Ashfaq Yusufzai
PESHAWAR, Apr 6 2006 (IPS) – A parasitic skin disease spread by a hairy fly, that thrives in insanitary conditions, has assumed epidemic proportions in Afghanistan and across the border in camps for Afghan refugees in Pakistan.
HealthNet International (HNI), which has been running clinics with support from the World Health Organisation (WHO) in the war-destroyed country since 1993, has estimated that the illness, cutaneous leishmaniasis, which causes large ulcers on the body, is prevalent in seven percent of the population (roughly 75,000 people) in Kabul alone.
According to WHO s Dr Quaid Saeed, many among the estimated two million Afghan refugees in Pakistan, also suffer from active leishmaniasis, spread by the female sandfly.
Leishmaniasis is endemic in 88 countries throughout Africa, Asia, Europe, and North and South America. There are an estimated 12 million cases worldwide, with 1.5 million to 2 million new cases every year. While it is associated with rural areas and poverty, research shows that the disease has adapted to urban areas as well.
As preparations were underway to observe World Health Day on Friday, health experts said Leishmaniasis needed special attention because the disease, left untreated, presented social problems.
Naeem Durrani, HNI s coordinator for leishmaniasis control in Afghanistan, told IPS that most patients do not seek treatment. The result is horrible scarring and disfigurement the infection does not heal spontaneously, and can go on for years.
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Durrani estimates that, in Kabul, not more than 5,000 cases are treated a year . The Netherlands-based HNI works in war-affected countries only.
Until recently, treatment was also prohibitively expensive. Now the drugs are imported from India, which has slashed the treatment cost per case to only 13 dollars from 84 US dollars , said Saeed.
Leishmaniasis in not new in Afghanistan but a resurgence has occurred because of deficiencies in the control of the vector and lack of access to medical treatment because of political instability, costs and increasing drug resistance to first-line treatment.
The global health body has warned that the disease is likely to spread further in Afghanistan, and has suggested comprehensive control measures, such as the removal of rubble, prevention of large-scale population displacement, and eradication of vectors.
Women s rights groups have said that the infection may be another factor marginalising Afghan women. HNI recently reported that children in an Afghan family refused to eat their mother s cooking because she had ugly lesions on her body.
Also, as a result of the permanent scarring, girls who have recovered from the infection are being discriminated against in marriage. The girl may lose her chance of marriage because of the stigma, according to the HNI report.
WHO s Saeed said that a major public health challenge is to put brakes on the spread of the disease from Afghan refugee camps in Pakistan to the host population. WHO has imparted training to the local doctors, nurses and paramedics, besides provision of medicines so that the disease s spread could be overcome, he told IPS.
According to Saeed, some 10,000 Pakistanis have been treated for cutaneous leishmaniasis in Kurram Agency, on the Pakistan-Afghanistan border. Most of the infected were children, he said.
It is quite communicable given the fact that when untreated patients arrive in an area where the sandfly vector exists, transmission from untreated patients to uninfected people begins quickly through the bite of the female sandfly. Moreover, an epidemic can flare up quickly as the population is non-immune with no previous contact with the parasite, Quaid says.
Children, especially in the age of 1-5 years are common victims of the disease, said Jorge Olvar, a Geneva-based WHO expert on the disease who recently toured parts of embattled Afghanistan.
WHO is conducting a study in Pakistan and Afghanistan to examine whether the sandfly in these countries belong to he same species.
In Pakistan, the disease has penetrated the local population at an alarming speed. Of the four provinces, the North Western Frontier Province and Balochistan, both sharing a border with Afghanistan, are the worst affected.
The WHO has also confirmed outbreaks of the epidemic in parts of southern Sindh province, adjacent to Balochistan.
More recently, some 125 members of Pakistan s Frontier Constabulary, deployed on the international border with Afghanistan, were found infected with the parasitic disease. Their treatment, reportedly, was difficult because of unavailability of trained doctors.
In September 2005 several Dutch marines stationed in Mazar-e-Sharif were found infected and had to be repatriated for treatment, for lack of facilities in northern Afghanistan.
This may be the case in other parts of Pakistan and Afghanistan. There are at least some 40,000 patients in the NWFP alone, said Saeed Akbar Khan, a doctor in Peshawar. Some of the districts have already experienced an epidemic, he added.
In Kandahar district, which adjoins Pakistan, the prevalence rate is reported to be 29 per 1,000 people, which is an estimated total of some 20,000 people, said HNI s Durrani.
Leishmaniasis was contracted by troops involved in the 2003 invasion of Iraq with soldiers nicknaming it the Baghdad boil . During 2004, some 3,400 troops from the Colombian army, operating in the jungles near the south of the country, were found infected.
