In Kenya, millions are threatened by climate-driven kala-azar

Longorot Epuu's 8-year-old niece, his namesake, fell ill.

Epuu quickly recognized the signs of kala-azar, “black fever,” when visiting his brother's family in a nearby village in Kenya's vast, arid Turkana region last September. The youngest Longorot had a high fever, her stomach was swollen, and she was very weak. Kala-azar, also known as visceral leishmaniasis, is caused by the bites of female mosquitoes and primarily affects children under 15 years of age. But Epuu did not know that if left untreated, the disease attacks vital organs and affects fatal in 95 percent of cases.

Yet he could tell that something was wrong. He picked up his niece and took her on his motorcycle to a local hospital 6 miles away. On the sixth day of her stay, she died.

“We were shocked and completely shocked,” Epuu said. “It was too late.”

East Africa currently accounts for more than 70 percent of the approximately 50,000–90,000 cases of kalaazar disease worldwide each year—and disease becomes endemic in Kenya in more and more areas, partly due to climate change. Rising temperatures and erratic rainfall, including extreme swings between severe droughts and flash floods, have accelerated the breeding of infected mosquitoes and the spread of kala-azar in the region.

Five million people are at risk of kala-azar in Kenya, which has set itself the goal elimination disease by 2030. Scientists, doctors and field workers have said the goal is too ambitious, in part because U.S. President Donald Trump has unilaterally cut much international aid to countries like Kenya and shut down the U.S. Agency for International Development (USAID), which funded many local health workers who treat kalaazar cases and raise awareness locally. Due to extreme weather conditions and funding cuts, Turkana is losing many of the resources needed to combat kalaazar as it becomes more widespread.

“The cuts are really tragic,” said James Ekamais, coordinator for kalaazar and other so-called neglected tropical diseases in Turkana County. “Early detection and management of patients is now compromised. We will lose them. We expect the mortality rate to rise.”

Kala-azar was the first registered in Kenya in the early 19th century, when an outbreak occurred around Lake Turkana, the largest desert lake in the world. Since then, the decades-long gap between outbreaks in Turkana and across Kenya has narrowed.

Since the end of last year there has been significant surge in cases in northeastern Kenya. Turkana, an area of ​​about 1 million people, is a national hotspot with between 200 and 300 cases reported annually over the past five years. In September, the county government officially declared a state of emergency in Qala Azhar as 2025 would see its highest annual number of cases on record, with more than 520 cases recorded so far. Turkana has become one of the first counties in Kenya to officially escalate the disease to crisis level as it fears a full-blown outbreak. Meanwhile, Kenya Ministry of Health and local health workers in Turkana say the number of cases and deaths is grossly underreported.

For mosquitoes, the dry, degraded land around Lake Turkana provides an ideal environment. They breed in warm temperatures and dark places, especially in cracked soil and anthills surrounding manyattas, a community of traditional houses built from mud and grass. The region's traditional nomadic lifestyle only exacerbates this problem, as it increases the vulnerability of herders who constantly move their livestock in search of water and food. Mosquitoes can also easily enter the temporary shelters and huts used by this population.

Temperatures in the area can reach 110 degrees Fahrenheit. From 1967 to 2012, minimum and maximum air temperatures in Turkana. increased 2 to 3 degrees Celsius (3.6 to 5.4 degrees Fahrenheit)—significantly more than the global average. According to climate report By 2030, average surface temperatures in Kenya are projected to increase by 1 to 1.5 degrees C (1.8 to 2.7 degrees F), according to Turkana County data released in 2023. Rainfall is also becoming more uneven, leading to severe droughts that further degrade land conditions.

“Just a small change in climate can make a big difference,” said Chris Murray, professor of environmental change and health at the London School of Hygiene and Tropical Medicine. “This could speed up the life cycle of the vector”—in this case the mosquito—“leading to an increase in the number and frequency of bites in the area.”

Insect repellents and bed nets help prevent disease, but are not available in poor areas. Kala-azar is often treated with daily injections for 17 to 30 days, including antimony-based drugs, which are known to be toxic and have severe side effects. Although the oral drug currently undergoing clinical trials in Ethiopia, it is unclear when it will become available.

Many patients with kala-azar have comorbidities. In the remote town of Kaikor, where Epuu's niece died, most also suffer from hepatitis B, a serious liver infection. Another common one coinfection HIV/AIDS weakens the immune system and makes people more vulnerable to getting kala-azar from mosquito bites.

Remote areas such as Turkana have long relied on local health workers to disseminate information about both kala-azar and HIV/AIDS, and monitor and report case numbers. Many of these workers were supported by USAID, and their funding dried up after Trump cut the agency's budget. USAID's global funding for neglected tropical diseases, a category that includes kala-azar as well as more common infections such as dengue, was $115 million in 2024. Now all funding for the fight against neglected tropical diseases by 2025 is fully frozenand funding for the fight against HIV/AIDS was cut 70 percent.

A US State Department spokesman told Grist that “the programs have been determined not to meet the standards set by the US Secretary of State.” [Marco] Rubio for foreign assistance to make the United States stronger, safer and more prosperous.” They did not answer questions about which Kala Azar programs were cut and how much money they cost.

USAID leaflets are still plastered all over dilapidated hospitals in Turkana, from refrigerators storing medicine to building facades. Meanwhile, Turkana, like nearly a dozen counties in Kenya experiencing kalaazar outbreaks, is suffering from critical shortage medicines and rapid diagnostic kits.

Ekamais, Turkana County's tropical disease coordinator, said in mid-May that he had only received five test kits from the national government this month. Without kits, doctors try to make a diagnosis by physically assessing symptoms, which can be unreliable given their similarities to malaria. The local hospital has already reported 68 cases in May and is seeing a growing number of sick refugees arriving from the borders of South Sudan, Ethiopia and Uganda.

Public health workers across Turkana also said they were grappling with shortages of tests and medicines as cases rise.

They also claim that funding from Kenya's national government is being cut, despite its goal of eliminating the disease. The Kenya Institute of Medical Research, the government corporation that monitors Kala Azar, did not respond to a request for comment.

“Funding is negligible right now,” said James Ekiru Kidalyo, director of health services for Turkana County. “Kala-azar is deadly and must be treated with the seriousness it deserves.”

Unfortunately, large pharmaceutical corporations have shown little interest in this disease. “Kala azar is a serious public health problem, but the problem is that it typically affects poor people in rural areas,” said James McKerrow, director of the Center for Parasitic Disease Discovery and Innovation at the University of California, San Diego. “As a result, developing drugs or simply studying a disease is not something that international pharmaceutical companies want to do because they are not going to make money from it.”

There are a few small success stories so far. In mid-May, Eketan Amurey, who did not know her age but appeared to be in her 20s, completed her 30-day treatment plan in Loima, Turkana County.

The road to recovery was extremely difficult. Amurei experienced severe abdominal pain for a month and tried local and herbal treatments, including cutting her spleen with a razor blade to release “bad blood” – a common practice among Turkana residents with kala-azar symptoms.

When this did not relieve her illness and swelling, Amurey went to a local hospital. The walk was over 15 miles and, due to her weakness, took her five days. Along the way, she slept on the ground outside.

Now finally fully recovered, Amurei said she will go home and return to selling firewood to support her five children. “I wonder how my family stayed afloat,” she said. “And I'm scared, will I get it again?”

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