Hospitals urged to stress-test readiness, simulate emergencies ahed of heavy "Super" EL Nino rains

360 Degrees Estate at Katani submerged in water after a heavy downpour that has led to flash floods. Residents of the Estate are lamenting the poor state of the drainage system by the developer and Machakos County Government that have left them exposed to waterborne diseases. May 1, 2026. [Kanyiri Wahito, Standard]

With heavy rains expected to strain the heath system during the October-November-December (OND) season across the East Africa region, countries have been urged to conduct emergency simulations at high-risk health facilities to identify weaknesses before disasters strike.

The Intergovernmental Authority on Development’s Climate Predictions and Applications Centre (ICPAC) said the drills are expected to test hospitals’ ability to handle sudden surges in patients, coordinate emergency referrals, maintain essential supplies and continue operating when floods disrupt transport, electricity, access to medical facilities and supply of medical services.

The simulations are part of a wider preparedness strategy being proposed ahead of the October-December rainfall season, which could expose different parts of the region to a combination of flooding, disease outbreaks, extreme heat and disrupted access to healthcare.

Hospital and other health facilities in high-risk and flood-prone areas are particularly susceptible to health emergencies; hence the advisory to stress-test their preparedness before the season begins.

"If your hospital is usually in a flood-prone area, if the roads are usually closed, health authorities should conduct exercises to determine what happens when the facility is cut off and what minimum requirements must be maintained if everything shuts down,” said Dr Linda Ogolla, Climate Change Information Expert at ICPAC.

She noted that simulations will help the health workers develop an emergency plan, map out referral hospitals and alternative emergency routes, and stock necessary drugs and other medical supplies relevant to the region.

“We are calling for early detection, planning for access cutoff, last mile messaging, and facilitation awareness,” said Ogolla, noting that a pre-season risk profiling of regions and facilities would be impactful to avid major health catastrophe.

“Every area has different risks. So we're encouraging health sectors at the national level, community level, to be able to map their hazards early, so that they can begin to know which drugs to pre-position for,” she added.

In areas that are at risk for landslides, she urged countries to place mobile clinics n different strategic areas to ensure that people who are cut off have access to health services.

According to the climate change expert, the simulations should test triage protocols-systematic rules used to sort and prioritize patients based on how sick or hurt they are, surge capacity limits and emergency management, while also assessing whether facilities can quickly refer patients requiring specialised or time-sensitive care.

Health authorities are further advised to simulate mass-casualty incidents resulting from heat-related illness and verify plans for relocating critical equipment and records when facilities face flooding.

The exercises are intended to expose gaps in preparedness while there is still time to address them, rather than waiting until an actual emergency overwhelms the health system.

However, she cautioned that the health effects of heavy rainfall may not be immediate and instead, flooding can be followed by an increase in vector-borne and waterborne diseases, including malaria, Rift Valley fever, cholera and typhoid.

Further, she said floodwaters can contaminate clean water sources, increasing the risk of disease transmission even in urban areas.

To avoid being caught unprepared, health authorities were advised to pre-position medicines and other supplies in areas likely to experience outbreaks following heavy rainfall.

“Each area needs to be able to understand what the risk is based on the climate. The Greater Horn of Africa encompasses areas with widely different topographies and climate conditions, meaning an outbreak or hazard affecting one location may not occur at the same time or with the same intensity elsewhere."

“For some facilities, the biggest risk may be  flooding itself. A health centre may remain structurally intact but become inaccessible because surrounding roads have been submerged,” she added, calling on countries to localise their preparedness plans.

In other areas, the major concern could be disease outbreaks following floods, while some communities could face extreme heat or a combination of heat and heavy rainfall.

Under the flooding scenario, authorities are expected to prepare for a delayed increase in diseases such as malaria, Rift Valley fever, cholera and typhoid.

Areas affected by water scarcity, she said, could face increased risks of measles and other faecal-oral infections, while concentrated water points in urban areas could create breeding grounds for mosquitoes associated with diseases such as Dengue and Chikungunya.

According to her, pregnant women and people with cardiovascular conditions could face increased health risks when exposed to very high temperatures, including dehydration, hypertension, death and psychosocial heat stress.

Higher temperatures could also expand areas suitable for malaria transmission and increase food-safety risks as food spoils faster.

According to the ICPAC forecast, the OND season will also have above-normal temperatures noting that there are areas expected to experience both heavy rainfall and extreme heat.

In Kenya for example, there is a more than 70 per cent probability that most parts of the country will experience high temperatures above normal.

In these locations, health authorities were advised to establish local heat-stress thresholds, including wet-bulb temperature thresholds, and tailor their warnings and hospital preparedness accordingly.

She emphasised that facilities could simultaneously face heat-related illness, vector-borne diseases and flood-related health emergencies, hence creating a compounded burden on already stretched services.

To further enhance preparedness, ICPAC’s advisory called on health authorities to protect a minimum package of essential services regardless of the severity of a disaster, including routine childhood immunisation, emergency obstetric care, treatment of severe acute malnutrition, HIV and tuberculosis treatment, as well as basic water, sanitation and hygiene services in health facilities.

At community level, the advisory recommends strengthening disease surveillance to detect outbreaks early with frontline health workers urged to have rapid, event-based notification channels for suspected cases of cholera, malaria, Rift Valley fever and heat-related illnesses.

Where laboratory confirmation is delayed, ICPAC recommended that syndromic surveillance should be activated to enable health officials to identify unusual patterns of illness and begin a response before confirmation is available.

In the situation where floods could cut off entire communities from conventional health services, authorities were urged to deploy pre-assigned mobile health teams capable of providing autonomous care, particularly malaria and maternal health services.

“Female health workers should also be integrated into these teams to help overcome cultural barriers that could prevent women from seeking reproductive healthcare,” said Ogolla, urging authorities to use trusted Community Health Volunteers to deliver simple, hazard-specific messages on waterborne diseases and heat-related illnesses.