Recent conflicts in Egypt, Iraq, Libya, Pakistan, Syria, Tunisia, Yemen, and elsewhere in the Middle East may have sufficiently destabilised national and international public health control measures to a point where several tropical diseases have either emerged and are sickening large populations in the region.
The most dramatic example is currently happening in Syria, where cutaneous leishmaniasis, a disfiguring parasitic skin disease transmitted by sandflies and also known as “Aleppo Evil”, is now affecting tens of thousands of innocent civilians both within the country and among refugees fleeing across the border to Lebanon or Turkey. But this disease is also flourishing in Afghanistan, Algeria, and Iraq where breakdowns in public health have allowed sandflies to breed and transmit disease.
Several mosquito-transmitted virus infections have also become important public health problems in the region. According to recent estimates 6 million cases of dengue fever occurred in Egypt in 2010 – more than 7 percent of that country’s population, while almost 14 million cases occurred that year in Pakistan. Dengue has also emerged in Saudi Arabia, Syria, and Yemen, while in both Saudi Arabia and Yemen, Rift valley fever has also appeared – the first time this mosquito-transmitted viral infection has been seen outside of Africa. There is concern that such viral infections could affect pilgrims entering Saudi Arabia during the Hajj this coming fall, as could the new MERS coronavirus, or the recently discovered Alkhurma hemorrhagic virus. Both viruses were first discovered in Saudi Arabia.
Newly released information reveals that fewer children in the World Health Organisations’s Eastern Mediterranean Region (which includes the Middle East but also Sudan and Pakistan) receive regular deworming medicine to treat intestinal parasitic worm infections than any other. Overall, just over 5 percent of the roughly 80 million children who should receive regular deworming are actually treated, including less than 1 percent of school-aged children. In contrast approximately 30 percent of children in developing countries who require deworming globally receive annual medication. Even in n Sub-Saharan Africa almost one-quarter of those children get dewormed. The Middle East also appears to be doing poorly in terms of providing access to treatments of other neglected tropical diseases.
One of the most important social determinants of neglected tropical diseases is extreme poverty. Of the almost 400 million people that live in the Middle East and North African region approximately 65 million people (17 percent) live on less than $2 per day. But even considering this important level of poverty the Middle East sadly appears to be punching below its weight when it comes to controlling its tropical diseases.
So what’s going on? In many cases widespread conflict, together with its fellow travellers including destabilised communities, human migrations, and collapse of public health infrastructure work together with poverty to promote the emergence of tropical diseases. Breakdowns in animal control and veterinary public health infrastructure also contribute to the emergence of tropical infections transmitted from animals such as brucellosis and rabies. The recent finding of MERS coronavirus possibly being spread from camels could also be relevant to this observation.
We need to act soon in order to prevent the further spread and emergence of neglected tropical diseases in the Middle East. Certainly, United Nations agencies, especially the WHO have a key role to play in terms of convening health ministers from the region and implementing meaningful disease control measures that include mass treatments for intestinal worm infections, animal control, and vector control for disease-transmitting mosquitoes and sandflies. The newly launched US State Department Office of Global Health Diplomacy should also be mobilised in order to identify how the United States Government, possibly in partnership with research universities and institutes could provide important technical assistance for disease control and elimination, but also to promote international and diplomatic cooperation across the region for this purpose. Some of the wealthier Middle Eastern countries, such as Kuwait, Qatar, Saudi Arabia, and United Arab Emirates have important responsibilities both in terms of providing technical assistance and financial support for such efforts.
Global action is needed now in order to better contain emerging tropical diseases affecting the Middle East and North Africa. Further delays could have permanent and long-lasting destabilizing consequences for this already volatile region.
Peter Hotez, MD, PhD, is Dean, National School of Tropical Medicine at Baylor College of Medicine, President, Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, and Fellow in Disease and Poverty, James A. Baker III Institute for Public Policy at Rice University. He is the author of Forgotten People, Forgotten Diseases (ASM Press), Second Edition.
Follow him Twitter: @PeterHotez