Malaria persists among Yanomami one year after emergency – 01/19/2024 – Balance and Health

One year after the health emergency in the Yanomami Indigenous Land, in the north of the country, malaria continues to be among the main causes of hospitalizations and deaths in the region. “The children are getting sick again,” says Junior Hekurari, president of the Yanomami District Health Council, who has been denouncing new invasions by miners since September.

“Almost every community in the territory has malaria today”, adds the leader.

Data from the Mortality Information System, from the Ministry of Health, show that the Federal Government’s operation did not contain the disease in the territory. In 2023, there were 25 deaths, compared to 21 in the previous year, which represents an increase of 19%.

Notifications of the disease also increased. According to preliminary data from the Sivep-Malaria system, the DSEI (Special Indigenous Health District) Yanomami registered 25,895 cases of malaria in 2023, which represents 20% of the total in the country. The level is a record, and indicates an increase of 64% compared to the previous year (15,284 cases).

According to the ministry, endemic control agents were sent to the region to actively search for patients, and more than 140,000 diagnostic tests were carried out last year. The ministry also says that it has drawn up an action plan to control the disease based on the identification of breeding sites for the mosquito vector and priority areas for treating patients.

Caused by a parasite and transmitted to humans by mosquito bites, malaria is endemic throughout the Amazon region, but in the last decade it has seen marked growth in the Yanomami DSEI – a period that coincided with the spread of illegal mining throughout the region.

“When miners invade the forest, they alter the environment through open-pit mining, excavating holes and benches throughout the landscape, which produces a multitude of mosquito breeding sites”, explains Maria de Fátima Ferreira da Cruz, deputy head of the Laboratory of Fiocruz Malaria Research (Fundação Oswaldo Cruz), which coordinates studies on the topic.

According to the researcher, every time mining is established in a new location, it creates a nucleus for transmitting the disease, directly affecting the surrounding villages. The high mobility of miners is also pointed out as a factor that perpetuates the malaria cycle. “If he is infected and goes to another area, he will spread the disease,” says Cruz.

Authorities attribute the increase in the number of cases to the lack of testing and active search in the territory during the administration of Jair Bolsonaro (PL) in the federal government, which would have resulted in underreporting.

Before recording drops in 2021 and 2022, however, notifications of the disease in the territory had been growing continuously since 2014. Compared to that year, the most recent data represents an increase of 784%. Compared to 2019, before the pandemic, the increase was 57%. Launched in 2015, the National Malaria Elimination Plan seeks to eradicate the disease in the country by 2035.

The Fiocruz researcher also warns of the growth of malaria caused by the species falciparum, which causes the disease in its most serious form, capable of causing death. In contrast to Brazil, the parasite is responsible for the rising cases in Yanomami territory and today accounts for 3 out of every 10 notifications, while the national average is 1.6.

“This is a sign that health teams did not carry out active surveillance, diagnosis and treatment as they should, which is what blocks the disease transmission chain”, says doctor Paulo César Basta, researcher at ENSP (National School of Health Public) of Fiocruz. “A falciparum There is faster treatment, and the growth in cases is an indicator that healthcare is not fulfilling its role.”

The researcher, who has worked with the Yanomami since 1998, attributes the escalation of the disease to the disruption of services during the Bolsonaro government. “The Yanomami DSEI was practically sabotaged, with many management changes and allegations of misappropriation of resources.”

For Basta, the actions of the Lula (PT) government in the first half of last year were important, but did not bring a permanent solution to the indigenous health problem. “Lives were saved and the government fulfilled its role in emergency actions, with medical care and removal of patients with more serious conditions. But the actions were discontinued in the second half of the year, there was a certain demobilization”, says Basta.

In addition to the problematic infrastructure, the presence of mining also makes it difficult for health teams to work in the region, according to Júnior Hekurari, a Yanomami leader. He states that professionals are unable to reach communities because they are threatened by armed “invaders”.

“As long as mining continues, the Yanomami people will continue to suffer from these problems, especially children, who are more vulnerable to catching diseases”, says Hekurari. “We want the government to plan care with permanent security bases. Without security there is no way to maintain health care for the Yanomami population.”

The position is shared by the executive coordinator of Apib (Articulation of Indigenous Peoples of Brazil), Kleber Karipuna. “The State does not have to just expel [o garimpo ilegal], but remain in the territory. It is essential so that miners do not return or invade other communities, as happened at the beginning of the operation”, he says.

When contacted, the Ministry of Health states, in a note, that it has invested “more than R$220 million to restructure access to health for indigenous people in the region” since January 2023, when a public health emergency was declared. The value, according to the department, more than doubled compared to the previous year.

According to the agency, the number of professionals working in the territory increased from 690 to 960, and seven health units that were closed due to criminal actions were reopened, totaling 68 establishments in Yanomami land.

“In these locations, where it is possible to provide assistance and humanitarian aid, 307 children diagnosed with severe or moderate malnutrition were recovered. Furthermore, the federal government, through the Mais Médicos Program, allowed an increase from 9 to 28 in the number of doctors for the assistance to the Yanomami”, says the document.

The most recent report from the Yanomami COE (Emergency Operation Center) shows that 308 indigenous people in the region have died by November 2023 – a 10% reduction compared to the previous year. More than half of the victims were children up to four years old. In addition to malaria, the main causes were pneumonia, diarrhea and malnutrition.

On the 9th, after a ministerial meeting called by Lula, the federal government announced the presence of a “government house” in Roraima to deal with actions in indigenous land and the installation of three surveillance bases in the territory, with security forces such as the PF (Federal Police) and the Armed Forces. The expected expenses are R$1.2 billion.