Extreme weather events and risk perception among healthcare staff: evidence from the Matanza–Riachuelo Basin, Argentina

1 Introduction

Climate change is increasingly recognized as one of the greatest threats to human health in the twenty-first century. By altering environmental determinants of health and increasing the frequency and intensity of extreme weather events, it is placing unprecedented pressure on health systems worldwide (Intergovernmental Panel on Climate Change, 2023). Health outcomes are determined by the interaction of environmental, social, and health system factors (Solar and Irwin, 2010). Consequently, the ability of health systems to anticipate, respond to, and adapt to climate-related hazards has become an essential component of protecting population health (World Health Organization, 2023).

These challenges are particularly evident in highly urbanized territories where climate hazards interact with environmental degradation and social inequalities. The Buenos Aires Metropolitan Area (AMBA, by its Spanish acronym) exemplifies this situation. It is characterized by marked socioeconomic inequalities and heterogeneous living conditions (Prévot-Schapira, 2001; Clichevsky, 2002; Cravino, 2016; Henry et al., 2020). Environmental management has historically been challenging due to the coexistence of residential and industrial activities, inadequate solid waste management, and insufficient sanitation infrastructure, resulting in long-term contamination of surface waters and soils (Casares and de Cabo, 2018; Autoridad de Cuenca Matanza Riachuelo, 2023).

Within AMBA, one of Argentina’s most significant environmental conflicts is concentrated in the Matanza-Riachuelo River Basin (Tobías, 2019; Fainstein and Castilla, 2026). Covering approximately 2,047 km², the basin encompasses 14 municipalities in the Province of Buenos Aires and parts of nine districts of the Autonomous City of Buenos Aires. According to the 2022 National Population Census, it is home to more than 4.7 million inhabitants, representing approximately 10% of Argentina’s population (Instituto Nacional de Estadística y Censos, 2023). The combination of environmental degradation, social vulnerability, and high population density makes the basin particularly susceptible to the health impacts of extreme weather events and climate change.

The region has a temperate climate with a mean annual temperature of approximately 17.6 °C. Summers are typically hot, with very high temperatures around midday and during the early afternoon, followed by mild nights. Winters are characterized by moderately cool daytime temperatures and very cold nights. Precipitation is distributed throughout the year, without a distinct dry season. In addition to recurrent heatwaves and some cold waves, the region is affected by the sudestada, a synoptic weather system characterized by persistent southeasterly winds, heavy rainfall, and elevated water levels in the Río de la Plata, frequently resulting in flooding along the metropolitan coastline (Nadale, 2014; Barros et al., 2015).

As has been shown in various studies, this average climate is accompanied by longer-term climate variability, in Buenos Aires, the frequency of heatwaves—defined as periods in which both maximum and minimum temperatures exceed the 90th percentile—has nearly quadrupled between the 1961–1970 and 2001–2010 decades (Rusticucci and Barrucand, 2004; Rusticucci et al., 2016). Likewise, precipitation has increased substantially across subtropical Argentina since the 1960s, accompanied by higher mean streamflows in the major rivers of the Río de la Plata Basin since the early 1970s (Barros et al., 2015). This variability has been accompanied by an expanding body of research examining their implications for population health in Argentina (Rusticucci et al., 2002; Alexander, 2013) and Almeira et al., 2016 analyzed long-term climatic trends and incorporated relative humidity as a complementary variable to improve the assessment of thermal comfort. Evidence from the AMBA indicates that heatwaves and cold waves disproportionately affect vulnerable population groups, particularly children under 5 years of age, older adults, and individuals with pre-existing chronic conditions (Chesini et al., 2015; Chesini et al., 2019a, 2019b; Chesini et al., 2022; Fontan and Rusticucci, 2021; Chesini and Rusticucci, 2025). Climate change also affects health through indirect pathways. Heatwaves and droughts may reduce agricultural productivity, threatening food security (Food and Agriculture Organization of the United Nations, 2015), while heavy rainfall and flooding increase the risk of waterborne diseases, including gastrointestinal infections and diarrheal diseases, particularly among children (Hadley et al., 2023).

Beyond documenting the health impacts of climate variability, previous research in Argentina has also informed public health practice. Studies on heat-related health risks provided the scientific basis for the development of Argentina’s Heat Early Warning System (Sistema de Alerta Temprana, SAT), illustrating the potential of interdisciplinary research to support climate adaptation and evidence-informed public health decision-making (Herrera et al., 2018).

In this context, adaptation has become a central concept in climate change research and policy. The Intergovernmental Panel on Climate Change (IPCC) defines adaptation as a dynamic social process, closely linked to the capacity of communities and institutions to act collectively in response to climate-related hazards. This process involves the interaction of economic, social, institutional, and human resources and often requires changes in everyday practices and behaviors to sustain health and well-being (Amar-Amar et al., 2018). Community-based adaptation approaches emphasize that effective adaptation strategies should build on community participation, local capacities, and place-based knowledge to strengthen resilience and support locally appropriate responses to climate-related hazards (Reid et al., 2009; Intergovernmental Panel on Climate Change, 2023).

Previous experience with extreme weather events may also shape adaptive responses. López Vázquez et al. (2015) found that individuals who had experienced flooding, particularly those who had been evacuated, reported greater risk awareness, higher levels of post-traumatic stress, more frequent use of coping strategies, and greater engagement in preventive actions. Similarly, García Lirios et al. (2018) argues that effective adaptation requires both institutional action and the resilience of affected communities, highlighting the importance of interactions between public policies, health services, and local adaptive capacities. Surveying health professionals’ perceptions of climate-related risks provides an initial understanding of how this perception influences strategies for anticipation, response, and adaptation, and contributes to climate-resilient health systems.

Despite growing evidence on the health impacts of climate variability and extreme weather events in Argentina, comparatively little is known about how healthcare professionals perceive climate-related risks and the anticipation, response, and adaptation strategies within health services, particularly in highly vulnerable urban territories. Understanding these perceptions is essential for strengthening climate-resilient health systems and informing local adaptation policies. The aim of this study was to explore healthcare professionals’ perceptions of anticipation, response, and adaptation strategies adopted by a tertiary care hospital in relation to extreme temperature and precipitation events in the Matanza-Riachuelo River Basin. To provide contextual evidence, these perceptions and reported strategies were triangulated with meteorological records from the National Meteorological Service (Servicio Meteorológico Nacional, SMN) and documentary information from local media reports on extreme weather events. This study aims to contribute by combining and triangulating meteorological data with the perceptions of healthcare personnel and local media coverage in a highly socio-environmentally vulnerable area such as the Matanza-Riachuelo Basin.

2 Materials and methods

A mixed-methods study was conducted to examine perceptions and anticipation, response, and adaptation strategies implemented by the health care system in response to extreme temperature and precipitation events in the Matanza-Riachuelo River Basin. The study integrated quantitative and qualitative approaches to enable the triangulation of primary and secondary data collected at different sources and temporal scale. This design was selected to capture both the occurrence of extreme climate events and the institutional responses developed by health services. Three components were analyzed independently and then compared in a matrix that allowed comparing climate extreme events identified, local newspaper coverage and survey answers. This mixed-methods approach allows us to highlight the subjective and emotional dimensions, as well as the care practices, in the face of extreme weather events—aspects that have been scarcely explored.

2.1 Identification of extreme climate events

Extreme climate events occurring between 2015 and 2023 were identified using meteorological data obtained from the Argentine National Meteorological Service (Servicio Meteorológico Nacional, SMN), from the Ezeiza monitoring station. This station was chosen because it best represents the climate of the study region and serves as a reference station for the SMN.

As the SMN definition of extremes, temperature-related events included heatwaves and cold waves. Heatwaves were defined as periods of at least three consecutive days during which both daily maximum and minimum temperatures exceeded the 90th percentile of the historical reference period (1961–2010). Cold waves were defined as periods of at least three consecutive days during which maximum and minimum temperatures remained below the 10th percentile of the same reference period. Precipitation-related events included intense rainfall episodes, defined as daily precipitation exceeding the 75th percentile of the historical distribution according to Penalba and Robledo (2010). They established monthly thresholds for daily precipitation over a 50-year period and defined the 75th percentile as the baseline threshold for identifying days with extreme or moderately intense precipitation. The information was complemented with secondary sources, including local media reports.

2.2 Extreme temperatures events in local media news

To complement the surveys and contextualize the occurrence of extreme temperature events in the study area, a documentary analysis of local media coverage was conducted. A web search was conducted for local digital media outlets in the Cañuelas area and five news portals from Cañuelas were found. News articles published by Cañuelas Ya,¹ El Ciudadano de Cañuelas,² Cañuelas News,³ Cañuelas al Día⁴ and Info Cañuelas⁵ were systematically searched for the study period (January, 2015–March, 2023).

The search was performed using the internal search engines of each news outlet. The review included all news published during the study period. News articles describing heatwaves, cold waves, or other extreme temperature events occurring in the municipality of Cañuelas, or reporting their consequences for the local population, infrastructure, public services, or health, were identified and included. Articles referring exclusively to events outside the study area, routine weather forecasts unrelated to an extreme event were excluded. No duplicate removal was performed across news outlets. When the same extreme temperature event was reported by multiple local media sources, all articles were included in the documentary analysis because each report could contribute additional details regarding the event, its impacts, or its relevance to the local context.

For each included article, information was extracted on the date of the event, the type of extreme temperature event (heatwave or cold wave), the reported impacts, and any references to health services or vulnerable populations. These reports were used to construct a chronological context that complemented the meteorological records and supported the interpretation of healthcare professionals’ accounts. Local media reports were analyzed as documentary evidence of the occurrence and coverage of extreme temperature events rather than as measures of public perceptions.

2.3 Healthcare staff structured survey

Primary data were collected through structured surveys with healthcare staff at a healthcare institution in the Matanza–Riachuelo Basin. Participants were purposively selected from clinical, administrative, epidemiological, maintenance, infrastructure, emergency, and management services. The areas were selected based on the criterion of representing different health specialties related to the direct and indirect impacts of climate on health, according to the literature, as well as diagnostic and treatment areas, and technical and administrative roles. A plurality of disciplines and tasks was sought to account for perceptions at different levels of healthcare work. Eligibility criteria included being at least 18 years old, having worked in the participating institution for at least 3 years, and providing written informed consent. It is a non-representative sample made up of between two and three people who met the eligibility criteria and worked in the areas of: Hospital Management, Epidemiology, Internal Medicine, Social Service, Pediatrics, Emergency, Traumatology, Mental Health, Nutrition, Nursing, Kinesiology, Cardiology, ICU, Maintenance, Infrastructure and telehealth, totaling 39 survey respondents, no one refused to participate.

The survey instrument included closed- and open-ended questions addressing: (1) perceptions of climate-related health risks; (2) experience with extreme weather events; (3) anticipation, response, and adaptation practices; (4) climate change and environmental health training; (5) communication and early warning systems; (6) recording and notification procedures; and (7) interinstitutional coordination mechanisms. A pilot test of the survey was conducted; no changes were needed. The surveys were administered in person by the research team, recorded on paper forms on the mornings of October 31 and November 1, 2024. Each survey lasted between 10 and 15 min and took place in an office provided by the hospital.

2.4 Data analysis

Descriptive statistics were used to summarize participant characteristics and survey responses. Categorical variables are presented as frequencies and percentages. To provide an estimate of precision for the main survey findings, 95% confidence intervals (95% CI) were calculated using the Wilson score method, which is recommended for estimating binomial proportions in relatively small samples. Confidence intervals were calculated for the frequency of climate-related health conditions reported by participants, perceived associations between climate-related health conditions and extreme weather events, and climate-related actions implemented within the hospital. All statistical analyses were performed using RStudio software.

Local media reports and survey open-ended responses were analyzed by coding the data into categories and concepts according to their salience, meaning, and interconnections. This process enabled the identification of thematic patterns across the surveys and the exploration of relationships among emerging themes. Open-ended responses were inductively coded into categories and concepts based on their relevance, meaning, and interrelationships. Five members of the research team participated in the coding process, and a coding framework was developed. Coding discrepancies were solved by consensus between coders. Memos were used to document and refine the coding process, and the findings were synthesized and visually represented using word clouds. Data visualization was conducted using RStudio with the R statistical environment. Bar charts were generated to illustrate the distribution of categorical variables, while heatmaps and scatter plots were used to explore temporal patterns and trends in the occurrence, duration, and evolution of extreme weather events over the study period.

3 Results

3.1 Extreme climate events identified in the Matanza-Riachuelo River basin

Analysis of meteorological records identified multiple extreme temperature and precipitation events between 2015 and 2023 (Figure 1). Intense precipitation events occurred throughout the study period, with higher frequency during March and October and generally lasting between 1 and 8 days. Two cold-wave episodes were documented: the first occurred in July 2019, lasted 3 days, and reached the lowest minimum temperature recorded during the study period (−3.6 °C); the second occurred in June 2021, lasted four consecutive days, and reached a minimum temperature of −3.0 °C. In addition, 33 heatwave periods were identified during the study period representing the most frequent and longest-lasting extreme weather events during the study period. Regarding temperature, higher maximum values were observed during the heatwaves recorded in the most recent years of the study period, with some events exceeding 40 °C. In contrast, the lowest precipitation levels were recorded in 2022, consistent with the severe drought that affected much of the country during that year.

In the temporal evolution of heat wave occurrence, the recent period, starting in 2015, stands out as having the most heatwaves (Figure 2). The warm semester of 2022–2023 is noteworthy, with 5 heatwaves between November 2022 and March 2023, with the longest wave occurring between February 28 and March 14 (with an interruption on March 8, possibly due to not exceeding the proposed threshold). The highest maximum temperature of the study period (42.0 °C) was recorded in January 2022, followed by 41.3 °C in December 2021.

The monthly distribution of intense rainfall events showed considerable variability throughout the study period (Figure 3). It is interesting to note that, during the period analyzed in this study, extreme precipitation events were recorded nearly every month and year, although their duration differed substantially. The longest monthly accumulations (5 days) were observed in November 2015, while durations of 4 days were recorded in December 2018, November 2018, and October 2019. Between June 2022 and May 2023 there were only 3 days of extreme rainfall, which would coincide with a period of severe drought in the country (Conte, 2023).

3.2 Local media coverage of the extreme temperature events

Review of local media sources showed substantial public attention to these events, particularly heatwaves. A total of 29 news reports related to heatwaves and 3 related to cold waves were identified. The most frequent topics included record electricity demand, official warnings issued by the National Early Warning System, preventive measures, health risks, and coordinated responses involving provincial and municipal authorities.

News articles reflect the social, health, environmental, and economic consequences of extreme weather events and analyze the strategies implemented to mitigate their effects, from local policies to community initiatives. The phenomenon of heatwaves has taken on an alarming prominence in Cañuelas, exposing weaknesses in the social and environmental infrastructure, as well as challenges to public health and the local economy. Intense heatwaves in Cañuelas, with temperatures exceeding 40 °C, have increased the risk of heat stroke and heat exhaustion, endangering vulnerable groups such as children and the elderly (InfoCañuelas, 2016). These conditions have forced schoolchildren to make difficult decisions, such as suspending classes on occasion due to inadequate conditions in schools and classrooms (Cañuelas al Día, 2023; Cañuelas al Día, 2020). The increased energy demand during heatwaves led to power outages (Cañuelas al Día, 2015; Cañuelas al Día, 2019a). Rising temperatures have created favorable conditions for wildfires, impacting biodiversity and contributing to the emission of harmful gasses (El Ciudadano, 2019, 2021a). The livestock sector in Cañuelas suffered a considerable impact due to heat stress, which affected production and animal health (El Ciudadano, 2021b). Furthermore, the prolonged drought complicated agricultural activities, exacerbating economic losses (Cañuelas Ya, 2018). Faced with this scenario, preventive measures were implemented, such as issuing climate alerts and awareness campaigns on the responsible use of water (InfoCañuelas, 2015; Cañuelas Ya, 2021). In addition, animal welfare was promoted, and public spaces were adapted to ensure safe conditions during extreme heat (Cañuelas al Día, 2019b; Figure 4).

News reports illustrate how extreme weather conditions affect multiple aspects of daily life while also exposing pre-existing social and infrastructural vulnerabilities. In low-income areas, the risk of adverse health outcomes, such as carbon monoxide poisoning, is significantly higher (Cañuelas Ya, 2018). The resumption of in-person classes following weather-related disruptions presents the challenge of balancing educational continuity with student safety. Addressing this challenge requires adapting school facilities to withstand extreme temperatures and ensuring safe transportation, particularly in communities with inadequate road infrastructure (Cañuelas Ya, 2021).

3.3 Perceptions of climate-related health impacts among healthcare staff

Thirty-nine structured surveys were conducted with healthcare staff. Participants were predominantly female (66%). Most respondents were healthcare professionals (84.6%), while the remainder held administrative (12.8%) or technical positions (2.6%).

Survey respondents consistently reported having experienced the impacts of extreme weather events during their professional activities. Heatwaves and flooding were the hazards most frequently mentioned, particularly those occurring during 2023 and 2024. Participants perceived an increase in both the frequency and visibility of climate-related events and their associated impacts on health (Figure 5).

Respondents linked extreme climate events to a broad range of health outcomes, including dengue, heat-related illnesses, dehydration, diarrheal diseases, hypothermia, injuries, and respiratory conditions.

Regarding the association between health conditions and extreme precipitation events, 56,4% of respondents reported a perceived relationship. Health impacts associated with heavy rainfall included road traffic injuries, increased dengue transmission, the proliferation of Aedes aegypti, hantavirus infections, electrical burns due to electrocution, and traumatic injuries. Drought conditions were primarily associated with wildfires. More broadly, participants emphasized that these events expose and exacerbate the population’s socioeconomic and housing vulnerabilities (Figure 6). Participants perceived those conditions such as dengue, heat-related illnesses, and dehydration were associated with extreme climate events. However, these findings reflect participants’ perceptions rather than objective evidence of increased disease occurrence, as they were not corroborated by hospital admission data, emergency department records, or clinical time-series analyses.

Overall, 82% of respondents recalled experiencing an extreme precipitation or drought event while working at the institution. Participants reported that this event prompted institutional changes, including the installation of flood barriers and the establishment of an Emergency and Disaster Committee to strengthen preparedness and response capacity in 2023. The second most frequently recalled event was the 2023 heatwave, which was associated with a wildfire in the area surrounding the hospital.

Emotional and psychological consequences, such as anxiety, distress, fear, and uncertainty, were also frequently reported (Figure 7).

Participants identified older adults, children, pregnant women, people with pre-existing chronic conditions, and residents living in precarious housing conditions as particularly vulnerable groups.

3.4 Anticipation, response, and adaptation strategies

Healthcare staff described a variety of strategies aimed at anticipating and responding to climate-related risks. More than half of respondents reported routinely incorporating prevention messages into their professional practice. Communication channels included interpersonal communication, social networks, educational materials, and institutional information systems.

When asked about the response actions implemented within the services where they worked, the most frequently selected option was health promotion (27 respondents), followed by green and healthy hospitals (25) and energy conservation (19). Notably, only two respondents selected climate change as a response action, highlighting the need to strengthen institutional training and capacity-building on climate change (Figure 8).

Regarding climate-related health conditions managed in clinical practice, 69% of respondents reported having treated patients with malnutrition at some point during their professional careers (Table 1) Respondents also identified other health conditions that they perceived as being associated with climatic conditions, including leishmaniasis, traumatic drowning, skin cancer, skin lesions, burns, mosquito bites, tuberculosis, Chagas disease, and pneumonia (Table 2).

Table 1. Frequency of health conditions reported by healthcare staff as climate-related.

Table 2. Climate-related actions implemented within the hospital.

A major organizational milestone reported by participants was a fire that occurred in an area adjacent to the hospital during the 2023 heatwave. This event prompted improvements in emergency preparedness, infrastructure planning, and institutional coordination mechanisms. Participants also highlighted strengthened collaboration with the SMN Early Warning System as an important component of preparedness (Table 3).

Table 3. Themes collected in open ended answers¹.

¹Translated from Spanish.

Interinstitutional collaboration emerged as a key adaptation strategy. Respondents described active coordination with municipalities, fire departments, civil protection agencies, and other local stakeholders. These collaborative networks facilitated information sharing and enhanced emergency response during extreme weather events (Table 3).

Participants proposed several priority actions for the coming years, including improving the systematization of health records, explicitly documenting the links between health outcomes and climate-related events, and providing specific training on climate change (Table 4). Information-sharing networks and interinstitutional coordination were identified as important protective factors, particularly through official early warning systems and collaboration among institutions (Tables 3, 4). However, participants also emphasized the need to strengthen, formalize, and expand these networks through training and capacity-building to improve anticipation of, preparedness for, and early response to extreme weather events (Table 4).

Table 4. Suggested topics as future actions¹.

¹Translated from Spanish.

The most frequently reported climate-related health conditions were malnutrition (69.2%; 95% CI: 53.6–81.4%), dengue (64.1%; 95% CI: 48.4–77.3%), and diarrheal diseases (59.0%; 95% CI: 43.4–72.9%). Approximately half of the participants also reported other climate-related conditions (51.3%; 95% CI: 36.2–66.1%), heat stroke (46.2%; 95% CI: 31.6–61.4%), and hyperthermia (46.2%; 95% CI: 31.6–61.4%). Less frequently reported conditions included injuries (41.0%), hypothermia (35.9%), hantavirus (33.3%), leptospirosis (12.8%), and leishmaniasis (2.6%), with corresponding confidence intervals reflecting greater uncertainty for the least frequently reported conditions (Table 1).

Most participants perceived an association between climate-related health conditions and extreme temperature events (76.9%; 95% CI: 61.7–87.4%). In contrast, the perceived association with extreme precipitation and drought events was lower (56.4%; 95% CI: 41.0–70.7%), indicating greater variability in participants’ perceptions regarding precipitation-related health impacts (Table 5).

Table 5. Perceived association between climate-related health conditions and extreme weather events.

The most frequently reported climate-related actions implemented within the hospital were health promotion (69.2%; 95% CI: 53.6–81.4%) and participation in the Green and Healthy Hospitals initiative (64.1%; 95% CI: 48.4–77.3%). Energy-saving measures (48.7%; 95% CI: 33.9–63.8%) and health network management (46.2%; 95% CI: 31.6–61.4%) were also commonly reported. In contrast, activities explicitly related to climate change were reported by only 5.1% of participants (95% CI: 1.4–16.9%), representing the least frequently identified institutional action (Table 2).

4 Discussion

Climate, as a determinant of human health, requires the study of the convergence between atmospheric physical phenomena, biological and epidemiological processes, and the ways in which people live and access healthcare systems (World Health Organization and UN-Habitat, 2016). The findings of this study show that, among extreme temperature events, heatwaves increased in recent years of the analyzed period in both duration and recorded temperature intensity. This trend is consistent with national climate patterns and with projected climate change scenarios, as discussed in this study. When asked about perception of the occurrence of extreme temperature events, most surveyed healthcare personnel identified the summers of 2022 and 2023. Regarding perceived impacts of extreme temperature and precipitation events on patient care in daily clinical practice, the majority of respondents reported experiencing such impacts on patients’ health for both types of events, epidemiological data was not analyzed.

Media analysis of local news sources indicates that most reports on extreme events were published in the final years of the study period, with heatwaves being the most frequently reported phenomenon. These trends are consistent with meteorological data. Notably, three respondents recalled the April 2013 flood in the city of La Plata when asked about extreme precipitation events, as they were working there at the time. This was a highly significant disaster in the region’s recent history, which appears to have left a strong imprint on the memory of healthcare workers. As reported in the literature, disaster situations leave lasting marks on individual and collective memory, in this case within the healthcare community.

A large majority of participants reported experiencing extreme climate events during their professional activity in the hospital, highlighting recent episodes of heatwaves, extreme cold days, and severe precipitation events. In their descriptions, healthcare workers used terms such as “suffocating” for heat and “flooding” for precipitation, reflecting a lasting cognitive and emotional imprint of climatic hazards. These findings are consistent with López Vázquez et al. (2015).

Healthcare staff reported that these extreme events affected their daily lives, including commuting to the hospital, as well as the well-being of colleagues and patients. In relation to their professional role, they described themselves as being on the “front line” of the socio-health consequences of these events. Risk perception is shaped not only by the objective characteristics of an event but also by its interpretation, a dynamic process influenced by both direct and indirect experience and contextual factors. These elements affect hazard perception and response development (López Vázquez et al., 2015). This is reflected in their perceptions of the clinical demand associated with climate-related morbidity, including malnutrition, dengue, acute diarrheal diseases, heat stroke, hypothermia, and trauma. These demands place significant pressure on health services in terms of anticipation, rapid response, and adaptation to extreme climate events.

A high frequency of answers was also found regarding emotional and psychological impacts on hospital staff, who reported having to respond to threatening situations and frequently recalled these experiences in the surveys. Regarding patients, respondents identified emotional impacts described as “distress,” “anxiety,” and “concern.” Stress represents an initial physiological response based on neurophysiological mechanisms, followed by a cognitive appraisal process influenced by prior experience and available coping resources, as well as contextual variables (Selye, 1973).⁶ Healthcare staff answers remarked that the impact of extreme events extends beyond physical harm and also affects mental health at both individual and community levels, so adaptation requires strategies, resources and measures to reduce extreme events impacts associated with stress and emotions.

Protective factors in the face of climate-related hazards were also identified. Among them, participants highlighted a strong sense of belonging within the hospital community during critical events such as a nearby fire and a flood. Collective responses were emphasized, suggesting a key potential for developing future anticipation and response strategies to mitigate adverse impacts of extreme events. Adaptation and care practices converge in the implementation of actions aimed at sustaining livelihoods and improving population living conditions (Amar-Amar et al., 2018), where the construction of social networks that strengthen community capacity to manage climate risks is essential (Brokensha, 2014).

Extreme climate events in the Matanza–Riachuelo Basin not only represent a climatic phenomenon but also exacerbate social, health, and structural inequalities, highlighting the need for a comprehensive and sustained approach to prevention and impact reduction. Local media reports show how extreme weather conditions affect multiple aspects of daily life and reveal pre-existing vulnerabilities. These reports rely on official meteorological data from the National Meteorological Service, underscoring the importance of accessible public information. They also highlight local experiences and responses, such as assistance provided to unhoused populations during cold spells and the role of civil protection agencies, emphasizing the potential of community networks to strengthen anticipation, response, and adaptation strategies.

Given the socio-spatial vulnerability of the Matanza–Riachuelo Basin—characterized by high population density, intense industrial activity, and marked social inequalities—these findings are of critical relevance. The results underscore the need to integrate climate change perspectives into public health planning. In this framework, it is essential to strengthen healthcare workforce training, improve early warning systems, and develop robust institutional adaptation and response strategies. A systematic approach to these impacts supports the design of effective interventions aimed at safeguarding population health and promoting community resilience in the context of increasing global climate variability.

The Intergovernmental Panel on Climate Change (2023) emphasizes that health systems must adapt their capacities to reduce vulnerability and strengthen resilience, including the development of anticipation, preparedness, response, and institutional learning capacities that ensure continuity of services, protect vulnerable populations, and enhance the resilience of both health professionals and healthcare organizations.

At the governance level, policies and management strategies aimed at anticipating, responding to, and adapting to extreme events and their health impacts operate across international, national, and provincial scales. Climate adaptation has thus been progressively integrated into major global frameworks, including the UNFCCC, the Paris Agreement, the Sendai Framework, and the Sustainable Development Goals. However, the effectiveness of these policies depends largely on their implementation at national and subnational levels, as well as on the capacity of health systems to respond to climate-related challenges.

In Argentina, these commitments have been translated into national and provincial climate adaptation policies aimed at integrating climate risk assessment into public health planning. Law No. 27.520/2019 establishes minimum standards for climate change adaptation and mitigation, creates the National Cabinet on Climate Change, and strengthens the institutional framework for climate action. In the health sector, the Ministry of Health established the National Program for the Reduction of Health Risks Associated with Climate Change (Resolution 555/2021) and the Climate Change and Health Working Group (MeTraCCyS, Resolution 2956/2021), formally integrating climate vulnerability assessment into sectoral planning.

Given the decentralized management of health services in Argentina’s provinces (Lieutier et al., 2022), the Province of Buenos Aires, through its Ministry of Environment, developed the Provincial Climate Change Adaptation and Mitigation Program and the Provincial Climate Change Response Plan (PRCC, Provincial Resolution 2371/22). The effective implementation of these policies depends on coordination among government levels, civil society, and the private sector, as well as on intersectoral consensus-building to strengthen response capacity to the health impacts of climate change.

Heatwaves represent a critical public health challenge in the Matanza–Riachuelo Basin, and effectively mitigating the impacts of climate change on society requires both the strengthening of infrastructure and the promotion of community education and support. The observed increase in the frequency, duration, and intensity of heatwaves is consistent with national trends and climate change projections, and aligns with the perceptions and experiences of healthcare personnel in the study area.

Healthcare workers reported not only direct clinical impacts—such as heat-related illness, infectious diseases, and injuries—but also significant psychological and social effects on patients and staff. These events are embedded in professional practice and collective memory, shaping risk perception and reinforcing the role of health workers as first responders to climate-related emergencies.

The findings underscore the importance of strengthening early warning systems, workforce training, and institutional preparedness to reduce health risks and ensure continuity of care under increasingly frequent extreme climate conditions.

Finally, effective adaptation requires collaborative work among government sectors, hospitals and their staff, communities, and universities to develop appropriate and timely strategies in response to future climate change scenarios. Strengthening these networks is essential to build resilience and support sustainable, context-sensitive responses to the health impacts of climate change.

This study has several limitations that should be considered when interpreting the findings. First, surveys were conducted in a single tertiary care hospital located in the Matanza–Riachuelo River Basin. Although this institution serves a highly vulnerable population and represents an important referral center within the basin, the findings may not be directly generalizable to other healthcare settings with different organizational structures, resources, or climatic contexts. Second, the surveys explored healthcare professionals’ perceptions and experiences rather than objectively measured institutional performance. Consequently, the findings may have been influenced by recall bias, particularly because some of the most salient events, including the severe heatwaves and flooding episodes, had occurred relatively recently. It is important to note that the temporal references recalled by survey respondents do not necessarily correspond precisely to the events recorded by the SMN, as they reflect personal recollections shaped by individual and professional experiences. Nevertheless, these perceptions are highly relevant because they shape preparedness, decision-making, and adaptation practices within health services. Third, the study was not designed to establish causal relationships between specific meteorological events and health outcomes. Instead, it sought to characterize how healthcare professionals perceived climate-related risks and how health services anticipated and responded to these events. Meteorological records and local media reports were used to complement and triangulate participants’ accounts rather than to estimate causal effects. In particular, media reports provided contextual information on local attention to and narratives surrounding extreme events but were not considered objective measures of the magnitude of their health, economic, educational, agricultural, or infrastructural impacts unless corroborated by other sources. The interpretation of media coverage should also consider potential variations over time in public awareness, the availability of digital archives, editorial priorities, and the prominence given to recent events. Despite these limitations, an important strength is the integration of evidence across multiple levels, combining regional meteorological observations, community-level information from local media, and institutional perceptions from healthcare professionals. This multilevel mixed-methods approach enabled the triangulation of objective climate data with institutional perceptions and community-level information, providing a more comprehensive understanding of how extreme weather events are experienced, interpreted, and managed within a highly vulnerable urban territory. In addition, the collaboration between climate scientists, public health researchers, healthcare professionals, and social scientists provided an interdisciplinary perspective that allowed the analysis of climate change not only as an environmental phenomenon but also as a challenge for health systems, institutional preparedness, and community resilience. Finally, the findings have immediate practical relevance because they identify institutional strengths, gaps, and opportunities that may inform the development of climate-resilient health services in the region.

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Footnotes

Edited by: Adugna Woyessa, Ethiopian Public Health Institute, Ethiopia

Reviewed by: Sankha Randenikumara, Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka

Ronan Adler Tavella, Federal University of São Paulo, Brazil

Footnotes

https://www.canuelasya.com/

https://elciudadano.com.ar/

https://canuelasnews.com.ar/

https://canuelasaldia.com.ar/

https://www.infocanuelas.com/

https://www.zotero.org/google-docs/?zquf7G