Continuing our new series about palliative care in the context of humanitarian crisis. In the coming weeks, we shall be looking at the implications of providing palliative care and bereavement care for migrants, refugees and people who have fled war-torn countries and places of conflict and how the hospice and palliative care community can offer appropriate support.
Today, we hear from Joan Marston, Co-chair of PALCHASE – Palliative Care in Humanitarian Aid Situations and Emergencies – and ICPCN (International Children’s Palliative Care Network) Global Ambassador.
I often wonder whether we have become almost inured to the suffering around the world, overwhelmed as we are by images of starving children, soldiers fighting, rescuers digging into rubble, overloaded boats sinking and refugees seeking help and asylum. The needs of those affected in humanitarian situations, whether immediate or prolonged, are immense, with the necessity for providing basic support understandably a priority.
As palliative care practitioners and human rights activists, we have almost all been guilty of overlooking a population that is difficult to access, growing, mobile, but where there is an increasing realisation that palliative care has a role to play.
For many of us the ‘wake up call’ has come from images of children and their suffering. I found the naming of a new syndrome by Dr MK Hamza, Head of the Mental Health Division of the Syrian American Medical Society, particularly haunting. ‘Human Devastation Syndrome’ goes some way to describing the impact of this unutterable horror that children are experiencing.
When the need is overwhelming, spread around the world, resources are limited and life-sustaining interventions are paramount, where can palliative care find an entry point? We have the knowledge and skills to provide palliative care; we know what medicines are required and we know who needs palliative care.
We are very resourceful! When the hospice palliative care community in sub-Saharan Africa responded effectively to the HIV and AIDS epidemic, it was a case of doing what we knew: applying principles, learning quickly, being resourceful and adapting to a new, rapidly growing patient population. Practical, applied compassion was the driver. We overcame challenges with limited resources, and we can do this again. There are examples of palliative care being provided in humanitarian and post-humanitarian settings – Nepal, Uganda, Greece, Jordan, Germany and Austria are all examples. Research is being carried out and planned. Models are to be piloted and humanitarian response organisations, such as Médecins Sans Frontières/Doctors without Borders (MSF), are open to including palliative care. The World Health Organization has a Community of Practice looking to develop guidance for palliative care in humanitarian situations; and we are hopeful that the next edition of the Sphere Handbook will contain relevant information.
A strength of palliative care is multidisciplinary teamwork; the setting up of PALCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies) and a group that is forming a European Association for Palliative Care task force have brought together those with many different types of expertise. Perhaps in itself a new model for palliative care? The crisis is now and our response needs to be in the present.
If you would like to be involved in PALCHASE please email Joan Marston.
James Smith, Tamman Aloudat. Palliative Medicine. 2017. Vol. 31 (2) 99-101.
J Marston, L De Lima, RA Powell. Palliative care in complex humanitarian crisis response. The Lancet. Nov 2015. Vol 386, No.10007, P.1940.
Links and further reading
- EAPC Task Force for Refugees and Migrants.
- PALCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies). For information please email Joan Marston.
- PALCHASE Facebook page.
- If you’ve worked in humanitarian health care in the last two years, please complete this survey and add your voice to a global discussion on current practices and needs related to non-curative healthcare in humanitarian emergencies.
- Palliative care in humanitarian crises: Always something to offer. The Lancet Online, 15 April 2017.