Islamabad, Pakistan: On World Neglected Tropical Diseases (NTDs) Day, international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF) is calling on 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 of cases likely to be much higher. Despite the high disease burden, access to timely and effective treatment remains limited.
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 a life-threatening disease, 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 patients in vulnerable conditions from far-flung 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,” he added.
Limited awareness of CL, combined with unregulated or ineffective treatments, often worsens patients’ conditions, leading to enlarged lesions that result in bigger scars, greater disfigurement, and increased social isolation and stigmatization. Ineffective treatments may also cause treatment failures or drug resistance, further prolonging suffering, particularly among rural and low-income communities, where the disease is most prevalent.
“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 assist those who are affected by the disease 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.
He added that it is also important to educate people about this disease so they can take precautionary measures and, if infected, seek timely treatment instead of going to places where the treatment does not meet their actual needs.
Besides access to meglumine, there is an urgent need for sustained political commitment, strengthened surveillance, and community-based interventions that can reduce transmission, prevent disfigurement, and assist the affected individuals to live a dignified life, 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. MSF is also investing in capacity building, providing targeted training to Ministry of Health staff and other healthcare actors to improve diagnosis, treatment quality, and long-term sustainability for CL. In 2025, MSF screened over 11,000 patients for CL across its facilities, with over 7,000 patients starting treatment in KP and Balochistan.
Currently, MSF operates six CL centres in collaboration with [local] health authorities. Three are in Quetta district of Balochistan: Kuchlak Health Centre, Mohtarma Shaheed Benazir Bhutto General Hospital, and Bolan Medical Complex Hospital. Three are in Khyber Pakhtunkhwa: Government Naseer Ullah Khan Babar Memorial Hospital in Peshawar, Khalifa Gul Nawaz Teaching Hospital in Bannu, and Dogra Hospital in Bara, Khyber district.
