Ethical Challenges of Chronic Disease Care in Humanitarian Settings (360G-Wellcome-336216_Z_25_Z)

Humanitarian Medical Organisations (HMOs) are known to provide life-saving care for people with chronic diseases in some of the world’s most unstable settings. Yet, operating amid escalating political turmoil, their projects are forced to close in the face of armed conflict and dwindling funds leaving patients without medicines and staff without support. Despite its frequency and devastating impact, little is known about how patients and staff experience the closure of humanitarian health services, what frameworks exist to support patient-led healthcare, or how to define and implement an ‘ethical exit’ that promotes continuity-focused care, and safeguards dignity and trust. This expert-by-experience led fellowship will generate new knowledge on how HMOs can ‘close well’, using creative, participatory methodologies that bring patient and practitioner voices to the heart of research. Working in Kenya, Yemen, and Lebanon, I will use (i) storyboards to map experiences of past closures, (ii) participatory workshops to co-create an ethical exit framework, and (iii) theatre-for-development techniques to explore ethical dilemmas and procedural scenarios through role play. Findings will be embedded into sector- wide practice through co-authored reports with HMOs and policy engagement at UK Parliament, creating the first actionable roadmap for ‘closing well’ in humanitarian healthcare.