MSF calls for sustainable access to treatment for cutaneous leishmaniasis in Pakistan

ISLAMABAD: On World Neglected Tropical Diseases (NTDs) Day, international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF) has urged the government, donors, and international partners to urgently strengthen funding, procurement, and supply systems to ensure uninterrupted and sustainable access to meglumine antimoniate, the first-line treatment for cutaneous leishmaniasis (CL) in Pakistan.

Cutaneous leishmaniasis remains a significant yet neglected public health burden in the country. An estimated 600,000 to one million new CL cases occur globally each year, according to the World Health Organization (WHO), though only around 200,000 cases are reported. In 2023, approximately 91 per cent of reported cases came from just eleven countries, including Pakistan, which recorded an estimated 59,255 cases — with the actual number likely to be much higher. Despite the high disease burden, access to timely and effective treatment remains limited.

“Meglumine is one of the most efficient treatments against CL; however, it is not produced in Pakistan. Its supply largely depends on imports, which often arrive irregularly and in insufficient quantities,” said Dr Abdulwahab Mohamed, MSF Medical Coordinator in Pakistan. “Since the COVID-19 pandemic, supply disruptions have become more frequent, making sustainable care a serious challenge. Government facilities often run out of stock before replacements arrive, putting patients at risk of delayed or missed treatment,” the MSF said.

For patients like Tahir Zaman, a 42-year-old from Karak, a city over 131 km from Peshawar in Khyber Pakhtunkhwa (KP), access to proper treatment has meant long journeys and months of suffering. Eight members of his family have been affected by CL.

“In our area, this is a serious problem,” he said. “We understand that CL is not life-threatening, but it still causes great difficulty, mainly because treatment is not available nearby. Many times, people waste months visiting different doctors without healing. For example, my mother and elder brother spent six to seven months receiving spray treatment in Karak, but instead of improving, their condition worsened. Finally, we brought them to Peshawar to start proper treatment.”

Commonly known as Saldana or Kaldana in Urdu, CL is the most prevalent form of leishmaniasis. It causes skin lesions and often ulcers on exposed parts of the body. While not life-threatening, the disease can result in severe scarring and disfigurement, leading to stigma, discrimination, and long-term psychological distress.

“Even when meglumine antimoniate is registered, it is rarely available in public health facilities,” said Dr Mohamed. “This forces vulnerable patients from remote areas to seek care at MSF clinics when possible, or at private facilities where treatment is often unaffordable. Combined with a shortage of trained clinicians and rising CL cases in endemic areas, this puts immense pressure on already limited supplies and delays timely care.”

Limited awareness of CL, combined with unregulated or ineffective treatments, often worsens patients’ conditions. This can lead to enlarged lesions, bigger scars, greater disfigurement, and increased social isolation. Ineffective treatments may also contribute to treatment failures or drug resistance, prolonging suffering, particularly among rural and low-income communities.

“CL is a disease of neglect, one that disproportionately affects the poorest and most remote communities,” added Dr Mohamed. “Ensuring sustainable access to effective treatment is essential to reduce suffering, prevent disability, and support those affected to live a dignified life.”

Eighteen-year-old Mudasir Ahmad, from the Tirah Valley in Khyber district, KP, is receiving care from the MSF CL centre at Government Naseer Ullah Khan Babar Memorial Hospital in Peshawar.

“I would urge that treatment for this disease be made as common and accessible as treatment for any other disease, so people do not have to travel to specific locations to receive care,” he said. “It is also important to educate people so they can take precautionary measures and, if infected, seek timely treatment instead of going to places where care does not meet their actual needs.”

Besides access to meglumine antimoniate, there is an urgent need for sustained political commitment, strengthened surveillance, and community-based interventions that can reduce transmission, prevent disfigurement, and support affected individuals, particularly children and young people in endemic settings like Pakistan.

MSF has been providing CL diagnosis and treatment services in Pakistan since 2008. Beyond service delivery, MSF is exploring alternative treatment options and supporting research on CL drugs in collaboration with the University of Peshawar in KP, alongside clinical trials in Quetta, Balochistan.