Save lives, make hospitals safe in emergencies

Wars, cyclones, earthquakes, tsunamis, disease outbreaks, famine, radiological incidents and chemical spills — all are emergencies that, invariably, impact heavily on public health. Internal emergencies in health facilities — such as fires and loss of power or water — can damage buildings and equipment and affect staff and patients. In conflicts, reasons for hospital breakdowns include staff being forced to leave due to insecurity and the looting of equipment and drugs.
World Health Day 2009 focuses on the safety of health facilities and the readiness of health workers who treat those affected by emergencies. Health centres and staff are critical lifelines for vulnerable people in disasters — treating injuries, preventing illnesses and caring for people's health needs.
The official slogan is "Save lives, make hospitals safe in emergencies", which signifies the importance of investing in health infrastructure that can withstand hazards and serve people in immediate need. WHO urges health facilities to implement systems to respond to internal emergencies, such as fires, and ensure the continuity of care.
In 2008, 321 natural disasters killed 235 816 people — a death toll that was almost four times higher than the average annual total for the seven previous years. This increase was due to just two events. Cyclone Nargis left 138366 people dead or missing in Myanmar, and a major earthquake in south-western China's Sichuan province killed 87476 people, according to the United Nations' International Strategy for Disaster Reduction (UNISDR).
Asia, the worst-affected continent, was home to nine of the world's top 10 countries for disaster-related deaths. Along with other weather-related events, floods remained one of the most frequent disasters last year, according to UNISDR. Conflicts around the globe have also led to great human suffering and have stretched health care services to the extreme.
In Bangladesh, magnitude of health problems due to disaster is very high. For example, flood inundated a considerable area of the country every year. 15th November, 2007, Cyclone SIDR attacked Bangladesh. It killed about 10000 people and affected healthcare systems and millions of beneficiaries, particularly the poor, at an untold cost. Statistics says that it damaged 71% of health facilities in the region. According to the government of Bangladesh, more than 8 million people were affected by SIDR. Evidence indicated that people living in low income countries like Bangladesh are 4 times more likely to die from extreme natural disasters than those of in high-income countries. Moreover, disasters also exact a devastating economic toll.
Planning and preparation are needed to protect health facilities and make sure they are able to continue providing health care during and after emergencies. A safe health facility will protect patients, visitors and staff from hazards. It will continue to function and provide essential services when they are most needed. And it will have emergency response plans and a trained workforce to continue the normal provision of health care and cope efficiently with the additional demands resulting from the emergency.
Building hospitals safe from disaster or making existing ones safer by retrofitting is surprisingly cost-effective. In many new health facilities, incorporating comprehensive protection from earthquakes and extreme weather events into the design from the beginning will add no more than 4% to the cost. Retrofitting is an effective way to make existing hospitals safer, and thereby save lives. Using a tool to assess hospital safety will allow health authorities to determine priorities for renovating or retrofitting health facilities A Costa Rican hospital retrofitted before the 1990 earthquake withstood the shock of a 5.8 magnitude quake in excellent condition, with the savings far exceeding the cost of retrofitting.
Most of a hospital's value is represented by non-structural elements, including mechanical, electrical and communications equipment, shelving and water heating. It is damage to these that most often renders a facility inoperable. Retrofitting non-structural elements in an otherwise structurally sound facility costs about 1% of the hospital's budget but will protect up to 90% of its value.
We can all help to support better health care in emergencies. Wide support for safer hospitals is needed from all within the community. Partnerships between different sectors (including emergency services) are vital to ensure that health facilities receive priority attention when an emergency occurs — for instance, by safeguarding the water supply or securing access to hospitals and other health centres.
Many do this already. Some volunteer in health facilities. Professional bodies encourage innovations and designs that make health facilities safer and more functional in emergencies. But more can be done. Urgent action needs to be taken if we are to prevent unnecessary death and suffering when our hospitals fail in emergencies. Here is what you can do to start making hospitals safe in emergencies.