Structural determinants of communicable disease risk in asylum reception centers

Forced displacement affects more than one hundred million people worldwide, making asylum reception systems important interfaces between population mobility, collective accommodation, and host-country health services. Within a One Health perspective, communicable disease risk arises not from displacement itself but from interactions among accommodation density, environmental conditions, infrastructural capacity, and access to prevention and care. Differences between reception models make these structural determinants particularly relevant to infection prevention and control.

This narrative synthesis examines evidence published between 2015 and early 2026, primarily from asylum reception systems in Europe and other high-income settings. We consider respiratory infections, tuberculosis, faecal-oral diseases, ectoparasitic and dermatological conditions, and vaccine-preventable diseases. Across these scenarios, crowding and inadequate ventilation can intensify exposure, while constrained water and sanitation systems facilitate enteric transmission. Population turnover, fragmented surveillance, delayed vaccination, and interrupted clinical follow-up further undermine timely prevention and outbreak management. We examine how these patterns relate to architectural layout, occupancy governance, service organisation, and integration with public health systems. Given the heterogeneity of outbreak investigations, observational studies, and operational reports, the available evidence supports identification of recurring structural vulnerabilities rather than pooled effect estimates or definitive causal thresholds.

Reception centres should be understood as epidemiological infrastructures whose capacity to prevent transmission depends on alignment between spatial design, operational governance, and healthcare delivery. Modular accommodation, functional zoning, occupancy management, effective ventilation and sanitation, interoperable surveillance, early vaccination assessment, and continuity of care could reduce conditions favourable to outbreak amplification. However, quantitative reception-specific design thresholds and robust comparative evidence remain limited. Prevention should therefore prioritise structural readiness and coordinated systems rather than rely predominantly on reactive containment or attribute inherent infectious risk to displaced populations.