Hundreds of healthcare workers treating Covid patients around the world have experienced verbal, physical, and sometimes life-threatening attacks during the pandemic, prompting calls for immediate action from human rights campaigners.
Covid-related attacks on healthcare workers are expected to rise as new variants cause havoc in countries such as India and rollouts of vaccination programmes belatedly get under way in some countries, according to the UN special rapporteur on the right to health.
“With the added stress of Covid, these attacks will go up,” said Tlaleng Mofokeng. “That’s the sad part. There’s already a shortage of health workers, and many did die. On top of that, we know the developed world has been hoarding vaccines, we know pharmaceutical companies don’t want to share their intellectual property. We have created an artificial situation where there’s even more scarcity. That will trickle down and add even more pressure at the point of care.”
A doctor herself, Mofokeng said these attacks were “disheartening and disappointing”. She said violence against healthcare staff was not new but Covid had compounded circumstances born out of lack of government leadership and investment in public health systems.
“Where governments fail, it’s the health workers who pick up the slack and who ensure health systems don’t collapse,” she said. “But how much longer can they do this under these circumstances?”
According to the latest figures from the International Committee of the Red Cross (ICRC), 848 violent incidents associated with Covid-19 were recorded from February to December last year. This number is likely to be “the tip of the iceberg” and part of “a much more widespread phenomenon”, said Maciej Polkowski, head of the Health Care in Danger initiative at the ICRC. Many incidents go unreported.
ICRC analysis showed that the vast majority of incidents were interpersonal violence where community groups, patients or their relatives lashed out at healthcare workers, with sometimes severe consequences. Polkowski gave an example of a patient with Covid symptoms in Naples, Italy, who was angry after being told to wait and spat at a doctor and a nurse. As a result, the entire ward had to be closed and staff were sent to quarantine.
Reactions also turned physically violent. In India and Pakistan, Covid wards have been ransacked and staff assaulted. In Mexico, bleach was thrown at healthcare workers on the street. The words “contagious rat” were daubed on the car of a health worker in Spain, and communities on the west coast of the US forced Covid treatment centres out of the area, said Polkowski.
In the UK, NHS staff were spat at, patients verbally abused staff who asked them to wear masks in hospital settings, and GP surgeries reported unprecedented abuse and aggression from patients.
Polkowski blamed governments for allowing misinformation to spread. “A lot of anxieties come from the fact that governments have not communicated clearly on the issue,” he said. “They have downplayed the seriousness, prioritised the economy over the health of populations, so this violence is one of the repercussions.”
When patients or their relatives were responsible for violence, it was usually linked to a relative’s death, or fear they might die, Polkowski said. The inability to carry out burial rituals due to coronavirus restrictions also prompted some relatives to attack healthcare staff or facilities.
State forces are also responsible for about 20% of Covid-related attacks, according to Polkowski. In Myanmar, medical teams on their way to treat Covid patients in respiratory distress were detained, leading to patients dying unnecessarily, according to one doctor in the country who cannot be named for security reasons.
In Nicaragua, the government repeatedly understated the scale of the pandemic in the country, according to Amnesty International. Health workers were fired for using personal protective equipment at work, and also had it violently stripped from them.
In response to rises in Covid-related attacks, some countries took action. India amended its emergency epidemic law to make attacks on healthcare workers punishable by up to seven years in prison. Authorities in Sudan announced the creation of a dedicated police force to protect healthcare workers during the pandemic. In Algeria, the penal code was amended to increase protection for healthcare workers against attacks and to punish individuals who damage health facilities.
In the UK, the police, crime, sentencing and courts bill proposes increasing the maximum penalty from 12 months to two years in prison for anyone who assaults an emergency worker. Paramedics in England are to be given body cameras after a sharp rise in attacks. Data shows that 3,569 ambulance staff were physically assaulted by members of the public last year – 30% more than in 2016–17.
For healthcare workers, the impact of violence can lead to mental health issues, burnout and in some instances, suicide, said Mofokeng. She called for increased monitoring and data collection of violent attacks. “The needs are immediate and in some cases life-threatening. We need advocacy at all levels and for member states themselves to do the right thing.”
She would also like to see a broadening of the UN security council resolution passed in 2016 obliging countries to prevent and respond to attacks on healthcare in areas of conflict, to take Covid-related incidents into account.
But that on its own won’t solve the issue, according to Prof Leonard Rubenstein, founder and chair of the Safeguarding Health in Conflict Coalition. “Until there is a willingness not just to condemn attacks and support resolutions, but to really act towards prevention and accountability, attacks will continue.”
He added: “Health workers will always need support. They would like to be supported and protected, not have people banging pots and pans.”