Rise of the MIC: Middle Income Crisis

Historically health management in crisis situations focused on infections and trauma, both treatment and prophylaxis. No doubt do these remain important even today as cholera outbreaks in Yemen and diarrhoeal diseases in Rohingya refugees demonstrates.

However, the world is changing and health dynamics are changing alongside it. Iraq and Syria, nations which previously had successful healthcare systems, have shone a light on non-communicable disease (NCD) management during humanitarian crises. This is where things get difficult because we already have strong frameworks with clear goals around treatment and prevention of infectious diseases (WASH campaigns, vaccination campaigns, appropriate antibiotics, etc) and yet we still struggle with them. As such, adding on a further burden of NCD management makes all healthcare provision in these fields even more difficult.

Syria is a clear example of the need for new frameworks in crisis intervention. Pre-crisis it had already transitioned away from communicable disease into a society where the majority of deaths were due to NCDs[1]. This burden of disease was not going to disappear during a crisis and in fact would be a contributing factor to morbidity and mortality if not managed appropriately. Syria isn’t a unique case either: conflict in eastern Ukraine, Typhoon Haiyan in the Philippines, and others show that crises in Middle Income Countries continue to happen.

It isn’t all doom and gloom as interventions as the global health community has already taken steps to address the issues. The WHO has had the “Global Plan for the prevention and control of NCDs 2013-2020” but has also created Mobile Emergency Primary Healthcare Units specifically targeting NCD diagnosis and management. These kits were first piloted in eastern Ukraine and showed success suggesting they will be rolled out in other crises[2]. Additionally, NGOs have taken a stronger view on NCD management; for example, Medecins sans Frontieres rolled out their NCD guidelines in 2016[3]. Alongside fieldwork, more academic institutes are putting an emphasis on global NCD research with the London School of Hygine and Tropical Medicine, University College London, and the Wellcome Trust with Cambridge University all creating centres for global NCD research[4].

Major next steps involve increased research particularly into NCD management during crisis situations including possible strategies to tackle chronic health needs of refugees. Increased co-operation between humanitarian agencies and government organizations may be useful if existing health systems can be harnessed. Finally, middle income populations will have their own skills which still exist in refugee populations. Efforts to harness these may well help tackle a host of issues around humanitarian care including those not touched on in this article.

[1] Rahim, HFA, Sibai, A, Khader, Y et al. Non-communicable diseases in the Arab world. Lancet. 2014;383: 356–367.

[2] http://www.who.int/features/2015/ncd-emergencies-ukraine/en/

[3] http://fieldresearch.msf.org/msf/handle/10144/619201

[4] https://chronicconditions.lshtm.ac.uk/, http://www.ucl.ac.uk/igh/igh-centre-list/centre-gncd, and https://wt-globalhealth.cam.ac.uk/directory/NCDs respectively

Author Details: Dr. Eliot Hurn, Foundation Year 2 County Durham and Darlington Foundation Trust.


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