Another War Front
Cutaneous leishmaniasis, also known as oriental sore, tropical sore, chiclero ulcer or Aleppo boil, affects humans in a big way. It is currently a major issue in Afghanistan and poses a serious health hazard.
A serious epidemic that needs to be fought on a war footing.
The influx of a wide array of militants into Afghanistan from different parts during the Afghan-Soviet war of 1980s is now having serious implications for the country. Mlitants poured into the country when the current Afghan war started in 2001. This phenomenon of influx has brought manifold devastations for the Afghan population. Among many others is a flesh-eating tropical disease which is spreading like wildfire. The disease originally stemmed from Latin America and the Horn of Africa. It has now reached the Middle East and Afghanistan and claims around 40,000 lives annually. It is the second largest parasitic-killer disease in the world after malaria.
Cutaneous Leishmaniasis (CL) is a vector borne disease which is found in the tropical regions. It is caused by a parasite transmitted by a tiny sandfly which leads to severe scarring of the spot bitten by the fly. Usually the exposed part of the body like nose, face, ear or hands is affected by the bite. It is not a fatal disease but its other form, Visceral Leishmaniasis is life-threatening as it damages internal body organs. The ulcers caused by the parasite, if they remain untreated, lead to disfigurement and can take many months to cure. That is why it is called one year sore.
Kabul is witnessing the worst outbreak of cutaneous leishmaniasis, as confirmed by the World Health Organization. According to Dr. Richard Peeperkorn, a WHO representative in Afghanistan, 15,000 cases of the disease were reported in Kabul in 2012. There are around 200,000 estimated cases of CL in the country whereas in Kabul alone, the number of the victims surged to 67,500 in 2016. Suraya Dalil, former Afghan Minister for Public Health, believes that Afghanistan is a cutaneous leishmaniasis endemic country as 40,000 new cases are registered by the ministry each year.
“It is a disease of destruction,” says Toby Leslie, a researcher from the London School of Hygiene. It is not a fatal disease but the social stigma attached with it can turn one’s life into a nightmare. The stigma from the scarring can induce social ostracism of the affected person as a misconception about the disease prevails that it is directly contagious. The prevalence of such a fallacy is evident from the fact that infected mothers are prohibited from touching their children while young girls with disfiguring scars are deemed inappropriate for marriage. Even children with the condition are deprived of education because of the concerns that other children may get affected by the disease.
Rahima hails from the Khost province and is a victim of social exclusion. The 22-year old girl knows little about the disease she is suffering from, but what she is aware are the continuous stares of passers-by at her due to the purple-coloured open sore she has on one of her hands. “I have hidden my hand because people are horrible to me,” Rahima complained.
Another young girl, Farzana, has faced a similar traumatic experience. In her words: “People are really mean to me and say bad things, although they know they can’t catch this disease from me.”
Reasons for the rampant epidemic are many. The foremost is the population displacement as the country has seen many migrations over the past decades. In 2016, 600,000 Afghans returned from Pakistan and Iran and 623,000 fled their homes to settle in the urban areas inside the country, to avoid the conflict. This has resulted in overcrowding of the cities, giving rise to pathetic sanitation, poor housing and overstretched health services in Kabul and other urban areas. The migration has paved the way for the wide spread of the disease as the Afghan migrants are returning from various countries where the occurrence of the disease is already high.
It is true that Leishmaniasis primarily affects the marginalized community in rural areas or urban slums where poor sanitation, shoddy housing schemes and overcrowded conditions facilitate the growth of the sandflies that breed in rubbish and spread the parasite. This is also happening in Afghanistan where the wretched sight of economic deprivation prevails in Kabul, Badakhshan, Zabul and other cities. The poverty-stricken population is at high risk of catching the disease. This argument holds water given the fact that the impoverished people lack personal protective measures and are denied access to medical assistance due to the heavy cost.
“We must act now if we are going to have any chance of controlling the situation,” says Dr. Desjeux, former head of WHO Leishmaniasis Control Programme.
Afghanistan is entangled in sundry complexities and finds it difficult to cope with the outbreak of the epidemic which can be cured by employing various methods. A series of injections of sodium stibogluconate to the lesions helps in treating the disease. Similarly, nets and window screens can be used to avoid exposure to the insects. All this appears a painless job, but it is easier said than done, especially when a country neglects the very existence of the menacing problem. Afghanistan lacks the facilities to restrain the growth of the disease.
There are a few leishmaniasis treatment centres in the country for the swelling number of patients. These are far-flung and lack the capability to administer injections. Dr. Sami Nazhat, Director of the National Malaria and Leishmaniasis Control Programme, described the situation: “Leishmaniasis is a neglected disease. We don’t have enough treatment centres in Afghanistan. Drugs are often not available at the primary healthcare level and healthcare staff lacks the capacity to diagnose and treat patients.”
The flesh-eating disease has put the lives of 33 million Afghans at risk. The disease is not fatal in most of the cases but it does bring horrible consequences. Scarring of the exposed part of the body of the victim makes his life miserable as the patient receives ignominious treatment from fellow beings who outcast him on the premise of being contagious. Women and young girls tend to experience social ostracism more often. To counter the misconception, the mindset needs to be changed as indicated by Dr. Warusavithana, a WHO coordinator: “We need to fight the stigma associated with the disease by raising people’s awareness, improving early treatment and changing harmful attitudes, especially against women and girls. High occurrence of the disease reflects lack of seriousness on the part of government authorities who have failed to preempt and determine the menace in the first place.”
The writer is a member of the staff.