Nursing ethics in times of conflict and crisis

There is little doubt that the world is going through trying times. Throughout the world we find conflict, violence, and instability on scales that are difficult to comprehend; we find indifference from governments for the rights and welfare of their citizens. We see growing polarisation and unrest on the streets, with fault lines becoming increasingly visible. At the same time, public discourse has become increasingly polluted by misinformation and disinformation, eroding trust in institutions, expertise, and even healthcare itself. Those seeking to help are increasingly caught in the crossfire. Nurses and other healthcare workers have not been spared. In Gaza, the scale of violence directed at those providing care has been vast. The World Health Organization has documented over seven hundred attacks on healthcare workers and facilities since October 2023, with well over a thousand health workers killed or arrested, alongside entire hospitals destroyed. 1 Nurses have been amongst those targeted; shot while working in hospitals, killed in airstrikes and arrested. In Sudan, health facilities have been destroyed amid ongoing civil war, with healthcare workers forced to flee or provide care in the ruins of what were once functioning hospitals. 2 None of this is new, nor is it isolated to the last few years. In 2021, following the military coup in Myanmar, nurses and doctors led a civil disobedience movement. Healthcare workers walked out of military-controlled hospitals in protest, refusing to work under military rule and setting up parallel health systems, pop-up clinics and clandestine care networks. They did so at enormous personal cost; nurses were arrested, imprisoned, and in some cases killed for their participation in the resistance. 3 Going back further, the targeting of healthcare workers in conflict has a long and deeply troubling history. In the years preceding the COVID-19 pandemic, attacks on health facilities were already increasing globally, a trend that has only accelerated in the years since. 4 These issues are not only found in places of conflict or crisis, but they also pervade places of 'routine' care. In the United States, for example, it was recently estimated that two nurses were assaulted every hour, a figure that equated to over 20,000 assaults in 2023 alone. 5 Nurses have not only been the targets of violence; they have also been amongst those willing to act in its midst, to resist, to protest, to put themselves in the way of injustice. Take the example of the Seeds of Hope, a