Continuity of NCD care in emergencies

Diabetes, hypertension, cardiovascular disease, asthma and COPD are common in almost every displaced population, and most of the people who have them were on treatment before the crisis. When that treatment stops, the harm comes quickly for some (insulin-treated diabetes) and more slowly for others (uncontrolled blood pressure leading to stroke).

UNHCR and the International Rescue Committee's operational guide (2020) asks agencies to integrate NCD care into primary health care from the acute phase onwards, rather than running it as a separate service later. Its priority conditions are diabetes, hypertension, cardiovascular disease, asthma and COPD. Mental health is covered separately by the mhGAP Humanitarian Intervention Guide.

The Sphere Handbook (2018) includes a dedicated health standard for non-communicable diseases, and WHO's 2021 hypertension guideline names hypertension care in humanitarian settings as a priority for agencies and a gap in the evidence.

WHO Noncommunicable Diseases Kit (NCDK) 2022

• Designed for an outreach population of 10,000 people for 3 months; replaces the 2016 kit.
• Five modules: medicines; cold chain (human insulin); supplies and renewables; equipment (BP machine, stethoscope, peak flow meter, scale, foot monofilaments, spacers); and a glucometer module.
• Covers hypertension and cardiac conditions, diabetes and other endocrine conditions, and chronic respiratory disease.
• Mental health medicines are in a separate WHO mental health kit.

Interagency Emergency Health Kit (IEHK)

• Covers about 10,000 people for 3 months, built from basic units for 1,000 people each (oral medicines for nurses and community health workers) and supplementary units for larger facilities.
• A 2024 version replaces the 2017 kit.
• It holds few NCD medicines, so plan an NCD kit or local procurement alongside it.

Choose medicines from the WHO Model List of Essential Medicines and your national list, and keep the range small so that every clinician uses the same few medicines.

• One protocol per condition, drug- and dose-specific, so that nurses and clinical officers can treat safely (WHO HEARTS and PEN).
• Task-sharing: WHO suggests nurses and pharmacists can manage hypertension with training, prescribing authority, a protocol and physician oversight, which can be remote.
• Community health workers can find people with NCDs, measure BP, deliver medicines and follow up those who miss visits.
• A register of everyone on NCD treatment: who is due, who missed a visit, who is controlled.
• Enough medicine to the next visit, and a plan for what happens if the clinic has to close or people move on.
• Referral routes agreed early: where to send emergencies, and how to get there when roads are unsafe.

• Keep your medicine card with you and show it at any clinic.
• Do not stop your tablets because you feel well. If they run out, come to the clinic before the last one.
• If you take gliclazide or insulin and cannot eat regularly, tell the health worker, and carry sugar for a low.
• Come at once for chest pain, sudden weakness or difficulty speaking, a very bad headache, or vomiting with diabetes.
• Less salt, no tobacco, and keep moving where it is safe.

Your tablets protect your heart and your brain. Please keep this card, and come back before your tablets run out, even if you feel well.