To celebrate World Refugee Day 2018, we are delighted to republish this post that originally featured in 2017 in a series about palliative care in the context of humanitarian crises. The series looks 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.
Colleagues from the World Health Organization Eastern Mediterranean Regional Office: Dr Ibtihal Fadhil, Regional Adviser, Noncommunicable Diseases, and Gemma Lyons, UNV Technical Officer, Noncommunicable Diseases and Mental Health Division, introduce the series.
In conflict situations, chronic medical conditions, such as cancer, can become a life sentence. Even the most treatable cancers are difficult to survive because access to diagnostic and treatment facilities is limited and unaffordable. Just transporting essential food and medications to besieged areas is difficult and risky; the world watched in September when a convoy of 31 United Nations aid vehicles was attacked in Syria.
Also, basic healthcare infrastructure has all but collapsed in some areas, and the number of medical professionals available is diminishing in war zones.1 Even medical facilities are not a safe haven for treatment and recover. Hospitals are being attacked.
Currently, in WHO’s Eastern Mediterranean Region, half of the 22 countries are experiencing an acute or protracted emergency. On top of this, we are faced with the worst refugee crises the world has ever known. Today, there are 65 million displaced people globally. And while the Western media spent much of 2016 broadcasting the European refugee crisis, most displaced people are actually being hosted within the Middle East.
Therefore, most refugees are being accommodated in countries with already-stretched healthcare services. So access to treatments, particularly cancer facilities, is limited. The healthcare budget for each refugee is around $1,000 to $2,000, eliminating all access to expensive cancer treatments.2 And, in reality, many refugees do not access even basic services, due to the complexity of their living situation.
Mashal al-Kuraimi, a 25-year-old with liver cancer in Yemen told Al Jazeera: “Cancer patients in Taiz are waiting for either the shelling or the cancer to kill them.” 3
Consequently, the importance of palliative care in conflict situations and among refugee populations cannot be understated. UNHCR (The United Nations High Commission for Refugees) does not have sufficient resources to fund cancer treatments; therefore most cancer patients require palliative care.2 However, palliative care is usually not being addressed in these situations.
While there are some examples of good practice, such as in Saudi Arabia and Jordan, palliative care services are generally limited in the region. And most countries of the region rank poorly in the Global Atlas of Palliative Care and the Quality of Death Index. There are a number of reasons for this. Challenges for palliative care development in the region include: lack of policies and funding, cultural barriers, training and education, and a lack of access to opioids. Furthermore, in conflict situations, most attention is focused on trauma care, infectious diseases, and maternal and child health.
So what can be done to improve palliative care during conflicts? Fortunately, the topic is gaining momentum. WHO is working jointly with relevant partners to develop guidance and essential packages for emergency settings, including medications for pain management and essential devices.
For palliative care in emergency situations, training is required for staff and volunteers to provide psychosocial and spiritual support, and patients need improved access to opioids. Policy-makers and international organisations must work collaboratively to make this happen, and to reduce pain and suffering at the end of life, in already complex and difficult circumstances.
- Sahloul, E. Cancer Care at Times of Crisis and War: The Syrian Example. Journal of Global Oncology. Published online before print. August 31, 2016, doi:10.1200/JGO.2016.006189.
- Spiegel P, Khalifa A, Mateen FJ. Cancer in refugees in Jordan and Syria between 2009 and 2012: challenges and the way forward in humanitarian emergencies. Lancet Oncol. 2014;15(7):e290-e297. doi:10.1016/S1470-2045(14)70067-1.
- Al-Sakkaf N, What it’s like to be a cancer patient in Yemen today, Al Jazeera [accessed: 18 October 2016].
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.
- 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.
- 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 health care in humanitarian emergencies.
- Palliative care in humanitarian crises: Always something to offer. The Lancet Online, 15 April 2017.
Read more in this series on the EAPC Blog.