Natural and man-made disasters affect people around the world every year, sometimes destabilizing regions for decades. In the wake of such events, medical professionals can find themselves in high-pressure situations and extreme personal danger, as they are made to uphold their Hippocratic Oath even in the face of adversity.
It’s not always a remote threat either. Staff may find their medical centre caught up in the middle of a crisis - from outbreaks of disease to natural disasters. And while the damage caused by most disasters is immediate, they can also create a recovery period just as fraught with dangers and complications. Diseases, water shortages, and prolonged political crises test medical institutions across the planet. Here’s our pick of 10 hospitals coping under extreme circumstances.
10. Motoyoshi Hospital, Japan
In the aftermath of the 8.9-magnitude earthquake that rocked Japan on March 11, 2011, the world’s attention focussed on the Fukushima Daiichi Nuclear Power Plant. The impact on the country’s wider infrastructure was just as dramatic. The coastal area of Tohoku lost nine hospitals and 68 clinics, and a further 53 hospitals and 327 clinics were severely damaged.
Total human losses eventually exceeded 20,000, and over a year later, the effects are still being felt. To the northwest of Fukushima, the Motoyoshi Hospital is just one of many facing a daily struggle to meet patients’ needs. On top of having no central heating and unreliable electricity supplies, their medical records are still caked with mud.
While the radiation risk is now considered slight, the lack of quality food and reliable electricity create serious health risks. However, the biggest challenge is posed by staff shortages in hospitals like Motoyoshi. As foreign help dwindled following the disaster, locals now have to cope with having only one physician for every 700 patients.
9. Keysaney Hospital, Somalia
Somalia has been a warzone for over two decades, affecting every part of the country and leaving the health care system struggling to deal with the consequences. While the country’s infrastructure has suffered greatly, including the destruction of hospitals, there are still signs of hope.
Located in north east Mogadishu, Keysaney Hospital has survived the hostilities and built on its success. Based in a former prison, the hospital has treated over 216,000 patients. In 2012, Keysaney’s 20th anniversary was marked with refurbishments and a new operating theatre.
Run by the Somali Red Crescent and supported by the ICRC, Keysaney struggled to cope with old equipment and large patient numbers. The new facilities will enable the hospital to improve on the 2,500 operations it currently performs each year.
8. Krabi Hospital, Thailand
A 9.0 earthquake - said to have released the energy of 23,000 atomic bombs - precipitated the epic December 26, 2004 Indian Ocean tsunami. The gargantuan tidal wave spread across the Indian Ocean, wreaking havoc from Sri Lanka to Indonesia.
For Thailand, this would go down in history as one of its worst ever natural disasters. As well as causing huge damage to property and the environment, the tsunami killed more than 5,000 people in Thailand alone. To address the massive influx of the injured, the Thai government established emergency medical centres, and it was at Krabi Hospital where many of the victims of the tsunami were treated.
In the midst of chaos, death and destruction, the hospital’s nursing and medical staff performed above and beyond, treating some 500 people by the end of that dark day. This amount exceeded its ‘worst case scenario’ planning, in no small part due to the hospital’s finely-tuned contingency plans which allowed for the treatment of 40 trauma victims in the case of a mass emergency.
In the coming days 1,357 victims were treated at the hospital, while a philanthropic effort on the part of both Thai and foreign volunteers ensured that the shell-shocked and wounded were provided with not just essentials like water, food and clothing, but ‘simple human comfort.’
7. Hudaida Regional Hospital, Yemen
Situated on the Arabian Peninsula, Yemen is racked with political and health crises and is one of the poorest Arab states. The Red Sea city of Hudaida has witnessed the effects of both. Anti-government demonstrations have left the city hospital in Yemen’s fourth biggest town full to capacity. Following an incident on March 16 2011, the hospital admitted over 200 wounded, some of whom alleged that security forces had followed them into the hospital and beaten them.
Recent years have also seen floods and droughts ruin crops, which has added to the growing humanitarian crisis. It was announced in 2011 that half a million Yemeni children were suffering from acute malnutrition. In addition, concerns continue over poor vaccination rates and the outbreak of disease. With much of the world’s attention focussed on the war on terrorism, hospitals like Hudaida find themselves at the centre of Yemen’s mounting internal crises.
6. Touro Infirmary, New Orleans, USA
When Hurricane Katrina hit south east Louisiana on August 29, 2005 it dealt a savage blow to New Orleans’ infrastructure, forcing the closure of many health centres. Even the city’s busiest public health care unit, 70-year-old Charity Hospital, was abandoned.
Touro Infirmary was the only emergency department that managed to remain open in the city during the disaster. And when the water supply ran dry, the infirmary was forced to dig its own well.
The medical centre was subsequently evacuated and reopened just a month later. As a result of the tragedy, institutions like Tuoro Infirmary are now far better prepared. But the effects of Katrina continue to be felt.
Before 2005, health care was one of New Orleans’ major private employers. Since the hurricane the number of health professionals and people with health insurance has fallen, while waiting times and mortality rates have risen.
5. Al-Shifa Hospital, Gaza, Palestine
Situated in the Rimal district of Gaza, al-Shifa Hospital has been embroiled in the on-going Israel/Palestine conflict since it was converted from a British army barracks in the 1940s. At times occupied, at others the only medical facility in Gaza, al-Shifa is now the area’s largest medical complex, taking in patients from all around the Gaza strip.
Throughout its turbulent history, the hospital has been overwhelmed by patients, with staff having to make critical decisions during predominantly human-inflicted crises. The hospital has tended patients for more than 70 years: most recently, through the Gaza War of the past decade and the 2012 airstrikes.
One such attack occurred on August 19, 2012, when, in response to an attack along the Egyptian border which left eight Israelis dead, Israel instigated an overnight airstrike in response, which injured five people and killed one teenager. Graphic photographs of patients arriving at al-Shifa vividly document the on-going conflict.
4. La Trinite Hospital, Haiti
A medical emergency program was established at La Trinite Hospital in Port au Prince in 2004. At the heart of a city fraught with violence, the Medecins Sans Frontieres-run free hospital in Port-au-Prince frequently admits victims with gun-shot wounds. The number of patients is staggering: doctors treated nearly 18,000 trauma cases in 2008.
Haiti’s healthcare system was already near breaking point. Then the January 2010 earthquake made everything even worse. The statistics were different but even more horrific: 222,000 deaths and 300,000 injuries.
Most health centres suffered damage themselves, not least Trinite, whose roof collapsed on a number of patients. However, the hospital continued to play a significant part in Medecins Sans Frontieres’ largest ever disaster response, as they quadrupled their field staff on the island.
La Trinite staff continued to treat emergency patients in tents and a converted shipping container. More than three years on from the disaster, health care in Port Au Prince remains in disarray.
3. Juarez General Hospital, Mexico
20 years ago, Ciudad Juarez was a quiet border town with a growing tourism industry. The past two decades have turned it into a battleground and filled its hospitals with gun and knife injuries.
After President Calderon launched a war on drug cartels in 2006, deploying 5,000 troops on the streets, Juarez has seen over 8,000 people killed in drug-related violence. Abductions of those considered wealthy are a daily occurrence, including doctors and nurses.
While many medical professionals have left and clinics are forced to close as a result, institutions that remain, like Juarez General, are patrolled by heavily armed guards.
In 2012 it was announced that homicides had halved in Juarez since 2010, but the direct cause and effect of this drop remains unclear. At present, Juarez is still one of the most dangerous places on earth for medical professionals.
2. Christchurch Hospital, New Zealand
In September 2012 the New Zealand government announced a $500 million redevelopment of Christchurch’s hospitals, just over a year and half after the earthquake that devastated the city.
The effect of the killer February 22, 2011 earthquake on the city’s health care infrastructure was significant: approximately 200 buildings and more than 1,200 rooms needed repair in the aftermath. In addition, the forced closure of two floors of Christchurch Hospital lost the city 106 beds.
Against incredible pressure, a recent review of the disaster in The Lancet found that the hospital had coped well under the circumstances, despite issues with water and power supply.
The hospital’s emergency department was forced to instigate outside triage areas when it became overwhelmed with patients. Following the disaster, orthopaedic injuries have become common and the hospital has reported a high demand for orthopaedic equipment and surgery.
1. Sardjito Hospital, Indonesia
Mount Merapi in central Java is revered by the local population, thousands of whom live on its fertile, lava-enriched slopes. But despite its large surrounding population, this ‘mountain of fire’ is actually one of the world’s most volatile volcanoes.
With eruptions occurring many times over the past two centuries, some of the area’s darkest days occurred in 2010 when 75,000 people were evacuated. Nearly 140 people were killed in just two weeks. And with air travel impossible, Yogyakarta Hospital, one of three nearby hospitals, was overwhelmed by the mounting casualties.
Many patients had inhaled volcanic vapour, and with a burn unit capable of providing just 10 beds, the hospital was forced to turn away patients with less than 40% burns while treating some with 95% burns.
But the natural disaster was only the start of the crisis, as sheltered populations swelled to 200,000 and poor sanitation and a lack of clean drinking water created new health concerns for the small hospital.
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