A/HRC/38/42 for the elimination of discrimination against persons affected by leprosy and their family members (A/HRC/15/30, annex). In 2016, WHO adopted the Global Leprosy Strategy 2016–2020, which is based upon three strategic pillars, the third of which is on stopping discrimination and promoting inclusion.4 B. Gap between curing and healing 8. Despite being curable, if not detected early and treated, leprosy can cause irreversible damage to the skin, nerves, limbs and eyes, leading to disfigurement, blindness, loss of sensation, chronic wounds and neuropathic pain. 5 9. A unique feature of the impairments6 caused by leprosy are their preventable nature, which depends on access to early diagnosis, treatment and high-quality care. However, late diagnosis is very frequent. Moreover, the global elimination of leprosy as a public health problem has resulted in a loss of expertise in diagnosis and treatment. Finally, a highquality treatment to address nerve damage, which is the main cause of leprosy-related impairments, is yet to be achieved.7 10. Leprosy is undoubtedly a neglected disease and the lack of funds for basic and clinical research explain why the main available drugs for treating leprosy reactions (which are a major cause of nerve damage and resulting impairment) are steroids and thalidomide, the latter of which carries a high risk of causing severe iatrogenic effects. 8 11. Institutional and extra-institutional barriers to access to an early diagnosis, lack of medical expertise among health services and professionals and drugs with severe iatrogenic effects explain why so many persons affected by leprosy claim that, after completing multidrug therapy, even though they are said to be cured, they do not feel healed. 9 12. Few other diseases show the gap between a medical cure and the phenomenological experience of healing as much as leprosy. Such a gap is deeply forged by social mediator factors and the social determinants of health and illness, among which stigmatization and discrimination play a critical role. C. Epidemiology and human rights 13. In 2016, 214,783 new cases were reported to WHO by 145 countries. The highest absolute and relative number of cases of leprosy were reported in India, Brazil and Indonesia. There is still a worrying prevalence in 22 countries that, according to a set of indicators (which includes prevalence, the detection of new cases and the proportion of female, child and grade-2 disability10 cases), are identified as global priority countries for leprosy control. The countries with more than 1,000 new cases in 2016 were: Bangladesh, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Madagascar, 4 5 6 7 8 9 10 4 WHO Regional Office for South-East Asia, Global Leprosy Strategy 2016−2020. Accelerating Towards a Leprosy-free World (New Delhi, 2016). See www.who.int/en/news-room/fact-sheets/detail/leprosy. In the present report, the Special Rapporteur uses the terms “impairment” to refer to the loss of functioning or the detriment to the health of persons affected by leprosy and “disability” to refer to the social responses of discrimination and exclusion to leprosy-related impairments. This distinction is based upon the social model of disability, which is embraced by the Special Rapporteur in her work. WHO Regional Office for South-East Asia, Global Leprosy Strategy 2016−2020. Accelerating Towards a Leprosy-free World — Operational Manual (New Delhi, 2016), pp. 5–6. Alice Cruz, “Leprosy as a multilayered biosocial phenomenon: the comparison of institutional responses and illness narratives of an endemic disease in Brazil and an imported disease in Portugal”, Clinics in Dermatology, vol. 34, No. 1 (2016), pp. 16–23. Ibid. Grade-2 disability refers to visible impairment. The grading system used by the Global Leprosy Programme consists of “grade 0” meaning no impairment, “grade 1” meaning loss of sensation in the hand, eye or foot and “grade 2” meaning visible impairment.