1 UiT The Arctic University of Norway, Department of Technology and Safety, Tromsø, Norway

2 Iran Alumina Company, Jajarm Alumina Complex, Jajarm, Iran

3 Imam Khomeini International University, Qazvin, Iran

4 Shahrood University of Technology


Background: Large-scale events such as COVID-19 show that there are situations that can lead to huge stress on health
infrastructure systems (HIS). The pandemic reveals that it is very difficult to protect HIS from all kinds of possible hazards.
They can be unpredictable and spread rapidly; hence, it is hard to find an effective mitigation strategy to completely protect
society and its important HIS.
Methods: An often raised central question is what we should do if we cannot protect HIS from these types of hazards. To
answer this question, the focus should move from HIS protection to HIS resilience. Therefore, in this paper, the Critical
Infrastructure Resilience Index (CIRI) is used to estimate the resilience of health infrastructure systems.
Results: The results of the case study show that HIS resilience was enhanced significantly after the implementation of
measures. The results indicate that among the resilience phases the learning phase of resilience is the weakest part.
This requires a root cause analysis, which should be prioritized by HIS managers and stakeholders.
Conclusion: This paper discusses how the resilience concept will help decision- and policy-makers to have a clear
view of HIS performance before, during, and after the disaster. An easy-to-use and applicable methodology for HIS
assessment and evaluation was employed. It can be concluded that resilience and its identified phases can help HIS
managers to allocate available resources accordingly in the phases during and post-crisis.
Level of evidence: V