The Aga Khan Development Network has always worked in areas of the world susceptible to natural disasters: in the seismically active and landslide affected mountain areas of South and Central Asia, in the flood and typhoon prone coastal areas of East Africa and South Asia, and in places that are regularly victim to drought and famine. Climate change is likely to increase the frequency and severity of these natural disasters.
In a hundred years of activity, Aga Khan Institutions and their personnel have experienced many such disasters firsthand. We have seen and felt the human, physical and financial cost of catastrophes. However these difficult experiences have also taught us the value of investing in disaster preparedness, mitigation, and response.
We see the United Nations International Strategy for Disaster Reduction’s World Campaign for Hospitals Safe from Disasters as a useful tool in making sure that we all understand the need to be better prepared. In any disaster situation, the ability to maintain functioning health services is a matter of life and death. The success of a disaster preparedness effort depends on our ability to ensure that health facilities can perform three vital functions:
• To protect the lives of patients and health workers by ensuring the structural resilience of health facilities;
• To ensure that health facilities and services are able to function in the aftermath of emergencies and disasters; and
• To improve the ability of health workers and institutions, to react to and manage emergency situations.
I would like to offer a few observations on these objectives, based on the experience of the AKDN, which owns and operates more than 200 private-not-for profit health facilities including 12 hospitals, as well as 300 schools, and numerous other institutions. The AKDN also provides technical assistance and support to government facilities and systems in a total of 19 countries in South and Central Asia, Africa and the Middle East.
Our experience has taught us to view disaster preparedness and mitigation as core components of our overall development approach. In the Network, we use the term mitigation to describe the measures incorporated into physical infrastructure that increase its ability to withstand the worst effects of natural disasters. We use the term preparedness to describe the community’s ability to plan for and react to these disasters. We have learnt that preparedness and mitigation are not marginal activities – they are fundamental, cost-effective, and they save lives.
All AKDN buildings are built to withstand the seismic risk of their individual locations - “Code +2” or simply put - exceeding the required safety standards. In the last five years we have initiated a survey that includes every single Network building in a risk area, mapping those risks and evaluating the resilience of each building.
We intend to ensure that every AKDN building will withstand the effects of natural disasters.
Since 1983 the AKDN has developed and employed state-of-the-art technologies, including modified versions of older seismic resistant, low-cost techniques in the construction of its health and education facilities. The Network has ensured that the technologies are not only used, but acquired and adopted by the communities in which we work, thus spreading the benefits of these simple, locally-available disaster mitigation techniques.
We have also initiated a programme to stock key facilities with essential food, water and medical supplies, as well as communication systems, for use during and after emergencies. Furthermore, we have developed training programmes for communities at risk and health workers so that they are able to use these facilities and react to natural disasters.
These facilities therefore can also serve as safe havens.
Access to clean water is another critical component of post-disaster response as it prevents the spread of communicable disease. This is why communal water-distribution systems should also be built to withstand natural disasters.
We are currently endeavouring to build access to transportation to all our programme areas, including safe helipads that would ensure rapid evacuation of victims and distribution of essential supplies.
Let me share with you the AKDN experience in Kashmir, where we have been implementing a multi-input programme since the devastating earthquake of 2005 in the Chakama Valley in Pakistan and the Uri Block in India. In the particular programme areas assigned to us, all health units and schools had been partially or totally destroyed. When reviewing the aftermath, we thought it would be irresponsible to rebuild the health clinics and schools without first obtaining a better understanding of the levels of seismic risk for each institution. Resisting the pressures to rebuild this critical infrastructure quickly, we commissioned a series of micro-zoning and geotechnical studies to evaluate the safety of their original locations, and to identify safer sites if necessary.
This allowed us to categorise the overall programme areas by levels of relative risk and to identify the types and probability of localized hazards such as flooding and landslides.
This analysis provided other concrete benefits:
Firstly, we were able to demonstrate to the governments that many of the original clinics and schools should never have been built at their original sites. Along with this, the very sad experience of having a newly built health facility wash away in a mudslide led the Pakistani Government to issue a decree stating that no public buildings could be reconstructed before a risk assessment had been undertaken for any proposed site.
Secondly, sharing our risk assessments with local communities allowed us to discuss and develop a disaster preparedness programme. Indeed, after they acquired a better understanding of the potential risks to their health facilities and schools, communities in both the Indian and Pakistani programme areas donated safer land to the reconstruction of the public buildings.
Thirdly, the seismic analyses have enabled us to design and build new health facilities and schools incorporating seismically resistant features responding to the conditions of the site.
What happens inside a health facility is more important than the physical building itself. Ensuring that health facilities and services are able to function in the aftermath of emergencies and disasters is only possible if the health system functions well before disasters strike.
In many critical situations, air access is the only means of reaching stricken areas and it is essential that as much information as possible is made available to the air services, such as the availability of fuel, coordinates of landing areas, access to spare parts etc. This is particularly critical in the interfacing between military and civilian infrastructure.
The private sector can play an important role in strengthening health systems and in developing technologies and programmes that promote disaster mitigation and preparedness. AKDN’s efforts to re-establish the health system in disaster-affected areas has allowed us to interact closely with local and central governments to introduce better clinical and preventive programmes. We believe that these activities have positive impacts on the health status of the affected communities. Partnerships between the public and private sectors in healthcare can provide new dimensions of complementary and collaborative work aimed at improving people’s health.
The experience of our Network underscores the need for new thinking that emphasizes disaster preparedness and mitigation as well as supporting the continued functioning of critical health facilities and systems. These are the means to save lives and to reduce destruction to infrastructure and livelihoods. In our areas of operation, disasters have taken place and will certainly occur in the future. We believe that we have developed some robust means to prepare for and to ease the effects of future disasters. We also know that implementing these measures is cost-effective and essential to safeguarding investments in infrastructure and human life.
When a disaster strikes, many look to the government and the international inter-governmental and non-governmental agencies. However the private sector’s involvement on both preparedness and response is equally important.
As I wrap up, let me emphasise once more that perhaps one of the most vital lessons the Aga Khan Development Network has learned in the field is that disaster resistant health facilities, staffed with well trained personnel and capable of functioning in a situations where all else seems to fail, are key to saving lives. Helping the world understand that is a noble cause. I wish much success to this campaign.