Natural hazards, climate change, conflicts, and disease outbreaks are creating increasingly complex challenges for countries and communities. These factors generate multifaceted threats to health systems, requiring robust responses to save lives and minimize health service disruptions. COVID-19 has been a significant wake-up call globally, highlighting the urgent need for more comprehensive risk mitigation and preparedness in the health sector.  

Health systems are particularly vulnerable to the impacts of disaster. Many countries already struggle to meet routine health care demands for essential services; and this is exacerbated by the added burden from climate change, outbreaks, pandemics, demographic shifts, and aging infrastructure. For example, the 2021 earthquake on the Indonesian island of Sulawesi severely affected the four largest hospitals in the area, obstructing critical relief and treatment efforts, while annual floods in South Sudan disrupt health service delivery in an already resource-limited setting. The increasing frequency and intensity of such events, driven by climate change, further blur the lines between high-impact, low-probability hazards and recurrent, lower-impact events, creating compounded risks that continue to disrupt health services and impact human health. 

Operational health systems play a crucial role in emergency preparedness and disaster response. Building resilience and promoting cross-sectoral coordination are essential for health systems to effectively respond to emergencies and disasters with minimum disruptions to essential health service delivery. The Japan Disaster Medical Assistance Team (DMAT) exemplifies this need. Established after the Great Hanshin Awaji Earthquake in 1995 to provide effective emergency medical services, DMAT has more than 1,700 teams with 15,000 members nationwide and a cross-sector coordination system. DMAT has responded to many major disasters—including earthquakes, tornadoes, avalanches, and train and airline accidents—alongside first responders. During the 2016 Kumamoto Earthquake, 466 DMAT teams with 2,071 members evacuated over 1,400 patients from damaged hospitals. Through coordinated efforts with other disaster medical relief teams and local authorities, DMAT was able to maintain vital medical and public health operations and save lives. 

Given the complexity of these challenges and the scarcity of resources—both on the ground and at institutional level—continued collaboration in disaster risk management (DRM) for health systems is crucial. The Global Program on Climate and Disaster Risk Management for Health Systems under the Global Facility for Disaster Reduction and Recovery (GFDRR) at the World Bank, the Disaster Risk Management and Resilience Unit of the World Health Organization (WHO) Health Emergency Programme, and the WHO Centre for Human Development actively support countries to enhance health system resilience. At the 2024 Understanding Risk Forum (UR24) in Himeji, Japan, they highlighted their collaborative efforts during a joint panel discussion on the current state of DRM in health systems and a complementary technical deep dive into data driven solutions and ready-to-deploy tools assisting policy makers for DRM in health. This note summarizes those discussions, detailing the resources and strategies developed by the World Bank Group and WHO to address this challenge, and outlining next steps for effective global disaster management and response.  

Global Program on Climate and Disaster Risk Management for Health Systems (GFDRR) 

The program aims to support countries in their efforts to enhance the resilience of their health systems and supporting environments to a range of shocks by developing three types of product: targeted knowledge products to support health teams and service providers on the ground; assessment tools; and high-resolution geospatial analytics. These resources identify critical gaps and opportunities within country health systems and prioritize measures that can guide sustainable and green resilient investments. The program integrates lessons from lifeline infrastructure sectors—such as transport, energy, and water—and emergency preparedness and response, and invests in these areas to generate co-benefits for health systems. Harmonized investments across all service-enabling factors can help achieve results, as disruptions in any one of these sectors can undermine the overall effectiveness of health services. 

The GFDRR report, Frontline: Preparing Healthcare Systems for Shocks from Disasters to Pandemics, explores the functional dependence of health systems on lifelines infrastructure and their integration with other emergency and response actors during and after shocks. It outlines five pillars for analyzing DRM in health systems to better prepare them for a range of shocks to ensure more resilient services.  

The program also works to enhance health system resilience against climate and disaster risks by identifying the strengths and weaknesses in their DRM. The Frontline Scorecard provides a data-driven, country-specific gap analysis that evaluates the intersection of countries’ health system capabilities, climate and DRM capabilities, and lifeline infrastructure to guide investments and reforms for building resilient health systems. This rapid assessment tool has been applied in several countries—including Peru, Colombia, Tajikistan, Moldova, Mauritania, and Belize—to identify strategic actions for strengthening health system resilience. It has also been piloted as a health system resilience monitoring tool to track national-level targets over a 10-year period. 

Understanding how disasters impact lifelines infrastructure and therefore access to public services, especially health care, is another priority. The program assesses the functionality of lifeline infrastructure services and accessibility to health infrastructure, leveraging open data to simulate disaster scenarios through an open-source, peer-reviewed methodology published in Nature, “Measuring Accessibility to Public Services and Infrastructure Criticality for Disasters Risk Management”. After being piloted in Lima, Peru and Manila, Philippines, the analysis was applied in major cities in Colombia. Outputs identify strategic bottlenecks that impact access to critical public services, which policy makers can use to enhance their resilience and accessibility. Such analyses consider both low-impact, high-probability events and high-impact, low-probability events, identifying, for example, roads that are frequently obstructed by seasonal flooding as well as those at severe risk of damage from large-scale disasters, such as earthquakes.  

Finally, the program supports several instruments to improve response capacity to natural disasters and address fiscal risk in developing countries. For example, the Disaster Risk Financing and Insurance (DRFI) Program develops and executes tailored financial protection strategies to enhance the financial resilience of governments, businesses, and households against disasters. To support clients, the World Bank also rapidly mobilizes emergency resources via tools such as Catastrophe Deferred Drawdown Options. From February of 2020 to June of that year, 20 countries withdrew nearly $1.7 billion (2020 dollars) in CAT DDOs for emergencies, predominantly in response to COVID-19. There has been a notable increase in health system strengthening, with the percentage of CAT DDOs including health-related indicators rising from 32% before 2020 to 64% from 2020–22. In response to this, and informed by discussions in Colombia, Nepal, Tajikistan, Belize, and other countries, GFDRR has adapted the Frontline Scorecard to offer recommendations for health sector considerations of CAT DDOs. 

WHO Health Emergency Programme DRR Unit and WHO Centre for Human Development  

WHO is leading the advancement of DRM in health systems by deepening risk knowledge and integrating broader disaster risk reduction strategies into health. It supports the implementation of comprehensive all-hazard approaches to DRM by collaborating with partners and stakeholders, providing guidance on research methods, and developing tools and strategies to enhance preparedness, response, and hospital safety to ensure health systems are resilient and capable of managing emergencies effectively. 

Reducing the risk of emergencies and disasters is central to achieving sustainable development and is among the pressing priorities in the Sendai Framework for Disaster Risk Reduction, International Health Regulations 2005, and Paris Agreement on Climate Change. WHO has developed a conceptual framework or paradigm of health emergency and disaster risk management (Health EDRM) to consolidate contemporary approaches and practices for addressing current and emerging risks to public health and the need for effective resource use and management. Health EDRM emphasizes the critical importance of prevention and preparedness, together with response and recovery, to save lives and protect health, through an all-hazard, community-centered, whole-of-society approach.  

WHO has continued to operationalize Health EDRM functions in countries and communities, including by adopting a risk-based approach to prioritizing actions and planning for sound risk management. The Strategic Toolkit for Assessing Risks (STAR) offers a comprehensive approach for all-hazard health emergency risk assessments to help countries, states, provinces, and communities map risks to prioritize health emergency preparedness and response actions and inform country planning processes, such as National Action Plan for Health Security (NAPHS), business continuity planning (BCP), and contingency planning for specific risks. WHO is also consolidating STAR country risk profiles with other country risk assessments to develop an emergency and disaster risk calendar (EDRC) to enable countries to better anticipate threats and potential emergencies, triggering early warnings and actions for timely risk mitigation.  

Since the inception of STAR in 2016, WHO has supported around 100 countries to conduct over 160 strategic risk assessment exercises. As a flexible approach, it has adapted STAR for assessing risks in multiple country contexts — at national, subnational, municipal, community, and even hospital (STAR-H) levels — and of specific hazards, such as climate change or disease/infection outbreaks. 

Reliable evidence is also crucial for informing effective health EDRM decisions and strategies to reduce health risks and consequences. WHO’s guidance on research methods for health EDRM supports the research community, policy makers, practitioners, and other stakeholders to generate research and build effective collaboration. 

In emergencies, disasters, and other crises, the lives and well-being of affected populations must always be protected, particularly in the minutes and hours immediately after impact or exposure, as speed is vital when saving lives. For critical infrastructure such as health facilities to be able to deliver services without interruption in these situations is a matter of life and death. This is underlined in Target D of the Sendai Framework for Disaster Risk Reduction 2015–30, which aims “to substantially reduce disaster damage to critical infrastructure and disruption of basic services, among them health and educational facilities, including through developing their resilience by 2030”. 

WHO’s safe health facilities program supports countries to: develop national policies and regulations to make health facilities safe from disasters; protect the lives of occupants and the functionality of health facilities; and support the implementation of policies and strategies, including risk assessments, national and international regulations on safe health facilities, and climate change adaptations, such as ensuring health infrastructure is energy efficient and resilient to future risks.  

Assessing the safety and resilience of health facilities is essential for identifying gaps to guide investments and enhance preparedness for emergencies and disasters. WHO has developed systematic and evidence-based approaches to improve hospital readiness and safety through tools like the Rapid Hospital Readiness Checklist and the Hospital Safety Index, which health authorities and multidisciplinary partners can use to gauge the probability that a health facility will continue to be safe and operational in emergency situations. 

Initiatives by both the World Bank Group and WHO will further advance the preparation of health systems for disasters, leveraging their unique strengths and expertise. The Global Program on Climate and Disaster Risk Management for Health Systems generates country-specific knowledge, scalable evidence-based tools, and high-resolution geospatial analytics for resilient investments, while providing cross-sectoral insights to integrate health systems with broader emergency management and transport, water, energy, telecommunications, and other lifeline infrastructure investments. WHO advances health system resilience by developing technical tools, frameworks, and research methods, and collaborating with partners to integrate health into broader disaster risk reduction (DRR) strategies and enhance emergency preparedness and response. Outputs of both organizations’ assessments and knowledge tools create synergies and complementary results, enabling low-and middle-income countries to effectively strengthen their health systems’ resilience to shocks. 

At the UR24 panel event, the World Bank, WHO, and other stakeholders discussed the following key areas for enhancing effectiveness and strengthening the DRM agenda in health systems to ensure an effective global DRM and emergency response. 

1. Advancing tool development 
   Continue developing innovative tools and inclusive approaches for systematic risk assessment to better prepare for and respond to emergencies and disasters. 
2. Addressing data gaps 
   Identify and address gaps in data availability and reliability through partnerships, by improving the accuracy and effectiveness of DRM strategies, and by harmonizing existing datasets. 
3. Promoting investment 
   Maximize investments through various financing mechanisms, emphasizing that proactive measures and capacity building lead to significant savings in disaster response and recovery. Consider increasing access to disaster risk financing for the most vulnerable populations and pooling health strengthening and resilience financing—for example, through pandemic funds. 
4. Strengthening governance 
   Encourage governments to establish clear policies and robust legal frameworks and ensure coordination across sectors to enhance disaster resilience. Continue to integrate health into national DRM policies and strategies to support vulnerable populations. 
5. Supporting vulnerable populations 
   Promote inclusive DRM, gender equality, and support for small states and fragility, conflict, and violence (FCV) settings to enhance disaster resilience and achieve more sustainable solutions. 
6. Fostering collaboration 
   Support the formation of public-private partnerships and community engagement initiatives, ensuring broad stakeholder investment in building emergency and disaster resilience.