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Violence and Harassment Against the Health Workforce, an International Legal Approach

Until recently we did not have a way to directly address violence and harassment against health workers at the international level. What has changed? Last June, the ILO Member States, worker representatives, and employers’ organizations voted to adopt the Convention 190, and a non-binding Recommendation 206, both regulating on violence and harassment in the world of work. With this new international legal framework we are one step closer to eradicating these “pandemics” from the health sector and our society.

Violence and harassment in the workplace are unacceptable and incompatible with the principle of decent work and constitutes a violation of human rights because it affects the dignity of the human being. In this blog, we present an analysis of how violence affects the health workforce; how the issue was legally addressed before June 2019; and the importance of the adoption of the new legal instruments with some reflections.

Workplace violence can affect all sectors and all workers, but the health sector is at major risk. Data from the World Health Organization shows that between 8% and 38% of health workers suffer physical violence at some point in their careers and the number significantly increases when threats and verbal aggression are included. The categories most at risk are nurses and the staff directly involved in patient care, emergency room personnel and paramedics. Quite ironically, “helping people at risk and providing health to others becomes a dangerous occupation for the providers”.

Before June 2019, violencein the workplace in international legal instruments was recognized to a certain degree only by an interpretation of the regulations to protect women. We refer to the Universal Declaration of Human Rights (UDHR, 1948), the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW, 1979), the Universal Declaration on the Elimination of Violence Against Women (1993), and the General Recommendations No. 19 (Violence against women, 1992) and No. 28 (Discrimination against women, 2010).

None of the instruments listed cover the topic directly, thus they were not enough to tackle the epidemic of violence and harassment on the job. First, because even acknowledging that gender-based violence and harassment disproportionately affects women, it is important to reject those acts against all human beings (women and men). Second, because the world of work has its own characteristics and violence there can affect the quality of the services and may prevent people -particularly women-, from accessing, and advancing in the labour market, which negatively impacts the organization of work, workplace relations, worker engagement, enterprise sustainability, and productivity.

The Convention 190 takes a direct approach, and provides a broad definition of violence and harassment (with an encompassing coverage of behaviours, practices and threats, without needing any pattern of conduct from the perpetrator) across the full spectrum of work arrangements, such as all work-related activities and work-related communications technologies. Also, there is a clear and specific protection from the “gender-based violence and harassment” and the recognition of the problem in private and public spheres of the labour market.

Furthermore, the Convention 190 formally opens the door for ILO’s regular supervisory system to ensure the Convention’s implementation in every State that ratifies it. Special procedures contained in the ILO Constitution such as “Complaints of non-observance” submitted by an ILO Member State against another Member State for not securing an effective observance of the Convention; or the possibility of the ILO’s Government Body to refer the complaint to a “Commission of Inquiry” for investigation and recommendations to a Member State; or the option to refer the dispute to the International Court of Justice, in case the Member State does not accept the recommendations.

These strong protections against workplace violence and harassment are expected to lead Member States and employers to work actively in preventing, policing and designing work conditions and regulations to avoid and sanction violence and harassment in the workplace. It also spells out workers responsibilities, such as refraining from acts of violence and harassment and to comply with any policies or other steps taken by employers to prevent it.

Obviously, regulations contained in the Convention 190 are all applicable to the health workforce but a significant improvement should be pointed out: Article 9 of the Recommendation 206 recognizes for the first time at this level that health workers are particularly exposed to violence in the workplace, which is why States should adopt specific measures. Despite the fact it is not legally binding, it constitutes a guideline on how the Convention 190 should be applied, representing a significant progress in the protection of health workers’ well-being and therefore in the health sector in general.

The international legal framework seeks the elimination of violence and harassment in the workplace. How is this going to happen in the health sector? Patients and their families that have contact with health workers are in a sensitive situation, they are concerned about the health/life of someone. We all have been in that situation. But the fact that there are predisposing factors cannot justify the presence of violence in any of its manifestations.

Every health worker should feel safe in their workplace. As individuals and society, we must work on building a strong culture of rejection of violence and denounce these acts when they occur. Institutions must work on prevention, mitigation and sanction of workplace violence, support and care of workers affected and on sustainability of initiatives undertaken. Governments need to invest money to meet the basic demand for healthcare and create national laws that regulate violence and harassment situations (e.g. by creating obligations to the government itself, employers and workers, by generating effective channels that health workers and their associations can rely on to report these acts, by having law enforcement and criminal consequences when needed, among others). After all, health workers take care of us, isn’t it reasonable we guarantee their safety while they do that?


About the Author

Katherine Durand is a Peruvian lawyer with a Master degree in Public Policy, with an interest in human rights, social justice, and labour policies. She was supported by the School of Public Policy at the Central European University, to be a fellow at Health Law Institute.

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