Review on progress, challenges, and recommendations for implementing the One Health approach in the Eastern Mediterranean Region.

Background: Emerging infectious Diseases have affected many Eastern Mediterranean Region (EMR) countries in the past two decades, leading to outbreaks and considerable increases in mortality rates. In addition, fragmented or destroyed health care infrastructure due to ongoing conflicts and humanitarian crises, weak governance and regulatory capacity, including poor infection prevention and control measures, and a lack of access to clean water, sanitation, and hygiene exacerbate this region's vulnerability to health threats like antimicrobial resistance (AMR). This document aimed to provide a comprehensive overview of the progress, challenges, and recommendations for implementing the One Health approach in the EMR. It highlights the interconnected health challenges at the human- animal- environment interface, such as zoonotic diseases, vector-borne diseases, AMR, food safety, environmental contamination, and climate change impacts. The document reviews advancements made at global, regional, and national levels, including initiatives by the Quadripartite organizations (WHO, FAO, WOAH, UNEP) and frameworks like the Regional One Health Framework. Challenges in implementing the One Health approach include governance, leadership, and financing issues such as political instability, inadequate data on governance mechanisms, fragmented sectors, lack of funding, and the absence of a comprehensive legal framework. Tailoring the Regional One Health framework, securing sustainable financing, and engaging key stakeholders are crucial in addressing these challenges. Building trust among different sectors is essential for collaboration, and clear communication and well-defined roles help foster that trust. Countries are sharing their experiences and challenges and learning from one another, contributing to the overall improvement of One Health implementation and operationalization in the region. Conclusions: The EMR has achieved great progress in implementing the One Health approach. This progress should be maintained and continuously monitored to ensure the preparedness of the health system to control and prevent health hazards.