Care of non-communicable diseases in emergencies.

Introduction Emergencies include natural disasters such as earthquakes and severe meteorological events, but also armed confl ict and its consequences, such as civil disruption and refugee crises (sometimes termed chronic emergencies). The health component of the humanitarian response to emergencies has traditionally focused on management of acute conditions such as trauma and infectious illnesses. However, noncommunicable diseases (NCDs) such as diabetes, hypertension, cardiovascular disease, cancer, and chronic lung disease are now leading causes of disability and death in low-income and middle-income countries (LMICs) and disaster-prone areas. NCDs require ongoing management for optimal outcomes, which is challenging in emergency settings because natural disasters or confl icts increase the risk of acute NCD exacerbations and decrease the ability of health systems to respond. Also, complex emergencies compromise NCD prevention and control over a prolonged period; limited access to timely treatment can lead to poor outcomes for patients and impose the high costs of managing complications on humanitarian agencies. Therefore, a more comprehensive approach to NCD management in emergencies is an important but neglected aspect of humanitarian response. Management of NCDs in emergencies requires inclusion of NCD care into standard operating procedures, which would facilitate horizontal and vertical integration with other aspects of relief eff orts. Humanitarian response in emergencies can be divided into three phases: mitigation and preparedness, emergency response, and post-emergency phase. Existing guidance for humanitarian response identifi es certain NCD-relevant considerations, but these chiefl y refer to the emergency response phase and are limited in scope. Here we propose the content of a minimally adequate response to NCDs in emergencies. This Viewpoint proposes specifi c actions organised by phase of the humanitarian response (fi gure), as well as some potential indicators for assessment of progress. We selected actions for inclusion based on their potential to reduce morbidity and mortality while minimising administrative and logistical burden for humanitarian responders. Where possible, we have prioritised actions that align with existing eff orts to strengthen NCD care.