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THAILAND: Malaria Spreads Amidst Insurgency in South

Marwaan Macan-Markar

BANGKOK, Apr 25 2011 (IPS) - A raging insurgency in Thailand’s southernmost provinces has become a breeding ground for another potential killer – the malaria-carrying Anopheles mosquito – that is threatening to wipe out the gains Thailand has achieved in fighting the disease.

The number of malaria cases has risen to over 4,000 in the area close to the Thai-Malaysian border where a shadowy network of rebels has been fighting Thai troops since 2004.

The area – including the provinces of Yala, Narathiwat and Pattani – is far from the traditional locations where Thailand has been combating the killer mosquito, setting off alarm bells within the country’s public health community.

“The number of malaria cases reported near the Thai-Malaysia border for last year was 4,269,” Dr. Wichai Satimai, director of the Bureau of Vector-borne Diseases at the Health Ministry, told IPS. “Yala province had the highest with over 3,000, which is a huge increase from what it was before 2004, when there were less than 30 cases per year.”

Yala, known for its hilly terrain covered with thick tropical forests and rubber plantations, had emerged with the second highest number of malaria cases out of all provinces in this South-east Asian kingdom last year, according to the country’s Public Health Ministry. The neighbouring province of Narathiwat has also climbed into the top 10 provinces where the mosquito-borne killer parasite has left its mark.

The traditional malaria locations include Tak province along Thailand’s north-western border with Burma. Last year, 15,181 out of the total 22,342 cases were detected along the Thai-Burma border.

“If ignored, the number of cases could rise to 30,000 or even 300,000 rapidly,” warned Dr. Pratap Singhasivanon, dean of the faculty of tropical medicine at Mahidol University, on the outskirts of Bangkok. “Those infected will carry the parasites longer if we do not increase our mosquito control activity.”

Such disturbing numbers would mark a dramatic reversal from the feat Thailand achieved in rolling back the spread of malaria over the past decade. In 1999, the country recorded 125,359 cases, with 740 fatalities. By 2007, the numbers slid down to 33,178 cases, with 0.15 deaths per 100,000 people.

Thailand’s success has been attributed to the spread of nearly 900 malaria posts and clinics offering universal free treatment to anyone falling ill from malaria. These posts succeeded in limiting malaria hotspots to the borders Thailand shares with Burma, Cambodia, Laos and, now, Malaysia.

At the malaria posts, a trained staff pricks the finger of a patient to get blood samples, followed by a course of drugs to kill the malaria parasite. They also help with prevention, reminding communities to spray homes to keep them free of mosquitoes.

These posts have taken on added importance in the wake of a deadly malaria parasite that has developed resistance to the effective anti-malaria drugs.

But the conflict in Yala, Narathiwat and Pattani has hampered the operations of malaria posts spread across remote villages that are home to the Malay-Muslims, the largest minority in predominantly Buddhist Thailand.

Fear of getting caught in the insurgency has resulted in a drop in the number of medical staff willing to go to health centres in isolated areas, said Rungrawee Chalermsripinyorat, Thailand analyst for the Crisis Group, the Brussels-based think tank. “Medical staff is reluctant to go to villages considered ‘red zones’ by the army.”

The insurgency has claimed more than 4,500 lives and left more than 11,000 people injured.

“Some places in the ‘red zones’ require the medical staff to walk to access communities to give them treatment, and this has decreased,” she told IPS. “Some hospitals in remote areas are also facing staffing shortages, because the medical staff fear working there.”

In over seven years of the insurgency, Thailand’s military has classified as ‘red zones’ nearly 350 areas where Malay-Muslim rebels are most active, out of nearly 2,000 villages nestled amid rice fields, rubber plantations and forests.

The recent weeks have seen a spike in the violence, including bomb explosions in Pattani and a late evening gun battle, which left a paramilitary soldier and two suspected Malay-Muslims dead following an ambush on an army outpost in Pattani.

“The violence since 2004 has seen a breakdown of the health outreach services to stop the spread of malaria,” said Arafen Thaipratan, a surgeon at the main hospital in the city of Yala, the capital of the province. “Before, the staff went to get rid of the source, in addition to helping with awareness and health care.

“People living and working in the rubber plantations have been most affected,” he revealed, in a telephone interview from Yala. “They are the people who work while it is still dark, to tap the rubber trees.”

The reluctance of health workers who are Thai-Buddhists to go to areas perceived as hostile is not the only reason undermining Thailand’s battle with malaria. Even Malay-Muslim recruits refuse to go, but for different reasons. “They are viewed with suspicion, as spies or government informers, by the locals,” said a health worker.

The current conflict is rooted in tensions that have grown since 1902, when Siam, as Thailand was then known, annexed the three southern provinces that were then part of the Malay-Muslim kingdom of Pattani.

Malay-Muslim feelings of cultural, linguistic and economic marginalisation in the wake of heavy- handed policies by Bangkok gave rise to the first generation of rebels, who mounted a separatist campaign in 1970.

Tropical medicine experts like Pratap cite the need to draw a distinction between the insurgency and the looming malaria threat in the south. “We are trying to make the local people separate the health issue from the conflict,” he told IPS. “The health system is there, but the medical staff does not have access to it.”

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