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Social work in the sphere of palliative and hospice care to persons injured during the ATO in Eastern Ukraine


Alexander Wolf


Ukrainian Association of Palliative and Hospice Care; National Medical Academy of Postgraduate Education, Institute of Family Medicine, Department of Palliative and Hospice Care.


Anti-terrorist operation in Eastern Ukraine (ATO) has become a tragic phenomenon of social and political life of Ukraine, the result of which was about 1 million вимушених переселенців and nearly 4 million people who remain in the area of ​​ATO (the territory controlled by the Armed Forces of Ukraine and / or Donetsk folk republic / Luhansk folk republic).

The civilian population suffered during the ATO, can be divided into the following groups:
1. IDPs;

2. Citizens who live in the area ATO;

3. Internally displaced persons, family members of which remain in the ATO area.
Key aspects of social work in the sphere of palliative and hospice care to migrants is related to the following circumstances:

- numerous cases of murder, including mass, torture, inhuman treatment, etc., associated with military action, where displaced took part as witnesses or active participants totally contradict the assertion of life and the value of each person - the fundamental principle of palliative and hospice care;

- Lack of legal framework related to support of ATO victims;

- Lack or absence of material support for institutions and clients (patients);

- The need for social and psychological assistance due to the crisis, depression, anxiety, pain, post-traumatic stress disorders, cognitive processes, neurotic reactions, etc;

- Image risks associated with regional psycho-behavioral pecularities of IDPs from the Donetsk and Lugansk regions;

- The need of IDPs to be adapted to new environmental conditions;

- The significant role non-governmental and voluntary organizations play in support victimized population.

Key social work aspects to civilians in need of palliative and hospice care and whose living in the ATO area (territory controlled by the Armed Forces of Ukraine and / or Donetsk folk republic / Luhansk folk republic) associated with such circumstances (to addition to above mentioned):

- Evacuation, transfer, or changing of the profile of medical institutions and social care institutions;

- Political, economic and regulatory uncertainty on a number of issues (providing medicines, including coping pain and special equipment, institutional  affiliation of institutions, etc.);

Key social work aspects to civilians in need of palliative and hospice care and whose living in the ATO area (territory controlled by the Armed Forces of Ukraine and / or Donetsk folk republic / Luhansk folk republic) associated with such circumstances (to addition to above mentioned):
- Lack of effective communication between family members;

- Breach of continuity in service delivery.

In this context, the main tasks of social work in the sphere of palliative and hospice care to persons injured during the ATO are:

- Training, education and advocacy measures to build the capacity of citizens (clients) to overcome their difficult life circumstances;

- Establishing of effective psychosocial rehabilitation with involvement of non-governmental (volunteer) organizations;

- Establishing networks of people (clients) with existing social services and other organizations that have the necessary resources, provide appropriate services. A special role in this process is the establishment of cooperation with international humanitarian, technical assistance programs and fundraising (raising additional funds).
It must be emphasized that social work with children's population requires special approaches. Many cases are complex. This applies in particular to cases when seriously ill children have parents who, although not deprived of parental rights (this is the basic norm, or status, of parents in Ukraine) do not execute parental duties but receive proper payment from state and have the further social securities. In cases when child is from ATO region, it is very difficult to organize the proper care as there is a misbalance between the formal status and supporting documents.  Often difficulties also arise in the cases when the need for psychiatric health care to the victims of the ATO is needed. Oftentimes no legal representative of the child can give consent to the rescue (which is mandatoty in such cases).

Accordingly, the functions of social work in palliative and hospice care to persons injured during the ATO as professional activity should be:
1) diagnostic - study, analysis and evaluation of customer life conditions;
2) predictive - development of plan for solving the problem of the client or social problems in society considering possible alternatives, prospects and options for change;
3) organizational - activities of social service to ensure the cooperation of all stakeholders and institutions involved in working with the client;
4) communication – establishment and developing of necessary professional contacts, exchange of information;
5) protecting human rights - use laws and regulations to ensure and protect the rights and interests of clients;

6) preventive - preventing of negative impacts in the life of individuals and vulnerable groups;

7) correcting - structural changes in life-support system;

8) socio-economic - the satisfaction of material interests and needs of low-income clients.

 



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