Conflict and Outbreak Visibility: How War Shapes Global Disease Reporting

Original publisher: The Conversation. The article examines how war and violence shape the spread of infectious diseases and, crucially, how they affect the ability of the world to detect and report outbreaks. Through a cross-country analysis of WHO outbreak news from 1996 to 2024 and armed-conflict records, the piece highlights patterns that suggest conflict can both drive transmission and obscure visibility, with notable emphasis on sub-Saharan Africa and diseases tied to the collapse of basic services. The Ebola outbreak in the eastern Democratic Republic of the Congo and its spillover into Uganda is used as a case study to illustrate these dynamics and the challenges of outbreak detection in conflict zones.

• War can worsen disease spread by weakening clinics, labs, and reporting systems, while violence also complicates outbreak detection.
• Outbreak reporting is biased by visibility; many outbreaks may occur without being detected or reported to international bodies, influencing global understanding of disease dynamics.
• Patterns of disease during conflict vary by disease type; polio and cholera show increases linked to service collapse, whereas influenza reporting declines may reflect disrupted surveillance networks.
• Preparedness efforts since COVID-19 emphasize labs and monitoring networks, but their effectiveness hinges on functioning health workers and open clinics in conflict settings.

Author: The Conversation

Overview: War, disease and visibility

The article synthesizes findings from a study that cross-referenced infectious disease outbreaks reported in the World Health Organization’s disease outbreak news (DONs) between 1996 and 2024 with records of armed conflict across 236 countries and territories. The aim is to understand how conflict interacts with disease dynamics and, importantly, how it shapes the world’s ability to notice and publish information about outbreaks. The Ebola epidemic in eastern Democratic Republic of the Congo (DRC) and its cross-border spillover into Uganda is used as a contemporary, real-world example of how conflict can create a dangerous mix: clinics and laboratories in conflict zones are weakened, routine reporting is disrupted, and health workers may be prevented from reaching communities. This confluence can accelerate spread while simultaneously diminishing outbreak visibility to international audiences.

The article emphasizes that the WHO DONs archive is not a complete record of all outbreaks. It includes selected events that were detected, reported to the WHO, and published, and researchers note inconsistencies in disease names, case numbers, and other details. As a result, the study highlights patterns in outbreaks that were reported, not every outbreak that occurred. Despite these limitations, the authors argue that conflict can influence both the spread of diseases and the likelihood that outbreaks become visible to the global community.

Data sources and key findings

The analysis draws on two primary data sources: (1) the WHO DONs archive, which documents selected outbreaks that were detected and publicly reported, and (2) records of armed conflict, used to categorize countries by the intensity and impact of violence. By comparing timing and location of outbreaks with conflict patterns, the study identifies several robust patterns. In sub-Saharan Africa, several diseases linked to weak basic services—most notably polio and cholera—appear more frequently during civil conflicts. Cholera outbreaks often rise one to two years after the onset of fighting, consistent with the gradual deterioration of water and sanitation systems, healthcare delivery, and displacement dynamics. However, influenza shows the opposite trend: outbreaks are reported less often during conflict, a result that likely reflects disruptions to laboratories, surveillance networks, and reporting channels rather than a true decline in transmission.

The Ebola case in the DRC and Uganda underscores the real-world implications: conflict can impede access to clinics and laboratories necessary for timely detection, testing, and containment. The article stresses that while the patterns observed are consistent with the logic that war undermines health infrastructure, they cannot irrefutably establish causation. The observed patterns persist even after adjusting for country income, suggesting that the effect of conflict on detection and reporting goes beyond economic capacity alone, though income remains an important factor in how diseases tend to occur and are reported in different regions.

Implications for policy and pandemic preparedness

The piece argues that pandemic-preparedness programs since COVID-19 have prioritized strengthening laboratories and disease-monitoring networks. Yet, these systems rely on health workers reaching communities, clinics staying open, and institutions being able to share results—conditions that are often not met in conflict zones. The authors stress that even advanced warning systems can lose their value if foundational health infrastructure collapses. An outbreak map, while useful as a picture of disease presence, is also a map of visibility: where the world can still see outbreaks. In conflict-affected areas, visibility may fade exactly when the need for timely reporting is greatest, complicating global response efforts and resource allocation.

In interpreting the results, the article cautions that the DONs archive does not capture routine, day-to-day disease activity and may underrepresent outbreaks in fragile states with limited reporting. The patterns identified in the study do not prove causation, but they offer important directions for policymakers and health workers about where to focus efforts to maintain surveillance and healthcare access in times of conflict.

Overall, the article frames a sobering view: conflict not only drives disease dynamics but also shapes the global community’s ability to detect and respond to outbreaks. The Ebola example and the broader patterns across outbreaks remind readers that improving outbreak detection in war zones requires strengthening ground-level health delivery and reporting pathways even in the most volatile settings.

Key takeaways for researchers and policymakers

• Outbreak visibility is as important as outbreak control; conflict can reduce the world’s ability to detect and report outbreaks, creating a blind spot in global health surveillance.
• Polio and cholera patterns during conflict reflect the collapse of essential services, including vaccination and sanitation, while influenza may appear to decline in official records due to surveillance disruption.
• Context matters: sub-Saharan Africa shows particularly strong patterns, though environmental and climatic factors also play a role in disease distribution and reporting.
• Pandemic preparedness must go beyond laboratories to ensure consistent health worker mobility, clinic operation, and cross-border reporting in conflict areas.

Original publisher: The Conversation