The future of space exploration: Why astronaut health must come first

Space is no longer just a distant dream — it’s swiftly becoming our next great frontier. Increasingly space is playing a role in addressing Earth-based concerns - public health, global health, natural disasters, pandemics, climate change and the environment.

Additionally, from established space nations to emerging ones, nations across the globe are increasingly recognising space exploration as a defining endeavour of our time.

Several nations are sending astronauts into space, including on the upcoming Axiom 4 mission, which will carry the first astronauts from India, Hungary, and Poland to the International Space Station — each becoming their country’s second person in space (excluding space tourists and private astronauts).

Other nations such as Pakistan are also advancing their human space missions with their soon to be selected astronaut, announced as the first foreign national that will enter and conduct experiments on the Chinese Space station. Not only nations, but developments involving the private sector are redefining space exploration with private citizens flying on SpaceX, Blue Origin and Virgin Galactic.

The UAE has established itself among the leading space nations taking on ambitious steps such as Project Hope - becoming the first Arab nation and overall fifth nation globally to reach Mars - and developing its astronaut programme with 2 astronauts in space, Hazza Al Mansouri and Sultan Al Neyadi. Neyadi also became the longest serving Arab in space.

In the space sector, our sights are now set towards Mars, while at the same time revisiting the Moon and establishing a sustained long term presence there.

NASA’s Artemis programme is gearing for its next mission, to return to lunar orbit with three NASA astronauts and one Canadian. The related Artemis Accords will enable such initiatives to become a global collaboration with over 50 signatories, including the UAE. Just few days ago space visionary Elon Musk announced SpaceX’s plans to head towards Mars, including possibly sending humans to Mars in 2028-2029.

Beneath all these impressive progress, engineering and ambitious timelines, a fundamental truth underpins all future success of human missions: the health and well-being of humans in space.

I was invited to write and publish in Nature - among the world’s leading scientific journals - on keeping astronauts healthy in deep space.

The publication, released this week, highlights the profound challenges human physiology, health, and psychology face in space’s extreme environment. Moreover, it delves into the specific intricacies of deep space, an area with sparse research concerning human health, sustained radiation exposure, and other unique challenges that greater distances bring up. While we have been studying radiation exposure on Earth and the ISS, previous findings have indicated that astronauts on the Moon could face 200-1000 times more radiation compared to that on Earth.

The space sector has mastered telemedicine to take care of the astronauts, and during and after the COVID-19 pandemic, telemedicine has become the norm and a useful tool to provide care to patients on Earth. It is important to realise that communication delays can hamper healthcare delivery on Mars. These communication delays could range from 4 to around 20 minutes for a one-way interaction between Earth and Mars. Thus, as the Nature publication highlights, we cannot rely on Earth-based support of healthcare in space. For example, by the time Earth’s mission control receives the news of someone having a heart attack on Mars, around 20 minutes may have passed already. And it will take another 4-20 minutes for Earth to convey back its first recommendations. One solution to address these healthcare delivery challenges can involve incorporating AI, which goes hand in hand with the UAE’s National AI Strategy 2031 and UAE Centennial 2071 vision.

Another key area of concern is the psychological and mental health challenges. While astronauts are trained to be resilient, heading to Mars will bring a number of stressors such as knowing the possible challenges to one’s health, knowing it will be few years before they can physically see their family again. And travelling to Mars would take around 7-10 months. Can you imagine how you would feel if you were stuck in your car or even on a plane non-stop for 10 months?

My fascination with space medicine and health stems from a core belief, reinforced by my background as a medical doctor, academic and space medicine researcher: the health of astronauts will always take precedence in human space missions. It cannot be overstated that the health of astronauts is the main factor determining the viability of any crewed mission. No matter how advanced our engineering, policies, propulsion systems, or how precise our navigation technology are, the human body remains the most vulnerable, yet indispensable, component. Should an astronaut’s health be impacted, even the most technologically advanced mission will be jeopardised. Even if we possess the capability to reach Mars today, no crewed space mission would receive approval until we ensure the health and well-being of the astronauts can be adequately maintained throughout the mission.

This makes space medicine and health not just important, but absolutely vital. For these reasons countries must prioritise the development of their own robust capabilities in this field. Establishing national leadership in this critical domain is crucial for future endeavours.

Dr Farhan M. Asrar is a Canadian physician, academic, and internationally known space medicine researcher and educator.