There is no one single aid organization providing relief in Syria or in refugee camps in bordering countries. Medical supplies for Syrians suffering from leishmaniasis both inside and outside the country come from a patchwork of local aid organizations, private donors, and international aid organizations like the WHO and UNHCR -- all of which struggle to get medicine to those in Syria who are in need.
In past years, Save the Children has teamed up with the WHO to spray chemicals in sand-fly breeding grounds, thereby reducing the chances of a leishmaniasis outbreak. But this year, according to Crago, preventive spraying was disrupted by the fighting. As a result, he expects the disease to spread more quickly than in previous years.
The lack of medical supplies and preventive spraying isn't the only obstacle to containing leishmaniasis. Poor education about what causes the Aleppo boil -- and how to treat it -- means that many children continue to suffer unnecessary pain and disfigurement. "Do you see what is happening to my child? Just look at this. It is because of that dirty water," one middle-aged woman told me as she pointed to a stream of garbage flowing between tents.
Most mothers in Bab al-Salam whose children had visible sores thought they were caused by poor camp conditions. Doctors with MRFS seemed to shrug off the disease -- and the refugees' ignorance of how it spreads.
"They always say it is from the water. They don't understand they probably got the disease before they came here," said one doctor. "I am not as worried about the leishmaniasis as I am about the possible cholera outbreak. The summer months are coming."
According to Peter Hotez, a professor of molecular virology and microbiology at Baylor College of Medicine and founding dean of its National School of Tropical Medicine, lack of preventive medicine -- like nets and spraying for sand flies -- is the main driver of leishmaniasis infections in Syria. As a result, Hotez and his team are working to develop a vaccine that prevents the ulcers from forming -- though it is still in early, pre-clinical stages.*
Treatment with sodium stibogluconate, moreover, "requires intramuscular injections" and prolonged treatment by specialized doctors, according to Hotez -- an unrealistic scenario for victims of the disease still living in war-torn areas.
Another force propelling Syria toward a devastating outbreak is the rapid deterioration of sanitary conditions within the country. Trash pickup is virtually nonexistent, and in many cities garbage has begun to collect in the streets. In places like Aleppo and the suburbs surrounding Damascus where the fighting is at its worst, there is no electricity or running water. The subsequent buildup of sewage in the streets -- combined with Syria's extreme heat -- attracts the sand flies that carry leishmaniasis, according to Crago.
"Syria has been teetering on a leishmaniasis outbreak for a while," Hotez said. "It makes sense. Anytime a war like this starts, the chances of outbreak increase."
*Correction: A previous version of this article incorrectly stated that a vaccine for Leishmaniasis won't be available for distribution for another three years. In fact, the vaccine is still in early, pre-clinical stages, so it's difficult to say how long until it reaches the market. FP regrets the error.