Leishmaniasis Ruins Afghan Women’s Lives

Sitting in the government-run Leishmaniasis Treatment Centre in Khost, 22-year-old Rahima covered her hand with her scarf.

She said that she was sick of being stared at and insulted because of the open sore on her hand, a sign of leishmaniosis infection.

“I have hidden my hand because people are horrible to me,” Rahima said, explaining that she was poor and lived in a village.

She knew little about leishmaniasis apart from the fact that it was transmitted to human beings by a kind of fly.

 “In the past, medicine and mosquito nets were distributed free by government and some organisations, but now we have to pay for them,” Rahima continued. ”I come from a big family and when we tell our men that we need mosquito nets, they say that we don’t have money because every mosquito net costs 10 dollars.”

Leishmaniasis is a parasitic disease tramsitted by sandflies. Its cutaneous form results in a rash that turns into a painful ulcer. Even after this sore heals, whch usually takes between a few months to a year and-a-half, it leaves an ugly scar.

If left untreated, certain forms of the disease lead to prolonged fever and weakness. More serious visceral leishmaniasis, also known as kala azar, is almost always fatal.

Mohammad Gulab Mangal, head of the Leishmaniasis Treatment Centre, said that incidences of the disease were growing in the southeastern province. The sandflies that carry the disease mainly live in the cracks of walls and barns, and treated mosquito nets were an important part of preventing its spread. This also meant that women were more vulnerable to infection, Mangal continued.

 “Most of our patients are women because men don’t value women very much, they don’t buy them mosquito nets, and another reason is that women mostly work where Leishmania flies live,” he said. “For example, women clean houses, barns and ruined buildings where the flies bite them.”

Shapeary, a woman receiving treatment at the centre, agreed.

“Men don’t listen to us,” she told IWPR. “They themselves use mosquito nets, but when we ask them to bring mosquito nets for us from the city, they don’t accept our requests. They don’t value our rights and we spend the whole summer without mosquito nets.”

Shapeary added that most people were ill-informed about the disease, assuming that it was transmitted by contact with an infected person.

“But doctors have told me that this disease is transmitted to a human being by a fly. If people knew this, they wouldn’t hate an infected person so much and wouldn’t laugh at him or her.”

Mangal said that public awareness was indeed vital and that they had made great efforts to spread information on the disease via the media. Progress was still slow, especially when it came to practical resources.

“We don’t have the resources to buy mosquito nets for all the residents of Khost. The population of Khost has been estimated at around 160,000. If we provide a mosquito net for every two persons, we have to distribute 80,000 nets. So we don’t have the ability to do so unless international organisations help us.”

Officials at Khost’s department of health said that they were also concerned about the spread of leishmaniasis in the province.

Gul Ahmad Shah Lakanwal, head of the department for infectious disease control, said that the ministry wanted international support to distribute leishmaniasis medicine in all Khost’s district health clinics as well as to hire more personnel.

 “We have a plan to distribute 110,000 mosquito nets to prevent leishmaniasis and malaria,” he said, adding that Kabul also needed to address the local health department’s lack of both medicine and staff.

Even the less serious cutaneous form of the disease can have severe social effects.

In Pashtun society, people often taunt each other and laugh at shortcomings and flaws. This is especially prevalent among women, and those who bear the marks of leishmaniasis on their faces and hands usually avoid participating in communal life.

 “After leishmaniasis appeared on my face, I went to a relative’s wedding,” said Sabria, another treatment centre patient. “There, I saw that women were looking at me and then laughing with each other. I was really embarrassed, and have not been to any ceremony since then.”

The stigma can be long lasting and have a devastating effect on a young woman’s future.

Women’s affairs activist Kamila Akbari said, “I know that some beautiful girls with the signs or scars of leishmaniasis who have never been able to get married.”

Even Akbari said that she could herself understand this reluctance to marry someone disfigured by the disease.

 “I also want my son to marry,” she continued. “But for sure, I will avoid letting him get engaged to a girl marked by leishmaniasis on her face or hands.”

This report was produced under IWPR’s Promoting Human Rights and Good Governance in Afghanistan initiative, funded by the European Union Delegation to Afghanistan.