New patterns of violence against healthcare in the covid-19 pandemic

Tributes to health workers are pouring in from around the world amid the covid-19 pandemic, as they are saluted as heroes and receive standing ovations from balconies. Nevertheless, an increasing number of attacks against the healthcare providers engaged in the pandemic response have been reported worldwide by media, humanitarian organizations and health workers. The International Council of Nurses has spoken out against this growing global issue. What is triggering this wave of violence against healthcare? Identifying and understanding the new patterns of violence is essential to address them. However, no comprehensive analysis has been conducted so far: the reported incidents remain anecdotal evidence. 

Emerging patterns of violence against health facilities, ambulances and staff have been recorded in Europe, the Middle East, the US, Latin America, Asia, the Pacific and Africa. They fall within three groups: attacks from patients or families; aggressions from the general public; and use of force by law enforcement officials. The attacks from patients or families currently reported across the world often originate out of the health workers’ attempt to implement some essential—but unpopular—covid-19 prevention and control measures, such as placing a family member in a quarantine or isolation facility, or not allowing the family to attend to the body of the deceased loved-one. 

Tensions between the general public and the health services have also arisen worldwide, to varying degrees: from demonstrations outside health premises to hospitals being set on fire, from roadblocks to stone-throwing at ambulances, from verbal threats to physical aggressions against health workers. These incidents share a common trait: the perpetrators are community members persuaded that the geographic proximity to potentially infected people would expose the whole community to risk. In a telling example from Ukraine demonstrators suggested Chernobyl as the most suitable place to quarantine covid-19 patients. Additionally, health workers have also encountered stigmatization by some communities labelling the covid-19 pandemic as “divine punishment” and dismissing the required prevention and control measures.

Finally, violent clashes between law enforcement officials and health workers have also been reported across the world, during demonstrations staged by medical staff to demand protective equipment and improvement in their working conditions. These clashes led sometimes to mass arrests, injuries and beatings of the health staff. In other instances, health workers were reportedly suspended for refusing to perform without protective equipment or escorted by law enforcement officials for compulsory covid-19 duty. 

These incidents show that, while health workers are needed more than ever, they are also exposed to multiple new threats. To break this vicious circle, which undermines the health system capacity in a moment when it shall be enhanced, urgent pragmatic measures are needed. By ensuring minimum standard living conditions for individuals placed in quarantine and isolation facilities, virtual communication with their families, and financial support when the patient is the breadwinner, communities will probably be more likely to accept the transfer of some members to these facilities. Likewise, by providing dedicated transport to healthcare staff, hospitals can reduce the risk of stigmatization and attacks by other public transport passengers. Furthermore, by ensuring protective equipment and better working conditions to the healthcare workers, protests will decrease.

Additionally, long-term multidisciplinary responses—supported by history, social sciences, and law—are needed. Although the described trends may appear new, during previous epidemics—such as the recent Ebola outbreak in West Africa and Congo, or the cholera pandemic in Europe in the 19th and early 20th centuries—healthcare workers were also targeted as a consequence of community distrust, widespread panic, narratives of denial and stigmatization. Lessons learned stress the key role of communication, social mobilization, and community engagement to foster people’s trust. Involving local leaders and disease survivors from the communities can generate confidence in the healthcare system among their fellow community members, and counter narratives of denial, panic, and stigma.

Research from previous epidemics shows that misinformation, disinformation, conflicting information and rumors in media and social media contribute to spread anxiety and fear, which can trigger violence against healthcare workers. Twitter and other social media appropriately adopted a covid-19 self-regulation, committing to remove any unsubstantiated claims causing widespread panic or denying established scientific facts. Finally, when it comes to using public force against health workers, States should be reminded that even times of “public emergency which threatens the life of the nation” do not stop the enjoyment of some rights and freedom, such as the freedom from cruel inhuman treatment (Article 4, International Covenant on Civil and Political Rights). As for the coercion to perform while lacking protective equipment, not only it is questionable under medical ethics, but also under the International Covenant on Social, Economic and Cultural Rights, which requires States to ensure “safe and healthy working conditions” (Article 7).

Paola Forgione worked for four years in Africa, the Americas and the Middle East with the International Committee of the Red Cross (ICRC). In 2019, she joined the ICRC Healthcare in Danger initiative at the Geneva headquarters.

Competing interests: None declared