Excerpts from the MSF Refugee handbook
Although the degree of malaria transmission varies greatly from one part of the world to another, more than 80% of cases are observed in tropical Africa. The majority of malaria deaths occur in Africa and among non-immune individuals in areas where appropriate treatment is not available.
Over recent years, there has been an increasing number of malaria epidemics in endemic areas. This is due to many factors, including wars and disasters which play an obvious role by provoking the displacements of population which may be non-immune, and the collapse of public health services.
Malaria is frequently a leading cause of morbidity, and an important cause of death among adult refugees in some areas (Sudan, Malawi, Mozambique and Thailand). It is already a major health problem in many countries hosting refugee populations.
Since malaria can be difficult to implement within the constraints of many refugee emergencies, particular attention should be given to the prompt and effective management of malaria illness. There is no standard treatment for malaria because of its growing resistance to certain drugs and the different immunity levels in refugee populations.
No clear definition or thresholds for epidemics have been determined. An epidemic should be suspected when there is a local increase in malaria morbidity and or mortality. In the occurrence of an outbreak due to a febrile illness and causing deaths, blood smears (even post-mortem) will confirm or exclude a malaria outbreak.