June 20, 2011
In a report on the global state of pain treatment, Human Rights Watch states that tens of millions of people worldwide are denied access to inexpensive medications for severe pain.
The report, Global State of Pain Treatment: Access to Palliative Care as a Human Right, details the failure of many governments to take even basic steps to ensure that people with severe pain due to cancer, HIV, and other serious illnesses have access to palliative care, a health service that seeks to improve quality of life. As a result, millions of patients live and die in great agony that could easily be prevented, Human Rights Watch said.
“My leg would burn like a chili on your tongue,” Dilawar Joshi, a Nepali man with a bone tumor living in India told Human Rights Watch. “The pain was so severe I felt like dying. I was very scared. I felt that it would be better to die than to have to bear this pain. [I thought], just remove the leg, then it will be alright. Just get rid of the leg so I’ll be free of pain.”
Experts estimate that 60 percent of those who die each year in low- and middle-income countries – 33 million people – need palliative care. In these countries, most cancer patients are diagnosed when they already have advanced disease and can no longer be cured. The only treatment option is palliative care. In high-income countries, palliative care needs are increasing with aging populations and the resulting higher cancer incidence.
Limited availability of pain medications
The report is based on a survey of policy barriers to palliative care in 40 countries and an assessment of the availability of pain-relieving drugs worldwide. Human Rights Watch found that in 35 of 192 countries reviewed, fewer than 1 percent of patients with moderate to severe pain from terminal cancer or HIV could get the strong pain medications they needed. These countries are concentrated in Sub-Saharan Africa, but some are in Asia, the Middle East, North Africa, and Central America. Availability of strong pain medications is very limited in many of the world’s most populous countries. At least 100,000 people die from cancer or AIDS each year without access to adequate pain treatment in countries such as China, India, Indonesia, Nigeria, Russia, and South Africa.
The survey found multiple barriers to palliative care in most of the countries surveyed. Three quarters do not have national palliative care policies, despite a World Health Organization recommendation to develop such policies. In most of these countries, healthcare workers are not adequately trained in pain management or palliative care, and in some, no training is offered at all. In 33 of the countries, the government imposes restrictions on prescribing morphine beyond the requirements of UN drug conventions.
Download the report (PDF)