Means

A record wave of early voting promises to cut crowding on election day, but the trend has also front-loaded this year’s election with problems — long lines at early-voting stations, missing absentee ballots and controversy over retooled rules for early balloting.

Analysts and opinion surveys project that more than 26 million of an estimated 120 million voters might cast their ballots before the traditional start of polling — at midnight on election eve in Dixville Notch, N.H.

Despite hopes that early voting would reduce anxiety after a highly contentious 2000 election, a recent survey found that 40% of Americans believe that most of the problems exposed in that election have not been corrected. And nearly half of Americans in another survey said they think this year’s results will be challenged in court.

Many local election officials share those fears. Already overtaxed by voting that now lasts for weeks, some doubt that their work will be finished Tuesday.

“It will not be over on Nov. 2, and you can put that on the record,” said Susan Miller, elections director for Colorado’s Jefferson County. “We have 12 days to certify provisional ballots. In Colorado, there is more than likely to be a recount.”

Miller says she has already been told about four or five groups that might file lawsuits to challenge results in her county, which includes the town of Golden. She worries that “another Florida” — with its 36-day recount and disputed ballots — could become a self-fulfilling prophecy.

“We’ve been working six-day weeks, 12-, 14-hour days for a month,” Miller said. “When the public calls and says they don’t trust us, it breaks my heart…. We’re at the point where we don’t care who wins. We just want him to win by a landslide. Then we don’t have to recount the ballots.”

The Washington-based Committee for the Study of the American Electorate has projected turnout as high as 60% this year (compared with 54% in 2000), which would mean voting by more than 120 million Americans. Twenty-two percent of them, or more than 26 million, planned to cast votes before Tuesday, according to the National Annenberg Election Survey.

That trend has been evident across the country, in states where the presidential election is close and where it is not, such as California.

In Palm Beach County, Fla., requests for absentee ballots have more than doubled, and retirees and others have waited as long as two hours in line at satellite voting stations. Iowa has seen a nearly 55% jump in absentee ballot requests. New Mexico’s secretary of state expects half of her votes to be cast before Tuesday. The number of residents on the Hawaiian island of Oahu asking for mail-in ballots has spiked by nearly 82%.

In California, an enormous jump in absentees has been led by Orange County, with an increase of 200,000 to about 450,000. Los Angeles County has seen a more modest 18% increase, to 740,000, said Conny McCormack, the county’s registrar-recorder.

Officials nationwide say the deluge of early voting has them in effect running two elections — requiring extra staffing and long shifts to handle absentees and then a second push to prepare election day polling places.

“It’s time-consuming and tiring,” McCormack said.

Most of those voting by mail will avoid such a crunch and should have their ballots counted without glitches, experts said. But there already have been some trouble spots.

In Broward County, north of Miami, officials have been deluged with hundreds of complaints from voters who say they never received their absentee ballots. U.S. Postal Service investigators were trying to find an undetermined number of the 60,000 ballots the county mailed out Oct. 7 and 8.

“That is something beyond our control,” said the county’s deputy supervisor of elections, Gisela Salas. “We really have no idea what’s going on.” Salas advised voters who did not receive their ballots to go to the county’s early-voting stations.

But Florida’s voting stations — at libraries, city halls and other civic buildings — have not necessarily made balloting easier.

In Del Rey Beach, Judy Sternberg nearly fainted after a two-hour wait in the sun. Paramedics came to her aid, but Sternberg, 69, was not about to go home.

“They really wanted me to come back a day later,” said Sternberg, who voted for President Bush. “I said, ‘I am not coming back. I am voting.’ ”

Attempts to clarify rules since the 2000 election have not eliminated disputes, particularly over how mail-in ballots should be treated. One of the most emotional and politically charged disagreements has been over military ballots from overseas.

Republican Sen. Rick Santorum of Pennsylvania has been pressuring Democratic Gov. Ed Rendell to accept ballots from military personnel up to 15 days after the election.

Rendell has declined, saying he had already attended to the issue by making special accommodations for two counties, Venango and Huntingdon, which have presented evidence that military personnel got their ballots late. Those service members got new absentee ballots by express mail, with prepaid express mail envelopes in which to send their completed ballots back.

A federal judge last week backed Rendell, saying that overseas military voters should cast their ballots by Tuesday.

But other states, including Arkansas, Colorado and Florida — will allow absentee ballots from overseas to arrive at elections offices as much as 10 days after the election, as long as they were postmarked by Tuesday.

Another group that has complained about access to absentee ballots is college students. Although well over half of collegians this year plan to vote absentee, according to a Harvard University study, six states have laws that can make that difficult. In Louisiana, Tennessee, Michigan, Illinois, Nevada and West Virginia, voters must cast their first ballot in person, according to election watchers at Rock the Vote.

That means young people from those states who attend out-of-state universities may not get to vote, said Hans Riemer, Washington director for Rock the Vote.

“This is really made to disenfranchise college students,” Riemer said.

An additional concern could be presented to students in New Hampshire, who are warned on the secretary of state’s website that establishing their residence in the Granite State could affect insurance and some types of financial aid.

“This is a totally outrageous, preposterous, outlandish intimidation of young people,” Riemer said of state restrictions that affect students.

Not surprisingly, supporters of both Bush and Sen. John F. Kerry have claimed their side is getting the best of the early voting.

In most jurisdictions it is impossible to tell who is right. But a few states record the party affiliation of those voting absentee or at early voting locations.

In Polk County, the most populous in hard-fought Iowa, Democrats had a nearly 2-to-1 edge in early ballots cast — 32,924 to 17,340.

In Los Angeles, McCormack was crossing her fingers that voters were prepared for a long ballot, jammed with state propositions. If not, she predicted, “it could be really ugly.”

Gary Smith, the Forsyth County, Ga., director of elections, said many of his colleagues had taken to reciting what he called the “night-before prayer”:

“Dear God, don’t let this election be close.”

NEW YORK — Wellness influencer Dr. Casey Means’ nomination to be U.S. surgeon general is stalled a month after senators of both major political parties grilled her on vaccines and other health topics during a tense confirmation hearing, deepening doubts about her ability to secure the votes she needs for the role.

The nomination has languished despite ongoing efforts from the White House and Make America Healthy Again activists, revealing how intractable rifts over health policy can be even when Congress has shown deference to President Trump. It’s become the latest snag in Health Secretary Robert F. Kennedy Jr.’s agenda after two legal setbacks last week.

Means, a 38-year-old Stanford-educated physician who became disillusioned with traditional medicine and did not finish her surgical residency program, has faced scrutiny for her lack of experience and potential conflicts. Another sticking point has been her close alignment with Kennedy, whose efforts to dramatically pull back vaccine recommendations have been slammed by lawmakers and medical groups.

To advance to a full Senate vote, Means likely needs every Republican on the Senate Health, Education, Labor and Pensions Committee to support her nomination. But after last month’s hearing, two of them — Sens. Lisa Murkowski of Alaska and Susan Collins of Maine — told reporters they still had questions for her.

Murkowski told reporters Tuesday that “I’m just in the same spot” when it comes to those hesitations. Collins and Republican committee chairman Sen. Bill Cassidy, a physician from Louisiana who interrogated Means about vaccines during the hearing, didn’t respond to multiple inquiries about the delay.

White House spokesman Kush Desai said in a statement that the Trump administration has been having “productive conversations with the Senate” to advance Means. He added that her “elite academic credentials, research background and advocacy on America’s chronic disease epidemic will make her a critical asset for President Trump’s push to Make America Healthy Again.”

Kennedy spokesman Andrew Nixon reinforced the Republican administration’s support for Means and praised her message calling for healthier lifestyle choices rather than “sick care.”

Contentious hearing set the stage for a tough path to confirmation

Means promotes ideas popular with the MAHA movement, including that Americans are overmedicalized and that diet and lifestyle changes should be at the center of efforts to end widespread chronic disease.

But she’s been criticized for having an inactive medical license, for sometimes failing to disclose financial relationships with brands she promotes and for some of her past health-related comments.

Senators asked her during her hearing about how she would speak to the public about vaccines.

Murkowski and Cassidy pressed Means about her past doubts about the birth dose of the hepatitis B vaccine, which the U.S. Centers for Disease Control and Prevention stopped recommending for all children late last year in a move later temporarily blocked by a federal judge. Means called the hepatitis B vaccine important and lifesaving but said parents should make their own decisions with their doctors.

Cassidy also asked Means whether she would advise Americans to vaccinate against the flu and measles amid outbreaks across the country. She didn’t make that commitment, instead emphasizing the importance of informed consent.

Collins asked Means about her past advocacy for the therapeutic use of psychedelic mushrooms. Means, who has spoken positively of her own experience with the drugs, said she wouldn’t recommend psychedelics for the American public.

Kennedy’s supporters put pressure on hesitant senators

Once it appeared Murkowski and Collins were undecided, MAHA activists orchestrated a push to support Means’ bid by surging phone calls to the two senators.

“Please call both of them. Call them time after time. Get your friends to call them,” Tony Lyons, head of the Kennedy-aligned group MAHA Action, told supporters earlier this month.

Others have loudly opposed Means’ nomination. Dr. Jerome Adams, Trump’s first-term surgeon general, has repeatedly called her unqualified for her lack of an active medical license. He said in an interview that Republicans in Congress and in the Trump administration have told him they disapprove of the pick but see it as Kennedy’s choice.

“What I keep hearing from folks is, ‘This is what Bobby wants,’” he said.

While surgeons general aren’t mandated by law to have an active medical license, they are required to be part of the U.S. Public Health Service Commissioned Corps, a group of health professionals that says members should have up-to-date licenses.

Means said during her confirmation hearing that she had voluntarily made her Oregon medical license inactive, and that Adm. Brian Christine, who runs the Commissioned Corps, had testified that she was eligible to serve.

Even if Means advances out of committee, she might have difficulty securing confirmation by the full 100-member Senate. Republican Sen. Thom Tillis of North Carolina, who isn’t seeking another term, told the Associated Press that he’s leaning against voting for Means.

“Her resume already puts me on alert — and then I don’t think she did herself any favors in the hearing,” Tillis said.

Means’ confirmation delay is unusually long

At nearly 300 days since her nomination in May, Means’ confirmation process has taken almost twice as long as the average presidential pick in Trump’s second term, according to data from the nonprofit Partnership for Public Service. The group found that in the first 400 days, the average time between nomination and confirmation for Trump’s nominees was 157 days.

Sometimes the process has gone far more quickly. Markwayne Mullin, the new Department of Homeland Security secretary sworn in Tuesday, had his confirmation hearing, floor vote and swearing-in all within a weeklong period.

One reason for Means’ drawn-out nomination is the birth of her son, which happened last October on the day of her initially scheduled confirmation hearing.

But Chris Piper, manager of public policy and stakeholder engagement at the Partnership for Public Service, said the length of time that has passed since Means’ rescheduled confirmation hearing also is unusual. He said candidates are often voted out of committee within a week of their hearing.

“A monthlong delay following a hearing is atypical for most nominations, particularly at this level of position,” he said.

Swenson writes for the Associated Press. AP writers Joey Cappelletti and Stephen Groves in Washington contributed to this report.

For years, Beirut’s southern suburb has been spoken about as though it were a world apart: A Hezbollah bastion, a target, a warning, or a battlefield. But in Arabic, the word “dahiyeh” simply means “the suburb”.

The word itself is ordinary. What makes it extraordinary in Lebanon is its history.

When the Lebanese speak of Dahiyeh, they do not mean any suburb of their capital city. They mean southern Beirut in particular – a dense belt of neighbourhoods that grew from villages, fields, informal housing and municipal edges into a major extension of the city.

Dahiyeh – in size nearly as big as municipal Beirut – has been shaped by migration and displacement in the past 50 years. While many moved there in search of work or housing, most of the others were pushed there by wars, political unrest, evictions and a general sense of being neglected by the Lebanese state.

The social geography of Lebanon, which gained independence from French colonisers in 1943, began to be transformed in 1948 when Israel’s establishment saw the expulsion of more than 700,000 Palestinians from their land in what is commonly referred to as the Nakba. After Israel’s further occupation of Palestinian lands in 1967 and the expulsion of Palestinian fighters from Jordan in 1970, southern Lebanon and parts of Beirut became increasingly bound up with the Palestinian national movement.

Beirut’s ‘belt of misery’

Dahiyeh’s growth, however, accelerated after 1975, when the Lebanese civil war broke out. People displaced from other parts of Beirut moved south. The subsequent Israeli attacks and invasions in 1978 and 1982 drove more people to the edge of the capital. In that sense, Dahiyeh was not just a destination for “migrants”. It was also a refuge for the uprooted, the poor, and those repeatedly forced to start over.

Studies by scholars such as Mona Harb, professor of urban studies and politics at the American University of Beirut (AUB), show how a common noun – Dahiyeh – gradually evolved into a distinct political space: A stigmatised periphery marked in the Lebanese imagination as Beirut’s “belt of misery” that hardened into a territory with its own social and political significance. Today, it is part of Greater Beirut, woven into the capital geographically, economically and socially, even if the country’s politics may have treated the area as an outlier.

Harb’s work explicitly frames the southern suburb as a politically produced urban territory rather than just a space outside Beirut. To understand how that happened, one has to begin with the making of modern Lebanon.

Under the French Mandate, and later through the political order consolidated at independence in 1943, power in Lebanon was distributed through a sectarian system that heavily favoured the established elites, especially the Maronite Christians, who dominated the presidency and other key positions. The system not only created inequality, but also formalised and reproduced it.

Rural Lebanon, especially the south and the Bekaa Valley, remained underdeveloped and politically neglected for decades. Among those most affected were Lebanon’s Shia community, who were disproportionately concentrated in the poorer agricultural regions and had less access to state investments, infrastructure and patronage than the more privileged urban and mountainous centres. Scholars say it was not simply a temporary developmental gap, but a long history of marginalisation that defined the country’s politics.

Israeli attacks on Palestinian positions inside Lebanon repeatedly hit the surrounding Lebanese communities as well, mainly in the south. For the Shia in southern Lebanon, these attacks sharpened a bitter awareness: They were living on the front lines of a bitter regional conflict, while they were also being denied equal economic rights and meaningful political inclusion in Lebanon itself.

Out of that reality emerged a new form of Shia political mobilisation centred not only on identity, but also on deprivation, dignity and state neglect. That mobilisation found its earliest expression in Harakat al-Mahroumin, the Movement of the Deprived, founded by Imam Musa al-Sadr in the 1970s. Al-Sadr became a towering figure of modern Lebanese Shia politics because he gave social, religious and political forms to grievances building up for decades. That movement later grew an armed wing: Amal.

Al-Sadr’s mysterious disappearance during a 1978 trip to Libya remains unresolved and politically contested to this day. What is not contested is his historical importance. He helped turn the Shia of Lebanon from a neglected rural underclass into an organised political constituency demanding equal rights, representation, and a defining national presence.

The rise of Hezbollah

The 1982 Israeli invasion of Lebanon changed the Shia political landscape yet again. Israel’s siege of Beirut, the departure of Palestinian icon Yasser Arafat and his Palestine Liberation Organization forces, and Syria’s desire to dominate Lebanon all intensified divisions within Lebanese society.

Amal, which meanwhile had grown closer to Damascus to get weapons, money and political backing, remained a major force. But new Islamist movements emerged from within and around it, shaped by the Israeli occupation, disillusionment with older leaderships, and increasing support from Iran’s Islamic Revolutionary Guard Corps, especially in the Bekaa region.

Over time, these currents crystallised into Hezbollah. The split within the Shia movement was less theological and more about political strategy, defined by questions over aligning more closely with Syria, solidarity with the Palestinians, and general resistance against the Israeli occupation. Differences between Amal and Hezbollah over these questions turned violent in the 1980s, an intra-Shia fighting that Lebanese often recall as “a war among brothers”.

As Hezbollah grew stronger, Dahiyeh became much more than a residential belt. It turned into an urban heartland of a social and political force. Hezbollah built institutions there: Offices, schools, clinics, welfare networks and media infrastructure. Amal also had a presence, but the common shorthand that reduces Dahiyeh to a “Hezbollah stronghold” always conceals more than it reveals.

Today, Dahiyeh hosts a Shia majority, but also has a small minority of Palestinians and other Lebanese communities, including Christians. It bleeds physically into what is known as Greater Beirut, including its Christian and mixed areas. So when the suburb is bombed, it is not some isolated military island that is hit, but a deeply inhabited part of urban Beirut.

That is precisely why Dahiyeh is so central to the Israeli military’s thinking. During the 2006 war, large sections of the southern suburb, especially Haret Hreik, were devastated by Israel. The destruction became so emblematic that Israeli military strategists came up with what came to be known as the Dahiyeh Doctrine: Use of overwhelming force and large-scale destruction of areas associated with an armed group, with the aim of generating deterrence and putting pressure on residents supporting the group. Rights activists and legal scholars say the doctrine violates international humanitarian law, as civilian neighbourhoods and infrastructure do not become legitimate targets simply because an armed group is embedded among the population.

That Israeli pattern, however, has intensified since October 2023, when a genocidal war on Gaza and attacks on Lebanon began. Meanwhile, the killing of Hezbollah leader Hassan Nasrallah in an Israeli strike in late 2024 eroded Dahiyeh’s resistance. That erosion is more visible in the ongoing Israeli attacks on Beirut and southern Lebanon, where more than a million people have registered as displaced since March 2. The old formula – that Dahiyeh was the principal red line and that any strikes there could be deterred by Hezbollah’s threats of retaliatory strikes on several Israeli cities – no longer holds.

Once again, Dahiyeh has become a focal point of the war, with repeated bombardment sending plumes of smoke over a place that many outsiders still describe as a world apart, but which is in fact woven into Beirut’s daily life. Built over decades by the poor, the migrants and the repeatedly uprooted – and shaped by the politics of marginalisation against those whom al‑Sadr once named “the deprived” – Dahiyeh has long served as both a refuge and a front line. Today, it is again being made to carry the costs of a conflict larger than itself.