Pan American Health Organization
Regional Office of the
World Health Organization
News and Information for the International Disaster Community
Do we evacuate our hospitals prematurely?
Currently, when health facilities are evacuated after a disaster, often the reason is not solely the physical damage that occurs after an earthquake, hurricane, or any other natural catastrophe.
When health facilities are evacuated after a disaster, often the reason is not solely the physical damage that occurs after an earthquake, hurricane, or any other natural catastrophe. During recent disasters in Latin America and the Caribbean, many heath care facilities were completely evacuated when the actual damage did not merit such drastic action. Often the physical damage justified only a partial evacuation of the areas most affected by the disaster, and in some other cases, no evacuation was necessary at all.
This phenomenon is, in many ways, due to an assumption on the part of the health sector that they must be as prepared as possible in the face of a disaster. This assumption has led to the promotion of the idea that hospital emergency and disas- ter plans must include evacuation plans. The problem resides in the fact that the criteria for judging a successful evacuation plan after a simulation focused on deeming those hospitals which carried out the evacuation most quickly as the best quali fied. It is time to revise this narrow vision in light of recent events that have occurred around the world.
Photo C. Osorio, PAHO/WHO
The goal of evacuating a health care facility is to safeguard the health and lives of its occupants. However, if we define the purpose of a health care facility in the aftermath of a disaster, it is to ensure that the population affected by the disaster continues to receive the medical attention it requires, whether inside or outside the hospital. Generally there is an increase in the demands placed on the hospital (due to injuries, illness, etc.) in the hours and days that follow the disaster. In addition, it will take several weeks or even months to completely restore services in a hospital that has been evacuated. An unnecessary evacuation imposes a substantial loss in the quality and quantity of attention the health care system can provide to the population.
Thus, the decision to evacuate a health care facility is a strategic one that will have implications beyond how and where the evacuation takes place. One must consider how the health sector will be able to ensure that the population receives the attention it needs, taking into account that many people will require services that only a complex health care facility will be able to provide. Therefore, many times the decision to evacuate will also depend on whether or not the facility is the only functioning hospital in an area or whether it is part of a health services network.
Preliminarily, these questions should be considered before evacuating a health facility:
• Does the magnitude of the physical damage to the facility make its evacuation necessary? (This opinion should be based on results of vulnerability studies or on the criteria of experts in post-disaster assessments).
• Should the entire facility be evacuated? (In most cases it will be necessary to evacuate only part of the institution.)
• How can the provision of continuing health coverage be guaranteed for the population affected by the disaster?
• Where to evacuate? (Relocation to another health facility, another type of building or a makeshift field hospital.)
With regard to the use of temporary hospitals after natural disasters, special attention should be paid to those situations where it will be necessary to use them for several months or years. Many times these facilities do not meet minimum standards of hygiene and sanitation, in addition to being very expensive. Furthermore, on some occasions they pose health risks to their occupants, in which case the decision to evacuate defeats its own purpose of safeguarding the health of its occupants.
The decision to evacuate a health care facility should be closely tied to the magnitude of the damage to the hospital's physical infrastructure, but human factors such as the mental health of the occupants (patients and health workers) intervene as well. In some cases only fear and poor information make hospital personnel and the patients themselves risk their lives for an unnecessary evacuation.
In order to avoid this type of situation, it is necessary to strengthen the resiliency of health workers after a disaster. The best way to do this is to educate them about the facility's vulnerability before a disaster so they will be armed with the knowledge they need to respond when a disaster strikes.
The evacuation of health facilities in disaster situations has much more serious consequences than other types of evacuations such as a fire alarm. Hospital evacuations should be a last resort-a measure taken to preserve the health of the patients and the overall population. Other steps can and should be taken before disaster strikes to reduce the physical vulnerability of the buildings, develop appropriate emergency and disaster plans for hospitals, and educate administrative and professional personnel about the buildings' true vulnerability in the face of disasters.
Avoiding, when possible, the evacuation of a health care facility in the aftermath of a disaster, and consequently preserving its operation, is the best way to ensure an adequate level of health care and medical attention for the population.
Gender and Disasters
The collection and dissemination of information on this important topic is one way to increase awareness.
Many experts and practitioners in the development and disaster reduction arena seem to agree that a focus on gender is a key ingredient of successful community development and disaster management programs. There is no doubt that the absence of gender awareness on the part of project planners can explain why some community develop- qualiment and disaster prevention initiatives fail, in spite of substantial investments of time and money.
Photos J. Jenkins, PAHO/WHO
Following natural disasters, most assistance is directed toward providing roofs or food or controlling disease epidemics. This is, of course, extremely important. However gender-based mitigation responses can also help in the reconstruction of a healthy social fabric and increase the community’s resilience. Gender-tailored actions are just as important during complex disasters, such as the displacement of large segments of the population, which fosters an increase in domestic violence and alcoholism.
There is an urgent need to bring this approach closer to all involved actors, local NGOs and government agencies. One way to do this is to make information available from anywhere, to anyone through free web-based services such as those offered by CRID.
The Regional Disaster Information Center has assembled an international collection of documents on their web site: http://www.crid.or.cr/. These include topics such as a survey of compliance with UNHCR’S policies on refugee women, children, and the environment; food aid and gender in emergencies; mainstreaming gender in unstable environments, and more. To access these documents, click on "Other topics of interest" on the right hand side of the home page. Do you have other documents on gender and disasters to add to this collection? Please send them to CRID at the address on page 8.