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MSF hospital in Agok

South Sudan 2017 © Peter Bauza


Malaria is the world’s most deadly parasite, killing hundreds of thousands each year—the vast majority in Africa.

Putting malaria in context

In 2022, there were nearly 250 million malaria cases around the world, with over 600,000 deaths as a result of the disease. Africa bears the greatest burden: 95 percent of malaria deaths occur on the continent, and 78 percent of these deaths are children under five years old. This suffering and loss of life is all the more tragic because malaria is preventable and treatable. Doctors Without Borders/Médecins Sans Frontières (MSF) treated 4.2 million cases of malaria in 2022 in some of the most at-risk, hard-to-reach parts of the world. 

1 child

dies of malaria every 2 minutes on average

24 hours

time to treat malaria before it turns severe


cost of anti-malarial pills to treat one child

Facts about malaria

Malaria is a parasitic infection spread by the bite of infected female Anopheles mosquitoes. Once the parasite is inside the human body, it makes its way to the red blood cells, where parasites multiply rapidly until they burst out of the red blood cells and into the bloodstream.

Infants and children under five years old are especially vulnerable to infection and serious consequences of malaria since they haven't yet developed immunity. People displaced by conflict or natural disaster are also at an increased risk of malaria, often due to living conditions that fuel transmission: inadequate shelter in overcrowded camps near standing water and livestock. Displaced people coming from places where malaria is not common to areas where malaria is common are particularly vulnerable because they lack the partial immunity developed by continuous exposure since childhood; when infected, they tend to get very sick. 

Pregnant women with malaria are at increased risk of anemia, severe sickness, and death; there is also a higher chance that the pregnancy will develop complications or end in miscarriage, or cause fetal growth restriction. 

Malaria often begins as a flu-like illness. Fever typically appears 9-14 days after infection (typical cycles of fever, shaking chills, and drenching sweats may develop) and may be accompanied by multiple non-specific symptoms, which makes clinical diagnosis difficult. The disease also causes the destruction of red blood cells, leading to anemia.  

If simple malaria is not treated, it can become severe, increasing the risk of death. That’s why early diagnosis and quick treatment are vital. Severe malaria parasites that attack the brain can cause seizures and coma, and other severe cases can lead to breathing problems, kidney failure, and/or severe anemia. Each year about eight million malaria patients develop life-threatening complications. 

Malaria-carrying mosquitoes usually bite from dusk to dawn. Since mosquitoes breed in water, they are especially plentiful during the rainy season, causing malaria infections to increase.

The most basic prevention measure is to avoid bites. This can be done through indoor spraying of homes with safe, long-lasting insecticides and/or by sleeping under mosquito nets treated with long-lasting insecticide. More recently, antimalarial drugs have been used to prevent infection among the most at-risk populations for limited periods of time. Seasonal malaria chemoprevention (SMC) is now recommended for children during the highest-transmission months in some regions. Preventive drug treatment is also recommended for pregnant women at routine prenatal care visits after the first trimester of pregnancy, for infants during routine vaccination visits, and at the time of discharge for some hospitalized children.

Diagnosing malaria is usually done with rapid diagnostic tests using blood from a finger prick. The tests are easy to perform, and community health workers can be trained to do them. A more accurate test is done by using a microscope to look directly for malaria parasites in a drop of blood. But most primary health facilities don't have microscopes or trained lab technicians, and microscopy is much more labor-intensive, so this diagnostic test is often not feasible.

In some settings, no testing is available at all, so community health workers must diagnose sick children based on symptoms alone. This often leads to the overdiagnosis of malaria while the real cause of patients’ symptoms goes untreated.

The most effective treatment for malaria is a combination of two drugs known as artemisinin-based combination therapy (ACT), which cures most infections in three days. These ACTs consist of a potent antimalarial from the artemisinin family combined with a second “partner” antimalarial drug.

Early treatment is essential since the longer the disease lasts, the more likely it will progress to severe malaria. Severe malaria requires hospitalization so patients can be given intravenous antimalarials along with supportive treatment. Patients often need blood transfusions, which in turn requires a safe, adequately-stocked blood bank—something that’s difficult to achieve in under-resourced areas, especially in sub-Saharan Africa. 

Without treatment, or with significantly delayed treatment, severe malaria kills. Treatment with artemisinins is usually very effective but the malaria parasite has developed resistance to artemisinin in some regions, particularly in Southeast Asia, meaning that ACT may no longer be effective. If the spread of resistance cannot be stopped, it could mean a resurgence of malaria since there aren’t currently any new drugs available. 

Larviciding using biological insecticides

How MSF responds to malaria

Malaria is one of the most common diseases MSF treats. A big part of our efforts is focused on South Sudan, Democratic Republic of Congo, and Central African Republic, and we treat malaria in dozens of other countries as well. Our malaria strategy is focused on improving prevention, reaching and treating the most vulnerable, and enhancing advance planning for malaria seasons in the most affected regions where we work. 

Reaching the hard-to-reach 

One of the biggest challenges MSF faces is getting malaria care to those who need it the most: people living in remote, insecure areas with little or no health care access. Whether because of seasonal rains that flood roads or active armed conflict that forces people to leave their homes, finding better ways to effectively reach and treat our patients where they are is a challenge MSF is always trying to overcome. 

One strategy is to use mobile clinics that travel to remote villages without health clinics nearby. For example, in the Central African Republic, many regions are isolated because of armed conflict, which has disrupted the already weak government health services. There is no public transportation for people to travel to larger towns. MSF mobile clinics drive two to three hours to visit remote villages to test for and treat malaria, transferring those already severely sick to hospitals. 

Another strategy is to train and equip community health workers with supplies for providing care in areas MSF teams can’t reach consistently reach. In South Sudan, MSF has de-centralized simple malaria care by training community health workers who can test for and treat malaria in clinic teams. When people are forced to leave their homes because of fighting nearby, these health worker teams move with them since they are part of the community, and continue providing health care. The teams run clinics wherever they are six days a week, caring for thousands of people displaced by the conflict while on the move. MSF re-supplies them with tests and drugs when security allows. 

Community health workers in all projects also pass on vital educational messages about the importance of using mosquito nets wherever possible and seeking treatment for children when they have fever. 

Prevention activities 

Our programs incorporate various prevention approaches, depending on context—from distribution of mosquito nets to spraying larvicide to prevent the breeding of mosquitoes. In some affected regions malaria is highly seasonal, with the number of infections increasing exponentially during the few months of the rainy season.  

Innovating against resistance 

In Southeast Asia, a key epicenter of resistance to anti-malarial drugs globally, our projects are actively researching the emergence of artemisinin-resistant malaria and piloting strategies to combat it. We’re also working to find and treat patients with artemisinin-resistant (ACT) strains of malaria, and along the way adapting strategies and tools to better meet the challenges of resistance and malaria elimination. 


Malaria spikes are too often treated as an unpredicted emergency despite the fact that we now have tools—from weather monitoring to close surveillance of new cases—to anticipate the onset of malaria peaks. Countries need to use these tools better to prepare for seasonal outbreaks by pre-positioning preventive antimalarials and mosquito nets that can be distributed once the rainy season begins and by investing more in community-based care.

Three questions on malaria