From a legal point of view, the personal safety and security of individuals, establishments and emergency services is largely overlooked. There are instances where we hear of doctors being kidnapped, nurses being harassed and emergency service technicians manhandled. Regardless, the only thing that has been scrutinised in detail is the killing of polio workers by terrorists.
This has left a vacuum in terms of knowledge and capacity to deal with an issue that is of considerable concern to those involved. Research shows that violence against the latter community of different types is not only common, but is an epidemic.
Research suggests that the reasons for targeting healthcare personnel cannot solely be attributed to the fact they work as part of the medical fraternity. Rather, they are targeted because of an assumption that all doctors are wealthy, or have access to drugs or that healthcare establishments can afford to cover any losses incurred. This is particularly relevant in cases of extortion and kidnapping for ransom.
Furthermore, in instances of target killing, there is little to no evidence that suggests that medical personnel are targeted on account of their profession. Most target killings have more commonly been linked to general sectarian violence or the ethnic origin of the victims. In this regard, reference can be made to the Anti-Terrorism Act of 1997 (ATA). Section 6(2)(f) and Section 8 talk about hatred and contempt on religious, sectarian or ethnic basis. Any offender found guilty of these may be tried and punished as a terrorist under Sections 7 and 9 of the ATA. The ATA, being a federal statue, can be utilised in the absence of any provincial laws on the subject.
The healthcare community also encounters verbal and physical assaults by the attendants of patients, which is very rarely reported because of the commonly held view that this is ‘a part of the job’ in Karachi. More grievous violent incidents also occur and are reported to varying degrees of success. There is also a recurring concern of interference from law-enforcement agencies, which prohibits medical personnel from carrying out their duties — especially where the patient is the victim of a violent crime.
Ambulance drivers and emergency technicians often face violence, such as the misuse of ambulances to transport criminals, weapons or to avoid the police. Additionally, they also fall victim to the traffic at large as drivers have no real training of what to do when they encounter an ambulance on the road. Despite meeting private ambulance service providers who do provide trainings, the majority of them still require minimum standards of training in order to fully comprehend how to proceed on the road in cases of emergencies. It is also worth noting that attacks on hospitals or within hospitals are also not uncommon.
Interestingly, relevant stakeholders have also said that the 18th Amendment has weakened the public healthcare system in Karachi. Before the promulgation of the amendment there was regular and direct contact between the federal minister for health and the managers of the various public sector medical establishments (including the largest and most frequently visited hospitals). Therefore, the entire weight of the federal government was behind the Sindh Health Department. After the 18th Amendment, the already overburdened Sindh Health Department has been unable to cope with the added pressure.
It would be easy to explain the existing situation if there were no legislative structure or framework in Karachi to deal with these problems. However, there is in fact a robust regime that exists solely for the protection of those involved in the provision of healthcare in Sindh. Of particular importance are the Sindh Healthcare Commission Act, 2013 and the Sindh Injured Persons (Medical Aid) Act, 2010.
The Sindh Healthcare Commission Act establishes a commission that caters to the concerns of the healthcare community in Sindh. Primarily concerned with improving the quality of healthcare services in the province, the law also contains provisions to protect both doctors and their patients, including obliging healthcare establishments to provide protection to both medical personnel and patients. The law has been modelled after the Punjab Healthcare Commission Act, 2010, which has been very successful since its promulgation.
Unfortunately, there is no concrete evidence to suggest that such a commission, under the Sindh Act, has become operational in practice. If operationalised, it could prove to be a model for other provinces to replicate.
The Sindh Injured Persons (Medical Aid) Act of 2014 protects medical personnel from being unfairly harassed by the police, and places the health of the patient before any medico-legal formalities. Section 3 of this law provides that injured persons are to be treated on a priority basis without delay. Section 4 states that no law-enforcement personnel can “interrupt or interfere” during the period that an injured person is under treatment in a hospital. This allows healthcare professionals to perform their duties without fear of reprisals or unnecessary hassle that could prohibit them from working to the best of their efforts.
In the overall context of the protection and enhancement of human rights, the Sindh Protection of Human Rights Act, 2011 can also be utilised by healthcare professionals to air their grievances and seek restitution. This law also establishes a commission that can follow up on the petitions presented to it and can investigate on its own allegations of human rights abuse. Another very interesting provision of the Sindh Protection of Human Rights Act is that it requires the commission to study treaties and conventions and advise the government on the same.
Apart from a focussed implementation of the aforementioned laws, there also exist other options that could be used as a last resort.
A new law could be drafted that specifically targets those who commit violence against healthcare professionals and establishments. The law could provide for trainings and proactive steps to be taken by healthcare establishments towards protecting their employees. Secondly, amendments could be made to the existing laws, such as the Sindh Health Care Commission Act and the Sindh Injured Persons (Medical Aid) Act, both of which have some limitations.
Karachi is a mega city. As is the case with all metropolitan centres, where hundreds of cultures converge, there will most likely always be criminal elements. Though the government of Sindh has taken many positive steps to stem crime, especially in the protection of vulnerable groups such as those involved in providing healthcare services, much still remains to be done vis-à-vis holistic safeguards for the latter.
The writers are lawyers at the Research Society of International Law.