Beyond shocks: climate stress, vulnerability, and coping in resource-constrained primary care hospitals
1
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
In climate-vulnerable LMICs like Bangladesh, primary care hospitals are central to health system’s response to extreme weather events (e.g., flooding and heat), but they experience them as extensions of everyday strain rather than isolated disasters.1-3 Hospital-level climate vulnerability and resilience assessment tools rarely capture this reality as they prioritize aggregated and episodic event-based indicators while overlooking how climate stress interacts with pre-existing systemic weaknesses, and how coping burdens are distributed within/ between facilities.4-6
METHODS:
This multi-site qualitative case study, informed by rapid ethnography,7 was conducted across six Bangladeshi primary-level hospitals. Data included in-depth interviews with healthcare workers across cadres, extended on-site observation, and detailed fieldnotes, and were analyzed using hybrid inductive-deductive coding,8 with cross-case comparison of infrastructure, workforce, governance and service delivery.
RESULTS:
Flooding and extreme heat produced distinct disruptions while simultaneously aggravating chronic constraints. Flooding compromised hospital siting, WASH and drainage systems, rendering ground-floor spaces unusable; staff and patients navigated access breakdown through boats, wading and swimming, with some staff sheltering on-site. Extreme heat intensified poor ventilation, erratic electricity, and overcrowding, increasing physical strain and constraining routine work. Hospitals still remained functional through informal improvisations rather than formal preparedness, including relocating services to higher floors and repurposing non-clinical spaces. These practices were unevenly distributed as lower-cadre staff absorbed disproportionate labour burden, while remote hospitals experienced deeper disruption and slower external support than centrally located facilities.
CONCLUSIONS:
Climate-related disruptions in hospitals cannot be understood solely through event-focused damage assessments, which risk masking baseline vulnerabilities and unequal coping burdens that shape hospital functioning over time.2,35 Hospital-level climate assessments must therefore move beyond facility and infrastructure-focused checklists and treat equity as a core analytic dimension to examine how vulnerability and resilience are produced in hospitals and to inform sustainable and equitable adaptation strategies as climate stress becomes more frequent and cumulative.3,5,6
In climate-vulnerable LMICs like Bangladesh, primary care hospitals are central to health system’s response to extreme weather events (e.g., flooding and heat), but they experience them as extensions of everyday strain rather than isolated disasters.1-3 Hospital-level climate vulnerability and resilience assessment tools rarely capture this reality as they prioritize aggregated and episodic event-based indicators while overlooking how climate stress interacts with pre-existing systemic weaknesses, and how coping burdens are distributed within/ between facilities.4-6
METHODS:
This multi-site qualitative case study, informed by rapid ethnography,7 was conducted across six Bangladeshi primary-level hospitals. Data included in-depth interviews with healthcare workers across cadres, extended on-site observation, and detailed fieldnotes, and were analyzed using hybrid inductive-deductive coding,8 with cross-case comparison of infrastructure, workforce, governance and service delivery.
RESULTS:
Flooding and extreme heat produced distinct disruptions while simultaneously aggravating chronic constraints. Flooding compromised hospital siting, WASH and drainage systems, rendering ground-floor spaces unusable; staff and patients navigated access breakdown through boats, wading and swimming, with some staff sheltering on-site. Extreme heat intensified poor ventilation, erratic electricity, and overcrowding, increasing physical strain and constraining routine work. Hospitals still remained functional through informal improvisations rather than formal preparedness, including relocating services to higher floors and repurposing non-clinical spaces. These practices were unevenly distributed as lower-cadre staff absorbed disproportionate labour burden, while remote hospitals experienced deeper disruption and slower external support than centrally located facilities.
CONCLUSIONS:
Climate-related disruptions in hospitals cannot be understood solely through event-focused damage assessments, which risk masking baseline vulnerabilities and unequal coping burdens that shape hospital functioning over time.2,35 Hospital-level climate assessments must therefore move beyond facility and infrastructure-focused checklists and treat equity as a core analytic dimension to examine how vulnerability and resilience are produced in hospitals and to inform sustainable and equitable adaptation strategies as climate stress becomes more frequent and cumulative.3,5,6
| eISSN: | 2654-1459 |
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