Addressing noncommunicable diseases in emergencies

September 2015

WHO/Ogtay Gozalov

In the shadow of the humanitarian crisis in Ukraine, people are struggling to receive treatment for their noncommunicable diseases (NCDs) such as cancer, lung and heart disease and diabetes.

Roads are blocked, health facilities are in disrepair, medicines are scarce and financial resources to make out-of-pocket payments are absent.

Humanitarian health workers like Dr Tamara Rudalovska in Mariupol, Eastern Ukraine, who works from one of the WHO-supported Mobile Emergency Primary Healthcare Units, is also finding it difficult to monitor and treat patients with NCDs.

“Due to the ongoing crisis it is not always possible to control the treatment of patients, especially when they change their place of residence and medications are in short supply,” says Dr Rudalovska. “However, timely disease detection and a comprehensive treatment plan are essential to maintaining healthier and longer lives and preventing premature deaths from NCDs.”

Responding to the need

A lapse in care for NCDs, even for a short period of time, can result in higher levels of disability and premature deaths. Worldwide, NCDs take 16 million lives prematurely every year. Without adequate supplies and trained staff to treat patients with NCDs in humanitarian emergencies, this number is expected to grow.

Working closely with the Ukrainian Ministry of Health and local health authorities, WHO has been piloting emergency NCD kits in the Mobile Emergency Primary Healthcare Units since early 2015. The kits provide many fundamental supplies for treating NCDs including, drugs for managing cardiovascular disease, insulin and glucometers to measure blood sugar levels for diabetes, and inhalers for asthma.

Training materials have also been developed to teach health workers in the field how to diagnose, treat and follow patients during humanitarian emergencies.

The kits are a success. Patients who were not able to afford medications or find pharmacies with supplies are now continuing treatment for their NCDs.

“People are very grateful and pleased when the Mobile Emergency Primary Healthcare Unit’s team comes to their village to provide medical care and medicines to them,” Dr Rudalovska explains. “WHO’s actions have improved the quality of life for internally displaced persons and the affected populations, prevented complications of diseases, and increased the diagnosis and efficiency of treating NCDs in the field.”

Scaling up globally

Based on the success of Ukraine’s pilot emergency kit, WHO is working to improve the emergency health kits it already deploys to humanitarian emergencies so they better address the needs of people living with NCDs.

The existing Interagency Emergency Health Kits, managed by WHO, provide essential medicines, supplies and equipment to provide basic medical care for 10 000 people for 3 months. The kit, however, does not provide the tools needed to prevent and treat NCDs.

“Access to medications to treat NCDs is critical in a humanitarian crisis, not only to maintain continuity of care but also as the crisis itself can often worsen peoples conditions. In humanitarian crises such as in the Ukraine, the demand for these medications continues even though many people flee the problematic areas, as the persons who flee tend to be younger and able-bodied,” says Dr Dorit Nitzan, WHO Representative to Ukraine.”

Later this year, WHO and other humanitarian agencies plan to review the possibility to increase the quantity and types of medicines for NCDs in the Interagency Emergency Health Kit. These could include lifesaving medicines for severe asthma, heart failure and Type I diabetes.

“There is a high demand for emergency kits with supplies to treat noncommunicable diseases,” says Hyo Jeong Kim, technical officer in Emergency Risk Management and Humanitarian Response department at WHO. “In order to create the most applicable kits for all settings, we need to understand the burden of disease in emergencies and identify what types and quantities of medicines are needed.”

Because humanitarian organizations need to ensure the kits are light and mobile, heavy equipment like defibrillators and dialysis machines cannot be included in the Interagency Emergency Health Kit. A separate global emergency NCD kit, like the one in Ukraine, is being discussed.

“The burden of NCDs is becoming ever more prominent in humanitarian emergencies,” says Kim. “Treating these patients will not only help to save lives of those experiencing severe symptoms but also alleviate the longer term health consequences, which can put an exponential burden on the health systems as they recover.”