Menu ENN Search

Improving care of people with NCDs in humanitarian settings

News

By Emily Mates, ENN Technical Director (meeting attendee)

There is an increasing burden of non-communicable diseases (NCDs) among people displaced and otherwise affected by humanitarian crises. Humanitarian organisations are facing new challenges when confronting them as there are many uncertainties regarding the best strategies to implement NCD care in these crisis-affected settings.

A recent (2nd September 2016) one-day symposium on the topic was hosted by the London School of Hygiene and Tropical Medicine (LSHTM) Centre for NCDs and Centre for Health and Social Change (ECOHOST) and Médecins Sans Frontières (MSF). It brought together speakers from academic, development and humanitarian organisations to address some key issues faced when working to improve the care of patients with NCDs. Presenting agencies included MSF, International Medical Corps, LSHTM, NCD Alliance, United Nations High Commissioner for Refugees (UNHCR), United Nations Relief and Works Agency for Palestine (UNRWA), International Rescue Committee, International Committee of the Red Cross and the University of Geneva.

The burden of NCDs in the Middle East region is increasing, particularly cardiovascular disease (CVD), respiratory disease, diabetes and cancers, with an estimated 1.7 million deaths per year; diabetes rates are amongst the highest in the world. It is very difficult to get people to change behaviour even in the developed world; in crisis situations, this becomes ever more difficult. Mental health issues are often an acute problem amongst refugees. Particular problems associated with NCDs in humanitarian settings include:

Some lessons can be drawn from the global response to the HIV pandemic, although with HIV there is a single cause with high burden, which makes it easier for researchers and practitioners to activate around it. The situation with NCDs is more complex, as it involves a heterogenous group of diseases with no single cause and variable burden, depending on context.  A key considerations is the mortality risk when treatment is interrupted. For example with CVD and statin treatment, if treatment is interrupted the results are not too serious; with type 1 diabetes, mortality risk is extremely high with treatment interruptions.

Regarding nutrition, obesity was raised as a causal factor but further nutrition considerations regarding NCDs (prevention or management) in humanitarian settings were not discussed.

Main summary points included:

-          We must improve our understanding of the needs, which will vary by context, to respond to the challenges effectively – traditional humanitarian systems do not currently cater well for assessment of NCD needs.

-          Lessons can be applied from other chronic disease programmes such as HIV/AIDS.

-          Standardised guidelines, tools and training are needed on how to deal with NCDs in emergency settings.

-          Cohort monitoring is required to identify gaps in service provision and evaluate services.

-          Service must be patient centred, with trained and incentivised health workers.

-          Institutional structures and resources supportive of integration for chronic disease management alongside traditional humanitarian response are required.

-          Recognising the mortality consequences of treatment interruptions, it was suggested that a matrix is needed for use at organisational level regarding what problems exist and how acute they are, to ensure continued treatment.

-          More research is needed: two systematic reviews on effectiveness of NCD interventions and integration of HIV/NCDs presented at the meeting were inconclusive due to lack of evidence.

Video recordings of all presentations are available at: www.msf.org.uk/event/symposium-improving-care-of-people-with-non-communicable-diseases-in-humanitarian-settings

This symposium is linked to a thematic series on NCDs in humanitarian crises being published in the journal ‘Conflict and Health’. See:

www.conflictandhealth.biomedcentral.com

More like this

FEX: Tackling non-communicable disease among Syrian refugees and vulnerable host communities in Jordan

By Loren Hyatt Loren Hyatt is the Programme Manager for International Orthodox Christian Charities (IOCC) in Amman, Jordan, where she oversees a wide portfolio of projects...

FEX: Research Snapshots

The following provides a short summary of each of these important research studies. A fuller summary of each can be found online at www.ennonline.net/fex Inpatient management...

FEX: Management of hypertension and diabetes for the Syrian refugees and host community in selected health facilities in Lebanon

By Maguy Ghanem Kallab Maguy Ghanem Kallab is the health coordinator of HelpAge International in Lebanon. She holds a Master's degree in Public Health and is currently...

FEX: Contribution of six risk factors to achieving the 25x25 non-communicable disease mortality reduction target

Summary of study1 Location: Global What we know: Non-communicable diseases (NCDs) cause more than 35 million deaths every year and account for more than half of the deaths...

FEX: Tackling the double burden of malnutrition in low and middle-income countries: response of the international community

Research By Alexandra Rutishauser-Perera Alexandra Rutishauser-Perera is a Humanitarian Nutrition Adviser with Save the Children. She has ten years of experience of public...

FEX: Chronic disease outcomes after SAM in Malawian children (ChroSAM): A cohort study

Summary of research* Location: Malawi What we know: Little is known about the long-term health effects of survivors of severe acute malnutrition (SAM), particularly risk of...

FEX: Characteristics and challenges of the health sector response in Lebanon

By Frank Tyler Frank Tyler was Senior Public Health Coordinator in the Inter-agency Coordination Unit, UNHCR Lebanon from January to October 2014. He is a humanitarian and...

FEX: ENN’s perspective on the nutrition response in the Syria crisis

By Carmel Dolan, Marie McGrath and Jeremy Shoham Unless otherwise stated, referenced articles feature in Field Exchange 48. While the ENN's role is first and foremost to...

FEX: Nutrition in health response in emergencies: WHO perspectives and developments

By Zita Weise Prinzo, Adelheid Onyango, Dr Ferima-Coulibaly Zerbo, Hana Bekele, Dr Ngoy Nsenga and Adelheid Marschang Zita Weise Prinzo is the Focal Point for Nutrition in...

FEX: The situation of older refugees and refugees with disabilities, injuries, and chronic diseases in the Syria crisis

By Lydia de Leeuw Lydia de Leeuw is the Regional Inclusion Programme Manager for both HelpAge International and Handicap International in the Syria crisis. She has extensive...

en-net: Treatment of SAM and special cases

I'm writing this question on behalf of Dr. Huda, IRC in Yemen. Dr Huda wants to know if there is any adverse effect of using plumpy nut with a SAM patient who has sickle cell...

FEX: Regional Consultation on Nutrition and HIV in South East Asia

A regional consultation on nutrition and HIV in South East Asia was held in Bangkok, 8-11 October 2007. Represenatives of countries from the region, together with scientists,...

en-net: Nutrition and NCDs

I work as a Principal Nutritionist in Lusaka province in Zambia. There has been an increase in morbidity of hypertension and diabetes in the hospitals in the province. I...

FEX: Editorial

A number of the recommendations in the Grand Bargain reported on in the last issue of Field Exchange speak to the need to forge stronger links between humanitarian and...

en-net: Announcement: Upcoming Inagural National Nutrition Symposium by the Academia and Research SUN Network in Kenya

The Academia and Research Network of the Scaling Up Nutrition Movement (SUN) in Kenya is organising a National Nutrition Symposium to be held in Nairobi from 23-25 November...

FEX: Editorial

There are three themes running through this issue of Field Exchange. We have four field articles which describe the very real practical challenges of having to adapt...

FEX: Early stages of a ‘Food by Prescription’ programme for HIV infected adults

By Elizabeth Bontrager and Kate Sadler Elizabeth Bontrager joined the Feinstein International Centre at Tufts University in 2008, where she coordinates Tufts' involvement in...

FEX: Cotrimoxazole as a Prophylaxis for HIV Positive Malnourished Children

Summary of review1 By Susan Thurstans, AAH Susan Thurstans is the HIV adviser with Action Against Hunger (AAH), based in Malawi Thanks to Amador Gomez, Technical Advisor,...

FEX: Nutritional support services and HIV in sub-Saharan African countries

Summary of research1 On the basis of the latest WHO criterion for HIV treatment initiation (CD4 cell count =350 cells/mm³), anti-retroviral therapy (ART) was accessed by an...

FEX: Editorial

This rather large issue of Field Exchange has a typically wide range of material from field practitioners and researchers. Some examples of innovative practice include an...

Close

Reference this page

Emily Mates (2016). Improving care of people with NCDs in humanitarian settings. Field Exchange 53, November 2016. p64. www.ennonline.net/fex/53/peoplewithncds