Making health facilities safe in disasters

When the Indian Ocean tsunami struck Aceh on 26 December 2004, it left about 170,000 dead and thousands more injured.



But along with the houses and bridges washed away by the massive swell, more than half the 240 hospitals and health facilities were destroyed or badly damaged and 700 of the province’s 9,800 health workers dead or missing, according to the World Health Organization (WHO) in Indonesia. As a result, more than 20,000 patients had to wait up to 10 days before being admitted to a hospital.



“These damaged facilities lost their capacity to protect and cater to the needy during those emergency periods as health facilities and health professionals too became victims of the disaster,” said Subhash R Salunke, country representative for the world health body in Indonesia, at a seminar in Jakarta on making hospitals safe in emergencies, the global theme of 2009 World Health Day on 7 April.

 

“The tragedy of a major emergency or disaster is compounded when health facilities fail,” WHO Director-General Margaret Chan said in a statement issued to commemorate the day. “When a hospital collapses or its functions are disrupted, lives that depend on emergency care can be lost,” she said.

 

“Emergency Hypermarket”

 

The vulnerability of Indonesia, which sits on the boundaries of four moving tectonic plates and the “ring of fire” with 126 active volcanoes, to natural disasters makes this global campaign all the more urgent.

 

From 2004 to 2008, the country suffered 771 different emergencies and disasters that killed about a quarter of a million people, injured almost a million and left more than four million displaced, according to the Ministry of Health.

 

“On average, Indonesia has five earthquakes a day measuring above five on the Richter scale,” Lucky Tjahjono, head of the Ministry of Health’s Emergency Preparedness and Response Unit, told the seminar.

 

“Recently, we also had the dam collapse in Situ Gintung. That is why, as we used to say, Indonesia has an ‘emergency hypermarket’ - more than a supermarket.”

 

Healthcare structures are not immune. The three major natural disasters in recent years - the tsunami and the earthquakes in Nias and Yogyakarta - left at least 713 hospitals and health facilities badly damaged, according to WHO-Indonesia.

 

Toward safer health facilities

 

To address the problem, the WHO campaign is advocating a series of best practices - such as using early warning systems and good site planning - to ensure the healthcare system is better prepared for emergencies.

 

There are low-cost solutions for ensuring structural integrity, so that health facilities do not collapse during earthquakes or cyclones, WHO Regional Director for Southeast Asia, Samlee Plianbangchang, said in a statement.

 

He added that lifelines such as water and electricity must be backed up to ensure health facilities remain functional during disasters, and that the workforce should be trained to deal with emergencies and carry out contingency plans.

 

Indonesia has nine regional crisis centres designed to reduce the vulnerability of a 230-million population on 17,000 islands, Tjahjono said.

 

But as Aryono Pusponegoro of 118 Emergency Ambulance Service Foundation told the seminar, it is “impossible to manage disasters and mass casualties properly” as even “day-to-day emergency care in Indonesia is not up to standard”.

 

Nevertheless, SKM Mudjiharto, director of community empowerment for the National Disaster Management Agency, said Indonesia was shifting its focus from disaster response to disaster risk reduction.

 

“Indonesia is committed to improving its disaster management system,” he said.

 

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