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.