The tumours that kept growing in her chest were cut out three times before Noor Saimun, a Rohingya refugee in Bangladesh, was tested for cancer. By the time it was diagnosed, the cancer had spread from her breast throughout her body.
Saimun now spends her days incapacitated by pain, lying on the floor of her bamboo shelter. Around her, many of her neighbours suffer other types of non-communicable and chronic illnesses – cancers, diabetes and hypertension – but they often go without treatment and the tools they need to manage their conditions.
“My life is meaningless, I can’t move anywhere, I can’t do anything,” says Saimun. “I sit here in pain, I can’t even get up to eat. I spend my whole day lying in bed. I can’t explain how much pain I’m in.”
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
This week the UN warned that people caught up in humanitarian emergencies are at increased risk of cardiovascular disease, cancer, diabetes and other non-communicable diseases (NCDs), which are responsible for more than 70% of deaths worldwide.
It is estimated that strokes and heart attacks are up to three times more likely after a disaster, and UN agencies are meeting in Denmark this week to ensure that care and treatment for NCDs are included as a standard part of humanitarian emergency preparedness and response.
A million people live in the Rohingya refugee camps of Bangladesh’s Cox’s Bazar district, and today, six years after the refugees started to arrive, driven from their homes in Myanmar by the military, the prospect of returning home is as distant as ever. For those living with chronic illnesses, they contend with funding cuts that mean a lack of medication, struggles to get the nutrition needed to avoid or manage their conditions and a lack of health services that can even detect their ailments.
“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,” said Dr Tedros Adhanom Ghebreyesus, the head of the World Health Organization.
For Saimun, it was only after the three surgeries and an incorrect tuberculosis diagnosis from camp clinics that she found the money and obtained the permission necessary to travel the 25 miles to a hospital in Cox’s Bazar town, that she was finally told she had cancer.
But chemotherapy was only available at a hospital in Chattogram – 100 miles away – and while money lent by neighbours helped fund her journey there for the first three rounds, Saimun could not afford the fourth and final journey.
Restrictions on Rohingya working or moving beyond the camps are among the conditions that make living with chronic illnesses more difficult than in Myanmar, where despite persecution from the military, their rural surroundings provided them with better access to healthy food and a more active lifestyle.
The camps, which grew into the world’s largest in 2017 after genocidal massacres by the Myanmar military, are sprawling and many of their residents desperate. Funding cuts have hit food as well as healthcare, which only had 25% of its needs funded in 2023, while rising crime inside the camps and de facto bans on internal transport make it hard for patients to access healthcare.
While most Rohingya would like to return to their homes, they demand a guarantee of safety and the restoration of their citizenship – removed in 1982. Instead, Myanmar faces widespread fighting between the military junta and armed groups, including in their native Rakhine where the rebel Arakan Army recently forced hundreds of Myanmar troops into Bangladesh.
In response the Myanmar military has reportedly conscripted Rohingya in their fight against the Arakan Army, who belong to Rakhine state’s other major ethnic group, the Rakhine.
Bangladeshi official sources said the government is struggling to deal with the long-term burden of the refugees, especially with reduced aid funding, and that it wants a dignified and voluntary repatriation. But they accused the world of forgetting the Rohingya crisis and said influential countries such as the US and UK had not put enough pressure on Myanmar to ensure the Rohingya’s safety.
Many of the Rohingya living with chronic illnesses blame their lives in the camps for their conditions, saying the restriction on movement and work force them into being idle while the lack of access to healthy food increases the risk of becoming ill.
Abul Hossain, 41, says he recently spent several months in Myanmar working as a fisher and farmer because he could not work in Bangladesh and that the activity meant he no longer experienced the symptoms of the diabetes he was diagnosed with in 2019, two years after he arrived as a refugee.
Back in Bangladesh, Hossain says he now feels the symptoms again – he often has to urinate and has bouts of weakness. While he was told to take four tablets of metformin a day to lower his blood sugars, he is given only two.
“The doctor tells me to avoid stress, to try to have a calm home life but how can I?” says Hossain. “The situation around me makes me depressed. The life we’re spending here is painful. Camp life is like an open prison, we can’t move beyond the boundaries. We can’t move around. Prisoners wait for their meals to be delivered at a certain time – we are like that.”
He was told to get regular eye tests and to get checked for kidney disease but he cannot afford to pay for the tests. He has no blood-testing kit of his own and the clinic that treats him provides only one test a month.
Jennifer Stella, the Médecins Sans Frontières project medical referent at the Jamtoli refugee camp, says the charity has seen 56,000 people over the past year and treats 5,000 but that the camps in general have a lack of capacity.
“There’s limited access to healthcare and facilities, with very hilly terrain and no transportation within the camps, particularly for people who already have chronic conditions or older patients,” she says.
She says refugees have to often leave the camps and pay for private healthcare, which presents specific challenges to some, such as insulin users who must go to a clinic for injections but need to organise transport.
“Healthcare in most facilities are not set up to treat people with chronic illnesses. We are, but we don’t have anywhere near the capacity to treat everyone in need,” she says.
Some of the complaints the Rohingya have were recognised by a 2022 study by Bangladeshi researchers, which found that among the risk factors of NCDs, 89% of the respondents lacked physical activity in their daily lives and almost a quarter did not eat enough fruit and vegetables.
Sajida, 38, has diabetes and was told she should eat more healthily – reduce rice and eat more vegetables. Her rations, however, barely cover the basics and do not allow her to buy a varied diet.
Funding cuts have also hit rations provided by the World Food Programme for refugees, limiting food choices mostly at the expense of protein or fibre and leaving people reliant on rice to fill them up.
The number of crises affecting people’s health has been increasing internationally. In 2023, the WHO responded to 65 health emergencies worldwide, up from 40 in 2013. UNHCR also issued 43 emergency declarations to scale up support in 29 countries – the highest number in decades.
“The camp is full of difficulties, there’s a huge difference between our lives in Myanmar and here. There we had everything we needed but here we are stuck in our tents. In Myanmar we had good, fresh food. We had fish, fruit, meat. Here it costs money to get fresh food but we don’t have the money for it,” says Sajida.
“The doctor told me to have fresh fruit, vegetables, to have less rice and to exercise. But I don’t have the money for these things. We can afford only the most basic things with the rations we’re given, nothing extra. I mostly eat rice and lentils and sometimes dried fish. I eat the same thing morning, lunch and dinner.”
