcomes. One group has estimated the risk of a baby developing microcephaly at about 1% when the mother is infected during the first trimester, with the risk of developing microcephaly becoming uncertain beyond the first trimester. Affected babies might appear normal but actually have brain abnormalities; infection in newborns could also lead to brain damage. Zika virus is a mosquito - borne flavivirus closely related to the dengue and yellow fever viruses. While mosquitoes are the vector , the main reservoir species remains unknown, though serological evidence has been found in both West African monkeys and rodents. Transmission is via the bite of mosquitoes from the genus Aedes , primarily Aedes aegypti in tropical regions. It has also been isolated from Ae. africanus , Ae. apicoargenteus , Ae. luteocephalus , Ae. albopictus , Ae. vittatus and Ae. furcifer . During the 2007 outbreak on Yap Island in the South Pacific, Aedes hensilli was the vector, while Aedes polynesiensis spread the virus in French Polynesia in 2013. Zika virus can also spread by sexual transmission from infected men to their partners. Zika virus has been isolated from semen samples, with one person having 100,000 times more virus in semen than blood or urine, two weeks after being infected. It is unclear why levels in semen can be higher than other body fluids, and it is also unclear how long infectious virus can remain in semen. There have also been cases of men with no symptoms of Zika virus infection transmitting the disease. The CDC has recommended that all men who have travelled to affected areas should wait at least 6 months before trying to attempt conception , regardless of whether they were ill. To date there have been no reported sexual transmissions from women to their sexual partners. Oral, anal or vaginal sex can spread the disease. Cases of vertical perinatal transmission have been reported. The CDC recommends that women with Zika fever should wait at least 8 weeks after they start having symptoms of disease before attempting to conceive. There have been no reported cases of transmission from breastfeeding, but infectious virus has been found in breast milk. Like other flaviviruses it could potentially be transmitted by blood transfusion and several affected countries have developed strategies to screen blood donors. The U.S. FDA has recommended universal screening of blood products for Zika. The virus is detected in 3% of asymptomatic blood donors in French Polynesia. Zika virus is a mosquito - borne flavivirus closely related to the dengue and yellow fever viruses. While mosquitoes are the vector , the main reservoir species remains unknown, though serological evidence has been found in both West African monkeys and rodents. Transmission is via the bite of mosquitoes from the genus Aedes , primarily Aedes aegypti in tropical regions. It has also been isolated from Ae. africanus , Ae. apicoargenteus , Ae. luteocephalus , Ae. albopictus , Ae. vittatus and Ae. furcifer . During the 2007 outbreak on Yap Island in the South Pacific, Aedes hensilli was the vector, while Aedes polynesiensis spread the virus in French Polynesia in 2013. Zika virus can also spread by sexual transmission from infected men to their partners. Zika virus has been isolated from semen samples, with one person having 100,000 times more virus in semen than blood or urine, two weeks after being infected. It is unclear why levels in semen can be higher than other body fluids, and it is also unclear how long infectious virus can remain in semen. There have also been cases of men with no symptoms of Zika virus infection transmitting the disease. The CDC has recommended that all men who have travelled to affected areas should wait at least 6 months before trying to attempt conception , regardless of whether they were ill. To date there have been no reported sexual transmissions from women to their sexual partners. Oral, anal or vaginal sex can spread the disease. Cases of vertical perinatal transmission have been reported. The CDC recommends that women with Zika fever should wait at least 8 weeks after they start having symptoms of disease before attempting to conceive. There have been no reported cases of transmission from breastfeeding, but infectious virus has been found in breast milk. Like other flaviviruses it could potentially be transmitted by blood transfusion and several affected countries have developed strategies to screen blood donors. The U.S. FDA has recommended universal screening of blood products for Zika. The virus is detected in 3% of asymptomatic blood donors in French Polynesia. In fruit flies microcephaly appears to be caused by the flavivirid virus protein NS4A , which can disrupt brain growth by hijacking a pathway which regulates growth of new neurons. It is difficult to diagnose Zika virus infection based on clinical signs and symptoms alone due to overlaps with other arboviruses that are endemic to similar areas. The US Centers for Disease Control and Prevention (CDC) advises that "based on the typical clinical features, the differential diagnosis for Zika virus infection is broad. In addition to dengue, other considerations include leptospirosis , malaria , rickettsia , group A streptococcus , rubella , measles , and parvovirus , enterovirus , adenovirus , and alphavirus infections (e.g., chikungunya, Mayaro , Ross River , Barmah Forest , O'nyong'nyong , and Sindbis viruses)." In small case series, routine chemistry and complete blood counts have been normal in most patients. A few have been reported to have mild leukopenia , thrombocytopenia , and elevated liver transaminases . Zika virus can be identified by reverse transcriptase PCR (RT-PCR) in acutely ill patients. However, the period of viremia can be short and the World Health Organization (WHO) recommends RT-PCR testing be done on serum collected within 1 to 3 days of symptom onset or on saliva samples collected during the first 3 to 5 days. When evaluating paired samples, Zika virus was detected more frequently in saliva than serum. Urine samples can be collected and tested up to 14 days after the onset of symptoms, as the virus has been seen to survive longer in the urine than either saliva or serum. The longest period of detectable virus has been 11 days and Zika virus does not appear to establish latency. Later on, serology for the detection of specific IgM and IgG antibodies to Zika virus can be used. IgM antibodies can be detectable within 3 days of the onset of illness. Serological cross-reactions with closely related flaviviruses such as dengue and West Nile virus as well as vaccines to flaviviruses are possible. As of 2019, the FDA has authorized two tests to detect Zika virus antibodies. The CDC recommends screening some pregnant women even if they do not have symptoms of infection. Pregnant women who have traveled to affected areas should be tested between two and twelve weeks after their return from travel. Due to the difficulties with ordering and interpreting tests for Zika virus, the CDC also recommends that healthcare providers contact their local health department for assistance. For women living in affected areas, the CDC has recommended testing at the first prenatal visit with a doctor as well as in the mid-second trimester , though this may be adjusted based on local resources and the local burden of Zika virus. Additional testing should be done if there are any signs of Zika virus disease. Women with positive test results for Zika virus infection should have their fetus monitored by ultrasound every three to four weeks to monitor fetal anatomy and growth. For infants with suspected congenital Zika virus disease, the CDC recommends testing with both serologic and molecular assays such as RT-PCR, IgM ELISA and plaque reduction neutralization test (PRNT). RT-PCR of the infants serum and urine should be performed in the first two days of life. Newborns with a mother who was potentially exposed and who have positive blood tests, microcephaly or intracranial calcifications should have further testing including a thorough physical investigation for neurologic abnormalities, dysmorphic features, splenomegaly, hepatomegaly, and rash or other skin lesions. Other recommended tests are cranial ultrasound, hearing evaluation, and eye examination. Testing should be done for any abnormalities encountered as well as for other congenital infections such as syphilis , toxoplasmosis , rubella, cytomegalovirus infection, lymphocytic choriomeningitis virus infection, and herpes simplex virus . Some tests should be repeated up to 6 months later as there can be delayed effects, particularly with hearing. In response to the widespread transmission of Zika virus during the 2016 outbreak and concerns of viral genetic material detected in breast milk the World Health Organization (WHO) released a Guideline of infant feeding in areas of Zika virus transmission, first in 2016 and updated in 2021, where the evidence showed that despite the detection of Zika virus in breast milk, there is unclear evidence of transmission to the infant, and considering that Zika virus infection among infants is mild, the balance between desirable and undesirable effects favours breastfeeding versus not breastfeeding. According to the 2021WHO guidelines: The CDC recommends screening some pregnant women even if they do not have symptoms of infection. Pregnant women who have traveled to affected areas should be tested between two and twelve weeks after their return from travel. Due to the difficulties with ordering and interpreting tests for Zika virus, the CDC also recommends that healthcare providers contact their local health department for assistance. For women living in affected areas, the CDC has recommended testing at the first prenatal visit with a doctor as well as in the mid-second trimester , though this may be adjusted based on local resources and the local burden of Zika virus. Additional testing should be done if there are any signs of Zika virus disease. Women with positive test results for Zika virus infection should have their fetus monitored by ultrasound every three to four weeks to monitor fetal anatomy and growth. For infants with suspected congenital Zika virus disease, the CDC recommends testing with both serologic and molecular assays such as RT-PCR, IgM ELISA and plaque reduction neutralization test (PRNT). RT-PCR of the infants serum and urine should be performed in the first two days of life. Newborns with a mother who was potentially exposed and who have positive blood tests, microcephaly or intracranial calcifications should have further testing including a thorough physical investigation for neurologic abnormalities, dysmorphic features, splenomegaly, hepatomegaly, and rash or other skin lesions. Other recommended tests are cranial ultrasound, hearing evaluation, and eye examination. Testing should be done for any abnormalities encountered as well as for other congenital infections such as syphilis , toxoplasmosis , rubella, cytomegalovirus infection, lymphocytic choriomeningitis virus infection, and herpes simplex virus . Some tests should be repeated up to 6 months later as there can be delayed effects, particularly with hearing. In response to the widespread transmission of Zika virus during the 2016 outbreak and concerns of viral genetic material detected in breast milk the World Health Organization (WHO) released a Guideline of infant feeding in areas of Zika virus transmission, first in 2016 and updated in 2021, where the evidence showed that despite the detection of Zika virus in breast milk, there is unclear evidence of transmission to the infant, and considering that Zika virus infection among infants is mild, the balance between desirable and undesirable effects favours breastfeeding versus not breastfeeding. According to the 2021WHO guidelines: The virus is spread by mosquitoes, making mosquito avoidance an important element to disease control. The CDC recommends that individuals: The CDC also recommends strategies for controlling mosquitoes such as eliminating standing water, repairing septic tanks and using screens on doors and windows. Spraying insecticide is used to kill flying mosquitoes and larvicide can be used in water containers. Because Zika virus can be sexually transmitted, men who have gone to an area where Zika fever is occurring should be counseled to either abstain from sex or use condoms for 6 months after travel if their partner is pregnant or could potentially become pregnant. Breastfeeding is still recommended by the WHO, even by women who have had Zika fever. There have been no recorded cases of Zika transmission to infants through breastfeeding, though the replicative virus has been detected in breast milk. When returning from travel, with or without symptoms, it is suggested that prevention of mosquito bites continue for 3 weeks in order reduce the risk of virus transmission to uninfected mosquitos. Because of the "growing evidence of a link between Zika and microcephaly", in January 2016, the CDC issued a travel alert advising pregnant women to consider postponing travel to countries and territories with ongoing local transmission of Zika virus. Later, the advice was updated to caution pregnant women to avoid these areas entirely if possible and, if travel is unavoidable, to protect themselves from mosquito bites. Male partners of pregnant women and couples contemplating pregnancy who must travel to areas where Zika is active are advised to use condoms or abstain from sex. The agency also suggested that women thinking about becoming pregnant should consult with their physicians before traveling. In September 2016, the CDC travel advisories included: Cape Verde Many parts of the Caribbean: Anguilla, Antigua and Barbuda, Aruba, The Bahamas, Barbados, Bonaire, British Virgin Islands, Cayman Islands, Cuba, Curaçao, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Puerto Rico, Saba, Saint Saint Barthélemy, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Eustatius, Sint Maarten, Trinidad and Tobago, and the U.S. Virgin Islands Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama Mexico Most of South America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela Several Pacific Islands: American Samoa, Fiji, Marshall Islands, Micronesia, New Caledonia, Papua New Guinea, Samoa, and Tonga In Asia: Singapore, Malaysia, Brunei In December 2020, no active Zika outbreaks were reported by the CDC. Both the regional Pan American Health Organization (PAHO) as well as the WHO have issued statements of concern about the widespread public health impact of the Zika virus and its links to GBS and microcephaly. The WHO Director-General, Margaret Chan , issued a statement in February 2016 "declaring that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern." The declaration allowed the WHO to coordinate international response to the virus as well as gave its guidance the force of international law under the International Health Regulations . The declaration was ended in November 2016. As of 2016 there was no available vaccine. Development was a priority of the US National Institutes of Health (NIH), but officials stated that development of a vaccine could take years. To speed new drug development regulatory strategies were proposed by the WHO and NIH. Animal and early human studies were underway as of September 2016. As of December 2019, there were several vaccine candidates in various stages of development. Disease control in the affected countries currently centres around mosquito control. Several approaches are available for the management of Aedes aegypti mosquito populations, including the destruction of larval breeding sites (the aquatic pools in which eggs are laid and larvae hatch prior to mosquito development into flying adults); and, insecticides targeting either the larval stages, adult mosquitoes or both. Additionally, a whole host of novel technologies are under current development for mosquito control and the World Health Organization has recently lent its support for the accelerated development of modern methods for mosquito control such as the use of Wolbachia bacteria to render mosquitoes resistant to the virus, and, the release of sterilized male mosquitoes that breed with wild female mosquitoes to give rise to non-viable offspring (offspring that do not survive to the biting, adult stage). Oxitec 's genetically modified OX513A mosquito was approved by Brazil's National Biosecurity Technical Commission (CTNBio) in April 2014 and it was being used to try to combat mosquitoes carrying the Zika virus in the town of Piracicaba , São Paulo in 2016. In the 1940s and 1950s, the Aedes aegypti mosquito was eradicated on some Caribbean islands and in at least eighteen Latin American countries. Decreasing political will and presumably available money, mosquito resistance to insecticide, and a pace of urbanization which exceeded eradication efforts led to this mosquito's comeback. Because of the "growing evidence of a link between Zika and microcephaly", in January 2016, the CDC issued a travel alert advising pregnant women to consider postponing travel to countries and territories with ongoing local transmission of Zika virus. Later, the advice was updated to caution pregnant women to avoid these areas entirely if possible and, if travel is unavoidable, to protect themselves from mosquito bites. Male partners of pregnant women and couples contemplating pregnancy who must travel to areas where Zika is active are advised to use condoms or abstain from sex. The agency also suggested that women thinking about becoming pregnant should consult with their physicians before traveling. In September 2016, the CDC travel advisories included: Cape Verde Many parts of the Caribbean: Anguilla, Antigua and Barbuda, Aruba, The Bahamas, Barbados, Bonaire, British Virgin Islands, Cayman Islands, Cuba, Curaçao, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Puerto Rico, Saba, Saint Saint Barthélemy, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Eustatius, Sint Maarten, Trinidad and Tobago, and the U.S. Virgin Islands Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama Mexico Most of South America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela Several Pacific Islands: American Samoa, Fiji, Marshall Islands, Micronesia, New Caledonia, Papua New Guinea, Samoa, and Tonga In Asia: Singapore, Malaysia, Brunei In December 2020, no active Zika outbreaks were reported by the CDC. Both the regional Pan American Health Organization (PAHO) as well as the WHO have issued statements of concern about the widespread public health impact of the Zika virus and its links to GBS and microcephaly. The WHO Director-General, Margaret Chan , issued a statement in February 2016 "declaring that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern." The declaration allowed the WHO to coordinate international response to the virus as well as gave its guidance the force of international law under the International Health Regulations . The declaration was ended in November 2016. As of 2016 there was no available vaccine. Development was a priority of the US National Institutes of Health (NIH), but officials stated that development of a vaccine could take years. To speed new drug development regulatory strategies were proposed by the WHO and NIH. Animal and early human studies were underway as of September 2016. As of December 2019, there were several vaccine candidates in various stages of development. Disease control in the affected countries currently centres around mosquito control. Several approaches are available for the management of Aedes aegypti mosquito populations, including the destruction of larval breeding sites (the aquatic pools in which eggs are laid and larvae hatch prior to mosquito development into flying adults); and, insecticides targeting either the larval stages, adult mosquitoes or both. Additionally, a whole host of novel technologies are under current development for mosquito control and the World Health Organization has recently lent its support for the accelerated development of modern methods for mosquito control such as the use of Wolbachia bacteria to render mosquitoes resistant to the virus, and, the release of sterilized male mosquitoes that breed with wild female mosquitoes to give rise to non-viable offspring (offspring that do not survive to the biting, adult stage). Oxitec 's genetically modified OX513A mosquito was approved by Brazil's National Biosecurity Technical Commission (CTNBio) in April 2014 and it was being used to try to combat mosquitoes carrying the Zika virus in the town of Piracicaba , São Paulo in 2016. In the 1940s and 1950s, the Aedes aegypti mosquito was eradicated on some Caribbean islands and in at least eighteen Latin American countries. Decreasing political will and presumably available money, mosquito resistance to insecticide, and a pace of urbanization which exceeded eradication efforts led to this mosquito's comeback. There is currently no specific treatment for Zika virus infection. Care is supportive with treatment of pain, fever, and itching. Some authorities have recommended against using aspirin and other NSAIDs as these have been associated with hemorrhagic syndrome when used for other flaviviruses. Additionally, aspirin use is generally avoided in children when possible due to the risk of Reye syndrome . Zika virus had been relatively little studied until the major outbreak in 2015, and no specific antiviral treatments are available as yet. Advice to pregnant women is to avoid any risk of infection so far as possible, as once infected there is little that can be done beyond supportive treatment. Most of the time, Zika fever resolves on its own in two to seven days, but rarely, some people develop Guillain–Barré syndrome . The fetus of a pregnant woman who has Zika fever may die or be born with congenital central nervous system malformations, like microcephaly . In April 1947, as part of studies sponsored by the Rockefeller Foundation into yellow fever , 6 caged rhesus monkeys were placed in the canopy of the Zika Forest of Uganda. On April 18 one of the monkeys (no. 776) developed a fever and blood samples revealed the first known case of Zika fever. Population surveys at the time in Uganda found 6.1% of individuals to be seropositive for Zika. The first human cases were reported in Nigeria in 1954. A few outbreaks have been reported in tropical Africa and in some areas in Southeast Asia. Until recently there were no documented cases of Zika virus in the Indian subcontinent , however, the first cases were reported in 2017 from Gujarat state and Tamil Nadu, more cases were reported in Rajasthan state involving an outbreak of 153 reported cases and in a pregnant women living in Kerala state. A 1954 study assessing blood samples from several people from different states found antibodies to Zika in healthy people in India which could indicate past exposure, though it could also be due to cross-reaction with other flaviviruses. By using phylogenetic analysis of Asian strains, it was estimated that Zika virus had moved to Southeast Asia by 1945. In 1977–1978, Zika virus infection was described as a cause of fever in Indonesia. Before 2007, there were only 13 reported natural infections with Zika virus, all with a mild, self-limited febrile illness. As of July 2019, evidence of local transmission from mosquitoes to humans has been reported in a total of 87 countries from four of six WHO Regions ; African, Americas, South-East Asia and Western Pacific. The first major outbreak, with 185 confirmed cases, was reported in 2007 in the Yap Islands of the Federated States of Micronesia. A total of 108 cases were confirmed by PCR or serology and 72 additional cases were suspected. The most common symptoms were rash, fever, arthralgia, and conjunctivitis, and no deaths were reported. The mosquito Aedes hensilli , which was the predominant species identified in Yap during the outbreak, was probably the main vector of transmission. While the way of introduction of the virus on Yap Island remains uncertain, it is likely to have happened through introduction of infected mosquitoes or a human infected with a strain related to those in Southeast Asia. This was also the first time Zika fever had been reported outside Africa and Asia. Before the Yap Island outbreak, only 14 human cases had ever been reported. In 2013–2014, several outbreaks of Zika were reported in French Polynesia , New Caledonia , Easter Island and the Cook Islands . The source of the virus was thought to be an independent introduction of the virus from Southeast Asia , unrelated to the Yap Islands outbreak. Genetic analyses of Zika virus strains suggest that Zika first entered the Americas between May and December 2013. It was first detected in the Western Hemisphere in February 2014, and rapidly spread throughout South and Central America, reaching Mexico in November 2015. In 2016 it established local transmission in Florida and Texas. The first death in the United States due to Zika occurred in February 2016. In May 2015, Brazil officially reported its first 16 cases of the illness. Although, a case of illness was reported in March 2015 in a returning traveller. According to the Brazilian Health Ministry, as of November 2015 there was no official count of the number of people infected with the virus in Brazil, since the disease is not subject to compulsory notification. Even so, cases were reported in 14 states of the country. Mosquito-borne Zika virus is suspected to be the cause of 2,400 possible cases of microcephaly and 29 infant deaths in Brazil in 2015 (of the 2400 or so notified cases in 2015, 2165 were under investigation in December 2015, 134 were confirmed and 102 were ruled out for microcephaly). The Brazilian Health Ministry has reported at least 2,400 suspected cases of microcephaly in the country in 2015 as of 12 December, and 29 fatalities. Before the Zika outbreak, only an average of 150 to 200 cases per year were reported in Brazil. In the state of Pernambuco the reported rates of microcephaly in 2015 are 77 times higher than in the previous 5 years. A model using data from a Zika outbreak in French Polynesia estimated the risk of microcephaly in children born to mothers who acquired Zika virus in the first trimester to be 1%. On 24 January 2016, the WHO warned that the virus is likely to spread to nearly all countries of the Americas, since its vector, the mosquito Aedes aegypti , is found in all countries in the region, except for Canada and continental Chile . The mosquito and dengue fever have been detected in Chile's Easter Island, some 3,500 km (2,200 mi) away from its closest point in mainland Chile, since 2002. In February 2016, WHO declared the outbreak a Public Health Emergency of International Concern as evidence grew that Zika is a cause of birth defects and neurological problems. In April 2016, WHO stated there is a scientific consensus, based on preliminary evidence, that Zika is a cause of microcephaly in infants and Guillain–Barré syndrome in adults. Studies of this and prior outbreaks have found Zika infection during pregnancy to be associated with early pregnancy loss and other pregnancy problems. In the Americas the number of cases peaked during the first half of 2016 and declined through 2017–2018, with a total of 31,587 suspected, probable, and confirmed cases of ZIKV disease were reported in the Region of the Americas. Of these, 3,473 (11%) were laboratory confirmed. In general, transmission persists at low levels in some areas and is not uniformly distributed within countries. In 2016 imported or locally transmitted Zika was reported in all the countries of Asia except Brunei, Hong Kong, Myanmar and Nepal. Serological surveys have indicated that Zika virus is endemic in most areas of Asia, though at a low level. While there was a sharp rise in the number of cases of Zika detected in Singapore after the 2016 Summer Olympics in Brazil, genetic analysis revealed that the strains were more closely related to strains from Thailand than from those causing the epidemic in the Americas. The first major outbreak, with 185 confirmed cases, was reported in 2007 in the Yap Islands of the Federated States of Micronesia. A total of 108 cases were confirmed by PCR or serology and 72 additional cases were suspected. The most common symptoms were rash, fever, arthralgia, and conjunctivitis, and no deaths were reported. The mosquito Aedes hensilli , which was the predominant species identified in Yap during the outbreak, was probably the main vector of transmission. While the way of introduction of the virus on Yap Island remains uncertain, it is likely to have happened through introduction of infected mosquitoes or a human infected with a strain related to those in Southeast Asia. This was also the first time Zika fever had been reported outside Africa and Asia. Before the Yap Island outbreak, only 14 human cases had ever been reported. In 2013–2014, several outbreaks of Zika were reported in French Polynesia , New Caledonia , Easter Island and the Cook Islands . The source of the virus was thought to be an independent introduction of the virus from Southeast Asia , unrelated to the Yap Islands outbreak. Genetic analyses of Zika virus strains suggest that Zika first entered the Americas between May and December 2013. It was first detected in the Western Hemisphere in February 2014, and rapidly spread throughout South and Central America, reaching Mexico in November 2015. In 2016 it established local transmission in Florida and Texas. The first death in the United States due to Zika occurred in February 2016. In May 2015, Brazil officially reported its first 16 cases of the illness. Although, a case of illness was reported in March 2015 in a returning traveller. According to the Brazilian Health Ministry, as of November 2015 there was no official count of the number of people infected with the virus in Brazil, since the disease is not subject to compulsory notification. Even so, cases were reported in 14 states of the country. Mosquito-borne Zika virus is suspected to be the cause of 2,400 possible cases of microcephaly and 29 infant deaths in Brazil in 2015 (of the 2400 or so notified cases in 2015, 2165 were under investigation in December 2015, 134 were confirmed and 102 were ruled out for microcephaly). The Brazilian Health Ministry has reported at least 2,400 suspected cases of microcephaly in the country in 2015 as of 12 December, and 29 fatalities. Before the Zika outbreak, only an average of 150 to 200 cases per year were reported in Brazil. In the state of Pernambuco the reported rates of microcephaly in 2015 are 77 times higher than in the previous 5 years. A model using data from a Zika outbreak in French Polynesia estimated the risk of microcephaly in children born to mothers who acquired Zika virus in the first trimester to be 1%. On 24 January 2016, the WHO warned that the virus is likely to spread to nearly all countries of the Americas, since its vector, the mosquito Aedes aegypti , is found in all countries in the region, except for Canada and continental Chile . The mosquito and dengue fever have been detected in Chile's Easter Island, some 3,500 km (2,200 mi) away from its closest point in mainland Chile, since 2002. In February 2016, WHO declared the outbreak a Public Health Emergency of International Concern as evidence grew that Zika is a cause of birth defects and neurological problems. In April 2016, WHO stated there is a scientific consensus, based on preliminary evidence, that Zika is a cause of microcephaly in infants and Guillain–Barré syndrome in adults. Studies of this and prior outbreaks have found Zika infection during pregnancy to be associated with early pregnancy loss and other pregnancy problems. In the Americas the number of cases peaked during the first half of 2016 and declined through 2017–2018, with a total of 31,587 suspected, probable, and confirmed cases of ZIKV disease were reported in the Region of the Americas. Of these, 3,473 (11%) were laboratory confirmed. In general, transmission persists at low levels in some areas and is not uniformly distributed within countries. In 2016 imported or locally transmitted Zika was reported in all the countries of Asia except Brunei, Hong Kong, Myanmar and Nepal. Serological surveys have indicated that Zika virus is endemic in most areas of Asia, though at a low level. While there was a sharp rise in the number of cases of Zika detected in Singapore after the 2016 Summer Olympics in Brazil, genetic analysis revealed that the strains were more closely related to strains from Thailand than from those causing the epidemic in the Americas. It is named after the Zika Forest near Entebbe , Uganda , where the Zika virus was first identified. Zika virus was first identified in the late 1940s in Kampala, Uganda, Africa but was first confirmed in Brazil. Since it was first identified, Zika has been found in more than 27 countries and territories. Following the initial Zika outbreak in Northeastern Brazil in May 2015, physicians observed a very large surge of reports of infants born with microcephaly , with 20 times the number of expected cases. Many of these cases have since been confirmed, leading WHO officials to project that approximately 2,500 infants will be found to have born in Brazil with Zika-related microcephaly. Proving that Zika causes these effects was difficult and complex for several reasons. For example, the effects on an infant might not be seen until months after the mother's initial infection, long after the time when Zika is easily detected in the body. In addition, research was needed to determine the mechanism by which Zika produced these effects. Since the initial outbreak, studies that use several different methods found evidence of a link, leading public health officials to conclude that it appears increasingly likely the virus is linked to microcephaly and miscarriage. On 1 February 2016, the World Health Organization declared recently reported clusters of microcephaly and other neurological disorders a Public Health Emergency of International Concern (PHEIC). On 8 March 2016, the WHO Committee reconfirmed that the association between Zika and neurological disorders is of global concern. The Zika virus was first linked with newborn microcephaly during the Brazil Zika virus outbreak. In 2015, there were 2,782 suspected cases of microcephaly compared with 147 in 2014 and 167 in 2013. Confirmation of many of the recent cases is pending, and it is difficult to estimate how many cases went unreported before the recent awareness of the risk of virus infections. In November 2015, the Zika virus was isolated in a newborn baby from the northeastern state of Ceará , Brazil, with microcephaly and other congenital disorders . The Lancet medical journal reported in January 2016 that the Brazilian Ministry of Health had confirmed 134 cases of microcephaly "believed to be associated with Zika virus infection" with an additional 2,165 cases in 549 counties in 20 states remaining under investigation. An analysis of 574 cases of microcephaly in Brazil during 2015 and the first week of 2016, reported in March 2016, found an association with maternal illness involving rash and fever during the first trimester of pregnancy. During this period, 12 Brazilian states reported increases of at least 3 standard deviations (SDs) in cases of microcephaly compared with 2000–14, with the northeastern states of Bahia, Paraíba and Pernambuco reporting increases of more than 20 SDs. In January 2016, a baby in Oahu , Hawaii, was born with microcephaly, the first case in the United States of brain damage linked to the virus. The baby and mother tested positive for a past Zika virus infection. The mother, who had probably acquired the virus while traveling in Brazil in May 2015 during the early stages of her pregnancy, had reported her bout of Zika. She recovered before relocating to Hawaii. Her pregnancy had progressed normally, and the baby's condition was not known until birth. In February 2016, ocular disorders in newborns have been linked to Zika virus infection. In one study in Pernambuco state in Brazil, about 40 percent of babies with Zika-related microcephaly also had scarring of the retina with spots, or pigment alteration . On 20 February 2016, Brazilian scientists announced that they had successfully sequenced the Zika virus genome and expressed hope that this would help in both developing a vaccine and in determining the nature of any link to birth defects. Also in February 2016, rumors that microcephaly is caused by the use of the larvicide pyriproxyfen in drinking water were refuted by scientists. "It's important to state that some localities that do not use pyriproxyfen also had reported cases of microcephaly", read a Brazilian government statement. The Brazilian government also refuted conspiracy theories that chickenpox and rubella vaccinations or genetically modified mosquitoes were causing increases in microcephaly. Researchers also suspected that Zika virus could be transmitted by a pregnant woman to her baby (" vertical transmission "). This remained unproven until February 2016, when a paper by Calvet et al. was published, showing not only was the Zika virus genome found in the amniotic fluid but also IgM antibodies against the virus. This means that not only can the virus cross the placental barrier, but also the antibodies produced by the mother can reach the fetus, which suggests that vertical transmission is plausible in these cases. One other study published in March 2016 by Mlakar and colleagues analyzed autopsy tissues from a fetus with microcephaly that was probably related to Zika virus; researchers found ZIKV in the brain tissue and suggested that the brain injuries were probably associated with the virus, which also shed a light on the vertical transmission theory. Also in March 2016, first solid evidence was reported on how the virus affects the development of the brain, indicating that it appears to preferentially kill developing brain cells. The first cases of birth defects linked to Zika in Colombia and in Panama were reported in March 2016. In the same month, researchers published a prospective cohort study that found profound impacts in 29 percent of infants of mothers infected with Zika, some of whom were infected late in pregnancy. This study did not suffer from some of the difficulties of studying Zika: the study followed women who presented to a Rio de Janeiro clinic with fever and rash within the last five days. The women were then tested for Zika using PCR, then the progress of the pregnancies were followed using ultrasound. A high rate of the autoimmune disease Guillain–Barré syndrome (GBS), noted in the French Polynesia outbreak, has also been found in the outbreak that began in Brazil. Laboratory analysis found Zika infections in some patients with GBS in Brazil, El Salvador, Suriname and Venezuela, and the WHO declared on 22 March 2016 that Zika appeared to be "implicated" in GBS infection and that if the pattern was confirmed it would represent a global public health crisis. It is named after the Zika Forest near Entebbe , Uganda , where the Zika virus was first identified. Zika virus was first identified in the late 1940s in Kampala, Uganda, Africa but was first confirmed in Brazil. Since it was first identified, Zika has been found in more than 27 countries and territories. Following the initial Zika outbreak in Northeastern Brazil in May 2015, physicians observed a very large surge of reports of infants born with microcephaly , with 20 times the number of expected cases. Many of these cases have since been confirmed, leading WHO officials to project that approximately 2,500 infants will be found to have born in Brazil with Zika-related microcephaly. Proving that Zika causes these effects was difficult and complex for several reasons. For example, the effects on an infant might not be seen until months after the mother's initial infection, long after the time when Zika is easily detected in the body. In addition, research was needed to determine the mechanism by which Zika produced these effects. Since the initial outbreak, studies that use several different methods found evidence of a link, leading public health officials to conclude that it appears increasingly likely the virus is linked to microcephaly and miscarriage. On 1 February 2016, the World Health Organization declared recently reported clusters of microcephaly and other neurological disorders a Public Health Emergency of International Concern (PHEIC). On 8 March 2016, the WHO Committee reconfirmed that the association between Zika and neurological disorders is of global concern. The Zika virus was first linked with newborn microcephaly during the Brazil Zika virus outbreak. In 2015, there were 2,782 suspected cases of microcephaly compared with 147 in 2014 and 167 in 2013. Confirmation of many of the recent cases is pending, and it is difficult to estimate how many cases went unreported before the recent awareness of the risk of virus infections. In November 2015, the Zika virus was isolated in a newborn baby from the northeastern state of Ceará , Brazil, with microcephaly and other congenital disorders . The Lancet medical journal reported in January 2016 that the Brazilian Ministry of Health had confirmed 134 cases of microcephaly "believed to be associated with Zika virus infection" with an additional 2,165 cases in 549 counties in 20 states remaining under investigation. An analysis of 574 cases of microcephaly in Brazil during 2015 and the first week of 2016, reported in March 2016, found an association with maternal illness involving rash and fever during the first trimester of pregnancy. During this period, 12 Brazilian states reported increases of at least 3 standard deviations (SDs) in cases of microcephaly compared with 2000–14, with the northeastern states of Bahia, Paraíba and Pernambuco reporting increases of more than 20 SDs. In January 2016, a baby in Oahu , Hawaii, was born with microcephaly, the first case in the United States of brain damage linked to the virus. The baby and mother tested positive for a past Zika virus infection. The mother, who had probably acquired the virus while traveling in Brazil in May 2015 during the early stages of her pregnancy, had reported her bout of Zika. She recovered before relocating to Hawaii. Her pregnancy had progressed normally, and the baby's condition was not known until birth. In February 2016, ocular disorders in newborns have been linked to Zika virus infection. In one study in Pernambuco state in Brazil, about 40 percent of babies with Zika-related microcephaly also had scarring of the retina with spots, or pigment alteration . On 20 February 2016, Brazilian scientists announced that they had successfully sequenced the Zika virus genome and expressed hope that this would help in both developing a vaccine and in determining the nature of any link to birth defects. Also in February 2016, rumors that microcephaly is caused by the use of the larvicide pyriproxyfen in drinking water were refuted by scientists. "It's important to state that some localities that do not use pyriproxyfen also had reported cases of microcephaly", read a Brazilian government statement. The Brazilian government also refuted conspiracy theories that chickenpox and rubella vaccinations or genetically modified mosquitoes were causing increases in microcephaly. Researchers also suspected that Zika virus could be transmitted by a pregnant woman to her baby (" vertical transmission "). This remained unproven until February 2016, when a paper by Calvet et al. was published, showing not only was the Zika virus genome found in the amniotic fluid but also IgM antibodies against the virus. This means that not only can the virus cross the placental barrier, but also the antibodies produced by the mother can reach the fetus, which suggests that vertical transmission is plausible in these cases. One other study published in March 2016 by Mlakar and colleagues analyzed autopsy tissues from a fetus with microcephaly that was probably related to Zika virus; researchers found ZIKV in the brain tissue and suggested that the brain injuries were probably associated with the virus, which also shed a light on the vertical transmission theory. Also in March 2016, first solid evidence was reported on how the virus affects the development of the brain, indicating that it appears to preferentially kill developing brain cells. The first cases of birth defects linked to Zika in Colombia and in Panama were reported in March 2016. In the same month, researchers published a prospective cohort study that found profound impacts in 29 percent of infants of mothers infected with Zika, some of whom were infected late in pregnancy. This study did not suffer from some of the difficulties of studying Zika: the study followed women who presented to a Rio de Janeiro clinic with fever and rash within the last five days. The women were then tested for Zika using PCR, then the progress of the pregnancies were followed using ultrasound. A high rate of the autoimmune disease Guillain–Barré syndrome (GBS), noted in the French Polynesia outbreak, has also been found in the outbreak that began in Brazil. Laboratory analysis found Zika infections in some patients with GBS in Brazil, El Salvador, Suriname and Venezuela, and the WHO declared on 22 March 2016 that Zika appeared to be "implicated" in GBS infection and that if the pattern was confirmed it would represent a global public health crisis. Early in the 2015–16 Zika virus epidemic , research was begun to better understand how Zika virus causes microcephaly and other neurological disorders. However, with the 2019 election of Jair Bolsonaro in Brazil, who cut funding for research, and the emergence of the COVID-19 pandemic in early 2020, most Zika-related research projects were abandoned or reduced. It may involve infection of the primary neural stem cells of the fetal brain, known as neural progenitor cells. The main roles of brain stem cells are to proliferate until the correct number is achieved, and then to produce neurons through the process of neurogenesis . Zika proteins NS4A and NS4B have also been shown to directly suppress neurogenesis. Infection of brain stem cells can cause cell death, which reduces the production of future neurons and leads to a smaller brain. Zika also appears to have an equal tropism for cells of the developing eye, leading to high rates of eye abnormalities as well. In addition to inducing cell death, infection of neural progenitor cells may alter the process of cell proliferation, causing a depletion in the pool of progenitor cells. A large number of cases of microcephaly have been associated with inherited gene mutations, and specifically with mutations that lead to dysfunction of the mitotic spindle . There is some evidence that Zika virus may directly or indirectly interfere with mitotic function, this may play a role in altering cell proliferation. Another line of research considers that Zika, unlike other flaviviruses, may target developing brain cells after it crosses the placenta, and considers the resulting damage likely to be the result of inflammation as a byproduct of the immune response to the infection of those cells. Some experimental methods of prevention include breeding and releasing mosquitoes that have been genetically modified to prevent them from transmitting pathogens, or have been infected with the Wolbachia bacterium, believed to inhibit the spread of viruses. A strain of Wolbachia helped to reduce the vector competence of the Zika virus in infected Aedes aegypti released in Medellin, Colombia. Gene drive is a technique for changing wild populations, for instance to combat insects so they cannot transmit diseases (in particular mosquitoes in the cases of malaria and Zika). Another method which been researched aims to render male mosquitoes infertile by nuclear radiation in the hope to reduce populations; this is done with a cobalt-60 gamma cell irradiator. In 2016 the World Health Organization encouraged field trials of transgenic male Aedes aegypti mosquitoes developed by Oxitec to try to halt the spread of the Zika virus. Early in the 2015–16 Zika virus epidemic , research was begun to better understand how Zika virus causes microcephaly and other neurological disorders. However, with the 2019 election of Jair Bolsonaro in Brazil, who cut funding for research, and the emergence of the COVID-19 pandemic in early 2020, most Zika-related research projects were abandoned or reduced. It may involve infection of the primary neural stem cells of the fetal brain, known as neural progenitor cells. The main roles of brain stem cells are to proliferate until the correct number is achieved, and then to produce neurons through the process of neurogenesis . Zika proteins NS4A and NS4B have also been shown to directly suppress neurogenesis. Infection of brain stem cells can cause cell death, which reduces the production of future neurons and leads to a smaller brain. Zika also appears to have an equal tropism for cells of the developing eye, leading to high rates of eye abnormalities as well. In addition to inducing cell death, infection of neural progenitor cells may alter the process of cell proliferation, causing a depletion in the pool of progenitor cells. A large number of cases of microcephaly have been associated with inherited gene mutations, and specifically with mutations that lead to dysfunction of the mitotic spindle . There is some evidence that Zika virus may directly or indirectly interfere with mitotic function, this may play a role in altering cell proliferation. Another line of research considers that Zika, unlike other flaviviruses, may target developing brain cells after it crosses the placenta, and considers the resulting damage likely to be the result of inflammation as a byproduct of the immune response to the infection of those cells. Some experimental methods of prevention include breeding and releasing mosquitoes that have been genetically modified to prevent them from transmitting pathogens, or have been infected with the Wolbachia bacterium, believed to inhibit the spread of viruses. A strain of Wolbachia helped to reduce the vector competence of the Zika virus in infected Aedes aegypti released in Medellin, Colombia. Gene drive is a technique for changing wild populations, for instance to combat insects so they cannot transmit diseases (in particular mosquitoes in the cases of malaria and Zika). Another method which been researched aims to render male mosquitoes infertile by nuclear radiation in the hope to reduce populations; this is done with a cobalt-60 gamma cell irradiator. In 2016 the World Health Organization encouraged field trials of transgenic male Aedes aegypti mosquitoes developed by Oxitec to try to halt the spread of the Zika virus.

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Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Oropouche_fever/html

Oropouche fever

Oropouche fever is a tropical viral infection transmitted by biting midges and mosquitoes from the blood of sloths to humans . This disease is named after the region where it was first discovered and isolated at the Trinidad Regional Virus Laboratory in 1955 by the Oropouche River in Trinidad and Tobago . Oropouche fever is caused by a specific arbovirus , the Oropouche virus (OROV), of the Bunyaviridae family. Large epidemics are common and very swift, one of the earliest largest having occurred at the city of Belém , in the Brazilian Amazon state of Pará , with 11,000 recorded cases. In the Brazilian Amazon, oropouche is the second most frequent viral disease, after dengue fever. Several epidemics have generated more than 263,000 cases, of which 130,000 alone occurred in the period from 1978 to 1980. Presently, in Brazil alone it is estimated that more than half a million cases have occurred. Nevertheless, clinics in Brazil may not have adequate testing reliability as they rely on symptoms rather than PCR viral sequencing, which is expensive and time consuming, in many cases there may be co-infection with other similar mosquito-borne viruses. Oropouche fever is characterized as an acute febrile illness, meaning that it begins with a sudden onset of a fever followed by severe clinical symptoms. It typically takes 4 to 8 days from the incubation period to first start noticing signs of infection , beginning from the bite of the infected mosquito or midge. Fevers are the most common symptom with temperatures as high as 40 °C (104 °F) . Clinical symptoms include chills, headache, myalgia, arthralgia, dizziness, photophobia, vomiting, joint pains, epigastric pain , and rashes. There also have been some cases where rashes resembles rubella and patients presented systematic symptoms including nausea , vomiting , diarrhea , conjunctive congestion , epigastric pain, and retro-orbitial pain. The initial febrile episode typically passes after a few days, but it is very common to have a reoccurrence of these symptoms with a lesser intensity. Studies have shown this typically happens in about 60% of cases. The oropouche virus is an emerging infectious agent that causes the illness oropouche fever. This virus is an arbovirus and is transmitted among sloths, marsupials, primates, and birds through the mosquitoes Aedes serratus and Culex quinquefaciatus . The oropouche virus has evolved to an urban cycle infecting humans though midges as its main transporting vector. OROV was first described in Trinidad in 1955 when the prototype strain was isolated from the blood of a febrile human patient and from Coquillettidia venezuelensis mosquitoes . In Brazil, OROV was first described in 1960 when it was isolated from a three-toed sloth ( Bradypus tridactylus ) and Ochlerotatus serratus mosquitoes captured nearby during the construction of the Belém-Brasilia Highway . The oropouche virus is responsible for causing massive, explosive outbreaks in Latin American countries, making oropouche fever the second most common arboviral infection seen in Brazil. So far the only reported cases of Oropouche fever have been in Brazil, Panama, Peru, and Trinidad and Tobago. ORO fever occurs mainly during the rainy seasons because there is an increase in breeding sites in the vector populations. There has also been reports of the oropouche epidemics during the dry season but this is most likely due to the high population density of mosquitoes from the past rainy season. Moreover, during the dry season there is a deceased chance of outbreaks which decreases the amount of midges this is because the amount of outbreaks is related to the number of human population that has not yet been exposed to this virus. Oropouche fever is caused by the oropouche virus (OROV) that belongs to the Peribunyaviridae family of arboviruses. This virus is a single-stranded, negative sense RNA virus which is the cause of this disease. There are no specific ultrastructural studies of the oropouche virus in human tissues that have been recorded to this date. It is likely that this viral agent shares similar morphological characteristics with other members of the Orthobunyavirus genus. Members of the Orthobunyavirus genus have a three part, single-stranded, negative sense RNA genome of small (S), medium (M) and large (L) RNA segments. These segments function to encode nucleocapsids , glycoproteins and the RNA polymerase in that sequential order. Through phylogenetic analysis of nucleocapsid genes in different oropouche virus strains, it has been revealed that there are three unique genotypes (I, II, III) that are currently spreading through Central and South America. Genetic reassortment is said to be one of the most important mechanisms in explaining the viral biodiversity in orthobunyaviruses. This occurs when two genetically related viruses infect the same cell at the same time forming a progeny virus and this virus holds various components of genetic L, M and S segments from the two parental viruses. In reassortment, the S and L segments are the ones that are usually exchanged between species further, the S segment, that is coded by the nucleocapsid protein, and the L polymerase function together to create a replication of the viral genome. Due to this, one segment will restrict the molecular evolution of another segment and this is said to be inherited as a pair. On the contrary, the M segment codes for viral glycoproteins and these could be more prone to mutations due to a higher selective pressure in their coding region because these proteins are major host range determinants. There is not a significant amount of information about regarding the natural pathogenesis of OROV infections because there have been no recorded fatalities to date. It is known that within 2–4 days from the initial onset of systematic symptoms in humans, the presence of this virus is detected in the blood. In some cases this virus has also been recovered from the cerebrospinal fluid, but the route of invasion to the central nervous system remains unclear. To further understand the pathogenesis of how this virus manifests in the body experimental studies using murine models have been performed. BALB/c neonate mice were treated with this virus subcutaneously and presented clinical symptoms five days after inoculation . The mice revealed a high concentration of the replicating virus in the brain along with inflammation of the meninges and apoptosis of neurons without encephalitis, which is inflammation of the brain due to an infection. These findings confirmed the neurotropism of this virus, which means that this virus is capable of infecting nerve cells. Immunohistochemistry was used to reveal how this virus had access to the central nervous system. The findings indicated that the OROV infection starts from the posterior parts of the brain and progresses toward the forebrain. The oropouche virus spreads through the neural routes during early stages of the infection, reaching the spinal cord and traveling upward to the brain through brainstem with little inflammation. As the infection progresses, the virus crosses the blood-brain barrier and spreads to the brain parenchyma leading to severe manifestations of encephalitis . Damage to the brain parenchyma can result in the loss of cognitive ability or death. Genetic reassortment is said to be one of the most important mechanisms in explaining the viral biodiversity in orthobunyaviruses. This occurs when two genetically related viruses infect the same cell at the same time forming a progeny virus and this virus holds various components of genetic L, M and S segments from the two parental viruses. In reassortment, the S and L segments are the ones that are usually exchanged between species further, the S segment, that is coded by the nucleocapsid protein, and the L polymerase function together to create a replication of the viral genome. Due to this, one segment will restrict the molecular evolution of another segment and this is said to be inherited as a pair. On the contrary, the M segment codes for viral glycoproteins and these could be more prone to mutations due to a higher selective pressure in their coding region because these proteins are major host range determinants. There is not a significant amount of information about regarding the natural pathogenesis of OROV infections because there have been no recorded fatalities to date. It is known that within 2–4 days from the initial onset of systematic symptoms in humans, the presence of this virus is detected in the blood. In some cases this virus has also been recovered from the cerebrospinal fluid, but the route of invasion to the central nervous system remains unclear. To further understand the pathogenesis of how this virus manifests in the body experimental studies using murine models have been performed. BALB/c neonate mice were treated with this virus subcutaneously and presented clinical symptoms five days after inoculation . The mice revealed a high concentration of the replicating virus in the brain along with inflammation of the meninges and apoptosis of neurons without encephalitis, which is inflammation of the brain due to an infection. These findings confirmed the neurotropism of this virus, which means that this virus is capable of infecting nerve cells. Immunohistochemistry was used to reveal how this virus had access to the central nervous system. The findings indicated that the OROV infection starts from the posterior parts of the brain and progresses toward the forebrain. The oropouche virus spreads through the neural routes during early stages of the infection, reaching the spinal cord and traveling upward to the brain through brainstem with little inflammation. As the infection progresses, the virus crosses the blood-brain barrier and spreads to the brain parenchyma leading to severe manifestations of encephalitis . Damage to the brain parenchyma can result in the loss of cognitive ability or death. BALB/c neonate mice were treated with this virus subcutaneously and presented clinical symptoms five days after inoculation . The mice revealed a high concentration of the replicating virus in the brain along with inflammation of the meninges and apoptosis of neurons without encephalitis, which is inflammation of the brain due to an infection. These findings confirmed the neurotropism of this virus, which means that this virus is capable of infecting nerve cells. Immunohistochemistry was used to reveal how this virus had access to the central nervous system. The findings indicated that the OROV infection starts from the posterior parts of the brain and progresses toward the forebrain. The oropouche virus spreads through the neural routes during early stages of the infection, reaching the spinal cord and traveling upward to the brain through brainstem with little inflammation. As the infection progresses, the virus crosses the blood-brain barrier and spreads to the brain parenchyma leading to severe manifestations of encephalitis . Damage to the brain parenchyma can result in the loss of cognitive ability or death. Diagnosis of the oropouche infection is done through classic and molecular virology techniques. These include: Clinical diagnosis of oropouche fever is hard to perform due to the nonspecific nature of the disease, in many causes it can be confused with dengue fever or other arbovirus illness. Prevention strategies include reducing the breeding of midges through source reduction (removal and modification of breeding sites) and reducing contact between midges and people. This can be accomplished by reducing the number of natural and artificial water-filled habitats and encourage the midge larvae to grow. Oropouche fever is present in epidemics so the chances of one contracting it after being exposed to areas of midgets or mosquitoes is rare. Oropouche Fever has no cure or specific therapy so treatment is done by relieving the pain of the symptoms through symptomatic treatment . Certain oral analgesic and anti-inflammatory agents can help treat headaches and body pains. In extreme cases of oropouche fever the drug Ribavirin is recommended to help against the virus. This is called antiviral therapy . Treatments also consist of drinking plenty of fluids to prevent dehydration. Aspirin is not a recommended choice of drug because it can reduce blood clotting and may aggravate the hemorrhagic effects and prolong recovery time. [ citation needed ]The infection is usually self-limiting and complications are rare. This illness usually lasts for about a week but in extreme cases can be prolonged. Patients usually recover fully with no long term ill effects. There have been no recorded fatalities resulting from oropouche fever. One study has focused on identifying OROV through the use of RNA extraction from reverse transcription-polymerase chain reaction. This study revealed that OROV caused central nervous system infections in three patients. The three patients all had meningoencephalitis and also showed signs of clear lympho-monocytic cellular pattern in CSF , high protein, and normal to slightly decreased glucose levels indicating they had viral infections. Two of the patients already had underlying infections that can effect the CNS and immune system and in particular one of these patients has HIV/AIDS and the third patient has neurocysticercosis . Two patients were infected with OROV developed meningitis and it was theorized that this is due to them being immunocompromised. Through this it was revealed that it's possible that the invasion of the central nervous system by the oropouche virus can be performed by a previous blood-brain barrier damage.

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Dengue fever

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National Environment Agency

National Environment Agency ( NEA ) is a statutory board under the Ministry of Sustainability and the Environment of the Government of Singapore . NEA is responsible for improving and sustaining a clean and green environment in Singapore. Its role is to fight pollution, maintain public health, and provide meteorological information. On April 1, 2019, NEA's food related duties were absorbed by its successor Singapore Food Agency (SFA) which also absorbed the food related duties of two other statutory boards namely Agri-Food and Veterinary Authority of Singapore (AVA) and Health Sciences Authority (HSA). SFA is a statutory board under the Ministry of Sustainability and the Environment. NEA comprises three operational divisions: Environmental Public Health Environmental Protection Meteorological Service Singapore The Environmental Public Health Division conducts comprehensive ground surveillance and takes preventive measures to ensure a high standard of public health and hygiene . It is responsible for the overall cleanliness in Singapore and imposes a high standard of hygiene requirements on the food retail industry. It also implements the Hawker Centres Upgrading Programme (HUP) and the Clean Public Toilets Programme. It enforces smoking ban in places such as hawker centres, food shops, shopping centres, factories and offices; and conducts vector control against mosquitoes and rats. The Environmental Protection Division is responsible for implementing programmes to monitor, reduce and prevent environmental pollution. It is also responsible for providing refuse disposal services through four waste-to-energy incineration plants and an off-shore sanitary landfill. To conserve energy resources and landfill space, the division implements programmes to minimise waste generation, and maximise recycling and energy conservation. The Meteorological Service Singapore (MSS) provides weather information to support public health and socio-economic activities. It also issues haze alerts and provides vital meteorological services to the aviation and maritime communities and the military. MSS is also on tsunami watch as part of a regional network set up after several coastal areas in Asia were devastated by the 2004 Indian Ocean earthquake and tsunami .The Environmental Public Health Division conducts comprehensive ground surveillance and takes preventive measures to ensure a high standard of public health and hygiene . It is responsible for the overall cleanliness in Singapore and imposes a high standard of hygiene requirements on the food retail industry. It also implements the Hawker Centres Upgrading Programme (HUP) and the Clean Public Toilets Programme. It enforces smoking ban in places such as hawker centres, food shops, shopping centres, factories and offices; and conducts vector control against mosquitoes and rats.The Environmental Protection Division is responsible for implementing programmes to monitor, reduce and prevent environmental pollution. It is also responsible for providing refuse disposal services through four waste-to-energy incineration plants and an off-shore sanitary landfill. To conserve energy resources and landfill space, the division implements programmes to minimise waste generation, and maximise recycling and energy conservation.The Meteorological Service Singapore (MSS) provides weather information to support public health and socio-economic activities. It also issues haze alerts and provides vital meteorological services to the aviation and maritime communities and the military. MSS is also on tsunami watch as part of a regional network set up after several coastal areas in Asia were devastated by the 2004 Indian Ocean earthquake and tsunami .NEA adopts a multi-pronged approach – which includes surveillance and enforcement, community outreach and education, and research, to tackle vector-borne diseases such as dengue fever . Most recently, it rolled out educational home visits, where NEA officers visit homes in areas where there are less than 10 dengue cases, to educate residents on how to prevent mosquitoes from breeding in their homes. During these visits, the officers will highlight all potential mosquito breeding grounds in that particular home and the corrective measures the resident needs to undertake. No enforcement action will be taken against the resident for any mosquito breeding found on such visits. This approach has yielded good results, with Singapore successfully avoiding a serious dengue outbreak, as experienced in 2005 when 14,209 people were infected with the fever. From 2007 to 2011, the number of dengue cases were 8,826; 7,031; 4,497; 5,363; and 5,330 respectively. NEA plays an important role in overseeing the cleansing of public areas in Singapore. NEA takes a three-pronged approach to keeping our environment clean, which includes: Public Cleansing; Public Education and Enforcement. NEA maintain an effective system of public cleansing to keep Singapore clean and prevent environment-related diseases. The cleansing of public roads and pavements is largely carried out by contractors engaged by the NEA. The NEA works closely with their "3P Partners" (the people, public and private sectors) to promote anti-littering practices and to encourage members of the community to take ownership of their litter and keep their surroundings clean. Regular checks on food establishments, swimming pools and public toilets are carried out to ensure that a high standard of hygiene is maintained. In April 2006, Singapore announced accession to the Kyoto Protocol . As a non-Annex I country, Singapore does not have targets set under KP, but it is eligible to participate in carbon credit exchanges arising from approved Clean Development Mechanism projects conducted in the country. The National Environment Agency is the designated authority coordinating CDMs. It is also spearheading ongoing measures to encourage energy efficiency and lower carbon emissions. In April 2008, NEA launched the 10% Energy Challenge to get households to cut their electricity consumption by at least 10%. As part of this campaign, NEA collaborated with grassroots organizations and charities to train volunteers to conduct energy audits and identify wasteful energy consumption habits. On 11 September 2009, NEA signed a landmark Voluntary Agreement with 16 major retailers and suppliers, to provide more energy efficient appliances and encourage more Singapore households to purchase them. Under the Voluntary Agreement, participating retailers and suppliers will voluntarily commit to achieving targets set out by the NEA, including retiring stock of energy inefficient models and introducing more 3- and 4-tick models, so that energy efficient models form at least 50% of their model range after six months, and 60% of their model range after one year. Signatories also voluntarily commit to promote energy efficient appliances, as well as improve the availability and affordability of energy efficient appliances available in their stores. Since independence, Singapore's growing population and economy have resulted in a large increase in solid waste. In 1970, about 1,300 tonnes per day of solid waste were disposed of. This increased to 7,000 tonnes per day by 2006, a six-fold increase from 1970. To address the solid waste problem, Singapore has put in place an integrated solid waste management system that ensures that all waste that are not recycled, are collected and disposed of safely at waste-to-energy incineration plants or at the offshore sanitary landfill ( Semakau Landfill ) in the case of non-incinerable waste. As a result, overall recycling rate has increased from 40% in 2000 to 56% in 2008. Waste growth has also been curtailed. The total waste (domestic and non-domestic) disposed of in 2008 was 7,179 tonnes per day, a 6% reduction as compared to 2000. As a result, the lifespan of Semakau Landfill has increased from 25–30 years to 35–40 years.NEA adopts a multi-pronged approach – which includes surveillance and enforcement, community outreach and education, and research, to tackle vector-borne diseases such as dengue fever . Most recently, it rolled out educational home visits, where NEA officers visit homes in areas where there are less than 10 dengue cases, to educate residents on how to prevent mosquitoes from breeding in their homes. During these visits, the officers will highlight all potential mosquito breeding grounds in that particular home and the corrective measures the resident needs to undertake. No enforcement action will be taken against the resident for any mosquito breeding found on such visits. This approach has yielded good results, with Singapore successfully avoiding a serious dengue outbreak, as experienced in 2005 when 14,209 people were infected with the fever. From 2007 to 2011, the number of dengue cases were 8,826; 7,031; 4,497; 5,363; and 5,330 respectively.NEA plays an important role in overseeing the cleansing of public areas in Singapore. NEA takes a three-pronged approach to keeping our environment clean, which includes: Public Cleansing; Public Education and Enforcement. NEA maintain an effective system of public cleansing to keep Singapore clean and prevent environment-related diseases. The cleansing of public roads and pavements is largely carried out by contractors engaged by the NEA. The NEA works closely with their "3P Partners" (the people, public and private sectors) to promote anti-littering practices and to encourage members of the community to take ownership of their litter and keep their surroundings clean. Regular checks on food establishments, swimming pools and public toilets are carried out to ensure that a high standard of hygiene is maintained.In April 2006, Singapore announced accession to the Kyoto Protocol . As a non-Annex I country, Singapore does not have targets set under KP, but it is eligible to participate in carbon credit exchanges arising from approved Clean Development Mechanism projects conducted in the country. The National Environment Agency is the designated authority coordinating CDMs. It is also spearheading ongoing measures to encourage energy efficiency and lower carbon emissions. In April 2008, NEA launched the 10% Energy Challenge to get households to cut their electricity consumption by at least 10%. As part of this campaign, NEA collaborated with grassroots organizations and charities to train volunteers to conduct energy audits and identify wasteful energy consumption habits. On 11 September 2009, NEA signed a landmark Voluntary Agreement with 16 major retailers and suppliers, to provide more energy efficient appliances and encourage more Singapore households to purchase them. Under the Voluntary Agreement, participating retailers and suppliers will voluntarily commit to achieving targets set out by the NEA, including retiring stock of energy inefficient models and introducing more 3- and 4-tick models, so that energy efficient models form at least 50% of their model range after six months, and 60% of their model range after one year. Signatories also voluntarily commit to promote energy efficient appliances, as well as improve the availability and affordability of energy efficient appliances available in their stores.Since independence, Singapore's growing population and economy have resulted in a large increase in solid waste. In 1970, about 1,300 tonnes per day of solid waste were disposed of. This increased to 7,000 tonnes per day by 2006, a six-fold increase from 1970. To address the solid waste problem, Singapore has put in place an integrated solid waste management system that ensures that all waste that are not recycled, are collected and disposed of safely at waste-to-energy incineration plants or at the offshore sanitary landfill ( Semakau Landfill ) in the case of non-incinerable waste. As a result, overall recycling rate has increased from 40% in 2000 to 56% in 2008. Waste growth has also been curtailed. The total waste (domestic and non-domestic) disposed of in 2008 was 7,179 tonnes per day, a 6% reduction as compared to 2000. As a result, the lifespan of Semakau Landfill has increased from 25–30 years to 35–40 years.

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Dengue fever

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Zika virus

Zika virus ( ZIKV ; pronounced / ˈ z iː k ə / or / ˈ z ɪ k ə / ) is a member of the virus family Flaviviridae . It is spread by daytime-active Aedes mosquitoes, such as A. aegypti and A. albopictus . Its name comes from the Ziika Forest of Uganda , where the virus was first isolated in 1947. Zika virus shares a genus with the dengue , yellow fever , Japanese encephalitis , and West Nile viruses. Since the 1950s, it has been known to occur within a narrow equatorial belt from Africa to Asia. From 2007 to 2016 [ update ] , the virus spread eastward, across the Pacific Ocean to the Americas, leading to the 2015–2016 Zika virus epidemic . The infection, known as Zika fever or Zika virus disease, often causes no or only mild symptoms, similar to a very mild form of dengue fever . While there is no specific treatment, paracetamol (acetaminophen) and rest may help with the symptoms. As of April 2019, no vaccines have been approved for clinical use, however a number of vaccines are currently in clinical trials. Zika can spread from a pregnant woman to her baby. This can result in microcephaly , severe brain malformations , and other birth defects. Zika infections in adults may result rarely in Guillain–Barré syndrome . In January 2016, the United States Centers for Disease Control and Prevention (CDC) issued travel guidance on affected countries, including the use of enhanced precautions, and guidelines for pregnant women including considering postponing travel. Other governments or health agencies also issued similar travel warnings, while Colombia , the Dominican Republic , Puerto Rico , Ecuador , El Salvador , and Jamaica advised women to postpone getting pregnant until more is known about the risks. Zika virus belongs to the family Flaviviridae and the genus Flavivirus , thus is related to the dengue , yellow fever , Japanese encephalitis , and West Nile viruses. Like other flaviviruses, Zika virus is enveloped and icosahedral and has a nonsegmented, single-stranded, 10 kilobase , positive-sense RNA genome . It is most closely related to the Spondweni virus and is one of the two known viruses in the Spondweni virus clade . A positive-sense RNA genome can be directly translated into viral proteins. As in other flaviviruses, such as the similarly sized West Nile virus, the RNA genome encodes seven nonstructural proteins and three structural proteins in the form of a single polyprotein ( Q32ZE1 ). One of the structural proteins encapsulates the virus. This protein is the flavivirus envelope glycoprotein, that binds to the endosomal membrane of the host cell to initiate endocytosis. The RNA genome forms a nucleocapsid along with copies of the 12-kDa capsid protein. The nucleocapsid, in turn, is enveloped within a host-derived membrane modified with two viral glycoproteins . Viral genome replication depends on the making of double-stranded RNA from the single-stranded, positive-sense RNA (ssRNA(+)) genome followed by transcription and replication to provide viral mRNAs and new ssRNA(+) genomes. A longitudinal study shows that 6 hours after cells are infected with Zika virus , the vacuoles and mitochondria in the cells begin to swell. This swelling becomes so severe, it results in cell death, also known as paraptosis. This form of programmed cell death requires gene expression. IFITM3 is a trans-membrane protein in a cell that is able to protect it from viral infection by blocking virus attachment. Cells are most susceptible to Zika infection when levels of IFITM3 are low. Once the cell has been infected, the virus restructures the endoplasmic reticulum, forming the large vacuoles, resulting in cell death. There are two Zika lineages: the African lineage and the Asian lineage. Phylogenetic studies indicate that the virus spreading in the Americas is 89% identical to African genotypes, but is most closely related to the Asian strain that circulated in French Polynesia during the 2013 – 2014 outbreak . The Asian strain appears to have first evolved around 1928. The vertebrate hosts of the virus were primarily monkeys in a so-called enzootic mosquito-monkey-mosquito cycle, with only occasional transmission to humans. Before 2007, Zika "rarely caused recognized 'spillover' infections in humans, even in highly enzootic areas". Infrequently, however, other arboviruses have become established as a human disease and spread in a mosquito–human–mosquito cycle, like the yellow fever virus and the dengue fever virus (both flaviviruses), and the chikungunya virus (a togavirus ). Though the reason for the pandemic is unknown, dengue, a related arbovirus that infects the same species of mosquito vectors , is known in particular to be intensified by urbanization and globalization . Zika is primarily spread by Aedes aegypti mosquitoes, and can also be transmitted through sexual contact or blood transfusions . The basic reproduction number ( R 0 , a measure of transmissibility) of Zika virus has been estimated to be between 1.4 and 6.6 . In 2015, news reports drew attention to the rapid spread of Zika in Latin America and the Caribbean. At that time, the Pan American Health Organization published a list of countries and territories that experienced "local Zika virus transmission" comprising Barbados, Bolivia, Brazil, Colombia, the Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, and Venezuela. By August 2016, more than 50 countries had experienced active (local) transmission of Zika virus . Zika is primarily spread by the female Aedes aegypti mosquito, which is active mostly in the daytime. The mosquitos must feed on blood to lay eggs. : 2 The virus has also been isolated from a number of arboreal mosquito species in the genus Aedes , such as A. africanus , A. apicoargenteus , A. furcifer , A. hensilli , A. luteocephalus , and A. vittatus , with an extrinsic incubation period in mosquitoes around 10 days. The true extent of the vectors is still unknown. Zika has been detected in many more species of Aedes , along with Anopheles coustani, Mansonia uniformis , and Culex perfuscus , although this alone does not incriminate them as vectors. To detect the presence of the virus usually requires genetic material to be analysed in a lab using the technique RT-PCR . A much cheaper and faster method involves shining a light at the head and thorax of the mosquito, and detecting chemical compounds characteristic of the virus using near-infrared spectroscopy . Transmission by A. albopictus , the tiger mosquito, was reported from a 2007 urban outbreak in Gabon, where it had newly invaded the country and become the primary vector for the concomitant chikungunya and dengue virus outbreaks. New outbreaks can occur if a person carrying the virus travels to another region where A. albopictus is common. The potential societal risk of Zika can be delimited by the distribution of the mosquito species that transmit it. The global distribution of the most cited carrier of Zika, A. aegypti , is expanding due to global trade and travel. A. aegypti distribution is now the most extensive ever recorded – on parts of all continents except Antarctica, including North America and even the European periphery ( Madeira , the Netherlands, and the northeastern Black Sea coast). A mosquito population capable of carrying Zika has been found in a Capitol Hill neighborhood of Washington, DC, and genetic evidence suggests they survived at least four consecutive winters in the region. The study authors conclude that mosquitos are adapting for persistence in a northern climate. Zika virus appears to be contagious via mosquitoes for around a week after infection. The virus is thought to be infectious for a longer period of time after infection (at least 2 weeks) when transmitted via semen . Research into its ecological niche suggests that Zika may be influenced to a greater degree by changes in precipitation and temperature than dengue, making it more likely to be confined to tropical areas. However, rising global temperatures would allow for the disease vector to expand its range further north, allowing Zika to follow. Zika can be transmitted from men and women to their sexual partners; most known cases involve transmission from symptomatic men to women. As of April 2016, sexual transmission of Zika has been documented in six countries – Argentina, Australia, France, Italy, New Zealand, and the United States – during the 2015 outbreak. ZIKV can persist in semen for several months, with viral RNA detected up to one year. The virus replicates in the human testis, where it infects several cell types including testicular macrophages, peritubular cells and germ cells, the spermatozoa precursors. Semen parameters can be altered in patients for several weeks post-symptoms onset, and spermatozoa can be infectious. Since October 2016, the CDC has advised men who have traveled to an area with Zika should use condoms or not have sex for at least six months after their return as the virus is still transmissible even if symptoms never develop. Zika virus can spread by vertical (or "mother-to-child") transmission , during pregnancy or at delivery. An infection during pregnancy has been linked to changes in neuronal development of the unborn child. Severe progressions of infection have been linked to the development of microcephaly in the unborn child, while mild infections potentially can lead to neurocognitive disorders later in life. Congenital brain abnormalities other than microcephaly have also been reported after a Zika outbreak. Studies in mice have suggested that maternal immunity to dengue virus may enhance fetal infection with Zika, worsen the microcephaly phenotype and/or enhance damage during pregnancy, but it is unknown whether this occurs in humans. As of April 2016 [ update ] , two cases of Zika transmission through blood transfusions have been reported globally, both from Brazil, after which the US Food and Drug Administration (FDA) recommended screening blood donors and deferring high-risk donors for 4 weeks. A potential risk had been suspected based on a blood-donor screening study during the French Polynesian Zika outbreak, in which 2.8% (42) of donors from November 2013 and February 2014 tested positive for Zika RNA and were all asymptomatic at the time of blood donation. Eleven of the positive donors reported symptoms of Zika fever after their donation, but only three of 34 samples grew in culture. Zika is primarily spread by the female Aedes aegypti mosquito, which is active mostly in the daytime. The mosquitos must feed on blood to lay eggs. : 2 The virus has also been isolated from a number of arboreal mosquito species in the genus Aedes , such as A. africanus , A. apicoargenteus , A. furcifer , A. hensilli , A. luteocephalus , and A. vittatus , with an extrinsic incubation period in mosquitoes around 10 days. The true extent of the vectors is still unknown. Zika has been detected in many more species of Aedes , along with Anopheles coustani, Mansonia uniformis , and Culex perfuscus , although this alone does not incriminate them as vectors. To detect the presence of the virus usually requires genetic material to be analysed in a lab using the technique RT-PCR . A much cheaper and faster method involves shining a light at the head and thorax of the mosquito, and detecting chemical compounds characteristic of the virus using near-infrared spectroscopy . Transmission by A. albopictus , the tiger mosquito, was reported from a 2007 urban outbreak in Gabon, where it had newly invaded the country and become the primary vector for the concomitant chikungunya and dengue virus outbreaks. New outbreaks can occur if a person carrying the virus travels to another region where A. albopictus is common. The potential societal risk of Zika can be delimited by the distribution of the mosquito species that transmit it. The global distribution of the most cited carrier of Zika, A. aegypti , is expanding due to global trade and travel. A. aegypti distribution is now the most extensive ever recorded – on parts of all continents except Antarctica, including North America and even the European periphery ( Madeira , the Netherlands, and the northeastern Black Sea coast). A mosquito population capable of carrying Zika has been found in a Capitol Hill neighborhood of Washington, DC, and genetic evidence suggests they survived at least four consecutive winters in the region. The study authors conclude that mosquitos are adapting for persistence in a northern climate. Zika virus appears to be contagious via mosquitoes for around a week after infection. The virus is thought to be infectious for a longer period of time after infection (at least 2 weeks) when transmitted via semen . Research into its ecological niche suggests that Zika may be influenced to a greater degree by changes in precipitation and temperature than dengue, making it more likely to be confined to tropical areas. However, rising global temperatures would allow for the disease vector to expand its range further north, allowing Zika to follow. Zika can be transmitted from men and women to their sexual partners; most known cases involve transmission from symptomatic men to women. As of April 2016, sexual transmission of Zika has been documented in six countries – Argentina, Australia, France, Italy, New Zealand, and the United States – during the 2015 outbreak. ZIKV can persist in semen for several months, with viral RNA detected up to one year. The virus replicates in the human testis, where it infects several cell types including testicular macrophages, peritubular cells and germ cells, the spermatozoa precursors. Semen parameters can be altered in patients for several weeks post-symptoms onset, and spermatozoa can be infectious. Since October 2016, the CDC has advised men who have traveled to an area with Zika should use condoms or not have sex for at least six months after their return as the virus is still transmissible even if symptoms never develop. Zika virus can spread by vertical (or "mother-to-child") transmission , during pregnancy or at delivery. An infection during pregnancy has been linked to changes in neuronal development of the unborn child. Severe progressions of infection have been linked to the development of microcephaly in the unborn child, while mild infections potentially can lead to neurocognitive disorders later in life. Congenital brain abnormalities other than microcephaly have also been reported after a Zika outbreak. Studies in mice have suggested that maternal immunity to dengue virus may enhance fetal infection with Zika, worsen the microcephaly phenotype and/or enhance damage during pregnancy, but it is unknown whether this occurs in humans. As of April 2016 [ update ] , two cases of Zika transmission through blood transfusions have been reported globally, both from Brazil, after which the US Food and Drug Administration (FDA) recommended screening blood donors and deferring high-risk donors for 4 weeks. A potential risk had been suspected based on a blood-donor screening study during the French Polynesian Zika outbreak, in which 2.8% (42) of donors from November 2013 and February 2014 tested positive for Zika RNA and were all asymptomatic at the time of blood donation. Eleven of the positive donors reported symptoms of Zika fever after their donation, but only three of 34 samples grew in culture. Zika virus replicates in the mosquito's midgut epithelial cells and then its salivary gland cells. After 5–10 days, the virus can be found in the mosquito's saliva. If the mosquito's saliva is inoculated into human skin, the virus can infect epidermal keratinocytes, skin fibroblasts in the skin and the Langerhans cells . The pathogenesis of the virus is hypothesized to continue with a spread to lymph nodes and the bloodstream. Flaviviruses replicate in the cytoplasm , but Zika antigens have been found in infected cell nuclei. The viral protein numbered NS4A can lead to small head size ( microcephaly ) because it disrupts brain growth by hijacking a pathway which regulates growth of new neurons. In fruit flies, both NS4A and the neighboring NS4B restrict eye growth. Zika fever (also known as Zika virus disease) is an illness caused by Zika virus . Around 80% of cases are estimated to be asymptomatic, though the accuracy of this figure is hindered by the wide variance in data quality, and figures from different outbreaks can vary significantly. Symptomatic cases are usually mild and can resemble dengue fever . Symptoms may include fever , red eyes , joint pain , headache, and a maculopapular rash . Symptoms generally last less than seven days. It has not caused any reported deaths during the initial infection. Infection during pregnancy causes microcephaly and other brain malformations in some babies. Infection in adults has been linked to Guillain–Barré syndrome (GBS) and Zika virus has been shown to infect human Schwann cells . Diagnosis is by testing the blood, urine, or saliva for the presence of Zika virus RNA when the person is sick. In 2019, an improved diagnostic test, based on research from Washington University in St. Louis , that detects Zika infection in serum was granted market authorization by the FDA . Prevention involves decreasing mosquito bites in areas where the disease occurs, and proper use of condoms. Efforts to prevent bites include the use of DEET or picaridin - based insect repellent , covering much of the body with clothing, mosquito nets , and getting rid of standing water where mosquitoes reproduce. There is no vaccine . Health officials recommended that women in areas affected by the 2015–2016 Zika outbreak consider putting off pregnancy and that pregnant women not travel to these areas. While no specific treatment exists, paracetamol (acetaminophen) and rest may help with the symptoms. Admission to a hospital is rarely necessary. It is advised, for an affected person with the zika virus, to drink a lot of water to stay hydrated, to lie down, and to treat the fever and agony with liquid solutions; taking drugs like acetaminophen or paracetamol helps to relieve fever and pain. [ according to whom? ] Referring to the US CDC it is not recommended to take anti-inflammatory and non-steroid drugs like aspirin for example. If the patient affected is already taking treatment for another medical condition it is advisable to inform your attending physician before taking any other drug or additional treatment; The World Health Organization has suggested that priority should be to develop inactivated vaccines and other nonlive vaccines, which are safe to use in pregnant women. As of March 2016 [ update ] , 18 companies and institutions were developing vaccines against Zika, but they state a vaccine is unlikely to be widely available for about 10 years. In June 2016, the FDA granted the first approval for a human clinical trial for a Zika vaccine. In March 2017, a DNA vaccine was approved for phase-2 clinical trials. This vaccine consists of a small, circular piece of DNA, known as a plasmid, that expresses the genes for the Zika virus envelope proteins. As the vaccine does not contain the full sequence of the virus, it cannot cause infection. As of April 2017, both subunit and inactivated vaccines have entered clinical trials. It is advised, for an affected person with the zika virus, to drink a lot of water to stay hydrated, to lie down, and to treat the fever and agony with liquid solutions; taking drugs like acetaminophen or paracetamol helps to relieve fever and pain. [ according to whom? ] Referring to the US CDC it is not recommended to take anti-inflammatory and non-steroid drugs like aspirin for example. If the patient affected is already taking treatment for another medical condition it is advisable to inform your attending physician before taking any other drug or additional treatment; The World Health Organization has suggested that priority should be to develop inactivated vaccines and other nonlive vaccines, which are safe to use in pregnant women. As of March 2016 [ update ] , 18 companies and institutions were developing vaccines against Zika, but they state a vaccine is unlikely to be widely available for about 10 years. In June 2016, the FDA granted the first approval for a human clinical trial for a Zika vaccine. In March 2017, a DNA vaccine was approved for phase-2 clinical trials. This vaccine consists of a small, circular piece of DNA, known as a plasmid, that expresses the genes for the Zika virus envelope proteins. As the vaccine does not contain the full sequence of the virus, it cannot cause infection. As of April 2017, both subunit and inactivated vaccines have entered clinical trials. The virus was first isolated in April 1947 from a rhesus macaque monkey placed in a cage in the Ziika Forest of Uganda , near Lake Victoria , by the scientists of the Yellow Fever Research Institute . A second isolation from the mosquito A. africanus followed at the same site in January 1948. When the monkey developed a fever, researchers isolated from its serum a "filterable transmissible agent" which was named Zika in 1948. Zika was first known to infect humans from the results of a serological survey in Uganda, published in 1952. Of 99 human blood samples tested, 6.1% had neutralizing antibodies. As part of a 1954 outbreak investigation of jaundice suspected to be yellow fever, researchers reported isolation of the virus from a patient, but the pathogen was later shown to be the closely related Spondweni virus . Spondweni was also determined to be the cause of a self-inflicted infection in a researcher reported in 1956. Subsequent serological studies in several African and Asian countries indicated the virus had been widespread within human populations in these regions. The first true case of human infection was identified by Simpson in 1964, who was himself infected while isolating the virus from mosquitoes. From then until 2007, there were only 13 further confirmed human cases of Zika infection from Africa and Southeast Asia. A study published in 2017 showed that the Zika virus, despite only a few cases were reported, has been silently circulated in West Africa for the last two decades when blood samples collected between 1992 and 2016 were tested for the ZIKV IgM antibodies. In 2017, Angola reported two cases of Zika fever. Zika was also occurring in Tanzania as of 2016. In April 2007, the first outbreak outside of Africa and Asia occurred on the island of Yap in the Federated States of Micronesia, characterized by rash, conjunctivitis, and arthralgia, which was initially thought to be dengue, chikungunya , or Ross River disease . Serum samples from patients in the acute phase of illness contained RNA of Zika. There were 49 confirmed cases, 59 unconfirmed cases, no hospitalizations, and no deaths. After October 2013 Oceania's first outbreak showed an estimated 11% population infected for French Polynesia that also presented with Guillain–Barre syndrome (GBS). The spread of ZIKV continued to New Caledonia, Easter Island, and the Cook Islands and where 1385 cases were confirmed by January 2014. During the same year, Easter Island acknowledged 51 cases. Australia began seeing cases in 2012. Research showed it was brought by travelers returning from Indonesia and other infected countries. New Zealand also experienced infections rate increases through returning foreign travelers. Oceania countries experiencing Zika today are New Caledonia, Vanuatu, Solomon Islands, Marshall Islands, American Samoa, Samoa, and Tonga. Between 2013 and 2014, further epidemics occurred in French Polynesia , Easter Island , the Cook Islands , and New Caledonia . There was an epidemic in 2015 and 2016 in the Americas . The outbreak began in April 2015 in Brazil , and spread to other countries in South America , Central America , North America , and the Caribbean . In January 2016, the WHO said the virus was likely to spread throughout most of the Americas by the end of the year; and in February 2016, the WHO declared the cluster of microcephaly and Guillain–Barré syndrome cases reported in Brazil – strongly suspected to be associated with the Zika outbreak – a Public Health Emergency of International Concern . It was estimated that 1.5 million people were infected by Zika in Brazil, with over 3,500 cases of microcephaly reported between October 2015 and January 2016. A number of countries issued travel warnings , and the outbreak was expected to significantly impact the tourism industry. Several countries have taken the unusual step of advising their citizens to delay pregnancy until more is known about the virus and its impact on fetal development. With the 2016 Summer Olympics hosted in Rio de Janeiro , health officials worldwide voiced concerns over a potential crisis, both in Brazil and when international athletes and tourists returned home and possibly would spread the virus. Some researchers speculated that only one or two tourists might be infected during the three-week period, or approximately 3.2 infections per 100,000 tourists. In November 2016, the World Health Organization declared that Zika virus was no longer a global emergency while noting that the virus still represents "a highly significant and a long-term problem". As of August 2017 the number of new Zika virus cases in the Americas had fallen dramatically. On May 15, 2017, three cases of Zika virus infection in India were reported in the state of Gujarat . By late 2018, there had been at least 159 cases in Rajasthan and 127 in Madhya Pradesh . In July 2021, the first case of Zika virus infection in the Indian state of Kerala was reported. After the first confirmed case, 19 other people who had previously presented symptoms were tested, and 13 of those had positive results, showing that Zika had been circulating in Kerala since at least May 2021. By August 6th 2021, there had been 65 reported cases in Kerala. On October 22, 2021, an officer in the Indian Air Force in Kanpur tested positive for Zika virus, making it the first reported case in the Indian state of Uttar Pradesh . On 22 March 2016, Reuters reported that Zika was isolated from a 2014 blood sample of an elderly man in Chittagong in Bangladesh as part of a retrospective study . Between August and November 2016, 455 cases of Zika virus infection were confirmed in Singapore . In 2023, 722 Zika virus cases were reported in Thailand. From 2019-2022 the Robert Koch-Institut reported 29 imported Zikavirus cases imported into Germany. Of the altogether 16 imported Zika virus cases in 2023, 10 were diagnosed after a trip to Thailand with 62% of all Zika virus cases a significant relative and absolute increase. The virus was first isolated in April 1947 from a rhesus macaque monkey placed in a cage in the Ziika Forest of Uganda , near Lake Victoria , by the scientists of the Yellow Fever Research Institute . A second isolation from the mosquito A. africanus followed at the same site in January 1948. When the monkey developed a fever, researchers isolated from its serum a "filterable transmissible agent" which was named Zika in 1948. Zika was first known to infect humans from the results of a serological survey in Uganda, published in 1952. Of 99 human blood samples tested, 6.1% had neutralizing antibodies. As part of a 1954 outbreak investigation of jaundice suspected to be yellow fever, researchers reported isolation of the virus from a patient, but the pathogen was later shown to be the closely related Spondweni virus . Spondweni was also determined to be the cause of a self-inflicted infection in a researcher reported in 1956. Subsequent serological studies in several African and Asian countries indicated the virus had been widespread within human populations in these regions. The first true case of human infection was identified by Simpson in 1964, who was himself infected while isolating the virus from mosquitoes. From then until 2007, there were only 13 further confirmed human cases of Zika infection from Africa and Southeast Asia. A study published in 2017 showed that the Zika virus, despite only a few cases were reported, has been silently circulated in West Africa for the last two decades when blood samples collected between 1992 and 2016 were tested for the ZIKV IgM antibodies. In 2017, Angola reported two cases of Zika fever. Zika was also occurring in Tanzania as of 2016. In April 2007, the first outbreak outside of Africa and Asia occurred on the island of Yap in the Federated States of Micronesia, characterized by rash, conjunctivitis, and arthralgia, which was initially thought to be dengue, chikungunya , or Ross River disease . Serum samples from patients in the acute phase of illness contained RNA of Zika. There were 49 confirmed cases, 59 unconfirmed cases, no hospitalizations, and no deaths. After October 2013 Oceania's first outbreak showed an estimated 11% population infected for French Polynesia that also presented with Guillain–Barre syndrome (GBS). The spread of ZIKV continued to New Caledonia, Easter Island, and the Cook Islands and where 1385 cases were confirmed by January 2014. During the same year, Easter Island acknowledged 51 cases. Australia began seeing cases in 2012. Research showed it was brought by travelers returning from Indonesia and other infected countries. New Zealand also experienced infections rate increases through returning foreign travelers. Oceania countries experiencing Zika today are New Caledonia, Vanuatu, Solomon Islands, Marshall Islands, American Samoa, Samoa, and Tonga. Between 2013 and 2014, further epidemics occurred in French Polynesia , Easter Island , the Cook Islands , and New Caledonia . There was an epidemic in 2015 and 2016 in the Americas . The outbreak began in April 2015 in Brazil , and spread to other countries in South America , Central America , North America , and the Caribbean . In January 2016, the WHO said the virus was likely to spread throughout most of the Americas by the end of the year; and in February 2016, the WHO declared the cluster of microcephaly and Guillain–Barré syndrome cases reported in Brazil – strongly suspected to be associated with the Zika outbreak – a Public Health Emergency of International Concern . It was estimated that 1.5 million people were infected by Zika in Brazil, with over 3,500 cases of microcephaly reported between October 2015 and January 2016. A number of countries issued travel warnings , and the outbreak was expected to significantly impact the tourism industry. Several countries have taken the unusual step of advising their citizens to delay pregnancy until more is known about the virus and its impact on fetal development. With the 2016 Summer Olympics hosted in Rio de Janeiro , health officials worldwide voiced concerns over a potential crisis, both in Brazil and when international athletes and tourists returned home and possibly would spread the virus. Some researchers speculated that only one or two tourists might be infected during the three-week period, or approximately 3.2 infections per 100,000 tourists. In November 2016, the World Health Organization declared that Zika virus was no longer a global emergency while noting that the virus still represents "a highly significant and a long-term problem". As of August 2017 the number of new Zika virus cases in the Americas had fallen dramatically. On May 15, 2017, three cases of Zika virus infection in India were reported in the state of Gujarat . By late 2018, there had been at least 159 cases in Rajasthan and 127 in Madhya Pradesh . In July 2021, the first case of Zika virus infection in the Indian state of Kerala was reported. After the first confirmed case, 19 other people who had previously presented symptoms were tested, and 13 of those had positive results, showing that Zika had been circulating in Kerala since at least May 2021. By August 6th 2021, there had been 65 reported cases in Kerala. On October 22, 2021, an officer in the Indian Air Force in Kanpur tested positive for Zika virus, making it the first reported case in the Indian state of Uttar Pradesh . On 22 March 2016, Reuters reported that Zika was isolated from a 2014 blood sample of an elderly man in Chittagong in Bangladesh as part of a retrospective study . Between August and November 2016, 455 cases of Zika virus infection were confirmed in Singapore . In 2023, 722 Zika virus cases were reported in Thailand. From 2019-2022 the Robert Koch-Institut reported 29 imported Zikavirus cases imported into Germany. Of the altogether 16 imported Zika virus cases in 2023, 10 were diagnosed after a trip to Thailand with 62% of all Zika virus cases a significant relative and absolute increase.

Wiki

Dengue fever

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Chikungunya

Chikungunya is an infection caused by the Chikungunya virus ( CHIKV ). The disease was first identified in 1952 in Tanzania and named based on the Kimakonde words for "to become contorted". Symptoms include fever and joint pain . These typically occur two to twelve days after exposure. Other symptoms may include headache , muscle pain , joint swelling , and a rash . Symptoms usually improve within a week; however, occasionally the joint pain may last for months or years. The risk of death is around 1 in 1,000. The very young, old, and those with other health problems are at risk of more severe disease. The virus is spread between people by two types of mosquitos : Aedes albopictus and Aedes aegypti . They mainly bite during the day. The virus may circulate within a number of animals including birds and rodents . Diagnosis is by either testing the blood for viral RNA or antibodies to the virus. The symptoms can be mistaken for those of dengue fever and Zika fever . It is believed most people become immune after a single infection. The best means of prevention are overall mosquito control and the avoidance of bites in areas where the disease is common. This may be partly achieved by decreasing mosquitos' access to water and by the use of insect repellent and mosquito nets . In November 2023 the USFDA approved an adults-only vaccine ( Ixchiq ) for prevention of the disease. Once infected and symptomatic, recommendations to patients should include rest, fluids, and medications to help with fever and joint pain. In 2014, more than a million suspected cases occurred globally. While the disease is endemic in Africa and Asia, outbreaks have been reported in Europe and the Americas since the 2000s; in 2014, an outbreak was reported in Florida in the continental United States , but as of 2016 there were no further locally-acquired cases. Around 85% of people infected with Chikungunya virus experience symptoms, typically beginning with a sudden high fever above 39 °C (102 °F) . The fever is soon followed by severe muscle and joint pain . Pain usually affects multiple joints in the arms and legs, and is symmetric – i.e. if one elbow is affected, the other is as well. People with Chikungunya also frequently experience headache , back pain, nausea , and fatigue . Around half of those affected develop a rash , with reddening and sometimes small bumps on the palms, foot soles, torso, and face. For some, the rash remains constrained to a small part of the body; for others, the rash can be extensive, covering more than 90% of the skin. Some people experience gastrointestinal issues, with abdominal pain and vomiting. Others experience eye problems, namely sensitivity to light , conjunctivitis , and pain behind the eye. This first set of symptoms – called the "acute phase" of Chikungunya – lasts around a week, after which most symptoms resolve on their own. Many people continue to have symptoms after the "acute phase" resolves, termed the "post-acute phase" for symptoms lasting three weeks to three months, and the "chronic stage" for symptoms lasting longer than three months. In both cases, the lasting symptoms tend to be joint pains: arthritis , tenosynovitis , and/or bursitis . If the affected person had pre-existing joint issues, these tend to worsen. Overuse of a joint can result in painful swelling, stiffness, nerve damage, and neuropathic pain . Typically the joint pain improves with time; however, the chronic stage can last anywhere from a few months to several years. Joint pain is reported in 87–98% of cases, and nearly always occurs in more than one joint, though joint swelling is uncommon. Typically the affected joints are located in both arms and legs. Joints are more likely to be affected if they have previously been damaged by disorders such as arthritis . Pain most commonly occurs in peripheral joints, such as the wrists, ankles, and joints of the hands and feet as well as some of the larger joints, typically the shoulders, elbows and knees. Pain may also occur in the muscles or ligaments . In more than half of cases, normal activity is limited by significant fatigue and pain. Infrequently, inflammation of the eyes may occur in the form of iridocyclitis , or uveitis , and retinal lesions may occur. Temporary damage to the liver may occur. People with Chikungunya occasionally develop neurologic disorders, most frequently swelling or degeneration of the brain, inflammation or degeneration of the myelin sheaths around neurons, Guillain–Barré syndrome , acute disseminated encephalomyelitis , hypotonia (in newborns), and issues with visual processing. In particularly rare cases, people may develop behavioral changes, seizures, irritation of the cerebellum or meninges , oculomotor nerve palsy , or paralysis of the eye muscles . Newborns are susceptible to particularly severe effects of Chikungunya infection. Signs of infection typically begin with fever, rash, and swelling in the extremities. Around half of newborns have a mild case of the disease that resolves on its own; the other half have severe disease with inflammation of the brain and seizures . In severe cases, affected newborns may also have issues with bleeding and bloodflow, and problems with heart function. In addition to newborns, the elderly, and those with diabetes , heart disease , liver and kidney diseases, and human immunodeficiency virus infection tend to have more severe cases of Chikungunya. Around 1 to 5 in 1,000 people with symptomatic Chikungunya die of the disease. Chikungunya virus (CHIKV), is a member of the genus Alphavirus , and family Togaviridae . It was first isolated in 1953 in Tanzania and is an RNA virus with a positive-sense single-stranded genome of about 11.6kb. It is a member of the Semliki Forest virus complex and is closely related to Ross River virus , O'nyong'nyong virus , and Semliki Forest virus . Because it is transmitted by arthropods , namely mosquitoes, it can also be referred to as an arbovirus ( ar thropod- bo rne virus). In the United States, it is classified as a category B priority pathogen , and work requires biosafety level III precautions. Chikungunya is generally transmitted from mosquitoes to humans. Less common modes of transmission include vertical transmission , which is transmission from mother to child during pregnancy or at birth. Transmission via infected blood products and through organ donation is also theoretically possible during times of outbreak, though no cases have yet been documented. The incubation period ranges from one to twelve days, and is most typically three to seven. Chikungunya is related to mosquitoes , their environments, and human behavior. The adaptation of mosquitoes to the changing climate of North Africa around 5,000 years ago made them seek out environments where humans stored water. Human habitation and the mosquitoes' environments were then very closely connected. During periods of epidemics humans are the reservoir of the virus. Because high amounts of virus are present in the blood in the beginning of acute infection, the virus can be spread from a viremic human to a mosquito, and back to a human. During other times, monkeys, birds and other vertebrates have served as reservoirs. Three genotypes of this virus have been described, each with a distinct genotype and antigenic character: West African, East/Central/South African, and Asian genotypes. The Asian lineage originated in 1952 and has subsequently split into two lineages – India (Indian Ocean Lineage) and South East Asian clades. This virus was first reported in the Americas in 2014. Phylogenetic investigations have shown that there are two strains in Brazil – the Asian and East/Central/South African types – and that the Asian strain arrived in the Caribbean (most likely from Oceania) in about March 2013. The rate of molecular evolution was estimated to have a mean rate of 5 × 10 −4 substitutions per site per year (95% higher probability density 2.9–7.9 × 10 −4 ). Chikungunya is spread through bites from Aedes mosquitoes, and the species A. aegypti was identified as the most common vector, though the virus has recently been associated with many other species, including A. albopictus . Research by the Pasteur Institute in Paris has suggested Chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by the Asian tiger mosquito ( A. albopictus ). Other species potentially able to transmit Chikungunya virus include Ae. furcifer-taylori , Ae. africanus , and Ae. luteocephalus . Chikungunya virus (CHIKV), is a member of the genus Alphavirus , and family Togaviridae . It was first isolated in 1953 in Tanzania and is an RNA virus with a positive-sense single-stranded genome of about 11.6kb. It is a member of the Semliki Forest virus complex and is closely related to Ross River virus , O'nyong'nyong virus , and Semliki Forest virus . Because it is transmitted by arthropods , namely mosquitoes, it can also be referred to as an arbovirus ( ar thropod- bo rne virus). In the United States, it is classified as a category B priority pathogen , and work requires biosafety level III precautions. Chikungunya is generally transmitted from mosquitoes to humans. Less common modes of transmission include vertical transmission , which is transmission from mother to child during pregnancy or at birth. Transmission via infected blood products and through organ donation is also theoretically possible during times of outbreak, though no cases have yet been documented. The incubation period ranges from one to twelve days, and is most typically three to seven. Chikungunya is related to mosquitoes , their environments, and human behavior. The adaptation of mosquitoes to the changing climate of North Africa around 5,000 years ago made them seek out environments where humans stored water. Human habitation and the mosquitoes' environments were then very closely connected. During periods of epidemics humans are the reservoir of the virus. Because high amounts of virus are present in the blood in the beginning of acute infection, the virus can be spread from a viremic human to a mosquito, and back to a human. During other times, monkeys, birds and other vertebrates have served as reservoirs. Three genotypes of this virus have been described, each with a distinct genotype and antigenic character: West African, East/Central/South African, and Asian genotypes. The Asian lineage originated in 1952 and has subsequently split into two lineages – India (Indian Ocean Lineage) and South East Asian clades. This virus was first reported in the Americas in 2014. Phylogenetic investigations have shown that there are two strains in Brazil – the Asian and East/Central/South African types – and that the Asian strain arrived in the Caribbean (most likely from Oceania) in about March 2013. The rate of molecular evolution was estimated to have a mean rate of 5 × 10 −4 substitutions per site per year (95% higher probability density 2.9–7.9 × 10 −4 ). Chikungunya is spread through bites from Aedes mosquitoes, and the species A. aegypti was identified as the most common vector, though the virus has recently been associated with many other species, including A. albopictus . Research by the Pasteur Institute in Paris has suggested Chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by the Asian tiger mosquito ( A. albopictus ). Other species potentially able to transmit Chikungunya virus include Ae. furcifer-taylori , Ae. africanus , and Ae. luteocephalus . Chikungunya virus is passed to humans when a bite from an infected mosquito breaks the skin and introduces the virus into the body. The pathogenesis of chikungunya infection in humans is still poorly understood, despite recent outbreaks. It appears that in vitro , Chikungunya virus is able to replicate in human epithelial and endothelial cells , primary fibroblasts , and monocyte-derived macrophages . Viral replication is highly cytopathic , but susceptible to type-I and -II interferon . In vivo , in studies using living cells, chikungunya virus appears to replicate in fibroblasts, skeletal muscle progenitor cells, and myofibers. The type-1 interferon response seems to play an important role in the host's response to chikungunya infection. Upon infection with chikungunya, the host's fibroblasts produce type-1 alpha and beta interferon ( IFN-α and IFN-β ). In mouse studies, deficiencies in INF-1 in mice exposed to the virus cause increased morbidity and mortality. The chikungunya-specific upstream components of the type-1 interferon pathway involved in the host's response to chikungunya infection are still unknown. Nonetheless, mouse studies suggest that IPS-1 is an important factor, and that IRF3 and IRF7 are important in an age-dependent manner. Mouse studies also suggest that chikungunya evades host defenses and counters the type-I interferon response by producing NS2, a nonstructural protein that degrades RBP1 and turns off the host cell's ability to transcribe DNA. NS2 interferes with the JAK-STAT signaling pathway and prevents STAT from becoming phosphorylated . In the acute phase of chikungunya, the virus is typically present in the areas where symptoms present, specifically skeletal muscles, and joints . In the chronic phase, it is suggested that viral persistence (the inability of the body to entirely rid itself of the virus), lack of clearance of the antigen , or both, contribute to joint pain. The inflammation response during both the acute and chronic phase of the disease results in part from interactions between the virus and monocytes and macrophages. Chikungunya virus disease in humans is associated with elevated serum levels of specific cytokines and chemokines . High levels of specific cytokines have been linked to more severe acute disease: interleukin-6 (IL-6), IL-1β , RANTES , monocyte chemoattractant protein 1 (MCP-1), monokine induced by gamma interferon (MIG), and interferon gamma-induced protein 10 (IP-10). Cytokines may also contribute to chronic Chikungunya virus disease, as persistent joint pain has been associated with elevated levels of IL-6 and granulocyte-macrophage colony-stimulating factor (GM-CSF). In those with chronic symptoms, a mild elevation of C-reactive protein (CRP) has been observed, suggesting ongoing chronic inflammation. However, there is little evidence linking chronic Chikungunya virus disease and the development of autoimmunity . [ citation needed ] The virus consists of four nonstructural proteins and three structural proteins. The structural proteins are the capsid and two envelope glycoproteins: E1 and E2, which form heterodimeric spikes on the viron surface. E2 binds to cellular receptors in order to enter the host cell through receptor-mediated endocytosis . E1 contains a fusion peptide which, when exposed to the acidity of the endosome in eukaryotic cells , dissociates from E2 and initiates membrane fusion that allows the release of nucleocapsids into the host cytoplasm, promoting infection. The mature virion contains 240 heterodimeric spikes of E2/E1, which after release, bud on the surface of the infected cell, where they are released by exocytosis to infect other cells. The virus consists of four nonstructural proteins and three structural proteins. The structural proteins are the capsid and two envelope glycoproteins: E1 and E2, which form heterodimeric spikes on the viron surface. E2 binds to cellular receptors in order to enter the host cell through receptor-mediated endocytosis . E1 contains a fusion peptide which, when exposed to the acidity of the endosome in eukaryotic cells , dissociates from E2 and initiates membrane fusion that allows the release of nucleocapsids into the host cytoplasm, promoting infection. The mature virion contains 240 heterodimeric spikes of E2/E1, which after release, bud on the surface of the infected cell, where they are released by exocytosis to infect other cells. Chikungunya is diagnosed on the basis of clinical, epidemiological, and laboratory criteria. Clinically, acute onset of high fever and severe joint pain would lead to suspicion of chikungunya. Epidemiological criteria consist of whether the individual has traveled to or spent time in an area in which chikungunya is present within the last twelve days (i.e.) the potential incubation period). Laboratory criteria include a decreased lymphocyte count consistent with viremia . However a definitive laboratory diagnosis can be accomplished through viral isolation, RT-PCR, or serological diagnosis. The differential diagnosis may include other mosquito-borne diseases , such as dengue or malaria , or other infections such as influenza . Chronic recurrent polyarthralgia occurs in at least 20% of chikungunya patients one year after infection, whereas such symptoms are uncommon in dengue. Virus isolation provides the most definitive diagnosis, but takes one to two weeks for completion and must be carried out in biosafety level III laboratories . The technique involves exposing specific cell lines to samples from whole blood and identifying Chikungunya virus -specific responses. RT-PCR using nested primer pairs is used to amplify several chikungunya-specific genes from whole blood, generating thousands to millions of copies of the genes in order to identify them. RT-PCR can also be used to quantify the viral load in the blood. Using RT-PCR, diagnostic results can be available in one to two days. Serological diagnosis requires a larger amount of blood than the other methods, and uses an ELISA assay to measure chikungunya-specific IgM levels in the blood serum. One advantage offered by serological diagnosis is that serum IgM is detectable from 5 days to months after the onset of symptoms, but drawbacks are that results may require two to three days, and false positives can occur with infection due to other related viruses, such as o'nyong'nyong virus and Semliki Forest virus . Presently, there is no specific way to test for chronic signs and symptoms associated with Chikungunya fever although nonspecific laboratory findings such as C reactive protein and elevated cytokines can correlate with disease activity. Because no approved vaccine exists, the most effective means of prevention are protection against contact with the disease-carrying mosquitoes and controlling mosquito populations by limiting their habitat . Mosquito control focuses on eliminating the standing water where mosquitos lay eggs and develop as larva; if elimination of the standing water is not possible, insecticides or biological control agents can be added. Methods of protection against contact with mosquitos include using insect repellents with substances such as DEET , icaridin , PMD ( p-menthane-3,8-diol , a substance derived from the lemon eucalyptus tree), or ethyl butylacetylaminopropionate (IR3535). However, increasing insecticide resistance presents a challenge to chemical control methods. [ citation needed ] Wearing bite-proof long sleeves and trousers also offers protection, and garments can be treated with pyrethroids , a class of insecticides that often has repellent properties. Vaporized pyrethroids (for example in mosquito coils) are also insect repellents. As infected mosquitoes often feed and rest inside homes, securing screens on windows and doors will help to keep mosquitoes out of the house. In the case of the day-active A. aegypti and A. albopictus , however, this will have only a limited effect, since many contacts between the mosquitoes and humans occur outdoors. [ citation needed ] A Chikungunya vaccine is a vaccine intended to provide acquired immunity against the chikungunya virus . The most commonly reported side effects include headache, fatigue, muscle pain, joint pain, fever, nausea and tenderness at the injection site. A Chikungunya vaccine is a vaccine intended to provide acquired immunity against the chikungunya virus . The most commonly reported side effects include headache, fatigue, muscle pain, joint pain, fever, nausea and tenderness at the injection site. Currently, no specific treatment for chikungunya is available. Supportive care is recommended, and symptomatic treatment of fever and joint swelling includes the use of nonsteroidal anti-inflammatory drugs such as naproxen , non-aspirin analgesics such as paracetamol (acetaminophen) and fluids. Aspirin is not recommended due to the increased risk of bleeding. Despite anti-inflammatory effects, corticosteroids are not recommended during the acute phase of disease, as they may cause immunosuppression and worsen infection. Passive immunotherapy has potential benefit in treatment of chikungunya. Studies in animals using passive immunotherapy have been effective, and clinical studies using passive immunotherapy in those particularly vulnerable to severe infection are currently in progress. Passive immunotherapy involves administration of anti-CHIKV hyperimmune human intravenous antibodies (immunoglobulins) to those exposed to a high risk of chikungunya infection. No antiviral treatment for Chikungunya virus is currently available, though testing has shown several medications to be effective in vitro . In those who have more than two weeks of arthritis, ribavirin may be useful. The effect of chloroquine is not clear. It does not appear to help acute disease, but tentative evidence indicates it might help those with chronic arthritis. Steroids do not appear to be an effective treatment. NSAIDs and simple analgesics can be used to provide partial symptom relief in most cases. Methotrexate , a drug used in the treatment of rheumatoid arthritis , has been shown to have benefit in treating inflammatory polyarthritis resulting from chikungunya, though the drug mechanism for improving viral arthritis is unclear. In those who have more than two weeks of arthritis, ribavirin may be useful. The effect of chloroquine is not clear. It does not appear to help acute disease, but tentative evidence indicates it might help those with chronic arthritis. Steroids do not appear to be an effective treatment. NSAIDs and simple analgesics can be used to provide partial symptom relief in most cases. Methotrexate , a drug used in the treatment of rheumatoid arthritis , has been shown to have benefit in treating inflammatory polyarthritis resulting from chikungunya, though the drug mechanism for improving viral arthritis is unclear. The mortality rate of chikungunya is slightly less than 1 in 1000. Those over the age of 65, neonates, and those with underlying chronic medical problems are most likely to have severe complications. Neonates are vulnerable as it is possible to vertically transmit chikungunya from mother to infant during delivery, which results in high rates of morbidity, as infants lack fully developed immune systems . The likelihood of prolonged symptoms or chronic joint pain is increased with increased age and prior rheumatological disease. Historically, chikungunya has been present mostly in the developing world . The disease causes an estimated 3 million infections each year. Epidemics in the Indian Ocean, Pacific Islands, and in the Americas, continue to change the distribution of the disease. In Africa, chikungunya is spread by a sylvatic cycle in which the virus largely cycles between other non-human primates , small mammals, and mosquitos between human outbreaks. During outbreaks, due to the high concentration of virus in the blood of those in the acute phase of infection, the virus can circulate from humans to mosquitoes and back to humans. The transmission of the pathogen between humans and mosquitoes that exist in urban environments was established on multiple occasions from strains occurring on the eastern half of Africa in non-human primate hosts. This emergence and spread beyond Africa may have started as early as the 18th century. Currently, available data does not indicate whether the introduction of chikungunya into Asia occurred in the 19th century or more recently, but this epidemic Asian strain causes outbreaks in India and continues to circulate in Southeast Asia. In Africa, outbreaks were typically tied to heavy rainfall causing increased mosquito population. In recent outbreaks in urban centers, the virus has spread by circulating between humans and mosquitoes. Global rates of chikungunya infection are variable, depending on outbreaks. When chikungunya was first identified in 1952, it had a low-level circulation in West Africa, with infection rates linked to rainfall. Beginning in the 1960s, periodic outbreaks were documented in Asia and Africa. However, since 2005, following several decades of relative inactivity, chikungunya has re-emerged and caused large outbreaks in Africa, Asia, and the Americas. In India, for instance, chikungunya re-appeared following 32 years of absence of viral activity. Outbreaks have occurred in Europe, the Caribbean, and South America, areas in which chikungunya was not previously transmitted. Local transmission has also occurred in the United States and Australia, countries in which the virus was previously unknown. In 2005, an outbreak on the island of Réunion was the largest then documented, with an estimated 266,000 cases on an island with a population of approximately 770,000. In a 2006 outbreak, India reported 1.25 million suspected cases. Chikungunya was introduced to the Americas in 2013, first detected on the French island of Saint Martin , and for the next two years in the Americas, 1,118,763 suspected cases and 24,682 confirmed cases were reported by the PAHO . An analysis of the genetic code of Chikungunya virus suggests that the increased severity of the 2005–present outbreak may be due to a change in the genetic sequence which altered the E1 segment of the virus' viral coat protein, a variant called E1-A226V. This mutation potentially allows the virus to multiply more easily in mosquito cells. The change allows the virus to use the Asian tiger mosquito (an invasive species ) as a vector in addition to the more strictly tropical main vector, Aedes aegypti . Enhanced transmission of Chikungunya virus by A. albopictus could mean an increased risk for outbreaks in other areas where the Asian tiger mosquito is present. A albopictus is an invasive species which has spread through Europe, the Americas, the Caribbean, Africa and the Middle East. [ citation needed ] After the detection of zika virus in Brazil in April 2015, the first ever in the Western Hemisphere, it is now thought some chikungunya and dengue cases could in fact be zika virus cases or coinfections .The disease was first described by Marion Robinson and W.H.R. Lumsden in a pair of 1955 papers, following an outbreak in 1952 on the Makonde Plateau , along the border between Mozambique and Tanganyika (the mainland part of modern-day Tanzania ). Since then outbreaks have occurred occasionally in Africa, South Asia, and Southeast Asia; recent outbreaks have spread the disease over a wider range. [ citation needed ] The first recorded outbreak may have been in 1779. This is in agreement with the molecular genetics evidence that suggests it evolved around the year 1700. According to the original paper by Lumsden, the term 'chikungunya' is derived from the Makonde root verb kungunyala , meaning to dry up or become contorted. In concurrent research, Robinson [ citation needed ] glossed the Makonde term more specifically as "that which bends up". It is understood to refer to the contorted posture of people affected with the severe joint pain and arthritic symptoms associated with this disease. Subsequent authors apparently overlooked the references to the Makonde language and assumed the term to have been derived from Swahili , the lingua franca of the region. The erroneous attribution to Swahili has been repeated in numerous print sources. Erroneous spellings of the name of the disease are also in common use. [ citation needed ]Chikungunya is one of more than a dozen agents researched as a potential biological weapon . This disease is part of the group of neglected tropical diseases .

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Dengue fever

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2019–2020 dengue fever epidemic

The 2019–2020 dengue fever epidemic was an epidemic of the infectious disease dengue fever in several countries of Southeast Asia , including the Philippines , Malaysia , Vietnam , and Bangladesh , Pakistan , India , Thailand , Singapore , and Laos . The spread of the disease was exacerbated by falling vaccination levels in certain areas, and by a growing population of mosquitoes , which are the primary carriers of the disease, and which are able to reproduce in larger numbers where humans have littered the environment with plastic containers, which provide an ideal breeding ground for mosquitoes. Affected countries have sought to control the epidemic through increased vaccination efforts, and through efforts to control the mosquito population.In Bangladesh , the Communicable Disease Control (CDC) unit of the Directorate General of Health Services (DGHS) carried out a survey in Dhaka city in January 2019, where they found both larva and adult Aedes mosquitoes in different parts of the city. Based on the outcome of the survey, in March 2019, warned of a potential outbreak DGHS alerted both city corporations about a possible outbreak in upcoming months. According to CDC director Sanya Tahmina, they also started training the doctors and nurses from February considering the possibility of a future outbreak. The 2019 outbreak in Bangladesh began primarily in April 2019. According to Directorate General of Health Services (DGHS), 14 people had died and 19,513 people had been affected by August 2019, a majority of whom were children, with other sources reporting that the death toll had already passed 50. DGHS confirmed the outbreak affecting all districts of the country , with Dhaka being the worst-hit city in the country and districts in Dhaka Division among the most affected regions. The Institute of Epidemiology, Disease Control and Research (IEDCR) expected the outbreak to continue until September 2019. In August 2019, the Bangladesh government withdrew all tariffs on dengue test kits imports. The Malaysian Ministry of Health reported that by 3 August 2019, the number of cases in Malaysia had reached a record 80,000 on the year, with 113 deaths reported. The highest incidences were in the states of Selangor , the Johor , Kelantan , Sabah , Penang , Sarawak , Negeri Sembilan and Pahang , as well as the Federal territories . The Malaysian government sought to counter the epidemic by releasing mosquitoes of the genus Aedes infected with the Wolbachia bacteria , which was expected to reduce the mosquito population. In Pakistan, in the summer of 2019, more than 47 people died and more than 30,000 were infected by dengue fever, the worst outbreak of the disease in the history of the country. In October 2019, Prime Minister Imran Khan took notice of the outbreak and sought a report from the Special Assistant to Prime Minister on National Health Services Zafar Mirza. On 10 October 2019, a Peshawar High Court bench sent summons to the Khyber Pakhtunkhwa 's provincial health secretary to explain the situation related to dengue outbreak in parts of the province. In August 2019, the Philippines declared an epidemic after more than 622 people had died of the disease in that country. The Philippines Department of Health reported that there were over 146,000 dengue fever cases from the beginning of 2019 to 20 July, which was "a 98% increase from the same time period last year". The epidemic occurred in the regions of Calabarzon , Mimaropa , Bicol , Western Visayas , Eastern Visayas , Zamboanga Peninsula , and Northern Mindanao . The epidemic was largely blamed on falling vaccination rates, following a series of issues with the Dengvaxia vaccine manufactured by Sanofi Pasteur . In 2017, Sanofi warned of possible adverse effects, and in 2018 the vaccine was blamed for the deaths of children during a national vaccination program. In Singapore, there were 15,998 reported cases of dengue fever in 2019, five times more than in 2018 but fewer than previous outbreaks in 2013 and 2014. 2020 started off with a four-year high in the number of people infected with dengue in the first six weeks of the year and eventually broke records for both the number of reported cases and deaths, at 35,315 and 32 respectively. In 2021, 5,261 people got infected with dengue fever and 5 people died with dengue fever in Singapore. In 2022, 32,365 people got infected with dengue fever and 19 people died with dengue fever in Singapore. In 2023, 5,207 people got infected with dengue fever and 2 people died with dengue fever in Singapore. In total, 94,146 people got infected with dengue fever and 78 people died with dengue fever in Singapore from 2019 to 2023. In Vietnam, dengue fever cases tripled from the previous year, to 88,000 by mid-July, with six deaths. By 19 November, Vietnam had recorded 250,000 cases with 50 deaths. The epidemic is most prevalent in the southern region of the country, where locals store rainwater in containers for use in farming, providing a breeding ground for mosquitoes. In neighboring Laos, dengue fever cases exceeded 11,000 by mid-year, with 27 deaths, prompting the Lao Ministry of Health to recommend that likely mosquito breeding sites should be drained. In total, Vietnam had 815,274 infections and 238 deaths of dengue fever from 2019 to 2023. In Latin America, 2019 was a record-setting dengue fever outbreak, with more than 2.7 million cases and 1206 deaths during the first 10 months of 2019. As of 2023, cases and Deaths of dengue fever reached up to 3 million cases and 1302 deaths. In the summer of 2019 an outbreak was confirmed in Oceania. 276 cases and one death were reported in the Marshall Islands , resulting in the government halting travel between the urban centers of Ebeye and Majuro to the outer islands. Outbreakers were also reported in Palau , Federated States of Micronesia , the Cook Islands , Tuvalu , and the Philippines . The European Centre for Disease Prevention and Control reported that the epidemic had affected the French island of Réunion , off the coast of Africa, with "over 15,000 autochthonous confirmed cases" being reported as of mid-2019, including nine deaths. The ECDC expressed concern that Réunion's European tourism industry could provide a vector for the transmission of the virus to Europe. A systematic review that was done by Ahmed et al. revealed the appearance of autochthonous dengue in Europe along with the increase in imported dengue and dengue severity. Therefore, health authorities pay more attention and update the protocols in order to catch dengue infection among travelers coming from and to Europe. In November 2019, the epidemic struck Yemen , with nearly 8,000 cases in Taiz Governorate before the end of the month. In Bangladesh , the Communicable Disease Control (CDC) unit of the Directorate General of Health Services (DGHS) carried out a survey in Dhaka city in January 2019, where they found both larva and adult Aedes mosquitoes in different parts of the city. Based on the outcome of the survey, in March 2019, warned of a potential outbreak DGHS alerted both city corporations about a possible outbreak in upcoming months. According to CDC director Sanya Tahmina, they also started training the doctors and nurses from February considering the possibility of a future outbreak. The 2019 outbreak in Bangladesh began primarily in April 2019. According to Directorate General of Health Services (DGHS), 14 people had died and 19,513 people had been affected by August 2019, a majority of whom were children, with other sources reporting that the death toll had already passed 50. DGHS confirmed the outbreak affecting all districts of the country , with Dhaka being the worst-hit city in the country and districts in Dhaka Division among the most affected regions. The Institute of Epidemiology, Disease Control and Research (IEDCR) expected the outbreak to continue until September 2019. In August 2019, the Bangladesh government withdrew all tariffs on dengue test kits imports. The Malaysian Ministry of Health reported that by 3 August 2019, the number of cases in Malaysia had reached a record 80,000 on the year, with 113 deaths reported. The highest incidences were in the states of Selangor , the Johor , Kelantan , Sabah , Penang , Sarawak , Negeri Sembilan and Pahang , as well as the Federal territories . The Malaysian government sought to counter the epidemic by releasing mosquitoes of the genus Aedes infected with the Wolbachia bacteria , which was expected to reduce the mosquito population. In Pakistan, in the summer of 2019, more than 47 people died and more than 30,000 were infected by dengue fever, the worst outbreak of the disease in the history of the country. In October 2019, Prime Minister Imran Khan took notice of the outbreak and sought a report from the Special Assistant to Prime Minister on National Health Services Zafar Mirza. On 10 October 2019, a Peshawar High Court bench sent summons to the Khyber Pakhtunkhwa 's provincial health secretary to explain the situation related to dengue outbreak in parts of the province. In August 2019, the Philippines declared an epidemic after more than 622 people had died of the disease in that country. The Philippines Department of Health reported that there were over 146,000 dengue fever cases from the beginning of 2019 to 20 July, which was "a 98% increase from the same time period last year". The epidemic occurred in the regions of Calabarzon , Mimaropa , Bicol , Western Visayas , Eastern Visayas , Zamboanga Peninsula , and Northern Mindanao . The epidemic was largely blamed on falling vaccination rates, following a series of issues with the Dengvaxia vaccine manufactured by Sanofi Pasteur . In 2017, Sanofi warned of possible adverse effects, and in 2018 the vaccine was blamed for the deaths of children during a national vaccination program. In Singapore, there were 15,998 reported cases of dengue fever in 2019, five times more than in 2018 but fewer than previous outbreaks in 2013 and 2014. 2020 started off with a four-year high in the number of people infected with dengue in the first six weeks of the year and eventually broke records for both the number of reported cases and deaths, at 35,315 and 32 respectively. In 2021, 5,261 people got infected with dengue fever and 5 people died with dengue fever in Singapore. In 2022, 32,365 people got infected with dengue fever and 19 people died with dengue fever in Singapore. In 2023, 5,207 people got infected with dengue fever and 2 people died with dengue fever in Singapore. In total, 94,146 people got infected with dengue fever and 78 people died with dengue fever in Singapore from 2019 to 2023.In Vietnam, dengue fever cases tripled from the previous year, to 88,000 by mid-July, with six deaths. By 19 November, Vietnam had recorded 250,000 cases with 50 deaths. The epidemic is most prevalent in the southern region of the country, where locals store rainwater in containers for use in farming, providing a breeding ground for mosquitoes. In neighboring Laos, dengue fever cases exceeded 11,000 by mid-year, with 27 deaths, prompting the Lao Ministry of Health to recommend that likely mosquito breeding sites should be drained. In total, Vietnam had 815,274 infections and 238 deaths of dengue fever from 2019 to 2023.In Latin America, 2019 was a record-setting dengue fever outbreak, with more than 2.7 million cases and 1206 deaths during the first 10 months of 2019. As of 2023, cases and Deaths of dengue fever reached up to 3 million cases and 1302 deaths.In the summer of 2019 an outbreak was confirmed in Oceania. 276 cases and one death were reported in the Marshall Islands , resulting in the government halting travel between the urban centers of Ebeye and Majuro to the outer islands. Outbreakers were also reported in Palau , Federated States of Micronesia , the Cook Islands , Tuvalu , and the Philippines . The European Centre for Disease Prevention and Control reported that the epidemic had affected the French island of Réunion , off the coast of Africa, with "over 15,000 autochthonous confirmed cases" being reported as of mid-2019, including nine deaths. The ECDC expressed concern that Réunion's European tourism industry could provide a vector for the transmission of the virus to Europe. A systematic review that was done by Ahmed et al. revealed the appearance of autochthonous dengue in Europe along with the increase in imported dengue and dengue severity. Therefore, health authorities pay more attention and update the protocols in order to catch dengue infection among travelers coming from and to Europe. In November 2019, the epidemic struck Yemen , with nearly 8,000 cases in Taiz Governorate before the end of the month.

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Dengue fever

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Chhom Nimol

Chhom Nimol ( Khmer : ឆោម និមល ; [ cʰaom niʔmɔəl ] ) is a Cambodian-American singer and lead vocalist for the band Dengue Fever , which she joined in 2001.Chhom Nimol was born in Cambodia and for a time her family lived in a refugee camp in Thailand . She learned how to sing from her family, who are well-known musicians and singers in Cambodia. In 1997, she won Cambodia's Apsara Awards, a national singing competition. She emigrated to the United States in 2001. Upon arriving in America, Nimol began singing in restaurants and bars in the Little Phnom Penh area of Long Beach, California . She was soon discovered at an audition by the American rock band Dengue Fever , who were interested in the Cambodian rock and pop music of the 1960s and 70s and sought a singer who could handle the Khmer lyrics of the original Cambodian songs they wished to perform. Dengue Fever released their first album in 2003 and have since expanded their repertoire into original songs inspired by Cambodian rock and many other world music styles. Nimol still usually sings in Khmer but now occasionally sings in English as well. She became a United States citizen in 2014.

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Health in Cambodia

The quality of health in Cambodia is rising along with its growing economy. The public health care system has a high priority from the Cambodian government and with international help and assistance, Cambodia has seen some major and continuous improvements in the health profile of its population since the 1980s, with a steadily rising life expectancy. A health reform of Cambodia in the 1990s, successfully improved the health of the population in Cambodia, placing Cambodia on a track to achieve the Millennium Development Goal targets set forth by the United Nations. One such example is the Cambodian Health Equity Fund, largely financed by the country itself, created in 2000 to increase access to free health care to around 3 million poor people. The Fund, which pays for traveling expense and even daily allowance for anyone accompanying a patient, has resulted in increasing health care seeking among Cambodians who otherwise could not afford any kind of medical care. As a result of the reform, mortality rates significantly dropped. Similarly, life expectancy at birth in 2010 was 62.5 years, a 1.6 folds increase from 1980. The Cambodian population and healthcare system struggles with many of the diseases common to the Tropics , in particular in rural areas. In addition, malnutrition of children has long been a major problem. HIV became an increasing problem in 1998, but the epidemic has since been almost curbed. The Human Rights Measurement Initiative finds that Cambodia is fulfilling 81.2% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Cambodia achieves 96.8% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 89.7% of what is expected based on the nation's level of income. Cambodia falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 57.1% of what the nation is expected to achieve based on the resources (income) it has available. Cambodia gained its independence from France in 1953, but the road to self-governance would prove to be very difficult. In 1967, the Cambodian Civil War broke out and the following decade turned out disastrous for the country and the Cambodian people. The Vietnam War spread across the border and the US initiated massive bombing campaigns in Cambodia, which further aggravated the civil war and destroyed infrastructure and agricultural resources in the entire eastern half of the country, in particular the rural areas. In 1970, a coup d'état , supported by the United States, brought down the Cambodian government of King Norodom Sihanouk, and the Khmer Republic , an unstable military republican regime, was installed. As the civil war progressed, the regime was eventually overthrown by the Khmer Rouge in 1975 and in the aftermath, an internal genocide began, further destroying the economy and the capital city, massacred intellectuals, and crumbled the country apart, resulting in the deaths of around 1.7 million people (21% of the population) in total. The Khmer Rouge came to a demise in 1989, and the United Nations took over and sponsored a national election that supported numerous developmental agencies and nongovernmental organizations (NGOs) to come into Cambodia, which helped in the rebuilding of the country. Cambodia is officially no longer a country of military conflict, as it has experienced a period of relative political stability in response to the 1998 election. During the newfound political stability, the country has experienced significant and consistent economic growth, but from a very deprived foundation. To be specific, Cambodia experienced a gross domestic product (GDP) increase of more than 7% per year. As of 2012, Cambodia has reached GDP per capita of US$944, right on the verge of achieving the threshold for lower middle-income country status of US$1035. Although the economy has been growing, the gains have not been equally distributed. Most of the income gain has been distributed exclusively to the urban population. Inequality in health care persists between people of different socioeconomic backgrounds, most prominently contrasted between the rural and urban population. According to the CDHS data in 2010, the rate of children under 5 with moderate to severe malnutrition or with acute respiratory infection was more than twice as high in children living in rural areas compared to those living in urban areas, as well as children in lowest quintile household compared to those in highest quantile household. There are many social stratifications, such as wealth, education level, and living location, that influence inequality among access to health care services. An in-depth study by The Centre for Advanced Studies was done in four poor communities of Phnom Penh Cambodia which resulted in the conclusion that more specifically, a females lack of general education is the leading cause to low levels of health systems being utilized by women. Due to a woman lacking education, they lack the knowledge that services to benefit their health are even available to them, creating this health care inequality. Dual Burden of disease refers to the prevalence of both infectious and chronic disease in each population, mainly due to shifts in diet and physical activity pattern in response to globalization, especially in the low and middle income countries. Currently, rate of non-communicable diseases occurring in Cambodia has been rising, and mortality due to non-communicable increasingly matching up with the number of death due to infectious disease. Such dual burden/epidemiological transition from infectious to chronic disease burden has been identified, as the burden death due to infectious disease has shifted towards deaths due to injuries and chronic diseases, bush as cardiovascular disease, cancers, and respiratory diseases. Malnutrition remains to be a major risk factor for children's health. Childhood stunting, wasting, and underweight due to malnutrition remains to be a problem in Cambodia. Mortality data suggests emerging burdens specifically from injuries (traffic accidents), high blood pressure, heart disease, and liver cancer. Average life expectancy at birth was determined to be about 71.4 years in 2012. Specifically, the average life expectancy for females has been 74.2 years, and the average for males has been 68.8 years. This is a significant, more than two times longevity increase from only 29.6 years in 1980. Source: UN World Population Prospects Inequality in health care persists between people of different socioeconomic backgrounds, most prominently contrasted between the rural and urban population. According to the CDHS data in 2010, the rate of children under 5 with moderate to severe malnutrition or with acute respiratory infection was more than twice as high in children living in rural areas compared to those living in urban areas, as well as children in lowest quintile household compared to those in highest quantile household. There are many social stratifications, such as wealth, education level, and living location, that influence inequality among access to health care services. An in-depth study by The Centre for Advanced Studies was done in four poor communities of Phnom Penh Cambodia which resulted in the conclusion that more specifically, a females lack of general education is the leading cause to low levels of health systems being utilized by women. Due to a woman lacking education, they lack the knowledge that services to benefit their health are even available to them, creating this health care inequality.Dual Burden of disease refers to the prevalence of both infectious and chronic disease in each population, mainly due to shifts in diet and physical activity pattern in response to globalization, especially in the low and middle income countries. Currently, rate of non-communicable diseases occurring in Cambodia has been rising, and mortality due to non-communicable increasingly matching up with the number of death due to infectious disease. Such dual burden/epidemiological transition from infectious to chronic disease burden has been identified, as the burden death due to infectious disease has shifted towards deaths due to injuries and chronic diseases, bush as cardiovascular disease, cancers, and respiratory diseases. Malnutrition remains to be a major risk factor for children's health. Childhood stunting, wasting, and underweight due to malnutrition remains to be a problem in Cambodia. Mortality data suggests emerging burdens specifically from injuries (traffic accidents), high blood pressure, heart disease, and liver cancer.Average life expectancy at birth was determined to be about 71.4 years in 2012. Specifically, the average life expectancy for females has been 74.2 years, and the average for males has been 68.8 years. This is a significant, more than two times longevity increase from only 29.6 years in 1980. Source: UN World Population Prospects Major infectious diseases includes food and waterborne diseases (of which there is a very high risk) such as bacterial and protozoal diarrhoea, hepatitis A , and typhoid fever . Vector borne diseases include dengue fever , Japanese encephalitis , and malaria . Cambodia has been certified as being polio free since October 2000. Tuberculosis incidence and prevalence declined significantly, and within just 20 years from 1990 to 2010, the incidence rate declined by 25%, and the prevalence rate declined by 48%. Efforts through active screening, such as outreach activities conducted by the National Centre for Tuberculosis and Leprosy Control, and introduction of directly observed treatment short course (DOTS) in 1990s drastically reduced burdens due to TB in Cambodia. Significant progress has been achieved in malaria prevention and control in Cambodia in the last decade. Since 2009, malaria incidence, cases, and deaths have all decreased. Despite the successes, malaria remains a major public health concern. Challenges to reaching national elimination goals include mobile populations and artemisinin resistance . Mobile populations are a challenge because malaria predominantly affects adult males who move from low to high transmission areas and lack access to malaria services and education, making them more vulnerable to infection. Artemisinin drugs are the first-line treatment for malaria throughout the Greater Mekong Subregion . Plasmodium falciparum resistance to artemisinin drugs was first confirmed in western Cambodia; treatment failures to artemisinin-based combination therapy (ACT) have been reported from multiple sites on the Thailand -Cambodia border. Currently five ACTs are failing in Cambodia. In 2014, Malaria Elimination in the Greater Mekong Subregion countries was developed as a coordinated strategy for malaria elimination by 2030. As a result, the Cambodian National Malaria Program updated its national strategic plan to the Malaria Elimination Action Framework 2016-2020 which has the ultimate goal of national elimination of P. falciparum and multi-drug resistant malaria by 2020. In 2016, Cambodia moved from control to elimination activities concentrated in 18 operational districts in the northwest of Cambodia. The following surveillance activities were intensified in the 18 districts: following up on cases, investigating focal areas, and conducting response interventions. The National Malaria Program aimed to develop evidence-based approaches that could be scaled up to these 18 operational districts targeting elimination. Dengue fever is especially prevalent among children in between 4 and 6 years old, living in urban Cambodia. Dengue fever was first isolated in Cambodia in 1963. Since the beginning of passive surveillance in 1980, the case fatality rate has decreased from 15% to 0.3% from 1980 to 2010 HIV emerged as a major infection affecting the lives of approximately 2.4% of the population in 1998. Major public health work has been done to reduce the prevalence rate through implementing education and promoting safe sex via condom use targeted to specific population groups who are at the core of the infection web, including commercial sex workers, injecting drugs users, men who have sex with men. Some of the interventions implemented include awareness of safer sex and condom use campaign, universal access to HIV testing, and prophylaxis to HIV positive mothers to reduce mother-to-child transmission of the virus. Cambodia's HIV/AIDS epidemic is spread primarily through heterosexual transmission and revolves largely around the sex trade . HIV transmission occurs mainly in sexual partnerships where one partner has engaged in high-risk behaviors. Women constitute a growing share of people living with HIV/AIDS, comprising an estimated 47 percent of people living with HIV/AIDS in 2003, compared with 37 percent in 1998. This increased proportion of infections among women may reflect declining prevalence rates among males, as well as deaths among males infected in the early years of Cambodia's epidemic. Significantly, a low prevalence rate in the general population masks far higher prevalence rates in certain sub-populations, such as injecting drug users , people in prostitution , men who have sex with men , karaoke hostesses and beer girls, and mobile and migrant populations. By 2014, HIV prevalence was reduced to 0.4 percent through a successful prevention program. However, in 2015 a localized, yet massive, outbreak of HIV stemming mostly from Roka occurred. The cause is thought to be the reuse of syringes by an unlicensed doctor operating in the region who has since been jailed. Cambodia is still psychologically struggling with the painful legacy of the Khmer Rouge era. At the same time, the people must cope with challenges like poverty, unemployment, political tensions and climate change . The health-care system is still ill-prepared to deal with mental-health problems. One NGO is standing out in providing mental-health services: the Transcultural Psychosocial Organisation (TPO) Cambodia. A survey from MOH, done in 2010, indicated that 2.9% of population among adults aged 25 – 64 years had diagnosed diabetes . Similar, 11.2% of the population among adults aged 25 – 64 years self-identified as having been diagnosed as having high blood pressure . Since 1996, reported incidences of death due to injury have increased drastically in corollary to increasing number of vehicles. According to the health data from MOH, being male and being a motorcycle rider contributed most significantly to the burden, accounting for 80% and 67% of all mortalities due to injuries in 2010, respectively. The 2015 maternal mortality rate per 100,000 births for Cambodia is 161. This is compared with 290 in 2010, 265.8 in 2008, and 409.1 in 1990. The under 5 mortality rate, per 1,000 births is 90 and the neonatal mortality as a percentage of under 5's mortality is 34. In Cambodia the number of midwives per 1,000 live births is 6 and the lifetime risk of death for pregnant women 1 in 110. Prematurity, pneumonia, birth asphyxia, diarrhea, and injuries remain the top 5 killers of children under 5 years of age in Cambodia. Notably, the rate of diarrheal disease and measles decreased significantly in response to high vaccination coverage campaign set forth by the Ministry of Health.Major infectious diseases includes food and waterborne diseases (of which there is a very high risk) such as bacterial and protozoal diarrhoea, hepatitis A , and typhoid fever . Vector borne diseases include dengue fever , Japanese encephalitis , and malaria . Cambodia has been certified as being polio free since October 2000. Tuberculosis incidence and prevalence declined significantly, and within just 20 years from 1990 to 2010, the incidence rate declined by 25%, and the prevalence rate declined by 48%. Efforts through active screening, such as outreach activities conducted by the National Centre for Tuberculosis and Leprosy Control, and introduction of directly observed treatment short course (DOTS) in 1990s drastically reduced burdens due to TB in Cambodia. Significant progress has been achieved in malaria prevention and control in Cambodia in the last decade. Since 2009, malaria incidence, cases, and deaths have all decreased. Despite the successes, malaria remains a major public health concern. Challenges to reaching national elimination goals include mobile populations and artemisinin resistance . Mobile populations are a challenge because malaria predominantly affects adult males who move from low to high transmission areas and lack access to malaria services and education, making them more vulnerable to infection. Artemisinin drugs are the first-line treatment for malaria throughout the Greater Mekong Subregion . Plasmodium falciparum resistance to artemisinin drugs was first confirmed in western Cambodia; treatment failures to artemisinin-based combination therapy (ACT) have been reported from multiple sites on the Thailand -Cambodia border. Currently five ACTs are failing in Cambodia. In 2014, Malaria Elimination in the Greater Mekong Subregion countries was developed as a coordinated strategy for malaria elimination by 2030. As a result, the Cambodian National Malaria Program updated its national strategic plan to the Malaria Elimination Action Framework 2016-2020 which has the ultimate goal of national elimination of P. falciparum and multi-drug resistant malaria by 2020. In 2016, Cambodia moved from control to elimination activities concentrated in 18 operational districts in the northwest of Cambodia. The following surveillance activities were intensified in the 18 districts: following up on cases, investigating focal areas, and conducting response interventions. The National Malaria Program aimed to develop evidence-based approaches that could be scaled up to these 18 operational districts targeting elimination. Dengue fever is especially prevalent among children in between 4 and 6 years old, living in urban Cambodia. Dengue fever was first isolated in Cambodia in 1963. Since the beginning of passive surveillance in 1980, the case fatality rate has decreased from 15% to 0.3% from 1980 to 2010 HIV emerged as a major infection affecting the lives of approximately 2.4% of the population in 1998. Major public health work has been done to reduce the prevalence rate through implementing education and promoting safe sex via condom use targeted to specific population groups who are at the core of the infection web, including commercial sex workers, injecting drugs users, men who have sex with men. Some of the interventions implemented include awareness of safer sex and condom use campaign, universal access to HIV testing, and prophylaxis to HIV positive mothers to reduce mother-to-child transmission of the virus. Cambodia's HIV/AIDS epidemic is spread primarily through heterosexual transmission and revolves largely around the sex trade . HIV transmission occurs mainly in sexual partnerships where one partner has engaged in high-risk behaviors. Women constitute a growing share of people living with HIV/AIDS, comprising an estimated 47 percent of people living with HIV/AIDS in 2003, compared with 37 percent in 1998. This increased proportion of infections among women may reflect declining prevalence rates among males, as well as deaths among males infected in the early years of Cambodia's epidemic. Significantly, a low prevalence rate in the general population masks far higher prevalence rates in certain sub-populations, such as injecting drug users , people in prostitution , men who have sex with men , karaoke hostesses and beer girls, and mobile and migrant populations. By 2014, HIV prevalence was reduced to 0.4 percent through a successful prevention program. However, in 2015 a localized, yet massive, outbreak of HIV stemming mostly from Roka occurred. The cause is thought to be the reuse of syringes by an unlicensed doctor operating in the region who has since been jailed. Tuberculosis incidence and prevalence declined significantly, and within just 20 years from 1990 to 2010, the incidence rate declined by 25%, and the prevalence rate declined by 48%. Efforts through active screening, such as outreach activities conducted by the National Centre for Tuberculosis and Leprosy Control, and introduction of directly observed treatment short course (DOTS) in 1990s drastically reduced burdens due to TB in Cambodia. Significant progress has been achieved in malaria prevention and control in Cambodia in the last decade. Since 2009, malaria incidence, cases, and deaths have all decreased. Despite the successes, malaria remains a major public health concern. Challenges to reaching national elimination goals include mobile populations and artemisinin resistance . Mobile populations are a challenge because malaria predominantly affects adult males who move from low to high transmission areas and lack access to malaria services and education, making them more vulnerable to infection. Artemisinin drugs are the first-line treatment for malaria throughout the Greater Mekong Subregion . Plasmodium falciparum resistance to artemisinin drugs was first confirmed in western Cambodia; treatment failures to artemisinin-based combination therapy (ACT) have been reported from multiple sites on the Thailand -Cambodia border. Currently five ACTs are failing in Cambodia. In 2014, Malaria Elimination in the Greater Mekong Subregion countries was developed as a coordinated strategy for malaria elimination by 2030. As a result, the Cambodian National Malaria Program updated its national strategic plan to the Malaria Elimination Action Framework 2016-2020 which has the ultimate goal of national elimination of P. falciparum and multi-drug resistant malaria by 2020. In 2016, Cambodia moved from control to elimination activities concentrated in 18 operational districts in the northwest of Cambodia. The following surveillance activities were intensified in the 18 districts: following up on cases, investigating focal areas, and conducting response interventions. The National Malaria Program aimed to develop evidence-based approaches that could be scaled up to these 18 operational districts targeting elimination. Dengue fever is especially prevalent among children in between 4 and 6 years old, living in urban Cambodia. Dengue fever was first isolated in Cambodia in 1963. Since the beginning of passive surveillance in 1980, the case fatality rate has decreased from 15% to 0.3% from 1980 to 2010 HIV emerged as a major infection affecting the lives of approximately 2.4% of the population in 1998. Major public health work has been done to reduce the prevalence rate through implementing education and promoting safe sex via condom use targeted to specific population groups who are at the core of the infection web, including commercial sex workers, injecting drugs users, men who have sex with men. Some of the interventions implemented include awareness of safer sex and condom use campaign, universal access to HIV testing, and prophylaxis to HIV positive mothers to reduce mother-to-child transmission of the virus. Cambodia's HIV/AIDS epidemic is spread primarily through heterosexual transmission and revolves largely around the sex trade . HIV transmission occurs mainly in sexual partnerships where one partner has engaged in high-risk behaviors. Women constitute a growing share of people living with HIV/AIDS, comprising an estimated 47 percent of people living with HIV/AIDS in 2003, compared with 37 percent in 1998. This increased proportion of infections among women may reflect declining prevalence rates among males, as well as deaths among males infected in the early years of Cambodia's epidemic. Significantly, a low prevalence rate in the general population masks far higher prevalence rates in certain sub-populations, such as injecting drug users , people in prostitution , men who have sex with men , karaoke hostesses and beer girls, and mobile and migrant populations. By 2014, HIV prevalence was reduced to 0.4 percent through a successful prevention program. However, in 2015 a localized, yet massive, outbreak of HIV stemming mostly from Roka occurred. The cause is thought to be the reuse of syringes by an unlicensed doctor operating in the region who has since been jailed. Cambodia is still psychologically struggling with the painful legacy of the Khmer Rouge era. At the same time, the people must cope with challenges like poverty, unemployment, political tensions and climate change . The health-care system is still ill-prepared to deal with mental-health problems. One NGO is standing out in providing mental-health services: the Transcultural Psychosocial Organisation (TPO) Cambodia. A survey from MOH, done in 2010, indicated that 2.9% of population among adults aged 25 – 64 years had diagnosed diabetes . Similar, 11.2% of the population among adults aged 25 – 64 years self-identified as having been diagnosed as having high blood pressure . A survey from MOH, done in 2010, indicated that 2.9% of population among adults aged 25 – 64 years had diagnosed diabetes .Similar, 11.2% of the population among adults aged 25 – 64 years self-identified as having been diagnosed as having high blood pressure . Since 1996, reported incidences of death due to injury have increased drastically in corollary to increasing number of vehicles. According to the health data from MOH, being male and being a motorcycle rider contributed most significantly to the burden, accounting for 80% and 67% of all mortalities due to injuries in 2010, respectively. The 2015 maternal mortality rate per 100,000 births for Cambodia is 161. This is compared with 290 in 2010, 265.8 in 2008, and 409.1 in 1990. The under 5 mortality rate, per 1,000 births is 90 and the neonatal mortality as a percentage of under 5's mortality is 34. In Cambodia the number of midwives per 1,000 live births is 6 and the lifetime risk of death for pregnant women 1 in 110. Prematurity, pneumonia, birth asphyxia, diarrhea, and injuries remain the top 5 killers of children under 5 years of age in Cambodia. Notably, the rate of diarrheal disease and measles decreased significantly in response to high vaccination coverage campaign set forth by the Ministry of Health.Unsafe drinking water and lack of sanitation facilities are major risk factors of infectious disease, especially diarrhea. However, such sanitary conditions have been improving since the 1990s along with the improvements of the economy and governance of the nation. Specifically, in 2010, it was estimated by the WHO that around 64% of households were able to receive safe drinking water, with urban counterparts of the country receiving higher rates (87%) of improved water than the rural counterpart (58%). Ministry of Health (MOH): Ministry of Health in Cambodia has been taking the leading role in improving the health of the people in Cambodia since the 1990s when help from foreign NGOs and external government aids were welcomed in Cambodia after the establishment of relative political stability. Thanks to the MOH, public health administration governance has been centralized and organized so that decisions and actions are facilitated to act quickly and critically in response to public health problems. Specifically, the MOH follows the current Health Strategic Plan 2008-2015 to better the health of the nation. Under the supervision of Cambodian Ministry of Health, governmental health facilities are reimbursed for treatment of low-income patients. In 2012, it was estimated that subsidies were given to around 25,000 inpatients and outpatients, with a total expenditure of US$285,000. [ citation needed ] However, such governmental infrastructure is not available in rural provinces: NGOs take bigger roles in the rural healthcare setting in Cambodia.Ministry of Health (MOH): Ministry of Health in Cambodia has been taking the leading role in improving the health of the people in Cambodia since the 1990s when help from foreign NGOs and external government aids were welcomed in Cambodia after the establishment of relative political stability. Thanks to the MOH, public health administration governance has been centralized and organized so that decisions and actions are facilitated to act quickly and critically in response to public health problems. Specifically, the MOH follows the current Health Strategic Plan 2008-2015 to better the health of the nation. Under the supervision of Cambodian Ministry of Health, governmental health facilities are reimbursed for treatment of low-income patients. In 2012, it was estimated that subsidies were given to around 25,000 inpatients and outpatients, with a total expenditure of US$285,000. [ citation needed ] However, such governmental infrastructure is not available in rural provinces: NGOs take bigger roles in the rural healthcare setting in Cambodia.Health indicators in Ratanakiri are the worst in Cambodia . Malaria , tuberculosis , intestinal parasites , cholera , diarrhea , and vaccine -preventable diseases such as measles are endemic. Rattanakiri has Cambodia's highest rates of maternal and child mortality , with 22.9% of children dying before the age of five. Ratanakiri also has the country's highest rates of severe malnutrition . Ratanakiri residents' poor health can be attributed to a variety of factors, including poverty, physical remoteness, language and cultural barriers that prevent Khmer Loeu from obtaining medical care, poor infrastructure and access to water, lack of accountability in the medical community, and exacerbating environmental factors such as natural resource degradation, decreasing food production, and internal migration. The province has one referral hospital, 10 health centers, and 17 health posts. Medical equipment and supplies are minimal, and most health facilities are staffed by nurses or midwives, who are often poorly trained and irregularly paid. Note: These statistics are aggregated for both Ratanakiri and Mondulkiri provinces. DPT1: 44% DPT2: 24% DPT3: 19% Measles: 39% Children moderately underweight: 35% Children severely underweight: 19% Visited health facility in last year: 13% Age at first intercourse: 18.0 Age at First Marriage: 18.6 Knows that a healthy person can have AIDS: 78% Knows that condoms can be used to prevent AIDS: 33% Uses any method of birth control: 8% Uses condoms: 1% Uses modern method of birth control: 7% Delivery Assistance by Doctor: 1% Delivery Assistance by SBA: 14%Note: These statistics are aggregated for both Ratanakiri and Mondulkiri provinces. DPT1: 44% DPT2: 24% DPT3: 19% Measles: 39% Children moderately underweight: 35% Children severely underweight: 19% Visited health facility in last year: 13% Age at first intercourse: 18.0 Age at First Marriage: 18.6 Knows that a healthy person can have AIDS: 78% Knows that condoms can be used to prevent AIDS: 33% Uses any method of birth control: 8% Uses condoms: 1% Uses modern method of birth control: 7% Delivery Assistance by Doctor: 1% Delivery Assistance by SBA: 14%

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Dengue fever

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Health in Thailand

Thailand has had "a long and successful history of health development," according to the World Health Organization . Life expectancy is averaged at seventy years. Non-communicable diseases form the major burden of morbidity and mortality, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues. The Human Rights Measurement Initiative finds that Thailand is fulfilling 91.0% of what it should be fulfilling for the right to health based on its level of income. In 2008, 98 percent of the population had access to an improved water source . Ninety-six percent of the population have access to improved sanitation facilities. Non-communicable diseases form the major burden of mortality in Thailand, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues. The mortality rate is 205 per 1,000 adults for those aged between 15 and 59 years. The under-five mortality rate is 14 per 1,000 live births. The maternal mortality ratio is 48 per 100,000 live births (2008). Years of life lost, distributed by cause, was 24 percent from communicable diseases, 55 percent from non-communicable diseases, and 22 percent from injuries (2008). Life expectancy in Thailand is 71 for males and 78 for females. Major infectious diseases in Thailand also include bacterial diarrhea , hepatitis , dengue fever , malaria , Japanese encephalitis , rabies , and leptospirosis . The prevalence of tuberculosis is 189 per 100,000 population. The first case of dengue fever was recorded in Thailand in 1949. Since then, it has been controlled, but not eradicated. Dengue cases soared in 2019. During the first six months of 2019, 28,785 people contracted dengue fever in Thailand. Forty-three died. The 2019 figures are double the five-year average and exceeds 2018's full-year total of 14,900 infections and 19 deaths. There is no treatment for dengue fever. Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2009, Thailand had the highest prevalence of HIV in Asia . The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behaviour, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs. The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the anti-retroviral drug Tenofovir as a prevention measure. The results of the study were released in mid-June 2013 and revealed a 48.9 percent reduced incidence of the virus among the group of subjects who received the drug, in comparison to the control group who received a placebo. The principal investigator of the study stated in Lancet , "We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use." The prevalence of leprosy (Hansen's disease) in Thailand is declining. Statistics from the Ministry of Public Health's Department of Disease Control indicate that there were 155 new leprosy patients countrywide in 2015, as compared to the 405 new cases found in 2010. Leper colonies are found in Chanthaburi, Nan, Chiang Rai, Maha Sarakham, Surin, Roi Et, Khon Kaen, and Nakhon Si Thammarat. In 2017 there were 11,440 confirmed cases of malaria in Thailand with 11 reported fatalities. The nation has committed to becoming malaria-free by 2024. In 2017, the Health Ministry declared 35 of Thailand's 76 provinces malaria-free. The persistence of malaria in border regions and the increasing drug resistance of new strains jeopardize the achievement of that goal. The WHO hopes to eliminate malaria by 2025. Food safety scares are common to Thailand. Besides, common is microbial contamination of street food left out in the hot sun and dusty roads as well as store food contamination by banned or toxic pesticides and fake food products. In July 2012 consumer action groups demanded four unlisted toxic pesticides found on common vegetables at levels 100 times the EU guidelines (which are banned in developed countries) be banned. Chemical companies are requesting to add them to the Thai Dangerous Substances Act so they can continue to be used, including on exported mangoes to developed countries which have banned their use. In 2014, Khon Kaen University concluded after a study, that Thailand should ban 155 types of pesticides, with 14 listed as urgent: Carbofuran , Methyl Bromide , Dichlorvos , Lambda-cyhalothrin , Methidathion-methyl , Omethoate , Zeta Cypermethrin , Endosulfan sulfate , Aldicarb , Azinphos-methyl , Chlorpyrifos-ethyl , Methoxychlor and Paraquat . As of 2019 [ update ] sugar consumption in Thailand is 28 teaspoons (131 grams) per person per day, four times the World Health Organization (WHO) recommendation. Excessive consumption of sugar leads to obesity , a public health issue. Thailand is number two in ASEAN , behind Malaysia , in the prevalence of obesity. In 2017, Thailand levied an excise tax on sugary drinks to pressure manufacturers to reduce the amount of sugar put in their products. A hike in the tax expected in October 2019. According to WHO in 2017, Thais consume an average of 10.8 grams of salt per day (over 4,000 milligrams of sodium), a rate more than double the recommended daily intake of salt. The main sources of salt are salt added during cooking, packaged food, and street food. Researchers claim that more than 22 million Thais suffer from salt-related ailments. Each year 20,000 of them die from related diseases, costing the country losses estimated at 98.9 billion baht a year. Thai health officials are calling for a tax on high-sodium food products to reduce demand. A study by the health ministry and Britain's Wellcome Trust released in September 2016 found that an average of two people die every hour from multi-drug resistant bacterial infections in Thailand. That death rate is much higher than in Europe. The improper use of antibiotics for humans and livestock has led to the proliferation of drug-resistant microorganisms, creating new strains of "superbugs" that can be defeated only by "last resort" medicines with toxic side effects. In Thailand, antibiotics are freely available in pharmacies without a prescription and even in convenience stores. Unregulated use of antibiotics on livestock is also problematic. Drug-resistant bacteria spreads through direct contact between humans and farm animals, ingested meat, or the environment. Antibiotics are often used on healthy animals to prevent, rather than treat, illnesses. In November 2016, Thailand announced its intent to halve antimicrobial-resistant (AMR) infections by 2021, joining the global battle against "superbugs". It aims to reduce the use of antibiotics in humans by 20 percent and in animals by 30 percent. The health minister said that about 88,000 patients develop AMR infections a year. The infections claim at least 38,000 lives in Thailand each year, causing 42 billion baht in economic damage. Without measures to address the issue, he said that the world would enter a "post-antibiotic era" with at least 10 million people around the world dying from AMR by 2050, 4.7 million of them in Asia. Thailand had 35 cases of teen pregnancies for every 1,000 girls from the ages of 15 to 19 in 2018. Health officials have set a target of 25 cases per 1,000 by 2026. In 2014, some 334 babies were born daily in Thailand to mothers aged between 15 and 19. The World Bank estimates that deaths in Thailand attributable to air pollution has risen from 31,000 in 1990 to roughly 49,000 in 2013. A hospital in Thailand is allegedly turning away a critically injured tourist, leaving them to die. Life expectancy in Thailand is 71 for males and 78 for females. Major infectious diseases in Thailand also include bacterial diarrhea , hepatitis , dengue fever , malaria , Japanese encephalitis , rabies , and leptospirosis . The prevalence of tuberculosis is 189 per 100,000 population. The first case of dengue fever was recorded in Thailand in 1949. Since then, it has been controlled, but not eradicated. Dengue cases soared in 2019. During the first six months of 2019, 28,785 people contracted dengue fever in Thailand. Forty-three died. The 2019 figures are double the five-year average and exceeds 2018's full-year total of 14,900 infections and 19 deaths. There is no treatment for dengue fever. Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2009, Thailand had the highest prevalence of HIV in Asia . The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behaviour, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs. The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the anti-retroviral drug Tenofovir as a prevention measure. The results of the study were released in mid-June 2013 and revealed a 48.9 percent reduced incidence of the virus among the group of subjects who received the drug, in comparison to the control group who received a placebo. The principal investigator of the study stated in Lancet , "We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use." The prevalence of leprosy (Hansen's disease) in Thailand is declining. Statistics from the Ministry of Public Health's Department of Disease Control indicate that there were 155 new leprosy patients countrywide in 2015, as compared to the 405 new cases found in 2010. Leper colonies are found in Chanthaburi, Nan, Chiang Rai, Maha Sarakham, Surin, Roi Et, Khon Kaen, and Nakhon Si Thammarat. In 2017 there were 11,440 confirmed cases of malaria in Thailand with 11 reported fatalities. The nation has committed to becoming malaria-free by 2024. In 2017, the Health Ministry declared 35 of Thailand's 76 provinces malaria-free. The persistence of malaria in border regions and the increasing drug resistance of new strains jeopardize the achievement of that goal. The WHO hopes to eliminate malaria by 2025. The first case of dengue fever was recorded in Thailand in 1949. Since then, it has been controlled, but not eradicated. Dengue cases soared in 2019. During the first six months of 2019, 28,785 people contracted dengue fever in Thailand. Forty-three died. The 2019 figures are double the five-year average and exceeds 2018's full-year total of 14,900 infections and 19 deaths. There is no treatment for dengue fever. Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2009, Thailand had the highest prevalence of HIV in Asia . The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behaviour, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs. The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the anti-retroviral drug Tenofovir as a prevention measure. The results of the study were released in mid-June 2013 and revealed a 48.9 percent reduced incidence of the virus among the group of subjects who received the drug, in comparison to the control group who received a placebo. The principal investigator of the study stated in Lancet , "We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use." The prevalence of leprosy (Hansen's disease) in Thailand is declining. Statistics from the Ministry of Public Health's Department of Disease Control indicate that there were 155 new leprosy patients countrywide in 2015, as compared to the 405 new cases found in 2010. Leper colonies are found in Chanthaburi, Nan, Chiang Rai, Maha Sarakham, Surin, Roi Et, Khon Kaen, and Nakhon Si Thammarat. In 2017 there were 11,440 confirmed cases of malaria in Thailand with 11 reported fatalities. The nation has committed to becoming malaria-free by 2024. In 2017, the Health Ministry declared 35 of Thailand's 76 provinces malaria-free. The persistence of malaria in border regions and the increasing drug resistance of new strains jeopardize the achievement of that goal. The WHO hopes to eliminate malaria by 2025. Food safety scares are common to Thailand. Besides, common is microbial contamination of street food left out in the hot sun and dusty roads as well as store food contamination by banned or toxic pesticides and fake food products. In July 2012 consumer action groups demanded four unlisted toxic pesticides found on common vegetables at levels 100 times the EU guidelines (which are banned in developed countries) be banned. Chemical companies are requesting to add them to the Thai Dangerous Substances Act so they can continue to be used, including on exported mangoes to developed countries which have banned their use. In 2014, Khon Kaen University concluded after a study, that Thailand should ban 155 types of pesticides, with 14 listed as urgent: Carbofuran , Methyl Bromide , Dichlorvos , Lambda-cyhalothrin , Methidathion-methyl , Omethoate , Zeta Cypermethrin , Endosulfan sulfate , Aldicarb , Azinphos-methyl , Chlorpyrifos-ethyl , Methoxychlor and Paraquat . As of 2019 [ update ] sugar consumption in Thailand is 28 teaspoons (131 grams) per person per day, four times the World Health Organization (WHO) recommendation. Excessive consumption of sugar leads to obesity , a public health issue. Thailand is number two in ASEAN , behind Malaysia , in the prevalence of obesity. In 2017, Thailand levied an excise tax on sugary drinks to pressure manufacturers to reduce the amount of sugar put in their products. A hike in the tax expected in October 2019. According to WHO in 2017, Thais consume an average of 10.8 grams of salt per day (over 4,000 milligrams of sodium), a rate more than double the recommended daily intake of salt. The main sources of salt are salt added during cooking, packaged food, and street food. Researchers claim that more than 22 million Thais suffer from salt-related ailments. Each year 20,000 of them die from related diseases, costing the country losses estimated at 98.9 billion baht a year. Thai health officials are calling for a tax on high-sodium food products to reduce demand. Food safety scares are common to Thailand. Besides, common is microbial contamination of street food left out in the hot sun and dusty roads as well as store food contamination by banned or toxic pesticides and fake food products. In July 2012 consumer action groups demanded four unlisted toxic pesticides found on common vegetables at levels 100 times the EU guidelines (which are banned in developed countries) be banned. Chemical companies are requesting to add them to the Thai Dangerous Substances Act so they can continue to be used, including on exported mangoes to developed countries which have banned their use. In 2014, Khon Kaen University concluded after a study, that Thailand should ban 155 types of pesticides, with 14 listed as urgent: Carbofuran , Methyl Bromide , Dichlorvos , Lambda-cyhalothrin , Methidathion-methyl , Omethoate , Zeta Cypermethrin , Endosulfan sulfate , Aldicarb , Azinphos-methyl , Chlorpyrifos-ethyl , Methoxychlor and Paraquat . As of 2019 [ update ] sugar consumption in Thailand is 28 teaspoons (131 grams) per person per day, four times the World Health Organization (WHO) recommendation. Excessive consumption of sugar leads to obesity , a public health issue. Thailand is number two in ASEAN , behind Malaysia , in the prevalence of obesity. In 2017, Thailand levied an excise tax on sugary drinks to pressure manufacturers to reduce the amount of sugar put in their products. A hike in the tax expected in October 2019. According to WHO in 2017, Thais consume an average of 10.8 grams of salt per day (over 4,000 milligrams of sodium), a rate more than double the recommended daily intake of salt. The main sources of salt are salt added during cooking, packaged food, and street food. Researchers claim that more than 22 million Thais suffer from salt-related ailments. Each year 20,000 of them die from related diseases, costing the country losses estimated at 98.9 billion baht a year. Thai health officials are calling for a tax on high-sodium food products to reduce demand. A study by the health ministry and Britain's Wellcome Trust released in September 2016 found that an average of two people die every hour from multi-drug resistant bacterial infections in Thailand. That death rate is much higher than in Europe. The improper use of antibiotics for humans and livestock has led to the proliferation of drug-resistant microorganisms, creating new strains of "superbugs" that can be defeated only by "last resort" medicines with toxic side effects. In Thailand, antibiotics are freely available in pharmacies without a prescription and even in convenience stores. Unregulated use of antibiotics on livestock is also problematic. Drug-resistant bacteria spreads through direct contact between humans and farm animals, ingested meat, or the environment. Antibiotics are often used on healthy animals to prevent, rather than treat, illnesses. In November 2016, Thailand announced its intent to halve antimicrobial-resistant (AMR) infections by 2021, joining the global battle against "superbugs". It aims to reduce the use of antibiotics in humans by 20 percent and in animals by 30 percent. The health minister said that about 88,000 patients develop AMR infections a year. The infections claim at least 38,000 lives in Thailand each year, causing 42 billion baht in economic damage. Without measures to address the issue, he said that the world would enter a "post-antibiotic era" with at least 10 million people around the world dying from AMR by 2050, 4.7 million of them in Asia. Thailand had 35 cases of teen pregnancies for every 1,000 girls from the ages of 15 to 19 in 2018. Health officials have set a target of 25 cases per 1,000 by 2026. In 2014, some 334 babies were born daily in Thailand to mothers aged between 15 and 19. The World Bank estimates that deaths in Thailand attributable to air pollution has risen from 31,000 in 1990 to roughly 49,000 in 2013. A hospital in Thailand is allegedly turning away a critically injured tourist, leaving them to die.

Wiki

Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Hand,_foot,_and_mouth_disease/html

Hand, foot, and mouth disease

Hand, foot, and mouth disease ( HFMD ) is a common infection caused by a group of enteroviruses . It typically begins with a fever and feeling generally unwell . This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet and mouth and occasionally buttocks and groin. Signs and symptoms normally appear 3–6 days after exposure to the virus . The rash generally resolves on its own in about a week. Fingernail and toenail loss may occur a few weeks later, but they will regrow with time. The viruses that cause HFMD are spread through close personal contact, through the air from coughing and the feces of an infected person. Contaminated objects can also spread the disease. Coxsackievirus A16 is the most common cause, and enterovirus 71 is the second-most common cause. Other strains of coxsackievirus and enterovirus can also be responsible. Some people may carry and pass on the virus despite having no symptoms of disease. Other animals are not involved. Diagnosis can often be made based on symptoms. Occasionally, a throat or stool sample may be tested for the virus. Most people with hand, foot, and mouth disease get better on their own in 7 to 10 days. Most cases require no specific treatment. No antiviral medication or vaccine is available, but development efforts are underway. For fever and for painful mouth sores, over-the-counter pain medications such as ibuprofen may be used, though aspirin should be avoided in children. The illness is usually not serious. Occasionally, intravenous fluids are given to children who are dehydrated. Very rarely, viral meningitis or encephalitis may complicate the disease. Because HFMD is normally mild, some jurisdictions allow children to continue to go to child care and schools as long as they have no fever or uncontrolled drooling with mouth sores, and as long as they feel well enough to participate in classroom activities. HFMD occurs in all areas of the world. It often occurs in small outbreaks in nursery schools or kindergartens. Large outbreaks have been occurring in Asia since 1997. It usually occurs during the spring, summer and fall months. Typically it occurs in children less than five years old but can occasionally occur in adults. HFMD should not be confused with foot-and-mouth disease (also known as hoof-and-mouth disease), which mostly affects livestock. Common constitutional signs and symptoms of the HFMD include fever, nausea, vomiting, feeling tired , generalized discomfort , loss of appetite , and irritability in infants and toddlers. Skin lesions frequently develop in the form of a rash of flat discolored spots and bumps which may be followed by vesicular sores with blisters on palms of the hands, soles of the feet, buttocks, and sometimes on the lips. The rash is rarely itchy for children, but can be extremely itchy for adults. Painful facial ulcers , blisters , or lesions may also develop in or around the nose or mouth . HFMD usually resolves on its own after 7–10 days. Most cases of the disease are relatively harmless, but complications including encephalitis, meningitis, and paralysis that mimics the neurological symptoms of polio can occur. The viruses that cause the disease are of the Picornaviridae family . Coxsackievirus A16 is the most common cause of HFMD. Enterovirus 71 (EV-71) is the second-most common cause. Many other strains of coxsackievirus and enterovirus can also be responsible. HFMD is highly contagious and is transmitted by nasopharyngeal secretions such as saliva or nasal mucus, by direct contact, or by fecal–oral transmission . It is possible to be infectious for days to weeks after the symptoms have resolved. Child care settings are the most common places for HFMD to be contracted because of toilet training, diaper changes, and the fact that children often put their hands into their mouths. HFMD is contracted through nose and throat secretions such as saliva, sputum, nasal mucus and as well as fluid in blisters, and stool. HFMD is highly contagious and is transmitted by nasopharyngeal secretions such as saliva or nasal mucus, by direct contact, or by fecal–oral transmission . It is possible to be infectious for days to weeks after the symptoms have resolved. Child care settings are the most common places for HFMD to be contracted because of toilet training, diaper changes, and the fact that children often put their hands into their mouths. HFMD is contracted through nose and throat secretions such as saliva, sputum, nasal mucus and as well as fluid in blisters, and stool. A diagnosis usually can be made by the presenting signs and symptoms alone. If the diagnosis is unclear, a throat swab or stool specimen may be taken to identify the virus by culture. The common incubation period (the time between infection and onset of symptoms) ranges from three to six days. Early detection of HFMD is important in preventing an outbreak in the pediatric population. Preventive measures include avoiding direct contact with infected individuals (including keeping infected children home from school), proper cleaning of shared utensils, disinfecting contaminated surfaces , and proper hand hygiene. These measures have been shown to be effective in decreasing the transmission of the viruses responsible for HFMD. Protective habits include hand washing and disinfecting surfaces in play areas. Breast-feeding has also shown to decrease rates of severe HFMD, though does not reduce the risk for the infection of the disease. A vaccine known as the EV71 vaccine is available to prevent HFMD in China as of December 2015 [ update ] . No vaccine is currently available in the United States. A vaccine known as the EV71 vaccine is available to prevent HFMD in China as of December 2015 [ update ] . No vaccine is currently available in the United States. Medications are usually not needed as hand, foot, and mouth disease is a viral disease that typically resolves on its own. Currently, there is no specific curative treatment for hand, foot and mouth disease. Disease management typically focuses on achieving symptomatic relief. Pain from the sores may be eased with the use of analgesic medications . Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, but may occasionally run a longer course. Fever reducers can help decrease body temperature. [ citation needed ] A minority of individuals with hand, foot and mouth disease may require hospital admission due to complications such as inflammation of the brain , inflammation of the meninges , or acute flaccid paralysis . Non-neurologic complications such as inflammation of the heart , fluid in the lungs , or bleeding into the lungs may also occur. Complications from the viral infections that cause HFMD are rare, but require immediate medical treatment if present. HFMD infections caused by Enterovirus 71 tend to be more severe and are more likely to have neurologic or cardiac complications including death than infections caused by Coxsackievirus A16. Viral or aseptic meningitis can occur with HFMD in rare cases and is characterized by fever, headache , stiff neck , or back pain. The condition is usually mild and clears without treatment; however, hospitalization for a short time may be needed. Other serious complications of HFMD include encephalitis (inflammation of the brain), or flaccid paralysis in rare circumstances. Fingernail and toenail loss have been reported in children 4–8 weeks after having HFMD. The relationship between HFMD and the reported nail loss is unclear; however, it is temporary and nail growth resumes without treatment. Minor complications due to symptoms can occur such as dehydration, due to mouth sores causing discomfort with intake of foods and fluid. Hand, foot and mouth disease most commonly occurs in children under the age of 10 and more often under the age of 5, but it can also affect adults with varying symptoms. It tends to occur in outbreaks during the spring, summer, and autumn seasons. This is believed to be due to heat and humidity improving spread. HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered. Poor hygiene is a risk factor for HFMD. [ better source needed ] An outbreak of an illness referred to as tomato fever or tomato flu was identified in the Kollam district on May 6, 2022. The illness is endemic to Kerala , India and gets its name because of the red and round blisters it causes, which look like tomatoes . The disease may be a new variant of the viral HFMD or an effect of chikungunya or dengue fever . Flu may be a misnomer. The condition mainly affects children under the age of five. An article in The Lancet states that the appearance of the blisters is similar to that seen in monkey pox , and the illness is not thought to be related to SARS-CoV-2 . Symptoms, treatment and prevention are similar to HFMD. An outbreak of an illness referred to as tomato fever or tomato flu was identified in the Kollam district on May 6, 2022. The illness is endemic to Kerala , India and gets its name because of the red and round blisters it causes, which look like tomatoes . The disease may be a new variant of the viral HFMD or an effect of chikungunya or dengue fever . Flu may be a misnomer. The condition mainly affects children under the age of five. An article in The Lancet states that the appearance of the blisters is similar to that seen in monkey pox , and the illness is not thought to be related to SARS-CoV-2 . Symptoms, treatment and prevention are similar to HFMD. HFMD cases were first described clinically in Canada and New Zealand in 1957. The disease was termed "Hand Foot and Mouth Disease", by Thomas Henry Flewett , after a similar outbreak in 1960. Novel antiviral agents to prevent and treat infection with the viruses responsible for HFMD are currently under development. Preliminary studies have shown inhibitors of the EV-71 viral capsid to have potent antiviral activity.

Wiki

Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Health_in_Vietnam/html

Health in Vietnam

Health in Vietnam encompasses general and specific concerns to the region, its history, and various socioeconomic status, such as dealing with malnutrition , effects of Agent Orange as well as psychological issues from the Vietnam War, tropical diseases , and other issues such as underdeveloped healthcare systems or inadequate ratio of healthcare or social workers to patients. Life expectancy has risen by two years for males and females in Vietnam between 2000 and 2012. This is half of the average rise in life expectancy for other parts of the world during the same time period. Malnutrition is still not as common as it was in the provinces and the government spending on health care corresponded to just 0.9 percent of gross domestic product (GDP). Government subsidies covered only about 20 percent of health care expenses, with the remaining 80 percent coming out of individuals' own pockets. Although cases of malnutrition has decreased overall, it still remains a concern, particularly among the ethnic minority. In 2012, almost 22% of deaths could be attributed to strokes. This leading cause of death was followed by heart disease with 7% of deaths, and Chronic obstructive pulmonary disease with 4.9% of deaths. The two largest risk factors for adults are tobacco use and raised blood pressure. The Human Rights Measurement Initiative finds that Vietnam is doing 91.1% of what should be possible at its level of income, for the right to health. Human rights expects have identified that people groups such as people who are homeless, people with low social or economic status, and street children/homeless youth are particularly at risk of having their right to health violated. Additionally, as Vietnam is also within the tropical zone , tropical diseases have also been a major concern past and present, such as from malaria , dengue fever , etc, where branches of medicine such as tropical medicine or infectious disease was required to help treat patients. Neglected tropical diseases have also been a concern as well. Beginning in the late 1980s, the quality of health care began to decline as a result of budgetary constraints, a shift of responsibility to the provinces, and the introduction of charges. Inadequate funding had led to delays in planned upgrades to water supply and sewage systems. Consequently, at that time almost half the population had no access to clean water, a deficiency that promotes such infectious diseases as malaria , dengue fever , typhoid , and cholera . Additionally, inadequate funding has contributed to a shortage of nurses , midwives , and hospital beds. In 2000, Vietnam had only 250,000 hospital beds, or 14.8 beds per 10,000 people, a very low ratio among Asian nations, according to the World Bank . Government expenditure on health has declined and the health system is largely financed through user-fees, which has direct implications for the rural poor, deterring them from accessing health care. As of 2017, Vietnam has a population of 96.1 million people.  Drug-resistant tuberculosis, pathogenic influenza, HIV/AIDS, and smoking are continuous problems that impact the quality of health in Vietnam. Health risk factors such as smoking and the lack of funding for healthcare attribute to the epigenetic health of the population In 2008, the Government of Vietnam adopted a USAID methadone program that served 50,000 clients. Since 2014, Vietnam is transitioning its country to a universal healthcare system since 70% of its citizens have to pay out-of-pocket payments.  There is also an inadequate ratio of doctors to patients. There are 8 doctors for every 10,000 patients. Preventive treatments such as the HPV vaccination are prohibitively expensive, and thus not effective in battling chronic diseases. Several health defects have been correlated with the use of the chemical dioxin, also known as Agent Orange , during the Resistance War Against America (Vietnam War). Dioxin was used by U.S military forces in the war as a defoliant and is now considered a carcinogen. Major differences in dioxin levels have been measured in the blood and breast milk of those living in areas that had been sprayed with Agent Orange when compared to other areas of Vietnam. This carcinogen is associated with tumors, immune deficiency, reproductive and developmental disorders, nervous system defects, and a variety of other birth defects including Spina bifida . Agent Orange continues to be a risk factor in Vietnam today because of its continued presence in soil, wildlife, and food. In addition, the effects continue to be seen in generations born to those exposed to Agent orange. Beginning in 2007, Vietnam Veterans are now compensated for detrimental health effects due to Exposure. Psychological warfare was practiced in Vietnam in the form of Operation Wandering Soul from U.S. forces against North Vietnamese and Viet Cong soldiers, which continues to be a risk factor in the form of intergenerational trauma for descendants of war. Social stigma around the issues of psychological ailments make it difficult to access required help, including issues revolving around anxiety, stress, alcoholism, depression, etc., which may be compounded by the effects of natural disasters or chronic poverty. Younger generations psychological issues may stem from increased access to the online world, causing overthinking, anxiety, insomnia. Vietnam has made progress in combating malaria , for which the mortality rate declined sharply, to about 5 percent of the rate in the early 1990s, after the country introduced antimalarial drugs and treatment. Vietnam has the 13th highest tuberculosis burden in the world. There are an estimated 89 positive cases for every 100,000 individuals. Approximately 55 tuberculosis-related deaths occur in Vietnam each day. Vietnam's healthcare system consists of four levels: the central level headed by the Ministry of Health (MOH), provincial health services, district health services, and commune health centers. The Viet Nam National Tuberculosis Control Program (NTP) worked with a control strategy recommended by the World Health Organization to lower Tuberculosis (TB) rates, and successfully exceeded target goals in 1997. However, although there was a decrease in TB incidence among women and persons over 35, the rates of Tuberculosis among young men in Vietnam significantly increased during this time, causing a stabilization of the overall rate. In 1989, the Ministry of Health in Vietnam addressed the tuberculosis burden by establishing the National Institute of Tuberculosis and Lung Diseases and implementing the DOTS strategy as a national priority. The National Institute of Tuberculosis supports developing TB- related strategies and managing guidelines for the different levels of healthcare in Vietnam. At the provincial level, there are health centers that diagnose and treat patients. The district health services detect tuberculosis and provide stipends to treat patients. District health services work on detecting TB, providing stipends for treatment, implementing DOTS strategy, and supervising TB programs at the commune level. The commune level provides treatment and vaccination for children. All four levels work together not only to provide ongoing treatment and examination, but also to establish trust in the government health services implemented through community relationships and a close network of doctors, faculty, and patients. With an intensified vaccination program, better hygiene , and foreign assistance, Vietnam hopes to sharply reduce the number of TB cases and annual number of new infections. In 2002, Vietnam also implemented a communication plan to provide accurate information in order to respond to any barriers or misconceptions about tuberculosis treatment. The government worked with the World Health Organization, Center for Disease and Control Prevention, and local medical non-profits such as Friends for International Tuberculosis Relief to provide information about the causes of TB, sources of infection, how it is transmitted, symptoms, treatment, and prevention. A 2012 study of tuberculosis control in Vietnam identified a shortcoming in the current strategy of attending solely to symptomatic patients, as it has not been marked by any significant decrease in TB rates. Instead, the authors of the research advocated for a strategy of contact tracing that would focus on household members of Tuberculosis patients in Hanoi. The study found a high incidence of TB rates in the household contacts tested and concluded that household contact investigation would be a feasible disease management strategy in Vietnam. In Vietnam, 40,000 people die due to tobacco-related diseases. Smoking continues to be seen as a risk-taking behaviour and is associated with a male predilection, especially with traditional tobacco pipes such as the use of Thuốc Là o ( Nicotiana rustica ) . Thirty percent of heart disease deaths are caused by smoking cigarettes. Lung cancer is the third leading cause of death in Vietnam and tobacco risk factors that cause death and disability. Vietnam has reduced the supply of tobacco products through the ratification of the World Health Organization Framework Convention on Tobacco Control. Examples of steps towards tobacco prevention is banning the advertisement of tobacco, requiring health warnings on tobacco packaging, and increasing tobacco taxes. In 2013, Vietnam launched the National Strategy on Tobacco Control which prohibits smoking in indoor public and workspaces in an effort to significantly reduce smoking rates across many demographic groups. The goal is to reduce smoking rates among youth (15–24 years old) from 26% (2011) to 18% (2020), and adult males from 47.4% (2011) to 39% (2020). In 2018, the World Health Organization surveyed that one in two male adults (45.3%) were smoking tobacco. Vietnam's government is incorporating a plan that will utilize the taxes from tobacco and alcohol to cover the cost of universal healthcare and make sure its population is ensured. As of January 2005, Vietnam had diagnosed 101,291 human immunodeficiency virus (HIV) cases, of which 16,528 developed acquired immune deficiency syndrome (AIDS) and 9,554 died. But the actual number of HIV-positive individuals is estimated to be much higher. An average of 40–50 new infections are reported every day in Vietnam. Vietnam hopes to contain the HIV infection rate at the current official rate of 0.35 percent, which is about average worldwide, by limiting the disease as much as possible to sex workers and intravenous drug users. However, if the current trend continues, the number of infected persons could reach 1 million by 2010. One of the impediments to containing HIV/AIDS is that the victims face discrimination and stigmatization that are more severe than almost anywhere else in the world, according to a United Nations official. However non-governmental organizations, like the Supporting Community Development Initiatives (SCDI) Archived 2020-10-26 at the Wayback Machine for example, are devoted to improve the situation and quality of life of HIV/AIDS affected people. In June 2004, the Bush Administration announced that Vietnam would be one of 15 nations to receive funding as part of a US$15 billion global AIDS plan. People who inject drugs, commercial sex workers and potential clients, and men who have sex with other men are the most at-risk and susceptible to HIV infections in Vietnam. Since the mid-1990s, the United States Agency for International Development (USAID) collaborates with the Government of Vietnam at the national, provincial, and district levels through delivering preventive care and treatment services, advocating to strengthen the health system, and providing sustainable long-term plans. USAID provides a community-based approach by treating patients with anti-retroviral treatments. USAID helps provide funding to achieve Vietnam's "90-90-90" goals which is to ensure 90% of people that have HIV are aware they have HIV, 90% of people diagnosed with HIV will receive anti-retroviral therapy, and 90% of people receiving treatment will be able to see the virus suppressed. Most of the testing occurs in Hanoi, Quang Ninh, Dong Nai, Tay Ninh, Tien Giang, and Ho Chi Minh City. Vietnam experienced an epidemic of dengue fever when 181,054 infection cases and 30 deaths were reported in almost localities in Hanoi and Ho Chi Minh City. As many as 14,079 dengue fever cases with three deaths have been reported in the first four months of 2018. In the first 8 months of 2019, 130,000 cases of dengue have been reported, and 16 deaths. The 2019 outbreak is concentrated in Ho Chi Minh City, Da Nang, Khanh Hoa, Ba Ria-Vung Tai and Binh Duong provinces. In 2023, Hanoi experienced up to 4 times the cases of dengue fever then in the same period of 2022. Vietnam is located in the tropical and temperate zone and prone to zoonotic diseases. In recent years, the country has been affected by SARS, avian influenza A(H5N1), influenza A (H5N6), and COVID-19, although the spillovers of viruses from animals to humans is attributed to the agriculture-centered economy and animal consumption. In the light of COVID-19 pandemic , Vietnam was praised by the international community to have successfully contained the spread of the disease with no deaths yet as being reported by mid-April 2020. The Global Health Security Agenda and USAID address the disease surveillance and outbreak response in Vietnam through operational platforms and creating disease portfolios with animal origins. On February 1, 2020, the Vietnamese government suspended all flights to and from China in order to combat COVID-19, making it one of the first countries to enforce travel restrictions. The country then implemented a 21-day quarantine in Vinh Phuc province. Vietnam is a single-party state with a centralized government that is able to utilize its military resources in order to implement surveillance and contact tracing. Vietnam also has the lowest COVID-19 mortality rates (As of 2021 and 2022). Although over the years illicit narcotics trade has decreased via application of stringent laws, the opioid epidemic such as with heroin and cocaine still remains a concern, especially with Vietnam's geographical proximity to the Golden Triangle in Southeast Asia that stretches across China, Myanmar, Thailand, Laos. Illicit drugs such as illegal meth use also remains a concern. Additionally, whilst views on the health effects on cannabis may vary, cannabis is classified as an illegal narcotic in Vietnam and concerns remain about it being associated with illegal worldwide trafficking. Several health defects have been correlated with the use of the chemical dioxin, also known as Agent Orange , during the Resistance War Against America (Vietnam War). Dioxin was used by U.S military forces in the war as a defoliant and is now considered a carcinogen. Major differences in dioxin levels have been measured in the blood and breast milk of those living in areas that had been sprayed with Agent Orange when compared to other areas of Vietnam. This carcinogen is associated with tumors, immune deficiency, reproductive and developmental disorders, nervous system defects, and a variety of other birth defects including Spina bifida . Agent Orange continues to be a risk factor in Vietnam today because of its continued presence in soil, wildlife, and food. In addition, the effects continue to be seen in generations born to those exposed to Agent orange. Beginning in 2007, Vietnam Veterans are now compensated for detrimental health effects due to Exposure. Psychological warfare was practiced in Vietnam in the form of Operation Wandering Soul from U.S. forces against North Vietnamese and Viet Cong soldiers, which continues to be a risk factor in the form of intergenerational trauma for descendants of war. Social stigma around the issues of psychological ailments make it difficult to access required help, including issues revolving around anxiety, stress, alcoholism, depression, etc., which may be compounded by the effects of natural disasters or chronic poverty. Younger generations psychological issues may stem from increased access to the online world, causing overthinking, anxiety, insomnia. Vietnam has made progress in combating malaria , for which the mortality rate declined sharply, to about 5 percent of the rate in the early 1990s, after the country introduced antimalarial drugs and treatment.Vietnam has the 13th highest tuberculosis burden in the world. There are an estimated 89 positive cases for every 100,000 individuals. Approximately 55 tuberculosis-related deaths occur in Vietnam each day. Vietnam's healthcare system consists of four levels: the central level headed by the Ministry of Health (MOH), provincial health services, district health services, and commune health centers. The Viet Nam National Tuberculosis Control Program (NTP) worked with a control strategy recommended by the World Health Organization to lower Tuberculosis (TB) rates, and successfully exceeded target goals in 1997. However, although there was a decrease in TB incidence among women and persons over 35, the rates of Tuberculosis among young men in Vietnam significantly increased during this time, causing a stabilization of the overall rate. In 1989, the Ministry of Health in Vietnam addressed the tuberculosis burden by establishing the National Institute of Tuberculosis and Lung Diseases and implementing the DOTS strategy as a national priority. The National Institute of Tuberculosis supports developing TB- related strategies and managing guidelines for the different levels of healthcare in Vietnam. At the provincial level, there are health centers that diagnose and treat patients. The district health services detect tuberculosis and provide stipends to treat patients. District health services work on detecting TB, providing stipends for treatment, implementing DOTS strategy, and supervising TB programs at the commune level. The commune level provides treatment and vaccination for children. All four levels work together not only to provide ongoing treatment and examination, but also to establish trust in the government health services implemented through community relationships and a close network of doctors, faculty, and patients. With an intensified vaccination program, better hygiene , and foreign assistance, Vietnam hopes to sharply reduce the number of TB cases and annual number of new infections. In 2002, Vietnam also implemented a communication plan to provide accurate information in order to respond to any barriers or misconceptions about tuberculosis treatment. The government worked with the World Health Organization, Center for Disease and Control Prevention, and local medical non-profits such as Friends for International Tuberculosis Relief to provide information about the causes of TB, sources of infection, how it is transmitted, symptoms, treatment, and prevention. A 2012 study of tuberculosis control in Vietnam identified a shortcoming in the current strategy of attending solely to symptomatic patients, as it has not been marked by any significant decrease in TB rates. Instead, the authors of the research advocated for a strategy of contact tracing that would focus on household members of Tuberculosis patients in Hanoi. The study found a high incidence of TB rates in the household contacts tested and concluded that household contact investigation would be a feasible disease management strategy in Vietnam. In Vietnam, 40,000 people die due to tobacco-related diseases. Smoking continues to be seen as a risk-taking behaviour and is associated with a male predilection, especially with traditional tobacco pipes such as the use of Thuốc Là o ( Nicotiana rustica ) . Thirty percent of heart disease deaths are caused by smoking cigarettes. Lung cancer is the third leading cause of death in Vietnam and tobacco risk factors that cause death and disability. Vietnam has reduced the supply of tobacco products through the ratification of the World Health Organization Framework Convention on Tobacco Control. Examples of steps towards tobacco prevention is banning the advertisement of tobacco, requiring health warnings on tobacco packaging, and increasing tobacco taxes. In 2013, Vietnam launched the National Strategy on Tobacco Control which prohibits smoking in indoor public and workspaces in an effort to significantly reduce smoking rates across many demographic groups. The goal is to reduce smoking rates among youth (15–24 years old) from 26% (2011) to 18% (2020), and adult males from 47.4% (2011) to 39% (2020). In 2018, the World Health Organization surveyed that one in two male adults (45.3%) were smoking tobacco. Vietnam's government is incorporating a plan that will utilize the taxes from tobacco and alcohol to cover the cost of universal healthcare and make sure its population is ensured. As of January 2005, Vietnam had diagnosed 101,291 human immunodeficiency virus (HIV) cases, of which 16,528 developed acquired immune deficiency syndrome (AIDS) and 9,554 died. But the actual number of HIV-positive individuals is estimated to be much higher. An average of 40–50 new infections are reported every day in Vietnam. Vietnam hopes to contain the HIV infection rate at the current official rate of 0.35 percent, which is about average worldwide, by limiting the disease as much as possible to sex workers and intravenous drug users. However, if the current trend continues, the number of infected persons could reach 1 million by 2010. One of the impediments to containing HIV/AIDS is that the victims face discrimination and stigmatization that are more severe than almost anywhere else in the world, according to a United Nations official. However non-governmental organizations, like the Supporting Community Development Initiatives (SCDI) Archived 2020-10-26 at the Wayback Machine for example, are devoted to improve the situation and quality of life of HIV/AIDS affected people. In June 2004, the Bush Administration announced that Vietnam would be one of 15 nations to receive funding as part of a US$15 billion global AIDS plan. People who inject drugs, commercial sex workers and potential clients, and men who have sex with other men are the most at-risk and susceptible to HIV infections in Vietnam. Since the mid-1990s, the United States Agency for International Development (USAID) collaborates with the Government of Vietnam at the national, provincial, and district levels through delivering preventive care and treatment services, advocating to strengthen the health system, and providing sustainable long-term plans. USAID provides a community-based approach by treating patients with anti-retroviral treatments. USAID helps provide funding to achieve Vietnam's "90-90-90" goals which is to ensure 90% of people that have HIV are aware they have HIV, 90% of people diagnosed with HIV will receive anti-retroviral therapy, and 90% of people receiving treatment will be able to see the virus suppressed. Most of the testing occurs in Hanoi, Quang Ninh, Dong Nai, Tay Ninh, Tien Giang, and Ho Chi Minh City.Vietnam experienced an epidemic of dengue fever when 181,054 infection cases and 30 deaths were reported in almost localities in Hanoi and Ho Chi Minh City. As many as 14,079 dengue fever cases with three deaths have been reported in the first four months of 2018. In the first 8 months of 2019, 130,000 cases of dengue have been reported, and 16 deaths. The 2019 outbreak is concentrated in Ho Chi Minh City, Da Nang, Khanh Hoa, Ba Ria-Vung Tai and Binh Duong provinces. In 2023, Hanoi experienced up to 4 times the cases of dengue fever then in the same period of 2022. Vietnam is located in the tropical and temperate zone and prone to zoonotic diseases. In recent years, the country has been affected by SARS, avian influenza A(H5N1), influenza A (H5N6), and COVID-19, although the spillovers of viruses from animals to humans is attributed to the agriculture-centered economy and animal consumption. In the light of COVID-19 pandemic , Vietnam was praised by the international community to have successfully contained the spread of the disease with no deaths yet as being reported by mid-April 2020. The Global Health Security Agenda and USAID address the disease surveillance and outbreak response in Vietnam through operational platforms and creating disease portfolios with animal origins. On February 1, 2020, the Vietnamese government suspended all flights to and from China in order to combat COVID-19, making it one of the first countries to enforce travel restrictions. The country then implemented a 21-day quarantine in Vinh Phuc province. Vietnam is a single-party state with a centralized government that is able to utilize its military resources in order to implement surveillance and contact tracing. Vietnam also has the lowest COVID-19 mortality rates (As of 2021 and 2022).Although over the years illicit narcotics trade has decreased via application of stringent laws, the opioid epidemic such as with heroin and cocaine still remains a concern, especially with Vietnam's geographical proximity to the Golden Triangle in Southeast Asia that stretches across China, Myanmar, Thailand, Laos. Illicit drugs such as illegal meth use also remains a concern. Additionally, whilst views on the health effects on cannabis may vary, cannabis is classified as an illegal narcotic in Vietnam and concerns remain about it being associated with illegal worldwide trafficking.

Wiki

Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/List_of_diseases_spread_by_arthropods/html

List of diseases spread by arthropods

Arthropods are common vectors of disease . A vector is an organism which spreads disease-causing parasites or pathogens from one host to another. Invertebrates spread bacterial, viral and protozoan pathogens by two main mechanisms. Either via their bite, as in the case of malaria spread by mosquitoes, or via their faeces, as in the case of Chagas' Disease spread by Triatoma bugs or epidemic typhus spread by human body lice. Many invertebrates are responsible for transmitting diseases. Mosquitoes are perhaps the best known invertebrate vector and transmit a wide range of tropical diseases including malaria, dengue fever and yellow fever. Another large group of vectors are flies. Sandfly species transmit the disease leishmaniasis, by acting as vectors for protozoan Leishmania species, and tsetse flies transmit protozoan trypansomes ( Trypanosoma brucei gambiense and Trypansoma brucei rhodesiense ) which cause African Trypanosomiasis (sleeping sickness). Ticks and lice form another large group of invertebrate vectors. The bacterium Borrelia burgdorferi , which causes Lyme Disease, is transmitted by ticks and members of the bacterial genus Rickettsia are transmitted by lice. For example, the human body louse transmits the bacterium Rickettsia prowazekii which causes epidemic typhus. Although invertebrate-transmitted diseases pose a particular threat on the continents of Africa, Asia and South America, there is one way of controlling invertebrate-borne diseases, which is by controlling the invertebrate vector. For example, one way of controlling malaria is to control the mosquito vector through the use of mosquito nets, which prevent mosquitoes from coming into contact with humans.

Wiki

Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Euphorbia_hirta/html

Euphorbia hirta

Chamaesyce gemella (Lag.) Small Chamaesyce hirta (L.) Millsp. Chamaesyce karwinskyi (Boiss.) Millsp. Chamaesyce rosei Millsp. Desmonema hirta (L.) Raf. Euphorbia bancana Miq. Euphorbia capitata Lam. Euphorbia chrysochaeta W.Fitzg. Euphorbia gemella Lag. Euphorbia globulifera Kunth Euphorbia karwinskyi Boiss. Euphorbia nodiflora Steud. Euphorbia obliterata Jacq. Euphorbia pilulifera (L.) Thell. Euphorbia verticillata Vell. Euphorbia hirta (sometimes called asthma-plant ) is a pantropical weed, originating from the tropical regions of the Americas. It is a hairy herb that grows in open grasslands , roadsides and pathways. It is widely used in traditional herbal medicine across many cultures, particularly for asthma , skin ailments, and hypertension . It is also consumed in herbal tea form as folk medicine for fevers in the Philippines (where it is known as tawa-tawa ), particularly for dengue fever and malaria . This erect or prostrate annual herb can grow up to 60 cm (24 in) long with a solid stem that is furnished with many yellow to reddish coarse hairs, and produces an abundant white latex. There are stipules present. The leaves have an oblique base and are simple , elliptical to slightly rhombic, hairy (on both upper and lower surfaces but particularly on the veins on the lower leaf surface), with a finely dentate margin, the veins upperside being deep-set and conspicuous on the underside, and the leaf surface somewhat leathery. Leaves occur in opposite pairs on the stem. The flowers are unisexual and found in axillary cymes at each leaf node, held as dense balls of flowers and fruit capsules usually close to the stem, the flower glands with tiny white/pinkish petal-like appendages. The fruit is a capsule with three valves (creating 3 sides), uniformly appressed hairy, containing tiny (0.7–0.9 mm), oblong, four-sided orange to pink or red seeds. It has a white or brown taproot . FNA

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Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Project_Artichoke/html

Project Artichoke

Project Artichoke (also referred to as Operation Artichoke ) was a project developed and enacted by the United States Central Intelligence Agency (CIA) for the purpose of researching methods of interrogation . Initially known as Project Bluebird, Project Artichoke officially arose on August 20, 1951, and was operated by the CIA's Office of Scientific Intelligence . The primary goal of Project Artichoke was to determine whether a person could be involuntarily made to perform an act of attempted assassination. The project also studied the effects of hypnosis , forced addiction to (and subsequent withdrawal from) morphine , and other chemicals, including LSD , to produce amnesia and other vulnerable states in subjects. Project Artichoke was succeeded by Project MKUltra , which began in 1953. Project Artichoke was a mind control program that gathered information together with the intelligence divisions of the Army , Navy , Air Force and FBI . In addition, the scope of the project was outlined in a memo dated January 1952 that asked, "Can we get control of an individual to the point where he will do our bidding against his will and even against fundamental laws of nature, such as self-preservation ?" Project Artichoke was the Central Intelligence Agency's secret code name for carrying out in-house and overseas experiments using LSD, hypnosis and total isolation as forms of physiological harassment for special interrogations on human subjects. At first agents used cocaine , marijuana , heroin , peyote and mescaline , but they increasingly saw LSD as the most promising drug. The subjects who left this project were fogged with amnesia, resulting in faulty and vague memories of the experience. In 1952, LSD was increasingly given to unknowing CIA agents to determine the drug's effects on unsuspecting people. One record states that an agent was kept on LSD for 77 days. Artichoke researched the potential of dengue fever and other diseases. A declassified Artichoke memo read: "Not all viruses have to be lethal… the objective includes those that act as short-term and long-term incapacitating agents ." The CIA disputed which department would take over the operation. Finally, it was decided that an agent from the CIA research staff, former U.S. Army brigadier general Paul F. Gaynor , would oversee it. The CIA sought to establish control over what it perceived as the "weaker" and "less intelligent" segments of society, or for potential agents, defectors, refugees, prisoners of war and others. A CIA report states that if hypnosis succeeded, assassins could be created to assassinate "a prominent [redacted] politician or if necessary, [an] American official." The overseas operations took place in locations throughout Europe, Japan, Southeast Asia and the Philippines. Teams were assembled to manage these operations and they were told to "conduct at the overseas bases operational experiments utilizing aliens as subjects."

Wiki

Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/2023_dengue_outbreak_in_Jamaica/html

2023 dengue outbreak in Jamaica

In the 2023 dengue outbreak in Jamaica , a significant rise in the number of dengue fever cases was reported in Jamaica. In September 2023 The Ministry of Health and Wellness , Jamaica declared it as an outbreak. The Guardian reported that the outbreak was influenced by the heat as summer of 2023 was recorded as the highest temperature in 100,000 years. The outbreak peaked at around September with over 500 cases across the island. Andrew Holness , the Prime Minister of Jamaica announced a programme of around $200 million to curb the spread of virus at schools, households and communities. It was declared as outbreak by Health ministry in September citing that virus surpassed the epidemic threshold for July and August and was heading towards same for September. The number of confirmed cases as reported by health ministry were 3,147 with nine deaths, as of November 2023.

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Dengue fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Cody_Garbrandt/html

Cody Garbrandt

Cody Garbrandt (born July 7, 1991) is an American professional mixed martial artist . He currently competes in the Bantamweight division of the Ultimate Fighting Championship (UFC), where he is a former UFC Bantamweight Champion .Garbrandt was born in Uhrichsville, Ohio , on July 7, 1991, and raised there mostly by his mother Jessica. Cody is ten months younger than his brother Zach, who he grew up constantly fighting. Garbrandt has claimed in several interviews that his drug addict father was never in the picture, spending most of his life in prison. Garbrandt's parents separated after a domestic abuse incident when Cody was one year old. Eventually, Cody was adopted by his mother's now ex-husband at the age of 10. At the ages of four and five, Cody and Zach, respectively, had already been dabbling into boxing with their uncle Robert Meese who was an Olympic alternate in the sport. However, their mother was concerned about the boys becoming punch-drunk thus forbidding boxing and directing them towards wrestling. At Claymont High School , Garbrandt competed in wrestling and football , winning a state championship as a freshman in 2007, by defeating Zach Neibert, 4–2, and was a runner-up in 2008. In football, Garbrandt won All–State honors as a linebacker during his junior season. After failing to claim the second state championship, Garbrandt became the NHSCA Sophomore National runner–up and subsequently stopped wrestling and convinced his mother to let him start training boxing seriously. Over about six years, Garbrandt compiled a 32–0 record as an amateur boxer. Despite not competing in wrestling during his final two years of high school, Garbrandt competed at the national tournament as a senior and placed fifth, claiming All–American honors and receiving interest from several NCAA Division I schools, such as Penn State and Rutgers . He was then recruited by the Michigan State Spartans , but due to academic reasons, he ended up at Newberry College , a Division II school, before dropping out for academic and personal reasons, explaining; "I guess my heart wasn't into (wrestling) anymore. I was doing boxing, and that's what I wanted to do." After dropping out, Garbrandt sold marijuana , worked as a bouncer , and eventually completed coal miner training in order to work in the field familiar to his family. However, he decided to commit completely to his amateur MMA career, which was afoot after helping several MMA camps with wrestling. Garbrandt ended up taking his first amateur bout in 2009 and compiled an amateur MMA record of 6–2 before making his professional debut in 2012. Prior to his finish of James Porter in May 2014, he moved from Ohio to Sacramento, California to train at Team Alpha Male in an attempt to further his career. After a first-round finish of Charles Sanford in October 2014, he signed with the Ultimate Fighting Championship in the fall of 2014. Garbrandt made his promotional debut against Marcus Brimage on January 3, 2015, at UFC 182 . He won the fight via TKO in the third round. Garbrandt faced Henry Briones on July 11, 2015, at UFC 189 . He won the fight by unanimous decision, going the distance for the first time in his professional career. Garbrandt was expected to face long-time veteran John Lineker on February 21, 2016, at UFC Fight Night 83 . However, Lineker pulled out of the fight during the week, after contracting Dengue Fever , and he was replaced by Augusto Mendes . Garbrandt won the fight via TKO in the first round. Garbrandt faced fellow undefeated prospect Thomas Almeida on May 29, 2016, headlining UFC Fight Night 88 . He won the fight by knockout in the first round and also earned a Performance of the Night bonus. Garbrandt next faced Takeya Mizugaki on August 20, 2016, at UFC 202 . He won the fight via TKO in the opening minute of the first round. Garbrandt faced Dominick Cruz for the UFC Bantamweight Championship on December 30, 2016, at UFC 207 . Garbrandt won the fight by unanimous decision after knocking Cruz down twice and nearly finishing him in the fourth round. In January 2017, the UFC announced that Garbrandt would be one of the coaches on The Ultimate Fighter 25 opposite former UFC Bantamweight champion (and former Team Alpha Male teammate) T.J. Dillashaw , with the two expected to face each other on July 8, 2017, at UFC 213 . However, the bout was scrapped on May 23, after Garbrandt sustained a back injury. The bout was rescheduled and eventually took place on November 4, 2017, at UFC 217 . Despite knocking him down at the end of the first, Dillashaw rallied in the second round and defeated Garbrandt via technical knockout, marking his first loss in his professional career and losing the title. Garbrandt then faced T.J. Dillashaw in a rematch for the UFC Bantamweight Championship on August 4, 2018, at UFC 227 . He lost the fight via knockout in the first round. Garbrandt made his return against Pedro Munhoz on March 2, 2019 at UFC 235 . In a frenetic and short bout, Garbrandt was knocked out in the first round. Both participants received the Fight of the Night bonus award. Garbrandt was scheduled to face Raphael Assunção as the co-main event on March 28, 2020 at UFC on ESPN 8 . However, Garbrandt pulled out of the fight on March 12 due to kidney problems. Instead the pair fought each other on June 6, 2020 at UFC 250 . Garbrandt got back into the winning column in big fashion, winning the bout via one-punch knockout in the second round. This win earned him the Performance of the Night . On August 7, 2020, it was announced that Garbrandt intended to move down a division (from bantamweight to flyweight ) and was scheduled to face Deiveson Figueiredo for the UFC flyweight championship on November 21, 2020, at UFC 255 . However, it was reported on October 2, 2020 that Garbrandt had to pull out of the contest. Garbrandt later revealed he tested positive for COVID-19 on August 29, 2020, as well as suffering from thrombosis , brain fog , and pneumonia . Following his illness, Garbrandt returned at bantamweight and faced Rob Font on May 22, 2021 in the main event at UFC Fight Night: Font vs. Garbrandt . He lost the bout via unanimous decision. Garbrandt made his Flyweight debut against Kai Kara-France on December 11, 2021 at UFC 269 . He lost the fight via TKO in the first round. Garbrandt was scheduled to face Rani Yahya on July 9, 2022, at UFC on ESPN 39 . However, Yahya withdrew in mid June due to a neck injury. The bout with Yahya was rescheduled and was expected to take place on October 1, 2022 at UFC Fight Night 211 . In turn, Yahya withdrew again in mid-September for unknown reasons. While seeking a new opponent, Garbrandt also suffered a training injury, pulling him from the card. Garbrandt was scheduled to face Julio Arce on March 4, 2023 at UFC 285 . However, Arce withdrew in late January due to a knee injury. and he was replaced by Trevin Jones . He won the fight via unanimous decision. Garbrandt was scheduled to face Mario Bautista on August 19, 2023 at UFC 292 . However, Garbrandt withdrew a week before the event due to injury, and was replaced by Da'Mon Blackshear. Garbrandt faced Brian Kelleher on December 16, 2023 at UFC 296 . He won the fight via knockout in the first round. Garbrandt faced Deiveson Figueiredo on April 13, 2024, at UFC 300 . He lost the fight by rear-naked choke submission in the second round, marking his first loss by submission. Garbrandt ended up taking his first amateur bout in 2009 and compiled an amateur MMA record of 6–2 before making his professional debut in 2012. Prior to his finish of James Porter in May 2014, he moved from Ohio to Sacramento, California to train at Team Alpha Male in an attempt to further his career. After a first-round finish of Charles Sanford in October 2014, he signed with the Ultimate Fighting Championship in the fall of 2014. Garbrandt made his promotional debut against Marcus Brimage on January 3, 2015, at UFC 182 . He won the fight via TKO in the third round. Garbrandt faced Henry Briones on July 11, 2015, at UFC 189 . He won the fight by unanimous decision, going the distance for the first time in his professional career. Garbrandt was expected to face long-time veteran John Lineker on February 21, 2016, at UFC Fight Night 83 . However, Lineker pulled out of the fight during the week, after contracting Dengue Fever , and he was replaced by Augusto Mendes . Garbrandt won the fight via TKO in the first round. Garbrandt faced fellow undefeated prospect Thomas Almeida on May 29, 2016, headlining UFC Fight Night 88 . He won the fight by knockout in the first round and also earned a Performance of the Night bonus. Garbrandt next faced Takeya Mizugaki on August 20, 2016, at UFC 202 . He won the fight via TKO in the opening minute of the first round. Garbrandt faced Dominick Cruz for the UFC Bantamweight Championship on December 30, 2016, at UFC 207 . Garbrandt won the fight by unanimous decision after knocking Cruz down twice and nearly finishing him in the fourth round. In January 2017, the UFC announced that Garbrandt would be one of the coaches on The Ultimate Fighter 25 opposite former UFC Bantamweight champion (and former Team Alpha Male teammate) T.J. Dillashaw , with the two expected to face each other on July 8, 2017, at UFC 213 . However, the bout was scrapped on May 23, after Garbrandt sustained a back injury. The bout was rescheduled and eventually took place on November 4, 2017, at UFC 217 . Despite knocking him down at the end of the first, Dillashaw rallied in the second round and defeated Garbrandt via technical knockout, marking his first loss in his professional career and losing the title. Garbrandt then faced T.J. Dillashaw in a rematch for the UFC Bantamweight Championship on August 4, 2018, at UFC 227 . He lost the fight via knockout in the first round. Garbrandt made his return against Pedro Munhoz on March 2, 2019 at UFC 235 . In a frenetic and short bout, Garbrandt was knocked out in the first round. Both participants received the Fight of the Night bonus award. Garbrandt was scheduled to face Raphael Assunção as the co-main event on March 28, 2020 at UFC on ESPN 8 . However, Garbrandt pulled out of the fight on March 12 due to kidney problems. Instead the pair fought each other on June 6, 2020 at UFC 250 . Garbrandt got back into the winning column in big fashion, winning the bout via one-punch knockout in the second round. This win earned him the Performance of the Night . On August 7, 2020, it was announced that Garbrandt intended to move down a division (from bantamweight to flyweight ) and was scheduled to face Deiveson Figueiredo for the UFC flyweight championship on November 21, 2020, at UFC 255 . However, it was reported on October 2, 2020 that Garbrandt had to pull out of the contest. Garbrandt later revealed he tested positive for COVID-19 on August 29, 2020, as well as suffering from thrombosis , brain fog , and pneumonia . Following his illness, Garbrandt returned at bantamweight and faced Rob Font on May 22, 2021 in the main event at UFC Fight Night: Font vs. Garbrandt . He lost the bout via unanimous decision. Garbrandt made his Flyweight debut against Kai Kara-France on December 11, 2021 at UFC 269 . He lost the fight via TKO in the first round. Garbrandt was scheduled to face Rani Yahya on July 9, 2022, at UFC on ESPN 39 . However, Yahya withdrew in mid June due to a neck injury. The bout with Yahya was rescheduled and was expected to take place on October 1, 2022 at UFC Fight Night 211 . In turn, Yahya withdrew again in mid-September for unknown reasons. While seeking a new opponent, Garbrandt also suffered a training injury, pulling him from the card. Garbrandt was scheduled to face Julio Arce on March 4, 2023 at UFC 285 . However, Arce withdrew in late January due to a knee injury. and he was replaced by Trevin Jones . He won the fight via unanimous decision. Garbrandt was scheduled to face Mario Bautista on August 19, 2023 at UFC 292 . However, Garbrandt withdrew a week before the event due to injury, and was replaced by Da'Mon Blackshear. Garbrandt faced Brian Kelleher on December 16, 2023 at UFC 296 . He won the fight via knockout in the first round. Garbrandt faced Deiveson Figueiredo on April 13, 2024, at UFC 300 . He lost the fight by rear-naked choke submission in the second round, marking his first loss by submission. Garbrandt faced Dominick Cruz for the UFC Bantamweight Championship on December 30, 2016, at UFC 207 . Garbrandt won the fight by unanimous decision after knocking Cruz down twice and nearly finishing him in the fourth round. In January 2017, the UFC announced that Garbrandt would be one of the coaches on The Ultimate Fighter 25 opposite former UFC Bantamweight champion (and former Team Alpha Male teammate) T.J. Dillashaw , with the two expected to face each other on July 8, 2017, at UFC 213 . However, the bout was scrapped on May 23, after Garbrandt sustained a back injury. The bout was rescheduled and eventually took place on November 4, 2017, at UFC 217 . Despite knocking him down at the end of the first, Dillashaw rallied in the second round and defeated Garbrandt via technical knockout, marking his first loss in his professional career and losing the title. Garbrandt then faced T.J. Dillashaw in a rematch for the UFC Bantamweight Championship on August 4, 2018, at UFC 227 . He lost the fight via knockout in the first round. Garbrandt made his return against Pedro Munhoz on March 2, 2019 at UFC 235 . In a frenetic and short bout, Garbrandt was knocked out in the first round. Both participants received the Fight of the Night bonus award. Garbrandt was scheduled to face Raphael Assunção as the co-main event on March 28, 2020 at UFC on ESPN 8 . However, Garbrandt pulled out of the fight on March 12 due to kidney problems. Instead the pair fought each other on June 6, 2020 at UFC 250 . Garbrandt got back into the winning column in big fashion, winning the bout via one-punch knockout in the second round. This win earned him the Performance of the Night . On August 7, 2020, it was announced that Garbrandt intended to move down a division (from bantamweight to flyweight ) and was scheduled to face Deiveson Figueiredo for the UFC flyweight championship on November 21, 2020, at UFC 255 . However, it was reported on October 2, 2020 that Garbrandt had to pull out of the contest. Garbrandt later revealed he tested positive for COVID-19 on August 29, 2020, as well as suffering from thrombosis , brain fog , and pneumonia . Following his illness, Garbrandt returned at bantamweight and faced Rob Font on May 22, 2021 in the main event at UFC Fight Night: Font vs. Garbrandt . He lost the bout via unanimous decision. Garbrandt made his Flyweight debut against Kai Kara-France on December 11, 2021 at UFC 269 . He lost the fight via TKO in the first round. Garbrandt was scheduled to face Rani Yahya on July 9, 2022, at UFC on ESPN 39 . However, Yahya withdrew in mid June due to a neck injury. The bout with Yahya was rescheduled and was expected to take place on October 1, 2022 at UFC Fight Night 211 . In turn, Yahya withdrew again in mid-September for unknown reasons. While seeking a new opponent, Garbrandt also suffered a training injury, pulling him from the card. Garbrandt was scheduled to face Julio Arce on March 4, 2023 at UFC 285 . However, Arce withdrew in late January due to a knee injury. and he was replaced by Trevin Jones . He won the fight via unanimous decision. Garbrandt was scheduled to face Mario Bautista on August 19, 2023 at UFC 292 . However, Garbrandt withdrew a week before the event due to injury, and was replaced by Da'Mon Blackshear. Garbrandt faced Brian Kelleher on December 16, 2023 at UFC 296 . He won the fight via knockout in the first round. Garbrandt faced Deiveson Figueiredo on April 13, 2024, at UFC 300 . He lost the fight by rear-naked choke submission in the second round, marking his first loss by submission. On May 8, 2018, Garbrandt's autobiography was published, titled The Pact. The book details his life, and explains his deep connection, and completed promise, with young Leukemia survivor Maddux Maple. During Garbrandt's run with the MMA promotion Pinnacle FC, he met and began dating Danny Pimsanguan. The couple eventually married in July 2017. In October, the couple announced they were expecting their first child. In March 2018, the couple announced the birth of their son. Garbrandt announced in 2023 that he and his wife have divorced. On May 8, 2018, Garbrandt's autobiography was published, titled The Pact. The book details his life, and explains his deep connection, and completed promise, with young Leukemia survivor Maddux Maple. During Garbrandt's run with the MMA promotion Pinnacle FC, he met and began dating Danny Pimsanguan. The couple eventually married in July 2017. In October, the couple announced they were expecting their first child. In March 2018, the couple announced the birth of their son. Garbrandt announced in 2023 that he and his wife have divorced.

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Dengue fever

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Mosquito

Mosquitoes , the Culicidae , are a family of small flies consisting of 3,600 species . The word mosquito (formed by mosca and diminutive -ito ) is Spanish and Portuguese for little fly . Mosquitoes have a slender segmented body , one pair of wings, three pairs of long hair-like legs, and specialized, highly elongated, piercing-sucking mouthparts . All mosquitoes drink nectar from flowers ; females of some species have in addition adapted to drink blood. Evolutionary biologists view mosquitoes as micropredators , small animals that parasitise larger ones by drinking their blood without immediately killing them. Medical parasitologists view mosquitoes instead as vectors of disease , carrying protozoan parasites or bacterial or viral pathogens from one host to another. The mosquito life cycle consists of four stages: egg , larva , pupa , and adult . Eggs are laid on the water surface; they hatch into motile larvae that feed on aquatic algae and organic material . These larvae are important food sources for many freshwater animals, such as dragonfly nymphs , many fish, and some birds. Adult females of many species have mouthparts adapted to pierce the skin of a host and feed on blood of a wide range of vertebrate hosts, and some invertebrates , primarily other arthropods . Some species only produce eggs after a blood meal. The mosquito's saliva is transferred to the host during the bite, and can cause an itchy rash . In addition, blood-feeding species can ingest pathogens while biting, and transmit them to other hosts. Those species include vectors of parasitic diseases such as malaria and filariasis , and arboviral diseases such as yellow fever and dengue fever . By transmitting diseases, mosquitoes cause the deaths of over 725,000 people each year.Like all flies, mosquitoes go through four stages in their life cycles: egg , larva , pupa , and adult . The first three stages—egg, larva, and pupa—are largely aquatic, the eggs usually being laid in stagnant water. They hatch to become larvae , which feed, grow, and molt until they change into pupae . The adult mosquito emerges from the mature pupa as it floats at the water surface. Mosquitoes have adult lifespans ranging from as short as a week to around a month. Some species overwinter as adults in diapause . Mosquitoes have one pair of wings, with distinct scales on the surface. Their wings are long and narrow, while the legs are long and thin. The body, usually grey or black, is slender, and typically 3–6 mm long. When at rest, mosquitoes hold their first pair of legs outwards, whereas the somewhat similar Chironomid midges hold these legs forwards. Anopheles mosquitoes can fly for up to four hours continuously at 1 to 2 km/h (0.62 to 1.24 mph) , traveling up to 12 kilometres (7.5 mi) in a night. Males beat their wings between 450 and 600 times per second, driven indirectly by muscles which vibrate the thorax. Mosquitoes are mainly small flies; the largest are in the genus Toxorhynchites , at up to 18 mm (0.71 in) in length and 24 mm (0.94 in) in wingspan. Those in the genus Aedes are much smaller, with a wingspan of 2.8 to 4.4 mm (0.11 to 0.17 in) . Mosquitoes can develop from egg to adult in hot weather in as few as five days, but it may take up to a month. At dawn or dusk, within days of pupating, males assemble in swarms , mating when females fly in. The female mates only once in her lifetime, attracted by the pheromones emitted by the male. In species that need blood for the eggs to develop, the female finds a host and drinks a full meal of blood. She then rests for two or three days to digest the meal and allow her eggs to develop. She is then ready to lay the eggs and repeat the cycle of feeding and laying. Females can live for up to three weeks in the wild, depending on temperature, humidity, their ability to obtain a blood meal, and avoiding being killed by their vertebrate hosts. The eggs of most mosquitoes are laid in stagnant water, which may be a pond, a marsh, a temporary puddle, a water-filled hole in a tree, or the water-trapping leaf axils of a bromeliad . Some lay near the water's edge while others attach their eggs to aquatic plants. A few, like Opifex fuscus , can breed in salt-marshes. Wyeomyia smithii breeds in the pitchers of pitcher plants , its larvae feeding on decaying insects that have drowned there. Oviposition , egg-laying, varies between species. Anopheles females fly over the water, touching down or dapping to place eggs on the surface one at a time; their eggs are roughly cigar-shaped and have floats down their sides. A female can lay 100–200 eggs in her lifetime. Aedes females drop their eggs singly, on damp mud or other surfaces near water; their eggs hatch only when they are flooded. Females in genera such as Culex , Culiseta , and Uranotaenia lay their eggs in floating rafts. Mansonia females in contrast lay their eggs in arrays, attached usually to the under-surfaces of waterlily pads. Clutches of eggs of most mosquito species hatch simultaneously, but Aedes eggs in diapause hatch irregularly over an extended period. The mosquito larva's head has prominent mouth brushes used for feeding, a large thorax with no legs, and a segmented abdomen . It breathes air through a siphon on its abdomen, so must come to the surface frequently. It spends most of its time feeding on algae , bacteria, and other microbes in the water's surface layer. It dives below the surface when disturbed. It swims either by propelling itself with its mouth brushes, or by jerkily wriggling its body. It develops through several stages, or instars , molting each time, after which it metamorphoses into a pupa . Aedes larvae, except when very young, can withstand drying; they go into diapause for several months if their pond dries out. The head and thorax of the pupa are merged into a cephalothorax , with the abdomen curving around beneath it. The pupa or "tumbler" can swim actively by flipping its abdomen. Like the larva, the pupa of most species must come to the surface frequently to breathe, which they do through a pair of respiratory trumpets on their cephalothoraxes. They do not feed; they pass much of their time hanging from the surface of the water by their respiratory trumpets. If alarmed, they swim downwards by flipping their abdomens in much the same way as the larvae. If undisturbed, they soon float up again. The adult emerges from the pupa at the surface of the water and flies off. Mosquitoes have one pair of wings, with distinct scales on the surface. Their wings are long and narrow, while the legs are long and thin. The body, usually grey or black, is slender, and typically 3–6 mm long. When at rest, mosquitoes hold their first pair of legs outwards, whereas the somewhat similar Chironomid midges hold these legs forwards. Anopheles mosquitoes can fly for up to four hours continuously at 1 to 2 km/h (0.62 to 1.24 mph) , traveling up to 12 kilometres (7.5 mi) in a night. Males beat their wings between 450 and 600 times per second, driven indirectly by muscles which vibrate the thorax. Mosquitoes are mainly small flies; the largest are in the genus Toxorhynchites , at up to 18 mm (0.71 in) in length and 24 mm (0.94 in) in wingspan. Those in the genus Aedes are much smaller, with a wingspan of 2.8 to 4.4 mm (0.11 to 0.17 in) . Mosquitoes can develop from egg to adult in hot weather in as few as five days, but it may take up to a month. At dawn or dusk, within days of pupating, males assemble in swarms , mating when females fly in. The female mates only once in her lifetime, attracted by the pheromones emitted by the male. In species that need blood for the eggs to develop, the female finds a host and drinks a full meal of blood. She then rests for two or three days to digest the meal and allow her eggs to develop. She is then ready to lay the eggs and repeat the cycle of feeding and laying. Females can live for up to three weeks in the wild, depending on temperature, humidity, their ability to obtain a blood meal, and avoiding being killed by their vertebrate hosts. The eggs of most mosquitoes are laid in stagnant water, which may be a pond, a marsh, a temporary puddle, a water-filled hole in a tree, or the water-trapping leaf axils of a bromeliad . Some lay near the water's edge while others attach their eggs to aquatic plants. A few, like Opifex fuscus , can breed in salt-marshes. Wyeomyia smithii breeds in the pitchers of pitcher plants , its larvae feeding on decaying insects that have drowned there. Oviposition , egg-laying, varies between species. Anopheles females fly over the water, touching down or dapping to place eggs on the surface one at a time; their eggs are roughly cigar-shaped and have floats down their sides. A female can lay 100–200 eggs in her lifetime. Aedes females drop their eggs singly, on damp mud or other surfaces near water; their eggs hatch only when they are flooded. Females in genera such as Culex , Culiseta , and Uranotaenia lay their eggs in floating rafts. Mansonia females in contrast lay their eggs in arrays, attached usually to the under-surfaces of waterlily pads. Clutches of eggs of most mosquito species hatch simultaneously, but Aedes eggs in diapause hatch irregularly over an extended period. The mosquito larva's head has prominent mouth brushes used for feeding, a large thorax with no legs, and a segmented abdomen . It breathes air through a siphon on its abdomen, so must come to the surface frequently. It spends most of its time feeding on algae , bacteria, and other microbes in the water's surface layer. It dives below the surface when disturbed. It swims either by propelling itself with its mouth brushes, or by jerkily wriggling its body. It develops through several stages, or instars , molting each time, after which it metamorphoses into a pupa . Aedes larvae, except when very young, can withstand drying; they go into diapause for several months if their pond dries out. The head and thorax of the pupa are merged into a cephalothorax , with the abdomen curving around beneath it. The pupa or "tumbler" can swim actively by flipping its abdomen. Like the larva, the pupa of most species must come to the surface frequently to breathe, which they do through a pair of respiratory trumpets on their cephalothoraxes. They do not feed; they pass much of their time hanging from the surface of the water by their respiratory trumpets. If alarmed, they swim downwards by flipping their abdomens in much the same way as the larvae. If undisturbed, they soon float up again. The adult emerges from the pupa at the surface of the water and flies off. Both male and female mosquitoes feed on nectar , aphid honeydew, and plant juices, but in many species the females are also blood-sucking ectoparasites . In some of those species, a blood meal is essential for egg production; in others, it just enables the female to lay more eggs. Both plant materials and blood are useful sources of energy in the form of sugars. Blood supplies more concentrated nutrients, such as lipids , but the main function of blood meals is to obtain proteins for egg production. Mosquitoes like Toxorhynchites reproduce autogenously, not needing blood meals. Disease vector mosquitoes like Anopheles and Aedes are anautogenous , requiring blood to lay eggs. Many Culex species are partially anautogenous, needing blood only for their second and subsequent clutches of eggs. Blood-sucking mosquitoes favour particular host species, though they are less selective when food is short. Different mosquito species favor amphibians , reptiles including snakes , birds , and mammals . For example, Culiseta melanura sucks the blood of passerine birds, but as mosquito numbers rise they attack mammals including horses and humans, causing epidemics of Eastern equine encephalitis virus in North America. Loss of blood from many bites can add up to a large volume, occasionally causing the death of livestock as large as cattle and horses . Malaria -transmitting mosquitoes seek out caterpillars and feed on their haemolymph, impeding their development. Most mosquito species are crepuscular , feeding at dawn or dusk, and resting in a cool place through the heat of the day. Some species, such as the Asian tiger mosquito , are known to fly and feed during daytime. Female mosquitoes hunt for hosts by smelling substances such as carbon dioxide (CO 2 ) and 1-octen-3-ol ( mushroom alcohol , found in exhaled breath) produced from the host, and through visual recognition. The semiochemical that most strongly attracts Culex quinquefasciatus is nonanal . Another attractant is sulcatone . A large part of the mosquito's sense of smell, or olfactory system, is devoted to sniffing out blood sources. Of 72 types of odor receptors on its antennae, at least 27 are tuned to detect chemicals found in perspiration. In Aedes , the search for a host takes place in two phases. First, the mosquito flies about until it detects a host's odorants; then it flies towards them, using the concentration of odorants as its guide. Mosquitoes prefer to feed on people with type O blood , an abundance of skin bacteria, high body heat, and pregnant women. Individuals' attractiveness to mosquitoes has a heritable , genetically controlled component. Female mosquito mouthparts are highly adapted to piercing skin and sucking blood. Males only drink sugary fluids, and have less specialized mouthparts. Externally, the most obvious feeding structure of the mosquito is the proboscis, composed of the labium , U-shaped in section like a rain gutter , which sheaths a bundle (fascicle) of six piercing mouthparts or stylets. These are two mandibles , two maxillae , the hypopharynx , and the labrum . The labium bends back into a bow when the mosquito begins to bite, staying in contact with the skin and guiding the stylets downwards. The extremely sharp tips of the labrum and maxillae are moved backwards and forwards to saw their way into the skin, with just one thousandth of the force that would be needed to penetrate the skin with a needle, resulting in a painless insertion. Mosquito saliva contains enzymes that aid in sugar feeding, and antimicrobial agents that control bacterial growth in the sugar meal. For a mosquito to obtain a blood meal, it must circumvent its vertebrate host's physiological responses. Mosquito saliva blocks the host's hemostasis system, with proteins that reduce vascular constriction , blood clotting , and platelet aggregation, to ensure the blood keeps flowing. It modulates the host's immune response via a mixture of proteins which lower angiogenesis and immunity ; create inflammation ; suppress tumor necrosis factor release from activated mast cells ; suppress interleukin (IL)-2 and IFN-γ production; suppress T cell populations; decrease expression of interferon −α/β, making virus infections more severe; increase natural killer T cells in the blood; and decrease cytokine production. Females of many blood-feeding species need a blood meal to begin the process of egg development. A sufficiently large blood meal triggers a hormonal cascade that leads to egg development. Upon completion of feeding, the mosquito withdraws her proboscis , and as the gut fills up, the stomach lining secretes a peritrophic membrane that surrounds the blood. This keeps the blood separate from anything else in the stomach. Like many Hemiptera that survive on dilute liquid diets, many adult mosquitoes excrete surplus liquid even when feeding. This permits females to accumulate a full meal of nutrient solids. The blood meal is digested over a period of several days. Once blood is in the stomach, the midgut synthesizes protease enzymes, primarily trypsin assisted by aminopeptidase , that hydrolyze the blood proteins into free amino acids . These are used in the synthesis of vitellogenin , which in turn is made into egg yolk protein. Both male and female mosquitoes feed on nectar , aphid honeydew, and plant juices, but in many species the females are also blood-sucking ectoparasites . In some of those species, a blood meal is essential for egg production; in others, it just enables the female to lay more eggs. Both plant materials and blood are useful sources of energy in the form of sugars. Blood supplies more concentrated nutrients, such as lipids , but the main function of blood meals is to obtain proteins for egg production. Mosquitoes like Toxorhynchites reproduce autogenously, not needing blood meals. Disease vector mosquitoes like Anopheles and Aedes are anautogenous , requiring blood to lay eggs. Many Culex species are partially anautogenous, needing blood only for their second and subsequent clutches of eggs. Blood-sucking mosquitoes favour particular host species, though they are less selective when food is short. Different mosquito species favor amphibians , reptiles including snakes , birds , and mammals . For example, Culiseta melanura sucks the blood of passerine birds, but as mosquito numbers rise they attack mammals including horses and humans, causing epidemics of Eastern equine encephalitis virus in North America. Loss of blood from many bites can add up to a large volume, occasionally causing the death of livestock as large as cattle and horses . Malaria -transmitting mosquitoes seek out caterpillars and feed on their haemolymph, impeding their development. Most mosquito species are crepuscular , feeding at dawn or dusk, and resting in a cool place through the heat of the day. Some species, such as the Asian tiger mosquito , are known to fly and feed during daytime. Female mosquitoes hunt for hosts by smelling substances such as carbon dioxide (CO 2 ) and 1-octen-3-ol ( mushroom alcohol , found in exhaled breath) produced from the host, and through visual recognition. The semiochemical that most strongly attracts Culex quinquefasciatus is nonanal . Another attractant is sulcatone . A large part of the mosquito's sense of smell, or olfactory system, is devoted to sniffing out blood sources. Of 72 types of odor receptors on its antennae, at least 27 are tuned to detect chemicals found in perspiration. In Aedes , the search for a host takes place in two phases. First, the mosquito flies about until it detects a host's odorants; then it flies towards them, using the concentration of odorants as its guide. Mosquitoes prefer to feed on people with type O blood , an abundance of skin bacteria, high body heat, and pregnant women. Individuals' attractiveness to mosquitoes has a heritable , genetically controlled component. Female mosquito mouthparts are highly adapted to piercing skin and sucking blood. Males only drink sugary fluids, and have less specialized mouthparts. Externally, the most obvious feeding structure of the mosquito is the proboscis, composed of the labium , U-shaped in section like a rain gutter , which sheaths a bundle (fascicle) of six piercing mouthparts or stylets. These are two mandibles , two maxillae , the hypopharynx , and the labrum . The labium bends back into a bow when the mosquito begins to bite, staying in contact with the skin and guiding the stylets downwards. The extremely sharp tips of the labrum and maxillae are moved backwards and forwards to saw their way into the skin, with just one thousandth of the force that would be needed to penetrate the skin with a needle, resulting in a painless insertion. Mosquito saliva contains enzymes that aid in sugar feeding, and antimicrobial agents that control bacterial growth in the sugar meal. For a mosquito to obtain a blood meal, it must circumvent its vertebrate host's physiological responses. Mosquito saliva blocks the host's hemostasis system, with proteins that reduce vascular constriction , blood clotting , and platelet aggregation, to ensure the blood keeps flowing. It modulates the host's immune response via a mixture of proteins which lower angiogenesis and immunity ; create inflammation ; suppress tumor necrosis factor release from activated mast cells ; suppress interleukin (IL)-2 and IFN-γ production; suppress T cell populations; decrease expression of interferon −α/β, making virus infections more severe; increase natural killer T cells in the blood; and decrease cytokine production. Females of many blood-feeding species need a blood meal to begin the process of egg development. A sufficiently large blood meal triggers a hormonal cascade that leads to egg development. Upon completion of feeding, the mosquito withdraws her proboscis , and as the gut fills up, the stomach lining secretes a peritrophic membrane that surrounds the blood. This keeps the blood separate from anything else in the stomach. Like many Hemiptera that survive on dilute liquid diets, many adult mosquitoes excrete surplus liquid even when feeding. This permits females to accumulate a full meal of nutrient solids. The blood meal is digested over a period of several days. Once blood is in the stomach, the midgut synthesizes protease enzymes, primarily trypsin assisted by aminopeptidase , that hydrolyze the blood proteins into free amino acids . These are used in the synthesis of vitellogenin , which in turn is made into egg yolk protein. Mosquitoes have a cosmopolitan distribution , occurring in every land region except Antarctica and a few islands with polar or subpolar climates , such as Iceland , which is essentially free of mosquitoes. This absence is probably caused by Iceland's climate. Its weather is unpredictable, freezing but often warming suddenly in mid-winter, making mosquitoes emerge from pupae in diapause, and then freezing again before they can complete their life cycle. Eggs of temperate zone mosquitoes are more tolerant of cold than the eggs of species indigenous to warmer regions. Many can tolerate subzero temperatures, while adults of some species can survive winter by sheltering in microhabitats such as buildings or hollow trees. In warm and humid tropical regions, some mosquito species are active for the entire year, but in temperate and cold regions they hibernate or enter diapause . Arctic or subarctic mosquitoes, like some other arctic midges in families such as Simuliidae and Ceratopogonidae may be active for only a few weeks annually as melt-water pools form on the permafrost. During that time, though, they emerge in huge numbers in some regions and may take up to 300 ml of blood per day from each animal in a caribou herd. For a mosquito to transmit disease, there must be favorable seasonal conditions, primarily humidity, temperature, and precipitation. El Niño affects the location and number of outbreaks in East Africa, Latin America, Southeast Asia and India . Climate change impacts the seasonal factors and in turn the dispersal of mosquitoes. Climate models can use historic data to recreate past outbreaks and to predict the risk of vector-borne disease, based on an area's forecasted climate. Mosquito-borne diseases have long been most prevalent in East Africa, Latin America, Southeast Asia, and India . An emergence in Europe was observed early in the 21st century. It is predicted that by 2030, the climate of southern Great Britain will be suitable for transmission of Plasmodium vivax malaria for two months of the year, and that by 2080, the same will be true for southern Scotland. Mosquito larvae are among the commonest animals in ponds, and they form an important food source for freshwater predators . Among the many aquatic insects that catch mosquito larvae are dragonfly and damselfly nymphs, whirligig beetles , and water striders . Vertebrate predators include fish such as catfish and the mosquitofish , amphibians including the spadefoot toad and the giant tree frog , freshwater turtles such as the red-eared slider , and birds such as ducks. Emerging adults are consumed at the pond surface by predatory flies including Empididae and Dolichopodidae , and by spiders . Flying adults are captured by dragonflies and damselflies, by birds such as swifts and swallows , and by vertebrates including bats . Mosquitoes are parasitised by hydrachnid mites, ciliates such as Glaucoma , microsporidians such as Thelania , and fungi including species of Saprolegniaceae and Entomophthoraceae . Several flowers including members of the Asteraceae , Rosaceae and Orchidaceae are pollinated by mosquitoes, which visit to obtain sugar-rich nectar . They are attracted to flowers by a range of semiochemicals such as alcohols, aldehydes, ketones, and terpenes. Mosquitoes have visited and pollinated flowers since the Cretaceous period. It is possible that plant-sucking preadapted mosquitoes to blood-sucking. Ecologically, blood-feeding mosquitoes are micropredators , small animals that feed on larger animals without immediately killing them. Evolutionary biologists see this as a form of parasitism ; in Edward O. Wilson 's phrase "Parasites ... are predators that eat prey in units of less than one." Micropredation is one of six major evolutionarily stable strategies within parasitism. It is distinguished by leaving the host still able to reproduce, unlike the activity of parasitic castrators or parasitoids ; and having multiple hosts, unlike conventional parasites. From this perspective, mosquitoes are ectoparasites , feeding on blood from the outside of their hosts, using their piercing mouthparts, rather than entering their bodies. Unlike some other ectoparasites such as fleas and lice , mosquitoes do not remain constantly on the body of the host, but visit only to feed. Mosquitoes have a cosmopolitan distribution , occurring in every land region except Antarctica and a few islands with polar or subpolar climates , such as Iceland , which is essentially free of mosquitoes. This absence is probably caused by Iceland's climate. Its weather is unpredictable, freezing but often warming suddenly in mid-winter, making mosquitoes emerge from pupae in diapause, and then freezing again before they can complete their life cycle. Eggs of temperate zone mosquitoes are more tolerant of cold than the eggs of species indigenous to warmer regions. Many can tolerate subzero temperatures, while adults of some species can survive winter by sheltering in microhabitats such as buildings or hollow trees. In warm and humid tropical regions, some mosquito species are active for the entire year, but in temperate and cold regions they hibernate or enter diapause . Arctic or subarctic mosquitoes, like some other arctic midges in families such as Simuliidae and Ceratopogonidae may be active for only a few weeks annually as melt-water pools form on the permafrost. During that time, though, they emerge in huge numbers in some regions and may take up to 300 ml of blood per day from each animal in a caribou herd. For a mosquito to transmit disease, there must be favorable seasonal conditions, primarily humidity, temperature, and precipitation. El Niño affects the location and number of outbreaks in East Africa, Latin America, Southeast Asia and India . Climate change impacts the seasonal factors and in turn the dispersal of mosquitoes. Climate models can use historic data to recreate past outbreaks and to predict the risk of vector-borne disease, based on an area's forecasted climate. Mosquito-borne diseases have long been most prevalent in East Africa, Latin America, Southeast Asia, and India . An emergence in Europe was observed early in the 21st century. It is predicted that by 2030, the climate of southern Great Britain will be suitable for transmission of Plasmodium vivax malaria for two months of the year, and that by 2080, the same will be true for southern Scotland. Mosquito larvae are among the commonest animals in ponds, and they form an important food source for freshwater predators . Among the many aquatic insects that catch mosquito larvae are dragonfly and damselfly nymphs, whirligig beetles , and water striders . Vertebrate predators include fish such as catfish and the mosquitofish , amphibians including the spadefoot toad and the giant tree frog , freshwater turtles such as the red-eared slider , and birds such as ducks. Emerging adults are consumed at the pond surface by predatory flies including Empididae and Dolichopodidae , and by spiders . Flying adults are captured by dragonflies and damselflies, by birds such as swifts and swallows , and by vertebrates including bats . Mosquitoes are parasitised by hydrachnid mites, ciliates such as Glaucoma , microsporidians such as Thelania , and fungi including species of Saprolegniaceae and Entomophthoraceae . Several flowers including members of the Asteraceae , Rosaceae and Orchidaceae are pollinated by mosquitoes, which visit to obtain sugar-rich nectar . They are attracted to flowers by a range of semiochemicals such as alcohols, aldehydes, ketones, and terpenes. Mosquitoes have visited and pollinated flowers since the Cretaceous period. It is possible that plant-sucking preadapted mosquitoes to blood-sucking. Ecologically, blood-feeding mosquitoes are micropredators , small animals that feed on larger animals without immediately killing them. Evolutionary biologists see this as a form of parasitism ; in Edward O. Wilson 's phrase "Parasites ... are predators that eat prey in units of less than one." Micropredation is one of six major evolutionarily stable strategies within parasitism. It is distinguished by leaving the host still able to reproduce, unlike the activity of parasitic castrators or parasitoids ; and having multiple hosts, unlike conventional parasites. From this perspective, mosquitoes are ectoparasites , feeding on blood from the outside of their hosts, using their piercing mouthparts, rather than entering their bodies. Unlike some other ectoparasites such as fleas and lice , mosquitoes do not remain constantly on the body of the host, but visit only to feed. The oldest known mosquitoes are Libanoculex intermedius found in Lebanese amber , dating to the Barremian stage of the Early Cretaceous, around 125 million years ago. The mouthparts of male individuals of this species are similar to living female mosquitoes, indicating that they consumed blood, unlike living male mosquitoes. Three other species of Cretaceous mosquito are known. Burmaculex antiquus and Priscoculex burmanicus are known from Burmese amber from Myanmar, which dates to the earliest part of the Cenomanian stage of the Late Cretaceous, around 99 million years ago. Paleoculicis minutus , is known from Canadian amber from Alberta, Canada, which dates to the Campanian stage of the Late Cretaceous, around 79 million years ago. P. burmanicus has been assigned to the Anophelinae , indicating that the split between this subfamily and the Culicinae took place over 99 million years ago. Molecular estimates suggest that this split occurred 197.5 million years ago, during the Early Jurassic , but that major diversification did not take place until the Cretaceous. Over 3,600 species of mosquitoes in 112 genera have been described . They are traditionally divided into two subfamilies, the Anophelinae and the Culicinae , which carry different diseases. Roughly speaking, protozoal diseases like malaria are transmitted by anophelines, while viral diseases such as yellow fever and dengue fever are transmitted by culicines. The name Culicidae was introduced by the German entomologist Johann Wilhelm Meigen in his seven-volume classification published in 1818–1838. Mosquito taxonomy was advanced in 1901 when the English entomologist Frederick Vincent Theobald published his 5-volume monograph on the Culicidae. He had been provided with mosquito specimens sent in to the British Museum (Natural History) from around the world, on the 1898 instruction of the Secretary of State for the Colonies , Joseph Chamberlain , who had written that "in view of the possible connection of Malaria with mosquitoes, it is desirable to obtain exact knowledge of the different species of mosquitoes and allied insects in the various tropical colonies. I will therefore ask you ... to have collections made of the winged insects in the Colony which bite men or animals." Mosquitoes are members of a family of true flies (Diptera) : the Culicidae (from the Latin culex , genitive culicis , meaning "midge" or "gnat"). The phylogenetic tree is based on the FLYTREE project. Ptychopteromorpha (phantom and primitive crane-flies) Chironomidae (non-biting midges) Simulioidea (blackflies and biting midges) Dixidae (meniscus midges) Corethrellidae (frog-biting midges) Chaoboridae (phantom midges) Culicidae other midges and gnats all other flies, inc. Brachycera Kyanne Reidenbach and colleagues analysed mosquito phylogenetics in 2009, using both nuclear DNA and morphology of 26 species. They note that Anophelinae is confirmed to be rather basal, but that the deeper parts of the tree are not well resolved. basal spp. other spp. Aedini other spp. SabethiniThe oldest known mosquitoes are Libanoculex intermedius found in Lebanese amber , dating to the Barremian stage of the Early Cretaceous, around 125 million years ago. The mouthparts of male individuals of this species are similar to living female mosquitoes, indicating that they consumed blood, unlike living male mosquitoes. Three other species of Cretaceous mosquito are known. Burmaculex antiquus and Priscoculex burmanicus are known from Burmese amber from Myanmar, which dates to the earliest part of the Cenomanian stage of the Late Cretaceous, around 99 million years ago. Paleoculicis minutus , is known from Canadian amber from Alberta, Canada, which dates to the Campanian stage of the Late Cretaceous, around 79 million years ago. P. burmanicus has been assigned to the Anophelinae , indicating that the split between this subfamily and the Culicinae took place over 99 million years ago. Molecular estimates suggest that this split occurred 197.5 million years ago, during the Early Jurassic , but that major diversification did not take place until the Cretaceous. Over 3,600 species of mosquitoes in 112 genera have been described . They are traditionally divided into two subfamilies, the Anophelinae and the Culicinae , which carry different diseases. Roughly speaking, protozoal diseases like malaria are transmitted by anophelines, while viral diseases such as yellow fever and dengue fever are transmitted by culicines. The name Culicidae was introduced by the German entomologist Johann Wilhelm Meigen in his seven-volume classification published in 1818–1838. Mosquito taxonomy was advanced in 1901 when the English entomologist Frederick Vincent Theobald published his 5-volume monograph on the Culicidae. He had been provided with mosquito specimens sent in to the British Museum (Natural History) from around the world, on the 1898 instruction of the Secretary of State for the Colonies , Joseph Chamberlain , who had written that "in view of the possible connection of Malaria with mosquitoes, it is desirable to obtain exact knowledge of the different species of mosquitoes and allied insects in the various tropical colonies. I will therefore ask you ... to have collections made of the winged insects in the Colony which bite men or animals." Mosquitoes are members of a family of true flies (Diptera) : the Culicidae (from the Latin culex , genitive culicis , meaning "midge" or "gnat"). The phylogenetic tree is based on the FLYTREE project. Ptychopteromorpha (phantom and primitive crane-flies) Chironomidae (non-biting midges) Simulioidea (blackflies and biting midges) Dixidae (meniscus midges) Corethrellidae (frog-biting midges) Chaoboridae (phantom midges) Culicidae other midges and gnats all other flies, inc. Brachycera Kyanne Reidenbach and colleagues analysed mosquito phylogenetics in 2009, using both nuclear DNA and morphology of 26 species. They note that Anophelinae is confirmed to be rather basal, but that the deeper parts of the tree are not well resolved. basal spp. other spp. Aedini other spp. SabethiniMosquitoes are members of a family of true flies (Diptera) : the Culicidae (from the Latin culex , genitive culicis , meaning "midge" or "gnat"). The phylogenetic tree is based on the FLYTREE project. Ptychopteromorpha (phantom and primitive crane-flies) Chironomidae (non-biting midges) Simulioidea (blackflies and biting midges) Dixidae (meniscus midges) Corethrellidae (frog-biting midges) Chaoboridae (phantom midges) Culicidae other midges and gnats all other flies, inc. BrachyceraKyanne Reidenbach and colleagues analysed mosquito phylogenetics in 2009, using both nuclear DNA and morphology of 26 species. They note that Anophelinae is confirmed to be rather basal, but that the deeper parts of the tree are not well resolved. basal spp. other spp. Aedini other spp. SabethiniMosquitoes are vectors for many disease-causing microorganisms including bacteria , viruses , and protozoan parasites. Nearly 700 million people acquire a mosquito-borne illness each year, resulting in over 725,000 deaths. Common mosquito-borne viral diseases include yellow fever and dengue fever transmitted mostly by Aedes aegypti . Parasitic diseases transmitted by mosquitoes include malaria and lymphatic filariasis . The Plasmodium parasites that cause malaria are carried by female Anopheles mosquitoes. Lymphatic filariasis, the main cause of elephantiasis , is spread by a wide variety of mosquitoes. A bacterial disease spread by Culex and Culiseta mosquitoes is tularemia . Many measures have been tried for mosquito control , including the elimination of breeding places, exclusion via window screens and mosquito nets , biological control with parasites such as fungi and nematodes, or predators such as fish, copepods , dragonfly nymphs and adults, and some species of lizard and gecko . Another approach is to introduce large numbers of sterile males . Genetic modification methods including cytoplasmic incompatibility, chromosomal translocations, sex distortion and gene replacement, solutions seen as inexpensive and not subject to vector resistance, have been explored. Control of disease-carrying mosquitoes using gene drives has been proposed. Insect repellents are applied on skin and give short-term protection against mosquito bites. The chemical DEET repels some mosquitoes and other insects. Some CDC -recommended repellents are picaridin , eucalyptus oil ( PMD ), and ethyl butylacetylaminopropionate (IR3535). Pyrethrum (from Chrysanthemum species, particularly C. cinerariifolium and C. coccineum ) is an effective plant-based repellent. Electronic insect repellent devices that produce ultrasounds intended to keep away insects (and mosquitoes) are marketed. No EPA or university study has shown that these devices prevent humans from being bitten by a mosquito. Mosquito bites lead to a variety of skin reactions and more seriously to mosquito bite allergies . Such hypersensitivity to mosquito bites is an excessive reaction to mosquito saliva proteins. Numerous species of mosquito can trigger such reactions, including Aedes aegypti , A. vexans , A. albopictus , Anopheles sinensis , Culex pipiens , Aedes communis , Anopheles stephensi , C. quinquefasciatus , C. tritaeniorhynchus , and Ochlerotatus triseriatus . Cross-reactivity between salivary proteins of different mosquitoes implies that allergic responses may be caused by virtually any mosquito species. Treatment can be with anti-itch medications include some taken orally, such as diphenhydramine , or applied to the skin like antihistamines or corticosteroids such as hydrocortisone . Aqueous ammonia (3.6%) also provides relief. Both topical heat and cold may be useful as treatments. Mosquitoes are vectors for many disease-causing microorganisms including bacteria , viruses , and protozoan parasites. Nearly 700 million people acquire a mosquito-borne illness each year, resulting in over 725,000 deaths. Common mosquito-borne viral diseases include yellow fever and dengue fever transmitted mostly by Aedes aegypti . Parasitic diseases transmitted by mosquitoes include malaria and lymphatic filariasis . The Plasmodium parasites that cause malaria are carried by female Anopheles mosquitoes. Lymphatic filariasis, the main cause of elephantiasis , is spread by a wide variety of mosquitoes. A bacterial disease spread by Culex and Culiseta mosquitoes is tularemia . Many measures have been tried for mosquito control , including the elimination of breeding places, exclusion via window screens and mosquito nets , biological control with parasites such as fungi and nematodes, or predators such as fish, copepods , dragonfly nymphs and adults, and some species of lizard and gecko . Another approach is to introduce large numbers of sterile males . Genetic modification methods including cytoplasmic incompatibility, chromosomal translocations, sex distortion and gene replacement, solutions seen as inexpensive and not subject to vector resistance, have been explored. Control of disease-carrying mosquitoes using gene drives has been proposed. Insect repellents are applied on skin and give short-term protection against mosquito bites. The chemical DEET repels some mosquitoes and other insects. Some CDC -recommended repellents are picaridin , eucalyptus oil ( PMD ), and ethyl butylacetylaminopropionate (IR3535). Pyrethrum (from Chrysanthemum species, particularly C. cinerariifolium and C. coccineum ) is an effective plant-based repellent. Electronic insect repellent devices that produce ultrasounds intended to keep away insects (and mosquitoes) are marketed. No EPA or university study has shown that these devices prevent humans from being bitten by a mosquito. Mosquito bites lead to a variety of skin reactions and more seriously to mosquito bite allergies . Such hypersensitivity to mosquito bites is an excessive reaction to mosquito saliva proteins. Numerous species of mosquito can trigger such reactions, including Aedes aegypti , A. vexans , A. albopictus , Anopheles sinensis , Culex pipiens , Aedes communis , Anopheles stephensi , C. quinquefasciatus , C. tritaeniorhynchus , and Ochlerotatus triseriatus . Cross-reactivity between salivary proteins of different mosquitoes implies that allergic responses may be caused by virtually any mosquito species. Treatment can be with anti-itch medications include some taken orally, such as diphenhydramine , or applied to the skin like antihistamines or corticosteroids such as hydrocortisone . Aqueous ammonia (3.6%) also provides relief. Both topical heat and cold may be useful as treatments. Ancient Greek beast fables including "The Elephant and the Mosquito" and " The Bull and the Mosquito ", with the general moral that the large beast does not even notice the small one, derive ultimately from Mesopotamia . The peoples of Siberia have origin myths surrounding the mosquito. One Ostiak myth tells of a man-eating giant, Punegusse , who is killed by a hero but will not stay dead. The hero eventually burns the giant, but the ashes of the fire become mosquitoes that continue to plague mankind. Other myths from the Yakuts , Goldes ( Nanai people ), and Samoyed have the insect arising from the ashes or fragments of some giant creature or demon. Similar tales found in Native North American myth, with the mosquito arising from the ashes of a man-eater, suggest a common origin. The Tatars of the Altai had a variant of the same myth, involving the fragments of the dead giant, Andalma-Muus , becoming mosquitoes and other insects. Lafcadio Hearn tells that in Japan, mosquitoes are seen as reincarnations of the dead, condemned by the errors of their former lives to the condition of Jiki-ketsu-gaki , or "blood-drinking pretas ". Winsor McCay 's 1912 film How a Mosquito Operates was one of the earliest works of animation. It has been described as far ahead of its time in technical quality. It depicts a giant mosquito tormenting a sleeping man. Twelve ships of the Royal Navy have borne the name HMS Mosquito or the archaic form of the name, HMS Musquito . The de Havilland Mosquito was a high-speed aircraft manufactured between 1940 and 1950, and used in many roles. Ancient Greek beast fables including "The Elephant and the Mosquito" and " The Bull and the Mosquito ", with the general moral that the large beast does not even notice the small one, derive ultimately from Mesopotamia . The peoples of Siberia have origin myths surrounding the mosquito. One Ostiak myth tells of a man-eating giant, Punegusse , who is killed by a hero but will not stay dead. The hero eventually burns the giant, but the ashes of the fire become mosquitoes that continue to plague mankind. Other myths from the Yakuts , Goldes ( Nanai people ), and Samoyed have the insect arising from the ashes or fragments of some giant creature or demon. Similar tales found in Native North American myth, with the mosquito arising from the ashes of a man-eater, suggest a common origin. The Tatars of the Altai had a variant of the same myth, involving the fragments of the dead giant, Andalma-Muus , becoming mosquitoes and other insects. Lafcadio Hearn tells that in Japan, mosquitoes are seen as reincarnations of the dead, condemned by the errors of their former lives to the condition of Jiki-ketsu-gaki , or "blood-drinking pretas ". Winsor McCay 's 1912 film How a Mosquito Operates was one of the earliest works of animation. It has been described as far ahead of its time in technical quality. It depicts a giant mosquito tormenting a sleeping man. Twelve ships of the Royal Navy have borne the name HMS Mosquito or the archaic form of the name, HMS Musquito . The de Havilland Mosquito was a high-speed aircraft manufactured between 1940 and 1950, and used in many roles.

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Conditional probability

In probability theory , conditional probability is a measure of the probability of an event occurring, given that another event (by assumption, presumption, assertion or evidence) is already known to have occurred. This particular method relies on event A occurring with some sort of relationship with another event B. In this situation, the event A can be analyzed by a conditional probability with respect to B. If the event of interest is A and the event B is known or assumed to have occurred, "the conditional probability of A given B ", or "the probability of A under the condition B ", is usually written as P( A | B ) or occasionally P B ( A ) . This can also be understood as the fraction of probability B that intersects with A, or the ratio of the probabilities of both events happening to the "given" one happening (how many times A occurs rather than not assuming B has occurred): P ( A ∣ B ) = P ( A ∩ B ) P ( B ) {\displaystyle P(A\mid B)={ rac {P(A\cap B)}{P(B)}}} . For example, the probability that any given person has a cough on any given day may be only 5%. But if we know or assume that the person is sick, then they are much more likely to be coughing. For example, the conditional probability that someone unwell (sick) is coughing might be 75%, in which case we would have that P(Cough) = 5% and P(Cough|Sick) = 75 %. Although there is a relationship between A and B in this example, such a relationship or dependence between A and B is not necessary, nor do they have to occur simultaneously. P( A | B ) may or may not be equal to P( A ) , i.e., the unconditional probability or absolute probability of A . If P( A | B ) = P( A ) , then events A and B are said to be independent : in such a case, knowledge about either event does not alter the likelihood of each other. P( A | B ) (the conditional probability of A given B ) typically differs from P( B | A ) . For example, if a person has dengue fever , the person might have a 90% chance of being tested as positive for the disease. In this case, what is being measured is that if event B ( having dengue ) has occurred, the probability of A ( tested as positive ) given that B occurred is 90%, simply writing P( A | B ) = 90%. Alternatively, if a person is tested as positive for dengue fever, they may have only a 15% chance of actually having this rare disease due to high false positive rates. In this case, the probability of the event B ( having dengue ) given that the event A ( testing positive ) has occurred is 15% or P( B | A ) = 15%. It should be apparent now that falsely equating the two probabilities can lead to various errors of reasoning, which is commonly seen through base rate fallacies . While conditional probabilities can provide extremely useful information, limited information is often supplied or at hand. Therefore, it can be useful to reverse or convert a conditional probability using Bayes' theorem : P ( A ∣ B ) = P ( B ∣ A ) P ( A ) P ( B ) {\displaystyle P(A\mid B)={{P(B\mid A)P(A)} \over {P(B)}}} . Another option is to display conditional probabilities in a conditional probability table to illuminate the relationship between events.Given two events A and B from the sigma-field of a probability space, with the unconditional probability of B being greater than zero (i.e., P( B ) > 0) , the conditional probability of A given B ( P ( A ∣ B ) {\displaystyle P(A\mid B)} ) is the probability of A occurring if B has or is assumed to have happened. A is assumed to be the set of all possible outcomes of an experiment or random trial that has a restricted or reduced sample space. The conditional probability can be found by the quotient of the probability of the joint intersection of events A and B , that is, P ( A ∩ B ) {\displaystyle P(A\cap B)} , the probability at which A and B occur together, and the probability of B : For a sample space consisting of equal likelihood outcomes, the probability of the event A is understood as the fraction of the number of outcomes in A to the number of all outcomes in the sample space. Then, this equation is understood as the fraction of the set A ∩ B {\displaystyle A\cap B} to the set B . Note that the above equation is a definition, not just a theoretical result. We denote the quantity P ( A ∩ B ) P ( B ) {\displaystyle { rac {P(A\cap B)}{P(B)}}} as P ( A ∣ B ) {\displaystyle P(A\mid B)} and call it the "conditional probability of A given B ." Some authors, such as de Finetti , prefer to introduce conditional probability as an axiom of probability : This equation for a conditional probability, although mathematically equivalent, may be intuitively easier to understand. It can be interpreted as "the probability of B occurring multiplied by the probability of A occurring, provided that B has occurred, is equal to the probability of the A and B occurrences together, although not necessarily occurring at the same time". Additionally, this may be preferred philosophically; under major probability interpretations , such as the subjective theory , conditional probability is considered a primitive entity. Moreover, this "multiplication rule" can be practically useful in computing the probability of A ∩ B {\displaystyle A\cap B} and introduces a symmetry with the summation axiom for Poincaré Formula: Conditional probability can be defined as the probability of a conditional event A B {\displaystyle A_{B}} . The Goodman–Nguyen–Van Fraassen conditional event can be defined as: It can be shown that which meets the Kolmogorov definition of conditional probability. If P ( B ) = 0 {\displaystyle P(B)=0} , then according to the definition, P ( A ∣ B ) {\displaystyle P(A\mid B)} is undefined . The case of greatest interest is that of a random variable Y , conditioned on a continuous random variable X resulting in a particular outcome x . The event B = { X = x } {\displaystyle B=\{X=x\}} has probability zero and, as such, cannot be conditioned on. Instead of conditioning on X being exactly x , we could condition on it being closer than distance ϵ {\displaystyle \epsilon } away from x . The event B = { x − ϵ < X < x + ϵ } {\displaystyle B=\{x-\epsilon <X<x+\epsilon \}} will generally have nonzero probability and hence, can be conditioned on. We can then take the limit For example, if two continuous random variables X and Y have a joint density f X , Y ( x , y ) {\displaystyle f_{X,Y}(x,y)} , then by L'Hôpital's rule and Leibniz integral rule , upon differentiation with respect to ϵ {\displaystyle \epsilon } : The resulting limit is the conditional probability distribution of Y given X and exists when the denominator, the probability density f X ( x 0 ) {\displaystyle f_{X}(x_{0})} , is strictly positive. It is tempting to define the undefined probability P ( A ∣ X = x ) {\displaystyle P(A\mid X=x)} using this limit, but this cannot be done in a consistent manner. In particular, it is possible to find random variables X and W and values x , w such that the events { X = x } {\displaystyle \{X=x\}} and { W = w } {\displaystyle \{W=w\}} are identical but the resulting limits are not: The Borel–Kolmogorov paradox demonstrates this with a geometrical argument. Let X be a discrete random variable and its possible outcomes denoted V . For example, if X represents the value of a rolled dice then V is the set { 1 , 2 , 3 , 4 , 5 , 6 } {\displaystyle \{1,2,3,4,5,6\}} . Let us assume for the sake of presentation that X is a discrete random variable, so that each value in V has a nonzero probability. For a value x in V and an event A , the conditional probability is given by P ( A ∣ X = x ) {\displaystyle P(A\mid X=x)} . Writing for short, we see that it is a function of two variables, x and A . For a fixed A , we can form the random variable Y = c ( X , A ) {\displaystyle Y=c(X,A)} . It represents an outcome of P ( A ∣ X = x ) {\displaystyle P(A\mid X=x)} whenever a value x of X is observed. The conditional probability of A given X can thus be treated as a random variable Y with outcomes in the interval [ 0 , 1 ] {\displaystyle [0,1]} . From the law of total probability , its expected value is equal to the unconditional probability of A . The partial conditional probability P ( A ∣ B 1 ≡ b 1 , … , B m ≡ b m ) {\displaystyle P(A\mid B_{1}\equiv b_{1},\ldots ,B_{m}\equiv b_{m})} is about the probability of event A {\displaystyle A} given that each of the condition events B i {\displaystyle B_{i}} has occurred to a degree b i {\displaystyle b_{i}} (degree of belief, degree of experience) that might be different from 100%. Frequentistically, partial conditional probability makes sense, if the conditions are tested in experiment repetitions of appropriate length n {\displaystyle n} . Such n {\displaystyle n} -bounded partial conditional probability can be defined as the conditionally expected average occurrence of event A {\displaystyle A} in testbeds of length n {\displaystyle n} that adhere to all of the probability specifications B i ≡ b i {\displaystyle B_{i}\equiv b_{i}} , i.e.: Based on that, partial conditional probability can be defined as where b i n ∈ N {\displaystyle b_{i}n\in \mathbb {N} } Jeffrey conditionalization is a special case of partial conditional probability, in which the condition events must form a partition :Given two events A and B from the sigma-field of a probability space, with the unconditional probability of B being greater than zero (i.e., P( B ) > 0) , the conditional probability of A given B ( P ( A ∣ B ) {\displaystyle P(A\mid B)} ) is the probability of A occurring if B has or is assumed to have happened. A is assumed to be the set of all possible outcomes of an experiment or random trial that has a restricted or reduced sample space. The conditional probability can be found by the quotient of the probability of the joint intersection of events A and B , that is, P ( A ∩ B ) {\displaystyle P(A\cap B)} , the probability at which A and B occur together, and the probability of B : For a sample space consisting of equal likelihood outcomes, the probability of the event A is understood as the fraction of the number of outcomes in A to the number of all outcomes in the sample space. Then, this equation is understood as the fraction of the set A ∩ B {\displaystyle A\cap B} to the set B . Note that the above equation is a definition, not just a theoretical result. We denote the quantity P ( A ∩ B ) P ( B ) {\displaystyle { rac {P(A\cap B)}{P(B)}}} as P ( A ∣ B ) {\displaystyle P(A\mid B)} and call it the "conditional probability of A given B ." Some authors, such as de Finetti , prefer to introduce conditional probability as an axiom of probability : This equation for a conditional probability, although mathematically equivalent, may be intuitively easier to understand. It can be interpreted as "the probability of B occurring multiplied by the probability of A occurring, provided that B has occurred, is equal to the probability of the A and B occurrences together, although not necessarily occurring at the same time". Additionally, this may be preferred philosophically; under major probability interpretations , such as the subjective theory , conditional probability is considered a primitive entity. Moreover, this "multiplication rule" can be practically useful in computing the probability of A ∩ B {\displaystyle A\cap B} and introduces a symmetry with the summation axiom for Poincaré Formula: Conditional probability can be defined as the probability of a conditional event A B {\displaystyle A_{B}} . The Goodman–Nguyen–Van Fraassen conditional event can be defined as: It can be shown that which meets the Kolmogorov definition of conditional probability. Given two events A and B from the sigma-field of a probability space, with the unconditional probability of B being greater than zero (i.e., P( B ) > 0) , the conditional probability of A given B ( P ( A ∣ B ) {\displaystyle P(A\mid B)} ) is the probability of A occurring if B has or is assumed to have happened. A is assumed to be the set of all possible outcomes of an experiment or random trial that has a restricted or reduced sample space. The conditional probability can be found by the quotient of the probability of the joint intersection of events A and B , that is, P ( A ∩ B ) {\displaystyle P(A\cap B)} , the probability at which A and B occur together, and the probability of B : For a sample space consisting of equal likelihood outcomes, the probability of the event A is understood as the fraction of the number of outcomes in A to the number of all outcomes in the sample space. Then, this equation is understood as the fraction of the set A ∩ B {\displaystyle A\cap B} to the set B . Note that the above equation is a definition, not just a theoretical result. We denote the quantity P ( A ∩ B ) P ( B ) {\displaystyle { rac {P(A\cap B)}{P(B)}}} as P ( A ∣ B ) {\displaystyle P(A\mid B)} and call it the "conditional probability of A given B ."Some authors, such as de Finetti , prefer to introduce conditional probability as an axiom of probability : This equation for a conditional probability, although mathematically equivalent, may be intuitively easier to understand. It can be interpreted as "the probability of B occurring multiplied by the probability of A occurring, provided that B has occurred, is equal to the probability of the A and B occurrences together, although not necessarily occurring at the same time". Additionally, this may be preferred philosophically; under major probability interpretations , such as the subjective theory , conditional probability is considered a primitive entity. Moreover, this "multiplication rule" can be practically useful in computing the probability of A ∩ B {\displaystyle A\cap B} and introduces a symmetry with the summation axiom for Poincaré Formula:Conditional probability can be defined as the probability of a conditional event A B {\displaystyle A_{B}} . The Goodman–Nguyen–Van Fraassen conditional event can be defined as: It can be shown that which meets the Kolmogorov definition of conditional probability. If P ( B ) = 0 {\displaystyle P(B)=0} , then according to the definition, P ( A ∣ B ) {\displaystyle P(A\mid B)} is undefined . The case of greatest interest is that of a random variable Y , conditioned on a continuous random variable X resulting in a particular outcome x . The event B = { X = x } {\displaystyle B=\{X=x\}} has probability zero and, as such, cannot be conditioned on. Instead of conditioning on X being exactly x , we could condition on it being closer than distance ϵ {\displaystyle \epsilon } away from x . The event B = { x − ϵ < X < x + ϵ } {\displaystyle B=\{x-\epsilon <X<x+\epsilon \}} will generally have nonzero probability and hence, can be conditioned on. We can then take the limit For example, if two continuous random variables X and Y have a joint density f X , Y ( x , y ) {\displaystyle f_{X,Y}(x,y)} , then by L'Hôpital's rule and Leibniz integral rule , upon differentiation with respect to ϵ {\displaystyle \epsilon } : The resulting limit is the conditional probability distribution of Y given X and exists when the denominator, the probability density f X ( x 0 ) {\displaystyle f_{X}(x_{0})} , is strictly positive. It is tempting to define the undefined probability P ( A ∣ X = x ) {\displaystyle P(A\mid X=x)} using this limit, but this cannot be done in a consistent manner. In particular, it is possible to find random variables X and W and values x , w such that the events { X = x } {\displaystyle \{X=x\}} and { W = w } {\displaystyle \{W=w\}} are identical but the resulting limits are not: The Borel–Kolmogorov paradox demonstrates this with a geometrical argument.Let X be a discrete random variable and its possible outcomes denoted V . For example, if X represents the value of a rolled dice then V is the set { 1 , 2 , 3 , 4 , 5 , 6 } {\displaystyle \{1,2,3,4,5,6\}} . Let us assume for the sake of presentation that X is a discrete random variable, so that each value in V has a nonzero probability. For a value x in V and an event A , the conditional probability is given by P ( A ∣ X = x ) {\displaystyle P(A\mid X=x)} . Writing for short, we see that it is a function of two variables, x and A . For a fixed A , we can form the random variable Y = c ( X , A ) {\displaystyle Y=c(X,A)} . It represents an outcome of P ( A ∣ X = x ) {\displaystyle P(A\mid X=x)} whenever a value x of X is observed. The conditional probability of A given X can thus be treated as a random variable Y with outcomes in the interval [ 0 , 1 ] {\displaystyle [0,1]} . From the law of total probability , its expected value is equal to the unconditional probability of A .The partial conditional probability P ( A ∣ B 1 ≡ b 1 , … , B m ≡ b m ) {\displaystyle P(A\mid B_{1}\equiv b_{1},\ldots ,B_{m}\equiv b_{m})} is about the probability of event A {\displaystyle A} given that each of the condition events B i {\displaystyle B_{i}} has occurred to a degree b i {\displaystyle b_{i}} (degree of belief, degree of experience) that might be different from 100%. Frequentistically, partial conditional probability makes sense, if the conditions are tested in experiment repetitions of appropriate length n {\displaystyle n} . Such n {\displaystyle n} -bounded partial conditional probability can be defined as the conditionally expected average occurrence of event A {\displaystyle A} in testbeds of length n {\displaystyle n} that adhere to all of the probability specifications B i ≡ b i {\displaystyle B_{i}\equiv b_{i}} , i.e.: Based on that, partial conditional probability can be defined as where b i n ∈ N {\displaystyle b_{i}n\in \mathbb {N} } Jeffrey conditionalization is a special case of partial conditional probability, in which the condition events must form a partition :Suppose that somebody secretly rolls two fair six-sided dice , and we wish to compute the probability that the face-up value of the first one is 2, given the information that their sum is no greater than 5. Probability that D 1 = 2 Table 1 shows the sample space of 36 combinations of rolled values of the two dice, each of which occurs with probability 1/36, with the numbers displayed in the red and dark gray cells being D 1 + D 2 . D 1 = 2 in exactly 6 of the 36 outcomes; thus P ( D 1 = 2) = 6 ⁄ 36 = 1 ⁄ 6 : Probability that D 1 + D 2 ≤ 5 Table 2 shows that D 1 + D 2 ≤ 5 for exactly 10 of the 36 outcomes, thus P ( D 1 + D 2 ≤ 5) = 10 ⁄ 36 : Probability that D 1 = 2 given that D 1 + D 2 ≤ 5 Table 3 shows that for 3 of these 10 outcomes, D 1 = 2. Thus, the conditional probability P( D 1 = 2 | D 1 + D 2 ≤ 5) = 3 ⁄ 10 = 0.3: Here, in the earlier notation for the definition of conditional probability, the conditioning event B is that D 1 + D 2 ≤ 5, and the event A is D 1 = 2. We have P ( A ∣ B ) = P ( A ∩ B ) P ( B ) = 3 / 36 10 / 36 = 3 10 , {\displaystyle P(A\mid B)={ frac {P(A\cap B)}{P(B)}}={ frac {3/36}{10/36}}={ frac {3}{10}},} as seen in the table.In statistical inference , the conditional probability is an update of the probability of an event based on new information. The new information can be incorporated as follows: Let A , the event of interest, be in the sample space , say ( X , P ). The occurrence of the event A knowing that event B has or will have occurred, means the occurrence of A as it is restricted to B , i.e. A ∩ B {\displaystyle A\cap B} . Without the knowledge of the occurrence of B , the information about the occurrence of A would simply be P ( A ) The probability of A knowing that event B has or will have occurred, will be the probability of A ∩ B {\displaystyle A\cap B} relative to P ( B ), the probability that B has occurred. This results in P ( A ∣ B ) = P ( A ∩ B ) / P ( B ) { extstyle P(A\mid B)=P(A\cap B)/P(B)} whenever P ( B ) > 0 and 0 otherwise. This approach results in a probability measure that is consistent with the original probability measure and satisfies all the Kolmogorov axioms . This conditional probability measure also could have resulted by assuming that the relative magnitude of the probability of A with respect to X will be preserved with respect to B (cf. a Formal Derivation below). The wording "evidence" or "information" is generally used in the Bayesian interpretation of probability . The conditioning event is interpreted as evidence for the conditioned event. That is, P ( A ) is the probability of A before accounting for evidence E , and P ( A | E ) is the probability of A after having accounted for evidence E or after having updated P ( A ). This is consistent with the frequentist interpretation, which is the first definition given above. When Morse code is transmitted, there is a certain probability that the "dot" or "dash" that was received is erroneous. This is often taken as interference in the transmission of a message. Therefore, it is important to consider when sending a "dot", for example, the probability that a "dot" was received. This is represented by: P ( dot sent | dot received ) = P ( dot received | dot sent ) P ( dot sent ) P ( dot received ) . {\displaystyle P({ ext{dot sent }}|{ ext{ dot received}})=P({ ext{dot received }}|{ ext{ dot sent}}){ rac {P({ ext{dot sent}})}{P({ ext{dot received}})}}.} In Morse code, the ratio of dots to dashes is 3:4 at the point of sending, so the probability of a "dot" and "dash" are P ( dot sent ) = 3 7 a n d P ( dash sent ) = 4 7 {\displaystyle P({ ext{dot sent}})={ rac {3}{7}}\ and\ P({ ext{dash sent}})={ rac {4}{7}}} . If it is assumed that the probability that a dot is transmitted as a dash is 1/10, and that the probability that a dash is transmitted as a dot is likewise 1/10, then Bayes's rule can be used to calculate P ( dot received ) {\displaystyle P({ ext{dot received}})} . P ( dot received ) = P ( dot received ∩ dot sent ) + P ( dot received ∩ dash sent ) {\displaystyle P({ ext{dot received}})=P({ ext{dot received }}\cap { ext{ dot sent}})+P({ ext{dot received }}\cap { ext{ dash sent}})} P ( dot received ) = P ( dot received ∣ dot sent ) P ( dot sent ) + P ( dot received ∣ dash sent ) P ( dash sent ) {\displaystyle P({ ext{dot received}})=P({ ext{dot received }}\mid { ext{ dot sent}})P({ ext{dot sent}})+P({ ext{dot received }}\mid { ext{ dash sent}})P({ ext{dash sent}})} P ( dot received ) = 9 10 × 3 7 + 1 10 × 4 7 = 31 70 {\displaystyle P({ ext{dot received}})={ rac {9}{10}} imes { rac {3}{7}}+{ rac {1}{10}} imes { rac {4}{7}}={ rac {31}{70}}} Now, P ( dot sent ∣ dot received ) {\displaystyle P({ ext{dot sent }}\mid { ext{ dot received}})} can be calculated: P ( dot sent ∣ dot received ) = P ( dot received ∣ dot sent ) P ( dot sent ) P ( dot received ) = 9 10 × 3 7 31 70 = 27 31 {\displaystyle P({ ext{dot sent }}\mid { ext{ dot received}})=P({ ext{dot received }}\mid { ext{ dot sent}}){ rac {P({ ext{dot sent}})}{P({ ext{dot received}})}}={ rac {9}{10}} imes { rac { rac {3}{7}}{ rac {31}{70}}}={ rac {27}{31}}} When Morse code is transmitted, there is a certain probability that the "dot" or "dash" that was received is erroneous. This is often taken as interference in the transmission of a message. Therefore, it is important to consider when sending a "dot", for example, the probability that a "dot" was received. This is represented by: P ( dot sent | dot received ) = P ( dot received | dot sent ) P ( dot sent ) P ( dot received ) . {\displaystyle P({ ext{dot sent }}|{ ext{ dot received}})=P({ ext{dot received }}|{ ext{ dot sent}}){ rac {P({ ext{dot sent}})}{P({ ext{dot received}})}}.} In Morse code, the ratio of dots to dashes is 3:4 at the point of sending, so the probability of a "dot" and "dash" are P ( dot sent ) = 3 7 a n d P ( dash sent ) = 4 7 {\displaystyle P({ ext{dot sent}})={ rac {3}{7}}\ and\ P({ ext{dash sent}})={ rac {4}{7}}} . If it is assumed that the probability that a dot is transmitted as a dash is 1/10, and that the probability that a dash is transmitted as a dot is likewise 1/10, then Bayes's rule can be used to calculate P ( dot received ) {\displaystyle P({ ext{dot received}})} . P ( dot received ) = P ( dot received ∩ dot sent ) + P ( dot received ∩ dash sent ) {\displaystyle P({ ext{dot received}})=P({ ext{dot received }}\cap { ext{ dot sent}})+P({ ext{dot received }}\cap { ext{ dash sent}})} P ( dot received ) = P ( dot received ∣ dot sent ) P ( dot sent ) + P ( dot received ∣ dash sent ) P ( dash sent ) {\displaystyle P({ ext{dot received}})=P({ ext{dot received }}\mid { ext{ dot sent}})P({ ext{dot sent}})+P({ ext{dot received }}\mid { ext{ dash sent}})P({ ext{dash sent}})} P ( dot received ) = 9 10 × 3 7 + 1 10 × 4 7 = 31 70 {\displaystyle P({ ext{dot received}})={ rac {9}{10}} imes { rac {3}{7}}+{ rac {1}{10}} imes { rac {4}{7}}={ rac {31}{70}}} Now, P ( dot sent ∣ dot received ) {\displaystyle P({ ext{dot sent }}\mid { ext{ dot received}})} can be calculated: P ( dot sent ∣ dot received ) = P ( dot received ∣ dot sent ) P ( dot sent ) P ( dot received ) = 9 10 × 3 7 31 70 = 27 31 {\displaystyle P({ ext{dot sent }}\mid { ext{ dot received}})=P({ ext{dot received }}\mid { ext{ dot sent}}){ rac {P({ ext{dot sent}})}{P({ ext{dot received}})}}={ rac {9}{10}} imes { rac { rac {3}{7}}{ rac {31}{70}}}={ rac {27}{31}}} Events A and B are defined to be statistically independent if the probability of the intersection of A and B is equal to the product of the probabilities of A and B: If P ( B ) is not zero, then this is equivalent to the statement that Similarly, if P ( A ) is not zero, then is also equivalent. Although the derived forms may seem more intuitive, they are not the preferred definition as the conditional probabilities may be undefined, and the preferred definition is symmetrical in A and B . Independence does not refer to a disjoint event. It should also be noted that given the independent event pair [A B] and an event C, the pair is defined to be conditionally independent if the product holds true: P ( A B ∣ C ) = P ( A ∣ C ) P ( B ∣ C ) {\displaystyle P(AB\mid C)=P(A\mid C)P(B\mid C)} This theorem could be useful in applications where multiple independent events are being observed. Independent events vs. mutually exclusive events The concepts of mutually independent events and mutually exclusive events are separate and distinct. The following table contrasts results for the two cases (provided that the probability of the conditioning event is not zero). In fact, mutually exclusive events cannot be statistically independent (unless both of them are impossible), since knowing that one occurs gives information about the other (in particular, that the latter will certainly not occur).In general, it cannot be assumed that P ( A | B ) ≈ P ( B | A ). This can be an insidious error, even for those who are highly conversant with statistics. The relationship between P ( A | B ) and P ( B | A ) is given by Bayes' theorem : That is, P( A | B ) ≈ P( B | A ) only if P ( B )/ P ( A ) ≈ 1, or equivalently, P ( A ) ≈ P ( B ). In general, it cannot be assumed that P ( A ) ≈ P ( A | B ). These probabilities are linked through the law of total probability : where the events ( B n ) {\displaystyle (B_{n})} form a countable partition of Ω {\displaystyle \Omega } . This fallacy may arise through selection bias . For example, in the context of a medical claim, let S C be the event that a sequela (chronic disease) S occurs as a consequence of circumstance (acute condition) C . Let H be the event that an individual seeks medical help. Suppose that in most cases, C does not cause S (so that P ( S C ) is low). Suppose also that medical attention is only sought if S has occurred due to C . From experience of patients, a doctor may therefore erroneously conclude that P ( S C ) is high. The actual probability observed by the doctor is P ( S C | H ). Not taking prior probability into account partially or completely is called base rate neglect . The reverse, insufficient adjustment from the prior probability is conservatism .In general, it cannot be assumed that P ( A | B ) ≈ P ( B | A ). This can be an insidious error, even for those who are highly conversant with statistics. The relationship between P ( A | B ) and P ( B | A ) is given by Bayes' theorem : That is, P( A | B ) ≈ P( B | A ) only if P ( B )/ P ( A ) ≈ 1, or equivalently, P ( A ) ≈ P ( B ).In general, it cannot be assumed that P ( A ) ≈ P ( A | B ). These probabilities are linked through the law of total probability : where the events ( B n ) {\displaystyle (B_{n})} form a countable partition of Ω {\displaystyle \Omega } . This fallacy may arise through selection bias . For example, in the context of a medical claim, let S C be the event that a sequela (chronic disease) S occurs as a consequence of circumstance (acute condition) C . Let H be the event that an individual seeks medical help. Suppose that in most cases, C does not cause S (so that P ( S C ) is low). Suppose also that medical attention is only sought if S has occurred due to C . From experience of patients, a doctor may therefore erroneously conclude that P ( S C ) is high. The actual probability observed by the doctor is P ( S C | H ).Not taking prior probability into account partially or completely is called base rate neglect . The reverse, insufficient adjustment from the prior probability is conservatism .Formally, P ( A | B ) is defined as the probability of A according to a new probability function on the sample space, such that outcomes not in B have probability 0 and that it is consistent with all original probability measures . Let Ω be a discrete sample space with elementary events { ω }, and let P be the probability measure with respect to the σ-algebra of Ω. Suppose we are told that the event B ⊆ Ω has occurred. A new probability distribution (denoted by the conditional notation) is to be assigned on { ω } to reflect this. All events that are not in B will have null probability in the new distribution. For events in B , two conditions must be met: the probability of B is one and the relative magnitudes of the probabilities must be preserved. The former is required by the axioms of probability , and the latter stems from the fact that the new probability measure has to be the analog of P in which the probability of B is one - and every event that is not in B , therefore, has a null probability. Hence, for some scale factor α , the new distribution must satisfy: ω ∈ B : P ( ω ∣ B ) = α P ( ω ) {\displaystyle \omega \in B:P(\omega \mid B)=lpha P(\omega )} ω ∉ B : P ( ω ∣ B ) = 0 {\displaystyle \omega otin B:P(\omega \mid B)=0} ∑ ω ∈ Ω P ( ω ∣ B ) = 1. {\displaystyle \sum _{\omega \in \Omega }{P(\omega \mid B)}=1.} Substituting 1 and 2 into 3 to select α : So the new probability distribution is ω ∈ B : P ( ω ∣ B ) = P ( ω ) P ( B ) {\displaystyle \omega \in B:P(\omega \mid B)={ rac {P(\omega )}{P(B)}}} ω ∉ B : P ( ω ∣ B ) = 0 {\displaystyle \omega otin B:P(\omega \mid B)=0} Now for a general event A ,

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Dengue fever

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Gangrene

Gangrene is a type of tissue death caused by a lack of blood supply . Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the gangrene is caused by an infectious agent, it may present with a fever or sepsis . Risk factors include diabetes , peripheral arterial disease , smoking , major trauma , alcoholism , HIV/AIDS , frostbite , influenza , dengue fever , malaria , chickenpox , plague , hypernatremia , radiation injuries , meningococcal disease , Group B streptococcal infection and Raynaud's syndrome . It can be classified as dry gangrene , wet gangrene , gas gangrene , internal gangrene , and necrotizing fasciitis . The diagnosis of gangrene is based on symptoms and supported by tests such as medical imaging . Treatment may involve surgery to remove the dead tissue, antibiotics to treat any infection, and efforts to address the underlying cause. Surgical efforts may include debridement , amputation , or the use of maggot therapy . Efforts to treat the underlying cause may include bypass surgery or angioplasty . In certain cases, hyperbaric oxygen therapy may be useful. How commonly the condition occurs is unknown. Symptoms may include a change in skin color to red or black, numbness, pain, skin breakdown, and coolness. The feet and hands are most commonly involved. Gangrene is caused by a critically insufficient blood supply (e.g., peripheral vascular disease ) or infection. It is associated with diabetes and long-term tobacco smoking. Dry gangrene is a form of coagulative necrosis that develops in ischemic tissue , where the blood supply is inadequate to keep tissue viable. It is not a disease itself, but a symptom of other diseases. The term dry is used only when referring to a limb or to the gut (in other locations, this same type of necrosis is called an infarction, such as myocardial infarction ). Dry gangrene is often due to peripheral artery disease , but can be due to acute limb ischemia . As a result, people with atherosclerosis, high cholesterol, diabetes and smokers commonly have dry gangrene. The limited oxygen in the ischemic limb limits putrefaction and bacteria fail to survive. The affected part is dry, shrunken, and dark reddish-black. The line of separation usually brings about complete separation, with eventual falling off of the gangrenous tissue if it is not removed surgically, a process called autoamputation . Dry gangrene is the result of chronic ischemia without infection . If ischemia is detected early, when ischemic wounds rather than gangrene are present, the process can be treated by revascularization (via vascular bypass or angioplasty). However, once gangrene has developed, the affected tissues are not salvageable. Because dry gangrene is not accompanied by infection, it is not as emergent as gas gangrene or wet gangrene, both of which have a risk of sepsis. Over time, dry gangrene may develop into wet gangrene if an infection develops in the dead tissues. Diabetes mellitus is a risk factor for peripheral vascular disease, thus for dry gangrene, but also a risk factor for wet gangrene, particularly in patients with poorly controlled blood sugar levels, as elevated serum glucose creates a favorable environment for bacterial infection. Wet, or infected, gangrene is characterized by thriving bacteria and has a poor prognosis (compared to dry gangrene) due to sepsis resulting from the free communication between infected fluid and circulatory fluid. In wet gangrene, the tissue is infected by saprogenic microorganisms ( Clostridium perfringens or Bacillus fusiformis , for example), which cause tissue to swell and emit a foul odor. Wet gangrene usually develops rapidly due to blockage of venous (mainly) or arterial blood flow. The affected part is saturated with stagnant blood, which promotes the rapid growth of bacteria. The toxic products formed by bacteria are absorbed, causing systemic manifestation of sepsis and finally death. The affected part is edematous, soft, putrid, rotten, and dark. [ citation needed ] Because of the high mortality associated with infected gangrene (about 80% without treatment and 20% with treatment), an emergency salvage amputation, such as a guillotine amputation , is often needed to limit systemic effects of the infection. Such an amputation can be converted to a formal amputation, such as a below- or above-knee amputation . Gas gangrene is a bacterial infection that produces gas within tissues. It can be caused by Clostridium , most commonly alpha toxin -producing C. perfringens , or various nonclostridial species. Infection spreads rapidly as the gases produced by the bacteria expand and infiltrate healthy tissue in the vicinity. Because of its ability to quickly spread to surrounding tissues, gas gangrene should be treated as a medical emergency . Gas gangrene is caused by bacterial exotoxin -producing clostridial species, which are mostly found in soil, and other anaerobes such as Bacteroides and anaerobic streptococci . These environmental bacteria may enter the muscle through a wound and subsequently proliferate in necrotic tissue and secrete powerful toxins that destroy nearby tissue, generating gas at the same time. A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen, and 16.1% oxygen was reported in one clinical case. Gas gangrene can cause necrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid. Dry gangrene is a form of coagulative necrosis that develops in ischemic tissue , where the blood supply is inadequate to keep tissue viable. It is not a disease itself, but a symptom of other diseases. The term dry is used only when referring to a limb or to the gut (in other locations, this same type of necrosis is called an infarction, such as myocardial infarction ). Dry gangrene is often due to peripheral artery disease , but can be due to acute limb ischemia . As a result, people with atherosclerosis, high cholesterol, diabetes and smokers commonly have dry gangrene. The limited oxygen in the ischemic limb limits putrefaction and bacteria fail to survive. The affected part is dry, shrunken, and dark reddish-black. The line of separation usually brings about complete separation, with eventual falling off of the gangrenous tissue if it is not removed surgically, a process called autoamputation . Dry gangrene is the result of chronic ischemia without infection . If ischemia is detected early, when ischemic wounds rather than gangrene are present, the process can be treated by revascularization (via vascular bypass or angioplasty). However, once gangrene has developed, the affected tissues are not salvageable. Because dry gangrene is not accompanied by infection, it is not as emergent as gas gangrene or wet gangrene, both of which have a risk of sepsis. Over time, dry gangrene may develop into wet gangrene if an infection develops in the dead tissues. Diabetes mellitus is a risk factor for peripheral vascular disease, thus for dry gangrene, but also a risk factor for wet gangrene, particularly in patients with poorly controlled blood sugar levels, as elevated serum glucose creates a favorable environment for bacterial infection. Wet, or infected, gangrene is characterized by thriving bacteria and has a poor prognosis (compared to dry gangrene) due to sepsis resulting from the free communication between infected fluid and circulatory fluid. In wet gangrene, the tissue is infected by saprogenic microorganisms ( Clostridium perfringens or Bacillus fusiformis , for example), which cause tissue to swell and emit a foul odor. Wet gangrene usually develops rapidly due to blockage of venous (mainly) or arterial blood flow. The affected part is saturated with stagnant blood, which promotes the rapid growth of bacteria. The toxic products formed by bacteria are absorbed, causing systemic manifestation of sepsis and finally death. The affected part is edematous, soft, putrid, rotten, and dark. [ citation needed ] Because of the high mortality associated with infected gangrene (about 80% without treatment and 20% with treatment), an emergency salvage amputation, such as a guillotine amputation , is often needed to limit systemic effects of the infection. Such an amputation can be converted to a formal amputation, such as a below- or above-knee amputation . Gas gangrene is a bacterial infection that produces gas within tissues. It can be caused by Clostridium , most commonly alpha toxin -producing C. perfringens , or various nonclostridial species. Infection spreads rapidly as the gases produced by the bacteria expand and infiltrate healthy tissue in the vicinity. Because of its ability to quickly spread to surrounding tissues, gas gangrene should be treated as a medical emergency . Gas gangrene is caused by bacterial exotoxin -producing clostridial species, which are mostly found in soil, and other anaerobes such as Bacteroides and anaerobic streptococci . These environmental bacteria may enter the muscle through a wound and subsequently proliferate in necrotic tissue and secrete powerful toxins that destroy nearby tissue, generating gas at the same time. A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen, and 16.1% oxygen was reported in one clinical case. Gas gangrene can cause necrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid. Treatment varies based on the severity and type of gangrene. Exercises such as walking and massage therapy may be tried. Medications may include pain management, medications that promote circulation in the circulatory system and antibiotics. Since gangrene is associated with periodic pain caused by too little blood flow, pain management is important so patients can continue doing exercises that promote circulation. Pain management medications can include opioids and opioid-like analgesics. Since gangrene is a result of ischemia , circulatory system management is important. These medications can include antiplatelet drug , anticoagulant , and fibrinolytics . As infection is often associated with gangrene, antibiotics are often a critical component of its treatment. The life-threatening nature of gangrene requires treatment with intravenous antibiotics in an inpatient setting. Antibiotics alone are not effective because they may not penetrate infected tissues sufficiently. Surgical removal of all dead tissue, however, is the mainstay of treatment for gangrene. Often, gangrene is associated with underlying infection, thus the gangrenous tissue must be debrided to hinder the spread of the associated infection. The extent of surgical debridement needed depends on the extent of the gangrene and may be limited to the removal of a finger, toe, or ear, but in severe cases may involve a limb amputation . Dead tissue alone does not require debridement, and in some cases, such as dry gangrene, the affected part falls off (autoamputates), making surgical removal unnecessary. Waiting for autoamputation, however, may cause health complications as well as decreased quality of life. After the gangrene is treated with debridement and antibiotics, the underlying cause can be treated. In the case of gangrene due to critical limb ischemia , revascularization can be performed to treat the underlying peripheral underlateral artery disease. [ citation needed ] Ischemic disease of the legs is the most common reason for amputations. In about a quarter of these cases, the other side requires amputation in the next three years. Angioplasty should be considered if severe blockage in lower leg vessels ( tibial and peroneal artery ) leads to gangrene. Hyperbaric oxygen therapy treatment is used to treat gas gangrene. It increases pressure and oxygen content to allow blood to carry more oxygen to inhibit anaerobic organism growth and reproduction. Regenerative medical treatments and stem-cell therapies have successfully altered gangrene and ulcer prognosis. [ citation needed ]Exercises such as walking and massage therapy may be tried. Medications may include pain management, medications that promote circulation in the circulatory system and antibiotics. Since gangrene is associated with periodic pain caused by too little blood flow, pain management is important so patients can continue doing exercises that promote circulation. Pain management medications can include opioids and opioid-like analgesics. Since gangrene is a result of ischemia , circulatory system management is important. These medications can include antiplatelet drug , anticoagulant , and fibrinolytics . As infection is often associated with gangrene, antibiotics are often a critical component of its treatment. The life-threatening nature of gangrene requires treatment with intravenous antibiotics in an inpatient setting. Antibiotics alone are not effective because they may not penetrate infected tissues sufficiently. Surgical removal of all dead tissue, however, is the mainstay of treatment for gangrene. Often, gangrene is associated with underlying infection, thus the gangrenous tissue must be debrided to hinder the spread of the associated infection. The extent of surgical debridement needed depends on the extent of the gangrene and may be limited to the removal of a finger, toe, or ear, but in severe cases may involve a limb amputation . Dead tissue alone does not require debridement, and in some cases, such as dry gangrene, the affected part falls off (autoamputates), making surgical removal unnecessary. Waiting for autoamputation, however, may cause health complications as well as decreased quality of life. After the gangrene is treated with debridement and antibiotics, the underlying cause can be treated. In the case of gangrene due to critical limb ischemia , revascularization can be performed to treat the underlying peripheral underlateral artery disease. [ citation needed ] Ischemic disease of the legs is the most common reason for amputations. In about a quarter of these cases, the other side requires amputation in the next three years. Angioplasty should be considered if severe blockage in lower leg vessels ( tibial and peroneal artery ) leads to gangrene. Hyperbaric oxygen therapy treatment is used to treat gas gangrene. It increases pressure and oxygen content to allow blood to carry more oxygen to inhibit anaerobic organism growth and reproduction. Regenerative medical treatments and stem-cell therapies have successfully altered gangrene and ulcer prognosis. [ citation needed ]As early as 1028, flies and maggots were commonly used to treat chronic wounds or ulcers to prevent or arrest necrotic spread, as some species of maggots consume only dead flesh, leaving nearby living tissue unaffected. This practice largely died out after the introduction of antibiotics to the range of treatments for wounds. In recent times, however, maggot therapy has regained some credibility and is sometimes employed with great efficacy in cases of chronic tissue necrosis. The French Baroque composer Jean-Baptiste Lully contracted gangrene in January 1687 when, while conducting a performance of his Te Deum , he stabbed his own toe with his pointed staff (which was used as a baton ). The disease spread to his leg, but the composer refused to have his toe amputated , which eventually led to his death in March of that year. French King Louis XIV died of gangrene in his leg on 1 September 1715, four days prior to his 77th birthday. Sebald Justinus Brugmans , Professor at Leyden University , from 1795 on Director of the Medical Bureau of the Batavian Republic, and inspector-general of the French Imperial Military Health-Service in 1811, became a leading expert in the fight against hospital-gangrene and its prevention. He wrote a treatise on gangrene in 1814 in which he meticulously analyzed and explained the causes of this dreadful disease, which he was convinced was contagious. He completed his entry with a thorough evaluation of all possible and well experienced sanitary regulations. His work was very well received and was instrumental in convincing most later authors that gangrene was a contagious disease. John M. Trombold wrote: "Middleton Goldsmith, a surgeon in the Union Army during the American Civil War, meticulously studied hospital gangrene and developed a revolutionary treatment regimen. The cumulative Civil War hospital gangrene mortality was 45%. Goldsmith's method, which he applied to over 330 cases, yielded a mortality under 3%." Goldsmith advocated the use of debridement and topical and injected bromide solutions on infected wounds to reduce the incidence and virulence of "poisoned miasma". Copies of his book were issued to Union surgeons to encourage the use of his methods. The etymology of gangrene derives from the Latin word gangraena and from the Greek gangraina (γάγγραινα), which means " putrefaction of tissues".

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Dengue fever

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Petechia

pɪˈtiːkɪə A petechia ( / p ɪ ˈ t iː k i ə / ; pl. : petechiae ) is a small red or purple spot (≤4 mm in diameter) that can appear on the skin , conjunctiva , retina , and mucous membranes which is caused by haemorrhage of capillaries. The word is derived from Italian petecchia , 'freckle,' of obscure origin. It refers to one of the three descriptive types of hematoma differentiated by size, the other two being ecchymosis (>1cm in diameter) and purpura (4-10mm in diameter). The term is typically used in the plural (petechiae), since a single petechia is seldom noticed or significant.The most common cause of petechiae is through physical trauma such as a hard bout of coughing, holding breath, vomiting, or crying, which can result in facial petechiae, especially around the eyes. Excessive scratching and friction, especially on thin and poorly circulated parts of the body may also cause petechiae. Such instances are generally considered harmless and usually disappear within a few days, but depending on severity and frequency may be indicative of an underlying medical condition.The most common cause of petechiae is through physical trauma such as a hard bout of coughing, holding breath, vomiting, or crying, which can result in facial petechiae, especially around the eyes. Excessive scratching and friction, especially on thin and poorly circulated parts of the body may also cause petechiae. Such instances are generally considered harmless and usually disappear within a few days, but depending on severity and frequency may be indicative of an underlying medical condition.Petechiae on the face and conjunctiva (eyes) are unrelated to asphyxiation or hypoxia . Despite this, petechiae are used by police investigators in determining whether strangulation has been part of an attack. The documentation of the presence of petechiae on a victim can help police investigators prove the case. Petechiae resulting from strangulation can be relatively tiny and light in color to very bright and pronounced. Petechiae may be seen on the face, in the whites of the eyes or on the inside of the eyelids.

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Dengue fever

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Break-bone fever

Break-bone fever may refer to

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Dengue fever

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Yash Chopra

Film director producer Yash Raj Chopra (27 September 1932 – 21 October 2012) was an Indian film director and film producer who worked in Hindi cinema . The founding chairman of the film production and distribution company Yash Raj Films , Chopra was the recipient of several awards, including 6 National Film Awards and 8 Filmfare Awards . He is considered among the best Hindi filmmakers, particularly known and admired for his romantic films with strong female leads. For his contributions to film, the Government of India honoured him with the Dadasaheb Phalke Award in 2001, and the Padma Bhushan in 2005. In 2006, British Academy of Film and Television Arts presented him with a lifetime membership, making him the first Indian to receive the honour. Chopra began his career as an assistant director to I. S. Johar and his elder brother, B.R. Chopra . He made his directorial debut with Dhool Ka Phool in 1959, a melodrama about illegitimacy, and followed it with the social drama Dharmputra (1961). Chopra rose to prominence after directing the critically and commercially successful family drama Waqt (1965), which pioneered the concept of ensemble casts in Bollywood. In 1970, he founded his own production company, Yash Raj Films, whose first production was Daag: A Poem of Love (1973), a successful melodrama about polygamy. His success continued in the seventies, with some of Indian cinema's most successful and iconic films, including the action-thriller Deewaar (1975), which established Amitabh Bachchan as a leading actor in Bollywood; the ensemble musical romantic drama Kabhi Kabhie (1976) and the ensemble family drama Trishul (1978). Chopra collaborated with Sridevi in two of what has been considered to be his finest films; the romantic musical Chandni (1989), which became instrumental in ending the era of violent films in Bollywood and rejuvenating the romantic musical genre, and the intergenerational musical romantic drama Lamhe (1991), considered by critics and Chopra himself to be his best work, but underperformed at the domestic box-office, although bringing major profits overseas. After helming the critically-panned Parampara (1993), Chopra directed the musical psychological thriller Darr (1993), the first of his collaborations with Shahrukh Khan . Chopra directed three more romantic films, all starring Khan; Dil To Pagal Hai (1997), Veer-Zaara (2004) and Jab Tak Hai Jaan (2012), before announcing his retirement from direction in 2012. He died of dengue fever during Jab Tak Hai Jaan ' s production in 2012. He is considered one of the all-time best directors in Bollywood industry. Chopra was born on 27 September 1932 in Lahore , Punjab Province , British India into a Punjabi Hindu Khatri family. His father was an accountant in the PWD division of the British Punjab administration. He was the youngest of eight children, the oldest of whom was almost 30 years his senior. The eminent film-maker B. R. Chopra is one of his brothers. Chopra was largely brought up in the Lahore house of his second brother, B. R. Chopra, then a film journalist. Chopra studied at Doaba College Jalandhar and originally sought to pursue a career in engineering. He later moved to Ludhiana , East Punjab (in India ) after the Partition of India . His passion for film-making led him to travel to Bombay , where he initially worked as an assistant director to I. S. Johar , and then for his director-producer brother, B. R. Chopra, while another brother, Dharam Chopra, worked as his cameraman. Chopra received his first directorial opportunity in 1959 with the social drama Dhool Ka Phool , produced by his elder brother B.R. Chopra and starring Mala Sinha , Rajendra Kumar and Nanda . The film revolved around a Muslim bringing up an "illegitimate" Hindu child. The film was well received by critics and became the fourth highest-grossing film of the year. Encouraged by their success, the Chopras made another hard-hitting social drama, Dharmputra (1961). It was one of the first films to depict the Partition of India and Hindu fundamentalism. The film marked the debut of Shashi Kapoor in a fully fledged role and was awarded with the National Film Award for Best Feature Film in Hindi . Chopra's collaboration with his brother continued in the form of the 1965 film Waqt , which featured an ensemble cast including Sunil Dutt , Raaj Kumar , Shashi Kapoor , Sadhana , Balraj Sahni , Madan Puri , Sharmila Tagore , Achala Sachdev and Rehman . The film became a critical and commercial success. It is acknowledged as a "found film" of the "lost-and-found" genre. Setting many other trends, it was one of Indian cinema 's first multi-starrers, a mode which became increasingly popular among the producers during the 1970s. It also began the now-obligatory style of depicting wealth and social class. Chopra received his first Filmfare Award for Best Director for the film. In 1969, Chopra directed two films produced by his brother. The first was Aadmi Aur Insaan , which featured Dharmendra and Saira Banu in the lead roles. He directed Ittefaq (1969), a mystery thriller film based on a Gujarati play, depicting the events of a single night, with Rajesh Khanna and Nanda in the lead roles. Shot in a month and on a low budget, the film was deemed unusual by critics. It was one of the first Hindi films which did not have any songs or an interval. It was eventually declared a semi-hit at the box-office and won Chopra his second Filmfare Award for Best Director. In 1970, Chopra founded the independent Yash Raj Films , terminating his creative collaboration with his brother. His first independently-produced film, Daag: A Poem of Love (1973), a melodrama about polygamy, starring Rajesh Khanna , Sharmila Tagore and Raakhee was a major critical and commercial success and Chopra won his third Filmfare Award for Best Director for the film. He directed a number of cult classic films starring Amitabh Bachchan and scripted by Salim–Javed , notably Deewaar (1975) and Trishul (1978), which were major critical and commercial successes and remain popular even today. These films set the trend for the late-'70s and '80s, establishing Bachchan as the "angry young man". Chopra received nominations for the Filmfare Award for Best Director for both the films, winning for the former, his fourth win in the category. Chopra produced, directed and scripted 2 more films starring Bachchan. Unlike his earlier action-oriented films, these 2 were musical romantic dramas: Kabhi Kabhie (1976), co-starring Raakhee , Shashi Kapoor , Waheeda Rehman , Rishi Kapoor and Neetu Singh , followed by Silsila (1981), co-starring Jaya Bachchan , Rekha and Sanjeev Kumar . Chopra suggested Javed Akhtar to become a lyricist, starting from this film. He also directed Bachchan in the action drama Kaala Patthar (1979), based on the Chasnala mining disaster . However, the film fared average at the box office. He received nominations for the Filmfare Award for Best Director for both Kabhi Kabhie and Kaala Patthar . The '80s marked a professional setback in Chopra's career, as several films he directed and produced in that period failed to leave a mark at the Indian box-office. His film Mashaal (1984) was his first collaboration with the legendary actor, Dilip Kumar . The action-oriented film, which was based on the well-known Marathi play titled Ashroonchi Zhali Phule , received critical acclaim, but fared only average at the box-office. A year later, he made Faasle , a romantic drama starring Sunil Dutt , Rekha , Rohan Kapoor and Farah , which proved to be a critical and commercial disaster at the box-office. He and critics consider it his worst film. Vijay (1988) was also a box-office failure. The film received mixed-to-negative reviews from critics and was dubbed a remake of Trishul . Chopra's lean phase ended in 1989 with the highly-successful romantic musical Chandni , a film with all the hallmarks of what has come to be known as the "Yash Chopra style": heroine-oriented, romantic, emotional, depicting the lifestyle of the elite, with melodious music used in songs picturized in foreign locations. It marked the first collaboration between Chopra and Sridevi . The huge success of its soundtrack was instrumental in ending the era of violence in Bollywood films and bringing back music into Hindi films. After a string of critically and commercially films, the success of Chandni consolidated Sridevi's position as the top female Bollywood star of the era. Though it was not the first time Chopra shot a film in Switzerland , the extensive scenes shot there made it a popular tourist destination for Indians. The film won the National Film Award for Best Popular Film Providing Wholesome Entertainment for 1989, in addition to earning Chopra his eighth nomination for the Filmfare Award for Best Director. He followed it with Lamhe (1991), an intergenerational musical romantic drama starring frequent collaborators Sridevi and Anil Kapoor . The film received widespread critical acclaim, had exceptional music, and was one of the biggest Bollywood hits in the overseas market; however, it was a moderate box-office success in India due to its controversial storyline. The film won five Filmfare Awards , including the Filmfare Award for Best Film , and earned Chopra his ninth nomination for the Filmfare Award for Best Director. Over the years, Lamhe has been hailed as a cult classic; it is regarded as a modern masterpiece and possibly his finest film to date. It was featured in Outlook magazine's list of All-Time Great Indian films. It has been cited by Chopra as his personal favourite of his films. In 1992, Chopra directed Parampara . Despite an all-star cast of Ramya Krishnan , Aamir Khan , Raveena Tandon , Sunil Dutt , Anupam Kher , Vinod Khanna , Ashwini Bhave and Saif Ali Khan (in his film debut), the film was a commercial failure and was panned by critics for its weak storyline and soundtrack, although Chopra's direction was commended. In 1993, Chopra directed the newcomer Shahrukh Khan along with Juhi Chawla and Sunny Deol in the musical psychological thriller Darr . The film depicted the story of an obsessed lover (Khan) and the lengths to which he goes to get the girl (Chawla) who is already happily engaged to another man (Deol). The film was a runaway success and is now considered a cult classic. Darr emerged as one of the highest-grossing Hindi films of 1993. It also established Khan as a bankable star and earned Chopra the National Film Award for Best Popular Film Providing Wholesome Entertainment , in addition to his tenth nomination for the Filmfare Award for Best Director. In 1995, Chopra launched the television production house Metavision . This company produced a singing reality show Meri Awaaz Suno (1995–1997), a talk show Meri Pasand (1995–1996), and a telefilm Humko Ishq Ne Mara (1997). In 1997, Chopra directed, produced and co-wrote the musical romantic drama Dil To Pagal Hai , starring yet again Shahrukh Khan in a love quadrangle with Madhuri Dixit , Karisma Kapoor and Akshay Kumar . It was the first Bollywood film to be shot in Germany . The film became the highest grosser for the year and won several awards, including 8 Filmfare Awards (including an eleventh nomination for the Filmfare Award for Best Director for Chopra) and 3 National Film Awards , including the National Film Award for Best Popular Film Providing Wholesome Entertainment . Chopra then took a sabbatical from directing and focused solely on producing films for over 7 years. In 2004, he returned to direction with the epic love saga Veer-Zaara . Starring Shahrukh Khan again, Preity Zinta and Rani Mukerji in lead roles, the film was the biggest hit of 2004 in both domestic and overseas markets, with a worldwide gross of over ₹ 940 million and was screened at the Berlin Film Festival to high critical appreciation. The film which narrated the star-crossed love story of an Indian air-force officer Veer Pratap Singh (Khan) and a Pakistani woman, Zaara Hayaat Khan (Zinta) was highly appreciated by critics. Rama Sharma from The Tribune wrote: "Giving love its due, Chopra has understandably linked the script to the life of a common man. The pace is exacting. Drawing from the best of the two countries, the story is made more colorful by a spray of the Punjabi culture—be it celebrating Lohri in India or visiting a dargah in Pakistan . He has handled the script cleverly. Whenever the pace begins to slacken, he introduces a new character and a twist." Veer-Zaara won 4 Filmfare Awards , including the Filmfare Award for Best Film, and earned Chopra a record-setting twelfth nomination for the Filmfare Award for Best Director. The film also won the National Film Award for Best Popular Film Providing Wholesome Entertainment . In September 2012, in a special interview with actor Shahrukh Khan on the occasion of his 80th birthday, Chopra announced that Jab Tak Hai Jaan (2012) would be his last directorial venture and that he would opt to focus on his production company and his personal life. For the shoot of the last remaining song in Jab Tak Hai Jaan, director Yash Chopra wanted to shoot a scene with a sari-clad Katrina Kaif romancing Shahrukh Khan in the lush meadows of the Swiss Alps . But his illness, caused by a bout of dengue , stymied the plan for the song, which would have reflected his trademark directorial style. Chopra was known to often cast the same actors in his films, his most famous collaborations being with Amitabh Bachchan , Sanjeev Kumar , Madan Puri , Amrish Puri , Prem Chopra , Nirupa Roy , Aruna Irani , Bindu , Manmohan Krishna , Poonam Dhillon , Parikshit Sahni , Shashi Kapoor , Rishi Kapoor , Neetu Singh , Raakhee , Rajesh Khanna , Sunil Dutt , Anil Kapoor , Waheeda Rehman , Hema Malini , Anupam Kher , Iftekhar , Achala Sachdev , Vikas Anand and more recently, Shahrukh Khan .Chopra received his first directorial opportunity in 1959 with the social drama Dhool Ka Phool , produced by his elder brother B.R. Chopra and starring Mala Sinha , Rajendra Kumar and Nanda . The film revolved around a Muslim bringing up an "illegitimate" Hindu child. The film was well received by critics and became the fourth highest-grossing film of the year. Encouraged by their success, the Chopras made another hard-hitting social drama, Dharmputra (1961). It was one of the first films to depict the Partition of India and Hindu fundamentalism. The film marked the debut of Shashi Kapoor in a fully fledged role and was awarded with the National Film Award for Best Feature Film in Hindi . Chopra's collaboration with his brother continued in the form of the 1965 film Waqt , which featured an ensemble cast including Sunil Dutt , Raaj Kumar , Shashi Kapoor , Sadhana , Balraj Sahni , Madan Puri , Sharmila Tagore , Achala Sachdev and Rehman . The film became a critical and commercial success. It is acknowledged as a "found film" of the "lost-and-found" genre. Setting many other trends, it was one of Indian cinema 's first multi-starrers, a mode which became increasingly popular among the producers during the 1970s. It also began the now-obligatory style of depicting wealth and social class. Chopra received his first Filmfare Award for Best Director for the film. In 1969, Chopra directed two films produced by his brother. The first was Aadmi Aur Insaan , which featured Dharmendra and Saira Banu in the lead roles. He directed Ittefaq (1969), a mystery thriller film based on a Gujarati play, depicting the events of a single night, with Rajesh Khanna and Nanda in the lead roles. Shot in a month and on a low budget, the film was deemed unusual by critics. It was one of the first Hindi films which did not have any songs or an interval. It was eventually declared a semi-hit at the box-office and won Chopra his second Filmfare Award for Best Director. In 1970, Chopra founded the independent Yash Raj Films , terminating his creative collaboration with his brother. His first independently-produced film, Daag: A Poem of Love (1973), a melodrama about polygamy, starring Rajesh Khanna , Sharmila Tagore and Raakhee was a major critical and commercial success and Chopra won his third Filmfare Award for Best Director for the film. He directed a number of cult classic films starring Amitabh Bachchan and scripted by Salim–Javed , notably Deewaar (1975) and Trishul (1978), which were major critical and commercial successes and remain popular even today. These films set the trend for the late-'70s and '80s, establishing Bachchan as the "angry young man". Chopra received nominations for the Filmfare Award for Best Director for both the films, winning for the former, his fourth win in the category. Chopra produced, directed and scripted 2 more films starring Bachchan. Unlike his earlier action-oriented films, these 2 were musical romantic dramas: Kabhi Kabhie (1976), co-starring Raakhee , Shashi Kapoor , Waheeda Rehman , Rishi Kapoor and Neetu Singh , followed by Silsila (1981), co-starring Jaya Bachchan , Rekha and Sanjeev Kumar . Chopra suggested Javed Akhtar to become a lyricist, starting from this film. He also directed Bachchan in the action drama Kaala Patthar (1979), based on the Chasnala mining disaster . However, the film fared average at the box office. He received nominations for the Filmfare Award for Best Director for both Kabhi Kabhie and Kaala Patthar . The '80s marked a professional setback in Chopra's career, as several films he directed and produced in that period failed to leave a mark at the Indian box-office. His film Mashaal (1984) was his first collaboration with the legendary actor, Dilip Kumar . The action-oriented film, which was based on the well-known Marathi play titled Ashroonchi Zhali Phule , received critical acclaim, but fared only average at the box-office. A year later, he made Faasle , a romantic drama starring Sunil Dutt , Rekha , Rohan Kapoor and Farah , which proved to be a critical and commercial disaster at the box-office. He and critics consider it his worst film. Vijay (1988) was also a box-office failure. The film received mixed-to-negative reviews from critics and was dubbed a remake of Trishul . Chopra's lean phase ended in 1989 with the highly-successful romantic musical Chandni , a film with all the hallmarks of what has come to be known as the "Yash Chopra style": heroine-oriented, romantic, emotional, depicting the lifestyle of the elite, with melodious music used in songs picturized in foreign locations. It marked the first collaboration between Chopra and Sridevi . The huge success of its soundtrack was instrumental in ending the era of violence in Bollywood films and bringing back music into Hindi films. After a string of critically and commercially films, the success of Chandni consolidated Sridevi's position as the top female Bollywood star of the era. Though it was not the first time Chopra shot a film in Switzerland , the extensive scenes shot there made it a popular tourist destination for Indians. The film won the National Film Award for Best Popular Film Providing Wholesome Entertainment for 1989, in addition to earning Chopra his eighth nomination for the Filmfare Award for Best Director. He followed it with Lamhe (1991), an intergenerational musical romantic drama starring frequent collaborators Sridevi and Anil Kapoor . The film received widespread critical acclaim, had exceptional music, and was one of the biggest Bollywood hits in the overseas market; however, it was a moderate box-office success in India due to its controversial storyline. The film won five Filmfare Awards , including the Filmfare Award for Best Film , and earned Chopra his ninth nomination for the Filmfare Award for Best Director. Over the years, Lamhe has been hailed as a cult classic; it is regarded as a modern masterpiece and possibly his finest film to date. It was featured in Outlook magazine's list of All-Time Great Indian films. It has been cited by Chopra as his personal favourite of his films. In 1992, Chopra directed Parampara . Despite an all-star cast of Ramya Krishnan , Aamir Khan , Raveena Tandon , Sunil Dutt , Anupam Kher , Vinod Khanna , Ashwini Bhave and Saif Ali Khan (in his film debut), the film was a commercial failure and was panned by critics for its weak storyline and soundtrack, although Chopra's direction was commended.In 1993, Chopra directed the newcomer Shahrukh Khan along with Juhi Chawla and Sunny Deol in the musical psychological thriller Darr . The film depicted the story of an obsessed lover (Khan) and the lengths to which he goes to get the girl (Chawla) who is already happily engaged to another man (Deol). The film was a runaway success and is now considered a cult classic. Darr emerged as one of the highest-grossing Hindi films of 1993. It also established Khan as a bankable star and earned Chopra the National Film Award for Best Popular Film Providing Wholesome Entertainment , in addition to his tenth nomination for the Filmfare Award for Best Director. In 1995, Chopra launched the television production house Metavision . This company produced a singing reality show Meri Awaaz Suno (1995–1997), a talk show Meri Pasand (1995–1996), and a telefilm Humko Ishq Ne Mara (1997). In 1997, Chopra directed, produced and co-wrote the musical romantic drama Dil To Pagal Hai , starring yet again Shahrukh Khan in a love quadrangle with Madhuri Dixit , Karisma Kapoor and Akshay Kumar . It was the first Bollywood film to be shot in Germany . The film became the highest grosser for the year and won several awards, including 8 Filmfare Awards (including an eleventh nomination for the Filmfare Award for Best Director for Chopra) and 3 National Film Awards , including the National Film Award for Best Popular Film Providing Wholesome Entertainment . Chopra then took a sabbatical from directing and focused solely on producing films for over 7 years. In 2004, he returned to direction with the epic love saga Veer-Zaara . Starring Shahrukh Khan again, Preity Zinta and Rani Mukerji in lead roles, the film was the biggest hit of 2004 in both domestic and overseas markets, with a worldwide gross of over ₹ 940 million and was screened at the Berlin Film Festival to high critical appreciation. The film which narrated the star-crossed love story of an Indian air-force officer Veer Pratap Singh (Khan) and a Pakistani woman, Zaara Hayaat Khan (Zinta) was highly appreciated by critics. Rama Sharma from The Tribune wrote: "Giving love its due, Chopra has understandably linked the script to the life of a common man. The pace is exacting. Drawing from the best of the two countries, the story is made more colorful by a spray of the Punjabi culture—be it celebrating Lohri in India or visiting a dargah in Pakistan . He has handled the script cleverly. Whenever the pace begins to slacken, he introduces a new character and a twist." Veer-Zaara won 4 Filmfare Awards , including the Filmfare Award for Best Film, and earned Chopra a record-setting twelfth nomination for the Filmfare Award for Best Director. The film also won the National Film Award for Best Popular Film Providing Wholesome Entertainment . In September 2012, in a special interview with actor Shahrukh Khan on the occasion of his 80th birthday, Chopra announced that Jab Tak Hai Jaan (2012) would be his last directorial venture and that he would opt to focus on his production company and his personal life. For the shoot of the last remaining song in Jab Tak Hai Jaan, director Yash Chopra wanted to shoot a scene with a sari-clad Katrina Kaif romancing Shahrukh Khan in the lush meadows of the Swiss Alps . But his illness, caused by a bout of dengue , stymied the plan for the song, which would have reflected his trademark directorial style.Chopra was known to often cast the same actors in his films, his most famous collaborations being with Amitabh Bachchan , Sanjeev Kumar , Madan Puri , Amrish Puri , Prem Chopra , Nirupa Roy , Aruna Irani , Bindu , Manmohan Krishna , Poonam Dhillon , Parikshit Sahni , Shashi Kapoor , Rishi Kapoor , Neetu Singh , Raakhee , Rajesh Khanna , Sunil Dutt , Anil Kapoor , Waheeda Rehman , Hema Malini , Anupam Kher , Iftekhar , Achala Sachdev , Vikas Anand and more recently, Shahrukh Khan .In 1970, Chopra married Pamela Singh and together they have two sons Aditya Chopra and Uday Chopra , born in 1971 and 1973, respectively. Aditya Chopra is also a film director and producer and holds the position of chairman and managing director of Yash Raj Films, while Uday is an assistant director turned actor who made his acting debut in 2000 in his brother's directorial, Mohabbatein . He is currently the Director – Yash Raj Films, CEO – YRF Entertainment.On 13 October 2012, Chopra was diagnosed with dengue fever and was admitted to Lilavati Hospital in Bandra , Mumbai. On 21 October, Yash Chopra succumbed to death following multiple organ failure . He was 80 years of age. The Chautha ceremony for Yash Chopra was held on 25 October 2012 at Yash Raj Films studio. Yash Chopra's final rites took place at Pawan Hans crematorium on 22 October 2012. The Yash Chopra Memorial Award ceremonies were instituted by the TSR Foundation of T. Subbarami Reddy , which carries Rs 10.00 lakhs cash and citation. These awards ceremonies started in 2013, on the eve of Chopra's death and are dedicated to his memory. The ceremonies are held annually in Mumbai, and feature awards to people in recognition of their outstanding contribution in the field of art and culture.The Yash Chopra Memorial Award ceremonies were instituted by the TSR Foundation of T. Subbarami Reddy , which carries Rs 10.00 lakhs cash and citation. These awards ceremonies started in 2013, on the eve of Chopra's death and are dedicated to his memory. The ceremonies are held annually in Mumbai, and feature awards to people in recognition of their outstanding contribution in the field of art and culture.

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Dengue fever

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2023 dengue outbreak in Bangladesh

In Bangladesh's ongoing 2023 dengue epidemic season , the country has been witnessing the deadliest outbreak of dengue fever ever since the first outbreak in Bangladesh in 2000 . As of 31 December 2023, the Directorate General of Health Services (DGHS) has reported 321,179 hospitalizations and 1,705 deaths due to the Aedes mosquito-borne tropical disease in the 2023 outbreak year. Like previous years, the outbreak started in Summer (April–May), spread and surged nationwide in the monsoons (July–August). On 3 August, the number of deaths surpassed previous years; and on 21 August, the tally of hospitalization surpassed the previous highest record of the 2019 outbreak . Dhaka is the worst-hit area and the epicentre of the outbreak, with more than half of the cases being reported in the megacity . On 25 July, hospitalizations were reported in all districts; and the tally of hospitalizations outside Dhaka city surpassed the figure of the capital on 14 August. In June 2023, the Institute of Epidemiology, Disease Control and Research (IEDCR) reported that people are getting affected with the DENV-2 and DENV-3 variants this season, the two with the highest rates of infections and death. In 2022 and 2021, DENV-4 and DENV-3 were found for the first time, respectively. Although a patient does develop immunity to a certain variant after being infected with it, cross-infection with different variants raises the chance of complications and mortality. Secondary infections show changed symptoms, thus delayed hospitalizations are causing more deaths. It's notable that the death rate has more or less increased in Bangladesh in past years. With more severe cases being referred to the capital, Dhaka's hospitals struggle to control the situation.According to the World Health Organization , Dengue Fever is a primarily mosquito-borne illness that can last between 1 and 2 weeks with a majority of cases not showing any symptoms. In cases with symptoms, the WHO says that the most common symptoms are "high fever, headache, body aches, nausea and rash" and the symptoms can last between 2 and 7 days from the first observation, although in severe cases hospitalization and death are possible. While no dengue-specific treatment exists, prevention by avoiding mosquito-heavy areas and draining standing water are the most common ways to prevent and deal with the illness. DEN-1, DEN-2, DEN-3, and DEN-4 are the main observed strains of Dengue in Bangladesh with any strain giving previously infected individuals cross-immunity between the different strains. However, the individual will only retain long-term immunity against the strain that the individual was infected with originally meaning that someone can be infected up to four times in their lifetime. Bangladesh has also experienced several smaller spread Dengue outbreaks with a notable outbreak in 2000 infecting 5,551 individuals and resulting in the deaths of 93. Since 2017 the most common form of Dengue has been DEN-3, and according to the Bangladesh Medical Research Council from 20 to 19 indicated an increase in the density of mosquitos in and around Dhaka in the "monsoon survey (18-27 July 2019) of 100 sites of 98 wards in Dhaka city both North and South revealed that the number of adult aedes mosquito was increased by 13.52 folds, in compare to the pre-monsoon (3-12 March 2019) survey." Bangladesh is a nation particularly vulnerable to Dengue Fever due to the warm climate and heavy rainfall, enabling the fever to spread through Aedes aegypti and Aedes albopictus mosquitoes which are described by the UN as "long plagued tropical and sub-tropical regions". ACAPS noted in a briefing note that "Dengue outbreaks usually coincide with the warmer months and monsoon season" which for Bangladesh is typically between May and September. ACAPS also noted that poor urban planning for water and waste allowed water to sit in dense areas, allowing mosquitoes to have ease of spreading and reaching humans.

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Dengue fever

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MKUltra

Project MKUltra [lower-alpha 1] [lower-alpha 2] was an illegal human experiments program designed and undertaken by the U.S. Central Intelligence Agency (CIA) to develop procedures and identify drugs that could be used during interrogations to weaken people and force confessions through brainwashing and psychological torture . It began in 1953 and was halted in 1973. MKUltra used numerous methods to manipulate its subjects' mental states and brain functions, such as the covert administration of high doses of psychoactive drugs (especially LSD ) and other chemicals without the subjects' consent, electroshocks , hypnosis , sensory deprivation , isolation, verbal and sexual abuse , and other forms of torture . MKUltra was preceded by Project Artichoke . It was organized through the CIA's Office of Scientific Intelligence and coordinated with the United States Army Biological Warfare Laboratories . The program engaged in illegal activities, including the use of U.S. and Canadian citizens as unwitting test subjects. : 74 MKUltra's scope was broad, with activities carried out under the guise of research at more than 80 institutions aside from the military, including colleges and universities, hospitals, prisons, and pharmaceutical companies. The CIA operated using front organizations , although some top officials at these institutions were aware of the CIA's involvement. MKUltra was revealed to the public in 1975 by the Church Committee of the United States Congress and Gerald Ford 's United States President's Commission on CIA activities within the United States (the Rockefeller Commission). Investigative efforts were hampered by CIA Director Richard Helms 's order that all MKUltra files be destroyed in 1973; the Church Committee and Rockefeller Commission investigations relied on the sworn testimony of direct participants and on the small number of documents that survived Helms's order. In 1977, a Freedom of Information Act request uncovered a cache of 20,000 documents relating to MKUltra, which led to Senate hearings. Some surviving information about MKUltra was declassified in 2001.During the early 1940s, Nazi scientists working in the concentration camps of Auschwitz and Dachau conducted interrogation experiments on human subjects . Substances such as barbiturates , morphine derivatives, and hallucinogens such as mescaline were employed in experiments conducted on Jews and Soviet prisoners of war which aimed to develop a truth serum which would, in the words of one laboratory assistant to Dachau scientist Kurt Plötner , "eliminate the will of the person examined". American historian Stephen Kinzer argues that the CIA project was a "continuation" of these earlier Nazi experiments, citing the numerous German scientists who were hired to work for the U.S. as part of Operation Paperclip . American interest in drug-related interrogation experiments began in 1943, when the Office of Strategic Services began developing a "truth drug" that would produce "uninhibited truthfulness" in an interrogated person. In 1947, the United States Navy initiated Project CHATTER , an interrogation program which saw the first testing of lysergic acid diethylamide (LSD-25) on human subjects. In 1950, the Central Intelligence Agency under the direction of general Walter Bedell Smith initiated a series of interrogation projects involving human subjects, beginning with the launch of Project Bluebird, officially renamed Project Artichoke on August 20, 1951. Directed and overseen by brigadier general Paul F. Gaynor , the objective of Artichoke was to determine whether an individual could be made to involuntarily perform an act of attempted assassination. Morphine , mescaline and LSD were all administered on unknowing CIA agents in an attempt to produce amnesia in the subjects. In addition, Project Artichoke aimed to employ certain viruses such as dengue fever as potential incapacitating agents . The project was headed by Sidney Gottlieb but began on the order of CIA director Allen Dulles on April 13, 1953. Its aim was to develop mind-controlling drugs for use against the Soviet bloc in response to alleged Soviet , Chinese , and North Korean use of mind control techniques on U.S. prisoners of war during the Korean War . The CIA wanted to use similar methods on their own captives, and was interested in manipulating foreign leaders with such techniques, devising several schemes to drug Fidel Castro . It often conducted experiments without the subjects' knowledge or consent. In some cases, academic researchers were funded through grants from CIA front organizations but were unaware that the CIA was using their work for these purposes. The project attempted to produce a perfect truth drug for interrogating suspected Soviet spies during the Cold War and to explore other possibilities of mind control. Subproject 54 was the Navy's top-secret "Perfect Concussion" program, which was supposed to use sub-aural frequency blasts to erase memory; the program was never carried out. Most MKUltra records were destroyed in 1973 by order of CIA director Richard Helms , so it has been difficult for investigators to gain a complete understanding of the more than 150 funded research subprojects sponsored by MKUltra and related CIA programs. The project began during a period of what English journalist Rupert Cornwell described as "paranoia" at the CIA, when the U.S. had lost its nuclear monopoly and fear of communism was at its height. CIA counter-intelligence chief James Jesus Angleton believed that a mole had penetrated the organization at the highest levels. The agency poured millions of dollars into studies examining ways to influence and control the mind and enhance its ability to extract information from resistant subjects during interrogation. Some historians assert that one goal of MKUltra and related CIA projects was to create a Manchurian Candidate -style subject. American historian Alfred W. McCoy has claimed that the CIA attempted to focus media attention on these sorts of "ridiculous" programs so that the public would not look at the research's primary goal, which was effective methods of interrogation. The 1976 Church Committee report found that, in the MKDELTA program, "Drugs were used primarily as an aid to interrogations, but MKULTRA/MKDELTA materials were also used for harassment, discrediting or disabling purposes." In 1964, MKSEARCH was the name given to the continuation of the MKULTRA program. The MKSEARCH program was divided into two projects dubbed MKOFTEN and MKCHICKWIT . Funding for MKSEARCH commenced in 1965, and ended in 1971. The project was a joint project between the U.S. Army Chemical Corps and the CIA's Office of Research and Development to find new offensive-use agents, with a focus on incapacitating agents . Its purpose was to develop, test, and evaluate capabilities in the covert use of biological, chemical, and radioactive material systems and techniques of producing predictable human behavioral and/or physiological changes in support of highly sensitive operational requirements. By March 1971 over 26,000 potential agents had been acquired for future screening. The CIA was interested in bird migration patterns for chemical and biological warfare (CBW) research; subproject 139 designated "Bird Disease Studies" at Penn State . MKOFTEN was to deal with testing and toxicological transmissivity and behavioral effects of drugs in animals and, ultimately, humans. MKCHICKWIT was concerned with acquiring information on new drug developments in Europe and Asia, and with acquiring samples. During the early 1940s, Nazi scientists working in the concentration camps of Auschwitz and Dachau conducted interrogation experiments on human subjects . Substances such as barbiturates , morphine derivatives, and hallucinogens such as mescaline were employed in experiments conducted on Jews and Soviet prisoners of war which aimed to develop a truth serum which would, in the words of one laboratory assistant to Dachau scientist Kurt Plötner , "eliminate the will of the person examined". American historian Stephen Kinzer argues that the CIA project was a "continuation" of these earlier Nazi experiments, citing the numerous German scientists who were hired to work for the U.S. as part of Operation Paperclip . American interest in drug-related interrogation experiments began in 1943, when the Office of Strategic Services began developing a "truth drug" that would produce "uninhibited truthfulness" in an interrogated person. In 1947, the United States Navy initiated Project CHATTER , an interrogation program which saw the first testing of lysergic acid diethylamide (LSD-25) on human subjects. In 1950, the Central Intelligence Agency under the direction of general Walter Bedell Smith initiated a series of interrogation projects involving human subjects, beginning with the launch of Project Bluebird, officially renamed Project Artichoke on August 20, 1951. Directed and overseen by brigadier general Paul F. Gaynor , the objective of Artichoke was to determine whether an individual could be made to involuntarily perform an act of attempted assassination. Morphine , mescaline and LSD were all administered on unknowing CIA agents in an attempt to produce amnesia in the subjects. In addition, Project Artichoke aimed to employ certain viruses such as dengue fever as potential incapacitating agents . The project was headed by Sidney Gottlieb but began on the order of CIA director Allen Dulles on April 13, 1953. Its aim was to develop mind-controlling drugs for use against the Soviet bloc in response to alleged Soviet , Chinese , and North Korean use of mind control techniques on U.S. prisoners of war during the Korean War . The CIA wanted to use similar methods on their own captives, and was interested in manipulating foreign leaders with such techniques, devising several schemes to drug Fidel Castro . It often conducted experiments without the subjects' knowledge or consent. In some cases, academic researchers were funded through grants from CIA front organizations but were unaware that the CIA was using their work for these purposes. The project attempted to produce a perfect truth drug for interrogating suspected Soviet spies during the Cold War and to explore other possibilities of mind control. Subproject 54 was the Navy's top-secret "Perfect Concussion" program, which was supposed to use sub-aural frequency blasts to erase memory; the program was never carried out. Most MKUltra records were destroyed in 1973 by order of CIA director Richard Helms , so it has been difficult for investigators to gain a complete understanding of the more than 150 funded research subprojects sponsored by MKUltra and related CIA programs. The project began during a period of what English journalist Rupert Cornwell described as "paranoia" at the CIA, when the U.S. had lost its nuclear monopoly and fear of communism was at its height. CIA counter-intelligence chief James Jesus Angleton believed that a mole had penetrated the organization at the highest levels. The agency poured millions of dollars into studies examining ways to influence and control the mind and enhance its ability to extract information from resistant subjects during interrogation. Some historians assert that one goal of MKUltra and related CIA projects was to create a Manchurian Candidate -style subject. American historian Alfred W. McCoy has claimed that the CIA attempted to focus media attention on these sorts of "ridiculous" programs so that the public would not look at the research's primary goal, which was effective methods of interrogation. The 1976 Church Committee report found that, in the MKDELTA program, "Drugs were used primarily as an aid to interrogations, but MKULTRA/MKDELTA materials were also used for harassment, discrediting or disabling purposes." In 1964, MKSEARCH was the name given to the continuation of the MKULTRA program. The MKSEARCH program was divided into two projects dubbed MKOFTEN and MKCHICKWIT . Funding for MKSEARCH commenced in 1965, and ended in 1971. The project was a joint project between the U.S. Army Chemical Corps and the CIA's Office of Research and Development to find new offensive-use agents, with a focus on incapacitating agents . Its purpose was to develop, test, and evaluate capabilities in the covert use of biological, chemical, and radioactive material systems and techniques of producing predictable human behavioral and/or physiological changes in support of highly sensitive operational requirements. By March 1971 over 26,000 potential agents had been acquired for future screening. The CIA was interested in bird migration patterns for chemical and biological warfare (CBW) research; subproject 139 designated "Bird Disease Studies" at Penn State . MKOFTEN was to deal with testing and toxicological transmissivity and behavioral effects of drugs in animals and, ultimately, humans. MKCHICKWIT was concerned with acquiring information on new drug developments in Europe and Asia, and with acquiring samples. CIA documents suggest that they investigated "chemical, biological, and radiological" methods of mind control as part of MKUltra. They spent an estimated $10 million or more, roughly $87.5 million adjusted for inflation. Early CIA efforts focused on LSD-25 , which later came to dominate many of MKUltra's programs. The CIA wanted to know if they could make Soviet spies defect against their will and whether the Soviets could do the same to the CIA's own operatives. Documents obtained from the CIA by John D. Marks under Freedom of Information in 1976 showed that, in 1953, the CIA considered purchasing 10 kilograms of LSD, enough for 100 million doses. The proposed purchase aimed to stop other countries from controlling the supply. The documents showed that the CIA purchased some quantities of LSD from Sandoz Laboratories in Switzerland. Once Project MKUltra got underway in April 1953, experiments included administering LSD to mental patients, prisoners, drug addicts, and prostitutes – "people who could not fight back", as one agency officer put it. In one case, they administered LSD to a mental patient in Kentucky for 174 days. They also administered LSD to CIA employees, military personnel, doctors, other government agents, and members of the general public to study their reactions. The aim was to find drugs that would bring out deep confessions or wipe a subject's mind clean and program them as "a robot agent". Military personnel who received the mind-altering drugs were also threatened with court-martials if they told anyone about the experiments. LSD and other drugs were often administered without the subject's knowledge or informed consent , a violation of the Nuremberg Code the U.S. had agreed to follow after World War II. Many veterans who were subjected to experimentation are now seeking legal and monetary reparations. In Operation Midnight Climax , the CIA set up several brothels within agency safehouses in San Francisco to obtain a selection of men who would be too embarrassed to talk about the events. The men were dosed with LSD, the brothels were equipped with one-way mirrors , and the sessions were filmed for later viewing and study. In other experiments where people were given LSD without their knowledge, they were interrogated under bright lights with doctors in the background taking notes. They told subjects they would extend their "trips" if they refused to reveal their secrets. The people under this interrogation were CIA employees, U.S. military personnel, and agents suspected of working for the other side in the Cold War. Long-term debilitation and several deaths resulted from this. Heroin addicts were bribed into taking LSD with offers of more heroin. At the invitation of Stanford psychology graduate student Vik Lovell, an acquaintance of Allen Ginsberg , Ken Kesey volunteered to take part in what turned out to be a CIA -financed study under the aegis of MKUltra, at the Menlo Park Veterans' Hospital where he worked as a night aide. The project studied the effects of psychoactive drugs , particularly LSD , psilocybin , mescaline , cocaine , AMT and DMT on people. The Office of Security used LSD in interrogations, but Sidney Gottlieb , the chemist who directed MKUltra, had other ideas: he thought it could be used in covert operations. Since its effects were temporary, he believed it could be given to high-ranking officials and in this way affect the course of important meetings, speeches, etc. Since he realized there was a difference in testing the drug in a laboratory and using it in clandestine operations, he initiated a series of experiments where LSD was given to people in "normal" settings without warning. At first, everyone in Technical Services tried it; a typical experiment involved two people in a room where they observed each other for hours and took notes. As the experimentation progressed, a point arrived where outsiders were drugged with no explanation whatsoever and surprise acid trips became something of an occupational hazard among CIA operatives. Adverse reactions often occurred, such as an operative who received the drug in his morning coffee, became psychotic and ran across Washington, D.C., seeing a monster in every car passing him. The experiments continued even after Frank Olson , an army chemist who had never taken LSD, was covertly dosed by his CIA supervisor and nine days later plunged to his death from the window of a 13th-story New York City hotel room, supposedly as a result of deep depression induced by the drug. According to Stephen Kinzer , Olson had approached his superiors some time earlier, doubting the morality of the project, and asked to resign from the CIA. Some subjects' participation was consensual, and in these cases they appeared to be singled out for even more extreme experiments. In one case, seven drug-addicted African-American volunteers at the National Institute of Mental Health Addiction Research Center in Kentucky were given LSD for 77 consecutive days. MKUltra's researchers later dismissed LSD as too unpredictable in its results. They gave up on the notion that LSD was "the secret that was going to unlock the universe", but it still had a place in the cloak-and-dagger arsenal. However, by 1962, the CIA and the army developed a series of super-hallucinogens such as the highly touted BZ , which was thought to hold greater promise as a mind control weapon. This resulted in the withdrawal of support by many academics and private researchers, and LSD research became less of a priority altogether. Another technique investigated was the intravenous administration of a barbiturate into one arm and an amphetamine into the other. The barbiturates were released into the person first, and as soon as the person began to fall asleep, the amphetamines were released. Other experiments involved heroin , morphine , temazepam (used under code name MKSEARCH), mescaline , psilocybin , scopolamine , alcohol and sodium pentothal . Declassified MKUltra documents indicate they studied hypnosis in the early 1950s. Experimental goals included creating "hypnotically induced anxieties", "hypnotically increasing ability to learn and recall complex written matter", studying hypnosis and polygraph examinations, "hypnotically increasing ability to observe and recall complex arrangements of physical objects", and studying "relationship of personality to susceptibility to hypnosis". They conducted experiments with drug-induced hypnosis and with anterograde and retrograde amnesia while under the influence of such drugs.Early CIA efforts focused on LSD-25 , which later came to dominate many of MKUltra's programs. The CIA wanted to know if they could make Soviet spies defect against their will and whether the Soviets could do the same to the CIA's own operatives. Documents obtained from the CIA by John D. Marks under Freedom of Information in 1976 showed that, in 1953, the CIA considered purchasing 10 kilograms of LSD, enough for 100 million doses. The proposed purchase aimed to stop other countries from controlling the supply. The documents showed that the CIA purchased some quantities of LSD from Sandoz Laboratories in Switzerland. Once Project MKUltra got underway in April 1953, experiments included administering LSD to mental patients, prisoners, drug addicts, and prostitutes – "people who could not fight back", as one agency officer put it. In one case, they administered LSD to a mental patient in Kentucky for 174 days. They also administered LSD to CIA employees, military personnel, doctors, other government agents, and members of the general public to study their reactions. The aim was to find drugs that would bring out deep confessions or wipe a subject's mind clean and program them as "a robot agent". Military personnel who received the mind-altering drugs were also threatened with court-martials if they told anyone about the experiments. LSD and other drugs were often administered without the subject's knowledge or informed consent , a violation of the Nuremberg Code the U.S. had agreed to follow after World War II. Many veterans who were subjected to experimentation are now seeking legal and monetary reparations. In Operation Midnight Climax , the CIA set up several brothels within agency safehouses in San Francisco to obtain a selection of men who would be too embarrassed to talk about the events. The men were dosed with LSD, the brothels were equipped with one-way mirrors , and the sessions were filmed for later viewing and study. In other experiments where people were given LSD without their knowledge, they were interrogated under bright lights with doctors in the background taking notes. They told subjects they would extend their "trips" if they refused to reveal their secrets. The people under this interrogation were CIA employees, U.S. military personnel, and agents suspected of working for the other side in the Cold War. Long-term debilitation and several deaths resulted from this. Heroin addicts were bribed into taking LSD with offers of more heroin. At the invitation of Stanford psychology graduate student Vik Lovell, an acquaintance of Allen Ginsberg , Ken Kesey volunteered to take part in what turned out to be a CIA -financed study under the aegis of MKUltra, at the Menlo Park Veterans' Hospital where he worked as a night aide. The project studied the effects of psychoactive drugs , particularly LSD , psilocybin , mescaline , cocaine , AMT and DMT on people. The Office of Security used LSD in interrogations, but Sidney Gottlieb , the chemist who directed MKUltra, had other ideas: he thought it could be used in covert operations. Since its effects were temporary, he believed it could be given to high-ranking officials and in this way affect the course of important meetings, speeches, etc. Since he realized there was a difference in testing the drug in a laboratory and using it in clandestine operations, he initiated a series of experiments where LSD was given to people in "normal" settings without warning. At first, everyone in Technical Services tried it; a typical experiment involved two people in a room where they observed each other for hours and took notes. As the experimentation progressed, a point arrived where outsiders were drugged with no explanation whatsoever and surprise acid trips became something of an occupational hazard among CIA operatives. Adverse reactions often occurred, such as an operative who received the drug in his morning coffee, became psychotic and ran across Washington, D.C., seeing a monster in every car passing him. The experiments continued even after Frank Olson , an army chemist who had never taken LSD, was covertly dosed by his CIA supervisor and nine days later plunged to his death from the window of a 13th-story New York City hotel room, supposedly as a result of deep depression induced by the drug. According to Stephen Kinzer , Olson had approached his superiors some time earlier, doubting the morality of the project, and asked to resign from the CIA. Some subjects' participation was consensual, and in these cases they appeared to be singled out for even more extreme experiments. In one case, seven drug-addicted African-American volunteers at the National Institute of Mental Health Addiction Research Center in Kentucky were given LSD for 77 consecutive days. MKUltra's researchers later dismissed LSD as too unpredictable in its results. They gave up on the notion that LSD was "the secret that was going to unlock the universe", but it still had a place in the cloak-and-dagger arsenal. However, by 1962, the CIA and the army developed a series of super-hallucinogens such as the highly touted BZ , which was thought to hold greater promise as a mind control weapon. This resulted in the withdrawal of support by many academics and private researchers, and LSD research became less of a priority altogether. Another technique investigated was the intravenous administration of a barbiturate into one arm and an amphetamine into the other. The barbiturates were released into the person first, and as soon as the person began to fall asleep, the amphetamines were released. Other experiments involved heroin , morphine , temazepam (used under code name MKSEARCH), mescaline , psilocybin , scopolamine , alcohol and sodium pentothal . Declassified MKUltra documents indicate they studied hypnosis in the early 1950s. Experimental goals included creating "hypnotically induced anxieties", "hypnotically increasing ability to learn and recall complex written matter", studying hypnosis and polygraph examinations, "hypnotically increasing ability to observe and recall complex arrangements of physical objects", and studying "relationship of personality to susceptibility to hypnosis". They conducted experiments with drug-induced hypnosis and with anterograde and retrograde amnesia while under the influence of such drugs.The CIA exported experiments to Canada when they recruited Scottish psychiatrist Donald Ewen Cameron , creator of the " psychic driving " concept, which the CIA found interesting. Cameron had been hoping to correct schizophrenia by erasing existing memories and reprogramming the psyche. He commuted from Albany, New York to Montreal every week to work at the Allan Memorial Institute of McGill University , and was paid $69,000 from 1957 to 1964 (US$579,480 in 2023, adjusted for inflation) to carry out MKUltra experiments there. The Montreal experiments research funds were sent to Cameron by a CIA front organization, the Society for the Investigation of Human Ecology, and as shown in internal CIA documents, Cameron did not know the money came from the CIA. : 141–142 In addition to LSD, Cameron also experimented with various paralytic drugs as well as electroconvulsive therapy at thirty to forty times the normal power. His "driving" experiments consisted of putting subjects into drug-induced comas for weeks at a time (up to three months in one case) while playing tape loops of noise or simple repetitive statements. His experiments were often carried out on patients who entered the institute for common problems such as anxiety disorders and postpartum depression , many of whom suffered permanent effects from his actions. : 140–150 His treatments resulted in victims' urinary incontinence , amnesia , forgetting how to talk, forgetting their parents and thinking their interrogators were their parents. During this era, Cameron became known worldwide as the first chairman of the World Psychiatric Association as well as president of both the American Psychiatric Association and the Canadian Psychiatric Association . Cameron was also a member of the Nuremberg medical tribunal in 1946–1947. : 141 His work was inspired and paralleled by the British psychiatrist William Sargant at St Thomas' Hospital , London, and Belmont Hospital, Sutton , who was also involved in the Secret Intelligence Service and who experimented on his patients without their consent, causing similar long-term damage. In the 1980s, several of Cameron's former patients sued the CIA for damages, which the Canadian news program The Fifth Estate documented. Their experiences and lawsuit were adapted in the 1998 television miniseries The Sleep Room . Naomi Klein argues in her book The Shock Doctrine that Cameron's research and his contribution to the MKUltra project was not about mind control and brainwashing, but about designing "a scientifically based system for extracting information from 'resistant sources'. In other words, torture." Alfred W. McCoy writes, "Stripped of its bizarre excesses, Dr. Cameron's experiments, building upon Donald O. Hebb 's earlier breakthrough, laid the scientific foundation for the CIA's two-stage psychological torture method", referring to first creating a state of disorientation in the subject, and then creating a situation of "self-inflicted" discomfort in which the disoriented subject can alleviate pain by capitulating. His work was inspired and paralleled by the British psychiatrist William Sargant at St Thomas' Hospital , London, and Belmont Hospital, Sutton , who was also involved in the Secret Intelligence Service and who experimented on his patients without their consent, causing similar long-term damage. In the 1980s, several of Cameron's former patients sued the CIA for damages, which the Canadian news program The Fifth Estate documented. Their experiences and lawsuit were adapted in the 1998 television miniseries The Sleep Room . Naomi Klein argues in her book The Shock Doctrine that Cameron's research and his contribution to the MKUltra project was not about mind control and brainwashing, but about designing "a scientifically based system for extracting information from 'resistant sources'. In other words, torture." Alfred W. McCoy writes, "Stripped of its bizarre excesses, Dr. Cameron's experiments, building upon Donald O. Hebb 's earlier breakthrough, laid the scientific foundation for the CIA's two-stage psychological torture method", referring to first creating a state of disorientation in the subject, and then creating a situation of "self-inflicted" discomfort in which the disoriented subject can alleviate pain by capitulating. In areas under American control in the early 1950s in Europe and East Asia, mostly Japan , West Germany and the Philippines , the CIA created secret detention centers so that the U.S. could avoid criminal prosecution. The CIA captured people suspected of being enemy agents and other people it deemed "expendable" to undertake various types of torture and human experimentation on them. The prisoners were interrogated while being administered psychoactive drugs, electroshocked and subjected to extremes of temperature, sensory isolation and the like to develop a better understanding of how to destroy and to control human minds. In 1973, amid a government-wide panic caused by Watergate , CIA Director Richard Helms ordered all MKUltra files destroyed. Pursuant to this order, most CIA documents regarding the project were destroyed, making a full investigation of MKUltra impossible. A cache of some 20,000 documents survived Helms's purge, as they had been incorrectly stored in a financial records building and were discovered following a FOIA request in 1977. These documents were fully investigated during the Senate Hearings of 1977. In December 1974, The New York Times alleged that the CIA had conducted illegal domestic activities, including experiments on U.S. citizens, during the 1960s. That report prompted investigations by the United States Congress , in the form of the Church Committee , and by a commission known as the Rockefeller Commission that looked into the illegal domestic activities of the CIA, the FBI and intelligence-related agencies of the military. In the summer of 1975, congressional Church Committee reports and the presidential Rockefeller Commission report revealed to the public for the first time that the CIA and the Department of Defense had conducted experiments on both unwitting and cognizant human subjects as part of an extensive program to find out how to influence and control human behavior through the use of psychoactive drugs such as LSD and mescaline and other chemical, biological, and psychological means. They also revealed that at least one subject, Frank Olson , had died after administration of LSD. Much of what the Church Committee and the Rockefeller Commission learned about MKUltra was contained in a report, prepared by the Inspector General's office in 1963, that had survived the destruction of records ordered in 1973. However, it contained little detail. Sidney Gottlieb , who had retired from the CIA two years previously and had headed MKUltra, was interviewed by the committee but claimed to have very little recollection of the activities of MKUltra. The congressional committee investigating the CIA research, chaired by Senator Frank Church , concluded that "prior consent was obviously not obtained from any of the subjects." The committee noted that the "experiments sponsored by these researchers [...] call into question the decision by the agencies not to fix guidelines for experiments." Following the recommendations of the Church Committee, President Gerald Ford in 1976 issued the first Executive Order on Intelligence Activities which, among other things, prohibited "experimentation with drugs on human subjects, except with the informed consent, in writing and witnessed by a disinterested party, of each such human subject" and in accordance with the guidelines issued by the National Commission. Subsequent orders by Presidents Carter and Reagan expanded the directive to apply to any human experimentation. In 1977, during a hearing held by the Senate Select Committee on Intelligence , to look further into MKUltra, Admiral Stansfield Turner , then Director of Central Intelligence, revealed that the CIA had found a set of records, consisting of about 20,000 pages, that had survived the 1973 destruction orders because they had been incorrectly stored at a records center not usually used for such documents. These files dealt with the financing of MKUltra projects and contained few project details, but much more was learned from them than from the Inspector General's 1963 report. On the Senate floor in 1977, Senator Ted Kennedy said: The Deputy Director of the CIA revealed that over thirty universities and institutions were involved in an "extensive testing and experimentation" program which included covert drug tests on unwitting citizens "at all social levels, high and low, native Americans and foreign." Several of these tests involved the administration of LSD to "unwitting subjects in social situations." At least one death, the result of the alleged defenestration of Frank Olson , was attributed to Olson's being subjected, without his knowledge, to such experimentation nine days before his death. [ citation needed ] The CIA itself subsequently acknowledged that these tests had little scientific rationale. The officers conducting the monitoring were not qualified scientific observers. In Canada, the issue took much longer to surface, becoming widely known in 1984 on a CBC news show, The Fifth Estate . It was learned that not only had the CIA funded Cameron's efforts, but also that the Canadian government was fully aware of this, and had later provided another $500,000 in funding to continue the experiments. This revelation largely derailed efforts by the victims to sue the CIA as their U.S. counterparts had, and the Canadian government eventually settled out of court for $100,000 to each of the 127 victims. Cameron died on September 8, 1967, after suffering a heart attack while he and his son were mountain climbing. None of Cameron's personal records of his involvement with MKUltra survived because his family destroyed them after his death. The U.S. General Accounting Office issued a report on September 28, 1994, which stated that between 1940 and 1974, the Department of Defense and other national security agencies studied thousands of human subjects in tests and experiments involving hazardous substances. The quote from the study: Working with the CIA, the Department of Defense gave hallucinogenic drugs to thousands of "volunteer" soldiers in the 1950s and 1960s. In addition to LSD, the Army also tested quinuclidinyl benzilate , a hallucinogen code-named BZ . (Note 37) Many of these tests were conducted under the so-called MKULTRA program, established to counter perceived Soviet and Chinese advances in brainwashing techniques. Between 1953 and 1964, the program consisted of 149 projects involving drug testing and other studies on unwitting human subjectsThe U.S. General Accounting Office issued a report on September 28, 1994, which stated that between 1940 and 1974, the Department of Defense and other national security agencies studied thousands of human subjects in tests and experiments involving hazardous substances. The quote from the study: Working with the CIA, the Department of Defense gave hallucinogenic drugs to thousands of "volunteer" soldiers in the 1950s and 1960s. In addition to LSD, the Army also tested quinuclidinyl benzilate , a hallucinogen code-named BZ . (Note 37) Many of these tests were conducted under the so-called MKULTRA program, established to counter perceived Soviet and Chinese advances in brainwashing techniques. Between 1953 and 1964, the program consisted of 149 projects involving drug testing and other studies on unwitting human subjectsGiven the CIA's purposeful destruction of most records, its failure to follow informed consent protocols with thousands of participants, the uncontrolled nature of the experiments, and the lack of follow-up data, the full impact of MKUltra experiments, including deaths, may never be known. Several known deaths have been associated with Project MKUltra, most notably that of Frank Olson . Olson, a United States Army biochemist and biological weapons researcher, was given LSD without his knowledge or consent in November 1953, as part of a CIA experiment, and died after falling from a 13th-story window a week later. A CIA doctor assigned to monitor Olson claimed to have been asleep in another bed in a New York City hotel room when Olson fell to his death. In 1953, Olson's death was described as a suicide that had occurred during a severe psychotic episode. The CIA's own internal investigation concluded that the head of MKUltra, CIA chemist Sidney Gottlieb , had conducted the LSD experiment with Olson's prior knowledge, although neither Olson nor the other men taking part in the experiment were informed as to the exact nature of the drug until some 20 minutes after its ingestion. The report further suggested that Gottlieb was nonetheless due a reprimand, as he had failed to take into account Olson's already-diagnosed suicidal tendencies, which might have been exacerbated by the LSD. The Olson family disputes the official version of events. They maintain that Frank Olson was murdered because, especially in the aftermath of his LSD experience, he had become a security risk who might divulge state secrets associated with highly classified CIA programs, about many of which he had direct personal knowledge. A few days before his death, Frank Olson quit his position as acting chief of the Special Operations Division at Detrick, Maryland (later Fort Detrick) because of a severe moral crisis concerning the nature of his biological weapons research. Among Olson's concerns were the development of assassination materials used by the CIA, the CIA's use of biological warfare materials in covert operations, experimentation with biological weapons in populated areas, collaboration with former Nazi scientists under Operation Paperclip , LSD mind control research, and the use of psychoactive drugs during "terminal" interrogations under a program code-named Project Artichoke . Later forensic evidence conflicted with the official version of events; when Olson's body was exhumed in 1994, cranial injuries indicated that Olson had been knocked unconscious before he exited the window. The medical examiner termed Olson's death a "homicide". In 1975, Olson's family received a $750,000 settlement from the U.S. government and formal apologies from President Gerald Ford and CIA Director William Colby , though their apologies were limited to informed consent issues concerning Olson's ingestion of LSD. On 28 November 2012, the Olson family filed suit against the U.S. federal government for the wrongful death of Frank Olson. The case was dismissed in July 2013, due in part to the 1976 settlement between the family and government. In the decision dismissing the suit, U.S. District Judge James Boasberg wrote, "While the court must limit its analysis to the four corners of the complaint, the skeptical reader may wish to know that the public record supports many of the allegations [in the family's suit], farfetched as they may sound." A 2010 book alleged that the 1951 Pont-Saint-Esprit mass poisoning was part of MKDELTA, that Olson was involved in that event, and that he was eventually murdered by the CIA. Earlier academic sources had attributed the incident to ergot poisoning through a local bakery. The revelations about the CIA and the Army prompted a number of subjects or their survivors to file lawsuits against the federal government for conducting experiments without informed consent. Although the government aggressively, and sometimes successfully, sought to avoid legal liability, several plaintiffs did receive compensation through court order, out-of-court settlement, or acts of Congress. Frank Olson's family received $750,000 by a special act of Congress, and both President Ford and CIA director William Colby met with Olson's family to apologize publicly. Previously, the CIA and the Army had actively and successfully sought to withhold incriminating information, even as they secretly provided compensation to the families. One subject of army drug experimentation, James Stanley, an army sergeant, brought an important, albeit unsuccessful, suit. The government argued that Stanley was barred from suing under the Feres doctrine . In 1987, the Supreme Court affirmed this defense in a 5–4 decision that dismissed Stanley's case: United States v. Stanley . The majority argued that "a test for liability that depends on the extent to which particular suits would call into question military discipline and decision making would itself require judicial inquiry into, and hence intrusion upon, military matters." In dissent, Justice William Brennan argued that the need to preserve military discipline should not protect the government from liability and punishment for serious violations of constitutional rights : The medical trials at Nuremberg in 1947 deeply impressed upon the world that experimentation with unknowing human subjects is morally and legally unacceptable. The United States Military Tribunal established the Nuremberg Code as a standard against which to judge German scientists who experimented with human subjects... [I]n defiance of this principle, military intelligence officials [...] began surreptitiously testing chemical and biological materials, including LSD. Justice Sandra Day O'Connor , writing a separate dissent, stated: No judicially crafted rule should insulate from liability the involuntary and unknowing human experimentation alleged to have occurred in this case. Indeed, as Justice Brennan observes, the United States played an instrumental role in the criminal prosecution of Nazi officials who experimented with human subjects during the Second World War, and the standards that the Nuremberg Military Tribunals developed to judge the behavior of the defendants stated that the 'voluntary consent of the human subject is absolutely essential [...] to satisfy moral, ethical, and legal concepts.' If this principle is violated, the very least that society can do is to see that the victims are compensated, as best they can be, by the perpetrators. In another lawsuit, Wayne Ritchie, a former United States Marshal , after hearing about the project's existence in 1990, alleged the CIA laced his food or drink with LSD at a 1957 Christmas party which resulted in his attempting to commit a robbery at a bar and his subsequent arrest. While the government admitted it was, at that time, drugging people without their consent and that Ritchie's behavior was typical of someone on LSD, U.S. District Judge Marilyn Hall Patel found Ritchie could not prove he was one of MKUltra's victims or that LSD caused his robbery attempt, and dismissed the case in 2005. Confirmed: Alleged: Confirmed: Sit back picture yourself swooping up a shell of purple with foam crests of crystal drops soft nigh they fall unto the sea of morning creep-very-softly mist [...] and then sort of cascade tinkley-bell-like (must I take you by the hand, ever so slowly type) and then conglomerate suddenly into a peal of silver vibrant uncomprehendingly, blood singingly, joyously resounding bells [...] By my faith if this be insanity, then for the love of God permit me to remain insane. Alleged:Confirmed: Alleged:Confirmed: Sit back picture yourself swooping up a shell of purple with foam crests of crystal drops soft nigh they fall unto the sea of morning creep-very-softly mist [...] and then sort of cascade tinkley-bell-like (must I take you by the hand, ever so slowly type) and then conglomerate suddenly into a peal of silver vibrant uncomprehendingly, blood singingly, joyously resounding bells [...] By my faith if this be insanity, then for the love of God permit me to remain insane. Alleged:After retiring in 1972, Gottlieb dismissed his entire effort for the CIA's MKUltra program as useless. Files discovered in 1977 containing 700 pages of new information showed that experiments had continued until Gottlieb ordered the program halted on July 10, 1972. MKUltra plays a part in many conspiracy theories due to its nature and the destruction of most records.

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Dengue fever

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Health in Singapore

Singapore is one of the wealthiest countries in the world, with a gross domestic product (GDP) per capita of more than $57,000. Life expectancy at birth is 82.3 and infant mortality is 2.7 per 1000 live births. The population is ageing and by 2030, 20% will be over 65. However it is estimated that about 85% of those over 65 are healthy and reasonably active. Singapore has a universal health care system . There are a variety of health screening and healthy lifestyle programmes for both adults and children. Only 14% of the population smokes. The Temasek Cares programme supports a wide range of interventions for disadvantaged people. Singapore in recent years has the lowest infant mortality rate in the world and among the highest life expectancies from birth, according to the World Health Organization . A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. Singapore had the thirteenth-highest level of expected human capital with 24 health, education, and learning-adjusted expected years lived between age 20 and 64 years. Some common indicators used to indicate health include total fertility rate , infant mortality rate, life expectancy , crude birth and death rate . As of 2017, Singapore has a Total Fertility Rate of 1.16 children born per woman, an Infant Mortality rate of 2.2 deaths per 1000 live births, Crude Birth Rate of 8.9 births per 1000 people and a Death Rate of 3 deaths per 1000 inhabitants. The average lifetime expectancy at birth slightly increased from 83 to 83.1 between the period 2016 and 2017. In comparison, the average lifetime expectancy for China grew from 76.3 in 2016 to 76.4 in 2017. Other parameters are outlined below: In general, all indices showed improvement except for the Total fertility rate , which dropped to 1.16 in 2017, making it the lowest figure since 1.15 in 2010 and the second lowest ever recorded in the city-state. This general slow-down can be explained by the 'demographic-gift', term defined by the United Nations Population Fund (UNFPA) according to which increases in income, education and health and the changing role of women in the workforce were strongly connected to levels of low fertility rate. The median age of the resident population rose from 40.0 years to 40.5 years between June 2016 and June 2017. Residents aged 65 years and over made up 13% of the resident population in Singapore in 2017, compared to 12.4% in 2016. The Age dependency ratio in Singapore was reported at 37.98% in 2016, according to the World Bank collection of development indicators, and is expected to reach 36.3% by 2030 and 60.6% by 2050. The retired population will therefore make up a growing share of the population in the upcoming years. Factors contributing to this growth include rising life expectancy and falling birth rates . The median age of the resident population rose from 40.0 years to 40.5 years between June 2016 and June 2017. Residents aged 65 years and over made up 13% of the resident population in Singapore in 2017, compared to 12.4% in 2016.The Age dependency ratio in Singapore was reported at 37.98% in 2016, according to the World Bank collection of development indicators, and is expected to reach 36.3% by 2030 and 60.6% by 2050. The retired population will therefore make up a growing share of the population in the upcoming years. Factors contributing to this growth include rising life expectancy and falling birth rates . Malnourishment is "a condition caused by inadequate, excessive or imbalance intake of nutrients". Common indicators used to measure malnourishment are body mass index and vitamin deficiencies. From 1977 to 2000, children malnutrition for those aged five and younger had moments of improvement and backtrack. The prevalence of children being underweight, having stunted growth or being weak has improved. More specifically, in 2000 it was 8.9% less common for a child to be underweight compared to rates in the 1970s. Conversely, between the years of 1970 and 1977, the prevalence of a children being overweight increased. Similarly, in 2016 22.4% of school-aged children and adolescents aged 5 to 19 years were overweight. From 1980 to 2016, the World Health Organization (WHO) measured females malnutrition based on body mass index (BMI). BMI is used to identify if an individual is normal weight, overweight or underweight. From 1980 to 2016, the percentage of females who were underweight stayed at 8%, indicative of the static relationship and trend. From 1980 to 2010, the percentage of females who were overweight increased from 25% to 33.6%. WHO indicates that being overweight is a "major determinant of many non-insulin-dependent diabetes mellitus, coronary heart diseases and stroke," along with many other health consequences. The percentage of females who are overweight has, however, decreased from 33.6% to 27.4% from 2010 to 2016. Conversely, the percentage of females who are obese has increased steadily from 2.5% to 6.1% from 1990 to 2016. Obesity, as indicated by the WHO, can be mitigated through lifestyle changes. Climatic characteristics such as high temperatures and high humidity facilitate the transmission of dengue virus by Aedes aegypti mosquitoes. Owing to its tropical climate, Singapore is a highly-endemic area for dengue, and experiences 20–330 cases per 100,000 people each year, depending on the severity of outbreaks, with higher rates of transmission in the September to February rainy season. The economic burden of this disease is significant, costing Singapore between 850 million and 1.15 billion USD between 2000 and 2010. Dengue fever is a mosquito-borne disease, transmitted primarily by the species Aedes aegypti. Transmission of the dengue virus occurs through the bite of the infected insect. Dengue fever varies in clinical presentation. Many cases of dengue virus infection are asymptomatic, but headaches, high fevers, pain behind the eyes, muscle, joint and bone pain, and a skin rash with red spots within 4 to 7 days of being infected may occur. In these cases, the World Health Organization (WHO) differentiates between undifferentiated febrile illness caused by dengue, dengue fever (DF), or dengue haemorrhagic fever (DHF) including dengue shock syndrome (DSS). DHF, characterised by increased vascular permeability and blood plasma leakage, may result in death, especially in the case of DSS, where shock results from decreased intravascular pressure caused by this leakage of plasma. While intensive mosquito vector control historically limited dengue incidence in Singapore, since the 1980s, the nation has experienced dengue outbreaks occurring cyclically, with increasing severity, every 5–6 years. The most recent sustained major outbreak of dengue occurred in 2013 and 2014, reaching peaks of 842 cases in June 2013 and 891 cases in July 2014, the greatest weekly dengue incidence recorded in Singaporean history. Singapore's National Environment Agency (NEA) has incorporated the use of sophisticated machine learning techniques in dengue forecasting. The Environmental Health Institute (EHI) of the NEA uses a model incorporating Least Absolute Shrinkage and Selection Operator (LASSO) methods in predictive outbreak forecasting, integrating population, meteorological, and vector surveillance data-based variables with epidemiological case report data collected through the Singaporean Ministry of Health and updated weekly to produce nationwide forecasts up to 3 months in advance. The team's model successfully predicted outbreak patterns during the major dengue outbreak of 2013, forecasting a peak count of 863 dengue cases in the 26th week of 2013 (compared to the actual peak of 842 dengue cases, during the 25th week of 2013.) This prediction enabled better planning of resource and medical care allocation, including an early launch of a government-led public health education campaign two months earlier than scheduled to more effectively preempt the outbreak. Singapore is believed to have the highest prevalence of myopia in children worldwide. More specifically, about "65% of children aged 12 in Singapore are myopic". Myopia is a vision problem, affecting an individual's ability to see distant objects. The major causes are still unclear. However, near work activities such as staring at a screen or reading a book are said to worsen the condition. Annually from May to October, Singapore experiences a smoke haze which can cause or worsen pre-existing health issues. The haze is largely caused by, "winds bringing in tiny particles of ash," from the burning of forestry in Indonesia, the neighbouring country. A person's likelihood of developing viral and bacterial infections is increased by breathing in an excess of these particles. Additionally, individuals may experience irritation of the eyes, nose and throat if exposed to an excess amount of the haze. However, in most cases these aforementioned health issues will resolve on their own. The haze can also perpetuates existing heart and lung conditions, such as asthma. Compared to most cities in Asia, Singapore's levels of air pollution are rather lower. Singapore has experienced rapid urbanisation and industrialisation over the years. Thus, "the main sources of air pollution in Singapore are emissions from the industries and motor vehicles". The National Environment Agency has indicated that the most concerning air pollutants are particulate matter, carbon monoxide, ozone nitrogen dioxide and sulphur dioxide. Continuous exposure to these air pollutants can "cause respiratory symptoms and aggravate existing heart or lung disease". Malnourishment is "a condition caused by inadequate, excessive or imbalance intake of nutrients". Common indicators used to measure malnourishment are body mass index and vitamin deficiencies. From 1977 to 2000, children malnutrition for those aged five and younger had moments of improvement and backtrack. The prevalence of children being underweight, having stunted growth or being weak has improved. More specifically, in 2000 it was 8.9% less common for a child to be underweight compared to rates in the 1970s. Conversely, between the years of 1970 and 1977, the prevalence of a children being overweight increased. Similarly, in 2016 22.4% of school-aged children and adolescents aged 5 to 19 years were overweight. From 1980 to 2016, the World Health Organization (WHO) measured females malnutrition based on body mass index (BMI). BMI is used to identify if an individual is normal weight, overweight or underweight. From 1980 to 2016, the percentage of females who were underweight stayed at 8%, indicative of the static relationship and trend. From 1980 to 2010, the percentage of females who were overweight increased from 25% to 33.6%. WHO indicates that being overweight is a "major determinant of many non-insulin-dependent diabetes mellitus, coronary heart diseases and stroke," along with many other health consequences. The percentage of females who are overweight has, however, decreased from 33.6% to 27.4% from 2010 to 2016. Conversely, the percentage of females who are obese has increased steadily from 2.5% to 6.1% from 1990 to 2016. Obesity, as indicated by the WHO, can be mitigated through lifestyle changes. From 1977 to 2000, children malnutrition for those aged five and younger had moments of improvement and backtrack. The prevalence of children being underweight, having stunted growth or being weak has improved. More specifically, in 2000 it was 8.9% less common for a child to be underweight compared to rates in the 1970s. Conversely, between the years of 1970 and 1977, the prevalence of a children being overweight increased. Similarly, in 2016 22.4% of school-aged children and adolescents aged 5 to 19 years were overweight. From 1980 to 2016, the World Health Organization (WHO) measured females malnutrition based on body mass index (BMI). BMI is used to identify if an individual is normal weight, overweight or underweight. From 1980 to 2016, the percentage of females who were underweight stayed at 8%, indicative of the static relationship and trend. From 1980 to 2010, the percentage of females who were overweight increased from 25% to 33.6%. WHO indicates that being overweight is a "major determinant of many non-insulin-dependent diabetes mellitus, coronary heart diseases and stroke," along with many other health consequences. The percentage of females who are overweight has, however, decreased from 33.6% to 27.4% from 2010 to 2016. Conversely, the percentage of females who are obese has increased steadily from 2.5% to 6.1% from 1990 to 2016. Obesity, as indicated by the WHO, can be mitigated through lifestyle changes. Climatic characteristics such as high temperatures and high humidity facilitate the transmission of dengue virus by Aedes aegypti mosquitoes. Owing to its tropical climate, Singapore is a highly-endemic area for dengue, and experiences 20–330 cases per 100,000 people each year, depending on the severity of outbreaks, with higher rates of transmission in the September to February rainy season. The economic burden of this disease is significant, costing Singapore between 850 million and 1.15 billion USD between 2000 and 2010. Dengue fever is a mosquito-borne disease, transmitted primarily by the species Aedes aegypti. Transmission of the dengue virus occurs through the bite of the infected insect. Dengue fever varies in clinical presentation. Many cases of dengue virus infection are asymptomatic, but headaches, high fevers, pain behind the eyes, muscle, joint and bone pain, and a skin rash with red spots within 4 to 7 days of being infected may occur. In these cases, the World Health Organization (WHO) differentiates between undifferentiated febrile illness caused by dengue, dengue fever (DF), or dengue haemorrhagic fever (DHF) including dengue shock syndrome (DSS). DHF, characterised by increased vascular permeability and blood plasma leakage, may result in death, especially in the case of DSS, where shock results from decreased intravascular pressure caused by this leakage of plasma. While intensive mosquito vector control historically limited dengue incidence in Singapore, since the 1980s, the nation has experienced dengue outbreaks occurring cyclically, with increasing severity, every 5–6 years. The most recent sustained major outbreak of dengue occurred in 2013 and 2014, reaching peaks of 842 cases in June 2013 and 891 cases in July 2014, the greatest weekly dengue incidence recorded in Singaporean history. Singapore's National Environment Agency (NEA) has incorporated the use of sophisticated machine learning techniques in dengue forecasting. The Environmental Health Institute (EHI) of the NEA uses a model incorporating Least Absolute Shrinkage and Selection Operator (LASSO) methods in predictive outbreak forecasting, integrating population, meteorological, and vector surveillance data-based variables with epidemiological case report data collected through the Singaporean Ministry of Health and updated weekly to produce nationwide forecasts up to 3 months in advance. The team's model successfully predicted outbreak patterns during the major dengue outbreak of 2013, forecasting a peak count of 863 dengue cases in the 26th week of 2013 (compared to the actual peak of 842 dengue cases, during the 25th week of 2013.) This prediction enabled better planning of resource and medical care allocation, including an early launch of a government-led public health education campaign two months earlier than scheduled to more effectively preempt the outbreak. Singapore is believed to have the highest prevalence of myopia in children worldwide. More specifically, about "65% of children aged 12 in Singapore are myopic". Myopia is a vision problem, affecting an individual's ability to see distant objects. The major causes are still unclear. However, near work activities such as staring at a screen or reading a book are said to worsen the condition. Climatic characteristics such as high temperatures and high humidity facilitate the transmission of dengue virus by Aedes aegypti mosquitoes. Owing to its tropical climate, Singapore is a highly-endemic area for dengue, and experiences 20–330 cases per 100,000 people each year, depending on the severity of outbreaks, with higher rates of transmission in the September to February rainy season. The economic burden of this disease is significant, costing Singapore between 850 million and 1.15 billion USD between 2000 and 2010. Dengue fever is a mosquito-borne disease, transmitted primarily by the species Aedes aegypti. Transmission of the dengue virus occurs through the bite of the infected insect. Dengue fever varies in clinical presentation. Many cases of dengue virus infection are asymptomatic, but headaches, high fevers, pain behind the eyes, muscle, joint and bone pain, and a skin rash with red spots within 4 to 7 days of being infected may occur. In these cases, the World Health Organization (WHO) differentiates between undifferentiated febrile illness caused by dengue, dengue fever (DF), or dengue haemorrhagic fever (DHF) including dengue shock syndrome (DSS). DHF, characterised by increased vascular permeability and blood plasma leakage, may result in death, especially in the case of DSS, where shock results from decreased intravascular pressure caused by this leakage of plasma. While intensive mosquito vector control historically limited dengue incidence in Singapore, since the 1980s, the nation has experienced dengue outbreaks occurring cyclically, with increasing severity, every 5–6 years. The most recent sustained major outbreak of dengue occurred in 2013 and 2014, reaching peaks of 842 cases in June 2013 and 891 cases in July 2014, the greatest weekly dengue incidence recorded in Singaporean history. Singapore's National Environment Agency (NEA) has incorporated the use of sophisticated machine learning techniques in dengue forecasting. The Environmental Health Institute (EHI) of the NEA uses a model incorporating Least Absolute Shrinkage and Selection Operator (LASSO) methods in predictive outbreak forecasting, integrating population, meteorological, and vector surveillance data-based variables with epidemiological case report data collected through the Singaporean Ministry of Health and updated weekly to produce nationwide forecasts up to 3 months in advance. The team's model successfully predicted outbreak patterns during the major dengue outbreak of 2013, forecasting a peak count of 863 dengue cases in the 26th week of 2013 (compared to the actual peak of 842 dengue cases, during the 25th week of 2013.) This prediction enabled better planning of resource and medical care allocation, including an early launch of a government-led public health education campaign two months earlier than scheduled to more effectively preempt the outbreak. Singapore is believed to have the highest prevalence of myopia in children worldwide. More specifically, about "65% of children aged 12 in Singapore are myopic". Myopia is a vision problem, affecting an individual's ability to see distant objects. The major causes are still unclear. However, near work activities such as staring at a screen or reading a book are said to worsen the condition. Annually from May to October, Singapore experiences a smoke haze which can cause or worsen pre-existing health issues. The haze is largely caused by, "winds bringing in tiny particles of ash," from the burning of forestry in Indonesia, the neighbouring country. A person's likelihood of developing viral and bacterial infections is increased by breathing in an excess of these particles. Additionally, individuals may experience irritation of the eyes, nose and throat if exposed to an excess amount of the haze. However, in most cases these aforementioned health issues will resolve on their own. The haze can also perpetuates existing heart and lung conditions, such as asthma. Compared to most cities in Asia, Singapore's levels of air pollution are rather lower. Singapore has experienced rapid urbanisation and industrialisation over the years. Thus, "the main sources of air pollution in Singapore are emissions from the industries and motor vehicles". The National Environment Agency has indicated that the most concerning air pollutants are particulate matter, carbon monoxide, ozone nitrogen dioxide and sulphur dioxide. Continuous exposure to these air pollutants can "cause respiratory symptoms and aggravate existing heart or lung disease". Annually from May to October, Singapore experiences a smoke haze which can cause or worsen pre-existing health issues. The haze is largely caused by, "winds bringing in tiny particles of ash," from the burning of forestry in Indonesia, the neighbouring country. A person's likelihood of developing viral and bacterial infections is increased by breathing in an excess of these particles. Additionally, individuals may experience irritation of the eyes, nose and throat if exposed to an excess amount of the haze. However, in most cases these aforementioned health issues will resolve on their own. The haze can also perpetuates existing heart and lung conditions, such as asthma. Compared to most cities in Asia, Singapore's levels of air pollution are rather lower. Singapore has experienced rapid urbanisation and industrialisation over the years. Thus, "the main sources of air pollution in Singapore are emissions from the industries and motor vehicles". The National Environment Agency has indicated that the most concerning air pollutants are particulate matter, carbon monoxide, ozone nitrogen dioxide and sulphur dioxide. Continuous exposure to these air pollutants can "cause respiratory symptoms and aggravate existing heart or lung disease".

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