Building to Last
Reflections on the International Day for Disaster Risk Reduction
Last Sunday, October 13th, was noteworthy for two reasons. First, it was the International Day for Disaster Risk Reduction and second, it marked 6 weeks since Hurricane Dorian first struck Abaco Island in the Bahamas on September 1st. Hurricane Dorian would go on to ravage Abaco Island and Grand Bahama over the course of the next several days, levelling critical public infrastructure and leaving over 70,000 Bahamians homeless. Multiple clinics on Grand Bahama were destroyed or catastrophically damaged, and 80% of the general hospital in Freeport was flooded with 2+ feet of water. Sanitation and water systems outside of the city of Freeport were compromised by sea water flooding and sewer leakage. A major oil spill on the Western end of the island will likely have public and environmental health consequences for decades to come.
To us at Build Health International, Hurricane Dorian is emblematic of the need for emboldened action to understand and respond to the critical linkages between natural disaster, health infrastructure, and health equity. In the context of climate change, especially, there can be no compunction in efforts to build resilient, high-quality health infrastructure and systems in low- and middle-income countries (LMICs). According to the UN Climate Summit held in September 2019, 91% of disasters have been caused by climate-related events, the frequency and intensity of which are accelerating. Since 2015, an average of 412 health facilities per year have been damaged or destroyed by small- and medium-scale natural disasters (note that this number excludes damage as a result of large-scale disasters, like Dorian). Furthermore, climate-related disasters are most likely to affect low- and middle-income countries, particularly the poorest and most vulnerable populations therein.
Resilient, high-quality, and climate-smart healthcare infrastructure is critically important in this context. A hospital, for example, must be designed, constructed, and equipped such that it cannot only withstand floodwaters, high winds, and seismic activity, but can also provide emergency and standard care even when inundated with patients following a disaster. Certainly, other ‘vertical’ elements of health systems strengthening -such as adequate health worker staffing and training, and consistent supply chains for medications and consumables- are also essential to this response. But Build Health International believes that the facility stands as the literal foundation to both emergency response and standard care delivery.
These sentiments are echoed in the World Health Organization’s 2015 Comprehensive Safe Hospital Framework. Here, the WHO points out that efforts in LMICs to conduct facility assessments, retrofit existing facilities, and implement resilient design in new facilities “have been sporadic and insufficiently integrated into government plans for development and emergency response”. Particularly for Ministries of Health in low-resource contexts, already operating on shoestring budgets, the WHO’s directive often presents a catch-22: it’s too expensive to build or rebuild, but also too expensive not to amidst the growing threat of disaster.
Build Health International is committed to supporting partners in low-resource settings to achieve resilient health infrastructure at the lowest possible cost and with attention to sustainable clinical and operational planning. Following Hurricane Dorian, an assessment team from Build Health International -consisting of a structural and civil engineer, Master Plumber, site work expert, and public health practitioner- completed a full damage assessment of the hospital and clinics on Grand Bahama island, and provided critical recommendations for renovation and rebuilding. BHI is eager to further support the Ministry of Health in rebuilding several clinics, and building these clinics back better. From solar grid design and installation, to facilities assessments and master planning, to a full suite of architecture, engineering, and construction services, BHI works in partnership with Ministries of Health and NGOs in 15 countries to build resilient, risk-reducing health infrastructure — infrastructure that is undoubtedly #BuiltToLast
