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> 5. Working in fragile and conflict affected states
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People living in conflict affected and fragile states are disproportionately affected by malaria. Mortality rates are 13 times greater in fragile states than in other developing countries. In 2000, it was estimated that up to 30% of malaria deaths in Africa occur in the wake of a war, local violence or natural disaster (B Whyte, World Health Organisation, August 2000 bulletin).
What issues and approaches should we particularly focus on to control malaria in fragile and conflict affected states and in humanitarian situations?
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In situations where large numbers of people aggregate (refugee camps) or become displaced, elimination is not possible. In such situations, vector control based on insecticide treated materials (tents, tarpaulins etc) are an option, besides proper case management. In the immediate surroundings of such places larval source reduction may help. I am under the impression that malaria control in complex emergencies has been undergoing much improvement over the last decade, with better implementation and new tools. In war-stricken areas area-wide approaches are impossible and interventions at household level will be the only option.
In Orissa state, there is a coincidence between areas affected by armed militant political movement and malaria.
The focus should be accelerating all development processes and making the system of governance functional. The intervention cannot be just focus on malaria only. However the strategy can include one time coverage of LLINs to entire High burden areas, intensifying programme strategies, streamlining supply chain management, developing management skills of the programme managers and intensified capacity building of service deliverers.
The focus should be on making all things transparent and making social audit processes ingrained to the programme implementation strategy.
In addition to vector control interventions a liberal use of antimalarials should be employed, similar to IPT, in order to reduce the parasite biomass in the populations and reduce transmission of malaria within camps.