EASTERN TURKEY–With nearly 600 confirmed cases of “Baghdad Boil” among U.S. troops, medical experts are wondering what can done to contain the disease. Military forecasts only a few weeks ago said there wouldn’t be more than 400 cases by the end of April. So what is going wrong? The military cannot claim that it is a new problem; after all, during Operation Desert Storm to liberate Kuwait in 1991 there were 34 cases of Baghdad Boil, more correctly known as Leishmaniasis.
Medical experts within the military claim they knew about the problem. But does that mean it was always inevitable that there would be thousands of cases? Well, no. There were bound to be some, perhaps even a few hundred cases, but according to informed sources, the military have been incompetent and astonishingly unprepared, which is why we will probably see thousands of cases within months.
First, approximately 85 percent of U.S. soldiers sent to Iraq were not issued with proper bed nets and mosquito repellent, says a senior U.S. military medical expert. “It is understandable that these items are not top of any soldier’s equipment list, but 85-percent failure rate is ridiculously high,” he says. And not all the bed nets deployed by U.S. and other allied forces are adequate. Bed nets must have a very fine mesh, at least 18 holes per square inch, otherwise the tiny sand fly can penetrate and go about its ghastly business of extracting a blood meal and laying its eggs in human skin.
Second, insecticide choices are not determined solely on medical grounds, but partly to appease largely false green concerns about impacts on wildlife. The military should impregnate all equipment with the best insecticides, including DDT. Indeed, the expert entomologist in Iraq I spoke with would love to use DDT but he cannot since its not available due to the U.S. government ban on it. Although this is annoying, the entomologists’ largest frustration is that in some instances requests for insecticides last summer went unanswered for many months.
Third, it is vital that more is done to educate the soldiers themselves about what they can do to prevent being bitten. According to one medical entomologist, “we started seeing soldiers basically eaten alive, 1,000 bites a night in a handful of cases.”
You may think that a soldier bitten a thousand times in one night must be stupid, surely all he has to do is wear long sleeve clothes and apply a bit of repellent (assuming his unit has a supply). But it was incredibly hot in the desert last summer and most soldiers slept in shorts and nothing else, with their tent flaps wide open to keep the air flowing. Even when they applied repellent, by the middle of the night they had sweated most of it off and the flies bit incessantly.
One solution is mobile air-conditioning units, which keeps the troops cool enough so they can shut the flaps on the tents and sleep in more than just shorts. Where these tents have been used biting rates and infections fell massively. And it’s essential they are in some locations, such as Nasiriyah, because some 10-15 percent of troops in a few small units are coming down with the infection–compromising their military potency.
So while vigilance and education of troops of the dangers of the tiny sand flies is crucial, we have to make it easier for the troops to help themselves. Their officers need to make sure they wear the appropriate clothing, the uniforms should be impregnated with insecticides that work, and more AC units need to be supplied.
More broadly a massive spray program using insecticides should be undertaken of the areas where the sand flies are most likely to carry the Leishmaniasis parasite. This would lower the incidence of bites, and hence disease, not just of the military, but of the children of Iraq, who are most likely to die from the nastier form of the disease.
Prevention beats treatment
Its vital the disease is prevented because treating the disease, as Private Zachary Lasiter of the 4th ID is finding out, is not only painful, but even after recovering from the disease there are long-term nasty effects. Private Lasiter says that the treatment is “strong enough to kill everything but you.” Although, according to recent news reports, he is recovering well at home in Alaska, he has apparently lost 20 pounds and has developed asthma–perhaps a side effect of the drugs or the disease.
Private Lasiter, like many servicemen, thinks the official figures under-represent the number of Leishmaniasis cases. The consensus among troops is that there already could be thousands of cases. They are not accusing their bosses of a cover-up, just that people may be sicker than is currently reported.
It remains to be seen how widespread Baghdad Boil will become, but at a time when suicide bombers, random shootings, and other problems are confronting our military, surely helping the servicemen from becoming Leishamaniasis victims will save money and ensure our best troops can do their job. After all, every single confirmed case has to be sent to America for treatment, none are treated on the ground in Iraq because there are no drugs there.
For those people who return home, the dangers of visceral Leishmanisais remain. In Desert Storm over a third of the cases were visceral, with organ damage occurring in a few cases. The danger is that the visceral Leishmaniasis patients take longer to exhibit symptoms. So far none of the 600 cases have been visceral (although some sand flies collected and tested are carrying the more dangerous visceral parasite). This might be because in Desert Storm most of the troops were stationed in Saudi Arabia, where visceral Leishmaniasis is more common, but it may also be that the soldier’s immune systems are fighting off the disease at the moment. But that may not last long because the parasite can survive in the body for years, and may start damaging the organs of soldiers’ years from now.
Vigilance is required for returning troops, they deserve better than waiting and hoping they do not develop a potentially fatal disease, when with better thought and preparation by the military this would be a minor concern rather than an increasingly dangerous situation.
–Dr. Roger Bate is a fellow of the American Enterprise Institute and a director of health-advocacy group Africa Fighting Malaria.