Displacement, dignity and disease: a systematic review of WASH gaps and infectious disease risk in conflict-affected displacement settings

Armed conflict and forced displacement create conditions in which social and political determinants of health strongly shape exposure to infectious diseases. Water, sanitation, and hygiene (WASH) systems, essential to population health, are frequently disrupted or destroyed during conflict, generating environments of structural vulnerability. This systematic review examines how WASH deficiencies increase the risk of infectious diseases among conflict-affected displaced populations, drawing on the frameworks of structural violence and the political ecology of health. A systematic search identified 1,950 records, of which 29 studies met the inclusion criteria. Five cross-cutting domains emerged: WASH infrastructure and access; hygiene behaviour and social norms; infectious disease outbreaks; effectiveness of WASH-related interventions; and structural barriers and enablers to implementation. Findings revealed that inadequate WASH systems were consistently associated with cholera, diarrhoeal diseases, and reduced vaccine effectiveness. Hygiene behaviours were shaped not only by knowledge but also by social inequalities, gender roles, caregiving pressures, and trust in humanitarian actors. Overall, the findings show that WASH deprivation in displacement settings is not merely a technical failure but a socially and politically driven determinant of preventable disease, requiring long-term, inclusive, and locally led WASH systems to strengthen public health resilience.