Structural determinants of communicable disease risk in asylum reception centres

With over 120 million people forcibly displaced globally, asylum reception systems represent critical epidemiological interfaces. This synthesis is not confined to a single geographic region: evidence was drawn from reception systems across high-income host countries in Europe and, where available, comparable settings elsewhere, reflecting the substantial heterogeneity of reception models worldwide. Within a One Health framework, these socio-spatial environments shape communicable disease dynamics through accommodation density, sanitation capacity, and governance continuity.

Synthesizing evidence from 2015-2026, we examine transmission patterns of respiratory infections, fecal-oral diseases, ectoparasitic and dermatological conditions, tuberculosis, and vaccine-preventable diseases in reception infrastructures. Outbreaks cluster around occupancy density, ventilation constraints, sanitation integrity, mobility, and discontinuity of care. Transmission dynamics are structurally produced by interactions between built environments, organizational processes, and health system integration.

Reception systems are conditionally amplifying environments: outbreak magnitude depends on spatial configuration, occupancy governance, surveillance interoperability, and clinical continuity. Reframing centers as epidemiological infrastructures enables a shift from reactive containment to structural calibration. Modular design, density thresholds, and integrated preventive-clinical pathways enhance epidemiological predictability and reduce transmission risk. Amplification is not intrinsic to populations but to the environments accommodating them, with implications for broader collective housing and public health system design.