Foreword

Just over ten years ago, a powerful earthquake hit Mexico City, causing thousands of deaths and injuries. The health infrastructure suffered terrible losses. Patients and their families, physicians, nurses, and emergency health personnel were killed when hospitals collapsed; health services needed during this crisis could not function. We have seen these tragedies repeated in Chile, Costa Rica, Ecuador, El Salvador, Panama, and other countries prone to seismic activity.

It is not just earthquakes that have taught us these lessons. The Caribbean frequent!! suffers through hurricanes. In 1995, health centers and hospitals in the Eastern Caribbean were seriously damaged by Hurricane Luis; in many cases they were the same facilities that were damaged by Hurricane Hugo seven years earlier.

The health sector of these countries cannot allow such losses to be repeated' and the technical know-how exists to lessen the impact of such events on health facilities. There are strong economic reasons for applying disaster mitigation measures in new constructions and in existing buildings. However, when resources are scarce, budgets for maintenance are often the first to be cut; cost- or time-saving construction methods are used and choices are made that can he very costly in the long-term.

In 1990, PAHO/WHO began a program to strengthen national efforts to increase the disaster resistance of new and existing health facilities. Guidelines and pilot projects were developed to analyze the vulnerability of existing health facilities. In February 1996, at the invitation of the Government of Mexico, and with the support of numerous agencies, PAHO convened the International Conference on Disaster Mitigation in Health Facilities in Mexico City.

The objectives of the Conference were:

· To define concrete measures to reduce the impact of earthquakes and hurricanes on the physical plant, lifeline services, and equipment in health facilities in order to ensure that they continue to operate without interruption after a disaster;

· To establish regional goals that include identifying which existing hospitals have the greatest priority for vulnerability studies and necessary retrofitting, as well as applying mitigation standards in new constructions, from now until the year 2001;

· To contribute to the work of Governments of the Region in giving high priority to adopting disaster mitigation measures in health facilities, and assign, within national budgets, funds for these measures.

While there has been progress, much more needs to be done to convince decision-makers that reducing the health sector's vulnerability to natural disasters is an essential part of national planning. The Conference Recommendations presented in these Proceedings reflect the commitment of Governments, institutions, and individuals to work toward the goal of reducing the loss of life, material damage, and the social and economic disruption caused by natural disasters.

George A.O. Alleyne
Director
PAHO