By Laurence Smith, Co-Founder, Greybeard Healthcare
April 2026
On 10 April 2026, the Artemis II spacecraft and its remarkable four crew members completed its nine-day lunar flyby mission, returning to Earth after viewing the far side of the moon and traveling further from the Earth than any previous astronauts.
Reflecting on the success of the mission, NASA has reconfirmed its commitment to the next three phases of the programme, including a crewed lunar landing planned for late 2028 (Artemis V), when work will commence on the construction of a moon base.
Of course, whenever human beings spread themselves into new territories, one can expect healthcare services to open shortly afterwards. It is no coincidence that, in Star Trek, the Chief Medical Officer is one of the Starship Enterprise’s four most senior officers.
This is why NASA’s unprecedented ambition prompted me to reflect on the nature of, and clinical specifications for, the first clinic to be built on the moon.
Let us assume that the pioneering explorers will be early middle aged (NASA reveals the average age for astronaut candidates is 34, with a range from 26 to 46), and at the peak of mental and physical fitness (NASA states: “For maximum crew safety, each crew member must be free of medical conditions that would either impair the person’s ability to participate in, or be aggravated by, space flight, as determined by NASA physicians”).
So there will no particular need for our first health clinic to have expertise in paediatrics, long-term chronic disabilities, obesity management, or diseases associated with old age such as dementia.
Similarly, there are at least two reasons why the clinic would not need to commit resources to campaigns to combat smoking or alcohol addictions: firstly, NASA’s astronaut screening programs would have disqualified astronaut candidates suffering from such dependencies (smoking is prohibited on spacecraft and alcohol must not be consumed in the 12 hours prior to launch); moreover, smuggling routes are not yet sufficiently sophisticated for contraband to find its way to the colony (though, give it time and all things are possible – how ironic that a slang term for a smuggler is a ‘moonshiner’).
Having identified services which the clinic will not need to prioritise, we can move to the more interesting topic: addressing healthcare risks which, by virtue of the colonists being away from Earth, will be more prevalent.
These include:
Service #1: Physical well-being in a low gravity environment
The lower gravity for moon-dwellers poses a number of health risks – such as: to eyesight (microgravity-induced fluid shifts within the eye and changes to intraocular pressure), bone density (which can reduce by 1.5% per month), and muscular atrophy.
Rather than wait for the worst to arise and then deal with the consequences, lunar-based primary care physicians will be highly proactive in prescribing personalized daily exercise routines and then monitoring key vitals.
Expect all members of the lunar colony to be issued with an assortment of wearable devices, feeding information in real time to the doctor’s office, and allowing early intervention whenever a key metric is tracking in an undesirable direction.
The primary care clinic will be particularly alert to risks associated with pregnancy – as yet, there is no established body of literature on the effects of low gravity on gestation; the science is not yet sufficiently advanced for safe delivery of the first off-world baby. Given the demographics of the lunar colonists, birth control will be a vital element of population health.
Service #2: Cognitive excellence with the best possible sleep
There are a number of other fields in which the data is not yet sufficient to optimize conditions on the lunar base, one of which is the psychiatric effect on individuals of extended periods away from Earth. It has been rare for astronauts visiting the International Space Station (ISS) to remain aboard for longer than four to six months.
In anticipation of longer missions, NASA has developed a ‘human research’ roadmap to assess the risks of adverse cognitive or behavioural changes and psychiatric disorders and the consequences for in-mission health and performance and long-term health effects. It concluded that lunar orbital and surface mission with a duration between 30 days and one year ‘Requires Characterization and Mitigation’ 1.
While this is a nascent field of research, one theme from the early studies is the importance of sleep for astronaut wellbeing 2. On Earth, physician’s interest in sleep habits often begins and ends with a single tick box on the final page of a routine health questionnaire; it is not a major area for primary care intervention. For astronauts, effective sleep is critical. This is partly because the risks of sleep deprivation are magnified due to adrenalin and the absence of the Earth’s 24-hour rotation cycle; partly, because the tasks undertaken by astronauts are mentally demanding and easily compromised by fatigue. Moreover, the experience of astronauts aboard the ISS is that an uninterrupted period of sleep can be difficult to achieve, due to physical discomfort, noise, temperature changes and general disturbances.
Expect our lunar primary care doctors to receive special training in sleep disorders and sleep management, including the range of sleep-inducing medications that are available. (The American Academy of Sleep Medicine has 11,000 members worldwide; I suspect a disproportionate number of those may be invited to serve as advisers to the moon’s first primary care clinic).
Service #3: (extremely) Remote specialist teleconsultations
On Earth, patients frequently complain about the time and complexity of referral pathways between primary care and specialty consultations. These pathways will be no easier on the moon, where the volume of cases will make it impractical for all specialties to be represented on-site until the colony reaches significant scale.
Accordingly, almost all specialty diagnosis and treatment will need to be delivered remotely, using highly advanced and interactive virtual consultation platforms.
To support these consultations, the lunar facility will need to be equipped with point of care diagnostics (a placeholder arrangement until a fully staffed laboratory can be justified), able to take samples and undertake basic tests. Interpretation of the results and discussion about treatment protocols would then be led by Earth-based specialists who have access to the data and can interact with the patient from a distance of 250,000 miles.
Mindful of the demographics and key off-world health risks, specialties that need to be covered include cardiology, endocrinology, ENT, gastroenterology, haematology, pulmonology, urology and rheumatology. Expect NASA to assemble a panel of leading world consultants in each of these major specialties.
Service #4: Emergency and disaster management
Despite the robust physical condition of the early colonists, the unforeseen will occasionally happen leading to a need for emergency intervention, up to and including surgery. Examples might include patients suffering from appendicitis or needing gallbladder removal, hernia repairs, emergency laparotomy, perforated ulcer repairs, or even reconstructive plastic surgery due to accidents (such as burns injuries) that occur in the course of duty.
NASA will surely wish to engage the world’s leading surgeons in each of these disciplines; yet (as with specialist consultants) it would be impractical to have a multidisciplinary team on-call within the lunar facility itself. For this reason, expect the moonbase to showcase the most advanced da Vinci-style robotic surgery platform ever mobilized, with surgical tools and instruments that can be controlled by top surgeons, based on Earth, sitting at their consoles (I trust that NASA’s wifi connection will be faster and more reliable than the one I’m using as I scribe these words).
Turning to disaster management: whilst most Earth-based primary care doctors are located in towns and cities where the risk of a mass casualty event is minimal, some operate in situations where there is daily exposure to heightened levels of danger. These can include underground mining, operations dealing with explosives or hazardous materials, or the frontline during active combat. Alternatively, the service might happen to be based in regions prone to natural disasters such as flooding, or hurricanes.
It goes without saying that the first, pioneering lunar colony, will face multiple risks of danger. These could range from radiation shield failure, to dust storms from meteor impacts, and to life support systems going offline for temporary periods.
Some of these scenarios can be mitigated but, as the colony tests new ideas and it will be wrestling with a host of unknowns and learning from experience – meaning that things will happen which were never listed on the risk register. Expect physicians to spend at least half a day every week running simulations of how different disaster scenarios would be managed.
When such disasters arise, the sick bay might be overwhelmed, and the attending physicians will need the capability to make quick judgments and set priorities using imperfect and even erroneous information. This ‘behavioral’ competency will be almost as important as raw medical knowledge for the moon’s first elite primary care physician team.
Service #5: Next generation blood transfusions
The World Health Organization cautions that “many patients requiring transfusion do not have timely access to safe blood” and recommends “providing safe and adequate blood should be an integral part of every country’s national health care policy and infrastructure” 3.
If timely access is a challenge on Earth, the issue is magnified in space, where the perilous environment means that astronauts are often one dose of bad luck away from needing an emergency transfusion. Examples include ulceration or internal haemorrhaging from radiation exposure, injuries such as crashes or falls sustained while exploring the planet’s surface away from the compound, or even severe anaemia (studies suggest red blood cells are lost at a faster rate when off-planet 4) .
In a recent report, the WHO concluded that only 125 of 171 countries have a national blood policy; it will be intriguing to see whether the lunar colony boosts the number to 126 .
Unfortunately, it will not be possible for the designers of the colony to take the short-cut of duplicating the specifications used for a regular Earth-based blood transfusion service. The storage of fluids such as blood is complicated by microgravity, which can cause liquids to form globules rather than flow freely and increase the life-threatening risk of an accumulation of air bubbles (venous air embolism. Moreover, the maximum recommended storage period for refrigerated blood is only 35 to 42 days, meaning the moon-based service would be facing the formidable logistics of constant replenishment.
Expect NASA to accelerate some of the ground-breaking technologies which present potential solutions to this dilemma. Perhaps the most promising is lyophilized blood, “the next generation advancement in dried blood preservation using a three-step process of supercooling, sublimation, and diffusion to remove the solvent water.” 5 The result is freeze-dried or spray-dried blood plasma and platelets “suitable for packaging and transporting to austere environments”, and then long-term storage at ambient temperatures within off-world facilities.
This is a positive development for any astronauts experiencing traumatic injury as a result of a hazardous mission. It is equally good news for biotech research scientists with credentials and pedigree in this field – they will not be short of work during the coming years.
Final thoughts:
The eyes of the world’s entire population will be upon the activities of our inaugural lunar-based primary care service (especially if, despite the precautions described above, it is called upon to deliver humanity’s first space baby).
Since its inception, the World Health Organization has been a powerful advocate for the essential role of primary care. It has stated: “Health systems with a primary health care-based foundation result in improved clinical outcomes, increased efficiency, better quality of care, enhanced patient satisfaction.”
All these features and more will need to be embedded in the first lunar clinic; we may even need its activities to be guided by a new WHO-adjacent body: The Off–World Health Organization.
Acknowledgements
The author would like to thank Dr JJ de Gorter and Mark Adams for making a number of valued contributions that shaped the ideas explored in this article
Sources:
- https://humanresearchroadmap.nasa.gov/Risks/risk.aspx?i=99
- https://trialx.com/space-health-research-how-astronaut-sleep-data-collection-powers-new-discoveries/
- World Health Organization Fact Sheet, ‘Blood safety and availability’, May 2025 (https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability)
- Edouard Lansiaux et all, ‘Understanding the complexities of space anaemia in extended space missions: revelations from microgravitational odyssey, Frontiers in Physiology, March 2024
- Kaden Golda et al, ‘The effects of rocket travel and near-space environment on dried blood and blood plasma’, Journal of Emerging Technologies, 17 February 2026
