A journey into the interior of Diourbel, one of the regions most affected by malaria in Senegal: “We are losing the progress we have made”

A child crosses a road transformed into a river in the Senegalese city of Diourbel. In the dry season, this area is usually an unpaved road, but the stretch, several hundred meters long, has been flooded since August. During the day, a few mosquitoes can be seen buzzing over the stagnant water. At night, their numbers multiply, and hidden among the swarm are those of the Anopheles species, which spread malaria, the world's deadliest mosquito-borne disease .

The little boy holds onto a rope tied to a row of poles and wades forward with his feet submerged in the water. He's heading toward the bank where the Cheikh Gueye Roukhou Kocci daara is located, one of the largest in the city, where a thousand boys study the Quran. At this religious school, the students, called talibes , are Senegalese living in poverty, migrants from neighboring countries like Gambia, or orphans. Some spend the night there, in enormous dark rooms where a rug is spread out, on which some 20 or 30 children sleep. Over them is a huge mosquito net impregnated with long-lasting insecticide, which protects the children from mosquitoes and malaria between June and October, Senegal's rainy season .

The Diourbel region is among the five territories with the highest incidence of malaria in Senegal: the national average is 22.8 cases per 1,000 inhabitants, while Diourbel has 43.3, according to data from the National Malaria Control Program . In its three departments—Diourbel, Bambey, and Mbacke—there were 91,502 cases and 68 deaths in 2024. For years, the health authorities have partnered with international organizations to contain the spread of the disease. However, there is now concern in Diourbel about cuts in aid from countries like the United States.

One of the strategies whose future worries the authorities is, in fact, the enormous mosquito nets for the daaras . In 2017, the MEGA MILDA project began, which, with the support of the USAID/OWOD cooperation agency, hired local tailors to make enormous insecticide-treated mosquito nets large enough to cover all the children sleeping in the daaras, since, on the market, they were only available for beds and not for the enormous mats. In addition, an alliance was established with religious leaders to allow health personnel to enter the daaras to conduct educational outreach and testing.

Mbacké Gueye, a key figure in Pecadom de Diourbel, a community health program that aims to diagnose and treat malaria in people's homes, celebrates the MEGA MILDA project as a way to tackle malaria with a solution that understood the region's specific context. "At the health centers, we received many cases of severe malaria and deaths from the daaras ," she recalls in an interview with this newspaper, adding that the strategy helped reduce morbidity and mortality among children. However, the project ended in 2024.

“ The routine MILDA [distributed by the health district] is still available. But there is no longer funding to mobilize the tailors,” Gueye acknowledges.

In the daara visited by EL PAÍS, on a trip organized by the Global Fund, mosquito nets from the last batch paid for by the district still remain. “Perhaps they were managed well, which is why they’re still there, but in a few weeks they’ll deteriorate and there won’t be any left if there aren’t replacement parts from MEGA MILDA,” Gueye confirms.

This is just one of the signs of unrest in Diourbel. Not only are malaria cases rising due to high population density and mosquito infestations during the rainy season—when the incidence increases by up to 30%—but the battle against the disease is being fought with less funding. In Diourbel, USAID (the US development agency), UNICEF, and the Global Fund were the three partners providing resources for malaria prevention, diagnosis, and treatment. Now, with the suspension of USAID funding and a 10% reduction in the Global Fund's budget allocated to Senegal, the situation is becoming more complicated.

Since 2004, the Global Fund has invested $166 million (€142 million) in the fight against malaria through community health worker programs, training for healthcare professionals, and intermittent preventive treatments. In 2022, it distributed 7.6 million insecticide-treated bed nets in eight of the country's 14 regions and conducted another recent campaign in 2025. But now, it is evaluating its next steps. Mark Taylor, head of the team for Senegal, is cautious in his projections. “We hope the replenishment in November [ in which $18 billion is expected to be raised for the 2027-2029 cycle ] goes well. We plan to maintain, at least, the eight regions [where they are already distributing bed nets] and purchase medications,” he explains. Before the crisis in external funding for global health, the fund's objective was to cover all 14 regions.

There is no concrete data quantifying the economic and human impact of malaria in Senegal, but the organization Malaria No More recently calculated it for Sub-Saharan Africa. According to a report published last week, if the Global Fund does not secure the $18 billion needed for the 2027-2029 cycle by November and suffers a 20% reduction in donations, 82,071 more people could die by 2030 than projected in a scenario where funding remains constant. Economically, this would mean a loss of $5.14 billion in the region's GDP by 2030 and $30 billion by 2040.

We haven't secured new partners; instead, we've worked to mobilize domestic funding, but it's precarious and inconsistent, so it can't cover all our needs.

Mamadou Dieng, regional health director of Diourbel

Dr. Mamadou Dieng, regional health director of Diourbel, explained at a press conference, which included a report from EL PAÍS, that “funding has decreased considerably.” “We haven’t secured new partners; instead, we’ve worked to mobilize national funding, but it’s precarious and inconsistent, so it can’t cover all our needs,” he explained.

This, he says, has led to a significant reduction in community activities that allowed for education about the symptoms of the disease: how to prevent it, access a diagnosis and treat it so that it did not develop into severe malaria.

A key part of this strategy is the networks of community workers, who make home visits for early malaria detection in areas of Diourbel that are far from a health center.

One of these networks, for example, allowed them to find Falou, an 11-year-old boy, in time. Khardiata Ba, a 25-year-old community worker, found the boy's home during one of her rounds in a suburb of Diourbel. “I came to do some testing and spotted a child with a fever. I gave him a rapid test, and it came back positive. I gave him home treatment, and he's feeling much better,” she recounts, after a second visit to Falou and his parents in early October. Ba doesn't receive a salary, only some cash bonuses and, when possible, support with transportation. “If someone gets sick here, especially at night, it's very difficult. It's very dark and not safe, not even for a man,” she explains, maintaining, however, that early detection of malaria in children prevents severe cases.

For the past three years, there has been a resurgence of cases, especially in Touba. We are losing the progress we have made; malaria is gaining ground.

Serigne Diaye, primary care supervisor and malaria focal point in Diourbel

Another concern for health authorities is the availability of medicines, since malaria treatments were financed by foreign partners and not by the government.

Serigne Diaye, primary care supervisor and malaria contact person in Diourbel, adds that there are also difficulties accessing sufficient rapid diagnostic tests. The suspension of USAID funding, he adds, exacerbates long-standing problems. “For the past three years, there has been a resurgence of cases, especially in Touba [the capital of Mbacké, 40 kilometers from Diourbel],” he says. “We are losing the progress we have made; malaria is gaining ground,” he laments.

Malaria in the holy city

Touba, Senegal's second most populous city after Dakar, is also plagued by floods, mosquitoes, and malaria. It is the area in the Diourbel region where the incidence has increased the most. In 2023, it was 27.7 cases per 1,000 inhabitants; in 2024, it was 64.5. More than 90% of the deaths recorded last year in this region occurred there.

In the holy city of Mouridism, a Sufi brotherhood, there is not only a high population density. This city also attracts some three million people each year for the great Magal of Touba pilgrimage. This massive religious celebration has led to increased monitoring of malaria programs, according to the regional health authority. Although it is a risk factor due to the increased population density and the potential arrival of diseases, to date there has been no malaria epidemic associated with the pilgrimage.

About four kilometers from the Great Mosque of Touba, Dr. Ibrahima Alpha Touré finishes his consultations for the day at the Daroul Manane health center. Touré confirms that the situation in Touba is worrying. “The increase in cases is due to the heavy rainfall and flooding. The soil doesn't absorb the water, so there are many mosquito larvae,” he explains to this newspaper. “It also helps that not all the daaras (religious houses) are registered. And, given the living conditions there, there is pollution and a proliferation of mosquitoes,” he adds.

But for Touré, a growing risk factor is the lack of diagnostic resources. “Here we have the RDT [rapid diagnostic test for malaria] and the thick blood smear [which detects the parasites in the blood]. The RDT is free, but we often run out of it. The thick blood smear is more sensitive, but it requires significantly more resources [such as laboratory equipment, microscopes, and trained personnel] and must be paid for by the patient,” the doctor explains. The lack of RDTs and the resources to facilitate thick blood smear detection lead to delays in diagnosis and, consequently, in treatment and control.

The regional health directorate of Diourbel warns that containing malaria is also a fight against poverty in a highly vulnerable region. “The rainy season is the time when the population works in the fields. Diourbel’s economy is based on agriculture and livestock farming. But, unfortunately, this is also when malaria cases emerge. If the head of the household gets sick, there is a decrease in household income,” explains the regional director.