4.2. Proposal for Improving Bursa s Resiliency to Natural Disasters Current Status and Needs of Bursa City

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1 4.2. Proposal for Improving Bursa s Resiliency to Natural Disasters Current Status and Needs of Bursa City General background information and disaster risks are as mentioned in 4.1. Bursa city extends to the foot of the slopes of Uludağ Mountain, mostly in the east to west direction along the Izmir road. Bursa is surrounded by mountain, lakes and farmland. The current status and needs for the resiliency of Bursa city are described below based on information gathered from interviews with relevant authorities. (1) General Matters 1) Basic Understanding to Disaster - Bursa has historically had high risk of natural disasters such as floods and landslides in addition to earthquakes. Prior to 1999, the main natural disasters of concern used to be landslides; however since 2000, earthquakes have been perceived as a more significant threat. - Bursa is a transport hub of the Marmara region and will be able to function as a back-up center for disaster response activity if Istanbul is affected by a natural disaster. Because Bursa is a major center of industrial activities, impacts could be magnified and extreme in the event of a natural disaster affecting Bursa. 2) Vulnerable Residential Areas - The city of Bursa is composed of the old town with a number of historic buildings in the south of the city and the new town in the north. The old town was developed before the 1999 Kocaeli Earthquake, and presents many issues identified for disaster prevention, such as densely built old buildings with weak structures and poor road access. Many buildings are not earthquake-resistant. - In the old town, a large area of congested and dilapidated buildings are at the foot of Uludağ Mountain, and redevelopment of such a large area into a safe township will likely extend over a long period of time. - A number of reconstruction projects in the old town have included high-rise or mid- to low-rise housings, even before the Urban Transformation Law. Such developments increase population concentration. - North of the Ankara-Izmir highway, and expending from east to west, there is a mixeduse residential and industrial area and a large densely-built residential area with many buildings unlawfully occupied and/or not structurally sound. There is a high necessity for improvement in the safety of this area from a disaster prevention perspective. - Local governments started an evaluation of building structures in each district with respect to the Urban Transformation Law; however, it has not been completed yet. The process requires the district administration to propose urban redevelopment plans, and the Provincial office of MOEU through Bursa Metropolitan Municipality to review and approve the plans. - A redevelopment project has been launched in an area of about 500 ha in Yıldırım District. In Osmangazi District, risk assessment of buildings has been completed for the whole district, and high-risk areas have been identified and given two different classifications based on the level of risk. Redevelopment plans for areas of high priority are now being prepared. 4-19

2 Source: Prepared by the Inspection Team Based on Information from Osmangazi and Yildirim District Authorities Figure Locations of risky areas in Osmangazi and Yildirim Districts 3) Measures for Disaster Prevention - AFAD Bursa facilities are on the same site as a fire station and a MOH heliport. This site is indeed a model of disaster management complexes in Turkey, but components such as the education center for disaster prevention (Bosaikan) are spread over several locations. - Bosaikan was constructed for the purpose of educating the general public on disaster prevention. Bosaikan has started offering services to people from Bursa province as well as people from other provinces. - There are 120 staff members in the search and rescue team in Bursa, covering Çanakkale, Balıkesir, Yalova, Bilecik, and Bursa city proper. In normal times, the team offers training to provincial level officials, private companies, and the public. Training facilities and equipment of the current center should be upgraded. - Bursa AFAD has selected evacuation/gathering sites in the city in the event of disaster and parks to be turned into tent cities for afflicted people. - An AFAD logistics center is planned to be constructed in the western part of Bursa to store and distribute materials, supplies, and equipment in case of a disaster. - Currently, the status of district disaster management centers to collect information and coordinate efforts in the event of a major disaster differs by district. - It is essential to strengthen the capabilities of the information communication system and computer functionality at AFAD Bursa because telephone communication could break down during a major disaster. - AKOM, a Disaster Coordination Center, is established under the Bursa municipal fire department. In the event of a disaster, it is expected to coordinate with other institutions if required by AFAD. 4-20

3 (2) Spesific Matters 1) Road Traffic - As traffic in Bursa is concentrated on a major arterial road that crosses the city center from west to east, it is important to provide alternative routes. With many rivers in Bursa, more bridges are needed. - To improve the road network, Bursa Metropolitan Municipality recently developed a transportation master plan for 2030 in coordination with Germany. The plan includes the construction of additional roads and bridges as alternative routes. Part of the plan is already in the implementation phase. - Security of the transport network connecting the airport, Gemlik Port, and Mudanya Port is imperative for times of disaster. (When the Kocaeli Earthquake struck, Bursa did not experience major damages to the roads and bridges, but roads to Istanbul and Izmit were congested for a week after the earthquake limiting the support Bursa could provide to Istanbul and Izmit. - Emergency roads need to be designated and/or regulations put in place to ensure an emergency network for times of disaster. - Strengthening of roads and bridges is underway. 2) Supply of Clean Water - A disaster water supply plan (e.g., substitute pipelines) already exists, and there is also a water reservoir. In addition, the municipal water department has a number of 20-tonne water tanks ready. Privately-owned water tanks would also be mobilized in the event of a major disaster. - Although Bursa has a wealth of groundwater supplies, these supplies are saved for emergency use. At the time of a disaster, groundwater can be used. 3) Medical/Health Facilities - With the evaluation of seismic resistance already conducted on hospital buildings, a plan for necessary reconstruction and retrofits was established and is currently being implemented. - Specific projects for reconstruction or retrofit are planned and/or in progress at 17 of the 20 hospitals of the province. Plans at two of the 20 hospitals (Çekirge and Yenişehir) are yet to be established. - All hospitals should operate in the event of a disaster, and two A1-class hospitals (Şevket Yılmaz Hospital and Uludağ University Hospital) are expected to play key roles as bases for disaster medical services. - Buildings currently under construction satisfy earthquake resistance standards structurally; however, improvement of the earthquake resistance of non-structural materials and equipment is needed. A response project has already been commenced by the Ministry of Health. 4) Education Facilities - Schools are assumed to function as evacuation sites in times of disaster. At the time of the 1999 earthquake, tents for refugees were placed on school grounds. Since the earthquake, schools are planned to be used as evacuation centers in times of disaster, open for residents of their neighborhood. 4-21

4 - According to the AFAD disaster prevention plan, newly constructed schools are expected to store emergency supplies for disasters. However, the reality is that schools hold a small quantity of stocks. AFAD keeps large quantities of stock in various other locations across the city. - According to MONE Bursa, seismic evaluation and retrofit of existing schools to meet the Urban Transformation Law requirements are complete. - With the increasing population, there has been a shortage of schools, and even double shift schools are not able to cope with the demand. Subsequently a plan has been developed to build school campuses in the suburbs where high schools will be relocated. School facilities within the city center will be converted into primary and secondary schools. Although 12 new school campuses are planned, and sites have been identified, construction has not started yet. (3) Sesific Situation by Districts 1) Osmangazi District - A vulnerability assessment has been carried out in accordance with the Urban Transformation Law on most buildings in the district. - Based on the results of this assessment, a redevelopment plan of the areas identified as risky is currently being prepared. For certain residential areas on the mountain sides, roads need to be upgraded to allow for easier access by motor vehicles. 2) Yıldırım District - Even though approximately 20,000 25,000 buildings in the district do not meet the building standards, retrofits are difficult due to the financial situation of the residents of the 69 Mahalles (community-scale administrative units) in the district have a warehouse with disaster supplies at the Mahalle chief office, and the remaining 3 Mahalles are planning on establishing such a warehouse. The three to four community centers of each Mahalle will be used as evacuation sites at the time of a disaster. These were set up according to the regulations of the Ministry of Labor and Social Security. They conduct an evacuation drill once or twice a year. 3) Nilüfer District - Previously, the district authority had started an independent survey of the earthquake resistance of the existing buildings within the district. This effort stopped with the enactment of the Urban Transformation Law and the evaluation is now being conducted by the provincial office of MOEU. - Since most areas of this district have been developed after 1999, only a few buildings are not earthquake resistant. - The Civic Defense Department of the district administration has actively engaged in training exercises of search and rescue operations in accordance with the district disaster response plan. Training of rescue dogs has also been conducted with support from a German organization. - Institutions like Istanbul Technical University have also installed seismographs in the district and are monitoring them. 4-22

5 4) Gemlik District - 90% of the buildings in Gemlik District were constructed before 1999, and are not earthquake resistant. - Gemlik s citizens have demanded that the municipality actively construct earthquake resistant buildings. - There are no disaster response plans or guidelines prepared by the municipality. - There is a 150-member volunteer organization called MAG. Members share knowledge regarding disaster prevention and receive search and rescue training. MAG has three storage rooms containing materials and equipment for disaster response Proposed Improvements for Disaster Prevention and Disaster Mitigation in the Bursa Province Based on the current status, important challenges in making the resilient city in Bursa province (i.e. developing the city that is to be capable of quickly recovering from functional breakdown caused by disasters) are summarized as follows. We postulate the following perspectives to evaluate the challenges. Perspectives are basically those referred to as perspectives of seismic disaster prevention measures stated in the Charter on measures against the earthquake that directly strikes the south Kanto region under Tokyo Metropolitan White Paper (Shuto-ken Hakusho). Original perspectives were reviewed with taking into account of the disaster resilient urban planning point of view as well as the current situation in Turkey. 6 perspectives listed up in the charter as seismic disaster prevention measures are: a) Prevention and mitigation of damages in the urban area from the seismic disaster. b) Development of urban structure resilient to earthquakes, c) Capacity enhancement of disaster prevention system, d) Promotion of public awareness and community activity, e) Disaster drill, f) Observation and prediction research. The assessment, information gathering and analysis of disaster risks,which serve as the basis for above-mentioned measures, are not well organized in Turkey. Therefore disaster risk assessment is added as one of the perspectives to be considered in the disaster resilient urban planning in this study. Since the present project aims at formulation of the disaster resilient urban planning, we particularly focus on a)to d). It should be noted that, since f) Observation and prediction research has been being conducted by universities in Turkey and it contributes to c) Capacity enhancement of disaster prevention system, f) is regarded as a part of c) in this study. Also, since e) Disaster drills are not prevailing in Turkey yet, it is regarded as a part of d) Promotion of public awareness and community activity. Thus, we set the following 5 perspectives to evaluate and categolize challenges in the resilient urban planning of Bursa. Perspectives on the Resiliency of the Bursa s Urban Plan 4-23

6 (1) Disaster Risk Assessment (2) Reduction of Disaster Risks in the Urban Areas (3) Formation of a Disaster Resistant Urban Structure (4) Disaster Management System Development (5) Enhancement of Public Awareness regarding Disaster Risk Management (1) Disaster Risk Assessment: 1) Review of Seismic Risk and Hazardous Estimates Assessments of disaster risks, vulnerability, and hazards have not been conducted since the latest one in Collection and analysis of updated information would contribute to an effective disaster prevention in urban planning. (2) Reduction of Disaster Risks in the Urban Areas: 1) Regeneration of Vulnerable Residential Area Regeneration of vulnerable urban areas is currently in progress pursuant to the Urban Transformation Law. Despite different approaches taken by each municipality, the basic method is redevelopment of housing. Safety of the urban area will be comprehensively improved by creating a public disaster management complex combined with some open space amid the redeveloped area. 2) Establishment of a Disaster-Resistant Infrastructure Network Disaster risk mitigation measures taken for each infrastructure are not satisfactory, and destruction and/or breakdown are anticipated for infrastructure such as ports, roads, transport system, supply, and processing facilities. Investment into both hard and soft ware is needed in order to establish a disaster-resilient infrastructure network that can recover its functions quickly after disaster. (3) Formation of a Disaster Resistant Urban Structure 1) Establishment of Disaster Management Bases It is necessary to establish disaster bases in a strategic manner and to clarify the main bases for each district and region, taking into account the risks specific to Bursa city such as geographic character, vulnerability of densely populated areas, and large scale manufacturing complexes. 2) Security of Road Network for Evacuation and Implementation of the Disaster Response Activities Traffic in Bursa tends to heavily depend on the east-west transport link because of the limited road network. Since there is only a very limited number of alternatives, fundamental weaknesses exist in the road network system. Construction of alternative routes are necessary. 3) Security of Gemlik Port In addition to securing an emergency road network, it is necessary to ensure the safety and availability of Gemlik Port in times of disasters, as it is an indispensable hub for business 4-24

7 continuity in Marmara region. Gemlik Port is also an important base to receive relief supplies and it is expected to be a major source of assistance if Istanbul is hit by a serious disaster. 4) Enhancement of Evacuation Points ant Neighborhood Level Bursa boasts plenty of green spaces, and some residential areas have a historic building (referred to as Külliye in the old Ottoman era) at the center of community with a mosque and community facilities. However, these sites are not always well prepared in a comprehensive and strategic manner, with their functions not being uniformly provided. Therefore, it is assumed that the safety of the urban area will be enhanced by the following measures: 1) secure evacuation points accessible on foot in the densely populated areas, ensure their safety, and clearly identify the evacuation routes 2) add disaster prevention facilities to these evacuation points. It is also recommended to establish open spaces and public disaster management bases in the redevelopment activities conducted pursuant to the 2012 Urban Transformation Law. 5) Emergency Medical System and Enhancement of its Functions in the Populated Area at the time of Disaster Although a number of hospital construction projects are planned, due to the limitation of land availability, actual constructions are limited mainly to major hospitals in the suburbs. Construction or expansion of hospitals in the densely populated area, especially in the old town, is not taking place. In consideration of the expansion and improvement of medical system in the event of disasters, new approaches will be desired with consideration of the anticipated damages, such as upgrading existing core hospitals within the city from the viewpoint of protecting human lives from a major disaster. 6) Maintain Flexibility for Possible Expansion of Evacuation Spaces by using School Facilities According to the MONE Bursa, the anti-seismic reinforcement works of school facilities is complete. However, some damages to buildings constructed before 1999 can be expected in the event of a major disaster. As the city is likely to receive numerous refugees and injured people in such an event, it is imperative to maintain flexibility for expanding evacuation space as needed. Utilization of school facilities will be an effective measure to that effect. It will also be beneficial from the perspective of disaster management to incorporate the possibility in the planning process of the construction, taking into account possible usage of evacuation points. 7) Development of a Sustainable City Resilient to Disaster The infrastructure investment has not been able to meet the demand from increased residential development in proportion to the population. Development of a sustainable society with low-carbon footprint, energy-efficient systems, and limited waste of resources will increase its tenacity against the regional isolation expected at the time of a major disaster. (4) Disaster Management System Development: 1) Collection of Disaster Information and Clarification of Command Structure to Avoid Confusion Regarding disaster management at the provincial level, concerned parties are to congregate at the disaster command room of the provincial AFAD and take necessary measures. Disaster 4-25

8 management at the district level is under the district administration. The DMC, which is to oversee the evacuation points, is supposed to always receive and dispatch information related to disaster prevention, and conduct effective and immediate disaster relief efforts as well as evacuation activities while avoiding confusion. 2) Enhancement of Training Facilities for Search & Rescue Team Members Although AFAD Bursa already has some training facilities, they are not sufficient to provide technical training. It is believed that the development of an appropriate facility is required to upgrade and train search and relief rescue specialists in such as for lifesaving efforts, etc. (5) Enhancement of a Public Awareness regarding Disaster Risk Management: 1) Establishment of Promotion Center for Educational Activities of Disaster Prevention and Disaster Mitigation (Initiatives on soft component) It cannot be said that the citizens awareness of disaster prevention is high. Although an education center for disaster prevention (Bosaikan) were built and children have been taught about disaster prevention at school, regular practices of disaster prevention drill at many levels of the society will be indispensable to raise their awareness of the importance of disaster prevention on a daily basis. Disaster prevention awareness activities at the community level such as MAG in Gemlik have not been widely conducted so far. At the moment an earthquake strikes, such community level activities are highly effective. Hence, in addition to training and facility development, further awareness of community level organizations is required. In order to fix the problems listed above, we propose the deployment of a structured DMC as well as the establishment of Disaster-Resilient Infrastructure, which is to support the DMC operations in Bursa Province. 4-26

9 Table Needs and Challenges in improving Bursa s Resiliency Challenges in Disaster Prevention and Mitigation Needs for Disaster Prevention and Mitigation (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12] (13) Review of Seismic Risk and Hazardous Estimates Regeneration of Vulnurable Residential Area stablishment of Disaster-Resistant Infrastructure Network Establishment of Disaster Bases Security of Road Network for Evacuation and Implementation of the Disaster Response Activities Security of Port Gemlik Enhancement of Evacuation Points at Neighborhood Level Emergency Medical System and Enhancement of its Functions in the Populated Area at the time of Disaster Maintain Flexibility for Possible Expansion of Evacuation Spaces by using School Facilities Development of Sustainable City Resilient to Disaster Collection of Disaster Information and Clarification of Command Structure to Avoid Confusion Enhancement of Training Facilities for Search & Rescue Team Members Establishment of Promotion Center for Educational Activities of Disaster Prevention and Disaster Mitigation (1)General Basic Understanding to Disaster Vulnurable Residential Area 〇 〇 〇 (2)Spesific Suppy of Clean Water Medical/Health Facility 〇 Measures Disaster Preevntion for Road Traffic Education Facilit y 〇 〇 〇 Yıldırım District 〇 〇 3)District Osmangazi District Nilüfer District Gemlik Significance and Necessity of the Deployment of DMC in Bursa Province Reflecting on our own disaster experiences in Japan and the directions of DMC development currently in progress mainly in the metropolitan areas of Japan, the necessity, benefits, and effectiveness of introducing the concept of DMC in Bursa as a pilot project is explained in Chapter

10 Particularly, the establishment of the DMC in the central area of Bursa, where many of the old buildings constructed before 1999 are concentrated, is highly valuable as a model project to be later deployed nationwide in terms of analyzing the effectiveness of the project. Source: JST Figure DMC Network in Bursa province 4-28

11 Necessity Benefits Effectiveness With the high probability of major earthquakes in the Marmara coastal region, disaster response strategy should be immediately prepared against large-scale damages anticipated at the time of a major disaster. Being a center of the densely populated region, priority is given to prepare DMC in the Marmara coastal area. With the high concentration of manufacturing facilities around the Marmara coastal region, the backbone of the Turkish economy, a DMC is crucial for providing emergency response as well as recovery and reconstruction efforts. The transport network in the Marmara coastal region is relatively advanced, with road, sea, and air transport facilities in place, in addition to a plan for major rail network construction, holding a superior position for providing quick relief efforts against a broad-based disaster inflicting the densely populated cities of Ankara, Istanbul, and Izmir. Bursa Province, at the center of the Marmara region, is conveniently located for relief/rescue operations at the time of a disaster in this region. There are urban areas developed before 1999 in Bursa Province, especially concentrated in the central part of Bursa city. Construction of the DMC in Bursa will be effective as a a pilot project to improve situation of high density area in Turkey. Establishment of a Regional Level DMC in Bursa as the first pilot model to be deployed nationwide Source: JST Figure The role of DMC in Bursa province 4-29

12 Approach to Resilient Urban Planning in Bursa Province It is essential to take an integrated approach, incorporating the following listed points, in urban planning in order to increase the resilience of the urban area in Bursa: - A regional-level DMC will be established at the center of Bursa, which is at the center of the South Marmara region. - A regional-level DMC and district-level (I) DMCs (in Osmangazi, Yildirim, and Nilüfer) will be established in close connection to each other and located with good access to the transportation system, while being relatively close to the city centers, where population is concentrated with a higher risk of damages from disasters. - An information communication network with Ankara and Istanbul should be secured, along with a redundant system so as to maintain connectivity under normal and disaster circumstances. - Bursa city center should be connected to Gemlik port, Mudanya port, and Yenişehir airport through a disaster-resistant road network. Coastal DMCs are proposed to be set up both in Gemlik and Mudanya. - Establish district-level (II) DMCs in Kütahya, Balıkesir, and Karacabey. - Establish an emergency road network with disaster-resistant roads to connect various DMCs to support coordination of disaster relief activities among DMCs. - Set up an environment to enhance public awareness on disaster prevention, and to foster specialists and leaders of disaster prevention activities. Wide-AreaBroad-area Emergency Road Source: JICA Study Team Figure DMC network in Bursa province 4-30

13 The following figure shows the stratified DMC structure deployment proposed in Chapter 3 with a regional DMC in Bursa Province. Source: JICA Study Team Figure Stratified DMC Structure Proposed for Turkey 4.3. Proposal for Resilient Urban Planning for the city of Bursa Characteristics and Issues in the city of Bursa Based on the approach that has been described in the above sections up to 4.2, specific suggestions are made below to make Bursa a resilient city. The characteristics of Bursa are as follows: - The city is located on a long basin-shaped flatland stretching east to west (including areas at risk of liquefaction and flood) at the foot of Mount Uludağ (including areas at risk of landslide). - New urban areas are expanding to the suburbs and the city has been extended. - The highway has been developed along an east west axis. The urban area is expanding along the framework created by the highway with high traffic volume. Congested urban areas are expanding mainly from the old town in the center of the city towards the east. - Small-scale manufacturing industries are concentrated in the city in areas which are also residential. Comparatively large factories are expanding along the highway outside of the city center. - Risky areas and reserved areas have been designated in Osmangazi and Yildirim based on the Urban Transformation Law and urban redevelopment is in progress. - Although a number of medical facilities, such as hospitals, are located in populated urban areas, A1 class hospitals, which can provide advanced medical services, are 4-31

14 located on either side of the city in the east and west, away from the city center. The new City Hospital is planned to be located in a suburb to the northwest of the city. - The majority of high schools are planned to move to the suburbs in accordance with the planned school campus projects, aiming to improve the beyond capacity situation of schools within the city. Rearrangement of primary and secondary schools is progressing in the city. - There are old city areas with dense population on the slope of the mountain, where access by car is limited. - In addition to an earthquake due to the Uludag and Bursa faults and an earthquake in the coastal area of Marmara Sea, it is necessary to consider landslides and floods. Source: JST Figure Perception of Structure of Bursa City If a disaster of extreme severity hits Bursa, the densely populated old town with many dilapidated buildings at the foot of the mountain and highly populated residential-industrial mixed use area (the center of it is designated as a risky area) will have high need for search & rescue operations. Additionally, the road network consists mainly of east-west highways, so traffic at the time of a disaster is likely to be heavily congested. Some of the areas on the mountainside are inaccessible by emergency vehicles, which will also be a cause of traffic congestion Suggestions for Making City of Bursa Resilient to Disasters With the above characteristics of the city center of Bursa as well as Japan s experience in disaster resilient urban planning stated previously, suggestions to enhance the resilience of the city were studied in accordance with the following five policies. The main suggestions are presented in this section: 4-32

15 Policies 1) Collection and evaluation of information on disaster risks that should underpin the development of disaster resilient urban planning. 2) Reduction of disaster risks in urban areas by: improving and strengthening vulnerable areas, reinforcing existing building structures, securing essential utilities, etc. 3) Development of a disaster-resistant urban structure by: ensuring a disaster-resistant road network and sea and air transportation routes, creating disaster management complexes, etc. 4) Development of a disaster management system: institutional development, human resources development, legal framework development, etc. 5) Enhancement of disaster prevention awareness and of disaster preparedness. Information on disaster risk and hazard maps is not available for Bursa, but AFAD has started to work on this matter with a JICA Technical Support Project. It is recognized that the high density residential-industrial mixed area and the densely inhabited districts on the mountain side need improvements to reduce disaster risks in Bursa. It has been confirmed that the municipalities have been taking initiatives to improve these residential areas in accordance with the Urban Transformation Law. Much effort is needed for local communities to establish local DMCs within walking distance of the community residences and to create a network of these local DMCs. These local DMCs do not necessarily need to include all components of a DMC presented in Chapter 3; some local DMCs can be set up to solely act as evacuation centers. Existing public facilities (including government buildings and community centers), school buildings, small medical facilities, bus terminals (also referred to as otogar), and areas surrounding shopping centers can serve as these community DMC evacuation centers. As for the development of the disaster management system, new efforts in line with the revision of the AFAD Law have been launched. With regard to raising awareness and knowledge about disaster prevention, the Bursa provincial governor s office built its own education center for disaster prevention (Bosaikan). Japan has been providing assistance in cooperation with the city of Kobe. As for the development of a disaster-resistant urban structure, roads have been widened and bridges have been built to improve the network. No comprehensive plan has been established to improve the disaster resistance of the urban structure. (1) Suggestions for Developing a Network of Wide-Area DMCs Taking account the situations stated above and focusing on development of a disasterresistant urban structure, in order to make the urban area more resilient to disasters, the following suggestions to develop DMCs and a road network connecting the DMCs are proposed. A DMC network should be set up with DMCs at the regional level (also serve as a provincial DMC) as a center of the South Marmara Region and district levels. Establishment of the district level DMC in all 17 districts is necessary; however, Osmangazi and Yildrim Districts, which include the old historical area with dense population, residential and industrial mixed area and vulnerable areas with illegal occupation should be prioritized. Also, coastal DMC should be developed together with enhancement of Gemlik Port as the entrance point of relief supply from outside, since the road network will be unserviceable in the event of a disaster, ocean transportation over the Marmara sea is being utilized during 4-33

16 the normal period due to geographical features and Gemlik Port support is essential for the economy of Bursa. We envisage that local temporary evacuation centers (local DMCs) will be located within walking distance and connected to each other by evacuation routes. We propose that district and regional DMCs be set up to manage the local temporary evacuation centers. DMCs would be connected by an emergency transportation road network. - Component A: Development of regional DMCs as centers in the South Marmara Region - Component B: Development of District Level (I) DMC in the Osmangazi District - Component C: Development of District Level (I) DMC in the Yildirim District - Component D: Development of a coastal DMC in Gemlik District - Component E: Development of emergency road networks - Component F: Improvement of urban area on steep slopes Other suggestions about medical services and anti-disaster prevention facilities will be stated in Section 4.4 and later sections. District DMCs should be developed in all districts. However, in this project, priority is given to Osmangazi District and Yildirim District, which are the highly populated districts, covering historical and old areas and vulnerable residential-industrial mixed areas. A coastal DMC is also proposed at Gemlik as a gate to receive support from outside in case of disaster. B Center of the City A Mutual Support Mutual Support D Level DMC: C Coastal DMC (District Level (II)DMC) Regional Level DMC (Center for Disaster Management or South Marmara Region Centered on Bursa Province) E Emergency Road Network District Level (I) DMC (DMC for Osmangazi District, example of DMC in conjunction with Urban Transformation Project/ Public Park) District(I) Level DMC F (DMC for Yildirim District, example of DMC with Disaster Base Medical Center) Transport System for the Sloped Urban Area Source: JST Figure Proposed Components for Strengthening Disaster Risk Management of the Urban Structure of Bursa Province 4-34

17 Suggestion for Developing the Regional Level DMC (Component A) (1) Current Status The Bursa AFAD office does not yet have a function as a commanding headquarters to control the Marmara region. Although the AFAD office is located on a main road and on the same ground as the fire department and the MOH heliport, its location is far from the densely populated city center. A logistics center to handle disaster aid materials is planned to be constructed at a different location from the mentioned premises. (2) Main Challenges The existing facility may be used as a back-up support base in case of a disaster of extreme severity, but performance as a frontline base cannot be expected due to its location outside the city center. There is a need for constructing facilities for a disaster management center (the main component of a DMC, see Chapter 3) where officers in charge of disaster management of the national, provincial, and municipal authorities in the Marmara region can gather and control information. It is also necessary to construct a base to control search and rescue teams ( training center under the DMC model presented in Chapter 3), to manage aid materials effectively ( logistics center under the DMC model presented in Chapter 3), and to secure connecting routes between Marmara and surrounding major cities The resilience of the Marmara region must be enhanced and Bursa s disaster prevention functions must be improved. (3) Proposals The regional level DMC should be constructed in a sizable open space as close to the city center as possible, close to existing parks and green areas, and connected to multiple access routes. Based on the DMCs at a regional level proposed in Chapter 3, and taking into account existing infrastructure in Bursa, the following facilities are proposed to be included in the regional level DMC. Supervisory authorities of each facility are shown in parenthesis. Proposed facilities [1] Disaster control management center (AFAD offices and operation room)) [2] DRM-related facilities (Firefighting brigade, AKOM, 112, police etc.) [3] Main disaster base hospital (MOH): To be relocated to the military base site [4] Disaster-prevention parks/open spaces as evacuation center (BBB) [5] Sports facilities (BBB) [6] Logistics center (AFAD) [7] Waste incineration plant (BBB) [8] Search and rescue training center (AFAD) [9] Heliport (4) Considering Potential Sites The proposed criteria for site selection to develop a regional level DMC are as follows: 4-35

18 1) Criteria for site selection Easy access from emergency road network (to/from other emergency facilities, key facilities, and surrounding provinces). Presence of alternative ground routes to/from: surrounding provinces, airports (including military airports), and Gemlik and Mudanya ports. Sufficient distance to fault lines and high-risk facilities. Firm ground with low potential for liquefaction. Close to densely populated areas. Availability of the land. Based on the above criteria, three sites in the city of Bursa were chosen as shown in Figure and the pros and cons of these sites are described in Table Industrial parks in Bursa: Source: JST Figure Location of three potential sites for Component A 4-36

19 Table Comparison of potential sites for Component A Potential site 1a: An area planned for a new stadium and hospital Potential site 2a: Military airport Pros. Military land planned for a new stadium and a new hospital Having access to the highway to the east and west as well as Yalova road and Mudanya road via the bypass Close to the military airport. Currently the city hall and the municipal water department of Bursa are located here but are to move soon. Cons Difficulty in acquisition of the land. The green area to the north is privately owned and the owner intends to maintain it as a green area. Access to the highway and the military airport needs to be improved. Pros It used to be a military airport. Currently it is used not as an airport but as accommodation for military staff. The site has an extensive flat area. Close to Mudanya road and Ankara road. Cons Currently managed by the Ministry of Finance. The city of Bursa is not aware of a redevelopment plan. Access from the highway needs to be improved and roads need to be expanded. Potential site 3a: Site in the vicinity of the AFAD offices Pros Located directly adjacent to the existing AFAD offices and the exhibition center. The area is owned by the Bursa Metropolitan Municipality, and part of the area is used as a training center and storage for construction machinery. The area has good access to Yalova road and Ankara road. Cons The area carries a high risk of liquefaction. The area is surrounded by rivers and there are nine bridges around the area, which could become isolated if bridges were to fail in a disaster. Source: JICA Study Team (5) Recommendation: Site 1a Among the above three potential sites, an image of facilities regarding the potential site 1a was created in order to give shape to a regional DMC. The characteristics of the site are as follows: - The site has easy access to the east and west of Bursa via the highway. - The site is located next to the business district currently being developed. A new stadium and a new large-scale park are being constructed. 4-37

20 - The site has a large green area, which is an advantage for operations in disasters. An additional open space is being created around the new stadium, and a large park is being constructed in the south. - There is a plan to relocate a general hospital to the military site for use as a base for disaster and emergency medical services. The DMC can be developed in cooperation with this relocation plan. - The site is close to the military airport, which is currently operational although not in use. By extending roads from the airport to the site, the site will become convenient for access from the air as well. - The highway crosses the site in its middle, so the proposed facilities would be on either side of the highway. It is necessary to create local access routes between facilities, and it will be necessary to extend the road to improve access from the highway to each facility. Source: JST Figure Image of provincial DMC The concept of each facility is described in Section Suggestion for Developing the District Level DMC (Level l) in Osmangazi District (Component B) (1) Current status: Covering the old town, Osmangazi is densely populated and its land is highly utilized, but no emergency base or evacuation facility is built close to civilian areas. Most properties in the old town were constructed before 1999, and would have difficulty in withstanding a mega earthquake. On the other hand, there is a plan under consideration to update and improve the buildings in the urban areas based on the Urban Transformation Law. 4-38

21 (2) Main Challenges It is important to incorporate components of DMCs into the urban transformation plan such as parks, which may serve as evacuation bases. This will facilitate developing disasterprevention capabilities of the urban areas. If it is difficult to secure land through projects related to the Urban Transformation Law, the District Level DMC may be developed utilizing existing large parks. (3) Proposals We propose development of a district-level DMC (level I), either in the target redevelopment areas under the Urban Transformation Law or by utilizing existing parks, to serve as disasterprevention bases for Osmangazi, which has historical areas, and has approximately 900,000 people and high-risk areas. The following facilities are proposed in consideration of the current status of Osmangazi. Supervisory authorities are shown in parenthesis. Proposed facilities [1] District disaster control management center, including emergency stock storage (District) [2] Schools (MONE) [3] Sports facilities: gymnasiums and playgrounds, grounds etc. (Municipality) [4] Parks and green areas (Municipality) (4) Considering Potential Sites 1) The criteria for site selection to develop district level DMCs were set as follows: Criteria for Choosing the Site Based on the above criteria, three sites in the city of Bursa were chosen as shown in Figure 4.3.5, and the pros and cons of these sites are described in Table As a case study of a DMC at a district level (Level I), the DMC in Osmangazi District is presented as follows. Based on the three potential sites illustrated in the following figure, the possibility of a DMC at the district level was considered. Source: JST Figure Location of three potential sites for Component B 4-39

22 Table Potential site 1b: Reserved Area Comparison of potential sites for Component B Pros The site is a Reserved Area for Urban Transformation specified by the Law. Development can be executed by the authority of IUT under MOEU, and may include housing and public facilities. The northern part of the site is a botanical park, which is assigned as an evacuation area (meeting point) by AFAD in case of disasters. Cons The site is located in the northern part of Osmangazi District. Access from the old town on the hillside is not easy. The site is owned by private owners. Potential site 2b: Site in the vicinity of the AFAD offices Potential site 3b: The area of the stadium and Culture Park Pros Located directly adjacent to the existing AFAD offices and the exhibition center. The area is owned by the Bursa Metropolitan Municipality, and part of the area is used as a college and storage for construction machinery. The area has good access to Yalova road and Ankara road. Cons The area carries a high risk of liquefaction. The area is surrounded by rivers and there are nine bridges around the area, which could become isolated if bridges were to fail in a disaster. Pros This is a well-known culture park and existing stadium. The site is located in the center of Osmangazi District and directly south of Izmir-Ankara road. Easily accessible to the residential area on the hillside. No need to obtain the land, if it is in the park. Cons As this area is in the cultural heritage area as well as a natural protection area, the committee that maintains cultural aspects needs to approve new constructions. The area of the existing stadium is going to be redeveloped as a civic plaza. Source: JST (5) Recommendation: Site 1b or 1c Regarding the Osmangazi district, two case studies were conducted on proposed sites of different types. 1) Recommendation of Site 1b The site is a Reserved Area under the Urban Transformation Law. It has an area of approximately 35 ha, and was planned to be utilized as a temporary housing site for relocation of people living in the risky area to improve the living condition of high-risk areas. The suggestion is to develop a residential area that incorporates the DMC. Half of the site will be utilized as a residential area with an open and green space, and the other half will be utilized for the DMC, which will be an effective evacuation and rescue base in case of disasters. 4-40

23 The proposed development of the residential area will be a model town that is robust against disasters with facilities for disaster prevention, highly efficient energy use, and a smart community approach. The facilities considered to be included in the district level DMC (I) in Osmangazi are as follows: - Disaster management center of the district - Community health-care and welfare facilities - Schools - Sports facilities (gymnasiums and grounds) - Parks and green areas Given the current nationwide promotion of the projects to improve vulnerable areas through the implementation of the Urban Transformation Law, this proposal shows significant advantages in promoting incorporation of the disaster risk management approach into projects related to the Urban Transformation Law. Source: JICA Study Team Figure Conceptual layout of a district DMC (I) combined with a housing development by the Urban Transformation Scheme 2) Suggestion for the Potential Site 2b The potential site 2b is the Culture Park and the existing stadium area located in the center of Osmangazi District, south of the Izmir-Ankara road. The site includes a culture park (about 38 ha), and sports facilities and schools are around the park. 4-41

24 It has been decided that a new stadium will be built at another location, the existing stadium will be demolished and its grounds will be redeveloped as a civic plaza, after completion of the new stadium. The site can be easily accessed from the residential area on the high-risk slope ground in the south. As the park is owned by the Bursa Metropolitan Municipality, there is no need to secure the land. However, because the area is in a Cultural Heritage Area as well as a Natural Protection Area, the Cultural Heritage Project Committee reviews all construction projects. The following facilities are suggested to be built in this component: - Disaster management center of the district - Storage warehouse - Sports facilities (swimming pools and gymnasiums) Following is an image of the DMC layout proposed for this Culture Park: Source: JICA Study Team Figure Image of District DMC (I), utilized with a large park 4-42

25 District Level DMC (Level I) in Yıldırım District (Component C) (1) Current Status Yıldırım District has a comprehensive set of educational and cultural facilities as well as the first education center for disaster-prevention (Bosaikan) in Turkey and the A1 level Şevket Yılmaz Hospital where excellent research facilities and functions are available. On the other hand, as a result of the sharp increase of population in the last 20 years, the Yıldırım District has urban areas and mixed residential-industrial areas with high disaster risks. A large-scale redevelopment is being carried out through the application of the Urban Transformation Law. (2) Main Challenges The Şevket Yılmaz Hospital is to be used as a base for medical services when disasters occur. However, access roads from the highway to the hospital are narrow and the area tends to have traffic congestion with users of other facilities. (3) Proposals By utilizing parks and public owned lands and by advancing medical facilities, development of a district level (I) DMC in the Yıldırım District is proposed in this area with the purpose of enhancing the resilience of urban areas. This DMC will incorporate the A1 level hospital and the Centre for Disaster Prevention (Bosaikan). The Şevket Yılmaz Hospital stands on a site along a river. Several public facilities including government offices, schools, and other hospitals, and parks are around the hospital site. The hospital is already planned as a base in case of disasters in Bursa, and has stocks for disaster medical care. A new hospital for cardiovascular diseases will be constructed soon. The hospital is also planning on expanding its capacity by acquiring the site of the adjacent police academy. In line with the redevelopment of public facilities around the hospital, the Şevket Yılmaz Hospital is likely to be upgraded and developed as a base for disaster medical care. Proposed facilities [1] Enhancing the function of the Şevket Yılmaz Hospital - Increase the number of beds - Increase the capacity of medical gas equipment - Base for the activities of UMKE - Introduction of a medical information system (backing up information and segregation, information communication equipment using satellite) [2] Accommodation for medical staff in case of disasters [3] Storage of supplies for disaster preparation [4] Park and green areas to use as an evacuation place in times of disasters [5] Heliport 4-43

26 Site Existing C Proposed Plan Source: JICA Study Team Figure Image of the proposed District DMC (I) located on a large park 4-44

27 Suggestion for a Coastal DMC (Gemlik) (Component D) Source: JST (1) Current Status Figure Location of Gemlik port zone The Gemlik Port Zone, ranked fifth to sixth in Turkey in terms of the export amount, is the entrance to Bursa, and supports the industry of Bursa. The port zone is facing the Sea of Marmara, and there are six private commercial ports (it will become five when two ports are merged) controlled by the Ministry of Transport, Maritime Affairs and Communications and one small port controlled by the Gemlik Municipality. The private commercial ports are shown in the above figure. They are relatively close to each other but are located about 10km from the Gemlik city center. The private port facilities are concentrated on a fault, and are thus at high risk of being damaged by an earthquake. At those private commercial ports, chemical/petrochemical products are received, and mechanical products such as components of automobiles produced in the industrial park of Bursa are shipped. There is no disaster operation plan, but when a disaster of extreme severity occurs and the nation declares a state of emergency, the port facilities owned by private companies can be used for official relief activities. On the other hand, public ports are mainly used for fishing boats and do not have sufficient capacity for large ships. In Gemlik, urban development projects based on the Urban Redevelopment Law are being carried out mainly on higher ground. (2) Main Challenges When private port facilities are used for official relief activities their owner may not be able to continue to operate their businesses, which goes against the principles of disaster resiliency. Additionally, some facilities developed by those private companies store chemical substances and oil, which could cause fire or pollution, intoxication, or other risks when a disaster occurs. In addition, these ports are built on a fault; the risk of earthquake needs to be investigated and necessary measures need to be taken. The disaster-prevention plan should include alternatives to relying on these private port facilities, as they are privately 4-45

28 owned and operated, are located away from the urban areas and have some risks, including fire. For BCP in the industrial park of Bursa, when a large-scale earthquake occurs, measures need to be taken so that those private ports will not stop functioning or will quickly return to operation even if damages were caused. (3) Japan s Experience There is a DMC (27.9 ha) at the Sakai Senboku Port in the Sakai Second District of the Osaka Prefecture (with highly advanced support functions). The area provides a place for recreation and relaxation for the citizens as a seaside park during normal circumstances but plays the following roles when a disaster occurs. The roles of DMC at a port 1) Receive and distribute relief goods. 2) A base camp to gather support for wide-area relief units. 3) Store materials and equipment for emergency and restoration. 4) Support marine transport. Under normal circumstances, the area can be used for community activities and disaster drills. 5) Support disaster medical care. In case of disaster In case of disasters: - Receiving, transporting and allocating of aid supply and relief teams from outside. - A base camp for relief teams. - Base for disaster relief activities in Gemlik. Disaster management centre Accumulation yard of relief goods Base Camp Heliport Disaster Management Centre Earthquake-proof quay Reference: Disaster-Prevention Centre on the Coast in the Kinki Region (4) Proposals Supply of relief goods Floating Bridge Versatile expansive area Figure Image of coastal DMC (Japanese example for reference) Based on the above case in Japan and the current conditions in Gemlik, development of a coastal DMC that includes the expansion of the public port in Gemlik is suggested together with retrofits to make commercial port facilities earthquake-proof. To enhance the capacity of disaster prevention of Gemlik district, the following specific suggestions are made: - Apart from the measures to be taken in preparation for disasters in those private commercial ports with high-risk facilities, it is suggested that public ports should have the facilities to accept large ships in case of disasters so that access to relief supply and relief workers will be secured. - Reclamation work at the inner part of the bay in Gemlik may be carried out in conjunction with the development of higher ground. Soil and sand from housing developments on higher ground can be used for reclamation work. 4-46

29 - Develop the port as a base to receive relief goods by making the base accessible from the park, which can function as an evacuation site in the case of a tsunami. - Ensure that the capacity of DMC can be expanded by liaising with the existing university and the high school when a large-scale disaster occurs. Enhance the connection with the emergency roads that lead to the city center of Bursa. - Incorporating the function of district level DMC in Gemlik will be effective for disaster prevention and will contribute to improve disaster prevention and mitigation in Bursa. Dock Upgrade Expansion Disaster prevention park + site for DMC 25ha (including the sea surface). Army site. Utilising the campus of Uludag university when a disaster occurs. Disaster prevention park Utilise a part of the sloping land. Disaster prevention park Expand the site by land reclamation. Base to distribute relief goods. Storage for goods and equipment. Source: JICA Study Team Figure Image of portside DMC in Gemlik Proposal for Emergency Road Network (Component E) (1) Current Situation of Road Network in Bursa The roads of Bursa have been administrated by two organizations. The planning, construction, and maintenance of the main roads in Bursa and the roads connecting to neighboring provinces were under the responsibility of 14 Regional Directorates (Burusa) and of the General Directorate of Highways, while the planning, construction, and maintenance of the roads within Bursa city were under the responsibility of the Bursa Metropolitan Municipality. After the expansion of the metropolitan area in March 2014, the Bursa roads have come under the control of Bursa Metropolitan Municipality. Since the transportation between Bursa and neighboring cities mainly relies on ground transportation, the road network has been well established. Bursa city is spread longer in the east-west direction and traffic is concentrated on the Ankara-Izmir road, the main road which passes through the center of the city. Traffic jams can often be seen in the city. There is a bypass on the north side of the Ankara-Izmir road. The old city area is located on the south side of the road and a lot of narrow and steep-sloped roads are located there. On the other hand, on-street parking can be seen everywhere (Figure ) and slows traffic. A regulation is necessary to prohibit on-road parking. Bursa Metropolitan Municipality has worked out a road master plan for the improvement of traffic conditions. Additional roads and bridges were planned in the master plan for 4-47

30 decreasing traffic congestion and providing alternative routes in case of disaster. During the process of preparing the master plan, there was an idea to construct a bypass in the southern part of the city, but it was abandoned because the road would have had to avoid historical and forested areas and most of it would have had to be constructed in the steep mountainous areas. In accordance with the master plan of Bursa city, a highway connecting Istanbul and Izmir via Bursa is under construction and is on schedule to be finished in This highway is expected to contribute to the transportation of support goods, equipment, and staff in case of disaster. (2) Preparation for Disaster Management During the 1999 Kocaeli earthquake, damages to transportation infrastructure in Bursa were limited to slight damage to the road to Kocaeli and slight damage to a bridge. The road to Kocaeli became congested for a period of about one week after the earthquake and caused difficulty for emergency traffic. The importance of securing emergency traffic during a disaster has been widely recognized. Currently, the provincial governor has the authority to limit road use of general vehicles in case of a disaster, but there is no clear designation of an emergency road network or corresponding operating procedures. Source: JST Figure On-street Parking in Bursa (3) Concept of Emergency Road Network in Japan During the 1995 Great Hanshin-Awaji earthquake, roads were obstructed due to damages to viaducts and bridges as well as collapsed buildings, leading to difficulties for emergency traffic. shows the locations of road damages in the Great Hanshin-Awaji earthquake. Since then, the designation of an emergency road network and the formulation of operating procedures have become a part of municipalities disaster management plans in Japan. Source: Ministry of Land, Infrastructure, Transport and Tourism Figure Road Damages from the Great Hanshin-Awaji Earthquake 4-48

31 In the 2011 Great East Japan earthquake, although there was no road damage in Tokyo, the traffic in Tokyo was abnormally congested for the entire day of the earthquake because of the closure of highways, the soil liquefaction in coastal areas, and the service disruption of public train transportation. Supposing that an earthquake happened in Tokyo, it is easy to imagine the traffic situation that might occur based on what happened during the Great East Japan earthquake if no appropriate measures are taken. The necessity of an emergency road network is again demonstrated. The emergency road network of Japan is usually composed of highways, national roads and the roads which connect the abovementioned roads and major disaster management facilities. According to the function and importance of roads, the emergency roads are generally classified into primary to tertiary in many cases and have been given different names by the municipality. For example, the classifications of the emergency transportation roads of Tokyo are as follows: - Example of Primary emergency transportation roads: roads needed to transport for a wide area, linking the Tokyo metropolitan office, disaster operation center, important airports, and seaports. - Secondary emergency transportation roads: roads linking primary emergency roads to disaster management facilities such as police stations, fire stations, hospitals, and district offices. - Tertiary emergency transportation roads: roads linking primary and secondary roads to logistics centers and supply warehouses. (4) Proposed Emergency Road Network in Bursa Based on the city scale and current road network, the proposed emergency road network is composed of wide area emergency roads and city emergency roads. 1) Wide Area Emergency Roads Wide area emergency roads are roads that are important to allow traffic of emergency vehicles for rescue, relief, firefighting and, at the same time, reception of outside support personnel and relief materials. Wide area emergency roads are also important for providing support personnel and relief materials to neighboring provinces in case of a large scale disaster in those provinces. The roads should be controlled immediately after a disaster for dedication of enough lanes (which may mean all lanes depending to the disaster and road situation) for the sole traffic of emergency vehicles. Wide area emergency roads are meant to link the following facilities. - Provincial governor s office, Metropolitan office, Regional disaster management complex - AFAD office, AFAD logistics center - Airport, Gemlik port, Mudanya port - Neighboring support provinces designated by the Turkey disaster response plan 2) City Emergency Roads City emergency roads are roads necessary for rescue, relief and fire fighting in case of a disaster in Bursa. These roads also need to be controlled immediately after a disaster. Since roads within the city limits generally have a limited number of lanes, city emergency roads will typically be completely dedicated to the use of emergency vehicles. Details of the control of these roads, for example the control period, should be decided based on the disaster scale and road situation. City emergency roads are roads connecting the following facilities: 4-49

32 - District office, district disaster management center - Police station, fire station, disaster base hospital - Wide area emergency roads - Stockpile warehouse, tent city The major emergency road network of Bursa, based on the principles described above, is shown below. Source: JST Figure Proposed Major Emergency Road Network (5) Proposal for introducing an Emergency Road Network system In order to make the emergency road network function well in times of disasters, prior preparation is necessary. The preparation could be divided, in general, into two categories, i.e. structural and non-structural. The structural preparation includes the vulnerability assessment and associated necessary improvements. The vulnerability assessment includes a review of the road damage caused by ground deformation, elevation, subsidence, liquefaction, and landslide, and the damage to bridges, viaducts, and retaining walls. The nonstructural preparation means the regulation, standard operation procedures, and a plan and operation manual covering the roles and coordination methods of concerned organizations. The plan and operation manual should consider all potential situations after a disaster, for example, the obstruction of roads by collapsed buildings and utility poles, a traffic light system problem due to power failure or the damage to the traffic light itself, the increase of traffic volume caused by emergency traffic, and the damage to the other transportation means such as airports and railways. The plan should also consider the fast recovery by rapid removal of debris and by specifying alternative roads. Based on our survey, the following improvements to the emergency road network are considered necessary. 1) Road Widening and Landslide Prevention for Gemlik Mudanya Road There are six private sea ports in Gemlik, being the base of transport of raw materials and products to the industrial areas of Bursa. An agreement between three port owners and the municipality allows the use of these ports in case of emergency. The road connecting to the port is also important for securing the supply chain and a rapid return to normal industrial activities after a disaster. There is a single road between the port and the city. The port in Mudanya is where the ferries between Bursa and Istanbul operate. A section of the road between Gemlik and Mudanya is narrow and not well-paved (Figure Road 4-50

33 between Gemlik and Mudanya). The Bursa Metropolitan Municipality has started widening the road and extending it to Bandirma, another port city. In this way, the road between Gemlik and Mudanya could be an alternative road in case of damage to the road connecting Gemlik to Bursa or Mudanya to Bursa. The improvement of the road also makes it possible to secure the receipt of support materials by sea even if one of the ports is damaged. Source: JST Figure Road between Gemlik and Mudanya a. Seismic Performance Assessment and Strengthening of Bridges Bridge damage was experienced in many past earthquakes from flexural failure or shear failure of piers caused by ground shaking, or from bridge collapse due to large ground deformations or liquefaction. Seismic strengthening of bridge piers and bridge collapse prevention have been promoted in Japan since the Great Hanshin-Awaji earthquake. It is important to ensure the seismic performance of the bridges because a damaged bridge will considerably affect emergency traffic. There are a number of bridges in Bursa. Most of them are multi-span and simple girder reinforced concrete bridges. There are three bridges on the Ankara-Izmir road, which is the main emergency road. These are the Nilufar bridge, Baliklidere bridge and Delicay bridge (Figure ). It was found by visual inspection that the Baliklidere and Delicay bridges are in good condition and that the Nilufer bridge shows severe deterioration and tilted piers as shown in Figure Bursa Metropolitan has planned to rebuild the bridge. Nilufer bridge Baliklidere bridge Delicay bridge Nilufer Source: JST Figure The Bridges on Ankara-Izmir Road 4-51

34 Source: JST Figure Deterioration of Piers and Girders of Nilufer Bridge b. Seismic Strengthening of Buildings along the Emergency Road In the Great Hanshin-Awaji earthquake, roads were obstructed by collapsed buildings. It was found that the degree of obstruction was related to the width of the road and the ratio of building collapse, as shown in Figure The narrower the road and the higher the building collapse ratio, the greater the possibility of obstruction. Tokyo Metropolitan has derived a numerical relationship, shown below, for the estimation of expected road obstruction in future earthquakes. Road width less than 3.5 m Ratio of expected road obstruction (%)= Ratio of building damage Road width more than 3.5 m and less than 5.5 m Ratio of expected road obstruction (%)= Ratio of building damage Road width more than 5.5 m and less than 13.0 m Ratio of expected road obstruction (%)= Ratio of building damage The ratio of building damage will be evaluated by the following relationship. The damage to buildings includes the damage by both ground shaking and liquefaction. Ratio of building damage =Ratio of collapse+1/2 Ratio of half collapse Obstruction assessment and seismic strengthening of buildings along emergency roads are necessary. 4-52

35 Source:Tsukaguchi et al. (1997) Figure The Relationship of Road Obstruction and Road Width c. Seismic Performance Assessment of Grade Separation There exist a number of grade separations in Bursa city and the grade separations on the Ankara-Izmir road are mostly underpasses (Figure ). Damage to this kind of grade separation could cause the collapse of bridges and/or damage to retaining walls. Since grade separation is a key point on the emergency road, it is important to perform the seismic assessment of grade separations. Source: JST Figure Grade Separation on Ankara-Izmir Road d. Preparation of Regulations and Manuals for Emergency Road Operation In addition to seismic strengthening of the road, it is also necessary to prepare regulations and operation procedures for the efficient operation of the Emergency Road Network during a disaster. Based on the experience in Japan, the following contents are proposed to be included in the regulations and manuals: - Securing the number of emergency vehicles - Pre-registration of emergency vehicles - Determining the roles and cooperation of the municipality, police, firefighting, etc. - Conditions for the announcement of emergency control - Administration of emergency control 4-53

36 - Road damage information collection and distribution - Regulation for prohibiting on-street parking along the emergency road - Traffic control for the first three days after a disaster, when time is a critical issue for lifesaving and firefighting. - Traffic control after the first three days of the disaster, when the main activity is shifted to the recovery phase. - Resuming the operation of public transportation as fast as possible. - Preparation of staff and equipment for rapid removal of debris on the Emergency Roads caused by landslides and collapsed buildings. - Assessment of the bottlenecks on the emergency road network and their improvement. Note that the above list is not comprehensive and additional content should be included after further review of the needs of the regulations and manuals Improvement of urban area on steep slopes(component F) (1) Current Status: - In the southern part of the Yildirim or Osmangazi District, there are dense urban areas at the foot of Uludag mountain, which from the beginning, did not follow public procedures, and many of the buildings were built without permits. - However, many residents are living there currently. In addition, businesses are operating in the area. The risks and challenges for the city are recognized by the government, who has however not undertaken sufficient measures. This has led to the present situation. - In steep slope areas, there is a difficult passage and stairs must be climbed for people to access their vehicles. Further there are many two-story masonry (thus not seismically safe) buildings concentrated in the area. The area has electricity, water, sewage, and gas. This was confirmed by site visits by the JICA study team. - Public transportation is by minibus. But for many residents, moving on foot is the basic means. - The roads for access to the slopes of the city are not wide enough for the traffic demand, and roads have been chronically congested. 4-54

37 - Source: JST Figure Urban areas of steep slopes on In the Osmangazi District Source: JST Figure State of dense urban areas spread on steep slopes In the Osmangazi District zzzzzzzzzzzzzzzzzz Source: JST Figure Situation of dense urban areas on the steep slope of Osmangazi District 4-55

38 Source: JST Figure Mosque on the steep slope of Osmangazi District (2) Reference in Japan: - In a large earthquake or heavy rain, there is a risk of slope collapse and landslide in steep slope areas. In addition, in a large earthquake, there is a risk that the buildings could collapse, and evacuation routes and relief supply routes become clogged. And, there is also a danger of fire. - At present, the number of roads that can be used for emergency supplies and evacuation routes is limited. If there is some blockage of the road, considerable time is required before recovery. Therefore, there is a large possibility that the dense urban areas on the slope will be isolated. - Open space adequate for refuge cannot be found within these areas. There are open spaces around the mosque, etc., and a children's small park next to the mosque. However, the area of the open spaces is not sufficiently secured. There is not enough space for relief activities such as distribution of relief supplies to the victims and evacuation of residents of the surrounding urban area. - On the other hand, it may be possible to improve urban safety while promoting the renovation of the mosque, etc. In Japan, it takes a considerable time to improve dense urban areas that have wooden buildings. "The extremely dangerous and dense urban areas during an earthquake, etc." Among the dense urban areas, evacuation difficulties and risk is particularly high in a disaster, there is a possibility of loss of the evacuation route due to road closure or large fire. Because of the amount of lives and property in dense urban areas, safety is extremely difficult although critical to ensure, and improvements of these areas should be a priority. Among those that the National government recognizes as dense urban areas in steep slope areas, there are examples of efforts for Nagasaki, in Nagasaki Prefecture and Onomichi, in Hiroshima Prefecture. There are the following basic measures: - Fireproofing and earthquake resistance of buildings - Ensuring evacuation routes (emergency roads)ensuring open space which is the shelter and evacuation place 4-56

39 - Promoting the awareness of the residents (Residents are informed of the nature of the risk) In addition to those measures, if a public building became vacant in these Japanese prefectures it was demolished and developed as a public square or other component along the concept of DMC. 1) Measures in Nagasaki In Nagasaki, about 70% of the urban area is on a steep slope. Most of the streets in the steep area are steep and narrow (1-2m wide) with staircases, and houses are very concentrated. In these steep areas, there are not enough roads that allow vehicle access. The specifications for the following areas have established. Steep slope collapse danger zone Landslide prevention area Fire danger forecast area, other Disaster prevention measures based on the zoning (Disaster Prevention Projects, etc.) have been developed. For this reason, transport equipment (South Oura area) such as simplified inclined elevators have been developed in five locations in the city. (In, stepped road, 3 locations)) Even the elderly and disabled can move safely and in comfortwith this new means of transportation. Mizunoura district (suspension type) "Mizudori-go" Glover-en (land-based) Capacity: 2 people ride Speed: 15m / min - Can carry a wheelchair Mizudori-go: can carry a folded wheelchair Glover-en: Available remains wheelchair ride Source:Nagasaki city Figure Mini monorail installation in Nagasaki 4-57

40 2) Measures case of Onomichi Onomichi is a port city that was developed as a commercial port a long time ago. (JR Sanyo Line currently) Sanyo railway was developed in the Meiji era. Thus the area has developed as a hub of shipping and rail. There are many historic remains in the town. On the other hand, it is less flat along the coastline. Due to its topographical characteristics the urban area has expanded to the sloped areas. Therefore, there are many steep and narrow roads, and stairs. Maintenance of the living environment has become an issue. In the sloped part of the city, there is no willingness for rebuilding the housing. Currently, houses cannot be rebuilt. Therefore, a house usually becomes vacant after the residents leave. A number of vacant houses are gradually aging. Therefore, the risk of collapse of the house has increased. In addition, management of vacant houses is insufficient, which increases the danger of fire and crime and this is spreading. As a result, the entire district became the image of devastation. It was a situation where the outflow of population proceeds further, and the number of vacant houses continues to increase. So, the city has introduced measures to increase the value of the region by effectively utilizing the vacant land or vacant houses. Efforts for community regeneration that take advantage of the empty houses and the management of vacant slopes have been carried out. In addition, as illustrated in Figure , areas prone to landslides are published on a Web site. As a result, it is encouraging disaster reduction activities and awareness of the residents. Shelters are displayed on the map. In this way, the path is updated on a daily basis and made available to residents so that they know where to evacuate in the event of a disaster. As shelters, a high school existing, elementary school, Working Youth Home, lifelong learning center, community center, and green space have been used. Landslide hazard Debris flow Debris flow danger mountain stream Debris flow: Phenomenon due to Damage is heavy rain ad, and sediment intention assumed area of mountains and rivers flows vigorously together with the water Steep terrain Steep slope collapse hazard Steep slope collapse: In the influence Damage is of rain, snowmelt, such as an assumed area earthquake, a phenomenon that slope collapse rapidly Landslide Heavy rain warning, alarm and special alarm Landslide hazard Damage is Landslide: Snowmelt and rain to wetout into the basement. Phenomenon assumed area that is sliding out slope intermittently Other Shelter Source: Hiroshima Prefecture Disaster Prevention Web (3) Proposals: Figure Hazard Map Created and Published by Hiroshima prefecture (Enlarged view of a part of Onomichi range) On the basis of the above-mentioned case of Japan, urban environmental improvement measures for dense urban areas with steep slopes in Osumangazi District are proposed below to ensure both convenience during normal times and the safety of the city in a disaster. 4-58

41 Source: JST Figure A proposal for improvement of urban steep slopes in Osmangazi District With the aim to strengthen the performance of disaster prevention at the community level, the following proposals have been made in particular. 1) Improvement of the road network From the general urban area, access roads leading to the sloped built-up areas must be made available to allow adequate passage of emergency vehicles, even if there is a disabled car parked temporarily on the road. In order to expand the width and increase the traffic speed, the roads should be as linear as possible. This would make it possible to increase the capacity and smooth the traffic flow. In addition, a new round road that is accessible from above the slope in the urban area on the slope is proposed to be put in place. Existing roads on the slope within the existing urban area is better to be connected as much as possible to eliminate dead end roads. 2) DMC development at the community level The DMC at the community level shelters nearby residents, would act as a distribution center for relief supplies, etc. Also it would receive information from various quarters that is transmitted to the management center of the District by aggregating the status of the disaster site, process incoming information, and transmit outgoing information. It should also have an open space of a certain scale, a meeting place that can accommodate nearby residents that have evacuated, supply equipment warehouses, and communication facilities. It is desirable for the community level DMC to have the important points mentioned above in conjunction with the open space along with the development of new roads. Further, as described below, the community level DMC could consider utilizing the existing peripheral mosques. 3) Development of community center based in Külliye There is a complex tradition called Külliye in Turkey, on which the mosque is centered. 4-59

42 It is a group of welfare facilities such as schools, medical facilities, dining rooms, and baths, gathered around the mosque. Külliye means General, kull in Arabic. Meeting facilities and an open space were developed in the vicinity of the existing mosque following the Külliye tradition. In normal times, this is used as a community center. In a disaster it is used as a community level DMC distribution center for relief supplies such as shelter. Tomb School Clinic Park Yildirim,Beyazit, Camii Source: JST Figure A Külliye that plays a community center function (Yildirim, Beyazit, Camii, Bursa) 4) To develop a transport system for the sloped urban area A transport system can be introduced to help the logistics and transportation of people and goods on the slope in the city. Practical application of a slope car or mini monorail is advancing in Japan. It is conceivable to take advantage of this technology. The slope car or mini monorail, network should be created as a base in the community level DMC. The transportation system is used as a means of transport in normal times. And in the event of a disaster, it is utilized to transport emergency relief supplies, and also the transport of the sick or injured. The facility is made for that purpose. An emergency power source (generator) is installed. It is possible to travel even in the event of a power failure. 4-60

43 Source: Kita city, Tokyo Figure Reference case of mini monorail "Asuka Pearl Rail Asukarugo" (16-seater, Kita-ku, Tokyo Asukayama Park) Proposal for supply chain improvement of industrial parks (1) General condition of Turkey s economy and the industry of Bursa The Turkish economy has shown remarkable performance with its steady growth, as the GDP more than tripled from 231 billion USD in 2002 to 786 billion USD in 2012 and the GDP per capita soared from 3,500 USD to 10,504 USD in the same period. The visible improvements in the Turkish economy have also boosted foreign trade, with exports increasing from 36 billion USD in 2002 to 153 billion USD in Significant improvements in such a short period of time have registered Turkey on the world economic scale as an exceptional emerging economy, the 17th largest economy in the world and the 7th largest economy when compared with the EU countries, according to GDP figures in Turkey had a vision to become one of the top 10 economies in world by The province of Bursa is ranked sixth in Turkey according to the Socio-Economic Development Ranking Survey of Provinces and Regions (SEGE) by the Ministry of Development 3. Bursa has become an important province responsible for socio-economic development in the country In the 1970s, the Turkish government made it a priority to attract Renault S.A.S. (French automobile manufacturer) and FIAT (Italian automobile manufacturer) factory to develop the 2 IMF World Economic Outlook Databases Oct. 2013, Investment Support and Promotion Agency, Turkey Prime Ministry, WB 3 UNDP in Turkey, Note: In SEGE-2011, 61 variables, mostly from the years 2009 and 2010, in 8 subcategories were used. These variables touch upon demographics, education, health, employment, competitive and innovative capacity, financial capacity, accessibility, and quality of life. The top ten provinces are 1. Istanbul, 2. Ankara, 3. Izmir, 4. Kocaeli, 5. Antalya, 6. Bursa, 7. Eskisehir, 8. Mugla, 9. Tekirdag, and 10. Denizli 4-61

44 automotive industry in Bursa. In addition, manufacturers of automobile parts established factories around the Renault S.A.S. and FIAT factories, and thus developing the industrial area involved in automobile manufacturing in Bursa. Currently, according to the Automotive Manufacturers Association in Turkey, one million automobiles were produced in Turkey in 2012, and 730,000 of which for export; the resulting profit was approximately 20 billion USD. In addition, the textile industry of silk such as traditional also prosperous, Bursa is one of the important industrial areas in Turkey. (2) General situation of the industrial parks in Bursa There are 13 industrial parks in Bursa and an additional eight industrial parks are planned for development in the near future. As of 2013, BURSA OSB (46,184 employees) and DOSAB Demirtas (41,094 employees) are the largest industrial parks in Bursa. Another 11 industrial parks have 200 to 18,000 employees. BURSA OSB industrial park has OYAK RENAULT (the joint venture of Renault and OYAK financial group in Turkey), DOSAB industrial park has TOFAŞ (the joint venture of FIAT and Koç Holding in Turkey) and a bus factory. Automobiles and textiles are the main industries in Bursa. For the future, there are construction plans for eight additional industrial parks for factories such as leather factories and painting material factories. In the past, the industrial parks had been developed without a strategic plan. However, recently, industrial parks have been developed strategically by the sector. Table Industrial parks in Bursa District OSB Directorate Total Area (ha) Total Industrial Area (ha) Number of total employment NUMBER OF INDUSTRIAL PARCELS Occupied Parcel In Production Out of Production Empty Parcels (Land) Total Industrial Parcels Parcels with technical infrastructure and Social Equipage Total Number of Parcels 1 Osmangaz Bursa i OSB 2 Osmangaz Demirtas i 3 Nilufer Nilfufer Gursu Gursu Nilfuer Hasanag a 6 Nilfuer Deri Kestel Kestel Inegol Inegol M.K.Pasa M.K.Pasa Yenisehir Yenisehir Inegol Mobilya M.K.Pasa Mermer Nilfuer Tekstil Source: Bursa Governorship Provincial Directorate of Science, Industry and Technology Eight additional industrial areas which are planned are: Akgalar, Kayapa, Gali, Baskoy-Gorukle, Kestel2, Barakfakih-icestel, Inegol Cerrah, and Inegol Yenice. The locations of existing industrial parks in Bursa Province are shown in the figure below. The number corresponds to the numbers in the above table. 4-62

45 Figure Map of Industrial Parks in Bursa DOSAB Demirtas Industrial Park (USD 150 million capital) has 414 private companies (total of 41,094 employees) and is the second largest Industrial Park in Bursa. The percentages of products of the main factories are textile factories (70%), auto parts factories (20%), and plastic and other factories (10%). The production in the DOSAB industrial parks is approximately 4.0 billion USD per year, due to the big production of the TOFAŞ factory (7,000 employees). There are firefighting facilities in the industrial park, and the management of infrastructure facilities such as electricity, gas and water supply has been centralized and lines were installed underground. There is also a clinic onsite. In addition, DOSAB is a model of an advanced industrial park in Turkey, mainly due to its natural gas power plant. Figure Map of DOSAB Demirtas Industrial park 4-63

46 (3) Disaster Management in the industrial park Newly constructed factory buildings follow the earthquake-resistance standards, and they are single-story buildings. Handling of hazardous materials such as gas, chemicals, and toxic substances is managed by the provisions of the Ministry of Labor and Social Security. These provisions have become stricter and require an inspection of the containers every two or three months. In addition, fire drills are carried out at a similar interval in the DOSAB. (4) The importance of disaster preparedness in the industrial area from the experience of Japan In the Great East Japan Earthquake, a variety of production and distribution resources, such as transportation infrastructure of ports, airports, etc., factory, logistics and distribution facilities, transport vehicles, containers, etc., were affected at the same time. Because the supply of various materials and parts was interrupted, the impact on the manufacturing businesses extended widely and over the whole country and foreign countries. In addition, a fire occurred as a secondary disaster in a factory that handles nitrogen. It had a major impact on the transportation network, but in the recovery phase, routes to the affected areas were connected like "comb teeth" to the main road. The advantage of having access from several arterial roads in the event of disaster was recognized again. With regard to the export of the manufactured products in Bursa, the ratio of the container shipping is 85% of the transport by sea through the Gemlik port and 15% of the transport by land through Istanbul. Therefore, regarding transport from the factory, the stakeholders have recognized that the main road to Gemlik port is very important. However, currently, there is only one main road from Bursa center to Gemlik. If the road is disrupted by a disaster, serious traffic disturbance is expected when using the narrow detour. Other EU countries have taken measures to prepare alternative routes for the main roads. In addition, there is no particular relationship between AFAD and the industrial park, and guidance and disaster preparedness planning is not carried out in the industrial park. Therefore, we would like to recommend the following proposal. (5) Proposal for disaster prevention at the industrial park 1) Assessment of Supply Chain and Logistic Route Prepare to create the disaster preparedness plan by assessing the supply chain and logistic route status from each factory to Gemlik port and to Istanbul or Ankara by land. 2) Creation of Sustainable Supply Chain and Logistic Plan and Manual Create a plan and manual for securing the supply chain and logistic route in a disaster. 3) Assessment of industrial area in terms of disaster management, and improvement Create a disaster preparedness plan for each factory. 4) Support creation of BCP plans at the industrial park Create a Business continuity plan (BCP) for each industrial park. 5) Introduction of the Fast Response Equipment against Quake Load (FREQL) system FREQL has a combined alarm and sensor function. This system gives an alert as soon as it senses an earthquake, without waiting for the information from the state. It is expected that BCP measures for a factory can be begun more quickly and minimize the impact on production 4-64

47 activities. Further, it will help to minimize the effects of secondary disasters in a factory that is handling gases, chemicals, and toxins. It is expected to reduce interrupting the factory production and supply chain in the event of a disaster, and will reduce the impact on the economy by applying the above proposed measures Proposed Disaster Healthcare Services in Bursa The present state of disaster healthcare services (1) Disaster healthcare systems 1) Organizational system a. Ministry of Health (MOH) - The General Directorate of Emergency Health Service of the MOH is responsible for disaster measures in the health services in Turkey. More specifically, the Department of Disaster and Emergency Management takes disaster preparedness and response measures. 4-65

48 DEPUTY OF DISATER AND EMERGENCY MANAGEMENT Source: Figure Organization chart of the General Directorate of Emergency Health Service Tasks of the General Directorate of Emergency Health Service - Coordination and provision of emergency health services during and after disasters in Turkey - Assistance to humanitarian aid bodies during and after disasters outside Turkey - Supply of telecommunication equipment, medical supplies, and healthcare equipment during and after disasters, and formulation of storage plans Tasks of the Department of Disaster and Emergency Management - Surveys on health service delivery needs during and after disasters, and formulation of disaster preparedness healthcare plans to respond to the needs - Operation of SAKOM 1 24 hours a day - Gathering and assessment of information during and after disasters from SAKOM and other entities, and information sharing with governmental administrations if necessary - Recruitment, training, and supervision of UMKE 4 members, and provision of healthcare 1 SAKOM: Health Disaster Coordination Center 4-66

49 materials and equipment necessary for activities of UMKE - Provision of psychological and social care to UMKE members and international aid personnel during and after disasters - Planning of response to chemical, biological and radiological disasters b. Bursa Governorate - In the Province of Bursa, the Provincial Directorate of Health is responsible for disaster preparedness. Personnel of the directorate are from the central government s MOH, but the directorate is affiliated with the Bursa Governorate. c. Bursa Metropolitan Municipality - In the Bursa metropolitan municipality, the Disaster Coordination Center (AKOM) founded within the Fire Fighting Department is responsible for disaster measures. It undertakes no specific activities in healthcare but works together with the Bursa Governorate and the Provincial Directorate of Health in times of disasters. 2) Disaster medical plan a. AFAD Disaster plan for all sectors AFAD formulated the Turkey Disaster Action Plan which covers all sectors in the country. The plan defines disaster management measures taken by each organization. As for health services, it refers to the mutual backup system among the UMKE teams in each region. b. Organizations in charge of disaster management in health services and their tasks The MOH takes the initiative in the management of disaster health services with the collaboration of the Ministry of Environment and Urbanization, the Ministry of Food, Agriculture and Food Stock, the Ministry of Internal Affairs, the Turkish Red Crescent, citizen groups and private companies. Their tasks include: - Installation of temporary healthcare facilities (healthcare tents, etc.) and supply of necessary equipment during and after disasters - Supply of personnel, equipment, and materials to afflicted areas - Provision of triage and first-aid in afflicted areas - Isolation of patients to prevent spreading infectious diseases - Elimination of risk factors related to the environment and water quality, including prevention of infectious diseases - Prevention of risks factors that may arise in the event of poor environment and water sanitation - Acquisition of information held by regional blood transfusion centers, and improvement of their capacity 4 UMKE: Ulusal Medikal Kurtarma Ekibi, known as the National Medical Rescue Team in English 4-67

50 - Acquisition of information held by hospitals and examination centers across the country, and improvement of their capacity - Preventive measures against infectious diseases and hazardous substances at checkpoints near the national boundary - Statistics of the number of injured and sick people c. Disaster medical plan of the MOH The General Directorate of Emergency Health Services of the MOH is formulating disaster medical plans for the entire country. The Study Team requested the ministry to disclose information about these plans but has not obtained it yet. d. Guidelines issued by the MOH for provincial disaster medical plans The General Directorate of Emergency Health Service of the MOH issued guidelines for provincial disaster medical plans (including planning formats) in 2010, and the Provincial Directorates of Health are required to formulate their disaster medical plans according to the guidelines. e. Disaster medical plans at the provincial level The MOH requests the provinces to formulate their disaster medical plans. - The Implementation Directive of province-based disaster and emergency plans published on August 27, 2013, by the General Directorate of Emergency Health Services of the MOH requires the Provincial Directorates of Health to formulate their own provincial disaster medical plans. f. Summary of the Implementation Directive of province-based disaster and emergency plans The Provincial Directorates of Health will: - formulate emergency health plans; - update their plans on March 15 every year. They are required to submit their first plan on March 15, 2014; - Demonstrate their plans indoors in the second week of May and on the field in the second week of October every year; and - Include their roles as backup provinces (referred to as Emergency Health Service Region ) in their plans. The MOH will provide training necessary to execute these plans. Bursa Governorate: The Study Team requested the Bursa Provincial Directorate of Health to disclose information about their disaster medical plan but has not obtained it yet. g. Hospitals in the Province of Bursa under the management of the MOH All hospitals in Turkey have been required to formulate hospital disaster plans since 2008, and hospitals in Bursa prepare their disaster plans under the instruction of the Association of Bursa Public Hospitals (regional organization of the Association of Turkey Public Hospitals affiliated to the MOH). Hospitals use a format standardized under a WHO project, which includes responses to disasters and risk management to prevent disasters (education and training of staff members, furniture and fixtures fall prevention, securing of evacuation routes, etc.). Hospitals are also required to set forth in detail fall-prevention measures for non-structural members and equipment. Although legally required, many hospitals comply with the standards stipulated by the Kandilli Observatory in the Boğaziçi University and the 4-68

51 standards approved by the JCI when preparing their disaster plans. Moreover, they are required to have the ability to decontaminate chemical, biological and radiological substances (including radiological substances from nuclear power stations and nuclear weapons, and substances that are normally used). According to a directive of the Prime Minister s Office and the MOH (issued in October 2009), hospitals were required to have these functions operational by 2012, but only some hospitals have managed to do so (including the Şevket Hospital). Hospitals are also required to conduct emergency drills twice or more (including at least one actual training session) each year according to their disaster plans. (Source: Meeting with Hacettepe University staff on ) (2) The present emergency healthcare cooperation system in Turkey 1) Emergency Health Services Region The General Directorate of Emergency Health Services of the MOH divided the country into 21 emergency health regions according to population, access to hospitals, and available health services. It also stipulated that, according to the impact of disasters, regions mutually shall help and provide each other with necessary personnel and materials. Figure Emergency Health Service Region - Definitions of damage levels 1. Large scale disaster (S3 and S4): Case where two or more provinces in a region cannot handle the disaster on their own. 2. Medium scale disaster (S2): Case where one province in a region cannot handle the disaster on its own. 3. Medium scale disaster (S1): Case where damage is limited to a certain area of one province. - Response system from bodies outside the affected region, based on damage level S4: backup regions of the 1st degree and 2nd degree, aid from the national government, and international aid 4-69

52 S3: backup regions of the 1st degree and 2nd degree and if necessary, aid from the national government S2: backup regions of the 1st degree S1: no need of backup aid from other regions 2) Backup regions for individual provinces The following maps illustrate backup regions of Istanbul and Bursa, respectively. In the same fashion, each province has its own backup regions. Red: afflicted area, Yellow: backup region 1st degree, Blue: backup region 2nd degree Istanbul Bursa Source: JST prepared based on Health Statistics Yearbook 2011(MOH) Figure Backup Regions 3) Role of the Provincial Directorate of Health in Bursa The Provincial Directorate of Health in Bursa is designated as playing a leading role in Emergency Health Region 17. As stated in the previous section, if a disaster occurs in Bursa, regions in yellow or blue provide the province with assistance. Similarly, if these regions are affected by a disaster, the Province of Bursa offers assistance. According to Figure 4.4.3, the Province of Bursa will give assistance if any disaster or emergency arises in the following regions: Region 14. (KOCAELI, SAKARYA, DUZCE); Region 15. (ESKIEEHIR, BILECIK, KUTAHYA, AFYONKARAHISAR); Region 18.(IZMIR, MANISA, USAK); Region 20. (EDIRNE, KIRKLARELI, TEKIRDAG); or Region 21. (ISTANBUL). 4) Disaster Medical Plan by the Turkish Red Crescent The Turkish Red Crescent has blood centers and disaster management centers with a total of over 700 branches in 81 provinces across the country. Its Disaster Management Directorate, nine regional disaster management bureaus (BAYM), 23 rural disaster management divisions (YAYS), and AFOM (Disaster Coordination Center) provide humanitarian support activities at times of disasters. The Turkish Red Crescent has established a disaster logistics system with regional disaster management logistics centers across the country in preparation for and response to disasters. Its disaster response system is well organized with the nationwide network. Efforts of the Turkish Red Crescent for disaster medical service are summarized in Appendix A

53 Source: :Regional Disaster Management Directorate (BAYM) :Local Disaster Management Chieftaincies (YAYS) Figure Locations of the Turkish Red Crescent Disaster Management Centers (3) Disaster management chain of command At the time of a disaster, AFAD makes a report on the situation of the disaster and formulates a specific action plan in collaboration with the SACOM of the MOH, other disaster management organizations of ministries and agencies, and regional organizations. Specific activities are performed according to an emergency disaster management plan formulated by AFAD. Until AFAD was founded, the Disaster Coordination Center (AKOM) used to be a part of the Fire Fighting Department of the Metropolitan Municipality and was giving instructions concerning disaster management. In 2009 when AFAD was founded, the AKOM was placed under AFAD and has engaged in disaster management activities only under the supervision of AFAD. In the Province of Bursa, to avoid any confusion, signboards of AKOM are no longer used at the premises of the Fire Fighting Department. SAKOM The Health Disaster Coordination Center (SAKOM) is affiliated with the Deputy of Disaster and Emergency Management of the General Directorate of Emergency Health Service of the MOH, and its Disaster Management Center, launched in 2009, collaborates with relevant organizations and afflicted areas in times of disasters. When a disaster occurs, the local 112 Command Control Center responds to it and, depending on the scale of the disaster, the SAKOM works with various directorates of the MOH, armed forces, Ministry of Energy, Ministry of Communication & Information, Ministry of Environment & Urbanism, AFAD, Red Crescent, international organizations and other parties to to provide emergency healthcare services in affected areas. 4-71

54 Source: Schematic by SARMaster System of SAKOM, MOH Figure Coordination between SAKOM and Organizations Concerned The Central SAKOM in Ankara works together with the AKOM of the Ministry of Interior at the time of disasters. All provinces have their provincial SAKOM, which are comprehensively controlled by the Central SAKOM. Only four provincial SAKOMs (in Istanbul, Sakarya, Bursa and Izmir provinces), as well as the Central SAKOM in Ankara, are active in normal times. However during a disaster, provincial SAKOMs are required to engage in disaster management depending on the level of the disaster and necessity even if they are non-active at normal times. The Provincial SAKOM is staffed by members of the Provincial Directorate of Health and is given necessary equipment by the General Directorate of Emergency Health Service of the MOH. The Provincial SAKOM has several responsibilities during disasters including: reporting to the Central SAKOM on the extent of damage seen in the province, sharing information with relevant organizations, specifying triage hospitals, dispatching UMKE volunteers, and establishing temporary emergency healthcare facilities. Disaster response is conducted at three levels: (i) provincial level, (ii) response including the relevant region, and (iii) national level, and the SAKOM coordinates specific actions for disaster response, while AFAD makes decisions on the level of disaster response. The National Earthquake Strategy and Action Plan of AFAD states three matters for which the MOH is responsible. The SAKOM is responsible for two of the three matters: updating of provincial and hospital Disaster Plans, and improving and enhancing transportation means in times of disasters. The remaining matter, improvements in hospital systems, is assigned to the Health Investment General Directorate. The SAKOM in Ankara engages in the following activities at normal times. - In 2010, the Central SAKOM in Ankara introduced the SAR Master Search and Rescue System, which monitors the number of emergency patients, number of patients transported, and the number of available beds at all the public, private and military hospitals and their departments, and displays information on a map. The map is updated every five minutes. The system also manages activities of the 112 Command and Control Centers and displays the movements of the 4,000 ambulances across the country on the map. - There are 17 emergency helicopters, which are used in 15 provinces and monitored by a tracking system to control long-distance transportation of patients. - The system monitors the status of earthquakes on screen; the information about earthquakes in Turkey arrives from the earthquake observation center of Bogazici University 4-72

55 in Istanbul and AFAD. It uses a system different from the system at AFAD, but they share information with each other, if necessary. Source: Picture taken by JST(Upper ) Figure SAKOM Webpage(Lower) Information center of SAKOM 1) Information system of the SAKOM As telecommunication devices in disasters and emergencies, the Central SAKOM is equipped with video remote communication systems, high-frequency radio, satellite telephones, facsimiles and ordinary telephones. Thus, even if it has a bad telephone connection, it can connect emergency dial (112) through the high-frequency radio. The Central SAKOM uses GPS to learn the locations of UMKE members and ambulances and arrange them in disasters and emergencies. UMKE members and ambulances are given an electronic device enabling instant messages, voice mails, 112 calls, and GPS locators. Through this system, the locations of callers/message senders are shared by 112 Command and Control Center. Source:Website of General Directorate of Emergency Health Service, MOH Figure Information system of SAKOM According to interviews with officials of the Bursa Provincial Directorate of Health on October 3, 2013, the Provincial SAKOM has a system linked to the 112 system and hospitals through the Internet to find vacancies in intensive care units, CT and bedrooms at each hospital. If the 4-73

56 system goes down because of a disaster or other reason, Provincial SAKOM in the neighboring provinces and regions support the Provincial SAKOM in trouble. 2) 112 Command and Control Centers Emergency calls (112) are answered at the local 112 Command and Control Centers, where resident doctors assess the state of the patient based on the information provided on the phone. If deemed necessary by the doctors, staff members make arrangement for a 112 Ambulance Station to take the patient and issue an order to send emergency personnel. Some 112 Ambulance Stations always have local doctors who work shifts upon the order of the Bursa Provincial Health Bureau. 112 Ambulance Stations are classified into four types A1, A2, B and C in terms of whether or not they operate on 24-hour schedules, whether or not doctors are always stationed, and other factors. 112 Ambulance Stations are built so that each covers 50,000 inhabitants and in consideration of traffic conditions, time required for transportation and other local factors. In the Province of Bursa, there are a total of Ambulance Stations (28 stations in the 3 metropolitan districts Osmangazi, Yıldırım and Nilufer and 24 stations in other districts), some of which are located on the premises of hospitals. 112 Command and Control Centers are also responsible for coordination of regions, provinces and cities outside Bursa which can offer support to the Province of Bursa. (A 110 call is for the fire department.) They arrange ambulances within 10 minutes of a 112 call receipt for 90% of all calls. The Provincial Directorates of Health manage ambulances other than those owned by the Ministry of National Defense. They also manage ambulance crews other than those owned by the Ministry of National Defense. The Command and Control Centers, ambulance stations, ambulance personnel and staff members communicate with each other by radio. In disasters and emergencies, they use a special frequency for 112 calls. They also have special communication devices for marine and air rescue. In the Province of Bursa, emergency helicopters, which are owned by contracted private companies are available in Osmangazi; no public hospital owns a helicopter. In 2013, helicopters were used for patient transportation 293 times. Since Bursa is the center of the Marmara Region, quite a few patients are sent to Bursa from the region. 4-74

57 Waiting Position of Helicopter District Name Population Population Density (/km2) Number of 112 Station Yıldırım 631,482 9,867 7 Osmangazi 792,219 1, Nilüfer 339, Gürsu 64, Gemlik 101, Mudanya 75, İnegöl 229, Orhangazi 75, Kestel 48, Yenişehir 51, Karacabey 79, İznik 43, Mustafakemalpaşa 99, Orhaneli 22, Büyükorhan 11, Keles 13, Harmancık 7, Bursa Province 2,688, Source: JST prepared based on documents from Provincial directorate of health in Bursa Figure Ambulance Stations in Bursa 3) UMKE (in Turkish, or the National Medical Rescue Team in English) The UMKE is a team undertaking rescue activities in afflicted areas during and after disasters. It is affiliated with the General Directorate of Emergency Health Service of the MOH and there is a UMKE center that has established its own independent office within one of the hospital premises at each province. Persons with certain qualifications can join the team after receiving training and registering at the MOH. (Since they are on a voluntary basis, members engage in their own works in normal circumstances.) According to interviews with officials of the Bursa Provincial Directorate of Health on October 3, 2013, the UMKE comprises medical doctors, nurses, officers of 112 centers and other personnel, and members are normally available within minutes after being called. The UMKE trains their personnel at the civil defense training facilities of the AKOM and AFAD. Each Provincial Directorate of Health has staff members qualified as UMKE members. In the event of a disaster, officers of the directorate form a disaster unit to supervise the UMKE in the afflicted area, and the leader of the disaster unit serves as a leader of the UMKE. Working together with the Provincial SAKOM, the disaster unit gives instructions and supervises the UMKE, and provides the UMKE with necessary equipment. If there is a shortage of UMKE members, officers of the Provincial Directorate who are qualified as UMKE members are mobilized, too. A total of 6,000 people in Turkey are registered as UMKE members and Ankara has 600 of them. The UMKE uses radio contacts via mobile vehicles and personal devices, and GPS-mounted electronic devices of SAKOM as communications means. 4-75

58 Source: Picture taken by JST Figure UMKE Center in Bursa (located in Yuksek Ihtisas Hospital) City Health Authority Disaster Afflicted site SACOM SAKOM Vice manager in charge of disaster and emergency Bureau of health service of disaster and emergency Chief of city ambulance service stations command and control centers Provincial MoH(Permanent) Disaster Unit (Control UMKE) UMKE Dispatch To be established In case of Disaster Source: Figure Command Chain of UMKE Table UMKE members OCCUPATION NUMBER PERCENTAGE DOCTOR % NURSE % MEDICAL OFFICER % EMERGENCY MEDICAL TECHNICIAN 193 8% ANESTHESIA TECHNICIAN 54 2% LABORATORY TECHNICIAN 35 1% OTHER 176 7% TOTAL % Source: Basic training curriculum and advanced training courses for UMKE members are shown in Appendix

59 (4) Healthcare service system in Turkey 1) Number of medical institutions and beds (by type of founder, region, etc.) The number of medical institutions, excluding outpatient institutions, has been increasing in Turkey, totaling 1,453 in By type of founder, the number of MOH hospitals is the largest, accounting for 58% of all, followed by private hospitals (35%) and university hospitals (4%). Other hospitals account for 3%, including municipal hospitals and social insurance union hospitals (Table 4.4.2). Both the numbers of medical institutions and patients have been increasing, but it seems that the increase in the number of patients outstrips that of medical facilities. While the number of patients has been increasing, the growth rates of the number of medical institutions and that of beds, compared to the figures in 2006, were 121% and 112%, respectively, in The growth rates of the numbers of inpatients and outpatients over the same period were both approximately 150%, showing the gap in the growth rates of the numbers of patients and medical institutions (Figure ). Accordingly, the number of patients per bed increased about 15 from 2006 to 2011, and the total number of patients per medical institution increased 53,000 (Table 4.4.3). The medical demand in the Provinces of Ankara, Istanbul, Bursa and elsewhere with high population rates is expected to continue to be high over the years to come. Table Changes in the number of hospitals ( ) No. of Ratio No. of Ratio No. of Ratio No. of Ratio No. of Ratio No. of Ratio Hospitals (%) (%) (%) (%) (%) (%) Hospitals Hospitals Hospitals Hospitals Hospitals Total 1, , , , , , MOH Universit y Private Others Source: MOH Health Statistics Yearbook 2011 No. of hospitals No. of inpatients (1,000) No. of beds No. of outpatients (1,000) No. of inpatients per bed Source: prepared based on MOH Health Statistics Yearbook 2011 Figure Increase rate of number of hospitals and patients in Turkey from 2006 to

60 Table Changes in number of hospitals, beds and patients ( ) No. of hospitals 1,203 1,317 1,350 1,389 1,439 1,453 No. of beds MOH 110, , , , , ,297 University 31,193 30,978 29,912 30,112 35,001 34,802 Private 14,639 17,397 20,983 25,178 28,063 31,648 Others 17,691 17,588 17,905 17,905 16,995 6,757 Total 174, , , , , ,504 No. of inpatients (1,000) 7,689 8,720 9,684 9,902 10,528 11,437 No. of outpatients (1,000) 217, , , , , ,850 Ratio of the No. of annual inpatients over the No. of beds No. of inpatients per hospital (1,000) ) Classification of medical institutions by type of founder, function and size Hospitals in Turkey are classifiable into university hospitals, national hospitals (MOH), private hospitals and a small number of municipal hospitals and other hospitals (including military hospitals). There is no national center equivalent to national cancer centers or cardiovascular centers that are common in Japan. In this sense, Turkish hospitals do not form any functional pyramid. A referral system is available but does not work properly, so patients tend to concentrate in general hospitals. By function, there are maternal and child medical care centers, heart disease centers and other hospitals specializing in particular functions, as well as general hospitals. Quite a few national and private hospitals have centers specializing in particular functions on the same premises (hospital complexes). 3) Healthcare Personnel (doctors, nurses, medical engineers, etc.) a. Number of healthcare personnel In Turkey, the absolute number of both doctors and nurses is much fewer than that in other countries. As of 2011, the number of doctors and nurses per 1,000 patients was approximately 1.7, whereas the figures in other countries are commonly between four and eight. In 2006, however, the number of outpatients per doctor was 4.6, which was lower than that in other countries. In 2008, the figure outnumbered that in the U.K., increasing to 6.3, more or less the same as the number in France. This was because the number of patients in Turkey is relatively fewer than other countries, but Turkey's population will certainly increase in the future while the population will age with the decreasing number of children. This suggests that the number of patients will sharply increase in future, unless the number of doctors increases at the same rate, which is currently not the case. In fact, the number of doctors per 1,000 persons increased from about 1.1 doctors in 2002 to about 1.5 doctors in 2008, but the number of patients per doctor almost doubled from about 2.6 patients in 2002 to 6.3 patients in 2008 (Table 4.4.4). 4-78

61 Table Number of health care workers per 1,000 inhabitants in major OECD countries ( ) No. of doctors per 1,000 people No. of nurses per 1,000 people No. of outpatients per doctor Japan Turkey Spain Greece Italy France Germany United Kingdom United States Source:OECD Health Data 2013 b. Regulations for Personnel allocation Personnel allocation and facilities at national hospitals are regulated pursuant to the Regulations of the Ministry of Health on Bed and Personnel Standards in Provincial Organizations (Regulation No ) and the Regulations on Operation of Treatment Institutions with Beds (Regulation No ). These regulations set forth the statutory number of personnel at national hospitals in accordance with the sizes (number of beds 5 ) and types of hospitals. They specifically determine the number and types of staff members necessary for each hospital. The types of staff members include medical practitioners, dentists, pharmacists, nutritionists, psychiatrists, nurses, laboratory technicians, midwives, drivers and treasurers. 4) Healthcare Insurance System in Turkey Persons under the social insurance system (employees, self-employed and civil servants) are subject to the insurance set forth in the Social Insurance and Universal Health Insurance Law and are eligible for medical benefits and cash benefits. The system of healthcare Insurance is summarized in Appendix 9. (5) Current Situation of Hospitals in Turkey 1) Hospitals in Bursa The Study Team visited the hospitals (3 public hospitals, 1 private hospital and 1 university hospital) listed below and the Bursa Provincial Directorate of Health. The following are important matters clarified in the survey. 5 For personnel allocation, public hospitals are classified into 19 classes in terms of the number of beds: 25 beds, 50 beds, 75 beds, 100 beds, 150 beds, 200 beds, 250 beds, 300 beds, 350 beds, 400 beds, 450 beds, 500 beds, 600 beds, 700 beds, 800 beds, 900 beds, 1,000 beds, 1,100 beds and 1,200 beds. 4-79

62 Hospitals visited - Medical Park Bursa (private) - Şevket Hospital (public) - Çekirge Hospital (public) - Bursa Devlet Hospital (public) - Uludağ University Hospital (university) Important matters: - A total of 20 hospital construction projects are in progress in the Province of Bursa. Half of them will be seismic isolated structures. - Reinforcing works are in progress to make the existing hospitals earthquake resistant. - Fall-prevention measures are to be taken for non-structural members and equipment. - The hospitals surveyed have storage plans, but the storage spaces for the amount of stock are uncertain. - The hospitals surveyed have their hospital disaster plans, but the plans do not include a clear statement about collaboration with other hospitals. - None of the hospitals surveyed has satellite communications means. - The hospitals surveyed have neither a backup information system placed outside the hospitals nor alternative system in case of malfunction of the information system. - None of the hospitals surveyed has any plan to deal with the stoppage of elevators. - None of the hospitals surveyed has estimated the number of patients to expect at the time of disasters. Results of the inspection of hospitals related to hospital buildings including structure and MEP work are described in ) Operation status of national hospitals The following table outlines the operation status of national hospitals that is, the Çekirge and Şevket Hospitals in the Province of Bursa, as well as national hospitals in Ankara and Antalya for reference. 4-80

63 Table Operation status of four national hospitals Hospital name Ankara Ataturk Sevket Yilmaz Antalya Education and Çekirge National Education and Education and Research Research Hospital Hospital Research Hospital Hospital (reference) (reference) Year of opening Healthcare services Mon-Fri (8:00 a.m. 4:00 p.m.) Emergency services Mon-Fri (8:00 a.m. 5:00 p.m.) Emergency services N/A Mon-Fri (8:00 a.m. 5:00 p.m.) Emergency services available 24 hrs/7 days available 24 hrs/7 days available from 7:00 a.m. to midnight Dialysis available Mon- Sat No. of beds 529 beds 879 beds 471 beds 914 beds No. of beds N/A 88 (42 beds in the main 52 beds 71 beds in intensive building and 46 beds in care unit the annex) No. of beds in emergency room N/A N/A N/A 50 beds (18 beds for primarily emergency healthcare) Dispensary N/A N/A N/A 155 rooms rooms Total floor area 55,400 m 2 Main building: 65,000 m 2 119,500 m 2 62,000 m 2 Annex building: 55,700 m 2 (A building of 2200 m 2 is under construction) Land area 47,500 m 2 Main building: 70,000 m 2 122,609 m 2 20,000 m 2 Annex building: 25,000 m 2 Parking lot 600 cars 800 cars 420 cars (for staff) cars (for visitors) 800 cars (there are 4 parking lots) No. of staff 1,500 persons 1,509 persons (fulltime) 794 persons (under 1,706 persons members and 1,384 contract with the (of whom about 500 persons (part-time) government) (The hospital outsources some services to the private sector, but the number workers are from external organizations) of workers is unknown.) Doctors 200 persons 330 persons 291 persons (under 454 persons contract with the government) Nurses 450 persons 563 persons 451 persons (under 610 persons contract with the government) No. of inpatients 37,578 persons/year 54,737 persons/year 85 persons/year 160 persons/year No. of outpatients 851,937 persons/year 767,009 persons/year 5,000 persons/year 3,174 persons/year Occupation rate of beds Average length of stay 87.6% 75.25% N/A N/A 4.47 days 4.46 days N/A N/A 4-81

64 Hospital name No. of operating rooms No. of operations (FY2009) Ankara Ataturk Sevket Yilmaz Antalya Education and Çekirge National Education and Education and Research Research Hospital Hospital Research Hospital Hospital (reference) (reference) 14 rooms 21 rooms (15 rooms in 12 rooms (plus a robot 23 rooms main building and 6 operation room) rooms in annex building) 26,061 81,240 41,000 36,231 (most of which were major operations.) Artificial dialysis Available 16 units Available Available MRI CT PET MRI (1) CT (1) Mammography (1) Nuclear scintigraphy (1) Endoscopes (7) MRI (2) CT (2) PET (1) Gamma-camera (1) Liniac (2: including tomotherapy) MRI (1) Manufactured by Philips 120 times /day Radiation therapy machines (10) EEG (2) CT (2) Major medical EMG (2) Manufactured by equipment Ultrasonic inspection Toshiba and Shimazu instruments (26) 20~25 times/day Mammography (3) Angiography (2) Endoscopes (one each for upper and lower bodies) Generators: 1,650KW, 250KW 5.5KW (mobile) Generators : 1,650KW, 680KW 60KW UPS:120KVA 5 N/A N/A Major facilities UPS: 160KVA x 2, 60KVA 2 30KVA 40KVA 2 20KVA 8 Water tank: 1,000 tons (total) Storage Inside the building Inside the building N/A N/A Source: JST prepared based on the interview survey result (6) Demand for Healthcare in Bursa 1) Population The table obtained from Bursa Municipality, gives estimates of future population. The table shows that the population is estimated to increase from approximately 2.6 million in 2012 to approximately 4 million in The following table shows the trend in birth rate in the Province of Bursa. The figures outnumber those of OECD countries. (e.g., the rate in Japan is 8.39.) Table Birth rate in Bursa Number of Births Birth rate (births/1,000 population) Population ,571 38,894 39,129 38,540 41, ,507,963 2,550,645 2,605,495 2,652,126 2,688,171 Source: Provincial directorate of health in Bursa 4-82

65 The Republic of Turkey, as Japan, will be increasingly aging, so the number of patients is likely to increase in future. The population of the Province of Bursa is distributed as drawn intable 4.4.6, which shows that population is concentrated in Osmangazi, Yıldırım and other urban districts. 2) Numbers of hospitals and patients The following table lists the number of beds, discharged patients, outpatients, bed occupancy rate and average length of stay for the hospitals under the management of the MOH. The table shows that the Şevket Hospital in Yildrim district, and the Çekirge and Bursa Devlet Hospitals in Osmangazi district receive the largest number of patients. Table Number of patients of MoH hospitals in Bursa No. of Beds No of Discharge /Year No of Outpatients /Year Bed Occpanc y Rate (%) Ave. length of stay (days) YILDIRIM 1,272 67, ,705 Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi 261 8, , Şevket Yılmaz Eğitim Araştırma Hastanesi , , Prof. Dr. T. Akyol Göğüs Hastalıkları Hastanesi 135 5, , OSMANGAZİ 1,856 98,199 2,060,043 Bursa Devlet Hastanesi , , Dr.Ayten Bozkaya Spastik Çocuk Hast. Rehabilitasyon Merkezi , Ali Osman Sönmez Onkoloji Hastanesi , , Bursa Zübeyde Hanım Doğumevi , , Çekirge Devlet Hastanesi , ORHANGAZİ , ,685 Orhangazi Devlet Hastanesi 60 2, , Dörtçelik Çocuk Hastanesi , , İNEGÖL , ,010 İnegöl Devlet Hastanesi , , MUDANYA 45 5, ,712 Mudanya Şaziye Rüştü Devlet Hastanesi 45 5, , YENİŞEHİR 75 4, ,156 Yenişehir Devlet Hastanesi 75 4, , ORHANELİ 25 1,897 36,172 Orhaneli Devlet Hastanesi 25 1,897 36, İZNİK 75 2,319 63,698 İznik Devlet Hastanesi 75 2,319 63, GEMLİK 128 8, ,143 Muammer Ağım Gemlik Devlet Hastanesi 128 8, , MUSTAFA KEMAL PAŞA , ,193 Mustafa Kemal Paşa Devlet Hastanesi , , KARACABEY 151 5, ,674 Karacabey Devlet Hastanesi 151 5, , Sum 4, ,971 5,131,479 Source:Bursa Health Office 3) Deaths by Diseases The following table lists the number of deaths by disease in Turkey and the Province of Bursa. The percentage of deaths by each disease in the province is more or less the same as that in the entire country: the percentages of deaths by problems with circulatory system and malignant neoplasms are relatively high. Table Number of deaths by diseases Total Endocrine, Diseases of Diseases of Diseases of External Nutritional, the nervous the Malignant the causes of and system and circulatory Neoplasms respiratory injury and metabolic the sensory system system poisoning diseases organs Others Turkey 294, ,710 62,587 24,418 18,992 10,807 12,985 48, % 40% 21% 8% 6% 4% 4% 16% Bursa 12,806 5,414 2, , % 42% 21% 7% 6% 4% 4% 15% Source: TUIK 4-83

66 Proposed Disaster Healthcare Services Data Collection Survey For Disaster Resilient Urban Plan in Turkey (1) Proposed disaster healthcare service system; Japan s experience and the role of Disaster Base Hospitals 1) Japan s experience Based on experience with the Great Hanshin Awaji Earthquake in 1995, Japan s medical institutions, Japan Medical Association and other relevant organizations, and experts on disaster medical services, architecture, equipment and facilities, information telecommunications, and pharmaceutical products have made the following proposal. - If a natural disaster has occurred, medical institutions in the afflicted areas themselves are often affected by the disaster. But they must still play a crucial role in offering emergency healthcare services promptly at the scene of the disaster. What is necessary for this are the establishment of emergency hospitals that have prepared for disasters in advance and provide assistance to other medical institutions in the afflicted areas; the establishment of a wide-area disaster and emergency healthcare information system that swiftly and accurately supports rescue operations at the time of disasters; the strengthening of the functions of health centers to deal with emergency healthcare; and the collaboration with transport organizations. - What is necessary are the establishment of emergency hospitals that have prepared for disasters in advance and provide assistance to other medical institutions in the afflicted areas; the establishment of a wide-area disaster and emergency healthcare information system that swiftly and accurately supports rescue operations at the time of disasters; the strengthening of the functioning of health centers to deal with emergency healthcare; and the collaboration with transport organizations. Accordingly, the Ministry of Health, Labor and Welfare of Japan has presented the following requirements for Disaster Base Hospitals. - Critical care services for seriously ill patients - Earthquake resistant structure - Possession of EMIS (Emergency Medical Information System) terminals - Lifeline maintenance functions - Heliport - Emergency supply of first-aid materials and equipment for use at the hospital or for provision to another hospital in the affected area. - Training on emergency healthcare Following the Great East Japan Earthquake in 2011, the Ministry of Health, Labor and Welfare has added the following requirements to the original requirements for Disaster Base Hospitals. - Possession of satellite telephones and access to satellite Internet connection - Develop organization to input data to EMIS - Possession of non-utility power generation with the capacity of about 60% of the utility power generation, and storage of fuels for 3 days - Possession of water tanks, development of water wells, and conclusion of agreements or other form of priority supply of water - Storage of foods, drinking water, medicines and other articles for 3 days or so 4-84

67 - Establishment of a system of Disaster Base Hospitals by concluding agreements with local relevant organizations and businesses - Heliport - Emergency supply of first-aid materials and equipment for use at the hospital or for provision to another hospital in the affected area Possession of DMAT and development of a system that enables accepting DMAT and medical teams - Lease of first-aid medical materials and equipment at the time of disasters - Regular training in cooperation with regional medical institutions 2) Roles of Disaster Base Hospitals The roles of Disaster Base Hospitals in Japan are defined as: a. Medical institutions with 200 or more beds in principle b. The buildings are earthquake-resistant and fire-resistant structures. c. Possession of large lecture halls and meeting rooms that can accommodate severely injured and ill persons for first aid d. Possession of hospital wards (patients rooms, ICU, etc.) and medical care wards (dispensary rooms, examination rooms, X-ray rooms, operation rooms, dialysis rooms, etc.) and storage for stocks and cot beds e. The function of maintaining electric power and other necessary infrastructures f. Possession of a heliport on the premises (If it is difficult to have a heliport on the premises, the hospital is required to secure a place near the hospital, which can be used as a heliport at the time of emergencies.) g. Terminals of a wide-area disaster and emergency healthcare information system h. Medical care facilities necessary to deal with critical patients (multiple trauma, crush syndrome and extensive burns) who will increase in number during and after disasters i. Cot beds for patients who will increase in number during and after disasters j. Possession of first-aid medical materials and equipment, medicines, power generator, etc. that are potable and self-contained for healthcare services in afflicted areas 3) Situations during and after disasters The Great East Japan Earthquake in 2011 fully destroyed 10 healthcare facilities and partially destroyed 290 healthcare facilities out of a total of 380 facilities in the afflicted Iwate, Miyagi and Fukushima prefectures. Because of this, surviving hospitals were obliged to limit the number of patients to accept or even refuse to accept patients. In other words, natural disasters may damage hospitals and increase the number of injured people, causing congestion in hospitals. 4-85

68 Table Facility situation in the Great East Japan Earthquake Total Limited Outpatients Couldn t accept Outpatients Limited Inpatients Couldn t accept Inpatients Iwate Miyagi Fukushima Total Source: JST (2) Proposed establishment of a disaster medical system in the Province of Bursa 1) Necessity of Disaster Base Hospital in city center a. Healthcare service supply system in urban districts The number of hospital beds in urban districts totals 3,565 (of which those at national hospitals account for 88%) and the number of doctors per 1,000 people in the province is about 1.5, less than half of the average number among the OECD countries, Bursa Zübeyde Hanım Doğumevi (163) Doruk özel Bursa Hastanesi (55) Dr.Ayten Bozkaya Spastik Çocuk Hast. Rehabilitasyon Ali Osman Sönmez Onkoloji Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi (261) Çekirge Devlet Hastanesi(525) Bursa Devlet Hastanesi(808) Medical Park Bursa (287) Bursa Vatan Hastanesi (95) Prof. Dr. T. Akyol Göğüs Hastalıkları Hastanesi(135) Şevket Yılmaz Eğitim Araştırma Hastanesi(876) Source: JST Figure Distribution of hospitals and population b. Damage estimation in the city center The number of outpatients at public hospitals in the urban district of the Bursa metropolitan municipality is 8,364 per day. Taking the case of the 1999 İzmit earthquake for damage estimation. In Gölcük (with the population of about 109,000), the numbers of injured persons and deaths totaled 5,064 and 4,656, respectively. The population of Osmangazi, Yildrim and Nulifer, the central areas in the Province of Bursa, totals about 1,400,000, so the estimated numbers of injured persons and deaths are 65,000 and 60,000, respectively. This suggests that in the event of disasters hospitals will be flooded with patients considerably outnumbering the present capacity of the hospital. Certain measures must be taken to estimate the number of casualties. c. Necessity of continued medical care of patients immediately after disasters and in the 4-86

69 super-acute phase in urban districts In urban districts, where the lifelines and transport means are not functioning due to a disaster, it is necessary to care for a great number of patients immediately after the disaster and in the super-acute phase. Table Healthcare needs in disaster Category Assumed Period Situation Immediate After Disaster Occurrence - 6hours Mass injured and sick people. Rescue work is started. Super Acute Phase -72 hours 6 hours Although a lot of rescued injured and sick people are transported to hospitals, staff and material support from outside of the disaster area is insufficient by disruption of lifelines and transportation. Sub Acute Phase 1 week -1 month Regional medicine, lifelines and transportation are recovered gradually. Chronic Phase 1 month - 3 months Evacuation life is prolonged. Lifelines are almost recovered and regional medical institutions and pharmacies restart their services gradually. Medium- to Long- Term After 3months Almost all medical rescue stations are closed and regional medical services are recovered as ordinary. Source: JST Emergency healthcare is in the highest demand immediately after a disaster. Response of hospitals in urban districts is crucial during the time until a rescue team such as UMKE arrives. The following figure schematically illustrates the trend in the number of patients during a disaster in red, and the trend in the number of patients helped by UMKE in blue. The circle shows the need for medical care immediately after the disaster, for which hospitals in the city center themselves must take action because patients cannot wait for a rescue team to arrive from outside the affected area. Immediate Medical Needs after No. of Patients helped by UMKE No. of patients 0 hours 24 hours 48 hours Source: JST Figure Medical needs until arrival of UMKE d. Importance of access to hospitals During disasters, although they are the key to the provision of medical services staff members of hospitals have difficulty rushing to emergency healthcare services for the following reasons. 4-87

70 - The fact that staff members and their families themselves are affected by the disaster - Road disconnection - Depletion of gasoline - Loss of transport means - Disconnection of public transport network - Secondary disaster on the way to hospitals On the day when the Great Hanshin Awaji Earthquake occurred in the early morning in 1995, a mere 58.4% of medical doctors and 44.2% of nurses showed up at their hospitals. This highlights the importance of the location of hospitals: they must be located conveniently enough not only for injured persons but also for staff members to reach without difficulty even at the time of disasters. Moreover, the number of medical staff members at work varies depending on the day and time of day (daytime, night and holidays have less staff members), which must be taken into account when disaster risk management plans are formulated. 2) Emergency healthcare cooperation in the Province of Bursa Public hospitals in Turkey are classifiable into various levels: those which supply advanced healthcare services and are equipped with research and educational functions are designated as A-1, and general hospitals following A-1 hospitals in terms of the quality are designated as A-2. In the Province of Bursa, there are two A-1 hospitals: the Uludag University Hospital and the Şevket hospital (Şevket Yılmaz Eğitim Araştırma Hastanesi). In addition, the City Hospital for which the construction plan is in progress is expected to be another leading hospital with the largest capacity (1,355 beds). The green areas in the following figure are within 10km of any of the A-1 hospitals. The figure also shows that the urban district around the Çekirge Hospital (529 beds, and A-2 level) is not covered by any of the A-1 hospitals. 1City Hospital 2Uludag Univ. Hospital City Center Cekirge State Hospital 3Sevket Hospital Source: JST Figure The coverage area (Green) by A1 level hospital To deal with such situations, the Study Team proposes that the Çekirge Hospital should be upgraded so that it can serve as a Disaster Base Hospital for the city center, which will lead to better disaster medical services in the Province of Bursa. When the construction is completed, the City Hospital (1,355 beds) will be regarded as the top-level hospital in the province. But the Study Team proposes that, because it is located on the outskirt of the central area, it should be counted as a core Disaster Base Hospital that accepts seriously injured or ill patients who cannot be treated at hospitals in the urban 4-88

71 district at the time of disasters. The Study Team also proposes that the A-1 hospitals in the urban district should be refurbished and upgraded as regional Disaster Base Hospitals, and that the Çekirge and Şevket Hospitals should be made components of the Disaster Management Complex (DMC). The following figure shows the image of the disaster medical cooperation scheme. Figure Proposal for medical cooperation in a disaster The core Disaster Base Hospital and regional Disaster Base Hospitals will accept chiefly seriously injured and ill patients, centrally gather regional information, coordinate the liaisons with various organizations and other hospitals, and serve as backup hospitals for each other. The table below lists the functions and roles of the core Disaster Base Hospital and Disaster Base Hospitals. 4-89

72 Table Function and roles of core disaster base medical centers and regional disaster base medical centers Source: JST 3) Proposed disaster medical plans in the Province of Bursa Japan s experience Lessons learnt from the Great East Japan Earthquake in 2011 include the following situations. - The afflicted Iwate Prefecture had not stipulated a command channel for rescue teams in advance and thus was unable to dispatch rescue teams efficiently to where they were needed. After the disaster, a collaboration scheme was established, which specifies the command channel and the roles of the prefecture, prefectural medical association, dentist association, pharmaceutical association, nursing association, medical institutions, prefectural police and the Self-Defense Forces. - The Japanese Red Cross Ishinomaki Hospital in another afflicted prefecture, Miyagi, had already built cooperative relationships with the neighboring hospitals prior to the earthquake. Staff members in charge of emergency medical services held meetings, and a network for dialysis treatment was built with the neighboring hospitals, and the emergency healthcare departments and rescue teams of these hospitals had already worked together to consider various medical cases. Thanks to these collaborative relations, the Ishinomaki Hospital successfully built an emergency medical service scheme at an early stage after the disaster. - In order to make any collaboration plans function properly at times of disasters, hospitals and other parties concerned must establish close connections in advance in normal circumstances, based on which they are also required to formulate a collaboration plan at the prefectural level which specifies the roles of the parties concerned and the command channel. 4-90

73 - Because the damage from the earthquake disaster was extensive, quite a few patients were transferred to the neighboring prefecture and staging care units (SCUs) of other prefectures. But it took time to commence transfer of patients because prior planning was insufficient and also because healthcare services in other prefectures were under the management of other prefectural governments. - Transfer plans and wide-area healthcare transfer plans involving the neighboring prefectures must be formulated in advance. Inter-prefectural transfer, in particular, requires administrative arrangements, so the command channel and decision-making must be established and conducted at the national governmental level. Figure Wide-area medical transportation in case of disaster (Proposal) The prefectural governments arranged dispatches of rescue teams but had many difficulties in inter-prefectural transfer, allocation of rescue teams to the prefectures concerned, and inter-prefectural coordination. They also had difficulty making arrangements because they relied on telephones only to contact the national government and the bureau of rescue teams. The liaison among the afflicted prefectural governments did not work properly, confusing the command channel. Although the hospitals were expected to gain support of the Internet telecommunications from rescue teams, they did not have sufficient instruments and failed to get the Internet connections. - That is, the operation under emergency circumstances is extensive across more than one province, so that the SAKOM of the MOH, Prefectural SAKOM, UMKE and other parties concerned must clarify the command channel and communication methods, while all UMKE must be equipped with satellite telecommunication devices to get Internet connection. Disaster medical plans of the Province The present provincial disaster medical plan does not refer to the role-sharing among medical institutions. This means that they would not understand which hospitals are responsible for what kinds of activities and with which hospitals they should collaborate with if a disaster occurred. The Study Team proposes the role-sharing and collaboration among medical institutions to be included in the disaster medical plan of the Province of Bursa. 4-91

74 Medical Facility Severe Severe-Moderate Moderate-Mild Mild Core Disaster Base Hospital> City Hospital Disaster Base Hospital> Cekirge State Hospital Sevket Hospital Uldag University Hospital Hospital other than above Close clinics and gather staff and medical resources of the clinics to the above hospitals for effective medical services / Clinics. Only limited clinics Transfer Patient transfer to outside of the province Figure Role for each facility in a disaster (Proposal) 4) Development of an emergency medical information system a. Japan s experience Lessons learned from the Great East Japan Earthquake in 2011 include the following situations. - Many hospitals lost connections to the internet and failed to input information. Those which could not directly input information were contacted by their local disaster management headquarters to confirm and input information on their behalf. Even so, it was still difficult to gather information from areas which had not had any collaboration system for data inputting by proxy. - The authorities could not confirm the safety of hospitals that had not had the system. The Miyagi prefectural government had not had such a system either, and had difficulty gathering information about damage to hospitals, resulting in delay in assistance to isolated hospitals. - The authorities collected information about healthcare services only and failed to have enough information that could help collaboration with the Self Defense Forces and other relevant organizations. A collaboration system to input information in the network by proxy must be established in advance. A cross-sectoral information gathering system involving all the provinces and hospitals must be built. The Study Team proposes that Disaster Base Hospitals should adopt the hospital information display system of the Provincial Directorates of Health so that they can grasp information about possible hospitals that can host patients in a wider area. Japan s emergency medical information system (EMIS) may be a good example for a useful disaster healthcare system. The proposals are to establish a disaster healthcare system integrated with the nationwide information system network, an on-line system which specializes in medical information at the time of disasters, enables all hospitals in Turkey to share information, and allows the general public to have access to healthcare information. b. Japan s experience - While many medical institutions lost clinical records and other medical information, Ishinomaki City Hospital managed to recover its medical information data after the 4-92

75 disaster because it shared the data with Yamagata City Hospital Saiseikan, some 100km from the city of Ishinomaki. After the disaster, many hospitals began to use the data center or introduce a system to keep backup data at other medical institutions and elsewhere. A system to keep backup data on medical information such as mutual data sharing with a remote hospital must be established. Loss of information about patients because of disasters results in disruption of continued healthcare services. The Study Team proposes that hospitals should work together with other hospitals or external entities to keep backup data on their patients. (3) The present state of hospital PPP projects in Turkey 1) Progress of PPP projects MOH has been promoting City Hospital-PPP projects as national projects for improvement of the quality and efficiency of health service provided by public hospitals. The following table lists hospital PPP projects currently in progress as national projects in Turkey. A total of 20 buildings are now in the bidding stage, 5 projects have been approved by a higher planning council, 2 projects have been transferred to the council and 26 projects are in preparation stage. Out of all the 53 projects, the bidding for 17 projects has already been closed. But none of the 17 projects has yet secured financial resources. (List of PPP projects is attached : Appendix-8) The failure in securing funds is chiefly attributable to uncertain sharing of responsibilities between the public and private sectors for services that SPV 6 (Special Purpose Vehicle) plan to offer (a total of 18 services including image diagnoses, inspections, transportation and catering), and thus to uncertain risk and costs to be borne by the private SPV. Currently, successful bidders have already submitted their proposed service contracts to the MOH, and the MOH is examining the proposals. 2) Comparison of Disaster Base Hospitals as facilities to respond to BCP In hospital planning including PPP in Turkey so far, securing of healthcare functional continuity in disasters has not been clearly defined and taken into consideration. In hospital PPP projects, buildings are designed to be anti-disaster, but no specific conditions are given in advance; hospital functional continuity has been left to the discretion of the SPV or negotiations between the SPV and the hospitals at the design stage. In short, the function necessary for Disaster Base Hospitals is not necessarily secured. The Study Team representing Japan will propose the desirable features of Disaster Base Hospitals as follows. 6 SPV (Special Purpose Vehicle): Business corporation established in order to undertake a special enterprise. In PPP, the consortium that makes proposal to the general invitation, establishes SPV and is in charge of construction, management and management. 4-93

76 Table Desirable features of Disaster Base Hospitals Facilities Functions (i) Space (including space for triage) large enough to handle twice as many inpatients and five times as many outpatients as normal times, medical gas outlets, cots, medical supplies and materials for emergency (ii) Private power generators that can produce electricity at 60% of the normal consumption level, and fuels for three days (iii) Storage of food, drinking water, medicines and other supplies for the estimated number of patients for three days in an emergency (iv) Satellite telephone and satellite Internet connections (v) Heliports (two or more) (vi) Special ICU beds, emergency resuscitation units, emergency examination units, radiographic rooms and operating rooms (i) Response to critical patients (multiple trauma, crush syndrome and extensive burns) who will increase in number during and after disasters (ii) Response to patients with acute-phase heart disease and stroke patients who need emergency treatment. (iii) Response to patients with chronic diseases who need continued treatment even at the time of disasters (iv) Coordination at the time of disasters * Gathering information about damage, patients and activities of healthcare organizations, and reporting to the province * Gathering of healthcare staff members, medical supplies, etc., dispatch of personnel to the province, and request for supplies Hospitals under PPP projects have requested the following facilities, but no specific specifications of these facilities are defined. The storage and management plans in preparation for an increase in the number of patients in disasters are basically proposed by PPP SPV, and the MOH and consultants examine and decide to approve such proposals. Thus, the nature and types of facilities in preparation for disasters, as well as management plans, are likely to vary substantially among hospitals. In such circumstances, Japan s desirable features of Disaster Base Hospitals will be a meaningful reference for Turkey. Table Anti-disaster facilities included/not included in PPP hospitals Facilities required by PPP hospitals Earthquake-absorbing technology Use of reclaimed water and rainwater Cogeneration/tri-generation Renewable energy Energy-saving measures Duplication of power sources and backup generators Heliports Medical shelters * These facilities are cited, but no specific specifications are defined. (The hospitals have not made specific requests, such as something for a certain number of days to deal with such and such number of patients in disasters.) The capacity and specifications are proposed by PPP SPV first, and then examined and approved by the consultants and MOH. Facilities not included in PPP hospitals (1) The following plans for an increase in the number of patients in disasters Extra medical gas outlets Stockpile (water, medicines, medical supplies, food and fuel) Waste water management (2) Operation and development of backup functions in case the following facilities become disabled Elevators Transport devices (medicines, food, etc.) Electronic health records, etc. * The designing and planning of anti-disaster facilities greatly depend on proposals of PPP SPV, and the authorities simply give approval. The nature and types of facilities in preparation for disasters vary substantially among hospitals, depending on the competence of SPV and consultants. (4) Proposed formulation of a hospital disaster plan during and after disasters 1) The present situation Each hospital in Turkey formulates its hospital disaster plan (HDP) according to a format prepared by the MOH. Hospitals annually update and biannually review their HDP. Hospital disaster plans basically stimulate disaster preparedness, procedures, plans (who undertakes what in what kind of manner), and action plans of personnel in charge of disaster management which define actions in the initial 2 hours, 12 hours and 24 hours after disasters. 4-94

77 In the event of disasters, hospital administrators, head physicians, and administration specialists establish a hospital incident command center in collaboration with the officers in charge and supervisors designated in the HDP, and put their emergency action plan into practice. The action plan list of officers in charge of disaster management is used by the HDP. The officers in charge confirm whether actions have been taken timely according to the action plan, and record the execution time and sign the list. The HDP stipulates that officers in charge are required to: - Determine the period for preparing the emergency action plan and the date of execution; - Create a list of personnel subject to training, and determine the training dates; - Ensure that the HDP training is included in the annual training program; - Hold meetings prior to training to prepare information; - Decide the place of meeting - Supply waistcoats, training materials, equipment and other necessary tools for the HDP. The HDP is required to include the following matters. - Preparation of a disaster preparedness list - Standards for the commencement and termination of the HDP - Procedures to get access to personnel - Safety measures - Standards for decision-making on evacuation order - Measures for voluntary participation - Standards for care of patients in emergencies - Regulations on emergency evacuation standards in disasters All the staff members of the hospitals are required to have HDP training which includes 1- hour programs and, for administrators, advanced training for minutes. The following figure illustrates an organizational chart of the HDP which is headed by the hospital administrator at the time of disasters. Source: Cekirge HDP Figure Organization of Hospital Disaster Management Plan (HDP) 4-95

78 The HDP is required to include statements about communication means in emergencies and disasters; operation rules of the disaster management center (triage, evacuation, acceptance of patients, transfer, and standards for registration and notification); evacuation from the hospital; tasks of evacuation supervisors in the departments and divisions; areas for emergency healthcare and triage; and protective measures against disasters (earthquakes, fires, SBRN contamination, terrorist attacks, crowd of people, power outage, water failure and floods). Procedures for actions at the time of disasters - Establishment of a hospital incident command center - Assessment of damage (according to the technical board) - Decision-making on whether to evacuate entirely or partially according to the assessment - The evacuation order is based on the priority order specified by the hospital incident command center - Patients are given priority for evacuation and led to designated evacuation shelters (meeting places are specified in the main and annex buildings) - Patients are given a triage tag staging their healthcare records. Those who are able to return home are advised to go home, while those who need treatment are given the relevant treatment. - If the hospital becomes unable to provide healthcare services, patients are transferred to neighboring hospitals, with which the hospital has concluded a cooperation agreement in advance. An agreement is also concluded with the fire department. - Contact the 112 center. 2) Japan s experience and proposed formulation of hospital BCP plans a. Facility and equipment fall prevention The Great East Japan Earthquake was not a local earthquake such as the 1995 Great Hanshin Earthquake but a subduction-zone earthquake causing vibration with flexible structure. Thus, the quake-absorbing structure alone was unable to prevent damage, movement and falling of facilities in buildings. Accordingly, various facility and equipment fall-prevention measures have been examined in Japan since then. Japan s National Research Institute for Earth Science and Disaster Prevention, an independent administrative agency, has conducted quake tests using full-sized hospital models and produced a manual for fall-prevention measures to fix facilities in hospital rooms. The Study Team proposes that Japan offer cooperation for development of a manual and training on facility and equipment fall-prevention measures in Turkey in accordance with the lessons learned from the Great East Japan Earthquake. b. Storage and lifeline measures according to damage estimation Storage and lifeline measures must be designed to cover the amount of necessities until the recovery by assuming (i) the number of patients; (ii) healthcare services to offer (the amount of medical resources varies substantially depending on the need of dialysis, operations, ICU and other healthcare services); and (iii) the time required to recover the lifelines. In Japan, the time required for the recovery of lifelines is assumed to be about 2-3 weeks for water and 8-72 hours for electricity if an earthquake with a magnitude of 6+ occurs. The Study Team proposes that Turkey should formulate a plan that meets the circumstances in various regions in the country. Storage and lifeline measures must be formulated in consideration of (i) the estimated 4-96

79 number of patients; (ii) healthcare services to offer; and (iii) the time required to recover the lifelines at the time of disasters. As for healthcare services to offer, in particular, the province must specify the role-sharing of hospitals in its disaster medical plans, formulate an action plan to have each hospital to play its role, and conduct necessary training. c. Measures against stoppage of elevators Stoppage of elevators causes considerable trouble with transfer of patients. Hit by the Great East Japan Earthquake, Kesen-Numa City Hospital suffered from stoppage of its elevators so that 4-5 staff members were needed to carry one patient. The Japanese Red Cross Ishinomaki Hospital, hit by the Great East Japan Earthquake, had its heliport not on the roof of the building but on the ground floor, so that it managed to conduct wide-area transfer of patients even if its elevators stopped. In the event of the Great East Japan Earthquake, there was little stoppage of elevators that were built in and after 2009 when the official earthquake resistance standards were revised. The Study Team proposes that the authorities in Turkey should prepare manuals including the following matters in preparation for stoppage of elevators. Transfer routes and means in consideration of stoppage of elevators Earthquake-resistant standards for the elevators themselves Early recovery measures against stoppage (system to promptly secure elevator maintenance workers, introduction of at least one elevator satisfying the latest standards for each building, etc.) d. Measures to use electronic medical records at the time of disasters After the Great East Japan Earthquake, hospitals that could not use their electronic medical records, and therefore, continued their operation with medical records on paper. In afflicted areas, more than one physician at more than one medical institution examines one single patient. Thus, it is effective to use duplicate record formats and give a copy to the patients. (At normal times, duplicated medical records are used as emergency medical records.) If access to electronic medical records is disconnected, advanced medical equipment using the picture archiving and communication system (PACS) such as computed tomography (CT) and magnetic resonance imaging (MRI) is also disabled. Thus, measures to prevent these medical instruments from stopping are also needed. Plans to use medical records on paper at normal times, and disaster measures for the electronic medical information system (location of the server room, quake-absorbing measures, measures to fix the instruments, etc.) must be prepared. e. Proposed hospital operation plans in disasters backed by the experience and realistic training The Great East Japan Earthquake caused power shortage and stopped air conditioners. Hospitals became unable to sterilize or clean medical equipment and conduct operations for many days except for emergency operations. Persisting aftershocks, shortage of consumable goods and water and various other factors obstructed medical operations. Meanwhile, since 1990, the Osaka Police Hospital has practiced disaster drills by actually turning off electricity and continuing to update its operation plan for disasters. Actual experience is reflected in hospital operation plans and disaster drills. Disaster drills are designed to include planned outage and water outage and to be conducted at night. This will clarify possible obstacles to continued provision of healthcare services in line with the actual circumstances of hospitals, and help formulate better hospital disaster plans. 4-97

80 Proposal for disaster base hospitals (1) Architectural Planning 1) Current situation of hospitals in Turkey Data Collection Survey For Disaster Resilient Urban Plan in Turkey The current situation of hospitals in Turkey was assessed through inspections and interview surveys, from the viewpoint of a disaster base hospital. Assessment of hospitals in Turkey from the viewpoint of a disaster base hospital During the survey in Turkey (October in 2013 and February in 2014), 8 hospitals (2 private, 4 public, and 2 national university hospitals) were investigated. Assessment of the hospitals was made according to the criteria which were set from the view point of disaster base hospitals. The results of 7 hospitals out of 8 hospitals are shown in Table One private hospital at the city center of Bursa, located in a high story building originally built as a hotel, is excluded from the table as their building differs from other hospitals. Uludag University Hospital (1,200 beds) * There is a ground type heliport on the premises. Cekirge Hospital (529 beds) Bursa Devlet Hospital Sevket Yilmaz Research and Education Hospital (879 beds) The maternity department (371 beds) was investigated. Hacettepe University Hospital (1,150 beds) * There is a plan for building a heliport on the premises. A budget request has been made. Kanuni Sultan Suleyman Egitim ve Arastisma Hospital (650 beds) ACIBADEM Maslak Hospital (205 beds) Table Results of Hospital Building Assessment in Turkey (Architectural Plan) Assessment Points Legend of assessment C Compliant N Having some challenges - Unconfirmed or other A B C D E F G Ideal situation 1) Is there a heliport on the ground? Architectural Planning C N N N N N C A heliport is provided only on the premises of Hospital A. Hospital E has a plan to build a new heliport, and has been waiting for the budget allocation. There is currently no heliport in the other hospitals. Whether any alternative heliport exists outside is unconfirmed. If a heliport is built outside of the premises, it is necessary to secure a reliable emergency traffic route to the hospitals. 4-98

81 2) Are there two or more heliports including an emergency heliport? 3) Is there a waiting space and equipment space for disaster medical assistance teams been secured near the emergency heliport? 4) Relief supplies will be carried in. Is there enough space for parking trucks and setting up a tent for storing supplies on the premises? 5) Is there a plan for setting up toilets and other infrastructure for the support staff on the outside space of the premises? 6) Are there large entrance eaves where a triage tent can be set up to protect patients from rain or snow in the event of a disaster? 7) Has space been secured in the emergency zone so that an additional tent can be set up outside? 8) Is there outpatient space which will function as a space for accepting moderatelyinjured patients in the event of a disaster? How many patients can be accepted in that space? 9) Has medical gas been secured in the outpatient space for accepting patients in the event of a disaster? 10) Has a courtyard which can secure daylight and ventilation been provided for outpatient space for accepting patients in the event of a disaster? N N N N N N N It is important to equip at least 2 heliports, because the transfer of patients in critical condition will concentrate on these hospitals, in the event of disaster. This is a lesson learned from the case of the Japanese Red Cross Ishinomaki Hospital after the Great East Japan Earthquake. N N N N N N N Securing of equipment for the teams and meeting place C C N N C C C As many trucks loaded with relief supplies will arrive at the disaster base hospitals, it is necessary to set up a tent for storing supplies on the premises, and an outside space is needed on the premises. N N N N N N N It is preferable to prepare an infrastructure on the outside space of the premises as a place of operation for support teams from the outside. N N C N N C C It is preferable to provide large entrance eaves so that a tent can be set up even in bad weather such as a snowfall. N C C C C C C Secure outside space for setting up additional tents as well as a traffic route so that an increased number of patients in critical condition can be accepted. C C C C C C C As the reference area of the hospital is large, there is no problem with the space for an emergency response. _ Portable gas cylinders will be used to supply medical gas for emergency response. The gas should be maintained based on a clear acceptance plan and the amount corresponding to the plan. C C C C C C N Daylight and ventilation from the courtyard are secured in the medical examination rooms and treatment rooms. 4-99

82 11) Has a short and safe traffic route been secured so that a critical condition emergency patient zone can be linked with the operation department even while use of the elevators is suspended? 12) Are operating rooms or halls provided with windows which can secure natural lighting and ventilation so that they will function even in the event of a disaster? 13) Is there allowance for setting up temporary beds in hospital rooms and accepting emergency inpatients in the event of a disaster? (What percent increase can be accepted by the entire hospital?) 14) Is the first floor or its vicinity in the hospital provided with information facilities as well as a room in which a disaster response headquarters can be set up? 15) In addition, can the room in which a disaster response headquarters be set up secure natural lighting and ventilation? 16) Has the possibility of a tsunami or flooding been analyzed? If there is a possibility of a tsunami or flooding, it may be preferable to place kitchen devices and the machine room which is highly important, on the second floor to be less susceptible to flood damage. 17) Is there a plan for securing space which can provide a place to stay and meals for the hospital staff s family members so that the staff can be engaged in medical services feeling certain about family members even in the event of a disaster? JICA Study Team N N N N N N C For Hospital E, when a new emergency ward is completed, which is now under construction. N N N N N N N In-house power generation will be used in the event of a disaster. However, if fuel is used up, no operating rooms can function. _ * _ * * In Hospital D, the amount of medical gas for 2 bed rooms is prepared for 1 bed rooms, and 1 bed rooms will be used as 2 bed rooms in case of an emergency. N N N N N N N If a room such as a conference room which can be used as a disaster response headquarters is located on the first floor or its vicinity and emergency power and communication facilities are prepared, a response headquarters can be set up in the event of a disaster. N N N N N N N To save fuel for in-house power generation and maintain the medical care function, the room should be located in a place where natural lighting and ventilation can be secured. _ Kitchen devices and the important machine room should be placed on the second or higher floor so as to be less susceptible to flood damage. N N N N N N N If the safety of family members is not secured, the staff cannot be engaged in medical services

83 2) Regulations for hospital buildings a. Hospitals under MOH Areas, etc. No particular law or regulation exists in Turkey to regulate the total floor area, land area or the number of floors of national hospitals. These elements of national hospitals are specified by technical specifications and project agreements concluded between the MOH and contractors. As for the area per bed at existing hospitals, the MOH introduces the standard of 200m 2 per bed. Number of beds The number of beds at national hospitals is regulated in accordance with the types of hospitals. For example, any general hospital must have 50 or more beds, and any day hospitals, five or more beds. No national hospital is allowed to provide new medical services or change the number of beds 7 unless it obtains the approval of the MOH. Other than these legal regulations, the Manual on Minimum Design Standards of Turkish Healthcare Facilities stipulates construction of national hospitals. The manual is a standard recommended by the MOH but has no legal binding force in the present situation. Even so, technical specifications in the manual are expected to be incorporated in regulations with legal binding force in the future. Patient rooms There is no law or regulation on the size of patient rooms, which is generally regulated by the Manual on Minimum Design Standards of Turkish Healthcare Facilities. For example, the manual requires each room with one bed to have an area of 9m 2 or more, and each room with two beds to have an area of 7m 2 or more per bed 8. It also requires to have a distance of 110 cm or more between beds. As for the number of beds per room, there used to be 3-4 beds in each patient room. Since the healthcare reform in 2002, however, the country has been planning to create a new facility environment to provide higher quality healthcare services. The 2010 Guideline on Minimum Design Standards for Healthcare Buildings in Turkey published by the MOH and the Regulation on Private Hospitals (Regulation No , issued on March 27, 2002) stipulate that the maximum number of beds in each patient room must be two. b. Private Hospitals There are various healthcare-related laws and regulations applicable to municipal and private 7 Patient rooms are classified into private rooms, first-class rooms and second-class rooms. A private room must have a bed, refrigerator, TV, telephone, space for attendants, unit bath and sink; a first-class room must have a bed, space for attendants and sink; and a second-class room must have two or three beds and a sink. 8 The standards on the area of special patient rooms per bed stipulate that a paediatric patient room must have an area of 6m 2 or more per bed; an intensive care unit must have an area of 12m 2 or more per bed; a new born intensive care unit (NICU) must have an area of 6m 2 or more per bed; and an intensive observation unit (IOU) must have an area of 6m 2 or more per bed

84 hospitals. ÖZEL HASTANELER YÖNETMELİĞİ provides a wide range of regulations for facilities and personnel of private hospitals as follows. It also applies to the floor planning of public hospitals. Facility size The Regulations on Private Hospitals require private hospitals to have in principle 100 or more beds. The MOH, however, allows the establishment of a private hospital with less than 100 beds in accordance with hearings of the Planning and Employment Commission, and the number of doctors and nature of necessary services (still, all private hospitals are required to have at least 50 beds and each medical department must have at least one bed). There is no regulation on the total floor area, land area or the number of floors, but hospitals are required to have staircases of 1.5 meters or more in width for stretchers and corridors of two meters or more in width. Private hospitals are also required to have power generators capable of producing 70% or more of power consumption calculated in their power consumption plans. Moreover, they are required to have at least two elevators that have passed the standards of the Turkish Standards Institute, and at least one elevator must be large enough to have wheelchair and stretcher access. Necessary facilities The Regulations on Private Hospitals stipulate that all private hospitals must have the following facilities: (i) general treatment rooms (treatment rooms for obstetrics and genecology departments and urology departments must in principle have bathrooms); (ii) at least two operating rooms and awakening areas (the space in each operating room must be 30m 2 or larger, and the height from the floor to the ceiling of the operating rooms must be in principle three meters or more. The corridors inside operating rooms must be two meters or more in width); (iii) intensive care units with two or more beds; (iv) emergency room; (v) pharmacy; (vi) examination units with special permission granted; (vii) specimen room; (viii) disinfection room; (ix) central heating system (particularly hygienic air-conditioning systems must be installed in operating rooms, ICU and other facilities that require disinfection processes); (x) a sufficient number of sinks, toilets and bathrooms; (xi) garbage storage for medical and general wastes; (xii) morgue; (xiii) kitchen and washing room; and (xiv) ambulance

85 Necessary equipment The Regulations on Operation of Treatment Institutions with Beds stipulates the nature of services that national hospitals are required to provide 9, setting forth the general conditions of facilities to provide these services. The regulations, however, do not stipulate any specific technical requirements. The Manual on Minimum Design Standards of Turkish Healthcare Facilities, on the other hand, stipulates a wide range of technical requirements, though it has no legal binding force as stated above. 3) The MOH s plan to adopt new technologies for disaster medical services Currently, there is no standard or rule for the following technologies in Turkey. But hospitals to be newly constructed are expected to have such standards and rules, and the MOH is planning to formulate them. - Seismic isolation structure: Hospitals with 100 or more beds in regions designated as earthquake hazard levels 1 and 2 are required to adopt quake-absorbing structures. - Cogeneration - Green roof and energy-saving facilities - Grey water facilities - Facilities to allow the use of rainwater - Geothermal power generation - Power generation Standards for installation of medical shelters - Underground - Close enough to ICU and operation room and directly accessible - Place safe from damage by fire or disaster - Spacious enough to accommodate half of the beds in the ICU at the hospital 9 The Regulations on Operation of Treatment Institutions with Beds specifies the following healthcare services that national hospitals must provide: (i) outpatient treatment services; (ii) diagnostic, treatment and care services provided by doctors, resident physicians, pharmacists, nutritionists, physiotherapists, psychiatrists or a team of specialists according to the nature of cases; (iii) 24-hour emergency medical care services provided by a sufficient number of personnel; (iv) laboratory services; (v) operating room services including necessary facilities and the necessary number of personnel under the supervision of doctors; (vi) disinfection services for facilities for operations; (vii) intensive care and resuscitation services; (viii) postoperative services to prevent complications; (ix) dispensing services; (x) cleaning services; (xi) meal and nutrition services for patients and hospital staff; (xii) cleaning services provided by persons responsible according to disinfection rules; (xiii) procurement and storage services for consumables, medicines, food, cleaning supplies, fuels, medical care supplies and others; and (xiv) gardening and other technical services

86 - Equipped with a care unit with equipment enabling temporary care of patients in the ICU and operating room - Equipped with electric outlets at bed side and having room for medical gas, medical preparation and equipment - Having medical equipment exclusively for medical shelters - Unnecessary to have the inside of shelters completely sterilized - Equipped with elevators satisfying the following requirements One elevator each for hospitals with beds, two elevators each for hospitals with beds, three elevators each for hospitals with beds, four elevators each for hospitals more than 400 beds Loading capacity: 1600kg Door: 1.5m wide Dimensions: 2.4m x 2.4m Directly linked to rescue divisions at the time of fires and natural disasters Equipped with 4 electrical outlets (220V), 2 medical gases, 2 oxygen tanks and 1 aspirator Electricity supplied from the usual main power supply of the hospital. In case of failure in electricity supply, a power generator exclusively for elevators of the medical shelter will supply electricity to the elevators. 4) Experience in Japan, requirements for designing Disaster Base Hospitals Design criteria and requirements for Disaster Base Hospitals are described in In the Great Hanshin-Awaji Earthquake, massive damage was caused by the unexpected impact of the earthquake. From that experience, the importance of the Disaster Base Hospital has been recognized and a new standard for the Disaster Base Hospital has been institutionalized. Disaster Base Hospital means a general hospital, which has additional or specific arrangements for facilities, utilities, equipment and stockpiles etc. to provide medical service even in the event of disasters. The hospital should be nominated as a Disaster Base Hospital by local government authorities. From the experience of the Great East Japan Earthquake in 2011, additional issues came out, and the standard of Disaster Base Hospital has been revised. It is proposed to develop facilities which will operate and keep providing medical services in the event of disaster, i.e., facilities similar to disaster base hospitals in Japan, and to establish a new system so that medical services can reliably be provided in the event of a disaster. a. Requirements to operate as a disaster base hospital in Japan (in terms of major facilities and equipment) Accept inpatients twice the normal number, and outpatients 5 times the normal number in the event of a disaster. Having an electric generator which can supply 60% of the amount of electric power at a normal time for 3 days. Having a water reservoir tank(s) with an appropriate capacity and water well facilities which can be used during a power outage. Internet network via satellite communication system Participation in widespread disaster and emergency medical service information systems 4-104

87 Self-contained medical services using portable medical devices for an emergency. Stockpiles of food, drinking water, and drugs for approx. 3 days Secure a heliport basically on the premises of the hospital. b. Requirements to be enhanced in consideration of the experiences in the Great East Japan Earthquake Secure 2 heliports. At least one of them shall be set up on the ground. Secure traffic routes to transfer emergency patients to the operating room even if use of the elevators is suspended Operating room/hall with natural lighting and ventilation, which can be used in case of power failure Large entrance eaves where a triage tent can be set up Secure a room with natural lighting, ventilation, and information facilities on the ground floor or in the vicinity of an entrance, in which a disaster response headquarters can be set up Earthquake-resistant measures for building equipment, large-sized medical equipment, and interior finishing materials Storage of sewage water Duplexing of electric power supply system Cooking devices which can be operated by an emergency generator Elevator which can be recovered (restarted) immediately after an earthquake It is required to build hospitals which satisfy all of the above mentioned requirements. It is also necessary to secure a place appropriate for a base of disaster medical service from allround view points, including the condition of surrounding roads and urban infrastructure. In the event of a disaster of extreme severity, hospitals will be crowded with the affected citizens. In addition to space necessary during normal times, it is necessary to envision the required additional space in the event of a disaster including triage space for the affected citizens and space for medical experts and volunteers who have come to engage in support activities, and to secure necessary space and facilities in advance. 5) Issues and Proposal for Disaster Base Hospitals in Turkey It was recognized that hospitals in Turkey have been doing considerable work on preparation for disaster response according to the rules and systems in Turkey. However, from the inspection of the existing hospitals, many challenges regarding the hospital buildings were observed that need to be improved / upgraded to be disasterresistant as a disaster base hospital, with consideration of lessons learned from Japanese experience. Restructuring of the concept and system of disaster base hospital in Turkey is proposed. Following are the significant challenges observed in the hospital investigations in Turkey. a. Floor planning with consideration of the situation when an elevator stops due to an earthquake Floor plan of Uludag University Hospital is shown below. This hospital has rooms for patients in critical condition and operating rooms on the 3rd floor in the disaster medical service building. This floor layout is planned based on the premise of using an elevator from the entrance on the ground floor

88 It seems that a scenario in which the use of the elevators would be suspended during and after disaster was not taken into account in the hospital building design. It is a common issue among all of the hospitals investigated in the survey. It is proposed to ensure circulation routes to transfer patients in critical condition from an emergency entrance to the operating room, even if the elevators are suspended. A horizontal route or sloped route for patient transfer from the emergency entrance to the operating room should be considered. Disaster Medical Service Building Ward Building Outpatient Building Figure Building Layout of Uludag University Hospital 4-106

89 Figure Floor Plan of Uludag University Hospital Elevators will stop in the event of an earthquake or fire. Even if the in-house power generator can be reliably operated, the elevators will stop for the sake of safety. The elevator can be used after a qualified maintenance engineer has come and restarted it after confirming the safety of the elevator itself and the internal shafts. In the event of a large-scale disaster, there is no guarantee that a maintenance engineer will come immediately. In this case, unless a horizontal traffic route is secured on the same floor, the staff members need to take a patient who will undergo emergency surgery to the operating room or a patient after surgery to the ICU or HCU by stairs. Many staff members are required for transport and the burden on the patient becomes large. Figure Training for transporting a patient by stairs assuming a case when an elevator stops (example in a Japanese hospital) 4-107

90 By providing a structure which allows horizontal movement from the emergency entrance to a room for a critical condition patient such as an operating room or ICU on the same floor, the hospital can function in the event of a large-scale disaster. b. Securing of space for accepting outpatients and facilities (medical gas, outlets for medical care) in the event of a disaster The following pictures show a scene in the waiting space for outpatients in the Japanese Red Cross Ishinomaki Hospital during normal times, and after the Great East Japan Earthquake. Normal Time After the Disaster Figure Waiting Space for Outpatients in the Japanese Red Cross Ishinomaki Hospital As there were outlets for medical gas and medical care on the walls, the waiting space was used for emergency treatment in the disaster and saved many lives. In the disaster base hospitals in Japan, outlets for medical care and medical gas are generally provided on the walls of the waiting space, conference room, and rehabilitation room. This installation of extra outlets for medical care and medical gas will be useful in Turkey. In Turkey, it seems that emergency gas cylinders are frequently used. However, in case of an emergency, it will take time to carry the heavy iron gas cylinders from the storeroom, even though the cylinder becomes empty of oxygen. Emergency response will be easier by providing outlets on walls as much as possible. Medical gas Outlet for medical care Figure Example of outlets for medical gas and medical care on the wall of the conference room (in Japan) Figure Scene of carrying in/out medical gas cylinders in Hacettepe University Hospital c. Secure water to continue medical services A large amount of water is used for medical services in a hospital. It could become impossible to provide medical services continuously in the event of a disaster if water is not 4-108

91 secured for drinking and hand washing before and after treatment, treatment of the affected part of a patient before disinfection, and cleaning of medical devices. According to the common practice in Turkey, a water storage tank should have a capacity above a certain level (in Japan, the amount for approx. 3 days), and if city water supply has been halted due to damage to the water piping there will be a wait for aid while using the water remaining in the storage tank. However, the data required to determine the necessary capacity for the number of patients to be accepted are unclear. Thus, it is necessary to clarify the basis for the capacity calculation and determine the capacity. Figure Water supply by a water tank truck in the event of disaster d. Considerations given to power failure in the Architectural Design of a Disaster Base Hospital Even if a private electric generator is installed to cope with power outage during a disaster, it will not be enough to continue hospital service until power supply system is recovered. Some of the operating rooms should have windows that will allow natural light into the arena. It will help to save energy by cutting light use in the daytime. Figure Operating room with natural lighting & ventilation system in a hospital in Germany 4-109

92 e. Installation of heliports From the experience of the Great East Japan Earthquake, it was learned that a great number of patients will be transported by helicopters in the event of a wide-scale disaster, and disaster response activities will be made easier by having two heliports on the premises of the hospital. If a heliport is located on the top of the building, there will be difficulties if the elevators are stopped due to power outage. Thus, it is important to set up at least one heliport on the ground. It was confirmed that having two heliports is useful for the disaster base hospital in order not to consume precious time in waiting for landing. Figure Heliports In Turkey, it has been determined that there are not many hospitals equipped with a heliport. Due to the cost for building heliports and the difficulty in securing safe air routes in the urban areas, building of heliports has not been proceeding smoothly, even if the need is recognized. It is impossible to set up heliports in all hospitals, unless hospitals which take on special tasks as a disaster base are clearly designated and an adequate budget is allocated to those hospitals. f. Earthquake-resistant measures for building facilities Even when the collapse or damage of the building can be avoided in the event of a disaster, the hospital will not be able to maintain its functions and disaster response cannot be taken, if the facilities or finish materials are damaged. (h1) Water tanks Sufficient earthquake-resistant measures should be taken for building facilities such as water storage tanks. Otherwise, the certainty of disaster response cannot be ensured

93 Figure Damaged Water Tanks Figure Damaged Water Tanks Water tank panel was damaged and caused water leakage as a result of a shock from the Great East Japan Earthquake The panels of the water tank were deformed and the lower part of the panel was damaged. It is also important to secure the earthquake resistance of building facilities other than the above-mentioned water storage tanks, including large-sized medical equipment, and interior materials such as walls and ceilings in the hospital as with the case of securing the earthquake resistance of the building structure. (h2) Power generators Generally, hospitals in Turkey handle energy in a separate building. However, whether the earthquake resistance is sufficient is uncertain. The following photo shows the installation state of the in-house power generators. From the magnified photo of the footing (photo below), it is found that the generators are not fixed to the floor. Kanuni Sultan Suleyman Egitim ve Arastisma Hospital (National hospital in Istanbul) is a general hospital in Istanbul completed in May It is the largest scale hospital on the European side of Istanbul, with 650 beds and an area of 115,000 m2. The iron angle is provided with a hole for fixing to the floor, but it is not fixed by bolts. Although it is a national hospital in Istanbul which was completed in May 2011, no reinforcement has been made even after 2 years have passed. Figure Backup Generators in Kanuni Sultan Suleyman Egitim ve Arastisma Hospital As a countermeasure, it will be effective and necessary to establish a system of obligatory regular inspection and maintenance, with a list of check items for disaster prevention, in addition to the sevior inspection before completion of construction

94 g. Storage of sewage water Not only water supply but also sewage water measures are important. However, measures to handle sewage water tend to be insufficient in many cases. If water is supplied, the used water will become sewage. In the Great Hanshin-Awaji Earthquake, a lack of toilets became a great issue at that time. In facilities such as hospitals, it is important to prepare portable toilets and tanks for storing sewage as well. Figure Temporary Toilets (in Japan) In Turkey, it seems that there are not many hospitals which have a sewage storing function. However, it is important to secure sewage tanks as well as water supply functions such as water storage tanks. Sewage tanks should be provided in disaster base hospitals. h. Earthquake-resistant measures for non-structural materials and interior finish materials With regard to the anti-seismic reinforcement in the ceilings and the openings for connection between facilities and building materials, damage and collapse by a big earthquake must be prevented. The pictures show ceiling materials which were damaged and collapsed due to insufficient reinforcement of the ceiling backing materials in the Great East Japan Earthquake. Figure Damaged Ceiling Materials 4-112

95 (2) Structural planning 1) Current situation in Turkey Results of investigation of the existing hospitals in terms of building structure are summarized below. (Names of the hospitals are described in (1) 1)). Assessment Points Legend of assessment C Compliant Table Result of Assessment (Structure) N Having some challenges - Unconfirmed or other A B C D E F G Ideal situation 1 Has the aseismic performance target been clearly specified? 2 Have earthquake-resistant measures been taken for building facilities, large-sized medical equipment, and non-structural components (such as ceilings and exteriors)? 3 What about the spread of earthquake-absorbing structures (number of cases, application purpose)? 4 Has the aseismic performance target been clearly specified? 5 To what extent have displacement follow-up properties been secured for the vertical transfer devices and facilities in the base-isolated layer? Structure N N N N N N N As the standard was revised in 2007, an efficient usage of 1.5 was allocated for hospital construction. However, comprehensive criteria are necessary including nonstructural components. _ A guideline has been established. Reinforcement will be promoted in the future according to the guideline. However, it is necessary to establish detailed assessment and design methods. N N N N N N N There is a plan to build new public hospitals with 100 or more beds which are earthquake-proof (MOH). However, there are only a few practical examples. The plan has just begun. With regard to major disaster prevention facilities including base hospitals in the area with a high risk of earthquakes, it is preferable to promote seismic isolation in the existing facilities. N N N N N N N Only the method dependent on recording the earthquake vibrations based on the U.S.- style method. It is necessary to add verifications on long-period and long-duration earthquake vibrations by using a rational simulation method. C C C C C Displacement follow-up properties need to be secured depending on predicted displacement values by various types of earthquake vibrations. The administrative worker at the site said that the displacement follow-up property was secured. However, it is necessary to verify the effects of various earthquake vibrations mentioned in

96 6 Can various base isolation devices be used? 7 Has an inspection system for ordinary circumstances and in the event of a big earthquake been established for base isolation devices? N N N N N N N There was no practical example as far as the engineers that were interviewed at the site knew. The system should be established as soon as possible. _ There was no practical example as far as the engineers that were interviewed at the site knew. The system should be established as soon as possible. To ensure the continuation of hospital functions after the occurrence of a disaster, the structurally safest earthquake-absorbing structure will be proposed. By adopting an earthquake-absorbing structure, damage to building facilities, finish materials, and largesized medical equipment can be minimized in the event of an earthquake. On the occasion of adopting an earthquake-absorbing structure, it is proposed to realize a highly-reliable hospital by performing simulations using a large amount of earthquake data obtained from the experience in Japan and making optimum seismic isolation designs in comprehensive consideration of propagation of vibrations depending on the soil structure on the premises (for details, refer to Chapter 5). (3) MEP system 1) MEP system of hospitals in Turkey The facility standard for hospitals in Turkey is stipulated by THE 2010 GUIDELINE ON MINIMUM DESIGN STANDARDS FOR HEALTHCARE FACILITIES IN TURKEY. However, this is a minimum standard. Specific facility criteria for disaster measures are not described there. It seems that the recently planned PPP project has been designed at the discretion of each business establishment. Investigation on site is given below. (Names of surveyed hospitals are in (1), 1)) Assessment Points Legend of assessment C Compliant Table MEP system assessment of hospitals in Turkey N Having some challenges - Unconfirmed or other A B C D E F G Ideal situation 1. Stockpile of drinking water 2 Emergency generator capacity 3 Fuel storage capacity for emergency generator 4 Protection against flood for important rooms (electrical, telecommunication, heat source equipment and control room) MEP Work C N N N C N N N C C C C N N C --- C C N N N *:Over 3 days n:1-2 days ----:Unconfirmed or other *:70% or more of demand n:50-70% ---:Unconfirmed or other * : 3 days or more or supply contract n:1-2 days --:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other

97 5 Stockpile of domestic water (flushing water and etc.) N N N N N --- N 6 Temporary storage of sewage in case of infrastructure breakdown N 7 Backup of city water 8 Sufficient backup for heat source, boiler, etc. normally driven by city gas C C N Availability of the usage of natural ventilation and lighting in case of emergency C C C C C C C 10 Redundancy of communication systems (dual incoming, satellite C C system, etc.) 11 Availability of temporary generator connection Dual power incoming from power company N N N N N Backup of cooking devices normally driven by city gas (Electric cooker, etc.) 14 Sufficient stock of medical gas N N N N N Emergency generator and UPS backup of medical information system C C C --- C 16 Restoration system for elevator after earthquake N N N N N * : 3days or more or water recycling system n:1-2 day ---:Unconfirmed or other *:Storage for 3days or more n:no ---:Unconfirmed or other *:Well water supply or stockpile n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other *:Comply n:not comply ---:Unconfirmed or other Table shows a summary of the MEP system of Sevket Yilmaz Research and Education Hospital which would be a disaster base hospital in Bursa

98 Table Investigation of Sevket Yilmaz Research and Education Hospital Item Seismic resistant Power Gas Communication Domestic water Sewage Emergency generator Heat source Energy-saving system Location of main plant Cooking devices Medical gas Seismic resistant fixing for MEP equipment Specification Seismic resistant structure Single incoming from power company (unconfirmed) City gas Fiber optics and metal (No satellite communication system) City domestic water, Water storage tank for 1 3 days Sewage infrastructure (No temporary storage) % capacity of demand Fuel storage for 1 day operation) Chiller for cooling, Gas boiler for heating Nothing in particular (unconfirmed compliance with Energy Efficiency Law) There is an energy efficiency law in Turkey. >Secondary Legislation in Energy Performance in Buildings >Minimum performance criteria Independent building other than hospital building Gas-operated devices are mainly used Stockpile amounts are not confirmed Weak compared to that in Japan 2) MEP requirements for disaster base hospitals in Japan The current facility requirements for disaster base hospitals in Japan are described for the purpose of comparison. Table MEP requirements for disaster base hospitals in Japan Item Requirements Seismic resistant Seismic resistant and isolation structure Power Dual incoming from power company *1 Gas City gas Communication Fiber optics, metal and satellite communication system *2 Domestic water City domestic water, Water storage tank for 3 days and well water backup *2 Sewage Sewage infrastructure and temporary storage for 3 days Emergency generator 60% capacity of demand *2 Fuel storage for 3 days operation *1, 2 Heat source Diverse energy sources (Gas and electricity) Energy-saving system Energy consumption standard based on CASBEE Location of main plant Inside of hospital building Cooking devices Gas-operated devices are mainly used Medical gas Stockpiles for 3 days *2 Seismic resistant fixing for MEP Fixation which can withstand a seismic force approx. twice the minimum limit *1 equipment *1: General seismic resistance standards for government facilities of the Ministry of Land, Infrastructure, Transport and Tourism *2: Requirements for disaster base hospitals specified by the Ministry of Health, Labor and Welfare Compared to Japanese requirements, there seems to exist some concerns regarding Sevket Yilmaz Research and Education Hospital which are listed below. Provision of earthquake protection 4-116

99 - Dual power and communication and incoming satellite communication system - Fixation of MEP equipment - Seismic resistant energy plant building Provision of infrastructure failure countermeasures - Fuel storage capacity for 3 days or more - Temporary sewage tank - Backup for gas operated equipment (Boiler, cooking devices) 3) Proposed MEP requirements for a disaster base hospital As a major condition of the MEP system for disaster base hospitals, operations should be performed 24 hours a day as these hospitals provide important medical facilities not only in normal operation but also in the event of a disaster. To achieve this, systems required for maintaining the functions of the facility such as a power supply system, air-conditioning system in the important rooms, and water supply system shall be duplexed or organized with a redundant configuration. The systems shall be configured so that operations will not be stopped on the occasions of a facility inspection, equipment failure, future upgrading of facilities, etc. In addition, in consideration of the risk of fires in the facility, the electrical room will be divided into 2 fireproof compartments to ensure the operation of the facility. Furthermore, to operate the facility even in the event of a disaster, the period when the facility can operate independently during infrastructure breakdown shall be 3 to 7 days. (Three days shall be the minimum standard. Maximum 7 days shall be assumed depending on regional characteristics.) The independent operation for a certain period shall be achieved by the stockpiles of fuel and water, diversification of energy sources (electric power, city gas), and ensuring of alternative means (well water, wastewater recycling system). Also, to make the above functions maintainable, facilities for which energy and operation cost can be saved will be introduced proactively with state-of-the art technologies

100 Figure MEP system image of a highly-reliable cost-saving system Table Proposed MEP requirements for a disaster base hospital Item Requirements Seismic resistant Seismic isolation structure Power Dual incoming from power company Dual power distribution system Division of the electrical room into two compartments (to avoid the risk of fires in the electrical room and operation interruption during periodic inspection and expansion/repair work) Gas City gas Communication Fiber optics, metal and satellite communication system Domestic water City domestic water Water storage tank for 3 days Water recycling system for flushing water (for 7 days operation at maximum) Well water backup Sewage Sewage infrastructure Temporary storage for 3 days Water recycling system Grey water service Grey water service piping to use recycled water Emergency generator 100% capacity of demand Dual fuel turbine generator (can be operated by diesel fuel and city gas) Division of generator room into 2 fire compartments (to avoid the risk of fires) Fuel storage for 3 to 7 days operation (Fuel is divided into 2 tanks to avoid breakdown) Heat source Diverse energy sources (Gas and electricity) Energy-saving system Co-generation system LED lighting fixtures, Highly efficient heat source Rainwater utilization system Location of main plant Inside of hospital building Cooking devices Gas and electric operated devices are used Medical gas Stockpiles for 3 to 7 days Seismic resistant fixing for Fixation in accordance with horizontal acceleration by base isolation MEP equipment Proposed Disaster Base Hospitals in Bursa (Components A & C) As for earthquakes with a seismic intensity of 7 or higher, Japan experienced the Great Hanshin earthquake in 1995 and the Great East Japan earthquake in 2011, while Turkey experienced the İzmit earthquake in 1999 and the Van earthquake in Having learned 4-118

101 from a series of big earthquakes, both countries have made improvements in hospital information systems, emergency medical assistant teams and other fields. As for hospital facilities, Turkey has promoted earthquake resistance and developed disaster risk management manuals. But there is still room for improvement in the manuals in terms of approach to securing stockpiles and lifelines, response to an increase in the number of patients in disasters, and task sharing and collaboration with other healthcare institutions. Contrary to the decentralized hospital system in Turkey, the concept of Disaster Base Hospitals which incorporates the idea of a business continuity plan (BCP) recently established in Japan is considered to produce great beneficial effects if it is applied to disaster medical measures in Turkey. The following table compares improvements in the healthcare sectors after the recent great earthquakes in Japan and Turkey

102 Table Improvements in the healthcare sector after the recent great earthquakes in Japan and Turkey Recent great earthquake Great Hanshin earthquake (M7.3, 1995) Great East Japan earthquake (M9.0, 2011) Japan Improvements (i) Disaster Base Hospitals (1996) * Earthquake-resistance * Enhancement of wider area transport * Establishment of the concept of BCP (ii) EMIS (2001) (iii) DMAT (established in 2005) Recent great earthquake İzmit earthquake (M7.6, 1999) Van earthquake (M7.2, 2011) Turkey Improvements (i) Enhancement of disaster risk management * Introduction of earthquakeresistance to buildings * Preparation of disaster risk management manuals * Preparation of temporary residences and hospitals (ii) Establishment of SAKOM (development of information system) (2009) (iii) UMKE (established in 2003) Table Comparison of disaster healthcare in Japan and Turkey, and proposals Item Disaster Base Hospitals Wide area transport BCP Referral system Wide-area emergency medical information systems Emergency medical assistance teams Japan Turkey Present state Features Present state Features 662 hospitals have Bases to accept been remodeled as injured and sick Disaster Base persons from areas Hospitals (2013) afflicted by disasters Transport of injured and sick persons to outside the afflicted areas Facilities, equipment and stockpiles The primary, secondary and tertiary referral systems have been established. EMIS (web-based disaster medical information system) DMAT Installation of heliports. SCU (transport bases) established will enable appropriate transport of patients in disasters. BCP has been established as a system covering entire facilities including non-infrastructure and capable of performing comprehensive antidisaster measures Each hospital can now deal with an appropriate number of patients. Not just information about vacancies in each department of the hospitals but also healthcare information, especially for the time of disasters, can be provided through portal sites that are available to the public. Disaster Base Hospitals now perform integrated training, specializing in disaster healthcare Promotion of earthquakeresistance, development of disaster risk management manuals, etc. Chiefly, transport within the region The concept of BCP has not yet taken root. Low function SAKOM medical information system gives vacancy information at each hospital. UMKE Integrated disaster medical measures, and development of bases Installation of heliports, and consideration of transport bases (SCU) Fixing of non-structural materials, calculation of stock and raw materials, and establishment of the concept of BCP Establishment of the system The following functions will be added. (i) Information provision through portal sites that are available to the public (ii) Medical information, especially for the time of disasters Making provincial bases and Disaster Base Hospitals

103 Disaster Base Hospital Disaster Base Hospital Disaster Base Hospital Figure Proposal for Disaster Base Hospitals in Turkey In line with the foregoing consideration of the disaster healthcare system, construction, structures, and facilities of Disaster Base Hospitals, this section outlines proposals for the two hospitals cited in the case study in Bursa. (1) Çekirge Hospital 1) Proposed Disaster Base Hospital The Çekirge Public Hospital (hereinafter called the Çekirge Hospital ) was founded at the center of Bursa in With a total of 529 beds, it is an A-2 level hospital with the third largest bed capacity in Bursa and is under the management of the MOH. According to interviews with officers of the MOH of the central government on October 4, 2013 and February 5, 2014, the Çekirge Hospital is planned to be merged with a perinatal hospital and a pediatric hospital and moved to a neighboring military reservation to be rebuilt as a new hospital with 700 beds. Because there is no A-1 level hospital in the city center of Bursa, the Çekirge Hospital currently deals with about one sixth of all the patients at the hospitals under the management of the MOH. It is also expected to accept many patients if a disaster occurs. 2) Geographical significance in the Province of Bursa - The Çekirge Hospital is located conveniently, covering the central area of the urban district, adjacent to the traffic node, and accessible to patients and staff both at normal times and in an emergency. - It is adjacent to a military airport and thus can accept emergency patients at the time of disasters and easily procure medical materials and equipment. - The new location is adjacent to vacant land and a park which can serve as first-aid stations in an emergency. Located near three high schools, it can secure emergency evacuation areas and triage spaces. 3) Proposed roles as a Disaster Base Hospital - In case of disasters, the hospital will centrally gather information about the surrounding areas, report to the SAKOM of the Bursa Provincial Health Directorate and the regional 4-121

104 headquarters for disaster control, dispatch necessary medical staff and medical supplies, and make requests for such personnel and supplies. - The hospital will deal with critical patients (multiple trauma, crush syndrome and extensive burns) who will increase in number during and after disasters. - The hospital will deal with patients with acute-phase heart disease and stroke patients who need emergency treatment. - The hospital will care for patients who need continued treatment even at the time of disasters (provision of oxygen to home patients with chronic diseases, administration of medicines to patients with high blood pressure and diabetes, etc.) - The hospital will deal with patients with heart diseases who will increase in number during and after disasters because of acute stress and stress from living in evacuation shelters. - The hospital will take in 112 centers and serve as a basis of UKME in Bursa. - The hospital will be equipped with advanced functions to deal with critical patients requiring diagnosis and treatment in more than one medical department. Medical staff Facilities Table Medical Staff and facilities for Disaster Base Hospital 1 Doctors versed in the special knowledge and skills of tertiary emergency medical care Physicians specializing in critical emergency patients who will increase in number during and after disasters Full-time physicians and surgeons specializing in heart diseases and cerebral hemorrhage, and pediatricians Full-time emergency nurses and emergency nurses specializing in pediatrics Radiological technologists and clinical laboratory staff Other medical staff members necessary for emergency surgical treatment Special beds (20 or more) and special ICU / coronary care units (CCU) / stroke care units (SCU) / pediatric intensive care units / emergency resuscitation units / emergency examination units, radiology rooms and operating rooms 4) Summary of the present state of the Çekirge Hospital The number of beds, etc. - Number of beds: 529, number of inpatients: 37,578 patients/year, number of outpatients: 851,937 patients/year, bed occupancy rate: 87.60%, average length of hospitalization: 4.47 days (2011) Departments - Emergency, internal medicine, general surgery, gastroenterology, thoracic surgery, cardiology, cardiovascular surgery, neurosurgery, neurology, kidney disease, urology, incretion and metabolic disease, rheumatism, radiology, obstetrics and gynecology, pediatrics, psychiatry, ophthalmology, otorhinolaryngology, infection and clinical microbiology, dermatology, plastic and reconstructive surgery, orthopedics and external injuries, physiotherapy and rehabilitation, sports medicine, geriatrics, anesthesiology, pathology, biochemistry, and microbiology Medical doctors (Specialist) - 6 emergency physicians. No other emergency medical specialists. - 4 specialists in circulatory organs; 2 neurosurgeons; 2 cardiovascular surgeons; and 3 pediatricians 4-122

105 5) Summary of the Plan The following plan is presented to make the Çekirge Hospital function as a Disaster Base Hospital as described above. - Development of a function as an emergency healthcare center, and strengthening of the functions of cardiovascular surgery, neurosurgery and pediatric departments - Equip an information system to build a cooperation scheme with various organizations (a system including not just ordinary telephone lines but also disaster preparedness administration radio systems, satellite phones, satellite communication functions enabling Internet connection, and wide-area disaster medical information systems) - Strengthening of facility measures for continued medical care and backup measures (as listed in the following table) Facilities Backup measures Table Disaster measures for the facilities for Cekirge hospital Seismic isolation structure Space and functions for dealing with twice as many inpatients and five times as many outpatients as those in ordinary times Triage space and installation of outlets for medical gas for increasing the feasible number of patients Facility and equipment fall prevention Measures against stoppage of elevators Backup infrastructures (energy saving measures, cogeneration, etc.) Heliport Storage of medical supplies, food, fuels and other necessities by considering the damage estimation Formulation of disaster-preparedness manuals and training scheme for staff members Backups of healthcare information 6) Proposed Architecture for the Disaster Base Medical Centre Source: JST Figure Image of the Disaster Base Medical Centre 4-123

106 The figure above shows an image of ideal hospital facilities that reflects the proposed Disaster Base Hospitals. The buildings are all low-rise for a hospital, and the hospital wards are laid out separately from the outpatient treatment ward. Advanced medical care units such as emergency rooms, operating units and ICU should be horizontally placed on the same floor to make mutual communications easier through sloped ramps and other foot traffic lines at the time of disasters. As for the external facilities, certain space and necessary facilities must be secured in advance so as to accept emergency assistant teams at the time of disasters. Proposed hospital size The latest standards of the MOH (2012 version) stipulate that the area per bed must be 200m 2 or larger. The hospital size planned according to the standards is assumed as follows. Table Proposed hospital size for Cekirge Hospital (Component A) Major contents No. of beds Total proposed area Structure proposed Improve the Çekirge ,000m2 - Seismic isolation structure Hospital to be a core Disaster Base Hospital by - Hospital wards are laid out separately from the outpatient treatment ward encouraging its relocation and renewal plan Table Facility plan: standards to be developed Item Earthquake-resistance Electric power Gas Telecommunication Water Wastewater Grey water Emergency generator Heat source Energy-saving system Energy plant Kitchen equipment Medical gas Aseismic fixing method for equipment Contents Seismic isolation Lead in 2 lines from electric company Duplication of substation facilities and division of electricity room into two places (Reduce a risk of fire in an electric room and of stopping of operation during regular inspection and repair and extension works) City gas Optical fiber and communication satellite Lead in water Storage for around 3-day use (ensuring water quality) Waste water reprocessing system (available for around 7 days) Use of well-water Discharge into the general waste water system Backup drainage tank (for 3 days) and waste water reprocessing system Build grey water system and utilize it for flushing toilets (by reprocessing rainwater and wastewater) Backup 100% of electricity Dual fuel gas turbine generator (operable either by light oil or city gas) 2 fuel tanks for 3- to 7-day use (divided into 2 tanks to reduce the risk of failure) Divide generator rooms into two. (Reduce the risk of fire in the electric room and of stopping of operations during regular inspection and repair and extension works) Chiller (air conditioning) and gas boiler + heat pump (heater) (electric heating is available during city gas outage) Cogeneration system LED lighting, highly efficient heating system, and system to permit use of rainwater Seismic isolated building integrated with the Emergency Operation Center Gas + electric apparatus Backup gas storage for 3- to 7-day use Fix in line with horizontal acceleration for seismic isolation 4-124

107 (2) Şevket Hospital 1) Proposed Disaster Base Hospital The Şevket Yılmaz Eğitim Araştırma Hospital (hereinafter called the Şevket Hospital ) was founded in the east of the city of Bursa in It is an A-1 level core hospital with a total of 876 beds. According to interviews conducted on October 7, 2013, there is a plan to construct a hospital specializing in cardiovascular diseases with 200 beds and a heliport in a vacant lot adjacent to the hospital. The Şevket Hospital provides specialized medical education in 13 fields but is considering increasing the number of fields to 25. As for disaster-preparedness measures, the hospital is earthquake resistant and has elevators with earthquake sensors. It has a plan to have containers to store water, food, healthcare supplies and rescue kits to last for three days in case of disasters. It is equipped with a water treatment unit for CBRN. 2) Geographical significance in the Province of Bursa The Şevket Hospital is in Yildrim, a highly populated district like Osmangazi, in Bursa. The main access road is E90, but the hospital will be equipped with a heliport so that it can serve as a core hospital that can transport patients from remote places during and after disasters. It has a vacant lot in the vicinity, which can be used as a rescue base, evacuation shelters and triage space during and after disasters. In light of the expansion plan, there is a possibility that the hospital will acquire the surrounding land. 3) Proposed Roles as a regional Disaster Base Hospital - The Şevket Hospital will provide healthcare services that other healthcare institutions in the region can hardly provide during and after disasters, serve as a core hospital in the eastern part of Bursa, and collaborate with the Çekirge Hospital - In case of disasters, the hospital will centrally gather information about the surrounding areas, report to the SAKOM of the Bursa Provincial Health Directorate and the regional headquarters for disaster control, dispatch necessary healthcare staff and medical supplies, and make requests for such personnel and supplies. - The hospital will deal with critical patients (multiple trauma, crush syndrome and extensive burns) who will increase in number during and after disasters. - The hospital will deal with patients with acute-phase heart disease and stroke patients who need emergency treatment. - The hospital will care for patients who need continued treatment even at the time of disasters (provision of oxygen to home patients with chronic diseases, administration of medicines to patients with high blood pressure and diabetes, etc.) - The hospital will deal with patients with heart diseases who will increase in number during and after disasters because of acute stress and stress from living in evacuation shelters. - A 112 ambulance station will be allocated in the hospital and incorporate UMKE in Cekirge hospital through SAKOM. - The hospital will be equipped with advanced functions to deal with critical patients requiring diagnosis and treatment in more than one medical department

108 Table Medical Staff and facilities for Disaster Base Hospital 2 Medical staff Doctors versed in the special knowledge and skills of tertiary emergency healthcare services Physicians specializing in critical emergency patients who will increase in number during and after disasters Full-time physicians and surgeons specializing in heart diseases and cerebral hemorrhage, and pediatricians Full-time emergency nurses and emergency nurses specializing in pediatrics Radiological technologists and clinical laboratory staff Other medical staff members necessary for emergency surgical treatment Facilities Special beds (20 or more) and special ICU / coronary care units (CCU) / stroke care units (SCU) / pediatric intensive care units / emergency resuscitation units / emergency examination units, radiology rooms and operating rooms 4) Summary of the present state of the Şevket Hospital The number of beds, etc. - Number of beds: 879, number of inpatients: 54,737 patients/year, number of outpatients: 767,009 patients/year, bed occupancy rate: 75.25%, average length of hospitalization : 4.46 days Departments - Emergency, internal medicine, general surgery, gastroenterology, thoracic surgery, cardiology, cardiovascular surgery, pulmonary disease and tuberculosis, neurosurgery, neurology, kidney disease, urology, incretion and metabolic disease, rheumatism, nuclear medicine, radiology, obstetrics and gynecology, neonatology, pediatrics, pediatric cardiology, pediatric neurology, pediatric kidney disease, pediatric psychiatry, psychiatry, ophthalmology, otorhinolaryngology, infection and clinical microbiology, dermatology, plastic and reconstructive surgery, orthopedics and external injuries, physiotherapy and rehabilitation, sports medicine, heredity clinic, anesthesiology, and dentistry Medical doctors (Specialist) - 5 emergency physicians, 1 traumatologist. No other emergency medical specialists. - 4 specialists in circulatory organs; 8 neurosurgeons; 3 cardiovascular surgeons; and 32 pediatricians 5) Summary of the Plan The existing hospital buildings will be refurbished, a new hospital extension with 150 beds will be built for high care, and the hospital functions strengthened. Possible measures to strengthen the hospital functions include the use of the premises of the police school currently not in use in order to enhance specialized education, build accommodations for staff members, storage and evacuation shelters, and ensure triage space. - Development of a function as an emergency healthcare center, and strengthening of the functions of cardiovascular surgery - Equip an information system to build a cooperation scheme with various organizations (a 4-126

109 system including not just ordinary telephone lines but also disaster preparedness administration radio systems, satellite phones, and satellite communication functions thus enabling Internet connection, and wide-area disaster medical information systems) - Strengthening of facility measures for continued medical care and backup measures (as listed in the following table) Empowerment (Extension of existing hospital) Hospital extension (150 beds) Existing Police College Proposed hospital size Table Disaster measures for facilities for Sevket hospital Twice bed capacity in disaster (Currently 10% only) with Medical gas system Heliport shall be allocated Separate patient data backup Satellite communication system Specialized educational function Coordination function with UMKE Seismic isolation Emergency supplies for disaster Double bed capacity in disaster Patients, staff and material flow with Sevket hospital Common HIMS with Sevket hospital and data back-up New hospital for additional clinical departments/ Disaster Management function Accommodations for staff members, storage and evacuation shelters, and ensure triage space As in the case of the Çekirge Hospital, the hospital size can be assumed as follows in accordance with the latest standards (2012 version) of the MOH. Table Proposed hospital size for Sevket Hospital (Component C) Major contents To strengthen the size and function as a hospital with advanced medical care, associated with the Şevket Hospitals and equipped with 150 beds No. of beds Total proposed area Structure proposed ,000m 2 Same as above 4-127

110 Table Facility plan: standards to be developed Item Earthquake-resistance Electric power Gas Telecommunication Water Wastewater Grey water Emergency generator Heat source Energy-saving system Energy plant Kitchen equipment Medical gas Aseismic fixing method for equipment Contents Seismic isolation Lead in 2 lines from electric company Duplication of substation facilities and division of electricity room into two places (Reduce the risk of fire in an electric room and of stopping of operations during regular inspection and repair and extension works) City gas Optical fiber and communication satellite Lead in water Storage for around 3-day use (ensuring water quality) Waste water reprocessing system (available for around 7 days) Use of well-water Discharge into the general waste water system Backup drainage tank (for 3 days) and waste water reprocessing system Build grey water system and utilize it for flushing toilets (by reprocessing rainwater and wastewater) Backup 100% of electricity Dual fuel gas turbine generator (operable either by light oil or city gas) 2 fuel tanks for 3- to 7-day use (divided into 2 tanks to reduce the risk of failure) Divide generator rooms into two. (Reduce the risk of fire in an electric room and of stopping of operations during regular inspection and repair and extension works) Chiller (air conditioning) and gas boiler + heat pump (heater) (electric heating is available during city gas outage) Cogeneration system LED lighting, highly efficient heating system, and system to permit the use of rainwater Seismic isolated building integrated with the Emergency Operation Center Gas + electric apparatus Backup gas storage for 3- to 7-day use Fix in line with horizontal acceleration for seismic isolation 4.5. Proposal for Other Facilities for Disaster Prevention The following is a proposal for other facilities for disaster prevention based on the current situation Disaster and Emergency Management Center The Disaster and Emergency Management Center is the main facility of a proposed DMC as stated in Chapter 3. This section describes the current situation of the Disaster and Emergency Management Center in Bursa Province and the proposal for Bursa. (1) Current Situation of Disaster and Emergency Management Center The provincial AFAD, the fire station and the emergency heliport for the Ministry of Health are located together in the northern part of Bursa Municipality. A training center for the search and rescue team and storage facilities of related organizations are also located on the site. In Bursa Province, the Disaster and Emergency Management Center is set up in the AFAD Bursa building, which consists of a meeting room for about 20 persons and a communication center. The communication center has different systems according to purpose and communication distance: 4-128

111 - Radio communication system: Long distance radio communication system for national level communication such as between Ankara and Bursa Short distance radio communication system for communication within Bursa Province Frequency bands are also allocated to the metropolitan municipality, municipalities, and the gas company for their internal communication - Satellite phone For communication with Ankara For international communication - Early warning system: For military use such as air-raid alarm The Disaster and Emergency Management Center has seven stations where responsible persons from each public institution (such as security forces, police and Department of Forestry) will collect information. Radios for different frequencies such as public radio, aircraft radio, VHF-UHF, and HF-VHF-SSB are also installed and communication with Japan is possible from 4:00 to 7:00 AM. All of the equipment uses analogue communication systems and is in good working condition. The cost of converting from analogue systems to digital systems is estimated at about USD 200,000 to USD 300,000. Source: JST Figure Bursa Disaster and Emergency Management Center According to AFAD Bursa, there is a plan to establish a Disaster and Emergency Management Center with construction costs of about EUR 2,000,000, but it has not been implemented yet. Source: JST Figure Plan of Bursa Emergency Operation Center 4-129

112 (2) Proposal for Facilities 1) Concept and Architectural Plan The Disaster and Emergency Management Center must be a reliable facility able to function during disasters to collect and provide information and to give instruction to relevant organizations. Utilizing low-rise buildings, such as a one or two-story building, is preferable in order to minimize the damage to the building and enable the center to carry out efficient operations after a disaster event. The mechanical room and storage are important facilities so they must be integrated with the main building. If the Disaster and Emergency Management Center is planned together with the disaster and emergency training center, meeting rooms can be utilized as lecture rooms and the facility use can be optimized during normal periods as well. The following are conceptual and architectural plans: Layout and Flow Planning Required Function Operation Center Meeting Rooms Information collection and analysis Living Area Car Parking : Buildings shall not be placed in the flow of people from other facilities so that the officials can easily gather in the event of a disaster. An exclusive driveway, approach, car parking and heliport shall be planned. : The facility shall be able to accommodate with the disaster and emergency board for initial response and shall include an operation zone and a living zone to allow for efficient use of staff around the clock. A security system shall be planned for smooth operation of the disaster and emergency board. : A large display shall be arranged for integrated management of disaster information. Each organization that is a part of the disaster and emergency board shall have exclusive space for their own operations. : Small meeting rooms shall be planned for each organization. Partition walls shall be movable to accommodate various requirements. : A computer room shall be planned for analysis of collected disaster, traffic, and relief supply information. : Dining room, rest room, bedroom, locker room and storage for staff shall be planned. : Necessary area for car parking shall be maintained. 2) Structural Plan The building shall be a seismically isolated structure because of the importance of the facility. Details on seismic isolation are included in Chapter 5. 3) Mechanical, Electrical and Plumbing Plan In Turkey, there are no specific facility standards for disaster control centers. Thus, the existing facilities were investigated to capture current conditions

113 Table Data Collection Survey For Disaster Resilient Urban Plan in Turkey Investigation on existing facilities (AFAD Istanbul emergency operation center) Item Specification Outline There are 3 emergency operation centers in Istanbul (2 facilities in addition to this operation center). It is planned that they will be able to back up each other. In principle, this facility supports regions in Thrace. Seismic Resistant Seismic resistant buildings (2 stories max) structure Power Dual power incoming from power company (Unconfirmed) Gas City gas (LNG) Backup LPG tank Communication Fiber optic lines, metallic lines, VHF/UHF/HF radio, satellite communication Domestic water City water 20 tons of water supply x 2 tanks Sewage Sewage infrastructure line Emergency generator 1200kW x 2 (100% backup x 2) Fuel storage tank for 15 days operation (80 tons) Heat source Chiller (cooling), Gas boiler (Heating) Data center An independent data center is established in this facility to collect and manage information related to disasters in Istanbul (whether an external backup system is provided is uncertain) Energy plant Independent building different from the Emergency Operation Center Other Radio facilities Mobile (in-vehicle) command center Table Item Seismic resistant structure Power Gas Communication Domestic water Sewage Emergency generator Heat source Data center Energy plant MEP requirements for disaster and emergency management center in Japan Requirements Base-isolated building Dual power incoming from power company No city gas (electrical heating) Fiber optic lines, metallic lines, VHF/UHF/HF radio, satellite communication City water 7 days of water supply in a tank City sewage line Backup sewage tank for 3 days Water recycling system 100% backup x 2 sets Fuel storage tank for minimum 3 days operation and special supply contract Electric heat source system (Chiller, heat pump system) Offsite data center Base isolation building Compared to the requirements of emergency operation centers in Japan, the operation center in Istanbul is almost at the same level on preparedness for the case that infrastructure 4-131

114 will be damaged. Items to be improved are the redundancy of systems (dual systems for 24/7 operation) and the provision for an internal fire (such as a fire compartment for electrical room and communication room) Proposed standards for MEP In Bursa s case, it is difficult to justify establishing as many backup facilities as in Istanbul due to the population size. Thus, the facilities of each center shall be reinforced to allow 24/7 operations. To achieve this, systems required for maintaining the functions of the facility such as the power-supply system, the air-conditioning system of important rooms, and the water supply system shall be doubled or made with a redundant configuration. The systems shall be configured so that operations will not be stopped due to equipment failure or for inspections and future upgrades of the facility. In addition, due to the risk of fires in the facility, the electric room will be divided into two fireproof compartments to ensure the continuous operation of the facility. Furthermore, to operate the facility even in the event of a disaster, the recommended period when the facility can operate independently without supply of electricity or water from the outside (due to breakdown of infrastructure) is 3 to 7 days. Three days shall be the minimum standard. A maximum of 15 days could be assumed depending on regional characteristics. This independent operation shall be achieved by having a reserve of fuel and water, diversification of energy sources (electrical power, city gas), and ensuring alternative supply means (well water, wastewater recycling system). Also, to make the above functions sustainable, facilities for energy with state-of-the-art technologies and low operational costs will be introduced proactively. Table Proposed MEP requirements for disaster and emergency management centers Item Seismic resistant structure Power Gas Communication Domestic water Sewage Emergency generator Heat source Data center Energy plant Requirements Seismically isolated structure Dual incoming from power company Dual power distribution system Division of the electrical room into two compartments (to avoid the risk of fires in the electrical room and operation interruption during periodic inspection and expansion/repair work) City gas Fiber optic lines, metallic lines, and satellite communication system City domestic water Water tank available for 3 days Water recycling system for flushing water (for 7 days operation at maximum) Well water backup Sewage infrastructure Temporary storage for 3 days Water recycling system 100% backup x 2 sets Dual fuel turbine generator (can be operated by diesel fuel or city gas) Division of generator room into 2 fire compartments (to avoid the risk of fires) Fuel storage for 3 to 15 days operation (Fuel is divided into 2 tanks to avoid breakdown) Diverse energy sources (Gas and electricity) Offsite data center Base isolation building 4-132

115 Education Facility (1) Current Situation of Schools 1) Seismic Strengthening Data Collection Survey For Disaster Resilient Urban Plan in Turkey According to the Ministry of National Education (MONE), there are about 144,000 schools in Turkey but most schools do not meet the seismic resistance standard legislated in The cost for seismic strengthening or the necessary reconstruction work to meet the standard was estimated at 6 Billion USD based on a survey conducted in Most schools do not have alternative classrooms to be used during renovation work and the overall number of classrooms is insufficient nationwide. Therefore, seismic strengthening methods that can be implemented during school activities without disturbance have been sought. On the other hand, seismic strengthening of schools is almost complete in Bursa according to the MONE Bursa provincial office. Source: JST Figure shows a primary school in Osmangazi district in Bursa in which the columns have been strengthened seismically. Source: JST Figure ) Strengthening of Disaster Prevention Capability Seismically Strengthened School in Bursa AFAD encourages schools to strengthen their disaster prevention capability. AFAD has completed a school information survey to determine where to install storage areas for emergency supplies but storage areas have not yet been installed according to MONE Bursa. 3) School Campus Project Currently, the classroom shortage due to the increase in the number of students, especially in the urban areas has become a serious problem throughout the country. In order to deal with this issue, the School Campus Project was launched in 33 provinces among all 81 provinces which moves existing schools in urban areas to the suburbs and integrates them into a large school. In the current plan, existing high schools will be moved to the suburbs and the remaining buildings and lots will be utilized as primary and junior high schools. Once relocation of high schools has been completed, junior high schools are planned to be moved to the suburbs and the remaining buildings will be utilized as primary schools. The prime minister decided that these projects will be implemented by means of PPP scheme and will be solely funded by government budget. A total of 11 School Campus Projects are planned in Bursa as shown in Figure However, construction has not been started at the time of this report

116 Source: JST based on data from MONE Figure ) Urban Transformation and Other Projects Locations of School Campus Projects in Bursa The Osmangazi district office plans to develop the north-western area of the district and has reserved large areas for schools. In Yıldırım district, the Urban Transformation Project has been implemented in disaster risky areas. Yildrim s Urban Transformation Project involves demolishing existing buildings, lot by lot in risky areas and constructing apartments which are safe in terms of disaster. Residents will basically be able to return to the same lots and schools will remain at the same locations. (2) Lessons learned from the Great East Japan Earthquake: Necessity to Strengthen School Capability for Disaster Prevention The improvement of the safety of school structures, of the capacity to act as an evacuation center, and the ability to coordinate with public facilities are important for strengthening school capability for disaster prevention based on the lessons learned from the Great East Japan Earthquake. At the time of the earthquake, various issues were brought up regarding safety, emergency evacuation, and living in evacuation centers while schools were damaged and played a role as evacuation centers for the neighborhoods. 1) Improvement of Safety The primary purpose of strengthening school structures is to protect students from disasters. There have been no deaths reported due to damage to a school facility but there are cases where the structures of school buildings were seriously damaged as they had not been seismically strengthened. A building without seismic resistance cannot be utilized as an evacuation center

117 2) Improvement of Function to be used as Evacuation Center Schools are required to be equipped so as to act as education facilities as well as evacuation centers since many schools were utilized as evacuation centers for students and neighborhoods during the Great East Japan Earthquake. A safe space needs to be available for storage for supplies during a disaster since food, water, blankets and equipment for withstanding the cold is essential before relief supplies arrive. In addition, temporary toilets, wells, water reservoirs, portable generators, photovoltaic power cells and radio communication devices are also important. If a school is to be utilized as an evacuation center for a long period, spaces for administration and operation, health care, cooking, relief supply and communication must be planned. Changing rooms in consideration of women s privacy and universal design for elderly and physically disabled people shall be considered. At the time school activities are resumed, clear zoning for educational areas and evacuation areas is important. There are cases that operation of evacuation centers could not perform successfully because of the unclear status of schools as evacuation centers and supply storage could not be opened because of the lack of administrative staff. It is important to conduct periodical training regarding the operation of the evacuation center and share manuals of operation among school organizations and the local government. Figure School Facility as Evacuation Center 3) Coordination with Public Facilities The importance of schools as community centers was recognized again in Japan after the Earthquake. Therefore, in addition to capability for disaster prevention, strengthening of coordination with other public facilities is necessary in order to address various needs as community centers. In normal time, integrated public facilities such as school, library, hospital, sports center, fire station and government office contribute to students in terms of gaining experience through after school education and holiday education programs and they also contribute to the neighborhood in terms of lifelong learning

118 In the event of a disaster, the school plays an important role as disaster management complex with the function of emergency operation center at the community level Figure Coordination with School and Public Facilities (3) Proposal for School Facilities 1) School Development in District Level Disaster Management Complex (DMC) Schools which are strengthened against disaster shall be constructed in the district level Disaster Management Complex (DMC). As mentioned above, improvement of safety, of the ability to act as an evacuation center, and of coordinating with public facilities is important. These concepts shall be reflected in the new school plan of the school standards in Turkey. 2) School Development in the Urban Transformation Project In the Urban Transformation Project, existing schools will remain in the same locations, while vulnerable schools will be demolished and replaced by strengthened schools and residential apartment buildings. It is expected that the community s capability regarding disaster would be further strengthened through the simultaneous reconstruction of apartment buildings, public facilities, and schools. 3) Seismic Strengthening of Structural and Non-structural Members for Existing Schools According to the MONE Bursa provincial office, seismic strengthening has been completed for most schools in Bursa. Table represents the number of schools by construction year in Bursa and it also shows that 584 schools of the total 660 schools were constructed before 2007 when the seismic structure standard was enacted. Inspections and review of plans shall be carried out to evaluate the seismic safety of school buildings and if necessary, strengthening work on structural and non-structural members shall be implemented for existing schools

119 Table Number of Schools by Construction Year in Bursa Municipality ~ ~ ~2007 Construction Year ~2007 Total 2008~ Not Identified YILDIRIM YENİŞEHİR OSMANGAZİ ORHANGAZİ ORHANELİ NİLUFER MUSTAFAKEMALPAŞA MUDANYA KESTEL KELES KARACABEY İZNİK İNEGÖL GURSU GEMLİK BUYUKORHAN Total Source: AFAD Bursa GIS Data A construction method which only requires a short period and which will not disturb school activities is required for seismic strengthening of schools. The following seismic strengthening methods implemented in Japan can be completed within short periods and without interruption of school activities. - SPAC Method (Steel Plate and Aramid Fiber Composite): 22-day construction period The method is to strengthen the existing columns by wrapping existing reinforced concrete column with steel plate and aramid fiber sheet and filling with grout in the gap. Seismic resistance is increased since the column is surrounded with steel plates and fiber sheets. The shape of the building remains unchanged. Features: This method does not change the shape or design of the building and maintains the size of internal space, doors and windows. Construction work can be implemented while school activities are conducted. Temperature during the work shall be monitored since bonding and grout are used. Total Grout Steel Plate Aramid Fiber Sheet Finishing Source: JST based on MEXT Seismic Retrofit Case Studies Figure SPAC Method 4-137

120 - External Pre-cast and Pre-stressed Concrete Frame: 129-day construction period Connected external pre-cast and pre-stressed concrete frames and existing structures resist seismic forces. Features: Construction work is possible while the building is utilized for school activities, the period generating noise is short, the traffic lines for school staff and students as well as construction workers can be clearly divided, and the quality of the frame is high because it is pre-cast and pre-stressed. However, the concrete strength of the existing structure must be 18N/mm 2 or more. Source: JST based on MEXT Seismic Retrofit Case Studies Figure External Pre-cast and Pre-stressed Concrete Frame - Additional Pre-cast Concrete Wall: 138-day construction period Improvement of seismic resistance is accomplished by connecting a pre-cast concrete wall to the existing column/beam using post-installed anchors, bolts and non-shrink grout. Features: The construction period can be shortened because the concrete is pre-cast, work can be done without interrupting school activities, and noise is minimal. Carry-in routes for the pre-cast walls shall be secured, and size and position of the opening becomes limited. The compressive strength of the existing concrete structure must be 15N/mm 2 or more. Post-installed Anchor Non-shrink Grout Re-bar Bolt Beam Column Pre-cast Wall PC Steel Source: JST based on MEXT Seismic Retrofit Case Studies Figure Additional Pre-cast Concrete Wall 4-138

121 - Steel Plate and Tightly Attached Concrete Column Method: 140-day construction period Connecting a thin reinforced concrete member (250mm) including a steel plate to an existing structure with post-installed anchors. Features: Work can be done without interruption of school activities, there is limited demolition of the existing structure, and future maintenance of members is easy. This method depends on the situation of the existing structure and repair of the existing structure may be necessary. Steel Plate Anchor Re-bar Existing Structure Reinforced Member Source: JST based on MEXT Seismic Retrofit Case Studies Figure Steel Plate and Tightly Attached Concrete Column Method There are many school buildings in Japan where non-structural parts were damaged by earthquakes. Therefore, seismic retrofit should strengthen non-structural elements as well as structural elements. The following are examples of strengthening of non-structural elements implemented in Japan. - Prevention of the Fall of Ceilings A brace shall be installed (with screws, not welding) for X and Y (horizontal) directions for every 9m 2 of ceiling. Important or large elements shall be fixed with bolts and hardware in accordance with horizontal forces. Clearance Brace Brace Source: Drawing; Nikken Sekkei HP Nikken Solution, Non Safety and Security of Non-structural component Picture; MEXT Seismic measure case studies of Non-structural component in School facilities March Figure Prevention of Fall of Ceiling 4-139

122 - Prevention of the Fall of Interior Wall Inner walls shall be placed so as to allow inter-laminar deformation, pitch of base stud shall be close, and reinforcing steel bars shall be installed on large walls. Source: Drawing; Nikken Sekkei HP Nikken Solution, Non Safety and Security of Non-structural component Picture; MEXT Seismic measure case studies of Non-structural component in School facilities March Figure Prevention of the Fall of Inner Wall - Prevention of the Fall of Air Conditioning Air conditioning units shall be hung with an anchor to the slab of the above floor rather than to the ceiling. Anchors shall be post-installed anchors. Slab Source: Drawing; Nikken Sekkei HP Nikken Solution, Non Safety and Security of Non-structural component Picture; MEXT Seismic measure case studies of Non-structural component in School facilities March Shatterproof Window Glass A/C Figure Prevention of the Fall of Air Conditioning A shatterproof film shall be place on the interior of transparent window glass. Frosted windows shall be replaced with reinforced glass and fixed with elastic sealing

123 Reinforced Glass Shatterproof Film Source: Drawing; Nikken Sekkei HP Nikken Solution, Non Safety and Security of Non-structural component Picture; MEXT Seismic measure case studies of Non-structural component in School facilities March Disaster Prevention Park (1) Current Situation of Parks in Bursa Figure Shatterproof Window Glass Bursa, known as green Bursa (Yeşil Bursa), has many parks, gardens and open spaces. There is a large park near the existing stadium in Osmangazi district and another large park is planned near the new stadium as well. Osmangazi district office has constructed 51 parks, one for each Mahalle (neighborhood). However, the concept of disaster prevention parks and evacuation locations was not considered so there is no plan for seismic resistant water reservoirs, supply storage, or plants that help prevent the spread of fires. Planning of parks is controlled by the Ministry of Environment and Urbanization (MOEU) and the district government needs to obtain approval of plans from MOEU. (2) Disaster Prevention Park in Japan Level of disaster prevention parks is defined as follows in Japan. Disaster Prevention Park as Wide-area Disaster Prevention Base Disaster Prevention Park as Regional Disaster Prevention Park Disaster Prevention Park as Wide-area Evacuation Place Disaster Prevention Park as Temporary Evacuation Place Table Definition of Disaster Prevention Park Level - Park as a base for recovery and reconstruction in a wide area - Area of 50ha or more - 1 park for the appropriate region considering size, traffic and logistics - Park with smooth access to wide-area disaster prevention base or evacuation place by emergency road network or main road - Park as a relief activity base for self-defense forces, fire fighters and volunteers - Park as relay base for transportation of relief supplies from another base or region - Area of 10ha or more - To be located in major cities, cities with prefectural offices, and cities with a population of 100,000 or more - Park as a wide-area evacuation place in case of disaster - Area of 10ha or more - 1 park for each 1km radius urban area - Park as temporary evacuation park in case of disaster - Area of 2ha or more - 1 park for each 250m radius urban area Source: Guideline for disaster prevention park planning, Public Works Research Institute of Japan (3) Proposal for Disaster Prevention Parks There are many parks or open spaces in Bursa that can be utilized as evacuation places in case of disaster. However, it is necessary to equip them with storage for supplies, temporary toilets, and other necessary elements of disaster prevention parks in the Disaster 4-141

124 Management Complex (DMC), as described in Chapter 3. The following are important concepts for disaster prevention parks. 1) Disaster Prevention Park - Evacuation Place:Open area for evacuees and disaster response activities - Supply Storage Area:Administration office with storage for food, water, blankets, portable generators, floodlights, cooking equipment, and gas cylinders - Consolidation Area:Open area for consolidation and distribution of relief supplies and tent space for rescue teams - Water Supply:Seismic resistant water reservoir and emergency well to secure potable and service water in case of disaster - Fire Spread Prevention:Planting zone to prevent fire spread and heat radiation - Emergency Transportation:Heliport for transportation of critical patients, emergency materials, information collection, etc. - Temporary Toilets:Temporary toilets which can be used without water or electricity The following is the proposed layout of neighborhood parks, and can be used as a guideline for park planning. Figure Disaster Prevention Park 2) Neighborhood Parks Neighborhood parks and community (Mahalle) centers with supplies shall be constructed in areas developed in accordance with the Urban Transformation Law. Constructing parks near schools is preferable for easier coordination of these facilities in times of disaster. Besides a mosque, an evacuation facility shall be developed within walking distance of the park or open space

125 3) Hierarchy and Guideline for Disaster Prevention Parks Parks shall be classified into wide-area disaster prevention base, regional disaster prevention base, wide-area evacuation place and temporary evacuation place. Definitions and standards of each park shall be compiled into a guideline Waste Incineration Plant (1) Current Situation of Waste Treatment Facility 1) Landfill and its Capacity There are landfills in the north-western part of Osmangazi district and Inegol in Bursa and general waste from Bursa municipality is managed at the landfill in Osmangazi. The total area of Osmangazi Landfill is 156ha, 83ha of which are utilized for landfill, and the remaining 73ha are used as buffer zone. Development of the first section was completed in 1995 and the successive sections have been continuously developed. The total cost of development amounts to 23 Million USD, including 12.5 Million USD financed by the World Bank. The landfill is scheduled to expand over the entire 156ha by 2025 with a total amount of waste of 22,200,000 tons. Currently 9,000,000 tons have been disposed of at the landfill which represents 40% of the total final capacity. By regulation, no development is allowed on the site within 30 years of the landfill closure but thereafter, a park and an open space are planned to be developed over the landfill. At first, waste landfilled at Osmangazi Landfill was only from Osmangazi, Yildirim and Nilufer districts, but it is currently receiving waste from Gursu, Kestel, Gemlik and Mudanya at a total rate of 2,100 tons per day, or approximately 400 garbage truckloads. The administrative area of Bursa Municipality was extended to the Bursa provincial boundaries in March 2014 and waste from the remaining 10 districts will be landfilled at Osmangazi Landfill as well. It is expected that the amount of waste will increase by tons per day to a total of about 2,500 tons per day. Center of Bursa Figure Landfill at Osmangazi District 4-143

126 2) Garbage Collection In accordance with the regulations of Bursa Municipality, garbage collection is conducted by the relevant districts and waste treatment and storage is conducted by the municipalities. Garbage collection is entrusted to the private sector through an annual tender. Twelve private companies participated to the tender in 2013, and four companies were selected to implement garbage collection that year. Previously, the district governments managed garbage collection and a large budget was allocated to this service, but the expense was reduced and the service was improved by outsourcing to the private sector. 3) Waste Treatment All garbage is landfilled together without segregation and most of the garbage is wet garbage. In Osmangazi district, separation of plastic garbage started in 1987 but it was not obligatory. In 2004, separation of plastic garbage became a requirement, but currently garbage is not being separated properly. Bursa municipality plans composting or incineration of waste as the next waste treatment after 2025 and is considering waste incineration methods used in the EU which have been promoted in Turkey. Waste treatment is administrated by the Ministry of Environment and Urbanization (MOEU) and MOEU has made policies, regulations and carried out supervision with regard to the issue. 4) Thermal Power Generation by Methane Gas A thermal power generation facility has been developed at Osmangazi Landfill by an independent power producer. Daily, 9.8MW (7 generators x 1.4MW), which represents the power consumption of 47,000 households, can be produced from methane gas which is generated from the landfill. This project is being implemented based on a 29-year contract between Bursa municipality and the power producer. The power producer sells electricity and gives a commission to the municipality so the project is a source of income for Bursa municipality. Methane gas is generated after 6 months of the landfill of general waste and after 3 months of the landfill of organic waste. Methane gas has been generated from the section since ) Medical and Industrial Waste Medical waste is landfilled, after sterilization, at a medical disposal treatment facility in Osmangazi Landfill. Treatment is entrusted by Bursa municipality to a private company under a contract that runs until The facility is operated by a staff of 28 with 6 garbage trucks and medical waste is collected from 2,200 medical institutions in Bursa, Yalova and Balikesir provinces. Medical waste to be treated amounts to 300 tons per month. Medical institutions pay the treatment cost to the private company and the private company pays a commission to Bursa municipality so this project is also a source of income for Bursa municipality. Industrial waste such as concrete is treated at Izmit landfill in Kocaeli. (2) Waste Incineration Plant by Japanese Company The following are major incineration plants are operated by Japanese companies. Setagaya Incineration Plant Site Area :approx. 30,000m 2 Incinerator type : Gasification scorifier Continuous Operation Type (Fluid Bed Type) Scale : 300t(150t 2)/24h Incineration : 300t/day 4-144

127 Power generation capacity capacity : 6,750kW Heat supply : Vapor Source: JST Figure Setagaya Incineration Plant Shinagawa Incineration Plant Site Area : approx. 47,000m 2 Incinerator type : Stoker furnace Ash melting furnace fuel type Scale : 600t(300t 2)/24h Incineration : 600t/day Power generation capacity capacity : 15,000kW Heat supply : Hot water Source: JST Figure Shinagawa Incineration Plant Chengdu Incineration Plant (China) Incineration capacity Power generation capacity :1,200t/day(600 2) :24,000kW Riverside Resource Recovery Ltd. (UK) Incineration capacity Power generation capacity :2,290t/day(763 3) :73,000kW 4-145

128 Source: JST Figure Incineration Plants Overseas (3) Proposal for Waste Incineration Plant As mentioned earlier, Osmangazi landfill will be completed by 2025 and Bursa municipality is considering composting and incineration of waste instead of landfill. It is recommended that a waste incineration plant with a power generator be developed at the Disaster Management Complex (DMC) so that the plant can supply electricity to DMC and the neighborhood. Advantages of incineration plants are as follows. - Power generation from incineration plants as a renewable energy source contributes to reduction of environmental load in normal times - Safe facility by Japanese seismic resistant and isolation technology and disaster prevention technology - Electricity supply to DMC (emergency operation center, hospital, etc.) from power generation at the time of disaster, regardless of the state of long distance utility lines - Reduction of waste amount - Hygienic treatment of organic waste - Power generation is greater than that of methane gas power generation plants - The first waste incineration plant with power generator for disaster prevention in Turkey Figure Function of Waste Incineration Plant with Power generator 4-146

129 Outline specifications of the incineration plant are as follows. - Incineration : 3,000t/day(750t/day 4 lines) Capacity - Thermal Input : 260MW - Steam Condition : 40bar Electrical Power : 54MW Output - Steam Supply : 0.06MPa 20t/h - CO2 Reduction : 201,400t(Reduction base unit 0.555kg-CO2/kWh, Yearly operation 280 days) - Flue Gas Treatment System : SNCR (Selective non-catalytic reduction for NOx emission control), Dry system, Fabric Filter - Area : Furnace 20,000m 2, Power generator 2,500m

130 5. Study on Possibility to Introduce Japanese Advanced Technology related to DRM In this chapter, regarding the disaster reduction field in Turkey, a list of Japanese technology that has potential to be introduced to Turkey is summarized below Prospective Japanese Technology to be Introduced to Turkey Japanese technologies to strengthen the disaster management system and to contribute to resilient city planning in Turkey are listed below. 5-1

131 Prospective Japanese Companies to Introduce Degree of Possibility ABC Corporation Very good - Good Data Collection Survey For Disaster Resilient Urban Plan in Turkey 5-2 Fields Prospective Technologies to Introduce in Turkey Seismic Isolation Earthquake Ground Motion Simulation Technology to Verify Performance for Various Types of Earthquake Action. Structural design methodology of seismically isolated buildings for vertical earthquake motion. Table Japan s Technology Considered for Introduction in Turkey Competitive advantages of Japan technology compared with Turkey and American countries Seismically isolated structures in Turkey are designed using the response spectrum procedure. The dynamic time history response analysis to verify seismic performance is conducted after the manufacturer of the devices are selected and full dynamic analysis is not usually performed on the structural design. In the US design code which is adopted by Turkey, recorded earthquake ground motions with some modifications are used in the dynamic analysis. Performance is not verified for a number of ground motions such as those with predominant long-period components and/or longer duration of motions which have been observed in recent earthquakes in Japan and could occur in Turkey in the future. Seismic isolation systems would be more reliable and high-performance by introducing using the this earthquake ground motion simulation technology to simulate various ground motions due to inland near fault earthquakes, mega earthquakes etc. which are different in their characteristics and using these in time history earthquake response analyses. In the US design code, vertical ground motions due to earthquakes are not considered in the seismic isolation system specifications although they are considered for the design of ordinary buildings. Therefore, potential effects of uplift force on isolation devices are overlooked. On the other hand, the Japanese design methodology takes into account the effects of vertical ground motions on seismically isolation systems, and would enhance the safety of seismically isolated buildings in Turkey. Needs from Turkey Side/ Challenges to be considered in introductions Needs Only a limited number of structural engineers and researchers in Turkey recognize the importance of simulated earthquake ground motions. Challenges Awareness among the structural engineers should be increased to highlight the fact that there are significant differences in the characteristics of earthquakes and that it is important to verify the performance of seismically isolated structures for various characteristics of seismic ground motions. Needs Seismic isolation structures are not common in Turkey yet. Further awareness of the need for seismic isolation is necessary, and that includes the need to consider uplift in seismic isolation systems. Seismic isolation and design against uplift is particularly critical for high buildings and long span constructions, and are expected to become more and more critical in the future as Turkey continues to improve its urban infrastructure. Challenges Awareness of Turkish engineers that this issue is important should be enhanced.

132 Oiles Corporation, Bridgestone, SWCC Showa holdings, Aseismic Devices, Yokohama Rubber, Kawasaki Metal Industry, Nippon Pillar Packing, NTN Corporation, Daido Seimitsu Corporation, KOKANKYO Engineering Corporation, Mitsubishi Heavy Industry, Nippon Steel and Sumitomo Metal Corporation, THK Tomoe Corporation, KYB Corporation, Sanwa Tekki Corporation, Hitachi. ABC shokai Palacap Very good, although will require a substantial period to set conditions. Commitment from Japanese companies is necessary. Very good Good: There are some needs for specific buildings such as hospitals. 5-3 Seismic isolation device. Prototype tests of seismic isolation devices are mandatory in Turkey (since the product quality verifying system in the US is still immature ). As these tests are non-destructive, various quality aspects of the products under large displacements caused by earthquake motions greater than the design motions are not taken into account. These aspects include but are not limited to: variations in the device s characteristic values, variations due to cyclic loading and temperature, influence of axial loading due to the vertical seismic motion, and performance at and in the vicinity of ultimate drift. Consequently, the level of reliability of isolation devices is not as high as in Japan where these aspects are required to be taken into account in design documents, which are then reviewed and approved for use by the certification agency. Seismically isolated buildings in Turkey could become highly reliable by introducing Japanese isolation devices. Limited types of isolation devices are currently used in Turkey: isolators (bearings) combined with dampers. In Japan, in addition to such combined products, various types of isolators and dampers have been developed. By using these Japanese isolation devices and dampers, the optimum solution of isolation system suited to the characteristics and demands of each building can be realized in Turkey. Needs Japanese seismic isolation devices shall achieve high reputation in Turkey in terms of their performance and quality. Challenges In Turkey, engineers and academics do not reckon that isolation devices of the performance and quality of Japanese products are necessary. In general, many building owners do not realize the difference in performance of seismic isolation systems and are satisfied by any seismic isolation system. In addition, suppliers of isolation devices are not selected by the quality and performance of their products but by their engineering ability in structural design and analysis as well as for economic reasons (cost). It is necessary to establish a new process of procurement in which design engineers conduct a more detailed evaluation to select isolation systems and a public evaluation system is developed and applied to verify the overall performance of isolation systems. The Japanese product appraisal and approval system could be adopted in Turkey to assist engineers in designing seismic isolation systems and in choosing devices based on published, reliable, and transparent data. On the other hand, it is still necessary for Japanese suppliers to improve their ability in engineering. Japanese way of operating and maintaining seismic isolation devices There is no clear stipulation in Turkey for the operation and maintenance of seismic isolation devices. Therefore, Japanese expertise regarding inspection for deterioration needs to be introduced. Introducing Japanese devices for recording the drifts in isolated stories during intense earthquakes is helpful to confirm that no unexpectedly excessive displacements of the stories take place and to check the soundness of the structure immediately after the earthquake. Needs Limited number of structural engineers recognize the importance of this issue in Turkey. Challenges Promotion activities to show the need for operation and management personnel and for legal requirements for the inspection and maintenance. Training for the technicians and companies in charge of inspections are required. Data Collection Survey For Disaster Resilient Urban Plan in Turkey Expansion joints for seismic structures and flexible joints for piping A fully flat expansion joint which does not make a level difference is commonly used for floors for its accuracy and usability. Needs Not as much accuracy is required in the Turkish market compared with the Japanese market. Challenges Specifications of Japanese products should be adjusted to suit the situation

133 Toshiba elevator, Hitachi, Fujitech, Mitsubishi Electric, Structural Quality Assurance(SQR), Nippon Steel and Sumitomo Metal, Shimizu Corporation, Takenaka Corporation, Obayashi Corporation, Ryoko Sangyo Corporation, Magune kagaku Very good Good - Very good Data Collection Survey For Disaster Resilient Urban Plan in Turkey in Turkey to reduce overall costs and enable products to be manufactured in Turkey. 5-4 Seismic Retrofit Construction Elevator systems to withstand the forces in a seismic structure Products and construction methodology for seismic retrofit Seismic measures for non-structural buildi ng components and mechanical, electrical and plumbing (MEP) elements Advanced technologies for elevators which penetrate a base-isolated layer. In Turkey, the Minister of Health and the department of construction have set a policy that public hospitals with more than 100 beds shall be seismically isolated. In fact, seismic assessment is required in the building code for existing buildings with an importance factor of 1.5 (which is the case for hospital buildings). This assessment is conducted in accordance with the method stipulated in the 2007 seismic design code. If the results of the assessment indicate insufficient seismic safety, the building has to be seismically retrofitted or demolished for reconstruction. The seismic assessment and retrofitting standard of Japan is not adoptable to those in Turkey. Furthermore, as a result of survey on some retrofitting projects, it turned out that the objectives and efficiency of the retrofitting work in some projects are not clear. The construction methods and materials developed in Japan, if they are adopted appropriately in Turkey, are expected to increase the number of more efficient and highly effective retrofitting works. Although MOH issued a guideline to improve the resistance of non-structural building components and MEP elements, relevant efforts and activities are just starting now. Many components and elements identified as important for the resiliency of Turkey s society are not properly stiffened for intense seismic motions, and would greatly benefit from the recently developed know-how of Japan. The introduction of isolation systems for individual equipment is also necessary. In hospitals, there are certain pieces of medical equipment that have to be movable and these may slide, collide, or overturn during earthquakes, even in facilities with enhanced seismic strength, unless the facilities are seismically isolated. Floor isolation systems developed in Japan will improve this situation. Needs The current needs are low. However, in the future, if the variety of the seismic structure, including the intermediate base isolation layer will be developed, the technology will be highly demanded. Challenges None. Needs The need for specific specialized products and methods is high but ordinary products and construction methods are already available in Turkey. Challenges As there is a big difference in assessment and retrofitting methods between Turkey and Japan, the consent from Turkish engineers and researchers to use Japanese products are necessary. Needs The concern for this issue is increasing in Turkey and the need to introduce Japanese products is continuously increasing. Challenges No substantial barrier was identified but efforts of the suppliers to promote Japanese products to the construction society of Turkey are highly recommended.

134 Mitsubishi Heavy Industry Very good ACCUTHERA Good JSAT TOSHIBA, JRC, MELCO Very good MELCO Very good System and data research Very good since this technology is exclus ively developed in Japan Data Collection Survey For Disaster Resilient Urban Plan in Turkey 5-5 Communication Early warning system/ sensor Three dimensional shaking table Non-destructive inspection technology by X-ray Satellite communication system: fixed stations and mobile stations (including vehicle mounted stations) such as EsBird Helicopter satellite communication system Early seismic detection and warning system utilizing preliminary earthquake tremors (Pwaves) The only manufacturers of large scale three-dimensional shaking tables are MTS Systems Corporation in the USA, and Mitsubishi Heavy Industry in Japan. Mitsubishi is the manufacturer of the world s Largest shaking table like E- Defense which has excellent technology for manufacture and control systems. Japan has a compact and lightweight system that enables inspection for cracks in the piers of bridges. There is not much delay in information transmission (single-hop connection). In case of emergency, the transfer of information is controlled so that prioritized information can be transmitted without delay. This technology was proven during the Great East Japan Earthquake in Establishment is not difficult. High volume data such as images can be distributed from the helicopter through the satellites. Unlike JMA early seismic warning systems, P-wave detectors combine the sensor and the warning function in one system and hence can be utilized in individual facilities (e.g. Tokyo Metro, Sapporo Dome, Boğaziçi University in Turkey). Railway operators in Japan utilize P-wave sensors and JMA early seismic warning systems so that trains stop safely as soon as the early signs of an earthquake are detected. Earthquake Quick Alarm System (EQAS), Fast Response Equipment against Quake Load (FREQL) Needs There is currently no large scale three dimensional shaking table in Turkey. A small three dimensional shaking table is under construction in Istanbul Technology University. There was a plan to build a shaking table in Middle East Technology University, but the project was not implemented due to insufficient funding. Challenges There are associated costs for operation and maintenance, and for a technician. Needs The importance of strengthening bridges is recognized in Turkey. Challenges The existence of regulations on X-ray utilization needs to be confirmed. Needs A consortium of private Japanese companies (listed in the next column) has already presented this system to AFAD. Its high performance is widely recognized among AFAD staff. Issues Intense competition with American and European companies is expected. In comparison, Japanese technology shows better performance but higher costs. Needs Japanese companies have already presented this system to AFAD. Its high performance is widely recognized among AFAD staff. Challenges The small number of competitors is an advantage, but rather costly Needs Currently, construction of early seismic warning systems in Turkey is in the pilot study stage. Prompt introduction in several facilities such as the subway and hospitals is essential, particularly for Bursa which is in high seismic danger. Challenges Introduction depends on the intention of individual operators and will require personal training.

135 System and data research NTT Communications, Rikei Combination of multiple products of several manufacturers Very good since this technology is exclus ively developed in Japan Good Good NEC Good Sending side: Hitachi Kokusai Electric, etc. Receiving side: mobile phone manufacturer producing devices that can receive One SEG service. (e.g. Sharp) Good Data Collection Survey For Disaster Resilient Urban Plan in Turkey 5-6 Immediate alarm system Information Dissemination Compact digital accelerometer This system is capable of triggering an earthquake alarm based on the detection of P-waves, even in the epicenter area. It can also provide real time intensity and trigger an alarm based on acceleration or intensity. J-ALERT In case of emergency in Japan such as ballistic missile, tsunami, and early earthquake warning, the national government communicates information via satellite communication. Emergency information is then immediately distributed in cooperation with the emergency broadcasting systems at the provincial level. Currently, systems are in operation in most of the local public bodies. Em-Net (Emergency information netwo rk system) Public Information Commons Mobile Phone One SEG broadcasting (Community One SEG) Public bodies share emergency information via a local Government Wide area network (LAGWAN). Despite less immediacy than J-ALERT, most of the local public bodies have already introduced this system because it enables simultaneous transmission of emergency information by push mail at fairly low costs. A centralized information base will be established in which information organizers (government, local public bodies, lifeline and transportation operators) and transmitters (Broadcasting Media, Mobile Phone operators) will be able to share immediate and precise information and provide facilities in which they will be able to establish their living quarters in times of large scale disaster. This is a regional version of Japanese terrestrial digital broadcasting One SEG. This device allows local residents to gain disaster information via mobile phone and TV during power outage. This device is automatically activated and the warning function starts in case of emergency. Needs Currently, construction of early seismic warning systems in Turkey is in the pilot study stage. Prompt introduction to several facilities such as the subway and hospitals is essential, particularly for Bursa which is in high seismic danger. Challenges Introduction depends on the intention of individual operators and will require personal training. Needs Demand for an alert system seems high, especially for flood and landslides, in addition to earthquakes. Challenges The importance to provide information directly to public should be shared with AFAD. Needs When AFAD develops disaster & emergency operation centers at the provincial level, this system will be useful to support their activities. Challenges It is necessary to coordinate AFAD s concept regarding whether the emergency information is to be transmitted on national level. Needs Adoption of the system for the new Central AFAD disaster management center in Ankara has already been envisaged by IT division. Challenges Systems adopted at the provincial level shall be able to communicate and share information with that of Ankara. Needs Since mobile phones are popular in Turkey, there is a possibility to introduce the One SEG system. Challenges Although Turkish terrestrial digital broadcasting is in the European style, One SEG for mobile phones, for which the working area is limited, can be introduced regardless of the style. It has been successfully introduced in other countries such as Indonesia.

136 Message boards combine multiple manufacturers products Device for FM radio: Hitachi Kokusai Yagi Solutions FM Studio devices: combination of multiple manufacturers products Japan Radio, NEC, Panasonic, OKI, Toshiba, Hitachi Kokusai, Fujitsu General, Mitsubishi Electric Horn Array Speaker TOA Difficult to specify company name, since this is a part of various products. Very good Very good Very good Very good Good Data Collection Survey For Disaster Resilient Urban Plan in Turkey Message Board Carriers and mobile phone carriers provide message board services at the time of disaster. It can be in the form of push button, voice recording, or web texting. Community FM radio Local FM radio stations can easily be established and require limited investment. Those stations are established for the purpose of disaster prevention which can be distributed to a wider area. The radio station may be temporarily established in the disaster stricken area. Needs AFAD intends to introduce message boards. Challenges Coordination with carriers is essential. Needs Istanbul AFAD has been providing radio service, which is used not only for disaster information but also for disaster prevention purposes. There is a potential to use radio for the same purposes. 5-7 Disaster prevention administration wireless system. Loud speaker for long distance transmission Information transmission system from local municipal entities to residents is established by utilizing a VHF wireless system. This system should not be the only communication system in place, as it has been witnessed in the Great East Japan earthquake that messages are not always heard. In normal times, this system can be utilized for various purposes, including broadcastings disaster prevention awareness programs. This speaker transmits over longer distances than the trumpet speaker commonly used by radio communication for disaster prevention and administration. Effective covering reduces the total investment costs. It solves difficulties in hearing due to echo etc. However, there are disadvantages including; relatively heaviness, consuming a lot of energy. Combination with the existing style speaker will be effective. Needs It will be effective to provide disaster information and instruct the public of the next steps via this wireless system, rather than a simple siren. Challenges A system to collect and screen information to be disseminated should be established. Needs Loudspeakers are particularly effective in the remote areas. Challenges Price is much higher than the traditional speakers. This loud speaker should be coordinated with the siren system planned to be installed by Turkish side. Remote starting loudspeaker (DTMF etc) The system is established with fairly low costs such that in the case of emergency, loudspeakers in the distant areas are activated and send out information via radio waves. Although it is certain to control activation by utilizing the general V/UHF wireless, controlling sizable speakers in a wide area requires a large investment. By superposing the speaker control signal onto the radio broadcast waves, distance speakers can be controlled. Needs Remote control system of loudspeakers will be effective in remote areas.

137 Not open to the public Good NTT Data Very good, after further technical studies Mitsubishi Electric, Hitachi, Toshiba Very good: in Turkey there are a large number of patients with cancer Hospital management/ medical services System for Prediction of Environmental Emergency Dose Information (SPEEDI) Emergency Medical Information System SPEEDI has been established by the Nuclear Regulation Agency (NRA). When sizable radioactive substances may have been released from nuclear plants, the NRA immediately predicts the atmospheric level of radioactivity and exposure dose in the surrounding area based on relevant information including emission source, meteorological conditions and topographic data. In the event of disaster, this assists in immediate and precise medical/relief activities over a widespread area across regions. During an acute phase of disaster, information from the medical institutions regarding damage situation and the number of patients that can be accepted will be put together and shared Need for a disaster medical assistance team and a dispatch management system. This information is shared amongst teams. Needs Due to the project to construct new nuclear power plants, interest of prevention of nuclear-related disasters has been increasing in Turkey. Needs This system enhances the understanding of the situation in medical institutions in the event of a disaster, and it provides information for appropriate patient transportation. Also it allows UMKE to work efficiently. Challenges The development of IT software compatible with the existing SAKOM system and a relevant technical surveys are required. Data Collection Survey For Disaster Resilient Urban Plan in Turkey 5-8 Information regarding the patients, transport aircraft will be shared and managed. In Turkey and Europe where earthquakes are not as frequent as in Japan, establishment of an information base in the event of a great disaster is not easy. Baryon Line, Proton Beam, Boron Neutron Capture Therapy (BNCT) The disaster medical care system in Japan allows smooth cooperation amongst hospitals and ambulance services. It has been gradually developed through trial and error. The Japanese system excels in sharing and providing information regarding medical care nationwide in the event of disaster. Six Baryon Line facilities are currently operating worldwide, four of which are in Japan. Thirty Proton Beam facilities are currently operating worldwide, eight of which are in Japan. Needs There is great demand in Turkey where a fairly large number of cancer patients exist, thus it will be a great contribution to Turkish medicine. Challenges There is currently no such facility in Turkey, hence the metropolis of Ankara or Istanbul would be the first candidates for introduction. Implementation as well as maintenance cost is great.

138 Hitachi Olympus, Universities Kurashiki Kako Co.Ltd. Kawasaki Heavy Industry Mitsubishi, Hitachi, Toshiba Very good: in Turkey there are a large number of patients with cancer Very good Good Very good: Some Japanese companies have already delivered systems in Turkey. Panasonic, Not good Toshiba Lighting and Technology Co. Azbil Not good Daikin Industry, Mitsubishi, Toshiba, Hitachi Good Data Collection Survey For Disaster Resilient Urban Plan in Turkey 5-9 Hospital Facilities and Equipment Advanced medical services such as regenerative medicine, diagnosis and treatment of cancer by endoscope. pipe joints, water supply pipe, drainage pipe, storm water pipe, gas pipe Dual Fuel Generator In Japan, advanced research and development through the cooperation between Universities and Medical equipment makers are under way. Japan has various facilities regarding disaster prevention. Their effectiveness was proven in past experiences (including the Great East Japan Earthquake) and their quality is continuously being improved. A Dual Fuel generator is a gas turbine generator which can use gas or oil (paraffin/diesel). Additionally, it can be used as cogeneration (environmentally friendly performance). Japanese companies are the only manufacturers of 1000kw generators which are typically used in Emergency Operation Centers and Hospitals. (foreign companies produce larger capacity generators ) Elevator Automatic diagnosis system allows immediate restoration without manual inspection. Additionally, the elevator is highly resistant to earthquakes. Needs Contribution of advanced medical services facilities to Turkish medicine is large. Challenges Joint development with universities in Turkey can be considered. Needs Japanese facilities performed well in the Great East Japan Earthquake. Challenges Relatively high cost comparing with competitors overseas. Needs Small scale generators that can be introduced into disaster base hospitals are only manufactured in Japan. Challenges Relatively high cost compared to competitors overseas Needs In Turkey, the recognition of the importance of this technology is not sufficient because there are only a small number of cases where it has been an issue. Challenges Mitsubishi Electric already has delivery records. Costs and effectiveness of Challenges Relatively high cost compared to risk reduction needs to be explained. LED lighting LED lighting saves energy Needs Japan has a good record in terms of energy efficiency BMS (Building Management System) Packaged air conditioning system BMS saves energy and cost in building management by using labor-saving technology and optimizes the operation. Japanese BMS products have an advantage in terms of energy saving. A packaged air conditioning system operates with electricity. In the event of a disaster, it is able to operate on an emergency generator. Japanese products are particularly efficient and energy-saving. competitors from overseas Needs Japan has a good record in terms of energy efficiency Challenges Relatively high cost comparing with competitors overseas Needs Japan has a good record in terms of energy efficiency Challenges Relatively high cost comparing with competitors overseas

139 Torey, Hitachi Good Tokyo Gas, Osaka Gas Good Tokyo Gas Very good Y's Global Vision co. Ltd. Public Works Research Institute(PWRI) Oriental Consultants Good Very good since those technologies are only developed in Japan Very good, especially for automatic alarm systems and anomaly detection systems DOMINGO Very good Data Collection Survey For Disaster Resilient Urban Plan in Turkey 5-10 Water recycling system Heat supply Regional heating and cooling Utility Lifelines (Gas/Electricit y/water) Monitoring of the road damage situation Gas: Superdense Real time seismic disaster prevention system Water Pure Hybrid: Portable water purification system Damage degree in a highway bridge determination system Anomaly detection system These are sewage treatment and water recycling systems. Particularly, facilities operating independently in the event public infrastructure break downs will need this technology. In Japan, BCP of energy-saving as well as highly efficient regional heating and cooling system from best-mix of energy of gas and electricity can be established. SUPEREME (Super-dense Real time Monitoring of Earthquakes) has a remote shutoff function employing a super-dense SI sensor and damage estimation. Portable water purification system for the event of disaster, which works with a solar panel It immediately evaluates the damaged degree in bridges by using the damaged degree determination sensor and wireless communication. The anomaly detection system analyzes images from monitoring cameras and reports to road manager/operators, who are not required to monitor it themselves. Needs Japan has a good record in terms of energy efficiency Challenges Relatively high cost comparing with competitors overseas Needs Japan has a good record in terms of energy efficiency Challenges Relatively high cost comparing with competitors overseas Needs Currently, the gas supply system in Bursa requires manual shutdown in the event of a disaster or accident. The current situation might cause secondary disasters such as fire. Challenges Since the gas is supplied by private companies, it is important to make an agreement with them. Needs It can be used as a backup for drinkable water in a disaster. Challenges Relatively high cost compared with competitors overseas Needs Evaluation of damage degree in bridges is particularly important for emergency roads. Challenges Training for the system operation including determination of the damaged degree is required. Needs It allows the immediate detection of abnormal conditions on roads by continuous monitoring both in normal times and in the event of a disaster. Establishment of monitoring cameras is proceeding in Bursa. Challenges Training for anomaly detection and automatic alarm system are required. Simulation/M onitoring Tsunami evacuation simulation There are several simulation models applicable to specific characteristics of various regions. Needs In Bursa, the sea coast of Marmara might suffer from tsunami. In Gemlik and Mudanya, assessment for tsunami and development of evacuation spaces are important because there are residents close to the coast and the land elevation is low. Challenges The danger of tsunami is not widely recognized.

140 Hitachi Solution Good JRC Good JRC Good Construction companies Construction Consultants Port and Airport Research institution (PARI) Good Should be investigated Good Flood simulation River/water resource management system This analyses and predicts the flood area on the basis of various data. Hazard maps can also be created. For the purpose of the prevention of water disaster, it manages the riverside and dam discharge, and mitigates damage from Tsunami/high tide, and monitors landslides. Needs Flood simulation is a useful analytical tool to assess flood hazards. Challenges Not only simulation, but total solutions to flooding should be considered. Needs Monitoring systems for river level and landslides are essential for early warning. Issues Introduction of flood simulation would be effective. Data Collection Survey For Disaster Resilient Urban Plan in Turkey 5-11 Precipitation radar Port/Airport Soil improvement technologies for harbors and airports Port/airport asset management technology Harbors: a seismic quay wall and reinforcement project Japanese technology regarding sensors and telemeters have been tracking good records abroad and therefore are competitive. Multi parameter metrological radar (MP radar) is quite effective for sensing technologies for precipitation prediction. MP radar is capable of predicting precipitation with a high accuracy. Soil improvement measures against liquefaction such as high pressure injection of cement slurry. There are a number of successfully implemented examples in Japan. Technology and know-how to maintain existing ports and airport facilities long-term, according to the longterm repair plan prepared based on the investigation and assessment of safety of the existing ports and airport facilities. Strengthening the structure of the quay walls will create a quay that can be used for the transport of emergency supplies even after an earthquake. (Kobe port demonstrated this function in the Kobe earthquake in Maya Pier) Needs Precipitation prediction is important for disaster evacuation. Challenges In combination with the water/river resource management system it would be effective Needs At the Gemlik Port, there is a need for liquefaction prevention measures such as soil improvement technologies, as well as for earthquake-resistance retrofits by both the public and private sectors. Challenges It is necessary to reinforce earthquake-resistance, to filter the area of foundation improvement, as well as to consider the priority. Japanese technology s competitiveness is not confirmed. [Needs] In the ports of Gemlik and Mudanya, facility management methodology and technique that include collection, process and analysis of data, can be introduced. However, the needs of Turkey are unconfirmed. Challenges There is a possibility that the experience, technology, and information storage of Japan does not apply to the specifications of Turkey as it is. Turkey specifications for software development are necessary. Needs Application is expected in Gemlik and Mudanya. In addition, there is a need for earthquake resistance of the quay in the existing port in the back of the Gemlik Bay. Challenges Since the port itself is small compared to those in Japan, cost-effectiveness of the investment should be studied.

141 Port and Airport Research institution (PARI) Good Hitachi Zosen Very good since Japanese makers have good records in the E.U. Data Collection Survey For Disaster Resilient Urban Plan in Turkey Waste treatment Container crane seismic isolation technology Garbage incineration facilities with generators This has been already enforced. Needs There is a need for container crane seismic isolation at the private Gemlik Port. Challenges Production of cranes in or near Turkey. (Alternatively, transfer of technical license can be considered) This facility will meet the strict exhaust gas regulations by introducing pollution control systems, and hence possibly be constructed in an urban area. Low air ratio combustion technology for a high-efficiency generator will be developed. Needs In Turkey, it is required to meet regulations for garbage incineration in the EU. Japanese technology meets those requirements. Challenges An institution to classify noncombustibles is required. 5-12

142 5.2. Study on Seismic Isolation Need for Seismic Isolation Technology in Turkey Although regional differences of seismicity in Turkey are large, the highest expected intensities of earthquake ground motions are at the same level as those in Japan. Figure below shows maps of Turkey and Japan which were developed by the collaboration of geological survey institutes in the world in GSHAP (Global Seismic Hazard Assessment Program) that shows the anticipated value of an earthquake s strongest acceleration on standard ground (bedrock) for a return period of 475 years with an exceedance probability of 10% in 50 years. It is obvious from these maps that seismic risks in the two countries are similar. Comparing Figure with Figure which shows the zoning of design earthquake loads of the Turkish Seismic Design Code, it is seen that the latter strongly reflects the former. Figure Seismic Risk of Turkey and Japan The Turkish Seismic Design Code has 5 Seismic Zones (from I to V) as shown in Figure Roughly speaking, the value of design earthquake loads stipulated in Zone I, which has the highest seismic risk, is close to those stipulated in the Building Standard Law and the Enforcement Order of Japan for the areas with the highest Z aerial coefficient such as Tokyo and Osaka. Turkish Design earthquake loads in Zone II, III, IV and V correspond to the Japanese aerial coefficients of 0.75, 0.50, 0.25 and 0.0 respectively. However, the actual zone factors stipulated in the Japanese Building Standard Law for the area with the lowest seismic risks are 0.7 (for Okinawa only), 0.8 or 0.9. Compared to the Turkish Code that strictly follows the results of the probabilistic seismic risk assessment in the Global Seismic Hazard Assessment Program (GSHAP), the Japanese Building Standard Law still assigns rather conservative earthquake loads even to the area with low seismic risks from the probabilistic point of view. In conclusion, Turkey is under similarly severe seismological conditions as Japan, but its current building practices are not adapted to resist likely earthquakes. Therefore, Turkey is in great need for seismic isolation technology with enhanced seismic safety and reliability. It is compulsory to promote the application of seismic isolation systems to the facilities critical to disaster response after strong earthquake motions such as disaster management centers and hospitals. Seismic isolation is the only technology to realize such performance today. 5-13

143 Additionally, the importance of mitigating damages in non-structural elements 10 and in the MEP (mechanical, electrical and plumbing) systems should also be highlighted. Concerns regarding these issues are currently increasing in Turkey and guidelines to install earthquakeresistant devices are being developed, especially for hospitals. Many operators of the hospitals interviewed in this study were also concerned by the risk of non-structural elements to break or fall during an earthquake. However, just like in Japan, various factors and problems that hinder sufficient strengthening can be predicted by implementing a reinforcement plan. In addition, visits to some hospitals during this survey revealed that wall and floor connectors of important MEP elements were clearly insufficient. Though it will take time to entirely install seismic isolation, a radical solution to this matter, is highly significant Status of Seismically Isolated Buildings in Turkey (1) Introduction and Widespread Status The first code for seismic design in Turkey was established in After several revisions, the 1998 edition, the main body of which was kept unchanged in the latest edition in 2007, was established. In fact, the main modification in the 2007 edition is the additional requirement for seismic assessment and retrofit, based on the experience of the 1999 Kocaeli Earthquake. The history and outline of the Turkish Seismic Design Code are described in more detail in the Appendix entitled General Technical Report on Turkish Seismic Design Code by Dr. F. Sutcu from Istanbul Technical University, which is linked to this project. It can be said that when compared to The Japanese or US Building Codes, which are considered as the international standard for earthquake-resistance and that have a long history, Turkish Seismic Design Code is not too far behind. However, the actual application of seismic design in buildings in Turkey (including seismic isolation) has largely fallen behind other countries. The first application of seismic isolation in Turkey was for the seismic retrofit of Atatürk International Airport which was damaged by the 1999 Kocaeli Earthquake. The isolation system provided for the roof was designed based on the US seismic code (the American Society of Civil Engineers / Structural Engineers Institute [ASCE/SEI] 7) which was adopted as the basis of the Design Standard for Seismically Isolated Structures provided by the Turkish Association for Seismic Isolation (TASI) in Since then, the number of applications of seismic isolation to building structures in Turkey has remained limited according to a number of local structural engineers interviewed during our survey. No official statistical data was identified during our investigation and the number of seismically isolated buildings in Turkey was not confirmed, even in the interview with the vice president of the TASI. An academic study report dated December 2013 indicates that the total number of buildings and civil works to which seismic isolation has been applied to date is 42 including retrofitting works and those under construction. This problem is common in many countries where seismic risk is not negligible. A result of investigation on the number of seismically isolated structures in countries of high seismicity in the world conducted by A. Martelli in 2011 is shown in Figure Approximately Non-structural building components: a component of buildings which is not a part of structural system such as claddings, interior partitions, ceilings, etc. 5-14

144 percent of seismically isolated structures in the world are in Japan. The Turkish design code for seismic isolation is greatly influenced by the US code even though the number of seismically isolated buildings in the US is much lower than in Japan, buildings in many high seismicity areas of the US are not built with seismic isolation. Additionally, recent US experience of intense earthquakes is limited, especially compared to Japan, so US standards can be expected to not be as safe as the Japanese standards. roof truss isolator Figure Seismic Isolation System of Ataturk International Airport by A. Martelli, 2011 Figure Number of buildings with seismic isolation Turkish engineers are becoming more interested today in seismic isolation technologies and their application to building structures. Academic and practical engineering symposiums and conferences are often held in Turkey. In March 2013, the Japanese Society of Seismic 5-15

145 Isolation (JSSI) sent a delegation of experienced specialists to Turkey. The Ministry of Health (MOH) of Turkey issued a policy that public hospital buildings with 100 beds or more should be seismically isolated and published the Standards for Design and Construction of Seismically Isolated Medical Buildings. However, from the overall performance point of view, there are still some problems regarding dispersion in the anticipated performance level in the seismically isolated structures to build in Turkey. (2) Current State of Seismic Isolation and its Challenges in Turkey The Seismic Isolation Design Code for Buildings, which was prepared by TASI in 2009 but became less influential after the publication of Standards by MOH in 2013, has played an important role in the development of seismic isolation in Turkey. However, the Seismic Isolation Design Code for Buildings, which is based on the US code, is limited to two types of isolation devices only: (Laminated Rubber Bearing (LRB) with lead plug and Friction Pendulums as shown in Figure 5.2.4). On the other hand, the Standards published by MOH were prepared gathering various opinions of specialists around the world and referring to well-known international codes such as Eurocode 8 and Notice 2009 of the Ministry of Land and Infrastructure for the Building Standard Law of Japan in addition to the US code. This mixture of various codes and standards resulted in some questions of efficiency as design standards. The two main concerns are whether the integrity of the philosophy as a design standard is maintained, and whether the various stipulations and criteria are harmonized and organized practically to the level to integrate design performance of the seismically isolated buildings. Based on interviews with Turkish structural engineers who are experienced in designing seismically isolated structures, the present design practices of seismic isolation in Turkey should be improved significantly, as explained below. steel plate & rubber plate Rubber covering lead plug Laminated Rubber Bearing with Lead Plug Friction Pendulum The lead plug installed at the center of ordinary laminated rubber bearing acts as a Friction between a steel stud and concave damper. Figure Isolation Devices Used Most steel Commonly plates produces in Turkey damping force. 1) Challenges in Structural Design: According to the structural engineers in Turkey, the general method of designing a seismically isolated structure is to first complete an analysis based on the response spectrum derived from the seismological study. Then, based on this, only the expected performances 5-16

146 (usually, horizontal stiffness 11 and damping ratio 12 of the isolation layer) will be specified in the tender documents of projects that use this method. Since the suppliers are required to not only conduct tests showing the validity of their products in satisfying requirements, but also to provide a detailed layout of isolators and dampers, these two types of isolation devices shown infigure are overwhelmingly abundant in Turkey, though combined devices that function as both isolators and dampers have large advantages over the ones with only either function. In addition, the input earthquake ground motions employed in the time-history response analysis are the recorded ground motions of past earthquakes which are scaled in the manner stipulated in US codes. These input ground motions are strictly in consistence with the probabilistic theory and are adopted in most major international codes today. However, the scaling processes are sometimes unreliable because there are some cases with an insufficient number of recorded ground motions to fit the purpose of the analysis but are still being used, thus resulting in various results, making the evaluation difficult. Employing these procedures for setting input ground motions sometimes leads to a situation in which the verification for certain types of earthquake ground motions such as motions with predominant long-period components or with long duration are overlooked, as is the case in the US practice. Seismically isolated structures are more sensitive to these types of motions than ordinary structures due to their special structural characteristics. 2) Selection of Isolation Devices There are many cases where the actual situation does not meet with the above design methodology where the design structural engineer should select isolation devices to be employed in the project based on the specific and individual characteristics of each structure. Types of isolators and dampers are selected in the early stage, meaning that the selection may not be based on this design methodology to achieve the optimum combination. Also, it should be noted that there are many important performance aspects of the devices other than the horizontal stiffness or damping coefficient, such as displacement limit, temperature and/or axial load dependency of horizontal stiffness, characteristics of aging deterioration, etc. This design methodology makes it difficult for the structural engineers to verify or confirm these performances. 3) Maintenance (daily and periodical) History of seismic isolation technology is not as long as those of other types of structures and aging characteristics should be further evaluated. Also, the importance of damage to isolation devices should be confirmed soon after severe seismic motions in order to understand if sufficient performance is maintained to resist expected aftershocks. A framework for routine maintenance and emergency inspection should be established and necessary devices installed in advance. However, the results of our study indicate that no provisions for these issues are in place, and owners, facility managers, and structural engineers do not appear to recognize the issue. 11 Lateral (horizontal) stiffness: ratio of applied lateral force to the corresponding lateral displacement or drift of a building or structure. 12 Damping ratio: ratio of damping force to the lateral stiffness of a building or structure. 5-17

147 4) Non-structural Building Components and MEP Systems Plumbing, ducts and elevator shafts passing through isolated stories and non-structural building components located between isolated and non-isolated portions shall have the ability to absorb the horizontal deformation of the two portions. According to Turkish structural engineers experienced in designing seismically isolated buildings, the importance of these issues is not sufficiently recognized in general by Turkish architects and MEP engineers and precautions for differential displacement are likely not sufficient in many cases. In fact, we identified a lack of such precautions during our visit to a seismically isolated building in Turkey (Figure 5.2.5). These elements and firefighting installations shown in the figure will likely be severely damaged during large earthquake ground motion, resulting in loss of functionality. Clearance of plumbing works is small compared to that of seismic isolation. Probable damage to the plumbing system. Fire extinguishers are fixed to both isolated and non-isolated portion. They will likely overturn or break due to difference in movement of both portions under seismic action. Figure MEP Likely to be Easily Damaged by Horizontal Displacement of the Base-isolated Stories Introducing the Japanese Seismic Isolation Technology (1) Purpose and Expected Effect The design, device production, and appraisal of Japanese seismic isolation technology have a longer history than of other countries and have been in continuous development due the experiences of many intense earthquakes with a great variety of characteristics. That is, Japanese isolation systems are not only a result of theoretical development but also of continuous training and evolution of the discipline through actual earthquakes including experience of partial damage. Enhanced performance and reliability of seismically isolated buildings in Turkey are expected from introducing these technologies into Turkey where the level of seismic risk is similar to Japan. (2) Recommended Japanese Technology 1) Simulation of Input Earthquake Ground Motion In Japan, it is not common to use scaled records of past earthquakes as described in (2). Instead, a simulation of input earthquake ground motion with a responsive spectrum matching the design spectrum is commonly used. The ground motion models simulated in this way give more stable responses than the scaled records of past earthquakes. These ground motion models also prevent large variations in the results of the analysis due to little variation allowed to the individual engineers applying the method. As a result, unified and 5-18

148 reasonable evaluation standards for results of response analysis can be established. This type of ground motion simulation is also incorporated in the US code, although without detailed description, and the Turkish engineers we interviewed recognize the necessity of these simulations. Therefore, it is expected that this Japanese methodology to simulate ground motions can be accepted by Turkish engineers without substantial difficulty by encouraging and facilitating their understanding. Simulated ground motions of another type, artificial motions, are often essential in designing seismically isolated buildings. The seismic energy input to seismically isolated structures is remarkably reduced by making use of their peculiar characteristics such as elongated natural periods and increased damping performances which are largely different from the ordinary structural systems. Therefore, as aforementioned, designing seismically isolated buildings requires an investigation of the effects of long period components and of a long seismic action durations, which leads to increased energy absorption capacity 13 in dampers. These effects are usually negligible in ordinary low to medium rise buildings. It is often difficult or even impossible to represent such motions by recorded motions. Problems associated with long period components and longer duration of seismic actions observed in the 2011 Great East Japan Earthquake attracted public attention. In Japan, the risk of slip in various inland faults such as the Tachikawa Fault, the Ue-machi Fault and other unnamed ones has been recognized. A technology to simulate the most critical earthquake ground motions that can happen in each specific site has been developed aiming at ensuring safety beyond just complying with codes and regulations. It is called the ground motion simulation for Scenario Earthquakes. 14 Figure shows examples of ground motions for a site near Tokyo simulated for earthquakes from three different sources: slips in an unconfirmed but possible inland fault in the vicinity of the site, slips in a large scale inland fault, and occurrence of a mega-earthquake on the boundary of tectonic plates, which is commonly called Plate Tectonics 15. These ground motions take into account the characteristics of the source, the bedrock seismic wave transmission, and site soil amplification. Long-period and long-duration motions as well as the intense motion due to the fault in the vicinity of the site largely influence the simulation. This simulation technology makes it possible to remarkably enhance the reliability of seismic design by evaluating structural response to seismic actions which may be less probable but more critical than more probable ground motions, due to the characteristics of each building. This technology also evaluates the structural response to traditional ground motions derived from seismological theory. The importance of the issues presented in this section may not be recognized sufficiently in Turkey and knowledge and experience acquired by Japanese engineers should be shared in 13 Energy absorption: amount of input energy to buildings or structures which is absorbed by damping and/or plastic deformation of structures. 14 Scenario Earthquake : an earthquake of an assumed focal location and assumed focal mechanism 15 Plate Tectonics: a theory in earth science that the surface of earth is covered by several plates which are moved slowly by the convection in mantle beneath. It is explained that the energy accumulated in the plates by their movement is released abruptly along boundaries of or at parts in the plates and cause earthquakes 5-19

149 Turkey to popularize the significance and needs for considering ground motions from less traditional earthquake scenarios before the Japanese simulation technology can be generally recognized and applied. Slip in Large Scale Inland Fault Slip in Inland Fault in Vicinity of Site Mega Earthquake on Tectonic Plate Boundary Slip in Inland Fault in Vicinity of Site Slip in Large Scale Inland Fault Mega Earthquake on Tectonic Plate Boundary Figure Earthquake Ground Motion Simulation 2) A variety of Isolation Devices and Product Appraisal Systems In Japan, methods for evaluating various aspects of performance of isolators and dampers have been developed. These include a range of characteristics including stiffness, damping capacity, aging, ultimate horizontal deflection, permissible compressive and tensile stresses on the bearing surfaces of isolators, dependency of stiffness on temperature, and cyclic deformation. In addition, a technical appraisal of public organizations established a system for approval of isolation devices by the Minister of Land, Infrastructure and Transportation. The characteristics of approved products are made public so that structural engineers can compare the performance of the various types of devices. Based on this information, they can select a combination of devices and determine their layout for an optimum seismic isolation system for each building. Through this approval system, various types of isolators, as shown in Figure 5.2.7, and dampers in Figure 5.2.8, have been developed in Japan. Products in which laminated rubber isolators and steel dampers are combined were also developed. The devices shown in Figure 5.2.4, which are frequently used in Turkey, have excellent performance in various aspects but their performance in other aspects may be behind others. What is important in development of seismic isolation technology in Turkey is to provide Turkish structural engineers with a system based on Japanese technology of a performance evaluation method that enable them to design with optimum selection, combination, and layout of isolation devices that suit the buildings in Turkey. 5-20

150 Laminated Rubber Bearing Fundamental type of isolator but can also be dampers by replacing natural rubber with high damping rubber. interior rubber sheet interior steel sheet rubber covering bolt hole natural rubber sheet or high damping rubber sheet steel flange Slide Bearing Single Slide Bearing Elastic Slide Bearing Slider (teflon plate) Laminated Rubber Bearing Base Plate Roller Bearing Double Tier of Rail Type Roller Bearing Plane Roller Bearing Roller Bearing on Concave Plates Made movable in two orthogonal directions by stacking rail type roller bearings Structure of Rail Type Roller Bearing Multiple Ball Bearing Figure Examples of Isolators (Bearings) used in Japan 5-21

151 Hysteresis Type Damper Energy dissipation due to cyclic plastic deformation of materials produces damping. Lead Damper Fluid Type Damper (Viscous Liquid in Steel Wall) Cover Plate Steel Damper The resistance to deformations in the viscous material between steel wall panels produces a damping force. Viscous Material Inner Steel Plate Outer Steel Plate Single Type Double Type Fluid Type (Oil Damper) The frictional resistance of oil moving in the device produces the damping force Figure Examples of Dampers used in Japan It is possible to establish a Turkish approval system for isolation devices but it will take a substantial time. Some foreign products obtain approval from the Japanese approval system, which is becoming globally recognized. The Japanese system could be adopted in Turkey. As both technical appraisal and approval are carried out by a public organization in the Japanese system, use of the product specifications in selecting isolation devices for each project provides sufficient transparency for the design process. 3) Maintenance In order to fix the manifestly insufficient maintenance of seismic isolation systems in Turkey, it is important to first establish a cooperation system for building owners, operators, design engineers and maintenance engineers. Figure is the conceptual outline of the 5-22

152 cooperative organization for the maintenance proposed in the Standard for Maintenance of Seismically Isolated Buildings published by JSSI. It is necessary to establish the organization at the time of building delivery to make it possible to continue appropriate regular inspections to confirm that no critical aging deterioration is taking place and to require emergency inspections to confirm that isolation devices suffered no excessive damage after intense seismic actions. The concept shown in Figure has been developed based on the current social conditions and construction industry in Japan and has contributed to efficient maintenance of seismically isolated buildings. It has been applied in most of the seismically isolated buildings in Japan. The main background of this development is the requirement in Japan to establish a maintenance organization and plan for each seismically isolated building in order to obtain a building permit. Adapting this concept to fit the current situation in Turkey and applying it to every seismically isolated building will ensure the seismic safety of these buildings for an extended duration, to the benefit of the owners and users of the buildings. As this is a soft technology, it is not difficult to introduce it in Turkey. USER MANUAL Figure Maintenance Organization Proposed in the Standard for Maintenance of Seismically Isolated Buildings by JSSI Proper installations and detailed descriptions for monitoring and inspection are necessary. It is not appropriate to make a generic statement to identify which installations or tools are necessary because they depend on the characteristics of the isolation system and its 5-23

153 surrounding environment. Product Specimens 16 and Story Drift Recorders which are simple mechanisms and often installed in isolated stories are shown in Figure Product Specimen In addition to acting as isolation devices, product specimens are provided in isolation stories to monitor deterioration caused by various factors including aging, fire accident and flooding. Drift of the isolation story is recorded by simple tools to identify any excessive displacement or cyclic movement cause problems to isolation devices are taking place. Story Drift Recorder Example of Record Figure Examples of Installations for Maintenance 16 Product Specimen: Isolation devices which are installed in addition to the working devices as test specimens to confirm mainly the influence of aging on the characteristics of the devices under actual conditions of use in regular maintenance activities. 5-24

154 4) Plumbing and Non-structural Components Capable of Following Drift As mentioned in (2), there are still some non-structural components between isolated and non-isolated portions and plumbing and other MEP systems passing through isolation stories that are not capable of following the drifts in the isolation stories in Turkey. The cause of this problem is believed to be the insufficient attention in the architectural details of nonstructural components, and not about technology. Thus, it seems solvable just by making use of the local products without having to procure them all the way from Japan or use Japanese technology. On the other hand, in the case of plumbing and other MEP systems, the demand to follow three-dimensional movements calls for use of special products. Japanese products, such as those shown in Figure , are the results of continued research and development for this issue and provide solutions applicable in Turkey as well. Indicates a movable section Figure Japanese Plumbing Systems to Follow Drift in Isolated Stories 5-25

155 5.3. Information Communication Technology Among Japanese information communication technologies (ICTs) that are considered available to be proposed to address challenges in Turkey described in Chapter 3.8, some have products that are directly applicable in Turkey, while others are difficult to apply directly; however, it is appropriate to describe or introduce them at the current stage. The following are descriptions of those ICT elements/products that would benefit Turkey in the disaster prevention field. The proposals in this study focus on satellite communication systems and information transmission systems in the Platform of the overall image shown in the following figure. Figure Relevant Japanese ICT Products (1) Satellite communication system (EsBird system) Vehicle-mounted transportable VSAT earth station The Uninterruptable and Secure Communication System (KGHS) plan that AFAD is implementing is a plan to procure a total of 700 VSTA earth stations in the three years, from 2015 to Approximately 200 of these stations are expected to be vehicle-mounted transportable VSAT, and there is a possibility for Japanese products to be selected if the price is competitive. Helicopter mounted VAST earth station Overall concept of the disaster prevention communication systems The helicopter on-board version of VAST is a system that can transmit high-resolution pictures from an in-flight helicopter to relevant organizations via satellite communication by direct uplink. This technology is only offered by Japanese companies and the Japanese products can enter the market since the System Management and Information Security Working Group of AFAD shows a strong interest in them. 5-26

156 < Fixed Terminal on town > Terminal Fixed Terminal < VSAT> Portable VSAT Vehicle mounted VSAT Helicopter mounted VSAT Figure Overall Image of Proposed Satellite Communication Systems -All disaster-related information is collected by AFAD -Provincial/district level would be the base Order by disaster prevention center (fixed terminal) of Provincial/District Telecommunication between AFAD and fixed terminals of Provincial/District Weather report Disaster prevention center of Province/District Area stricken by Disaster Figure Operational Image of Satellite Communication Systems 5-27

157 Advantages of Japanese products are as follows. Table Advantages of Japanese products Low latency Always connectable by private line Easily usable anywhere and by anyone A variety of equipment lineups Large-capacity video and audio data can be transmitted without delay by a single hop. Connectable by private line with no line congestion at the time of disaster. The mainstream system in other countries is the best-effort system which may become congested during a disaster. Small and light transportable station that can be easily operated by anyone. A remote UAT function enables immediate communication. There are four Japanese manufacturers. It can be used for 10 years continuously, and less risk of discontinuity. HQ Blanch (2) Information Transmission System 1) Comprehensive disaster prevention information system (distributing information from central government to local governments and citizens) Although the central command system of AFAD and a comprehensive disaster system in Turkey are currently in the development phase, the following aspects are not considered sufficient: collection of information on disaster prevention at the local government level, common information distribution systems to residents within a community, decision-making support, evacuation order management, supply management, and damage prediction system. It is also necessary to raise the awareness of the Turkish government to understand the importance of information transmission to various organizations and to citizens prior to introducing an information distribution system, such as the system used in Japan. When the laws and organizations regarding disaster prevention are developed in Turkey and the responsibilities are clarified between central and provincial levels in the future, a comprehensive disaster prevention information system and a common data distribution system are expected to be required by provinces according to their sizes and needs. Disaster Information System Resource: Hitachi Solutions, Ltd HP Figure Comprehensive disaster prevention system for local governments 5-28

158 Wireless Delivery Deliver to Market, Hospital 市役所 Municipality IP Red Disaster Information Ststem Radio Internet Mobile red Deliver to Town Deliver to Home FM Radio J-Alert Remote Access Deliver to Mobile NTT 東日本資料より抜粋 Source: NTT East Figure Common data distribution system for local governments (Disaster prevention information system) 2) Emergency information transmission system (J-ALERT element technology) The project for the development of highly reliable communication infrastructure between central and local disaster prevention agencies is in development in Turkey, and this project mainly aims for the establishment of communication infrastructure. The interface technology that J-ALERT provides to transmit information from several authorities (such as the cabinet secretary and JMA) in Japan, has not yet been developed in Turkey. This Japanese technology might be useful in the implementation of an instant alarm transmission by the development of highly reliable communication infrastructure with TURKSAT satellite communications, which is under development in Turkey. National Level Regional/ District Level Cabinet Secretariat Fire Defense Agency Receive Antena Disaster prevention Control Meteorological Agency Receiver Broadcast Community FM Disaster prevention Radio Disaster Information (3) Others Source: FDMA Figure 消防庁資料より抜粋 Emergency Information transmission system The needs of AFAD are not clarified at the moment. The following items are recommended for the future proposal. 1) Flood simulation system This flood simulation system is to analyze and predict flood areas based on various data. The IT Department of AFAD acknowledged the necessity of the system and mentioned the name of the product of a specific Japanese manufacturer which they would like to use. The system can also create various kinds of hazard maps. 5-29

159 Resource: Hitachi Solutions, Ltd HP Figure ) Rivers and water resources management system Image of Flood Simulation System The IT department of AFAD showed an interest to learn from Japan regarding this system for river management, dam water discharge management, tsunami and storm surge disaster prevention, as well as landslide disaster monitoring. However, it is important to define the line of demarcation with DSI that manage the Telemetry and Discharge Alarm Systems in Turkey beforehand. Resource: Japan Radio CO., Ltd. Figure Outline of Telemetry and Discharge Alarm Systems 3) Rainfall radar Rainfall prediction in upriver regions is important for flood prediction and water resource management. For rainfall prediction, the use of multi-parameter weather radar (MP radar) as a sensing technology is extremely effective. The MP radar can predict the amount of rainfall with a high degree of accuracy, and this Japanese disaster prevention technology can be applied in Turkey. 5-30

160 Resource: Japan Radio Co., Ltd. Figure Image of Rainfall Radar Introduction of Japanese ICTs Table shows examples of disaster prevention related Japanese ICTs, as a summary of previous sections in Chapter 5. The need for such technologies is expected to grow in Turkey, since these systems and technologies have the potential to contribute to reinforcing the disaster prevention capabilities of Turkey. Table Examples of Japanese Knowledge, Experiences, and Technologies regarding Disaster Prevention Information Transmission J-ALERT Japanese Technologies Em-Net (Emergency information system) Public Information Commons Mobile One-Segment Broadcasting (Community One-Segment) Warnings by mobile phones (Area mail/cell Broadcast) (Cell Broadcast) Disaster Message Board Community FM radio broadcasting Brief Summary J-Alert is a satellite based system that allows authorities (from Cabinet Secretary and JMA via FDMA) to quickly and directly broadcast alerts of emergencies such as ballistic missile information, tsunami information, and early earthquake warning to local media and to citizens by automatically activating wireless disaster administration communication. Today, it is operated by almost all local governments in Japan. Em-Net is the emergency contact information system for governmental agencies which utilizes a local government wide area network (LGWAN). Em-Net does not act as fast as J-Alert, however, almost all local governments in Japan have installed Em-Net since the installation of this emergency information system is low cost and it allows for simultaneous delivery of push notifications. Public Information Commons is the information system to promptly provide accurate information to residents at the time of large-scale disasters. It establishes information infrastructure that shares and centralizes information between information providers such as central bureaucracy, local governments, utility providers, transportation related operators, and information communicators (e.g. mass media and mobile companies) to facilitate the distribution of information to local residents. As of Feb. 6, 2014, thirteen prefectures in Japan have installed the system, and another fifteen prefectures are considering it. Mobile One-Segment Broadcasting can disseminate the disaster information in case of power outage via TV broadcasting means, by mobile phones that are the regional limited editions of a Japanese terrestrial digital one-segment broadcasting system. In emergencies, it automatically starts up terminals and delivers warnings. The terrestrial digital broadcasting in Turkey follows the European system, but a community onesegment broadcasting system with a limited area can be successfully introduced to mobile phones in Turkey as it has been in Indonesia. Delivering warning messages such as SMS to large numbers of specific subscribers is not suitable because the line congestion may hinder message delivery. When prompt transmissions such as early earthquake warnings are required, Cell Broadcast is effective. The system is under study in Turkey. Disaster Message Board is the service provided by carriers and mobile companies to notify family and friends with safety information. There are three ways to use the service: push button style, voice recording, and written words on the Web. Community-based broadcasting stations at a municipal level that can be utilized for disaster prevention. They can broadcast the information over a wide range with small investment. They can be established on a temporary basis in the affected areas. 5-31

161 Disaster Administrative Radio System Long Distance Horn Array Speakers Remote Activation of Loud Speakers Railway stop system by detecting preliminary earthquake tremors (P-waves) System for the Prediction of Environmental Emergency Dose Information (SPEEDI) The system utilizes VHF radio to transmit pre-alarms and evacuation orders from local government facilities to local residents by sound. Direct sounds can easily transmit messages to local residents. The system is available during normal times, thus, it is effective to use it to raise the awareness of residents about disasters. Its effectiveness was again acknowledged after experiencing the Great East Japan Earthquake, but it has the shortcoming of its audibility depending on the location and environment. The sounds from horn array speakers reach far greater distances than trumpet speakers, which are typically used for disaster administration radio communications. Horn array speakers reduce investment costs and resolve the problem of echoes that makes it difficult to hear. On the other hand, they have shortcomings in that they are heavy and require more power. It is effective to use both horn array speakers and trumpet speakers in combination. This system starts up speakers in remote areas and transmits emergency messages by utilizing the radio airwaves with simple installation and low cost. The start-up using the VHF/UHF radio is more reliable, but it is costly to control a number of speakers over a wide area. It can be controlled in a wide area by overlapping speaker control signals with radio airwaves. J-Alert has achieved the practical use of automatic start-up by utilizing community FM airwaves. The automatic start-up by utilizing AM middle-wave radio has also been examined. This automatically reduces the speed and stops trains safely by utilizing P-wave sensor detective signals installed by railway companies and Early Earthquake Warnings provided by JMA. Different kinds of systems are applied by each railway company. Immediate Earthquake Alarm System (EQAS) is applied to bullet trains by JR Fast Response Equipment, while Quake Load (FREQL) is applied by Tokyo Metro. SPEEDI is the system installed by the Nuclear Regulation Authority of Japan to estimate concentrations of radioactive materials in areas around a plant, and the exposure doses based on the information of emission source, weather condition, and topography data during a state of emergency when a large amount of radioactive material is released from a nuclear power plant, or when there is a possibility of such a situation. 5-32

162 6. Project Proposals for Disaster Resilient Urban Planning 6.1. Long List of Proposed Projects The proposed projects that are expected to contribute to disaster resilient urban planning in Turkey and Bursa are listed and summarized in the project long list (Table 6.1.1). The projects are listed in accordance with five key perspectives as discussed in Chapter 4.2.2, with consideration for AFAD s current initiatives regarding disaster risk management in Turkey and the disaster risk management system in Japan. The scope of measures against disaster is broad. In order to contribute to comprehensive disaster management, each project is studied with consideration of the synergy effect among the proposed projects. Direction of possible support to disaster management sector in short, medium and long term range was taken into consideration to the project long list. Projects in the long list for Bursa province are classified into 5 categories numbered (1) through (5). Projects in the long list for the national level are classified into the categories (3), (4) and (5); because projects for category (1), Capacity Development toward Effective Disaster Risk Management are already in progress as a Technical Cooperation Project by JICA, and for (2), MOEU is already working on Urban redevelopment plan for vulnerable areas in cities. The five categories are described on Figure The project map for Bursa province is shown on Figure 6.1.2; the project long list is in Table Source: JICA Study Team based on the system of the Charter related to earthquake preparedness of the southern Kanto region directly under the "metropolitan area White Paper" Figure Framework of Project Formulation related to Disaster Resilient Urban Planning [1]Disaster Risk Assessment: Disaster risk and vulnerability assessment is recommended for the development of a disaster prevention plan; however, information for disaster risk assessment is not yet available for any of regions or provinces in Turkey, including Bursa province. Currently, JICA s technical cooperation project "Capacity Development toward Effective Disaster Risk Management is ongoing with AFAD, and AFAD has been working on information gathering and risk assessment through collaboration with relevant authorities and universities. The assessment of hazardous areas should be conducted as the first step, especially for the resilient urban planning in Bursa. 6-1

163 [2] Reduction of Disaster Risks in the Urban Areas: In Japan, Disaster Risk Mitigation is a key concept for disaster risk management. Based on this concept, the improvement of vulnerable areas that are at high risk of disaster is the second step for disaster resilient urban planning. As a result of the rapid influx of people into urban areas, along with the illegal occupation of land and unpermitted housing, highly dense and vulnerable residential areas are commonly seen in large cities in Turkey. Improvement of vulnerable areas with reinforcement or reconstruction of existing buildings and utilities are urgently required. The Turkish government has been working on redeveloping these areas in order to improve the situation. Through the enactment of the Urban Transformation Law in 2012 (Law No.6306), MOEU and local governments (metropolitan municipalities and municipalities) have been formulating or implementing urban transformation projects. [3] Formation of a Disaster Resistant Urban Structure: In order to mitigate disaster risk and make the city resilient, the formation of an urban structure that will withstand disasters is also important and should be done in parallel with efforts to improve vulnerable areas. The key components of disaster resistant urban structure are: to create centers/bases for disaster response activities (Disaster Management Complexes); to establish an emergency road network and resilient infrastructure; to strengthen the airports and ports; to secure evacuate routes; etc. In addition, it is important to build a DMC network connected by an emergency transport road network and to secure alternative transportation routes by land, sea, and air to ensure that routes to receive support and supplies are available when needed. [4] Disaster Management System Development: In order to realize the above mentioned measures, the development of a disaster risk management (DRM) system is required. This includes many supporting components, such as institutional development, legislation arrangement, disaster response system development, human resources development, etc. [5] Enhancement of Public Awareness regarding Disaster Risk Management: In Japan, the concepts of self/mutual/public assistance in disaster prevention and response are widely recognized. Sound knowledge of historical and potential disasters and disaster prevention and sufficient preparation are crucial to mitigate damages before a disaster even occurs. In addition, enhancement of the capacity of community organizations and volunteer activities are also important components. The list of proposed projects for the five categories above address essential elements to enhance the resiliency of Turkey s society, based on our understanding of the current state of Turkey s existing disaster risk management and disaster resilient elements, as well as Japan s experience and expertise. While formulating the list of projects, expectation of multiple effects by combination of various kinds of aspects were also kept in mind. To make disaster prevention mainstream and to incorporate disaster prevention into ordinary construction, projects of buildings and infrastructure were considered, and construction of hospitals, schools, and incineration plants are included as elements of disaster management complexes (DMCs). 6-2

164 From a long-term urban planning perspective, projects were prioritized according to their necessity and urgency. This long list is intended as a roadmap to lead to a disaster resilient urban plan in the future. In the process of formulating the proposed project long list, information was shared with the JICA technical cooperation project Capacity Development toward Effective Disaster Risk Management team, for use in the output of their project. 6-3

165 Figure Map of Long Listed Proposed Projects 6-4

166 National Level Table Proposed Projects Long List 3. Disaster Resistance Urban structure Category 1 Core DMC(Disaster Management Complex) 2 Transportation 3 Strengthening of disaster medical structure Project Current Situation Proposal and Impact 1-1. Development of a network at each level of distaster management plans 2-1. Development of an emergency road network and operation regulations at the national level 3-1 Developement of emergency medical information system 3-2 Improvement of the guideline for hospidal disaster plan There is a disaster management plan at the national level, but the management plan in consideration for their relevance and disaster management planning regional level, provincial and municipal level can not be found. AFAD are planning to building 27 logistic centers to store emergency goods. According to the national response plan, neighboring provinces will support each other in case of a large scale disaster. On the other hand, there is no plan to secure the transportation system for delivery of the emergency goods It is possible for MOH and the provincial DOH to check the vacancy and capacity of each hospital's room including ICU and CT through internet. However, in case of disaster, they cannot have information especially related to each hospital's damage level. Proposal To create the content and disaster prevention base hierarchy of neighborhoods to unit level from the national level. ((Tentative name) disaster-prevention facility maintenance manual) Impact To understand the need and the amount of stockpile items necessary for different levels of up to Neighborhood unit level from the national level, and disaster prevention base. It should be reflected that the regional disaster prevention plan. Clarifying the priority maintenance shelters and evacuation routes are also included in it. Proposal Development of emergency road network by specifying the emergency road which is composed of the main road connecting to airport, seaport and logistic centers. Improving the road network by upgrading bridges and landslide prevention and creating the necessary regulations and operation procedures Impact Securing the delivery of emergency goods to the disaster area Proposal To develop a medical information sharing system in case of disaster through a website similar to the Japanese EMIS in order: 1To provide citizens with information through a website 2To provide with each hospital' information specialised in case of disaster Additionaly, a backup system at the national level needs to be provided. Impact By sharing information among all hospitals and each UMKE, information will be communicated quickly and countermeasures against disaster will be implemented faster. In daily use, local medical information can be provided to citizens through the portal website. An information backup system will prevent information loss. A guideline for hospital disater plans is Proposal To prepare the guideline for provided to the provincial health office hospital disaster plan specifying roles of by MOH. However, roles of each each hospital and proposing a supply hospital and cooperation system of storage plan, and a patient transfer hospitals during disasters are not method. clear. Impact By specifying the method of providing the medical services according to each provincial level, the application of facility plan depend on the hospital level becomes concrete in preparation for disaster. And cooperation of each institution can be strengthened beyond provinces. Implementing Organization AFAD High High 50.0 AFAD Med High MOH MOH Urgency Importance Rough Estimate Cost US$ Project Implmentation Period

167 4. Disaster Management System Development 4 Disaster and emergency training center for professionals 5 ICT Category Project Current Situation Proposal and Impact 4-1. Upgrade of Disaster and Emergency Training Center (AFADEM) for Professional/Government Staff 5-1. Satellite communication system AFAD has requested upgrade of training facilities for professionals involved in search and rescue. A development project of a highly reliable communication infrastructure that connects the central level and provincial level disaster & emergency management centers/agencies across the country. A combination of redundant VSAT (using satellite TURKSAT), optical fiber, GSM cell phone, UHF, HF etc, and to build a reliable communication infrastructure. Regarding to satellite communicationsystem, the project is on the way (installation of 500 fixed base stations and 200 mobile stations) Proposal Upgrade of disaster and emergency training center Impact Promotion of human resource development for search and rescue Proposal Uninterrupted and Secure Communication System (KGHS) plan that AFAD proceeds has a plan to procure 700 VSTA earth stations for three years from 2015 to Impact It's avilable to provide real time infomation between centaral and each provice of AFAD in case of disaster Although central command system of Proposal Establishment of a platform for Information transmission system AFAD and comprehensive disaster information system are under development, collecting information on disaster prevention at the local information collection and transmission in case of disaster Impact Mitigation a damage in case of disaster government level, decision-making support, evacuation order management, supply management, and damage prediction support system are not considered sufficient yet. Implementing Organization AFAD High High 15.2 AFAD High High 80.0 AFAD High High Enhancement Awareness on Disaster Management Urgency Importance Rough Estimate Cost US$ Project Implmentation Period Category Project Current Situation Proposal and Impact 6 Disaster education center for citizens 7 Research & Development institution 6-1. Construction of disaster education center for citizens 7-1. Establish data base and archive system 7-2. Establishment of R&D institute for policy making Disaster prevention experiencelearning facility is open in Bursa Information has not been integrated. R&D activity is conducted at earthquake section of AFAD Proposal Establishment of disaster education center Impact Increase in citizen's awareness of disaster prevention Proposal Integration and archive of information stored in university, related government and etc. Impact Effective provision for disaster Proposal Establishment of R&D center for comprehensive research activity on disaster prevention Inpact Information archive and technology development for disaster prevention and mitigation Implementing Organization Urgency Importance Rough Estimate Cost US$ AFAD High High 22.0 AFAD High High 50.0 AFAD High High 19.4 Project Implmentation Period

168 Provincial Level 1. Risk Assessment Category Project Current Situation Proposal and Impact 1-1 Risk Assessment Seismic risk assessment for buildings and utility infrastructure Bursa carried out a seismic risk Proposal Risk assessment for buildings, roads, bridges, utility assessment for buildings in But infrastructure for a design earthquake the population, land use and building Impact The risk assessment results can be used in the structure from that time are different disaster prevention plan, the development of disaster from now and it is difficult to apply the prevention facilities, and the determination of a disaster results for the disaster plan now. prevention target There are 14 seismic ground Development of seismic observation stations in Bursa, but no observation technology for observation on structures critical buildings and bridges for real time damage assessment Landslide risk assessment Assessment of Supply Chain and Logistic Route Simulation and analysis of emergency wide area transportation for province level Seismic performance assessment and strengthening of dam Many buildings were built on the slope of mountains and there is a possibility of big damage in case of landslide during an earthquake. The active fault may be under the slope and the movement of the fault may also trigger a landslide. With regard to the export of manufactured products in Bursa, the ratio of container shipping is 85% of the transport by sea through the Gemlik port. Therefore, regarding transport from the factory, factory stakeholders have recognized that the main road to Gemlik port is very important. However, currently, there is only one main road from Bursa center to Gemlik. It is hard to say the road network of bursa is enough and the traffic is concentrated on Ankara-Izmir road. The limited road network has many grade separation and mountain road. The information of road damage is important, but now the information is rely on the report of local residents There are two dams on Nilüfer river. One is Doğancı dam and the other is Nilufer dam. The dam were built 20 years ago and it is necessary to make the risk assessment Proposal Seismic observation for critical structures of city hall, disaster base hospital, Emergency operation center and bridges on emergency road Impact The observation in ordinary time can be useful to understand the vibration characteristics of the structure and that after the disaster is useful for rapid damage assessment Proposal Slope stability assessment not only for strong ground motion but also the movement of fault Impact Knowing the risk of landslide and prevention measures could mitigate the disaster caused by landslide Proposal Prepare to create the disaster preparedness plan by assessment of supply chain and logistic route status from each factory to Gemlik port and to Istanbul or Ankara by land. Impact Reducing the impact on the economy in Bursa in times of disaster by reducing the expected duration the factory production is stopped. Proposal Conduct traffic simulation with considering the traffic volume and road damage during a disaster. The improvement of road and traffic regulations will be made based on the simulation results. A monitoring and alarm system will be established for automatic inspection and assessment of unusual situation Impact From traffic simulation, the problems for road planning and emergency use could be found and useful for the determination of alternative road, traffic control in emergency case Proposal Seismic performance assessment by dynamic response analysis and strengthening if necessary Impact Damage prevention of dam Implementing Organization AFAD High High AFAD Med Med AFAD Low Low AFAD MOSIT MOTMA C Urgency High Med 2.0 Med Importance Med DSI High High Rough Estimate Cost US$ Project Implementation Period # Liquefaction susceptibility assessment Risk Assessment for Tsunami The ground water level is high in Bursa and the possible liquefaction area has been estimated, but not given the rank of the possibility There is no concrete measure for tsunami, though there are some risk assessments for tsunami in the sea of Marmara. Proposal The liquefaction risk is estimated for a scenario earthquake by PL value and zoning the liquefaction with high, medium and low susceptibility Impact Promotion of countermeasures for liquefaction in building construction Proposal Simulate tsunami height including upstream calculation in the case of earthquake caused by the fault of the bottom of the Marmara sea. By using calculation of height of tsunami, evacuation from tsunami is simulated and site and route for evacuation are analyzed. Effect Evacuation route and space can be improved properly and damage of human resources can be reduced by knowing height of tsunami and the flow of people in disaster. AFAD Med High AFAD Med Med 6-7

169 2 Mitigation of Disaster Risk in Urban Area Category Project Current Situation Proposal and Impact Redevelopment of risky Redevelopment of Risky Area 2-3. Seismic strengthening of water supply facilities, pipelines and joints area based on the result of risk assessment Seismic strengthening of non-structural part for school 2-2. Development of School 2-4 Establishment of Disaster Base Medical Center in the city center 2-4 Establishment of Disaster Base Medical Center in the city center 2-5 Retrofitting of Existing Building Seismic strengthening of structural member for school Seismic resistant school model project Seismic strengthening of water supply facilities, pipelines and joints Development of remote emergency gas shutdown system Installation of key facilities for smart city Enhancing seismic performance of hospital buildings by introducing seismic isolation Anti-earthquake measures for non-fixed components Seismic upgrading of buildings of central and local government Anti-flood Maintenance and widening measures for of existing rivers existing rivers Urban Transformation is in progress according to the law of urban transformation. Proposal Urban Transformation includes DMC Impact To improve disaster preventing function of urban area MOEU /Municip High alities Seismic strengthening has been Proposal Upon confirmation of existing school situation, completed for most of schools in Bursa seismic strengthening shall be done if necessary by method according to Ministry of National which will not interrupt school activities. Education (MONE) Bursa provincial Impact It is expected that school is recognized as safe space office. and utilized as neighborhood disaster management base and However, according to MONE most of evacuation center. school does not meet the standard. According to MONE Bursa provincial office, seismic strengthening of nonstructural part such as ceiling, wall, door and window has not been conducted nor planned. School Campus Project is implemented Proposal Construction of school in consideration of seismic as PPP project by MONE which resistant structure and non-structural part, plan as evacuation transfer schools (about 8 schools) to center, water reservoir and stockpile in School Campus Project suburb. High school will be transferred and Urban Transformation Project. and remaining building will be used as Impact Safety of students will be secured in case of disaster primary and junior high school. Urban during school activities and neighborhood can evacuate to Transformation Project includes school. Redevelopment will be more effective through not only development of public facility such as new construction of residential apartment but also school. school. The water supply pipelines are metal pipes but whether or not the joint is seismic resistant is unclear. The seismic capability of water process facilities is necessary to be assessed High MONE High Med - MONE Low Low - MONE Low Low - BUSKI Med Med The seismic performance of gas Proposal Development of seismic disaster prevention system pipelines of Bursa has been considered. based on the real time monitoring and remote shutdown The whole supply area is divided into system of Tokyo gas Co. BursaGa 159 sub-areas. The shutdown of the Impact Real time earthquake disaster assessment and z High Med sub-area in case of a disaster or remote shutdown for affected area. incident is made manually now. Currently, DHC (District Heating Cooling) plant for smart city is not constructed in Bursa. Proposal Optimize energy demand and supply inside district, and use reserve energy in DHC for emergency case. Impact Diffusion of combination system to achieve energysaving Med Med and emergency preparation. The guideline of MoH requires that hospital buildings with 100 or more beds should be seismically isolated. Comprehensive and complete design standards for seismically isolated buildings are not provided in Turkey. Types of isolation devices actually used in Turkey are very limited. Proposal Realize more reliable seismically isolated buildings applying the technologies of Japan concerning: earthquake ground motion simulation; evaluation of performance and diversification of isolation devices; systematic approach for inspecting and maintenance activities.; use of non-structural building components and MEP equipment harmonized with isolation systems etc. Impact Promote hospital buildings with enhanced robustness MOH High Med and high reliability for business continuity. By constructing a model hospital building focusing medical activities after disastrous earthquakes in Bursa which is one of the most risky district for seismic action in Turkey, facilitate public recognition and activities for developing disaster management hospitals in the whole country. The anti-earthquake measures to nonfixed component, such as non-structure components on the basis of Japanese experience and Proposal To provide anti-earthquake measures for non-fixed elements, medical equipment and furniture are under examination in Turkey. Seismic assessment and retrofitting have been conducted in accordance with the 2007 seismic design code. Areas at high risk of flooding are being identified. River works are already underway in Bursa. Proposal Upon confirmation of existing school situation, seismic strengthening of non-structural part shall be done if necessary. Strengthening of ceiling and equipment fixing method done in Japan shall be proposed Impact It is expected to reduce the damage to student and teacher and school can be utilized as evacuation. Right after disaster. Proposal Seismic strengthening of water process facilities, pipelines and joints Impact Securing water supply in case of a disaster experiment. To train on the basis of actual situation of each hospital. Impact Realize the measures on the basis of each hospital situation and the secondary damage to people and other things can be prevented. Implementing Organization MOH High High Proposal Introduce products and construction methods developed in Japan in addition to those existing in Turkey Effects Facilitate upgrading work by increasing the variety MOEU in adoptable products and construction methods. By providing /Municip High an model application in Bursa which is one of the most risky alities district for seismic action in Turkey, facilitate the movement in the whole country. Proposal Mitigating risks of flooding by creating drainage channels from flood prone areas Impact Mitigating the damage of flooding in the urban district and farmland of Bursa Urgency Importance High DSI Med Med Rough Estimate Cost US$ Project Implementation Period # 6-8

170 3. Disaster Resistance Urban structure Category Project Current Situation Proposal and Impact Formulation of Formulation of Disaster Disaster Resilient Urban Plan Resilient Urban Plan 3-1 Establishment of Regional/Provin cial Disaster Management Complex 3-1 Establishment of Regional/Provin cial Disaster Management Complex 3-2. Establishment of DMC Disaster and emergency management center Logistics center Establishment of regional disaster and emergency training center for professional/government staff Disaster Base Medical Center Heliports for disaster prevention bases and medical centers Waste incineration plant with power generator Construction of well and water tank for water supply in disaster Securing power supply by emergency power equipment for wide area disaster mitigation facilities Establishment of sports center in regional/provincial DMC There is no urban plan based on the Proposal Formulating a masterplan for urban development disaster risk assessment. It is difficult with concept of disaster resilience. to expect upgrading urban area's Impact Efficient urban development will be implemented to capacity of the disaster risk realize a disaster resilient city. management. There is a plan to establish disaster and emergency management center in AFAD Bursa but not yet realized. AFAD is currently developing a system to deliver relief supplies stored in containers as needed. A container terminal will be installed in a suburb of the west. There is a simple training facility in Bursa. Functions of Disaster Base Medical Centers are not specified as Japanese ones in Turkey. Although AFAD is equipped with a heliport, there are no medical centers with a heliport (or adjacent to a heliport). There is no waste incineration plant in Bursa but landfill. It is necessary to secure water supply for daily life and fire fighting in case of disasters. Bursa is rich in underground water. The emergency water supply by well is a realistic and economic way. Power supply will be automatically stopped when sensors in transmission system cached the signal of earthquake, this will lead to the power stop of disaster prevention facilities and hospitals no matter whether the power system was damaged or not. Sports center as disaster management base in coordination with other facilities has not been planned Disaster prevention park as regional Development of park/open disaster management base or widearea evacuation place has not been space in regional/provincial DMC developed Construction of facilities related to Disaster Risk Management (1-1-4 と同じ ) Disaster medical base hospital Reinforcement of public port in Gemlik Seismic resistant school model in district DMC Establishment of sports center in district DMC Several types of disaster related organizations exist in several levels. The standard for a disaster medical base hospital in Turkey has not been clearly defined as the one in Japan. Although a small wharf exists, earthquake protection and other necessary measures are not fully implemented. School as disaster management base in coordination with other facilities has not been planned. Sports center as disaster management base in coordination with other facilities has not been planned. Proposal Establishment of regional/provincial disaster and emergency management center as the central facility of Disaster Management Complex (DMC). Impact Improve of regional response to wide-area disaster. Proposal In the wake of large scale disasters, a large number of rescue teams and supplies are sent to disaster affected areas both from home and abroad. In order to deal with the situation, a logistics center to supplement AFAD's container approach will be developed at disaster prevention bases that are set up at airports, ports, and roadside of emergency transportation routes. Impact Smooth, quick, and accurate temporary storage and shipping of emergency aid supplies (e.g. medicines, papers, blankets, other daily necessities, food, water). Proposal Construction of regional disaster and emergency training center and development of training program, curriculum and training material for various disasters. Impact Trainer trained at AFADEM will instruct at each regional training center and promote disaster prevention training at regional and provincial level. Training for regionspecific disaster will be conducted effectively. Proposal Although it is a new concept in Turkey, introduction of the concept of "Disaster Base Medical Center" is proposed and the model hospital will be constructed. Impact By specifying functions and facility content of disaster base medical center, facility arrangement will be specified and ensured. By cooperating with non-medicalrelated facilities, disaster base medical center will take measures more effectively and rapidly against disaster in the Disaster Management Complex. Construction of medical facility in Bursa, model province for disaster measures, has great significance as a model case of cooperation between facilities. Proposal Building a heliport at disaster prevention bases Impact Since disaster prevention bases will be equipped with medical centers, rescue efforts using a helicopter will be possible. Proposal Construction of waste incineration plant with power generator in DMC instead of landfill. Impact The plant is able to supply electricity to DMC in disaster. Proposal Construction of wells around disaster prevention facilities, hospitals and tent cities and underground water tank for densely populated area. Effects Securing water supply in case of a disaster. Proposal Preparation of emergency power generation equipment for disaster prevention facilities and hospitals. Impact Securing continuous functioning of disaster prevention facilities and hospitals by emergency power generation equipment in case of a disaster. Proposal Construction of sports center in regional/provincial DMC (athletic field, gymnasium and swimming pool) Impact In disaster, sports center can be utilized as evacuation place and storage of relief supply. Proposal Development of disaster prevention park in regional/provincial DMC. Impact Open space can be utilized for multipurpose in disaster. Proposal Allocate disaster related facilities (Fire Station, AKOM, Police Station, 112 Station, Station of Civil Defense, etc.) in DMC for smooth coordination and collaboration among them. Impact Smooth collaboration in relief effort and realize efficient relief activities. Proposal 1. To ensure implementation of disaster medical base hospital by clearly defining the functions and facility standards. 2. To collaborate within a group of buildings in the neighborhood of disaster base hospital in order to enable effective quick response actions to a disaster. Effect It is meaningful for development of disaster medical base hospital in Turkey to set a model case of collaboration within a group of buildings in the neighborhood of the disaster medical base hospital in the model city, Bursa, and clearly define their functions. Proposal Widening and earthquake resistance improvement of public port in the vicinity of the urban district of Gemlik as well as construction of parks that will serve as bases to receive aid supplies in the wake of disasters and disaster prevention parks for Gemlik residents. Impact Establishing bases to receive aid supplies when incidents related to petroleum or chemicals occur at the side of commercial port during disasters. Proposal Construction of school in consideration of seismic resistant structure and non-structural part, plan as evacuation center, water reservoir and stockpile in district DMC. Impact School in district DMC can be utilized as evacuation center, triage space, ward and storage and distribution of relief supply in coordination with other facilities. Proposal Construction of sports center in district DMC (athletic field, gymnasium and swimming pool) Impact Sports center can be utilized as evacuation place and storage of relief supply. 6-9 Implementing Organization AFAD Med High AFAD High High 14.8 AFAD High High 1.3 AFAD High High 15.2 MOH Med Med AFAD High High 2.2 Metropoli tan Municipa lity BUSKI Metropoli tan High Municipa lity AFAD MOH Med High High High High Metropoli tan Municipa lity MOYS Med Med 7.6 MOEU High High 24.3 AFAD Police MOH Etc. Med High 6.8 MOH Med High MOTMA C Urgency Importance Rough Estimate Cost US$ High High MONE Med Med 2.0 Metropoli tan Municipa lity MOYS Med Med 7.6 Project Implementation Period #

171 Establishment of evacuation sites at the neighborhood level and Storage of survival 3-3. equipment and supplies Establishment of Neighborhood DMC The development status of parks and Mahalle centers differs depending on each Mahalle. However, there is an insufficient stored supply of water and food and an overall insufficient number of secured open Proposal Building neighborhood parks and Mahalle centers (including a supply warehouse) at each Mahalle. If there is Kulliye in the neighborhood, open spaces and meeting spot are established around the Mosque. Impact Raising awareness towards disaster prevention at the Mahalle level and using the facilities as disaster prevention space and other evacuation sites where bases. The facilities will function as convention facilities at a large number of people can evacuate. the neighborhood unit level during normal times and as disaster prevention bases (evacuation centers, logistics centers, information hubs) during disasters. Securing bases for systemic disaster prevention activities (rescue, evacuation) in the wake of large scale disasters. Municipa lities Med High 3-4. Establishment of emergency road network 3-5. Seismic performance assessment of main facilities Traffic congestion happened in 1999 Development of emergency Kocaeli earthquake on the road to road network and operation disaster area. There is not a concrete regulations for province system to securing the smooth traffic level during disaster There are a number of narrow road in Seismic strengthening and central area of bursa and the set-back of buildings possibility of blockage due to the along emergency road collapse of buildings Seismic performance upgrading for bridges, intersections and retaining walls Landslide prevention for emergency road network Road widening and seismic strengthening of buildings for the emergency road around DMC The degradation of pier of the bridge on Ankara Izmir road can be confirmed by eye-inspection. There needs seismic assessment for the bridges, intersections and retaining walls on the emergency road and the seismic strengthening, if necessary. The landslide possibility within Bursa city is considered small. Some of the roads to neighbor cities are in the mountain areas. The assessment of landslide possibility along the road is necessary Some of the roads around Component C are narrow and many on-road parking, which may lead to difficulties of emergency vehicles during a disaster The access to the main road (Ankara- Improvement of emergency Izmir road, Mudanya road) is limited road network by increasing grade crossing and crossing Seismic performance assessment and strengthening of subway station and tunnel Seismic performance assessment and strengthening of bus terminal Support for creation of the BCP plans at industrial park Assessment of Introduction of the Fast Infrastructure Response Equipment against Quake Load (FREQL) system Disaster Information Establishment network of Disaster ICT Network 3-8 Establishment of Early warning system Redevelopment of existing roads and establishment of round roads in the sloped urban area Introduction of a transportation system to the sloped urban area Introduction of independent earthquake alarm equipment for critical facilities The roads for access to the slopes of the city generally do not have adequate width for traffic demand from the city, and have been chronically congested. The number of roads that can be used Proposal Introduction of the slope car or mini monorail in the for emergency supplies and evacuation sloped urban area routes is limited Impact In the event of disaster, it is utilized to transport emergency relief supplies and the ill and injured. Public transportation is especially important during disaster because the road damage and the limitation of road use for general vehicles. For the handling of hazardous materials such as gas, chemicals, and poison, etc., it is managed by the provisions of the Ministry of Labor and Social Security. However there is no plan to measure of secondary disasters in factory. Metropoli tan High Municipa High 3.9 lity High High Metropoli tan Municipa Med Med 1.3 lity Metropol itan Municip ality Municip alities AFAD MOSIT AFAD MOSIT High High Med Med High Med Med High 0.4 Med Med 21.9 High Med High Med Med Med 2.0 Med Med 1.0 Radio system is used for internal communication of province section (AFAD, MOH, Municipality and etc.) Proposal Establishment of information network connected to AFAD satellite communication system and early warning system that are developing. AFAD High High 2 Impact Prior to all provinces, establishment of early warning system in Bursa. Bursa has a high seismic risk and the earthquake alarm is impotent for disaster mitigation. Although AFAD has a pilot project for earthquake early warning, the development of whole system for turkey needs a long time. Proposal Development of emergency road network by specifying the emergency road which connects important disaster prevention facilities and operation regulations for the network Impact Securing the smooth traffic of vehicles for search and rescue, ambulance, firefighting. Proposal Seismic performance assessment and strengthening of building along the emergency road to prevent the collapse Impact Avoiding blockage of emergency road Proposal seismic assessment for the bridges, intersections and retaining walls on the emergency road and the seismic strengthening Impact Securing the function of emergency road Proposal Landslide susceptibility assessment for wide area emergency road and widening or construction of retaining walls in the case of necessity Impact Securing the function of emergency road Proposal Estimating traffic volume around DMC during disaster and road improvement to secure the access to DMC (widening, seismic strengthening of buildings along road) Impact secure the access to DMC Proposal Improvement of the access among emergency road and the other road to secure the access to emergency in case of disaster Impact Securing the function of emergency road Proposal Espansion of the width and linearity in the sloped urban area of the city. Development of round roads. Removal of dead end roads. Impact Improvement of smoothness and capacity of the emergency vehicle traffic. Proposal Seismic performance assessment and strengthening of subway station and tunnel Impact The improvement of public transportation system will provide efficient transportation means for general public in disasters Bursa bus terminal has a large building Proposal Seismic performance assessment and strengthening and large parking space. The bus of bus terminal terminal is the transportation center for Effects Smoothing the transportation, store and distribution neighboring cities. The terminal building of emergency materials in case of the large scale disaster and parking space can be used as the base for receiving and distributing the support materials Many Industrial parks in Bursa do not Proposal Create a Business continuity planning (BCP) for have a BCO. Therefore industrial park, each industrial park. supporting BCP is needed. Impact Reducing the impact on the economy in Bursa by reducing the impact of stopping the factory production and supply chain disruptions is expected. Proposal Introduction of FREQL system which is combined alarm and sensor function. This system when it was sensing a shake, alert without waiting for the information from the state. Impact By BCP a measure in factory is possible to quickly, minimizing the impact of production activities is expected. Further, to minimize the effects of secondary disasters in factory that is handling gases, chemicals, and toxins. Proposal Introduce independent earthquake early warning equipment (FREQL) for hospital, school as well as important disaster management facilities Impact Disaster mitigation by evacuation, emergency stop of dangerous material processing facilities AFAD Med Med 6-10

172 3-9 Arrangement of disaster medical information system Improvement of hospital disaster plan Prevention of medical information system's functional decline and shutoff Development of emergency medical information system Roles of each hospital and cooperation system of hospitals during disasters are not clear. MOH Med Med Back up of medical information such as Proposal Build the backs up system of medical information electronic medical records are kept in the same hospital or at a data center nearby. such as electronic medical record, etc., bilaterally by each hospital or the remote place, so that the function of each hospital may not decline or shutoff in cease of disaster. MOH Med High Impact Medical services will be continued in damaged area by protecting necessary medical information including patient information. It is possible for MOH and the provincial DOH to check the vacancy and capacity of each hospital's room including ICU and CT through internet. However, in case of disaster, they cannot have information especially related to each hospital's damage level. Proposal To specify roles of each hospital and propose stockpile plan, patient transfer method, staff training and cooperation with related facilities based on damage estimation. Impact Application of facility plan and training by making a healthcare plan become concrete in preparation for disaster. And cooperation of each institution can be strengthened. Proposal To develop medical information sharing system in case of disaster through website such as Japanese EMIS. Concretely, the function below need to be added. 1To provide citizens with information through portal website 2To provide with each hospital' information specialized in case of disaster Additionally, backup system at the national level needs to be provided. Impact By sharing information among all hospitals and each UMKE, provision of information will be fast and counter measure against disaster will be faster. In daily use, local medical information to citizens can be provided through portal website. By information backup system, information loss by any possibility can be prevented. MOH Med Med Designation and Designation and development of development of evacuation regional/provincial level space evacuation place Wide-area evacuation place has not been designated. Proposal Designation of several parks as wide-area evacuation place and install necessary facility such as storage MOEU for stockpile and seismic resistant water reservoir Municipa High Impact temporary evacuation place for neighborhood from lity building collapse, fire, flood, etc. will be secured. High 4. Disaster Management System Development Category Project Current Situation Proposal and Impact 4-1. Institutional Capacity Institutional development for strengthening disaster management system Legislative Arrangement Development of guidelines for disaster prevention activities Development of emergency evacuation plans and Identification of safe evacuation routes Creation of Sustainable Supply chain and Logistic Plan and Manual Assessment of industrial area in terms of disaster management, and improvement. And creation of BCP Rescue activity plans for ports operated by companies Organizational structure of AFAD has been modified. Strengthening of the cooperation system between AFAD and ministries, provincial governorates, related authorities, and municipalities is necessary Disaster response activities are Proposal Establish legislative code of conduct for planned basically to be provided by the government and citizens. government in Turkey. There is no code Impact Relief activities by the self-help and mutualsupport will be implemented legally in order to cover the of conduct in the event of disaster in Turkey. It is said that public awareness portion that can not be covered by the government like AFAD. on disaster prevention and mitigation is relatively low. Some of medical and industrial facilities (e.g. large plants, port facilities) have developed disaster prevention plans and taken action for BCP. However, these are self contained plans and lack collaboration or mutual support with neighboring facilities. AFAD High High Med High AFAD Med High Action guidelines for disasters are not Proposal Developing action guidelines for disasters published. Impact Presenting appropriate action guidelines for disasters High High will mitigate the damage during evacuation. Evacuation routes during disasters have not been identified. Whether buildings located alongside roads that can be used as evacuation routes are earthquake resistant or not is unclear. Proposal Designating roads with a low risk of fire or building collapse that lead into evacuation sites as evacuation routes during disasters. Securing safety of roadside buildings including their earthquake resistance. Impact Raising awareness towards evacuation routes during AFAD High High disasters will mitigate the damage during evacuation. Reducing the danger of obstruction of evacuation routes will increase the safety of evacuation and certainty of rescue efforts. There is no plan to assessment for current status confirmation of the supply chain and logistic route in disaster There is no plan to create of Sustainable Supply chain and Logistic Plan and BCP for each factory Use of commercial ports for the purpose of disaster prevention activities during disasters is stipulated under the law. Three out of six commercial ports in Gemlik can be used for disaster prevention / rescue activities during disasters, Operation system of school as Preparation of manual for evacuation center has not been school as evacuation place established. Proposal Strengthening provincial AFAD, establish a system to coordinate with neighboring provincial governorates and related organizations. Impact Smooth operation of disaster response activities will be realized. Proposal Developing guidelines for disaster prevention / mitigation with eyes to regional disaster prevention activities including mutual support at local communities to supplement public support provided by the government including the handling of people who are unable to go home and assisting disaster victims. Impact Stockpiling by medical and industrial facilities and temporary use of facilities will increase the capacity of emergency response to disaster victims in surrounding urban areas. Proposal Create a plan and manual for securing the supply chain and logistic route in disaster. Impact Reducing the impact on the economy in Bursa by reducing the impact of stopping the factory production and supply chain disruptions is expected. Proposal Create a disaster preparedness plan and BCP for each factory. Impact Reducing the impact on the economy in Bursa by reducing the impact of stopping the factory production and supply chain disruptions is expected. Proposal Evaluating the danger of three commercial ports in Gemlik and developing plans for the use of the ports during disasters. Impact Clarification of facilities owned by private commercial ports and cooperation plans for disasters will enable smooth action during disasters. Proposal Preparation of operation and management manual for school as evacuation place Impact Confusion of evacuation place can be avoided Implementing Organization Urgency MOSIT Med Med 2.0 MOSIT Med Med 2.0 Med Importance High Rough Estimate Cost US$ MONE Low Low - Project Implementation Period # 6-11

173 4-2. Emergency Response Plan 4-3. Provision of Disaster Information Development of a debris removal management system Stockpiling emergency food and daily necessities Prevention of information overload through use of mass media As mentioned above, progress has been made in the removal of debris as part of rescue efforts. However, no measures have yet to be taken for a large volume of debris caused by large earthquakes. There does not seem to be much encouragement for people to make voluntary efforts to stockpile water / food. Since a large number of houses are expected to collapse in the wake of large earthquakes, even if progress has been made in the voluntary stockpiling of water / food, it is unlikely that the stock can be utilized. Proposal Engaging in coordinated and systematic processing of debris through predetermined methods with eyes to the recycling of debris. (development of plans for debris removal and system for managing the plans) Impact Early removal and processing of debris is expected to speed up the recovery. Proposal Simultaneously achieving: (1) improvement of earthquake resistance of houses, (2) promotion of stockpiling of water / food at the household and corporate level, and (3) stockpiling of water / food in the public sector to the extent possible. Stockpiling a large volume of emergency food by creating stock warehouses at disaster prevention bases. Installing disaster prevention well to ensure water supply in disasters (private power generator, purification equipment). Impact Stockpiling water / food in preparation for disasters will prevent unnecessary panic during disasters, facilitating calm evacuation and survival of disaster victims. MoEU Med Med AFAD Med Med There does not seem to be a Proposal Central information management by the Control framework to centrally manage Center installed at DMC. information on disasters. Impact Delivering accurate information on disasters to AFAD Low Med reduce confusion at disaster affected areas. 5. Enhancement Awareness on Disaster Management Category Project Current Situation Proposal and Impact 5-1. Development of Disaster Prevention Educational Facilities 5-2. Creation of Leaders for Disaster Risk Management in the Society 5-3. Enhancement of Community Resistance to Disaster through Social Education Preparation of Disaster Prevention Education Facilities and Materials for the Disaster Risk Management Training Center Development of Training Programs of Governmental Staff of Municipality Training Governmental Staff and Community Members through the P Development of Community Level Education and Training Development of Training Programs for Community Leaders Enhancement of the Community Capacity for Disaster Management Disaster Prevention Education for Citizens is planned and conducted by AFAD Search and Rescue Team. Training programs of governmental staff of municipality is planned and conducted by AFAD Search and Rescue Team. Disaster education and training at mahalle level is made by mahalle As training programs and activities for bringing up disaster prevention leaders at community level are prepared by each districts, implementation status are different from each district. As formulation conditions of disaster prevention structure are different from each district, capacity for disaster management is not enough. Proposal Preparation support for disaster prevention program and curriculum which offered in Education Center for Disaster Prevention in Bursa. Impact Enhancement of disaster prevention consciousness will be achieved through Education Center for Disaster Prevention and schools in Bursa. Proposal Training programs of governmental staff of each municipalities which revised in cooperation with AFADEM are conducted Impact Governmental staff of municipality who can manage disaster risk will be made. Impact Governmental staff of province, metropolitan and district municipality can be trained. Proposal Disaster education and training programs at community level planned by province level. Impact Capacity building of disaster risk management of community can be developed. Proposal Making plan and training program for disaster prevention community leaders and practice in a strategic way. Impact Disaster prevention community leaders are selected and grow up. Therefore, disaster prevention activities in community are forwarded. Proposal Preparation support for construction of disaster prevention structure and disaster management manual. Impact Disaster management in mahalle level can achieve disaster mitigation by formulating disaster prevention structure in community level and performing preparation activity of the evacuation planning and the disaster management. Projects with high emergency and importance are shown in red. Implementing Organization AFAD High High AFAD Med High AFAD AKOM AFAD AKOM AFAD AKOM Urgency Med Importance High Med High Med High Med Med Rough Estimate Cost US$ Project Implementation Period # 6-12

174 6.2. Selection of Priority Projects Projects highlighted in red in Table (high emergency and importance)were evaluated and prioritized according to the following criteria: (1) their expected contribution to disaster resilient urban planning and (2) their relative feasibility. These criteria were applied in two areas as detailed below: [1]nationwide projects and [2]projects in Bursa. Table Criteria for Shortlisted Project (1) Expected Contribution to Resilient Urban Planning (2) Feasibility of the Project Effectiveness :Expected to contribute to the formulation of disaster resilient urban plans. Collaboration with other projects or contribution to the realization of disaster resilient urban plans. Urgency: Necessity to be implemented in the earliest stage, at the earliest time. Implementation Agency: Implementation agency and its capability: availability of human resources and technical level Maturity of the Project Maturity of the project, intentions of the Turkish side, and consistency with AFAD s plan. Project Cost: Approximately estimated project cost Technical Feasibility: Availability of technology or knowledge in Turkey or Japan. (1) Expected Contribution to Disaster Resilient Urban Planning 1) Effectiveness This criterion assesses the degree of contribution to the Disaster Resilient Urban Planning in Turkey for [1] nationwide projects and [2] case study projects in Bursa: [1] Nationwide Projects a) Projects expected to contribute to strengthening the disaster and emergency management system targeted in the TAMP (Turkey Disaster Response Plan). In particular, projects expected to support AFAD s role of coordination with the relevant authorities at the national and provincial levels, gathering information, providing instructions, and managing activities for search and rescue and recovery is important. b) Projects expected to contribute to strengthening the function of the provincial level AFADs which were transferred from provincial governorship to AFAD through the revision of Law No [2] Case Study in Bursa 2) Urgency a) Projects expected to support the strengthening of disaster & emergency management systems, including the cooperation systems among relevant authorities in Bursa Province. b) Projects expected to be effective and have a ripple effect in making Bursa City more resilient. Projects studied herein need to be promptly implemented because either a potential risk in the event of disaster is great, these projects are expected to help directly in the disaster response, or these projects are supposed to implemented prior to other projects. 6-13

175 (2) Feasibility of the Project 1) Implementation Agency The implementation agency is the agency that will be in charge of the implementation. Its capacity is based on the availability of human resources and their technical level. Nationwide projects that will be implemented by AFAD appear more feasible than projects implemented by various government agencies or ministries, as AFAD is the body for disaster preparedness and response, and as a single agency, internal coordination is seamless. Because there is difficulty in coordination among the different ministries, as determined by the study of the organizations, their roles, and the collaboration systems for disaster management of the relevant authorities, nationwide projects that will be implemented by AFAD were selected for the priority projects. Similarly, for Bursa, implementation of projects involving multiple agencies will likely take more time and effort than projects run entirely by one organization. We propose to start with a limited number of organizations, only AFAD and Bursa Metropolitan Municipality at first, both of which will be key players for the establishment of DMCs, with the expectation of gradual involvement of other agencies in the future. 2) Maturity of the Project: The maturity of a project is assessed based on the intention of the implementation agency, consistency with the plan of the AFAD (or plan in Turkey), financial status in Turkey, etc. 3) Estimated Project Cost: One of the indicators for the possibility for implementation is project cost. The costs of proposed projects were estimated according to the unit cost of each facility set based on the construction costs in Turkey and Japan. The methodology used to estimate project costs is described in ) Technical Feasibility As one of the purposes of this study, the possibility and likelihood of introducing technologies and utilizing experiences of Japan to projects are evaluated. Particularly in prioritizing projects, this study focuses on projects that would benefit the most from Japanese technologies. 6-14

176 6.3. Priority Nationwide Projects Nationwide projects are expected to cover the whole country, to be executed in all provinces in Turkey, or to contribute to national-level activities. Projects of facitiy development and ICT in high priority are selected in accordance with the ciriteria above and analyzed based on their functional aspects (1) Assessment of projects with a criteria of expected contribution to Disaster Resilient Urban Planning As discussed in Chapter 2.2.3, a disaster response system is planned for the national level in the TAMP and includes establishment of a AFAD Disaster and Emergeny Management Center (AADYM), coordination with Ministries disaster and emergency management centers, and establishement of a,command system of disaster response activities for the operation service groups. At the provincial level, the establishment of Provincial Disaster and Emergency Management Center (VALI) which will coordinate with the national level organization is also planned. However, the construction of the system seems still on the way and not complete yet. AFAD developed a plan for the disaster response system of national/provincial in TAMP (Figure 2.2.3). To achieve disaster resilient urban planning, the Study Team proposes several systems including the establishment of DMCs with the regional disaster operation center, a collaboration system with back-up supports and relevant ministries, and an information gathering system that will function when a disaster strikes. The DMC proposed herein is the main base to respond to large scale disasters, consisiting of the disaster operation center in its heart and additional relevant facilities. It is a hub for rescue activities, information, relief supplies, and volunteers. This study proposes that DMCs should be established at all of the national/regional/provincial levels. Regional DMCs established in the 15 logistic zones of AFAD are expected to be the bases responding to large scale disasters hitting across provinces. The location of the 11 search and rescue teams is also proposed to match the location of the regional DMCs. 6-15

177 Note) Number in the figure is reffered following items Figure (2) Proposal in functional aspects Develop the Disaster Response System (a)proposal for the disaster countermeasure coordination system a-1 Enhancing the function of the National Disaster and Emergency Management Center (AADYM): The disaster and emergency management center, empowered by the prime minister or deputy prime minister and chaired by the AFAD president, plays a central role in the disaster response system proposed by TAMP. Enhancement of its capacity in information analysis, countermeasure evaluation, decision making, and commanding are crucial. a-2 Prompt information gathering capacity in the event of disaster: In order to perform appropriate countermeasures in the event of disaster, immediate collection of data and information is necessary. For this purpose, establishment of the data collection system including other ministries, is required. a-3 Strengthening collaboration among national, regional, and provincial disaster and emergency management centers as well as relevant ministries: Strengthening the collaboration system among relevant authorities, which corresponds to the triangle collaboration system proposed by TAMP: national level/ministries/provincial level. a-4 Emergency support system by region: The backup support from DMC outside disaster area is effective and helpful in the event of a disaster. Mutual supporting systems among neighboring provinces are stated in TAMP. However in the case of serious disasters beyond provincial boundaries, collaboration among regional level DMCs is required. a-5 Upgrading disaster response capacity of search and rescue teams: 6-16

178 11 search and rescue teams have key roles in the disaster response activities. Upgrade of these teams will enhance the capacity of disaster response activities. a-6 Enhancement of disaster prevention capacity of personnel in AFADs (national/provincial): For the purpose of enhancing the capacity of the disaster and emergency headquaters, capacity building of AFAD staff for disaster response as well as disaster prevention and mitigation is required. a-7 Enhancement of disaster prevention capacity of personnel in relevant institutions: For information gathering and effective response, collaboration among relevant institutions is vital. Therefore, capacity enhancement of AFAD s own system and collaboration system with relevant institutions is also indispensable. (b)proposal for the functions and roles of provincial AFADs With revision of Law No. 5902, provincial AFADs came under the authority of Central AFAD, and the capacity of provincial AFADs now needs to be enhanced. b-1 Enhancing the functions of Disaster and Emergency Management Centers at the regional/provincial level: Disaster and emergency management centers at the regional/provincial level are expected to perform as front-line bases for disaster response. Their role includes information gathering, negotiation with the national level disaster and emergency operation center, instruction of measures and management of activities. It is necessary to enhance capacities through the establishment of a collaborative system with relevant institutions. b-2 Disaster prevention capacity of personnel in provincial AFADs: To strengthen disaster response systems at the provincial level, human resource development and capacity building of provincial AFADs is requird. Staff of provincial AFADs now work under the oversight of Central AFAD. A national level effort for human resource development is required. b-3 Awareness of disaster prevention for the public: AFAD has been working on education of disaster preparedness, through cooperation with MONE. However, further efforts are required to enhance public awareness of disaster prevention. (3) Proposal for Disaster Information System When a large scale disaster strikes across provinces, it is especially important to promptly gather information from stricken areas as well as quantitative information from relevant institutions including the metrological agency, DSI, and seismometers. Information should be analyzed and utilized to estimate the damage and decide on an appropriate disaster response. According to TAMP, a collaboration system has been planned so that, in the event of a disaster, relevant ministries and response members in stricken areas will take measures in collaboration led by the disaster and emergency management center. The disaster and emergency management center may request support from outside of the stricken provinces and call for appropriate measures to counterparts (including other ministries). The disaster managemnt center at the national level serves as a base for this collaboration and its 6-17

179 construction is already in progress. For a sound judgement and decision making, a set of systems to gather, analyze and broadcast precise information is also vital. Regional DMCs in the stricken area are front-line bases for collaboration. They collect and share bottom-up disaster information and evaluate measures in collaboration with the national level DMC and organizations. They are also the hub for relief supplies and volunteers from outside the stricken area. Meanwhile, DMCs outside the stricken area are bases for logistics supports; accepting injured individuals and sending relief supplies and volunteers as needed. For these collaborative disaster response systems to work, it is essential to build a secure communication network which is accessible at the time of disaster. AFAD has been already working on such a network. Particularly, satellite fixed stations to connect relevant national and provincial organizations are essential. Additionally, visual images of the stricken area would be very effective to get a specific and precise understanding of the situation and of the disaster damage. Hence, equipping each province with portable satellite facilities that are capable of sending visual images in real time has significant importance. Information gathered via the above technologies is also effective to alert and prevent secondary damage. In addion, to fulfill the capacity of these disaster response systems, regular base activities are also important such as research and development to enhance the functional capacity of the disaster management center, training for search and rescue teams and municipality personnel, and activities for public awareness of disaster prevention. Facilities and infrastructures shown in the above table are proposed for these reasons. The results of an evaluation of the effectiveness of the following facilities are also shown in the table: disaster operation center, provincial search and rescue team center, disaster prevention education center, R&D center, and VSAT (for the disaster information system). 6-18

180 Table Proposed projects with high effectiveness Criteria and key points Proposed project components Disaster & Emergency Management Center, Logistic Center, and Heliport National Level (Under Construction) Regional Provincial Level Training Center for Search & Rescue: ーNational Level Regional Level National Level Education Center for Disaster Preparedness Regional Level R & D Center National Level Satellite Network (VSAT) Information Gathering & Dissemination System (a) Projects expected to contribute to strengthening the disaster and emergency management system targeted in the TAMP. a-1. Strengthening IAADYM s function, such as (data collection, analysis, coordination with AADYM, ordering relief activities) a-2. Support data collection, discussion of countermeasures, and decision making of AADYM. a-3. Support coordination between AADYM and IAADYM a-4. Strengthening the mutual support system among neighboring provinces a-5. Upgrading capacity of Search & Rescue Teams a-6. Support capacity building of AFAD a-7. Upgrading DRM capacity of relevant authorities (b) Projects expected to contribute to strengthening the function of the provincial level AFADs b-1. Capacity Building of provincial AFADs b-2. HR Development of provincial AFAD b-3. Upgrading disaster education of provincial AFAD Source: JICA Study Team AFAD Strategic Plan Goal Notes: Disaster and Management Center in the national level is listed because it is one of the key facilities although this cannot be a proposed project as it is under construction now. Goal Goal Goal Goal Goal Goal Goal2 2.6 Goal (4) Outline of the proposed projects and proposed planning level Outlines of the above listed project components are summarized as follows. These proposed facilities and Disaster Information System are core facilities and systems of the Disaster Management Complex as shown below. 6-19

181 Table Outline of the Project Components (1) (facilities) Disaster & Emergency Management Center The center which has the functions of data collection, decision making, command for relief activities, management of support items/personnel etc. Main facilities Operation room (large screen), meeting room, office space for relevant authorities, data room, dormitory, AFAD office, heliport, storage, etc. Planning Level Required in national, regional and provincial levels. Focusing on regional and provincial levels in this project, as the national level center is now under construction. Regional Level Provincial Level Training Center for Search & Rescue Training center for experts in search and rescue. It will become a center for search and rescue activities in the event of disaster. Main facilities Lecture room, auditorium, training facilities (rubbles, climbing, fire, transportation accidents, CBRN, etc.), library, dormitory etc. Planning Level Because AFAD s search and rescue teams are currently stationed in 11 provinces, and the number of trainers is limited, it is proposed to upgrade the national level training center and establish regional level training centers. National Level Regional Level Education Center for Disaster Preparedness Education center which will provide education programs for the general public, students, leaders of the community etc. It will be used as a center for volunteer activities in the case of disaster. Main facilities Exhibition of disasters in Turkey, scientific information, experiencing simulation, prevention measures, workshop, library, education material development room, etc. Planning Level With consideration of operation and maintenance cost and limited number of trainers, it is proposed to establish education centers at the national and regional levels in the beginning. Provincial level centers will be developed in the future. National Level Regional Level Research & Development Center R&D center to support AFAD s policy making, strategy for disaster response. Having experimental research facilities for seismic engineering, and disaster management archive system. Main facilities Archive center, research laboratory for disaster risk management policy, seismic engineering experimental apparatus, etc. Planning Level In order to operate efficiently with a limited number of researchers and experimental apparatus, the R&D center is proposed in the national level only National Level Concept of DMC Source: JICA Study Team 6-20

182 Table Outline of the Project Components (2) (Disaster Information System) Very Small Aperture Terminal (VSAT) By introducing fixed stations of satellite communication, it will become possible to promptly share visual images of the stricken area among emergency response headquaters of the national/provincial level. This information will help to understand the precise extent of disaster damage and hence contribute to taking effective measures. Prompt information gathering/alerting system By building an information-sharing network with relevant ministries, it will become possible to take appropriate measures. Broadcasting of this information will also help for public bodies and residents to make a sound judgement of whether to evacuate and hence contribute to mitigating secondary damages. Satellite Network / Information Gathering & Dissemination System Source: JICA Study Team (5) Priority Projects Among projects that are judged as high in emergency and priority in the long list, components of high priority are selected in accordance with 6.2 and analyzed by 6.3.Evaluation results are shown below. Based on the prioritization of projects using the abovementioned criteria, the nationwide priority projects are shown below. These are core facilities of the Disaster Management Complex. In this project, the facilities under AFAD management were prioritized with consideration of ease in the implementation; however, the remaining facilities such as hospitals or schools are also expected to be developed in the future. Result of assessment is marked as A (high), B (medium), and C (low). 6-21

183 Table Summary of Priority Nationwide Project Project Effectiveness & Efficiency Urgency Implementation Agency Maturity Approx. Cost(100 million Yen) Technical Feasibility National Level 1) Training Center for Search & Rescue: 11,700 m2 A A AFAD A ) National Education Center for Disaster Preparedness:12,000 m2 A A AFAD A 22 3) Research & Development Center: 10,000 m2 A B AFAD B 20 4) Satellite Network (VSAT) A A AFAD A 50 5) Information Gathering & Dissemination System A A AFAD B 150 6) Development of a network at each level of distaster management plans A AFAD 50 7) Establish data base and archive system A AFAD 50 8) Establishment of R&D institute for policy making A AFAD 19.4 Regional Level 1) Disaster & Emergency Management Center, Logistic Center, and Heliport: 6,000 m2 A A AFAD A ) Training Center for Search & Rescue: 11,700 m2 A A AFAD A ) Education Center for Disaster Preparedness (Regional level): 6,000 m2 A A AFAD A 11 4) Seismic risk assessment for buildings and utility infrastructure A AFAD 5) Seismic performance assessment and strengthening of dam A DSI 6) Redevelopment of risky area based on the result of risk assessment A MOEU /Municipalities 7) Anti-earthquake measures for non-fixed components A MOH 8) Seismic upgrading of buildings of central and local government. A MOEU /Municipalities 9) Logistics center A AFAD ) Heliports for disaster prevention bases and medical centers A AFAD ) Construction of well and water tank for water supply in disaster A 12) Securing power supply by emergency power equipment for wide area disaster mitigation facilities A BUSKI Metropolitan Municipality AFAD MOH 13) Development of park/open space in regional/provincial DMC A MOEU ) Reinforcement of public port in Gemlik A MOTMAC ) Development of emergency road network and operation regulations for province level A 16) Seismic strengthening and set-back of buildings along emergency road A 17) Road widening and seismic strengthening of buildings for the emergency road around DMC A 18) Seismic performance assessment and strengthening of subway station and tunnel A Metropolitan Municipality 19) Disaster Information network A AFAD 2 20) Designation and development of regional/provincial level evacuation place A MOEU Municipality 21) Institutional development for strengthening disaster management system A AFAD 22) Development of emergency evacuation plans and guidelines A 23) Identification of safe evacuation routes A AFAD Provincial/ District Level 1) Disaster & Emergency Management Center, Logistic Center, and Heliport: 6,000 m2 A A AFAD A ) Development of park/open space in regional/provincial DMC A MOEU ) Designation and development of regional/provincial level evacuation place A MOEU Municipality 3.9 (6) Projects with Potental Support from the JICA scheme Based on the above discussions, possible projects to be supported by the JICA scheme in the disaster risk management sector are discussed in this section. Two criteria under Effectiveness for the selection of priority projects related to nationwide expansion or coverage were considered in the formulation of projects as discussed above (see (1)). 6-22

184 For the purpose of making a good example of a DMC network from the national level to the provincial level, the following three nationwide package projects were prepared: Packages PackageA PackageB PackageC Scenario Establish a DMC network from national Level to regional Level as one package. Provincial level and lower level will be developed later. Establish 6 core-regional DMCs and a provincial DMC in the zone where core-regional DMCs will be developed. (6 Core-regional DMCs will also function as back-ups for national level.) Develop an example of national-regional-provincial network of DMCs in the 3 prioritized zones. (Establish model of DMC network within a zone) An outline of the proposed project packages, including conceptual distribution of DMCs, listing of facility components, and estimated project costs are summarized in the following table. The proposed components at the national level are common for all three packages. These packages were compared in terms of effectiveness, efficiency, cost, and feasibility. The characteristics and the pros and cons of each package are also summarized in the following tab le. 6-23

185 Table Summary of Proposed Nationwide Project Packages Package A Package B Package C General Description DMC network from national to regional level will be established by construction of Regional DMCs (one Regional DMC in each logistic zone) and nationwide satellite communication system. 6 core-regional DMCs and one provincial DMC per each Regional DMC. One Regional DMC and four Provincial DMCs (all provincial DMCs in zones) in each of the three prioritized zones. Expected Pros. Disaster management system with DMC will be established from national to regional levels. Training centers for search and rescue teams will be developed in all regions (logistic zones). Higher-ranked Regional DMC may be a back-up for the national level DMC in the event of a disaster in Ankara. Model of National-Regional-Provincial DMC will be established. Model of DMC network from national to provincial levels will be established in 3 zones, which can be examples for other zones. Logistic zones which have high risk can be selected as model zones. Results Cons. Since DMC at provincial and lower levels are not included, strengthening of the provincial level disaster management system will be limited. Training center for search & rescue teams will be limited to 6 centers. One regional DMC and one provincial DMC will be developed in each logistic zone. Difference between targeted zone and others will be significant. National Level Regional Level Provincial Level Training Center for Search & Rescue Education Center for Disaster Preparedness Satellite Network (VSAT) Information Gathering and Dissemination System R&D Center Regional DMC (13 centers*1) Disaster & Emergency Management Center (Including Operation Center, AFAD office, Logistic Center, Heliport) Training Center for Search & Rescue Education Center for Disaster Preparedness Training Center for Search & Rescue Education Center for Disaster Preparedness Satellite Network (VSAT) Information Gathering and Dissemination System R&D Center Regional DMC (5 centers*2) Disaster & Emergency Management Center (Including Operation Center, AFAD office, Logistic Center, Heliport) Training Center for Search & Rescue Education Center for Disaster Preparedness Provincial DMC (5 Provinces surrounding Regional DMC ) Disaster & Emergency Management Center (Including Operation Center, AFAD office, Logistic Center, Heliport Training Center for Search & Rescue Education Center for Disaster Preparedness Satellite Network (VSAT) Information Gathering and Dissemination System R&D Center Regional DMC (3 centers*3) Disaster & Emergency Management Center (Including Operation Center, AFAD office, Logistic Center, Heliport) Training Center for Search & Rescue Education Center for Disaster Preparedness Provincial DMC (12 Provinces surrounding Regional DMCs) Disaster & Emergency Management Center (Including Operation Center, AFAD office, Logistic Center, Heliport) National 1 Center National 1 Center National 1 Center Facilities Level Quantity Unit Unit Cost (100 Total (100 Unit Cost (100 Total (100 Unit Cost (100 Total (100 Level Quantity Unit Level Quantity Unit million Yen) million Yen) million Yen) million Yen) million Yen) million Yen) 1) Disaster & Emergency Regional 13 Center Regional 5 Center Regional 3 Center Management Center: 6,000 Provincial Provincial m 2 0 Center Center Provincial 12 Center ) Training Centre for Search & Rescue: 11,700 m 2 Regional 13 Center Regional 5 Center Regional 3 Center ) Education Centre for National 1 Center National 1 Center National 1 Centre Disaster Regional Regional Preparedness:12,000 m 2 (National), 6,000 m 2 13 Center Center Regional 3 Center (Regional ) 4) Satellite Network (VSAT) National 1 Set National 1 Set National 1 Set ) Information Gathering & National National 1 Set Dissemination System 1 Set National 1 Set ) Research & Development National National Centre: 10,000m 2 1 Center Center National 1 Center Total Total Total *1:One DMC for each AFAD Logistic Zone= 15 DMCs minus 2 existing DMCs (Ankara and Istanbul). *2: Higher-ranked Regional level DMCs are proposed to be in the following 7 provinces: Ankara, Istanbul, Izmir, Bursa, Samsun, Adana, and Erzurm, excluding Ankara and Istanbul. * Tentatively proposed at Bursa in the Western part of Turkey, Adana in the South-Eastern part of Turkey, and Erzurm in the Eastern part of Turkey. *4: Location of Regional DMC: provinces having the largest population in each logistic zone are selected as the location of the Regional level DMC. 6-24

186 6.4. Priority Projects for the Case Study of Bursa Priority projects selected for the case study in Bursa are shown below. (1) Assessment of projects with a criteria of expected contribution to Disaster Resilient Urban Planning Effectiveness respect to the contribution to the disaster resilient urban planning, is assessed based on two criteria. A criteria Projects expected to contribute to countermeasures and collaboration system of provincial AFAD is set based on necessity of strengthening provincial AFAD in association with the revision of AFAD law as well as from Disaster Management System Development countermeasures discussed in (4). Another criteria Projects expected to be effective and have a ripple effect in making Bursa City more resilient is also set based on selected challenges from a. Projects expected to support the strengthening of disaster & emergency management systems, including cooperation system among relevant authorities in Bursa Province : With consideration of necessity to strengthen the provincial AFAD according to the revision of Law No.5902, and expected function of Bursa DMC as a regional center of the South Marmara region, necessity of stregtheing the Bursa AFAD was recognized. The following two points were considered as criteria. a-1. Support to establish provincial disaster and emergency management center with a collaboration system with relevant authorities to collect data and manage disaster relief activities. a-2. Capacity building of Provincial AFAD b. Projects expected to be effective and have a ripple effect in making Bursa City more resilient: Challenges in facility development for disaster resilient urban planning in Bursa are as summarised in In order to improve the situation, the following points were considered as criteria to select priority projects, which will contribute to construct disaster resilient urban structure by the deployment of a structured DMC and infrastructure which support the DMCs function. Point b-6 is added from the view point of which has possibility to introduce concept of disaster management to the Urban Transformation project that has been promoted in nation wide. b-1. Establishment of Disaster Management Bases b-2. Security of Road Network for Evacuation and Implemenation of the Disaster Response Activities b-3. Ensuring Evacuation Points in the Neighbourhood Level b-4. Emergency Medical System and Enhancement of its Functions in the Populated Area at the time of Disaster b-5. Enhancement of Public Awareness regarding Disater Risk Management b-6. Collaboration with regeneration of Vulnerable Residential Area (Urban Transformation Project) Become an example of an urban transformation project with consideration of DRM In general, projects related to development of the DMC and its network were prioritized. The result of the assessment is summarized below. 6-25

187 Table Proposed projects with high effectiveness & efficiency Criteria and key points Proposed project components (a) Projects expected to support the strengthening of disaster & emergency management systems, including cooperation system among relevant authorities in Bursa Province. a-1. Support to establish IAADYM with a system to collect data and manage disaster relief activities. a-2. Capacity building of Provincial AFAD (b) Projects expected to be effective and have a ripple effect in making Bursa City more resilient b-1. Establishment of Disaster Management Bases b-2. Security of Road Network for Evacuation and Implemenation of the Disaster Response Activities b-3. Ensuring Evacuation Points in the Neighbourhood Level b-4. Emergency Medical System and Enhancement of its Functions in the Populated Area at the time of Disaster b-5. Enhancement of Public Awareness regarding Disater Risk Management b-6. Collaboration with regeneration of Vulnerable Residential Area (Urban Transformation Project) Source: JICA Study Team (2) Outlines of the proposed projects and proposed planning level Outlines of the proposed projects are described in to and summarized below. Table Component A Outline of the proposed projects Components Outline Components Component A Component B Component C Component D Develop Regional Level DMC to cover Bursa and surrounding provinces. It will help AFAD to coordinate with other relevant authorities. DMC for Osmangazi District. Disaster management center at district level, sports facilities and schools will be developed with disaster prevention facilities. DMC for Yuldirim District, with A-1 class disaster management hospital and several community facilities. Seaside DMC at Gemlik port. It will be a base to receive support from outside. 1) Disaster & Emergency Management Centre, Logistic Centre, and Heliport: 6,000 m 2 2) Training Centre for Search & Rescue: 11,700 m 2 3) DRM related facilities (Fire Dept. /AKOM/112 etc.): 6,000 m 2 4) Disaster Base Hospital: 140,000 m 2 (700 beds) 5) Park/Open Space: 10ha 6) Waste Incineration Plant: 22,500 m 2 (3,000t/day) 7) Seismic strengthening of bridge: main road 100m 1) Disaster & Emergency Management Centre, Logistic Centre, Heliport: 6,000 m 2 2) Sports Centre (Gymnasium, pool): 7,500 m 2 3) Park/Open Space: 10ha 4) School: 3,500m 2 1) Disaster & Emergency Management Centre, Logistic Centre, and Heliport: 6,000 m 2 2) Renovation work for Şevket Yılmaz Hospital: 180,000m 2 (900 beds) 3) Extension work for Şevket Yılmaz Hospital: 30,000m 2 (150 beds) 4) Park/Open Space: 10ha 1) 1) Seaside Disaster Management Complex: Gemlik port 10ha 2) Disaster & Emergency Management Centre, Logistic Centre, and Heliport: 6,000 m 2 3) Park/Open Space: 10ha Component E Secure emergency access 1) Emergency Road Network:20km Component F Source: JICA Study Team Improvement of the mountainous area. 1) Road Network:5km 2) Park/ Open Space:2500 m2 3) Stockpile Storage 4) Mini Monorail:250m Component b Component C Component D Component E Component F 6-26

188 (3) Proposed Projects for JICA Scheme The expected effects on disaster resilient urban planning from the implementation of these projects are summarized as follows: - Through the process of developing DMCs, the coordination system between AFAD and related organizations is expected to be established, which will help smooth collaboration in the event of a disaster. - DMCs will be a place to receive, sort, and distribute supporting goods and human resources from outside. By defining this role of the DMC, confusion will be avoided by outside institutions who are willing to support the disaster-struck areas and of recipients who are waiting for support. - Construction of DMCs in the city will inform the general public about government efforts in disaster prevention. Parks in DMCs and education/training in DMCs will also help inform people about the roles and functions of the DMCs. This will be effective in enhancing public awareness for disaster preparedness. - This set of projects in Bursa will showcase an example of a DMC through the planning process and promote it to the whole country. - In collaboration with the Turkish Government s efforts for urban transformation, there is a potential to promote and disseminate the idea of creating DMCs nationwide. As a result of the study, priority is shown in [ ] in the following table. 6-27

189 Table Summary of Priority Projects ( Bursa) Project Effectiveness & Efficiency Urgency Implementation Agency Maturity Approx. Cost (100 million Yen) Japanese technology Component A 1) Disaster & Emergency Management Center, Logistic Center, and Heliport: 6,000 m A A AFAD A ) Training Center for Search & Rescue: 11,700 m2 A A AFAD A ) DRM related facilities (Fire Dept. /AKOM/112 etc.): 6,000 m2 A B AFAD/Bursa Metropolitan Municipality 4) Disaster Base Hospital: 140,000 m2 (700 beds) A B MOH B ) Park/Open Space: 10ha 6) Waste Incineration Plant: 22,500 m2 (3,000t/day)) 7) Seismic strengthening of bridge: main road 100m Component B 1) Disaster & Emergency Management Center, Logistic Center, Heliport: 6,000 m2 A A Bursa Metropolitan Municipality B B Bursa Metropolitan Municipality B A Bursa Metropolitan Municipality B A B A 6.8 [I] A A Osmangazi A ) Sports Center (Gymnasium, pool): 7,500 m2 B B MOYS B ) Park/Open Space: 10ha A A Bursa Metropolitan Municipality A ) School: 3,500m2 B B MONE B 1.5 Component C 1) Disaster & Emergency Management Center, Logistic Center, and Heliport: 6,000 m2 A A Yildirim A ) Renovation work for Şevket Yılmaz Hospital: 180,000m2 (900 beds) B B MOH B ) Extension work for Şevket Yılmaz Hospital: 30,000m2 (150 beds) B B MOH B ) Park/Open Space: 10ha Component D 1) Seaside Disaster Management Complex: Gemlik port 10ha A B 2) Disaster & Emergency Management Center, Logistic Center, and Heliport: 6,000 m2 A A 3) Park/Open Space: 10ha Component E 1) Emergency Road Network: 20km A A Component F A A A B Bursa Metropolitan Municipality Gemlik AFAD/ Bursa Metropolitan Municipality Bursa Metropolitan Municipality AFAD/ Bursa Metropolitan Municipality A 24.3 [III] [II] [II] B A A B ) Improvement of Mountainous Area A A Osmangazi B 24.3 Details of each priority project are described in the form of project profile summary sheets, which are attached. 3.9 [I] [III]

190 6.5. Implementation Body of Proposed Projects Each DMC proposed in this study, both for the nationwide and the case study in Bursa, consists of a complex containing several facilities related to disaster management. A multi-sectoral approach and coordination among the relevant authorities are essential to realizing the concept of DMC. The table below shows the authorities expected to be involved with each component of a DMC. Table Priority projects and responsible authorities Priority Projects Responsible Authorities National Level DMC Regional Level DMC Provincial Level DMC District Level DMC AFAD Metropolitan Municipality/ Municipality MOH MONE Others 1) Disaster & Emergency Management Center 〇〇 2) Training Center for Search & Rescue 〇 3) Education Center for Disaster Preparedness 〇 4) Research & Development Center 〇 5) Disaster Risk Management Related Facilities (AKOM/Fire/Police/112 etc.) 〇〇 AKOM/ Fire 112/ UMKE 6) Disaster Base Hospital 〇〇 7) Park/Open Space 〇 8) Sports Facilities 〇〇〇 MOYS 9) Waste Incineration Plant 〇 10) School 〇〇〇 〇 11) Emergency Road Network 〇 12) Satellite Network (VSAT) 〇 13) Information Gathering & Dissemination System 〇 Source: JICA Study Team Coordination with Relevant Authorities In the event of a disaster, coordination with the relevant authorities is one of AFAD s missions. To enhance the involvement of several authorities such as MOEU, MOH and MONE, which is critical for implementation of disaster prevention, the possibility to establish a crossministerial project implementation committee to materialize the idea of DMC was studied at the beginning of this project. Through the survey, it was recognized, however, that a cross-ministerial effort will take time especially during the project formulation stage, and delay the much needed implementation of the projects. In addition, keeping AFAD as the main leader of the projects will allow continuity and consistency throughout each province as well as throughout the country, and 6-29

191 will allow for easier efficient and timely project completion, since AFAD is the expert disaster management body in Turkey. Therefore, it was recommended to start with the projects which can be completed by AFAD or by a combination of AFAD and the metropolitan municipality. As shown in the table above, the main DMC facilities are under AFAD responsibility. Facilities under the metropolitan municipality or the municipality responsibility are also critical. For all DMC projects, securing land for the DMC facilities as well as for the essential large open space adjacent to the facilities is the very first step, and requires collaboration with MOEU, the metropolitan municipality and provincial directorate. The participation of the Bursa Metropolitan Municipality, which is a key player in the establishment of the foundation for DMC, shall be effective for the formulation of a resilient city. Other facilities under the responsibility of other ministries can be developed later. Facilities under AFAD The revision of Law No stipulated the transfer of the disaster & emergency management center, training center, and education centers to the provincial level and for them to be under AFAD. This will likely make project implementation easier, although it also raises the possibility of some difficulties in coordinating with other agencies at the provincial level Challenges Regarding Project Implementation The following describes the challenges for realization and implementation of proposed projects through the consultation with relevant agencies of this study. Way forward During this survey, due to the limited opportunity to discuss matters with the director of AFAD, it was difficult to confirm the intentions of AFAD regarding the implementation of the proposed packages, though they have expressed their positive opinions for our proposals. Further discussion with AFAD is necessary on the proposed project packages and on the contents of the projects. The project proposal and feasibility study should be prepared and submitted to the Ministry of Development (MOD) for approval to request a Japanese ODA loan. Initiatives of AFAD The development of DMCs for wide areas, the main proposal of this study, requires the cooperation of various ministries including AFAD and local governments. As a result, this study proposes starting with an improvement of AFAD facilities during the first stage; however, it is important to engage other related authorities and make them understand the importance and advantage of joining the DMC and allocating their facilities or resources to the DMC in the future. Through this process, it is also important to form a cooperative framework with relevant ministries that can be implemented in a disaster. Through the study, some personnel, being familiar with the idea of disaster prevention, stated their expectations for stronger initiatives from AFAD, whereas others complained about the bureaucratic sectionalism during consultation with other organizations. For pervasion of the idea of disaster prevention and mitigation, a further strengthened initiative 6-30

192 by AFAD is required to overcome such bureaucratic sectionalism. Disaster complex bases for wide areas might be the first step for the breakthrough. Adjustment with Bursa City It was difficult to advance concrete discussion with the Bursa side because of upcoming local elections and some confusion with the study of technical cooperation. However, being listed in the program and vision of the new mayor will be effective to advance the projects. Hence this election would be a good opportunity for local cities to consider the concept of disaster resilient urban planning and disaster prevention. The Bursa Metropolitan Municipality has experience implementing various urban development projects and at the end of March 2014 their autonomy was expanded to the boundary of the province. Therefore, it is essential to cooperate with the Bursa Metropolitan Municipality and the provincial directorate of MOEU regardless of whether land is secured for the projects. Disaster Base Hospital In the study, the Deputy General Director of Health Services showed a certain understanding of the importance of the disaster base hospital in Japan. At the same time, however, due to shortage of their own funds, the construction of the Cekirge hospital in Bursa, which is proposed to be constructed in this project, will be implemented through PPP. Consultation with the Department of Health Investment office needs to be held for this issue. PPP is to be used for hospital construction projects, but most of the projects have not yet proceeded due to financial problems. Since the prime minister is still promoting those City Hospital-PPP projects, it is an absolute must for the MOH to make progress on these PPP projects. In the City Hospital-PPP configuration, the private company owns the hospital for the first 25 years and lends it to the Minister of Health. However, in the case of Japanese ODA loans, the owner shall be the MOH and the operation of hospital facilities can be run by a private company. Introduction of a combination of Japanese ODA loan and PPP in the operation stage may attract the MOH. Attitudes from relevant ministries toward disaster prevention It was a frequent comment from institutions that sufficient measures for disaster preventions were already in place or in the planning phase, while academics as well as those who experienced past great earthquakes agreed with the importance of further measures. In this regard, it is essential to increase opportunities to share past experiences in Japan and Turkey and emphasize the importance of further measures. Possibility to introduce Japanese technology Through the study, the competitive advantage of Japanese technology to meet the needs for Turkey as identified and the possibility of introduction of that technology in Turkey were examined. However, it is likely that European products will be more attractive, especially because of the lower cost and the geographical vicinity. It may take time for Turkey to understand the value of certainty and comprehensive approaches, which are the advantages of Japanese technology. Further promotion activities, such as an inspection tour in Japan, would likely benefit the adoption of Japanese systems. 6-31

193 Necessity for phased and strategic plan in consideration of disaster risk analysis Through the study of technical cooperation, Turkey attempts to understand future disaster risks and develop appropriate associated management plan. This study, on the other, is based on available information up to this point and examined only feasible high priority projects that are expected to be implemented immediately and have certain outcomes. For comprehensive resilient urban planning, however, diversified, local, and long-term approaches would also be necessary. In parallel with the implementation of these proposed projects, resilient urban planning based on the disaster risk assessment should also be considered for more comprehensive planning. This approach is expected to promote appreciation and understanding of Japanese technology and knowledge. The effort for cooperation of Japan and Turkey on disaster prevention were stated by the Vice Prime Minister of Turkey and the Ministry of Land, Infrastructure, Transport and Tourism of Japan during the Turkish Prime Minister s visit to Japan in January Based on that, we invited the AFAD director general and hosted a workshop in April 2014, as to introduce the disaster prevention system of Japan. In turn, a workshop in Ankara is planned in June 2014 as to introduce the disaster prevention system of Turkey to Japanese side. 6-32

194 6.7. Roughly Estimated Cost for Project Implementation The method of calculation for cost of the proposed project is Total floor area (m2) Building cost per m2 + Equipment cost + Other expenses. It should be noted that estimated costs in this chapter are nothing more than preliminary. It will be reviewed and revised through detail designing process. Total floor area (m2): Building cost per unit area: Equipment cost: Other expense: If available, use the total floor area of a similar facility in Turkey. If this information is not available, assume the floor area of a similar facility in Japan. Use the cost per m2 of public buildings in Turkey. Add the cost of the heliport and/or seismic isolation costs as needed. If available, use equipment costs in Turkey. If this information is unavailable, assume the cost of the equipment in Japan. Include indirect costs (incl. design fee), escalation and tax. Exclude contingency. The currency rate used the average of the Telegraphic Transfer Selling (TTS) rate of Japanese MUFG bank on January The currency rate is shown below. 1.0TL = Yen, 1.0USD = Yen Where TL is Turkish Lira, Yen is Japanese Yen, USD is US Dollar Disaster & Emergency Management Center (1) Total floor area Currently, AFAD has a plan to develop DMCs of the three following floor areas; A: 6,000 m2, B: 5,250 m2, C: 4,500 m2. This estimate was set for total floor area of 6,000 m2; the largest one. (2) Analysis and estimate of building cost per unit area (m2) 1) Comparison of the building costs of Turkey and Japan a. Public Building cost per unit area in Turkey Every year the public building cost per unit area is estimated from the fixed property tax imposed by the Ministry of Finance and Ministry of Environment and Urbanization. Public building costs per unit area for major buildings in 2014 are shown in the table below. The original table is attached as Annex A

195 Table Cost per unit area of selected Public Buildings in (TL/ m2) 2014 Building Steel Building Framework Concrete Framework Brick Masonry Building Factories and Plant Buildings Min Max Ave. Min Max Ave. Min Max Ave. Grade B Grade C Grade D Grade E Hotel Building Grade A Grade B Grade C Grade D Theatre Building Grade A Grade B Grade C Grade D Grade E Hospital-Clinic Building Grade A Grade B Grade C Grade D Grade E Administration Building Grade A Grade B Grade C Grade D Grade E School Building Grade C Grade D Grade E Swimming Pool Grade B Grade C Grade D Buildings in an Exhibition Market Place Grade D Grade E Storage /Cold storage Grade C Grade D Grade E Source: JST Note: Costs don t include the cost for hydronic panel heating, air conditioning or elevator facilities. Hence, 8% for the air conditioning and the heating and 6% for the elevator will be added as needed. 6-34

196 The maximum building cost per m2 for the Disaster & Emergency Management Center is assumed based on the maximum Grade A Administration Building cost per m2 in Turkey, increased for air conditioning, heating, and elevators. According to Table 6.7.1, the unit cost is 1, TL/m2, and with the additional 8% for air conditioning and heating and 6% for the elevator, the building cost is 1, TL/m2 (58,000 yen/m2). This unit cost includes the cost for construction work, electrical work, mechanical work and temporary site expenses, but doesn t include the design fee or costs associated with site procurement. This unit cost is used in the bid evaluation of the governmental construction project for comparing with the bidding cost. b. Unit cost in Japan The building cost per m2 of Administration Building in Japan in 2012 was 220,000 yen/m2 (inhouse office building) and 283,000 yen/m2 (rental office building) according to JBCI 2012 (Japan Building Cost Information; Construction Research Institute in Japan). The unit cost in Turkey (58,000 yen/m2) is approximately 1/5 of the unit cost in Japan (283,000 yen/m2). c. The comparison of combined cost of major construction materials We compared the material cost plus labor cost (combined cost) of construction materials in Turkey and Japan. The unit cost of concrete work in Turkey (9,384 yen/m3) is approximately 4/5 of the Japanese unit cost (11,980 yen/m3), and the unit cost of re-bar work in Turkey (73,656 yen/ton) is approximately 3/5 of the Japanese unit cost (114,000 yen/ton). Details are included in the table below. Table Comparison of the combined costs of major construction materials (Unit: Yen) Item Spec Q ty Unit Turkey Japan Sand for concrete (Material cost) 0-5mm 1 m3 2,067 3,900 Concrete work (Combined cost) 21N SL=18cm 1 m3 9,384 11,980 Form work Standard Plywood (Combined cost) t=12mm 1 m2 4,911 4,000 Re-bar work (Combined cost) D10 ~ D16 1 ton 73, ,000 Brick work (Combined cost) Single Lay 1 m2 2,067 4,410 Source: Turkish information by Bosphorus Project, Japanese information by Construction & Material Costs in Japan and Building cost information d. Comparison of the labor cost Labor cost in Turkey and Japan are compared below. In general, Turkey s unit cost is approximately 1/10 of the Japanese unit cost. Table Comparison of the labor cost (Unit: Yen) Description Q ty Unit Turkey Japan Carpenter 1 day 2,399 22,800 Mason 1 day 2,399 23,100 Tile Worker 1 day 2,399 21,700 Interior Finish Worker 1 day 2,399 21,300 Plaster Man 1 day 2,399 22,300 Glazer 1 day 2,399 19,800 Plumber 1 day 2,399 19,500 Driver 1 day 2,436 16,700 Driver(Heavy Vehicle) 1 day 2,773 20,200 Source: Construction and Installation Analysis and Unit Cost 2013 by MOEU, Japanese information by Construction & Material Costs (Dec. 2013) 6-35

197 (3) Disaster and Emergency Management Center as a DMC Facility The Disaster and Emergency Management Center proposed in this project is designed as a seismic isolation structure (including seismic isolation devices) and the design incorporates a heliport both on the roof and the ground. These costs were calculated based on the Japanese examples. - Cost for heliport: The cost of a rooftop heliport is estimated at 100 million yen (steel framed construction) and the cost of a heliport on the ground level is estimated at 20 million yen. Total cost is 120 million yen. - Cost for the seismic isolation structure (including seismic isolation devices): 15,000 yen/m2 (the cost of the seismic isolation devices amounts to approximately 5% of the total construction costs in Turkey). (4) Approximate cost estimate for Disaster & Emergency Management Center The table below shows the estimate of the unit cost for the Disaster & Emergency Management Center based on the assumptions presented above. Table Estimated Construction Unit Cost of Disaster & Emergency Management Center Description Note 1 6,000m2 58,231 yen/m2=349,386,000 yen Building cost per m2 based on public buildings in Turkey 2 120,000,000 yen Adding a heliport cost 3 6,000m2 15,000 yen/m2=90,000,000 yen Adding a seismic isolation structure cost =559,386,000 yen 4 559,386,000 yen/6,000m2=93,231 yen/m2 Building cost per m2 Building cost per m2 of Disaster & Emergency Management Center is calculated at about 93,231 yen/m2. (5) Equipment cost The cost for the network system necessary for the Disaster and Emergency Management Center was assumed based on the cost of equipment in the main building of the Japanese Ariake no Oka DMC. The total unit cost of the equipment by area of the Ariake no Oka Building (9,411m2) was calculated and assumed for the proposed 6,000 m2 Disaster and Emergency Management Center: 429,000,000 yen (6,000m2 9,411 m2)= 274,002,000 yen Major equipment that is included in this equipment cost, Private Branch exchange system, Audio/Visual system, Public address system, Common Antenna Television system, CCTV system, room access control system, Fire alarm system, and emergency power supply. Detailed information regarding the main building of the Ariake no Oka disaster prevention complex is as follows; the building area is 6,110 m2, the total floor area is 9,411 m2, the structure is reinforced concrete and steel frame (seismic isolation structure), there are two stories in the main building and one story in the tower building, construction started in March 2006 and lasted 25 months, for a total project cost of approximately 4.8 billion yen before taxes (including the cost of network facilities of 0.4 billion yen). (6) Other necessary expenses: indirect cost, consumer price variation and VAT 1) Indirect cost Indirect costs for this project are assumed based on the Japanese experience that indirect costs represent approximately 30% of the total costs for building construction and equipment purchase. 6-36

198 2) Design fee Based on a survey of local architectural offices in Turkey, the design fee of an architectural office in Turkey is approximately 3% or 4 % of total construction costs (see annex A-5-5). Therefore, the design fee of a few percent is included in the indirect cost. 3) Setting of the coefficient of consumer price variation According to the International Monetary Fund (IMF), consumer prices have shown an upward trend every year in Turkey due to inflation, and this trend is expected to continue in the future. Assuming the project is complete by April 2016, the calculated inflation coefficients from February 2014 to April 2016 are shown below: Based on the inflation rates shown in table 6.5.5:Year 2014 : 6.491% 11 months 12 months=5.95% Year 2015 : 6.041% 12 months 12 months=6.041% Year 2016 : 6.041% 4 months 12 months=2.014% Total= % Therefore, the coefficient of consumer price variation was set at 14.0% Table Inflation and average consumer prices in Turkey Gross domestic product, current prices (GDP) (USD billions) Inflation, average consumer prices (Index) Inflation, average consumer prices (%) source:imf:world Economic Databases, Oct, 2013 Coefficient of consumer price variation applies to construction material costs as well as labor costs. 4) Value added tax (VAT) Based on our survey in Turkey, we expect that an 18 % VAT will be imposed on this project. The approximate complete cost estimate for the Disaster & Emergency Management Center is calculated below: 6,000 m2 93,000 yen/m million yen (equipment cost) million yen (expenses) = 1,349 million yen. In addition, a stockpile storage facility (adding 130 million yen) is proposed to be included in the Disaster & Emergency Management Center Disaster Base Hospital The method of calculation of the approximate cost estimate for the Disaster Base Hospital is Total floor area (m2) Building cost per m2 + Medical Equipment cost + Other expenses (1) Total floor area According to the MOH, the floor area per bed in a new hospital in Turkey is 200m2. The Disaster Base Hospital proposed in this report is based on the scale of Çekirge Hospital in Bursa, which has a total of 700 beds. 6-37

199 The total floor area of the model of the Disaster Base Hospital is 200m2/bed 700bed= 140,000m2. The details of the model of the Disaster Base Hospital are shown in the Table below. Table Details of the Model Hospital Condition Çekirge Hospital (virtual model) 1) Number of Beds 700 beds 2) Total floor area 140,000m2 (200m2/bed) 3) Ratio of single rooms 50% 4) Number of beds for standard patient rooms 1 bed~2 bed 5) Standard nurse unit 10 beds 6) Intensive care section (ICU, CCU, NICU, etc.) Approximately 90 rooms 7) Outpatient consultation rooms 100 rooms 8) Operating rooms 18 rooms 9) Radiodiagnosis rooms 16 rooms 10) Angiography rooms 3 rooms 11) Radiotherapy rooms 3 rooms (2) Analysis and setting of building cost per unit area (m2) 1) Comparison of the building costs of Turkey and Japan a. Public Building cost per unit area in Turkey The building costs per unit area in 2014 for public Hospital-Clinic buildings are shown below: Table Public Building cost per unit area (extract) (TL/ m2) ver Building Steel Building Framework Concrete Framework Brick Masonry Building Min Max Ave. Min Max Ave. Min Max Ave. Hospital-Clinic building Grade A Grade B Grade C Grade D Grade E Note: Costs don t include the cost for hydronic panel heating, air conditioning, or elevator facilities. Hence, 8% for the air conditioning and the heating and 6% for the elevator will be added as needed. This building cost per m2 is used to estimate the cost for the Disaster Base Hospital in Turkey. According to Table 6-3-7, the maximum unit cost for a Hospital-Clinic Building, Steel Frame, Grade A, is 1, TL/m2 or 2, TL/m2 (102,000 yen/m2) with air conditioning, heating and elevator. This is consistent with the unit cost range provided by MOH in Bursa: 900 USD to 1,000 USD (94,000 yen/m2 to 105,000 yen/m2), including construction work, electrical work, mechanical work and temporary site expenses. This cost does not include the design fee or site procurement. b. Unit cost in Japan The Building cost per m2 of hospital building in Japan ranges from 215,000 yen/m2 for a general hospital to 262,000 yen/m2 for a high performance hospital, according to JBCI 2012 (Japan Building Cost Information; Construction Research Institute). The unit cost for the Ishinomaki Red Cross Hospital is 274,000 yen/m2. The unit cost in Turkey (105,000 yen/m2) is approximately 1/3 of the unit cost in Japan (274,000 yen/m2). 6-38

200 (3) Analysis of Hospital construction costs in Turkey and Japan Hospital construction cost information in Turkey and Japan was compared and analyzed. Table Comparison of Hospital construction cost in Turkey and Japan Country Turkey Japan Province Sakarya Istanbul Bursa Istanbul Miyagi Name of Hospital SAKARYA HOSPITAL SEYRANTEPE HOSPITAL İNEGÖL HOSPIT SANCAKTEPE HOSPITAL Ishinomaki Red Cross Hospital AL Total floor 67,693 m2 169,760 m2 51,000 m2 53,335 m2 32, m2 area Structure RC Frame RC Frame RC Frame RC Frame Steel and RC frame with Seismic isolation structure Stories Underground 1F, above ground 6F Underground 4F, above ground 3F Underground 1F, above ground 18F 2010(contract year) Underground 1F, above ground 3F Underground 1F, above ground 6F Underground 1F, above ground 7F Period 2008 (contract year) 2011(contract year) 2011(contract year) Aug.2004~ Feb.2006 Beds 400 beds 600 beds 400 beds 400beds 392 beds Total 4,334,890,000 yen 8,488,049,000 yen 2,631,283,000 ye 3,113,183,000 yen 9,003,694,000 yen (100%) (100%) n (100%) (100%) (100%) Architectu 2,232,468,000 yen 4,524,130,000 yen 1,407,737,000 ye 1,654656,000 yen 5,240,000,000 yen ral Work (51.5%) (53.3%) n (53.2%) (58.2%) (53.5%) Electrical 565,703,000 yen 1,243,499,000 yen 335,489,000 yen 499,043,000 yen 1,200,000,000 yen Work (13.0%) (14.7%) (12.8%) (16.0%) (13.3%) Mechanica 994,857,000 yen 2,134,744,000 yen 703,868,000 yen 766,777,000 yen 2,470,000,000 yen l Work (23.0%) (25.2%) (26.8%) (24.6%) (27.4%) Elevators 346,791,000 yen 118,833,000 yen 26,313,000 yen 67,382,000 yen (4.5%) (1.4%) (1.0%) (0.7%) Landscape 64,037,000 yen 466,843,000 yen 157,877,000 yen 192,706,000 yen 26,312,000 yen (8.0%) (5.5%) (6.0%) (6.2%) (0.3%) 64,037 yen/ m2 50,000 yen/ m2 51,594 yen/ m2 58,370 yen/ m2 274,265 yen/ m2 Total cost /total floor area Source: local architectural office A comparison of the breakdown of the construction costs of the Turkish and Japanese hospitals shows that building construction costs in Japan are approximately 5% more expensive than in Turkey and the landscape cost in Turkey is approximately 6% more expensive than in Japan. Overall, the total of building construction, electrical and mechanical work, and landscape costs are similar in Japan and Turkey. According to a local Electrical & Mechanical (M&E) office we visited in Turkey, the unit cost per m2 of M&E is approximately 300 USD/m2 (see detailed costs in Annex A-5-4). In conclusion, with regard to the comparison of the construction costs of Turkey and Japan, it was confirmed that construction costs in Turkey are less than in Japan; with Turkey s construction materials cost and labor costs approximately 1/3 and 1/10, respectively, of those in Japan. (4) Design Differences between General Hospital and Disaster Base Hospital The main difference in the design of a general hospital and a disaster base hospital is that the disaster base hospital is designed with two heliports (one on the rooftop and one on the ground) and a seismic isolation structure including seismic isolation devices. 6-39