Humanitarian emergencies can destabilise every part of epilepsy care at once. Armed conflict, forced displacement, natural disaster and health-system collapse can interrupt access to antiseizure medicines, destroy medical records, close clinics, displace specialist staff, cut electricity, disrupt transport and leave people living far from the services they previously relied on.
For someone with epilepsy, this can rapidly turn a previously controlled condition into a medical emergency. Missed doses, sudden medicine withdrawal, sleep disruption, dehydration, injury, infection and severe stress can all increase seizure risk. At the same time, the emergency itself can reduce access to the very services needed when seizures worsen.
The problem is therefore not simply that epilepsy continues during a crisis. The crisis can actively dismantle the systems that were keeping epilepsy under control.
WHO and UNHCR explicitly include epilepsy in humanitarian emergency care
The World Health Organization and the United Nations High Commissioner for Refugees developed the mhGAP Humanitarian Intervention Guide specifically for non-specialist health workers operating in humanitarian emergencies. Epilepsy is one of the neurological conditions included in that guidance.
This is important because humanitarian settings rarely have enough neurologists. Care often has to be delivered by general doctors, nurses, clinical officers and other non-specialist staff working with limited investigations and medication choices.
The aim is not to recreate a specialist epilepsy centre inside an emergency setting. It is to preserve essential, evidence-based care despite disruption.
Medication continuity can become the most urgent issue
Many antiseizure medicines must be taken regularly. Abrupt interruption can lead to breakthrough seizures and, in some people, seizure clusters or status epilepticus.
Conflict and disaster can break medicine supply chains through damaged roads, border closures, destroyed pharmacies, interrupted imports, shortages of fuel, disrupted cold chains and loss of routine health-service funding.
A person may know exactly which medicine they need and still be unable to obtain it.
Stock-outs are not a minor inconvenience
Recent conflict data illustrate how serious this can become. A 2026 clinical audit of children with epilepsy during armed conflict in Sudan found very high levels of treatment interruption and poor adherence, with medicine stock-outs, displacement and loss of medical records among the most commonly reported barriers. Increased seizure frequency, hospital admission and status epilepticus were all documented during the conflict period.
This kind of evidence shows that treatment continuity is not simply a quality-of-life issue. In humanitarian settings it can become a direct safety issue.
Switching medicines during shortages is clinically complicated
When a usual antiseizure medicine becomes unavailable, substitution may sometimes be necessary. However, medicines are not interchangeable in a simple one-for-one way.
Choice depends on seizure type, epilepsy syndrome, age, pregnancy potential, comorbidities, interactions, previous response and the pharmacology of the available medicines. Switching also creates risks if doses are converted incorrectly or if a drug that can worsen a particular seizure type is used without recognising the epilepsy classification.
The International League Against Epilepsy has published expert recommendations for situations involving severe antiseizure medicine shortages, including emergencies, conflicts and supply-chain disruption. These recommendations emphasise careful substitution rather than abrupt, improvised switching.
People may arrive without records
During rapid displacement, people may leave home with little more than what they can carry. Clinic letters, EEG reports, MRI scans, medicine lists and prescription records may be lost, destroyed or left behind.
This creates a practical problem for receiving clinicians. A person may know that they have epilepsy but not remember the exact medicine, dose, formulation or previous treatment history. Parents may remember the colour or shape of a child’s tablets but not the generic name.
Where possible, maintaining a written medicine list, photographs of packaging or a digital copy of key records can reduce this risk. In a crisis, however, many people will understandably have no such documentation.
Loss of records can lead to repeated diagnosis
When medical history cannot be verified, clinicians may have to reconstruct the diagnosis from the beginning. This can lead to repeated EEG, imaging or specialist assessment where those services remain available.
In lower-resource humanitarian settings, however, those investigations may not exist. The person may then receive treatment based largely on history and observed seizure features.
This is one reason continuity of health information matters in humanitarian planning, not just continuity of medicines.
EEG access can disappear quickly
EEG depends on functioning equipment, electricity, trained staff and the ability to interpret recordings. In conflict or disaster, any of these can be lost.
Routine EEG may become unavailable, and prolonged video-EEG or intensive-care EEG is even more vulnerable because it requires more infrastructure.
WHO guidance is clear that convincing clinical epilepsy should not necessarily go untreated simply because EEG is unavailable. In emergency settings, a carefully taken history can become even more important.
MRI and CT access can also collapse
Neuroimaging services are concentrated in hospitals that may themselves be damaged, overwhelmed or inaccessible. MRI requires electricity, specialist maintenance and a stable physical environment. CT may be more resilient in some emergency settings, but it still depends on equipment, radiography staff and functioning referral systems.
This matters when seizures are new, when there has been head trauma, when infection or stroke is suspected, or when a person develops new focal neurological signs.
A person with epilepsy may therefore lose access not only to routine care but also to the investigations needed to identify a new and potentially urgent neurological problem.
Emergency departments may be overwhelmed
During conflict, disaster or mass displacement, hospitals may prioritise trauma, infection, surgery and other immediate threats to life. Neurological services can be reduced or absorbed into general emergency care.
People with epilepsy may delay seeking help because they believe their seizures are less urgent than visible injuries around them, or because travel to hospital is unsafe.
Health systems therefore need clear pathways for recognising seizure emergencies even when services are under extreme pressure.
Status epilepticus becomes especially dangerous when systems fail
Status epilepticus requires urgent treatment. In humanitarian settings, delays can occur because rescue medicines are unavailable, transport is interrupted, emergency services cannot reach the patient or hospitals lack intensive-care capacity.
Stocking appropriate emergency medicines and training non-specialist staff in seizure emergency management can therefore save lives.
Community-level planning also matters when people are living in camps, shelters or remote settlements far from hospital care.
Displacement creates new seizure risks
Forced displacement can involve prolonged travel, crowded shelters, disrupted sleep, heat or cold exposure, dehydration, irregular meals and interruption of established routines.
None of these factors automatically causes epilepsy, but several can lower seizure threshold or make existing epilepsy harder to control in susceptible people.
The risk is amplified when medicine doses are missed at the same time.
Sleep disruption is easy to underestimate
People fleeing conflict may sleep in vehicles, shelters, transit centres or temporary accommodation. Night-time alarms, overcrowding, fear, noise and changing environments can make sustained sleep difficult.
For many people with epilepsy, sleep deprivation is a recognised seizure trigger. Maintaining regular sleep may be impossible in the acute phase of an emergency, which makes continuity of medication and seizure safety planning even more important.
Heat, dehydration and environmental stress can matter
Refugee and displacement settings may expose people to extreme heat, inadequate shelter or limited clean water. A 2026 study of children with epilepsy in Sahrawi refugee camps in Algeria described substantial diagnostic and treatment gaps, inconsistent medicine supply and caregiver concerns about environmental stressors in a low-resource desert setting.
Evidence on individual environmental triggers remains variable, but dehydration, illness, sleep loss and medicine interruption are all clinically relevant concerns in extreme conditions.
Infectious disease can complicate epilepsy care
Humanitarian emergencies can increase exposure to infectious disease through overcrowding, damaged sanitation, interrupted vaccination and reduced access to treatment.
Some infections can provoke acute symptomatic seizures or cause later epilepsy through central nervous system injury. In endemic regions, conditions such as neurocysticercosis, cerebral malaria, meningitis and encephalitis may contribute to seizure burden.
Clinicians therefore need to distinguish between established epilepsy and new seizures caused by acute illness whenever possible.
Head injury can create both immediate and later seizure risk
Conflict and disasters increase traumatic brain injury through blast injury, falls, road collisions, building collapse and direct violence.
Seizures can occur soon after severe head injury, while post-traumatic epilepsy can develop later. A person with no previous epilepsy history may therefore enter the epilepsy care pathway because of the emergency itself.
This adds to neurological demand at the same time that specialist services may be least available.
Children are particularly vulnerable
Children with epilepsy depend heavily on caregivers for medicines, appointments and seizure observation. Separation from parents, school closure, displacement and disrupted paediatric services can therefore have an especially large effect.
Weight changes can also affect dosing over time, and some childhood epilepsy syndromes require specialist treatment choices that may not be available in emergency formularies.
Children with developmental disabilities or communication difficulties may be at additional risk if new caregivers do not recognise their usual seizure pattern.
Pregnancy adds another layer of risk
Pregnant people with epilepsy need continuity of antiseizure medication, because uncontrolled tonic-clonic seizures can endanger both parent and fetus. At the same time, medication choice during pregnancy requires careful risk-benefit assessment.
Humanitarian disruption may interrupt antenatal care, specialist review and access to preferred medicines. Emergency substitution without awareness of reproductive safety can create additional risks.
Where possible, epilepsy care should therefore be integrated with maternal and reproductive health services during emergencies.
People with disabilities may face physical barriers to care
Epilepsy often coexists with intellectual disability, cerebral palsy, mobility problems or other neurological conditions. Evacuation routes, shelters and clinics may not be accessible for people with these additional needs.
Caregivers may also struggle to transport someone who requires supervision after seizures or who uses mobility equipment.
Humanitarian epilepsy care therefore overlaps with disability-inclusive emergency planning.
Seizure first aid still matters when specialist care is absent
In crowded shelters and camps, seizures may occur in front of people who have little understanding of epilepsy. Harmful practices such as restraining the person or placing objects in the mouth can still occur.
Simple seizure first-aid education can reduce preventable injury. People should be protected from hazards, not restrained, and breathing should be observed. Emergency help is required for prolonged seizures, repeated seizures without recovery, serious injury, breathing concerns and other red flags.
Public information needs to be culturally and linguistically appropriate.
Stigma can become more dangerous during crisis
Humanitarian emergencies can intensify dependence on family and community networks. Where epilepsy is associated with stigma, supernatural beliefs or fear of contagion, a person may be hidden from aid workers or excluded from communal accommodation.
Stigma can also prevent people from disclosing their diagnosis when registering with a new clinic or relief agency.
Because treatment continuity depends on identifying who needs medication, anti-stigma work can have direct clinical value during emergencies.
Language barriers can affect medicine safety
Displaced people may receive care in a country where they do not speak the main language. Medication names may differ by brand, packaging may look unfamiliar and dosing instructions can be misunderstood.
Professional interpretation, pictorial instructions and use of generic medicine names can reduce risk. Relying entirely on children or untrained family members to interpret complex medication changes is particularly problematic.
Functional seizures and epilepsy can both occur in displaced populations
Forcibly displaced populations experience high levels of trauma and psychological stress. A 2021 scoping review found that both epilepsy and psychogenic non-epileptic seizures, now often termed functional or dissociative seizures, require attention in displaced populations.
The two conditions can also coexist. Where video-EEG is unavailable, distinguishing them may be difficult.
This reinforces the need to avoid assuming that every seizure-like event in a traumatised person is either automatically epileptic or automatically psychological.
Emergency care must avoid unsafe abrupt withdrawal
When medicine supply is uncertain, people may ration tablets by skipping doses or taking less than prescribed to make the supply last longer.
This can create unstable drug levels and increase seizure risk. It is usually safer to seek clinical advice about available alternatives than to improvise dose reduction without guidance.
Humanitarian programmes need mechanisms for rapidly identifying medicine shortages before patients are forced into this situation.
Generic availability can help — but formulation matters
In many emergencies, the available medicine may be a different brand or generic manufacturer from the one a person normally uses. For many antiseizure medicines, generic substitution is possible, but clinicians still need to consider formulation, release mechanism and dose equivalence.
Modified-release and immediate-release versions should not be assumed to be interchangeable without attention to dosing schedules.
Clear labelling is particularly important when people receive medicines from several humanitarian providers.
Non-specialist care is essential
WHO’s humanitarian guidance is built around the reality that specialist services may not be available. Trained non-specialist clinicians can diagnose and manage many common epilepsy situations, provide continuing prescriptions and identify when referral is necessary.
This form of task sharing is not second-rate care. In many emergencies it is the only realistic way to prevent a complete collapse of treatment.
Specialists can support frontline teams through referral pathways, telephone advice and telemedicine where communication systems remain available.
Telemedicine can preserve expertise across distance
When roads are unsafe or specialists have been displaced, remote consultation can connect general clinicians with neurologists elsewhere.
Digital photographs of medicine packaging, scanned clinic records and remotely shared EEG or imaging can help reconstruct care.
Telemedicine depends on electricity, connectivity and secure communication, so it is not universally available. But where infrastructure survives, it can extend specialist support far beyond the physical location of the neurologist.
Humanitarian supply chains need epilepsy medicines on the list
Emergency medical supply planning often focuses understandably on trauma, infection, maternal health and other acute needs. Chronic neurological conditions can be overlooked.
Yet epilepsy is common, and abrupt medicine interruption can create acute emergencies. Essential antiseizure medicines therefore need to be incorporated into humanitarian procurement rather than treated as optional specialist drugs.
WHO’s broader mhGAP approach supports the use of evidence-based treatments for epilepsy in non-specialist settings precisely because specialist-only models are unrealistic in many low-resource environments.
One medicine list will not suit every population
Humanitarian formularies need to consider local prescribing patterns, age groups, reproductive safety, available laboratory monitoring and the epilepsy syndromes being treated.
A medicine that is inexpensive and familiar to clinicians may still be unsuitable for some patients. Conversely, a newer drug may be difficult to sustain if international donations stop.
Continuity and sustainability are therefore as important as the initial emergency supply.
Long emergencies create different problems from sudden disasters
An earthquake may create an acute period of disruption followed by rebuilding. Protracted conflict or long-term displacement can last years or decades.
In prolonged crises, epilepsy care must move beyond emergency refills. Patients need ongoing review, dose adjustment, pregnancy counselling, assessment of treatment resistance, mental-health support and referral for investigations when possible.
A temporary humanitarian service can gradually become the de facto health system for an entire population.
Refugee camps can contain large unmet neurological need
Studies of forcibly displaced populations have repeatedly identified epilepsy among the neurological conditions requiring ongoing care. A broad 2021 review found substantial variation in reported epilepsy prevalence but consistently highlighted difficulties involving access, cost, repeated health visits and cultural understanding of seizures.
More recent work in Sahrawi refugee camps has documented practical treatment gaps involving inconsistent medicine supply and limited diagnostic access.
The exact epidemiology differs between populations, but the service problem is consistent: chronic neurological disease does not disappear when people cross a border.
Humanitarian workers also need to recognise new-onset seizures
Not everyone who has a seizure during a crisis has pre-existing epilepsy. Acute symptomatic seizures can result from head injury, stroke, infection, metabolic disturbance, toxic exposure, alcohol withdrawal, severe hypoglycaemia and other causes.
Where possible, the clinical priority is to identify and treat the underlying cause rather than automatically label the person as having epilepsy.
This distinction can be difficult when laboratory testing and imaging are limited, which makes careful history and examination especially important.
Mental health and epilepsy care should not be separated
People living through conflict and displacement may experience grief, trauma, depression, anxiety and post-traumatic stress alongside epilepsy. WHO’s humanitarian guidance deliberately places neurological and mental-health conditions within the same practical framework for non-specialist care.
Mental-health symptoms can affect medicine adherence, sleep and willingness to seek care. Some antiseizure medicines can also affect mood or behaviour.
Integrated care is therefore particularly valuable in emergency settings where patients may have multiple overlapping needs.
Safety planning changes when the environment changes
A seizure plan designed for someone’s home may no longer work in a shelter, camp or temporary accommodation. Cooking may happen over open flames, water access may involve communal facilities, sleeping arrangements may be unfamiliar and roads may be unsafe.
Risk assessment therefore needs to be adapted to the actual environment.
Simple changes — such as ensuring companions know seizure first aid, keeping medicine accessible and identifying the nearest functioning health post — can become important parts of emergency planning.
Humanitarian care should protect dignity as well as seizure control
People with epilepsy can become dependent on others during displacement, particularly when seizures are frequent. This can increase vulnerability to neglect, exploitation and loss of privacy.
Care should therefore preserve autonomy wherever possible. A person with epilepsy should not automatically be excluded from education, communal activities or decision-making simply because they have seizures.
Humanitarian standards apply to people with chronic neurological conditions as much as to anyone else.
What health systems can do before a crisis
Preparedness can reduce later harm. Useful measures include maintaining resilient medicine stocks, using generic drug names in records, enabling portable or digital summaries, training primary-care teams in epilepsy, identifying referral centres and incorporating chronic neurological conditions into emergency health plans.
Patients can also be encouraged, where feasible, to keep an up-to-date medicine list and emergency information. This should be seen as an additional safeguard rather than shifting responsibility onto patients for failures in the health system.
What humanitarian programmes need during a crisis
Core priorities include maintaining a reliable supply of essential antiseizure medicines, avoiding abrupt treatment interruption, training non-specialists, recognising status epilepticus and other emergencies, preserving referral routes, restoring diagnostic capacity where possible and making services accessible to children, pregnant people and people with disabilities.
Data collection also matters. Without knowing how many people are receiving treatment, which medicines are running out or how often seizures are leading to emergency care, services cannot plan effectively.
Recovery should rebuild more than the pre-crisis minimum
After the acute emergency, there is an opportunity to rebuild neurological services in a stronger and more decentralised way. Task-sharing models, reliable medicine procurement and better referral networks developed during a crisis can sometimes become permanent improvements.
Recovery planning should therefore include epilepsy within broader neurological and non-communicable disease services rather than allowing emergency programmes simply to disappear.
The central issue is continuity
For people with epilepsy, humanitarian crises create a distinctive danger: a condition that may have been stable for years can become unstable because the systems around the person collapse.
The medicine may disappear. The doctor may leave. The clinic may close. The records may be lost. Sleep and safety may vanish at the same time.
Protecting epilepsy care in emergencies therefore means protecting continuity — of medicines, information, clinical knowledge, emergency treatment and follow-up.
What this page does — and does not — explain
This page focuses on epilepsy care during humanitarian emergencies, armed conflict and major health-system disruption. The separate page on Migration, Displacement and Continuity of Epilepsy Treatment will focus more specifically on the longer journey between health systems, cross-border care, asylum and resettlement, prescription transfer and continuity after relocation.
Sources
WHO and UNHCR — mhGAP Humanitarian Intervention Guide
WHO and UNHCR — mhGAP-HIG training of health-care providers
ILAE expert recommendations — treatment strategies during shortages of antiseizure medicines
Epilepsy and psychogenic non-epileptic seizures in forcibly displaced people: scoping review
Treating epilepsy in forcibly displaced persons
Neurological care priorities for refugees and other forcibly displaced people
Neurological Care of Refugees and Other Forcibly Displaced Persons
Epilepsy in refugee camps in Algeria: treatment gaps and environmental challenges
Medication adherence and treatment gaps in Sudanese children with epilepsy during armed conflict
Evidence checked: September 2026.