Globally, a vast amount of investment is heading towards climate resilience, but reliable infrastructure must account for issues beyond general climate concerns. Earthquake resilience is one such problem as the dangers of large-scale destruction have increased in the past few decades due to higher population densities in at-risk sites. Investment can save billions in disaster relief for the public sectors of many regions.
America’s National Institute of Building Sciences has estimated that every $1 spent on earthquake resilience should save $4 in recovery costs. Whilst commercial and residential building resilience is important, it is public buildings such as hospitals and education establishments that require the most urgent intervention; health infrastructure is particularly vulnerable to large seismic events due to increased patient numbers and a lack of equipment and safe space. More importantly, if healthcare facilities collapse, there will be even greater numbers of deaths due to a lack of available care.
The cost of not preparing
The cost of not doing so can be high. In California, many lives have been lost in the past decades due to the destruction of healthcare facilities. In 1994, the Northridge quake hit the region affecting 11 hospitals and causing $3 billion in damage. The area around UCLA was badly affected, with significant structural damage to the medical centre. This became one of the first medical developments to follow more stringent seismic resilient regulations, which included specially designed steel beams, able to withhold seismic activity of up to 8.0 magnitude. These changes were funded by a combination of sources, the Federal Emergency Management Agency accounted for $432 million, California State provided $44 million and private donors contributed $300 million. The remainder came from hospital financing and bonds.
New building codes have come into effect in the past few years, and further regulation is set to change in 2030. The new standards state that every healthcare facility building in which care is provided must be “fully operational” following an earthquake, and if this is not the case, the buildings must close. However, these codes do not come with funding, putting hospitals under pressure. Estimates show that meeting the 2030 regulations will cost between $34 billion and $143 billion. Stanford Medicine’s new building cost $3 billion; it is built on base isolators, as well as having flexible water and electricity piping to withstand shocks. However, the smaller hospitals and clinics in the area have struggled to attract investment. This is an ongoing challenge for such projects.
Construction from the ground up
Earthquake resilience is not new. Since the 70s, Japan has led the world in resilient construction; the engineering capabilities that now exist are sophisticated. This is due to the extremely high level of seismic activity, Japan faces around 56,000 earthquakes a year, 148 of which are magnitude 5 or higher. The vast majority of these events have no casualties, however some larger quakes still result in a high death toll, due to population density. The key to success in Japan is the use of regulation. Unlike in other regions, Japanese infrastructure must closely follow regulation, as such there are almost 10,000 buildings constructed with base isolation techniques in the country.
Red Cross Hospital in Ishinomaki, Japan is a good example of this infrastructure in action. This hospital withstood a magnitude 9 earthquake in 2011 without a single broken window, and with no damage to any equipment. It was able to continue functioning immediately after the quake ended. This was achieved by the use of base isolation, large springs under the foundations, as well as emergency water and electricity supplies.
Partnering for success
Turkey is another country that experiences frequent seismic activity, but has historically struggled to enforce building regulations to prevent damage. In the runup to the 2018 elections, the government offered amnesties for buildings not meeting the new codes, in effect allowing more new buildings to miss regulatory targets. In 2023, a large quake devastated regions of the country, costing the country $34 billion. The loss of life was also significant, with more than 41,000 recorded fatalities. The region’s healthcare facilities often failed to ride out the disasters, compounding these challenges.
The government was aware of the problem, and in 2019, the Bursa healthcare campus was inaugurated. The project was funded by Meridiam, a B-corp infrastructure investment fund, as part of a public private partnership including the World Bank. The 459,588 m2 site is located in a 1st degree seismic zone, a local designation, and as such followed the local regulatory framework, the Turkish Regulation on the Buildings to be Constructed in Seismic Zones. In addition to the required standards which included base isolation techniques, the main hospital building was constructed with seismic isolators to ensure that the building would be minimally affected in case of a large-scale quake. Since inauguration, the hospital has withstood a number of earthquakes without issue. The project was given the highest possible ESG rating by Moody’s given the wide scope, covering 5 key Sustainable Development Goals. Meridiam received an award for “ESG Investor of the year” from the Istanbul Public-Private Partnership Centre Of Excellence, a premier provider of PPP consultancy services, due to their commitment in investing in high quality disaster resilient structures.
Meridiam has been involved in a total of 5 hospital projects in Turkey, which represents a total capacity of 6,300 beds and employs around 6,000 people. The then-director of Meridiam’s Istanbul office, Mete Saracoglu, worked closely with the local government to deliver the results needed whilst ensuring that the objectives of Meridiam stayed front of focus, to ‘deliver sustainable infrastructure that improves the quality of people’s lives.’
A global effort
Similar struggles exist in the Philippines. In 2013, a 7.2 earthquake in the central region affected over 3.2 million people, killing 200. Recently, in 2025, another earthquake hit the same region, killing at least 69 people. In 2021, the World Bank committed US$300 million funding for a project focused on providing retrofitted safety features for public buildings in Manila, with a focus on education and healthcare. Not only will the work save lives, it also creates employment opportunities. The World Bank has estimated that the project will generate up to four million days of labour for locals, significantly boosting the local economy that was badly hit by Covid-19. The project is funded by the International Bank for Reconstruction and Development, a global development cooperative.
The Philippine government has also been prioritising public private partnerships to enable more rapid development. Part of the effort to invest in better public infrastructure has been achieved by the Megawide Construction Corporation, a local Philippines organisation that is working alongside the Department of Education to deliver ₱2.26B of new educational buildings. Although not specialised in sustainable infrastructure, Megawide prides itself on using world-class technologies to raise standards in local construction. A multi-region project, this has so far achieved the goal of creating 2438 new classrooms for the local governments. These new buildings have been constructed with earthquakes in mind; “New buildings for learners, including the ones under this program, should meet the new specifications required and should be able to withstand earthquakes, floods, and typhoons,” Education Secretary Armin Luistro stated.
Globally, earthquake risk zones are well understood, despite the fact that individual quakes cannot be anticipated. Risks to property and life correlate to the zones with the highest magnitude quakes, but population density and quality of existing infrastructure are also important in predicting damage and deaths. As such, it is possible to identify regions that would benefit most from the sort of investment required. Anticipating such disasters is more desirable and more profitable than waiting until afterwards; hopefully local authorities will prioritise this so that more finance can be directed towards seismic resilient infrastructure in the coming years.
