Editorial

World Conference on Disaster Reduction - Kobe, Japan
Safe Hospitals: what better indicator of overall disaster vulnerability reduction?

Thousands of lives were lost in the January 2001 earthquake in Gujarat, India; close to 200,000 injured persons required medical care. In Bam, Iran last December, another devastating earthquake killed 26,271 people and seriously injured thousands. In both of these locations, health infrastructure was virtually destroyed or knocked out of commission.

By comparison, Mexico City may have been more fortunate in the 1985 earthquake, because not all the nation’s hospitals were damaged or destroyed. Yet, in the affected hospitals, devastation was tremendous. Images of the collapse of a 12-story tower of the Juarez Hospital left nothing to the imagination. In the city’s public sector hospitals alone, 4,400 hospital beds were lost. The 900 lives lost at these sites included a substantial number of medical and health personnel, many of whom had participated in mass casualty management training. This tragedy is often cited in Latin America as the tipping point—a point at which a critical mass came to acknowledge that it was no longer acceptable to continue investing in disaster preparedness training if the infrastructure in which health personnel worked was not safe from disasters.

Levels of Protection

Reducing the vulnerability to disasters of any construction involves distinct levels of protection: Protecting lives, the most basic level, ensures that occupants can evacuate a building in time and is applicable to any construction. Hospitals, however, present a singular challenge. Unlike many other buildings, they are occupied 24 hours a day, and in disaster situations, this round-the-clock population is difficult to evacuate.

Protecting the investment preserves a higher level of physical protection and is directed to costly infrastructure and equipment. Again, hospitals rank among the highest on the scale of expensive investments.

Operational protection, the most stringent level, is reserved for those facilities that must—at any cost—remain not only standing but functioning: power stations, water systems, security facilities and hospitals are among the limited number of facilities that must remain operational immediately after a disaster. Emergency lifesaving treatment simply cannot wait. If a hospital collapses or is rendered useless, many lives can and will be lost. Hospitals may be the only social facility with high marks in all categories.

The most recent earthquakes in Turkey, India, Algeria, Iran and Morocco are eliciting a groundswell of support for disaster mitigation—calling on countries to pay as much attention to preserving the structural and functional integrity of their infrastructure as to preparing human resources to deal with the aftermath of disasters. The UN General Assembly has called on the International Strategy for Disaster Reduction (ISDR) to organize a World Conference on Disaster Reduction. The Conference, which will be held in Kobe Japan in January 2005, will review the past decade’s progress on the Yokohama Strategy and Plan of Action for a Safer World (1994) and define remaining challenges, critical needs and opportunities.

The time is at hand for countries worldwide to demonstrate their commitment to a concrete topic, and no topic is more appealing to both the social and economic sectors than hospital vulnerability reduction.

Reducing Vulnerability in Hospitals: lessons learned

Latin America and the Caribbean have advanced significantly in reducing their overall vulnerability to disasters. The contribution of the health sector to this multisectoral effort has been acknowledged by all. Efforts to reduce structural, non-structural and functional vulnerability in health facilities have served as a model and a catalyst for other sectors. They are also case studies in terms of success and limitations in protecting critical facilities:

• Protecting the functionality of complex structures requires a proven methodology and techniques. Tools, such as the methodology promoted by the World Bank and the WHO Collaborating Center on Disaster Mitigation, have been tested and are available to all (see page 2 of the Supplement).
• Low and middle-income countries have demonstrated, through pilot projects, that it is possible to significantly reduce the vulnerability of existing health infrastructure to disasters with technical and financial resources already at hand. However, this is not the most economical route, as retrofitting existing facilities can cost 15-30% (or more) of the cost of the construction.
• Surprisingly, including disaster reduction as criteria at the earliest stage of site selection, design and construction of new facilities—the most economical route—has not been as readily accepted by key decision makers as would have been expected.
  In brief, the challenge is not a lack of health or engineering knowledge, but one of political commitment at the multisectoral level; in other words, a perfect candidate for the attention of the world leaders at the Kobe World Conference (WCDR).

Safe Hospitals: a WCDR goal and indicator of success

Recently, WHO, through its regional office for the Americas, organized intercountry meetings to review where the Region stands in terms of disaster vulnerability in the health sector. Based on this status report, a forward-looking strategy was proposed to guide regional efforts through 2015.

Vulnerability reduction depends on many factors and sectors. Although completely reducing a country’s overall vulnerability is not feasible by 2015, efforts and funds should be directed to improving critical social facilities where some degree of progress has been made since the Yokohama World Conference in 1994 and further success is within reach. The degree of protection built into the design of new health facilities is a sensitive indicator of political commitment to overall disaster reduction across sectors.

Recommending that hospitals safe from disasters be designated as a target and a global indicator for measuring multisectoral disaster reduction is an opportunity for all—not just for the health sector.

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