Health Facilities in emergencies


A.N. Khan**

Significant advances in health, social and economical development have been made in recent decades. And yet, this progress has been repeatedly tested by man-made and natural disasters. One cannot pursue long-term strategies for health for all without paying attention to this global problem.

Disaster is “any occurrence that causes damage, economic disruption, loss of human life and deterioration in health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area”. The response to a disaster must involve all sectors of government and the whole community. Functional health facilities and trained staff are crucial in times of emergencies and disasters.

The World has long experienced many disasters and in some of these, health facilities were a major casualty. For example during December 26, 2004, tsunami —30 of the 240 health clinics were destroyed in Aceh province, Indonesia and seriously damaged 77 others. In Sri Lanka, 92 health facilities were destroyed including 35 hospitals. In 2001 in Gujarat, a magnitude of 7.7 earthquake destroyed 3812 health facilities. More than 11,000 medical institutions were damaged in China’s Wenchuan earthquake in May 2008, forcing tens of thousands of people to seek treatment elsewhere. Current conflicts in Ethiopia and Gaza are hampering primary health services, such as immunization. These are some examples of disaster situations where health services are affected and at times unavailable when needed the most.

World Health Day 2009 focuses on the safety of health facilities and the readiness of health workers who treat those affected by emergencies. Health centers and staff are critical life-lines for vulnerable people in disasters – treating injuries, preventing illness and caring for people’s health problems, such as safe child birth services, immunization and chronic disease care, which must continue in emergencies. Often, already fragile health systems are unable to keep functioning through a disaster, with immediate and future public health consequences.

The focus of the biennial World Disaster Reduction Campaign 2008-2009, is also on the same issue :Hospitals Safe from Disasters – Reduce Risk, Protect Health Facilities, Save Lives”. In this global effort World Health Organisation is working with UN International Strategy for Disaster Reduction (ISDR) and World Bank so that all facilities stand upto emergencies and continue to function.

On International Day for Disaster Reduction, 8 October 2008 in New York, experts from China, India and Caribbean shared experiences with International agencies, Diplomatic Missions and health sector academics on how to make hospitals and schools safe from disasters. India outlined a ten-point approach to ‘Building Back Better’ from Gujarat’s massive 2001 earthquake, ranging from seismic risk assessment to training masons and local communities.

It was the Disaster Mitigation Advisory Group (DIMAG) that originally conceived the idea of Hospital Safety Index, which is gaining acceptance as a global tool for assessing the likelihood of a hospital remaining functional in disaster situations. A strategy should be developed to sustain current efforts to apply the Hospital Safety Index, including training the evaluators who use the safe hospital check list to assess health facilities. DIMAG will also promote creation and use of learning tools and methodologies.

DIMAG proposes that future safe hospital measures take into account the risks associated with climate change such as flooding, stronger hurricane and storm surge and increase awareness regarding these hazards.

A fire safety guide for hospitals will be developed and published and will include procedure for evacuation exercise, as part of the Hospital preparedness programme.

The Pan American Health Organisation (PAHO) and DIMAG will encourage and lend support to the June 2009 Conference on ‘Safe Hospitals’.

Several countries are working to keep hospitals safe, improving preparedness to protect lives. In Mexico, trained evaluators have diagnosed the safety of 200 health facilities, identifying which health facility needs improvements. In Japan, Pakistan and Peru health facilities are now build to withstand earthquakes. Multifunctional facilities for health education and agriculture are built in Bangladesh to aid relief after cyclones and floods – which saved thousands of lives after Cyclone Sidr in 2007. WHO is also urging health facilities to respond to internal emergencies, such as fires, and ensure the continuity of care.

The goal of raising awareness in this issue is to affect changes that will ensure that health facilities are able to function in the aftermath of emergencies and disasters. This means ensuring the structural resilience of health structures with existing technologies; keeping the equipment and supplies of these health facilities intact should an emergency happen; improving preparedness and risk reduction capacity of health workers; and involving communities in this effort.

Safe health facilities are those that are accessible and function at maximum capacity immediately after a disaster event. This is not just the work of the health sector and health professionals alone but experts from other fields such as urban planners, architects, engineers to bring not just awareness, but action.

Unfortunately, it is impossible to prevent most disasters. Nevertheless, we can forestall or alleviate many of their worst effects by anticipating them and by being prepared. Our concern is with reducing the adverse impact of disasters on human health, through preparedness and by bringing the right technology to bear in a timely, coordinated and effective manner, for each phase of operation, namely, relief, rehabilitation and reconstruction. (PIB Features)

*Senior Scientist, Former Assistant Director, National Environmental Engineering Research Institute, Nagpur.

Disclaimer : The views expressed by the author in this feature are entirely his own and do not necessarily reflect the views of  INVC

*Senior Scientist, Former Assistant Director, National Environmental Engineering Research Institute,



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