Whether they are responding to a heart attack or combating the spread of Ebola, we know that first responders and medical professionals perform dangerous work, often under tough circumstances. This month, the Safeguarding Health in Conflict Coalition — a group of nongovernmental organizations and university researchers created in 2012 to raise awareness and strengthen documentation of attacks on health — put out its latest report.
The numbers are staggering: 973 attacks in 23 countries against vaccination workers, paramedics, nurses, doctors, midwives, patients, community volunteers, health facility drivers, and guards. As many as 167 workers died and 710 were injured. Bombings of hospitals and clinics in 15 countries, more than 120 aerial attacks affecting health facilities in Syria, and violence and threats forcing 140 health clinics in Afghanistan to close, all limited the availability of critical medical care. Vaccine outreach workers were attacked in the previous year in Afghanistan, the Central African Republic, the Democratic Republic of Congo (DRC), Pakistan, Somalia, and Sudan. Armed men entered a health facility in the DRC, looted and beat patients, and attacked and raped a nurse. Each attack impedes delivery of health care far beyond the individual incident, disrupting access to care temporarily or permanently.
Recent reports from the Ebola crisis in eastern Congo have described unimaginable scenes of health workers being threatened, attacked, and killed. But health workers and first responders are not only at risk in the middle of armed conflict or deadly disease outbreaks. Fire and rescue workers in the United States face injury and assault as well. For both groups, the mental-health impact of emotionally demanding work takes a toll. Whether it’s climate change, infectious disease outbreaks, or violence, it’s important to think, and act, globally and locally.
First, the thinking part. The phenomenon of health workers and first responders under attack is common, but little studied. Better information on the frequency and types of attacks is needed to document the scale of the problem and the ways workers can be protected. The Safeguarding Health in Conflict Coalition, of which Drexel University is a member, has gained ground in this effort. Additionally, Drexel’s Center for Firefighter Injury Research and Safety Trends (FIRST), has researched urban fire departments and paramedics, looking at injuries and occupational fatalities.
The FIRST Center has identified high risks of assault among paramedics: 14-fold more so than among firefighters. EMS responders were threatened or assaulted by patients, family members, and bystanders. Not only do these responders suffer physical injury, but their rates of burnout are concerningly high and their job satisfaction rates low — significantly impairing their ability to perform their lifesaving work.
Next, comes the acting part. Translating evidence into policy is critical. Putting the evidence of risks for first responders into action includes creating systems-level checklists for some of the nation’s busiest EMS-running fire departments (Chicago, Dallas, Philadelphia, and San Diego). Also needed is the development of community paramedicine models of care that provide health services to communities from people they already know and trust.
To protect health workers globally also requires expanding trust. Building local relationships can combat the irrational fear and misinformation that can arise in disease outbreaks like Ebola or in tense conflict settings where health personnel maintain impartiality by treating all victims without discrimination.
Globally and nationally, these heroic responders are trying to ensure health as a human right. We must continue working beside them to document attacks when they occur and work to prevent the violence and instability they face.