18 April 2024 – In the Iranian coastal town of Konarak, on the country’s southern shores, a young sailor’s journey took an unexpected turn. Esmaeil, aged 19 years, found himself grappling with a high fever and crippling body pain while aboard a fishing vessel.

With his condition rapidly deteriorating, the boat made an unplanned stop near Bandzark, in Minab county, Hormozgan. Recognizing the gravity of the situation, the boat’s owner went with Esmaeil to the nearest district health centre in Minab. This facility is open for emergency cases even on holidays, a fact known among the community thanks to prior awareness-raising by behvarz (rural health workers).

In search of a diagnosis and treatment, the boat owner swiftly took the ailing sailor for a malaria microscopy examination, for which they would have to wait an hour for the results. The patient chose, however, to return to his temporary lodgings in Bandzark before receiving the test results or any medical intervention.

Urgency swept over the community when the test confirmed Plasmodium falciparum malaria, a potentially deadly disease. Malaria experts wasted no time in travelling directly to Esmaeil’s lodgings to initiate life-saving treatment. But feeling a little better, the sailor had already left for the boat.

A race against time ensued to track down Esmaeil and ensure that he began his treatment and ongoing care. A team of local health workers, including district malaria expert Mojtaba Roknoddini, provincial disease control expert Jafar Hatami and behvarz Hossein Zakeri set off for the boat in search of the sailor.

Having located Esmaeil on the fishing vessel, the health workers ran tests on his contacts – mainly others on the boat. They also closely monitored the patient’s condition, gave him some health tips, and provided directly observed therapy. This involves a health worker watching the patient take the prescribed medicine to ensure adherence to treatment.

When the boat set sail once more, the sailor was armed with renewed health and a renewed sense of vigilance. Esmaeil’s story highlights not only the resilience of individuals but also the need for joint efforts to combat malaria’s resurgence in Iranian at-risk communities.

Proactive and prompt action on malaria

Malaria is a silent threat that has loomed once more over the Iranian landscape and the country’s communities since 2022. Fuelled by the complex interplay of climate change, mosquito migration and human mobility, the resurgence of local malaria transmission has cast a shadow over affected areas.

In response, a strategy emerged of active case finding and treatment follow-up, spanning towns and villages across the country, to combat the deadly disease. This proactive approach aimed to identify and treat malaria cases promptly and stem the spread of the disease before it could take hold.

Health workers under the Iranian malaria programme led this effort, tirelessly traversing communities to detect and respond to cases swiftly. Support from international partners, notably WHO, but also other United Nations agencies, bolstered this work.

WHO provided technical assistance to strengthen malaria and vector-borne diseases surveillance, as well as rapid diagnostic tests for case detection, medicines for treatment, and insecticides and long-lasting insecticidal nets for prevention. This WHO support was pivotal in strengthening the national malaria programme.

Equipped with the tools and expertise provided by WHO, health workers have worked diligently to safeguard communities – from remote villages to bustling urban centres – against the threat of malaria.

Yet malaria knows no borders, and so fighting the disease calls for international efforts. In neighbouring Pakistan, a similar battle raged on, with malaria cases skyrocketing since 2022 owing to massive floods and protracted emergencies, extreme climate variation, and poor living conditions.

WHO’s support to the Islamic Republic of Iran thus extended across borders, to foster collaboration and coordination to address malaria as a regional concern. As part of this, in 2023, WHO supported 17 health experts from 4 countries of the Eastern Mediterranean Region to take part in the Diploma Course in Vector Biology and Control at Tehran University of Medical Sciences.

Communities, health workers and international partners united to commit to actively control malaria, prevent local transmission, preserve zero mortality, and safeguard the health and well-being of present and future generations.