Humanitarian emergencies often bring increased suffering across the world. Conflicts, climate-amplified disasters, displacement, chronic and infectious disease, often together and in settings of entrenched poverty, have an immense impact on social, economic, political, belief and health systems, and the individuals, families and communities that compose these systems.
Throughout history, wars and conflict have led to changes and development within the fields of medicine and humanitarian response. From Henri Dunant who founded the International Red Cross after the battle of Solferino; Florence Nightingale during and after the Crimean War, World War I and World War II and the present conflict in Ukraine and other countries, medicine and implementation science have been challenged to develop new and innovative modalities of health care provision.
Early pioneers of the modern Hospice and Palliative Care movement were affected by WWII. Cecily Saunders left Oxford University to become a Nurse wanting to be useful during the war, and Elisabeth Kubler-Ross left school at 16 to cross Europe and work with refugees.
Currently, almost 300 million people require humanitarian aid and assistance. However huge cuts in funding for these emergencies decrease the resources available for even the most basic response. The numbers of children and adults experiencing serious health-related suffering is increasing. Access to essential medicines, including pain medicines and palliative care, is often inadequate and interrupted resulting in increased mortality and human suffering. At present, over 50% of all maternal, newborn and under five deaths are in humanitarian settings. Access to basic palliative care still lags behind global need.
In this current reality, palliative care practitioners must challenge the status quo and learn from the provision of palliative care in different humanitarian settings in countries such as Ukraine, Bangladesh, Uganda, Lebanon and India.
The huge outflow of refugees from Syria, and awareness of their suffering led to a new movement in palliative care, with the goal of integrating palliative care, for all age groups into humanitarian responses. PallCHASE – Palliative Care in Humanitarian Aid Situations and Emergencies – was initiated in Salzburg in 2014 at a farewell seminar for Dr Kathy Foley and Mary Callaway of the Open Society Foundations.
Now hosted by the Global Health Academy of the University of Edinburgh, the goal of PallCHASE is to integrate palliative care into the humanitarian health response through advocacy, education, research and networking. We believe every humanitarian health responder should have knowledge and skills in palliative care and every palliative care practitioner must have basic awareness and skills to respond to humanitarian disasters.
Together, we must respond collaboratively within these crises to provide palliative care within humanitarian emergencies, in both triage and treatment, developing policies, legislation and protocols for compassionate and effective health care service delivery.
Preparing Palliative Care programmes, health systems and pre-service and inservice education for a changing world is a critical and essential task. This must include preparations for providing palliative care in unexpected, expanded and prolonged humanitarian crises – and proactive planning for the immediate and prolonged impact of a nuclear disaster.
Palliative Care Guidelines may need to be condensed and shortened for efficient access and implementation in a high stress situation. Training courses for volunteers and families can be streamlined and embedded in community response documents. Avenues of communication developed for specialist advice will be described in a new PallCHASE Position Paper, with input from authors from across the globe. This will soon be available on the PallCHASE website: www.pallchase.org and from admin@pallchase.org. This working Position Paper, initially developed by the PallCHASE Advocacy subgroup, identifies the need for palliative care in humanitarian settings, addresses a variety of issues related to palliative care implementation, and ends concludes with a strong Call for Action.
Ensuring the dignity of people enduring health related suffering is a universal human concern that transcends borders, cultures and political divisions. The question is no longer whether palliative care should be integrated into humanitarian responses, but how quickly and effectively this integration can be achieved.
Joan Marston and Richard Bauer: Coordinators of the PallCHASE Advocacy Working Group and members of the Executive Committee of PallCHASE
