Evolving inclusion: A global review of disaster risk reduction (DRR) for individuals with chronic illnesses (ICI) in developing countries

Disasters disproportionately impact Individuals with Chronic Illnesses (ICI) in developing countries, where health systems are often under-resourced and fragmented. Despite global commitments such as those in the Sendai Framework for Disaster Risk Reduction (SFDRR), the integration of chronic illness care and the meaningful participation of ICI in Disaster Risk Reduction (DRR) preparedness remain limited. This systematic review examined how developing countries have progressed in addressing the health needs and inclusion of ICIs within DRR strategies, focusing on the role of Primary Healthcare (PHC), and the barriers and facilitators to participation. A comprehensive literature search was conducted across six databases for English-medium peer-reviewed articles published between 2000 and 2024. Using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 17 studies were selected based on Population, Concept, Context, Outcome (PCCO) criteria and assessed for quality using the Mixed Methods Appraisal Tool (MMAT) tool. Thematic synthesis revealed that most research and interventions remain focused on post-disaster response, with limited attention to preparedness and mitigation for ICIs. PHC is critical in ensuring continuity and access to chronic care before, during, and after disasters, but persistent gaps exist in PHC disaster preparedness, integration, and equity. Common barriers included health system weaknesses, poor PHC integration, financial and physical access challenges, and social vulnerabilities. Facilitators included strong social support networks, community outreach, innovative PHC models, public-private partnerships, and inclusive policy frameworks. Despite growing recognition of the needs of ICIs within DRR, meaningful inclusion and proactive planning are limited. Strengthening PHC systems, promoting community-centred approaches, and ensuring the voices of ICIs are central to DRR policy and practice are essential for achieving equitable disaster resilience in developing countries and ensuring no one is left behind in disaster events.