The section discussing drought will present the confusion that exists in information reported by meteorologists, newspapers, local agencies, and farmers. Both low-temperature and drought conditions significantly impacted farmers during the fieldwork campaign, and a better understanding of their impacts should help in assessing vulnerability to such events. Heat can take an enormous toll on human life, and most people are acutely conscious of its impacts, especially when in recent years the world has experienced heatwaves that have cost many human lives . However, many people are surprised to find that deaths attributed to cold temperatures are higher in number than those caused by heatwaves. Berko et al. performed a study of weather-related deaths that occurred in the United States from 2006 to 2010 and found that 91% of them were temperature-related. The study revealed that high temperatures caused 31% of the deaths, while low temperatures caused 63%. Furthermore, a study by Gasparrini et al. examined 74 million deaths in 13 countries—including high income countries such as Australia, Canada, Japan, South Korea, and the United Kingdom—and found that between 1985 and 2012, a total of 7.3% deaths were attributed to cold temperatures while 0.4% were related to heat. However, the relationship between deaths and temperature extremes is more complicated. Some studies have found a smaller difference between the number of deaths caused by cold temperatures versus hot temperatures . The recent focus on heatwaves is a valid approach to temperature-related impacts; however, stakeholders and public authorities should not underestimate cold-related impacts. Populations with high levels of social vulnerability possess fewer tools to protect themselves from cold temperatures, especially in high mountainous regions. In the Andes, any region more than 3,200 meters above sea level experiences frosts and low temperature conditions. A frost occurs when the ambient temperature is equal to or less than zero degrees Celsius. In the department of Puno,rolling grow table the daily temperature can fluctuate 30⁰C from day to night. Therefore, its population often experiences freezing temperatures at night, with a dangerously high level of ultraviolet rays during the day.

The coldest temperatures in Puno occur during the austral winter, with differing intensity throughout the region. Figure 6 presents the minimum temperature typically experienced in Puno, which varies across the region. The areas reporting emergencies due to cold temperatures—not related to frosts—do not possess a spatial association with areas with similar minimum temperatures. Figure 7 presents the emergencies reported in Puno 2009–2017 due to decreases in temperature that were unrelated to frost events . This incompatibility might be an indication of a missing component when evaluating impacts and, as expected, a complexity in linking the actual hazard with its impacts. On the other hand, every municipality reported emergencies due to frost events during the same time. The months of May to September are known as frost season in Puno, with the highest occurrence of these events in June and July. Nevertheless, some areas might experience permanent frost conditions in the austral seasons of fall, winter, or spring. Figure 8 shows the number of days in a year an area might experience frost. Areas located beyond the end of the Altiplano experience five to ten days of frost conditions in a year. However, areas in the center of the west department’s boundaries and at the south border with Bolivia experience more than 180 days of frost conditions a year. The situation in Puno can be dire since the region has no heating systems, poor electricity coverage, and high poverty levels. Deaths and respiratory problems due to cold temperatures are of great concern. Every year, Puno suffers from adverse effects and damage caused by cold weather. From January 2003 until August 2016, Puno reported a total of 1,943,002 impacts related to a hazard. Figure 9 presents the number of registered impacts by hazard, and 63% of them are related to frost. The second highest number of report accounts for only 8% of total reports. However, are these impacts solely related to low temperatures, or does social vulnerability play a crucial role?Emergencies reported outside frost season happened in various municipalities during the 2015–2016 austral summer .

The region was experiencing months of below average precipitation, and a couple days with frost condition led to emergency alerts for many communities. I observed farmers burst into tears when expressing the recent impacts. They commented how unexpected the frost conditions were and how in combination with the drought now they lost the crops and livestock to feed their families. During this out of-season frost, there were complaints mainly due to crops, notwithstanding both droughts and frost weather events. This combination was difficult to observed since the emergency reports were for one event and only by reading the document, I would see the combination of both hazards. However, during the rest of the year, reported emergencies led to numerous deaths . Figure 11 presents the location of the emergencies experienced during 2016 austral winter. The return of frost and its consequences is something that locals experience every year in Puno. According to the farmers and administrative personnel from the Ministry of Agriculture, animals that are thin or young do not survive this cold temperature. Furthermore, pregnant animals abort during the frost season, affecting the income and food supply for the local population. In the middle of the 2016 frost season, the regional government reported 61,000 animals died due to cold temperatures, and many other required medical interventions. However, animals are not the only ones suffering or dying from complications related to low-temperatures. At the start of the frost season, I was informed that two kids died due to health complications related to cold temperatures. By the middle of the frost season, Puno’s regional goverment reported 47 deaths related to low temperatures, and 12 of those deaths were children. By then, humanitarian aid from numerous sources started to pour into the region, a yearly occurrence in the Peruvian Andes. This aid included food, blankets, and jackets delivered to affected areas. As the season progressed, the number of deaths, pneumonia cases, and complications kept rising. Toward the end of the frost season, the government declared 72 municipalities in Puno as emergency zones. Regardless of the impacts, farmers indicated that that season was not the coldest they experienced; such conditions are a battle re-experienced every year.

Every night, farmers and their families try to survive the cold temperatures; indoor temperatures are hardly warmer than outdoor. Nights are long, especially for mothers who indicate a constant fear of losing their kids. During the harshest days of winter, I observed many kids coughing, and living conditions that did not aid in health recovery. Even with the high UV rays in the morning,indoor plant table the interior of the house occasionally remains colder than the outside. I also experienced such difference in temperature which force me to relocate residence for a house that received more direct sunlight. I observed how many houses have no beds, forcing families to place blankets on the cold floor and sleep on top of them. As indoor temperatures reach -17⁰C, people sleep with six alpaca blankets and up to seven thick jackets to protect themselves from the cold while they sleep. Some individuals’ clothes have holes, or the layers used to keep warm are the entirety of their closet. Indoor thermal comfort is rarely present in the region regardless of economic status. Thermal comfort is a subjective concept, defined as “that condition of mind which expresses satisfaction with the thermal environment and is assessed by subjective evaluation” . However, Puno’s residents apply a simpler interpretation of the term. People want an optimal indoor temperature for a healthy life. Thermal comfort prevents contracting diseases within the home, and in case of illness, promotes a healthy space for recovery. Moreover, it allows people to carry out daily activities without the interference caused by excessive cold. For many residents outside the Andes, indoor heating is not considered to be a necessity; they underestimate the constraints imposed by such a lack. Puno possesses various limitations that hinder the viability of indoor heating: inadequate infrastructure to support indoor heating, lack of an industry to manufacture and assemble the heating systems; and, among the most vulnerable, inability to pay the costs of energy services. Electrical heaters are available, but the energy cost of using them is extremely high. This cost depends on the plan for electricity that a family possesses—given that they can afford electricity or that it is available—which varies by peak hours and the voltage of the cables near the residence, among other variables. Therefore, many families rely on using their kitchens to heat themselves, which brings health problems.The typical kitchen in rural Puno generates combustion gases that are harmful to health, especially to the respiratory system and eyesight . Firewood is not accessible in the region, and many use manures, which is worst for health. Vulnerability studies sometimes overlook this, but in Puno, the use of an improved kitchen has substantial health benefits. This benefit is in part the result of not inhaling smoke. Farmers that recently obtained an improved kitchen commented to me about the surprising improvements in their daily energy and health.

Many commented not realizing that such difference was possible or that the type of kitchen made a big difference. The use of the kitchen for warming the house results from a lack of indoor thermal heating. Therefore, developing and encouraging a local heating industry adapted to this region is imperative, although outside the scope of this study. However, adequate infrastructure is an aspect of indoor thermal comfort that could be address by local stakeholders or the individual himself. In a region where temperatures can change from 20⁰C to -10⁰C in just 12 hours, infrastructure is crucial in reducing people’s vulnerability. In most cases, Puno’s houses do not possess the minimum infrastructure to prevent the passage of cold air to the inside. I observed about the high number of houses that possess deficient sealing in their doors, windows, and roof. Combining these poor housing characteristics with farmers that do not possess enough resources to buy proper clothing, blankets, beds, and nutritious foods aggravates the problem. Humanitarian aid consisting of food and blankets continually arrives in the region from various groups . Humanitarian aid is of great help; however, the problem of a lack of indoor thermal comfort will likely continue. Even though most of Puno struggles with indoor thermal comfort, several projects and campaigns are searching to improve such comfort. The efforts started in 2007, but the problem persists. This study concentrates on changes happening in Puno; however, most of the efforts come from the national authorities. How this affects Puno? Why is indoor thermal comfort still a big problem causing deaths every year? Why with ten years of performing investigations and providing warmer houses the problem is still at alarming levels? What is the role of social vulnerability in these results? During the fieldwork campaign, the data collected pointed to various projects related to warmer houses and one related to education facilities in the region. One of those projects is K’ONICHUYAWASI Casa Caliente Limpia proposed by the Pontifical Catholic University of Peru’s Support Group for the Rural Sector and implemented by Kusimayo . The name means Warm and Clean House in two languages: K’ONICHUYAWASI in Quechua and Casa Caliente Limpia in Spanish. The group started the project in 2008 and had modified over 100 houses and plans to modify 30 houses per year. In 2016, the project won the Inter-American Biennial Design award from the Madrid Design Foundation. This foundation collects money from donations and an annual activity in Lima. K’ONICHUYAWASI improves rural houses by implementing a hot wall, an insulation system, and an improved kitchen. The hot wall is a structure of polycarbonate and wood located outside of the house. This wall increases the indoor temperature up to ten degrees Celsius using the heat of the sun. The insulation system, placed on the ceiling in order to conserve the heat generated by the hot wall, is a burlap type mesh covered with a layer of glue and plaster.