The flames stood at the gates of Athens. On August 11, 2024, in Greece, patients from two hospitals, including a pediatric hospital, were quickly transferred away from the fire. A decision that symbolizes the lack of preparation of our healthcare systems for fires, whether hospitals are vulnerable to the intrusion of toxic smoke, dated evacuation plans or lack of training of nursing staff.
This is described in an article published in the journal The Lancet Planetary Healthwhere an international team of policy, emergency medicine and mental health researchers calls for strengthening health systems in the face of these fires.
For Jeffrey Tochkin, from the British University of Sheffield, the management of health institutions must anticipate – in advance of disasters – hospital evacuation scenarios. In 2017, nearly 900 patients and 700 healthcare workers had to quickly flee nineteen clinics as flames ravaged British Columbia, Canada. In 2023, the evacuation of the hospital in Yellowknife, Northwest Territories involved the creation of a military airlift.
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Professor at the University of Calgary, emergency medicine specialist Courtey Howard is affiliated with this institution: “ We never anticipated this eventualityshe testifies. Our shelter-in-place plan dates back to XXe century. And as we publish this study, Yellowknife is once again being invaded by smoke. » For the researcher, it is important to prepare these evacuations today, since the task is dangerous: we must anticipate loss of visibility – due to smoke and probably interrupting flights, deterioration of air quality in the ambulances transporting patients, power cuts or even lack of gas stations.
Need for training in air pollution
With wildfires mainly affecting rural areas, where limited health workers have different roles, many doctors and nurses do not have enough specific training to deal with these crises: “ Most medical courses still do not include teaching on climate change and air pollution. Only a few programs around the world treat itwrite the authors. This leaves health professionals unsure of how to advise their patients or policy makers regarding climate-enhanced health risks, such as wildfires and smoke. »
“ Our shelter-in-place plan dates back to XXe century »
Furthermore, hospital infrastructure must be improved to ensure better resistance to smoke. Driven by the wind, they can travel thousands of kilometers. In the eyes of the researchers, it seems imperative to carry out all the necessary repairs to prevent them from infiltrating via heating, ventilation, air conditioning or more simply windows and doors. The installation of air quality sensors should also be developed. “ All identified vulnerabilities must be tested during realistic and regular simulations, organized by experts »concludes the investigation.
“ Fires don’t just threaten our physical integritywarns Ejemai Eboreime, from the department of psychiatry at Canadian Dalhousie University. They can also leave a lasting mark on our mental landscape. » In the 3 to 6 months after a fire, symptoms of post-traumatic stress can affect 24 to 60 % of surviving adults. For severe depressive disorders, the percentage is around 30 %. As these repercussions are more subtle to detect, the authors particularly call for the integration of climate education and the notion of eco-anxiety into school programs.
Breaking down the barriers
In addition to this inventory, the authors encourage the medical community to dare to address political issues. Aim: to balance the scope of international climate negotiations, where fossil fuel lobbies outcompete NGOboth in number and influence. In the wake of COP26 in Glasgow, more than 80 countries expressed the ambition to build low-carbon, sustainable and climate-resistant health systems. Two years later, under COP28 in Dubai, 140 states had also signed an international appeal called “ The declaration on climate and health ».
Despite the consensus, the mobilization of the human, political and financial capital needed for this implementation is slow. Health professionals could therefore establish an advocacy strategy to demand a new direction in public spending, the creation of cross-ministerial bodies with a direct line of communication with decision-makers, or even the renovation of housing for vulnerable patients.
“ We must break down silos to save lives »
In other words, “ we must break down silos to save lives »writes Attila Hertelendy, the first author of the study, affiliated with Harvard. To do this, universities will need to strengthen the incentives to work towards real policy progress and not limit themselves to producing data and analysis.
Last Vigilance: Climate Justice. The Paris Agreement set in stone the need for financial contributions from a large majority of rich countries to help finance the adaptation of those that have produced fewer emissions but suffer the worst consequences. But even today, these countries still have the least developed health systems to deal with climate hazards. This worsening of inequalities, especially caused by colonialism according to the authors, must also be fought loudly and clearly by the medical sector.
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