Compassion in health emergency management in Sri Lanka

Abstract

Compassion, defined as awareness of suffering, empathic attunement, and action to alleviate it, has been widely recognized in health care yet seldom examined systemically within Health Emergency Management (HEM). In Sri Lanka, recurrent crises provide a unique context for understanding how compassion is experienced, enacted, constrained, and sustained across the emergency management system.

A constructivist grounded theory study was undertaken through 23 semi-structured interviews with professionals across national, district, and divisional levels, including health staff, administrators, pre-hospital services, security forces, disaster managers, civil society, disability activists, and community representatives. Online interviews were conducted in Sinhala and English, recorded with consent, and analyzed using open, axial, and selective coding with constant comparison and iterative memoing.

Findings indicated broad recognition of compassion as essential in health emergencies, yet fragile in the face of stress, rigid rules, poor leadership, and resource shortages. Compassion emerged through interconnected layers: individual roots of upbringing, education, faith, and prior adversity; organizational stems shaped by resources, adaptive policies, and leadership culture; systemic flows of reciprocity between leadership, staff, patients, and communities; and cultural-philosophical traditions such as the Brahma Vihāras and Sangraha Vasthu that infused humanitarian practice with deeper ethical grounding. While some respondents perceived tension between compassion and humanitarian principles, narratives demonstrated that compassion reinforced and animated these principles when supported by organizational flexibility and cultural ethics. Instances of compassionate problem-solving contrasted sharply with harms caused by rigid application of insensitive rules.

The Lotus of Compassion in Health Emergencies Model synthesizes these findings, depicting compassion as seeds of innate potential, roots of individual formation, stems of organizational support, leaves of everyday practice, and flowers of visible expression in crises, nourished by leadership as sun and sustained by beneficiary reciprocity as bees and air. Compassion in Sri Lanka’s HEM is thus not an intangible or abstract value but a systemic quality that strengthens resilience and operationalizes humanitarian principles in practice.