Rapid Alert, Faster Response: WHO Reviews EWARS in Refugee Camps

The World Health Organization (WHO), in collaboration with the Institute of Epidemiology, Disease Control and Research (IEDCR), and the Civil Surgeon’s Office of Cox’s Bazar, conducted a comprehensive review of the Early Warning, Alert and Response System (EWARS) in Cox’s Bazar, Bangladesh. The review included a one-day Intra-Action Review (IAR) workshop held on 24 July 2025, followed by key informant interviews and field record reviews conducted from 25 to 30 July.

EWARS, developed by WHO, is designed for the early detection of and rapid response to disease outbreaks, particularly in emergency settings and among vulnerable populations.  Introduced in Cox’s Bazar in October 2017 following the mass displacement of Rohingya refugees, EWARS has since become a cornerstone of communicable disease surveillance and response efforts in the region.  

As of June 2025, EWARS is operational across all 33 refugee camps, serving both refugee and host communities in Ukhiya and Teknaf upazilas. More than 95% of the 110 designated reporting sites submit weekly surveillance data, and over 95% of alerts are verified within 48 hours. The system has facilitated the timely detection and response to 19 priority conditions, including suspected measles, Acute Jaundice Syndrome (AJS) and dengue, playing a critical role in managing outbreaks and reducing morbidity and preventable mortality. Dengue has shown consistent seasonal surges over multiple years, highlighting its status as a recurring public health threat. The trendline below illustrates how EWARS has enabled the timely identification and response to dengue outbreaks.

Weekly trends of Dengue in Rohingya Refugee Camps from 2018 to 2025.
Sours: EWARS

“Timely reporting is the cornerstone of effective disease surveillance. Early alerts enable swift responses to potential outbreaks. This intra-action review is a valuable opportunity to identify our strengths and gaps and develop actionable recommendations to strengthen the system,” said Dr Mohammadul Hoque, Civil Surgeon of Cox’s Bazar District.

The 2025 evaluation builds on the findings of the previous assessment conducted in 2019. It applies WHO’s global IAR methodology, a qualitative tool designed to assess emergency response actions, identify best practices, and enhance future preparedness. The evaluation focused on key areas including system performance, stakeholders’ collaboration, sustainability of community engagement, and interoperability with national platforms such as the District Health Information System 2 (DHIS2), covering both refugee and host populations.

“Despite the challenges of working in complex settings, WHO, through strong partnerships, has successfully implemented EWARS in Cox’s Bazar. This review helps us assess what’s working well and what can be further improved. It’s a continuous journey of learning together and strengthening our systems for response,” said Dr Masaya Kato, Programme Area Manager for Health Emergency Information and Risk Assessment, WHO Regional Office for South-East Asia  (SEARO).

Participants work in teams to reflect on progress and co-create solutions for stronger disease surveillance and response.
Photo: WHO/Terence Ngwabe Che

The workshop brought together over 40 participants from the Ministry of Health and Family Welfare, UN agencies, NGOs, and WHO offices at the subnational, national, regional, and global levels. Through group exercises and plenary discussions, stakeholders shared their experiences and proposed priority actions to strengthen disease surveillance and response. Following the workshop, field visits were conducted at 25 health facilities to review records and engage with clinic managers and healthcare workers on the implementation of EWARS.

“We look forward to gathering valuable insights from key informants to complement the discussions from the workshop. It’s encouraging that we’ve already received input from those directly involved before visiting the health facilities. All contributions will inform a report with recommendations aimed at saving lives, reducing suffering, and improving well-being,” said Dr Boris Pavlin, Team Lead for Humanitarian and Field Epidemiology and the Global EWARS Project Lead, WHO Headquarters.

Dr Masaya speaks with a frontline healthcare provider during a field visit to the Rohingya refugee camps, as part of WHO’s ongoing efforts to strengthen disease surveillance.
Photo: WHO/ Terence Ngwabe Che

Findings from this review will inform efforts to further strengthen outbreak surveillance and response in both Rohingya and host communities. They will also contribute to the implementation of Bangladesh’s National Action Plan for Health Security (NAPHS). The final report is expected to serve as a reference for similar humanitarian operations globally.

For more information on this publication, please email Terence Ngwabe Che, External Communications Officer at WHO Cox’s Bazar Office, Bangladesh, at chet@who.int.