Security guards patrol Sir J.J. Group of Hospitals in Mumbai. Doctors in India say that their medical residents and others have been subjected to a series of attacks by angry patients and their relatives in recent years, prompting new laws and security measures at medical facilities. (Annie Gowen/The Washington Post)

On the closed-circuit tape, the young resident doctor works on his computer in a hospital ward as a patient and two men approach. The patient, who police say was frustrated by delay in treatment, confronts the doctor, hitting him and then picking up a nearby chair and bringing it sharply down on his head.

The late April incident in a city in the western state of Maharashtra is one of a growing number of attacks on doctors in health-care facilities in India by patients or their families unhappy with the quality of care. The trend has prompted strikes by health-care workers throughout the country and calls for new laws and greater security in emergency rooms and intensive care units.

Some doctors have sought permission to carry guns.

Last week, young residents in the eastern state of Bihar went on strike after an altercation over a patient death — a walkout that quickly spread to other facilities around the state. More than 20,000 doctors in New Delhi went on strike in June to demand better working conditions and security, temporarily shuttering hospitals and delaying surgeries.

In January at Maulana Azad Medical College in New Delhi, doctors who had treated a pregnant woman who died from respiratory failure were attacked by a mob of about 50 of her relatives, who threw chairs, saline bottles and equipment at them, doctors said. Terrified staffers avoided the melee by locking themselves into a nearby room until help arrived.

Attacks against doctors are on the rise in India. Experts say that many people are frustrated about rising  health care costs and low quality health care. (Video courtesy of the Maharashtra Association of Resident Doctors)

To combat the violence, one group of doctors working in small private hospitals in Maharashtra has hired a security team, and after the April attack, an association of medical residents asked the state for licenses to carry firearms in government hospitals.

“We do not have adequate security, so we are saying we need to be armed,” said Sagar Dilip Mundada, president of the group, whose members have been involved in 90 altercations since 2013.

Since 2007, 18 Indian states have passed laws protecting doctors and health-care workers from attacks, but more needs to be done, said K.K. Aggarwal, the general secretary of the Indian Medical Association. The group is pushing for a nationwide law to curb workplace violence in health facilities.

Three out of 4 doctors in India have reported some kind of verbal or physical abuse in the workplace, according to an Indian Medical Association survey, with more than half of those assaults occurring in intensive care wards and surgical units involving families or other escorts of patients. The confrontations are often sparked by a sudden, unexpected death, a delay in providing care, denial of admission due to overcrowding or allegations of abuse or negligence by staff.

Experts say that dual forces are driving the increase in India, a country that spends only about 1 percent of its gross domestic product on public health, far less than many other countries.

Those in the emerging and Internet-savvy middle class are paying more for health care and turning to private and corporate hospitals — raising expectations, sometimes unrealistic, about the standard of care.

Salma Begum, left, and her husband, Meraj Qureshi, whose 3-year-old son Abu Sufian died from complications of dengue in September. (Annie Gowen/The Washington Post)

The country’s poor are increasingly fed up with India’s fraying and overcrowded government hospitals, where drugs and supplies are often in short supply
and the doctor-patient ratio is
1 to 11,500, according to last year’s National Health Profile.

“The expectation levels have gone up exponentially,” Mundada said. “If the doctor is not able to save the patient, they blame the doctor.”

Resident doctors are so overworked — with 18- to 20-hour workdays commonplace — they have little time to adequately counsel family members of a patient, even in the case of a life-threatening emergency, he said.

Khushal Sharnagat, 25, a ­second-year pediatric resident at King Edward Memorial Hospital in Mumbai, was treating a gravely ill 3-year-old boy suffering from dengue last September when four relatives of the boy stormed past guards and attacked him and two colleagues with wooden sticks and a metal stool. The men were eventually arrested, but the episode left Sharnagat shaken.

“Is it because of frustration they were beating us? Is it because they were losing hope?” he wondered. “At that time, they became angry and they were blaming us.”

In a small home in a crowded lane in Mumbai’s Govandi slum area, Meraj Qureshi, 32, a garage mechanic, and his wife, Salma, 30, are still mourning the death of their boy, Abu Sufian.

They say they had taken Abu Sufian to the hospital when he began vomiting earlier that day. They say he was feeling fine, sitting up and asking for a glass of water, before he was given an injection that sparked breathing problems. Sharnagat denies this and says the boy was treated
with antibiotics and intravenous fluids.

“According to us, doctor is next to God,” Meraj Qureshi said. “But in this case, we lost a child due to negligence.”

After the incident, Mundada said, the state medical education ministry installed 500 closed-
circuit security cameras in government teaching hospitals throughout the state. Although security has been beefed up at K.E.M. Hospital, he said, additional security guards promised for other facilities have yet to materialize.

Naazma Siddiqui and Farheen Fatima contributed to this report.