Article Text

Original research
Extreme heat and work injuries in Kuwait’s hot summers
  1. Barrak Alahmad1,2,3,
  2. Ali Al-Hemoud4,
  3. Mohammed Al-Bouwarthan5,
  4. Haitham Khraishah6,
  5. Mohamed Kamel7,
  6. Qassem Akrouf7,
  7. David H Wegman1,8,9,
  8. Aaron S Bernstein10,11,
  9. Petros Koutrakis1
  1. 1 Environmental Health Department, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
  2. 2 Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Kuwait City, Kuwait
  3. 3 Dasman Diabetes Institute, Kuwait City, Kuwait
  4. 4 Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Safat, Kuwait
  5. 5 Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  6. 6 Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  7. 7 Occupational Health Administration, Ministry of Health, Kuwait City, Kuwait
  8. 8 Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
  9. 9 La Isla Network, District of Columbia, Washington, DC, USA
  10. 10 Center for Climate, Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  11. 11 Department of Pediatrics, Harvard University, Cambridge, Massachusetts, USA
  1. Correspondence to Dr Barrak Alahmad, Environmental Health Department, Harvard University, Cambridge, Massachusetts, USA; BALAHMAD{at}HSPH.HARVARD.EDU


Background Hot, desert Gulf countries are host to millions of migrant workers doing outdoor jobs such as construction and hospitality. The Gulf countries apply a summertime ban on midday work to protect workers from extreme heat, although without clear evidence of effectiveness. We assessed the risk of occupational injuries associated with extreme hot temperatures during the summertime ban on midday work in Kuwait.

Methods We collected daily occupational injuries in the summer months that are reported to the Ministry of Health’s Occupational Health Department for 5 years from 2015 to 2019. We fitted generalised additive models with a quasi-Poisson distribution in a time series design. A 7-day moving average of daily temperature was modelled with penalised splines adjusted for relative humidity, time trend and day of the week.

Results During the summertime ban, the daily average temperature was 39.4°C (±1.8°C). There were 7.2, 7.6 and 9.4 reported injuries per day in the summer months of June, July and August, respectively. Compared with the 10th percentile of summer temperatures in Kuwait (37.0°C), the average day with a temperature of 39.4°C increased the relative risk of injury to 1.44 (95% CI 1.34 to 1.53). Similarly, temperatures of 40°C and 41°C were associated with relative risks of 1.48 (95% CI 1.39 to 1.59) and 1.44 (95% CI 1.27 to 1.63), respectively. At the 90th percentile (42°C), the risks levelled off (relative risk 1.21; 95% CI 0.93 to 1.57).

Conclusion We found substantial increases in the risk of occupational injury from extremely hot temperatures despite the ban on midday work policy in Kuwait. ‘Calendar-based’ regulations may be inadequate to provide occupational heat protections, especially for migrant workers.

  • Climate
  • Public health
  • Environment
  • Transients and Migrants

Data availability statement

Data are available from the corresponding author on reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available from the corresponding author on reasonable request.

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  • Contributors BA drafted the original manuscript and did the statistical analysis. BA, AA-H, MK and QA did the datacollection and curation. BA, ASB, DHW and PK conceptualised and supervised the analysis. All authors reviewed and edited the manuscript. BA, as guarantor, accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding US Environmental Protection Agency (EPA) grant RD-835872.

  • Disclaimer The contents are solely the responsibility of the grantee and do not necessarily represent the official views of the EPA. Further, EPA do not endorse the purchase of any commercial products or services mentioned in the publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.