January 17, 1995, 05:46. This was the moment 20 years ago that the Great Hanshin-Awaji Earthquake struck and resulted in 6,434 lost lives, 200,000 destroyed buildings, 300,000 people made homeless, and a staggering economic cost then calculated at 2.5 percent of Japan’s GDP (approximately $100 billion).

As for all disasters, the human toll, including the psycho-social impact on survivors, is the greatest tragedy. It reminded us of the constant need for communities, cities, and nations to enhance prevention and preparedness, to ensure that response systems are efficient, and that communities build their resilience to withstand and cope with any future disaster.

The Great Hanshin-Awaji Earthquake ushered in a new era of volunteerism in Japan, and highlighted many lessons on how to prepare for disasters arising from hazards of all kinds, improve care and support for the survivors, as well as to rebuild cities and their health systems. The 2011 Great East Japan Earthquake, and so many other natural disasters in the past two decades across the world, illustrated the need to continuously apply past lessons.

The number of people affected by emergencies and disasters continues to increase year after year, with climate change further exacerbating the frequency and magnitude of climate-related hazards. Underlying all efforts is the need to reinforce the role of communities, for which lessons from the Great East Japan Earthquake are being transmitted through the concept of “kizuna” (human bonds).

The Ebola emergency in West Africa has once more demonstrated the need to ensure that preparedness is in place and response plans are up-to-date, disease surveillance, health facilities and health systems are operational in any circumstances, health education is implemented, and social mobilization and risk communication plans are available in case of an emergency.

Investing in health systems is critical to ensure that all countries can prevent, detect and respond to known and emerging health threats, as well as to ensure increased resilience and response and recovery capacity. A key part of this is emphasizing that hospitals and other health facilities are safe and operational in times of disasters to deliver life-saving care, for which the World Health Organization and its partners are supporting through a global Safe Hospitals Initiative.

All of these experiences further increase the urgency to focus on vulnerable populations, such as the aged, disabled, women and children, and the poor, across the continuum of prevention, preparedness, response and recovery from disasters.

For example, understanding the risk context of various communities, subpopulations and the nature of inequities can help local actors form social mobilization strategies for more effective preparedness and response. Knowing where people live, coupled with effective early warning systems, can help ensure that first responders can locate populations and save lives. An increasing aged population and people with life-threatening chronic diseases also introduces new challenges to ensuring the continuity of care for survivors.

The spirit and determination of the people of Kobe and other municipalities in Hyogo Prefecture inspired the world on how to “build back better” that ensures that post-disaster recovery, including social and health rehabilitation and reconstruction, provides the opportunity to reduce future risk and make communities safer and better places to live and work.

This spirit, and the vision of former Gov. Toshitami Kaihara (who recently passed away), and of the former director-general of the World Health Organization, Dr. Hiroshi Nakajima, inspired the creation of the WHO’s Kobe Center in the aftermath of the Great Hanshin-Awaji Earthquake, a commitment continued by Gov. Toshizo Ido and Mayor Kizo Hisamoto to this day.

Among the key legacies of the Hyogo and Kobe experience had been the incorporation of their experience into the ground-breaking Hyogo Framework for Action, 2005-2015, Building the Resilience of Nations and Communities to Disasters, which defined global action for disaster risk reduction.

Ten years later, this framework will be discussed with all nations and updated at the upcoming World Conference on Disaster Reduction on March 14-18 in Sendai.

For the good of all citizens worldwide, there is an urgent need to expand international, national and local efforts to reduce disaster and health emergency risks, to put a greater focus on prevention and community-centered action, to increase preparedness capacity, and response and recovery when needed.

Alex Ross is the director of the World Health Organization’s Center for Health Development, located in Kobe.

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