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It is over and everything is lost. This is the refrain repeated by Armenian families as they take that final step across the border out of their home of Nagorno Karabakh. In just a handful of days more than 100,000 people, almost the entire Armenian population of the breakaway enclave, has fled fearing ethnic persecution at the hands of Azerbaijani forces. The world barely registered it. But this astonishing exodus has vanished a self-declared state that thousands have died fighting for and ended a decades-old chapter of history. Today, along that dusty mountain road to neighbouring Armenia, a few remaining people limp to safety after enduring days in transit. Among them is the Tsovinar family who appear bundled in a hatchback littered with bullet holes, with seven relatives crushed in the back. Hasratyan, 48, the mother, crumbles into tears as she tries to make sense of her last 48 hours. The thought she cannot banish is that from this moment forward, she will never again be able to visit the grave of her brother killed in a previous bout of fighting. “He is buried in our village which is now controlled by Azerbaijan. We can never go back,” the mother-of-three says, as her teenage girls sob quietly beside her. “We have lost our home, and our homeland.” “It is an erasing of a people. The world kept silent and handed us over”. She is interrupted by several ambulances racing in the opposite direction towards Nagorno Karabakh’s main city of Stepanakert, or Khankendi, as it is known by the Azerbaijani forces that now control the streets. Their job is to fetch the few remaining Karabakh Armenians who want to leave and have yet to make it out. “Those left are the poorest who have no cars, the disabled and elderly who can’t move easily,” a first responder calls at us through the window. “Then we’re told that’s it.” As the world focused on the United Nations General Assembly, the war in Ukraine and, in the UK, the felling of an iconic Sycamore tree, a decades old war has reignited here unnoticed. It ultimately heralded the end of Nagorno Karabakh, a breakaway Armenian region, that is internationally recognised as being part of Azerbaijan but for several decades has enjoyed de facto independence. It has triggered the largest movement of people in the South Caucasus since the collapse of the Soviet Union. Azerbaijan has vehemently denied instigating ethnic cleansing and has promised to protect Armenians as it works to re-integrate the enclave. But in the border town of Goris, surrounded by the chaotic arrival of hundreds of refugees, Armenia’s infrastructure minister says Yerevan was now struggling to work out what to do with tens of thousands of displaced and desperate people. “Simply put this is a modern ethnic cleansing that has been permitted through the guilty silence of the world,” minister Gnel Sanosyan tells the Independent, as four new busses of fleeing families arrive behind him. “This is a global shame, a shame for the world. We need the international community to step up and step up now.” The divisions in this part of the world have their roots in centuries-old conflict but the latest iterations of bitter bloodshed erupted during the collapse of the Soviet Union. The Karabakh Armenians, who are in the majority in the enclave, demanded the right to autonomy over the 4,400 square kilometre rolling mountainous region that has its own history and dialect. In the early 1990s they won a bloody war that uprooted Azerbaijanis, building a de facto state that wasn’t internationally unrecognised. That is until in 2020. Azerbaijan, backed by Turkey, launched a military offensive and took back swathes of territory in a six-week conflict that killed thousands of soldiers and civilians. Russia, which originally supported Armenia but in recent years has grown into a colder ally, brokered a fragile truce and deployed peacekeepers. But Moscow failed to stop Baku in December, enforcing a 10-month blockade on Nagorno-Karabakh, strangling food, fuel, electricity and water supplies. Then, the international community stood by as Azerbaijan launched a 24-hour military blitz that proved too much for Armenian separatist forces. Outgunned, outnumbered and weakened by the blockade, they agreed to lay down their weapons. For thirty years the Karabakh authorities had survived pressure from international powerhouses to give up statehood or at least downgrade their aspirations for Nagorno-Karabakh. For thirty years peace plans brokered by countries across the world were tabled and shelved. And then in a week all hope vanished and the self-declared government agreed to dissolve. Fearing further shelling and then violent reprisals, as news broke several Karabakh officials including former ministers and separatist commanders, had been arrested by Azerbaijani Security forces, people flooded over the border. At the political level there are discussions about “reintegration” and “peace” but with so few left in Narargno-Karabakh any process would now be futile. And so now, sleeping in tents on the floors of hotels, restaurants and sometimes the streets of border towns, shellshocked families, with a handful of belongings, are trying to piece their lives together. Among them is Vardan Tadevosyan, Nagorno Karabakh’s minister of health until the government was effectively dissolved on Thursday. He spent the night camping on the floor of a hotel, and carries only the clothes he is wearing. Exhausted he says he had “no idea what the future brings”. “For 25 years I have built a rehabilitation centre for people with physical disabilities I had to leave it all behind. You don’t know how many people are calling me for support,” he says as his phone ringed incessantly in the background throughout the interview. “We all left everything behind. I am very depressed,” he repeats, swallowing the sentence with a sigh. Next to him Artemis, 58 a kindergarten coordinator who has spent 30 years in Steparankert, says the real problems were going to start in the coming weeks when the refugees outstay their temporary accommodation. “The Azerbaijanis said they want to integrate Nagorno Karabakh but how do you blockade a people for 10 months and then launch a military operation and then ask them to integrate?” She asks, as she prepares for a new leg of the journey to the Armenian capital where she hopes to find shelter. “The blockade was part of the ethnic cleansing. This is the only way to get people to flee the land they love.” “There is no humanity left in the world.” Back in the central square of Goris, where families pick through piles of donated clothes and blankets and aid organisations hand out food, the loudest question is: what next? Armenian officials are busy registering families and sending them to shelters in different corners of the country. But there are unanswered queries about long-term accommodation, work and schooling. “I can’t really think about it, it hurts too much,” says Hasratyan’s eldest daughter Lilet, 16, trembling in the sunlight as the family starts the registration process. “All I can say to the world is please speak about this and think about us. “We are humans, people made of blood, like you and we need your help. “ Read More More than 70% of Nagorno-Karabakh's population flees as separatist government says it will dissolve ‘Centuries of history lost’: Armenians describe journey to safety after fall of Nagorno-Karabakh Nagorno-Karabakh: Tearful 16-year-old describes ‘bombing’ while she was in school Why this week's mass exodus from embattled Nagorno-Karabakh reflects decades of animosity

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People who use marijuana were found to have higher levels of lead and cadmium in their blood and urine, in comparison to those who do not use weed, according to a new study. The team of researchers at Columbia University analysed data from blood and urine samples collected between 2005 and 2018 as part of the National Health and Nutrition Examination Survey, a program conducted by the National Center for Health Statistics. They looked at samples of 7,254 people who said they had used marijuana in the last 30 days. Participants were examined for levels of heavy metals and 358 people were found to have 27 per cent higher blood lead levels than those who said they didn’t use either marijuana or tobacco. There were also 22 per cent higher levels of cadmium in those marijuana users according to the research, which was published Wednesday in the journal Environmental Health Perspectives. Researchers also found that the urine samples showed similar results. High levels of cadmium can cause stomach irritation, abdominal cramps, nausea, vomiting and diarrhoea, according to Better Health. Researchers found that although tobacco is the main source of cadmium exposure in the general population, the study showed similar exposure levels among cannabis users. “For both cadmium and lead, these metals are likely to stay in the body for years, long after exposure ends,” Tiffany Sanchez, an author of the study and an assistant professor of environmental health sciences at Columbia’s Mailman School of Public Health said to NBC News. As cannabis plants can absorb heavy metals from soil - the new findings demonstrate that heavy metals in cannabis plants can also wind up in the human body. “Previous studies have measured metals in marijuana plants, products, or marijuana smoke,” study authors have said. Lead exposure can be particularly harmful to children and pregnant women. In adults, chronic exposure to lead increases the risk of high blood pressure, heart problems and kidney damage. “Our study wasn’t able to tease apart whether or not self-reported cannabis users were using medical or recreational cannabis, so we can’t say definitively if medical cannabis users specifically had higher metal levels,” Sanchez said as reported by CNN. “This is something that should be evaluated in future studies.” Heavy metals bind to parts of your cells that prevent your organs from doing their job, according to the Cleveland Clinic and symptoms of heavy metal poisoning can be life-threatening and can cause irreversible damage. “Immunocompromised people, such as those going through chemotherapy, may be at greater risk from metal exposure or from other common cannabis contaminants like molds. However, this is very much an understudied area,” Sanchez added. On Wednesday, the Department of Health and Human Services recommended that the Drug Enforcement Administration ease restrictions on marijuana by moving it from Schedule I drug to Schedule III. HHS Secretary Xavier Becerra said on X, the platform formerly known as Twitter, that the agency has responded to President Joe Biden’s request “to provide a scheduling recommendation for marijuana to the DEA.” “We’ve worked to ensure that a scientific evaluation be completed and shared expeditiously,” he added. Senate Majority Leader Chuck Schumer said in a statement that HHS had recommended that marijuana be moved from a Schedule I to a Schedule III controlled substance. “HHS has done the right thing,” Schumer said. “DEA should now follow through on this important step to greatly reduce the harm caused by draconian marijuana laws.” Rescheduling the drug would reduce or potentially eliminate criminal penalties for possession. Marijuana is currently classified as a Schedule I drug, alongside heroin and LSD. According to the DEA, Schedule I drugs "have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse." Additional reporting from agencies Read More Biden health agency recommends classifying marijuana as lower-risk, opening potential for major policy changes Seth Rogen reveals why he smokes marijuana ‘all day, every single day’ Rugby star Ugo Monye: Boarding school shaped my career and my personality Queen Latifah calls for more ‘inclusive healthcare’ for people with obesity As Simon Cowell shares positive therapy experience, how can it help even if you aren’t in crisis?

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Close to 250 of Vladimir Putin’s soldiers have been killed or injured in southern Ukraine in the past 24 hours, a Ukrainian military commander said. Ukraine’s authorities said the casualties occurred on Saturday in Tavria, a village in southern Ukraine’s Zaporizhzhia, just 23km from the major town of Tokmak, where Ukrainian forces are looking to advance for a strategic territorial advantage. “Over the last day, the enemy lost 248 people (84 dead, 163 wounded and one captured),” Brigadier General Oleksandr Tarnavskyi, who is in-charge of the strategic and operational group of forces in Tavriia, said in his Telegram channel on Sunday. He said the Russian losses also include 20 units of military equipment, including a tank, three anti-aircraft guns and three ammunition depots. “In general, during the past day, the enemy attacked our positions 23 times and carried out 717 shelling and 23 airstrikes. Artillery units of the Defense Forces of the Tavriia direction performed 1,236 fire missions during the day,” he said, detailing the military offensive in the area. The Ukrainian General Staff said its forces continued offensive operations in the Melitopol direction and near Bakhmut. Russian forces continued limited ground attacks in the Donetsk-Zaporizhia Oblast border area on 30 September but did not make any confirmed advances, said the Institute for the Study of War (ISW), a US-based think-tank monitoring the war, in its latest assessment of the battlefield situation. “Ukrainian forces continued counteroffensive operations in western Zaporizhia Oblast on 30 September but did not make any confirmed advances. The Ukrainian General Staff reported that Ukrainian forces continued offensive operations in the Melitopol (western Zaporizhia Oblast) direction,” the ISW said. While the town is 12 miles from the existing front line, wrestling its control before the rains wet the battlefield will result in Ukraine taking over Russia’s key railway, command and logistics hub. Russia’s forces have reportedly guarded the prized town with fresh defensive networks to halt Ukraine’s push to the north. Ukrainian forces have around 3-5 weeks to dismantle the second layer of Russian defences laid on the road and fields to Tokmak. Earlier this week, military analyst Roman Svitan said there have been “three or four days of painstaking hard work by our assault group and commanders in the area which have led to very serious problems for the Russians”. “I would not speak of a breakthrough until we reach Tokmak.” Read More Grant Shapps reveals military training plans inside Ukraine Ukraine aid left out of government funding package, raising questions about future US support Ukraine-Russia war - live: Moscow could annex more Ukrainian regions, says Medvedev Putin marks anniversary of annexation of Ukrainian regions as drones attack overnight Putin launches overnight drone and missile attacks on eastern and southern Ukraine