Challenges and barriers to effective COVID-19 screening at Iran’s air border crossings: a qualitative study and proposed solutions

International air border crossings are crucial for controlling the spread of respiratory pandemics like COVID-19. Effective screening at these points is vital for national health security and meeting global health obligations under the revised International Health Regulations (IHR) 2005. This qualitative study aimed to identify and analyze the challenges, barriers, and proposed solutions in COVID-19 screening and management at Iran’s air border crossings and situates these findings within the context of global health governance and pandemic response frameworks. Using purposive sampling, twelve key stakeholders involved in border health management were interviewed between Mar and Nov 2024. Data were collected through semi-structured interviews and supplemented by a field visit to Imam Khomeini International Airport’s border health base and a review of relevant international regulations and recent scholarly literature. Content analysis combined with Fishbone root cause analysis was employed to explore underlying factors. Findings revealed multifaceted challenges including inconsistent implementation of screening protocols, shortage of trained personnel, inadequate technological infrastructure, poor interagency coordination, and legal ambiguities related to data privacy and quarantine enforcement. Behavioral factors such as passenger resistance and limited airline cooperation further undermined screening effectiveness. Additionally, the assessment identified significant gaps in meeting global standards and IHR core capacities (points of entry, public health emergency preparedness and surveillance) at air border points. Proposed solutions emphasized integrated digital platforms for real-time data sharing, enhanced staff training, improved quarantine facilities, legal reforms, and targeted multilingual communication campaigns. This study indicates that strengthening air border screening during pandemics requires a multisectoral approach aligned with IHR. Identified human, technical, organizational, legal, and environmental challenges may hinder full compliance with these regulations. Addressing these barriers through practical solutions could improve preparedness and response to health emergencies at both national and international levels.