The weather of hell: Experience of Italian Red Cross during 2023 heat waves

2023 officially has been named the hottest year on record, marked by scorching heatwaves across the globe – from the United States to southern Europe to parts of Asia. As the frequency and intensity of heatwaves are projected to rise, it is crucial to prepare and reduce risks to save lives. The Global Disaster Preparedness Center (GDPC) asked National Red Cross Red Crescent (RCRC) Societies to reflect on their response to 2023 heatwaves and share lessons learned to better prepare for future extreme heat events.

This case study explores the preparedness and response efforts by the Italian Red Cross (Croce Rossa Italiana) during the 2023 heatwaves, which pushed temperatures as high as 48.8°C (118.4°F). The focus is on showcasing effective strategies and drawing insights from the lessons learned to improve preparedness for future heatwaves.

Context

In July 2023, Italy and southern Europe experienced a heatwave, with temperatures first reaching 38°C (100°F). The heatwave was caused by an anticyclone named Cerberus, followed by a more intense one called Caronte, sending temperatures above 40°C (104°F) in central and southern regions, with peaks of 48°C (118.4) in Sicily and Sardinia.

The heatwaves unofficially were named after mythological creatures: “Cerberus,” after the three-headed dog that guarded the gates of the underworld, and “Caronte” (Charon in English), the ferryman of the underworld. The Italian weather website iLMeteo did the naming, as the Italian Meteorological Society does not name heatwaves. iLMeteo has been using mythological references to name high-pressure regions causing extreme heat in Europe since 2017, stating it helps alert the public about the risks and dangers of heatwaves.

Atmospheric conditions, less cloud cover, and longer days during summer months lead to increased heat exposure and maximize threats. This affects vulnerable groups like the elderly, children, and pregnant women, in particular. Heat waves increase pressure on health services and can also spark wildfires and environmental risks.

Early reported victims of Cerberus and Caronte included a 44-year-old worker in Lodi, outside Milan, who collapsed due to heat stress. Six men died from heat stroke in the middle of their workday in the same region. In Rome, tourists collapsed on their way to the Colosseum. Cities like Cagliari, Palermo, Florence, and Bologna warned people to avoid the sun from 11 AM to 6 PM.

In 2022, Italy had one of Europe’s highest heat-related death rates, with over 18,000 fatalities attributed to heatwaves per a study in Nature. The heatwaves disproportionately affected age groups 65-79+ years and caused 56% more heat-related deaths among women in those age groups.

The Italian Red Cross actions

“10 Commandments” for Coping with Extreme Heat

Since July 10th when the early summer heatwave began affecting parts of Italy, the Croce Rossa Italiana re-launched the Effetto Terra (Earth Effect) information campaign in partnership with other organizations. This served to raise awareness about the danger of extreme heat and good practices for mitigating risks.

Originally launched in 2021, the Effetto Terra campaign focused more broadly on improving the public understanding of climate change adaptation and mitigation. However, given the pressing urgency of extreme summer heat episodes, the campaign was adapted to focus on preparedness and response to heatwaves.

As part of this awareness-raising campaign, the Italian Red Cross published an updated decalogue outlining 10 key tips or “commandments” for coping with heatwaves, focusing on vulnerable citizens,  in particular. The campaign used traditional media like television and radio, digital platforms and social media channels to share information. Other actions included organizing flash mobs where Red Cross volunteers directly engaged the public by distributing informative flyers and materials. Local branches also provided direct support to vulnerable families and individuals, such as supplying items to help cool down houses and so on.

The core goal of the campaign was to circulate accurate, reliable and evidence-based information so citizens could take preventative actions to avoid heat-related health issues. Messaging also aimed to spur self-reliance and proactive self-care when responding to weather extremes. “People often view the Red Cross as a ‘superhero’ entity that can wave a magic wand and make problems disappear. We need to shift this mindset, so citizens see themselves as empowered ‘first responders’ when crisis hits,” noted Andrea Giovannoni, Head of Emergency Department for the Italian Red Cross.

A hotline for support and companionship

In addition to the 10-point decalogue, the Italian Red Cross also publicized the phone number for its dedicated National Response Call Center hotline (1520). The Center serves as a critical hub that manages calls and connects them with the appropriate regional office for people to receive safety information, request home delivery of essentials like food or medicine, or access to companionship over the phone. The publication of the decalogue was covered by the national media, leading to many calls to the ICR Response Center and activating local branches to provide immediate assistance when necessary and possible.

The services provided by Red Cross branches included home grocery and medication delivery for older people who were unable to go outside due to high temperatures, roundtrip ambulance transportation for members of the community in need, and information to help to help identify the symptoms of dangerous heat-related medical emergencies. The hotline played a dual role, offering services to the public and serving as an internal communication channel for the Red Cross to collect and share real-time information about community needs with local branches.

Valerio Mattia, a coordinator for the National Response Center in the Italian Red Cross, emphasized the importance of coordination and collaboration to better respond to community needs:

“By working in close collaboration with all other Italian Red Cross units and departments, our aim is to keep call center operators as updated as possible. We continually integrate the latest data from our Monitoring, Evaluation and Learning team so that our people are prepared to address public information requests and offer timely support. This means not only closely tracking our organization's initiatives, but also maintaining open cooperation with governmental agencies like the Civil Protection Department on their ongoing relief programs.”

One service that aims to address the needs of high-risk people was the Italian Red Cross’ companionship phone-in program. “Many senior citizens across Italy are impacted by loneliness and lack of social contact,” said Mattia. “Simultaneously, this demographic often bears the most severe health consequences when extreme temperatures hit. By providing a caring voice, answering questions, and sharing heat coping suggestions, our simple conversations can provide major comfort during difficult times.” 

Door-to-door approach

In addition to mass communication efforts, the Italian Red Cross also activated its network of volunteers to spread awareness of heat-related risks and respond to heatwaves. Volunteers engaged in activities such as distributing water bottles and setting up cooling centers.

In smaller cities, volunteers took an even more personal approach – conducting house visits to inform and support vulnerable groups. Volunteers check in on isolated seniors, pregnant women, and others at heightened risk, identifying pressing needs, sharing heat safety information, and providing vital reassurance during stressful times. Mattia emphasized the importance of these interactions: "It's about addressing their feelings of loneliness and the sense of being overlooked by the community, which often arises during emergencies”. 

Good practices from the Italian Red Cross’ experience

• Close coordination with civil institutions like the Health Ministry and Civil Protection Agency to enable a holistic, streamlined emergency response approach. Coordinated efforts of government agencies and the Red Cross were required to provide a more well-rounded, holistic approach to the needs of the diverse communities during heat waves. Strategies included sharing up-to-date information transparently and collaborating with the Health Ministry and Civil Defense system. This ensures an adequate number of responders and services while establishing a reliable network of well-informed stakeholders.
• Adapting an existing, widely recognized public information campaign to increase awareness of heat waves. The Italian Red Cross integrated heatwave messages and recommendations into the ongoing Effetto Terra campaign. Recognizing heatwaves as one of the deadliest consequences of climate change, the campaign aims to elevate public education and safety awareness.
• Operating a dedicated 24/7 hotline for emergency assistance and advice. The call center seamlessly channels requests to the relevant local Red Cross branches. A dedicated national hotline efficiently channels public requests to relevant Red Cross branches during heat emergencies. Whether individuals need information, personal advice, social services or simply a listening ear, this integrated approach helps vulnerable people access appropriate real-time local support, preventing unnecessary outdoor heat exposure.

Key lessons learned

• Expand engagement efforts with smaller communities and networks to maximize outreach to vulnerable groups during extreme heat event. While the Italian Red Cross has a national hotline and wide network of volunteers, they acknowledge the need to recruit more people to meet the demand during heatwaves. In Italy, especially in regions with smaller cities, there are fewer volunteers and limited services.

  Andrea Giovannoni acknowledged the need for understanding where help might not be reaching effectively and why: “It's crucial to analyze not just our current reach but where we aim to be in the future — identifying which communities remain underserved and understanding the reasons behind this gap, which is an analysis we have not previously undertaken."

• Adopt customized communication and intervention approaches responding to the cultural values, languages, challenges and expectations of each local community. Italy’s diversity necessitates tailored strategies that consider cultural differences, social and personal risks, and adapt communication and intervention efforts to each region's unique context. This is particularly critical for the Italian Red Cross, which places great emphasis on social support aspects when working with vulnerable groups and communities.
• Monitor macro-level weather shifts and prepare for simultaneous extreme weather events which can overburden response. While heatwaves primarily affected Central and Southern Italy, some northern cities faced different extreme weather events linked to the same anticyclone. This led to an increased demand for services, putting pressure on the National Response Call Center and impacting service availability, as response teams were addressing various types of disasters simultaneously.

As 2023 was the warmest year on record globally, projections indicate 2024 may surpass it, increasing the likelihood of longer and more severe heatwaves. By studying other Red Cross and Red Crescent Societies' efforts during extreme heat events, we can adapt best practices to improve our own preparedness for the coming summer and future years.

This is especially crucial for heatwaves. Despite being among the deadliest natural hazards, their negative impact can largely be prevented with the right preparedness and risk reduction measures in place. By learning from peer National Societies, we can fine-tune our systems to face the challenges ahead while sharing best practices across our global network.