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Earthquakes and tsunamis - Eduqas Case study: Haiti Earthquake, 2021

Earthquakes are caused by the release of built-up pressure at plate boundaries. They can destroy buildings and infrastructure. Tsunamis can also occur, with equally devastating and deadly effects.

Part of Geography Hazardous landscapes

Case study: Haiti Earthquake, 2021

On 14th August 2021 a magnitude 7.2 earthquake struck Haiti in the Caribbean. The plate boundaries around Haiti are complex. The North American Plate lies to the north and the Caribbean Plate to the south. The earthquake took place at a conservative plate boundary, where the Caribbean plate moved eastwards. The focus was only 10 km deep, and the epicentre was 125 km from the capital Port-au-Prince.

Increased vulnerability – Physical Factors

• Landslides affected the area close to the epicentre, some of which were sizeable. This made it difficult to access some parts of the country.
• A 3 m high tsunami was recorded around the capital, Port-au-Prince.
• Tropical Storm Grace brought heavy rainfall, which hampered relief efforts and caused further problems with mudslides and flooding.
• Liquefaction occurred along many coastal areas and the seaport of Cayes. Liquefaction is when the vibrations from an earthquake cause the ground surface to lose strength and begin to flow like a liquid. More than 50,000 people were affected by liquefaction.
• Social - More than 2,000 died, at least 12,000 were injured and 332 were still missing five days after the earthquake. The delivery of essential aid supplies were hampered by heavy rains from Tropical Storm Grace. Hospitals, schools and homes were destroyed.
• Economic – The estimated cost of damages from the earthquake is around US$1.6 billion. This amounts to 9.6 per cent of Haiti’s GDP.
• Environmental – Hundreds of landslides took place, which destroyed local ecosystems and habitats . Further damage was caused when heavy rainfall from Tropical Storm Grace turned the landslides into mud, leading to widespread flooding.
• 332 people were still missing five days after the earthquake.
• Hundreds of landslides took place, which destroyed local ecosystems and habitats.
• Heavy rainfall from Tropical Storm Grace turned the landslides into mud and led to widespread flooding.
• The United Nations and charities, such as the Red Cross and CAFOD, sent aid. However, the delivery of essential supplies was hampered by heavy rains from Tropical Storm Grace.
• Temporary shelters were provided by the International Organization for Migration. These helped people who had lost their homes.
• The World Food Programme increased their provision of hot meals for school children. This helped to deal with food shortages.
• Temporary hospitals were constructed to help the injured. They also provided routine care, for example, some pregnant women gave birth safely within the temporary facilities.
• The estimated cost of damages from the earthquake is around US$1.6 billion. This amounts to 9.6 per cent of Haiti’s GDP

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Earthquake case studies

Earthquake case studies Below are powerpoint presentations discussing the primary and secondary effects and immediate and long-term responses for both the Kobe, Japan and Kashmir, Pakistan earthquakes.

Effects of the Italian earthquake – http://www.bbc.co.uk/learningzone/clips/the-italian-earthquake-the-aftermath/6997.html Responses to Italian earthquake – http://www.bbc.co.uk/learningzone/clips/the-italian-earthquake-the-emergency-response/6998.html The Kobe earthquake – http://www.bbc.co.uk/learningzone/clips/the-kobe-earthquake/3070.html General effects & responses & Kobe (Rich) & Kashmir (Poor)

O Ltb Eartqaukes Cs from donotreply16 Kobe earthquake (Rich country)

Koberevision from cheergalsal Haiti 2010 – Poor country Picture Facts On 12th January, an earthquake measuring 7.0 on the Richter scale struck close to Haiti’s capital Port-au-Prince The earthquake occurred at a destructive plate margin between the Caribbean and North American Plates, along a major fault line. The earthquakes focus was 13km underground, and the epicentre was just 25km from Port-au-Prince Haiti has suffered a large number of serious aftershocks after the main earthquake

Primary effects About 220,000 people were killed and 300,000 injured The main port was badly damaged, along with many roads that were blocked by fallen buildings and smashed vehicles Eight hospitals or health centres in Port-au-Prince collapsed or were badly damaged. Many government buildings were also destroyed About 100,000 houses were destroyed and 200,000 damaged in Port-au-Prince and the surrounding area. Around 1.3 million Haitians were displaced (left homeless)

Secondary effects Over 2 million Habitats were left without food and water. Looting became a serious problem The destruction of many government buildings hindered the government’s efforts to control Haiti, and the police force collapsed The damage to the port and main roads meant that critical aid supplies for immediate help and longer-term reconstruction were prevented from arriving or being distributed effectively Displaced people moved into tents and temporary shelters, and there were concerns about outbreaks of disease. By November 2010, there were outbreaks of Cholera There were frequent power cuts The many dead bodies in the streets, and under the rubble, created a health hazard in the heat. So many had to be buried in mass graves

Short-term responses The main port and roads were badly damaged, crucial aid (such as medical supplies and food) was slow to arrive and be distributed. The airport couldn’t handle the number of planes trying to fly in and unload aid American engineers and diving teams were used to clear the worst debris and get the port working again, so that waiting ships could unload aid The USA sent ships, helicopters, 10,000 troops, search and rescue teams and $100 million in aid The UN sent troops and police and set up a Food Aid Cluster to feed 2 million people Bottled water and water purification tablets were supplied to survivors Field hospitals were set up and helicopters flew wounded people to nearby countries The Haitian government moved 235,000 people from Port-au-Prince to less damaged cities

Long-term responses Haiti is dependent on overseas aid to help it recover New homes would need to be built to a higher standard, costing billions of dollars Large-scale investment would be needed to bring Haiti’s road, electricity, water and telephone systems up to standard, and to rebuild the port Sichuan, China 2008 – Poor country case study Picture On 12th May at 14:28pm, the pressure resulting from the Indian Plate colliding with the Eurasian Plate was released along the Longmenshan fault line that runs beneath. This led to an earthquake measuring 7.9 on the Richter scale with tremors lasting 120 seconds.

Primary effects · 69,000 people were killed · 18,000 missing · 374,000 were injured · between 5 -11 million people were missing · 80% of buildings collapsed in rural areas such as Beichuan county due to poorer building standards · 5 million buildings collapsed

Secondary effects · Communication were brought to a halt – neither land nor mobile phones worked in Wenchuan · Roads were blocked and damaged and some landslides blocked rivers which led to flooding · Fires were caused as gas pipes burst · Freshwater supplies were contaminated by dead bodies

Immediate responses · 20 helicopters were assigned to rescue and relief effects immediately after the disaster · Troops parachuted in or hiked to reach survivors · Rescuing survivors trapped in collapsed buildings was a priority · Survivors needed food, water and tents to shelter people from the spring rains. 3.3 million new tents were ordered.

Long-term responses · Aid donations specifically money – over £100 million were raised by the Red Cross · One million temporary small were built to house the homeless · The Chinese government pledged a $10 million rebuilding funds and banks wrote off debts by survivors who did not have insurance

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• Chris Johnson, Matthew D. Affolter, Paul Inkenbrandt, & Cam Mosher
• Salt Lake Community College via OpenGeology

Video explaining the seismic activity and hazards of the Intermountain Seismic Belt and the Wasatch Fault, a large intraplate area of seismic activity.

North American Earthquakes

Basin and Range Earthquakes —Earthquakes in the Basin and Range Province, from the Wasatch Fault (Utah) to the Sierra Nevada (California), occur primarily in normal faults created by tensional forces. The Wasatch Fault, which defines the eastern extent of the Basin and Range province, has been studied as an earthquake hazard for more than 100 years.

New Madrid Earthquakes (1811-1812) —Historical accounts of earthquakes in the New Madrid seismic zone date as far back as 1699 and earthquakes continue to be reported in modern times [ 11 ]. A sequence of large (M w >7) occurred from December 1811 to February 1812 in the New Madrid area of Missouri [ 12 ]. The earthquakes damaged houses in St. Louis, affected the stream course of the Mississippi River, and leveled the town of New Madrid. These earthquakes were the result of intraplate seismic activity [ 9 ].

Charleston (1868) —The 1868 earthquake in Charleston South Carolina was a moment magnitude 7.0, with a Mercalli intensity of X, caused significant ground motion, and killed at least 60 people. This intraplate earthquake was likely associated with ancient faults created during the breakup of Pangea. The earthquake caused significant liquefaction [ 13 ]. Scientists estimate the recurrence of destructive earthquakes in this area with an interval of approximately 1500 to 1800 years.

Great San Francisco Earthquake and Fire (1906) —On April 18, 1906, a large earthquake, with an estimated moment magnitude of 7.8 and MMI of X, occurred along the San Andreas fault near San Francisco California. There were multiple aftershocks followed by devastating fires, resulting in about 80% of the city being destroyed. Geologists G.K. Gilbert and Richard L. Humphrey, working independently, arrived the day following the earthquake and took measurements and photographs [ 14 ].

Alaska (1964) —The 1964 Alaska earthquake, moment magnitude 9.2, was one of the most powerful earthquakes ever recorded. The earthquake originated in a megathrust fault along the Aleutian subduction zone. The earthquake caused large areas of land subsidence and uplift, as well as significant mass wasting.

Video from the USGS about the 1964 Alaska earthquake.

Loma Prieta (1989) —The Loma Prieta, California, earthquake was created by movement along the San Andreas Fault. The moment magnitude 6.9 earthquake was followed by a magnitude of 5.2 aftershock. It caused 63 deaths, buckled portions of the several freeways, and collapsed part of the San Francisco-Oakland Bay Bridge.

This video shows how shaking propagated across the Bay Area during the 1989 Loma Prieta earthquake.

This video shows the destruction caused by the 1989 Loma Prieta earthquake.

Global Earthquakes

Many of history’s largest earthquakes occurred in megathrust zones, such as the Cascadia Subduction Zone (Washington and Oregon coasts) and Mt. Rainier (Washington).

Shaanxi, China (1556) —On January 23, 1556 an earthquake of an approximate moment magnitude 8 hit central China, killing approximately 830,000 people in what is considered the most deadly earthquake in history. The high death toll was attributed to the collapse of cave dwellings ( yaodong ) built in loess deposits, which are large banks of windblown, compacted sediment (see Chapter 5 ). Earthquakes in this are region are believed to have a recurrence interval of 1000 years. [ 15 ].

Lisbon, Portugal (1755) —On November 1, 1755 an earthquake with an estimated moment magnitude range of 8–9 struck Lisbon, Portugal [ 13 ], killing between 10,000 to 17,400 people [ 16 ]. The earthquake was followed by a tsunami.

Valdivia, Chile (1960) —The May 22, 1960 earthquake was the most powerful earthquake ever measured, with a moment magnitude of 9.4–9.6 and lasting an estimated 10 minutes. It triggered tsunamis that destroyed houses across the Pacific Ocean in Japan and Hawaii and caused vents to erupt on the Puyehue-Cordón Caulle (Chile).

Video describing the tsunami produced by the 1960 Chili earthquake.

Tangshan, China (1976) —Just before 4 a.m. (Beijing time) on July 28, 1976 a moment magnitude 7.8 earthquake struck Tangshan (Hebei Province), China, and killed more than 240,000 people. The high death toll is attributed to people still being asleep or at home and most buildings being made of URM.

Sumatra, Indonesia (2004) —On December 26, 2004, slippage of the Sunda megathrust fault generated a moment magnitude 9.0–9.3 earthquake off the coast of Sumatra, Indonesia [ 17 ]. This megathrust fault is created by the Australia plate subducting below the Sunda plate in the Indian Ocean [ 18 ]. The resultant tsunamis created massive waves as tall as 24 m (79 ft) when they reached the shore and killed more than an estimated 200,000 people along the Indian Ocean coastline.

Haiti (2010) —The moment magnitude 7 earthquake that occurred on January 12, 2010, was followed by many aftershocks of magnitude 4.5 or higher. More than 200,000 people are estimated to have died as a result of the earthquake. The widespread infrastructure damage and crowded conditions contributed to a cholera outbreak, which is estimated to have caused thousands more deaths.

Tōhoku, Japan (2011) —Because most Japanese buildings are designed to tolerate earthquakes, the moment magnitude 9.0 earthquake on March 11, 2011, was not as destructive as the tsunami it created. The tsunami caused more than 15,000 deaths and tens of billions of dollars in damage, including the destructive meltdown of the Fukushima nuclear power plant.

9. Hildenbrand TG, Hendricks JD (1995) Geophysical setting of the Reelfoot rift and relations between rift structures and the New Madrid seismic zone. U.S. Geological Survey, Washington; Denver, CO

11. Feldman J (2012) When the Mississippi Ran Backwards: Empire, Intrigue, Murder, and the New Madrid Earthquakes of 1811 and 1812. Free Press

12. Fuller ML (1912) The New Madrid earthquake. Central United States Earthquake Consortium, Washington, D.C.

13. Talwani P, Cox J (1985) Paleoseismic evidence for recurrence of Earthquakes near Charleston, South Carolina. Science 229:379–381

14. Gilbert GK, Holmes JA, Humphrey RL, et al (1907) The San Francisco earthquake and fire of April 18, 1906 and their effects on structures and structural materials. U.S. Geological Survey, Washington, D.C.

15. Boer JZ de, Sanders DT (2007) Earthquakes in human history: The far-reaching effects of seismic disruptions. Princeton University Press, Princeton

16. Aguirre B.E. (2012) Better disaster statistics: The Lisbon earthquake. J Interdiscip Hist 43:27–42

17. Rossetto T, Peiris N, Pomonis A, et al (2007) The Indian Ocean tsunami of December 26, 2004: observations in Sri Lanka and Thailand. Nat Hazards 42:105–124

18. Satake K, Atwater BF (2007) Long-Term Perspectives on Giant Earthquakes and Tsunamis at Subduction Zones. Annual Review of Earth and Planetary Sciences 35:349–374. https://doi.org/10.1146/annurev.earth.35.031306.140302

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Case Study on Earthquakes

Earthquakes case study:.

An earthquake is a number of the underground seismic waves, which are caused by the natural factors (primarily, tectonic processes), and sometimes artificial processes (explosions, the filling of the water reservoirs, collapse of the deep mines, etc).

Slight seismic waves also can be caused by the raise of lava during the volcanic eruption. Every year there are more than a million of earthquakes occur on the planet but most of them are so insignificant that remain unnoticed.Serious earthquakes which can cause considerable damage occur approximately once a fortnight. Most of such strong earthquakes occur on the bottom of the oceans, that is why there are no serious destructions. On the other hand, if there is a strong earthquake in the ocean quite close to a continent or any land (island, subcontinent) there is a possibility of tsunami (extremely high and fast waves coming from an ocean to the land destroying everything on their way), which can be even more dangerous than the earthquake itself.

We Will Write a Custom Case Study Specifically For You For Only $13.90/page!

The power of the earthquakes can be strong enough to ruin buildings and roads. The history knows very strong earthquakes which managed to destroy big cities and kill thousands of people. The power of earthquakes is measured with the help of the special appliances, called seismometers, so when there is a release of the energy in the crust of Earth, seismometers report its strength according to the scale from 1 to 12. The seismic waves up to the 5th point are considered to be slight and moderate, 6 and 7 – strong, 8 and 9 – destructive and devastating, from 10 to 12 – catastrophic.Earthquakes have always interested and scared people, so it is important to know at least basic information about their origin and the factors which cause them. A student who is asked to analyze a problem for the case study based on earthquakes should devote much time to collect enough data for the research.

It is important to know whether people were prepared for the earthquake and what their behaviour was. A student should learn the reason of the occurred problem and analyze its consequences. If one analyzes the effect of an earthquake, he should provide the professor with the strength of the earthquake, ruins and the number of victims. In the end one should try to think over the methods and techniques which could prevent the problem and solve it.An inexperienced student will never complete a successful case study without the direct example.

A free sample case study on earthquake in India written in the Internet can be a good piece of writing assistance for every student. If one looks through the structure, formatting and the manner of the presentation of data in a free example case study on earthquake in Gujarat, he will complete a successful paper himself.

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Bhuj Earthquake India 2001 – A Complete Study

Bhuj earthquake india.

Gujarat : Disaster on a day of celebration : 51st Republic Day on January 26, 2001

• 7.9 on the Richter scale.
• 8.46 AM January 26th 2001
• 20,800 dead

Basic Facts

• Earthquake: 8:46am on January 26, 2001
• Epicenter: Near Bhuj in Gujarat, India
• Magnitude: 7.9 on the Richter Scale

Geologic Setting

• Indian Plate Sub ducting beneath Eurasian Plate
• Continental Drift
• Convergent Boundary

Specifics of 2001 Quake

Compression Stress between region’s faults

Depth: 16km

Probable Fault: Kachchh Mainland

Fault Type: Reverse Dip-Slip (Thrust Fault)

The earthquake’s epicentre was 20km from Bhuj. A city with a population of 140,000 in 2001. The city is in the region known as the Kutch region. The effects of the earthquake were also felt on the north side of the Pakistan border, in Pakistan 18 people were killed.

Tectonic systems

The earthquake was caused at the convergent plate boundary between the Indian plate and the Eurasian plate boundary. These pushed together and caused the earthquake. However as Bhuj is in an intraplate zone, the earthquake was not expected, this is one of the reasons so many buildings were destroyed – because people did not build to earthquake resistant standards in an area earthquakes were not thought to occur. In addition the Gujarat earthquake is an excellent example of liquefaction, causing buildings to ‘sink’ into the ground which gains a consistency of a liquid due to the frequency of the earthquake.

India : Vulnerability to earthquakes

• 56% of the total area of the Indian Republic is vulnerable to seismic activity .
• 12% of the area comes under Zone V (A&N Islands, Bihar, Gujarat, Himachal Pradesh, J&K, N.E.States, Uttaranchal)
• 18% area in Zone IV (Bihar, Delhi, Gujarat, Haryana, Himachal Pradesh, J&K, Lakshadweep, Maharashtra, Punjab, Sikkim, Uttaranchal, W. Bengal)
• 26% area in Zone III (Andhra Pradesh, Bihar, Goa, Gujarat, Haryana, Kerala, Maharashtra, Orissa, Punjab, Rajasthan, Tamil Nadu, Uttaranchal, W. Bengal)
• Gujarat: an advanced state on the west coast of India.
• On 26 January 2001, an earthquake struck the Kutch district of Gujarat at 8.46 am.
• Epicentre 20 km North East of Bhuj, the headquarter of Kutch.
• The Indian Meteorological Department estimated the intensity of the earthquake at 6.9 Richter. According to the US Geological Survey, the intensity of the quake was 7.7 Richter.
• The quake was the worst in India in the last 180 years.

What earthquakes do

• Casualties: loss of life and injury.
• Loss of housing.
• Damage to infrastructure.
• Disruption of transport and communications.
• Breakdown of social order.
• Loss of industrial output.
• Loss of business.
• Disruption of marketing systems.
• The earthquake devastated Kutch. Practically all buildings and structures of Kutch were brought down.
• Ahmedabad, Rajkot, Jamnagar, Surendaranagar and Patan were heavily damaged.
• Nearly 19,000 people died. Kutch alone reported more than 17,000 deaths.
• 1.66 lakh people were injured. Most were handicapped for the rest of their lives.
• The dead included 7,065 children (0-14 years) and 9,110 women.
• There were 348 orphans and 826 widows.

Loss classification

Deaths and injuries: demographics and labour markets

Effects on assets and GDP

Effects on fiscal accounts

Financial markets

Disaster loss

• Initial estimate Rs. 200 billion.
• Came down to Rs. 144 billion.
• No inventory of buildings
• Non-engineered buildings
• Land and buildings
• Stocks and flows
• Reconstruction costs (Rs. 106 billion) and loss estimates (Rs. 99 billion) are different
• Public good considerations

Human Impact: Tertiary effects

• Affected 15.9 million people out of 37.8 in the region (in areas such as Bhuj, Bhachau, Anjar, Ganhidham, Rapar)
• High demand for food, water, and medical care for survivors
• Humanitarian intervention by groups such as Oxfam: focused on Immediate response and then rehabilitation
• Of survivors, many require persistent medical attention
• Region continues to require assistance long after quake has subsided
• International aid vital to recovery

Social Impacts

• 80% of water and food sources were destroyed.
• The obvious social impacts are that around 20,000 people were killed and near 200,000 were injured.
• However at the same time, looting and violence occurred following the quake, and this affected many people too.
• On the other hand, the earthquake resulted in millions of USD in aid, which has since allowed the Bhuj region to rebuild itself and then grow in a way it wouldn’t have done otherwise.
• The final major social effect was that around 400,000 Indian homes were destroyed resulting in around 2 million people being made homeless immediately following the quake.

Social security and insurance

• Ex gratia payment: death relief and monetary benefits to the injured
• Major and minor injuries
•  Cash doles
• Government insurance fund
• Group insurance schemes
• Claim ratio

Demographics and labour market

• Geographic pattern of ground motion, spatial array of population and properties at risk, and their risk vulnerabilities.
• Low population density was a saving grace.
• Extra fatalities among women
• Effect on dependency ratio
• Farming and textiles

Economic  Impacts

• Total damage estimated at around $7 billion. However $18 billion of aid was invested in the Bhuj area.
• Over 15km of tarmac road networks were completely destroyed.
• In the economic capital of the Gujarat region, Ahmedabad, 58 multi storey buildings were destroyed, these buildings contained many of the businesses which were generating the wealth of the region.
• Many schools were destroyed and the literacy rate of the Gujarat region is now the lowest outside southern India.

Impact on GDP

• Applying ICOR
• Rs. 99 billion – deduct a third as loss of current value added.
• Get GDP loss as Rs. 23 billion
• Adjust for heterogeneous capital, excess capacity, loss Rs. 20 billion.
• Reconstruction efforts.
• Likely to have been Rs. 15 billion.

Fiscal accounts

• Differentiate among different taxes: sales tax, stamp duties and registration fees, motor vehicle tax, electricity duty, entertainment tax, profession tax, state excise and other taxes. Shortfall of Rs. 9 billion of which about Rs. 6 billion unconnected with earthquake.
• Earthquake related other flows.
• Expenditure:Rs. 8 billion on relief. Rs. 87 billion on rehabilitation.

Impact on Revenue Continue Reading

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Earthquake case study

This PowerPoint Presentation (PPT) is a case study of the Bhuj Earthquake 26th January 2001, prepared by my friend Nitin. I'm uploading this PPT inly because it may useful to some one in their study. Read less

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• 1. Earthquake Case study: Bhuj Earthquake 26th January 2001 Presented by Nitin Chandra J 1221113109
• 2. Disaster A disaster is a natural or man-made (or technological) hazard resulting in an event of substantial extent causing significant physical damage or destruction, loss of life, or drastic change to the environment.
• 3. Classification of Disaster Natural disasters Human made disasters Human induced disasters
• 4. Earthquake? Earthquake is a violent tremor in the earth’s crust, sending out a series of shock waves in all directions from its place of origin or epicenter. Earthquakes constitute one of the worst natural hazards which often turn into disaster causing widespread destruction and loss to human life.
• 5. Causes of Earthquake Earthquakes are caused by sudden release of energy in rocks. Plates in the form of rocks are moving very slowly and earthquake occur when moving plates grind and scrape against each other. Terminology : The point at which an earthquake originates is the focus or hypocenter and the point on the earth’s surface directly above this is epicenter. The study of earthquake is called seismology.
• 6. Tectonic Plates There are 7 large and 12 small such plates which are in continuous motion. These plates move along three distinctive types of boundaries, that is : Convergent boundaries : where plates push each other and one plate slides down the other one Divergent boundaries: where plates pull away from each other Transformed boundaries : where plates slide past each other. Earthquake occur due to several causes such as volcanic eruption, etc. but the plate tectonic theory is the most convincing and widely accepted
• 8. Strength of earthquake The intensity and strength of an earthquake is measured on Richter scale, the scale invented by Charles Richter California, USA in 1935, which categories earthquake on the basis of energy released.
• 9. The amount of energy released during different categories of Richter scale earthquake as follows: Intensity of earthquake (Richter scale) Energy release (amount of TNT) 1.0 170 grams 2.0 6 kilograms 3.0 179 kilograms 4.0 5 metric tons 5.0 179 metric tons 6.0 5643 metric tons 7.0 1,79,100 metric tons 7.5 One megaton 8.0 5,64,300 metric tons
• 10. India -Depending upon the frequency and intensity of the earthquakes, the whole country can be divided into three broad seismological zones Himalayan zone The areas most prone to earthquake in India is the Fold Mountains ranges of the Himalayan zone. The states of Jammu and Kashmir, Himachal Pradesh, Uttaranchal, Bihar, the Bihar- Nepal border and north eastern states. The earthquakes in these zones are primarily due to plate tectonics. The region along the Himalayas where two plates meet is highly earthquake prone and hence known as the zone of maximum intensity
• 11. The indo-gangetic zone To the south of the Himalayan zone and running parallel it is the indo-gangetic zone. Most of the earthquakes striking this zone are of moderate intensity of 6 to 6.5 on Richter scale. Therefore this zone is called the zone of comparative intensity. The earthquakes along the foothill are of medium to high intensity. However, the earthquakes of this zone are more harmful due to high density of population in this area.
• 12. The peninsular zone The peninsular India has presumably remained a stable landmass and only few earthquakes have been experienced in this region. This region is, therefore, called the zone of minimum intensity. But the sever earthquakes of Konya (1967), Latur (1993) and Jabalpur (1997) have raised doubts about the seismic stability of this landmass.
• 14. Date Place m Scale Set.2 , 1993 Latur (maharashtr a) 6.3 Large areas of Maharashtra rocked. 10,000 people lost lives May 22, 1997 Jabalpur (Maharashtr a) 6.0 40 person killed and over 100 injured March 29, 1999 Nandprayag 6.8 widespread destruction in chamoli , rudraprayag and other areas. Massive loss of human life Jan. 26 2001 Bhuj (gujrat) 7.8 Tremors left by India and its neighboring countries. Over 1 lakh people killed. Huge loss to property and infrastructure Oct. 8, 2005 Muzzaffarab ad in Pakistan occupied Kashmir 7.4 Heavy damage to life and property. Death toll about one lakh in Pakistan and nearly 2000 in India
• 15. Picture of search and rescue phase of Latur earthquake 1993
• 16. Post – disaster picture from Kashmir earthquake 2005
• 17. Hazardous Effects of Earthquake - Loss of life and property - Damage to infrastructure - Topographical changes - Damage to transport system i.e. roads, railways, highways, airports, marine. - Chances of fire short-circuit. - Chances of Floods – Dams and Embankments can develop cracks - Chances of outburst of epidemic - Water pipes, sewers are disrupted - Communications such as telephone wires are damaged. - Economic activities like agriculture, industry, trade and transport are severely affected.
• 18. Introduction to Gujarat Gujarat, state, in western India, bordered on the northeast by Rajasthan state, on the east by Madhya Pradesh state, on the southeast by Maharashtra state, on the south and southwest by the Arabian Sea, and on the northwest by Pakistan The state covers an area of 196,024 sq km (The capital is Gandhinagar, on the outskirts of Ahmadabad, the former capital and largest city in the state. Date: Origin line: Epicenter: Magnitude: Focal Depth: 26 January 2001 08 hrs.46 min. 42.9 sec. IST Latitude 23.40° N Longitude 70.28° E 7.7 25 kms.
• 19. Bhuj Earthquake 26th January. 2001 On the morning of January 26, 2001, the Nation’s 52nd Republic Day, a devastating earthquake occurred in the Kutch district of the state of Gujarat. The earthquake was felt as far away as Delhi in the north, Kolkata in the east and Chennai in the south. Bhuj town and the village Bhachau, 60 km east of Bhuj, were the worst affected and many other areas of Gujarat including its state headquarters Ahmedabad, were badly affected The earthquake devastated the Bhuj and nearby regions of Gujarat causing extensive loss of life and property.
• 20. Damage assessment • There were more than 20,000 deaths and 167,000 people injured • Four districts of Gujarat lay in ruin and altogether, 21 districts were affected • Around 300,000 families and at least 3 million children aged 14 and under were affected. • Around 600,000 people were left homeless. • In the city of Bhuj, more than 3,000 inhabitants of the city lost their lives; the main hospital was crushed and close to 90% of the buildings was destroyed. • There was significant damage to infrastructure with facilities such as hospitals, schools, electric power and water systems, bridges and roads damaged or destroyed.
• 21. 40 to 50 high-rise buildings crumbled.
• 22. Resource Details Railways Damage to track between Viramgam to Gandhidam; Gandhidham to Bhuj; Viramgam to Okha; and Palanpur to Gandhidam. Heavy damage to various station buildings, station cabins, bridges, residential quarters and signalling systems. Rail links as far as Bhuj have been restored. Roads 650 kilometres of national highways damaged, 100 kilometres severely. National highways are now traffic-worthy. Bridges Many minor and major bridges damaged including the Syurajbari bridge at Bachau. Most main road bridges have been repaired and are capable of accepting limited weight traffic. Ports Berths 1-5 at Kandla Port suffered major structural damage. Telecommunications 147 exchanges, 82,000 lines and optical fibre systems damaged. All exchanges and at least 40,000 lines have been restored. Power 45 sub-stations and power supply to 50% of feeders in Kutch damaged. Power supply to nine towns & 925 villages affected. All substations and 225 feeders have been restored and there is now power to all villages in Kutch. Water Water supply to 18 towns and 1340 villages damaged or destroyed. Piped water restored to 9 towns and 480 villages. Tube wells are gradually being restored. Fuel Jamnager refinery shutdown 26 January by power failure. Crude oil and product pipelines were shut down for checking. Crude oil pipeline for one day, product pipelines for nine days. Availability of product not affected as alternative arrangements have been made. Schools Kutch District had 1359 primary schools with 5168 schoolrooms. Of these, 992 schools and 4179 classrooms were destroyed. There were 38 secondary schools of which six were destroyed, 14 suffered heavy damage and 12 were partially damaged. Of 128 non-government schools, nine were destroyed, 11 suffered heavy damage and 99 were partially damaged.
• 23. Local response The response within India was immediate. The national and state governments quickly provided assistance in many forms including cash, medical supplies, communications teams, shelters, food, clothing, transport and relief workers. There were more than 185 non-government organizations (NGOs), mostly Indian charities, which undertook earthquake- related activities
• 24. International response Search and Rescue teams soon arrived from Switzerland, United Kingdom, Russia and Turkey to find and rescue survivors buried under debris. Relief teams and supplies soon followed from 38 countries as well as United Nations agencies and many international NGOs such as the Red Cross.
• 25. Rescue & Relief The short term rescue and relief operation were being undertaken, medium term and long term recovery aspects were analyzed. Rehabilitation schemes Government of Gujarat tired to, known as packages, were formulated. The world bank and Asian development bank sanction loans in less than three months after the earthquake.
• 26. Contd. Several state governments came forward to participate in, the reconstruction work in different villages. The UN system, multilateral and bilateral agencies, NGOs and the corporate sector participated in the relief and reconstruction work. Government of Gujarat provided assistance in the form of materials and cash to about 218,000 families. NGOs supplemented the efforts by providing shelter to about 7000 families.
• 27. Reconstruction A public private partnership program was started to help in reconstruction, which was undertaken by GSDMA. A number of NGOs like FICCI-CARE venture, manav sadhana, rashtriya swabhiman, jai prakash industries, etc. came forward to help. About 65 NGOs were active in kutch alone who adopted 211 villages and constructed 32,297 houses at the cost of Rs. 185.80 crores. Gujarat earthquake emergency reconstruction project (GEERP) was started by GSDMA, with financial help from world bank, Asian development bank, govt of India and other donor agencies.
• 28. Contd. Architects, engineers and masons were trained in construction of disaster resistant houses . The technical support was made available to the owners who were provided loan to reconstruct the houses. The houses were registered in the joint names of husband and wife. More than 2 lac houses have been constructed under this program; all houses being multi hazard resistant.
• 29. Thank you!!!

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Earthquake Case Study

Kaatje Kraft , Mesa Community College Author Profile

This activity was selected for the On the Cutting Edge Exemplary Teaching Collection

Resources in this top level collection a) must have scored Exemplary or Very Good in all five review categories, and must also rate as "Exemplary" in at least three of the five categories. The five categories included in the peer review process are

For more information about the peer review process itself, please see https://serc.carleton.edu/teachearth/activity_review.html .

This activity has benefited from input from faculty educators beyond the author through a review and suggestion process. This review took place as a part of a faculty professional development workshop where groups of faculty reviewed each others' activities and offered feedback and ideas for improvements. To learn more about the process On the Cutting Edge uses for activity review, see http://serc.carleton.edu/NAGTWorkshops/review.html .

This activity is a multiple case study analysis of different earthquakes that leads to student interpretation of claims, evidence and prediction/recommendations.

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Grade level.

Skills and concepts that students must have mastered

How the activity is situated in the course, content/concepts goals for this activity, higher order thinking skills goals for this activity, other skills goals for this activity.

• Reading evaluation
• Oral communication
• Written communication
• Data Analysis
• Collaborative skills
• Group presentations
• Time management
• Self evaluation of performance and comprehension

Description of the activity/assignment

Students work in a jigsaw format, they start in an expert group analyzing one particular aspect of the earthquake that occurred (e.g., tsunami, geologic maps, damage assessment). After analyzing the data/information provided, students get into their new groups, which are a "consulting team" to make recommendations to key governmental officials about the earthquake they studied and implications for future development. These are presented in a poster session style event, which then leads to individual papers that are written about the same topic, which are peer reviewed and revised. Students are asked to reflect on their strengths and weaknesses in the process and to consider changes for future opportunities, as well as connect the curriculum to the overall process of science.

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• Group presentation & comprehension
• Notebook evaluation of activity completion and detailed reflections
• Written assignment
• Quiz questions

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• Grading rubric for written assignment (Microsoft Word 34kB May5 08)
• Question sets for the Alaska 1964 earthquake (Microsoft Word 28kB May5 08)
• Question sets for the Sumatra 2004 earthquake (Microsoft Word 36kB May5 08)
• Question sets for the Loma Prieta 1989 earthquake (Microsoft Word 35kB May5 08)

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Nepal Earthquake 2015

A case study of an earthquake in a low income country (LIC).

Nepal, one of the poorest countries in the world, is a low-income country. Nepal is located between China and India in Asia along the Himalayan Mountains.

A map to show the location of Nepal in Asia

What caused the Nepal Earthquake?

The earthquake occurred on a  collision plate boundary between the Indian and Eurasian plates.

What were the impacts of the Nepal earthquake?

Infrastructure.

• Centuries-old buildings were destroyed at UNESCO World Heritage Sites in the Kathmandu Valley, including some at the Changu Narayan Temple and the Dharahara Tower.
• Thousands of houses were destroyed across many districts of the country.

Social and economic

• Eight thousand six hundred thirty-two dead and 19,009 injured.
• It was the worst earthquake in Nepal in more than 80 years.
• People chose to sleep outside in cold temperatures due to the risk of aftershocks causing damaged buildings to collapse.
• Hundreds of thousands of people were made homeless, with entire villages flattened.
• Harvests were reduced or lost that season.
• Economic losses were estimated to be between nine per cent to 50 per cent of GDP by The United States Geological Survey (USGS).
• Tourism is a significant source of revenue in Nepal, and the earthquake led to a sharp drop in the number of visitors.
• An avalanche killed at least 17 people at the Mount Everest Base Camp.
• Many landslides occurred along steep valleys. For example, 250 people were killed when the village of Ghodatabela was covered in material.

What were the primary effects of the 2015 earthquake in Nepal?

The primary effects of the 2015 earthquake in Nepal include:

• Nine thousand people died, and 19,000 people were injured – over 8 million people were affected.
• Three million people were made homeless.
• Electricity and water supplies, along with communications, were affected.
• 1.4 million people needed support with access to water, food and shelter in the days and weeks after the earthquake
• Seven thousand schools were destroyed.
• Hospitals were overwhelmed.
• As aid arrived, the international airport became congested.
• 50% of shops were destroyed, affecting supplies of food and people’s livelihoods.
• The cost of the earthquake was estimated to be US$5 billion.

What were the secondary effects of the 2015 earthquake in Nepal?

The secondary effects of the 2015 earthquake in Nepal include:

• Avalanches and landslides were triggered by the quake, blocking rocks and hampering the relief effort.
• At least nineteen people lost their lives on Mount Everest due to avalanches.
• Two hundred fifty people were missing in the Langtang region due to an avalanche.
• The Kali Gandaki River was blocked by a landslide leading many people to be evacuated due to the increased risk of flooding.
• Tourism employment and income declined.
• Rice seed ruined, causing food shortage and income loss.

What were the immediate responses to the Nepal earthquake?

• India and China provided over $1 billion of international aid .
• Over 100 search and rescue responders, medics and disaster and rescue experts were provided by The UK, along with three Chinook helicopters for use by the Nepali government.
• The GIS tool “Crisis mapping” was used to coordinate the response.
• Aid workers from charities such as the Red Cross came to help.
• Temporary housing was provided, including a ‘Tent city’ in Kathmandu.
• Search and rescue teams, and water and medical support arrived quickly from China, the UK and India.
• Half a million tents were provided to shelter the homeless.
• Helicopters rescued people caught in avalanches on Mount Everest and delivered aid to villages cut off by landslides.
• Field hospitals were set up to take pressure off hospitals.
• Three hundred thousand people migrated from Kathmandu to seek shelter and support from friends and family.
• Facebook launched a safety feature for users to indicate they were safe.

What were the long-term responses to the Nepal earthquake?

• A $3 million grant was provided by The Asian Development Bank (ADB) for immediate relief efforts and up to $200 million for the first phase of rehabilitation.
• Many countries donated aid. £73 million was donated by the UK (£23 million by the government and £50 million by the public). In addition to this, the UK provided 30 tonnes of humanitarian aid and eight tonnes of equipment.
• Landslides were cleared, and roads were repaired.
• Lakes that formed behind rivers damned by landslides were drained to avoid flooding.
• Stricter building codes were introduced.
• Thousands of homeless people were rehoused, and damaged homes were repaired.
• Over 7000 schools were rebuilt.
• Repairs were made to Everest base camp and trekking routes – by August 2015, new routes were established, and the government reopened the mountain to tourists.
• A blockade at the Indian border was cleared in late 2015, allowing better movement of fuels, medicines and construction materials.

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Case study: The 2023 Türkiye–Syria earthquake

Case study: The effects of climate change in the Mekong Delta, Viet Nam

The 2023 türkiye– syria earthquake.

As a GCSE geographer you will learn about a range of natural hazards, their causes, impacts and how we can prepare for and respond to them. This article provides a case study of the massive and tragic earthquake that occurred in Türkiye, and the bordering country of Syria, in February 2023.

• Volume 35, 2023/ 2024
• Tectonic hazards
• Natural disasters
• (Global) Physical Geography

Michelle Minton

Earthquakes are not uncommon in this part of the world. However, the one that happened on 6 February 2023 had a magnitude of 7.8 and was the deadliest and strongest recorded in Türkiye since 1939, and was the world’s deadliest since the 2010 Haiti earthquake.

The earthquake’s epicentre was 34 km west of the city of Gaziantep in southern Türkiye, near the northern border of Syria (see back page). Türkiye is vulnerable to earthquakes as it sits on the Anatolian plate, between the large tectonic plates of Eurasia, Arabia and Africa. Within the Anatolian tectonic plate there are two major faults — the North Anatolian fault and the East Anatolian fault, and it is on the latter that the 2023 earthquake occurred.

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“Recovering, not recovered” Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal

Maria moitinho de almeida.

Centre for Research on the Epidemiology of Disasters (Cred), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium

Disasters are an increasing threat to human health, but we know little about their impact on health services, particularly in low and middle-income settings. ‘Resilient hospitals’ have been increasingly recognized as a cornerstone of disaster management. While various frameworks of hospital resilience exist, they emerged from pre-disaster considerations, and do not incorporate evidence from post-disaster settings.

This dissertation investigated the impact of a large-scale sudden onset disaster in a tertiary hospital in Nepal, and explored its resilience mechanisms.

Methodology

This consists of an in-depth case-study combining quantitative data from routinely generated hospital records and qualitative data from semi-structured interviews with hospital staff. We used both advanced statistical methods and mixed inductive and deductive coding to analyze the data.

Most of the admitted earthquake victims required surgical interventions and long hospitalizations, considerably straining the hospital. For six weeks, the average number of daily admissions decreased. During this period, the share of injury-related admissions was particularly high, and such admissions were particularly long compared to the baseline. Admissions due to other conditions relatively decreased and were shorter. We found that the hospital’s resilience was highly dependent on emerging adaptations, in addition to the pre-existing disaster plan. Individual resilience of staff also played a major role, and was influenced by senses of safety, meaningfulness, and belonging.

Hospitals should prepare resources and plan for their known disaster risks, but should also allow for a certain flexibility to innovative adaptions to emerging, unforeseen challenges. Challenges faced by hospital workers should not be undermined, and addressing them will increase hospital resilience.

Disasters are not natural. They consist of serious disruptions in the ‘functioning of a community or a society’ [ 1 ], and they result from interactions between a hazard, which can be natural, and the community’s vulnerability and coping capacity. Earthquakes are an example of large-scale, sudden-onset disasters, because they occur quickly and unexpectedly, and they can be so destructive that affected communities need external assistance [ 1 ]. Millions of earthquakes occur every year around the globe, but only small part of these are sufficiently strong to be measured. Of these, a very small fraction actually has human impact [ 2 ]. Between 2000 and 2019, 552 earthquakes with human impact were captured in the international disaster database (EM-DAT), having affected about 118million people [ 3 ]. Earthquakes are not distributed equally across the globe, and Asia is disproportionately affected, having hosted two thirds of earthquakes that occurred in the last 20 years [ 3 ].

Earthquakes carry important human health consequences. A major predictor of mortality is the built environment, and head and trunk injuries are typically deadlier than injuries to the limbs [ 4 , 5 ]. The number of injured victims can be very high after earthquakes, making hospital care an important aspect of disaster response. However, hospitals face several challenges and their ability to provide care can be seriously disrupted after large-scale sudden-onset disasters. They can suffer from building damage or even collapse, hospital staff can be affected or unable to reach the workplace, patients themselves may be unable to access the hospital, and there is a sudden increase of healthcare demand [ 6 ].

Resilience of health services

It is hence important that hospitals are able to absorb the shock of disasters, retain their essential functions, surge their capacity to provide emergency care, and recover to their original or to a new adaptive state. In other words, resilient [ 7 ]. But resilience is a maturing concept and its definition remains elusive in multiple fields of knowledge [ 8 ].

With regard to health, resilience is often linked to a community’s or a system’s capacity to cope with and manage health risks while maintaining essential functions of health systems [ 9 ]. Health systems and health services are complex systems and can be influenced by external shocks that disrupt their functioning [ 10 ]. Health System Resilience can be presented in a ‘shock cycle’ that consists of four phases [ 8 ]:

• System preparedness to shocks
• Shock onset and alert
• Shock impact and management
• Recovery and learning

For a national or regional health system to be resilient, the health facilities that compose it must also be independently resilient, increasing the complexity of health system resilience. Different frameworks have separately attempted to define health system or health service resilience, and the fact that many have emerged in parallel further challenges operationalizing the concept of resilience. Table 1 [ 11 ] presents an overview of existing frameworks of hospital and health system resilience.

Overview of major hospital and health system resilience frameworks [ 11 ]

Hospital resilience was the first resilience concept to emerge in the domain of health systems and services. More comprehensive than ‘preparedness’ and ‘safety’, the concept of hospital resilience includes the actual disaster scenario. The engineering sciences were the first to study this phenomenon, and used the 4 R framework to conceptualize hospital resilience [ 14–16 ]. This framework consists of ends of resilience (Robustness and Rapidity) and means of resilience (Redundancy and Resourcefulness). Robustness is the strength to withstand a given level of stress without suffering degradation or loss of function. Rapidity means that priorities are met

and goals are achieved in a timely manner, in order to contain losses, recover

functionality, and avoid further disruption. Redundancy is the ability to replace disrupted elements, and Resourcefulness is the capacity to mobilize and use resources, including through coordination [ 14–16 ].

But these concepts needed to be easily interpreted by hospital managers and health decision-makers, which led to the research conducted by Zhong and colleagues [ 7 , 17 , 18 ]. They found that a hospital’s resilience depended on structural and non-structural components, as well as emergency medical functions and disaster response capacity [ 7 ] and, they identified four primary domains where the 4 R dimensions could be applied: (i) hospital safety and vulnerability, (ii) disaster preparedness and resources, (iii) continuity of essential services, and (iv) recovery and adaptation. The empirical work that followed to develop a hospital resilience assessment tool included expert consultations [ 18 ] and a pilot test in 41 tertiary hospitals in China [ 17 ]. A more recent systematic review identified a set of hospital resilience indicators that could also be linked to the 4 R dimensions [ 19 ].

However, while research is ongoing and advancing this unique field of knowledge, many questions remain. First, we know little about how disasters affect the functioning of hospitals, particularly in low and middle-income settings. Second, while hospital resilience frameworks exist, they were not developed from actual disaster contexts. This means that we don’t know whether they actually picture what happens after disasters occur. It is a critical limitation as resilience is more comprehensive than just preparedness, and includes phases such as response and recovery. These important research gaps hinder optimal disaster management, and addressing them can substantially reduce the human impact of disasters.

Aim and objectives

This dissertation investigated the impact of an earthquake on the functioning of a tertiary hospital in Nepal, and explored hospital resilience mechanisms. The specific objectives were:

• To study the clinical and demographic profile of earthquake victims who were admitted in the hospital, and what influenced their length of hospital stay (LOS)
• To compare hospital admissions before and after the earthquake, and estimate the effect of the earthquake on admissions
• To assess the impact of the earthquake on the hospital functioning, and explore resilience as experienced by hospital staff.

This dissertation consisted of an in-depth case-study that combined quantitative and qualitative methodologies, allowing to explore a complex phenomenon in its real-life context [ 20 ]. It is based on a series of three articles, each focusing on a different study addressing a specific objective. Table 2 presents an overview of the studies, their methodologies, and their relation to the health system resilience shock cycle. Study I and II both used complementary datasets containing information about patient admissions in the hospital. Study III collected qualitative information through 18 in-depth interviews with hospital staff from different professions and seniority levels; 7 of those interviews were conducted in Nepali with an interpreter present, and the transcripts were later translated into English. For this study, we used a mixed deductive and inductive approach, using the 4 R resilience framework [ 14–16 ], which was theoretical framework of this thesis.

Overview of studies composing the dissertation presented in this article

The complementary use of different sources and type of data is believed to increase the internal validity of a case-study, and helps create a holistic picture of the topic under study. Using mixed-methodology in health service research and humanitarian contexts also allows to gain a comprehensive view of complex phenomena [ 21 ]. Understanding contextual factors is also critical in case-studies, and this is more successful with field work and associated immersion, observations and interactions [ 22 ]. In this case, field work was an essential aspect to develop the studies presented in Table 2 .

The focus of this work was a reference tertiary hospital in Nepal, a lower middle-income country landlocked between India and China that faced political instability for decades until 2008. Nepal is considered at high risk for humanitarian crises and disasters [ 23 ], and the entire territory is regularly affected by disasters with reported human impact [ 3 ]. While maternal and child mortality indicators have seen steady improvements over the years [ 24 ], several health challenges persist in Nepal. For instance, hospital care is only free for people in verified poverty situations and other vulnerable groups [ 25 , 26 ], leaving a substantial share of the population paying out-of-pocket for health care. On Saturday, 25 April 2015, a high-magnitude earthquake Nepal, followed by many aftershocks, a major one on May 12 th . This series of earthquakes killed nearly 9,000 people and injured another 22,000 [ 27 ]. Almost one third of the country’s population was affected by the disasters, and about 84% of the health services in the affected districts were destroyed or damaged [ 28 ]. The study hospital, located in the capital city Kathmandu, was built with earthquake-resistant standards and had a disaster plan in place [ 29 , 30 ], having played a major role in the earthquake response [ 31 ].

Study I: what is the profile of earthquake victims who needed hospital admission?

We studied the profile of 501 earthquake victims who were admitted in the study hospital [ 32 ]; 254 (51.2%) were women and 17.2% (n = 85) were children aged 0–14 years. Nearly half (n = 195, 48.9%) had a lower limb injury as main diagnosis of admission, and two thirds (n = 226, 65.7%) needed orthopedic surgery. Fractures represented 65.8% of all injury cases (n = 288). The most common cause of admission were femur and lower leg fractures, accounting for 26% of all earthquake victim admissions. For diagnoses not belonging to the injury group, the most common cause of admission was coded as ‘post-surgical states’. Date of admission ranged between 0 and 166 days after the first earthquake of April 25 th ; the peak occurred five days after the earthquake with 77 admissions. In 37 cases (7%), death was reported as an outcome.

The median length of stay in the hospital was 10 days, and the mean was 14.7 days. We first conducted bivariate log-rank tests, and found that demographic variables were not associated with length of hospital stay. We calculated individual hazard ratios for the variables that showed a significant association with length of stay, and they are presented in Table 3 . Longer hospitalizations were associated with lower limb and trunk injuries, crushing injuries, and undergoing an amputation or plastic surgery.

Measures of association (unadjusted hazard ratios) of different characteristics with hospital length of stay

HR: hazard ratio (unadjusted); 95%CI: 95% confidence interval; Z: Z-score; p: p-value; Ref: reference category. Significant p-values (lower than 0.05) are presented in bold. This table is adapted from [ 32 ].

Consistent with the literature, the majority of the victims who made it to the hospital and were hospitalized had orthopedic injuries and underwent surgical intervention. This is probably because such injuries are more survivable, as opposed to injuries to the head, chest or abdomen [ 5 ]. However, in this study earthquake victims have particularly long hospitalizations; information from the other two studies provides additional insights into this finding. Another finding that merits attention is the fact that children are underrepresented in this sample in comparison to the population distribution in Nepal at the time of the earthquake, which was estimated at 33.4% [ 24 ]. This can be because the earthquake occurred on a Saturday during the day, and children were not in school neither sleeping, so they were not as affected as they could have been. But another plausible explanation is the fact that children have growing bones which are more resistant than adult bones, and when they sustain a fracture they don’t need surgery as often as adults do [ 33 ]. This would mean that many fractures in children did not warrant inpatient treatment, and are hence not reflected in admission data.

Study II: how were hospital admissions affected with the earthquake?

We included 9,596 admissions occurring between March 15 th and 17 August 2015, and defined four periods of analysis: a pre-earthquake baseline (pre-EQ), acute (EQ1), post-acute (EQ2), and post-earthquake period (post-EQ). EQ1 and EQ2 were three-week intervals after the April 25 th earthquake. The rationale for this approach is explained elsewhere [ 34 ].

Overall, the most common causes of admission were injuries, pregnancy-related conditions, diseases of the digestive system, respiratory diseases, genitourinary diseases, and factors influencing health status and contact with health services. The post-EQ period contained 49% of all admissions, followed by the pre-EQ period with 26%. Women accounted for 56% of all admissions, while children under 15 years of age represented 17% of all admissions.

Average length of stay (LOS) was significantly longer in EQ1 than during pre-EQ (9.80 vs. 7.05, respectively, p < 0.001). This was particularly the case for injury-related admissions, where LOS increased by 57.3% (CI: 37.0–80.7; p < 0.001), whereas LOS for respiratory diseases was 21.6% shorter in EQ1 (CI: 7.1–34.6; p = 0.008).

In EQ1, the odds of injury admissions increased (aOR = 5.33, CI: 4.44–6.40), while they decreased for the majority of other diagnoses. Pregnancy-related admissions relatively decreased in EQ1 and remained low until post-EQ. The total number of admissions dropped in EQ1 and EQ2, and returned to pre-EQ trends in post-EQ. We estimate that there were in total 381 fewer admissions in this six-week period (CI: 206–556).

These results consolidate the findings from the previous study. The injury patterns seen after the earthquake in our study hospital required particularly long hospitalizations compared to before the earthquake. This may be related to injury characteristics, associated with high-energy trauma, and to the fact that this is a reference hospital and this is probable a selected sample of more severe cases. Two other findings merit attention: the relative but sustained decrease of respiratory and pregnancy-related conditions. In fact, previous work has reported an increase of respiratory diseases after earthquakes [ 35 , 36 ]. One explanation is the fact that respiratory conditions sustained would not require hospitalization, and would rather be reflected in outpatient care. Indeed, a study in a hospital near Kathmandu found an increase in emergency department visits due to respiratory diseases [ 37 ]. Such an explanation is not plausible for pregnancy-related admissions, and it may indicate that pregnant women are not receiving skilled care and deliveries are not conducted in health facilities. We elaborate on this finding in light of the qualitative results and the broader literature in the general discussion section.

Study III: how did staff experience hospital resilience?

Following recommendations for health service research [ 38 ], we used a mixed deductive and inductive approach to analyze the data from the 18 interviews, with the starting themes from the 4 R resilience framework. The context of the interviews and characteristics of the interviewees are detailed elsewhere [ 39 ]. We categorized the burden to the hospital into material challenges, challenges to health service provision, challenges to management and coordination, and emotional and physical impact on individuals. Material challenges included shortages of medicines and of surgical and rehabilitation equipment. The high influx of injured victims created challenges to health service provision, as the capacity to treat trauma conditions was overwhelmed. Challenges to management and coordination occurred for a variety of reasons, but one aspect is that the earthquake occurred on a Saturday, senior staff were absent, and junior staff who were present were hence less likely to know the disaster plan. Individual staff experienced an increased workload in difficult conditions, while they were also concerned with their personal and family situations.

Ends of resilience

In terms of robustness, the hospital maximized capacity to provide emergency care, interrupting routine or elective activities. But questions regarding maintenance of quality of care arose, as well as concerns that patients were discouraged to travel for deliveries and other essential care.

During that time, we were not focusing on quality of care. (…) We had a lot of wound infections, we were not taking care of sterility properly … We just needed to provide care, we were focusing on life-saving and limb-saving activities.

We identified three stages of hospital rapidity. Critical rapidity was the time needed for the hospital to start essential work and assist injured victims while also self-organizing.

We tried to manage the pharmacy without a software system, but for two days, we failed. We were almost out of stock after two days. Then we started to ask for medicine supply from different agencies, from the government …

After this reorganization, stabilizing rapidity allowed the hospital to address earthquake-related surges in a new, stable rhythm, until routine activities restarted and the hospital reobtained a ‘normal look’.

(…) That made us feel like “ok we are back into function”: no patients treated on the ground, all patients treated in the wards.

After routine activities restarted, time was still needed to recover to a new, non-emergency phase and feeling. We found that recovery rapidity was subjective and person-specific, with many interviewees struggling to explain their experiences of ‘recovery’ – some even mentioned they were still recovering, and not recovered .

Means of Resilience

The hospital found suitable alternatives to many disrupted elements. An example of its redundancy is that it established linkages with ‘step-down centers’ to refer patients no longer requiring advanced hospital care, which liberated beds to accommodate severe cases.

Looking at resourcefulness, the pre-existing disaster plan and trainings were important, but many if not the majority of adaptations were spontaneous, compensating for a perceived lack of coordination. Many new partnerships or collaborations were established with external organizations, health services were rearranged, and staff changed their tasks or assumed new roles to adapt to emerging situations.

At a disaster time, everyone needs to know their job. But I did not know my job: the scenario drove me to that job.

Individual resilience

During our analysis, it became evident that hospital staff were essential to the resilience of the hospital as a whole. But the resilience of staff as individuals could not be analyzed in light of the 4 R framework, which is designed for systems. We identified three major determinants of hospital staff resilience: safety, meaningfulness, and sense of belonging. Feeling safe allowed staff to continue working despite recurrent aftershocks, and seemed to influence full recovery. Meaningfulness helped making sense of the tireless work, the putting family second, the constant fear. Interviewees who did not feel their experiences were meaningful were more often frustrated, or felt trapped in their work. In general, interviewees felt that family cohesiveness in Nepal was an important aspect, allowing them to leave their loved ones with extended families or with friends or neighbours. This contributed to cultivating a sense of belonging to a supportive community.

We were terrified, but we knew that we were safe in ICU because that building was safe.

After the second day I shifted my family to uncle’s house (…). They had like a family get-together. And I was free to work.

Earthquake impact

In our study, earthquake victim admissions were particularly long (mean = 14.7 days; median = 10) compared to studies in other hospitals, either in Nepal [ 40 ] (median = 8 days) or in China after the 2008 earthquake [ 41 ] (mean = 7 days). A study in Italy after the L’Aquila earthquake in 2009 found that the average length of hospital stay (LOS) of admitted earthquake victims was 12.11 days; LOS was significantly associated with age, in a sample where 57% of patients were older than 60 years [ 42 ]. In our sample, only 29% of patients were older than 50 years, and age was not associated with length of stay, suggesting a different cause for the long hospitalizations. Study II showed that in the three weeks after the earthquake, injury admissions were significantly longer than before the earthquake. This long LOS is probably related to the fact that we focused on a reference hospital that received more severe cases, and that people from remote districts reached the hospital with considerable delay, probably with more advanced conditions. Previous research on earthquake injuries found that length of hospital stay was associated with the level of resource use [ 41 ], suggesting that our study hospital was particularly strained during the earthquake response.

Was the hospital overwhelmed? Our studies show some nuances. The total number of admissions decreased in the six weeks after the earthquake. Pressure points were elsewhere, not reflected in hospital admissions. Reports show that a total of 1,723 injured victims were treated at TUTH [ 43 ], but less than a third were admitted. The cases that needed admission presented a specific profile: from a share of 11.1% of all admissions in the pre-earthquake period, injuries represented 38.5% of all admissions in the 3 weeks after the earthquake (aOR = 5.3, p < 0.001). The average length of stay also significantly increased during the same period, and mostly due to injury-related admissions, which were significantly longer. The majority of admitted earthquake victims required a surgical intervention (69%, n = 345), with many needing reinterventions. Staff reported that operation theatres were constantly occupied with earthquake-related surgeries, and new intensive care beds had to be set up. To deal with this sudden increase of demand for surgical care, non-urgent activities were put on hold. As explained in a conceptual model by von Schreeb et al., the need for hospital care due to injuries is concentrated in the days after a sudden-onset disaster, while other elective and less urgent conditions are deferred [ 44 ]. We lack information on which exact activities were cancelled or postponed, and we are hence unaware of which were time-sensitive conditions, like cancer surgical care. We can only assume that this was the case for all non-urgent care, which would then substantially aggravate the negative consequences of the earthquake. Compensating for this interrupted care I quite a complex endeavor. A study from the COVID-19 pandemic modeled that that clearing the backlog of elective surgical care after the first lockdown could last up to 45 weeks if the surgical volume increased by 20% [ 45 ].

A concerning finding from study II is the sustained decrease of pregnancy-related admissions. This was confirmed in Study III by perceptions of hospital staff, who believed this reduction was due to insufficient delivery beds and preference of pregnant women to use services closer to their residence. One study shows, after the earthquake, women in rural Nepal preferred to deliver at home rather than at a health facility, seriously challenging referral in case of complications [ 46 ]. This finding is not unique to the Nepal earthquake context, and there is evidence of reduced pregnancy-related admissions after disasters in other settings [ 47 ], or of worse maternal outcomes in general [ 48 , 49 ]. Possible explanations in the literature include reduced access to hospitals and health facilities [ 47 ], the death of many skilled attendants [ 49 ], and the lack of specific provisions for women and children in disaster plans [ 48 ].

Hospital function and resilience

Studies I and II attempted to measure the burden to the hospital and the changes in function, and were complemented by the qualitative information obtained in Study III. These findings can be put in perspective with the conceptual models proposed by von Schreeb et al. (2008) and Zhong et al. (2014) [ 7 , 44 ], and may contribute to future studies that attempt to measure hospital resilience, or the lack of it. Study III is one of the first to use the well-established 4 R system resilience framework as a starting point to explore mechanisms of hospital resilience in a post-disaster setting, as experienced by its staff. We captured a richness of experiences and complexity of events that the 4 R framework failed to reflect. For instance, the importance of emerging adaptations even when a disaster plan exists is not really featured in this framework. This can be a consequence of the fact that the majority of the literature, both empirical and theoretical, is actually generated from pre-disaster contexts. Although recent work highlights the need of ‘adaptive flexibility’ [ 17 ] or ‘adaptive capacity’ [ 50 ], these concepts remain vaguely defined in the scientific literature. Moreover, while previous studies have demonstrated the important role of staff experiences in hospital disaster response [ 51 , 52 ], ours is the first to identify individual resilience of hospital staff in the frontlines as an important contributor to hospital resilience. In our study, we identified three major determinants of hospital staff resilience: meaningfulness, sense of safety, and sense of belonging. The importance of staff feeling safe in hospital disaster response had already been identified in a study after Typhoon Haiyan [ 51 ]. In line with the literature, making sense of a difficult experience is important for hospital staff to believe efforts were worthwhile; and the safety recurrently mentioned by health and humanitarian workers in times of emergencies [ 53 ,54, 54 ].

Global implications

Several recommendations can be made for global disaster and hospital management practices. While important, structural resistance alone is not sufficient to ensure resilience of health services; functional aspects, if not well managed, can create major bottlenecks.

Earthquake-prone countries should have strategies that ensure sufficient equipment to treat high numbers of orthopaedic injuries, and that strengthen surgical capacity in peripheral services. To achieve this, diplomatic agreements with neighbouring countries may be required in order to improve efficiency. If able, tertiary hospitals should provide advanced care to disaster victims, but disruption of non-earthquake specialized care should be minimized.

After any type of disaster, the population and frontline workers experience great levels of suffering and stress that can seriously impact their mental health and ability to reach their full potential in the future [ 55 ]. Hospital disaster plans should have specific provisions to ensure appropriate and skilled support to their own staff. Strategies that contribute to staff wellbeing in times of disaster response also increase hospital resilience. This could be leveraged in international initiatives such as the ‘Hospitals Safe from Disasters’ Campaign [ 56 ] or the HOPE network [ 29 ].

Finally, the perspectives from different stakeholders should be fed into hospital disaster plans when they are being designed. This can greatly increase adherence to such plans and their effectiveness.

Relevance for the COVID-19 pandemic

As the results of this work were being finalized, the world was hit by a pandemic disease caused by a novel coronavirus. As of early March 2021, more than 116 million people have been infected with this virus, and nearly 2.6 million have died from the novel coronavirus disease (COVID-19) [ 57 ]. Hospital and health system resilience became extremely relevant as we witnessed the collapse of critical care facilities and the prolonged interruption of non-emergency care, in rich and poor settings. It became evident that health facilities cannot face crises without engaging and collaborating with other actors in health systems, highlighting the complexity of health system and health service resilience. The pandemic also emphasized that crisis response plans could be obsolete if there is no adequate follow-up, and institutions must adapt as the situation evolves.

Societies also became more aware of the important role of frontline workers such as hospital staff during crisis response. As shown in our study, their resilience is critical for the resilience of a health service and a society as a whole. In the first wave occurring in early 2020, adequate personal protective equipment was lacking, putting staff at great risk of acquiring a severe infection, and transmitting it to their household members. This is a serious challenge to staff safety [ 54 ], and influences their ability to work, even if unconsciously. But during this period, countless global movements of solidarity were occurring, celebrating the courage of healthcare workers and valuing their work, ultimately contributing to a sense of belonging. However, as the situation is getting more and more protracted with recurrent waves of infection, ‘pandemic fatigue’, or ignoring preventive measures, is a dangerous threat to resilience of healthcare workers. The lack of collaboration from the general public can make staff feel their efforts are in vain and that the community is overlooking their needs.

Conclusions

Our findings empirically support conceptual models of disaster impact on hospital care and show concrete, measurable changes in hospital function. This is the first research work to further explore the suitability of the 4 R framework on hospital disaster resilience through empirical post-disaster data collection and analysis. We argue that resilience is only evident after a disaster occurs, when unplanned adaptations emerge and individual staff face unique challenges. We recommend additional case-studies to quantify the short and long-term impacts of different disaster types on hospitals in different contexts, and to identify the main concepts that can be measured and used to predict resilience before a disaster happens. By producing evidence from different events and contexts, we will be able to differentiate contextual factors that influence resilience from other factors that are more easily modifiable. These could be further elaborated through the co-construction of a hospital resilience assessment tool where diverse stakeholders are engaged.

Acknowledgments

I am thankful to my supervisors and to my colleagues in Nepal: Prof. Debarati Guha-Sapir Prof. Isabelle Aujoulat, Prof. Deepak Prakash Mahara, Dr. Sunil Singh Thapa, and Mr. KC Kumar. I would like to acknowledge the members of my steering committee, who followed my work over three and a half years, and the opponents of my dissertation, Prof. Johan von Schreeb (Karolinska Institutet) and Prof. Ali Ardalan (Tehran University of Medical Sciences and WHO/EMRO). Finally, I am grateful to all my co-authors and to the hospital staff who participated in the interviews and who assisted in the data collection.

Maria Moitinho de Almeida wrote this PhD review article based on key findings from her dissertation and from three articles that she wrote as first-author.

Funding Statement

This PhD thesis was supported by the USAID/OFDA, the Special Research Funds of UCLouvain, the Horlait-Dapsens medical foundation, and the Education, Audiovisual, Culture Executive Agency.

Responsible Editor

Julia Schrders

Disclosure statement

The author declares that she does not have any competing interest.

Ethics and consent

All of the studies from this dissertation were approved by the Institutional Review Committee of the Tribhuvan University’s Institute of Medicine, Kathmandu, Nepal. An informed consent was not necessary for Studies I and II as they used secondary data. Written informed consents were obtained from participants in Study III.

Paper context

Resilient hospitals are essential to reduce the health consequences of disasters, but few studies examine the disaster impact on hospitals, and research on hospital resilience is mostly from pre-disaster conceptualizations. This article shows the complex and nuanced impact of a high-magnitude earthquake on a tertiary hospital in Nepal, and documents the resilience of the hospital as experienced in the frontlines.