ESRS E3 Water resources [E3] Water resources

Our impacts, risks, and opportunities [E3 SBM-3] Material impacts, risks, and opportunities and their interaction with strategy and business model

Water consumption has been increasing worldwide for decades and water is becoming scarce in more and more regions. We also need this resource in our production facilities and healthcare facilities and therefore want to use it consciously and efficiently. There is an increased demand for water in our production in particular, e.g. due to water-intensive cooling or sterilization processes. In the long-term, we could thereby contribute to shortage of water in some regions. The operation of our healthcare facilities as well is highly dependent on the availability of drinking water from the municipal water supply.

Our approach [E3-1] Policies related to water resources

Environmental Policy

Our Group-wide Environmental Policy also addresses the issue of water. In this policy, we commit to the responsible use of water and to compliance with the legally applicable regulations for wastewater, e.g. with regard to wastewater limits. In areas with high water stress, we also aim to reduce the water withdrawal of key production facilities. Water stress refers to a situation in which the demand for water exceeds the available quantity or the water quality is so poor that it restricts its use. This often occurs in regions with high or extremely high water abstraction.

Further information on the Environmental Policy can be found in the topical standard E1 Climate change, section E1-2 Our approach.

Other concepts related to water resources

We use local management systems, process owners, and operating procedures to ensure in our own operations that the respective local guidelines on water and wastewater are strictly adhered to. Water management measures consider a reduction in water and wastewater volumes and monitor the quality and authorized withdrawal of water and discharge of wastewater.

Fresenius continuously reviews national and international regulations on water management. The internal principles, guidelines, and operating procedures – which contain instructions for the responsible handling of water, including the control of wastewater – are adapted to the applicable regulatory requirements. Our water management is closely linked to our hygiene management. Depending on the business segment, either environmental or hygiene experts ensure that internal guidelines and external regulations are adhered to.

Water usage and withdrawal

In production, water is used for most sterilization and cooling processes, as a component in the production of medical products, and for hygiene procedures. The water used for our products, e.g. for infusion solutions such as sodium chloride, must meet stringent quality requirements to ensure product quality and patient safety.

For our healthcare facilities, a sufficient supply of fresh water is central to the delivery of healthcare services, patient well-being, and hygiene.

Most of the water withdrawal in production and at the healthcare facilities is from municipal water supplies.

Beyond the quality and hygiene requirements, we do not address any water-related goals in the design of products and services, as water is indispensable wherever we use it as a component. Information on our water reduction target can be found in this topical standard, section E3-3 Our goals and ambitions.

Water quality

We have implemented applicable risk management procedures in all facilities that come into action if impurities are detected or if the quality of water is not compliant with standards set – and established dedicated reporting lines. The local government is informed immediately in accordance with legal requirements of any critical deviations from local drinking water provisions that are detected. In Germany, some of our clinic laboratories are accredited as testing centers for local drinking water quality. In this way, we support not only the safety of our patients, but also that of the surrounding population and the municipalities that supply us with drinking water.

In the case of contaminated fresh water from the public network, many of our German clinics have the option of taking additional protective measures in addition to its own treatment facilities.

In our Spanish clinics, we do not perform water treatment. However, we produce osmosis water, which is required for dialysis treatments, to operate washing machines in sterilization units, and for the biochemical analyzers in the clinical laboratory. We treat water for the production of certain pharmaceutical products. For example, water for infusion solutions must be of a quality that exceeds that of drinking water (water for injection (WFI)).

All hospitals have emergency plans in place to ensure the healthcare of patients in the event of supply bottlenecks. In most of our Spanish clinics, we use water tanks to ensure supply in the event of a drinking water failure. These tanks are extended pipes in which, during flow, water reserves remain that can be used in an emergency. Depending on the center and consumption, the autonomy of the systems and thus the amount of water reserves varies. In JCI-certified centers (Joint Commission International accreditation), the emergency plans also include the delivery of water in tankers in case of need.

For further information about water pollution, please refer to the topical standard E2 Pollution.

Identification and management of water risks

To address our potential negative impacts related to the water needs of our production sites and hospitals, we analyze water availability using the World Resources Institute’s Aqueduct Water Risk Atlas, which contains information on current and future water risks globally. We have identified sites that are in areas with extremely high or high risk of water scarcity. At these sites, efficient water management is especially important to ensure water availability for production and our hospitals and to prevent negative impact on the local water situation as far as possible. In our Environmental Policy, we set the goal to reduce process water withdrawal in production in water stressed areas. For more information, please refer in this topical standard to the section E3-1 Our approach and to the section E3-3 Our goals and ambitions.

Our manufacturing plants and hospitals are also part of the Group-wide climate risk assessment, which includes water risks such as floods, or heavy rain. If a risk is identified, measures are derived.

We do not include the upstream and downstream value chain in the assessment of water risks.

Our actions [E3-2] Actions and resources related to water resources

The use of fresh water in our healthcare facilities is essential to meet hygiene requirements and is therefore indispensable for patient safety. Therefore, we do not implement measures in this context that address our potential negative impacts related to our increased water demand and the associated local withdrawal. Due to internal requirements regarding drinking water quality, we do not reuse water or use gray water – i.e. treated water from showers or washbasins.

We will implement and report on measures, including required resources, to achieve our new target for water reduction at production sites in areas with high water stress from the 2025 reporting year. Further information on the target can be found in the next section, Our goals and ambitions.

Our goals and ambitions [E3-3] Targets related to water resources

Our ambition is to ensure that water is used safely in every area of our business operations, that it does not pose a risk to the health of patients and employees, and is always available in sufficient quantities at all times. As stated in our Environmental Policy, we are committed to using water responsibly and complying with the applicable legal regulations. In addition, we want to reduce the water withdrawal of our production facilities in areas with high water stress. To achieve this, we have set ourselves the voluntary goal of reducing the process water withdrawal of production facilities in areas of high water stress by 20% in absolute terms by 2030 (baseline year: 2023; baseline value: 3,313,000 m³). The improvement of water quality is not addressed.

To define our target, we first evaluated our own water consumption and sources of consumption and analyzed future scenarios (for 2030 and 2050, each optimistic and pessimistic scenario) using the Aqueduct tool and considered the assumption that water stress will increase in certain regions. As no specific targets have been set by the European Union, we evaluated measures and their potential. We also carried out benchmarking in order to compare and adjust ambition levels.

The main factor for target-setting is based on scientific publications evaluating water stress as an increasing risk for the environment and business activities. The data used in the Aqueduct tool is based on scientific collaborations.

Stakeholders were involved via assessment meetings in the target-setting process in order to jointly define the measures, potential and ambition level. External stakeholders were indirectly involved through considering public opinions, e.g. initiatives, and available standards.

As the target was set newly in the reporting year, any adjustments to the targets or the data collection process are not yet relevant.

We collect water data on an ongoing basis and will be setting this against our targets from the 2025 reporting year onwards.

Metrics [E3-4] Water consumption

Water consumption

In 2024, Fresenius withdrew a total of 14,959,196 m³ of water. Water consumption accounts for 2,310,508 m³. In our healthcare facilities, water withdrawal depends on the number of patients treated in hospitals and the type of treatment performed. At our production sites, the production volume has an impact on our water consumption.

Water consumption was calculated as the difference between water withdrawal and water discharge. The water withdrawal is totaled on the basis of meter readings and invoices. If no value is available, we estimate it based on a reference value. The water discharge is totaled on the basis of meter readings and invoices. If there is no value, it is assumed that the quantity of water discharge is equal to the withdrawal.

For the evaluation of water quantity of the water basins, the Aqueduct tool has been used, disclosing those material locations in water stress areas where the available renewable surface and groundwater supplies are limited. The water quality was measured by the Aqueduct tool and by untreated connected wastewater as well as coastal eutrophication potential which are included in the areas at water risk.

Significant locations were evaluated for water risks and high water stress using the Aqueduct tool and their water consumption totaled.

Recycled and reused water is determined on the basis of meter readings. If no readings are available, the quantity of recycled and reused water is estimated by the person responsible for the process and on the basis of reference values.

The amount of stored water is determined on the basis of year-end water level values. If no exact meter reading is available, the quantity is estimated using reference values.

68.1% of the quantitative data on water is based on measurements, 31.9% on estimates.

Water intensity

Water intensity describes our total water consumption per €1 million in net revenue.

At sites with ISO 14001 certification, the water management systems, that are also used to collect the key figures, are audited by an external auditor. This concerned sites and facilities of Fresenius Kabi and Helios Spain in the reporting year. The auditor dertermines the specific aspects to be audited.