In Kenya's Turkana region, rising temperatures and erratic rainfall are driving a surge in kala-azar cases, a deadly sandfly-borne disease. The situation has worsened by U.S. aid reductions that have crippled local health efforts. Over 520 cases were reported in 2025 so far, prompting an emergency declaration.
Longorot Epuu’s 8-year-old niece died from kala-azar in September last year while visiting family in Kenya’s arid Turkana region. Recognizing symptoms like high fever, swollen stomach, and weakness, Epuu rushed her to a hospital 6 miles away on his motorbike, but she succumbed on the sixth day of her stay. “We were shocked and completely shaken,” Epuu said. “It was just too late.”
Kala-azar, also known as visceral leishmaniasis or “black fever,” is caused by bites from infected female sandflies and primarily affects children under 15. Untreated, it attacks vital organs and proves fatal in 95 percent of cases. East Africa accounts for over 70 percent of the world’s estimated 50,000 to 90,000 annual cases. In Kenya, 5 million people are at risk, with the country aiming to eliminate the disease by 2030—a goal experts deem overly ambitious.
Climate change is a key driver. Rising temperatures, which reached 110 degrees Fahrenheit in Turkana, and erratic rainfall—swinging between droughts and floods—have boosted sandfly breeding. From 1967 to 2012, minimum and maximum air temperatures in Turkana rose by 2 to 3 degrees Celsius (3.6 to 5.4 degrees F), exceeding global averages. A 2023 Turkana County climate report projects Kenya’s mean surface temperature to increase by 1 to 1.5 degrees C (1.8 to 2.7 degrees F) by 2030. “Just a small climatic change can make a big difference,” said Kris Murray, a professor at the London School of Hygiene and Tropical Medicine. “It can speed up the life cycle of the vector leading to an increase in abundance and the biting rate.”
The dry, degraded land around Lake Turkana, the world’s largest desert lake, provides ideal breeding grounds in cracked soil and ant hills near traditional mud-and-grass homes. Nomadic herders’ lifestyles heighten exposure as they move cattle in search of water and food.
Compounding the crisis, U.S. President Donald Trump’s cuts to international aid shuttered much of USAID’s operations, which funded community health workers crucial for detection and awareness. Global USAID funding for neglected tropical diseases, including kala-azar, totaled $115 million in 2024 but was frozen for 2025; HIV/AIDS funding dropped 70 percent. “The cuts are really tragic,” said James Ekamais, Turkana County’s coordinator for neglected tropical diseases. “Early detection and the management of patients is now compromised. We will lose them. We anticipate the death rate going up.”
Turkana, home to about 1 million people, has seen 200 to 300 cases annually over the past five years. In 2025, over 520 cases were reported, the highest on record, leading to an emergency declaration in September. Cases and fatalities are underreported, with shortages of test kits and medications. In mid-May, the local hospital received only five test kits from the national government. Community health workers report decreasing national funding despite elimination goals. “The funding right now is negligible,” said James Ekiru Kidalio, Turkana County’s director of medical services. “Kala-azar is deadly and needs to be handled with the seriousness it deserves.”
Treatment involves 17 to 30 days of toxic antimony-based injections, with an oral drug in trials in Ethiopia. Co-infections like HIV/AIDS and hepatitis B, common in areas like Kaikor, complicate cases. Pharmaceutical companies show little interest, as James McKerrow of the University of California San Diego noted: “Kala-azar is a major health problem, but the issue is that it generally affects poor people in rural areas.”
Amid challenges, successes occur. In mid-May, Eketan Amurei, in her early 20s, completed 30 days of treatment in Loima subcounty after a grueling 15-mile, five-day walk to the hospital, weakened by abdominal pain and failed herbal remedies. Now recovered, she plans to return to selling firewood for her five children. “I’ve been wondering how my family has stayed afloat,” she said. “And I’m scared, will I get it again?”