Italy toughens sanctions against perpetrators of violent attacks on hospital staff

The Italian government has moved to impose tougher measures against people who attack healthcare staff in hospitals in response to a recent surge in violent incidents.

A decree passed on 3 October1 is designed to tackle the growing number of reported assaults on doctors, nurses, and other healthcare professionals across Italy, which recently drew calls for the military to be deployed to protect staff.2 The decree allows for perpetrators to be arrested at the scene of the crime or up to 48 hours after an attack. Violence against healthcare staff, damage to hospital equipment and other assets, or both, during an assault will be punishable with a prison sentence of up to five years and a fine of up to €100 000.

Fabio De Iaco, president of the Italian Society of Emergency Medicine, said that the decree was welcome. He told The BMJ, “The attacks against NHS healthcare staff are on the rise. These are not isolated events.”

In 2023, there were over 16 000 reports of assaults on healthcare workers across Italy, with two thirds of the assaults reported by female workers.3 In the most recent survey of 1200 doctors by Italy’s biggest trade union for doctors, Anaao-Assomed, published in March 2024, 81% reported having been victims of violence. Of these, 23% reported physical aggression, 77% reported verbal abuse, and 75% said that they had personally witnessed incidents involving other colleagues. Around half of the attacks (51%) were reported as being carried out by the patient, and 42% by relatives.4

While welcoming the decree, De Iaco said that wider efforts were needed to tackle the root causes of the problem and in particular the increasing pressures on Italy’s health service. The pressures are particularly being felt in emergency departments, which are absorbing more demand from patients who are unable to access healthcare elsewhere owing to a shortage of family doctors. According to data published in 2023 by Agenas, the Italian National Agency for Regional Healthcare Services, there were 18 million visits to emergency departments, of which 12 million were categorised as white and green codes, meaning a low level of urgency that in some cases could be managed safely in other facilities in the community.5 Emergency departments are also managing patients waiting to be admitted to other hospital wards, where there is a shortage of beds. “All this increases the diffidence of patients and their relatives as well as the frustration of operators” De Iaco said.

At the national call for residency held in September 2024, 70% of positions in emergency medicine remained vacant.6 Healthcare professionals have been on strike calling for structural reform to the health service to tackle problems including chronic underfunding and shortages of staff.7 The Anaao-Assomed union estimates that Italy needs an additional 15 000 doctors and 65 000 nurses. As well as overcrowded emergency departments, the service is contending with long waiting lists, increasing levels of staff burnout, and doctors leaving hospitals for the private sector or moving abroad.

Meanwhile, Filippo Anelli, president of Italy’s National Federation of Surgeons and Dentists, has urged the government to include sufficient funding in the next financial bill to provide all hospitals and healthcare facilities with video cameras to make the decree effective.8