COVID Exacerbating Severe Violence Against Health Workers
Front line healthcare workers at Thailand Bamrasnaradura Infectious Disease Institute faced workforce shortages and had limited access to personal protective equipment as violence against healthcare workers worsened globally.

An unprecedented number of healthcare workers were seriously assaulted last year, even as health workers risked their lives on the front lines of the COVID-19 response. 

Over 412 COVID-related attacks on health workers, including kidnappings and murders, occurred between January and December 2020, experts reported at a World Health Assembly side event. The session Monday was co-organized by the Global Health Center; the Safeguarding Health in Conflict Coalition; the Swiss Confederation; and the Government of Spain. 

Panelists said that as most countries went into lockdown last year, public frustration, anger and anxiety fuelled violence against health workers worldwide. 

Violence against health care in the context of the COVID-19 pandemic in 2020. Reported COVID-19-related violence (in green) peaked in the early weeks of the pandemic and has since fallen.

The majority of perpetrators of pandemic-triggered violence were patients and their family members, or local community members. In 59% of cases, violence was triggered by opposition to COVID diagnostic testing or a decision to hospitalize a patient, said a “Threats and Violence against Health Care during the COVID-19 Pandemic” report by Insecurity Insight.

Healthcare workers faced abuse while traveling to and from work in 30% of cases. In 11% of incidents, health workers were threatened or injured for speaking out against challenges they experienced at work, including protests over the lack of personal protective equipment and masks. 

“Sadly, these violations in dozens of countries and situations of conflict are the new normal. And this normal is not acceptable,” said Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights. 

Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights.

“It is especially unconscionable during the time of a global health crisis, the COVID-19 pandemic, which compounds the situation of devastation from attacks on health in war and other situations of conflict,” Sirkin added

While generally there were fewer assaults in 2020 compared to previous years, the nature of the events became more severe, with an increase in the number of health workers killed and kidnapped. 

Assaults on Health in Conflict Situations

Beyond COVID-related attacks, deeply-entrenched patterns of violence against health workers in conflict-ridden countries also continued. 

This included attacks on health workers and destruction of health facilities associated with the ongoing conflicts in Libya and Yemen – which continued despite the UN Secretary’s call for a ceasefire due to the pandemic. 

The Central African Republic, plagued by armed conflict, social unrest and political instability, also has seen a high proportion of health facilities destroyed or rendered non-functional.

“Killings, assault, kidnapping, verbal threats and overt acts of intimidation against healthcare workers are commonplace,” said Minister of Health Pierre Somse. 

Pierre Somse, Minister of Health of the Central African Republic.

He said that in the country, the number of attacks against healthcare workers rose 79% from October 2020 to February 2021.

The Central African Republic has one of the world’s lowest physician-to-patient ratios and among the highest rates of maternal and infant mortality. 

In one district in the Central African Republic with high levels of violence against health personnel, tuberculosis vaccination rates also dropped to 45%, as compared to the national average of 81%. 

“Conflict and violence against healthcare workers is worsening inequality and inequities in access to health services,” said Somse. “Addressing all forms of violence against healthcare workers in conflict settings is an urgency. It is needed today more than ever, as we confront COVID-19.”

Trends in Violence Against Health Workers for 2021 

Over the past five years, a health facility in a conflict zone was destroyed or severely damaged every other day, on average. Every two days a health worker was kidnapped or injured, and every three days a health worker was killed. At least 600 health workers were killed and over 1000 health facilities were damaged. This violence was concentrated in Syria, Nigeria, Afghanistan and the Democratic Republic of Congo. 

“Where does this leave us for this year? I’m afraid the picture doesn’t look good,” said Christina Wille, Director of Insecurity Insight, a Geneva-based NGO. “I’m afraid we’ll probably be here next year again with a report that has a few little positive notes to report.”

In 2021, increasing attacks on healthcare workers were witnessed and reported in Tigray, Gaza, and in Myanmar. In Myanmar, there were over 500 arrest warrants issued against healthcare workers since the coup in February.

Barely a day has gone by without violence against health workers being reported in Myanmar. Some 19 health facilities were damaged in Gaza over the past two weeks, including its main COVID-19 laboratory. 

“It seems that whenever there’s violence, it’s accompanied by violence against healthcare,” said Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition. 

Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition.

The violence is sometimes the collateral damage associated with larger strategic objectives. Other times it is an end in itself, as in Afghanistan, where the Taliban forces closures of health facilities in order to exert their leverage over health services. Health workers are sometimes punished for providing care to enemy combatants, although occasionally the violence is a result of recklessness, said Rubenstein.

Actions Needed by States, the UN and WHO

This month marks five years since the United Nations Security Council adopted a resolution against attacks on health workers in situations of armed conflict. On this anniversary, little progress has been made on implementing the resolution and reducing violence. 

“A few states have demonstrated their commitments and followed through on them, but these unfortunately are exceptions,” said Rubenstein.

The resolution was prompted by the 2015 US bombing of the Kunduz Trauma Center in Afghanistan, operated by Médecins sans Frontières, which killed 42 patients and health-care workers. 

An operating room in the Kunduz Trauma Center in Afghanistan, operated by Médecins Sans Frontières, that was destroyed in a US airstrike in 2015.

“In the darkness of the night, my hospital was on fire and I was hearing the screams of patients, caretakers, and staff for help. No one could help them. And all of them, the ones who had been trapped inside, died,” said Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

“I have seen terrible consequences of attacks on healthcare: patients and medical personnel directly killed and injured, and essential in life saving medical services lost for current and future patients,” said Nasim.

Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

Calling for Five Concrete Steps by Global Community

“After five years of inaction, the international community must take a much more vigorous stance,” said Rubenstein.  He laid out five concrete steps to be taken by the international community:

  • A special representative of the UN Secretary General should be appointed to monitor and report on the compliance of states with the resolution;
  • Political leaders must demand that ministers of defense get involved in reforming operational procedures and protecting healthcare;
  • WHO should convene health ministers to address the issue of violence against health workers at the ongoing 74th World Health Assembly;
  • WHO must take action to address the underreporting of data collected on violence against healthcare;
  • States and the UN must stop taking actions that undermine protection and legitimize violence against healthcare.

Multiple times over the past five years, the Security Council has blocked referrals to the International Criminal Court. In response, the General Assembly should establish new tribunals to prosecute perpetrators. 

Additionally, member states that sell arms to perpetrators of violence against healthcare must start adhering to laws prohibiting such sales. 

“These five steps take commitment and political will,” said Rubenstein. “We don’t want to meet in another five years and have the same discussion.”

“We all have a role to play in preventing these terrible events, which continuously reduce and impair the capacity of the impact of healthcare systems around the world,” said Maciej Polkowski, Head of the Health Care in Danger Initiative at the International Committee of the Red Cross. 

“The very least we can ask is that people stop attacking medical facilities and healthcare workers who are trying to save human lives,” said Nasim. “It must stop.”

Image Credits: Global Health Center, UN Women Asia and the Pacific.

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