Neglected safety: The hidden fire risk in Bangladesh’s health facilities

Recently, fire safety has become one of the most pressing concerns in hospitals and healthcare facilities across Bangladesh. As urban populations expand rapidly and clinics, diagnostic centres, and hospitals mushroom - not just in the cities of Dhaka and Chattogram, but also in the periphery and smaller towns - a dangerous pattern has emerged: fire planning and preparedness are lacking. Health care facilities, which are supposed to be safe havens for the sick and vulnerable, are often turned into death traps after disasters.

Reflecting on past incidents brings the horror to life. Five patients tragically died in a fire that broke out at the ICU in Dhaka in March 2021. Additionally, in July 2022, a fire engulfed a Diagnostic Centre in Narayanganj, causing panic among patients and staff, but fortunately, no lives were lost. Among the many fire incidents in health facilities, these are just a few examples. 

Fire exits are inadequate, emergency routes are blocked, medical gases like oxygen are improperly stored, sprinklers are absent, and emergency response training is inadequate. The consequences of these issues colliding with a fire outbreak are devastating.

Bangladesh's hospitals and clinics are usually built in converted residential or commercial buildings. It is common for them to be located in narrow lanes, making it difficult for emergency services such as fire trucks and ambulances to get to them. There are many buildings in Bangladesh that do not adhere to the Bangladesh National Building Code (BNBC), which specifies fire safety measures. 

Additionally, relevant authorities do not conduct regular inspections and enforce laws. Fire licenses are sometimes forged, expired, or never obtained. Many private facilities prioritise profits over patient safety, increasing the risk multifold.

ICU patients, people on life support, and the elderly are most vulnerable in these unplanned and poorly regulated buildings. In the event of a fire, it becomes nearly impossible to evacuate these patients without pre-established protocols, fire-rated zones, and trained staff. In addition to the fire itself, the tragedy is the system that fails to protect those already in harm's way.

Hospital management is not the only one affected by this issue. The failure reflects a broader culture of non-compliance with safety regulations due to structural, architectural, and policy failures. Health infrastructure must be resilient in a country prone to various disasters - fire, earthquakes, and flooding. As far as public and private healthcare development is concerned, it is one of the most overlooked factors.

What can be done to change this dangerous trajectory?

A national fire safety audit must first be conducted in all healthcare facilities, starting with high-risk areas in major cities and then extending to peripheral areas. Health regulators, independent technical experts, and the Fire Service and Civil Defence Department must all be involved. Failure to comply with minimum fire safety standards should result in strict penalties, including temporary closures.

Second, architects and planners play a crucial role. Unlike other commercial buildings, healthcare facilities require specialised design thinking. There must be dedicated fire exits, protected corridors, fire zones, smoke evacuation systems, and clear vertical and horizontal circulation paths in hospitals. 

Fire-retardant materials must be used. There should be a ventilated, protected area for storing medical gases away from patient areas. Architects should have the power to refuse to cut corners when clients or developers try to do so. There must be a balance between professional ethics and regulatory enforcement.

In addition, fire safety should be integrated into the approval and renewal of hospital licenses. A hospital's fire safety clearance should be renewed annually, just as it requires a medical license to operate. In order to support this process, a robust digital monitoring and reporting system is needed. The city corporation and the local authority should work together to ensure that building uses, heights, access, and services meet safety standards.

The fourth aspect is awareness and capacity building. All hospital staff members, including nurses, cleaners, administrative personnel, and even family members of patients, should receive periodic fire evacuation training. 

It is important to have multilingual emergency signage that is easily visible. The simplest things, like not blocking stairs with furniture or files, or keeping flammable materials away from oxygen outlets, can save lives. As well as education, vigilance is required.

Resilience is a function of healthcare infrastructure safety, which policymakers must recognise. Similarly to the government's investment in disaster risk reduction strategies, health facilities should be included in disaster preparedness programs. It is possible to provide incentives for hospitals that upgrade their fire safety systems through tax rebates, recognition, or access to soft loans. Additionally, urban planners should consider zoning rules that allow emergency vehicles easier access to these facilities.

It is also necessary to localise fire safety codes. It is imperative that the BNBC be contextualised, especially for informal and small-scale healthcare facilities in rural and peri-urban areas. Collaborative efforts between architects, engineers, healthcare experts, and fire authorities are needed to develop localised safety models.

There is too much risk associated with inaction. Fire does not discriminate, spreading fast, killing silently, and leaving behind long-term effects. In addition to sympathy, our hospitals need to provide patients with safety, dignity, and protection. It is essential that Bangladesh continues to expand its healthcare services in the post-pandemic world, ensuring that no clinic or hospital becomes a death trap.

Collectively, we need to awaken. Architecture and design are the responsibility of architects, doctors are the responsibility of doctors, bureaucrats are the responsibility of bureaucrats, and politicians are the responsibility of politicians. Safe construction is the first step toward not only curing, but also caring for.

Dr Sajal Chowdhury is an architect, educator and Head at the Department of Architecture, CUET and researcher focusing on Environmental Experience Design, IEQ, Architectural Science and Well-being.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard