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While the humanitarian crisis in the Middle East is one of the most devastating of our era according to Antonio Guterres, UN High Commissioner for Refugees (UNHCR), humanitarian aid approaches its limits. This paper will look into one of those limits: the challenges of addressing non-communicable diseases (NCDs) in humanitarian interventions. First, the development of humanitarian health interventions, and the changing nature and contexts of emergencies are described. Second, the specific con...

International audience; The gold standard in treatment of acute cholecystitis is cholecystectomy associated with antibiotics. In certain circumstances, percutaneous cholecystostomy is an interventional alternative. Percutaneous cholecystostomy is usually performed under local anesthesia by the radiologist using ultrasonographic or CT guidance. A drain can be inserted either through a trans-hepatic or a trans-peritoneal approach. Complications occur in nearly 10% of cases including hemorrhage, hemobilia, pneumothorax or bile leaks, depending on whether the approach was trans-hepatic or trans-peritoneal. The main indications for percutaneous cholecystostomy are resistance to medical treatment or severely-ill patients in intensive care. Drains should be maintained 3 to 6 weeks before removal. In patients with good general condition (ASA score I-II), secondary cholecystectomy can be recommended to avoid recurrence.; Le gold standard dans le traitement de la cholécystite aiguë est la chirurgie associée à un traitement antibiotique. Dans certaines situations, une alternative à la chirurgie est représentée par la cholécystostomie percutanée. Cette cholécystostomie est habituellement réalisée par le radiologue sous anesthésie locale, sous guidage par échographie ou scanner. Le drainage peut suivre 2voies, la voie transhépatique ou la voie transpéritonéale. Les complications, qui surviennent dans environ 10% des cas, sont représentées selon la voie utilisée respectivement par l’hémorragie, l’hémobilie ou le pneumothorax, d’une part, et la fuite biliaire, d’autre part. Les indications de la cholécystostomie percutanée sont principalement la résistance à un traitement médical bien conduit et les patients hospitalisés en réanimation. Le drain doit rester en place en principe 3à 6semaines avant d’être ôté. Chez les patients en bon état général (ASA I-II), une cholécystectomie à distance semble recommandée pour éviter toute récidive.

Since late 2003 in Senegal, voluntary tests, ARVs and CD4 counts have been provided free of charge by the State within the framework of public health services. Debate now focuses on expanding free access to other components of care (consultations, hospitalizations, complementary exams for opportunistic infections). A preliminary study assessed the supplementary cost needed to fund all care and appraised this measure's impact on the national program. Direct costs for treatment were calculated using two different methods: (1) by calculating total expenditures for a sample of 299 patients over a 22-month period (July 2003 to April 2005) treated by HAART (2 NRTI + 1 PI or NNRTI); and (2) by assessing the theoretical costs necessary to apply the national treatment protocols. Furthermore, national budgetary projections were analyzed to estimate possible margins available to officials. In 2006, the total cost of medical care for someone taking ARVs falls around 412€ per year; 84% of the cost covers the price of ARVs and reagents for CD4 counts. The total annual cost of medical care for a PLWHA who does not need ARV drugs is approximately 40€ per year, with 90% of this amount covering biological exams. Projections concerning changes in the number of PLWHA and treatment needs and analysis of budget estimations for 2007-2011 demonstrate that supplementary costs incurred by complete free access could be easily covered without disrupting the proposed funding plan. Complete free access for medical care for all PLWHA in the country is therefore economically feasible; what remains is to define this decision's integration into the current paying health system without causing disturbances that render the decision ineffective.