Donald Trump visited hurricane-ravaged Puerto Rico on Tuesday, where he remarked that officials should be “proud” because the death toll was not as high as “a real catastrophe” like Hurricane Katrina.

Mr Trump and his wife Melania were briefed on relief efforts, after the president noted as he landed that the hurricane had "thrown our budget out of whack".

“If you look at a real catastrophe like Katrina, and you look at the hundreds and hundreds of people that died - what is your death count? Sixteen. You can be very proud of all of your people,” he said.

Doctors, however, warn that significant numbers of people are at now risk of dying from treatable diseases because they cannot access their routine prescriptions.

There is also growing concern about the spread of disease on an island which still is largely without power, a fortnight after Hurricane Maria hit, and where mountain communities remain flooded and largely cut off.

Mr Trump visited the affluent district of Guaynabo, telling a family who showed him their damaged home to “have a good time”, before heading to a community centre distributing aid, where he tossed rolls of toilet paper into the crowd.

Puerto Rican radio talk shows were dominated by discussion of Mr Trump's throwing of paper towels. Some called it humiliating and insulting, watching people bussed in from shelters having lost their homes leap for toilet paper.