A plague of parasites

Torn-off limbs, people on crutches, in wheelchairs, with eye patches. If a war doesn't kill, but maims instead, these are the images that spring to mind. And indeed, the battles that are taking place between the Levant and the Tigris have created a host of people like this, disabled by conflict.

But there are yet more facets to the destruction. The Syrian war is also making people vulnerable in quite a different way. It is weakening their immunity. Many are undernourished and surviving in conditions where hygiene is a struggle to say the least. At the same time, the war is bringing them into closer contact with the sandfly. A combination with serious implications.

The insect is finding new habitats in the ruins of the towns and villages, in the piles of rubbish left on the streets and around improvised latrines. Its population is flourishing in the fissures, fractures and toilets of a foundering civilisation. People on the run often spend in the night out in the open, or in tent camps, ensuring above-average exposure to the bug.

Infection rate soaring

The female sandfly carries a parasite that causes a skin infection very familiar to Syrians. It is known colloquially as the "Aleppo Evil", after the historic metropolis in the north of the country. The parasite feeds on the skin, leaving behind ulcerous sores. Infection rates have soared since the start of the war.

"Before the war, there were around 10,000 new cases every year in Syria," reports Kinan Hayani. The skin doctor worked at the university hospital in Aleppo until late 2011. Then he escaped. Now, the 35-year-old is an assistant doctor at the Institute for Clinical Social Medicine at the university clinic in Heidelberg. He is an expert on cutaneous leishmaniasis, the scientific name for the skin disease. Hayani is still in touch with his former colleauges in Aleppo. "In the year 2013, my former colleagues counted 23,000 new infections in the city alone and that was only in the area of Aleppo controlled by government troops," he says. Thereafter, he adds, the Assad regime forbade the leishmaniasis centre at the Aleppo clinic from publishing any statistics, "for national security reasons".

There are no longer any exact figures available, due to the confusion of the war. Hayani says that on a national level, it is thought that infection rates are "three to five times higher" than before the war. This translates to hundreds of thousands of infections since the conflict began. Hayani describes this outbreak of the disease as "horrifying", particularly as those affected are often not given proper treatment, if they receive any at all. The parasite is stopped in its tracks by a medication containing the active substance antimony, which must be injected into infected areas of the skin.

Permanently disfigured

"If leishmaniasis is untreated, the disease leaves behind ugly scars," explains the doctor from Syria. Studies show that patients left disfigured by the wounds and scars of the Aleppo Evil often suffer from depression and anxiety disorders.

The symbolism could not be more obvious. Perhaps one day in history books or art exhibitions, the image of a little girl whose nose and cheeks have been eaten away by the leishmaniasis parasite will represent one of the many grotesque legacies of the Syrian war. The bug that spreads when civilisation implodes, when co-operation and understanding between peoples fails: this topos emerged in the Middle East in Biblical times. And now it is engulfing the region yet again.

And not just this region. Of course, some of the refugees arriving in Germany are suffering from leishmaniasis. For example Khalaf Bare from Hasake, who escaped to join relatives in Germany in October 2015. The man showed his wounds on his left hand and right leg to three doctors in Lower Saxony and Bremen. They suspected that the lesions were war injuries, perhaps caused by burns. Khalaf Bare was initially given no treatment at all.

Germany is ill-prepared to deal with the matter, as demonstrated by calls to services that should actually be in the know. The relevant expert at the Bernhard Nocht Institute for Tropical Medicine in Hamburg was unable to respond to the question of how the Syrian war is affecting the incidence of leishmaniasis. He passed the call on to the Hamburg-Eppendorf University Hospital (UKE), where the query was also met with a shrug of the shoulders and even a denial that leishmaniasis cases have increased as a consequence of the war, although doctors in walk-in clinics are "occasionally seeing refugees" afflicted with the parasite.

A lack of empathy

In many places it is not the expertise that is lacking, but empathy. This is also evident from the armed forces' hospital in Hamburg. People here are only too familiar with the disease. In Afghanistan, German soldiers feared the sandfly more than the Taliban. The author of this article knows this from visits he made to the German army camp at Kunduz in the year 2006. Mosquito repellent was a key weapon of defence there. Nevertheless, several soldiers fell ill, triggered a panicked reaction. But Syrians, refugees suffering from leishmaniasis? No one is interested in that here. It's not something anyone wants to bother with.

Again, the symbolism is difficult to ignore. The indifference of leading German institutions to this issue recalls the nonchalance with which the international community has for years regarded the fighting in Syria.

The comparitively small clinic in Bassum near Bremen leads by a better example. Its department for hand and plastic surgery was the fourth port of call for Khalaf Bare in his quest for assistance. It was there that doctors listened carefully to the Syrian patient and his reports of mosquito bites and made the correct diagnosis.

Overall, professionals in Germany need to demonstrate "a little more sensitivity" on the issue, advises Kinan Hayani, the doctor from Aleppo. After all, this is about more than medicine. As the Persian poet Saadi (1210 – 1292) warned:

"The sons of Adam are limbs of each other

Having been created of one essence.

When the calamity of time affects one limb

The other limbs cannot remain at rest."

Stefan Buchen

© Qantara.de 2016

Translated from the German by Nina Coon

Stefan Buchen is a television journalist working for "Panorama" and other ARD programmes