NEW YORK // Efforts to rid the Arabian Peninsula of malaria are in jeopardy, with fighting between rebels and government forces on either side of the border between Saudi Arabia and Yemen expected to spawn fresh outbreaks of the mosquito-borne killer. Health chiefs from across the Gulf were previously confident of declaring victory over the parasite infection in the region by the target date of 2020.
But, after this year's World Malaria Report, researchers in the World Health Organisation (WHO) are warning that a drawn-out conflict between government troops and Yemen's Shia rebels could see that malaria goal missed. Dr Hoda Atta, WHO's malaria expert for a 22-nation bloc called the Eastern Mediterranean, said: ""The conflict is in exactly the same area where malaria is most prevalent in Saudi Arabia, as well as the high endemic area in Yemen.
"If we are not able to reach the population and there are weaknesses in the programme, I expect the prevalence will increase. This political situation presents a big challenge to malaria elimination efforts in our region." While Saudi officials have battled hard against malaria over the past decade, bringing the number of confirmed locally acquired cases down from about 1,614 in 2001 to 61 last year, instability in Yemen has seen the number of confirmed cases fluctuating around 50,000 for the past five years.
Yemen's actual number of cases of the infectious disease, which is transmitted to humans by the bite of an infected female anopheles mosquito and causes high fever, shaking and chills, was estimated at about 287,500 last year. A fresh outbreak of fighting between a tribe of Yemeni Shias, called the Houthis, and government forces in northern Yemen beginning in August snowballed into a cross-border conflict in November when the rebels began battling Saudi troops within the kingdom's territory.
Saudi Arabia recently said the Houthis had been mostly beaten back into Yemen, but the rebels have vowed to fight on. The UN estimates 175,000 people have been displaced in five years of fighting, with many now living in overcrowded refugee camps and makeshift accommodation, with cramped conditions and poor sanitation raising fears of disease outbreaks. Adrian Edwards, the spokesman for the UN's refugee agency, said displaced Yemeni families are receiving mosquito nets to sleep under because many of the camps are located in areas in which the disease is endemic.
Tests on a selection of 181 refugees in November revealed about eight per cent were infected with malaria, he said, adding: "Right at the moment it looks like things are under control, but we are still in early days." With anti-malaria crews unable to spray insecticides and access rural populations, Dr Atta fears a resurgence of the mosquito-borne killer in a manner she likens to the disease's comeback following wars in Afghanistan and Iraq.
"Before these political problems, a lot had been achieved in building a relationship between Saudi Arabia and Yemen," she said. "There was strong cross-border co-ordination of malaria control, with Saudi Arabia generously donating insecticide and spraying machines. The financial support to Yemen's malaria-control efforts has been extended to include other Gulf countries under the umbrella of the Malaria-Free Arabian Peninsula Initiative.
"But conflict in Yemen represents a challenge to combating malaria in the border area between Saudi Arabia and Yemen. If the situation gets worse or continues like this, it might be difficult for the Saudis or Yemenis to reach some places near the border and they may not be able to implement the anti-malaria campaign." Health chiefs must wait until the end of the season in which malaria-carrying mosquitoes are most active in mountainous areas, between October and April, before they can assess how many people have fallen victim to the disease.
A combination of spraying insecticides on mosquito-breeding grounds, speedy treatment of sufferers and widespread testing of migrant workers has seen malaria largely eradicated across much of the peninsula over recent decades. Experts laud progress in the UAE, which reported its last home-grown case in 1997 and was certified malaria-free in January 2007, for preventing "re-establishment of transmission - despite having areas with abundant malaria vectors and suitable climate conditions", the 66-page report said.
Princess Astrid of Belgium, a special representative for the UN's Roll Back Malaria Partnership, visited the UAE, Qatar and Saudi in March in a bid to secure extra funding for tackling the disease on the peninsula and beyond. "This report shows that it is still possible to achieve the goal of having an Arabian Peninsula free from malaria by the target date," said the campaign's spokesman, Herve Verhoosel. "But to make that happen we need to focus on prevention, adequate treatment and political leadership.
"That's why we're looking to the UAE and other countries that have successfully eradicated malaria to provide leadership and guidance." Although malaria remains a concern on the peninsula, Yemen and Saudi Arabia account for only a fraction of the estimated 8.6 million cases across the wider region - with 90 per cent of the Eastern Mediterranean zone's infections occurring in Afghanistan, Pakistan, Somalia and Sudan.
Globally, the WHO reports that increases in international funding pledges, from US$730 million (Dh2.681 billion) in 2006 to $1.7bn this year, are helping to reduce the number of infections, with malaria nets and treatments achieving significant gains across Africa. @Email:firstname.lastname@example.org