By Augustine Omilo
The recent demise of the former president of Nigeria, General Muhammadu Buhari (rtd.) while on medical tourism abroad has once again brought the issue of poor health care delivery in the country to the fore.
Late President Buhari is not the only prominent Nigerian, dead or living that has placed premium on foreign medical facilities while making choices of where to get adequate health attention at times of need. This pattern of health care delivery choices by the high and the mighty in Nigeria is hinged on factors such as inadequate health care facilities, lack of enough health care workers, particularly doctors and nurses largely due to brain drain, flooding of the health markets with fake drugs, poor training of local health care managers and lack of motivation for workers in the industry amongst others.
Talking about brain drain, whereas Indian doctors and their counterparts from Philippine were trooping to Nigeria to boost the activities of the health sector of the economy in the 70s, 80s and 90s, today, Nigerians are the ones seeking medical attention by traveling to far-away countries to meet their doctors. The country’s hospitals have become unattractive due the factors already enumerated, coupled with the poor value of the Naira compared to other foreign currencies.
However, a new disturbing trend appears to be infiltrating the health care delivery system of the country, described as the world’s most populous nation of the black people. This emerging threat called “violence against health workers” is fast taking root in the various hospitals around the country.
In August, 2024 Resident doctors in the country embarked on a 7-day strike to press home the demand for the release of their colleague, Dr. Ganiyat Popoola who, at the time was held for eight months by kidnapers. The woman who worked for one of the biggest eye hospitals in Nigeria – the National Eye Centre Hospital, Kaduna, North west Nigeria was kidnapped on the 26th of December 2024 alongside her husband and a nephew. She was released in October, 2024, after about 10 months in captivity.
Ganiyat’s case is one of the many cases of violence against medical personnel in the country. The Safeguarding Health in Conflict Coalition identified 19 incidents of violence against or obstruction of health care in Nigeria in 2023, compared to 47 in 2022. At least 19 health workers were kidnapped in 12 incidents that year.
In a recent research conducted by Alphonsus Rukevwe Isara, out of a total of 1,218 HCWs comprising Borno State, 407 (33.4%), Plateau State, 401 (32.9%) and the Federal Capital Territory 410 (43.7%) who were interviewed, the overall prevalence of physical and psychological violence was 16.7% and 62.4%, respectively.
It further stated that pushing and slapping were the predominant forms of physical violence while weaponized violence with weapon was the highest in conflict areas. The research outcome added that Verbal abuse, threats, bullying and harassment were the predominant forms of psychological violence.
Isara opines that the major consequences of violent attacks on the health care workers were lack of job satisfaction, loss of confidence, low self-esteem, decreased productivity and post-traumatic stress disorder.
In another research made by Usman et al in Kaduna metropolis of Northern Nigeria, it was discovered that 64.4% of health workers who participated in the study have experienced workplace violence, while 66.1% of health workers were reported to have witnessed at least one case of a colleague’s harassment in the hospital in Southwest Nigeria. Usman adds that in Southeast Nigeria, 49.7% of the respondents experienced psychological workplace violence in recent years.
Violence against these health professionals is often perpetrated by patients or their relatives. They range from verbal abuse to physical violence including murder as was reported by the Nigeria Medical Association, NMA in January 2023.
Contributing to the conversations on the increasing wave of violence against health workers, the former Physician to the Delta State Government House during the administration of Senator Dr. Ifeanyi Okowa as governor, Dr. Martins Orie submitted that violence against medical personnel has become real in Nigeria.
Though Dr. Orie who runs his thriving hospital in Agbor, Delta State declined to speak on the global perspective, he stated that most acts of violence exhibited in hospitals are carried out due to two major reasons – ignorance and undeserved high expectations from medical officials.
According to him, many Nigerians, including even the urban dwellers are mainly in the habit of resorting to medical doctors’ assistance only when they have exhausted their alternatives to orthodox medicines that fail to yield fruitful results.
According to him; “except for accident victims, when ailments occour amongst our people, many will first attribute them to spiritual attacks and take their matters to the Church. Some will hold the view that such sicknesses are better cured with native herbal drugs. Worst still, there are people who will resort to self-help, simply going to small medicine retail outlets where they sometimes buy and apply drugs that are banned or no longer valid for the cure of their ailments”.
Dr. Martins Orie further stated that, when this category of persons later realize they could not get the expected results from their self-help, they approach the hospitals as last resort and expect doctors to perform wonders. And when their expectations are not met, they go into making troubles with health officials with threats of violence, which may even result into the killing of unwise medical officials who would not know when to meander their ways out of the confusing scenes.
Explaining further, Orie submitted that, these ugly occurrences mainly take place when promising young people pass on in hospitals, and at other times when clear cases of negligence are established.
According to him; “let me just give you only two cases of negligence that resulted in protests. One footballer who collapsed on the field of play, obviously due to heart failure was rushed to a near-by government hospital. Those who took him there met a doctor who was on phone discussing with his girlfriend to their hearing. He ignored them until he finished with the lady on the other side. Of course, he acted late and the young man died. Who would not blame the doctor for negligence, he queried.”
In another instance, he narrated how an elderly man was driven to the hospital in an ambulance under emergency but the doctor they met asked them to go to the service area, promising that he was going to meet them there instead of swiftly attending to them. Again the old man gave up the ghost before the physician’s arrival.
Asked whether the medical professional bodies have a system in place to discipline negligent and erring health workers, Orie answered in the affirmative but quickly added that, due to societal ignorance, many citizens would rather put calls across to “big men” instead of reporting to the appropriate quarters. He added that, even when some people know what to do, many of them would prefer to allow the sleeping dogs to lie instead of being seen to be instigating the sack of a health worker.
Apart from violent attacks by patients’ relatives, a Nigerian national daily, the Punch newspapers reported on Sunday, 10th of August, 2025 under what it titled ‘Suffering and smiling: Tales of Nigerian nurses’ endless sacrifice with poor pay,’ that there are other serious hazards faced by nurses in the country.
It reported the case of a government hospital nurse, simply identified as Nurse Adeyinka who suddenly collapsed midway into her 8-hour shift, thereby becoming a patient herself. It was not the first time the 34-year-old had worked through fatigue, hunger, and aching legs, according to the report. But that morning in May 2025, her body finally gave out.
There was another case of Nurse Lucky, a registered nurse at a General Hospital in Ondo, Ondo State, who collapsed beside the stretcher he had been tending to all night. For days, he had been battling malaria and diarrhoea, but had refused to call in sick since there was no one else to take his shift. The hospital, already short-staffed, was running on skeletal strength.
This shortage of medical services staff has equally remained a source of concern to hospital administrators as it often results to the untimely death of health workers.
With more than usual patients in the hospital that night in June 2025, Lucky was moving from bed to bed, pale and visibly weak, attending to patients when he collapsed to the cold tiled floor, unconscious.
Also, one of the highbrow hospitals in Asaba, Delta State recently witnessed what would have resulted to the killing of a medical doctor who was accused of being responsible for the death of a patient. According an angry relative of the deceased, the doctor acted in error when he disengaged his sick brother from medical life support via artificial oxygen administration.
In the same hospital, a relative of a diabetic patient with an open wound was found in a hot argument with a nurse who was assigned to treat the patient. While the Nurse who was acting on the recommendations of the doctor opted to apply bandage around the wound spot, the patient’s cousin argued that bandage was not necessary as it would obstruct air around the troubled place. It took the intervention of another relative for the nurse to change her decision of not going further with the patient’s treatment until the attention of the doctor is drawn to the disagreement.
Although, reasons for violence are not justifiable, they are perceived to be caused by long waiting times, lack of bed space and drugs, attitude of some health workers or their absence from duty post during night shift or call hours, or even attitude of patients or their relatives.
With the continuous exodus of health professionals from Nigeria, experiencing workplace violence in addition constitutes a double crisis for the already depleted Nigerian healthcare system. Health delivery is hampered by brain drain of the public healthcare workforce and this brain drain is attributed to job dissatisfaction, caused by inadequate remuneration, lack of career growth opportunities, and inadequate health infrastructures, etc.
The consequences of health workplace violence are not only limited to work injuries, leading to absenteeism and job dissatisfaction, but can also aggravate the current brain drain concern.
The World Health Organisation, WHO defines violence against health workers as incidents involving work-related abuse, threats or assaults among health workers including physical, sexual, verbal and psychological abuse and workplace harassment.
In a jointly developed training manual with the International Labour Organisation in 2024, WHO states that up to 62% of health workers have experienced workplace violence and that verbal abuse (58%) is the most common form of non-physical violence, followed by threats (33%) and sexual harassment (12%).
To stem the tide, the global health body recommends that; the recognition of actions that constitute violent incidents and identify the risks of violence, take measures to improve work organization, ensure optimal staffing levels, working time, supportive work teams and improved working conditions, prevent staff from working alone and minimize patient waiting time, provide timely information to patients and family to reduce stress, restrict movement of the public in health facilities, alert security personnel if and when violence is threatened.
WHO also suggests that organisations provide security measures, ensure proper lighting, installation of security cameras, alarms and panic buttons, emergency signaling, security escorts to the parking lots at night, lock drugs and valuables, prepare and support workers, and train workers in conflict resolution and managing assaults.
Health care agencies, according to WHO must also provide counselling to recognize the danger of violent behaviour and assistance to change the conduct/attitude, maintain physical fitness and emotionally stable psychical conditions, respond quickly and appropriately to incidents if they occur, encourage reporting, recording and monitoring of all incidents, ensure a confidential complaint or grievance procedure and monitor violent trends and the effectiveness of preventive measures.
However, cases of violence against health workers are not limited to Nigeria. Rather, it has become a world-wide phenomenon. The Indian Medical Association has reported that 75% of doctors face verbal or physical abuse in hospital premises and fear of violence was the most common cause for stress for 43% of their doctors. The highest number of violence was reported at the point of emergency care and 70% of the cases of violence were initiated by the patient’s relatives.
The incidence of reported violent crimes against doctors in India has been increasing from 2006 to 2017, with the highest violence rate occurring in Delhi, Maharashtra and Uttar Pradesh.
Factors attributed to violence against doctors in the country are: absence of post-graduate training in emergency medicine in India, long working hours of up to 120 hours a week for doctors, demonisation of doctors in news media and films, poor quality of emergency-care infrastructure, poor mechanism for redressing grievance, delayed legal procedural outcomes, a poor emergency network among hospitals, poor communication skills of healthcare workers, resource poor emergency settings (fewer drugs, fewer facilities for investigations), high patient load, lack of proper training of healthcare staff, high work load, and excessive political interference in hospital affairs amongst others.
The issue is not too different in the USA, where a 2018 survey conducted by the American College of Emergency Physicians showed that out of more than 3,500 E.R. doctors, 47% of the doctors had been assaulted and 97% of the time, the assailant was a patient.
A 2014 survey conducted by the Chinese Medical Doctor Association (CMDA) found that the 60% of medical professionals surveyed had faced verbal abuse from patients and their relatives and 13% of the professionals had been physically assaulted and harmed.
In curbing the menace of the deadly violence against health workers, Nigeria must go beyond the recommendations of the International Labour Organisation, ILO and the World Health Organisation, WHO and offer solutions that are peculiar to the nation.
For example, the issue of deaths resulting from the administration of fake drugs must be tackled by the National Agency for Food and Drug Administration and Control, NAFDAC. It is not enough to lock up the sales outlets of drug peddlers. International border officials of the agency must wake up to their responsibilities of ensuring that unwanted items in the country are stopped from coming into Nigeria illegally.
Like Dr. Martins Orie suggested that, medical practitioners must know the limits of their strength and resources available to them. This will be with a view to referring cases beyond their scope to appropriate hospitals.
According to him; “the guiding principle of our profession is that you should not make a patient’s condition worse if you cannot help him.” It will therefore not be out of place for the health workers to also begin to proffer solutions from within them.
