May 28, 2016 – A catastrophic outbreak of Aleppo boil is underway in the Middle East, according to scientists collating data and information from refugee camps and conflict zones in the region.
The disease, properly known as cutaneous leishmaniasis, is caused by a parasite in the blood stream and transmitted through the bite of the sand fly. It provokes disfiguring lesions on the body, which are liable to secondary infection.
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Hundreds of thousands of people across the Middle East region are now affected by cutaneous leishmaniasis, which until recently was contained to areas around Aleppo and Damascus in Syria.
Accirding to the CDC until 1960, cutaneous leishmaniasis prevalence in Syria was restricted to 2 areas to which it is endemic (Aleppo and Damascus); preconflict (c. 2010) incidence was 23,000 cases/year.
However, in early 2013, an alarming increase to 41,000 cutaneous leishmaniasis cases was reported.
The regions most affected are under Islamic State control; 6,500 cases occurred in Ar-Raqqah, Diyar Al-Zour, and Hasakah.
Because these places are not historical hotspots of cutaneous leishmaniasis, this change might be attributed to the massive human displacement within Syria and the ecologic disruption of sand fly habitats.
According to the United Nations High Commissioner for Refugees, 4.2 million Syrians have been displaced into neighboring countries; Turkey, Lebanon, and Jordan have accepted most of these refugees. As a result, cutaneous leishmaniasis has begun to emerge in areas where displaced Syrians and disease reservoirs coexist.
In Lebanon, the figures jumped to 1,033 in 2013 from six in the previous 12 years. Turkey and Jordan have also reported hundreds of cases.
Similarly in Turkey, nonendemic parasite strains L. major and L. donovani were introduced by incoming refugees.
A similar situation may be occurring in Eastern Libya and Yemen, scientists say. Eastern Libya has reported increasing numbers of leishmaniasis and anecdotal evidence supports the spread of the disease in refugee camps in neighboring Tunisia. In Yemen, roughly 10,000 new cases are reported every year. With Yeminis migrating to Saudi Arabia, the concern is that the disease might spread there too.
Worse, these figures may be significantly underestimated because surveillance systems are badly affected or absent in conflict areas, scientists fear.
“It’s nearly impossible to have on the ground tropical disease experts and epidemiologists in Syria, Iraq, eastern Libya so we are only getting glimpses of the situation from refugees fleeing the conflict zones and going to camps in Jordan, Lebanon, Turkey,” says Hotez.