The World Health Organization (WHO) says countries across the Eastern Mediterranean are steadily strengthening systems to detect and respond to respiratory diseases, even as conflict, displacement and political instability continue to strain public health infrastructure.

In a feature released on April 17, WHO described the Eastern Mediterranean Region (EMR) as one of the most complex operating environments for infectious disease preparedness. The region comprises 22 countries and more than 700 million people, with frequent outbreaks ranging from seasonal influenza to zoonotic infections and other respiratory illnesses with epidemic potential.

WHO data show that more than half of these countries are affected by prolonged crises, including armed conflict and humanitarian emergencies, resulting in large-scale population displacement that complicates surveillance and service delivery.The region’s geographic position along major migratory bird pathways and international travel corridors gives it added importance in global influenza monitoring.

Viruses detected in EMR countries are routinely shared with international networks, contributing to global risk assessments and informing seasonal vaccine composition through the WHO-led Global Influenza Surveillance and Response System.WHO attributes much of the region’s progress to the implementation of the Pandemic Influenza Preparedness Framework, adopted in 2011 to improve global readiness for influenza pandemics.

At the time of its introduction, surveillance coverage and laboratory capacity across the EMR varied significantly, and most countries lacked formal vaccination policies. Through the framework’s Partnership Contribution funding mechanism, 11 countries, including Afghanistan, Iran, Iraq and Egypt, received sustained financial and technical support to develop core capacities, while additional countries benefited indirectly.

By 2025, WHO reports that 18 of the 22 EMR countries were regularly submitting influenza data to regional and global platforms, including EMFLU-2, FluNet and FluID. These systems are supported by an expanding network of sentinel surveillance sites that provide epidemiological data.

At the same time, 18 countries had established functioning National Influenza Centres, with at least 14 routinely sharing virus samples with WHO collaborating centres under GISRS.Despite operational challenges linked to insecurity and resource limitations, WHO said laboratory and surveillance functions remained active across most of the region.

This continuity was tested during the COVID-19 pandemic, when countries adapted existing influenza systems to incorporate SARS-CoV-2 testing. WHO described this transition as a catalyst for broader integration, accelerating the shift from single-disease monitoring to multi-pathogen surveillance.

According to WHO, 21 EMR countries now operate integrated sentinel surveillance systems capable of tracking influenza, COVID-19, respiratory syncytial virus and other respiratory pathogens simultaneously.

These systems are designed to enable earlier detection of outbreaks and support more timely public health responses.WHO officials also highlighted efforts to strengthen workforce capacity through regional training programmes in epidemiology, laboratory diagnostics and outbreak investigation.

These initiatives have supported the adoption of genomic surveillance techniques, allowing for more detailed analysis of circulating viruses and improving risk assessment capabilities.The organisation said that lessons learned during the COVID-19 pandemic informed the development of a regional operational strategy focused on community protection under the PIP framework.

This strategy is aligned with broader global mechanisms, including the International Health Regulations (2005) and WHO’s Health Emergency Preparedness and Response framework. It is intended to guide the use of funding, support evidence-based policymaking and improve resilience at the community level.Countries that have invested in influenza preparedness infrastructure have also been able to apply these systems to other respiratory threats.

WHO cited responses to Middle East respiratory syndrome (MERS), avian influenza and emerging pathogens as examples of how established surveillance and laboratory networks can be leveraged beyond their original scope.Investment priorities have evolved over time, moving from the establishment of basic surveillance systems to improvements in quality, integration and advanced capabilities such as genomic sequencing.

WHO said regional technical teams have played a role in strengthening virus characterisation and ensuring that data generated in the EMR contribute effectively to global decision-making processes.The framework has also supported countries in generating national-level evidence on disease burden and vaccine effectiveness. WHO noted that Iraq has formally adopted a national influenza vaccination policy, while Tunisia, Lebanon and Jordan are in the process of developing similar frameworks.

These policy developments reflect varying national priorities, with some countries focusing on innovation and system integration and others concentrating on maintaining essential services in fragile settings.WHO emphasised that tailored approaches remain critical given the diversity of conditions across the region. Targeted support, adapted to individual country contexts, is seen as key to strengthening health systems and ensuring continuity of surveillance and response activities.

Looking ahead, WHO said continued alignment with global strategies, including the Global Influenza Strategy and ongoing discussions around a Pandemic Agreement, will be necessary to sustain progress.

The organisation highlighted the importance of long-term investment and regional collaboration in maintaining preparedness gains and mitigating the risk of cross-border disease transmission.

A growing body of scientific evidence is reinforcing the link between prolonged exposure to fine particulate matter and adverse health outcomes across northern India, particularly in densely populated urban centres. Seasonal spikes in air pollution, especially during winter months, have drawn attention to sustained exposure levels that frequently exceed national safety standards.

Residents in cities such as Delhi report recurring episodes of respiratory distress, with many describing a sense of inevitability around declining air quality.Medical practitioners have observed a steady increase in pollution-related ailments, including chronic bronchitis, asthma exacerbations, and reduced lung function.

Public health experts point to fine particulate matter, especially PM2.5, as a critical risk factor due to its ability to penetrate deep into the respiratory system and enter the bloodstream. While short-term exposure can trigger acute symptoms, long-term exposure has been associated with cardiovascular disease and reduced life expectancy.

Individuals with no prior history of respiratory illness have also reported new symptoms during peak pollution periods.

For many residents, particularly children and the elderly, exposure is not limited to outdoor environments but extends indoors due to infiltration of polluted air, raising questions about the effectiveness of mitigation measures at the household level.

Air quality deterioration in northern India is driven by a combination of local emissions and regional factors. Vehicular pollution, industrial activity, and construction dust contribute to baseline pollution levels throughout the year.

However, the onset of winter introduces additional stressors, including temperature inversions that trap pollutants close to the ground.Agricultural stubble burning in neighboring states such as Punjab and Haryana has been identified as a significant seasonal contributor.

Satellite data and atmospheric modelling have consistently indicated that smoke from crop residue burning can travel long distances, intensifying pollution episodes in urban areas downwind. Farmers, citing economic constraints and limited alternatives, continue to rely on burning as a cost-effective method for clearing fields between crop cycles.

Government data and independent monitoring agencies have reported that air quality indices during peak episodes frequently reach “severe” levels, indicating conditions that pose serious health risks even to healthy individuals.

These episodes often persist for several days, reducing visibility and disrupting daily activities, including transportation and outdoor work.

Authorities have implemented a range of measures aimed at controlling emissions, including restrictions on construction activity, temporary bans on certain vehicles, and the introduction of graded response action plans.

The Central Pollution Control Board regularly issues advisories and monitors air quality across major cities, while state governments coordinate emergency responses during critical periods.Despite these efforts, enforcement remains uneven. Analysts note that regulatory interventions are often reactive, triggered by acute pollution spikes rather than sustained preventive strategies.

Compliance challenges, particularly in informal sectors and among smaller industrial units, complicate implementation. In addition, coordination between state governments has proven difficult, especially in addressing transboundary pollution such as stubble burning.Judicial intervention has also played a role, with the Supreme Court of India periodically directing authorities to take stricter action.

However, long-term solutions require structural changes, including cleaner energy transitions, improved public transport infrastructure, and viable alternatives for agricultural waste management.

The economic impact of air pollution is increasingly evident, affecting productivity, healthcare costs, and overall quality of life. Businesses report disruptions during severe pollution episodes, while educational institutions have occasionally been forced to suspend in-person classes.

For daily wage workers and those in outdoor occupations, reduced air quality directly translates into health risks and income instability.Public awareness of pollution risks has grown, leading to increased demand for air purifiers and protective masks. However, such measures remain inaccessible to large segments of the population, highlighting disparities in exposure and protection.

Experts emphasize that while individual precautions can offer limited relief, systemic interventions are necessary to address the scale of the problem.Scientific studies continue to underline the cumulative impact of chronic exposure, suggesting that air pollution is not only an environmental issue but also a major public health challenge.

As evidence mounts, policymakers face increasing pressure to shift from short-term mitigation to comprehensive, long-term strategies that address both sources and structural drivers of pollution in India’s rapidly urbanizing regions.