In February, Cairdeas joined with Ednburgh University's Global Health Academy & PallCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies) to host a hybrid conference, entitled 'Palliative Care: rethinking coping, exploring hope, in the midst of conflict and change.' This conference was a wonderful time of community among the global movement to make palliative care accessible to all, and we were delighted to help bring together so many friends and colleagues from over the years, to discuss this most pressing global health challenge. 

Michelle McGannan, one of the conference's organising committee members and a member of PallCHASE, wrote this report on the conference for the e-hospice and kindly agreed to share it with us, so we could bring some of the content from the conference to our supporters. 

The Global Health Academy (GHA) at University of Edinburgh, PallCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies) and Cairdeas International Palliative Care Trust were delighted to jointly undertake this hybrid conference. We were joined by 26 participants in-person in Edinburgh, Scotland, and 43 online from countries including South Africa, Lesotho, Malaysia, Mozambique, Jordan, Kenya, Ghana, Ukraine, Germany, Dubai and Egypt.

The conference began with a welcome by Prof Liz Grant (Scotland), where the importance of compassion in both responding to, and taking action to alleviate, suffering was emphasised, with participants being challenged to consider what action can be undertaken individually and collectively.

The plenary sessions commenced with Dr Mhoira Leng (Scotland, Gaza and Uganda) setting the context of palliative care in humanitarian crises/conflict settings, including a focus on non-communicable diseases and holistic needs, with an emphasis on the need to hold onto our shared humanity. Practice exemplars from Sudan and northern Uganda were shared, emphasising the importance of the emerging evidence base. The 2024 WHO report ‘In the Line of Fire’ which outlines the ever-increasing attacks on healthcare workers in conflict zones including Gaza, Ukraine and Myanmar, was shared. Powerful personal experiences of supporting palliative care development and medical student education in Gaza were outlined, concluding with one student’s description of palliative care as ‘humanity until infinity’.

Dr Yasser Abu Jamieh (Gaza and Italy) presented ‘Gaza Community Mental Health programme. Rethinking trauma and healing’. A reminder of the challenges experienced in Gaza prior to October 2023, was shared, with the impact of the subsequent conflict including widespread destruction of infrastructure and multiple displacements of people. Powerful children’s art therapy was presented, demonstrating the internal and external impacts of the war, highlighting the magnitude of internal pain experienced. The ongoing impact of collective trauma, in both adults and children, was outlined, and the strength of community and family support emphasised. The critical importance of mental health interventions during crisis and trauma was outlined, especially pertinent in Gaza due to the relentless impact of multiple traumas from ongoing conflict. The session concluded emphasising the equality of all people.

Rev Rick Bauer’s (USA and East Africa) session focused on integrating spiritual and existential care in the midst of conflict and trauma. Participants were challenged to consider how they can support people dealing with loss and grief in situations of unimaginable devastation, with the importance of listening to, being alongside and not running away from, people experiencing spiritual distress in conflict and trauma being subsequently emphasised. Healthcare workers were also reminded to both recognise, and value, their own humanity as much as their clinical skills. The relatively new field of disaster spiritual care was shared, with the challenges of how to create space for prayer and ritual in the midst of disaster, in addition to providing a source of hope, being discussed.

The second part of the morning session comprised a series of short online recorded interviews with doctors sharing their experiences of working in conflict zones. Prof Khamis Elessi (Gaza and Jordan) was interviewed by Dr Mhoira Leng and stressed that humanity is a critical component of the healthcare role, to subsequently enable appreciation of the suffering experienced by others. He reminded participants of the obligations we have to care for all people, wherever they are, and to maintain hope for a better future.

Dr Nahla Gafer (Sudan and Egypt) was also interviewed by Dr Mhoira Leng and shared her personal journey of displacement in Sudan during the conflict, in addition to her work in cancer and palliative care. Her learning from both these experiences included the importance of information giving, communication and connection with family and colleagues.

Dr Olena Riga (Ukraine) was interviewed by Joan Marston (South Africa) and outlined the importance of developing an action plan for palliative care in conflict, prior to the event. She also shared how she derives hope and energy from patients and their families, in addition to collaborations with local and international colleagues.

Discussions, both in-person and online reflected on the powerful sessions and considered individual response. Areas addressed included the importance of locally led, contextual palliative care programmes being integrated in primary care systems and emergency response, and the importance of humanity and compassion on both a local and global scale.

The afternoon session was purely in-person and comprised a series of short presentations, interspersed with discussion.

Dr Anna Cleminson’s (Ireland) presentation focused on palliative care education in conflict, sharing experiences from Gaza. The importance of joint working between local and international colleagues and the two-way learning that took place was emphasised. The need for trauma sensitive crisis support was highlighted, in addition to supporting sustainable education approaches that were appropriate to the conflict setting.

Dr. Nuhamin Gebre (Ethiopia) gave an overview of her PhD research, exploring digital health in palliative care. The development, testing and launch of a mobile App in Ethiopia was outlined, with conference participants expressing interest in learning more about the App and potential transferability to a UK setting. Dr Gebre also emphasised the importance of empowering community health workers in Ethiopia.

Further discussion included an update on current bereavement research in Africa, with a focus on empowering communities to support in loss. The traumatic impact of both uncertainty and grieving when there is no actual body present to mourn, in conflict settings, was also considered. Additionally, the importance of helping people remember through silence and ceremony, and the question of how to incorporate ritual into individual and collective bereavement was also deliberated.

The conference concluded with a reminder of both the value of our collective humanity and compassion, and of the need for healthcare workers in situations of conflict and trauma to ensure they care for their own soul/spirit to enable them to continue in their work.

Thank you again to Michelle for sharing this excellent report with us, and for all her hard work in organising the conference, as well as the rest of the organising committee. We hope you have picked up a flavour of the topics and discussions and will join us for future conferences. Video recordings of the morning plenaries will be available soon on our website, keep an eye on social media channels and our newsletter for more info.

One of Cairdeas’ closest friends and colleagues over the years has been Professor Khamis Elessi, from Gaza, who we have worked in partnership with to help deliver teaching and support to Palestinian healthcare workers, hospitals and students. Over the past few years of targeted attacks by Israel against healthcare workers in Gaza, Khamis has worked tirelessly to treat his patients, look after his staff and continue to educate the next generation of Gazan doctors.

During our recent Edinburgh conference, we heard from Professor Elessi, through an interview with Dr Mhoira Leng, whom he calls sister, where he spoke on keeping hope alive in the middle of genocide and his sense of a common humanity with all people:

M: We have been exploring the topic of rethinking coping and exploring hope in midst of conflict and change. We would love to hear your personal perspective on coping in a time of genocide and also exploring hope.

K: There are three main factors which help us to cope during these times of massacre and genocide: First is our religion, which gives us a strong foundation, that whatever happens to you has been destined. If we keep being patient and looking at things positively, we will be rewarded. We’ll be setting a model to others to withstand their sufferings, especially if you’re the head of your family, you’ll become a role model to your medical students or your junior colleagues. Second when we see our co-citizens, our fellow Palestinians are enduring even more harsh conditions than you, and they still put all praise to Allah and still find ways to continue with their lives despite the loss of their loved ones, their homes and belongings, their possessions and their life-long savings. They still aspire for a brighter tomorrow. If they can do it, why can’t I. Third, and most importantly, is the unprecedented international solidarity with Palestinians. When we see hundreds of thousands of people marching in the streets and gathering in every square around the globe to demonstrate for the sake of Palestine, we realise that we are not alone, that we have brothers and sisters in each corner of the world who are standing with us and supporting us and we are reassured that we are on the right path. We are humanitarians who want to help other humans to have a dignified life and to live pain free, to enjoy every basic human right that they deserve to have here in Gaza. When we see millions of people pouring into the street from all directions, in all different capitals of the world, we feel that, yes, there is hope. It makes us feel better despite all the hardship we’ve been enduring for the past 2 years.

M: One of the things I have learned from you over the years, particularly in discussions about palliative care, is that deep sense of humanity, which I saw in you and also saw in the culture and community of Gaza. Would you say more about the sense of being human together, what that means to you?

K: Being human, I think, is the most important ingredient in being a successful doctor, a successful healer, a successful compassionate leader. If you are not a human, you cannot feel the suffering of other humans as well, but if you truly are a human you can feel the pain of colleagues, patients, friends, neighbours, etc. Humanity is the common trade name for any person who wants to act and do what humans should do. When we see other humans in all continents feeling and sympathising with us, enduring violence, punishment, interrogation by authorities worldwide, and still insisting on supporting Palestinian humans as equal human beings like any other person, we feel that, yes, humanity is a common language – we are all humans, we are all created by the same creator, we all have the same rights and we all have the same obligations to save one another. If we all apply this, we feel strong, because we are not alone. We are not alone in Gaza, although there are only two million of us inside Gaza, but we have tens of millions of supporters worldwide. So, in reality, we are a strong nation, a global community comprised of tens of millions of humans, all living together on one planet called Mother Earth, and that is why we should stand next to each other and support each other and this is the secret that gives us more strength and more hope for a better and brighter tomorrow.

M: Thank you so much, I have been reading comments from some of your students recently, and I saw one which said that you were the professor that taught us empathy, which I think you have shown through this discussion. I also want to congratulate you on the honourary FRCPE - Fellowship of the Royal College of Physicians of Edinburgh and we look forward to welcoming you to Edinburgh soon to share that honour with you.

We are happy and relieved to share that, after 810 days of rendering noble services to patients inside Gaza, Khamis and his wife and six children have now reached safety in Oslo, Norway. They now face the new challenges of a new home in a new country, very different to the culture and climate of Palestine. Norway in winter means contending with lots of deep snow, something Khamis and his family are not used to, as well as the extremely expensive life in Oslo with new culture, new food and a new language.

Having lived through years of immense fear, massive losses in lives and assets, repeated displacement and violence from Israel, the adjustment to safety and security can be a surreal one. Khamis shared with us the words of his youngest son, who said to him “pinch my arm, pinch me so I can believe we got out of Gaza alive.”

We look forward to welcoming Khamis to Scotland soon and to continuing our work together, to keep supporting those still living in Gaza and West Bank, under the continued violence of Israel. If you would like to support Khamis, his family and our work in Gaza, please follow this link to our donation page, where you can select Gaza as the cause you wish to give to.

Hello friends and supporters, and happy New Year! We hope this year brings peace and joy to you all. As we look forward at the Cairdeas plans for this year, we want to share with you an exciting event coming up which we are looking forward to, and hope to see many of you there.

On February 7th, we will be co-hosting a palliative care conference, in partnership with Edinburgh University’s Global Health Academy & PallCHASE, in George Square, Edinburgh. Entitled ‘Palliative Care: Rethinking Coping, Exploring Hope, In the Midst of Conflict and Change’, the conference will focus on palliative care in fragile settings affected by conflict, and the support needed by patients and healthcare workers in these settings.

With humanitarian crises ongoing in Gaza and Sudan, this conference is a timely event speaking to vitally important issues. Over the past few years we have seen healthcare workers targeted in these and other regions, and it is critical that we are equipped to support them, so that they can continue to support their extremely marginalized patients.

The conference is host to an exciting line up of speakers, bringing expert knowledge and perspectives from all around the world. Featuring presentations by Rev. Rick Bauer, Dr. Nahla Gafer, Dr. Yasser Abu Jamieh & our own Medical Director, Dr. Mhoira Leng, we will hear perspectives from USA, Sudan, Gaza and Scotland.

As the rapidly changing geopolitical landscape continues to affect how countries co-exist and how responses to humanitarian emergencies are coordinated, having such a breadth of global perspectives makes this an invaluable opportunity to learn more about palliative care around the world.

Tickets are still available, and you can register now for this exciting event by clicking here! We also ask you to consider sharing with friends and colleagues who may be interested.

We look forward to seeing you in Edinburgh on February 7th!