Government health workers in South Africa have to watch their patients die of preventable causes — often due to a lack of equipment and understaffed health facilities — because they’re banned from speaking out about their working conditions, a report of the Campaign for Free Expression found.

The Public Service Rules and Regulations prevent state health workers from speaking to the media — they are only allowed to raise issues internally, regardless of the public interest, or else they face disciplinary action.

The researchers interviewed public health workers and reviewed legal frameworks, international guidelines on human rights and media reports.

Researchers argue the “growing” attempt to silence government health workers point “to efforts to cover up maladministration, corruption, and the violation of human rights emanating from the  government’s failure to provide basic healthcare services to the public.”

Some health workers told them that when they try to raise their concerns, hospital managers harass and intimidate them, and because whistleblowers aren’t protected they simply keep quiet.