World Health Organization · 2nd edition, 2015 · 173 pages
A rapid, low-cost diagnostic tool for assessing the probability that a hospital will remain operational in emergencies and disasters.
- Issuer
- World Health Organization
- Edition
- 2nd edition, 2015
- Audience
- Evaluation teams (structural engineers, architects, hospital engineers, health professionals, emergency management specialists); hospital administrators; ministries of health; national disaster management organizations
- Evidence
- Expert consensus with contributions from national and international specialists across WHO regions; incorporates experience from >3,500 facility evaluations since 2008
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
The Hospital Safety Index is a standardized evaluation tool designed to assess whether a hospital’s structural safety, nonstructural safety, and emergency and disaster management capacity will allow it to function during and after emergencies and disasters. It uses a 151-item checklist organized into four modules to calculate a safety index from 0 to 1, classifying hospitals into categories A (safe, likely to function), B (intervention needed), or C (urgent intervention required).
The tool addresses the reality that most hospital disruption in disasters comes not from structural collapse but from failure of critical systems, equipment, and emergency management. Evaluations are conducted by multidisciplinary teams including engineers, architects, health-care professionals, and emergency management specialists, and take 8 hours to 3 days depending on hospital complexity.
More than 3,500 facilities worldwide have been evaluated using the Index since 2008. This revised edition expands coverage of security, staff availability, fire protection, maintenance of critical systems, and all-hazards resilience. Results guide prioritization of investments to improve hospital safety and inform national safe hospitals programmes.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Hospital safety evaluation uses 151 items across structural safety (18 items), nonstructural safety (93 items), and emergency and disaster management (40 items) modules
- Safety index calculated as 0–0.35 (C: urgent intervention needed), 0.36–0.65 (B: short-term intervention), or 0.66–1.0 (A: likely to function in disasters)
- Two calculation models: Model 1 (earthquake/wind zones): structural 50%, nonstructural 30%, emergency management 20%; Model 2 (other contexts): each module 33.3%
- Evaluation teams must include structural engineers, architects, critical systems specialists, health-care professionals, and emergency management experts
- Building separation in earthquake zones: low safety if <0.5% of building height, average if 0.5–1.5%, high if >1.5%
- Emergency generator must start within seconds of power loss and cover all critical areas (emergency department, ICU, operating theatres, maternity)
- Water reserves must cover a minimum of 3 days at 40–60 litres per bed per day for essential hospital functions
- All critical areas require fire detection systems, sprinklers or suppression systems within 5 metres, and emergency lighting lasting minimum 90 minutes
Hospital safety index classification and recommended actions
Table extracted from the guideline
| Safety Index | Classification | Recommended Action |
|---|---|---|
| 0–0.35 | C | Urgent intervention measures needed. Hospital unlikely to function during/after emergencies; current safety levels inadequate to protect patients and staff |
| 0.36–0.65 | B | Intervention measures needed in short term. Safety levels are such that patient and staff safety, and hospital function during/after emergencies, are potentially at risk |
| 0.66–1.0 | A | Likely to function in emergencies. Continue measures to improve emergency management capacity; carry out medium- and long-term safety improvements |
Source: World Health Organization, Hospital Safety Index: Guide for Evaluators, 2nd ed.. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- Items expanded from original 2008 version to 151 items with greater emphasis on security, staff availability, fire protection systems, maintenance of critical systems, and emergency operations coordination
- Modified to address all types of hazards that may affect hospital safety, not only earthquakes and hurricanes
- Section on infrastructure protection and access added; details of supplies and equipment consolidated into same submodule
- Some items moved between modules (e.g. structural safety module strengthened with elements from nonstructural module)
- Expanded explanations and references for each item; guidance provided for multiple presentation options for results and calculation of safety index to reflect different political, risk and resource contexts
From the guideline
Verbatim
“A safe hospital is a facility whose services remain accessible and functioning at maximum capacity, and with the same infrastructure, before, during and immediately after the impact of emergencies and disasters.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked on health system resilience in conflict-affected and disaster-prone regions, I recognize that Georgia's seismic risk, aging infrastructure, and geopolitical vulnerabilities make systematic hospital safety assessment not merely advisable but essential. The Hospital Safety Index offers Georgian health authorities a practical, standardized method to inventory the safety of our hospital network—something we have not yet done comprehensively. I would stress to colleagues the finding that most hospital disruption in disasters comes from failure of nonstructural elements and critical systems, not building collapse; this means relatively modest investments in generator capacity, water storage, equipment anchoring, and emergency planning can yield substantial improvements in resilience. The realistic caveat is that while the Index rapidly identifies problems, addressing Category C and B hospitals will require sustained political commitment and multi-year budgets that compete with other health priorities; we must sequence interventions strategically, beginning with hospitals serving the largest populations in highest-risk zones and those providing specialized services (trauma, burns, infectious disease) most critical in emergencies.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia’s health infrastructure includes both Soviet-era hospitals requiring seismic retrofitting (Georgia is in a moderate-to-high seismic zone) and newer facilities. The Universal Health Coverage programme since 2013 and ongoing health system reforms make hospital safety assessment particularly relevant. National disaster preparedness programmes would benefit from systematic Hospital Safety Index evaluations across public and private hospitals, prioritizing those in seismically active regions (Tbilisi, Kutaisi, western Georgia) and areas exposed to flooding, landslides, or proximity to conflict zones. The tool’s emphasis on nonstructural safety and emergency management capacity—which require less capital investment than structural retrofitting—offers cost-effective entry points for improving hospital resilience in resource-constrained settings typical of the South Caucasus and Eastern Europe.
Questions this guideline answers
Quick answers
How long does a Hospital Safety Index evaluation take?
An on-site evaluation typically takes 8 hours for a standard hospital, but may require up to 3 days for highly complex or large facilities. Additional time is needed for organizational meetings, consolidation of findings, and preparation of the final report.
Who should conduct the evaluation?
A multidisciplinary team including structural engineers, architects with hospital design training, critical systems specialists, health-care professionals, and emergency management experts. Each evaluator should have at least 5 years of relevant experience; less experienced professionals may participate under supervision of national or international experts.
What is the difference between the Hospital Safety Index and a detailed vulnerability study?
The Hospital Safety Index is a rapid, low-cost diagnostic tool providing an 'out-of-focus snapshot' to confirm or disprove genuine risks. Detailed vulnerability studies include in-depth analysis of hazards, structural, nonstructural, and health system vulnerability, require several months, and may cost tens of thousands of dollars. The Index helps determine which hospitals need detailed studies.
How should results be used for a network of hospitals?
Results enable comparison of relative safety across hospitals in a region or country, showing which facilities need priority investment. Authorizing entities may review hospitals by overall index or by individual modules, useful for resource allocation since costs differ significantly between structural retrofitting, nonstructural improvements, and emergency management strengthening. Hospitals classified as C require urgent attention.
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- Issuer
- World Health Organization
- Type
- Publication
- Edition
- 2nd edition, 2015
- Replaces
- Hospital Safety Index: Guide for Evaluators, PAHO, 2008
- Status
- Current
- Published
- 2021-05-25
- Languages
- English
- Scope
- Assessment of structural safety, nonstructural safety, and emergency and disaster management capacity of tertiary/university/major referral hospitals
- Audience
- Evaluation teams (structural engineers, architects, hospital engineers, health professionals, emergency management specialists); hospital administrators; ministries of health; national disaster management organizations
- Pages
- 173
- Licence
- WHO standard copyright
- ISBN
- 9789241548984
- Evidence
- Expert consensus with contributions from national and international specialists across WHO regions; incorporates experience from >3,500 facility evaluations since 2008
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
Hospital safety index: guide for evaluators, 2nd ed. Geneva: World Health Organization and Pan American Health Organization; 2015. 173 p.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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