Table 2 Direct quotes form participants in the studies on the effect of CL

Marriage

‘She [woman with a CL scar] will be afraid about her future especially for the wedding. Meanwhile, in our society, an affected boy remains a man. There is no harm if he has scars.’

Morocco

‘Well I got married at 17 and I got divorced because of this issue. He told me something about my face and I finally got separated when we were engaged. [...] I got married again, and my husband’s skin is white without any spots. I had to use creams since I was a kid. [...] Yeah, I married twice and I didn’t have a wedding ceremony both times due to my CL. [...] Because they took films at weddings and the camera takes a close shot from your face and I didn’t want that... ‘

Iran

Beauty

‘For a girl when the disease leaves a mark on the face for example, the girl will think that is dangerous for her beauty, which will influence her psychological state. Especially in our traditional society that is absolutely not lenient towards those who have spots on the face because they think it is hereditary.’

Morocco

Women ‘are disgraced with this disease.’

Afghanistan

‘It will cause their faces to be disfigured.’

Scars

‘The scar is a mark of shame and contempt.’

Morocco

‘The psychological state of the affected person can worsen after receiving treatment because the problem is that scars never disappear [even after treatment].’

Morocco

Psychosocial effects

‘She [a girl with CL] will have depression, a durable fear, and shame. She does not have the absolute courage to sit with her friends for fear of their mockery.’

Morocco

‘A catastrophe [...] in my life named leishmaniasis, I swear. I can’t talk. I’m thinking how my leg could be amputated. How my life will look like after amputating my leg, I think about suicide, at the same time I think about my daughter how she will calm down after my death. I can’t live without my leg.’

Tunisia