Operational decarbonization of a tertiary hospital in Egypt using a sequenced pathway: efficiency-first interventions followed by solar thermal diesel displacement

Operational decarbonization of a tertiary hospital in Egypt using a sequenced pathway: efficiency-first interventions followed by solar thermal diesel displacement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Operational decarbonization of a tertiary hospital in Egypt using a sequenced pathway: efficiency-first interventions followed by solar thermal diesel displacement Ekram Abdelmaged Abdelhafez, Mohamed Mostafa, Mahmoud Essam Abdelfattah, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8925571/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Hospitals in hot-arid, lower-middle-income settings face rising cooling demand while needing to cut emissions. We evaluated a phased decarbonization pathway at Aswan Heart Centre (AHC), Egypt, combining demand-side efficiency with renewable thermal energy. Methods We used a longitudinal quasi-experimental design across 46 months (Jan 2022–Sep 2025), split into three phases: baseline (2022), green interventions (Jan 2023–Aug 2024), and solar thermal integration (Sep 2024–Sep 2025). Monthly electricity (kWh) and diesel (L) data were compiled from hospital operations. Emissions were calculated using the GHG Protocol Corporate Standard for Scope 1 (diesel) and Scope 2 (grid electricity). Cooling Degree Days (base 24°C) were used to account for thermal stress. Results Despite institutional expansion, electricity use increased only + 2.96% (2022–2024), suggesting stabilized electricity intensity under rising cooling demand. Scope 1 emissions fell from 1367.65 tCO₂e (2022) to 885.54 tCO₂e (2024) (− 35.25%), contributing to an overall ~ 29.9% reduction in total operational emissions (Scopes 1 + 2). After solar thermal commissioning, diesel use declined by ~ 20.8% (40,365 L to 31,949 L across matched 12-month periods), with ~ 219,000 L of thermal output in the first year. Post-intervention changes were statistically significant for electricity consumption (p = 0.037) and Scope 2 emissions (p = 0.043). Cooling Degree Days strongly correlated with electricity use (r = 0.72, p < 0.01). Conclusion A sequenced strategy that prioritizes efficiency measures first, followed by replacing fossil-based thermal demand, can help hospitals decouple service growth from emissions in hot-arid climates while maintaining operational reliability. Hospital decarbonization Decoupling Energy efficiency Solar thermal heating Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 23 Apr, 2026 Reviewers invited by journal 04 Mar, 2026 Editor assigned by journal 26 Feb, 2026 Submission checks completed at journal 25 Feb, 2026 First submitted to journal 25 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8925571","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602444317,"identity":"ce1c6289-1de5-4a14-8515-d6ccc9bb48b2","order_by":0,"name":"Ekram Abdelmaged 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Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hospital decarbonization, Decoupling, Energy efficiency, Solar thermal heating","lastPublishedDoi":"10.21203/rs.3.rs-8925571/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8925571/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHospitals in hot-arid, lower-middle-income settings face rising cooling demand while needing to cut emissions. We evaluated a phased decarbonization pathway at Aswan Heart Centre (AHC), Egypt, combining demand-side efficiency with renewable thermal energy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe used a longitudinal quasi-experimental design across 46 months (Jan 2022\u0026ndash;Sep 2025), split into three phases: baseline (2022), green interventions (Jan 2023\u0026ndash;Aug 2024), and solar thermal integration (Sep 2024\u0026ndash;Sep 2025). Monthly electricity (kWh) and diesel (L) data were compiled from hospital operations. Emissions were calculated using the GHG Protocol Corporate Standard for Scope 1 (diesel) and Scope 2 (grid electricity). Cooling Degree Days (base 24\u0026deg;C) were used to account for thermal stress.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDespite institutional expansion, electricity use increased only\u0026thinsp;+\u0026thinsp;2.96% (2022\u0026ndash;2024), suggesting stabilized electricity intensity under rising cooling demand. Scope 1 emissions fell from 1367.65 tCO₂e (2022) to 885.54 tCO₂e (2024) (\u0026minus;\u0026thinsp;35.25%), contributing to an overall\u0026thinsp;~\u0026thinsp;29.9% reduction in total operational emissions (Scopes 1\u0026thinsp;+\u0026thinsp;2). After solar thermal commissioning, diesel use declined by ~\u0026thinsp;20.8% (40,365 L to 31,949 L across matched 12-month periods), with ~\u0026thinsp;219,000 L of thermal output in the first year. Post-intervention changes were statistically significant for electricity consumption (p\u0026thinsp;=\u0026thinsp;0.037) and Scope 2 emissions (p\u0026thinsp;=\u0026thinsp;0.043). Cooling Degree Days strongly correlated with electricity use (r\u0026thinsp;=\u0026thinsp;0.72, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eA sequenced strategy that prioritizes efficiency measures first, followed by replacing fossil-based thermal demand, can help hospitals decouple service growth from emissions in hot-arid climates while maintaining operational reliability.\u003c/p\u003e","manuscriptTitle":"Operational decarbonization of a tertiary hospital in Egypt using a sequenced pathway: efficiency-first interventions followed by solar thermal diesel displacement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-09 15:53:09","doi":"10.21203/rs.3.rs-8925571/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"276597596020252839648156668330715390905","date":"2026-04-23T14:40:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-04T11:49:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-26T09:27:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-26T03:13:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bulletin of the National Research Centre","date":"2026-02-25T21:06:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bulletin-of-the-national-research-centre","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnrc","sideBox":"Learn more about [Bulletin of the National Research Centre](https://BNRC.springeropen.com)","snPcode":"42269","submissionUrl":"https://submission.springernature.com/new-submission/42269/3","title":"Bulletin of the National Research Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7631fd8f-ce0c-476d-b3da-5422e542f507","owner":[],"postedDate":"March 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T15:53:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-09 15:53:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8925571","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8925571","identity":"rs-8925571","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}