Ethiopia recorded more than 10 million malaria cases in 2024, a dramatic surge from fewer than one million cases in 2019, according to official local figures and the World Health Organization country profile drawing on the World Malaria Report 2025. However, researchers, international public health agencies, and legal specialists point to a complex mix of climatic variability, health-service disruptions, emerging parasite drug resistance, and diagnostic escape mutations rather than a single hydraulic cause.
Malaria Burden Around the GERD Site
Benishangul-Gumuz, the western Ethiopian region hosting the Grand Ethiopian Renaissance Dam reservoir, has a long history of high malaria transmission. Research from the Mankush Health Centre in Guba district documented substantial malaria positivity among patients tested between 2014 and 2018, years before the reservoir began filling. Out of 16,964 suspected patients tested during that window, 8,658 tested positive. The proportion testing positive actually declined from about 85 percent in 2014 to 35 percent in 2018, demonstrating an existing disease burden rather than an immediate increase driven by the dam project itself.
Parallel modeling systems and official data reveal a severe nationwide crisis. This widespread resurgence overlaps chronologically with the dam’s filling stages, though health authorities emphasize that the timeline alone does not establish direct causation.
Survey reveals drug resistance mutations across twenty sentinel sites
A rapid cross-sectional survey conducted by the Ethiopian Public Health Institute between July and August 2024 across 20 sentinel sites in 11 transmission-heavy regions investigated genetic drivers behind the resurgence. Published in JAMA, the study enrolled 2,204 symptomatic, microscopy-positive patients. Among 1,751 participants with available PCR results, 62.2 percent carried Plasmodium falciparum, 21.6 percent had Plasmodium vivax, and 9.5 percent harbored both species.
Sequencing revealed World Health Organization-validated artemisinin resistance mutations in the pfk13 gene, including R622I at a 35.5 percent prevalence, alongside A675V and P574L. Furthermore, researchers detected deletions in the histidine-rich proteins 2 and 3 (pfhrp2/3) genes in Plasmodium falciparum isolates. These deletions allow parasites to evade detection by standard HRP2-based rapid diagnostic tests, generating false-negative results that delay critical treatment.
Standing water supplies habitats for mosquito vectors
Dr Mohamed Abdel-Salam explained that Anopheles mosquitoes require favorable temperature and humidity, with immature stages developing in aquatic environments. Standing water does not transmit malaria directly, but it supplies habitats for the mosquito vector.
However, the ultimate impact on disease transmission depends heavily on local environmental conditions, reservoir operations, settlement geography, and active vector-control interventions.
Legal Dimensions of the Water Dispute
Dr Mohamed Mahmoud Mahran, an international law specialist, argued that documented scientific research connecting reservoir filling periods to the rise in malaria cases introduces an unexamined health dimension to the broader GERD dispute between Egypt and Ethiopia. Mahran pointed to the principle of preventing significant harm, reflected in Article 7 of the 1997 UN Convention on the Law of the Non-Navigational Uses of International Watercourses, suggesting that environmental and health consequences could form part of an assessment of major alterations to shared watercourses.
This legal argument relies on establishing a clear scientific chain of causation across borders. Existing scientific literature establishes a dramatic national malaria resurgence and highlights potential local breeding habitats near the reservoir, but it does not prove that the dam itself caused Ethiopia’s nationwide epidemiological increase.
Climatic variability and conflict drive malaria surge in Ethiopia
What caused the sharp increase in malaria cases in Ethiopia by 2024?
The World Health Organization and the Ethiopian Public Health Institute attribute the rise from under one million cases in 2019 to over 10 million in 2024 to climatic variability, conflicts, population displacement, health-service disruptions, and the spread of drug-resistant parasite strains.
How do parasite genetic mutations affect malaria treatment in Ethiopia?
Mutations in the pfk13 gene cause partial resistance to artemisinin-based combination therapies, meaning parasites clear more slowly. Additionally, deletions in the pfhrp2/3 genes enable parasites to escape detection by standard rapid diagnostic tests.
Did the filling of the Grand Ethiopian Renaissance Dam cause the nationwide malaria surge?
While studies from the Ethiopian Public Health Institute warn that the reservoir can create mosquito-breeding environments if unmanaged, researchers and international agencies emphasize that chronological overlap with dam filling does not establish direct causation for the national epidemic.
Related reading