On Election Day, a week after Hurricane Sandy had brought the largest city in America shuddering to a halt, there were still lines of cars at gas station stretching for blocks. At polling stations, the lines of voters stretched nearly as far. The Manhattan skyline twinkled with light again, and most of the subway tunnels had been dewatered by the Army Corps of Engineers. The parks buzzed with the sound of chain saws. After one of the worst disasters in its history, indomitable New York City seemed to be dusting itself off and returning to some semblance of its usual frenetic normalcy.

At an emergency clinic in the Far Rockaways.

Dr. Lucy Doyle, a physician with Doctors Without Borders, examines patients in a makeshift medical clinic in a building at the Ocean Village housing complex.

Dr. Lucy Doyle, a physician with Doctors Without Borders, examines a patient in a makeshift medical clinic in a building at the Ocean Village housing complex.

But crossing the Marine Parkway Bridge onto the Rockaway Peninsula, the densely populated 15-mile spit of sand that shields New York City from the open Atlantic, signs of destruction and catastrophe were everywhere. Breezy Point, at the tip of the peninsula, had lost more than 100 houses in a wind-whipped conflagration at the height of the storm. For miles the sodden contents of gutted houses lay in heaps on sidewalks, ruined family photos had been laid out to dry in the thin sunlight. Convoys of National Guard humvees rolled through intersections with dead stoplights. Soldiers unloaded crates of vacuum-sealed military rations to hand out to the thousands still without power, heat, and water. The massive silhouette of the helicopter carrier USS Wasp loomed on the horizon.

Nearby, in Far Rockaway, an impoverished enclave of wood-frame houses and brick public-housing towers stacked along the beach at the far terminus of the A train, there was little evidence of the government relief effort that was assembling just a few miles west. Hundreds of swamped and scattered cars had been pushed into piles, dune grass still packed into their wheel wells. A white Cadillac Escalade sat wrecked on the median, its vanity plate reading “UENVME2.” People strained behind shopping carts of supplies in the sand-clogged streets.

A vast relief effort led by city, state, and federal agencies was under way, but the affected area was so widespread that many people, particularly along the poorer, low-lying margins of the city, felt forgotten and abandoned by their government. Lights were on in Manhattan, but a week after the storm there were still pockets, like Far Rockaway, that had received scant aid. When Mayor Michael Bloomberg visited the neighborhood a few days earlier, one desperate and frustrated woman screamed at him in front of rolling news cameras: “Where’s the help? Where’s the fucking help?”

A BLOCK IN FROM what remained of the beach and its shattered boardwalk, in a community meeting room on the ground floor of the darkened Ocean Village apartment towers, the international humanitarian-aid group Doctors Without Borders had set up an emergency clinic with a volunteer staff of a dozen or so doctors, nurses, and assorted health professionals. A folding table was piled high with medical supplies, and a sheet strung up in a corner created a makeshift private screening area. An empty Starbucks jug doubled as an ad hoc sharps disposal container. Misha Friedman, a Moldovan photographer in his thirties with a shaved head—a veteran of Doctors Without Borders missions from Sudan to Uzbekistan—was briefing a pair of volunteers about the dire health situation faced by 800 senior residents in a nearby housing complex who had had no running water or electricity for a week.

“No one’s been evacuated,” he told me. “There is no evacuation. Doctors have been flooded out, pharmacies have been closed. Some patients are on dozens of medications, and they kind of fall off the grid.”

All across Far Rockaway, high up in the darkened towers and out in the flooded houses, scores of sick and elderly people, cut off from access to their doctors and medical care, needed help. When the clinic door opened at 10 a.m., there was already a group of patients waiting.

Doctors Without Borders (known around the world by the initials of its French name, Médecins Sans Frontières, or MSF) was founded to be quick on its feet, rushing into disaster and post-conflict zones to respond to the emergency medical needs of affected populations, seeking to fill the gaps left by the often slow and inadequate relief efforts of local governments and the international community. Working with a volunteer base of doctors and other health professionals, it has conducted emergency health care interventions in over 70 countries, a roll call of catastrophe: Rwanda, Sierra Leone, Chechnya, Libya. It was awarded the 1999 Nobel Peace Prize for its efforts.

The scene in Far Rockaway could certainly have passed for any global disaster zone, so perhaps it shouldn’t seem strange that Doctors Without Borders had arrived to do exactly what it does in crises around the world, from Port-au-Prince, Haiti, to Banda Aceh, Indonesia. But this was the first time in the organization’s 40-year history that MSF did its work on American ground, on the devastated periphery of the most powerful city in the world.

SOPHIE DELAUNAY, THE EXECUTIVE director of MSF, spearheaded the organization’s relief work in the wake of Sandy. “When these things happen in developed countries, we assume the government knows how to deal with it,” she told me. “That isn’t necessarily the case. We assumed with Katrina that authorities would cope with medical needs.” So the organization had decided to sit out the disaster. “By the time we realized we were wrong, it was too late, and the moment when we could have most helped had passed. It was a bitter experience.”

Self-critique is an essential part of MSF’s philosophy, and Delaunay said the organization had become “much more vigilant” in assessing what role to play when a large-scale disaster hits the developed world. It established mental-health trauma clinics after the 2011 Japanese tsunami, and in the first few chaotic days after Hurricane Sandy made landfall, Delaunay dispatched a half-dozen volunteer medical “explo-action” teams to the hardest-hit areas around New York City. When MSF realized that Far Rockaway had a large population of chronically ill people who were now cut off from their primary physicians—not to mention heat, water, and electricity—it set up the clinic. The main goal was to establish amid the chaos of the early response what is called a continuum of treatment, to make sure that ailing people could receive everything from insulin to asthma inhalers.

One of the volunteer doctors in Far Rockaway was Maureen Suter, a 34-year-old family physician from New York City’s northern suburbs who had driven down with her friend Sean Jones, a mental-health officer. Suter had recently returned from a nine-month MSF mission in the Congo, where she had worked with a local hospital and helped organize small health clinics spread out around the countryside. “This really isn’t all that different,” she said, headlamp on, scanning a printed spreadsheet filled with the names and addresses of a dozen patients.

This was MSF’s fourth day on the ground in the Rockaways, an area that has a very poor public-health picture at the best of times. It is geographically and hence economically isolated; the neighborhood’s median income is less than half that of the rest of New York City. It is filled with elderly people, many of whom don’t speak English, with a wide array of chronic health problems. Diabetes, hypertension, and asthma are pandemic. The pharmacies had been closed for a week, and local doctors had no way of getting in touch with many of their patients.

Prior to MSF’s arrival, much of the relief work was done by a highly organized group that had arrived on the scene earlier than most: Occupy Sandy. A new iteration of the lower Manhattan based anti-one-percent group, Occupy Sandy was incredibly fast and organized in its response, bringing food and supplies to hard-hit areas like New Dorp, Staten Island, and Red Hook, Brooklyn, as the official response only began. And it wasn't slowing down; a week into the crisis, Occupy Sandy’s massive Rockaways relief effort looked like a DIY version of the Normandy landings. Its early reports of the dire medical need in Far Rockaway had helped stir Doctors Without Borders to action. The list of patients Suter was working from had been compiled by Occupy volunteers, who had canvassed the desolate blocks of the neighborhood and the darkened halls of housing projects, knocking on doors and assembling names of people with medical needs. Now Suter was taking that list to make some house calls.

“It’s a mess down here,” she said. “Like you stepped into a little zone that somehow the radar just skipped over.”

Suter and Jones piled into her car—one of the few in the area with a full tank of gas—and I tagged along. The first stop was a house a few blocks away. MSF had mandated that all volunteer staff go out in pairs; there had been some press reports of robberies, and the New York Police Department had arrested more than a dozen looters in the neighborhood in the immediate aftermath of the storm. There were even rumors of people posing as FEMA agents and forcing their way into apartments. People were on edge, and many were reluctant to leave their homes or even answer the door. The first house Suter tried was empty, as she pounded on the door and announced that she was with MSF. After several minutes, we trudged to the next address.

As Suter knocked at a second door, a heavyset woman called over from across the street, where she was looking after a sick neighbor. Her name was Agatha Duke, a 66-year-old Trinidadian woman who walked with a pronounced limp. “Miss Duke,” as she introduced herself, showed us around to the back of her house, just a block from the ocean. The front door had been swollen shut by the storm surge that had coursed down her block. Inside, the house was a wreck. The floodwaters had swept through and soaked the carpets, which were already beginning to smell of mold. The lower level of the house would likely need to be gutted. She had been alone in the cold and dark house for a week, heating water over an oil-barrel grill in the backyard, sleeping under a pile of blankets and eating ramen noodles brought to her by relief volunteers. A bible was propped open on top of her television, and a fragment of the 82nd psalm caught my eye: “Do justice to the afflicted and needy.”

Suter took Miss Duke’s blood pressure, which was elevated, and examined the medications she took. She had no insurance and suffered from hypertension. The stress of the situation clearly wasn’t helping, but she didn’t want to leave. Miss Duke said there had been no sign of the government on her block since the storm, an assertion supported by the fact that just walking around the neighborhood, several people had asked me, with a mix of frustration and resignation, if I was a cop or with FEMA. Suter promised to have someone check in on Miss Duke the next day. Then she moved on, working her way down the list and racing against the afternoon sunlight. After dark the unlit clinic would need to be shuttered.

“At baseline this is a very underserved, neglected corner of New York City,” Suter said, as we walked past a row of wrecked cars to the next address on her list. “Add to that a disaster of this magnitude and you really feel that it’s turned into something more like a war zone, that kind of level of neglect.”

A disaster like Sandy reveals fractures in our public-health system. It pulls back the curtain on stark inequities and structural flaws, but long-term institution building is not MSF’s mission. It wants to get to an emergency quickly, and with a minimum of red tape, to fill the gaps in treatment while gargantuan institutions are just getting going. To foster that capability, Delaunay would like to see a sort of disaster waiver established that allows experienced organizations like MSF to do their work quickly and without fear of liability. As Delaunay put it, “We aim to have a very quick response, and a very brief presence.”

So MSF will not be staying long in the Rockaways. At a certain point, very soon, it will hand off the work it has done there to the larger governmental agencies responsible for maintaining public-health infrastructure. Delaunay was impressed by the size and scale of New York’s emergency system, their ability to get water and blankets to people. But as was shown by Sandy, a system so vast can be completely overwhelmed or overlook crucial deficiencies. “The continuum of care was not anticipated,” she says, and the city needs to rethink how to take care of its most vulnerable citizens during a large-scale and complex disaster.

New York City is not Port-au-Prince, of course, and Delaunay does not view MSF’s presence on the ground after Sandy as being an implicit critique of the government’s handling of the disaster. “It’s absolutely not political,” she says. “We want to understand how to maximize the response. We found a niche where we tried to intervene.”

AFTER VISITING MISS DUKE, Suter moved on to a nearby 20-story apartment building. With the power off, people had jury-rigged refrigerators, hanging what fresh food they could find in bags from their windows. The city had managed to connect a generator to the building, but it was only sufficient for emergency lighting in the hallways and stairwells. The apartments were still dark, and the water ran only to the sixth floor. People gathered around a power strip in the lobby, charging phones.

With the elevators out, Suter and Jones climbed nine stories up the stairwell. Suter knocked on an apartment on the ninth floor. Two sisters from the Dominican Republic lived there, Urania and Reinira Castillo, both in their seventies. We had enough Spanish and English between us to find out what medications they were running low on, and Suter called in a prescription to the only open pharmacy in the neighborhood.

And so it went, apartment after apartment. Some people were afraid to open their doors—several residents told me there had been a shooting in the building the day before—and Suter told them information about the MSF clinic through their locked doors. The medical needs were endless: insulin, blood thinners, asthma inhalers, blood-pressure meds. This was not treating gunshot victims in Liberia, but Suter’s role was no less vital in keeping people alive.

“There are a lot of these silent-killer diseases,” Suter told me. A weeklong lapse in treatment or medication of diabetes or hypertension can be a disaster. And there was no clear sense of when things would return to normal. “We really don’t want to drop the ball.”

We panted our way up to an apartment on the 13th floor, where an 81-year-old Puerto Rican man named Harold Rosario opened the door. He had come by public transport all the way from Pennsylvania to visit his friend Maria, who had diabetes and high blood pressure and was a cancer patient. Harold had bad knees, so it had taken him a half-hour to climb the stairs, but she’d been trapped here for a week, too frail to leave for supplies and make the long haul back up.

Rosario told Suter he was doing fine, though he wished we had brought a “big bottle of whiskey.” Maria pulled out a huge container of medications, many of which were running low. Suter called in more prescriptions to the pharmacy.

The view from Maria’s window was exquisite, the afternoon light setting the wide reach of Jamaica Bay aglow, in the distance the twin ranges of midtown and lower Manhattan etched the horizon. The lights would soon wink on there, and though Manhattan was only 10 miles away it may as well have been another country. The A-train causeway that stretched across the bay to the city like an umbilicus was knocked out and would remain so for the immediate future. Tonight, on election night, Far Rockaway would be cold and dark. I asked one older man in a darkened apartment if he was able to vote, and he just laughed and shook his head. The next day a second storm, a nor’easter with snow and high winds, would pummel the city.

Suter and Jones worked their way down the stairwell and had almost reached the lobby when they came across an old man with a cane, trying to haul a grocery cart of supplies and water up the stairs. He stopped at each stair to catch his breath, stooped over. Suter asked him what floor he was going to. Fourteen, he replied, wheezily. She and Jones glanced at each other, and each grabbed an end of the man’s cart. They turned and carried it, all the way up the dozen flights they had just descended.