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A fully probabilistic seismic risk assessment of Medellín, Colombia, was conducted using a building by building resolution level database with more than 240,000 dwellings. An updated seismic hazard assessment was used in the analysis and a set of stochastic seismic scenarios was generated. Because the city has a seismic microzonation study, the dynamic soil response was taken into account. A set of building classes was identified and vulnerability functions were developed to calculate the seismic risk in terms of probabilistic metrics using several modules of the CAPRA Platform. Risk premiums by sectors, as well as casualties and other direct effects were calculated on a building by building basis and then aggregated at county level. Furthermore, a holistic approach, using the holistic evaluation module of CAPRA, was used to take into account social fragility and lack of resilience conditions in each county that could increase the second order effects in case a strong earthquake strikes the city. These conditions were inferred from a set of indicators that are meant to capture the aggravating conditions of the direct physical impact, the second order effects and the intangible impact of future seismic events. A comprehensive Urban Seismic Risk Index was obtained at county level in order to communicate risk to stakeholders and decision-makers, helping identify areas that would be particularly problematic in terms of vulnerability, both in physical and socioeconomic dimensions. This study constitutes a complete example of how an integrated research on disaster risk reduction has been performed with the aim to decrease the gap between the risk …