Where Bullets Fly, Malaria Kills
In a camp in Darfur, an infant develops a fever. All too often, the cause is malaria, a disease that flourishes in the chaos of conflict. If the family can access prompt diagnosis and treatment, the child is unlikely to develop a severe case of the disease, let alone die. But time is of the essence. Survival rates plummet if the parasite is left undetected and untreated for more than a couple of days. Where health care facilities have been destroyed, medical supply chains disrupted and health workers overwhelmed by the sheer volume of cases, too many children are dying because conflict prevents timely access to care.
Malnutrition, another consequence of conflict, also contributes to the malaria death toll. Poorly nourished children are far less likely to survive.
Whether in Sudan, Yemen, Myanmar or the Sahel, we see the same pattern. Where bullets fly, malaria becomes even more deadly. In some cases, the disease kills more people than the fighting. With conflicts escalating in so many parts of the world, we are seeing an upsurge in malaria cases and deaths.
The convergence of conflict and malaria is most devastating in Africa, where around 95% of deaths from the disease occur. In Sudan, millions have been displaced. Families are forced into overcrowded settlements, often in areas where malaria transmission was already high. Health facilities have been damaged, looted or abandoned. Supply chains have fractured. Surveillance systems – the early warning mechanisms that allow us to detect and respond to outbreaks – have weakened or disappeared altogether.
Together with partners, we are doing our utmost to contain the disease. In 2025, in conjunction with the Sudanese Federal Ministry of Health and UNICEF, we launched a campaign to deliver 15.6 million insecticide-treated mosquito nets to protect around 28 million people – roughly two-thirds of the population – in the most affected areas. By the end of the year, 12.7 million had been distributed, while the remainder – largely for North Darfur and internally displaced communities living in camps – should be delivered by May 2026.
Providing such protection to families in the midst of conflict requires determination, courage and flexibility. Health workers have had to reach across lines of conflict. Net distribution has been combined with other efforts, including vaccination and nutritional support. Mobile health units – effectively clinics on pickup trucks – are now providing testing and treatment to people in displacement camps and remote areas. Community health workers are filling the gaps left by the destruction of formal health systems.
Sudan is not unique. In Myanmar, increased conflict is fueling a resurgence in malaria cases. In Ethiopia, Nigeria, Mozambique and the Democratic Republic of the Congo, malaria is increasing in regions where conflict disrupts efforts to provide surveillance, prevention, diagnosis and treatment.
In each of these cases, and in many areas afflicted by conflict elsewhere, we are working with overstretched national malaria programs and brave, committed frontline health workers to prevent the malaria challenge from becoming a catastrophe. But while such efforts are saving lives and helping to reduce malaria transmission, we cannot pretend we are winning: In too many conflict zones, malaria cases and deaths are on the increase.
Of course, the best answer would be to end the fighting. The indisputable fact that conflict fuels deadly diseases like malaria should give even greater urgency to efforts to find peace. Yet we also cannot simply wait in hope. Many of these conflicts are not going to be resolved quickly, since the underlying causes are often deep-rooted and intractable. So we must act to contain malaria even while conflict rages – not only to save lives, but because letting malaria run rampant will only exacerbate divisions, undermine the search for peaceful solutions and endanger any post-conflict recovery.
Saving the lives of hundreds of thousands of young children and pregnant women from a preventable, curable disease made worse by conflict might seem an utterly compelling proposition. We know what works. We have the tools. Almost every analysis of the cost-effectiveness of health interventions ranks malaria programs amongst the top. Yet global malaria funding is declining. At a time when conflict, climate change, and vector and parasite resistance are making this age-old disease even deadlier, the money is being cut.
From a moral perspective, this is hard to explain or justify. It is equally hard to see the logic from either epidemiological or economic perspectives. The rational approach to malaria is to invest enough to break the transmission cycle and eliminate it. Forty-five countries have succeeded in doing this, many of them supported by the Global Fund. Among the most recent are Timor-Leste and Suriname. When countries eliminate malaria, their need for external funding plummets. Educational attainment and labor productivity jump, and health system performance increases as capacity is freed up.
Yet when we invest too little, which is the sad reality in many of the most affected parts of the world, we are not just letting too many children die now, but creating a much bigger problem for the future. Malaria is very unforgiving: It gets worse very quickly when uncontained, and it spreads across borders with little regard for national frontiers. Ultimately, intense malaria transmission is incompatible with sustained social and economic development. So if we want to help the poorest communities in the world escape poverty and flourish, we will have to tackle malaria. Letting it get worse before we do so will only increase the cost.
In Darfur, and in too many places riven by conflict, the outcome for a child with malaria depends on a few things that might, in theory, be simple: whether prevention tools are available, whether a diagnosis can be made in time, and whether effective treatment is within reach.
These are solvable problems. But only if we choose to solve them.
On this World Malaria Day, we should be clear-eyed about the challenge. Conflict is reshaping the malaria landscape – making the fight harder, more complex and more urgent. But it does not have to determine the outcome.
We have the tools. We have the knowledge. What we need now is the resolve – to ensure that even in the world’s most difficult places, a preventable and treatable disease does not continue to take a child’s life every minute.
Because no child should die for lack of a net, a test or a simple course of treatment – no matter where they are.
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