At least 275 children in southern Iraq have been infected with a disfiguring skin disease, an outbreak some health officials are blaming on the war's devastating effect on the public health system.
According to the United Nations — citing reports from Iraq's southern province of Qadissiyah — 275 children have been struck with leishmaniasis, which is spread by sand flies. Most have a form that causes skin sores, but others have a type that strikes internal organs and can be fatal.
"This is a killer disease and we are trying to stop its spread," said Dr. Omer Mekki, an epidemiologist at the World Health Organization's Iraq office.
Two types of leishmaniasis have been found in southern Iraq, according to Mekki: 212 cases of cutaneous leishmaniasis, also known as Baghdad boil disease, and 63 cases of visceral leishmaniasis, or kala azar, which is Hindi for black fever.
Cutaneous leishmaniasis is not fatal but can cause facial lesions and crater-shaped sores, leaving patients disfigured. Kala azar can kill, and causes fever, weight loss, anemia, and swelling of the spleen and liver.
Children are particularly at risk because they typically have weaker immune systems than adults. A single sand fly bite can transmit the disease.
Outbreaks once rare
Though the disease was first identified in Iraq more than a century ago, outbreaks were rare during Saddam Hussein's regime. But since the conflict began, experts say the destroyed health system has opened the way for diseases lurking in the environment.
"The war has exacerbated the problems in Iraq that are one or two decades old," said Claire Hajaj, a spokeswoman for UNICEF's Iraq office. "Their health system has been undermined by violence, insecurity and sabotage."
Mekki said WHO is working with the Iraqi government to conduct spraying campaigns to kill sand flies. He added that cases of leishmaniasis have dropped substantially since 2004, but progress eliminating the disease has been slow.
The incubation period can be up to six months, and some suspect the reported number of cases may be an underestimate. Patients are treated with a course of injections, which costs about $40.
Since the conflict began, hundreds of U.S. soldiers have also been infected and scarred by leishmaniasis.
Leishmaniasis also surged in Afghanistan after decades of civil war and the 2001 U.S.-led invasion. Though data about the historical number of cases are sketchy, experts say Afghanistan now has about 200,000 cases per year.
In Iraq, WHO officials estimate there are nearly 3,000 leishmaniasis cases per year. But in neighbouring Jordan, there are only about 300 cases annually.