The figure was four times greater than estimates in the media in late August that put the number of heat-releated deaths at around 1,000.

Health Minister Girolamo Sirchia warned the new figure was still provisional. Covering the period of July 16 to August 15, it showed 4,175 Italians over 65 years of age died during that month -- a 14 percent rise over the same period last year.

The final toll was expected to surpass the 5,000 mark when figures through August 31 were compiled, warned Donato Greco, head of Italy's National Epidemiological Centre.

"(Old people) don't make demands. They are easily forgotten," the health minister said.

"We must set up an activist health service for seniors that will go into their homes to see how they are living" to prevent any recurrence of the events of this summer.

Sirchia wants the new program in place by next summer and said it would rely heavily on local councils, which have already complained their budgets are stretched.

He said he "never doubted" there was a health emergency in the making, and on August 21 ordered an investigation, already with a view to putting together a series of preventive measures.

At that point, the government in neighboring France, where Europe's heatwave took perhaps the worst toll, was coming under fire for failing to anticipate or respond to a shocking rise in fatalities among the elderly -- allegations French Health Minister Jean-Francois Mattei admitted to Thursday.

The heat wave officially took 11,435 lives in France, but funeral directors there said the final figure would be around 15,000.

Questions are also arising in Spain, where the media has queried the official figure of 107 deaths, suggesting the toll might be up to 6,000.

Sirchia noted the heatwave-related mortality was strongest in the northern cities, including Milan, Turin and Genoa, notably in "industrial zones that had imported workers from the south" in years past.

He said the typical victim suffered from a chronic condition, lived by themselves in small lodgings without air-conditioning and had a low income, noting the minimum pension in Italy is about 500 euros (dollars) a month.

"It wasn't only the heat that killed them. Their friends were gone, children on vacation... Old people don't realize their condition might be worsening, that they are suffering more, that their food has gone bad," he said.

His plan to focus efforts on the local level however is likely to draw more fire from mayors, whom he irritated in August when he said their slim, summertime staffs were neglecting old people in need.

The mayors shot back that Rome kept cutting their budgets, but Sirchia warned Thursday they will just have to "best use the means at hand" as there will be no new funds.

TERRA.WIRE