Transforming health systems in crisis: innovative infrastructure adaptations for Marburg outbreak response in...

Marburg virus disease (MVD), a highly fatal haemorrhagic fever with a fatality rate that can reach up to 88%. The outbreak in Biharamulo District in Tanzania in 2025 prompted a rapid transformation of the district hospital into a Marburg treatment unit (MTU). We describe approaches to our innovative solutions and highlight best practices for adapting existing infrastructure in resource-limited and emergency settings.

We used a mixed-methods approach, integrating observational assessments, facility design analysis, disease containment and clinical data review into the following '5S' framework, that is, systems, security, structure, staff and supplies.

The MTU was systematically organised into green and red treatment zones to prevent cross-contamination. Structural innovations included controlled entry and exit points, a low-risk monitoring area with observation windows and a contactless patient monitoring and medication delivery system. Clinical care strategies focused on implementation of effective systems for triage, early case detection, use of point-of-care (POC) diagnostics, like POC malaria rapid diagnostic test, i-STAT Chem 8, blood gas analysis and bedside ultrasound to guide supportive therapy, including provision of critical care. Deployment of a mobile laboratory to the nearby health facility enabled real-time diagnostics and efficient referral system to improve case management. Staff preparedness and healthcare system's ability to rapidly expand beyond normal services to meet an increased demand for clinical care during emergencies (surge capacity) were strengthened through infection prevention and control training, basic emergency care training, emergency response drills and psychological support.

The structured response to the Biharamulo MVD outbreak demonstrated the effectiveness of adaptable healthcare infrastructure, evidence-based clinical management and workforce capacity building. These locally-context innovations have highlighted the importance of flexibility, timely intervention and effective collaboration in addressing public health emergencies, while ensuring optimal protection for patients, health staff and the community.