Portal de Periódicos da CAPES

Morphine for Gaza? Limits of care during genocidal violence

2024; Elsevier BV; Volume: 403; Issue: 10424 Linguagem: Inglês

10.1016/s0140-6736(24)00014-x

1474-547X

Rachel Coghlan, James Smith, Osaid Alser,

Torture, Ethics, and Law

In a 2023 Correspondence,1Rosa WE Connor S Downing J Marston J Radbruch L Access to palliative medicine in armed conflict: a basic right and an urgent need.Lancet. 2023; 402: 2291-2292Summary Full Text Full Text PDF Google Scholar global palliative care professionals made cursory reference to Israel's violence in Palestine to advocate for access to morphine and other palliative medicines in situations of extreme violence and armed conflict. The importance of palliative care as a component of humanitarian health response, inclusive of pain relief, should not be underestimated.2Smith J Aloudat T Palliative care in humanitarian medicine.Palliat Med. 2017; 31: 99-101Crossref PubMed Scopus (12) Google Scholar, 3WHO Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises. World Health Organisation, Geneva2018Google Scholar However, as humanitarian health and palliative care professionals, we caution against isolated calls that fail to name and advocate for an end to the violence that renders palliative care necessary for a substantial proportion of people in armed conflict. In Gaza, during escalations in Israeli aggression and clearly illustrated in the current crisis, most palliative care needs are the direct consequence of life-threatening injuries sustained after Israeli military violence, coupled with the intentional decimation of the health-care system and the blatant denial of life-sustaining assistance. The decision to provide palliative care for many Palestinians is rarely—if ever—biomedically determined at the limits of comprehensive health-care provision. Rather, the threshold for palliative care is dynamic and politically determined by the Israeli state's impunity to its international legal obligations as related to the right to health as an occupying power.4Alkhaldi M Coghlan C Miller S et al.State accountability for the good health of Palestinians has failed.Health Hum Rights. 2022; 24: 77-84Google Scholar The priority for “our collective social conscience”1Rosa WE Connor S Downing J Marston J Radbruch L Access to palliative medicine in armed conflict: a basic right and an urgent need.Lancet. 2023; 402: 2291-2292Summary Full Text Full Text PDF Google Scholar is not simply the provision of morphine. Depoliticised and decontextualised positioning fails to recognise the roots of illness-related suffering, and risks causing more harm than benefit. A narrow focus on pain relief also ignores aspects of holistic palliative care delivered every day by courageous health-care workers, when the odds of survival are stacked against them.5Coghlan R Caring for the seriously ill and dying in humanitarian crisis and conflict: shifting a “usual” palliative care paradigm to Gaza's own.PhD thesis. Deakin University, 2023: 128-129Google Scholar At the time of writing, one of our authors is working alongside Palestinian health-care workers in the emergency unit of one of Gaza's remaining functional hospitals. Several injured people are conveyed in single ambulances, while other patients arrive at hospital alone. Many patients are treated on the floor with no space for people to die with comfort. On multiple occasions, the team has run out of morphine and other pain-relieving medicines. Despite these pressures, nurses and doctors reassure injured children, hold the hands of the dying, console grieving relatives, and offer prayers for those killed by Israeli airstrikes, artillery shells, and gunfire. We must expose and remediate these root causes of suffering by advocating for an immediate end to the genocidal violence perpetrated against the Palestinian people. Such acknowledgment and action is the necessary response from a profession whose role is to promote dignity, care, and compassion in death and dying. RC has obtained a PhD on palliative care in Gaza and has travelled to Gaza to support palliative care education and training. At the time of writing, JS is in Gaza with an emergency medical team and is witnessing some of the traumatic and palliative consequences of the Israeli state's violence first-hand. OA declares no competing interests. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published text and institutional affiliations