Argentina
Safer Hospitals: Let’s Act Now

Arq. Virginia I. Rodríguez de Acosta
Architect who specializes in planning, prevention and integrated management of disaster-prone areas. She is a member of the Faculty of Architecture, Urban Development and Design of San Juan, Puerto Rico’s National University.

Seismic vulnerability reduction of public health infrastructure is a high social and economic priority for the government of San Juan, Puerto Rico. That should come as no surprise: the Pan American Health Organization (PAHO) has assessed that disaster vulnerability in a significant number of the hospitals and other health facilities in Latin America and the Caribbean is unacceptably high, and has led to massive human and material losses.

Disaster prevention is a key component of sustainable development. In the face of natural or manmade hazards, the resources invested in vulnerability reduction pale in comparison with the resources required to respond to major emergencies at the expense of social development.
From an integrated perspective of socio-natural disasters, risk is the product of two factors: a hazard (i.e., a natural or man-made physical phenomenon) and the degree of vulnerability. This view emphasizes those conditions that make a society more or less prone to suffering the impact of a significant physical phenomenon—in short, its vulnerability, which builds up over time as part of a process of misalignment between the natural environment and human patterns of settlement, construction, production and ways of life.

In recent years, much greater attention has been paid to the integrated management of disasters, understood as a continuum of interrelated stages that must be handled comprehensively as well as specifically. These are the stages and related actions:

1. Before the disaster: Prevention, mitigation, preparedness and
early warning activities.

2. During the disaster: Response, evacuation, search and
rescue, assistance and care of the affected population.

3. After the disaster: Rehabilitation and reconstruction.

Historically, attention has been overwhelmingly paid to the response stage: the actions that may be taken in the immediate aftermath of an adverse event, and the actors who can play a leading role in such actions, such as the armed forces, the police, firefighters, and other first responders. The rehabilitation and reconstruction of the affected area has generally come in second, with the first stage a distant third—often focusing only on the study of the hazard in question (from the point of view of earth sciences or engineering) or the reduction of the society’s physical vulnerability (built infrastructure).

We call our approach “An Ounce of Prevention (or Mitigation)”. Current, more proactive approaches such as ours pay special attention to the “before” stage and considers vulnerability in all the complexity of its physical, socioeconomic and cultural dimensions. This in turn underscores the key importance of building a community’s capacity to confront, withstand and recover from the impact of an adverse natural or man-made phenomenon. In short, risk management is a joint task of government and civil society—which calls for a change of social attitudes and behaviors so that all citizens, instead of contributing to the gradual increase of vulnerabilities, feel committed to the creation of safer living conditions for all.

Disaster risk can be unusually high among health facilities, for reasons that are well known and have been highlighted by the U.S. Federal Emergency Management Agency (FEMA) and others: Such facilities are highly complex, have high around the clock occupancy levels, depend on external basic services for the fulfillment of life and death tasks, and contain large quantities of equipment that is vital but potentially lethal when overturned or otherwise perturbed, not to mention highly toxic substances.

All too frequently, however, hospital disaster plans, if they exist at all, focus on the external consequences of a disaster, such as an increase in the number of victims who will require triage and other emergency services, possibly overflowing the hospital’s response capacity. And yet an earthquake will not tiptoe around a hospital: if the facilities are not structurally and non-structurally resilient enough, they will simply add to the statistics regarding fatalities and destruction.

Lessons learned from the impact of earthquakes on health facilities stress the need to review the criteria for the siting, design, construction and maintenance of such facilities. What is required is for every hospital to be viewed as a whole; in order to fulfill its functions, not only must its structure and equipment prove less vulnerable, but also its human and organizational resources.

Given the high risk that hospitals face in the event of a disaster, new facilities must be designed and built to meet the characteristics and nature of the seismic hazards prevalent in the area. It is also necessary to assess the vulnerability of existing facilities in order to determine their weaknesses and come up with vulnerability reduction measures and mitigation plans.

The philosophy behind most current seismic building codes tends to focus on minimizing structural damage and limitingnon-structural damage during an earthquake in order to save lives. But health facilities need to do more than withstand a disaster until evacuation has been completed. They should be able to continue to function, which calls for reducing the facilities’ operational vulnerability.

The risk faced by health facilities is a function of the ratio between the likelihood of a given event occurring and the vulnerability of the facilities’ components. Hence, risk mitigation has to focus on reducing the vulnerability of those components that are likely to be affected. In order for this to take place, the first step must inevitably be assessing the vulnerability of the facilities.

A vulnerability assessment must begin with a visual inspection of the facilities and the production of a preliminary vulnerability report. This makes it possible to identify the most flagrantly vulnerable components and area that require urgent attention by means of a prompt mitigation schedule, while less obvious vulnerabilities are identified and mitigation measures are designed to correct them.

Most natural hazards are unavoidable; not so their effects. The time to act is now, before new disasters undermine the health infrastructure of the region.

The alternative to implementing effective mitigation actions is to bemoan the consequences of what might have been foreseen. Not to incorporate vulnerability reduction and risk management among development policies amounts to nothing less that mismanagement of resources.

Virginia Irene Rodríguez de Acosta is an architect who specializes in planning, prevention and integrated management of disaster-prone areas. She is a member of the Faculty of Architecture, Urban Development and Design of San Juan, Puerto Rico’s National University.

For more information contact:
Virginia Rodríguez
deskjet@sinectis.com.cr