On 7th August 2012, Bart Knols brought to our attention a lecture by Margaret Heffernan entitled ‘Dare to Disagree’, and which can be seen at http://www.malariaworld.org/blog/margaret-heffernan-must-see-all-mw-subscribers . Margaret Heffernan spoke amongst other things about a scientist, Alice Stewart, who, in the 1950s, investigated and demonstrated the incidence of childhood cancer and its connection with the practice of X-raying pregnant women. Margaret explained the data was out there, it was open, it was freely available, but nobody wanted to know. A child a week was dying but nothing changed. It was fully 25 years before the British and medical establishments abandoned the practice of X-raying pregnant women. As Margaret commented, openness alone can’t drive change.
And so it also appears with malaria elimination.
For the umpteenth time now, it has been written that 100 years ago Palestine was drenched in malaria, and was either thinly populated or uninhabitable in many areas. And yet the following illustration shows Israel (along with Europe and North America) was free of malaria by 1970, whilst most of the rest world continued to languish with the disease.
The method employed in Palestine/Israel 90 years ago for malaria-elimination was based principally on larval-control through destruction of the mosquito breeding sites. It was not reliant on vaccines or drugs. Nor was it reliant on mosquito bednets. Its unique aspect was that of one-to-one Education, which not only ensured the co-operation of Arab and Jew, but also the durability of the malaria elimination through the maintenance of the anti-malaria works.
And perhaps the following will demonstrate the strength of that one-to-one Education, and the resulting commitment by the population to malaria elimination.
Subsequent to the defeat of the Ottoman Empire in World War 1, in 1922 Britain was commissioned by the League of Nations to administer Palestine and Jordan (formerly parts of the Ottoman Empire), and which became known as the British Mandate for Palestine and Trans-Jordan. Each year, the British Government submitted a Report to the League of Nations on the administration of Palestine and Jordan.
However, in 1936 and again in 1937, Britain reported to the League of Nations ‘that public security in Palestine was seriously disturbed by a campaign of murder, intimidation and sabotage conducted by Arab law breakers’. A British Royal Commission reported in 1937 that the manifestoes issued by the Higher Arab Committee under the chairmanship of the Grand Mufti of Jerusalem, the leader of the Palestine Arabs, were clearly prejudicial to law and order and the Mufti had to bear his full share of responsibility for those disorders. The British 1937 League of Nations Report described the violence as a ‘terrorist campaign which took the form of isolated murder and attempted murder; of sporadic cases of armed attacks on military, police and civilian road transport; on Jewish settlement and on both Arab and Jewish private property’. In 1938, the British reported to the League of Nations that the Arab campaign of murder, intimidation and sabotage ‘persisted on lines similar to those followed by Arab law breakers in 1937’, the campaign was intensified and a ‘gradual development during 1938 of Arab gang warfare on organized and to a certain extent co-ordinated lines’ took place. The 1938 Report described not only Arab violence against the British and the Jews but also acts of village and isolated murders and armed robberies by Arabs against Arabs.
Clearly the whole Arab population in Palestine was not responsible for the violence. The Reports referred to brigands and armed bandits escaping into Jordan and Lebanon, and sniping from across the Syrian border, and so it must be assumed that not only Arabs from within Palestine were involved but also Arabs from elsewhere.
There were sections of the Arab community in Palestine which did not sympathise with this violence, and it was these sections which were usually targeted by extreme Arab elements. In order to give an idea of the terror that must have existed, the 1938 Report further stated that many Arabs, ‘as the result of the local terrorism’, left Palestine ‘in the interest of their personal safety’. They became refugees. In 1938, many Jews had fled to Palestine, desperate to escape the Nazis in Germany. But even so, despite such numbers arriving, the Palestine Government statistics for that year show more Moslems and Christians left Palestine than all the Jews who had arrived that year – there was, overall, a negative number of people entering Palestine.
The fact that the Arab and Jewish co-operation with the anti-malaria maintenance works continued throughout this period, that the co-operation had managed to withstand the violence and intimidation, is a testimony to the effectiveness and strength of the one-to-one Education (which education had been an absolutely essential part of the anti-malaria campaign from the outset in 1922). The Arab and Jewish population in Palestine had previously been educated to realise the anti-malaria work was for its benefit, and accordingly, despite the conduct of the extreme Arab elements, the population continued to cooperate with the work. Despite the above turmoil, despite the threats and intimidation, the Palestine Department of Health in its Annual Report for 1938 could still state:
“There was no cessation in antimalarial measures, either urban or rural. In the case of the latter, mixed areas of Jews and Arabs were sometimes a problem, but the difficulties in ALL cases were surmounted by voluntary Arab or Jewish labour with [the protection of] guards, …”
“Expansion in routine work in both urban and rural areas can again be recorded, although the generally unsettled state of the country probably rendered control of malarial conditions in the rural districts more difficult in this disease than in any other. Nevertheless, routine measures were well maintained and general incidence continued to be negligible. …”
But openness alone can’t drive change. You may read this, and still feel perhaps it is better for you not to have to change course (or perhaps you can’t be bothered to change), or perhaps that you will need to convince yourself why the anti-larval and education method couldn’t work in your area, you can give-up and return to your mosquito bednets or your elusive search for the ‘silver bullet’.
But for those who are disappointed or disillusioned with anti-malaria progress, remember the malaria elimination campaign in Palestine/Israel worked. It was not a ‘silver bullet’ however. It took almost 40 years. It was not easy – but it worked. And for those who perhaps wish to examine this further, see
You can take a horse to water, but you can’t make it drink.