What every American needs to know about Puerto Rico’s hurricane disaster

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Early on Wednesday, September 20, Hurricane Maria — a powerful Category 4 hurricane with 150 mph winds — made direct landfall on Puerto Rico, bisecting the entire island and drenching it with feet of rain. What’s happened since has been truly catastrophic for Puerto Rico.

There’s still little power on the island. In many places, there’s still no water to drink or bathe in or to flush toilets. There’s limited food and cell service, and dozens of remote villages have been completely cut off from everything for weeks.

“Make no mistake — this is a humanitarian disaster involving 3.4 million US citizens,” Puerto Rico Gov. Ricardo Rosselló said the Monday after Maria hit.

The initial recovery response from the US federal government has been lackluster, and President Trump’s comments have not inspired confidence. After dwelling early in the week on the facts that 1) Puerto Rico is an island, and 2) Puerto Rico is in massive debt, the president and his senior officials then went on the defensive, describing the administration’s response so far as a “good news story.” The Federal Emergency Management Agency still has not authorized full reconstruction aid to Puerto Rico.

“Help us. Without robust and consistent help we will die,” Carmen Yulín Cruz, the mayor of San Juan, said in a statement on October 12. “Mr. President, fulfill your moral imperative towards the people of Puerto Rico.”

This is still a terrible disaster that deserves more coverage and a better-coordinated response — and both appear to have been impeded by widespread confusion about Puerto Rico’s relationship to the United States and the severity of its current situation. Here’s what every American needs to know.

1) 3.4 million US citizens live in Puerto Rico, and they are entitled to the same government response as any state. But half of Americans don’t even know that.

According to a new Morning Consult poll published in the New York Times, only 54 percent of Americans know that Puerto Ricans are US citizens. The poll found 81 percent of those who knew Puerto Ricans were citizens supported sending to aid to the island. Just 44 percent of those who didn’t know said the same.

Puerto Ricans have been citizens of the United States since 1917, when President Woodrow Wilson signed the Jones-Shafroth Act. Citizens mean citizens. Puerto Ricans can travel freely to and from the continental United States without a passport. They’re protected by the same Bill of Rights as anyone else born in the United States. They vote in presidential primaries.

The island does not get electoral votes in general presidential elections. It also does not have voting representatives in Congress. Jenniffer González-Colón serves as resident commissioner of Puerto Rico, a nonvoting member of the US House of Representatives.

If Puerto Rico were a state, it would be the 30th most populous — with more people than Wyoming, Vermont, and Alaska combined.

Under the Stafford Act, which governs federal response to major disasters, the federal government must treat Puerto Rico like a state.

“[Puerto Ricans] are entitled to the same response from the federal government as the citizens of New York or Kansas would be if they were visited by a natural disaster on the scale of Hurricane Maria,” the editors of America magazine, a Catholic publication, wrote on September 25. “Although the United States has long benefited from the geographical reach they provide ... [island territories] have been taken for granted and denied full political representation. Hurricane Maria is a reminder that this two-tiered system of American citizenship is neither democratic nor tenable.”

2) Hurricane Maria was like a 50-mile-wide tornado that made a direct hit on the island

This hurricane season has been punishing for Puerto Rico. First, it got clipped by Hurricane Irma, a huge Category 5 storm whose eye passed just north of the island. That storm — which had ravaged several Caribbean islands — left 1 million people without power on Puerto Rico. By the time Maria hit, 60,000 people were still without electricity. That means there are many people on the island who haven’t had power for more than a month. (Irma passed by on September 7.)

Maria was a slightly smaller storm, but it was far, far more devastating. That’s because it charted a course directly over Puerto Rico, hit near its peak intensity, and passed around 25 miles away from San Juan, the capital, which is home to about 400,000 people. No nation or territory could suffer such a direct hit without some damage.

“It was as if a 50- to 60-mile-wide tornado raged across Puerto Rico, like a buzz saw,” Jeff Weber, a meteorologist with the National Center for Atmospheric Research, says. “It’s almost as strong as a hurricane can get in a direct hit.”

By the record books, it was the fifth-strongest storm ever to hit the US, and the strongest storm to hit the island in 80 years. “The devastation is vast,” Gov. Rosselló said in a statement. “Our infrastructure and energy distribution systems suffered great damages.”

3) There’s not enough water or food on the island. Power will be out for months in some places.

Exact figures on the extent of the damage and the costs of repairs on the island are not yet known. This is partly due to the fact that communications on the island are strained. But it’s also because many roads are damaged and it’s hard to get around. Moody’s Analytics, a financial services firm, estimates the storm could cost Puerto Rico $45 billion to $90 billion.

Photos show whole communities with roofs torn off, second floors of houses ripped apart, water flooding the streets, and people resorting to waiting in long lines for clean water and fuel. In reports, the word “apocalyptic” is used often.

More concretely, we do know that Puerto Rico’s infrastructure is severely crippled. These are major problems that will make living even in an intact house more difficult in the coming weeks and months.

Power is out across the island — and Puerto Rico’s energy system was troubled to begin with

The storm knocked out 80 percent of the island’s power transmission lines, the Associated Press reports. And as of October 16, some 86 percent of the island’s 1.57 million electricity customers were still without power. Many people have generators, and new ones are being distributed. According to Army Lt. Gen. Jeffrey S. Buchanan, the commander of ground forces on the island, the fuel situation had largely returned to normal by October 16, though 20 percent of gas stations are still closed.

In the photos below, NOAA compares what the lights of Puerto Rico looked like from space on a calm night in July to what the island looked like post–Hurricane Maria. The faint lights that remain are powered by gas generators.

It could be four to six months before power is fully restored on the island, though the government has set a goal of restoring 95 percent by December. That’s months with Puerto Rico’s 3.4 million residents relying on generators, months without air conditioning in the tropical climate, months that electric pumps can’t bring running water into homes, months with even the most basic tasks of modern life made difficult.

PREPA, the electric company on the island, has a massive $9 billion debt, as Vox’s Alexia Fernández Campbell has explained, and in July it defaulted on an interest payment. For years, it hasn’t had the money to invest in modernizing Puerto Rico’s electrical systems. Even without hurricanes, power outages are frequent on the island. Making things worse: There aren’t enough workers to fix the infrastructure. Young people have been leaving the island in droves as the economy has tightened, and older workers have been retiring en masse, securing their pensions.

Rebuilding the system on the island will be a long and difficult process. Getting the power back on in Puerto Rico “will be daunting and expensive,” the New York Times explains. “Transformers, poles and power lines snake from coastal areas across hard-to-access mountains. In some cases, the poles have to be maneuvered in place with helicopters.”

Fresh water is scarce

No electricity means no power to pump water into homes, no water to bathe or flush toilets. As of October 16, the government said municipal water services had been restored for 72 percent of people on the island. But there are still significant health concerns about the water shortages on the island — among them that people are drinking from contaminated streams and other sources. Rescue workers have been distributing bottled water, but in some places, there isn’t enough to go around.

The Guardian reported on October 11 that FEMA officials were concerned about a huge food shortage on the island. FEMA says the government is providing 200,000 meals a day, but there was a shortfall of 2 million meals a day.

Cellphone towers are knocked out

The storm knocked out 1,360 out of 1,600 cellphone towers on the island, but only 43 percent have been fixed. Many communities have been isolated from the outside world for nearly 4 weeks, relying only on radios for news. National Guard members told the Daily Beast they were struggling to communicate on the ground, making their ability to respond to the disaster exceptionally hard. “There’s no communication, that’s the problem,” said Capt. Jeff Rutkowski.

Most hospitals are running on generators with limited fuel

In its latest report, FEMA says 64 of 67 hospitals are open.

Most are running on generators, and there are issues with distributing fuel. So there’s still limited access to X-ray machines and other diagnostic and lifesaving equipment.

Initially, power was knocked out at almost all the island’s hospitals, leading to life-threatening emergencies. “Two people died yesterday because there was no diesel in the place where they were ... In San Juan, a hospital,” Mayor Yulín Cruz told CBS News in an emotional interview September 26. “We need to get our shit together.”

"I know that leaders aren't supposed to cry...But we are having a humanitarian crisis here," San Juan mayor tells @DavidBegnaud pic.twitter.com/pa7Hd6HZ1n — CBS News (@CBSNews) September 26, 2017

And the health crisis on the island could grow if power is not soon restored, as Vox’s Julia Belluz reports.

“Just about every interaction with the health system now involves electricity, from calling a hospital for help to accessing electronic medical records and powering lifesaving equipment like hemodialysis machines or ventilators,” Belluz writes.

As of October 12, four people had died and 10 were sickened with leptospirosis, a bacterial illness spreading in the aftermath of the storm through contact with contaminated animal urine either directly or via water or soil.

Farms are decimated

Agriculture is a small part of the Puerto Rican economy, contributing just 0.8 percent to its GDP and employing 1.6 percent of its labor force. But it was decimated — in a nearly literal sense of the word — by Hurricane Maria.

“In a matter of hours, Hurricane Maria wiped out about 80 percent of the crop value in Puerto Rico,” the New York Times reports. That amounts to a $780 million loss. The island imports 85 percent of its food, but the destruction of its agricultural sector is likely to increase prices and exacerbate the scary prospect of continued food shortages on the island.

Weather radar is down, making it harder to forecast new storms

Actual situation of Doppler radar after Hurricane María.

Situación actual del radar Doppler luego del paso del huracán María. #prwx #usviwx pic.twitter.com/PtljfuaWoY — NWS San Juan (@NWSSanJuan) September 24, 2017

On September 24, the National Weather Service reported that its Doppler radar station on the island had been destroyed. That’s the radar that helps meteorologists see where thunderstorms and other weather systems are moving in real time. “Not having radar does make future storms more hazardous,” says Weber.

It’s hard to get a flight off the island

Residents of Puerto Rico have had a difficult time evacuating the island. Luis Muñoz Marín International Airport — the island’s main airport, in San Juan — reopened to commercial flights September 24. But residents can expect to wait a long time in uncomfortable conditions if they want a flight. Some airlines reportedly have waiting lists of 20,000 people.

4) Puerto Rico’s economy is in shambles, and the storm will make it worse

As Vox’s Fernández Campbell explains, Puerto Rico’s government is broke. Its infrastructure is aging and in disrepair on a good day. And it can’t borrow money to fix it. In May, Puerto Rico — which has a $103 billion economy — declared bankruptcy, and it has since then been trying to restructure more than $70 billion in debt. The island’s finances are currently controlled by a federal board, which made just $1 billion available for relief, the Associated Press reports.

Certain US policies have contributed to Puerto Rico’s economic deterioration. One of them is the Jones Act (different from the Jones-Shafroth Act mentioned above), an antiquated law that forces Puerto Ricans to pay nearly double for US goods through various tariffs, fees, and taxes. The act stipulates that any goods shipped from one American port to another must be on American-made and -operated ships. As Vox’s Matthew Yglesias explains, it means shipping to Puerto Rico is more costly because there’s little competition among freighters.

It’s “a shakedown, a mob protection racket, with Puerto Rico a captive market,” as Nelson A. Denis, a former New York State Assembly member and author of War Against All Puerto Ricans: Revolution and Terror in America’s Colony, wrote in the New York Times.

On Thursday morning, the Trump administration finally granted the island a temporary waiver from the law’s requirements, which should help somewhat with the immediate disaster relief.

At @ricardorossello request, @POTUS has authorized the Jones Act be waived for Puerto Rico. It will go into effect immediately. — Sarah Sanders (@PressSec) September 28, 2017

But it has since expired, and the Department of Homeland Security has said it doesn’t plan to renew the exemption, according to the Hill.

Meanwhile, economic woes have contributed to severe brain drain over the years: The population has dropped by more than 8 percent since 2010. According to the Times: “the cost of living in Puerto Rico is 13 percent higher than in 325 urban areas elsewhere in the United States, even though per capita income in Puerto Rico is about $18,000, close to half that of Mississippi, the poorest of all 50 states.”

The population drain in turn makes it harder and harder for Puerto Rico’s economy to recover. People will likely migrate on account of the storm, which will make recovery more difficult. It’s a classic vicious cycle.

5) Experts believe the death toll could reach into the hundreds

With each passing day, we’re learning more about the frightening conditions on the ground, from the sick being turned away from barely functioning hospitals to mothers desperate for water for their babies. But one figure is disquietingly absent: an accurate death toll.

As of October 16, the official death toll was 48. But for nearly two weeks after the storm, the official death count didn’t budge from 16. During his visit to Puerto Rico, President Trump said officials should be “very proud” of that number, as it doesn’t compare to a “real catastrophe like Katrina.”

But there is good reason to believe the actual figure is in the hundreds, according to a Vox analysis of public information, which found 81 deaths confirmed by officials as linked to the storm and reports of another 450 deaths without a known cause of death. Vox’s analysis suggests that the government is being very cautious in designating deaths as directly or indirectly hurricane-related, and painting a less severe picture, compared to the public information available.

In Puerto Rico, as in any disaster situation, health hinges on electric power: Dialysis, refrigeration for insulin and other medicine, and nebulizers for people with asthma all need electricity to be useful. But it goes deeper than that: Electricity provides for the sanitation that prevents many illnesses like typhoid from spreading in the first place.

“Across Puerto Rico, people need electricity to get clean water from the faucet and flush the toilet,” Vox’s Julia Belluz writes. “They also need it to keep their air conditioning systems running. Without it, there’s the looming risk of people getting sick from dirty water, waste that can’t be disposed of, or heatstroke.”

And the storm will be a strain not just on physical health but on mental health as well. “Expect a burden of mental health problems, which will include depression, post-traumatic stress disorder, and it’s particularly going to impact groups who don’t have access to rapid opportunities for recovery,” Sandro Galea, dean of the Boston University School of Public Health, told Vox after Hurricane Harvey hit Texas.

After a major disaster, studies find a 5 to 15 percent increase in the incidence of mental health problems among survivors.

“We all have a threshold that if we watch a loved one swept away in rushing water and drown, that can definitely create post-traumatic stress disorder,” Charles Benight, who studies trauma at the University of Colorado, said.

6) The US government is responding to the disaster, but it’s going slowly

Puerto Rico is an island, which complicates recovery efforts. Supplies have to be flown in or arrive via ship. Residents can’t drive to a nearby state or city for shelter to wait out the worst of it.

Some 14,300 troops and National Guard members are now on the ground in Puerto Rico. "When I got here two weeks ago, we had 25 helicopters and 4,500 troops," Army Lt. Gen. Jeffrey S. Buchanan told DOD News on October 16. "Now we have 68 helicopters and 14,300 troops. We're getting a lot done, but we have a long way to go."

The Coast Guard and Army Corps of Engineers are working to reopen more ports on the islands and deliver supplies to remote villages in the mountains.

FEMA also has thousands of people on the ground coordinating relief efforts. It reports that millions of meals and millions of liters of water have been distributed, with more arriving each day. The USNS Comfort, a combat surgical hospital ship, is docked in Puerto Rico and assisting with medical care.

But many have argued that help didn’t come fast enough, or in high enough quantities.

“Given the size of Puerto Rico and the U.S. Virgin Islands, and the scale of devastation, it may take a task force of 50,000 service members to fully meet the needs of Americans suffering after Maria’s passage,” Phillip Carter, a fellow at the Center for a New American Security, argues at Slate.

7) Trump could be doing much more to help

President Trump approved a disaster declaration for Puerto Rico the day after the storm hit, freeing up federal resources for the recovery. Then for several days through the weekend, he remained silent on the issue, focusing his Twitter feed on a mounting feud with professional athletes.

On September 25, he broke his silence with a series of tweets that focused not on the shocking situation on the ground and the need for aid, but on Puerto Rico’s troubled recent history.

Texas & Florida are doing great but Puerto Rico, which was already suffering from broken infrastructure & massive debt, is in deep trouble.. — Donald J. Trump (@realDonaldTrump) September 26, 2017

...It's old electrical grid, which was in terrible shape, was devastated. Much of the Island was destroyed, with billions of dollars.... — Donald J. Trump (@realDonaldTrump) September 26, 2017

...owed to Wall Street and the banks which, sadly, must be dealt with. Food, water and medical are top priorities - and doing well. #FEMA — Donald J. Trump (@realDonaldTrump) September 26, 2017

Trump traveled to Puerto Rico on October 3. “It's the earliest I can go because of the first responders, and we don't want to disrupt the relief efforts,” he said the previous week. He also said the disaster response on Puerto Rico will be tougher than the one in Texas for Hurricane Harvey or in Florida for Irma “because it's an island.”

Trump also amended the disaster declaration, increasing the amount of funds available for recovery in Puerto Rico. And he authorized the temporary waiver of the Jones Act. But then it expired and wasn’t renewed.

As Vox’s Tara Golshan reported, the House passed an emergency relief package that would direct $36.5 billion toward recovery efforts in Puerto Rico, California, and other communities affected by natural disasters. But 69 Republicans voted against it, ostensibly because it would be too big a blow to the deficit.

As of Tuesday, FEMA had yet to authorize reconstruction aid for Puerto Rico — a level of assistance it has already authorized for Texas and the US Virgin Islands. This type of help is a crucial source of funding for governments to repair damaged infrastructure.

8) Other Caribbean islands are hurting too

As Vox’s Julia Belluz summarizes here, many Caribbean islands are going through similar crises after being hit by Hurricanes Maria and Irma. The island of Barbuda has been completely abandoned, and residents still can’t return home. Twenty-seven people died in Dominica. And thousands are still without power in the US Virgin Islands.

Throughout these islands, homes are destroyed and people are displaced. And lives will have to start over.

9) You can help

It’s easy to feel overwhelmed and numb in the face of such destruction. In fact, it’s a frustrating psychological tendency inside all of us: When the number of victims in a disaster rises, our compassion doesn’t always rise with it. But remember, “even partial solutions can save whole lives,” as psychologist Paul Slovic has said.

Here’s how you can help, at least in part. My colleagues Dylan Scott and Ella Nilsen have complied this list of charities accepting donations to help Puerto Rico.

United for Puerto Rico: A charity organization chaired by Beatriz Rosselló, the wife of the governor, to provide aid and support to victims of Hurricane Maria. You can give here. ConPRmetidos: The Puerto Rican organization focused on public-private partnership is aiming to raise $10 million for relief and recovery. You can give here. American Red Cross: Usually the first group people think of when giving after a disaster. It says it has a multi-island relief effort underway to help people impacted by Hurricane Maria in Puerto Rico and the U.S. Virgin Islands, with thousands of volunteers on the ground. You can give here. (3/4 stars from Charity Navigator.) Global Giving: A charity crowdfunding site that is attempting to raise $5 million to be used exclusively for local relief and recovery efforts. You can give here. (4/4 stars from Charity Navigator.) Salvation Army: The Christian charity is emphasizing its intentions to help with long-term recovery. You can give here. Americares: The nonprofit focused on medicine and health is seeking to provide emergency medical supplies and other basic resources to first responders and others. You can give here. (4/4 stars from Charity Navigator.)

It’s also a good idea to do some research before giving to a charity. Not all of them have a great track record of making sure your money directly goes to helping others. Vox’s Dylan Matthews has a great list of advice here.