30 September 2024, Cairo, Egypt – The Eastern Mediterranean Region faces a huge burden of noncommunicable diseases (NCDs), including chronic kidney disease (CKD). The Region’s frequent humanitarian emergencies –including conflicts, natural disasters and public health crises – place enormous strain on health care systems, making it particularly difficult to provide specialized care such as renal dialysis.
In times of crisis, ensuring continuity of care for patients with chronic kidney disease – including those on dialysis and transplant patients – becomes an enormous challenge. Patients can face life-threatening interruptions in their treatment due to damaged health infrastructure, shortages of essential medications and supplies, unreliable sources of water and electricity and shortages of health care personnel.
In Sudan, the armed conflict that began in April 2024 has placed over 8000 dialysis patients at severe risk of service disruption. By August 2024, only 44 functioning facilities remained out of the 102 available before the crisis, leaving 5000 patients without adequate care. In Gaza, where the unprecedented levels of destruction caused by the ongoing conflict has resulted in a devastating humanitarian crisis, the need to ensure continuity of care for CKD patients has never been more urgent.
In response to the challenges, the WHO Regional Office for the Eastern Mediterranean has established a regional expert network on chronic kidney disease management, with a special focus on dialysis and kidney care during emergencies.
The initiative aims to support Member States explore innovative ways to maintain dialysis services and build resilience into health care systems across the Region so as to ensure that even in the most challenging circumstances patients receive the life-saving care and medications they need.
The network convened its first meeting on 10 September 2024, bringing together leading nephrologists, experts from the Region and beyond, professionals who have supported recent crises and focal points from the three levels of WHO. The agenda included presentations on regional and global perspectives, the International Society of Nephrology’s efforts to address kidney disease in emergencies, and the challenges facing efforts to maintain dialysis services in Sudan and the occupied Palestinian territory.
Participants identified several key domains essential to maintaining dialysis services during emergencies. Priority areas included the availability of functioning dialysis machines, stockpiles of dialysis and supportive supplies, ensuring reliable water sources and treatment systems, stable electricity supplies and continuous infection prevention and control measures.
Technical support to maintain equipment and ensure the quality of long-term care is critical. Guided by the regional framework for action on addressing NCDs in emergencies, cross-cutting health system domains such as governance, information systems, human resources, financing, community engagement and logistics – including transportation and evacuation for both patients and supplies – were also cited by participants as essential for sustaining dialysis services in crisis settings.
The meeting concluded with an agreement to establish sub-working groups that will focus on the key domains highlighted during discussions. These working groups will be tasked with driving forward targeted actions with a clear action plan to ensure the coordination of efforts to maintain continuity of dialysis services during emergencies.
