Paediatric Palliative Care During Conflict and Crisis

Author: Anindita Rochili 

15 February 2024

The healthcare system has been strained and tested over the years, with or without conflict. According to the UNHCR report (2022), the number of displaced people has been increasing with the wars in several areas, with the majority (57%) coming from Syria, Ukraine, and Afghanistan. By late 2022, this figure reached approximately 108 million people, with children constituting around 40% of the total count. This sizable number is likely to rise, especially in regions like Ukraine and other conflict-affected areas. Fleeing persecution or oppression, these children face healthcare concerns and needs, particularly those dealing with serious illnesses like cancer.

Underinvestment in health services and research has taken its toll on health and social protection systems, especially for those they are intended to serve. This challenge is more pronounced in humanitarian settings, where families and individuals who are internally displaced or cross borders for safety may find themselves in areas lacking the necessary support. The report notes that around 76% of refugees are hosted in low-and-middle-income countries (LMICs), including Middle Eastern countries such as Iran (3.4 million), and Türkiye, which has the highest population at 3.6 million. The ratio of forcibly displaced people is 1 in 7 people in Lebanon and 1 in 16 in Jordan, with both countries facing their own internal crisis and instability.

Children in these situations, besides having limited access to clean water and food, may lack the necessary tools for timely diagnosis and access to crucial medical interventions. This includes pharmaceuticals, medical equipment, and procedures vital for conditions that could benefit from palliative care. The hindrance in pain and symptom management, often due to a shortage of pain-relief medicine, poses a significant concern.

Wars may delay and interrupt care in an already fragile infrastructure. This may not only prolong suffering, it also overwhelms systems and workforce, all while violating the sanctity of healthcare. It is known that most children (around 70%) experience severe pain with cancer, both in solid and blood tumours, either from the disease or medical interventions (Le-Short et al., 2022). There are a number of ways to alleviate pain in cancer, one of them is through procuring and administering the appropriate pain-relief medication or analgesics. This includes prioritizing the availability of Morphine or other Opioid alternatives. Unfortunately, achieving this baseline is often challenging, even in non-conflict settings, due to underfunding directed to specialized medical treatment, including for non-communicable diseases (NCDs).

Potential solutions lie in networks of humanitarian organizations collaborating to coordinate and generate funding. Notable examples, among others, are collaborations in the Middle East between St. Jude Children’s Research Hospital and the American Lebanese Syrian Associated Charities (ALSAC) with national or local institutes and foundations. In Lebanon, with The American University of Beirut Medical Center (AUBMC) and the Children’s Cancer Center of Lebanon Foundation (CCCL); also with King Hussein Cancer Center and Foundation (KHCC and KHCF) in Jordan. Such partnerships may help with coordination and generation of funding, which results in guidelines, initiatives, and other innovations.

Support platforms across countries, sectors, and institutions can play a pivotal role in finding resources and increasing inventory through advocacy for the needs of the children population. Navigating the political economy in conflict settings is challenging but not impossible. With a commitment to universal health coverage, countries can assess national resources to develop interventions aiming for equal healthcare outcomes, as seen in Türkiye (Sullivan et al., 2018). It’s crucial to emphasize that ceasefires are imperative for aid delivery and resolving the primary causes of conflict, allowing for lasting peace. In places like Gaza and other occupied Palestinian territories, a ceasefire would facilitate aid delivery and enable the safe return of refugees.

As a final note, I used to think that growing up in a safe, comforting environment is a staple for everyone. Until I realised that going to bed soundly, with good health, and full stomach somehow remains a luxury for millions of children everywhere. That in this modern age, with the variety of pain-relief medicines that are available, every unnecessary death is one too many. 

What about you, what do you wish for? Let’s initiate a conversation within the global PallCHASE community to explore their perspectives regarding advocacy for improved access to pain-relief medicine, especially for vulnerable populations such as children with cancer in conflict settings.

About the author
Anindita Rochili is a volunteer and researcher with a background in biomedicine and health economics. She works in paediatric palliative care from the Asia Pacific region, with interests in socioeconomic outcomes, sustainable financing, and environmental health. She is glad to connect with palliative care communities globally.




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