Humanitarian emergencies caused by armed conflict, natural disasters or disease outbreaks place immense pressure on health systems and significantly increase the demand for medical care. In such circumstances, people often require immediate treatment, including pain relief, palliative care, surgical care and anaesthesia, as well as mental and psychological support.
Nonetheless, ensuring timely access to life-saving medicines remains one of the key challenges in many humanitarian emergencies.
The increasing number of disasters caused by climate change and armed conflict not only significantly increases the number of persons requiring humanitarian assistance but also greatly compounds the risks in humanitarian operations.
Many controlled substances required for emergency medical care, such as morphine, diazepam and phenobarbital, are included in emergency health kits. Other substances, including fentanyl and midazolam, are widely used in intensive care units, including in the treatment of critically ill patients, for example during the COVID-19 pandemic.
Many of these substances are included in the WHO Model List of Essential Medicines.
Access to such controlled substances in emergency settings can be complicated by the additional requirements that govern their import and export. Administrative procedures may delay urgent deliveries, and in some cases humanitarian organizations have even had to remove controlled substances from emergency health kits to avoid delays in delivering humanitarian assistance.
Recognizing this challenge, the international community has long sought practical solutions to ensure rapid access to essential controlled medicines during emergencies. An important step in this direction was the publication by WHO in 1996 of the Model Guidelines for the International Provision of Controlled Medicines for Emergency Medical Care, which introduced simplified procedures designed to facilitate the rapid supply of controlled medicines in emergency situations.
Under these simplified mechanisms, national authorities may authorize the export of controlled medicines even in the absence of the usual import authorizations or estimates when urgent humanitarian needs arise. This flexibility is reflected in Article 21, paragraph 4 (b) (ii), of the 1961 Single Convention on Narcotic Drugs, which allows for such measures in exceptional circumstances. In some cases, estimates for emergency deliveries may be submitted by the exporting country instead of the importing country. Such measures help ensure that life-saving medicines can reach people more quickly when and where they are needed most. These mechanisms have already helped facilitate access to medicines in several recent crises, including the Beirut explosion in 2020, the COVID-19 pandemic in multiple countries and the earthquake in Haiti in 2021.
The COVID-19 pandemic provided a major test for these mechanisms, as many countries declared national emergencies and faced unprecedented demand for critical medicines. In March 2021, the International Narcotics Control Board (INCB) convened consultations with national authorities, humanitarian organizations and United Nations partners to review lessons learned and identify effective practices for ensuring timely access to medicines during emergencies.
The outcome of these discussions was the document Lessons from countries and humanitarian aid organizations in facilitating the timely supply of controlled substances during emergency situations. It outlines practical steps that Governments can take to strengthen preparedness, including reviewing national legislation, introducing more flexible mechanisms for emergency deliveries and ensuring that medical and humanitarian personnel are aware of existing procedures and are trained to implement them effectively.
