Volume 11, Issue 3 (Autumn 2025 2025)
JMIS 2025, 11(3): 251-256 |
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ahmadizadeh fini A, ahmadizadeh fini E. Resilience of Iranian Hospitals against Disasters: An Evidence Based Gap Abstract. JMIS 2025; 11 (3) :251-256
URL: http://jmis.hums.ac.ir/article-1-636-en.html
URL: http://jmis.hums.ac.ir/article-1-636-en.html
Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Abstract: (639 Views)
Human societies have become increasingly affected by both natural and man‑made disasters in recent years. Due to its location on the Alpine‑Himalayan seismic belt, its climatic diversity, and the high population density in cities such as Tehran, Iran is recognised as one of the world’s disaster‑prone countries. Earthquakes, floods, droughts, and chemical incidents are among the threats that could impose a major crisis on the nation’s health system. Under such circumstances, hospitals play an undeniable and vital role as the first and most important line of defence for saving the lives of the injured.
However, effective hospital functioning during a disaster is not limited solely to the strength of the building structure. Global experience has shown that many hospitals fail to provide services during disasters – not because of structural collapse – but due to deficiencies in non‑structural safety (e.g., emergency power supply, communication systems, fuel and water reserves) and functional safety (e.g., response plans, triage, staff training, and recovery plans). It is essential to note that non‑structural and functional safety are necessary prerequisites for achieving hospital resilience against disasters. In other words, without securing these two components, health system resilience is meaningless.
Unfortunately, solid evidence indicates an alarming situation regarding these two areas in Iranian hospitals. While attention is mainly focused on structural safety, research findings show that the most significant gaps lie in non‑structural and functional safety – the two areas directly related to continuity of service delivery during a crisis.
According to a study conducted in three selected hospitals in Ahvaz, the average functional safety was only 30.81%, and non‑structural safety was 59.17%. Based on the World Health Organization classification, this functional safety score requires immediate action to protect the lives of patients and staff (1). This finding is thought‑provoking because hospital performance during a crisis depends more on operational response plans, alternative communication systems, emergency financial resources, and staff training than on the robustness of the building frame. The Ahvaz study also identified critical weaknesses in fuel storage systems, fire protection systems, internal communication systems, and water storage capacity (1).
A more comprehensive study conducted in Tehran province on 165 hospitals deepens this concern. Although the overall average for disaster risk management was 69.35%, the lowest scores were assigned to the post‑disaster performance analysis standard (average 59.9%) and the post‑disaster recovery plan (average 58.5%) (2). In other words, even after conducting drills, Iranian hospitals do not systematically analyse their performance and have no plan for returning to normalcy after a crisis. This represents a clear policy gap: emphasis on immediate response rather than on sustainable preparedness and planned recovery.
Improving non‑structural and functional safety is not an end goal but the first step toward achieving genuine hospital resilience. Without these prerequisites, any planning for health system resilience will fail. The Tehran study also showed that military and social security hospitals obtained the highest scores in preparedness, response, and recovery standards, while private hospitals obtained the lowest scores (2).
A comparative review of the health systems of Iran, Iraq, and Afghanistan indicates that despite Iran’s progress in disaster risk reduction, a significant gap remains in non‑structural and functional safety compared with international standards. The study emphasises that countries in the Eastern Mediterranean region, due to natural and technological hazards and high levels of vulnerability, need to integrate disaster risk reduction measures into all phases of disaster management programmes (3).
International experiences confirm these findings. A study conducted in Luksumawhe, Indonesia – an area with high disaster risk – using the same Hospital Safety Index (HSI) tool showed that although the studied hospitals were generally in category A (optimal safety), fuel storage systems and fire protection indicators were identified as the most vulnerable points (4). Interestingly, these are exactly the same weak points reported in the Ahvaz study (1). This consistency of findings in two different countries indicates that weaknesses in fuel storage and fire protection systems are a global and common challenge in hospitals located in disaster‑prone areas and require special attention from policymakers. The Indonesian study also emphasises that the Hospital Safety Index (HSI) is an effective tool for identifying shortcomings and guiding improvements in hospital preparedness (4). Therefore, domestic and international evidence consistently show that investing in non‑structural and functional safety is the most fundamental action to improve hospital resilience against disasters.
Thus, based on the evidence presented, immediate policy action is needed along the following three axes:
However, effective hospital functioning during a disaster is not limited solely to the strength of the building structure. Global experience has shown that many hospitals fail to provide services during disasters – not because of structural collapse – but due to deficiencies in non‑structural safety (e.g., emergency power supply, communication systems, fuel and water reserves) and functional safety (e.g., response plans, triage, staff training, and recovery plans). It is essential to note that non‑structural and functional safety are necessary prerequisites for achieving hospital resilience against disasters. In other words, without securing these two components, health system resilience is meaningless.
Unfortunately, solid evidence indicates an alarming situation regarding these two areas in Iranian hospitals. While attention is mainly focused on structural safety, research findings show that the most significant gaps lie in non‑structural and functional safety – the two areas directly related to continuity of service delivery during a crisis.
According to a study conducted in three selected hospitals in Ahvaz, the average functional safety was only 30.81%, and non‑structural safety was 59.17%. Based on the World Health Organization classification, this functional safety score requires immediate action to protect the lives of patients and staff (1). This finding is thought‑provoking because hospital performance during a crisis depends more on operational response plans, alternative communication systems, emergency financial resources, and staff training than on the robustness of the building frame. The Ahvaz study also identified critical weaknesses in fuel storage systems, fire protection systems, internal communication systems, and water storage capacity (1).
A more comprehensive study conducted in Tehran province on 165 hospitals deepens this concern. Although the overall average for disaster risk management was 69.35%, the lowest scores were assigned to the post‑disaster performance analysis standard (average 59.9%) and the post‑disaster recovery plan (average 58.5%) (2). In other words, even after conducting drills, Iranian hospitals do not systematically analyse their performance and have no plan for returning to normalcy after a crisis. This represents a clear policy gap: emphasis on immediate response rather than on sustainable preparedness and planned recovery.
Improving non‑structural and functional safety is not an end goal but the first step toward achieving genuine hospital resilience. Without these prerequisites, any planning for health system resilience will fail. The Tehran study also showed that military and social security hospitals obtained the highest scores in preparedness, response, and recovery standards, while private hospitals obtained the lowest scores (2).
A comparative review of the health systems of Iran, Iraq, and Afghanistan indicates that despite Iran’s progress in disaster risk reduction, a significant gap remains in non‑structural and functional safety compared with international standards. The study emphasises that countries in the Eastern Mediterranean region, due to natural and technological hazards and high levels of vulnerability, need to integrate disaster risk reduction measures into all phases of disaster management programmes (3).
International experiences confirm these findings. A study conducted in Luksumawhe, Indonesia – an area with high disaster risk – using the same Hospital Safety Index (HSI) tool showed that although the studied hospitals were generally in category A (optimal safety), fuel storage systems and fire protection indicators were identified as the most vulnerable points (4). Interestingly, these are exactly the same weak points reported in the Ahvaz study (1). This consistency of findings in two different countries indicates that weaknesses in fuel storage and fire protection systems are a global and common challenge in hospitals located in disaster‑prone areas and require special attention from policymakers. The Indonesian study also emphasises that the Hospital Safety Index (HSI) is an effective tool for identifying shortcomings and guiding improvements in hospital preparedness (4). Therefore, domestic and international evidence consistently show that investing in non‑structural and functional safety is the most fundamental action to improve hospital resilience against disasters.
Thus, based on the evidence presented, immediate policy action is needed along the following three axes:
- Revision of accreditation standards: Give more weight to functional safety components (especially the recovery plan, post‑incident performance analysis, and alternative communication systems) and require private hospitals to comply with these standards.
- Reinforcing critical systems as a high priority: Considering the common findings of the Ahvaz and Indonesian studies, fuel storage systems and fire protection should be considered the first priority for corrective actions (1 and 4).
- Regional cooperation and experience sharing: As suggested by the review study, establishing a network of disaster risk reduction experts at the regional level and utilising the successful experiences of countries such as Indonesia in using the HSI tool can help formulate evidence‑based policies (3 and 4).
Type of Study: Letter to editor |
Subject:
Special
Received: 2025/08/30 | Accepted: 2025/09/21 | Published: 2025/12/21
Received: 2025/08/30 | Accepted: 2025/09/21 | Published: 2025/12/21
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