Picture this: Amjad Siraj Memon, professor of surgery at Karachi’s Civil Hospital, says a few years ago a group of armed young men wheeled in a man with severe head injuries and demanded that his brains, which they were carrying in a plastic bag, be replaced and the patient revived.

“We were told to comply or face dire consequences," Memon told SciDev.Net.

From handling angry mobs to emotionally charged attendants; to the entire hospital being ransacked and held hostage; to being held at gun-point while being cowered into telling their ethnicity; to the regular verbal and physical abuse junior doctors, paramedics and nurses face on the hands of patients and relatives; to the violence perpetrated by seniors on juniors and recently of juniors beating up or holding their seniors hostage — all this is happening in the medical profession once considered noble.

Those saving and serving humanity are, today, in need of being protected from hostile forces.

Abusive language and physical violence against doctors and other staff by patients' families are common in the emergency department (ED) and wards of Pakistan’s public hospitals, according to studies.

Read: CMCH doctors, paramedics thrashed after patient’s death

Research carried out in 2015 in Karachi’s hospitals by the International Committee of the Red Cross (ICRC), in collaboration with the Jinnah Sindh Medical University, included interviews with doctors, nurses, paramedics, non-medical hospital staff and law enforcement authorities that showed the enormity of the problem.

Medical practitioners said they felt scared, helpless and also demotivated. The findings of the study, released in November 2015, are in conformity with several earlier studies on violence in Pakistan’s hospitals.

But there have also been cases when violence has been severe.

Also read: Gunmen beat doctor, paramedics

Scores of similarly hostile situations experienced by senior doctors were shared at an annual symposium in November 2015 at the Aga Khan University, Karachi. Most participants agreed that junior doctors, nurses and paramedics at the ED face some form of violence on a daily basis.

Professor Majid Chaudhry, a former head of the department of surgery, at Lahore's Mayo Hospital recounted how he calmed down a mob of 350 Kalashnikov-toting men from a religio-political party after their leader was brought to his ward suffering from multiple gunshots. They had come to take him away.

"He was out of danger but he couldn't be released," he said.

"The first thing that came to my mind was to open up his dressing after which I called in his two sons into the operation theatre where they saw their father in quite a 'critical' state. I told them I was about to do a risky 'procedure' on him to save his life and to tell the mob to put down their guns and to start praying for their father's recovery."

A couple of hours later, said the doctor, the crowd quietly dispersed.

It may be "nerve-wracking" and difficult to "keep the heart beat going at a regular rate" when a gun is being pointed at them, or when an angry mob surrounds the doctor menacingly, said the physicians present that day, but keeping calm and thinking rationally has diffused the situation and saved their skins and those under their care on several occasions.

Read more: Accident victims’ kin rough up doctors

A lot of the violence from families can be avoided through effective patient-doctor communication.

A little more compassion, time and involvement of the patient can become central to effective treatment and recovery, many agreed.

Being forthright, honest, explaining the complications, even alluding to the possibility of serious consequences, "even death" and documenting everything the physician has discussed with the patient and his relatives can pay off and lower the unrealistic expectations the patient and the attendants may have.

But that may not be so in an emergency situation where time is of essence as is taking quick decisions. Often there is not enough time to counsel and explain the risks to the family. With the result, junior doctors and nurses present on the frontline face the wrath.

The first ever nation-wide study, conducted in 2011, on violence and abuse faced by junior physicians in the emergency departments of nine public hospitals in Pakistan showed that nearly 76.9 per cent of the 675 doctors interviewed had experienced violence — 65 per cent verbal and 11.9 per cent physical.

Male doctors were at a higher risk of facing violence than their female counterparts and most acknowledged that violence perpetrated on them affected their performance.

Also read: Confessions of Pakistani doctors

In a similar 2013 study involving 164 healthcare professionals, carried out in a public health care facility in Lahore, 74 per cent of the doctors said they had experienced violence in the year preceding the study with a majority of cases (76.8 per cent) taking place in the ED.

The perpetrators were mostly patients' relatives (71 per cent).

Both the reports concluded that "too many" attendants, long waits, limited contact with the physician, resulted in chaos and mayhem and in turn led to violent incidents.

In the Lahore study, more than two-thirds of those interviewed reported violence while most of the others only disclosed it to colleagues. Lack of confidence that action would be taken (73 per cent) was the main reason for not reporting to the hospital administration.

Some doctors assumed it came with the job (38.7 per cent).

Read more: Doctors’ accountability

The ICRC study found that most victims considered it useless to report abuse or were afraid of negative consequences. It observed that there was a need for intervention to address the behavioural, institutional and socio-political factors responsible for violence against health care practitioners.

— This piece was first published on SciDev.Net and has been reproduced with permission