About the Author: Ms. Joan Marston is a paediatric palliative care nurse, educator and advocate living in South Africa. A belief that everyone should have access to palliative care led her to co-found PallCHASE Palliative Care in Humanitarian Aid Situations and Emergencies.
On the 16th of May the world commemorated the International Day of Living Together in Peace. Sadly, for many, peace is just a pipe-dream. According to the Global Humanitarian Overview of April 2022, there are 303 million people needing humanitarian assistance with 100 million displaced within their own countries or as refugees; 8.5 million in Ukraine alone.
Ukrainians are suffering from the appalling destruction of lives, property, facilities and land caused by war; and the impact is felt far beyond the country’s borders. In Yemen, frail children are dying of starvation. Climate change in India, Mozambique and South Africa have brought floods that have destroyed lives, homes and infrastructure; and grinding, unremitting poverty across the world, impacts health and drives people to despair. Add the ongoing impact of Covid and there does not seem to be much peace or togetherness to commemorate.
Hidden amongst these numbers and situations is an unknown number of adults and children who need palliative care – and the human and material resources so necessary to provide this.
For those who believe palliative care is a human right, an integral part of Universal Health Coverage UHC) the global situation poses highlights many challenges.
The unfortunate reality is that palliative care is not available to most of the world’s population even in relatively stable, high-income countries. The challenge is not only what can be done to increase access to palliative care in peaceful settings – but also in humanitarian crises which impact health, destroy fragile health systems and lead to increased mortality, suffering, grief and bereavement. The need for palliative care increases and this is being recognised by humanitarian health responders such as Medicins Sans Frontieres and is included in the Sphere Standards for humanitarian action. However, it remains a low priority and competes for relevance and funding with many other humanitarian response activities such as saving lives, providing food, water, sanitation, and shelter.. Palliative care agencies simply do not have the capacity to respond on the ground, and aim to educate and integrate palliative care into the humanitarian health response.
Can anything be done to ensure that palliative care reaches all who need it? There are examples of successful provision in ecological and man-made disasters such as during the floods in Kerala and recently in Kwazulu-Natal. Palliative care is developing in areas of chronic humanitarian need and unrest such as Gaza and South Sudan. It has been provided in refugee settings in Uganda and Bangladesh; and it continues to be recognized as relevant to treating Covid.
In Ukraine, Palliative care had developed across the country with government funding and support. This tragic war has impacted these services in many ways. In more peaceful areas at present, such as Kyiv , services have continued but supplies and funding are severely disrupted. In Kharkiv palliative care health care facilities and the homes of personnel have been destroyed. Some patients have been taken to other countries through effective collaborations such as SAFER Ukraine which takes children requiring cancer treatment to peaceful countries.
There are lessons being learned from these crises.
- All palliative care services should have an Emergency Plan in place and ensure adequate supplies are always available.
- Collaboration is key and should be guided by those who are directly impacted by the crisis.
- Education of humanitarian health responders must include palliative care, and palliative care practitioners should include humanitarian health responses in their education.
- Essential palliative care medicines and resources must always be included in humanitarian health supplies.
- Advocacy for these resources must be ongoing with policy makers and funders.
A humanitarian disaster can affect anyone anywhere in the world. Climate change, natural disasters, diseases, civil unrest and war increase the need for palliative care but we have been slow in preparing and in responding.
“Hope for the best but prepare for the worst” is a long-standing palliative care principle. We hope for peace – but prepare for these crises.
- A Field Manual for Palliative Care in Humanitarian Crises
- Neglected Suffering: The unmet need for palliative care in Cox’s Bazaar
- Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises