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The document provides a standardized protocol for evaluating the Early Warning Alert and Response Network (EWARN), a surveillance system used during humanitarian emergencies when regular national health surveillance may be disrupted. The purpose of EWARN is to detect outbreaks of communicable diseas
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es early and enable rapid public health response. The guidance explains how the system should be assessed in terms of its structure, implementation, effectiveness, and usefulness. It outlines the key steps of evaluation: preparation, system description, data collection, and post-evaluation reporting. The protocol highlights common challenges observed in previous EWARN implementations, such as delays in establishing the system, limited data quality, weak outbreak response, and lack of clear transition plans back to routine surveillance systems. It emphasizes the need to evaluate both weekly disease reporting and alert verification processes, and to review attributes such as simplicity, data quality, timeliness, sensitivity, and stability. The document also provides templates for interviews, data review forms, and laboratory assessment, as well as guidance on conducting remote evaluations when access is limited. The overall goal of the protocol is to ensure that EWARN functions effectively to detect and respond to outbreaks and that practical recommendations are developed to improve the system’s performance and sustainability in emergency settings.
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The WHO Health Security Learning Platform (HSLP) is an online training hub that provides courses and toolkits to strengthen countries’ capacities in public-health preparedness, emergency response, and implementation of the International Health Reg
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ulations (IHR). It offers self-paced modules and practical training materials on topics such as outbreak response, points-of-entry management, One Health, and laboratory preparedness, helping health professionals build essential skills for global health security.
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Rwanda’s mountainous topography makes ground transportation of medical supplies unreliable — some roads stretching into rural areas remain uncared for and unpaved. Between 25 and 40 per cent of all temperature-sensitive medical supplies sent from urban centres to rural health clinics are wasted
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because of an unreliable cold-chain infrastructure. Rural clinics are also often subject to stockouts, and patients in need of specialized blood products, drugs and other supplies are unable to acquire them. Zipline, a US-based health logistics company, aims to address the issue of access to medical supplies, largely leapfrogging traditional modes of transportation and various obstacles. Zipline uses drones to deliver blood and other routine and emergency medical supplies from distribution centres to district hospitals and rural health centres.
Although the company has been celebrated in the media for its operations, there is little scholarly work on its operations and performance. This has led to some confusion over its scale. We aimed to gain insight into the details of Zipline’s business model, including the infrastructure, regulations and government support that make Zipline possible, and to understand its impact on health outcomes in Rwanda. Our work was entirely based on published materials since our research was conducted during the COVID-19 pandemic.
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The WHO “Surveillance” page on the Emergencies section explains how the World Health Organization supports disease surveillance in the context of health emergencies. It highlights that effective surveillance systems are essential to detect disease outbreaks quickly in
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emergency settings, such as during conflicts, natural disasters, or humanitarian crises, so that outbreaks can be identified before they spread widely and cause many deaths. The page also describes WHO’s approaches and tools for surveillance, including standardized data collection on attacks on health care, early warning, alert and response systems, and guidance materials that help countries monitor and analyse health threats, share information, and improve their early detection and response capacities during public health emergencies.
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This Mobile user guidance is aimed at supporting implementation of EWARS in a box, WHO’s electronic early warning, alert and response system in emergencies. This guidance fulfills a long felt need to have an easy to use resource with step-by-step instructions in establishing EWARS in a box, facili
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tating field epidemiologists, surveillance officers and emergency responders.
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An ALNAP Guide. Pilot Version.
This pilot guide is intended to help evaluation managers to commission and oversee, and team leaders to conduct, RTEs of humanitarian operational responses. Drawing on a synthesis of existing good practices, it sets out a flexible approach that can be adapted to a var
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iety of contexts. While it concentrates on the particular problems posed by RTEs undertaken within a few months of the start of an emergency response, it addresses how such RTEs can also feed into on-going operations. While the guide focuses on RTEs, some of the advice applies to all evaluations.
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Environmental Health Management After Natural Disaster
recommended
Ruth Newman, Richard Hansen, John Quigley and Don Schramm
Pan American Health Organization
(2003)
C_WHO
Natural disasters often increase morbidity and mortality rates. Taking appropriate measures to maintain environmental health helps to reduce or eliminate the risks of preventable disease and death. Such measures contribute not only to the health of individuals in and near disaster-stricken areas, bu
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t they also contribute to decreasing the high costs of providing emergency health services in the aftermath of disaster.
This document is divided into several parts. The first section primarily addresses the effects of natural disasters on environmental health conditions and services. In the second section, environmental health measures are described that should be undertaken in each of three time frames: the predisaster, disaster, and postdisaster periods.
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The CDC document "How to make oral rehydration solution (ORS)" provides clear, step-by-step instructions for preparing and using ORS to treat dehydration caused by diarrhea. It emphasizes the importance of using clean water, salt, and sugar in precise proportions to create the solution. The document
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is particularly relevant in emergency settings, such as during cholera outbreaks or in areas with limited medical resources, like Haiti. It highlights the effectiveness of ORS in saving lives by rehydrating individuals suffering from severe diarrhea and encourages its use as a simple, accessible treatment method.
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Pandemic Preparedness and Response – Lessons from the H1N1 Influenza of 2009
Harvey V. Fineberg
(2014)
New England Journal of Medicine 2014; 370:1335-1342. Please download the pdf-file from the nejm Website!
A number of viruses have pandemic potential. The most recent global pandemic was caused by the influenza A (H1N1) strain, which was first detected in North America in 2009. The 2009 H1N1 pande
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mic presented a public health emergency of uncertain scope, duration, and effect. At the request of the WHO, an international committee reviewed the experience of the pandemic, with special attention given to the function of the 2005 International Health Regulations (IHR) and the performance of the WHO. The most fundamental conclusion of the committee, which applies today, is not reassuring: “The world is ill prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency
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In response to a call by the United Nations Secretary-General and the Governments of Guinea, Liberia and Sierra Leone, an international team conducted an Ebola Recovery Assessment.The aim was to contribute towards laying the foundation for short-, medium- and long-term recovery while the medical
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emergency response continues to tackle the epidemic.
This summary report is based on a full report as well as three detailed reports submitted to each of the three governments as contributions to their national recovery planning processes.
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Recovering from the Ebola Crisis
Magdy Martínez-Solimán; Abdoulaye Mar Dieye; Izumi Nakamitsu et al.
United Nations, The World Bank, European Union and African Development Bank
(2015)
Full Report.
In response to a call by the United Nations Secretary-General and the Governments of Guinea, Liberia and Sierra Leone, an international team conducted an Ebola Recovery Assessment. The aim was to contribute towards laying the foundation for short-, medium- and long-term recovery while
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the medical emergency response continues to tackle the epidemic. This report is a contribution to ongoing efforts by the Governments of Guinea, Liberia and Sierra Leone to design their national Ebola virus disease recovery strategies
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Available in English and Spanish, Hesperian’s comprehensive app on pregnancy and birth contains a wealth of information on:
how to stay healthy during pregnancy
how to recognize danger signs during pregnancy, birth, and
after birth
what to do when a danger sign arises
whe
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n to refer a woman to emergency care
instructions for community health workers with step-by-step explanations such as “How to take blood pressure,” “How to treat someone in shock,” “How to stop bleeding.”
more
Lancet Glob Health 2016; 4: e856–63. Open Access
The article "Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study" investigates whether a single dose of the Shanchol oral cholera vaccine can provide effective protection during an outbreak. Conducted i
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n Juba, South Sudan, in 2015, the study involved a case-cohort approach, analyzing vaccination status and disease outcomes.
Findings showed that a single dose was 80.2% effective in preventing medically attended cholera cases, increasing to 87.3% after adjustments for confounding factors. These results suggest that a single-dose strategy can be an effective emergency response, particularly in settings with limited vaccine supply and high mobility of affected populations. The study supports using a single-dose approach during outbreaks when a two-dose regimen is logistically challenging.
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Fact sheet Cholera in Creole
The cholera factsheet provides key information on prevention, symptoms, and treatment. It emphasizes hygiene, safe food handling, and water treatment through boiling, filtering, or disinfection. Cholera, a severe diarrheal disease from contaminated water, causes dehydra
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tion and can be fatal if untreated. Symptoms include watery diarrhea, vomiting, and weakness. Treatment focuses on rapid rehydration with oral rehydration solutions (ORS) and continued feeding. The guide also covers safe waste disposal, emergency latrines, and burial practices to prevent spread. It aims to educate communities on cholera prevention, early detection, and life-saving care.
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A Review of Needs Assessment Tools, Response Analysis Frameworks, and Targeting Guidance for Urban Humanitarian Response
Lili Mohiddin, Gabrielle Smith
International Institute for Environment and Development, Norwegian Refugee Council, International Rescue Committee, World Vision
(2016)
C1
The magnitude of urban disasters, high population densities, and a complex social, political and institutional environment has challenged the manner in which humanitarian agencies are used to working. Humanitarian agencies are now grappling with how to change their approaches to this reality. This d
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esk review aims to provide an audit and analysis of existing needs assessments, response analysis frameworks and targeting approaches for use in urban post-conflict emergency response.
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Notable progress has also been made on other key health indicators such as reducing maternal, infant and child deaths and malnutrition, increasing immunization coverage, eliminating infectious diseases such as polio and reducing the incidence of malaria, tuberculosis and diarrhoeal diseases.
But
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despite such substantial progress, the country now faces new and emerging new challenges such as the rising burden of noncommunicable diseases, increased risks associated with disasters, environmental threats and health emergencies during disease outbreaks including the COVID-19 pandemic that is a serious public health threat to Bangladesh. To establish a resilience system for future potential pandemics, the national capacity for emergency preparedness and early response to health emergencies needs to be bolstered considerably.
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Integrating Clinical Research into Epidemic Response: The Ebola Experience
Gerald Keusch, Keith McAdam, Patricia Cuff, Michelle Mancher, and Emily R. Busta
National Academies of Sciences, Engineering, and Medicine
(2017)
C1
The 2014–2015 Ebola epidemic in western Africa was the longest and most deadly Ebola epidemic in history, resulting in 28,616 cases and 11,310 deaths in Guinea, Liberia, and Sierra Leone. The Ebola virus has been known since 1976, when two separate outbreaks were identified in the Democratic Repub
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lic of Congo (then Zaire) and South Sudan (then Sudan). However, because all Ebola outbreaks prior to that in West Africa in 2014–2015 were relatively isolated and of short duration, little was known about how to best manage patients to improve survival, and there were no approved therapeutics or vaccines. When the World Heath Organization declared the 2014-2015 epidemic a public health emergency of international concern in August 2014, several teams began conducting formal clinical trials in the Ebola affected countries during the outbreak.
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The document is a UNICEF cholera toolkit designed to support prevention, preparedness, and response to cholera outbreaks. It provides guidance on water sanitation, hygiene, and health education, along with practical tools and resources for managing outbreaks. It is intended for use by UNICEF teams,
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governments, and partners to integrate cholera prevention into development programs and emergency response strategies.
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"Achieving, maintaining and improving accuracy, timeliness and reliability are major challenges for health laboratories. Countries worldwide committed themselves to build national capacities for the detection of, and response to, public health events of international concern when they decided to eng
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age in the International Health Regulations implementation process. Only sound management of quality in health laboratories will enable countries to produce test results that the international community will trust in cases of international emergency. This handbook is intended to provide a comprehensive reference on Laboratory Quality Management System for all stakeholders in health laboratory processes, from management, to administration, to bench-work laboratorians. This handbook covers topics that are essential for quality management of a public health or clinical laboratory. They are based on both ISO 15189 and CLSI GP26-A3 documents"--Page 7.
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The technical note by the Global Task Force on Cholera Control (GTFCC) discusses the use of Oral Cholera Vaccines (OCVs) for international workers and travelers in cholera-affected areas. It reviews the effectiveness of WHO-prequalified vaccines (Dukoral®, Shanchol™, and Euvichol®), emphasizing
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their role in preventing infection and reducing transmission risks.
The document highlights concerns about travelers contracting cholera in endemic regions and potentially spreading the disease upon returning home. While the overall risk is considered low, certain groups, such as humanitarian workers and travelers to high-risk areas like South Asia, face a higher exposure.
Recommendations include vaccination for emergency and relief workers who may come into direct contact with cholera patients or contaminated environments. However, routine vaccination for general travelers is not widely recommended. The note also calls for better surveillance and studies to assess the potential of vaccines in preventing international transmission.
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