Indian football's big decision - can Anwar Ali follow his heart?

File photo: Anwar Ali looks on prior to the FIFA U-17 World Cup match between Ghana and India on October 12, 2017 Maja Hitij - FIFA/FIFA via Getty Images

In November last year, in the university town of Rennes, France, a nervous young man barely out of his teens sat across the table from a grey haired doctor who was explaining to him the possibility that a fledgling footballing career might have to be cut short due to heart disease.

"If you have to stop football, what is on your mind?," asked Dr. Francois Carre, the head of sports medicine at the Centre Hospitalier Universitaire, and one of the leading experts on cardiology in sports.

"Nahi chodna chahta (I don't want to stop)," answers Anwar Ali softly.

Nearly a year later, the 20-year-old waits as the All India Football Federation (AIFF) decides whether Ali will play professionally again. They have referred the case to their medical committee. A final decision will be made based on the committee's recommendation.

The AIFF was initially supposed to make its decision by the end of last week, but the matter is complicated. Should the AIFF prohibit Ali, it would be the first time an Indian footballer would be barred from competing due to health concerns.

Ali isn't just any young footballer, though -- he was a key member of the Indian squad at the 2017 U-17 World Cup. The centre back was one of the standout performers, impressing enough to be signed by Indian Super League (ISL) side Mumbai City FC for a sum of INR 30 lakhs (approx. USD 40,000).

The future seemed bright for Ali, who had grown up herding cattle just as his father and family had done in the outskirts of Adampur (near Jalandhar) in Punjab. "To say he's poor is an understatement. His family didn't even have a proper house. If it wasn't for football, that's where he'd be today too," says Ranjit Bajaj, who initially scouted him for the Minerva Football Academy, from where he was picked for the Indian U-17 team. And it wasn't just the ISL sides who were interested. Senior India team manager Igor Stimac called him up for a national camp last year.

Then, just like that, it ended. During a medical examination prior to training with the Mumbai City squad, Ali was diagnosed with hypertrophic cardiomyopathy (HCM), a condition where the heart muscle wall becomes abnormally thick and affects the pumping of blood. Undiagnosed, the condition can have severe consequences. In 2012, English footballer Fabrice Muamba, who was later diagnosed with the condition, collapsed on the pitch. While he recovered, the episode was the end of his footballing career.

Following his diagnosis, that seemed the likely fate for Ali too. Mumbai City referred his case to cardiologists in the city and subsequently to experts in France. The consensus was that Ali faced a major health risk if he continued playing. His contract with Mumbai City was subsequently terminated.

Ali then consulted specialists in Jalandhar and Chandigarh. They suggested he displayed no symptoms of his medical condition and could play. Eventually he was approached by Kolkata-based Mohammedan Sporting, who are playing in the second division of the I-League.

Even playing in the third tier of Indian football, though, might not be possible. While the AIFF still hasn't made its decision, a member of the medical committee says, on condition of anonymity, that there isn't a lot to argue over. "We had him undergo another test on September 3 in Kolkata. The fact is that he has been tested on multiple occasions. There is no doubt about the nature of his condition. The only disagreement is in the assessment of what is permissible for him to do. From our end, it is clear that it is unsafe for him to compete," says a member of the committee.

That disagreement, in the assessment of his condition, is a ray of hope for Ali. In his discussion with Ali, Dr Carre had suggested the conditions under which Ali might be able to play.

Carre explained that the European Society of Cardiology has a risk calculator according to which the level of risk to Ali, in normal conditions and at his age, was low. However, he added that the risk rose significantly during match conditions owing to the production of hormones like adrenaline. The level of risk in such conditions would place Ali into the high-risk category. And age would be a factor, too, over the years.

Carre added that while Ali's condition would disqualify him from playing in Europe, the situation would be different elsewhere. According to the recommendations of the American College of Cardiology for Sports, patients with a mild expression of HCM can be selectively allowed to participate in sports. Carre would also add that Ali could continue to play as long as he had an AED (arterial defibrillator machine) at hand.

However, there was a caveat. "Low risk doesn't mean no risk," Carre would tell Ali. Regardless of whether he be allowed to participate in professional sport, the doctor insisted that Ali undergo cardiac tests each year to make sure his condition did not deteriorate further.

And so, Carre said, Ali would have to consider the possibility of giving up his football career.

Ali is currently in Kolkata in the same hotel as the rest of his Mohammedan Sporting teammates, who are preparing for a play-off tournament next month. While he stays with them, he's not allowed to train until he receives a verdict in his favour. "He's not allowed to train with us, so we are having him practise by himself. Right now he is in a positive frame of mind and we are hoping we get the good news from AIFF soon," says an official with the club.

Earlier, club secretary Dipendu Biswas told PTI that they were ready to arrange training sessions under special supervision for Ali, even reduce his game time to 30 minutes per match. "He [Ali] is a fine prospect for the country, and will be an asset to any team, not just Mohammedan," Biswas said, adding that they would follow what the AIFF and the Asian Football Confederation decided.

Ali has pleaded his case in a letter to the AIFF, who are reportedly considering helping him transition into a career in coaching. "Football is the only thing I know and if AIFF bans me, I'll be forced to play in low-level tournaments ... to make ends meet. There are no medical facilities in these tournaments so the chances of me dying on the field will be much higher. Your disqualification of me will be a death sentence for me and my family..." he wrote.

For now, though, all he can do is wait.