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NCDs in humanitarian crises

Worldwide, close to a billion people live in fragile and conflict-affected contexts, and this number is expected to grow.1,2 Among those impacted globally, it is estimated that 274 million people need humanitarian assistance and protection.3 Many of these individuals live with non-communicable diseases (NCDs) such as diabetes and hypertension. Partnering for Change is a unique public-private partnership created with a view to help address this challenge.

A novel partnership

Humanitarian crises cause widespread human suffering and result from complex political, economic or social upheaval.4 Increasingly, climate-change-related environmental disasters also drive displacement and make life harder for those already forced to flee.5 Humanitarian crisis settings, characteristics and intensity can vary considerably. For example, a humanitarian crisis may have a sudden onset and be temporary, or it can be protracted. Either way, all humanitarian crises severely impact the lives of affected individuals, including their health.  

Within these complex settings, Partnering for Change – a collaboration between humanitarian organisations, the private sector and academia – has come together in search of ways to support people living with NCDs. The partnership recognises that in challenging circumstances, novel solutions are needed to provide the necessary care for those most in need.

2 out of 3

of the world’s extreme poor could live in fragile, conflict and violent settings by 2030.2

71%

of global deaths are caused by NCDs16

85%

of forcibly displaced people are hosted in low- and middle-income countries2 where health systems are weak and often already overburdened.7,8

Reaching the most vulnerable

Millions of people worldwide live with NCDs and people in humanitarian crises are particularly vulnerable.6-8 Heart attacks and strokes are 2-3 times more common in emergency settings than in normal circumstances.6 Diabetes and hypertension are also common and independent major risk factors for cardiovascular disease.10 These diseases requires continuity of care to avoid complications, disability and premature death.9 Even a short lapse in care for NCDs can result in disability and premature death.6

However, providing healthcare for people living in humanitarian settings remains a challenge.11 In humanitarian crises, there are often disruptions in health services. Essential services often get thrown into disarray because critical infrastructures break down or healthcare systems collapse entirely. Large-scale population movements and generalised instability further complicate the provision of continuous care.

Moreover, people forced to flee their homes are overwhelmingly hosted by low- and middle-income countries. These countries tend to have health systems that are weakened or already overburdened by acute health threats such as injuries and infectious diseases such as malaria and HIV/AIDS.7,12,13 Consequently, NCDs often remain undiagnosed in humanitarian crisis settings, leading to further health problems.

As such, people with NCDs are among the most vulnerable groups in humanitarian crisis settings. Many of them are at risk of developing or already suffering from complications that can be controlled under normal circumstances but which, without treatment, are disabling and even life-threatening.6,14

Humanitarian crises inflict a hefty toll on the health of people living with NCDs6

Physical injuries can precipitate acute cardiovascular events, worsen chronic respiratory disease and lead to poor blood glucose control.

Displacement can result in loss of access to existing medication and/or assistive devices, loss of prescription and lack of access to healthcare services.

Interruption of care due to the destruction of health infrastructure, disruption of medical supplies and impeded access to healthcare providers may incite complications and the deterioration of the condition.

Interrupted food and supplies are aggravating factors where diseases have specific dietary triggers

Degradation of living conditions can mean loss of shelter, poor sanitation and lack of income, compounding physical and psychological strain.

Stress, trauma and harsh living conditions

Beyond possible lack of diagnosis and detection, damaging or compounding factors, such as proximity to conflict, trauma, stress and harsh living conditions suffered by displaced and affected populations, can increase the risk of developing mental health conditions and NCD-related complications.6,14,15

The high prevalence of mental ill-health in humanitarian settings is not only a major health crisis in its own right but also exacerbates the effects of other chronic conditions.6,14,15 Humanitarian actors have learned from experience that mental health and psychosocial support (MHPSS) must be integral to care for physical NCDs and experts have called for better integration of MHPSS and protection services into NCD programmes. 

About 20%

of people living in humanitarian settings have mental health conditions, such as depression, anxiety or posttraumatic stress disorder.15

REFERENCES
  1. World Bank. Data: Population, total – Fragile and conflict affected situations. https://data.worldbank.org/indicator/SP.POP.TOTL?locations=F1. Published 2020. Accessed January, 2022.

  2. World Bank. Fragility, Conflict & Violence. World Bank. https://www.worldbank.org/en/topic/fragilityconflictviolence/overview#1. Published 2022. Accessed 27 June, 2022.

  3. UNOCHA. Global Humanitarian Overview 2022. UNOCHA. https://gho.unocha.org. Published 2022. Accessed.

  4. Jordan K, Lewis TP, Roberts B. Quality in crisis: a systematic review of the quality of health systems in humanitarian settings. Conflict and health. 2021;15(1):1-13.

  5. UNHCR. Climate change and disaster displacement. UNHCR. https://www.unhcr.org/climate-change-and-disasters.html. Accessed 6 July, 2022.

  6. World Health Organization. Noncommunicable diseases in emergencies. Geneva, Switzerland: World Health Organization;2016.

  7.   Doocy S, Lyles E, Hanquart B, Team LS, Woodman M. Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon. Conflict and health. 2016;10:21.

  8. World Bank. Forcibly displaced: Toward a development approach supporting refugees, the internally displaced, and their hosts. The World Bank;2017. 1464809380.

  9.  Parving H-H, Hommel E, Mathiesen E, et al. Prevalence of microalbuminuria, arterial hypertension, retinopathy, and neuropathy in patients with insulin dependent diabetes. Br Med J (Clin Res Ed). 1988;296(6616):156-160.

  10. Rabkin M, Fouad FM, El-Sadr WM. Addressing chronic diseases in protracted emergencies: lessons from HIV for a new health imperative. Global Public Health. 2018;13(2):227-233.

  11. eldis. Health systems in fragile and conflict-affected settings. https://www.eldis.org/collection/health-systems-fragile-and-conflict-affected-settings. Published 2021. Accessed April, 2021.

  12. Besançon S, Fall I-S, Doré M, et al. Diabetes in an emergency context: the Malian case study. Conflict and health. 2015;9(1):15.

  13. World Bank. Forcibly Displaced: Toward a Development Approach Supporting Refugees, the Internally Displaced, and Their Hosts. License: Creative Commons Attribution CC BY 3.0 IGO. Washington, DC: World bank;2017.

  14. Hayman KG, Sharma D, Wardlow RD, Singh S. Burden of cardiovascular morbidity and mortality following humanitarian emergencies: a systematic literature review. Prehospital and disaster medicine. 2015;30(1):80-88.

  15. Gyawali B, Harasym MC, Hassan S, et al. Not an ‘either/or’: Integrating mental health and psychosocial support within non-communicable disease prevention and care in humanitarian response. Journal of global health. 2021;11.

  16. World Health Organization. Noncommunicable Diseases. Fact sheet. https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases. Published 2021. Accessed March, 2021.