ALICANTE, Spain — Health care workers have been the primary targets of coronavirus-related acts of violence, harrassment, and discrimination recorded by the International Committee of the Red Cross across more than 40 countries.
Based on firsthand accounts gathered by ICRC, data from other organizations, and the tracking of news reports and social media, a total of 611 incidents were recorded between Feb. 1 and July 31. While patients and medical infrastructure were often on the receiving end, 67% of incidents were directed at health care workers. More than 20% involved physical assaults, 15% were incidents that ICRC classed as “fear-based discrimination,” and 15% were verbal assaults or threats.
“We see a lot of talk [about how to tackle violence against health workers] ... but we don’t really see that much action on the ground," says ICRC's Maciej Polkowski.
This is likely an undercount, said Dr. Michele Heisler, medical director at Physicians for Human Rights. “There is so much hostility, anger, and fear, and that is being taken out on health care workers,” Heisler said. ICRC also noted that many cases go unreported and that actual figures are likely to be much higher.
In an incident in Bangladesh, bricks were thrown at a doctor’s house after he tested positive for COVID-19. In the Philippines, a health worker who tested positive and his family were forced to flee after neighbors cut off their electricity and harassed them. In other incidents, workers were refused access to public transport, doused in bleach, or pelted with stones.
Maciej Polkowski, head of ICRC's Health Care in Danger initiative, said that fears related to the spread of COVID-19, worry for a patient’s well-being, or an inability to carry out rituals such as burials due to restrictions were often to blame.
“In some cases, people may blame health workers for not being able to provide treatment or not being able to save loved ones or for the restrictions in place,” said Stephen Cockburn, head of economic and social justice at Amnesty International.
While health workers have always faced risks — in 2019, 151 health workers were killed and 502 were injured — Polkowski said the pandemic has put health care workers in harm's way at a time when they are needed most.
“There is so much hostility, anger, and fear, and that is being taken out on health care workers.”— Dr. Michele Heisler, medical director, Physicians for Human Rights
Blaming misinformation around COVID-19 for perpetuating a level of fear that can lead to aggression, ICRC is calling for governments and communities to ensure safer working environments for health care professionals and to address misinformation.
But Heisler said that it is populist leaders themselves who have contributed to the spread of misinformation, conspiracy theories, stigmatization, and a culture of blame. “I think this spate of violence, which is increasing and spreading, is a symptom of, in general, a horrifically poor response by leadership,” she said.
It is not too late to change course, however. Governments must investigate and take action when such incidents occur, while state and local governments should invest in health security measures, she advised.
ICRC has developed a checklist to help health facilities implement security measures. It recommends controlling entrances and exits, conducting a risk analysis of the area, and ensuring staff members have skills in de-escalating tension.
“Better communication systems and procedures of how to contact and update relatives regularly and how to communicate difficult information are essential to protect health workers from being at the receiving end of the frustration,” said Christina Wille, director of Insecurity Insight.
There is also a critical need to listen to communities and involve local leaders and individuals who have had COVID-19 in discussions, Heisler added. “Good governance and transparent governance can have a ripple effect so people are more trusting of health care systems and health care workers,” she said.
Cockburn said there are already some examples of governments taking steps to protect health workers. “In Mexico, for example, the government made public statements in support of health workers and took steps to increase security for them, while legislation was introduced in countries including Italy, the Philippines, and Argentina prescribing penalties for harassing or discriminating against health workers,” he said.
The mental health of frontline health workers has been greatly impacted by the COVID-19 pandemic. For many, the most severe mental health effects are likely to come in the aftermath of it. We hear why it’s essential to be ready for an emerging mental health crisis.
But more still needs to be done, Cockburn said, adding that governments should take the time to listen to health workers. “They are best placed to advise on what is needed to keep them safe both at work and in the community, while their free speech is also essential for an effective public health response,” he said. In some countries, health workers have been threatened with reprisals for speaking out.
The international aid community could also help by developing security risk management structures for local health workers, Wille said. “Most health workers work for local health structures, and they are not under a direct employment contract with aid agencies, so they don’t benefit from advances made within the wider aid sector,” she said.
“In my view, the only solution to protect health workers is to strengthen their ability to communicate, to help them defuse potentially risky situations, and to address the underlying issues that make health workers the target for wider frustrations,” she added.
Visit the Duty of Care series for more coverage on how health systems can function better so that health care workers are supported and protected. You can join the conversation using the hashtag #DutyOfCare.