An assessment of the social, economic and environmental challenges amongst community members with cutaneous leishmaniasis in the Northwestern Syria Conflict Zone.

Leishmaniasis has been endemic in Syria for hundreds of years. Cutaneous Leishmaniasis (CL) has become an urgent public health challenge in the conflict-affected Northwestern Syria (NWS), where there has been significant community displacement, healthcare deterioration, and environmental degradation. We investigated the socio-economic, health awareness, psychosocial, and environmental awareness of community members afflicted with CL in the Aleppo region (NWS). A questionnaire was completed in June 2024 by 320 randomly selected members of the community with active or past CL in the districts of Atareb, Daret Azza, and Afrin, including 130 internally displaced people (IDP) and 38 individuals living in camps. Focus group discussions were held with public health center staff in the same districts. Data was analyzed using Bayesian log-linear modeling and one-way ANOVA. Many respondents have good understanding about the disease, with 88.44% of respondents receiving information about CL. Despite misconceptions regarding CL transmission 28% of respondents accurately identified bites of sand flies as the main reason for infection. Sleeping indoors and conducting sand fly control were associated with a lower likelihood of past leishmaniasis. 43% of participants reported that they had to take leave from work, leading to severe financial strains exacerbated by CL treatment costs averaging $135 USD, when only 12% of participants earned more than $165 USD per month. There were many comments from respondents regarding fear and pain of multiple weekly injections around every lesion and the stigma from possessing CL associated scars. The study provides a unique and timely insight into the basis for targeted interventions aimed at improving health burden of CL for people in NWS through integrated interventions.