Morocco
History of Leprosy in Morocco
Since the word “leprosy” does not exist in Berber it is believed that this disease was imported by successive civilisations who came to Morocco, such as the Phoenicians, the Romans and then the Arabs, who introduced the word “jdam” into the spoken language.
In 1065 the Arab geographer El Bekri found mention, in a manuscript written by Mohammed Ibn Youssef (904-973), of people affected by leprosy who worked emptying cesspits in Sijilmassa, a town founded by the Arabs in 722. Ibn Youssef’s manuscript is thought to contain the earliest mention of leprosy in Morocco.
The first description of a leprosarium in Morocco dates back to El Ouazani (Léon the African), who spoke about leprosy in Fez at the beginning of the sixteenth century. The best run leprosaria mentioned in historical literature were in Marrakech, Fez and Doukkala.
At the time of France establishing a Protectorate in Morocco, the authorities were doing everything possible to establish a prophylactic anti-leprosy programme following guidelines provided by Dr Colombani, who was then Minister for Public Health and Hygiene. That was in 1925 and can be considered the first attempt at a nationwide policy for leprosy in Morocco.
Until 1925, treatment of leprosy was based on the plant Smilax aspera, a species of flowering vine. In addition, those who could took sulphur baths in thermal stations such as Moulay Yacoub.
National epidemiological research was conducted nationally between 1925 and 1940. During this period a leprosarium was set up on the Bay of Mogador (today known as Essaouira).
Sulphone treatments brought huge improvements in the management of leprosy cases in the period 1948-1952 and many people were cured of leprosy before complications developed.
In 1952 a survey was undertaken to evaluate the scale of leprosy cases in the country. It confirmed pockets of leprosy in Rif, the Moyen (Middle) Atlas, the Doukkala and Souss.
In 1954 leprosy was considered a public health concern. A prophylactic and medico-social policy was developed as well as a structure to take care of people affected by this disease.
Around 1960 there were already:
- 79 beds at the Aïn-Chok Hospital in Casablanca and 31 beds at the Ibn Rochd Hospital, which kept the national records of cases of leprosy.
- 50 beds in Marrakech
- 50 beds in Fez
- 50 beds in Larache
By 1965, 216 beds at the Aïn-Chok Hospital were allocated to people with leprosy.
A survey carried out in four rural communes in 1968 revealed twenty cases of leprosy among 18,165 examined.
An ad hoc survey conducted in 1972 uncovered 5.8 cases of leprosy per 1,000 inhabitants. Whilst a survey organised in Ouled Ali in the province of Boulmane in 1980 showed a prevalence of 5 people with leprosy per 1,000 inhabitants.
The strategy adopted until 1980 allowed the authorities to find pockets of endemnicity of leprosy. But there was no precise knowledge about the actual epidemiological situation. Thus an anti-leprosy programme was developed within the Government’s Plan for Social and Economic Development. A ministerial circular of February 1982 outlined how anti-leprosy structures should be organised. A unit was set up within the Department for Epidemiology and the Government employed a National Leprosy Programme Manager, who would be responsible for planning, managing, co-ordinating and evaluating all programme activities. Nine regional leprosy services were established to manage itinerant persons affected by leprosy. FAIRMED (known at the time as Aide aux Lépreux Emmaüs-Suisse) helped finance the establishment of these services and continues to provide support to this day.
Multi-drug therapy (MDT) was introduced as treatment for leprosy in Morocco in 1982. René Rollier oversaw several therapeutic trials and in 1989 one regimen was selected as the standard treatment for leprosy across the country. However, it was only from 2007 that Morocco adopted the standard WHO regimen for leprosy.
During the era of monotherapy, 1950 – 1980, 200 new cases of leprosy, on average, were detected each year. At the time the National Leprosy Programme was established, which helped extend coverage of services, many mass campaigns were conducted. On average, 140 new cases were detected annually. In the period 2001-2006 national campaigns were replaced by regional ones, which revealed an average of 60 new cases of leprosy a year.
The anti-leprosy programme was reviewed in 1991. In 2005 the challenge was to decide how to provide anti-leprosy services in a situation of low endemnicity and how such services could successfully be incorporated into the basic health care services.
There was concern in 2007 about the high level of grade two disability among cases of leprosy in Morocco (around 20%).
Presentation on Leprosy in Morocco made in July 2008
Click on link for presentation on leprosy in Morocco made at the WHO Eastern Mediterranean National Leprosy Programme Managers' Meeting in Tunis, Tunisia, 7th - 9th July 2008.
Presentation on Leprosy in Morocco made in July 2009
Click on link for presentation on leprosy in Morocco made at the WHO Eastern Mediterranean National Leprosy Programme Managers' Meeting, held in Cairo, 15th - 16th July 2009.