Death comes to everyone, and death by life-limiting illness is not put on hold, even when there are more immediate threats to life and survival.
Elsewhere in the world, this tragic time may be buffered through adequate access to pain management and the presence of professionals to support patients and families through the dying process and into bereavement.
But when the whole of life is shattered by war, what would under ordinary circumstances be an impossibly difficulty time, becomes unbearable.
Added to that is the heightened potential for tragedy. Opportunities are missed, through fear or frustrated efforts, that may have made the difference between life or death, sickness or health, excruciating pain and the relief of that pain.
The onset of war heralds a massive disruption to the lives of ordinary people, and yet the extraordinary events that disrupt ordinary lives are not superseded. Since the onset of civil war in Syria in 2011, the world’s media has been debating the use of chemical warfare or commenting on the involvement of other states.
The enduring violence in Syria has so far displaced millions of people, with the UN registering 1 million people as Syrian refuges in Lebanon. The Lebanese population is only 4.5 million. This increase in the population brings with it an increased demand on palliative care services.
Opioid medications, essential for treating pain in palliative care patients are strictly controlled worldwide. Although Lebanon is one of the few countries in which morphine and other opioids are legal and relatively accessible, the increase in population due to the influx of refugees has caused a critical shortage of these vital painkillers. Lebanon has already consumed its quota of injectable morphine for 2014. Health providers are depending on oral morphine and fentanyl – which is a much more expensive alternative.
In Lebanon, burial procedures are complicated since a person can only be buried in cemeteries associated with her or his religious sect. Syrian immigrant families face many challenges when they need to bury a family member who died in Lebanon, and transferring patients back to Syria for burial is complicated and can be unsafe.
Dr Hibah Osman and Loubna Batlouni of Balsam palliative care centre in Beirut commented on the impact that the increase in the number of people needing their services has had on their ability to provide quality palliative care.
Staff at Balsam have taken care of a number of Syrian patients, but Dr Osman emphasized the fact that it is mostly the educated who have been able to find and access Balsam services by finding the organisation’s website on the internet or through referral by private physicians.There are many more who are not receiving the care they need either because the have no access to information about the services or because they are outside Beirut and not accessible to the Balsam team.
A few months ago a young mother was dying of advanced colon cancer in the Bekaa, nearly two hours away from the region in which Balsam operates. The woman was in pain and also struggling with her rapidly advancing illness and the impact her impending death would have on her young children who were already suffering the insecurity and trauma of displacement. The Balsam team did not have the resources to assist her directly. However, they supported the mental health team from International Medical Corps (IMC) by directing them to local resources, ensuring that she received proper pain management, and teaching IMC staff how to support her and her family psychologically.
Find out more about the work of the Lebanese Center for Palliative Care – Balsam – online.