TEMPO/Muhammad Hidayat

Unprotected, Overworked, Ailing Indonesian Health Workers Face Avalanche of COVID-19 Cases

Amnesty International Indonesia is deeply concerned that health workers in Indonesia do not have adequate protection despite reports of rising cases in the world’s fourth largest country.

The organization made the statement after the Jakarta administration revealed on September 9 that the city’s hospitals would be overwhelmed with COVID-19 patients within the next few days if it failed to reduce the rate of daily infection in the capital, which is currently the epicentre of the pandemic in the country.

According to the Jakarta administration data, the city has 4,053 hospital beds that are expected to be fully occupied by September 17, while the number of patients in need of beds continues to grow and is expected to reach 4,807 by October 8. The data also shows that the city now has 528 intensive care units (ICUs), while the number of patients in need of the health facility is expected to reach 636 by September 15.

Indonesia is among the countries with the highest number of health workers who have lost their lives to COVID-19, with 188 deaths recorded as of September 8, according to Amnesty International Indonesia monitoring.  

Amnesty International warns that the failure on the part of the government to fulfil the rights of health workers will lead to more deaths, and further reduce the capacity of the nation’s health system to treat COVID-19 patients as the pandemic grows. According to a study conducted by Nanyang Technological University (NTU) and the LaporCOVID19 (Report COVID-19) community, Indonesia’s health care system will collapse by the end of this year should the government fail to implement strict preventive measures.

“The death rate among health workers has risen significantly. In July, when Amnesty International released the global report on health care and essential workers, a total of 89 health workers had died of the disease. The number has doubled since then,” says Usman Hamid, the Executive Director of Amnesty International Indonesia.   

“Their right to life, and health have been denied. We urge the Government of Indonesia to take serious actions to ensure the safety of the medical workers.”

Health workers have also experienced stigma and violence because of their work. The chair of the Indonesian Nurses Association (PPNI), Harif Fadhillah, said people are afraid that medical workers can transmit the virus. Unable to find accommodation, some medical workers have been forced to live at the hospital.

Exposed to a deadly disease, silenced by a ‘culture of secrecy’

The lack of transparency or ‘culture of secrecy’ at Indonesian hospitals has deprived medical workers and staff of an effective complaints mechanism or a safe space to channel their grievances, particularly in regard to the availability of good quality PPE and the efficacy of health protocols at health facilities, which are extremely crucial for their safety.

According to the Indonesian Medical Association (IDI), there is still a shortage of PPE for around 185,000 doctors and around 1 million nurses in the country.

The slow distribution of PPE is not keeping pace with the vast increase of COVID-19 cases in Indonesia. The slow distribution process of PPE in various regions is putting health workers at risk. In one case recorded in Flores, Eastern Indonesia, a doctor claimed that doctors there needed to wash and iron disposable surgical masks and re-use them since they had run out of stock.

A September 7 report by Tempo magazine revealed that the government had ordered 5 million items of PPE from a consortium of South Korean companies, but decided to halt the purchase for the last 2 million items following the discovery by the Development Finance Comptroller (BPKP) of pricing irregularities in the procurement process. The agency, according to the report, suspected that the government had paid in excess of Rp 666 billion (US$44.7 million) for the purchase of the first 2 million PPE and Rp 48 billion for the next 1 million PPE.  

A senior health worker who declined to be named due to fears of reprisal told Amnesty International Indonesia that the health facility he works at has sufficient personal protective equipment (PPE) but the quality is not up to standard and is thus unable to provide them with the protection they need. That not all COVID-19 patients are being honest about their disease due to fears of stigma has made medical workers, even those who are not in the frontline, even more vulnerable to infection, he said. 

He also reported that some health workers are still working even though they may unwittingly be carrying the virus as the country still lags begins with its testing drive.

“The cost for swab tests for health workers is still very high. Some hospitals are still refusing to pay for the screening test of their employees,” said the source, who works with COVID-19 patients. Several hospitals have charged IDR 2.5 million (USD 168) for one swab test (PCR), forcing the government to set the price of a PCR test at a ceiling of IDR 500,000 or USD 33,65.

He added: “Hospitals often cover up [COVID-19 cases in their facilities]. So when one health worker is infected, others will get infected too.”

Samples of blood from rapid tests held at Siloam Hospitals, West Jakarta, August 2020. Source: TEMPO/M Taufan Rengganis.

Aside from the risk of contracting COVID-19, long working hours, psychological distress, and fatigue are also of great concern for medical workers. Dr. Mohammad Adib Khumaidi, the Deputy Chairman of the Indonesian Medics Association (IDI), who also treats COVID-19 patients, argues that long working hours due to the insufficient number of health workers in the country has taken a toll on medical workers during the pandemic. With a population of more than 270 million, Indonesia has 0.13 specialist doctors per 1,000 people, according to the National Development Planning Agency (Bappenas).

The PPNI has expressed concerns regarding the lack of transparency at health facilities. “Doctors have yet to conduct a comprehensive inquiry into the deaths of medical workers. They are not easily provided with access to the hospitals,” said the chair, Harif Fadhillah. “We suggest that the government sets up an investigative team to understand the causes of transmission and deaths [of the doctors and nurses] so that we can take preventive measures.”

“For the sake of public health”

Amnesty International supported the call made by PPNI, saying that the government needs to take drastic measures to ensure the safety of the health workers.

‘An investigation into the deaths of health workers is urgently needed, as are strong and consistent measures to protect the rights of all medical staff. This includes giving them access to testing, protective equipment, adequate sick pay and a secure way to raise complaints so they can protect themselves and their patients. Their safety is extremely important in order to uphold their rights and for the sake of public health,” Usman said.

Amnesty also calls on the government to make the PCR tests free for health workers. Early prevention by complimentary regular monitoring of the virus for those on the front lines is crucial to contain transmission within health facilities. This measure is essential for safeguarding public health.

Background

The right to health is protected under the International Covenant on Economic, Social and Cultural Rights (ICESCR), ratified by Indonesia through Law No. 11 of 2005. The ICESCR requires state parties to achieve full implementation of the right to health, including with regard to “prevention, treatment and control of epidemic, endemic, occupational and other diseases.”

The ICESCR also obliges the state parties to utilize “technical assistance and cooperation of the WHO” when formulating their national health strategy. The WHO has published a series of guidelines to prevent and control infection during treatment and there is the possibility of novel coronavirus (nCoV) infection.

Moreover, the ICESCR also protects the right of everyone to the enjoyment of just and favourable conditions of work which includes safe and healthy working conditions.

The duty to use adequate PPE is also regulated under national law. Article 164(1) of the Health Law emphasizes the importance of the health of medical workers, addressing their right to enjoy good health and to be free of health disruptions.

With regard to the right to health, Law No. 1 of 1970 on Occupational Safety requires that the safety of workers and heads of workplaces must be protected. The Health Law also states that a responsible institution or organization is obliged to perform a continuous physical, mental, and medical examination for its workers following the nature of their occupation.