Boston Children’s faced months of death threats and hate mail. Here’s how staff members are coping.

On a Wednesday morning last month, Boston Police swept into Boston Children’s Hospital to investigate the fourth bomb threat at the institution in just four months. They evacuated a building and cordoned off the area, blocking staff from reaching offices and operating rooms. About an hour later, BPD gave the all clear, and life inside the sprawling campus on Longwood Avenue resumed.

Until the next day, that is, when yet another bomb threat was received.

Since August, Boston Children’s Hospital, widely considered the top pediatric hospital in the country, has been the target of a barrage of hate mail, death threats, and vitriolic and antisemitic messages. Many appeared to have been spurred by an anti-LGBTQ+ Twitter account that attacked the hospital for providing care to transgender children and teens.

The attacks come as caregivers at Children’s and beyond are already stretched thin from a surge of respiratory infections, a historic hospital capacity crisis, and several years of pandemic-induced exhaustion.

After the first incendiary tweets in August, one Boston Children’s physician, whose work involves a broad array of services to trans youth, said she had received death threats via e-mail and phone and that social media users disclosed the names and home addresses of her family members. She, like other Children’s staff, spoke to the Globe on the condition of anonymity out of concern for her safety. The threats to her and her family persisted for much of August and September.

While she has previously experienced anti-trans protests about her work, the current level of hostility is something new. She felt distracted by thoughts about her family’s and her patients’ safety, she said.

Another Children’s staffer who conducts research on transgender health said it was the numerous security alerts at the hospital that made her feel unsafe. She frequently works in the building that was targeted in mid-November, and has avoided returning there since, shifting some meetings from in-person to virtual.

The threats have also made it harder for her to do her work. She’s found that, in the current climate, transgender individuals and their families are more reluctant to participate in research, saying it feels scary to be associated with Children’s when it’s the target of so much hate. When people do volunteer online for research studies, she and her colleagues devote extra time to screening the volunteers to weed out those who have tried to disrupt the work. She said such intensive screening tools haven’t needed to be implemented in the past.

The threats have taken a toll on staffers.

“I mentor a lot of trainees and students and everyone is feeling unsafe and afraid to do the work,” the researcher said. “We’re committed to doing this work ... but it’s distracting and difficult to do it in this space where there are continuous threats.”

Boston Children’s Hospital has been providing transgender care since 2007, when it founded the first major program in the United States focused on gender-diverse and transgender adolescents. Its Gender Multispecialty Service has since expanded to treat patients between the ages of 3 and 25. (Children as young as 3 may say their gender doesn’t match the sex they were assigned at birth, in which case, Children’s said, care might include a meeting with a psychologist and additional resources and support for the family.)

Today, several major hospitals that treat children deliver transgender care, including others in the Boston area.

The types of gender-affirming care that Children’s offers ranges from simple interventions such as allowing patients to use preferred names and pronouns in their medical records, to counseling, hormonal therapy to delay puberty or transition to a different gender. For patients 15 and older, breast surgery is an option, as is genital surgery for those 18 and older.

Despite wide adoption and recognition of the need for transgender care, political attacks against providers continue to mount, breeding broader anti-trans sentiments. Several pieces of legislation have been introduced in some states in recent years to restrict the type of care transgender youth can receive. Recently passed bills in Arkansas, Arizona, and Tennessee impose civil penalties, including disciplinary action, for clinicians who either prescribe hormone therapy for transgender youth or refer youth to other health care professionals who provide gender-affirming care.

While Boston Children’s sees hundreds of transgender patients, they are a fraction of the 4,000 to 5,000 visits the hospital sees daily, and the effects of the violence have rippled beyond those involved in transgender medicine.

“Staff are trying to focus on things that are high level, high risk,” said an ICU nurse at Boston Children’s. But now “we don’t feel safe and secure. In the middle of trying to do something critical for someone else’s child, our thoughts are being distracted.”

According to a hospital leader at Boston Children’s who was involved in response to the threats, the hospital is working closely with the Boston Police Department to track all the threats and is talking through other ways to help staff feel safe.

So far, three people have been arrested in connection with threats to Boston doctors, including a Texas man who allegedly sent a profanity-laden voice mail to a physician at the Fenway Institute’s National LGBTQIA+ Health Education Center; and a Westfield woman and a Canadian man charged in connection with bomb threats to Boston Children’s.

Legislators nationally have also called for the Department of Justice to detail the steps it is taking to improve safety for children’s hospitals and investigate the people who threaten them. In March, the department sent a letter to all state attorneys generals reminding them that laws that prevent individuals from receiving gender-affirming medical care may infringe on constitutional protections.

Clinicians outside Boston Children’s have also been impacted. Dr. Carl Streed Jr., a primary care physician and a research lead for the Center for Transgender Medicine and Surgery at Boston Medical Center, said even though Massachusetts protects transgender care and those who provide it, he worries about patients he sees from out of state. Not knowing if they will be able to access care wears on him. And he worries whether the ongoing threats will dissuade people from training in gender-affirming medicine.

“We know trainees or future clinicians are worried about how safe it will be for them to enter the field,” he said. “These laws have a chilling effect on the next generation of clinicians.”

Dr. Mandy Coles, medical director of the Child and Adolescent Transgender Center for Health at Boston Medical Center, said that her patients have shown remarkable resilience in the face of discrimination. Though BMC had not received any targeted threats, several patients had checked in with her to make sure she was staying safe.

“Any concerns I have over my personal safety are overshadowed by my patients’ and families’ need for support and their access to receive gender affirming care,” Coles said.

At Boston Children’s, no patients have so far taken up the hospital on offers to move their gender-affirming care to other providers. In fact, the physician who had received direct threats said parents have expressed gratitude.

“I have a lot more parents hugging me now on a day to day basis,” she said.

Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.