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On the night Superstorm Sandy hit New York in October 2012, seawater from the Atlantic Ocean surged into the emergency room of what was then known as Coney Island Hospital. Staff scrambled to evacuate 28 patients to higher floors, wading through knee-deep water and holding flashlights to navigate dark hallways.
“The damage was extensive. The hospital was fully evacuated. We lost all power in the campus. It was multiple months before [the hospital] can be utilized again,” Svetlana Lipyanskaya, CEO of NYC Health + Hospitals/South Brooklyn Health, said in an interview. (Lipyanskaya, who was not at Coney Island Hospital in 2012, worked at Weill Cornell at the time.)
Today, the site, now called South Brooklyn Health, is fortified by a four-foot flood wall. A new hospital building, named after the late Supreme Court Justice Ruth Bader Ginsburg, features hurricane-resistant glass, and power and water systems designed to withstand future storms that could have once crippled the facility.
As climate change accelerates, South Brooklyn Health’s transformation reflects a growing recognition of the vulnerability of health care facilities to extreme weather events and the need for resilient infrastructure to maintain essential services. Michele Baker, policy coordinator of The Global Climate and Health Alliance, said many health facilities “were not built with these kinds of weather events in mind.”
“We learned what our vulnerabilities are,” Lipyanskaya said. “And so when we rebuilt, we rebuilt with that in mind.”
Crucial services moved to higher floors
In May 2023, the $923 million Ruth Bader Ginsburg Hospital opened, offering services to nearly 875,000 residents of South Brooklyn and nearby neighborhoods, many of whom are immigrants and low-income individuals. The Federal Emergency Management Agency funded the construction of the new hospital.
One of the key features of the hospital is its emergency department located on the second floor to ensure continuity of care during floods.
“Our new building is built so that, post-event, we could be up and running very quickly because there’s literally nothing of any key importance on the first floor,” Lipyanskaya said. The hospital’s first floor houses just the lobby and a seven-foot bronze statue of Ginsburg.
Clinical services, along with power, heating, cooling, and water systems are located on higher floors. Aside from the flood wall surrounding the hospital campus, flood barriers are installed within the building. A wind-resistant envelope further protects the structure against severe storms. During Sandy, seawater from the Atlantic, just a mile away from the hospital, easily breached the facility, even over sandbags. Violent winds blew open the windows.
In addition to infrastructure upgrades, South Brooklyn Health has also trained staff to respond to disaster situations, and the hospital has implemented a robust supply chain system to ensure uninterrupted patient care during emergencies.
“We have backups of everything, and we’re able to replenish very quickly and move forward very quickly,” Lipyanskaya said, adding that the supply chain efficiencies were more a result of the Covid-19 pandemic than Sandy.
South Brooklyn Health is not alone in bolstering its defenses against climate impacts in the city. With a grant from FEMA, NYC Health + Hospitals Bellevue, Metropolitan and Coler, which were also devastated by Sandy, have installed flood walls to protect against storm surge, elevated electrical equipment and alarm systems, and put in place backup generators to ensure operations can continue for at least 72 hours during a power outage.
Atlanta hospital flooded during extreme cold
Many hospitals across the United States remain ill-equipped to withstand the increasing severity and frequency of climate-related disasters.
About 515 hospitals in North America could face high risk of a total or partial shutdown due to extreme weather events if global emissions continue to rise at a rapid pace, according to a December 2023 report by climate-risk data analysis company XDI. Large corporations, financial institutions, insurance companies, real estate developers, and governments rely on XDI’s data to assess the climate risks faced by their properties, infrastructure, and operations.
By 2100, Florida is expected to have the highest number of hospitals at high risk under a high emissions scenario, followed by Louisiana, California, Texas, and New York, according to the report.
Last year, Hurricanes Helene and Milton paralyzed health care facilities in Florida, Georgia, Tennessee, and other Southern states, and led to shortages of IV solutions.
In 2022, Grady Memorial Hospital, a public hospital that primarily serves low-income patients in Atlanta, was crippled after an HVAC system failure triggered by extreme cold led to widespread flooding. Dr. Jamaji Nwanaji-Enwerem, an emergency medicine physician, recalled how it damaged the burn unit and knocked out several CT scanners.
“These cascading failures revealed how aging infrastructure in safety-net hospitals, which already face financial and operational challenges, is especially vulnerable to climate-related events,” Nwanaji-Enwerem said.
Safety-net hospitals may lack funding for climate-proofing
While FEMA grants provide critical funding for disaster resilience, other programs often rely on tax-related incentives, such as credits, which require upfront capital investments, said Winslow Dresser, associate director of regional climate solutions at Health Care Without Harm, a nonprofit advocating for sustainable health care practices. Wealthier institutions with strong credit ratings and better access to capital are more likely to benefit from these programs, Dresser said.
“Many safety-net hospitals lack the financial flexibility to make these changes alone,” Nwanaji-Enwerem said. “Broader federal, regional, and state policies are needed to provide funding, technical support, and incentives for climate-resilient upgrades.”
Nwanaji-Enwerem added that strengthening partnerships with local governments and community organizations can also improve hospitals’ readiness and response.
For some hospitals, bolstering defenses against climate disasters can be especially challenging if they have not experienced a major storm or wildfire. In those cases, Dresser said, the hospital leader “does not have those kinds of risks top of mind.”
While South Brooklyn Health’s infrastructure upgrades were designed to ride out the challenges of a changing climate, its CEO stressed that resilience is about more than just disaster-proof buildings.
“We really need to focus on providing care to patients where they are and think much more broadly about what happens outside the walls of the hospitals,” Lipyanskaya said, adding the improvements have also allowed the hospital to expand its services to better support the surrounding community.
Gaea Cabico is a freelance reporter in New York.
