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Containing measles in conflict-driven humanitarian settings
  1. Debarati Guha-Sapir1,
  2. Maria Moitinho de Almeida1,
  3. Sarah Elisabeth Scales1,2,
  4. Bilal Ahmed3,
  5. Imran Mirza3
  1. 1Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
  2. 2Columbia University Mailman School of Public Health, New York, New York, USA
  3. 3UNICEF, New York, New York, USA
  1. Correspondence to Dr Maria Moitinho de Almeida; maria.rodrigues{at}

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Summary box

  • The persistence of measles incidence and outbreaks in humanitarian settings is troubling and needs urgent attention.

  • There is now a pressing need to develop, test and implement innovative approaches to vaccinate populations affected by humanitarian emergencies in light of the new and heightened threats posed by COVID-19.

  • Humanitarian interventions must keep a balance between Supplementary Immunization Activities and Routine Vaccination Programs, as well as between host and displaced communities.

  • Building strong partnerships, including with warring parties and the local communities, will support the delivery of broader primary healthcare services including immunisation in humanitarian settings.

Measles: a well-studied disease, yet a long way to go

The fragile capacity of health systems to respond to measles in humanitarian settings is likely to break down completely, should the current COVID-19 pandemic ravage these populations.1 Conflict-driven humanitarian settings (hereafter humanitarian settings), characterised by armed conflict, insecurity, and mass displacements, are particularly vulnerable to the detriments of competing epidemics where a low capacity to carry out basic health system functions, such as vaccination programmes, facilitates the occurrence of disease outbreaks.2 Supply chains become sporadic, cold chains lose viability, beneficiaries avoid unsafe trips to health centres, and human resources are dissipated, creating ever-larger pools of unvaccinated children and jeopardising herd immunity. Delays in case detection due to disrupted healthcare or lack of laboratory capacity, exacerbated by the dynamic nature of conflicts, lead to late epidemic response and control. With over 135 million people living in areas of conflict,3 epidemics in humanitarian settings are a pressing global health concern: 14 million out of the 20 million (70%) unvaccinated children in 2018 are zero dose children, and an estimated 5.6 million are in conflict-affected settings.

Measles is a highly contagious and potentially deadly disease that can spread among malnourished and vitamin A deficient populations in humanitarian settings.4 Globally, measles cases have appreciably increased in …

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