So you live in DR Congo. Your youngest child has visited the health post today, she is diagnosed with malaria. You were lucky that there was somebody at the clinic today. They gave you a blister with drugs. It is not quite clear how you got the first capsule into this two year old, but you managed. She is asleep now, safely under a mosquito net that was donated to you last year.
All of a sudden you hear noise outside. Gunshots, men running, men screaming. You know what this means. You, your family, you have to run. NOW.
With your five children and your pregnant wife, you run. You flee into the bush, in the dark night. You carry two children; the rest has to take care of them selves. Two hours later, you find yourself in the pitch dark forest with most of the rest of the villagers. Your two year old is asleep in her mother’s arms, the rest of your family is right awake. You are safe for tonight.
After a scary two nights in the bush, you return to your village. There is nothing left of your village. All the houses have been burned down. There is nothing left of your possessions, no food, nothing. Not even the birds sing. Your child is getting more ill by the hour. The only hospital that you know is a day’s walk. It is too late to go today, you will try tomorrow.
One more night in the open air. One more night at the mercy of the most aggressive Anopheles species. Your whole family is now being attacked, not by rebels, but by mosquitos. When you reach the hospital the next day, they can just safe your two year old with iv artesunate. The whole family tests positive with an RDT. You receive treatment, and you can actually take it, staying in relative safety of yet another village. It will take only two months, before the scenario repeats itself.
You and I cannot stop the war. But we can think out of the box and try to look for solutions that can reach people who live in conflict and war.
This is a daily scenario for families all over eastern Congo. If you live in a village is DR Congo, sleeping under a mosquito net could mean a fatal delay in fleeing if the rebels attack. A certain death sentence. Would you take your ACT blister to treat your child if you had to run? Would you take a net to hang in the bush in the middle of the night? No, you would probably not.
Most of us in the malaria community are content with the decline of malaria morbidity and mortality in the world. We focus on success countries. We focus on countries that are thinking about elimination after a tremendous effort to scale up malaria control. The success of the increased funds to combat malaria is something to be proud of. But fragile states do not benefit enough. They see the reverse trend. Malaria is on the rise again. The effect of conflict on malaria has been documented over the last century (Cohen et al 2012).
And it is documented NOW by aid organisations working in conflict settings. Every year they see more and more malaria cases. It is a battle that seems to be without end.
Data of one MSF clinic as example.
Prevention, good diagnostics and effective treatment are the mainstay of our tools to fight malaria. But how can you spray a house, when there is no house? Where should you hang a mosquito net in the bush? Can we blame papa Kambale for leaving his ACT blisterpack when he had to run? Can we blame the health worker for not being in his clinic when he has not been paid or received supplies in this part of the country? The tools we have will not work for papa Kambale. If we don’t want malaria to be a synonym for conflict and poverty, we must act NOW.
So if you walk to your office/lab/university tomorrow, think about papa Kambale. What can you do to make him less vulnerable to malaria? You and I cannot stop the war. But we can think out of the box and try to look for solutions that can reach him. And his family. Whether they sleep in their hut, in a refugee tent, under plastic sheeting, or under the naked sky in the tropical rainforest of Congo. He needs you.
Cohen et al: Malaria resurgence: a systematic review and assessment of it’s causes. Malaria Journal 2012 11: 122
Note: The people in the story are not featuring on the photo.
Marit de Wit is the Malaria Advisor for MSF-Operational Centre Amsterdam. She is also the Health Advisor (overall medical programme responsible) for Ethiopia, Kenya and Nigeria. Her passion is improving malaria care in conflict settings, where conventional malaria interventions can’t be applied.