Continental scale geographic analysis of hospital exposure to natural hazards in the Americas.

Natural hazards-including earthquakes, hurricanes, floods, landslides, and volcanic activity-pose substantial threats to healthcare systems in the Americas. This study aims to evaluate the exposure of primary, secondary, and tertiary hospitals across the Americas to natural hazards and to identify the most affected areas and hospital facilities. This study assembled a harmonized inventory of hospitals with emergency services (2017-2021) and quantified geographic exposure via GIS overlays. Hospital point locations were intersected with the ZC-NASA-CU multi-hazard zoning and hazard-specific layers (earthquakes, hurricanes, floods, landslides, volcanoes). We summarized exposure by deciles, proximity to hazard features, and multi-hazard overlap, and classified facilities by their highest exposure decile. No site-level engineering, vulnerability, or damage modeling was performed. Across 51 countries and territories, 20,396 hospitals were identified; 88.1% are exposed to ≥ 1 hazard. By hazard, floods potentially affect 85.1%, hurricanes 28.3%, and earthquakes 15.1% of hospitals. High-exposure zones encompass 13.6% of the continental area; 42.5% of hospitals fall within the highest exposure deciles (8-10), and 38.1% intersect ≥ 2 hazards. Notable clusters occur in Central America and the Caribbean, along the U.S. East Coast (hurricane-flood), and along the Pacific margin/Andes (earthquake-volcano-landslide). This study shows that hospitals across the Americas face substantial exposure to natural hazards, underscoring the urgent need to strengthen disaster risk reduction. A harmonized, continental-scale exposure map-built on reliable GIS data-enables evidence-informed screening, prioritization, and strategic investment, while detailed risk and vulnerability assessments are best conducted through site-specific studies.