Microcourse
Climate Change Adaptation for Health Infrastructure
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Estimated completion time: 60 minutes
Welcome to the microcourse
« Climate Change Adaptation for Healthcare Infrastructure »
Let's get started!
Healthcare facilities are increasingly exposed to climate-related risks, such as heatwaves, floods, and extreme weather events, which can disrupt services and threaten the continuity of care. Strengthening the resilience of hospitals and health systems thus becomes an urgent priority. This training, developed as part of the LIFE RESYSTAL project, presents the main challenges related to adapting to climate change for healthcare facilities. Based on the experience of the project's pilot hospitals, it provides key information to help health professionals understand climate risks and explore practical approaches to enhance resilience.
SUMMARY
Understanding Climate Change
Mastering Key Concepts
Understanding the Challenges for Healthcare Facilities
Strengthening the Resilience of Healthcare Facilities
Discover the LIFE RESYSTAL project and its tool
Understanding Climate Change
Climate Change: A Reality
From a Future Phenomenon to a Present Challenge
Climate change is no longer a long-term projection. It is now an observable reality, already affecting territories, populations, and infrastructure. Extreme weather events are increasing and intensifying, necessitating rapid adaptation of our systems.
Climate Change: A Reality
A Global Upward Trend
Global average temperature differences, compared to the 1850-1900 reference, for the 5 main global climate data
© Crown copyright, Met Office
Year
In recent years, major cities around the world have recorded 25% more hot days. As global temperatures continue to rise, heatwaves are becoming more frequent, longer, and more intense.
Use this side of the card to provide more information on a topic. Focus on a concept. Make learning and communication more efficient.
Use this side of the card to provide more information on a topic. Focus on a concept. Make learning and communication more efficient.
According to a new climate bulletin published by the United Nations World Meteorological Organization (WMO), the probability of a temporary exceedance of the 1.5 °C threshold has been increasing since 2015, the year when this risk was close to zero. For the years between 2017 and 2021, the exceedance probability was 10%. It has risen to "nearly 50% for the period 2022-2026," states the WMO. But there is only a low probability (10%) that the five-year average will exceed the +1.5 °C threshold.
Go Further
Your turn to play!
Climate Change: A Reality
Climate Developments in Europe
The climate in Europe has warmed by 2.3 degrees compared to the pre-industrial era (1850-1900), with a rate twice as fast as the global average since the 1980s, announced the UN and the European Copernicus program on June 19, 2023.
Climate projections show that Europe's warming will continue throughout the 21st century. By 2050, heatwaves, droughts, and heavy rainfall episodes are expected to become more frequent and intense. According to IPCC scenarios, temperatures in Europe could increase by +2°C to +4°C by 2100, with particularly marked impacts in southern Europe.
Use this side of the card to provide more information on a topic. Focus on a concept. Make learning and communication more efficient.
Annual temperature anomalies compared to the reference period 1991-2020 in Europe, based on six different data sources © AFP - Valentin RAKOVSKY
Go Further
Faced with these developments, it is necessary to act now. Even if efforts are made to limit climate change, its effects are already present...
It is therefore essential to adapt to reduce impacts!
Mastering Key Concepts
Weather vs Climate
What’s the difference?
Weather
Climate
Climate can be defined as the average conditions in a given location, calculated from observations over at least 30 years. It is therefore characterized by average values, but also by variations and extremes.
Weather is the assessment of the current or upcoming short-term conditions. It is defined by instantaneous and local values of temperature, precipitation, pressure, cloudiness, etc.
Your turn to play!
Weather vs Climate
What’s the difference?
Weather
Climate
Climate variability
Climate change
"The weather" in a given day and place
Deviations from the climate average, short-term variations (annual)
Long-term climate variations (multi-decadal and centennial)
Days
Months
Years
Decades
Centuries
Examples of phenomena
Examples of phenomena
Examples of phenomena
Wet season / Dry
Decadal Pacific Oscillation (DPO)
Sea level rise
Rain
Global warming
Heatwaves Cyclones
El Niño
Understanding the concepts of weather, climate, and climate change is an essential first step.
However, to concretely assess the consequences of climate change on territories and infrastructure, it is also necessary to understand how climate risk is constructed.
Components of Climate Risk
Vulnerability
Exposure
Hazards
Risk
Damage caused by a climate signal or biophysical impact
Crisis management capabilities and difficulties in facing crises due to economic, social, or demographic factors
Nature of the hazard, intensity, frequency
Technical characteristics (construction, network reliability and resilience...)
Environmental aggravating or mitigating factors
Field of
Field of
Adaptation
Mitigation
Apply what you just saw!
Mitigation vs Adaptation
What is the difference?
It involves adjusting to the current or future climate.
Adaptation
The goal is to reduce greenhouse gas emissions into the atmosphere.
Mitigation
Test your knowledge...
Attenuation & Adaptation
Two complementary strategies
Increase in greenhouse gas concentrations
Changes in the climate system
Climate change risks
CO2, N2O emissions, ...
Temperature rise, changes in precipitation...
Impacts on ecosystems and society
Attenuation
Acting on the causes of climate change
Adaptation
Managing the consequences of climate change
To avoid the unmanageable
To manage the inevitable
Go further
Attenuation & Adaptation
Examples of measures
Attenuation
Adaptation
Climate change risk management measures
Measures to reduce emissions related to climate change
Education
Crisis management
Sustainable transport
Nature
Water conservation
Infrastructure improvement
Energy efficiency
New energy systems
Clean energy
Protections against floods
Resilience
To increase
In order to better anticipate future climate changes and adapt strategies (mitigation, adaptation, and resilience) accordingly, scientists also use
climate scenarios, which allow exploring different possible trajectories based on the evolution of greenhouse gas emissions.
Climate Scenarios
What do they represent?
SSP (Shared Socio-economic Pathways)
RCP (Representative Concentration Pathways)
SSPs are socio-economic scenarios describing different possible developments of society (population, economy, policies, lifestyles) and their effects on greenhouse gas emissions and adaptation capacities.
RCPs are climate scenarios representing different levels of greenhouse gas concentrations in the atmosphere and the associated warming levels by 2100.
SSPs describe societal trajectories, while RCPs represent their climate consequences. They are used together to build future climate projections.
SSP
Value of radiative forcing reached by the end of the century corresponding to the RCP.
Number (1 to 5) of the socio-economic scenario SSP used to develop the emission trajectory.
Climate scenarios
What do they represent?
SSP 5
SSP 3
(Mitigation challenges dominate)
(High challenges)
Fossil-fueled development
Regional rivalry
Socio-economic challenges for mitigation
SSP 2
(Intermediate challenges)
Middle of the road
SSP 4
SSP 1
(Adaptation challenges dominate)
(Low challenges)
Inequality
Sustainability
Go further
Socio-economic challenges for adaptation
Understanding the Challenges for Healthcare Facilities
Climate projections and future scenarios show that extreme events will become more frequent and intense in the coming decades. These changes will have direct consequences on many sectors,
notably healthcare facilities, which, due to their essential role and their need to operate continuously, are on the front line.
Understanding the exposure of healthcare facilities
A sector of particular concern
Healthcare facilities are particularly exposed to climate risks due to their critical role and reliance on sensitive infrastructure.
Evacuation of Brooklyn's Woodhull Hospital due to a storm - September 2023
Closure of Saint-Affrique Hospital due to flooding - November 2014
Postponement of operations at Milton Keynes Hospital due to a heatwave - July 2022
Visualizing the impacts on infrastructure
A comprehensive view of risks
Extreme weather events
Main impacts
Water quality reduction
Modification of infectious agents
Flooding
Air quality deterioration
Wildfires
Drought
Extreme heat
Infrastructure damages
Increased temperatures
Impacts on ecosystems
Climatic hazards
Impacts on patient care
Risks to health and facilities
Disruption of health services
Supply chain disruptions
Adapted from a figure from "Mainland Facilities Management: Moving towards Climate Resilient Health Facilities for Vancouver Coastal Health, Vancouver, BC, Canada, 2018"
Sea level rise
Observing the already visible impacts
Recent feedback
Healthcare facilities have already faced service interruptions, infrastructure damages, or evacuations following extreme weather events. Here are some examples illustrating the impacts that different weather hazards can have on hospitals.
Heatwaves
Drought
Wildfires
Floodings
Storms
Test your understanding of resilience issues
Identify the strengthening of the regulatory framework
Growing requirements for healthcare facilities
In response to the increasing risks of climate change and their impacts on health systems, public policies and regulatory frameworks are gradually evolving. Healthcare facilities are increasingly encouraged — or even required — to incorporate climate issues into their strategies, infrastructures, and continuity plans to enhance their resilience against extreme events.
Since 2021, the European Climate Law makes climate change adaptation an obligation for member states and encourages the integration of climate resilience into all public policies.
The new European Climate Change Adaptation Strategy aims to build a climate-resilient Europe by 2050, notably by improving the preparedness of the most vulnerable sectors, including health.
In parallel, the European Directive on Critical Entity Resilience, which came into force in 2023, explicitly recognizes the health sector as an essential sector. It requires member states and critical infrastructures to strengthen their preparedness against natural risks, disasters, and major crises.
These regulatory developments are also accompanied by international recommendations. WHO encourages healthcare facilities to become both resilient to climate change and environmentally sustainable, to ensure continuity of care in an increasingly unstable climate.
Title
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Subtitle
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The impacts of climate change on healthcare facilities are already visible, and regulatory requirements are evolving rapidly.
In response to these challenges, it becomes essential to strengthen the resilience of hospitals to ensure continuity of care, protect infrastructure, and guarantee the safety of patients and staff.
Strengthening the Resilience of Healthcare Facilities
Understanding the Resilience of Healthcare Facilities
Anticipate, absorb, and adapt to crises
The resilience of a healthcare facility refers to its ability to anticipate climate risks, maintain essential functions during a crisis, and quickly return to normal operation after an extreme event. According to WHO, a resilient health system must be able to "predict, respond, absorb, and adapt" to climate shocks while maintaining quality of care.
Learn More
Understanding resilience as a systemic approach
A challenge that concerns all stakeholders
Hospital resilience does not solely depend on infrastructure. It involves the entire operation of the facility and requires a collective and coordinated approach.
Climate issues concern: - hospital management;
- technical teams;
- healthcare providers;
- logistics services;
- local authorities;
- energy, water, and transportation operators...etc.
Strengthening resilience therefore involves bringing together various stakeholders around the table to identify vulnerabilities, share responsibilities, and develop coordinated responses.
Identify the dimensions of hospital resilience
A multidimensional approach
According to the World Health Organization (WHO), the resilience of health facilities relies on several complementary dimensions. This approach is also used in the LIFE RESYSTAL toolbox to analyze vulnerabilities and structure adaptation strategies.
Health Workforce
Water, Sanitation, and Healthcare Waste Management
Energy
Infrastructures, Technologies, Products, and Processes
This dimension concerns all hospital staff: healthcare workers, technical teams, administrative and logistical staff. Climate change can affect their health, safety, working conditions, and availability, especially during heatwaves, extreme events, or prolonged crises.
This dimension covers access to drinking water, sanitation systems, hygiene, and medical waste management. Climate events can disrupt water supply, damage networks, or increase health risks.
Health facilities heavily depend on a continuous energy supply to provide care, operate medical equipment, and maintain critical systems. Climate events can cause power outages or energy surges, especially during heatwaves.
This dimension concerns hospital buildings, medical equipment, digital systems, supply chains, and operational processes, which can be damaged or disrupted by climate events.
All these dimensions are interdependent: a failure in one can affect the overall functioning of the facility and compromise the continuity of care.
Identifying the benefits of a resilience approach
Reducing impacts and improving preparedness
Strengthening the resilience of healthcare facilities helps better anticipate the consequences of extreme weather events and limit their effects on infrastructure, care services, and people.
It also helps improve the overall preparedness of the facility through:- better identification of vulnerabilities;
- development of business continuity plans;
- implementation of emergency procedures;
- strengthening coordination among internal and external stakeholders.
A resilience approach notably contributes to:- reducing service interruptions and temporary closures;
- limiting damage to buildings, equipment, and essential networks;
- protecting patients, visitors, and hospital staff;
- improving response and crisis management capacity;
- ensuring faster recovery of activities after an extreme event.
Beyond crisis management, investing in resilience can also generate long-term benefits, such as:- reducing costs related to damages and activity interruptions;
- improving working conditions and user comfort;
- better anticipating future climate and regulatory changes.
Can you guess?
Strengthening the resilience of healthcare facilities is essential to address the impacts of climate change. But a key question remains: how to concretely move from understanding these issues to structured and operational actions?
To answer this question a progressive methodology is necessary, allowing the transformation of risk analysis into concrete adaptation strategies that are planned over time.
Understanding the adaptation methodology
A structured approach in two main steps
Building an adaptation strategy is based on a logical process in two complementary phases:
Weaknesses
Identify and understand risks
Identify solutions and build adaptation trajectories
This first step involves analyzing weather hazards, vulnerabilities of facilities, and their potential impacts. It helps to precisely understand where the risks are and which hospital functions are most exposed.
Once risks are identified, the second step is to select relevant adaptation measures and organize them over time in the form of trajectories. This approach allows for building flexible, scalable strategies that are adapted to climate uncertainties.
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This approach is fully operationalized within the LIFE RESYSTAL toolbox, which guides healthcare facilities step by step through this process. The tool is not limited to planning adaptation: it also includes additional modules to enrich the analysis and support decision-making, including: economic impact assessments and potential losses related to weather events; cost-benefit analysis of measures and trajectories; as well as a dedicated module for crisis management.
Understanding the different types of adaptation solutions
Complementary responses to climate risks
Adaptation solutions can be classified into four main complementary categories:
Green solutions
Relying on nature
Blue solutions
Managing water as a resource and as a risk
Gray solutions
Acting through infrastructure and technologies
Soft solutions
Acting on organization and governance
Examples of adaptation solutions
Concrete illustrations in healthcare facilities
Green roof: Reduce heat and improve insulation.
Green spaces and vegetation: Limit heat islands.
Outdoor shaded areas: Protect from high temperatures.
Rainwater harvesting: Secure water supply.
White roof: Limit building overheating.
Backup power: Ensure continuity of activities.
Insulating glazed windows: Reduce heat transfer.
Porous coatings: Promote water infiltration.
Protection of sensitive equipment: Placed at height to protect them.
Once the solutions are identified and prioritized, they need to be organized over time. Indeed, not all measures should be implemented immediately. Some are suited for the short term, others for the medium or long term.
This is where adaptation pathways come into play, which help structure actions over time and adapt the strategy based on the evolution of climate risks and the institution's capacities.
Understanding adaptation pathways
Planning in an uncertain context
Climate change is evolving and uncertain. Risks can intensify, appear earlier than expected, or develop differently depending on the territories. Adaptation pathways help address this uncertainty by building progressive strategies over time. Instead of defining a single definitive solution, they organize a sequence of actions suited to different risk levels.
Adapting decisions over time
An adaptation pathway is based on step-by-step planning:
Short term
Medium term
Long term
Immediate and regret-free actions
Adjustments and reinforcements
Structural transformations
This approach allows adjusting decisions based on evolving climate conditions, available resources, and new knowledge. It also helps avoid inappropriate or overly rigid investments in the face of climate uncertainty.
A flexible and robust approach
Adaptation pathways offer a planning method more robust than traditional approaches. They allow: to anticipate different possible climate futures; to maintain flexibility in decisions; to secure investments over time; to gradually strengthen the resilience of health facilities. This approach is now widely used in climate change adaptation strategies at the international level.
Go further
Building an adaptation pathway
Concrete example in a hospital setting
Scenario
Hospital X is regularly exposed to episodes of intense heatwaves. Among the identified risks, one of the most critical concerns the overheating of the MRI room. In case of cooling system failure, the helium necessary for the machine's operation may evaporate, leading to a complete shutdown of the equipment. This situation would have a major impact on the hospital's activity, paralyzing some of the essential diagnostic examinations for patients.
Learn more
Build an adaptation pathway
Concrete example in a hospital setting
Low
Medium
Medium
Risk levels of risk
Identified solutions
Spray water on the cooler to cool it down
Selected pathway
Cool tap water before spraying
Monitor temperature trends closely
Capture and reuse the heat from coolers
Abandoned maladaptation solution (unsustainable)
Implementation of backup air conditioners
Change technology and buy an MRI that does not require chilled water (air thermodynamics)
Use superconductors for the magnet, requiring a lower temperature
Improve thermal insulation in the examination room
Switch to standard air conditioners and coolers for tropical climates
Ad hoc solutions that are not sustainable long-term
Decision among these 4 last structural solutions based on context / feasibility / cost
Low-regret solutions that can be implemented immediately
Test your understanding of adaptation pathways
Understanding climate risks, identifying solutions, and building adaptation pathways are essential steps to strengthen the resilience of healthcare facilities.
To concretely support this approach, the LIFE RESYSTAL project has developed resources and operational tools for stakeholders in the health sector.
Discover the LIFE RESYSTAL project and its tool
Explore the project resources
A dedicated website and knowledge hub
The LIFE RESYSTAL project provides a website gathering information related to the project, partners, results, and news. A Knowledge Hub is also available to centralize useful resources on climate change adaptation, health facility resilience, methodologies, best practices, and tools developed within the project.
Access the LIFE RESYSTAL project website
Access the LIFE RESYSTAL Knowledge Hub
Explore the project resources
An online tool to support you
The LIFE RESYSTAL toolbox is accessible online and allows healthcare facilities to concretely implement the various steps presented in this training, from risk assessment to the development of adaptation pathways.
Access the LIFE RESYSTAL tool portal
You have just completed the microcourse « Climate Change Adaptation for Health Infrastructure »!
Test your knowledge with this covering the main concepts discussed.
Summary Quiz
Thank you for your participation
Contact us : houda.fikrat@actierra.com climat@actierra.com
Storms
- Storms can damage roofs, walls, windows, and doors due to wind and debris, which can lead to significant interior damage.
- High pressure exerted by strong winds combined with heavy rainfall causes water intrusion.
- Flying debris can cause serious injuries to people.
- Power supply may be interrupted due to damage to power lines.
A case of storms at White Memorial Medical Center in Los Angeles, United States
Following major power outages, White Memorial Medical Center in Los Angeles had to mobilize over 100 firefighters and numerous ambulances to evacuate 28 critical patients and transfer 213 others to a backup building.
Elevators out of service
Backup generators also fail even if they have been periodically checked.
Hillary storm hit Southern California. It is the first tropical storm to hit Los Angeles in 84 years.
The building has six floors, making it difficult to evacuate patients via stairs.
"One of the issues we encountered, due to the total power outage, was the lack of light. Visibility was therefore zero. We did not have any operational elevators, so paramedic firefighters had to help critically ill patients, whose vital prognosis was not at risk, to descend the stairs and take them to an ambulance". (Testimony)
Activation of backup generators
Power outages
Storm
Medical equipment failure
"Many years ago, I worked at White Memorial in the neonatal intensive care unit. A power outage endangers the lives of all these babies, as well as other ICU patients whose lives depend on ventilators and other life-sustaining equipment". (Karen Bass, Mayor)
Most likely cause: water caused a short circuit in a panel or electrical system, cutting it off from the city’s power supply.
Heatwaves
Rising temperatures can lead to:
- Discomfort for patients and hospital staff
- Dangerous health effects on individuals, especially the most vulnerable
- Malfunction of medical equipment
- Expansion of materials that can eventually cause significant damage and irreversible changes to the building structure
A case of heat waves at Saint Thomas Guy’s in London, UK
In July 2022, the heatwave in the United Kingdom caused a critical IT failure at St Thomas and Guy’s hospitals, forcing massive care delays and emergency transfers of patients whose safety was compromised.
- No access to electronic patient records
“Patient safety was undoubtedly compromised”
(Chief Medical Officer of St Thomas Hospital for The Guardian)
- Inability to monitor patient reactions to treatments
Heat wave
IT system failure
- No access to patient location within hospitals
- Inability to perform data checks to prevent errors
Soft solutions concern organizational, human, and strategic aspects. Examples :
- business continuity plans ;
- crisis management protocols ;
- staff training ;
- early warning systems ;
- service reorganization in case of heatwave.
They are often inexpensive and very flexible.
Blue solutions concern water management in all its forms. Examples:
- drainage and rainwater retention systems;
- storage basins;
- securing drinking water supply;
- flood protection.
They are essential in the face of increasing episodes of heavy rain and droughts.
This is the presence of people and resources in a hazardous location.
Drought
A drought can:
- Cause the shrinking of reactive clay and subsidence that exerts extreme pressure on the building's structure and foundations.
- Directly affect water supply.
Case of Tri-City Medical Center Hospital, Oceanside, California, USA
To address a historic three-year drought in California, many hospitals conduct audits and implement conservation programs to sustainably reduce their water consumption.
Hospitals are among the largest water consumers in communities. To combat drought, hospitals conduct water audits.
Between 2012 and 2016, California experienced the most severe drought on record.
Find and repair leaks
Installing flow restrictors
Hospitals are implementing measures
Water shortage
Drought
Upgrading sterilizers
Modifying cooling tower operation
Governor Jerry Brown ordered California to adopt permanent water conservation measures, including long-term bans on wasteful water practices and mandatory reporting standards.
Modernizing showers and toilets
Replacing refrigeration compressors
The capacity to : - prepare oneself, - face, - recover from the impacts of climate phenomena with minimal damage to society, the economy, and the environment, and - adapt to future disruptions.
Gray solutions correspond to physical infrastructures and technical equipment. They aim to directly protect buildings and hospital systems against weather hazards. Examples:
- air conditioning and cooling systems;
- building reinforcement;
- backup generators.
They are often effective but can be costly and resource-consuming.
Green solutions use ecosystems and vegetation to reduce climate impacts. Examples:
- vegetation of yards and roofs;
- creation of cool islands;
- natural management of stormwater;
- trees to reduce heat islands.
They often provide co-benefits (comfort, biodiversity, air quality).
Wildfires
A forest fire can:
- Directly: injure, or even cause death.
- Indirectly: cause multiple respiratory and cardiovascular problems.
- Damage equipment and infrastructure.
A case of forest fires at Cervello Hospital, in Palermo, Italy
Firefighters evacuated a pavilion of Cervello Hospital in Palermo located under the Inserra neighborhood, a hill on the outskirts of the capital that had been burning for hours during the heatwave, making the air unbreathable in the area and causing failures in the hospital systems.
Hospital staff had to do two full shifts instead of one. The mortality rate in the emergency department increased by a third.
Impact on residents' health
The heatwave (July 2023) lasted 10 consecutive days. Outside temperatures reached a maximum of 47 °C.
Power outage
Damage caused by heat to cables
Heat wave
Degradation of air conditioning systems
Closure of the intensive care unit
Forest fires
Forest fires ravaged a hill near the hospital, affecting air quality in the region.
"During the 30 years I worked as a doctor, I saw 4 or 5 cases of hyperthermia. During these 10 days, I saw 5 or 6 cases per day [...]. On a normal day, we have a red code 30 times a day, when a patient's life is really at risk, but during these days, we had 50 per day - so, a significant increase..."
(Tiziana, a doctor at Cervello Hospital)
It encompasses sensitivity and the inability to cope or adapt.
Floodings
Floods can:
- Damage roads and infrastructure, disrupting access to hospitals.
- Cause costly infrastructure, medical equipment, hospital furniture, vital installations, and medical supplies damage.
- Cause power outages.
- Contaminate water.
- Threaten lives.
Case of the CH Emile Borel Hospital in Saint-Affrique, France
On November 28, 2014, following an exceptionally heavy rainstorm, the Saint-Affrique hospital experienced a devastating flood. The waters invaded the lower levels, paralyzing the technical facilities, kitchen, laundry, and care services of the Caylus building. This disaster required the urgent evacuation of 123 patients and significantly impacted medical activities for several months.
Laundry – Kitchen – Bio-cleaning Room
Facilities, techniques, and services
Technical facilities and services
Building B – USLD – Caylus Nursing Home
Photos taken on November 28, 2014. Source: Mrs. Corine Barthe-Cadier
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Transcript
Microcourse
Climate Change Adaptation for Health Infrastructure
This presentation contains several interactive elements. Click the button at the top right to help you identify them!
Estimated completion time: 60 minutes
Welcome to the microcourse
« Climate Change Adaptation for Healthcare Infrastructure »
Let's get started!
Healthcare facilities are increasingly exposed to climate-related risks, such as heatwaves, floods, and extreme weather events, which can disrupt services and threaten the continuity of care. Strengthening the resilience of hospitals and health systems thus becomes an urgent priority. This training, developed as part of the LIFE RESYSTAL project, presents the main challenges related to adapting to climate change for healthcare facilities. Based on the experience of the project's pilot hospitals, it provides key information to help health professionals understand climate risks and explore practical approaches to enhance resilience.
SUMMARY
Understanding Climate Change
Mastering Key Concepts
Understanding the Challenges for Healthcare Facilities
Strengthening the Resilience of Healthcare Facilities
Discover the LIFE RESYSTAL project and its tool
Understanding Climate Change
Climate Change: A Reality
From a Future Phenomenon to a Present Challenge
Climate change is no longer a long-term projection. It is now an observable reality, already affecting territories, populations, and infrastructure. Extreme weather events are increasing and intensifying, necessitating rapid adaptation of our systems.
Climate Change: A Reality
A Global Upward Trend
Global average temperature differences, compared to the 1850-1900 reference, for the 5 main global climate data © Crown copyright, Met Office
Year
In recent years, major cities around the world have recorded 25% more hot days. As global temperatures continue to rise, heatwaves are becoming more frequent, longer, and more intense.
Use this side of the card to provide more information on a topic. Focus on a concept. Make learning and communication more efficient.
Use this side of the card to provide more information on a topic. Focus on a concept. Make learning and communication more efficient.
According to a new climate bulletin published by the United Nations World Meteorological Organization (WMO), the probability of a temporary exceedance of the 1.5 °C threshold has been increasing since 2015, the year when this risk was close to zero. For the years between 2017 and 2021, the exceedance probability was 10%. It has risen to "nearly 50% for the period 2022-2026," states the WMO. But there is only a low probability (10%) that the five-year average will exceed the +1.5 °C threshold.
Go Further
Your turn to play!
Climate Change: A Reality
Climate Developments in Europe
The climate in Europe has warmed by 2.3 degrees compared to the pre-industrial era (1850-1900), with a rate twice as fast as the global average since the 1980s, announced the UN and the European Copernicus program on June 19, 2023.
Climate projections show that Europe's warming will continue throughout the 21st century. By 2050, heatwaves, droughts, and heavy rainfall episodes are expected to become more frequent and intense. According to IPCC scenarios, temperatures in Europe could increase by +2°C to +4°C by 2100, with particularly marked impacts in southern Europe.
Use this side of the card to provide more information on a topic. Focus on a concept. Make learning and communication more efficient.
Annual temperature anomalies compared to the reference period 1991-2020 in Europe, based on six different data sources © AFP - Valentin RAKOVSKY
Go Further
Faced with these developments, it is necessary to act now. Even if efforts are made to limit climate change, its effects are already present...
It is therefore essential to adapt to reduce impacts!
Mastering Key Concepts
Weather vs Climate
What’s the difference?
Weather
Climate
Climate can be defined as the average conditions in a given location, calculated from observations over at least 30 years. It is therefore characterized by average values, but also by variations and extremes.
Weather is the assessment of the current or upcoming short-term conditions. It is defined by instantaneous and local values of temperature, precipitation, pressure, cloudiness, etc.
Your turn to play!
Weather vs Climate
What’s the difference?
Weather
Climate
Climate variability
Climate change
"The weather" in a given day and place
Deviations from the climate average, short-term variations (annual)
Long-term climate variations (multi-decadal and centennial)
Days
Months
Years
Decades
Centuries
Examples of phenomena
Examples of phenomena
Examples of phenomena
Wet season / Dry
Decadal Pacific Oscillation (DPO)
Sea level rise
Rain
Global warming
Heatwaves Cyclones
El Niño
Understanding the concepts of weather, climate, and climate change is an essential first step.
However, to concretely assess the consequences of climate change on territories and infrastructure, it is also necessary to understand how climate risk is constructed.
Components of Climate Risk
Vulnerability
Exposure
Hazards
Risk
Damage caused by a climate signal or biophysical impact
Crisis management capabilities and difficulties in facing crises due to economic, social, or demographic factors
Nature of the hazard, intensity, frequency
Technical characteristics (construction, network reliability and resilience...)
Environmental aggravating or mitigating factors
Field of
Field of
Adaptation
Mitigation
Apply what you just saw!
Mitigation vs Adaptation
What is the difference?
It involves adjusting to the current or future climate.
Adaptation
The goal is to reduce greenhouse gas emissions into the atmosphere.
Mitigation
Test your knowledge...
Attenuation & Adaptation
Two complementary strategies
Increase in greenhouse gas concentrations
Changes in the climate system
Climate change risks
CO2, N2O emissions, ...
Temperature rise, changes in precipitation...
Impacts on ecosystems and society
Attenuation
Acting on the causes of climate change
Adaptation
Managing the consequences of climate change
To avoid the unmanageable
To manage the inevitable
Go further
Attenuation & Adaptation
Examples of measures
Attenuation
Adaptation
Climate change risk management measures
Measures to reduce emissions related to climate change
Education
Crisis management
Sustainable transport
Nature
Water conservation
Infrastructure improvement
Energy efficiency
New energy systems
Clean energy
Protections against floods
Resilience
To increase
In order to better anticipate future climate changes and adapt strategies (mitigation, adaptation, and resilience) accordingly, scientists also use
climate scenarios, which allow exploring different possible trajectories based on the evolution of greenhouse gas emissions.
Climate Scenarios
What do they represent?
SSP (Shared Socio-economic Pathways)
RCP (Representative Concentration Pathways)
SSPs are socio-economic scenarios describing different possible developments of society (population, economy, policies, lifestyles) and their effects on greenhouse gas emissions and adaptation capacities.
RCPs are climate scenarios representing different levels of greenhouse gas concentrations in the atmosphere and the associated warming levels by 2100.
SSPs describe societal trajectories, while RCPs represent their climate consequences. They are used together to build future climate projections.
SSP
Value of radiative forcing reached by the end of the century corresponding to the RCP.
Number (1 to 5) of the socio-economic scenario SSP used to develop the emission trajectory.
Climate scenarios
What do they represent?
SSP 5
SSP 3
(Mitigation challenges dominate)
(High challenges)
Fossil-fueled development
Regional rivalry
Socio-economic challenges for mitigation
SSP 2
(Intermediate challenges)
Middle of the road
SSP 4
SSP 1
(Adaptation challenges dominate)
(Low challenges)
Inequality
Sustainability
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Socio-economic challenges for adaptation
Understanding the Challenges for Healthcare Facilities
Climate projections and future scenarios show that extreme events will become more frequent and intense in the coming decades. These changes will have direct consequences on many sectors,
notably healthcare facilities, which, due to their essential role and their need to operate continuously, are on the front line.
Understanding the exposure of healthcare facilities
A sector of particular concern
Healthcare facilities are particularly exposed to climate risks due to their critical role and reliance on sensitive infrastructure.
Evacuation of Brooklyn's Woodhull Hospital due to a storm - September 2023
Closure of Saint-Affrique Hospital due to flooding - November 2014
Postponement of operations at Milton Keynes Hospital due to a heatwave - July 2022
Visualizing the impacts on infrastructure
A comprehensive view of risks
Extreme weather events
Main impacts
Water quality reduction
Modification of infectious agents
Flooding
Air quality deterioration
Wildfires
Drought
Extreme heat
Infrastructure damages
Increased temperatures
Impacts on ecosystems
Climatic hazards
Impacts on patient care
Risks to health and facilities
Disruption of health services
Supply chain disruptions
Adapted from a figure from "Mainland Facilities Management: Moving towards Climate Resilient Health Facilities for Vancouver Coastal Health, Vancouver, BC, Canada, 2018"
Sea level rise
Observing the already visible impacts
Recent feedback
Healthcare facilities have already faced service interruptions, infrastructure damages, or evacuations following extreme weather events. Here are some examples illustrating the impacts that different weather hazards can have on hospitals.
Heatwaves
Drought
Wildfires
Floodings
Storms
Test your understanding of resilience issues
Identify the strengthening of the regulatory framework
Growing requirements for healthcare facilities
In response to the increasing risks of climate change and their impacts on health systems, public policies and regulatory frameworks are gradually evolving. Healthcare facilities are increasingly encouraged — or even required — to incorporate climate issues into their strategies, infrastructures, and continuity plans to enhance their resilience against extreme events.
Since 2021, the European Climate Law makes climate change adaptation an obligation for member states and encourages the integration of climate resilience into all public policies.
The new European Climate Change Adaptation Strategy aims to build a climate-resilient Europe by 2050, notably by improving the preparedness of the most vulnerable sectors, including health.
In parallel, the European Directive on Critical Entity Resilience, which came into force in 2023, explicitly recognizes the health sector as an essential sector. It requires member states and critical infrastructures to strengthen their preparedness against natural risks, disasters, and major crises.
These regulatory developments are also accompanied by international recommendations. WHO encourages healthcare facilities to become both resilient to climate change and environmentally sustainable, to ensure continuity of care in an increasingly unstable climate.
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The impacts of climate change on healthcare facilities are already visible, and regulatory requirements are evolving rapidly.
In response to these challenges, it becomes essential to strengthen the resilience of hospitals to ensure continuity of care, protect infrastructure, and guarantee the safety of patients and staff.
Strengthening the Resilience of Healthcare Facilities
Understanding the Resilience of Healthcare Facilities
Anticipate, absorb, and adapt to crises
The resilience of a healthcare facility refers to its ability to anticipate climate risks, maintain essential functions during a crisis, and quickly return to normal operation after an extreme event. According to WHO, a resilient health system must be able to "predict, respond, absorb, and adapt" to climate shocks while maintaining quality of care.
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Understanding resilience as a systemic approach
A challenge that concerns all stakeholders
Hospital resilience does not solely depend on infrastructure. It involves the entire operation of the facility and requires a collective and coordinated approach.
Climate issues concern:- hospital management;
- technical teams;
- healthcare providers;
- logistics services;
- local authorities;
- energy, water, and transportation operators...etc.
Strengthening resilience therefore involves bringing together various stakeholders around the table to identify vulnerabilities, share responsibilities, and develop coordinated responses.
Identify the dimensions of hospital resilience
A multidimensional approach
According to the World Health Organization (WHO), the resilience of health facilities relies on several complementary dimensions. This approach is also used in the LIFE RESYSTAL toolbox to analyze vulnerabilities and structure adaptation strategies.
Health Workforce
Water, Sanitation, and Healthcare Waste Management
Energy
Infrastructures, Technologies, Products, and Processes
This dimension concerns all hospital staff: healthcare workers, technical teams, administrative and logistical staff. Climate change can affect their health, safety, working conditions, and availability, especially during heatwaves, extreme events, or prolonged crises.
This dimension covers access to drinking water, sanitation systems, hygiene, and medical waste management. Climate events can disrupt water supply, damage networks, or increase health risks.
Health facilities heavily depend on a continuous energy supply to provide care, operate medical equipment, and maintain critical systems. Climate events can cause power outages or energy surges, especially during heatwaves.
This dimension concerns hospital buildings, medical equipment, digital systems, supply chains, and operational processes, which can be damaged or disrupted by climate events.
All these dimensions are interdependent: a failure in one can affect the overall functioning of the facility and compromise the continuity of care.
Identifying the benefits of a resilience approach
Reducing impacts and improving preparedness
Strengthening the resilience of healthcare facilities helps better anticipate the consequences of extreme weather events and limit their effects on infrastructure, care services, and people.
It also helps improve the overall preparedness of the facility through:- better identification of vulnerabilities;
- development of business continuity plans;
- implementation of emergency procedures;
- strengthening coordination among internal and external stakeholders.
A resilience approach notably contributes to:- reducing service interruptions and temporary closures;
- limiting damage to buildings, equipment, and essential networks;
- protecting patients, visitors, and hospital staff;
- improving response and crisis management capacity;
- ensuring faster recovery of activities after an extreme event.
Beyond crisis management, investing in resilience can also generate long-term benefits, such as:- reducing costs related to damages and activity interruptions;
- improving working conditions and user comfort;
- better anticipating future climate and regulatory changes.
Can you guess?
Strengthening the resilience of healthcare facilities is essential to address the impacts of climate change. But a key question remains: how to concretely move from understanding these issues to structured and operational actions?
To answer this question a progressive methodology is necessary, allowing the transformation of risk analysis into concrete adaptation strategies that are planned over time.
Understanding the adaptation methodology
A structured approach in two main steps
Building an adaptation strategy is based on a logical process in two complementary phases:
Weaknesses
Identify and understand risks
Identify solutions and build adaptation trajectories
This first step involves analyzing weather hazards, vulnerabilities of facilities, and their potential impacts. It helps to precisely understand where the risks are and which hospital functions are most exposed.
Once risks are identified, the second step is to select relevant adaptation measures and organize them over time in the form of trajectories. This approach allows for building flexible, scalable strategies that are adapted to climate uncertainties.
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This approach is fully operationalized within the LIFE RESYSTAL toolbox, which guides healthcare facilities step by step through this process. The tool is not limited to planning adaptation: it also includes additional modules to enrich the analysis and support decision-making, including: economic impact assessments and potential losses related to weather events; cost-benefit analysis of measures and trajectories; as well as a dedicated module for crisis management.
Understanding the different types of adaptation solutions
Complementary responses to climate risks
Adaptation solutions can be classified into four main complementary categories:
Green solutions
Relying on nature
Blue solutions
Managing water as a resource and as a risk
Gray solutions
Acting through infrastructure and technologies
Soft solutions
Acting on organization and governance
Examples of adaptation solutions
Concrete illustrations in healthcare facilities
Green roof: Reduce heat and improve insulation.
Green spaces and vegetation: Limit heat islands.
Outdoor shaded areas: Protect from high temperatures.
Rainwater harvesting: Secure water supply.
White roof: Limit building overheating.
Backup power: Ensure continuity of activities.
Insulating glazed windows: Reduce heat transfer.
Porous coatings: Promote water infiltration.
Protection of sensitive equipment: Placed at height to protect them.
Once the solutions are identified and prioritized, they need to be organized over time. Indeed, not all measures should be implemented immediately. Some are suited for the short term, others for the medium or long term.
This is where adaptation pathways come into play, which help structure actions over time and adapt the strategy based on the evolution of climate risks and the institution's capacities.
Understanding adaptation pathways
Planning in an uncertain context
Climate change is evolving and uncertain. Risks can intensify, appear earlier than expected, or develop differently depending on the territories. Adaptation pathways help address this uncertainty by building progressive strategies over time. Instead of defining a single definitive solution, they organize a sequence of actions suited to different risk levels.
Adapting decisions over time
An adaptation pathway is based on step-by-step planning:
Short term
Medium term
Long term
Immediate and regret-free actions
Adjustments and reinforcements
Structural transformations
This approach allows adjusting decisions based on evolving climate conditions, available resources, and new knowledge. It also helps avoid inappropriate or overly rigid investments in the face of climate uncertainty.
A flexible and robust approach
Adaptation pathways offer a planning method more robust than traditional approaches. They allow: to anticipate different possible climate futures; to maintain flexibility in decisions; to secure investments over time; to gradually strengthen the resilience of health facilities. This approach is now widely used in climate change adaptation strategies at the international level.
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Building an adaptation pathway
Concrete example in a hospital setting
Scenario
Hospital X is regularly exposed to episodes of intense heatwaves. Among the identified risks, one of the most critical concerns the overheating of the MRI room. In case of cooling system failure, the helium necessary for the machine's operation may evaporate, leading to a complete shutdown of the equipment. This situation would have a major impact on the hospital's activity, paralyzing some of the essential diagnostic examinations for patients.
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Build an adaptation pathway
Concrete example in a hospital setting
Low
Medium
Medium
Risk levels of risk
Identified solutions
Spray water on the cooler to cool it down
Selected pathway
Cool tap water before spraying
Monitor temperature trends closely
Capture and reuse the heat from coolers
Abandoned maladaptation solution (unsustainable)
Implementation of backup air conditioners
Change technology and buy an MRI that does not require chilled water (air thermodynamics)
Use superconductors for the magnet, requiring a lower temperature
Improve thermal insulation in the examination room
Switch to standard air conditioners and coolers for tropical climates
Ad hoc solutions that are not sustainable long-term
Decision among these 4 last structural solutions based on context / feasibility / cost
Low-regret solutions that can be implemented immediately
Test your understanding of adaptation pathways
Understanding climate risks, identifying solutions, and building adaptation pathways are essential steps to strengthen the resilience of healthcare facilities.
To concretely support this approach, the LIFE RESYSTAL project has developed resources and operational tools for stakeholders in the health sector.
Discover the LIFE RESYSTAL project and its tool
Explore the project resources
A dedicated website and knowledge hub
The LIFE RESYSTAL project provides a website gathering information related to the project, partners, results, and news. A Knowledge Hub is also available to centralize useful resources on climate change adaptation, health facility resilience, methodologies, best practices, and tools developed within the project.
Access the LIFE RESYSTAL project website
Access the LIFE RESYSTAL Knowledge Hub
Explore the project resources
An online tool to support you
The LIFE RESYSTAL toolbox is accessible online and allows healthcare facilities to concretely implement the various steps presented in this training, from risk assessment to the development of adaptation pathways.
Access the LIFE RESYSTAL tool portal
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Summary Quiz
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Storms
A case of storms at White Memorial Medical Center in Los Angeles, United States
Following major power outages, White Memorial Medical Center in Los Angeles had to mobilize over 100 firefighters and numerous ambulances to evacuate 28 critical patients and transfer 213 others to a backup building.
Elevators out of service
Backup generators also fail even if they have been periodically checked.
Hillary storm hit Southern California. It is the first tropical storm to hit Los Angeles in 84 years.
The building has six floors, making it difficult to evacuate patients via stairs. "One of the issues we encountered, due to the total power outage, was the lack of light. Visibility was therefore zero. We did not have any operational elevators, so paramedic firefighters had to help critically ill patients, whose vital prognosis was not at risk, to descend the stairs and take them to an ambulance". (Testimony)
Activation of backup generators
Power outages
Storm
Medical equipment failure
"Many years ago, I worked at White Memorial in the neonatal intensive care unit. A power outage endangers the lives of all these babies, as well as other ICU patients whose lives depend on ventilators and other life-sustaining equipment". (Karen Bass, Mayor)
Most likely cause: water caused a short circuit in a panel or electrical system, cutting it off from the city’s power supply.
Heatwaves
Rising temperatures can lead to:
A case of heat waves at Saint Thomas Guy’s in London, UK
In July 2022, the heatwave in the United Kingdom caused a critical IT failure at St Thomas and Guy’s hospitals, forcing massive care delays and emergency transfers of patients whose safety was compromised.
“Patient safety was undoubtedly compromised” (Chief Medical Officer of St Thomas Hospital for The Guardian)
Heat wave
IT system failure
Soft solutions concern organizational, human, and strategic aspects. Examples :
- business continuity plans ;
- crisis management protocols ;
- staff training ;
- early warning systems ;
- service reorganization in case of heatwave.
They are often inexpensive and very flexible.Blue solutions concern water management in all its forms. Examples:
- drainage and rainwater retention systems;
- storage basins;
- securing drinking water supply;
- flood protection.
They are essential in the face of increasing episodes of heavy rain and droughts.This is the presence of people and resources in a hazardous location.
Drought
A drought can:
Case of Tri-City Medical Center Hospital, Oceanside, California, USA
To address a historic three-year drought in California, many hospitals conduct audits and implement conservation programs to sustainably reduce their water consumption.
Hospitals are among the largest water consumers in communities. To combat drought, hospitals conduct water audits.
Between 2012 and 2016, California experienced the most severe drought on record.
Find and repair leaks
Installing flow restrictors
Hospitals are implementing measures
Water shortage
Drought
Upgrading sterilizers
Modifying cooling tower operation
Governor Jerry Brown ordered California to adopt permanent water conservation measures, including long-term bans on wasteful water practices and mandatory reporting standards.
Modernizing showers and toilets
Replacing refrigeration compressors
The capacity to : - prepare oneself, - face, - recover from the impacts of climate phenomena with minimal damage to society, the economy, and the environment, and - adapt to future disruptions.
Gray solutions correspond to physical infrastructures and technical equipment. They aim to directly protect buildings and hospital systems against weather hazards. Examples:
- air conditioning and cooling systems;
- building reinforcement;
- backup generators.
They are often effective but can be costly and resource-consuming.Green solutions use ecosystems and vegetation to reduce climate impacts. Examples:
- vegetation of yards and roofs;
- creation of cool islands;
- natural management of stormwater;
- trees to reduce heat islands.
They often provide co-benefits (comfort, biodiversity, air quality).Wildfires
A forest fire can:
A case of forest fires at Cervello Hospital, in Palermo, Italy
Firefighters evacuated a pavilion of Cervello Hospital in Palermo located under the Inserra neighborhood, a hill on the outskirts of the capital that had been burning for hours during the heatwave, making the air unbreathable in the area and causing failures in the hospital systems.
Hospital staff had to do two full shifts instead of one. The mortality rate in the emergency department increased by a third.
Impact on residents' health
The heatwave (July 2023) lasted 10 consecutive days. Outside temperatures reached a maximum of 47 °C.
Power outage
Damage caused by heat to cables
Heat wave
Degradation of air conditioning systems
Closure of the intensive care unit
Forest fires
Forest fires ravaged a hill near the hospital, affecting air quality in the region.
"During the 30 years I worked as a doctor, I saw 4 or 5 cases of hyperthermia. During these 10 days, I saw 5 or 6 cases per day [...]. On a normal day, we have a red code 30 times a day, when a patient's life is really at risk, but during these days, we had 50 per day - so, a significant increase..." (Tiziana, a doctor at Cervello Hospital)
It encompasses sensitivity and the inability to cope or adapt.
Floodings
Floods can:
Case of the CH Emile Borel Hospital in Saint-Affrique, France
On November 28, 2014, following an exceptionally heavy rainstorm, the Saint-Affrique hospital experienced a devastating flood. The waters invaded the lower levels, paralyzing the technical facilities, kitchen, laundry, and care services of the Caylus building. This disaster required the urgent evacuation of 123 patients and significantly impacted medical activities for several months.
Laundry – Kitchen – Bio-cleaning Room
Facilities, techniques, and services
Technical facilities and services
Building B – USLD – Caylus Nursing Home
Photos taken on November 28, 2014. Source: Mrs. Corine Barthe-Cadier