PallCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies) is an international network which aims to improve access to palliative and end of life care for people living through humanitarian crises. A humanitarian crisis may be the result of conflict, epidemics or natural disaster.
PallCHASE started as a multi-professional network of volunteers in 2016 (initially known as PALCHE – Palliative Care in Complex Humanitarian Emergencies). The idea for the network was developed by a global network of palliative care leaders, originally in response to the large number of refugees fleeing from conflict in Syria in 2015. The group recognised that humanitarian medical response focuses on life-saving activity, and neglects the suffering of patients with life-limiting and life-threatening illnesses or injuries and those at end of life.
The PallCHASE network aims to address the limitations in providing palliative care to people living through humanitarian crises through advocacy, research and education. In its early years, PallCHASE prioritised advocacy and guideline development, which contributed to the publication of the WHO guide ‘Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises (1) ’ and later contributed to the publication of ‘A field manual for Palliative Care in Humanitarian Crises (2)’.
The network published an article in the Lancet in 2017 ‘Palliative Care in Humanitarian Crises: Always something to offer (3)’ and successfully advocated for a palliative care standard to be included in the Sphere handbook (4) . At the start of the COVID pandemic, PallCHASE worked together with the International Association of Hospice & Palliative Care (IAHPC), The Worldwide Hospice & Palliative Care Association (WHPCA) and the International Children’s Palliative Care Network (ICPCN) on briefing notes and a webinar series (5).
PallCHASE today is a network of around 200 volunteers from 31 countries with expertise in palliative care or humanitarian response. Originally hosted by IAHPC , PallCHASE is now within the Global Health Academy of the University of Edinburgh. PallCHASE hosts quarterly online webinars, with speakers sharing experiences of providing palliative care to populations living through humanitarian crises. Recordings of the presentations and webinars are available using the following link: https://www.youtube.com/channel/UCGb_uVj0FucQkqTWI0dqdjA
The next PallCHASE online webinar will be on 20th October, 2021. For more information about PallCHASE or to join the PallCHASE network, visit our website http://www.PallCHASE.org. Alternatively, send an email to email@example.com.
Kathryn Richardson World Health Organization. (2018). Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises: a WHO guide. World Health Organization  Waldman E, Glass M ‘A field manual for Palliative Care in Humanitarian Crises’ Oxford University Press 2019 DOI: 10.1093/med/9780190066529.001.0001  Powell R et al ‘Palliative Care in Humanitarian crises: Always something to offer’ Lancet. 2017 Apr 15;389(10078):1498-1499 DOI: 10.1016/S0140-6736(17)30978-9  The Sphere handbook. Available at: https://spherestandards.org/handbook-2018/ Accessed on 21.8.21  Global Palliative care and COVID series. Available at: http://globalpalliativecare.org/covid-19/ Accessed on 21.8.21
Principles of Humanitarian Palliative Care
The WHO defines humanitarianism as the benevolent response to the suffering and needs of others. It is action to prevent and alleviate human suffering wherever it may be found, to protect life and health, and to ensure respect for the human being. Motivated typically by charity, solidarity or a sense that one should not remain passive while others are in need, humanitarianism encompasses responses to suffering caused by disaster, conflict, a health emergency or protracted poverty. It often entails providing health care and social supports such as protection, food, water, shelter, sanitation and education.
The following four principles also help to define humanitarianism:
- Humanity: preventing and alleviating human suffering wherever it may be found, protecting life and health, ensuring respect for the human being, promoting mutual understanding, friendship, cooperation and lasting peace among all peoples.
- Impartiality: making no discrimination as to nationality, race, religious beliefs, class, gender or political opinions; endeavoring only to relieve suffering, giving priority to the most urgent cases of distress.
- Neutrality: taking no sides in hostilities or engaging at any time in controversies of a political, racial, religious or ideological nature.
- Independence: maintaining autonomy so as to be able at all times to act in accordance with the principles of humanity, impartiality, and neutrality.
Humanitarianism implies recognition that suffering is universal and requires a response, that suffering cannot be met with indifference. Humanitarianism entails respect for human dignity, helping and protecting others regardless of who they are or what they have done. It involves protecting life and health not only by responding to disaster and disease, but also by preventing them.
Principles of Palliative Care in Humanitarian Emergency or Crises:
People affected by different types of emergencies or crises, such as earthquakes, major storms, hemorrhagic fever epidemics or political violence, may suffer in different ways and require care of different kinds. The principles are:
- Relieve human suffering: The most fundamental goal not only of palliative care, but also of medicine itself, including medicine practiced in humanitarian emergencies and crises, is to relieve human suffering. Saving lives is a crucial way to achieve this goal but not the only way.
- Palliative care and symptom control: Humanitarian responses to emergencies and crises should include palliative care and symptom control. There is an ethical and medical imperative to include palliative care in humanitarian responses.
- “Regards dying as a normal process” and never intends to “postpone death”
In humanitarian emergencies and crises, the statements that palliative care “regards dying as a normal process” and never intends to “postpone death”, as in the 2002 WHO definition, require additional clarification. In this setting, clinicians should provide care aimed at saving life, while also providing appropriate treatment for pain, symptoms and other sources of suffering. Palliative care never intentionally hastens death but provides whatever treatment is necessary to achieve an adequate level of comfort for the patient in the context of the patient’s values.
Palliative care and life-saving treatment should not be regarded as distinct. Palliative care and symptom control should be integrated as much as possible with life-saving treatment for patients with acute life-threatening conditions or triaged red. These tables incorporate recent suggestions from WHO guidelines regarding recommendations for standard triage categories in humanitarian situations.
- Palliative care should commence immediately, as needed, for patients with non-life-threatening conditions (triaged yellow) whose injury- or disease-specific treatment may be delayed.
- Palliative care must be provided for all patients deemed expectant (triaged blue) and should commence immediately.
Table Reference: 1. World Health Organization. Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises: a WHO guide [Internet]. Geneva: World Health Organization; 2018 [cited 2019 Feb 11] p. 107. Available from: https://apps.who.int/iris/bitstream/handle/10665/274565/9789241514460-eng.pdf?sequence=1&isAllowed=y