In a small insectary in Siphofaneni, the air feels oddly cool—like the building is always holding its breath. Inside, Nombuso Princess Bhembe checks mosquitoes and talks about work that’s both meticulous and urgent, down to how colonies are tended and how quickly action has to happen once a case appears.
Eswatini, a landlocked nation of 1.2 million people (formerly known as Swaziland), is trying to eliminate malaria even as headwinds stack up. Those pressures aren’t just biological. They include the climate crisis, aid cuts, insecticide resistance, and economic migration from countries with higher case numbers. In 2024, Eswatini recorded 362 confirmed malaria cases, while neighbouring Mozambique recorded 11.6m cases, one of the world’s highest figures. Next door, South Africa recorded 4,639.
The problem, Misryoum newsroom reporting highlights, is that malaria can travel in the blood of people using informal crossings along porous borders. A changing climate then makes it easier for mosquitoes to survive and reproduce, creating better breeding conditions—and even shifting the malaria season to overlap with the sugarcane harvest, when many people are in the fields. In the insectary, Bhembe explains that the team goes out daily to set traps for mosquitoes in “sentinel sites,” then returns them to microscopes where colours and wing patterns help reveal which species they are. Some samples are also used to test how well the insecticides already in use are performing.
“With time, we have seen change,” Bhembe says. Species that can transmit malaria are showing up in new areas, potentially tied to shifting temperatures. That matters because the window between “new pattern” and “new outbreak” can be short.
Last week, a patient in Eswatini’s northern Hhohho region began to feel unwell—weak and shivery. Paracetamol helped the headaches for a day or so, but then she felt worse. At a local health centre, she tested positive for malaria. The result triggered an immediate phone alert to the national malaria prevention team. By the same day, workers—equipped with leaflets, malaria tests and insecticide sprays—were going house to house in the hamlet where the now-recovering woman lives.
Nomcebo Dlamini, chief malaria surveillance officer, argues for rapid action now rather than waiting “in a few weeks when there might be more cases.” She describes the close-to-elimination feeling as fragile: “As you think you’re getting closer and closer [to elimination], something happens – like extreme weather patterns.” A flood can suddenly turn many places into ponds, collecting stagnant water and pulling breeding sites closer to people. In the Hhohho area, there hadn’t been any cases for about four years. Dlamini says the closest prior case was probably two, three kilometres away, which would make the new cluster a “new focus for investigation” — to find what brought transmission back “out of the blue.”
The response is also constrained by time. The insecticide used for spraying only lasts three months, so houses need to be resprayed to protect residents. The team sees malaria cases seasonally—about 50 cases in the worst months, but as few as three in the dry months of August and September. Yet Dlamini says the season is getting longer, used to peak in March, but now high case numbers persist into the May harvest. There’s also the messy reality of illegal farming: farms in the region are illegally growing cannabis—known locally as dagga—employing workers from Mozambique, who accept lower wages. If mosquitoes bite infected workers, “you find that you now have a clustering of cases.”
Even the logistics of prevention get tricky. Homes were sprayed before the malaria season began, but once a case is found residents must move belongings away from the walls so insecticide can be applied from top to bottom. Mosquitoes from the insectary are placed in a cone on walls to check spraying effectiveness, and during surveillance visits the team points out potential breeding sites like wheelbarrows that can hold water when not stored upside down. Residents can be wary of engaging authorities, including clinics. Some historically sleep outside to guard fields, without bed nets.
Misryoum newsroom reporting adds that the broader fight is also under strain. Mark Edington, head of grant management at the Global Fund to Fight Aids, Tuberculosis and Malaria, which partly funds Eswatini’s malaria programme, says elimination is proving harder than hoped, with global cases rising for six consecutive years. Aid cuts have been sharp: the Global Fund had to make $1.4bn of cuts to existing grants last year after donors failed to fulfil pledges. Edington frames it as a “mixing bowl” of factors—decreased malaria funding, resistance to both drugs and insecticide, population growth, and extreme weather events “which are increasing.” In Eswatini, officials say aid cuts have had a small effect on malaria services, mostly through reduced training for workers.
Eswatini’s health minister, Mduduzi Matsebula, hopes that integrated border controls with neighbouring countries can simplify health surveillance, including making travel documents and passports easier to access so people don’t rely on informal crossings that are harder to track. The country’s sights are set on elimination. “We are ambitious about it and we believe it’s doable,” Misryoum editorial desk notes he says—though actually, everyone working the ground seems to know “doable” depends on keeping that fragile chain of response unbroken, even when weather, funding and borders refuse to cooperate. The work continues, day after day, and sometimes with just enough time to make a difference before mosquitoes—and people—shift the pattern again.
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