An estimated 40,000 boxing fans watched Oleksandr Usyk beat Tyson Fury at the Kingdom Arena in Riyadh earlier this month.

Millions tuned in over legal and illegal streams across the world to witness Usyk defend his title against Fury in an enthralling contest that reportedly earned the boxers a combined $191m in prize money.

Earlier this year, an estimated 60 million households watched the punch-up between ageing boxing legend Mike Tyson and YouTube celebrity fighter Jake Paul. This was in addition to the 72,000 people inside the arena in Texas that together paid a whopping $18.1m to watch the fight in person, according to the promoters.

Boxing: It’s a knockout

In 2024, the extraordinary number of eyeballs, online search queries and audience figures across viewing platforms confirmed boxing’s status as one of the most popular and followed sports in the world.

But given the brutal nature of boxing, should it even be considered a sport?

While other sports are working hard towards increased protection for participants, especially from concussion-related injuries, boxing promotes the very opposite: cause as much harm to your opponent as possible, leading to submission or knockout as a possible outcome, all of it intentional, celebrated and lauded with fame and financial rewards.

“Compared with other contact sports, boxing has been known to have some of the highest rates of concussion,” Dr Ejaz Shamim, a neurosurgeon and chair of Mid-Atlantic Kaiser Permanente Research Institute, told Al Jazeera.

“A concussion occurs when the brain thrusts back and forth hitting the inside of the skull. This causes damage to the brain and occurs every time a boxer is hit in the head. Each concussive event is akin to traumatic brain injury (TBI). With each TBI, there is irreversible brain damage.

“It is thought that in boxing, an individual gets a concussion about every 12.5 minutes of fight time alone. The protective headgear does not help much with the concussion. The internal trauma to the brain occurs every time a boxer is punched in the head, with or without external head protection.”

According to the Manuel Velazquez Collection which documents deaths in boxing, an average of 13 boxers are killed in the ring annually. Separate research conducted by the Association of Ringside Physicians said there were at least 339 deaths from 1950 to 2007, with a “higher percentage at lower weight classes”.

The surreal sight of a 58-year-old Tyson back in the ring delighted millions of his fans. But should the popularity, fame and revenue the sport brings absolve it of the risks and threats? And which outweighs the other?

“People may come into boxing to vent anger and frustration, but they quickly learn that these things have little or no place in the training gym or the ring,” Philip O’Connor, a sports journalist, said.

“Very, very few have what it takes to get in the ring to compete with another human being using a limited rule set where the objective is to knock your opponent unconscious or at least hurt them more than they hurt you.

“After a lifetime of watching boxing and various martial arts and practising more than my fair share, I can say that from my perspective, the mental and physical benefits far outweigh the risks, but we must always strive to improve safety and remove or reduce risk to the greatest extent possible.”

Nothing amateurish about boxing injuries

Studies show that up to 20 percent of boxers will suffer a concussion in their careers, though many are not reported, especially in amateur boxing.

At the 2020 Tokyo Olympics, where boxing is classified as an amateur sport, it had the highest number of injuries, according to the British Journal of Sports Medicine (BJSM). At the 2016 Rio de Janeiro Olympics, it was second to BMX.  Overall, it sits fifth in the list of Olympic sports with the highest injury rates.

The American Association of Neurological Surgeons says 90 percent of boxers sustain a traumatic brain injury during their career. Alzheimer’s Research and Therapy reported that former boxers remain more vulnerable to the natural ageing of the brain and diseases of the brain.

While the World Boxing Federation (WBF) and International Boxing Federation (IBF) did not respond to Al Jazeera’s questions on the brutality of the sport and the safety aspects, the International Olympic Committee (IOC) said “providing athletes and spectators with the best and safest conditions possible are top priorities for the IOC and the entire Olympic Movement”, adding that “Olympic-style boxing does not have knockouts as an objective, nor do knockouts have any scoring advantage”.

A WBF spokesperson had earlier stated that “boxing does so much good for young people, keeps them off the streets, away from drugs, teaches them discipline, self-confidence, that the good by far outweighs the bad”.

Boxing’s popularity

Given the history of the sport, the number of participants worldwide and the finances at play, boxing is unlikely to cease existing as a sport.

In the United States alone, the number of people participating in boxing reached about 6.7 million in 2021, according to market research company Statista, which added that the market size of the global boxing equipment industry amounted to over $1.6bn in the same year.

The total revenue of the World Boxing Council (WBC) from 2011 to 2020 was more than $32m.

Forbes reported that professional boxer Floyd Mayweather Jr pocketed $275m from his fight against MMA-turned-boxer Conor McGregor in 2017, with the latter taking home about $100m in the single biggest payout in the history of sports.

“In terms of global media popularity, boxing in 2024 is the fifth most popular sport in the world and the most popular combat sport,” Kamilla Swart-Arries, an associate professor at Hamad Bin Khalifa University in Qatar, said.

“It has attracted legendary figures who have also transcended their sport to become global cultural icons. Many boxers achieve international fame. Coupled with the icons and role models, boxing also has low barriers to entry, is easily accessible and fosters community building with boxing gyms becoming integral to communities where youngsters can let off steam and practise sport as an alternative to social ills.”

The way forward

So rather than banning boxing, can increased safety protocols, stricter regulations and banning certain practices ensure the sport becomes safer?

“Significant safety improvements have been made in boxing over the years to enhance the protection of fighters and reduce the risk of serious injuries. While the nature of the sport makes it high-risk, these advancements aim to create a safer environment for fighters, minimising the likelihood of severe injuries and fatalities,” Swart-Arries added.

“I don’t think it [boxing] should be abandoned as there are many other sports that are also deemed to be dangerous. All these sports will continue to generate global interest and appeal thus they won’t be abandoned so it is important that they continually making improvements to make them safer.”

Another study published by the BJSM said there are about six to eight injuries per 1,000 rounds of boxing. Approximately 10 to 20 percent of injuries in boxing are severe or potentially life-threatening, according to the BJSM research.

O’Connor, who is also a martial arts coach, says “one boxer dying is one boxer too many”, adding that the sport “still has a long way to go in terms of fighter safety”.

“Boxing has, in some form, always been with us and will always be with us. The objective should be to ensure it is run in a fair, transparent and safe manner that ensures the physical wellbeing of the participants. Any and every change should be considered and implemented in order to uphold the integrity of the sport.”

Head injuries, including concussions, brain bleeds and skull fractures, are the most common and most serious injuries in boxing. Among other injuries are cuts, broken noses and eye damage, bringing to the fore the brutality of the sport.

While research is continuing, some studies have suggested that up to 50 percent of former professional boxers may show signs of chronic traumatic encephalopathy – a chronic degenerative brain disorder – after their career has finished.

“Concussion prevention is very important in preventing the development of permanent brain damage in the future,” said Shamim, the neurosurgeon. “Each concussion has an additive effect and with every concussion you are more at risk of developing subsequent concussions.

“One-on-one combat as a spectator sport like boxing has existed for thousands of years and it’s unlikely that it would ever go away. But boxing carries with it a high risk of concussions and traumatic brain injury. With combat sports, the risk of concussion and other trauma will always be there.”