At the Heart of Care: The Expanding Scope of Palliative Care Nurses in Humanitarian Settings

At the Heart of Care: The Expanding Scope of Palliative Care Nurses in Humanitarian Settings

– Ms. Erin Das, Nairobi, Kenya

This article was written with support and input from colleagues working in a refugee camp in Kenya, Annalice Otoro and Ali Abdullahi Khamis, whose insights from the field continue to inform and inspire efforts to strengthen palliative care in humanitarian settings.

Introduction: The Vital Role of Nurses

Nurses are essential healthcare providers in every context, bringing deep knowledge, clinical skill, and compassion to the care of patients and families. Over the years, the scope of nursing practice has expanded dramatically, enabling many to pursue fulfilling careers and contribute meaningfully to improved health outcomes. Nowhere is this more evident than in the growing field of palliative care.

Palliative Care: A Holistic Approach

Palliative care is an approach that focuses on improving the quality of life for people living with serious illness. It addresses not only physical symptoms like pain and breathlessness but also psychological, social, and spiritual needs. Nurses play a central role in this care—supporting patients to live well and die with dignity, while also attending to the needs of family caregivers.

In humanitarian settings, where illness and suffering are often compounded by crisis, displacement, and systemic neglect, the importance of palliative care cannot be overstated. Here, nurses are not only caregivers—they are advocates, leaders, and lifelines.

The Challenge of Humanitarian Contexts

Resource limitations, overcrowded facilities, trauma, and the emotional toll of displacement put enormous pressure on both healthcare providers and the communities they serve. In Kenya, for example, nurses caring for refugees and internally displaced populations in the northeastern and northwestern regions are tasked with managing complex health conditions, often without adequate supplies or support.

While many international NGOs now recognize the importance of integrating palliative care into humanitarian responses, practical challenges remain—especially in staffing. Nurses in these settings often juggle general ward duties alongside complex palliative responsibilities, managing advanced disease and end-of-life care with minimal backup.

A Broad and Compassionate Scope

The International Council of Nurses (ICN) describes nursing scope as encompassing not just tasks, but a combination of knowledge, judgment, and skill. According to their 2009 position statement, this scope includes caregiving, evaluating care, patient advocacy, delegation, leadership, education, research, and policy development. With this in mind, the contributions of palliative care nurses in humanitarian crises are not just admirable—they are essential.

What Do Palliative Care Nurses Do in Crisis Settings?

In times of crisis—whether natural disasters, pandemics, or armed conflict—palliative care often falls to the bottom of the priority list. Yet, it remains a critical component of a humane and comprehensive response.

Nurses in these settings provide:

• Symptom Management: Regularly assessing symptoms and coordinating treatment plans with the multidisciplinary team. Administering medications to relieve pain, breathlessness, nausea, and other distressing symptoms.
• Emotional Support: Listening actively and being a calm, reassuring presence for patients and families navigating unimaginable stress.
• Cultural Sensitivity: Respecting diverse beliefs and practices around death and dying. Nurses play a key role in navigating sensitive issues across cultures.
• End-of-Life Care: Ensuring comfort and dignity when curative treatment is no longer possible. Even in the most austere settings, nurses find ways to honor this fundamental aspect of care.

The Power of Advocacy

Perhaps the most powerful role of nurses in these environments is that of the advocate. Nurses ensure that the needs of patients with severe symptoms and advanced illness are heard and respected—whether that means fighting for access to morphine, advocating for family privacy, or making space for cultural mourning practices.

In dehumanizing situations, nurses bring humanity. Through their presence, they can transform spaces of suffering into places of comfort, care, and even peace.

A Call to Action

If you are a nurse working in humanitarian settings, or someone supporting frontline care providers, here are four practical ways to strengthen palliative care delivery:

1. Integrate palliative care into emergency protocols – Make it a core component of preparedness and response planning.
2. Train community health workers in basic palliative skills – Extend reach and capacity through task-sharing.
3. Utilize mobile health teams – Bring care directly to displacement camps and remote communities.
4. Support bereavement care – Address the emotional and psychological toll on both families and healthcare staff.

Conclusion: Recognizing the Full Scope of Nursing

The scope of the nurse working in humanitarian contexts is vast—encompassing physical, emotional, social, and spiritual care. In countries like India, Kenya, and others increasingly involved in disaster response, we must formally recognize and strengthen the role of nurses in providing palliative care in emergencies. This requires investment in training, policy support, and appropriate resourcing.

Palliative care is not just about dying well—it is about living with dignity until the last breath. And at the heart of this sacred mission are nurses. We must empower them, support them, and celebrate them—especially in the most difficult of places.

Photos were shared on behalf of PallCHASE and IRC Kenya.

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Important References:

1. International Council of Nurses. (2009). Position Statement: The Scope of Nursing Practice. https://www.icn.ch
2. WHO. (2018). Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/274565
3. PallCHASE. (2022). Palliative Care in Humanitarian Settings: Advocacy Briefs and Tools. https://www.pallchase.org
4. ICRC and Humanitarian Health Ethics. (2021). Dignity in Death: The Role of Palliative Care in Conflict Settings.
5. Sphere Handbook 2018: Contains guidance on integrating palliative care into humanitarian health standards. https://spherestandards.org

IAPC features this article in commemoration of World Refugee Day (20^th June).