Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak

Abstract

Background: Leishmaniasis is a neglected tropical disease, endemic in many worldwide foci including the Middle East. Several outbreaks have occurred in the Middle East over the past decades, mostly related to war-associated population migration. With the start of the Syrian war, the frequency and magnitude of these outbreaks increased alarmingly. We describe the epidemiology of Leishmania infection in Lebanon and the most recent outbreak relevant to the Syrian war. Methods: We reviewed all leishmaniasis cases reported to the Epidemiologic Surveillance Department at the Lebanese Ministry of Public Health between 2001 and the first quarter of 2014. The demographics and distribution of Syrian refugees in Lebanon were linked to reports of new Leishmania cases. Results: In total, 1033 new cases of leishmaniasis were reported in 2013 compared to a previous annual number in the range of 0–6 cases. The majority of cases reported in 2013 involved Syrian refugees and their relevant areas of concentration. Conclusions: This new outbreak of leishmaniasis in Lebanon is the first of its kind for more than a decade. The sudden increase in Leishmania cases in Lebanon in 2013 is attributed to the increasing numbers and wide distribution of Syrian refugees in Lebanon. This serves as an example of the risks associated with military conflicts and the ability of communicable diseases to cross borders.

Keywords

• Leishmania
• Middle East
• Lebanon
• Cutaneous leishmaniasis
• Visceral leishmaniasis