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In this research-based blog, Sehrosh Mustajab reflects on gender-based violence in healthcare facilities in Pakistan. She presents the results of a qualitative study investigating GBV on healthcare workers in the capital of Pakistan that engaged nurses, support staff, junior trainees, and contract employees. The analysis shows how GBV violence is deeply rooted in broader social inequalities, institutional weaknesses, and cultural norms that shape both patient and provider experiences. The blog explains that healthcare settings are not neutral spaces; instead, they often mirror and sometimes reinforce existing gender hierarchies, leading to neglect, mistreatment, or inadequate care for survivors of violence. Ultimately, the blog calls for systemic change, including better training for healthcare workers, stronger institutional accountability, and more survivor-centred approaches. It argues that improving healthcare responses is essential not only for treating the consequences of gender-based violence but also for identifying, preventing, and addressing it more effectively within society.
Gender-based violence (GBV) is a well-known public health, human rights, and development issue. International discussions have mainly focused on violence towards women and girls in households, societies, and war fronts. Although this attention is required, in most cases they have been blind to another key area: healthcare. In what are designed to be safe, thoughtful, and ethical institutional settings, healthcare employees are often vulnerable to workplace violence themselves.
This blog is a reflection on the results of a qualitative study investigating GBV on healthcare workers and puts the results into the context of the existing open-access literature on workplace violence in healthcare systems. This qualitative research was conducted in Islamabad, Pakistan, specifically targeting a diverse cross-section of both public and private healthcare institutions. Carried out in early 2025, the study engaged a broad range of healthcare professionals, including nurses, support staff, junior trainees, and contract employees, who represent some of the most vulnerable cohorts within the medical workforce. By focusing on the unique dual-sector landscape of the capital city, the research provides critical evidence for understanding how systemic power hierarchies and institutional cultures in Pakistan silence or safeguard those on the frontlines of care.
Ethical Considerations
Given the sensitive nature of GBV and the involvement of healthcare professionals, several ethical considerations and potential risks were carefully considered and addressed throughout the study to ensure participant safety and confidentiality. Participation in the research was entirely voluntary, and informed consent was obtained from all respondents prior to data collection. Participants were clearly informed about the purpose of the study, their right to withdraw at any time, and the measures taken to protect their anonymity. To minimise potential risks such as emotional distress, fear of retaliation or professional repercussions, the survey was designed to avoid collecting personally identifiable information and responses were kept strictly confidential. Data were stored securely and used solely for academic purposes. Additionally, questionnaires were self-administered to allow participants to respond privately and reduce pressure or influence from supervisors or colleagues. Institutional permission was obtained from relevant hospital authorities before conducting the research, and the study adhered to standard ethical research guidelines to ensure that no harm came to participants while discussing their experiences related to GBV. These measures helped maintain the safety, dignity, and privacy of all healthcare workers who participated in the study.
Why GBV in Healthcare Matters
Healthcare employees are in an especially challenging position: they are direct providers of support for violence, trauma, and abuse while also being at risk of abuse themselves in their places of work. Multiple studies have revealed that healthcare structures are one of the most vulnerable workplaces in the world. Systematic reviews have shown that over half of healthcare workers had faced some form of workplace violence such as verbal abuse, sexual harassment, and bodily assault during and after the COVID-19 pandemic (Magnavita et al., 2019). The most vulnerable to abuse appear to be women, early-career professionals, nurses, and support staff.
In terms of the consequences of violence, individual harm is only the tip of the iceberg. GBV exposure is one of the factors that can lead to burnout, mental suffering, absenteeism, and job dissatisfaction. In the long-term, these outcomes undermine retention of workforce, service delivery, and trust in health systems. The need to combat GBV in healthcare workplaces is therefore not only a concern of occupational safety, but a structural mandate to ensure that health systems remain ethical and effective.
Understanding the Research: Anchoring Experiences in Evidence
The qualitative research presented in this paper investigated GBV experienced by healthcare workers in public and private healthcare institutions. The data demonstrated a high level of thematic consistency among respondents, with similar experiences, perceptions, and concerns reoccurring in interviews.
Difficulty experienced in the process of recruitment constitutes an important finding in itself. For instance, despite guarantees about confidentiality and anonymity, numerous healthcare professionals refused to take part. Their resistance indicates a culture of fear and institutional mistrust as well as professional precarity. The same trends are reported in other countries, as medical staff members are afraid of retaliation, lack of belief, or even professional penalties upon reporting physical attacks (Parkar et al., 2025).
Structural/Institutional Obstacles to Reporting
A pattern was observed when participants explained the structural barriers that prevented open discussions of GBV in a healthcare environment. These involved the existence of power hierarchies, as well as weak accountability structures and independent reporting mechanisms. Most of the times, cases were reported to supervisors, who were perceived as unhelpful or even tolerant of abusive attitudes and norms keeping quiet.
The fear of professional punishment was also prevalent. Respondents raised issues of job stability, halted career growth, broken reputation, and social loneliness. These fears are well-founded. The very high rates of sexual harassment among female healthcare workers and low rates of reporting have been previously documented in South Asia, as well as other areas. An open-access Indian study, for instance, identified more than 90 percent of female medical personnel to have been sexually harassed but less than a quarter to have reported the abuse to any authorities (Shaikh et al., 2025).
These results highlight that institutional cultures can normalise abuse and make reporting dangerous or futile. Within such environments, silence is a survival strategy, not an indication of acceptance.
The Human and Professional Cost of Silence
Gendered power relations are closely interconnected with GBV in healthcare and overlap with other social inequalities, including the concentration of authority in older-male-dominated leadership systems and disproportionate female representation in lower-paying, insecure, or care-providing roles. Such disparities of power determine who is listened to, who is shielded, and who is likely to bear the cost of speaking the truth.
The stories of participants revealed the intersection of gender, professional rank, and contract status that contributes towards vulnerability. The junior employees, trainees, and contractors stated that they were exposed to increased levels of harassment and had fewer redress mechanisms. The experiences mirror the findings of the research on workplace violence all around the world, with abuse towards contingent staff with less institutional power and job security being most visible (WHO, 2012).
Institutional Silence as a Systemic Failure
The effect of GBV is long lasting and compounded. The participants reported chronic stress, emotional depletion, and increased vigilance at the workplace. Others said that they avoided professional interaction with certain spaces or colleagues, or that they were doubting their long-term career in the profession. These results are consistent with evidence in the rest of the world which connects workplace violence with mental health struggles, physical harm, and detachment of professionals (WHO, n.d.).
These harms are increased through institutional silence. Where cases are not recognised or dealt with, the violence becomes institutionalised and embedded in organisational culture. Surveys on health records and surveillance systems have indicated that acts of violence in healthcare are systematically under-reported, not due to a lack of incidents, but due to root causes in the system that do not capture a record or react to such occurrences (Steel et al., 2024). Such invisibility perpetuates impunity and normalisation.
Ethical and Safeguarding Implications
As well as the researcher, healthcare institutions have an ethical responsibility of their own. The inability to prevent, approach, or intervene in GBV does not comply with the basic principles of duty of care, workplace safety, and professional dignity. Ethical mechanisms should not only safeguard the patient but the caregiver too.
What Can Be Done: Evidence-Based Pathways Forward
There is a number of measures that could significantly decrease GBV in healthcare settings:
- Safe and Independent Reporting Mechanisms
It is necessary to have confidential reporting systems which do not depend on hierarchies of managers. These processes are needed to ensure that there is a clear avenue of investigation and redress without any risk of retaliation.
- Training and Capacity Building
GBV awareness as well as rights and response training opportunities can enhance workers’ ability to identify violence and intervene. Evidence from Pakistan indicates that training gave healthcare workers a better understanding of GBV and confidence in how to respond to it (UNFPA, n.d).
- Accountability
An institution’s leaders are instrumental in defining its culture as a workplace. There should therefore be an active enforcement of zero-tolerance policy, not just a symbolic approval. The leadership has a primary responsibility in transforming of the norms of silence and protection.
- Psychosocial and Peer Support
Emotional support such as counselling, peer-support networks, and the use of psychological first aid is also important to victims of GBV and should be openly available.
- Policy Integration
The integration of GBV prevention at a systematic level should be incorporated in workforce planning, occupational safety and national health policy. The World Health Organisation (WHO) highlights the role of coordinated and multisectoral responses used in the health sector in dealing with GBV, such as legal measures and data tracking that reflect on workplace violence (UN Women, n.d.).
Conclusion
The results of this research revealed that GBV in healthcare institutions is prevalent but preventable. It is an institutional issue perpetuated by silence, power politics, and institutional failures.
Healthcare employees are in the background of the institutions supporting entire populations. Guaranteeing their safety and dignity is not an idealistic notion but a precondition to ethical, effective, and sustainable healthcare delivery. It takes institutional bravery, long-lasting dedication, and an alternative structure to address the invisibility of GBV in the sector. The evidence is clear. All that remains is the desire to act.
References
Magnavita et al. (2019) “Workplace Violence against Healthcare Workers: A Systematic Review and Meta-Analysis,” Occupational and Environmental Medicine 76, no. 12: 927–937, https://oem.bmj.com/content/76/12/927.
Parkar, S.R. et al. (2025), “Sexual Harassment among Female Healthcare Workers: A Cross-Sectional Study,” Indian Journal of Community Medicine 50, no. 3: 312–318, https://pmc.ncbi.nlm.nih.gov/articles/PMC12470406/.
Shaikh, S. et al. (2015) “Effectiveness of Life Skills-Based Training to Improve Healthcare Providers’ Response to Gender-Based Violence in Pakistan,” BMC Health Services Research 25, no. 1: 13041, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-025-13041-9
Steel, H. et al. (2024) “Gender-Based Violence and Harassment at Work and Health Outcomes: A Systematic Review,” BMC Public Health 24, no. 1: 1189, https://pubmed.ncbi.nlm.nih.gov/38965519/.
United Nations Population Fund (n.d.), “Gender-Based Violence,” UNFPA Pakistan, accessed January 2026, https://pakistan.unfpa.org/en/topics/gender-based-violence-6.
UN Women (n.d.), “Gender-Based Violence: Pakistan Country Profile,” UN Women Data Hub, accessed January 2026, https://data.unwomen.org/country/pakistan.
World Health Organization (2012), Gender-Based Violence in Pakistan: A Health Sector Response. Cairo: WHO Regional Office for the Eastern Mediterranean, accessed January 2026, https://applications.emro.who.int/dsaf/emrpub_2012_en_858.pdf.
World Health Organization (n.d.), “Strengthening Health Sector Response to Gender-Based Violence in Humanitarian Emergencies,” WHO, accessed January 2026, https://www.who.int/activities/strengthening-health-sector-response-to-gender-based-violence-in-humanitarian-emergencies.
Sehrosh is a health researcher with global attention to the matters of gender, health systems and equity at the workplace. Their contributions explore institutional obstacles to safety and inclusion within health organisations, arguing in favour of policies that will allow healthcare workers to remain safe from gender-based violence. Sehrosh has worked in the fields of qualitative research and policy analysis, and has participated in evidence-based debate on GBV prevention on an international level. Sehrosh can be reached at: sehrosh24@gmail.com
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