The 22 countries of the World Health Organization's Eastern Mediterranean Region (EMR) are experiencing an increase in the burden of non-communicable diseases, including cancer. Of the six WHO regions, the EMR is projected to have the highest increase in incidence of cancer over the next 15 years. Furthermore, most cancers are diagnosed at a late stage, resulting in a lower cancer survival rate than in Europe and the Americas. Therefore, with increasing numbers of cancer deaths, it is important that palliative care is available to relieve suffering for patients with advanced disease and at the end of life.In the Region, it is evident that the palliative care offer is patchy and inconsistent. Gaps include: the lack of inclusion within national policies and limited partnership working; insufficient palliative care education for health professionals and volunteers; lack of public awareness; and a gap in access to essential pain relief medicines. Addressing these barriers would result in improvements to palliative care delivery in the EMR. To this end, this review explores the current status of palliative care in the region, including challenges and opportunities. It explores data and evidence from published literature, WHO meeting reports, cancer control mission reports, and the WHO global non-communicable diseases country capacity survey.

Running Title: Boston DeclarationWord Count: 689 (not including the table) 2 Nearly three out of every four deaths globally in 2017 were caused by non-communicable diseases (NCDs). 1 Many countries have made progress reducing NCD risk factors such as tobacco use, hyperlipidemia, and hypertension, but no countries have successfully reversed the increasing trends in diabetes prevalence and mortality from diabetes is increasing. 1 This represents a massive global health failure considering the fact that type 2 diabetes is largely preventable with lifestyle modification and that cost-effective treatments exist for both type 2 and type 1 diabetes. 2 Specific concern is needed for type 1 diabetes, which without insulin, it is fatal.In parallel, forced migration has reached a record high with 68.5 million people displaced from their homes around the world, 85% being hosted in low or middle-income countries such as, Uganda, Lebanon, and Pakistan, and 65% occurring in protracted refugee situations. 3 In addition, there are over 100 million conflict-affected non-displaced people and 175 million people who are affected by natural disasters annually. 4 These individuals are particularly vulnerable in crises due to disrupted health services and unpredictable-and often unhealthy-food supplies, which may exacerbate their condition and lead to complications.To date, diabetes and other NCDs have largely been underserved in humanitarian settings. 5,6,7 The true scope of the problem has not been established and it is not known which interventions are efficacious, feasible, and cost-effective in these contexts. With respect to type 1 diabetes, arguably the most immediately life-threatening NCD, the supply and cost of insulin, blood glucose monitoring and diagnostic tools are barriers for both humanitarian responders and their host countries, as well as patient adherence, life expectancy, quality of life, follow-up and provider training in diabetes care.In order to begin to address these major gaps, on 4-5 April 2019, Harvard University convened a meeting of humanitarian and other actors in global health to discuss the immediate needs and barriers to tackling diabetes in humanitarian crises, and to adopt a unified, action-oriented agenda to address this pressing global health issue (http://globalendocrinology.bwh.harvard.edu/symposium). Whilst it was recognised that there are substantial gaps in care for diabetes in all low-resource settings, 8 not just humanitarian crises, and that many other NCDs (e.g., cardiovascular disease, chronic obstructive pulmonary disease and asthma) are also prevalent globally and inadequately addressed in humanitarian settings, 9 we chose to prioritize efforts on diabetes in humanitarian crises, for the following reasons:First, because people with type 1 diabetes who cannot access insulin and continuity of care in a crisis are at acute risk of death. The principles of the Humanitarian Charter and United Nations Universal Declaration of Human Rights include the right to life with dignity. 10 The human rig...

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Nutrition is a key component of care for critically ill patients; yet nutrition delivery is below international recommendations. In order to improve nutrition delivery to critically ill patients, an understanding of the barriers that prevent guideline adherence is required. It is known that clinicians' knowledge, attitudes, and beliefs of the role of nutrition may act as a potential barrier to nutrition delivery, but whether this remains true in critical care is unknown. The aim of this systematic scoping review was to summarize the literature exploring the knowledge, attitudes, and beliefs of clinicians around nutrition support in critically ill patients. A search of four online databases (MEDLINE via Ovid, Emcare via Ovid, PsycINFO, and CINAHL via EBSCOhost) was conducted on August 14, 2020, to identify literature that reported on clinicians' knowledge, attitudes, and beliefs of nutrition in adult intensive care patients. Data were extracted on study and participant characteristics, methodology, and key study outcomes related to nutrition. Eighteen articles met eligibility criteria and were included in the review. Key findings included the following: nutrition was seen as a priority that ranked below life-saving interventions; differences in perceived clinician responsibilities exist; common barriers to nutrition delivery included inadequate resourcing, lack of nutrition protocols, and gastrointestinal intolerance; and identified facilitators included nutrition education and the presence of a supportive multidisciplinary team. The implementation of nutrition protocols, enhanced clinical nutrition education, and further clarification of roles and responsibilities pertaining to nutrition may assist in improving nutrition delivery in critical care.

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