The Syrian civil war, which began in 2011, has created the perfect environment for the proliferation of leishmaniasis, a vector-borne disease that is transmitted by sand flies. Sand flies breed in cracks and crevices, in uncollected waste and the rubble of destroyed buildings.
Accumulating household waste, general debris, rubble and ongoing bombardment and artillery shelling of civilian infrastructure have greatly increased the number of leishmaniasis infections. The situation is compounded by poor living conditions and limited access to healthcare services. The disease is also often associated with malnutrition, population displacement, poor housing and weakened immune systems, all widespread across Syria.
While leishmaniasis has historically been endemic in the country, case numbers have exploded in the years since the Syrian conflict began. Prior to 2011, there were an annual average of 23,000 cases a year.
In 2021, more than 93,000 cases of leishmaniasis were diagnosed in the northern governorates of Syria alone. 85% of which were diagnosed and treated in MENTOR-supported health facilities and mobile clinics.
The MENTOR Initiative has been supporting the control of Cutaneous Leishmaniasis (CL) and Visceral Leishmaniasis (VL) in Northern Syria since 2013.
Leishmaniasis (in Syria also named ‘Aleppo boil’) is transmitted by the bite of an infected female phlebotomine sand fly, which transmits the leishmanial parasites to the human skin. Here they invade macrophage immune cells.
The parasitic activity results in the development of raised, red lesion at the site of the bite, which often happens weeks or sometimes months after a person has been infected. Lesions can ulcerate and may become secondarily infected with bacteria.
There are three types of leishmaniasis, caused by different Leishmania species:
- Visceral leishmaniasis, which is fatal in 95% of cases if left untreated. It targets the inner organs, mostly the liver and spleen, and most commonly affects young children.
- Cutaneous leishmaniasis, which is the most common form of the disease, causes skin lesions. These lesions can lead to permanent scarring and disfigurement if not treated. Everyone is equally susceptible to leishmaniasis but the psychological impact of CL is greater in children and women. If left untreated, it can result in social stigmatisation, the possibility of community exclusion, as well as being disadvantaged in seeking job opportunities, education and marriage.
- Mucocutaneous affects mucous membranes lesions can lead to partial or total destruction of the membranes of the nose, mouth and throat cavities and surrounding tissues.
- Annual Indoor Residual Spraying (IRS) campaigns targeting the sand fly population: In 2022 over 1.5 million people benefitted from IRS and reduced transmission of leishmaniasis.
- Support over 130 static health facilities and several mobile clinics run by partner organisations with training, supply chain management, data collection and disease surveillance.
- Large-scale Information, Education and Communication (IEC) campaigns are delivered in vulnerable communities which focus on symptoms, prevention and treatment options.
Highly successful and effective disease control has been achieved within some of the most challenging settings of Syria, due to MENTOR’s unique services.
MENTOR works closely together with WHO, OCHA, Syrian health authorities as well as national and international partner organisations to continue providing these services to people in Syria.
MENTOR in co-operation with WHO is also implementing community-based surveillance projects, which aim to provide health partners with accurate data on the most common causes of morbidity and mortality in vulnerable communities.