The 2019 Theme of World Refugee Day is #StepWithRefugees – Take A Step on World Refugee Day. Taking steps in solidarity with refugees ensures that one recognizes that refugees experience several health problems, with malaria being especially devastating. Refugees may come from a malaria endemic area and move to one where there is no malaria and health workers may not recognize and treat it correctly. In contrast they may move from a non-endemic area into one with malaria transmission. Even if refugees move from one malarious area to another, the conditions of the camps where they shelter may lead to increased malaria morbidity and mortality.
In fact, Jamie Anderson and colleagues observe that, “Almost two-thirds of refugees, internally displaced persons, returnees and other persons affected by humanitarian emergencies live in malaria endemic regions. Malaria remains a significant threat to the health of these populations.” They found that, “an average of 1.18 million refugees resided in 60 refugee sites within nine countries with at least 50 cases of malaria per 1000 refugees during the study period 2008-2009,” a major disease burden. According to the authors, groups like UNHCR and the UN Foundation’s Nothing But Nets aim to increase LLIN coverage of vulnerable groups in emergency situations.
The US Centers for Disease Control and Prevention offers guidance to health staff in the United States who may encounter refugees coming from a malaria endemic country. These guidelines look at appropriate treatment regimens for either pre-travel or on arrival presumptive treatment. They address the challenges of sub-clinical disease, as well as testing and treatment for people with symptoms. Likewise, the Refugee Technical Assistance Center stresses the need for, “All refugees from malaria endemic areas, including those who have been presumptively treated for P. falciparum, should be tested for malaria if they develop clinical signs or symptoms of the disease.” Stefan Collinet-Adler et al. found that “Overseas presumptive therapy has greater cost-benefits than U.S. based screening and treatment strategies.”
The challenge of refugees moving from one endemic country, such as Burundi, to another was highlighted by MSF staff in Tanzania. Saschveen Singh reported that she, “was well versed in the emergency management of these cases from my previous training and from reading all the MSF clinical guidelines. But it was quite overwhelming to see how many admissions we had on the wards, and to see the outpatient area absolutely overflowing with patients with malarious fevers, and the number of our Burundian staff succumbing to the disease. With malaria, the worst of the worst cases are sadly always children.”
A few years ago, the US President’s Malaria Initiative in Kenya contributed to indoor residual spraying at a refugee camp. “Malaria has also been a recurrent problem in Kakuma Refugee Camp, particularly following large-scale population influxes from South Sudan, where malaria is endemic. Both ITNs and IRS have been used historically for malaria prevention in the camp along with prompt, effective case management for persons diagnosed with malaria. With the pyrethroid donation from PMI-Kenya, NRC implemented a successful IRS program,” covering an estimated 143,000 people.
It is encouraging to note that many agencies, international and domestic, and not just those specializing in refugee needs, lend a hand guaranteeing that refugees have a right to basic malaria prevention and treatment.