How emergencies threaten health facilities and delivery of care
Apart from their effects on people, emergencies can pose huge threats to hospitals, clinics and other health facilities. Structural and infrastructural damage may be devastating exactly at the time when health facilities are most needed. Health workers have been killed in collapsing hospitals. The number of other deaths and injuries is compounded when a hospital is destroyed or can function only partially. Health facilities should be the focus for assistance when disaster strikes but, if they are damaged or put out of action, the sick and injured have nowhere to get help.
The 2003 Algerian earthquake rendered 50% of health facilities in the affected region non-functional due to damage. In Pakistan's most-affected areas during the 2005 earthquake, 49% of health facilities were completely destroyed, from sophisticated hospitals to rural clinics and drug dispensaries. The December 2004 Indian Ocean tsunami affected national and local health systems that provided health services for millions of people. In Indonesia's northern Aceh province 61% of health facilities were damaged.
Despite international laws, health facilities continue to be targeted or used for military operations in conflicts. Health facilities in Bosnia and Herzegovina, Somalia, the Central African Republic and the Gaza Strip are among those that have been caught in the line of fire.
An emergency may be limited to the health facility infrastructure – for example, fire damage, power cut or loss of water supply. Chemical and radiological emergencies in or near a health facility can also disrupt the delivery of care. In addition, emergencies threaten health staff – the doctors, nurses, ambulance drivers and other staff working to save lives. When a hospital collapses, or an artillery shell destroys a ward or an ambulance, health staff are killed or injured. When staff are incapacitated and cannot do their work, health care is further interrupted.
Even if health facilities themselves are not affected during disease outbreaks and epidemics, their services and provision of safe care may be. Increased demands for services and a decreased workforce can impact on health care by disrupting communications, supplies and transport. Continuity of care is then in turn disrupted, including for chronic diseases like HIV and tuberculosis.
If measures to prevent and control infection are not effective, health-care facilities may act as "amplifiers" of outbreaks, generating cases of the disease among other patients or health-care workers and further decreasing the capacity to provide services.
Power cuts linked to disasters may disrupt water treatment and supply plants, thereby increasing the risk of waterborne diseases and affecting proper hospital functioning, including preserving the vaccine cold chain. A massive power outage in New York in 2003 was followed by an increase in diarrhoeal illness.