Palliative Care in Low-Resource Contexts

23 July 2021


As part of the R4HC-MENA Project, between 2018 and 2020, the R4HC Policy Fellows visited Cambridge to explore research needed to help tackle health policy questions affected by conflict in the MENA region. In the Summer of 2021, CSaP hosted a series of online seminars to explore what the Fellows learnt during their time in the UK, and the opportunities and barriers they have faced when implementing these ideas in practice. In the third session of this series, CSaP was joined by Dr Khamis Elessi, a Neurorehabilitation and Pain Medicine consultant, Associate Professor and Head of Evidence-Based Medicine Unit, Faculty of Medicine, Islamic University, Gaza, Palestine, who shared his experiences working in Gaza with an audience of policy fellows.

How can we integrate palliative care into the medical curriculum? What is the best way to inform the public about palliative care service and to deliver palliative care in low-resource contexts such as Palestine? These are the questions that motivate pain medicine consultant Dr Khamis Elessi, who has been working to develop a palliative care curriculum that is suitable and culturally sensitive to the Palestinian circumstances.

Appropriate palliative care has been labelled by the WHO as a health systems necessity, and as a global priority for all patients with life-limiting illnesses – particularly those who need continuous care such as cancer patients. Dr Elessi has led the development of a curriculum for fifth year medical students on palliative care and was responsible for the creation of the first palliative care team at the main hospital for paediatric cancers and children with organ failure in Gaza. His goal has been to ‘bring life to days, where days cannot be added to life.’

Dr Elessi has also been involved in the creation of similar palliative care teams at other hospitals in Gaza and was involved in the first international conference on palliative care in Palestine. This conference – attended by more than 500 specialists, doctors, and health professionals – was a turning point for palliative care inside the Gaza Strip, in Dr Elessi’s view. Recently, the Gaza Strip’s Minister of Health allocated a hospital for the care of cancer patients – including palliative care provision – making this the first comprehensive hospital in Palestine.

This work has involved an approach which to pain which draws on evidence-based policy in healthcare, and which treats pain as a symptom that can be rooted in the physical, the spiritual, or the psychological. In implementing this approach, Dr Elessi has had to overcome knowledge barriers amongst fellow practitioners who have not been trained in palliative care or pain management, to confront regulatory barriers to the treatment of pain using medication and help practitioners to overcome the ‘culture shock’ of moving towards interdisciplinary and holistic health teams which draw upon tools such as physiotherapy, recreational therapy, and spiritual support. Ultimately, Dr Elessi believes that patient-centred care, which involves active listening to patients, is the way to provide a better healthcare system.

Wards co-opted for managing covid-19 cases in the Gaza Strip have disrupted the provision of palliative care and services such as chemotherapy throughout the pandemic, however, Dr Elessi has used this time to further strengthen training programmes which he hopes will help to further strengthen palliative care provision in Gaza in the long term.

Since the onset of the covid-19 pandemic, Dr Elessi has also been involved in international advisory work in covid-19 diagnostics, management, and prevention, including advising on the management of palliative care. He has worked to inform the public locally and internationally about latest evidence regarding the effectiveness of any intervention regarding covid-19, including the provision of palliative care. Throughout this work, Dr Elessi has drawn upon the expertise of colleagues and experts, including those from Cambridge University, Addenbrooke’s Hospital, and King’s College London.