[The malaria situation in the WHO eastern Mediterranean region]

About 45% of the population of the Eastern Mediterranean Region live under the risk of both falciparum and vivax malaria, and additional 15% under the risk of P. vivax alone. The estimated annual number of malaria cases is about 14 million, out of which 95% occur in four countries: Afghanistan, Somalia, Sudan and Yemen. In Afghanistan malaria is endemic throughout the country at altitude below 1500 m. About 80-90% of malaria cases belong to P. vivax, the rest to P. falciparum (the latter is prevalent mostly in the South and in Badakhshan). In Islamic Republic of Iran 16% of the population live in initially non-malarious areas, 66% in areas freed from malaria, 12% in areas with sporadic transmission, mostly of P. vivax, and only 6% in areas of continuous transmission with a high proportion of P. falciparum. As much as 77% of the recorded cases belong to the latter territories. Iraq. After the Gulf war, the situation deteriorated in the three north-eastern governorates, and malaria spread outside this area and rooted in the south (Basra). Syria. Transmission of P. vivax still occurs, mostly along the western part of the border with Turkey and in the north-eastern corner of the country. At present, there are three areas that causes concern along borders between the European and Eastern Mediterranean Regions: Afghanistan is a source of importation of malaria to all its neighbours; areas on the borders between Iran, Azerbaijan and, to some extent, Armenia; 4 northern governorates of Iraq and parts of southeastern Turkey, with repercussions in Syria and, to a Lesser extent in Iran, along its western border. To some extent, Cyprus is also threatened, since importation of malaria to the northern part of the island from Turkey has been documented. In practical terms, there is a need for co-ordination of antivectorial activities and standardization of control methods between the countries with strong programmes and relatively intense transmission in border areas, i.e. between Iran, and Azerbaijan, Iraq and Turkey, Syria and Turkey.