Addressing chronic diseases in protracted emergencies: Lessons from HIV for a new health imperative

Abstract

Forcible displacement has reached unprecedented levels, with more refugees and internally displaced people reported since comprehensive statistics have been collected. The rising numbers of refugees requiring health services, the protracted nature of modern displacement, and the changing demographics of refugee populations have created compelling new health needs and challenges. In addition to the risk of malnutrition, infectious diseases and exposure to the elements attendant upon conflict and the breakdown of public health systems, many displaced people now require continuity care for the prevention and treatment of cardiovascular disease, diabetes, asthma, cancer, and mental health, as well as maternal and child health services. In some regions, most refugee health services need to be provided in dispersed settings within host communities, rather than in traditional refugee camps, and the number of refugees suffering protracted displacement is growing rapidly. These realities highlight a significant disconnect between the health needs of twenty-first century refugees, and the global systems that have been established to address them. The global response to the HIV epidemic offers lessons about ways to support continuity care for chronic conditions during complex emergencies and may provide important blueprints as the global community struggles to redesign refugee health services.

The health status of newly arrived Syrian refugees at the Refugee Health Service, South Australia, 2016

“…8 Healthcare in a humanitarian crisis is generally poorly equipped to deal with chronic disease management. 9,10 NCDs are prevalent in Syrian refugees living in Lebanon, Turkey and Jordan, and access to healthcare was reported as a major issue for this population. 8,11,12 It is likely that the Syrian refugee population in Australia will have a high prevalence of NCDs, and these conditions may have been affected by poor access to healthcare.…”

Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study

“…As noted by Rabkin et al [ 26 ], most health services to displaced populations should preferably be provided in dispersed settings within the hosting communities, rather than in traditional refugee camps (or, in the case of Ukraine, in the places of compact residence). This was also the situation observed in Ukraine, where IDPs were not restricted from using health care services within the hosting communities.…”

MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

“…In the case of chronic NCD care, many humanitarian actors recognise that integration within the existing health system, ideally at primary care level, may be the optimal approach (60). Moreover, integrating such services may provide an opportunity for health system strengthening, particularly in contexts where constrained health systems have historically focussed on episodic emergency or infectious disease care and have limited capacity to provide chronic disease care (1,40,61). However, this potential blurring of the lines between humanitarian action and development must be balanced with the goal of rapidly reaching the most marginalised and vulnerable populations and with operational priorities.…”