Israeli Prime Minister Benjamin Netanyahu left hospital Sunday after being admitted the previous day for dehydration amid a heat wave in the country.

Amit Segev, the cardiology unit director at the Sheba Medical Center – where Netanyahu was treated – said the prime minister was fitted with a heart monitor during his stay.

Segev said tests had shown that Netanyahu’s heart was normal and that no heart arrhythmia or irregular heartbeat had been found.

“Prime Minister Netanyahu has completed a series of tests and is in excellent condition,” said Segev.

The prime minister released a video statement later Saturday suggesting he was dehydrated and advising people to drink more water.

“Yesterday, I spent time with my wife in the Sea of ​​Galilee, in the sun, without a hat, without water. Not a good idea,” Netanyahu said, “So first of all I want to thank all of you for your concern and also to the excellent teams here at Sheba who examined me.

“Thank God, I feel very well, but I have only one request from you: we are going through a heat wave in the country, so I ask you, be less in the sun and drink more water and let us all have a good week.”

Temperatures in Israel have been reaching the mid-30s Celsius (low 90s Fahrenheit) for several days and are expected to continue at that level for the next week, the Israel Meteorological Service said.

Opposition leader Yair Lapid wished Netanyahu “a complete recovery and good health” in a tweet.

A cabinet meeting set for Sunday has been postponed to Monday, the leader’s office said.

Netanyahu, 73, is the leader of Israel’s center-right Likud Party and has been the dominant figure in Israeli politics for nearly three decades.

In June 2021, he lost office for the first time in 12 years after rival Naftali Bennett won a parliamentary vote to form a government.

Eighteen months later, he was once again sworn in as prime minister in a dramatic return, cobbling together a coalition.

During Yom Kippur in October 2022, Netanyahu took ill while visiting a synagogue.

He was admitted to hospital where he stayed overnight before being released.

Phoenix once again hit 110 degrees Monday for a record-tying 18th consecutive day at that temperature or higher as the Southwest sizzles under a deadly, unrelenting heat wave.

The record is expected to be broken Tuesday as the streak continues, with temperatures of at least 115 degrees in the forecast for Phoenix every day through next weekend.

The dangerously hot temperatures are also taxing hospitals as people suffering from heat-related illnesses seek treatment.

Heat is the number one killer of all natural disasters, studies show, and as temperatures continue to rise, scientists expect it to make even more people ill.

With residents cranking up their air conditioning this heat wave, Arizona Public Service utility customers’ demand on Saturday set the record for the most electricity used at once in the utility’s history, according to a news release from the company.

It’s not just Arizona sweltering in the intense heat: Over 90 million people are under heat advisories across the United States, including at least 50 million who have been under heat alerts for the past 10 days.

There have been heat alerts for dangerously high temperatures in the Southwest – stretching from Texas to Arizona – for 38 consecutive days dating back to June 10.

And the streak shows no signs of ending any time soon. The heat is expected to continue across the region through at least July 28, and overnight temperatures will provide very little relief, the National Weather Service warned.

More than 1,500 record-high temperatures were recorded in the US so far this month, according to the National Oceanic and Atmospheric Administration.

Over 35 daily high temperature records were broken on Sunday alone, according to the weather service, with Death Valley, California, hitting a daily record-breaking 128 degrees and Las Vegas shattering its record with 116 degrees.

Phoenix and Tucson, Arizona; El Paso, Corpus Christi and Brownsville, Texas; and Tampa and Fort Myers, Florida, are all having their hottest July’s on record to date, according to NOAA climate data.

El Paso reached 100 degrees for the 32nd straight day, “with no end in sight,” the weather service tweeted. The previous record for consecutive days over 100 was 23 in 1994.

“Take the heat seriously and avoid extended time outdoors,” the weather service said. “Temperatures and heat indices will reach levels that would pose a health risk, and be potentially deadly, to anyone without effective and/or adequate hydration.”

Patients being placed in body bags with ice

At Valleywise Health Medical Center, LoVecchio said he has seen three to four cases per shift of patients who faced death without emergency treatment.

Body temperatures of 107 or higher can result in death or permanent brain damage. LoVecchio said it could take as little as five to 10 minutes to cause brain cell death at these high temperatures.

LoVecchio said that pavement in the sun can reach up to 180 degrees. Patients may fall on the pavement due to dehydration, heat stroke or another medical condition, he said.

“It doesn’t cool down here at all and surface temps can get so ridiculously high and people can get burns in a matter of seconds,” Murphy said.

Over the past five years, Murphy said contact burns have become a “big problem.”

Everyone is susceptible to heat related injuries, including those who have lived in Arizona for their entire lives, Maricopa County Department of Public Health spokesperson Sonia Singh said.

“It doesn’t matter how long you’ve lived in the heat, how old you are or how healthy you are,” Singh said. “It impacts everyone.”

Correction: A previous version of this story mischaracterized the status of the 55 other suspected heat-related deaths; they are still under investigation. It also misstated where the deaths occurred; they were in Maricopa County.

As an unrelenting heat wave enters its 39th consecutive day, millions of people from California to Florida are asking: When will it end?

The long-term forecast looks bleak. For most, the extreme heat will continue for the foreseeable future, with no end in sight for the rest of the month, but there is a brief glimmer of hope for some parts of the country headed into the weekend.

An area from South Texas to Arizona to South Florida has had the worst of it and that will only continue. El Paso, Texas, has been in the triple digits for 32 consecutive days. In Miami, the record warm sea surface temperatures, combined with light winds are causing stifling heat: The heat index there topped 100 degrees or more for a record 37 consecutive days. Phoenix will break the record of 18 consecutive days at or above 110 degrees today and the streak will likely continue for at least another week or more.

That longevity combined with the dangerously low overnight temperatures in the 90s are taking a toll on human health and infrastructure there. There have been 12 confirmed heat-related deaths in Maricopa County in the first week of July, and 55 deaths in the county are suspected to be heat related and are under investigation, according to data from the Maricopa County Department of Public Health.

Heat is the number one killer of all extreme weather, National Weather Service data shows, and as temperatures continue to rise, scientists expect it to make even more people ill.

Historic heat dome to shift later this week

An enormous, relentless stubborn ridge of high pressure has trapped air inside in a “heat dome” resulting in extreme temperatures as the dome parks itself over areas.

The heat will remain until a shift in the weather pattern occurs and either breaks apart the heat dome or moves it out of the country completely. That’s not expected anytime soon.

Instead, the dangerous heat will continue through this week, with more records broken each day. More than 1,500 heat records have already been broken this month and another 75-plus could fall by the end of the weekend.

The Desert Southwest and Texas will continue to see daytime highs in the triple digits this week. High temperatures along the Gulf Coast and mid-South will be in the upper 90s for the rest of the week, with heat indices as high as 115 degrees. Record-breaking warm low temperatures will provide little relief in what’s typically the coolest time of the day.

Only the Southern Plains and Gulf Coast could see some relief in the coming days as the heat dome shifts back to the west and a cold front advances across the area. By the end of the week, numerous cities will at least temporarily get out of the most intense heat.

Little Rock, Arkansas, will go from a high of 101 today to a high of 87 on Friday. Oklahoma City will also go from triple digits today to the mid-80s on Friday.

No end in sight for hardest-hit areas

The heat streak will continue headed into August in the Desert Southwest and South Florida.

The only hope for the Southwest is that sporadic monsoonal rain will bring some temporary relief, however, the overall temperature pattern will remain hot. Areas that do see any rain could see higher heat indices because of additional moisture and higher humidity coming in from Mexico.

According to the Climate Prediction Center, temperatures in much of the South, including South Florida, and the Southwest will remain above normal, meaning the next two weeks should continue to be hot.

If that holds true, then the heat wave will be approaching two consecutive months, or more than 50 days, over these same areas.

Correction: A previous version of this story mischaracterized the status of the 55 other suspected heat-related deaths; they are still under investigation. It also misstated where the deaths occurred; they were in Maricopa County.

The jiggling and jostling atop the global passport rankings for 2023 just got a little more interesting.

For five long years, Japan has been sitting pretty in the No.1 position in the Henley Passport Index, which measures global travel freedom in terms of how much visa-free and visa-on-demand access to the world different citizens enjoy.

But for summer 2023, Japan’s been knocked down into third place and the new titleholder is Singapore, whose citizens are able to visit 193 destinations out of 227 around the world visa-free.

And while Asia has long dominated the top of the leaderboard in the index created by London-based global citizenship and residence advisory firm Henley & Partners, Europe is bouncing back. Germany, Italy and Spain have all moved up into second place with visa-free access to 190 destinations, while Japan and South Korea are joined in the No.3 slot by Austria, Finland, France, Luxembourg and Sweden. Citizens from that particular magnificent seven enjoy access to 189 destinations without needing a prior visa.

The United States and the United Kingdom have both been on a downward trajectory since the halcyon days when they jointly held the No.1 spot way back in 2014, but the UK, at least, appears to be turning things around. It’s made a sprightly two-rankings hop to No.4 in the ranking, a position it’s not held since 2017. The US, meanwhile, has dropped a further two places to eight spot, with access to a mere 183 destinations visa-free.

The Henley Passport Index is based on data from the International Air Transport Association (IATA) and ranks 199 passports worldwide. It’s updated in real time throughout the year, as and when visa policy changes come into effect.

In its latest release, Henley & Partners notes that over the history of the 18-year-old ranking the average number of destinations travelers are able access visa-free has nearly doubled, from 58 in 2006 to 109.

However, the travel freedom gap between those at the top and the bottom of the ranking is wider than ever. Citizens of Afghanistan are only able to visit 27 destinations without a prior visa, just below Iraq (with 29 destinations) and Syria (with 30).

Cristian H. Kaelin, chairman of Henley & Partners, notes that Singapore has been busy securing greater travel freedom for its citizens over the past decade, gaining visa-free access to 25 new destinations.

“The UAE has added an impressive 107 destinations to its visa-free score since 2013,” he says. “Of the countries sitting in the Top 10, the US has seen the smallest increase in its score, securing just 12 additional destinations.”

Greg Lindsay, from Cornell Tech’s Jacobs Institute, says in the Henley & Partners release, “The story is a simple one — by more or less standing still, the US has fallen behind. America’s relentless slide down the rankings is a warning to its neighbor Canada and the rest of the Anglosphere as well.”

Other indexes

Henley & Partner’s list is one of several indexes created by financial firms to rank global passports according to the access they provide to their citizens.

Arton Capital’s Passport Index takes into consideration the passports of 193 United Nations member countries and six territories – Taiwan, Macao, Hong Kong, Kosovo, the Palestinian territories and the Vatican. Territories annexed to other countries are excluded.

Arton’s Global Passport Power Rank 2023 puts the United Arab Emirates in the top spot, with a visa-free/visa-on-arrival score of 180.

As for second place, that’s held by 11 countries, most of which are in Europe: Germany, Sweden, Finland, Luxembourg, Spain, France, Italy, Netherlands, Austria, Switzerland and South Korea.

The UK is at No.3, alongside Denmark, Belgium, Portugal, Norway, Poland, Ireland and New Zealand. The US and Japan are down in fourth place.

The best passports to hold in 2023 are:

1. Singapore (192 destinations)

2. Germany, Italy, Spain (190 destinations)

3. Austria, Finland, France, Japan, Luxembourg, South Korea, Sweden (189)

4. Denmark, Ireland, Netherlands, UK (188 destinations)

5. Belgium, Czech Republic, Malta, New Zealand, Norway, Portugal, Switzerland (187 destinations)

6. Australia, Hungary, Poland (186 destinations)

7. Canada, Greece (185 destinations)

8. Lithuania, United States (184 destinations)

9. Latvia, Slovakia, Slovenia (183 destinations)

10. Estonia, Iceland (182 destinations)

The worst passports to hold:

Three countries around the world have visa-free or visa-on-arrival access to 30 or fewer countries. These are:

101. Syria (30 destinations)

102. Iraq (29 destinations)

103. Afghanistan (27 destinations)

The Russian State Duma, or lower house of parliament, has voted in favor of a new law banning nearly all medical help for transgender people including gender reassignment surgery, in a raft of new anti-LGBTQ laws in Russia.

The bill, which had its third and final reading on Friday, prohibits doctors from conducting gender reassignment surgeries, except in cases related to treating congenital physiological anomalies in children. It also restricts registry offices from amending official documents based on medical certificates of gender change.

The law must still be approved by the Federation Council and signed by President Vladimir Putin before it comes into force.

Amendments made for its third reading include disqualifying individuals who have undergone gender changes from becoming adoptive parents or guardians, as well as the possibility of annulling a marriage if one or both spouses undergo a gender change and update their civil status records.

Putin has toughened anti-LGTBQ legislation in recent months, as the Kremlin clamps down on free speech and human rights amid the war in Ukraine.

These recent legal developments in Russia expand the constraints on the LGBTQ community and reflect a tightening of regulations and control over transgender rights in the country.

In December 2022, Russia expanded its existing “gay propaganda” law to exert control over public discussions and narratives surrounding non-heterosexual relationships and identities. The package of amendments signed by Putin includes heavier penalties for anyone promoting “non-traditional sexual relations and/or preferences,” as well as gender transition.

Russia’s first transgender politician, Yulia Alyoshina, has warned of the severe consequences of the proposed transgender bill.

“This bill is not just discriminatory, it is a real genocide of transgender people,” she added.

In October, amid the hearings on “LGBTQ propaganda” law amendments and the bill passing its first reading in the State Duma, Alyoshina, who obtained her new passport in 2020, resigned from her position as a regional head of the Civic Initiative party and chose to end her political career.

‘Politics of terror’

The latest restrictions seem to be closely intertwined with the ongoing dissent on the political and human rights activity in Russia.

Notably, on the eve of the final reading, Russia’s Federal Security Service (FSB) announced it had detained a transgender activist on suspicion of treason.

The FSB alleged that the activist, a Russian citizen from the Oryol region, supported the Armed Forces of Ukraine by providing financial assistance through a donation to the independent human rights monitoring group OVD-Info.

The Russian state labeled OVD-Info a foreign agent in 2021 under a law that critics say suppresses dissent. The group has continued to document alleged rights abuses inside Russia and expanded its mandate to help anti-war protesters following Russia’s full-scale invasion of Ukraine.

Vanya Solovey, a trans rights campaigner, said “it is no coincidence” that the law is being read in Russian parliament amid Moscow’s war on Ukraine.

“This anti-trans politics is indeed a politics of terror. It affects not only trans people but everyone living in Russia.”

Russian tour operators are pleading with vacationers to Crimea not to make decisions “based on emotions,” as Ukraine’s strike on the Crimea bridge on Monday played havoc on travel between the occupied Ukrainian peninsula and Russia.

Hundreds of cars were waiting Tuesday to cross the bridge both to and from Crimea, and Russian-backed officials were encouraging drivers to travel along the land route through occupied southern Ukraine.

“We have cancellations for the end of July and August,” Elena Bazhenova, head of the Laspi Crimean tour company said, according to the Russian Union of Tourist Industry. “We are explaining to tourists that cancellations for these dates are only possible with penalties.”

“We [are trying to] convince tourists not to make decisions based on emotions,” Bazhenova said. “We expect the situation to normalize in the coming days.”

Crimea, which was illegally annexed by Russia from Ukraine in 2014, is a popular Russian destination for summer vacations. But a Ukrainian attack on Monday destroyed a large section of the Crimea bridge’s road span – which connects Kerch in Crimea to Russia’s Krasnodar region – upending the main route for car traffic to the peninsula.

Evgenia Kizey, sales director for Multitour, said tourists were having different reactions but there was “no panic.”

“People will leave as exit routes are opened by train or car,” Kizey said, according to The Russian Union of Tourist Industry. “For those who arrive by car in Crimea in the near future, we offered to rebook tours to our hotels in the Krasnodar Territory. Tourists also willingly choose the Moscow region and other regions. Or we shift their reservations in Crimea to later dates.”

Road traffic over the Crimea bridge resumed overnight over one of the bridge’s four lanes, but there is heavy traffic. Public traffic mapping tools show that there are significant delays for cars both entering and leaving Crimea, and Russia state media distributed video of long lines of cars.

As of late morning on Tuesday, there were around 700 cars waiting to cross the strait into Crimea and 500 cars waiting to cross the bridge into Russia’s Krasnodar region, according to a Telegram account devoted to facilitating Crimean travel.

Rail traffic continues to operate over the bridge, albeit with delays.

Russia-backed leaders in occupied southern Ukraine are encouraging drivers to use the land route through the occupied portions of Ukraine’s Donetsk, Zaporizhzhia and Kherson regions. That route passes through Mariupol, which was devastated last year by Russia’s invasion, and Melitopol, which as a Russian military hub is regularly subject to long-range Ukrainian missile strikes.

Curfews have been lifted on the road to and from Crimea, the leaders in those regions said Monday, to allow for “round-the-clock” travel.

“A number of measures are being introduced to ensure the faster passage of checkpoints on the administrative border,” Denis Pushilin, head of the separatist so-called Donetsk People’s Republic, said on Telegram.

Russian state media RIA Novosti reported Tuesday morning that the line of cars waiting to enter Crimea at Chonhar, in Ukraine’s Kherson region, stretched for more than 1.5 kilometers (just under a mile).

TASS reported that bus services from Rostov, in southern Russia, to Crimea had been restored – via southern Ukraine, rather than over the Crimea bridge.

A tourist from the Russian city of Rostov told the Russian tourism website Tourdom about her experience driving to Crimea.

“We left Rostov yesterday at 11 a.m., around 7 p.m. we were at the Chongar checkpoint,” she said, using the Russian spelling for that town. She said that they waited for several hours at the checkpoint and they were sent to the back of the queue after – in the chaos – she tried to jump the line.

“I was very tired,” she said. “It’s good that after Chonhar my husband drove. Because of this delay, we arrived in Alushta only at one o’clock in the morning.”

Hotels in Crimea are helping tourists stranded by the lack of travel options by extending their stays, sometimes free of charge, the head of the Russian Union of Travel Industry said.

“We call on all members of the Crimean hotel industry to behave responsibly in this difficult situation, so that people understand that they will not be left alone with their problems,” Ilya Umansky, said in a statement.

This week’s NATO summit in the Lithuanian capital of Vilnius provided a valuable reminder that during a war, the battle for communications is as important as anything happening on the ground.

On its own terms, the summit was a success.

The main goals in Vilnius were to reach an agreement that Sweden could join the security alliance – which Turkey had blocked – and to strengthen support for Ukraine.

Both of those goals were achieved – and in the case of the agreement on Sweden’s membership, it was a not insignificant milestone. But officials at NATO HQ in Brussels have expressed some frustrations that much of the coverage focused on the specific and thorny issue of Ukraine joining the alliance.

Ukrainian President Volodymyr Zelensky has been pushing for a clear path to join NATO for some time. He wanted more than just a restatement of the existing, vague expression of support for Kyiv’s membership of the bloc, arguing instead for a clear timetable to accession.

Western officials and diplomats, however, hoped that the issue would not be the focus of this week’s summit. Zelensky’s maximalist position was understood to be a way to ratchet up the pressure, but they say he would have known that the summit would not have been the moment he got his way.

That hope turned out to be misplaced. 

Nothing he said was particularly controversial, nor did it depart from the prevailing view in NATO. Most allies agree that Ukraine is not in a position to join while it is under invasion. 

There are many reasons for this, but the most important is that membership would immediately give Ukraine the right to invoke Article 5 of the NATO treaty – which would force the rest of the alliance to join Ukraine in the war against Russia. 

But the timing of Biden’s comments, on the eve of the summit, and his position as leader of the most powerful NATO state, meant that the question of Ukrainian membership was front and center as the alliance convened. 

It didn’t help matters that Zelensky sent a blistering tweet criticizing NATO as “absurd” for not offering a clearer path to membership in its joint communique on Tuesday. 

Nor did it help when British Defense Secretary Ben Wallace commented that Ukraine should be more grateful for the support it has already received. 

All of which created room for speculation about NATO’s unity, and allowed its adversaries to call the summit a failure.

One example: Sputnik, the Russian state-owned news agency, was able to publish a story headlined “NATO Summit Exposes Fractures in Alliance Over Support for Ukraine.” The article contains a quote from an analyst stating that “the decision by the USA to quietly pull the plug on the Ukrainians is only natural and certainly not ‘absurd.’ The game is up.”

Given the millions of dollars the US and its allies have provided to Ukraine since the start of the war and the commitment to send even more money and arms, this is a dubious claim. But Biden’s comments, combined with Zelensky’s public anger, provided space for the claim to be made.

This might feel like nitpicking over things that are trivial while a nation is under invasion. But Russia has historically been better than the West at spinning events to fit a narrative. These information wars are not just for the benefit of Russian audiences at home, but for people who live in NATO territories who might be susceptible to misinformation.

Western leaders are keenly aware of the power of messaging during a war. NATO officials privately wished that the key delegations in Vilnius – whether they had traveled from Washington or Kyiv – had remembered that lesson this week.

Fans turned out in their droves to watch Lionel Messi’s official unveiling as an Inter Miami player.

They had braved heavy rain and thunder to catch a glimpse of the Argentine superstar wearing Inter’s distinctive pink kit for the first time.

But as they did so, spare a thought for Rodolfo Pizarro.

A Mexican international, Pizarro joined Inter in 2020 ahead of its inaugural Major League Soccer (MLS) season.

He scored the team’s first-ever goal later that year, going onto make 58 appearances for the club, scoring seven goals and providing 13 assists across his Inter career.

When Pizarro signed for Inter, he filled one of the club’s three ‘Designated Player’ spots. Designated players in the MLS are not restricted by the league’s salary cap.

The rule is also known as the ‘Beckham Rule’ after David Beckham – now Inter’s co-owner – became the first designated player when he joined LA Galaxy in 2007. The rule allows teams to compete for players outside of the league’s pay structure and potentially attract stars like Messi.

So, with Messi signing a contract reportedly worth between $50 to $60 million per year, the 35-year-old Argentine fills one of Inter’s designated player spots.

It was on Friday – the before day Messi’s official signing took place – that Inter announced that Pizarro’s contract had been mutually terminated, thereby freeing up a designated player slot.

In a heartfelt goodbye message on Instagram last, Mexican international Pizarro said it had been an honor to play for Inter Miami.

Greek top-flight side AEK Athens announced on Monday that it had signed Pizarro, reuniting him with the team’s manager Matías Almeyda after he coached the 29-year-old at Mexican team Chivas. “Very happy to be here, fulfilling a dream,” wrote Pizarro on Instagram.

‘Building a roster’

Inter has also recently announced the signing of Messi’s longtime Barcelona teammate Sergio Busquets.

Which means Inter, according to the club’s website, has four designated players on its roster – Messi, Busquets, as well as Josef Martínez and Gregore.

Either Inter can look to move one of their designated players on or they can “buy down” a player’s contract. The club can spend a portion of their allocated money to reduce one of their player’s contracts, which means they will no longer be deemed a designated player. As the MLS guidelines explain: “A club may buy down a player earning $700,000 to a Salary Budget Charge of $500,000 by using $200,000 of General Allocation Money.”

Inter will be keen to comply with MLS regulations having already fallen foul of them before.

In 2021, the club was hit by an MLS-record $2 million fine and a $2.2 million cap hit over the misuse of the designated player allocation and violations of the league’s salary budget.

The violations included the incorrect roster categorization for players Blaise Matuidi and Andrés Reyes who should have occupied a designated player slot, MLS said in its statement.

“The violations also included undisclosed agreements that resulted in the underreporting of salary budget amounts for players Leandro González Pirez, Nicolás Figal and Julián Carranza,” according to MLS.

Inter Miami’s managing owner Jorge Mas was also personally fined $250,000.

“We have worked closely with MLS to address these issues and have made significant changes in our management structure,” Mas said in a statement at the time.

“Following our inaugural season, we took a deep look at our soccer operations leadership group and made decisions that not only strengthened our internal roster compliance measures, but also better positioned us to build a sustainable, long-term competition strategy with the hiring of Chris Henderson as Chief Soccer Officer and Sporting Director in 2021.

“Inter Miami is an ambitious Club with big aspirations. We believe our fanbase, market and ownership group propel us to be one of North America’s most-followed fútbol teams in the world. We are committed to supporting our team and building a roster we are proud of.”

In 2022, Simone Magill arrived at the Women’s Euros with Northern Ireland full of hope. Here she was, representing her tiny nation in one of world soccer’s biggest tournaments.

But during the team’s opening match against Norway, disaster struck. Magill went down in agony and Northern Ireland fans held their breaths. She had suffered a dreaded anterior cruciate ligament (ACL) injury.

“There were a million thoughts going through my head when it happened. I was thinking about how long I’d be out for, how long the recovery would take, about needing surgery, and there were lots of tears.”

Magill wasn’t the only player to have her tournament ruined by the devastating knee injury. Fast-forward to the upcoming Women’s World Cup, which starts on July 20 in Australia and New Zealand, and a host of the game’s best players will also be absent because of an injury which appears to be endemic in the women’s game.

England captain Leah Williamson, the Netherlands’ all-time leading women’s scorer Vivianne Miedema and England’s Euro 2022 top scorer Beth Mead will all miss the biggest international competition in the women’s game.

Cat Macario, a rising star for the US Women’s National Team (USWNT), is also out, as is Germany’s Giulia Gwinn, named the Best Young Player at the 2019 Women’s World Cup, and Switzerland’s teenage midfielder Iman Beney – ruled out a day after being called up to the national team.

During the 2022/23 season, so many female soccer players across Europe’s top leagues suffered ACL injuries that an entire starting XI could be made up of those individuals. But why are so many female soccer players suffering from the same injury?

What is the ACL?

The ACL is one of the key ligaments inside the knee. It joins the thigh bone to the shin bone and keeps the knee stable. It also prevents the thigh and shin bones from moving out of place. It most often can be injured by quickly changing direction at high speed – a typical action for many athletes in soccer, football and basketball, among other sports.

Tearing an ACL is one of the most serious injuries an athlete can endure. The best option for repairing an ACL rupture is to have surgery and, after that, it takes between six and 12 months to return to full activity – often ruling soccer players out for entire seasons.

Sarah Milner, a specialist musculoskeletal sports and rehab physiotherapist, says that, if a professional athlete doesn’t have surgery for an ACL tear, they “essentially won’t have a career anymore.”

According to a study published in the peer-reviewed British Journal of Sports Medicine, females are three to six times more likely to experience an ACL injury compared with males.

Another study published by the medical journal Arthroscopy estimates that women’s soccer and basketball players are three times more likely to tear their ACL than their male counterparts.

Of the 20 nominees for the 2022 Ballon d’Or Féminin – the highest individual honor for soccer players – 25% suffered an ACL injury in the same year.

But of the 30 nominees for the 2022 men’s Ballon d’Or, none had sustained an ACL injury that year.

Why are female soccer players at a higher risk than their male counterparts? A number of academics, players and soccer medical experts have identified a common theme: a lack of sufficient funding for the women’s game.

Dr Katrine Okholm Kryger is a senior lecturer in sports rehabilitation at St Mary’s University in Twickenham, London. She said many observations around ACL injuries among female players are often centered around “nature and nurture.” Nature, in this case, refers to the anatomy and biomechanics of women. Kryger thought too much blame had been placed on this factor.

“A common argument is that women’s menstrual cycle leads to fluctuating hormones, which makes them more physically unstable when playing,” Kryger said. “But research shows that there may be a slightly higher risk of injury during the ovulation period but that risk is really very minor.

“Also, if you’re on any hormonal contraception, that risk should be leveled out and many women players are on hormonal contraception, so it’s difficult to imagine that the menstrual cycle factor is the driving cause behind ACL injuries.”

Kryger also had reservations about the argument that uses the way women’s bodies are built as a cause.

“I don’t think anyone is ‘designed’ to play the game, so I really want to break down those philosophies that imply women are too ‘weak’ or too ‘physically unstable’ to play.”

According to Kryger, the key factors behind the disparity in rates of ACL tears between women and men in soccer are not only controllable, but also gendered.

‘It doesn’t have to happen’

“Women have just never been a priority in the sport,” Kryger said. “At elite clubs in the men’s game, players have access to exceptional academies and training facilities from a very young age.

“They are able to start work with excellent strength and conditioning coaches even as early teenagers and, by the time they are playing as adult professionals, they’ve been able to build up a huge amount of physical resilience – which is key in lowering the likelihood of an ACL rupture.

“But, in the women’s game, the youth academies are nowhere near as professionalized or developed in the way that the men’s are. Many women’s clubs, especially if they aren’t the top ones in the Women’s Super League [in England], for example, do not have access to the best training grounds and resources from a young age in the way that elite male players do.”

Indeed, players at the top of the men’s game have usually been able to commit completely to soccer even before their teenage years – youth contracts for academy players ensure that they can focus fully on the sport.

But, as Kryger argued, the professionalization of women’s soccer is relatively recent compared to the men’s game and there is far less funding for women’s academies.

The career of Manchester United forward Rachel Williams, who damaged her ACL in 2018, serves as a perfect example of that disparity.

At 20 years old, the point at which the majority of male players are playing in a full-time professional capacity, Williams was working as a plasterer alongside appearing in the Women’s Super League.

According to a BBC interview, in the early days of the WSL (formed in 2011), Williams said she only trained twice a week and made her money from plastering, rather than playing soccer.

Kyrger said the lack of football shoes specifically designed for women has also contributed to ACL ruptures.

“Football boots, or cleats, are very tight-fitting – unlike running shoes. But the vast majority of them are designed to fit men’s feet, rather than women’s, despite the fact that women’s feet are different to men’s in several ways.”

According to an article in the Aspetar Sports Medicine Journal, co-authored by Kryger, footwear molds used by manufacturers designing cleats are based on “Caucasian male foot shapes” – but the adult female foot is on average smaller than the male foot and women “generally have a wider forefoot relative to their foot length, a greater ankle circumference and a different ankle shape.”

A recent report by the European Club Association revealed that as many as 82% of women’s players in Europe who took part in a survey experience discomfort wearing boots.

About 350 players from 16 top teams across the continent were surveyed.

According to the findings, 34% of women players reported discomfort specifically in their heel and the majority use specialized insoles. Some have even improvised in order to find more comfort when playing by cutting holes in their boots to alleviate and avoid blisters.

Ahead of the 2023 World Cup, Nike has unveiled the Phantom Luna, the most “researched women’s-led football boot design,” according to the sports manufacturer. The new boot has been trialed by top women’s soccer stars, including Crystal Dunn of the USWNT, and is designed to reduce rotational traction at the knee – which can help to lower the risk of sustaining an ACL injury.

“The only good thing about the factors in these injuries such as ill-fitting boots is that it’s something that can be changed,” Kryger said. “It doesn’t have to happen. It isn’t something we’re stuck with – we can do something about it. Or, rather, boot manufacturers and club executives can do something about it!”

‘We haven’t had the time to adjust’

Asked about the spate of ACL injuries, Magill cited multiple factors, including a lack of medical resources and inadequate pitches.

The recent rapid growth of the women’s game has also created new challenges, according to Magill.

“My generation has gone from being semi-pro to full-time, pro footballers in a very short period of time. All of a sudden, it’s like: ‘Ok, I’m a totally professional athlete now!’ But we haven’t had much time to adjust to that.”

The impending World Cup marks the second summer in a row that women players across Europe won’t have had much of a break between the end and start of the domestic seasons. Last year, the 2021 Euros – delayed one year by the Covid pandemic – took place. Next summer, Paris will host the 2024 Olympics, another prestigious tournament on the women’s soccer calendar.

The pitches that women play on are also an issue, according to Magill.

“When I was playing as a teenager, we were often playing on 3G pitches and those surfaces are just not ideal for playing football on at all. Some of them were abysmal.”

A 3G pitch is an artificial field made up from rubber crumbs and synthetic grass. The vast majority of players much prefer playing on real grass, said Magill, with many feeling that injuries are more common on artificial surfaces.

While some WSL teams sometimes play on the same pitches as their male equivalents, Kryger highlights there are teams that have to “share pitches with lower-league men’s clubs, who often get to play on a Saturday, while the women’s team often have to play on Sundays – once the pitch is already scuffed up and not exactly in pristine condition.”

Magill said her rehabilitation had been “smooth” but reflected on other players outside of the top women’s league in England whose road to recovery may not have gone so well.

“One of my best friends in Northern Ireland tore her ACL some years ago,” she explained. “And I know her rehabilitation took longer than mine and she basically went through it on her own because the league at home was so much less developed back then and it still isn’t like the WSL now.”

‘Funding should not be an issue’

Milner, the rehab physiotherapist, said that there are some clear solutions to many of the factors associated with the disproportionate rate of ACL injuries among women players.

“So much of the issue comes down to funding. There needs to be proper funding towards women’s training grounds, funding towards the academies for girls and young women, so that they don’t have to get a part-time job and can focus completely on football,” she said.

“There needs to be more funding to facilitate better education for those who want to work on the medical side of the women’s game, so that they’re as informed as they possibly can be on the specific requirements of women athletes and their strength and conditioning needs.”

Milner placed great emphasis on the need for strength and conditioning in the women’s game to be adapted in order to suit female players – and stressed the importance of getting this right.

Considering the huge wealth that global soccer boasts, and the exploding popularity of the women’s game, Milner said there was no excuse to not properly fund women’s clubs – whether that be the club’s medical facilities, academies or the quality of their training grounds and pitches.

“The demand for women’s football is growing but the adequate support isn’t there,” Milner said.

Along with putting the onus for change on the top decision makers in soccer, Milner said that schools, at least in England, must take responsibility to ensure that physical education lessons home in on the needs of girls and women in soccer.

“The England women’s team are pushing for all girls in school to have access to football,” she explained, “and, for any future professional players, it’s essential that attention is paid to how to best prevent injuries and that their strength and conditioning is tailored to them as girls, rather than being based only on studying boys’ needs.”

With necessary funding funnelled into the medical facilities and staffing at women’s clubs, along with the development of boots designed specifically for female players and the improvement of women’s professional academies, the disproportionate number of ACL tears amongst female players can be confronted and reduced.

The eyes of the world is now on the women’s international game again. The 2023 World Cup is expected to smash viewing records, while the tournament is set to become the most attended standalone women’s sporting event – with more than one million tickets sold, surpassing the 2019 edition in France.

Cristiano Ronaldo has claimed the Saudi Arabian soccer league is better than Major League Soccer (MLS) just a day after long-time rival Lionel Messi completed his move to the US to play for Inter Miami.

Messi had reportedly been offered a huge contract to join a Saudi club, but the World Cup winner instead opted to move to the US following the expiry of his contract with Paris Saint-Germain.

“The Saudi league is better than MLS,” Ronaldo said following Al Nassr’s 5-0 pre-season friendly defeat to Celta Vigo, Reuters reported.

“Now all the players are coming here … In one year, more top players will come to Saudi Arabia.”

Ronaldo signed a two-and-a-half year contract estimated by media to be worth more than 200 million euros ($220.16 million) with Al Nassr in December after leaving Manchester United.

The 38-year-old said last month that any new signings for Saudi clubs would be “very welcome” to join him in the league.

Since then, Karim Benzema, N’Golo Kante, Kalidou Koulibaly, Edouard Mendy and Roberto Firmino have been among the star names to move to the Saudi Pro League (SPL).

Ronaldo also said he would never return to Europe to play soccer as the strength of the leagues are diminishing.

“I’m 100% sure I won’t return to any European club. I’m 38-years-old,” he said, according to ESPN.

“European football has lost a lot of quality. The only valid one and still doing good is the [English] Premier League. They’re way ahead of all the other leagues.”

Ronaldo scored 14 goals in 16 games following his move, but it was not enough to help his side win the SPL title, with Al Nassr finishing second behind Al Ittihad.