Blazing hot surfaces are a danger for catastrophic burn injuries in the urban desert Southwest

PHOENIX (AP) — Ron Falk lost his right leg, had extensive skin grafting on the left one and is still recovering a year after collapsing on the searing asphalt outside a Phoenix convenience store where he stopped for a cold soda during a heat wave.

Now using a wheelchair, the 62-year-old lost his job and his home. He’s recovering at a medical respite center for patients with no other place to go; there he gets physical therapy and treatment for a bacterial infection in what remains of his right leg, too swollen to use the prosthesis he’d hoped would help him walk again.

“If you don’t get somewhere to cool down, the heat will affect you,” said Falk, who lost consciousness due to heatstroke. “Then you won’t know what’s happening, like in my case.”

Sizzling sidewalks and unshaded playgrounds pose risks for surface burns as air temperatures reach new summertime highs in Southwest cities like Phoenix, which just recorded its hottest June on record. The average daytime high was 109.5 degrees Fahrenheit (43 Celsius), without a single 24-hour high below 100 (37.7 C).

Young children, older adults and homeless people are especially at risk for contact burns, which can occur in seconds when skin touches a surface of 180 degrees Fahrenheit (82 C).

Since the beginning of June, 50 people have been hospitalized with such burns, and four have died at Valleywise Health Medical Center in Phoenix, which operates the Southwest’s largest burn center, serving patients from Arizona, New Mexico, Utah, Nevada, Southern California and Texas, according to its director, Dr. Kevin Foster. About 80% were injured in metro Phoenix.

Last year, the center admitted 136 patients for surface burns from June through August, up from 85 during the same period in 2022, Foster said. Fourteen died. One out of five was homeless.

“Last year’s record heat wave brought an alarming number of patients with life-threatening burns,” Foster said of a 31-day period, including all of last July, with temperatures at or above 110 degrees (43 C) during Phoenix’s hottest summer ever.

A map released this week by NASA’s Jet Propulsion Laboratory in Southern California makes clear just how hot surfaces like asphalt and concrete get in metro Phoenix. The data for the visualization of land surface temperatures was collected the afternoon of June 19 by a NASA instrument aboard the International Space Station that measures thermal infrared emissions from the Earth’s surface. The yellow, red and purple of hot urban areas on the map contrast with cooler green spaces.

In Las Vegas, which regularly sees summertime highs in the triple digits, 22 people were hospitalized in June alone at the University Medical Center’s Lions Burn Care Center, said spokesperson Scott Kerbs. That's nearly half as many as the 46 hospitalized during all three summer months last year.

As in Phoenix, the desert sun punishes Las Vegas for hours every day, frying outdoor surfaces like asphalt, concrete and metal doors on cars and playground equipment like swings and monkey bars.

Surface burn victims often include children injured walking barefoot on broiling concrete or touching hot surfaces, adults who collapsed on a sidewalk while intoxicated, and older people who fell on the pavement due to heatstroke or another medical emergency.

Some don’t survive.

Thermal injuries were among the main or contributing causes of last year’s 645 heat-related deaths in Maricopa County, which encompasses Phoenix.

One victim was an 82-year-old woman with dementia and heart disease admitted to a suburban Phoenix hospital after being found on the scorching pavement on an August day that hit 106 degrees (41.1 C).

With a body temperature of 105 degrees (40.5 C) the woman was rushed to the hospital with second-degree burns on her back and right side, covering 8% of her body. She died three days later.

Many surface burn patients also suffered potentially fatal heatstroke.

Valleywise hospital’s emergency department recently adopted a new protocol for all heatstroke victims, submerging patients in a bag of slushy ice to quickly bring down body temperature.

Recovery for those with skin burns was often lengthy, with patients undergoing multiple skin grafts and other surgeries, followed by months of recovery in skilled nursing or rehabilitation facilities.

Bob Woolley, 71, suffered second- and third-degree burns to his hands, arms, leg and torso after he stumbled onto the broiling backyard rock garden at his Phoenix home, wearing only swim trunks and a tank top.

“The ordeal was extremely painful; it was almost unbearable,” said Woolley, who was hospitalized at the Valleywise burn center for several months. He said he considers himself “95% recovered” after extensive skin grafts and physical therapy and has resumed some former activities like swimming and motorcycle riding.

Some skin-burn victims, both in Phoenix and Las Vegas, were children.

“In many cases, this involves toddlers walking or crawling onto hot surfaces,” Kerbs said of those hospitalized at the Las Vegas center.

Foster said about 20% of the hospitalized and outpatient skin-burn victims seen at the Phoenix center are children.

Small children aren’t fully aware of the harm a sizzling metal door handle or a scorching sidewalk can cause.

“Because they’re playing, they don’t pay attention,” said urban climatologist Ariane Middel, an assistant professor at Arizona State University who directs the SHaDE Lab, a research team that studies the effects of urban heat.

“They may not even notice that it’s hot.”

In measuring surface temperatures of playground equipment, the team found that in 100-degree Fahrenheit (37.7 C) weather without shade, a slide can heat up to 160 degrees (71.1 C), but a covering can bring that down to 111 degrees (43.8 C). A rubber ground cover can hit as high as 188 degrees (86.6 C), a handrail can heat up to 120 degrees (48.8 C) and concrete can reach 132 degrees (55.5 C).

Many metro Phoenix parks have covered picnic tables and plastic fabric stretched over play equipment, keeping metal or plastic surfaces up to 30 degrees cooler. But plenty do not, Middel said.

She said cooler wood chips are better underfoot than rubber mats, which were designed to protect kids from head injuries but soak up heat in the broiling sun. Like rubber, artificial turf gets hotter than asphalt.

“We need to think about alternative surface types, because most surfaces we use for our infrastructure are heat sponges," Middel said.

Hot concrete and asphalt also pose burn risks for pets.

Veterinarians recommend dogs wear booties to protect their paws during outdoor walks in summer, or keeping them on cooler grassy areas. Owners are also advised to make sure their pets drink plenty of water and don’t get overheated. Phoenix bans dogs from the city’s popular hiking trails on days the National Weather Service issues an excessive heat warning.

Recovering at Phoenix's Circle the City, a respite care facility he was sent to after being released from Valleywise's burn unit, Falk said he never imagined the Phoenix heat could cause him to collapse on the broiling asphalt in his shorts and T-shirt.

Because he wasn't carrying identification or a phone, no one knew where he was for months. He has a long road ahead but still hopes to regain part of his old life, working for a concessionaire for entertainment events.

“I kind of went into a downward spiral,” Falk acknowledged. “I finally woke up and said, ’Hey, wait, I lost a leg.' But that doesn’t mean you’re useless.”

People keep cool under misters outside a homeless shelter, Thursday, May 30, 2024 in Phoenix. Sizzling sidewalks and unshaded playgrounds increasingly are posing risks for surface burns as air temperatures reach new highs during the searing summers in Southwest cities like Phoenix and Las Vegas. Very young children and older adults are especially at risk for contact burns. So are homeless people. (AP Photo/Matt York)

Ron Falk, 62, puts on his prosthetic leg, Tuesday, June 25, 2024 in Phoenix. Falk lost his right leg, had extensive skin grafting on the left one and is still recovering a year after collapsing on the searing asphalt outside a convenience store where he stopped for a cold soda during a blistering heat wave. (AP Photo/Matt York)

Homeless people sit in the shade of a box container while eating food from a soup kitchen, Thursday, May 30, 2024 in Phoenix. Sizzling sidewalks and unshaded playgrounds increasingly are posing risks for surface burns as air temperatures reach new highs during the searing summers in Southwest cities like Phoenix and Las Vegas. Very young children and older adults are especially at risk for contact burns. So are homeless people. (AP Photo/Matt York)

A children's playground is unused in the heat, Tuesday, June 25, 2024 in Phoenix. Sizzling sidewalks and unshaded playgrounds increasingly are posing risks for surface burns as air temperatures reach new highs during the searing summers in Southwest cities like Phoenix and Las Vegas. Very young children and older adults are especially at risk for contact burns. So are homeless people. (AP Photo/Matt York)

A man who said he was homeless tries to keep cool on a children's splash pad, Tuesday, June 25, 2024 in Phoenix. Sizzling sidewalks and unshaded playgrounds increasingly are posing risks for surface burns as air temperatures reach new high during the searing summers in Southwest cities like Phoenix and Las Vegas. Very young children and older adults are especially at risk for contact burns. So are homeless people. (AP Photo/Matt York)

Ron Falk, 62, speaks of losing his leg, Tuesday, June 25, 2024 in Phoenix. Falk lost his right leg, had extensive skin grafting on the left one and is still recovering a year after collapsing on the searing asphalt outside a convenience store where he stopped for a cold soda during a blistering heat wave. (AP Photo/Matt York)

Phoenix firefighters give medical attention to a homeless man, Thursday, May 30, 2024 in Phoenix. Sizzling sidewalks and unshaded playgrounds increasingly are posing risks for surface buns as air temperatures reach new highs during the searing summers in Southwest cities like Phoenix and Las Vegas. Very young children and older adults are especially at risk for contact burns. So are homeless people. (AP Photo/Matt York)

Ron Falk, 62, uses his wheelchair to navigate the corridors of his temporary lodging, Tuesday, June 25, 2024 in Phoenix. Falk lost his right leg, had extensive skin grafting on the left one and is still recovering a year after collapsing on the searing asphalt outside a convenience store where he stopped for a cold soda during a blistering heat wave. (AP Photo/Matt York)

A woman who said she was homeless tries to keep cool on a children's splash pad, Tuesday, June 25, 2024 in Phoenix. Sizzling sidewalks and unshaded playgrounds increasingly are posing risks for surface buns as air temperatures reach new high during the searing summers in Southwest cities like Phoenix and Las Vegas. Very young children and older adults are especially at risk for contact burns. So are homeless people. (AP Photo/Matt York)

Ron Falk, 62, speaks of losing his leg, Tuesday, June 25, 2024 in Phoenix. Falk lost his right leg, had extensive skin grafting on the left one and is still recovering a year after collapsing on the searing asphalt outside a convenience store where he stopped for a cold soda during a blistering heat wave. (AP Photo/Matt York)

GENEVA (AP) — The United Nations and partners say more migrants and refugees in Africa are heading northward toward the Mediterranean and Europe, crossing perilous routes in the Sahara where criminal gangs subject them to enslavement, organ removal, rape, kidnapping for ransom and other abuses.

A report released Friday by the U.N. refugee and migration agencies and the Mixed Migration Centre research group estimated that land routes in Africa are twice as deadly as the sea lanes across the Mediterranean — which is the deadliest maritime route for migrants in the world.

The report said new conflict and instability in countries including Mali, Burkina Faso and Sudan have been behind a rise in the number of journeys toward the Mediterranean. But Nigeria, Ivory Coast and Guinea were the top countries of origin of migrants.

It comes as many politicians in Europe and beyond, in an important election year, have fanned or drawn support from anti-immigrant sentiment. But conflict, economic strife, repression and the impact of climate change in many countries in the developing world has fanned the flow of migrants across borders nonetheless — at the risk of physical abuse and death.

“Refugees and migrants are increasingly traversing areas where insurgent groups, militias and other criminal actors operate, and where human trafficking, kidnapping for ransom, forced labor and sexual exploitation are rife,” according to a summary of the report, which follows up on a similar study four years ago.

The authors admit there are no comprehensive statistics on deaths on the land routes in Africa. But refugee agency UNHCR has cited a more-than-tripling of the number of refugees and asylum-seekers in Tunisia — a key transit country for migrants aiming to get to Europe — between 2020 and 2023.

The report aimed to spotlight the dangers of land routes that lead to the Mediterranean, which was crossed by over 72,000 migrants and refugees in the first half of this year, and where 785 people have died or gone missing over those six months, according to UNHCR figures.

UNHCR special envoy Vincent Cochetel, citing accounts from some migrants and refugees who survived, said some smugglers dump sick people off pickup trucks ferrying them across the desert, or don't go back to retrieve others who fall off.

"Everyone that has crossed the Sahara can tell you of people they know who died in the desert, whereas you interview people in Lampedusa: Not that many people will tell you about people they know who ... died at sea,” he said, alluding to an Italian island in the Mediterranean.

The U.N.'s International Organization for Migration reported earlier this year that more than 3,100 people died on the Mediterranean crossing last year.

The authors of the report, which drew on testimonies from over 31,000 people, said international action has been inadequate and pointed to “huge gaps” in protection and help for people making the perilous journey.

“In total, 1,180 persons are known to have died while crossing the Sahara Desert for the period January 2020 to May 2024, but the number is believed to be much higher,” it said.

The risk of sexual violence, kidnapping and death was reported by higher percentages of migrants questioned for the report compared to the previous one in 2020, and Algeria, Libya and Ethiopia were considered by respondents as the most dangerous.

The teams have tallied hundreds of cases of organ removals — a practice that has happened for years, Cochetel said. Sometimes, migrants agree to such removals as a way to earn money.

“But most of the time, people are drugged and the organ is removed without their consent: They wake up, and a kidney is missing,” he said.

Libya has emerged as a primary transit point for migrants fleeing war and poverty in Africa and the Middle East. In March, authorities discovered a mass grave containing the bodies of at least 65 migrants in the deserts of western Libya.

Follow AP’s global migration coverage at https://apnews.com/hub/migration

Vincent Cochetel, UNHCR special envoy for the Western & Central Mediterranean Situation, speaks about the launch of new UNHCR / IOM /MMC report on risks faced by refugees and migrants on the Central Mediterranean route during a press conference at the European headquarters of the United Nations in Geneva, Switzerland, Thursday, July 4, 2024. (Martial Trezzini/Keystone via AP)

Vincent Cochetel, UNHCR special envoy for the Western & Central Mediterranean Situation, speaks about the launch of new UNHCR / IOM /MMC report on risks faced by refugees and migrants on the Central Mediterranean route during a press conference at the European headquarters of the United Nations in Geneva, Switzerland, Thursday, July 4, 2024. (Martial Trezzini/Keystone via AP)

Vincent Cochetel, UNHCR special envoy for the Western & Central Mediterranean Situation, speaks about the launch of new UNHCR / IOM /MMC report on risks faced by refugees and migrants on the Central Mediterranean route during a press conference at the European headquarters of the United Nations in Geneva, Switzerland, Thursday, July 4, 2024. (Martial Trezzini/Keystone via AP)