There's an increasing attention to people living with NCDs and emergencies, and many challenges to come as the number of people affected by NCDs is rising. High-quality evidence and epidemiology is limited, and there is little consensus on strategic or operational guidelines except the recommendation to avoid interruption of medication, and a set of do's and don'ts, which are helpful in navigating a largely undescribed field. Let's listen to the experience of Sigiriyas Aebischer Perone, a medical doctor at the Geneva University Hospital, who is in charge of integrating the management of NCDs in the International Red Cross health program. In my experience, there are five main do's In management of NCDs in humanitarian settings. The first one it's to work with existing health structures and Ministry of Health. Never forget what is still existing in the countries, and assess the existing local health system, and respect the Ministry of Health because management of NCDs it's a long-term approach. Even in emergency, usually humanitarian organizations are there for a long term. So, the second point, It's about strengthening the remaining health infrastructure. It is about identifying what are the gaps? What are the needs? And not coming with our perceptions, but look really what is still working and build resilience of what is still working. Do they need help in HR? Do they need help in medicine? Do they need help in training? Whatever it is, and provide it. The third one would be to identify the priority NCD in the specific context. It really depends on where you work. In many countries, hypertension, it has to be addressed because the prevalence is worldwide very high. Diabetes depends. It's very high in the Middle East, far lower in Africa for example. So, you have really to adapt your answer to what is the priority. Asthma can be also very high NCD. Cancer, It's a challenge in every humanitarian settings, where even basic needs are not addressed. So, humanitarian organizations very often do not address cancer in their response, at least not in the earlier response. The next one, it is to be very clear with the limit. What can you provide? What is your organization able to provide? Meaning, how far do you go with the care you have? Very often in acute emergencies, it is not possible to provide all the care you would do in your own home settings. So, that's very important to set limits and to be clear with them, and clear also with the authorities what you can do. If you are specialized in some highly technical care, that could be the gap to be filled. If your organization, it's not very trained and skilled in it, I wouldn't go for it in a humanitarian emergency. The last point, it's really to move from an individual approach to a public health approach. This is very difficult for clinicians. We are used here at least in Europe to do most what is ever feasible for individuals. Unfortunately, this is not any more possible in humanitarian emergencies. There, the means are restricted, you have limited resources, human resources, financial resources in medicine which are available. Therefore, you have to see with the limited means you have how to use them best to address the problems of most of the patients. Those were the do's. Now, let's focused on what Sigiriyas has to tell us about the dont's. If we look at the don'ts of NCD management in humanitarian crisis, one don't would be to have a vertical approach. Would be to build just care for one specific NCDs like it was done for HIV or tuberculosis, to setup a specific clinic for just diabetes management. Because persons with NCDs, they don't have only one NCD, very often have more than one, and they might have also acute conditions. Therefore, an vertical approach would not at all address the needs of these patients. The second don't would be to come with already made answers. Meaning, if your organization is used to address NCDs in one context, you cannot take the same answer to the next one. You have really to look what are the gaps? Identify them, and what is the resilience of the existing system? And to adapt the answers locally. So, there is no one size fits all solution. In the same line, comes the third point. Meaning, don't work alone. Work in a system and involve local staff in decisions. Not only local staff, but also communities to identify how to best care for the patients? And how to take sometimes difficult decisions? For example, decisions for complications of NCD cares regarding amputations for patients with diabetes. These kinds of decisions should never be taken alone by external set-ups. Really to be discussed with the families, with the patient, with the community, what is acceptable, and what isn't. Then to go on the choice of the patient first. The fourth point would be just to stick to classical NCDs like the WHO define them. It can be that in some settings, for example epilepsy would be a big burden. For example, in South America where there is a lot of neurocysticercosis. People with epilepsy, if you interrupt their treatment, they will have very rapidly complications and seizure and they need actually the same care and follow-up as diabetes or hypertension would have. So, I wouldn't work also there in some kind of silos, I say it's image gap and that's NCDs. So, I would really look, what are the conditions which need chronic care, and then address them in the same way in a comprehensive way. The last point would be, never to have just short term perspective. Meaning, now humanitarian crisis last over unfortunately very often over years. So, don't think you'll be there just for a few months. Have always a long-term perspective, and with this don't substitute the health system, rather work with it, and build local capacity on each level. Therefore, in addressing NCDs in humanitarian crisis, we have to look at, what are the capacities of the remaining health system? With whom do we work? Identify the local partners, strengthen the capacities, have a long-term approach, don't work in silos, look who's capacities can be improved, and work on ownership and long-term response.
