France: More than 10,000 dead in record heat wave

By Francis Dubois
22 August 2003

The unprecedented heat wave in Europe has caused many deaths across the continent, but the highest number of victims has been in France, where illness and death have reached epidemic proportions.

While the full extent of the health disaster has still to emerge, the heavy death toll has led to a serious political crisis for the French government. At the beginning of this week, the number of deaths linked to the heat was estimated at 5,000, and this figure was, according to medical experts, likely to rise, since 50 percent of the deaths have occurred outside hospitals and are not yet accounted for.

France’s leading undertakers organisation reported on Thursday that as many as 13,000 may have died from exposure to the intense heat.

After unusually high temperatures throughout June and July, the heat wave reached its peak between August 6 and August 11, with temperatures soaring to 40 degrees Centigrade (104 degrees Fahrenheit). In the course of the week, hospitals were thrown into crisis, unable to cope with the increasing numbers of people—mostly the elderly and frail and those with chronic illnesses—brought to them by the emergency services.

The number of deaths in the Paris region increased dramatically, up to four times the number normally seen at this time of year. Most deaths were from dehydration or heatstroke. For many of those brought to hospital, it was already too late. According to one estimate, 80 percent of those who died were over 75 years of age.

Hospitals eventually stopped admitting patients, and people calling for ambulances were told they would have to cope where they were. As a result, people died in hotels, in their homes or, even more often, in old people’s homes. Homeless people simply expired on the street.

Morgues and funeral homes ran out of space, and some of the dead were left for days on end where they had perished.

To cope with the growing number of bodies, the government of conservative Prime Minister Jean-Pierre Raffarin decided, on August 18, to open a central morgue in an old fruit and vegetable market in Rungis, south of Paris. The improvised mortuary can house up to 2,000 bodies.

This choice was a fitting symbol of the attitude of Raffarin and President Jacques Chirac. For the thousands who had lost relatives or friends, it had the effect of a further slap in the face.

The government ignored warnings by the meteorological office and failed to anticipate the consequences of the intense and prolonged heat in a country where few private homes or offices have air conditioning. It compounded its dereliction by refusing to take steps to cope with the crisis as it grew in urgency from day to day.

Many doctors and health experts have pointed out that a good number of the deaths could have been prevented. As early as August 7 there were warnings that the heat would have severe consequences and calls for emergency plans to be put into place, but the government remained totally passive. This led to an open conflict between various branches of the health system and the government over the developing disaster. In the second week of August the government was obliged to answer accusations of negligence and indifference.

Instead of taking serious steps to meet the situation, the government’s response was to cite crisis management measures based on a plan for responding to terrorist attacks or natural disasters in general. Already by the first days of August, hospitals and emergency services were reporting deaths caused by the heat, but the government was still insisting as of the middle of the second week in August that all such deaths were due to “natural causes.”

This prompted Patrick Pelloux, the head of France’s emergency doctors’ association, to say, “They dare to talk about natural deaths. I absolutely do not agree with saying that.”

On August 11, the Ministry of Health was still maintaining that “emergency departments are not massively clogged” and “the difficulties are comparable with previous years, with the exception of some hospitals and one or two departments in Ile de France (the Paris area)”.

“Plan blanc” (the White Plan), which is supposed to make extra equipment, transport, staff and beds available in emergency situations, was put into effect only on August 13, after public criticism had grown louder and the peak of the heat wave had been reached.

This situation was not simply the result of the government’s attitude over the last few weeks. As many doctors and health experts pointed out, it was bound up with a lack of preventive measures, which would have been relatively easy to implement, and a general downgrading of the health service over the past 15 years. Hospitals have been starved of funds. They have no margin to provide for unanticipated situations, and lack the wherewithal to hire additional staff.

According to Professor Pierre Carli, the head of the SAMU (Paris ambulance service) at the Necker Hospital, and Professor Bruno Riou, the head of emergencies at the Pitié Salpétrière Hospital in Paris, the heat wave “has highlighted in a dramatic way a permanent shortage... If the situation [of victims of the heat having no hospital bed] seems scandalous, it is indicative of a daily scandal in many hospitals, even when there is no epidemic.”

At the end of July, the association of emergency doctors had warned that the cutback of hospital beds by 25 percent to 30 percent during the summer vacation months had created a dangerous situation. These summer closures were carried out to deal with a general deficit in hospital beds.

The president of the association of directors of old people’s homes, Pascal Champvert, denounced the “lack of staff in old people’s homes,” and blamed this for the heavy death toll in the heat wave. “Thousands of old people are dead,” he said, “because there aren’t enough staff in old people’s homes. One knows that in this milieu ... lack of staff kills every day. He demanded that the health minister restore the 100 million euro credits meant for old people’s homes that had been “frozen” at the beginning of 2003.

At one old people’s home in Vitry sur Seine, a doctor explained that there was one nurse for 72 people, and some of the staff was barely trained.

The government was put onto the defensive by the reaction its indifference provoked. It responded with a mixture of arrogance and ignorance. Damage control was the order of the day. At the same time, it appealed to the opposition parties not to engage in partisan polemics.

Forced to break off his holiday on August 14, Raffarin initially blamed the mounting death toll on the public, denouncing families for leaving elderly relatives on their own and without help while they went on vacation. This charge was clearly contradicted by the fact that half of the people who died were living in homes for the elderly, and weren’t alone at all.

At the same time, he and his minister of health, Jean François Mattei, pontificated about the need for solidarity and commiseration—precisely what the government had failed to exhibit. Raffarin rushed to an old people’s home in the Bourgogne area (one that hadn’t suffered any casualties) to try belatedly to answer criticisms that his government had abandoned the old and the sick.

Mattei made statements redolent of the infamous words of Marie Antoinette in 1789: “Let them eat cake!” He said in an interview that the reason so many old people were dying from the heat was that there were more of them around, as a result of rising life expectancy.

One of the mantras of the government was that the heat wave was not its responsibility. A government official was quoted as demanding: “Are you saying the government’s role is to give bottles of water to babies on motorway service areas?”

The health minister attempted to deflect criticism by putting the blame on his immediate underlings, arguing that his apparent lack of concern was due to the fact that he hadn’t been informed of the seriousness of the crisis. He pointed the finger at the Directorate General of Health (DGS), the department responsible for supervising the health situation nationally. This led to the resignation of the head of DGS, Lucien Abenhaïm, who in subsequent interviews contested the government’s version of events and insisted that he had issued the necessary warnings in time.

In a crude attempt to bribe and soothe those who had to cope with the crisis—doctors, nurses and the staff of old people’s homes—Mattei promised a lump sum to staff who helped those suffering from the heat.

The Raffarin government came to power last year in the aftermath of the re-election of Chirac as president. The entire official left of French politics—the Socialists, the Communist Party, the Greens—as well as sections of the so-called “far left,” openly campaigned for Chirac’s re-election following the defeat of the Socialist Party candidate, Lionel Jospin, in the first round of the election at the hands of the National Front fascist, Jean-Marie Le Pen. These “left” forces portrayed Chirac, the most prominent leader of the traditional right-wing parties, as the defender of democracy against Le Pen, and called for working people to give him a massive mandate. The predictable result was not only the re-election of Chirac as president, but a sweeping victory for the right-wing parties in the parliamentary election that followed soon after.

The present political crisis of both Raffarin and Chirac arising from the heat wave demonstrates how isolated and weak the right-wing government actually is, despite the large majority of right-wing deputies in the National Assembly. Out of touch with the reality faced by tens of millions of ordinary people and representing the interests of a thin layer of the wealthy and super rich, it rests on the narrowest of social bases.

The present health catastrophe has provided an ominous illustration of the government’s overall intentions with regard to France’s health system, and made people more aware of what is to come than Raffarin and Chirac would have liked. The crisis has erupted just days before the government is set to launch a fundamental assault on the health insurance system and the health service, attacking the foundations of the health system as it has existed since the end the Second World War.

The political crisis has emerged as well only weeks after the government carried out an unprecedented attack on pension rights, which was facilitated by the trade unions’ sabotage of a mass movement of strikes and protests.

The reaction of the parties of the official left has been to help contain the crisis of the Raffarin government. François Hollande, the national secretary of the Socialist Party, has mildly reproached the government, while the Greens have called for the resignation of Mattei, and some left deputies have called for a parliamentary inquiry into the management of the crisis by the government.

The Stalinists of the Communist Party have called the government’s performance in the heat wave a “fiasco,” but have avoided raising any political demands.

None of these parties are seriously questioning the policies that led to the disaster, or pointing to the underlying failure of the French capitalist system itself. This comes as no surprise, since these same parties were implementing health care cuts when they were in government only a year ago.