Preparing for the inevitable earthquake risk in Dhaka: A physiatrist’s perspective

Dhaka, a densely populated megacity, faces a real and potentially catastrophic earthquake risk. Even moderate earthquakes have caused fatalities, highlighting vulnerability to larger events. Unplanned urbanization, vulnerable infrastructure, and seismic proximity increase its risk of mass casualties. Studies show low seismic risk perception and inadequate household preparedness, revealing critical gaps in public awareness and institutional readiness [1]. Bangladesh’s disaster preparedness focuses on mortality reduction and emergency response, with limited attention to injury, disability, and long-term functional loss, reflecting a critical deficiency from a physiatrist’s perspective. This study examines the rehabilitation preparedness in Dhaka and proposes a practical, physiatrist-led framework for integrating rehabilitation into disaster response. Recent earthquakes in and around Dhaka (2017–2025), including moderate events up to magnitude 6.2 with reported deaths, injuries, and structural damage, demonstrate ongoing seismic activity and highlight the city’s vulnerability, although these events do not represent probabilistic risk projections.

Geographically, Bangladesh lies close to the Indian–Eurasian plate boundary, with several active fault systems capable of producing large earthquakes. Seismological data indicate that Dhaka is at risk from both distant major events and moderate-to-severe earthquakes originating near or beneath the city. In this context, earthquake impacts extend far beyond immediate mortality. Evidence from global disasters shows that many survivors sustain fractures, spinal cord and traumatic brain injuries, crush injuries, amputations, and soft-tissue trauma, leading to substantial long-term disability without early rehabilitation. Although Bangladesh-specific data are limited, findings from disaster-affected settings such as the 2017 Bangladesh landslide indicates substantial unmet rehabilitation needs and system constraints [2]. Similar patterns are likely in Dhaka due to urban and health system vulnerabilities, which may overwhelm response and, without integrated rehabilitation, convert survivable injuries into long-term disability [3].

Physiatry plays a central yet often overlooked role in disaster response. Physiatrists focus on function, independence, and participation beyond the acute phase of injury [4]. In disaster settings, physiatrists serve as team leaders, multidisciplinary coordinators, policy advocates, and liaisons between acute care and long-term functional recovery. Early rehabilitation during acute care reduces complications and, as demonstrated in earthquakes in Nepal and Türkiye, improves functional outcomes and reduces long-term disability. Key interventions including mobilization, positioning, pain management, and timely provision of assistive devices further enhance recovery [5]. Without physiatrist-led coordination, these opportunities are often missed.

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Figure 1 Physiatrist-led rehabilitation preparedness framework for earthquake response in Dhaka

Equally concerning is the vulnerability of people with pre-existing disabilities. Individuals who depend on wheelchairs, prostheses, orthoses, or caregivers face heightened risks of injury, displacement, and loss of independence during earthquakes. Disaster preparedness plans seldom address accessible evacuation, continuity of rehabilitation care, or replacement of assistive devices, contradicting principles of disability-inclusive disaster risk reduction and further marginalizing this population.

Integrating rehabilitation into national disaster policies and emergency medical team frameworks is essential for system-level implementation. As a major earthquake in Dhaka remains inevitable, preparedness must address the predictable surge of disability. A physiatrist-led approach can reduce suffering and support resilient, function-focused health systems.