“Their suffering also plagues us": A narrative ethnographic exploration of humanitarian healthcare workers’ moral experiences of providing pediatric palliative care in Cox’s Bazar, Bangladesh

This focused ethnography was conducted between March-August 2021 at the Médecins Sans Frontières (MSF) Goyalmara Mother–Child Hospital in Cox’s Bazar, Bangladesh, which serves the Rohingya refugee and Bangladeshi host community. Data collection involved participant-observation, individual interviews (22), focus group discussions (5), and analysis of protocols and other documents. In this paper, we present three composite stories which explore the meaning of empathy to international, Bangladeshi, and Rohingya MSF staff and their moral experiences of attempting to provide empathetic palliative care to children and their families in a humanitarian context.

Empathy, as well as related Bangla concepts such as shohanubhuti and shohomormita, were central to how MSF staff understood good palliative care. These concepts informed how MSF staff experienced their relationships with the children and caregivers receiving palliative care. In the story “their suffering also plagues us”, Haawa (pseudonym) tries to support a woman whose newborn baby is dying. In “if it were my child”, the team struggles when Layla’s (pseudonym) parents decide to leave the hospital. Finally, in the story “becoming a mechanical person”, the team wrestles with how to maintain empathy as they share difficult news with a family.

Innovative approaches to education and mentorship are needed to ensure that humanitarian healthcare workers have the capacity to engage empathetically with their patients. Considering the moral experiences of front-line staff and incorporating local empathy-like concepts and practices may contribute to the development of organizational strategies that are more relevant in diverse humanitarian crisis contexts.