Typhoons, disease outbreaks and now escalating protests: Hong Kong isn’t ready for a citywide disaster

Hong Kong is ranked as Asia’s most disaster-prone city, and while this is usually associated with natural hazards, the next catastrophe may well be man-made. In the current setting of mass civilian anti-government demonstrations, the danger and institutional weakness could arguably have been predicted and mitigated against. Preparation is key. Although unpredictability underlies risk-reduction principles for all disasters, some emerging threats should be foreseen. The cornerstone of disaster management is resilience – a city’s ability to absorb and recover from the impact of an event. The essential elements of resilience are readiness, response and restoration. Anticipation (and, where possible, avoidance) is critical; the foundation is rehearsal of the coordinated action plan. Unfortunately, independent studies indicate that the governance and institutions of Hong Kong are inadequate for the task. In the 2016 “Disaster Preparedness in Hong Kong – A Scoping Study”, led by the Harvard School of Public Health, 40.6 per cent of nursing and medical staff interviewed thought the city was at risk of disaster due to civil unrest. However, only 25.6 per cent of medical personnel surveyed had taken part in a hospital disaster drill in the previous two years, and only a fifth of those exercises had been multi-agency, involving the emergency services. Realistic major incident planning is crucial for optimising clinical outcomes when casualties exceed customary handling capacity. Senior health care clinicians, while acknowledging the existence of Hospital Authority disaster contingency plans, were concerned about “table-top gaming exercises” supplanting practical rehearsals. Emergency services (police, fire, ambulance) were generally better prepared: 90.2 per cent of personnel said their organisation conducted regular disaster drills, including for terrorism and aviation accidents. Nevertheless, 63 per cent of emergency services personnel assessed Hong Kong’s overall disaster response preparedness as inadequate or very inadequate. Lawmakers call on protesters to calm down and rethink strategy The UN Office for Disaster Risk Reduction launched a worldwide “Making Cities Resilient” campaign in 2010, identifying 10 essential points. This was evaluated locally in the 2018 study “Assessing the Disaster Resilience of Megacities: The Case of Hong Kong”. Unfortunately, Hong Kong’s disaster preparedness was judged to have failed on three counts. Specifically, the city came up short in “institutional capacity” and “risk identification”; and, under “organising for disaster resilience”, Hong Kong was said to have inadequate governance and a lack of a strategic “city vision”. Infrastructure development and financial resourcing were seen as the strengths. But, notably, new and unpredictable risks precipitated by unstable sociopolitical dynamics were flagged as challenges comparable to climate change. The emergency and disaster response system in Hong Kong is administered by the Security Bureau, and consists of three tiers. The first level is based on primary emergency services. Aggravated risk to property or life requires the second tier, involving government monitoring by a Security Bureau duty officer and emergency support unit. In the event of large-scale threats to property, life, public order or security, the third-tier response is triggered, coordinating emergency services, security control, civil support actors (including auxiliary medical staff and hospitals) and maintenance of essential infrastructure, supervised by the chief executive’s security committee. Hong Kong police caught between a rock and hard place This system is designed to operate the three phases of emergency response – rescue, recovery and restoration – under one umbrella. Events requiring more assets than those used on a day-to-day basis by emergency services are deemed major incidents; when the capacity is overwhelmed by the number of injured, the situation becomes a mass-casualty incident. Relevant here are the concepts of “population at risk” and the “casualty estimate”. Recent public demonstrations have involved hundreds of thousands, even millions – and violent confrontations with police are taking place. A misjudgment in protest control by law enforcement officers, causing a crowd crush or stampede, or an overly vigorous ballistic response, could result in a (conservative) casualty rate of 0.1 per cent, potentially creating many hundreds of victims. This should be considered in the context of the overall “casualty handling capacity” of Hong Kong’s hospitals, where intensive care unit beds – totalling perhaps 300 – would be quickly overwhelmed. When the response system itself becomes impaired, it can lead to a compound disaster. Given the critical role of police in disaster management – in terms of cordon, control and co-ordination (with ambulance and first aid responders for triage and casualty evacuation) – a conflict where there is widespread hostility between the public and law enforcement officers involves an amplified risk of a crisis during the handling of victims. How to heal the rift between police and protesters The right to medical care for injured civilian protesters is provided under international human rights law (and these protections extend to the humanitarian work of identified first aid volunteers embedded within the protests). These global norms would still apply even if martial law were declared. An often-overlooked but necessary contingency plan involves ensuring injured police or military reinforcements and the public are treated at different hospitals to prevent continued unrest and disruption of services at the facility. Furthermore, such disturbing circumstances may challenge the ethical convictions of health care workers, who often sympathise with injured civilians – with uncomfortable implications for prioritisation of care. And at the extreme? Think what would happen if the waning loyalty of a vilified and demoralised police force (who are, after all, also citizens) leads to questioning loyalty to the government. The last thread on which a community hangs is social capital – the connectedness of a society, which more than any government response is the chief determinant of disaster resilience. This quantity was considered plentiful in the Hong Kong disaster resilience study of a year ago, but it has been squandered. The Hong Kong government is clearly inadequately prepared for the humanitarian cost of an unnatural disaster of its own making. Darren Mann is a consultant military surgeon with combat and mass-casualty incident experience