In San Juan, folks have to choose between different lines: at the supermarket for food, at the gas station for a fill-up or at the bank to access cash — the only form of payment accepted at most stores, since ongoing telecommunications outages make it difficult to accept credit cards or other electronic payment methods. Even the commonwealth’s Nutritional Assistance Program, which feeds 1.3 million people out of Puerto Rico’s population of nearly 3.4 million, operates mostly electronically, which means it’s currently also not accepted at many retail outlets, so poorer residents can’t buy food without cash. Thankfully, many low-lying areas in San Juan do have potable water service. El Nuevo Día, the island’s largest and most influential newspaper, reported on Friday that 45 to 50 percent of the Aqueduct and Sewer Authority’s customers now have service. But that number has barely budged since the first wave of repairs began days after the disaster.

Still, outside the San Juan metro area, reports paint starker choices. In many rural towns there are no lines; stores haven’t been able to open, tanker trucks can’t reach distant gas stations to resupply and many bank branches are still closed. Water service has not been reestablished in many areas, and people I’ve spoken with tell me of hour-long slogs just to get drinking water for their families. Rural residents have no basic goods to buy, and no way to buy them even if supplies arrived. They need help immediately.

This past weekend, I spoke to an aid worker for an international NGO and a high-ranking official in the federal disaster response bureaucracy in Puerto Rico. To my surprise, they both agreed that the island’s current predicament is one of the worst, if not the worst, natural and human catastrophe they’d worked on. Both also agreed on the logistical issues raised by the scope of the disaster and the difficulty in coordinating efforts without adequate communications. There’s no neighboring state in which to set up a staging area for support. The capital is the best we’ve got at this point and, although communication within the metro area itself is possible, reaching folks on the ground anywhere else is nearly impossible. According to the Telecommunications Regulatory Board, only 38.5 percent of cell towers are currently in operation, mostly those that are being powered by generators.

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An executive at a large food and beverage distributor in San Juan reiterated the same concerns: Many small retailers from elsewhere in Puerto Rico have to travel to the city to put in orders, without knowing when or whether those orders will be filled. This only worsens conditions on the ground in areas that have become food deserts and where drinking water is not readily available.

Even within San Juan, distributing aid is still very complex more than a week after the hurricane. Since the storm, I’ve been working with state Rep. Luis Vega Ramos and Mayor Carmen Yulín Cruz to help coordinate groups of volunteers for the municipality of San Juan to reach out to the urban elderly poor. Patchy communications are making it very difficult. A centralized, top-down approach does not work because it requires a level of coordination that is simply impossible without working cellular networks and other basic technology on which modern bureaucracies have come to depend. Aside from the aid we’ve been able to provide, only one of the more than 30 residences for low-income seniors we’ve visited had received any supplies, in that case from the Red Cross. And again, I should emphasize, this is in San Juan.

Although other recovery and rebuilding projects down the road may benefit from a more centralized approach, current work to save lives requires greater agility and less red tape.

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Supplies must be moved closer to where they are needed and not hoarded in warehouses in San Juan. The response has to be regional and local. Teams of aid workers on the ground must to be empowered to make decisions as to how to disburse much-needed help. And the U.S. military has to provide support with improved communications systems that can operate even when everything that can go wrong does. Here in Puerto Rico, it already has.

If current efforts aren’t redirected and allowed to function independently throughout the island, the current crisis will escalate with hunger, thirst and mounting public- health issues driving people to desperation and to the very brink of mere survival.