GCRI · Critical Infrastructure
Healthcare and emergency services
Hospitals, emergency dispatch, ambulances and fire and rescue services must work hardest when other infrastructure fails. They depend on power, water, medical gases, communications, fuel and staff who can reach work. This page sets out how these services lose function in a disaster, how facility safety and dependency are assessed, and what evidence serves the health and emergency authorities responsible for them.
How the work runs.
Asset criticality register
Healthcare and emergency services · Lifeline system A · Register v5
Critical assets
| SS-12 | Electricity | Tier 1 | Flood 1-in-100 | 9 |
| WTW-2 | Water | Tier 1 | Flood 1-in-100 | 41 |
| DX-1 | Telecom | Tier 2 | Heat | 6 |
| H-Campus | Health | Tier 1 | Earthquake | 63 |
| PN-3 | Transport | Tier 2 | Storm surge | n/a |
SS-12 dependencies
- Upstream
- Transmission L4, L7
- Downstream
- WTW-2, H-Campus, DX-1
- Restoration target
- 11 h
- Owner
- Asset owner
Dependency graph
red: SS-12 and its dependants
Restoration time by sector
Fig.Asset criticality register: example names and illustrative values, not a record or a live system.
Healthcare and emergency services: how the risk develops.
Essential facility dependencies. The dossier below sets out how the risk develops, what is measured, where the data come from, how it is modelled and who decides.
Hospitals run on other lifelines
Operating theatres, intensive care and laboratories need continuous power, water and medical gases. Backup buys time, and fuel, water storage and supplier contracts determine how much.
Non-structural failure stops care
Buildings may stand while equipment falls, ceilings collapse, pipes burst and lifts stop. Non-structural damage is a common reason for hospitals losing function after earthquakes.
Dispatch depends on networks
Emergency calls, radio and computer-aided dispatch depend on telecommunications and power. Outages and call surges can block access to help.
Access determines reach
Ambulances, staff and supplies need open roads. Floods, debris and traffic cut access to facilities even when the facilities themselves are intact.
Environmental exposure in Western Europe.
Population density, daytime surface heat, haze and true-colour imagery over Western Europe, from NASA GIBS. Each layer carries its own date.
The interactive map needs JavaScript; the layer list and sources are below.
Layers 4
Environmental exposure, for this page
Keyboard, with the map focused
Hold Ctrl or ⌘ and scroll to zoom
Latest available
NASA GIBS / EOSDIS · ASTER GDEM (METI, NASA) · Blue Marble (NASA) · © OpenStreetMap contributors (ODbL) · Natural Earth
Loading the latest NASA imagery.
Drag to move. Ctrl or ⌘ and scroll, pinch or the buttons to zoom; hover for the values under the pointer; reset returns to the region.
Environmental exposure, framed on Western Europe.Satellite and model products as NASA publishes them, each with its own date. They are indicators, not assessments of any place.
Data: NASA GIBS · ASTER GDEM · Blue Marble · © OpenStreetMap contributors · Natural Earth · NASA EONET · NASA HLS S30Sources and licences
- We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS). Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS). Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- Center for International Earth Science Information Network (CIESIN), Columbia University. 2018. Gridded Population of the World, Version 4 (GPWv4): Population Density, Revision 11. NASA Socioeconomic Data and Applications Center (SEDAC). Licensed under CC BY 4.0. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). doi:10.7927/H49C6VHW. CC BY 4.0
- VIIRS near-real-time products (flood, land surface temperature, snow cover, corrected reflectance), NASA LANCE; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- MODIS and VIIRS atmosphere products, NASA LANCE and LAADS DAAC; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- MODIS land products (vegetation indices, gross primary production, land cover), NASA LP DAAC and LANCE; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- ASTER GDEM is a product of METI and NASA (ASTER Global Digital Elevation Model V003, NASA LP DAAC); imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). Cite as: NASA/METI/AIST/Japan Spacesystems and U.S./Japan ASTER Science Team (2019). ASTER Global Digital Elevation Model V003. doi:10.5067/ASTER/ASTGTM.003. NASA open data
- Made with Natural Earth. Free vector and raster map data @ naturalearthdata.com. Public domain
- © OpenStreetMap contributors (ODbL), via NASA GIBS (coastlines, boundaries, roads and place names). Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). ODbL
- Blue Marble, NASA Earth Observatory; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- Context on the globe and flat map: coastlines, boundaries, roads and place names from NASA GIBS reference layers (OpenStreetMap data, ODbL, © OpenStreetMap contributors); Blue Marble imagery as an optional base; 3D terrain and the elevation read-out from the ASTER GDEM elevation colour index (5 m to 200 m classes, exaggerated for legibility). Boundaries are drawn as published and imply no position on any territory.
- Live events: NASA Earth Observatory Natural Event Tracker (EONET); events are indicative and keep their original source links.
- Live: NASA EONET Events are indicative, not authority warnings.
- Observed (EO): NASA HLS S30 (contains modified Copernicus Sentinel data 2026). We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS).
- NASA GIBS: We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS).
- Air quality forecast, 5 days, PM2.5 (CAMS via Open-Meteo): Contains modified Copernicus Atmosphere Monitoring Service information 2026.
- Past year, daily temperature (ERA5 via Open-Meteo): Contains modified Copernicus Climate Change Service information 2026.
- Weather data by Open-Meteo.com (https://open-meteo.com/), licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/).
- Optional layers (14 sources in the layer list: live, forecast, observed and context) print their provider credit on the map and here when switched on; forecasts are model output and derived indices are estimates.
Layers and dates
- Population density, 2020: Population: CIESIN, Columbia University, Gridded Population of the World v4.11 (2018), NASA SEDAC, CC BY 4.0 · static
- Land surface temperature, day, 8-day composite: VIIRS NOAA-20 Level 3, 8-day, NASA LANCE · 14 Sep 2026
- Aerosol optical depth, daily: VIIRS NOAA-20 Deep Blue AOD, NASA LANCE · 13 Oct 2026
- True colour: VIIRS NOAA-20 corrected reflectance, NASA LANCE · 13 Oct 2026
- Flood water, 3-day composite: VIIRS Global Flood Product, NASA LANCE · 14 Oct 2026
- Land cover type (IGBP), yearly: MODIS Terra and Aqua land cover (MCD12Q1), NASA LP DAAC · 2024
Health and emergency services depend on every lifeline.
- EnergyCouplingFacility power is a precondition of care.What to watchFacilities with reliable electricity
- WaterCouplingFacilities need safe water for care and sterilisation.What to watchWater storage at facilities
- HealthCouplingEmergency services coordinate surge across facilities.What to watchAmbulance and dispatch continuity
Facility studies are designed for the Country Systems Risk and Resilience series. The Hospital Safety Index (2015) and the 2023 joint report on electricity access in health-care facilities (WHO, World Bank, SEforALL and IRENA) set the evidence base.
- Facility safety assessments ministries publish.
- Service continuity in past events.
Model healthcare and emergency services as a system. Run the cascade.
Assembled from the Nexus Standards area profile Critical infrastructure and critical entities: the hazards it names, the systems and sectors that carry the loss, the controls that dampen it and the data that observe it. Choose the components, pick an initiating hazard and step through the cascade. The Map view places the run on an example geography with open data. Every coupling weight is a stated assumption you can change. A teaching model, not a forecast, an assessment or a certification. To model a place of your own choosing, open the full System Builder.
Hazards
- Dam failure
- River flood (set off downstream)
- Flash flood (set off downstream)
- Mass displacement (set off downstream)
- Widespread power outage (set off downstream)
- Water supply shortfall (set off downstream)
Systems and couplings
- Critical infrastructure and critical entities
- Energy risk standards Dependency
- Space weather, spectrum and timing risk standards Common-mode dependency
- Compound and cascading hazard standards Cascade
- Cyber resilience and digital operational resilience Common driver
Controls
NS-0Constitution and principlesNS-3Risk record UNIs (grammar, legacy crosswalk, allocation authority)NS-9Contextual UNIs (deployments, instances, programme instances)NS-10Policies and clauses (machine-readable obligations: definition, binding, evaluation and enforcement)NS-11Verification and monitoring (evidence, attestations, zero-trust conformance observation)NRS-H61Hazard family: Cascading failure (NHS-1 sys.cascade)NRS-H94Hazard family: Systemic cyber events (NHS-1 cyber.systemic-cyber)NRS-H107Hazard family: Digital infrastructure concentration and monoculture (NHS-1 tech.digital-concentration)NRS-K31Domain pack profile: Cyber national resilience (DOMAIN-031)NRS-K36Domain pack profile: Critical infrastructure (DOMAIN-036)NRS-K48Domain pack profile: Financial system resilience (DOMAIN-048)
Observation
- OpenStreetMap planet and replication (listed for reference)
- Global Power Plant Database (listed for reference)
- NASA Black Marble night-time lights (VNP46) (listed for reference)
- Global Human Settlement Layer (listed for reference)
- Damage to critical infrastructure attributed to disasters
- Number of disruptions to basic services attributed to disasters
- Proportion of the rural population who live within 2 km of an all-season road
Example geography
- Europe: 113 hexagonal cells
- Night lights tonight, outages (VIIRS Day/Night Band), NASA GIBS
- Surface water through cloud, 30 m (OPERA DSWx-S1 radar), NASA GIBS
- Rain rate, last half hour (IMERG), NASA GIBS
- Surface soil moisture (SMAP), NASA GIBS
What is measured, and how well.
Each indicator carries its unit, its cadence, the kind of source behind it and the evidence label a value would carry. No values are shown: a programme supplies them under its own authority.
| Indicator | Unit | Cadence | Source type | Label |
|---|---|---|---|---|
| Hospital Safety Index rating | safety category | per assessment | Hospital Safety Index assessments | Published statistics |
| Hospitals with backup power for critical areas | percent of hospitals | annual | Facility assessments | REPORTED |
| On-site water storage | hours of normal use | per facility | Facility records | DECLARED |
| Emergency call answer time | seconds | monthly | Dispatch centre records | OBSERVED |
| Facilities reachable during flood scenarios | percent of facilities | per scenario | Access modelling | MODELLED |
| Health facility functionality after events | percent fully functional | per event | WHO HeRAMS and assessments | REPORTED |
How healthcare and emergency services is modelled, measured and tested.
The model, its assumptions, its data and its uncertainty, in the form a scientist or engineer would check. Structures follow published methods. The values drawn are illustrative, not findings.
System model
The couplings between the systems in healthcare and emergency services: signs of influence, a reinforcing and a balancing loop, and cross-links where stress jumps.
Where the evidence comes from.
Named public datasets and institutional records, each with its licence class. Sources by agreement are used only under their terms and never republished.
| Source | What it gives | Licence class |
|---|---|---|
| WHO and PAHO Hospital Safety Index guide | Assessment method for structural, non-structural and emergency management safety | Public, WHO terms of use |
| WHO Health Resources and Services Availability Monitoring System (HeRAMS) | Facility functionality and services in emergencies | By agreement; public summaries |
| Healthsites.io | Locations of health facilities from OpenStreetMap | Open, ODbL |
| National master facility lists | Government registers of health facilities | Licence per ministry |
| Emergency services performance statistics | Response and call handling times where published | Public records, licence per authority |
Who decides, and what the evidence serves.
Critical Infrastructure prepares evidence. The decisions below are taken by the authorities named, under their own rules, and never by the platform.
| Who decides | The question | Evidence this page serves |
|---|---|---|
| Ministries of health | Which hospitals to strengthen, and in what order | Safety index results; dependency reviews |
| Hospital managers | Which backup systems and supplies to invest in | Endurance hours; non-structural safety evidence |
| Emergency services authorities | How to keep dispatch and response running in outages | Dispatch continuity reviews; access analyses |
Outputs this topic produces
- Dependency reviews of hospitals on power, water, gases and staff
- Access analyses for facilities under flood and debris scenarios
- Non-structural safety checklists linked to the Hospital Safety Index
- Dispatch continuity reviews
What experts ask.
- Which hospital functions stop first when power, water or communications fail?
- How long can essential facilities operate on their own reserves?
- How do staff access, supply deliveries and patient transport depend on other lifelines?
- How do surges in demand during disasters interact with reduced capacity?
- How are emergency call and dispatch systems protected against single points of failure?
Drivers and failure pathways.
A hospital is a dense cluster of dependencies. Life support, imaging, sterilisation, refrigeration, laboratory testing and electronic records all need power. Dialysis, sterilisation and sanitation need large volumes of water. Records, pharmacy systems and coordination need communications. Medicines, blood, oxygen and food arrive through logistics networks. When several lifelines fail at once, facilities can be forced to evacuate patients, which is itself dangerous.
Disasters both reduce capacity and increase demand. Injured people arrive while staff struggle to travel, and damage to buildings can make parts of a facility unusable. Emergency call centres and dispatch depend on telecommunications and power; their failure delays every response. Disaster experience across many countries has repeatedly shown that backup arrangements, rather than primary systems, determine whether facilities keep working.
Public health systems and their wider risks are studied at Health Nexus.
How it is studied.
- 01
Facility dependency assessment
Structured assessments record each critical function's dependencies, reserves and tolerable outage duration.
- 02
Structural and non-structural safety
Methods from structural and earthquake engineering assess whether buildings, equipment and utilities remain usable after earthquakes and storms.
- 03
Surge and access modelling
Simulation from optimisation and operations research and urban and transport engineering explores patient flows and staff access when networks are degraded.
- 04
Limits
Facility data is often confidential, backup systems are tested less than assumed, and demand surges are hard to predict. Clinical judgement remains outside the scope of engineering models.
How it is studied, and what the methods cannot say.
- 01Reliability and resilience engineeringResilience metrics for lifelines · Reliability analysis of networks · Restoration planningApplied here
- 02Structural and earthquake engineeringFragility of infrastructure components · Retrofit of critical structures · Post-event inspectionApplied here
- 03Communications and network technologyMission-critical communications · Backhaul diversity · Communication dependencies of operatorsApplied here
- 04Urban and transport engineeringNetwork criticality · Climate-resilient design · Disruption operationsApplied here
- 05Power systems engineeringContingency analysis · Hardening distribution networks · Black-start and restoration plansApplied here
Where this page's references lead.
The bodies and documents this page is read against. Status and editions change; each link goes to the issuing body.
Questions and answers.
What is a safe hospital?
What is non-structural damage?
Why do emergency services depend on telecommunications?
Are hospitals usually first in restoration priorities?
Does the platform give clinical guidance?
Why do backup systems matter so much?
Who reviews coverage of this topic?
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