Structure, function and performance of Early Warning Alert and Response Network (EWARN) in emergencies in the Eastern Mediterranean Region.

Abstract Introduction The Eastern Mediterranean Region (EMR) has experienced several protracted humanitarian crises. The affected population are served by eight EWARN systems for outbreak detection and response. Our aim was to compare structure, function, and performance of the systems, adherence to current guidance, and note emerging lessons. Methods This study included a review of published and unpublished literature, a structured survey, and interviews. Results Findings showed all systems adhered to basic EWARN structure. Four of eight systems had electronic platforms while one was implementing. Regarding key EWARN function of outbreak detection, out of the 35 health conditions, 26 were communicable diseases and nine were non-communicable; only two systems focused on epidemic-prone diseases. Half the systems achieved ≥60% population coverage, five achieved ≥80% reporting timeliness, six achieved ≥80% reporting completeness, and seven achieved verification of ≥80% of alerts of suspected outbreaks. Conclusion Findings showed that the systems followed EWARN structure while increasing adoption of electronic platforms. Performance, including timeliness and completeness of reporting, and timely verification of alerts, were optimal for most of the systems. However, population coverage was low for most of the systems, and EWARN’s primary focus of outbreak detection was being undermined by increasing number of non-epidemic diseases.