Continuing the Salzburg Questions series that encourages a global discussion about the key issues affecting palliative care.
On World Refugee Day today, 20 June, Dr Emmanuel Luyirika, Executive Director, and Shelley Enarson, Communications Consultant, both of the African Palliative Care Association, explore the fourth question in the Salzburg Questions that asks why refugees have limited access to quality health care and end-of-life care.
The refugee crisis is reaching epidemic proportions globally with cross-border migration from countries in the Middle East, North and West Africa – especially Syria, Libya, Afghanistan, Nigeria, Gambia – and other refugees from the region entering Europe.
In Africa, the situation is no better.
During the month of May, Uganda received 2,000 refugees daily from South Sudan, and currently hosts about 1.2 million refugees from across the continent – making it the third highest refugee host country in the world.
This is happening in a country where the health system already falls short of meeting the needs of its citizens, with palliative care coverage still low.
Other refugee host countries are facing similar challenges across Europe, Africa, Asia, and South America, as well as other regions of the world.
Influxes of refugees in some of the lesser-developed regions, such as Africa, are transitioning to neighbouring countries where healthcare systems are not well developed and are struggling to meet the need of their national citizens. The addition of refugee populations stretches these systems to near-breaking points within a context of already limited resources allocated to health services.
Refugees often find it easier to move to less developed countries because of limited immigration controls. More developed countries with more robust health systems are often more stringent in allowing in refugees, which keeps most refugee resettlement within lesser-developed countries.
This exposes refugees to healthcare services that are often not able to offer comprehensive care, including palliative care.
As a way of solving this problem, the UNHCR (UN Refugee Agency) donor countries and organisations working in refugee situations should ensure that palliative care is included in all emergency responses to limit the suffering that refugees with palliative care needs experience.
Core to palliative care inclusion in emergency response services is a move towards the inclusion of palliative care into the Sphere Handbook, which serves as the gold standard for complex humanitarian emergency interventions. This Humanitarian Charter is regarded by implementing agencies, as well as bilateral and multilateral donors, as the “ethical and legal backdrop to protection principles” of refugees and other vulnerable populations (The Sphere Project, p. 6).
The inclusion of palliative care is included in a first phase of open online public consultation until 30 June 2017.
An inclusion of palliative care into the Sphere Standards could ideally lead to a broader allocation of palliative care funding as a mainstreamed priority in complex humanitarian emergencies globally.
Such a move would not only lead to an expansion of palliative care services as part of UHC objectives, it would also ensure its services and ethos impacts communities in situations of dire need, with lesser infringement on resource strapped health systems.
Links and further reading
- Follow the EAPC Blog for more posts in the Salzburg Questions series.
- Follow the global dialogue on Twitter. Using the hashtag #allmylifeQs the nine Salzburg Questions will be debated throughout 2017.
- Follow the Palliative Care in Humanitarian Crises series on the EAPC Blog.
- The African Palliative Care Association.
- 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.
- New PALCHASE Survey on palliative care in humanitarian contexts – interested in joining a community of practice? Read more about the survey and take part here.
- Ethics Narratives in Humanitarian Aid (ENHA), February 2017. (Accessed 8 June 2017).
- The Sphere Project – Humanitarian Charter and Minimum Standards in Humanitarian Response. (Accessed 8 June 2017).
- Marston J, Palliative Care in Humanitarian Situations – is it achievable? February 2017. (Accessed 8 June 2017).
- University of Glasgow End of Life Studies: Death, dying and end of life care among Syrian refugees in Lebanon. (Accessed 8 June 2017).
- McDonald M, Palliative Health Care in Jordan for Syrian Refugees, Master’s thesis. McMaster University, Canada, May 2017. (Accessed 8 June 2017).
- South Sudan war strains Uganda’s generous refugee policy, April 2017. (Accessed 8 June 2017).
- Uganda at ‘breaking point’ from S Sudan refugee crisis, 23 March 2017. (Accessed 8 June 2017).