Acute Skin Disease Striking Children in Northern West Bank Settlements

The disease is carried by hyraxes; many residents blame separation barrier for attracting them.

Rock hyraxes near Sea of Galilee, April 9, 2016.
Gil Eliahu

In the West Bank settlement of Tzofim, residents hesitate to let their children out to play these days. “We’re in a ghetto inside our houses, thinking twice before venturing outside, avoiding inviting guests,” says Liat Cento, whose children, ages two and three, were both recently infected with cutaneous leishmaniasis, an acute, scarring skin disease that mainly affects children. It is popularly known in Hebrew as the “Jericho Rose.”

At least 56 cases were reported in this one settlement. It is estimated that actual numbers are even higher. Many of the victims live in the southerly neighborhood, near the separation barrier, which is often blamed by residents for attracting the hyraxes that carry the disease.

“In almost every house in this neighborhood there’s at least one person who’s been affected. In some families, three or four members have contracted the parasite,” says Dr. Gabriel Schwartz, the Samaria Regional Council’s veterinarian, in an interview with Haaretz.

The first case was registered in the settlement of Peduel almost a decade ago. The infection then moved to Elkana and is now well-established in Tzofim. “These are the three settlements with the highest numbers of victims,” says Schwartz. “There are affected people in Avnei Hefetz, Etz Efraim, Bruchim and other settlements as well. It’s spreading westwards towards Oranit and Rosh Ha’ayin, as well as to the Neve Yaakov and Pisgat Zeev neighborhoods of Jerusalem.”

The leishmania parasite affecting West Bank residents, similarly to residents in the northern Sea of Galilee area, is the Leishmania tropica, which is one of the two types known in Israel, along with Leishmania major which is found mainly in the south. Hundreds of cases are reported each year across the country, with the parasite originating in hyraxes and transmitted by the female sand fly.

“Leishmania tropica is a virulent type of skin disease. It doesn’t affect internal organs but it’s a very bothersome disease, more resistant than Leishmania major,” explains Dr. Michal Salomon, a senior dermatologist and expert on leishmania at the dermatology department at Sheba Medical Center, Tel Hashomer.

“One of the main problems is that the disease affects mainly children, since the flies fly low. The disease often leaves a prominent aesthetic defect.” She says that it’s very difficult to treat children who’ve been affected by Leishmania tropica. “There is some topical treatment but it’s usually ineffective against the tropica strain. This requires treatment by injections which are very painful. For small children it’s done under anaesthesia. When this doesn’t help or when large skin areas are affected we give intravenous treatment,” she adds.

'Treatments very hard on you'

According to the affected Tzofim resident, “The treatments are very hard on you. Their side effects resemble those of chemotherapy. This includes nausea, vomiting, weakness and more.” The treatment takes several months, sometimes involving difficult procedures. This can include direct injection into affected areas, taking antibiotics and more. The treatment is not recognized by the National Insurance Institute so affected people receive no financial support from the state.

Salomon says the number of cases is constantly increasing. “The number of cases we’re treating has increased 10-fold in a decade. We have a lot of experience and many Samaria residents come to us, from Elkana, Alei Zahav, Tzofim, Beit Arieh and others.”

According to the Health Ministry, there has been a dramatic uptick in the incidence of cutaneous leishmaniasis in recent years with its appearance in new areas. Between 2003 and 2014 the incidence has surged from 1.3 to 4.2 cases per 100,000 people.

Tip of the iceberg

However, according to Schwartz and other sources, the numbers reported to the Health Ministry are only the tip of the iceberg. “Some people don’t bother going to a doctor. There is also under-reporting by doctors, with doctors who are supposed to submit this information not doing so. Some affected people receive treatment in their community clinics, with only cases that develop complications ending up in hospitals,” says Schwartz.

Salomon participates in evenings devoted to dissemination of information regarding protection and ways of reducing the chance of contracting the disease in communities in which the incidence has grown.

In addition, steps are being taken to reduce the presence of hyraxes, the carriers of the disease, such as the erection of fences and treatment of rock gardens where they live. According to Schwartz, the factor leading to the recurrence of the disease in these communities is construction work and expansion of infrastructure, which spans areas inhabited by hyraxes.

In 2012, the government allocated 10 million shekels ($2.6 million) for research and the development of solutions. This effort was spearheaded by a steering committee including officials from the Health Ministry, the Ministry for Environmental Protection and the Nature and Parks Authority. “Research was done and field trials were conducted, but the budget ran out and we’ve been waiting for a year and a half to receive recommendations. Unofficial results showed that when a population of hyraxes is removed or culled there is a drop in the incidence of the disease. The next phase is to implement solutions in the field.”

This isn’t happening, and the number of affected people is rising. According to Yossi Dagan, head of the Samaria Regional Council, in Tzofim there are entire streets whose inhabitants have been affected. “It’s unacceptable that the most basic area of public health has been abandoned. This isn’t a decree of fate. This is a result of government agency decisions. The relevant ministries must transfer the funds required to combat this scourge. All the agencies involved are aware of the source of the problem – the separation barrier built by the Defense Ministry has created new habitats for hyraxes which carry the disease.”