Invisible but Important: IDPs, Refugees and Malaria

Between 1998 and 2008 there were 30 malaria endemic African countries with ≥10,000 refugees and 18 countries with ≥10,000 internally displaced persons (IDPs) according to Paul Spiegel and colleagues. Speigel’s group examined whether these populations were accounted for in National Strategic Plans (NSPs) and approved Global Fund applications.

The results were not encouraging. 7th Space reports that, “For malaria, refugees were not included in 47% of NSPs compared with 44% for IDPs.” National plans and proposals were slightly more accommodating of refugees ans IDPs for HIV. Even when such populations were mentioned, the plans and proposals often did not include specific actions to reach them.

Spiegel reminds us that, “Infectious diseases and neonatal disorders remain the largest cause of excess mortality in conflict settings of low incomes and life expectancies.” Furthermore, the needs of these populations may be hidden when they do not live in designated camps.

Africa is not the only place where people affected by conflict are at great risk of malaria. Richards et al. found that, “Prevalence of plasmodium falciparum in conflict areas of eastern Burma is higher than rates reported among populations in neighboring Thailand, particularly among children. This population serves as a large reservoir of infection that contributes to a high disease burden within Burma and likely constitutes a source of infection for neighboring regions.”

Fürst and co-researchers looked at pre- and post-conflict settings in Côte d’Ivoire and found that, “… the inadequate sanitation infrastructure prior to the conflict further worsened, and the availability and use of protective measures against mosquito bites and accessibility to health care infrastructure deteriorated.”

Nigeria is one of the endemic countries that does not address IDPs or refugees in its 2009-2013 National Strategy or its most recent Round 8 Global Fund malaria grant. Nigeria is not without its IDPs, whether it is the constant threat in the Niger Delta, exemplified by today’s plan by militant groups to abandon their truce, or the recent tragedy of religious conflict in Jos, Plateau State, where over 200 people have been killed and over 3,000 have been forced to flee their homes.

From the foregoing we can see that IDPs, refugees and all those affected by conflict are at greater risk of malaria, and yet we are not adequately planning for this population.  Such neglect will only postpone the day when we can certify elimination of malaria in those countries affected by conflict.

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