One of the least known consequences of modern conflict in the Middle East and East Africa has been the widespread devastation that results from a tropical infection known as leishmaniasis. The international scientific and diplomatic communities now have an opportunity to work together to prevent the spread of this neglected tropical disease and to develop new treatments or vaccines.
Leishmaniasis is caused by a microscopic protozoan parasite that is transmitted through the bite of small and delicate blood feeding insects known as sandflies. Mostly because of forced human migrations that expose people to sand fly bites as they flee conflicts or while living in refugee settings, together with breakdowns in public health infrastructure, leishmaniasis outbreaks have become the new hallmark of late 20th or 21st century wars and human misery.
This week the community of tropical disease experts working in South Sudan is holding its collective breath over recent news of ethnic attacks, a potential for civil war, and the prospect that a public health tragedy could soon emerge in the region.
A landlocked country about the size of Texas but with a population density equivalent to Utah or Nevada, South Sudan is a sparsely settled, highly rural, and profoundly poor tropical developing nation. Such conditions of extreme poverty and hot climate create the perfect storm for tropical diseases to flourish. Indeed, almost all of the 17 major neglected tropical diseases currently recognized by the World Health Organization are found in South Sudan.
The neglected tropical diseases (NTDs) are highly endemic but patchily distributed among the 20 countries and almost 400 million people of the Middle East and North Africa (MENA) region, and disproportionately affect an estimated 65 million people living on less than US$2 per day. Conflict and human and animal migrations are key social determinants in preventing the control or elimination of NTDs in the MENA, while local political will, strengthened international and intersectoral cooperative efforts for surveillance, mass drug administration, and vaccination are essential for elimination.
Founded in 1969, the Organisation of the Islamic Conference (OIC) is comprised of 57 nations that together represent the second largest international organization after the United Nations. According to their Web site, the OIC serves as the “collective voice of the Muslim world,” both protecting its interests and settling conflicts and disputes between member states. In addition to several important and prosperous oil- and gas-producing nations in the Middle East, the OIC nations also include some of the world’s poorest countries as well as large middle-income countries with regions of great poverty. In these geographic areas of poverty are also found some of the highest infection rates and endemicity of the neglected tropical diseases (NTDs).
In the United States, there is a largely hidden burden of diseases caused by a group of chronic and debilitating parasitic, bacterial, and congenital infections known as the neglected infections of poverty. Like their neglected tropical disease counterparts in developing countries, the neglected infections of poverty in the US disproportionately affect impoverished and under-represented minority populations. The major neglected infections include the helminth infections, toxocariasis, strongyloidiasis, ascariasis, and cysticercosis; the intestinal protozoan infection trichomoniasis; some zoonotic bacterial infections, including leptospirosis; the vector-borne infections Chagas disease, leishmaniasis, trench fever, and dengue fever; and the congenital infections cytomegalovirus (CMV), toxoplasmosis, and syphilis.