Quick and Effective: Rapid Assessment for EWAR Surveillance Priorities

When disaster strikes-whether through conflict, natural hazards, or disease outbreaks-health systems face immediate pressure to detect and respond to emerging threats. In these critical moments, establishing an effective Early Warning, Alert, and Response (EWAR) system can mean the difference between containing an outbreak and facing a widespread health crisis. At the heart of this process lies a crucial first step: rapid assessment of surveillance priorities.

Rapid assessment is the foundation upon which effective EWAR systems are built. This systematic evaluation guides decision-making on when and how to implement surveillance in emergency settings, ensuring that limited resources are directed where they matter most. The goal is simple but vital: produce actionable recommendations for a surveillance system that fits the specific emergency and context.

Understanding rapid assessment in EWAR 🔗

A rapid assessment always precedes EWAR implementation, led by national public health authorities with support from WHO and partner organizations. Unlike broader public health situation analyses, rapid assessment specifically focuses on surveillance needs-identifying priority diseases, determining geographical scope, and evaluating existing capacity to detect and respond to health threats.

The assessment must move quickly. In emergency settings, time is of the essence. WHO’s Emergency Response Framework sets a performance standard of establishing or strengthening EWAR within three to ten days after a sudden-onset emergency. This means rapid assessments typically take no more than three days to complete, including design and formulation of recommendations.

Key steps in rapid assessment 🔗

The rapid assessment process follows a structured approach with six essential steps, each building upon the previous to create a comprehensive picture of surveillance needs.

Determining geographical coverage and affected populations 🔗

The first step involves mapping who has been affected and where they are located. This includes identifying displaced populations, vulnerable groups, and hidden communities that might not have access to health services. Understanding population movement patterns helps determine the boundaries of the surveillance area and ensures no group falls through the cracks.

Setting timeline and scope 🔗

Assessment teams must develop a clear plan outlining key activities and geographical areas to cover. In situations where security or infrastructure damage limits physical access, teams can use alternative methods such as telephone or radio contact with focal points. When direct access is impossible, sampling representative areas and generalizing findings may be sufficient.

Reviewing information sources and community consultation 🔗

Effective assessment draws on multiple information sources. Teams gather existing documents including disease profiles, surveillance system documentation, health facility reports, and partner lists. Just as important is community consultation, which helps identify transmission drivers, health-seeking behaviors, and community-level reporting mechanisms. These conversations reveal vulnerabilities and strengths that numbers alone cannot capture.

Identifying priority diseases through risk assessment 🔗

Not all diseases require the same level of surveillance attention. Assessment teams conduct a risk assessment to identify 8-12 priority epidemic-prone diseases and conditions based on agent, host, and environmental factors. This involves evaluating both the potential health impact and likelihood of outbreaks for each disease, considering factors like population immunity, overcrowding, access to clean water, and presence of disease vectors.

For example, during the Rohingya crisis in Bangladesh, teams identified 12 priority syndromes including acute watery diarrhea, measles, and acute respiratory infections. In contrast, following Cyclone Winston in Fiji, nine syndromes were initially prioritized, with Zika-like illness added three weeks after surveillance started as risks evolved.

Verifying existing surveillance capacity 🔗

Understanding current capacity helps teams determine whether to strengthen existing systems or establish new ones. Assessment focuses on several domains: population coverage, diseases under surveillance, early warning mechanisms, alert management processes, outbreak response capacity, data analysis capabilities, infrastructure availability, and coordination structures.

Key questions address practical realities: Are health workers trained to detect priority diseases? Do laboratories have capacity for rapid testing? Can reporting sites communicate immediately when they detect potential threats? Are there dedicated teams for investigation and rapid response?

Making actionable recommendations 🔗

The final step translates findings into clear, focused recommendations. A brief written report documents populations to be covered, priority diseases, existing capacity, and gaps requiring urgent attention. Teams present findings to stakeholders including national authorities, WHO, health clusters, and partner organizations. The recommendations must clearly indicate whether the current system can be strengthened or if a new EWAR system is needed, along with specific resource requirements for human capacity, materials, and transportation.

The power of stakeholder collaboration 🔗

Rapid assessment and EWAR implementation succeed only through effective collaboration among diverse stakeholders. National authorities and WHO partners must work together to design effective EWAR systems, bringing together government agencies, international organizations, NGOs, and community representatives.

National public health authorities typically lead implementation, but their role varies by context and capacity. WHO provides technical support and guidance. Health and WASH clusters play crucial coordination roles, helping streamline communication among partners and ensuring EWAR reporting reaches all stakeholders.

Research shows that stakeholder collaboration is one of the most common facilitators of effective emergency governance. When partners coordinate well, they can pool resources, share expertise, and avoid duplication of efforts. Conversely, poor coordination and unclear responsibilities frequently emerge as barriers to effective response.

Successful collaboration requires several elements: clear coordination structures with regular meeting forums, defined roles and mandates, sufficient capacity including staff and funding, high-level political leadership, and incentives for collaboration. When these elements align, stakeholders can comprehensively review systems, identify strengths and improvements, and plan concrete actions to strengthen health security.

Translating assessments into action 🔗

Rapid assessments gain value only when they lead to practical action. The recommendations must address immediate gaps while building toward sustainable surveillance systems. This means identifying human resources needed for data collection and analysis, determining material requirements like mobile phones and laboratory supplies, and securing transportation for supervision and specimen collection.

WHO’s EWARS in a box exemplifies practical implementation-a kit containing 60 mobile phones, laptops, a local server, and solar generators that can support surveillance for 50 health facilities serving roughly 500,000 people. Such targeted solutions address the reality that emergency settings often lack reliable electricity and internet.

Practical recommendations also account for training needs, supervision structures, and feedback mechanisms. Health workers need clear standard operating procedures, case definitions adapted to context, and regular supportive supervision. Training sessions on EWAR core functions help public health authorities become familiar with available tools and strengthen their capacity for emergency response.

Importantly, assessments should plan for transition from the start. EWAR systems established during emergencies should eventually integrate into national surveillance systems rather than operating as permanent parallel structures. This requires ongoing dialogue about sustainability, capacity building, and handover strategies.

Lessons from the field 🔗

Experience across diverse emergencies has refined rapid assessment approaches. The 2017 Rohingya crisis demonstrated how quickly systems can be deployed-WHO organized workshops and field visits over two weeks, enrolling 151 health facilities run by 23 humanitarian organizations to create a functional reporting network serving over 700,000 refugees.

These real-world implementations reveal common challenges: lack of defined data collection strategies, insufficient use of event-based surveillance to complement routine reporting, delays in data compilation, inadequate response capacity, and insufficient feedback to reporting sites. Addressing these challenges requires not just initial assessment but ongoing monitoring and adjustment as situations evolve.

What do you think? How can emergency response teams better balance the need for speed in rapid assessment with the requirement for comprehensive evaluation? What role should affected communities play in shaping surveillance priorities during emergencies?

References

1. https://emergency.unhcr.org/sites/default/files/2024-01/EWAR%20in%20emergency.pdf
2. https://www.who.int/publications/i/item/9789240063587
3. https://www.who.int/emergencies/surveillance/early-warning-alert-and-response-system-ewars
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199978/
5. https://www.who.int/europe/news-room/events/item/2025/10/06/default-calendar/armenia-national-early-warning–alert-and-response-(ewar)-assessment
6. https://www.paho.org/en/health-emergencies/health-emergency-information-and-risk-assessment/early-warning-alert-and
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC9706990/
8. https://www.who.int/europe/news-room/events/item/2023/08/28/default-calendar/regional-training-in-ewar-core-functions-for-emergency-response