Event highlights
Ready for when it matters most: Hospital Safety Index training and hospital assessment in Romania
When emergencies strike, hospitals become more than health facilities. They become lifelines: places where the injured are treated, essential health services continue despite disruption and communities turn in times of uncertainty. But for hospitals to fulfil this role, they must be prepared to withstand and respond to a range of emergencies.
Today’s threats are becoming increasingly complex. Alongside natural disasters and disease outbreaks, countries across the WHO European Region are also preparing for chemical, biological, radiological and nuclear (CBRN) threats. Whether caused by industrial accidents, natural hazards, conflict or deliberate acts, these events can place extraordinary pressure on health systems and require specialized preparedness and response capacities.
This was the focus of a recent training and hospital assessment led by WHO in Bucharest, Romania, which brought together clinicians, public health specialists and emergency preparedness experts to strengthen national capacity for assessing and improving hospital readiness.
Organized by the WHO Regional Office for Europe and the WHO Country Office in Romania, as part of a regional project funded by the European Union through the EU4Health CBRN Action, the activity centred on the WHO Hospital Safety Index (HSI), a standardized tool that assesses structural and non-structural safety and emergency and disaster management capacity to help countries evaluate whether hospitals can continue functioning during emergencies and disasters, and a pilot annex designed to assess preparedness for CBRN hazards.
Looking beyond day-to-day operations
Over 2 days, participants learned how to apply the HSI tool and its CBRN-focused annex and then put their knowledge into practice during a hands-on assessment exercise at the Bucharest University Emergency Hospital (SUUB), one of Romania’s largest emergency care facilities.
For many participants, the experience offered a rare opportunity to step back from their daily responsibilities and view the hospital through a different lens.
“The HSI training was a very useful experience. My work as a clinician mainly focuses on individual patient care, and this course helped me see the hospital from a broader perspective, as a whole system that needs to remain safe and functional during emergencies. ... I believe this type of training is very valuable for health-care professionals and should continue, as it helps us better understand hospital preparedness and identify areas that can be improved,” said Dr Nader-Mugurel Jafal, an intensive care unit physician at the Bucharest University Emergency Hospital, who participated in the training and assessment exercise.
The practical assessment examined critical aspects of hospital preparedness, including structural and non-structural safety, emergency management systems, staff protection, coordination mechanisms and readiness for CBRN incidents.
For infection prevention and control specialist Dr Nicolae-Adrian Rizea, the field exercise offered an entirely new perspective on how a hospital functions during emergencies.
“Participating in the training on using the HSI tool to prepare for emergencies or potential CBRN hazards was an extremely valuable learning experience. The most important part was the practical field exercise, during which each group assessed a section of the HSI evaluation tool. The activity helped me look at the hospital from a completely different perspective, beyond the operational flows I am accustomed to in my daily work.”
Testing and refining a new CBRN preparedness tool
The training also marked an important milestone for the development of the CBRN preparedness annex, which is being piloted across the Region to strengthen health system readiness for complex emergencies.
“The assessment carried out in our hospital gives us the opportunity to objectively analyse our capacities and identify concrete solutions to strengthen preparedness for emergencies. The fact that the new CBRN annex is being tested here for the first time within the EU4Health project enables us to contribute, through our experience and feedback, to the development of a useful tool for hospitals in Romania and across Europe,” said Professor Corina Pop, Medical Director of the Bucharest University Emergency Hospital. She added: “For us, the continuous training of staff remains a priority. Every training course, simulation exercise and assessment helps us become better prepared, more coordinated and more confident in our ability to respond to difficult situations.”
Building on earlier testing of the draft CBRN annex in Poland, the exercise in Romania formed part of the first field testing of the revised draft, providing an opportunity to gather practical feedback from frontline health professionals and translate it into further improvements that can benefit hospitals across the Region.
Building capacity for the future
Beyond the assessment itself, the activity followed a training-of-trainers approach, helping to build a national network of professionals who can support future hospital assessments and preparedness efforts across Romania.
For participants working at the national level, the training offered practical insights into how preparedness can be systematically evaluated and strengthened.
“Participating in this training was highly relevant both for my work at the National Centre for Surveillance and Control of Communicable Diseases and for my role as National Focal Point for Preparedness and Response. The practical component highlighted the importance of assessing not only whether plans and procedures exist, but whether they are functional, coherent and applicable in real-world settings. Furthermore, the training-of-trainers approach also creates opportunities to transfer this knowledge into future preparedness and assessment activities,” said Lavinia-Cipriana Rusu of the National Institute of Public Health of Romania.
From assessment to action
Preparedness is not a checklist completed once and put aside. It is a continuous process of learning, testing and improving.
The HSI helps hospitals identify strengths, address gaps and prioritize actions that can make the difference when emergencies occur. By strengthening preparedness today, hospitals are better positioned to protect patients, maintain essential services and support communities tomorrow.
As Laura Lloyd-Braff, Preparedness Officer at WHO/Europe, noted:
“When emergencies happen, communities rely on their hospitals more than ever. Assessments like this help hospitals identify gaps and prioritize practical improvements to protect patients and staff and maintain essential services, including during CBRN incidents. The next step is to translate these findings into action and regularly test whether those arrangements work.”
The activity is designed to bolster public health capacities related to CBRN threats in Ukraine, neighbouring countries and beyond. Through training, assessments, exercises and technical support, the initiative helps countries strengthen preparedness and build more resilient health systems capable of responding to complex emergencies.
Romania is among the 7 countries contributing to this effort by testing innovative tools and helping to advance practical approaches to hospital preparedness that can be applied across the WHO European Region.
Event notice
Health emergencies can place hospitals under severe pressure, requiring them to remain safe, functional and able to maintain essential services during crises. To support Romania’s efforts to strengthen hospital resilience and emergency preparedness, WHO, in collaboration with the Ministry of Health of Romania, will conduct a 2-day training on the WHO Hospital Safety Index (HSI). The HSI is a standardized assessment tool used to determine the likelihood that a hospital will remain safe and functional during emergencies and disasters. This training will introduce participants to the HSI methodology and prepare them to apply the tool consistently and objectively.
As a part of the training, participants will conduct a practical HSI assessment of Bucharest Emergency University Hospital (SUUB), examining its structural, non-structural, emergency and disaster management, and functional capacities. During the assessment, participants will also be introduced to a pilot annex with indicators related to chemical, biological, radiological and nuclear (CBRN) preparedness, developed to complement the HSI, and will provide feedback on how the annex works alongside the core tool.
The event forms part of the 3-year joint CBRN action implemented by the European Commission's Directorate-General for Health and Food Safety (DG SANTE) and WHO/Europe.