A wall of flames met David Matear when he finally stepped outside of the downtown Fort McMurray hospital, after the final patient was hurried out of the building and into a waiting bus.

鈥淵ou couldn鈥檛 see the trees. You just saw fire,鈥� said Matear, the senior operating director for the health system in northern Alberta at that time.

鈥淭he fire was right on the doorstep 鈥� literally, probably about, I don鈥檛 know, 200 metres away.鈥�

The sky glowed red over the northern Alberta town, which felt eerily abandoned as tens of thousands of people fled the encroaching wildfire.

That was eight years ago, during the largest medical evacuation in Canadian history.

Everyone got out safely and, remarkably, the Northern Lights Regional Health Centre was still standing when the flames died down. But the smoke did considerable damage.

The 90,000 people who fled the region had to wait until the hospital and other essential services were back up and running before they could return home.

The ventilation system was scrubbed clean and every one of the 8,200 ceiling tiles in the facility had to be replaced.

Matear oversaw some of the work as the incident commander. He later went on to work in British Columbia, which endured terrible wildfire seasons, and helped hospitals in Manitoba and California weather waves of COVID-19.

He said there鈥檚 more Canada can do to protect its hospitals, and 鈥渋t needs to be on a much larger scale.鈥�

That means shoring up Canada鈥檚 hospitals against a growing number of disasters, said Ryan Ness, director of adaptation research at the Canadian Climate Institute.

Disasters that bring people to the emergency room 鈥� like fires, floods, heat waves and other extreme weather 鈥� often also strike the hospitals themselves, Ness said.

And with the number of climate-related emergencies expected to worsen in coming years, some parts of the country will need to move quickly to disaster-proof life-saving infrastructure.

鈥淚n the most vulnerable locations, it is very urgent,鈥� he said.

鈥淚 think every health authority, every health ministry in every part of the country should be thinking about this.鈥�

Last month, the Canadian Medical Association warned that Canada鈥檚 health-care facilities are among the oldest public infrastructure in use. Half were built more than 50 years ago, making them especially vulnerable to extreme climate events.

Several hospitals outside of Fort McMurray have also been forced to close due to extreme weather.

The Regina General Hospital was closed for eight days in 2007 due to high heat and humidity; a hospital in New Brunswick was flooded in 2012; and air quality warnings in 2017 resulted in the temporary closure of 19 health-care facilities.

The threat varies across the country. One study found 10 per cent of Canada鈥檚 hospitals and major health-care facilities were located within a 100-year flood zone, Ness said.

Five per cent were in a 20-year flood plain, which means they have a five per cent chance of being flooded in any given year.

鈥淭he results were quite surprising,鈥� he said. 鈥淓ven under existing climate conditions, plenty of facilities are in high-risk flood zones.鈥�

The fix could mean moving the electrical workings of the hospital out of the basement to avoid floodwaters seeping in and shorting them out, or upgrading the ventilation systems so they aren鈥檛 overpowered by smoke drifting in from nearby wildfires.

It could also be as simple as installing air conditioning to combat extreme heat, as high temperatures become increasingly common.

None of those solutions are cheap, but Ness said the cost is preferable to the alternative.

鈥淚 guess the opposing question is, can we afford not to do something about this?鈥� he said.

鈥淐an we can we afford not to make sure these facilities are resilient and available and accessible and functioning in the times of greatest need?鈥�

Otherwise, Canada could pay in the form of added costs or even lives lost, he said.

A report prepared for the B.C. government in 2018 made a similar case using the example of Superstorm Sandy in 2012, which forced the closure of six hospitals in New York City.

When two backup generators failed, hundreds of patients, including 20 babies from the neonatal unit, had to be evacuated from the New York City Hospital.

The hospitals suffered US$800 million in damage and the total recovery costs were estimated to be $3.1 billion, according to the report prepared by Island Health.

The Spaulding Rehabilitation Hospital in Boston famously tried to learn from that harrowing and costly experience by designing the building with disasters in mind. Emergency services are provided above the predicted 2085 100-year flood plain, accounting for expected sea-level rise in future years.

That kind of future-proofing was highlighted as a priority in a massive report issued by Health Canada in 2022, called Health of Canadians in a Changing Climate.

鈥淎daptation measures that get ahead of the curve of increasing climate impacts on ecosystems, infrastructure, communities and health systems will need to move beyond incremental approaches to adopt transformative changes,鈥� the authors of the report said.

The authors of that study pointed to a 2019 survey, which found only eight per cent of Canadian health-care facilities acknowledged climate change in their strategic plan or had identified climate risks in specific policies.

The report was intended to help federal and provincial governments be more prepared for the effects climate change will have on the health of Canadians.

For example, the new St. Paul鈥檚 Hospital in Vancouver, expected to open in 2027, is being built five metres above the sea-level rise predicted by the year 2100, so it isn鈥檛 shut down in the event of a major flood. The cooling system has also been designed to withstand temperatures predicted by the year 2080.

Of course, not every hospital will have to be fortified against every disaster, Ness said. They just need to know where the risks are.

But those risks are increasing, Matear said, as emergency events become more and more common.

People were shocked when the wildfire tore through Fort McMurray in 2016, he said, but fires have continued to be threatening every year since.

People in Fort McMurray recently returned home after another wildfire encroached on their community and forced evacuations.

鈥淚 think, as a result of that, you need to be very much more prepared than 鈥� provinces were pre-2016,鈥� said Matear.

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Laura Osman, The Canadian Press