BENI MELLAL, Morocco (AP) — In the unrelenting heat of Morocco’s Middle Atlas, people were sleeping on rooftops. Hanna Ouhbour needed refuge too, but she was outside a hospital waiting for her diabetic cousin who was in a room without air conditioning.

On Wednesday, there were 21 heat-related deaths at Beni Mellal’s main hospital as temperatures spiked to 48.3 degrees (118.9 degrees Fahrenheit) in the region of 575,000 people, most lacking air conditioning.

“We don’t have money and we don’t have a choice,” said Ouhbour, a 31-year-old unemployed woman from Kasba Tadla, an even warmer city that some experts say is among the hottest on Earth.

“The majority of the deaths were among people suffering from chronic diseases and the elderly, as the high temperatures contributed to the deterioration of their health condition and led to their death,” Kamal Elyansli, the regional director of health, said in a statement.

This is life and death in the heat.