Twenty years after deadly 2003 heatwave, what has France learned?

June 2003 was hot. July 2003 was hotter. August 2003 was fatal. 

“There were actually three significant heatwaves in the summer of 2003 – there was one in June, one in July, and then the real whopper came in August,” says Richard C Keller, an historian of public health who was in France during the first part of that summer and later wrote a book about its devastating consequences.  

In the first days of the month, daily temperatures were normal for the time: on average, around 25 degrees Celsius maximum. By 5 August, they had risen to 37 degrees, and they would remain between 36 and 37 degrees until the 13th.  

It was the length of the heatwave that made it exceptional, and its reach. A weather pattern known as “blocking” meant that hot, dry air remained stuck over France for two weeks, day and night.  

Even parts of the country where intense heat was rare weren’t spared – notably Paris, where the nighttime temperature barely dropped below 23 degrees throughout the second week of August. 

This fact would prove deadly: most of France simply wasn’t prepared.  

Danger underestimated

At the time, heat wasn’t seen as a killer. France had had two fatal heatwaves within living memory – in 1976 and in 1983 – but they were seen as freak events, or confined to the south. 

As temperatures rose in 2003, newspaper front pages were filled with pictures of tourists splashing in fountains to cool off, recalls Keller, today a professor of medical history and population health at the University of Wisconsin-Madison in the US.

“For the most part the heat was billed as an inconvenience,” he says.

The first warnings that it could be more than that didn’t start appearing until a few days into the August heatwave, when French weather service Météo France cautioned that the elderly, the sick and infants might be at risk. 

People on the front lines could already see the proof: they reported that hospitals were being flooded by people suffering from dehydration and other tell-tale signs of heat stress. 

“The problem is real – we have sick people here who are dying,” Patrick Pelloux, a doctor at Saint-Antoine Hospital in Paris and head of the union of French emergency room physicians, told France 3 television, visibly frustrated. 

But the government was slow to admit that the heat was killing people. After Pelloux sounded the alarm bell, the then health minister Jean-François Mattei also went on TV – from his holiday home in the Riviera where, dressed in a polo shirt, he assured that the situation was under control.  

“At this point, the bodies were just absolutely piling up in makeshift morgues in cities like Paris and Lyon,” notes Keller. By 10 August, he says – the day before Mattei’s interview – at least 6,500 people had already died from the heat.

Morgues overflowing

In the days that followed, the government ordered hospitals onto an emergency footing. But it was already too late: most of the deaths occurred in the first two weeks of August. 

As the heat abated, emergency services and undertakers struggled to collect and bury the bodies. In Paris, the city ran out of places to store them. 

Others wouldn’t be discovered until later.

Those who could had left on holiday. When they returned to big cities, some found gruesome scenes: apartment buildings pervaded by the reek of decomposing flesh; ceilings stained by bodily fluids that had dripped through from the flat above, where an upstairs neighbour had died and lain undiscovered for weeks.

Ultimately, 14,802 deaths in France would be attributed to the August 2003 heatwave. Over the entire summer, the toll has been estimated at around 19,000. 

The statistics painted a bleak picture. Around 82 percent of the victims were 75 or older. Many of the deaths took place in big cities, Paris above all, where the excess mortality rate was 141 percent compared to an average summer. Of those in the capital who died in their homes, 92 percent were estimated to have lived alone. 

The tragedy left France soul-searching, according to Keller: “How can the nation that claims to be the originator of the notion of human rights and dignity be in such a place that people could die in such misery, and completely alone, completely isolated?” 

Efforts to correct mistakes

France put the question to a parliamentary inquiry, which published its conclusions in February 2004.

It identified multiple failings: decision-makers absent during the August holidays, hospitals and nursing homes understaffed, lack of a monitoring system or any kind of heat emergency plan, poor information sharing, a general failure to join the dots. 

By that summer, France had put in place its first national heatwave plan.

It introduced a warning system that automatically puts each department of France on alert from June to September. During this period meteorologists and health experts assess risks daily and advise local authorities to issue warnings for intermittent heat (yellow alert), heatwaves (orange alert) or severe heatwaves (red alert). 

Each alert is linked to an action plan, setting out specific measures the authorities and emergency services should take.

Crisis mode kicks in with an orange alert. In Paris, for instance, that’s when the city begins opening public cool spaces in council offices and stepping up checks on people living on the street. A red alert gets the national government involved. 

Since 2004, old people’s homes and nursing centres have been required to set up at least one common room with air conditioning where elderly residents can cool off. They must have an emergency strategy in place for heatwaves, including plans to mobilise extra staff if needed. 

Meanwhile local councils encourage over-65s and people with disabilities who live at home to sign up to receive phone calls checking in in the event of an orange or red alert. If they report signs of distress, operators can connect them with a doctor or send someone round to their home. 

Preventable deaths

“That’s a nice sentiment, but who really wants to lump themselves in with the idea of being at risk during a heatwave?” says Keller, who says France’s community registers are limited by requiring people to opt in.  

Many people who need help may be reluctant to seek it out, he points out, or simply unaware the service exists. Some don’t have a permanent address where they can be reached, or a phone.  

In his book, “Fatal Isolation: The Devastating Paris Heat Wave of 2003”, Keller investigated the abandoned victims of that summer: some 60 Parisians whose bodies were never claimed after their deaths.

Speaking to neighbours and others who had known them, he was struck to see that most people only believed victims had died because of the heatwave if they were over 60. Younger victims were described as dying during the heatwave, but of other causes – alcoholism, heart problems, obesity. 

“The framing of the typical victim of the heatwave as an older French person led people to think that those are essentially the only people who are at risk,” Keller says.

In fact, around a third of the 32,658 people who died from heat in France between 2014 and 2022 were under 75, according to national public health institute Santé Publique France.

While Keller understands why the state has focused on the elderly in the wake of 2003, he’d like to see it take a more comprehensive view of what can put two people of the same age at different risk of dying from heat. 

“This is a difficult task because the people who are at the greatest vulnerability of dying are in many cases difficult people to reach,” he says.

“They’re people who live in isolation, they’re people who suffer from physical or mental disabilities, or addictions, or a range of other health problems that make them difficult to contact. They’re people who are unhoused, and in many cases mentally ill.    

“These are difficult people to reach and difficult people to help, and people who may reject help. I don’t think that makes their lives worth any less, though. I think these are important lives to save, and it’s important to remember that heat deaths are, for the most part, preventable deaths.” 

Better prepared, but more exposed 

No summer in France has ever been as deadly as 2003, nor as hot. But 2022 came close: it was France’s second-hottest summer on record and overall hottest year.  

Meanwhile heat-related deaths in France last year were estimated at around 4,800. That suggests France has got better at preventing at least some deaths from heatwaves. 

Everything indicates it will have to improve further. In the years since France introduced its first heatwave plan, extreme heat has ceased to be a contingency: between 2004 and 2018, France did not once issue a red alert for heat; since 2019, the maximum warning has been declared five times. 

“We’re certainly better prepared and the public is much more aware,” says Guillaume Boulanger, a public health expert who studies living and working environments at Santé Publique France.  

“But the difficulty we face today is real and rapid climate change, bringing higher temperatures and more frequent, more intense hot spells that now affect the whole of the country,” he told Le Monde newspaper. 

Based on its observations over the past decade, the public health institute says that France’s emergency response to hot weather “needs to be complemented by structural and systemic adaptation to heat”. 

From emergency to adaptation

Earlier this year France unveiled its first “heatwave management plan”, made up of longer-term measures. They include annual temperature checks on school buildings, better monitoring of the electricity network to avoid power cuts, and inspections of working conditions in especially exposed sectors. 

The strategy also proposes strengthening the existing prevention system, notably sending volunteers and postal workers door to door to sign vulnerable people up to community registers. Emergency text messages might also be sent out en masse in the event of a heatwave, not only to the elderly. 

Local authorities, too, are seeking to make French cities more bearable in hot weather. Paris – which has the highest number of heat deaths of any capital in Europe, according to one recent study – has put in place policies to limit traffic, plant more trees and replace heat-trapping tarmac with lighter, more permeable materials.  

In future, the city aims to cover the iconic zinc rooftops that turned top-floor apartments into ovens in 2003 with reflective paint, greenery or solar panels. 

“Those are the kind of things that can be broadly effective, but they’re going to take lots of time to work,” comments Keller. “And in the meantime, the heat’s rising.” 

As it does, France may find it still has more to learn from the summer of 2003 – the first time the country saw heat as a killer, and the last time anyone could say they didn’t see it coming.