On August 27, 2003, public health authorities in France signed the death certificate for “Petar, a 77-year-old Serbian who had lived in Paris for some 20 years.” By the decayed condition of his body, they estimated that he had died at least two weeks earlier.
Not entirely surprising given that it was “the smell of Petar’s death” that had led the authorities to break into his tiny attic apartment.
Petar at that earlier point would have been in the second wave of victims of the natural and social disaster analyzed by Richard C. Keller, a professor of Medical History and Bioethics at the University of Wisconsin-Madison, in Fatal Isolation: The Devastating Paris Heat Wave of 2003. Although demographers now believe that as many or more died in Spain and Italy – for Europe as a whole the death total for the 2003 heat wave now tops 70,000 – Keller focuses on the 15,000 who died in France, especially those who died in Paris.
Age, Architecture, and Isolation
Like Petar, most of those who died in the August heat wave in France were senior citizens. (Unlike Petar, however, most of these elderly victims were women.) Like Petar, most of the victims lived in small (often less than 100 square feet) apartments on the upper floors of Paris’s many Haussmann-era buildings. There, without air-conditioning or even adequate cross-ventilation, they became dehydrated and disoriented in the stifling heat. And like Petar, many were so isolated in these buildings that their bodies were not discovered until days or even weeks after they had died – when more prosperous tenants returned home from their August vacations.
It was the combination of these social, architectural, and cultural factors, Keller argues, that made the meteorological event – the three-week August heat wave – so lethal. But in the post-mortem reports on the heat wave, Keller says, the larger failings of the system were transcribed as unforeseeable contingencies and individual culpabilities. Not a successful strategy for meeting the challenge of climate change, which makes such heat waves more likely.
The Anti-Cyclone and the August Vacation
The 2003 disaster began as an anti-cyclone – “a large-scale system bound by rotating winds and marked by extremely high pressure that prevents other [systems] from displacing or disrupting it” – settled over southern Europe at the beginning of that August, just as the traditional French “vacation exodus” was beginning.
Weather forecasters, news media, and civil authorities were slow to recognize the growing threat, despite reports that overheated vehicles and melting train power lines were slowing the streams of vacationers. By the time the first real alarm was sounded, on August 10, more than 6,500 people had already died, and first responders, emergency rooms, and funeral parlors, short-staffed as a result of colleagues’ vacations, were feeling the pressure.
Two days later, when “nearly 2,000 deaths occurred throughout France . . . , the capital region [ran] out of places to store bodies and vehicles to transport them.” Despite regulations against the practice, the authorities were forced to use refrigerated food trucks to store the bodies that exhausted emergency responders continued to collect.
Even after the heat finally broke the following week, the tally continued to rise as vacationers returned home to apartments reeking of decay, with ceilings and walls fouled by the body fluids of those who had died in attic apartments.
The Political Psychology of Disaster
By the middle of the second week, the heat wave had become a major news story – with a sharp political edge. Speaking for exhausted emergency room physicians across France, Patrick Pelloux — an emergency physician, columnist, and author — argued that the government had failed its citizens, having cut funding for medical services now so desperately needed.
Health Minister Jean-Francois Mattei rejected the charge and instead pointed to the breakdown in social solidarity and a failure to meet familial obligations. Elderly citizens were dying, he said, because their neighbors, friends, and family had been so preoccupied with their vacations that they gave no thought to those at risk at home.
Mattei was mocked for wearing a polo short while scolding his fellow citizens for their August outings, but the repeated news images of frail individuals – or their bodies – being taken from isolated apartments reinforced his message: the deaths resulted from personal failings, not from the failure of the system.
But once created, this sense of collective personal guilt had to be countered, which it was by shifting the blame to the victims themselves. That effort was easy to do with the homeless, the addicted, and the mentally ill. The elderly, by contrast, were viewed more abstractly, as a problem of shifting demographics. The limited means and mobility that trapped the elderly in their small walk-up apartments had effectively disenfranchised them: They were no longer citizens of the state, but its wards.
After the 2003 heat wave, air conditioning was mandated for nursing homes, and cooling rooms were set up in vulnerable neighborhoods. Health and weather agencies now work more closely together. Summer temperatures are watched more closely, and heat warnings now trigger public advertising campaigns and emergency outreach efforts.
Authorities relied on these measures in 2006 and again earlier this past July. This last time the death toll was 700, roughly the same number as died in 1995 in Chicago during the 1995 heat wave “autopsied” by Eric Klinenberg in a 2002 book that Keller says influenced his own.
Lessons seem to have been learned.
For Keller, however, critical underlying problems have not been addressed. Although the 2003 heat wave has now been the subject of several documentaries, at least three novels, and numerous critical studies, too many of the vulnerable elderly still live in buildings ill-suited to a changing climate.
“‘The roofs of Paris are ovens,’” Patrick Pelloux says in the concluding pages of Keller’s book, “but that is what the tourists want to see. It [is] this deadly charm – along with its hidden populations in its upper corridors – that . . . continue to make the city so vulnerable.”
But this too may change. As part of its preparations for the 21st meeting of the Conference of Parties to the United Nations Framework Convention on Climate Change in December, Paris will convene a meeting on climate change and health at the end of November. According to Keller, at least one panel will be devoted to the 2003 heat wave.
On the July 2015 heat wave in France:
As it turns out, I was in Paris and Versailles at the end of June and beginning of July this summer for the European Society for Environmental History Conference, and thus had the opportunity to experience this summer’s heat wave firsthand. I was lucky enough to be able to meet with someone from the Institut de Veille Sanitaire, France’s epidemiological surveillance agency, to talk about the heat wave response as it was happening in early July. The response was impressive: the agency was extremely attentive, while recognizing the difficulty of aiding those most in need. The officer with whom I met detailed the ways in which the country’s warning systems and the integration of the weather and health agencies have improved responses to heat emergencies, but also pointed to how many at-risk populations remain difficult to reach. This officer also noted that given the centralization of the French government, outreach to NGOs remains less effective than it might otherwise be.
On the decision to focus on France rather than Spain or Italy:
I focused on France because the heat wave achieved a level of social and political crisis in France that it never reached elsewhere. Media surveys show that French newspapers covered the disaster far more extensively than their Spanish and Italian counterparts, for example. But part of this also has to do, ironically, with France’s relatively immediate reaction to the disaster. France conducted a mortality survey relatively quickly after the disaster, and released official figures for the death toll at the end of September 2003, therefore creating an opportunity for an intense media and political scrutiny of the disaster. By contrast, mortality estimates varied widely for Spain and Italy until years after the disaster had passed. In 2003, both countries claimed only a handful of deaths, but revised their numbers upward dramatically in 2005, when the media and the public had lost interest in the disaster. Finally, while death tolls for the summer of 2003 in Spain and Italy approached or exceeded those in France, in Spain and Italy they were spread over the entire summer. In France, they occurred primarily within the first 20 days of August, meaning that mortality was far more concentrated in the French case than in those of its neighbors.
As an analogy, one could argue that many disasters have surpassed Hurricane Katrina in terms of mortality. Yet for the United States, that disaster has played a critical role in shaping concerns about disaster response, the ways in which meteorological catastrophes prey unevenly on different communities, and the relationship between communities and their governments. In short, Katrina has scarred American consciousness about disaster. I argue in Fatal Isolation that the heat wave of 2003 did the same in France, to an extent that was not equaled in Spain or Italy.