Author: Chesney O’Donnell, Manager, Health Policy and Advocacy team
Royal Australasian College of Surgeons

The threats of violence and extremism motivated by hate have largely been framed through the context of criminal justice and national security. Although these threats have had an impact on hospitals and trauma systems, the effect of these threats on the surgical workforce has not been as widely acknowledged. Surgeons are regularly experiencing the impact of these forms of violence in emergency departments, operating theatres and intensive care units.

On January 15, 2026, the Royal Australasian College of Surgeons (RACS) submitted a response to the Australian Government regarding the Combatting Antisemitism, Hate and Extremism Bill 2026. RACS supports the Bill's intent to prevent harm caused by hate and violence committed by persons motivated by extremist views. However, in order to effectively implement this Bill, RACS believes it is crucial that any proposed actions consider the experience of trauma care and the capabilities of a health care system. 

Surgeons specialising in dermatology, trauma, burns, orthopaedics, Plastic Surgery, Vascular Surgery, ENT, and General Surgery often treat victims of interpersonal violence or those influenced by ideological beliefs. Injuries inflicted by acts of violence motivated by hate cause complex injury patterns—including penetrating trauma, severe bleeding, spinal and brain injuries, burns, disfiguring scars, and long-term disabilities. These injuries require rapid surgical interventions, lengthy periods of treatment in the ICU, and long-term rehabilitation—all of which put an extensive burden on an already overworked medical healthcare workforce.

The submission to this inquiry highlights the impact of hate-motivated violence not only from a criminal perspective, but as a significant public health issue. The violence causes immediate and long-term physical injury, however, the fear created by these violent acts also harms patients and healthcare staff. It may also affect the ability of a healthcare provider to deliver care to patients, cause healthcare staff to leave the profession, make healthcare providers less trusted, and limit their ability to serve their communities effectively. The impact of hate-motivated violence is intensified during an influx of patients to healthcare institutions following major incidents of mass casualty. Healthcare institutions are often overwhelmed and forced to provide care at or above their normal surge capacity.

RACS supports a number of provisions of the proposed Bill including: 
•    an increase in penalties for persons convicted of hate-motivated offenders 
•    the creation of strategies to disrupt online sexual grooming of children to violent extremist groups 
•    amendment provisions aimed at limiting access to high-risk firearms. Reducing access to high-risk firearms and minimising the lethality of weapons would significantly reduce the frequency of catastrophic injuries, the number of emergency surgeries performed, and the level of long-term disability from such trauma.

The submission notes, however, that legislating these provisions alone will not solve the problem of hate-motivated violence. RACS believes that legislation must be implemented in a trauma-informed manner. Therefore, an evaluation framework that evaluates health outcomes along with justice measures must be developed and implemented. Although prosecutions and compliance rates are key indicators of progress, they do not measure whether a given program is effectively preventing severe injuries, decreasing the need for patients to receive an ICU level of care, or providing a safe environment for healthcare workers. Relating the passage of legislation with de-identified trauma registry data would provide a better measure of the overall effectiveness of the legislation.

Australia's trauma system depends on staff trained in a variety of disciplines and trained in other countries, particularly for personnel working in rural and remote areas. RACS believes migration-related components should provide equal opportunity for all individuals, regardless of race, religion or ability level, to obtain jobs they are qualified for. These components must also avoid unintentionally disrupting much-needed trauma services or creating an unsafe environment for communities.

Finally, RACS’ submission also expresses the importance of safeguarding valid professional development and research initiatives. While many individuals must experience traumatic events in order to become qualified for trauma training programs, we know from experience that graphic images or injury mechanisms can help prepare them for this work. These visual materials enhance their ability to intervene calmly during medical emergencies and perform their jobs effectively.

RACS knows surgically at the firsthand what it is like to experience the effects of hate and extremism. Our submission supports creating practices that not only hold individuals accountable for their actions but also actively work to prevent harm to patients and staff. It also advocates for fostering a trauma surgical system in Australia that increases the capacity to provide high quality trauma care.

RACS would like to thank our president, Professor Owen Ung, Bi-National Trauma Committee, NSW Trauma Committee, Health Policy and Advocacy Committee, and the Professional Standards Committee for their engagement in this process. 

Read submission.