A gunman who murdered four people in a New York office building before taking his own life had CTE, a degenerative brain disease which has been linked to playing American football.

It is believed Shane Tamura targeted the skyscraper in Manhattan because it houses the headquarters of the NFL.

The 27-year-old, who played high school football, had “unambiguous diagnostic evidence” of low-stage CTE, or chronic traumatic encephalopathy, the New York City medical examiner said.

In a three-page note discovered by police after the mass shooting, Tamura made repeated references to CTE.

In his note, which was written on notepad paper and using a variety of ink, Tamura wrote “CTE study my brain please. I’m sorry.” And again: “Please study brain for CTE. I’m sorry.”

He also specifically refers to Terry Long, a former NFL player who starred for the Pittsburgh Steelers. Long was diagnosed with CTE after drinking antifreeze to take his own life 20 years ago. CTE can only be diagnosed after death via post mortem.

In a statement, the NFL said: “We continue to grieve the senseless loss of lives, and our hearts remain with the victims’ families and our dedicated employees.

“There is no justification for the horrific acts that took place. As the medical examiner notes ‘the science around this condition continues to evolve, and the physical and mental manifestations of CTE remain under study’.”

A Sky News investigation last year explored the link between CTE and violent attacks, including mass murder.

We looked at the case of former high school football player Noah Green. He was 25 when he crashed into a security cordon protecting the capitol building in Washington DC and stabbed police officer William Evans to death, before he too was shot dead by responding police.

Green’s mother, Mazie, told me she believes his crime was caused by brain injuries sustained on the American football field. He also had CTE.

The theory of a link between CTE and violent crime is increasingly cited in the courtroom.

Kellen Winslow, a former NFL player, argued for his sentence for multiple rapes to be reduced because of head trauma suffered on the football field.

Former San Francisco 49ers star Phillip Adams shocked the country when he shot dead six people, including grandparents and their two grandchildren, then himself in 2021. He had severe CTE.

Medical charity Doctors without Borders (MSF) has said it had been forced to suspend its work in Gaza City because of the ongoing Israeli offensive there.

The statement came after the Israeli military pressed its offensive against Palestinian Islamist group Hamas in Gaza City, from which hundreds of thousands of people have been forced to flee.

“We have been left with no choice but to stop our activities as our clinics are encircled by Israeli forces,” said Jacob Granger, MSF emergency coordinator in Gaza.

“This is the last thing we wanted, as the needs in Gaza City are enormous, with the most vulnerable people – infants in neo-natal care, those with severe injuries and life-threatening illnesses – unable to move and in grave danger.”

Israel’s military said in a statement that the air force had over the past day “struck over 140 targets throughout the Gaza Strip, including terrorists, tunnel shafts (and) military infrastructure”.

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Netanyahu vows to ‘finish the job’

Gaza’s civil defence agency said Israeli forces killed at least 50 people across the Palestinian territory on Friday, as Prime Minister Benjamin Netanyahu vowed in a defiant UN address to “finish the job” against Hamas.

The Israeli military is pressing an offensive against the Palestinian Islamist movement in Gaza City, from which hundreds of thousands have been forced to flee in recent weeks.

The civil defence agency – a rescue force operating under Hamas authority – reported at least 50 people killed across the territory since dawn, 30 of them in Gaza City.

Israel’s military said the air force had during the past day “struck over 140 targets throughout the Gaza Strip, including terrorists, tunnel shafts (and) military infrastructure”.

Footage from Al-Shati refugee camp near Gaza City showed heavy damage to buildings after an air strike.

A barefoot young girl was among those searching through the rubble for belongings. Toppled poles left a web of cables on the ground.

Mr Netanyahu said at the United Nations that the military had “crushed the bulk” of Hamas’s “terror machine” and sought to finish the job “as fast as possible.”

He said his speech was being partially broadcast in Gaza on military loudspeakers.

A statement from his office said the military had “taken over the telephones of Gaza residents and Hamas members”, and that the address was being broadcast live on the devices.

“It’s a lie – we haven’t received any messages or anything on the phone, and we didn’t hear any loudspeakers,” said Randa Hanoun, 30, a displaced Palestinian living in Deir el-Balah in the central Gaza Strip.

“This is just an attempt to stir fear in our hearts and to make us pay attention to Netanyahu’s speech… But we don’t care about his speeches and we don’t want to hear a single word from him.”

Two AFP contributors in southern Gaza and one in Gaza City said they hadn’t heard the speech on the loudspeakers, nor received anything on their phones.

‘Piled on top of each other’

Israel launched its ground offensive on Gaza City on 16 September. The military said yesterday that 700,000 Palestinians had fled the urban hub since late August.

The UN humanitarian office said the displacement of 388,400 people had been recorded since mid-August, most of them from Gaza City.

Um Youssef al-Shaer, a 50-year-old displaced Palestinian living in the tent city of of Al-Mawasi on the Mediterranean coast, told AFP that the area had become overcrowded as more and more Palestinians sought refuge there.

“We are piled on top of each other in a single tent – me, my husband, our six children and my husband’s elderly parents – 10 people in a small tent,” she said.

Over nearly two years, Israeli military operations in Gaza have killed at least 65,549 Palestinians, mostly civilians, according to the health ministry in Hamas-run Gaza, figures the UN considers reliable.

Hamas’s 7 October 2023 attack on Israel that sparked the war resulted in the deaths of 1,219 people, mostly civilians, according to an AFP tally based on Israeli figures.

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An expert in international relations has told RTÉ’s Behind the Story podcast it is “extremely alarming” that Donald Trump has the full force of the US government behind him for another three years.

Alex Dukalskis, associate professor in the School of Politics and International Relations at UCD, said he believes the US is shifting “more into a dark place” under Mr Trump.

His co-written book – Dictating the Agenda: The Authoritarian Resurgence in World Politics – examines how authoritarian states have repurposed tools and norms, previously used to promote Western-backed liberalism, now turning them against liberal ideas.

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Trump backs Israel, warns Russia in combative UN speech

Prof Dukalskis said he believes the policies of Mr Trump are actually helping authoritarian regimes.

“It’s accelerating and we are shifting more into a dark place – it’s not completely hopeless [because] liberal democracy is still a very valued norm globally.

“I don’t think it’s hopeless but it’s certainly very alarming”.

‘Catastrophic mistakes’

Prof Dukalskis told David and Evelyn that when the Berlin Wall fell in 1989, the US had “disproportionate global power”.

“The most liberal democratic countries in the world at the time had something like 85% of global GDP – just a dominant status,” he explained.

“The US could at the time really advance the norms it preferred and, crucially, people saw it as a gold standard”.

Prof Dukalskis said a series of “catastrophic mistakes” – such as the invasion of Iraq and the 2010 economic crash – has seen alternatives appear.

“Around that time, you had these non-democratic states that were starting to pedal another model,” he said.

“Recall 2012 was around the time when Xi Jinping took power in China; so you had a new confidence that not only were authoritarian states rising in power, but they increasingly had a good story to tell about the decline of the west”.

Prof Dukalskis said the west’s attempt to draw China into the global economic system has had the opposite effect.

“There was an assumption that globalisation was going to socialise others to be like ‘us’.

“There was no thought given to the idea that the arrow could run in the other direction: that authoritarian states and actors could learn to use the interconnectedness of globalisation to exert points of leverage on liberal democratic societies,” he added.

David and Evelyn also discuss the dismissal of a terrorism charge against Kneecap rapper Mo Chara in the UK, as well as the logistics of an upcoming EBU vote on Israel’s participation in Eurovision.

You can listen to Behind the Story which is available on the RTÉ Radio Player.

You can also find episodes on Apple here, or on Spotify here.