Without a rapid phaseout of fossil fuels, one in 12 hospitals worldwide run the risk of total or partial shutdown from extreme weather events by 2100, with North American facilities facing the greatest risk increase of 430% above 2020 levels, a new physical climate risk analysis finds.

A rapid phaseout of fossil fuels will be key to keeping the world’s hospitals operational, but plenty of damage is already in the pipeline, including for Canada, with hospitals in Nunavut and New Brunswick at particular risk, found a team of climate risk experts at the Cross Dependency Initiative (XDI).

Published just ahead of the inaugural Health Day at the COP28 climate conference in Dubai, the report analyzes the vulnerability of more than 200,000 hospitals to six climate hazards: river flooding, surface flooding, coastal inundation, wildfires, extreme wind, and cyclones. It tracks how those risks increase out to the century’s end, and how a fossil fuel phaseout would reduce risk and increase resilience.

Defining “high-risk hospitals” as ones where there is a “high probability of total or partial shutdown of the hospital within the design life of the building,” the authors explain that “if this was a residential or commercial building it would be considered uninsurable.”

XDI analysts modelled the risks arising from two scenarios: a high-emissions based on the United Nations’ RCP 8.5 pathway, where temperatures rise by around 4.3°C by 2100, compared to a low-emissions RCP 2.6 pathway with around 1.8°C increase by 2100. Explaining the possibly controversial RCP 8.5 choice, they write that though evidence indicates greenhouse gas emissions are flattening and annual emissions are not tracking to RCP 8.5, the high-emissions scenario is still “prudent” to use, “given that it remains a feasible bound of future levels of warming and impact.”

“RCPs are based on cumulative greenhouse gases in the atmosphere, rather than annual emissions levels, and this concentration tracked closest to RCP 8.5 at least up to 2020,” they add. “Feedbacks remain highly uncertain and aren’t included in all models, so using a higher carbon emission scenario can be used as a proxy to capture low likelihood high-end impacts. Modelling potential worst-case outcomes is important.”

On a global scale, XDI found that:

• Of 16,245 hospitals projected to be at high risk by 2100, 71% are in low- and middle-income countries.

• Even with a rapid decrease in fossil fuel use, “the risk of damage to hospital infrastructure will still increase by 2100, due to emissions that have already occurred or appear unavoidable.”

• However, a rapid phaseout to limit global heating to 1.8°C will halve the damage risk to hospital infrastructure compared to a high-emissions scenario.

• Today, river and surface water flooding pose the dominant risk to hospitals.

• Towards the end of 2100, coastal inundation will be the dominant risk.

In the high-emissions scenario, North America stands to experience “the greatest increase in risk of damage to all hospital infrastructure by 2100, with a more than five-fold (430%) increase in the amount of damage risk since 2020.”

But this huge spike pales against the 1000%+ risk increase by 2100 that could face hospitals in Delaware, Florida, Maryland, New Jersey, and South Carolina. And, in Canada, New Brunswick and Nunavut.

These seven jurisdictions are particularly at risk, with hospitals “not being built specifically to withstand severe weather events.”

Hospitals in Newfoundland, Labrador, and British Columbia are also at considerable risk (371-1000%) in the high-emissions scenario.

While the big hazard for most hospitals in Canada is coastal inundation, “there is also an increase in extreme wind.” And under a high-emissions scenario, wildfires become the dominant, driving hazard in Manitoba by 2100.

Rapidly phasing out fossil fuels will make a considerable difference, however, reducing the increase in damage risk across the continent to 180%.

Elsewhere:

• South East Asia has the highest percentage of hospitals at high risk of damage from extreme weather, with close to one in five projected to be high risk by 2100 under a high-emissions scenario.

• South Asia’s hospitals have the most to gain from a rapid phaseout out fossil fuels: if global heating is kept below 1.8°C, “the increase in damage risk to hospital infrastructure by 2100 is estimated to be just one-quarter of what it will be under a high emissions scenario,” rising 76% versus 295%.

• Failing to achieve a rapid phaseout of fossil fuels could find hospitals in Albania, Belgium, Denmark, England, Greenland, Ireland, Monaco, and Wales experiencing an exponential (500-1000%) increase in damage risk to physical infrastructure by 2100.

• Absent a rapid reduction in fossil emissions, Papua New Guinea is set to experience the greatest escalation in risk to hospitals in the Oceania region (861%) by 2100. “This damage risk increase is reduced to 235% in a low emissions scenario—one of the most significant decreases in risk in the world,” notes XDI.