Osman H, Rihan A, Garralda E, Rhee JY, Pons JJ, de Lima L, et al. Atlas of Palliative Care in the Eastern Mediterranean Region. Houston: IAHPC Press; 2017.
Information on the state of palliative care development in Eastern
Mediterranean countries is scant. This study is the first of its kind in
conducting a systematic descriptive analysis of palliative care development
in the region.
To describe the current status of palliative care in the Eastern
Mediterranean Region according to the World Health Organization
(WHO) public health strategy for integrating palliative care: policies,
opioid accessibility, services availability, and educational programs
plus palliative care professional activity.
Surveys were sent by email to two leaders of palliative care in each
country. A follow-up telephone interview was conducted with one
leader from each available country. A scoping review of the state of
palliative care in Eastern Mediterranean countries using the WHO
palliative care public health strategy was conducted using PubMed,
CINAHL, Embase, and Google Scholar. RESULTS
Sixty eight percent (15/22) of countries in the EMRO region responded
to the survey. Of the fifteen participating countries, Saudi Arabia
had the highest number of total palliative care programs across
the Eastern Mediterranean region, followed by Egypt and Jordan,
while Iraq and the Occupied Palestinian Territories reported no palliative
care programs. Saudi Arabia, Iran, and Lebanon have official
licensing programs in palliative care for physicians, and a further
four countries (Egypt, Jordan, Oman, and Qatar) have developed
other advanced training programs (such as Masters or Diploma).
In terms of education, Jordan, Oman, and Lebanon report having
at least one medical school teaching palliative care as an independent
subject, though four additional countries (Egypt, Kuwait, Pakistan,
and Tunisia) report teaching palliative care integrated into
other subjects. There are no nursing schools in the region that teach
palliative care as an independent course. In terms of policies, only
Tunisia has a stand-alone national palliative care plan. However,
73% (11/15) of participating countries reported having a section for
palliative care within their national cancer plan/strategy. In terms of
medicine availability, Saudi Arabia reported the highest opioid consumption
in morphine equivalence, excluding methadone, at 33.55
mg/capita/year in 2015, with the next highest being Kuwait at 5.59
mg/capita/year. Finally, in terms of professional activity, Morocco,
Tunisia, Lebanon, Jordan, Saudi Arabia, Kuwait, and Iran reported
having national palliative care associations, though not all are currently
Palliative care remains underdeveloped in most countries. Efforts
and resources should be mobilized to address the gaps identified
to ensure that palliative care becomes accessible across the region.
The Atlas of Palliative Care in the Eastern Mediterranean Region is a joint project between the Lebanese Center for Palliative Care – Balsam and the ATLANTES Research Program at the Institute for Culture and Society, University of Navarra, Spain. The World Health Organization (WHO EMRO) contributed to the project offering financial support for the printed version of this Atlas. The International Association for Hospice and Palliative Care (IAHPC) provided funding for design and printing.