In 1997, there was the first major outbreak of cutaneous leishmaniasis due to L. tropica. The outbreak occurred in parts of northeast Afghanistan and north-west Pakistan, in Timargara, an Afghan refugee camp established 17 years earlier in the district of Dir, North West Frontier Province of Pakistan.

As part of the investigation for that outbreak, each section of the camp was surveyed for cutaneous leishmaniasis. About 38% of the 9200 inhabitants bore active lesions and a further 13% had scars from earlier infections.

P. sergenti was captured within the camp, indicating the possibility of local transmission from this vector, and humans acting as the reservoir hosts. Cutaneous leishmaniasis had not previously been reported from this area of Pakistan. Although the majority of refugees left Afghanistan two decades earlier, cross-border movement of men was common. It was suggested that the infection had been introduced from Kabul.

It has been suggested that it was in the wake of the war in Afghanistan, with the migration of Afghan refugees into Pakistan that cutaneous leishmaniasis was introduced into the hilly areas of the Larkana district i.e. Warah, Kamber and Shahdad Kot talukas, bordering with Baluchistan and the Khirthir mountain range from February 2001 onwards.

In a seven day detailed survey conducted in 2002, in the affected areas of Dadu and Larkana districts, 2500 cases of active lesions were found and treated. 

Patients were studied in the Department of Dermatology, Chandka Medical College, Larkana, for 15 months in 2004–2005. Among the 1640 patients seen, 470 were residents of different cities of Balochistan Province; and 1170 were residents of different cities of Sindh province, such as Jacobabad, Ratodero, Shahdadkot, Qambar, Warah, Mehar, Dadu, Dokri and Larkana. It was concluded that cutaneous leishmaniasis was endemic in the Sindh Province.