Table 2.
Selected EIDs/REIDs outbreaks associated with wars.
| Year | Continent/Region | EID/REID | Summary |
|---|---|---|---|
| Africa | |||
| 1998 | DRC | African trypanosomiasis | Because of the weakness of many general health services which seriously hamper the integration of control activities, the annual number of reported sleeping sickness cases rose from 5,825 in 1991 to 26,318 in 1998 (23). |
| 2005 | Angola | Marburg | Nine Marburg hemorrhagic fever cases were diagnosed on 21 March, 2005 by the Centers for Disease Control and Prevention (CDC) in the samples sent from Angola. Being the first natural outbreak of the disease to take place in an urban setting, 270 cases with a case fatality rate of 92 percent were reported within the outbreak. Almost three decades of civil unrest have created additional challenges in the effort to contain the outbreak (32). |
| 2006 | DRC | Plague | Several plague outbreaks have been reported in DRC. 100 cases of suspected pneumonic plague, including 19 deaths were reported on June 2006 (27). |
| 2020–2021 | DRC | Plague | Implementation of control measures had been difficult due to security concerns in the area. More than 400 cases have been reported during outbreaks in 2020 and 2021 which were aggravated by conflict, poverty, increased population movement and displacement, and instability in some areas (25, 26). |
| 2020 | Guinea | Yellow Fever | A yellow fever outbreak with 50 suspected cases was reported in Guinea in 2020. The yellow fever vaccination coverage was found to be 16% in the Koundara district which was one of the affected areas while the estimated vaccination coverage against yellow fever for the whole country had been 40% for the years 2016 to 2019 (33). |
| 2022 | DRC | Ebola | EVD re-emerged in the Beni health zone, which was affected by insecurity from armed groups, DRC, 21 August 2022. Frequent protests against the security measures put in place by the authorities and against international organizations increased the risk of refusal of outbreak control measures (34). |
| 2022 | Malawi | Polio | Malawi reported a wild poliovirus type 1 (WPV1), which was later shown to be genetically linked to a Pakistan sequence detected in 2020 in Sindh province, in February 2022. The detection of WPV1 outside Pakistan, where the disease is endemic demonstrated the continuous risk of international spread of the disease (35). |
| Asia | |||
| 1994 | Tajikistan | Malaria | The number of laboratory-confirmed malaria cases increased from 175 in 1990 to 2,400 in 1994 in Tajikistan during the civil strife in 1992–1993 which caused massive internal displacement of people combined with deteriorating living conditions, and paralysis of the health system, especially public health programs. Additional to the major malaria outbreak, falciparum malaria transmission in some areas of the country was re-established for the first time in 35 years (36). |
| 1997–1998 | Pakistan | Cutaneous Leishmaniasis | A major cutaneous leishmaniasis outbreak was seen in an Afghan refugee camp in a non-endemic area in north-western Pakistan in 1997–1998. Before the outbreak, there were only a few cases in the camp, which was hosting more than 9,000 residents, mostly from eastern, central, and northern Afghanistan. Additionally, this outbreak caused disease establishment in the neighboring Pakistani villages (37). |
| 2002 | Afghanistan | Malaria | There had been a reemergence of malaria in Afghanistan with an estimation of 3 million cases in 2002 of which most of them in Kundoz Province. The annual incidence of Plasmodium falciparum and Plasmodium vivax malaria fluctuated from 0.0088 to 4.39 and from 3.58 to 13.37 episodes per 1,000 person-years, respectively. The introduction of P. falciparum and P. vivax malaria by returning refugees was one of the contributing factors (38). |
| 2012 | Lebanon | Leishmaniasis | The annual number of leishmaniasis cases reported in Lebanon sharply increased to 1,275 in 2012 due to mass population migration from Syria. All the cases were Syrian refugees from Aleppo, where they had been infected, causing re-emergence of the disease in the country. Lebanon reported ranged between 0 and 6 cases with no local transmission before 2012 (39). |
| Europe | |||
| 2000 | Kosovo | Tularemia | A tularemia outbreak with 327 cases in 2000 was seen in Kosovo as a result of environmental disruption, mass population displacements, the collapse of public health functions, such as disease surveillance and outbreak response, and a breakdown of sanitation and hygiene due to more than 10 years of political crisis and warfare (40). |