“There is a fear that you will be attacked just for the act of working in health”: A survey of experiences of violence against healthcare in Colombia
Abstract
Background
Colombia has experienced decades of conflict between the government and non-state actors. Attacks on healthcare have been an unfortunate but regular facet of that violence. In response, the Misión Médica program was developed to support, protect, and defend healthcare. Sporadic violence continues, with many recent attacks perpetrated not by armed actors but by community members. Given the history of conflict and ongoing violence, capturing the perspectives of both healthcare workers (HCWs) and community members (CMs) they serve regarding the characteristics and impacts of attacks on health in Colombia may provide some insight into how to better prevent violence and mitigate its impacts.
Methods
A cross-sectional survey was conducted from January to March 2021 in seven departments in Colombia in regions that witnessed attacks on healthcare. Questionnaires were administered to HCWs and CMs via purposeful sampling, probing their experiences with attacks on health with both closed and open-ended questions. The categorical responses were stratified by health worker vs. non health worker and descriptively analyzed. Narrative responses were analyzed via a hybrid deductive/inductive thematic approach.
Results
Seventy three individuals participated in the study (36 HCWs and 37 CMs). Approximately, 77% of HCWs believed that attacks on healthcare impacted health outcomes while 68% of CMs did not see a direct connection between violence against healthcare and poor health outcomes. Awareness of the Misión Médica program was significantly different between HCWs (83.3%) and CMs(37.8%). The survey responses explored the characteristics of attacks on health, compounded impacts of violence on the health system, personal impacts, and perspectives on mitigation efforts.
Conclusions
The study demonstrates that: (1) attacks on healthcare are context-dependent and require a local lens for mitigation and management; (2) both HCWs and CMs have critical perspectives that must be considered, and (3) the impacts of violence against healthcare are complex and compounded. HCWs experience a lack of support and require protection while working as well as psychosocial services. Both CMs and HCWs experience fear as a result of the attacks and therefore are reluctant to speak about them, suggesting the need for stronger protections and a better reporting system.