KAMPALA, Uganda — Pain is only the latest woe in John Bizimungu’s life.

Rwandan by birth, he has lived here as a refugee since his family was slaughtered in the 1994 genocide. A cobbler, Mr. Bizimungu used to walk the streets asking people if he could fix their shoes.

Now, at 75 and on crutches, he sits at home hoping customers will drop by. But at least the searing pain from the cancer that has twisted his right foot is under control.

“Oh! Grateful? I am so, so, so, so grateful for the morphine!” he said, waving his hands and rocking back in his chair. “Without it, I would be dead.”

Mr. Bizimungu’s morphine is an opioid, closely related to the painkillers now killing 60,000 Americans a year — a situation President Trump recently declared a “health emergency.”

The cobbler’s desperate need exemplifies a problem that deeply worries palliative care experts: how they can help the 25 million people who die in agony each year in poor and middle-income countries without risking an American-style overdose epidemic abroad or triggering opposition from Western legislators and philanthropists for whom “opioid” has become a dirty word.


Bottles of liquid morphine being readied before shipment in a facility in Kampala. With doctors in short supply, nurses are trained to prescribe morphine to those in need. Credit Charlie Shoemaker for The New York Times

The American delegation to the International Narcotics Control Board, a United Nations agency, “uses frightening war-on-drugs rhetoric,” said Meg O’Brien, the founder of Treat the Pain, an advocacy group devoted to bringing palliative care to poor countries.

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