International Health Regulations: Legal framework for managing cross-border health risks
International Health Regulations: Legal framework preventing disease spread
Dr. Amina Hassan (Guinea) was working at the Guéckédou District Hospital when a 2-year-old boy arrived with fever, vomiting, and bloody diarrhea in December 2013. The child died the same day. Within weeks, several family members who had cared for the child developed identical symptoms. They died too. More patients with similar presentations began arriving at the hospital. Healthcare workers who treated them started getting sick.
“We didn’t know what we were dealing with. The symptoms resembled cholera or dysentery, but nothing responded to standard treatments. Patients deteriorated rapidly, bleeding from multiple sites, dying within days. By March 2014, we had dozens of cases, and I began to suspect we were facing something far worse—possibly Ebola virus disease, which had never been documented in Guinea before,” Dr. Hassan recalled.
“I reported our suspicions to the Ministry of Health. They were skeptical—Ebola outbreaks had never occurred in West Africa. But they conducted laboratory testing. On March 22, 2014, the results came back: Ebola virus. The Ministry immediately notified WHO through Guinea’s National IHR Focal Point, as required under the International Health Regulations. That notification triggered international support—laboratory capacity, epidemiological expertise, infection control resources, contact tracing systems. But it came too late. The virus had already spread to neighboring Liberia and Sierra Leone,” Dr. Hassan explained.
“By the time the outbreak ended in 2016, over 28,000 people had been infected and more than 11,000 had died across West Africa. The delay in detection and notification—those critical first three months when we didn’t recognize what we were dealing with—cost thousands of lives. If Guinea had stronger disease surveillance systems, if we had laboratory capacity to rapidly test suspected cases, if our reporting mechanisms to WHO had been more efficient—all capacities required under the International Health Regulations—we might have contained Ebola before it became the worst outbreak in history.”
According to WHO, while disease outbreaks and other acute public health risks and events are often unpredictable and require a range of responses, the International Health Regulations (2005) (IHR) provide an overarching legal framework that defines States Parties’ (countries’) rights and obligations in managing public health risks, events and emergencies that have the potential to cross borders.
For more on disease surveillance, see our articles on global health security and outbreak response at ObserverVoice.com.
Legal Framework and Obligations
The IHR are an instrument of international law that is legally-binding on 196 countries, including the 194 WHO Member States. They establish rights and obligations for countries, including the requirement to designate or establish Responsible Authorities; establish and maintain core capacities for surveillance and response, as well as at points of entry; notify to WHO public health risks and events with actual or potential international public health implications, regardless of their origin or source; verify information of public health risk and events of which WHO has become aware through informal and unofficial sources.
The IHR set forth the obligation for WHO to maintain the global public health early warning function and to coordinate international response efforts. Additional provisions address the areas of international traffic, such as health documents for international travelers and conveyances on an international voyage. The IHR include important safeguards to protect individual rights in relation to the treatment of personal data, informed consent and non-discrimination in the application of health measures under the Regulations.
September 2025 WHO announced Amended International Health Regulations enter into force. Current International Health regulations (2005) as amended 2014, 2022 and 2024 includes amendments adopted by Health Assembly in 2014 through WHA67.13, 2022 through WHA75.12, and 2024 through WHA77.17 and applies to 182 of 196 States Parties.
WHO provides Q&A on International Health Regulations amendments, Q&A on International Health Regulations and emergency committees, and 10 things you need to do to implement IHR.
Related topics include Coronavirus disease (COVID-19), Ebola virus disease, Malaria, Travel and health, WHO Pandemic Agreement, Yellow fever, and Zika virus disease. For more on emergency preparedness, see our article on pandemic response systems at ObserverVoice.com.
Purpose and Implementation
The purpose and scope of the International Health Regulations (2005) are to prevent, prepare for, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risk and which avoid unnecessary interference with international traffic and trade.
The responsibility for implementing the IHR rests upon all States Parties, across government sectors, and on WHO. The IHR require that all countries have capacity to prevent public health risks and events; detect acute public health risks and events in timely matter; assess acute public health risks and events guided by Annex 2 of the IHR; report public health risks and events to WHO, through the National IHR Focal Points those that may constitute a public health emergency of international concern; and respond to public health risks, events, and emergencies.
The IHR require WHO to maintain the global public health early warning function – through global surveillance and information sharing; coordinate international response efforts; upon countries’ request, support them in capacity building and response efforts; and ensure secretariat-like functions.
WHO’s International Health Regulations (IHR) Secretariat team leads implementation. WHO established Emergency Committees including COVID-19 IHR Emergency Committee, Monkeypox IHR Emergency Committee, and Poliovirus IHR Emergency Committee. WHO established Review Committee of IHR during COVID-19 response.
WHO Support and Recent Activities
To support countries in strengthening and maintaining their capacities for ensuring rapid detection, verification and response to public health risks, WHO develops and provides tools, guidance and training. WHO’s support focuses on the priority needs identified by the WHO Regional and Country Offices, in order to help each country meet its IHR commitment. This includes designating WHO IHR Contact Points at the headquarters or the regional level; conducting global public health surveillance and assessment of significant public health events; disseminating public health information to Member States; offering technical assistance to Member States; supporting Member States in their efforts to assess their existing national public health structures and capacities for surveillance and response, including at designated points of entry; monitoring the implementation of IHR (2005) and updating guidelines; and if required, determining whether or not a particular event constitutes a public health emergency of international concern (PHEIC), with advice from external experts.
If a PHEIC is declared, WHO develops and recommends the critical health measures for implementation by Member States during such an emergency. WHO provides GHO health emergencies data and State parties self-assessment annual reporting tool country profiles. WHO provides Disease outbreak news (DONs) with latest updates.
November 2025 WHO issued Statement of Forty-third meeting of Polio IHR Emergency Committee. July 2025 WHO issued Statement of Forty-second meeting of Polio IHR Emergency Committee. April 2025 WHO issued Statement of forty-first meeting of Polio IHR Emergency Committee.
WHO Activities and Publications
WHO works on Strengthening global health security at human-animal interface, Supporting national implementation of International Health Regulations, Strengthening public health laboratory services, Implementing health emergency and disaster risk management, Minimizing health risks at airports, ports and ground crossings, Managing health risks during mass gatherings, Rapidly detecting and responding to health emergencies, Prioritizing diseases for research in emergency contexts, and Laboratory quality management.
June 2025 WHO published Joint external evaluation of IHR core capacities of South Africa: mission report, 16-20 September 2024 mandating each country to build and maintain capacities. June 2025 WHO published Joint external evaluation of IHR core capacities of Botswana: mission report, 11-15 March 2024. June 2025 WHO published Joint external evaluation of IHR core capacities of Sri Lanka: mission report: 4-8 September 2023. May 2025 WHO published Joint external evaluation of IHR core capacities of Zambia: mission report, 2-6 October 2023.
World Health Assembly Resolutions
World Health Assembly passed multiple resolutions: WHA56.28 (2003) on Revision of International Health Regulations, WHA58.3 on Revision of International Health Regulations, WHA72.8 on Public health emergencies: preparedness and response IHR (2005): annual report on implementation.
WHO provides resources including Health Security Learning Platform, Strategic Partnership for IHR (2005) and Health Security (SPH), IHR portal, and IHR Annual Reporting video. WHO provides infographics Detect earlier to better protect and IHR: from policy to people’s health security.
Transformation Through Compliance
Dr. Hassan’s experience with the 2014-2016 West Africa Ebola outbreak transformed Guinea’s approach to health security. Following the outbreak, Guinea invested heavily in strengthening IHR core capacities with WHO support and international partnership.
“Guinea established a National Public Health Institute with modern laboratory facilities capable of diagnosing dangerous pathogens within hours rather than weeks. We trained epidemiologists, laboratory technicians, and healthcare workers in disease surveillance and infection control. We strengthened our National IHR Focal Point with 24/7 capacity to report suspected outbreaks to WHO immediately. We established rapid response teams that can deploy to outbreak sites within hours. We built laboratory networks connecting district hospitals to the national reference laboratory,” Dr. Hassan explained.
“In 2021, when Ebola re-emerged in Guinea, the difference was dramatic. The first case was detected within days—not months. Guinea notified WHO within 24 hours through our IHR Focal Point. International support mobilized immediately. Vaccination campaigns began within a week. The outbreak was contained within four months with just 23 cases and 12 deaths—a tragedy, but nothing like 2014’s catastrophe. That’s the power of IHR implementation—early detection, rapid notification, coordinated response,” Dr. Hassan emphasized.
“WHO’s work on International Health Regulations provides the legal framework, technical guidance, and support systems that make effective outbreak response possible. WHO conducts joint external evaluations helping countries identify gaps in their capacities. WHO provides training through the Health Security Learning Platform. WHO coordinates Emergency Committees that determine when outbreaks constitute public health emergencies of international concern, triggering international support. WHO maintains global surveillance systems that detect emerging threats,” Dr. Hassan continued.
“The 2024 amendments to IHR that entered into force in September 2025 strengthen these systems further—enhancing financing mechanisms for preparedness, improving equity in accessing medical countermeasures during emergencies, and establishing stronger accountability mechanisms for implementation. These improvements emerged from lessons learned during COVID-19, when weaknesses in global health security became devastatingly apparent. My work now focuses on supporting other African countries to strengthen their IHR capacities—because outbreaks don’t respect borders. A disease detected late anywhere threatens people everywhere. WHO’s International Health Regulations are our collective insurance policy against pandemics—but only if every country implements them fully.”
For more information, visit WHO’s International Health Regulations topic page or explore related content at ObserverVoice.com.
Frequently Asked Questions (FAQs)
The International Health Regulations (2005) (IHR) provide overarching legal framework that defines States Parties’ (countries’) rights and obligations in managing public health risks, events and emergencies that have potential to cross borders. IHR are instrument of international law that is legally-binding on 196 countries, including 194 WHO Member States. They establish rights and obligations for countries, including requirement to designate or establish Responsible Authorities; establish and maintain core capacities for surveillance and response, as well as at points of entry; notify to WHO public health risks and events with actual or potential international public health implications, regardless of their origin or source. IHR set forth obligation for WHO to maintain global public health early warning function and to coordinate international response efforts. Additional provisions address international traffic, such as health documents for international travelers. September 2025 Amended IHR enter into force. WHO provides Q&A on IHR amendments. Related: Coronavirus disease (COVID-19), Ebola.
Purpose and scope of International Health Regulations (2005) are to prevent, prepare for, protect against, control and provide public health response to international spread of disease in ways that are commensurate with and restricted to public health risk and which avoid unnecessary interference with international traffic and trade. Responsibility for implementing IHR rests upon all States Parties, across government sectors, and on WHO. IHR require that all countries have capacity to prevent public health risks and events; detect acute public health risks and events in timely matter; assess acute public health risks and events; report public health risks and events to WHO through National IHR Focal Points those that may constitute public health emergency of international concern; and respond to public health risks, events, and emergencies. IHR require WHO to maintain global public health early warning function; coordinate international response efforts; support countries in capacity building; and ensure secretariat functions. WHO provides Q&A on IHR and emergency committees. WHO’s IHR Secretariat team leads implementation. Related: Travel and health, WHO Pandemic Agreement.
WHO develops and provides tools, guidance and training to support countries in strengthening and maintaining capacities for ensuring rapid detection, verification and response to public health risks. WHO’s support focuses on priority needs identified by WHO Regional and Country Offices to help each country meet its IHR commitment. This includes designating WHO IHR Contact Points; conducting global public health surveillance; disseminating public health information to Member States; offering technical assistance; supporting Member States in assessing national public health structures and capacities; monitoring IHR implementation and updating guidelines; and if required, determining whether particular event constitutes public health emergency of international concern (PHEIC). If PHEIC declared, WHO develops and recommends critical health measures for implementation. WHO provides 10 things you need to do to implement IHR. WHO provides Health Security Learning Platform and IHR portal. WHO works on Supporting national implementation of IHR. Related: Malaria, Yellow fever.
June 2025 WHO published Joint external evaluation of IHR core capacities of South Africa: mission report mandating each country to build and maintain capacities. June 2025 WHO published Joint external evaluation of IHR core capacities of Botswana: mission report. June 2025 WHO published Joint external evaluation of IHR core capacities of Sri Lanka: mission report. May 2025 WHO published Joint external evaluation of IHR core capacities of Zambia: mission report. November 2025 WHO issued Statement of Forty-third meeting of Polio IHR Emergency Committee. July 2025 WHO issued Statement of Forty-second meeting of Polio IHR Emergency Committee. Current IHR (2005) as amended 2014, 2022 and 2024 applies to 182 of 196 States Parties. WHO provides GHO health emergencies data. Related: Zika virus disease.
WHO works on Strengthening global health security at human-animal interface, Supporting national implementation of IHR, Strengthening public health laboratory services, Implementing health emergency and disaster risk management, Minimizing health risks at airports, ports and ground crossings, Managing health risks during mass gatherings, Rapidly detecting and responding to health emergencies, and Laboratory quality management. WHO established Emergency Committees including COVID-19 IHR Emergency Committee, Monkeypox IHR Emergency Committee, Poliovirus IHR Emergency Committee. WHO provides Disease outbreak news, Strategic Partnership for IHR and Health Security, and State parties self-assessment country profiles. Related: Coronavirus disease (COVID-19), Ebola
- WHO International Health Regulations Topic Page
- International Health Regulations (2005) as amended 2014, 2022 and 2024
- WHO IHR Secretariat
- Health Security Learning Platform
- WHO Emergency Committees
Disclaimer: This article is an adaptation of publicly available information from WHO’s International Health Regulations health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the content or accuracy of this adaptation. This content is for informational and educational purposes
only and does not constitute medical advice. ObserverVoice.com is a news and information platform
— not a healthcare provider.
Observer Voice is the one stop site for National, International news, Sports, Editor’s Choice, Art/culture contents, Quotes and much more. We also cover historical contents. Historical contents includes World History, Indian History, and what happened today. The website also covers Entertainment across the India and World.
