Assessing the Role of Military Units in Epidemic Response: A Scoping Review of Key Issues

INTRODUCTION: Military forces have long supported epidemic and pandemic response, offering rapid mobilization, logistics, and operational capacity in challenging environments. Their roles-from building treatment centers and transporting supplies to enforcing quarantines-were especially visible during the 2014-2016 Ebola outbreak and the COVID-19 pandemic. Despite abundant case-specific literature, no broad synthesis has examined operational contributions, ethical dilemmas, coordination mechanisms, and long-term effects on health systems. METHODS: Following Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a scoping review across PubMed, Scopus, Journal Storage (JSTOR), the WHO Library (WHOLIS), Military Health System publications and Google Scholar, including studies up to December 2024. Eligible sources described military involvement in epidemic or pandemic responses and included peer-reviewed articles, reports, and case studies. Two reviewers independently screened and selected studies, extracting data on context, epidemic type, military role, coordination, and outcomes. Thematic analysis grouped findings into 4 domains: logistics and rapid deployment, ethical considerations and human rights, civil-military coordination, and long-term implications for health systems and governance. RESULTS: Of 5,000 records identified, 100 met inclusion criteria. Most addressed Ebola or COVID-19, with geographic coverage spanning West Africa, Southeast Asia, and high-income countries. Militaries excelled in logistics-airlifting supplies, building facilities, and restoring disrupted supply chains. Ethical tensions arose in enforcement roles, where measures sometimes undermined public trust. Coordination quality varied, with integrated command structures improving efficiency. Long-term impacts were inconsistently reported, with benefits such as infrastructure transfer alongside risks of civilian dependency. DISCUSSION AND RECOMMENDATIONS: Pre-established civil-military frameworks, ethical safeguards and community engagement are key to maximizing benefits and mitigating risks. Military roles should be framed as surge capacity with planned transition to civilian control. CONCLUSIONS: Military forces are valuable epidemic partners but require strategic integration, ethical oversight and focus on strengthening civilian systems. Standardized evaluation frameworks are needed to measure short- and long-term impacts.