Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.

Of the 8 malaria-endemic countries in the Eastern Mediterranean Region, 6 carry a high burden, namely Afghanistan, Djibouti, Pakistan, Somalia, Sudan and Yemen. Sudan accounts for the highest percentage of cases at about 46%, followed by Yemen at 17%. In these countries, lockdowns and reduced access to health care in the context of the COVID-19 pandemic have led to a reduction in health-seeking behaviour when people are experiencing fever.

Two countries (Saudi Arabia and Islamic Republic of Iran) are at the elimination stage. The Islamic Republic of Iran reported zero indigenous cases between 2018 and 2020 and is eligible for certification of malaria-free status. In Saudi Arabia, the number of reported indigenous cases declined from 272 in 2016 to 38 in 2019. The remaining 14 countries in the Region are free of indigenous malaria and are working hard to prevent re-establishment.