JUNE 22 2021 – 12:00 HRS EDT

Registration at bit.ly/palliative-care-ebola

Join HHE’s Dr. Kevin Bezanson and Prof. Elysée Nouvet for their upcoming webinar, hosted with the World Association for Disaster and Emergency Medicine (WADEM), entitled Life, Death, and Isolation: Reflections on Palliative Care from Ebola to COVID-19. Registration is required!

New Publication: Dying in Honor: experiences of end-of-life palliative care during the 2013-2016 Ebola outbreak in Guinea

LINK: https://rdcu.be/ckfTE

CITATION: Nouvet et al. Dying in Honor: experiences of end-of-life palliative care during the 2013-2016 Ebola outbreak in Guinea. Journal of International Humanitarian Action 2021 6(10): 1-17.  Open access link

ABSTRACT: With no cure and a high mortality rate, Ebola virus disease (EVD) outbreaks require preparedness for the provision of end-of-life palliative care. This qualitative study is part of a larger project on palliative care in humanitarian contexts. Its goal was to document and deepen understanding of experiences and expectations related to end-oflife palliative care for patients infected with Ebola virus disease (EVD) in West African Ebola treatment centres (ETCs) during the 2013–2016 epidemic. It consisted of 15 in-depth semi-structured interviews with individuals impacted by EVD in a Guinean ETC: either as patients in an ETC, healthcare providers, healthcare providers who were also EVD patients at one point, family relations who visited patients who died in an ETC, or providers of spiritual support to patients and family. Analysis was team based and applied an interpretive descriptive approach. Healthcare delivery in humanitarian emergencies must remain respectful of patient preferences but also local and contextual values and norms. Of key importance in the Guinean context is the culturally valued experience of “dying in honour”. This involves accompaniment to facilitate a peaceful death, the possibility of passing on final messages to family members, prayer, and particular practices to enact respect for the bodies of the deceased. Participants emphasized several challenges to such death in Ebola treatment centres (ETCs), as well as practices they deemed helpful to alleviating dying patients’ suffering. An overarching message in participants’ accounts was that ideally more would have been done for the dying in ETCs. Building on participants’ accounts, we outline a number of considerations for optimizing end-of-life palliative care during current and future public health emergencies, including for COVID19.

May 17-20 Virtual Event: Lessons from the Field: Confronting the Challenges of Health Research in Humanitarian Crises

Event Description and Registration Details: https://www.fic.nih.gov/About/center-global-health-studies/Pages/health-research-humanitarian-crises-lessons-launch-event.aspx

In association with the “Lessons from the field: Confronting the challenges of health research in humanitarian crises” collection in BMC Public Health and Conflict and Health, Fogarty’s Center for Global Health Studies (CGHS) will host an online launch event May 17 – 20, 2021.

This virtual event will take place in four sessions over four days. Each session will be 90 minutes, and participants will have the option of joining an additional 30-minute breakout discussion and networking session at the end. The events will feature case study authors, Steering Committee members, and experts in the field. The events will help audiences understand best how to utilize the case studies for educational, training and other purposes, as well as highlight the importance of conducting research in the context of humanitarian crises and share some common themes, strategies and lessons learned.

Each session will be held at 9 am EDT (Washington, D.C.) | 4 pm (Nairobi) | 7 pm (Dhaka) to accommodate as many time zones as possible. This event is open to the public. Participants must register in advance for each session individually.

Webinar (Mar 31) – Humanitarian ethics: moral purpose and moral hazard (Transformative Disaster Risk Governance Series)

The Transformative Disaster Risk Governance Webinar Series at York University is continuing with a session on Humanitarian ethics: moral purpose and moral hazard. The keynote is Prof. Hugo Slim, followed by a panel discussion with Professors Peter Timmerman and Nergis Canefe from York University, as well as a Q&A session with the audience.

Jan 27 Webinar: MSF’s Stories of Change as a health promotion method in humanitarian settings

Join the Canadian Coalition for Global Health Research and Western University (London, Canada) on Wednesday January 27 @ noon for a webinar on “MSF’s Stories of Change as a health promotion method in humanitarian settings”

Webinar link is (no registration needed or password): https://westernuniversity.zoom.us/j/94114166799


Health-care decisions, such as changing practices to reduce the risk of the transmission of an illness, are not only based on biomedical knowledge but also on local knowledge, perspectives and experiences. Health promotion (HP) strategies should therefore both disseminate biomedical illness information and information that includes local knowledge and experiences. Yet, in practice it remains challenging to move away from the more ‘traditional’ health education approaches to participatory approaches that include local knowledge.

In 2019, MSF provided medical support in Goma responding to a cholera outbreak. A pilot of a participatory storytelling intervention was carried out to support the HP team in their efforts to encourage people to adapt protective hygiene practices. This interactive storytelling method presented an alternative to the traditional HP approach of top-down one-way communication. This webinar brings four individuals with front line experience using MSF’s Story of Change as a simple, sustainable, cost effective method for health promotion.

“We Live on Hope…”: Ethical Considerations of Humanitarian Use of Drones in Post-Disaster Nepal

PhD candidate Ning Wang at the Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich recently published an articles in the IEEE Technology and Society Magazine  entitled: “We Live on Hope…”: Ethical Considerations of Humanitarian Use of Drones in Post-Disaster Nepal. This work results from a three-week field study in rural Nepal, where local population’s livelihood was affected by the 2015 earthquake, and where drones were used in assisting disaster relief work. The article focuses on the ethical considerations associated with the use of technology for humanitarian purposes, and raises awareness for the need of critical analysis in the deployment of technology in the aid sector.

Full text can be accessed here. A related live talk regarding this case study is available here. The author can be contacted at: ning.wang@ibme.uzh.ch.

The noticeable turn to technology in humanitarian action raises issues related to humanitarianism, sovereignty, as well as equality and access for at-risk populations in disaster zones or remote areas lacking sufficient healthcare services. On a technical level, practical challenges include heightened risks of data safety and security, and the potential malicious use of technology. On a societal level, humanitarian innovation may disrupt relations between different stakeholders, may widen inequality between those with access and those without, and may threaten privacy, disproportionately affecting the vulnerable population. Drawing on the empirical findings of a case study of the 2015 Nepal earthquake, this paper presents an in-depth normative analysis to identify contextualised ethical considerations, and illuminate the wider debate about how technological innovation in the aid sector should be operationalised. In conclusion, on the normative level, a prudent attitude in adopting novel technology in the aid sector is required; while on the operational level, proposals for actionable ethical standards to guide and safeguard sector-wide innovation practices are needed.

Humanitarian technology; community consent; technology assessment; data safety and security; regulation deficit; stakeholder accountability

New Publication – Closing well: national and international humanitarian workers’ perspectives on the ethics of closing humanitarian health projects

Read the full paper: https://jhumanitarianaction.springeropen.com/articles/10.1186/s41018-020-00082-4

Abstract excerpt: We identified six recurrent ethical concerns highlighted by interviewees regarding closure of humanitarian projects: respectfully engaging with partners and stakeholders, planning responsively, communicating transparently, demonstrating care for local communities and staff during project closure, anticipating and acting to minimize harms, and attending to sustainability and project legacy. We present these ethical concerns according to the temporal horizon of humanitarian action, that is, arising across five phases of a project’s timeline: design, implementation, deciding whether to close, implementing closure, and post-closure. This exploratory study contributes to discussions concerning the ethics of project closure by illuminating how they are experienced and understood from the perspectives of national and international humanitarian workers. The interview findings contributed to the development of an ethics guidance note that aims to support project closures that minimize harms and uphold values, while being mindful of the limits of ethical ideals in non-ideal circumstances.

Hunt, M., Eckenwiler, L., Hyppolite, SR. et al. Closing well: national and international humanitarian workers’ perspectives on the ethics of closing humanitarian health projects. Int J Humanitarian Action 5, 16 (2020). https://doi.org/10.1186/s41018-020-00082-4

New Publication: Addressing obstacles to the inclusion of palliative care in humanitarian health projects

Read the full paper at: https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-020-00314-9

Abstract excerpt:
Participants discussed various obstacles to the provision of palliative care in humanitarian crises. More prominent obstacles were linked to the life-saving ethos of humanitarian organizations, priority setting of scarce resources, institutional and donor funding, availability of guidance and expertise in palliative care, access to medication, and cultural specificity around death and dying. Less prominent obstacles related to continuity of care after project closure, equity, security concerns, and terminology. Opportunities exist for overcoming the obstacles to providing palliative care in humanitarian crises. Doing so is necessary to ensure that humanitarian healthcare can fulfill its objectives not only of saving lives, but also of alleviating suffering and promoting dignity of individuals who are ill or injured during a humanitarian crises, including persons who are dying or likely to die.

Hunt, M., Nouvet, E., Chénier, A. et al. Addressing obstacles to the inclusion of palliative care in humanitarian health projects: a qualitative study of humanitarian health professionals’ and policy makers’ perceptions. Confl Health 14, 70 (2020). https://doi.org/10.1186/s13031-020-00314-9

Palliative Care in Natural Disaster Response

Reports for humanitarian practitioners & policymakers

Dying alone is hard anywhere in the world”: Palliative care in natural disaster response 

“Dying alone is hard anywhere in the world” (PDF): Palliative care in natural disaster response 

Natural Disasters – Report and Recommendations”: Palliative care in natural disaster response. A research snapshot


Key Findings 

The following key findings emerged from the natural disasters sub-study: 

  • Participants described palliative care as a key component of comprehensive humanitarian healthcare involving companionship and psychosocial support for patients and their families, dignity in death and dying, and the management of pain and other distressing symptoms.
  • Barriers to the provision of palliative care in natural disaster settings included damage to health structures; inadequate resources; disrupted supply chains; the invisibility of patients with palliative needs; differences in local cultural norms; the prioritization of acute needs; and challenges of mobility and access to care. 
  • Despite existing limitations, respondents agreed that humanitarian aid organizations have an ethical obligation to provide palliative care.
  • Integration of palliative care may play a role in alleviating distress among disaster responders, particularly those from affected communities. 
  • Participants emphasized that palliative care must be integrated into disaster planning from the beginning; otherwise, it is likely to be neglected during a crisis. 
  • There was a clear consensus concerning the need for palliative care training and protocols to guide practice in natural disaster settings. 


Overview: Focus on Natural Disasters Settings  

According to the World Health Organization, a natural disaster is “an act of nature of such magnitude as to create a catastrophic situation in which the day-to-day patterns of life are suddenly disrupted and people are plunged into helplessness and suffering, and, as a result, need food, clothing, shelter, medical and nursing care and other necessities of life, and protection against unfavourable environmental actors and conditions.” [1] While we use the term “natural disasters” in this sub-study, it is widely recognized that the impacts of natural disasters such as earthquakes and tsunamis are shaped by human activity, degrees of vulnerability of certain communities, and action or inaction to mitigate natural hazards. [2] The annual death rate due to natural disasters is around 90,000 people worldwide, with approximately 160 million others also affected. [3] Over the last 10 years, 95% of the nearly two billion people affected by natural disasters were affected by a weather-related event. [4] 

Like conflict settings and public health emergencies, natural disasters can overwhelm the capacity of health systems to meet the needs of the general population. This constitutes a humanitarian crisis, wherein the health and well-being of large groups of people are threatened due to factors such as lack of access to care, infrastructure damage, and resource scarcity. In recent years, many nations, including Haiti, Nepal, Pakistan, India, and Japan have experienced significant losses of life and devastation to infrastructure due to natural disasters. 

Natural disasters, including famine, can exacerbate conditions in regions experiencing conflict, and are often a factor in the development or escalation of violence. Likewise, ongoing conflict in disaster-affected countries can further limit or hinder disaster response. This perpetuates a continuous cycle of poverty and instability for such countries and constrains the possibilities for disaster preparedness and response by local and international care providers.


Natural Disasters Sub-Study Objectives 

  1. To develop evidence clarifying the ethical and practical possibilities, challenges, and consequences of palliative care needs following natural disasters. 
  2. To inform realistic, context-sensitive guidance, education, and practices for the provision of palliative care during natural disaster response. 


Summary of our Approach

In-depth, semi-structured interviews (N = 20) were conducted with international and local healthcare providers who had responded to a variety of natural disasters. For this sub-study, we included natural disasters that often strike without warning (earthquakes, landslides, and flash floods); those with a short warning time frame (tsunamis, hurricanes, typhoons and flooding); and protracted or foreseeable disasters (famine). The relationship between conflict and natural disasters was also explored. 

Natural Disasters Team 

Team Lead:  



Rachel Yantzi RN, MSN/MPH – PhD student in Health Research Methodology, McMaster University, Hamilton, Canada 




Takhliq Amir, BHSc – MD student at the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada 


Matthew Hunt, PhD, PPT – Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Canada  

Lisa Schwartz,PhD – Professor & Arnold L. Johnson Chair in Healthcare Ethics, McMaster University, Hamilton Canada 

Sonya de Laat, PhD – Academic Advisor & Global Health Scholar, Global Health Program, McMaster University, Hamilton, Canada 

Carrie Bernard MD MPH CCFP FCFP – Assistant Professor, Department of Family and Community Medicine, University of Toronto, Toronto, Canada 

Laurie Elit, MD – Professor of Obstetrics and Gynecology, McMaster University, Gynecologic Oncologist, Hamilton Health Sciences, Hamilton, Canada 

Corinne Schuster-Wallace, PhD – Associate Professor, Faculty of Geography & Planning, University of Saskatchewan, Saskatoon, SK

Lynda Redwood-Campbell, MD, FCFP, DTM&H, MPH, Canadian Red Cross International Emergency Response Unit, Professor of Family Medicine, McMaster University, Hamilton, Canada



Conference Oral Presentations: 

  • Schwartz L, de Laat S, Yantzi R, Nouvet E, Bezanson K, Amir T, et al. Refugee experiences of palliative care in humanitarian settings: Views from conflict and disaster. 30th Annual Canadian Bioethics Society Conference; 2019 May 22-24; Banff, Canada.  
  • Yantzi R. Dying in the margins: Palliative care, humanitarian crises and the intersection of global and local health systems. Presented at: 16th Annual HEI Research Day, McMaster University; 2019 Mar 14; Hamilton, ON.  

Conference Poster Presentations: 


  1. Assar, M. Guide to sanitation in natural disasters. World Health Organization. 1971. Available from: https://apps.who.int/iris/bitstream/handle/10665/41031/10678_eng.pdf;jsessionid =890EB054FAB45D038B5BC2F479F6E813?sequence=1 
  2. World Health Organization. Definitions: emergencies. 2020. Available from: https://www.who.int/hac/about/definitions/en/ 
  3. World Health Organization. Environmental health in emergencies. 2020. Available from: https://www.who.int/environmental_health_emergencies/natural_events/en/ 
  4. International Federation of Red Cross and Red Crescent Societies. (2018). World disaster report: Leaving no one behind. Available from: https://media.ifrc.org/ifrc/world-disaster-report-2018/