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I am a medical student, resident in Mashad, with access to the Iranian Ministry of Health and the Ministry of Environmental Protection. Given the poor state of the health services in my country, I am sending the following for your information, which I believe should be publicised. I am doing this out of concern for the Iranian public's welfare.
The Salak disease, known by its medical term as leishmaniasis, has reached epidemic proportions in Iran. The disease strikes mostly children, youth and young people between the ages of 20-30. It is a serious source of concern among the population and Iranian and international health authorities.
Sources close to the Iranian Ministry of Health and the Ministry for Environmental Protection have reported a sharp increase in the number of patients who contracted this disease recently. Some of the patients showed severe complications and symptoms which have up to now been unknown in Iran.
Reports have arrived from clinics throughout Iran and elements in charge of public health in cities like Mashhad, Isfahan, Tehran, Tabriz, Birjand, Zabol, Shiraz – mainly in the suburban areas, as well as towns and rural areas such as Zavoreh, Ardestan, Naser Abad,Sarakhs, Yazdan, Taherabad, Meshkin Shahr, Sanandaj, Ilam and others.
Salak was known and widespread in Iran in the 19th century. The prevalent type attacks mainly the facial skin and is known as cutaneous Leishmaniasis (CL). The disease leaves deep lesions which cannot be cured even with plastic surgery. This has serious implications both for the body and social status of the individual.
As a result of the social-environmental (ecological) and epidemological changes in Iran, the number of cases of Leishmania have increased and the chances of curbing the disease are currently very slim. Salak (CL) is caused by the Leishmania parasite. It is transferred to humans from animals such as mice, dogs, foxes and jackals by a bite from the mosquito-like sand fly, mainly in the spring and summer months, at twilight and during the night.
The disease is caused by L.major and L.tropica parasites. In the first stage the bite is not felt and there is slight swelling under the skin. This develops gradually to a chronic ceration which discharges pus in the area of the fly bite. The disease lingers on from several months to years. When the sores heal they leave deep scars which disfigure the facial skin leaving an ugly appearance. This has a negative social and psychological effect on children,youth and especially women.
In addition to this type of disease, there has been a prominent rise recently in the rate of patients suffering from a disease which was up to now unknown in the country. Kala-Azar, or visceral Leishmania (VL) is a dangerous disease with a mortality rate greater than 90 percent. It is caused by a parasite called L.Donovani. The parasite penetrates through the point of contact (fly bite) into the bloodstream,liver, spleen, bone marrow and lymph gland.
There has been a sharp rise in the number of victims of this type of disease in the Northwest region of Iran, including Sardasht and Eslam Abad-e-Gharb. This has raised doubts whether there are additional factors increasing the danger of contracting the VL type of Leishmania, such as the low level of immunization or the complete failure at the immunization level among aids ufferers.
It is known that the number of people suffering from this disease in Iran has risen recently, especially in the border regions, but in the major cities as well. For this reason, and according to these data, medical elements assess that Iran could become the center for the spread of Leishmania of the types described above.
Senior public officials are currently blaming the government for these troubling data. They claim that methods used by public health authorities to contend with the disease are outdated. These involve the use of spray containing very toxic pesticides that adversely affect patients or drive away the sand fly to other areas that have not yet been infected by the disease. The disease is therefore spreading quickly throughout Iran and even across its borders.
The Iranian Ministry of Health's attempts to use toxic materials to disinfect contaminated animals are also ineffective. In most cases, they cause serious damage to the environment and to domestic wild animals.
The absence of minimal sanitary conditions, rinking water pollution, eradication of forests and the lack of medical know-how and professional experience to handle the sick scientifically, alongside poor socio-economic conditions of those stricken with the disease are factors which accelerate the spread of the disease. This subject has risen to the public agenda and is accompanied by penetrating criticism of the government.
This is due to the absence of the allocation of financial and social resources to solve the serious medical problem that is endangering the health of the Iranian public and could give it a bad name among countries on the other side of the border.