This document discusses strengthening public health readiness for mass gatherings in the Eastern Mediterranean Region. It begins by defining mass gatherings and the obligations under the International Health Regulations. It then outlines some of the public health threats that can arise from mass gatherings, including infectious diseases, non-communicable diseases, injuries, and psychological impacts. However, it also notes that mass gatherings can create opportunities to enhance health systems and increase disease prevention awareness. The document discusses examples of WHO's support for mass gatherings in the region. It proposes a regional framework to guide countries in establishing arrangements and capacities to safely host mass gatherings. The framework focuses on risk assessment, health system strengthening, multisectoral coordination, partnerships, planning, and

1. Strengthening public health
readiness for mass gatherings in the
Eastern Mediterranean Region
Dr Dalia Samhouri
Programme Area Manager, Emergency Preparedness
and International Health Regulations
11 October 2023

2. Types
• Concentration of people with potential to strain
resources
• Planned, spontaneous
• Seasonal, once in a lifetime
Diverse experiences
• Religious, sports, cultural
• Routine and emergency situations
Obligations under International Health Regulations
2005 (IHR)
• Control potential public health threats posed by
mass gatherings and prevent cross-border spread
of disease
What is a mass gathering?

3. Mass gatherings are associated with threats
They can lead to urgent and complex health situations
Public health Environmental Psychological Individual Management
• 53% infectious
diseases
(obstructive
pulmonary
disease)
• 24% NCDs and
injuries
• 10% traumatic
injuries
• 267 admitted
due to heat
stroke in Hajj
• 56% of mass
casualties from
crowd
movement
• 769 deaths and
934 injuries due
to stampedes in
Hajj
• Literacy and
awareness of
risks and
prevention
(chronic diseases,
gender, old age)
• Limited personnel
and planning
• Deliberate events
(mass shooting,
explosions)

4. Enhanced health system
capacities
Accelerated IHR implementation
1
2
Generated legacy for evidence
base and country support
Increased awareness of risks and
preventive measures
3
4
4
Mass gatherings create opportunities for success
No reported disease outbreaks

5. 5
▪ Multisectoral coordination
▪ Risk-based approach
▪ Operational plans
▪ Risk communication and infodemics
▪ Early warning and contact tracing
▪ Surveillance and health information system
▪ Documentation
But they are still surrounded by many challenges…

6. WHO support for mass gatherings
▪ Risk assessment
▪ Building capacities of workforce
▪ Use of public health emergency operation centre
▪ Mass causality management and simulation exercises
▪ Developing tools and guidance
▪ After Action Reviews and legacy generation
▪ WHO Collaborating Centre in Saudi Arabia advancing
evidence-based knowledge
Examples include support for Ramadan and Eid during COVID-19, the Hajj in Saudi
Arabia, Ashura and Arba’een in Iraq, COP27 in Egypt, Dubai Expo 2020 in United
Arab Emirates, 2021 FIFA Arab Cup and 2022 FIFA World Cup in Qatar

7.  Hajj: travel advice, application of digital
tools
 Arba’een: trained medical teams and
community engagement
 FIFA tournaments: primary health care-
based model of care, emergency
operations centre, multi-hazard bank of
messages
 EXPO 2020: multisectoral coordination
cells and committees and risk assessment
 COP27: multisectoral coordination cells
and committees and triage plans
 Islamic Republic of Iran and Iraq: Cross-
border collaboration
Great examples adopted during mass gatherings

8. Regional framework to enhance readiness for mass
gatherings
To guide countries to establish institutional
arrangements and capacities to safely host mass
gatherings
Consultation with countries, literature review,
After Action Review reports, country missions
Sharing of expertise by WHO collaborating
centres for mass gatherings

9. Guiding
principles
Guiding
principles
Health system strengthening Multisectoral coordination Partnerships Planning and preparation
Gender, rights and equity

10. • Early warning
• Service provision
• Digital applications
• Risk assessment
• Risk mitigation plans
Five strategic objectives and areas of work
Strategic
objectives
Establish
standardized
approach to risk
assessment
Strengthen public health
and health system capacity
Improve multisectoral
coordination
• Stakeholder mapping
• Incident management
system and public
health emergency
operation centres
(PHEOCs)
Establish cross-
border
collaboration
• Joint activities
• Points of entry
• Travel advice
• Research priorities
• Documentation
Develop public health
research agenda

11. 8
To move forward, we invite the Regional Committee to
endorse the Framework and adopt the related resolution
WHO Regional Director
Member States
• Multisectoral risk assessment
and planning
• Integrated public health and
health system capacity
• Capacity-building programmes
• International collaboration
• Research agenda
• Operational plans
• Technical support
• Evidence and legacy
generation
• Resource mobilization
• Cross-border collaboration

12. Much is already in place.
Let us join forces for enhanced
readiness to mitigate the risks and
ensure safer mass gatherings

13. Thank you