Training on Safe Hospitals in Disasters Module 1: Safe Hospitals Concepts

Session 3: Safe Hospitals

Background World Conference on Disaster Reduction in Kobe, Japan One of the key priorities for action: Promote the goal of “hospitals safe from disaster” Inter-agency Task Force of the ISDR made “Safe Hospital” as the focus of the global risk reduction campaign (2008 – 2009) Hyogo Framework for Action (2005-2015)

HYOGO FRAMEWORK FOR ACTION 2005 - 2015 Building the Resilience of Nations and Communities to Disasters Expected Outcome The substantial reduction of disaster losses, in lives and in the social, economic and environmental assets of communities and countries Strategic Goals The integration of disaster risk reduction into sustainable development policies and planning The development and strengthening of institutions, mechanisms and capacities to build resilience to hazards Systematic incorporation of risk reduction approaches into implementation of emergency preparedness, response and recovery programmes Priorities for Action 1. Ensure that disaster risk reduction (DRR) is a national and a local priority with a strong institutional basis for implementation Identify, assess and monitor disaster risks and enhance early warning Use knowledge, innovation and education to build a culture of safety and resilience at all levels Reduce the underlying risk factors Strengthen disaster preparedness for effective response at all levels Cross Cutting Issues Capacity building and technology transfer Multi – hazard approach Gender perspective and cultural diversity Community and volunteers participation

Goals “Promote the goal of “hospitals safe from disasters” Ensure that all new hospitals are built with a level of resilience that strengthens their capacity to remain functional in disaster situations Implement mitigation measures to reinforce existing health facilities, particularly those providing primary health care

Why are Safe Hospitals the Focus of Global Risk Reduction? Receiving end of victims Responders to emergencies/disasters Direct life saving roles Symbol of social progress Prerequisite for social stability and economic development

Definition “Safe Hospital or Safe health facilities” are hospitals that have the capacity and capability to remain functional and operational during and even after disaster those which health services remain accessible and functioning at maximum capacity during and immediately after disasters/emergencies they must be physically resilient and able to remain operational and continue providing vital health services

Special considerations in “safe hospital Infrastructure point of view Reduce vulnerability to increase level to protect: lives; investments; and ability to function Risk mitigation observed in new facilities Financial investment to retrofit existing facilities can be high but the cost of ignoring the risks can be much higher in terms of money, loss of human life and social recovery

Special considerations in “safe hospital” Operational point of view Better prepared to mitigate and manage their risks Ready to respond properly and efficiently to emergencies which create additional unexpected demands on their services (Surge Capacity)

“Safe hospital”: Public health implications Offers curative and preventive medical services Host to public health reference laboratories Contribute to diagnosis, prevention and control of diseases Signal early warning of communicable diseases Resource Center for public health education Centers for research

“Safe hospital”: Socio-political implications Hospitals are expected not only to provide good medical care but also to ensure the safety of their vulnerable clientele The fact that hospital is occupied 24/7 by a an entirely dependent population Emotional repercussion of losing a hospital can lead to loss of morale, insecurity, and social instability

“Safe hospital”: Economic implications A sophisticated hospital represents an enormous investment and its destruction poses major economic burdens for society The cost of non-structural elements in most facilities is higher than the structure itself Temporary facilities like field hospital cannot compensate the loss of hospital Lack of medical services adversely affect economic and business recovery process

Wider benefits of “safe hospital campaign” Using hospitals as entry point, will target all health facilities/systems in communities at risk All-hazard approach, including biological; technological; environmental & societal hazards Beyond risk management approach, it will reach public safety and health security Beyond health infrastructure: functionality and risk management capabilities of hospitals and other health facilities will benefit

Objectives of “Safe Hospitals” (HFA)‏ Reduce risk Protect health facilities Save lives “A safe hospital must be structurally, non- structurally, and functionally sound to be able to maintain continuous operation during and even after disaster when it is needed most”

Objectives of “Safe Hospitals” (HFA) Structural resilience of health facilities Functional continuity of hospital services in emergencies Hospitals have risk & emergency management capability to operate in emergency settings Multidisciplinary involvement in identifying & reducing risk as well as resilience building Incorporate above priorities in national development plans and building longer term programs

Definitions of Elements

Major Elements of “Safe Hospital” Structural Component Non-structural Component Functional Component Lifeline Facilities Medical Facilities Architectural Elements Emergency Exit System Fire System Electricity System Critical Systems Water Supply System Medical Gas Supply System Communication System

Structural Parts of hospital those that resist gravity, earthquakes, wind and other types of loads load bearing components that make a building stand Include the following: columns (posts and pillars) beams (girders, joists) walls that strengthen the infrastructure Product of Structural Engineers, masons, labor contractors

Non-structural Parts of hospital all non-load bearing parts including content of the building or attached to the structure Includes: ceilings, windows equipment HVAC (heating, ventilating, air con)‏ furnishings, lights, etc Done by: Architects, interior designers Mechanical and electrical engineers purchased by owners after construction

Functional elements of hospital Include physical design, maintenance, and administration the site, external and internal distribution of space, access routes Ensure that hospitals continue operating when most needed

Functional Components To ensure that health services will keep running to meet the demands of the community at a time when these are most needed General physical layout of the facility including its location, accessibility, and the distribution of areas within the facility Ex. Near good roads with adequate means of transportation

Individual services both medical (equipment and supplies) and non-medical (utilities, transportation and communication) vital to the continuous operation of the facility Public services and safety measures available inside the facility Hospital service area Hospital zoning (interoperability) Facility’s design Systems, plans, policies, SOPs, etc.

Advocacy for “Safe Hospital”: 10 Basic Facts to know Many factors put hospitals, health facilities, their workers and the people the care at risk, from the design of the building, to the ability of people to manage an emergency Components of a hospital or health facility are typically divided into: structural elements (the building) and non-structural elements (the contents) which can comprise around 80% or more of the total cost of the facility in the case of hospitals

10 Basic Facts to know 3. Functional collapse, not structural damage, is the usual reason for hospitals being put out of service during emergencies 4. Hospitals and health facilities can be built to different levels of protection: life safety, investment protection, and operations protection

10 Basic Facts to know 5. Making new hospitals and health facilities safe from disasters is not costly: it has been estimated the incorporated mitigation measures into the design and construction of a new hospital will account for less than 4% of the total initial investment 6. Field hospitals are not necessarily the best solution to compensate for the loss of a hospital or health facility during a natural disaster

10 Basic Facts to know 7. Using a check consultant is the best way to ensure that facilities are built according to the disaster-resilient designs that have been approved 8. Building codes are of utmost importance 9. Creating safe hospitals is as much about having vision and commitment as it is about actual resources 10. The most expensive hospital is the one that fails!

Key Messages 1. The most expensive hospital is the one that fails Hospitals and health facilities represent an enormous investment for any country. Their destruction imposes major economic burdens. 2. Disasters are health and social issue: Not only is health treatment critical in the aftermath of a disaster, damage to health facilities and systems affects development long into the future

Key Messages 3. Protecting critical health facilities from disasters is possible and cost effective Including risk reduction in the design and construction of all new health facilities, and reducing vulnerability in existing health facilities through selecting and retrofitting the most critical facilities, costs less than you might expect

Key Messages 4. The health workforce must be agents of disaster risk reduction Health workers are central to identifying potential health risks from natural hazards and promoting personal and community risk reduction measures

Key Messages 5. Low cost design safety: New hospitals Incorporating comprehensive disaster protection from earthquake and weather events into designs adds only 4% to the cost (priority for advocacy)‏

Key Messages 6. Low cost retrofitting: Targeted protection Prioritizing the protection of critical care and hospital functionality reduces potential costs Non-structural elements represent most of the value of hospitals Damage to non-structural elements renders a hospital inoperable during natural disaster Retrofitting non-structural elements costs only about 1% while protecting up to 90% of the value of a hospital

Implementation arrangements of “Safe Hospital Initiative National level: DOH with partners (WHO) facilitate the recognition and integration of safe hospital as priority area of focus of the government’s development policy ISDR assistance to governments in developing their national strategies for disaster risk reduction

Implementation arrangements of “Safe Hospital Initiative DOH level: Collaborative advocacy campaign for “Safe Hospital” DOH hospital surge capacity assessment Facility upgrading into safe hospitals (structural, non-structural and functional)‏ Establish hospital preparedness to emergencies or disasters

Thank You