❝Gun violence is bleeding health systems dry. WHO leadership is overdue

Gun violence kills not only through bullets, but through displacement: cancelled surgeries, exhausted and traumatised staff, depleted blood supplies, and health systems pushed into permanent crisis mode.

Every gunshot wound sets off a chain reaction. Emergency medical services are diverted. Operating theatres are reprioritised. Intensive-care beds fill. Rehabilitation services are stretched. Mental-health providers confront trauma. Other patients wait, and some never receive the care they were meant to have.

The harm of a single shooting extends far beyond the person who was shot, quietly claiming lives that will never appear in gun-death statistics.

As global federations representing millions of nurses, social workers, and public-health professionals worldwide, the World Federation of Public Health Associations and the International Federation of Social Workers have joined more than 100 organisations in endorsing the Call to Action issued by the Global Coalition for WHO Action on Gun Violence. This call is also informed by the lived experience and professional insights of the world’s nursing workforce, represented globally by the International Council of Nurses (ICN), whose members are often on the front lines of responding to firearm-related injury and trauma. We are not asking the World Health Organization to step outside its mandate. We are asking the organisation to fulfil it.

Effective responses to firearm violence do not stop at emergency care. Prevention and recovery depend on strong community-based and social services, including social workers, health professionals, counsellors, and survivor-support organisations. Where these services are integrated into health systems, the continuum of care is stronger, from prevention and early intervention to trauma care, rehabilitation, and long-term healing. Where they are not, cycles of harm deepen.

Firearm injuries are consistently more severe, more resource-intensive, and more costly than other forms of trauma. Research from multiple regions illustrates the scale of the burden. In the Caribbean, treating a single firearm injury has been shown to cost between two and eleven times annual per-capita health spending. In Brazil, a firearm-related hospitalisation costs at least 3.2 times more than the federal per-capita healthcare expenditure. In the Western Balkans, the cost of a single firearm-injury admission exceeds an entire year of per-capita health spending.

These figures capture only direct medical costs. They do not account for lost system capacity, long-term disability, or the cumulative toll on health workers and services stretched beyond safe limits.

That toll is increasingly well documented. Research among ambulance workers in South Africa, community social-service staff after mass shootings in the United States, and emergency nurses in Australia and Canada shows elevated rates of post-traumatic stress, burnout, depression, substance use, and workforce attrition among those repeatedly exposed to firearm violence.

In already strained systems, these pressures translate into fewer skilled professionals, poorer continuity of care, and weakened public-health infrastructure, precisely in the communities where needs are greatest.

More than two decades ago, the World Health Organization’s 2002 report on violence in the workplace in the health sector recognised that health-care workers face specific dangers from “patients with firearms and convicted criminals attacking the staff”, as well as from gang violence spilling into hospitals.

Despite the impact of gun violence on health workers, the WHO has failed to treat gun violence as a priority.

New research undertaken by the Global Coalition for WHO Action on Gun Violence highlights a striking gap. Among more than 3,200 World Health Assembly resolutions adopted since 1948, not one explicitly mentions firearms. The research also documents a steady decline in attention to gun violence within WHO publications and technical frameworks.

The WHO’s limited attention to firearm violence reflects political constraints, competing global health demands, and insufficient staffing, not indifference among the professionals working inside the organisation.

Firearm violence sits at the intersection of multiple WHO priorities that are already recognised but insufficiently connected. Guns are central to violence against children through direct injury and exposure to community shootings. They are a leading cause of violent death among adolescent boys in several regions. Firearms are also deeply implicated in violence against women, dramatically increasing the lethality of intimate-partner violence and femicide. Men, particularly young men, bear the brunt of public gun violence as both victims and perpetrators, with devastating consequences for families, services, and social cohesion.

These realities demand that the WHO integrate a strong focus on firearm violence into its existing research, frameworks, and guidance to Member States.

The WHO also has a critical role to play in strengthening the evidence base that informs laws and policies to reduce firearm-related harm. Reviews of firearm legislation across multiple countries consistently find that stronger regulatory frameworks are associated with lower rates of firearm violence.

The WHO’s comparative advantage is prevention: setting norms, consolidating evidence, supporting health-system responses, and addressing the social and commercial drivers of harm. Where the WHO has led, on tobacco, road safety, alcohol harm, HIV, and maternal health, countries have followed with evidence-based action.

Gun violence is preventable. The evidence exists. What is missing is global health leadership. The World Health Organization can, and must, help turn the tide.

Dr. Bettina Borisch is a physician, histopathologist, and global health scholar serving as director and head of the World Federation of Public Health Associations. Her work as a professor at the University of Geneva spans neoplastic disease of the immune system, breast cancer, community oncology, and health communication.

Pascal Rudin is interim secretary general of the International Federation of Social Workers and a research fellow at the University of Stellenbosch. He holds a PhD in social work and degrees in engineering and business administration. His work focuses on social justice, ethical practice and strengthening social and health systems.

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