Introduction

There is a widely held expectation that health care facilities are prepared to deal with emergency situations. The impact of past earthquakes and hurricanes has proven that hospitals and health care installations may be vulnerable and therefore rendered unable to respond.

During the last two decades more than one hundred hospitals in the Americas have reported severe disruption, if not total collapse, as a consequence of earthquakes. For instance, during the San Fernando, California, earthquake of 9th February 1971, four hospitals were damaged so severely that they were no longer operational just when they were most needed. Furthermore, the majority of deaths caused by that earthquake occurred in two of the hospitals which collapsed. It was an ironic feature of that earthquake that the most hazardous place to be in San Fernando was in a hospital!

In the Caribbean, hurricanes have caused severe damage to hospitals in Dominica, Jamaica, Montserrat, and St. Kitts. In Jamaica, some hospital buildings had to be evacuated because of damage by hurricane Gilbert in 1988.

There are indeed many similar examples worldwide in respect of earthquakes, hurricanes, and floods.