Epidemiology of Infectious Disease Outbreaks in Displacement Settings: Surveillance Gaps and Community-Based Solutions in Refugee Camps

Abstract

Abstract:
Infectious disease outbreaks are a persistent threat in displacement settings, particularly refugee camps where overcrowding, poor sanitation, and limited healthcare access prevail. According to WHO estimates, over 60% of disease outbreaks in humanitarian crises are reported late, resulting in delayed response and avoidable fatalities. This cross-sectional study investigates outbreak surveillance performance in five refugee camps across Sudan, Syria, and South Sudan, collectively hosting over 410,000 displaced individuals. Data collected over 12 months show that 71% of outbreak cases (n=2,847) were reported with a delay exceeding 72 hours. Cholera outbreaks had a case fatality rate (CFR) of 17%, while hepatitis E showed a CFR of 12%. Only 28% of the camps had functional early warning alert systems (EWARS), and 62% lacked structured community reporting mechanisms. Community health workers (CHWs) were active in 49% of the camps but were not formally trained in outbreak identification protocols. Mobile health reporting tools, introduced in a pilot phase, reduced reporting delays by 39%. Integration between health posts and central surveillance units was weak, with only 31% of weekly reports reaching the central system on time. The study recommends expanding EWARS, training CHWs in community-based disease surveillance, and equipping camps with mobile reporting apps. These improvements could increase system responsiveness by over 45% and mitigate outbreak escalation in humanitarian emergencies.