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Reasons For The Re-mergence Of Tuberculosis (TB)

March 24, 2025, was set aside by the World Health Organisation as World Tuberculosis Day to commemorate the day in 1882 when one of the true giants of early medicine, Dr Robert Koch, announced his discovery of the bacterium that causes the disease. The first World TB Day was observed in 1982, a full century after Koch’s groundbreaking discovery. Tuberculosis is notable for causing fever, a persistent cough that produces yellowish sputum, increasing sputum production, which may occasionally be bloody, and weight loss. This date is marked globally to raise awareness about the devastating health, social, and economic consequences of TB and to accelerate efforts to end the global TB epidemic. The re-emergence of tuberculosis around the world is a complex issue influenced by a variety of remote and immediate factors. Understanding these requires examining the underlying social, economic, and biological determinants, as well as more recent events and trends. In an essay titled, ‘An Old Disease Strikes Back’ published on this page in 2013, we argued that various strains of the disease were re-emerging in different ways, not least due to its close association with people living with HIV/AIDS, but also because, at the time, the country appeared likely to witness a rise in TB cases if the required level of disease surveillance were to weaken. Well, we have seen how remote causes behind this renewed spread, such as weak healthcare systems across many regions of the world, particularly in low- and middle-income countries, have worsened the problem. In Nigeria’s case, the steady emigration of all categories of healthcare workers, the rising level of insecurity, especially in the north, and failing, dilapidated infrastructure, particularly concerning electricity supply and the lack of motorable roads, have all contributed to a retreat in basic services, even in areas where the country had previously made some progress. A steady power supply is indispensable for the proper storage of vaccines, for instance. When this singular factor is absent, entire communities may have their children denied the health benefits of immunisation against tuberculosis. A fortnight ago, we examined some of the reasons why diphtheria was ravaging the country. Now, the conversation has shifted to tuberculosis. Together, these two infections account for one-third of the six most common killer diseases in infants and young children under the age of five. To be sure, tuberculosis is the most common infectious disease in the world, and also the most deadly. It is estimated that up to one-quarter of the global population has had this infection. Yet it is a preventable disease, treatable with antibiotics. TB exists everywhere in the world; no country is exempt. However, the majority of infections occur in the poorest and middle-income nations. It is no coincidence that these are the very countries plagued by inadequate health services, leading to poor TB diagnosis, treatment, and management. These are also the countries least equipped to mount the levels of disease surveillance and reporting mechanisms required to track and control TB outbreaks effectively. The disease is caused by bacteria that primarily affect the lungs, and like diphtheria, most infections are spread through coughing and sneezing. However, other parts of the body can also be affected, depending on how the infection is contracted. For example, the stomach can be involved if people consume fresh milk from goats, sheep, or cows infected with the animal variant of TB. In individuals with compromised immune systems, such as those living with HIV/AIDS or chronic illnesses like diabetes, liver disease, or kidney disease, or in cases of severe malnutrition, the infection can spread to other parts of the body, including the kidneys, brain, spine, and reproductive system. Additionally, rapid urbanisation in developing countries has led to overcrowded living conditions, which further facilitates the spread of TB. Many of these countries are located in sub-Saharan Africa, which remains a massive reservoir for both the bacteria and the disease. Economic and social inequalities have understandably arisen in many of these countries. Such disparities, caused either by design or circumstance, have further deepened the inequalities in social conditions. Economic globalisation can worsen these gaps in health investment, as governments often divert much-needed resources to other areas of development, resulting in poor TB control in certain regions. In Nigeria, as in many other similarly positioned countries both geographically and economically, high levels of poverty limit access to healthcare, proper nutrition, and living conditions conducive to good health. Worse still, these vulnerable populations are the very same people forced to pay for healthcare out of pocket. There is little to no health insurance, and where any exists, as in the chaotic structure we have, many essential medications are often unavailable. These vulnerable groups are also more susceptible to infections like TB. Global travel and migration have further facilitated the spread of TB across borders, as impoverished individuals and ambitious others seeking to climb the socioeconomic ladder travel the globe in search of better opportunities, trade links, and education. The emergence of the HIV epidemic also contributed significantly to TB’s resurgence, as individuals with compromised immune systems became more vulnerable to TB infection. As if these challenges weren’t already enough, the emergence of multidrug-resistant TB (MDR-TB)—resulting from inadequate treatment regimens and poor adherence to TB therapy—has further complicated control efforts. Then came the COVID-19 pandemic, which severely disrupted health services worldwide, diverting attention and resources from TB programmes and leading to missed diagnoses, treatment delays, and interruptions. In many of our traditional communities, TB remains heavily stigmatised, often leading to delays in seeking treatment. Public awareness campaigns are generally inadequate, perpetuating the cycle of transmission and creating diagnostic challenges. This leads to delayed diagnoses, particularly in remote areas and in communities under siege by gunmen. In these regions, the lack of awareness about TB symptoms and the limited access to diagnostic tools are especially pronounced. Additional contributing factors, such as malnutrition, poor housing, and substance abuse, previously discussed under the concept of “health poverty”,—further increase susceptibility and facilitate transmission within communities. Global efforts to combat TB have reportedly saved an estimated 79 million lives since the year 2000. However, drastic and abrupt cuts to global health funding, particularly under United States President Donald Trump, now threaten to reverse these hard-won gains. Rising drug resistance, especially across Europe, as well as ongoing conflicts across the Middle East, Africa, and Eastern Europe, are further worsening conditions for the most vulnerable. The U.S. support for global health may constitute a small portion of its domestic budget, but it accounts for a significant share of international health funding. In 2023, U.S. global health spending represented just about 0.3 per cent of its federal budget, approximately $20.6bn out of a $6.1tn appropriation. Yet, that same year, the U.S. was responsible for nearly three-quarters of international development assistance for HIV/AIDS, 40 per cent of global malaria aid, and over one-third of TB funding. Until recently, the U.S. was also the single largest financier of the World Health Organisation, the biggest provider of vaccines to the COVID-19 multilateral vaccine initiative, and the main driver behind the Pandemic Fund, a World Bank vehicle that invests in low-income countries to prevent infectious disease outbreaks. Unfortunately, America’s retreat from these initiatives is unlikely to be compensated for by countries like China, which, despite its considerable wealth, has often acted with self-interest, aggressively extracting resources from nearly every corner of the globe. Reduced funding for TB control programmes will inevitably result in insufficient outreach and treatment efforts, allowing the disease to re-emerge within vulnerable populations. The resurgence of tuberculosis is therefore a complex interplay of remote and immediate factors. Addressing it requires a multipronged approach: strengthening healthcare systems, tackling the social determinants of health, improving access to diagnostic tools, ensuring adherence to proper treatment regimens, and scaling up public awareness. These steps are essential for combating this global health threat, but they will take time and demand strong political will from the leadership of the most affected nations. Sadly, most of the countries most vulnerable to TB have neither of these attributes. For years, funding for TB research and treatment has been inadequate, resulting in a shortage of effective treatments and diagnostic tools. The development of new drugs and vaccines has been slow, and the few that exist are often inaccessible to those who need them most. Lastly, climate change and conflict, as we currently experience in Nigeria’s north, have also played a role in the TB resurgence, by causing displacement, poor living conditions, and increased transmission of the disease. Good day, Doctor Sylvester. I have been having this recurring headache over the past few days. The headache is mostly on my forehead. I think it may be related to my broken sleep during the night, around 2 am when I wake up to pray, and the need to wake up early to drive my children to school. I checked my blood pressure this morning, and it was 138/71 with a pulse of 52. This evening (about 2 minutes ago), the reading was 144/77 with a pulse of 62. I don’t usually have any problems with my blood pressure, but we have this machine at home because of my late brother, who was hypertensive. What could the problem be, and what is the solution? 08064863*** Thank you for your important question. If your body or system is accustomed to a particular sleep pattern, disrupting that, such as waking up in the middle of the night for prayers, can lead to consequences for how you feel when you wake up to carry out your daily chores. If the timing of your night-time prayers is flexible, you might consider adjusting the timing to around 4 am. This way, once you finish your prayers, you can easily transition into your usual activities. This adjustment may be easier on your body. Unfortunately, you didn’t mention your age, which would be useful in further assessing your situation. Please, I have been feeling light-headed since yesterday. I thought it might be due to the ongoing fasting, but I also had some body aches when I woke up yesterday, though the body pain is no longer there. However, I still feel light-headed. What should I do about this? Thank you. 08027202*** Good afternoon to you as well. It’s not clear what type of fasting you are doing, but generally, fasting can lead to inadequate fluid intake, especially with the heat we are experiencing. If you’re not drinking enough water, it’s quite common to feel light-headed. Since your only symptoms are headaches and light-headedness, it’s crucial to focus on staying hydrated over the next two days and observe how your body responds. Aim to drink a minimum of 3 litres of water a day. Dear Dr Sylvester, my mother is 90 years old, and she is constantly scratching her body. It disturbs her at night, and she cannot sleep well. Now, for the past 5 days or so, whenever she scratches her skin, it begins to peel. The problem we have is how to get her to the hospital, as she is almost confined to a wheelchair. What can we do about this skin itching? 08033526*** Thank you for your question. At her age, her skin is likely very dry and thin, which could explain the intense itching she is experiencing. Ideally, a doctor should examine her skin, but in the meantime, you can help by applying a good moisturising cream or lotion that has excellent hydrating properties. Additionally, a low dose of Piriton tablets, taken twice a day, can help relieve her discomfort and help her sleep. If the itching persists after five to seven days of this treatment, you will need to get her to see a doctor or have one come to examine her at home. Dear doctor, thank you immensely for how kindly you solve people’s problems. God will bless you abundantly. I have been experiencing infections on and off in my private parts for the past seven weeks. I am a 46-year-old woman, and I am also struggling with menopause, which was so bad that my doctor had to prescribe a pill that has helped somewhat. This infection is terrible; there is a whitish discharge that is very itchy but has no smell. I did some tests, and my doctor put me on treatment for 10 days with tablets and injections. These treatments were very expensive, and to now find out that the infection is still there is depressing. It stopped for about two weeks and has now returned. This is very tiring. What is the solution, please? 08054192*** Thank you for your kind words and prayers, madam. The symptoms you’ve described are likely related to menopause. The vaginal dryness that often accompanies menopause makes you more susceptible to infections, particularly fungal ones. The situation you are experiencing sounds like a recurring fungal infection, which is common during this stage. Unfortunately, there is no quick fix without proper laboratory testing to identify the exact organisms causing the infection. These tests will help determine which antibiotics or antifungal treatments are most effective. Since the infection returned quickly, it is possible that the treatment you received was inadequate or that a different organism is involved that wasn’t addressed in the original treatment. Dear doctor, thank you for your previous advice on health issues. My problem is that I had unprotected sex with a man I randomly met, and now my period is one week overdue. This has never happened to me before. I am 31 years old and very worried. What should I do now? Please help me. +23490472761*** Thank you for your kind words. This is a common concern among young women who may feel anxious after such an experience. The first step is to take a rational approach. Since your period is delayed and you had unprotected sex, you should take a laboratory pregnancy test. The next steps will depend on the result. It may simply be a harmless delay or a missed period, but the best way to find out for sure is to conduct a pregnancy test, preferably a blood test. Good morning, doctor. I wish to thank you for the free healthcare consultations you render every Sunday in the Punch Newspaper. God Almighty will continue to bless and prosper you and your family in Jesus’ Mighty Name. Here is my issue: It concerns my 3-year-old son, who has been coughing on and off for almost 2 weeks now. He also has a runny nose. He plays well during the day and hardly even coughs. But at night, we hardly sleep because he starts coughing from the moment he lies down till early in the morning. Why is this? What should we do about it? 08023450*** Thank you very much for your prayers and kind words. This kind of situation often results when a child lies down and the secretions from the nostrils then flow backwards into the throat. There, the secretions, called mucus, irritate the tiny hairs in that area and initiate a cough. For as long as the backflow of mucus goes on, so will the child cough. You should get a doctor to examine him and be sure his chest is not involved in this event. After that, successful treatment with relevant medications should be pretty satisfactory. Good day to you, doctor. My granddaughter is just over one year and five months old, but she has been coughing persistently without any improvement since the beginning of February. She has been to the hospital several times — about three times — and each time, after examining her, the doctors prescribe the same medications: Primpex, Vitamin C, and Coflin. The cough has not stopped; there is no improvement at all. What can we do about this? I am very worried, please.  08034441*** Good day to you as well. The fact that the cough is not stopping does not necessarily mean there is a serious problem. Many common episodes of respiratory tract infections like this are most likely caused by a virus. So, if she is not running a fever, continues to play, is feeding well, and is not breathing abnormally fast, there may be no cause for alarm. However, depending on the type of hospital your granddaughter has been attending, she should be scheduled to see a paediatrician. The paediatrician may have a different perspective from the doctors who have treated her so far and could make some changes to her prescription that may lead to a more effective outcome. Good luck with that.

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News_Naija

The Abuja-Kano Road Kalokalo

On April 14, 2025, President Bola Tinubu “flagged off” the reconstruction of the Abuja-Kaduna-Zaria-Kano federal highway. Tinubu, for the record, was away on vacation in France in an endeavour mischievously labelled a “working visit,” a contradiction in terms. Under the new arrangement, the 700-kilometre road will cost N777bn and is meant to be completed within 14 months, according to the Minister of Works, David Umahi. The problem is that Nigeria’s APC government has no track record of accountability or performance, even on large infrastructure projects that people can readily monitor.  I cite the example of another segment of the same A2 highway, the Lokoja-Benin City road that it promised in March 2024 to complete within six months.  First, the AKR is NOT 700 kilometres (or 1500 as Umahi’s predecessor, Babatunde Fashola, once called it); this is a corrupt obfuscation. The road is 375.9km long, and the APC government, as well as Julius Berger and the Nigerian Sovereign Investment Authority, through the PDIF, have always treated it as such. Second, the AKR is NOT a new road, and it is curious that APC wants to present it as such.  It is a road that is largely completed.  In brief, here is its sad history under this government: In December 2017, President Muhammadu Buhari awarded to Julius Berger a whopping N155.7bn contract for the job.  Widely advertised by a presidential spokesman as one of Buhari’s “roads to glory,” its construction commenced in May 2018, and the project was to be completed in 36 months – by 2021. Funding was to be with government appropriations starting in 2017, along with “additional provisions.”  One of those provisions was the PDIF, and its audit reports show that: In 2018, it “invested US$260 million” into five projects, which included the Lagos-Ibadan Expressway, the Second Niger Bridge (SNB) and the AKR; In 2019 it “deployed N208.2 billion” into the Lagos-Ibadan Expressway, the SNB and the AKR; and in 2020, it “disbursed approximately N92.2 billion” into the three projects. Further funds inflow into those projects arrived in the form of fresh Abacha loot repatriations in February 2020 when the United States and the Island of Jersey concluded an agreement to return US$311 million, to be invested exclusively in them. Under a subsequent agreement in August 2022, the US repatriated another $23m. “Combined with a $311.7m seized and repatriated with the assistance of the Bailiwick of Jersey and the government of Nigeria in 2020, this repatriation brings the total amount of funds repatriated in this case by the US to more than $334.7 million,” US ambassador Mary Leonard said. She affirmed that the money would be used for the three projects so that it would be “transformed into a visible and impactful representation of the possibilities of government assets that directly improve the lives of average Nigerians.” Despite all of the promises and funding, by the end of 2020 it was glaring that the AKR would not be completed in 2021 or during Buhari’s years. The executive and the legislative arms squabbled over the design of the project, including Buhari giving Yolas Consultants a gift of N867m allegedly to redesign the road from four to six lanes, only to revert to two lanes. “With barely 30% of the road project completed in more than two years, meeting up with the May 2021 deadline is highly unlikely,” the International Centre for Investigative Reporting said in December 2020, noting that the relevant Ministries had ignored its Freedom of Information requests. And so, instead of delivering the project at the end of 36 months, in March 2021 Buhari ordered a two-year “complete reconstruction,” at a cost of N797.2bn! It was a good, if belated decision, as the new project would feature footbridges, lighting, toll roads, service stations and rest stops.  Mr. Minister Fashola affirmed that the project would be completed in the second quarter of 2023. In April 2023, however, with time running out on the administration, Fashola was still singing that false song.  Following an inspection, he declared that the road would be completed and commissioned before the Buhari administration expired.  At the same event, Buhari’s Chief of Staff, Ibrahim Gambari, assured Nigerians that funding was “guaranteed.” Project contractor Julius Berger sat through all the twists and turns as if it was an episode of ‘The Village Headmaster’ on television.  While government officials went in circles about how the project would be completed in or before May 2023, at a Town Hall meeting in Kaduna in November 2020, Managing Director Lars Richer was emphatic that the completion date was 2025. In January 2024, as the Tinubu government asserted itself in power, Mr. Umahi commended Julius Berger’s competence and performance, asserting that AKR would be completed by the end of that year. He confirmed that 45 km of the 165km Abuja-Kaduna section had been completed, as was the entirety of Kaduna to Zaria. “We have only 20 kilometres between Zaria and Kano, and then we have 40 or 38 kilometres from zero point,“ he said. In September 2024, the government unilaterally imposed on Julius Berger a full downward review of the contract value to N740 billion, including a completion obligation of 14 months and the addition of solar lights. Predictably, the contractor demurred, and in November, the government terminated the deal.  It was quickly re-awarded to President Tinubu’s highly-connected friends at Hitech Construction Company, and then—as Daily Trust reported—to Infiouest International Limited (originally mistaken for Infoquest Nigeria). What does this all mean? First, that AKR is a potent example that while Nigeria’s ruling APC can serve power, it is incapable of serving people.  Consider just how much time it has squandered on just 379km of one heavily-funded road, and you have the answer as to why Nigeria’s infrastructure is pathetic. And now, to begin the next 10 years, the government introduces a contractor whose claim to fame is that it is “corporately active” and has leased equipment to Berger! Remember: this is the same government that, among others, in July 2021, contracted Dangote Industries for N309bn to construct five roads.  Remember: this is the same government that, in October 2021, gave over the construction of 21 roads to NNPC for N621bn.  Have you seen those roads? Whatever the problem may be with Julius Berger, it arrived on AKR with credibility and favourable credentials, including previous jobs nationwide, and the innovative and environmentally friendly cold recycling methodology about which even the Buhari government was enthusiastic. Infiouest, whose spokesman so far is its employer, Umahi, has 14 months to demonstrate what it is capable of.  But as I have argued in the past, the problem with Nigeria’s infrastructure development is the government, not contractors. I therefore challenge Umahi not simply to make speeches and give contracts, but to establish a tracker on his Ministry’s website, with hyperlinks, so that Nigerians can track each contract, contractor and expenditure.  And he should also account for all expenditure on AKR, as his most notable challenge, beginning from 2017. My final invitation is to Nigerian civil and highway engineers.  Towards providing an external  check on government officials and contractors, I propose a national network of professionals to undertake and share occasional inspections of ongoing major highway projects.

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News_Naija

Let Us Make Sauerkraut Sour Cabbage (2)

I would like to seize this opportunity to thank readers who have not forgotten that I am April-born. Thank you so much for all your birthday wishes and gifts. It feels so great to be showered with so much love. I had no idea that this discussion on sauerkraut would receive such a good response. I was practically begging readers to wait for the concluding part of the article because people were too eager to know how it is made. What we need are cabbage and salt. Although some people add carrots and some spices, these are totally optional. Salt pulls water out of the cabbage to create an environment where the good bacteria (mainly Lactobacillus) can grow and proliferate, and the harmful bacteria can die off. It is generally recommended to use non-iodised salt. Iodine in iodised salt can inhibit the growth of beneficial lactic acid bacteria, which are crucial for the fermentation process. Sea salt is often considered a good choice, especially if it is unrefined. Pink Himalayan salt is rich in minerals and less processed, making it a good option for fermentation. Sauerkraut, through its fermentation process, produces lactic acid bacteria. These beneficial bacteria can be found in both the sauerkraut itself and the juice that surrounds it. Kraut juice can be used in various ways beyond just drinking. It can be a flavourful addition to salad dressings, marinades, soups, and even cocktails. You can also use it as a base for dips, sauces, or even in place of vinegar or lemon juice in certain recipes. It is one of the alternatives used in Romania to give the traditional soups ciorbă their sour taste. It is essential for preserving the sauerkraut. It creates an acidic environment that prevents harmful bacteria from growing. Keeping the sauerkraut submerged in it helps it stay fresh and prevents it from drying out or becoming mouldy. Cruciferous veggies like cabbage are very high in a special sulphur-derived phytochemical called sulforaphane. Sulforaphane in cruciferous veggies and in sauerkraut helps promote healthy detoxification by activating special enzymes, opening detox pathways, and even turning on certain beneficial genes that promote detoxification in the body. Red cabbage sauerkraut is significantly higher in a type of antioxidant called anthocyanins (the red-blue-purple pigment also found in berries, beets, red grapes, and cherries) compared to sauerkraut made with green cabbage. Anthocyanins are known for their cancer-preventive activity. Let us see the step-by-step guide to sauerkraut fermentation: Remove the outer layers of your cabbage that may be discoloured. Remove some inner layers and keep them aside because we will need them to cover the sauerkraut. Weigh the cabbage. This is very important because the salt you need is actually 2 per cent of the weight of your cabbage. For example, for 1 kg of cabbage when making sauerkraut, you will typically need about 20 grams of salt, which is roughly equivalent to one heaping tablespoon of salt. Slice the cabbage thinly and cut out the core. Rinse the cabbage well, allowing the water to flow between the cabbage leaves. Drain well. Place your cabbage in a large bowl. Sprinkle the calculated amount of salt over the cabbage and toss well. Let it sit for 15 minutes. The salt will naturally draw water out of the cabbage. Massage the cabbage with your hands for 5 minutes. The cabbage should release a good amount of liquid during this time. The juice that is created when massaging the cabbage and salt together is the brine. You may have to work it for several minutes before it creates enough brine to move on to the next step. Put all the cabbage and the brine into a clean jar. Punch it down until all the cabbage is submerged beneath the brine. Fold up the leaves you reserved earlier and place them on top to keep all the cabbage down beneath the brine. In most cases, mould occurs when the cabbage is not submerged under the brine. Place a fermentation weight on top of the folded cabbage leaves you used to cover your shredded cabbage and brine. Press down, making sure there is enough brine to cover all the cabbage. You could also place a stone in a ziplock bag and put it on top of your shredded cabbage if you do not have a fermentation weight glass. These are just to weigh your cabbage down and keep it submerged in the brine. If your brine is not enough, you can create extra brine for the sauerkraut. A simple 2% salt solution can be made by dissolving 1 teaspoon of salt in 1 cup (250 ml) of water. If needed, more of this brine can be added until the cabbage is fully submerged. Place your jars in a cool, dark place to ferment. The first visible signs of fermentation will be a developing cloudiness in the brine. This will be followed by the formation of gas bubbles. Depending on the temperature, fermentation can take from two weeks to a month. Some traditional krauts were fermented for more than six months to generate an intense sourness. If you notice signs of active fermentation—like bubbles and a pleasantly sour smell—then your sauerkraut is ready for eating. Usually, it will be ready to eat after five days, but for maximum flavour, leave the cabbage to ferment for a longer period. After it is done fermenting, store the sauerkraut in the refrigerator. If your sauerkraut will take a longer time to ferment, you will need to loosen the lid occasionally, probably every three to four days, ‘burp’ the gas away and then, close the lid again. Please do NOT rinse your sauerkraut after fermenting it. You will be rinsing away the good bacteria at the same time. Because sauerkraut is made from cabbage, it is high in insoluble fibre, which can help maintain regular bowel habits. Insoluble fibre is known as the ‘sweeper’ fibre, aiding in bulking stool and moving out waste,” says a registered dietitian specialising in gut health, Beth Rosen, M.S., RD, CDN, According to the founder of the IBS Nutrition Podcast, Jessie Wong, M.Acc., RDN, LD, “Sauerkraut is safe for most people, but if you have a histamine intolerance or a cabbage allergy, you should avoid it. Reactions may include digestive discomfort, headaches or bloating,” she says. “Those on low-sodium diets or with high blood pressure should also be cautious because of its high salt content.” A registered dietitian nutritionist, Jenna Volpe, RDN says “The brine in sauerkraut has a protective, immune-balancing effect on the gut by helping the immune system to fight off pathogenic microbes. While we don’t know the exact mechanism, it is safe to assume the immune-enhancing benefits of sauerkraut are likely attributed to a combination of the healthy probiotics and the vitamin C in sauerkraut.” Grab a fork and eat your sauerkraut straight out of the jar! You can add sauerkraut to salads, enjoy it as a side dish with your favourite meal, mix it into stews, add it to mashed potatoes and eggs. You can eat it with anything you wish. I have a video on how to make sauerkraut. It will guide you.

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Worldnews

Thousands Gather For Centuries-old Holy Fire Ceremony In Jerusalem

In Pictures Orthodox Christians celebrate Holy Fire tradition in Jerusalem, passing miraculous flame in the ancient basilica. Thousands of Christians gathered in the cavernous Church of the Holy Sepulchre for a centuries-old Holy Fire ceremony. Holding unlit candles, they packed into the sprawling 12th-century basilica built on the site where, according to tradition, Jesus was crucified and buried. In near-total darkness, the Greek patriarch entered the Holy Edicule and emerged with two lit candles. The flame was passed from one candle to the next, the light overcoming the darkness in the rotunda. The flame was later transferred to Orthodox communities in other countries on special flights. Eastern Orthodox Christians believe the light miraculously appears inside the Holy Edicule, built on the traditional site of Jesus’s tomb, while sceptics going back to the Middle Ages have dismissed it as a carnival trick for the masses. Either way, the ceremony, which goes back at least 1,200 years, is a sight to behold. It has also ignited safety concerns. In 1834, a frenzied stampede broke out in the darkened church, and the ruler of the Holy Land at the time barely escaped after his guards drew swords and hacked their way through the crowd, historian Simon Sebag Montefiore recounts in his history of Jerusalem. Some 400 pilgrims died in the melee, most from suffocation or trampling. Israeli authorities have sought to limit participants in recent years, citing safety concerns. That has drawn protests from church leaders, who have accused them of upsetting the delicate, unwritten arrangements around Jerusalem’s holy sites known as the status quo. On Saturday, there was a heavy military presence as thousands of worshippers passed through Israeli checkpoints to enter. Some worshippers lamented that the turnout lacked numbers this year because of Israel’s 18-month war on Gaza. “The number of police is higher than the number of pilgrims,” said Adeeb Joude, key holder for the Holy Sepulchre. Israel captured East Jerusalem, including the Old City with major sites sacred to Jews, Christians and Muslims, in the 1967 Middle East War, and annexed it in a move not recognised internationally. The Palestinians want East Jerusalem to be the capital of their future state. The Old City has a long history of tensions between Israelis and Palestinians, among different religious groups that share its hilly confines and even within certain faiths. Perceived infringements on the status quo in the Church of the Holy Sepulchre have led to brawls between monks of different denominations. Israel says it is committed to ensuring freedom of worship for Jews, Christians and Muslims, and has long presented itself as an island of tolerance in the Middle East. In recent years, however, tensions have risen with the local Christian community, most of whom are Palestinian Christians, a population that has dwindled through decades of conflict as many have moved abroad. Follow Al Jazeera English:...