Key Evidence: Mass displacement of people during a complex humanitarian emergency can trigger a “cascade” of risk factors for communicable disease outbreaks, including a breakdown in health services (such as disease surveillance and immunization services); over-crowding (increasing disease transmission rates); inadequate water, sanitation and hygiene; and exposure of displaced population to endemic diseases for which they have no immunity.
Key Evidence: This modeling study examined the impact of conflict events on disease control efforts during an Ebola outbreak in the Democratic Republic of the Congo. The model used a timeline of conflict events and an ethnographic appraisal of attacks on health care workers and treatment centers to estimate their impact on the epidemic trajectory of Ebola. Overall, the population-level effectiveness of vaccination was reduced by 43% due to disruptive conflict events. The researchers also found that declining incidence of Ebola was repeatedly reversed by conflict events. This framework can be extended to other diseases and regions experiencing conflict.