When preparation meets the unpreparable

In 2023, following the earthquake in Türkiye, some of our colleagues were involved in rapid on-the-ground assessments of emergency health services in the affected areas.

What made this experience particularly striking was not evidence of failure. Turkish emergency services are professional, well-structured, and routinely train for large-scale disasters. By most measures, Türkiye was better prepared than the majority of countries in the region.

And yet. More than 50,000 people died. Over a million were displaced within days. Infrastructure collapsed across entire provinces simultaneously. The scale and speed of the event pushed every system - medical, logistical, administrative - to and beyond its limits.

There is a tendency in emergency preparedness to treat readiness as a problem that can be solved. Train enough, plan enough, exercise enough, and you will be ready. The Türkiye earthquake was a reminder that this framing, while useful, has limits. At sufficient scale and speed, even well-prepared systems face demands they were never designed to meet.

What determines how a system holds up in those moments is not the size of the hospital or the quality of its equipment. It is the degree to which staff at every level know what to do, who to report to, and how to keep essential functions running when the normal operating environment no longer exists. It is the depth of the preparedness, not just its presence.

That kind of readiness is built before the emergency, not during it. And it is never quite finished.