133 attacks in a year: How India is failing its health workers

Yash Kamath, Madhav Bansal, Siddhesh Zadey, Christina Wille, Rohini Haar
Nearly two years into a global pandemic that has turned the world upside down, strange happenings and unforeseen breaking news have become our staple diet. In this overwhelming barrage of negativity and abject nihilism, it may seem cumbersome to read yet another article that makes you worry about the world. But we assure you, this isn’t the regular read. What we’ve tried to do is put forth some numbers and experiences for your perusal. Empathise, or sympathise, we would leave that to your judgment.
Like every other ‘normal’ that’s been flipped, there’s a shift in hospitals these days. Doctors, nurses, and other healthcare workers not only have to put on personal protective equipment (PPE) but also have to steel themselves against their fears of being abused, threatened, and even violently attacked.
India presents a difficult dichotomy where a culture of deifying medical professionals runs parallelly with anger and violence towards them.
Generalised name-calling, including ‘demons’ and ‘money-making parasites’, by patients, their families, and even the media, has somehow become a norm.
Staggering Figures
Some of the patients’ frustrations are understandable and healthcare workers (HCWs) have their share of responsibility towards enhancing the quality of medical care and improving the communication with the patients and families. However, violence against people caring for your health hardly seems like a valid response. Violence against healthcare workers has risen globally in the past few years, and the COVID-19 pandemic has only exacerbated the problem.
Globally, 62% of HCWs have experienced some kind of violence at the workplace, with close to 25% having experienced physical assault, while 57% have faced some form of non-physical assault such as verbal abuse. While these numbers are staggering, India has a disproportionately high share of violence-related incidents and has garnered global attention for the particularly discriminatory and vehement opposition to doctors during the COVID-19 pandemic. A recent study found that 75% of Indian doctors have experienced violence of some kind in the workplace, with 63% unable to visit patients without fear of violent action. Most of these issues materialise in high-stress situations, like during psychiatric treatment or in an intensive care unit (ICU).
Insecurity Insight (II), a not-for-profit organisation dedicated to collecting global data on people in high-risk situations and generating actionable insights based on them, has reported a total of 200 incidents of violence against healthcare workers (VAHCW) in India during the past five years, of which 133 (66.5%) incidents took place during the pandemic in the past one year
Data from the Safeguarding Health in Conflict Coalition (SHCC) show that there has been a sharp rise in the number of healthcare workers assaulted in India, from 49 in 2017 to 155 in 2020. (Figure 1)
While violence against healthcare workers and disruption of health systems is considered primarily a problem in conflict settings, where it might be beneficial to cripple your adversaries’ health infrastructure, data clearly highlight the extent to which violence is also perpetrated by civilians – a group composed mostly of relatives of the patients. Although the II monitoring systems have started picking up more of the Indian data only since the last year, the problem has been chronic. When the Association for Socially Applicable Research (ASAR) reviewed data from two previously published studies covering the period from 2007-2019, they found a high incidence of violent events.
But Who Ultimately Gets Hurt?
However, looking at the number of such incidents is a very narrow way of understanding the problem. Beyond the numbers, we need to look into the downstream impacts of such attacks on healthcare workers, i.e., how they affect the broader society. Can unsafe healthcare workers do their jobs well? If healthcare workers can't function at their best, wouldn't it ultimately hurt the patients? Employing the rhetoric of the impact that violence against healthcare workers might have on the population's health can enable better advocacy for the protection of healthcare workers.
The problem of violence also needs to be understood within the context of the health system. For instance, improper management due to limited resources and staff in public hospitals, high care costs, and extended stays in private hospitals are key factors leading to situations that can turn violent. to be contd