No honors being on MSF’s top 10 list

For the past 12 years Doctors Without Borders/Médecins Sans Frontières (MSF) have produced a list of the top 10 humanitarian crises of the year. In 2009 the shame manifested in three distinct patterns:

  1. governments blocked lifesaving assistance to trapped populations, including in Sri Lanka, Pakistan, and Sudan, where aid groups—including some MSF teams—were expelled from Darfur
  2. respect for civilian safety and neutral humanitarian action further eroded, such as in Yemen, Afghanistan, Pakistan, DRC, and Somalia, where people—and in some cases aid workers—were either indiscriminately or directly attacked
  3. people suffering from a host of largely ignored diseases were again neglected by the international community, and those living with HIV/AIDS saw their chances of receiving life extending therapy further diminished

Though malaria is not specifically singled out as a top 10 crisis, it is intricately related to several of the problem locations identified –

  • In the malaria endemic eastern DR Congo, “Throughout 2009, the civilians suffered continuous violence from different armed groups in eastern Congo. Hundreds of people were killed, thousands of women, children, and, sometimes, men were raped and hundreds of thousands of people fled their homes.” Displacement and poor or no access health services increased exposure to malaria morbidity and mortality.
  • Southern Sudan is experiencing renewed violence. “Nearly five years after the Comprehensive Peace Agreement (CPA) ended a brutal, decades-long civil war, medical needs throughout southern Sudan remain at urgent levels, and escalating tensions are creating a precarious security situation.” Again, displaced people are at greater risk of malaria. As AlertNet reminds us, “political and social upheaval which moves populations into endemic areas,” is a key factor exposing people to malaria.
  • MSF also notes a general shortfall in funding for HIV, TB and Malaria as well as neglected diseases. “MSF is calling for governments to fulfill their commitments to provide access to life-saving AIDS treatment for every person in need and to fully fund the fight against AIDS, including through the Global Fund to Fight AIDS, TB, and Malaria.” The timing of the shortfall also could not be worse for malaria programs that are trying to achieve universal coverage in 2010.

The Humanitarian Practice Network points out several conditions where malaria becomes a humanitarian crisis –

  • Severe weather events and changes produce epidemics in areas where malaria transmission is unstable. For example, “In Ethiopia, a malaria epidemic in 2003 is estimated to have affected 21.9 million people in 38 zones, resulting in (at a conservative estimate) 8.7 million cases, with 263,000 deaths.”
  • “Complex emergencies created by war or civil unrest undermine efforts to improve malaria control. In 1984, when Burundi was politically stable, the number of malaria cases each year was 200,000. In 2000, following a period of internal violence and instability, reported annual malaria cases in Burundi were over 3 million. In the late 1970s, the authorities in Afghanistan reported around 300,000 malaria cases annually. By the 1990s, this had risen to 2–3 million cases a year – one of the highest malaria burdens outside Africa.”

Mentor, another malaria partner, wants health workers to be prepared to handle malaria in a humanitarian crisis. After training these health workers should “Be able to prepare and plan for effective priority interventions for the acute emergency context and modify programme approaches according to changes in the situation as the situation moves towards post emergency phase to reconstruction.”

Clearly an emergency response by agencies like MSF and Mentor is needed to save lives from malaria.  The bigger question is what can we do to prevent these humanitarian crises that arise not only from neglect but from outright oppression of peoples? Malaria elimination will never be achieved if such crises continue to create ideal disease breeding grounds.

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