In Maraña, Lina Pinto-Garcia rethinks infectious disease, war and biomedicine through an ethnographic study of cutaneous leishmaniasis (a parasitic disease) in Colombia’s long armed conflict. Her central claim is precise and consequential: in Colombia, leishmaniasis is not merely a disease that occurs during war, but a disease of war, co-produced through the ecological, political, pharmaceutical and epistemic infrastructures of conflict. By tracing how sandflies, parasites, soldiers, guerrillas, drugs, laboratories and regulations are held together in what she calls a maraña, a tangled mesh of human and more-than-human relations, Pinto-Garcia challenges pathogen-centered and depoliticized models of infectious disease and situates war itself as a formative dimension of disease ontology.

The book operates at the intersection of science and technology studies (STS), critical medical anthropology and Latin American history, while addressing questions central to the history of science about knowledge making under conditions of violence. Pinto-Garcia argues that leishmaniasis in Colombia has been socially and materially constructed as a ‘war disease’ and, more pointedly, as a ‘guerrilla disease’, a stigmatizing designation with serious consequences. Skin lesions become legible as signs of insurgency, collapsing diagnosis into counterinsurgency logics and rendering sufferers vulnerable to state and paramilitary violence. Disease marks function as biopolitical identifiers, illustrating how medical categories and bodily signs can be incorporated into state practices of surveillance and control.

Conceptually, Maraña engages several foundational currents in the history and anthropology of science. Pinto-Garcia’s insistence that leishmaniasis cannot be reduced to a parasite–host interaction, but must be understood as emerging from historically specific social, ecological and political arrangements echoes Charles Rosenberg’s formulation of disease as a ‘configuration’ that stabilizes at the intersection of biological events and social negotiation. What Maraña adds is a sustained demonstration that protracted armed conflict can become one of the structuring conditions through which such configurations cohere. Her analysis of Glucantime (the medical treatment for leishmaniasis) as a technology that produces both medical effects and social distinctions resonates with Sheila Jasanoff’s notion of co-production: pharmaceutical regulation, clinical practice and scientific knowledge help constitute categories of ally, enemy, deserving patient and disposable body. Pinto-Garcia’s account of stigma, diagnosis and access to care also parallels Charles Briggs’s work on ‘sanitary citizenship’ and the making of ‘unsanitary subjects’, in which medical classifications and narratives sort populations into those worthy of protection and those rendered suspect. Read through these lenses, Maraña appears as a conflict-specific elaboration of a broader historiographical insight that disease categories, technoscientific infrastructures and political belonging are made together.

Chapter 1 reframes the Colombian conflict as a ‘war ecology’. Because the war has largely unfolded in forested zones where sandflies thrive, it has funnelled soldiers, guerrillas, displaced people and coca workers into environments of heightened exposure. Armed conflict reshapes not only human mobility but also parasite epidemiology, contributing to the disease’s spread into new regions. Pinto-Garcia’s most original move is to read shifting parasite distributions as historical traces of war itself. Rather than treating leishmaniasis as an incidental byproduct of jungle warfare, she shows how conflict reorganizes ecological relations in ways that make specific pathological encounters more likely. This approach extends environmental and medical histories of war beyond battlefield injury into vector ecologies.

The analytical core of the book lies in its concept of the ‘pharmaceuticalization of war’, developed in Chapters 2 to 4. Colombia’s public-health response to leishmaniasis centers almost exclusively on Glucantime, a highly toxic antimonial drug. Pinto-Garcia demonstrates that access to this medicine is governed by restrictive regimes that mirror wartime distinctions between allies and enemies. Soldiers are fast-tracked for treatment so that they can return to combat, while civilians in conflict zones, especially those suspected of guerrilla affiliation, face barriers, delays or exclusion. The drug thus operates as a biopolitical instrument: it includes, excludes, heals, harms and ranks bodies according to the social order of war. Even soldiers’ ‘privileged’ access is ambivalent, as repeated treatments expose them to significant toxicity, producing what the author terms pharmacological casualties. Violence emerges both through denial of care and through excessive, coercive medication.

Chapter 5, on ‘pacified scientific accounts’, will be of particular interest to historians of science. Pinto-Garcia shows that biomedical research on leishmaniasis routinely erases the armed conflict from its narratives, even though research sites and clinical realities are shaped by war. Drawing on work on ‘public secrets’ and organized unknowing, she argues that claims to neutrality allow scientists to produce usable knowledge while disavowing the violent conditions that make that knowledge possible. This analysis extends scholarship on colonial and military medicine into contemporary global health, showing how pharmaceutical framings reduce the problem to drug development while sidelining the political economies and conflicts that sustain transmission.

A limitation of the book lies in the relative novelty it claims for its biosocial framing of disease. Historians of medicine have long treated diseases as historically situated configurations of biological processes, social relations and political economies. Pinto-Garcia’s intervention is therefore best understood as an extension of this tradition into the domain of protracted internal conflict. In addition, the emphasis on inseparability sometimes risks flattening distinctions between different scales and modalities of violence. These tensions do not undermine the analysis and instead prompt useful reflection on causality, responsibility and intervention.

Maraña makes a significant contribution to the history and anthropology of science, medicine and war. It demonstrates how technoscientific practices, including drug regulation, clinical protocols and research writing, participate in the production of wartime social orders. By centring a disease that is neither spectacular nor usually fatal, Pinto-Garcia illuminates how the costs of war accumulate in bodies, infrastructures and epistemologies beyond armed confrontation. The book will be of value to scholars of science, medicine and the state, and to those interested in how conflict reshapes the conditions under which disease is known, managed and lived.