Photo: Swiss RadioPHNOM PENH, 4 February 2011 (IRIN) - Health officials warn that an ongoing border dispute and subsequent military build-up along the Thai-Cambodian frontier could undermine global efforts to contain drug-resistant malaria, citing limited access for surveillance, early diagnosis and treatment.
A fisherman plying his trade on the waters of the Tonle Sap lake, Cambodia.
“I hope the critical importance of a global health emergency takes precedence over a political conflict,” Robert Newman, director of the Global Malaria Programme for the World Health Organization (WHO), told IRIN.
His comments follow a three-day visit to what WHO calls the epicentre of the public health emergency: the former Khmer Rouge stronghold of Pailin on the Thai-Cambodian border.
Health officials are concerned that along this forested and mountainous border the parasite that causes malaria is increasingly becoming resistant to the most effective drug they have for treating it, artemisinin.
They are most concerned that the parasite might become completely resistant to the drug, and that this drug resistant parasite could reach Africa.
Photo: Geoffrey Cain/IRIN : A strong military presence is making surveillance efforts difficult In January, WHO launched a US$175 million global containment plan, in partnership with Roll Back Malaria.
Worries about drug-resistant malaria reaching Africa “wake me up in the middle of the night,” Newman said.
A failure of current containment efforts had the potential to be “a public health disaster”, he added.
Recent tests had found that in some villages it was taking twice as long for the drug to clear the parasite from an infected patient, and that in some clusters more than one third of those infected were showing resistance to the drug. The drug resistance was first detected in 2009.
“We need to stop it in its tracks,” Newman warned.
Cambodian warning
His comments follow a similar warning on 1 February from Doung Socheat, the director of the National Center for Parasitology, Entomology and Malaria that the containment effort could be hampered by the border dispute.
After noting correlations between rises in the number of malaria cases along both sides of the border as the conflict escalated over the past three years, Socheat said the containment effort could be delayed if conflict flared again.
The situation was too unpredictable to provide a timeframe, he said.
Socheat also said he had no direct access to data on the incidence of malaria among Cambodian soldiers, as the military operates its own health system, which reports to the Ministry of Defence.
Some health data, primarily reports on fatalities and injuries, is reported to the Ministry of Health.
Epicentre
WHO is working closely with the Thai Ministry of Health as well as their Cambodian counterparts, but public health sources in both countries say they are concerned their respective militaries are reluctant to share medical data due to perceived security concerns.
The first phase of the containment project has received $22.5 million from the Bill and Melinda Gates Foundation. It is focused on the area of the border believed to be the epicentre of drug resistant malaria, and first detected in 2009.
This area encompasses Pailin and several districts of Battambang, Pursat and Banteay Meanchay provinces in western Cambodia, as well as districts on the Thai side of the border.
A section of Kampot Province near Cambodia’s Vietnamese border is also included.
Temple
The majority of troops from both countries are believed to be stationed on each side of the disputed ruins of the Preah Vihear temple along the border.
Both sides have, however, placed reinforcements at other sites along the 800km frontier.
In 2008 Cambodia applied to the UN Educational, Scientific and Cultural Organization (UNESCO) to have the temple - to which both countries lay claim - declared a World Heritage Site.
The application was backed by the Thai government at the time, but was sharply opposed by those who said it threatened Thailand's sovereignty.
Since then, strong nationalist sentiment continues, and there have been sporadic exchanges of fire in areas around the disputed site.
According to WHO, about 3.3 billion people - half the world's population - are at risk of malaria. Every year, this leads to about 250 million malaria cases and nearly one million deaths.
http://www.irinnews.org/report.aspx?ReportID=91827
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