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Case Study 1: St Thomas

Updated: Feb 15, 2020

We will be putting together some case studies to explore what we mean by better action design and mitigations. This involves in part looking at where XR actions have had unintended consequences, and what can be learned.


Doing XR Better starts from the belief that non-violent disruption is essential to push action on climate crisis, that we’re already in an emergency and the effects of the crisis unchecked will disproportionately impact vulnerable groups. But that we still need to plan our actions so that they don’t push people already struggling underwater; that our movement takes everyone with us in a just transition rather than building a world only for the abled and well. We talk more about why this is important here.


Case Study 1 is looking at access to St Thomas hospital in the October 2019 uprising. This two week action targeted Parliament and the west bank of the Thames, initially closing Lambeth and Westminster bridges. On the east side of the Thames between these bridges is St Thomas’ Hospital and the Evelina Children’s Hospital. Inevitably, public access to the hospital became an issue throughout the uprising. Whilst it is absolutely the case that roadblocks stepped aside for ambulances, there were significant knock on effects for those trying to reach the hospital by public transport or by themselves. We discuss why access to hospital is a disability issue, and why it’s profoundly disablist to assume that it’s only life or death if someone is travelling in an ambulance here. This was a much bigger issue than in other disruptive actions as a result of the proximity to the hospital, which did not appear to have been specifically planned for at any level.

On the first Monday of the uprising, there was a bomb scare on the east side of the river which meant that both sides of the river and almost all access to St Thomas was heavily shut down. There was initial confusion, as people encountering police roadblocks as a result of the bombs assumed this was also part of the XR protests. Large numbers of stories of ill people unable to reach hospital, in some cases seriously so, flooded twitter and local news.

It also became apparent that people trying to reach the hospital, especially those travelling by public transport, could not get accurate information as to which routes were open. Google maps, the TFL website and the automatic displays at bus stations were all giving incorrect advice at different points, leading to some people trying multiple routes while in significant pain and eventually giving up in despair. There were large queues forming at out of service bus stops near the hospital where routes had been changed around the protest. However no notifications had been put up at the stops and the electronic timetables were still showing buses imminent that would never arrive.

The reaction in disabled activist groups and amongst some disabled members of XR was wholesale betrayal. The perception was that disabled lives were considered a price worth paying, that primarily affluent and able-bodied activists didn’t care or understand how significant a delay in hospital access could be. XR spokespeople appeared caught off guard, leading to some tone-deaf and ableist off the cuff responses that reinforced the impression that XR hadn’t planned for or considered the hospital proximity.

Mitigation - taking action in the thick of it

As well as being active on the ground in the October rebellion, we realised as soon as we became aware of the problem that we also wanted to do what we could to address the issues around hospital access. XR does not have leaders - “we are all crew” is a mantra of the movement. If you see a problem it’s everyone’s responsibility to do something about it. This is what we did. This is a fairly minor example of a mitigation - we’re not saying in any way that it “solved” the problem, rather that it’s important to acknowledge unplanned side effects, do what you can at the time and later, look at ways that the movement could do better next time.

After the chaos of the Monday bomb scare, it became apparent that lack of accurate information was still a major factor in making it difficult for people to get to hospital around the protests.


  • Remote rebels who were not at the front-line started cross-referencing the different sources of online information to get as accurate a picture as possible of the changing transport provision to and from the hospital. There was no central source where all this data could be found up to this point.

  • An up to date summary of the info from multiple sources was put online, and kept up to date in real time as further information came in.

  • A twitter handle @xrstthomas was set up, to direct attention to the online summary, keep track of new access issues as they arose in real time on twitter and reach out to anyone struggling with access information

  • Rebels on the ground at the protest fed information back to the remote team about road closures and bus routes

  • When it became apparent that there was no information at the bus stops that had been closed due to route redirection, the online team were able to direct Rebels on the ground to the closed stops so that they could put up notices directing travellers to the nearest functioning stop

  • On the Monday there had been reports of people needing to access the hospital turning up directly at the roadblocks, which were unprepared for this eventuality. We explored the possibility of getting a Rickshaw to the site and using this to provide transport to those in need across the protest site. We did not eventually follow through with this as it became apparent both that the demand was much reduced after the Monday, and that the Police were highly likely to immediately confiscate any large vehicle entering the site.

What could be done better with planning in advance?

Potentially, consideration of sites taken to minimise access issues while still holding Parliament and governmental buildings on the west side of the Thames - the core objective of the uprising. Disruption could be caused by “away” actions located further from the site hospital, as indeed occurred successfully on many occasions.


It was extremely clear that the proximity to the hospital either hadn’t been considered in action design, or hadn’t been well communicated. The October Uprising was undertaken by activists from all across the country - the key thing is that the vast majority were not London locals and did not have local knowledge. Highlighting the proximity of the hospital would have given the autonomous sites - and rebels on the front line at roadblocks - a chance to plan accordingly.


XR Spokespeople appeared initially caught out by the proximity of the hospital and therefore the extent to which it was a live issue in the coverage. This led to a number of off-the-cuff responses which caused huge pain within the Disabled communities - “anyone who misses an appointment can just reschedule”. XR Spokespeople are volunteers doing a difficult job who were put on the spot - but with better advance knowledge could have given a better answer.


The mitigations that we were able to undertake in terms of finding and helping people struggling to access the hospital would have been far more effective if we had been able to advertise from the start that we were providing these services - if we had known they would be needed! For example if XR Spokespeople had been able to broadcast this in interviews it would have significantly boosted the reach. Mitigations are more effective if they are planned in from the start.


Whose responsibility is it?

Short answer, We Are All Crew - it is everyone’s responsibility. If you see a problem, do something about it. At the design stage, check and see if someone has considered these issues. If not, bring them into the discussion. Anyone can and should do this - the burden of making the movement better can’t lie entirely on the shoulders of those already disadvantaged.


Long answer - you will have much better results at creating actions that don’t trample over the vulnerable if you consider your impacts right from the top design stage. It’s also critical to communicate what you have or have not considered. XR often operates as a collective of autonomous groups. There can be a lot of power and fluidity in this approach! But if you’re creating an overarching structure that other groups will fit it, it’s important to either flag risks or make it clear that you’re not doing so and they need to do their own risk analysis for impact. In October this appeared to fall between the cracks.

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