Heba Shaban, a 43-year-old Syrian woman who lives with her husband in a refugee camp in Amman, Jordan, was diagnosed with both diabetes and high blood pressure three years ago. Since early 2020, the supply of medication she was receiving through an NGO serving the camp has been interrupted and she no longer has access to the essential medicines needed to manage her chronic conditions.
For Shaban, hope is dwindling. She cannot afford medicine through private health care, and as a refugee she has no national health care system to fall back on. She is rationing her medicine in the hope that what she has left will get her through the coronavirus pandemic.
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COVID-19 has been unforgiving for people living with noncommunicable diseases, or NCDs, such as diabetes, cardiovascular-related illness, cancers, and mental health conditions, as well as other conditions such as high blood pressure and obesity.
Among the people dying of COVID-19 in hospitals in Italy, 68% had high blood pressure and 31% had Type 2 diabetes, according to a recent report by the World Health Organization. Of those suffering severely from COVID-19 in Spain, 43% had existing cardiovascular diseases. Reports and studies from around the world are showing similar results.
In addition to this, almost all countries are reporting disrupted services for cardiovascular emergencies, cancer treatment, high blood pressure, and diabetes management due to COVID-19. This could result in a surge of complications and deaths from NCDs in the long term.
In cases where chronic conditions are well managed, the risk of becoming severely ill with COVID-19 might be comparable to the general population. However, most people worldwide still do not have the luxury of adequate health care. Refugees and people displaced within their own countries already faced a struggle to access treatment for NCDs — and this has been compounded by the coronavirus pandemic.
The eastern Mediterranean region where Shaban lives is home to a majority of today’s refugees and internally displaced people, and it is estimated that 20% to 30% of adults in the region have high blood pressure and 14% have diabetes. Without secure and reliable access to medicine and treatment, these people face an amplified risk of developing complications from their conditions.
Poor control of diabetes, for example, can lead to several severe complications including blindness, cardiovascular disease, and kidney disease. These are the risks without exposure to COVID-19.
Therefore, let us not underestimate the enormity of the challenge that is unfolding in humanitarian settings around the world. Roughly 71 million refugees and internally displaced people worldwide are potentially facing deprivation of basic health care, and the risk is further exacerbated by COVID-19.
We know already that there have been episodes of virus transmission in the Dadaab refugee complex in Kenya and in the Rohingya refugee camps in Bangladesh. In the latter, 35 refugees have tested positive for COVID-19 and three have died, according to WHO. In total, 30 are in quarantine, though this could very well be the tip of the iceberg.
While testing, contact tracing, and isolation are being implemented by the United Nations Refugee Agency, there remain concerns about the ability to control the spread of infection in densely populated camps with tightly packed tents and shacks, as well as challenges in accessing clean water and sanitation.
Keeping all people … healthy from preventable NCDs is not simply about a choice to invest in health, but an investment in economic stability, security, and pandemic preparedness.—
Addressing NCDs requires continuity of care, which can be challenging to ensure in humanitarian contexts, where NCD prevention and care has often remained underprioritized. The current coronavirus pandemic and accompanying lockdown measures are exacerbating the lack of access to essential lifesaving health services for members of these populations, who are already suffering from poverty and exclusion.
For instance, in the Syrian province of Idlib, people living with cancer are dependent on crossing the border into Turkey for treatment because medical facilities in the region have been destroyed. The COVID-19 travel restrictions have been threatening their treatment and their lives.
In such difficult circumstances, how do we move forward?
The recently announced WHO and UNHCR partnership to improve health services for displaced people during the coronavirus pandemic is a welcome response.
At the same time, humanitarian organizations, academia, and civil society have key roles to play. They are essential for gathering firsthand accounts and supporting assessment of the short-, medium-, and long-term needs of people living with NCDs in humanitarian settings. Any intervention, in response, must be context-specific and rights-based.
The private sector can play its part, too. For example, pharmaceutical companies can have protocols in place to ensure that they are ready to respond to humanitarian crises rapidly and to a high standard and that they work with health authorities and international bodies to identify the best possible way to respond when a crisis like COVID-19 unfolds.
They can also commit to affordable and equitable medicine prices for people in humanitarian settings and optimize and adapt their ordering, production, and shipment procedures to ensure a reliable supply of medicines in a way that best serves the needs of humanitarian organizations delivering care on the ground.
This will ultimately support the common goal of making quality, effective, affordable, and appropriate medicines and care available to those who need them — especially the most marginalized — to make sure no one is left behind.
NCD prevention and care — including screening, diagnosis, treatment, rehabilitation, and palliative care — have already suffered from chronic underinvestment for many years. COVID-19 has been a bitter pill to swallow, but going forward, it must serve as a wake-up call for all decision-makers: Keeping all people, including older people and those living with NCDs, whether they are citizens or refugees, healthy from preventable NCDs is not simply about a choice to invest in health, but an investment in economic stability, security, and pandemic preparedness.