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Serious violations of health workers’ rights during pandemic

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2824 (Published 14 July 2020) Cite this as: BMJ 2020;370:m2824

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New patterns of violence against healthcare in the covid-19 pandemic

  1. Julian Sheather, specialist adviser, ethics and human rights,
  2. Arthy Hartwell, head of international,
  3. Dominic Norcliffe-Brown, senior ethics adviser
  1. British Medical Association, London, UK
  1. Correspondence to: J Sheather JSheather{at}bma.org.uk

States are failing to uphold even basic obligations to essential healthcare workers

Just weeks ago, British streets were ringing with applause for health workers and a million homemade rainbows celebrated the NHS and its heroic staff. Feted by politicians and lionised by journalists, healthcare workers were an angelic host holding our imperilled world together.

But globally the mood is changing. An important new report from Amnesty International, drawing on data from its monitoring of the rights of health and other essential workers in 63 countries, reveals a darkening picture.1 Public fear of the virus is morphing into stigmatisation of health professionals. And with it comes violence. Punched in the face in Chicago, doused with bleach in the Philippines, stoned by mobs in India, healthcare workers, already under enormous strain, are increasingly becoming targets.2

According to Amnesty, as of 28 April the Mexican Ministry of Interior had documented at least 47 acts of aggression against health workers. There is also a separate harrowing report of a nurse being drenched with chlorine when walking home. The report details health professionals being evicted from homes for fear of infection, refused access to public transport, uniformed Nigerian nurses being denied access to supermarkets, and ambulance staff being assaulted by mobs in Russia.

State obligations

It is a complex picture. No one would expect the world’s health systems to respond without strain to such a sustained, systemic, and global shock. Nor has humankind traditionally been at ease in the face of pestilence. But Amnesty’s report is important as it emphasises the persistence of the state’s ordinary obligations during extraordinary times. As the pandemic plays out, early notions of heroism cannot, indeed must not, be relied on. Healthcare professionals are workers and citizens. Their professional duties come with associated rights. As Amnesty makes clear, states have strong human rights obligations to protect healthcare workers from harm.

That healthcare workers in even the wealthiest countries have had to work without protective equipment is not just a scandal, it is a violation of their fundamental rights: rights to health, rights to just and favourable conditions of work, and rights to life. Figures from the International Council of Nurses quoted by Amnesty indicate that, worldwide, more than 600 nurses have already died from covid-19. Globally, the numbers of healthcare workers infected could be approaching 200 000.3 Among Amnesty’s recommendations is for states to “collect and publish data by occupation, including the number of infections among categories of health and other essential workers, and how many have died as a result.”1

Amnesty also documents worrying global trends in employment for health workers. Precarious employment is widespread. Locum doctors who develop covid-19 lose their income. Overtime contracts are not honoured. Compensation for serious illness and even death has been withheld. Unsurprisingly, workplace stress is also reaching crisis levels. In an April survey of 1500 health workers in Portugal, almost 75% of respondents described their anxiety levels as high or very high, with nearly 15% reporting moderate to high levels of depression, a trend replicated in country after country.1

More sinister perhaps than state failures to protect health workers from violence, to meet minimum standards of personal protection, or to honour contracts of employment are reports of deliberate attempts to stop healthcare workers from speaking out. In March this year the Russian endocrinologist Yulia Volkova posted a video on Twitter asking for doctors to be provided with protective equipment. She is now under investigation for “knowingly disseminating false information.”1

Covid-19 descended on an unequal world. Even in the wealthiest countries, the poorest are hit hardest. Amnesty highlights four areas of deep structural concern exposed by the pandemic: historic underinvestment and deprioritisation of health and social care; a grave lack of preparedness for a predictable event; a lack of international cooperation and corresponding failure to offset global inequalities; and a lack of proper transparency and accountability.

Human rights are not aspirational. They describe a minimal set of freedoms and entitlements that we share, as workers, citizens, and human beings. We are not at the end of the pandemic. We may just have passed through the beginning. In the long months to come, as the applause fades and essential workers seek the personal and professional resources to respond to the pandemic’s long game, it is critical that their fundamental rights are honoured. If we do not meet these minimal requirements, if the state cannot honour even its ordinary obligations, all of us will be far less safe.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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References

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