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World Health Organization (WHO) has today published a new, comprehensive diagnostic manual for mental, behavioural, and neurodevelopmental disorders: “ The clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (ICD-11 CDDR)”.

The manual has been developed using the latest available scientific evidence and best clinical practices and is designed to support qualified mental health and other health professionals to identify and diagnose mental, behavioural and neurodevelopmental disorders in clinical settings.

“An accurate diagnosis is often the first critical step towards receiving appropriate care and treatment. By supporting clinicians to identify and diagnose mental, behavioural and neurodevelopmental disorders, this new ICD-11 diagnostic manual will ensure more people are able to access the quality care and treatment they need” said Dévora Kestel, Director, Mental Health and Substance Use Department, World Health Organization.

The new diagnostic guidance, reflecting the updates to the ICD-11, includes the following features:

• Guidance on diagnosis for several new categories added in ICD-11, including complex post-traumatic stress disorder, gaming disorder and prolonged grief disorder. This enables improved support to health professionals to better recognize distinct clinical features of these disorders, which may previously have been undiagnosed and untreated.
• The adoption of a lifespan approach to mental, behavioural and neurological disorders, including attention to how disorders appear in childhood, adolescence, and older adults.
• The provision of culture-related guidance for each disorder, including how disorder presentations may differ systematically by cultural background.
• The incorporation of dimensional approaches, for example in personality disorders, recognizing that many symptoms and disorders exist on a continuum with typical functioning.

The ICD-11 CDDR are aimed at mental health professionals and qualified non-specialist health professionals such as primary care physicians responsible for assigning these diagnoses in clinical settings as well as other health professionals in clinical and non-clinical roles, such as nurses, occupational therapists and social workers, who need to understand the nature and symptoms of mental, behavioural and neurodevelopmental disorders even if they do not personally assign diagnoses.

The ICD-11 CDDR were developed and field-tested through a rigorous, multi-disciplinary and participatory approach involving hundreds of experts and thousands of clinicians from around the world.

Notes:

• The CDDR are a clinical version of ICD-11 and thus complementary to the statistical reporting of health information, referred to as the linearization for mortality and morbidity statistics (MMS).
• The World Health Organization (WHO) Eleventh Revision of the International Classification of Diseases (ICD-11) is a global standard for recording and reporting diseases and health related conditions. It provides standardized nomenclature and common health language for health practitioners across the world. 
• ICD-11 was adopted at the World Health Assembly in May 2019 and came into effect formally in January 2022. 

 

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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 momentum 

There 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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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:

1. An immediate ceasefire.
2. Civilians and the infrastructure they rely on to be protected.
3. The hostages to be released immediately.
4. Reliable entry points that would allow us to bring aid in from all possible crossings, including to northern Gaza. 
5. Security assurances and unimpeded passage to distribute aid, at scale, across Gaza, with no denials, delays and access impediments.
6. A functioning humanitarian notification system that allows all humanitarian staff and supplies to move within Gaza and deliver aid safely.
7. Roads to be passable and neighbourhoods to be cleared of explosive ordnance.
8. A stable communication network that allows humanitarians to move safely and securely. 
9. UNRWA (1) , the backbone of the humanitarian operations in Gaza, to receive the resources it needs to provide life-saving assistance.
10. 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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