From balconies, windows and door fronts around the world, citizens are applauding healthcare workers on the frontline of the COVID-19 response for their commitment and care. Despite these visible shows of support, all is not well – because in addition to the risks of exposure to a largely invisible enemy, these medics also face threats of various kinds in the workplace.
We usually think of attacks on healthcare as something that happens in the context of war or political repression. Such attacks have been reported in Yemen, Afghanistan, Syria, the Democratic Republic of Congo and Sudan. In these cases, the attackers are usually aiming to gain a military advantage or to deny healthcare to enemy forces and civilian populations.
But what the COVID-19 pandemic illustrates is that attacks against healthcare can – and do – happen everywhere. Since the start of the pandemic, different forms of aggression have combined to interfere with the professional and personal lives of healthcare workers. As well as exposing them, in some cases, to real physical danger it also increases psychological pressure at a time when many are already under a huge amount of stress.
Intimidation
Silencing is a key example. Healthcare workers in China, Thailand, Turkey and Pakistan have faced intimidation or arrest for casting doubt on government policies or for suggesting that casualty numbers and infection rates have been minimised or obscured.
In the UK and US staff also report being gagged for criticising the lack of proper personal protective equipment made available to them.
This lack of transparency about the response and the difficult working conditions can be partially attributed to the politicisation of the COVID-19 response. In a contentious political environment, observers and authorities are more likely to interpret criticism in a partisan way. Authorities are judged by the success of their actions, often in comparison to other governments.
Xenophobia, nationalism and competition for resources are byproducts of this politicisation. The need to demonstrate governmental competence is visible in the one-upmanship on victories over the virus and public spats and controversies. For example, Germany accused the US of “modern piracy”, after much needed face masks were diverted while in transit. The US denied any wrongdoing.
Death threats and assaults
There is public pressure too. Anthony Fauci, a key figure in the US national response and the director of the National Institute of Allergy and Infectious Diseases, has received death threats accusing him of contradicting the president and politicising the response. He now requires a personal security detail. The fact that healthcare workers and scientists around the world are discouraged from speaking freely directly hampers the effectiveness of the response on a local, national and international level.
Healthcare and other key workers in New Zealand, Australia and the UK have all been subjected to deliberate coughing and spitting. This constitutes a deliberate weaponisation of COVID-19.
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People have also been physically assaulted and mugged due to their association with the COVID-19 response and assumed access to medicine and food. In the UK, spitting and other assaults on emergency workers were already happening regularly and were addressed in the Assaults on Emergency Workers (Offences) Act.
With the COVID-19 lockdown, widespread uncertainty and economic repercussions have contributed to a rise in domestic violence. In one case in Italy, a man is alleged to have killed his partner, who was a medical student. He falsely accused her of exposing him to COVID-19.
Medics have been experiencing stigma and ostracism and been verbally assaulted or evicted by fearful landlords in the UK, US, India, Myanmar and the Philippines.
These incidents contribute to safety issues and economic hardship at a time of profound personal and professional pressure. In general, healthcare workers are subject to severe psychological stress, raising concerns about their mental wellbeing. One Italian nurse tragically took her own life – an act that colleagues attributed to the stresses of her work caring for COVID-19 patients.
Disinformation, misinformation and the proliferation of conspiracy theories) not only hamper an effective response, but can directly affect the people on the frontline. In past outbreaks, misinformation transformed into rumours contributed to the deaths of workers in the West Africa Ebola response and of polio vaccinators in Pakistan.
Recently, fact checkers had to rectify social media reports claiming that an Italian doctor had been charged with killing over 3,000 COVID-19 patients. Disinformation campaigns have resulted in a backlash against suspected patients. In Ukraine, residents attacked busses with evacuees from China after a hoax email falsely attributed to the Ministry of Health suggested some carried the virus.
The virus highlights preexisting pressures and violence against healthcare workers. In many cases, it has aggravated them. Like the spread of the virus, COVID-19-related violence has proliferated around the globe, so far largely out of sight and unchecked. It is in all our interests that such violence is closely monitored, addressed and – where possible – prevented. Only then will the people responsible for keeping us alive be able to work without fear for their safety.