It is estimated that over 200 million people worldwide will need humanitarian assistance in 2021 (UNOCHA). Humanitarian crises may be the result of epidemics of life-threatening infections, conflict or disaster, and are all associated with high mortality. The majority are protracted crises, lasting for many years, and where the pre-crisis care for patients with life-limiting illness may have been interrupted, resulting in large numbers of patients with serious health related suffering who require access to palliative care.
COVID and the 2014 Ebola epidemic in West Africa exposed the gap in access to palliative care for patients living through humanitarian crises. The WHO publication ‘Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises’ (2018) and the inclusion of a new chapter on palliative care into the Sphere handbook (Humanitarian Charter and minimum standards in humanitarian response, 2018), have further pushed the conversation within the humanitarian sector about the need to integrate palliative care within medical response.
What does (or could) palliative care in humanitarian response look like? We need a model of palliative that is clearly defined and maintains simplicity, so that it can be realistically implemented by humanitarian medical staff tending to large numbers of patients in challenging contexts. Focusing on some key areas of palliative care, such as pain and symptom relief, improving communication, training family members to provide care in the home and basic care planning could relieve significant suffering for patients and their families. Care needs to be multidisciplinary and patient-centred.
There are common principles of humanitarian response and palliative care. Both share similar ethical foundations and engage people with a similar drive to respond with humanity and compassion to relieve human suffering. Both are interested in maintaining dignity, helping the most vulnerable and being present for people in difficult times. This overlap of goals and ethics presents an opportunity when integrating palliative care in humanitarian response.
Palliative care in humanitarian settings is in its infancy, and we have a long way to go before all patients and families living through conflicts, disasters and epidemics can access palliative care. The theme for World Hospice and Palliative Care Day this year ‘Leave no one behind – equity in access to palliative care’ is a call for us to take action, and think about how we can help those living through humanitarian crises to access palliative and end of life care.
Kathryn is a palliative care specialist from the UK, and a member of the executive committee for PallCHASE (Palliative care in Humanitarian Aid Situations and Emergencies). Kathryn is currently working as a Palliative Care Specialist for Medecins Sans Frontieres (Doctors without Borders).