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close this book Disaster mitigation guidelines for hospitals and other health care facilities in the Caribbean
View the document Table of contents
Open this folder and view contents Chapter 1: Scope and objectives
Open this folder and view contents Chapter 2: The nature of natural hazards in commonwealth Caribbean countries
Open this folder and view contents Chapter 3: The critical nature of health care facilities in disaster mitigation
Open this folder and view contents Chapter 4: Design considerations for natural hazards
Open this folder and view contents Chapter 5: Designing new health care facilities for multiple hazards
Open this folder and view contents Chapter 6: Retrofitting of health care facilities for multiple hazards
View the document Annex 1: modified Mercalli intensity scale
View the document Annex 2: sample form for vulnerability analysis
View the document Annex 3: checklist
View the document References
View the document Recommended reading

Disaster mitigation guidelines for hospitals and other health care facilities in the Caribbean





This document represents a collaborative effort of engineers and health sector administrators. PAHO wishes to acknowledge the following persons, whose technical input resulted in the valuable publication: Mr. Tony Gibbs, Director of Consulting Engineers Partnership, Ltd. in Barbados; Mr. Jose Grases, Director of Coral '83, an engineering consulting firm in Caracas, Venezuela; and Mr. James Williams, retired Director of the Queen Elizabeth Hospital in Barbados. Dr. Jean Luc Poncelet, the Pan American Health Organization's Subregional Disaster Adviser for the Caribbean coordinated the preparation of this publication.

This publication has been made possible thanks to the generous financial support of the Overseas Development Administration of the U.K., the Canadian International Development Agency, and the Office of U.S. Foreign Disaster Assistance of USAID.


The Commonwealth Caribbean Countries are at risk to many natural hazards including hurricanes and earthquakes. Within the last few years, they have been subjected to two major hurricanes that have caused severe damage to health care facilities. Particularly devastating was the damage done to hospitals throughout Jamaica by hurricane Gilbert in 1988, and to the main hospital in Montserrat by hurricane Hugo in 1989.

The costs of restoration of these facilities have already run into millions of United States dollars, at a time when almost all of these countries are experiencing adverse economic pressures, and when some have already entered economic structural adjustment arrangements with the International Monetary Fund. Many governments are finding it extremely difficult to meet their budgeted recurrent expenditures, and except for Trinidad and Tobago, are becoming increasingly dependent on tourism as their principal source of income and the main prop for their economies.

On the other hand, funds are being received for major capital projects in the service sectors of governments, mainly by grants and loans from international agencies. In particular, funding for capital projects for the restoration, retrofitting and expansion of hospitals is being made available to many of these countries either by the Inter-American Development Bank or the European Economic Community.

A major consideration when executing these capital projects must be to ensure that any construction and retrofitting of facilities be done in such a way that they not only achieve their primary health objectives, but also minimize adverse impact on the future earnings and recurrent expenditures of governments. This can only be accomplished by utilizing design and construction techniques which will make the facilities adequately resistant to damage by any type of hazard, and which can be cost-effectively and affordably maintained and managed.

Only within the last decade has systematic consideration being given in the Commonwealth Caribbean Countries to designing and constructing health care facilities to withstand the impact of natural hazards. Among them, hurricanes and earthquakes have been particularly destructive during historical times.

It is difficult to design buildings to withstand the dynamic actions due to both high winds and strong ground shaking because the effects of their respective forces on building structures are markedly different. There are, however, well established cost-effective design and construction techniques that are available for reducing property losses due to these hazards. Appropriate standards are contained in the Caribbean Uniform Building Code which is currently called CUBIC. This code was formally accepted by the Caribbean Council of Ministers of Health in 1988, but is not yet mandatory in any of these countries.

This booklet is consistent with the philosophy and aims of CUBIC. It identifies and explains in layman's terms the characteristics to be considered in the design and construction of buildings in order to effectively resist both hurricanes and earthquakes, and highlights critical and cost-effective factors in order to reduce the vulnerability. It is intended to help health and hospital administrators, as well as construction and maintenance personnel, to understand design and construction requirements in order to adequately mitigate the hazards of hurricanes and earthquakes threatening health care facilities. It also provides them with a basic knowledge to communicate sensibly, viligantly and purposefully with the architects, engineers, and contractors involved in the construction, restoration, and retrofitting of their facilities.


1. The CUBIC code for building construction should be made mandatory in all Commonwealth Caribbean Countries.

2. Health service administrators and construction and maintenance personnel should have at least a basic knowledge of the engineering requirements for hazard-resistant construction.

3. Vulnerability analyses should be carried out on all health service buildings.

4. Performance specifications should be part of purchasing procedures for critical hospital equipment.

5. Hospital disaster preparedness plans should be revised where necessary to include response procedures for earthquakes, and should also include vulnerability analysis as part of the requirements for retrofitting of the facility.

6. Disaster response exercises should be mandatory for hospitals and should he held at least once a year.

7. Countries without hazard evaluations in respect of earthquakes, hurricanes, and floods should seek to obtain this information as soon as possible for use in the vulnerability analyses.

8. Hospitals should keep available in safe custody updated architectural and engineering drawings of their buildings.