The overarching goal of PalCHASE is to help meet the palliative and end of life needs of people affected by humanitarian disasters and mass casualty incidents.

Numerous ethical, practical and political dilemmas must be considered in providing palliative care in such contexts.

It is also necessary to engage in advocacy, raise awareness, address misconceptions, develop standards, provide training and conduct research –  to name but a few types of activity supporting our overarching goal.

We are in the process of specifying and prioritising the aims of PalCHASE.

 

Below, we first list the original objectives of PCHAS (Palliative Care in Humanitarian Aid Settings), one of the two organisations which merged into PalCHASE. We also asked, in a survey, colleagues committed to the idea of palliative care in humanitarian crises for their opinions on key priorities and challenges. You can access the survey here. The summary of our findings so far are also presented.

PCHAS original objectives:

• Incorporate palliative care standards and guidance into the Sphere Project: Humanitarian Charter and Minimum Standards in Humanitarian Response.
• Explore the expansion of the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings to incorporate Palliative Care standards.
• Advocate for, and draft amendments to the Major Incident Medical Management and Support (MIMMS) manual to provide a minimum level of care standards for the dying.
• Advocate for, and draft amendments to the Australian Medical Assistance Team (AusMAT) manual to provide guidance on palliative care for Australian teams deployed to emergencies internationally.
• Promote the adoption of these various standards in humanitarian aid settings.

Key priorities in providing palliative care in humanitarian crises according to our survey (47 respondents so far):

• 87% – pain relief
• 65% – psychological support
• 59% – social support
• 57% – medical care for patients with chronic conditions which may worsen significantly without appropriate care
• 55% – spiritual support
• 53% – enabling locally appropriate burials and mourning while also meeting public health needs
• 51% – triage of patients whose likelihood of survival/ dying is hard to determine
• 45% – support for  humanitarian workers who find it hard to deal with death-related experiences
• 40% – bereavement support during the humanitarian emergency
• 38% – bereavement support as part of the long-term recovery of a community
• 33% – triage of patients in general
• 30% – involvement in the documentation of individual deaths, e.g. to enable adoption decisions, insurance claims, investigations of human rights violations, etc.
• 30% – involvement in the collection of death-related data.

In all cases, the second most frequent answer was that a particular area was a ‘priority’. Opinions that such support was ‘good to provide, but low priority’ or ‘out of scope’ were a far smaller proportion.

 

Top 5 challenges identified in the survey:

• lack of palliative care knowledge amongst humanitarian workers
• the natural priority given to life-saving interventions in the context of scarce resources
• lack of opioids in typical medicines packages
• lack of humanitarian-specific standards, guidelines and protocols
• fears that commitment to palliative care may weaken efforts to improve access to curative treatments, where appropriate.