Iran’s Hospitals and Clinics are Overwhelmed by Violence

News that a young man has been murdered in his hospital bed has sparked fresh fears about the safety and security of Iran’s hospitals.

A 26-year-old man was taken to Pirooz Lajihan Hospital suffering stab wounds after a fight in the Lahijan area of Langarud, Gilan province. His assailants then reportedly arrived at the hospital after the man was admitted, and attacked him again, killing him.

Stunned by the incident, members of the public are asking: Are our hospitals and medical centers becoming battlegrounds? How can we protect people, so many of them vulnerable, in our hospitals? What security measures are in place and can they be improved?

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On the morning of November 20, a bloody fight broke out between several people on a street in Lahijan, northern Iran. Witnessed called the emergency services to report that a man had been stabbed, and also alerted police stationed at the Layalistan checkpoint.

Police reports said the men involved in the violence were not in a “normal” state, but they provided no further information for this claim.

When the ambulance arrived, the man was in critical condition. He was taken by ambulance to Pirooz Lahijan Hospital. But a few minutes after he arrived at the hospital, a group of men claiming to know the patient entered the ward, where they attacked him again. Following the attack, the man was taken into surgery, but he soon died from his injuries.

Dr. Mohammad Hatef, the director of the hospital, told local media in Gilan province that two hospital guards witnessed and tried to stop the attack on the wounded young man.

Colonel Ghassem Janalipour, commander of the Lahijan police force, announced that 12 hours after the man was initially attacked, four people between the ages of 23 and 27 were arrested in the city of Astaneh Ashrafieh.

 

Violence in Hospitals

Prior to this, on September 30, a man was taken to the emergency unit at Poursina Hospital in Rasht at about 2am following a bloody clash in the city. As with the man in Lahijan, soon after the wounded man’s transfer to the hospital, several men arrived at the hospital armed with machetes, attacking three people who were with the injured man. They also attacked another patient who tried to mediate during the confrontation.

Sirus Amir Alavi, the head of the Poursina Hospital in Rasht, told reporters that hospital guards had called the emergency number 110 for police support. Police did arrive, but it is not clear whether this was before or after the four people sustained injuries at the hospital.

In an interview with IranWire, Fariba Shahsavandi, a nurse at Imam Khomeini Hospital in Tehran, said the situation was frightening. Hospitals should be places of refuge and safety, where vulnerable, sick people come for care and treatment. They are, she said, the last places one would imagine a bloody attack to take place.

Medical staff also face threats of violence while at work, and some of them have been attacked.

On the morning of Sunday, July 21, 2020, seven people violently attacked an anesthesiologist at Piranshahr Hospital, breaking several of his bones and injuring his face. The group carried out the attack after the person they had come to visit at the hospital died there, reportedly from Covid-19.

Following the incident, the president of the Iranian Association of Anesthesiologists, Alireza Salimi, called for the perpetrators to be dealt with severely, and said that all hospital workers should expect to be able to carry out their work safely and without fear of violence.

 

Violence by Medical Staff

Yet there are also complaints of patients being badly treated by medical and hospital staff. This ranges from dismissive attitudes and prejudice to medical negligence to outright violence.

In one example, on April 3, 2019, a patient with a heart problem was beaten by staff at Rezvanshahr Martyrs Hospital in Gilan Province. A video taken of the incident shows the patient being attacked by hospital staff and even a hospital security guard after the patient complained that he had not received the appropriate treatment for heart disease.

"Hospitals are often stressful environments," Marzieh Shabanzadeh, a clinical psychologist based in Iran, told IranWire. "The patient's visiting family and friends are in a nervous, fragile state. If you remember, a few years ago, a person accompanying a patient to the hospital and who had expressed dissatisfaction with the medical treatment the patient was receiving attacked a nurse in Beheshti Hospital in Yasuj with a boxing glove, resulting in the nurse going blind. Since the tension levels are often high in hospital settings, the need for measures to control these tensions is more urgent than it is in other medical offices or centers, or even in other places where groups congregate."

And now, with the country in crisis due to the coronavirus pandemic and people’s anxiety over its management, plus a severe lack of hospital beds, staff, and medical equipment, disputes and even clashes between medical staff and patients, or between staff and patients'  families and friends, are on the rise.   

"There's long-term homelessness, lack of physical activity and restrictions on leisure activities, restrictions on travel and family visits, and on everything else that used to bring happiness. Plus there is the fear of becoming infected or of family members being infected, and even death, and this can undoubtedly affect people's mental health,” Marzieh Shabanzadeh says. “The stress and fear created by the coronavirus pandemic will lead to an increase in mental disorders and an increase in tension and conflict in human society."

However, she accepted that not everything could be blamed on the pandemic, and that hospitals and other medical centers were stressful environments even before the outbreak.

 

Who is Accountable?

What institution is responsible for maintaining the security of hospitals? At least in part, this responsibility falls to the Ministry of Health. But does the ministry’s police unit create a safe environment in Iran’s medical centers? Are its staff adequately trained? Have measures been taken to fundamentally strengthen the security and safety of medical centers during the coronavirus pandemic, or before? Have security forces in the medical centers increased in size or strength?

A man going by the name Abazar works as a guard in a hospital in Karaj. He says that as Iran’s coronavirus outbreak began and the health service saw an increase in referrals and patients, the Ministry of Health hired more staff for hospital security units, but not all of them are necessarily trained.

"I was the guard at a plastic tablecloth factory, and with the increase in the spread of the coronavirus and the fact that the hospital needed new staff, I got a job here with the help of an acquaintance, who is the head nurse of the hospital. I am a guard but I do not have a gun. Of course, if they gave me one I wouldn’t even know how to hold it. They did give me a baton and tear gas for emergency situations."

He says the hospital security unit is divided into three categories; people officially employed by and affiliated with the Ministry of Health, which mainly constitutes the highest levels of hospital protection; guards hired on a contract basis by private companies, most of which have not received any training; or they are military conscripts.

According to Abazar, during the last few months, when clashes and tensions have been on the rise in hospitals, the hospital he works in has been trying to ensure that in addition to ordinary guards who have not received specialist training, an officer from the Ministry of Health is present during each shift. But due to lack of manpower, the implementation of this program has not been fully possible or been made permanent.

He says the hospital's security force consists of an ordinary guard, a shift officer or head guard, plus the head of security.

In order to be accepted as a security and protection officer in most countries in the world, the employee must complete courses in physical training, self-defense, crisis management, weapons and equipment training, and how to deal with aggressors and intruders. In Iran, however, most government and private bodyguards do not undergo training.

The security section of the website for the Razi Specialist Hospital lists various duties for the hospital’s law enforcement officers. These include: "preserving the principles and deepening the values ​​of the holy system of the Islamic Republic,” "providing appropriate suggestions and solutions to detect any deviation from and violations of the executive affairs" and "monitoring and advising the manager in intelligence matters."

However, these core tasks do not appear to be directly applicable or relevant to the job of protecting people working, visiting or receiving care in a medical center.

On July 24, 2020, people accompanying a patient who was having a medical examination after his finger was amputated used an iron bar to destroy emergency equipment at Bagher al-Oloum Hospital in the city of Ahar city in protest against the length of time it took for the patient to receive treatment. They also physically assaulted a hospital guard. A nurse later told the media it was not the first time that thugs had attacked the hospital’s emergency room and beaten medical staff.

"In my opinion, the most important solution is to educate the people and train the medical staff,”  Fariba Shahsavandi, a nurse at Imam Khomeini Hospital in Tehran, who has 25 years of experience, told IranWire. “People should know that it is not the nurses and doctors at the hospital who have caused their illness or death. They should know we are on their side and trying to help, and that hospital staff knows it is their duty and job, not a favor, and that they must treat people kindly.

“It is important that both sides respect each other's rights. When working in the field of treatment, you should know that a boss-subordinate relationship upsets the balance. On the other hand, people should learn to show a higher level of tolerance when it comes to treatment and health, and of course, legal support for medical staff should not be ignored."

In March 2017, a senior emergency services official outlined a proposed law to ensure the security and safety of medical personnel. The legislation was to be tabled after consultation with the Ministry of Health, law enforcement agencies and the judiciary. But three years later, the law has still not moved beyond draft stage, and no deterrent regulations have been passed to protect medical staff from potential dangers posed by the public.