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The key to successful malaria eradication in Palestine/Israel 90 years ago

June 1, 2012 - 15:25 -- Anton Alexander

The article or blog ‘How was malaria of 100 years ago eradicated in Palestine/Israel? And without vaccine?’ of 21st May 2012 seemed incomplete, and needed an additional essential point explained.

The methods of Dr Kligler, the architect of the eradication campaign, were based on sound principles, and while not novel in practice, were unique in many of their details. (See www.eradication-of-malaria.com).  But the long term personal involvement of anti-malaria experts in diseased Palestine, and the education provided to the population about the anti-malaria campaign, may appear to have been the key to successful malaria eradication.

The impressive fact that the area of malaria-saturated, thinly populated Palestine 100 years ago is today the vibrant country of Israel, the 30th most densely populated country in the world, has obscured an important element of how malaria was eradicated. This article will now examine that aspect which appears to have perhaps passed unnoticed.

Palestine, 90 years ago was deemed by the British Mandate to be almost ‘hopeless from the malarial standpoint’**, with much of the area uninhabitable on account of the severity of the disease. But only twenty years later, Dr Kligler’s methods were already shown to be effective, when the British could write in 1941:

‘An interesting recent feature has been noticed. In a number of areas where intense endemic malaria had resulted in NO population for generations, recent schemes (of malaria control) have created large tracts of cultivatable land.’**

** Dept. of Health. British Mandate. A Review of the control of Malaria in Palestine 1918-1941.

Many may need to be reminded of the effect of malaria. Many think in terms only of mortality of the disease. But not everyone dies from it, and the following was written by Dr Kligler in 1925:

‘For it is an accepted fact that chronic parasitic diseases such as malaria, sleeping sickness and hookworm exert a far more profound influence on the rate of progress in a country than do any of the acute epidemic diseases. The constant presence of yellow fever, for example, in Havana or Merida from about 1650 until quite recently has had but little effect on the prosperity of those cities. Malaria, on the other hand, although less fatal than yellow fever, has greatly retarded the development of areas where it prevails, witness the large tracts in the lime sink belt of Georgia and the marshy areas in Mississipi, which are all but devoid of upstanding, productive inhabitants.’

Of the inhabitants of Palestine at that time, many would already have been stricken with the disease, and Kligler’s description above of them would have meant a community without energy or vitality, and therefore unlikely on its own to initiate change to or improvements of the health conditions.

Even the early pre-WW1 idealist Zionists attempts to survive the conditions then prevailing in Palestine, before Kligler’s arrival in 1920, were mainly unsuccessful, and of the approximate 75,000 Zionists who arrived to settle in Palestine between 1882-1914, by 1914 about half this number either had died or had left unable to cope with the severe conditions.

Apart from not possessing  the knowledge or expertise to battle malaria, the inhabitants probably also lacked (due to endemic malaria) the productive drive to initiate and organise the country for such a task. These matters needed to be arranged for them.

Dr Kligler had arrived in Palestine in 1920. He had a vision, along with all the other idealistic Zionists, of Jewish self- determination in Palestine. Control of malaria was a necessary goal, and failure was not an option, otherwise much of Palestine would have remained uninhabitable, and Zionism would have remained unfulfilled.

Kligler already had a significant scientific reputation when he arrived to make the country habitable. He was motivated, he came to settle, he  therefore  was patient (as he was there for the long term)  and applied that which was practical rather than only theoretical.

Anti-malaria measures involving the population were repetitive, possibly tedious, detailed, and sometimes without apparent purpose or end, and required constant vigilance. The Palestine  malaria elimination campaign for years required monotonous daily, weekly or monthly routine inspections, but attention to detail  ensured the data recorded was accurate, so that conclusions could be drawn from valid correct data. This was the aspect of the Palestine anti-malaria campaign which the League of Nations’ visit in 1925 in their Report stressed as vital.

Collection of data regarding the prevalence of the disease, types and breeding places of the mosquitoes concerned went hand in hand with the education of the public in regard to controlling the disease, and Kligler emphasised the value of this education was probably as important as the immediately practical results obtained.

The phase of education was particularly stressed: by means of illustrated lectures on malaria, its causes, prevalence and modes of prevention; by illustrated pamphlets; and by personal interviews and visits to delinquent families by local malaria inspectors.  Palestine had its own Health Day with lectures, visits to breeding places and demonstrations of methods of control.

(Illustration from 1920s/1930s showing Protection measures against mosquito breeding. - From Israel State Archives, Jerusalem)

Whilst the British Mandate introduced ordinances and regulations to facilitate the anti-malaria works, eventually enforcement of the regulations obliging co-operation became usually unnecessary because the population generally understood and appreciated the purpose of the anti-malaria methods , thanks to the education about the anti-malaria steps being undertaken.

The population had to be pulling in the same direction as those conducting the anti-malaria campaign. Kligler was dealing with a very thinly populated country (with a density of only 29.1 inhabitants per sq km) so his task was that much easier than had it been denser, as that would have then required more intense and prolonged education.

A problem for each country wishing to rid itself of malaria is to possibly find the equivalent of a ‘Zionist’ cause, thereby attracting anti-malaria experts to come, to remain and participate in the future of that country, which may perhaps be the recipe for success. Perhaps each country can then secure a long term commitment to the elimination of this accursed disease.

Comments

Submitted by Guest (not verified) on

Dear Anton,

VERY WELL done, and VERY WELL represented!

I would like onlt to stress, that about 60% of Israel's area are a DESERT, which is deprived of water and so is also malaria free. But due to its dryness it is also nearly human free. Which leaves only about 50% of the country's area for dense human settlement. So its REAL population density grew within one hundred years c. 200 times!

Zvi Shilony