Nurses at the Federal Medical Centre in the Southwestern city of Owo, Nigeria stopped treating patients after two nurses were badly beaten early last month.
Relatives of a COVID-19 patient who died attacked the nurses on duty. One nurse had her hair ripped out and suffered a fracture. The second was beaten into a coma. Both are recovering from their injuries.
Following the assaults, the nurses demanded justice and called for the hospital to improve security and other working conditions. Almost two weeks passed before they returned to work.
"Armed security personnel have now been posted to the hospital to run 24-hour service within the hospital," said Felix Orobode, secretary of the National Association of Nigeria Nurses and Midwives.
The attack in Nigeria was just one of many on health workers globally during the COVID-19 pandemic. A new report by the Geneva-based Insecurity Insight and the University of California, Berkeley's Human Rights Center identified more than 1,100 threats or acts of violence against health care workers and facilities last year.
Researchers found that about 400 of those attacks were related to COVID-19, many motivated by fear or frustration, underscoring the dangers surrounding health care workers at a time when they are needed most. Insecurity Insight defines a health care attack as any physical violence against or intimidation of health care workers or settings, and uses online news agencies, humanitarian groups and social media posts to track incidents around the world.
Dr. Rohini Haar, an emergency room physician and Human Rights Center research fellow, said she expected health care workers to be widely celebrated for their lifesaving work during the pandemic, just as Italians sang tributes to doctors during the lockdown.
"But actually, that didn't happen in many, many places," she said. "There's actually more fear, more distrust, and attacks grew rather than decreased."
Medical professionals from surgeons to paramedics have long confronted injury or intimidation on the job, especially in conflict zones. Experts say many attacks are rooted in fear or mistrust, as family members react to a relative's death or a community responds to uncertainty around a disease. The coronavirus has amplified those tensions.
Nurse Ángeles Carrillo Mercado used her cellphone to record a man outside her hospital last June in San Francisco del Rincón, Mexico. Carrillo says the man threw coffee at her after she had escorted his children who were not wearing masks out of the COVID-19 ward.
"I feel very sad because independent from the fact that we receive a salary, we do this out of vocation and love toward humanity," said Carrillo.
It took Ligia Kantún almost eight months before she felt comfortable wearing her nursing scrubs in public after a similar incident.
Kantún has worked as a nurse for 40 years in Mexico and never felt threatened until last spring. As she was leaving a hospital in Merida in April, she heard someone shout the word "Infected!" She was drenched in hot coffee before she could turn around.
"I got into my car immediately, with a lot of anguish, a lot of fear and I started crying," said Kantún, whose daughter posted pictures of her mother's stained scrubs on Facebook.
Now, one year into the pandemic, she feels health workers are more respected. But she still worries.
"I've had that fear of going out and finding my car scratched, or my car window broken," she said. "I do have that fear, since I lived it."
Researchers saw the most attacks last spring and summer as the coronavirus swept across the globe. Yet recent events from Nigeria to the Netherlands, where in January rioters set fire to a coronavirus testing center, prove the threat remains.
Many attacks may have gone undetected because they are never reported to police or in the media.
Insecurity Insight scrambled to expand its monitoring as a flood of attacks were detected in countries that have traditionally been safe for health workers, said director Christina Wille.
In the United States, for example, researchers counted about a dozen threats to health care workers last year. Several incidents involved the injury or arrest of street medics during Black Lives Matter protests.
Experts say that even though health workers are in many cases the target of attacks, entire communities suffer when they lose access to medical care after a clinic or medical facility is forced to close due to threats.
"They are actually impeding access to health care for the affected population in a situation where they would need it the most," said Hyo-Jeong Kim, who monitors attacks on health care for the World Health Organization.