Violence Against Healthcare Workers in Turkey: Prevalence, Causes, and Solutions

Hello friends,

Today I wanted to write about cases of violence in healthcare in Turkey. This issue is no longer an internal professional problem discussed only among physicians, nurses, emergency medical technicians, security personnel, or hospital staff. Violence in healthcare has become a public health crisis that affects all of us: access to care, waiting times in hospitals, how much time a physician can give to a patient, whether healthcare workers remain in the profession, and ultimately the quality of healthcare that every citizen receives [1], [2].

When we enter a hospital or an emergency department as patients, we usually carry pain, fear, anxiety, and uncertainty. That is human. But at the same time, inside that institution there are healthcare workers trying to serve hundreds of people, making rapid clinical decisions, working under shift fatigue, and carrying the responsibility of not making a mistake. When these two tense worlds are not managed properly, the ground becomes open to conflict. That is why violence in healthcare cannot be reduced to “one angry person losing control.” It is a complex, layered, system-wide problem.

The source analysis I reviewed examines violence against healthcare workers in Turkey through prevalence, types of violence, victim and perpetrator profiles, high-risk settings, White Code data, international comparisons, root causes, systemic consequences, and solution proposals. I will translate those findings into a reader-friendly but comprehensive language.

What do we mean by violence in healthcare?

Violence in healthcare is not only physical assault. It includes insults, shouting, threats, humiliation, psychological pressure, sexual harassment, mobbing, threats with firearms or sharp instruments, and at its most tragic point, fatal attacks [2], [3]. Shouting at a nurse, threatening a secretary in the emergency department, attacking a security officer, telling a physician “I will find you,” pressuring a medical decision, or cornering an ambulance crew are all part of the same violence climate.

The most common form is verbal and psychological violence. Many studies report verbal violence rates above 80-90%, and one study found a rate of 99.3% [2], [14], [16]. Around 89% of White Code notifications include verbal violence [16]. This means that the visible news story is often the physical attack, but the everyday trauma is usually the constant exposure to insult, threat, shouting, and humiliation.

How serious is the situation in Turkey?

The figures in the source are alarming. Workshop reports by the Turkish Medical Association indicate that the prevalence of violence among healthcare workers ranges between 50% and 75% [2]. In a 2023 survey of physicians, nearly 90% of respondents stated that they had experienced violence by a patient or patient relative at least once in their working life, while 60% stated that they had been exposed to violence in the previous year [2].

The Lokman Hekim Health Foundation study found that 69% of physicians and healthcare workers had experienced violence in healthcare [11]. A national study from 2015 found that 44.7% of healthcare workers had experienced workplace violence during the previous 12 months [12]. Another study reported that 83.3% of physicians had experienced at least one violent incident during their career [13].

These numbers are already severe, but the real picture may be even heavier because many incidents are not reported. According to a Turkish Medical Association survey, around 66% of physicians who experienced violence did not report the incident [2]. The reasons include the belief that “nothing will change,” fear of retaliation, bureaucratic difficulty, lack of time, and the normalization of violence as if it were part of the job [2], [10]. Therefore official statistics may show only the visible part of the iceberg.

Where does violence happen most?

Violence is concentrated in specific healthcare environments. Emergency departments are repeatedly identified as the highest-risk areas [2]. More than half of White Code notifications come from emergency departments; some studies report rates between 54.7% and 57.7% [16]. This is understandable: emergency departments combine high stress, overcrowding, long waiting times, critical patients, triage decisions, anxious relatives, and exhausted staff.

Psychiatric services are also high-risk settings [2]. Outpatient clinics, inpatient wards, operating rooms, ambulances, and field services also carry risk [4], [6]. The source also notes that violence is more frequent in public healthcare institutions than in private institutions, likely due to patient density, resource limitations, waiting times, and systemic pressure [2], [10].

This point matters: violence in healthcare is not only a matter of “an angry patient relative.” Crowded hospitals, short consultation times, insufficient staff, heavy shifts, poor communication infrastructure, and constant patient flow all prepare the ground for violence.

Who is exposed to violence?

Nurses and physicians are among the most frequently targeted groups [3]. In the 2023 ATTDER report, nurses accounted for 43.3% of victims and physicians for 40.9% [3]. Some other studies report higher rates for physicians [4]. Security officers, emergency medical staff, pharmacists, data-entry staff, and other healthcare personnel are also affected [3].

Gender patterns are complex. Some studies show that women and nurses are more frequently exposed to violence or sexual harassment [2]. Other findings suggest that male physicians may be more likely to experience physical violence [2]. White Code data show that most victims are women [16]. This means that the type of violence, professional role, workplace, shift, and gender must all be considered together. Solutions should be role-specific and gender-sensitive.

Who commits the violence?

The perpetrators are mostly patients and patient relatives [2]. In many studies, patient relatives appear very frequently as perpetrators; in some White Code data, the patient personally is reported as the most frequent perpetrator [16]. Men are strongly overrepresented among perpetrators; one study reported that 79.7% of perpetrators were male [13].

Yet identifying the perpetrator does not fully explain the cause. Panic, grief, pain, substance use, psychiatric illness, low health literacy, unrealistic expectations, frustration with waiting, dissatisfaction with treatment, or demands that violate rules may contribute to the incident [2], [10], [16]. None of these justify violence. But without understanding the ground that produces aggression, we cannot design effective prevention.

The most tragic consequence: deaths

The most unacceptable result of violence in healthcare is the death of healthcare workers on duty. The source names Dr. Ersin Arslan, Dr. Kamil Furtun, Dr. Ekrem Karakaya, and security officer Tuğrul Okudan as symbolic examples of this tragedy [3], [6]. These are not isolated names; they are reminders that people who are present to help can become targets.

Violence against a healthcare worker is also violence against the health service itself. When an emergency physician is killed, not only one life is lost; the care that physician would have provided to thousands of future patients is also lost.

White Code: necessary but not enough

Turkey has established the White Code system to report violence, theft, or sexual harassment against healthcare workers. The aim is rapid intervention, notification of security and hospital administration, initiation of legal procedures, and legal support for the worker [1], [16], [29]. Reports can be made through the internal hospital code 1111, the 113 call center, or the Ministry of Health web portal [16].

However, the source emphasizes that White Code is mostly reactive. It records and responds after an incident rather than preventing violence before it occurs [35]. Many healthcare workers also doubt that reporting will produce meaningful results [2]. White Code notifications increased from 7,751 in 2017 to 46,274 in 2019, 72,158 in 2020, and 101,984 in 2021 [18]. This may reflect both a real increase in violence and increased use of the reporting mechanism. But because underreporting remains common, the real scale is still uncertain.

The Grey Code mobile early-warning initiative is presented in the source as an attempt to intervene before violence fully emerges [36]. Such early-warning mechanisms may be important, but they cannot replace deeper systemic reforms.

Is the problem only communication?

Communication matters. Informing patients, explaining triage, reducing uncertainty, and choosing the right words in moments of crisis can reduce tension [2]. But the source is very clear: communication problems are often the visible result of deeper systemic pressures.

If a physician has only five minutes per patient, dozens of people are waiting outside the door, the emergency department is full, relatives have not received information for hours, nurses are insufficient, security is weak, and staff are exhausted, then “better communication” alone cannot solve the problem [2], [10].

The source groups the root causes into several categories. First, the Health Transformation Program increased access but also raised demand, intensified performance pressure, made patient satisfaction a central measure, and changed expectations in the physician-patient relationship [2]. Physician visits rose from 208 million in 2002 to nearly one billion in 2023 [45]. This creates a massive pressure on the system.

Second, workload and time pressure are central. Turkey has a low physician density and a high annual consultation frequency [9], [44], [45]. Short consultation times, sometimes described as falling to five minutes, reduce care quality and make meaningful communication difficult [2].

Third, the perception of impunity lowers the threshold for violence. The source notes that in 2022, only 96 of 494 attackers were arrested, strengthening the belief that perpetrators may avoid serious consequences [10]. Fourth, political or media language that devalues healthcare workers damages social trust [2]. Fifth, the broader social climate of violence, including aggression in daily life, digital lynching, and the normalization of threats, also enters healthcare institutions [2].

Turkey in the global context

Violence against healthcare workers is a global problem. WHO, ILO, and ICN-related data suggest that more than half of healthcare workers worldwide may be exposed to workplace violence when verbal violence is included, with estimates reaching around 62% [8].

Turkey, however, appears to be among the countries with very high rates. The source reports lifetime violence exposure among Turkish physicians around 83-84%, and violence exposure in the previous year at 44.7% [10], [12]. International examples include high rates among family physicians in Germany, emergency workers in China, healthcare workers in India, and emergency workers in the United States [10].

The Turkish context is especially pressured because low physician density exists together with high consultation frequency. Turkey has around 2.18 physicians per 1,000 people, one of the lowest ratios in Europe, while annual doctor consultations per person are above the OECD average [9], [44], [45]. In plain language: many patients, many visits, few physicians, little time, and high expectations. That formula increases the risk of violence.

Effects on healthcare workers

Violence causes physical injuries, but its psychological effects are often more widespread and lasting. Healthcare workers may experience fear, anxiety, anger, helplessness, humiliation, guilt, sleep problems, concentration difficulties, depression, post-traumatic stress symptoms, and burnout [2]. In the Lokman Hekim Health Foundation study, 77% of exposed workers reported shouting, 63% threats, and 58% humiliation [11].

Violence also changes professional behavior. Job satisfaction decreases, institutional commitment weakens, absenteeism may increase, and leaving the profession or migrating abroad becomes a stronger possibility [2], [6], [8]. Physicians may practice defensive medicine by ordering unnecessary tests, avoiding high-risk patients, or making decisions under legal and security pressure rather than purely clinical reasoning [2], [25].

Patients are harmed too

This is not only a healthcare worker problem. When violence occurs in an emergency department, service is interrupted. Security is called, staff must deal with the incident, attention is diverted, and other patients wait longer. If healthcare workers leave risky departments, the profession, or the country because of violence, the system becomes more understaffed [2], [6], [7].

Violence also damages the trust relationship between patients and healthcare workers [2]. Without trust, medicine becomes defensive and mechanical. A physician who fears violence may avoid difficult conversations; a patient who distrusts the system may become more reactive. In the end, violence reduces the quality, accessibility, and sustainability of healthcare for everyone.

What should be done?

The solution cannot be a single measure. Metal detectors alone will not solve it. Communication training alone will not solve it. Legal penalties alone will not solve it. A campaign slogan alone will not solve it. The source argues for a multi-layered strategy.

First, the legal framework must be strengthened. Violence in healthcare should be handled with a comprehensive and deterrent legal approach, and the perception of impunity must be broken [2]. Professional organizations' demand for a specific and comprehensive law on violence in healthcare should be evaluated seriously [2].

Second, White Code must be strengthened. Reporting should lead to transparent, rapid, traceable legal and institutional processes [1], [16], [35]. Workers must know that they will not be left alone after reporting. Early-warning mechanisms such as Grey Code may help before a situation turns violent [36].

Third, hospital security must be risk-based. Emergency departments, psychiatry, night shifts, ambulance services, and crowded outpatient clinics need different safety plans. Trained security staff, cameras, alarms, safer space design, better waiting areas, clear information for patients and relatives, prevention of lone working, and rapid response teams are all important [2], [25], [35].

Fourth, the system load must be reduced. Primary care should be strengthened, staffing should be increased, consultation times should be brought closer to humane and scientific standards, and performance pressure and one-sided patient satisfaction metrics should be reconsidered [2], [9], [44], [45].

Fifth, the public language must change. Political language, media language, and everyday speech should not devalue or target healthcare workers [2]. Health literacy should be improved. Society must understand what triage is, why waiting can occur, why every demand cannot be fulfilled, and why unlawful report or prescription requests are not legitimate healthcare demands [10].

Sixth, support systems for healthcare workers must be strengthened. Psychological support, legal counseling, peer support, institutional follow-up, and post-incident debriefing should be easily accessible [2]. “Get well soon, now return to work” is not an acceptable response to trauma.

Do not normalize violence

The most dangerous outcome is normalization. If insulting a physician is treated as ordinary, if shouting at a nurse is excused, if attacking a security officer becomes routine, and if emergency staff begin every shift by wondering what may happen to them, then the problem is no longer only occupational safety. It becomes a wound in the conscience of society.

Healthcare workers must understand patients' suffering, yes. But patients and relatives must also understand that healthcare workers are human beings, not limitless machines. Medical priority is determined by clinical need, not by who shouts the loudest.

Violence is never a way to seek rights. Shouting at a physician does not speed treatment. Threatening a nurse does not improve care. Attacking security does not fix the system. It only makes an already overloaded system more fragile.

Final word

Violence in healthcare in Turkey is not only an occupational safety issue. It is a social issue connected to the sustainability of the health system, public trust, legal accountability, health policy, hospital organization, media language, and our collective expectations from healthcare.

If healthcare workers do not feel safe, patients are not safe in the long run either. Good healthcare cannot be delivered under fear, threat, and pressure. It requires a safe and respectful environment.

To reduce violence, we must begin with a simple truth: a hospital is not a place to discharge anger; the emergency department is not a space for revenge; the outpatient clinic is not a place for threats; the ambulance is not a target; and the healthcare worker is not a scapegoat for society's anger.

Protecting healthcare workers is, in fact, protecting our own health.