French Toll Draws Vow of Reform

French President Jacques Chirac, facing his worst political crisis since winning reelection last year, promised reforms of the country’s health-care system Thursday and an investigation into the government’s response to a heat wave that has led to as many as 10,000 deaths.

The record-breaking temperatures of early August have dissipated, but it was nonetheless warm for Chirac on Thursday as he chaired a long Cabinet meeting the day after his return from vacation.

Critics say the president’s silence and his failure to cut short his three-week vacation in Quebec are symbolic of the official indifference that aggravated a disaster in a country with one of the world’s most advanced systems of medical care.

The failure of the government to react rapidly as corpses literally piled up undercuts the image of dynamic reform that Chirac has cultivated. A poll published Thursday pointed to a 51% disapproval rating for the official response to the heat wave.

“His silence has been incomprehensible, even during vacation time,” declared Francois Holland, a leader of the opposition Socialist Party. “That’s what has been striking about this crisis -- the delay, the inertia, the underestimation of the risks, the distance with regard to suffering. For a government that had made accessibility and initiative campaign slogans, this is a grave deficiency.”

A government minister for senior citizen services acknowledged after the Cabinet meeting that the latest estimate of more than 10,000 dead, calculated by an undertakers association, could well be accurate. Chirac announced a comprehensive study to determine the actual toll and identify weakness in emergency-response procedures and social services. Many of the dead were elderly or infirm.

“I have asked the government that the causes of these dramas that we have just lived be analyzed in depth, in the most total transparence,” Chirac said in a short speech.

After officials in the center-right government acknowledged that the death toll had topped 5,000, Chirac’s surgeon general resigned this week, and more political casualties could follow.

Last year’s presidential election was seen as a warning shot from voters disgruntled with aloof, unresponsive and lethargic politicians. In the first-round vote, far-right candidate Jean-Marie Le Pen upset traditional parties to face Chirac in the runoff. After winning that handily, Chirac appointed Prime Minister Jean-Pierre Raffarin to head a government that has emphasized pragmatism, vigor and efficiency.

In addition to correcting bureaucratic breakdowns, the president’s remarks Thursday addressed a more complex and human dysfunction: He urged the French to reflect on the lack of compassion and solidarity revealed by the killer heat.

“The tragic consequences of the heat wave show -- and each one of us must take stock -- to what extent it is necessary that our society be more responsible for and attentive to others, to their problems, their suffering, their vulnerability,” Chirac said. “Many fragile people died alone in their homes. These dramas have once again shined a light on the solitude of many of our aged or handicapped citizens.”

Although the heat was unusual for France, simple steps and a measure of sensitivity might have mitigated the effect. Few hospitals -- let alone homes or public places -- have air conditioning in France, with concerns about global warming often cited. Many of the victims of heatstroke and dehydration succumbed in suffocating, overcrowded hospitals where nurses and family members fanned them vainly with cardboard and towels.

Bureaucrats did not plan for a heat wave, did not conduct awareness campaigns ahead of time and were slow to realize the dimensions of the disaster, according to Patrick Pelloux, the head of an association of emergency-room doctors.

“We realize that this public health system had not looked ahead, had not really reflected about catastrophic scenarios,” Pelloux said in an interview. “So there was a failure.”

Moreover, the national obsession with taking long summer vacations apparently contributed to the deaths. This is a society that all but shuts down in August.

Not only were key government officials and front-line medical workers missing in action as the mercury shot up, the harsh reality is that many vacationers simply left frail and elderly relatives to fend for themselves in half-deserted neighborhoods.

Some people whose relatives died in cities even postponed funerals in order not to cut short their stays at the beach, news reports quoted mortuary operators as saying.

The French need to revive the networks of family and community that could have saved the elderly from solitary deaths, Pelloux said.

“It has to be a global analysis and an analysis of our society: Why in France finally do families break apart and there is no longer a culture of the elderly and of aid to the infirm?” Pelloux said. “France must rediscover citizenship and solidarity.”

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Times staff writer Rotella reported from Milan, Italy, and special correspondent Urbajtel from Paris.