World humanitarian day: Violence against doctors is un-humanitarian

World humanitarian day: Violence against doctors is un-humanitarian

“Health workers are being killed in hospitals and in clinics. The safety of health workers must be guaranteed. We call on powers that be to make the protection of health workers a priority.”        -  United Nations Population Fund

               While the world celebrates August 19 as World Humanitarian Day, one needs to recognize that health professionals—in the form of doctors, nurses, and other health workers—too, are humanitarians who work day in and out for the care of the sick and the alleviation of suffering. Undoubtedly, it is humanitarian work; all of them are humanitarians who would deserve a safe and protected work environment just like other humanitarian workers. Shockingly, violence against them is on the rise in India and poses a serious threat to the health delivery system. This blog looks at the effect such violence has on healthcare and considers what can be done to minimize the risks and ensure the safety of people who dedicate their lives to save others.

Latest Case of Violence:

Thus, one of the latest and most ominous of violent incidents is this brutal rape and killing of a 31-year-old trainee woman doctor at RG Kar Medical College and Hospital in Kolkata on the night of August 9. The incident has drawn national outrage, not only for the very heinous crime but also for the indifferent response by the hospital, the police, and the state government.

The principal of the medical college commented on the assault, saying that it was bound to happen because the victim had gone to sleep at night in the seminar hall. He had been on duty continuously for thirty-six hours and had been in desperate need of rest. But the hospital had no resting or sleeping arrangements for doctors.

Following a hue and cry by the public, the principal was then once again reinstated but was appointed as the principal of Calcutta National Medical College and Hospital in four hours, which made the public, even more, angered.

Four hours after the parents and family had lost their loved one, they were made to think that it was a case of suicide. Upon reaching the hospital, the parents were kept in the dark for another three hours. They hold the Chief Minister responsible for the apathy of the authorities and even suspected a larger conspiracy behind this crime. According to them, she must have discovered something that she wasn't supposed to; hence she was murdered.

Case at court:

The apathetic behavior of the hospital, the police, and the government has shocked the courts so much that the Calcutta High Court ordered the transfer of the case related to her rape and murder to the Central Bureau of Investigation.

Terming it a rare move, the Supreme Court took Suo motu cognizance of the doctor's rape and murder. A Bench headed by the Chief Justice of India will hear the matter on August 20.

Other recent cases 

Over the past decade, the nation has been rocked by several alarming incidents of violence toward health professionals:

Rape and Murder of Woman Health Workers:

• P. Nivedita from Andhra Pradesh, a junior doctor working in Kerala,
• Nurse Aruna Ramchandra Shanbaug, in Mumbai who was raped and remained in a vegetative state for 41 years,
• A 34-year-old nurse in Rajasthan,
• A 33-year-old nurse in Uttarakhand, a 30-year-old nurse in Kerala
• A health worker in Telangana.

Hospitals/clinics were either killed or committed suicide:

• Ganesh Rakh (2014) of Pune,
• Sanjay Chaudhary (2014) of Allahabad,
• Bhaskar Reddy of Kadapa, Andhra Pradesh, in 2016,
• S. Shankaran, Coimbatore in 2017,
• K. Srinivasan of Chennai in 2019,
• Prakash Bhujbal, Nashik, 2016,
• Archana Sharma of Rajasthan in 2022 due.

The Impact of Violence on Healthcare Delivery

The very recent incidents are a reflection of graded threats that are gradually evolving on the lives of healthcare workers in India.

Violence and Healthcare Delivery

Violence against healthcare professionals has impacts that compromise not only the effectiveness of the healthcare system but also have broader implications for society. The important effects are presented below:

Morale and Health Workforce Retention: The constant threat of violence might turn the morale of health professionals very low, increase their anxiety, reduce their job satisfaction, and decrease productivity. Some may abandon this profession to seek a safer, less demanding environment. This can lead to a shortage of skilled and motivated health care workers, weakening the general health system.

Lower Quality of Care: If caregivers are fearful for their safety, it impairs judgment and the capacity for empathy toward their patients. It might result in errors and decreased contact with patients, leading to reduced quality of care.

Increased Defensive Medicine: Here, doctors might start practicing defensive medicine to ward off the impending acts of violence and litigation. The practice involves ordering tests, procedures, or medicines with no major clinical value, avoiding high-risk patients or procedures, and making excessive referrals. This will perhaps help save the healthcare providers from risk in the short term but can have serious consequences of inefficiency and stress on the system.

Mounting Costs of Health Care: Defensive medicine, in addition to the Raised premiums for malpractice insurance Enhanced security measures Financial burden of legal proceedings after assaults, immensely adds to the health care costs. Resources that should otherwise be used for the treatment of patients are absorbed by such additional costs.

Erosion of Public Trust: The violence against healthcare professionals leads to an erosion in public trust in the healthcare system. Thereafter, patients are less likely to seek health care, either perceiving the facilities as unsafe or hostile in nature. As such, avoidance can exacerbate health issues within the community and lead to a less healthy and less productive society.

Acts to Reduce Violence Against Healthcare Professionals

The following would be key to responding to and reducing violence against healthcare professionals:

Reinforcement of Legal Protection: The enactment and implementation of stringent laws that punish any person who would attack healthcare workers can act as a very strong deterrent. Fast and fair trials for the violators are also necessary to ensure justice and reinforce the message across that violence against healthcare providers will not be taken lying down.

Security Enhancements: Hospitals and other health care facilities must have installed surveillance cameras and security staff on duty, with clearly defined protocols in case of emergency. The concept of establishing these features should have special attention for areas where emergency treatment is being provided and other high-risk areas for the safety of healthcare providers.

Public Awareness Campaigns: There are misconceptions relating to healthcare professionals which, to some extent, are the result of some wrongdoers within the professionals. Publicity campaigns are key to let the public know that everyone can be treated but everyone need not be cured, that not all illnesses have good prognosis, that healthcare providers are well-intentioned professionals, and that the more knowledgeable and informed the public is, the less violent their drives would be, and hence, a more lenient acceptance and support for healthcare personnel.

Building Institutional Capacity in Health: Enhancing infrastructure and resources in health institutions in the public domain would reduce patient congestion and with it the time patients have to wait long hours in lines, one of the most irritating factors for the patients and their attendants. Further, training the staff to be able to defuse conflicts and de-escalate moments of tension will prevent further escalation into violence, therefore providing critical support to healthcare professionals in tough times.

Support Systems for Health Workers: The establishment of different types of support structures, such as counseling and psychological help at the workplace, would serve the general line in the handling of stress and trauma related to violence. These support structures are vital in the maintenance of mental health and well-being of the healthcare worker for the continuation of high-quality care.

In doing so, we can establish a safer, more supportive environment for health workers and, consequently, assure better outcomes for patients and a very robust health system.

Protection in conflicts

Geneva, Switzerland, 19 August 2024 — On this World Humanitarian Day, health professionals are joining humanitarians to strongly denounce the increasing violence against health facilities and workers.

As such, health professionals from 76 countries and territories have come together in support of the call by the World Health Professions Alliance for protection under international humanitarian law for health facilities and personnel working in conflict zones.

This call to action comes in response to an alarming increase in attacks on health care, which are becoming increasingly lethal. According to global data from WHO, the number of attacks that result in the death or injury of health personnel globally increased by 75% in the past three years compared with the previous three years. These assaults have consequently led to a 240% increase in the deaths of health workers and patients.

"If world leaders continue to turn a blind eye when IHL is breached, and when health professionals are targeted, killed, or injured while carrying out their duties in conflict zones, perpetrators will persist in their attacks on health facilities and personnel," said Catherine Duggan, Chair of WHPA and CEO of the International Pharmaceutical Federation.

She urged all heads of state to enforce existing laws and to hold violators accountable. Health professionals working in conflict zones treat people regardless of political, religious, or ethnic affiliation, often at immense personal risk. We urge all health professionals to sign the WHPA Open Letter and unite in our call to ensure that healthcare facilities and personnel are protected.

On this World Humanitarian Day, WHPA demands an end to violations of international humanitarian law and to the impunity with which they are committed.

It's about time that those in power stopped acting like these atrocities never took place and acted #ForHumanity.

               The steeply rising violence against health professionals in India has reached a critical level and requires immediate attention. According to a recent study by the Indian Medical Association, approximately 75% of doctors in this country have suffered some type of violence during their career. These violations include verbal abuse and threats but extend into actual physical attack, which often leads to serious injury. Such acts of violence do not only endanger healthcare workers' lives but also threaten the integrity and effectiveness of the entire healthcare system.

The response to this crisis calls for multi-pronged interventions to strengthen legal protections, improve security measures at health-care facilities, raise public awareness, and build capacities of health care institutions. By putting priorities on the safety and well-being of those who are committed to saving lives, India will help create a more competent and sensitive healthcare system—one that preserves healthcare professionals and the future patients from them. Protective and supportive environments for healthcare workers represent a need for society as a whole, impacting the continued delivery of quality care.