Background Alleviating suffering and preserving dignity are essential components of healthcare. Patients in need of palliative care often require opioid medication to relieve breathlessness and pain. However, lack of access to essential opioids, particularly morphine, remains a major challenge in low and middle-income countries (LMICs). This is notably critical in the humanitarian context. We conducted two case studies to identify the barriers to and facilitators of access to opioids, particularly morphine, for palliative care patients in humanitarian settings, while exploring humanitarian healthcare workers’ perceptions and experiences with opioid use.

Methods Two case studies were carried out based on Médecins Sans Frontières (MSF) projects which integrated palliative care: advanced HIV care in Patna, Bihar, India, and paediatric and neonatal care in the refugee context, in Cox’s Bazar, Bangladesh. Six semi-structured interviews were conducted with key MSF humanitarian healthcare workers. Interviews were conducted in English, video- and/or audio-recorded and transcribed verbatim. Transcripts were coded and analyzed using the grounded theory approach.

Results Several barriers impeding access to and use of essential opioids in palliative care were reported by the participants. These included: limited availability, accessibility obstacles, socio-cultural challenges such as low awareness and misconceptions, lack of healthcare providers’ training on opioid use, and burdensome regulatory processes. Most participants reported that clinical guidelines, familiarization with the use of opioids and interdisciplinary team working were important facilitators to opioid prescribing. Participants expressed the urgency for further educational and advocacy initiatives to improve access to essential opioids for patients requiring palliative care.

Conclusions Humanitarian healthcare workers face multiple challenges leading to inadequate access to opioid medication, which undermines effective palliative care delivery. Adequate training on the use of opioids and strong advocacy led by humanitarian organizations and the medical community are critical to improve access to these essential medicines for relief of pain and suffering.