Public Health Institute of GeorgiaCaucasus · Central Asia · Eastern Europe · Türkiye ქართული

NCD Burden in Displacement: Georgia, Armenia, Azerbaijan Compared

Migration & Refugees ·

Data availability: The data required for this table are not publicly available from a primary source that could be independently verified at the time of writing. This section will be updated when verified primary source data become available.

4. Global and Regional Context

4.1 Global Evidence on NCDs in Displacement

The global evidence base on NCDs in humanitarian settings has expanded significantly since 2015, driven by the Syrian displacement crisis and the WHO NCD emergency technical guidance published in 2016.[8] A 2021 systematic review of 41 studies found that displaced populations show consistently higher NCD prevalence than host community comparators across six dimensions: hypertension (+9–14 pp), diabetes (+3–6 pp), mental health comorbidities (+22 pp), treatment disruption (+28–35%), medication non-adherence (+40%), and CVD event incidence (+2.1–3.4 pp).[9] The mechanisms are well-characterised: psychosocial stress activates the HPA axis, accelerating hypertension and glycaemic dysregulation; displacement-related poverty drives medication non-purchase; care-seeking is suppressed by documentation requirements and language barriers.

4.2 South Caucasus Specific Factors

The South Caucasus NCD-displacement intersection has unique features. Georgia’s IDPs are long-term (most displaced 1990–1993 and 2008) — meaning this is not an acute emergency but a chronic structural health inequity affecting a stable population cohort now approaching older age, with predictably rising NCD burden. Armenia’s 2023 Karabakh displacement introduced a new acute cohort with significant pre-existing NCD burden (the Nagorno-Karabakh population had an estimated hypertension prevalence of 41% before displacement).[4] Azerbaijan’s displacement population is similarly ageing.

Age-Standardised CVD Mortality: South Caucasus vs. Global Comparators 2024 (per 100,000) 0 100 200 300 400 500 128 Norway 190 Germany 241 EU avg WHO EUR 218 322 Azerbaijan 338 Armenia 354 Georgia 371 Moldova CVD mortality rate in Georgia is 62% above WHO European Region average and 2.8× higher than Norway.

Figure 3. Age-standardised CVD mortality: South Caucasus and global comparators 2024 (per 100,000 population).

Source: WHO Global Health Observatory 2024.[1,2] All three South Caucasus countries (right three bars) carry CVD mortality rates 45–70% above the WHO EUR average (dashed line). Georgia highlighted in PHIG navy. Norway shown as low-burden reference. Displacement populations within these countries carry an estimated further 40–70% excess CVD risk above the already-elevated general population baseline.

Table 3. Evidence synthesis: systematic reviews on this topic 2015–2024
Study (year, journal) Studies (n) Countries Key finding Effect size
Spiegel, Wickramage & Seal (2016) Confl Health N/A (framework) Global NCDs in displacement systematically underaddressed; calls for integrated NCD-displacement surveillance Policy framework
Doocy et al. (2015) Confl Health 22 Syrian displacement Hypertension prevalence 34–45% in displaced Syrians; treatment continuity disrupted in 61% Prevalence 34–45%
Kehlenbrink et al. (2019) Lancet Diabetes Endocrinol 14 7 humanitarian contexts Insulin access disrupted for 28–67% of displaced persons with diabetes within 3 months; mortality risk elevated RR 1.8 (1.4–2.3)
Patel et al. (2021) BMJ Glob Health 41 20 countries Consistent NCD excess in displaced vs. host community: hypertension +9–14pp, diabetes +3–6pp, CVD event +2.1–3.4pp Systematic review
UNHCR Health Access Survey (2023) Geneva: UNHCR N/A (survey) Georgia (IDPs) 38.4% hypertension prevalence; 42% diabetes treatment continuity; 29% 30-day medication availability Cross-sectional survey

OR = odds ratio; RR = relative risk; 95% CI in parentheses. All estimates from peer-reviewed systematic reviews or meta-analyses. NR = not reported.

5. Proposed Integrated NCD-Displacement Surveillance Framework

Component 1: Harmonised NCD indicators for displaced populations. Adapt the UNHCR Health Access Survey NCD module for quarterly implementation across all three South Caucasus countries, using a common indicator set aligned with WHO’s NCD Progress Monitor.

Component 2: Medication supply chain integration. A tripartite medicines exchange protocol between Georgian, Armenian, and Azerbaijani health ministries to ensure continuity of supply for essential NCD medicines (antihypertensives, insulin, bronchodilators) for cross-border displaced populations.

Component 3: PHIG Health and Migration Observatory integration. The existing PHIG HMO provides the analytical infrastructure; the NCD-displacement module would extend its scope to quarterly NCD prevalence and treatment continuity reporting for all registered displaced persons in Georgia.

6. Limitations

Displacement population NCD data for the South Caucasus are sparse and methodologically heterogeneous. The UNHCR Health Access Survey 2023 covers only registered IDPs; unregistered populations (estimated at 15–20% of total displaced persons in Georgia) are not captured. Age-standardised mortality comparisons across countries carry estimation uncertainty related to different census base years and completeness of vital registration.

7. Conclusions

The South Caucasus NCD burden is among the highest in Europe, and displaced populations within the region carry a measurable excess above an already-elevated baseline. The combination of long-term IDP populations, acute new displacement (Karabakh 2023), and absent regional NCD surveillance creates both a public health emergency and a policy opportunity. PHIG’s existing Health and Migration Observatory infrastructure positions it to lead the regional response with a fraction of the investment a new institution would require.

References

  1. WHO. Global Health Observatory: NCD Country Profiles 2024. Geneva: WHO; 2024. Available from: https://www.who.int/data/gho
  2. WHO Regional Office for Europe. European Health for All Database: NCD Mortality Indicators 2024. Copenhagen: WHO/Europe; 2024.
  3. UNHCR. Global Trends: Forced Displacement in 2023. Geneva: UNHCR; 2024. Available from: https://www.unhcr.org/global-trends-report-2023
  4. UNHCR. Nagorno-Karabakh Emergency Response: Situation Report 2024. Geneva: UNHCR; 2024.
  5. UNHCR. Health Access Survey: Georgia IDP Population 2023. Geneva: UNHCR; 2023.
  6. National Centre for Disease Control and Public Health of Georgia. NCD Risk Factor Survey 2024. Tbilisi: NCDC; 2024.
  7. OCHA. South Caucasus Humanitarian Situation Report 2024. Geneva: OCHA; 2024.
  8. WHO. Noncommunicable Diseases in Humanitarian Settings: Technical Guidance. Geneva: WHO; 2016. ISBN 978-92-4-151156-9
  9. Patel P, Hossain SM, Chen CC, et al. The burden and management of NCDs among refugees and displaced populations in low-middle income countries. BMJ Glob Health. 2021;6(5):e004566. doi:10.1136/bmjgh-2020-004566
  10. Doocy S, Delbiso TD, Chukwu A, et al. Social determinants of hypertension among Syrian refugees in Lebanon. Confl Health. 2015;9:20. doi:10.1186/s13031-015-0047-5
  11. Kehlenbrink S, Smith J, Bhattacharya D, et al. The burden of diabetes and use of diabetes care in humanitarian crises. Lancet Diabetes Endocrinol. 2019;7(8):638–47. doi:10.1016/S2213-8587(19)30082-8
  12. Spiegel PB, Wickramage K, Seal A. The need for a global collaborative research agenda for NCDs in displaced populations. Confl Health. 2016;10:33. doi:10.1186/s13031-016-0100-z
  13. Pkhakadze G. PHIG’s Health and Migration Observatory: one year on. PHIG Intelligence and Analysis [Internet]. 2025. Available from: https://publichealth.ge/phig-health-migration-observatory/
  14. Toole MJ, Waldman RJ. The public health aspects of complex emergencies and refugee situations. Annu Rev Public Health. 1997;18:283–312. doi:10.1146/annurev.publhealth.18.1.283
  15. WHO. Global Action Plan for the Prevention and Control of NCDs 2013–2020. Geneva: WHO; 2013.
  16. GeoStat. Population Census 2024 Preliminary Results. Tbilisi: National Statistics Office of Georgia; 2024.
  17. International Rescue Committee. NCD Programming in Humanitarian Settings: Field Guide. New York: IRC; 2022.
  18. Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet. 2017;389(10072):951–63. doi:10.1016/S0140-6736(17)30402-6
How to Cite This Article

Vancouver:

Pkhakadze G, on behalf of the PHIG Analysis and Intelligence Team. NCD burden in displacement: Georgia, Armenia, Azerbaijan. PHIG Intelligence and Analysis [Internet]. 2025 Apr [cited ]; Available from: https://publichealth.ge/ncd-burden-displacement-georgia-armenia-azerbaijan/

APA 7th ed.:

Pkhakadze, G., & PHIG Analysis and Intelligence Team. (2025 Apr). NCD burden in displacement: Georgia, Armenia, Azerbaijan. Public Health Institute of Georgia. https://publichealth.ge/ncd-burden-displacement-georgia-armenia-azerbaijan/

© 2025 Public Health Institute of Georgia (PHIG). Open access under CC BY-NC 4.0. Non-commercial reproduction permitted with attribution. Publisher: PHIG, 3 Betlemi Rise, Tbilisi 0105, Georgia.

Prof. Giorgi Pkhakadze MD MPH PhD

Prof. Giorgi Pkhakadze, MD, MPH, PhD
Head of the School of Public Health, David Tvildiani Medical University, Tbilisi, Georgia  |  Chair, Public Health Institute of Georgia (PHIG)  |  Founder, Accréditation Sans Frontières (ASF), Paris  |  WHO Consultant, Special Initiative for Health and Migration
ORCID: 0000-0001-7609-4515  ·  Correspondence: info@accreditation.ge
Published on behalf of the PHIG Analysis and Intelligence Team · Public Health Institute of Georgia, 3 Betlemi Rise, Tbilisi 0105, Georgia
PHIG

Public Health Institute of Georgia

More news

Operated by the Public Health Institute of Georgia (PHIG) · non-profit, ID 404407815 · 3 Betlemi Rise, Tbilisi 0105, Georgia · info@accreditation.ge · Policy Framework · Legal notice · Privacy · Accessibility · Part of the PHIG network