Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018
Background Large epidemics frequently emerge in conflict-affected states. We examined the cholera response during the humanitarian crisis in Yemen to inform control strategies.Methods We conducted interviews with practitioners and advisors on preparedness; surveillance; laboratory; case management;...
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/4/e001709.full |
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| author | Paul Spiegel Ruwan Ratnayake Nora Hellman Mija Ververs Moise Ngwa Paul H Wise Daniele Lantagne |
| author_facet | Paul Spiegel Ruwan Ratnayake Nora Hellman Mija Ververs Moise Ngwa Paul H Wise Daniele Lantagne |
| author_sort | Paul Spiegel |
| collection | DOAJ |
| description | Background Large epidemics frequently emerge in conflict-affected states. We examined the cholera response during the humanitarian crisis in Yemen to inform control strategies.Methods We conducted interviews with practitioners and advisors on preparedness; surveillance; laboratory; case management; malnutrition; water, sanitation and hygiene (WASH); vaccination; coordination and insecurity. We undertook a literature review of global and Yemen-specific cholera guidance, examined surveillance data from the first and second waves (28 September 2016–12 March 2018) and reviewed reports on airstrikes on water systems and health facilities (April 2015–December 2017). We used the Global Task Force on Cholera Control’s framework to examine intervention strategies and thematic analysis to understand decision making.Results Yemen is water scarce, and repeated airstrikes damaged water systems, risking widespread infection. Since a cholera preparedness and response plan was absent, on detection, the humanitarian cluster system rapidly developed response plans. The initial plans did not prioritise key actions including community-directed WASH to reduce transmission, epidemiological analysis and laboratory monitoring. Coordination was not harmonised across the crisis-focused clusters and epidemic-focused incident management system. The health strategy was crisis focused and was centralised on functional health facilities, underemphasising less accessible areas. As vaccination was not incorporated into preparedness, consensus on its use remained slow. At the second wave peak, key actions including data management, community-directed WASH and oral rehydration and vaccination were scaled-up.Conclusion Despite endemicity and conflict, Yemen was not prepared for the epidemic. To contain outbreaks, conflict-affected states, humanitarian agencies, and donors must emphasise preparedness planning and community-directed responses. |
| format | Article |
| id | doaj-art-3dc2d8d6c1ff49bdbafcf36bb7f3d1f6 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-3dc2d8d6c1ff49bdbafcf36bb7f3d1f62025-08-20T02:37:43ZengBMJ Publishing GroupBMJ Global Health2059-79082019-07-014410.1136/bmjgh-2019-001709Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018Paul Spiegel0Ruwan Ratnayake1Nora Hellman2Mija Ververs3Moise Ngwa4Paul H Wise5Daniele Lantagne6Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USADepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAEmergency Response and Recovery Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USADepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USARichard E Behrman professor of child health and societyDepartment of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USABackground Large epidemics frequently emerge in conflict-affected states. We examined the cholera response during the humanitarian crisis in Yemen to inform control strategies.Methods We conducted interviews with practitioners and advisors on preparedness; surveillance; laboratory; case management; malnutrition; water, sanitation and hygiene (WASH); vaccination; coordination and insecurity. We undertook a literature review of global and Yemen-specific cholera guidance, examined surveillance data from the first and second waves (28 September 2016–12 March 2018) and reviewed reports on airstrikes on water systems and health facilities (April 2015–December 2017). We used the Global Task Force on Cholera Control’s framework to examine intervention strategies and thematic analysis to understand decision making.Results Yemen is water scarce, and repeated airstrikes damaged water systems, risking widespread infection. Since a cholera preparedness and response plan was absent, on detection, the humanitarian cluster system rapidly developed response plans. The initial plans did not prioritise key actions including community-directed WASH to reduce transmission, epidemiological analysis and laboratory monitoring. Coordination was not harmonised across the crisis-focused clusters and epidemic-focused incident management system. The health strategy was crisis focused and was centralised on functional health facilities, underemphasising less accessible areas. As vaccination was not incorporated into preparedness, consensus on its use remained slow. At the second wave peak, key actions including data management, community-directed WASH and oral rehydration and vaccination were scaled-up.Conclusion Despite endemicity and conflict, Yemen was not prepared for the epidemic. To contain outbreaks, conflict-affected states, humanitarian agencies, and donors must emphasise preparedness planning and community-directed responses.https://gh.bmj.com/content/4/4/e001709.full |
| spellingShingle | Paul Spiegel Ruwan Ratnayake Nora Hellman Mija Ververs Moise Ngwa Paul H Wise Daniele Lantagne Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018 BMJ Global Health |
| title | Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018 |
| title_full | Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018 |
| title_fullStr | Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018 |
| title_full_unstemmed | Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018 |
| title_short | Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018 |
| title_sort | responding to epidemics in large scale humanitarian crises a case study of the cholera response in yemen 2016 2018 |
| url | https://gh.bmj.com/content/4/4/e001709.full |
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