At the end of last year, we published a series about palliative care in the context of humanitarian crises. Contributors looked at the implications of providing palliative care for migrants, refugees and people who have fled war-torn countries and places of conflict.
Today, we hear from Rachel Coghlan, a PhD candidate at the Centre for Humanitarian Leadership, Deakin University, Australia, who shares four emerging ideas from her research.
Palliative care and humanitarian action share goals to relieve suffering and uphold dignity; and both hold an ethical root in compassionate action in response to suffering. Some of the central aims of palliative care have featured throughout the history of humanitarian response.
Given these shared goals and ethos, you would think that the delivery of palliative care in humanitarian crises would be widespread, but in practice today this is not the case.
Whilst there is encouragingly a growing consciousness of need, leadership for action tends to arise from external palliative care specialists and less so from within the humanitarian sector itself. There has been little research focused on armed conflict settings. My work focuses on the role of humanitarian actors in delivering palliative care in conflict.
Here, I outline four emerging ideas in my research:
Idea one: What does care for the seriously ill and dying look like in the humanitarian response in conflict settings?
In humanitarian response, the superiority of saving lives and a bias towards curative medicine takes precedence over palliation. The individual approach to caring for a sick or dying person becomes extremely challenging in a context where staff and resources may be overwhelmed or finite. While there are strong ethical arguments for the inclusion of palliative care in humanitarian settings, how it is implemented in modern humanitarian contexts is still an emerging area of practice.
The practical business of integrating palliative care becomes even more convoluted amidst complex and often dangerous conditions (Slim, 2015). This is “the humanitarians’ tragedy”(de Waal, 2010, p.S130), throwing wide open the inherent tensions between humanitarian ideals and realities.
Idea two: What is the role of humanistic responses in palliative care delivery in conflict settings?
When all the practical offerings of palliative care – medicines, equipment, beds, needles, food – cannot be sourced because of dire or perilous circumstances, sometimes “small but potent” offerings of compassionate care are all we have or can be just as important. Sitting and “being”with a patient, providing sips of water, acknowledging their stories – things that can be provided at the community level by non-specialist humanitarian actors.
Without efforts to explore the role of “small but potent” acts of compassion across cultures and contexts, and the role that humanitarian actors could play in their delivery, they may be rendered a mere afterthought to medical intervention or specialist (Western) models of care.
Idea three: What is the role and nature of standards and metrics in guiding the provision of palliative care in conflict?
A bias of medicine in humanitarian action is propped up by global health metrics (e.g. lives saved) – placing the qualitative aspects of human lives, relationships and suffering in simple counting terms.
Standards and metrics are all enablers of better quality and more effective action. But can they fully capture the complexity of humanitarian situations, or all dimensions of quality palliative care?
The profound impacts of “small but potent” acts of compassion deserve greater attention in palliative care and in humanitarian emergencies more broadly. But how this might be achieved through guidelines or metrics needs exploration.
Idea four: Could the broader practice of palliative care serve to remind humanitarian actors of the essence of a humane response?
The humanitarian principle of humanity holds that humanitarian actors should help everyone suffering from the effects of conflict or disaster. Easing suffering requires that human relationships and spirituality are treasured.
The power of “small but potent” acts of compassionate palliative care could serve to remind the humanitarian sector of the art of caring, the act of standing with and alongside, and of our common humanity. Such acts of compassion could offer a path through which to recover a sense of wonder at the preciousness of every human. This power should not be underestimated.
You can read more about these ideas in my recent paper.
de Waal, A. (2010), ‘The humanitarians’ tragedy: escapable and inescapable cruelties’, Disasters, 34:S2, S130-S137, doi: 10.1111/j.1467-7717.2010.01149.x.
Slim, H. (2015), Humanitarian ethics: a guide to the morality of aid in war and disaster. Oxford: Oxford University Press.
Read more in the ‘Palliative Care in Humanitarian Crises’ series on the EAPC blog. Look out in the next couple of weeks for a post from Dr Mhoira Leng, Dr Elizabeth Swain and Dr Alice Gray who will be sharing their teaching experiences in Gaza.
- Waldman E and Glass M (eds.) A Field Guide for Palliative Care in Humanitarian Crises. Oxford University Press; November 2019. https://oxfordmedicine.com/view/10.1093/med/9780190066529.001.0001/med-9780190066529 OUP has generously provided free open access to every chapter.
- PalCHASE – Palliative Care in Humanitarian Aid Situations and Emergencies network with a web page of resources for ‘Palliative Care in the Time of Coronavirus’.