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PLoS One. 2016 Sep 7;11(9):e0161542. doi: 10.1371/journal.pone.0161542. eCollection 2016.

2015 Estimation of Hospitals Safety from Disasters in I.R.Iran: The Results from the Assessment of 421 Hospitals.

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Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, United States of America.
Disaster and Emergency Management Center, Ministry of Health and Medical Education, Tehran, Iran.
Department of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Clinical Science and Education, Karolinska Institute, Stockholm, Södersjukhuset, Sweden.



Iran's health system has developed a Farsi edition of the Hospital Safety Index (HSI) and has integrated the related assessment program into the health information system. This article presents the results of the 2015 estimation of hospital safety from disasters in I.R.Iran using HSI.


We analyzed data from 421 hospitals that had submitted a complete HSI assessment form on the Ministry of Health and Medical Education Portal System. Data collection was based on the self-assessments of the hospital disaster committees. HSI includes 145 items categorized in three components including, structural, non-structural and functional capacity. For each item, safety status was categorized into three levels: not safe (0), average safety (1) and high safety (2). A normalized scoring scheme on a 100-point scale was developed. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0).


The average score of all safety components were 43.0 out of 100 (± 11.0). Eighty-two hospitals (19.4%) were classified as not safe, and 339 hospitals (80.6%) were classified in the average safety category. No hospital was placed in the high safety category. Average safety scores were 41.0, 47.0, and 42.0 for functional capacity, non-structural safety, and structural safety respectively. The average safety score increased between 2012 and 2015, from 34.0 to 43.0.


Hospital safety in the event of disasters has improved in Iran in recent years and more hospitals have joined the HSI program. This is a result of continuous efforts invested in capacity building programs and promotion of the 2012 HSI estimation. The HSI should be maintained to monitor the progress of Iran's health system in regards to hospital safety in the case of disasters. It is recommended that WHO continue advocacy of HSI, establish a HSI monitoring system, and add it to country profiles on WHO website.

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