Leaving No One Behind: Addressing Malaria among Migrants on the Thai-Myanmar Border

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For over two decades, Thailand has been a leader in the fight against malaria. Case numbers fell sharply from more than 78,000 in the year 2000 to just over 2,000 in 2021. Many provinces had already been verified malaria-free, and the country seemed on track to achieve its elimination goals. Yet, recent years have brought new challenges. Between 2021 and 2023, malaria cases almost tripled, with the majority occurring along the 2,400-kilometre-longThai-Myanmar border, a surge primarily driven by the political instability in Myanmar.

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At the heart of this resurgence is the influx of mobile and migrant populations from Myanmar who live, work, or seek refuge in the border areas. These groups are diverse, ranging from registered migrant workers to displaced families in temporary shelters, and undocumented individuals who cross for trade or survival. What unites them is their heightened vulnerability to malaria and the many barriers they face in accessing essential health services. Language barriers, irregular legal status, poverty, and geographic isolation intersect to keep them on the margins of health systems.

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Human faces of the challenge

Consider the daily life of a family living in a temporary shelter in Tak Province. Crowded living conditions and limited protection from mosquitoes leave parents in constant worry about their children falling ill from mosquito-borne diseases. Having fled Myanmar in pursuit of stability, they now face a different kind of threat unbeknownst to them – malaria.

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Under the same canopy of vulnerabilities, a young man who regularly crosses the forest border for seasonal work similarly faces the threats of malaria. With little knowledge of malaria and irregular legal protection, he often resorts to over-the-counter and potentially poor quality medications instead of seeking formal treatment.

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These stories are the lived reality of people living in border areas, and stand as a stark reminder that despite national progress, malaria continue to persist in these shadowed landscapes.

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Thailand’s inclusive approach

Recognising the urgency, Thailand has stepped up its elimination strategies, placing a strong and renewed focus on social inclusion. Thailand’s inclusive approach is reflected in a range of coordinated efforts from policies to on-the-ground implementation.

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Civil society organizations are at the forefront of identifying and reaching at-risk populations. By mapping where they gather, distributing insecticide-treated nets and forest packs, and providing culturally appropriate information, their networks have proven to be critical in extending essential provisions into areas where government services have limited reach.

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At the same time, community-based services have expanded significantly. Malaria Posts now offer free testing and treatment in remote villages, shelters, and forested areas. Village Health Volunteers, a longstanding contributor of Thailand’s primary care system, have received additional training to conduct proactive case detection and support treatment adherence. Migrant health workers and volunteers play a crucial bridging role, offering interpretation and cultural mediation to ensure that at-risk populations feel safe and understood when seeking care.

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Nationally, Thailand has introduced enabling policies that seek to lower financial and administrative barriers. The Migrant Fund, established in 2017, offers affordable health insurance for those excluded from the national schemes. Recent government measures offering pathways to citizenship for hundreds of thousands of stateless people are also helping to reduce inequities in access to health services.

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Remaining challenges

Despite these advances, challenges remain. Many of the civil society organizations providing frontline services rely on external funding, which puts the continuity of these essential services at risk. Ensuring sustainable financing, either through social contracting or integration into national health budgets, will be crucial to sustain the hard-earned progress.

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Another challenge is the growing dominance of Plasmodium vivax, which requires a radical cure to prevent relapse. Finally, as malaria becomes less prevalent in these areas, the sustenance of community health workers whose roles are centered exclusively on malaria, face uncertainties, unless their roles are integrated with other health priorities to ensure continuation.

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Why equity matters

Thailand’s experience demonstrates that malaria elimination is not only a technical challenge, but also a test of equity. Success will depend on ensuring that the most marginalised communities are not left behind. Social inclusion is not a peripheral consideration, but a central pillar of malaria elimination strategy. Along the forests and shelters of the Thai-Myanmar border lies a constant reminder that malaria elimination requires more than just essential medications and nets. It demands trust, empathy, and policies that recognize health as a universal right.

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As the region moves towards the 2030 elimination goal, Thailand’s approach provides valuable lessons. By combining strong policy commitments with community engagement and civil society partnerships, Thailand is advancing its progress in bringing the benefits of malaria elimination to everyone within its borders.

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