Since August 2013, the MENTOR Initiative has been working to support the control of cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) in Syria. Communities are increasingly displaced and infrastructures degraded, creating a fragile existence in which to survive with limited access to routine health services.
Disease quickly gains a stronghold on communities as situations worsen, no less so in the northern parts of Syria. Already six years into what has been described as the worst humanitarian crisis since World War II, this conflict has provided the perfect conditions for the transmission of CL and VL. The MENTOR Initiative has found innovative ways in its approach to tackling this most pressing health issue.
What is Leishmaniasis?
Leishmaniasis (‘Aleppo boil’) is transmitted by the bite of an infected female phlebotomine sandfly. When bitten by the sandfly, the Leishmania parasite can enter the blood and invade the macrophage immune cells. This is what causes the open sores surrounding the bite. There are three types of leishmaniasis, caused by different Leishmania species:
1. Visceral leishmaniasis (VL, kala-azar) which is fatal if left untreated.
2. Cutaneous leishmaniasis (CL) which is the most common, causing skin lesions that can be self-resolving but if untreated can lead to mucocutaneous lesions.
3. Mucocutaneous lesions can lead to partial or total destruction of the mucous membranes of the nose, mouth and throat cavities and surrounding tissues.
Leishmaniasis in Syria
Cutaneous leishmaniasis is often associated with malnutrition, population displacement, poor housing and weakened immune systems, which is wide spread across Syria. Leishmaniasis is a huge public health concern, endemic in many areas and in some is the most prevalent communicable disease.
MENTOR adopts a multi-pronged approach to combating vector borne diseases, such as leishmaniasis, which can provide cross-cutting benefits. This includes indoor residual spraying (IRS) of the inside surfaces in the camp shelters and urban buildings people live in, in order to kill resting sandflies. Long lasting insecticidal nets (LLINs) and curtains (LLICs) are distributed to people living in more rural settings to protect them from sandfly bites. Waste management, particularly in urban settings, helps to reduce sandfly breeding sites. All of these activities are supported by contextually appropriate education and communication.
Treatment of Leishmaniasis for CL includes intra-lesional injections of glucantime for first line treatment or pentostam. However, administration of intra-lesional injections is painful for the recipient and requires well trained and equipped health workers. MENTOR trains health workers in high transmission areas and is providing technical and material support to health facilities to ensure access to effective treatment services for a population of approximately 4.1 million people.
Through the uniqueness of MENTOR’s services, we have been highly successful in being able to achieve effective disease control within some of the most challenging settings.