Diabetes affect hundreds of millions of people worldwide, a large majority of them living in low- and middle-income countries. Yet finding effective strategies, tools and policies for effectively managing this chronic illness—especially amid war, displacement or exclusion from care—is a neglected area of humanitarian medicine. Here we present a cross-section of work on this front by MSF and collaborators. Several studies assess the shift towards community-based, nurse-led models of care in rural settings. Others explore obstacles to diabetes care for war refugees living in camps in Jordan or Lebanon, highlighting how health programs can adapt to their needs. The demonstration that insulin retains potency for 30 days if cooled without refrigeration is opening doors to more patient self-management, as a case study in remote South Sudan shows. At the same time, MSF and others call for regulatory and financing policies that make diabetes medications and supplies cheaper, better adapted to humanitarian settings, and far more available to patients whose lives depend on them.

Drug-resistant tuberculosis (DR-TB) remains an especially deadly form of the ancient scourge of TB, while current treatments are long, toxic, and ineffective for half of all patients. Aiming to change this unacceptable status quo, in the mid-2010’s MSF and partners launched three clinical trials to test novel regimens containing the first new TB drugs in decades. On 22 December 2022 the New England Journal of Medicine published findings from TB-PRACTECAL, a three-country randomized controlled trial, showing that a shorter regimen is safer and cured 89% of DR-TB patients, compared with 52% on the standard of care. These findings have already been incorporated into the World Health Organization’s new TB treatment guidelines. A separate study shows that the new regimen is also more cost-effective. Alongside these results the content collection linked below highlights other aspects of the trial, from community engagement strategies that helped shape TB-PRACTECAL to setbacks arising from the Covid-19 pandemic. It also examines urgent challenges in scaling up access to these life-saving drugs, including affordability and patent barriers.

Each year hundreds of millions of people suffer from chronic or acute liver disease caused by hepatitis viruses, and over one million die. To mark World Hepatitis Day (July 28th) we bring you a selection of MSF research exploring how to better prevent, identify and treat hepatitis infection in lower-income countries and emergency contexts where the burden is heaviest. For example, in a South Sudanese camp for displaced people—a type of setting where poor sanitation and water quality regularly lead to hepatitis E outbreaks—MSF and the Ministry of Health (MoH) are conducting the world’s first reactive vaccination campaign against this disease, and evaluating the process and outcomes. In Cambodia, MSF and MoH collaborators found that a simplified community-based model of care for hepatitis C was safe and highly effective in diagnosing patients and in curing them with new antiviral drugs. It was also cost-effective, according to studies in several countries and patient populations. And these new drugs were safe and effective even in patients also being treated for drug-resistant tuberculosis.