Written by JVR Prasada Rao & Swarup Sarkar
In August 2024, the Indian Supreme Court established a National Task Force (NTF) to address the epidemic of violence against healthcare workers — a crisis underscored by the gruesome rape and murder of a junior doctor at Kolkata’s RG Kar Medical College. Representatives of the agitating doctors and all professional bodies initially welcomed this initiative.
The NTF’s mandate was clear: Propose actionable solutions to protect doctors, nurses, and hospital staff, particularly women who face disproportionate risks. This offered a unique opportunity to address the root causes of patient grievances that stem from overcrowded, limited and suboptimal services offered to large numbers of patients, particularly the underprivileged.
However, the current version of the NTF recommendations, which are in the public domain, relied on piecemeal and cosmetic measures — more security guards, fast-track courts, and surveillance cameras — while sidestepping the root causes: Systemic underfunding, congested healthcare services, political instigation, and a culture of impunity that normalises violence against medical professionals. An opportunity is being lost for making bold reforms, looking into the causes of systemic failures, and addressing special problems of women healthcare workers.
The health workforce in India suffers disproportionate scale of violence in the workplace. India contributes less than 1 per cent of the global healthcare workforce while facing 3 per cent of reported violence incidents, several times higher than in developed countries. This epidemic of violence demands comprehensive, not cosmetic, solutions. Our research shows that 80 per cent of violent incidents stem from patient grievances fuelled by an inefficient healthcare system — long waits, absence of basic facilities, and inadequate emergency care, escalating frustration to dangerous levels.
The NTF’s approach is based on assumptions that have severely limited the scope of its recommendations.
• Geographic limitations: Problems only in urban tertiary care government hospitals were addressed, ignoring the reality that violence occurs across rural and urban areas, in private and government sectors, and against both institutional and individual care providers.
• Types of violence: Primarily, physical violence was dealt with in the report, and insufficient attention was given to other manifestations such as threatening behaviour, verbal abuse, psychological violence, internet bullying, and threats to family members. The humiliation in public by political party members and officials/activists — a particularly insidious form of violence — remains unaddressed.
• Training environments: Violence/bullying during undergraduate medical training has been overlooked, particularly during examinations. For both undergraduate and post-graduate students, issues like corruption, nepotism, and ragging persist despite the National Medical Commission’s defined role.
The NTF characterises minimum healthcare facility standards required under the National Health Mission as “aspirational goals” rather than necessities. This goes against the spirit of the National Health Policy 2017, where minimum healthcare facilities were guaranteed. These standards should have been the starting point to address patient grievances. By branding them as aspirational goals, the NTF ignored the basic fact that inadequate health care facilities drive patient frustration, resulting in violence.
While many governments and ruling political parties strive to improve healthcare, it’s common to see that the realities of service provision don’t always align with stated goals. The issue of chronic resource inadequacy in healthcare settings often contributes to public unrest.
The Task Force should have consulted with a wide range of stakeholders most affected by this crisis. Patient groups were not heard, and the agitating doctors, whose protests sparked the formation of the NTF, were not listened to. The NTF had not consulted with aggrieved families whose legitimate grievances are often weaponised by political actors. Independent researchers highlighting staff shortages and funding gaps compared to WHO standards were similarly not given an opportunity to represent facts.
The report observed that almost all states have laws and ordinances to combat violence, but has not gone into the abysmal implementation record of the states. 25 Indian states and union territories have enacted Medicare Service Persons and Medicare Service Institutions Acts, yet these laws lack awareness among police, severely impacting their enforceability.
The conviction statistics are abysmally low. Punjab and Haryana have zero convictions from 2010-2015. In Maharashtra, out of 157 violent incidents in 2019, only 77 were reported, 71 were charge-sheeted, only two cases reached judgment, and none resulted in convictions.
Women constitute 51 per cent of India’s healthcare workforce and face unique vulnerabilities — sexual harassment, bullying, and unsafe night shifts. Our data shows that 72 per cent of female healthcare workers face verbal abuse, while 30 per cent experience sexual harassment. The doctors have therefore called for women-led grievance cells and women-supervised monitoring of accommodation and transport as essential protections.
NTF suggested women-centred recommendations, such as transport or confidential reporting mechanisms. It requires a stronger analysis of why current measures don’t work. This oversight is particularly egregious given that the RG Kar tragedy specifically involved gender-based violence.
To prevent another RG Kar-like tragedy, India needs comprehensive reform that addresses the root causes of hospital violence: What could have been a watershed moment for healthcare safety should not become a missed opportunity.
First, hospitals must be decongested by establishing accessible 15-minute clinics in both urban and rural areas, supported by ICU-equipped ambulances for emergencies.
Second, gender-sensitive security measures should be implemented, including ensuring at least 30 per cent women officers and providing 24/7 escort services for safety.
Third, dedicated counsellor and social work cadres must be created across all levels of healthcare to provide mental and emotional support by acting as the first point of contact for patients, their families and healthcare workers.
Fourth, judicial accountability should be strengthened through a judge-led commission tasked with auditing state failures and ensuring transparency.
Fifth, our proposal for a Health Infrastructure Protection Force (HIPSS) — following successful models such as the Central Industrial Security Force (CISF) merits serious consideration.
Finally, political disincentives must be introduced to hold authorities accountable, particularly in hospitals where incidents of violence occur. These reforms are essential for building a more equitable, efficient, and just system.
The RG Kar tragedy should mark a turning point, not another missed opportunity for meaningful health care reform.
Rao is former Secretary of Health to the Government of India and special envoy of the UN Secretary-General for Asia Pacific. Sarkar is a distinguished public health expert who served in senior leadership roles at both UNAIDS and WHO
This op-ed draws from the protesting doctors’ petition to the NTF
