Carbon footprint trends and cost-emission dynamics of a Saudi tertiary hospital

Abstract

Introduction: Hospitals are both highly vulnerable to climate change and significant contributors to greenhouse gas (GHG) emissions. In hot-arid regions such as Saudi Arabia, conventional annual carbon footprint assessments often obscure seasonal demand patterns and operational inefficiencies critical for effective mitigation planning. Aim: This study examined carbon footprint trends and cost-emission dynamics within a large tertiary healthcare facility to generate operationally relevant insights for hospital sustainability in extreme climatic conditions. Methods: A hybrid activity-based and spend-based carbon footprint assessment was conducted at Sultan Bin Abdulaziz Humanitarian City (SBAHC), a 511-bed rehabilitation hospital. Monthly emissions were quantified across Scope 1, Scope 2, and selected Scope 3 categories to enable temporal analysis. Cost-emission efficiency metrics were applied to integrate financial expenditure with environmental impact, supporting prioritization of decarbonization interventions. Results: SBAHC’s total 2023 carbon footprint was 41.76 kt CO₂e, corresponding to an emission intensity of 262.9 kg CO₂e/m²/year. Scope 2 emissions from grid electricity constituted the largest share (49.13%, 20.52 kt CO₂e), closely followed by Scope 3 emissions (48.55%, 20.28 kt CO₂e), indicating near parity between operational energy use and supply-chain impacts. Electricity emissions exhibited pronounced summer peaks associated with cooling demand, highlighting the influence of climatic stress on hospital energy systems. Cost-emission analysis identified grid electricity and refrigerants as priority leverage points for emissions reduction, diverging from supply-chain-dominated patterns reported in temperate-region hospitals. Conclusion: By combining temporal disaggregation with cost-emission efficiency metrics, this study extends conventional hospital carbon accounting and provides a decision-support framework for climate-responsive healthcare sustainability in hot-arid settings.