Author: Joan Marston: Advocacy Lead Executive Committee for Pallchase
The following statement by Joan Marston was made to UICC & Team Humanity at an International Side Event CND 68 in Vienna on Access and Availability of controlled substances for medical and scientific purpose. The event was held on Thursday 13 March 2025.
Thank you, Your Excellency, Dr Hastie, UICC for the opportunity to speak and greetings from South Africa
We live in a world of increasing humanitarian crises- man-made Conflict, Climate crises, mass displacement and disease pandemics.
Humanitarianism and Palliative Care meet in their overarching goal – their active, compassionate and coordinated response to suffering. While palliative care addresses serious health-related suffering and restores dignity, involving clinical, spiritual and psychosocial interventions, including the management of pain and distressing symptoms which often require the use of controlled substances must be integrated into the overall humanitarian health response. WHO has published a Guide to the Integration of Palliative Care and Symptom Management in Humanitarian Settings includes information of where it can be integrated in each humanitarian triage level; and includes a recommended Package for Palliative Care in Humanitarian Settings. Controlled substances are part of the package.
So why must palliative care, and paediatric palliative care (essential to the achievement of SDG 3 and Universal Health Coverage,) be included humanitarian settings?
The December 2024 Report from the UN Office for the Coordination of Humanitarian Affairs estimates that in 2025
- Over 305 million people will require humanitarian aid
- 1 in 6 / 19%children worldwide are living in or affected by conflict
- UNHCR estimates that by the end of this year 139.3 million people will be displaced or stateless
- Children make up 40% of refugees and 49% of internally displaced persons
- 50% of all maternal, newborn and under 5 mortality occurs in humanitarian settings
- In humanitarian crises and settings, we have those with existing palliative care needs, those who will be diagnosed with advanced disease during the crisis, and those whose condition is controlled but due to a breakdown in access to treatment and essential medicines will progress to requiring palliative care.
- Support for the dying and bereaved and often forgotten caregivers and staff
- Added to these is often an increase in traumatic and painful injuries, more surgical interventions, malnutrition, disability, and increased morbidity and mortality together with destruction of health services and facilities as well as transport routes
- What is required are national and international policies; political will, integration into health systems and Disaster Response strategies, education of all health professionals in both palliative care and humanitarian response principles guidelines, expertise that can be accessed so easily in our technology-driven times and funding
We have examples of provision: the outstanding rapid assessment and programme set up for Rohingya refugees Cox’s Bazaar in Bangladesh; during the floods and Climate emergency in Kerala the established palliative care services and networks ensured access to essential medicines and care; and in Ukraine in a prolonged conflict palliative care, development, education and research continues. Palliative care clinicians including paediatric palliative care experts, called up for army service took their expertise into the conflict zones and the front lines and improved pain management practices. Countries and individuals continue to collaborate across borders in Ukraine and more recently in Gaza.
Common to all these successes is integration into health systems.
A recent Report from INCB stated that “the international drug control conventions allow for the expedited movement of controlled substances for medical use during emergencies. Competent national authorities may permit the export of medicines containing narcotic drugs or psychotropic substances to the affected areas in the absence of the corresponding import authorization or estimate. Urgent deliveries do not need to be included in the estimates of the receiving country.” (Report of the International Narcotics Control Board for 2024). https://www.incb.org/documents/Publications/AnnualReports/AR2024/Annual_Report/E-INCB-2024-1-ENG.pdf)
When the 2014 WHA Resolution on Palliative Care was written with major input from the global palliative care community, we did not consider humanitarian crises. It took the Syrian refugee crisis to alert us to the need.
At present we have accessible online training courses eg through PallCHASE, International Children’s Palliative Care Network and Medicine Sans Frontieres.
We have in this world all that is necessary to provide palliative care, pain and symptom management and the use of controlled medicines in humanitarian settings. We could make it happen
Martin Luther King Jnr said: There is no deficit in human resources. The deficit is in human will.
We have an obligation to ensure access and availability in humanitarian settings, to relieve suffering and promote dignity, not because of any policy or Resolution but because it is simply the right thing to do.
Krakauer, E. L., Daubman, B. R., & Aloudat, T. (2019). Integrating palliative care and symptom relief into responses to humanitarian crises. The Medical journal of Australia, 211(5), 201–203.e1. https://doi.org/10.5694/mja2.50295
