Abstract
Armed conflict and humanitarian crises severely disrupt health systems, particularly in LMICs, increasing suffering, and strain healthcare providers. Despite the need for palliative care in these settings and growing recognition of its role as a humanitarian imperative, it remains marginalized with limited integration into crisis response. How palliative care providers sustain care delivery, adapt practice and navigate constraints in such contexts is understudied. This study explores how palliative care providers in Lebanon experienced, navigated and sustained care delivery during the 2024 war, as well as the key barriers and adaptive strategies. In-depth interviews with 14 multidisciplinary palliative care providers (physicians, nurses, psychologists and social workers) were conducted. Four interconnected themes emerged. Negotiating between professional duty and fear described the emotional strain, safety concerns, and moral distress while providing care under threat. Care disruption within systemic constraints reflected structural challenges, including medication shortages, unsafe travel, disrupted patient access and death burials. Tailoring palliative care to emerging needs reflected adaptive responses, including telehealth consultations, relocation of services, and expansion of care to war-related injuries and humanitarian aid. Holding on to meaning and purpose illustrated how professional commitment, political neutrality, teamwork, and appreciative relationships with patients helped providers sustain practice despite adversity. Palliative care providers showed strong adaptability despite fragile, unprepared systems, often relying on improvisation and moral support. Ensuring continuity of compassionate care in conflict settings requires integrating palliative care into preparedness plans, strengthening supply chains, securing safe access and burial processes, and supporting workforce well-being.