Since the beginning of the outbreak, health care providers have been shown more support, solidarity and gratitude than they ever have. Yet, attacks on health care have continuously been reported and now also include incidents linked to the COVID-19 pandemic across the world.
This unprecedented public health emergency has demonstrated that health facilities, medical transport, patients as well as health care workers and their families can – and do – become targets everywhere. This alarming trend reinforces the need for improved measures to protect health care from acts of violence. During the COVID-19 pandemic more than ever, protecting the health and lives of health care providers on the frontline is critical to enabling a better global response.
This page provides information about the essence of COVID-19-related attacks, their impact on the response, the role of stigma in driving them and, finally, a brief overview of actions taken to minimize their impact.
Defining attacks on health care
Ensuring access to health services is the cornerstone of a successful health response. Any verbal or physical act of violence, obstruction or threat that interferes with the availability, access and delivery of such services is defined as attack on health care by the World Health Organization (WHO).
As shown in the infographic below, the nature of attacks on health care related to COVID-19 varies greatly across contexts and can range from the use of heavy weapons targeting health facilities to the stigmatization of health care workers. Ultimately – whether they take the form of a cyber attack or a physical assault – they deprive people of urgently needed care, endanger health care providers, and undermine health systems.
Impact on the response
The COVID-19 pandemic has put some health systems under immense pressure and stretched others beyond their capacity. As such, responding to this public health emergency and successfully minimizing its impact requires every health resource to be leveraged. Failure to protect health care in this rapidly changing context exposes health systems to critical gaps in services when they are most needed, and can have a long-lasting impact on the health and wellbeing of populations.
In fragile and conflict-affected countries, acts of violence during the COVID-19 pandemic have already deprived hundreds of medical services and severely hindered the response. Among others, the bombardment and destruction of a 400-bed facility in Libya1 (United Nations, 2020) further reduced the ability of health authorities and aid agencies to prepare for a full-blown epidemic.
In other countries where attacks on health care have been noticed, the COVID-19 pandemic has sometimes created hostile environments for health care providers who have reported incidents of violence, discrimination and harassment. Stigmatized as vectors of contagion in many countries, some have been assaulted, others were denied transport while commuting to work, and entire families were evicted from their homes. Furthermore, reports of attacks on medical vehicles carrying COVID-19 samples, on-duty COVID-19 drivers as well as patients are accumulating and raising concerns worldwide.
However, attacks on health care not only have a direct impact on the ability of health systems to deliver services to those most in need, but also take a heavy toll on the psychosocial health of patients, critical health care providers on the frontline and their families. As those continue to be targeted by acts of violence during this public health emergency, health systems must – among other things – prepare for shortages of health care workers unwilling or unable to report to work due to unsafe environments or obstruction in their personal lives.
The role of stigma
Acts of violence related to the COVID-19 pandemic take place against the backdrop of growing social stigma and discriminatory behaviours against anyone perceived to have been in contact with the virus. Health resources, patients, health care providers and their family members are at particularly high risk of experiencing attacks due to the wrongful belief that they have become vectors of contagion in a community.
COVID-19 misinformation plays an important role in shaping such beliefs and behaviours across the world. The ‘infodemic’ of false information about the disease exacerbates fear of contagion, misconceptions and myths about the virus. Amid growing mistrust, health care providers increasingly come to be seen as a risk to communities rather than the solution to this public health emergency. To illustrate, health care workers have reported being spat on, called ‘contagious rat’, assaulted after boarding public transports, having their belongings vandalized and their children discriminated against by their classmates.
These attacks on health care speak to the importance of adequate risk communication at all levels of society to reduce fear, stigma and – ultimately – violence. How we communicate about COVID-19 is critical in supporting people to take effective action to combat the disease and protect health care.
Responding to attacks
During the pandemic, the international community, governments and civil society have taken the first steps to protect health systems by addressing attacks on health care as well as their roots.
To stop attacks on vital infrastructure such as health facilities and water and sanitation systems, the international community has called for ceasefires in conflict-affected areas. Some national and local governments introduced new policies to protect health care, including in India where perpetrators are punishable with prison terms up to 7 years. In Mexico, some cities have implemented dedicated transport services for health care workers after many were refused entry on public buses.
Doctors’ associations across the world have also initiated talks with authorities to make their work environment safe from infections and to better protect health care providers outside the hospital. Through its Health Care in Danger initiative, the International Committee of the Red Cross published a checklist for a safer COVID-19 response addressed to managers of health-care services, individual practitioners and health policymakers. WHO and partners are also conducting communication and outreach campaigns at country-level to support governments in addressing attacks on health care.
WHO, governments and the international community have also taken measures to address stigma around COVID-19. In addition to regular social media campaigns, the Government of the United Kingdom and WHO launched the collaborative campaign ‘Stop the Spread’ to raise awareness about the dangers of misinformation across Africa, Asia, Europe, the Middle East and Latin America. WHO has also made available a COVID-19 risk communication package for healthcare facilities, as well as dedicated risk communication and community engagement (RCCE) guidance for countries, and a guide for governments, the media and local organization to prevent and address social stigma.
WHO continues to collect information and data to improve our understanding of COVID-19 related attacks, inform its network of partners and document good practices.
1United Nations (2020) Statement attributable to the Spokesman for the Secretary-General on Libya [Press statement]. Available at: https://www.un.org/sg/en/content/sg/statement/2020-04-07/statement-attributable-the-spokesman-for-the-secretary-general-libya