A case of leprosy has been detected in the Northern Territory, prompting outcry over remote living conditions for Indigenous Australians.
Aboriginal and Torres Strait Islander readers are advised that this article may contain images of people who have died.
A much-misunderstood bacterial infection, leprosy can cause skin lesions and permanent nerve damage if left untreated.
It is nearly eradicated in the developed world, but cases remain common in large developing countries including India, Bangladesh and Brazil.
A spokesperson for the NT Health Department confirmed the NT's first leprosy case since 2021 had been detected in the Top End region this year.
They also said that nationally, four other cases had been confirmed so far in 2024 — three in New South Wales and one in Queensland — according to the federal government's dashboard for nationally notifiable diseases.
Leprosy was introduced to Australia during colonisation in the mid-1800s, but today cases are extremely rare and almost solely recorded among migrants and Indigenous people living in remote areas.
Although its exact causes are unknown, the disease is associated with severe overcrowding.
Steve Rossingh, chief executive of Aboriginal community-controlled health organisation Miwatj Health, said Australia "should be pretty ashamed" the disease was continuing to impact Indigenous communities.
"It's not because people are unclean themselves, or dirty. It's because of the conditions they're forced to live in – and there's no alternative," the Kamilaroi man said.
There are 50 people on the waitlist for every vacant public home in Darwin, according to the NT government's website, and in remote areas of the NT, families of 10 to 20 people can occupy a three-bedroom house.
The Northern Territory and federal governments are pouring $4 billion into efforts to reduce overcrowding in remote communities over the next 10 years.
But Mr Rossingh said in the short-term, simple solutions such as mobile and community laundries were needed right now, to help reduce cases of leprosy and other infections including scabies.
NT Chief Minister Eva Lawler said health was a "whole-of-community issue, particularly in remote areas".
Leprosy hard to catch and easy to treat
For centuries, leprosy was mistakenly believed to be highly contagious, and triggered widespread panic when it was detected in communities.
But dermatologist Aaron Boyce, who has firsthand experience treating leprosy patients in Cambodia and Fiji, said the disease was in fact "really difficult to catch".
"It's not particularly contagious at all," he said.
Revolutionary treatments led by NT doctor John Hardgraves in the 1970s helped to drastically reduce leprosy's prevalence, and today the infection can be easily treated with a range of drugs.
Dr Boyce says public health officials also conduct "contact tracing", similar to that used during the COVID-19 pandemic, to identify and treat any other people at risk.
A painful legacy
Mr Rossingh said the fact rare cases of leprosy were still being detected in remote areas of the Northern Territory was a symptom of economic inequality between Indigenous and non-Indigenous Australians.
"It's another thing that happens when people are living in poverty," he said.
Historically, Australian public health officials used discriminatory policies to contain the disease's spread.
As recently as last century, Indigenous children with leprosy were forcibly removed from their families and exiled to facilities then known as leprosariums, dotted throughout Australia.
The Northern Territory's Channel Island Leprosarium, about a 40-minute drive from Darwin, only closed down in the mid-1950s, in part because of national outrage about a non-Indigenous girl being sent there years prior.
Today, the NT's Centre for Disease Control screens at-risk populations for the disease, but it also relies on referrals from frontline health clinics such as Miwatj Health.
However, Mr Rossingh said the organisation was having to rely on less money to do it, and there wasn't enough money for measures that would prevent it.
In real terms, the NT government cut Miwatj Health's grant funding for a second consecutive year in last month's NT budget by indexing it at a rate below inflation.
"We're probably losing around three nurse positions every year to accommodate that," Mr Rossingh said.
In a statement, Health Minister Selena Uibo said all NT government grants were indexed at that same rate except for those in "identified priority areas", including domestic, family and sexual violence and mental health.
With the World Health Organisation setting a global target of reducing leprosy cases to zero, Dr Boyce said leprosy prevention must not be forgotten.
"We should be aiming for no leprosy cases in Australia, and beyond that, in the world," he said.
