Volcanic eruptions and public health in Ecuador: an analysis of institutional gaps and integrated strategies

Ecuador, a country with high volcanic activity, faces substantial public health risks from frequent eruptions. This review examines the health impacts of recent volcanic events and assesses the national health system's preparedness and response capacity. Through a critical review of public policies, current regulations, Ministry of Public Health interventions, its inter-institutional coordination and local experiences, this review identifies persistent gaps in governance, operational continuity, primary care, epidemiological surveillance, and risk communication. Both acute and chronic health effects are highlighted, alongside limitations in reaching vulnerable populations. The article proposes an integrated approach grounded in geological, biomedical, and social sciences, framed within the One Health paradigm. Strategic recommendations are presented to strengthen institutional capacity, secure essential resources, and develop a national research agenda on volcanic risk and health. Reducing health impacts require evidence-based policymaking, intersectoral coordination, and sustained community engagement.