A Field Manual for Palliative Care in Humanitarian Crises

Abstract

For years, humanitarian relief efforts have focused primarily on saving lives. Traditional methods of triage have been employed, and those thought likely to die have been placed in an “expectant” tent or area. Recently however there has been increasing recognition that palliative care should play an essential role in relief efforts. The goal of humanitarian aid really shouldn’t just be saving lives, but should also include management of suffering, regardless of expected outcome. Humanitarian crises come in many forms, each with their own unique set of challenges. The challenges faced in dealing with high-mortality infectious disease outbreaks may differ significantly from those faced dealing with the movement of massive refugee populations or those faced in environmental disasters. In each of these situations, there may be many patients who could potentially benefit from palliative care. In addition to those facing death or disability as a result of the crisis itself (e.g. Ebola) there may be others with preexisting conditions, chronic illnesses, or new injuries who would benefit from incorporation of palliative care. And, of course, there are the psychological, spiritual, and psychosocial wounds that many bear because of these crises, all of which could be helped by incorporation of principles of palliative care into relief efforts. There are simply not enough palliative care specialty-trained clinicians to staff every humanitarian aid mission. To that end we have collaborated with a group of clinicians from around the globe in creating this field manual of palliative care in humanitarian crises, a focused, easy to use guide for incorporating palliative care into international humanitarian aid operations of all sorts. This guide may be used in the field for on-site planning and management, for education of local personnel, and for training purposes in advance of deployment. There remains much work to be done. We hope to someday see more comprehensive textbooks and more formalized training programs to optimize integration of palliative care into humanitarian relief efforts. In the meanwhile, we hope that this manual provides some useful, practical guidance for those undertaking this incredibly important work.