At major events around the world, scenes of extreme heat stress are starting to look familiar. Older men, shirts unbuttoned, lying with their eyes closed. Aid tents filled with unconscious people. And rows of worshippers — whether seeking religion, music, the ballot box or sport — sweating in glimpses of shade.
The consequences have been dire. At least 1,300 people died at this year’s hajj, the Islamic pilgrimage in Saudi Arabia, when temperatures soared above 37 degrees Celsius. And in many ways, that high death toll was just the latest sign that crowd control and the heat waves brought on by climate change are on a dangerous collision course.
During the recent elections in India, dozens of election workers died on the job. Last summer, Boy Scout squads visiting South Korea for a jubilee fell ill from the heat, as did others at music festivals in Australia, Europe and North America.
Although heat now kills more people than any other extreme weather event, a dangerous cultural lag remains. Many of the organizers and attendees of major events remain at a disadvantage in the face of climate change and are unable to cope with the degree to which global warming has raised the risk for summer crowds.
“As warm seasons get longer and heat waves come earlier, we’re going to have to adapt,” said Benjamin Zaitchik, a climate scientist at Johns Hopkins University who studies unhealthy weather events. Zaitchik added that along with people’s behavior, infrastructure, emergency management and societal calendars “really need to recognize this new reality.”
Among the many unsophisticated ways to prevent illness and death are shade, water stations, sidewalks painted white to reflect heat, and emergency toilets to treat severe cases of heat stroke. Some innovative hot places, such as Singapore, have built public spaces that link the outdoors with the indoors. They have added air conditioning to areas where people might have to wait, such as bus stops.
The hardest solution of all may also be the easiest in some ways: educate people about the risks of heat, including people who are used to living in hot places. Often, these people are unaware of the early symptoms of heat stress or how high temperatures are especially dangerous for people with preexisting conditions, such as kidney disease or high blood pressure. Even medications, such as anticholinergic drugs, that treat allergies or asthma can accelerate problems by restricting sweating.
“Heat is a very, very complex and stealthy killer,” said Tarik Benmarhnia, an environmental researcher and senior lecturer at the University of California, San Diego. “It’s very silent.”
A religious pilgrimage can be the most delicate of events. In recent years, devotees of many faiths — Christians in the Philippines, Hindus in India, Muslims in Saudi Arabia — have died from heat stroke during religious rituals.
However, hajj perhaps carries the greatest degree of danger.
The entire Arabian Peninsula is hot and warms up quickly, and nighttime temperatures also rise, stealing the hours when the body usually cools down. Hajj lasts five or six days, which makes heat exposure in the holy city of Mecca even more severe.
The timing of the hajj is also determined by the lunar cycle, so the hours scheduled for the journey may be the hottest, as was the case this year. And, because there is a disproportionate number of elderly people among the pilgrims, they are more vulnerable to the effects of intense heat.
Benmarhnia was shaken when she heard the news of the deaths in this year’s hajj.
“I thought this could have happened to my grandmother,” she said by phone Monday.
He had paid for her trip to Mecca in 2019. Her grandmother was 75, but said she was lucky to make a smaller pilgrimage during a cooler time, in April. With this year’s death toll, he suggested heat experts use the experience to immediately devise adaptation strategies with religious authorities.
The Saudi Ministry of Health had launched educational campaigns urging people to stay hydrated and use umbrellas. Authorities set up field hospitals and water stations. Thousands of paramedics were deployed.
It wasn’t enough for a surge of millions of people, many of whom flouted nationwide quotas aimed at limiting crowd size. And Saudi Arabia has faced criticism over the deaths for its handling of the pilgrimage.
This year’s elections in India showed that even in places where people think they are accustomed to the heat, much more awareness is needed about the dangers of extreme heat.
In Bihar, at least 14 people died in late May, at least 10 of them election workers, according to state disaster relief officials. In June, nearly 100 people died in 72 hours in Odisha in cases suspected to be related to heat conditions.
Indian health authorities have had to prepare. In heat stroke units in Delhi hospitals, patients were immediately plunged into a tub of ice to cool down. In a ward equipped with freezers, fans and an ice-making refrigerator, critically ill patients were immediately placed on ice blocks and injected with cold fluids.
In many areas, however, heat waves and voting peaked around the same time, such as in Bihar’s Aurangabad district, home to 3 million people, where temperatures hovered around a casual 48 degrees Celsius in late May.
Ravi Bhushan Srivastava, a senior doctor at a government hospital, was on his way to assess the daily post-mortem reports on a particularly bad day, when 60 patients were admitted for heat stroke.
“At least 35 to 40 were in a bad state,” he said. “They were unconscious or had altered consciousness, their bodies were very hot and they had trouble breathing.”
“I have never seen so many patients with heat stroke symptoms and at such intensity in my entire career,” he added.
In particular, election rallies can be vulnerable because of the large crowds that gather. But there are plenty of workable solutions, too. Aditya Valiathan Pillai, an adaptation specialist at Sustainable Futures Collaborative, a research organization in Delhi, said attendees should be able to see local temperatures in real time, with color-coded risk levels. Water stations, shade, and cooling centers can be set up. In particular, public agencies should do everything they can to ensure heat warnings. “We now have heat wave forecasts that are fairly accurate five days in advance, so this kind of advance awareness is possible,” Pillai said.
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David Bowman, a climatologist in Tasmania who wrote an article that garnered widespread online attention during Australia’s 2020 wildfires calling for an end to summer school holidays, said people were already starting to adapt in small ways. Umbrellas are becoming fashion accessories for shade, shorts are becoming more acceptable at work and road workers are working at night.
Climate change could force even further changes to major events.
“All of these disasters are like a cultural signal of the price of climate change,” Bowman said. “Sure, we can be stubborn and keep going despite climate change, but in the end the climate will win.”
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