Until recently, little attention from humanitarian agencies has been given to management of noncommunicable diseases in emergencies.1 Chronic kidney disease (CKD) is a common non-communicable disease, and despite its increasing prevalence, management of CKD, including kidney failure (KF) and kidney transplantation, receives little support in health emergencies.2 Management of patients with end-stage kidney failure on maintenance dialysis requires a complex infrastructure consisting of a built environment, electricity, water delivery, dialysis equipment, secure dialysis supplies chain, skilled medical staff, and leadership, which may not be available in many situations. Where these requirements do exist, they are easily disrupted in humanitarian emergencies. Protracted conflicts, such as those in the Democratic Republic of the Congo, Iraq, Libya, Syria, Somalia, Yemen, and Ukraine, have produced a new urgency for the planning and management of persons with KF and other non-communicable diseases.3,4

An example of the effect of armed conflict on dialysis operations comes from the 10-year Syrian conflict.5 This conflict has created an area in northwest (NW) Syria that has become outside of government control. This area contains around 800 dialysis patients.6 With the destruction of public facilities in this area, several nongovernmental organizations (NGOs) took over management of existing hemodialysis centers.7 Cross-border support is provided from neighboring Turkey. At present, 14 units, operated by different NGOs, are providing hemodialysis in this area. The World Health Organization (WHO), as the lead agency of the healthcare cluster hub in Gaziantep, Turkey, has provided logistical support to these centers. An early review of these facilities showed weak observance of medical protocols and infection prevention and control standards, leading to high infection rates.7 In response to these findings, the cluster established a hemodialysis taskforce in 2019, which is led by the WHO and composed of representatives of the NGOs implementing hemodialysis. In 2021, with collaboration with Johns Hopkins University, the WHO initiated a 3-phase quality improvement project to improve care to these patients. First-phase activities included a survey, small group interviews, and workshops with stakeholders and were conducted between October 2021 and January 2022, to collect dialysis performance information. The survey consisted of 346 questions developed by a US-based lead nephrologist using accepted US standards and was modified with assistance by US- and NW Syria–based dialysis experts familiar with the Syrian situation. The second phase will consist of agreeing on infection prevention and control and minimal standards, and building the capacity to meet these standards, based on data gathered in the first phase. In the third phase, a support supervision system is planned, to monitor and support agreed-upon standards.