As climate change increases the frequency and intensity of extreme weather events, understanding how health systems respond to sudden infrastructure shocks is becoming a policy priority. This paper studies the 2017 Coastal El Niño — an exceptionally rapid and largely unanticipated flooding event that damaged nearly 1,000 health facilities across northern Peru — to identify the causal effects of flood-driven care disruption on maternal and neonatal outcomes.
Using nationwide birth registry data and hospital discharge records, and exploiting cross-district variation in flood exposure in an event-study and difference-in-differences framework, we document two distinct channels through which the shock propagated. In the short run, flood exposure raised the probability of preterm birth and triggered a surge in maternal infection and pregnancy-loss hospitalisations. In the medium run, it induced a sustained reallocation of deliveries away from damaged primary-care facilities and toward higher-level hospitals — a structural shift that was strongest in districts most reliant on primary care before the disaster.
These findings point to frontline obstetric infrastructure as a critical vulnerability in climate-exposed health systems, and suggest that resilience investments targeting primary facilities may yield larger equity gains than hospital-centred emergency responses.
This is a joint work with Igna Bonfrer, Tom Van Ourti (Erasmus University Rotterdam)
