Leave no one behind: NCDs in humanitarian crises cannot be ignored

Globally, non-communicable diseases are now the leading cause of death. And there is a growing awareness that humanitarian emergencies are increasingly occurring in populations who – as a result of changes in demographics (ageing population) and environment (unhealthy diet, tobacco use, physical inactivity) – are already at high risk of NCDs. In increasingly protracted crisis situations, in which refugees and internally displaced people are living in limbo for many years, short-term responses are no longer sufficient.

PCI’s Julia Beart recently participated in a Young Leaders NCD bootcamp co-hosted by the Danish Red Cross and NCDFREE. She shares what the event was all about and how it links to PCI’s experience in humanitarian settings, focusing on our work in Syria.

“Sitting on a rainy runway in Copenhagen heading for home, I’m reflecting on the bootcamp. Historically, NCD care and humanitarian responses have followed parallel tracks without much crossover. Now, many agencies are beginning to bring the two together and facing up to the multiple challenges of ensuring continuous access to medication for chronic diseases, providing consistent long-term care for transient populations, and strengthening primary health care capacity to deliver services within the community.

The idea of the bootcamp was to generate new ideas around solutions for ensuring NCD care in humanitarian settings is provided, and to spark momentum for sharing the urgency of the issue to policy makers at the UN High Level Meeting on NCDs this September. Well, the bootcamp certainly did that, and all with a tremendous amount of energy and passion. 70 people from 35 organisations assembled together, fusing together academics, clinicians, humanitarians and communications professionals from around the world.

PCI was invited to present its experience in this field as part of a bootcamp workstream on ‘Access to Treatment’. I decided to showcase our work with the WHO in Syria, where we have seen a very high burden of NCDs pre-conflict (WHO estimated 79% of deaths were attributable to NCDs) translate into significant NCD-related morbidity and mortality as health services have broken down and medicine supplies have been disrupted. 

PCI’s role has been to provide technical support to cross-border operations from Gazientep and from Amman in the form of concise evidenced-based guidelines (incorporated into WHO NCD Emergency Kits now deployed into Syria), deliver Training of Trainer programmes, and mentor a cohort of NCD Champions to deliver cascade training and support optimal use of the NCD Kits in their clinics. You can read more about this work here  

Back at bootcamp, meanwhile, a fascinating parallel workstream focused on ‘Preparedness’: considering what needs to be in place for NCDs before an emergency. It is often not acknowledged that primary health care is often poorly equipped to deal with NCDs even before the onset of crisis. Syria is perhaps an outlier in this regard, since it had a well-functioning health system dealing with an established NCD disease burden before the conflict began. But in other settings where PCI works such as the DRC or Bangladesh, formal medical training has not kept pace with the epidemiological transition we are seeing. Nor has the status of primary care practitioners matched the prestige associated with specialisations in surgery or cardiology. The result is a lack of investment in primary health care doctors and nurses to manage NCDs, despite broad international consensus that early diagnosis and intervention to prevent the onset of complications is by far the most cost-effective (and equitable) way to manage NCDs. 

This is all by way of saying that there is not much hope of a good NCD response in a crisis setting if the NCD response was poor even before the onset of crisis. Awareness of NCD risk factors (particularly smoking and poor diet) are not well understood by many people, and unhealthy coping mechanisms amongst traumatised populations are common. Yet it is unfeasible to tell a traumatised refugee who has lost his home and family that, now, he must also stop smoking if he is to access medical care. If global leaders push for action to increase capacity to prevent and manage NCDs in stable settings, we then have a much better chance of providing continuous care during a crisis.  

As I finish writing this, my flight is getting ready to touch down in the UK. But it is my sincere hope that the ideas springing forth from the bootcamp take flight of their own, and help bring a fresh sense of urgency to the UN High Level Meeting in September.”

The bootcamp organisers have since developed a call for action in advance of the UN High Level meeting: “We call on all those with influence over the negotiations on the Political Declaration to raise the issue of NCDs in humanitarian crises as a major and growing health threat to some of the world’s most vulnerable populations and ensure its inclusion in the Political Declaration.” Read more here.