Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.
Geographical diversity in the Eastern Mediterranean Region determines malaria variability in terms of endemicity, intensity of transmission and type of malaria. Malaria-endemic countries of the Region are situated in the three eco-epidemiological zones of malaria: Afrotropical, Oriental and Palaearctic. In Saudi Arabia, Yemen and the sub-Saharan countries of the Region (Djibouti, Somalia, Sudan, South Sudan), P. falciparum is predominant. In the other endemic countries, mainly Afghanistan, Islamic Republic of Iran and Pakistan, both P. falciparum and P. vivax are transmitted.
In 2011, countries in the Eastern Mediterranean Region reported a total of 3 058 639 cases; only 37% of which were confirmed parasitologically. Five countries accounted for more than 98% of the confirmed cases in 2011: Sudan (44%), Pakistan (29%), South Sudan (10%), Yemen (8%) and Afghanistan (7%). The 2011 total figures are missing clinical cases from Pakistan that used to report about 4 million clinical cases annually, until 2010. WHO estimated that 10.4 million (range 6.4–16.6) cases of malaria occurred in the Region, and P. falciparum accounted for 83% of these.
Based on WHO estimation in 2010, the number of deaths due to malaria in the Eastern Mediterranean Region were 15 000 (range 7000–24000 deaths), of which 70% were in children under 5 years of age. The reported deaths due to malaria were only 1148 with more than 53% from Sudan.