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Improving care of people with NCDs in humanitarian settings

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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

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

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