with organic theories and with the compromise theory of an organic nucleus. another possible case occurred in belgium in june 1999 when people, mainly schoolchildren, became ill after drinking coca-cola. in the end, scientists were divided over the scale of the outbreak, whether it fully explains the many different symptoms and the scale to which sociogenic illness affected those involved. a possible outbreak of mass psychogenic illness occurred at le roy junior-senior high school in 2011, in upstate new york, us, in which multiple students began having symptoms similar to tourette syndrome. various health professionals ruled out such factors as gardasil, drinking water contamination, illegal drugs, carbon monoxide poisoning and various other potential environmental or infectious causes, before diagnosing the students with a conversion disorder and mass psychogenic illness. starting around 2009, a spate of apparent poisonings at girls' schools across afghanistan began to be reported; symptoms included dizziness, fainting and vomiting. the united nations, world health organization and nato's international security assistance force carried out investigations of the incidents over multiple years, but never found any evidence of toxins or poisoning in the hundreds of blood, urine and water samples they tested. the conclusion of the investigators was that the girls were experiencing a mass psychogenic illness. in august 2019 the bbc reported that schoolgirls at the ketereh national secondary school (smk ketereh) in kelantan, malaysia, started screaming, with some claiming to have seen 'a face of pure evil'. simon wessely of king's college hospital, london, suggested it was a form of 'collective behaviour'. robert bartholomew, an american medical sociologist and author, said, "it is no coincidence that kelantan, the most religiously conservative of all malaysian states, is also the one most prone to outbreaks." this view is supported by afiq noor, an academic, who argues that the stricter implementation of islamic law in school in states such as kelantan is linked to the outbreaks. he suggested that the screaming outbreak was caused by the constricted environment. in malaysian culture burial sites and trees are common settings for supernatural tales about the spirits of dead infants (toyol), vampiric ghosts (pontianak) and vengeful female spirits (penanggalan). authorities responded to the kelantan outbreak by cutting down trees around the school. outbreaks of mass psychogenic illness "have been reported in catholic convents and monasteries across mexico, italy and france, in schools in kosovo and even among cheerleaders in a rural north carolina town". episodes of mass hysteria has been observed in schools of nepal frequently, even leading to closure of schools temporarily. a unique phenomenon of "recurrent epidemic of mass hysteria" was reported from a school of pyuthan district of western nepal in 2018. after a 9-year-old school girl developed crying and shouting episodes, quickly other children of the same school were also affected resulting in 47 affected students (37 females, 10 males) in the same day. since 2016 similar episodes of mass psychogenic illness has been occurring in the same school every year. this is thought to be a unique case of recurrent mass hysteria. in july 2022 reports of up to 15 girls showing unusual symptoms such as screaming, trembling, and banging their heads came up from a government school in bageshwar, uttarakhand. mass psychological illness has been suggested as a possible cause. terrorism and biological warfare bartholomew and wessely anticipate the "concern that after a chemical, biological or nuclear attack, public health facilities may be rapidly overwhelmed by the anxious and not just the medical and psychological casualties." additionally, early symptoms of those affected by mpi are difficult to differentiate from those actually exposed to the dangerous agent. the first iraqi missile hitting israel during the persian gulf war was believed to contain chemical or biological weapons. though this was not the case, 40% of those in the vicinity of the blast reported breathing problems. right after the 2001 anthrax attacks in the first two weeks of october 2001, there were over 2300 false anthrax alarms in the united states. some reported physical symptoms of what they believed to be anthrax. also in 2001, a man sprayed what was later found to be a window cleaner into a subway station in maryland. thirty-five people were treated for nausea, headaches and sore throats. in 2017, some employees of the us embassy in cuba reported symptoms (nicknamed the "havana syndrome") attributed to "sonic attacks". the following year, some us government employees in china reported similar symptoms. some scientists have suggested the alleged symptoms were psychogenic in nature. however, one study using neuroimaging suggest at least some organic, non-psychogenic cause. children in recent refugee families refugee children in sweden have been reported to fall into coma-like states on learning their families will be deported. the condition, known as resignation syndrome (swedish: uppgivenhetssyndrom), is believed to only exist among the refugee population in the scandinavian country, where it has been prevalent since the early part of the 21st century. commentators state "a degree of psychological contagion" is inherent to the condition, by which young friends and relatives of the affected individual can also come to have the condition. in a 130-page report on the condition, commissioned by the government and published in 2006, a team of psychologists, political scientists and sociologists hypothesized that it was a culture-bound syndrome, a psychological illness endemic to a specific society. this phenomenon has later been called into question, with children witnessing that they were forced, by their parents, to act in a certain way in order to increase chances of being granted residence permits. as evidenced by medical records, healthcare professionals were aware of this scam, and witnessed parents who actively refused aid for their children, but remained silent. later, sveriges television, sweden's national public television broadcaster, were severely critiqued by investigative journalist janne josefsson for failing to uncover the truth. internet after the rise of a popular breakthrough youtube channel in 2019 where the presenter exhibits extensive tourette's-like behavior, there was a sharp rise in young people referred to clinics specializing in tics, thought to be related to social contagion spread via the internet, and also to stress from eco-anxiety and the covid-19 pandemic. the authors of an august 2021 report found evidence that social media was the primary vector for transmission and that it predominantly affects adolescent girls, declaring the phenomenon the first recorded instance of "mass social media–induced illness" (msmi).