Abstract
BackgroundMalaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration.ObjectivesTo examine the impact of political upheaval and population displacement in Timor-Leste (2006) on malaria in the country.MethodCase study approach drawing on both qualitative and quantitative methods including document reviews, in-depth interviews, focus group discussions, site visits and analysis of routinely collected data.FindingsThe conflict had its most profound impact on Dili, the capital city, in which tens of thousands of people were displaced from their homes. The conflict interrupted routine malaria service programs and training, but did not lead to an increase in malaria incidence. Interventions covering treatment, insecticide treated nets (ITN) distribution, vector control, surveillance and health promotion were promptly organized for internally displaced people (IDPs) and routine health services were maintained. Vector control interventions were focused on IDP camps in the city rather than on the whole community. The crisis contributed to policy change with the introduction of Rapid Diagnostic Tests and artemether-lumefantrine for treatment.ConclusionsAlthough the political crisis affected malaria programs there were no outbreaks of malaria. Emergency responses were quickly organized and beneficial long term changes in treatment and diagnosis were facilitated.
Highlights
Malaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration
The malaria rates based in Dili District and the rest of the country were estimated from clinically suspected cases reported to the Ministry of Health (MoH)
Key questions covered in this discussion are: what factors helped to avoid a malaria outbreak during the crisis?; who was targeted in the interventions?; and to what extent were opportunities seized from the crisis response for improvement in malaria control in the long term?
Summary
Malaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration. In April and May 2006 serious political instability and violence affected the newly independent Democratic Republic of Timor-Leste. The risk of infectious diseases in conflict-affected settings is increased. Violent conflict causes population displacement and destruction of infra-. Conflict and Health 2009, 3:11 http://www.conflictandhealth.com/content/3/1/11 structure, as well as the reduction or disruption of health services, including routine disease control programs, which can lead to outbreaks [2,3,4,5]. The lack of clean water supplies, poor sanitation and waste management, overcrowding and poor shelter can increase the risk of communicable diseases including malaria [2,6,7]. The increase in malaria incidence in refugees and displaced populations in African countries has been well documented [11]
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