The main types of difficulty encountered during the 5 years of existence of the Malaria Task Force are:

• Those related to the political situation: although relatively quiet for most of the last 15 years, there have been outburst of violence including attacks on refugee camps by armed groups. Populations have been displaced and the total number of refugees continues to increase steadily, resulting in deadly malaria epidemics. In recent years the deterioration of the economy in the region and in Myanmar in particular, has resulted in an influx of migrants looking for work in Thailand. Their number probably exceeds that of the refugees and malaria is the first cause of disease related mortality in this mostly illegal population. Virtually no medical assistance is provided for the migrant workers apart of a limited malaria programme from MTF and a recent TB clinic in Mae Sot run by MSF-F. An important fraction of the population of the refugee camps also work as daily workers in the Thai farms surrounding the camps or in the forest. This explains that over 80% of the malaria cases seen in the camps are in patients who recently travelled to (or live in) the surroundings of the camps.
  
  
• Those related to rapid turn-over in the expatriate staff of the medical NGOs. This imposes the six monthly rhythm of the malaria meetings, to offer the new workers the opportunity to catch up with the local malaria situation. By and large the collaborative effort of the NGOs within the MTF has been sustained and produced positive and measurable results, although a poor commitment at the individual or at the organisation level has occasionally caused problems. Working closely to the local staff has proved useful to overcome difficulties related to expatriate turn-over.
  
  
• Those related to the financial support: the MTF has been supported by the European Union (ECHO) through AMI. However the actual funding has been erratic and unreliable. This year, the contribution of ECHO to the MTF has ceased on the ground that malaria was not a significant health problem in the camps anymore. This unfortunate decision indicates that medical programs in refugee situation should remain opaque and relatively unsuccessful in order to continue being funded. Recently USAID has responded favourably to a request for financial support. Extending the malaria control programme to displaced communities other than refugees will inevitably increase the need for financial assistance.