1. To hear the types of ethical challenges foreign health care workers (HCWs) experience while providing health care in conditions of disaster and deprivation. 2. To hear how they responded 3. To understand the kinds of resources that may have been helpful to support HCWs in these ethical dilemmas.

Qualitative study, loosely grounded theory. Canadian trained HCWs (n = 20, mean age 39) who have worked in disaster response, conflict, post disaster.

Ethical dilemmas emerged from 4 main sources: resource scarcity, historical/political/social structures, aid agency policies/agendas, HCWs norms roles/interactions. Participants described little preparation to deal with ethical dilemmas, and the value in pre-departure training. Clinicians are nurtured in western ethics- mostly formed on autonomy, beneficence, non-maleficence and justice. New realities for many were related to community oriented Public Health Ethics. Early discussion has emerged about the possibility of developing a simple, practical, hand held decision-making model (toolkit) to be used in the field to help guide reflection about ethical dilemmas for HCWs in disaster settings.