Eliminating malaria in conflict zones: public health strategies developed in the Sri Lanka Civil War

Abstract

Despite the 26-year long civil war, Sri Lanka was declared malaria-free by WHO in 2016. This achievement was the result of nearly 30 years of elimination efforts following the last significant resurgence of malaria cases in Sri Lanka. The resurgence occurred in 1986–1987, when about 600 000 cases of malaria were detected. Obstacles to these efforts included a lack of healthcare workers in conflict zones, a disruption of vector control efforts, gaps in the medication supply chain, and rising malaria cases among the displaced population.This article seeks to describe the four strategies deployed in Sri Lanka to mitigate the aforementioned obstacles to ultimately achieve malaria elimination. The first approach was the support for disease elimination by the government of Sri Lanka and the Liberation Tamil Tigers of Elam. The second strategy was the balance of centralised leadership of the federal government and the decentralised programme operation at the regional level. The third strategy was the engagement of non-governmental stakeholders to fill in gaps left by the conflict to continue the elimination efforts. The last strategy is the ongoing efforts by the government, military and non-profit organisations to prevent the reintroduction of malaria.The lessons learnt from Sri Lanka have important implications for malaria-endemic nations that are in conflict such as Ethiopia, Afghanistan, Yemen and Somalia. To accomplish the World Health Assembly goal of reducing the global incidence and mortality of malaria by 90% by 2030, significant efforts are required to lessen the disease burden in conflict zones. In addition to the direct impacts of conflict on population health, conflicts may lead to increased risk of spread of malaria, both within a country and consequently, abroad.

What India can learn from globally successful malaria elimination programmes

“…Despite facing a civil war, Sri Lanka achieved the elimination of malaria. The realisation that malaria is deadly but can be prevented and cured, the motivation and cooperation of conflicting groups to work with the government to protect the populations, and the involvement of neutral organisations played crucial roles 24…”

Utilization of insecticide-treated nets and associated factors among childbearing women in Northern Nigeria

“…Two, armed insurgency usually causes environmental disruption that not only encourages the breeding of malaria vectors but also hinders larval source management [ 34 , 34 ]. Three, the movement of government military forces in and out of the battlefronts increases the risk of malaria spread and infection among soldiers who may transmit the same to members of their households [ 35 ]. These possibilities do not only adversely affect women’s and children’s health outcomes in the communities affected by armed conflicts but also significantly alter health-seeking behaviour in the affected communities [ 36 – 38 ].…”

A History of Malaria and Conflict

“…Nevertheless, there is also a glimmer of hope on the horizon regarding malaria and conflict: it comes in the form of the nations of El Salvador and Sri Lanka. In the former, an eradication program had proven very successful amidst civil conflicts in the 1980s (Packard 2007a ), whereas in Sri Lanka, malaria elimination was officially declared by the WHO fairly recently in 2016, despite the country having suffered from a 26-year-long civil war (Ahmed et al 2021 ). Strategies employed there could serve as a template for future elimination campaigns in other war-ravaged regions with malaria endemicity such as Somalia, Ethiopia, Yemen, and Afghanistan.…”