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A new estimate: about 20 thousand died in Europe in the heat

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About 20 people, most of them elderly, died as a result of the heat wave that hit Europe last month - according to updated estimates that were published yesterday on the continent, amid severe public criticism.

In France, the government admitted that it had failed to deal with the crisis, and appointed experts to find out how many people were direct victims of the heat out of the 13,600 people who died in August. The grim spectacle of corpses, piled up in makeshift refrigerators and no one coming to take them away, shocked the French.

The Italian government is investigating reports that the number of summer deaths rose by 20% in Spain, a human rights group claimed, as the hot weather caused the deaths of 2,000 people in the country. In doing so, the organization contradicted the estimates of the Spanish government, according to which only 101 Spaniards died from the heat. Portugal, where many forested areas burned, estimates that the heat caused the death of 1,300 people.

Even in the generally cool Netherlands and Britain, the number of deaths in the summer rose. The Ministry of Health of the Netherlands said that between 500 and 10 people died from the heat. The high number of deaths in Britain - almost 10,132% above the average - is also attributed to liver fever. The British National Service for Statistics (NOS) said on Tuesday that 5 people died in the week of August 10 to 907; This is XNUMX deaths above the average for these dates.

Although the number of deaths can vary every week by differences of several hundred, and although there is still no proof that the deaths were caused by the heat, NOS said that it is likely that the high number of deaths was caused by the heat.
In Germany, where the humidity this summer was relatively low compared to its neighbors to the south and west, no official estimates have yet been published. Italy too - where media broadcasts have recently been dominated by reports of the heat wave - will have to wait until September to publish its final estimates. However, Italy's health minister, Geraldo Circe, has already proposed imposing a new tax that would allow for improved services for the elderly.

In France, many are calling for a full investigation into the handling of the heat crisis. "Our neighbors in Germany, Belgium and Luxembourg suffered from the same heat wave, but it seems that the results in these countries were less severe," said Jean-Louis Debre, president of the National Assembly. "We need to understand how it happened."

A deadly vacation in the capital of France

by Claude Escolovich

The key personnel of the health services in France were on vacation at the beginning of August, when the tragedy of the plague occurred. The heat wave hit mainly the weakest - the sick and elderly who died in their homes or nursing homes. The incarnation of a crisis that got out of control

There is a limit to the insults a defeated general is willing to absorb. Jean-Francois Mattay, the French health minister, defeated by the heat wave, lashed out on August 17 at an insult given to his friend by the Saa. The minister spent this day in the field. He went to greet the staff members of the SAMU (Emergency Medical Service) in Paris, who have been on the first front line since the start of the conflict. The usual consolation in such cases is that the warriors fought well, even if death had the upper hand.

Matai is a doctor, a hospital man. He loves the people of his world and his circle, he also loves the little victims, that "human dust" that disappeared in the inferno of August. "These elders are like little candles, so fragile," he told "Noble Observer Water", "they extinguished before their time because they were treated cruelly." But he is also a minister who is required to give an account.

He was asked about the number of dead in the heat wave. "Between 1,600 and 3,000," he replied over several days. The number 1,600 seems to grow out of the empty space, as if the minister wanted to reduce the drama of a situation beyond his control. 3,000 on the other hand is a reasonable estimate, raised in the midst of the crisis. In the afternoon of that day, Matai again verified the number with Lucien Ebenheim, the CEO of his office. Abenheim confirmed the information. Then, at eight in the evening, the TV channel TF1 surprised the minister. Gilles Bricker, director of the National Institute for Sanitary Inspection, punched in another, higher number on the air: .5,000 and then Matai erupted. How did they fail to predict the impending disaster, and how does Bricker, who has just returned to Paris, allow himself to throw out higher numbers, thus risking portraying himself, Matai, as an insensitive person who diminishes the scope of the drama?

The minister's anger burned. He summoned the CEO of his office, Ebenheim, and Bricker. He wanted to know why he hadn't been warned. from what? From the heat, from the risks, from the mortality. The next day in an interview, he said that "as the minister in charge of the position, I was not properly warned." Since the beginning of the crisis, the minister has been loyal to his health services.
This time he blamed his subordinates. Ebenheim understood the message. He resigned and defended himself. Bricker hesitated but decided to stay. He admitted the failures of the system, but said that these are systemic problems. He pledged to improve the work of his institute, so that next time he would be ready for the climatic lightning strikes.

next time. But in the meantime the bodies are being counted. 3,000 or ?5,000 cannot be determined. Some have already reached 10,000 or more. The count will continue even with the end of the vacation. Sorting and classification will then be required, following up on the work of an internal investigation committee established by Metai and the expectation of a parliamentary investigation in the future. Things may develop into an endless legal process, if the families of the dead demand compensation. In many days, the massacre of August 2003 will stand trial like the case of the infected blood (with the AIDS virus).

The current drama was born from a deadly combination of a tropical air bubble and the French disease - centralization, bureaucratic heaviness and clumsiness, compartmentalization (when one state body does not know what the other is doing and everyone acts without coordination), state holidays, the inability to anticipate problems and political psychodrama.
One thing must be understood. The characters in this story are not ordinary people. Matai is a professor of medicine, a geneticist, aware of his status, but also a great humanist. Ebenheim is a celebrated epidemiologist, a professor at "McGill" University in Canada. He was active for ten years in the extreme left. He denounced the risks associated with anti-starvation drugs. Abenheim went against the laboratories of the pharmaceutical companies. He defended rationality. Epidemics are a matter of curves, statistics, comparisons. Matei and Ebenheim are similar: renowned doctors, university people, self-confident. Maybe too much. They value themselves and they inspire confidence. Gilles Bricker is also a "heavy cannon". The former chairman of the "Doctors of the World" organization, a friend of Bernard Kushner. The latter is considered to be the man who embodies doctor French (as the founders and people of "Doctors Without Borders" are called, the first organization of this kind, of which Kushner is one of the founders) and he appointed Bricker to stand in charge of the Republic's health care. These are three brilliant people. But these are also three vacationers who were on vacation at the beginning of August when the tragedy of the plague occurred.

The key people of the health services in France were therefore on vacation. Matai and Abenheim were both at La Verre. Bricker was in Ardash. It's the holiday season. All of France then goes on strike. The newspapers told about the trips in the mountains of the good Monsieur Raffarin (Prime Minister Jean-Pierre Raffarin). Is the country protected and safe on such days? They say yes. It seems not. For several days, the state services, the administrations of the offices, the hospitals, the doctors, the emergency room workers acted and fought without any coordination between them. And in the headquarters, those in charge and superiors remained groping in the dark, without information. The management of the Ministry of Health did not know for days that people were dying in their apartments. The bodies were removed by firefighters who are required to give an account only to the Minister of the Interior. Ober Falko, the Secretary of State for Elderly Affairs, did not know that old people die in their homes. Welfare organizations forwarded the mortality data in Parisian hospitals to the Ministry of Health only eight days after the start of the heat wave. But even the senior officials of the Ministry of Health did not think to demand such data. Raffarne had to stop his vacation on August 14 for someone to talk. And then the damage is already done. Maybe it was inevitable.

Because it was necessary to speak, to cry out, before the things happened, long before that month of August - in July, for example, and even in June, when the first warnings about the heat wave came. An emergency plan had to be prepared. She didn't exist. The elderly should have been monitored just as the children are protected on the beaches. Didn't think about it. It should have been known that the heat waves would cause disasters in population concentrations. Ignore it, or forget it. The senior officials of the Ministry of Health did not read Jean-Pierre Bezanneau's article, which was published in the scientific journal "Environment, Risks and Health" in the fall of 2002. Risks associated with large heat waves were only discovered in the midst of a tragedy.

France is a country where the weather is stable. The French know how to monitor the development of the flu virus and prevent it. One day they will know how to fight against bacteriological warfare. They do not know how to fight the heat even when damp curtains on windows, wet bricks on the bodies of the sufferers, or simply air conditioning are enough.

The heat takes effect from the beginning of August. He attacks first and foremost those for whom death is already waiting in the corner. "We cannot come to terms with what happened," said Jean-Francois Mattay, "but in the end the number of deaths this year may not be higher than usual." The heat attacks the weakest, the old patients already in treatment, the forgotten. Death has class consciousness. The invisible are the ones who suffer. The old people lost inside their apartments, or those who were transferred to nursing homes. The potential victims of SARS, the same disease that mobilized health services in the spring, were leading players in modern life, people flying airplanes, traveling around the world. Sars was a disease of people who are an integral part of the world. The heat is less luxurious, but far more deadly. After three days the heat wave began to overwhelm its victims. The elders began to die on August 7th. They got to the emergency rooms and then just faded away. They suffered from edema and embolism. They put ice around their suffering bodies, chilled them, connected them to an infusion. The staff in the hospitals was less than usual and soon exhausted.

You will perform better on the hospital front than on other fronts. A state of emergency was declared in Paris. The welfare services came into action. There was mobilization, but strangely there was no awareness that it was a war. The health authorities did not know that people were dying in their homes, unknown. They focused on the hospitals. Technical issues were addressed and resolved. Emergency services were overwhelmed. The management of the Ministry of Health also reacted to what was happening but blindly, without knowing. This management is a sophisticated animal, but it was without eyes, ears, hexagons. No one described things to her as they were. Yves Koken, the deputy director general of the Ministry of Health, together with the ministry's epidemiologist, William Dove, drafted a warning message to the public on August 8. The evening before, the meteorological service of France announced that the heat had increased. He called for precautions, but the death toll was already steadily rising. However, at the end of that week there seemed to be a lull. The death toll has stabilized. Many were still fighting for their lives in the hospitals. There was someone who said to himself that the worst is a thing of the past.

Dov went on vacation. In the office of the Minister of Health, Ann Bollo-Gitler, deputy director, returned from vacation on Monday, August 11. Koken wanted to update her on what was happening. He sent her an e-mail, described his efforts and then said that "the situation is under control" - a phrase that the minister himself adopted before regretting it.

That evening, August 11, the minister appeared on television. He was at home, still on vacation. He was not stern, because he wanted to be portrayed as more reassuring than worrisome. "For days I was immersed in the problem of the hospitals because they only talked to me about that," he says today. "And they didn't put me on the seriousness of the human drama, the people who died alone (...)". Matai is not insensitive, but his words were not enough and they were not heard.

One person spoke louder than the others - Patrick Flo, director of the emergency room in Saint-Antoine and a senior member of the emergency room workers' union. Flo, a doctor and political activist, who was briefly in the Socialist Party and at one point was close to Bernard Kushner, is a known troublemaker. He always requires additional measures and more than once heralds the death of the hospital. He was not wrong. The emergency room bathroom in Saint-Antoine had nothing but a broken sink. The sliding door of the emergency room was stuck. During the burning days, 38 degrees were measured in the halls where Flo received the victims. He was the first to reveal the hard data to the public.
The media has found its man. The problem was simple: the truthful words of the man in the field versus the inflated statements of the appointed officials. Compared to Flo, Matai seems the epitome of caution.

For a moment it seemed that the situation was under control. On Sunday, August 10, there was a slight decrease in the death rate. Epidemic means bell curves - there is an increase and there is a decrease, as if the sick evil - a virus, a bacterium, a natural phenomenon - harms those intended for it and then it disappears. The heat wave is also an epidemic, like climatic flu. The deaths were concentrated in and around Paris. If the heat attack had not intensified twice, the situation would have returned to the best. And the expression "situation under control" would not shock anyone today.

But bad luck insisted. On Monday and Tuesday, for two consecutive nights, the temperature was more than 25 degrees, an unprecedented phenomenon. Night is the time when the body recovers, but this respite was denied to the sufferers this time. The heat is smarter than a virus. The curve was no longer a bell curve, it became steep. On Monday, August 11, the number of dead increased. On August 12 and 13, the numbers reached their peak. Since then France has calmed down. What remained were the corpses stored in refrigerated trucks, refrigerated tents, and the first evidence of the macabre discoveries of the firefighters. The disaster did happen and all the precautions announced in official speeches and pronouncements are now repugnant.

The opposition began to blame the government. The feeling is that this tragedy touches the heart of Raffarin's promise. Chirac and he claimed to establish an administration of compassion, which would pay attention to the weak, but the weak are the ones who died. The Greens and others demanded Matai's resignation. Raffarin spoke disparagingly of political considerations that entered the debate, but the right is convinced that he ignored the tragedy. In the midst of the heatwave, it seemed that the government was more concerned with saving energy than saving lives. Roslin Bashlo, Minister of the Environment, called for "good citizenship". Nicole Fontan, the Minister of Industry, boasted that she turned off the air conditioner in her room.
The drama swept it all away. However, the government must give an answer. Some on the right blame the 35-hour work week. The others, including Jean-Pierre Raffarin, want with utmost urgency to start a major social debate: France as a whole is guilty of neglecting its elderly. The claim is not entirely untrue, but it all seems like a diversionary exercise.

The government acted, but it was too late. On August 14, Raffaran came down from his vacation mountain and called a coordination meeting with the heads of the health system, representatives of the Ministry of Interior, the Ministry of Welfare and the governors of the districts. This was the heyday of Flo, the emergency room doctor with the bad news. He was invited to sit in front of the Prime Minister. A few days later Raffaran announced that hospital emergency rooms are a national concern. And to show that he is not cut off from the field, Matai showed reporters that Flo's phone number appears on his cell phone. General conscription was then announced, but the war soon ended. It was a war that France lost. The announcements following the meeting did not match the intensity of the grief everyone was supposed to feel. Matai, pale, exhausted, tense, refused to admit guilt. He revealed numbers. He spoke about the number of dead, explaining that until a few days ago nothing justified the declaration of a general state of emergency.
The minister continued to speak in the language of his office. On the evening of August 13, a meeting of the office's management was held. CEO Ebenheim is back from vacation. Does he complain to himself for not returning earlier? Without a doubt. He is aware of his political weight. If he had been present, he said, he would have alerted the situation firmly. He confirmed there were 3,000 dead and spoke through direct media, but refused to wallow in blame.
In four days, the Minister of Health was supposed to fire the CEO of his office. "People don't understand our explanations", sighed Matai in Ebenheim's ears, before accepting his resignation.

Only after six days

Friday August 8. Paris firefighters reported more than a hundred distress calls resulting from the heavy heat conditions. On the sixth day of Shreb, the hospitals of Paris decided to introduce changes in their reception system "due to the continuation of the extraordinary climatic conditions". The management of the Ministry of Health appealed to the "weakest" with a warning and provided preventive advice.

Sunday August 10th. Patrick Flo, president of the Association of Emergency Room Doctors, announced that 50 people died in the four days of heat in the Paris area. He condemned the inaction of the Ministry of Health management.

Monday August 11th. The Hospitals Authority of Ile-de-France has decided to move to phase B of the "Heavy Fever" action plan. Funeral services announced a 20% increase in the death rate in France. The spokesman for the Ministry of Health denied that the emergency rooms are busier than usual and said that "the difficulties are not unusual compared to previous years, except for isolated cases."

Tuesday August 12. From his place of vacation in Combelo, the Prime Minister, Jean-Pierre Raffarin, announced the allocation of additional beds in the military hospitals.
Wednesday August 13. Francois Aubar from the coordination administration of the hospitalization system estimated that the number of dead in the hospitals amounts to "several hundred". The French Minister of Health, Jean-Francois Matthias, said that "the health system has demonstrated impressive adaptability". and that there was no "delay or non-implementation of the measures implemented since Friday (August 8)". Prime Minister Raffarin ordered "to mobilize all available hospitalization means" in Ile-de-France.

Thursday August 14. After a coordination meeting with all the professional bodies, Matai spoke of 3,000-1,500 dead.
Saturday August 16. Raffarn rejects any allegation of the government's malfunctioning.
Monday August 18. Matai admitted that the number of 5,000 dead due to the fire was "acceptable", and he indirectly blamed his subordinates. "We didn't have the information and the warning signals we should have received. And when you are not made aware of the seriousness of the situation, you cannot act on time." Lucien Ebenheim, Director General of the Ministry of Health, understood the hint and resigned.

Environmentalist - Earth

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