Once an inmate with a propensity for violence “sees that they are allowed to be violent, they will be,” a social worker who has worked at Rikers for nearly a decade and a half said.

“If you are going to assault someone, you should be punished for it,” the social worker continued. “And they are not getting punished for it.”

Nearly all health care personnel interviewed for this article spoke only on the condition of anonymity. Many said they feared retribution by their employer, Corizon, a company based in Tennessee that has a contract with the city to provide health care services at the jail complex. After the two interns were assaulted in April, the company circulated an email warning staff members not to speak to reporters.

The attacks on the health care staff mirror the increasing overall violence at Rikers that has prompted comparisons by current and former correction officials to the turmoil inside the jail complex in the late 1980s and early 1990s during the height of the crack era. Conditions at Rikers have rarely been a priority for city officials, but recent revelations about the deaths of two mentally ill inmates have prompted heightened scrutiny.

In February, Jerome Murdough, 56, a mentally ill homeless man who had been arrested on a trespassing charge, died in an overheated cell after being left alone for hours. And on Tuesday, federal authorities indicted a correction officer, Terrence Pendergrass, with violating the civil rights of a mentally ill inmate who ingested a toxic detergent and died after begging for medical attention for hours.

The underlying causes of the attacks are complicated. Part of the problem is the large number of inmates who now require services. Social workers, who provide counseling to mentally ill people and monitor their behavior for signs of volatility, say they see as many as 70 patients a week. Though required to meet with each inmate for 45 minutes a week, social workers said they rarely had more than several minutes for each. Inmates often lash out to get attention and refuse to take medication, they said.

Making matters worse are backlogs at clinics. Of the 65,000 planned inmate medical visits last year, 47 percent had to be rescheduled, according to the Doctors Council. This and long wait times at clinics tend to upset inmates and increase the chances of an assault, doctors said.