Safe hospitals in disaster situations and challenges for resilient health systems

Abstract

Hospitals represent critical infrastructure whose operational capacity during disasters determines the response capacity of the healthcare system. This article systematically reviews the published evidence on the dimensions that characterize hospitals as safe and resilient in the face of disasters. A structured search was conducted in PubMed, Scopus, and Web of Science, identifying 347 potential articles, of which 40 met the inclusion criteria for qualitative analysis. Four core dimensions emerged: (1) assessment and mitigation of structural and non-structural risks, where damage to non-structural components is the main cause of hospital disruption; (2) staff preparedness, with evidence supporting simulation-based training over purely theoretical formats; (3) operational continuity and business plans, whose systematic implementation is associated with lower preventable mortality during crises; (4) information systems and inter-institutional coordination, identified as critical enablers during the COVID-19 pandemic. Safe hospitals require an integrated approach that combines secure infrastructure, staff trained using proactive methodologies, validated continuity plans and interoperable information systems, supporting the adoption of the Hospital Safety Index as a standard tool, complemented by adaptive resilience approaches.