The horrific rape and murder of a 31-year-old female trainee doctor at Kolkata’s RG Kar Medical College has sent shockwaves through the nation. Found half-naked and bearing severe injuries in a seminar hall where she had retired after a grueling shift, her death has ignited a firestorm of outrage and grief. A hospital volunteer has been arrested in connection with the crime.

In response, tens of thousands of women are set to participate in a “Reclaim the Night” march on Wednesday, demanding safety and freedom from fear. Healthcare workers across India have also launched strikes, demanding stricter laws to protect them.

The incident has once again underscored the pervasive issue of violence against healthcare workers, particularly women, who make up a significant portion of the medical workforce. Despite constituting nearly 30% of India’s doctors and 80% of nursing staff, they face disproportionate risks. Official data reveals a troubling increase in crimes against women, with rape and assault being alarmingly prevalent.

The murder at the Kolkata hospital has exposed the alarming security lapses in many of India’s public healthcare facilities, leaving women particularly vulnerable.

The story’s brutality goes beyond what happened in the wee hours of that morning. The cruelty lies in how the political and judicial systems have responded to past incidents of violence and continue their inefficiency in delivering justice.

Safety at the workplace should be a given. However, people in most workplaces are denied this necessity. People working to alleviate the suffering of others (like HCPs) deserve a workplace that protects them from violence. Working long hours and in poor living conditions is by itself, quite stressful. Adding to that, the ill-treatment of HCPs by patients and/or their acquaintances can significantly harm their mental health. Indian doctors can easily relate to the threat of violence that looms just behind their doors.

Most HCPs have faced violence at work and have not received help when they needed it. The mob in the emergency room, the violent patient’s relative, the accusatory look, the threat on the phone, the endless trolling on social media…  The author remembers her time as a postgraduate resident when her lone female colleague had to hear about 20 people banging on her door in the middle of the night for no fault of hers. They were threatening to break the door and barge in, while she was desperately calling the consultant senior doctor. Thankfully the mob was dispersed and she was safe.

Most doctors in India can recount such ‘scary stories’ from their workplace. Violence sneaks into the daily lives of HCPs and has been normalized to the extent that it is joked about. The danger of normalizing serious social problems like violence is that rooting them out becomes even more challenging.

There are several reasons why violence against HCPs is commonplace in India. At the core, however, are three main issues: (1) Poor Infrastructure: Due to inadequate funding or the underutilization of available funds, healthcare facilities continue to be unsafe for patients and HCPs. Amenities like a safe space for HCPs to rest, a security system, and a central control room with CCTV monitoring are rare. (2) Poor trust: The widespread hate of the public towards the healthcare fraternity stems from (perceived and real) malpractice and high costs of healthcare.

When incidents of violence against HCPs surface in the media, there is a section of society that feels “they must have been negligent/ must have ‘fleeced’ the patient and hence they deserve it.” (3) Inequity in healthcare: Inequity plagues the health system in India. The distribution of HCPs in rural-urban areas is skewed. The quality of healthcare improves considerably based on the patient’s gender, paying capacity, position in society, and ‘influence (who the patient is connected to’). ‘VIP (a very important person)’ – is a common tag used for patients who are treated better (clinically and more humanely) when they are known to or are in positions of power. Most perpetrators of violence get away without any accountability and this can encourage continued violence.

It is hence pertinent to be aware of the laws that prevent such acts of crime. In 2020, during the pandemic, when the country needed its HCPs the most, the central government passed an amendment to the Epidemic Diseases Act. This amendment provides that acts of violence against HCPs would be cognizable and non-bailable offenses. Health, law & order are state subjects. 19 states of the country have laws to prevent violence against HCPs, however, implementation is poor. A 2017 article by the convener of Medicos Legal Action Group, filed RTIs in two states where the prevention of violence acts were in place for 8 years. The RTIs stated that complaints against patients were not registered as FIRs, filing which was mandatory by law. In cases where FIR was lodged, it was cancelled after mutual agreement and no perpetrator had been penalized in the 8 years. While there are several laws to hold the HCP accountable like the Clinical Establishments Act, the Consumer Protection Act, PCPNDT Act, etc. the same is not the case in penalizing the perpetrators.

The need to ensure safety at the workplace cannot be overemphasized. A mechanism to restrict entry into healthcare facilities is a simple step that can prevent heinous crimes like the one in Kolkata. Standard operating procedures, mock drills to deal with violence, staff training in communication, and delivering evidence-based high-quality healthcare are some measures that HCPs can take to protect themselves. Of course, implementing safety measures like CCTV monitoring, employing security personnel, etc. will need financial investment, however, this is not enough. The strong patriarchal and aggressive milieu we live in needs to be uprooted and this will require radical change in the way we grow, educate, and parent as a society.