WHO addressing leishmaniasis in high-risk areas of the Syrian Arab Republic

23 July 2019

WHO/Colin Tucker

Batul’s thought nothing of it when she felt irritating bites traced to little black flies. Little did she know that the biting insects were sandflies, the main carriers of the leishmaniasis parasite. It is characterized by irregular bouts of fever, weight loss and skin lesions amongst others. The little bumps quickly swelled, opening to disfiguring lesions urgently requiring treatment. Batul lives in north-western Syrian Arab Republic, where one of the world’s most severe humanitarian crises has left over four million people struggling to access health care.

Leishmaniasis is a neglected disease. It is estimated that every year over 40 000 new cases occur in Idleb, northern Hama and rural Aleppo alone, making this one of the worst-affected areas in the Syrian Arab Republic. It causes immense human suffering. Prevention and treatment solutions are in hand, and some countries have realized eradication. Despite the urgency and potential for eradication, leishmaniasis control and treatment activities have been structurally underfunded every year.

In 2019, with financial support from the United States Agency for International Development (USAID), WHO and its partner have implemented one of the first large-scale leishmaniasis prevention, control and treatment projects reaching approximately 1.25 million people in north-western parts of the Syrian Arab Republic. WHO has increased access to appropriate care by improving leishmaniasis knowledge and skills in primary health-care facilities. Preventative measures include the distribution of protective bed nets and spraying sandfly-preventing insecticides.

Prevention is better than cure, controlling the sandfly

Leishmaniasis disproportionally impacts communities already burdened by conflict due to a lack of infrastructure and poor health systems. Over the past two months, over 300 000 people have been newly displaced mostly living in make-shift camps with little protection from the sandfly and low hygiene standards conducive to high transmission. WHO has distributed 81 500 bed nets through the intersectoral rapid response teams and health partners to protect people living in makeshift camps. A stock of 18 500 bed nets will be reserved in case there is an outbreak over the coming months.

In addition to the distribution of bed nets, WHO and implementing partner have sprayed the homes of 250 000 families with sandfly-preventing insecticides. Female sandflies primarily bite humans and cattle, mostly at night. The insecticide will assist in limiting the multiplication of the sandfly and therefore transmission just before the summer months, when they are most active. “We can clearly credit prevention activities to a reduction in leishmaniasis patients. Our current activities can control the transmission of the disease, but if we stop, the disease will re-emerge again. We need to sustain these efforts,” highlights Annette Heinzelmann, WHO Emergency Lead working in Gaziantep, Turkey for the cross-border response into the Syrian Arab Republic.

Focusing on the patient

For the first time in the Syrian Arab Republic, health partners have received five thermotherapy machines for their use in specialized leishmaniasis treatment centres. It works by transmitting radio frequency through the skin to create heat, which affects the diseased cells. The machines have been found to have less side-effects than traditional methods and highly effective. It is a portable, hand-held, non-surgical device to be used for specific patients who have special needs including pregnant women, very young children and relapsing patients.

“Most patients can be treated by their local doctors close to home, but there are cases that need specialized care. Innovating with this technique shows a commitment to find fitting solutions for each patient,” says Asm Amjad Hossain, WHO Technical Officer.

A push for mainstreaming knowledge and care

As leishmaniasis is a neglected disease, one of the main challenges is a lack of expertise. For several years, leishmaniasis treatment was limited to specialized centres after diagnosis by a general practitioner. In north-western parts of the Syrian Arab Republic, one of the main barriers to care is lack of transportation to health-care facilities. By integrating treatment in primary health-care facilities and mainstreaming leishmaniasis knowledge and skills amongst health staff, WHO addressed this barrier.

Through a cascade of trainings in 2019 on patient treatment, WHO trained 29 doctors as trainers. They went on to train over 400 health staff in 19 various locations in north-western parts of the Syrian Arab Republic. Moreover, WHO completed another cascade of trainings for surveillance, certifying over 27 trainers who went on to train 560 health staff inside the Syrian Arab Republic. A robust surveillance system is an essential component of control or elimination programmes.

With funding from the Swedish International Development Cooperation Agency, WHO could support 30 000 patients in over 200 health-care facilities with medicines. Leishmaniasis medicines are very expensive and there are global shortages. Due to the weakened health system and frequent displacement, most patients would not be able to access treatment without support. Community engagement is needed for the implementation of both prevention and control measures. The community needs to understand what the disease is, ask questions and know where to access treatment. As an integrated component of the programme, social mobilization is done through various activities including awareness raising sessions, social media campaigns and dissemination of posters.