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It sounds like a freak disaster: a blistering heat wave hits a country known for mild temperatures, killing thousands and prompting a breakdown in one of the world's best health systems.

People enjoy a day at the beach in Nice, southern France, Sunday, Sept. 21, 2003. Unusually warm weather stood over France on Sunday, with temperatures up to 25 degrees Celsius (77 degrees Fahrenheit) in Nice, and up to 30 degrees Celsius, 86 degrees Fahrenheit in Paris.   [AP]

But experts say the factors behind France's heat wave this summer are common in Europe and North America — and higher temperatures linked to global warming mean a similar disaster could easily happen again.

"We have to recognize that in the next years and decades, these episodes of heat waves will even be more frequent, sometimes even more severe," said Roberto Bertollini, an environmental health expert with the World Health Organization.

Paris has yet to compile a final death toll from the heat wave, which pummeled France and much of Europe with temperatures up to 104. But the preliminary toll is staggering: 11,435 deaths in France alone.

The country is far from fully figuring out why so many died, but early assessments point to several factors: a rapidly aging society, a health care system short on care for the elderly, and low awareness of environmental health hazards.

While such circumstances can go unnoticed for long periods of time, they rush to the fore in a crisis.

"Heat waves are important precisely because they help us understand everyday conditions that always affect the society but are difficult to see," said Eric Klinenberg, a New York University sociologist and author of "Heat Wave: A Social Autopsy of Disaster in Chicago."

Those conditions were made painfully apparent in France this summer.

Like many countries in the industrialized world, France is aging quickly. The percentage of the population 60 or older is expected to rise from 20.6 percent in 2000 to 35 percent in 2050, according to the National Institute for Statistics and Economic Studies.

The elderly are especially vulnerable in a heat wave. Not only are they physically susceptible to heat-related illnesses, but they often take medicines which make them even more sensitive to rising temperatures.

Those problems are further compounded because elderly people in urban France, like elsewhere, are often isolated in small apartments with few friends or relatives nearby to look after them.

As temperatures soared in the first two weeks of August, elderly victims — alone at home or at overwhelmed nursing homes and hospitals — began to die of heat stroke, dehydration and other heat-related maladies at alarming rates.

Another condition behind the crisis was something of a shocker for the French and others in Europe: problems with the much-lauded health care system.

Much of the praise for French health care is deserved. It provides high-quality, virtually universal coverage through a combination of public and supplemental insurance schemes, and is considered one of the best in the world.

But the heat wave revealed some crucial flaws.

A report commissioned by the Health Ministry and released in September pointed to lack of coordination, lethargic methods of compiling death statistics and the inability to handle a large-scale geriatrics crisis.

"The hospital network at present is not adapted for geriatric patients," the study concluded. "These patients ... need to be taken care of by a team that's competent in geriatrics."

The shortcomings were apparently compounded by a sacred institution in France: the summer vacation.

In August nearly everybody in France from the neighborhood baker to the president clears out of town. The health establishment is no different: with patients gone, doctors lock up shop and head for the beach and hospitals close down whole sections.

Heat wave sufferers said they couldn't get in touch with doctors, harried emergency workers arrived at hospitals only to find no beds available, and the elderly were often left to fend for themselves.

Health Minister Jean-Francois Mattei ordered a special study this month to look into the link with vacations after general doctors strongly denied allegations their absence put the elderly in danger. The results were due in mid-November.

The role of vacations is a touchy subject. Michel Combier, president of the National General Practitioners Union, said he estimated only about 20 percent of general practitioners were away during the heat wave.

"It is absolutely false to say that all the doctors were on vacation," he said.

Other European countries hit by the heat have been slower than France to come out with death tolls, but it's clear they also suffered thousands of deaths.

Environmental experts warn that because of climate change, such heat waves are expected to increase in number in coming years, meaning Europe — a continent that historically has enjoyed a temperate climate — will have to make adjustments.

"We're not talking about an isolated phenomenon affecting a few people," said Bertollini. "We are talking about something which apparently is affecting large numbers of people living in particular conditions."

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