The World Innovation Summit for Health (WISH), a global health initiative of Qatar Foundation, has announced the development of a groundbreaking Paediatric Trauma Pain Management Manual. This resource, available in both Arabic and English, aims to support clinicians treating children with life-altering injuries in conflict-affected areas.
Addressing a critical gap in paediatric care
Despite the alarming statistic that one in six children reside in conflict zones [1], there has been a notable absence of comprehensive guidance for clinicians treating paediatric blast injuries. Children exposed to blast events often sustain more severe injuries than adults and face higher mortality rates. The underestimation and undertreatment of pain in these young patients can lead to poor outcomes and lifelong physical, psychological, and social consequences.
Dr Paul Reavley, Paediatric Emergency Medicine Consultant at Bristol Royal Hospital for Children and project lead, emphasised the importance of the manual: “Paediatric care in conflict zones is often delivered by clinicians who have little experience in treating children. We are looking to give doctors working on the ground in conflict zones both the tools and the confidence to treat children experiencing the horrific and painful consequences of blast injuries, which in turn will allow for better assessment, treatment, and communication with children, from injury to rehabilitation and beyond.”
Collaborative development and expertise
The manual is being developed in collaboration with the UK-based Paediatric Blast Injury Partnership, building upon their 2019 Paediatric Blast Injury Field Manual[2]. WISH facilitated the Arabic translation of the original manual with support from the Translation and Interpreting Institute of Qatar Foundation’s Hamad Bin Khalifa University.
The new resource will encompass pain management strategies across the entire care continuum, from the initial point of blast injury through acute care and long-term follow- up. A diverse team of experts is contributing to its development, including:
- Doctors undergoing training at Hamad Medical Corporation (HMC) from Gaza
- Pain specialists from Qatar
- Clinicians and academics in paediatrics and pain management from Bristol Royal Hospital for Children, the University of Bath, and Kidconfident.org
Addressing immediate needs in conflict zones
The manual’s development has been accelerated in response to the urgent situation in Gaza. Since November 2023, over 1,000 copies of the Arabic version of the Paediatric Blast Injury Field Manual have been distributed to medics in the region. Additionally, WISH has facilitated Ukrainian and Russian translations of the blast injury manuals, which have been disseminated across Ukraine by Save the Children.
Clinical focus group refines content
To ensure the manual’s relevance and efficacy, WISH convened a Pain Management Clinical Focus Group in Doha on 27 April. This meeting brought together 30- 40 Qatar-based clinicians with first-hand experience in Palestine and other conflict settings. Participants included pain experts from Sidra Medicine and HMC, as well as doctors from Gaza and the West Bank currently enrolled in fellowship training at HMC as part of a programme organised by Qatar’s Ministry of Public Health.
Dr Abdullatif AlKhal, Deputy Chief Medical Officer and Director of the Department of Medical Education at HMC, highlighted the value of this collaborative approach: “Their first-hand knowledge of working on the ground in extremely challenging conditions gives them a valuable perspective on delivering care. Working together with the Paediatric Blast Injury Partnership and WISH, we have the best chance of developing a Paediatric Pain Management Manual that will provide vital support to healthcare professionals working on the ground in conflict zones in Gaza and elsewhere.”
Launch and future impact
The Paediatric Trauma Pain Management Manual is scheduled for official launch at the WISH 2024 international healthcare summit on 13-14 November this year at the Qatar National Convention Centre in Doha. This resource is poised to make a significant impact on paediatric care in conflict zones globally.
Sultana Afdhal, Chief Executive Officer of WISH, underscored the urgency of this initiative: “Given the suffering of the growing number of severely injured children in Gaza, we knew that there was a chronic need for a focus on pain relief. Speaking with Paul Reavley made it clear that developing a follow-on manual to the Paediatric Blast Injury Field Manual would be an effective way to provide help.” The development of this manual represents a important step forward in addressing the complex medical needs of children affected by conflict. By providing clinicians with specialised guidance on pain management, it has the potential to improve outcomes and quality of life for countless young patients in some of the world’s most challenging healthcare environments.
About the Paediatric Trauma Pain Management Manual
The comprehensive end-to-end pain management manual will guide the clinician at each point of the child’s care pathway, from point of injury to discharge from care. The manual will address acute and chronic pain management and will use pharmacological and non- pharmacological techniques as well as addressing psychosocial aspects of pain management. The manual will complement the Paediatric Blast Injury Field Manual but it will also be a standalone resource. The manual will be relevant in multiple contexts but will be targeted for clinicians dealing with conflict trauma in children.
The manual will be divided into sections relevant to the stage of the child’s care pathway:
- Prehospital
- Resuscitation
- Perioperative
- Intensive care
- Ward and rehab
- Chronic pain
It will include pharmacological and non-pharmacological management of pain, regional anaesthesia techniques, procedural pain management (and sedation) and play/distraction techniques. There will be a strong theme of psychosocial care throughout the manual. It will also include pain and distress management in the dying child.
It will be made freely available and be translated into a number of different languages.
References:
- Østby, G., Rustad, S. A., Tollefsen, A. F. (2020). Children affected by armed conflict, 1990–2018. Conflict trends, 1.
- https://www.imperial.ac.uk/media/imperial-college/research-centres-and-groups/centre-for-blast-injury-studies/PBIP-BlastInjuryManual2019_I_web.pdf
