Aleppo, Asharq Al-Awsat—Choked, chaotic Aleppo: two years ago this was the mercantile capital of Syria, now it is a city made medieval by war. Since last summer there has been no grid power in the neighborhoods controlled by the Free Syrian Army (FSA), and as the sun sets at six o’clock the streets are bathed in an inky black. Street sellers do a fast trade in diesel generators and as darkness arrives people hurry home to rev them up, cloying the air with the smell of petrol. No-one is foolhardy enough to walk the streets after nightfall so the city’s stray cats have reclaimed them, their eyes the only pinpricks of light on the sullen and dangerous walkways. Bottled water and fuel have become precious, and expensive, commodities.

This revolution has made many people powerful and rich—warlords, criminals and opportunists. But they are thriving on the suffering of the weak and the ill, and the people who have no means of escape the rotting city. Opposite a shelled house on a side street, a former school has been turned into a clinic to treat the increasing cases of Leishmaniasis, a skin disease spread by parasites. In the 18th century this illness was endemic to the city—the doctors who first discovered it nicknamed it the ‘Aleppo Boil’. Now, thanks to the piles of garbage lying uncollected in the streets, it has made a rampant return.

“In some areas we go to, eight out of every ten people are infected,” says Hussein. Before the war, Hussein was an actor. He studied Brecht, made short films, and staged radical plays about dangerous subjects. “When the regime started killing people I wrote a play about it,” he says. “At the end of each performance we told the audience how many people had been killed at demonstrations, and every day that number got bigger. We performed in people’s houses, and we never had more than twenty people watching, so that we didn’t draw the attention of the security services.”

But Aleppo today has little space for theater: the people are too exhausted by the very effort of living. So Hussein now volunteers at the clinic, driving to infected areas of the city to pick up patients and bring them for their injections. “Every day there are new areas to go to,” he says. “In Deir Al-Zour there have been two or three cases of cholera now, and I think that soon we will have that in Aleppo too.”

Leishmaniasis starts as a sore. Left untreated it grows and deepens, and multiplies across the host’s body. At the clinic Um Ali has brought her son and two daughters for their injections. They’ve all had the disease for a year, and must come here every three days for treatment. Her youngest girl watches as the nurse slides the needle into her mother’s face, then her wide eyes fill with tears as she realizes that her turn is next. But without her injections, painful though they are, her sores will only get worse.

Mahmoud (not his real name) is the only doctor at the clinic. “At first we treated everything here,” he says, “but as Leishmaniasis became more and more of a problem we decided that we had to focus on that. Now we see between three and four hundred patients every day.”

As the FSA captured hospitals in the regime held areas of Aleppo, Dr. Mahmoud went in after them and gathered up their supplies of Glucantime, the medicine most widely used to treat the disease. But seven weeks ago his supplies ran out and he is struggling to find the money to buy more. Each ampule costs up to SYP 200, and they have to be brought into Aleppo from abroad. And to compound the clinic’s problems, not every patient can be treated with Glucantime. “It’s not safe for pregnant women because it can cause heart palpitations,” says Dr. Mahmoud. “We need to treat them with liquid nitrogen, to freeze the sores off, but we have no supplies of that at all.” In a final, cruel twist, Leishmaniasis sufferers often develop a resistance to the treatment. In other cities doctors would move on to a different medicine, but in Aleppo there are no second options.

So now Dr. Mahmoud and his team are focusing their efforts on preventing the further spread of the disease. As Hussein travels to pick up infected families, he takes with him a laptop and PowerPoint presentation, and teaches them how their uninfected relatives can avoid succumbing to the disease. “Children are searching for scrap metal in the garbage here. It’s a way of earning some money, but we have to tell them not to. That’s how they pick up the disease,” he says.

According to Dr Mahmoud, it is now coming to the time of year when it is critical to confront the disease head on. In the streets outside the clinic, a solitary garbage truck has started to tackle one of Aleppo’s mountains of waste. “Spring is the time when the eggs hatch, so before they do we have to clear away the garbage from the streets,” he says. “If we do that, we can stop this disease spreading further.”