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War and Sickness in Afghanistan

• November 03, 2010 • 3:53 PM

Neglected diseases exacerbate the awful toll already taken by world conflicts, U.S. researcher says.

The Associated Press has recently reported on findings from the World Health Organization that there has been a massive surge of a disfiguring skin disease in Afghanistan, especially in Kabul, known as cutaneous leishmaniasis.

Leishmaniasis is a parasitic infection found in pockets of severe poverty in Central Asia and the Middle East. The sandfly that transmits this neglected tropical disease flourishes in conditions where there is inadequate sanitation and garbage pick up, poor housing and a breakdown in public health infrastructure. When the lesions of leishmaniasis appear on the face, they can cause permanent disfigurement.

Leishmania scars on the face are especially devastating for young women, who are stigmatized to the point where they are rendered unmarriageable. Mothers with the disease are often prevented from holding their own children.

Conflict and war have almost certainly contributed to the resurgence of leishmaniasis in Afghanistan. Dr. Chris Beyrer at Johns Hopkins Bloomberg School of Public Health has described a similar rise in the disease as a result of guerrilla activities and drug trafficking in Colombia.

Sadly, this link between contagion and conflict is a common theme for many neglected tropical diseases. They are the most important diseases you have probably never heard of: Chronic parasitic infections such as hookworm, schistosomiasis, Chagas disease, African sleeping sickness, elephantiasis and river blindness, as well as bacterial and viral infections such as trachoma, cholera and dengue fever.

They almost always affect the poorest segments of our society — the “bottom billion” who live on less than $1.25 per day. They arise in remote rural areas or in urban slums where the diseases and their victims go unseen. We now know that neglected tropical diseases also are a major cause of poverty, because they cause cognitive and intellectual delays in children and impair worker productivity.

And they are inextricably linked to war. A systemic form of leishmaniasis, known as visceral leishmaniasis, killed more than 100,000 people fleeing the war in Southern Sudan in 1988. African sleeping sickness was almost eliminated as a public health problem in Sub-Saharan Africa during the 1960s, but subsequent decades of conflict in Angola, Sudan and the Democratic Republic of Congo resulted in large epidemics. Because African sleeping sickness, a parasitic infection transmitted by tsetse flies, tends to occur in remote rural areas of these countries, we may never really know how many Africans died from this disease during the closing decades of the 20th century.

Last year, together with former Wisconsin Gov. Tommy Thompson, I wrote in the Public Library Science Neglected Tropical Diseases about how neglected tropical diseases may actually exacerbate war and strife. A map of the world demonstrates a provocative geographic overlap between chronic infections and the conflicts that have occurred over the past few decades. These diseases trap the poorest segments of society in a vicious cycle of poverty, and they can reduce agricultural productivity. Entire communities are destabilized when people flee an infected area, abandoning fertile lands.

The geopolitical implications have stimulated an interesting dialogue with the U.S. Department of State and other branches of government over how to control neglected tropical diseases as part of our foreign policy. This would include providing low-cost packages of drugs, many of which are donated by the large pharmaceutical companies, in programs of mass drug administration; or in some cases, developing new vaccines.

Today, we can actually eliminate some of these diseases as public health problems, potentially reducing the rates of devastating poverty and conflict in these regions and improving the health and well-being of the world’s populations.

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Peter Hotez
Peter Hotez. M.D. P.hD., is dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas Children’s Hospital Endowed Chair of Tropical Pediatrics, and director of the Texas Children’s Hospital Center for Vaccine Development.

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