1. Fouad M.Fouad MD American University of Beirut June 23, 2016
The changing health needs of refugees and displaced people in the 21st century
Fouad M.Fouad MD
American University of Beirut
June 23, 2016

2. 5 years, 3 months, 1 week and 1 day of conflict: from peaceful demonstrations ---- civil war--- proxy war- massive demographic changes
Half million death (direct violence)
1.8 million injuries
5 million registered refugees (record)
7.5 million IDPs

3. Syria before 2011: 21 million Middle income country
Relatively good indicators: health and educational
Country in transition: 77% of death causes are NCDs, 16% DM, 47% HT, 42% of women are obese >30
new cancer cases yearly (incidence rate 0.7:1000)- 10% are pediatric cancer (national cancer registry 2006)

4. EU and Syrian MOH report 2005:
Hemodialysis-treated ESRD : 226 patients per million, (# 5000 pts) need in average two sessions/week= 480,000 sessions per year (2006, est. from Aleppo)
EU and Syrian MOH report 2005:
10,000 ESRD patients who required renal replacement therapy.
dialysis machines in Syria met only 6% of needs (data from public sector)
no data on dialysis in the private sector

5. Syria
Lebanon
Source: WHO- NCDs country profile 2011

6. Current situation 5 million refugees: different expectations:
NCDs
Education
Job opportunities
Long-term needs and response
NCDs program : no effective, evidence-based interventions – innovative approach ?
Primary care vs secondary and tertiary care
Preventive programs
Cancer, renal diseases, COPD program (30% of death causes before war)
Example: If 1 million in Lebanon = 700 new cancer cases a year X 5 years = cases (accumulative)? Where do they get their treatment and care?

7. Very few studies on Chronic diseases in humanitarian crises
Evidence on the effectiveness of interventions targeting NCDs during humanitarian crises in LMICs. (Ruby A PloS One)
8 studies met inclusion criteria. Seven of the 8 studies were observational, and one study was a non-blinded randomised-controlled trial. Diseases examined included hypertension, heart failure, diabetes mellitus, chronic kidney disease, thalassaemia, and arthritis.
No studies examined intervention costs.

8. Hard questions on the humanitarian response system in protracted crises:
Acute vs. chronic conditions ?
Universal coverage vs. Refugees coverage ?
Integrated system vs. parallel system (s) ?
Human rights vs. citizen’s rights ?
What does that mean to be refugee/forced displaced and migrant? It’s NOT a genetic disorder !