France experienced a record-breaking heat wave between 2 and 15 August 2003. All the French regions were affected by this heat wave, which resulted in an excess of 14 800 deaths between 1 and 20 August. The increase in the number of excess deaths followed the same pattern as the increase in temperatures. No deviance from the normal death rate was observed in the month of August during the last third of the month, nor during the following three months. There was a clear discrepancy in the impact of the heat wave from city to city. If the effect of duration of consecutive days with high minimal temperatures and deviance with the seasonal normal temperature was patent, this could not explain all of the observed variability of the death incidence. The victims were mainly elderly women older than 75 years. In terms of relative risk and contribution to the global toll, deaths linked to heat were the most important. Based on these results, the French government developed a Heat Health Watch Warning System and set up a preventive action plan for each region in 2004.