Palliative care in humanitarian action
- Page updated onSeptember 9, 2026
Palliative care relieves the suffering of people with life-threatening health problems and that of their families. This makes it an essential component of health care at every level. Yet access to it remains highly unequal, as does its integration into responses to emergencies and humanitarian crises, where this need has traditionally been pushed into the background.
This article explains what palliative care is, why it matters, who needs it in a humanitarian crisis and how it should be delivered and integrated into health systems and humanitarian interventions.
Table of contents:
What is palliative care?
Palliative care helps relieve the suffering of patients and their families
Palliative care covers the prevention and relief of suffering caused by life-threatening illnesses and health problems. It aims to improve the quality of life of the adults and children living with them, as well as that of their families and those close to them (WHO, 2014).
The conditions affecting people who need palliative care at the end of their lives include non-communicable diseases such as cancer, cardiovascular, kidney and liver problems, congenital anomalies, Alzheimer's disease and other dementias. This care may also be needed, however, in cases of serious and potentially fatal infectious diseases such as HIV/AIDS, Ebola or drug-resistant tuberculosis. Most of these people live in low- or middle-income countries and are often over 60, although some of these conditions also affect children.
Palliative care helps prevent and relieve physical, psychosocial and spiritual problems in the final stages of life. Among the most common and severe symptoms addressed at this stage are moderate and severe pain, as well as breathlessness. Treatment with opioid analgesics such as morphine is, in many cases, essential (WHO, 2014).
To understand the need for palliative care, we must first understand what serious health-related suffering is
Although the history of palliative care emerges in the 1960s and 1970s, a new concept was developed in 2018: serious health-related suffering. Understanding this concept is now essential to grasping the importance and the need for palliative care, seen through people's own experience.
Serious health-related suffering is suffering that compromises physical, psychosocial and emotional functioning, cannot be relieved without medical intervention, and can be eased by pain relief and palliative care (Knaul et al., 2018). Neither suffering nor functional capacity moves in a straight line from diagnosis to death; the path each takes depends on the person. The way people suffer changes too. Pain is a common cause of physical suffering, as are nausea, breathlessness and weakness, but other causes of serious suffering also need to be considered, such as anxiety, worry, depression, memory loss or insomnia. All of this can fluctuate, with intermittent episodes of acute distress and short periods of visible decline. The prognosis is not always easy to establish clearly, which is why palliative care needs to be integrated alongside disease management and curative treatment, flexibly and seamlessly.
In 2015, more than 61 million people were estimated to have experienced serious health-related suffering, including over 25 million who died. Around 45% of the people who died that year experienced this kind of suffering, concentrated mainly in low- and middle-income countries. This is especially true for children: more than 98% of children under 15 who died with serious health-related suffering lived in low- and middle-income countries (Knaul et al., 2018). Nor is this proportion static: between 1990 and 2021 this kind of suffering rose by 83% in these countries, compared with a 46% rise in high-income ones, with population growth accounting for only half of that increase (Knaul et al., 2025).
Palliative care is an effective and essential health service, but one that few can access
In its 2014 Resolution WHA67.19, the World Health Organization (WHO) recognises that palliative care is fundamental to protecting human dignity and quality of life for people in the final stages of their lives. It also recognises that palliative care should be integrated into all health and social care systems, within the framework of universal health coverage, and particularly into primary health care, to ensure equitable access (World Health Assembly, 2014).
Despite this, and more than a decade after that resolution was published, only 14% of the world's palliative care needs are met today, even as those needs grow with population growth and ageing. This inequity is clearly linked to income. In 2023, 86.1% of morphine was consumed by just 19.8% of the population who needed it, concentrated in wealthy countries (Peeler et al., 2025). At the same time, the lack of access to this care can push many families into poverty, as they sacrifice their scarce resources trying to look after loved ones who are suffering (Knaul et al., 2018). Social protection is essential in all these cases, as a complement to essential health services.
One of the main barriers to global access to palliative care is its cost, although this is not particularly high. An essential package of medical products for palliative care is estimated to cost around 2.16 dollars per person per year in low- and middle-income countries, just 2-3% of the cost of the essential package for universal health coverage (Knaul et al., 2018). Even so, it is frequently left out of public health investment, which tends to focus on health outcomes that extend life and increase productivity rather than on relieving suffering or upholding dignity in life's final moments.
Palliative care must be integrated into health system strengthening
Guaranteeing universal access to palliative care and to the management of pain and serious health-related suffering requires it to be fully integrated into the health system, from its policies through to every programme, function and service (Knaul et al., 2018). Examining the barriers and the progress made in Kerala (India), Chile, Mexico, Costa Rica, Vietnam and Turkey, among other places, makes it possible to identify priorities for the different health system building blocks, following WHO's classic framework:
- Governance. A comprehensive regulatory framework and public awareness of palliative care are needed, supported by professional groups and civil society organisations. These groups should also take part in monitoring and evaluating the effects on coverage and health outcomes.
- Financing. Palliative care should be included in the service packages funded by health insurance. Public investment in the essential service package also needs to increase, and its costs can be brought down through appropriate pooled procurement strategies.
- Medical products. Some issues, such as the management of opioid analgesics, require particular attention. Laws and guidelines may be needed to regulate access for the patients who need them, along with tools to ensure a secure supply chain and sound prescribing practice.
- Human resources. Competencies in pain management and palliative care should form part of the training curricula for medicine, nursing, psychology, pharmacy and social work, and should also come to be recognised as a specialty in its own right.
- Service delivery. Pain relief and palliative care should be integrated at all levels of care, including primary health care, with sound referral mechanisms between them and with social protection services. They should also be integrated into programmes for specific conditions. Involving communities and community-based organisations can be a vital complement to home-based care, in coordination with public health facilities. Experience from small pilot programmes can be scaled up nationally.
- Information systems. Governments should invest in research and in analysing lessons learned on palliative care. They should also build in and monitor indicators on access to pain management, opioid availability and the quality of palliative care within their health information systems.
The importance of palliative care in humanitarian emergencies
Palliative care has been a forgotten priority in humanitarian action for years
The push given to palliative care by the World Health Assembly in 2014 soon extended to humanitarian action, at least in the normative field. One of the factors that contributed most was the Ebola epidemic that hit Liberia, Sierra Leone and Guinea, in West Africa, that same year (Hunt et al., 2020). Organisations such as MSF found that, faced with the outbreak's high mortality rate, health workers could only offer palliative care so basic that it fell short of relieving patients' suffering at the end of life (Smith & Aloudat, 2017), just as had happened years earlier with the HIV/AIDS epidemic, before antiretrovirals were available, and as would become clear again years later with the COVID-19 pandemic (Schwartz et al., 2023).
There are many reasons why palliative care has been left in the background for so many years (Hunt et al., 2020). On the one hand, there are never enough resources to do everything, and prioritising some actions over others is unavoidable, however far from ideal. In humanitarian emergency response, where measurable results such as reduced mortality take precedence, this has come before relieving the suffering of those unlikely to survive their illness (Powell et al., 2017), a worthy goal whose results are not so easy to demonstrate. It can even clash at times with the heroic image of humanitarian action sold in marketing and fundraising campaigns (Hunt et al., 2020). On the other hand, integrating palliative care into health services calls for technical guidance adapted to unstable, low-resource contexts, along with a set of resources rarely available in these settings: staff who are trained and aware of the issue, access to the necessary medical products, and regulations that allow opioids to be imported (Kaade et al., 2026).
The social and cultural aspects that shape how death is understood locally, and the decision to begin palliative care, also need to be taken into account (Smith & Aloudat, 2017). In many cases, without clear guidance or enough training, health workers find it hard to know at what point they should accept that curative treatment needs to be complemented by non-curative care aimed solely at relieving the patient's suffering.
Progress on palliative care in humanitarian emergencies
In recent years, and mainly since 2014, there has been some progress towards integrating palliative care into humanitarian crisis response, though only partially.
- In 2016, a group of humanitarian medical organisations formed what is now PallCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies) (Smith & Aloudat, 2017), to look more closely at how to address this need. Institutions such as Elrha (Research for Health in Humanitarian Crises) and the Humanitarian Health Ethics Research Group have likewise helped to build a better understanding of the challenges and possibilities for integrating palliative care into humanitarian response.
- In 2018, the updated Sphere Handbook recognised, for the first time, palliative care as a minimum standard in humanitarian health care (EAPC, 2019). Since then it has been included to relieve the suffering of patients and their families and to protect their comfort, dignity and wellbeing at the end of life, whatever the cause and however certain the prognosis. Staff should be trained and able to identify and provide palliative care to those who need it, with the necessary medicines and medical supplies, such as opioids, catheters and pads or nappies for incontinence, prioritising home- and community-based care wherever possible, and attending to people's psychological and spiritual needs as well (Sphere Association, 2018).
- That same year, WHO also published two important guides on palliative care: one on integrating it into primary health care (WHO, 2018a) and another on integrating it into humanitarian action (WHO, 2018b).
All of this, along with other guidance and manuals developed by various humanitarian organisations, has helped raise the profile of palliative care and its importance in international cooperation and humanitarian health action. Yet this normative progress has still not spread far enough across the sector, which often continues to see it as something aspirational but unfeasible (Schwartz et al., 2023). As a result, palliative care is still left out of the health services available in emergencies, and therefore out of reach for many of the people who need it (Kaade et al., 2026).
Who might need palliative care in a humanitarian crisis, and what should it look like?
Unfortunately, the need for palliative care does not diminish in humanitarian emergencies, even though it is rarely measured (Nouvet et al., 2018).
Accompanying people in their suffering becomes more necessary than ever in humanitarian crises for those living with Ebola and with severely limiting conditions such as kidney failure, cancer, HIV/AIDS and other incurable chronic conditions. Sometimes these people already depended on medical care to survive before the emergency, or were living with a condition that is now deteriorating acutely. The medical care they need may now be out of reach or not covered by the basic services currently available (Nouvet et al., 2018).
Beyond the usual causes of life-threatening illness and the symptoms they bring, it is important to understand that people who have been forcibly displaced may also experience profound social isolation at the hardest moments of their lives. For many of them, the distress deepens with the knowledge that they will die far from their families, in a strange place and away from their roots and ancestral ties (Schwartz et al., 2023). Another frequent worry is who will care for their children and other dependants once they are gone, knowing how little protection they have and the risk that an unending conflict may flare up again.
We cannot think of palliative care in humanitarian settings as mere pain relief, or as medical care given just before death. Palliative care must always be patient- and family-centred, integrated, comprehensive and continuous, from the moment suffering begins right through to the end, whatever that end may be, covering both symptom relief and an empathetic, deeply human attention to the smallest things (Schwartz et al., 2023). The humanitarian system needs to abandon the false dichotomy between saving lives and relieving suffering, along with the idea of death as failure, since in many cases it is an inevitable outcome that can be reached with dignity and with far less suffering.
In many cases, this care does not require people with specialist health training. Volunteers and community health workers can receive the training and supervision needed to support patients and their families (Hunt et al., 2020).
Palliative care and the humanitarian imperative: "saving lives" and "relieving suffering"
Within the framework of the humanitarian principles, palliative care is a fundamental element. On the one hand, because it aligns with the humanitarian imperative: we have an obligation to act to relieve human suffering in crises and emergencies. On the other, from the standpoint of impartiality: protecting the dignity and relieving the suffering of the person who may survive matters just as much as doing so for the person who probably will not (Schwartz et al., 2023).
That said, even the firmest grounding in humanitarian principles does not fully resolve the traditional ethical dilemma of humanitarian action: the impossibility of deciding correctly which needs to prioritise when there are not enough resources for everything (Hunt et al., 2020). More and better humanitarian funding is of course needed, but always alongside the proper integration of palliative care into humanitarian standards, policies and essential services. There are many obstacles to achieving this, but none is insurmountable.
References
- European Association for Palliative Care. (2019, December 2). Palliative care as a basic healthcare right: A new consensus within the humanitarian community. https://eapcnet.wordpress.com/2019/12/02/palliative-care-as-a-basic-healthcare-right-a-new-consensus-within-the-humanitarian-community/
- Hunt, M., Nouvet, E., Chénier, A., Krishnaraj, G., Bernard, C., Bezanson, K., de Laat, S., & Schwartz, L. (2020). Addressing obstacles to the inclusion of palliative care in humanitarian health projects: A qualitative study of humanitarian health professionals’ and policy makers’ perceptions. Conflict and Health, 14, 70. https://doi.org/10.1186/s13031-020-00314-9
- Kaade, H., Muehlensiepen, F., Rosa, W. E., Heinze, M., Kamp, M., & Allsop, M. J. (2026). Palliative care in humanitarian responses. Bulletin of the World Health Organization, 104(8), 582–584. https://doi.org/10.2471/BLT.25.295240
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Abarca, B. (September 9, 2026). Palliative care in humanitarian action. Salud Everywhere. https://saludeverywhere.com/en/health-in-humanitarian-crises/palliative-care-humanitarian-action/