ICN’s report to UN Special Rapporteur highlights need to protect nurses as critical human rights defenders

In a report submitted to the UN Special Rapporteur on the Right to Health, the International Council of Nurses (ICN) presents strong evidence of nurses' fundamental role in defending the right to health worldwide and the enormous challenges they face. The submission combines evidence from ICN’s published reports with direct testimony from national nursing associations gathered through the #NursesforPeace campaign as well as recent interviews and conversations with nurse leaders in conflict-affected regions undertaken by ICN’s CEO Howard Catton and ICN’s Humanitarian Liaison Officer. ICN’s full report can be read here.

Submissions will be used to inform the Special Rapporteur’s June 2025 report to the Human Rights Council on “health and care workers as key protectors of the right to health”.

Howard Catton, ICN’s CEO, remarked: “Our submission to the Special Rapporteur makes nurses’ experiences and voices heard, with firsthand accounts from nurses who are safeguarding health amid the unique challenges of conflicts and crises. ICN’s report shows that while nurses are crucial human rights defenders, they are being systematically undermined by inadequate workplace protections, chronic underinvestment, and violent attacks on health facilities.”

Inadequate working conditions and unfair treatment

ICN’s report raises the alarm on widespread patterns of poor working conditions facing nurses around the world.

Mr Catton said:

“ICN’s submission provides clear evidence that nurses routinely face substandard conditions, insufficient compensation, excessive working hours, and severe understaffing, based on ICN’s research. We are also seeing a dangerous lack of workplace protections for nurses and other health care workers. ICN reported on these issues during the pandemic, with health personnel disproportionately affected by the virus but not provided with adequate Personal Protective Equipment (PPE), mental health support, and compensation—and we are continuing to see nurses consistently undervalued and under protected in these ways. As we highlighted in our submission to the Special Rapporteur, this is pushing our profession to breaking point, with rising levels of burnout, mental health concerns, industrial action, and nurses leaving their jobs. These critical issues contribute to the nursing shortage that is now a global health emergency, threatening the right to health for populations worldwide.”

ICN’s submission also notes that nurses, women, and gender-diverse persons in the health care workforce receive less pay, lower status jobs, fewer leadership roles, and are more likely to face workplace violence and harassment and highlights the importance of gender equity and for support for older persons within the health workforce. In the report, ICN also stressed the need for a regulated professional health workforce to protect the right to health and documented the harmful effects of excessive reliance on unregulated workers, such as community health workers, who may lack formal training, which can significantly impact patient safety and strain health systems.

Attacks on health care workers and insufficient crisis protections

ICN’s report emphasized the urgent need to protect healthcare workers in conflict zones. Reinforcing its #NursesforPeace campaign and humanitarian advocacy, ICN condemned increasing attacks on health facilities and reiterated calls for all health personnel to receive the protection owed to them under International Humanitarian Law.

“Our report provides firsthand testimony from national nursing associations in crisis-affected regions which indicate a devastating failure to protect health care workers,” Mr Catton stated.

‘We included accounts from colleagues in Nigeria reporting unsafe working conditions, including being sent without their choosing to dangerous, insecure regions in the north of the country. We also shared reports that unprecedented numbers of nurses have been killed and injured on duty in Gaza, with ~200 nurses and doctors detained without trial and with no news of their safety or whereabouts. Gaza’s nurses are continuing to work though they have received no salary and face extreme food insecurity. ICN’s submission also highlighted the conditions reported by nurses in the West Bank, who describe workplace harassment by the army entering into hospitals and disrupting their work, administrative blocks preventing them from being paid their full salary, and army roadblocks which significantly delay them arriving to work. Meanwhile, nurses in Lebanon’s red zones report poor working and living conditions, displacement and high nurse unemployment due to destruction of hospitals. Health workers in conflict zones are losing faith in International Humanitarian Law to protect them and allow them to carry out their life-saving work protecting health, which requires urgent attention from the Special Rapporteur and Human Rights Council.”

Barriers to providing and protecting health care

ICN’s report also documents direct observations from nurses who witness and experience severe obstacles to delivering care, including chronic under-resourcing of health systems, exclusion of refugees and migrants from health services, and legal policies and frameworks that restrict certain health procedures, such as abortion, or fail to enable advanced nursing practice.

For instance, following the war in Sudan, nurses report the destruction of their health system during the war there, with health infrastructure in a state of collapse and a lack of electricity and essential equipment, including PPE, and consumables necessary to prevent and control infections. South Sudanese nurses also describe harsh conditions and shortages of equipment, supplies and essential medications, with families of children at paediatric hospitals often forced to buy basic items themselves. Meanwhile, Afghanistan’s nurses report severe financing obstacles to health care, including international freezes on funding, and specific barriers to health care access for women who are not allowed to show any part of their body or face to a male health worker.

Additionally, ICN’s submission includes testimony from Mauritania’s nurses concerning vulnerable internally displaced persons and migrants who are unable to access care, including individuals displaced by the climate crisis and transitory migrants without registered refugee status. Turkish nurses also report unregistered migrants and refugees excluded from existing health services due to their lack of legal status as well as migrant workers within Turkey who do not have access to health care or adequate hygiene or sanitation when outside of their region.

Nurses defending the right to health

“Despite the enormous challenges they are facing,” Mr Catton stressed, “nurses worldwide continue to fight to protect the right to health every day by providing care, advocating for health equity and health-promoting policies, and working to dismantle barriers to access.”

ICN’s report highlights several examples of nurses advancing health care access, including New Zealand’s nurses addressing health disparities facing Māori and Pacifica communities while strengthening disaster preparedness and India’s nurses expanding access to care by leading community health and wellness centres.

ICN also documented testimony from nurses playing a vital role as first responders, coordinators of crisis care and advocates for vulnerable populations in conflicts and crisis, often at great personal risk. This includes nurses in Somaliland, who have volunteered to work in conflict-affected border regions where women face increased gender-based violence and healthcare access is severely limited. Nurses in Ethiopia's Tigray region continued providing care despite going unpaid during the civil war while facing severe food insecurity themselves, and Gaza's nurses have also continued to work long hours without compensation amid extreme hardship to maintain access to essential health services.

Mr Catton added: “The examples we documented show that nurses play a vital role as human rights defenders, but often without the support and security they need and deserve. ICN appreciates the opportunity to contribute to the Special Rapporteur's investigations and calls for strengthened support for the nursing profession. If we want to protect the right to health, we must protect and invest in health care workers.”

The Special Rapporteur’s thematic report on health and care workers as key protectors of the right to health will be presented to the Human Rights Council, 59th Session, in June.