FEALAC Symposium on Pan-Oceanic Cooperation for Disaster Risk Reduction Bangkok, Thailand 9-12 November 2009 Patricia Bittner Pan American Health Organization.

FEALAC Symposium on Pan-Oceanic Cooperationfor Disaster Risk Reduction

Bangkok, Thailand9-12 November 2009

Patricia BittnerPan American Health Organization

Area on Emergency Preparedness and Disaster Relief

Disaster Risk Reductionand Safe Hospitals:

A Goal within our Reach

CONTENT

General health effects of disasters

The impact of disasters on hospitals and health services

The loss of a hospitals is more than a health issue

Safe hospitals and the Hospital Safety Index

Partnerships…discussion

Disasters and health

• WHO defines health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.”

• It is difficult for disaster risk and good health to coexist!

Effects of disasters on thegeneral population

• Loss of homes forces the displaced to seek temporary shelter.

• Needs of IDPs: basic supplies and sanitation, epidemiological surveillance.

• Locating disaster victims in temporary settlements should be the last alternative, spending money in other basicneeds is more necessary .

180,000 persons in Managua, Nicaragua moved in with friends, relatives after 1972 earthquake

Effects of disasters on food and nutrition

• Food is usually locally available in sudden-impact natural disasters.

• Supply can be affected in slow-onset disasters (floods and drought)

• Food food shortages may occur when: Existing stocks or crops are destroyed Food distribution systems are disrupted

Effects of disasters on mental health

• Generally, anxiety and depression are not major health factors among survivors – most people find the strength to take care of immediate needs.

• Most cases can be treated with a minimum of trained staff. The issue is to diagnoseand refer serious cases.

• Foreign medical teams are not the best equipped or prepared to deal with local or culturally sensitive situations.

Management of cadavers

• It is a myth to believe that dead bodies pose a major risk for disease.

• The bodies of victims of natural disasters in non- epidemic areas do not present a public health risk of cholera, typhoid, fever or plague.

• Even the carriers of communicable diseasesare, in fact, a less serious public healththreat than when they were alive.

Health impact varies by type of disaster

Effect

HazardEarthquake

High Winds(without flooding)

Tsunami Flash floods

Slow-onsetfloods

Volcanoes

Death Many Few Many Few Many

Severe injury Many Moderate Few Few Few

Risk ofcommunicable

diseases

Potential risk following all major disasters(probability rises as sanitary conditions deteriorate)

Damage to health facilities

Severe (structureand equipment)

SevereSevere butlocalized

Severeto equipment

Severe

Food shortagesRare

due to economic or logisticCommon Rare

Populationmovements

Raredue to heavily damaged areas

Common but generally limited

Effects of climate change on health

Source: WHO. Climate change andhuman health-Summary

One of the greatest risks to health is the impact of disasters on hospitals and

health services

• More than 67% of the nearly 18,000 hospitals in Latin America and the Caribbean are located in areas at highr risk of disasters.

• Major disasters have left hundreds of thousands of persons without access to health care.

• In most cases, this was because the health facility simply could not function.

• Prior to 1985, the safety of hospitals was not one of PAHO’s main concerns, nor that of health managers in Latin America and the Caribbean.

The trigger…Mexico City, 1985

Damage to health infrastructureEl Salvador earthquakes 2001

• Loss of 1,917 beds (39% of the country’s installed capacity.

• Preventive evacuation was costly and often based on unfounded fear.

• Field hospitals donated at great cost – money could have been better used elsewhere.

Hospital Beds Post earthquake situation

San Rafael(tertiary level hospital)

222 Severe damage, partially operating outdoors

Maternity Hospital

388 Damage to obstetrics wing and elevators

Rosales Hospital 531 Surgical center not functioning

Primero de Mayo 239 Obstetric services evacuated

San Juan de Dios San Miguel

398 Operating outdoors

San Pedro de Usulután

130 Operating outdoors

• Five hospitals (almost 25%) and 19 health centers (8%) destroyed.

• Damage to public hospitals and health centers, including replacement costs, estimated at US$53 billion.

Damage to health infrastructurefrom tsunami in Aceh Province, Indonesia

Source: World Bank, based on information from Indonesia Ministry of Health

0%

20%

40%

60%

80%

100%

Per

cen

tag

e

A'abad Bat Man Shan Bagh Muz

Functional

Partially Damaged

Destroyed

Damage to health infrastructurePakistan earthquake, October 2005

Not just a problem in natural disasters… Damage to health facilities—Lebanon, 2006

The loss of a hospital is a health issue…

• Disasters produce an intense demand for health services. In addition to treating disaster victims, hospitals must quickly resume treatment of everyday emergencies and routine care.

• The hospital network (laboratories, blood banks, etc.) are integral components of a nation’s public health system.

• The long-term impact of losing these services is difficult to quantify and therefore may be overlooked.

But the loss of a hospital or health facility is more than a health issue

• Safe hospitals have symbolic social value; losing a health facility leads to a sense of insecurity and social/political instability.

• They are occupied around-the-clock with the most vulnerable population.

• Disaster-resilient hospitals must be able to protect the lives of patients and staff and continue to function.

A social/political issue

A public opinion survey carried out following the 2001 El Salvador earthquakes cited hospitals and

blood banks as two of the three public facilities whose post-disaster functionality must be

guaranteed.

• Hospitals represent an enormous investment for any country.

• Destruction or loss of functionality pose a major economic burden.

• Direct economic losses involve more than the structure: the value of non-structural elements can be higher than the structure itself.

• Generally, it is much less expensive to incorporate risk reduction measures in the design of new health facilities than it is to retrofit existing facilities.

An economic issue

• UN/ECLAC estimatesthat damage to health infrastructure in Latin America and the Caribbean represented direct losses of US$ 3.12 billion between 1981-1996.

An economic issue

• Indirect costs—such as a decline in health and wellbeing of the population, the impact on overall recovery and a disincentive for future external investments—are difficult to measure.

An economic issue

The direct and indirect costs of disasters far exceed what it would have cost to mitigate the damage to hospitals.

What is a Safe Hospital?

• …a health facility whose services remains accessible and functioning, at maximum capacity and in the same facility, immediately following a large-scale disaster or emergency.

• The key issue is in the level of protection!

Levels of Protection

I. Life Protection (patients, health personnel and visitors)

II. Investment Protection (equipment, furnishings and utility services)

III. Operational Protection (maintain or improve the facility’s capacity to function).

This is a problem that can be solved...

• Clear mandate exists: Hyogo Framework for Action

• Tools are available to reduce risk Technical publications on vulnerability reduction in health

facilities Courses on Hospital Disaster Planning Advocacy print and audiovisual material

The Hospital Safety Index

What is the Hospital Safety Index?

• Rapid, reliable and low-cost diagnostic tool

• Easy to apply by a trained team of engineers, architects and health professionals

• Values entered in a spreadsheet (mathematic model)

• Four components: Location, Structural, Non-Structural and Functional

• 145 items or areas are assessed

• Three categories of safety: High, Average and Low

What the Checklist Evaluates

• Location in relation to hazards (geological, hydro-meteorological, environmental etc.)

• Structural safety (history of the buildings, structural systems, construction materials etc.)

• Non-structural safety (electrical, communications water supply systems etc.)

• Organization and management (disaster plans, EOC, preventive maintenance, etc.)

SAFE HOSPITALS CHECKLIST

Geographic location (mark with an X where applicable).

1.1 Hospital location

Request the hospital team to provide the map(s) showing hazards at the site of the building.

Safety LevelNote: ranking indicates the level of

SAFETY, NOT risk.

NO

HAZARD

YES

LOW AVERAGE HIGH

1.1.1 Geological phenomena

Earthquakes

Rate the safety level of the hospital in terms of geological and soil analyses.

Volcanic eruptions

Refer to hazard maps to rate the safety level of the hospital in terms of its proximity to volcanoes and volcanic activity, lava and pyroclastic flow, and ash fall.

Landslides

Refer to hazard maps to rate the safety level of the hospital in terms of landslides caused by unstable soils (among other causes).

Tsunamis

Refer to hazard maps to rate the safety level of the hospital in terms of previous tsunami events caused by submarine volcanic or seismic activity.

Non-structural safety

3.1 Critical systems

Safety Level

Electrical system LOW AVERAGE HIGH

Generator has capacity to meet 100% of demand.

Verify that the generator begins to operate within seconds of the hospital losing power, covering power demands in the emergency department, intensive care unit, disinfection and sterilization unit, surgery, etc.

Low =0–30%; Average = 31–70%; High = 71–100%

Performance of generator tested regularly in critical areas.

Low = > 3 months; Average = 1–3 months; High = < 1 month.

Generator protected from potential damage due to natural phenomena

Low = No; Average = Partially; High = Yes.

Scoring Calculator     

 2.1 History of facility’s safety CONTROL

Safety Level

  LOW AVERAGE HIGH

1

Has has been prior structural damage to the hospital as a result of natural phenomena Determine whether structural reports indicate that the level of safety has been compromised. If no natural phenomena has occurred in the last 30 years, do not fill in any box – leave blank. Low = Major damage; Average = Average/moderate damage; High =Minor damage.

BLANK

2

Was the hospital built and repaired using current safety standards? Verify whether the building was repaired, the date of repairs, and whether repairs were carried out using current standards for safe buildings.

Low = Standards not applied; Average = Standards partially applied; High = Standards fully applied

ERROR

1  1   

3

Has the hospital been adapted or remodeled or modified affecting the structural behavior of the building? Verify whether modifications were carried out using current standards for safe buildings

Low = Major remodelling or modifications have been carried out; Average = Average/moderate modifications; High = Minor changes or no remodelling or modification was needed.

OK

    1

CategoryUnlikely to

functionLikely to function

Highly likely to function

Total

Structural 7.50 24.38 18.13 50.00

Non-structural 10.36 10.98 8.67 30.00

Functional 6.93 6.92 6.15 20.00

Total 24.79 42.37 32.94 100.00

Assessment of a Health Facility

Safety of Non-structural Elements

Non-Structural Safety

LOW35%

AVERAGE36%

HIGH29%

The Result

Preventative measures are suggested at some point, as the health facility’s current safety levels can cause acceptable damages, which nevertheless reduce the overall safety level of the installation.

Category A

0.66 – 1

Necessary measures are required at some point, as the health facility’s current safety levels can potentially put at risk patients and staff during and after a disaster event.

Category B

0.36 – 0.65

Urgent measures are required immediately, as the health facility’s current safety levels are not sufficient to protect patients and staff during and after a disaster event.

Category C

0 – 0.35

What should be done?CategorySafety Score

Result for this facility: Category B

Role of the ‘Safe Hospitals’ Evaluators Advocacy

• Preliminary meetings with senior managers to explain the rationale and purpose of the “Safe Hospitals Initiative” and the assessment.

• Assurances of confidentiality of the results.

Interpretation of the results

• Able to explain the basic methodology of scoring the instrument.

• Able to analyze the results, identify and justify priorities based on these.

The good news…

• The knowledge exists to assess vulnerability and reduce risk in health facilities.

• Well-built or retrofitted hospitalshave continued to function following disasters.

• The health sector is working hard to improve the safety health facilities.

Two realities…

One choice

The Hyogo Framework for Action

The Hyogo Framework for Action 2005-2015 (HFA) included the following measure of commitment to and success of national risk reduction:

Integrate disaster risk reduction planning into the health sector; promote the goal of “hospitals safe from disaster” by ensuring that all new hospitals are built with a level of resilience that strengthens their capacity to remain functional in disaster situations and implement mitigation measures to reinforce existing health facilities, particularly those providing primary health care services.

. . . next steps with FEALAC???