For Anne-Marie Azevedo, 13 July 2022 started off like a normal day. Her brother David was staying with her while he got his life back on track after a period of unemployment. He was on the third day of a new job in construction and had been asked to work extra hours. Eager to make a good impression, David was up and out of the door first thing.
As she got ready for work later in the morning, Anne‑Marie thought David had mistakenly picked up her house keys, so she called him. She was reassured to hear that he sounded fine, despite the fact that the previous evening he had been exhausted and visibly unwell from the heat. France was in the grip of an intense heatwave, and he was working outside all day. David hadn’t taken the keys, so after a quick chat Anne-Marie got on with her day.
At 11.50am, she received a call from an unknown number. It was someone from the construction site saying that David was unwell and she needed to come and collect him. Anne-Marie immediately got into her car and drove the 10 minutes to the site.
Nothing had prepared her for what she saw. David was lying on the pavement, under a small tree – a patch of shade so small that part of his body was still in the sunlight. He was convulsing and drooling. No one was attending to him, and there were no medics to be seen. Anne-Marie screamed, and someone told her that an ambulance was on its way. “I didn’t understand what was happening,” she says. “I didn’t understand why my brother was like that, why they had called me, why they hadn’t called the emergency services first.” She is still haunted by the idea that the delay in medical treatment could have made a crucial difference.
Anne-Marie had no idea what was wrong with her brother, but she kicked into action. She works as a medical secretary and had some first-aid knowledge. She immediately removed his safety boots and socks, thinking – correctly – that he needed to cool down. She searched for water, which she says was not readily available. Someone handed her a bottle with a small amount in the bottom, and she used it to moisten her brother’s mouth. “I asked myself thousands of questions, but at the same time I tried to see if he was talking to me, if he was still conscious,” she says.
It was about half an hour before the ambulance arrived. One of the first things the paramedics did was to check David’s body temperature. It was 42C. He was in the throes of heatstroke. This is the most serious heat-related illness: it means that the body cannot control its temperature. As the temperature rises rapidly, the sweating mechanism fails and the body is unable to cool down. If treatment is delayed, the condition is fatal.
David was taken to hospital, where for hours doctors tried to save him. Just after midnight, he died. On his death certificate, the cause of death is written: “Cardiac arrest caused by severe hyperthermia”. David died because of the heat.
***
Anne-Marie is a small woman with dark brown hair, who speaks with firm clarity and wears her emotions on her face. This summer I visit her apartment in Clermont-Ferrand, a small city in central France nestled in the volcanic Chaîne des Puys region. It has been two years since David’s death – an event so sudden and shocking, and a loss so enormous, that Anne-Marie is still struggling to come to terms with it. Her home is full of painful reminders of her older brother. “This is where David spent his last days,” she says simply, gesturing at the small living room and the sofa where she found him asleep the night before he died.
We sit at her dining table and talk about happier times. Anne-Marie tells me that she, David and their middle brother, Eric, grew up in social housing in Brioude, a small town about an hour south of Clermont-Ferrand. The family didn’t have much, but they were close-knit, supportive and loving. “We chose to be together as much as possible,” she says. David was exceptionally generous. As a teenager, he would sometimes take food from the cupboard to sneak to friends whose families were struggling more than his own, or give away his clothes or shoes. “He was someone who loved people,” says Anne-Marie. “He never fought with anyone, he was never mean, he said hello to anyone who passed him on the street.”
When Anne-Marie was eight and David was 16, he left home to complete a qualification in masonry. He moved in with his girlfriend, but was always back and forth to his parents’ house. Anne-Marie remembers him poking his head round her bedroom door one evening. Thinking Anne-Marie was asleep, he told his girlfriend: “This is my little princess.” This continued into adulthood. “We called each other all the time; we were always together,” says Anne-Marie. “At one point he came over for lunch every day – he practically lived at my house.”
When Anne-Marie separated from her husband in 2009, she found herself socially isolated, with two young children. David, who never had children of his own, loved being an uncle. He stepped in, babysitting whenever Anne-Marie needed him, and introducing her to a new set of friends. “He helped me get my life back and flourish after divorce,” she says.
On 28 May 2022, David turned 50 and decided it was time to change his life. He was living in Brioude and had been out of work for a couple of years, drinking too much and struggling to break out of bad habits. He called Anne-Marie and told her: “I’m tired of life right now, and I want to start a new one.” David’s drinking was a taboo subject – he denied having a problem – and Anne-Marie was relieved to hear him talking about the future. “He realised that, at 50, he still had time to do a lot of things,” she recalls. “I was going to support him.”
The siblings hatched a plan. David – who had always worked in construction – would find a job in Clermont-Ferrand, staying with Anne-Marie until he’d saved up enough money to rent a place of his own. She lives in a modest two-bedroom apartment with her younger daughter, Emma, who was 16 at the time. They agreed that David would take Emma’s room, and mother and daughter would share.
In June 2022, David signed up with Sovitrat, a major temp agency. As he was filling in the application forms and going to interviews, extreme heat swept across Europe, the first of several intense heatwaves that would hit the continent that summer. France was one of the worst-affected countries, with temperatures of 40-43C recorded in some places. The heat briefly let up, returning to summer averages as David got the good news: Sovitrat had found him a job in Clermont-Ferrand, working for the construction giant Eiffage. The contract was temporary, but the agency said that if all went well it could be extended until 2025. David was determined to make a good impression.
In July, David moved in with Anne-Marie, and a second, even more severe heatwave struck. It extended north to the UK, where temperatures surpassing 40C were recorded for the first time. France’s public health authority operates a colour-coded warning system for heatwaves: on 9 July 2022, they issued a red alert in Auvergne-Rhône-Alpes, the region in which Clermont-Ferrand is situated. David’s first day of work was 11 July. Those most at risk in high temperatures are elderly people, young children, pregnant women, people with health conditions and outdoor labourers.
* * *
As climate change radically alters the world we live in, extreme heat in Europe is becoming an annual occurrence. According to Copernicus, the EU’s Earth observation programme, 2022 was at the time Europe’s hottest ever summer. (It has since been surpassed by the summer of 2023.) Intense periods of heat over the past few summers have caused wildfires in countries from Greece to France, led to parched riverbeds across the continent, and created issues with water supply.
Heatwaves also have a devastating effect on human health, typically causing a significant increase in deaths. But establishing which deaths are actually caused by the heat is not a straightforward process. The human body’s reaction to heat is complex: there is no set temperature at which heat is dangerous to human life; no specific limit to the time that can be safely spent outside. This is why one person might collapse and die in the heat, while another working alongside them might emerge unscathed.
Clermont-Ferrand is home to a large Michelin tyre factory, and David was working on the construction of a new truck depot, pouring a large concrete slab as a base. He worked in direct sunlight. Temperatures in Clermont-Ferrand soared to around 35C. That first day, David came home exhausted. He had no appetite, so he skipped dinner, took a shower and went straight to bed.
“I asked him, ‘Is there any shelter on the site?’” Anne‑Marie remembers. “He said there was no shade at all, just a little hut to eat lunch.” The next morning, he seemed better, and went to work as normal. Anne‑Marie didn’t think much of it. It had been a while since David had worked, so it was no surprise he was tired – and besides, she too was feeling the effects of the heat. Everyone was.
The second evening, David was clearly unwell. When Anne-Marie came home at 7.30pm, she found him asleep on the sofa. She roused him and prepared a salad, something light and fresh, to encourage him to eat. He told her that he had been asked to work overtime the next day – starting early and finishing late. Anne‑Marie was surprised. Every day, the news showed public health warnings about the need to stay hydrated and avoid being outside. “I told him, ‘It’s incredible to do overtime in these temperatures,’” she says. “But he said he was only a temporary employee and didn’t dare say no because he wanted to keep the job.”
When Anne-Marie recalls the events of 13 July 2022, her eyes fill with tears. “I relive that day very often,” she says. When the paramedics finally arrived at the construction site, they took David into the ambulance to provide treatment and get him out of the sun. When someone has heatstroke, their heart beats rapidly, trying to get blood to the skin to cool it. The heart can’t always keep up and, in the meantime, the other vital organs are starved of oxygen. Inside the vehicle, David had a cardiac arrest. He was transferred to intensive care at the hospital, where he was tested for Covid, as well as for alcohol and drugs in his system: all tests came back negative. For several hours, doctors tried and failed to lower his core body temperature. A quick response to heatstroke is vital.
Eiffage, the construction company running the site, disputes Anne-Marie’s account of the day David died, and says the site manager immediately took care of David, placing him in a lateral safety position and contacting emergency services. A spokesperson says: “All the preventive measures necessary to prevent heat-related risks were in place, in particular the provision of water on the site and the installation of a cooler on a generator as close as possible to the work area.”
Anne-Marie says she later found out that David had first felt unwell and fainted at 10.30am, over an hour before anyone on site called her, and nearly two hours before the emergency responders arrived. In hospital, he had a second cardiac arrest. He briefly came to his senses, and then deteriorated again. The doctor came to speak to Anne-Marie and told her that David’s organs were failing, one after the other. He said they would keep trying to treat him, but warned that he might not survive and that she should inform the rest of her family.
“What I was experiencing didn’t feel real,” says Anne-Marie. “I couldn’t comprehend that I spoke to my brother on the phone in the morning, and in the afternoon I was asking myself, ‘How am I going to tell my parents that my brother is going to die?’”
Anne-Marie’s daughter Emma was in Brioude visiting her sister Morgane when their mother rang to say their uncle was seriously unwell. They rushed to Clermont-Ferrand, taking their grandmother – David’s mother – with them. Anne-Marie’s father has his own health problems, so he and her brother Eric stayed behind in Brioude. The women arrived in the evening, joining Anne-Marie anxiously waiting at the hospital. Around 11pm, the doctor said that David’s situation was stabilising and they should go home and get some sleep. They had only got as far as the car park when Anne-Marie’s phone rang. It was the doctor, asking them to return immediately. Anne‑Marie and Morgane ran to find out what was going on, while Emma stayed with her grandmother outside.
Emma has never forgotten those moments. “My grandmother was screaming in the parking lot. She was in a state that I wouldn’t wish on anyone,” she says. “The pain crushed her as she realised she was going to lose her son.” Inside, the doctors told Anne-Marie that David was dying and it was time for the family to say their last goodbyes. Emma and her grandmother joined them inside the hospital. The doctors warned they might not recognise David because his face was so swollen. They each went into the room to say goodbye. Around midnight, David was pronounced dead. Emma recalls going in to see her uncle’s body after his death, and feeling that his body had gone cold. “I squeezed his left hand very tightly and I said to myself, ‘This will warm him up, he will come back.’ I kept repeating that to myself,” she says, and starts to cry. “I couldn’t understand why he was there, lying on this table – and how he went so quickly.”
* * *
A death like David’s, which happened as a direct result of exposure to heat, is unusual: more often, people die from heat placing a strain on their bodies and triggering another health issue. This means that it takes time to understand the death toll of a heatwave.
“Unlike other disasters, which are happening in real time, we only really know the true impacts of extreme heat weeks or months after the event itself – it comes from analysing death records, for instance,” says Julie Arrighi, associate director of the Red Cross and Red Crescent Climate Centre. “This is challenging from a risk communication perspective. With extreme heat, you end up talking about population-level statistics, which are harder to connect with.”
Nonetheless, those statistics are alarming: across Europe, people are dying in large numbers from the heat every summer. One study looking at excess mortality data across 16 European countries estimated that 70,000 people died due to heat in the summer of 2022. Italy was worst affected, with more than 18,000 heat-related deaths.
The increased risk to elderly people is due to the cardiovascular strain caused by extreme temperatures. But those with no choice but to be outside – homeless people, agricultural or construction workers – are also in more danger than the general population. The public health advice to stay indoors where possible, keep out of the midday sun, and avoid physical exertion is impossible for most labourers to follow.
“Fundamentally, illness related to heat is incredibly preventable. All you have to do is not overexpose someone and allow them to recover,” says Cora Roelofs, a professor at the University of Massachusetts Lowell, who studies worker safety and the environment. “But workers are compelled to be in the heat. They have to work or they lose their livelihood. This speaks to a wider dynamic: power and money determine your vulnerability to climate change.”
A week after David’s death, José Antonio González, a street sweeper in Madrid, died of heatstroke after collapsing at work. He was 60, and like David was working on a temporary contract and determined to prove himself. His son told the Spanish newspaper El País: “I am convinced that he did not stop cleaning that street until he fainted. He thought his contract was not going to be renewed and he was giving his all to prove himself.”
There is a sad echo of this in the French public health insurer’s report into David’s death, which recorded Eiffage’s site manager telling investigators: “He was running everywhere. He wanted to prove that he was valuable to be kept.”
In her research on heat death in the US, Roelofs has found that it is common for workers to die in their first few days on the job, not just because of the physiological adjustment to heat exposure, but social factors.
“People don’t know their name, they feel like they can’t step out and say to a manager: ‘I don’t feel well.’ They don’t know where the water is, where the shade is, when it’s acceptable to slack off,” she says.
What is happening to outdoor workers is a concern for all of us. Back in 2014, Roelofs wrote a paper for the American Journal of Public Health in which she warned that workers are “the canary in the climate coalmine”: a warning of the health risks that are coming for the general population as extreme temperatures become the norm. “I wouldn’t use that phrasing now, because canaries were dispensable,” Roelofs tells me. “I’d say now that workers are the sentinels.”
Safeguards for workers are a major frontier in climate policy. Spain introduced a raft of new protections after the outcry that followed the death of González, including a requirement for employers to specifically risk assess for heat, prohibiting certain tasks in high temperatures, and making it mandatory to adapt work during a heatwave, with measures such as reducing or modifying work hours. But not all countries have taken such steps: in France, a “bad weather fund” is available for workers affected by storms or other adverse conditions, but it does not currently cover heatwaves.
“There’s basic good practice: shifting work schedules, frequent breaks, access to water, and training so that everyone can spot signs of heat stress – such as confusion – in their colleagues and administer immediate first aid,” says Arrighi. “But this is an area that absolutely needs strengthening. It’s a challenge that’s only going to get worse as temperatures increase.”
When David died, Anne-Marie didn’t know that it was not an isolated incident: Santé Publique France, the public health agency, would later release figures estimating that more than 2,800 people died in France in the heatwaves of summer 2022, with a significant proportion in the region around Clermont-Ferrand. At the time, the family was consumed by their own personal tragedy. Anne-Marie organised the funeral, handling the grim logistics that follow a death. (“My mother was very, very, very strong,” says Emma, who is now 18.) She was so busy, she barely had time to think, let alone to grieve. The whole family was anxious that people would think David had died because of his drinking, when in fact he was at a turning point.
“He died because he wanted to go back to work and it wasn’t because of alcohol, or being lazy, or anything like that,” Anne-Marie tells me. When she stood up to speak at his funeral, she addressed her brother: “You came to Clermont more determined than ever to take control of yourself, but unfortunately life has decided not to take this new path. Instead, eternal rest.”
The shock and grief of the early days soon gave way to anger. Sovitrat, the temp agency, sent the family flowers, but Eiffage, the construction company he had been working for, sent nothing. (When asked why, a spokesperson said: “Our teams were not aware of the family’s wishes, ahead of the funeral organised very quickly.”) A week after David’s death, Anne-Marie received paperwork from Eiffage. In it, the company denied any link between David’s death and his work on the construction site. Later, in an email to Sovitrat, Eiffage reiterated this, writing that David’s collapse and subsequent death were “simply the manifestation of a health problem totally independent of work”.
To Anne-Marie, this felt like an abdication of responsibility. When her brother died, his body temperature had been 42C. He had never had heart problems or other health conditions, and his death certificate stated that his cardiac arrest was caused by heatstroke. Had he not been working, David would not have spent three full days out in the sun, physically exerting himself. Anne-Marie thought of the lack of water, the overtime, the state she had found him in, convulsing and drooling in partial shade. She worried that if the company didn’t take responsibility, this could happen to someone else. “I can’t stand injustice,” she says. “I can’t stand when things aren’t taken seriously.”
That August, the French public health insurer l’Assurance Maladie conducted an administrative investigation, interviewing the site managers and Anne-Marie. The report concluded that David’s death should be deemed a workplace accident – not put down to a totally unrelated illness. Eiffage did not accept the finding. In March 2023, Anne-Marie’s lawyer filed a manslaughter case with the French public prosecutor against multiple parties, and followed this up in January 2024 with a complaint in Clermont-Ferrand. To date, they have heard nothing. Eiffage says they are still awaiting the insurer’s position on “which accidental event was the cause of Mr Azevedo’s discomfort”, and that they will comply if the prosecutor decides to open an investigation.
Anne-Marie doesn’t care about compensation.
“I would simply like the people who work for them to work in humane conditions,” she says. “They should have water, they should have reduced hours in the extreme heat, they should be taken care of quickly if they’re unwell.”
More than anything, the family craves information: what happened in that crucial hour and a half when David was taken ill? “I don’t understand why a company, when an employee doesn’t feel well, doesn’t call for medical help, doesn’t do first aid,” she says. They still don’t have answers, and sometimes it feels as if they never will. “I think about it all the time,” says Anne-Marie. “Will I get mail today? Will someone call to tell me the investigation has started?”
As they wait, they feel David’s absence keenly. When the family comes together, as they often do, they don’t talk about his harrowing and avoidable death, but about his life. The jokes they shared, his love of silly hats and cycling, the way he taught his nieces and nephews the value of respect and generosity. “We often talk about David, even if it hurts us,” says Anne-Marie. “We still try to make him live with us. But we constantly ask ourselves the questions: why, and for what?”
Around the world, extreme heatwaves are happening more frequently and hitting ever-higher temperatures. If we continue on our current trajectory, global temperatures will reach 2C above pre-industrial averages by the 2040s. One recent study in the Lancet predicted that if this happens, heat-related deaths will quadruple. This would take us into uncharted territory – and nowhere in the world is adapting fast enough to these rapidly changing temperatures to prevent deaths on a massive scale.
David’s loved ones all bear the trauma in different ways. His father rarely discusses the death, but goes to the cemetery to visit his eldest son’s grave every day. Since seeing her uncle swollen and dying in the hospital, Emma has suffered with sleep paralysis. Every time her phone rings with a call from a family member, she gets a jolt of panic that something awful has happened.
Anne-Marie used to love sitting in the sun, but now she is filled with a deep, bodily fear when the temperature rises. She stays inside as much as she can, and anxiously checks on her elderly parents, wishing she could afford to move them to a place with air conditioning. “Whenever they announce heat,” she says, “it scares me.”
