Malaria and Complex Emergencies.

Malaria control in a complex emergency is once again a different situation from normal malaria control and should be recognized as such.  Complex emergencies in Southern Africa (Due to local circumstances) are essentially considered as those situations that experience Internally Displaced People (IDPs) or refugees, either as a direct or indirect result of conflict, using the basis that these situation may change rapidly, but can continue on an indefinite basis.  Complex emergency situations can vary dramatically within Southern Africa.  Whether the situation be refugees in Zambia, in a stable country, with easy access to the vulnerable group, or be it IDPs in Bie province of Angola, which is difficult to access, unstable and unpredictable.

In the latter situations, service delivery is limited to accessible areas, which in the case of Angola, results in operations being limited to a relatively small percentage of the country. However, as a consequence of population movements and insecurity, a large portion of the countries population can be reached in these areas, providing a clear direction for an operational approach.  Trying to deliver a service to a mobile population that moves according to growing season’s, the availability of food distribution and changing security risks complicates the issue further, particularly when attempting to deliver preventative or curative health services.  

In the more extreme complex emergency situations, almost all supplies (Medical, chemicals for prevention, and bed nets etc) must be flown in, resulting in operations that are expensive, complex and must be well planned.  Supervision is difficult because of the time spent traveling, and the commitment of provincial teams to direct and coordinate activities varies.

However, in these situations, the energy of the additional delivery services such as NGOs and Church groups become valuable allies, and if strong, credible leadership can be made by the Ministry of Health to co-ordinate these activities, a systematic and diverse malaria control program can be developed.