The impact of a large scale earthquake in the Kathmandu Valley will be devastating. The latest estimates suggest that an 8 magnitude earthquake would kill 100,000 people, injure 200,000 and displace 1.8 million. The response to this crisis will be immense and complex, which is why preparedness and risk reduction is critical.
A key priority in Nepal is the preparation of health facilities for emergency response. With such a large number of injuries expected, immediate health response will be critical to saving lives. Unfortunately, the safety and preparedness levels of public and private health facilities has been limited in Nepal. This is beginning to change with increased focus on health sector preparedness under the lead of the Ministry of Health and Population (MoHP).
Hospitals are one of the essential institutions that must continue to function when an emergency strikes. The Nepal Risk Reduction Consortium has prioritized hospital safety in recognition of the critical role hospitals will play in saving lives immediately after a disaster. This work is being coordinated by MoHP and the World Health Organization (WHO). In a broader term, hospital safety entails structural, non-structural and functional safety of the hospital buildings, facilities and services
Simply put, structural safety is about making sure the hospital building can withstand an earthquake. While the concept is simple, the execution is complex. Many public and private hospitals are not built according to earthquake safe standards which means they must be retrofitted to improve their performance during earthquake shaking. However, retrofitting hospitals is very resource intensive exercise and it will be difficult to achieve in absence of dedicated resource, time and expertise. Another complicating factor for the retrofitting project is the continuity of service during retrofitting operations.
The MoHP, WHO and DfID are working to address the issue of structural safety. Currently, a detailed assessment with the retrofit design of priority ten hospitals is underway. The information obtained from this assessment will allow donors to justify investment in hospital retrofitting work. In the meantime, the Government has invested in ensuring Patan Hospital is earthquake resistant.
Non-structural and functional safety of hospital remains equally important. It includes the safety of medical and laboratory equipment, lifelines (oxygen, electricity, water supply) and architectural elements (such as ceilings, windows and doors). These elements are crucial to the daily operation of hospitals and if these are damaged, they would not be able to function and may even cause physical injury to patients and personnel. Similarly functional elements such as human resource, logistics and medical supplies and utilities, standard operating procedures and mass casualty management plans and procedure etc need to be in place all the times for hospitals to continue its services in an immediate aftermath of disaster.
A consortium of WHO, Handicap International, Oxfam and Save the Children has been implementing an earthquake preparedness project funded by the European Commission (ECHO) to support MoHP in enhancing non-structural and functional safety of the selected hospitals in the Kathmandu Valley. The Consortium successfully implemented two cycles of 18 months projects and has achieved a considerable progress during the last cycles in term of developing the health emergency policy guidelines, strategies and plans, establishing Health Emergency Operation Center (HEOC), developing training modules on health sector disaster risk management including non-structural assessment and mitigation of key central level referral hospitals such as TUTH, Civil Service, Patan and Bhaktapur hospitals.
In the previous 2 phases of the project, Consortium supported MoHP to develop (1) National Mass Casualty Management Strategy (2) Guideline on the Design of Disaster Resilient Hospital and Health Facilities (3) Emergency Referral Guidelines (4) Guidelines on Roster and Early Deployment Mechanism and (5) Trauma Protocols on Medical, Surgical, Nursing and Rehabilitation Management of Spinal Cord Injuries, Amputation, Open Fracture, Head and Burn Injuries.
Building on this work, the consortium (under the new cycle of ECHO funded project) aims to improve functional capacity of the health system during emergency by establishing a Health Incident Command System (ICS) under the MoHP, strengthening hospital networks comprising public and private health institutions (hub hospitals), integrating disaster preparedness activities in the municipality development plans and conducting awareness activities at the community level.
The scale of the disaster is immense and saving lives will be crucial in the immediate aftermath. This can only be done if public and private health facilities are part of the response effort. The work done now in health sector preparedness will go a long way in saving lives when the disaster does strike.
The EU Parliament Delegation to Nepal visits the EU funded project on health sector crisis preparedness for earthquake in Kathmandu valley
The EU Parliament Delegation to Nepal, led by Ms. Jean Lambert, the Chair, European Parliament Delegation for the relations with South Asia including the members of European Parliament (Mr. Cristian Dan Preda, Mr. Afzal Khan, Mr. Thomas Mann), members of European Parliament General Secretariat (Mr. Philippe Kamaris and Ms. Kristin Arp) and Political Group Advisor Ms. Sabine Meyer, visited the Ministry of Health and Population (MoHP) and Tribhuvan University Teaching Hospital (TUTH) on April 10, 2015.
The Delegation met with the Minister of Health and Population Mr. Khaga Raj Adhikari at MoHP. During the meeting, the Minister thanked the European delegation “…for supportive collaboration in health sector preparedness in Nepal.” Putting the visit into perspective, the Minister reflected that “the meeting reminds us of the common concern that we all share for the safety and security of life and property in the face to disaster, particularly the destructive ones.” Finally he hoped that “with continued support and collaboration, we will continue to make a difference.”
Mr. Toya Subedi (DIPECHO Coordinator for WHO Consortium) briefed the Delegation on earthquake risk and vulnerability in the Kathmandu Valley and its public health implication. Dr. Guna Raj Lohani (Chief of Curative Service Division/ MoHP) made a presentation on health sector preparedness initiatives and priorities of MoHP. On the occasion, WHO Representative to Nepal, Dr. Lin Aung, highlighted on the importance of health sector preparedness for country like Nepal and briefed the delegation on the comparative advantage of WHO Consortium for EU supported earthquake preparedness initiatives. The meeting was also attended by the Country Director of Save the Children and acting Country Director of Oxfam.
During the discussion, the EU delegation enquired about public awareness of earthquake risks, transportation and communications challenges during flash flood and earthquake, and enforcement of building codes for earthquake safety. Chief of Curative Service Division/MoHP and the representatives from WHO Consortium answered the queries of the Delegation.
The Delegation also observed Health Emergency Operations Centre (HEOC) at MoHP. HEOC is designed to serve as a high-level command centre in the event of health emergency and it hosts essential resources and data for effective coordination and response during emergencies.
After MoHP, the EU Delegation visited Tribhuvan University Teaching Hospital (TUTH) and observed the prepositioning of emergency medical and surgical supplies and non-structural mitigation measures applied in the hospital through EU support following a short presentation by Prof. Dr. Pradeep Vaidhya on the status of hospital preparedness for emergency.
Honorable Mr. Khaga Raj Adhikari, Minister of Health and Population (right) and Ms. Jean Lambert, Chair, European Parliament Delegation for the relations with South Asia (left).
The EU Parliament Delegation to Nepal, along with the representatives from WHO, DIPECHO, Handicap International, Oxfam and Save the Children, and Director of Department of IT at TUTH.