Editing IPCC:AR6/WGII/Chapter-6 (section)

==== 6.2.4.7 Health Systems Infrastructure ====

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Healthcare facilities (hospitals, clinics, residential homes) will suffer increasing shocks and stresses related to climate variability and change (Corvalan et al., 2020). Some may be sudden shocks from extreme weather events, which both threaten the facility, staff and patients and increase the number of people seeking health care. There are extensive reports of health facilities being damaged after major floods and windstorms (e.g., 2010 floods in Pakistan, Hurricane Sandy in the USA) which can be further exacerbated by power and water supply failures (Powell, Hanfling and Gostin, 2012). Disruption to services may persist for many months because of damage to buildings, loss of drugs and equipment, and damaged transport infrastructure significantly increasing travel time for patients (Hierink et al., 2020). The impacts of climate change on the health of residents of ‘slum’ settlements will also compound the existing health burdens faced by these individuals, including infectious disease and other environmental public health concerns (Lilford et al., 2016; Mberu et al., 2016).

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'''Box 6.2 | Infrastructure Interdependencies'''
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Infrastructure networks are increasingly dependent on each other—for power, control (via ICT) and access for deliveries or servicing (Figure 6.2). Moreover, a range of other mechanisms can create interdependencies that impact upon climate risks by creating pathways for cascading failure (Undorf et al., 2020; [[#Barabási--2013|Barabási, 2013]] ). In the UK, for example, all infrastructures utilities identify failure of components in another utility as a risk to their systems (Dawson et al., 2018).

Key interdependencies include:

# The use of ICT for data transfer, remote control of other systems, and clock synchronisation. Pant et al. (2016) show that ICT is crucial for the successful operation of the UK’s rail infrastructure. The study shows that flooding of the ICT assets in the1-in-200 year floodplain would disrupt 46% of passenger journeys across the whole network.
# Water to generate hydroelectricity and for cooling thermal power stations. Reductions in usable capacity for 61–74% of the hydropower plants and 81–86% of the thermoelectric power plants worldwide for 2040–2069 (van Vliet et al., 2016), with some power generation technologies, including carbon capture and storage, requiring far higher volumes of water for cooling (Byers et al., 2016).
# Energy to power other infrastructure systems. Failure of urban energy supply disrupts other infrastructure services, with disproportionate impacts on the urban poor ( [[#Silver--2015|Silver, 2015]] ).
# Transport systems that ensure access for resources such as fuel, personnel and emergency response. [[#Pregnolato--2017|Pregnolato et al. (2017)]] show disruption across the city from a 1-in-10 year storm event could increase by 43% by the 2080s.
# Green infrastructure can provide multiple services, creating interdependencies between multiple physical infrastructure systems. For example, green space can support sustainable urban drainage, ''in situ'' wastewater treatment and urban cooling (Demuzere et al., 2014).
# Geographical proximity of assets leads to multiple infrastructures being simultaneously exposed to the same climate hazard. Disruption is disproportionately larger for interconnected networks (Fu et al., 2014).

There is usually limited information on the risks between infrastructure sectors. Without frameworks for collaboration, and coupled with commercial and security sensitivities, this remains a barrier to routine sharing and cooperation between operators. Despite this, methods to tackle interdependence in climate risk analysis are emerging ( [[#Dawson--2015|Dawson, 2015]] ). For example, [[#Thacker--2017|Thacker et al. (2017)]] analysed the criticality of the UK’s infrastructure networks by integrating data on infrastructure location, connectivity, interdependence and usage. The analysis showed that criticality hotspots are typically located around the periphery of urban areas where there are large facilities upon which many users depend or where several critical infrastructures are concentrated in one location. As infrastructure systems become increasingly interconnected, associated risks from climate change will increase and require a cross-sectoral approach to adaptation ( [[#Dawson--2018|Dawson et al., 2018]] ).

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