ViewpointCare of non-communicable diseases in emergencies
Introduction
Emergencies include natural disasters such as earthquakes and severe meteorological events, but also armed conflict and its consequences, such as civil disruption and refugee crises (sometimes termed chronic emergencies).1 The health component of the humanitarian response to emergencies has traditionally focused on management of acute conditions such as trauma and infectious illnesses.2 However, non-communicable diseases (NCDs) such as diabetes, hypertension, cardiovascular disease, cancer, and chronic lung disease are now leading causes of disability and death in low-income and middle-income countries (LMICs)3 and disaster-prone areas.4
NCDs require ongoing management for optimal outcomes, which is challenging in emergency settings because natural disasters or conflicts increase the risk of acute NCD exacerbations and decrease the ability of health systems to respond. Also, complex emergencies compromise NCD prevention and control over a prolonged period; limited access to timely treatment can lead to poor outcomes for patients and impose the high costs of managing complications on humanitarian agencies.5, 6 Therefore, a more comprehensive approach to NCD management in emergencies is an important but neglected aspect of humanitarian response.
Management of NCDs in emergencies requires inclusion of NCD care into standard operating procedures, which would facilitate horizontal and vertical integration with other aspects of relief efforts. Humanitarian response in emergencies can be divided into three phases: mitigation and preparedness, emergency response, and post-emergency phase. Existing guidance2 for humanitarian response identifies certain NCD-relevant considerations, but these chiefly refer to the emergency response phase and are limited in scope.
Here we propose the content of a minimally adequate response to NCDs in emergencies. This Viewpoint proposes specific actions organised by phase of the humanitarian response (figure), as well as some potential indicators for assessment of progress. We selected actions for inclusion based on their potential to reduce morbidity and mortality while minimising administrative and logistical burden for humanitarian responders. Where possible, we have prioritised actions that align with existing efforts to strengthen NCD care.
Section snippets
Mitigation and preparedness
Baseline information on local NCD burden (mortality, morbidity, and prevalence of risk factors) and on health-system structure and function is an important component of emergency preparedness. National surveys (including country health profiles available on a mobile application)7 are a good starting point, and can be supplemented by tools such as the WHO STEPwise approach to surveillance or epidemiological surveys to estimate local medication needs.8 National registries can aid estimation of
Potential indicators of progress
Existing indicators for monitoring of humanitarian response are divided into three phases that describe the situation, characterise the response, and evaluate impact (figure). Indicators relevant to health are usually divided into five subdomains.40 Metrics relevant to health are duly articulated in this list of indicators. Although in theory NCDs are reflected in the health indicator list, in practice this subdomain does not include any specific indicators relevant to NCD care.
Development of
Conclusion
A comprehensive response to management of non-communicable diseases in emergencies is an important but neglected aspect of non-communicable-disease control and humanitarian response, offering tremendous potential to reduce morbidity and mortality. We have outlined some considerations for addressing this issue and described a preliminary framework for assessment of progress. A sustained effort will be required to improve the health of the increasing number of people worldwide who suffer the dual
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