World Humanitarian Day 2021:
Humanitarian workers who save lives and care for the dying
– Ms. Rachel Coghlan, Melbourne, Australia
*This article contains excerpts from a Correspondence recently published in The Lancet by Rachel Coghlan for World Humanitarian Day 2021.
World Humanitarian Day is celebrated every year on August 19. It is a day in which we honour humanitarian workers who save lives and provide protection to people most in need in humanitarian crises, and remember those workers who have been killed or injured in the course of their work. World Humanitarian Day this year has also been a day dedicated to recognising the frontline healthcare workers who provide life-saving support during the pandemic and during climate-related emergencies. We recognise humanitarian workers who provide such support traversing severe circumstances and putting themselves in real danger – harsh geographical terrain, warzones, in the midst ofnatural disaster, or at risk of contracting disease.
The June 2021 newsletter of the IAPC paid tribute to the COVID-19 “warriors” in India – the healthcare workers, police personnel and volunteers, who have lost their lives to the virus whilst selflessly working to save the lives of others. The tragic number of Indonesian doctors who have died from COVID-19 has also been reported, forcing junior and trainee doctors to cope on the frontlines of response. The number of nurses who have died in the United States from the virus is now more than 1,200 and the country faces a “crisis in nursing staff shortages”. The immense workloads, burnout and anxiety being felt by healthcare workers whose duty it is to protect and save lives around the world is almost incomprehensible.
Sickness, injury, death and loss are inescapable realities in humanitarian crises. In this pandemic, many people have and will continue to face severe symptoms and die from COVID-19, including healthcare workers themselves. Communities around the world are facing care needs, pain and suffering that exceed the capacities of most health systems. New challenges have arisen from physical distancing restrictions and protective equipment that limit opportunities to accompany or touch the dying, attend funerals, and grieve in normal ways. At the same time as we plan for ways to prevent the spread of disease, or seek to provide measures such as intensive care beds, ventilators and oxygen tanks to save lives, we must also be talking about the need for compassionate care and support of those who are suffering serious illness or dying.
Before COVID-19, palliative care was very slowly gaining recognition as an important part of the healthcare continuum alongside life-saving treatment in humanitarian response. The 2017 Lancet Commission on Palliative Care and Pain Relief highlighted the lack of prioritisation of palliative care for those living through humanitarian crises. Published guidance on the issue has been growing (for example, the 2018 World Health Organisation Guide on integrating palliative care and symptom relief into responses to humanitarian emergencies and crises and the palliative care standard (Health standard 2.7) in the Sphere Handbook: Minimum standards for humanitarian response).
And yet the humanitarian narrative for World Humanitarian Day has continued to be one focused on saving lives; and the pandemic response for people already made vulnerable by humanitarian crisis does not appear to be talking about, nor programming for, how the suffering of the dying can be eased.
Those with experience in working in palliative care across the world have a role to play in shaping humanitarian policy and advocacy. At the policy level, humanitarian sector responses to COVID-19 have continued to omit palliative care. In a Correspondence written for The Lancet for World Humanitarian Day 2021, I gave some examples:
“The UN Office for the Coordination of Humanitarian Affairs’ COVID-19 global response plan, which guides the work and funding prioritisation of humanitarian organisations, does not incorporate palliative care alongside disease mitigation and case management, nor do any of its country response plans. WHO’s 2021 COVID-19 Strategy Preparedness and Response Plan does not include palliative care.”1
I also wrote that, “These plans demonstrate serious missed opportunities to insert palliative care more firmly in the consciousness of humanitarian agencies and in the practicalities of humanitarian response.”1 Ensuring the inclusion of palliative care in such policies provides practical ways to expand the humanitarian narrative and cement palliative care on the formal agendas of humanitarian organisations.
Those working in palliative care with an interest in humanitarian issues must also find ways to amplify the voices and actions of the real humanitarians – the informal world of families, neighbours, and communities. Most humanitarians are local volunteers, not members of large humanitarian organisations. In crisis, people first turn to their own community for help. Humanitarian Hugo Slim has observed that “At any moment, in any day, somewhere in the world a person is suffering from the violence of armed conflict or the devastation of disaster. As surely as this person is suffering, it is equally certain that someone will be trying to help them.” We must recognise the role that local humanitarian and healthcare workers already play in easing suffering and providing comfort for the seriously ill and dying, while doing their best amidst often dire and overwhelming conditions, and sometimes, losing their own lives as a result.
The critical role of local humanitarians has become amplified in a changed COVID-19 world: “Restrictions on travel and access for humanitarian operations have meant that local organisations and communities themselves are at the front line of COVID-19 response.”1 While we promote the provision of palliative care in humanitarian crises through policies and formal humanitarian organisational response, we also need to behighlighting the power of communities and volunteer networks to provide comfort and presence to those who are suffering and to provide vital support to families left behind. Even where there is no existing formal palliative care, we can celebrate what already exists organically within communities, and build on it: “In reality, humanitarian workers do not just save lives: they listen, they soothe, they take moments to feel pain alongside others, and they comfort colleagues. These are small but potent compassionate acts of humane care.”1
World Humanitarian Day must be about honouring those humanitarians who stay with the dying while they save the living. It’s time to broaden the narrative.
1 Coghlan R. 2021. Broaden the narrative this World Humanitarian Day: honour those who comfort the dying, The Lancet, 398(10301):659, https://doi.org/10.1016/ S0140-6736(21)01816-X
About the Author: Ms. Rachel Coghlan is undertaking a Doctor of Philosophy at the Centre for Humanitarian Leadership, Deakin University.
Her research explores the place of palliative care in humanitarian emergencies and crises, with a focus on armed conflict settings. Ms. Coghlan is a palliative care physiotherapist in Melbourne. She is a Board Director of Palliative Care Australia, an Executive Member of Australasian Palliative Link International, and a member of the Palliative Care in Humanitarian Aid Situations and Emergencies network, the Western Pacific Palliative Care Advocacy Network, and the Australian COVID-19 Palliative Care Working Group.
Ms. Coghlan lives in Melbourne with her 2 rambunctious sons, husband, and friendly chocolate Labrador Billie.