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Malaria control in emergencies: time for action

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This article was first published in BMJ Opinion.

A lunar landscape, cracked earth, and scorching heat. 4,000 rudimentary tents made from wooden poles and plastic sheeting. And people everywhere, 95% of them women and children, according to camp authorities, and a few men, hoping at least to find safety and security, and perhaps even to make a first step towards a new life. It’s another day at one of the refugee camps where Médecins Sans Frontiéres (MSF) is working in Ethiopia, and “home” to thousands of South Sudanese people fleeing the latest wave of violence in their country. Any day now the rainy season will begin, bringing floods, and creating endless breeding sites for mosquitoes, and with them a new spike in malaria.

Refugees are given insecticide treated bednets, but the shelter conditions are so poor that they’re using the nets as doors to their tents, to provide a modicum of privacy for the 7-10 people living inside.The population is not immunologically naive to malaria: the disease is endemic in the parts of South Sudan where they come from. Still, over one-third of camp residents are children under 5, the group most vulnerable to severe malaria—especially the 7-9% who are severely malnourished. The health of people in the camps is generally poor; many have been walking—sometimes for weeks—fleeing war, with little food or water, and no medical care along the way. Any disease in weakened people will have increased mortality; diarrhea, measles, pneumonia, and of course, malaria, all take a terrible toll.

What can be done beyond just waiting for malaria to sweep in and then treating people who become ill, as MSF and other aid organisations are now doing? We now have tools - from weather monitoring to close surveillance of new cases - to predict the onset of a malaria peak and a large proportion of severe cases, so shouldn’t we be taking more aggressive preventive measures?

Read the full article on BMJ Opinion.