Malaria in Libya: Re-emergence or Importation? A Short Literature Review

Libya recorded its last indigenous malaria case in 1973, yet confirmed cases continue to be diagnosed every year, and reports of locally acquired infections have prompted claims that the disease is returning. This review appraises published and official evidence on whether malaria in Libya represents re-emergence of local transmission or continued importation from endemic countries. The evidence indicates that endemic transmission has not been re-established. Nearly all diagnosed cases are imported, chiefly in migrants and workers from Niger, Chad, Sudan and other sub-Saharan countries, and positivity in southern convenience samples ranged from 14.8% to 64.4% depending on population and assay. Locally acquired events are few and heterogeneous: a suspected non-imported case in 2004, two cases without travel in Wadi Al-Shati in 2015 that were never fully published, and a fatal 2024 Benghazi cluster that investigators attributed to an aircraft-imported mosquito rather than to local vectors. Receptivity nonetheless persists, because Anopheles sergentii and An. multicolor remain established in Fezzan oases and An. sergentii has been recorded in north-western Libya. Rising vulnerability from Sahelian and Sudanese population movement, the spread of An. stephensi across Sudan to its border with Libya, and the absence of parasite genotyping or vector infection studies leave Libya at genuine risk of introduced transmission, particularly in the Fezzan.