1. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH The Sphere Project Humanitarian Charter and Minimum Standards in Humanitarian Response Standards for addressing Chronic Diseases Mesfin Teklu, MD, MAHA World Vision International 20 April 2012 Geneva

2. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Purpose  Highlight the growing burden of chronic diseases and the changing needs in humanitarian relief operations  Highlight the Sphere standards for addressing chronic diseases during emergencies

3. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Chronic Diseases  Cardiovascular disease, mainly heart disease, stroke  Diabetes  Chronic respiratory diseases  Cancer  HIV and AIDS  Tuberculosis

4. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Why chronic diseases matter  Rapid increase in prevalence of NCD in the world  In most populations at least one fifth are likely to have one or more chronic health conditions -The increasing proportion of older people in the global population is contributing to the increase of age-associated chronic diseases, particularly in developing countries  Populations affected by disasters may carry a large burden of chronic diseases

5. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH CountryTotal number of natural disasters 2000–2008 % chronic disease deaths (among total deaths) China23579 India16053 Indonesia13361 Pakistan6142 Source: Emily Y.Y. Chan and Egbert Sondorp, including chronic disease care in emergency responses. HPN Number 41, December 2008 The burden of chronic diseases in selected countries frequently affected by natural disasters

6. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Chronic diseases during emergencies  People with chronic diseases need long-term medication and follow-up which may be interrupted or stopped as a result of disasters  Interruptions in medication regimens and needed medical assistance can exacerbate underlying conditions and increase the risk of morbidity and mortality  Older people and populations whose health is already compromised are more vulnerable than healthy people to the stresses and disruptions caused by disasters  Natural disasters also put people with limited mobility at increased risk for adverse health outcomes

7. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Chronic diseases during emergencies  Conditions created by disasters such as lack of access to health care, food, water and sanitation, psychological distress, exposure to infection can contribute to rapid worsening of a chronic illness that was under control before the event  Acute care can be compromised by inadequately controlled NCDs E.g. after the Sichuan earthquake in May 2008, frontline medical teams found that up to 38% of survivors needed clinical management of their preexisting chronic medical conditions before further surgical interventions could be performed for their physical trauma (the untold stories of the Sichuan earthquake - The Lancet volume 372, Issue 9636)

8. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Chronic diseases during emergencies  In disasters, health infrastructures and essential medications may be destroyed or lost and evacuees may forget to take them  A significant proportion of morbidity after a disaster are as a result of inadequate health care services to cater for preexisting conditions and illnesses Chronic illness accounted for 33% of clinic visits, peaking 10 days after hurricane Katrina's landfall in 2005 (Miller C, Arquilla B 2008)

9. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Addressing NCD during emergency  No established guidelines regarding the management of chronic medical conditions after disasters -Guidelines in terms of which conditions to manage, minimum package of services, treatments to adopt in emergency settings -During the response to the 2004 tsunami in Aceh, health centres did not have chronic disease medications and staff were not trained to diagnose or treat chronic health conditions (Help Age International, 2005)  The 2011 edition of the Sphere Handbook has provided standard and guidance on addressing the growing burden of chronic diseases during disasters.

10. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Sphere standards – Chronic diseases  Documentation of key chronic disease burdens among the disaster-affected population so as to highlight health gaps that need to be addressed  Disaggregation of data by age to identify and manage age-related illnesses and conditions  Maintaining treatment for chronic diseases and avoiding sudden discontinuation of treatment  Ensuring treatment for people identified with acute complications and exacerbations of NCD that pose a threat to their life (e.g. severe hypertension, stroke)  Identifying and facilitating referral options, where relevant services for NCD are provided

11. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH In conclusion  Health infrastructure with resilience to disasters is necessary to ensure continuity of care for people with chronic diseases in emergencies.  Addressing the special needs of people with chronic diseases should be part of disaster preparedness  Guidelines for addressing chronic diseases in emergency is urgently needed  Emergency health kits should include essential drugs and supplies to cover for chronic diseases