NRRC interview feature: hospital safety in Nepal

1. Why is hospital safety important in DRR?

This is an important issue because hospitals play a lifesaving role in responding to large-scale, sudden onset disasters such as earthquakes.

It is really important that central, regional and district hospitals in Nepal have the capacity to undertake mass casualty management including surgical intervention, that they have well-practiced and clearly understood emergency plans in place and the resources to put those plans into practice.

We know from other big disasters around the world that hospitals that have experienced personnel trained in emergency management, with the proper medical equipment and supplies, save lives in the crucial immediate post disaster response phase.

2. How can we ensure hospital safety in Nepal?

In a crisis it is important that hospitals are able to continue to provide care to their existing caseload of hospitalised patients while being able to receive and treat new admissions.

But we all know that hospital infrastructure in Nepal is in poor condition with the majority of hospitals likely to collapse in an earthquake. A survey by NSET over ten years ago identified that 80% of assessed hospitals were in the ‘poor performance’ category for newly constructed buildings while the remaining 20% deemed at high risk of life-threatening collapse.

Given the ever-present earthquake risk in Nepal, we need to ensure that hospitals are structurally sound and able to withstand a high magnitude earthquake. We need to work collectively to understand the risk and build resilience. If we get this right we can ensure that hospitals not only remain standing, but can operate immediately after a major disaster.

3. How is the DFID-funded vulnerability assessment of hospitals different from ones in the past?

The assessment builds on the work undertaken by NSET in 2002. However, in assessing the structural and operational integrity of up to 60 hospitals across Nepal, this assessment will be far more comprehensive.

This isn’t just about undertaking ‘another’ survey. The DFID-funded seismic experts are working with various government ministries (MoHP, MoPPW, MoUD and DUDBC) and local construction companies to build Nepali capacity in construction practice, retrofitting techniques, inspection, monitoring, quality assurance and quality control of materials.

Our aim is to support Nepali construction expertise, rather than international contractors, to undertake the structural surveys and prepare the retrofitting plans.

4. What is the assessment process and why is it important to have such detailed assessments?

The DFID-funded assessment aims to identify the structural and operational vulnerability of key hospitals across Nepal. The assessment will consider both the structural susceptibility of hospitals, particularly the likelihood of their collapse during an earthquake of a certain magnitude, and operational elements such as maintaining electrical and water supplies, waste management and staff availability. The assessment builds on the work on “non-structural” safety that DIPECHO have funded in hospitals such as TUTH.

The initial assessment of 60 hospitals, which will include several priority hospitals in the Kathmandu Valley identified during a MoHP/ WHO consultation in 2010, will be narrowed down to 20 hospitals that require detailed structural and operational surveying. From this, retrofitting designs and budgets will be developed for 10 hospitals. Of course, in some instances the assessment will identify that hospitals will need to be completely reconstructed rather than just retrofitting existing buildings.
This final list of hospitals will be considered at a donor conference later in 2013 to consider the financing of retrofitting and reconstruction work. The plan is to mobilise sufficient resources to proceed with retrofitting and reconstruction works.

5. Who is involved with the assessment process?

Well, to start with, the 60 hospitals selected for the assessment. The process to identify these hospitals has been thorough and inclusive and endorsed by both MoHP as well as a Cross-Ministerial Advisory Group charged with overseeing the assessment process.

The structural aspects of the assessment will be conducted by specialist Nepali sub-contractors with oversight provided by a renowned international seismic engineering group. Both national and international contractors were selected following a rigorous and transparent tendering process. The structural and operational assessment will be carried out at the same time. The operational assessment work will be led by the World Health Organisation and MoHP in keeping with their commitment to Flagship 1 of the Nepal Risk Reduction Consortium.

6. When will this assessment be completed?

We are hoping to complete the initial assessment by mid-2013. We also hope to “fast track” a number of the larger hospitals for full structural surveys during this period.

7. What will the outcome of this assessment be and what are the important steps to take thereafter?

By the end of the assessment process, we will have detailed plans for retrofitting and operational needs for 10 hospitals. It is exciting work and we are hopeful that, through the donor conference, we will be able to attract other donors to fund hospital safety efforts. Hospital safety is a crucial aspect of disaster risk reduction in Nepal and we expect the assessments to help the Government to prioritise hospitals for retrofitting and to bring in new partners to support this work.

I am also hopeful that DFID will be able to announce additional resources to fund the retrofitting of two of the priority hospital projects. So watch for updates and future announcements!

8. Why is this an important project for DFID?

The UK recognises Nepal’s vulnerability and, in particular, the damage that would result from an earthquake striking the Kathmandu Valley. For this reason, DFID is working in partnership with the Government of Nepal and the international community to support ways of either preventing or at least mitigating the impact of earthquakes and a range of other hazards including floods and landslides. We are supporting a comprehensive, multi-year programme that combines material outputs, such as the structural assessment of hospitals and the rebuilding of schools affected in the 2011 earthquake, with improved planning and preparedness at the community, district, regional and central levels.

The assessment of hospitals is a key component of the UK’s broader earthquake resilience support to Nepal.