Needs assessments after disasters tied the largest death tolls to damage in energy, water-sanitation-hygiene and health infrastructure across 79 disasters. The association was sharper in low- and lower-middle-income countries. The study does not prove that a particular infrastructure investment would have saved lives.
Across 79 disasters, deaths lined up most tightly with harm to power networks, water and sanitation, and hospitals in the compared needs assessments. The pattern is an association in those reports. It does not rank roads, schools or housing as harmless, and it does not name a single disaster as the driver. The comparison stays inside the needs assessments.[1]
Low- and lower-middle-income countries showed the wider mortality gap. The same infrastructure damage lined up with a larger death toll where health systems and utilities were already thinner. That split is still a comparison of reports, not a ranking of governments.[1]
Report quality, unmeasured confounding and differences between disasters mean the comparison cannot show that repairing one asset changed the death toll. A ministry cannot read the comparison as a guarantee that repairing one plant would have changed a death toll. The 79-disaster set supports the association and stops there.[1]
