On the morning of January 7, 2025, the peaceful Pacific Palisades neighborhood of Los Angeles was engulfed in a catastrophic wildfire that would soon be classified as one of the most destructive urban fires in California’s history.
Within hours, the Palisades Fire consumed more than 23,000 acres, destroyed nearly 7,000 structures, and claimed 12 lives. Among the survivors was Dr. Ashraf Elsayegh, a respected pulmonologist affiliated with Saint John’s Medical Center and Cedars-Sinai Medical Center. But he didn’t just survive — he became one of the central figures in the medical response that followed.
That morning, Elsayegh had broken routine. Instead of heading out early for his hospital rounds, he was at home with his wife and 12-year-old son. When his son noticed the smell of smoke, they looked out the window and saw thick black plumes rising just two houses away. Without time to gather belongings, he rushed his family into their car to escape. As they tried to flee, fire raged on both sides of the road, and smoke thickened the air.
Spotting his medical scrubs, desperate neighbors ran toward him asking for help — how to escape, how the smoke might affect their asthma or cardiac conditions. Elsayegh instinctively handed out his personal number, offering what guidance he could.
They were eventually evacuated after firefighters bulldozed an emergency exit route. But when the flames subsided, Elsayegh returned to find his home, along with virtually the entire neighborhood, reduced to ashes. The loss was total — belongings, memories, a sense of stability — all gone.
Yet for Elsayegh, the next chapter began almost immediately. Within 24 hours, his phone was inundated with texts and calls from fellow fire victims seeking help for smoke inhalation, worsening respiratory conditions, and sheer emotional distress.
The sheer scale of the health fallout quickly became overwhelming. Drawing on his past experience during his residency in New York — where he had worked at a clinic formed in the aftermath of the 9/11 attacks — he proposed setting up a fire relief clinic. To their credit, Saint John’s Medical Center approved the plan without hesitation. Within 10 days, the clinic was operational.
Elsayegh continued his regular duties as a full-time pulmonary physician while simultaneously treating hundreds of fire victims. He also helped coordinate community recovery efforts, oversaw the slow and bureaucratic rebuilding of his own home, and managed the complex psychological needs of both patients and his own family. This convergence of personal tragedy and professional responsibility transformed his understanding of what it means to be a doctor in the era of climate crisis.
What he experienced underscored a truth that many health care professionals are only beginning to grasp: climate change is no longer a distant threat — it is an urgent, daily reality with direct and profound implications for human health.
Inhaling wildfire smoke is not a theoretical concern; it's an immediate trigger for respiratory distress, especially for children, the elderly, and those with pre-existing conditions. But the damage is not limited to the lungs. The stress of evacuation, loss, and displacement creates cascading psychological impacts — depression, anxiety, PTSD — that require just as much attention as any physical ailment.
Elsayegh noted that it was only after living through the disaster himself that he truly grasped the limits of traditional clinical advice. Advising patients to simply move away from high-risk areas or avoid smoke exposure seems logical on paper — but the reality is far more complicated.
Most people cannot simply abandon their lives, careers, or communities. Being both physician and victim gave him an acute sense of empathy and a deeper understanding of the complexity behind these seemingly simple medical recommendations.
Across the globe, similar events are occurring with alarming frequency. In 2019, Australia's bushfires exposed millions to hazardous smoke and contributed to hundreds of premature deaths. Germany’s 2021 floods, the 2022 water crisis in Mississippi, and recurrent heatwaves across Europe have placed enormous stress on health systems.
According to the World Health Organization, climate-related health threats may cause an estimated 250,000 additional deaths annually between 2030 and 2050, driven by malnutrition, heat stress, and vector-borne diseases. The medical profession is on the front lines — yet remains, in many cases, unprepared.
For Elsayegh, the implications for medical education are clear: training must evolve. During his time in medical school, HIV was the global health emergency that revolutionized clinical practice — from new infectious disease protocols to universal precautions like glove use.
Similarly, he believes climate change and its cascading effects represent the defining health crisis of this generation. Medical curricula must be adapted to incorporate environmental health, disaster response, and the complex interplay between physical illness and psychological trauma in the wake of climate-related disasters.
One of the most critical messages he emphasizes is that this is not an issue confined to specialists like pulmonologists. While smoke exposure may predominantly affect the lungs, every physician, nurse, and medical administrator must understand the holistic nature of post-disaster care. Healing from a disaster involves more than treating acute symptoms.
Patients arrive at clinics having lost everything — homes, livelihoods, sometimes loved ones. Effective care must address their mental, emotional, and psychological needs just as urgently as their physical ones.
This kind of holistic, trauma-informed care is something the current health care infrastructure struggles to deliver, especially when physicians themselves are reeling from the same disasters. As the COVID-19 pandemic already revealed, physician burnout and psychological distress are real and pervasive issues. Add in the pressures of climate catastrophe, and the profession faces a new frontier of stress, trauma, and moral injury.
For Elsayegh, this wasn’t theoretical. After the fire, he found himself running on adrenaline. He pushed through exhaustion to help others while tending to his children’s fear and confusion, mourning the loss of his own home, and coordinating with contractors and city agencies to rebuild — all while maintaining his clinical responsibilities.
At times, he admitted, it felt like too much. But there was no option to retreat. The community needed him — and, as he says, “Even though everything is better now, we’re still just starting the cleanup. And the cleanup has its own kind of weight.”
Now living in a rental home, with reconstruction expected to take years, Elsayegh balances roles as clinician, parent, advocate, and survivor. His personal trauma has not derailed his commitment to medicine; rather, it has deepened it. He hopes that by sharing his story, the medical community will recognize what lies ahead. Wildfires, floods, heatwaves, and storms are not aberrations — they are the new normal.
Physicians of the future will need to be more than experts in anatomy and pharmacology. They will need to understand systems, psychology, public health, and climate science. They will be first responders, counselors, and coordinators of community resilience. Medical institutions, in turn, must prepare to support them — academically, structurally, and emotionally.
Ashraf Elsayegh’s journey is a microcosm of a profession under transformation. His experience — deeply personal, undeniably professional, and increasingly common — is a warning and a call to action. As climate change accelerates, the role of the physician must evolve. Not just to save lives, but to help communities endure and heal.