Cutaneous leishmaniasis, caused by a parasite spread by biting sand flies, has been diagnosed in more than 150 US military personnel in Iraq so far. It causes ugly ulcerated skin lesions which may take months to heal and can only be treated by 10-20 days of a 50-year old unapproved drug that can be administered only intravenously and which is toxic to the liver and pancreas. So far the life-threatening visceral form of leishmaniasis, in which the parasites infest the internal organs rather than the skin, has not been seen. The invasion of Iraq began during the hot season when the sand flies start biting, in contrast to the 1991 Gulf War conducted in the colder season and in which very few contracted the disease. In the current military action, many soldiers have scorned precautions, sleeping outside in their underwear because of the heat and eschewing insect repellent because the sand sticks to it. But even those who sleep under mosquito netting indoors are susceptible, because the Army’s mosquito netting has holes too large to stop the sand flies. Some GIs have presented with more than 200 bites per night. The disease has a long incubation period and hundreds of soldiers in each unit have been bitten and are in danger of developing the disease in coming months. Currently, more than 40 new cases a day are being diagnosed but we can expect that to skyrocket. Soldiers are sent back to the US for treatment, out of service for 30-40 days. Will the Army quietly stop sending infected soldiers for treatment as the numbers continue to mount? —New York Times