May 20 2016


The global response to the HIV epidemic offers lessons about ways to support continuous care for chronic health conditions during complex and protracted emergencies, such as the current refugee crisis. Latest research by Wafaa-El Sadr, MD, MPH, professor of Epidemiology and ICAP global director at Columbia University; Miriam Rabkin, MD, associate professor of Epidemiology and director of Health Systems Strategy at ICAP; and Fouad M. Fouad, assistant research professor, Department of Epidemiology and Population Health, American University of Beirut, in the current issue of Global Public Health explores key lessons from HIV programs such as evidence-based approaches, intensive patient education, and the use of outreach workers and peer educators as possible blueprints for redesigning refugee health services.

While relief agencies and health organizations have traditionally largely focused on the prevention of infectious disease, treatment of acute illness, and provision of reproductive health services, all essential, the health needs of displaced people have expanded in recent years, reflecting changes in refugees’ countries of origin and in the burden of disease in these countries. Although chronic non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancers, and chronic lung disease are burdens for refugees and displaced people worldwide, they are particularly important causes of ill health in refugees from middle-income countries, such as Syria, Iraq, and Ukraine.

In addition to the changing burden of disease, today’s refugees are often displaced for longer periods of time; three-quarters live in protracted refugee situations of five years or more, increasing their need for chronic health services. Another important change is that in some regions, refugees increasingly live within host communities rather than in camp settings, further complicating the provision of health services. For example, only 11% of Syrian refugees in the Middle East and Turkey are currently living in refugee camps.

“The challenge of providing services for chronic illness in the context of displacement is a daunting one, given that a key element of effective care for NCDs is continuity – the need to deliver coordinated services over time,” said El-Sadr. “But evidence from HIV programs shows that continuity care can be delivered in challenging settings – including in complex humanitarian emergencies – and suggests key priorities for NCD services for forcibly displaced people.”