Philadelphia, U.S. — In the first months of the COVID-19 pandemic, at a certain hour of the evening, people in cities around the world opened their windows or stood on their rooftops and banged pots and rang bells. As the coronavirus spread and the number of deaths mounted, it was a moment for people distancing themselves from others to show solidarity and appreciation for the heroic work of health workers. But even as health workers were being celebrated by some, others attacked them.
In 400 incidents last year around the globe, health workers were attacked, clinics, hospitals and COVID-19 testing facilities were targeted, or public health officials were threatened.
Fear, misinformation and conspiracy theories flourished alongside frustration with the actions and inaction by governments to stem the pandemic and address the massive social and economic upheaval that accompanied it. At the same time, police and security forces arrested and assaulted health workers for protesting governments’ inadequate responses to the pandemic.
Health workers were assaulted by people who feared they were spreading the disease, and health facilities treating patients with COVID-19 were targeted
These incidents, and others, are documented in a newly released, interactive map developed by Insecurity Insight and the Safeguarding Health in Conflict Coalition, with technical support from MapAction. Documenting these incidents and understanding their causes is important so that governments and health facilities can prepare for and prevent such atrocities.
Threats and attacks often arose from opposition to health measures to contain the spread of the virus, such as community-wide lockdowns. Health workers were assaulted by people who feared they were spreading the disease, and health facilities treating patients with COVID-19 were targeted.
For example, in Hong Kong, Molotov cocktails were thrown at four health centers after the government designated them for COVID-19 treatment. Similarly, in Mexico, three health clinics under construction to fight the pandemic were threatened with or targeted in arson attacks.
Health workers were also threatened, or fired, by their employers, and in some cases arrested, for speaking out against the lack of protective equipment or government misinformation about the pandemic. Health workers were also targeted in settings of ongoing conflict.
For example, in Myanmar, a marked World Health Organization vehicle transporting COVID-19 testing samples came under gunfire, injuring a health care worker and killing the driver.
In Cameroon, a rebel militia destroyed a supply of hand sanitizers. In Libya, a plane reportedly carrying COVID-related equipment was shot down. And in Yemen, armed men in military vehicles stormed a health facility and confiscated COVID-19 disinfecting supplies.
Some of the attacks portray a desperation and despair in communities. In the Brazilian city of Belem, in April, dozens of people seeking medical treatment tore down the gate of a hospital that was reserved for COVID-19 patients and forced their way in.
In Dakar, Senegal, in May, people threw stones at Red Cross volunteers to prevent them from burying a person who had died from COVID-19 in the local cemetery. In the Mexican state of Guanajuato, in August, a group of people attacked a nurse at a store owned by her family, accusing her of spreading the coronavirus.
The Safeguarding Health in Conflict Coalition, as its name suggests, has previously focused exclusively on attacks in conflict settings. But 2020 was an exceptional year. The organizations in the coalition, which include academic and independent researchers, international nongovernmental organizations, and human rights, public health and health care associations, collected information on threats and attacks related to COVID-19 globally, from news accounts as well as confidential contributions from aid agencies and professional organizations.
These types of attacks are not unprecedented. In past outbreaks of SARS, Ebola, and H1N1, there were also attacks on health workers, facilities and ambulances. For example, in 2014, people attacked health workers and the hospital in Guinea’s second largest city, Nzerekore, shouting: “Ebola is a lie!” Violence against polio vaccination workers has halted progress toward elimination in Afghanistan, Pakistan, and Nigeria.
Although most governments have detailed pandemic preparedness plans, few include measures to protect health workers and facilities. The 103-page “Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers” published by the US government mentions violence against health workers in only one sentence.
More needs to be done to prepare and prevent attacks. Clear and honest communication is key. New, deadly, and poorly understood disease threats understandably cause anxiety and government policies such as quarantines can amplify fear and misinformation.
But communication is not enough. Governments, and health care workers, also have to show that their response is not only based upon the best available evidence, but that it is grounded on human rights principles such as transparency, participation and equity.
Engaging with the most affected communities early in a pandemic will open lines of communication and trust, as will transparency in demonstrating that supplies (such as PPE) and access to care is available, without discrimination, to those most affected.
There will be another global pandemic. Hopefully, not soon. But we should learn the lessons from the COVID-19 pandemic that we have failed to learn with past outbreaks and anticipate and protect health workers and facilities from threats and attacks.
And governments should act now to prepare for violence that may occur around COVID-19 vaccine implementation and to end the COVID-19 related violence still occurring. Banging on pots to show appreciation of health workers is not enough.
Joe Amon is clinical professor and director of global health at the Dornsife School of Public Health at Drexel University and a member of the Safeguarding Health in Conflict Coalition.
Christina Wille is director of Insecurity Insight. As a member of the Safeguarding Health in Conflict Coalition, Insecurity Insight collates data on violence against health care for the coalition.