A number of people around the world have died after taking part in an ancient healing practice known as kambo, which involves ingesting frog poison.

The spiritual ritual of kambo, which is promoted among Western “wellness communities” as a one‑stop cure for a spectrum of physical and mental ailments, from anxiety to arthritis, is not backed by any scientific evidence.

In April this year, 40-year-old United Kingdom wellness coach and cancer survivor Kristian Trend was the latest to die after reportedly taking part in a “cleansing ceremony” which involved kambo, local media reported.

Trend’s mother told the UK national newspaper, The Telegraph, that she wanted the practice to be banned. While it is legal to buy frog poison for kambo in the UK, it is not considered a licensed medicine.

The practice has also been banned by other countries.

What is kambo?

Kambo is an ancient shamanic healing ritual with its roots in traditional South American medicine. It was practised by Amazonian Indigenous tribes centuries ago. The term “kambo” refers to the secretions of the giant monkey frog (Phyllomedusa bicolor), which are applied to small burns on the skin during the ritual.

Experts say it is hard to pin down the exact origins of kambo since knowledge of the ritual was generally passed down orally, rather than being written down.

The earliest known written documentation of the practice was made in 1925, when French missionary Constant Tastevin wrote about kambo being practised in the border regions between Peru and Brazil.

The monkey frog actually secretes kambo to kill or harm predators that try to attack it. The secretions are also called sapo, which translates to “toad” in Spanish.

Many amphibians release such toxins. In February this year, European countries accused Russia of using a toxin made from the secretions of South American dart frogs to kill Kremlin critic Alexey Navalny.

How does kambo work?

Kambo is an ancient spiritual and healing practice traditionally carried out by a specialised practitioner called a shaman.

The frog’s secretions are collected and dried before the animal is released back into the wild. A heated rod is then used to make a series of small, superficial burns on the skin, and the dried secretion is applied to these points by the shaman, who recites hymns while waiting for the kambo to take effect.

A bucket is usually placed in front of the person receiving the treatment in anticipation of vomiting – a common reaction to the ritual. Then, the kambo is wiped off the burns.

What is the kambo poison?

Kambo is considered poisonous because it contains a complex mix of bioactive peptides – short chains of amino acids – including some that violently stimulate the digestive tract, causing intense nausea and vomiting, and others that act directly on the cardiovascular system, leading to rapid drops in blood pressure and fainting.

Some peptides have opioid‑like effects, altering breathing patterns and affecting the central nervous system. In extreme cases, this combination can trigger sudden cardiac problems or severe organ toxicity, which can be fatal.

Before the ritual, the person receiving kambo is often advised to drink large amounts of water. Combined with heavy vomiting and fluid shifts, this can lead to hyponatremia – dangerously low sodium levels in the blood, sometimes referred to as water intoxication. Severe hyponatremia can cause brain swelling, seizures, coma and, in the worst cases, brain death.

Kambo also causes the gastrointestinal tract to contract violently, which can cause the oesophagus to rupture, also resulting in death.

What is the kambo ritual for?

Kambo is known as a “cleansing” ritual, believed to detox the body and, in some traditions, to enhance fertility, virility and even bring good luck.

It is also used to treat diseases and disorders including addiction, Alzheimer’s disease, anxiety, cancer, chronic pain, depression, diabetes, hepatitis, HIV and AIDS, infections, rheumatism and vascular conditions, according to the US health information website, Healthline.

But doctors say there is no scientific evidence that kambo is effective at treating any of these conditions, and modern medical case reports have instead linked kambo to severe illness and death.

Healthline lists the possible side effects of kambo as nausea, vomiting, diarrhoea, abdominal pain, dizziness, heart palpitations, a sensation of a lump in the throat, difficulty swallowing, swelling of the lips, eyelids or face and even loss of bladder control.

Who has been using it?

Over the past two decades, kambo has become popular in Western and Latin American countries. It has been adopted in “wellness” circles and alternative medicine communities in Brazil, Australia, the UK and the United States.

Indigenous experts have warned against the use of kambo by non-Indigenous practitioners, however. UK media recently reported that Yamanawa leader Joaquim Luz has criticised the online sale of kambo and warned that using it without the preparation or permission of Indigenous communities puts people at risk. The Yamanawa people originate in the Brazilian Amazon state of Acre, with communities extending into Peru and Bolivia.

Who has died from kambo?

There have been at least six known deaths associated with the use of kambo worldwide in recent years.

In 2008, a 52-year-old man died in Brazil after receiving the kambo treatment.

In 2018, a man in Italy died from an abnormal heart rate while experiencing kambo. The man had obesity and ventricular hypertrophy, a condition which causes the heart’s main pumping chambers to thicken.

In 2019, Australian woman Natasha Lechner, 39, died while taking part in a kambo ceremony to cure her chronic back pain.

In October 2021, Australian man Jarrad Antonovich died after kambo was performed on him. It was suspected that he died from a perforated oesophagus after he had vomited excessively.

In 2024, Mexican actress Marcela Alcazar Rodríguez died aged 33 when she ingested kambo during a cleansing ceremony.

Then, in March this year, 40-year-old UK wellness coach Kristian Trend died after taking part in the ceremony.

How have authorities responded?

A recent review published in the medical journal Cureus concluded that the practice of kambo should be more tightly regulated, after it identified several cases of severe reactions and death linked to the ritual.

In 2004, Brazil banned the sale and marketing of kambo. It is also illegal to import the frog poison used in the ritual in Chile.

More recently, in 2021, the Australian Therapeutic Goods Administration (TGA), the country’s national medicine regulator, banned the use of kambo and classified it as a poison.

Kambo is also illegal in the US, and in January 2025, the US embassy in Peru released a circular advising US citizens visiting Peru not to use it.

Leaving Baniyas

By noon, the tankers are full, and the train is ready to depart. After weighing the wagons one by one, the shipment is handed off to the crew of locomotive number 708. The loco cab is the only place available to sit on the train.

Crammed inside, the three-man crew share just a few square metres of space. The steady rhythm of the rails and the low hum of the engine accompany their conversation.

Like all the locomotives still operating, 708  was built in the Soviet Union and dates back to the 1970s. Everything, from the dashboard to the stained windows, is from another era, and the largely metal interior offers little comfort.

A small circular stove allows the crew to keep cups of tea and traditional mate coming, helping them stay alert. The atmosphere is relaxed, and a small speaker plays the classics of Lebanese singer Fairuz.

At the controls is driver Abu Mahmoud. He will lead the first leg of the journey. He and the train chief, Hussein, are both over 50 and have spent their entire lives working for the SRC. Abu Mahmoud’s assistant, Mohammed, is a newcomer by comparison. At 37, he stands out, wearing a turtleneck sweater and well-polished boots. He is from a small village between Homs and Tartous and spent eight years in the army up to 2018.

He explains why he joined the army.

“At the time, the regime told young people on the coast: ‘You have no choice, there’s only the sea behind you. It’s either the army or death’,” he says.

“That’s why I enlisted, and also to earn a salary,” he adds.

After military service, he joined the SRC.

“I would not have opposed staying longer, but after eight years, you were usually demobilised,” he explains.
All three men are from the coastal region, which is predominantly Alawite. They admit to having felt apprehensive about the new government, particularly after the March 2025 killings targeting the Alawite community. Syria’s new leader, Ahmed al-Sharaa, is Sunni.

But Mohammed says, “Our mission is still the same, and we continue accomplishing it regardless.”

“People need to get used to change; it will inevitably take time to trust politicians again,” he adds.

Hussein and Abu Mahmoud nod, and through the window, a large statue of Hafez al-Assad lying on its side comes into view.

Despite their fears, they also see the train as a way of overcoming social divides.

“I am an Alawite, I could choose to sit at home and do nothing all day because I am scared, but I’d miss the locomotive, not making myself useful and enjoying the landscape,” says Hussein.

New Delhi, India – The foreign ministers of India, the United States, Australia and Japan have announced plans to jointly develop port infrastructure in Fiji, a strategically important Pacific island nation, following their meeting in New Delhi earlier this week.

Their grouping, called the Quadrilateral Security Dialogue alliance – or Quad, for short – has worked over the past two decades as a counter force to China’s economic and political influence in the Asia Pacific region.

China, in turn, has said groupings should “not target any third party”, and Beijing opposes “engaging in bloc confrontation”.

Australian Foreign Minister Penny Wong hailed the initiative in Fiji as the strongest commitment to deliver high-quality infrastructure that the Quad has made in the Pacific region. She said a pilot for port infrastructure in Fiji reflects the group’s ability to deliver high-quality infrastructure in response to Pacific priorities.

As the grouping faces questions about its relevance in today’s world order, and US President Donald Trump has been wooing China, Washington has pivoted away from the region as its top priority in favour of the Western Hemisphere and the Middle East.

So, what is the significance of a port development in Fiji? And could this be the next flashpoint in the up-and-down relationship between the US and China?

What are the plans for port development in Fiji?

Fiji’s foreign minister said Suva and Lautoka would be the first ports to be developed on the island under a pilot project by the newly announced “Quad Ports of the Future Partnership”.

This marks the first such joint initiative by the Quad.

Suva, the capital, is already the largest and busiest port of the country. Lautoka, which was historically established around sugar exports, sits in the northwest of Fiji, in the second-largest city.

“It will have to be the two major ones,” Sakiasi Ditoka told the Fijian press, referring to Suva and Lautoka. “And then eventually we’ll probably spread it around – maybe Vanua Levu if you look north, and then maybe Levuka if the project goes that far.”

However, there are as yet very few specific details about plans for the ports.

The Suva port agency, 41 percent of which is owned by Fiji’s government, has discussed $181m of port upgrades, as well as a potential $1.82bn plan to relocate Suva Port, with the US officials, Fijian media reported this week.

Suresh Prasad, the Fiji Ports acting chief executive officer who said he was “rather surprised” by the announcement, told reporters: “If it’s a Quad project, it is going to be a mega project, which is Suva Port most likely.”

In 2023, Fiji’s Prime Minister Sitiveni Rabuka discussed the redevelopment of the Suva port with China, but plans for that did not materialise.

Rabuka told the Fijian parliament this Monday about an agreement to undertake a study for potential US-backed infrastructure with the US Millennium Challenge Corporation, Washington’s foreign aid agency, adding that any project would be funded by grants, not loans.

What does the Quad do in the Asia Pacific?

The four Quad countries are the most influential powers in the region outside of Russia and China.

The Quad’s area of cooperation has expanded beyond its original security-focused outlook and now stretches to a wide range of Asia Pacific initiatives for maritime security, infrastructure, technology, health and supply chains.

The grouping also operates the Indo-Pacific Partnership for Maritime Domain Awareness (IPMDA), which helps Pacific countries monitor illegal fishing, smuggling and other maritime activity with the use of satellite data. It cooperates on facilitating supply chains for lithium, rare-earth minerals and other strategic minerals to reduce dependence on China, alongside cooperation on quantum computing and cybersecurity.

Fiji has traditionally been aligned with Australia, and the Quad countries have pledged cooperation on disaster relief, climate resilience and humanitarian assistance to smaller Pacific islands.

Quad countries also hold joint military exercises under the annual Malabar Exercise in the region, including anti-submarine warfare, aircraft carrier operations and maritime interoperability.

Why is China unhappy about the Quad?

“China perceives the Quad as an anti-China coalition, and this new project in Fiji is viewed as the Quad expanding its operations from Indo-Pacific hotspots into the Pacific Island countries,” said Sana Hashmi, a postdoctoral fellow at the Taiwan-Asia Exchange Foundation with a special focus on China.

Over the past few years, Beijing has pumped billions of dollars into the region, and its influence has risen in parallel.

In response to a question from the media this week about the Quad’s initiative in Fiji, Chinese Foreign Ministry spokesperson Mao Ning warned that any cooperation in the region “should not target any third party”.

“China has stated its position on the Quad on multiple occasions. Cooperation between countries should be conducive to regional peace, stability, and prosperity, and not target any third party,” she told reporters. “We oppose forming exclusive groupings or engaging in bloc confrontation.”

In a joint statement following their meeting in New Delhi this week, the Quad countries’ foreign ministers also expressed concern about rising tensions in the East China Sea and the South China Sea, reiterating “strong opposition to any destabilising or unilateral actions, including by force or coercion, that threaten peace and stability in the region”.

The statement did not name China specifically but is seen as referring to China’s claim over Taiwan and the number of military drills it has been conducting around the island. The next day, Chinese spokesperson Ning told reporters: “The situation in the East China Sea and the South China Sea is generally stable.

“Certain countries should stop meddling in maritime affairs in China’s neighbourhood and earnestly respect regional countries’ efforts to safeguard peace and stability,” she replied, apparently in reference to the Quad. “Those who attempt to patch up small groupings, hype up tensions, and stoke confrontation will find no support.”

How powerful is China in the region?

Beijing has transformed in the past decades since the end of World War II into a continental Asian power, now presenting itself as the central economic and increasingly strategic force across the region.

According to the Lowy Institute’s 2025 Asia Power Index, China is the region’s second-ranked comprehensive power after the US, but it dominates in several key areas, especially trade connectivity and economic leverage.

China is also the primary regional trading partner for 22 of the 27 countries measured in the index, underscoring the dependency of Asian and Pacific economies on Chinese markets, manufacturing chains and imports.

Beijing has recognised eight countries in the region as “comprehensive strategic partners”, the highest classification of diplomatic partnership in China’s foreign relations. Top Chinese officials have frequently visited the region, with Xi attending summits over the past decade.

“China’s growing footprint in the [Pacific Island countries] remains a major concern for Australia and other regional actors,” Hashmi told Al Jazeera. “Consequently, the Quad’s willingness to operate more actively in the region is seen by Beijing as a form of strategic encirclement and the emergence of countervailing coalitions that could constrain China’s regional ambitions in the [Pacific Island countries].”

Fiji, meanwhile, owes Chinese state banks more than $100m for road building and other infrastructure projects undertaken a decade ago.

What else have Western powers done to counter China in the region?

The US and Australia have stepped up their strategic engagement across the Pacific Islands in recent years as concerns grow over China’s expanding diplomatic and maritime footprint in the region.

The AUKUS agreement between Australia, the US and the United Kingdom was announced in 2021. Under that, Canberra and London are working with Washington to design nuclear-class submarines ready for delivery to Australia in the 2040s.

The US and Australia have also pursued a series of Pacific initiatives over the past year, including stronger defence agreements with Papua New Guinea. Australia has stepped up aid, policing support and climate financing for Pacific Island states.

In 2022, China signed a landmark agreement with the Solomon Islands to allow Beijing to dispatch police, military, and armed forces to the Pacific nation. That gives Beijing a strong foothold in the waters, less than 2,000km (1,240 miles) from Australia.

In the following months, Washington scrambled to reopen embassies and expand diplomatic outreach across the region. The US reopened its embassy in the Solomon Islands in 2023 after a 30-year absence, opened a new embassy in Tonga the same year, and announced plans for additional diplomatic missions in countries, including Vanuatu and Kiribati.

The White House, under Joe Biden’s presidency, renewed the strategic Compacts of Free Association with three Pacific countries: the Marshall Islands, Micronesia, and Palau.

However, China remains ahead of these collective efforts, Hashmi told Al Jazeera.

“For several countries, particularly the US, engagement with the region has been episodic and ad hoc, without sustained attention to core local concerns such as climate change, infrastructure, and economic resilience,” the analyst said.

“Countering China’s influence will, therefore, require sustained commitment and continuity. This is where the Quad’s recent announcement becomes important, although its impact will depend on whether these announcements are followed by implementation.”

Where does Fiji stand in this tango?

China’s bilateral relations with Fiji have also come a long way.

In 1975, Suva was among the first of the Pacific Island nations to recognise Beijing, rather than Taiwan, and to establish diplomatic relations with the People’s Republic of China.

A real breakthrough in relations came after a military coup ousted the Fijian government in 2006 and faced sanctions from traditional allies, like Australia and New Zealand. The result was that Suva moved closer to China. That has continued even after the democratically elected government led by Sitiveni Rabuka was voted to power.

“Fiji is considered the most influential country in the region and functions as a gateway and regional hub for the wider region,” said Hashmi, explaining the island nation’s importance for Beijing.

“The Pacific Islands occupy vast stretches of oceanic space and sit astride critical sea lanes linking Asia, Australia, and the Americas,” she added. “Influence there provides strategic depth and enables China to gradually expand its maritime presence beyond the first and second island chains. An important function for expanding into a formidable blue water navy.”

But this means that Fiji also has a balancing act on its hands.

Its traditional alliance with Australia, and with the US and other Western allies by extension, has kept its pace of growth, and Suva is seen as a partner in the Pacific as the Quad scrambles for a stronger foothold.

The US market is also the biggest export destination for Fijian goods, accounting for $383m in 2025, followed by Australia, worth $168m.

China is the top exporter for Fiji, billing $531m last year, only after Singapore’s $761m worth of exports. Suva’s exports to Beijing are worth only $49.2m, resulting in its biggest trading deficit with any partner.

Like Fiji, the Pacific Island nations maintain strong economic engagement with China while simultaneously deepening cooperation with Australia, the US, Japan, and India, said Hashmi.

“They have largely adopted a multi-vector foreign policy and hedging strategy, whereby engagement with all major actors is welcomed without formally siding with any one country,” she told Al Jazeera.

“No country wants to become entangled in major-power contestation.”

The attacks come as nearly 19.5 million Sudanese face severe hunger amid the country’s deepening humanitarian crisis.

A force affiliated with the paramilitary Rapid Support Forces (RSF) has killed at least 27 people, including elderly residents, in an attack on villages west of Bara in Sudan’s North Kordofan state, according to the Sudan Doctors Network.

The Cairo-based medical NGO said the attacks took place on Thursday in the al-Murrah area, describing them as “a new crime targeting unarmed civilians in areas with no military presence”.

Sudan has been engulfed in civil war since April 2023, when long-running tensions between the Sudanese army and the RSF erupted into a full-scale conflict that has killed hundreds of thousands of people and displaced millions.

The Kordofan region has become one of the war’s main battlegrounds, with fighting intensifying across several fronts, including through drone attacks.

The RSF and allied groups control much of the western Darfur region, as well as parts of Kordofan along the border with South Sudan, areas rich in oil fields and gold mines. The paramilitary force has also repeatedly clashed with the army over the town of Bara.

Thursday’s assault took place during the second day of Eid al-Adha.

In a statement posted on Facebook, the Sudan Doctors Network said that “targeting villages and civilian areas and executing citizens in such a brutal manner constitutes a flagrant violation of international humanitarian law and all norms and conventions that prohibit attacks on civilians, especially amid the catastrophic humanitarian conditions people are enduring because of the ongoing war”.

The group added that the “continued attacks on civilians and safe villages” are worsening the humanitarian crisis and forcing more families into displacement, suffering and the loss of their livelihoods.

The attacks come as more than 40 percent of Sudan’s population faces acute hunger, according to a report released on Thursday by the United Nations-backed Integrated Food Security Phase Classification (IPC).

The report said nearly 19.5 million people across the country are facing severe food insecurity as the conflict drives what aid agencies describe as one of the world’s worst humanitarian crises.

The Sudan Doctors Network also called on the “international community and human rights and humanitarian organizations to condemn these violations and act urgently to protect civilians and stop the repeated attacks on residential areas by pressuring RSF leaders to end violations against civilians”.