Improving care of people with NCDs in humanitarian settings
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:
- Varying burdens, depending on the context
- Impact on health care infrastructure of host nations; there are additional problems when host nations have largely private health care systems
- There are currently multiple protocols and guidelines in existence, depending on the context
- Insufficient mental health services
- As in non-crisis situations, people generally prefer medication to lifestyle change.
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:
More like this
FEX: Tackling non-communicable disease among Syrian refugees and vulnerable host communities in Jordan
By Loren Hyatt View this article as a pdf Loren Hyatt is the Programme Manager for International Orthodox Christian Charities (IOCC) in Amman, Jordan, where she oversees a...
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: 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: Call for papers on prevention of non-communicable disease in humanitarian settings
View this article as a pdf BMJ Global Health, in collaboration with the International Rescue Committee, the Conflict and Health Research Group at King's College London and the...
FEX: The link between foetal and childhood nutrition and adult non-communicable disease: lessons from birth cohort studies in India
View this article as a pdf Research summary1 Location: India What we know: Non-communicable diseases (NCDs) are rising in prevalence globally and they particularly affect...
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 in...
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...
en-net: Non-communicable diseases and food assistance and Rohingya refugees
Dear collegaues, I am posting a question from a colleague working in Bangladesh: My name is Nadirah, from Malaysia. I work with IFRC APRO as Regional community based health...
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: Joint IAEA-WHO-UNICEF workshop on biological pathways to better understand the double burden of malnutrition
While stunting and wasting are still important public health problems in low and middle-income countries, rapid nutrition and epidemiologic transitions have led to increased...
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: 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...
FEX: Extending support through CMAM to older people in Ethiopia
By Kidist Negash Weldeyohannis View this article as a pdf Lisez cet article en français ici Kidist Negash Weldeyohannis is a Regional Health and Nutrition Programme...
FEX: Systems approach to prevent all forms of malnutrition among children 5-19 years
View this article as a pdf By Deepika Sharma and Vilma Tyler Deepika Sharma is a Nutrition Specialist and the focal point for the nutrition of children in school-age and...
Resource: Women's nutrition: A summary of evidence, policy and practice including adolescent and maternal life stages
Please scroll down for links to download the Executive Summary (also available in French) and full report Lisez cet document d'information technique en français ici...
NEX: Nourishing the Sustainable Development Goals: Global Nutrition Report 2017
In this fourth Global Nutrition Report (GNR), significant burdens of three key forms of malnutrition (child stunting, anaemia in women of reproductive age and overweight in...
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...
NEX: Regional nutrition strategies to address the double burden in the Eastern Mediterranean
Dr Ayoub Al Jawaldeh has been the Regional Adviser for Nutrition in the WHO Regional Office for Eastern Mediterranean Region since 2009, leading the Regional Nutrition...
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...
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...
Reference this page
Emily Mates (). Improving care of people with NCDs in humanitarian settings. Field Exchange 53, November 2016. p64. www.ennonline.net/fex/53/peoplewithncds