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Developing and Implementing Emergency Response Plan of a Bheri Zonal Hospital in Nepal

Risk Reduction/Earthquake/Pre-disaster

Banke district


Hospitals would be among the first institutions to be affected after a disaster, natural or human induced. Because of the heavy demand placed on their services at the time of a disaster, hospitals need to be prepared to handle overwhelming huge workloads.

Despite the very critical role in disaster, hospitals in Nepal are not prepared to respond to the predicted disaster situation. Seismic vulnerability assessments of 19 major hospitals showed 80% of the hospitals will be out of function in a major earthquake. Bheri Zonal Hospital located in Nepalgunj, Banke district, the largest referral government hospital in the mid western region providing services to more than 100,000 people of the mid and far western region of Nepal per year, is amongst those most vulnerable to earthquakes. The cause of non-functionality of the hospital is not only attributable to structural components, but also non-structural and functional components. Realizing this, a comprehensive emergency response plan of the hospital was developed, followed by implementation of key activities under the project Developing and Implementing Disaster Preparedness Plan in Bheri Zonal Hospital. The project broadly covered and focused on awareness and capacity building in making the hospital safer and enabling it to cope with the pending disaster.

The project conducted a detail vulnerability assessment of structural and non-structural safety of Bheri Zonal Hospital in early 2010. The project was implemented by NSET with funding support from European Commission’s Humanitarian Aid Department (ECHO) through Action-Aid Nepal (AAN) under DIPECHO V together with Bheri Zonal Hospital (BZH). Based on the assessment report, preparation of comprehensive emergency response plan of the hospital and implementation of key activities to support the plan together with non-structural mitigations was chosen by the hospital management in consultation with Action Aid and NSET. With support from Handicap International (HI), the issues of accessibility were also included while preparing the emergency response plan as well as during implementation of activities to support the plan as far as possible.

Towards making the Bheri Zonal Hospital prepared for emergencies various activities were implemented such as; Assessment for functionality of the hospital (Structural, Non-Structural and Functional) was carried out, orientation and interaction program was organized on disaster preparedness planning,  Emergency Response Plan with Spatial Map was prepared and as suggested by the assessment report, non-structural mitigation measures were also carried out in the hospital.

In addition, works listed as Priority I such as putting sirens in four key locations around the hospital complex, construction of two emergency exit gates, two channel gates to guide the patient flow, clearing and planting of grass in the garden area to maintain as a lawn for allocating an overflow of patients, making and fixing of sign boards for quarters and the main entrance gates of the hospital, were carried out.

For Strengthening of critical life line facilities, as suggested by the vulnerability assessment, lifeline facilities including the generator and pump house, were strengthened by demolishing the existing one and reconstructing the housing and providing shelter for the generator. They were constructed incorporating earthquake resistant elements, to ensure they remain functional during post-disaster.

Development of hospital disaster response plan is not an end in itself and it is imperative to test the plan, therefore orientation training and Hospital Disaster Preparedness Drill program was developed as a continuing effort to help Bheri Zonal Hospital undertake effective and efficient drills specifically for emergency preparedness and response.


The overall goal of the project was to strengthen the mass casualty management system in BZH to ensure the prompt and sufficient performance of the hospital after a disaster building an effective, efficient and inclusive response mechanism.}

The various methodologies carried out in BZH to improve its functionality during a disaster, are as follows;
Coordination and Interactions with Various Stakeholders
Reference of Relevant Documents
Application of Hospital Incident Command System (HICS)



More than 100,000 people of the Mid and Far Western Region of Nepal


Planning is possible, even in busy operating hospital

Involvement of Hospital Staff in Planning and Implementation was effective

Application of new concept is challenging and requires patience

Integration with other programs was Cost effective

Regular practice of Triage is important

Continuous training for the staff needed

Linkage of Disaster Store with Emergency Store is necessary

Mass Casualty Management is not all technical

Drill was a learning experience for nursing students

Drill should to be conducted on regular basis


This was a pilot project primarily developed to design and build a replicable model that can be used in future hospital safety-related programs, whilst also demonstrating and advocating for a higher level of hospital safety in the country as per the first Flagship Program (a consortium  developed by the donors and endorsed by GON for Disaster Risk Management in Nepal).

As gleaned from the works of BZH and the lessons learnt, all approaches and methodologies were found to be highly effective and can be replicated with project-specific alterations in other health institutions in Nepal in future



Action-Aid Nepal (AAN) and Bheri Zonal Hospital (BZH), under the DIPECHO V, National Society for Earthquake Technology-Nepal (NSET), Handicap International (HI).

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