Unreasonable expectations, unexpected outcome, communication failure, human error, substandard care were major reasons

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 ICRC Report on Violence against HCPs released

Unreasonable expectations, unexpected
outcome, communication failure, human
error, 
substandard care were major reasons

Poor quality of service and low capacity of HCPs
contributed to violent incidents- Prof. Lubna Baig

Patient’s attendants were found to be the chief perpetrators

KARACHI: International Committee of the Red Cross (ICRC) formally released its report on violence against healthcare professionals in Karachi at a meeting held on November 13th 2015. Sindh Health Minister Jam Mahtab Hussain Dahar was the chief guest while Commissioner Karachi Shoaib Siddiqui, representative or the civil society, government officials, healthcare professionals, representatives of emergency services including Ambulance service and media was also present. The study was conducted by ICRC in collaboration with Jinnah Sindh University, JPMC, Ziauddin University and Aga Khan University. Prof. Lubna Baig Dean APPNA Institute of Public Health was the principal investigator of this research project. Other research workers included Prof. Kamran Hameed, Dr. Kausar S. Khan, Dr. Seemin Jamali and Dr. Syeda Kauser Ali.


Prof. Lubna Baig

Presenting salient features of this research report Prof. Lubna Baig said that violence has a very large spectrum and it has been a life changing research for her. She commended the efforts of all members of the research team for their commendable work.  In all eight hundred sixty one questionnaires, she said, were collected of which 822 were finally assessed. The responders included 491 (59.7%) male and 331(40.3%) were female. Data was collected from 581 (70.7%) hospitals, 148 (18.10%) ambulance services and 92 (11.20%) Non-Governmental Organizations. Ziauddin Hospital and JPMC were the major contributors. Majority of the violent incidents 41.8% occurred in Accidents and Emergency followed by 39.4% Emergency obstetrics, 13.6% in wards and 5.2% in community services. It included 124 physicians, 174 nurses, 161 ambulance drivers and security staff. Majority of the violent incidents 403 occurred at public hospitals.

The study showed that majority of the perpetrators of these violent incidents was patient’s attendants which accounted for (58%). Male healthcare professionals were affected the most as compared to female. It further revealed that 65.6% of healthcare professionals had either experienced or witnessed any kind of violence and one third (30.5%) had been attacked either verbally or physically. Verbal violence (30.5%) was experienced more than physical violence (14.6%). Major forms of violence included abusive language (82.8%), pushing and pulling (40.6%) threats (34.7%) Beating (20.8%) and damage to the healthcare facility accounted for 13.1%. About 39% of physicians, security staff and ambulance staff faced violence which was highest compared to other staff.


Speaking about the main reasons and consequences of violence Prof. Lubna Baig mentioned unreasonable expectations (56.1%), communication failure (55%) human error (53.7%), unexpected outcome (42.6%) and substandard care (35%). There was general acceptance of HCPs and ambulance staff to face verbal and even minor forms of physical offence. It was said that HCP should be patient and accept verbal abuse and minor forms of physical abuse as the patient’s attendants are anxious due to serious situation of the patient. Policemen reported tolerance among doctors for paying extortion money and being easy targets. Negligence in behaviour of HCP was reported by media and law enforcing agencies. Poor quality of service and low capacity of healthcare workers in particular was mentioned as the main factors that contributed to violent incidents. HCPs and HCFs were not prepared to deal with violence and most of the HCPs said they require training in dealing with violent incidents, how to de-escalate violence. Shortage of security staff and inadequate security training also contributed to increased violence incidents. Only 3% of the victims took legal action against the perpetrators, more than 50% did nothing and 31% said it was useless while some were afraid of negative consequences.  The types of violence included physical violence, verbal violence, mental torture, forcing, harassing, and firing in the air. Prof. Lubna Baig was of the view that the healthcare professionals should have a zero tolerance against violence. About 2% of the victims of violence died, 85% were injure, and 73% became super alert after these incidents while 55% had disturbing memories of these incidents.

Some of the recommendations with the research team has put forward to check violence against healthcare professionals include  their training in handling such situations, counseling, improving their communication skills, improvement in  health  services, literacy  rate,  creating awareness in the public to respect the law, no politics in hospitals and  good governance. Media was also advised to tell the Truth. Other recommendations deal with providing increased security, compulsory course on the dangers faced by prospective HCPs and how to minimize the risks posed to themselves and their patients, Hospitals should provide the facility to HCPs of anonymity  so that they can use their first name while dealing with patients to minimize the risks. Availability of various services  at different healthcare facilities should be made public, reduce political interference in institutions, encourage media to play a positive role in raising awareness on these issues,  training of HCPs in counseling the patients etc.


Earlier in his speech Mr. Reto Stocker ICRC Head of delegation in Pakistan said that healthcare is a basic right included in the constitution. Violence against hospitals, treatment facilities and healthcare professionals is a serious issue in many countries. Healthcare facilities are targeted. He also referred to the attack on a hospital in Kudzu in Afghanistan which killed thirty patients and many healthcare professionals.  Syria, Yemen has also seen attacks on doctors and hospitals and Pakistan was having his own challenges in this respect. Direct attacks on hospitals, he said, go back to several years. Polio workers were targeted and killed in Pakistan. Violence affects healthcare providers. This study will help us create awareness in public and government institutions but the main issue is implementation of its recommendations. He laid emphasis that let us go beyond documenting and get it implemented.

ICRC representative from Islamabad Maciej Polkowski made a presentation on “From research to making a difference”.  He gave details of the practical steps ICRC was taking, global IRC project details, humanitarian deployment, expert consultations, operational intervention and international campaigns. He further stated that they were working in more than twenty countries and we receive strong support from authorities and medical fraternities. We have witnessed sectarian killings, abduction for ransom, threats to life, use of abusive language and all this requires a set of interventions.  He also highlighted the importance of counseling, communicating, De escalating of violence, providing psycho social support to victims of violence, telling them about self protection. Curriculum in medical colleges on how to avoid violence was also being prepared with the help of Dr.Syeda Kauser Ali from Aga Khan University, he stated.

Mr. Saadar Rehman from Research Society for International Law said that this society was established to educate the young lawyers. There exists a vacuum in legal system. HCPs are vulnerable to violence. We have prepared recommendations for reforms. Sindh Healthcare Commission exists on paper only. It needs to be made operational. Vaccine workers also need to be covered in this. He further stated that we need to develop regulations for emergency services. He laid emphasis on training of ambulance drivers, technicians, improving relationship between police and emergency services, ambulance service. Increasing communication between police and emergency services, providing increased security to healthcare staff. He also suggested severest punishment to the perpetrators of this violence like other criminals and their cases should be tried in d anti-terrorism courts. We need a new legislation to protect healthcare workers, he added.


Prof. Tariq Rafi Vice Chancellor of Jinnah Sindh Medical University speaking on the occasion said that the situation was not so bad 25-30 years ago. HCPs need protection and juniors are abused more as compared to the seniors. Commissioner Karachi Mr. Shoaib Siddiqui said that the recommendations of the Research Team will be implemented. He commended the healthcare professionals and healthcare facilities for their commitment and responding to the situations. Mr.Qaiser Sajjad speaking on behalf of PMA said that misuse of ambulance should be checked.  This year four doctors were killed as compared to fourteen last year. Sindh Healthcare Bill 2014 should be made operational which will solve most of the problems. He also referred to the harassment by the media personnel. Now most often doctors are reluctant to handle serious patients and they are referred to hospitals.

Sindh Health Minister Jam Mehtab Hussain Dahar said that with quick diagnosis provision of treatment becomes easier. He promised that the recommendations of this research report will help the government to have effective policies. We will own these findings and also implement them, he remarked.