1 September 2025, Cairo, Egypt – A sub-regional tabletop simulation exercise (SimEx), held in Cairo from 18 to 20 August 2025, tested national and cross-border coordination mechanisms for public health threats posed by mass population movement.
The exercise brought together representatives and technical experts from 4 North African countries – Egypt, Libya, Tunisia and Sudan – alongside partners from the World Health Organization (WHO), the International Organization for Migration (IOM) and Africa Centres for Disease Control and Prevention (Africa CDC). The SimEx was designed to assess the functionality of multisectoral and cross-border coordination and information-sharing between national focal points and the health and non-health sectors, in line with the International Health Regulations (IHR) (2005).
Border crossings, which vary greatly in infrastructure and passenger volumes, present challenges to health security and the consistent implementation of IHR capacities to detect and respond to public health threats, especially during times of frequent cross-border population movement driven by conflict, climate change, trade and socio-economic challenges.
IHR (2005) provisions encourage member states to enter into bilateral and multilateral agreements to prevent and control the international transmission of disease. Building on 2 earlier technical workshops organized by IOM in Tunis, Tunisia, the SimEx was a direct response to the need to test operational readiness and expand collaboration between neighbouring countries.
The 3-day, discussion-based exercise provided a platform for participants to simulate a joint response to a hypothetical public health scenario. Following the WHO Simulation Exercise Manual, the comprehensive tabletop exercise aimed to foster a more coordinated and effective approach to managing public health threats across borders. It was designed to:
assess multisectoral coordination and evaluate the functionality of coordination mechanisms for the prevention of, preparedness for, detection and response to public health issues among travelers, refugees and migrants;
test cross-border information sharing, IHR communication channels, joint planning, alert protocols, communication flow and standard operating procedures (SOPs);
identify gaps and good practices and propose actionable recommendations to improve multisectoral coordination involving health, foreign affairs, transportation, border security and international agencies;
assess primary health care readiness services and referral systems, including surge capacity, triage and referral pathways, diagnostics and continuity-of-care mechanisms;
enhance preparedness planning and SOPs for cross-border infectious threats;
build national capacity to conduct simulation exercises for health authorities to respond to cross-border public health threats; and
reinforce collaboration and facilitate joint dialogue and policy discussions on cross-border collaboration on population movement, including migrant and refugee health, and strengthen collaboration among health, transport, foreign affairs and humanitarian actors, including UN agencies.
The development of a sustainable framework for cross-border public health collaboration, the setting up of steering and technical committees to continue discussions and regular annual exercises to test the functionality of collaboration mechanisms were among the exercise’s actionable recommendations.
The successful completion of the exercise constitutes an important step towards enhanced cross-border collaboration. By facilitating dialogue between countries on ways to enhance joint information sharing, investigate and respond to events of mutual concern, harmonize resources and improve capacity to manage cross-border population movement, the SimEx provided a blueprint for strengthened coordination and communication mechanisms between national and international stakeholders, laying the groundwork for a more robust and unified regional response to future public health threats.
Related resources
International Health Regulations (2005)
Press release: Egypt, Libya, Sudan and Tunisia advance cross-border collaboration for migrant health