Peste des petits ruminants (PPR) is a devastating disease of small ruminants that significantly hinders productivity in endemic areas. Kenya, Uganda and Tanzania reported their first cases in each country between 2006 and 2008 despite the disease being present in the region (Ethiopia and Sudan) since the 1990s. The time leading up to the outbreaks involved refugee movements, drought, civil unrest, and resulted in increased animal mingling, movement and density in these regions. Refugee camps with animal source food demands and a robust informal economy further added to the development of animal mingling and movement as well. Once introduced, common pastoral migration lands and trade routes likely transported the disease throughout the region. This paper highlights why trade routes, refugee camps and areas of animal crowding during droughts should be targeted for interventions, monitoring and surveillance as part of PPR control in a region.