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Control of three gastrointestinal illness outbreaks in a British Role 1 facility in Afghanistan: a primary care perspective
  1. Seth Makin1,
  2. L Hudson1,
  3. R Robinson2,
  4. M R Riley1 and
  5. D Murphy1
  1. 1RMAS, Army Medical Services, Camberley, Surrey, UK
  2. 2Royal Australian Army Nursing Corps, Bonegilla, Victoria, Australia
  1. Correspondence to Maj Seth Makin, RMAS, Army Medical Services, Camberley GU15 4NP, UK; smakin{at}


Introduction In 2019, Camp Qargha (QAA), a British-led multinational military camp in Kabul, had three of the largest outbreaks of gastrointestinal illness (GI) experienced by the British Military since 2003. This paper discusses the incidence, the response of the British-led Role 1 (R1) medical treatment facility, identifies potential causative and exacerbating factors, and explains the control measures initiated.

Method GI in QAA results in local and UK military-wide data collection including in the form of local GI questionnaires, FMed85 forms and EpiNATO returns. The data from these was used to identify trends during and after outbreaks and produce environmental health (EH) and local outbreak reports.

Results Overall, among the outbreaks 56% of stool samples tested positive for norovirus. In each outbreak incidence peaked within the first 3 days, and hardened multiperson rooms were worst affected. 206 patient presentations occurred during the three outbreaks, 706 working days were lost in isolation, with QAA shut down while in quarantine for 27 days.

Discussion Significant strain was placed on QAA and the R1. Causative factors may include close interaction with the local national (LN) population, a high population density and accommodation being limited by specific national infrastructure protocols in an operational environment.

Conclusion Early recognition of GI, positive standard operating procedures and good hygiene habits are essential to prevent the spread of GI such as norovirus. An early awareness of LN population illness patterns will allow the R1 and command to be better prepared for outbreaks in the future.

  • epidemiology
  • gastrointestinal infections
  • public health

Statistics from


  • Contributors SM was the lead author using data collected and reports written by DM. LH and RR wrote parts of the initial drafts and reviewed the original submission. Later versions were edited by MRR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was a service evaluation and did not use medical in confidence information.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request. At the time of submission Camp Qargha is still a functioning military camp and access to certain information is restricted. Information requests can be sent to Orcid ID 0000-0003-4137-4095.

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