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Background: We reviewed imported malaria cases in British troops stationed in Germany, to quantify the occupational health burden of malaria and audit the quality of local care., Methods: We used a capture-recapture technique to ascertain imported malaria infections acquired by our military population during a 2-year period of surveillance (2001 and 2002). We retrieved and analysed all hospital discharge summaries. We calculated direct treatment costs from bills raised by the admitting German hospitals., Results: Out of 24 600 British troops stationed in Germany, approximately 800 were occupationally exposed to malaria during 2001 and 800 during 2002. The mean duration of exposure was 1.5 months. All the occupational exposures in this period occurred during routine training exercises in the tropics and subtropics, or during short-term peacekeeping missions in endemic areas. There were three imported malaria cases in British soldiers during 2001 and 12 during 2002 (crude acquisition rates 3.75 and 15/1000). Two soldiers (one with Plasmodium vivax, the other with Plasmodium falciparum infection) required intensive hospital therapy. The median length of hospital inpatient stay was 7 days (for P. vivax infection) and 8.5 days (for P. falciparum). The direct treatment costs of the hospitalizations totalled 27,760., Conclusions: Comparing crude acquisition rates, non-immune soldiers carrying out peacetime activities in endemic areas may be at around 2-10 times greater risk of acquiring malaria than civilian travellers to the tropics. All military branches are at some risk, and the Royal Engineers may be at an especially high risk of occupationally acquired malaria. Better prevention is mandatory.