SAVE LIVES

MAKE HOSPITALS SAFE IN EMERGENCIES

Natural disasters such as floods, hurricanes or earthquakes and armed conflicts or wars can all lead to public health emergencies. In some situations, outbreaks of disease can also lead to an emergency. Hospitals themselves can sometimes worsen an epidemic because they are badly designed, damaged or not able to function properly. Other causes of emergencies include: tsunamis, famine, drought, chemical spills and large-scale accidents.

Emergencies can take a heavy toll on human life and health. Natural disasters alone have killed 235 816 people in 2008, a death toll that was almost four times higher than the average annual total for 2000–2007. Two events – Cyclone Nargis which left 138,366 people dead or missing in Myanmar, and the Sichuan earthquake in south-western China which killed 87,476 people – accounted for the vast majority of deaths. Natural disasters affected 211 million people in 2008 and cost US$ 181 billion. Asia was home to nine of the countries in the world’s top ten for disaster-related deaths. Floods were one of the most frequent disasters along with other weather-related events.

Emergencies damage hospitals and destroy health services
By damaging or destroying hospitals and other health facilities, emergencies can disrupt or even halt life-saving services. Structural and infrastructural damage may be devastating exactly at the time when health facilities and health services are most needed. Health workers and patients can be killed in collapsing hospitals. The number of other deaths and injuries is compounded when a hospital is destroyed or can function only partially. Health facilities should be able to provide care when disasters strike but, if they are damaged or put out of action, the sick and injured have nowhere to get help. But functional collapse, not structural damage, is the usual reason for health facilities failing in emergencies. Functional collapse occurs when the hospital or clinic can no longer perform because the disaster has overloaded the system.
Not only are survivors of a disaster unable to receive care, but people who need routine health services are left without them. These include women who need help in child birth, children who need routine vaccines, and those who need regular treatment for HIV/AIDS or depend on dialysis or surgery to stay alive.

Disasters may destroy not only architectural spaces, such as laboratories or operating theatres, but also:

• wipe out medical records as well as medical and support services;
• damage non-structural elements, such as water heaters or storage tanks, mechanical equipment, shelving and cabinets, which enable the facility to operate and often account for 80% or more of the facility’s cost;
• kill or displace health workers, thus compromising care for the sick and injured;
• prevent the delivery of medical supplies, equipment, food, water and other critical resources;
• leave facilities with limited capacities to help when equipment and drugs are looted.

Health facilities play vital roles during emergencies by providing acute emergency health care to the injured such as emergency surgery and blood transfusions. They provide lifesaving services to the critically ill – as in outbreaks of communicable disease. Health facilities deliver longer-term medical and health care to communities, such as maternal and child services, management of chronic diseases and mental health services and psychosocial support, in urban, rural and remote areas. Health facilities also offer triggers for the early warning and detection of communicable diseases by regularly collecting and analysing data on cases and deaths, and provide critical health services, through therapeutic feeding centres, laboratories, blood banks, ambulance services, rehabilitation facilities, aged care facilities and pharmacies.

We know how to protect hospitals from emergencies
Planning and preparation are needed to protect health facilities and ensure they can keep providing health care during and after emergencies. Also building hospitals safe from disaster or making existing ones safer by retrofitting can be cost-effective.

• Health facilities should establish an emergency planning committee responsible for preparing and implementing an overall emergency preparedness programme.
• A well-chosen site enables the hospital or other health facility to avoid many emergencies and to keep functioning if one occurs.
• A proper safety assessment of existing facilities and measures to address hospital’s vulnerabilities will protect staff and patients and ensure the facility can cope in an emergency.
• The protection of infrastructure, equipment and staff and patient security will enable health facilities to function more effectively in emergencies and will save more lives.
• Building partnerships and ensuring coordination in the development of health facilities between the health officials, funding sources, architects and builders, and emergency services will strengthen the facilities’ safety and its response in an emergency.
• Adhere to international humanitarian laws that call for the protection and neutrality of health facilities, staff and services during conflicts.

Making hospitals safe makes good economic sense
Building a hospital is a significant capital investment. In many countries, as much as 80% of the health budget is spent on building hospitals and other health facilities. In calculating the cost of a hospital, one must include both the structure itself and the non-structural elements. However building health facilities safe from disaster or making existing ones safer by retrofitting is surprisingly cost-effective. In many new health facilities, incorporating disaster protection from earthquakes and extreme weather events into the designs from the beginning will add no more than 4% to the cost. The extra cost will become negligible if the health facility is resilient and can keep providing care during emergencies. Retrofitting nonstructural elements in an otherwise structurally sound facility costs about 1% of the hospital’s budget but will protect up to 90% of its value.

Call to Action!
No country is immune to disasters and emergencies. WHO calls on all countries to:

• Protect and train health workers in emergencies
• Plan together for emergency response
• Adopt national policies and programmes for safe hospitals
• Assess the safety of your hospital
• Design and build resilient hospitals
• Protect equipment, medicines and supplies.