French government tries to quell scandal over heat wave deaths

By Alex Lefebvre
18 September 2003

Faced with the scandal over its response to the heat wave, the government of French prime minister Jean-Pierre Raffarin—with the aid of the media—is firmly denying that the government received adequate warnings. It hopes to use this lie to hush up the scandal and make people forget that health authorities were largely aware of the crisis as it occurred and did little or nothing to confront it.

The official report on the heat wave, prepared by a panel of experts appointed by Health Minister Jean-François Mattei, is one example of this argument. Its main health-related proposal is to put in place a better health alert system. As to whether the government acted in time, the document offers the following remarkable opinion: “The variations during the year in activity of [health services] did not allow us to perceive the unusual character of the situation up to August 10 inclusive... This mission thinks that a simple, real-time surveillance of the quantitative activity of emergency services would not have allowed us to raise a real alarm before the results of August 11.”

Ministers appearing before a fact-finding commission at the National Assembly took the same stance. François Fillon, minister for social affairs, noted: “No one had foreseen such a high peak in temperatures... Thinking today that there were indications which would have allowed the government to put a crisis-response system in place, that is not telling the truth.” According to Mattei, “The totality of consequences of this heat wave could hardly have been anticipated... [W]hat’s missing is the upward flow of information, synthesis, and reaction.”

The center-left daily Le Monde took up the same argument, publishing on September 10 an article entitled “The Paris firemen did not transmit their figures on mass deaths.” The article stated: “These figures were not, at least officially, transmitted to the Paris police prefecture or to the cabinet of the Interior minister, or to the authorities charged with large-scale health surveillance.”

The scale of lying manifested in these examples is an indication of the magnitude of the crisis shaking the Raffarin government.

According to a limited series of health ministry e-mails published by Le Monde on September 1, it is clear that government circles were aware of the danger from the beginning of the heat wave. Thus, on August 6, William Dab, then high counselor of the health minister and now head of the General Health Directory (DGS) after the resignation of Lucien Abenhaïm, sent an e-mail to the DGS. He indicated that “Epidemiology allows us to anticipate an excess mortality associated to the heat wave. It would be useful for the DGS to prepare a press release recalling a few elementary precautions, including for the elderly and the very young. There are numerous studies on the health consequences of heat waves.”

Over the next two days, officials at the Health Ministry and the DGS were clearly aware that “excess deaths” were due to the heat wave. Thus Yves Coquin, head of the DGS during Abenhaïm’s August vacation, received an August 8 e-mail from Professor Mac Verny of the Pitié-Salpêtrière hospital, who wrote of several sudden deaths there: “These cases present a certain number of resemblances: hyperthermia breaks out in a brutal fashion, immediately superior to 39 degrees Celsius... The most probable diagnosis for us is that of heat flush... In all, the problems encountered must be put in relation to the current unusual weather conditions.”

That same day, the Paris Fire Department published a press release, subsequently written up as an Agence France-Presse (AFP) dispatch, indicating hundreds of daily interventions for “heat flush” and an abnormally high death rate amongst the elderly. According to the Nouvel Observateur, hospital conditions were already becoming critical. An August 18 article in Le Monde noted that Interior Minister Nicolas Sarkozy’s office had been studying the firemen’s abnormal activity since August 4. This did not prevent Le Monde from implying on September 10 that the firemen had not warned the government.

For reasons that Le Monde did not elaborate, the DGS did not publish the press release mentioned in the August 6 e-mail about “elementary precautions” until the end of the afternoon on August 8. Coquin wanted to first obtain “other suggestions,” about which no details have been published.

If health officials were fully conscious of the heat wave-related deaths from their beginnings, they chose to deny the heat wave’s role in their public statements. Thus, on August 10, Dr. Patrick Pelloux, president of the Association of Emergency Hospital Physicians of France (AMHUF), criticised the DGS: “In four days, there were practically 50 deaths due to the heat... At the level of the DGS, absolutely nothing is happening. They dare to speak of natural deaths.”

From then on, political leaders, whose health officials were well informed on the severity of the crisis, did everything they could to minimise its importance and extent. Faced with criticisms from Pelloux and the Socialist Party (PS), Ecology Minister Roselyne Bachelot called on August 11 for “civic spirit” and told critics to keep quiet: “This is not the time for polemics.” The same day, Mattei announced that “there is no massive overflow in the emergency services” and that “the difficulties encountered are comparable to those of previous years.”

August 12—the deadliest day, according to preliminary figures—saw the deaths of thousands across France and the public announcement by funeral home directors that they were overflowing. From the Alps, where he was on vacation, Raffarin denounced the “partisan polemics” of those who were criticising the actions of his government. On August 13, he decided to set in motion a “white plan” that would mobilise more personnel and funds for hospitals. Luckily, temperatures also began to drop and emergency rooms began to be less crowded. Raffarin ended his vacation in the Alps on August 14.

Afterwards, the government principally tried to limit political fallout by casting doubts on the ever-larger heat-related death tolls that were being established. On August 17, Mattei certified that the situation was “completely under control” and categorically denied Pelloux’s estimation of 5,000 heat-related deaths. On August 18, Mattei reversed himself, considering the “hypothesis” to be “plausible” and provoking the resignation of DGS chief Abenhaïm. On August 20, Raffarin called for “prudence” as to the funeral home company OGF’s estimate of around 13,000 heat-related deaths, promising that an official death toll would be drawn up by experts designated by Mattei over the next month. Three days later, however, Raffarin was expressing his “immense sadness” and “profound anger” at not having “trustworthy estimates.” At present, the death toll is estimated at around 15,000, with 11,435 deaths occurring before August 15 and the rest after.

If the official explanation of the crisis directly contradicts the facts, it is because the fallout from the heat wave deaths has created a major political crisis for the Raffarin government. Raffarin’s official public approval rating has fallen, and he has been booed at public appearances. The BVA polling agency gave his ratings at 39 percent favorable and 50 percent unfavorable (the favorable ratings have decreased and unfavorable ratings increased since the massive strikes against pension cuts of May 2003). Other government figures—including President Jacques Chirac—have also slipped in the polls.

Before the heat wave, Raffarin’s social policy was already largely unpopular; he kept his numbers up in the official polls by cultivating an efficient, pro-law-and-order image around Sarkozy and a mythology according to which he “listened to Frenchmen.” The heat wave has left little intact of these pretensions, presenting the picture of a vacationing government of bureaucrats mainly concerned with the public-relations effects of a health disaster.

The true attitude of government circles towards the French people showed through in a September 9 interview with Le Monde by National Assembly deputies of the ruling conservative UMP party from the Loiret district. Jean-Louis Bernard tranquilly declared that the heat wave-related deaths were in the nature of things: “Before, there was plague and cholera. One could imagine in the future that a disease, respiratory for instance, might carry away older people. For the time being, we are headed for very long life expectancies.” Antoine Carré took a more haughty tone: “I do not have anything with which to refrigerate or cool down the populace,” he said, adding crudely, “The elderly do not stand up to such temperatures.”

One cannot trust the government or the National Assembly’s investigations to draw the conclusions that flow from the catastrophe. Those who participate in them are interested only in a cover-up, with their findings faithfully repeated by the mass media even when they blatantly contradict reports that these same organisations published previously.

Many questions have yet to be fully answered: Why did the DGS decide to wait from August 6 to August 8 to publish its press release, although it already anticipated “excess deaths” due to the heat wave? What political imperatives made the DGS speak of “natural deaths” even though high DGS officials knew that these deaths were due to the heat wave? What were the communications between political leaders and senior health officials, who knew about the “excess deaths” as they began to occur? What was the relation between the Raffarin government’s obvious desire to expend the minimum of resources at the beginning of the crisis and its policy of limiting health and social spending, as revealed in its proposed “reform” of Social Security, now put off until October 2004?

To answer these questions, only a public investigation independent from established political circles and a procedure to establish the criminal responsibility of those who obstructed the mobilisation of health resources during the heat wave will suffice.