“The greatest challenge is to reach populations in countries in conflict or those that have recently experienced civil unrest,” says Mr Allan, Founder and Director of the Mentor Initiative. “There is a huge sense of urgency that hasn’t yet been realised, particularly in relation to Central African countries such as South Sudan, Central African Republic, Democratic Republic of Congo and Angola.”

Whilst the global figures show great success in the fight against NTDs, more localised mapping indicates that the burden still lies in a small cluster of countries that have experienced recent humanitarian crises. For example, South Sudan, boasts the highest burden of Blinding Trachoma and 90% of cases of sleeping sickness can be found in South Sudan, northern Angola and the Democratic Republic of Congo.

Within a war zone the playing field shifts all the time as the destruction of communities creates breeding sites for many diseases and forces people to live often in temporary and unsanitary conditions, making them more vulnerable to infection. Add to that the lack of health care access, and it’s easy to see how epidemics emerge.

“Leishamaniasis, transmitted by sandflies in Syria, is just one example,” continues Mr Allan. “The annual case load increased from 30,000 to 200,000 as a direct result of conflict.” Tackling disease in such hostile conditions requires a complete re-evaluation of expectations and approach. “Countries at war are often written off as being just too difficult to work in,” warns Mr Allan. “But we have to invest in a different approach that allows NGOs to take a greater lead in delivery and we’ve seen it can work.”

As part of the Mentor Initiative, Mr Allan has seen great success in Angola where, after 25 years of conflict, NGOs are providing greater logistical support to allow community health workers and teachers to take a lead in delivering NTD treatment on the ground. “The success we’ve seen in Angola has been really exciting,” says Mr Allan. “But donors, apart from the End Fund, aren’t used to this approach. They usually opt for the low hanging fruit where they will see results much faster. There’s a nervousness about investing in countries where change is so slow, but morally we must respond where the greatest burden is.”

Time, however, is of the essence in the fight against NTDs. As has been seen with Dengue Fever, the fastest growing disease in the world, disease can spread with alarming pace. According to the World Health Organisation, before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries.

Great collaboration continues to take place in the fight against NTDs and all the evidence shows we can make progress in even the most hostile of environments, but more needs to be done, faster. “We can do it, and we are doing it,” says Mr Allan, “But it requires a willingness to innovate, to take risks and even to accept failure sometimes for the greater good.”