Four decades have passed since Aruna Shanbaug, a nurse working at KEM Hospital in Mumbai, was sexually assaulted by a ward boy, leaving her in a vegetative state. She died in the hospital on May 18, 2015 after living in a near-comatose state for 42 years. Her case is always invoked when an incident of sexual violence is recorded at any healthcare facility. A simple search on the internet generates a long list of incidents in Indian hospitals in which female staffers or patients, including children, have faced sexual violence.

On December 7, newspapers reported that a 21-year-old woman working with the Delhi Municipal Corporation hospital as an intern in the X-ray department was allegedly raped by a technician and a doctor inside the hopsital’s X-ray room. The woman had completed her internship and was no longer an employee of the hospital when the incident occurred, said the hospital superintendent Dr Ranbir Singh.

“I only got to know when the police came to us,” he said. The Delhi police came to the hospital on December 7 looking for close circuit television camera footage. “The incident happened in October and we got the CCTVs installed only in November,” said Singh, who plans to add more cameras and deploy more security personnel.

One would have thought there would be better protections for women employees in hospitals after Aruna Shanbaug case!https://t.co/8IpWyWiU6H — Anant Bhan (@AnantBhan) December 7, 2016

Singh feels that even these additional security measures might not ensure safety at the hospital. “This is such a big place,” he said. “How are we going to guard every bathroom and every corner of the hospital? I can’t put CCTV in the X-ray room for patient confidentiality. I can, at best, deploy a security guard outside but I don’t think it’s possible to do for every room.”

In a meeting shortly after the police visit, Singh along with the hospital’s doctors and administration staff decided that every possible empty room or corridor that could be an easy site for such sexual violence will be locked.

False security of CCTVs

Experts working on sexual harassment cases in the workplace observe that a hospital is as vulnerable as any other location. “Sexual harassment is universal,” said Kanti Joshi, convener of SASHA, an organisation working to address the problem of sexual harassment at workplace. “We are hearing more cases from hospitals perhaps because there is a better reporting mechanism.”

In September, a doctor and a sweeper raped a 19-year-old girl admitted in the intensive care unit of a private hospital in Gujarat. Earlier in June, a 22-year-old woman undergoing treatment for depression at a public hospital in Haryana was allegedly raped by a ward boy.

“Abuse happens in all environments,” said Dr Sunita Simon Kurpad, a psychiatrist at St John’s Medical College in Bangalore, who has made a film on sexual boundary violations in doctor-patient relationships. “People put their guard down in the hospital. We need to educate patients about inappropriate touch.”

Moreover, the nature of doctor-patient relationships makes patients easy targets of abuse. Kurpad recalled a case in which her patient recounted an incident where a man wearing a lab coat conducted a vaginal examination on her. “She was not sure why it was done but didn’t resist,” said Kurpad, who encouraged the patient to register a complaint with the hospital.

Kurpad added: “She didn’t complain but I feel hospitals have better redressal mechanisms in place. Complaints can help identify and correct behavior but punishment is a must.”

Most cases of sexual violence reported in the media are of women who have approached the police, like with the Delhi municipal hospital case.

IC Sisodia, former chief vigilance officer of the Brihanmumbai Municipal Corporation said that installing CCTVs is not enough. “You need manpower to monitor each screen to identify any such incident before it occurs,” he said. “For us, CCTVs are like post mortems, we look for the footage to know what happened and not to stop the act of crime.”

Similarly, there is no uniform role of security guards or assured safety by increasing their numbers. “The security is only looking for suspicious people inside the hospital campus and stop outsiders from entering,” said Sisodia. “Frequent patrolling in the campus by security and other supervisors can be helpful.”

Hospital staff at risk

Not much has changed since the Aruna Shanbaug incident, say nurses. Nursing unions across the country are still demanding basic facilities like dedicated changing rooms in hospital campuses. Shanbaug was assaulted in the KEM Hospital basement where she would go to change her uniform.

One characteristic of any hospital is its particularly large workforce is women. “Women work round the clock and are also assigned night shifts whereas women in other professions would not be working in the night,” said Dr Abhay Shukla from CEHAT, a non-profit organisation working for patient rights.

A junior female doctor in Mumbai told Scroll.in that she is afraid of using the hospital elevator during night duty. “I am always worried that a relative or staff will attack me,” she said.

The medical student recalled an incident during her residency days when she was “inappropriately touched” while she was going from one building to another within the hospital campus. “He [the attacker] left me only when I raised an alarm.”

Though hospitals are crowded like any other public space, most hospitals have blind spots. “Hospitals are not like call centres where many people are working on the same floor in the same building,” she said. “If I get a call on my night-duty to look at a patient, I have to go alone. No one is going to escort me.”

Outside cities, the dangers are more pronounced. “The biggest concern is the hospitals in rural areas where one or two nurses are deployed,” said retired nurse GK Khurana, who is the secretary of All India Government Nurses Federation. “They are alone and are always worried about their security.”

As Kurpad pointed out, most public and private hospitals have now formed sexual harassment committees to address complaints. However, Sagar Mudanda, psychiatrist and president of the Mumbai Association of Resident Doctors, said that women doctors are afraid to report harassment. “If you keep on complaining, you won’t be able to survive,” he said.

Preventive mechanism required

Hospitals, like any other workplace, need to have systems in place that prevent sexual harassment on the premises. Legally, they are mandated to follow the rules prescribed under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act. The Act mandates that the employer constitute an internal complaints committee that will clear all complaints related to sexual harassment within 90 days failing which a penalty of Rs 50,000 will be imposed.

Joshi from SASHA said redressal mechanisms are in place in bigger hospitals. “We had conducted a workshop and found that smaller hospitals didn’t have any system in place,” she said. “They told us that they will address it ​when the concerned authority issues notice for non-compliance​.”

Patient right activists said that continuous reports of violence from hospital settings reinforce the need for mechanism which can prevent such crimes. “These things are very rare but we need to inform public about it” said Kurpad who believes that increased awareness about sexual violence will act as a deterrent.

Shukla of CEHAT advocates setting up alarm systems in hospitals where any patient or employee can call within the hospital in case they fear abuse. “A much stronger message that any kind of violence will not be tolerated in hospitals should be given,” he said.

Other cases of sexual violence in hospitals in 2016 reported in the news