Majd Isreb, Mohamad AlyousefNada Obaid, Aula Abbara, Mohamed Sekkarie.

We read with interest the Viewpoint by Slim Slama and colleagues1 highlighting the important considerations for delivery of care for non-communicable diseases in emergencies. However, the article does not address the negative effects of besiegement on non-communicable disease care. More than 1 million people are estimated to be living under siege in Syria. Patients who need haemodialysis suffer during both natural and man-made disasters.2, 3 Minimum standards of care for patients who need haemodialysis include at least twice-weekly sessions of longer than 4 h and the availability of erythropoiesis stimulating agents and vitamin D supplements. In developed countries, annual mortality of patients who are on haemodialysis is less than 20%.4

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