


Regional collaborations
Gulf Cooperation Council
Established in 1981, the Gulf Cooperation Council (GCC) is a political and economic alliance among the governments of six Middle Eastern countries. GCC is an excellent example of malaria-free countries (Bahrain, Kuwait, Qatar, and United Arab Emirates) showing their commitment to regional elimination. GCC Malaria Fund and Malaria-Free Arabian Peninsula Initiative provide financial and technical assistance to Oman, Saudi Arabia, and non-GCC neighbor Yemen. GCC works in conjunction with the WHO EMRO office, as well as with Yemen’s National Malaria Control Program, to control malaria at the Saudi–Yemen border and prevent reestablishment of transmission in malaria-free countries in the region.
Challenges to elimination
Political instability
Political instability, particularly in the Middle East, presents a serious challenge to global malaria elimination. For example, malaria control in Afghanistan from the 1950s to 1979 was implemented through a vertical government program, but little of that original program remained functional during and after the Soviet invasion and civil war in the 1980s. Political upheaval and civil conflict lead to increased population movement, insecurity and inaccessibility; emigration of health staff; and declines in basic health service delivery. Furthermore, mobile populations and refugees are hard to track, which limits the reach and effectiveness of malaria prevention and treatment measures. As a result, epidemics become frequent and disease burden increases. A coordinated effort between public and non-governmental organizations is essential in rebuilding general health systems and malaria control programs post-conflict.
Importation from malaria-endemic neighbors
The greatest threat to the commendable progress made in the WHO EMRO and WHO EURO regions is the importation of malaria cases from endemic neighbors. Imported cases are attributable to porous borders and trade routes such as the trans-Saharan highway that cuts across malarious and non-malarious regions. Unregulated population movement at the Iran–Pakistan, Saudi–Yemen, and Tajikistan–Afghanistan borders increases the risk of importation. Countries in this region must strengthen cross-border collaboration and maintain robust surveillance, case detection, and outbreak response in order to achieve elimination and prevent reintroduction.