Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-06-17T20:41:09.909Z Has data issue: false hasContentIssue false

Health Care Needs in the Aftermath of Hurricane Maria in Puerto Rico: A Perspective from Federal Medical Shelter Manatí

Published online by Cambridge University Press:  15 April 2021

Arnab K. Ghosh*
Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New YorkUSA
Max Mecklenburg
Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New YorkUSA
Said Ibrahim
Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, New YorkUSA
Pia Daniel
Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New YorkUSA
Correspondence: Arnab K. Ghosh, MD, MSc, MA Department of Medicine Weill Cornell Medical College Cornell University 525 E 68th St., New York, New York, USA10065 E-mail:



On September 20, 2017, Hurricane Maria, a Category 4 hurricane, swept across Puerto Rico (PR), wreaking devastation to PR’s power, water, and health care infrastructure. To address the imminent humanitarian crisis, the US government mobilized Federal Medical Shelters (FMS) to serve the needs of hurricane victims. This study’s objective was to provide a description of the patients seeking emergency care at FMS and the changes in their needs over time.


This retrospective, cross-sectional study included all patients presenting to the FMS Manatí from October 6, two weeks after Hurricane Maria’s landfall, to November 2, 2017. Categories were created to catalogue the nature of new acute medical issues by patients presenting to the Shelter. Descriptive, graphical analyses were performed to assess changes to presenting complaints over time, and by age groups defined as infant (age ≤1 years), child (1 year < age ≤10 years), adolescent (10 years < age ≤ 25 years), and adult (age > 25 years).


Over the 30-day period, 5,268 patients were seen in the FMS seeking medical care (average 188.1 patients per day), spending less than five hours in the facility. The distribution of patients’ age was bimodal: the first peak at one year and the second at age 50. The most common patient complaint was infection (38.8%), then musculoskeletal (MSK) complaints (11.8%) and management of chronic medical conditions (11.8%). The proportion of patients presenting with chronic disease complaints declined over the course of the period of observation (21.4% on Day 4 to 8.0% on Day 30) while the proportion of patients presenting with infection increased (31.0% on Day 4 to 48.6% on Day 30). Infection complaints were highest in all age groups, but most in infxants (80.2%), while MSK and chronic disease complaints were highest in adults (14.9% and 14.9%, respectively).


Infection treatment and chronic disease management were important medical needs facing patients seeking care at FMS Manatí after Hurricane Maria. These findings suggest that basic needs related to sanitation and shelter remained important weeks after the hurricane, and a focus on access to medications, infection control, and injury prevention/management after a disaster needs to be prioritized during disaster response.

Original Research
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Silva, D. Half of Hurricane-Ravaged Puerto Rico Faces Lack of Drinking Water. Accessed September 18, 2020.Google Scholar
Puerto Rico: Fast Facts. San Francisco, California USA: Kaiser Family Foundation; 2017.Google Scholar
Krista, P, Nicole, L, Amanda, N, Stephen, Z. Environmental Scan of Puerto Rico’s Health Care Infrastructure. Washington, DC USA: Urban Institute; 2017.Google Scholar
Rodríguez-Díaz, CE. Maria in Puerto Rico: natural disaster in a Colonial Archipelago. Am J Public Health. 2017;108(1):3032.CrossRefGoogle Scholar
Lloréns, H. Ruin Nation: In Puerto Rico, Hurricane Maria laid bare the results of a long-term crisis created by dispossession, migration, and economic predation. NACLA Report on the Americas. 2018;50(2):154159.CrossRefGoogle Scholar
Survey AC. QuickFacts: Manati Municipio, Puerto Rico. Accessed October 21, 2020.Google Scholar
Kishore, N, Marqués, D, Mahmud, A, et al. Mortality in Puerto Rico after Hurricane Maria. N Engl J Med. 2018;379(2):162170.CrossRefGoogle ScholarPubMed
Scaramutti, C, Salas-Wright, CP, Vos, SR, Schwartz, SJ. The mental health impact of Hurricane Maria on Puerto Ricans in Puerto Rico and Florida. Disaster Med Public Health Prep. 2019;13(1):2427.CrossRefGoogle ScholarPubMed
Lin, Y, Sevillano-Rivera, M, Jiang, T, et al. Impact of Hurricane Maria on drinking water quality in Puerto Rico. Environ Sci Technol. 2020;54(15):94959509.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (CDC). Assessment of health-related needs after Hurricanes Katrina and Rita--Orleans and Jefferson Parishes, New Orleans area, Louisiana, October 17-22, 2005. MMWR: Morb Mortal Wkly Rep. 2006;55(2):3841.Google Scholar
Subaiya, S, Moussavi, C, Velasquez, A, Stillman, J. A rapid needs assessment of the Rockaway Peninsula in New York City after Hurricane Sandy and the relationship of socioeconomic status to recovery. Am J Public Health. 2014;104(4):632638.CrossRefGoogle Scholar
Fernandez, LS, Byard, D, Lin, CC, Benson, S, Barbera, JA. Frail elderly as disaster victims: emergency management strategies. Prehosp Disaster Med. 2002;17(2):6774.CrossRefGoogle ScholarPubMed
Ketterhagen, TM, Dahl-Grove, DL, McKee, MR. National survey of institutional pediatric disaster preparedness. Am J Disaster Med. 2018;13(3):153160.CrossRefGoogle ScholarPubMed
Burke, RV, Iverson, E, Goodhue, CJ, Neches, R, Upperman, JS. Disaster and mass casualty events in the pediatric population. Semin Pediatr Surg. 2010;19(4):265270.CrossRefGoogle ScholarPubMed
Jan, S, Lurie, N. Disaster resilience and people with functional needs. N Engl J Med. 2012;367(24):22722273.CrossRefGoogle ScholarPubMed
DeSalvo, K, Lurie, N, Finne, K, et al. Using Medicare data to identify individuals who are electricity dependent to improve disaster preparedness and response. Am J Public Health. 2014;104(7):11601164.CrossRefGoogle ScholarPubMed
Molinari, NA, Chen, B, Krishna, N, Morris, T. Who’s at risk when the power goes out? The at-home electricity-dependent population in the United States, 2012. J Public Health Manag Pract. 2017;23(2):152159.CrossRefGoogle ScholarPubMed
Alcorn, T. Puerto Rico’s health system after Hurricane Maria. Lancet. 2017;390(10103):e24.CrossRefGoogle ScholarPubMed
Ford, ES, Mokdad, AH, Link, MW, Garvin, WS, McGuire, LC. Peer reviewed: chronic disease in health emergencies: in the eye of the hurricane. Preventing Chronic Disease. 2006;3(2).Google Scholar
Mensah, GA, Mokdad, AH, Posner, SF, et al. When chronic conditions become acute: prevention and control of chronic diseases and adverse health outcomes during natural disasters. Prev Chronic Dis. 2005;2(Spec No):A04.Google Scholar
Ramphal, L. Medical and psychosocial needs of the Puerto Rican people after Hurricane Maria. Proc (Bayl Univ Med Cent). 2018;31(3):294296.CrossRefGoogle ScholarPubMed