Forgotten people

Malaria control in refugee camps

Controlling malaria amongst refugees is a major challenge for host countries. In sub-Saharan Africa, most refugees live in areas where malaria is the primary cause of illness and death.

Yet malaria control is insufficient in many refugee camps for the following reasons:

• Limited national resources are stretched beyond capacity.
• Shrinking amounts of donor funding and high staff turnover.
• Chronically insufficient rations of both food and non-food items (such as clothing and blankets).
• Malaria treatment continues to consist of a single less effective drug (monotherapy) rather than the internationally recognised combination antimalarial therapy (ACTs) which agencies cannot afford.

In most camps, efforts are made to distribute insecticide-treated nets (ITNs) to the most vulnerable, although this rarely achieves complete coverage. Given the chronic shortages, refugees sell ITNs in exchange for food, clothes or blankets. They are forced to choose between having enough food to eat and preventing disease. For families, hunger appears more 'real' and immediate than the threat of malaria.

The Global Fund for AIDS, TB and Malaria (GFATM) is currently financing many national malaria control programmes to buy ACTs and ITNs. However, in most, if not all, recipient countries, funding is targeted at the national population, not refugees, causing unequal provision of malaria services.

National populations and refugees need the same malaria control policies. This will encourage the more equal distribution of limited resources. Refugees will continue to suffer needlessly until policies address these inequities. Policymakers on a global level need to:

• include refugees in all GFATM-funded malaria interventions
• ensure that malaria treatment guidelines within camps reflect the policies of the host government, particularly if the host government has changed to ACTs
• increase food and non-food items to acceptable levels so that refugees do not have to choose between public health interventions
• provide adequate ITN coverage to both refugees and refugee-affected communities.

Holly Ann Williams
CAPT: US Public Health Service, International Emergency and Refugee Health Branch, Mail Stop E-97, 1600 Clifton Rd NE, Atlanta, GA 30333, USA
T +1 404 498 0467
F +1 404 498 0064
HAWilliams@cdc.gov or hbw2@cdc.gov

Views expressed on these pages are not necessarily those of DFID, IDS, id21 or other contributing institutions. Copyright remains with the original authors but (unless stated otherwise) any article may be copied or quoted without restriction, provided both source (id21, insights) and authors are properly acknowledged and informed. Copyright © 2006 id21. All rights reserved.