On 21 December 2009, the General Assembly of the United Nations (UN) designated 13 October as International Day for Natural Disaster Reduction in an effort to motivate governments and the general public to take the necessary steps to minimize risks and the occurrence of disasters, in particular those related to climate change.
In 2016, the United Nations Secretary General launched the "Sendai Seven" campaign to promote seven goals, one by one, over the campaign’s seven year duration. The 2019 goal, Goal D, is to “substantially reduce disaster damage to critical infrastructure and disruption of basic services, among them health and educational facilities, including through developing their resilience by 2030.”
In this context, we return to the “Hospitals Safe from Disasters” initiative launched at the Second World Conference on Disaster Reduction (Kobe, Japan, 2005). The greatest impact of this initiative has been in its use as an indicator of reduced physical and functional vulnerability in health facilities under normal conditions, and before, during, and following an adverse event.1
The Region of the Americas experienced 2,870 natural disasters between 1985 and 2019, affecting over 331 million people; 2,712,257 suffered injury and 392,578 died. The cost of the resulting damage totaled US$1,367,506,390.2
Many of the deaths occurred because the health systems were not prepared for effective response. Health services infrastructure was subject to continuing damage, which left the affected population unable to access care. Response capacity and preparedness were poor.
According to the Economic Commission for Latin America and the Caribbean (ECLAC), damage to health services infrastructure was responsible for losses of over US$3.12 billion in the countries of the Americas over a period of 15 years. Indirect losses are estimated to be considerably greater, with increased health costs for millions of people who went without medical care for an extended period.
We now know that over half the Region’s health facilities are located in areas at risk of exposure to a variety of natural phenomena.3
It is important to emphasize that disaster risk reduction is a systematic effort by countries, supranational agencies, civil society organizations, and local communities to analyze the factors that cause these disasters and reduce them.4
For the Americas and for much of the world, Mexico is an example of the progress that can be made by determined technical work specifically focused on preparedness for major disasters, such as that conducted in the country over three decades.
In the earthquakes of September 1985, of the 2,831 buildings that suffered structural collapse, 50 were medical care units. Between the General Hospital of Mexico and the Hospital Juárez de México facility alone, 1,200 beds were lost.5 The National Disaster Prevention Center (CENAPRED) calculates that 2,035 secondary care beds and 3,261 tertiary care beds were lost in Mexico City in 1985, which is equivalent to approximately 29% of the 17,965 beds available before the disaster. ECLAC estimated the death toll at 26,000; the Civil Registry of Mexico City estimated 12,000. Over 1,000 deaths, including deaths of health workers,6 are estimated to have occurred inside of health care facilities.
In September of 2017, 32 years later, the earthquakes that hit Mexico caused only 396 deaths, none of them in health care facilities. Moreover, although health sector infrastructure was affected, only 952 beds were made unavailable (2.9% of 34,022 beds). There were no structural collapses of hospitals and, although seven did suffer structural damage, they fulfilled one of the Safe Hospital principles: protecting the lives of their occupants.7,8
A comparison of the two events based on ECLAC data shows losses of close to US$4 billion in 1985, equivalent to US$9 billion in today’s currency considering exchange and inflation rates, while total damage in 2017 was US$6 million, according to EM-DAT (The International Disasters Database).9 Cost-benefit analysis of mitigation strategies varies according to the type of adverse event, building type, and timeliness of intervention, since the sooner safety measures are taken in a health facility the more cost-effective they prove.
The inclusion of earthquake safety measures (antiseismic structures) can increase overall construction cost by 2-4% (for infrastructure and equipment), while the cost of reinforcing existing facilities for earthquake resistance can average 8-15% of a facility’s total cost.10
As the “Safe Hospital” initiative has progressed, hospitals have come to be seen as a part of the national strategic infrastructure for emergency and disaster response. Based on the initiative’s positive impact in the Region, PAHO now promotes hospital construction based on more stringent regulations and requirements that consider geographical location, incorporating climate adaptation and mitigation elements, following a standard design to ensure that they are accessible to everyone, and implementing a risk management program as soon as they begin operation.11
This has facilitated successful piloting of the “resilient hospital” concept in designated health facilities. In addition, discussions now focus on the evolution of health systems effective commitments to users and workers, and comprehensive care that includes a focus on persons with disabilities.12
A new definition accompanies this conceptual change. A resilient hospital is a health facility whose services remain accessible and function to their maximum capacity with the same infrastructure during and immediately after the onset of an emergency or disaster of any origin, magnitude, intensity, or sequelae, by expanding the capacity of the facility’s critical services, reducing its carbon footprint impact, and including persons with disabilities in risk management.13
This resiliency approach gives a facility the ability to resist, assimilate, adapt to, and recover from the impact of an adverse event in a timely and efficient way by both preserving and restoring its structures and functions through comprehensive risk management, while effectively implementing the multi-hazard approach, multi-sectoral action, inclusion of persons with disabilities, and multicultural focus as described in the Sendai Framework for Disaster Risk Reduction 2015-2030.14
For this reason, we promote continued construction of stronger health systems and safe, smart, and resilient hospitals.
1 United Nations International Strategy for Disaster Reduction Risk (UNISDR), Hospitals Safe from Disasters [Internet], Geneva: EIRD; 2008 [accessed 28 August 2019]. Available at: https://www.unisdr.org/2009/campaign/pdf/wdrc-2008-2009-information-kit.pdf
2 Centre for Research on the Epidemiology of Disasters. EM-DAT The international disaster database [Internet]. Brussels: School of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-Champs; 2017 [cited 1 September 2019]. Accessed at: http://www.emdat.be/Database.
3 Knowledge Center on Public Health and Disasters. Disaster risk reduction in the health sector. Cost-benefit analysis of disaster mitigation in health services. [Internet], Washington D.C.: 2014 [accessed October 2019]. Available at: http://www.saludydesastres.info/index.php?option=com_content&view=category&layout=blog&id=135&Itemid=658&lang=en.
4 United Nations Office for Disaster Risk Reduction (UNDRR). What is disaster risk reduction? [Internet]. 2019. Available at: https://www.unisdr.org/who-we-are/what-is-drr.
5 Documentation and Archives Center of the Secretariat of Health. El Terremoto de México de 1985. Efectos e Implicaciones en el Sector Salud. México. Valdés Olmedo C, Martínez Narváez G. [Internet].1985. [consulted 29 August 2019]. Downloaded from: http://cidbimena.desastres.hn/pdf/spa/doc7499/doc7499-contenido.pdf
6 Secretaría de Salud (SSA). 1985. El terremoto del 19 de septiembre. [internet]. Mexico. 2018. [Consulted 6 September 2019].
7 Secretaría de Salud (SSA) Informe sobre las acciones realizadas ante el sismo del 19 de septiembre. [Internet]. México. 2017. [consulted 6 September 2019]. Available at: https://www.gob.mx/.
8 Centro de Estudios Demográficos Urbanos y Ambientales [Center of Urban and Environmental Demographic Studies]. Los Sismos de Septiembre y la Salud en México. Frenk J, González MA, Sepúlveda J. Estudios demográficos y urbanos. 1987;2(1):121-39. [consulted 29 August 2019]. Available at: https://estudiosdemograficosyurbanos.colmex.mx/index.php/edu/article/view/619 doi.org/10.24201/edu.v2i1.619. doi.org/10.24201/edu.v2i1.619.
9 Economic Commission for Latin America and the Caribbean (ECLAC/CEPAL) – Environment and Development Series, No. 157. Assessment of the effects of disasters in Latin America and the Caribbean, 1970-2010. Omar Bello, Laura Ortiz. A United Nations José Luis Samaniego Publication. ISSN 1564-4189. September 2014. Santiago, Chile.
10 Knowledge Center on Public Health and Disasters. Disaster risk reduction in the health sector. Cost-benefit analysis of disaster mitigation in health services. [Internet], Washington D.C.: 2014 [accessed October 2019]. Available at: http://www.saludydesastres.info/index.php?option=com_content&view=category&layout=blog&id=135&Itemid=658&lang=en.
11 Plan of Action for Disaster Risk Reduction 2016-2021, adopted by the 55th Directing Council of the Pan American Health Organization (PAHO).
12 Terminology on Disaster Risk Reduction. [Internet]. 1st ed. Geneva: International Strategy on Disaster Risk Reduction; 2017 [cited 27 September 2017]. Available at: https://www.unisdr.org/files/7817_UNISDRTerminologyEnglish.pdf
13 Nueva etapa, hospital seguro y resiliente. Cruz Vega F, Elizondo Argueta S, Sánchez Echeverría J, Loria Castellanos J, Cortes Meza H. Arch Med Urgen Mex Vol. 10 No. 1, January April 2018, pp. 27-30
14 United Nations Office for Disaster Risk Reduction (UNISDR), “Sendai Framework” [Internet], Washington, D.C.: UNISDR; 2015 [consulted 11 June 2017]. Available at: https://www.unisdr.org/.