This review summarizes progress in preventing and treating severe malaria, which has been accompanied by advances in our understanding of the pathogenesis of severe malaria complications. New drugs such as intravenous artesunate and oral artemisinin combinations, with increased access to insecticide-treated bed nets, are improving outcomes and decreasing malaria deaths. Several groups are beginning to identify characteristics of parasite var genes associated with cerebral malaria. Understanding of the interactions between malaria and other diseases in causing severe anaemia and cerebral malaria has increased substantially, and at the cellular level, the disturbances leading to coma or other complications are becoming clearer.