Donald Trump says that his administrations response to the disaster in Puerto Rico deserves a grade of 10 out of 10, even though much of the island is still without power nearly a month after Hurricane Maria smashed through the US territory.

The President boasted of his own administration’s work during a meeting in the Oval Office with the US territory’s governor, Ricardo Rossello. The Puerto Rican governor notably avoided the question when asked how he’d rate the US federal government’s response.

“I think we’ve done a really great job,” Mr Trump said. “I give ourselves a 10 [because] we have provided so much, so fast.”

Three weeks after Maria made landfall on the US territory, as much as 78 per cent of the island is still without power, endangering vulnerable populations in hospitals and elsewhere. Ninety-eight per cent of the hospitals on the island are reportedly open, but they are hobbled by unsteady access to electricity. Of those hospitals with generators, the influx of patients from other hospitals that don't have the resources to serve their patients has put strains on doctors and medical professionals there.

Emergency health services are also paralysed in many places, leaving many sick people trapped in their homes without access to phone services to call for help, and without access to their medications. People with lifelong medical conditions are particularly vulnerable, and many are being forced to go without the medications they need to survive.

In parts of the island, the supplies of life-saving medications like oxygen and insulin are running out, and some have spoiled. In some scenarios on the island, there simply isn't enough to go around already.

Bringing aid to Puerto Rico Show all 20 1 /20 Bringing aid to Puerto Rico Bringing aid to Puerto Rico Crew chief Kenney shelters under the blade of an HH-60 Blackhawk helicopter from 101st Airborne Division's "Dustoff" unit preparing to take off during recovery efforts following Hurricane Maria, in Isla Grande, Puerto Rico, October 6, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico An HH-60 Blackhawk helicopter from 101st Airborne Division's "Dustoff" unit takes off behind Crew Chief Alexander Blake and his fellow soldiers during recovery efforts following Hurricane Maria, in Morovis, October 5, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Crew member Bynum stands in tropical rain as a HH-60 Blackhawk helicopter from 101st Airborne Division's "Dustoff" unit prepares to take off during recovery efforts following Hurricane Maria, in Isla Grande, October 6, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico UH-60 Blackhawk helicopter pilot Chris Greenway receives a hug from a woman thanking him for water as he works with the First Armored Division's Combat Aviation Brigade during recovery efforts following Hurricane Maria, in Verde de Comerio, October 7, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico A man carries a case of water away from an HH-60 Blackhawk helicopter after soldiers working with 101st Airborne Division's "Dustoff" unit dropped off relief supplies during recovery efforts following Hurricane Maria, in Jayuya, October 5, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Crew chief Alexander Blake from 101st Airborne Division's "Dustoff" unit loads water into a helicopter during recovery efforts following Hurricane Maria, in Isla Grande, October 5, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Residents wait for soldiers in UH-60 Blackhawk helicopters from the First Armored Division's Combat Aviation Brigade to deliver food and water during recovery efforts following Hurricane Maria, in San Lorenzo Reuters Bringing aid to Puerto Rico An HH-60 Blackhawk helicopter from 101st Airborne Division's "Dustoff" unit lands in a field to avoid lightning during recovery efforts following Hurricane Maria, in Manati, October 5, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Residents hold their hands aloft to signal that they need water as UH-60 Blackhawk helicopters from the First Armored Division's Combat Aviation Brigade fly past during recovery efforts following Hurricane Maria, near Ciales, October 7, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Tropical rain splashes on a runway as HH-60 Blackhawk helicopters from 101st Airborne Division's "Dustoff" unit wait for weather to clear during recovery efforts following Hurricane Maria, in Isla Grande, October 6, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Pilot Eldwin Bocanegra Torres speaks with residents isolated by landslides in the mountains after unloading water and food from a helicopter during recovery efforts following Hurricane Maria, near Utuado, October 10, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Residents stand in front of wind-damaged trees as they wait for soldiers in UH-60 Blackhawk helicopters from the First Armored Division's Combat Aviation Brigade to deliver food and water during recovery efforts following Hurricane Maria, in San Lorenzo, October 7, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico The contents of a home are seen from the air during recovery efforts following Hurricane Maria near Utuado, October 10, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Thomas looks out of the window of an HH-60 Blackhawk helicopter from 101st Airborne Division's "Dustoff" unit, loaded with relief supplies, during recovery efforts following Hurricane Maria in Isla Grande, October 6, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico A message written on the rooftop is seen from the air during recovery efforts following Hurricane Maria near Humacao, October 10, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico A HH-60 Blackhawk helicopter from 101st Airborne Division's "Dustoff" unit lands in a field during recovery efforts following Hurricane Maria in San Sebastian, October 6, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Sergeant First Class Eladio Tirado, who is from Puerto Rico, looks for a landing spot for a UH-60 Blackhawk helicopter from the First Armored Division's Combat Aviation Brigade, during recovery efforts following Hurricane Maria near Ciales, October 7, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Boys carry water away from an HH-60 Blackhawk helicopter after soldiers working with the U.S. Army's 101st Airborne Division's "Dustoff" unit dropped off relief supplies during recovery efforts following Hurricane Maria, in Jayuya, October 5, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Sergeant First Class Eladio Tirado from the First Armored Division's Combat Aviation Brigade, who is from Puerto Rico, speaks with residents as he helps during recovery efforts following Hurricane Maria, in San Lorenzo, October 7, 2017 Reuters/Lucas Jackson Bringing aid to Puerto Rico Residents peek through a fence at helicopters from 101st Airborne Division's "Dustoff" unit that had parked in a locked field during recovery efforts following Hurricane Maria, in Lares, October 6, 2017 Reuters/Lucas Jackson

The dire medical situation on the island has led to deaths, though many of those may not be accounted for in the official death toll of 48 people. That's because, in areas that are harder to access, the deaths may not be officially certified. Reports of bodies piling up at some hospitals have hinted that the number of deaths may end up being much higher than currently reported.

Mr Trump has appeared openly resentful of the notion that the United States is obligated to provide aid to Puerto Rico, a US territory with 3.4 million American citizens, and has been repeatedly criticised for that perceived attitude. He tweeted last week that "we cannot keep [the Federal Emergency Management Agency (FEMA)], the Military & the First Responders, who have been amazing (under the most difficult circumstances) in P.R. forever!"

While visiting, the President also commented on the cost of the disaster relief, telling local officials there that they had thrown the US federal budget "out of whack".

Some in Mr Trump's administration appear to have a tenuous grasp on Puerto Rico's legal status, with Energy Secretary Rick Perry referring to the island as a "country" on the same day as that tweet, while fielding questions about efforts to repair the island's energy grid.

FEMA says that there are more than 20,000 federal civilian personnel and military members, including 1,700 FEMA personnel, who are in Puerto Rico and the US Virgin Islands. That response includes a Department of Defense hospital ship, the USNS Comfort, which is reportedly underutilized, since people on the island aren't sure how to get patients to the boat.