There are more than 100,000 Karen, Mon, and Karenni ethnic minority living in a string of refugee camps along the Thai- Myanmar border. This area is endemic for malaria, which results in symptomatic infection in all age groups. In Shoklo, in the 1990s the attack rate was three episodes per person per year for the potentially fatal Plasmodium falciparum parasite (which accounted for approximately 70% of infections). P. vivax accounted for 20% of cases, with the remaining being mixed PF/PV cases. The most important medical problem confronting the refugee community is still the increasing anti-malarial drug resistance. The main consequence of the deterioration of treatment efficacy is anaemia. Children and pregnant women are particularly susceptible to malaria- induced anaemia.

In 1992 mortality from malaria accounted for 15% of all deaths in the camps. Between 1995 and 2000 the burden of malaria has fallen dramatically in the refugee camps as a result of the strategy designed at SMRU and used by all medical NGOs. Since 2013, malaria is only a minor problem in the camps and the mortality is very low and limited to patients presenting late, usually from Myanmar. However, this progress is being challenged by the emergence of P. falciparum infections that are resistant to the artemisinine derivatives. See ARTE VIDEO


Since the middle of the 1990s the population influx from Myanmar has increased dramatically for both economic and political reasons. People from all ethnic groups (Shan, Karenni, Karen, Mon and Burman) are travelling back and forth across the border in search of work. It is thought that this population of migrant workers totals more than one million people in Thailand. Unlike refugees, they are highly mobile, and the majority does not have access to basic health care. Collectively, they harbour the majority of Thailand's malaria cases.

This population of migrant workers, especially those living in the border areas, constitutes a major challenge to the control of malaria in the region and is now probably the major factor contributing to the spread of resistant strains of malaria. As they have done before, these strains will spread to the host population, the entire region, and later to other parts of the world. Given the paucity of new drugs against malaria this apparently local problem takes on a global dimension. Untreatable malaria infections would be a major threat to anyone living in or travelling to endemic areas. 

The "border population" can be seen as a mosaic of various communities linked by cultural and/or geographical similarities: Thai nationals (the majority is ethnic Karen), refugees and migrant workers from Myanmar. This complicates the task of the Thai and Myanmar Malaria Control programme because of language barriers, cultural differences and access difficulties. As a result, many individuals remain out of reach. SMRU has initiated a novel approach for an effective malaria control programme in the populations living along the Thai-Myanmar border, through existing and new medical facilities, based on extensive experience with the displaced populations living in camps in this area.