The Global Centre for Risk and Innovation (GCRI)
Hospitals and clinics must stay safe, standing and functioning when they are needed most: in earthquakes, floods, storms, heat, fires and conflict. Their resilience depends on location, on the structure, on non-structural elements such as equipment and utilities, and on how quickly they recover after damage. This page sets out how facilities fail and recover, how their safety is assessed, and what the evidence serves for the institutions that build and operate them.
GCRI · Established · service level R0
A safe hospital is a health facility whose services remain accessible and functioning at maximum capacity during and immediately after a disaster, in the WHO and PAHO definition. Its safety depends on location, structure, non-structural elements such as equipment and utilities, and emergency management. The Hospital Safety Index assesses all three.
How far each division sits from a large city, with the roads and airports that carry patients and supplies, shown for the Philippines as an example geography for this subject.
The working screen behind this subject: its structure, terms and states. Names are placeholders and values illustrative.
Healthcare infrastructure · Province B · Month 10
| Oral rehydration salts | 1.0 | 5 | 6 | Low |
| First-line antibiotic | 0.7 | 14 | 12 | Low |
| Insulin | 4 | 4 | 10 | Adequate |
| Rapid diagnostic tests | 0.3 | 6 | 7 | Critical |
Facility resilience and recovery. The dossier below sets out how the risk develops, what is measured, where the data come from, how it is modelled and who decides.
Facilities built on flood plains, low coasts, unstable slopes or near active faults carry that hazard for their whole working life. Siting decisions made decades earlier constrain what retrofitting can achieve.
A building can stand while care stops: generators flood in basements, ceilings and medical gas lines fall, equipment topples and water tanks rupture. Non-structural elements fail at lower hazard intensities than structures and are cheaper to protect.
A hospital depends on roads for staff and patients, and on grid power, water mains, telecommunications and supply deliveries. A facility undamaged by a flood can still be unreachable or without water.
After damage, recovery depends on assessment, repair finance, procurement and staff returning. Temporary facilities and referral to other sites bridge the gap, and recovery time differs by facility and by service line.
Each term as this page uses it. Where a standard-setting body defines the term, the wording follows that body.
| Term | Definition |
|---|---|
| Hospital Safety Index | A WHO and PAHO tool that rates a facility's structural, non-structural and emergency management safety and its likelihood of functioning in emergencies. |
| Non-structural elements | Equipment, utilities, partitions, ceilings and supplies whose failure can stop care even when the building stands. |
| Master facility list | An authoritative register of health facilities with identifiers, locations and service details. |
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 category | safety category from the index | per assessment | Hospital Safety Index assessments | OFFICIAL |
| Facilities in hazard zones | count of facilities by hazard class | per update | Facility locations on hazard maps | ESTIMATED |
| Facility functionality after an event | percent of facilities fully, partially or not functioning | per event | HeRAMS and rapid assessments | REPORTED |
| Population losing access after an event | persons beyond a travel-time threshold | per event | Access models with damaged roads and facilities | MODELLED |
| Time to restore services | days by service line | per event | Facility recovery records | REPORTED |
| Attacks on health care | incidents; facilities affected | continuous | WHO Surveillance System for Attacks on Health Care | REPORTED |
| Deferred maintenance and retrofit backlog | cost of deferred works, local currency | annual | Capital asset registers | OFFICIAL |
The topic as a computational graph: named sources feed the methods, an evidence review gates the outputs, and the decisions stay with the authorities that hold them.
Fig. 02Nodes carry their type, two metric rows and a state; connectors show what feeds what; dashed frames name the owners; the timeline is the cadence. Design of the pipeline, not a record of a run.
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 |
|---|---|---|
| National master facility lists | Authoritative facility identifiers, locations and service types | By agreement; some published as open data |
| Healthsites.io | Open map of health facilities built on OpenStreetMap | Open Database Licence (ODbL) |
| WHO HeRAMS | Facility status, damage and service availability in emergencies | By agreement; public summaries |
| WHO Surveillance System for Attacks on Health Care | Attacks on facilities, transport, personnel and patients in emergencies | Public dashboard, WHO terms of use |
| Copernicus Emergency Management Service | Rapid damage and flood mapping after disasters | Free and open, attribution |
| GEM global seismic hazard map | Seismic hazard for assessing facility exposure | Attribution, non-commercial, share-alike (CC BY-NC-SA) |
| JRC global river flood hazard maps | River flood extent and depth by return period | Free and open, attribution |
Health Nexus 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 and capital planning units | Where to build, relocate or retrofit facilities, and in what order | Exposure profiles; Hospital Safety Index results; access loss scenarios |
| Hospital boards and facility managers | Which non-structural and utility protections to fund first | Dependency maps; failure modes by hazard; recovery times by service line |
| Disaster management agencies | Which facilities will remain reachable and functioning in an event, and where to send patients | Access loss scenarios; facility functionality reports |
| Humanitarian health clusters and WHO country offices | Where temporary facilities and mobile services are needed after damage or attack | HeRAMS functionality; attacks on health care; population without access |
Infrastructure questions follow a hazard through a building to a service.
Hospitals can lose function without structural collapse. Non-structural damage, such as fallen equipment, broken pipes or failed lifts, and the loss of utilities are common causes of evacuation. Overheating can make wards and operating theatres unusable and damage medicines and equipment.
Recovery depends on the availability of engineers, parts and temporary facilities, and on the condition of the surrounding area. Facilities built decades ago may not reflect current hazard knowledge, and hazard patterns are changing with the climate, so siting and design decisions made now will be tested by conditions different from the past.
| Method or data | What it shows | Limits |
|---|---|---|
| Hazard exposure mapping of facilities | Which facilities sit in hazard zones | Facility location and attribute data can be incomplete |
| Structural and non-structural assessment | How buildings and systems would perform | Requires on-site inspection and engineering expertise |
| Fragility and functionality models | Likely loss of function at given hazard intensities | Models generalize from limited observed damage |
| Post-event damage and recovery studies | What actually failed and how long recovery took | Each event is different; lessons need careful transfer |
The current service level is R0: information and enquiries. An enquiry receives a reference and names the next step; applications, payments, compute allocations and registrations open only when their team, terms and review capacity exist.