Healthcare resilience to natural hazards: an achievable target


International Journal of Disaster Resilience in the Built Environment

ISSN: 1759-5908

Article publication date: 4 October 2011


Achour, N. and Price, A.D.F. (2011), "Healthcare resilience to natural hazards: an achievable target", International Journal of Disaster Resilience in the Built Environment, Vol. 2 No. 3.



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

Healthcare resilience to natural hazards: an achievable target

Article Type: Guest editorial From: International Journal of Disaster Resilience in the Built Environment, Volume 2, Issue 3


There has been a significant number of highly disruptive geophysical, environmental and biological events of recent (e.g. Haiti (2010) and Christchurch (2011) earthquakes; the recent floods in Australia (2011); the earthquake and subsequent tsunami in Japan (2011) and Swine flu (2009)), which have demonstrated the catastrophic impact that natural hazards can have on health, the highly varied types of disruption society can be subjected to and re-emphasised the importance of healthcare facilities. Healthcare facilities represent one of the most complicated and critical facilities in any country, along with facilities such as fire departments and police stations. However, their distinctiveness comes from their critical role in maintaining health and wellbeing of the society and in dealing with the impact of disasters typically associated with major hazards. They are required to operate 24 hours per day, 365 days a year and must be physically and socially resilient to cope with any surge in demand. Various initiatives by the World Health Organisation (WHO) and the United Nation International Strategy for Disaster Reduction (UNISDR) have: highlighted many important issues that need to be given due consideration; raised the awareness of healthcare resilience in disasters; and encouraged researchers, engineers and decision makers to develop ways to improve the resilience of key infrastructure including healthcare facilities. Consequently, a considerable amount of work has been done; however, most of it has been unpublished and highly fragmented, thus reducing its potential impact on practice especially in countries where there has been little opportunity to learn from disasters. For example, compared to many countries, the UK is less exposed to many types of natural hazards; however, it has put considerable effort into preparing for disruptive events and has been successful on many issues, but due to the empirical approach adopted in assessing the risk many unforeseen problems were faced during the recent extreme events, the country went through, such as the lack of water supplies during the 2007 summer floods and lack of staff during the 2009 snow fall. Furthermore, many countries are at very high risk of natural hazards, such as those located in South Asia where lack of awareness and preparedness combined with the financial difficulties has resulted in many healthcare facilities being highly vulnerable. This themed issue aims to support decision makers, engineers and planners to identify the vulnerability of their existing facilities and ensure that new facilities are resilient enough to cope with the multiple adversities they face. As such, the ambition was to provide papers that present information about techniques to assess resilience to various hazards and scenarios and to improve planning and implementation.

A call was sent out at the beginning of 2010 to researchers, academics, policy makers and other professionals working with disaster prevention, mitigation, response and reconstruction responsibilities. A total of 26 abstracts were received from Australia, China, Germany, India, Japan, The Philippines, Turkey, the UK and the USA. The abstracts were reviewed by a review panel according to their relevance to the remit of the call and successful authors were invited to submit full manuscripts. These went through double-blind review process and were finally selected by the Guest Editorial Board. Six articles were selected for inclusion, due the topics they present which fall within the remit set for the themed issue, these have been complemented with two doctoral thesis abstracts to provide more detailed techniques and have been grouped under two headings: assessing the resilience of healthcare facilities and planning to improve the resilience of healthcare facilities.

Assessing the resilience of healthcare facilities

The first article in this issue, “Seismic vulnerability of the health infrastructure in the Himalayan township of Mussoorie, Uttarakhand, India”, by Piyoosh Rautela, Girish Chandra Joshi, Bhupendra Bhaisora and Shubham Pathak, presents the findings of a structural assessment of 14 healthcare buildings in a high-seismic risk area. The assessment profited from the technological advances such as geographic information systems (GIS), satellite imagery and rapid visualisation screening (RVS). About 80 per cent of the assessed healthcare facilities were deemed to be at a high risk of inoperability which will leave the town with no healthcare in case of earthquakes. The authors recommend detailed seismic vulnerability assessment of all healthcare facilities and related infrastructure components with the view to subsequent resilience improvement.

Detailed assessment techniques can provide accurate evidence of vulnerability; however, they can be expensive to apply as demonstrated in the abstract from Nebil Achour PhD “Estimation of malfunction of a healthcare facility in case of earthquake”. The study provides a detailed assessment methodology which takes into account most systems of typical healthcare facilities. It proposes studying the fragility of each system then combining all fragilities into a single fragility model (mathematical equation) that evaluates the resilience of the whole facility and estimates the level of damage it could go through during an earthquake. The study adopted a variety of quantitative and qualitative research techniques to provide a method of estimating resilience to be used for different decision processes. In a similar approach, the second research article “Climate change risks and opportunities in hospital adaptation” assessed the vulnerabilities and opportunities of four major hospitals, in Australia and New Zealand, when faced with extreme weather events. Their findings show that there are a wide range of health delivery objectives that can be affected by such events and are subject to threats from 120 identified risks which could be perceived as opportunities for improvement. They argued that despite the high number of risks derived from climate change, hospitals have significant opportunities to rethink the way that healthcare infrastructure could enhance the delivery of healthcare services into the future. An important risk/opportunity is the degree of cooperation between relevant stakeholders which if improved could help to mitigate the potential impact of risks was the conclusion of the third research article by Michael Hiete, Mirjam Merz and Frank Schultmann on “Scenario-based impact analysis of a power outage on healthcare facilities in Germany”. This study presents the potential impact of three power failure scenarios on the operation of healthcare facilities in Germany. It uses a mainly qualitative assessment approach where a group of experts gathered in a workshop and identified the risks and opportunities to German healthcare facilities. The findings demonstrate that healthcare facilities are relatively well prepared for short outages, but they are less prepared for longer durations or where power failure is usually associated with other lifeline shortages and suggest that more cooperation between the different actors of public administration, the healthcare sector and power suppliers are necessary to cope with such events.

Planning to improve the resilience of healthcare facilities

A major proportion of resilience lies in the planning and briefing processes as they provide information about the potential risks and opportunities healthcare facility has and also helps in understanding the culture of each stakeholder. The PhD abstract by Venny Chandra “An investigation of cultural learning during the hospital briefing process from a facilities management perspective”, which concluded that significant organisational cultures learning took place during the briefing process and that partnering projects can present opportunities for this to occur. Although the study was not conducted from resilience point of view, it provides a good approach to developing an understanding the different stakeholder cultures in order to improve the collaboration between emergency responders in disasters. In fact, the fourth research article by Jerry D. VanVactor “Cognizant healthcare logistics management: ensuring resilience during crisis” discusses the involvement of supply chain managers’ in the planning process. The paper defines healthcare supply chain as “a specialised genre of expertise within the healthcare industry and is largely contributive to the success or failure of a medical institution”. It suggests that healthcare logisticians need to maintain the level of consciousness concerning critical supplies and to evaluate the capacity for prolonged sustainment should it be required. The article concludes that the ultimate purpose of a supply chain is to serve end-users effectively through a process that cannot afford to be put at risk when a disaster strikes; planning ahead and understanding the healthcare supply chain manager’s role is one of the primary means for establishing resilience. On the other hand, the effectiveness of planning ahead cannot be reached except if substantial amount of information is provided. Amongst this lot of information, early warning systems provide excellent real-time information about the risk which impact could be mitigated. There are many early warning systems, but many of which are dedicated to seismic activities, tsunami and environmental hazards such as floods. The fifth research article by Shaobo Zhong, Zhanhui Sun, Quanyi Huang and Chunxiang Cao “A framework for geographical surveillance of disease in China” proposes a framework for disease surveillance in China. The framework provides an excellent attempt to develop an early warning system to be used during pandemic outbreaks such as SARS, Swine flu and the on-going Escherichia coli. The study applied several techniques such as disease clustering test and cluster detection, GIS and network and communications to find that a systematic, automatic, real-time surveillance and early warning system for prevention and control of disease could be built and implemented. The findings were tested using the 2003 SARS in Beijing and could be implemented to provide early warning system for hospitals to be prepared for disease outbreaks. The study will be taken further to improve its implementation through software, hardware and interface development. This leads us to the last research article by Lester Sam A. Geroy and Arturo M. Pesigan “Disaster risk reduction for health facilities in the Western Pacific Region” which focused on the implementation of the WHO/UNISDR initiative Hospital Safe from Disasters campaign (2008-2009) to reduce disaster risk through more resilient healthcare facilities. Activities were organised, in Cambodia, Lao PDR, the Philippines and Viet Nam to target five physical and social resilience key issues: assessment of hospital vulnerability; resources for disaster management planning; capacity enhancement for preparedness and response; provision of technical guides for structural integrity of health facilities and advocacy for safe health facilities. These activities demonstrate that the WHO and UNISDR are interested in all aspects of resilience and the choice of their location indicates that improving the resilience of healthcare facilities is inexpensive. The article concluded that advocacy, capacity enhancement and availability of technical resources on emergency preparedness of the health sector must go hand in hand.


The ever-increasing number of natural hazards is affecting health and stretching healthcare facilities to their limits. Many healthcare facilities could not perform as were expected due to physical damage and inappropriate social performance. This themed issue aims to support decision makers, engineers and planners (in less exposed countries and countries with financial, awareness and expertise constraints but are at high risk) to identify the vulnerability of their existing facilities and ensure that new facilities are resilient enough to cope with the multiple adversities they face. The key messages it provides are existing healthcare facilities need to conduct resilience assessment to identify room for improvement; this assessment needs to inform planning and improvements.

Nebil Achour, Andrew D.F. PriceGuest Editors