The impacts of an extreme El Niño event could be far-reaching, with vulnerable communities at the greatest risk. Rising temperatures and increased precipitation variability may lead to heat-related fatalities, infrastructure damage, and economic disruptions. During the 2023 El Niño, over 2,300 deaths in the U.S. were attributed to extreme heat. Urban areas, such as Washington, D.C., are particularly susceptible due to the urban heat island effect, though some cities are implementing cooling and resilience initiatives. However, many regions lack the necessary infrastructure and policy frameworks to withstand such events. The combination of climate change and El Niño could amplify risks, making preparedness and mitigation efforts critical.