**1.1 Background**

Leishmaniasis is one of the most common zoonotic infectious diseases worldwide. It is ranked second in mortality and fourth in morbidity among all tropical diseases [1].

According to the species of Leishmania parasite, there are three main forms: cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL) [2]. CL is the most common form of the disease and the skin is the most affected exposed part of the body characterized with symptoms such as skin sores or skin infection, which starting with small nodules that slowly enlarge, then ulcerate, and end within approximately 1 year with a characteristic permanent, depressed and disfiguring scar (**Figure 1**) [3].

Leishmaniasis is considered as an emerging and remerging disease and a major public health problem in some regions, mainly in developing countries [4–6]. This phenomenon is attributed to environmental changes, irregular construction,

**Figure 1.** *Lesions affect exposed areas.*

human activities, accumulation of waste, and increase in the number of stray dogs in the cities. Conflict, internal displacement, poverty, and malnutrition play a role in the CL occurrence and outbreak [3].

In 2012, the WHO estimated that about 350 million of the world population were at a risk of getting one form of leishmaniasis. Majority of cases (75%) are CL and MCL. Ninety-eight countries in four continents, including Latin America, Africa, Asia, and South Europe, reported cases of the disease [7, 8].

CL is endemic in Iraq and its neighboring countries; Syria, Saudi Arabia, and Turkey [9, 10]. In these countries, Sand-fly vectors and the reservoir for leishmaniasis species; dogs, foxes, rats, jerboas, and other small mammals have been described. Conflicts, violence, civil war, terrorism, limited funding, and internal displacement are *labeled* as predisposing factors to a reemergence of *the disease* in the Middle East [8, 11]. Consequently, the incidence of CL increases and becomes a public health problem, usually affecting poorer communities [12].

The epidemic of CL might occur when large numbers of nonimmune humans become exposed to infection for the first time. Travels from nonendemic areas to endemic areas during activities such as wars, military exercises, civilian works, and tourism may result in outbreak of the disease in certain populations [13].

In endemic areas, building mud houses near the natural habitats of the vector and the reservoir hosts increases human–sand fly contact and thus increases the risk for human Leishmaniasis [14].
