A review of interventions for noncommunicable diseases in humanitarian emergencies in low- and middle-income countries


  • Rebecca Leff, MD https://orcid.org/0000-0001-9254-6884
  • Anand Selvam, MD, MSc, DTM&H
  • Robyn Bernstein, MPH
  • Lydia Wallace, MD
  • Alison Hayward, MD, MPH
  • Pooja Agrawal, MD, MPH
  • Denise Hersey, MLS
  • Christine Ngaruiya, MD, MSc, DTM&H




NCDs, noncommunicable diseases, disasters, warfare and armed conflicts, cardiovascular disease, diabetes mellitus, pulmonary disease, chronic obstructive, asthma, disaster medicine


Objective: Noncommunicable diseases (NCDs) are of increasing prevalence in low- and middle-income countries (LMICs), affected by disasters. Humanitarian actors are increasingly confronted with how to effectively manage NCDs, yet primary focus on this topic is lacking. We conducted a systematic review on the effects of disasters on NCDs in LMICs. Key interventions were identified, and their effects on populations in disaster settings were reviewed.

Design: We electronically searched Medline, PubMed, Global Health, and Social Science Citation Index. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. Eligible articles incorporated core intervention components as defined by the United States Department of Health and Human Services. Key intervention components including target population, phase of crisis, and measured outcomes were extracted and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO (CRD42018088769).

Results: Of the 4,430 identified citations, we identified seven eligible studies. Studies reported on the response (n = 4) and recovery (n = 3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted predeployment risk assessments, performed training and capacity building for healthcare workers, worked in close cooperation with local health services, evaluated individual needs of subpopulations, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline implementation.

Conclusions: This review highlights the limited quantity and quality of evidence on interventions designed to address NCDs in humanitarian emergencies, with a particular paucity of studies addressing the mitigation and preparedness phases of disaster. While several challenges to NCD management such as insecurity and fluid movement of refugees create inherent challenges to NCD management in disasters, the lack of knowledge and training in NCD management among healthcare providers and the absence of basic medications and supplies for NCD management highlighted in this review are amenable to further intervention.


Author Biographies

Rebecca Leff, MD

Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota; Department of Emergency Medicine, Yale University, New Haven, Connecticut

Anand Selvam, MD, MSc, DTM&H

Department of Emergency Medicine, Yale University, New Haven, Connecticut

Robyn Bernstein, MPH

Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut

Lydia Wallace, MD

Department of Emergency Medicine, Yale University, New Haven, Connecticut

Alison Hayward, MD, MPH

Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island

Pooja Agrawal, MD, MPH

Department of Emergency Medicine, Yale University, New Haven, Connecticut

Denise Hersey, MLS

Director, Dana Medical Library, University of Vermont, Burlington, Vermont

Christine Ngaruiya, MD, MSc, DTM&H

Department of Emergency Medicine, Yale University, New Haven, Connecticut


Bosley C: How did you continue to provide cancer care for patients after a natural disaster? ONS Connect. 2012. Available at https://voice.ons.org/news-and-views/how-did-you-continue-to-provide-cancer-carefor-patients-after-a-natural-disaster. Accessed August 28, 2021.

World Health Organization: Noncommunicable diseases. 2018. Available at https://www.who.int/newsroom/fact-sheets/detail/noncommunicable-diseases. Accessed August 30, 2021.

World Health Organization: World health statistics 2016: Monitoring health for the SDGs, sustainable development goals. Available at https://apps.who.int/iris/handle/10665/206498. Accessed August 28, 2021.

World Health Organization African Region: Noncommunicable diseases. Available at https://www.afro.who.int/health-topics/noncommunicable-diseases. Accessed August 30, 2021.

Bausch FJ, Beran D, Hering H, et al.: Operational considerations for the management of non-communicable diseases in humanitarian emergencies. Confl Health. 2021; 15(1): 9.

Brown T: Vulnerability is universal: Considering the place of ‘security’ and ‘vulnerability’ within contemporary global health discourse. Soc Sci Med. 2011; 72(3): 319-326.

Kohrt BA, Mistry AS, Anand N, et al.: Health research in humanitarian crises: An urgent global imperative. BMJ Glob Health. 2019; 4(6): e001870.

United Nations High Commissioner for Refugees: UNHCR global trends 2019. Available at https://www.unhcr.org/en-us/statistics/unhcrstats/5ee200e37/unhcr-global-trends-2019.html. Accessed July 1, 2021.

Federal Emergency Management Agency: FEMA training modules, FEMA unit four: Emergency management in the United States. Livestock in Disasters. Available at https://training.fema.gov/emiweb/downloads/is111_unit. Accessed July 1, 2021.

International Committee of the Red Cross: Protracted conflict and humanitarian action: Some recent ICRC experiences. Available at https://www.icrc.org/en/publication/4265-protracted-conflict-andhumanitarian-action-some-recent-icrc-experiences. Accessed August 30, 2021.

Spiegel PB, Checchi F, Colombo S, et al.: Health-care needs of people affected by conflict: Future trends and changing frameworks. Lancet. 2010; 375(9711): 341-345.

The Sphere Project: Humanitarian charter and minimum standards in disaster response. 2004 edition. Available at https://spherestandards.org/wp-content/uploads/Sphere-Handbook-2004-English.pdf. Accessed August 30, 2021.

Spiegel P, Khalifa A, Mateen FJ: Cancer in refugees in Jordan and Syria between 2009 and 2012: Challenges and the way forward in humanitarian emergencies. Lancet Oncol. 2014; 15(7): e290-e297.

Aebischer Perone S, Martinez E, Du Mortier S, et al.: Noncommunicable diseases in humanitarian settings: Ten essential questions. Confl Health. 2017; 11: 17.

Ngaruiya C, Bernstein R, Leff R, et al.: Systematic review on chronic non-communicable disease in disaster settings. medRxiv. [Preprint]. DOI: 2020.10.15.20213025.

Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med. 2021; 18(3): e1003583.

Bangpan M, Felix L, Dickson K: Mental health and psychosocial support programmes for adults in humanitarian emergencies: A systematic review and meta-analysis in low and middle-income countries. BMJ Glob Health. 2019; 4(5): e001484.

Moore A, van Loenhout JAF, de Almeida MM, et al.: Measuring mental health burden in humanitarian settings: A critical review of assessment tools. Glob Health Action. 2020; 13(1): 1783957.

Jordans MJ, Tol WA: Mental health in humanitarian settings: Shifting focus to care systems. Int Health. 2013; 5(1): 9-10.

World Bank: World Bank Country and Lending Groups: 2015. Available at https://datahelpdesk.worldbank.org/knowledgebase/articles/906519. Accessed February 20, 2015.

Blasé K, Fixsen D: US Department of Health and Human Services: Core intervention components: Identifying and operationalizing what makes programs work. In Emphasizing Evidence-Based Programs for Children and Youth: An Examination of Policy Issues and Practice Dilemmas across Federal Initiatives. Available at https://aspe.hhs.gov/report/core-intervention-components-identifying-and-operationalizing-what-makes-programs-work. Accessed June 20, 2021.

Wells G, Shea B, O’Connell D, et al.: The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed June 20, 2020.

Higgins JPT, Green S, eds.: Cochrane: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, 2011. Available at http://www.cochrane-handbook.org. Accessed June 20, 2020.

Lo CK, Mertz D, Loeb M: Newcastle-Ottawa scale: Comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014; 14: 45.

Besançon S, Fall IS, Doré M, et al.: Diabetes in an emergency context: The Malian case study. Confl Health. 2015; 9: 15.

Kallab MG: Management of hypertension and diabetes for the Syrian refugees and host community in selected health facilities in Lebanon. Field Exchange Emerg Nutr Netw. 2015; 50: 68-72.

Marom T, Segal D, Erlich T, et al.: Ethical and clinical dilemmas in patients with head and neck tumors visiting a field hospital in the Philippines. Am J Disaster Med. 2014; 9(3): 211-219.

Read DJ, Holian A, Moller CC, et al.: Surgical workload of a foreign medical team after Typhoon Haiyan. ANZ J Surg. 2016; 86(5): 361-365.

Ebling B, Majnaric´-Trtica L, Gmajnic´ R, et al.: Psycho-social aspects of measures aimed at decreasing prevalence of chronic diseases in the population of returnees in the Osijek region. Coll Antropol. 2007; 31(2): 441-450.

McKenzie ED, Spiegel P, Khalifa A, et al.: Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: A retrospective cohort study 2012-2013. Confl Health. 2015; 9: 10.

Wagner J, Keuky L, Fraser-King L, et al.: Training Cambodian village health support guides in diabetes prevention: Effects on guides’ knowledge and teaching activities over 6 months. Int J Behav Med. 2016; 23(2): 162-167.

Khan SM, Gillani J, Nasreen S, et al.: Cancer in North West Pakistan and Afghan refugees. J Pak Med Assoc. 1997; 47(4): 122-124.

Otoukesh S, Mojtahedzadeh M, Sherzai D, et al.: A retrospective study of demographic parameters and major health referrals among Afghan refugees in Iran. Int J Equity Health. 2012; 11: 82.

Shamseddine A, Sibai AM, Gehchan N, et al.: Cancer incidence in postwar Lebanon: Findings from the first national population-based registry, 1998. Ann Epidemiol. 2004; 14(9): 663-668.

Gilder ME, Zin TW, Wai NS, et al.: Gestational diabetes mellitus prevalence in Maela Refugee camp on the Thai-Myanmar border: A clinical report. Glob Health Action. 2014; 7: 23887.

World Humanitarian: Commitment to action. 2016. Available at https://agendaforhumanity.org/summit.html. Accessed June 20, 2020.

Yaghi K, Yaghi Y, McDonald AA, et al.: Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007. East Mediterr Health J. 2012; 18(12): 1178-1186.

Spiegel P, Chanis R, Trujillo A: Innovative health financing for refugees. BMC Med. 2018; 16(1): 90.

The Sphere Project: The sphere project: Humanitarian charter and minimum standards in disaster response. 2018. Available at https://spherestandards.org/handbook-2018/. Accessed August 30, 2021.

Ngaruiya C: COVID-19, NCDs and emergency care: A plea from Africa’s front-lines. BMJ Global Health. Available at https://gh.bmj.com/content/5/5/e002647.responses. Accessed July 1, 2021.

Parker B: ICRC to pull out of war hospital in Lebanon in wide-ranging cuts. The New Humanitarian. November 30, 2020. Available at https://www.thenewhumanitarian.org/investigation/2020/11/30/ICRC-Lebanon-hospital-closure-budget-cuts. Accessed July 1, 2021.

Chang AY, Cullen MR, Harrington RA, et al.: The impact of novel coronavirus COVID-19 on noncommunicable disease patients and health systems: A review. J Intern Med. 2021; 289(4): 450-462.



How to Cite

Leff, MD, R., A. Selvam, MD, MSc, DTM&H, R. Bernstein, MPH, L. Wallace, MD, A. Hayward, MD, MPH, P. Agrawal, MD, MPH, D. Hersey, MLS, and C. Ngaruiya, MD, MSc, DTM&H. “A Review of Interventions for Noncommunicable Diseases in Humanitarian Emergencies in Low- and Middle-Income Countries”. American Journal of Disaster Medicine, vol. 16, no. 4, Dec. 2021, pp. 297-11, doi:10.5055/ajdm.2021.0412.



Review Articles

Most read articles by the same author(s)