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Principal Investigators: Sonja Merten, Swiss Tropical and Public Health Institute; Ghislain Bisimwa, Université Catholique de Bukavu; Riyadh Lafta, Mustansiryah University.


Violence against healthcare workers (HCWs) and alarming levels of distrust towards the medical profession is a humanitarian issue with long-term consequences especially in fragile and conflict settings.

This research proposes to evaluate the effectiveness of a de-escalating violence training for HCWs in combination with an organisational level intervention that may further contribute to curb the violence. For this purpose, a community-developed set of rules will be implemented in health facilities and hospitals via a displayed code of conduct. Citizen science and other participatory methods will ensure community engagement and increase community trust in HCWs. The validation of the code of conduct by government and health authorities will ensure that the code of conduct is enforced effectively. Through a stepped-wedge trial this study will generate robust evidence on the effectiveness, cost, and consequences of this combined intervention addressing violence against HCWs in fragile contexts, and on the scalability and applicability to other humanitarian settings.

The study will build on the work of the ICRC Healthcare in Danger initiative. Find out more in their 2020-2022 strategy.

From the Healthcare in Danger Strategy 2020-2022


While respect for health workers is declining it will not be possible to devise strategies to protect health care without evidence base. Health workers form part of the intellectual elites which is particularly propitious for generating – together with communities – quality evidence on patterns of violence and the effectiveness of activities to prevent it.

Expected Outcomes

Overall, it is expected that the proposed project will contribute towards reducing the prevalence of violence against HCWs and its severity in contexts of fragility. Further, the project will broaden the understanding of the motivations and underlying cultural and societal factors contributing to violence perpetrated by patients, affiliated third parties or co-workers.

The project will increase public trust in HCWs by empowering communities to co-design solutions and become advocates for a sustainable intervention. It is also expected that this research will contribute to developing a healthier and safer work environment for HCWs, improving their psychophysical well-being and adding to a general improvement in the quality of services.

The approach of this study will enable its integration into professional training and the implementation of hospital policies to reduce violence. This robust research will be essential in identifying the most (cost-) effective way to implement interventions in urban and rural areas of low and middle income countries.

Related Resources

Article, Peer Reviewed Health Systems & Services, Violence Against Health Care

Study Protocol: Understanding context of violence against healthcare through citizen science and evaluating the effectiveness of a code of conduct and of a de‑escalation of violence training

Article, Peer Reviewed Health Systems & Services, Violence Against Health Care

Violence against health care workers in a crisis context: a mixed cross-sectional study in Eastern Democratic Republic of Congo

Latest Updates

DRC Codes of Conduct Developed

Nov 2023

View the codes of conduct that were developed in DRC.


Iraq Codes of Conduct Developed

Aug 2023

Through a participatory process, the study team has finalised the codes of conduct to display in health facilities in Iraq.

ICRC training on the de-escalation of violence for the medical staff, Karachi, Jinnah postgraduate medical center. Credit: ICRC.
Healthcare in Danger Logo. Credit: ICRC


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