What are the top 10 non-communicable diseases (NCDs) to prioritize in crisis situations like flooding, shelter, or war?

Top 10 Non-Communicable Diseases to Prioritize in Crisis Settings

In humanitarian crises including flooding, shelter displacement, and war, prioritize these 10 NCDs based on global burden and crisis-specific vulnerability: (1) cardiovascular disease/hypertension, (2) diabetes mellitus, (3) chronic respiratory diseases (COPD/asthma), (4) mental health disorders (depression/PTSD), (5) chronic kidney disease, (6) musculoskeletal diseases/arthritis, (7) cancers requiring ongoing treatment, (8) epilepsy/neurological conditions, (9) cirrhosis/chronic liver disease, and (10) severe heart failure. 1

Evidence-Based Disease Prioritization

Cardiovascular Diseases and Hypertension (Priority #1)

• Ischemic heart disease and hypertension represent the leading NCD burden globally and in crisis-affected regions, with hypertension being particularly prevalent in displaced populations 1
• Disease-management protocols with cohort monitoring demonstrate the strongest evidence of effectiveness in humanitarian settings 2
• Patients with NYHA class III or IV heart failure require ICU-level resources and should be identified early for appropriate triage 1
• Systolic blood pressure monitoring is critical—patients with SBP <90 mmHg with shock require immediate vasopressor support 3

Diabetes Mellitus (Priority #2)

• Diabetes is among the top NCDs causing disability and death in crisis-prone regions, with particular vulnerability during infrastructure disruption 1
• Continuity of insulin access and blood glucose monitoring devices are frequently cited barriers during displacement 2, 4
• Refugee status independently increases both diabetes diagnosis risk and disease severity 4

Chronic Respiratory Diseases (Priority #3)

• COPD and asthma require ongoing medication access and monitoring, making them high-priority in crisis settings 1
• Exclusion criteria for ICU admission during mass casualty include: COPD with FEV1 <25% predicted, baseline PaO2 <55 mmHg, or requirement for home oxygen 1
• Respiratory rate >25 and oxygen saturation <90% indicate need for critical care level resources 3

Mental Health Disorders (Priority #4)

• Mental disorders including depression and PTSD represent major causes of disability in crisis-affected populations, particularly with conflict exposure 1
• War and displacement directly exacerbate mental health conditions through trauma, loss, and ongoing insecurity 1
• Severe baseline cognitive impairment affecting activities of daily living should be documented for triage purposes 1

Chronic Kidney Disease (Priority #5)

• CKD requires regular dialysis access and monitoring, which is severely disrupted during infrastructure damage 1
• Creatinine >5 mg/dl or need for renal replacement therapy indicates critical disease severity requiring specialized resources 1
• Centralized healthcare infrastructure for dialysis creates particular vulnerability during displacement 4

Musculoskeletal Diseases (Priority #6)

• Arthritis and musculoskeletal conditions cause significant disability and functional impairment in crisis-affected populations 1
• These conditions limit mobility and ability to evacuate or access services during disasters 5
• Advanced untreatable neuromuscular disease should be identified for appropriate resource allocation 1

Cancers Requiring Ongoing Treatment (Priority #7)

• Neoplasms represent a significant proportion of NCD burden, with particular focus on breast, cervical, colorectal, gastric, and lung cancers 1
• Metastatic malignant disease indicates poor prognosis and should guide triage decisions during resource scarcity 1
• Chemotherapy interruption and lack of palliative care access are critical concerns during displacement 2, 4

Epilepsy and Neurological Conditions (Priority #8)

• Neurological conditions including epilepsy require continuous medication access to prevent life-threatening seizures 1
• Severe and irreversible neurologic events should be documented for triage purposes 1
• Multiple sclerosis and other progressive neurological diseases require specialized monitoring 1

Cirrhosis and Chronic Liver Disease (Priority #9)

• Cirrhosis represents a significant cause of mortality in crisis-affected regions, particularly where alcohol use disorders are prevalent 1
• Child-Pugh score ≥7 indicates end-stage liver failure requiring specialized resources 1
• Bilirubin >3 mg/dl, albumin <2.8 g/dl, and INR >2.20 indicate severe disease 1

Severe Heart Failure (Priority #10)

• Advanced heart failure requires ongoing medication and monitoring, with high mortality risk during care interruption 1
• NYHA class III-IV heart failure indicates severe functional limitation and poor prognosis without specialized care 1
• Furosemide 40 mg IV for new-onset or 20-40 mg IV for established heart failure should be available 3

Critical Operational Considerations

Access and Continuity Barriers

• Common barriers across all NCDs include: displacement, medication unavailability, lack of monitoring devices, centralized infrastructure destruction, financial difficulties, and illiteracy 2, 4
• Refugee status independently worsens NCD morbidity and mortality across all disease categories 4
• Telemedicine, preplanning with medical suppliers, and mapping high-risk patients by disease type are essential mitigation strategies 5

Triage and Resource Allocation

• Disease-management protocols with standardized cohort monitoring demonstrate strongest effectiveness in humanitarian settings 2
• Evacuation centers must have power for medical equipment including oxygen concentrators, nebulizers, and dialysis machines 5
• Health professionals should visit evacuation centers rather than requiring patients to travel to centralized facilities 5

Prevention and Screening

• Screening for cardiometabolic risk factors (hypertension, diabetes, dyslipidemia) should occur in all disaster-prone settings to identify high-risk individuals before crisis escalation 6
• Evacuation of high-risk NCD patients prior to predicted disasters reduces mortality 5
• Accurate, accessible data on NCD patients by location allows disaster responders to adequately prepare resources 5

Implementation Pitfalls

• Do not assume NCD patients can access centralized facilities during active crisis—bring services to evacuation centers and shelters 5, 4
• Do not rely solely on blood film morphology for diagnosis—this is insufficient for minimum essential treatment standards 1
• Do not exclude NCDs from disaster planning—they generate the bulk of ill health and premature death even during acute emergencies 5, 4
• Do not forget medication stockpiling—interruption of chronic medications causes rapid decompensation in cardiovascular disease, diabetes, epilepsy, and mental health conditions 2, 7, 4