NCD care in humanitarian settings
When conflict, displacement or disaster strikes, people with long-term conditions often suffer most from losing their medicines, records and clinic. This course shows how a primary care team can find the people most at risk, treat NCD emergencies, restart essential treatment and keep care going, using WHO, UNHCR and inter-agency guidance.
- Explain which NCDs to prioritise in each phase of a crisis, and which people cannot miss treatment.
- Triage people with NCDs to find life-threatening emergencies quickly.
- Restart and continue treatment safely when medicines and records have been lost.
- Plan NCD supplies with the WHO NCD Kit and IEHK, and organise registers, patient-held records and task-sharing.
- Recognise and manage mental health conditions alongside NCDs, and avoid harmful medicine combinations.
- Keep insulin safe and effective when the cold chain and food supply are unreliable.
- Plan for people who depend on dialysis and other specialist care, and help patients prepare before displacement.
Why NCDs matter in a crisis, and what to prioritise
- Name the priority NCDs in humanitarian response.
- Explain why some people need treatment within days and others can wait weeks.
Diabetes, high blood pressure, heart disease, asthma and COPD are common in almost every displaced population, and many people were on treatment before the crisis. A crisis interrupts supplies, destroys records and makes clinics hard to reach. Deaths and complications from NCDs can be most frequent in the first days and weeks.
Priority conditions
The UNHCR and inter-agency operational guide (2020) asks agencies to build NCD care into primary health care from the acute phase onwards. Its priority conditions are diabetes, hypertension, cardiovascular disease, asthma and COPD. The inter-agency working group also includes epilepsy and heart failure of any cause. Mental health follows mhGAP and its humanitarian guide.
Not everyone is equally urgent
| Person | If treatment stops | Priority |
|---|---|---|
| Type 1 diabetes or anyone dependent on insulin | Ketoacidosis and death within days | Highest: find them first |
| Epilepsy on medicines | Stopping suddenly can bring back seizures | High |
| Severe asthma or COPD | Life-threatening attacks | High |
| Type 2 diabetes well controlled on tablets | Usually no immediate harm for a few weeks | Restart in a planned way |
| Hypertension | Rising risk of stroke and heart attack over weeks to months | Restart from a protocol |
What usually has to wait
Services such as cancer chemotherapy and dialysis are rarely possible in the acute phase and cannot be sustained by short-term responses. Refer to functioning hospitals where possible, and provide supportive and palliative care at every stage.
Worked case 2: An earthquake, day 3
Three days after an earthquake, a field clinic sees many injured people. A woman brings her 12-year-old son, who 'takes injections for sugar'; their house collapsed with his insulin inside.
- How urgent is he?
- Answer: Top priority: a child with type 1 diabetes can develop ketoacidosis within days without insulin. Check glucose and ketones and his state of hydration today.
- What should the clinic set up?
- Answer: A way to supply insulin, syringes and glucose testing at once (local procurement or the cold chain module of the NCD kit), and a question at every consultation and at registration to find other insulin users.
Ten days after a flood, 12,000 people are living in a temporary camp. Your mobile clinic has a basic emergency kit. Registration does not ask about long-term illness.
Which people should you look for first?
Anyone who uses insulin (especially children and young adults with type 1 diabetes), people with epilepsy on medicines, and people with severe asthma or COPD. Add a question at registration and in every consultation: do you take any medicine every day?
What can safely be planned rather than done today?
Restarting well-controlled type 2 diabetes tablets and blood pressure medicines can be organised over days to weeks from a standard protocol, once the emergencies and insulin users are covered.
- Priority NCDs: diabetes, hypertension, cardiovascular disease, asthma, COPD; epilepsy too.
- Insulin-dependent diabetes is the most urgent: days, not weeks.
- Integrate NCD care into primary care from the start.
- Do no harm: choose care that can be sustained and handed over.
Triage: finding NCD emergencies fast
- Use an ABCDE-based triage to detect the common NCD emergencies.
- Act on each within minutes and refer.
In the first phase of a crisis, NCD care should focus on life-threatening conditions. Quick triage finds the handful of emergencies that kill if missed but respond to prompt treatment.
About eight treatable NCD emergencies
- Acute coronary syndrome (heart attack): severe chest pain, sweating, nausea.
- Acute heart failure: breathlessness, cannot lie flat, crackles, swollen legs.
- Hypertensive emergency: very high BP with severe headache, blurred vision, chest pain, confusion or fits.
- Stroke: sudden weakness of one side, difficulty speaking.
- Diabetic ketoacidosis: thirst, vomiting, abdominal pain, deep fast breathing, drowsiness.
- Hypoglycaemia: sweating, shaking, confusion in someone on insulin or a sulfonylurea.
- Acute severe asthma or COPD: cannot complete sentences, cyanosis, silent chest.
- Status epilepticus: fits that do not stop.
Source: List adapted from the PEN-H triage chapter (International Rescue Committee, 2020), derived from WHO PEN.
How to triage
- Brief history from the person or family: chest pain? breathlessness? fever? known diabetes, hypertension, asthma, epilepsy?
- ABCDE: airway; breathing (rate, effort, chest sounds); circulation, chest pain, consciousness and convulsions; disability and dehydration; exposure and temperature.
- Decide and act: emergency NCD condition: treat now and refer; major NCD not acute: treat and follow up; other problems: manage as usual.
| Emergency | First actions at a first-level facility |
|---|---|
| Hypoglycaemia | Glucose by mouth if able to swallow; 50% glucose IV if unconscious (see the diabetes course) |
| Suspected DKA | 0.9% saline 1 litre over 2 hours, then 1 litre every 4 hours; refer |
| Severe asthma or COPD attack | Salbutamol by spacer or nebuliser, repeated; oxygen; refer if not improving |
| Status epilepticus | Benzodiazepine; second dose after 10 minutes if needed; no more than 2 doses; refer |
| Chest pain, stroke, hypertensive emergency, heart failure | ABCDE, oxygen if low, refer urgently; aspirin for suspected heart attack per protocol; do not try to lower BP rapidly in the clinic |
Worked case 2: Sudden weakness in a shelter
A 70-year-old woman in a collective shelter suddenly cannot move her right arm and her speech is slurred. Her BP medicines ran out two weeks ago. BP 190/110, glucose 6.8 mmol/L.
- What is likely?
- Answer: Stroke. Glucose is normal, so this is not a low glucose mimic.
- What do you do?
- Answer: ABCDE, protect the airway, nothing by mouth until swallowing is checked, and urgent referral. Do not try to lower her BP quickly in the clinic. Record the time she was last seen well.
At a clinic in a displacement site, a 66-year-old man is carried in at night. He has a history of 'heart trouble' and his tablets were left behind when he fled. He is breathless, cannot lie flat, has crackles at both lung bases and swollen legs. BP 170/100, pulse 112.
What NCD emergency is likely?
Acute heart failure, possibly with very high blood pressure, after stopping his medicines.
What are your first actions?
ABCDE; sit him up; oxygen if available or saturation is low; avoid IV fluids (overload); follow your protocol for acute heart failure; refer urgently. Record his history and medicines for the receiving team.
- In the acute phase, NCD care is first about finding and treating emergencies.
- Brief history plus ABCDE finds most NCD emergencies.
- About eight conditions: heart attack, heart failure, hypertensive emergency, stroke, DKA, hypoglycaemia, severe asthma or COPD, status epilepticus.
- Treat within minutes, refer, and use interim measures if referral is delayed.
Restarting and continuing treatment
- Apply simple clinical rules when treatment has been interrupted.
- Adapt diabetes and hypertension treatment to food insecurity and missing tests.
| Situation | What to do |
|---|---|
| Known hypertension, medicines lost | Measure BP properly. Restart from your protocol; long-acting amlodipine can be started without blood tests. Do not delay treatment for tests. See monthly until controlled. |
| Type 2 diabetes, tablets lost | Check glucose. Restart metformin, then gliclazide, following the WHO PEN steps. |
| Food short or meals irregular | Higher risk of hypoglycaemia on gliclazide or insulin. Ask about meals at every visit, reduce doses if needed, make sure people carry sugar. |
| Insulin-treated diabetes | Highest priority. Supply human insulin, syringes and a way to check glucose. Store insulin following the manufacturer's and national guidance. |
| Asthma or COPD, inhalers lost | Restart the usual inhaler with a spacer. Severe attack: lesson 2. |
| Epilepsy, medicines lost | Restart one antiepileptic that will be reliably available; do not stop antiepileptics abruptly. No valproate in women and girls who could become pregnant. |
| Past heart attack or stroke | Continue statin and low-dose aspirin; check BP every visit. |
When the old medicine is not available
If someone was well controlled on a medicine you do not stock, switch to the protocol medicine at a starting dose and see them again in a month. If their old medicine is available and affordable, keep it: frequent changes confuse people and reduce adherence. Where a protocol medicine runs out, another medicine of the same class may be used temporarily (for example another statin or beta-blocker).
No laboratory
Most decisions can be made on history, examination, blood pressure and capillary glucose. Do not hold back essential treatment because tests are not available; test later when you can.
Your tablets protect your heart and brain. Keep this card with you, and come back before the last tablet, even if you feel well.
Worked case 2: Epilepsy and a new medicine
Mr R, 28, took carbamazepine for epilepsy and has had no fits for two years. He has missed his tablets for a week and had one fit yesterday. The clinic stocks phenobarbital only.
- What do you do?
- Answer: Restart one antiepileptic that will be reliably available: phenobarbital at a starting dose per mhGAP or national protocol, or carbamazepine if it can be obtained reliably. Do not leave him without treatment while you wait.
- What advice does he need?
- Answer: Take it every day, do not stop suddenly, come back before the tablets run out, and what to do if a fit lasts more than 5 minutes. Avoid swimming alone or working at heights while fits are not controlled.
Mrs S, 45, has had diabetes for 15 years and used human insulin twice daily. She arrived a week ago with no insulin left. She is thirsty and tired, glucose 21 mmol/L, urine ketones 1+. She is alert and not vomiting. Meals in the site are irregular.
How urgent is this?
Very urgent: she depends on insulin and has high glucose with some ketones. She needs insulin today, close review, and immediate referral if she starts vomiting, breathing deeply, becomes drowsy or ketones rise to 2+.
What else must you plan?
A reliable insulin supply (cold chain module of the NCD kit or local procurement), syringes, a glucose meter, advice on safe storage per national guidance, and a plan to reduce the risk of hypoglycaemia with irregular meals: teach the signs, carry sugar, review doses at each visit.
- Restart BP medicines from a protocol; amlodipine needs no tests to start.
- Restart metformin then gliclazide stepwise; watch for lows when food is short.
- Insulin users and people with epilepsy cannot wait.
- Keep a working regimen if available; otherwise switch to protocol medicines and review in a month.
Kits, medicines and supplies
- Describe what the WHO NCD Kit 2022 and the Interagency Emergency Health Kit provide.
- Plan an NCD supply that avoids interruptions.
WHO Noncommunicable Diseases Kit (NCDK) 2022
- For an outreach population of 10,000 people for 3 months; replaces the 2016 kit.
- Five modules: medicines; cold chain (human insulin in 10 mL vials); supplies and renewables; equipment (BP machine, stethoscope, peak flow meter, adult scale, monofilaments, spacers); glucometer.
- Covers hypertension and heart conditions, diabetes and other endocrine conditions, and chronic respiratory disease.
- Gliclazide replaced glibenclamide to reduce hypoglycaemia. Mental health medicines are now in a separate WHO mental health kit.
Interagency Emergency Health Kit (IEHK) 2024
- Serves about 10,000 people for 3 months. Basic modules (each for 1,000 people) hold oral medicines for nurses and community health workers; a supplementary module serves hospitals and larger centres.
- The IEHK carries only a few medicines for NCD exacerbations, so it is not enough for long-term NCD care. Order the NCD kit or procure locally alongside it, and check exactly which units your kit contains.
- Expected to stay in use until 2030.
A supply plan
- A short medicine list based on the WHO Model List of Essential Medicines and the national list, so all clinicians use the same few medicines.
- Procurement, storage and cold chain (coordinate with immunisation teams).
- A buffer stock for supply breaks, sudden moves or a rise in demand.
- In insecure settings, consider giving patients a small emergency supply to carry if they have to flee.
Your agency is opening a primary care clinic for about 10,000 refugees. An IEHK has arrived. A rapid survey suggests several hundred adults with hypertension and diabetes, some using insulin.
Is the IEHK enough for their NCD care?
No. It has only a few NCD medicines. Order the WHO NCD Kit (designed for 10,000 people for 3 months), including its cold chain module for insulin, or procure locally from the essential medicines list.
What else do you need besides medicines?
Validated BP machines, a glucometer and strips, urine strips, monofilaments, spacers and a peak flow meter; cold storage for insulin; and a buffer stock.
- NCDK 2022: 10,000 people for 3 months; medicines, insulin cold chain, supplies, equipment, glucometer.
- IEHK: general emergency kit with few NCD medicines.
- Use a short list from the WHO Model List and national list.
- Plan cold chain and buffer stock from the start.
Organising care: records, teams and handover
- Set up a register and patient-held records.
- Share NCD care across the team and plan for handover.
- One protocol per condition, drug- and dose-specific, so that nurses and clinical officers can treat safely (WHO HEARTS and PEN).
- Task-sharing: doctors can start treatment and see complex cases; trained nurses can follow up stable patients. WHO suggests nurses and pharmacists can manage hypertension with training, prescribing authority, a protocol and physician oversight.
- Community health workers can find people with NCDs, measure BP, support self-care and follow up those who miss visits.
- A register of everyone on NCD treatment, with more than visit counts: cohort size, outcomes and who is controlled.
- Patient-held records (a card or booklet, or a photo of the file) so care continues if people move.
- Referral routes and transport for emergencies agreed early.
- Handover: work with national services from the start so care continues when the agency leaves.
Self-management
People who understand their condition do better when services are disrupted. Teach the essentials: what the medicine is for, what to do if it runs out, danger signs, and for diabetes the signs of a low.
Show this card at any clinic. It says what illness you have and which tablets you take. Come back before your tablets run out.
Six months into the response, many patients move between two sites and a town. Clinicians at each site keep starting people on different medicines, and there is no shared record.
What simple steps would improve continuity?
A patient-held card with diagnosis, medicines and doses; one shared protocol and medicine list across all three sites; a register at each site; and community health workers who know where people have gone.
What should the agency plan for now?
Handover to national or local services: align medicines with the national list, train local staff, and agree how registers and patients will be transferred.
- One protocol and one short medicine list across sites.
- A register and patient-held records keep care going when people move.
- Task-sharing with nurses and community health workers, with oversight.
- Plan handover to national services from the start.
Mental health and NCDs
- Recognise common mental health problems in people with NCDs during a crisis.
- Give basic support and treatment that is safe alongside NCD medicines.
- Keep people with severe mental disorders on treatment and watch their physical health.
Emergencies bring loss, fear and uncertainty. Most people recover with basic support, but depression, anxiety, alcohol problems and post-traumatic stress become more common. Mental and physical illness feed each other: depression makes it harder to take tablets and attend clinic, and people with severe mental disorders have more diabetes and heart disease and die younger.
Ask about mood at NCD visits
- Ask about sleep, energy, interest, worry and hopelessness. Poor control that does not improve despite medicines is a reason to ask.
- Ask directly about thoughts of self-harm. Asking does not put the idea into someone's head.
- Use psychological first aid principles for people in acute distress: look, listen, link to practical help.
Treat, using mhGAP
- Depression: psychoeducation, problem solving and activation, social support, and antidepressants where moderate to severe, following mhGAP. Fluoxetine is usually the first choice.
- Amitriptyline: avoid in people with heart disease, and be careful with overdose risk in people with thoughts of self-harm.
- Do not give benzodiazepines for distress or sleep problems in the weeks after a crisis; they cause dependence and do not help recovery.
- Alcohol: ask, give brief advice, and watch for withdrawal if supply stops suddenly.
Severe mental disorders
- People with psychosis or bipolar disorder can lose their medicines like anyone else. Restart a protocol medicine (for example haloperidol or chlorpromazine for psychosis) and do not stop lithium or antiepileptics abruptly.
- Some newer antipsychotics cause weight gain and raise glucose and lipids: check weight, BP and glucose.
- Protect their rights: people with severe mental disorders are at risk of neglect, abuse and being chained or locked up in a crisis.
Source: mhGAP Intervention Guide version 2.0 (2016); mhGAP Humanitarian Intervention Guide (2015); IASC Guidelines on mental health and psychosocial support in emergency settings (2007); Psychological first aid: guide for field workers (2011).
Worked case 2: Antipsychotics and a rising glucose
Mr D, 40, has schizophrenia and is stable on an antipsychotic from a previous clinic. He has gained weight and his random glucose is 13.5 mmol/L with thirst.
- What may be happening?
- Answer: Diabetes, possibly made worse by the antipsychotic's metabolic side effects.
- What do you do?
- Answer: Confirm diabetes and start treatment per protocol; do not stop the antipsychotic abruptly. Review the choice of antipsychotic with a supervisor; give diet and activity advice; check weight, BP and glucose at each visit.
Mrs A, 55, has type 2 diabetes. Since losing her home and her husband in a flood two months ago, her glucose has stayed high despite metformin and gliclazide. She says she often forgets her tablets, sleeps badly, has lost interest in everything and feels there is no point going on.
What else is going on, and what must you ask?
Likely depression, which is making adherence harder. Ask directly whether she has thoughts of ending her life, plans or past attempts.
What is your plan if she has no immediate plan to end her life?
Treat depression per mhGAP: psychoeducation, support, problem solving, link to community support; consider fluoxetine if moderate to severe. Simplify the diabetes regimen, involve a family member, and review in 1 to 2 weeks. If she has a plan or recent attempt: do not leave her alone, remove means, and act the same day.
- Ask about mood at every NCD visit, and ask directly about self-harm.
- Depression: mhGAP psychological care first; fluoxetine usually first choice; avoid amitriptyline in heart disease.
- No benzodiazepines for distress after a crisis.
- Keep people with severe mental disorders on treatment and check their weight, BP and glucose.
Insulin and the cold chain in a crisis
- Keep insulin supplied, stored and used safely when power and fridges fail.
- Reduce the risk of hypoglycaemia and ketoacidosis when food and testing are unreliable.
Insulin is the one NCD medicine whose interruption can kill within days. People with type 1 diabetes, children with diabetes, and some adults with type 2 diabetes or diabetes in pregnancy depend on it.
Supply
- The WHO NCD Kit 2022 has a separate cold chain module with human insulin in 10 mL vials. Order it early, or procure locally from the national essential medicines list.
- Every insulin user also needs syringes that match the insulin strength (U-100 syringes for U-100 insulin), a glucose meter and strips, and urine or blood ketone tests if possible.
- Keep a register of insulin users with their doses so that supply can be planned and no one is missed.
Storage
| Insulin | How to keep it |
|---|---|
| Unopened stock | Refrigerate at 2 to 8 °C in the clinic or pharmacy |
| Never | Freeze it, leave it in the sun, or leave it in a hot vehicle. Frozen insulin must be thrown away |
| In use at home | Follow the label: most insulins can be kept at room temperature for about 4 weeks once opened. Keep it in the coolest place available, for example a clay pot or a covered container in the shade |
| Check before use | Throw away clear insulin that has gone cloudy, or any insulin with clumps or crystals |
Food insecurity and hypoglycaemia
- Ask about meals at every visit. Food distributions are irregular; insulin and gliclazide doses may need to be lower.
- Teach the signs of a low (sweating, shaking, confusion) and to carry sugar.
- Teach the signs of ketoacidosis (thirst, vomiting, abdominal pain, deep breathing, drowsiness) and to come at once.
- Simple, fixed regimens (for example premixed or twice-daily human insulin) are easier to sustain than complex ones when testing is limited.
Worked case 2: The clinic fridge has failed
The generator at your clinic broke down two days ago. The fridge with 60 vials of human insulin has been at about 30 °C since then. Fuel will arrive in a week.
- Is the insulin wasted?
- Answer: Not necessarily: unopened insulin kept at room temperature for a few days is usually still usable, but it must not be frozen or overheated. Check the label and your supply chain guidance, look at each vial, and record what happened.
- What do you do now?
- Answer: Move it to the coolest shaded place or to another working fridge (for example the immunisation cold chain), issue it first, and ask for a replacement supply. Tell patients to keep their in-use vial cool at home.
Sami, 15, arrives at a border transit site with his mother. He has type 1 diabetes and has had no insulin for 2 days. He is thirsty, has vomited twice and is breathing deeply. Glucose reads 'HI', urine ketones 3+.
What is happening, and what is the immediate plan?
Diabetic ketoacidosis after stopping insulin. This is an emergency: ABCDE, IV normal saline, and urgent transfer to a facility that can give IV insulin and monitor him (lesson 2).
After hospital care he returns to the site. What does he need to stay safe?
Daily insulin with matching syringes, a glucose meter and strips, a cool storage place at home, education for him and his mother on lows, ketones and sick days, a patient-held record of his doses, and a named clinic for monthly supply. Register him so he is never without insulin again.
- Find every insulin user first; register them with their doses.
- Unopened insulin at 2 to 8 °C; never frozen or in the sun; in-use vials at room temperature as the label says, in the coolest place available.
- Never stop insulin in type 1 diabetes; reduce the dose if food is short.
- Matching syringes, a glucose meter and ketone tests go with every insulin supply.
Dialysis, specialist-dependent patients and planning before displacement
- Identify people who depend on specialist treatment that a crisis interrupts.
- Give first-level care to a person on dialysis who has missed sessions.
- Help patients and services prepare before displacement.
Some people depend on treatment that only a hospital can give. A crisis can cut them off within days. Primary care cannot replace this treatment, but it can find these people, keep them as safe as possible, and get them to a working service.
Who to look for
- Haemodialysis or peritoneal dialysis.
- Kidney or other transplant (daily immunosuppressants).
- Cancer treatment, and people who need strong pain relief or palliative care.
- Home oxygen; regular blood transfusion (thalassaemia, sickle cell disease); bleeding disorders such as haemophilia.
- Assistive devices: wheelchairs, hearing aids, prostheses.
Dialysis: why missed sessions are dangerous
Without dialysis, fluid and potassium build up within days. High potassium can stop the heart without warning; fluid overload causes breathlessness and swelling.
| Finding | Action |
|---|---|
| Breathlessness, cannot lie flat, crackles; palpitations, weakness; confusion; more than one session missed | ABCDE, sit up, oxygen, no IV fluids, urgent transfer to a working dialysis unit |
| Well, but due for dialysis and none available locally | Find the nearest functioning unit through the health cluster or referral network; arrange transport |
| While waiting | Limit fluids and salt; avoid high-potassium foods (for example bananas, oranges, tomatoes, potatoes, beans, dried fruit); keep taking usual medicines unless told otherwise |
Crush injury after building collapse can cause sudden kidney failure in people with healthy kidneys: give IV fluids early and transfer anyone with a crushed limb.
Planning before displacement
Where displacement can be foreseen (for example conflict moving closer, or a cyclone season), help patients and services prepare:
- A patient-held record: diagnosis, medicines and doses, allergies, last results; a photo on a phone as backup.
- Where policy and stock allow, a longer supply of medicines (for example two or three months for stable patients), and a small emergency supply to carry.
- A go-bag: medicines, record, glucose meter, spacer, sugar, and for insulin users a cool pouch.
- Dialysis and transplant patients: written instructions for an emergency diet and the names of other units they could go to.
- Services: keep the register with contact details, map which facilities will still work (WHO HeRAMS where in use), agree referral routes, and pre-position NCD kits.
If you have to leave in a hurry, take this card and your tablets. Show the card at any clinic so they can continue your treatment.
Worked case 2: Preparing a clinic for a cyclone
Your clinic serves a coastal district. A cyclone is forecast in 5 days. You have 400 people on NCD treatment, 25 using insulin and 6 on dialysis at the district hospital.
- What can you do this week?
- Answer: Contact everyone on the register, starting with insulin users and dialysis patients; give patient-held records and an extra month of medicines where stock allows; check insulin storage; agree with the hospital how dialysis patients will be dialysed before and after the storm.
- What does the clinic itself need?
- Answer: Medicines and NCD kits stored above flood level, a backup for the cold chain, a copy of the register held off-site, and a referral plan if the hospital is cut off.
Mr T, 52, had haemodialysis twice a week until his town was shelled 6 days ago. He arrives at your clinic short of breath, unable to lie flat, with swollen legs and a pulse that feels irregular. BP 178/100.
What are the immediate dangers?
Fluid overload and high potassium after missing at least three sessions. Both can kill quickly; high potassium can cause a sudden cardiac arrest.
What do you do?
ABCDE, sit him up, oxygen, no IV fluids, and urgent transfer to the nearest working dialysis unit, contacting them first. Send a record of his dialysis history and medicines. While waiting: no potassium-rich foods, minimal fluids, no NSAIDs.
- Find people who depend on dialysis, transplant medicines, cancer care, oxygen or transfusion early.
- Missed dialysis: fluid overload and high potassium; no IV fluids; urgent transfer.
- Emergency diet: little fluid, little salt, avoid high-potassium foods.
- Before displacement: patient-held records, extra medicine supply where allowed, a go-bag, a register held off-site, mapped referral routes.
Quiz and CPD certificate
Answer all 15 questions, then press Mark. You need 12 or more to pass. You can look back at the lessons: the aim is learning. A pass gives a printable certificate of completion for 4 hours of self-directed learning; you need a free account, signed in, to issue it.
Sources
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- Jacquerioz Bausch F, Beran D, Hering H and others (Conflict and Health). Operational considerations for the management of non-communicable diseases in humanitarian emergencies. 2021.
- International Rescue Committee. Package of essential non-communicable diseases interventions for humanitarian settings (PEN-H). 2020. Derived from WHO PEN; used for the triage chapter only.
- World Health Organization. Noncommunicable diseases kit (NCDK) 2022. 2022.
- World Health Organization. Interagency Emergency Health Kit 2024. 2024.
- World Health Organization. Diagnosis and management of type 2 diabetes (HEARTS-D). 2020 (WHO/UCN/NCD/20.1).
- World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. 2021.
- World Health Organization and International Committee of the Red Cross. Basic emergency care: approach to the acutely ill and injured. 2018.
- World Health Organization. mhGAP Intervention Guide, version 2.0. 2016.
- World Health Organization. mhGAP Humanitarian Intervention Guide (mhGAP-HIG). 2015.
- Inter-Agency Standing Committee. IASC Guidelines on mental health and psychosocial support in emergency settings. 2007.
- World Health Organization, War Trauma Foundation and World Vision International. Psychological first aid: guide for field workers. 2011.
- Kaufmann B, Boulle P, Berthou F and others (PLOS ONE). Heat-stability study of various insulin types in tropical temperature conditions: new insights towards improving diabetes care. 2021. Study by Médecins Sans Frontières and the University of Geneva.
- European Renal Association, Renal Disaster Relief Task Force (Nephrology Dialysis Transplantation). Lessons learned during the war in Ukraine: a report from the Renal Disaster Relief Task Force of the ERA. 2023.
- World Health Organization. Health Resources and Services Availability Monitoring System (HeRAMS). 2019. Year of the operational guidance; the system is updated regularly.