Settlements originally built to isolate people with leprosy still exist on every inhabited continent, though most have transformed dramatically from the quarantine camps of earlier centuries. India alone has several hundred such colonies, and smaller communities persist in countries including Brazil, China, Japan, Nigeria, and elsewhere. The reasons they endure have less to do with medical necessity and more to do with entrenched stigma, poverty, and the fact that many long-term residents simply have nowhere else to go. Leprosy, now more commonly called Hansen’s disease, has been curable with antibiotics since the early 1980s, which makes the continued existence of these settlements one of the more striking failures of public health policy to keep pace with medical science.
What Leprosy Actually Is and Why It Inspired Such Fear
Leprosy is caused by Mycobacterium leprae, a slow-growing bacterium that primarily affects the skin and peripheral nerves. Nerve damage is the hallmark of the disease: the bacterium invades Schwann cells, the cells that insulate nerve fibers, leading to loss of sensation, muscle weakness, and, if untreated, visible deformities of the hands, feet, and face.1Clinics in Dermatology. Pathogenesis of leprosy and leprous neuropathy These visible signs are what made the disease so terrifying throughout history and fueled the belief that people who had it needed to be separated from society.
The reality of transmission, though, undercuts the rationale for isolation. The bacterium spreads mainly through respiratory droplets after prolonged close contact with an untreated person, and possibly through skin contact or environmental exposure.2Leprosy Review. Current knowledge on Mycobacterium leprae transmission: a systematic literature review It is not highly contagious. About 95 percent of people have natural immunity and will never develop the disease even if exposed. The long incubation period, sometimes years or even decades, makes it difficult to trace how any individual case was acquired, which historically added to the mystery and dread surrounding it.
How Colonies Came to Exist
Forced isolation of people with leprosy has roots going back centuries, but the modern colony system took shape in the 1800s and early 1900s when governments formalized quarantine policies. One of the most infamous examples is Kalaupapa on the island of Molokai in Hawaii, where patients were exiled beginning in 1866. The settlement operated for over a century, and the isolation it imposed reflected both genuine fear of contagion and deep racial and social prejudice against the Native Hawaiian and other communities disproportionately affected.3PubMed Central. How Stigma Distorts Justice: the Exile and Isolation of Leprosy Patients in Hawai`i
Similar colonies were established worldwide. Brazil built dozens of “leprosários.” Japan maintained strict isolation laws well into the late twentieth century. The United States operated a facility at Carville, Louisiana, from 1894 until 1999. In both the U.S. and Japan, isolation policies persisted long after scientific evidence showed they were unnecessary, a pattern researchers have attributed to institutional inertia, the political difficulty of closing established facilities, and the enduring stigma attached to the disease.4PubMed Central. Termination of the leprosy isolation policy in the US and Japan: Science, policy changes, and the garbage can model By the time these policies were formally ended in the 1980s and 1990s, many residents had spent their entire adult lives inside the colonies and had no family, job prospects, or community connections on the outside.
Where Colonies Still Operate Today
India is home to the largest number of remaining leprosy colonies, with estimates ranging from roughly 750 to over 800 settlements across the country. Most are not government-run institutions in the traditional sense. They are self-settled communities where people affected by leprosy and their descendants live together, often in extreme poverty, because stigma has made it impossible for them to reintegrate into surrounding villages and cities. Residents frequently rely on begging for income, and access to healthcare, education, and sanitation can be poor.
Brazil still has communities that trace their origins to forced segregation policies that were officially in place until 1962. Some former colony sites now function as general hospitals or mixed communities, but clusters of leprosy-affected families remain. In China, hundreds of “leprosy villages” were established during the mid-twentieth century. Many have dwindled as aging residents die, but some still house elderly survivors and their families. Across sub-Saharan Africa, particularly in Nigeria, Tanzania, and Ethiopia, similar settlements persist. Japan’s former isolation facilities on islands like Nagashima and Oshima still house a handful of elderly former patients who chose to remain after the country’s leprosy prevention law was repealed in 1996.
Kalaupapa in Hawaii, though no longer admitting new residents, remains home to a small number of people who were sent there decades ago. The settlement is now managed as a national historical park, and the few remaining residents live there voluntarily.
Why Colonies Persist When a Cure Exists
The standard treatment for leprosy, called multidrug therapy, combines dapsone, rifampicin, and clofazimine. It has been available through the World Health Organization free of charge since 1995 and is effective at curing the infection and preventing drug resistance.5PubMed Central. Leprosy: current situation, clinical and laboratory aspects, treatment history and perspective of the uniform multidrug therapy for all patients Treatment typically lasts six months to a year depending on the type of leprosy. Once someone starts multidrug therapy, they quickly become non-infectious. If caught early, the disease can be cured before any nerve damage occurs.
So why do colonies still exist if the disease is curable? The answer is overwhelmingly about stigma and its downstream effects. In many communities, a leprosy diagnosis, even one that has been successfully treated, marks a person for life. Discriminatory laws in some countries have historically permitted divorce on the grounds of leprosy, restricted employment opportunities, and limited the movement of affected individuals and their families.6PubMed Central. Beating leprosy: Unmasking challenges, ending stigma, & prioritizing mental well-being Although many of these laws have been repealed on paper, informal discrimination continues. People cured of leprosy are turned away from jobs, denied housing, and socially excluded. Under those conditions, the colony becomes a refuge rather than a prison.
Research on colony communities has shown that the social identity tied to colony membership is distinct from the stigma of leprosy itself. People with leprosy living outside colonies face stigma too, but they also sometimes view colony residents as fundamentally different from themselves. The colony creates its own community identity, one that can be both protective and isolating.7PubMed. Leprosy, the key to another kingdom For many residents, leaving would mean losing the only social network they have.
The Mental Health Toll
Living with leprosy, whether inside a colony or not, carries a heavy psychological burden. A systematic review of the evidence found that leprosy-affected people experience elevated rates of depression, anxiety, and suicidal behavior.8PubMed Central. The impact of leprosy on the mental wellbeing of leprosy-affected persons and their family members – a systematic review A study from India found that roughly a third of leprosy-affected respondents had symptoms of depression, and about one in five had symptoms of anxiety. The presence of physical disability was the strongest predictor for both conditions, and women and people with lower incomes were disproportionately affected.9PLOS Neglected Tropical Diseases. Burden of depression and anxiety among leprosy affected and associated factors—A cross sectional study from India
Colony residents face a compounded version of this burden. Many arrived as children or teenagers and spent formative years in an institutional setting. The psychological effects of forced separation from family, combined with the physical effects of untreated or late-treated disease, create long-term mental health challenges that persist even after the infection itself is cured. Mental health services in most colonies are minimal or nonexistent.
Is Leprosy Still Spreading?
The global picture has improved considerably over the past three decades. From 1990 to 2019, the global age-standardized incidence rate dropped from about 1.5 per 100,000 people to about 0.65 per 100,000, and the decline was consistent across age groups.10PubMed Central. Global Trends in the Incidence, Prevalence and Disability-Adjusted Life Years of Leprosy from 1990 to 2019: An Age-Period-Cohort Analysis Using the Global Burden of Disease Study 2019 But “declining” is not the same as “gone.” More than 200,000 new cases are still reported worldwide each year, with the largest shares in India, Brazil, and Indonesia. Men are diagnosed more often than women, and countries with lower socioeconomic development carry a disproportionate burden of the disease.
One reason leprosy has been difficult to eliminate entirely is its long incubation period. Someone infected today might not show symptoms for five, ten, or even twenty years. During that time they may unknowingly transmit the bacterium. The disease also has animal reservoirs that complicate eradication. In the Americas, nine-banded armadillos are natural hosts of M. leprae, and studies have found identical bacterial strains in armadillos and nearby human populations.11PLOS Neglected Tropical Diseases. Reservoirs and transmission routes of leprosy; A systematic review In the Brazilian Amazon, a study found that over 60 percent of wild armadillos tested were infected with the bacterium, and human contact with armadillos, including hunting and consuming them, was identified as a risk factor.12PLOS Neglected Tropical Diseases. Evidence of zoonotic leprosy in Pará, Brazilian Amazon, and risks associated with human contact or consumption of armadillos In the southern United States, a small number of locally acquired cases each year are linked to armadillo exposure.
An unexpected finding in recent years was the discovery of M. leprae in red squirrels in the British Isles, a region where human leprosy had been absent for centuries.11PLOS Neglected Tropical Diseases. Reservoirs and transmission routes of leprosy; A systematic review The practical risk to humans from squirrels appears very low, but the finding shows that the bacterium can persist quietly in animal populations long after it vanishes from the human population in a given region.
Preventing New Cases
Beyond treating people who already have leprosy, public health researchers have been working on ways to prevent transmission among close contacts of diagnosed patients. A landmark trial tested whether a single dose of the antibiotic rifampicin, given to people who lived near a newly diagnosed case, could reduce their risk of developing the disease. Over four years of follow-up, the rifampicin group had about 35 percent fewer cases than the placebo group, with the protective effect strongest in the first two years, when incidence dropped by roughly 57 percent.13BMJ. Effectiveness of single dose rifampicin in preventing leprosy in close contacts of patients with newly diagnosed leprosy: cluster randomised controlled trial The intervention was also cost-effective, preventing cases at a relatively low cost per person.14PLoS Neglected Tropical Diseases. Cost-Effectiveness of a Chemoprophylactic Intervention with Single Dose Rifampicin in Contacts of New Leprosy Patients
Vaccine research is also ongoing. The existing BCG vaccine, primarily used against tuberculosis, provides some cross-protection against leprosy and is already recommended in endemic countries. But its protection is incomplete and variable. A newer candidate called LepVax, tested so far in animal models, showed promising results: in armadillos already infected with M. leprae, LepVax delayed and reduced nerve damage without the worsening effects sometimes seen with BCG.15PubMed Central. LepVax, a defined subunit vaccine that provides effective pre-exposure and post-exposure prophylaxis of M. leprae infection A meta-analysis of randomized controlled trials found that leprosy vaccines, including BCG-based approaches and a heat-killed vaccine called Mw/MIP, provided significant protection when combined with standard drug therapy.16PubMed Central. Efficacy of leprosy vaccines across the globe: A systematic review & meta-analysis of randomized controlled trials None of these are a silver bullet yet, but the pipeline is more active than many people realize for a disease often assumed to belong to the distant past.
Surgery and Rehabilitation for Long-Term Damage
Even when leprosy is cured with antibiotics, nerve damage that occurred before or during treatment can be permanent. Clawed hands, foot drop, and facial nerve paralysis are among the deformities that can result, and they are a major reason stigma persists. People who look visibly affected continue to face discrimination regardless of whether they are still infected.
Reconstructive surgery can restore some function and reduce visible deformity. Procedures like tendon transfers can correct clawed fingers, helping patients regain grip strength and the ability to perform daily tasks. One well-established technique, the Zancolli Lasso procedure, is valued for its relative simplicity and good outcomes.17Journal of Case Reports and Images in Medicine. Reconstructive surgical correction of ulnar nerve paralytic claw fingers in Hansen’s disease patients by Lasso procedure But access to these surgeries is limited in the places where leprosy is most common. Specialized surgical training for Hansen’s disease has declined as the disease has become rarer, and many affected people in low-income settings never learn that surgical options exist.
Rehabilitation extends beyond surgery. Protective footwear to prevent injuries to numb feet, physiotherapy to maintain hand function, and wound care for chronic ulcers are all part of long-term management. In colony settings, where many residents are elderly and have lived with disability for decades, these services can dramatically improve quality of life even when they cannot reverse the damage.
The Medieval Connection
Leprosy’s long history with humanity is part of why it remains so culturally loaded. Ancient DNA research has shown that M. leprae was genetically diverse in medieval Europe, with multiple distinct lineages circulating simultaneously. Researchers who sequenced the bacterium’s genome from medieval skeletons found strains on several different phylogenetic branches, including one branch shared by modern armadillo and red squirrel strains.18PLoS Pathogens. Ancient genomes reveal a high diversity of Mycobacterium leprae in medieval Europe Genome-wide comparisons between medieval and modern strains showed no obvious changes in virulence, suggesting the bacterium itself has not evolved to become less dangerous.19Nature Communications. Ancient DNA study reveals HLA susceptibility locus for leprosy in medieval Europeans The decline of leprosy in Europe was probably driven by improving living conditions, the rise of tuberculosis (which may have conferred some cross-immunity), and eventually public health measures, not by any weakening of the pathogen.
This matters for the colony question because it shows that leprosy did not disappear from Europe because of quarantine alone. The disease receded over centuries for complex reasons, and it receded from affluent countries first. The colonies that remain today are concentrated in places where poverty, crowded housing, and limited healthcare access perpetuate transmission, and where social structures have not caught up with the medical reality that the disease is curable and barely contagious once treated.
What the Remaining Colonies Actually Look Like
If you picture a walled compound with patients in rags, you are picturing something from a different century. Most surviving colonies are open communities. People come and go. In India’s colonies, residents often live in small houses along unpaved roads, grow food, and send their children to local schools when those schools will accept them. Some colonies have become small villages in their own right, with second and third generations who were never diagnosed with leprosy but remain because the colony is the only home they know.
In wealthier countries, former colonies have often been repurposed. Japan’s former isolation islands are now memorial sites and care homes for the few remaining elderly residents. Brazil’s former leprosários have, in some cases, been converted into general hospitals. Carville in Louisiana is now a training campus for the National Guard. Kalaupapa is a national historical park. These transformations are happening, but they are uneven. In low-income countries, many colonies remain functionally abandoned by the state, receiving minimal government support and relying on nongovernmental organizations for basic services.
The trajectory is clear: existing colonies are shrinking as their oldest residents die and new cases are treated in the community before isolation becomes entrenched. But “shrinking” is a slow process when it is driven by aging rather than active resettlement, and new informal colonies can still form in places where diagnosis comes late and stigma remains fierce. The answer to whether leper colonies still exist is not just yes, but that the conditions sustaining them, poverty, discrimination, and delayed access to healthcare, have not been adequately addressed in many parts of the world.