Breaking barriers: addressing systemic inequities in chronic disease care for displaced populations

BACKGROUND: Internally displaced persons (IDPs) in conflict-affected populations are disproportionately affected by non-communicable diseases (NCDs), while system-level barriers to healthcare access are under-researched. This mixed-methods research investigates the interplay between structural, socioeconomic, and NCD-related barriers to accessing care by IDPs with NCDs in Nigeria, identifying disparities in access. METHODS: We carried out a cross-sectional study (March-August 2024) among three IDP camps in Benue State, Nigeria, recruiting 345 adults (≥ 18 years) with hypertension, diabetes, asthma, or cancer. Quantitative surveys measured barriers (distance, cost, insecurity) using validated instruments, while qualitative interviews (n = 25 IDPs, 10 providers) investigated lived experiences. Multivariate logistic regression and Cox proportional hazards models predicted access delays, supported by thematic analysis of qualitative data. RESULTS: Structural barriers revealed that distance (> 5 km) doubled the access difficulties when combined with insecurity (OR = 3.17, 95% CI: 2.22-4.53, p < 0.001), while cost barriers were most significant for cancer (OR = 3.12, CI: 1.62-6.00) and diabetes (OR = 2.33, CI: 1.40-3.88). Demographic inequalities showed that low education raised odds of access barriers by 49% (p = 0.002); women had 24% lower odds than men (p = 0.049). Disease-specific delays demonstrates a median treatment delays of 14 days (hypertension), 21 days (diabetes), and 42 days (cancer). Qualitative themes showed that IDPs valued food more than care, viewed clinics as insecure, and believed NCDs were ignored in humanitarian response. CONCLUSIONS: IDPs with NCDs encounter worsening, discriminatory barriers based on structural and socioeconomic inequities. Policy actions need to incorporate decentralized NCD care, financial protection, and security-assured transportation. Disease-specific programming and health literacy interventions are essential to curb disparities in prolonged displacement.