The 2023 floods in the Emilia-Romagna Region, Italy: A retrospective qualitative investigation into response strategies and criticalities

In May 2023, the Emilia-Romagna Region experienced two unprecedented rainfall episodes, leading to severe flooding and landslides especially in its southernmost part, the Romagna area. This study aimed to assess the health response to the May 2023 floods in this area, by identifying the main actions undertaken in response to the floods and by highlighting criticalities and lessons learned. To achieve this objective, a retrospective qualitative case study design was chosen, and semi-structured interviews were carried out to gather in-depth information on the experiences and perspectives of 25 key informants (authorities and public administration, health management, public health, primary care, social services, hospital and emergency care system, communication, and third sector) involved in the response. The findings highlight the strain on the local health system, including service and infrastructure disruptions. The response strategies have been analysed and clustered in phases (alert and activation, coordination, communication, identification of vulnerable individuals, evacuations management, surge capacity, health service delivery, logistics, and the role of volunteers), offering a comprehensive overview of local disaster response strategies. Recommendations include enhancing interoperability of health information systems for disaster management, improving the coordination of evacuations for at-risk populations, and strengthening spontaneous volunteers’ management. This study highlights the importance of collaborations between local health authorities and academia for ongoing evaluations to enhance disaster response and resilience. • Floods affected health staff, service delivery, and infrastructure and equipment. • Difficulties were experienced in mapping resources and fragile people for evacuation. • Fragmented databases and platforms hampered information sharing across agencies. • Coordinating the influx of spontaneous volunteers in affected areas was complex. • Collaboration across professionals was a key strength in the response.