KABUL (Reuters) - The 10-year-old Afghan girl has big eyes, a shy smile and a dark lesion speckled with blood on her right cheek.
The girl has leishmaniasis, a disease caused by a parasite transmitted by a tiny sandfly that can lead to severe scarring, often on the face.
The girl, Sahima, wearing a purple tunic and trousers and pale blue shoes, answers “no” softly when asked if the sore hurts.
But her father is worried about the lesion, the size of a big coin.
“Of course, this doesn’t look good,” the father, Najibullah, said at a leishmaniasis clinic crowded with children with sores in the Afghan capital, Kabul.
Najibullah said he first noticed a mark on his daughter’s face two months ago. “It was a very small dot but it grew and grew. If it grows any more it will cover her whole face.”
Leishmaniasis isn’t a priority for the government and its aid donors, grappling with shocking rates of infant mortality, tuberculosis, malaria and trauma.
The most common form of the disease is not fatal but it causes untold misery. Victims with scarring on their faces are stigmatized: children are excluded at school and girls often won’t be able to find husbands.
Long-neglected by the rich world, the disease is attracting a bit more attention in the West, if not more funds.
Some foreign troops in Afghanistan and Iraq have also been bitten by the sandflies and have developed the disease. NATO saw about 150 cases in Afghanistan in 2005 and about 12 last year, a force spokeswoman said.
NATO camps have been fortified to try to stop the sandflies and soldiers are warned to keep sleeves rolled down, to use insect repellant and to watch for bites.
But it’s Afghanistan’s poor who are most vulnerable.
Kabul, battered and neglected for years, has the world’s worst outbreak of leishmaniasis, health experts say.
“It’s out of control, absolutely out of control,” said Reto Steiner, a medic with the German Medical Service which helps run the Kabul clinic.
“You won’t control it until the sanitation has recovered.”
The deep ulcers caused by the parasites will heal if left untreated, but that invariably involves disfigurement and can take many months. That has given rise to one of the diseases many nicknames: saldana, or one-year sore.
Though present in all Afghan cities, it is in Kabul’s crowded neighborhoods that the disease has exploded and spread to hundreds of thousands of people.
“When we have one case in a family, of course, it’s not only one case: it will be all the family and even the neighbors,” said Health Ministry official Abdullah Fahim.
The sandflies that spread the parasites are carried by animals including dogs and a species of gerbil, as well as people. The insects often breed on waste land and in rubbish.
Although they don’t fly well, the insects infest the cracks and crevices in people’s homes from where they emerge to bite exposed parts of the body — noses, chins, cheeks and hands — as people sleep, from late spring to autumn.
“It’s a disease of destruction,” said Toby Leslie, a researcher from the London School of Hygiene and Tropical Medicine. “It will thrive in post-war areas and areas where there’s poor sanitation, poor community services.”
Cutaneous leishmaniasis is not fatal although a less-common form, visceral leishmaniasis, can cause organ failure and death.
“Leishmaniasis is one of the top neglected diseases, certainly outside Africa, and it just doesn’t attract the funding that’s needed,” Leslie said.
Doctor Faquir Amin says he’s been treating leishmaniasis since the 1960s. Refugees returning from abroad are particularly susceptible as they have no resistance, he said.
“No one’s taking care of it. The people are coming, it’s crowded, the people are susceptible and the disease is increasing,” Amin said at his Kabul clinic. “It is not a killer disease but mentally people suffer. We have to deal with it.”
The sores are treated with a course of injections, or cauterized to kill the parasites. Amin’s clinic has the only laser cauterizing machine in Afghanistan. Electric cauterizing machines are also effective and much cheaper.
Prevention is also key, experts say.
Bed nets impregnated with insecticide are being distributed to stop malaria and they will also stop sandflies spreading leishmaniasis. But only a few nets are being distributed compared with the number needed.
“The ministry is battling to get funds and no one’s interested. It’s impossible to get funds,” said Health Ministry adviser Kathy Fiekert.
“This is an issue that needs to be addressed.”