Strengthening hospital resilience to earthquakes: a public health review of seismic risk reduction programs in the Middle East

INTRODUCTION: Maintaining hospital functionality during and after earthquakes is essential for effective disaster response in seismically active regions. In the Middle East, hospital resilience is challenged by limited infrastructure investment, variable enforcement of safety regulations, and inconsistent preparedness planning. METHODS: A systematic literature review was conducted across nine databases (2009-2024), including EBSCO, Cochrane, PsycINFO, Scopus, Web of Science, PubMed, Medline, EconLit, and Google Scholar. Studies were included if they assessed hospitals in the Middle East with comprehensive or partial seismic risk reduction programs. Three independent reviewers performed data extraction and quality appraisal using validated tools appropriate to study design. RESULTS: Five studies met the inclusion criteria. Hospitals with comprehensive seismic risk reduction programs, including structural retrofitting, disaster drills, surge capacity plans, and emergency communication protocols, demonstrated higher levels of functional continuity following earthquakes. In contrast, facilities lacking such measures reported structural damage, service disruptions, and patient evacuations. Mobile hospitals were identified as a promising adaptive strategy for mitigating overload in high-risk, resource-limited settings. CONCLUSION: Comprehensive seismic preparedness programs enhance hospital functionality in earthquake-prone regions. These findings underscore the importance of integrated risk reduction strategies, cross-sector coordination, and sustained investment. Further research is needed to evaluate the comparative impact of preparedness levels using standardized functionality indicators, and to explore scalable innovations such as mobile and modular healthcare units to strengthen regional disaster resilience.