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Enhancing integrated epidemic response mechanisms in humanitarian emergencies: a scoping review and qualitative study #MMPMID41344714
Esmail M; Chatterjee P; Parikh K; Quaye MA; Spiegel P
BMJ Open 2025[Dec]; 15 (12): e102482 PMID41344714show ga
OBJECTIVES: Epidemics pose significant challenges for fragile health systems, particularly in humanitarian emergencies. Recent responses to epidemics such as cholera in Yemen and Ebola virus disease in the Democratic Republic of the Congo have highlighted the lack of effective and integrated coordination. We review existing global models for addressing large-scale epidemics in humanitarian emergencies, identify gaps and inefficiencies, and propose operational recommendations to enhance response mechanisms. DESIGN: A two-pronged approach was used to identify and critically assess current response coordination frameworks. Using the Arksey and O'Malley framework, a scoping review was undertaken, which was complemented by key informant interviews with humanitarian emergency response experts. The interviews focused on identifying the existing challenges and potential strategies to improve epidemic response in humanitarian contexts. PARTICIPANTS: The scoping review included 51 documents (13 peer-reviewed articles and 38 grey literature documents). We conducted in-depth interviews with 28 respondents representing 17 different agencies and donors. INTERVENTIONS: We focused on two major response architectures: the Incident Management System (IMS) and the cluster system. IMS is an important coordination and response instrument increasingly being used to respond to infectious disease threats. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome measures of interest included the gaps in the current mechanisms to address infectious disease threats in complex humanitarian emergencies. RESULTS: Unlike the cluster system model, which relies on consensus decision-making, IMS has a command-and-control approach, ensuring rapid decision-making. However, it can also lead to vertical responses that neglect the cross-sectoral and complex needs of affected communities. In addition, we found that the absence of context-specific response coordination mechanisms, with clear roles and responsibilities for involved stakeholders, was a common shortcoming. Fragmented response efforts that sidelined national and local stakeholders and a lack of reliable funding were also identified as important weaknesses. CONCLUSIONS: We recommend the integration of coordination mechanisms into a sufficiently flexible framework that can be adapted to local contexts, while empowering national and local actors and ensuring the continuity of essential humanitarian services. We propose a paradigm shift towards mechanisms that respect humanitarian principles, effectively addressing the epidemic threats while remaining focused on deploying community-centric response efforts.
BMJ+Open 2025 ; 15 (12): e102482
