Scores of airlines have stumbled into a war zone in the Middle East; ‘we were lucky’
6 min
“Are those fireworks or something?” asked a passenger on Emirates flight EK146 from Amsterdam to Dubai last month, in a video posted to social media. In fact, what she was watching through her cabin window was a barrage of Iranian missiles headed to Israel.
Her flight was one of scores that shared the skies with Iranian missiles on Oct. 1, an example of how the escalating conflict in the Middle East is endangering commercial aircraft in some of the world’s busiest skies.
The number of missiles crisscrossing the region has surged since the start of Israel’s war with Hamas: An average of 162 missiles have been fired each month so far this year, up from 10 a month in 2023, according to aviation security firm Osprey Flight Solutions. This has led to warnings from airlines, crews, security experts and families of air crash victims that an airliner could inadvertently be shot out of the sky.
Missiles have been spotted in-flight by pilots and passengers, struck near airports, and been fired by militaries and militias without warning to airlines. Governments and aviation regulators have meanwhile failed or been slow to close or restrict airspace.
There is precedent for the concern. Two commercial aircraft have been shot down in recent conflicts. Malaysia Airlines flight MH17 was downed over eastern Ukraine by Russian-backed militants in 2014, and Ukrainian Airlines flight PS752 was mistaken for an incoming missile by Iranian forces shortly after takeoff from Tehran in 2020.
For passengers flying on Oct. 1, the threat felt real. Madalina Birca, 24, was flying with Emirates from Nice, France, to Dubai when the captain announced, with a slight tremble in her voice, that “due to the war situation” the flight was being diverted.
Passengers quickly switched their screens to news channels to find that Iran had started its attack on Israel. Birca followed on the live flight map as the aircraft made an abrupt turn just before crossing into Iranian airspace. She used the in-flight Wi-Fi to try to calculate the missiles’ trajectories and how close her flight had come to catastrophe.
“We were very lucky that we didn’t cross already into the airspace,” Birca said.
Birca’s was one of more than 80 flights that were diverted on Oct. 1 because of the attack. Many other flights continued uninterrupted over Iraq, Jordan, Syria and northern Saudi Arabia, with dozens passing close to launch sites in the north and south of Iran.
Radio messages from air-traffic control towers in Iraq, Kuwait and Bahrain captured some of the tumult in the skies, with pilots declaring emergencies and diversions, and in some cases exclaiming that they could see the projectiles themselves.
“Missiles over Baghdad, over Najaf, over everywhere,” one pilot radioed to Baghdad air traffic controllers, according to a feed from live radio specialist, Broadcastify.
“We noticed some missiles,” a Kuwait Airways pilot said.
“Lights, rockets, I don’t know, now they’re not visible anymore,” someone radioed to pilots on Air France flight 662 to Dubai. Air France has opened a probe into why the flight was caught in the affected airspace.
While ballistic missiles reach an apex far above the altitude of a commercial jet, they pose a major risk during their ascent and descent. About 10% of Iran’s ballistics are also estimated to fail midflight, which, along with their ejected boosters, leads to falling debris. Cruise missiles typically fly at lower altitudes, endangering aircraft as they take off and land. At times, the biggest risk is posed by air-defence systems misidentifying a commercial aircraft as incoming fire.
The tally of projectiles, tracked by Osprey, accounts only for ballistic and cruise missiles. Its figures don’t include unguided rockets, mortars, artillery fire and drone attacks, each of which can also endanger flights.
The risk is ongoing. Iran has briefed regional officials that it’s preparing a response to Israel’s latest retaliatory strike that will utilise more powerful warheads. Osprey has warned airline customers that the next attack could be coordinated with Iranian-backed militias in Iraq, Syria, Yemen and Lebanon, widening the areas of airspace at risk.
Meanwhile, strikes exchanged between Israel and Hezbollah have regularly targeted or struck areas near airports, including a missile that landed in a parking lot at Tel Aviv Airport this month and an Israeli airstrike that caused an explosion near Beirut Airport’s runways a day later.
Israel’s strike against Iranian sites on Oct. 26 was also launched without official notice to airlines, though the early morning timing—around 2:15 am in Iran—meant fewer aircraft were operating. The Israeli Air Force typically consults air-traffic controllers before any strike to try to minimise risk, according to an official.
“It’s a huge concern to civil aviation. We know what happened with the Ukrainian airliner that was shot down in Iran mistakenly,” said Hassan Shahidi , president of the Flight Safety Foundation, a global, nonprofit advocacy group, calling the incident “absolutely preventable.”
Despite the surge in military activity, Middle Eastern airspace has largely remained open over the past year. The region’s already busy skies have become more important after Russia’s invasion of Ukraine locked out carriers from swaths of airspace over both countries.
Aviation safety experts have criticised the inconsistent way in which the skies have been managed by governments, including issuing late or no airspace closures.
“National security and foreign policy trump aviation security, and it happens over and over again in conflict zones,” Osprey’s Chief Intelligence Officer Matt Borie said in an interview.
The U.S. Federal Aviation Administration and others have long imposed bans and restrictions on flights over North Korea because of the country’s tendency to conduct a handful of unannounced ballistic missile tests each year. Last year North Korea launched 37 missiles; this year so far, 52.
Days after Iran’s Oct. 1 launch, the FAA extended its ban on U.S. carriers crossing into Iranian airspace by three years until October 2027, a prohibition it first put in place after the downing of Ukrainian Airlines flight PS752 in 2020. A separate restriction that prevents flights over Syria is also in effect until 2028.
U.S. carriers aren’t restricted from flying over Iraq as long as the aircraft is traveling at a minimum altitude of 32,000 feet, according to the FAA’s latest advisory. There are no explicit warnings against operations over Jordan, Lebanon or Israel, though the agency maintains a 2021 notice that airlines “exercise caution” in those areas because of the proximity to the military situation in Syria.
A push at the United Nations to standardise rules for commercial flights over conflict zones that began after the downing of MH17 in 2014 has largely stalled, security experts say.
The U.N.’s International Civil Aviation Organization disputed that characterisation, citing an updated manual due this year, a meeting of its “Safer Skies” committee next year and the possible hosting of a third workshop on the subject. The measures demonstrate “the international community’s ongoing dedication to preventing future tragedies in conflict zones,” a spokesman said.
Outside of official bans, airlines typically make their own decisions about whether to fly over a conflict zone on any given day. They rely on a patchwork of advisories from regulators, intelligence from government agencies and advice from private security companies. Rerouting a flight can be a major operational challenge that adds additional fuel costs, can require additional staffing, and which disrupts preassigned takeoff and landing slots.
Even before Oct. 1, most Western carriers, including U.S. airlines, had withdrawn flights to Israel, Iran and Jordan. Many have also opted to reroute flights crossing that corridor to now fly via Egypt and Saudi Arabia.
Carriers are also taking other measures. Emirates is carrying additional fuel in case a flight is required to make an emergency diversion, while European discounter Wizz Air says it will only fly in certain airspace during daytime hours when the risk of an attack is lower. Israel’s flag carrier El Al, meanwhile, has long equipped its aircraft with antimissile defence systems.
Airlines say that safety is their top priority and that any flight path is carefully considered before being allowed to depart. But they’ve also criticized governments, including after Iran’s Oct. 1 attack, for not taking adequate care to protect commercial aviation.
“It’s quite volatile,” Emirates Chief Commercial Officer Adnan Kazim said in a recent interview, adding that his airline has regularly been holding multiple security meetings a day, in addition to its daily security briefing. “Some of these kinds of situations, unfortunately they don’t come with any alert, or any pre-information and you need to manage the situation as you go.”
Israel has rerouted standard flight paths in and out of the Tel Aviv airport away from danger zones since the start of the conflict, according to Libby Bahat, head of aerial infrastructure at the Civil Aviation Authority of Israel. When it learns of potential incoming attacks, it reduces the number of flights in the airspace to make it easier for air-traffic controllers to quickly scatter aircraft to safety, Bahat said.
A spokeswoman for the Israeli Defense Force declined to comment. Aviation regulators in Iran, Iraq, Jordan and Lebanon didn’t respond to requests for comment.
Pilots have expressed concerns. The European Cockpit Association has complained that some airlines are forcing pilots to fly routes even if they disagree with their airline’s safety assessment. The union also wants airlines to update life insurance policies, which typically don’t pay out in the case of a downing over a conflict zone.
“At any moment another disaster could happen that can take the life of innocent people again,” said Kourosh Doustshenas, whose partner died along with 175 others when Iran inadvertently shot down Ukrainian Airlines flight PS752. “We have gone through this, and this can happen any time.”
The U.S. had cautioned that morning of an increased risk of misidentification in Iranian airspace, but with most of its security team off work for Orthodox Christmas, Ukrainian Airlines failed to heed the warning.
Doustshenas has called for governments to be held legally accountable for failing to protect civilian airliners from becoming collateral damage. He also wants passengers to be informed if their flight is routed to fly over a conflict zone.
“Regular people going to the airport to catch their flight have no idea,” Doustshenas said.
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As millions flock to GLP-1s, doctors warn the drugs can cause rapid and significant muscle loss.
5 min
Chanel Robinson achieved exactly what the gold rush of blockbuster weight-loss drugs promised: She lost nearly 100 pounds, lowered her cholesterol to normal levels and reined in her polycystic ovary syndrome.
Yet, nearly three years into her journey on Mounjaro, the 30-year-old from Atlanta, Ga., is discovering the hidden costs of the slimmed-down life.
Robinson experiences muscle fatigue daily, feeling physically weak, frail and often cold. Robinson said she experiences bursts of sluggishness sporadically during the day, and has trouble with basic tasks like opening a jar. “It shouldn’t be this difficult,” she said.
GLP-1 drugs like Ozempic, Mounjaro and Zepbound have been a success for public health and the pharmaceutical companies that make them. Obesity rates are falling, the volume of food consumed in America is declining and retailers report a slump in sales of plus-size apparel. It has improved health and happiness for millions of people.
But for at least some of the 13 million Americans taking them, losing muscle along with fat is an unexpected downside that isn’t broadly discussed or immediately apparent.
The drugs can cause rapid and significant loss of lean muscle mass, up to 10%, comparable to a decade or more of aging, according to an analysis published by the American Diabetes Association.
The loss of lean tissue is similar to weight loss from dieting, but the magnitude over a short period can lead to frailty, instability and lack of coordination, doctors and researchers say. Another concern is that losing muscle could slow down patients’ metabolism, leading to weight regain.
“We are curing obesity by encouraging frailty,” said Daniel Green, principal research fellow at the University of Western Australia, who contributed to the analysis. Many taking weight-loss medications initially lose fat and feel great, but quickly start to feel weak and lethargic, he said.
Green’s research showed that the rate of muscle loss could be slowed significantly by regular strength workouts. “It should say ‘must be taken with resistance training’ on the box,” he said.
Drugmakers say weight-loss drugs should be taken only on the advice of a physician and as part of a long-term plan that includes diet and exercise.
A spokesperson for Eli Lilly, maker of Zepbound, said Food and Drug Administration guidelines say it should be used “with increased physical activity.” The spokesperson added: “Sustainable weight loss is about more than a number on a scale.”
Both Eli Lilly and Novo Nordisk said clinical trials showed users did lose some lean muscle tissue, though at far lower rates than fat. Liz Skrbkova, a spokeswoman for Novo Nordisk, said that trials for its drug Wegovy showed changes in muscle mass didn’t “significantly differ” from patients who took a placebo. Eli Lilly said users lost three times more fat weight than lean tissue.
Rayna Kingston, 30, from Denver, said her injections of Zepbound left her feeling so tired the following day that she struggled to complete anything other than basic tasks. She said she shifted her dose to a Sunday because Mondays were her least busy day. Her partner would bring her meals in bed because she felt so weak.
She stopped exercising, and said her doctor didn’t give her any guidance on strength training or muscle maintenance. “I was relying on Reddit forums to understand what was happening to my body,” she said. She got so frustrated with the fatigue she came off the medication just under two months later.
Experts say that losing muscle at such a rate can be especially dangerous for those over 50 or with osteoporosis or limited mobility as it could lead to an increased risk of injury. “Loss of muscle mass is detrimental to moving around and quality of life, but it is also not safe,” said Katsu Funai, associate professor at the University of Utah.
Elderly Americans are set to be able to get GLP-1s from Medicare from July.
There is also pushback from doctors and regulators against using weight-loss drugs as a “quick fix” to lose a bit of weight.
People who take GLP-1s regain weight four times faster than those who lose weight through lifestyle interventions, and weight regained is often mostly fat, according to a recent analysis published in the British Medical Journal. There currently are few, if any, guidelines or studies on de-prescribing the drugs, researchers say.
The nurse practitioner who prescribed Robinson the medication didn’t warn her that resistance training is essential to maintaining muscle mass, Robinson said. She said she regrets not exercising and now does Pilates once a week.
In the haste to disrupt the obesity epidemic, weight loss has been treated as the singular, undisputed metric of success, which experts say is problematic.
“People worship body weight as an outcome measure because it’s simple, quick and inexpensive,” said Green. “But what matters is fat and muscle mass, which is more expensive to measure as it requires an MRI.”
Grace Parkin, 34, a property manager from Sheffield, England, has lost 125 pounds after she started taking Mounjaro in 2024. “I don’t care about my muscle mass as long as I’m a healthy weight,” she said.
The doctor who prescribed the drug didn’t tell her to exercise, though the pharmacy that sold the medication gave her information on exercise and protein intake, she said.
She didn’t exercise and said she soon felt side effects: a “deathly cold, from the inside” likely because of the drug. Still, she vowed to keep going, saying the weight loss was worth it.
In response to some of the side effects, drug companies are hoping to develop weight-loss treatments aimed at preserving or even building lean muscle mass.
German drugmaker Boehringer Ingelheim recently said it had promising results from one such drug. Eli Lilly last September halted a trial of a similar drug.
While weight-loss medications are designed as lifelong treatments for chronic diseases, namely obesity and Type 2 diabetes, they are increasingly marketed as lifestyle fixes.
Tennis superstar Serena Williams, who used GLP-1s to slim down after having children, was featured in this year’s Super Bowl commercial promoting telehealth company Ro’s weight-loss medication.
Serena Williams poses for an ad campaign for a weight-loss drug. Ro/Handout/Reuters
Women may be particularly vulnerable to the drugs’s side effects, which can also include nausea, diarrhea, migraines and rarer cases of pancreatitis.
A study last year from a university hospital in Turin, Italy, showed that women are more prone to adverse reactions to weight-loss drugs than men, including muscle loss.
Green, the researcher, said the issue is of particular concern to those taking GLP-1s recreationally and who don’t have much muscle mass to begin with. Others say a lack of oversight is compounding the issue.
“Patients are self-reporting, and telehealth companies don’t have the patient in front of them to conduct a proper medical assessment,” said Rupal Mathur, an internist in Houston whose practice specializes in weight loss.
She said medical spas are prescribing off-label drugs that don’t meet the criteria set out by the FDA that justify a prescription.
The number of people taking weight-loss drugs who are not living with obesity or Type 2 diabetes is difficult to track since it is unregulated.
However, an analysis by the FDA from 2023 found that more than half of new Ozempic and Mounjaro users didn’t have Type 2 diabetes.
Scientists are calling for more clinical trials to pin down the full effects of weight-loss drugs on muscle loss in different demographics.
“The only studies that have been done have looked at people living with obesity or Type 2 diabetes,” said Green. “That makes it all the more concerning for those using weight-loss drugs in an ad hoc or unregistered way.”
