Sports
Sickle cell and football: Why the disease that mainly affects Black people needs more research
This article is part of The Athletic’s series marking UK Black History Month. To view the whole collection, click here.
Lassana Diarra was preparing for the 2010 World Cup in South Africa.
The midfielder, who had spells with Chelsea, Arsenal, and Portsmouth in the Premier League, was coming off the back of a difficult first season with Real Madrid. That campaign, 2009-10, he had made 30 appearances in all competitions for Manuel Pellegrini’s side as they finished second in La Liga, three points behind Barcelona. They had also crashed out of the Champions League at the last-16 stage against Lyon.
Keen to put an underwhelming club campaign behind him, Diarra, aged 25, joined up with the France squad — which included Thierry Henry, Franck Ribery, Hugo Lloris, Nicolas Anelka, and Karim Benzema — in a pre-tournament training camp. Tignes was the destination, chosen for its high altitude that would mimic conditions in South Africa.
However, on May 22, 2010, his hopes of playing on the world stage were dashed.
“Further to his intestinal pain contracted on the glacier in Tignes, check-ups have detected evidence of an unpredictable illness which justifies rest for an indeterminate period,” a statement from the France Football Federation read.
Diarra’s diagnosis was later confirmed as sickle cell anaemia.
Diarra playing for Real Madrid in 2010 (Elisa Estrada/Real Madrid via Getty Images)
The National Heart, Lung, and Blood Institute (NHLBI) defines sickle cell disease — the most common being called sickle cell anaemia — as a group of inherited disorders that affect haemoglobin (the major protein that carries oxygen in red blood cells). In sickle cell disease, red blood cells are misshaped, typically crescent- or “sickle”-shaped due to a gene mutation that affects the haemoglobin molecule. When red blood cells sickle, they do not bend or move easily and can block blood flow to the rest of the body.
Symptoms include painful episodes called sickle cell crises, an increased risk of serious infections and anaemia — where red blood cells cannot carry enough oxygen around the body — which can cause tiredness and a shortness in breath.
According to Healthline, a provider of healthcare information in the U.S., Black people are at a much higher risk of being affected by sickle cell disease. Researchers believe the reason lies in how this condition has evolved over time to protect against malaria — most common in sub-Saharan Africa, where sickle cell is prevalent. Having the sickle cell trait helps to reduce the severity of malaria.
The sickle cell trait is found in one in four west Africans and one in 10 Afro-Caribbeans. It is also found in people who originate from the Mediterranean, Asia, and the Middle East. It is less common in white Europeans.
Sickle cell disease and the sickle cell trait differ, as people with the trait carry only one copy of the altered haemoglobin gene and rarely have any clinical symptoms related to the disease, while people with the disease carry two copies.
The American Society of Hemotology say more than 100 million people worldwide have the sickle cell trait.
Despite how common the condition is and its sometimes fatal consequences, sickle cell is still a relatively unknown condition and its effect on sporting performance is lesser known still.
Part of the conclusion of ‘A Case Study of Two Premiership Footballers with Sickle Cell Trait’, a 2014 study conducted by the British Journal of Sports Medicine (BJSM), stated that “further research would be necessary with a larger cohort in order to further establish the relationship between redox homeostasis (defined as the maintenance of a balance between reducing and oxidizing reactions within a cell) and sickle cell trait in athletes”.
The BJSM did not respond to requests for comment from The Athletic.
Geno Atkins, a former defensive tackle for the NFL’s Cincinnati Bengals, spoke on his experience with the trait earlier this year. “I knew from my research that it would not be good for me to play in high altitude, so I prayed I wouldn’t get drafted by Denver, which is at a high altitude,” he told the Centers for Disease Control and Prevention (CDC). “I ended up in Cincinnati and have played at a very high level without any adverse effects of the sickle cell trait.”
He added: “Having the sickle cell trait does not exclude an athlete from participating in sports; however, the training staff and coaches need to take precautions to ensure the athlete is not put in dangerous situations.” In this case, Atkins cited an example of training in extreme heat.
Former Bengals defensive tackle Geno Atkins (Ian Johnson/Icon Sportswire via Getty Images)
Professional basketball player Billy Garrett Jr and former NFL running back Tiki Barber are two high-profile sportsmen with the disease, and wide receiver John Brown, most recently of the Buffalo Bills, possesses the trait.
Dr Mark Gillett, a consultant in sports and exercise medicine, tells The Athletic: “I’m not aware of it (sickle cell disease) in Premier League football or high-level football. I’ve not really seen it an awful lot at all. I am surprised that I haven’t. I would think that a player with full-blown sickle cell disease would find it difficult to compete at that level, just because of the physical demands of the game.
“At the same time, if you have sickle cell trait, you have that type of disease whereby extreme physical stress, altitude, or hydration can produce some symptoms. We may be seeing players with that and just not recognising it.
“Most Premier League football clubs are very diligent in the way they screen players. I think players at risk would have had their profiles done. If they have sickle cell trait, doctors would know about it. At the grassroots level, I suspect it happens a lot.”
Altitude was cited by Raymond Domenech, France’s national team manager at the time, when speaking about Diarra’s World Cup withdrawal in 2010.
“He wasn’t ready physically, he was really exhausted,” he said. “The illness was triggered by the altitude. He had predispositions that we couldn’t detect in advance. He needs a good 15 days of rest to fully recover, and he will recover, that’s for sure. It won’t have any bearing on the rest of his career but he’s not fit to play in a World Cup.” Diarra did not respond for comment when contacted by The Athletic.
Diarra, left, speaks with Domenech during France’s pre-2010 World Cup training camp (Franck Fife/AFP via Getty Images)
When asked how top-level teams would react to a player with the disease, Gillett says: “If they did find that when screening a player, obviously they would have to group that with the other things we look for when we assess players. We would have to speak to the player about it and make sure that their treatment is optimised.
“It would be a concern for players and clubs. Particularly when you get to the end of the season when the weather gets hotter and you’re more likely to be dehydrated. Sometimes, games have more riding on them and become more meaningful. It is certainly an added stress for them. It is hard enough being a Premier League footballer without having that to deal with as well. It would be a significant worry for them.”
The extent of Diarra’s illness was later confirmed by his club at the time, Real Madrid. In a statement, they said that Diarra was “now resting at home following medical advice due to asthenic syndrome secondary to a sickle cell anaemia that will be subjected to a hematological study (the study of blood and blood disorders) in Lyon Hospital”.
Valerie Davis, a haemoglobinopathy nurse counsellor at the Sickle Cell and Thalassemia support project in Wolverhampton, wants footballing authorities to increase their efforts in raising awareness and educate people within the game about the disease.
“There needs to be sessions whereby everybody is encouraged to be screened, irrespective of ethnicity,” she says. “Often it is thought that only specific ethnicities, such as those from African and Caribbean backgrounds can be impacted by this disease. The truth is anybody and everybody can be affected. Anyone who has haemoglobin and red blood cells can be impacted by sickle cell. It is the least likely for someone who is not from those backgrounds, but it can impact everybody.
“It could be a start to encourage everybody entering the sport to be screened. They then could do more work to bring in an expert to talk about the disease. Over the years, there has been a stigma around the disease and there shouldn’t be at all. This could help highlight the importance of screening. If someone is a carrier, they are normally absolutely fine. With rest, hydration, and nutrition, somebody can live an absolutely normal life.
“With a good lifestyle, it is a possibility that someone who is a carrier should have no issues going far in football. Even if they’re affected by the full-blown condition. I would encourage the football authorities to never reject someone based on them being a carrier of the sickle cell gene, but even with the full-blown condition with conditioning and support, it will not stop them from reaching the top.”
In 2022, former England international Emile Heskey discovered that two of his children had the sickle cell gene. He began giving blood and encouraging other Black donors to not only register but also be tested for the condition.
Emile Heskey revealed that two of his children have sickle cell trait (Mike Egerton/PA Images via Getty Images)
“We need a whole new generation of blood donors, especially people of Black heritage,” he told the Mirror. “Because they are more likely to donate better-matched blood to treat people with sickle cell disorder.
“Some patients with sickle cell rely on regular transfusions to stay alive. Giving blood is simple, easy and can save up to three lives.”
Davis shares Heskey’s sentiment in encouraging people to be tested for the disease.
“A lot of people do not know that they carry the sickle cell gene, perhaps until later,” she says. “A woman, for example, may only discover during pregnancy that she is a carrier of the gene.
“We are going all-out to educate people individually because sometimes people may know within their families that there may be a carrier but they often will deny they have it themselves. There is a stigma about the condition, so some people do not go and get screened for it.
“Unfortunately, partners decline screening and that is the sad case (that) very often we see the birth of children that are affected by sickle cell. There needs to be a lot more initiatives to highlight the importance of it. We need to explain ultimately what can happen if it is ignored.”
A treatment for sickle cell cure was approved by the Food and Drug Administration (FDA) in December 2023, with the therapy, called Casgevy, from Vertex Pharmaceuticals and CRISPR Therapeutics, becoming the first medicine to be approved in the United States. The same treatment was approved in the United Kingdom in November 2023, with experts calling it “a historic moment for the sickle cell community”.
However, in May 2024, the gene-editing sickle cell drug was not approved for National Health Service (NHS) use. The National Institute of Health and Care Excellence (NICE) did not recommend the gene therapy treatment, saying that it required “additional data” beyond the current proposal.
In September 2024, Pfizer voluntarily withdrew large amounts of the sickle cell disease treatment medication Voxelotor, sold under the brand name Oxbryta, from worldwide markets.
However, with stories like that of Diarra’s still sporadic within football, Davis believes the condition’s unpredictability means that conversations about sickle cell within the sport must continue.
“Like many conditions, there are varying degrees of the impact that it has on individuals but ultimately, it does limit because of the unpredictable nature of the condition, what very often people can do and when they can do it,” she says.
“Particularly in sport, and football, there is a lot of training and of course, a lot of commitment required to the sport. Somebody who is impacted or affected by sickle cell cannot always commit because they simply do not know when they will be affected. It is very hard to commit to a sport, especially football.”
Although progress has been made in the fight to find a cure to find a cure for the disease and raise awareness of the condition within sport, more needs to be done.
(Top photo: Franck Fife/AFP via Getty Images; design: Dan Goldfarb)
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The wait is officially over. The FIFA World Cup has arrived.
For the first time ever, three nations—the United States, Mexico, and Canada are co-hosting the tournament. It is also the largest FIFA World Cup in history, expanding to a 48-team field. Squads from around the world have arrived in North America with one ultimate goal: capturing the iconic World Cup trophy.
Here’s the latest look at some of the most notable news surrounding the World Cup.
June 12:
Official Injury Update On Neymar
Brazilian star Neymar Jr. will officially miss Brazil’s opening match against Morocco on Saturday. Neymar was named to Brazil’s 2026 FIFA World Cup squad despite a calf injury, and now won’t be available early on. Manager Carlo Ancelotti said that “Neymar is working very hard to recover as quickly as possible.
“The expectation is that he will recover and rejoin the group next week.”
Google Doodle Has World Cup Fever
In case fans didn’t already have World Cup fever, they can open their web browser.
Google is officially ready for USA’s opener against Paraguay, as the home page features a custom, USA-themed Google Doodle.
The Doodle features red text with a blue outline, as well as a soccer ball along with an interchanging USA crest replacing the “O’s” in Google.
James Cordon Stretches With Christian Pulisic
James Corden joined Christian Pulisic and the United States men’s national team for a training session ahead of their World Cup opener against Paraguay.
After meeting with head coach Mauricio Pochettino and going through a film session with the players, Corden and Co. hit the pitch for practice, where he helped serve as a water boy.
Corden tried to help Pulisic stretch out his legs after practice before he was stopped by a member of the coaching staff. As Corden walked off, Pulisic sprayed him with a water bottle.
DR Congo Arrives to the World Cup in Style
The DR Congo men’s national team isn’t set to play until Wednesday, June 17, against Portugal in Group K, but they’ve already made a statement upon arrival in Houston, Texas.
The squad arrived in style, stepping off the plane in striking black, jaguar-inspired outfits that quickly turned heads. The bold look fits their nickname, Les Léopards, and sets the tone for their World Cup presence before they even face Portugal.
DR Congo may be heavy underdogs, but they’re already winning where it counts off the pitch, taking the fashion battle before kickoff.
Canada’s Jesse Marsch Takes Dig At USA
The Canadian men’s national team is set to face Bosnia and Herzegovina on Friday afternoon. Ahead of the match, head coach Jesse Marsch took a subtle jab at the United States men’s national team during his remarks on Thursday.
“In the U.S., we had to beg players to sing the national anthem,” Marsch said.
The United States conducted a months-long search for a new head coach in 2023, with Marsch emerging as the frontrunner and making it clear he wanted the job. Instead, they chose to rehire Gregg Berhalter, a decision that may have left Marsch with some lingering resentment.
Marsch’s subtle jab could take on added stakes if the United States and Canada meet during the FIFA World Cup. The two nations could potentially face off as early as the Round of 32 or the Round of 16.
June 11:
The pressure of competing in the 2026 FIFA World Cup is high, but that hasn’t stopped players from enjoying some downtime with their teammates. Norway star Erling Haaland was spotted at the Stanley Cup Final between the Vegas Golden Knights and the Carolina Hurricanes.
Haaland appeared to be enjoying himself as the Hurricanes secured a Game 5 victory, taking a 3-2 series lead over the Golden Knights. The Manchester City striker drew plenty of attention from fans in attendance as he took in the action from the stands.
The Norway star was seen celebrating in the stands before turning his attention back to international duty, with Norway set to face Iraq in Group 1 play on Tuesday, June 16.
Australia Coach Popovic Signs Extension
Australia coach Tony Popovic has signed a contract extension through early 2027 on the eve of his team’s World Cup opening match against Turkey on Saturday.
Football Australia said Friday that the 52-year-old Popovic’s deal now extends through the Asian Cup, which will take place in January and early February in Saudi Arabia.
The former Australia international was hired in September 2024 and led the Socceroos to qualification for the 48-team tournament.
“I’m proud to lead my country into a World Cup, but most importantly, I want to ensure that our team is fully prepared and focused on our group matches against Turkey, the United States, and Paraguay,” he said of Australia’s opponents in Group D.
Canada Captain Sidelined For Opening Match
Canada’s captain and star defender Alphonso Davies will miss Canada’s World Cup opener against Bosnia and Herzegovina. Davies’ status has been questionable due to an ACL tear and other injuries during the club season, which limited Davies to appearing in two of Canada’s last 21 games.
Davies is one of the co-host’s more valuable players in terms of talent and experience, including 58 appearances in nine years with the national team. However, Davies’ injury does not rule him out of the entire tournament. His injury update and restraint from the opening match serves as a caution to heal his injury as the group stage unfolds.
After playing for the Vancouver Whitecaps in the MLS, Davies transferred to Bayern Munich, where he’s played since 2019. Canada is set to play Bosnia and Herzegovina on June 12, followed by Qatar on June 18 and Switzerland on June 24.
Captain Wataru Endo Withdraws From World Cup
Just ahead of Japan’s opening match against the Netherlands on June 14, captain and midfielder Wataru Endo has withdrawn his name from Japan’s World Cup squad and paired it with his national team retirement, per his statement on X. Endo has been dealing with an ongoing ankle/foot injury since February.
Endo has played for the Japan national team for over a decade, where he made 73 appearances and scored four goals. As a veteran anchor in the midfield, Endo has also served as Japan’s captain since their previous World Cup in 2022, where they reached the Round of 16.
As for Endo’s professional career, he first played for Shanon Bellmare from 2010-15, followed by the Urawa Red Diamonds from 2016-19, VfB Stuttgart from 2019-23 and has played for Liverpool FC since 2023. With Liverpool, Endo played a prominent role in the team’s Carabao Cup victory in 2024.
With Endo out, Japan has officially called Borussia Mönchengladbach midfielder Shuto Machino to join the 26-man roster. Machino is entering his second World Cup and his fifth year with the Japan national team.
Marco Senesi Called Up To 26-Man Roster
Following the injury of defender Leonardo Balerdi, Argentina has officially called up defender Marcos Senesi to the 26-man roster. Argentina is set to open their World Cup campaign on June 16 against Algeria.
Senesi has been training prior in case of a last-minute call-up, and was named to the roster after Balerdi’s muscle injury was ruled out. Senesi has played professionally since 2016, playing for clubs like San Lorenzo, Feyenoord, AFC Bournemouth and is currently with Tottenham Hotspur.
Joining Senesi in the back are defenders Lisandro Martínez, Nicolás Otamendi and Cristian Romero.
In what’s likely to be Lionel Messi’s last World Cup, Argentina will look to repeat their historic 2022 World Cup win this tournament.
Tyler Adams, USA Celebrate Shocking Knicks’ W
Tyler Adams, United States’ midfielder, is a fan of the National Basketball Association’s New York Knicks. The Knicks are in the NBA Finals, on the eve of the start of the 2026 FIFA World Cup, so members of the United States’ squad gathered together to watch what turned out to be the largest NBA Finals comeback in history, with the Knicks coming out on top.
When New York won, the room erupted, with Adams especially going wild. And we know this because the reaction was caught on camera in the moment.
That couch is destroyed, but at least no one watching the game ended up as damaged as it did after Adams went climbing and kicking all over it! If the United States ends up having a major comeback or win in the World Cup, maybe keep the players away from any obstacles like that, though. Just to be safe.
Morocco Loses 2 Players To Injury Before World Cup
Morocco replaced two injured players in its World Cup squad ahead of an opening game against Brazil, including star winger Abde Ezzalzouli.
FIFA confirmed late Wednesday that former Barcelona player Ezzalzouli and Marseille defender Nayef Aguerd were withdrawn from the Morocco squad for the tournament.
Ezzalzouli helped Real Betis qualify for next season’s Champions League and was a potential breakout star at the World Cup. Aguerd was a cornerstone of Morocco’s historic semifinals team at the 2022 World Cup in Qatar.
They were replaced by Amine Sbai of French club Angers and Marwane Saadane, who plays in Saudi Arabia for Al Fateh.
Morocco opens against Brazil on Saturday at MetLife Stadium near New York, then plays Scotland on June 19 near Boston and finishes Group C against Haiti on June 24 in Atlanta.
Ezzalzouli injured his right knee in a warmup game against Norway last weekend, though initial tests suggested he could be retained in coach Mohamed Ouahbi’s squad to play in the knockout rounds.
Surprise World Cup Comeback For Austrian Midfielder
The last time Dejan Ljubicic played for Austria was nearly three years ago. Now a teammate’s injury has given him a surprise comeback at the World Cup.
Austria coach Ralf Rangnick called up Ljubicic late Wednesday to replace key midfielder Christoph Baumgartner, who injured his right thigh while warming up for a pre-World Cup friendly against Tunisia last week and needed surgery.
Ljubicic is set to join Austria at the team camp in Santa Barbara on Thursday, ahead of the team’s first game on Tuesday against Jordan. Austria also plays Argentina and Algeria in Group J.
He’s more of a defensive midfield option than Baumgartner, who scored 17 goals in all competitions for Leipzig in Germany last season and has remained in camp to support the team.
Ljubicic also plays in Germany on the Schalke team which secured promotion from the second division last month.
Ljubicic has nine games for Austria but none at a major tournament. His last appearance was in a friendly against Moldova in September 2023, and he wasn’t in the squad for any World Cup qualifiers.
CHICAGO — Dodgers superstar Shohei Ohtani was out of the lineup Friday against the White Sox after exiting the game before with discomfort in the back of his left knee.
Manager Dave Roberts said Ohtani had imaging done on the knee and showed “the normal wear and tear.”
“He feels fine-ish,” said Roberts, who hopes Ohtani will be back in the lineup this weekend. Ohtani remains in line to make his next pitching start on Wednesday against the Tampa Bay Rays at Dodger Stadium.
Especially at this point in the season, the Dodgers have incentive to play it safe with Ohtani’s recovery. Pushing him to return early and exacerbating the injury would be a larger blow to a team seeking its third straight World Series championship.
With Ohtani out, left fielder Alex Call was in the leadoff spot, and Santiago Espinal served as the designated hitter.
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With the largest World Cup field in the history of the tournament, 32 of the 48 teams will be fighting for a spot in the knockout stage.
66.6% of nations will advance out of the group stage this summer, which is a massive upgrade from 50% in past World Cups. Because of this, sportsbooks have adjusted with less favorable odds.
Prior to the start of the tournament, Spain, Argentina, Brazil, England, and Germany entered with the strongest odds to advance from the group stage, supported by recent major-tournament success and talent-rich rosters.
All five nations are heavily favored at -10000 to advance to the knockout round.
The Spaniards are the defending European Champions while the Argentinians are looking to win back-to-back titles. Germany has not made it out of the group stage in the last two World Cups, but has always been a perennial contender— having won four titles in its history. And then of course there’s Brazil, which has more titles than any country with five.
Now, after the conclusion of the first day of the World Cup, Mexico has joined the group at the top. El Tri has surged to -10000 to advance to the knockout stage after initially being just -1400. Mexico’s huge leap up the oddsboard is a direct result of its dominating 2-0 win over South Africa.
With that in mind, let’s dive into the odds for each team to advance to the knockout stage of the 2026 FIFA World Cup as of June 12.
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Odds to Advance to Knockout Stage
Spain: -10000 (bet $10 to win $10.10 total)
Argentina: -10000 (bet $10 to win $10.10 total)
Brazil: -10000 (bet $10 to win $10.10 total)
England: -10000 (bet $10 to win $10.10 total)
Mexico: -10000 (bet $10 to win $10.10 total)
Germany: -10000 (bet $10 to win $10.10 total)
Portugal: -5000 (bet $10 to win $10.20 total)
France: -5000 (bet $10 to win $10.20 total)
Belgium:-3500 (bet $10 to win $10.29 total)
South Korea: -2500 (bet $10 to win $10.40 total)
Switzerland: -1800 (bet $10 to win $10.56 total)
Netherlands: -1400 (bet $10 to win $10.71 total)
Morocco: -1000 (bet $10 to win $11 total)
Colombia: -1000 (bet $10 to win $11 total)
Uruguay: -1000 (bet $10 to win $11 total)
Canada: -1000 (bet $10 to win $11 total)
Ecuador: -900 (bet $10 to win $11.11 total)
Norway: -900 (bet $10 to win $11.11 total)
United States: -750 (bet $10 to win $11.33 total)
The U.S. men’s national team is currently -750 to advance from Group D (Photo by Omar Vega/USSF/Getty Images).
Croatia: -500 (bet $10 to win $12 total)
Austria: -500 (bet $10 to win $12 total)
Türkiye: -500 (bet $10 to win $12 total)
Ivory Coast: -500 (bet $10 to win $12 total)
Japan: -500 (bet $10 to win $12 total)
Egypt: -340 (bet $10 to win $12.94 total)
Algeria: -310 (bet $10 to win $13.23 total)
Scotland: -310 (bet $10 to win $13.23 total)
Senegal: -230 (bet $10 to win $14.35 total)
Sweden: -230 (bet $10 to win $1435 total)
Bosnia and Herzegovina: -220 (bet $10 to win $14.55 total)
Paraguay: -205 (bet $10 to win $14.88 total)
Iran: -200 (bet $10 to win $15 total)
Czechia: -165 (bet $10 to win $16.06 total)
Ghana: -140 (bet $10 to win $17.14 total)
Australia: -110 (bet $10 to win $19.09 total)
DR Congo: +100 (bet $10 to win $20 total)
Raúl Jiménez helped propel Mexico to a 2-0 win over South Africa in the opening match of the 2026 FIFA World Cup (Photo by Yair Gonzalez/Jam Media/Getty Images).
Saudi Arabia: +105 (bet $10 to win $20.50 total)
Tunisia: +140 (bet $10 to win $24 total)
New Zealand: +150 (bet $10 to win $25 total)
Uzbekistan: +180 (bet $10 to win $28 total)
Cape Verde: +200 (bet $10 to win $30 total)
Panama: +200 (bet $10 to win $30 total)
Qatar: +275 (bet $10 to win $37.50 total)
South Africa: +320 (bet $10 to win $42 total)
Jordan +350 (bet $10 to win $45 total)
Iraq: +450 (bet $10 to win $55 total)
Haiti: +800 (bet $10 to win $90 total)
Curaçao: +1000 (bet $10 to win $110 total)
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