responding to changing health needs in protracted crises: the … · 2019-12-16 · responding to...
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The 9th Annual CUGH Global Health ConferenceNew York City, NYMarch 18, 2018
Responding to changing health needs in protracted crises: The case of the Syrian crisisAkik C, Ghattas H, Mesmar S, Rabkin M, El Sadr W, Fouad F
Presented by Fouad M. Fouad
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Background and context
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Push and pull factors of migration: A closer look
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Syrian conflict
Massive death toll &
Destruction of infrastructure and
social systems
Mass displacement: over 6 million
internally displaced and
over 5 million toJordan, Lebanon,
and Turkey
The Syrian conflict: Displacement in numbers
Conflicts have significantly contributed to the rise in the internally and externally displaced.
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During protracted humanitarian crises, if we only addressed:
• Evacuating people from affected areas• Providing transportation, shelter, food, and water• Prevention injury and infectious diseases
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What would happen to:
• Ischemic stroke survivors taking anticoagulants?• People whose diabetes is controlled by insulin?• Heart attack survivors taking clot-preventing medications?• People with severe lung disease receiving home oxygen therapy?• People with hereditary blood disorders?• Patients receiving hemodialysis for kidney failure?
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NCD status in numbersGLOBALLY
• CVD, cancers, chronic respiratory diseases, and diabetes cause an estimated 60% of all deaths worldwide annually
• 80% of these deaths are in low- and middle- income countries 1
• DALYs from NCDs shifted from 43% in 1990 to 54% in 2010 ²
• Cumulative economic losses due to NCDs in LMICs: estimated at $7 trillion, surpassing the yearly $11 billion cost of implementing effective interventions to decrease NCD burden ³
EASTERN MEDITERRANEAN REGION
• NCDs accounted for 57% of all deaths in 2014 4
• Almost 25% of adult population (15-65 years) were hypertensive
• Between 20% and 40% had hypercholesterolemia
• Out of the 10 countries highest in diabetes prevalence, 6 countries are from the region 5
• The leading cause of death in the region in 2013 was ischaemic heart disease (90.3 deaths per 100,000 people), which increased by 17.2% since 1990 6
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Percent of total deaths caused by NCDs in the largest source countries of refugees in 2015
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Pre-conflict NCD status in Syria
Proportional mortality (% of total deaths, all ages)
2011WHO Country Profile
NCDs 77% of total deaths NCDs 46% of total deaths
2014WHO Country Profile
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Objectives
Identify the NCD-related health needs of Syrian refugees in neighboring host countries
Explore the systems and services available to them in Turkey, Jordan, and Lebanon
Highlight gaps and best practices in NCD health service delivery in these settings
Identify the NCD-related health needs of Syrian refugees in neighboring host countries
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50.3
50.4
25
73.9
39.8
14.6
19.6
13
7.3
7.6
13.3
0 10 20 30 40 50 60 70 80
Jordan* - JHAS
Lebanon - LHAS
Turkey - Rapid Need Assessment of Gaziantep Based SyrianRefugees
Turkey - Evaluation of health status and health service utilization inZeytinburnu- Istanbul
Jordan - Health Access Utilization Survey
Lebanon - Health Access Utilization Survey
Jordan - Hidden victims of the Syrian crisis
Lebanon - Hidden victims of the Syrian crisis
Turkey - Syrian Refugees in Turkey (in camps)
Turkey - Syrian Refugees in Turkey (outside camps)
Turkey - Syrian refugees needs analysis survey
HHAd
ult
All a
ges
Percentage (%)
NCD status: The impact of conflict
There is a HIGH BURDEN OF NCDs reportedin Lebanon and Jordan (around 50%).
however:
1. Most data collected at Household level, and report at least one member living with at least
one chronic condition;
2. Only 5 chronic disease conditions assessed.
In Turkey, household prevalence ranged from 25 –74 %
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13
*HH : Household ∞ Asthma 18%®Coronary heart diseases prevalence at 23.4%¥ Ischemic heart diseases prevalence of 2.6%× Ischemic heart diseases prevalence of 2.5%, hypercholesterolemia prevalence of 22% and neurologic disorders (including stroke) of 5%
Prevalence is likely underreported:
Because the diagnosis of some conditions requires complex diagnostics
Reliance on self-reported household data as compared to clinic data
Surveys often limit the list of NCDs assessed (e.g. metabolic syndrome, osteoporosis, and cancer frequently not covered)
Challenges of estimating NCD prevalence in this context
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The result of challenges for addressing NCDs in emergencies/protracted crises
Impacts
Healthcare gap for individuals with NCDs
+Lack of evidence-based guidelines in
emergencies=
Greater NCD morbidity and mortality
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The heart of the problemManagement of NCDs is either ignored or not prioritized in emergency
The protracted nature of these crises implies long-term impact that can no longer be overlooked
Old solutions will not help us serve the needs of today. We must thus:
think differently in terms of our response to NCDs in crises understand the context, including the gaps and complexity of
NCDs in crises before proposing solutions
Where do we go from here?
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“It is not that sexy to fund for NCDs
and it is much more pulling at the heartstrings to fund for things for pregnant women and children. And we are guilty of [that] as well because we are responsible for prioritizing
these populations and the funds required to cover those diagnostic costs
... but if one thing has to be cut,
it has to be NCDs.
”iNGO key informant
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Thank you
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Conflict timelineYear Event2011 March –May
Nationwide uprising : Security forces shoot protestors in Deraa , triggering violent unrest
2011 July -2013 August
Opposition organizes, government retaliates: Opposition groups are formed (Free Syria Army, Jabhat al Nusra, ISIS) Government bombing of Homs and other cities. Siege of Yarmouk, a Palestinian refugee camp in Damascus, use of chemical weapons
on rebel-held areas2013 September - 2015 May
Rise of Islamists: Islamist rebels seize bases of Western-backed Free Syrian Army US and UK support for rebels suspended UN-brokered peace talks in Geneva fail Islamic State of Iraq and Syria declare "caliphate" in territory from Aleppo to eastern
Iraqi province of Diyala Islamic State fought against by US, Arab countries and Kurdish force Syrian Army recaptures Yabroud, rebel stronghold near Lebanon
2015 September - 2016 December
Russian intervention: Russia carries out its first air strikes in Syria against ISIS Syrian government forces retake Homs and Aleppo, depriving rebels of major urban
stronghold Russia, Iran and Turkey agree to enforce a ceasefire (government and non-Islamist
rebels)2017 April -October
US intervention: Syrian air force chemical attack on rebel-held Khan Sheikhoun in Idlib US forces intervene in Syria
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Syria: Displacement timelineCountry population (2016 – UN Population Division) 18,430,453% Refugees & Asylum seekers out of the pop. 31.0% in 2016% IDPs out of the pop. 34.3% in 2016
19
0
2000000
4000000
6000000
8000000
10000000
12000000
14000000
2 0 0 0 2 0 0 2 2 0 0 4 2 0 0 6 2 0 0 8 2 0 1 0 2 0 1 2 2 0 1 4 2 0 1 6
UNHCR - FORCIBLY DISPLACED SYRIANS 2000-2016Asylum-seekers Internally displaced persons
Refugees (incl. refugee-like situations) Grand Total