Record-breaking heatwaves across Europe this summer have exposed the vulnerability of hospitals and healthcare systems to extreme temperatures, raising urgent questions about their preparedness as the continent continues to warm. 

The heatwaves that recently swept the continent resulted in more than 35,000 excess deaths, though the true figure is probably much higher, as the estimate covers about half of the continent and excludes data from August. 

The heat crisis exposed the vulnerability of health systems across Europe, many of which are ill-equipped to cope with rising temperatures and an influx of patients presenting with heat-related illnesses such as dehydration, heat stroke, and worsening cardiovascular, respiratory, and neurologic conditions.

Beyond increased morbidity, mortality, and hospital admissions, extreme heat can also threaten the reliability of critical healthcare infrastructure, including electricity, cooling, and technology systems, medication storage, and workforce productivity. 

Despite these risks, Europe's health systems remain largely unprepared to manage the effects of climate change. "Before the severe heatwaves that hit western Europe this summer, climate adaptation was not seen as a priority for the healthcare sector," Gabriella Abruzzo, climate projects coordinator at Health Care Without Harm (HCWH) Europe, told Medscape News Europe. "The intense heat of this summer made evident how vulnerable healthcare facilities and services are to climate change and how necessary it is to plan and act to avoid another summer like 2026." 

A Romanian Hospital Builds Climate Resilience

One hospital in Romania is rising to the challenge with relatively simple measures that can save lives. Buhuşi Hospital in Bacǎu county, one of Romania's most disadvantaged areas, has become a national model of care. Once at risk of closure because of a shortage of doctors, Buhuși Hospital now employs more than 80 physicians and has invested in modern medical equipment and climate resilience measures. 

"We see climate change not only as an environmental issue, but as a matter of patient safety, prevention, and healthcare system resilience," Constantin Poiana, the hospital's manager, told Medscape News Europe. "Our approach is, first and foremost, practical." 

During periods of extreme heat, the hospital prioritizes maintaining safe medical services and ensuring that vulnerable patients receive timely assessment and treatment. This requires adequate indoor conditions, reliable utilities, sufficient supplies, functioning medical equipment, and the capacity to respond to increased demand for care. 

The hospital has a designated cool space, with cold water, for people suffering from heatstroke, and medical staff who are trained to recognize and manage not only heatstroke and heat exhaustion but also other conditions associated with excessive heat. The hospital has also applied for funding to install a cooling system for the whole building in preparation for even higher temperatures in the future. 

"Climate resilience is not achieved through one single measure. It requires infrastructure, clinical preparedness, prevention, and good organization to work together," he said.

For Poiana, a key part of this approach is preparing for heatwaves before patients arrive at the hospital. This includes giving patients, particularly those with chronic diseases, clear advice on staying hydrated, avoiding prolonged exposure to heat, recognizing warning signs, and knowing when to seek medical care.

Such measures are especially important because the health effects of extreme heat are not always immediately obvious. "What is important from a medical perspective is that extreme heat does not always present as a heat-related illness; it may [present as] dehydration, weakness, hypertension or worsening of an existing chronic condition," Poiana said.

Ready Before Heat Strikes

Earlier this year, the World Health Organisation (WHO) released updated guidance on its Heat-Health Action Plans (HHAPs) to help governments and authorities protect populations from extreme heat caused by climate change. 

The guidance outlines eight core elements, including health system resilience, and calls for better training in heat-related illnesses, stronger surveillance systems, climate-resilient infrastructure, and measures to maintain essential services during extreme heat.

Such preparedness is particularly important for patients with underlying health conditions, including cardiovascular disease (CVD), who face heightened risks during heatwaves.

Earlier this month, the European Society of Cardiology published a new statement bringing together existing research on preventing deaths and hospitalizations during heatwaves among people with CVD. Echoing the WHO's emphasis on health system resilience, the statement calls on hospitals to prepare for surges in demand while ensuring that infrastructure and staff can withstand extreme heat.

For Georgia Chaseling, PhD, lead author of the statement and leader of the Aging and Chronic Diseases Theme within the Heat and Health Research Center at the University of Sydney, Australia, it means having a plan in place before a heatwave strikes. In practice, hospitals need to prepare cooled treatment spaces, organize staffing, check cooling and backup power systems, and protect healthcare workers through regular breaks and access to cool rest areas.

But putting these measures in place requires institutional commitment and dedicated resources. "Hospitals should plan for extreme heat, but they need the resources to make those plans work. In reality, hospitals can develop and test operational plans, but governments and financial providers of health systems must act to enable them," she said.

The Cost of Climate Resilience

Caroline Maria Körner, PhD, a researcher at the Institute of Health Services Research and Clinical Epidemiology, Marburg University, Germany, has assessed climate change preparedness in hospitals in Hesse, Germany. She believes that a lack of funding and barriers in the healthcare system are the main reasons Germany's healthcare system is not yet climate-resilient. Her research found that in hospitals, air conditioning was generally limited to operating rooms and ICUs. This is a common occurrence across Europe, research has found.

"Patients should recover in the hospital, so extremely high temperatures in patient rooms aren't very helpful," she said. "No facility I interviewed could guarantee complete air conditioning throughout the building. Healthcare facilities want to change but they cannot because they lack the funds to implement such measures." 

Despite these challenges, more work is underway to make European health systems more resilient. In 2021, the LIFE RESYSTAL project, funded by the European Commission and led by HCWH Europe, was launched to develop tools and methodologies to help healthcare facilities become climate-resilient and prepared for the impacts of climate change. 

Abruzzo told Medscape News Europe that one of the project's most tangible outcomes, which concluded this year, was the implementation of nature-based solutions at the project's pilot sites. Hospitals in Spain, Italy, and Greece installed green walls and roofs, green pergolas, and water management systems to reduce the impacts of heatwaves, improve rainwater management, and increase energy efficiency. 

The measures were designed to bring both adaptation and mitigation benefits. They reduced the impacts of climate change, including lowering outdoor hospital temperatures and air pollution, while also reducing emissions and energy consumption.

However, Abruzzo agreed that funding remains the biggest obstacle to expanding climate resilience measures across Europe. "The lack of funding dedicated to healthcare climate resilience has cascading effects," she said. "Healthcare organizations lack the resources to retrofit healthcare infrastructure and implement measures to protect patients and healthcare professionals from the impacts of climate change." 

With research showing that heat-related mortality increased in 99.6% of monitored European regions between 2015 and 2024, the need to adapt is becoming increasingly urgent. "We cannot control the outside temperature, but we can improve how prepared we are, how quickly we recognize vulnerable patients, and how safely we continue to provide care," Poiana said. "At Buhuși Hospital, preparedness is integrated into everyday patient safety rather than treated as a separate subject. As climate-related risks evolve, our procedures, staff training, and organizational response must evolve with them." 

Abruzzo, Poiana, Chaseling, and Körner reported no relevant financial relationships.