Physicians, nurses, and other front-line health-care workers have been celebrated
in many countries as heroes for their work during the COVID-19 pandemic. Yet not everyone
appreciates their efforts and contributions. Since the beginning of this pandemic,
headlines have also captured stories of health-care personnel facing attacks as they
travel to and from health-care facilities. Nurses and doctors have been pelted with
eggs and physically assaulted in Mexico.
1
In the Philippines, a nurse was reportedly attacked by men who poured bleach on his
face, damaging his vision.
2
Across India, reports describe health-care workers being beaten, stoned, spat on,
threatened, and evicted from their homes.
3
These are just a few examples among many across numerous countries, including the
USA and Australia.
2
Sadly, violence against health-care personnel is not a new phenomenon. Before the
COVID-19 pandemic, such attacks were increasingly documented in clinics and hospitals
worldwide.3, 4 Attacks on health-care workers and health-care facilities also occur
as a deplorable tactic of war that defies international humanitarian and human rights
laws. In May, 2020, an armed attack on a hospital maternity ward in Kabul, Afghanistan,
killed at least 24 civilians, including two infants.
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And in the midst of the humanitarian emergency of thousands of people displaced in
opposition-held areas of northwest Syria, the Syrian Government has continued to bomb
health-care facilities in that region.
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Acts of violence in any context must be condemned. What makes the current attacks
specifically horrifying is that health-care personnel are responding to a crisis that
is deeply affecting all societies. Governmental failures in some countries to adequately
provide and manage resources in this pandemic mean that health-care personnel are
risking their lives daily by caring for COVID-19 patients without adequate personal
protective equipment and other safety measures in their workplaces.
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As a result, thousands of health-care workers worldwide have contracted severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) and have thus been perceived as public
health hazards themselves.
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This situation has generated violence against them in some places, essentially for
performing their professional duties. This response is likely to exacerbate already
unprecedented COVID-19-related stress and burnout that health-care workers and their
families are experiencing in this pandemic.
With the COVID-19 pandemic taxing the health-care systems of almost every country,
assaults on health-care workers are assaults against all of us. We depend on their
health and wellbeing so that they can continue to provide care to individuals, families,
and communities with and without COVID-19.
The reasons people attack and abuse health-care personnel during health emergencies
are many, and local contexts vary. In some settings during the COVID-19 pandemic,
fear, panic, misinformation about how SARS-CoV-2 can spread, and misplaced anger are
likely drivers. A few government leaders have responded by announcing swift and, in
some cases, draconian punishment for those who attack health-care workers.
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Yet threats of retribution do not address the causes of such violence and alone are
unlikely to curtail these attacks. Effective responses must address the root causes.
We recommend that the following actions be taken immediately.
First, collect data on the incidence and types of attacks on health-care personnel,
including in the context of the COVID-19 pandemic, in all countries to fully understand
the scope of the problem and to design interventions to prevent and respond to the
attacks. National and international bodies such as WHO must engage in a coordinated
global effort. And this initiative must incorporate lessons learned from previous
efforts to document violence against health-care personnel, such as attacks on those
leading polio vaccination campaigns or who cared for patients with Ebola virus disease.
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Data on attacks specific to COVID-19 should be systematically gathered and included
in the WHO Surveillance System of Attacks on Healthcare. Global support from all member
states and their communities for this effort is essential to achieve a robust surveillance
system. National data should be collected by ministries of health or occupational
health and safety bodies. Mechanisms to analyse, share, and widely disseminate this
information on violence against health-care personnel need to be developed or expanded,
following the example of the reports from the Safeguarding Health in Conflict Coalition
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and data gathered by Insecurity Insight,
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among others.
© 2020 Jose Luis Gonzales/Reuters
2020
Since January 2020 Elsevier has created a COVID-19 resource centre with free information
in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre
is hosted on Elsevier Connect, the company's public news and information website.
Elsevier hereby grants permission to make all its COVID-19-related research that is
available on the COVID-19 resource centre - including this research content - immediately
available in PubMed Central and other publicly funded repositories, such as the WHO
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or by any means with acknowledgement of the original source. These permissions are
granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Second, attacks against health-care personnel must be prevented and condemned. Partnerships
for the prevention of violence must be forged. Local and state governments must partner
with civil society, community-based groups, and media organisations to highlight the
problem of attacks on health-care workers and engage with the community on prevention,
bystander intervention, and reporting. The Health Care in Danger team of the International
Committee of the Red Cross, for example, recently published a checklist for preventing
violence against health-care workers in the COVID-19 response, which includes recommendations
for communication and collaboration.
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Third, misinformation and disinformation about COVID-19 must be countered. Widespread
misinformation and disinformation about COVID-19, including conspiracy theories, have
contributed to the demonisation of certain groups such as health-care workers.
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Governments, international collaborative bodies, and social media companies must further
refine and expand effective public information campaigns to keep members of the public
informed and educated and to correct misinformation. These should include clear and
concise information on how SARS-CoV-2 is and is not spread and the science behind
response measures. In the face of high levels of community distrust in many places,
active engagement of key trusted community stakeholders and organisations in information
campaigns will also be essential for success.
Fourth, accountability is needed. We must demand strong yet responsible enforcement
actions against perpetrators of attacks by local and national governments. Violence
against health-care personnel should be met with swift responses from law enforcement
and legal systems. Local law enforcement authorities must fully investigate each reported
incident, with an objective, evidence-based process. Full accountability for these
crimes must be ensured and perpetrators must be held accountable.
Fifth, state and local governments should invest in health security measures to protect
health-care workers as part of COVID-19 emergency budgets. Funding for the protection
of health-care personnel and health facilities is needed now.
Finally, health professional associations, societies, and organisations from all specialties
and disciplines should unite in speaking out forcefully against all acts of discrimination,
intimidation, and violence against health-care workers.
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They must immediately condemn violence when it occurs and participate in initiatives
aimed at responding to and eliminating violence.
These actions must be taken now. By protecting health-care personnel, we protect our
most valuable assets in the fight against COVID-19: doctors, nurses, emergency medical
technicians, medical and respiratory technicians, laboratory workers, and many others
on the front lines.