On French construction sites, heat kills in indifference
By Juliette Gache, Léontine Gallois, Amandine Hess, Lucie Remer
Fact-checking and translation by Aude Dejaifve and Jared Paolino
David Azevedo was about to start a new life. At the age of 50, after two years of job searching, he found work on an Eiffage Group construction site in Clermont-Ferrand, a small city in the center of France. To save money while searching for his place, he moved in with his little sister, Anne-Marie. The summer of 2022 had barely begun and the temperatures were already scorching.
On July 11, the evening after his first day on the job, David told his sister about the exhausting hours he spent pouring a large concrete slab in the sweltering summer heat.
On July 12, he went to bed at 7 p.m., exhausted by another day of hard labor in high temperatures.
On July 13, he collapsed at work and was announced dead within a day. The death certificate attributed his passing to cardiac arrest “in a context of severe hyperthermia” – a condition more commonly referred to as heat stroke.
Eiffage, one of the largest construction companies in Europe, does not recognize David’s death as a work accident. But Anne-Marie Azevedo claims the company bears responsibility in her brother’s death, and the investigation led by French Public Health Insurance has recognized it as a work accident.
On March 3rd, Anne-Marie pressed charges against multiple parties for manslaughter. “I am fighting for my brother so that this never happens to anyone else again,” she said.
But David was neither the first nor the last to die under similar conditions at work. Along with workers in labor-intensive sectors, construction workers are among the many men and women whose work puts them on the front lines of the climate crisis.
With France fresh on the heels of its hottest year ever, and on track for another record-breaking year in 2023, the families of victims, as well as trade unions and researchers, say that labor laws meant to protect workers are ill-fitted to the new climate reality. And with scientific projections leaving no doubt that temperatures will continue to rise, and that heat waves will become more intense and more frequent, they say the failure of the French state and private companies to protect these workers will only cost more lives in the coming years.
Anatomy of a heatstroke
On Wednesday, July 13, 2022, the temperature reached almost 35°C in Clermont-Ferrand. David left Anne-Marie’s home at dawn.
At noon, his sister received a call from an unknown number. David was feeling ill, someone told her. She had to come and pick him up.
When she arrived on the site ten minutes later, her brother was lying on the ground in the shade of a small tree. His body convulsed, and drool ran down his chin. His skin was hot to the touch, and he was unresponsive.
Anne-Marie panicked. “This is barbaric. Do you realize what you’re doing, making people work in this heat? You are crazy!” she shouted. Emergency services had not yet arrived.
Anne-Marie removed David’s boots and socks in an attempt to cool him. But in high temperatures, the amount of heat the body can evacuate is limited.
To keep the body at a comfortable 37 °C, blood flow to the skin increases, where heat can be emitted, and the body sweats.
If the muscles are also working, the internal temperature rises faster. The heart beats wildly, trying to get as much blood as possible to the skin to cool it, but it can’t keep up. As blood is diverted, the internal organs – the liver, kidneys, and brain – are starved for blood and the precious oxygen it carries. As the body temperature rises, you feel shaky and, because of the drop in blood pressure in the brain, you may faint.
At this point, if you get help and are quickly immersed in cool water, you can recover without much permanent damage.
David had lost consciousness by the time first responders arrived. They administered CPR, but his condition continued to deteriorate, and he was transported to the intensive care unit of the local hospital.
A legislative void
In France, there is no legal maximum working temperature; employees may be put to work regardless of the temperature. The Labor Code simply specifies that employers must guarantee the safety and protect the physical and mental health of their employees.
“The employer is required to put in place an organization and means adapted to situations of exposure to episodes of high heat,” writes the Ministry of Labor.
Additional legal requirements exist for employers in specific sectors, however, including construction. First of all, a minimum of three liters of water per person per day must be made available to all workers — a measure that is far from sufficient for the workers. Anne-Marie recounts that she searched in vain for a bottle of water on the site to try to hydrate her brother.
In addition, employers are obligated to provide a space onsite for workers to shelter the heat, as well as distribute heat protective equipment.
“David told me they had a little place on site where they could eat lunch,” said Anne-Marie.”But I never went there.”
According to the recommendations of the yearly heatwave plan, employers should also, if possible, take “adequate organizational measures so that work can be done without exposing employees.” Such measures may include the adjustment of work schedules. On July 13, 2022, David left his sister’s home at 5:50 a.m. He started earlier that day, and he expected to finish later that evening to earn his overtime.
The enforcement and monitoring of workplace regulations is the responsibility of the French Labor Inspectorate – a division under the supervision of the French Ministry of Labor. However, its resources are limited. “The Labor Code does not provide for very precise measures concerning the management of this risk,” said Julie Court, a staff representative at a labor inspection union. “Memos multiply every year warning of the heatwave situation and encouraging controls, but the regulations remain limited.”
French labor law further requires all companies to complete a risk assessment document for its employees, which lists the health and safety risks to which employees may be exposed, as well as suggests preventative actions. However, the heat factor is rarely taken into account. “The only specific provisions we have are to provide fresh drinking water and a suitable rest area with breaks. That’s all,” said Court.
A survey conducted at the end of 2022 by France’s Economic, Social and Environmental Council (CESE) — a consultative assembly of the government — revealed that 70% of private and public sector employees, as well as 50% of employers, are in favor of strengthening legal obligations to better address environmental risks.
A climate risk underestimated by companies
Under existing law, if an infraction is observed, it remains difficult for inspectors to prosecute the company. This is due to the long chains of responsibility that complicate investigations and diffuse responsibility. Employers are not directly responsible for accidents that occur on construction sites. This responsibility can be delegated to site managers or foremen, who do not always have the necessary skills or training to ensure safety and health obligations are met. Another way of passing the buck is through the use of subcontractors or temporary workers.
In the exercise of their mission, the labor inspectors face another difficulty: the lack of personnel. For several years, the profession has been experiencing significant recruitment problems. In 2021, the French General Directorate for Labour (DGT) counted 260 vacancies or 12.57% of the total number of inspector positions needed. At that time, there were 2,000 agents in France, each responsible for 80,000 employees.
Sitting behind his desk, Giovanni Verrecchia nods. His thick moustache and glasses conceal a worried expression. For more than twenty years, this trade union representative of the construction-wood branch of the CFDT— another of France’s major confederations of trade unions — has been fighting for the recognition of the heat risk on building sites. According to him, putting workers to work on a hot day should be prohibited. There are nine general principles of prevention in the Labor Code, he explained. The first is to avoid risk. To do this, Verrecchia wants to expand a rule that allows construction workers to be compensated for work stoppages caused by bad weather.
Currently, employers in the building and public works sector contribute to an unemployment and bad weather fund that compensates employees who have lost pay due to bad weather. This compensation amounts to 75% of their wages. However, unlike frost, snow, ice and rain, hot weather and heat waves are not considered “bad weather”.
“Heatwaves are therefore not included on the list of circumstances considered as bad weather, but it can, in practice, make the performance of work effectively dangerous or impossible with regard to the health or safety of workers,” explained Pascal Benfella, Director of the Caisse Nationale des Coopératives, the body in charge of handling the bad weather fund. “In this respect, the decision to stop work is the responsibility of the company or its representative on the site.”.
If the employer decides to halt work and a heat wave alert is issued by local authorities, then claims for compensation may be accepted on a case-by-case basis by a national commission.
“Our dream is to make this fund a joint body, managed by both employers and employees,” said Verrecchia.“The idea would be to use the money that is not spent in winter during periods of high temperatures” However, that idea is not easily accepted by employers.
“This is the tip of the iceberg”
On Wednesday, July 13, 2022, David arrived at the hospital and underwent numerous tests. Anne-Marie remembers being told that her brother had arrived with a body temperature of 43°C. The doctors placed him in an induced coma. His condition was critical.
A few hours later, David suffered a cardiac arrest. “The doctor told us that it was time to say goodbye, that his heart was failing and that there was nothing more they could do,” said Anne-Marie.
At 12:20 a.m., David was pronounced dead.
On the emergency report obtained by journalists of the Heat Trap Project, the attending doctor wrote: “Cardio-respiratory arrest due to hyperthermia”. His death certificate states “cardiac arrest in the context of severe hyperthermia”. Although the role of heat in David’s death is indicated by these documents, its effect on workplace accidents is not always noted.
In the summer of 2022, Santé Publique France, the national public health agency, counted seven fatal work accidents possibly related to heat, three of which were among workers in the construction sector.
“This is the tip of the iceberg,” said Guillaume Boulanger, head of a working environments and health unit at Santé Publique France. “You can have a decompensation of cardiovascular disease or a kidney disease linked to intense exposure [to heat] in the workplace but the person will die the next day or within 3 days or up to 10 days. “In these cases, the link between heat exposure and death is typically not established.
In its 2018 report on the effects of climate risk on workers’ health, France’s National Health Security Agency (ANSES) highlighted rising temperatures as one of the main factors behind the increase in occupational risks.
These risks to workers’ health are not limited to heat stroke. ANSES warns that rising temperatures can exacerbate “psychosocial risks,” cause “neuropsychological disorders,” and lead to increased workplace accidents.
Dr. Gérard Lucas, President of the National Council of Occupational Health Professionals until early 2023, acknowledges that health professionals are faced with the difficult task of identifying the warning signs of heat-related discomfort in workers. Referring to body temperature, he explained, would not be sufficient because heat resistance depends on multiple factors such as hydration, ventilation, or clothing.
“Heat resistance varies greatly from one individual to another and from one period to another in the same individual,” said Lucas, bemoaning the lack of studies that would establish objective thresholds of heat resistance.
The retired occupational physician also regrets several recent developments in occupational medicine. Since a law passed in January 2017, when current President Emmanual Macron served as economy minister, mandatory medical visits to worksites are done every five years, rather than every two years. The presence of occupational physicians has also become optional in employee representative bodies.
According to Lucas, the suppression of representative bodies specialized in health and working conditions “is really a huge loss of capacity to acculturate workers on the issue of health and safety at work.” In the long run, he said, there is a risk of becoming “doctors for the employers, and not doctors for the employees.”
Eiffage denies responsibility
The grieving Azevedo family is determined to know the details of David’s death. For Anne-Marie, the situation is clear: her brother died in a work accident. Eiffage denies it.
A week after the accident, the company denied any link between David’s accident and his professional activity. In the accident declaration form, which companies are required to fill out, the company’s accident prevention officer wrote: “We have strong reservations about this accident”.
Later, in an email addressed to the temporary employment agency that employed David, the company denied again any connection between David’s accident and his working conditions.
“There is no accidental event that occurred at the time and place of work, but simply the manifestation of a health problem totally independent of work,” said the person in charge of accident prevention at Eiffage.
L’Assurance Maladie, the French national health insurance provider, launched an administrative investigation in mid-August. Anne-Marie was questioned by the investigator, as well as by the site manager and the director of the temporary employment agency that employed David. The Assurance Maladie concluded that it was a work accident.
After the investigation, the Health Insurance finally certifies that it was a work accident.
The Heat Trap Project reached out to the Eiffage group for comment. The company continued to deny responsibility in the accident, despite the Assurance Maladie’s conclusions. “His death would not be considered a workplace accident,” said the communication department in an email to the consortium.
But the death would be linked to “a health problem unrelated to work”, according to information that the company would have obtained from “the competent medical services that took care of Mr. Azevedo.”
Eiffage refuses to provide further information to confirm these statements.
“All the necessary preventive measures had been put in place, including those designed to prevent any risk related to excessive heat,” they added.
The case of David Azevedo is no exception. In 2019, L’Assurance Maladie counted 733 workplace accidents, not including those in the agricultural and public sectors. Accidents in the construction sectors accounted for a third of these accidents — and these figures are likely greatly underestimated. According to a report by the commission in charge of evaluating the cost of unreported workplace injuries, health professionals will not link an employee’s death to their work activities if it is not obvious.
The report further highlighted criticisms by some unions that companies “conceal work accidents and occupational diseases, or even to put pressure on certain victims so that they do not declare their pathology.”
A work-related accident, especially a serious or fatal one, can be very costly for a company. In 2021, work-related deaths cost companies between 450,000 and 750,000 euros depending on the sector of activity.
Heat as an overlooked risk
This underestimation of the number of victims and the lack of general data on the consequences of high temperatures at work hinders efforts to understand the problem of occupational heat exposure more fully and adapt public policies accordingly.
The lack of data also concerns how work-related accidents are linked to heat. Following its investigation, L’Assurance Maladie rarely highlighted the role of temperatures in David’s death. In fact, the report written by the investigator in charge never mentioned temperature.
According to an email from the departmental branch of l’Assurance Maladie concerned with David’s case, the investigation report does not mention the temperature because “this is not information that is sought during the administrative investigation opened for a fatal accident at work. In fact, the aim here was to confirm that the accident had indeed taken place under the subordination of the employer, at the time and place of work, whatever the cause.”
“If an employee falls from the roof, we will ask ourselves if he fell from a height or because of the heatwave, it is obvious that the cause of the fall is more often considered as the main cause than the heat. The same thing happens with heart attacks when workers leave their jobs, we don’t assume it’s the heat. It’s a problem in the analysis of risks,” affirmed Anthony Smith, labor inspector and union representative at the DGT.
Cora Roelofs and David Wegman, researchers studying the impact of climate change on occupational health and safety, refer to workers like David as “climate canaries.” Like the canaries in the mines, whose deaths warned miners of danger, David’s death is a warning of the danger climate change poses to workers in France and elsewhere, especially in the absence of an adequate policy response by the French state.
“What we would like is to prevent this from happening to other people,” said Anne-Marie.