Malaria’s Silent Toll: Why Children and Pregnant Women Remain at Risk in Crises

Malaria remains a leading killer of children and pregnant women, especially in crisis-affected countries, with progress in reducing deaths now slowing and at risk of reversal due to fragile health systems and COVID-19 disruptions. Despite proven tools and clear strategies, insufficient funding and growing humanitarian crises continue to block global efforts to control and eventually end the disease.

Research led by institutions such as the World Health Organization (WHO), UNICEF, the RBM Partnership to End Malaria, and global academic researchers shows that malaria remains one of the world’s deadliest yet most preventable diseases. Children under the age of five account for about 67 per cent of all malaria deaths, meaning at least 274,000 young children die every year from a disease that can largely be treated and prevented. Malaria is now the fourth leading cause of death among children under five worldwide, trailing only neonatal conditions, pneumonia and diarrhoeal disease. Although global malaria cases and deaths have declined since 2000, progress has slowed sharply, and today a child still dies from malaria every two minutes.

Progress Made, but Momentum Is Slipping

Between 2000 and 2019, malaria incidence fell from 80 cases per 1,000 people to 56, and annual deaths dropped from about 736,000 to 409,000. These gains were driven by proven tools such as insecticide-treated mosquito nets, preventive medicines, faster diagnosis and effective treatments like artemisinin-based combination therapies. However, this progress is now stalling. In recent years, the decline in malaria case numbers has slowed, falling short of the pace required to meet global targets. WHO projections show that key goals under the Global Technical Strategy for Malaria 2016–2030 are unlikely to be met if current trends continue, signalling a dangerous loss of momentum.

Women, Children and Crisis Zones at Highest Risk

Malaria hits hardest in Sub-Saharan Africa, which accounts for 94 per cent of global malaria cases and deaths. Pregnant women face particularly severe risks, as malaria can cause anaemia, premature birth, stillbirth and maternal death. In 2019, more than one-third of the 35 million pregnant women in the region were exposed to malaria, leading to around 822,000 babies being born with low birth weight. The burden is even heavier in humanitarian and emergency settings, where conflict, displacement and natural disasters weaken health systems. Poor housing, lack of clean water and sanitation, food insecurity and overcrowding all increase exposure to mosquitoes, while damaged infrastructure and staff shortages limit access to prevention and treatment. Notably, six of the seven countries responsible for half of all malaria cases and deaths globally are also classified as humanitarian-context countries.

COVID-19: A Dangerous Setback

The COVID-19 pandemic has made malaria control even more difficult. While the virus does not directly spread malaria, it has disrupted health services across malaria-endemic countries. Lockdowns, supply chain interruptions and overwhelmed health systems reduced access to diagnosis and treatment. Modelling studies suggest that even a 25 per cent drop in antimalarial drug coverage could lead to 100,000 additional malaria deaths in Sub-Saharan Africa alone. Worse disruptions could double malaria deaths, effectively wiping out 20 years of global progress and pushing malaria control efforts back to early-2000s levels.

What UNICEF Is Doing and What Must Come Next

UNICEF’s response focuses on integrating malaria services into primary health care, especially in fragile and emergency settings. This includes distributing mosquito nets, supporting indoor spraying, expanding rapid diagnostic testing, ensuring access to effective treatment, and providing preventive medicines to pregnant women and young children. UNICEF also works across sectors, improving water and sanitation, nutrition and community awareness, while supporting research to improve programme effectiveness. Looking ahead, the report stresses the need for stronger political leadership, better disease surveillance, innovation to tackle drug and insecticide resistance, and continued progress on malaria vaccines. Climate change policies are also critical, as warming temperatures allow mosquitoes to spread into new areas. Above all, funding gaps must be closed: in 2019, only US$3 billion was available globally for malaria control, far short of the US$5.6 billion needed. Without sustained investment, malaria will continue to thrive where poverty, conflict and crisis collide.