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Inclusion of noncommunicable disease care in response to humanitarian emergencies will help save more lives
Noncommunicable diseases (NCDs), such as cardiovascular disease, cancer, chronic respiratory disease and diabetes, are responsible for 75% of deaths worldwide. People affected by humanitarian emergencies are at increased risk of NCDs. It is estimated that strokes and heart attacks are up to 3 times more likely following a disaster. However, care and treatment for NCDs are often not included as a standard part of humanitarian emergency preparedness and response, which focus on the most immediate needs.
To support integration of essential services for NCDs into emergency preparedness and humanitarian response, the World Health Organization (WHO), the Kingdom of Denmark, the Hashemite Kingdom of Jordan, the Republic of Kenya, and UNHCR, the UN Refugee Agency, are jointly convening a global high-level technical meeting on NCDs in humanitarian settings on 27-29 February in Copenhagen, Denmark.
Humanitarian emergencies in recent years are becoming more complex and interconnected. Hunger and shortages of essential goods exacerbate geopolitical conflicts, ecological degradation and climate change, resulting in more frequent and extreme natural disasters.
The number of crises impacting people’s health has been increasing. During 2023, WHO responded to 65 graded health emergencies worldwide, up from 40 a decade earlier. In the same year, UNHCR issued 43 emergency declarations to scale up support in 29 countries – the highest number in decades. United Nations estimates show that 300 million people will need humanitarian assistance and protection in 2024 with over half (165.7 million) in need of emergency health assistance.
“People living with NCDs in humanitarian crises are more likely to see their condition worsen due to trauma, stress, or the inability to access medicines or services. The needs are enormous, but the resources are not,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We must find ways to better integrate NCD care in emergency response, to protect more lives from these avoidable tragedies and improve health security.”
Refugees often face limited access to health care, which can be compounded by poor living conditions, financial difficulties, and precarious legal status. NCDs accounted for a significant proportion of all deaths in the top countries of origin of refugees under UNHCR's mandate: 75% in the Syrian Arab Republic, 92% in Ukraine, 50% in Afghanistan and 28% in South Sudan.
“As forced displacement grows, we must work to ensure the right to health of refugees, other forcibly displaced people and host communities. It is imperative that the policies, and resources are in place to support the inclusion of refugees in national health systems, including for access to care for noncommunicable diseases,” said Filippo Grandi, UN High Commissioner for Refugees. “We must be innovative, and work with governments and partners to respond to such challenges.”
Building solutions and momentumThere are many solutions countries and partners are putting in place to save more lives from NCDs among people affected by humanitarian crises. Since 2017, more than 142 000 WHO NCD kits containing various essential treatments for diabetes, hypertension, asthma, and other medicines have been disseminated. Each kit provides affordable, safe and dependable access to lifesaving NCD medicines and supplies for 10 000 people for over three months. These have been distributed to 28 countries affected by conflicts and or natural disasters and placed in humanitarian hubs including Gaza, South Sudan and Ukraine.
Many countries have included policies and services for the prevention and control of NCDs as part of their efforts to strengthen health systems to better prepare for, respond to, and recover from health emergencies. These efforts are aimed at achieving strong and resilient health systems with primary health care (PHC) and universal health coverage (UHC) as a foundation.
However, much more needs to be done. Some specialized services such as dialysis or cancer care require specific planning and adaptations during emergencies, and more insights are needed to better integrate NCDs into emergency preparedness and response. NCDs remain a neglected aspect of humanitarian responses, with significant gaps in technical and operational guidance, lack of capacity and resources.
Today’s global high-level technical consultation provides a critical platform to share best practices for effectively supporting Member States in delivering NCD prevention and control services within humanitarian responses. The outputs of this meeting will contribute to the 2024 progress report to the UN Secretary-General, informing plans for the Fourth UN High-level Meeting on NCDs scheduled for 2025.
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Statement by Principals of the Inter-Agency Standing Committee (IASC): Civilians in Gaza in extreme peril while the world watches on
In the less than five months that followed the brutal 7 October attacks and the ensuing escalation, tens of thousands of Palestinians – mostly women and children – have been killed and injured in the Gaza Strip. More than three quarters of the population have been forced from their homes, many multiple times, and face severe shortages of food, water, sanitation and healthcare – the basic necessities to survive.
The health system continues to be systematically degraded, with catastrophic consequences. As of 19 February, only 12 out of 36 hospitals with inpatient capacity are still functioning, and only partially. There have been more than 370 attacks on health care in Gaza since 7 October.
Diseases are rampant. Famine is looming. Water is at a trickle. Basic infrastructure has been decimated. Food production has come to a halt. Hospitals have turned into battlefields. One million children face daily traumas.
Rafah, the latest destination for well over 1 million displaced, hungry and traumatized people crammed into a small sliver of land, has become another battleground in this brutal conflict. Further escalation of violence in this densely populated area would cause mass casualties. It could also deal a death blow to a humanitarian response that is already on its knees.
There is no safe place in Gaza.
Humanitarian workers, themselves displaced and facing shelling, death, movement restrictions and a breakdown of civil order, continue efforts to deliver to those in need. But faced with so many obstacles – including safety and movement restrictions – they can only do so much.
No amount of humanitarian response will make up for the months of deprivation that families in Gaza have endured. This is our effort to salvage the humanitarian operation so that we can provide, at the very least, the bare essentials: medicine, drinking water, food, and shelter as temperatures plummet.
For this, we need:
- An immediate ceasefire.
- Civilians and the infrastructure they rely on to be protected.
- The hostages to be released immediately.
- Reliable entry points that would allow us to bring aid in from all possible crossings, including to northern Gaza.
- Security assurances and unimpeded passage to distribute aid, at scale, across Gaza, with no denials, delays and access impediments.
- A functioning humanitarian notification system that allows all humanitarian staff and supplies to move within Gaza and deliver aid safely.
- Roads to be passable and neighbourhoods to be cleared of explosive ordnance.
- A stable communication network that allows humanitarians to move safely and securely.
- UNRWA (1) , the backbone of the humanitarian operations in Gaza, to receive the resources it needs to provide life-saving assistance.
- A halt to campaigns that seek to discredit the United Nations and non-governmental organizations doing their best to save lives.
Humanitarian agencies remain committed, despite the risks. But they cannot be left to pick up the pieces.
We are calling on Israel to fulfil its legal obligation, under international humanitarian and human rights law, to provide food and medical supplies and facilitate aid operations, and on the world’s leaders to prevent an even worse catastrophe from happening.
Signatories:
- Mr. Martin Griffiths, Emergency Relief Coordinator and Under-Secretary-General for Humanitarian Affairs (OCHA)
- Ms. Sofia Sprechmann Sineiro, Secretary General, CARE International
- Dr. Qu Dongyu, Director-General, Food and Agriculture Organization (FAO)
- Ms. Jane Backhurst, Chair, ICVA (Christian Aid)
- Mr. Jamie Munn, Executive Director, International Council of Voluntary Agencies (ICVA)
- Mr. Tom Hart, Chief Executive Officer and President, InterAction
- Ms. Amy E. Pope, Director General, International Organization for Migration (IOM)
- Ms. Tjada D’Oyen McKenna, Chief Executive Officer, Mercy Corps
- Mr. Volker Türk, United Nations High Commissioner for Human Rights (OHCHR)
- Ms. Janti Soeripto, President and Chief Executive Officer, Save the Children
- Ms. Paula Gaviria Betancur, United Nations Special Rapporteur on the Human Rights of Internally Displaced Persons (SR on HR of IDPs)
- Mr. Achim Steiner, Administrator, United Nations Development Programme (UNDP)
- Dr. Natalia Kanem, Executive Director, United Nations Population Fund (UNFPA)
- Mr. Filippo Grandi, United Nations High Commissioner for Refugees (UNHCR)
- Mr. Michal Mlynár, Executive Director a.i., United Nations Human Settlement Programme (UN-Habitat)
- Ms. Catherine Russell, Executive Director, UN Children’s Fund (UNICEF)
- Ms. Sima Bahous, Under-Secretary-General and Executive Director, UN Women
- Ms. Cindy McCain, Executive Director, World Food Programme (WFP)
- Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization (WHO)
1. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) fully supports the statement.
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Children’s lives threatened by rising malnutrition in the Gaza Strip
A steep rise in malnutrition among children and pregnant and breastfeeding women in the Gaza strip poses grave threats to their health, according to a comprehensive new analysis released by the Global Nutrition Cluster.
As the ongoing conflict in the Gaza Strip enters its 20th week, food and safe water have become incredibly scarce and diseases are rife, compromising women and children’s nutrition and immunity and resulting in a surge of acute malnutrition.
The report “Nutrition Vulnerability and Situation Analysis - Gaza” – finds that the situation is particularly extreme in the Northern Gaza Strip, which has been almost completely cut off from aid for weeks. Nutrition screenings conducted at shelters and health centres in the north found that 15.6 per cent – or 1 in 6 children under 2 years of age – are acutely malnourished. Of these, almost 3 per cent suffer from severe wasting, the most life-threatening form of malnutrition, which puts young children at highest risk of medical complications and death unless they receive urgent treatment. As the data were collected in January, the situation is likely to be even graver today.
Similar screenings in the Southern Gaza Strip, in Rafah, where aid has been more available, found 5 per cent of children under 2 years are acutely malnourished. This is clear evidence that access to humanitarian aid is needed and can help prevent the worst outcomes. It also reinforces agencies’ calls to protect Rafah from the threat of intensified military operations.
“The Gaza Strip is poised to witness an explosion in preventable child deaths which would compound the already unbearable level of child deaths in Gaza,” said UNICEF Deputy Executive Director for Humanitarian Action and Supply Operations, Ted Chaiban. “We’ve been warning for weeks that the Gaza Strip is on the brink of a nutrition crisis. If the conflict doesn’t end now, children’s nutrition will continue to plummet, leading to preventable deaths or health issues which will affect the children of Gaza for the rest of their lives and have potential intergenerational consequences.”
Before the recent months’ hostilities, wasting in the Gaza Strip was rare with just 0.8 per cent of children under 5 years of age acutely malnourished. The rate of 15.6 percent of wasting among children under 2 in Northern Gaza suggests a serious and rapid decline. Such a decline in a population’s nutritional status in three months is unprecedented globally.
There is a high risk that malnutrition will continue to rise across the Gaza Strip due to the alarming lack of food, water and health and nutrition services:
- 90 per cent of children under the age of 2 and 95 per cent of pregnant and breastfeeding women face severe food poverty – meaning they have consumed two or less food groups in the previous day – and the food they do have access to is of the lowest nutritional value.
- 95 per cent of households are limiting meals and portion sizes, with 64 per cent of households eating only one meal a day.
- Over 95 per cent of households said they had restricted the amount of food adults received in order to ensure small children had food to eat.
“The steep rise in malnutrition that we are seeing in Gaza is dangerous and entirely preventable”, said WFP Assistant Executive Director for Programme Operations, Valerie Guarnieri. “Children and women, in particular, need continuous access to healthy foods, clean water and health and nutrition services. For that to happen, we need decisive improvements on security and humanitarian access, and additional entry points for aid to enter Gaza.”
Inadequate safe drinking water, as well as insufficient water for cooking and hygiene purposes, are compounding poor nutrition. On average, households surveyed had access to less than one litre of safe water per person per day. According to humanitarian standards, the minimum amount of safe water needed in an emergency is 3 litres per person per day, while the overall standard is 15 litres per person, which includes sufficient quantities for drinking, washing and cooking.
Hungry, thirsty and weak, more Gazans are falling sick. The report finds at least 90 per cent of children under 5 are affected by one or more infectious disease. Seventy per cent had diarrhoea in the past two weeks, a 23-fold increase compared with the 2022 baseline.
“Hunger and disease are a deadly combination,” said Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme. ”Hungry, weakened and deeply traumatised children are more likely to get sick, and children who are sick, especially with diarrhea, cannot absorb nutrients well. It’s dangerous, and tragic, and happening before our eyes.”
Without more humanitarian assistance, the nutritional situation is likely to continue to deteriorate rapidly and at scale across the Gaza Strip. With the majority of health, water and sanitation services severely degraded, it is essential that those that remain functional are protected and reinforced to stem the spread of diseases and stop malnutrition from worsening.
UNICEF, WFP and WHO call for safe, unimpeded and sustained access to urgently deliver multi-sectoral humanitarian assistance throughout the Gaza Strip. This includes nutritious foods, nutrition supplies and essential services for malnourished and at-risk children and women to safely access health and nutrition care and treatment services, particularly infants and young children under 5. Hospitals and health workers must be protected from attack so they can safely provide critical treatment and care. An immediate humanitarian ceasefire continues to provide the best chance to save lives and end suffering.
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Note to the editor
Due to security and access challenges throughout the Gaza Strip, it is nearly impossible to collect anthropometric data to measure rates of acute malnutrition. Collection of anthropometric data (MUAC) was only possible in two areas (North Gaza and Rafah) among children under 2 years of age. The report therefore used an innovative method of analysis to support this data and determine that acute malnutrition is rising throughout the Gaza Strip. This method analyzed data on the drivers of malnutrition – lack of food, rates of disease, lack of access to clean water and lack of available health services – which was collected through telephone and SMS questionnaires. From analyzing the key causes, we can conclude that acute malnutrition is rising throughout Gaza at speed.
About UNICEF
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and our work for children, visit www.unicef.org
About WFP
The United Nations World Food Programme is the world’s largest humanitarian organization saving lives in emergencies and using food assistance to build a pathway to peace, stability and prosperity for people recovering from conflict, disasters and the impact of climate change.
About WHO
Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable.Member States consider proposed amendments to the International Health Regulations with discussions on equity to continue
Digital payments to health workers boost retention, motivation, and impact
An immunization worker gets set up to receive her wages on her mobile wallet in the Democratic Republic of the Congo. Credit: WHO
Campaigns in Africa to stop polio and other diseases have a more stable, better-motivated workforce thanks to WHO’s collaboration with countries and partners to pay frontline health workers through their mobile phones instead of in cash.
“Over 80 percent of workers are saying they prefer the digital payments,” said Ahmed Hamani Djibo, head of WHO’s Digital Finance Team.
WHO has been leading among international organizations in moving away from the unwieldy, less-secure practice of disbursing salaries in cash. Over the past few years, the Organization launched its Digital Finance Team and joined the Better Than Cash Alliance, an 80-member United Nations partnership with a mandate to develop the digitization of payments and expand financial inclusion – activities that support the UN Sustainable Development Goals.
Since it was established in 2020, WHO’s Digital Finance Team has designed and implemented digital payment solutions in 24 countries in Africa, including, last year, in Benin, Botswana, Madagascar, Rwanda, Togo and Zimbabwe.
“WHO has successfully digitized payments for more than two million health workers across Africa,” said Tidhar Wald, Managing Director, a.i., at the Better Than Cash Alliance. “With these inspiring results, WHO is taking a clear leadership role in accelerating the digital transformation in the provision of health outcomes globally.”
A polio immunization team on the job in the Democratic Republic of the Congo. Credit: WHO
“A really big difference in speed”Workers surveyed in Côte d’Ivoire, Liberia and Tanzania said they appreciated the security of not carrying cash, the convenience of no longer having to travel to a disbursement site to receive their wages, and above all, the speed of payment – as short as half an hour after finishing work compared to waits of weeks or even months.
The surveys, funded by the Bill & Melinda Gates Foundation, linked timely compensation to better morale and worker retention.
“There is really a big difference in speed,” said Jean-Luc, a health worker interviewed in the Democratic Republic of Congo (DRC) at the end of a polio immunization campaign. “We finished the campaign mop-up yesterday and received a text notification the next evening. I’m going to pay my child’s school fees. Now we can relax.”
Digital payments also save time and money for health campaign organizers, including the burden and expense of transporting large sums of cash and completing documentation.
“When you have 300 to 500 volunteers to pay, doing accounts and signing receipts takes a lot of time,” said Saïdi, a polio team leader in DRC.
WHO first used the new digital payments in polio immunization campaigns in Côte d’Ivoire. Although outbreaks of vaccine-derived polio were on the rise, vaccination campaigns were having trouble getting off the ground. In the first quarter of 2020, almost half the polio campaigns in WHO’s African Region were postponed, saw workers drop out, or suffered other detrimental effects stemming from delays in cash disbursements.
As WHO and partners worked to develop the nuts-and-bolts aspects of a digital payment ecosystem (registering workers into a database, verifying their profiles with the mobile network operator and more) the benefits of a cashless approach became more apparent.
"There is substantial evidence that digitizing payments can support people, especially women, to gain access to financial services and increase control over their earnings,” said Maria May, Senior Program Officer, Inclusive Financial Systems, at the Gates Foundation. “Over the past four years, the World Health Organization has utilized the growing presence of mobile money across Africa to ensure that the courageous frontline vaccinators in polio outbreak campaigns are paid completely, quickly, and securely.”
Alain Labrique, director of WHO’s Department of Digital Health and Innovation, said that “digital payments are one of the key pillars of Digital Health Public Infrastructure currently strongly encouraged within WHO’s guidance to member-states on Digital Transformation.” WHO views digital payments as a foundation for many more digital development activities, together with Data Exchange and Digital ID Infrastructure. He added “we are delighted to work with partners in the digital space and add our voice to this celebration of WHO's joining the Better Than Cash Alliance”.
Putting survivors at the forefront of the global movement to end female genital mutilation
Joint Statement by UNFPA Executive Director Dr Natalia Kanem, UNICEF Executive Director Catherine Russell, OHCHR High Commissioner Volker Türk, UN Women Executive Director Sima Bahous, WHO Director-General Dr Tedros Adhanom Ghebreyesus on the International Day of Zero Tolerance for Female Genital Mutilation
Today, on the International Day of Zero Tolerance for Female Genital Mutilation, we reaffirm our dedication to the girls and women who have been subjected to this grave violation of human rights. Every survivor's voice is a call to action, and every choice they make in reclaiming their lives contributes to the global movement to end this harmful practice.
More than 200 million girls and women alive today have undergone female genital mutilation. This year, nearly 4.4 million girls will be at risk of it. This equates to more than 12 000 cases every day.
In keeping with the commitments outlined in the Beijing Declaration and platform for action, those agreed during the 25th Anniversary of the International Conference on Population and Development (ICPD25), Generation Equality, and other normative frameworks including The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Convention on the Rights of the Child (CRC) and their general recommendations, as well as the Sustainable Development Goals (target 5.3), we reiterate our commitment to prevent and respond to female genital mutilation.
Female genital mutilation is a violation of women’s and girls’ rights, one that endangers their physical and mental health and limits their potential to lead healthy and fulfilling lives. It increases their risk of serious pain, bleeding and infections and the likelihood of other health complications later in life, including risks during childbirth, which can imperil the lives of their newborns.
That is why, in our pursuit of a world free of discrimination and practices that harm girls and women, it is imperative that we turn our attention to the voices that matter most – the voices of survivors.
We must amplify the voices of survivors to raise awareness and inspire collective action, and promote their power and autonomy by ensuring they have an active role in prevention and response interventions.
Survivors have first-hand knowledge of the challenges and the tools needed to eliminate the practice. It is crucial that we invest in survivor-led movements, especially at the grassroots level, by dedicating resources that will advance their efforts.
We also must ensure that comprehensive and culturally sensitive services are available and accessible. This includes strengthening the provision of health care and social and legal services to support survivors.
UNFPA and UNICEF, as the lead agencies of the Global Joint Progamme on Eliminating FGM, OHCHR, UN Women, WHO, and other United Nations entities remain steadfast in partnering with survivors as community champions and leaders, while ensuring their voices and perspectives inform programmes to prevent and respond to FGM. Indeed, investing in movement-building and promoting girls’ and women’s agency is at the core of the UN Joint Programme on Eliminating FGM.
We celebrate progress that has been achieved: The practice of FGM has been declining over the last three decades, and in the 31 countries with nationally representative prevalence data, around 1 in 3 girls aged 15 to 19 today have undergone the practice versus 1 in 2 in the 1990s.
As of last year, the Joint Programme supported more than 11 000 organizations, of which 83 per cent were grassroots organizations partnering with coalitions and survivor-led movements, advocating for changes in policies and laws, and championing changes to social and gender norms.
Yet there is an urgent need for even more targeted, coordinated and sustained efforts if we are to achieve our common goal of ending female genital mutilation by 2030. Together, led by survivors, we can consign this harmful practice to history, once and for all.
