International Council of Nurses Virtual Congress

Esteemed colleagues,

As a fellow healthcare worker – and as the United Nations High Commissioner for Human Rights – I am delighted and honoured to address this Congress.

Thank you – for your tireless efforts in the face of much adversity, particularly in this very challenging period. Your work is an inspiration to me.

Thank you – for taking up the cause of gender equality and women’s empowerment, issues that are inextricably linked to the rights of nurses, and which are crucial to many other sectors of the economy and to all societies, everywhere.

Thank you – for promoting human rights through your advocacy and example.

Thank you – to those of you who, from Afghanistan to Myanmar, from Ethiopia to Ukraine, from Yemen to Haiti to Vanuatu, are first to respond when communities are hit by conflict or disaster.

When hospitals are deliberately targeted by bombs and missiles. When clinics are swept away by flooding. When medical services become so overstretched that beds only become available if someone dies. When life-saving supplies, such as oxygen, run out, and equipment is looted, while needs increase. When you are pushed into circumstances that also place your own lives and rights at risk – we see your courage. Your determination. Your commitment for principles. Your defence of human rights.

And no words can suffice to express our thanks to each one of you.

It has been five years since the UN Security Council adopted Resolution 2286 on the protection of medical care in armed conflict. But your work still puts many of you at risk.

And for all of you, COVID-19 has exacerbated the challenges of your work.

The pandemic has taken the many fractures that exist between and within our societies – including in our health systems – and has gouged them deeper.

It has magnified the impact of structural inequality and discrimination in our societies.

It has been fuelled by our societies' failures to eliminate structural discrimination and provide adequate protection of human rights, for everyone.

It is creating a legacy of massive development setbacks, unmet needs in health, including in mental health; damaging gaps in education; loss of jobs and financial insecurity.

And it has taught us, very clearly, that robust, resilient, and inclusive health systems which are grounded in human rights are not only vital goals in themselves – they are key levers to build resilient, fair, equal and successful societies.

This is a lesson that every decision-maker needs to learn: universal health coverage is not a cost, a debit item – it is an immediately effective investment in development, peace and well-being.

My esteemed colleagues,

While health systems have many components, skilled nurses on the frontlines are without question among the most essential factors. Without them, no one can get the care they need.

Yet they continue to face many challenges. And as we know, this is a highly gendered reality, with women the majority in the nursing workforce. And despite their importance to health care, nurses are frequently underpaid and disregarded – their views, needs and rights neglected.

For many years nurses and healthcare workers have called for governments to respect their international human rights obligations and national commitments.

They frequently suffer human rights violations at work – discrimination; unsafe and unhygienic working conditions; unequal and insufficient pay; harassment, mistreatment and abuse.

In some countries, nurses, health care workers and facilities are deliberately targeted because they provide life-saving services, including for sexual and reproductive health and rights.

The pandemic has been generating increased workloads, insufficient time for rest, and inadequate wages.

It is well past time for leaders to address the need to support good jobs for nurses and health workers – through adequate remuneration and social security; healthy and safe working conditions; work-life balance; freedom from discrimination; and meaningful participation in the decisions that affect their work and lives.

Nurses in all their diversity are entitled to protection of their rights, and to justice and effective remedy when they are wronged.

It is vital that leaders of every society and health-care system acknowledge and support the critical importance of nurses and healthcare workers to the fulfilment of everyone’s human rights. This means more resources for the health sector; better working conditions with decent wages and equal pay for work of equal value, and an end to gender inequalities and discrimination in the health workforce.

My Office, together with relevant partners, is developing tools to make universal health coverage possible in practice.

We also advocate for a workplace free of harassment. We collect information and we provide guidance and support for a coordinated and firm UN response.¹ Healthcare workers that disclose allegations of wrongdoing should be effectively protected from intimidation and retaliation.

Across the world, we also emphasise that the right to the highest attainable standard of health applies equally to nurses and healthcare workers. Governments must ensure access to all aspects of health, including mental health and psychosocial support services, for all, including healthcare workers.

We work with health systems and health workers to advance a human rights-based approach, which recognizes that nurses are fully entitled to have their human rights respected – and that they can, and should, help to uphold the human rights of others.

For example, in Uganda, we work with the Ministry of Health, health care workers, local communities and a range of UN bodies to promote human rights-based approaches in the provision of sexual and reproductive health and rights, including HIV health care services, while identifying and eliminating stigma and discrimination that affect women and key populations living with HIV.

I encourage you to consult our “Reflection Guide” for health workers, co-authored by my Office, which aims to raise awareness of how human rights promote health services free of all forms of stigma and discrimination.

Empowering health-care workers as human rights defenders can prevent human rights violations occur in the care of patients. It also promotes and protects the rights of healthcare workers, reduces power asymmetries, contributes to decent working conditions and builds a climate of respect.

This brings me to a critical point that connects both gender equality and the rights of nurses and healthcare workers: participation and leadership.

Initiatives such as this congress are key to building our forces for this central issue. Solidarity and sisterhood are critical to face the discrimination, resistance and even hostility that women often face in healthcare settings – especially in decision-making spaces and when assuming positions of power.

You, who are fully aware that your work protects rights and saves lives every day, know how vital it is that we dismantle the deeply rooted inequalities, discriminatory social norms and gender stereotypes that obstruct our initiatives and seek to silence or ignore our voices. And deny our stories and experiences.

Our struggle for equality has made powerful progress in many respects. Today, over 140 States guarantee gender equality in their constitutions; legal frameworks and policies to address gender-based violence have been put in place in virtually all countries; child marriage and maternal mortality have declined globally; women and girls’ access to health care and education has increased considerably, as has the percentage of women in paid jobs; in fact, in many professions once inaccessible to women, they now hold leading positions.

For instance, in 2017, almost half of all doctors in OECD countries were women.

But although women hold around 70% of jobs in the health workforce globally, almost 70% of the world's health organizations are headed by men. Only 20% have gender parity on their boards, and just one quarter have gender parity at senior management level.

Addressing gender inequality in the health workforce must be a priority – because health systems will be stronger when women have an equal say in the design of national health plans, policies and systems. And because better health systems build stronger economies and better, fairer and more equal societies.

That is why, now more than ever, we must continue to press forward for gender equality.

It is time – it is well past time – for governments to address these crucial issues with concrete and focused leadership.

Nurses and health-care workers, in all their diversity, must have a full and equal seat at the table in reforming policies and designing and implementing health responses – for the benefit of everyone.

I view your work as essential to human rights. And I praise, thank, and support you for caring for your patients and their rights – and for working to build stronger and more resilient and equal public health systems for your communities.

I and the United Nations stand with you in your work.