Making hospitals safe in emergencies/Gaza – WHO report (excerpts)

SAVE LIVES.

Make hospitals safe in emergencies.

Emergencies:

global and local impact

Wars, cyclones, earthquakes, tsunamis, disease outbreaks, famine,

radiological incidents and chemical spills – all are emergencies that,

invariably, impact heavily on public health.

Internal emergencies in health facilities – such as fires and loss of power or water – can damage buildings and equipment and affect staff and patients. In conflicts, reasons for hospital breakdowns include staff being forced to leave due to insecurity and the looting of equipment and drugs.

In 2008, 321 natural disasters killed 235 816 people – a death toll that was almost four times higher than the average annual total for the seven previous years. This increase was due to just two events. Cyclone Nargis left 138 366 people dead or missing in Myanmar, and a major earthquake in south-western China’s Sichuan province killed 87 476 people, according to the United Nations’ International Strategy for Disaster Reduction (UNISDR). Asia, the worst-affected continent, was home to nine of the world’s top 10 countries for disaster-related deaths. Along with other weather-related events, floods remained one of the most frequent disasters last year, according to UNISDR. Conflicts around the globe have also led to great human suffering and have stretched health care services to the extreme.

Disasters also exact a devastating economic toll. In 2008, disasters cost an estimated US$ 181 billion – more than twice the US$ 81 billion annual average for 2000–2007. The Sichuan earthquake was estimated to cost some US$ 85 billion in damages, and Hurricane Ike in the United States cost some US$ 30 billion. “The dramatic increase in human and economic losses from disasters in 2008 is alarming. Sadly, these losses could have been substantially reduced if buildings in China, particularly schools and hospitals, had been built to be more earthquakeresilient.

An effective early warning system with good community preparedness could have also saved many lives in Myanmar if it had been implemented before Cyclone Nargis,” said Salvano Briceno, the director of the UNISDR Secretariat.

Although only 11% of the people exposed to natural hazards live in developing countries, they account for more than 53% of global deaths due to natural disasters. The differences in impact suggest there is great potential to reduce the human death toll caused by natural disasters in developing countries – and that the key ingredient in these tragedies is human inaction.

This is only one part of the picture. There are many smaller-scale events that inflict an even greater toll in terms of human suffering, such as in the case of vehicle accidents and fires. Road traffic crashes kill 1.2 million people annually, or more than 3200 people a day, while a further 20–50 million people are injured or disabled every year. At least 90% of road and fire fatalities occur in low- and middle-income countries. There are also 300 000 deaths each year from fires alone.

How emergencies threaten

health facilities and delivery of care

Apart from their effects on people, emergencies can pose huge threats to hospitals, clinics and other health facilities.

Structural and infrastructural damage may be devastating exactly at the time when health facilities are most needed. Health workers have been killed in collapsing hospitals. The number of other deaths and injuries is compounded when a hospital is destroyed or can function only partially. Health facilities should be the focus for assistance when disaster strikes but, if they are damaged or put out of action, the sick and injured have nowhere to get help.

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Despite international laws, health facilities continue to be targeted or used for military operations in conflicts. Health facilities in Bosnia and Herzegovina, Somalia, the Central African Republic and the Gaza Strip are among those that have been caught in the line of fire.

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Gaza Strip

Even before the first casualties in the three week crisis that began in December 2008 came into hospitals, Gaza’s health system was ready for action. “The Ministry of Health had an integrated plan in place for all health facilities that assigned a role to each person,” said Dr Mohammed Al-Kashif, director-general of hospital services and head of emergency operations for the Gaza Strip.  Off-duty health staff had to report for work as soon as they received word of the commencement of hostilities.  "Within the first two hours we gathered more than 600 staff, including doctors, nurses, paramedics, operating room technicians and administrative staff to help the system cope with the initial shock.  In the first day, we received more than 350 casualties, many of whom died despite our efforts."

Dr Al-Kashif said the key needs for any emergency preparedness and management plan are to have well-trained staff, good working relations with other health providers in the community (NGOs, private sector, UN agencies and ICRC), the ability to expand operating room and intensive care unit space, readiness to decentralize control to local levels in case of a disruption of central command, and communications systems (particularly wireless radio) to guarantee communication during the crisis.

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