A Greek physician, Hippocrates once coined a phrase “Extreme times call for extreme measures.” This phrase tends to be so apt when perceived in situations such as this current one of Covid-19 pandemic. Not just India but the entire world is undergoing the extremities of this malady. And during such testing times, it is the doctors, nurses, paramedics and medical staff who have assumed the position of frontline warriors and are controlling the situation in an exceptionally selfless manner. But what essentially needs to be understood here is that these people also have a right to health.

In India, right to health is not directly enshrined in the Constitution but has been embodied under Article 21 of the Constitution. Article 21 guarantees protection of life and personal liberty to every citizen of this country. The Supreme Court has held that the right to live with human dignity as encompassed in Article 21 is derived from the directive principles of state policy and therefore includes protection of health within its ambit (1). Further, it has also been held that the right to health is an integral part of the right to life and the government has a constitutional obligation to provide health facilities to all the citizens and is thus duty bound (2).

These principles apply not just to the common citizens but also to the frontline warriors especially because in the times of pandemic they are the ones subjected to the highest amount of risk and it is of paramount importance that they remain in pink of health. It is important for the saviours to be healthy in order for them to save the world. But on the contrary, there are no sufficient measures taken for their safety and protection. This in turn undermines the treatment of myriad patients which lies in the hands of these doctors and medical staff.

Problems faced by the frontline warriors:

i. Dearth of protective gear

Medical staff across so many parts of India has been lamenting about the inadequate supply of protective gears such as the PPE kits, N95 masks, hand sanitizers, gloves and so on. The availability of these things is the basic pre-requisite that needs to be fulfilled in all the hospitals, be it private or public for the doctors and medical staff to efficaciously treat their patients with utmost care and caution. Three months ago, death of nearly 3000 patients in Wuhan, China was an alarming call for our health ministry to start garnering as many PPE kits, N95 masks and gloves as would suffice in fighting the unprecedented situation.

The government has advised all the doctors to wear a triple layer mask while dealing with the covid-19 patients but as a matter of fact they are itself not being provided to the doctors because of the scarcity. As a result, so many doctors have been skipping duty because of the apprehension of succumbing to the contagious coronavirus and subsequently jeopardizing their family members.

In a glaring instance of apathy towards safety needs of frontline warriors against Covid-19, approximately a 100 resident doctors and paramedic staff at SVP hospital in Ellisbridge area of Ahmedabad went on a flash strike complaining they were not provided with N95 masks and PPE equipment – the most fundamental safety gear required by the medicos (3). Hospital janitors also form a crucial part of the frontline warriors who play a pivotal role in the fight against coronavirus.

A special attention of the government for their protection is necessitated by the present situation. Dr Subarna Sarkar, resident doctor working in COVID ward at Sassoon General Hospital in Pune is of the view that in the fight for protective gears, the hospital janitors are often least prioritised although they are the ones who clean the floor, dispose of the trash, handle the bodies of those who have died due to Covid-19 and are vital to keep a hospital running (4).

Maharashtra accounted for close to 83% of all doctors quarantined, followed by 11% in Delhi and 6% in Karnataka (5). Many hospitals in Maharashtra, Delhi, Karnataka, West Bengal and Tamil Nadu have been partially or completely shut down due to the reason of their staff being quarantined after their exposure to Covid-19 patients. It was found that due to shortage of personal protective equipment (PPE) at the hospitals, the doctors and medical staff have become vulnerable to the coronavirus patients they are treating (6).

ii. Abuse faced by the frontline warriors

In the wake of the Covid-19 pandemic, the cases of abuse faced by the doctors have escalated to a large extent. On so many occasions the family members or the attendants of the coronavirus patient admitted in the hospital have rolled up their sleeves to pick a fight with the doctors. A lot of verbal abuses have been hurled on them which have eventually fuelled up into physical assault.

A plethora of incidents of abuse on the doctors and medical staff have been reported across so many cities of India. The list of deplorable incidents include stone pelting on ambulance and medical staff in Moradabad district of Uttar Pradesh, assault and manhandling of a woman doctor by a patient inside the surgical ward of Lok Nayak Hospital in Delhi, attack on two doctors by the family of a patient who died due to coronavirus in Gandhi Medical Hospital in Hyderabad, healthcare workers and civic officials beaten up by angry locals in a neighbourhood located in Indore in Madhya Pradesh, a doctor allegedly slapped and insulted by SDM and police officer in Government Medical College Bharatpur under RBM Hospital in Rajasthan and so on and so forth (7).

Apart from this, dreaded by the fact that they have been dealing with the coronavirus patients, many of our frontline warriors have faced ostracisation from their very own communities and have been evicted from their homes by the merciless landlords or hostile society members. Cremations and burials of many of them or their relatives have been a hard nut to crack for their families.

Stepping Stone

The aforementioned issues have proven to be unforeseen occupational hazards for our frontline warriors. There is dire need to resolve these issues and provide remedy to all those who have suffered and are still suffering while relentlessly rendering their service to the nation. The area of health including protection of doctors is a subject falling under the Sate list implying that only sates can enact laws related to it.

In regards to this fact, 19 states have passed what is called the Protection Of Medicare Service Persons And Medicare Service Institutions (Prevention Of Violence And Damage To Property) Act, also known as the Medical Protection Act (MPA). But it has not proved to be very efficient in spite of having stringent provisions as many of the state law enforcing agencies are still oblivious about such Act and moreover there is no mention of it in the Indian Penal Code (IPC).

Due to the rise in number of attacks on the health workers, the Union Government has promulgated Epidemic Diseases (Amendment) Ordinance, 2020. The salient features of the Ordinance include: (8)

• Attacks on doctors, paramedic staff and ASHA workers have been made non-bailable and cognizable offences.
• These attacks are punishable with imprisonment from 6 months up to 7 years and fine of one lakh up to Rs 5 lakhs.
• The police investigation will be completed within a month and the case will be fast-tracked with the final judgment to come within a year.
• Those found to be damaging the private clinic or a vehicle belonging to a doctor will be asked to pay compensation amounting to twice the market value of the damaged property or assets.

This amendment has come as a big sigh of relief for the healthcare workers though it may have some limitations such as prevention of stringency of punishment for offences against healthcare service personnel as compared to punishment for offences against public servants. Had the healthcare service personnel been included under the definition of Public Servant in Section 21 of the IPC then this problem could have been eschewed. But taking a majority view, it has immensely helped in assuaging the anguish of the frontline warriors. This ordinance will act as a deterrence against any troubles caused to them.

Meanwhile India has emerged to be the world’s second largest producer of PPE body coveralls as reported by the government recently. As we rejoice this news on one hand, the striking thought that permeates our mind on the other hand is about the quality control measures taken by the manufacturers while producing them and by the authorities while testing and examining them. While the moto of “Self-reliant India” has been taken up seriously and expeditiously, we can hope that the best quality will also be ensured keeping in mind the plight of our frontline warriors.

Preservation of human life and right to live with dignity are of paramount importance. It is about time that the Centre realizes the gravity of the problems faced by our frontline warriors and passes a central enactment for their protection ensuring the reinforcement of the medical fraternity.

References:

1. Bandhua Mukti Morcha v. Union of India (AIR 1984 SC 802).
2. State of Punjab v. Mohinder Singh Chawla (1997) 2 SCC 83.
3. Ahmedabad: Doctors at SVP strike work over N95 masks, available at https://timesofindia.indiatimes.com/city/ahmedabad/gujarat-doctors-at-svp-strike-work-over-n95-masks/articleshow/75706834.cms
4. Need Safety More: COVID-19 Warriors on Military Show of Support, available at https://www.thequint.com/news/india/covid-coronavirus-doctors-want-protection-not-one-day-appreciation-army-event
5. Data | How many doctors and nurses have tested positive for coronavirus in India? available at https://www.thehindu.com/data/how-many-doctors-and-nurses-have-tested-positive-for-coronavirus-in-india/article31410464.ece
6. Covid-19: Around 50 doctors, medical staff test positive in India, available at https://www.livemint.com/news/india/covid-19-around-50-doctors-medical-staff-test-positive-in-india-11585912669844.html
7. Abused, Attacked, Beaten: Frontline Workers Are Risking Their Lives Everyday In India, available at https://thelogicalindian.com/news/covid-19-healthcare-workers-attacked-20665
8. Govt Clears Ordinance On Attack On Doctors, Amends Epidemic Act To Bring 7 Years Jail For Assaulting Medicos, available at https://medicaldialogues.in/news/health/government-policies/govt-clears-ordinance-on-attack-on-doctors-amends-epidemic-act-to-bring-7-years-jail-for-assaulting-medicos-65086