The menace of climate change, civil strife, and growing resistance to conventional insecticides is paving the way for a concerning rise in disease cases.
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An entomologist is on the job, gathering mosquitoes along Butuji River in Dire Dawa, Ethiopia, thanks to Tiksa Negeri from The New York Times for the visuals.
Ethiopia is witnessing a dramatic spike in malaria infections, escalated by armed conflicts, climate change, and mosquitoes developing resistance to medications and insecticides — a setback for a nation that was once optimistic about controlling this disease.
This year, over 6.1 million malaria cases and 1,038 fatalities were reported up to September, a sharp increase from 4.5 million cases and 469 deaths recorded throughout 2023. The situation is expected to worsen, with malaria’s peak season aligning with the seasonal rains starting in September and persisting until the year’s end.
“We’ve regressed alarmingly; it feels like we’ve lost a decade’s worth of progress,” says Fitsum Tadesse, the key scientist directing the malaria initiative at Addis Ababa’s Armauer Hansen Research Institute.
The escalation of malaria cases in Ethiopia might signify a looming threat for neighboring nations dealing with similar biological challenges alongside war and climate upheaval, prompting increased susceptibility among populations.
According to Dr. Tadesse, the heightened resistance to drugs is a culprit: Malaria parasites in East Africa are becoming less responsive to long-standing treatments.
Moreover, mosquitoes are evolving, shrugging off insecticides intended for use on nets and indoor spraying. Add to that, they’ve adapted to sidestep detection by common malaria diagnostic tests.
“It’s a perfect storm with all the biological stars aligning in the worst way,” remarked Dr. Tadesse.
The Oromia region bears the brunt of this surge, where federal troops wrestle with separatist fighters amidst a protracted civil war. Fighting between the Ethiopian military and the Oromo Liberation Army has raged over five years, uprooting over 1.5 million residents. Some zones, such as West Welega — record-holder for 2024’s highest malaria cases, are out of reach for aid groups.
Ongoing hostilities have hampered Ethiopia’s healthcare, stalled malaria control efforts, and displaced folks, making it challenging and sometimes impossible for them to access healthcare. These individuals, residing in temporary shelters, face greater risks for mosquito bites and might inadvertently introduce the disease to new territories. Ethiopia’s porous borders, like the one adjoining conflict-ridden Sudan to the northwest, exacerbate the issue.
Humanitarian bodies are struggling to deliver bed nets, drugs, or diagnostic kits. Absent timely diagnosis and care, malaria can swiftly infiltrate families and expand through entire communities.
Coupled with this, the sweep of climate change is rendering new Ethiopian terrains susceptible; areas inexperienced with malaria are now grappling with infections. Numerous outbursts occurred in high-altitude locales — over 2,000 meters (approx. 6,560 feet) where mosquitoes and malaria carriers historically faltered. Now, warming, wetter climates are creating optimal conditions for these pests.
“We’re only beginning to understand how climate change factors into this mix, but its repercussions magnify amidst chaos,” Dr. Tadesse explained.
Ethiopia faces an additional hazard in the form of the invasive Asian mosquito, Anopheles stephensi, which has recently settled in various parts of the country. Once largely a rural adversary, malaria is now emerging in urban settings, courtesy of stephensi — thriving in cities’ nooks like discarded cans and drainage ditches. A malaria spike in Dire Dawa has alarmed health experts who had geared malaria strategies for rural areas.
Stephensi equally thrives at construction sites, with large water-holding containers for cement and bricks becoming a common sight in fast-growing urban regions.
Seada Ahmed, in charge of health education and communications at Oromia Health Bureau, revealed that certain urban locales reported inaugural malaria cases this year.
Years of targeted investment saw malaria incidences in Oromia plummet from 900,000 in 2011 to about 100,000 annually by 2019. However, last year’s figures rocketed to 2.8 million, with 1.4 million of the region’s 45 million diagnosed in only the past three months.
According to Ms. Ahmed, part of this elevated case count can be linked to improved case detection, with local health workers conducting door-to-door campaigns tracking new infections.
Numerous cases are severe; last year saw only 623 hospitalizations, yet, over 41,000 required hospitalization since this year’s July, Ms. Ahmed noted.
Ababaye Tilahun, a 15-year veteran health worker in West Welega, highlighted that “This year’s malaria crisis surpasses any previous experience.”
Stephanie Nolen covers global health for The Times.
Edited by: Ali Musa
alimusa@axadletimes.com
Axadle international–Monitoring
