A new Harvard study estimates that at least 4,600 people in Puerto Rico have died from causes related to Hurricane Maria, a far larger number than the official government death toll of 64.
According to the new study, which was conducted by a group of independent researchers from Puerto Rico and the U.S. mainland and published in the New England Journal of Medicine, these deaths could often be attributed to delayed and limited health care in the aftermath of the storm, which shuttered several hospitals, crippled the power grid, knocked out cell service, and made many roads impassable.
The study, released Tuesday, is based on researchers’ visits to more than 3,000 homes on the island. The residents reported that 38 people in those homes had died between the day of the storm and the end of the year, and that mortality rate allowed researchers to extrapolate a larger death toll from the overall population. They then could figure out how much higher that number was from the number of deaths during those three months the year before, giving them the number of “excess” deaths. The research leaves room for a more precise, exhaustive study of the death toll.
But the study also supports charges leveled against the territory’s government that the official toll had wildly undercounted the number of dead. Disaster-related deaths can be tricky to determine, according to the Washington Post, and they have to be confirmed by the government’s Forensic Sciences Institute. Individual disaster-related deaths can also be difficult to label when they are indirect, as when they are a matter of poor care for an otherwise natural cause or pre-existing condition.
According to the New York Times, the study criticized the territory’s lack of transparency in sharing information about the death toll. As a result, they argued, the government had made it harder to plan for future disasters.
Donald Trump also came under fire shortly after the storm, when he boasted of the hurricane’s low number of reported deaths, which, he said, meant it was not “a real catastrophe like Katrina.” According to the Federal Emergency Management Agency, roughly 1,800 deaths can be attributed to Hurricane Katrina.
News organizations soon began to disagree with the official count, and the resulting pressure caused Puerto Rico Gov. Ricardo Rosselló to recruit George Washington University researchers to review and recount deaths in the wake of the hurricane, according to the Times. Rosselló promised that each death following the hurricane would be inspected, and the researchers plan to release a report in the next few weeks.
It’s been eight months since the hurricane hit Puerto Rico, and the island still suffers from a damaged power grid, a short supply of clean water, and a dearth of other essential services. The stress from and effort to rebuild and recover after the storm also continues to put a strain on those suffering from medical conditions.