Commentary: Mass gathering healthcare and safety: current knowledge and future directions

Dear Prof. Ives Hubloue, Specialty Chief Editor, Disaster Medicine, We have read with interest the bibliometric review by Pigeon and Demers (Pigeon et al., 2025) titled "Mass gathering healthcare and safety: current knowledge and future directions.", recently published in Frontiers in Disaster and Emergency Medicine. This timely review examines key challenges encountered by the healthcare response during mass gathering events (MGEs), emphasizing the need for specific training and the development of formal expertise tailored to MGEs. The authors also stress the importance of required improvement in specific areas such as psychosocial aspects, quality evaluation and management, and supervision.However, despite its comprehensive and insightful nature, the title is somewhat misleading. The safety aspects and corresponding safety tools are not addressed sufficiently, and it is not clear whether the authors were referring to public safety or occupational safety. In the results section, the largest number of articles fall under the "public health and security" category but without any mention of "safety". In this specific context, many authors report that safety and security are being used interchangeably, and, in many dictionaries, they are defined as synonyms (Nas, 2015). Obviously, both concepts may have a lot in common, and the following statement reported by Line et al. (Line, 2006) seems a bit excessive:"two faculties have developed with a certain degree of rivalry between them. Security people maintain that the safety people are just a gang of old men who are unwilling to learn something new, the safety people retaliate that the security people are youngsters who haven't realized that they're re-inventing the wheel!" For the emergency management and occupational safety communities, the objective is not to focus on the semantic difference between the two words but on the existing complementariness and synergies. Obviously, the fundamental challenge facing security professionals is preventing losses, and the same challenges are shared with safety professionals.In the broad sense, security can be considered as protecting a system against intentional disruptions often caused by malicious parties, and safety can be considered as protecting that same system against unintentional disruptions. Hazards led to safety incidents in the same way that vulnerabilities lead to security incidents (Young, 2013). For a comprehensive system thinking approach, a security approach -which is largely threat-based and may be tempted to conduct assessments in isolation -will have to avoid missing the larger system's perspective.On the other hand, this review does not include several established benchmarks and updated guidelines that, in our view, are essential to the current understanding of MGEs context. This is fully understandable given their relatively recent publication dates, mainly in 2025. For instance, the World Health Organization (WHO) Mass gathering practical guide for simulation exercises and after-action reviews, published on April 11 th , 2025 (WHO, 2025), along with several systematic reviews (Alhajri et al. 2023, Çalışkan et al. 2024, PoshtMashhadi et al. 2025, Sultana et al. 2025) represent critical references that contribute to both theoretical and practical aspects of MGEs preparedness and management.In conclusion, the discussion related to the definition and interdisciplinarity between safety and security remains open. For the time being, we will maintain that the inability of the system to affect its environment in an undesirable way is usually called safety; the inability of the environment to affect the system in an undesirable way is usually called security.