Tens of millions of people worldwide are suffering in severe agony in their final days due to lack of access to pain medication, a Human Rights Watch report revealed.
The report released this month is based on a survey of policy barriers to palliative care in 40 countries and an assessment of the availability of pain-relieving drugs. It found a tremendous failure on the part of governments to take the basic steps to ensure that patients with end-stage disease are afforded palliative care.
A cancer patient from Ukraine told Human Rights Watch: “We have no pethidine, no DF-118 (dihydrocodeine) and no morphine… We have children here with advanced HIV: some are in severe pain. The pain management for children with advanced HIV is not enough.”
The World Health Organization considers palliative care ‘an integral component of cancer care’ and has urged countries to improve its availability. It is estimated that 60 percent of those who die each year in low-to-middle income countries – more than 30 million in total – need palliative care. Even in higher-income countries, the need for palliative care is increasing with ageing populations.
Yet, in 35 of the 192 countries reviewed in the report, fewer than 1 percent of patients with moderate to severe pain from terminal cancer or HIV had access to strong pain medications. These countries are concentrated in Sub-Saharan Africa, but some are in Asia, the Middle East, North Africa and Central America.
Thirty of the countries surveyed did not have palliative care policies despite a World Health Organisation recommendation to develop such policies. In many of the countries, healthcare workers were not adequately trained in pain management or palliative care, and in some, no training was offered at all. In 33 of the countries, the government imposes restrictions on prescribing morphine beyond the requirements of UN drug conventions.
While the statistics appeared predominantly grim, there were a few countries making good progress in palliative care including Colombia, Jordan, Romania, Uganda and Vietnam. These countries have undertaken programmes to help improve access to palliative care. Governments have worked with the medical community and civil society to identify and address barriers to palliative care.
Human Rights Watch health researcher Laura Thomas commented: “The key ingredient is the political will to make these health services available and to relieve people’s suffering.”
The 128-page report, Global State of Pain Treatment: Access to Palliative Care as a Human Right, is available here in full.