Background
Non-Communicable Diseases (NCDs) concern non-transmissible diseases such as strokes, cancers, mental health disorders and heart disease constitute a major health burden responsible for 74% of global deaths. Nevertheless, an estimated 80% of deaths from NCDs are preventable as NCDs mostly result from modifiable behaviours such as tobacco use, harmful alcohol consumption and physical inactivity. However, the impact of NCDs on Internally Displaced Persons (IDPs) is unknown. IDPs are individuals and groups who are compelled to flee their homes as a result of conflict, or in other situations (such as natural disasters) where their lives are at risk though unlike refugees, they do not cross an internationally recognised border. Currently, there are estimated around 71 million IDPs, with the majority (44.5 million) located in the Middle East, North Africa and sub-Saharan Africa regions. There is a lack of research examining the extent to which IDPs are affected by NCDs, which poses further questions as to what key NCDs issues face IDPs and how effective current policy responses have been to meet their health needs. This blog aims to improve understanding of this particularly overlooked issue in migration studies and recommends key policy interventions to ensure better responses and management of NCDs across IDP populations.
How are IDPs particularly affected by NCDs?
There are several ways in which IDPs face unique challenges from NCDs. As one study in Ukraine demonstrated, IDPs are at greater risk of Alcohol Use Disorder (AUD) compared to non-displaced populations, as a result of poorer mental health that emanates from their experiences of conflict. For example, mental health disorders, such as anxiety, amongst (predominantly male) IDPs were associated with increased use of alcohol as a coping mechanism which has contributed to AUD within IDP populations. This also reflects similar findings from studies in Georgia and Uganda.
The Ukraine study shows that IDPs with AUD have been reluctant to seek treatment, owing to factors such as social stigma and limited availability of services; consequently IDPs who have not utilised existing services have been associated with further negative behaviours, such as social isolation and self-blame. What this shows is that AUD not only arises from poor mental health (as a consequence of IDPs exposure to conflict and displacement) but can itself exacerbate the effects of diminished mental health. This demonstrates an urgent need for responses that take into account the complex relationship between AUD and mental health disorders: one way this can be done is for IDPs to be given improved access to mental health services whose treatments also screen for and treat their alcohol abuse.
Another key issue facing IDPs (and refugees too) stems from overcrowded camp conditions that result in physical inactivity. Although studies are limited, one study in Nigeria found one-third of IDPs in camps to be physically inactive, which increased with age. The implications of physical inactivity are that it heightens risk of a range of NCD issues such as coronary heart disease, multiple cancers, and type 2 diabetes. Furthermore, physical inactivity can worsen pre-existing mental health disorders of IDPs highlighting the breadth of problems that can emanate from this issue.
Current policy interventions: how effective are they?
So far, the issue of NCDs facing IDPs has largely been ignored in the literature and particularly by international donors. For example, the first in-depth study of Official Development Assistance (ODA) on IDP health found ‘negligible spending’ on NCDs (0.44%). The study even showed how certain areas, such as tobacco use control, have received no funding whatsoever. Considering existing evidence that suggests a link between conflict-related mental health disorders and negative coping mechanisms (such as substance abuse) use among IDP populations, it is imperative that, in order for ODA to be effective, donors reassess priorities and ensure IDPs can benefit from funding in areas such as tobacco control.
Conclusion
This blog recommends the following solutions be enacted to meet current challenges:
- Donor agencies should support local health authorities to establish integrated mental health services that treat both mental health disorders and related substance abuse (such as AUD or harmful tobacco use). Donor agencies can complement this policy with increased ODA on tobacco control within IDP populations.
- Local health authorities should provide targeted public health messaging to ensure that the most vulnerable IDPs in this respect (particularly men) are prioritised, as well as messaging that challenges negative social attitudes surrounding mental health service use.
However, although not previously acknowledged by this blog, it is necessary that survivors of sexual and gender-based violence are not overlooked by mental health services: as one study of Ukraine shows, not only is increased sexual violence associated with internal displacement but is also associated with reluctance of (mostly) young women, particularly those whom have experienced sexual violence from intimate partners, to seek immediate care. To encourage prompt utilisation of mental health services by such survivors, donor agencies should direct funding towards
helping local health authorities offer treatments, such as cognitive processing therapy, that include confidential safety plans for women who fear, or have experienced, sexual violence from intimate partners. This will allow women to access appropriate services with discretion.
Furthermore, it should be noted that some studies have shown, in situations of displacement, that substance abuse among male partners can increase intimate partner violence: therefore, these combined approaches, that both address substance abuse and offer care to survivors of sexual and gender-based violence, can be said to complement each other and may contribute to further prevention of intimate partner violence that stems from substance abuse.
- Humanitarian agencies should play a part by restructuring IDP camps (to address overcrowding), run daily outdoor clubs to increase physical activities(with increased focus on older IDPs), and provide education that increases awareness of the health impacts of physical inactivity and substance abuse.
About the author: Isaac has recently graduated with a BA in International Relations and Politics from the University of Sheffield, with a particular interest in the health status of displaced populations and more generally in issues relating to health inequities.
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