World Health Organization
منظمة الصحة العالمية
Organisation mondiale de la Santé

Response to a 2022 EMHJ paper on palliative care models in the Eastern Mediterranean Region

Print

PDF version

Letter to the editor

Noor Safar1 and Tala Al-Dabbous1

1Bayt Abdullah Children’s Hospice, Kuwait (Correspondence to Noor Safar: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Keywords: palliative care, paediatric, hospice, Kuwait, Eastern Mediterranean

Citation: Safar N, Al-Dabbous T. Response to a 2022 EMHJ paper on palliative care models in the Eastern Mediterranean Region. East Mediterr Health J. 2025;31(3):200–201. https://doi.org/10.26719/2025.31.3.200.

Received: 06/10/2024; Accepted: 15/01/2025

Copyright © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo

Dear Editor,

In our search for journal articles that discuss paediatric palliative care models in the Eastern Mediterranean Region (EMR), we came across this 2022 EMHJ report (1). The last sentence of the introduction claims that no country in the EMR had “achieved integration of palliative care services” in their healthcare system and that only 4 had “better than isolated care provision” (1,2). This assertion is inaccurate especially for Kuwait. Looking into the references, the data appears to have been sourced from 2 major reports: the WHO/WHPCA’s 2020 Global Atlas of Palliative Care and the IAHPC’s 2017 Atlas of Palliative Care in the EMR. Upon further reading, we discovered that the information in these sources was not entirely representative of the scope of palliative care services in Kuwait, as the services our centre offers were not explicitly mentioned.

The Kuwait Association for Care of Children in Hospital (KACCH) was founded in 1989 to provide psychosocial support for children and families at Amiri Hospital (3-5). Today, KACCH manages child life programmes across 7 government hospitals (6). The paediatric palliative homecare programme was initiated in 1992, driven by a single mother's wish to have her son die at home (3). The homecare service continued until a physical facility was built. In 2012, the freestanding Bayt Abdullah Children’s Hospice (BACCH) was opened to offer specialized paediatric palliative care (4-6). BACCH is currently the only children’s hospice in the Middle East (5), and its services include multidisciplinary clinical and medical support, terminal and emergency care, schooling, and even community outreach and respite programmes (4-6). Patients have the flexibility of receiving psychosocial and medical care at home, in the hospital, or at BACCH (4,5).

In 2020, these 2 entities merged into one organization, KACCH & BACCH, which has helped streamline our integrated in/outreach model and dual-keyworker system (5,6). Each child and their family members are assigned a clinical and psychosocial keyworker, who coordinate internally to ensure consistent and appropriate care provision (5). This duo acts as a link between the hospice and the hospital-based medical teams, which is meant to promote early referrals (5). As a non-profit private entity, BACCH is primarily funded by donations and support from the Kuwait Ministry of Health based on a Memorandum of Understanding.

Before writing this letter, we contacted Dr Eric Krakauer to inform him about this issue and he graciously connected us to the University of Navarra team and the Global Atlas editor to correct the misinformation. During our conversations, we found that the cause of this misrepresentation was that both reports used for the paper had relied on data that were provided by 1 or 2 key local informants (2,8). Although informants are typically screened and selectively chosen, the selection process is not totally error-free. With these newfound connections and the subsequent correction, we hope that a more comprehensive and more accurate documentation of adult and paediatric palliative care services in Kuwait will be presented.

Conflicting of interest: None declared.

Funding: None.

References

  1. Krakauer E, Al-Shammary SA, Duraisamy B, Rassouli M, Rizkallah R, Fadhil S, Osman H. Palliative care models and innovations in 4 Eastern Mediterranean Region countries: a case-based study. East Mediterr Health J. 2022;27(8):622-628. doi: 10.26719/emhj.22.038. PMID: 36134495.
  2. Connor SR. Global atlas of palliative care. 2nd edition. London: Worldwide Hospice Palliative Care Alliance, and Geneva & World Health Organization, 2020. https://www.thewhpca.org/resources/global-atlas-on-end-of-life-care.
  3. Kuwait Association for the Care of Children in Hospital & Bayt Abdullah Children’s Hospice. The story of KACCH and BACCH. Al-Souk Al-Dakhili: Kuwait Association for the Care of Children in Hospital & Bayt Abdullah Children’s Hospice, n.d. https://www.kacch.org/about-us/our-story/.
  4. Kuwait Association for the Care of Children in Hospital and Bayt Abdullah Children’s Hospice. Bristol: International Children’s Palliative Care Network, n.d. https://icpcn.org/member-directory/kuwait-association-for-the-care-of-children-in-hospital-and-bayt-abdullah-childrens-hospice-kacch-bacch/#:~:text=BACCH%20provides%20the%20highest%20standards,in%20Kuwait%2C%20and%20their%20families.
  5. Roland J, Lambert M, Shaw A, Williams I, Dale-Harris L, Fontana G. The children’s palliative care provider of the future: A blueprint to spark, scale and share innovation. London: Imperial College London, 2022. https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/IGHI_CPC_Report_Final.pdf.
  6. Kuwait Association for the Care of Children in Hospital & Bayt Abdullah Children’s Hospice. Factsheet. Al-Souk Al-Dakhili: Kuwait Association for the Care of Children in Hospital & Bayt Abdullah Children’s Hospice, 2022. https://www.kacch.org/wp-content/uploads/2022/04/Fact-Sheet-Final-%D9%90English.pdf.
  7. Al-Dabbous TA Hospice built on the imperative of a mother’s promise. Houston: International Association for Hospice & Palliative Care, 2023. https://hospicecare.com/what-we-do/publications/newsletter/2023/01/introducing/.
  8. Osman H, Rihan A, Garralda E, Rhee JY, Pons JJ, de Lima L, Tfayli A, Centeno C. Atlas of Palliative Care in the Eastern Mediterranean Region. Houston: International Association for Hospice & Palliative Care Press, 2017. https://dadun.unav.edu/handle/10171/43303.