This article was adapted, with permission, from Zeballos 1993b.
Latin America and the Caribbean have not been spared their share of natural disasters. Almost every year catastrophic events cause deaths, injuries and enormous economic damage. Overall, it is estimated that the major natural disasters of the last two decades in this region caused property losses affecting nearly 8 million people, some 500,000 injuries and 150,000 deaths. These figures rely heavily on official sources. (It is quite difficult to obtain accurate information in sudden-onset disasters, because there are multiple information sources and no standardized information system.) The Economic Commission for Latin America and the Caribbean (ECLAC) estimates that during an average year, disasters in Latin America and the Caribbean cost US$1.5 billion and take 6,000 lives (Jovel 1991).
Table 1 lists major natural disasters that struck countries of the region in the 1970-93 period. It should be noted that slow- onset disasters, such as droughts and floods, are not included.
Table 1. Major disasters in Latin America and the Caribbean, 1970-93
|
Year |
Country |
Type of |
No.of deaths |
Est. no. of |
|
1970 |
Peru |
Earthquake |
66,679 |
3,139,000 |
|
1972 |
Nicaragua |
Earthquake |
10,000 |
400,000 |
|
1976 |
Guatemala |
Earthquake |
23,000 |
1,200,000 |
|
1980 |
Haiti |
Hurricane (Allen) |
220 |
330,000 |
|
1982 |
Mexico |
Volcanic eruption |
3,000 |
60,000 |
|
1985 |
Mexico |
Earthquake |
10,000 |
60,000 |
|
1985 |
Colombia |
Volcanic eruption |
23,000 |
200,000 |
|
1986 |
El Salvador |
Earthquake |
1,100 |
500,000 |
|
1988 |
Jamaica |
Hurricane (Gilbert) |
45 |
500,000 |
|
1988 |
Mexico |
Hurricane (Gilbert) |
250 |
200,000 |
|
1988 |
Nicaragua |
Hurricane (Joan) |
116 |
185,000 |
|
1989 |
Montserrat, |
Hurricane (Hugo) |
56 |
220,000 |
|
1990 |
Peru |
Earthquake |
21 |
130,000 |
|
1991 |
Costa Rica |
Earthquake |
51 |
19,700 |
|
1992 |
Nicaragua |
Tsunami |
116 |
13,500 |
|
1993 |
Honduras |
Tropical storm |
103 |
11,000 |
Source: PAHO 1989; OFDA (USAID),1989; UNDRO 1990.
Economic Impact
In recent decades, ECLAC has carried out extensive research on the social and economic impacts of disasters. This has clearly demonstrated that disasters have negative repercussions on social and economic development in developing countries. Indeed, the monetary losses caused by a major disaster often exceed the total annual gross income of the affected country. Not surprisingly, such events can paralyze affected countries and foster widespread political and social turmoil.
In essence, disasters have three kinds of economic impacts:
- direct impacts on the affected population’s property
- indirect impacts caused by lost economic production and services
- secondary impacts that become apparent after the disaster—such as reduced national income, increased inflation, foreign trade problems, heightened financial expenses, a resulting fiscal deficit, decreased monetary reserves and so on (Jovel 1991).
Table 2 shows the estimated losses caused by six major natural disasters. While such losses might not seem particularly devastating for developed countries with strong economies, they can have a serious and lasting impact on the weak and vulnerable economies of developing countries (PAHO 1989).
Table 2. Losses due to six natural disasters
|
Disaster |
Location |
Year(s) |
Total losses |
|
Earthquake |
Mexico |
1985 |
4,337 |
|
Earthquake |
El Salvador |
1986 |
937 |
|
Earthquake |
Ecuador |
1987 |
1,001 |
|
Volcanic eruption (Nevado del Ruiz) |
Colombia |
1985 |
224 |
|
Floods, drought (“El Niño”) |
Peru, Ecuador, Bolivia |
1982-83 |
3,970 |
|
Hurricane (Joan) |
Nicaragua |
1988 |
870 |
Source: PAHO 1989; ECLAC.
The Health Infrastructure
In any major disaster-related emergency, the first priority is to save lives and provide immediate emergency care for the injured. Among the emergency medical services mobilized for these purposes, hospitals play a key role. Indeed, in countries with a standardized emergency response system (one where the concept of “emergency medical services” encompasses provision of emergency care through the coordination of independent subsystems involving paramedics, fire-fighters and rescue teams) hospitals constitute the major component of that system (PAHO 1989).
Hospitals and other health care facilities are densely occupied. They house patients, personnel and visitors, and they operate 24 hours a day. Patients may be surrounded by special equipment or connected to life-support systems dependent on power supplies. According to project documents available from the Inter-American Development Bank (IDB) (personal communication, Tomas Engler, IDB), the estimated cost of one hospital bed in a specialized hospital varies from country to country, but the average runs from US$60,000 to US$80,000 and is greater for highly specialized facilities.
In the United States, particularly California, with its extensive experience in seismic-resistant engineering, the cost of one hospital bed can exceed US$110,000. In sum, modern hospitals are highly complex facilities combining the functions of hotels, offices, laboratories and warehouses (Peisert et al. 1984; FEMA 1990).
These health care facilities are highly vulnerable to hurricanes and earthquakes. This has been amply demonstrated by past experience in Latin America and the Caribbean. For example, as table 3 shows, just three disasters of the 1980s damaged 39 hospitals and destroyed some 11,332 hospital beds in El Salvador, Jamaica and Mexico. Besides damage to these physical plants at critical times, the loss of human life (including the death of highly qualified local professionals with promising futures) needs to be considered (see table 4 and table 5).
Table 3. Number of hospitals and hospital beds damaged or destroyed by three major natural disasters
|
Type of disaster |
No. of hospitals |
No. of beds lost |
|
Earthquake, Mexico (Federal District, September 1985) |
13 |
4,387 |
|
Earthquake, El Salvador (San Salvador, October 1986) |
4 |
1,860 |
|
Hurricane Gilbert (Jamaica, September 1988) |
23 |
5,085 |
|
Total |
40 |
11,332 |
Source: PAHO 1989; OFDA(USAID) 1989; ECLAC.
Table 4. Victims in two hospitals collapsed by the 1985 earthquake in Mexico
|
Collapsed hospitals |
||||
|
General hospital |
Juarez hospital |
|||
|
Number |
% |
Number |
% |
|
|
Fatalities |
295 |
62.6 |
561 |
75.8 |
|
Rescued |
129 |
27.4 |
179 |
24.2 |
|
Missing |
47 |
10.0 |
– |
– |
|
Total |
471 |
100.0 |
740 |
100.0 |
Source: PAHO 1987.
Table 5. Hospital beds lost as a result of the March 1985 Chilean earthquake
|
Region |
No. of existing hospitals |
No. of beds |
Beds lost in region |
|
|
No. |
% |
|||
|
Metropolitan Area |
26 |
11,464 |
2,373 |
20.7 |
|
Region 5 (Viña del Mar, Valparaíso, |
23 |
4,573 |
622 |
13.6 |
|
Region 6 (Rancagua) |
15 |
1,413 |
212 |
15.0 |
|
Region 7 (Ralca, Meula) |
15 |
2,286 |
64 |
2.8 |
|
Total |
79 |
19,736 |
3,271 |
16.6 |
Source: Wyllie and Durkin 1986.
At present the ability of many Latin American hospitals to survive earthquake disasters is uncertain. Many such hospitals are housed in old structures, some dating from Spanish colonial times; and while many others occupy contemporary buildings of appealing architectural design, lax application of building codes makes their ability to resist earthquakes questionable.
Risk Factors in Earthquakes
Of the various types of sudden natural disasters, earthquakes are by far the most damaging to hospitals. Of course, each earthquake has its own characteristics relating to its epicentre, type of seismic waves, geological nature of the soil through which the waves travel and so on. Nevertheless, studies have revealed certain common factors that tend to cause death and injuries and certain others that tend to prevent them. These factors include structural characteristics related to building failure, various factors related to human behaviour and certain characteristics of nonstructural equipment, furnishings and other items inside buildings.
In recent years, scholars and planners have been paying special attention to identification of risk factors affecting hospitals, in hopes of framing better recommendations and norms to govern the building and organization of hospitals in highly vulnerable zones. A brief listing of relevant risk factors is shown in table 6. These risk factors, particularly those related to the structural aspects, were observed to influence patterns of destruction during a December 1988 earthquake in Armenia that killed some 25,000 people, affected 1,100,000 and destroyed or severely damaged 377 schools, 560 health facilities and 324 community and cultural centres (USAID 1989).
Table 6. Risk factors associated with earthquake damage to hospital infrastructure
|
Structural |
Non-structural |
Behavioural |
|
Design |
Medical equipment |
Public information |
|
Quality of construction |
Laboratory equipment |
Motivation |
|
|
Office equipment |
Plans |
|
Materials |
Cabinets, shelves |
Educational programmes |
|
Soil conditions |
Stoves, refrigerators, heaters |
Health care staff training |
|
Seismic characteristics |
X-ray machines |
|
|
Time of the event |
Reactive materials |
|
|
Population density |
|
|
Damage on a similar scale occurred in June 1990, when an earthquake in Iran killed about 40,000 people, injured 60,000 others, left 500,000 homeless, and collapsed 60 to 90% of buildings in affected zones (UNDRO 1990).
To address these and like calamities, an international seminar was held in Lima, Peru, in 1989 on the planning, design, repair and management of hospitals in earthquake-prone areas. The seminar, sponsored by PAHO, Peru’s National University of Engineering and the Peruvian-Japanese Center for Seismic Research (CISMID), brought together architects, engineers and hospital administrators to study issues related to health facilities located in these areas. The seminar approved a core of technical recommendations and commitments directed at carrying out vulnerability analyses of hospital infrastructures, improving the design of new facilities and establishing safety measures for existing hospitals, with emphasis on those located in high-risk earthquake areas (CISMID 1989).
Recommendations on Hospital Preparedness
As the foregoing suggests, hospital disaster preparedness constitutes an important component of PAHO’s Office of Emergency Preparedness and Disaster Relief. Over the last ten years, member countries have been encouraged to pursue activities directed toward this end, including the following:
- classifying hospitals according to their risk factors and vulnerabilities
- developing internal and external hospital response plans and training personnel
- developing contingency plans and establishing safety measures for the professional and technical hospital staffs
- strengthening lifeline backup systems that help hospitals to function during emergency situations.
More broadly, a principal aim of the current International Decade for Natural Disaster Reduction (IDNDR) is to attract, motivate and commit national health authorities and policy-makers around the world, thereby encouraging them to strengthen the health services directed at coping with disasters and to reduce the vulnerability of those services in the developing world.
Issues Concerning Technological Accidents
During the last two decades, developing countries have entered into intense competition to achieve industrial development. The main reasons for this competition are as follows:
- to attract capital investment and to generate jobs
- to satisfy domestic demand for products at a lower cost and to alleviate dependency on the international market
- to compete with international and subregional markets
- to establish foundations for development.
Unfortunately, efforts made have not always resulted in obtaining the intended objectives. In effect, flexibility in attracting capital investment, lack of sound regulation with respect to industrial safety and environmental protection, negligence in the operation of industrial plants, use of obsolete technology, and other aspects have contributed to increasing the risk of technological accidents in certain areas.
In addition, the lack of regulation regarding the establishment of human settlements near or around industrial plants is an additional risk factor. In major Latin American cities it is common to see human settlements practically surrounding industrial complexes, and the inhabitants of these settlements are ignorant of the potential risks (Zeballos 1993a).
In order to avoid accidents such as those that occurred in Guadalajara (Mexico) in 1992, the following guidelines are suggested for the establishment of chemical industries, to protect industrial workers and the population at large:
- selection of appropriate technology and study of alternatives
- appropriate location of industrial plants
- regulation of human settlements in the neighbourhood of industrial plants
- security considerations for technology transfer
- routine inspection of industrial plants by local authorities
- expertise provided by specialized agencies
- role of workers in compliance with security rules
- rigid legislation
- classification of toxic materials and close supervision of their use
- public education and training of workers
- establishment of response mechanisms in case of emergency
- training of health workers in emergency plans for technological accidents.