How Christians Learned the Wrong Story About Leprosy

One day, after washing the feet and hands of men and women with leprosy, Angela of Foligno, the 13th-century saint and mystic, ate a leperous sore. “We drank the very water with which we had washed him,” she writes. “And the drink was so sweet that, all the way home, we tasted its sweetness and it was as if we had received Holy Communion. As a small scale of the leper’s sores was stuck in my throat, I tried to swallow it. My conscience would not let me spit it out, just as if I had received Holy Communion.”

On the one hand, it’s a radical testament: that all bodies are holy, and those most marginalized and considered “unclean” are Christ’s truest flesh. But on the other hand—what was the man with leprosy thinking in that moment as he watched Angela do this? What was his story, his life, his human experience that Angela saw as a gateway to God?

It’s these questions, in part, that led me to Outcast: A History of Leprosy, Humanity, and the Modern World (Graywolf Press). Published in the U.S. in July, journalist Oliver Basciano shifts the reader’s focus to the dignity of leprosy patients themselves, and how they have long been fighting for their agency and freedom.

Through immersive global reporting, Basciano explores the stigma of leprosy throughout history into modern times, showing how this stigma was “used as the blueprint for other forms of discrimination.”

Basciano got the idea to write this book after hearing former U.S. Immigration and Customs Enforcement agent David Ward claim that caravans of Central American immigrants coming to the U.S. border “harboured diseases such as ‘leprosy and TB that are gonna infect our people in the United States.’” This perked Basciano’s interest in how leprosy has been used as a “trigger word for fear and panic, an age-old excuse for racism and repression.”

Many countries and medical professionals have stopped using the term “leprosy” in favor of “Hansen’s disease.” However, Basciano uses the term “leprosy” throughout the book to highlight its historical significance and how it’s been understood socially.

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Hansen’s disease is caused by a bacterium (Mycobacterium leprae), spread through water droplets, that hides in the nervous system and affects skin and sensation throughout the body. The bacteria was first identified in 1873 by Gerhard Armauer Hansen, a Norwegian physician. A multidrug cure has been available since 1981, reducing new cases from more than 5 million a year to hundreds of thousands.

“The history of leprosy is also the history of colonisation and oppression in Africa, Asia, South America and the Pacific,” Basciano writes. The disease spread from European colonizers to the countries they colonized in South America. And in other countries throughout the world, more recent exploitation of resources and labor on the part of Western companies has exacerbated how the disease impacts locals. Throughout Outcast, Basciano shows how leprosy has often been used as an excuse to subjugate. He traces the history of the stigma to specific places today where leprosy colonies—isolated areas where patients have been forced to live—existed (and in some cases, still exist): Norway, Hawaii, Russia, Romania, South Africa, Mozambique, Brazil, and Japan.

Basciano thoughtfully immerses himself among communities of leprosy patients, acknowledging the complexity of being “a stranger arriving with power and a pen among some of the most marginalised people in the world.” In vivid writing, Basciano situates himself not as an objective observer, but as someone who writes with genuine care about the relationships he forms and the injustice he hears about.

Leprosy gained a stigma in the Western world partly through a translation of the Hebrew Bible where God issues a “complex series of commands regarding ritual cleansing in the case of a person with a skin condition.” Leviticus 13 states that those with a skin “defiling disease” must live outside the camp and the priest must examine them to make sure the disease isn’t spreading.

In the Bible, leprosy became a symbol for sin. At the same time, through Jesus’ encounters with people with leprosy in the gospels and the miracles of healing he performed, leprosy also became the “disease iconic of Christian charity,” Basciano argues.

In the Middle Ages, Catholics founded monasteries where men and women with leprosy could work and pray alongside people who did not have leprosy. Many believed that those with leprosy would bypass purgatory, for they had already suffered enough. Some monks and nuns even prayed for the disease.

Basciano includes this research to show that the historical realities are “at odds with the cliche of the ‘medieval leper,’ outcast, feared in their rags, shunned as they rang their bell or sounded their clapper”—an image that, centuries later, governments and rulers would manipulate “to suit the prejudices of their present.” This prejudice came to fruition in laws like leprosy removal; isolation; forced labor; forced sterilizations and abortions; nonconsensual research and operations; and the removal of children from parents with leprosy.

In Brazil, Basciano travels to communities where “remarkable solidarity and activism in the face of social brutality” have taken place. After India, Brazil has the second highest annual number of leprosy cases, with 22,773 new diagnoses in 2023, Basciano writes, most prevalent in the country’s poorer northern areas. The disease arrived in Brazil with European colonizers in the 16th century.

From the 1930s onward, Brazil had federally enforced segregation for those with leprosy. Patients were essentially imprisoned—extremely isolated, not allowed to leave the hospitals, and living in poor conditions. This decision was “undertaken with the knowledge that it would largely affect the poorest and, because of their condition, least economically ‘useful’ Brazilians,” Basciano writes.

Morhan, a patients’ rights group in Brazil, was founded in 1981 by a group of patients including one man whose nickname was Bacurau. After nearly a lifetime of mistreatment at a leprosy colony, he decided to finally organize a protest after arguing with a nurse about whether or not he could take his shirt off in the heat. “It’s a beautifully Brazilian start to a revolution: the right to sit and have a beer in the sun with your shirt off,” Basciano writes.

For Christians, this book offers an important reckoning with the ways religion has been used to harm, both by stigmatizing people as sinful and by reducing them to props for charitable acts.

Morhan is active in helping the children who were forcibly removed from their parents get pensions, banning the words “leper” and “leprosy” from governmental literature, and helping start a DNA sampling initiative to find those who were put up for forced adoption.

Faustino Pinto, national coordinator of Morhan, told Basciano: “My diagnosis is not what shocked me, what shocked me was seeing how people were being treated in the health center, so I started complaining and fighting.”

If anti-leprosy laws and programs were blueprints for “segregation and subjugation,” Basciano writes, “then the fight and spirit of the patients offers us a vision of a world mended through care and reparation.”

For Christians, this book offers an important reckoning with the ways religion has been used to harm, both by stigmatizing people as sinful and by reducing them to props for charitable acts. Basciano offers another way forward. His reporting models a love of neighbor rooted not in pity or altruism, but in solidarity.

The communities in Outcast reveal a vision of the gospel more radical than charity. In the most horrific of circumstances, they practice love, resistance, and mutual care: This is liberation for the oppressed, the good news of abundant life.