Malaria is no stranger to Ethiopia. Every year, the disease poses a public health issue, especially in rural regions where the majority of the population lives in areas conducive to mosquito breeding. However, as the country wrestles with a sharp uptick in cases and fatalities in 2024, the ongoing crisis reveals deeper, systemic issues ranging from climate change and health infrastructure shortcomings to global supply chain disruptions.

Mandela Abiyu, a 24-year-old student from Butajira, Central Ethiopia Regional State, never imagined that a brief academic journey to Jinka General Hospital would bring him face-to-face with a disease that afflicts millions. He always considered himself to be “healthy as a horse,” recalling the years he lived without illness. But within days of arriving in the town, Mandela found himself bedridden, struggling with fever, loss of appetite, and severe weakness. He was diagnosed with malaria.

His case was complicated. Initially, only the weak species was detected, leading to treatment with a drug called chloroquine. With his symptoms like headache and appetite loss lingering, he was readmitted to the hospital for further testing. He said that doctors finally discovered the second, more serious, infection and Mandela was able to overcome the scary period.

“It took a few days until I felt strong enough to eat,” he told Fortune.

His experience is not unique. With about 75pc of the country's landmass categorised as malaria-endemic, nearly three-quarters of the population is at risk of infection. It is a leading cause of death among children under five, accounting for up to 20pc of fatalities in endemic areas.

However, malaria is making a resurgence with a higher number of cases and deaths than in previous years. Over 2.9 million cases were reported by the Ministry of Health in the last three months alone, representing a 200pc increase compared to the same period in the past few years.

According to Dereje Duguma (MD), state minister of Health, there is no shortage of medicine for malaria except the drug chloroquine. However, this does not mean that treatment is universally accessible.

The supply of malaria medications is not the only challenge facing Ethiopia’s health sector. Malaria cases have surged in several regions.

Hospitals and healthcare centres in the regional state seem to be struggling to keep up with demand. Jinka General Hospital in South Ethiopia Regional State, which serves a vast swath of the southern part of the country, has seen 2,655 confirmed cases in the last three months.

According to Beruktawit Assefa, the medical director, drug supply and blood donations are other issues.

“It’s not been consistent,” said Beruktawit.

The disruption is attributed to both logistical hurdles and financial constraints, as malaria treatment requires an array of medications, blood supplies for severe cases, and preventive tools like mosquito nets and insecticides—resources that are usually in short supply.

Since January, over 7.3 million cases and 1,157 deaths have been reported, according to World Health Organisation (WHO), double when compared to the previous year. Less than a million cases were reported in the year 2019. The WHO report suggests that the result was achieved following years of strong prevention and programs like chemical spraying, net distribution and awareness creation.

However, the resurgence of the disease began to take hold in 2021, driven partly by environmental issues, including climate changes.

State Minister for Health told local media that altered weather patterns have led to increased rainfall, creating more breeding grounds for the mosquitoes that transmit the disease. Warmer temperatures also extend the lifespan of mosquitoes, according to Dereje, allowing them to transmit the parasite over a longer period which has intensified the difficulties of controlling malaria in endemic regions.

The problem is compounded by a growing apathy toward preventative measures. According to health experts, a reduction in vigilance has allowed the mosquito to thrive unchecked.

Hiwot Solomon (MD), a disease prevention lead executive at the Ministry, noted that while bed nets and insecticides remain essential tools in the fight against malaria, many rural areas suffer from inadequate infrastructure to support these interventions.

“Poorly constructed with gaps in the walls and roofs make it difficult to ensure effective protection,” she told Fortune.