Primary healthcare in humanitarian settings: where is the evidence-base?

In January 2018, Harriet Blundell and Rachael Milligan from the CIDG editorial base attended a seminar on the prevention and management of non-communicable diseases (NCDs) in humanitarian settings. The seminar was part of the Royal Society of Medicines (RSM) Global Health series and drew almost 100 participants from a wide variety of professional backgrounds.  

At its core, the seminar highlighted a critical shortage of research on the prevention and management of NCDs in conflict settings. This is a topic that needs to be given higher priority given that NCDs are the leading cause of death globally (70%, WHO) and the number of forcibly displaced people is currently higher than ever before (65.6 million, UNHCR).

A cohort study conducted by Médecins Sans Frontières (MSF) demonstrated the challenges of managing diabetes in a conflict setting in the Democratic Republic of Congo (DRC). Challenges included: maintaining the cold chain for insulin delivery, giving dietary recommendations in absence of food security, reliability of the supply chain of essential medicines, capacity of healthcare professionals to effecitvely manage diabetes and conflict insecurity resulting in periods of restricted access to patients.

However, despite these challenges, the study concluded that simplification of protocols with algorithm driven care is feasible in these settings. It highlighted a need for simplified, context adapted protocols that enable task shifting to maximise their practicality in conflict settings.

This is something that we are currently working on here at the Cochrane Infectious Diseases Group (CIDG) in collaboration with the World Health Organization (WHO), specifically in the context of temporary settlements which frequently arise in conflict settings.  The RSM meeting was a good oppoprtunity to meet with other researchers and clinicians working in this field and discuss the challenges of finding evidence-based guidelines in these complex humanitarian settings.

  RSM reference link:

  WHO reference link:

  UNHCR reference link: