Inside a dank clinic in the north of war-torn Syria, a girl covered in scabs wails and tries to wriggle out of her mother’s arms to escape a nurse’s needle.
Gently holding fluffy cotton wool over her eyes, the male health worker injects a transparent liquid into the crusty blemishes on the tip of her nose.
She is one of hundreds in the northern province of Raqa to be suffering from leishmaniasis, a skin disease caused by a microscopic parasite spread by sandflies.
The illness is endemic to Syria, the World Health Organisation (WHO) says, but has become more prevalent during the eight-year civil war.
Dozens of children and adults are seeking treatment between the damp-smelling walls of the health centre in the northern town of Karama.
Among them, 15-year-old Shaza Al-Omar awaits her turn.
“I’ve got some on my leg, my sister’s got 11 lesions on her face, and my brother has some on his eye,” says the teenager, draped from head to toe in black.
Not far off, a father tries in vain to pacify his toddler daughter, who screams as the nurse injects solution into lesions on her face.
Once it is over, he carries her out of the clinic clutching a large packet of potato crisps.
A woman sits on a stretcher, an ailing leg stretched out in front on her, as a nurse injects medicine into one blemish after another.
The number of leishmaniasis cases in Syria doubled from 2010 to 2018 to more than 80,000 patients, WHO says.
Many were in northern and northeastern areas rocked in recent years by clashes to expel the Daesh group.
At the health centre in Karama, Wadha al-Jarrad, 55, has rushed in to ask about treatment for her family -- her grandchildren, her daughter-in-law, and even her elderly husband.
“He’s always scratching it until it bleeds,” she says of her husband’s sore on his hand.
“He itches it, and I tell him not to,” says Jarrad, a black and white scarf wrapped around her greying hair.
“We can’t sleep at night because of all the flies,” she adds.
Leishmaniasis is usually linked to poverty, poor sanitation, and malnutrition, WHO says, factors likely compounded by the war.
Agence France-Presse