Healthcare as a Target for Violence: From Conflicts to Pandemics

Since the onset of the COVID-19 pandemic, unanimous global support and gratitude have been shown to healthcare providers, who have appeared as the heroes of these turbulent times. Yet, and despite this wave of solidarity, attacks specifically targeting healthcare professionals and the places where they work have continuously been reported.

The World Health Assembly (WHA) requested the Secretariat in 2012 “to provide leadership at the global level in developing methods for systematic collection and dissemination of data on attacks on health facilities” and health workers, “in coordination with other relevant United Nations bodies and other relevant actors” (WHA 65.20). ¹ Four years later, on May 3, 2016, the United Nations Security Council unanimously adopted Resolution 2286, requiring member states to act to end violence against healthcare personnel and facilities. ²

Over recent years, attempts have been made to increase data availability on the nature and extent of attacks on healthcare through advocacy. International institutions such as the World Health Organization and the International Committee of the Red Cross (ICRC) as well as nongovernmental organizations have responded to this call with initiatives aimed at expanding investigations into and the documentation and dissemination of research on attacks on healthcare personnel and facilities and their consequences.^3,4

Literature on violence against healthcare reflects predominantly contexts of conflict. Moreover, much of the academic research on violence against healthcare is qualitative and focuses on analyses of secondary data. In a recent analysis, very few research articles or reports (4 out of 45) considered new quantitative data; this underscores the difficulty of collecting and compiling data in conflict settings, with the resulting knowledge not clearly linked to curbing of frequency and/or scale of incidents. ⁵ The same review article revealed a great imbalance with regards to the countries studies in the field of attacks against healthcare: while Syria was featured in 7 manuscripts, other conflict settings, such as Democratic Republic of Congo and Libya, where violence against healthcare is significant, were not studied at all. ⁵

The COVID-19 pandemic has sadly shown a broader escalation of violence against healthcare beyond conflict areas, with infrastructures damaged and human resources threatened, abused, and injured. In the period between January and December 2020, Insecurity Insight detected 412 attacks on healthcare facilities and personnel closely linked to the COVID-19 pandemic. ⁶ In contrast, the ICRC documented 611 COVID-19-related attacks against patients or healthcare workers or facilities—including threats and verbal and physical assaults—over the first 6 months of the pandemic in more than 40 countries. ⁷ According to the ICRC, in Colombia, of a total of 325 violent incidents reported targeting healthcare workers and infrastructure, 1 in 3 were related to COVID-19. In India and Mexico, similar COVID-19-related violent episodes have been documented.^6,8 Opposition to measures intended to contain the spread of the virus was the main reason for violence in the majority of cases; several pandemic-related acts of violence were closely connected to discrimination and stigma toward individuals believed to have been exposed to or contracted the SARS-CoV-2 virus.^9-11 The faulty perception of healthcare providers, patients and their families as carriers of COVID-19 has made them highly vulnerable to abuse and assault. ¹¹

The pandemic has clearly showed the striking incongruity between poor protection of health workers and infrastructures in times of increased need for it, likely resulting in a long-lasting impact on population health and wellbeing. ¹¹ More public attention is needed to shed light on the attacks being committed and governments must engage with the community on prevention, interventions, and reporting.

Leonard Rubenstein, founder and chair of the Safeguarding Health in Conflict Coalition, wisely stated “The pandemic is yet another reminder that the world's health workers are essential and that when we fail them, we fail all of us.” ¹² It is time we take action and ensure that the health and stability of those who take care of our health is guaranteed.