Leishmaniasis in Libya at the Human–Animal–Environment Interface: A Critical One Health Review for Climate-Resilient and Sustainable Control

Abstract

Leishmaniasis remains one of the most consequential neglected vector-borne parasitic diseases, yet its burden is unevenly visible because surveillance intensity, laboratory access and health-system resilience vary markedly between endemic settings. Libya represents a strategically important North African setting in which zoonotic transmission, arid and semi-arid ecologies, population mobility, urban expansion, climate variability and prolonged healthsystem disruption intersect. This critical narrative review synthesises contemporary Libyan, North African and international evidence on epidemiology, parasite–vector–reservoir ecology, immunopathogenesis, diagnosis, treatment safety and sustainable control. Recent national data documented 13,625 cutaneous leishmaniasis cases reported in Libyan hospitals during 2019–2022, with pronounced spatial and seasonal heterogeneity; a 2024–2025 study from Al-Khums further demonstrates that active transmission persists in contemporary urban and peri-urban contexts. Molecular evidence confirms circulation of both Leishmania major and Leishmania tropica, while major gaps remain in current species-resolved surveillance, visceral leishmaniasis burden estimation, sand-fly monitoring and reservoir attribution. The available evidence therefore argues against viewing leishmaniasis as an isolated dermatological problem. Instead, Libya illustrates how a neglected tropical disease can be sustained by interactions among ecological suitability, human vulnerability, animal reservoirs, vector ecology and fragmented surveillance. Antimonial treatment remains relevant but requires stronger pharmacovigilance, biochemical and haematological monitoring, and access to safer, context-appropriate alternatives. A national response should integrate geocoded human surveillance, reference molecular diagnostics, entomological and reservoir monitoring, climate-informed risk mapping, treatment-safety registries, community engagement and intersectoral governance. Aligning these actions with the WHO neglected tropical disease road map and Sustainable Development Goals 3, 6, 11, 13 and 17 would transform leishmaniasis control from episodic case management into a measurable programme of health-system, environmental and climate resilience. Libya should be regarded not as a peripheral endemic setting, but as a sentinel context for understanding how neglected diseases persist when ecological opportunity and institutional vulnerability converge.