Global Crisis of Attacks on Health Care in 2020 – Related to both COVID-19 and to Armed Conflicts – Caused Grave Harms and Impaired Global Pandemic Response
March 2, 2021
A new interactive map highlights 1172 attacks and threats against health workers, facilities, and transport around the world during 2020, as the COVID-19 pandemic pushed health systems to their limits and sparked widespread violence against frontline health workers.
Some 412 of these 1172 incidents were directly related to the COVID-19 pandemic and response measures, such as the arson of COVID-19 testing facilities, the targeting of health workers on their way home from clinics, and violent responses to mask requirements.The COVID-19-related attacks reveal a disturbing new dimension of violence against health care, which has in the past related primarily to attacks on health care amid armed conflict or routine health services provision.
Some 802 incidents in 2020 were related to ongoing wars and violent conflicts, ranging from the bombing of hospitals in Yemen to the abduction of doctors in Nigeria.
Developed by Insecurity Insight with support from MapAction and the Safeguarding Health in Conflict Coalition, the Violence against Health Care Related to COVID-19 and Conflict Map and an accompanying research brief display information about attacks on health care drawn from credible media reports as well as reporting by intergovernmental organizations, states, and NGO partners. In addition to data from public sources, confidential contributions from aid agencies and professional bodies are included in the figures.
“Health workers have been rightfully praised as heroes during the COVID-19 pandemic, but around the world they endured disturbing levels of threats and violence from individuals but also from governments, militias, and police,” said Christina Wille, director of Insecurity Insight, who led development of the map. “During the pandemic, nurses, doctors, and other health workers were threatened, beaten, assailed with stones or hot liquids, or fired from their jobs for voicing concerns about safety. In conflict zones, they were shot at and kidnapped. Hotspots for COVID-19-triggered violence included India and Mexico, but the map shows that violence and intimidation against health care was a truly global crisis in 2020, affecting 79 countries. Governments, international organizations, health care providers, and communities must step up to protect the health workers who have protected all of us during the COVID-19 pandemic.”
Because not all attacks on health are publicly reported by media, documented by NGOs, or acknowledged by governments, the map likely represents a significant underestimate of the total violence and intimidation suffered by health workers in 2020. The map and the 1172 incidents highlighted are not comprehensive, representative, or complete, but rather they represent a minimum estimate of the number of attacks and threats against health in 2020. The map is continuously updated and includes incidents from December 31, 2019 until approximately six weeks from the current date, which represents the time required for coding and periodically updating the map.
Analysts categorized reported attacks and threats against health care related to COVID-19 into five types of motivations based upon the underlying information available about the incidents:
- Objection to hospitals or other facilities being used to treat COVID-19 patients, such as the destruction of clinics treating COVID-19 patients or quarantine centers;
- Objection to medical measures, such as violence in response to COVID-19 testing efforts, changes in funeral regulations, or the locations of burials of COVID-19 victims;
- Objection to public health measures, such as violence in response to COVID-19 contact tracing or social distancing requirements;
- Assaults on or arrests of health workers by security forces for voicing concerns about their work, including being fired for speaking out about personal protective equipment (PPE) shortages or punished for criticizing the government’s response to the pandemic;
- Fear of health workers spreading infections in their community, such as attacks on health workers when en route to or from work.
The most frequent triggers for violence were objections to pandemic-related health measures. Health workers also frequently reported threats or violence while on the way to and from work.
Researchers also analyzed available information to discern, when possible, the perpetrator of the attack with categories such as civilian, police, military, or non-state actors like militias, gangs, and terrorist groups. Of the reported attacks related to COVID-19 health measures, 83 percent were carried out by civilians like local community members, COVID-19 patients, and patient family members.
“As we enter the second year of the COVID-19 pandemic, we must learn from the failures of year one and act immediately to safeguard health workers,” said Leonard Rubenstein, founder and chair of the Safeguarding Health in Conflict Coalition (SHCC) and professor at the Johns Hopkins Bloomberg School of Public Health and Center for Public Health and Human Rights. “Governments should do all they can to counter disinformation about the pandemic, better engage communities in the response, end repression against health workers who speak out, and implement measures to protect health workers, while ensuring that perpetrators are held accountable.”
While important caveats persist (see map guide here for more details on methodology), available data suggests that the highest number of reported incidents in 2020 occurred in India (128 incidents) and Mexico (49 incidents). In both countries, attacks were widespread, occurring across multiple states throughout much of the country and throughout the year. Two-thirds of the events in both countries occurred when health workers were targeted during their commutes to or from health facilities.
In India, police officers are frequently named as perpetrators of the attacks. In one incident, two junior doctors on their way home after their shift at a hospital were beaten with sticks by police officers, who accused them of spreading COVID-19. In Mexico, civilians are frequently named as perpetrators, individually or in groups. During one incident, for example, an individual accused a nurse of spreading COVID-19 and doused her with scalding coffee.
Pandemic-related attacks also occurred amid violent conflicts and wars around the world in 2020. For example, in Myanmar, a marked World Health Organization (WHO) vehicle transporting COVID-19 testing samples came under gunfire, injuring a health worker and killing the driver of the vehicle. In Cameroon, a supply of hand sanitizers was destroyed by a rebel militia. In Libya, a plane reportedly carrying COVID-19-related equipment was shot down. And in Yemen, armed men in military vehicles stormed a health facility and confiscated COVID-19 disinfecting supplies.
“When you bomb a health clinic, you cut off care to communities. When you kill a doctor, you wound her patients,” said Susannah Sirkin, director of policy at Physicians for Human Rights, a member of SHCC that contributed data for the map. “In a year when health systems were already under siege from the coronavirus, it was a profound injustice that those frontline workers who have saved countless lives had their own lives endangered.”
Recommendations for states, health worker associations, civil society organizations, health care organizations, donors, and the WHO are included in the map’s accompanying research brief, Threats and Violence against Health Care during the COVID-19 Pandemic in 2020.
Additional quotes from members of the Safeguarding Health in Conflict Coalition:
“In 2020, in countries around the world, we saw similar patterns of attacks on health workers and facilities as a result of fear, frustration, and false information about COVID-19. We’ve seen this before during Ebola, H1N1, and other outbreaks. To prevent this from happening again, to protect health workers from harm and ensure people have access to care, we need to anticipate and prepare to make sure these attacks don’t occur.” – Joe Amon, PhD, MSPH, clinical professor and director of global health, Drexel University Dornsife School of Public Health
“Health care workers are being put at increased risk at a time when their communities need them more than ever. The fact that they fear violence and abuse while on the front lines carrying out essential work is completely unacceptable and is adding to the mass traumatisation that they are experiencing. Governments and all stakeholders must do their part and take immediate action to stop this violence. As with COVID-19 infection rates amongst health care workers, it is essential that we have data on all threats and violence because without the data we cannot create effective strategies to prevent them.” – Howard Catton, RN, BSc, MA, CEO at International Council of Nurses