Non-communicable diseases in humanitarian settings: ten essential questions

• Published in: Conflict and health 2017-09, Vol.11 (1), p.17-17, Article 17
• Main Authors: Aebischer Perone, S, Martinez, E, du Mortier, S, Rossi, R, Pahud, M, Urbaniak, V, Chappuis, F, Hagon, O, Jacquérioz Bausch, F, Beran, D
• Format: Article
• Language: English
• Subjects: Amputation; Analysis; Cancer; Cardiovascular diseases; Care and treatment; Casualties; Chronic conditions; Chronic diseases; Chronic illnesses; Complications; Conflicts; Continuity of care; Continuum of care; Crises; Diabetes; Diabetes mellitus; Disease; Diseases; Displaced persons; Earthquakes; Emergencies; Emergency management; Emergency medical services; Emergency preparedness; Emergency response; Epidemics; Ethics; Health aspects; Health care; Health services; Heart diseases; Humanitarian emergencies; Hypertension; Infectious diseases; Lung diseases; Medical research; Morbidity; Mortality; Myocardial infarction; Natural disasters; Non-communicable diseases; Pandemics; Public health; Refugees; Respiratory diseases; Review; Rural areas; Seismic activity; Surgery; Trauma; Tsunamis; Urban areas; Viability; Violence
• ISSN: 1752-1505; 1752-1505
• DOI: 10.1186/s13031-017-0119-8

Non-communicable diseases, (NCDs), are the leading cause of mortality worldwide with 38 million deaths, (68%), mainly due to cardiovascular diseases, diabetes, chronic respiratory diseases and cancer [1]. Nearly three quarters of NCD-related deaths, (28 million), occur in low and middle-income countries, (LMICs). In addition, in many LMICs, the burden of NCDs is concurrent to the burden of infectious diseases causing a double burden of disease and stretching the capacities of weak health care systems [2]. In more than half of the countries where the International Committee of the Red Cross, (ICRC), conducts its main operations, the prevalence of diabetes among the population above 18 years is higher than 10%. ( Fig. 1 : Map with 15 main ICRC operations and distribution of diabetes). The epidemiological transition with a change from infectious to non-communicable diseases has obliged the ICRC over time to adjust its medical response to increasing needs, commencing in the Balkans, followed by Lebanon, Pakistan, Liberia and Sudan in 2004 and later Yemen, Syria and Iraq and countries of the region that receive refugees [3]. In those countries, diabetes is the cause of more than 25% of amputations in 1/3 of the centres in the cohort of amputees in ICRC’s Physical Rehabilitation Centres [4]. Fig 1 The 15 biggest operations of the ICRC in 2015 and global prevalence of diabetes. Prevalence of diabetes / raised blood glucose (%) for the population aged 18+; Prevalence of diabetes: WHO: 2014 15 biggest ICRC operations in 2015 Humanitarian emergencies or crises can result from internal or external conflicts, natural disasters, epidemic or pandemic diseases, and complex emergencies [5]. Levels range from an emerging crisis, (essential needs may or may not be covered), to an acute crisis, (or emergency phase of a crisis where some basic needs are no longer covered), a chronic crisis (insufficient coverage of basic needs, a return to an acute crisis is possible), and post-crisis, (essential needs are covered by structures whose viability remains fragile) [6]. These emergencies cause disruption of access to existing resources and further impair the capacity of services to meet essential needs due to the break down in authority, health care systems, and/or societal cohesiveness. The aim of the humanitarian response is to use a public health approach when assisting persons affected by a crisis. In emergencies, the priority is to minimise mortality as far as possible and to