"It's a nightmare," says Paula Gino of Tiberias, pointing to the large sore on her cheek, resulting from leishmaniasis, a disease known as "the Lily of Jericho." Caused by the leishmania parasite, the disease has been diagnosed over the past year in 95 Israelis, 24 of them Tiberias residents.
Gino and a group of 19 other victims are suing the Tiberias municipality and the Health Ministry for negligence, claiming that they did not deal to eradicate the sources of the disease.
The number of people suffering from Leishmaniasis rose by 150 percent in 2003 compared to the previous year. The most dramatic rise was in Tiberias, where the Health Ministry registered 44 cases in the past five years. Ha'emek Hospital in Afula reported 40 cases since September 2002 - 10 times more than in the previous three and a half years.
Leishmaniasis of the skin, unlike other forms of the disease, causes large wounds that heal eventually, but leave a scar. The leishmania parasite's larvae live in the sand fly's saliva. When the sand fly bites a domestic animal or person in order to extract blood, the parasite in its saliva enters the skin. A few weeks later the wound develops.
Since the sand fly is a low-flying insect, many leishmaniasis victims are children, who get bitten in the face; adults usually are affected in their lower exposed limbs, particularly their legs.
Leishmaniasis, which affects millions of people worldwide, was once prevalent in the Arava, the Dead Sea area and the Jordan Valley - hence its name: the Lily of Jericho. No inoculation for it has yet been found, but it can be treated with medication. However, the "northern" variety of the parasite, which has caused the disease in Tiberias, is more resistant to treatment than its "southern" relative. Most cases in Tiberias did not respond to treatment by ointment rubbed on the infected area. Other treatment involves injections into the wound, or into the vein.
Following the significant rise in the number of patients with the disease in Tiberias, experts began looking into its causes. "The primary suspect in Tiberias is the hyrax, a small, rodent-like mammal living in Africa and the Middle East - although leishmania-carrying hyraxes have so far been discovered only north of the Kinneret and not in Tiberias," says Dr. Alon Varbourg of the parasitology department in Hebrew University's medical school.
Dr. Ayelet Shani-Adir, a children's dermatologist who is coordinating treatment of Lily of Jericho cases in Ha'emek Hospital, says a "lack of balance in nature" caused the increase in them.
Dr. Gad Benat of Beit Dagan's veterinarian hospital explains: "The disease may break out in areas where new neighborhoods are being built. Large rocks are moved and such circumstances bring the hyraxes close to human beings."
Indeed, people with the disease who are living near open areas have been discovered in Jerusalem, Maccabim-Reut and Tel Aviv.
"Near my house was an open sewer that flowed for a long time. There were mosquitoes and rats there, perhaps that's how I got it," says Gino, who has been suffering from the disease for two years and is certain who the culprits are. "The Health Ministry and municipality knew of the danger and did nothing about it. They could have at least warned us ... Only after attorney Limor Hochfeld-Morad warned the municipality, did they fix the malfunction."
Now Hochfeld-Morad is preparing a negligence suit against the city and Health Ministry in the name of the 20 suffering Tiberians. "They knew of the eruption of the disease from 2000," she says. "I warned the city of the disease breaking out in November 2002, and no one paid any attention to me. Only in April 2003 did they begin to act - probably after public pressure."
She adds that the authorities should have handled the matter completely differently. "The Health Ministry and Tiberias municipality should have announced the [location of] the problematic areas at an early stage, and at the same time warn of the disease and spray the sand fly with pesticide."
Hochfeld-Morad's clients, she says, "especially the children, are undergoing very difficult treatment, sometimes accompanied by painful injections requiring complete anaesthesia."
"I was ashamed to go out," says Gino. "When people saw me they asked what I had on my face. People who passed me by in the street stared at me. It's a scar that could stay for life."
The Health Ministry commented that over the past year, it has taken intensive measures to contain the disease in the Tiberias area. After an epidemiological survey and analysis, a steering team was set up in the ministry's northern district to supervise these preventive steps, which included spraying in areas where the disease was detected, informing residents and doctors about the disease, and building a canvas fence soaked with pesticide around the infected quarters.